Not long ago, I was contacted by a follower on Twitter regarding a troubling case of chronic pain that this individual had been suffering with steadily since the age of 16—for almost 30 years. She wondered if I might be able to help her diagnose the cause of her ongoing symptoms, since a litany of doctors seemed perplexed as to how to stop her pain beyond prescribing a stream of heavy-duty opioid medication, which only temporarily masked her symptoms. We scheduled a phone consult and spent almost two hours thoroughly analyzing her case.
Leah, 46, is a stay-at-home single mother of three children: two boys and a girl. She was formally diagnosed with fibromyalgia in 1998, but had been suffering with full-body pain most of her adult life. It took us almost 30 minutes of two-way dialogue just to define the full constellation of symptoms she was suffering. We used the symptom checklist from my Problem Description Worksheets to be careful not to miss anything, and to be as specific as possible. This is the full list of symptoms Leah disclosed:
- bloating (stomach)
- burning (neck/shoulders)
- cramping (feet frequently, sometimes in hands)
- itchy (especially after taking gout medication)
- numbness (mostly in feet, toes, and right leg)
- pins and needles (arms, neck, shoulders predominantly)
- pulsing (in back of neck and base of head)
- shooting pain (in arms and legs)
- sleepy/drowsy (periodically)
- swelling (in hands, feet, and face)
- tender to touch (back/base of neck)
- itchy/‘crawly’ skin
- hives (periodically)
- frequent headaches/migraines
- popping/snapping in shoulder (started 15 years ago)
- ‘squiggly worm’ in left eye vision
Where does one start with such a long and varied list of symptoms? Normally, I like to separate out the seemingly unrelated symptoms and just focus on finding the cause of the most prevalent or serious symptom or closely related set of symptoms, then see if managing the cause helps alleviate the other symptoms. But in Leah’s case, the constellation of symptoms was so broad and diverse, we decided to group them together and see if we could find any commonalities among them.
The next question involved defining who had the problem and who didn’t. This ‘IS/IS NOT’ comparison often reveals telling differences which point to possible causes. The trick is to always look for closely related ‘IS NOTs’. I asked Leah who else most closely related to her or who shared many common activities does not have any similar symptoms? She indicated that none of her three sisters, her three children, mother or father, partner, co-workers, nor close friends had chronic symptoms that were anything like the ones she listed.
Next, I asked her to indicate as clearly as possible where on her body she experienced her symptoms, and where she did not. Oftentimes, when there is clear separation as to the location on the body where the symptoms are experienced and where they are not experienced, this can point to possible causes which can be quickly tested. In Leah’s case however, she said her symptoms were experienced in one form or another virtually everywhere on her body, with almost no one specific area untouched. This truly appeared to be an extreme case of fibromyalgia, which usually manifests with full-body pain of indeterminate origin and expression.
Fortunately, we still had two more primary areas to explore that might reveal some possible explanations for her complex and painful symptoms. I asked Leah to try to remember when she first experienced any of these symptoms. Even though it was almost thirty years ago, she remembered clearly how old she was and even what she was doing when it first started: at the age of 16, while playing the piano! She indicated that the frequency and severity of her symptoms came and went periodically, but generally had grown more severe and persistent with every passing year. Now, her muscle pain and headaches were so extreme it often made her cry, with flares often lasting two to three full days.
The last often revealing category to explore pertained to the geographic location(s) where Leah lived and traveled. She indicated that she had lived in the Portland/Eugene/Springfield area of Oregon most of her life, recently moving a bit further inland to central Oregon. When I asked where else she had traveled on vacation or visits, particularly areas where she did not experience her symptoms as severely, she volunteered the first sliver of hope. She remembered a very specific time almost fifteen years ago when her symptoms suddenly and temporarily cleared up completely for a few weeks, when she visited her sister in Tucson, Arizona in the spring of 1998.
Normally, I like to systematically search for and define the relevant distinctions under all of the problem description categories pertaining to who, when, and where, before formulating and beginning to test the full scope of possible causes. But in this case we had such a clear and sharp area of immediate contrast, we decided to explore this new distinction immediately. What was different about the areas she lived in Oregon where she experienced her severe fibromyalgia symptoms compared to the location in Tucson where they suddenly and temporarily disappeared? A number of differences immediately came to mind: Tucson is much drier than costal Oregon; Tucson is a higher elevation than Portland; the desert climate of Tucson has a completely different type of flora than the wet and cool Portland area; and of course, Tucson is much sunnier than the Portland area.
What possible causes could we speculate given these intriguing and sharp distinctions? A number of possible causes came to mind immediately. Was Leah possibly being exposed to hidden sources of mold in the damp and clammy environment of Oregon? Might she be allergic to certain airborne pollens or organic material from the dense and leafy fauna found in Oregon? Or maybe it was a dietary change than she suddenly went on when she visited her sister in Tucson? We explored each of these possibilities, but one by one each of the hypotheses got ruled out. Leah had moved from the coastal area of Oregon to inland Oregon where it was far drier, and she had lived in so many different residences in the past thirty years that it was hard to imagine every house would be infested with mold. Similarly, the high desert environment of central Oregon where she currently lived had far different flora from the wet coastal city of Portland, and her symptoms were just as severe if not worse there. Also, she said that the meals her sister cooked and the restaurants they frequently during her visit to Tucson weren’t much different from her regular diet back in Oregon.
This left one remaining area of sharp contrast between Oregon vs. Tucson: the duration and intensity of sunshine. Tucson is not only much drier and thus gets more hours of sunshine, but it is also much further south with stronger and more direct sun at the time of year when Leah visited her sister. But how did this explain that Leah was still experiencing her fibromyalgia symptoms as bad as ever now that she lived in central Oregon which had almost as much sun as Tucson many times of the year?
This was where Leah revealed the other ‘smoking gun’ in the investigation: she suffered with severe agoraphobia, something none of her siblings, children, partners, co-workers, or friends (that she knew of) also did. Agoraphobia manifests with a fear of open spaces, particularly public open spaces. It turned out that because of this condition, which she had suffered with all of her adult life, she rarely ventured outside in the limited sunshine which most of Oregon provided. On the other hand, Leah said that when she visited her sister in Tucson, the two of them spent quite a bit of time outside in the remote region of Arizona where her sister lived.
So what was it about the extra sunshine that could possibly explain the complete set of Leah’s painful symptoms? This brought up the possibility of Vitamin D deficiency. Vitamin D is supplied in plentiful quantities by ultraviolet B rays of natural sunshine (and also certain types of tanning beds), however there are only a few foods that naturally contain Vitamin D, and only in small quantities: mostly from fatty fish, eggs, or fortified milk and fruit juice. Leah mentioned that she was on a disability pension and consequently also a very limited diet, largely constrained by the use of food stamps. Vitamin D deficiency has been linked with fibromyalgia and chronic pain symptoms in various studies, and the facts clearly supported this as a strong possible trigger of Leah’s symptoms.
Fortunately, this would be easy to test with a quick blood test. Ironically, her regular doctor was reluctant to test for Vitamin D deficiency for Leah, arguing that this couldn’t be the cause of all her complex symptoms over such a long history of illness. Leah had to go to two clinics before she found one willing to run the test, and sure enough it immediately showed a significant deficiency. Leah began taking Vitamin D supplements, and even though it was not always easy for her to get outside because of her agoraphobia, she tried to get outside for daily sleeveless walks in the sunshine every day.
In the two months since conducting our analysis, Leah reports that her symptoms have done a complete 180° turn. She has only felt the need to take one pain pill, and has completely stopped taking the 2-3 daily anti-depressants that was a regular staple of her treatment program. She is happy, upbeat, and feeling stronger and healthier every day. (Watch for a video interview with Leah discussing her surprising and rapid turnaround on our YouTube channel in the coming weeks!)
If you have a similar health case or situation that you’d like to share with our readers, or additional insights from your own experience with fibromyalgia, please add your thoughts in the comment thread below. If you believe that you might benefit from a review of your own health problem with a view to identifying the underlying cause and finding a drug-free cure, download the free problem analysis worksheets at pinpointdiagnostics.net. A free sample of the book Be Your Own Health Detective can be downloaded via the link in the sidebar to the right, which provides additional success stories using the diagnostic technique outlined in this article.
Live long and live naturally!