Last week while getting my "steps" in on the PE field I was hit dead on while completing my crossover near the basketball net.  I am sure you're wondering "Why would you be in such a remote position knowing you have chronic health issues?" 

First let me plead my case.  I have been walking this same circular track for eight years.  I cross over the basketball net area on the backside of the course, and I am always diligent watching what court the team is rebounding.  So I may have looked up in the trees scanning for local birds flocking together in hopes of some early spring weather.  Nonetheless, as I circled the spot, I heard a warning yell and immediately felt the pain in the right side of my face which included the nose.

The sound was deafening.  It was a good, solid shot by a high school senior.  My senses were out of whack as I struggled to regain my composure.  The electrical circuit that our CNS paths run on became heightened.  Pain shot back through my skull.  It pulsed down the neck and spinal cord reverberating through my shoulders.  My arms and hands began to sting and shake uncontrollably.  It's path was relentless, sending tumultuous shocks down to my feet.   

Everything is 100 times worse with fibro.

Swelling began, but not too bad.  By the time I got home I was electrified, nerves pulsating throughout my body.  I was jittery, nervous, agitated, sick to my stomach, and had symptoms of head pressure and congestion on the right side of my face.  I slept 12 hours, woke with the same symptoms and called my doctor.

Because the swelling wasn't in need of ice at this point, I asked about the possibility of a concussion.  I explained my symptoms.  I had no time to circumvent such ideologies on the internet so I relied on my doctor for an explanation.  She said, "Were you knocked out? Well, then you couldn't have a concussion."  She ordered a CT scan that I was unable to get because my insurance regulated a simple xray first.  I knew something was wrong and spent the day arguing with the imagery site and the doctors office to get the approval through.  I did get in the next day for an xray that pointed to a small fracture to my nose.  

But, I had no doctor telling me to take it easy.  I was left with the feeling it may be my overactive CNS that is causing all this.  Meanwhile I slept 10-12 hours each day for the next four days which sustained the same symptoms.  More importantly, I went around my basic tasks, "pushing myself though."

It was during this time a friend who also happened to be a retired EMT said, "You have the classic symptoms of a mild concussion."  I was beyond pissed.   You can be certain I called that doctor's office to voice a complaint.  But in the meantime, Dear Reader, I am going to give you a bit of information in case you come into the same scenario so you will not be ringing you hands wondering what to do because your brain can't focus on the internet.  

​What Are Head Injuries?

Head injuries are injuries to the scalp, skull, or brain caused by trauma. Concussions are the most common type of sports-related brain injury with an estimated 1.6 million to 3.8 million sports-related concussions a year. A concussion is a type of traumatic brain injury (TBI) that happens when the brain is jarred or shaken hard enough to bounce against the skull. This can happen when two athletes collide or when someone falls and hits his or her head. It can also result from being hit in the head with a piece of sporting equipment. In a sport such as soccer, even "heading" the ball can cause a concussion. A concussion causes an alteration of a person's mental status and can disrupt the normal functioning of the brain. Multiple concussions can have a long-lasting, cumulative life-changing effect.

You don't have to be hit in the head to experience a concussion. An impact elsewhere on the body can create enough force to jar the brain. You also won't necessarily lose consciousness with a concussion. Concussions range from mild to severe. The effects may be apparent immediately, or they may not show up until hours or even days later.

Other types of TBIs are a contusion, which is a bruise on the brain that can cause swelling, and a hematoma, which is bleeding in the brain that collects and forms a clot. A skull fracture is another type of head injury that can affect the brain. Sometimes with a fracture, pieces of bone can cut into the brain and cause bleeding and other types of injury.

What Are the Signs and Symptoms of a Brain Injury?

Signs of a TBI include:

• Confusion
• Depression
• Dizziness or balance problems
• Double or fuzzy vision
• Feeling foggy or groggy
• Feeling sluggish or tired
• Headache
• Memory loss
• Nausea
• Sensitivity to light or noise
• Sleep disturbance
• Trouble concentrating
• Trouble remembering

Indications that a head injury is more serious than a concussion and requires emergency treatment include:

• Changes in size of pupils
• Clear or bloody fluid draining from the nose, mouth, or ears
• Convulsions
• Distorted facial features
• Facial bruising
• Fracture in the skull or face
• Impaired hearing, smell, taste, or vision
• Inability to move one or more limbs
• Irritability, nervousness, apprehensive
• Lightheadedness
• Loss of consciousness
• Low breathing rate
• Restlessness, clumsiness, or lack of coordination
• Severe headache
• Slurred speech or blurred vision
• Stiff neck or vomiting
• Sudden worsening of symptoms after initial improvement
• Swelling at the site of the injury
• Persistent vomiting

​
Receiving medical attention as soon as possible is important for any type of potentially moderate to severe TBI. Undiagnosed injuries that don't receive proper care can cause long-term disability and impairment. Keep in mind that although death from a sports injury is rare, brain injuries are the leading cause of sports-related deaths.

Symptoms should be closely monitored often with a moderate to severe injury and may require an overnight stay in the hospital. X-rays may be used to check for potential skull fracture and stability of the spine. In some cases the doctor may ask for a CT scan or an MRI to check on the extent of the damage that occurred. More severe injuries may require surgery to relieve pressure from swelling. 

​Guidelines urge doctors to be conservative in treating sports-related brain injuries and to not allow someone who has been injured to return to activity that involves risk of further injury until completely free of symptoms. That usually takes a few weeks. But symptoms of severe injury could persist for months or even years. A person with a moderate to severe injury will likely require rehabilitation that may include physical and occupational therapy, speech and language therapy, medication, psychological counseling, and social support.

It did take a week for symptoms to abate.  But, there is still a sense of fogginess and slight pressure that makes life activities a nuisance.  I'm sure I'd be better off if my prognosis was correct and treatment plan was clear.  ​

In a recent blog I mentioned my yearly optometrist screening and how I was referred out for glaucoma testing.  When you peruse the internet you'll immediately find:

Glaucoma tests are a group of tests that help diagnose glaucoma, a disease of the eye that can cause vision loss and blindness. ... The extra fluid causes an increase in eye pressure. Increased eye pressure can damage the optic nerve. The optic nerve carries information from the eye to the brain.

But that wasn't the most important concern on my list while speaking to the specialist.  I was remembering a short jaunt ago's visit for pupil dilation.  It was not a great experience to say the least.  The most prominent memory being that my eyes were burning for sometime while drops were put in, during the testing, and for a time afterwards.  I placed emphasis on the fact that it is due to over active nerve pain by nature from the fibromyalgia.  It was not a pleasant experience to say the least.  So it was only natural that I would be a bit apprehensive pertaining to my upcoming screening that could include many various tests in one sitting that would need several dilation eye drops. 

​There are several types of glaucoma. The main types are:

• Open-angle glaucoma, also called primary open-angle glaucoma. This is the most common type of glaucoma. It happens when the fluid in the eye doesn't drain properly from the eye's drainage canals. The fluid gets backed up in the canals like a clogged sink drain that gets backed up with water. This causes an increase in eye pressure. Open-angle glaucoma develops slowly, over a period of months or years. Most people don't have any symptoms or vision changes at first. Open-angle glaucoma usually affects both eyes at the same time.
• Closed-angle glaucoma, also called angle-closure or narrow-angle glaucoma. This type of glaucoma isn't common in the United States. It usually affects one eye at a time. In this type of glaucoma, drainage canals in the eyes get covered up, as if a stopper was put over a drain. Closed-angle glaucoma can be either acute or chronic.
  • Acute closed-angle glaucoma causes a rapid increase in eye pressure. It is a medical emergency. People with acute closed-angle glaucoma can lose vision in a matter of hours if the condition is not treated promptly.
  • Chronic closed-angle glaucoma develops slowly. In many cases, there are no symptoms until damage is severe.

Why do I need glaucoma testing?If you have open-angle glaucoma, you may not have any symptoms until the disease becomes severe. So it's important to be tested if you have certain risk factors. You may be at higher risk for glaucoma if you have a family history of glaucoma or if you are:

• Aged 60 or older. Glaucoma is much more common in older people.
• Hispanic and aged 60 or older. Hispanics in this age group have a higher risk of glaucoma compared with older adults with European ancestry.
• African American. Glaucoma is the leading cause of blindness in African Americans.
• Asian. People of Asian descent are at higher risk for getting closed-angle glaucoma.

Closed-angle glaucoma can cause sudden and severe symptoms. If not treated promptly, it can cause blindness. Symptoms include:

• Sudden blurring of vision
• Severe eye pain
• Red eyes
• Colored halos around lights
• Nausea and vomiting

If you have any of these symptoms, seek medical help right away.
What happens during a glaucoma test?Glaucoma is usually diagnosed with a group of tests, commonly known as a comprehensive eye exam. These exams are most often done by an ophthalmologist. An ophthalmologist is a medical doctor who specializes in eye health and in treating and preventing eye disease.

A comprehensive eye exam includes:

• Tonometry. In a tonometry test, you will sit in an exam chair next to a special microscope called a slit lamp. Your ophthalmologist or other health care provider will put drops in your eyes to numb them. Then you'll rest your chin and forehead onto the slit lamp. While you are leaning into the slit lamp, your provider will use a device on your eye called a tonometer. The device measures eye pressure. You will feel a small puff of air, but it won't hurt.
• Pachymetry. As in a tonometry test, you'll first get drops to numb your eye. Your provider will then use a small device on your eye called a pachymeter. This device measures the thickness of your cornea. The cornea is the eye's outer layer that covers the iris (colored part of the eye) and the pupil. A thin cornea may put you at higher risk for getting glaucoma.
• Perimetry, also known as a visual field test, measures your peripheral (side) vision. During perimetry, you'll be asked to look straight ahead at a screen. A light or image will move in from one side of the screen. You'll let the provider know when you see this light or image while still looking straight ahead.
• Dilated eye test. In this test, your provider will put drops in your eyes that widen (dilate) your pupils. Your provider will use a device with a light and magnifying lens to look at your optic nerve and check for damage.
• Gonioscopy. In this test, your provider will put drops in your eyes to both numb and dilate them. Then your provider will put a special hand-held contact lens on the eye. The lens has a mirror on it to let the doctor view the inside of the eye from different directions. It can show if the angle between the iris and cornea is too wide (a possible sign of open-angle glaucoma) or too narrow (a possible sign of closed-angle glaucoma).

Will I need to do anything to prepare for a glaucoma test?While your eyes are dilated, your vision may be blurred and you'll be extra sensitive to light. These effects can last for several hours and vary in severity. To protect your eyes from bright light, you should bring sunglasses to wear after the appointment. You should also make arrangements for someone to drive you home, as your vision may be too impaired for safe driving.
What do the results mean?Your ophthalmologist will look at the results of all your glaucoma tests to figure out whether you have glaucoma. If the doctor determines you have glaucoma, he or she may recommend one or more of the following treatments:

• Medicine to lower eye pressure or cause the eye to make less fluid. Some medicines are taken as eye drops; others are in pill form.
• Surgery to create a new opening for fluid to leave the eye.
• Drainage tube implant, another type of surgery. In this procedure, a flexible plastic tube is placed in the eye to help drain excess fluid.
• Laser surgery to remove excess fluid from the eye. Laser surgery is usually done in an ophthalmologist's office or outpatient surgery center. You may need to continue taking glaucoma medicines after laser surgery.

If you've been diagnosed with glaucoma, your ophthalmologist will probably monitor your vision on a regular basis.

I was fortunate enough to get into an office that houses a good team.  They were very explanatory through all the testing.  Best of all, I was informed immediately that these tests would not hurt.  It was standard procedure to begin with "numbing drops" before any actual dilation drops were utilized.  What a relief that was!  Deep breathing was less accelerated after hearing this.  

Luckily there was no definitive diagnosis of glaucoma for me.  But, the optical nerve was enlarged and must be monitored yearly to ensure there is no degeneration of the nerve that will result in glaucoma. 

I encourage you to keep up with yearly eye screenings.  You never know what is going to pop up on these routine medical tests that can result in preventative maintenance.    

I went for my annual eye exam recently to update my lens prescription.  I am so grateful that I've signed on to a simple vision plan to ensure my vision stays acute.  For the last several years, there has been always smooth sailing.  I go in.  And 10 minutes later I'm out with a new script.

This time was different.

It first began with a bit more length to my usual examination. As I was propped up on the phoropter, she had took a bit more time to ensure my prescription was accurate.  Then when she utilized the slip lamp, which allows a 3-D projection of the inside of my eye including the optical nerve, she waved it back and forth numerous times.  I took a deep breath.  What could it be now?

"I'm concerned that your optical nerve has changed.  I'd like you to get a more thorough study with an ophthalmologist just to make sure.  It may be nothing," she stated.  

"Nothing?!" I thought.  "It is always the beginning of something with fibromyalgia," I added.

I immediately went home and began searching correlations concerning fibromyalgia and optical nerve damage.  It may come as a surprise to you, but there is a connection here, too.  After all, we are dealing with sensitivities in the central nervous system.  

Research published in 2015 and 2016 suggests there may be connection with glaucoma and fibromyalgia.
.
Fibromyalgia is widely believed to be a condition of the central nervous system, which includes the brain and spinal column. It also includes the eyes and the structures that help our brains interpret what we see.
Chief among these structures is the optic nerve, which is similar to a cable made up of many smaller fibers. Among them is a layer of nerves called the retina nerve fiber layer (RNFL).

Those nerve fibers are of special interest to researchers because of other recent work that's uncovered dysfunction of the small nerve fibers. It suggests that, in people with fibromyalgia, small-fiber neuropathy (nerve damage) may be responsible for at least some of the pain.

In two studies, Spanish researchers have also discovered evidence of neuropathy in the small fibers of the eye.

Blood-Flow Problems

In the study published in 2015, researchers looked at blood flow to the optic nerve and the RNFL. Blood flow, also called perfusion, is hypothesized to be irregular in several regions of the brains of people with fibromyalgia.

Researchers examined and took photographs of the eyes of 118 people with this condition plus 76 healthy people in the control group.

The photos were then analyzed with special software. The researchers concluded that the fibromyalgia eyes did in fact show low perfusion rates in several sectors, but the only significant difference was in certain RNFL.

Optic Nerve Thinning

The study published in 2016 built on that research, involving many of the same researchers. This time, they included 116 people with fibromyalgia and 144 in the control group.
They found:

• A significant decrease in the RNFL in fibromyalgia compared to controls
• A thinning of multiple structures in the eye
• Greater optic nerve thinning in those with severe fibromyalgia than in those with a milder case
• Greater optic nerve thinning in subgroups without depression than in those with depression

Neurodegeneration

Before now, fibromyalgia has been considered non-neurodegenerative, meaning that no biological structures were being damaged or destroyed as they're known to be in other neurological diseases such as multiple sclerosis or Alzheimer's disease.

However, this research suggests that fibromyalgia may, in fact, involve some neurodegeneration in structures inside the central nervous system.

This, combined with earlier research on small nerve fiber damage in the skin, could mean that the degeneration is not confined to the central nervous system but may extend to the peripheral nervous system, which includes the nerves in the limbs, hands, and feet.

The Relationship Between Fibromyalgia, the Optic Nerve, and Neurodegeneration

Fibromyalgia has always posed problems for doctors. We have pain, but no obvious cause. If this research is accurate, which we won't know until it's been replicated, it could mean that our pain comes from a very understandable source. After all, neuropathic pain has been recognized for a long time. Suddenly, it makes our "mysterious" pain not mysterious at all.

On the other hand, it opens new doors for questioning. If we have damaged nerves, then why? What is causing the damage?

Possible candidates could include autoimmunity, which would involve the immune system going haywire and attacking the nerves as if they were bacteria or viruses, and problems with how the body uses substances that grow or maintain nerves.

Researchers have long speculated about possible autoimmunity in fibromyalgia, but so far we don't have solid evidence pointing toward it. Now that researchers have discovered actual damage, they may gain better insight into where to look for autoimmune activity. They may also be able to pinpoint shortages or inefficiencies in how nerves are maintained.

When it comes to diagnostic tests, it's too early to say whether abnormalities in the eye could lead to a more objective test than we currently have. If so, it would be a major advancement in how fibromyalgia is detected.
Because the thinning was worse in more severe cases, it could provide a marker for doctors to monitor treatments as well as progression.

It's also possible that these discoveries could lead to targeted treatments.
​
We won't know the full impact of this research for some time, as any advancement in diagnostics and treatments would have to come after further research either confirms or contradicts these findings.

Next article will detail more information on the the specifics of glaucoma.  In the meantime, get an eye exam. As the years pass, more is known about the correlation fibromyalgia plays in the CNS.

There's new research that the fascia, connective tissue which binds the muscles, causes the muscle pain in fibromyalgia.  This is not a new idea.  In fact, 1904 a physician proposed that inflammation of "white fibrous tissue" that surrounds the muscles was the source of fibromyalgia pain then called fibrosis or chronic rheumatism.  Many fibromyalgia sufferers further these studies by stating, "It hurts on the outside of my muscles not the inside." 

Fascia is connective tissue fibers, primarily collagen, that form sheets or bands beneath the skin to attach and separate muscles and other internal organs. Fascia are classified according to their distinct layers, their functions and their anatomical location: superficial fascia, deep (or muscle) fascia, and visceral (or parietal) fascia. Like ligaments and tendons, fascia are connective tissues, containing closely packed bundles of collagen fibers. Fascia are consequently flexible structures able to resist great tension forces until the wavy pattern of fibers has been straightened out by the pulling force. These collagen fibers are produced by the fibroblasts located within the fascia.

Fascia are similar to ligaments and tendons as they have collagen as their major component. They differ in their location and function: ligaments join one bone to another bone, tendons join muscle to bone, and fascia surround muscles or other structures. This connective tissue around muscle is highly sensitive to pain. In fact, the fascia is about as sensitive to pain as our skin. Needles inserted into the thick outer layer of fascia surrounding the muscle hurt more than needles poked into muscle tissue itself.

The cells of fascia direct the repair process of muscle by secreting more collagen, or "goo" that attracts immune cells to the area of damage.  The muscle tissue and especially the surrounding fascia is continually engaged in a process of damage and repair.  Fibroblasts are continually repairing the collagen network in which they live, just like a spider repairs its web.  Excess collagen and scar tissue can result.  This is why some massage therapists will say to their patients, "You're fascia feels tight and thick."

People with fibromyalgia often say their muscles feel "bruised" similar to muscle soreness.  One study found that an increase in collagen to the fascia may be the culprit.  Comparing specially stained muscle biopsies, researches described a "slight, but significant, increase in collagen surrounding the muscle cells of the fibromyalgia patients."

Chronic activation of the flight-or-flight response may be promoting tension in the fascia of the muscles and lead to tissue damage.  Studies show elevated pressures inside the muscles of fibromyalgia may reflect a flight-or-flight nervous system.  Muscles and fascia may be constantly tensed in fight-or-flight mode and more prone to injury and damage than just from our usual daily activities.  

Fascial dysfunction and inflammation may be the cause of wide-spread muscle pain in fibromyalgia.  Excess tension in the fascia due to activation of the fight-or-flight system may lead to excessive tissue damage, similar to over-exercised muscles.  Too boot, lack of sleep, a critical time for body tissue repair and remolding, does not provide adequate repair time for strained and damaged fascia.

I made and astonishing correlation recently during the last hurricane that donned our path.  I had always known that sugar creates irrefutable pain in the joints of those who suffer from fibromyalgia.  It's a never ending cycle, you experience pain, you suffer fatigue, you grab a sweet or candy for a quick uplift to get on with your day.

But recently I've been plagued with back pain.  On and off it comes and rears its ugly head when least expected.  One recent epiphany was when I was at the beach.  I stood up to walk gingerly to the ocean and was immediately sliced with intense pain as I stood fully erect.  It pinched so severely in my lower vertebrates that I stood crooked allowing other muscles in my body to take on my skeletal impact.  This pain consumed me for eight days making it difficult to preform my usual duties.  To bed I went and stayed there until my spine had a chance to regroup and redirect.  

It was the day I returned after being evacuated during the hurricane.  I went to the beach for a reprieve.  But during our stay at the hotel previously my mother brought her favorite treat, sugar.  There were several boxes of Reese's adorning her stand.  As you can imagine, the days of preparation reduce one's ability to think correctly when your planning on bringing enough supplies to last for a few days in cramped quarters.  I was tired, I ached, I reached for Reese's.

Several Reese's as a matter of fact.  In fact over the two days we succumbed to the storm, I was indulging  a rounded cup a few times daily.  I knew better.  My body's cravings weren't helping though, and so I did what any hurricane evacuee would do, I ate sugar and slept a lot.  

What I didn't realize is how much this was affecting my back and how much I'd pay in the future week ahead. 

We all know that eating a well-balanced diet is important for health and longevity. But did you know that studies have actually linked some forms of back pain with consuming certain types of food? Sugar is one of the major culprits.

Unfortunately, it’s too easy to overdo the sugar intake because it’s added to many everyday processed foods, including bread, yogurt, juices, and sauces. The average American consumes around 19.5 teaspoons (82g) of added sugar every day, which comes out to 66 pounds every year – the recommended daily allowance is about 6 teaspoons (25g) per day for women and 9 teaspoons (38g) for men!

Since it’s so easy to overconsume with our modern lifestyle, it’s important to understand the basics of how sugar affects your body and choices you can make for regulating your blood sugar levels.

Most people are aware that consuming too much sugar contributes to weight gain and a higher risk of diabetes, heart disease, and depression, but in recent years researchers have also found it can contribute to back and joint pain. When we consume too much of it, our body releases insulin and stress hormones. Those, in turn, trigger the inflammation process. Inflammation leads to chronic pain. The places where we have the least amount of blood circulation are at greatest risk of inflammation – that is why our joints and back can be so dramatically impacted by sugar consumption.

Here are 6 simple tips you can follow to help regulate blood sugar and keep painful inflammation at bay:

1. Choose foods with a low glycemic index
Every food item is rated by the percentage that the blood sugar level rises when that food item is consumed. Avoiding things that have a high glycemic index reduces sugar intake and helps stabilizes blood sugar levels.

2. Choose good carbs, avoid bad carbs
Good carbs contain lots of fiber and are absorbed slowly into our systems: whole grains, vegetables, fruits, and beans.

Bad cards spike blood sugar levels: processed foods, white bread, white rice, sugary beverages, and sweets.

3. Drink water
Keeping hydrated helps your kidneys flush out excess blood sugar.

4. Stay active
Maintaining a healthy weight helps to ensure that your body can process insulin effectively. Not to mention that a good walk can reduce stress and help avoid caving in to cravings.

5. Manage your stress
Stress can actually stimulate the release of hormones that cause blood sugar levels to rise. Hang out on your Teeter at least a few minutes a day for some mindful relaxation.
​
6. Get enough sleep!
Sleep deprivation can also impact your hormones which play an important role in controlling blood sugar, which is just one more reason to hit the hay early.

It's always profoundly interesting whenever I'm sitting in my neurologist's chair when new MRI news comes in.  Something new baffling, incomprehensible always hits my ears.

At this stage in our patient-doctor relationship, we are past the whining syndrome.  Gone are the days where I presumed the more symptoms I declared the more apt he will be able to find an answer to my woes.  Not so, my friends.  Instead I acquired mounds of paper work and extensive phone notes (so I can remember what to ask) that never seem to be answered.  The sad rule of thumb I've learned is that no one knows why most of my symptoms occur especially him.

I now sit motionlessly the new keen observer of symptoms that can be actually measured and diagnosed.  Those are the symptoms I share at this point.  He initiates the dialogue now as I sit braced for impact.   "Your recent MRI shows more degeneration in the lower vertebrates on your back,  we now have bulging discs, more inflammation and the beginning of Ankylosing Spondylitis. One of your bulging discs is maneuvering its way a half inch up your spine and may have caused you that severe pain in your back last month that..........."

"Wait, hold up, anklo what?" I asked.  This was a new term that I had not been privy to before.

"Ankylosoing Spondylitis is the fusion of your vertabrates in your back from inflammation.  Just a moment let me show you on the skeletale vertabrate I have here....., " he begins.  

​Ankylosing spondylitis is an inflammatory disease that, over time, can cause some of the vertebrae in your spine to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. If ribs are affected, it can be difficult to breathe deeply.

Ankylosing spondylitis affects men more often than women. Signs and symptoms typically begin in early adulthood. Inflammation also can occur in other parts of your body most commonly, your eyes.

There is no cure for ankylosing spondylitis, but treatments can lessen your symptoms and possibly slow progression of the disease.

Symptoms

Early signs and symptoms of ankylosing spondylitis might include pain and stiffness in your lower back and hips, especially in the morning and after periods of inactivity. Neck pain and fatigue also are common. Over time, symptoms might worsen, improve or stop at irregular intervals.

The areas most commonly affected are:

• The joint between the base of your spine and your pelvis (sacroiliac)
• The vertebrae in your lower back
• The places where your tendons and ligaments attach to bones (entheses), mainly in your spine, but sometimes along the back of your heel
• The cartilage between your breastbone and ribs
• Your hip and shoulder joints

When to see a doctor

Seek medical attention if you have low back or buttock pain that came on slowly, is worse in the morning or awakens you from your sleep in the second half of the night — particularly if this pain improves with exercise and worsens with rest. See an eye specialist (ophthalmologist) immediately if you develop a painful red eye, severe light sensitivity or blurred vision.

Natural treatments for Ankylosing Spondylitis

There isn’t a cure for AS. It’s a lifelong condition, but effective treatments are available. Treatment goals are to minimize pain and stiffness and reduce flares. Natural treatments may be used on their own or with traditional AS treatments.

These 10 natural therapies may help relieve symptoms:
1. Stretching
Stretching helps build flexibility and may reduce pain. Consider adding the spine stretch or the low-back rotation stretch to your daily routine.
2. Heat therapy
Apply a hot water bottle or heating pad to the affected area to reduce stiffness and pain. You may also use moist or dry heat. A warm bath may also help, especially before exercise. Don’t use heat therapy without consulting your doctor if you have diabetes, deep vein thrombosis, vascular disease, an open wound, or a skin condition such as dermatitis.
3. Cold therapy
Applying an ice pack, cold gel pack, or a bag of frozen vegetables to painful joints can help reduce swelling. After exercise, cold therapy may help reduce inflammation. Don’t apply ice for more than 20 minutes at a time. Don’t use cold therapy without consulting your doctor if you have circulation problems.
4. Acupuncture
Acupuncture is an ancient remedy for pain. It involves inserting thin needles into specific points in your skin. This is thought to activate your body’s pain-relieving hormones. Some people report acupuncture relieves AS pain.
5. Massage therapy
Massage helps you relax. It may also help you feel more flexible or “loose” so that you can exercise or stretch. Massage may cause pain at tender points around your spine. If this happens, avoid those areas and only use light massage techniques until the pain improves.
6. Movement
The more you sit, the stiffer you’re likely to feel. Get up, move around, and stretch regularly. If you have a desk job, take a “get up and move” break every hour.
7. Exercise
Gentle exercise programs such as yoga and Pilates are great for AS because they incorporate stretching. Swimming may also be beneficial because it’s easy on your joints. Strengthening exercises with weights can help build muscle, which supports joints affected by AS. Talk with your doctor or a physical therapist to determine the best exercise plan for you.
8. Alexander Technique
AS often leaves you hunched over. Practicing good posture is critical. The Alexander Technique teaches you to be aware of your posture throughout your day. It also teaches you how to correct poor posture and may be helpful for people with AS. To find a qualified teacher, visit the official website.
9. TENS therapy
TENS stands for transcutaneous electrical nerve stimulation. This therapy uses electrical current to stimulate nerves through the body for pain control. Electrodes are usually applied at the pain site and connected to a TENS machine. It’s thought that when TENS stimulates nerves, it overrides pain signals. The TENS technique is usually taught by a physical therapist and may be continued at home.
10. Stop smoking
Smokers, especially men, are at risk for greater spine damage from AS than non-smokers. Quitting smoking not only helps reduce AS damage, but also improves your overall health.

Natural ways to improve sleep

A good night’s sleep can often be an elusive goal if you have AS. Pain may be worse at night due to inadequate bedding. Your mattress should keep your spine straight when you lie on your side. Your mattress should also allow your spine to have an “S-curve” when you lie on your back.
Try these tips for a good night’s sleep:

• Use a medium-firm mattress, which can mold to the shape of your spine.
• Use only enough pillows to keep your neck aligned.
• Use heat therapy before bed to help reduce pain.
• Don’t sleep with a pillow between your legs.

Traditional treatments

Traditional treatments are also used to manage pain, reduce stiffness, and help prevent flares. Several types of medications may be used.

NSAIDs are anti-inflammatories that reduce pain. Ibuprofen, naproxen, and aspirin are NSAIDs. Corticosteroids may be offered when AS symptoms are severe and don’t respond to other medications. They also help reduce inflammation and pain. Corticosteroids are usually injected into the affected joint for fast pain relief.

Disease modifying anti-rheumatic drugs are used to help slow down the inflammatory process. Examples include sulfasalazine and methotrexate. These drugs are used for long-term treatment.

Biologic agents are used to block proteins that cause inflammation. Seven different biologics are approved by the U.S. Food and Drug Administration to treat AS:

• adalimumab (Humira)
• etanercept (Enbrel)
• golimumab (Simponi)
• infliximab (Remicade)
• Certolizumab pegol (Cimzia)
• Secukinumab (Cosentyx)
• Infliximab-dyyb (Inflectra)

These drugs are injected or given intravenously.

Outlook

Although most people require some type of medical therapy for AS, natural remedies may also help reduce symptoms.
​
Not all alternative treatments are right for everyone with AS. Some people may have success with yoga and acupuncture. Others may feel better using cold therapy and massage.

It never fails, I always have a new tale to tell with an adverse reaction.  I'm wondering out there: Has anyone had adverse reactions to stinging insects since being diagnosed with fibromyalgia?  

The other day I was trimming in my garden.  It had just down poured and released a few degrees off the heat wave we're having here. This allowed me to grab a few minutes outdoors to get some much needed gardening in.

Now, I'm quite aware that I have adverse reactions since being diagnosed so I'm extremely careful when out doors and around insects that bite or sting.  Bushes, in particular, can hide wasp nests.  So I broached it stealthy eyeing every nook and crevices between the leaves.  Nothing!  Nonetheless I exerted extreme caution while tackling and clipping the overgrown branches.

I was moving at a fairly smooth pace at one point since I could see the entire trunk of the bush easily.  All of a sudden, a wasp flew directly at me forming a straight line, onto the tip of my nose and stung with force.  No other wasp accompanied it so he must have been rouge, possible drenched from the torrential down pour and just got his wits about him.  .

Oh what pain! Everything is a 1,000 times worse when you have fibromyalgia.  It resonated through every cranny in your body.  I felt dizzy, pained, and off balance.   I rushed inside following suite with the normal wasp procedure:

• wash the sting area with soap and water to remove as much of the venom as possible
• douse the area with vinegar
• apply a cold pack to the wound site to reduce swelling and pain
• keep the wound clean and dry to prevent infection
• cover with a bandage if desired

I also lathered on hydrocortisone cream.  Then I waited like usual to see if anything unexpected will begin to pop up.  Nothing.  I thought I was in the clear.

Two days letter I woke up with severe swelling in my nose and below my left eye.  "Oh, no!" I lamented. "I thought I was in the clear!"  It seemed I had developed some form of Cellulitis which is a common, potentially serious bacterial skin infection. The affected skin appears swollen and red and is typically painful and warm to the touch .Left untreated, the infection can spread to your lymph nodes and bloodstream and rapidly become life-threatening. 

I had most of the symptoms:

​Possible signs and symptoms of cellulitis, which usually occur on one side of the body, include:

• Red area of skin that tends to expand
• Swelling
• Tenderness
• Pain
• Warmth
• Fever
• Red spots
• Blisters
• Skin dimpling

Off to see the doctor!  Once diagnosed I was told I could be given a steroid shot.  Knowing my chemical sensitivities and the fact that if this is a bacterial infection, my immune system may go a bit haywire, I opted for the antibiotics.  Several years ago I was released on antihistamines only to find out several days later I had incubated a severe case of cellulitis.  Which, in turn, sent me back to the doctors office for antibiotics.

The PA was a bit gruff indulging me in his self-wisdom of the correct route, but knowing that my illness is not something a medical professional can fully understand, I opted for personal intuition this time.  In fact, I found personal intuition was what got me on my feet working again to begin with.  If I spent my life basking on every word my doctors told me, I'd be on 20 different pills and in bed most of the day.

This is by no means telling you to counter what your doctor is telling you.  It is encouraging you to use common sense on minor situations.  

​Are you getting enough vitamin D? According to recent studies, there’s a good chance you aren’t. In 2009, researchers reported levels of vitamin D in the U.S. population had dropped between the years of 1988 and 1994, and then again between 2001 and 2004. Not only had average levels dropped, more than 75 percent of the people studied had inadequate levels of vitamin D in their blood.

Vitamin D deficiency is linked with an increased risk for serious diseases. Reduced levels of the vitamin are associated with cancer, cardiovascular disease, osteoarthritis, and autoimmune disorders. Deficiency is also linked with multiple sclerosis, type 1 diabetes, depression, fibromyalgia and more. That’s why it’s so import to get enough vitamin D. But identifying vitamin D deficiency can be tricky.
Our bodies don’t make vitamin D, so we have to get it from our environment. The primary source of vitamin D is the sun, but we can also get it from some foods. Lifestyle, race, age, and other factors can put you at risk for vitamin D deficiency

The truth is that it’s extremely difficult to tell whether you have a vitamin D deficiency. The only way to be absolutely sure is to take a blood test. Most people with a vitamin D deficiency won’t be aware of it. It doesn’t usually produce noticeable symptoms. However, symptoms are possible. If you are vitamin D deficient, you may experience:

• muscle/joint pain and weakness
• bone pain
• tiredness or fatigue
• depression

​Your body is designed to get the vitamin D it needs by producing it when your bare skin is exposed to sunlight. The part of the sun’s rays that is important is ultraviolet B (UVB). This is the most natural way to get vitamin D.

​Large amounts of vitamin D3 are made in your skin when you expose all of your body to summer sun. This happens very quickly; around half the time it takes for your skin to turn pink and begin to burn. This could be just 15 minutes for a very fair skinned person, yet a couple of hours or more for a dark skinned person.
You don’t need to tan or to burn your skin in order to get the vitamin D you need. Exposing your skin for a short time will make all the vitamin D your body can produce in one day. In fact, your body can produce 10,000 to 25,000 IU of vitamin D in just a little under the time it takes for your skin to turn pink. You make the most vitamin D when you expose a large area of your skin, such as your back, rather than a small area such as your face or arms.

The assumption that vitamin D supplements will protect you against diseases associated with low vitamin D levels is incorrect, according to Australian researchers. The report found that vitamin D supplements are immunosuppressive and may actually make diseases worse. 

Vitamin D Nuclear Receptor (VDR) influences the expression of over 1,000 genes, including those associated with diseases such as cancer and multiple sclerosis. According to the new study, supplemental vitamin D actually blocks VDR activation, which is the opposite effect to that of sunshine. Instead of positively impacting gene expression, vitamin D supplements appear to suppress your immune system.

Vitamin D has a remarkable role to play in your health, influencing nearly 3,000 of your 25,000 genes, and playing a critical role in your immune response. Vitamin D could rightly be described as a “miracle nutrient” for your immune system, as it enables your body to produce well over 200 antimicrobial peptides, which are indispensable in fighting off a wide range of infections.

​They say “the eyes are windows to the soul.” And while that may be true, way down at the opposite end of the body, our feet our offer a surprising number of clues about what’s going on inside us. And during these summer months, where insulated winter boots have made way for sandals, as a general rule, feet are exposed more than during any other season. Whether we’re lounging at the beach or walking barefoot through the grass, our feet tend to see the light of day more when the weather is warm. While we take deliberate action each day to care for our teeth, our hair, our skin, and more, we tend to take our feet for granted. As with many other parts of the body, we all but ignore our feet, expecting that they’ll always magically operate just as nature intended. Until, that is, something makes us take notice.

Many things about our feet can reveal issues going on at a deeper level inside us. The good news is, we don’t have to be podiatrists to recognize when something doesn’t look right. Also, when combined with other, seemingly “mild” or innocuous symptoms, out-of-the-ordinary issues with our feet can lend evidence as to what might be going on elsewhere in the body.

Cold feet aren’t just for weddings. When feet are uncomfortably cold on a regular basis, this may be indicative of hypothyroidism (particularly if experienced along with cold hands and other symptoms of low thyroid function). When toes become painfully cold, or possibly even numb, it may indicate Raynaud’s phenomenon. Another clue to Raynaud’s would be a color change: in Raynaud’s, blood vessels in the fingers and toes constrict and narrow, resulting in reduced blood flow to these extremities, giving them a white or even blueish appearance. (It tends to happen during cold weather and/or when affected individuals are under a lot of emotional stress.) Little is known about what causes Raynaud’s, but it is separated into two categories: Primary Raynaud’s, called Raynaud’s disease, “happens on its own” and is not associated with an underlying associated medical condition, while secondary Raynaud’s, or Raynaud’s phenomenon, is a condition that results when more serious diseases reduce blood flow to fingers and toes.

Other uncomfortable sensations in the feet and toes may be indicative of more dire health issues. Feelings of numbness, or feeling like one is wearing socks or stockings when they aren’t, may be symptoms of peripheral neuropathy or diabetic neuropathy. Coldness, tingling, and “pins and needles” sensations in the feet (and hands) could be symptoms of pernicious anemia, which stems primarily from a vitamin B12 deficiency.

Ridges and lines in the toenails not due to trauma/injury might be signs of nutrient deficiencies. Iron insufficiency may result in fingernail ridges, abnormally shaped nails, or even nails that are concave in spots (called koilonychias), and this may be mirrored in the toenails. Unsightly yellowish toenails may be a sign of fungal infection (the most common cause), but they could also be a sign of compromised liver function, with jaundice causing a yellowing of skin, nails, and whites of the eyes.

Another indication of an underlying issue our feet clue us in to is enlargement of the big toe, particularly when accompanied by redness, pain, and a sensation of heat. Taken together, these may be a sign of gout. Originally thought to be due mainly to a high intake of dietary purines (high purine foods include animal proteins and beer), more recent evidence suggests that excess fructose consumption contributes to gout. Some studies suggest that overconsuming even natural fruits and fruit juices that are relatively higher in fructose compared to other fruits may also contribute to gout, so it’s not just sodas sweetened with sugar or HFCS, as are often “blamed” in such situations.

While our feet do send us these clear messages, most of these issues would occur along with other signs and symptoms. For example, numbness and tingling in the feet and toes are unlikely to be the only signs of peripheral neuropathy or pernicious anemia. And cold feet would certainly not be the only symptom of hypothyroidism a patient would experience. But for those people—and there are plenty—who tend to ignore all “the little nagging things,” until they become very serious problems, paying more attention to their feet might help hammer home the possibility that something more sinister is going on elsewhere in the body.

Feet aren’t glamorous. Unlike the adrenal glands or the gut microbiome, there isn’t a lot of buzz about them in popular health and nutrition news. But we ignore the signals they send us at our peril. by Dr. David Brady

I am no stranger to back pain.  In fact, with my diagnosis of fibromyalgia, my lower back pain has steadily intensified periodically.  But, no where to the state I found myself recently, immobilized and bedridden for four days.  

We've all been there.  Those of us who share this elusive diagnosis.  Lying with our backs on the bed, staring at the ceiling fan wondering when this agonizing pain will subside.  Taking 'as needed' pain medication, breathing slowly deeply, trying to meditate on a far away planet until we regain sanity again.  But, usually we can attribute it to something.  We over did it, kept going the other day with no rest or reprieve.  Started lifting heavy objects while helping someone move.  Or, there was an all-day family affair, and we were feeling on top of the world and just stayed too late, feeling those effects slowly creeping on us as we're saying our goodbyes.  

But what if you're down flat on your back and can't move?  Your mind wanders aimlessly trying to latch onto a possibility so that it doesn't happen again?  And nothing comes up?  Pure panic I can attest.  To make things worse you can't get up to go to the bathroom?  To get a drink?  To make something to eat?  

Well, that's a whole 'nother animal I can tell  you.   It descends like a plague of fear that you can't get a grip on.

Recently, I walked out to my garage.  I was going to take my bike out and go for a leisurely spin.  There was a candy cane on a table and part of it was touching my handlebars.  It was light plastic and weighed all of 5 ounces.  I moved it to the left on a table about six inches to free my bike.  I didn't bend down, I didn't twist.  I just moved it.  All of a sudden I felt a "tinge". I've had these before.  I stretch, but usually I can do a little work and then just migrate to a heating pad for a few hours.  It wasn't too bad, really.  I went shopping that day, and even made it to the beach on Sunday.  I went to work on Monday with  a heating pad and just babied that lower area being careful not to move too much.  By Tuesday it felt better so I took the heating pad home.  On Wednesday morning I woke up nearly pain free and went into work again without the heating pad.  

For some reason by noon the right side of my back began spasming.  My co-worker had one of those lay over the chair seat pad massagers that provides heat.  I quickly slipped that on and laid back for a bi,t taking in deep breaths.  I had to go outside to retrieve the mail.  "Maybe this will loosen things up," I thought.  I barely made it 200 yards before there was definitely a feel of a hot knife jabbing into my lower vertebrates along with all those back spasms.  I stayed.  Not a bright idea, but I just had taken off four days for a virus-type sickness.  "Let me get through a couple of more hours," I prayed.  I held myself up in the chair, trying to straighten my back and pasted a smile on my face.

I got home around 5 pm.  I asked my youngest son to plug in the heating pad.  Something was wrong I explained as this pain was from another dimension.  I eased myself down, and that was it.  Thirty minutes later I could not move.  Not anywhere.  Not rolling from left to right, not even reaching for my drink on my nightstand.  My legs, though, I could prop up on a 90 degree angle to relieve some of the back spasms.  Then I waited.  I took medication to ease the agony, but it barely took the edge off.  

Three hours later into this intense pain I had to go to the bathroom.  My dear son looked up the best way to get out of bed with debilitating back pain on the Internet.  "Ok, Mom, let me get an ice block.  If we press on the nerve we can freeze it.  You just need to roll onto your stomach, slide/crab crawl down to the edge of the bed.  Then put one foot on the floor, and I will lift you up quickly but steadily," he said.

So the nightmare began.  Move a few inches, place the ice block firmly in the area, wait a minute and move again.  On and on we proceed for 10 minutes until my on foot is on the floor.  "Ok, you ok?" he asks.

"No," I answer, but I have to go.

"Ok, take a deep breath, I'm going to put my arms under you to help support your torso and I'm ready," he responds.  

Up I go, and I scream.  Scream so loud because the pain is excrutiating.  I can't seem to put any pressure on that disk in my back.  "What can I do?" he asks.

Put your two hands out, let me place my palms in them from behind I state.  And on I walk at a 120 degree angle like an old Popeye cartoon.  Gasping for breath and yelling.  Yes, yelling it was worse than childbirth.  

He lowers me, and I can't pee.  Well, pee a little I do, but how can you when you are in that much pain?  I've never experienced such intensity.  I quickly finish and make my way back to the bed.  This only intensifies the spasms, and I must endure more pain for another 30 minutes.

Another two hours I call him with my cell phone. He is sleeping in the next room.  "It's time for another round," I say.  This time the pain flares for over an hour when I get back into bed.

By 4 am I grab a towel to do my business.  I'm done.  I'm beaten. I can't do this any longer.  I feel like a broken doll.  I can't move, I'm alone, and I'm scared. Worst of all, the pain is still there immobilizing me.  

By the am I call my doctor and my son scours the local stores to find a bedpan with no luck.  He comes back with puppy pads.  "That will have to do," I say.   My doctor informs me of what medications to take.  No one seems concerned, they see this all the time apparently.  My friends are yelling to go to the ER.  "How?" I ask them.  "I can't even move!"

By the third day the spasms have subsided.  I try to sit up, still unable to put any pressure on my back.  It is still excruciating.  My primary instructs me to call my neurologist.  Five hours later his assistant calls back with instructions.  "Double your muscle relaxers," she says.

"It has been three days!" I yell.  "I can't go to the bathroom.  Should I go the the ER?" I ask.

"Do you have feeling in your legs?  Are you able to go to the bathroom?"

"Yes and yes," I reply.

"Most likely no," she says.  "I got an appointment for you in four days. Hang in there," and hangs up.

I take the muscle relaxers as instructed. Six hours later I can get up with the help of a cane.  By the following day I can move around a bit more and more.  It takes five days of bed rest before I can attempt work.  I call the assistant again, "Is this normal?" I ask.  "Should I go back to work?" 

"No, wait until your appointment.  He'll give you a work release to go back when he sees you tomorrow," she says.

I hang up and order a bed pain on Amazon just in case this happens again.  No more trying to make things worse the next time by moving I think.  

During my appointment he checks me.  Makes me stand.  Makes me bend over, tests my reflexes and orders an MRI and an EMG.  "We will have to wait and see," he says.

"Is this normal?  I mean pain to migrate like that? For over a week?" I demand.

"Yes," he says.

"Just peachy," I think.  "Just peachy."  

But apparently this does happen.  I probably could have saved myself some agony by just lying still.  I wanted to share this for all the other Avenger/Ninjas who will attempt and struggle to get out of bed. Don't, just lie there till it passes.  Get someone to wait on you.  You won't be able to move anyway.  

Here is some more points from the Illinois Back Institute:

​Often, the most debilitating lower back pain, for both men and women, is the type that comes on suddenly, leaving you in significant pain with limited mobility. The severity of the pain and the suddenness can be alarming—but it’s very common. In the vast majority of cases, this back pain is not related to a serious disease or severe back problem, but could be due to something simple like muscle spasm or another musculoskeletal cause. When the exact origin of back pain isn’t clear, it’s referred to as nonspecific low back pain. This “mechanical” back pain is generally eased by lying down flat and made worse when you move your back, sneeze or cough.

The next most likely cause of sudden onset back pain is irritation to the nerve root emanating from the spinal cord, called sciatica. What makes sciatica pain distinct is that you generally also feel pain down one or both buttocks and thighs, even into the calf or foot. You may also feel pins and needles and/or numbness/weakness through the buttock, leg and on down along the entire path of the sciatic nerve. Nearly 90 percent of the time, this pain is caused by a slipped disc, also called a bulging or prolapsed disc pressing on the nearby nerve.

Disc injuries can come to light suddenly with minimal trauma--and as much as one-third of the population at any given time are walking around with disc bulges. These previously painless, silent back problems can suddenly begin to put pressure on the spinal cord nerves--when you do something as minor as bending to pick up a pen from the floor. Then the pain begins.

​Less common conditions causing low back pain

Cauda equina syndrome is rare, but considered an emergency. Permanent nerve damage may result. Get medical attention immediately if you suspect cauda equina. This disorder causes pressure on nerves at the very bottom of the spinal cord with symptoms which may include:

• Lower back pain
• Bowel and bladder problems like inability to pass urine
• Numb sensation in the saddle region, below the tailbone
• Leg weakness

Osteoarthritis is a common form of arthritis causing spinal pain and joint inflammation in older people. Ankylosing spondylitis is a form of arthritis that may strike young adults, bringing on pain and lower back stiffness. Rheumatoid arthritis may affect the spine along with other joints throughout the body. Telltale signs of these arthritic conditions include:

• Pain that gets worse hours after going to bed or upon waking
• Stiffness, in addition to back pain, in the morning after rising, lasting over 30 minutes
• Pain eased (and not made worse) by activity

Rare bone disorders, tumors and infection cause less than 1 percent of sudden onset low back pain. Symptoms and signs may include:

• Onset of non-injury-related back pain in someone over 50 or under 20 years old
• History of cancer of any part of the body
• Depressed immune system
• Fever
• Unexplained weight loss

Abdominal aortic aneurysm (enlargement of the abdominal artery) occurs mostly in males over 60 who smoke, have high blood pressure or high cholesterol. Symptoms include:

• Pulsating feeling near the navel
• Constant pain in the abdomen/side of abdomen
• Back pain

The best way to distinguish between back pain’s many causes is to see your back specialist or health care professional. Seek natural, non-invasive treatment whenever possible, such as proven-effective Functional Disc Rehydration. This innovative treatment was developed at the Illinois Back Institute. It is offered along with other personalized treatments to help patients achieve a pain-free life. Contact us for a free consultation with a back specialist.  

So, if you don't fall into one of those above categories.  Don't freak out.  Call your doctor.  If I had to do it all over again, I would have went right to the the specialist, my neurologist.  I feel I would have hit the ground walking faster.  I was just so emotionally immobilized, too, with fear.  Which of course, doesn't help.  My hopes in you reading this, you will be aware and act rationally realizing that it will pass.  No, you will not be stuck in that bed forever.  God Bless, and hang in there.