### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am 56 years old and have had fibromyalgia since the early 1980 s. Over the years I have had lots of joint, tendon and ligament stresses and strains and muscle pain just from everyday things like holding and picking up my children when they were little. It appears that degenerative disc and joint problems run in my family. My mother has now had both hips and knees replaced and several other family members too. I have been told I need a knee replacement in one knee and will be having scope surgery on the other knee tomorrow to repair the meniscus and clear out whatever is floating around in there. What is bothering me the most right now though is I had cortisone injections this past year for tarsal tunnel and other nerve pain caused to the top of my foot from a foot insert that made my shoes too tight. The first injection was in August, and then a second one in November because it seemed they missed the spot on the top of the foot. After the August injection I didn t seem to notice any major side effect, but after the November injection I felt like a hit a wall and had no energy, my muscles felt exhausted and weak, I started having muscle cramps, especially in my calves in the night and pre-waking hours of the morning, for a couple weeks I felt shaky and light-headed, and I also started losing a lot of hair. My primary doctor told me it threw my blood sugars off (I don t have diabetes) and she did blood work and said everything else was fine other than low vitamin D levels. I was referred to an endocrinologist and told the same thing. I was told it would probably take 2-3 months for me to feel back to normal again. I ve been taking vitamin D supplements and a multivitamin with minerals consistently for 6 months now and I don t feel much better, the night time muscle cramping and hair loss has stopped, but I feel totally exhausted and my muscles feel weak and the leg muscles seem to contract and not release, especially in back of the upper leg and behind the knees and the overall joint and muscle pains throughout my body have increased. I can t stand or walk but a few minutes before the muscle cramping and pain kicks in. In the past I experienced hair loss a couple other times, but my doctor and I didn t know why. Now looking back I m sure it was due to the past cortisone injections I had for my knees and I assumed all the other symptoms were due to a fibromyalgia flare-up. I feel like I have aged and turned into my grandmother overnight this past winter. Even my own mother who had both hips and knees replaced moves better and is healthier than me. Is this all due to the cortisone injections? Is the fibromyalgia in hyper speed due to the injections? Could there be some other problem? Will I ever have enough energy and pain relief to get up and go again? I am beginning to think I will need a walker or wheel chair any day now.

### output:

Hello cortisone injected intra-articular does not produce systemic side effects elsewhere in the body as it is formulated to remain within joint and doesn't absorb in blood stream to reach elsewhere in body organs or system. Though your mother may look stronger but since you have fibromyalgia, your case is different. Hopefully you consulted endocrinologist and followed his advice thoroughly. See a fibromyalgia specialist who may like to prescribe pregabalin and amytrytaline tabs if necessary to give more symptomatic relief if necessary.Also, methycobalamin tabs may help. Do not worry, take fresh juices and nutritious diet and take physical therapy exercises.It's a difficult disease but there can be ways to improve quality of life, that is by practicing meditation and spiritual practices also and taking life easy. Mental happiness has proved to have benefited several fibromyalgia patients in some unknown ways. Probably, endorphins chemicals in brain which interpret pains and aches are regulated with meditation practices, and scientifically reduce pain perception or increase pain tolerance and thereby quality of lifebelt wishes