Visit 3: Integrative Medicine & Mind-Body Practices for the Management of Fibromyalgia

Transcript

1. Integrative Medicine & Mind - Body Practices for the Management of Fibromyalgia 3rd Group Visit Bottom-Up Strategies 3 group medical visit series presented by Integrative Medicine Specialist Marc Fierro, PA-C, L.Ac., Frank Russell MFT, Lauren McDaniel CNC, FMHC and Kimberly Defazio LVN, FMHC, at the Sutter Institute for Health and Healing
2. Welcome back! • Today’s class is the 3rd in the series. • In today’s group visit, the participants will have the opportunity to share how much they were able to implement the therapeutic recommendations from the initial group visit and assess how it is affecting their quality of life. • Today’s topics will include teaching how to implement the approaches from the categories of: • Bottom Up – We all have 2 hearts, 1 in the chest and the 2nd is the entire body! Move daily any way you can. PACED, short interval graduated exercise, aquatic therapy, recumbent biking or pedal device, especially if dysautonomia w/ low BP, modified Yoga, Tai Chi, Qi Gong . It is okay to take a short nap before you exercise and afterwards if needed Additional Tai Chi – Qi Gong exercises will be taught today.
3. Quick summary review of last group visit Tri flex approach to the management of Fibromyalgia. • 4 therapeutic directions organizes the 5’ R’s and 7 Seeds into a workable action plan, especially if you do ONE SMALL item from each group. • Top Down – Sleep, stress, and emotional regulation management techniques, MBCBT, journaling, counseling, cognitive training programs, biofeedback, meditation, observing nature, socializing, engaging in joyful activities. • Bottom Up – We all have 2 hearts, 1 in the chest and the 2nd is the entire body! Move daily any way you can. PACED, short interval graduated exercise, aquatic therapy, recumbent biking or pedal device, especially if dysautonomia w/ low BP, modified Yoga, Tai Chi, Qi Gong . It is okay to take a short nap before you exercise and afterwards if needed. • Inside Out – Diet, nutritional supplements, prebiotics, probiotics, herbs, essential oils, cannabinoids, low dose Naltrexone, Psilocybin and medications Lyrica, Gabapentin, Amitriptyline, Cymbalta, Savella and Ketamine. New research on Mestinon for post exertional fatigue at Brigham Young University and Harvard. • Outside In – Neurostim, laser, red light, sauna, acupuncture, massage, somatic therapy, craniosacral, osteopathy, chiropractic, injections, surgeries. • Bundled Activities – Listen to music while dancing, walking outside, Tai Chi, Yoga, Qi Gong and more exercises that use all the directions by design. Exercise with friends and pets. Participating in support groups and volunteering.
4. Patient check in: Patient check-in time! How have you been doing since last class? Please feel free to tell us what you have tried to incorporate from the Tri-Flex Lifestyle Changes into your self-care program since we met last. Please limit your comments to 2 minutes or less so everyone has a chance to share if they would like. Please raise your hand to speak or leave comments in chat. Thank you!
5. Sharing group wisdom and progress, 3rd group visit check in topics • TRI-FLEX CHECK IN: Which activities from the 4 therapeutic Directions, 7 S. E. E. D. S. and 5 R’s did you choose since the initial group visit? • Did you start or plan on seeing the health coach? • Did you start the Happiness Trap and practice with the Mindfulness Coaching program app? • Did you start reading the TIGER protocol book? • What has been the impact on your health and well-being since doing those activities?
6. Bottoms Up: Motion is Lotion: The importance of managing deconditioning that occurs with Fibromyalgia. • Deconditioning occurs with Fibromyalgia due to the natural human tendency to avoid making the symptoms worse. However, that exacerbates the condition. • Muscular atrophy develops and decreases energy producing mitochondrial units which decrease ATP production which decreases one's energy. → THIS CAN BE IMPROVED WITH STRENGTHENING THE MUSCLE. • Increased sedentary inactivity decreases the stress the bones need to maintain their integrity, osteopenia and osteoporosis develop more rapidly as a result. → THIS CAN BE IMPROVED WITH STANDING UP MORE OFTEN.
7. Bottoms Up: Motion is Lotion: The importance of managing deconditioning that occurs with Fibromyalgia. • Pain increases because of the combination of muscular weakness, decreased flexibility, increased muscle shortening and subsequent spasming with normal activity as a result. → THIS CAN BE IMPROVED WITH STRETCHING. • With inactivity there is increased fluid accumulation around joints that increase pain and swelling. → THIS CAN BE IMPROVED WITH MOVEMENT. • Muscle mass decreases while fat mass increases which leads to inflammation and arthritis which increases pain and brain fog. → THIS CAN BE IMPROVED WITH STRENGTHENING THE MUSCLE
8. Bottoms Up: Motion Is Lotion: The importance of managing deconditioning that occurs with Fibromyalgia. • Increase fat mass also increases insulin resistance and leads toward diabetes, high cholesterol, cardiovascular disease including heart attacks, cognitive impairment and strokes.. → THIS CAN BE IMPROVED WITH STRENGTHENING THE MUSCLE WITH MORE FREQUENT MOVEMENT AND ACTIVITY. • Mood disorders or pre-existing ones become exacerbated because there are lower amounts of neurotransmitters such as norepinephrine, dopamine, and serotonin. Brain inflammation also occurs.→ THIS IMPROVES WITH MORE FREQUENT MOVEMENT AND ACTIVITY. • Sleep becomes disrupted due to a combination of a lack of drive to create sleepiness and inflammation and low levels of neurotransmitters from being overly sedentary. → THIS IMPROVES WITH MORE FREQUENT MOVEMENT AND ACTIVITY.
9. Bottoms Up: Motion Is Lotion: The importance of managing deconditioning that occurs with Fibromyalgia. • Digestion is also affected and dysmotility can develop because of the lack of stimulation to the intestines causing conditions such as irritable bowel and problems with detoxification. → THIS IMPROVES WITH MORE FREQUENT MOVEMENT AND ACTIVITY. • Immune dysregulation leading to low resistance against infection and increased risk of cancers also develop. → THIS IMPROVES WITH MORE FREQUENT MOVEMENT AND ACTIVITY.
10. Bottoms Up: Boom or Bust Phenomena. The importance of Paced activity and exercise. • Often, we feel good when we embark on a new movement and exercise program, and we feel so good that we often overdo it and pay for it with an exacerbation of both pain and fatigue, which leads to a fibro flare and decreased capacity to do what matters. • It is very important to pace your activities and slowly increase the activity over a very long period as your capacity builds to tolerate more activity and capacity to obtain the goals of more energy and less pain. • Recommend starting at about 30% of what you think you can do and then start adding to that capacity by about 5% or 10% per month until you reach a tolerance level where you do not have unmanageable negative consequences.
11. Bottoms Up: Boom or Bust Phenomena. The importance of Paced activity and exercise. • For those who are very impaired, a simple prescription is to get up and walk or move like you’re walking in bed or from a chair for 3 minutes every hour that you are awake. Tai Chi and Qi Gong are very good gentle alternatives as well. By the end of the day most likely you will have managed to get in 30 minutes of movement more than what you were doing before you started. • Otherwise, if you have more capacity than that, see the recommended list of activities that are proven to improve fibromyalgia symptoms in the following slides.
12. Bottoms Up: Exercises that help manage Fibromyalgia. • Bottom Up – We all have 2 hearts, 1 in the chest and 2nd is the entire body! • Move daily anyway you can, PACED, short interval, graduated exercise. Goal is 5-30 minutes a day and is ok to break it up. • Aquatic therapy in warm water • Recumbent biking, trike, or pedal device [especially if dysautonomia w/ low BP] • Modified resistance training • Short Hikes or walks. • Dancing • Modified Yoga
13. Bottoms Up: Exercises that help manage Fibromyalgia with dysautonomia [POTS]
14. Bottoms Up: Exercises that help manage Fibromyalgia. • Bottom Up – We all have 2 hearts, 1 in the chest and 2nd is the entire body! • Move daily anyway you can, PACED, short interval, graduated exercise. Goal is 5-30 minutes a day and is ok to break it up. • Tai Chi • Qi Gong • Progressive muscle exercises especially if very sedentary or bed ridden. Very good for insomnia if done as a body scan exercise. • Infrared sauna or blankets can have a similar affect to mild exercise. • It is okay to take a short nap before you exercise and afterwards if needed.
15. The Health Benefits of Tai Chi: Harmony of Body and Mind • What is Tai Chi and Qi Gong? • Originating in ancient China, Tai Chi and Qi Gong blends gentle movements, deep breathing, guided imagery and meditation. • Known as "moving meditation," it fosters a profound mind-body connection. • No equipment is required to practice. Can even be done in the water. • Health Benefits: • Improves strength, balance, flexibility, mental wellbeing, and cardiovascular health, gently. • Alleviates pain and boosts the immune system. • Lots of clinical research that proves that it works to help fibromyalgia, neuro degenerative disease, cardiovascular disease, insomnia, depression and anxiety and arthritis. Is approved for cardiac rehabilitation. • Good way to make friends with similar interests. • Getting Started: • We will learn a short Medical Tai Chi form together as a group today. • Find a class, a qualified instructor or check out You Tube to help continue your practice long-term. • Start with basic movements and progress gradually. • Practice regularly for at least 5 minutes ad day and try to work up to 20-30 minutes.
16. Tai Chi - Qi Gong Therapy Form • Cloud Hands • Serve Tea • Dragon Swings its Tail • Dragon Pushes Its Palm • Crane Spreads it Wings • Take A Step And Push The Mountain • Pulse Breathing
17. Tai Chi - Qi Gong Therapy Form • Clouds Hands
18. Tai Chi - Qi Gong Therapy Form • Serve Tea (Grasping Sparrow’s Tail)
19. Tai Chi - Qi Gong Therapy Form Golden Dragon Swings Its Tail Dragon Pushes Its Palm
20. Tai Chi - Qi Gong Therapy Form • Crane Spreads Its Wings Take a Step and Push the Mountain
21. Tai Chi - Qi Gong Therapy Form • Pulse Breathing – notice your pulse at the fingertips or where ever it shows up and let your breath rise and fall evenly in harmony with your heartbeat. 5 in and 5 out.
22. Modified Resistance Training • Using gravity, a chair and countertop for support can be helpful. Please see fall prevention exercise handout in the after-visit summary for example of a routine. • Suitcase carry exercise very good for overall core strengthening if you like to use weights. • Overhead carry good for shoulder and upper back stability
23. Third group therapeutic recommendations • BOTTOMS UP • Pick 1-2 of the previous listed activities and start to gradually implement them into your self-care regimen as discussed. • Progressive Muscle Exercise and Tai Chi – Qi Gong Therapy form are great mind body exercises.
24. Next Class Topics: • Inside Out – Diet, nutritional supplements, prebiotics, probiotics, herbs, essential oils, cannabinoids, low dose Naltrexone, Psilocybin and medications Lyrica, Gabapentin, Amitriptyline, Cymbalta, Savella and Ketamine. New research on Mestinon for post exertional fatigue at Brigham Young University and Harvard. • Outside In – Neurostim, laser, red light, sauna, acupuncture, massage, somatic therapy, craniosacral, osteopathy, chiropractic, injections, surgeries. • Bundled Activities – Listen to music while dancing, walking outside, Tai Chi, Yoga, Qi Gong and more exercises that use all the directions by design. Exercise with friends and pets. Participating in support groups and volunteering.
25. 3rd group class question and answers.
26. Fibromyalgia Resources • Arthritis Foundation • American College of Rheumatology • National Fibromyalgia Association • Fibromyalgia on MedicineNet • Fibromyalgia on eMedicineHealth
27. Program support literature, and software apps are highly recommended for long- term success. Aim to read 3 chapters a week of the books and 3 minutes a day on the apps.
28. End of third class. Thank you for your participation!