“There is nothing like seeing a doctor who actually gets it when you talk about your illness. I love the personal touch that Dr. Liptan provides by sharing her own journey of sickness and healing. It is much easier to believe someone who has “been there, done that” than it is to believe someone who has never walked in your shoes.” ~ Tami Stackelhouse, fibromyalgia coach, author, speaker, advocate and founder of International Fibromyalgia Coaching Institute
Melissa: Would you tell us about your personal experience with fibromyalgia?
Dr. Liptan: I had just turned 25 and was in my second year of medical school when I injured my neck while lifting weights. The neck pain didn’t get better and just worsened over time and progressively became all-over muscle pain along with overwhelming fatigue. I remember my arms feeling too weak and exhausted to wash my hair, and I knew something was really wrong. But, as is the case for so many fibromyalgia patients, I saw doctor after doctor who told me all my labs were normal and suggested my symptoms were just due to depression. I had to take a leave from medical school. Ultimately, I was fortunate to find a chiropractor that gave me the diagnosis of fibromyalgia and directed me towards some helpful treatments.
Melissa: In addition to fibromyalgia what other diagnoses have you received?
Dr. Liptan: I have dealt with depression since I was a teenager and have had on and off issues with candida overgrowth, which started in college with recurrent yeast infections. I also used to have a lot of irritable bowel symptoms, but these improved with some dietary modifications.
Melissa: Did you always want to treat patients with fibromyalgia?
Dr. Liptan: When I went to medical school I didn’t even know what fibromyalgia was! I have, however, always been interested in holistic medicine and convinced that both western and alternative health treatments could help patients. After my own experiences with yeast infections in college, this became crystal clear to me — because I needed both western medicine with prescribed antifungals to treat the infection and then alternative medicine with dietary changes and herbal antifungals to stay healthy. It was shocking to me that my doctor didn’t know anything about what my naturopath was recommending and vice-versa. So when I developed fibromyalgia in med school, I vowed to devote my career to treating it with the most effective therapies whether they came from western or alternative medicine.
Melissa: Why did you choose to name your clinic the Frida Center?
Dr. Liptan: The Frida Center for Fibromyalgia is my private practice in Lake Oswego, Oregon (near Portland). I founded the clinic with my husband, a myofascial release massage therapist. It is one of the only clinics in the country that focuses specifically on treating fibromyalgia. I named it after Frida Kahlo, a Mexican artist who is thought to have suffered from fibromyalgia herself. Frida is my hero and inspiration because although she dealt with chronic pain, she lived a bold and powerful life.
Melissa: What does your clinic offer to your patients?
Dr. Liptan: We offer an integrative approach that combines effective western and alternative therapies. The only way I have found to get lasting improvement in fibromyalgia symptoms is to systematically address the negative effects on the body of a chronic hyperactive stress (fight or flight) response. The treatment approach I use in my clinic is that same as I outline in The FibroManual. It involves four manageable steps, called the 4 Rs:
Rest: purposefully enlisting a relaxation response and by restoring deep sleep.
Repair: to improve digestion and nutrition, along with gentle movement and myofascial release, a specialized manual therapy that targets painful connective tissue.
Rebalance: the problems with energy production, hormones, and inflammation caused by a chronic stress response.
Reduce: any remaining pain, fatigue, or fibrofog by treating specific symptoms with targeted medications and therapies.
Melissa: What other approaches do you use to treat someone with fibromyalgia?
Dr. Liptan: One of the main focuses of my treatment approach is a form of massage therapy called myofascial release (MFR) that involves applying gentle, sustained pressure to myofascial connective tissue restrictions. By going slowly and waiting for the body’s natural rhythm, the fascia responds by elongating, rehydrating, and reorganizing. You can also do self-myofascial release.
Compared to other forms of bodywork, myofascial release is very gentle and slow. My husband was so impressed with the low back pain relief he got personally using myofascial release that he went back to school to become a myofascial release therapist and joined me at the Frida Center!
Myofascial release is by far the most effective form of pain relief that I have found for fibromyalgia, both personally and for my clinic patients. Two European studies also found MFR helpful in providing long-term pain reduction in fibromyalgia. What was really great about these studies is that they showed long-lasting pain relief, with subjects reporting reduced levels of pain one month and six months after their last session. I led a pilot study that compared myofascial release to standard massage for fibromyalgia, and the group that received six sessions of MFR had more improvement in pain than the massage group. Learn more at http://www.myofascialrelease.com/.
Melissa: How do you describe to your patients how the pain cycle works?
Dr. Liptan: I think that the unpredictable symptom fluctuation from day to day is one of the hardest and most frustrating things about having fibromyalgia. So on a good day when you have less fatigue or pain, it is natural to then do more activity, which can then trigger a pain flare the next day. It takes a lot of discipline to pace yourself so that even on days when you are feeling better, you don’t overdo. Working with a health coach can help patients learn better ways to balance activity and avoid the Push-Crash cycle. In particular, I recommend health coaches and advisors trained specifically for fibromyalgia, like those at the http://fibromyalgiacoachinginstitute.com/.
Melissa: Are there different ways to treat each part of the pain cycle?
Dr. Liptan: A one size fits all treatment approach to fibromyalgia pain does not work. Within fibromyalgia, there are actually three separate types of pain, and each must be approached differently. The first is the vague, flu-like aching caused by high levels of inflammatory chemicals in the bloodstream. In this case, it is important to treat any triggers for inflammation such as food sensitivities and low-grade chronic infections. The second is muscle tenderness due to tension and inflammation in the fascia, the connective tissue that surrounds the muscle. This is best treated by manual therapies like myofascial release, gentle stretching, and trigger point injections. The third is all-over sensitivity resulting from the volume being turned way up in the nerves. This type of pain is the trickiest to understand but has the most medical options since it is where the pharmaceutical companies have focused most of their research. The three medications that are FDA-approved to treat fibromyalgia (Lyrica, Savella and Cymbalta) all work on this pathway.
Melissa: Can you tell us a little about your first book Figuring Out Fibromyalgia: Current Science and the most effective treatments published in 2011?
Dr. Liptan: My first book, Figuring Out Fibromyalgia, focused on my experience personally with this illness and reviewed the science of what was happening in the body with fibromyalgia. After that book was published, I was contacted by so many readers from all over the US (and the world), asking if I could recommend a doctor in their area. It was heartbreaking to have to say no over and over again. I realized I couldn’t personally be the doctor for every patient in the country and that the average doctor had no clue how to help their patients with this illness. That was my inspiration for the second book, The FibroManual. I wanted to help patients that might not have access to a knowledgeable doctor.
Melissa: There are still many doctors that either do not believe fibromyalgia exists or don’t have any understanding of what the patient is feeling. How do you explain it to other physicians?
Dr. Liptan: I start with explaining the basic science, because most doctors don’t know much about fibromyalgia beyond the pain hypersensitivity component. I review the overactive stress (fight or flight) response, disrupted sleep, and pain generated from tight muscles and trigger points. The other things I emphasize when I talk to other physicians:
Fibromyalgia is real. More than 6,000 studies say so!
It is common and can happen to anyone. (Yes, even doctors.)
There is no “cure,” but it is definitely treatable, although you have to go further than three FDA approved meds to get maximum improvement.
Melissa: I am excited to read your new book The FibroManual: A Complete Fibromyalgia Treatment Guide for You… and Your Doctor being released May 3, 2016. What can you tell us about it?
Dr. Liptan: The FibroManual is basically the “cliff notes” of my entire treatment approach. It contains lots of advice about self-care, along with a focused, well-referenced “Share With Your Health Care Provider” section, which contains research-supported guidance and is written in “medicalese.” Each chapter ends with bullet points to try yourself and to talk with your health care provider about. I tried to make it really easy to read – even through fibrofog. I hope I succeeded; let me know what you think!
After reading Dr. Liptan’s first book, having been a follower of her blog and now interviewing her, I have added another person to meet to my bucket list. Until I have a chance to meet her in person I am going to have to settle for the ONLINE EVENT ~ Meet the Author: The FibroManual by Dr. Ginevra Liptan on May 3rd.
You can find more about Dr. Liptan & read her blog by using the below links: