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Poor Sleep. Non-restorative sleep can intensify symptoms and precipitate a vicious cycle in which symptoms and poor sleep reinforce one another. This is an especially common problem for people with fibromyalgia. For ways to escape the cycle, see Chapter 8. Other Illnesses. Coming down with an acute illness or having multiple chronic illnesses can reduce energy and worsen symptoms. By treating other conditions and acknowledging that they intensify symptoms, you can reduce flares. One person in our program said, "I've learned that I have to lower my expectations and level of activity when I have [an] extra illness, so as not to make this unavoidable relapse worse and last longer.

I need to get treatment for the others, as well as taking care of my CFS. CFS and fibromyalgia are very stress-sensitive, so minimizing stress can prevent relapses. Stressors may include emotionally-charged events, such as financial problems, a disability review or a move, or can be long-term, such as family conflict. One student said, "I attempt to avoid all situations that will produce stress because stress inevitably triggers relapses.

For more, see the chapter on stress management. Special Events. Even eagerly-anticipated occasions, like a vacation, a wedding or the holidays, can trigger a relapse. Events like these are often associated with expectations both internal and from others about our level of participation, leaving us feeling pressured toward a higher-than-usual activity level. But such events need not lead to a relapse. You may be able to minimize the cost of participation by adjusting your schedule. You might, for example, attend a holiday celebration rather than hosting it.

Or you might go, but stay two hours, rather than the whole day or take periodic rest breaks. Travel can be made more doable by being less active than usual and by spending extra time resting. For more on planning for special events, see the section titled "Special Event Worksheet" in Chapter 7. Preventing Relapses You can use your knowledge of relapse triggers and the strategies described in this section to bring setbacks at least partially under your control, limiting both their severity and frequency.

You'll find eight strategies described in this section. In addition, you may want to use the worksheets in Chapter 7 to become aware of the warning signs of relapse and to plan your response.

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Pace Yourself Pacing is a favorite strategy for bringing stability to life and preventing setbacks. The term covers a variety of strategies, as described in Chapter At minimum, pacing means adjusting activity to the limits imposed by illness and to circumstances.

Dr. John Klippel discusses the difference between fibro and CFS.

As one person told us, "I've cut back my activity level substantially overall, and when I feel tired I cut it back even more. Pacing may also involve having short activity periods. Particularly with tasks that involve repetitive motion, such as food preparation, you may avoid symptoms by breaking the task down into five or ten minute segments with a rest between each work period. The same principle applies to mental work as well, as suggested by one student who said, "I do stressful things like taxes in small bites.

Just letting them pile up just adds more stress. You may be able to avoid an increase in symptoms by shifting among different activities and by including healthy activities in your day.

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I have recently introduced a checklist system to remind me about activities that are good for me such as walking, exercises, relaxing and hobbies. Lastly, you may add stability to your life by living according to a realistic schedule. This involves both scheduling an appropriate number of activities and allowing plenty of time between activities, not pushing to squeeze in too much.

One person in our program explained that she implemented scheduling by setting priorities for herself. She said, "It definitely helps me to make a list of weekly and daily activities so that I can prioritize them. I know how much physical activity I can handle in a day, so I remember this and make my list accordingly.

I always allow at least an hour's rest in the afternoon, so this is a given on my daily list. Another pacing strategy is to have a daily routine. Living your life in a planned and predictable way can help reduce relapses for two reasons. First, routine is less stressful than novelty. And, second, having a predictable life increases your chances for living within your limits.

Your ability to do this depends on your developing a detailed understanding of your limits and then creating a schedule of activity and rest that honors those limits. To read techniques for defining your limits, see Chapter 9. Some people have had success using very detailed and individualized rules they created for themselves, as described in the pacing chapter. A variant on this strategy is to write out a daily To Do list. Some people with severe brain fog have found it useful to tape a set of instructions for themselves in some prominent place, like the refrigerator.

For ideas on creating To Do lists, see the daily and weekly worksheets in Chapter 7. Another similar strategy is to have a series of rules for specific circumstances. For example, some people set a limit on how far they will drive, how long they stay on the computer and how long they spend with relatives.

Living with Fibromyalgia by Christine Craggs-Hinton

If you develop specific guidelines for yourself, you can simplify your illness management program into asking yourself two questions: "What situation am I in right now? Scheduled rests, done on a regular basis, can prevent relapses. Also, taking extra rest before, during and after special events, like vacations and the holidays, or after a secondary illness can help you avoid setbacks or limit their severity.

Here's what two people in our program say about the value of rest. I think my two daily fifteen-minute rests were the most important thing I did to aid my recovery. I can never get enough rest! The more I'm able to incorporate quality rest, even little bits and pieces, into my day, the better off I am.

Other symptoms include fatigue, sleep problems, allergies, anxiety, irritable bowel syndrome, headaches, morning stiffness and problems with difficulties with short term memory and concentration. Fibromyalgia is liable to flare-ups, and symptoms may be exacerbated by factors such as cold or stress. It affects mainly women. This book looks at how to reduce pain, boost energy levels and help with regular sleep patterns. It covers: fibromyalgia and immune dysfunction; the links with hypothyroidism; and fibromyalgia as a variant of thyroid disorder; antidepressant medication; psychotherapy; the vital importance of low-impact aerobic exercise such as walking, cycling or swimming; diet; posture; and, complementary therapies.

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Living with Fibromyalgia by Christine Craggs-Hinton (Paperback, 2000)

Best Selling in Nonfiction. Use your diary to see if any foods make you feel better. People with fibromyalgia tend to have low levels of vitamin D. That could worsen pain and other symptoms. A blood test can tell if you're short on D. Ask your doctor if you should take a supplement. One study showed that light and moderate but not heavy alcohol drinkers have a better quality of life and less severe symptoms than nondrinkers.

In this study, "moderate" meant drinks per week, and not all in one day. Avoid caffeine. While it may make you feel more alert, it can also put you on edge and make it harder to sleep. Drinking 4 or more cups of a caffeinated beverage a day has been linked with more fibro pain.

Effective Treatment of Chronic Fatigue & Fibromyalgia

Sit down with your partner on a regular basis to talk about what's going on with you. Listen to each other and problem-solve together. If that's difficult, counseling with a therapist may help bridge the gap.

Studies show that it's better when both of you agree about how fibro affects you. You could bring them to your next doctor visit if they're having a hard time grasping what it's like. Find out what really matters to the people you care about, like your kids' soccer games or the school play. Then plan your activities and save your energy to be there for them during those times.