Reducing Feelings of Resentment in Your Relationship

Reducing Feelings of Resentment in Your Relationship Having fibromyalgia in a partnership or marriage can dramatically change the relationship. Simple tasks that you both took for granted—mobility, housework, finances, social activities, and even making plans for the future—may be sidetracked. As household duties back up and the partner with fibromyalgia tries to take care of themself, the other person in the relationship often feels overwhelmed trying to manage a larger chunk of daily responsibilities. Both parties tend to hide their emotions. The partner who is taking on more duties can begin to feel frustrated, disappointed, sad, or lonely. These feelings can lead to anger or resentment. As the person with fibromyalgia, you may feel guilty and unsure about how to initiate a conversation about the obvious changes in our relationship, but silence can make you and your partner feel more awkward. Here are some strategies to improve communications and handle feelings of resentment with your partner: Initiate Friendly Discussion If the partner who is ill makes a loving effort to initiate discussion that will bring up the spouse’s feelings, the relationship can take a more constructive and supportive course, says Thomas Fuller, Ph.D., a psychologist in Grand Rapids, MI. “This isn’t an easy topic with an easy fix,” Fuller says. “I think the real key is for couples to talk about issues openly and without penalty so things don’t get all bottled up.” Also, you have to consider that while you are dealing with pain, your spouse’s life has changed, too. “Don’t be defensive about your illness or the situation, and accept that your spouse’s efforts, feelings, and struggles are normal. Validate their experience. Verbally appreciate what your spouse is doing to accommodate the situation.” Let them know you recognize the greater effort they are putting forth. Here is what you might say to initiate a friendly discussion: “I know that you are disappointed right now. I know that you love me and are trying not to blame me for being ill. I am so lucky to have a spouse who takes care of things like you do. I am so lucky to have you.” Only You Know How it Feels “Open and honest communication is the best protection against the inevitable hurt and anger that can damage a relationship,” says Connie O’Reilly, Ph.D., a psychologist in Beaverton, OR. “Only you know what it feels like to be in your body, yet it is important that you make a good faith effort to contribute to the household chores, even in small ways. And at the end of a day when your spouse walks in the door and you both realize you’ve not been able to do all each of you had hoped, remember that you are not responsible for anyone’s feeling but your own. Acknowledge the situation, accept that it’s okay, and remain optimistic.” For example: “I realize I did not accomplish many of the tasks I had hoped today. I can understand that you may be disappointed and frustrated. So am I. I plan to go to bed early tonight and try again tomorrow.” Suggest trading some duties and consider all options. While you both struggle to manage the house, parenting and finances, keep in mind the social aspects of a relationship can also suffer. See our articles on Socializing and New Hobbies (Daily Living), to help you as a couple and on an individual basis reap enjoyment out of life.

Letter to Normals

Letter to Normals: Getting Others to See Your Symptoms by Ricky Buchanan * These are the things that I would like you to understand about me before you judge me … Please understand that being sick doesn’t mean I’m not still a human being. I have to spend most of my day flat on my back in bed, and I might not seem like great company, but I’m still me stuck inside this body. I still worry about school and work and my family and friends, and most of the time I’d still like to hear you talk about yours too. Please understand the difference between “happy” and “healthy.” When you’ve got the flu, you probably feel miserable with it, but I’ve been sick for years. I can’t be miserable all the time, in fact I work hard at not being miserable. So if you’re talking to me and I sound happy, it means I’m happy. That’s all. I may be tired. I may be in pain. I may be sicker than ever. Please, don’t say, “Oh, you’re sounding better!” I am not sounding better, I am sounding happy. If you want to comment on that, you’re welcome. Please understand that being able to stand up for five minutes doesn’t necessarily mean that I can stand up for ten minutes, or an hour. It’s quite likely that doing that five minutes has exhausted my resources and I’ll need to recover. Imagine an athlete after a race. They couldn’t repeat that feat right away either. With a lot of diseases you’re either paralyzed or you can move. With this one it gets more confusing. Please repeat the above paragraph substituting, “sitting up,” “walking,” “thinking,” “being sociable” and so on … it applies to everything. That’s what a fatigue-based illness does to you. Please understand that chronic illnesses are variable. It’s quite possible (for me it’s common) that one day I am able to walk to the park and back, while the next day I’ll have trouble getting to the kitchen. Please don’t attack me when I’m ill by saying, “But you did it before!” If you want me to do something, ask if I can and I’ll tell you. In a similar vein, I may need to cancel an invitation at the last minute. If this happens, please don’t take it personally. Please understand that “getting out and doing things” does not make me feel better, and can often make me seriously worse. Fibromyalgia may cause secondary depression (wouldn’t you get depressed if you were stuck in bed for years on end!?) but it is not caused by depression. Telling me that I need some fresh air and exercise is not appreciated and not correct — if I could do it, I would. Please understand that if I say I have to sit down / lie down / take these pills now, that I do have to do it right now — it can’t be put off or forgotten just because I’m doing something. Fibromyalgia does not forgive. Please understand that I can’t spend all of my energy trying to get well. With a short-term illness like the flu, you can afford to put life on hold for a week or two while you get well. But part of having a chronic illness is coming to the realization that you have to spend some energy on having a life now. This doesn’t mean I’m not trying to get better. It doesn’t mean I’ve given up. It’s just how life is when you’re dealing with a chronic illness. If you want to suggest a cure to me, please don’t. It’s not because I don’t appreciate the thought, and it’s not because I don’t want to get well. It’s because I have had almost every single one of my friends suggest one at one point or another. At first I tried them all, but then I realized that I was using up so much energy trying things that I was making myself sicker, not better. If there was something that cured, or even helped, all people with Fibro then we’d know about it. This is not a drug-company conspiracy, there is worldwide networking (both on and off the Internet) between people with Fibro. If something worked, we would KNOW. If after reading that you still want to suggest a cure, then do it, preferably in writing, but don’t expect me to rush out and try it. If I haven’t had it suggested before, I’ll take what you said and discuss it with my doctor. Please understand that getting better from an illness like this can be very slow. People with Fibro have so many systems in their bodies out of equilibrium, and functioning wrongly, that it may take a long time to sort everything out. I depend on you — people who are not sick — for many things. But most importantly, I need you to understand me.

Take Care of Yourself

The holidays can be overwhelming or the most lonely season of the year. Whatever your circumstances, make the time to do the things that bring you happiness and provide you with a little extra comfort during the cold season. You are not being self-centered. Think of it as self-survival. You have put up with the pain and unexpected symptoms of fibromyalgia all year long. It’s time to focus on your own special needs. Consider these self-help tips: • Sit in a hot tub or sauna to warm up and relax. • Take a long hot bath, but make it special with scented candles, tub pillows or other bathtub comforts. • Give plenty of hugs (and receive them as well) to the special people in your life. If hugging hurts, then just give a snuggle. • Spend quiet time each day reading a book or an entertaining magazine, while sipping a special herbal tea or hot cocoa. • Get your family to help with cleaning all pillow casings and blankets, then surround your bed and favorite couch with them to put a little extra comfort in your life ... and if you share with your family, they will thank you for the great idea. • Liberally use your hot wraps and heating pads. Don't worry about looking fashionable. Just throw a scarf over your wrap and put your comfort first. • If you are hosting guests, close the bedroom door and take a short nap everyday (unless your company is under the age of 12, they can manage without you for a while). Take care of yourself this holiday season and throughout the New Year.

New Preliminary Diagnostic Criteria for FM

1. New Preliminary Diagnostic Criteria for FM It’s been 20 years since the American College of Rheumatology (ACR) published the criteria for the classification of fibromyalgia. The old requirement of a tender point exam has been omitted and replaced with a symptom checklist. Now that we’ve introduced you to the new preliminary criteria, we invite you to see how you measure up to this new grading system in the following survey. This does not take the place of a professional diagnosis, but will give you an idea of what is being proposed. You will have an opportunity to comment at the end of the survey. Make sure you have a pencil and a scratch sheet of paper before you begin so that you can write down three simple numbers during the survey. As usual, all information contained in this survey is anoymous. * 1. Age: Age: Younger than 20 21-29 30-39 40-44 45-49 50-54 55-59 60-64 65-69 70 or older * 2. Gender: Gender: Male Female 3. Which one of the following applies? (Check one) Which one of the following applies? (Check one) A physician has diagnosed me with fibromyalgia A healthcare provider has suggested that I might have fibromyalgia I suspect I have fibromyalgia, but have not been officially diagnosed I have a family member or friend who has fibromyalgia I have other painful conditions (such as Lupus, arthritis, complex regional pain syndrome, etc.) but not fibromyalgia I am only taking the survey out of curiosity None of the above * 4. If you have been diagnosed with fibromyalgia, how many years have you had the symptoms? If you have been diagnosed with fibromyalgia, how many years have you had the symptoms? 0-5 6-9 10-14 15-19 20-24 25-29 30 years or more Never officially diagnosed Not applicable * 5. How many years has it been since you were officially diagnosed with fibromyalgia? How many years has it been since you were officially diagnosed with fibromyalgia? 0-5 6-9 10-14 15-19 20-24 25-29 30 years or more Never officially diagnosed Not applicable * 6. Have you ever had a tender point exam? Have you ever had a tender point exam? Yes No I don’t recall 7. If Yes, did you have 11 or more of the 18 tender points? If Yes, did you have 11 or more of the 18 tender points? Yes No I don’t recall * 8. Are you a Member of the Fibromyalgia Network? Are you a Member of the Fibromyalgia Network? Yes No Former member I am not sure The following 3 questions apply to people with fibromyalgia, so if you do not have it please click Not applicable where appropriate. * 9. If you have been diagnosed with fibromyalgia, who officially diagnosed you? (Check one) If you have been diagnosed with fibromyalgia, who officially diagnosed you? (Check one) Rheumatologist Physical medicine and rehab specialist (physiatrist) Pain specialist Primary care physician / family doctor Internist Neurologist Osteopath Chiropractor Psychiatrist Infectious disease specialist Immunologist Acupuncturist Alternative medicine practitioner Nurse practitioner Physical therapist Other No one Not applicable * 10. If you have fibromyalgia, who is primarily in charge of your current treatment? (Check one) If you have fibromyalgia, who is primarily in charge of your current treatment? (Check one) Rheumatologist Physical medicine and rehab specialist (physiatrist) Pain specialist Primary care physician / family doctor Internist Neurologist Osteopath Chiropractor Psychiatrist Infectious disease specialist Immunologist Acupuncturist Alternative medicine practitioner Nurse practitioner Physical therapist Other No one Not applicable * 11. If you have fibromyalgia, how effective would you rate your treatment? If you have fibromyalgia, how effective would you rate your treatment? Not effective Mildly effective Effective Very effective Extremely effective Unsure Not applicable 2. New Clinical Fibromyalgia Diagnostic Criteria - Part 1 Make sure you have a pencil and a scratch sheet of paper before you begin so that you can write down three simple numbers during the survey. Determining Your Widespread Pain Index (WPI) The WPI Index score from Part 1 is between 0 and 19. To answer the following questions, patients should take into consideration • how you felt the past week, • while taking your current therapies and treatments, and • exclude your pain or symptoms from other known illnesses such as arthritis, Lupus, Sjogren’s, etc. * 1. Check each area you have felt pain in over the past week. (It may help to refer to the diagram about the new criteria.) Check each area you have felt pain in over the past week. (It may help to refer to the diagram about the new criteria.) Shoulder girdle, left Shoulder girdle, right Upper arm, left Upper arm, right Lower arm, left Lower arm, right Hip (buttock) left Hip (buttock) right Upper leg left Upper leg right Lower leg left Lower leg right Jaw left Jaw right Chest Abdomen Neck Upper back Lower back None of these areas * 2. Count up the number of areas checked and enter your WPI score here: Count up the number of areas checked and enter your WPI score here: This is your WPI score. You must write down this total from Part 1 on a separate piece of paper before continuing. Exit this survey >> 3. Symptom Severity Score (SS score) - Part 2a To answer the following questions, patients should take into consideration • how you felt the past week, • while taking your current therapies and treatments, and • exclude your pain or symptoms from other known illnesses such as arthritis, Lupus, Sjogren’s, etc. Indicate your level of symptom severity over the past week using the following scale. * 1. Fatigue Fatigue 0 = No problem 1 = Slight or mild problems; generally mild or intermittent 2 = Moderate; considerable problems; often present and/or at a moderate level 3 = Severe: pervasive, continuous, life disturbing problems * 2. Waking unrefreshed Waking unrefreshed 0 = No problem 1 = Slight or mild problems; generally mild or intermittent 2 = Moderate; considerable problems; often present and/or at a moderate level 3 = Severe: pervasive, continuous, life disturbing problems * 3. Cognitive symptoms Cognitive symptoms 0 = No problem 1 = Slight or mild problems; generally mild or intermittent 2 = Moderate; considerable problems; often present and/or at a moderate level 3 = Severe: pervasive, continuous, life disturbing problems * 4. Tally your score for Part 2a (not the number of checkmarks) and enter it here: Tally your score for Part 2a (not the number of checkmarks) and enter it here: You must write down this total from Part 2a on the same piece of paper you wrote your WPI score on (from Part 1) before continuing. 5. What Your Scores Mean You will be asked to enter scores from previous pages. If you forgot to write the three numbers down, or don't remember them, you may hit the previous button below or your browser back button. Your data will not be lost by doing either. 1. Enter your WPI score here: Enter your WPI score here: 2. Add your Part 2a AND Part 2b scores (not just the last number you jotted down). Enter the TOTAL here: Add your Part 2a AND Part 2b scores (not just the last number you jotted down). Enter the TOTAL here: The Symptom Severity Score (SS score) is the sum of Parts 2a & 2b. This total can range from 0 to 12 points. A patient meets the diagnostic criteria for fibromyalgia if the following 3 conditions are met: 1a. The WPI score (Part 1) is greater than or equal to 7 AND the SS score (Part 2a & b) is greater than or equal to 5 OR 1b. The WPI score (Part 1) is from 3 to 6 AND the SS score (Part 2a & b) is greater than or equal to 9. 2. Symptoms have been present at a similar level for at least 3 months. 3. You do not have a disorder that would otherwise explain the pain. For example: If your WPI (Part 1) was 9 and your SS score (Parts 2a & b) was 6, then you would meet the new FM diagnostic criteria. If your WPI (Part 1) was 5 and your SS score (Parts 2a & b) was 7, then you would NOT meet the new FM diagnostic criteria. *The new FM diagnostic criteria did not specify the number of "Other Symptoms" required to score the point rankings from 0 to 3. Therefore, we estimated the number of symptoms needed to meet the authors' descriptive categories of: 0 = No symptoms 1 = Few symptoms 2 = A moderate number 3 = A great deal of symptoms * 3. Did you meet the new diagnostic criteria for FM? Did you meet the new diagnostic criteria for FM? Yes No Unsure * 4. Do you feel the new criteria offers a fair and reasonable assessment of your symptoms? Do you feel the new criteria offers a fair and reasonable assessment of your symptoms? Yes No Unsure * 5. Was this survey helpful? Was this survey helpful? Yes No Unsure * 6. In your opinion, do you think this new criteria: (check all that apply) In your opinion, do you think this new criteria: (check all that apply) Makes it easier for doctors to diagnose fibromyalgia Makes it harder for doctors to diagnose fibromyalgia Makes it more confusing for doctors to diagnose fibromyalgia Makes it less confusing for doctors to diagnose fibromyalgia Is an improvement on the existing fibromyalgia criteria Will lead to a greater misdiagnosis of patients who have other illnesses Will improve the credibility of fibromyalgia patients Will worsen the credibility of fibromyalgia patients No opinion * 7. Do you think this new criteria will lead to better treatment of fibromyalgia symptoms? Do you think this new criteria will lead to better treatment of fibromyalgia symptoms? Yes No Unsure 8. We would appreciate your comments on the new diagnostic criteria. Please do not ask us questions that require a response in the survey comments sections because we will not be able to identify you (everyone is anonymous). We would appreciate your comments on the new diagnostic criteria. Please do not ask us questions that require a response in the survey comments sections because we will not be able to identify you (everyone is anonymous).

A Neurologist's Approach

A Neurologist’s Approach Many neurologists sub-specialize in the treatment of pain. The Fibromyalgia Network asked several different experts to offer their strategies for treating fibromyalgia. Here is one neurologist’s viewpoint on how to address the pain: Benjamin Natelson, M.D. Neurologist New York, NY As a neurologist, I often use anti-epileptic drugs (AEDs) to help control pain. There appears to be an overlapping neurological system involved in epilepsy, depression, and pain, because similar medications seem to exert an impact on those same systems. AEDs are often good at relieving migraines and they are effective at reducing burning pain. However, their ability to treat the dull, achy, widespread pain of fibromyalgia is not easy to predict. I start a person on one AED, and if it helps but the pain is still bad, I will usually add a second AED with a different mechanism of action. If cost is an issue, gabapentin (Neurontin) and lamotrigine (Lamictal) are off-patent and relatively cheap. If a person has insurance, I may prescribe oxycarbazepine (Trileptal) or pregabalin (Lyrica) because they only have to be taken twice a day, while the others must be taken more frequently. AEDs may be sedating and can reduce nighttime pain—effects that can lead to improved sleep. Regardless of which AED I prescribe, I always start patients on the lowest possible dose, taken at night, and then they increase dose every four days as tolerated. It takes two to three months to reach the target dose of 2,400 mg/day of Neurontin (taken in four divided doses). The target dose for Lamictal is 100 mg three times a day, Trileptal is 600 mg twice a day, and Lyrica is 150 mg twice a day. If a patient does not receive any benefit, or the side effects are intolerable, I switch them to a different AED. Patients may benefit from a healthcare professional, or coach, whom they can communicate with about their abilities and illness concerns. Psychologists working at pain management centers/hospitals may be suitable coaches. Specify up-front that you want help coping with your physical symptoms, not just emotional-related counseling, and use the tips below by Dr. O’Reilly. -------------------------------------------------------------------------------- Finding a Therapist by Connie O’Reilly, Ph.D., Beaverton, OR How do you select a good psychologist, particularly one who understands fibromyalgia? Most psychologists are willing to do a brief consult by phone before you schedule an appointment. Others may be able to consult by email, although some are limited due to confidentiality issues. What to Ask a Prospective Psychologist: •What is your experience in working with patients with chronic pain? •Have you worked with patients that have fibromyalgia? •What is your approach in to helping with such patients? In general, it is important that your psychologist have experience with chronic and painful conditions. However, if you get any hint that the therapist feels fibromyalgia is a questionable diagnosis, keep searching. Listen for this: •Does this professional convey respect and empathy for people dealing with chronic medical conditions, including chronic pain and fatigue? •Does this person recognize that chronic illness disrupts multiple areas of your life, causes a tremendous amount of stress, and can result in concurrent depression and anxiety? •Does this person have expertise in specific areas of concern to you? Identify what you want from a therapist. The better you are at communicating what you want, the more likely you will get it. •Does this person sound like a good fit for you? If not, trust your intuition and keep calling. Evidence suggests the therapeutic relationship is the key to a client receiving satisfying results.

Handling Guilt

How do you handle guilt? Handling Guilt Most everyone with fibromyalgia or chronic fatigue syndrome knows that they must pace their activities and avoid overexertion, even on a good day. Yet, this philosophy that is so essential for living with these syndromes also requires your family to work harder to make up for your limitations, which may cause feelings of guilt. “The issue of excessive guilt is so universal,” says Connie O’Reilly, Ph.D., a therapist in Oregon who counsels many patients with fibromyalgia and chronic fatigue syndrome. Although many people struggle with feelings of guilt, O’Reilly adds, “This issue happens to be particularly poignant when one has a chronic illness.” Why? You are forced to witness the people you love working overtime to do extra household chores and take over many roles in the home that were once your responsibility. The Fibromyalgia Network Journal includes a full feature on how to handle guilt, with input from four coping specialists. In the meantime, you should be comforted by the following comments made by Thomas Fuller, Ph.D., of Grand Rapids, MI: “Guilt is a sign that you have a conscience, and it is letting you know it is there. People with little conscience act selfishly, and without concern for their impact on others … If you feel guilty about your impact on others, then you are psychologically more healthy, actually.” The trick is to better understand the sources of your guilt and develop ways to control these feelings so that they do not become destructive. Hopefully, the statements above by the two counselors will help ease your struggle with this difficult emotion of guilt. In addition, there are many methods you can use to gain control over these feelings.

Maya Angelou Quote

Maya Angelou "If you cannot make a change, change the way you have been thinking. You might find a new solution. Never whine. Whining lets a brute know that a victim is in the neighborhood."

Do you have?

Question: Does anyone have problems with an on going headache that then turns into a migraine for more than one day? What have you found to help relieve this symptom? I eagerly await your reponses...

Does "Brain Fog" start in the Brain?

Why Stuff Bugs Us So Much with Fibromyalgia & Chronic Fatigue Syndrome

By Adrienne Dellwo, About.com GuideNovember 27, 2012 If you have fibromyalgia (FMS) or chronic fatigue syndrome (ME/CFS), you know that a lot of things started bugging you after you got sick. Bright lights, noise, crowds, clothing tags, waistbands, textures, fragrances, foods ... it seems that just about anything can rattle your nerves or stir up your symptoms, and all of it is aggravating. So why does so much stuff bug us? Two words: central sensitization. Let's take a closer look at the second word first. Sensitization A key aspect of both FMS and ME/CFS is that our bodies are overly sensitive to, well, pretty much everything. It's not that we're emotionally over sensitive -- it's a physiological thing. Medically speaking, the word sensitivity is most often used when talking about allergies. When allergies form, it's because something in the immune system malfunctions and begins reacting inappropriately to a substance. The immune system has been "sensitized" to the substance. In non-allergy situations, it's essentially the same but in a different system of the body. And that takes us to the first word above.... What Does "Central" Mean? In this case, "central" means "central nervous system," or CNS. The CNS is made up of your brain, spinal cord, and nerves of the spinal cord. In FMS and ME/CFS, the entire nervous system becomes sensitized. To what? Anything unpleasant. The medical term for those unpleasant things is "noxious stimuli." It can be a bad smell, pain, bright light, anything. Because our bodies are sensitized, they react more strongly than most people's. That means lights are too bright for us when they're just fine for other people. Same goes for noise, visual chaos, heat, cold, pressure on the skin, etc. Our nerves over-react to the things around us, and our brains basically throw a little hissy fit when they get the signals, and that makes it all the worse. Does Brain Fog from Chronic Fatigue Syndrome Start in the Heart? By Adrienne Dellwo, About.com GuideNovember 28, 2012 brain fog/fibro fogResearch Brief New research suggests that the cognitive function ("brain fog") of chronic fatigue syndrome (ME/CFS) may be due to irregularities in the heart, which in turn stem from impaired vagus nerve activity. Brain fog is one of the most pervasive symptoms of ME/CFS, and it can be a major debilitating factor. Brain fog can include short-term memory problems, inability to multitask, comprehension difficulties, language problems, and disorientation. In the study, researchers monitored cardiac activity while participants performed cognitive tasks. They found: • People with ME/CFS were slower than healthy controls • Heart-rate variability was low and unresponsive in the ME/CFS group • The heart rate was more reactive after cognitive challenges • Heart-rate recovery was slow after cognitive challenges • Heart-rate variability was an accurate predictor of cognitive outcome Those cardiac functions are regulated by the vagus nerve. Dysfunction of the vagus nerve has long been suspected in ME/CFS, especially when it involves a symptom called neurally mediated hypotension (dizziness upon standing due to a sudden drop in blood pressure.) When Kids Have Fibromyalgia or Chronic Fatigue Syndrome By Adrienne Dellwo, About.com GuideNovember 30, 2012 The stereotypical images of someone with fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) is usually either an old woman or a burned-out yuppie. That makes it easy for people to miss the fact that anyone, at any age, can get FMS or ME/CFS. That includes children. When you know how debilitating these illnesses are, it breaks your heart to think about what childhood is like for those who have them. When both of these conditions are under-researched, it's fairly obvious that the juvenile forms haven't gotten a lot of attention from the medical community.

Muscle Relaxants: Do they work for fibromyalgia?

Muscle Relaxants: Do they work for fibromyalgia? Your muscles are tight and achy. You may even feel ropy bands with firm knots in the mid-section of the muscle. These are myofascial trigger points, and their location often overlaps with the 18 tender points used for diagnosing fibromyalgia. Just pressing on them can send your pain through the roof. But can muscle relaxants ease the tension in your muscles and help untie (or at least loosen) your painful knots? The question of whether muscle relaxants can relieve your pain is complicated by the fact that this class of medications is very diverse, meaning that many drugs in this class vary substantially from the others. So some muscle relaxants might do the job better than others. Two fibromyalgia specialists offer advice on this topic based on their clinical experience, including which medications in this class they prefer and the doses they prescribe. See table below for more details. Robert Katz, M.D., of Rush University Medical Center in Chicago, IL, says: “Muscle relaxants do help reduce tenderness and may relax patients or ease their anxiety. I tend to prescribe Zanaflex and low dose Flexeril and use them quite often in the treatment of fibromyalgia. I tell patients I don’t want them sedated, but I also do not want their muscles so tender; I want their muscles relaxed. “I start with very low doses, sometimes half a tablet, and I see how the patient does on it. I try to give these medications during the daytime when patients have their greatest amount of pain and muscle tenderness. Muscle relaxants have a transient effect. This means that patients cannot take them at bedtime to reduce morning stiffness eight hours later. They must be on board when the patient has the most amount of pain. “I suspect that this class of medications somehow relaxes the central nervous system a bit and they also have a relaxing effect on the peripheral system (i.e., the muscles). It is somewhat like getting a massage. However, I have never been able to document how much these agents reduce muscle tenderness.” Richard Podell, M.D., of the UMDNJ-Robert Wood Johnson Medical School, with practices in Springfield and Somerset, NJ, offers the following advice: “Some patients find valium-type medications (i.e., benzodiazepines, including Klonopin and Xanax), Flexeril or Skelaxin useful for reducing muscle pain, stiffness, twitching, and spasms. Two muscle relaxants used in multiple sclerosis to treat muscle spasms, Zanaflex and Lioresal, are sometimes helpful in fibromyalgia, too. The major drawback for daytime use of these medications is sedation, with the exception of Skelaxin, because it does not effect the central nervous system. “With regards to dosing, I typically begin with 25 to 50 percent of the usual standard starting dose. Fibromyalgia patients as a group are very sensitive to medication side effects, necessitating that one start low and build up slowly. Otherwise, the initial drug effects are likely to bowl a patient over. “As to why these medications work, we know so little about drug mechanisms, I’ve learned to be quite humble. Some treatments should help in theory but they don’t and vice versa. More impressively, various drugs act one way in one person and the opposite in others, and it is not just people with fibromyalgia. It is well-known that benzodiazepine/valium-type relaxants cause sedation and relieve anxiety in most people, but produce activation and increased anxiety in a small yet significant subset.” Lowest Possible Doses In order to minimize daytime sedation and other side effects, Katz and Podell begin patients on the lowest possible dose. Here’s the rundown, with the generic name in parentheses: Highly Sedating •Flexeril (cyclobenzaprine): 5 mg (10 mg tablet cut in half) •Lioresal (baclofen): 5 mg (10 mg tablet cut in half) Benzodiazepines •Klonopin (clonazepam): 0.25 mg (0.5 mg tablet cut in half) •Valium (diazepam): 1 mg (2 mg tablet cut in half) •Xanax (alprazolam): 0.125 mg (0.25 mg tablet cut in half) Least Sedating •Skelaxin (metaxalone): 200 mg (400 mg tablet cut in half) •Zanaflex (tizanidine) : 1 mg (4 mg tablet is scored two ways)

Get Ahead of the Wintertime Blues

Get Ahead of the Wintertime Blues by Kristin Thorson, Fibromyalgia Network Editor Posted: October 31, 2008 Don’t dread the wintertime blues. Get a jump start in heading off the symptoms associated with Seasonal Affective Disorder (SAD). This common mood disorder can begin as early as October or November and persist through March. Symptoms include a depressed mood, loss of interest, low energy, social withdrawal, anxiety, feelings of guilt, cravings for starchy or sweet food, increased appetite, weight gain, and insomnia.1 Patients say that their worst month is either January or February. Many people who experience the winter blues are not aware that they have SAD. They may simply view this seasonal lull in mood as a normal stage that everyone goes through when the days are shorter and the body gets less sunshine. Because SAD is often overlooked, most patients endure roughly 13 seasonal episodes of this condition before getting treated for it. If you experience repeated bouts with depression during the winter and suspect that you have SAD, don’t assume it’s your fibromyalgia and don’t let it compound your symptoms. Effective therapies are available. Because the nights are longer in the winter, the body’s internal clock and its natural sleep/wake cycle shift.2 The body’s clock and sleep/wake cycle are controlled by the pineal gland at the base of the brain. It secretes melatonin when it is dark at night. When the eyes are exposed to light, melatonin production is shut off. Because the sun rises later in the winter, melatonin is secreted longer in the morning. In genetically predisposed individuals, it is suspected to be responsible for the common symptom of morning tiredness or sluggishness that is associated with SAD.3 Two other pieces of evidence that point to a malfunction in the body’s internal clock mechanism have to do with the effective treatment results obtained by using exposure to bright light in the early morning, or a small micro-dose of melatonin taken in the late afternoon to bring the melatonin “cycle” forward in an effort to reduce morning fatigue. Light Box Therapy Using a bright light box for 30 minutes each morning has been shown in studies to be just as effective as taking an antidepressant, such as Prozac.4 In fact, light therapy tends to work slightly faster and produce fewer side effects than Prozac, a selective serotonin re-uptake inhibitor (SSRI) medication that may cause agitation, sleep disturbance, and palpitations. Analysis of light therapy for treating SAD indicates that patients need to use a high intensity box that emits 10,000 lux; “lux” is the light intensity rating of the box. For a 10,000 lux box, 30 minutes of exposure with your eyes open (but not looking directly at the light) each morning is sufficient.5 Boxes with lower “lux” ratings may be cheaper, but more time is needed to get the same effect. Light boxes are not covered by insurance and can be costly. Shop online at superstores like Costco, or a local health products distributor. Prices start around $200. Light therapy may not be as convenient as taking medication, but the side effects are fewer, despite speculation that these devices may cause an increase in eye strain and headaches. Supplements Research is ongoing on the use of a tiny dose of melatonin (0.1 mg) taken in the late afternoon, but so far it appears to work synergistically with light therapy to treat SAD.3 This small dosage does not produce sedation, but it has enough of a physiological impact to signal the pineal gland to reset the body’s clock. The typical over-the-counter doses of melatonin are much higher (e.g., 3 mg), so you would need to seek the help of a compounding pharmacist to prepare the smaller dose formula. This would also require a doctor’s prescription. When the days are shorter, people are at an increased risk of developing vitamin D deficiency. Talk to your doctor. A vitamin D deficiency is easy to identify and inexpensive to correct. Another option might be to visit a tanning salon a couple of days a week for a limited amount of time to make up for the loss of sun exposure and the ultraviolet (UV) rays that help your skin make vitamin D. A small study showed that UV light helped produce natural substances in the body that made people feel better, experience less pain, and improve mood.6 Medication What about preventing SAD episodes from occurring each winter? First, all other medical reasons for depressed mood need to be checked (such as thyroid problems, sleep disorders, lung difficulties, chronic sinus infections, etc.) One study using long-acting Wellbutrin (buproprion) showed that initiating treatment in November and tapering off the dose at the end of March prevented SAD in 50% of patients.1 The starting dose of buproprion XL was 150 mg/day, and if tolerated or needed, was increased to 300 mg/day. Buproprion is less likely than Prozac to cause side effects, with its primary side effect being dry mouth. In fact, if you have restless legs syndrome (RLS), buproprion is the one antidepressant that will not aggravate this sleep disorder. Self-Help Strategies •Avoid becoming “house bound” by going outside each day. •Make a point of keeping your house or apartment well-lit. •If you have a fireplace, try lighting it on cold days; there are certain comforts associated with warm fires. •Be careful not to unintentionally compensate for increased sluggishness by eating lots of sweets. Weight gain will not lift your mood. •Loosely structure your days to have a blend of time spent on yourself, with others, and doing something productive. Lack of structure is a major contributor to feeling down or blue. •If you are not working outside the house, try getting dressed and leaving the house at the same time each day, say, 10:00 a.m. (just like going to work). This is a good opportunity to run errands, shop, and accomplish other duties early. It can help you feel more productive and stave off some guilty feelings. As you get into the heart of winter, create a plan. Everyone thrives on a mixture of people, activities, stimulation, rest, structure, alone time, and time with others. 1.Modell JG, et al. Biol Psychiatry 58:658-667, 2005. 2.Lewy AJ, et al. PNAS 103(19):7414-7419, 2006. 3.Srinivasan V, et al. World J Biol Psychiatry 7(3):138-151, 2006. 4.Lam RW, et al. Am J Psychiatry 163:805-812, 2006. 5.Golden RN, et al. Am J Psychiatry 162:656-662, 2005. 6.Feldman SR, et al. J Am Acad Dermatol 51:45-51, 2004.

Fibro Out-of-Control?

Fibro Out-of-Control? … two experts offer treatment advice Is your fibromyalgia becoming more unmanageable and is staying awake during the day a constant struggle? Both of these situations can make you wonder, “What can I do to get out of this rut?” Two experienced clinicians describe common reasons for why fibro symptoms can worsen and offer their treatment advice to help you get back on your feet. Charles Lapp, M.D. Internist in Charlotte, NC New or worsening symptoms should not automatically be attributed to the fibromyalgia, even if they are common. The most frequently occurring medical problems I see that may help account for why a patient is in a rut include: Lyme disease, hypothyroidism, low cortisol production, and tooth/gum infections. When patients are not doing well, I always ask if they have had any recent illnesses or infections. If they have had dental work, an infected cap can definitely make them sick. I also inquire about skin bites because this helps to diagnose an ongoing case of Lyme disease (the blood work alone may be inconclusive). I will perform a mini-physical and order lab tests to help identify what might be causing a patient to feel worse. There are many tests for thyroid function, but in people with fibromyalgia the thyroid stimulating hormone (TSH) seems to go up and down, so TSH is not a useful marker. Instead, I measure the real hormones involved in regulating the body’s metabolism, which are T4 and T3 (T4 is the version that circulates throughout the body and is converted into the active version, T3, as it enters all cells before going to work). I also test for auto-antibodies, especially if the thyroid gland is tender. If T4 and T3 are both low, then I might put the patient on supplemental T4 (e.g., Synthroid). However, many of our patients do not efficiently convert T4 to T3, the active hormone. These patients need to be placed on T3 (such as Cytomel) or T3-containing formulas, such as Armour. In either case, I monitor their thyroid hormones at least annually. If anti-bodies to the thyroid are present, it can cause too much fluctuation in the hormone levels, making the tests unreliable. Then I have to go mostly by how the person feels to adjust the treatment dose. Many of my fibromyalgia patients have thyroid tests results in the normal range, but may have all of the symptoms of hypothyroidism. Examples include dry skin, brittle hair, constipation, and croaky voice—in addition to profound fatigue. I put them on a small dose of thyroid and they feel so much better. It’s not a cure, but it does help. The least expensive way to measure cortisol is to check it in the saliva. I ask patients to take two to three samples throughout the test day. The morning cortisol is usually normal, but by the afternoon some patients don’t have any at all, causing them to feel totally drained. For this group of people, I prescribe a tiny dose of hydrocortisone in the morning and another at noon, with the maximum daily dose not exceeding 15 mg. Often this will give them a small boost in daytime energy. If no other source of the patient’s symptoms is found but they are feeling as though their health is continuing to decline, that tells me they are using up all of their available energy. I always talk to my patients about their energy limits. Many will attempt to add a full exercise program onto what they are already doing, but this doesn’t work as expected. This happens because they overextended beyond the boundaries of their energy envelope. Patients who are experiencing increased symptoms need to incorporate at least two rest periods into their day. Then as soon as they feel they have the energy, they should slowly add small amounts of light activity into their schedule. The point is, patients cannot add an energy-consuming activity without first making room for it within the boundaries of their energy limits. To help patients stay within their energy boundaries, I teach them the three Ds: delay, defer, and delegate. Patients need help with solving relationships, work issues, and adjustments needed for living with a chronic illness. They need to find counselors who are willing to work like coaches to identify what is bothering them and help them work on solutions. These therapists can be hard to find. As an alternative, I have collaborated with Bruce Campbell, Ph.D., who coordinates group courses by email and Internet. The costs is $35. Bruce was an educational psychologist at Stanford University helping people with chronic illnesses before he developed chronic fatigue syndrome/fibromyalgia. His web-based classes require reading two chapters from a course book each week and answering questions for homework assignments. Examples might be: Give five situations when you have over-exerted yourself and could have triggered a flare in the past two months; or, list three things that your spouse does that frustrates you. Everyone in the course emails Bruce their answers, and then he hosts a chat group on the Web each week. Patients learn how other people are dealing with similar issues. Participants must be willing to commit three hours per week to the course, which is fully outlined at www.cfidsselfhelp.org. Carol Beals, M.D. Rheumatolgist in Lansing, MI I have fibromyalgia patients come in for a target visit when they sense their symptoms are getting worse. I look at their diet, sleep cycle, work and home stress, and their medication. If they are extremely tired, I will order blood tests to measure their vitamin B1 and B6 levels, as well as their “total” and “free” carnitine levels. Carnitine and the B vitamins are important for helping the cells make fuel. More than 50% of the time, I find low B vitamin levels are the reason patients are so fatigued. I have my patients take a B-complex with 100 mg of B1 and 100 mg of B6. Oral supplements work rather quickly and there is no need to administer expensive IV preparations. Carnitine is often low as well, so I supplement this energy nutrient with a Carnitor, a prescription medication. Patients take 330 mg three times a day, and it helps immensely with their energy levels. It’s available as a generic and most insurance companies will pay for it with the diagnosis of fatigue. Patients can get carnitine over-the-counter, but you never know how much carnitine they really contain, so prefer to use Carnitor (instead of acetyl-L-carnitine). I recheck the B-vitamins and carnitine levels two to three months later, and if they are normal I discontinue the supplements. With regards to diet, I recommend eating a small amount of protein three or four times a day. Protein gives people more energy and helps them stay away from sugar. I urge my patients to steer clear of processed sugar, excessive caffeine (no more than two colas a day), and aspartame, an artificial sweetener. Aspartame directly stimulates the receptors in the spinal cord to produce pain, which is why I ask patients to avoid Equal and NutraSweet, along with the many diet colas containing this sweetener (Splenda and Sweet ’N Low are okay). I provide my patients with a one-page sheet of stretching exercises they can do at home. I advise them to do no more than five minutes per session once or twice a day until they notice symptom improvements. It is better for them to do five minutes and be successful than to try 30 minutes and not be able to reach that goal. During the target visit, I help patients identify new or increasing stressors that could be contributing to their decline. They may be more tired and achy, and have no energy. Often, there is a reason, such as their child was sick, a husband lost his job, they took a trip, or they did something to over-exert themselves. I ask them when their symptoms started to flare, and then I take out the calendar to find out what happened during the week prior to the onset of the severe symptoms. Almost always, I can find a triggering event. Once we can determine what set off their symptom flare-up, they know they are not crazy and something can be done to turn their symptoms around. Next, I go over the various ways to control pain. Four different types of medications can be used, and I prescribe them in small quantities because fibromyalgia patients cannot tolerate drugs very well. I may use a low dose of an antidepressant, an anti-epileptic drug, a sleep agent, and sometimes a mild pain medication. When I use all of them, I can intercept the pain four different ways. The patient usually gets relief and allows them to get out of their painful flare-up. There are several other methods I use to turn a patient around who is having too many down days and stuck in a rut. However, when I bring a patient in for a target visit, together we can always think of something that will help improve their situation. Still Struggling with Pain? Lapp and Beals address common reasons that may prevent you from improving despite valid efforts by you and your doctor. Yet, if the pain or tight, knotted muscles are still nagging you, check out the two sample articles: A Neurologist’s Approach and Muscle Relaxants. In addition, enter your email address into the right-hand box underneath the print button to receive another free article, Peeling the Layers of Your Pain. -------------------------------------------------------------------------------- Tests •Vitamins B1 and B6 blood levels •Carnitine (total and free blood levels) •Thyroid function: T3, T4 and, auto-antibodies (especially if the thyroid gland in the neck is tender or enlarged) •Adrenal function: measure saliva cortisol throughout the day •Lyme disease antibodies (especially with a history of a skin bite) •Look for infections: gums/teeth and other sources -------------------------------------------------------------------------------- Treatments •Carnitor: 330 mg three times per day (if tests show low carnitine) •B-complex: 100 mg each of B1 and B6 (if tests show low levels) •Thyroid hormone: T4 (such as Synthroid) or T3 (such as Cytomel or Armour) •Hydrocortisone: take a small dose in the morning and at noon (total dose not exceeding 15 mg/day) -------------------------------------------------------------------------------- Self-Help •Eat small amounts of protein throughout the day to provide energy and reduce sugar craving •Minimize caffeine and foods loaded with processed sugar •Avoid Aspartame (Equal, NutraSweet, and many diet drinks) •Add at least two rest periods to your day until you begin to feel better •Stretch for five minutes of each day until you are able to be more active (this will reduce muscle stiffness and the development of painful knots) •Identify the trigger that set off your flare-up by looking at events one week prior getting worse •Inquire about the web-based classes at www.cfidsselfhelp.org •Seek out compassionate, knowledgeable providers to treat your fibromyalgia-related symptoms (see instructions on how to receive a list of healthcare providers in your area in our Coping Resources section) Get reliable, patient-focused advice and input from the treatment experts when you become a Member of the Fibromyalgia Network. Use Promo Code 604 when you join and get your first issue free!

Flu Shots: Yes or No for Fibromyalgia & Chronic Fatigue Syndrome?

Flu Shots: Yes or No for Fibromyalgia & Chronic Fatigue Syndrome? By Adrienne Dellwo, About.com Guide November 7, 2012 Fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) involve dysfunctional immune systems. The flu can be especially hard on us. So we should get flu shots, right? You didn't expect an easy answer, did you? With FMS & ME/CFS, it's never simple. The flu shot contains dead flu virus, and while most people's immune systems do just fine with that, many of us do not. Some leading experts in our illnesses, and especially ME/CFS, caution against flu shots. They say the risk is too great that it'll make your symptoms significantly worse, possibly for months. Other say we should get the vaccine because if we get the flu we'll get especially sick and take a long time to recover. That leaves us in a quandry. Who is right? How do we know how we'll react? Which route is safer? I didn't used to get flu shots. I've never had a bona fide case of the flu and I'd never, as an adult, been vaccinated. FMS is different for everyone, and in my case, it caused very little immune dysfunction. Therefore, for my first few years of being sick, I didn't get the shot. However, then there was the whole "swine flu" scare, and I got it because I had young children and had developed an autoimmune disease (Hashimoto's autoimmune thyroiditis). I didn't have any problems, so I've gotten one every year since. Again, my immune dysfunction is mild. The vaccine is much harder on some people. It's a bit of a gamble, really - do you risk a symptom flare by getting the shot, or risk a potentially devastating illness by not getting it? We have to consider a lot of factors, such as: 1.How likely are you to get the flu? 2.Have you had reactions to flu vaccines in the past? 3.Do you have other illnesses that put you at risk of the flu? (These include autoimmunity, diabetes, COPD/emphysema and heart disease In the end, it's a personal decision. I'd love to hear what decision you make and your reasons for it, so leave a comment below! (This topic can get heated, so please do NOT criticize or second-guess other people's decisions. This is about sharing information in a safe and open environment.) Darla's Comment: I get the flu shot every year, but it doesn't prevent me from getting some type of flu's. But it does prevent me from getting sick all the time. Check with your doctor so that you can get his/her opnion on what is best for you.

How to Dress for Less Fibromyalgia Pain

How to Dress for Less Fibromyalgia Pain Fibromite-Tested Tips! By Adrienne Dellwo, About.com Guide Updated May 10, 2011 About.com Health's Disease and Condition content is reviewed by the Medical Review Board. Is your skin painful to touch? Do your clothes cause fibromyalgia pain? Mine do! Bras, waistbands, even the tie on my old bathrobe -- anything that puts pressure on my chest or abdomen can at times set off either burning or intense, stabbing pains. I've tailored my entire wardrobe to accommodate this particular symptom, but I've never read a word about it anywhere. Wondering if I was crazy or if it was a common thing among those of us with fibromyalgia syndrome (FMS), I asked about it in the About.com Fibromyalgia and Chronic Fatigue forum. Turns out, I'm not alone. A lot of people posted that they have the same problem and thought they were the only ones. One woman described the pain as feeling like a "terrible sunburn." Clothes can cause pain all over, on your tender points, and on areas that are numb or tingly. With the help of our forum users, I've put together these tips for dressing when you have fibromyalgia: Spare Your Waist Unless you want to wear long, flowy dresses all the time, you've got to find ways to spare your waist from all of those waistbands. I've found several ways to get around this: •Pitch the Pantyhose -- Buy Thigh-Highs Forget control tops! They might feel OK when you put them on, but the last thing your body wants is to be squeezed for hours on end. Thigh-highs keep your legs looking nice while keeping your mid-section much happier. •Go Low! When it comes to underwear, try bikini briefs that sit down on your hips instead of the fuller styles that go clear up to your waist. And while you may not like the thought of low-rise pants that expose your belly button, try on a pair to see how much kinder they are to your gut. For those of us who don't want to bare all that skin, a long shirt can cover your midsection nicely. •Do the Sit Test When you try on pants, don't just stand in front of the mirror. Sit down. Slouch. Lean forward. If they're still comfortable, you've got a winner. •Venture into the Maternity Section I'm not talking about those horrid pants with the big baggy section in front, but about the ones with the "under belly" band. It's a nice wide band at the top that's designed to sit lower on an expanding belly. For the non-pregnant, these pants are just an incredibly comfortable way to go. I got this style of pants and skirts while I was pregnant, and I'm still wearing them. No one knows they're maternity, and I can keep them on all day. •Draw-String v. Elastic When it comes to sweat pants, a draw string wins out over an elastic waistband because it's adjustable. If your weight fluctuates or you eat a lot while wearing them, you can give yourself a little more room. True, the elastic will stretch, but you'll find it puts more pressure on you when it does. Some people have luck with loosening or removing the elastic. •Lounging About Let's face it -- some days, clothes are just out of the question. A lot of us have spent entire days, maybe even weeks in attire most people consider only appropriate for sleeping. For those times, I recommend a bathrobe with a zipper instead of a tie. Also, a lot of pajamas these days are shirts with pants or shorts. A nightgown is kinder to your body, but of course, your legs might get cold. I'm considering leg warmers, especially now that 1980s styles are all the rage. Beating the Bra Blues An underwire may support you nicely, but you'll likely be ready to rip it off before lunch. Here are some alternatives: •Soft-Cup Bras Even if you're a larger size, you can find soft-cup bras that will give you support. Check out the selection at a specialty shop or a plus-size boutique. Also, get a bra fitting. Most women don't wear the right size, and a too-tight band is doing you no favors. Look for wide shoulder straps as well -- they don't dig into the shoulders like thinner straps often do. •Sports Bras As long as they're not too tight, sports bras are comfortable and put far less of a squeeze around your rib cage. They also hold everything right in place. •Bralettes or Bandeaus If you're smaller, one of these styles might be the way to go. A bralette is an unlined soft-cup bra that's designed for comfort. It's most popular among teenagers because it doesn't provide much lift. A bandeau is basically a tube of fabric that goes around your chest. Again, the support isn't the best, but it won't poke you anywhere and cause pain. A Feel for Fabrics The texture and weight of a fabric can make a big difference in how it feels to you. Here are the ones that come highly recommended for those with fibromyalgia: •Cotton •Silk/Satin •Stretchy knits •Fleece •Flannel Some people also prefer shirts with the tags printed on the fabric instead of sewn in. Socks that Squeeze Ah, that elastic dilemma again! This is a tough one, since many of us seem to have chronically cold feet, but no one wants loose, sloppy socks bagging around their ankles. So what can you do? •Experiment with length Look at where your socks hurt you, and see if a different length will miss those spots. •Try thinner fabric A heavy sock will put more pressure on your foot when you wear shoes. Thinner might be better. •Look into socks made for people with diabetes Fibro pain has a lot in common with diabetic neuropathy, so this makes a lot of sense. "Sensitive foot" socks are widely available online and at specialty shoe stores. Take it Off! Lastly, if you're in the privacy of your own home, take off everything that's not comfortable and find something that is. The UPS guy has seen it all, I'm certain, and you'll feel better for it. And really, isn't that the most important thing?

Unrefreshing Sleep in Fibromyalgia

Unrefreshing sleep has long been noted as a feature of fibromyalgia, and it's one that may be linked to many of our symptoms. One study reports that as many as 95 percent of people with fibromyalgia report having unrefreshing sleep. A growing body of research is leading to a better understanding of unrefreshing sleep in this condition -- its features, its effect on us, and how it may be alleviated. What is Unrefreshing Sleep? Unrefreshing sleep, also called nonrestorative sleep, is not the same thing as insomnia (which can also be present in fibromyalgia). It's not tied to how hard it is to get to sleep or to how long you sleep. Instead, unrefreshing sleep is more about the quality of your sleep. It's light, and even after sleeping for a full night, you wake up feeling exhausted and as if you've hardly slept. However, the impact of unrefreshing sleep can go well beyond feeling tired. While unrefreshing sleep and other sleep-related problems are considered a symptom of fibromyalgia, research shows that they're tied to abnormalities in brain chemistry and the immune system in a complex way and, according to a 2012 study, may serve as "both a cause and a consequence of fibromyalgia." Impact of Unrefreshing Sleep Research links this poor-quality sleep to multiple symptoms of fibromyalgia, including: •Increased tenderness •Lack of overnight recovery from pain •No morning feelings of well-being •Cognitive impairment (fibro fog) •Poor performance of tasks •Morning achiness •Stiffness •Fatigue •Psychological distress Why is Sleep Unrefreshing in Fibromyalgia? So far, it's not well understood why sleep is generally unrefreshing in people with this condition. The most obvious explanation is that it's hard to sleep when you're in pain, and many people with fibromyalgia report significant pain from simply lying down on their tender muscles. The tendencies to get chilled or become overheated and sweat excessively may also contribute to sleep problems. Research shows that dysfunction in the autonomic nervous system (ANS) may play a key role, as well. The ANS is separated into two parts -- the sympathetic (fight-or-flight mode) and parasympathetic (rest-and-digest mode.) According to an emerging theory of fibromyalgia, the sympathetic nervous system appears to be stuck "on," preventing the body from truly relaxing and being able to sleep. This state is similar to "sleeping with one eye open," such as new parents do when they're alert to a baby's every cry, or like you might experience when you're especially worried about oversleeping and therefore wake up and check the clock over and over. A 2009 study suggests that heart-rate variability, which is a measure of autonomic function, was abnormal during sleep in participants with fibromyalgia. This supports the theory of increased sympathetic activity that disrupts sleep. Because pain disrupts sleep and poor sleep leads to pain, it can become a self-perpetuating cycle. Treating Unrefreshing Sleep Research suggests that several medications may be able to improve sleep quality in fibromyalgia. These include: •Lyrica (pregabalin) •Cymbalta (duloxetine), Savella (milnacipran) and other SNRIs •Elavil (amitriptyline) •Xyrem (sodium oxybate) Lyrica, Cymbalta and Savella are FDA-approved for this illness. Elavil is a tricyclic antidepressant, and Xyrem is a narcolepsy drug that's strictly controlled. Some people with fibromyalgia report success with other prescription or over-the-counter sleep aids as well. Research suggests that melatonin supplementation may improve sleep and pain in fibromyalgia. If your sleep is unrefreshing, you should talk to your doctor about what options may be right for you. Sources: Chervin RD, et al. Journal of rheumatology. 2009 Sep;36(9):2009-16. Objective measures of disordered sleep in fibromyalgia. Citera G, et al. Clinical rheumatology. 2000;19(1):9-13. The effect of melatonin in patients with fibromyalgia: a pilot study. Clauw DJ. PM & R: the journal of injury, function, and rehabilitation. 2010 May;2(5):414-30. Perspectives on fatigue from the study of chronic fatigue syndrome and related conditions. Hussain SA, et al. Journal of pineal research. 2011 Apr;50(3):267-71. doi: 10.1111/j.1600-079X.2010.00836.x. Adjuvant use of melatonin for treatment of fibromyalgia. Moldofsky H. CNS spectrums. 2008 Mar;13(3 Suppl 5):22-6. The significance, assessment, and management of nonrestorative sleep in fibromyalgia syndrome. Moldofsky H. Joint, bone, spine: revue du rhumatisme. 2008 Jul;75(4):397-402. The significance of the sleeping-waking brain of the understanding of widespread musculoskeletal pain and fatigue in fibromyalgia syndrome and allied syndromes.

Sleep in Fibromyalgia

Research Brief New research demonstrates that the sleep problems associated with fibromyalgia have a substantial impact on quality of life, suggesting that sleep problems may need to be more of a focus for treatment. Fibromyalgia is frequently accompanied by sleep disorders, including: •Insomnia, •Restless legs syndrome, •And obstructive sleep apnea. However, another sleep problem is suspected of being a core feature of the illness. It's called "unrefreshing sleep." In this study of nearly 2,200 people with fibromyalgia, researchers report that: •11% reported no symptoms related to sleep difficulty, •Nearly 26% reported one symptoms related to sleep difficulty, •And 63.5% reported two or more such symptoms. The more symptoms people reported, the worse they rated their health-related quality of life. The impact of sleep-related problems was significantly greater for people with fibromyalgia than for health people in the control group, suggesting "a uniqueness of the burden of sleep difficulties" for people with this condition. Researchers concluded that sleep problems should be emphasized more by doctors and patients when deciding on treatments. My Perspective I whole-heartedly believe that our sleep problems should get more attention. Some experts won't even diagnose fibromyalgia in someone who doesn't have disrupted sleep, and some researchers believe the illness may be the result of long-term sleep dysfunction. While that may not be true of every case, I think it applies to at least one subgroup. I've had sleep disorders my entire life, and I do believe they lead to poor healing, chronic pain, and, eventually, fibromyalgia. Most of us know that the better we sleep, the better we feel - and vise versa. However, the goal of treatment for most of us is alleviating pain, with little consideration for the fact that improving sleep quality may well be the best way achieve pain relief. A few years ago, I saw research calling for sleep studies as part of the fibromyalgia diagnosis and treatment process. While it's an expensive and, quite honestly, grueling process, I agree with that. (See: Getting a Sleep Study with Fibromyalgia Have you focused on getting sleep problems diagnosed and treated? What helps you sleep better?

Why pain from head to toe?

Article Samples Home > Free Articles > Article Samples > Why Head to Toe Pain From the Skin Tissue to the Brain It all signals pain! How can you hurt from heat to toe? Research shows the pain control system in the skin, spinal cord, and brain of fibromyalgia patients is overloaded, offering a reason for why you ache all over. In particular, immune cells that generally do not cause pain, contribute to the flu-like fibro symptoms that make your whole body hurt. Nerve Fibers in Skin Alterations in the way the central nervous system (brain and spinal cord) works are believed to be a major cause of your fibromyalgia pain, but researchers are finding that’s not the only source. The immune cells surrounding the nerve endings in your skin appear to be contributing to your pain as well. Seong-Ho Kim, M.D. and colleagues in South Korea took tiny biopsies of the skin tissue from a group of fibromyalgia patients and compared them to healthy controls.1 They found that most of the fibromyalgia patients, but none of the controls, showed enlarged or ballooned Schwann cells. These cells, which look like a string of sausage links, encase the nerve fibers that connect your spinal cord to peripheral tissues like your skin and muscles. These fibers relay information from your tissues to your spinal cord, and vice versa. Under normal situations, Schwann cells provide nutritional support and protection for nerves. But since they are part of your immune system, they are always surveying the nearby environment to make sure nothing happens to threaten or harm your nerves. Enlarged Schwann cells are in an activated state, usually triggered by infections and tissue injury. When activated, these cells pump out pain-causing chemicals to prompt your immune system to clean up debris and help repair damaged tissues. But in people with fibromyalgia, something unusual happens. Although the Schwann cells are enlarged, there are no obvious signs of tissue injury in fibromyalgia patients’ skin. But everything is not normal. When their skin is examined under an electron microscope, the pain-producing chemicals secreted by the immune cells are present in high concentrations.2 These chemicals, called cytokines, activate nearby nerve endings and make the skin hurt. Cytokines are also elevated in the blood and can cause flu-like achiness everywhere. Faulty Pain Filter In order for you to actually feel pain, transmissions from your skin, muscles and other tissues has to reach a level of consciousness in your brain. Otherwise, all sensations, including light touch, would hurt. That’s where your spinal cord comes in handy. The cord’s role is to filter out the less serious nerve signals traveling from your tissues to your brain and from your brain out to your tissues. In essence, your spinal cord works like a pain filter, but studies show it’s doing a poor job in fibromyalgia patients. Kim’s team suspects that fibro patients have too many signals are traveling down through the cord to the tiny nerves in the skin, causing the fibers to become overstimulated. The Schwann cells attempt to keep pace by clearing out the waste products and debris, while providing nutrients to the overworked nerve fibers. In the process, they become enlarged. How do ballooned Schwann cells impact your pain? They secrete pain-promoting cytokines that irritate nearby nerve fibers. The irritated nerve fibers in the skin then start relaying signals back to your spinal cord, saying, “Ouch … help me out!” But the cord fails to filter the signals and the brain shoots more transmissions back to the tissues. This process leaves you with painful skin, even though it looks normal. The same situation likely occurs in your muscles to make them ache. Spinal Cord Opioids When experiencing fibro pain, you would think the neurons in your spinal cord and brain would release lots of pain-killers to get your symptoms under control. Operating under this assumption, James Baraniuk, M.D., of Georgetown University, and Daniel Clauw, M.D., of the University of Michigan in Ann Arbor, measured the spinal fluid level of naturally produced opioid-like endorphins called enkephalins. They compared a fibro group to chronic low back pain patients (regional pain) and healthy pain-free controls.3 The concentration of enkephalins in the fibromyalgia group was almost fourfold greater than the controls, but pain alone was not the reason for this difference. The enkephalin levels were nowhere near as high as in the chronic back pain patients. This means a fibro patient’s spinal cord is pouring out natural pain-killers (e.g., enkephalins) in a valid attempt to contain the pain, but given its widespread nature, that’s just not enough. Opioid Receptors in Brain You may wonder if the high concentration of enkephalins in the spinal fluid (which bathes the brain) are not properly activating the pain-relieving centers in your brain. After all, given the high concentrations of spinal opioids, you should not be feeling any pain whatsoever. Clauw’s team measured the number of receptor sites in the brain that opioid-like substances target to put out the pain. He compared a group of fibromyalgia patients to a group of healthy controls using brain imaging.4 The opioid receptors in the brain were almost completely occupied in the fibromyalgia patients, particularly in the areas known to regulate pain. So the higher amount of enkephalins (opioid-like substances) in the spinal fluid appear to be properly working on the brain’s receptors to control your pain. So Why Do You Hurt? If you are producing plenty of opioid-like enkephalins and they are activating the pain-relieving receptors in your brain, why do you still hurt all over? Researchers don’t know all the details, but the foregoing findings offer some important clues. Studies show the skin is a source of continuous pain transmissions traveling to your spinal cord. The cytokines produced by enlarged Schwann cells cause local irritation, which would be expected for injuries or infections, but there is no evidence of destroyed tissue in fibro. Yet cytokines continue to be produced for unclear reasons, causing your flu-like achiness. Substantial elevations of the opioid-like enkephalins in your spinal fluid could be doing more than trying to provide analgesia. They might also be activating the immune cells in your spinal cord to produce pain-promoting cytokines, and one study indicates this is the case.5 Your body is trying to put out your pain by producing large amounts of opioid-like endorphins (e.g., enkephalins). But opioids don’t just relieve pain, they also activate immune cells to release cytokines to help heal injuries (usually a temporary process). Despite there being no tissue destruction in fibro, your immune system seems to think there is. This means your body’s attempts to ease discomfort backfires (e.g., the pain-promoting cytokines win out over the opioids), leading to more rather than less pain. Curious about other symptoms caused by pain-promoting cytokines and your treatment options? The topic was covered in the Summer 2012 issue of the Fibromyalgia Network Journal. Get more with Membership. Learn about Member benefits. 1. Kim SH, et al. Clin Rheumatol 27:407-11, 2008. 2. Salemi S, et al. J Rheumatol 30:146-50, 2003. 3. Baraniuk JN, et al. BMC Musculoskel Dis 5:48-54, 2004. 4. Harris RE, et al. J Neurosci 27:1000-6, 2007. 5. Kadetoff D, et al. J Neuroimmunol 242(1-2):33-8, 2012.

Morning Stiffness Among Common Symptoms of Fibromyalgia

Morning Stiffness Among Common Symptoms of Fibromyalgia

Morning Stiffness in Fibromyalgia

by Kristin Thorson, Editor, Fibromyalgia Network

Posted: March 27, 2012

“When clinicians are asked which symptoms are the most debilitating in patients with fibromyalgia, the most common responses include pain, fatigue, and sleep disturbances,” states lead author of a recent study by Robert Bennett, M.D., of Oregon Health and Science University in Portland.¹ He also adds patients report stiffness as an important symptom. And who wouldn’t complain about waking up each morning to a body that feels in the final stages of rigor mortis?
Indeed, 90 percent of the fibromyalgia patients in the Fibromyalgia Network’s recent survey of Fibro Over Time endorsed significant problems with morning stiffness (see our Winter 2012 Journal). But what do most doctors think of your stiffness? Bennett says they “generally regard it as a minor symptom,” or a sign of inflammation unrelated to the fibromyalgia.
When doctors think of stiffness, they conjure up rheumatoid arthritis and other inflammation-related joint diseases that make it harder for these patients to get going in the morning. Yet studies in fibromyalgia patients show stiffness is usually worse in the morning and Bennett points out, “morning stiffness has been rated as more severe in fibromyalgia than rheumatoid arthritis.” He says people with both conditions have worse stiffness than those with fibro alone. But why would fibromyalgia patients be troubled by stiffness?
As people age, they get arthritis, become less active, and expect a little morning stiffness. However, this does not explain why 25 or 45-year-old fibromyalgia patients showed signs of joint stiffness on a test involving the ankle.² A detailed report was provided in our February 2011 eNews Alert, but suffice it to say, fibro patients showed twice as much stiffness as age-matched healthy controls.
Stiffness sometimes correlates with pain, and since Cymbalta is FDA-approved to treat the pain of fibromyalgia, Bennett and colleagues thought it might relieve the symptom of stiffness. The study was supported by Eli Lilly, the maker of Cymbalta, to see if the drug could help with this symptom. Stiffness did improve, but only by a tiny amount of 10 percent. This compares closely to the 13 percent benefit found in the trials of Lyrica.
If the pain of fibro was solely related to the stiffness, the FDA-approved drugs should be able to produce significant improvement in this symptom. Yet they don’t.
Fibromyalgia is a rather “messy” multi-system condition. There is the central nervous system component involved in processing pain, an area all three FDA-approved drugs work on (Cymbalta, Lyrica and Savella). People with fibro also have trigger points or knots in their muscles, which cause serious pain and restrictive movement.³ In addition, one has to remember the circulatory system, and fibromyalgia patients have increased arterial stiffness (see the Winter 2012 Journal).⁴
Your arteries should be flexible, but studies show a reduction of the elastic-like qualities in fibro patients compared to age-matched controls. An overly active sympathetic nervous system is thought to be partly to blame.
Therapies to relax your sympathetic nerves, such as a hot shower and many other approaches, often ease morning stiffness. Even one of the three FDA-approved drugs may help, but just don’t expect too much from them.

1. Bennett R, et al. Clin Ther 34(4):824-37, 2012.
2. Dierick F, et al. Eur J Appl Physiol 111:2163-71, 2011.
3. Ge HY, et al. Arthritis Res Ther 13(2):R48, Mar 22, 2011.
4. Cho KI, et al. Clin Rheumatol 30:647-54, 2011.

Avoiding Distractions With Fibromyalgia & Chronic Fatigue Syndrome

Avoiding Distractions With Fibromyalgia & Chronic Fatigue Syndrome

By Adrienne Dellwo, About.com GuideSeptember 5, 2012

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• living with fibromyalgia
• living with chronic fatigue syndrome
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When you have cognitive dysfunction along with your fibromyalgia and chronic fatigue syndrome, distractions can be a big problem. It can be hard enough for us to follow our trains of thought, and a distraction can derail us completely.
Being distracted isn't just an annoyance and possibly embarrassing. It can also make our brain fog worse, and sometimes it can really increase our anxiety.
It's easy to spot some possible distractions - such as a TV on while you're having a conversation - but others aren't nearly as obvious.
I was recently watching a science special that tested how distracting it is to hear different types of conversations. They had people perform simple tasks in quiet, then while two people in the room were talking, and then while someone was talking on the cell phone.
It turns out that the cell phone conversation was far more distracting than the two people talking. Researchers said it was because the human brain occupies much of itself by trying to fill in the parts of the conversation we can't hear. Most of us know that it's annoying to sit and listed to one side of a conversation, and this explains why - it over-taxes our brains.
So how does this help us? I know that now I'll make an effort to leave the room if someone is talking on the phone, or ask the other person to leave the room.
Researchers also looked at how distracted people were when on a cell phone in public. To a person, they were so oblivious to their surroundings that they didn't notice a clown on a unicycle buzzing by them multiple times. They compared the level of distraction to driving drunk. It's made more more cognizant of how dangerous it is to talk while driving, especially since I know I'm easily distractable.
Other things I found to be really distracting are:

• White noise
• Repetitive background noises
• Music with lyrics
• Visual clutter

What distracts you? Have you noticed that cell phones are a big distraction, whether it's you or someone else talking? Leave your comments below!

Photo © Stockbyte/Getty Images

Where have you gone?

June 23, 2012

I did not realize how much has happened in the last month until I came to make a post. I appologize for not posting sooner...I have been dealing with my son, daughter-in-law, and grandbabies moving from Cali to N.Y...had an accident...I'm okay,and now sick with pneumonia...so this is going to be short...I haven't quit the blogging...just needing to take a break from it...I will be on as soon as I get better....
love to all
D

Akemi Collection

Found this Royal Website on Fibro and Chronic Pain...check it out!

Handling Chronic Pain

Check out this site....
here is an excerpt from it: We also provide healing support for fibromyalgia patients at the Princess in the Tower. Our aim is to keep sharing healing and chronic pain management tips, while maintaining a happier outlook. Check back often to learn about new contributions to our site. If you have any questions or comments, make sure to get in touch through the Contact Us section of the site. We're here to help, bring comfort and healing, even if it's healing of the spirit, we hope you enjoy your stay

Fibromyalgia

Fibromyalgia (pronounced fy-bro-my-AL-ja) is a common and complex chronic pain disorder that affects people physically, mentally and socially.

Fibromyalgia is characterized by chronic widespread pain, multiple tender points, abnormal pain processing, sleep disturbances, fatigue and often psychological distress. For those with severe symptoms, fibromyalgia can be extremely debilitating and interfere with basic daily activities. ...

100 gift Ideas for Mum...

100 Gift Ideas for Mum
Mothers Day is just around the corner, here are some gifts ideas for Mum for all price ranges!

• Dressing Gown and Slippers
• Good pair of Ugg Boots
• Silk or Satin Pajamas
• Book by her favorite Author
• Bunch of flowers
• Double pass to the cinema
• A Beauty voucher for a manicure, pedicure or facial
• A Hair voucher for a Cut and Colour
• Gardening Gloves and Tools
• A potted plant in a fancy pot
• A massage voucher
• Dancing Lessons
• Hot Air Balloon Experience
• A hot cooked champagne breakfast
• A good bottle of wine and a set of wine glasses
• Cookies in a Jar
• Home made shortbread
• A home cooked baked dinner – by you!
• A voucher for new underwear
• A new handbag or purse
• A platter of her favorite nibbles like sundried tomatoes, gooey cheese and biscuits
• A picture frame with your picture
• A subscription to her favorite magazine
• A bottle of scotch
• Personalised mug or calander
• Scrapbooking, painting, drawing or Twilling classes
• Pottery or ceramics classes
• A new jumper or coat
• A six pack of fancy beers from around the world
• An automatic card shuffler and a few packs of new cards
• Box of chocolates
• A wine and cheese appreciation course
• A yogurt making kit
• A cheese making kit
• A fruit basket
• Computer lessons
• A new coffee mug filled with chocolates
• A fancy teacup and teapot
• New saucepans
• Cookbooks
• New sheets for the bed
• Picnic at the park
• Gift pack of spices
• Home made chutneys and fancy butters etc
• Bowling
• Day out on a bike with the family
• A new picnic basket
• Breakfast in bed
• Foot spa
• Selection of seeds or seedlings
• New Music CD
• Bottle of wine
• Chore vouchers
• Personal training session
• Piece of fitness equipment
• Bed & Breakfast weekend
• Tickets to a show
• Drive in the country
• Lunch at the Pub
• Trip to the beach
• Trip to the zoo
• Lunch or dinner cruise
• Kayaking
• Fishing trip
• Weekend on a houseboat
• Go to a country market
• New chopping board and knife
• Knife sharpener
• Fluffy socks
• A Snuggie
• Range of a hair treatments
• New diary
• Fountain pen set and calligraphy classes
• Selection of fancy tea’s
• Cheese making course
• New make-up
• A hair straightener
• Curlers
• Eyelash extensions
• Historical Walk through a small town
• Cemetery walk or ghost tour
• Organise a Progressive Dinner with the family
• Board Game Marathon
• Watch her favorite movie without complaining (supply popcorn)
• A new Doona cover and fancy pillows
• A new pillow
• Teeth whitening kit
• Electronic kitchen scales
• Clean the house for Mum
• Painted hand prints of the kids in a frame
• A framed poem or the words ‘Mummy” written by your little ones
• An essential oil kit with oil burner
• Home made book mark
• An e-reader or Kindle
• Mobile phone cover
• Salt Dough Gifts from the Kids
• Set of earrings
• Shoe Cleaning Kit
• Car Cleaning Kit
• New Car Seat Covers

For more ideas....check out Stay at Home Mum

Read more http://www.stayathomemum.net.au/shopping/gifts/100-gift-ideas-mum/

More Mothers' Day Ideas...

check out more mother's day ideas

and check this one too....

crafts for mothers day

still looking...here is another one...

Creative Ideas!

Akemi's Heart, Mind, and Soul: Ramblings about Happiness and Gratitude...

Akemi's Heart, Mind, and Soul: Ramblings about Happiness and Gratitude...: In putting my rambling thoughts down in type, my hope is that others can learn from what I have experienced,and learned throughout my life....

Ramblings about Happiness and Gratitude...

In putting my rambling thoughts down in type, my hope is that others can learn from what I have experienced,and learned throughout my life. Tonight was especially filled with learning moments. I was watching the season finale of Oprah's LifeClass Tour. During the show which was about Gratitude, Oprah teamed up with all four teachers—Iyanla Vanzant, Tony Robbins, Bishop T.D. Jakes and Deepak Chopra. The show was on mastering the art of gratitude. I thought I was doing pretty good in this area of my life. Well, as the show continued I could feel a wetness well up in my eyes and later it went further down my cheek. I allowed myself to feel what ever came and then after the show I began what I always do...analyze it. I realized that I had forgotten to be grateful for many things. I was only focusing on those things that were right in front of my face, but what about the memories of good things, relationships, important times in my life? I have been so focused on my aches, pains and trials that I had pushed them to the deep recesses of my brain. The show brought them out and I am so grateful for that. I came to the conclusion that I have to remind myself daily that what I am going through in my life right now does not define me nor my happiness. As I was surfing the web I found a Happiness test through the OWN site. You can find it here:http://www.oprah.com/spirit/Take-the-Happiness-Test-Quiz. I took it and realized that there are areas that I need to work at to improve my score. (As a teacher, I think best in terms of scores...lol.) I then found an article by Dr. Robert Holden titled: "10 Ways to Increase Your Happiness." I found it at Oprah.com. You can bet that I am going to be working on improving my happiness and spending less time focusing on the pain from all my illnesses. I then found quotes about Gratitude and found the following two to be most striking to me.

and

In having rambled on long enough, I will close by simply saying "Thank You." Love, Darla

Sopapillas

Sopapillas Recipe

Photo by: Taste of Home Sopapillas Recipe These deep-fried breads were a hit when I made them for out daughter's birthday party. They're a fun way to round out a Mexican-theme meal.—Glenda Jarboe, Oroville, California Sopapillas Recipe Prep/Total Time: 30 min. Yield: 12 Servings Ingredients •1-3/4 cups all-purpose flour •2 teaspoons baking powder •1 teaspoon salt •2 tablespoons shortening •2/3 cup water •Oil for deep-fat frying •Honey Directions •In a small bowl, combine the dry ingredients; cut in shortening until crumbly. Gradually add water, tossing with a fork until mixture holds together. • On a lightly floured surface, knead dough for 1-2 minutes or until smooth. Cover and let stand for 5 minutes. Roll out to 1/4-in. thickness. Cut with a 2-1/2-in. star cookie cutter or into 2-1/2-in. triangles. • In an electric skillet or deep

Peach/Mango Salsa

Fresh Peach Mango Salsa Recipe

Photo by: Taste of HomeFresh Peach Mango Salsa Recipe Rate recipe This colorful, freshly-made salsa tastes wonderful on fish tacos. The garlic and veggies nicely complement the peach and mango flavors. This Recipe is Quick and Diabetic Friendly Fresh Peach Mango Salsa Recipe Prep/Total Time: 20 min. Yield: 16 Servings Ingredients •1-1/2 cups chopped fresh tomatoes •3/4 cup chopped peeled fresh peaches •1/2 cup chopped red onion •1/2 cup chopped sweet yellow pepper •1/2 cup chopped peeled mango •2 tablespoons chopped seeded jalapeno pepper •3 garlic cloves, minced •1-1/2 teaspoons lime juice •1/2 teaspoon minced fresh cilantro •Tortilla chips Directions •In a large bowl, combine the first nine ingredients. Cover and refrigerate until serving. Serve with tortilla chips. Yield: 4 cups. Editor's Note: Wear disposable gloves when cutting hot peppers; the oils can burn skin. Avoid touching your face. Nutritional Facts 1/4 cup (calculated without chips) equals 14 calories, trace fat (trace saturated fat), 0 cholesterol, 2 mg sodium, 3 g carbohydrate, 1 g fiber, trace protein. Diabetic Exchange: Free food. Originally published as Fresh Peach Mango Salsa in Taste of Home June/July 2006

Amish Breakfast Casserole

Amish Breakfast Casserole Recipe

Photo by: Taste of Home Amish Breakfast Casserole Recipe "We enjoyed a hearty breakfast bake during a visit to an Amish inn," recalls Beth Notaro of Kokomo, Indiana. "When I asked for the recipe, one of the ladies told me the ingredients right off the top of her head. I modified it to create this version my family loves. Try breakfast sausage in place of bacon." Amish Breakfast Casserole Recipe Prep: 15 min. Bake: 35 min. + standing Yield: 12 Servings Ingredients •1 pound sliced bacon, diced •1 medium sweet onion, chopped •6 eggs, lightly beaten •4 cups frozen shredded hash brown potatoes, thawed •2 cups (8 ounces) shredded cheddar cheese •1-1/2 cups (12 ounces) 4% cottage cheese •1-1/4 cups shredded Swiss cheese Directions •In a large skillet, cook bacon and onion until bacon is crisp; drain. In a large bowl, combine the remaining ingredients; stir in bacon mixture. Transfer to a greased 13-in. x 9-in. baking dish. • Bake, uncovered, at 350° for 35-40 minutes or until a knife inserted near the center comes out clean. Let stand for 10 minutes before cutting. Yield: 12 servings. Nutritional Facts 1 serving (1 piece) equals 273 calories, 18 g fat (10 g saturated fat), 153 mg cholesterol, 477 mg sodium, 8 g carbohydrate, 1 g fiber, 18 g protein. Originally published as Amish Breakfast Casserole in Quick Cooking May/June 2002, p12