Posted by TENA/DIAMOND on 9/25/2009, 11:02 pm, in reply to "Fatigue plus Pain � Fibromyalgia�s Double Whammy and What to Do About It"
TREATING FATIGUE #2
There are many strategies for treating fatigue. Fatigue will probably never be
completely eliminated, but many things can be done to control its consequences
and minimize its impact on everyday life.
Your doctor may first want to investigate for underlying diseases such as
hypothyroidism, sleep disorders, anemia, and connective tissue disease – which
involve different treatment approaches. If there are no significant underlying
diseases present, the fatigue may be attributed to the fibromyalgia syndrome (or
chronic fatigue syndrome).
Some specific labs that I frequently order in fibromyalgia patients with
significant fatigue include:
• Complete blood count (to evaluate for anemia or blood disorders)
• Sedimentation rate (to evaluate for any underlying inflammation)
• T4, TSH levels (to evaluate for any thyroid abnormalities)
• Insulin-like growth factor 1 level (to measure for growth hormone
deficiencies)
• Magnesium RBC (to measure for any intracellular magnesium deficiency).
If labs are in the normal range but low/normal, I may interpret these to be
“abnormal” for an individual patient. That is, the patient’s level is
still too low for what the patient needs, even though the level may be within
the normal range.
What steps can be taken to minimize the potential debilitating effects of
fatigue?
Below is a list of strategies that I have found helpful.
1. Develop Good Sleep Habits
Quality sleep is necessary for the body to manufacture energy. Develop a good
sleep routine. (Reviewed in Chapter 22 of Fibromyalgia: Up Close & Personal.)
2. Avoid Long Daytime Naps
Although fatigue may be compelling at times, it is best to try to avoid taking
naps since this alters the body’s sleep rhythm. Naps are often non-refreshing
and time-consuming. Upon awakening, many people feel even less energetic and
have more difficulty getting going again. They may even have a period of
increased confusion and mental fogginess.
In some people, however, a strategic nap (less than one hour) accomplishes its
goal by refreshing and restoring the individual for more successful completion
of the remainder of the day. As long as the primary nighttime sleep is not
disturbed any more than usual, these naps are not to be discouraged.
However, it is my experience (and sleep studies show) that most people who try
to overcome fatigue with a nap actually do not accomplish the refreshing and
restoring mood that they are seeking, and the evening sleep pattern is
disrupted.
3. Proper Nutrition
A higher protein/lower carbohydrate diet has helped many people improve their
energy. Diets too rich in fat can put the body into a lazy mode, but if you
reduce your fats at the expense of getting too little protein, you may have more
fatigue, so find your balance. (For details, see “Why weight gain is a problem
with fibro, and what to do about it.”)
4. Natural Supplements - and Prescription Medications
The dozens of natural supplements advertised to increase energy are successful
for some people. However, many energy products contain the stimulants caffeine
or ephedrine, which can long-term adverse effects on the body and can be
dangerous if taken together. Before trying any natural energy product, I
recommend first consulting with your doctor.
• I recommend a Magnesium and Malic Acid combination, and Colostrum as the top
two supplements to try to improve energy levels. Magnesium and Malic Acid
combinations work by increasing energy formed in the muscle. Colostrum promotes
improved metabolism and energy by increasing growth hormone levels.
• If the B-12 level is low/normal, I may recommend vitamin B-12, in either
lozenge, sublingual (under the tongue) or injection form. B-12 pills may not
absorb well from the stomach, whereas the other forms of B-12 are absorbed
differently (lozenges and sublingual forms are absorbed into the blood from the
capillaries in the mouth and underneath the tongue, and injection B-12 is
absorbed into the bloodstream from the muscle).
• If the thyroid is low or low/normal, I may prescribe Armour Thyroid in the
morning. Co-enzymeQ10 (CoQ10) is another supplement that can help increase
ATP/energy levels in the muscles.
• Prescribed medicines that increase serotonin levels can help improve energy
as well. These include the selective-serotonin reuptake inhibitors (SSRI’s)
such as Prozac, Zoloft, Paxil, Celexa, Lexapro and Effexor.
• Welbutrin is a different type of antidepressant that is reported to increase
the norepinephrine level instead of the serotonin level. Norepinephrine is
important in improving our focusing, concentration and energy levels.
• 5-HTP is a natural nutritional building block for serotonin which can help
improve sleep and mood and decrease pain, all of which can help fatigue. St.
John’s Wort and SAM-e are other natural herbal antidepressants that can help
increase serotonin levels. If underlying depression is a problem, your physician
may opt to prescribe an antidepressant medication because improving the
depression will usually improve the fatigue as well.
• Certain prescription medicines known as central nervous system stimulants
can be prescribed by your doctor in cases of extreme fatigue causing
debilitating functional problems. These medicines are similar to the ones used
for children with attention deficit disorders. They include Ritalin, Cylert and
Provigil.
6. Plan Scheduled Activities, Especially in the Evening
The late afternoon and early evening are often the most difficult times for
persons with fatigue. After supper can be an especially difficult time,
especially if the person sits down to relax or lies down to read the paper.
‘Crashing’ and inability to do any useful activity for the rest of the
evening may occur.
My advice is to routinely plan some activity, especially for after supper, that
includes running errands, getting outside, visiting people, or just staying up
on your feet. You will be surprised to learn how frequently a second wind will
come. Many people have a natural rhythm that causes low energy in the late
afternoon and early evening, but then the mood and energy level swings back up
again.
If you are a night owl, you tend to feel better and more energetic around 9 PM
and may have a few good hours where you feel alert and can accomplish a lot.
Recognize your own biorhythm and take advantage of it to:
• Plan your best work around your high points
• And try to stimulate yourself through the low points by involving yourself
in an activity.
7. Divide Your Task into Smaller Projects Instead of One Big One
Do a little at a time and do more at your best time. For example, yard work can
be divided into specific chores for different nights of the week. You may mow
the front lawn one night, the back another, and trim on a third night, instead
of doing all three in one day. If we are moving and decide to do our own
packing, it is much easier to pack a box per day for the six weeks prior to the
actual moving date, than to try to do all the packing in one or two days prior
to the move. This type of self-discipline is also needed when vacationing and
decorating for the holidays. (Actually, self discipline could help a lot of
things!)
8. Perform Regular Exercise and Relaxation
Exercise increases endurance, cardiovascular conditioning, and a sense of well
being. In fact, regular exercise is the best way to improve the ATP/energy
manufacturing within our muscles. Relaxation decreases stress and reduces pain.
A 30-minute brisk walk after supper provides exercise and mental relaxation and
counteracts the low biorhythm point at the same time.
One does not have to sit perfectly still to physically and mentally relax; in
fact, this often increases fatigue and the tendency to sleep. Remember to relax,
not nap.
9. Make a Daily Schedule and Check Off Things as You Accomplish Them
Allow plenty of time to complete the task. By keeping a structured list, you
have a better chance of motivating yourself to reach daily goals.
10. Delegate Chores to Others
One of the best energy-saving techniques known is to have someone else use his
or her energy to do your task! While delegating responsibilities is difficult
for many people, there are others who will gladly perform certain chores for
you. It is best to be as independent as possible, but it is better to allow
someone else to helpl if it means you will have energy for a longer portion of
your day.
TENA/DIAMOND
People come into your life for a reason, a season or a lifetime.
� A ROSE FROM MOM AND I !!
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