What Is Fibromyalgia? How a Rheumatologist Can Help

Do you experience widespread musculoskeletal pain? Do you often experience extreme fatigue, problems sleeping, cognitive disturbances, or mood disorders?

If you answered “Yes” to these questions, you might have fibromyalgia.

Fibromyalgia is a common cause of widespread musculoskeletal pain, affecting connective tissues, including muscles, ligaments, and tendons. People with fibromyalgia often experience chronic and persistent pain that is usually described as a deep muscular ache with associated soreness, stiffness, burning, and throbbing sensations. The pain may be confined to specific areas, often the neck and shoulders, early in the course of the disease. Multiple muscle groups may eventually become involved as the disease progresses, leading to many painful areas caused by slight pressures called “tender points.” There are no specific laboratory tests or imaging studies used to diagnosis fibromyalgia, so doctors will generally make this diagnosis based upon a thorough medical history, a complete physical exam, and blood tests, which are generally used to exclude other conditions with similar symptoms.

Do I Have Fibromyalgia?

The cause of fibromyalgia is unknown, though it is thought to be caused by a combination of genetic, environmental, and emotional factors. It is estimated that approximately 2-4 percent of the general population has fibromyalgia, and the chance of developing this disease is increased eightfold in family members of a person with fibromyalgia compared to the general population. Similar genetic factors are noted in people with a history of irritable bowel syndrome, depression, and migraines.

Fibromyalgia is the most common cause of generalized, musculoskeletal pain in women between the ages of 20 and 55 years and is six times more prevalent in women. It is characterized by multiple symptoms, including:

  • Widespread musculoskeletal pain with extensive tenderness to touch and pressure affecting muscles, joints, ligaments and even the skin
  • Severe fatigue
  • Trouble sleeping or waking up with diffuse body stiffness and feeling unrefreshed
  • Poor memory, migraines/headaches, or poor attention
  • Pelvic pain
  • Overactive bladder
  • Temporomandibular disorder

Fortunately, while there is no known cure for fibromyalgia, there are multiple modalities that can be used in a stepwise approach to reduce the most prevalent symptoms. A combination of effective treatments consisting of both pharmacologic and non-pharmacologic therapies, including physical therapy, can help patients feel better and improve overall health. Our Nashville rheumatologists can help diagnose patients suffering from fibromyalgia.

How can a Rheumatologist help?

Rheumatologists are physicians specializing in musculoskeletal and immune diseases such as osteoarthritis, gout, rheumatoid arthritis, chronic back pain, tendonitis, and lupus. While everyone experiences occasional muscle and joint pains, long term muscle and joint pain that does not improve with rest may need further evaluation.

Because fibromyalgia is complex in nature and difficult to diagnose, a rheumatologist will perform a complete medical history and a full physical exam. A physical exam can help reveal signs of inflammation throughout the body’s joints and musculoskeletal system.

Treatment and management for fibromyalgia

The best overall treatment for fibromyalgia is a multidisciplinary, individualized approach directed at reducing the major symptoms of the disorder, including chronic widespread pain, fatigue, insomnia, and cognitive dysfunction. No single treatment modality works for all symptoms, so each treatment plan is individualized for each patient, consisting of both medication management and multiple self-care physical therapy measures.

  • Medications might include Duloxetine (Cymbalta), Milnacipran (Savella), or Pregabalin (Lyrica). Over-the-counter painkillers such as Tylenol or ibuprofen can help provide some comfort from the pain. However, narcotics and opioids are not advised, as patients can develop long-term dependence on the drugs and generally do not achieve the desired pain relief.
  • Physical therapy exercises and other nonpharmacologic interventions can form the general backbone of a pain reduction strategy. Strengthening exercises have been shown to help improve the overall musculoskeletal system while improving patient’s quality of life. Swimming and water-based exercises have been found to be particularly helpful because of minimal surface impact compared to land-based exercise.

Self-care has been found to be the most important aspect in keeping fibromyalgia controlled and consists of several main points:

-Regular exercise is important for reconditioning and improving your functional capacity, even though it might initially cause increases in general muscle pain. As your body strengthens and your exercise routine improves, positive results will quickly follow. Consulting a physical therapist can help expedite this process.

-Stress has been proven to be one of the leading causes of fibromyalgia and needs to be reduced as much as possible. In order to reduce stress, following stress management techniques such as meditation and deep breathing exercises are recommended. Even visiting a psychotherapist can provide added benefits.

-Sufficient sleep and rest is essential in keeping fibromyalgia from worsening. It is imperative to follow a well-planned sleep schedule consisting of appropriate sleep hygiene techniques and habits. Common sleep disorders such as obstructive sleep apnea and restless leg syndrome may also require intervention.

-Consuming healthy foods regularly can help with symptoms. A varied diet high in vegetables and low in saturated fats can help you feel better and prevent worsening exacerbations of fibromyalgia. Caffeine, as well as salt and sugar, should be consumed in moderation.

Our Nashville Rheumatologists

At St. Thomas Medical Group, our rheumatologists treat patients in Nashville, Gallatin, Brentwood, and the surrounding areas. Dr. Poonam Somai has been practicing at Saint Thomas Medical Group since 2009 and specializes in ultrasound guided injections of the joint, tendon, and bursa. Dr. Leslie Cuevas moved to Nashville in 2002 and has a special interest in treating patients with fibromyalgia.

Preparing for Your Appointment

Fibromyalgia can be difficult to diagnose. Your physician will want to rule out other causes such as arthritis and similar conditions, which is why an appointment with a rheumatologist may be advised. Prior to your appointment, keep a detailed list of your symptoms. Be descriptive about past medical problems as well as medical problems of parents or siblings. Please bring all medications and dietary supplements to your appointment.

It can also be helpful to keep a written list of questions you want to ask your doctor.

With the correct medical help and guidance, patients can lead much happier and healthier lives. St. Thomas Medical Group has excellent staff specializing in rheumatology in Nashville, TN. Take your first step and make an appointment by calling +1 (615) 964-5823.

What Causes Allergies in Nashville? ENT Doctors Weigh In…

While Nashvillians tend to be a good-natured bunch, there are three things we like to complain about: traffic, shopping for a home (no complaints from the sellers!), and allergies.

If you recently moved to Nashville and find yourself wondering, “Were my allergies this bad before I came here?” you may be relieved to know you’re not mistaken. Wherever you came from, the allergies probably weren’t as bad they are here in Nashville! (Okay, maybe “relief” isn’t the right emotion – but, at least you’re right, right?)

Nashville Ranks in the Top 30 for Allergies

Every season, the Asthma and Allergy Foundation of America (AAFA) releases a report on the Allergy Capitals of the U.S. In Spring 2016, Nashville ranked at #29, pushed further down the list from its previous ranking at #23. (If it makes you feel any better, Memphis ranked #2 and consistently appears at the top of allergy and asthma lists.)

In the Fall 2016 allergy season, Nashville ranked #27 (down from #20).

What Causes Allergies in Nashville?

Springtime brings a variety of blooming flowers and budding trees, which create the perfect storm for pollen-sensitive residents. With long growing seasons and a geography that causes air to “sit” over the Middle Tennessee region for extended periods, pollens and other irritants can accumulate in the area, irritating sinuses for weeks or months on end.

In the fall, ragweed (“hay fever”) can cause those infamous symptoms of sneezing, runny nose, congestion, headache, and irritation of the throat and eyes. Of course, our homes can also act as host to a variety of allergens, from dust, mold, and mites to pet dander.

Allergy Testing Methods

Nashville ENT specialists at St. Thomas Medical Group have several methods for screening allergies.

    • Skin Prick Testing: The most common form of testing, the skin prick method involves creating several pricks on the skin with droplets of various allergens. After 20 minutes, test results can be read. Results may prompt further testing. (See below.)
    • Intradermal Dilutional Testing (IDT): Using this method, the healthcare provider injects small amounts of allergens under the skin of the upper arm. The test can take three hours.
    • Modified RAST (mRAST): This blood test measures the amount of ImmunoglobinE (IgE) specific to each allergen. IgE is an antibody the immune system produces in reaction to an allergen. These antibodies are what cause the symptoms you have observed as an “allergic reaction.” It can take two to three weeks to receive results from the lab.

Treatments for Nashville Allergies

There are several methods that may be recommended to you for managing allergy symptoms. These may include:

    • Medication Therapy: Antihistamines, nasal sprays and other drugs can be helpful in many cases for reducing allergy symptoms. Many of these drugs are available over the counter without a prescription.
    • Desensitizing Immunotherapy (IT): Also known as “allergy injections,” immunotherapy is an option for some patients. Injections may be done weekly in a physician’s office; some immunotherapy drugs are taken orally under the tongue twice a week at home.
    • Avoidance Therapy: As you may guess, this therapy is based on strategically eliminating or reducing exposure to known allergens. Your ENT specialist may be able to recommend air filters, cleaning methods, household modifications, and lifestyle changes that can help you reduce exposure to known allergens.
Find a Ear, Nose & Throat Doctor In Nashville, TN

St. Thomas Medical Group is home to three ENT specialists. Meet:

Mitchell K Schwaber, M.D.
Steven Enrich, M.D.
Matthew Speyer, M.D.

For more information or to schedule an appointment with a Nashville ear, nose and throat specialist at St. Thomas Medical Group, call +1 (615) 297-2700.

Our Favorite Immune-Boosting Drinks in Nashville

In January 2017, The Tennessean reported that Nashville has seen 490 new restaurant openings since 2010 – a 10 percent increase. From health-minded juice bars and trendy cocktail lounges to ethnic eateries and James Beard-award winning restaurants, Nashville’s food scene is finally approaching the ranks of larger foodie cities like New York, Chicago and Atlanta.

While Nashville’s burgeoning food scene has so much to offer, perhaps one of the most unique benefits for health-conscious Nashvillians is the surge in delicious, organic immune-boosting drinks. This month, as we find ourselves in the midst of a busy holiday season, take a moment to check the stress and to-do list at the door of one of these St. Thomas Medical Group favorites!

EiO & The Hive

Just a 9-minute drive north of St. Thomas Medical Group, EiO & The Hive is an all-organic restaurant serving creative dishes made from high quality, mostly local, and sustainable ingredients. (We also love that they compost 95% of waste, recycle 4%, and send less than 1% to the landfill!)

While you could spend several days sampling their breakfast, brunch, lunch and dinner, we’re big fans of their “elixirs” – small 2-ounce shots of pure immune-boosting liquid. These little glasses pack a punch!

Don’t Miss: We have to recommend EiO’s Help elixir, which contains turmeric, ginger, grapefruit and honey for “disease fighting, anti-inflammatory, allergy relief.” Turmeric is believed to help reduce inflammation – even helping with joint pain. It’s also believed to help protect the liver from harmful toxins, which can be beneficial for patients with diabetes or other chronic illnesses that require long-term use of certain medications.

Juice Nashville

Since 2012, Juice Nashville has handmade over 30,000 juice kits. Their juices have been featured on Food Network and USA Today. We love popping in their storefront in The Gulch to grab a quick cold-pressed juice to go.

Don’t Miss: While you really can’t go wrong with any of these immune-boosting drinks, we’re partial to oh yeah., a kale/collard/apple/lemon combo that delivers plenty of Vitamin K, A and C. A little tangy, a little sweet, oh yeah. is loaded with phytonutrients that may help reduce risk associated with heart disease, Alzheimer’s and asthma.

High Garden

A self-proclaimed “Woodland Tea House and Sipping Apothecary,” East Nashville’s High Garden delivers on a wild, organic, handmade vibe that invites customers to sit and stay a while. We especially love that they don’t have wifi and that they ask you to leave your laptop at home when you come to sip some tea. Refreshing and unique among Nashville’s coffee shop scene, High Garden is not to be skipped.

Don’t Miss: While High Garden is home to dozens of delicious teas, their most unique offering is a rotating selection of six to eight house-brewed kombuchas and other fermented offerings. Based on black tea, kombucha is rich in antioxidants, which can help reduce inflammation. Many people with joint pain or digestive problems have found kombucha to help improve their symptoms. Also, because kombucha is so rich in antioxidants, it’s a wonderful immune-boosting drink for combatting Nashville’s flu season!

Find a Holistic & Integrative Health Specialist In Nashville

St. Thomas Medical Group is home to two Holistic and Integrative Medicine specialists. If you’re looking for a Nashville provider who understands and promotes healthy aging, as well as a holistic approach to caring for chronic disorders, contact us by calling +1 (615) 297-2700. Internal Medicine and Holistic providers may utilize alternatives to traditional medicine, as well as lifestyle modification and herbal, nutritional and cognitive therapies.

Why Do Babies Get Baby Acne?

Most of us can remember at least one semi-traumatizing experience from our teen years involving acne, right? With those days likely behind you now, acne may have fallen off your radar – aside from the occasional pimple or blemish.

And then one day you pick up your newborn to find… baby acne? Yes, baby acne is surprisingly common! Our Nashville pediatricians at St. Thomas Medical Group have put together this brief Q&A to address your questions and help you care for your infant.

Is baby acne normal?

First off, yes! Don’t worry. Baby acne is quite common among infants. (And it won’t cause them anywhere near the level of social embarrassment they’ll have the opportunity to experience fourteen years later!)

Newborns still have many maternal hormones circulating in their system in the first few weeks following birth. These hormones can cause pimples to develop on the face (chin, cheeks, forehead and eyelids, for example). It’s not uncommon to see baby acne on the chest, neck or back, too.

Before you blame yourself, Mom, it’s worth mentioning that baby acne isn’t only caused by maternal hormones. Because the pores in your newborn’s skin aren’t completely developed, your baby may be susceptible to developing acne caused by some other external irritant.

When does baby acne start?

Forty percent of all newborns develop baby acne at two to three weeks of age. (In some cases, baby acne may be present at birth.) This condition can last until six months of age. It’s important to note that baby acne does not cause scarring (like acne later in life), nor is it an indicator of future teen/adult acne issues.

What helps baby acne?

Baby acne typically resolves itself without any specific home-care or professional medical care. However, you can gently cleanse and pat-dry the area two or three times a day. Do not use acne medicine, soap, lotion or any other chemicals. Also, just as is the case with adult acne, no squeezing or picking!

Can I be sure it’s baby acne? Or is it something else?

Of course, not all raised or pimply-looking skin conditions are baby acne. Infants may develop similar signs of irritation as a result of milia, heat rash, diaper rash, infant eczema or cradle cap. If you’re concerned that skin irritation could be something more than baby acne, talk to your Nashville pediatrician at St. Thomas Medical Group.

What’s the difference between milia and baby acne?

Milia (small white bumps that sometimes develop on an infant’s face) are similar to baby acne, but completely unrelated. These bumps are typically present at birth, while baby acne typically develops several weeks later. These white bumps occur when small flakes of skin become trapped in pockets just beneath the surface of the skin. Nearly half of all babies have milia on the upper cheeks, chin or nose. These little bumps are neither painful nor contagious and will resolve on their own in just a couple of weeks. No special washing, scrubbing or treatment is necessary.

Baby acne (and milia) is usually more upsetting to new parents than to the baby. Both of these conditions just require a little time and patience! In a few weeks (or months at the latest) your baby will develop a smooth, clear complexion!

See a Pediatrician In Nashville, TN

Are you concerned about baby acne in your infant? To schedule an appointment with a board-certified pediatrician in Nashville, contact St. Thomas Children and Adults Medical Group by calling +1 (615) 297-2700. Our Nashville pediatricians have offered quality care at the intersection of Green Hills, Sylvan Park and Belle Meade for over 40 years.