ON THE SUBJECT OF FIBROMYALGIA:
The online literature is replete with both scientific and lay articles on fibromyalgia, the cause of which has not been elucidated and treatment for which is as yet non-existent.
Perhaps my experience and an interpretation of my history may be of benefit to some sufferers: hereunder the story.
CASE HISTORY
I had the childhood good fortune to be blessed with an extraordinarily stable, supportive, appreciative family and my innate self-confidence and self-reliance, combined with very mild autism spectrum (? slight Asperger’s) attributes, made me subjectively, extremely steady, stress resistant and consciously tranquil.
However I am subject to mild future-oriented apprehension (?fear?), first noted by my mother when I was age 6 (she frequently noticed me clenching my hands during sleep).
1974: I was fit and healthy. I qualified as a Urologic surgeon in April and on the 30th of June, left for Montego Bay, Jamaica, to be the sole urologist for a population of approximately 600,000 (very high professional stress).
1976: Professionally, life was great; but living in Montego Bay was untenable due to socio-economic and political factors. I returned to Canada on 1st July.
1976: I began work as a Urologist in September. Starting a freelance practice in the inner city and competing with 25 urologists at eight teaching hospitals and two other urologists at my own facility, was extremely stressful.
1979: My legs lost hair and my kneecaps developed tendinitis.
1981: The tendinitis continued, with the beginnings of calcium deposition in the patellar tendons. I had severe constipation for the first time, with intermittent bouts of IBS. I gained weight, increasing from 145 pounds to 170 in 1990 and a maximum of 193 pounds by 2001.
1982: I started to have constant hives: complete laboratory testing was normal (HSCRP was not done). Bone growths in my Kneecaps grew larger, then my “sitbones” developed painful, very tender tendinitis. Heberden’s nodes developed in both hands.
1994: Kneecap and sitbone pain and tenderness (severe, spreading pain at the slightest touch) continued. My professional practice was good, but I had my prostate removed for cancer and couldn’t work for 3 months.
1997: Michael Harris closed my 3 hospitals: I was “fired”! I accepted a professorship at Tabuk hospital in Saudi Arabia.
1998: I developed fibromyalgia, which maximised by 2004 and then persisted.
2001: Weighing 193 pounds, I developed mild diabetes, which went away after weight loss to 176 pounds.
2006: I began taking DHEA, which helped the fibromyalgia, reduced the tendinitis pains, started to shrink the bony kneecap lumps and made the Heberden’s nodes shrink slowly.
2015: I self-diagnosed functional hypothyroidism (FH) and tried desiccated thyroid: it made the FH worse, so I stopped it (see “the thyroid, T3 and rT3 dominance”).
2016: My IBS became constant. Colonoscopies showed multiple diverticula and mild colitis.
2017: In January I began to treat my FH with T3. The fibromyalgia improved a bit, but In April I developed Polymyalgia rheumatica. (severe shoulder pain). A prescription of Prednisone “cured” the polymyalgia, but the IBS got worse and blood tests showed that “HS CRP”**** was up to 134 (normal = less than 1.0). In May a CAT scan showed an abscess of the colon. Treatment with antibiotics, until October, was unsuccessful.
2018: My sigmoid colon was removed in February and within one week, my IBS symptoms disappeared, the hives went away and the fibromyalgia pain stopped (this, after 20 years!).
2021: Since the surgery in February, 2018 I have remained well. Heberden’s nodes no longer exist. the bony Patellar tendon lumps are half their previous size. I continue taking DHEA, Progesterone, Melatonin and T3. I also take CoQ 10 (200 mg), I3C (200 mg), Mg citrate (150 mg), NAC (900 mg), MTHF (2 mg), Vit.D (5000 iu). Now, retrospective analysis has led to the conclusion that although I was not consciously aware of stress between age 20 and age 75, constant, subconsciously perceived stress (from medical school, marriage at age 23 while still a student, then internship, then managing a remote, 60 bed country hospital for a population of 4000 with no assistant and no specialists to refer to, then moving to Canada for a 5-year residency in Urology, then 2 years in Montego Bay as the only urologist for 600,000 people, then relocating to Toronto to start a solo, unsupported urology practice in the inner city core) had eventually led to functional hypothyroidism*, starting a cascade of conditions for which the eventual cure was (A) NeuroHormone support, (B) Correction of Functional Hypothyroidism and (C) surgical removal of the potentially lethal end result-of the “cascade”.
OPINION I can’t say categorically that fibromyalgia is usually due to IL-6, which the bowel makes to heal diverticulitis, but in my case, it was. The thought process is as follows:
- Stress caused Functional Hypothyroidism.
- (Functional) Hypothyroidism caused constipation and eventually, weight gain.
- Constipation caused increased pressure in the colon, producing diverticulosis.
- Diverticular inflammation caused IBS and secretion of IL-6, which caused patellar tendinitis with bone formation in the kneecap tendons and (beginning in1982) muscle aches, especially where Gluteus Maximus attaches to the “sitbones”.
- Stress from being “fired” by Michael Harris and relocating to a teaching position in Saudi Arabia in 1997 caused subconscious PTSD and worse functional hypothyroidism, which caused weight gain and borderline diabetes.
- By 1998, the diabetes facilitated inflammation of the diverticula (“diverticulitis”).
- Diverticulitis damaged the bowel lining, which increased production of IL-6 so as to heal itself.
- The increased level of IL-6 caused increased muscle inflammation, presenting as fibromyalgia.
- Prescription of DHEA in 2006 produced slight improvement of the fibromyalgia.
- Stress from “semiretirement” in 2014 increased FH, recurrence of constipation/IBS/diverticulitis.
- Massive elevation of IL-6 from one diverticulum which had become badly infected led to polymyalgia rheumatica.
- Prednisone, prescribed for polymyalgia rheumatica, restarted the diabetes.
- Diabetes caused the inflamed diverticulum to form a huge, closed abscess.
- Complete removal of the diverticulitis-laden bowel resulted in complete cure of the IBS, hives and fibromyalgia.
- NOTE: the Heberden’s nodes were incidental, caused by age-relatedDHEA hormone deficiency. They had nothing to do with IL6, Thyroid or Diabetes.
* ”Functional hypothyroidism” is a condition in which “T3”, the active thyroid hormone, stops working. It can coexist with true hypothyroidism. See the page titled “THYROID”.
** IL-6 is a “cytokine”, which promotes healing of damage to the bowel lining but produces inflammation elsewhere, particularly in muscles. Cortisone/Prednisone and other “Glucocorticoids” block it 100%, resulting in improvement of muscle pain, but failure of the bowel damage to heal. There are many other cytokines, some anti-inflammatory and some ruinously pro-inflammatory: see Wikipedia (blog follows later).
*** “Perceived stress” is stress which is subconsciously perceived by the brain, even if the individual claims to be stress-free.
“Subjective stress” is stress which is consciously noted and “felt”, and can be described, by the individual.
“Objective stress” is an evaluative term to denote stress to the individual, as observed by others.
**** HS CRP is made in the liver, in response to rising IL6.
***** ”Steroidopenia” is deficiency of the neurosteroid hormones, DHEA, Testosterone, Oestrogen and Progesterone.
REGARDING FUNCTIONAL HYPOTHYROIDISM Functional Hypothyroidism is a state in which the thyroid “#4″ hormone, T4, produced by a normally functioning thyroid gland, is converted by the body into a “twisted” form of thyroid 3 hormone called Reverse T3 (rT3), which does not work. In this situation, symptoms of thyroid 3 hormone deficiency (see list, below) develop even though routine thyroid hormone testing (TSH, T4, T3) is normal. Functional Hypothyroidism cannot be diagnosed by family MDs because they do not test for rT3 …….. OHIP won’t pay for the test either and the lab will charge you $50.00.
See “reverse T3 dominance” on the THYROID page of this website.
The effects of functional hypothyroidism are the same as those of true hypothyroidism: see “the symptoms, signs, diagnosis and treatment of hypothyroidism” on the THYROID page.
Twisted thyroid 3 is produced when the brain perceives high stress: see “the thyroid, T3 and reverse T3 dominance”.
FH is easily treated with Triiodothyronine (thyroid hormone #3, or “T3”): see “treating Functional Hypothyroidism”.
Over-treating functional hypothyroidism can produce hyperthyroidism (too much thyroid 3 hormone): this is easily diagnosed by testing 2 weeks after starting the prescription and resolves as soon as the dose of T3 is reduced:
see “treating functional hypothyroidism”.
Stress-induced functional hypothyroidism (“FH”), which may be superimposed on true hypothyroidism, is endemic in our population and is a factor in all severe illness, either as a partial cause of the illness or as a result of it.
My history is a good example – it is easily explained on the basis of stress-induced FH, which began in 1979 but was not diagnosed until 2015.
Since my bowel problem began because of functional hypothyroidism, early diagnosis of FH, with appropriate therapy, might have prevented the entire scenario.
Early (3rd or 4th decade) assessment of hormonal balance, with appropriate supplementation, might have prevented the development of FH by reducing the level of “perceived” stress**.
Routine surveillance for steroidopenia***** and functional hypothyroidism should begin as early as possible, ideally at age 15, with a view to correction of hormonal imbalances and therapy for functional hypothyroidism ASAP.
PROPOSAL FOR ASSESSMENT OF AND SUPPORT FOR FIBROMYALGIA, SPECIFICALLY
Once the fibromyalgia diagnosis has been made, or even suggested, lab, Ultrasound and CAT/MRI investigation should look for inflammations: possible causes of elevated CRP and other cytokines. The list should include a blood count with ESR, urine examination with culture for germs, kidney and liver function tests, cholesterol and HS CRP, stool tests for blood, worms and infections, vitamins B12, B6, B9 and D, hormone check (DHEA, free testosterone, oestradiol, oestrone, progesterone), thyroid (TSH, T4, T3, rT3 and thyroid antibodies) and homocysteine. Men over 40 should do a PSA test and if available, the new blood test for Alzheimer’s should be requested. Correction of problems demonstrated by this testing, plus hormonal balancing, should be instituted in addition to fibromyalgia treatments.
