by Mark Pellegrino MD
Vacation time should be relaxing and free from pain. Having fibromyalgia (FMS) can make vacations extremely stressful since it does not distinguish good stress from bad stress. In FM, they can both hurt. There are many reasons why vacations cause paradoxical flare-ups: happy stress, a hectic schedule, increased physical activities (walking, hauling luggage, etc.), and changes from our proper posture. In our eagerness to take our vacation, we often forget our necessary daily routine for controlling fibromyalgia. Since we are bringing our FM with us, we have to make sure our fibromyalgia has a good time too!

Planning
Vacations, like everything else involving FMS, have to be planned in detail. Think of as much as possible ahead of time to anticipate potential problems and avoid surprises. Always try to plan a few days at home after the vacation strictly to rest and recover before returning to work or whatever you do in the "real world." Getting home on Sunday night and returning to work Monday morning will only invite a prolonged fibromyalgia flare-up.

What do you want to do?
So how does one prepare for a "Fibro" vacation? First, decide on a suitable vacation spot. Locations with hot, dry climates are best. I haven't met anyone with FMS who has taken a vacation to Siberia!

If you like to stay busy, pick locations that offer a variety of attractions or events involving sitting as well as standing. Theme parks can be difficult places because of all the required walking and standing in lines. Avoid locations that require sleeping on the ground (camping out in a tent!) or sleeping on an impossible bed (recliner cot in an RV, Aunt Mae's sofa, etc.). My idea of camping is fishing, hiking, and boating during the day, and at night staying in an air conditioned hotel with a king-sized bed (firm mattress) and my pillows from home. You're allowed to get away to some relaxing resort and do absolutely nothing.

Some people have a difficult time planning for a vacation and this stress can increase pain even before the vacation starts. Many are so overwhelmed by everything that has to be done beforehand that they choose not to take a vacation at all. Or they don't want work to pile up while they’re gone, so they never leave!

Organize!
One way to avoid being overwhelmed by the big picture is to plan and organize. Write down every detail of your trip as exactly as possible and try to follow this agenda. Take care of all your home activities such as paying the bills, doing the laundry and shopping. Prepare a list of various vacation packing duties and spread out these duties each day for two weeks.

By planning each day and activity, you can keep your mind occupied and off the pain as much as possible. This also breaks down the very big stressful vacation into a series of small mini-events that are not as intimidating and seem possible to accomplish and enjoy. Organizing your vacation into a series of smaller events allows you to focus your attention and energy on smaller tasks that can be accomplished. Otherwise, you'll look at the whole vacation and may be so over whelmed, and not feel that you have the energy or motivation to do it.

Take Care of Yourself
Breaks. Since the majority of vacationers often spend several hours more on their feet during each vacation day than they would under non-vacation circumstances, we need to recognize the potential for aggravation of back, hip and leg symptoms. Carefully organize the vacation event so that you allow frequent breaks between walking, sitting and standing. It's a good idea to plan a rest day every third day for sitting and browsing only. Plan on watching a show, taking a seated sightseeing tour, or lounging at poolside. Planned rest breaks in a hectic schedule are very much appreciated by our muscles!

Boats, Planes & Automobiles
If you are traveling by car, make sure you allow plenty of extra time to give proper attention to your fibromyalgia. A good rule of thumb is to add 10 extra minutes per every hour of travel. Stop the car for every hour of driving and take a two-minute stretching break and a five-minute walking break before resuming the trip. Every four hours, take a five-minute stretching break, a five-minute walking break and at least a 30-minute seated break (eating a meal in a restaurant).

Watch your position and body mechanics while you are seated in the car. Don't turn your head in an awkward position to talk to someone for long periods of time. Likewise, if you are taking a nap, try not to lean on a pillow with your head tilted for a long period of time.

Many FMers are bothered by motion sickness, on the water and off. This is probably due to a hypersensitive vestibular system that overreacts to extra signals. There are several strategies for minimizing motion sickness if you are prone to it. Your doctor may prescribe a pill or patch to use as needed. Avoid reading while riding in the car; be especially careful when looking at maps while riding. When it's necessary to look at a map, look at it for no more than 15 seconds at a time before shifting your focus to outside the car at moving scenery for 15 to 30 seconds; then look at the map again, no more than 15 seconds at a time. Breathing fresh air, getting out of the car and walking, and switching roles with the driver are all helpful in combating motion sickness.

Watch out for drafts; vacation time seems to be a drafty time! Avoid direct air conditioning drafts in the car or in the restaurant and have a light coat to keep your arms and neck covered if it is chilly or drafty in an area. Don't roll windows down, especially when driving on the freeway.

If you are bothered by a lot of neck pain and fatigue during prolonged driving, you would be a good candidate for wearing a soft cervical collar during your trip. A soft collar can help rest the neck muscles while supporting the head; it can be particularly effective while driving over bumpy areas where there are more demands and strains on neck muscles. I recommend that the collars not be worn more than 50% of the time while driving or riding and no more than one hour at a time to prevent the neck muscles from getting stiff.

Help your fibromyalgia in any way you can while driving or riding in a car. Taking over-the-counter pain medications 30 minutes to an hour before an anticipated strenuous activity may help dampen the pain. Rubbing muscles with creams that generate either heat or cold can help. Bring along a tape player with earphones and play your favorite music or relaxation tape.

If you are traveling by airplane you need to maintain proper body mechanics and frequently reposition your body. An aisle seat is best so you can stretch out your legs and alternate positions, especially on long flights. Take your music with you. If you hate flying like I do, practice your deep breathing exercises especially just before take-off. Bring your own comfortable pillow to increase the chance of getting some restful sleep during those trans-continental or trans-oceanic flights at night. Your doctor may be willing to prescribe a sleep modifier to use especially on the plane to help achieve good quality sleep. In planes with larger aisles, walk around frequently. If your budget permits, buy first class or business seats simply for the extra space. Watch out for those air blowers above you so they don’t shoot cold air right on to your neck.

Luggage
Luggage can cause special problems you are loading your own luggage into the trunk or carrying it around for long distances, you are particularly prone to developing increased pains in your neck, shoulder, back and arm muscles. Take less! Use luggage racks, carts, and wheels whenever you can. Don’t sling straps over your shoulders as this will aggravate your trapezius and back muscles. The best way to transport luggage if you have fibromyalgia is to let someone else carry it for you. The next best way is to push a luggage rack on wheels in front of you. Pulling it behind you is harder. If you have to carry your own luggage, make sure that you switch arms frequently, take rest stops every hundred yards and actually set down your luggage, stretch your arms and massage your shoulders.

In addition to taking your own pillows, remember that many hotel air conditioners blow air directly on the bed, so be certain that you either block or re-direct the air to avoid direct drafts. Always make sure that the hotel you will be staying in has a hot Jacuzzi so you have a relaxing, deep heat modality. Pack your bathing suit. If you like ice packs, bring some instant cold packs or a Ziploc plastic bag to make your own.

Vacation is not a time to stop taking your supplements. Take along magnesium and malic acid for muscle support and energy, plus a good daily multiple. Also, bring any supplements that help you sleep since vacations notoriously disrupt one’s sleep routine. If you don’t want to take a dozen bottles, invest in a vitamin keeper that has special compartments and labels so you can organize them and know what and how many to take along.

Finally, in case you might need them, don’t forget to take your medicines along, especially sleeping pills or medicines that you use only for flare-ups. Never leave drugs in visible areas where they could be stolen.

TRAVEL SUMMARY
There is no need to let fibromyalgia ruin a perfectly good time. Nor should you let it prevent you from taking a well-deserved vacation. Bon voyage!

Remember...

• Vacation can be stressful. Fibromyalgia does not distinguish good stress from bad stress.
• Plan and anticipate potential problems.
• Organize and write down every detail of your trip.
• Organize your vacation into a series of smaller events so that you can focus on smaller tasks.
• Plan a rest day every third day.
• Add an extra 10 minutes per hour when traveling by car: 1 fibro hour = 70 minutes.
• Continue to take supplements, and extra ones for sleep.
• Take medicines for sleeping and flare-ups in case you need them.
• Give yourself permission to relax, enjoy, and do absolutely nothing!

For informational purposes only.

Mark Pellegrino, M.D. is Board Certified in Physical Medicine and Rehabilitation and Electrodiagnostic Medicine. He is one of the nation’s leading experts on fibromyalgia and in fact, has FMS himself. Dr. Pellegrino has authored numerous FMS books and articles both from a patient and first hand basis. He maintains an active medical practice, has cared for more than 25,000 FMS patients, and been named in the "Best Doctors in America". Dr. Pellegrino has been on the Health Points advisory panel since 1998.