Fibromyalgia or Chronic Fatigue
ByGabe Mirkin, M.D.
Fibromyalgia means that a previously healthy
person develops unexplained exhaustion, fatigue
and muscle aches and pains that last for more
than six months, all blood tests are normal
and doctors can't find a cause. One report
shows that a large number of people who were
diagnosed as having fibromyalgia really had
polymyalgia rheumatica that does have an abnormal
blood test. Another study shows that many
sufferers have low spinal fluid levels of
vitamin B12 and may be treated with 1000 mcg
B12 pills each day.
The diagnosis of fibromyalgia should
be made only after all other causes have
been ruled out. Many infections can cause
fatigue and muscle pain, such as parvovirus
B19, which was reported to be cured with
intravenous injections of immunoglobulin.
The evaluation should include tests for
infectious diseases; such as Lyme disease
and hepatitis B or C, cytomegalovirus,
toxoplasmosis or the helicobacter that
causes stomach ulcers; autoimmune diseases,
such as rheumatoid arthritis, lupus, Crohn's
disease or ulcerative colitis; hidden
cancers such as those of the breast or
prostate; hormonal diseases such as low
thyroid; or side effects from a medication
or illicit drug.
About twenty percent of the patients
are depressed, and most people miss work
and complain of illness long before their
diagnosis. A diagnosis of chronic fatigue
means that tiredness is the major complaint.
Fibromyalgia usually means that muscle
and joint pains are the major symptoms.
Many studies show that there is no dependable
way to define chronic fatigue syndrome
or fibromyalgia, and that three months
of antibiotics does not cure them, but
if the doctor suspects a reactive arthritis
it is reasonable to give a trial with
antibiotics for a longer term. Reactive
arthritis patients who may be be cured
with long-term antibiotics are:
* Those who have positive blood tests
for arthritis which are really measures
of an overactive immunity that is trying
to kill a germ,
* those who suffer from a chronic infection
characterized by burning on urination,
urgency or having to get up many times
during the night
* those who have chronic diarrhea,
* those who have belching and burning
in the stomach,
* those who have a chronic cough or sinus
infections,
* those who have swelling in the middle
of the hand which is characteristic of
Rheumatoid arthritis.
However, people who have reactive arthritis
must be treated for longer than three
months, often for more than a year.
An article from the University of Washington,
Seattle demonstrates that fibromyalgia,
chronic fatigue syndrome, temporomandibular
joint syndrome, irritable bowel syndrome,
interstitial cystitis and chronic headaches
share the same symptoms, occur in the
same people and doctors can't find a cause
or treatment. I have prescribed doxycycline
100 mg twice a day for several months,
and sometimes azithromycin 500 mg twice
a week, and some get better. However,
this treatment is controversial and is
not accepted by many doctors. Please check
with your doctor.
For journal references on the studies
mentioned in this article, see http://www.drmirkin.com/morehealth/G115.htm
Dr. Gabe Mirkin has been a radio talk
show host for 25 years and practicing
physician for more than 40 years; he is
board certified in four specialties, including
sports medicine. Read or listen to hundreds
of his fitness and health reports at http://www.DrMirkin.com
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