Winning at Fibromyalgia (Martina Ziegenbein MD Coaching)

In this first episode, I explain the difference between acute and chronic pain, or in in other words between the "regular" pain and "neuroplastic" or "brain" pain. The pain is always real, but it differs of where it comes from.

Hello there!

I am super excited to introduce you to my first Podcast ever called Winning At Fibromyalgia!

 Episode #1: Where does the pain of fibromyalgia come from?

 My name is Dr. Martina Ziegenbein, I am a board-certified Rheumatologist. For those of you who are wondering and do not know, Rheumatology is a field of Medicine that deals with all kinds of arthritis but also autoimmune conditions like lupus, vasculitis, myositis.

 It is October 15th 2021 at the time of the recording. The reason I am excited about this podcast, is because I believe a solution for women with pain from ibromyalgia IS available! And I want to share it with every woman who suffers with fibro. But first let me explain a little bit.

 Fibromyalgia is NOT considered an inflammatory condition at the time of the recording. It has many definitions in literature. It can be most simply described as “pain all over” that is often accompanied by slew of other symptoms including, but not limited to: brain fog, overwhelming fatigue, irritability, inability to concentrate, headaches, jaw or TMJ pain, IBS, vaginal or bladder pain (sometimes also referred to as interstitial cystitis). Many times patients with fibromyalgia also describe weird tingling or burning sensations in their hands or feet. Fatigue and pain are the most overwhelming symptoms and literally rule the life and make it miserable for many women who are unfortunate to suffer from it. Women are more often affected than men, and in summary, no one is really sure what is causing it. Genetic reasons, prior trauma (whether physical, emotional, or psychological) are all suspected causes. At the time of this recording, autoimmune origin was raised as a possibility in one recent research study but for the purposes of this podcast and discussion about fibromyalgia in general, the origin of the fibromyalgia pain is not believed to be autoimmune.

 Rheumatologists usually see a patient with fibromyalgia for the initial consultation, to confirm the diagnosis and then generally the patient is returned to the primary care doctor with recommendations on what to implement in treatment plan.

 I have been fascinated by fibromyalgia for a long time. I have been avoiding following these women regularly in my clinic initially, to give you a full disclosure. Reasons were several but mostly – the solution to pain felt too elusive and out of reach. Many times no matter what I tried for these patients, the pain would not remit or not remit consistently. Plus, I was reasoning, patients with Rheumatoid arthritis, psoriatic arthritis, gout and all the other diagnoses that also cause pain and suffering needed me more.

 This has changed recently. I moved from Wi to Cape Cod in March 2021. I have been re-evaluating my career and I realized that I truly, really, want to steer toward helping women with fibromyalgia. I studied more materials, immersed myself in all things fibromyalgia and I am happy to report that I think solution IS AVAILABLE. Which is the reason for my excitement to start this podcast and share with all the women with fibro 

 So the rest of this first episode is focused on the origins of the pain. What is causing the pain? First of all – PAIN IS REAL. In the past, many women felt not believed or dismissed because the pain was referred to as “psychosomatic” which for some reason meant that it was not real. Let me tell you – the pain IS REAL. You feel the pain, it hurts – the pain is real. However, the pain is not believed to be coming from the injured tissue or body – but rather from the brain or central nervous system! Let me explain.

 When we sprain our ankle or burn our hand on the stove – the pain is referred to as acute. The pain recetors in the tissues that are injured communicate the information through neurons into spinal cord and from spinal cord the information goes into the brain. Brain tells us to stop doing whatever we were doing that injured us. We limp for a while, we have a burn on our hand, we heal and the pain resolves. I will refer to that pain as “plain” pain or “regular” pain. There is nothing exciting about it. It is a survival mechanism and was meant to alert us to danger. So far so good? Acute pain = plain or regular pain

 Fibromyalgia pain on the other hand, is chronic, happening on daily basis and fluctuating in severity. It is a juicy and very exciting topic. There is nothing regular about it. Through rigorous and extensive research studying functional MRIs of the brain of patients with pain, it was discovered without any doubt that the chronic pain of fibromyalgia is basically a conglomerate of misfiring neurons. It is a mistake of the brain who is mis-interpreting regular signals from the body as “danger”. I just mentioned above that brain interprets pain as danger and that it is a survival mechanism. We are wired to interpret pain as danger. Danger is meant to put us on high alert. High alert means augmentation of our senses which can lead to (or even create) more pain. More pain leads in turn to more danger signals – which leads to more high alert messages to the brain which leads to more pain. It is referred to as NEUROPLASTIC or BRAIN PAIN. Chronic pain – neuroplastic pain. That means the fibromyalgia pain is brain pain, it comes from the pain.

 I feel it is important to stress again that the pain IS REAL. There is nothing imaginary about the pain. But the origin of the pain is basically brain centers that are full of misfiring neurons that are dealing with faulty information.

 As a side note, there are cases when chronic pain is NOT neuroplastic, for example patients with cancer or patients with severe damage to tissues that cannot heal – these patients have chronic pain that is not neuroplastic. OR they have a combination of acute and neuroplastic pain.

 One other way (though not a perfect way) to distinguish between acute and chronic pain is response of the patients to usual medical interventions or surgeries. Acute pain tends to respond well to meds. Chronic neuroplastic pain usually does not.

 The most exciting feature of the chronic pain is that it CAN Be made better. Our brains are adaptable. Neuroplasticity means that the brain pain pathways that are misfiring, CAN be rewired. And that Is why I am excited to start bringing this knowledge to all the women with fibromyalgia who have not been able yet to improve their pain consistently. It can be done and I will show you how.

So in summary, in this episode we covered the difference between acute or plan/regular pain and chronic pain of fibromyalgia that is also referred to as “neuroplastic pain” or brain pain. Stay tuned for next episode where I discuss how it comes to be. 

Hello there my friends and fibromyalgia warriors! I mean warriors in the most loving way.

Welcome to episode #2 of my podcast Winning at Fibromyalgia. I am Dr. Martina Ziegenbein, a rheumatologist and an executive producer of the podcast  Today’s episode title is: How does fibromyalgia pain come about?

One of my girlfriends just emailed me asking about the follow up episode to the first one. Thank you Sandi, I am a few hours behind on recording  I was told in the past I sometimes talk too fast and I am a little self-conscious about not being a native speaker. So I think about the BEST or OPTIMAL way to express myself and it may have caused a little paralysis  But here I go.

In the first episode last week, I explained the difference between acute and chronic pain, with the biggest contrast being that the former comes from the neurons in the injured tissues and the latter, also referred to as NEUROPLASTIC pain, comes from misfiring neurons in the brain. BOTH pains are processed in and by the brain, however. In the case of neuroplastic pain, brain changes in a way that reinforces chronic pain. The neurons in the brain are misinterpreting safe (or neutral) signals from the body as if they were dangerous.

BOTH PAINS feel the same AND ARE REAL. I feel It is important to stress this again. The PAIN of fibromyalgia, and any chronic pain for that matter, IS REAL. However, based on our current knowledge, there is no damage to the tissues that are hurting in patients with fibromyalgia. So what is going on?

I will give you short answer and then explain it: stress, emotions and especially fear.

It is common knowledge that stress can cause physical reactions. My face turns red when I am embarrassed. That’s because my emotions cause the autonomic nervous system to increase blood flow to the face. For somebody else it can be sweaty palms when they are nervous or upset stomach. These are not signs of disease, just normal physical reactions to stressful events and the mechanisms of BODY MIND SYNDROME. Stress causes emotions that cause our bodies to react by producing physical symptoms. The symptoms are real.

What is not common knowledge is that stress and emotions can create the neural pathways that can cause chronic and often severe physical symptoms. The cure for such chronic pain or other symptoms is not a drug but rather to identify and treat the underlying cause of the pain.   For most people, the underlying cause is that the emotional reactions to stress trigger neural circuits that create physical pain.

During times of stress, the emotion-based network sends signals to active the autonomous nervous system (ANS) and produce hormones of cortisol and adrenalin which turn on the “fight or flight” reaction. That’s a system that directs blood flow to muscles to get our body ready to run or do battle, and it causes our bodies to react instantly before we are aware of what is going on. We have this system to protect us from danger and improve our chances of survival. When we see a squiggly thing that looks like snake on the ground as we walk in the woods, we jump back, we don’t investigate what it might be.

The autonomic nerve system controls the nerve fibers that affects every area of our body. Studies have shown that emotions such as anxiety or anger cause increased tension in the back muscles of people with chronic back pain. This muscle tension, which can occur WITHOUT our conscious awareness, can cause severe and real physical pain. Often we are not aware of the emotions that are triggering these automatic physical responses.

The autonomous nervous system can produce a large variety of physical symptoms in humans in response to stress and emotions. They include: tingling, numbness, burning sensation, dizziness, tinnitus, anxiety, abdominal pain, heartburn, diarrhea, constipation, pain, itching…you get the idea, the list goes on.

The brain has complex mechanisms to handle pain that involves many structures. One part of this mechanism is anterior cingulate cortex (ACC). Emotional responses increase activity in this area, causing pain to be amplified. MRI studies show that when ACC is activated the pain is generally increased.

Emotional experiences in childhood are imprinted in the brain. Human infants are exposed to repeat blood drawing within the first few weeks of life have increased pain when they have medical procedures several months later. Adults who are exposed to traumatic events in childhood such as emotional, physical or sexual abuse have a much higher chance of developing chronic pain.

Chronic stress produces increased sensitivity to pain in the brain, the spinal cord, and the nerves. Certain cytokines are released during the times of stress, and these cytokines cause cells and nerve endings to be more sensitive to pain.

At least one study showed that adults with chronically elevated cortisol levels are more likely to develop pain. This further cemented the relationship between chronic stress and chronic pain.

Our brains have trouble dealing with chronic stresses of modern life. When stress becomes chronic and we feel trapped in situations for which there is no easy way out, we can easily develop a set of neural circuits that are painful.

Many patients I have worked with started experiencing pain shortly after or during a stressful situation in their lives. Big life changes, positive OR negative, can generate feelings of stress. With many of my other patients, it Is their past experience of exposure to physical or emotional or sexual abuse, that predisposed them to chronic pain. Certain behaviors, such as worrying, self-criticism and putting pressure on ourselves can also set up stage for chronic pain by putting our nervous system in the state of high alert (or chronic flight or fight reaction).

So how does an acute injury evolve into chronic pain in the setting of stress?

It can be a sprain, fracture or strain. Most injuries heal within several weeks. After that, if the pain does not go away, something else is usually going on. Many times, patients feel that the injury never healed or that there are “misalignments” that continue to cause pain. This is not really supported by research. Even if there is a scar tissue, scar tissue does not cause pain. The injury triggered a series of events that lead to the vicious CYCLE of pain.

In the setting of stressful life circumstances occurring around the same time as the injury, NERVES that carry danger signals from the site of injury to the brain are activated for prolonged time. They become SENSITIZED, meaning they are more likely to fire and send more danger signals with lesser amounts of tissue activations.

These small nerves learn to react to even very minor changes, such as tense muscles, which are EASILY triggered by an overly active ANS (autonomous nervous system) and ACC (anterior cingulate complex) – part of the brain that is closely connected to emotions.

These tiny nerves eventually start affecting the brain, through communications to the brain with other neurons. The areas of painful sensation in the brain also become sensitized. They continue to experience pain. Bam, this is where the scientists used the term of neuroplasticity (or brain reorganization= the brain ability to create NEW pain pathways).

The term BODY MIND SYNDROME (TMS) is used to express the connection between the reactions/symptoms in the body and the brain. One of the best examples of Mind Body syndrome is Phantom limb syndrome – people who had their limbs amputated continue to feel pain in an extremity that is no longer attached/present. That’s because brain re-organization and nerve sensitization happened.

Going one step further, a group of researchers tried to determine whether the brain could actually CREATE Pain. It is described in books by Dr. Alan Gordon in his new book WAY OUT and Dr. Schubiner’s book unlearn your pain: A study at University of Pittsburgh looked into hypnosis and pain. Researchers placed subjects in an fMRI machine and administered pain with a hot probe. The pain regions of the participants’ brains lit up. Then the scientists took the same subjects and HYPNOTIZED them, and induced pain through suggestion. The exact areas of their brains lit up on fMRIs. WHETHER THE PAIN WAS INDUCED PHYSICALLY OR THROUGH HYPNOSIS, THE SENSATION WAS THE SAME, as far as the brain was concerned.

This was the first evidence that the brain can CREATE PAIN that is indistinguishable from pain caused by stimulation of nerves in tissues! Real pain can be caused by either physical disease states OR by neuroplastic processes that create learned neural circuits. The fact is that ALL pain is experienced in the brain. We cannot have pain without activation of the pain pathways in the brain.

The pain is NOT in the HEAD, it IS IN THE BRAIN!

This concludes our second episode. If you liked it please share with friends or write a review. If you are interested to learn more, or have feedback please head on to my website martinaziegenbeinmdcoaching.com and click on “contact”.

I look forward to speaking with you next week again! 

In this episode I give a summary of my approach to fibromyalgia pain. It has 3 main steps and we talk about the first two and one substep of the 3rd step :-)

Hello there!

Welcome to Winning at Fibromyalgia Podcast

Episode #3: What can be done about fibromyalgia pain?

I am Dr. Martina Ziegenbein, the executive producer of the podcast. I am so excited to be here today.

In the first two episodes, I talked about what is fibromyalgia pain – that it is neuroplastic type of pain which comes from misfiring neurons of the brain pain centers and pain pathways.

IN the second podcast How does the fibro pain come to be, I explained that it is believed that certain emotions, including past traumatic events, current or past stress all increase cortisol levels in our system which sends danger signals in the brain and that CAN PRODUCE PAIN in the body!

I also stressed several times that the PAIN of FIBROMYALGIA IS REAL. You feel it is real. The reason it has gotten a lot of negative “press” in the past is that women were felt to be making the pain up or that the pain was “in their heads”.

The pain is REAL but it is caused by the brain. It is NOT a product of their imagination!

Today, I will summarize my framework of approaching this problem.

As a way of disclaimer and disclosure, I would like to mention my resources and where I go for information. I am a board certified Rheumatologist and my basic and first understanding of fibromyalgia was from reading all kinds of articles, resources and attending numerous lectures on fibromyalgia organized by ACR (American college of rheumatology).

In that regard, I follow work and available resources from the team of Dr. Daniel Clauw at University of Michigan who has been leading Fibromyalgia research for decades. His is the group that was among first to CONFIRM with fMRIs that the pain was real.

I also recently became acquainted with work of Dr. Alan Gordon whose book Way out talks about all kinds of research related to brain pain/neuroplastic pain and what to do about it. I will talk about his PAIN REPROCESSING SYSTEM In the coming episodes.

I integrate ALL of this information when I work with patients and am currently putting a course together for women in an online format.

So, in summary, there are only THREE BASIC steps that one has to follow in order to get started on the journey of improvement from fibromyalgia pain. They are:

1.  Confirm the diagnosis of Fibromyalgia
2.  START accepting the notion and concept of neuroplastic pain.

3.  Be willing to do things you have never done before, in order to get results you have never gotten before.

1. Practice of self-compassion and mindfulness DAILY.
2. Pain reprocessing therapy.
3. Evaluate your life for all stressors and where you might live out of integrity with your true self.

Let me elaborate on the first two.

1. Confirm the diagnosis of Fibromyalgia.

It is of crucial importance to have the diagnosis confirmed by a Rheumatologist. This is not just to plug for myself or my profession. I truly believe, and there is data to support this, that Rheumatologists are uniquely trained and positioned to diagnose the condition. Why you ask?

We are trained to look for clues on your history (meaning what you tell us, what your symptoms are) and your exam, that may point to the diagnosis of an inflammatory or autoimmune process. Fibromyalgia symptoms MAY LOOK LIKE inflammatory symptoms of someone with RA or other inflammatory condition. We, the rheumatologists are the ones who help you distinguish that.

The reason it is important is that RA, Lupus and other inflammatory conditions get treated with medications that suppress immune system and decrease inflammation. Fibromyalgia does not get treated with these meds. So it is of crucial importance to distinguish.

Generally speaking, once we are confident in our diagnosis, we don’t usually follow fibromyalgia patients longitudinally in our practice. I do so because I specialize in helping women with fibromyalgia. General rheumatologists specialize in seeing patients with inflammatory conditions. There is no harm, in my opinion, to check in with rheumatologists every 3-5 years, or if there are any new symptoms that worry you or your primary care physician.

For the first visit, we generally want to see, or check ourselves, several labs including blood counts, liver, kidney, inflammation, muscle test and thyroid. Sometimes we check vitamin D level. IF these are all normal and exam is normal, we don’t usually look further. In some instances, if the labs are normal but the exam is not completely normal we look further. That is why you want to see us first.

So I hope I helped explain this topic 

2. The second point was to start accepting the concept of neuroplastic pain. This is so crucially important. We as physicians are still learning how to explain this to our patients so that they have a good understanding of the scope. I still see quite a few patients whose first reaction to my explanation about neuroplastic pain is: “oh are you saying my pain is not real?”. That means that despite my best efforts to reassure the person that the pain is real, there is no damage to the tissues, the message still gets lost. It IS A LOT to take in. If you have lived with pain for years or even a decade, and you believe that there is something wrong with your body, you can feel naturally dis-inclined to believe that the body is ok and that the pain is all produced by your brain. You could ask “why would my brain do that”? So yes, I get it, it is hard to accept at first.

I usually just start by asking my patients to being OPEN to the idea of neuroplastic pain. They don’t have to believe it or accept it right away. Because you can start taking steps to feeling better even without believing it fully.

But it IS important to start being OPEN to the idea of neuroplastic pain. Acceptance changes something in our brain that allows learning and new information to settle in.

3. Step is to be willing to do things you never tried before.

I would like to touch upon the practice of Self compassion and mindfulness daily today.

I have to dislose something here. Up until today, this item only included practicing mindfulness. And as serendipity would have it, I had the privilege of listening to Dr. Kristin Neff speak earlier today. Dr. Neff is the leading researcher on compassion, self-compassion and its effects on mental health. I am part of the Empowering Women Physician coaching program and she was a guest speaker today. It was truly transformational for me to hear her confirm what I have suspected for so long. Mindfulness is important and is actually part of having and practicing self-compassion for ourselves.

So what does it mean, you might ask, to practice selfcompassion? It means CARING about the pain and suffering of others and YOUR OWN.

I mentioned in the earlier episode that stress activates our “flight or fight” response. That sends danger signals to our primitive brain and increases cortisol levels in our body. Increased cortisol levels can directly lead to pain through increasing tension in the back muscles (and other muscles in the body) or just increasing sensitivity of the neurons to pain signals.

Practicing self compassion lowers blood pressure, heart rate and INCREASES levels of oxytocin in our body. Oxytocin is the “feel good” hormone that is released when the mothers first bond with their newborns, or anytime we have somebody touch us with care and kindness.

A practice of selfcompassion does not have to be complicated. It has three main components (kindness, awareness and the sense of common humanity) and literally means the following steps:

• Find a comfortable position, close your eyes.
• Slow down your breathing.
• Bring your attention to something stressful happening in your life.
• ACKNOWLEDGE the pain or suffering you are feeling. Name it – it could be anxiety, sadness, frustration. FEEL THE EMOTION.
• Now Imagine what you would say to a good friend if they were in this situation – it could be something like: of course you are sad or frustrated. Or angry. This is the human experience. It happens. Life is not perfect. Mistakes happen. Life happens. This is the human experience. You did or are doing the best you can. This is all you can do.
• And NOW SAY IT TO YOURSELF.
• Feel the emotion, allow yourself to feel it.
• Put a hand over your chest as if putting it over the heart to protect it, and feel kindness to yourself as it if was your friend or someone you love, because - it is. you are your best friend.
• Believe this friend that this is part of human experience, other people suffer too. You are not alone.
• You don’t have to fix it, you don’t have to do anything else, you are just bringing awareness to the emotions you are feeling, and you say kind things to yourself, because you care.
• That’s it, you can open your eyes.

Selfcompassion is not sugarcoating things. It is also NOT letting yourself off the hook. It is OPENING YOURSELF TO PAIN WITH KINDNESS. If you made a mistake, and you feel guilt, with kindness you can commit to doing your best not making the same mistake again. Rather than feeling shame you feel resolved not to make the mistake again.

When your brain gets kindness in response to frustration, anger, anxiety, something changes in the way you are able to deal with stress and pain. Your chemistry changes.

Everyone has THEIR OWN flavor of suffering. I have rheumatoid arthritis and some chronic aching in my back, other person has back pain, and yet another person has history of significant trauma. Everyone has some flavor of pain and the amount is different and the way it manifests is different.  THE HUMAN EXPERIENCE is about CHALLENGES. That’s what it means to be HUMAN. There is not a single person alive who does not have some pain or difficulty.

When we remember that truth, what happens is that instead of feeling all alone in our suffering and isolated in our struggles, we feel more connected to other people. The sense of CONNECTEDNESS gives us a sense of strength and coping and feeling we can handle this because this is a human condition.

So the main three components of self compassion are mindfulness/awareness of our pain, kind warm response to the pain and remembering that everyone has struggles.

I am going to leave you with that thought.

If you like this or found it helpful, please leave a comment or review. You can find me at Fb as Martina lenartova. Or on my website at: https://www.winningatfibromyalgia.com.

I look forward to chatting with you in the next session.

In this episode I continue to delve into components of pain reprocessing therapy. The basic outline of this process include: 1. confirming the dg of Fibromyalgia, 2. being open to the concept of neuroplastic pain, 3. practice of self-compassion, somatic tracking, and emotional awareness and expression therapy. Today we talk about somatic tracking.

Hello and Welcome everyone to episode #5!

Today I am going to talk about another part of pain reprocessing therapy - Emotional Awareness and Expression therapy

Let me first briefly summarize the main teaching points of prior 4 episodes 

1. Fibromyalgia pain – neuroplastic pain - misfiring neurons in the brain pain centers and pain pathways. They are misinterpreting safe or neutral signals from the body. THE PAIN IS REAL. The good news is that the pain pathways CAN BE REWIRED and the pain reversed. Other names for neuroplastic pain are central SENSITIZATION or AUGMENTATION pain.
2. Reasons for pain: unprocessed emotions, prior traumatic experiences in life, exacerbated by current trauma or injuries.
3. Winning at fibromyalgia process – my unique method implemented in treatment of my patients with fibromyalgia that borrows from several fields. The principal parts of the process are: Confirm the diagnosis of fibromyalgia (best handled by a Rheumatologist), 2. Education about the neuroplastic pain and Being open to the diagnosis/the concept of neuroplastic pain, and
4. Willingness to Try the methods PRT (pain reprocessing therapy). Of those we talked about A) the practice of fierce self-compassion which combines mindfulness, identifying our emotions and giving ourselves love and compassion like we would do for other people. B) somatic tracking which consists of approaching your pain with curiosity and basically “scanning” your body for all the sensations you feel in the moment and instead of being annoyed or upset, you send safety messages to your brain such as “I am ok, brain, I am healthy and strong, it will be ok”. The purpose of that is to soothe the brain and reassure it like you would reassure a scared small child.

Today I will talk about a psychological therapy referred to as emotional awareness and expression therapy (EAET). It is SOMEWHAT new approach but HAS been studied with SUCCESS in patients with fibromyalgia. Some case studies even suggest it can lead to RESOLUTION or REMISSION of the pain in some people! This is why I am so excited about this technique and have started using it in my practice in selected patients in whom I deemed it safe to proceed.

We already touched upon how the stress and emotions from the stress, can trigger, worsen or maintain our pain. Focus of EAET is the trauma, stress and relationship problems found in many people with chronic pain. Even more precisely, it focuses on thoughts and feelings.

So how does it work? It is done in individual or group sessions, anywhere from 8-12 sessions.

After educating my patients about the role of stress and emotions in their pain, we talk about the traumas or conflicts in their lives that appear to drive their pain. Some patients have told me upon initial discussion that they did not have any repressed emotions or no past trauma. As we start talking more, it turns out they have been through so much emotional pain and charged experiences, but they just did not associate them with their physical pain. We talk about it and I ask them to express emotionsthey have been avoiding or blocking related to the trauma or stressors, especially anger, but also guilt, sadness, love and self-compassion.

Because EAET is rather new, there are few providers who have been trained specifically to deliver it. Many psychologists and other mental health providers have training in trauma-focused therapies and "exposure-based" therapies that help patients overcome their fears.

I am part of the pain reprocessing therapy course led by Dr. Schubiner who is one of the leading minds in the field of chronic pain and utilization of pain reprocessing therapy. He shares with us many successful stories and demonstrations of this techniques in his practice, the success and often immediate improvement is astounding.

A Therapist has patients revisit important conflicts or traumatic experiences that involve other people and helps patients "express the unexpressed" feelings to those people. This can be done with writing exercises but also involves "talking to" an empty chair where the imagined other person sits.

Patients are encouraged to activate and express their emotions fully, using their words, voice tone, and bodily expression (arms, face). Patients are helped to express the full range of avoided emotionsThey usually go through a range of emotions with guilt following anger, then sadness. Then they are guided by a therapist to love and self-compassion. This is all done with just imagining the other person.

Finally, patients are encouraged to plan and role play how they would like to be in real life with people who have been a source of stress or conflict. Such communication depends on the type of relationship and may involve healthy assertiveness and setting boundaries, and often includes being open, vulnerable, and expressing intimacy. Throughout therapy, patients are encouraged to work on emotional awareness, writing exercises, emotional expression, and healthy communication as homework. Successful EAET is typically associated with substantial reductions or even elimination of pain as well as improvements in functioning, mood, and relationships.

EAET and related approaches are associated with greater risk than CBT and other psychological treatments for chronic pain. EAET encourages patients to disclose and emotionally express experiences and feelings that may have been avoided for many years and that often are quite upsetting. It is not uncommon, therefore, for patients to become temporarily more upset (e.g., anxious, depressed, angry) as they start to deal with memories and feelings that have long been avoided. Pain and other physical symptoms sometimes increase temporarily. Because patients are encouraged to communicate and interact differently in their relationships, these relationships might change in ways that are unexpected. Practitioners of EAET believe, however, that such emotional and relationship changes are important to make, and even though they may be difficult in the short run, such changes can be healthy and lead to pain reductions in the longer-term.

EAET may not be appropriate for certain patients, especially those who have difficulties regulating their emotions, who have trouble thinking when they are emotional, or who tend to hurt themselves or others when memories or feelings are activated or intense. This would be all assessed during early sessions and decisions would be made how to best proceed.

That’s it for today’s session.

Please share or leave a review if you found it helpful. I would really appreciate it.

In the next episode, we will start tying all of these individual parts I have spoken about so far, together. A Winning at fibromyalgia approach is slowly emerging 

Until next time 

In this episode I introduce the 5 core steps of my Winning at Fibromyalgia Method. I have worked hard to distill it to just the main 5 so that it is short and simple. 

Today I am bringing you episode #6! It is so far my longest episode and possibly the most exciting.

I am explaining my “Method” how I approach fibromyalgia in my practice. It incorporates and summarizes things I learned from multiple years of rheumatology practice, attending, and listening to lectures on the topic of fibromyalgia, and attending courses of providers who treat (and often cure) chronic. It is a method I use on myself, as I have a mild to moderate case of myofascial or fibromyalgia pain in my back. I have worked hard to distill it to 5 basic steps and I will be sharing them with you in this episode.

Before I dive in, I want to mention that I do not talk about any medications that are frequently used in patients with fibromyalgia. The reason for this is that in my coaching practice, I do not prescribe medications. They CAN help but are rarely a long term solution on its own. I only rarely see cases when a medication works on its own, without the person doing any extra work. It does happen, but not that often. So I will not spend any time on medications today.

Another comment or disclaimer I need to mention is that The pre-requisite for working with me (whether privately or in my clinical practice) or applying this method on your own is that you do have a confirmed diagnosis of fibromyalgia. Which is best accomplished, IMO, by a rheumatologist. Reason for that is that as rheumatologists, we are uniquely trained to recognize and weed out all different sources of pain. So that’s a really important step “0”, ground 0, so to speak, before you can dive in the deep work of “Winning at fibromyalgia” method we will discuss here.

So, Are you ready? Here it is 

The 5 steps of my unique WINNING AT FIBROMYALGIA method are:

1. Be open to learning the concept of neuroplasticity
2. Believe you can and deserve to feel better.
3. Practice sending messages of safety to your brain.
4. Feel and process all of the emotions.
5. Listen to your intuition and let it guide you.

That’s it. 5 steps. Simple.

Let’s dive in each one.

Step #1: Be open to learning the concept of neuroplastic pain.

I have had many patients tell me that just the mere act of explaining the concept of neuroplastic pain literally lit the bulb in their head and they understood for the first time how their emotions are related to the pain. As a brief summary – neuroplastic pain means the pain you feel is REAL but is not caused by the injury or structural damage of tissues that are hurting (whether it be back, or arms or legs or any other body part). It is caused by misfiring neurons. Misbehaving neurons. Neurons that are misinterpreting neutral or safe information from the body as unsafe and translating it into pain. Brain is making a mistake.

WE ALL Know that stressful situations can cause symptoms – e.g. blushing in certain people (including me) when embarrassed, tightness or knots in the stomach when nervous, heart beating fast and sweaty palms – we accept those as normal and physiologic. We also accept that the symptoms described above are brief and resolve on their own.

But many people balk at the idea that physical PAIN ALSO can be a physiological response to stress. As if it was something to be embarrassed about. But guess what? It IS. Research has shown this. Pain in patients with fibromyalgia is facilitated through the SAME MECHANISM – of activating the “flight or fight” response. The difference is that it does not turn off. The neurons connections of pain pathways loops do not turn off, their pain volume is turned up.

Many people talk about pain in FM as just the pain volume control problem. It is volume control problem DUE to chronic stress, unprocessed emotions and all the past hurts dating as far back as our childhoods. Our memories, every single experience of our life is stored in the billions of neurons that compose our brain. Some of them are wired together through similar painful experiences, they created a NEURON SIGNATURE. And that gets activated when the “critical” threshold has been reached.

And as I mentioned many times before, the pain IS REAL, as documented by multiple studies with fMRIs (functional MRIs).

Understanding of neuroplastic pain, where it comes from AND THE FACT THAT IT IS NOT PERMANENT/it does NOT HAVE TO BE permanent, brings about a breath of hope. Because pain pathways CAN BE REWIRED 100 percent. Which brings me to #2 point.

Step #2. Believe you CAN and DESERVE to get better.

This has been arguably the toughest part for me on my own journey. And I have found to be the case with many of my female patients. Believing we CAN AND DESERVE to get better.

We often carry various burdens, sometimes dating way back to our childhoods, that we are not deserving of good things in life, or good health, or whatever good. It has been shocking to me to discover that I myself struggled with it, and MANY other women, including women physicians, have the same issue. At the same time, becoming aware that it might be your problem is a source of hope. Because believing one can get better is written all over the research studies and demonstrated by multiple success stories. Women with pain DO get unburdened from their pain, IT is a fact hence it is ok to believe it is possible for you too.

Believing we are DESERVING is separate from believing in a possibility of getting better. I struggled with this a lot and had a breakthrough in this belief (or rather, dis-belief) after hearing a comment of one of the prominent life coaches in my recent coaching program. It went something like this: “our innate essence, our pure SOUL, is inherently lovable”. The light went off in my brain, and I felt an instant relief.

How to go about this in general? IMO, it helps to identify where the idea of not being deserving comes from. My lack of belief in being deserving came from all the past wrongs I did (usually related to uttering hurtful words to family, or coworkers). I believed all the things I done wrong in my life made me undeserving. Nothing could be further from the truth. We are all humans and we all make mistakes. Hurting other people feelings does not make us undeserving, it means we have some faulty thought processes or beliefs that we need to work on. It makes us human. And forgiveness is available to each of us. If we give ourselves compassion, like we do to other people we love, we are able to see that making mistakes is human, it does not make us undeserving. Eventually my “disbelief” was released when I believed that I can forgive myself for all the past hurtful things I said.  It is a process though, and it does not happen overnight.

Believing is a HUGE step in getting better and I cannot overstate the importance of this. Power of belief has been written about by many authors, Dr. Bruce Lipton and Benson just to mention a couple. There is now scientific evidence that the power of belief can heal. Or harm. Our mind is very powerful and if we believe we can get better we usually do.

Step #3. Deliver messages of safety to the brain!

Another important one! Here belong the somatic tracking, fierce self-compassion and any other technique, of mindfulness or meditation that installs stillness and feeling of safety and calmness. It is also referred to as relaxation response.

We talked about how neuroplastic pain is a result of chronic irritation/activation of the flight or fight system (sympathetic nervous system) of which main hormones are the adrenalin and dopamine and cortisol. The brain needs to be calmed down, and it is achieved by activating the PARASYMPATHETIC nervous system.

We deliver messages of safety by calming our breathing, our thoughts, observing the sensations/pains in our body and telling brain – “it is ok, it is just pain, and we know where it is coming from. I am ok, my body is ok, you are ok, brain, it will be ok”.

I heard a very helpful comparison to what it means to activate a parasympathetic nervous response. The person explaining the process compared it to imagining you need to calm a scared child or scared self when you were little. You would soothe the child with calm voice, hugging and talking in a low voice and giving messages of safety and reassurance that everything will be ok. And our brain is behaving like a scared little child sometimes.

This is where FIERCE Self Compassion comes in also – recognizing all the emotions or difficult situations we are going through and giving ourselves love and compassion like we would to a good friend or someone we love.

When our breathing and heart rate slows down and blood pressure is lowered by eliciting the relaxation response, during somatic tracking or practice of self-compassion, our brain gets the messages of safety and reassurance. The practice of activating the parasympathetic nervous system literally activates the healing response. Chemicals produced by neurons during the relaxation response literally counteract the toxic effects of the chronic stress response. Your body starts healing DURING the practice of mindfulness, self-compassion and somatic tracking.

Step #4. FEEL and PROCESS all of the emotions.

So this is the step that is equally important to all the other steps. I talked a little bit about the importance of addressing emotions in the last podcast. People with chronic pain often have a lot of emotional distress, related to the pain but also to the current and past charged interactions or events in their lives. Often times the emotions were not being able to dealt with for one reason or another so the person suppressed them and just bottled them up.

Unprocessed emotions can manifest in myriad of ways, of which pain is just one. I don’t mean to talk about all the ways unprocessed emotions are detrimental to us. The most common examples are chronic irritability, or eating or drinking as ways of coping with unpleasant or difficult emotions.

I want to zero in on emotions as they pertain to chronic pain. Anger, guilt, resentment, all of them have a role in chronic pain. Mutliple studies have shown that processing and releasing the emotions leads to improvement in pain and overall life quality.

Possible avenues for release include EAET (emotional awareness expression therapy), IFS (internal family systems) and literally ANY THERAPY that allows for processing of the emotions related to current and past pains and hurts.

It can happen whatever way you know that works for you. I have searched many years to discover that IFS (internal family system) method is the best for me. It may be the same for you or something else. We will explore together what are your ways of coping and what would the most suitable step to engage in if you have not discovered your preferred method yet.

The bottom line of this step is to go back to the upsetting event, feeling the things you felt in the moment and REWRITING the story, in your imagination, of how you would have preferred to handle the upsetting event. It is/has been truly transformative for me.

Step #5. Get In touch with your intuition And let it guide you.

Your inner core self, your intuition, is like the all knowing guide that will tell you where you need to go. It is that little voice that you often feel, but many times don’t listen to, that knows what is best for you.

Dr. Lissa Rankin refers to it in her WHMI course as the inner pilot light.

Sometimes we call it gut feeling.

Steve Jobs had the best quote on this. He said: “"Have the courage to follow your heart and intuition. They somehow already know what you truly want to become.”

IN essence, our core self is calm, wise, curious, compassionate, loving, and having a lot of clarity.

Our inner self what is best for us and where it would like for us to go.

If we listen, amazing things happen.

If we don’t listen, interesting things happen. Sometimes we have pain, sometimes we feel uneasy or we can tell something is off.

The reason I mention intuition here is that following our inner wise or core self has implications on how we perceive our lives. If we live out of integrity with our core true beliefs, we often find ourselves feeling frustrated or stuck or irritated or angry or all of the above. And often we can experience pain.

Our inner core self can make us bold things, that sometimes others would judge or disapprove of. I am talking about people pursuing their dreams by changing careers, signing up for a school, or new course, asking for a promotion, asking for a raise, speaking up on behalf of others, becoming an activist. Or it can be ditching an old friendship if it does not feel it is serving us. Following our intuition can have MANY forms and it looks different for each of us.

I suspect we will talk more about this step in some of the future episodes but I considered it important enough to incorporate as one of the 5 core steps of my program.

I do need to mention one other disclaimer here at the end.

I DO NOT consider winning at fibromyalgia being pain free. What?? Yes, you heard me right. I do not believe that in order to live a good full life, free of fibromyalgia burden means being completely pain free. Don’t get me wrong, it IS nice to be pain free but I have found it is NOT required to be pain free in order to feel good. So how do I DEFINE a successful end to my method? For me personally, success means feeling good, healthy, strong, strong enough to do things I need to do and to enjoy life on my terms. Some pain is not a deal breaker – if it does not consume me.

So these are the 5 steps of my method (WINNING AT FIBROMYALGIA).

Shoot me a message if it piqued your interest.

Book a call with me on my website.

I would love to hear from you.

More good stuff to come from me in the future 

https://www.martinaziegenbeinmdcoaching.com

Welcome to Episode 7 of the (best ever) Winning at Fibromyalgia Podcast!!!

I am Dr. Martina Ziegenbein, a Rheumatologist and your Fibromyalgia expert and guide, bringing you news and all the things Fibromyalgia.

Timur and I spent some time with good friends in Boston and It was cold! I guess it is time for me to accept Cape Cod gets winter weather!

In the last episode, I talked about the 5 steps of my Winning at Fibromyalgia method. Today, I am talking about how do you know that you are winning, actually?

Your first response might be – well, I have no pain or less pain – and that is nice but it is only PART of having made good progress. What?? Yes, you heard me right. There are other “markers” or signs that tell you that you are succeeding with your efforts in setting yourself free from fibromyalgia forever. Here they are:

1. You now have the knowledge of what neuroplastic pain is.

Listen my friends, knowledge truly is power. It is not just a saying. Having knowledge is empowering and studies have shown that this fact alone can make some people feel better.

For the sake of rehearsal, I will summarize it here again. Neuroplastic pain is a result of misfiring neuronsthat are mis-interpreting signals from the body as dangerous and are putting the brain at alert mode/danger mode which in turn activates the pain (and other symptoms such as headache, IBS etc). The pain is a message from the brain that it is not feeling safe. Sometimes the reasons are obvious, sometimes less, but understanding that it is the danger signal that sets the pain off gives you a roadmap for investigation and curiousity. The brain has learned pain subconsciously, without you giving permission, and now the pain neurons are “wired”. The great news is that this pain can be RE-WIRED or UNLEARNED. And THAT part, my friends, is the good news and makes all the difference – that the pain can be UNLEARNED and pain pathways REWIRED!

2. As a result of having all this knowledge, You also understand that the road from pain to zero or very little pain is for the brain to receive messages of safety.

Consistently, every day. Imagine brain is Like a little child that is scared. It needs to be soothed and reassured. You achieve that, as we discussed, with somatic tracking or meditation or relaxation response and sending reassuring messages to the brain. Your brain literally learns how to feel safe and how good it feels to feel safe. It responds. I promise you, it does.

3. You feel HOPE.

You no longer feel that the pain must consume and dominate your life.  You know you can get better, and you believe you will. The hope changes at some point to having certainty, the feeling of inevitability, that your pain gets better.

I want to share my own breakthrough moment I recently had when I was doing a somatic tracking on myself. My upper back pain, that can be severe and annoying, just simply went away after I recognized the emotion I was feeling (I felt a lot of anxiety about an important meeting I had at work). It was glorious. It came back, but the moment made me realize I can and will get better.

The reason it was glorious is twosome – I felt better/the pain got better (yay)! But perhaps more importantly, I knew I DID it, and that means I can do it AGAIN. I can bring on that feeling myself.

4. You welcome all your emotions.

This does not mean that all emotions are pleasant. NOT AT ALL. Quite the opposite. But you are able to RECOGNIZE the emotion now, ALLOW yourself to FEEL it, and then soothe yourself/reassure yourself – by self-compassion or self-love or just by breathing.

I had a beautiful experience yesterday in my office. A patient came in, really upset about her knee pain. It was clear to me there was a lot of anxiety surrounding this pain. I was able to guide the patient through somatic tracking and then have the patient recognize she was feeling anxious, in her chest, and through the calm breathing and reassuring messages she was able to make it go away during our session. We were able to identify what is behind the anxiety (in her case, she lives alone and is concerned about not being able to get help should something happen to her).

5. You are not afraid of your pain anymore.

When it comes back or gets worse, you are able to say (even aloud): “Oh, ok, brain, I see what you are doing, you are sending me a message again. But it will be ok. It is just pain. I will be ok.

Now I have to say – this one I wish was easier. My back pain keeps coming back during driving – and I think I stress a bit especially on highways when I drive fast. I try to reassure my brain but it does not seem to respond very well.

That’s it for tonight my friends.

Connect with me via facebook or on my website: https://www.martinaziegenbeinmdcoaching.com

Hello Hello Hello!

I am excited to be back for an episode # 8 of Winning At Fibromyalgia podcast!

Title of today’s episode is: “How I reached breakthroughs on my own fibromyalgia journey”

I shared during an earlier episode on the podcast that I have fibromyalgia back pain. It is mostly in my upper and mid back. I have had it since 2010 or so. It has been really frustrating at times to figure out what works. I have been to PT, massages and even had a trigger injection by one of my Orthopedic colleagues. It helped for about 2-3 months then the pain returned.

 I did not have my Winning at Fibromyalgia method when I experienced my first breakthrough with my own pain. I did somatic tracking, WHILE ON MY LUNCH break, and my pain went away. It came back the next day but went away during meditation in the evening. And it has happened several times since then, my pain comes back but is less severe and one day I think it will stop coming back.

 So it was AFTER my breakthroughs that I mapped out the 5 step WAF method. I introduced the 5 steps in the last episode. They don’t have to be in the sequence I presented and here I share how they came to me.

1. Hope that I could feel better and the role of our past traumas play in our daily behavior.

Months before I started researching the neuroplastic pain concept in detail I signed up for the Whole health Medicine institute course for physicians organized by Dr. Lissa Rankin. It was organized online for the first time which made it immediately attractive to me. For a brief overview, Dr. Lissa Rankin is a leader in approaching health issues by digging in to find the root cause. I like her approach because she is NOT an anti-science or anti-medicine. Quite the contrary, she personifies the approach that I love – which si to combine the best of the best approaches – the best of the western medicine and everything else including harnessing the power of our brains and inner healing energy.

 The first online retreat happened in 7/2021 and Dr. Rankin introduced the concept of IFS (internal family system) approach to healing. It basically says we as humans have many parts within us, frozen in time, living inside our minds/hearts or memories. Like when you say “part of me wants to go (to a party but another part just wants to sit home and study… (or something similar). We have our responsible, reckless, fun loving, sad, angry parts. Any time our beliefs were formed in childhood or feelings hurt or anytime our worldview was shaped, our memory has an imprint of that part. Those that have been there since childhood are part of our subconscious mind. Richard Schwartz is the founder of this healing therapy method, and he has been perfecting it for over 30 years now. There are schools and courses to get trained at this and demand is super high.

 I realized that I had so much sorrow and pain hidden in my past that was connected how I acted and behaved in my daily life, years after my adverse childhood experiences and traumas. And when I say traumas I don’t mean anything super vicious like abuse. Adverse childhood experience is anything that does not allow a child to feel safe. You can put literally anything from verbal to physical to sexual abuse. But it does not have to be physical. Bullying is a good example. For the first time ever, truly ever, I knew I could “heal” my soul, all the past wrongs, and traumas. It was truly transformational. And from that experience came my everlasting hope for my own healing.

2. Deeper understanding of the neuroplastic pain concept.

 As a Rheumatologist I have been trained to view the fibromyalgia pain as central pain volume problem – that the pain is augmented in the brain or spinal cord due to various possibly even genetic factors. Factors that are out of our control. Meaning you can’t do anything about them.

 And That is not entirely true. Fibromyalgia pain is linked to emotions and chronically activate stress reaction, basically representing a chronic/perpetual body mind syndrome. And because of that (the link to emotions and chronic stress reaction, chronic activation of the sympathetic nervous system), WE CAN do something about it, if we CHOOSE.

 It took me a while to fully sink in – that my emotions – past and present, and stress (again past and present) could be causing my back pain. I was telling myself – the back trigger injection worked so it MUST be coming from my back at least to some degree right?!

 When you look at all the research, literature showcasing how emotions can bring on painful sensations, it is clear that the factors that affect pain are mostly WITHIN our control.

 And this is NOT to say that humans who have fibromyalgia are somehow personally responsible. NO! Not at all. All it means is that the pain is the message from the brain that it is not feeling safe.

 As soon as I did, and that would have been September 2021, amazing things started happening.

3. Somatic tracking and other messages of safety to the brain:

When I did somatic tracking the first time, I actually did not know it was called somatic tracking, or what the purpose was – my former coach told me to just basically “check in” with my body and check for any body sensations or emotions, and bring on a feeling of a warm light filling up my body, as if from the “Source”. It made me feel safe, and really cozy (the point of falling asleep). I do not remember whether it affected my pain at that time so I assume I did not have much pain around the time when I first did (January 2021). The method how this feeling of safety is brought on is different for different people, many people feel this way during a prayer. But the universal message this state of the mind and body it creates is the message of safety for the brain.

The purpose of somatic tracking is to focus on breathing, and ANY physical sensations one has in the body, including pain, and just observe it, without judgement and communicate a message of safety to the brain. Something like this: ”Brain I know what you are doing, I know you are sending this physical sensation of pain to me, and I know my body is ok, my body is healthy, and I want you to know I am safe”. You need to FEEL safe inside, you don’t have to say these things aloud, just to feel it and let the brain know that you know.

 I do somatic tracking daily, usually in the morning and at bed time, and also during my midday walk. Especially the midday walk time is special because I take a half an hour off after my morning clinic, I walk outside, and actively bring on relaxation response. It has now happened numerous times that even if I feel any tension in my jaw or my neck or upper back, it goes away during the walk.

4. I now view pain as an invitation to investigate/invitation to curiosity.

When my back pain first came back after disappearing during the meditation, I realized I needed to look “within”, find out what was going on that set my brain on high alert. It has now happened several times that I am able to make my pain go away with meditation and soothing messages, and it comes back. And instead of freaking out, or being annoyed or frustrated, I feel curiosity and start “investigation” of what is happening inside me that causes this “high alert” mode in my brain sending the pain message to me in form of back pain.

 My back pain comes on during driving. I just don’t like driving on highways between Cape Cod and Boston. Especially in the evening. I feel like I have to be on high alert. So I slow down. I feel better then. I also should mention that my back pain is less severe now when it comes back than it used to be even just 3 months ago. It is really incredible.

 5. I welcome my emotions.

I want to make it clear that I do not like feeling angry, or sad or frustrated. But I am so much better at mastering the awareness of them, which then allows me to respond rather than react to them – which makes me behave more calmly.

I have not mastered the entire range of my emotions and that’s why I think my pain comes back. However, the main message of this last point is that being aware of my emotions and breathing through them/my reactions to my circumstances has been one of the most pivotal parts of my healing journey.

I will dedicate more time to the topic of emotions in the future episodes.

Connect with me via facebook at my fb name martina lenartova or on my website: https://www.martinaziegenbeinmdcoaching.com

I showcase 3 patients who all have neuroplastic pain/symptoms and all three have different situations they are dealing with

Hello Friends and Winning at Fibromyalgia warriors!

Please know I mean the word “warrior” in the best possible sense of the word. My vision is to help a thousand women struggling with fibromyalgia every year. IN order to do that, I do have to become a warrior. Like a superwoman or Avenger. So I am becoming one 

Welcome to the Winning at Fibromyalgia podcast Episode #9!

Thank you to every single one of you who listens and downloads my podcast, it means the world to me. Thank you to those who share or spread the word. That’s how people find out about me and what I can do for them. So thank you I really appreciate it.

Today I talk about three patients from my practice this past week to showcase specific concerns and issues that come up during my encounters with real patients. It is one thing to talk theory and whole another ballgame to go out in the real world and practice what I teach.

Before I go on, I want to mention I purchased a new mike, that advertises to make my voice sound much better so as soon as next week you can assess whether that’s the case 

Let’s start with my first case. Let’s call her Julie, she is a lovely lady in her early 60’s, and she lives alone because her husband died. She has had chronic right knee pain that she believed was from RSD (reflex sympathetic dystrophy). In the weeks preceding her visit with me 2 weeks ago, she has been having high amount of R knee pain that sometimes would jump to the left one for no rhyme or reason, and seem to have responded only to short bursts of steroids or pain medications. Most peculiar of all, her R knee MRI was COMPLETELY normal. The patient was not reassured by that finding.

We met twice in the last 2 weeks. At the first visit I did a thorough exam of her joints and provided reassurance that her knee was fine. I also explained the concept of neuroplastic pain and she was surprised to find out such concept even existed! We did somatic tracking, at the beginning of which she had pain in the R knee and both ankles. ALL of the three locations had less or zero pain at the end of several minutes’ long somatic tracking session! She was very excited and happy.

During the session it did come up that she did not feel safe at home because she lived alone. As we probed it further, it turns out she does feel safe when she prays. And that’s what we held onto – the feeling she has when she prays – that’s exactly the same feeling we want the brain to have in order to feel safe.

She came to see me yesterday for a follow up. She told me that initially she felt so excited and reassured and the pain stayed away. But then the pain came back and she became anxious and stressed about it again – she felt and worried she was not “doing it right”. She worked herself up to believing she was NOT doing it right, and this was re-affirmed because the pain was not going away this time. She was stressed out and worried about whether she was “doing it right”.

What I want to highlight here is that there is no such thing as “doing it right” or in another words, perfectionism. The only requirement for doing somatic tracking is that you are relaxed, and calm, and curious– which is hard to do when the pain is severe – so we don’t recommend doing it then. Perfectionism is the opposite emotion we want you to be feeling and does not allow the brain to feel safe.

So that was one aspect that we addressed. The second was attachment to the outcome. Because the pain has gotten better every time she did somatic tracking up until that point, she expected the same outcome every time. And that’s the thing with somatic tracking. It usually does produce reduction of pain but often times, especially early on, it may “only” produce “shifts” in sensation. Sometimes sensation moves to another part of the body. Or the pain changes character – e.g. from burning to tingling. Which, in itself, is another proof of the concept of neuroplastic pain and should provide reassurance.

So however paradoxical it sounds, you want to be “unattached to the outcome” when doing any of the exercises for the pain. It is clear that we want your pain gone, but it is almost as if you “surrendered” to whatever may be, and not watching things like a “hawk” and expecting pain to go away. Expectation is a signal of alert to the brain which means danger and it produces more pain or allows the pain to stick. The pain reduces when the brain is reassured and feeling safe. Meaning – when you truly feel safe and reassured in the core of your soul.

Julie had a wonderful resolution of symptoms the second visit again, yesterday. It was a wonderful encounter for me also, to have an impact on someone’s life by sharing empowering knowledge and techniques to make the pain better. The impact is tremendous and very gratifying.

My second patient is Rebecca, who was referred to me for positive ana and sensation of “pins of needles” arms and legs but basically all over. She is in her late 40’s, and lives with her supportive husband and a school age daughter. Rebecca made it really easy for me because she beautifully described how her symptoms of IBS (irritable bowel season) got worse when her business got busy in the summer. She even said this is a pattern for her! It is a perfect example of a body-mind syndrome – real physical symptoms in response to stress.

This year, something new started happening – this was pins and needles sensation. It was there all the time but not the same intensity. And also new bladder symptoms (and negative urine tests for infection). I did a thorough exam, she already had normal labs done by her referring provider. There was no evidence of lupus or other autoimmune rheumatic disease. It was clear to me that her symptoms did not have any structural basis (yet they were clearly real), and I explained to her the concept of body-mind syndrome and neuroplasticity of the brain.

She was SO relieved to hear that body-mind syndrome can give people physical symptoms that are real and that can go away. We did not have time to do the somatic tracking because that was our first visit and I spent the time obtaining all the relevant history, doing the exam and explaining the neuroplasticity. Rebecca said that just hearing this information and knowing it exists made her feel better. I gave her some tools and we are meeting next week again to follow up and do somatic tracking.

My third patient was Mary, a pleasant lady in her 70’s who has severe PTSD and long history of chronic body pain. I again did thorough exam, and reviewed labs and confirmed the diagnosis of fibromyalgia for her. I explained the concept and she was very receptive to the idea, she even was able to immediately link her long-standing history of trauma and PTSD to her pain!

When I attempted to do somatic tracking with her, within the first minute of it she informed me she is unable to continue because relaxing with me in the office, having her eyes closed meant to her that she was letting go of the control and she was not able to do that. To let go of the hypervigilance.

What I want to point out here is that if that happens to you, and you encounter feeling like you cannot focus on your breath and relax because it means letting go of the control, it is also ok. It is maybe time to thank your anxiety for being such a good protector of you. The anxiety has been there for a long time and probably for a good reason. I recognize It is hard to imagine what people with physical or sexual trauma let go of the hypervigilance, and let their bodies be completely relaxed – it feels to them like they are defenseless. That’s ok. I am going to see Mary again and I suggested she tries this even for a second every day. And then maybe she will be able to do it for a few seconds. And slowly she may be able to build this to a minute. We will work with whatever we can get. As long as we are kind and compassionate with our bodies.

There is no “right” way to do this. Everyone is different and everyone’s physical body reacts differently. And it is all ok. This is all human experience. We meet it with Love and kindness and compassion.

This is all for today. I do look forward to catching up with all of you next week, hopefully with a new mic 

If you loved the episode, please let me know, or leave a review, I will appreciate it.

If you think someone else might benefit from it, please share, I will also appreciate it.

You can find me on facebook @martinalenartova and my website is: https://www.martinaziegenbeinmdcoaching.com.

My special guest Dr. Alexandra Stockwell and I discuss important conversations in a relationship as it pertains to someone in pain. I learned an important detail about approaching this type of conversation, that may have held me back in my own life because I have NOT been doing it!

Listen in and let me know what you think and whether approaching these conversations come to you naturally or you are like me and need some pointers :-)

You can find me at facebook under martina lenartova or on my website https://www.martinaziegenbeinmdcoaching.com

Dr. Stockwell is a host to Intimate Marriage Podcast or on her website https://www.alexandrastockwell.com/podcast/

Hi. This is Dr. Ziegenbein, your favorite Rheumatologist, and fibromyalgia expert.

Fibromyalgia has a capacity to rule, and even ruin your life. I am here to show you how to stand up to it, how to be your fibromyalgia boss. Once and for all. 

Welcome to episode # 11 Of the Winning at Fibromyalgia podcast!

I hope you LOVE my new intro and music as much as I do. I picked the music myself and then had someone with real mixing skillz attach it to my recording and then attach it to this episode.

Today I am going to talk to you about why It is important to see a rheumatologist to establish a diagnosis of fibromyalgia. I know I talked about it already in one of the earlier episodes. I feel strongly that it bears repeating because it comes up again and again. And I promise I am not just saying that to put a plug in for myself. I am talking about it because I find it crucial on the journey to finding answers and reliefs for all of you my lovely women with fibromyalgia pain.

So here are the reasons:

1. As rheumatologists, we are uniquely qualified to evaluate people with pain.

One of the important things a rheumatologist does is that we determine whether you have an inflammatory or non-inflammatory problem. Examples of an inflammatory problem are rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis. Examples of a non-inflammatory problem are fibromyalgia or osteoarthritis.

We are trained to ask questions that lead to uncover the source of your pain and we are trained to examine your joints and other parts of the body to look for inflammation.

So how do we do that? First, we LISTEN to you, your symptoms. We ask you specific questions, we look for specific things. We then examine you, the patient, and again we look for specific things. Generally, combination of exam and history is enough to determine which one of the two groups of problems the person has. Sometimes we do order specific labs and Xrays. This is either to confirm our suspicion of a diagnosis or rule out other things.

We give you the diagnosis. Sometimes things are not black or white, sometimes it takes a little longer to figure things out and sometimes a person has BOTH inflammatory and non-inflammatory problem. Which brings me to the next point.

2. We stay with you until we sort things out.

I remember once seeing a middle aged woman, her symptoms sounded very much like fibromyalgia and there was nothing inflammatory on exam. This was earlier in my career so it was possible I did not ask ALL the right questions. I sent her for labs and her sedimentation rate and CRP, which are the inflammatory markers were sky high! She did not have fibromyalgia, she had an inflammatory condition referred to as spondylarthropathy! We had to do a few more imaging studies to confirm the diagnosis but we did it. I put her on appropriate treatment and she got better!

I was very grateful that I was thorough and helped identify the problem. And that is what you get with a rheumatologist! We are smart, we are thorough, and we don’t let go until we are reasonably certain that we know what is going on.

Diagnosis of fibromyalgia is usually one of exclusion, meaning we can suspect it when we talk to you, but we rule out all other things we can think of, before we give you the dg.

Sometimes it takes extra time, sometimes it takes extra imaging studies like Xrays or even MRis but we are there with you until the diagnosis is made. Then you can have confidence that what you have is truly fibromyalgia.

With that confidence, you can move on forward with your plan to become the boss of fibromyalgia 

There is one more point I need to mention:

3.  We stay with you when things are gray/when the dg is not clear.

I want to be very honest here. Sometimes the diagnosis is really hard to make. Fibromyalgia can look very similar to two conditions in rheumatology – both psoriatic arthritis and spondylarthropathy can look similar if they are mild or have only subtle findings. It is a topic we even discuss in our facebook group for Women rheumatologists. AND, I have an article on my desk published in the journal of Rheumatology 4 years ago that is called: “The problem in differentiation between psoriatic-related polyenthesitis and fibromyalgia”! Enthesitis means inflammation of the tendon insertion to the bone. NORMALLY you can tell on exam that something is inflamed. But not always! The gray zones in Rheumatolgy are real! Sometimes it is simply too hard to make a 100 percent diagnosis. And we are honest about it and we tell you. And we tell you it might be ok to try something, a medication, to see whether it helps. If you have symptoms of fibromyalgia, and potentially another diagnosis, it is ok to work on BOTH SEPARATELY. So here is where the rheumatologists play a role – again. You work with your rheumatologist on the diagnosis that can be psa or SpA and you work with your rheumatologist OR ME on the fibromyalgia part that does NOT include any meds. That is still a win win situation to me.

 Ok, That is all for today  I Hope I made a case seeing a rheumatologist at some point in your journey.

 If you like this episode, please share with someone who can benefit from it too.

For questions or comments, you can find me on facebook under “martina lenartova” or on my website www.martinaziegenbeinmdcoaching.com.

And lastly, As always, I appreciate a lovely 5 star review or feedback from you :-)

Course announcement

Well hello everyone!

I am Dr. Ziegenbein, your favorite Rheumatologist and fibromyalgia expert coach!

Welcome to this bonus episode of WAF podcast! I have an exciting announcement and what a better time to announce it than at the end of the year? 

Can you believe it is New year’s eve tomorrow???

As you notice today I don’t have the fancy music/so called “intro” because my person who does it is on vacation, and I don’t know how to do that 

The announcement is that I created a brand new, one of its kind, Winning At Fibromyalgia online class!

I feel so dramatic (and excited) about it, because I believe this will create a breakthrough in your life and struggle with fibromyalgia.

As a rheumatologist I evaluate women with fibromyalgia EVERY day.

What I get to hear from these women is all or some variations of the following statements:

• “I am in a lot of PAIN, all the time!
• “Nothing I tried really worked!”
• Is this how the rest of my life will look like?? I don’t think I can live like this! I am tired of living like this!

And I am not even mentioning how they worry that there is something terribly wrong with their body, despite physicians not finding anything to put a finger on.

After MONTHS of studying, attending courses and reading books and scientific papers addressing this problem I Have a solution! I tried it myself, on my own fibromyalgia back pain and on my patients. It works.

The solution, in a nutshell is what neuroscience research had told us over the past decade. Which is that BRAIN IS CAUSING the pain and these brain pain pathways CAN BE REWIRED!!!!”

I have organized ALL of this information AND TOOLS in a way that you will go from “I can’t believe I will be in pain for the rest of my life!” –> to: “Oh my gosh, I can’t believe I did not know about this earlier!”

I believe in my program and the information I present so strongly that I GUARANTEE the results of empowering knowledge AND reduction in pain. Yes, you heard me right – I guarantee you the results. All you have to do is to show up and be willing to put in some work. I deliver the rest. Including your new belief and joyful excitement that your life CAN Look better! I promise you this is how powerful this information and tools are!

So how does this actually look like?

1. You sign up at my website www. Winningatfibromyalgia.com, under courses.
2. Starting the first week of January you will receive a small set of slides each week.
3. You study at your own pace, a little bit every day or all of the slides at once.
4. We meet as a small group of women, not more than 8, once a week, with me.

5,  The times will be Saturday or Monday at 9 pm. We review everything from the slides again and you will have a chance to ask questions.

6. I will demonstrate the technique to help chronic pain every zoom; then you will be able to use the healing technique on yourself, every day.
7. We will do it every week, for 6 weeks.

7. That’s it.

Doesn’t it sound wonderful?

I certainly think so!

The result of participation of this course is a breakthrough in 3 major areas:

• Knowledge base (you will know what fibromyalgia is and WHAT to do about it)
• You will experience significant reduction in pain
• You will notice looking forward to events and enjoying your life more.

Is that something you would LOVE to participate in and experience? I would!

To summarize:

• It is 6 modules, that you study on your own pace (not more than 20 slides each time)
• We meet weekly in small groups, on zoom for 60-90 minutes and we review all the information and I demonstrate the tools I talk about
• You can pick a start day January 8th (Saturday) or January 10th

First 8 of you will get it for 499 USD; After that the price goes up for future participants.

So, this represents truly unique opportunity for you to learn about fibromyalgia, what to do about it, basically become your fibromyalgia BOSS.

I have never done this before and you have an opportunity to be one of the first groups to try it!

Don’t wait. Go to: www.winningatfibromyalgia.com and click on the course to sign up!

 Or directly to:

https://www.martinaziegenbeinmdcoaching.com/offers/AY47nzDf/checkout

Episode 12 notes

Hello! It was so insightful to chat with Dr. Jill Bailey about her new adventure as a psychotherapist. She transitioned from being a Family Medicine physician into a psychotherapist after getting some additional training in 2021.

I picked her brain about how to approach anxiety and Here are some highlights on what we hit in our segment today:

• Bailey shares a bit of her story of how she got to where she is (1:45)
• Her journey to psychotherapy (2:42)
• What her strength is as a therapist (4:35)
• Why she enjoys addressing mental health of her clients (7:07)
• Setting realistic goals (as opposed to “dead people’s goals”) (9:57)
• What are automatic thoughts and how to break them (11:07), and balance thoughts (12:15)
• How and when to use a “noticing a thought” tool (13:12)
• Experiencing and awareness of emotions (14:11)
• Where our power lies (hint: in not reacting to our urges) (14:55)
• What are “core beliefs” (15:35)
• What is “flexible” belief (17:44)
• What is core belief record (18:44) – how a new core belief might be true
• What is the purpose of worry, really? (19:36)
• Awareness of how worry is not helpful
• Sensation of anxiety (22:33) – notice it, be aware of it, and how it may be rising (pot of boiling water – it starts with cold water first)
• Neat tool of “pocket relaxation” (23:44) and why it works (24:32), the science-y explanation for it! 

Dr. Jill Bailey can be found at www.telecbt.ca for psychotherapy session intake forms.

She also does life coaching at: www.jillbaileymdlifecoaching.ca.

She said she would love to be back 

You can reach me on facebook at "martina lenartova" or visit my website at: www.winningatfibromyalgia.com

Vulvar and vaginal pain, with and without sexual intercourse, is not particular or specific to fibromyalgia. However, it is not talked about often enough and it can be very disruptive to a woman's life. I am  chatting with Dr. Yasmin, a board Certified Gynecologist and Obstetrician who is specializing in intimate and sexual health of menopausal and postmenopausal women. 

SOme highlights:

5:20 - model of Dr. Yasmin's practice (both in office and virtual)

7:00 - the burden of pain in women with vulvodynia

9:13 - Dr. Yasmin's approach

12:52 causes of pain

14:10 approaches to treatment (hint: it may or may not involve injections!)

20:55 success rate of resolution of pain in Dr. Yasmin's hands

25:40 the switch of microphone and I answered some of Dr. Yasmin's questions :-)

Dr. Yasmin can be found online at www.alraymd.com, IG at @dryaz.alraymd and FB at Alray Direct Gynecology and Intimate Health Center https://www.facebook.com/alraymd

Episode 14: Who are you without your pain? Part 1.

I would appreciate any feedback so hop online to facebook or www.winningatfibromyalgia.com and leave me an email 

I have never considered the question fully, in reference to the pain until recently, when one of my young patients told me during a somatic tracking exercise we were doing in the office, that that’s her concern. She has had pain since she was 16. She got injured during martial art practice, doing something she routinely does, the injury was not properly addressed, and she developed headaches within a month of the injury that very soon became chronic. With time additional symptoms added on like lightheadedness upon standing up, fatigue and anxiety. The headaches became debilitating to the point she had to drop out of college.

We saw each other for the first time before Xmas, she was referred to me for a positive ANA. I did a thorough evaluation and did not think there was any evidence of lupus or other rheumatic autoimmune disease. I suspected that given her history of injury and not really having it addressed properly, her nervous system may have gotten a high alert signal and started misfiring. I explained to her the concept of neuroplastic pain. How the pain is generated by super-alerted brain. The pain is real but not caused by damage or injury (her MRIs have been normal). I explained that the pain pathways can be rewired because that’s what neuroplasticity means.

We talked about somatic tracking and meditation exercises. She came back last week and reported feeling a little better, with less anxiety, she said the headaches have not changed much. While we were doing somatic tracking exercise, she became very lightheaded, we paused, she drank some water and quickly recovered. As she was drinking water, she told me: “I have had the headaches for such a long time, I don’t really know who I am without them”.

It startled me because I have not been asking that question my clients and patients up until that point! But it makes PERFECT sense because if you have had pain for a LONG time, and it has limited what you do or how much you do in your daily life, of course it is a new circumstance to consider who you are without your pain! What will I do if I don’t have pain or if I have less pain? Who am I without my pain? What will be different? Will anything be different?

I want to share one more example of how this question is relevant. I have another patient, a lovely lady in her early 60’s who has been a part of addiction support group for years now. She has been so supportive of other members during the weekly sessions that the main coach suggested to her to become a coach herself. She initially did not consider it. Since we started working together utilizing the somatic tracking and self compassion approach last month, she has now started feeling better and has changed her mind about becoming a coach. Her Life path is changing as a result of pondering the possibility of who she was without her pain and what she could do without her pain!

I would like to summarize the process of pain reprocessing therapy that led my young patient to the thought of “who am I without my pain”:

• The default was – I have headaches, there is something wrong with me or my head.
• New consideration – my MRIs have been normal, and my exam is normal and my doctor is telling me that my nervous system is contributing or causing the pain.
• The brain research over the past decade shows that nervous system pathways CAN BE REWIRED!
• Hence, it is POSSIBLE, that my pain can get better! All it takes to send safety messages to my brain!
• I can do this! I am healthy, I can do somatic tracking, I can be kind to myself, I can have compassion for myself, and I can rewire the pain pathways!

I really really do want to hear from you! Have you been on the pain journey? Have you had experience with feeling the POSSIBILITY of being without pain? What did you do? What happened?

Please do contact me on fb or through my website at www.winningatfibromyalgia.com

Hello my lovely listeners!

Welcome to Episode 15 of the Winning at Fibromyalgia podcast!
Today I continue to ponder question: Who are you without your pain? part 2

DO you listen to your intuition?

In one of the earlier episodes (episode 5) I outlined my approach to my patients and clients with chronic pain and summarized it in 5 steps:

1. Be open to learning the concept of neuroplastic
2. Believe you can and deserve to feel better.
3. Practice sending messages of safety to your brain.
4. Feel and process all of the emotions.
5. Listen to your intuition and let it guide you.

Today I want to talk to you about the intuition part.

The pain reprocessing therapy focuses on sending safety messages to the brain as means of improving pain. And it does work. When I took the Pain reprocessing course of Dr. Alan Gordon (the author of the book WAY OUT) we learned to teach our patients to send safety messages to the brain. And it does seem to work for many patients with chronic pain.

But in my own practice and working with patients with fibromyalgia, it seems to me that identifying and understanding what led to the increased danger signal in the brain that triggered the pain circuitry in the first place is necessary to fully get out of it. That’s also emphasized in the Pain reprocessing course I took led by Dr. Schubiner, called “Freedom from Chronic pain” and the Whole Health Medicine Institute training I have been a part of for the past 6 months and bringing it to my clients live.

The WHMI method takes the approach of determining what is the root cause of whatever ailment that bothers the person the most. If any symptom is a message from the brain/our nervous system, what is the reason behind it?

Dr. Lissa Rankin is the founding “mother” of the WHMI and has been teaching health care providers on how to guide their patients/clients toward better health by over a decade. She is the author of the book Mind over Medicine, Fear cure and has a new book called Sacred Medicine out in April! We will talk about her book then because she agreed to be on my show around that time! So that’s super exciting! 

Dr. Rankin has been perfecting her method now for over a decade. The main premise of her method is that the body is wired for healing. When there is a disruption between our inner core, inner knowing or our integrity and what we do, chronic stress is a result of this imbalance. Then a symptom, or a group of symptoms resulting in a chronic illness or pain can develop. Chronic headaches, low back pain, IBS, obesity, high blood pressure, heart disease and even cancer. She helps guide patients and providers to their healthy self through series of 6 steps.

The 6 steps of WHMI include:

1. Believing you can heal; 2. Surrendering your attachment to outcome to a higher power or the inner knowing within yourself. 3. Building your healing circle. 4. Identifying the root cause; 5. Writing your own prescription and 6. Identifying any resistance to steps you need to take to heal.

Almost every one of these steps deals with trusting your intuition. And that’s what I would love to to talk to you about today.

Merriam Webster definition of Intuition: 1 : the ability to know something without having proof.

It is that little voice that lets us know what we should be doing, or not doing. It lets us know when we don’t live in alignment with our true self, our core values. Intuition is that thing you feel when you are doing something that does not feel right or event think you should not be doing it but you do it anyway. Think extra projects at work, think spending time with family members that make you feel like crap, think piling on an extra project for your friend that you then have resentment about but do it anyway.

Why am I saying all these things?

Once you start accepting of the neuroplastic pain concept, and pain being a message from the brain/nervous system, you inevitably start thinking about why. Why you are in pain, why did your brain feel overwhelmed. As we dig deeper into why, we inevitably uncover the things that may have piled up and caused an overwhelm (and as a result danger signal) in your brain. You uncover things. Things you are doing or are NOT doing that may lead to improvement.

Sometimes it may seem easy. Like a patient told me once when I explained the concept of brain pain in fibromyalgia – “of course I know why I am hurting. I don’t eat right, I don’t exercise and I am sad my sister is dying from cancer”. So if you just did all the things you would feel better right? If you ate better, and exercised better and accepted your sister’s fate, you would feel better. Except it does not work this way. The real reason behind the pain lies in what led her to not exercising, and not eating right. Being sad about your loved one dying is a normal response to a sad situation and in and of itself does not usually cause pain.

Utilizing the WHMI 6 step process I guide my clients to start the process of identifying what was the initial possible inciting event that led them to develop certain beliefs about themselves, that in turn may have led to various ailments or results of their actions.

Please know the invitation to dig deep is meant out of deep love and respect for you as my listeners, patients and clients. It is not meant to make you feel bad. It is truly an invitation to explore your inner knowing guide, your psyche, to find out what might have led to the results you are having today and where you need to go from here.

It is very often that we already know what we need to do. And we don’t do it. I know that if I want my joints to feel better in terms of my rheumatoid arthritis, I need to cut down on sugar and processed foods. And I am doing a world better since Christmas time. I am working with my faulty belief that full healing is not available for me. Because, it is.

One of my dreams is to found a brick and mortar Fibromyalgia healing center where I see patients in person, and where I will have a team of providers that help with various aspects of health including yoga teachers, massage therapists, physical therapists, psychotherapists. And I know that in order to get there I need to get more organized and keep taking action. And the reason this is SO hard is because it is better to stay invisible. More convenient. But that’s not an option for me anymore. The pain of regret is 100 times more heavier that pain of change and growth. So I keep forging forward.

I would like to know what is your intuition telling you? Are you heeding her call?

If not why not?

Can’t wait to hear from you.

Your loving expert fibromyalgia coach.

Find me on facebook under martina lenartova or on my website www.winningatfibromyalgia.com

Episode 16:

On PTSD, Chronic pain approach and CBT compassion with Dr. Leigh Ann Dooley

I am so excited about presenting this episode to all of you. Dr. Dooley is a board certified practicing Psychiatrist and currently works at Charlie Norwood VA Medical Center in Augusta, GA.

We chatted about so many things including what made her go into Psychiatry, who was her secret weapon in residency training and how she manages to stay above the stress. I loved her straight talk about her approach to PTSD and chronic pain. You will be able to hear and feel she truly cares about her patients. What I loved perhaps most about her is her passion for improvement and leaving things better than she found them. She is currently in the MPH program at Georgia State university, projected to graduate with the MPH degree in May. Because she wants to make things better for people and communities. I know I can find inspiration in that. And last but not the least, she is an ambassador to end the stigma around mental health in brown and black communities. It spoke to my heart when she genuinely sincerely talked about her experience and why she wants to make things better. I am so honored to introduce this human to you.

For the sake of disclosure, we do mention two non-FDA approved meds/approaches to pain and its associated symptoms: Provigil and cannabis.

On approaching PTSD in general 9:52

Importance of self-compassion 11:39

Delving deeper into trauma focused interventions at 14:10 including prolonged exposure 14:34

How symptoms can initially get worse before they get better 16:30

Her experience with CBT (cognitive behavioral therapy) 24:57 and why ACT is important (acceptance and commitment therapy)

Her most rewarding experience 29:31

Her most frustrating experience 32:25 (hint: seeing other humans suffer)

Her comments about MPH and pursuing her passions in non-clinical career 33:50

Why she says “nothing is off the table” in chronic pain management at 40:00

Facebook: Leigh Ann Dooley, MD

IG: @realdealdocDooley

Episode 17

Hello hello hello! 

Welcome to episode #17 of Winning at Fibromyalgia podcast!

I just want to spend a moment expressing gratitude to those who tune in and listen – thank you. I appreciate you. My little website analytics gives me some stats on my podcast and among them is a list of countries where my listeners are. I am so humbled to see I have listeners in US, Canada, Germany, UK, Australia, New Zealand, South Africa, Quatar. It is TRULY an honor to be reaching so many parts of the world. I would LOVE, love, love to hear from you. Who are you? What brought you to my podcast? What would you love to hear about that I have not addressed yet? I would love to know 

I was able to interview Dr. Howard Schubiner earlier this week. You are in for a treat. Dr. Schubiner is one of the leading researchers in the field of chronic pain but also actually runs a Mind Body program in Michigan, Ascension hospital in Southfield. The episode will drop soon. I learn from him every time I hear him talk, and I sat on 8 of his talks because I took his Pain reprocessing course.

SO How are you all doing?

In preparation for the episode with dr. Schubiner, I thought it would be an appropriate time to review some of the basic knowledge of the neuroplastic pain and what works for it. And also, to address what some of my patients have been telling me lately.

1. Neuroplastic pain of fibromyalgia is felt in the body, various places, all over, but is caused by the brain.
2. The pain is It is ALWAYS real.
3. People with fibromyalgia are more “sensitive” to various stimuli – touch, sounds, odors. The condition is still referred to as “central sensitization syndrome”. Meaning the volume button in the brain is turn “on” position.
4. The reason the button is in “ON” position can be generally ascribed to as “danger” signal. Brain produces pain as a sign of danger, it is a danger signal. Except in patients with fibromyalgia, there is no tissue damage. The alarm is fake. The signal – pain – is real, but the alarm is fake. There is no fire, there is no tissue damage, there is no structural damage (I will talk about exceptions in a moment).
5. The answer to improving pain is turning down or off the danger signal – and this is truly the most important answer to the pain. TURNING DOWN the danger signal. The nervous system will take care of the rest.

This may sound simple, almost silly, maybe, to some of you, but this is it. This is the secret to improving or elimination of pain.

The big question is of course “HOW DO I TURN THE DANGER SIGNAL DOWN”? I will answer with three examples and then summarize:

1. Example 1. 63 yo woman let’s call her Sylvia, with UCTD and new headaches for 4 months. UCTD stands for undifferentiated connective tissue disease and it means you have SOME features of autoimmune disease like lupus but they are not “full blown lupus” and they are not severe. She was extremely concerned about her headpain. It was daily, fairly widespread, and really concerning to her. I interviewed her and realized that her headache did not seem to be “organic” or related anything inflammatory, rather, it seemed neuroplastic. My main reason for identifying it as such was that Sylvia seemed to have put SO MUCH pressure on herself – to have her house clean, to do all the chores on time, to the point of having a guilty feeling just sitting down relaxing. We did somatic tracking in the office and Sylvia was able to relax enough to allow for the tension to come down during the somatic tracking, and her head pain was gone.

She saw me again two days ago. She reported that her head pain “wanted” to come back several times, and she quickly realized what was happening, that she was putting pressure on herself and getting stressed out and she gave herself permission to not be perfect.

SO in this case, the answer to HOW DO I TURN THE DANGER SIGNAL DOWN was: giving oneself permission to NOT be perfect and take time to relax.

She also told me about other wins related to this small change – her grandkids came to visit, and they are quite noisy and rumbunctious – and it went fine. Because she stayed calm and relax despite a little chaos.

Example 2: Another patient of mine, Mary, whom I mentioned in episode 14 (part one of my musings on Who are you without your pain). She has anxiety, fibromyalgia, chronic neck and back pain and headaches. We started working on her headaches and pain in December and she had almost immediate success especially with her anxiety and headaches. What somatic tracking has allowed her to do is to FEEL SAFE – and once she experienced it the first time, she knew she could experience the feeling again – because she now knows how to bring it back. So exampled two deals with feeling safe. When you genuinely feel safe, and let your brain know this lovingly, it responds. I promise it does.

Example 3: being open to the concept that neuroplasticity is responsible for their pain and that it can cause the pain.

This is the roadblock for most of my patients in my regular rheumatology practice when I talk to them about fibromyalgia.

I evaluate patients with pain to rule out any structural cause. I listen and examine them, I usually run labs and frequently also order Xrays. That often is sufficient to rule out a structural problem or inflammatory rheumatic process. And for a reminder, we do that so that we can be confident in the diagnosis of neuroplastic pain which underlies fibromyalgia. I am very thorough and sometimes I do go to greater lengths to rule out a disease process. Then I am usually satisfied. And here is what happens – I review the results with my patient, I explain there is good news because I did not find anything structural hence most likely the diagnosis is truly fibromyalgia – hence neuroplastic pain. And very often, the response is – I understand but I think there is something wrong because I cannot believe that the pain would be so severe if the brain was all causing it. My patient cannot believe there is nothing wrong structurally because of the severity of pain.

My heart aches for them. Yet the miracles won’t start happening until they believe.

So let’s break down this lack of belief a little bit. Can mistakes happen? As in – is it possible for a rheumatologist to mis-diagnose someone as having fibromyalgia when they do have something more serious such as psoriatic or rheumatoid arthritis? Of course it is possible. Is it likely? I would say not. Rheumatologists are trained to detect inflammation. We look for it everywhere on exam. We look for it in labs. We are like hound dogs. I would almost say that with us, it is almost like in that saying “if all you have is a hammer, everything looks like a nail”. We do NOT want to leave a diagnosis that has potential for joint damage undiagnosed! We WANT to find it. But if we don’t have any evidence of inflammation, or if the evidence is pointing in the direction of the fibromyalgia, we call it fibromyalgia.

I would say MOST cases of fibromyalgia are not equivocal – meaning, you have a good amount of certainty that there is nothing additional inflammatory going on.

In smaller percentage, we question ourselves and whether there is inflammation – that’s when we do more imaging. But at some point, we do draw a line when we don’t find any evidence of inflammation, even with advanced imaging. We say, let’s stop looking for non-existing inflammation and let’s start addressing your problem.

 And how to gain confidence in your doctor? It is a good question and one that only you as a patient can answer. Most of us endorse a second opinion even encourage our patients to get it if what we identified is not landing home.

To summarize the 5 steps of my Winning at Fibromyalgia method:

1. Believe you CAN and DESERVE to heal your pain.
2. Be open to the concept of neuroplastic pain and that it can cause even severe pain.
3. Practice sending safety messages to the brain (somatic tracking).
4. Feel all the emotions (fierce self compassion belongs here)
5. Look for and listen to your intuition.

I will leave you with that summary. I would love to hear back from you or if you left a feedback or lovely 5 star review.

Till next time 

Episode 18: Howard Schubiner, the Director of the Mind Body program and the best physician you can ask for when you have chronic pain

Dr. Schubiner is a clinical professor, Founder and Director of the Mind Body Medicine Center at Ascension Providence Hospital in Southfield, MI. He treats patients with chronic pain and makes their lives better. By curing or reducing the pain.

He is my role model, I have first met him in September 2021 on a conference call as part of my participation in Whole Health Medicine Institute course, and my whole trajectory was changed after his lecture. I then took his course Freedom from Chronic pain and learned so much about pain, and what to do about it. And I want to be a little bit like him  I want to be myself, of course but a little bit like him 

3:07 We started off by talking about Boulder Back pain study – the first of its kind, that showed that pain reprocessing therapy (PRT) works! For chronic back pain! 33 of the 44 patients in PRT arm experienced significant meaningful improvement in their pain! that’s huge!

5:43 Most patients with chronic back pain DO NOT have structural cause! (they may have “findings” on MRI but clinically they don’t account for the pain)

9:43 neuroplastic pain is real

10:00 neurocircuitry principles: brain processes ALL pain, with emotional injry/pain, brain can turn on the pain!

12:19 Diving into HOW DO WE KNOW WHETHER your pain is neuroplastic?

 15:15: we usually assume that pain means there is something wrong with our bodies

 16:48 It all comes down to HOPE

 18:35 Why it is important to have Marvel and be curious about your pain and brain

 20:05 Where to start with pain reprocessing – start with LOVE, COMPASSION and LISTENING

 22:56 the pain usually does not come out of nowhere

 23:45 Pain is reinforced and driven over time -> the more fear and frustration we have, the more pressure we put on ourselves, the more pain we often have

 26:25 How to overcome the lack of belief (in the diagnosis of neuroplastic pain)

 28:16 Ongoing stigma against role of psychology in pain but patients understand and get it – how the pain can be caused by our nervous systems/brain

31:31 Approach to pain reduction in fibromyalgia: education, emotional processing, what changes needs to happen in patients’ lives; gradual exposure to activities that cause pain

 35:50 PRT is not “coping” with pain but getting rid of the pain!

 36:11 speed of recovery depends on how fast we can learn, not on how long we had the disease!

 38:19 Predictive processing by the brain

 43:14 more about Emotions processing: NOT everybody needs to deal with emotions before they get better (boulder pain study emotional processing was not included). But given the state of current world, and high stress in everyone’s lives, it is important to at least address them because releasing the anger and resentment can be therapeutic

 You can find Dr. Schubiner at: https://www.unlearnyourpain.com

WAF Episode 19

Hello!

Welcome to episode 19 of the Winning at Fibromyalgia podcast! I feel a weird sense of pride that I am inching toward the number 20.

First of all, I want to acknowledge the tragedy and injustice going on in Ukraine. I am originally from Slovakia and during the era of Soviet union, Slovakia had Russian/Soviet military bases all over the country. We were still Czechoslovakia when we came under the political influence of the Soviet union in 1948. We were their “satellite” state until 1989 when the Velvet revolution happened and Communism and Soviet union fell apart. I do NOT know war.  My heart goes out to ALL the Ukrainians who did NOT sign up for this, who did NOT ask to be invaded. I am completely horrified by what unfolded this week. I hope and pray for miracles on the ground there.

I held my first virtual training on chronic pain last week, it was a success, I had one attendee who was a rheumatologist comment that she learned more from my presentation than she did in her fellowship. That was so good to hear and just solidified my conviction to continue doing this work. I will be doing more of these and I will always post on my website. So if you are not subscribed to my website, please do so right now so that you can be kept abreast of what is going on  www.winningatfibromyalgia.com

So today, I am going to share with you how life and mind and the body are interconnected in my OWN life. I teach my clients somatic tracking and fierce self-compassion and I practice it myself, but it does not always go as I want it to.

So this past week was my vacation week and it started off well enough. I gave the virtual talk on Fibromyalgia on Saturday. I joined a virtual coaching program for female physicians on Sunday. Life was good  I had big plans for how I am going to declutter my basement office  and all the things I was going to do for my business.

On Tuesday, while exploring cape cod with my son I found out I was on call for Rheumatology. ON my vacation – big fail in planning on my end. But it did not take too long, and I was able to solicit one of my colleagues help in switching the call. Which was great Except the staff would contact me basically every day until Friday about one or the other thing happening with my patients. I gently re-directed them to an on-call provider.

Then, an upsetting situation related to a close family member/members was culminating on Wednesday/Thursday. I do not have permission to share publicly but it has to do with rejection – I asked to be somewhere with a close family member, and I was told no. And I did not take it well. I felt rejected, hurt and I took it personally. So I said some harsh words – something along the lines, don’t ever contact me again then. The story already started unfolding 2 months ago but it was kind of culminating this week.

On Thursday I had a planned appointment for pelvic ultrasound due to some health issues I am dealing with. I woke up Thursday morning with a pelvic/bladder type of pain. I am not kidding you. I was initially surprised and still a little sleepy trying to figure out what is happening. And then it dawned on me – my body is experiencing pain IN ANTICIPATION of the pelvic ultrasound! I was completely fascinated. This has never happened to me like that before so that was all new to me. I lay down in bed and decided to try a little somatic tracking. And it worked! Within minutes, probably. I basically was sitting with that pain (actually I was laying down but you get the point), I was trying to describe it to myself, the best I could, and was telling my brain, listen buddy, I know what is going on, we don’t like the pelvic ultrasound, it can be annoying but our track record of surviving these is 100 percent – that’s pretty good right? So why don’t you let go. So that got better. I was so relieved.

Then I checked the news and found out about the attack on Ukraine – and almost immediately my back started hurting. In between my shoulder blades. Stabbing/burning, annoying pain I get mostly with driving, or when I have to work longer than I want to basically anytime I engage in activities I don’t fully enjoy or when I cannot relax.

Then I had the said ultrasound – and it was not normal but again, nothing horribly major. Then more news on Ukraine. And then I was reminded again about the sore family situation when I felt rejected (I still do).

So most of these things were out of my control. And they were affecting me. And I felt I was kind of losing it. I was catastrophizing and exaggerating: The world is falling apart (although one could argue that when innocent people are being slaughtered the world really is falling apart); my body is falling apart and my family is rejecting me. I needed help.

I did ask for help and received a lot of online support and suggestions on how to deal with the overwhelm over the news of war in Ukraine. One perspective stood out – from a friend who grew up in war time. She wrote: “I grew up in wartime. It started when I was 3 years old and went on for 8 years. I remember rationed oil, good and the long lines in front of bakeries and supermarkets. I missed schools and so many final exams. I well remember the red alarm and my parents rushing us out the door to go take shelter under the staircase. I remember the taped windows and the ruins of the bombed sites. War was ingrained into our lives from the beginning. It was part of our household, part of our daily life. We were awaiting the red alarm every damn night and having fun to reunite with the neighbors under the staircase or in the parking garage. …Life was going on. We were traveling, meeting with friends, celebrating birthdays at the same time that we were lining up outside phone kiosks after each attack to call our loved ones to make sure they are alive”. She was a young child, the war was engrained in her upbringing. This is not to diminish he tragedy of what is happening. My friend’s words were: This may sound absurd, but the passion and hope for living always overcomes killing…Its time for us to stop hate and war.

This gave me perspective. It is ok for me to be upset over the world’s events. It is ok for ALL of US to be upset. Because what is happening is horrid and unjust. At the same time, I am not helping anyone by freaking out. So I took a pause, I took a pause to breathe, to collect myself, to decide what to do next. While not being ok with all of this. But taking the pause and breathing did help me calm my brain. I felt at peace – still upset but realizing that I cannot help anyone by wrecking my mind and body over this. It helps to be calm and maybe plan out my next steps on how I can help.

My Doctor called me about the ultrasound the next day and we discussed the findings. She told me my options. I heard her out, without freaking out. I am not dying.

My situation with my family is not sorted out. When I am ready I will reach out to apologize for my harsh words. And we will see what happens. They may choose to forgive or not. We may be in each other’s lives again or we may not. IN the meantime, I am giving myself grace and patience and love. Because nobody else will love me and be my best friend if I am not my best friend first. If I don’t give myself what I need, nobody else will do it. That’s the thought I want to leave you all tonight. Meet yourself where you are at, give yourself all the love and all that you need. Like you would do to someone you truly love and care about. Because that person is you first.

Warmly

Martina Ziegenbein, MD

From my friend’s FB page:

1. Write a letter to your MP asking to remove Russia from the SWIFT payment system and establish a No Fly zone over Ukraine. I have provided templates in the comments.
2. Educate yourself and others. Remain aware of your sources and be wary of disinformation.
3. Sign this petition to help limit civilian casualties and give Ukraine a fighting chance. https://www.change.org/CloseTheSky
4. Donate. Below is a list of organizations, all vetted by Ukrainians either in Ukraine or Canada.

https://unitedhelpukraine.org/...

OR https://www.facebook.com/UnitedHelpUkraine.org/

https://www.redcross.ca/ (The federal government will match donations made to the Canadian Red Cross to help bring humanitarian relief to Ukraine)

https://bcufoundation.com/donate-today/ (Friends of Ukraine Defense Forces Fund (FUDF Fund)

https://www.ucc.ca

https://savelife.in.ua/en/donate/ (a Ukrainian organization operating on the grounds in Ukraine; I would hold off on this one since all banks are currently frozen and therefore relief efforts must be through other sources)

For other resources on how you can help as well as information on what is going on from people on the ground, please visit: linktr.ee/RazomForUkraine

Welcome to episode #21 of the Winning at Fibromyalgia podcast!

We have a special guest today Dr. Tamara Beckford. She is a Mom, Wife, ER physician, Host of Docs Who Care Podcast, Speaker and Wellness Expert coach and CEO of the Ur Caring Docs.

I brought Dr. Beckford on today because she helps professional women put their health and wellness first without guilt. She talks the talk and walks the walk. She is the embodiment of what it takes to live a full live and enjoy it. It takes work. I wanted to know her secrets.

We talk about so many things:

• How she decided to go into ER medicine (spoiler alert – she did NOT watch the ER show!)
• How she decided to be a nocturnist (someone who works nights only)
• What does she do during the day?
• Techniques she uses to wind down after her ER shift (spoiler alert – it has to do with murder mystery!)
• How she handles the stress/how she manages to stay calm during a shift. Here she provides perhaps the most beautiful explanation of why it is important to stay calm
• She tells me about her “wake up” routine (spoiler alert – it starts before she goes to bed after ER shift -she tosses her phone away)
• What she means when she says “I enter into my day, the day does not enter into me”.
• She does tell me her secret of staying calm and keeping the nervous system in parasympathetic mode after all – SELF CARE WITHOUT GUILT. It includes asking for help and receiving it. It includes understanding that in order for the wheels to spin, we have to be there – ergo, we have to take care of ourselves first. Reach out to your circle, community, ask for help.

She can be found on www.urcaringdocs.com .

IN today's episode, I am reminded of how many chronic pain sufferers do not know what kind of pain they have when they first start off with having pain. I have been participating in a book club of WAY OUT authored by Alan Gordon (through Tell me about your pain community on FB) and through talking to other attendees with chronic pain I was startled by the finding that it takes a long time for humans to find out what kind of pain they have. Finding a provider who can explain pain is #1 to getting better. 

I also review a few features of how to distinguish the brain pain (neuroplastic pain) from regular pain (structural pain).

Enjoy :-)

You can find me on facebook under Martina Lenartova or Dr. Martina Ziegenbein and of course as always I welcome your feedback at admin@martinaziegenbeinmdcoaching.com or website www.winningatfibromyalgia.com

Cheers

Martina

Welcome to part of my conversation with Dr. Lissa Rankin, a board certified Ob/Gyn who is now focusing most of her energy on healing work and just recently completed work on her newest book Sacred medicine (it can be pre-ordered on https://www.amazon.com/dp/B096NHG3M8/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1).

In the part two of our conversation, we talk about:

- cancer (and any chronic ailment) can be a a result of chronic overdoing/not caring for ourselves properly (and Dr. Rankin is careful to point out that she understands that it does not pertain to all cancer) 2:09

- 7:05 Sacred Medicine is a sequel to Mind over Medicine (2013, 2020). She has researched the stories of miraculous recovery/cure when we cannot clearly put a finger on it. Dr. Jeffrey Rediger chronicled cca 20 cases of miraculous recoveries in his book CURED

- Lissa's research led her to believe healing past traumas is incredibly important but there is NO ONE way to do it. The right "tool" or method is different for everyone, it is a matter of trial and error, doing the NEXT BEST STEP.

12:49 leaning into our 4 intelligences (mental, spiritual, emotional and somatic) will help us discover this next best step.

14:00 we discuss polyvagal theory (existence of sympathetic and parasympathetic nervous systems where the latter is divided into the ventral vagal system (the relaxation healing response) and dorsal vagal system the state of extreme threat). For some people with serious early trauma, only gentle somatic work can work. For others, IFS (internal family system) is the best next step/tool.

21:55 listen to what she thinks about what is the best place to start/how to choose what works for each of us :-)

Connect with Lissa at:
face book: LIssa Rankin

LissaRankin.com

HealAtLast.org 

Dr. Daniel Clauw is the leading researcher in the field of fibromyalgia and chronic pain at University of Michigan. HIs group was the first one to show that the pain of fibromyalgia was real. By using functional MRI of the brain (fMRI). We chatted about many things and today I am bringing you part 1 of the 2 part interview.

Part 1 brings the following:

- how it all came to be that he was leading the group in studying fMRIs in patient with fibromyalgia (his group got funding for studying various symptoms in Gulf of War veterans and used fibromyalgia patients as positive controls)

- What this meant for pain classification (entirely new group of pain type was created as a result of the study results - neuroplastic or nociplastic pain!)

- I asked whether you can actually see the fMRI "lighted up" images in real life (no, you cant :-()

- what the term neuroplasticity actually means (yes, the brain is trying to "shrink" certain regions and augments other regions!)

- is the cause of wide spread pain actually known?

- Children develop sleep problems and memory issues before they develop multisite pain

- Importance of correcting sleep (seriously)

- Effectiveness of NON-Pharmacological treatments as effective if not more than pharmacological treatments

- We did get to chat about pain reprocessing therapy and the approach that emphasizes focusing on prior trauma and psychological issues. 

His group offers free guide for patients called Painguide:

https://painguide.com

As always you can find me at: www.winningatfibromyalgia.com or on Apple Podcasts Winning at Fibromyalgia and I love if you can leave a 5 star review :-)

In the second part of the interview, Dr. Clauw discusses use of opioids, CBD and THC in fibromyalgia, as well as exciting new avenues the research is heading (study of psychodelics and calorie restriction).

As always don't hesitate to contact me at admin@martinaziegenbeinmdcoaching.com

or find me on facebook under Dr. Martina Ziegenbein Fibromyalgia Pain coaching! 

Episode 26: When sleep is a problem

 Dr. Afolabi-Brown is a board-certified sleep medicine physician and pediatric pulmonologist, founder of Restful sleep MD. She empowers busy moms prioritize their sleep.

 The struggle is real – pain and lack of refreshing sleep go hand in hand. We talked all things sleep:

• “It feels like I was hit by a truck”. Where do you even start when a client/patient tells you that’s how they fell?
• Two main issues with sleep: 1. Quantity versus quality.
  • Brown does not necessarily recommend using fitbit or “gadgets” to measure sleep (just another thing to worry about or stress about!)
  • She explains why sleep diary may be a good option
• Three “buckets” that can affect the quality of the sleep and lead to non-refreshing sleep:
  • Medical factors disrupting sleep: sleep apnea, restless leg syndrome, pain
  • Behavioral issues: habits such as caffeine consumption, napping during the day
  • Mood factors: anxiety, depression, autism, ADHD 
• The approach is INDIVIDUAL – meaning NOT Every person needs a sleep study! I gave Dr. Brown a challenge presenting a scenario when someone has a little bit from EACH BUCKET 
• We do talk about some basic labs that should be ordered for medical issues evaluation.
• If you have an underlying mood disorder, you should not be left untreated. Dr. Brown strongly endorses partnering with a psychiatrist or psychotherapists to help control those issues.
• What does it mean actually to have INSOMNIA – when you have it, you will need more than just sleep hygiene (which is a great tool to promote sleep)

 Insomnia means having difficulty falling and staying asleep or early morning awakenings.

• CBT-I (cognitive behavioral therapy for insomnia) is a recognized, tested therapeutical intervention for insomnia
• Sleep related issues are rarely just one cause/one solution situation (but sometimes they are)
• Brown answers my question on how to approach a situation when a client is not interested in pursuing medical evaluation for daytime sleepiness and fatigue.
• For physicians and providers = helpful suggestion on how to actually order a sleep study
  • Including ordering a HOME sleep test! – she explains what does the home sleep study actually accomplishes.

• Summary of Dr. Brown’s wise words: Start with fundamentals:
  • Healthy sleeping habits – wake up every day the same day!, meditation, mindfulness, journaling, many apps to help with sleep
  • Having a wind-down routine before the bedtime
  • Cool dark noise-free environment, reduce technology, use bed for sleep and intimacy only

• Of course we had to talk about THC gummies, valerian root and melatonin:
  • THC gummies help to fall asleep but not necessarily stay asleep or quality of sleep
• At the end Dr. Brown shares her secret – CONSISTENCY – she treats her sleep as an appointment with a doctor – because SLEEP IS TREATMENT, and is FREE. She makes an appointment with her sleep because it gives her multiple benefits.

• Dr. Brown can be found at:
  • RestfulsleepMD.com, also on IG
  •  

Today I am bringing to you Dr. Nissa Keyashian, an adult psychiatrist practicing and living in San Jose, CA. Her generosity in sharing her expertise may prove to be the most consequential of my guest episodes. We talk about mindfulness and stillness - the basics of what it means and how to start practicing.

STudies have shown that pain responds to stillness because that's when the "healing response" and parasympathetic nervous system are activated. Practicing stillness helps our mind, mood, immune system, sleep, and physical body in general.

Nissa shares the following gems:

- the 7 principles of mindfulness (and yes, she had to repeat it twice for me and I did not delete it from the episode :))

- The basics of practicing stillness

- Benefits of yoga

- Importance of forgiveness

- What was helpful the most to her as she started her mindfulness journey years ago.

- How to move through grief.

SHe can be found on AMindfulMD.com

SHe has a beautiful book out and you can pre-order it here:https://www.amazon.com/dp/1638077983?utm_source=Facebook&fbclid=IwAR1g2KDbwnTqLavgZ7vocDcDEXsTIUW-Il8-WloKzFC1Ekj7cZXYTXmeU7o

Episode 28: Recovering from Traumatic brain injury (TBI) and chronic pain with dr. Susan Hughes

Dr. Susan Hughes is a board certified currently non-practicing family medicine physician who survived and recovered from traumatic brain and other body injuries 8 years ago. She reveals:

- how it was to get through trauma of a car accidents, subsequent fall out including difficulty reading, speaking and remembering things and people and inability to continue practice medicine.

- Recovery is not linear

- She was not being the person whse wanted to be so At one point she had to make a decision to grow into a person she wanted to be – she poured herself into professional development

• Traumatic brain injury – the damage is not clearly visible (like a broken limb) and people may not believe that your symptoms are real/that you are not making them up!
• How you perceive something is how you receive something
• It is equally important to heal physically AND emotionally from the trauma. Important to talk to mental health provider if suffering mentally/emotionally
• She is now a speaker, author (chapter in a book GIFT of the Universe), coach, and connector

Website bouncehighest.com

Episode 29: why losing hope can torpedo your efforts at reducing pain from fibromyalgia

Well hello there my friends!

It has been a few weeks since I talked to you from my office in person  I brought several guests to you and I hope you loved the episodes.

Today I want to touch upon something that has been weighing on my mind last few days. I had a patient told me recently: “Doctor Z, I already DID ALL OF THAT. I tried EVERYTHING. I already did meditation, physical therapy, and more meditation and I am not better!”. This happened when I explained the neuroplasticity concept and how nervous system and our magnificent brain can produce pain. She has had fibromyalgia for over 25 years and also suffers from chronic low back pain.

I know it was frustration speaking. And also – to me anyway, it sounded like she may have started losing hope. Hope that her pain can get better. She had already tried all of the meds that are out there for fibromyalgia. Many of you may have already. They gave her side effects or did not help. Water aerobics have been beneficial but her pool is currently closed so she did not feel she could do that.

Here is what I want to tell you. The words matter. Language we talk to ourselves matters. And I have a science-y explanation for you, it is not just motivational speak that I am here to tell you 

There is a small structure, or should I say, a conglomerate of cells in the brain stem/right underneath the brain and at the top of the spinal cord referred to as RETICULAR ACTIVATION SYSTEM. Its sole job is to filter through millions bites of information our nervous system registers every second and only deliver to our cortex of our brain the relevant “stuff”. And how is it related to what I am talking here?

The cells of this reticular activation system (or simply RAS) comb through an ocean of information our nervous system is flood with. And by nervous system I mean input from eyes, mouth, touch and ears (the input from our smell goes somewhere else). What information gets to our conscious mind rests solely on this RAS guy! RAS regulates our wakefulness, flight or fight AND focus.

If the message we send to our brain (aka, the thought we think and words we say) is: I have already tried everything, this is pointless, nothing is working”, the RAS will look for information that confirms this thought. It will find all the ways we have already tried and failed in our efforts. It will emphasize how our pool is closed and will not let us think about other options. It will allow us to think that not moving is the best course of action, day after day, because what’s the point.

Please know I do not argue resting when it is warranted and when the body needs it. I do just that when I need it, when my body needs it. I absolutely 100 percent endorse the idea of listening to our body. What I am talking about here is indulging our primitive brain into thinking that we cannot do something or should not do something because it is not safe.

Our brains want to keep us safe. That’s their primary role. So if we feel we already tried everything, movement is not safe, there is no point in not trying anything else, the brain will say of course, don’t do anything new, stay where you are because you already know it is safe (eventhough you are miserable). A good day in the office, from brain perspective, is to stay dormant, and save energy.

If on the other hand, our thought is: ”Well this sounds weird and interesting at the same time, I wonder what is up with this neuroplasticity theory”, or “well this sounds interesting, I am not super excited but I am curious”, the RAS will filter through and lets in information that allows your curiosity and willingness to learn be satisfied.

So, to go along with the scenario I presented, the patient might say to herself: ”let me read the book the Dr. Recommended or let me try this somatic tracking thing – I am going to give it a try, it can’t hurt since I already tired other things!”.

Basically when the predominant feeling is curiosity, chemical and electrical changes happen in the brain, starting at the RAS level, that lead to different actions than the I give up approach. In our patient’s scenario, she might consider other pools acceptable options, or might try tai-chi and yoga instead.

One way how to get to change the default reaction of our brain, is to try the approach championed by Katie Byron. If you have a thought that suggests you already tried everything, you can ask ‘is it true” and answer it. Then ask “is it really true”? I don’t know about you but when the question is like that, I almost always say, well maybe not, maybe there are some holes in my theory. Next up is: ‘if you had a stroke and only the part of your brain with that though would be removed, who would you be without that thought?”. When I first heard that question as I was working with my limiting belief (of not being good enough), I literally cried, because if the negative belief is eliminated, we can be almost limitless. So who are you without the thought that everything was already tried?

And the last piece of tackling unhelpful thoughts is: how can you turn it around?

SO in this case, we could say: the pain has already tried everything. Now let me see what I can do to pain 

Episode 30: With Dr. Saloni Sharma on Solutions for back pain

I was so excited to talk to Dr. Sharma about back pain. Back pain is one of the most common problems of humans in general, and it does frequently bother patients with fibromyalgia. Dr. Sharma is a dual certified in Physical Medicine and rehabilitation (PM&R) and Pain management. She is medical director of the Orthopedic Integrative Health Center at Rohmans Orthopedics and specializes in the NON-operative care of musculoskeletal pain and dysfunction. She recently wrote and published a BOOK on back pain called THE PAIN SOLUTION and she CAME TO MY PODCAST TO TALK ABOUT IT! You are in for a treat.

In addition to the above qualifications, she studied Lifestyle medicine, Functional medicine and Integrative medicine through the Andrew Weill program at the Univ of Az. She had studied yoga and meditation, mindfulness and acupuncture!

We talked about:

• How she went from being traditionally trained pain medicine and Physical medicine and rehab specialist focused on physical causes and meds/interventions to Integrative realm where ALL modalities coexist in harmony AND WHOLE person is treated
• WHOLE person integrative approach is what allows for more effective approach to pain
• The exposure to yoga and meditation is part of her Indian culture and heritage
• A lot of patients ASK about non-traditional things BEYOND the injections and meds!
• She formed the integrative health center where she spends more time with patients and addresses all aspects of their life and health
• The book PAIN SOLUTION came out of desire and necessity to help our patients with chronic pain more
• The Relief 5R pillar plan:
  • Refuel (nutrition) – microbiome, fermented foods, sugar drama (answer – moderation)
  • Recharge (sleep/rest) – “build a sleep cave” (cool, dark and comfortable)!; “bedtime revenge procrastination” – avoid if you can (no screen time for 90 minutes before bedtime) BECAUSE I DESERVE IT (screen free time, mindfulness)
  • Re-vitalize (exercise): start small, literally even 5 minutes is better than 0!
  • Refresh (stress reduction) : “adult time out” – whatever gives us joy
  • Relate (relationship)
  •  
• What is microboost
• Microbiome: PAIN GUT connection, PAIN J
•  
• OINT connection
•  
• Few words of advice:
  • Take small steps, don’t beat yourself about setbacks.
  • There is no one single cure rather pieces of puzzle that just need to fit right, you have to figure which out works for you.
  • Set a goal, Write it down, commit to it. Your goal, you own it.
  • Track your progress and pat yourself on the back, give yourself praise.
  •  
• IN a way ALL OF THE THINGS THAT MAKE US BETTER ARE ALL COMMON SENSE.

https://www.amazon.com/Pain-Solution-Relieve-Prevent-Medication/dp/1608687937

https://www.salonisharmamd.com/

https://www.instagram.com/salonisharmamd/

https://rothmanortho.com/oihc

Episode 31: Winning at Fibromyalgia podcast

Well hello my friends!

It has been a while! I have been MIA a little bit, for a good reason and I am back  I met someone special, his name is Greg and he has swept me off my feet, that’s all I will say for now.

I am coming on today to introduce you to my new, simplified version 2.0.1 of my Winning at fibromyalgia method. It is very powerful and I am very proud of it.

For those who don’t know me, I am a board-certified rheumatologist and work almost full time at the Rheumatology office in Cape Cod. I am an expert fibromyalgia coach where I teach women with fibromyalgia tools to reduce their pain, and win at fibromyalgia.

The principle 4 steps are:

1. Believe (in the power of your own body to heal, in the power of your mind and nervous system)
2. Embrace (the concept of neuroplasticity)
3. Let go (of the expectations to get results fast) and
4. Do the work – mindfulness based exercises/techniques to bring peace and sense of safety to your nervous system that eventually reduces the pain

Rinse and repeat 

I want to start with the power of Belief today.

I cannot stress how important belief is. I truly cannot.

Believing my women can achieve pain reduction is #1 item I work on with my patients and clients alike. I want to tell you why it is so important.

I want to tell you this because I found out the hard way. I LACKED belief myself – until I took the Whole health medicine institute course led by Dr. Rankin. Going through her program made me realize I lacked belief in my body’s ability to heal. I was able to uncover where it was coming from, and then changed it around. It did not happen overnight. But I did it. And I now am sharing it with you, my listeners and clients.

I want the same for you.

SO first of all – why do I even talk about Believing?

There is an undeniable body of research supporting the notion that our thoughts and perceptions affect our physiology. That our mindsets can MEASURABLY affect physical healing. In research studies it is called placebo effect – meaning, taking a sugar pill has positive, measurable physiologic and physical effects (improvement in depression, mood, or asthma). There is even such thing as placebo surgeries! – when doctors opened up a patient/made an incision but did not do ANY instrumentation on patients knees and people felt better!!!! Can you comprehend this?

Fascinating research from Yale – IDENTICAL milkshake given to TWO groups of people with TWO different labels – one that suggested more “indulgent” or calorific drink triggered REAL body responses suggestive of having consumed more calories!! But they have not! That’s all our brains/minds at work!

Neurobiological research has shown that the placebo effect, which stems in part from individual’s mindset and expectation to heal, triggers DISTINCT BRAIN AREAS associated with ANXIETY and PAIN that activate physiological effects that lead to healing outcomes. The placebo effect is mediated by the release of neurotransmitters, consistently impacts certain areas of brain and even mirrors the action of of pharmaceuticals on human physiology.

In clinical trials it is actually NOT uncommon for the placebo to BEAT the active drug, especially in the studies on anti-depressants! Do you know what this means?? This means that our minds can produce the effects of a medication as powerful as an antidepressant!

This means that the mind is capable of great feats in healing the body. This should not come as surprise given that the body is an infinitely intelligent organism. Humans have been healing themselves long before the invention of modern medicine techniques. Indigenous shamans have been facilitating healing for thousands of years. They gave patients hope, and through expectation, the mind initiated the changes in physiology for the body to heal.

The question is not whether there is placebo effect (power of belief in healing) but WHAT CAN WE DO ABOUT IT?? How can we consciously deliberately harness that affect??

We don’t seem to know how to produce it on demand in health and medicine. We spend enormous amount of money developing meds trying to OUTPERFORM the placebo affect. How silly!

Mindset about treatments SHAPE treatment outcomes (antihistamine prick and cream test)

Placebo effect is the power of belief, and is related to multiple psychosocial factors. One factor is expectation, which relates to a reduction in anxiety, or in expectation of reward.

The placebo effect provides insight into the complexity of consciousness and how little we really know about the mind and its ability to heal. The scientific evidence is accumulating and points towards the possibility that the mind has an unlimited healing ability.

You heard me right – UNLIMITED healing ability. ALL WITHOUT OUR, HUMAN precious mind.

This makes a complete sense but skeptics don’t like common sense until the science proves it.

Where do the mindsets come from??

The placebo effect is a mind-body phenomenon that starts in the brain, results in clinical improvement and is intimately related to the ritual of the therapeutic act. This ritual involves things such as people in the room, spoken words, syringes or other devices and even the color of the pill.

One of the most important factors that trigger expectations and believe is a verbal suggestion. Verbal suggestions are frequently given in clinical studies of the placebo effect, and these words as part of the therapeutic ritual have powerful effects on the body. This is an important concept to remember because YOUR OWN WORDS BASED ON YOUR INNATE BELIEFS ARE part of your own therapeutic ritual every single day of your life.

The placebo effect emphasizes the importance of belief in overall health and wellness. BE positive in what you say and be discerning about what you believe. YOUR MIND-BODY IS listening.

More useful questions-  what is the best mindset to have, when diagnosed with fibromyalgia?

Answer” the one that empowers us. The one that enhances our belief in our body’s and mind’s ability to heal, to improve the pain. No matter what caused it.

The opposite is true also – injury to the body and negative thoughts can lead to stress, depression, anxiety and even to fear about getting injured again.

Standford University researchers found that what patients think and expect about treatments can influence health outcomes.

YOUR MINDSET CAN AFFECT YOUR RECOVERY.

Researcher Alia Crum, a psychologist at Standford describes her experience when she was 10 and broke her ankle while doing gymnastics but did not know it was broken first. She iced and taped it and competed the next day and qualified for nationals. Then she found out her ankle was broken. She basically MENTALLy overcame her injury.

Fibromyalgia CAUSES REAL pain but there is no injury. What a gift.

It is an invitation to us to utilize our brain, nervous system and mind healing potential to sway the course of the pain.

My entire coaching program is based on the premise that our brain has the power to alter the pain we feel in the body.

Once you start believing it can. And embrace the neuroplasticity as a real cause of pain, you have won.

Our brains usually need love or encouragement, sometimes both.

Our primitive brains are also wired to look for danger. Maybe in some of us the wiring is stronger than others.

What if our job was to provide reassurance to our primitive brains that we are safe, that we are strong, taking care of ourselves, attending to our needs and that things will be ok? And I am not talking about gaslighting and claiming everything will be fine if we are in real physical danger. I am talking providing our minds and nervous system reassurance and reassuring messages of safety when we are, in fact, physically ok, nobody is shooting at us or attacking us physically. Because short of physical danger, most of the time, we are ok.

The first step is to BELIEVE that we can get there – to the part where our nervous system is at peace, and we truly really believe we are ok. And that we can feel better. Things start changing then.

You can change your mindset.

The brain is NEUROPLASTIC – meaning neural networks can continue to grow, change and reorganize throughout the lifespan. By challenging yourself with new experiences and perspectives, you can FORM NEW NEURAL CONNECTIONS – OR MINDSETS – at ANY POINT in life.

I invite you to do the following exercise:

I am powerful.

I have the power (to change my neural connections).

I have the power to change my perception of pain.

I am strong, I am healthy, I am resilient.

I am learning to harness the power of my brain and nervous system

I believe in my body’s ability to heal and in my own ability to choose my own thoughts.

in episode 32: I talk about embracing the concept of neuroplasticity - the fact that the brain can determine what hurts, how much and can also make it better/we can rewire the brain neuro pain pathways.

ONe of the hallmarks of neuroplasticity is also the fact that the brain is wired for any sign of threat/danger. When it finds it, it can increase the sensitivity to pain and the pain perception itself.

It does not have to stay this way, and it never does. The pain can increase, or decrease, depending on our ability/on our brain's ability to increase or decrease activation of messages that turn off the pain.

enjoy :-)

Today we talk about somatic tracking as one of the core techniques on pain reduction.

You might wonder why we need to talk about self-compassion in pain reduction in fibromyalgia. What does it have to do with alleviating physical pain? Well, it turns out, a lot. Self-compassion is a way of soothing the over-agitated nervous system, that is amplifying our pain sensation on constant basis. We may not be directly to the part of our nervous system that amplifies the pain. WHen we practice self-compassion, we are addressing our suffering, whatever is the circumstance, and that soothes the nervous system as a whole - including parts that cause or amplify the pain.

enjoy, leave me a review or comment, appreciate hearing from you :-)

Martina

www.winningatfibromyalgia.com

Episode 37: Weaving the threads (of Winning at fibromyalgia philosophy) together

Hello friends.

In the past few episodes I discussed individual pieces of the Core Winning at Fibromyalgia program. Today I am coming on here for a sweet short episode to recap, and emphasize the most important pieces and what I am doing about it.

I do strongly recommend listening to prior episodes to learn more about the individual steps.

In summary, they include:

• The Neuroplasticity concept – the principle of this is that our central nervous sytem/brain can produce pain that is felt in the body, and more importantly, that it does not have to stay that way. Our brain has an amazing, incredible capacity to rewire itself, with a little bit of help.
•  
• The concept of Belief - in own’s body ability to heal, in our brain capacity to rewire, in ourselves, and our ability to get better.
•  
• Letting go of the attachment to the outcome. In short it means we can want something very much (to reduce our pain and improve our lives) but it can create a lot of pressure on our brain so it helps to feel certain lightness about our desire and journey to pain reduction. More curiousity and self compassion.

• The work – mindfulness based techniques that incoude somatic tracking, self compassion, healing emotional wounds from the past.

The most important pieces, in my opinion and the common denominator in all success stories are the belief in one’s ability to get better, to heal, to be pain free or with significantly less pain AND fierce self -love.

I have found on my own journey and from listening to the many women who got better – they believe and they love on themselves. Self-love can be hard to recognize as self love because the societal norms tell us what we “should” and should not do. And we put that pressure on ourselves. Some of the examples of the opposite of self love is:

• Putting others’ need ahead of your own – repeatedly. Many many moms do that. Every day. I just spoke to a good friend of mine whose husband took their kids to his parents for a weekend. For the first time in a long time she had 3 days to herself. She did not know what to do with herself. It was like a vacation. ALL MOMS need that. IF we don’t get our cups filled first, we cannot be tehre for other people, our subconcious brain detects a threat and boom, low level fight or flight reaction/stress response is on.
•  
• Working long hours just to be a good employee or feeling loyal to your employer. I am guilty of this and I am working hard on resolving this issue for myself. Many physicians and non-physicians in health care suffer from this condition – feeling responsible for the patient’s outcome so putting in extra time, extra mile to get things done. And many times that is appropriate and even desirable. But not every day, not all the time. The same applies to other industries.

• Staying in a toxic relationship or seemingly happy relatioinship when our intuition is screaming at us that we should get out.

We only have ONE precious life. We have to treat it like gift, we have to treat our health and our bodies as gifts.

What we feel, what we are going through matter. We should not be miserable at work or in life every day.

So here is what my team and I are doing.

Starting at the end of September,

I will be hosting weekly calls,

For women interested in supportive community and more knowledge about fibromyalgia and what to do about it.

We meet and talk about a topic each week

I share ways to assess your fibromyalgia and then

Prompts to do the tools

Or simply answer your questions

Being part of the supportive group where everyone knows what the other might have gone through thanks to fibromyalgia is priceless.

Support is the other key factor in becoming successful at winning at fibromyalgia. Support of people who know what you are going through, who hear you, see you AND believe in you.

That’s what I will be doing for you guys.

There will be a small fee associated with this activity, paid monthly, it will be a close knit and private community to get us started.

We will get to know each other story well, to whatever is each of you feeling comfortable,

And we share our knowledge and stories and tips every week

I will moderate it and it will be a positive, private, and confidential type of setting where everyone participating will feel comfortable and safe.

www.winningatfibromyalgia

admin@martinaziegenbeinmdcoaching.com

facebook name: martina lenartova

Episode 39: The pain of a break up is both emotional and physical

Hi! Welcome to episode #39!

Today I am going to talk about the pain of a break up! It is something I first heard about a year ago when I was taking pain reprocessing courses and at that time I found it fascinating. I was recently dating and it did not occur to me I would be “testing” on myself 

Break ups hurt. NO matter how many times you have thought about breaking up with the person or questioned whether your relationship was going to last – when it actually happens, and you like, loved them, it hurts.

So first, I met a great man, after not dating for almost 6 years, and he swept me off my feet and now we are broken up.  That’s the short story.

There is a study, believe it or not, that explored what happens when people are shown pictures of someone they loved/someone who broke up with them. Brain MRIs were done at the same time. They recruited 40 people for this, all of them had experienced a recent unwanted break up. The other part of the experiment was stimulation of the left forearm with a hot probe. Auch. And what they found is that the signal that is picked up at the time of looking at a picture of your ex overlaps significantly/almost identically with area in the brain that processes physical pain! Isnt’ this fascinating?

These findings give a new meaning to the sentence “break up hurts”. Because it does. And you can even prove it on the functional brain MRI!

But joking aside, these findings basically shed new insight into how emotional experiences lead to development of physical pain. They are consistent with the research on “embodiment” which means that emotional experiences are closely intricately and intimately connected to the physical sensation and processing of pain.

This explains why people may experience an uptick in pain after a breakup or whenever they are going through a difficult time that is accompanied by some kind of social rejection.

So the next question is what to do, can you make it better?

First of all, heart break is always hard and I am not here to tell you will make the pain go away. Break up means a loss of a relationship and no matter how bad it was, you still have to mourn the good and beautiful and wonderful things that you had experienced together. However, I do claim that what I am about to say will make YOU feel better about the whole situation and in turn, may improve the pain.

1. First, acknowledge the pain you are feeling, the heart ache.

The pain can be all consuming and excruciating. If you are anyone like me, who falls hard and experiences everything intensely, you will feel the pain intensely. trying to run away from it does not help. Acknowledge It is there and that it is ok.

2. Allow yourself a lot of grace and love.

You may cry, and feel intense sorrow, that may make it hard to function – let yourself feel it is ok. Love on yourself. Try to think of what gives you sense of love and reassurance. Then feel it, imagine it. I have been imagining a picture of me being a small girl, feeling sad and lost, and giving that little girl a huge loving warm and reassuring hug. Telling her it is going to be ok.

3. Know you are NOT alone.

Remember many other people have gone through this and you will get through this too. Almost anything we experience in life, and especially a break up, other humans have overcome. So can you. So can I.

4. Accept the decision.
5. If you are the one who was the recipient of the break up news, like me in this particular situation, accepting the decision is extremely important. For whatever reason the other person decided it was best for them to break up – that means it is best for you too. Because why would you want to be with someone who cannot see the same about you?

5. Try to learn from this experience – are there any ways you were not true to yourself in the process? If so, why not?

6. Know that you are going to be ok.

Episode 40: You experience an acute jolt of pain – now what?

Welcome to episode 40 of WAF Podcast!

I am recording this episode exactly on my podcast first anniversary! I launched The Winning at Fibromyalgia podcast exactly a year ago, October 15th 2021. It is now October 15th 2022. This is the 40th episode.

I could choose to be upset over not giving you 52 episodes – one per week.

But instead I am choosing to be grateful and excited. Grateful for all of you who listen and have found some form of helpful information, in one shape or another. I get excited when I get feedback that something I talked about or mention was helpful. I am also excited because a year ago I did not think I would do this, that I would be able to produce 40 episodes. It means putting my thoughts into words, on paper/computer screen, then recording it. It means picking and inviting guests on my podcast, recording the interview. Then listening to it and helping to edit. Hours and hours of work.

So, I am celebrating. This entire weekend. One of the questions I have for you – what are you celebrating when you look at the past year? I don’t think we should only reflect on the past year at the end of the year. I feel we can reflect any time of the year, especially if there is an anniversary.

It was also recently an anniversary of 8th year of my Mom passing. And I am not quite ready to talk about that on my podcast.

 I am so excited to be back. I have shared with you I have been going through a rather difficult time of accepting a dissolution of a romantic relationship. I am doing better and deeply appreciate all the messages of support and encouragement and love from you. It feels like I am almost over the hump 

Today, in addition to this being a celebratory podcast of one year anniversary  I am choosing to share another personal experience, intimately related to my story of fibromyalgia. Before I get to it, I do want to say one thing – aimed at all of you, my lovely women who suffer with pain every day, who wonder whether it can ever change, whether YOU can ever change it. I am here to tell you – YES YOU ABSOLUTELY CAN!

It is within your power to reduce your pain and turn the entire course of your fibromyalgia story around! I see it on myself, I see it in my patients, rewiring of the pain pathways, the pain neural circuits CAN be rewired, NEW neural connections can be created! Every minute. Every hour of every day, we have an opportunity create these new neuronal connections! That will translate in less pain and more enjoyment, and you doing things that you cannot imagine right now because you cannot see beyond the current moment 

My fibromyalgia back pain has been flaring through this break up time (and coming and going anniversary of my Mom’s passing). I have been doing somatic tracking every day and it is really good in the evening when I am relaxing and definitely flares up during the day when I am at work. But it has been tolerable. Now I decided a break up would be a good time to go to my old crossfit gym here on the cape. I was a member for several months last year but quit last September and joined more of a regular globo gym. I felt I was too destroyed after each workout back then, and my joints were sore after – I do have rheumatoid arthritis and I just did not feel it was right. 

So with this break up I decided to return to the crossfit. And there the second day I went, we were doing push press and split jerks. That’s a movement when you push the bar above your head while you catch it below – with your legs slightly apart, as if in a lounging position. And I overdid it, too enthusiastic, I put on too much weight. ON the way down, as I was receiving the bar with weights, I felt a pop/sharp pain in my R shoulder, followed by a temporary weakness, to the point of not being able to lift the arm for a few moments.

My first though was “no! I hurt my shoulder again!”, I do have a history of R shoulder injury/partial rotator cuff tear, from 10 years ago, that responded to PT but would flare every time I overdid things in Crossfit – lifting things above my head. And my first thought went to – OMG, I MUST HAVE NOW COMPLETELY TORN it, that’s why I have weakness and sharp pain, why else would the pain be there so sharp???

I was in a pure panic mode.

And this is where something magic happened and the reason I am sharing this episode with you. I WAS ABLE TO PAUSE. I was able to put a pause, a break between the trigger (the movement that I believed re-injured my shoulder) and my spiraling out of control, the dooms spiral. I already put the bar back on the rack.

 I went to the coach. I told her what happened/that I was worried about re-injury.

Then I tried and succeeded in calming myself down.

Two main things happened:

1. I focused on the pain and realized two areas were involved – my right mid back by the R shouldblade, that has had chronic flare over the last few weeks. It was on fire and super sore and the R shoulder – top/posterior, searing pain. Almost like somatic tracking but I don’t recommend somatic tracking in acute severe pain.
2. Second thing I did was that I told myself messages of reassurance – in my case it went like this: Martina, ok, so you MAY have torn the shoulder cuff, you MAY have. If you did, you know where to go – you will solicit help of one of the surgeons you are familiar with at your work place. You will be taken care of.

But right now you DON”T KNOW FOR SURE that you torn it. You just know that it is hurting.

Can you TRY to calm your breathing and mind down, and see whether it helps?

The coach came by in the meantime seeing I am trying to stretch and gave me a ball that they refer to as “Chinese torture” in my gym  She said I could try to use that to loosen up my muslces.

 Guys

That’s what did the trick – I was leaning against the ball against the wall on the SOREST spot on my R shoulderblade, to the point it was taking my breath away, that’s how sharp the pain was. YET I was successfully releasing the tension in my shoulders, I let the shoulders drop down, while staying calm and telling myself to stay calm, with my breath, with the pain, and applying the pressure.

I did NOT go to push press that gym session.

Over the next 48 hours, my pain went down from 9/10 down to 2-3/10. The pain was really severe that evening and I had trouble even just doing dishes – any motion with my right hand INCLUDING brushing teeth was flaring the pain. But I continued to breathe through all of it, and did not lose the sight of the fact that I would know what to do if the pain was not getting better.

The pain was better the next morning.

I went back to the gym the next day but did NOT do any overhead activity. I did stretching at home and in the gym for the next few days.

Then over the next several days the pain went almost back to baseline.

SO why am I talking about it?

For the following 3 reasons:

• Tense muscles can totally lead to acute muscle strains and acute pain. I clearly have myofascial pain and that underlying kind of baseline pain was there when the acute pain happened – and you need to know that this can happen.
• Acute pain does NOT mean automatically acute trauma or tear. It DOES or MAY mean injury, but there is a scale and degree to injuries. What I experienced was most likely minor muscle/tendon strain from overloading and not stretching enough or not having my shoulder muscles ready for the load I put on that bar.
• You can improve your pain experience by staying calm and knowing you have control over the physical experience of the pain. The main thing I did was to halt my anxiety or panic that I started feeling at the moment of the acute pain. I literally did not allow myself to go there. You can do it too and in fact you need to, in order to stay in control.

The second thing I did was I BELIEVED I COULD HANDLE things EVEN IF I HAD TRAUMA IN FORM OF TEAR> I never for a moment steered away from that though. And you can too – even if you are not a physician, you can have faith that you are able to seek help if the pain does not get better after the initial steps outlined above, or if it is getting worse in the first 48 hrs after injury.

Today's guest: Dr. Robyn Tiger

Physician | Trauma-Informed Self-Care Coach | Podcaster

Dr. Tiger shares so much good stuff it is hard to know where to start.

Robyn Tiger, MD is on a mission to empower busy humans with self-care tools backed by science and research. She does a lot of work with physicians on the verge of burnout or coming out of burnout but the tools she discusses in this episode are literally for EVERYONE.

At the beginning of the episode i asked her how she got to do the work she does - and she shares her OWN journey, how terrible her body felt while she was still working as a breast imaging radiologist. Her symptoms included body pain reminiscent of fibromyalgia and HOST of other symptoms that were ALL related to stress but nobody could diagnose it for her!

The signifcance of this episode that MOST of our chronic stress symptoms are completely reversible! IF and WHEN we are ready to start implementing simple, effective and ancient tools that old cultures thousands of years ago before us knew.

Dr. Tiger is certified in yoga therapy, meditation and life coaching. She offers innovative CME accredited courses, private coaching, and podcast that focus on complete physical, mental, and emotional well-being and resilience

When she’s not busy supporting her colleagues, Robyn can be found enjoying her own self-care through hiking, paddle boarding, meditating, yoga, playing with her dog, husband and kids in the mountains of Asheville, NC.

SHe is a host of Stress Free MD and her website is:

https://www.stressfreemd.net/

WAF Episode 44: The first of its kind, Winning at Fibromyalgia online course is born!

https://www.martinaziegenbeinmdcoaching.com/course-pre-sale-landing-page

https://www.martinaziegenbeinmdcoaching.com/offers/mgeMgobJ/checkout

Hello friends!

Today is a special day. First of all, I am recording this from my “studio” in England and when it airs, I will still be in England!  Of course, I don’t have a studio in England, I am visiting my sister and she lives in England, about 30 minutes southwest from London and so temporarily my recording studio is here 

 Second, today is day 3 of my new Winning at Fibromyalgia online course going live, meaning being available for purchase. This course is basically the labor of my study and research and seeing patients over the past 12 months and my desire to let the knowledge know the large swaths of people with fibromyalgia and other forms of similar chronic pains.

 What triggered me to get myself into high gear action was the culmination of events. I mentioned to you in one of the prior episodes I am working on a tedx talk about this new way of handling and reducing pain in fibromyalgia. I have continued seeing many women in my office with fibromyalgia and one of them literally told me she has felt crazy in medical offices when she would talk to physicians and other health care providers about her pain. Because she looks well, she did not feel believed, even dismissed. She felt she was viewed as a drug seeker when all she wanted was feeling better, feeling NORMAL.

If health care makes people feel crazy, something is very wrong. We can do better. I can do better.

 So I have put together an online format of material that I normally teach my patients in person, over the course of several sessions. It is an online program that teaches you everything about fibromyalgia and how to help yourself. It includes scientific information that I dissect into small digestible pieces. You learn at your own pace. From the comfort of your home.

 I am offering it for a super discounted price of 249 USD to a small number of participants who are eager to take advantage of this opportunity and realize this is a rare opportunity. This small group of learners we ask for your feedback on the course.

 t will only be available for purchase at this price tag until this coming Thursday. We will then close the cart and reopen in December at probably doubled price.8

 So why is it such a big deal?

1. It is first and only course of its kind at the moment in this space. You will not find another course geared toward humans suffering from fibromyalgia, not of this quality and not at this price.
2. When you purchase my course, you will have the advantage of learning from the Comfort of your home, even your PJs!
3. Price tag of 249 USD – I do not exaggerate when I say the courses of this kind, containing the type of information I cover are worth THOUSANDs of dollars. Thousands. I am making it available at this price so that it can become available to as many people with fibromyalgia of you as many are willing to learn and find out.
4. I have a unique combination of skills that were crucial for putting this course together – I am a rheumatologist so I have been seeing patients with fibromyalgia for over 15 years, I have the condition myself, and last but not the least I took special interest in understanding and trialing the tools to help – and proofed them on myself.
5. The information included in the course is the magic sauce:
   1. Scientific information I gathered over the course of many years as a rheumatologist and put it in small easy to digest bites. Examples of such information is how we know the pain in real in Fibromyalgia and what kind of factors affect it.
   2. I also summarize prior research done in the area of how our thoughts and beliefs affect our experiences of pain.
   3. I review, step by step, the WAF method to reduce the pain. It includes somatic experiencing of the pain, being able to be present in the moment and being able to be compassionate with and loving to ourselves.

I am obviously biased and I believe this is a great deal.

I say you jump in and see for yourself.

And until next time 

Episode 45: What does the pain relief in fibromyalgia really come down to?

Hello friends!

So Excited to be here, brining you episode #45.

The focus of today’s episode is zeroing in on what is the pain reduction really about. I had an epiphany very recently and realized that I have to share it with you because it just may help some of you to think of pain relief in fibromyalgia and other chronic pain conditions differently.

While I was still working on this episode, 2 days ago, I was in a car accident, I rear-ended a truck. I got distracted while in slow traffic, the line of cars stopped at a light and I did not realize this soon enough. The reason I am mentioning this is that I had yet another re-inforcement of the concept I am talking to you about!

So the question is: what does the pain relief in chronic pain and fibromyalgia really come down to? In a nutshell, the pain relief comes down to finding evidence for and focusing on all the ways our nervous system and brain ARE working FOR US as opposed to looking for evidence of how they do not. That’s it.

Let me explain.

If you listen to enough of my episodes or videos you know I view the process of recovery from chronic pain in 3 main steps or strategies:

1. Understand and embrace the concept of neuroplasticity – meaning – accept that the brain/central nervous system generate the pain (and as result can take it away because the neuronal connections are born and severed /deleted every day based on our practices and habits)
2. BELIEVE the pain relief is possible AND available to you
3. Lastly, engage the relaxation response that makes our primitive brains feel SAFE.

I notice that often, even myself, being an experienced pain coach that I am, I tend to first think of the worst case scenario when I experience worsening of pain. Basically, my brain offers the following thought: “You see?? It is NOT working! Your pain cannot and will not get better!” And in the past I would succumb to that thought which would lead me down the spiral of doom and would not lead to anything good, seriously.

The good news is that this is normal, Our brains, our lovely brains that want to keep us safe and comfortable and love familiarity above all else, even it is not serving us, will offer us that thought. And our job is to say, well, dear brain, how about focusing on ways this DOES work?

The way to achieve this, is to sit down with a pen and paper, and think of all the times your body DID do something that may have delighted or surprised you, or may not have even registered in your attention, basically you took it for granted. I will give you some examples:

• Think of one activity that you enjoy doing that you can actually forget a little or completely about your pain. Meaning, when you think about the pain then you may feel it but in the moment you are completely lost in the flow of things and you are blissfully unaware of any pain. This is a proof our nervous system is working as designed and intended. It takes away from the pain because it is focusing on something pleaseant and the pleasant and joy neurotransmitters temporarily win over the pain inducing ones.

• Think of ANY time your pain was clearly worse when you were stressed out or under enormous pressure – whether in personal life or in a workplace. Your pain was worse, you did not sleep well, you were more tired. This is a proof that the system is working. The stress response is resulting in increased production of stress related chemicals that make us feel worse.

• Have you ever felt excited about something, super excited, either an event you were going to go to, or a new movie, or a concert or a vacation you dreamt up and paid for, and transiently you could feel less burden of a pain? How about being excited about some project at home or at work where you were applying yourself creatively or in a leadership position – have you felt a jolt of energy, life force, energy to live and enjoy? The research has shown that when we feel good about ourselves, we feel better physically.

• At the time of my accident this past week, within moments of hitting the truck ahead of me, I started experiencing almost immediate sharp pains in my neck and upper back. Then as I moved my head the pain was worse, and I could feel my upper back spasming. It was fascinating how fast that happened. After calling 911 and securing my car out of traffic, I started actively communicating with my tight muscles and brain. I was still shaking a little but I was safe. I slowed down my breathing and actively relaxed my muscles of my neck and shoulders. And I was telling myself the words: “stay calm, breath, stay calm. This will be ok. Stay calm, breathe, you are safe, this will be ok”. It was incredible that it helped in the moment. I engaged this technique multiple times in the next 48 hours as I was dealing with the fallout of the accident and taking care of all the things. My pain was gone within 24-36 houts in my neck. I kid you neck. I get chronic pain by my right shoulderplain that flares with stress and it was still there but it subsided too.

To me that’s a clear evidence of how our nervous system and pain generators in the brain LISTEN and RESPOND to what we feed them. The words we tell ourselves matter because our primitive brains, and the structures in the brain whose sole purpose is to look for danger are looking and listening. And we can direct them.

So I invite all of you to think of ways how the “system” meaning our central nervous system, IS working right, is working for us.

Above all, I wish you a very happy and prosperous and safe and HEALHTY new year of 2023.

In this episode I give you suggestion on how to handle situation when you experience acute on top of chronic pain of fibromyalgia.

My patients often ask me: How do I know whether what I feel is my old fibromyalgia or something new and serious? in this episode I share my own recent experience after developing new symptoms of numbness tingling in R hand and R foot, how it freaked me out and what helped me feel better. The story is still evolving :-)

Break ups generally suck, for many reasons. But one of the main reasons is that they cause us a lot of pain. And emotional pain is very closely related to physical pain. In this episode i am sharing new thoughts that helped me overcome the crushing pain of my most recent break up.

Subtitled: The Power of Reframing In this episode, I dive into the power of reframing thoughts to alleviate chronic pain, particularly in fibromyalgia. Chronic pain originates in the brain's perception of threat, triggering a stress response. By learning to challenge and rewrite unhelpful beliefs, we can foster a sense of safety and improve our overall well-being. What You'll Learn: Why the brain matters in chronic pain: Chronic pain often stems from the brain’s perception of a threat, even when there’s no physical danger. A transformative case study: Meet Mary, a 70-year-old with severe knee osteoarthritis. Together, we worked to reframe her belief that sitting down made her unproductive. Embracing a new thought—that rest could be valuable and creative—helped her improve her mood, pain, and productivity. The power of belief: It’s not just about coming up with new thoughts; it’s about believing them and taking new actions from that belief. Insights from science: Drawing on Bruce Lipton's Biology of Belief, I explore how our thoughts act like the “medium” in which our cells thrive or fail.