Brief Answer:
Fibromyalgia symptom complex

Detailed Answer:
Hi there.

Welcome to Healthcare Magic.

I have read your query and understood your problem.

Fibromyalgia is disorder that has many symptoms in its complex presentation.

Decreased sleep, brain fog, depression, irritable bowel syndrome, painful points in the body, fatigue etc.
Since you are aisi having hypothyroidism, this cab add to most of the above symptoms like depression bowel problems, sleep disturbances etc.

Joint disease can occur in the form of specific arthritis like Rheumatoid arthritis, Crystalline arthritis, Pseudogout etc which can cause serious manifestations of joint pain and restriction of mobility. Usually Fibromyalgia can cause ah arthritis like picture which is not truly arthritis.

In Fibromyalgia there is joint stiffness and reduced mobility with can lead to joint disease and further therapy. I would firstly examine and investigate my patient to rule out other forms of joint disease line Rheumatoid arthritis, Osteoarthritis, Osteoporosis, Gout, Pseudogout, etc. Laboratory tests like anti ccp and Rheumatoid factor can help in the diagnosis of Rheumatoid arthritis. Joint aspiration and microscopic escalation of the joint fluid can help diagnose Gout. I am not sure if these test were performed by your doctor.

ESR and CRP are usually elevated in Fibromyalgia.
Other causes of their elevation needs to be sought out by your Doctor like Rheumatoid arthritis, Crystalline arthritis. Even Anaemia can cause increased ESR, which in your case could occur due to the Hypothyroidism or due to less intake of iron rich diet.

You also seen to be suffering for Upper GI ulceration.

Kindly understand that must of these symptoms are part of the Fibromyalgia complex and also overlap with Hypothyroidism. However as I mentioned earlier, I would run a few tests to rule out other possibilities before confirming the cause as fibromyalgia.

If fibromyalgia is confirmed, I would treat my patient with antidepressant like Escitalopram 20mg daily which will help with the symptoms of depression. CBT therapy involves a discussion of the patient's problems and logical reasoning out of them to help the patient understand how to effectively tackle them and avoid worrying excessively about a problem.

Further hypothyroidism needs to be treated with Thyroid hormonal therapy after doing tests to find the levels of Thyroid hormones in your blood. I've the hormonal therapy has started, many of the symptoms will improve. Your physician will know about the dose needed in your case. T

Eat healthy and include fresh fruits and green leafy vegetables which will help with nutritional anaemia. Keep well hydrated. Drink plenty of water. Stay stress free with Yoga. Get 6 to 8 hours of sleep. Exercise with cardio exercise daily for atleast 45 minutes to an hour daily. Avoid smoking, drinking alcohol, junk food, colas.

Kindly consult with a leading Psychiatrist who will be able to offer you the above mentioned treatment for Fibromyalgia and offer your relief.

Your Gastroenteroloist will help you manage the ulceration.kindly avoid the above mentioned diet to reduce the progression of stomach ulcers.

Fibromyalgia needs the combined treatment of your Primary care provider, Rheumatologist Orthopaedic surgeon, Gastroenterologist, Psychiatrist and Counsellor Psychologist for the proper management and effective therapy.

Kindly follow up with me once you consult your Doctor about the same.


I hope I have answered your query.

Thanking you.

Regards,

Dr. Aashish Raghu

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Brief Answer:
Needs multidisciplinary management

Detailed Answer:
Hi,

Thanks for the follow up query.

Though I am not a psychiatrist, I can see that you are already on a large number of medications. I do not understand why your Doctor has prescribed antipsychotic medication for sleep. I would prefer using benzodiazepines such as clonazepam instead for sleep purpose. Please check with your doctor. In my view, antipsychotic drugs have lot of side effects.

Raised ESR and CRP are non specific indicators. It may be elevated in fibromyalgia. Hypothyroidism and anemia besides other condition may also produce raised ESR and CRP. I understand medication like Methotrexate and Plaqentil are usually given in Rheumatoid arthritis and sometimes in Gout. However it would be worth to confirm / rule out arthritic conditions through proper protocol and laboratory tests. Discuss with your rheumatologist.

Perhaps you can also discuss the need for muscle relaxants in your treatment. It helps patients with pains and aches. Further there are a subset of Patients with Fibromyalgia who respond well to steroids and hence you need to studied about this with your Rheumatologist.

I hope I have answered your question.

Thanking you.

Regards,

Dr. Aashish Raghu

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