Show notes
Hi. This is Dr. Ziegenbein, your favorite Rheumatologist, and fibromyalgia expert.
Fibromyalgia has a capacity to rule, and even ruin your life. I am here to show you how to stand up to it, how to be your fibromyalgia boss. Once and for all.
Welcome to episode # 11 Of the Winning at Fibromyalgia podcast!
I hope you LOVE my new intro and music as much as I do. I picked the music myself and then had someone with real mixing skillz attach it to my recording and then attach it to this episode.
Today I am going to talk to you about why It is important to see a rheumatologist to establish a diagnosis of fibromyalgia. I know I talked about it already in one of the earlier episodes. I feel strongly that it bears repeating because it comes up again and again. And I promise I am not just saying that to put a plug in for myself. I am talking about it because I find it crucial on the journey to finding answers and reliefs for all of you my lovely women with fibromyalgia pain.
So here are the reasons:
As rheumatologists, we are uniquely qualified to evaluate people with pain.
One of the important things a rheumatologist does is that we determine whether you have an inflammatory or non-inflammatory problem. Examples of an inflammatory problem are rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis. Examples of a non-inflammatory problem are fibromyalgia or osteoarthritis.
We are trained to ask questions that lead to uncover the source of your pain and we are trained to examine your joints and other parts of the body to look for inflammation.
So how do we do that? First, we LISTEN to you, your symptoms. We ask you specific questions, we look for specific things. We then examine you, the patient, and again we look for specific things. Generally, combination of exam and history is enough to determine which one of the two groups of problems the person has. Sometimes we do order specific labs and Xrays. This is either to confirm our suspicion of a diagnosis or rule out other things.
We give you the diagnosis. Sometimes things are not black or white, sometimes it takes a little longer to figure things out and sometimes a person has BOTH inflammatory and non-inflammatory problem. Which brings me to the next point.
We stay with you until we sort things out.
I remember once seeing a middle aged woman, her symptoms sounded very much like fibromyalgia and there was nothing inflammatory on exam. This was earlier in my career so it was possible I did not ask ALL the right questions. I sent her for labs and her sedimentation rate and CRP, which are the inflammatory markers were sky high! She did not have fibromyalgia, she had an inflammatory condition referred to as spondylarthropathy! We had to do a few more imaging studies to confirm the diagnosis but we did it. I put her on appropriate treatment and she got better!
I was very grateful that I was thorough and helped identify the problem. And that is what you get with a rheumatologist! We are smart, we are thorough, and we don’t let go until we are reasonably certain that we know what is going on.
Diagnosis of fibromyalgia is usually one of exclusion, meaning we can suspect it when we talk to you, but we rule out all other things we can think of, before we give you the dg.
Sometimes it takes extra time, sometimes it takes extra imaging studies like Xrays or even MRis but we are there with you until the diagnosis is made. Then you can have confidence that what you have is truly fibromyalgia.
With that confidence, you can move on forward with your plan to become the boss of fibromyalgia
There is one more point I need to mention:
We stay with you when things are gray/when the dg is not clear.
I want to be very honest here. Sometimes the diagnosis is really hard to make. Fibromyalgia can look very similar to two conditions in rheumatology – both psoriatic arthritis and spondylarthropathy can look similar if they are mild or have only subtle findings. It is a topic we even discuss in our facebook group for Women rheumatologists. AND, I have an article on my desk published in the journal of Rheumatology 4 years ago that is called: “The problem in differentiation between psoriatic-related polyenthesitis and fibromyalgia”! Enthesitis means inflammation of the tendon insertion to the bone. NORMALLY you can tell on exam that something is inflamed. But not always! The gray zones in Rheumatolgy are real! Sometimes it is simply too hard to make a 100 percent diagnosis. And we are honest about it and we tell you. And we tell you it might be ok to try something, a medication, to see whether it helps. If you have symptoms of fibromyalgia, and potentially another diagnosis, it is ok to work on BOTH SEPARATELY. So here is where the rheumatologists play a role – again. You work with your rheumatologist on the diagnosis that can be psa or SpA and you work with your rheumatologist OR ME on the fibromyalgia part that does NOT include any meds. That is still a win win situation to me.
Ok, That is all for today I Hope I made a case seeing a rheumatologist at some point in your journey.
If you like this episode, please share with someone who can benefit from it too.
For questions or comments, you can find me on facebook under “martina lenartova” or on my website www.martinaziegenbeinmdcoaching.com.
And lastly, As always, I appreciate a lovely 5 star review or feedback from you :-)