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    Includes Expert Content
    Dr. P (And Others)---Advice, Please?
    angelswife posted:
    Hi Dr P,
    I am recovering from a Tri-Malleolar ankle fracture---I also broke both bones in my lower leg and dislocated my heel. I have been in a cast since mid-April, and have only begun walking a bit this last week or so. There is nerve damage but I don't know how bad yet. The initial signs show it's substantial, though.

    My question: I know overdoing it can cause a Fibro flare. My biggest worry is that after 12-plus weeks of low activity, my body will see ANY increase in activity as overdoing it. Can that happen? What can I do to minimize this risk? I will (hopefully) be starting PT within the next month, and I've already been warned it will be intensive. Thanks for your input! (And thank you to anyone else who can help.)
    xperky responded:
    Hi angelswife!

    Hopefully you will have a knowledgable PT person. In fact, can you set things up to be with a therapist who is familiar with how FM can change the pace of PT? That would be ideal.

    I look forward to hearing how it goes for you. I'm so happy you are walking some now!
    With Compassion,
    booch007 responded:

    My heart aches for your situation, you have ben such a trooper through the heat and making the best of it....

    I think this is such a great question for Dr P, it is equivelent to a newly diagnosed starting out and how far do you go. The problem you have is the therapist will ask for more. They really "go for it"

    Since Dr P is a physiatrist and PT follows the direction of the same, maybe GOOD guidance will follow from Dr P. "what to say to the PT".

    Another thought was that your doctor can do the same. Tone him down a bit if he is too aggressive for you. Their license if I remember right is "IN CONJUNCTION to a physician who tells them the work needed. We'll all pray you get a knowledgable one and one that understands the FM process.

    Good luck...........(((hugs))) Nancy B
    DakotaWilsonFM responded:
    I had some physical therapy after being hospitalized last year... the 2 therapists that worked with me both knew about FM and knew when I was hitting my limit... I hope you get so lucky... They had me work at my own pace... and I only hurt myself and went into a flare when I fell down during the night... no one was there helping and I was pretty weak yet... I just took a tumble coming back from the bathroom... by morning I was flaring... but they just slowed down a little and life went on...

    I hope you get the help you deserve and need... and they are kind to you... Just work steady and hold your head up with pride with every step you take... You have come a long way already... and have a long path ahead... Don't fear anything... Just face it with the strength your God provides you with and believe in yourself as He and I believe in you...

    Hugs... Kisses... Bless you... Love... Jan/Dakota
    Mark Pellegrino, MD responded:
    Dear Angelswife,

    So sorry you've had those leg injuries that put you at a low activity level. Hopefully your bones have healed. Any nerve damage needs to be evaluated. Your doctor may want to do nerve testing (called electrodiagnostic teating) to evaluate any nerve damage, and to determine if any damage is repairing itself.

    Any nerve damage and associated weakness, numbess, or pain has to be factored into your PT program when planning your treatment goals.

    You're right about overdoing it as a risk for fibro-flare, but don't assume you will automatically flare-up when you begin your PT program. Another risk for flares is "underdoing it" which you experienced when you had to lower your activity level after your fractures. Fibro doesn't like any change from what it's used to activity-wise, whether it's too much activity or too little activity, compared to the usual baseline. And with any change it doesn't like, it talks to us...painfully.

    It sounds like you made it through the "underactivity" phase without a flare-up, so if that's the case so far, good job!

    I believe the best way to reduce the flare-up risk when you begin to intrduce more activity into your fibro world is to progress your overall activity gradually with frequent rest /recovery periods.

    Your PT prescription will already have this strategy built into it, even though it may not be specifically addressing your fibro. You will probably begin therapy gradually, 2-3 times a week, so you have rest days in between therapy. Your emphasis will be gradually regaining strength, stamina and ambulation abilities. Hopefully as you continue with your leg PT program, your fibro will be cooperative and "goes along" with the progress you will make.

    It would be great if your physical therapist was knowledgable in fibro. Usually the PT script has to be written for only one problem at a time, in your case, for your leg injuries. But if your fibro should flare-up in areas other than your legs, then perhaps your PT would be able to incorporate some measures to address the fibro flare. There are restricitions based on treatment times, insurance coverage, number of areas/diagnoses treated that may limit what you can actually have done for a fibro flare while treating for your leg conditions.

    But if you and your therapist are aware of all this, then I think your proactive strategy will enable you to quickly notice any percolating flare-up and take measures to comfort the affected fibro areas and hopefully prevent a full blown flare-up. Be thinking about modalities (such as heat, ice, electric stim, water), massage/soft tissue work, meds, stretches and anything that works for you.

    Good luck with your reactivation project! Work with your doctors and therapists. I'm confident you will do great.

    Dr. P
    mypityparty replied to Mark Pellegrino, MD's response:
    Hi Dr. P, I have been taking Lyrica and cymbalta since Jan. Had some pain relief but still having REALLY bad times. My Rhum. just put me on a topical pain reliever. IT makes me sooo sleepy. it is supposed to be the latest thing in great pain relief. What is your view pointe on it? I have just made an appt. with a pain spec. with my primary care docs approval. my rhum. factor is 1600. but after months of blood work they decided I did not have rhumetoid arthritis? I am happy about that but like some I feel like I am dying and wonder... am I : (
    Where do I go from here?
    Mark Pellegrino, MD replied to mypityparty's response:
    Hi mypityparty,

    Sorry you are feeling so bad. Keep working with your doctors. Good luck with your visit with the pain specialist. The pain specialist would be an ideal person to discuss where you go from here.

    I prescribe topical pain relievers often. Some patients do very well with this treatment and others didn't notice any benefit. I'm not sure what type of medicine you tried but make sure your doctor knows of any side effects you had.

    Hopefully you will have other treatments available to you soon and they will help you!

    Dr. P
    Wesco replied to Mark Pellegrino, MD's response:
    Hi Dr. Pellegrino. Do you prescribe Norco to your patients with chronic pain?
    dollbug replied to Wesco's response:
    Hello Wesco and welcome....MiMi in NC...Dr. P has not been around now in 7 months or so. I am assuming that WebMD had some cutbacks....but we really do not know since no one officially bothered to inform us of what was taking place. We just know that we have not seen or heard from him in a very long while.

    I wanted to reply so that you would not expect to see an answer from him. I would encourage you though to click on his *discussions* above in the right hand corner where his picture is located....there are 674 discusssions that he posted while he was with us. He provided us with some great he also faces the wrath of the dragon each and every day. He has also written some very good books as well.

    We do have a good FM support group here. So I hope you will continue to post and please check out the info under *tips* and *resources* as well. I am sure that you will soon find something that will help you cope does takes a trial and error process...which does take time and effort on your part.

    Have you gotten your Vitamin D level checked? IF not...then perhaps you can speak to your doctor about doing this...which is really very important to a lot of people these days...low Vitamin D can cause some people to have additional pain and it can also affect other illnesses as well. I hope you will do your own research about Vitamin D on the will find some interesting information concerning what medical researchers have found out about it. The best thing is that this is really a very cheap fix...if you have low Vitamin D, which is common for a lot of people, not just those of us who have the wrath of the dragon, aka FM.

    I hope if there are others here who have tried Norco...that they will chime in and share what kind of experience they have had with it. I tried different medicines in the beginning but was unable to find anything which really helped me enough without causing other side effects...I am now one of the FMers here who has learned how to *control my FM pain by taking vitamins and supplements and doing other things as well*.

    You should know that since we are all different what helps one person may or may not help have to decide yourself.

    Take care and good luck.


    My personal exchanges are Vitamin D and Pain and Wrath of the Dragon....if you care to visit..
    An_251809 replied to Mark Pellegrino, MD's response:
    Hello Dr. Pellegrino, Short version of my Fibro. I know the exact date it began, 2 1/2 years ago, when I was exposed to a chemical at work. PTSD also from incident. Workers comp claim denied because OWCP 2nd opinion physician says no one knows what causes Fibro, therefore chemical didn't do it nor did PTSD. I am about to appeal but don't know how to prove that the chemical incident (still an ongoing criminal investigation) or the trauma of being targeted by an employee and the fight to get upper management to shut down facility and protect my employees and myself, or both?..triggered the Fibro. Any suggestions? Thank you,

    Smiling Still because God gave me my smile and no one can take it from me.
    dollbug replied to An_251809's response:
    Hello....I guess you did not read any of the other posts the post right above your post...(my post) I explained that Dr. P has not been here for several months now.....(around 9 or so now).

    So sorry that you are dealing with so much. I am also sorry that your workers comp claim was denied as well. Do you have long term disability? You are probably correct that I think we all know that *something triggered the FM....and it probably did have something to do with what you have been exposed to or gone through. I had carpal tunnel and the company I worked for approved my right hand and then denied the left hand. I appealed the decision and actually took it to 2 other appeals...I do not think anyone really cares about what happens to people...since it does not affect them. This is really very sad. I do hope that things work out for you.

    I do hope that you will check out the info here under *tips* and *resources* I am sure you will find some good *tools and tips* that perhaps you have not thought of. This is a good group of FMers here and I am sure that others can and will provide you with whatever questions you might have.

    Take care and good luck.


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