Good evening.

Thank you so much for watching HealthLine on PBS Fort Wayne I'm your host Mark Evans.

>> We'll be talking about a topic that I don't believe we've ever talked about on this program.

We have it's been a long, long time and it's something that's kind of surfing surfing up, you know, up there at the level and we're hearing more about it.

So that's why we're going to do a show on this evening and it's fibromyalgia and it is quite an interesting disorder or disease and we're going to find out more about that with our doctor here and he's been with us before.

>> We talked about long covid I believe the last time you were here together and you are Addio, correct?

>> Doctor of osteopath or pathing osteopathic medicine the very, very good and it's Doctor Keenon Ali Begovic.

>> Well, Denmark oh thanks because there's a lot of tough words I want to have to talk about and say during this program I want to make he said that correctly.

>> Great to have you by the way.

I found it very interesting when I was doing some research before the show about this particular subject and a couple of light bulbs went off because I believe they might have had some relatives are and still have relatives around that might be affected by this.

>> But I want to let our viewers know that our phone numbers on the screen there it's 866- (969) 27 to zero please call it any time in the next half an hour we'll address your concerns and of course we won't be stopping down for any commercials because it is public television.

>> We always thank you for your support by the way, Doctor, let's go and talk about this fibromyalgia.

>> I did find out that that name for that and it is a disease, is that correct?

>> Correct.

I consider it a pathology.

What is pathology?

OK, it's a Latin and Greek derivatives of course as many medical firms are.

>> But at one time this was called fibro situs.

Oh good.

Fine.

That was the original term back in the 1980s, is that right?

>> But I know it did change back.

>> They were working on changing the name of it back in the mid 70s about nineteen seventy six or so and fibromyalgia and I don't know what was a reason for them changing the name probably because whenever they tried to describe a syndrome, a disease they tried to make it something people can understand.

Of course there's such and such disease which someone laid their name to claim fame to name to claim to fame with that disease process.

But other times they tried to make it as direct as possible something like when people have rib pain that can be called osteoarthritis or pain of a bone on cartilage border say just to make it a little bit more direct.

>> Well, what exactly is fibromyalgia?

>> Very difficult question.

So the better way to describe it that's why we have you here.

>> Oh, I know the the best way to describe it is from my point of view because there's nothing definitive and it's everyone still trying to think about in different ways is I considered a disease of pain processing or how your body and brain from the reception of the pain signal interpret the pain?

The way I describe it is how can you ever be sure the colors you look at are the exact colors that someone else looks at OK in that way and then you know, people talk about like pain tolerance and something like that.

Well we truly don't know how people interpret pain.

They can tell it to us but we still can't truly understand like what agree it is another good example I give to people is when it comes to heartburn everyone knows what heartburn is.

It feels like a burning sensation.

>> Right.

Except when it feels like a stabbing sensation in your stomach which some people feel like that and other people almost feel like there's something stuck in their throat and doesn't go away and it's all about just how that person's nerves interpret that signal.

So we already have different examples of how this is and fibromyalgia.

That is how I apply it the same way it's when people interpret pain a certain way it comes out different than the general population.

I see and I broke the word down.

You know, I took a Latin in high school at one time I was thinking about being a doctor but obviously that didn't work out.

>> I guess I wasn't smart enough but anyway, Latin and Greek roots fibro is talking about the fibrous tissue and then of course the Greek Miyo from muscle and then the Algier for pain.

So I see how they put those words together and made this word for this disease.

>> So how many Americans are affected by this?

Roughly two to three percent according to some statistics and then sorry two to four percent in America.

>> And then if you extrapolate to the general world anywhere between two to three percent of the total population.

>> Wow.

And on that about two to three percent of the population which is approximately four million of adults living and who does it affect most?

>> Is it women or men or women predominately?

>> We don't know the reason why and personally in my practice I've seen it affect women almost ten times more.

>> Why not the actual statistic?

Just my personal anecdote.

Yeah, I'm sure they're trying to figure that out.

Why I wonder if that is a has something to do with maybe as we talked about in the green room before the show estrogen situation because that affects other diseases as well.

>> Another thing it could be as just the social policies of certain women in society and how sometimes they have to deal with a lot more of the stressors that others may have.

You know, I'm not saying guys have it easy when they are working all day but women might have multiple things affecting them at once and that's what can potentially cause fibromyalgia well and do we know exactly what causes it?

>> No, not directly usually without going into a huge tirade from what we know about pain reception, there's a few long words I'm going to try to describe.

There's what's known knows perception which is the interpretation of standard pain like you have pain receptors all over your body when it hits it.

That's where pain comes from.

Then we have what's known as neuropathic pain that is pain that comes directly from the nerves themselves.

So think like diabetes when something breaks down the nerve conduction then we have the one that was applied specifically for fibromyalgia.

It's called no see plastic pain or pain that is moldable and that's where this theory of it is how it's interpreted or what your brain has it here.

It can be molded.

I mean they say our brain is plastic.

The more memories you have the more like connections it makes.

Pain can be applied similarly it's fascinating.

>> So in that way I treat a bunch of patients who I'll say like this with examples I give are let's say someone has untreated generalized anxiety disorder that can come out different ways and people some people can have worse heartburn from it because we have our fight or flight system and we have our rest and digest if you're constantly in fight or flight these are supposed to be imbalance but if you're constantly in one area it disrupts everything else.

People can get back pain, people can get shoulder pain, people can get heartburn, stomach issues.

All of that is because your mind is so taken away with the stress that you're dealing with that it tries to displace it and similarly like let's say you one finger and then Bashour other finger with a hammer.

>> You don't notice the finger anymore because this is taking over.

>> That's that's my theory on why the body does some of the things it does and fibromyalgia fits in that spectrum for me.

>> OK, and so we don't know exactly what causes it but are there any specific risk factors?

I mean you talked about stress .

>> What else?

So there's a lot of conditions associated with it and because we talked about this last, they have shown that certain severe viral illnesses can cause it in the same way that people one of one of the predictions by people can get something like ironbar syndrome after the flu which is the body kind of starts to attack its own nerves in the legs.

They think the same thing might happen after a severe viral infection that it can just take away something from the way your brain can process things similar to long covid.

>> OK, that's interesting that there is similarities there.

>> Can it be handed down genetically from what I always like to use two distinctions I was like say there's something that's genetic and there's something that's familial and there's a big difference between that genetic is directly in your genes and familial something a pattern that you notice in a family that is clearly related to the family itself or the situation that they're in.

But it's essentially genetically driven.

>> OK, so in the same way they can't just because they have it their children aren't going to get it but if their children in the same scenario or stay around them the same stressors are things that can cause their fibromyalgia could potentially cause it to them.

>> Wow.

OK, the more we talk about this the more interesting it becomes so very theoretical.

>> Yeah yeah yeah exactly.

So how how is it diagnosed.

>> Of course you want to talk about the symptoms first let's let's do that let's talk about the symptoms first we'll talk about diagnosis.

>> Oh I'm sorry I realize they skipped over one of your questions so boys together other associated conditions that can come with it are different psychiatric conditions so we don't say it causes them but we say their core comorbid with them.

So things like generalized anxiety, major depressive disorder, chronic fatigue syndrome and then you can go into a whole bunch of other bodily symptoms like people who have irritable bowel syndrome interstitial cystitis, which is a type of burning pain in the bladder that doesn't have anything people can find migraines.

I could list things in every part of the body that people can experience that don't always have a definitive diagnosis or way to take a biopsy to give it and it can fit along the same spectrum as fibromyalgia either predisposed one to it or the fibromyalgia can cause them to develop it as well.

>> And there are other things too.

I mean we have chronic fatigue .

>> We have chronic fatigue syndrome to be exact and then or orthostatic hypotension.

>> Correct.

So it is everyone has that is a sensation when you stand up too quickly you get dizzy.

Oh OK. And so some people are predisposed to that to a pathological degree where this is not going away within a few seconds I'm going to fall over such and such as that.

>> Well and of course the interstitial cystitis again again that is just the oversimplification is it is a burning sensation of someone's bladder but you cannot find anything distinctive or what we call organic to cause it no UTI ,no tumor in the bladder, no chronic inflammatory disease like a rheumatoid arthritis or a lupus.

There's just something about it that causes them to be uncomfortable when they urinate and in the same way that I've seen with my fibromyalgia patients, those patients tend to carry a lot of like mood disorders, stress and because of the other issues that it's causing.

>> Is that correct?

Correct.

And then specifically related to the symptoms, the original way to diagnose it was they would use a set of twenty two tender points that were across the body so they would say be like here here here different type different tenderness attachments where they'd say if you meet like six of these twenty two you have fibromyalgia you can still use that but it's a little bit outdated because now they see that a spectrum kind of can go differently for everybody.

So they say that you at least have to have some widespread muscular pain and and tender points along those muscles that can't be described by some organic cause usually some degree of either inflammation of those tendons.

>> It can affect joints but the joints specifically can't involve any inflammation or swelling.

So essentially when we rule it out to find another disorder, those are the pain.

>> That's the pain side.

Typically it involves some degree of any one of those associated conditions decreased energy and then another common one is sleep well that is a lot of the things that fibromyalgia can carry.

>> We mentioned earlier that it does affect adults that do children come down with us?

>> Yes.

Oh, because of particular stress stressors.

>> That is my prediction because I say we're all equal in the eyes of our life stressors.

>> Yeah, OK, so it does affect some children but mostly it's an adult thing and mainly women.

>> I predominantly I've seen female adults but yes it could affect anybody.

Well OK.

So I would imagine you have a field day trying to diagnose this and make sure you've got the right prognosis and so forth.

>> So it's not a straightforward process unfortunately a bunch of other things that have to go into this what other kind of testing would be involved to narrow this down?

>> The generic answer everyone tells you is a good history once you start to figure out everything happening in that person's life , you can kind of get a good idea if something is more organic or something that could be coming from their body directly or if it's more psychosomatic which is coming from the mind and being displaced on the body, other ways to test it are besides taking a good history you feel you can physically do the exam on the points that hurt and if you don't find anything different besides the tenderness that can kind of clue you in ruling out the other conditions that I just told you about is another thing you have to keep in mind because can a lot of these mimic fibromyalgia?

Look, just like it?

Oh yeah.

Patient it's actually been shown that a lot of patients with true rheumatoid arthritis fully diagnosed have inflammatory markers or seeing a rheumatologist can have fibromyalgia pain on top of their rheumatoid arthritis pain and the rheumatologist can actually delineate that and say here's the thing I can treat you and the rest of this you should see your primary care doctor for more optimized treatment.

>> I see.

I see.

Very good.

If you're just joining us, your HealthLine here at PBS Fort Wayne, we're talking about fibromyalgia and Dr. Kanon L-A Begovic is with us tonight and a very interesting topic.

Give us a call if you have any questions regarding yourself or maybe someone you love or one of your friends might need some help as well.

>> So phone numbers on your screen excuse me.

>> So how do you cure fibromyalgia in the same way with patients who have a chronic pain syndrome?

It's not really about curing.

It's about keep getting your life as optimal as possible.

So we always talk about something called the addles the activities of daily living if you are able to do your activities of daily living without too much harm or weighing down on your mind, then we consider that well controlled again big difference between curing and controlling and the fibromyalgia is not something that we found out or a true cure.

So in that way the first thing I always talk about with my patients is to have a good goal in mind.

>> So for instance if they tell me they're muscle pains always in eight out of ten I say let's shoot four or five out of ten.

OK, well yeah well shoot for something.

>> So is rather distressful for some patients to find out that you will probably have this the rest of your life but we're going to have to control incredibly initially it's always the first discussion where people really take the severity of it.

I can say consistently for the for the people that I've treated that when it does get better they realize oh there's something I could do because it's always that initial desperation of this will not get better.

This will only continue getting worse and that thought process by itself will make the symptoms worse and you have to try various things.

>> Yes.

And it's usually the first time you have some sort of breakthrough.

That's when they say now I have the enthusiasm to keep going and that by itself will help the symptoms.

Is there a chance that that aha moment won't last forever?

I mean is that something that will you can you've discovered that it helps now but is that going to possibly wear off or change down the road potentially depending on again things that happen in your life you could develop other diseases, other disorders.

The stressors can change.

You might lose someone in your family.

>> A lot of things can hit you hard like that and it can work the same way.

How bad is this pain?

I mean is this pain to the point where people I mean just break down and cry?

It's so painful.

I mean or is it just an annoying agonizing pain that just won't go away when you're describing the sense of pain I've had patients tell me that it is this constant like pressure sensation across all of their body that they don't feel like it ever goes away.

Some patients have told me that it feels like the physical representation of what like their depression feels like whereas they say they always get weighed down mentally.

Oh, and then the fibromyalgia physically keeps me locked in place and not wanting to move my joints because it hurts so some people can describe it as incredible.

Ten out of ten pain at most of the time they say it's this constant pain somewhere between like a five or seven for the patients I see personally and they say it causes me a bother and I would like to do something about it because again their activities of daily living are not good for them.

>> It is a constant pain.

You might have touched on this earlier and I apologize if I'm being repetitive but is it a constant pain or is it pain that goes away comes and goes or is a little bit both?

>> Both can be both.

It's different for everybody.

OK, so it's very individualized disease for people.

>> Well OK are we I want to get into the treatments before we get into that.

>> Are we looking at a lot of research that's been going on?

I mean are we are we trying to tackle this and trying to get to the bottom of it aggressively?

>> I don't I would not say aggressively.

They've they've tried several times in the past and I mean when someone gets worked in the past when people got worked for fibromyalgia, I mean they would do things like muscle biopsies, nerve biopsies.

They'd rule out every potential inflammatory condition and they've tried so many different ways to figure out something but it just hasn't given up given us any significant evidence in the same way that like we discussed with the long covid there's only theories and ideas and nothing concrete has happened even after God knows almost four years of concrete evidence that the country has put in to try and figure it out where we don't know the half of it yet I feel it can be deadly.

>> Is this something that can affect your physiology as far as your health long term health ?

>> I mean can it kill you?

I'm just going to be blunt about in the same way that someone who has significant major depressive disorder commits suicide.

That is what fibromyalgia could lead if it's bad enough and untreated it just continues to wear down on the patient and it may lead them to different places in life that they wouldn't want to be and that can lead to the end of their life .

>> Well, let's hopefully I mean we don't get to that bridge or anybody but let's talk about the treatments, what's involved there so it's more targeted at the symptoms and everyone can have symptoms differently.

So like I said, there's usually some amount of decreased energy sleep pain.

>> Those are the three I usually hear in patients and each of them can be targeted differently.

The one that people may hear about the most is something like a antidepressant antianxiety medication so commonly for the energy component again it's not necessarily that everyone with fibromyalgia has true generalized anxiety disorder or major depressive disorder but they have something in their life that's affecting them that can drop down that energy level they say to go ahead and try something like an MRI.

So that's like a Cymbalta and Effexor upper Stik something like that.

And I've had good success in these patients people who have true fibromyalgia now and I know it's is a physical thing.

>> Oh, we have a call coming in per excuse me.

>> I will get back to that question just a moment.

We have a call coming in.

It's by Drew and preferring to stay offline.

>> He's asking how does the diet affect fibromyalgia and are there any lifestyle changes you can recommend?

>> Good question.

That's a great question because it goes into some of the treatment recommendations I have.

There's no specific diet for fibromyalgia but there have been a few small studies that have shown like the low inflammatory diets have been beneficial for it.

So ones that reduce the amount of omega six fatty acids that you use so like switching over from vegetable oil, canola oil, fats, margarine to stuff like avocado oil, olive oil actually canola oil has the best of the regular vegetable oils but stuff like that eating healthy fish, getting in good fats that's a way to reduce inflammation and there have been some studies that suggest that can help.

That's one good one.

You can also do a vegan diet.

I mean there's now been more than enough studies to show that that can be beneficial for multiple health conditions.

I don't know about a specific one for fibromyalgia but I would believe that would be incredibly beneficial.

>> And then going back to one of the associated syndromes irritable bowel syndrome that one there is actually a diet if a lot of people don't go out they're called low fat map fad map I'm not going to embarrass myself stands for a certain type of sugar structures and my theory is that everyone has their own unique set of bacteria and their stomach that processes foods differently.

>> The gut bacteria.

Correct.

And so what a low fat diet is is it takes away the change sugars that bacteria are more predisposed to cause like bubbles like whenever someone with some of my patients with fibromyalgia talk about being bloated all the time it's uncomfortable.

So I recommend that they look into a low fat map diet.

What is a low fat diet you will have to look it up online because it gives you like 50 different food options on both the bad and good side.

But those are a couple of different ways to look at it either a low inflammatory diet vegan diet or a low fat diet.

>> OK, very good.

So nutrition can help.

You've seen potentially significantly I've had some patients that just change their diet and it's already 50 percent better.

>> Well what about obesity?

Does this have anything to do with it in the same way that patients who one of the risk factors for developing osteoarthritis is weight because it's physically bearing down in your joints more than our ancestors evolved to have the joints to be able to handle things, the weight itself could potentially make joint pain and muscle pain worse.

>> All right.

They also say that with increasing weight it increases generalized body inflammation and so that can predispose people to pain.

>> So we've talked about some of the medications.

What psychiatry psychiatry are going to a psychologist.

>> Would that be able to help you in any way if you've really got the stressor situation going on here?

>> Oh yes.

certainly because I always offer it to my patients.

Some people don't have the time for going to see like a behavioral health therapist, seeing a psychologist, seeing a psychiatrist.

But if you feel like the behavior symptoms or the energy symptoms aren't being fully optimized, it's always reasonable to send out a referral.

Similarly with the other symptoms that I did describe some of the treatments like if someone has sleep there's an atypical depression medicine you can use called amitriptyline if that one doesn't work you can always send them to a sleep specialist to be evaluated for potentially they also have concurrent sleep apnea which would be a part of their workup to see if they're not physically getting enough oxygen to their brain and that's why everything's hurting and why they're so tired all the time.

>> Well well they're tired too because they're trying to I guess overcompensate, find it and fight the pain and that will wear you out.

>> Oh yes.

And then the other one that is I apologize it wasn't amitriptyline for sleep.

>> It was actually Gabapentin or Lyrica which are nerve agents sedate people and it just kind of works the same way that we think it's a nerve problem.

The amitriptyline is good for the pain component specifically if you just have all this generalized pain it's a type of medication that can help people with chronic neck pain.

>> Chronic back pain is always something reasonable to try.

Also I noticed in reading before that if the treatments that you did not that you actually mentioned don't work rheumatology can help as well and I wonder if that could be a significant help you and you have to have a high suspicion for an inflammatory condition at that time because there are a lot of goodwill mythologist out there that can get a lot of patients that have fibromyalgia and it is not a disease that I would say it's not that it's not worth their specialty to treat but that a lot of family medicine doctors could apply the techniques we learn to treat it and a lot of the times the specialist should be working on the specialized cases that need more help.

Obviously if you think they truly have something like lupus, rheumatoid arthritis, there's a basic work up a lot of family medicine doctors can do and then if there's further concern you go get a second opinion.

I've done that for a couple of patients that I thought may have something unique like what's known as a zero negative rheumatoid arthritis which is rheumatoid without any inflammatory markers.

And I've known people several people in my medical school who've had that.

>> So that's another conflicting thing and why it makes this whole picture conflicting.

Well, and yeah, it sounds like they have a lot more research to do on this.

>> But yes, it also sounds like from what you're telling me through your experience that you kind of got a handle on it and there are various options and you can go various directions to try to figure out what is causing this correct.

>> The big thing I like to tell people is there are options OK, And that's very important.

So I guess my final question here is when do you how do I phrase it?

>> When is it time to seek help and who should you consult first?

When do you know what is your body telling you to say hey, you probably need to go see a doctor?

>> It is all based on the individual's determination for themselves.

I just patient today who I thought they they had this raging heartburn that nothing else could help out with and they've tried a couple of different medications and some are helpful and ultimately I said I think you're stressed out.

We're going to try and antianxiety medication.

>> They're like no, no, no, no.

I think I'm fine.

I think I'm fine and that's true.

People can have major depressive disorder, generalized anxiety disorder and it's well compensated which is they can deal with it.

>> They can take the symptoms, they can groundsmen it's OK. >> But if the exposure to the stress gets worse or if they lose the ability to compensate for it than that is when it becomes a problem.

>> So most of the time when I would tell someone to come get help is if you start to feel your sleep just getting worse and you just don't know why if you feel your energy levels are dropping down and you don't know why or if there is this basic pain in your body that's something like stretching tile ibuprofen the usual stuff you can do isn't working.

Those are some of the things to say maybe I should go talk to your doctor to see if it's something I need to work up.

>> Excellent advice, Doctor.

Thank you so much again for being here tonight.

Very interesting subject when we find out more about it we'll have you back gladly recap everyone.

We thank you for watching and for your phone calls and much appreciated.

And of course you can watch this episode as well as other help on episodes on YouTube until next time.

>> Good night and good