Inside This Issue
Facing Fibromyalgia
Footprints in the Sand
Ask the Experts
My Forgetter
Fibromyalgia in Young People
Just For Laughs
Facts on Vitamins
Attitude is Everything
Can You Relate

In October of 1995, I was driving to a family event when a car ran a red light and hit me broadside. The resulting neck and back injuries were very painful and became worse over time instead of getting better. Rather than healing, the pain spread, becoming increasingly debilitating, and moving down my arms into my hands.

This pain was devastating on several fronts. Because I am a writer, my ability to earn a living was threatened, and I was soon laid off from my job. My active social life ground to a halt because I rarely felt like going out and could not sit still for long periods of time without becoming more stiff and sore. I had to quit a weightlifting program and martial arts lessons.

About six months after the accident, I was diagnosed with fibromyalgia syndrome (FMS), a condition that is characterized by muscle pain and stiffness, joint pain, flue-like body aches, intolerance to heat and cold, headaches, and extreme fatigue.

Although doctors do not know exactly what causes fibromyalgia, significant strides in research have been made in the last ten years. Many doctors regard fibromyalgia as a pain perception disorder. It often develops after a person has experienced painful physical trauma, such as injuries from an automobile accident or surgery, or following an illness, especially viral infections.

Poor sleep quality can be a precipitating factor, since your body does it healing and repair work in the deepest stages of sleep. Lack of sleep can also be a long term result of fibromyalgia, which sends the patient into a cycle of pain, inability to sleep because of pain, and more pain.

There are a number of medications that are used to treat fibromyalgia; none constitute a cure, but are prescribed in an effort to manage the condition. It is usually a matter of trial and error to determine the best combination for any given individual. The pain of fibromyalgia is not responsive to over the counter anti inflammatory pain remedies.

Since the accident, I have learned the best ways to manage my own condition, and have been able to resume a virtually normal lifestyle. If I were to give any advice to a newly diagnosed FM patient, the first thing I would say is not to give up! Fibromyalgia is not a death sentence, although the pain may take a harsh toll on your emotional and physical resources. It is very, very important to seek out a healthcare professional that is familiar with FMS and its treatment. A surprising number of doctors are still not well-versed in the diagnosis and treatment of FMS. Those that do specialize in its treatment are often rheumatologists, neurologists or pain management specialists.

It is important to arm yourself with as much information as possible in order to participate effectively in your own treatment. In my experience, gentle exercise has proven to be the key to optimum pain management. It is undeniably hard to keep a consistent exercise regime going; when every muscle in your body hurts, the last thing you want to do is exercise. But you absolutely must stay active to keep from becoming debilitated. That is where self determination becomes a factor.

I have found that gentle and controlled stretching exercises are most beneficial, along with moderate aerobic exercise such as walking. Strength training with minimal weight is also important. There are many excellent muscle training exercises one can do at home; I recommend talking to a physical therapist to work out an optimum exercise regimen that keeps you conditioned and flexible without exacerbating the pain. Allowing yourself to become physically deconditioned leads to increased pain and likelihood of injury in day to day activities.

It is important to know and respect the limits of your body, without asking too little of it. And by all means, enlist the help and support of your family and friends. When they see that you are determined to contribute to your own self care, then they are more likely to be understanding and have respect for your limitations.

Question

I have a patient with fibromyalgia (FM) who is being treated with 20 mg fluoxetine (Prozac) and 50 mg amitriptyline (Elavil) per day. She is not better after 2 months. What is the best antidepressant treatment for patients with FM?

Response from John J. Cush, MD, 05/15/01

Treatment of FM is complex and often frustrating because diagnosis and treatment may be significantly delayed in many cases, and because many treatments are ineffective for most patients. Moreover, there are few objective, well-done clinical trials to guide us on the most appropriate therapy. Most investigators believe that treatment of FM requires a multifaceted approach that specifically addresses:
   (1) pain control with simple analgesics;
   (2) improvement of sleep;
   (3) stretching exercise (eg, water exercise, water aerobics, yoga);
   (4) control of depression, if present.
Interestingly, fewer than 20% of patients with FM will demonstrate evidence of major depression, although many more will at times show depressive symptoms or poor coping skills.

Antidepressant drug use had been a major advance in the treatment of FM. Antidepressants are used for either control of depressive symptoms or as adjunctive agents in pain management. Both the tricyclic (TCI) antidepressants (eg, amitriptyline, trazodone) and the selective serotonin reuptake inhibitors (SSRIs, eg, paroxetine, fluoxetine, sertraline, venlafaxine) have been clearly shown to be effective antidepressants when used at appropriate doses. The TCIs and SSRIs are equally effective, although some evidence suggests that SSRIs are better antidepressants and TCIs are better pain modulators. Both classes have been used to modulate nociceptive responses in patients with neuropathic pain or chronic pain disorders such as FM, chronic low back pain, migraine headache, and phantom-limb pain. Unfortunately, data are still inadequate to answer your question, "What is the best antidepressant for patients with FM?" Both amitriptyline and fluoxetine have been tested in controlled trials and demonstrated some efficacy. Venlafaxine was tested in an 8-week, open-label trial of 15 patients with FM; 6 (55%) of the 11 patients who completed the trial experienced a 50% or more reduction in FM symptoms.

My advice is to maximize the treatment of depression in any patient with FM and depression because poorly or inadequately treated depression will undermine all other therapeutic interventions. If tolerated, higher doses of antidepressants (eg, fluoxetine 40 mg per day, venlafaxine 150-225 mg per day, or trazodone 200-400 mg per night) may be more effective in some patients.

The information in this article was taken from the Fibromyalgia Network's Information Package on FMS/CFS in Young People which was produced by the Health Information Network and Endorsed by a team of leading researchers David Bell, MD., Abraham Gedalia MD., Thomas Romano, MD.

You're searching for explanations and help. Maybe your situation is like many parents who themselves have already been diagnosed with FMS and your child is having symptoms that are hauntingly familiar to what you experience. Or it could be after many medical consultations, you have learned that your child's mysterious condition has a name. If the main symptom is chronic pain, the diagnosis is likely Fibromyalgia Syndrome(FMS).

Chronic muscle pain and cognitive difficulties present tremendous problems for children, such as physical and emotional development, social function, and educational achievement. With help from the adults in their lives, young people can carry on with their education, manage a social life and plan for the future despite the effects of these conditions. While complete remission of symptoms is not usually observed in adults with FMS, the news for young people is more encouraging. According to the 3 year study by Dan Buskila, M.D. and Abraham Gedalia, M.D., nearly 75% of young FMS patients were found to have a remission of symptoms. This study documents that young people have a good chance of getting better with the help of appropriate medical treatments, emotional support of family and friends, and some hands-on experience in how to manage their symptoms.

The signs and symptoms of young people with FMS are chronic pain, patterns of recurring illnesses such as ear infections, sinusitis, bronchitis, headaches, irritable bladder/bowels, migraines, lack of energy and stamina with complaints of exhaustion and sore muscles. They commonly experience a decline in their school performance and participation along with uncharacteristic changes in behavioral patterns, trouble concentrating, anxiety, clumsiness, work mix-ups, memory lapses, and sensitivity to light and noise. Even after adequate periods of sleep they are still tired or they may experience sleep disturbances throughout the night examples being muscle twitches, limb numbness or restless legs. Troublesome symptoms of all over pain and persistent exhaustion will probably be what keeps a child from being active. The symptoms in children typically fluctuate dramatically from day to day. A sore throat and headache are symptoms one day, followed the next day by abdominal pain and the next day have symptoms of joint pain. Parents might find it helpful to know that FMS often occurs after a lingering viral infectious illness, or may be brought on or "triggered" by a minor accident, shock or hormonal change. Changing hormones may be the reason FMS tends to strike young people around the time of puberty. The FMS sufferer requires rest, treatment and above all, a parent's determination to help the sick child squeeze as much out of life as possible. Therefore this condition must be managed in a way that permits young people to live a full life without aggravating their symptoms.

It can be particularly difficult to diagnose FMS in children as the onset of fibromyalgia is typically gradual. The symptoms may go unnoticed among many other changes in mental and physical abilities as a child grows and matures. Children will often overcompensate when slowed down by an illness. Many of these children have cognitive dysfunction, but they don't recognize it in themselves and will accept their limitations without knowing otherwise because they don't know they are supposed to wake up rested or that they should remember a paragraph they just read. Teenagers are easier to diagnose than young children because they can describe their symptoms. Most teenagers experience a sudden, acute onset of FMS after a flu-like illness. It may appear like mononucleosis or the symptoms may tend to linger after a documented case of mono. Teenagers are more aware and can describe the effects on their minds and bodies. A doctor's first steps in a diagnosis is to review the patient's medical history and order lab tests to rule out the possibility that some other known disease is causing the symptoms. If all test results are within a normal range, then official "criteria" or rules are applied that will distinguish FMS from localized pain conditions, stress-related fatigue or other disorders. The diagnostic criteria for FMS is limited by the fact that it can't rely on a definitive lab test or X-ray. The FMS criteria emphasizes the pain component of the disorder. Although fibromyalgia can be severe and disabling it is often overlooked and given limited attention or mis-diagnosed because the symptoms mimic those of other conditions, such as rheumatoid arthritis, lupus or other auto-immune diseases. Fibromyalgia is the only one of these conditions without a diagnostic test at this time but luckily your doctor can conduct a simple "tender point" exam. If 11 out of the 18 specific tender points on the body hurt when pressed, and aching or pain has persisted for more than three months, the diagnosis is confirmed.

Learn about your child's syndrome and the recommended treatment options. Keep a record with examples rather than vague statements of how the child feels and supply doctor/specialist with a record of all treatments, their progress and current ability level. These records will add to the credibility of the child's illness. The most useful information is usually available through patient self-help groups, which invite speakers to their meetings, share information and publish newsletters. They can give you written materials that you can pass along to teachers and child care providers. The hardest thing for a school to understand is the fluctuation of an illness like FMS. It's expected that young people get better and will start performing as they did before they got sick. After all, they look fine, and sometimes they are fine but chronic pain syndromes are invisible illnesses and therefore, their debilitating effects are not obvious. Provide your child's teacher and school with a brochure on FMS along with a letter from your doctor. You may have to explain to the school how the illness affects your child's ability to learn. It is best to center your discussion around the learning impairments rather than medical jargon as you are dealing with skilled educators not physicians and they will likely be thinking in terms of what can be done to help your son or daughter overcome their educational difficulties. These groups may also be able to provide the names of physicians who recognize your child's illness and are experienced in treating it. You can also supply your doctor and any specialists with a record of your child's treatment, progress and current level of ability. This will ensure that you do not forget or over look any important changes in your child's condition. Your records will also add to the credibility of the child's illness. Keep the information clear and concise, with examples rather than vague statements of how the child feels.

Treatments are geared to the most troublesome symptoms and what works for one child may not help another. Determine which symptoms are the most disabling, then target treatment towards minimizing them and make the necessary lifestyle adjustments. Rest is one of the most effective treatments for chronic pain but too much rest of course, can mean that the body gets de-conditioned and even more pain and fatigue can result. Mild daily exercise is recommended if it does not aggravate symptoms either at that time or the next day. Even ten minutes of rest occasionally will help keep pain and fatigue at manageable levels. Physical therapy is prescribed to help patients restore and maintain muscle tone. For young people with muscle discomfort, physiotherapists can help by teaching both stretching and muscle relaxation. Therapists can advise patients on what types of activities to avoid and what types of activities should be well tolerated. The trick is to learn to recognize when further exertion is likely to cause a relapse. It is encouraged to walk and to exercise in a heated pool as these activities have aerobic benefits, strengthen the large muscles, and enable people to gradually increase their endurance according to their ability. If your child is young, the physiotherapist may be able to make exercises seem more like play than a treatment. Unfortunately, children diagnosed with FMS often cannot tolerate exercise for very long. Massage at home may also be helpful. You might consult a physiotherapist or massage therapist for advice on techniques you could use. The idea is to build up strength through activity that does not aggravate the illness.

As a general rule, medicines that alter brain chemistry, will likely be used as a last resort when treating a child under 12 years old although, there are always exceptions and special circumstances. These meds have been tested for treating adult, but their impact on young developing bodies should understandably be a source of concern for both for parents and physicians. Medications that are often used to restore the normal sleep cycle may also reduce pain. Dosages are small, and must be monitored carefully, since children with FMS tend to be very sensitive to drugs. To ease pain and promote sleep, antidepressants like Elavil (amitriptyline) or Sinequan (doxepin) are sometimes prescribed, but in doses that are much smaller than those used for depression itself. Flexeril (cyclobenzaprine) is also a useful medication especially for tight, sore muscles. It will assist with sleep and work as a muscle relaxant as well. Improving the quality of sleep may also work to reduce the pain, stiffness and achy muscles that are usually associated with FMS. Even after everything has been done to improve a patient's quality of sleep, your child may still be hampered by a considerable amount of discomfort. Physical therapy should help to reduce this problem but medications may be needed to bring the pain down to a tolerable level. Aspirin, Tylenol and non steroidal anti-inflammatory drugs (NSAIDS like ibuprofen, naproxen, prioxicam) may be considered for the treatment of painful symptoms. Unfortunately all of these drugs have drawbacks. Aspirin has been documented to cause a rare disease named Reye Syndrome, in children. When too much Tylenol is consumed, liver and kidney problems may result. NSAIDS pose a threat of producing additional gastrointestinal problems in patients who may already have hypersensitive stomachs. Yet depending upon the child's age and dosage used, these medications may be beneficial for helping your child get by as far as pain goes. In general, medication is used as little as possible for children due to fear of long term effects on a growing body. Whether or not your child is taking medications, it is a good idea to practice other techniques to reduce the symptoms of chronic illnesses like FMS.

Despite attempts to eat a well balanced diet, a child who is chronically ill may possibly fall pray to nutritional deficiencies. Ask your doctor for a routine blood panel to make certain that your child hasn't developed a nutritional deficiency that is somewhat masked by the FMS symptoms. It's possible that some of the child's fatigue may be due to low iron levels which can easily be rectified. To avoid nutritional imbalances, ask your doctor to recommend a good multivitamin and mineral supplement for your child.

Children will learn to cope and live successfully much quicker if they are not over protected. Try to help your child develop a positive outlook by emphasizing ability, not disability. Older children can judge for themselves what the physical costs are for their various activities. They gradually realize that they have to take breaks and relax periodically throughout the day to budget their energy, so let them learn through experience.

JUST FOR LAUGHS
Personalized answering machine messages related to fibromyalgia.
By Mark J. Pellegrino, MD

• Hello, you've reached the Smith Residence. I'm unavailable because of my fibromyalgia. I'm either at the doctor's, getting massage therapy, taking a hot shower, or spending time in the bathroom. Leave a message, and when I remember to check the machine, I'll call you back.



• I can't come to the phone right now. In fact, I can't move from the couch because I hurt all over. If I reach for the phone, it would hurt, so I'm just going to lay here instead. My ears are fine though, so feel free to talk away when you hear the beep.



• Hello, I'm here but I can't find my cordless phone. I am always misplacing the dang thing. Just leave a message. When I find the phone, I'll call you back.



• The person you have reached has been changed. The new person has fibromyalgia and feels disconnected as if she is no longer in service.

FACTS ON VITAMINS
- Information taken from the Vitamin Knowledge Base -

Vitamin A is required for normal vision in dim light. The first distinctive effect of the lack of Vitamin A is usually night blindness (inability to see under conditions of darkness). The eyes may take a long time to adapt to dim light in theaters or outdoors at night after leaving lighted area. Vitamin A maintains normal structure and function of mucous membranes and helps in the growth of bones, teeth and skin. Vitamin A deficiency may result in dry skin, itchy eyes, and skin rashes and other eye disorders such as corneal ulcers, dry and brittle hair, loss of appetite and weight, sterility, poor growth, and increased susceptibility to infections. Vitamin A may help prevent or retard the onset of cancer. This effect of Vitamin A is believed to be from the Vitamin's necessity for integrity and efficiency of the epithelial cells and mucous membranes that line the respiratory passages. Well functioning cells here can help protect the body against air-borne cancer producing particles by their mucus flow and cilia action (tiny hairs that brush away damaging matter). Vitamin A also may help prevent bacteria and viruses from obtaining a freehold, thereby protect the body from infectious diseases. Vitamin A is stored in the liver. The liver is a principal organ for the purification of blood. Foreign poisons often collect there to be detoxified, and it is believed that Vitamin A plays an important role in dealing with substances as pesticide and fertilizer residues, industrial poisons and other toxic drugs. The body can manufacture this vitamin from the "carotene" in yellow vegetables, such as carrots and yellow sweet potatoes, and also in green vegetables such as spinach, turnip, dandelion, and beet greens. Other food sources are fish (especially liver oils), butter, butternut squash, tuna, cantaloupe, mangoes, apricots, broccoli and watermelon, liver, eggs, whole (but not skim) milk, fortified butter, and margarine.

Vitamin B12 is needed for new tissue growth, red blood cells, nervous system and skin. This vitamin is required for the proper functioning of all cells, especially those of the nervous system, the gastrointestinal tract and the bone marrow. The lack of Vitamin B12 causes pernicious anemia that results in blood weakness and irreversible neurological degeneration leading to paralysis and blindness. Vegetarians, who do not take any milk or eggs are particularly susceptible to this crippling disease. Significant improvement in mood and feeling of well being were reported by those receiving Vitamin B12 injections in a double-blind test carried out in Britain. Recently, this vitamin was shown to exert a strong protection among certain microorganisms against viruses. It is not known yet whether this anti-viral action also occurs in humans. This vitamin is virtually absent from all vegetable food sources. Only meat or animal products supply this vitamin. Sources include salmon, eggs, cheese, swordfish, tuna, clams, crab, mussels and oysters.

Vitamin B: Biotin Fat, protein and carbohydrate metabolism. Milder deficiency of Biotin has shown to result in lack of appetite, depression, skin changes, muscle pains and lassitude. Severe Biotin deficiency may result in heart conditions and paralysis. This vitamin is found in many foods such as peanut butter, eggs, oatmeal, wheat germ, poultry, cauliflower, nuts, liver, oysters, beans and legumes.

Vitamin B: Choline is an important nutrient essential for the formation of one of the crucial neurotransmitters in the brain. It can be helpful in increasing memory. Important in the human body's manufacture of thyroid hormones, in the functioning of the nervous system, and to prevent cirrhosis of the liver. It has been beneficially used with heart attack survivors and to treat viral hepatitis. Choline was also found to inhibit cancer growth in animals. It is one of the ingredients needed for the manufacture of lecithin in the human body which is believed to help in the removal of damaging cholesterol from the walls of arteries and to dissolve it in the bloodstream. Dietary Choline protects against poor growth, fatty liver development, and kidney damage in many experimental animals, and against pyrosis. It is also believed to protect against abnormalities in pregnancy and lactation, anemia, cardiovascular disease and muscular weakness. Absence of Choline was shown to result in high blood pressure in animal studies. This food source is found in whole grains, liver, eggs, beans, chicken, fish and vegetable foods

Vitamin B: Folic Acid is essential for red blood cell development, tissue growth and repair. Lack of folic acid results in diarrhea, gastrointestinal upsets and pernicious anemia. Folic Acids are found in legumes, poultry, tuna, wheat germ, mushrooms, oranges, asparagus, broccoli, spinach, bananas, strawberries, cantaloupe.

Vitamin B: Pantothenic Acid is very important biologically. Deficiencies produce biochemical defects that may ultimately result in tissue failure. Deficiencies may produce headaches, malaise, nausea, and occasional vomiting accompanied by flatulence and abdominal cramping, impairment of motor coordination, cramping of muscles and the legs and the loss of antibody protection. This vitamin along with pyridoxine are vital for body's defenses against infectious diseases. This vitamin is also important as a protective agent against stress. Some experiments indicate that it may promote longevity. Some food sources are fish ,whole grain cereals, mushrooms, avocados, broccoli, peanuts, cashews, lentils, soybeans, eggs

Vitamin B1: Thiamin is important in maintaining a healthy nervous system. Severe deficiency results in a mortal disease called Beriberi, which has symptoms such as weakness, paralysis, heart pains, and cardiac failure. Lesser deficiencies are known to reduce the efficiency of the brain and central nervous system. Several experiments reported that adding thiamin has the beneficial effect of improving the learning and intelligence. Older persons are especially advised to watch out for the deficiency of thiamin as they use it less efficiently. Thiamin is generally added to baked goods, breakfast cereals, snack foods and to bleached white flour. Other food sources are pork, wheat germ, pasta peanuts, legumes, watermelon, oranges, brown rice, oatmeal and eggs.

Vitamin B2: Riboflavin promotes healthy skin. The signs of deficiency are cracks around the mouth and lips, frequent occurrence of bloodshot eyes, purplish tongue, increased sensitivity to light, a need for bright lighting for proper vision, anemia, burning sensations in hands and feet, loss of hair and weight. This Vitamin is needed for the proper biochemical functioning of every living cell. Riboflavin aids the body in the absorption of iron. It also may have beneficial cancer inhibiting properties. Vitamin B2 therapy has been attributed to relief of cataracts. Riboflavin is found in beef and chicken liver, nuts, beans, milk and milk products. This product can be destroyed by light. Today, most of riboflavin in milk is destroyed by the action of light that is used to create Vitamin D milk. Other foods that the sources of Riboflavin include cottage cheese, avocados, tangerines, prunes, asparagus, broccoli, mushrooms, salmon and turkey.

Vitamin B3: Niacin is required for nervous system functions and is needed for oxygen use by cells. An extreme deficiency of niacin causes the mortal disease called pellagra, with mental symptoms such as hallucinations and dementia, skin rashes, and diarrhea. Lesser deficiencies give rise to depression, irritability, insomnia, backaches, headaches and so on. Niacin plays a major role in the new methods of treating schizophrenia and autistic children, and also in maintaining healthful non-excessive fat levels in the blood stream. This is one of the vitamins used to enrich white flour and bakery products. It is also found in meat, poultry, fish, peanut butter, legumes, soybeans, whole grain cereals and breads, broccoli, asparagus and baked potatoes

Vitamin B6: Pyridoxine is required for normal growth. Pyridoxine is essential for the metabolism of every amino acid protein. It helps to overcome the nausea and toxemia of pregnancy, and some adverse effects of birth control pills. It reportedly has shown beneficial effects in epileptic states, ulcers, heart conditions, anemia, rheumatism, and menstrual and menopausal disorders. It may also help diabetes. Some doctors believe that there is widespread deficiency disease associated with this vitamin resulting in muscle and nerve pains, and unnecessary swellings, and may be linked to rheumatism. In infants pyridoxine deficiency can be manifested by extreme convulsions. In adults, anemia may be the first sign. It is followed by difficulties with tendons and ligaments, especially in the hands, and swellings. New research from UK indicate that women who take birth control pills may get depression which can be reduced by taking Pyridoxine. Lancet, the British medical journal now recommends that women on pills consider such vitamin therapy. Pyridoxine also has been reported to reduce the level of free cholesterol circulating in the blood stream. Bananas are good source of pyridoxine, as well as raw meat. Other sources include fish, soybeans, avocados, lima beans, chicken, cauliflower, green peppers, potatoes, spinach and raisins. The heat of cooking is very destructive to this vitamin.

Vitamin C - Ascorbic Acid builds collagen, maintains healthy gums, teeth and blood vessels. Prolonged lack of Vitamin C produces the mortal disease of Scurvy. Lesser deficiencies often lead to bleeding gums, blood vessel fragility, bone and teeth weaknesses in growing children, anemia, general debility, and an increased susceptibility to infections. Vitamin C, in large doses, helps protect us against colds and minor illnesses. It promotes the healing of wounds and injuries. It is also believed to sharpen mental abilities. It also has significant anti-stress properties. Vitamin C aids in the absorption of iron into the body. It helps overcome foreign poisons and had been useful in treating schizophrenia and ulcers. It had helped cataract patients and those with back complaints. Vitamin C plays a special function in the white blood cells (which fight infection) and in the manufacture of collagen. Collagen is a binding substance that holds all cells and the bones together. There is growing evident that indicate that Vitamin C protects the circulatory system against damaging fatty deposits. Vitamin C deficiency may result in high cholesterol levels, which in turn, may lead to Atherosclerosis. Vitamin C can prevent or counteract chemical poisonings and toxins from a number of sources. This vitamin is found in oranges, grapefruit, bell peppers, strawberries, tomatoes, spinach, cabbage, melons, broccoli, kiwi and raspberries.

Vitamin D assists with calcium absorption for growth of bones and teeth. Vitamin D deficiency can cause constipation, muscular and nervous weaknesses, and cramps. Studies conducted in Denmark suggests that Vitamin D therapy helped control epileptic seizures among hospitalized patients. This is called "sunshine vitamin" because sunlight acting on the oils of the skin can produce it. Fish liver oils (especially cod liver oil) is an important source for this vitamin. Other foods that contain Vitamin D are eggs, milk, butter, tuna, salmon, cereals and baked goods using fortified flour.

Vitamin E protects against cells damage. It is necessary for the proper muscle functioning. It has anti-clotting and circulation improving abilities. Vitamin E also has shown to have beneficial effects on the lungs and heart and on aging and sexuality. Absence of Vitamin E has shown to have a deleterious effect on reproduction. One of the best sources for Vitamin E is fresh whole grain wheat products. It is also found in many vegetable oils (corn, soybean, safflower oil; but not in olive oil). Vitamin E is also present in liver, beans and peas, butter, eggs, leafy green vegetables, nuts, mangoes, blackberries, apples, broccoli, peanuts and spinach.

ATTITUDE isn't simply a state of mind...it is also a reflection of what we value.

Attitude is more than just saying "I can", it is BELIEVING you can.

It requires believing before seeing, because seeing is based on circumstances; believing is based on faith.

Attitude is so contagious, especially when we allow it to turn our doubts of the past into passions of today and set the stage for our tomorrows.

We have total ownership of our attitude. No one else has the power to alter our attitudes without our permission.

Our attitude allows us to become more empowering than money, to rise above our failures, and accept others for who they are and what they say. It is more important than giftedness, and is the forerunner of all skills needed for happiness and success.

Our attitudes can be used to build us up or put us down - - THE CHOICE IS OURS.

It also gives us the wisdom to know that we cannot change events of the past.

I AM CONVINCED THAT LIFE IS 10% WHAT HAPPENS TO ME, AND 90% HOW I RESPOND TO IT ....

And it is with this state of mind that I REMAIN IN CHARGE OF MY ATTITUDE.

This is an entry that I wrote in my journal back in 1989. Unfortunately, many of you will relate to my feelings of frustration and hopelessness in my struggle to find out what was wrong with me. I am hoping that by sharing my thoughts, they may reach someone who is experiencing a similar situation.

The constant pain distracts my thinking. The fight lowers my energy level at times into depression when I don't feel like doing anything. It disturbs my sleep. It effects everything I try to do. It makes me very tired. It has me very frustrated with doctors. They have tried to make me believe that the pain is all in my mind. I know they are wrong when my mind and body must constantly fight this pain. How could it possibly be in my mind when there are nights that I wake up unable to move my head, the pain is so unbearable even in a sound sleep. I'm sure my mind is not making my arms and legs fall asleep during simple tasks, even just sitting on the toilet for more than a few minutes. They keep putting me on anti-depressants that don't do a thing for me. I'm fed up with taking pills that are useless to me. It's like they have used my depression to over rule any other possibilities. I have had six accidents in five years, my first major one being in 1975 and the last one being in the late 1980's. It has taken a long time but I was finally diagnosed with Fibromyalgia in November 2000.

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