“Fibromyalgia affects an estimated 3.4% of women and 0.5% of men in the United States, or 3 million to 6 million Americans. It most commonly affects women of childbearing age or older. In fact, some estimates suggest that more than 7% of women in their 70s have fibromyalgia. Many people with fibromyalgia also have psychiatric problems such as depression, anxiety, or eating disorders, although the relationship between fibromyalgia and mental health disorders remains unclear.

While not a deadly disease, fibromyalgia can significantly impact one’s emotional well-being and overall quality of life. It strikes people of all ages, but it’s more common in women than men. It also runs in families. The risk of developing fibromyalgia is much higher if a first-degree relative, such as a parent or sibling, also has the condition.”

Harvard Health Publishing (Fibromyalgia – Harvard Health)

Signs and Symptoms of Fibromyalgia:

Fibromyalgia is a physical disorder, not a psychological condition. The most common constellation of Fibromyalgia symptoms (widespread chronic muscle pain, sleeplessness, relentless fatigue, cognitive dysfunction, and a host of other overlapping conditions like TMJD, IBS, migraine, interstitial cystitis, metabolic syndrome, endometriosis, and vulvodynia) can wax and wane over time.

Symptoms include:

• Tenderness to touch or pressure affecting muscles and sometimes joints or even the skin
• Severe fatigue
• Sleep problems (waking up unrefreshed)
• Problems with memory or thinking clearly

Some patients also may have:

• Depression or anxiety
• Migraine or tension headaches
• Digestive problems: irritable bowel syndrome (commonly called IBS) or gastroesophageal reflux disease (often referred to as GERD)
• Irritable or overactive bladder
• Pelvic pain
• Temporomandibular disorder – often called TMJ (a set of symptoms including face or jaw pain, jaw clicking, and ringing in the ears)

How Fibromyalgia is diagnosed:

A doctor will suspect fibromyalgia based on your symptoms. Doctors may require that you have tenderness to pressure or tender points at a specific number of certain spots before saying you have fibromyalgia, but they are not required to make the diagnosis (see the Box). A physical exam can be helpful to detect tenderness and to exclude other causes of muscle pain. There are no diagnostic tests (such as X-rays or blood tests) for this problem. Yet, you may need tests to rule out another health problem that can be confused with fibromyalgia.

Because widespread body pain is the main feature of fibromyalgia, health care providers will ask you to describe your pain. This may help tell the difference between fibromyalgia and other diseases with similar symptoms. Other conditions such as hypothyroidism (underactive thyroid gland) and polymyalgia rheumatica sometimes mimic fibromyalgia. Blood tests can tell if you have either of these problems. Sometimes, fibromyalgia is confused with rheumatoid arthritis or lupus. But, again, there is a difference in the symptoms, physical findings and blood tests that will help your health care provider detect these health problems. Unlike fibromyalgia, these rheumatic diseases cause inflammation in the joints and tissues.

“Soft tissue sarcomas form in cartilage, fat, muscle, blood vessels, tendons, nerves, and around joints. Osteosarcomas develop in bone; liposarcomas form in fat cells. Rhabdomyosarcomas form in muscle, and Ewing sarcomas form in bone and soft tissue.

About 22% of bone and joint cancer cases are diagnosed in those under age 20, while soft tissue cancers are more often diagnosed in those 55 years or older.”

American Association for Cancer Research – AACR (https://www.aacr.org/patients-caregivers/awareness-months/sarcoma-and-bone-cancer-awareness-month/)

“Fibromyalgia is a long-term condition that causes widespread muscle pain, fatigue and brain fog. It happens when your nervous system becomes more sensitive to pain signals. There isn’t a cure. But lifestyle changes, therapy and medication may help you manage flare-ups and improve daily life.

Research shows it involves changes in how your central nervous system processes pain. This system becomes more sensitive and amplifies pain signals. This means your body feels pain more strongly.

Symptoms often come and go in periods called flare-ups. There isn’t a cure, but treatment could help manage symptoms.”

Cleveland Clinic (Fibromyalgia: What It Is, Symptoms & Treatment)

Soft tissue sarcoma symptoms:

Like many forms of cancer, soft tissue sarcoma symptoms may appear at a more advanced stage of the disease, or you might not notice any symptoms at all. Symptoms, if they are present, will also vary depending on the type of sarcoma and its location.

Signs of soft tissue sarcoma include:

A lump or mass is the most common soft tissue sarcoma sign. The lump will form in the area in which the tumor is growing, and it may be accompanied by some pain if it is pressing on a nerve or muscle. Even if the lump isn’t painful, if it continues to grow, or if it is located deep within an extremity or body cavity, consult your doctor.

Uncomfortable swelling is another sign of soft tissue sarcoma, especially when it is located in the arms and legs.

Limited mobility may be a symptom of soft tissue sarcoma. Some tumors can restrict motion, such as those found in the hip, knee, shoulder or hands.

Skin lesions can occur when a sarcoma tumor breaks through the skin.

Other symptoms may be signs of soft tissue sarcoma, because a sarcoma tumor can form almost anywhere in the body and can therefore affect a variety of organs. For example, sarcomas in the abdomen may cause abdominal pain, vomiting or constipation, while sarcomas in the uterus may cause vaginal bleeding and/or abdominal pain. With gastrointestinal stromal tumors (GISTs), you may feel full after eating only very small meals, or you may vomit blood or have dark bowel movements.

Diagnosing Sarcoma:

If your doctor thinks you may have a sarcoma, you’ll probably need a full exam and tests, including: A sample of cells from the tumor, called a biopsy. A plain x-ray to imaging tests, such as a CT scan, an ultrasound, an MRI, a PET (Positron Emission Tomography) to help see inside your body. A bone scan, if you might have osteosarcoma.  Also a biopsy-several types of biopsies are used to diagnose sarcomas..

Treatment of Soft Tissue Sarcoma:

Surgery is typically the primary treatment for soft-tissue sarcoma, used to remove tumors. Chemotherapy, radiation therapy and/or targeted therapy may also be recommended, either alone or in combination with surgery, depending on the stage and extent of the disease, along with other factors.

Surgery

The goal of surgery is to locate and completely remove the soft tissue sarcoma tumor. Our pathologists then examine the tumor to determine whether or not additional treatment is necessary, and to reduce the risk of recurrence.

Chemotherapy

Chemotherapy may be used in combination with surgery and radiation therapy to treat advanced-stage soft tissue sarcoma. Chemotherapy drugs work to either destroy cancer cells or impede their ability to grow and reproduce.

At our hospitals, we are developing innovative therapies personalized to the care of each soft tissue sarcoma patient. Our medical oncologists work closely with soft tissue sarcoma patients to determine if chemotherapy is an appropriate treatment option. Throughout your soft tissue sarcoma treatment, your care team continually monitors the effect of chemotherapy on the disease, with physical exams, blood tests, CT scans, MRI scans and chest X-rays and imaging.

Radiation therapy

Depending on the type of soft tissue sarcoma you have and the extent of the disease, your soft tissue sarcoma treatment plan may include radiation therapy. Though surgery is usually the main treatment approach for soft tissue sarcoma, radiation treatments may also be used before (neoadjuvant therapy) or following surgery (adjuvant therapy).

Targeted therapy

Unlike standard chemotherapy drugs, which may affect all cells in the body, targeted therapy drugs are designed to seek out and kill specific cancer cells while sparing surrounding healthy cells. Targeted cancer therapies may be used alone, in combination with other targeted therapy treatments or with other soft tissue sarcoma treatments, such as chemotherapy, radiation therapy and surgery. Among the drugs used in targeted therapy are so-called kinase inhibitors, which target specific protein receptors that help regulate cell growth.

“Sarcomas are a rare group of cancers in which malignant cells form in the bones or soft tissues of the body.

Soft tissue sarcomas form in cartilage, fat, muscle, blood vessels, tendons, nerves, and around joints. Osteosarcomas develop in bone; liposarcomas form in fat cells. Rhabdomyosarcomas form in muscle, and Ewing sarcomas form in bone and soft tissue.”

American Association For Cancer Research – AACR (Sarcoma and Bone Cancer Awareness Month | AACR)

What is Sarcoma?

Sarcoma is a rare but deadly form of cancer affecting connective tissues such as fat, muscle, blood vessels, nerve, bone, deep skin and cartilage. There are roughly 15,000 new cases in the United States each year, with a very low median age of 36 (for bone sarcomas). Survival rates are low, even in comparison to other rare cancers. Rhabdomyosarcoma, a relatively common sarcoma, has a five-year survival rate of 65%, even if caught before metastasis. If caught after metastasis, the five-year survival rate lowers to approximately 30%. This is all to say that while sarcomas are rare, they are extremely devastating.

Sarcomas are a diverse and sporadic group of tumors that have minimal hereditary influence. They are generally classified into two major groups; the group of tumor-specific reoccurring genetic mutations via specific and aberrant chromosome translocation, and the group of non-reoccurring mutations which are based on severe genetic and chromosomal instability. Both groups have altered cell growth-factor signaling pathways. As a result, the introduction of drugs which can normalize growth-factor receptors and proteins are of great interest and the primary treatment given. With improvements in these drugs, it is believed that sarcoma can move from a deadly disease to a chronic but non-life-threatening disease.

Unfortunately, the specificity of the first group of sarcomas, where specific chromosomes are improperly translocated, can often permit the sarcoma to prevail after standard treatment. This is obviously problematic but, if overcome, could spark the development of a whole new field of cancer treatment. In other words, if scientists can discover how to isolate and guide specific chromosomal arrangement, they will able to address many of the hard to treat cancers of today.

With genetic engineering it is theoretically possible to prevent cancer before it begins. However, even without moving this far into the future, the improper chromosomal translocation can provide a sort of name-tagging of the cancer cell. With the cancer cells identified, it can guide modalities aimed at destroying diseased tissue while sparing healthy tissue.

Sarcoma is an under-researched cancer whose research can help to elevate cancer treatment, as a whole. Not only would breakthroughs save the lives of countless children, it could also advance medicine, as a whole. By bringing awareness to sarcoma and the potential development its research can spark, this potential can become a reality.

Soft tissue sarcomas may develop in any tissue that connects, supports or surrounds other structures and organs in the body. Some examples of where soft tissues sarcomas can develop are muscles, fascia (the tough membrane that surrounds muscles), tendons, fat, blood vessels, nerves and synovial tissues (connective tissue that makes up the membranes surrounding joints).

Soft tissue sarcomas are rare in adults, accounting for less than 1 percent of all new cases of cancer. The American Cancer Society reports that about 12,750 new cases of soft tissue sarcoma will be diagnosed in 2019 (7,240 cases in males and 5,510 cases in females). Sarcomas can be found almost anywhere in the body.

According to the National Cancer Institute, about 50 percent of soft tissue sarcoma cases occur in the extremities (arms and legs), 40 percent occur in the trunk (back and chest), and 10 percent occur in the head and neck.

Causes of Sarcoma:

“Brain injuries, encompassing traumatic brain injuries (TBI) from external forces and acquired brain injuries (ABI) resulting from internal factors, can drastically alter lives in an instant. The consequences of these injuries ripple through every aspect of an individual’s life, affecting their physical abilities, cognitive functions, emotional well-being, and social relationships. National Brain Injury Awareness Month, this past March, aimed to shed light on these challenges while fostering a supportive community for those affected. Their focus was more directed on “More Than My Injury,” aiming to humanize the experience of those living with brain injuries.”

Desert Clover Psychiatry (https://www.desertclover.com/blog/beyond-the-injury-empowering-lives-during-national-brain-injury)

Overview

Traumatic brain injury (TBI) is sudden damage to the brain caused by a blow or jolt to the head. Common causes include car or motorcycle crashes, falls, sports injuries, and assaults. Injuries can range from mild concussions to severe permanent brain damage. While treatment for mild TBI may include rest and medication, severe TBI may require intensive care and life-saving surgery. Those who survive a brain injury can face lasting effects in their physical and mental abilities as well as emotions and personality. Most people who suffer moderate to severe TBI will need rehabilitation to recover and relearn skills.

What is a traumatic brain injury?

TBI is an injury to the brain caused by a blow or jolt to the head from blunt or penetrating trauma. The injury that occurs at the moment of impact is known as the primary injury. Primary injuries can involve a specific lobe of the brain or can involve the entire brain. Sometimes the skull may be fractured, but not always. During the impact of an accident, the brain crashes back and forth inside the skull causing bruising, bleeding, and tearing of nerve fibers (Fig. 1). Immediately after the accident the person may be confused, not remember what happened, have blurry vision and dizziness, or lose consciousness. At first the person may appear fine, but their condition can decline rapidly. After the initial impact occurs, the brain undergoes a delayed trauma – it swells – pushing itself against the skull and reducing the flow of oxygen-rich blood. This is called secondary injury, which is often more damaging than the primary injury.

Figure 1. During impact to the head, the soft brain crashes back and forth against the inside of the hard skull causing bruising, bleeding, and shearing of the brain.

Traumatic brain injuries are classified according to the severity and mechanism of injury:

• Mild: person is awake; eyes open. Symptoms can include confusion, disorientation, memory loss, headache, and brief loss of consciousness.
• Moderate: person is lethargic; eyes open to stimulation. Loss of consciousness lasting 20 minutes to 6 hours. Some brain swelling or bleeding causing sleepiness, but still arousable.
• Severe: person is unconscious; eyes do not open, even with stimulation. Loss of consciousness lasting more than 6 hours.

Types of traumatic brain injuries

• Concussion is a mild head injury that can cause a brief loss of consciousness and usually does not cause permanent brain injury.
• Contusion is a bruise to a specific area of the brain caused by an impact to the head; also called coup or contrecoup injuries. In coup injuries, the brain is injured directly under the area of impact, while in contrecoup injuries it is injured on the side opposite the impact.
• Diffuse axonal injury (DAI) is a shearing and stretching of the nerve cells at the cellular level. It occurs when the brain quickly moves back and forth inside the skull, tearing and damaging the nerve axons. Axons connect one nerve cell to another throughout the brain, like telephone wires. Widespread axonal injury disrupts the brain’s normal transmission of information and can result in substantial changes in a person’s wakefulness.
• Traumatic Subarachnoid Hemorrhage (tSAH) is bleeding into the space that surrounds the brain. This space is normally filled with cerebrospinal fluid (CSF), which acts as a floating cushion to protect the brain. Traumatic SAH occurs when small arteries tear during the initial injury. The blood spreads over the surface of the brain causing widespread effects.
• Hematoma is a blood clot that forms when a blood vessel ruptures. Blood that escapes the normal bloodstream starts to thicken and clot. Clotting is the body’s natural way to stop the bleeding. A hematoma may be small or it may grow large and compress the brain. Symptoms vary depending on the location of the clot. A clot that forms between the skull and the dura lining of the brain is called an epidural hematoma. A clot that forms between the brain and the dura is called a subdural hematoma. A clot that forms deep within the brain tissue itself is called an intracerebral hematoma. Over time the body reabsorbs the clot. Sometimes surgery is performed to remove large clots.

Although described as individual injuries, a person who has suffered a TBI is more likely to have a combination of injuries, each of which may have a different level of severity. This makes answering questions like “what part of the brain is hurt?” difficult, as more than one area is usually involved.

Secondary brain injury occurs as a result of the body’s inflammatory response to the primary injury. Extra fluid and nutrients accumulate in an attempt to heal the injury. In other areas of the body, this is a good and expected result that helps the body heal. However, brain inflammation can be dangerous because the rigid skull limits the space available for the extra fluid and nutrients. Brain swelling increases pressure within the head, which causes injury to parts of the brain that were not initially injured. The swelling happens gradually and can occur up to 5 days after the injury.

What are the symptoms?

Depending on the type and location of the injury, the person’s symptoms may include:

• Loss of consciousness
• Confusion and disorientation
• Memory loss / amnesia
• Fatigue
• Headaches
• Visual problems
• Poor attention / concentration
• Sleep disturbances
• Dizziness / loss of balance
• Irritability / emotional disturbances
• Feelings of depression
• Seizures
• Vomiting

Diffuse injuries (such as a concussion or diffuse axonal injury) will typically cause an overall decreased level of consciousness. Whereas, focal injuries (such as an ICH or a contusion) will have symptoms based on the brain area affected (Fig. 2).

Lobes of the brain that can get affected by TBI:

Figure 2. The brain is composed of three parts: the brainstem, cerebellum, and cerebrum, which is divided into lobes. The table lists the lobes of the brain and their normal functions as well as problems that may occur when injured. While an injury may occur in a specific area, it is important to understand that the brain functions as a whole by interrelating its component parts.

Every patient is unique and some injuries can involve more than one area or a partial section, making it difficult to predict which specific symptoms the patient will experience.