Patients suffering from fibromyalgia used to be told that it was all in their. Not anymore
Fibromyalgia is a mysterious illness with a long name and a bad reputation. For years, patients who went to their doctors complaining of inexplicable pain, stiffness and fatigue were told that they were depressed or stressed out and their symptoms were psychosomatic. More recently, fibromyalgia has been linked to chronic-fatigue syndrome and the aftereffects of Lyme disease, which in some medical circles in enough to give any ailment a bad name.

But the reputation is undeserved. Fibromyalgia is a real medical syndrome that is being taken more seriously these days, thanks to a study out of the University of Alabama that has found what may be the underlying causes: a reduced blood flow to the parts of the brain that process pain and twice the normal level of a brain chemical called substance P, which helps nervous system cells send pain messages to the brain. Not only do patients now have scientific support to prove they are not crazy but doctors also have more reason to take their complaints seriously.
The complaints are serious indeed, from swelling, tingling, numbness and stiffness in the soft tissues (muscles, tendons and ligaments) to achy, throbbing pain that is worse in the morning intensifies
again at night and has been known to drive suffers to suicide. Fatigue is a common complaint (reported in as many as 9 out of 10 cases), caused perhaps by disturbances in the deep-sleep phase the body needs to get properly refreshed at night. Patients have told me that they feel so heavy in the morning they can hardly get out of bed and that they often find it difficult to concentrate on even minor tasks. For reasons that are not known, women get fibromyalgia seven times as often as men, but the ailment can strike anyone at any age.
Doctors are at a disadvantage in diagnosing fibromyalgia because many of its symptoms are shared by other illnesses. Compounding the problem is the fact that even with these recent findings, there are still no definitive fibromyalgia markers. X rays and blood tests can be used only to rule out other illnesses. To facilitate diagnosis, the American College of Rheumatology established a procedure for examining 18 tender points on a patient’s body. If the muscles feel very sore when pressed in 11 of these 18 points, a tentative diagnosis of fibromyalgia can be made.
Although there is no known cure, there are treatments that work. In fact, many patients have managed the disease successfully with a combination of simple exercises as cycling and jogging. Though many patients say these exercise only worsen the pain, working through the discomfort can eventually bring relief. Tricyclic antidepressants such as amitriptyline and cyclobenzaprine are sometimes prescribed to improve sleep and relax muscles. Some patients opt for temporary pain relief via local anesthetic or steroid injections. There is no single regimen that helps everyone. Just keep trying until you find one that words. And don’t let anyone tell you it’s all in your mind.

A pair of new lens-correcting procedures aer trying to steal LASIK’s glory. Beware the risk
You may have read about a pair of new procedures to help correct presbyopia, the difficulty focusing on close objects that typically begins around one’s 45th birthday and eventually leads to reading glasses. News that the U.S. Food and Drug Administration might soon be approving the operation called conductive keratoplasty (CK), having approved laser thermal keratoplasty (LTK) last June, has focused attention once again on the growing and confusing field for corrective eyes surgery.

With all the hype surrounding LASIK, the most popular laser treatment, and these newer producers, it’s hard for physicians to know what to advise patients who are tired of seeing the world through a couple of layer of glass. As promising as these operations may seem there are some serious considerations that must be addressed before you put down your money (more than $2,000 an eye for LTK) and jump on the operating table.
Presbyopia (not to be confused with farsightedness) is caused by a gradual stiffening of the lens of the eye, which makes it more difficult to focus an image sharply on the retina. CK tries to improve focus by shrinking collagen fibers in the periphery of the cornea with short bursts of radio-frequency energy. The energy is delivered by a hair thin probe to as many as 32 sites on each cornea. The contraction of the collagen has a purse-string effect that steepens to cornea’s curvature. The procedure usually lasts less than minute, but it can take several months for improvements to fully kick in.
LTK also works by heating and shrinking fibers in the peripheral cornea, but it has several advantages over CK. There are no probes, so nothing touches the cornea. Instead, laser energy is delivered directly to the surface of the eye. Only 16 spots are treated per eye, and they can be done all at once in less than three seconds. “LTK has the safest profile of any procedure thus far approved by the FDA,” says Dr. Sandra Belmont of New York Weill Cornell Medical Center. “The concern I have with CK, is its greater potential to produce astigmatism, because all of the spots are done individually, which constantly changes the shape of the cornea.”
CK and LTK, like any other corrective eye surgery, will cause patients temporary discomfort. There may be a 24 to 48 hour period during which tears flow, and there is a scratching sensation akin to getting sand stuck in you cornea. Near vision returns immediately, but it takes a couple of days for the eyes to achieve their best focus. Distance vision may take a few weeks to recover.
LTK would be the first choice for many ophthalmologists because it is less invasive than LASIK and there are fewer potential side effects. But if you also have astigmatism or your hyperopia (farsightedness) is greater than 3.0 diopters, then LASIK is probably the procedure of choice. Before making any rash decision, however, remember
¨ these are elective surgeries and
¨ you have only one pair of eyes. Generations before us have done quite well with bifocals. It wouldn’t hurt to keep yours around a few more years until the kinks in the new procedures have been worked out.