Has anyone else got PsA and Polymyalgia Rheumatica?

Has anyone else got PsA and PMR? It would be good to talk to you if you have.

No luck as yet, then. It's possible that someone will respond in time, a lot of members pop in only occasionally.

Which one got diagnosed first? Or did they give you the double whammy?

Yes I understand - I can wait!

The PMR was diagnosed first, the PsA took longer because I don't have psoriasis - close family members do. They thought I had Sjogren's syndrome to start with because I have SICCA.

Hi natkat

Sorry to hear about your difficulty with diagnosis - I think it it a common problem with PsA - as my consultant says - there is no definitive test just symptoms.

I believe that most of us are relieved when we actually do get a diagnosis, but that is where the fun begins - NOT!

I have been on just about every med possible - they either make me very sick, cause liver problems or don't work. I thought I had stuck gold with Humira and had weaned myself off Prednisilone. But things progressively got worse until I was having to use a stick and waking up with pain at night.

So I stopped the Humira. I got an appointment at the hospital but saw a very sweet young doctor who new nothing about me. She listened to my tale and trotted off to speak to my consultant and they agreed I should try Methatrexate.

Well the Methotrexate made me feel so very sick and headachy - I developed a migraine, so I stopped it. I can manage from day to day with pain - as I get some relief when I sew or write my blog. But when you feel sick and have a headache AND have pain all over - you can do nothing!

When I spoke to the young doctor , she yet again went off to speak to the consultant - and she told me they would reassess me in five weeks time. In the meantime the consultant said he was happy for me to go back on a low dose of Prednisilone. I replied that he was bound to be happy as it wasn't his body it was going into!

So not to be defeated I have embarked on an anti-inflammatory diet and loads of supplements: fish oil with more EPA, Curcumin (the active part of Turmeric) plus black pepper. Fresh lemon and ginger infusion to drink throughout the day. Cherry concentrate.

I'm also going to try the Nutri Thyroid Challenge - a variety of supplements to support Thyroid function. I have always suspected my thyroid was sluggish - and blood tests have shown me to be on the low side of normal. However, here in the UK our normal spectrum is much narrower than in the States and they only test for thyroxin not T4/3 conversion.

You never know in 5 weeks I may be able to throw away my stick!

So, natkat, if you managed to get to the end of this - I wish you the best of luck in getting a med that can help you. Do keep us posted.

Natkat, I completely agree with you about fibromyalgia's often being a "junk diagnosis". What really fries me is people getting diagnosed with FMS right off the bat: I agree that often a diagnosis like that is simply to get the person out of the office. There. Done. Case closed. THAT is a junk diagnosis, and sadly, a card that gets played all too often. (And I'll add "with women".)

But IF (and it's a big if) someone is diagnosed as having fibromyalgia after the doctor has thoroughly considered and tested (and maybe treated) for all other possibilities that's a different story. Under those circumstances, being told that you have FMS means that you have a very real and painful disorder. Sadly, there are still some doctors who consider FMS to be an imaginary disease, but current thinking now disagrees with that. We don't want people here with properly diagnosed FMS to feel that they've been dealt a "junk diagnosis".

Well said Seenie!

Yes, this thread needs to be steered back in the direction of the OP's original question. To help that happen, I've changed PMR to its full name.

I am sorry I missed this thread. I have been occupied elswhere in "Bens World" I have deleted some very dangerous posts and will try to bring things up to speed. And of course I'm sure you have all figured out (especially with Seenies redirection FMS (fibro) and PMR have nothing in common

So how long have you had PMR (or at least the diagnoses) A dead giveaway is a response to low dose steroids. So long as you are under 30mg a day and get relief why fix what ain't broke?? I realize there is a difference in how these "things" are treated from locale to locale and even dx'd. On the west coast (US) pretty much the only treatment for PMR is low dose steroids and NSAIDS. It works. They don't even feel bad about it. Classic PMR is a temporary condition so they can be pretty aggressive during its acute phases. When I say temporary, It almost always lasts five years or less. But what they do do is they very aggressively monitor your labs. PMR CAN (very infrequently) morph into temporal arteritis, which can be dangerous. Headaches -- particularly on the side of the head -- scalp tenderness, vision changes or jaw pain when eating can be signs of this condition. Run don't walk to your doc if these things start happening. And don't leave until they have done at min:

  • Anticyclic citrullinated peptide (anti-CCP)

  • Antinuclear antibody (ANA)

  • Complete blood count (CBC)

  • C-reactive protein (CRP)

  • Erythrocyte sedimentation rate (ESR, also called sed rate)

Especially the anti-CCP. FWIW there is no connection between PMR and PsA. Its just REEEEEALY bad luck.

Be VERY careful in the use of ANY supplements with this disease. It is one where they can kill you (literally) and for God sakes stay away from Naturpaths. Their approach while usually only helpful to their pocket books and only harmful to their patients finances is very dangerous with PMR

Most of the supplements you mentioned have a slowdown effect on DHEA which is a vital adrenal hormone that is converted into other hormones, including estrogen. i would check with your lady doctor. If you have PMR, you are very likly post menopausual (average age for onset is 70) Getting your hormone in check may be of help.

In people with polymyalgia rheumatica, inflammatory chemicals (including interleukin-6 (IL-6) and tumor necrosis factor-alpha [TNF-α]) are released into the bloodstream making it appear to be PsA. Besides causing the inflammation that leads to symptoms, these chemicals have a profound effect on the hypothalamic-pituitary-adrenal (HPA) axis, which is intimately involved in maintaining levels of vital hormones (eg, dehydroepiandrosterone [DHEA] and cortisol)

The last thing you want to do (and the first thing a Natuarpath will do) is mess with your thyroid. (A bit sluggish is good with PMR BTW) DO not involve yourself in supplementation without MEDICAL advice. While many docs will say its harmless the good one know its never "neutral" and can be bad.

Glucocorticoids inhibit thyroid-stimulating hormone (TSH) secretion and slightly reduce serum thyroid hormone concentrations. Aspirin and some nonsteroidal antiinflammatory drugs lower serum total thyroid hormone concentrations by interfering with thyroid hormone binding to its carrier proteins; serum free thyroid hormone concentrations do not change. Your slugginish may be complely normal and either a correct response from you immune system or evidnece the meds are working.

T4/3 conversion is a figmant of Naturpathic imaginations. Liver enzymes is where the science determine whether it is occuring or not. Thats why they don't do it. There are better tests

Vitamin D and Calcium are supplements you should consider (assuming your docs agree)

Most of the supplements out there are water soluble and a waste of time. If your body has "normal concentrations, extra is not absorbed. All you are doing is literally pissing away money and the "effect" placebo (which isn't always a bad thing)

I'm not trying to give "medical advice" but I am warning you some of the advice you were given (which is now gone) was really really bad advice.

I will say the one thing that makes the BIGGEST difference with PMR is Exercise. Its needs to be specific and doable. If available I would get a referal to a good PT and get started. (Yes I know when you are in pain, its impossible to imagine but it DOES pay off big in the long run)

I may have misunderstood - but are you suggesting that I do not have PsA but PMR that is mimicking PsA?

That is good news. I was diagnosed nearly four years ago - I'm 64 now - so in a year so I should be free of pain.

Wonderful.


tntlamb said:

I am sorry I missed this thread. I have been occupied elswhere in "Bens World" I have deleted some very dangerous posts and will try to bring things up to speed. And of course I'm sure you have all figured out (especially with Seenies redirection FMS (fibro) and PMR have nothing in common

So how long have you had PMR (or at least the diagnoses) A dead giveaway is a response to low dose steroids. So long as you are under 30mg a day and get relief why fix what ain't broke?? I realize there is a difference in how these "things" are treated from locale to locale and even dx'd. On the west coast (US) pretty much the only treatment for PMR is low dose steroids and NSAIDS. It works. They don't even feel bad about it. Classic PMR is a temporary condition so they can be pretty aggressive during its acute phases. When I say temporary, It almost always lasts five years or less. But what they do do is they very aggressively monitor your labs. PMR CAN (very infrequently) morph into temporal arteritis, which can be dangerous. Headaches -- particularly on the side of the head -- scalp tenderness, vision changes or jaw pain when eating can be signs of this condition. Run don't walk to your doc if these things start happening. And don't leave until they have done at min:

  • Anticyclic citrullinated peptide (anti-CCP)

  • Antinuclear antibody (ANA)

  • Complete blood count (CBC)

  • C-reactive protein (CRP)

  • Erythrocyte sedimentation rate (ESR, also called sed rate)

Especially the anti-CCP. FWIW there is no connection between PMR and PsA. Its just REEEEEALY bad luck.

Be VERY careful in the use of ANY supplements with this disease. It is one where they can kill you (literally) and for God sakes stay away from Naturpaths. Their approach while usually only helpful to their pocket books and only harmful to their patients finances is very dangerous with PMR

Most of the supplements you mentioned have a slowdown effect on DHEA which is a vital adrenal hormone that is converted into other hormones, including estrogen. i would check with your lady doctor. If you have PMR, you are very likly post menopausual (average age for onset is 70) Getting your hormone in check may be of help.

In people with polymyalgia rheumatica, inflammatory chemicals (including interleukin-6 (IL-6) and tumor necrosis factor-alpha [TNF-α]) are released into the bloodstream making it appear to be PsA. Besides causing the inflammation that leads to symptoms, these chemicals have a profound effect on the hypothalamic-pituitary-adrenal (HPA) axis, which is intimately involved in maintaining levels of vital hormones (eg, dehydroepiandrosterone [DHEA] and cortisol)

The last thing you want to do (and the first thing a Natuarpath will do) is mess with your thyroid. (A bit sluggish is good with PMR BTW) DO not involve yourself in supplementation without MEDICAL advice. While many docs will say its harmless the good one know its never "neutral" and can be bad.

Glucocorticoids inhibit thyroid-stimulating hormone (TSH) secretion and slightly reduce serum thyroid hormone concentrations. Aspirin and some nonsteroidal antiinflammatory drugs lower serum total thyroid hormone concentrations by interfering with thyroid hormone binding to its carrier proteins; serum free thyroid hormone concentrations do not change. Your slugginish may be complely normal and either a correct response from you immune system or evidnece the meds are working.

T4/3 conversion is a figmant of Naturpathic imaginations. Liver enzymes is where the science determine whether it is occuring or not. Thats why they don't do it. There are better tests

Vitamin D and Calcium are supplements you should consider (assuming your docs agree)

Most of the supplements out there are water soluble and a waste of time. If your body has "normal concentrations, extra is not absorbed. All you are doing is literally pissing away money and the "effect" placebo (which isn't always a bad thing)

I'm not trying to give "medical advice" but I am warning you some of the advice you were given (which is now gone) was really really bad advice.

I will say the one thing that makes the BIGGEST difference with PMR is Exercise. Its needs to be specific and doable. If available I would get a referal to a good PT and get started. (Yes I know when you are in pain, its impossible to imagine but it DOES pay off big in the long run)

It's possible. What I am suggesting is some of the natural stuff you are doing could possibly aggravate whole situation, especially the thyroid stuff PMR does get better, although I'm not sure I'd be checking days off the calendar. The physiological parts of both cross over. Your response to low dose predictive and none of the PsA meds is suspicious, don't you think?

Remember the goal is to SLOW down your immune system.

No - my joint pain started in my twenties. It got very much worse after my hysterectomy - along with muscle pains and exhaustion. I did respond to Leflunomide but it caused liver problems. Methotrexate and Sulphasalazine gave me horrendous nausea and headaches. Plaquenil helped a bit but not much.

On Humira my energy levels were much better, but my joint pains became much worse.

I know Prednisilone is the drug of choice for PMR - and it works - but it is not good long term. It is cheap and as you say most patients are women over seventy - so who wants to spend money researching something less harmful? Answer - hardly anyone.

I was diagnosed at 60 and was on Prednisilone for nearly four years - I put on loads of weight, and felt unclear in my head.I had one hell of a job getting off it and don't intend to go back on.

I was a Nutrition Consultant for ten years and I know how to eat healthily - and do - the weight gain changed my whole feeling of 'self'.

I take your point about slowing down the immune system and I'll look into it further.

Why don't doctors do the liver tests to show T4/3 conversion - is it cost?

Do you know much about functional medicine - are you a doctor?

I shall discuss all with my rheumatologist Dr Kaul - he was the one who told me I had both PsA and PMR - he did say it was unusual.

I started this thread to find someone else who had a dual diagnosis like me - so I could work out which pain was which. Not to be told I didn't have them both by someone who hasn't got the whole picture.

Never said you didn't have them both, just that one mimics the other and the overlap makes things a mess as you have discovered.

The t 4/3 conversion test is largley a product of the metabollic medicine movement. The test gives a general idea of how much hormone is circulating in the blood at a particular point in time, but not necessarily how much is reaching the cells. In the UK the most frequent test is a 24 hour urine collection test. It gives a better idea of the level of thyroid hormone that reaches the tissues that need it. Blood levels vary widley through the day............. If you haven't had one, I'd push for it. Its the only way to really know what happens in the course of a day.....

The liver test is routine. In hypothroidism the ALT and AST numbers will be "wrong" Either the ratio will be off, or the numbers slightly elevated. A repeat test should show an slight increase.

A person can go nuts reading Predi research, but it is generally accepted (in the US any way) that low dose is as effective as higher dose and daily amounts under 30mg have little or no effect on the adrenals. Thus the tapers of yore have been replaced with bursts, and more and more folks are on a 5 - 10 mg dose.and appreciative of the life it gives them back. You sonsultants statement "he was happy for me to go back on a low dose of Prednisilone" may not have been so off or trite as it appears. I however personally am not a fan of Prednisilone over regular ol' prednisone. (they sometimes interchangable terms but not where I live)

This is entirely personal, but being very close to your age myself, My rheumy who is 75 (and a friend,) when I was debating some replacement and a low dose predi regime. looked at me square in the eye and asked what the hell are you saving yourself for? We took an amazing fly fishing trip a few weeks later and I did things I never thought I'd do again.

I appreciate your concern about the effect of predi on your adrenals especially with a question (and a good one) about your thyroid, and you have a lot of decisions to make for sure. One of the most difficult parts of it for ME was to put my professional Bias' aside. and listen to my "team"

LIke I say PMR is fortunatly for almost everyone a temporary condition. It will complicate PsA treatment until its gone.

I am curious about one thing. When you were on Humira, was the increased joint pain in your shoulders and arms primarily?

Thank you - as you can probably see by reading between the lines that I am very frustrated with my whole situation. I hate being unable to do the things I used to do with ease.

You are lucky to have a friend who is a rheumy - I find it frustrating when I can't get to speak to mine - my next appointment is late September.

As you know both PsA and PMR are lonely conditions. Luckily I have a very supportive family but sometimes I just get overwhelmed and dare I say it pissed off. (remove that if you feel the need!)

I do so hope the PMR gives up the ghost before too long.

Of course you are frustrated. It can get worse if you let it. Just like diet, anything the Rheumie does takes weeks if not months to show up. Thats why this group exists. There are really two groups of people here, and a third that that is gone..... They did get treatment are better most of the time and only show up when something doesn't work, they are flaring or something else upset the apple cart. There are the newbies (and by our standards thats you). Between those two things seem pretty scary..... There is the old guard who on this site are a lot nicer than what you find on many forum where those folks think they own the place, We have been down the road you are travelling and "get it" I don't get to spend a lot of time here anymore, but I can tell you it changed my life.... We don't mean to sound cynical or uncaring quite the opposite. Our 'tell me something I haven't heard before" attitude is not being dismissive. Its really saying Yeah, we hear you and we get it. (in spades)

Now you are one in 16 million so yeah your combo is Unusual. Heck we even had a few who thought you had fibro.... But that doesn't make folks any less understanding of the journey

I'm still wondering about the pain you had on Humira and where it was at. I have a friend who I want to run it by..........

Of course you are frustrated. It can get worse if you let it. Just like diet, anything the Rheumie does takes weeks if not months to show up. Thats why this group exists. There are really two groups of people here, and a third that that is gone..... They did get treatment are better most of the time and only show up when something doesn't work, they are flaring or something else upset the apple cart. There are the newbies (and by our standards thats you). Between those two things seem pretty scary..... There is the old guard who on this site are a lot nicer than what you find on many forum where those folks think they own the place, We have been down the road you are travelling and "get it" I don't get to spend a lot of time here anymore, but I can tell you it changed my life.... We don't mean to sound cynical or uncaring quite the opposite. Our 'tell me something I haven't heard before" attitude is not being dismissive. Its really saying Yeah, we hear you and we get it. (in spades)

Now you are one in 16 million so yeah your combo is Unusual. Heck we even had a few who thought you had fibro.... But that doesn't make folks any less understanding of the journey

I'm still wondering about the pain you had on Humira and where it was at. I have a friend who I want to run it by..........

My thinking is if the joint pain was primarily in your shoulders and arms that was PMR. bringing the PsA under control (somewhat) could magnify the effect of the PMR (Long drawn out pain management theory) There are localized treatments that could effect the PMR and still give you some benefit of the Humira - fatique being the biggy and the one I hate the most. Anyway if thats the case it might be worth asking about at your next appointment. At the very least asking would demonstrate you are a strong self advocate which never hurts.....

Hello tntlamb,

First of all, it was my post in response to Seenie which lists main differences between PMR and Fibro.

Please give credit where its due.

Your comments about Naturopathic doctors are disturbing. I am headed to an Ayurvedic clinic and I assure you that they will most certainly NOT "mess with my thyroid"

Yes, of course bad doctors are a problem ... both allopathic AND naturopathic. Some of us have to deal with bad allopathic doctors ... for example I will be ASKING my rheumatologist for prednisone as I am fairly certain I have PMR ... but the allopathic doctors have missed this dx even after 7 months of presenting classic PMR symptoms.

Given the many severe adverse reactions to pharma meds ... isn't it a case of "the pot calling the kettle black" to cry out the dangers of naturopathic medicine? Like no one ever got deathly ill from the pharma meds???

I do not say ALL allopathic doctors are bad simply b/c they haven't helped me in 7 months (made me worse, in fact. The NSAIDs gave me an ulcer and the methotrexate nearly caused a life-threatening situation)

This site has been very helpful ... I would not have thought to research a PMR diagnosis if not for the informative and helpful posts here ... but posts which show bias and hostility make me feel unwelcome.

Seriously, what do you suggest for patients who have adverse reactions to the pharma drugs?

That they give up and die?

Or that they consider finding REPUTABLE naturopathic care?

Please give this some thought. Especially for a condition like PMR - which the primary treatment prednisone has such notorious side effects - shouldn't people be encouraged to find what works for them?

PS the Ayurvedic clinic I am going to put my stage 2C cancer into remission after allopathic treatment failed ... so please DON'T tell me that Naturopathic medicine sucks. It worked for me. I am open to BOTH types of medicine because I want to get well.



tntlamb said:

I am sorry I missed this thread. I have been occupied elswhere in "Bens World" I have deleted some very dangerous posts and will try to bring things up to speed. And of course I'm sure you have all figured out (especially with Seenies redirection FMS (fibro) and PMR have nothing in common

So how long have you had PMR (or at least the diagnoses) A dead giveaway is a response to low dose steroids. So long as you are under 30mg a day and get relief why fix what ain't broke?? I realize there is a difference in how these "things" are treated from locale to locale and even dx'd. On the west coast (US) pretty much the only treatment for PMR is low dose steroids and NSAIDS. It works. They don't even feel bad about it. Classic PMR is a temporary condition so they can be pretty aggressive during its acute phases. snip snip>>

Be VERY careful in the use of ANY supplements with this disease. It is one where they can kill you (literally) and for God sakes stay away from Naturpaths. Their approach while usually only helpful to their pocket books and only harmful to their patients finances is very dangerous with PMR

snip snaip>>

IThe last thing you want to do (and the first thing a Natuarpath will do) is mess with your thyroid. (A bit sluggish is good with PMR BTW) DO not involve yourself in supplementation without MEDICAL advice. While many docs will say its harmless the good one know its never "neutral" and can be bad.

Glucocorticoids inhibit thyroid-stimulating hormone (TSH) secretion and slightly reduce serum thyroid hormone concentrations. Aspirin and some nonsteroidal antiinflammatory drugs lower serum total thyroid hormone concentrations by interfering with thyroid hormone binding to its carrier proteins; serum free thyroid hormone concentrations do not change. Your slugginish may be complely normal and either a correct response from you immune system or evidnece the meds are working.

Wow ... it appears as if my post on the differences between PMR, FMS, and PsA is now gone from the thread?

Weird.

Was it deleted? Why? I don't think there was anything unhelpful or controversial in it. It was purely a listing of different symptomes for the different diseases. Why would that disappear?

???

Thanks again! My pain is primarily on the inside of my knees (worse on the right) and down the front of my shins.

Then my elbows - again on the inside and right side worse.

The upper outside of my hips - this has always been tender - i.e. I've always had trouble lying on my side for things like yoga and pilates - but now it hurts to turn over in bed

The muscles in my upper arms 'catch me' I find it painful to throw the bed clothes off in the mornings.

My thigh muscles scream when I stand up after sitting for any length of time and I walk like a rusty robot until I loosen up.

My hands ache and are losing strength in their grip, my feet ache and it often feels like I'm walking on cobbles.

Last but not least I have pain in my sternum causing referred breast pain and in the upper portion of my spine (upper lumber and lower cervical) is painful and feels swollen.

If I walk for more than half an hour it seems that my whole middle seizes up, it feels very weird.

Old crock or what?


tntlamb said:

Of course you are frustrated. It can get worse if you let it. Just like diet, anything the Rheumie does takes weeks if not months to show up. Thats why this group exists. There are really two groups of people here, and a third that that is gone..... They did get treatment are better most of the time and only show up when something doesn't work, they are flaring or something else upset the apple cart. There are the newbies (and by our standards thats you). Between those two things seem pretty scary..... There is the old guard who on this site are a lot nicer than what you find on many forum where those folks think they own the place, We have been down the road you are travelling and "get it" I don't get to spend a lot of time here anymore, but I can tell you it changed my life.... We don't mean to sound cynical or uncaring quite the opposite. Our 'tell me something I haven't heard before" attitude is not being dismissive. Its really saying Yeah, we hear you and we get it. (in spades)

Now you are one in 16 million so yeah your combo is Unusual. Heck we even had a few who thought you had fibro.... But that doesn't make folks any less understanding of the journey

I'm still wondering about the pain you had on Humira and where it was at. I have a friend who I want to run it by..........



E.Rose said:

Thanks again! My pain is primarily on the inside of my knees (worse on the right) and down the front of my shins.

Then my elbows - again on the inside and right side worse.

The upper outside of my hips - this has always been tender - i.e. I've always had trouble lying on my side for things like yoga and pilates - but now it hurts to turn over in bed

The muscles in my upper arms 'catch me' I find it painful to throw the bed clothes off in the mornings.

My thigh muscles scream when I stand up after sitting for any length of time and I walk like a rusty robot until I loosen up.

My hands ache and are losing strength in their grip, my feet ache and it often feels like I'm walking on cobbles.

Last but not least I have pain in my sternum causing referred breast pain and in the upper portion of my spine (upper thoracic and lower cervical) is painful and feels swollen.

If I walk for more than half an hour it seems that my whole middle seizes up, it feels very weird.

Old crock or what?


tntlamb said:

Of course you are frustrated. It can get worse if you let it. Just like diet, anything the Rheumie does takes weeks if not months to show up. Thats why this group exists. There are really two groups of people here, and a third that that is gone..... They did get treatment are better most of the time and only show up when something doesn't work, they are flaring or something else upset the apple cart. There are the newbies (and by our standards thats you). Between those two things seem pretty scary..... There is the old guard who on this site are a lot nicer than what you find on many forum where those folks think they own the place, We have been down the road you are travelling and "get it" I don't get to spend a lot of time here anymore, but I can tell you it changed my life.... We don't mean to sound cynical or uncaring quite the opposite. Our 'tell me something I haven't heard before" attitude is not being dismissive. Its really saying Yeah, we hear you and we get it. (in spades)

Now you are one in 16 million so yeah your combo is Unusual. Heck we even had a few who thought you had fibro.... But that doesn't make folks any less understanding of the journey

I'm still wondering about the pain you had on Humira and where it was at. I have a friend who I want to run it by..........

The biologics generally do a good job on axial pain, but less so on the peripheral stuff which is why they are often combined with NSAIDS or DMARDs. Here is the funny thing DMARD's often don't work by themselves but when added after a biologic is started do a lot of folks good. A lot of that pain sound pretty clearly like PMR. That frontal chest pain is pretty common with PsA. FWIW when its flaring for me, I use a hot pack on the back and cold packs on the front (or alternate)

I HATE getting up in the morning. MY coffee grinder/brewer is automatic great alarm... At least I know something good is waiting after my "routine" That stiffness is PsA and should be less than 20 minute if there is any control of your disease. You mentioned YOGA, Great stuff. I have a chair routine I do every morning (or as my wife calls it - unfolding) If I ever got on the mat again, they would have call in a crane. It really makes the day go better. With PMR, exercise, the right kind, usually improves things. I do a pretty goof stretch routine before bed. Don;'t know how much good it does, but it makes me feel like I have some control. I move evey joint especially the hands and toes. I write the alphabet with both ankles, that does make a difference)

I know you know this as a nutrtionist, but in the event you have forgotten. High protein diet will elevate some of your liver numbers. If you are trying to control that weight by cutting carbs as I am, some funky numbers can happen.