You can now follow Massage Therapy Works on Twitter.  As if this news wasn't exciting enough, we will be offering SPECIAL TWITTER-ONLY DISCOUNTS every week.  These specials will be day-of-service, because I've read in Wired that the point of Twitter is to be up-to-the-minute.  Just to add an element of suspense, the specials will be on a different day every week. 

(Psst.  There's one today, but this is the only hint you're going to get.)

Fibromyalgia and Chronic Fatigue have been the subject of some media intrigue over the past few years.  These amorphous, invisible diseases are characterized by constant, often debilitating pain (Fibromyalgia) or exhaustion (Chronic Fatigue) with no discernible cause. As one might expect, the fact that a certain sense of mystery is innate to the diagnostics of these diseases arouses curiosity, speculation,  and even doubt about the validity of patients' claims, while the fact that both of these conditions mostly affect women lends them to a sort of lame romanticization - the classic swooning damsel now re-imagined in Banana Republic khakis and a pastel cardigan.  Patients with these diseases are often met with condescension or even hostility from loved ones and acquaintances (Chronic Fatigue is sometimes still referred to as "Yuppie Flu"), and at the doctor's office, patients can expect an unpleasant series of tests, medications, and therapies which may or may not do any good.  

I make the trek over the river to Brighton to visit my old friend Sara.  She looks fantastic when she opens the door.  Slim, blond, pretty, and well-dressed, on first sight, Sara is one of those women who seems to have it all together.  On the outside, little has changed.  She is just as upbeat and quick to laugh as I remember.  When we hug our hellos and without thinking, I spout out a common long-time-no-see-type of greeting among female friends.  "You look great!" I tell her.  "You've lost so much weight." 

Sara smiles and thanks me, but adds, "Not all of it was intentional."

Sara was diagnosed with Fibromyalgia in November of 2007, but she was troubled by health issues long before that.  She has struggled with depression since she was a child, and first began to experience digestive problems and Irritable Bowl Syndrome (IBS) at age ten.  "My life is full of 'syndromes,'" Sara says, not without a trace of humor.  "Syndromes are categorizations of groups of symptoms without an understood cause.  So all doctors can really do is treat the symptoms without getting to the root of the problem."

Early in high school, Sara was one of the rare people who contracted two different strains of Mono, in two consecutive years.  At times her digestive issues were so bad that she would throw up from stomach pain after almost every meal.  She has also had trouble with insomnia since she was a teenager. 

In college she began suffering from intense, chronic back pain between her shoulders, down her spine, and into her sacrum.  Doctors and chiropractors offered little help, so she rationalized the pain, assuming it was more or less normal.  "It's easy, or maybe necessary in situations like that to tell yourself 'This must be normal.  Everyone must have pain like this when they grow up.'  It's a way to keep going and just try to ignore it as best as you can."

After she graduated she took a job in a biology research lab, but decided the sterile nature of the work wasn't for her. She wound up leaving the lab for a well-paying sales job.  While she enjoyed the social aspects of her new job, the long hours (sometimes 60-80 hour work weeks) and high-energy level required eventually took its toll.  Her chronic pain continued to get worse, and recurring bouts of insomnia added to the exhaustion of working fourteen hour days. 

In Spain on a business trip in January of 2007, Sara caught a bad cold.  When she came back the cold symptoms eventually subsided, but the fatigue and muscle aches never went away.  The pain in her back she had experienced since college worsened, but now it extended to her bones, her organs, and sometimes even her skin.  "At its worst, it's like that all-encompassing pain you get with a high fever," she says.  "It hurts to move, it hurts to stand, to sit, to lie down.  Your skin and tissue hurts with any pressure.  It hurts to be touched.  It makes it very difficult to be married."

Sara's husband Jeff has been supportive throughout Sara's diagnosis and treatment.  "But it's a challenge," she says.  "When he comes home wanting to hug and kiss me, sometimes I just can't because it hurts too much."

The constant pain and fatigue eventually led to depression and anxiety.  When she couldn't bear it anymore, she saw a series of doctors.  The rheumatologist who diagnosed Sara with Fibromyalgia (and later added Chronic Fatigue) was eager to treat her.  After the digestive side effects of low-dose tricyclic antidepressants proved intolerable and muscle relaxants were ineffective, the doctor jumped to try the exciting new drug, Lyrica, which had recently been FDA approved for the treatment of Fibromyalgia.

"The doctor was very nice, but he was extremely closed minded about anything outside of traditional Western medicine.  I took those pills for four months, and they did nothing to relieve my pain, though they did make me feel very stoned almost constantly."  Sara laughs remembering these spaced-out days.  "I understand people might think that would be fun, but it wasn't.  Every time I saw the doctor during those four months I would tell him the drug didn't work and I hated taking it, but he always convinced me to keep it up for just a few weeks longer, to just give it another chance.  I listened to him.  He was the doctor, and he had so much faith in this medicine.  I do know it has helped other people, it just did nothing for me.  Eventually I had to accept that my body wasn't responding, and I left to try other therapies."

Sara entered a functional rehabilitation program for chronic pain at Spaulding Hospital.  "This sounds cliche," she says, "but being around so many different people who are dealing with similar issues helped me so much.  There were people in there who had been in car accidents, who had been disabled by surgeries, as well as a few other people with Fibromyalgia.  It was such a grounding experience.  You're always worried that you're crazy with something like this.  They tell you, 'You have this thing but we can't find a reason for it.'  You doubt your own mind sometimes.  But this was a place where there were other people with the same experiences.  We were all supporting each other and going through it together.

"I'm blessed with a good attitude about most things, which is odd for some people to hear, especially considering my issues with depression.  But even on days when I can't get out of bed, my mindset is more like, "Okay, this hurts now, but I'm gonna get through it!'  One thing I had to learn was it's okay to be angry or sad sometimes.  To say, 'This sucks,' as long as you don't let yourself wallow for too long."

Sara responded well to the integrated therapy of the Spaulding program, where the focus was not to cure the problem, but to learn how to use one's body properly and live with the pain.

Sara regularly saw a psychological therapist, an occupational therapist, a physical therapist, and a physician.  Much of the work was done in a group, and involved movement exercises, lessons in proper body mechanics (how to properly position the body to bend over, for example), and meditation work.

"The meditation and state-of-mind exercises were invaluable.  That more than anything else helped me cope with what my body was doing.  So much is about awareness and attitude.  How we look at things in a large way defines how they actually are."

The program helped Sara feel so much more able to live with her pain and fatigue that she felt she was ready to go back to work.  "I was sending out resumes halfway through the program at Spaulding, and I went back to work full time immediately after.  I thought, 'Great!  I have all these coping techniques now.  I'm ready to get back out there.'"

But she only ended up working for about six weeks.  "My body said no," she says. 

Sara gets quieter now.  Less animated, more reflective.  "I grew up in a very poor family," she tells me.  "I always wanted to be a successful, independent career woman.  I wanted to make money so my family would never have to go through what I went through growing up.

"It's hard to accept that you're not meant for what you dreamed of as a kid.  We all grew up being told you can do whatever you want to do, but that's just not true sometimes.  Our society places so much value on working.  On career.  It can feel like you're not worth anything if you can't work."

"Especially as women growing up right after second-wave feminism," I add.  "We were all told that if we really wanted to be important, we had to go out and get these high-powered careers.  That that's the only thing we could do with our lives that would matter.  That staying home was for the weak-minded or useless."

"Exactly," says Sara.  "Growing up in the eighties we were taught, everyone was taught that the purpose of life was to make money and to consume."

Knees that are in need of more stability?  That's quite a mouthful.  But I guess changing your mind isn't always easy.

This Friday (that's tomorrow, folks!) Whole Foods on Prospect Street in Central Square is having a free Seasonal Wellness Fair from 4-7. Stop by for free vendor samples and info about natural remedies to guard against the coming flu season.

Stay healthy naturally this winter.

We all know someone who is in pain, either physical, mental, or emotional, who just doesn't seem to do anything about it.  For friends and family, it can be extremely difficult to watch a person you love suffer from what appears to be a solvable problem.  They may complain of debilitating muscle or joint pain and refuse to seek treatment.  They may suffer from depression and repeatedly skip therapy.  They may be so fraught with anxiety they can't sleep, but refuse to quit the job that's driving them crazy.  It's frustrating to watch, but we've all been in a place where our pain becomes not only normal, but somehow comfortable.

Charles Darwin said, "It is not the strongest of the species who survive, nor the most intelligent, but the ones most responsive to change."  According to Darwin, it is humanity's adaptability that has rocketed them (some would say bafflingly) to the top of the food chain. Say what you will about us, human beings can get used to anything. 

We can certainly get used to debilitating pain.  People do it all the time.  I remember last winter when I was working at a high-stress, low-paying, under-appreciated job, my back and neck hurt so badly I couldn't sleep at night.  There was literally no position I could find that didn't send shooting bolts of pain up my shoulders.  I remember driving and not being able to turn my head far enough to park my car.  I told myself this was normal, and I got used to it.  I knew massage would help, but I didn't think I could afford it, so I rationalized the thought away.  Occasionally I would solicit a free (albeit dilettante) back rub from my boyfriend, but my issues were in need of professional bodywork, not a flirtatious ten-minute rub with "Relaxing Lavender" oil from The Bodyshop.

During this time, the little sagacious voice in the back of my head (you have one too, don't pretend you don't) was practically shouting at me while wagging its ethereal finger.  "This can't go on," it would say.  "This pain is telling you this is wrong.  You will need to change soon, and you will look back at this time and not believe you lived this way."

As usually happens, this voice was 100% correct.  I changed jobs and worked out my back issues with massage, yoga, and generally shifting to a less stressful lifestyle.  Now I look back at those months and shake my head.  How did I live that way?  Of course the short answer is: I got used to it.

We know that all medical treatments, drugs, therapy, surgery, and yes, massage and holistic therapies, involve some aspect of a placebo effect.  There have been numerous studies which suggest that expectations of healing and faith in the abilities of doctors and medicine play much larger roles than previously thought in the efficacy of even the most scientific medical treatments, and a positive outlook can ease pain and strengthen the immune system. 

It is natural to assume that a person who has gone months or even years living in pain will also live with the expectation of pain.  The trick, then is to convince them that they can feel better.  Oftentimes we get the feeling in life that we are caught up in uncontrollable circumstances, that we are merely pinballs bouncing about in a machine of springs and and bells and blinking lights.  The power of choice is easy to forget about when everything seems out of our control.  But we have agency, and even small changes that we make can lead to a vastly higher quality of life.

For instance, the person complaining of back pain can begin a stretching routine, or tailor a workout to help his aching muscles even if he can't afford regular massage.  Even one massage can help jump start healing.  If money is tight, rearrange a few things.  Maybe a massage would be more beneficial this month than that new shirt or fancy dinner.  Some types of back pain can even be addressed by changing mattresses, chairs, or adjusting computer monitors.

Convincing a person he or she can do things to overcome pain may be more difficult if the problem is something psychological, like depression.  By its very nature, depression instills people with feelings of hopelessness and powerlessness, and these feelings leave little room for reasoning them away.  As a friend or family member, the goal can become inciting hope that the depressed person can feel better, a notion that often seems laughably impossible while in the depths of the disease.  Without focusing on the depression itself, encouraging the depressed person to do a physical activity which has been shown to reduce the symptoms of depression, such as exercising or cooking a healthy meal, may set them on a positive path and eventually allow them to experience some relief, which may in turn fill them with powerful, healing hope.

Darwin's statement is profound in the context of evolutionary theory, but one of humanity's gifts (and one which makes us so adaptable) is self-awareness.  It is part of our unique approach to adaptation to be able to look at a changing situation somewhat objectively, see our own place within it, and also realize our own power to make our own changes to what is already happening. 

It is important to be realistic in our expectations of self-healing.  If you have rheumatoid arthritis, you're probably not going to be pain-free tomorrow by thinking happy thoughts.  But strictly pessimistic expectations of suffering only fulfill themselves and keep us in pain.  I propose a practical everyday addendum to Darwin's comment.  The most productive forms of adaptation involve making some changes of our own.