New Fibromyalgia Diagnosis

[SCMRY]

Hi there,

I'm feeling lost with this diagnosis. I've had chronic pain in my right rib cage area for three years along with brain fog, exhaustion and muscle spasms and weakness in my legs. I was diagnosed with Celiac Disease, Gallbladder Disease, and Uterine Fibroids last year and have had to have surgeries for those issues. I have many GI and reproductive symptoms that are attributed to those conditions but I guess can also be symptoms of Fibromyalgia.

My question I guess is brain fog, muscle spasms, leg weakness, and exhaustion attributed to depression with this disease? I had my first Rheumatologist appointment today and he immediately said I must have a depressive disorder and/or Fibromyalgia. He kept insisting I'm depressed and have anxiety but I do not. I have a therapist who has been helping me to deal with managing the chronic pain and she's always told me that in her professional opinion I'm not depressed, just frustrated about not getting anywhere with a diagnosis.

My Rheumatologist told me if I'm not mentally showing signs of depression my symptoms are physical manifestations and I have to decide if I'm going to keep shopping around for a diagnosis or face my mental health issues. I guess he sees my working with a GI and OB specialists for valid medical conditions as shopping around? I'm just in shock and don't really know where to turn. Are depression and anxiety required for a Fibromyalgia diagnosis or is it just a symptom common with this disease? He told me to stop stigmatizing myself but I've never been diagnosed with any type of mental health issues! His insistence that I'm depressed has me rejecting the validity of his diagnosis completely even though I'm desperate to do something to feel better. Is this a thing that I'm just in denial about?

Thanks

 

[JayCS]

Hi SCMRY, and welcome!

My question I guess is brain fog, muscle spasms, leg weakness, and exhaustion attributed to depression with this disease?

Nope. Depression or just sadness / weariness can be a cause of fibro type symptoms, and like your therapist says an effect. But these 4 symptoms and many more are often present in people without any depression or anxiety at all. And where they come with depression and/or anxiety they are not normally attributed to it by people who understand fibromyalgia.
Of course, doing mental work on depression / anxiety - if we have it - will reduce our load just by reducing that, or by increasing resilience, the way we look at our pain etc., and if it is a trigger or even cause of some of the pain.
But you don't feel you have it, and even your therapist doesn't either, whilst you are brilliantly actually working on pain management. A rheumatologist is not an expert on psychiatric disease, and most aren't even experts on fibromyalgia, they're just lumped with it because they are the ones who have to exclude rheumatic diseases, which may present similarly.

Are depression and anxiety required for a Fibromyalgia diagnosis or is it just a symptom common with this disease? He told me to stop stigmatizing myself but I've never been diagnosed with any type of mental health issues! ....
His insistence that I'm depressed has me rejecting the validity of his diagnosis completely even though I'm desperate to do something to feel better. Is this a thing that I'm just in denial about?

No, your therapist shows you can't be in denial. Your rheumatologist who's seen you once and can't have gone in depth with any mental issues is putting himself above your therapist, who knows you well, and who you trust. To say "stop stigmatizing" without knowing you is presumptuous and psychologizing. However I think he will have meant well pointing this aspect out, and it is not an impossible one. So I'd take it with a pinch of salt, knowing what your therapist said. And I'd discuss exactly this with your therapist, to make sure he's probably wrong and help yourself regain certainty. What you could do to be on the safe side is talk about techniques for depression / anxiety if such situations come up, cos it's always good to know them, we are all sad or anxious sometimes.

Are depression and anxiety required for a Fibromyalgia diagnosis or is it just a symptom common with this disease?

You get only one point if you have depression in the current 2016 ACR criteria for fibromyalgia, whilst you can get up to 3 each if your "fatigue", "waking unrefreshed" and "cognitive symptoms" are "severe, continuous, pervasive, life-disturbing".

However what I can't yet see in your case is widespread enough pain to warrant the diagnosis.
You'd need pain in 4 of 5 body regions, and you say right rib cage and cramps in your legs.
If your cramps are in upper and lower leg that would be 2 points each, plus rib cage: If your Symptom Severity is 9 or above that would mean your Widespread Pain Index would be high enough. But pain as said also has to be generalized, pretty much all over.

Right rib cage: Have you checked for costochondritis? That's what it'd probably be if your rib muscles hurt when pushed. Youtube exercises for it would help, starting low, going slow.

I guess he sees my working with a GI and OB specialists for valid medical conditions as shopping around?

That sounds like he's keen to blame it all on one thing. How beautiful and easy that'd be. Instead I've found it very important not to "blame it on the fibro", but get each symptom checked to make sure, and then treat each singly. Getting things thoroughly checked is intended by the 2016 ACR criteria. Not getting things checked, but blaming it on the fibro is good for insurances, and if we haven't the motivation or money.

My story? No better than yours, at first... My first rheumatologist was in denial about my fibromyalgia, sent me to neurologist (and endocrinologist), he to psychiatrist (and sleep lab psychiatrist), and that psychiatrist was nice, but said he doesn't think it's "somatoform" depression, but an antidepressant might help, but then he wrote depression in my report. Then I went to a Christian counsellor I knew, who was also immediately convinced it's somatoform depression. I continued bravely in the hope that this would subside, until bits of anamnesis channeled into a generalized "we all need forgiveness, so that's your problem, this is the solution". However the sleep lab psychiatrist and a psychologist I'd been to a few times years ago and had confirmed I have no unresolved trauma both later confirmed: no depression, no anxiety, cheered me on on my health quest and supported me where they could. A bit difficult till then was that my wife had to be convinced that my traumas are resolved....

 

[sunkacola]

Hello SCRMY, and welcome to the forum . I agree with what Jay says above. It sounds to me as if you need a new doctor. You need to be thorooughly checked out for the various different things that could be causing these symptoms. This is not "shopping around" (what an insulting thing to be told), this is trying to find out if there's a cause that can be treated effectively, which is a completely reasonable and logical thing to do. Get a new doctor who will order the relevant tests.

If you get tested for everything and nothing comes up as a for sure cause, then it's likely you have fibromyalgia. If you do have fibro, having a doctor who keeps insisting that your problems are caused by a mental illness you know you don't have, and who speaks to you dismissively, is going to be detrimental to your efforts to manage life well.

 

[SCMRY]

Wow, this is so much information to digest but so helpful and really puts my mind at ease.

After sleeping on it I have to laugh at how quickly he had me doubting my own mental health. Despite my health issues I'm an active person who enjoys many hobbies and I have a great support network. My biggest problem is that I don't want to slow down and pay the price. Many of the physical activities he suggested I do to "get better" I already do.

I had to look up the somatoform but it's clear that's what he was referring to. My therapist had mentioned she didn't think I had any physical manifestations when I first started seeing her and she ruled that out after assessing me over many sessions. But I'll definitely be bringing this up when I meet her next week. I think she'll have a good laugh too.

After reading your feedback I'll be changing my PCP. She's never done a physical exam despite my ongoing complaints but my GI has and stated the rib cage pain was likely a musculoskeletal issue, though he didn't give it a name. I'll check out costochondritis therapies to see if the exercises help! It sounds exactly like what I've got going on.

Many of my other issues are directly likely related to my other diagnosed illnesses so it seems a bit extreme to lump them into a Fibromyalgia diagnosis. I'm also anemic and have vitamin deficiencies due to my Celiac Disease and Fibroids so the leg pain could be something as simple as restless leg syndrome which I never really considered. The more I think about it the more it seems like this is all related to those issues. My GI specialist said it could take up to two years to fix the intestinal issues I have so many given enough time this will all self resolve. I have another surgery for my fibroids coming up and I'm guessing the anemia and related symptoms will get better after that procedure.

I'm sorry you had a bad experience with your diagnosis though it does makes me feel better that I'm not the only one who's gone through this. And thank you so much for sharing your experience and suggestions. It means so much to me and I'm sure others as well.

Thank you for the support!