<p>EK,
All of the symptoms you’ve described sound consistent with fibromyalgia. (You may recall that I was diagnosed with the condition 1 1/2 years ago.) You may need to find a new doctor who’ll take you seriously and work with you to find a treatment that works.</p>
<p>I’ll tell you a bit about my personal experience. I injured my upper back 5 1/2 years ago. That led to constant neck and upper back pain. At first I was sure that the continuing pain, particularly the neck pain, was a result of bad chiropractic treatment. I stopped seeing the chiropractor after 11 months of adjustments. My pain was tolerable without any medication. I woke up stiff and sore every morning (classic FM), but I always felt better after I started moving around. I sometimes had trouble falling asleep because I couldn’t get comfortable, but using my heating pad usually helped. I was functioning well for the 1st 3 years after my injury. I was exercising and felt well rested most of the time. I kept looking for an explanation for my continuing pain. I read about FM, but decided that couldn’t be my problem because I didn’t believe I had any tenderness at any of the 18 tender points that are the old diagnostic criteria for FM.</p>
<p>About 2 1/2 years ago, my health went on a downhill slide. I was cold most of the time and had absolutely no energy. My heartrate would slow to 45 beats per minute multiple times every day. I was convinced that I had a thyroid problem. Because of a combination of not wanting to have to pay the full cost of several trips to the doctor - I had Blue Cross/Blue Shield at the time - and feeling depressed and lethargic due to my health, it took me several months (9 to be exact) before I finally decided that I HAD to see a doctor. When I attempted to make an appointment at the beginning of February, I was told there was nothing available in Feb., nothing in March, and nothing in April. I was further told that the calendar for May was not yet available on their computer and that I would need to wait until the beginning of May to call back. I hung up the phone and cried. The clerk I talked to at the doctor’s office had no idea how desperate I had to feel to even pick up the phone and try to make an appointment. She should have been concerned when I told her that my heartrate was as slow as 44 and gotten me in immediately, but I guess it’s to much to ask that personnel in a doctor’s office have any intelligence.</p>
<p>About a month later I finally mustered the energy to do an internet search for a new doctor. I’d decided I wanted a 40ish or 50ish female physician. The first dozen or so doctors I called were either not taking new patients or did research only. I finally found a nearby doctor who fit the bill and who was accepting new patients. All was going well until the clerk asked if I had been seeing anyone else in the area. I told her that I’d been seen occasionally over the years at ** in my town. I was informed that since their office was affiliated with that practice, I had to call them to get permission to see any of the doctors in their office! I was very angry and disheartened. I hung up and decided that the fates obviously did not want me to get treated.</p>
<p>It took me another couple of weeks before I decided that I would call my old doctor’s office back and just ask to come in for a blood test instead of reciting the laundry list of symptoms I’d been experiencing. I was given an appt. in mid-April with the physicians assistant. It only took me 2 1/2 months after my initial call to get in to see someone! I told the PA about many of my symptoms, including the extremely slow heartrate. He got very excited about that and told the staff that they had to squeeze me in with one of the doctors immediately. I was put it as an emergency case 6 days later. A thyroid test was run that day.</p>
<p>The doctor, a fairly new 30ish female in the practice, was very nice. I went in with a written list of symptoms, including my basal body temps over a 2 week period, and a 3 day list of my activities when I noticed the slow heartrate. The doctor told me that my thyroid tests came back normal. She then told me that she thought I had FM. We discussed it. I’ll admit that I wasn’t entirely convinced, but I told her that I was certainly willing to try a course of Cymbalta to see if that helped. She laughed and showed me that she’d already written a prescription for that drug. I was given a Holter monitor to wear for 24 hours to monitor my heartrate.</p>
<p>Within a week, I felt my energy level improving. The Holter monitor showed that my heart was indeed slowing multiple times per day and was also sometimes racing. I got referred to a cardiologist. I’ll spare you the details. After lots of expensive tests, I was told that my heart is normal. The slow heartbeats I was feeling were premature ventricular contractions, or PVCs. Everyone has them, I was just having many more than most. I noticed that once I was put on Cymbalta and was sleeping more normally, the PVCs virtually disappeared. The cardiologist agreed that I was probably right in concluding that my PVCs were triggered by exhaustion. I eventualy learned in my research on FM, that wacky heart rhythms are common in FM patients.</p>
<p>I wish I could say that my trouble with FM ended after being given a prescription for Cymbalta. Unfortunately, I learned after finishing the free trial package of Cymbalta the doctor gave me and finishing the free one month supply I got from an online coupon that the drug was going to cost me over $100.00 oer month. At the time we were still paying college expenses for DD. I asked to be switched to another SNRI, venlafaxine, the generic for Effexor. I hoped that venlafaxine would be similar enough to Cymbalta to work for me. It was completely ineffectual for my FM related sleep disorder. Over the course of the next 3 months all of my symptoms returned. The only thing venlafaxine did for me was raise my blood pressure! Fourteen months ago I decided I just couldn’t live with the fatigue any longer. I asked to be switched to the newest FM drug, Savella. It was expensive, but less costly than Cymbalta. Savella helped somewhat, but I thought that I didn’t have as much energy as I did during the 6 weeks I was on Cymbalta. H and I decided that it was time to put me back on his health insurance plan. I switched to his plan in January. As usual for me when I’m suffering the effects of FM exhaustion, it took me several months to get up the energy to do something about going back on Cymbalta. I saw a notice in May for a FM study at the U. of Cincinnati. It was an interview and survey-type study, not a drug trial, but I got to speak with one of the country’s leading FM researchers. She convinced me that it would be good to see her associate who runs a FM clinic. I weaned myself off of Savella and asked the FM doctor to put me back on Cymbalta.</p>
<p>My dose of Cymbalta went from 30 mg per day, to 60mg, and by the end of the summer, 90 mg. I’ve tried various other drugs along with the 3 different anti-depressants I’ve taken. I’ve taken tramadol, a pain med; cyclobenzaprine, a muscle relaxer that I refer to as fat pills; and gabapentin (Neurontin), an anti-seizure med used to help with sleep issues. None of them worked well for me. I finally learned that taking extended-release acetaminophen at bedtime along with my daily Cymbalta works for me. My sleep seems to be pretty normal now. I wake with less pain and stiffness thanks to the 2 meds. The extended-release acetaminophen is great because it lasts for 8 hours. If I am feeling particularly sore or stiff at bedtime, I use my heating pad to relax. I’m starting to feel almost normal again after a very difficult 2 1/2 years.</p>
<p>Hitting upon the right treatment for FM is very much trial and error. You need a doctor who’s willing to work with you and treats you seriously. Your symptoms are not in your head! Do some research on FM and consider joining a support group. I hope that you’ll soon be feeling better.</p>