Aa
Diagnosis Almost?!?!?! YEAH!!!!!!!
I know I put this at the end of the breakdown postings, but I though I would just shout my joy a little more. I just went to my PCP with all of my tests and notes and everything. He read through everything looked at MRI's and tests and all that. I actually watched him read through my notes of symptoms. Then he told me it was one of two things and he would need a spinal tap the next time symptoms flare really bad in order to be sure one way or the other. The two are MS or fibromyalgia. He is not sure as I am atypical for both. In the meantime, he gave me a prescription for neurontin (yes, finally someone who listens) and is going to watch.
I guess it is darkest just before the dawn.
Tahiri
I guess it is darkest just before the dawn.
Tahiri
I am glad that someone is finally listening to you and you are getting some answers too!! Keep us posted on the results. I know it is hard, but hang in there and keep pushing for answers, that is all any of us can do!!!!!!!!!!!!!!!!
Friends,
~Santana~
Friends,
~Santana~
I too am glad that your doc is really listening to you :)
Along with that great information that Rena just posted (thanks Rena :)
Fibromyalgia is often secondary to something else...meaning it can be scondary to MS, or a whole host of other diseases.
Again, I am so happy that you feel so good about your appointment and what transpired from it. Also, I forget....how was your MRI?
Hugs,
~Tonya
Along with that great information that Rena just posted (thanks Rena :)
Fibromyalgia is often secondary to something else...meaning it can be scondary to MS, or a whole host of other diseases.
Again, I am so happy that you feel so good about your appointment and what transpired from it. Also, I forget....how was your MRI?
Hugs,
~Tonya
I agree that ruling out MS in the event of another "flair" is a good idea but there are tests that a Rheumatologist can do to discern whether or not Fibromyalgia is the problem and they also test for various other problems. The following is the tender spot areas that the Rheumatologist would focus on:
Fibromyalgia Tender Points
Upon physical examination, the fibromyalgia patient will be sensitive to pressure in certain areas of the body called tender points. To meet the diagnostic criteria, patients must have:
Widespread pain in all four quadrants of their body for a minimum of three months. Pain is considered widespread when all of the following are present:
Pain in the left side of the body
Pain in the right side of the body
Pain above the waist
Pain below the waist
Pain in the neck, front of your chest, mid-back, or low back
At least 11 of the 18 specified tender points of fibromyalgia. These are areas of pain on touch but without signs of redness, swelling or heat in the surrounding joints or muscles. For a tender point to be considered "positive" you must feel pain when someone pushes with their finger with an approximate force of 4kg (roughly the amount of pressure needed to change the colour of the skin). Some health care providers may use an instrument called an algometer during the examination of the patient to ensure that only a 4kg load is being placed. The location of the 18 tender points are:
(1 & 2) Occiput: on both sides (bilateral), at the sub-occipital muscle insertions.
(3 & 4) Low Cervical: bilateral, at the anterior aspects of the inter-transverse spaces.
(5 & 6) Lateral Epicondyle: bilateral, 2 cm distal to the epicondyles
(7 & 8) Knee: bilateral, at the medial fat pad proximal to the joint line.
(9 & 10) Second Rib: bilateral, at the second costochondral junction, just lateral to the junctions on upper surfaces.
(11 & 12) Trapezius: bilateral, at the midpoint of the upper border of the muscle.
(13 & 14) Supraspinatus: bilateral, at origins, above the spine of the scapula (shoulder blade) near the medial border
(15 & 16) Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.
(17 & 18) Greater Trochanter: bilateral, posterior to the trochanteric prominence.
Why Eleven Points?
Some experts believe that a person does not need to have the required 11 tender points to be diagnosed and treated for fibromyalgia. This criterion was originally intended for research purposes. A diagnosis of fibromyalgia may still be made if a person has less than the 11 of the required tender points so long as they have widespread pain and many of the common symptoms and associated syndromes connected to fibromyalgia, such as sleep disorders and irritable bowel syndrome.
If a patient has some symptoms but does not meet the tender point criterion, a diagnosis of "possible fibromyalgia syndrome" may be assigned. You should also remember that self-diagnosis is not advised and that you should consult a skilled medical professional to conduct a thorough examination.
What Goes with Fibromyalgia?
Commonly associated symptoms of fibromyalgia include:
Fatigue
Irritable bowel syndrome
Sleep disorders
Chronic headaches
Jaw pain
Cognitive or memory impairment
Muscle pain or morning stiffness
Painful menstruation
Numbness and tingling in the extremities
Dizziness or light headedness
Skin and chemical sensitivities
Fibromyalgia Doctors
If your doctor is not familiar with fibromyalgia, the best thing to do is look for a local fibromyalgia support group meeting and ask for recommendations. This way, you’ll not only get a personal recommendation from someone who has a first-hand understanding of your issues, but it will enable you to meet others who share your concerns.
Limitations of the Diagnostic Criteria
Since fibromyalgia sufferers have typically normal laboratory or x-ray tests the above listed criteria are important for diagnosing and studying the syndrome. However, the criteria are not without their drawbacks.
First, the tender point paradigm assumes that fibromyalgia sufferers only experience pain in the 18 anatomical sites of the body. Recent research has made it evident that individuals with fibromyalgia are sensitive to painful stimuli throughout the body, not merely at the identified locations.
Second, many patients with fibromyalgia will often find that on a given day they will have less than the diagnostic 11 tender points in their body. Does this mean that some days you have fibromyalgia others you don’t? Obviously this is not the case.
Patient tenderness varies from day to day and, as a result, tender point counts on some days can be below the required 11 while on other days it may surpass it. Furthermore, some patients will not always have pain in all four quadrants of the body. Some experience pain only on one side or on the upper or lower half of the body. That being said, in the absence of a foolproof laboratory marker for fibromyalgia, the criteria explained above remains the best diagnostic tool for this condition.
I only had 6 of the tender spots myself so they were able to rule out Fibromyalgia but I was also told that the pain I am experiencing in my hands is due to Osteoporosis and that I was low in Vitamin D which can also cause problems in MS patients and that most MS patients are low in Vitamin D.
I wish you luck with your testing and it will be interesting to hear what your PCP decides to do but bringing up the Rheumatologist again is not, in my opinion, a bad idea.
Lots of Hugs,
Rena
Fibromyalgia Tender Points
Upon physical examination, the fibromyalgia patient will be sensitive to pressure in certain areas of the body called tender points. To meet the diagnostic criteria, patients must have:
Widespread pain in all four quadrants of their body for a minimum of three months. Pain is considered widespread when all of the following are present:
Pain in the left side of the body
Pain in the right side of the body
Pain above the waist
Pain below the waist
Pain in the neck, front of your chest, mid-back, or low back
At least 11 of the 18 specified tender points of fibromyalgia. These are areas of pain on touch but without signs of redness, swelling or heat in the surrounding joints or muscles. For a tender point to be considered "positive" you must feel pain when someone pushes with their finger with an approximate force of 4kg (roughly the amount of pressure needed to change the colour of the skin). Some health care providers may use an instrument called an algometer during the examination of the patient to ensure that only a 4kg load is being placed. The location of the 18 tender points are:
(1 & 2) Occiput: on both sides (bilateral), at the sub-occipital muscle insertions.
(3 & 4) Low Cervical: bilateral, at the anterior aspects of the inter-transverse spaces.
(5 & 6) Lateral Epicondyle: bilateral, 2 cm distal to the epicondyles
(7 & 8) Knee: bilateral, at the medial fat pad proximal to the joint line.
(9 & 10) Second Rib: bilateral, at the second costochondral junction, just lateral to the junctions on upper surfaces.
(11 & 12) Trapezius: bilateral, at the midpoint of the upper border of the muscle.
(13 & 14) Supraspinatus: bilateral, at origins, above the spine of the scapula (shoulder blade) near the medial border
(15 & 16) Gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle.
(17 & 18) Greater Trochanter: bilateral, posterior to the trochanteric prominence.
Why Eleven Points?
Some experts believe that a person does not need to have the required 11 tender points to be diagnosed and treated for fibromyalgia. This criterion was originally intended for research purposes. A diagnosis of fibromyalgia may still be made if a person has less than the 11 of the required tender points so long as they have widespread pain and many of the common symptoms and associated syndromes connected to fibromyalgia, such as sleep disorders and irritable bowel syndrome.
If a patient has some symptoms but does not meet the tender point criterion, a diagnosis of "possible fibromyalgia syndrome" may be assigned. You should also remember that self-diagnosis is not advised and that you should consult a skilled medical professional to conduct a thorough examination.
What Goes with Fibromyalgia?
Commonly associated symptoms of fibromyalgia include:
Fatigue
Irritable bowel syndrome
Sleep disorders
Chronic headaches
Jaw pain
Cognitive or memory impairment
Muscle pain or morning stiffness
Painful menstruation
Numbness and tingling in the extremities
Dizziness or light headedness
Skin and chemical sensitivities
Fibromyalgia Doctors
If your doctor is not familiar with fibromyalgia, the best thing to do is look for a local fibromyalgia support group meeting and ask for recommendations. This way, you’ll not only get a personal recommendation from someone who has a first-hand understanding of your issues, but it will enable you to meet others who share your concerns.
Limitations of the Diagnostic Criteria
Since fibromyalgia sufferers have typically normal laboratory or x-ray tests the above listed criteria are important for diagnosing and studying the syndrome. However, the criteria are not without their drawbacks.
First, the tender point paradigm assumes that fibromyalgia sufferers only experience pain in the 18 anatomical sites of the body. Recent research has made it evident that individuals with fibromyalgia are sensitive to painful stimuli throughout the body, not merely at the identified locations.
Second, many patients with fibromyalgia will often find that on a given day they will have less than the diagnostic 11 tender points in their body. Does this mean that some days you have fibromyalgia others you don’t? Obviously this is not the case.
Patient tenderness varies from day to day and, as a result, tender point counts on some days can be below the required 11 while on other days it may surpass it. Furthermore, some patients will not always have pain in all four quadrants of the body. Some experience pain only on one side or on the upper or lower half of the body. That being said, in the absence of a foolproof laboratory marker for fibromyalgia, the criteria explained above remains the best diagnostic tool for this condition.
I only had 6 of the tender spots myself so they were able to rule out Fibromyalgia but I was also told that the pain I am experiencing in my hands is due to Osteoporosis and that I was low in Vitamin D which can also cause problems in MS patients and that most MS patients are low in Vitamin D.
I wish you luck with your testing and it will be interesting to hear what your PCP decides to do but bringing up the Rheumatologist again is not, in my opinion, a bad idea.
Lots of Hugs,
Rena
Sounds like you have a good PCP. Is this someone you have been with awhile? The only reason I ask is that sometimes when I have gone to someone new, they are all gung-ho at the beginning and if you don't stay on top of them, they can get a little lazy. But your guy/gal sounds like a keeper.
I agree with Rena about seeing a rheumatologist while you wait for a "flair". Rheumy's see myalgia cases frequently and their findings can help explain or rule out FM as a cause of your symptoms. I found it worth my time to get evaluated by a very good and thorough rheumy who helped me sort out the possibility of having FM. I hope you get your answers one way or the other. A diagnosis is the end goal here, isn't it. Keep plugging away!
Julie (Sarahsmom46)
I agree with Rena about seeing a rheumatologist while you wait for a "flair". Rheumy's see myalgia cases frequently and their findings can help explain or rule out FM as a cause of your symptoms. I found it worth my time to get evaluated by a very good and thorough rheumy who helped me sort out the possibility of having FM. I hope you get your answers one way or the other. A diagnosis is the end goal here, isn't it. Keep plugging away!
Julie (Sarahsmom46)
well, it is great that you Doctor is listening and going to help... you have to listen to your body and let the Dr know...you did good...
let you know what happens with the test results...when you get the spinal..etc..
take care
andie
let you know what happens with the test results...when you get the spinal..etc..
take care
andie
My PCP said that fibromyalgia really had no tests, so I have to rule out MS. I will ask about this though if I can. Thanks,
Tahiri
Tahiri
It seems that way around here, that's for sure...always darkest before dawn I mean. Well at least you have someone that is listening and taking you seriously and for that I am very happy for you my dear! I just want to ask if you have seen an Rheumatologist yet to rule out the Fibromyalgia? I would think that if your pcp thinks it could be fibro or MS that the testing done for Fibromyalgia is a lot less traumatic than having to have a spinal tap and that way you can be sure. He may have other reasons for not referring you to a Rheumatologist but I my humble opinion an appointment with the Rheumatologist certainly wouldn't hurt.
Lots of Hugs,
Rena
Lots of Hugs,
Rena
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