How a “diagnosis of exclusion” can lead to better care

by Dr. Bill Rawls
Posted 11/08/16

Fibromyalgia patients know all too well the confusing and cumbersome process of diagnosis. For years, many in the traditional medical community regarded fibromyalgia as a psychosomatic condition, leaving patients with nothing but pain medication and a loss for answers.

But as conventional medicine begins to recognize fibromyalgia as a real and complicated condition, some doctors are shifting to a more comprehensive approach.

Dr. Singar Jagadeesan, a North Carolina neurologist who incorporates this type of holistic, functional approach, explains why the transition has been slow to catch on. (You can learn more about Dr. Jagadeesan in “Seeing Fibromyalgia Through New Lenses.”)

While many of Dr. Jagadeesan’s medical colleagues are interested in (and applying) complementary care to their own lives, Dr. Jagadeesan says that “traditional doctor’s offices are set up for 5- to 10-minute patient visits, with a physician seeing sometimes upwards of 30 patients per day. Fibromyalgia patients experience multiple symptoms, but when doctors only have time to discuss one or two of these things, the best they can do is prescribe medication or recommend various specialist visits.”

Five lifestyle strategies for a comprehensive path to recovery

Dr. Jagadeesan recommends these steps to help you support your body more effectively:

  1. Optimize your sleep. Dr. Jagadeesan says this is “the strategy with the most bang for your buck.” “Sleep can heal a lot of inflammation,” he explains, “so make sure you are scheduling enough hours each night (no less than 8) and working with your doctor on tactics to improve sleep.”
  2. Eliminate medications that could contribute to fibromyalgia-like symptoms. These may include statins, muscle relaxers or pain relievers, and sleep aids. “Work with your doctors to gently and gradually come off these medications,” says Dr. Jagadeesan. “While medications certainly help in the short-term, they do not treat fibromyalgia in a comprehensive way.”
  3. Change your diet to improve your digestive health. “Toxins in the diet can lead to small intestinal bacterial overgrowth, which slow down your body’s functions, weaken the immune system, and make it harder to heal,” he explains. Dr. Jagadeesan encourages his patients to go on a simple, gluten free diet with plenty of high-fiber, easily digestible foods like fruits and cooked vegetables. “Eat frequent small meals rather than a few large meals. This strategy helps with energy dips and is easier on your GI system.” He notes patients should start to notice gastrointestinal improvements in as quickly as 2 to 3 days. “In two weeks, you’ll be amazed at how much improvement you can notice.”
  4. Optimize your Vitamin D levels to increase energy and lower pain. Dr. Jagadeesan suggests getting enough sunlight, eating foods rich in Vitamin D like salmon or tuna, and taking natural supplements.
  5. Incorporate supplements like a probiotic and an anti-inflammatory with turmeric. “Keep in mind, though, that supplements work best when you make those other lifestyle changes first.”

Your doctor as a resource for important testing

While conventional medicine is typically geared toward doing a test, getting a result, and getting a diagnosis, there is no direct test for fibromyalgia. Its causes are still somewhat elusive. To combat the confusion and help patients in a comprehensive way, Dr. Jagadeesan recommends what he calls a “diagnosis of exclusion.”

“Rule out everything that you can test for,” he says. “Patients and their doctors should first make sure they don’t have any other autoimmune problems that can mimic fibromyalgia.” Dr. Jagadeesan recommends using your primary physician as a resource and focusing on doing the following:

  • Ask for a simple blood test to check your endocrine system, including adrenal and thyroid function. Conditions like hypothyroidism can slow the body’s functions, causing symptoms that mimic those of fibromyalgia.
  • Test for a Vitamin D deficiency. Low Vitamin D levels can cause nearly identical symptoms to fibromyalgia.
  • Do a basic sleep study to rule out any sleep disorders like sleep apnea or insomnia that could be the root cause of fatigue.
  • If you are taking any statins (medications like Lipitor that lower cholesterol), talk to your doctor about gently and gradually coming off of those, if possible. Statins can cause side effects like pain and inflammation that can mimic fibromyalgia, making it harder to diagnose or rule out.

Multiple lifestyle alterations and multiple medical tests: it can be a lot to tackle all whilst battling symptoms and trying to live a normal life. So how can you make your “diagnosis of exclusion” — and your continuing care — more manageable?

Dr. Jagadeesan’s final recommendations

Find a doctor who can spend at least 45 minutes to an hour with you during your first visit. “Subsequent visits can be shorter, but you need a physician who can understand the full picture and spend time working with you to create a long-term, comprehensive plan.”

Understand “there is no silver bullet for fibromyalgia,” says Dr. Jagadeesan. “Your doctor can provide information and strategies, but you need to be willing to do the work.”

Focus on 1 to 2 things to tackle at a time. “Don’t try to implement all these strategies at once. You are making big shifts and starting new habits, and that’s challenging work. For example, you can start with optimizing your sleep, then adjusting your diet, then weaning off prescription medications – work with your doctor to make it a manageable plan that doesn’t feel overwhelming.”

And the biggest piece of advice?

Have a positive outlook. “Our body instinctively wants to heal itself, you just have to give it enough nutrition and rest to do so,” says Dr. Jagadeesan. “Fibromyalgia is not as ‘incurable’ as you might hear from everybody. Once you have a diagnosis, don’t focus on the symptoms; focus on the things you can change. Monitor how you feel each hour, each day, each week, and go from there. Adjust your plan as needed. It takes time and patience, but your body will heal.”