Unfortunately, fibromyalgia remains a baffling illness
DEAR DR. DONOHUE: My daughter has been diagnosed with fibromyalgia. Could you give me some information on it? She walks on a treadmill daily and works out twice a week. She has been using artificial sweeteners for years and has been on birth control pills for 10 years. Would these have any bearing on the condition? — P.W.
ANSWER: Fibromyalgia is an enigma. Its cause is unknown, and its treatment is challenging. There is no substantial evidence to implicate either birth control pills or artificial sweeteners in its origin.
Symptoms are bodywide muscle pain, along with muscle stiffness and profound exhaustion. Neck, shoulder and hip muscles are almost invariably involved, and their involvement makes carrying out the most routine daily tasks difficult.
In addition, sleep disturbance is common. People with fibromyalgia never waken refreshed. They often find it impossible to concentrate, and their memory might not be as retentive as it once was.
There is no lab test that provides proof of this illness. There is no X-ray or scan that can support the diagnosis, and that makes fibromyalgia an elusive condition.
However, tender points help. Tender points are 18 specific body sites where moderate pressure from the doctor’s examining thumb produces pain far out of proportion to the pressure applied. Finding 11 of the 18 tender points puts the diagnosis on firmer ground.
Essential to the diagnosis is the elimination of any illness that has symptoms similar to those of fibromyalgia. Rheumatoid arthritis and lupus are two such illnesses, so lab tests are done to exclude those maladies.
Amitriptyline, an antidepressant, is often prescribed — not for its action against depression, but for its ability to restore sound sleep. Muscle relaxants and seizure medicines such as gabapentin and topiramate are also employed. An exercise program is an essential component of therapy.
The fibromyalgia booklet describes this illness and its treatment in greater detail. Readers can obtain a copy by writing: Dr. Donohue — No. 305W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
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DEAR DR. DONOHUE: I love orange juice but quit drinking it, thinking it might be causing gout flare-ups. Is that possible? — R.M.
ANSWER: Neither orange juice nor oranges are on any list of foods that precipitate a gout attack. Purine-rich foods — anchovies, organ meats (kidney, liver, sweetbreads), gravies, meats, fish, asparagus, peas, spinach and mushrooms — might lead to an attack. Purine is a precursor of uric acid, the stuff that infiltrates joints and causes gout.
Recent evidence simplifies the gout diet to eating less red meat and seafood and drinking more low-fat dairy products. Gout sufferers who drink two or more glasses of skim milk a day are half as likely to come down with an attack than are those who don’t do this.