Bleeding post menopause will rile up anyone's day.  Nothing worse than feeling the onset of cramping, that hasn't been experienced in years, accompanied by bleeding.  One's first precaution is to dive into the internet to see if you are not being afflicted with the big "C".  Step two is to call your GYN and ensure you are not harboring a mass of some sort. 

It's not that fibromyalgia offers a myriad of nuances as it is, try adding a bit of cramping, fatigue, and deviant emotions to your day that you haven't experienced for 15 years.  Yet, according to a recent study in NICHD titled, "Women with Endometriosis Have Higher Rates of Some Diseases," researchers found that woman who suffer from Fibromyalgia or Chronic Fatigue Syndrome have a higher risk for issues such as endometrial hyperplasia. That is due to this disease involving pain in the muscles, tendons, and ligaments.

Endometrial hyperplasia is a condition in which the endometrium (the lining of the uterus) becomes abnormally thick. Although endometrial hyperplasia is not cancer, it can lead to uterine cancer in some women.

Endometrial hyperplasia is usually caused by an excess of estrogen without progesterone (female hormones). The progesterone is not made and the lining of the uterus is not shed if ovulation does not occur. This means that the endometrium may continue to grow in response to the production of estrogen. The cells of the endometrium may abnormally crowd (hyperplasia), which may lead to the cancer of the uterus.

What is atypical endometrial hyperplasia?

Atypical endometrial hyperplasia is a premalignant condition of the endometrium. It occurs when there is an overgrowth of abnormal cells, or it may develop from endometrial hyperplasia. In some cases, polyps (tumors) in the uterus can lead to atypical endometrial hyperplasia.

Who is at risk for developing atypical endometrial hyperplasia?

Atypical endometrial hyperplasia usually develops in older women (after menopause). But it can develop in younger women if they do not ovulate or are obese.

What are the causes of atypical endometrial hyperplasia?

Atypical endometrial hyperplasia develops when there is no balance between the female hormones, estrogen and progesterone. This imbalance is called unopposed estrogen and it may be caused by a number of factors including:

• Hormone changes during menopause (cessation of menstrual period)
• Estrogen-hormone replacement therapy
• Breast cancer treatment, using drugs such as tamoxifen (Nolvadex®, Tamofen®)

What are the symptoms of atypical endometrial hyperplasia?

Abnormal vaginal bleeding is the most common symptom of atypical endometrial hyperplasia. Less common symptoms include abnormal vaginal discharges or an abnormal Pap test result.

An interesting comment my doctor asked first was, "Have you been sick recently?" 

"No," I replied

"Have you been under any stress lately?" he asked.

"Well, yes, but nothing out of the ordinary," I answered.

"Because stress plays a vital role in disrupting your hormone levels," he concluded.

You can bet i will be on another adventure here, offering you vital information on this topic upcoming.  He also prescribed progesterone therapy to regain my hormonal balance.  

​The new coronavirus — or COVID-19 — is spreading across the United States. Health officials are working to understand how to contain it. The Centers for Disease Control and Prevention (CDC) now recommends that everyone in the general public wear a cloth mask in addition to continuing to follow social distancing guidelines when they must go out into public.

Path to improved health

At first, the CDC said not to wear a mask. Why do we now need to wear cloth masks?

As we receive more data about COVID-19, we are learning more about how it spreads. Data shows that many people already have the virus who do not know that they have it. They are asymptomatic, or not showing symptoms. It can take up to 14 days for a person who has been infected to develop symptoms. That means that when these people go to places like grocery stores and cough or sneeze, they are unintentionally spreading the virus.

The new CDC recommendation is not intended to prevent you from getting COVID-19; it is to protect other people. In order to flatten the curve or slow the rate of spread of the virus in your community, assume that you already have the virus. Wearing a cloth mask will help to contain your own germs should you cough or sneeze in a public place. It will help to prevent you from giving COVID-19 to other people.

Should I try to buy a surgical mask or an N95 respirator?

No. Only health care professionals should wear surgical masks or N95 respirators. We are currently experiencing shortages of proper personal protective equipment (PPE) for the doctors, nurses, and other health care professionals who are working to fight COVID-19. Do not use a surgical mask or N95 respirator if you are not a health care professional. If you already have some of these in your home, you can donate them to a local hospital or health care facility.

Do I still need to practice social distancing?

Yes. Wearing a mask should not take the place of social distancing. You should still stay at least 6 feet away from other people when you go out in public. A cloth mask may help to prevent you from giving the virus to others, but it does not protect you (the wearer). It is still important that you stay home as much as possible and continue to properly wash your hands.
What makes an effective cloth mask?An effective cloth mask should:

• Cover the nose and mouth and fit snugly against the sides of the face.
• Be secured to the ear with ties or loops.
• Include multiple layers of fabric.
• Allow for breathing without restriction.
• Be machine washable and dryable without losings its shape or fit.

How do I make my own cloth mask?

The CDC has posted instructions for how to make your own cloth mask from materials you may already have at home. You can use a t-shirt or a bandana to make your own cloth mask. See instructions from the CDC.

Things to consider

When you wear a mask, it is important to know how to wear it properly. When using a mask, you should:

• Wash your hands with soap and water before putting on the mask. If you do not have soap and water available, used an alcohol-based hand rub.
• Cover your mouth and nose with the mask. Make sure it is snug to your face.
• Do not touch the mask while using it. Do not touch any other areas of your face.
• As soon as you return home, take the mask off and put it in the wash.
• Remove the mask by touching it from behind. Do not touch the front of the mask. Throw it in the washing machine and wash your hands immediately.

Click Below for Walmart Masks 50 for $11.60

With the advent of many businesses reopening it is normal to feel a bit of excitement as we begin to transition to normalcy.  

But this is not a time to let your guard down just yet.  Rather it's time to renew pertinent information as we head down the road of another month.

COVID-19, short for coronavirus disease 2019, is an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is a newly identified pathogen that has not previously been seen in humans and is highly contagious.

Although it belongs to the same category of viruses as SARS coronavirus (SARS-CoV) and influenza viruses, SARS-CoV-2 is a different strain with its own characteristics. 

COVID-19 was first reported in Wuhan, China, in December 2019, and the outbreak has spread quickly across the world, prompting the World Health Organization (WHO) to declare COVID-19 a pandemic.
How does COVID-19 spread?Because COVID-19 is a new virus, nobody has prior immunity to it, meaning the entire human population is prone to infection.

It primarily spreads via respiratory droplets when people cough or sneeze. Scientists have yet to understand how easily and sustainably the disease can spread among people. Based on available evidence, researchers do not think airborne spread is a major transmission route. 

Individuals over age 60 are at the highest risk of developing a severe case of COVID-19, while children do not seem to be at a higher risk than adults.

There are currently no reports about how susceptible pregnant women may be to COVID-19 or about transmission of the virus through breast milk.

What are the symptoms of COVID-19?

Common symptoms of COVID-19 begin two to 14 days after exposure. They include fever, tiredness, and dry cough. Other symptoms include sputum production, shortness of breath, sore throat, headache, myalgia (muscle pain) or arthralgia (joint pain), chills, vomiting, and nasal congestion. Less frequent symptoms include diarrhea, hemoptysis (coughing up blood from the respiratory tract), and conjunctival congestion.

Most of these symptoms are usually mild, and about 80% of people who get the virus will typically recover without needing any special treatment. However, about 1 in 6 patients become seriously ill and develop breathing difficulties.

What general preventive measures should people take?

The following simple preventive measures can help minimize the spread of COVID-19: 

• Wash your hands often with soap, lathering both the front and the back of the hands and fingers for at least 15 to 20 seconds. If soap is not available, use a hand sanitizer that contains at least 60% alcohol. The European Centre for Disease Prevention and Control produced a poster detailing effective handwashing.
• Avoid close contact with someone who is ill. (Maintain a distance of at least 6 feet, or 1.8 meters).
• Stay at home if you are sick.
• Use a tissue to cover your mouth and nose if you cough or sneeze and dispose of it properly afterward.
• Disinfect surfaces and objects you touch frequently. 
• Avoid touching your eyes, nose, and mouth with unwashed hands.

​

The U.S. Centers for Disease Control (CDC) does not recommend that healthy people wear a face mask.

But as a measure of precaution, it is always best to go out with a mask, preferably an N95.

Is there any specific advice for fibromyalgia patients take?

Because fibromyalgia is not an autoimmune disease, patients are not thought to be more at risk of COVID-19 than someone without the disease. People with fibromyalgia should follow the advice provided for the general population.

What should sick individuals do?If symptoms are present and a COVID-19 diagnosis is confirmed, patients should follow these steps to prevent the spread of the infection:

• Stay at home, preferably in a separate room not shared with others, and isolate themselves, with the exception of getting medical care.
• Avoid public areas and public transport.
• Limit contact with pets and animals.
• Avoid sharing personal items.
• Cover coughs and sneezes with tissues and dispose of them properly.
• Sanitize hands regularly. 
• Disinfect surfaces such as phones, keyboards, toilets, and tables.

People should call ahead before visiting the hospital for an appointment. This way, the hospital can take necessary steps to prevent the spread of the infection.

Patients who have confirmed COVID-19 should wear face masks when going out. The WHO’s website has a resource explaining the proper use of a face mask. 

What tests are available?  

Many tests for the detection of COVID-19 have been made available under the FDA’s emergency use authorization, including rapid tests that are being developed to detect the presence of the virus within minutes.

The Foundation for Innovative New Diagnostics provides an up-to-date list of different manual and automated tests that are available or currently in development.

Is there a treatment?

There are currently no vaccines available for human coronaviruses including COVID-19. This makes the prevention and containment of the virus very important.

Oxygen therapy is the major treatment intervention for patients with severe disease. Mechanical ventilation may be necessary in cases of respiratory failure.

Are there any new treatments in development?

Several clinical trials have been launched or are being planned to test a variety of potential treatments and vaccines for COVID-19. A complete list of all ongoing clinical trials pertaining to the virus is available here. by Fibromyalgia News Today
​

​Living with fibromyalgia means coping with a number of symptoms: widespread muscle pain (myalgia), extreme tenderness in many areas of the body, sleep disturbances, fatigue, headaches, and mood issues like depression and anxiety. But how does having fibromyalgia impact your risk of COVID-19 and ability to manage these symptoms while staying at home? Here’s what our experts want fibromyalgia patients to know about navigating the coronavirus pandemic.

Does Fibromyalgia Make You High-Risk for Coronavirus?

The answer depends on whether you have primary or secondary fibromyalgia, says Petros Efithimiou, MD, FACR, a rheumatologist who practices in New York City.

Primary fibromyalgia, which is the most common form, is a chronic pain syndrome in which the body and brain process pain and stimuli differently, explains Dr. Efithimiou. Importantly: “There is no immunosuppression.”

Since fibromyalgia doesn’t compromise your immune system, there is “no increased risk for acquiring COVID-19 nor increased risk for mortality from that disease,” says Frederick Wolfe, MD, a rheumatologist and fibromyalgia expert in Wichita, Kansas.

“People with a diagnosis of fibromyalgia should follow the suggestions of medical authorities for ordinary citizens,” he says, including proper hand-washing, practicing social distancing, and avoiding unnecessary travel and close contact with other people if you need to go to work or run an essential errand.

Secondary fibromyalgia, on the other hand, often occurs in patients with immune system disorders like lupus, rheumatoid arthritis, and axial spondyloarthritis. In this case, your immune system can be suppressed and you would be considered high risk for COVID-19.

Knowing the difference is crucial.

“People might think that fibromyalgia is an autoimmune disease since they are often referred to and treated by rheumatologists, and some of their symptoms may mimic those of lupus or other rheumatology patients,” says Nilanjana Bose, MD, MBA, a rheumatologist at the Rheumatology Center of Houston in Pearland, Texas.

But fibromyalgia is not an autoimmune disease, which occurs when the body’s immune system mistakenly attacks your own cells and tissues.

Do Fibromyalgia Medications Suppress the Immune System?There is not necessarily a straightforward or universal way to treat fibromyalgia. Your medication options will depend on your most concerning symptoms as well as if you have any co-occurring conditions. Drugs used to treat primary fibromyalgia may include antidepressants, anti-seizure drugs, and non-steroidal anti-inflammatory drugs (NSAIDs):

• Tricyclic antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor), cyclobenzaprine (Flexeril)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): duloxetine (Cymbalta) or milnacipran (Savella)
• Selective serotine-reuptake inhibitors (SSRIs): fluoxetine (Prozac) or paroxetine (Paxil, Pexeva)
• Anti-seizure drugs: gabapentin (Neurontin), pregabalin (Lyrica)
• Non-steroidal anti-inflammatory drugs (NSAIDs): Advil or naproxen

If you develop COVID-19 symptoms, it’s probably best to avoid NSAIDs like ibuprofen (Advil) or naproxen (Aleve); you’re better off taking acetaminophen (Tylenol). According to a well-publicized article in British Medical Journal, “prolonged illness or the complications of respiratory illness or the complications of respiratory infections may be more common when NSAIDs are used — both respiratory or septic [blood infection] complications and cardiovascular complications,” said Paul Little, MD, professor of primary care research at the University of Southhampton in the UK.

“The medication patients take for pain and fibromyalgia, such as gabapentin (Neurontin) and pregabalin (Lyrica) do not decrease the ability of the immune system,” says Dr. Efithimiou.

Additionally, antidepressants do not affect the immune system, says Dr. Bose, and “you should continue these medications to avoid flares.” Before stopping a medication, contact your physician over the phone or using a telehealth system to come up with a plan.

Distinguishing Fibromyalgia Symptoms from Coronavirus Symptoms

Many of the symptoms you may experience with fibromyalgia — including chest pain, body aches, fatigue, and malaise — can also be symptoms of COVID-19. But experts say you’ll be able to tell the difference.

“We tell our patients, if you feel any drastic changes — such as feeling out of breath or sharp pains in your chest — or feel different than your baseline, you need to tell us,” says Dr. Efithimiou. “We ask them to evaluate the intensity and character of symptoms. People are quite anxious, but they should stay away from the hospital.”

Anxiety and depression can cause physical symptoms, including body aches, fatigue, and chest pain. “The best way to tell the difference between potential COVID-19 symptoms and those of your chronic condition is to seek professional medical advice through an office visit or telehealth, which is available at many locations,” says Brett Smith, DO, a rheumatologist with Blount Memorial Physicians Group in Alcoa, Tennessee.

Managing Symptoms of Fibromyalgia Under Quarantine

Fibromyalgia symptoms like pain and stiffness, fatigue, disrupted sleep, anxiety, and depression may feel intensified right now. “It’s a two-way street,” says Dr. Efithimiou. “The more you can control anxiety, the better symptoms are going to be.”

We asked rheumatologists and psychologist John S. Fry, PhD, a former member of the National Fibromyalgia Association, what you can do to manage these symptoms during the COVID-19 pandemic.

Exercise

Many people find that exercise helps ease their fibromyalgia symptoms and quality of life. The coronavirus shouldn’t stop you from moving. Go for a walk, walk your dog, try online yoga, tai chi, or strength-training classes. Pace yourself and give yourself plenty of rest between sessions.

Practice relaxation techniques

It’s important for people with chronic pain and fatigue to learn how to relax their bodies by meditating, doing yoga, or practicing deep breathing or progressive muscle relaxation. While there are apps available to walk you through these strategies, telemental health can help you hone these and other pain management skills, says Dr. Fry, who is licensed to practice in California.

Lean on loved ones

Dr. Fry believes it should be called “spatial distancing” not “social distancing,” especially since it’s so important for people living with chronic illness to have social support from friends and loved ones right now. Make sure to carve out time to connect with others, whether that’s calling a friend, FaceTiming or Skyping, or arranging a Zoom meeting with family and friends, says Dr. Fry. And take advantage of those loved ones who are around you 24/7; don’t hesitate to ask for a gentle massage or help with household chores, he adds.

“Many fibro patients may have underlying depression and/or anxiety or a history of past trauma. It is important to broaden your safety net during the pandemic,” says Lenore Brancato, MD, clinical assistant professor in the division of rheumatology at NYU Langone Health in New York City. “With constant solemn news in the media and necessary isolation from family and friends, it can stoke anxiety for everyone, especially patients with fibro.”

Create a schedule

Whether you plan out a detailed schedule of your day or jot down a To-Do list every morning, creating a routine for yourself will help alleviate feelings of isolation and create some normalcy as you follow shelter-in-place orders. As you complete your tasks, “take a few seconds to savor the fact that you got it done,” Dr. Fry says.

Shift your self-talk

Self-talk can make a huge difference in how you manage your anxiety, which is likely causing you to catastrophize and think in black and white, explains Dr. Fry. Instead of saying to yourself something like: “Coronavirus is everywhere. I’m trying to protect myself. I’m scared. I’m going to get it — and if I do no one will be there for me,” say to yourself something like:  “I might get the coronavirus, but I might not if I’m careful.”

Remind yourself that you’re not alone. You likely have friends and family members and reaching out to them does not make you a burden. Think about the last time a friend called you for emotional support. After you hung up the phone, did you think it was a burden? Helping others is a behavior that’s been proven through research to make people happy, says Dr. Fry.

Find a healthy distraction

As you stay at home as much as possible, home in on hobbies and activities to help exacerbate feelings of anxiety and social isolation. Whether you paint, garden, color, scrapbook, or catchup on a Netflix series, it’s important to get into things that give you pleasure.

Prioritize sleep

When you live with fibromyalgia, getting quality sleep is a struggle. Unrelenting pain can disrupt sleep, which can lead to increased achiness and fatigue, creating a vicious cycle. Anxiety over the coronavirus can make it even harder to fall asleep or stay asleep all night. Now’s the time to make an extra effort to shut off those worries before shut-eye and change your perspective. “Before bed, write down three good things that happened, even if it’s been a horrible day,” says Dr. Fry. “Even if they’re little things: my dog licked my hand, I saw a pretty hummingbird, a friend called me today. This too shall pass.”

“Facilitating restorative sleep, which can be difficult during the best of times for fibro patients, requires attention,” says Dr. Brancato. “Sleep hygiene and  sleep rituals, such as legs up the wall or simple inversions and meditation practice may be helpful. Daily exercises (even seated biceps curls or leg lifts)can help reduce pain and relieve stress. Exercise can also foster improved sleep.” - Creaky Joints

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.
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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.
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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.
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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.
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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.