Tag Archives: fatigue

Effective Natural Alternatives for Fibromyalgia Sufferers

From the outside, a person with fibromyalgia looks perfectly normal. But on the inside, it can feel like the pain volume dial has been cranked up to high and can’t be turned down. On top of this, the high level of fatigue can interfere with life on every single level.

“Fibromyalgia is a very interesting illness,” says Dr. Jordan Tishler, a Harvard-trained physician who focuses on holistic care. “Twenty years ago we felt that it was largely a psychological illness, partly because we couldn’t find much else wrong, and partly because it responds, at least for some, to antidepressants like SSRIs.

“We’re now coming to learn that fibromyalgia is a complex illness with multiple things going on,” he adds. “There is clearly a psychological component, but this exists on top of a vague immune condition that we’re still working to define.”

The symptoms of fibromyalgia are widespread diffuse pain; psychological symptoms such as depression and anxiety; and somatic symptoms such as fatigue, memory difficulties and poor sleep quality. Due to these wide-ranging symptoms, there are an equally wide number of medications commonly prescribed for fibromyalgia — everything from strong pain medicines and sleeping pills to antidepressants.

While medications may provide benefits, all pharmaceutical drugs come with side effects that may contribute to more negative outcomes, rather than the positive improvements you might hope for. That’s why we’re here to inform you about the possible side effects of commonly prescribed medications and to provide more information about natural treatment options that are known to be effective.

MEDICATIONS

Lyrica (pregabalin)

You may have heard of the heavily advertised fibromyalgia drug, Lyrica (pregabalin). It’s an antiepileptic, anticonvulsant medication that slows down seizure-related impulses in the brain, and also influences nervous system pain-signalling chemicals in the brain, which is why it’s commonly prescribed for fibromyalgia.

According to a recent review of studies on Lyrica, using the drug daily does reduce pain by 30 to 50%. But 70 to 90% of people also experience side effects, the most common being dizziness (38%), drowsiness (23%), weight gain (9%) and peripheral edema (8%).

Common side effects of Lyrica are:

  • dizziness
  • drowsiness
  • loss of balance or coordination
  • problems with memory or concentration
  • breast swelling
  • tremors
  • dry mouth
  • constipation

There are more serious side effects that can also occur:

  • mood or behavior changes
  • depression and anxiety
  • panic attacks
  • trouble sleeping
  • feeling impulsive
  • irritable, agitated, hostile, aggressive behavior
  • suicidal tendencies, or having thoughts about suicide or hurting yourself

If you experience any of these more serious symptoms, consult with your doctor immediately.

Antidepressants

Antidepressants such as tricyclics (amitriptyline and cyclobenzaprine), selective norepinephrine reuptake inhibitors (SNRIs) such at Cymbalta (duloxetine), Savella (milnacipran) and the SSRI Prozac (fluoxetine) are often prescribed. Though they can be effective, nearly all antidepressants are associated with side effects and can sometimes result in serious adverse events, too.

‘We’re now coming to learn that fibromyalgia is a complex illness with multiple things going on.’
— Jordan Tishler, MD

Opioids

For more severe pain, opioid receptor agonists may be prescribed, the side effects of which are sedation, dizziness, nausea, constipation (very high rate), tolerance (requiring higher doses) and psychological addiction/physical dependence on the drug. Chronic opioid use leads to changes in brain neuroplasticity, which is what causes this.

As you can see, it’s important to read up on the possible side effects because if you find your fibromyalgia symptoms are getting worse, not better, it could be the type of medication you’ve been prescribed. Don’t be afraid to ask your doctor to review your options.

Alternatively, you could try some natural treatments that have demonstrated efficacy.

NATURAL TREATMENTS

Regular Exercise

“Even though it seems counteractive due to the high levels of fatigue experienced by fibromyalgia sufferers, exercise (both aerobic and strength-based approaches) actually works to decrease symptoms and fatigue,” says Dr. Tishler. “The message here, though, is to ‘start low and go slow.’”

Eliminate Inflammatory Foods

Registered dietitian Ryan Whitcomb recommends identifying inflammatory and allergenic foods through a food sensitivity test known as an MRT (mediator release test.)

“This is my first go-to line of defense because it eliminates all the guesswork when it comes to problematic foods,” says Whitcomb. “Once these foods are identified, they are removed from the diet and we slowly add in safe, non-reactive foods.”

One such inflammatory food identified as a problem is gluten. Studies have shown that people with fibromyalgia commonly have non-celiac gluten sensitivity — not an allergy, but an intolerance to gluten. In one small study with fibromyalgia patients, 75% of them experienced a dramatic reduction in widespread pain after eliminating gluten. Some even no longer had pain at all. And in a few of the patients taking opioid medications, the drugs were discontinued, simply by following a gluten-free diet.

Address Nutrient Deficiencies

Once inflammatory foods are removed from the diet, it may be that people have nutrient deficiencies that also need to be addressed.

“Magnesium and vitamin D are common deficiencies,” says Whitcomb. “But rather than assuming that’s the patient’s issue, I run a comprehensive micronutrient panel that looks at 33 nutrients to get a broad overview of what’s really going on in their body.

“Once we know their deficiencies, we can talk about repleting through food and supplements. Food is preferable, but some nutrients, like vitamin D, need to be supplemented since there aren’t many foods that contain it.”

Examine Sleep Quality

“Poor sleep seems to be a major contributor to this illness, so good sleep habits, such as reducing stimulants like coffee, and the occasional use of prescription sleep aids are important approaches,” says Dr. Tishler.

Try Medical Cannabis Therapy

“I have many fibromyalgia patients in my practice and have found cannabis can be a very effective treatment,” says Dr. Tishler, who is also a medical marijuana specialist. “Cannabis is great for pain control and equally good for promoting sleep. In fact, it’s considerably better for sleep than any conventional medication. It’s also considerably safer for pain control than opioid options.

“And on top of this, cannabis is effective for mild depression and anxiety, both of which are associated with fibromyalgia as well. I have certainly found cannabis to be truly effective for fibromyalgia patients because it addresses the illness on so many levels,” he adds.

Putting Pressure on Breast Cancer Fatigue

Many women survive breast cancer only to find that even a year after treatment ends, exhaustion is so great that it interferes with their life. While common, is it inevitable? Must one trade life activities for life?

About 1/3 of women have fatigue, including poor sleep quality, decreased quality of life leading leading to higher rates of depression, for up to 10 years after the end of breast cancer treatment.

At MedShadow, we caution our readers to balance the benefits of medical intervention against the risks. But when one determines that medical intervention is necessary, how to deal with the aftermath? How to cope with a life changing side effect of fatigue that won’t go away? It’s a delight to report on a method of self-care that is cheap, effective and has no discernible side effects except for some bruising in a few women.

A recent study published in JAMA Oncology compared 2 types of self-administered acupressure techniques against the “usual care,” which included any of the techniques used in western medicine that the women’s doctors chose. The women in the study were all from Michigan and nearly all were White/non-Hispanic (89.6%). Virtually all the non-white participants were African-American. All the women had completed treatments for stage 0 to 3 breast cancer at least 12 months earlier and were complaining of fatigue.

A group of the women were taught a relaxing acupressure technique to help them get more restorative sleep and lowered feelings of fatigue. A second group were taught stimulating acupressure points for alertness and daytime energy levels. The third group were given the usual care from their health care team. The acupressure trainings took 15 minutes and there was a follow up to check on technique.

After 6 weeks, both acupressure groups reported significantly less fatigue as compared to the group with usual care (more than 60% in each group). Those practicing relaxing acupressure found a significant effect on both insomnia and quality of life. And both acupressure groups felt a sustained benefit for 4 weeks after the study ended. In the usual care group, around 30% reported some (but not as dramatic) improvement.

Only 5 small studies have previously studied acupressure and fatigue in cancer patients. Those studies were highly promising, showing a reduction in fatigue of approximately 45% to 70%. This study had more that 400 women in it and was clinically rigorous. In other words, it was a well-designed study. It’s conclusions were also strongly positive, so much so that I hope cancer survivors experiencing fatigue will reach out to acupressurists to learn these techniques. More studies should be done to include minorities and to explore how to implement widescale training in real-world clinical settings. But it’s a credible start and I applaud the National Institutes of Health for funding this and other complementary medical studies.

Quick Hits: Light Therapy May Ease Cancer Symptoms

MedShadow is introducing a weekly news feature called Quick Hits: brief summaries of recent news items related to our mission.

Light therapy is under investigation as a way to ease the fatigue and depression that people with cancer often suffer from. Researchers at the Icahn School of Medicine at Mount Sinai in New York City conducted a series of clinical trials examining whether regular exposure to bright white light from a light box could improve their symptoms. In the latest trial, cancer patients exposed to the bright white light saw their depression symptoms subside much more than a control group that received no light therapy. Via The Wall Street Journal. Posted April 11, 2016.

Getting a flu shot while pregnant may also protect women against the risk of stillbirth, according to a new study. The observational study, based on birth and vaccination records of more than 58,000 pregnancies in Australia during the 2012 and 2013 flu seasons, found that mothers who received the flu shot had a 51% lower risk of stillbirth than peers who were unvaccinated. Although the Centers for Disease Control and Prevention recommends the flu vaccine during pregnancies, more than 50% of expectant mothers do not get one. Via The New York Times. Posted April 7, 2016.

Pressure is building on physicians to recommend alternate therapies to treat hypothyroidism as many people do not respond well to levothyroxine, a synthetic hormone considered the standard of care. Prior studies have confirmed that anywhere between 5% and 15% of those with hypothyroidism don’t see their condition improve with levothyroxine, and the reason may result from genetic variations in individual patients. Compounding the problem is that the symptoms of hypothyroidism, including depression, fatigue and weight gain, are associated with other medical ailments and some people may be misdiagnosed. Via The Wall Street Journal. Posted April 11, 2016.

Consumers are not motivated to ask their doctors about a drug after seeing a TV ad for it, according to a new survey of 500 consumers. Conducted by Treato, a health insights firm, found that 64% of respondents said they saw more pharma advertising this year compared to last year. Last year, the figure was 51%. But although pharmaceutical companies have boosted their overall advertising spend -– the industry tied an all-time high of $5.4 billion in 2015 according to Kantar Media — they appear to be getting less bang for their buck. Only 7% of those polled in Treato’s survey said they brought up a drug with their physician after seeing a TV ad. Last year, the figure was 21%. Via Treato. Posted April 18, 2016.

The FDA is launching an advertising campaign specifically targeted to white, rural teens to warn them of the dangers of smokeless tobacco use. The program will focus on placing ads in 35 markets across the United States. The move is an expansion of the agency’s “The Real Cost” youth tobacco prevention effort, which began in 2014. Nearly 32% of white, rural males between the ages of 12 and 17 use, experiment with, or are at risk of using smokeless tobacco, and about 1,000 males under the age of 18 begin using smokeless tobacco each day. Via FDA. Posted April 19, 2016.

Pros & Cons of Taking CoQ10

By Carrie Myers
Americans spend more than $28 billion on vitamins and supplements each year and increasingly coenzyme Q10 (CoQ10) is on their shopping lists. Devotees of the supplement say it can lower blood pressure, reduce migraines, improve symptoms of Parkinson’s and depression, ward off dementia and even halt the aging process. Not surprisingly, there are naysayers who says these claims are overblown. In addition, people taking a wide range of medications — including drugs for diabetes, blood thinners and beta blockers for high blood pressure — have to be careful about using CoQ10 and some may need to avoid it altogether.

Potential Drug Interactions

The University of Maryland Medical Center (UMM) is a good resource for information regarding the effects (positive and negative) of CoQ10 on certain medications and conditions. For example, it might help reduce the toxic effects certain chemotherapy drugs — daunorubicin (Cerubidin) and doxorubicin (Adriamycin) — on the heart.

On the other hand, there is some concern that CoQ10 might lower the effectiveness of some chemotherapy drugs. “There have been no well-controlled studies proving these interactions,” says Natalia Lukina, MS, founder and CEO of Vital Formulas, LCC. “People undergoing chemotherapy should consult their physicians.”

CoQ10 might enhance the effectiveness of certain blood pressure medications by adding to their ability to lower blood pressure. While this can be a benefit, it’s important to make sure your health care provider is aware that you are taking CoQ10 so that your blood pressure can be closely monitored and your medication adjusted accordingly to avoid low blood pressure (hypotension). Symptoms of low blood pressure include dizziness and fainting. If left untreated, low blood pressure can become life-threatening.

If you’re taking a blood thinner, do not use CoQ10 without consulting your healthcare provider. “CoQ10 can reduce the efficacy of Warfarin, a blood thinner,” explains Adam Splaver, MD, a cardiologist based in Hollywood, Florida. “Therefore, it is important to always inform your physician before you begin any vitamin supplementation and monitor your blood thinner levels a little more often when initiating such therapy.”

The Cleveland Clinic also issues this advisory in its CoQ10 guidelines:

“CoQ10 may lower blood sugar levels, and it should be monitored in patients with diabetes or patients taking medications or supplements that are known to lower blood sugar.”

The well-known medical center also raises a red flag on aspirin use and CoQ10.

“Caution is advised in people who have bleeding disorders or who are taking drugs that increase risk of bleeding, such as aspirin. For example, patients on CoQ10 are usually asked to discontinue use one week prior to surgery.”

Weighing the Risks & Benefits

Deciding whether to add CoQ10 to your daily health arsenal can be tricky. “Levels of CoQ10 produced by the body decrease as we age,” Lukina says, “Therefore, in my opinion, most people over 50 would benefit from taking CoQ10. Many feel a noticeable positive effect within days.”

The Mayo Clinic, on the other hand, has a long  list of warnings and dosing suggestions depending on what ailment is being treated.

Next: How it works >>

How to Cope with Chemo Side Effects

Often used in conjunction with radiation or surgery, chemotherapy is drug therapy tailored to each individual cancer patient with the aim of preventing cancer spread, slowing cancer growth and killing cancer cells. Doctors often combine several drugs chosen from a group of more than 100 chemo drugs to customize chemo treatment, according to The American Cancer Society. Unfortunately, chemotherapy can bring a host of debilitating side effects. While there is not much you can do about some of these side effects — hair loss, for example — you can take steps to alleviate some others.

‘Chemo Brain’

Some patients, like Idelle Davidson of Los Angeles who underwent chemotherapy for breast cancer in 2006, experience chemotherapy-related cognitive impact (CRCI). “After six rounds of carboplatin and docetaxel and then one year of trastuzumab infusions every three weeks, it was like a blanket of fog had descended over my brain. I couldn’t think straight. I couldn’t remember phone numbers, people’s names or calculate the tip on a restaurant tab. I got disoriented at shopping malls and directions made no sense to me,” said Davidson, who went on to co-author the book, Your Brain After Chemo, with Dan Silverman, MD, PhD.

Who: According to the American Cancer Society, estimates are that between 16 to 50 percent of all chemotherapy patients report brain problems.

When: Onset, duration and intensity vary with the individual.

What to do: Davidson, who also writes the blog YourBrainAfterChemo.blogspot.com, recommends:

  • If you are experiencing any memory issues, ask for a referral to a neuropsychologist for an evaluation.
  • Seek out emotional support. Depression and stress also can cloud memory. Join a support group, talk with your doctor about the pros and cons of antidepressants and consider practicing meditation or yoga. A 2011 study conducted by the Program in Physical Therapy at Richard Stockton College of New Jersey found that yoga (including stretching, breathing and relaxation) may improve “chemo brain” and quality of life for chemotherapy patients.
  • Physical exercise increases cerebral blood flow and promotes the growth of brain cells. It is a natural stress reducer as well.
  • Exercise your mind. Even if it is a struggle, challenge yourself: read, do a puzzle, learn a new dance step.

Diarrhea

chemoTips2d
Chemotherapy is known to alter the lining of the gastrointestinal (GI) tract, specifically the mucosal lining. “This alteration decreases the capacity to absorb nutrients and liquids resulting in shortened transit times through the GI tract. The result is increased bowel output,” explained Monica Key, NP-C, APRN, CCRN, AOCNP, oncology nurse practitioner affiliated with Norton Cancer Institute, Louisville, KY.

Who: According to Key, diarrhea often happens with certain types of cytotoxic chemotherapy. Chemotherapy drugs such as 5-fluorouracil, irinotecan, topotecan, methotrexate, cisplatin, docetaxel oxaliplatin and cytarabine often have diarrhea as a common side effect. Oral chemotherapy tends to have a higher chance of diarrhea since it is ingested directly into the GI tract and is not bypassed as it is with intravenous chemotherapy. Capecitabine is the oral (pill) form of 5-fluorouracil that often causes diarrhea as a side effect.

When:  Can occur anytime during therapy, and can be acute or chronic.

What to do:  Key recommends:

  • Make sure you understand the medications you are given to use at home to combat/control the diarrhea. There are different kinds and each come with specific instructions.
  • Reduce fiber intake.
  • Drink a lot of fluids such as water or sugar-free, caffeine-free drinks with electrolytes.
  • Know the signs of dehydration. If you are experiencing it, call your oncologist immediately. You will most likely be given intravenous fluids.

Patients with chronic or severe diarrhea may want to ask their doctor if they need to supplement their diet with vitamins or fortified drinks to maintain good nutrition.

Fatigue

Colleen Westerman of Lansing, MI, who underwent chemo in 2010 and 2012 for ovarian cancer, felt “completely drugged” a day after each treatment, and the exhaustion would last for four to six days. “It was sometimes so bad that I just could not keep my eyes open and would often fall asleep while talking to others,” she said.

“Most chemotherapy patients experience some form of myelosuppression, a decrease in the bone marrow’s ability to produce blood,” said Dishon Kamwesa, RN, BSN, Mercy Medical Center, Canton, OH. The most common reason for exhaustion among patients is due to anemia (lowered red blood cell count) or thrombocytopenia (lowered platelet count). It means your blood isn’t carrying enough oxygen around the body.

Who: Anyone, but more often patients in treatment for leukemias with medications such as Cytarabine.

When:  You will probably feel most exhausted for a few days after treatment, and then gradually feel better. Fatigue increases with each treatment.

What to do:  Kamwesa advises:

  • See your physician if you experience overwhelming fatigue, muscle weakness, rapid heartbeat, difficulty breathing or dizziness.
  • Have your blood levels monitored often to determine treatment dosage. Your physician will advise you if you need to take therapeutic doses of iron or get a blood transfusion.
  • Eat foods high in iron: dark green, leafy vegetables; sweet potatoes; prunes and raisins; dried apricots and peaches; beans; meat and fish; enriched bread, cereal, and pasta; and seeds.
  • Make sure you get enough sleep, nap when you can, and don’t push yourself too hard. “Basically just going to sleep was the only way I could deal with it,” said Westerman.
  • A 2012 study by Osher Center for Integrative Medicine, University of California, San Francisco discovered that yogic breathing (pranayama) helps chemotherapy patients with sleep disturbances.

Next:Side effects continued >>

Articles and Research on Use of Statins

Some drugs have long-term effects that are different from the immediate side effects. For many drugs the long-term effects aren’t known.

MedShadow Foundation is concerned that patients are not always warned about the long-term effects of some drugs have. Worse, some patients aren’t aware when the long-term effects are not known.

When reviewing risks and benefits to taking a drug, please include questions about the long-term effects: How long can I (or my child) safely take this drug? Do side effects change over time? Does the efficacy of the drug change over time? Will the changes the drug makes in me today result in something else years later?

To assist you, MedShadow Foundation searched the Internet for articles that focus on the long-term effects of drugs. Below is a listing, with links, of articles we found useful and credible with a short re-cap of each. Below that is a list of organizations you might find helpful.

A New Women’s Issue: Statins, May 5, 2014

A group of cardiologists believes that far too many healthy women are taking statins, though some research indicates the drugs will do them little good and may be more likely to cause serious side effects in women.

Muscle Aches from Statins? Drug Interactions May Play a Role, Dec. 4, 2013

At the end is a list of drugs that can interfere with statins causing lower effectiveness and unexpected side effects.

Could Statins Raise Diabetes Risk? May 23, 2013 WebMD

“Focusing on almost 500,000 Ontario residents, researchers in Canada found that the overall odds of developing diabetes were low in patients prescribed statins. Still, people taking Lipitor had a 22 percent higher risk of new-onset diabetes, Crestor users had an 18 percent increased risk and people taking Zocor had a 10 percent increased risk, relative to those taking pravastatin (Pravachol), which appears to have a favorable effect on diabetes.”

Stopping a Statin May Not Be a Forever Thing, Medpagetoday.com, April 2, 2013

Those who re-try statins due to side effects often stay on them the second time.

New Statins Also Produce Fatigue: Spontaneous Reporting as a Complementary System to Increase Safety Knowledge. Jama Internal Medicine, 2013

The first page preview indicates that all statins deplete energy and increase feelings of fatigue with exertion. This is unfortunate as any treatment program for high cholesterol should include exercise. Those taking statins should be warned about this side effect.

Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women’s Health Initiative, JAMA Internal Medicine (free article) Jan 23, 2012

Statin use increases the risk of diabetes in women.

Women Taking Statins Have Fewer Heart Problems During Anthracycline Chemotherapy, Journal of the American College of Cardiology, December 2012. Reported on Breastcancer.org, January 14, 2013

A retrospective study (the info was collected before the study was designed) indicates significant benefits to taking statin during anthracycline chemo.

Use of Statins and Risk of Glioma: a Nationwide Case-Control Study in Denmark, British Journal of Cancer, January, 15, 2013

Here’s one for a long-term benefit: A case-control (observational, not random control trial) study of Danes showed that the risk of glioma was lower among long-term statin users as compared to non-users. Long-term user was defined in this study as 5+ years. The clearest correlation was for men aged 60+. Women under 60 years was lower, but not for women 60+.

(Wikipedia: a glioma is a type of tumor that starts in the brain or spine. It is called a glioma because it arises from glial cells. The most common site of gliomas is the brain. Gliomas make up ~30% of all brain and central nervous system tumors and 80% of all malignant brain tumors.)

The study was supported by the Danish Cancer Society and University of Southern Denmark. The authors were independent from the funding sources.

Statins Use Linked to Reduction In Cancer Mortality, Forbes, November 7, 2012

An unexpected positive side effect of long-term statin use: lowers cancer mortality. According to the article, “Researchers in Denmark utilized health data from the entire population of the country and analyzed the information from nearly 300,000 patients who were diagnosed with cancer between 1995 and 2007. The authors note that the relationship is biologically plausible, since cholesterol synthesis is required for cell proliferation and other critical cellular functions.”

FDA: Limit Use of 80mg of Simvastatin, FDA, US Food and Drug Administration, June 8, 2011

80mg is the highest dose of simvastatin that has been approved. The FDA is now recommending that patients not use more than 40 mg of simvastatin. If 40mg of simvastatin aren’t meeting the LDL cholesterol goals, the FDA recommends choosing a different statin.

The higher dose of simvastatin increases the risk of myopathy, an injury to muscles causing pain, tenderness or weakness. An exception is noted for those who have been taking 80mg for 12 months or longer without adverse effects. In that case patients can continue.

2.1 million people (U.S.) were prescribed 80mg of simvastain in 2010. The statin is sold under the brand name Zocor (single ingredient) and Vytorin and Simcor (combination with other drugs).

 Suzanne B. Robotti