Diagnosis, Education and Treatment
Coordination for Adults and Children
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Fibromyalgia is a chronic pain syndrome of the muscles, tendons and ligaments that has an unknown cause. Fibromyalgia does not involve the joints, does not cause inflammation, is not an autoimmune illness, and all lab tests are normal. Numerous non-pain symptoms are also present (see below) and are just now becoming appreciated (non-pain symptoms are not part of the trigger point method of diagnosis, which has been found to miss the diagnosis in 25% of known fibromyalgia patients).
Most specialists believe that fibromyalgia and chronic fatigue syndrome are part of the same illness, with chronic fatigue syndrome being “fibromyalgia without the pain.” This is true in my experience. I see patients with chronic fatigue syndrome tending to have more central nervous system symptoms (like overwhelming fatigue, nervousness, trouble concentrating, etc) and less of the pain symptoms. A small number of Chronic Fatigue Syndrome patients are unique in that they do not have the typical symptoms or physical exam that places them along the Fibromyalgia/CFS spectrum. In these cases I recommend certain lab tests that may further uncover the nature of their CFS, and recommend practitioners who treat patients of this nature. If your symptoms began with a viral-like illness and you are experiencing no pain (other than headaches) your symptoms may not respond well to the treatments I offer.
The most common symptoms of fibromyalgia are non-restorative sleep, significant fatigue (80% of patients), and body pain. The other common symptoms are trouble with concentration and memory (sometimes called fibrofog), headaches, dizziness, muscle cramps, itching, rashes, strong smelling urine, pain during urination (without evidence of infection), nervousness, depression, anxiety, signs of hypoglycemia (which can be present in up to 40% of fibromyalgia patients), vulvodynia, history of growing pains, bad tastes in the mouth, sensitivity to light, sound, odors or chemicals, irritability, irritated eyes, nasal congestion, allergies, ringing ears, restless legs, nausea, gas, bloating, constipation or diarrhea, weight changes, brittle nails and easy bruising.
Of course you may have fibromyalgia and only have body pain and a few of the other common symptoms, or you could have many of these symptoms and not have Fibromyalgia/CFS—but these symptoms are more common in people with the syndrome. This history needs to be combined with the physical examination to make the diagnosis.
Yes. Recent genetic studies done at the City of Hope show that there is more than one gene that codes for the syndrome. You are 8.5 times more likely to have the syndrome if you have a family member who is affected.
If you have Fibromyalgia—think about your relatives—if they are having symptoms, they should be seen by a specialist sooner rather than later for diagnosis, education and treatment. There is no reason to wait for their symptoms to worsen before they see a doctor who is well informed in treating Fibromyalgia.
There have been recent changes to the original guidelines developed in 1990 for diagnosing fibromyalgia. These involved strict criteria regarding history of widespread body pain, and a trigger point exam; where the examiner would push with a predetermined amount of pressure on 18 places on the patient’s body. If the patient had a pain history that fit the criteria, and pain in at least 11 out of 18 trigger points, then a diagnosis of fibromyalgia could be made. This method of diagnosis is now thought to be too restrictive, missing people who actually have the syndrome and therefore preventing them from getting treatment. In April of 2010, the American College of Rheumatology recommended using a questionnaire, completed by the patient, which asks about pain and non-pain symptoms. The physician scores the patient questionnaire, using the ACR guidelines, and performs a physical exam. The tender point exam is no longer recommended. This is the type of method I use for diagnosis, and believe it is a much better way to accurately diagnose fibromyalgia than the old system. This method has been well received by other specialists around the country.
I think you should go to the physician who provides you with the highest quality of care for your specific needs. I LOVE taking care of patients with FM/CFS, and I have been specifically trained to do so. I find their cases interesting, challenging, rewarding and yes, sometimes even sad. Many of my patients have seen doctors who do not understand how all of their symptoms fit together to form FM/CFS, and patients have been made to feel their symptoms are not worthy of attention. I have lived with these frustrations, and am passionate about properly diagnosing, educating and guiding my patients to better health. Some doctors shy away from patients with FM/CFS because we can be so complicated, but over 90% of my practice is made up of FM/CFS patients because I find helping them so rewarding. It is satisfying to hear patients say “Now fibromyalgia/CFS makes sense to me. No one has been able to explain it to me before.” I try to go the extra mile to provide care that can make a difference in the lives of my patients. I make sure I am easily accessible to you to answer questions, and to see you in the office for ongoing management of your case. I am also easily accessible to your primary care doctor and specialists, providing them a written evaluation of each of your evaluations in my office, and speaking to them by phone on request.
I think the body has an amazing ability to heal, but can get out of balance due to illness, medication side effects, allergies, poor diet, and other stresses to the system. I understand that fibromyalgia is genetically based, so the root cause root cause cannot be eliminated, but I use the most healthy and natural treatments possible to help the sick body get back in balance and regain vitality. I understand that often prescription drugs are necessary to deal with certain symptoms of the illness, but there are a variety of treatments with fewer side effects, which can often achieve the same (or better) results. I continually work with you and your doctors to continually make sure that your health is improving over time.
I also try to keep an open mind about medical treatments. The root cause of fibromyalgia is not known, nor do doctors know everything about how a certain person is going to react to a specific treatment. You can count on me to respect you and your opinions because you know your body and how it reacts better than anyone. My role is to advise you on what my experience has shown may be the best treatment approach for you.
As a solo practitioner providing in-depth, time-intensive care, it would be prohibitively expensive for me to hire an emplyee to do insurance billing. Instead, I keep my charges fair, and provide quality time for the money. I am careful with my coding to help insure that your insurance provider will reimburse as much as is possible.
Many patients have told me that I actually save them money. Because I am so specifically trained, I can usually make the diagnosis of fibromyalgia/chronic fatigue syndrome in one visit. One more visit is usually required to discuss your optimal treatment plan. Then I see you in the office only as necessary. Many patients have spent hundreds to thousands of dollars on unnecessary or potentially harmful supplements or prescription medications. I can help prevent these unnecessary expenditures.