My Biggest Hit Song

I include this song here because I literally wrote it, in the car driving home, after a full day's research studying fibromyalgia in the Amish community just outside Aylmer Ontario. No guitar. No piano. I was driving, but the song just popped into my head. By the time I got home, it was done. Only THEN did I pull out my guitar to figure out what chords I needed. This song has been my biggest hit, recorded by other artists and even appearing on the radio from time to time. I hope you enjoy it.

To buy the CD that has this song on it, as well as 12 other original songs, just click here

The CD is called GHOSTS OF THE CPR

The paper reporting the results of my study of fibromyalgia in the Amish can be found at 

http://www.jrheum.org/content/30/8/1835.abstract

Two New Videos

Here are two new videos for you to look at and, I hope, enjoy.  The first is a YouTube video version of my previous blog post - Herbals & Gerbils: Fibromyalgia, Doctors and Herbal Remedies

And the second video - called When Even Hugs Hurt - is a personal plea for those who either have a loved one with fibro or somehow take care of them (as a health-care practitioner, lawyer or otherwise) to take time to learn the facts about fibro - especially that it is a REAL PHYSICAL DISEASE that has been proven such scientifically.

Again, I hope you enjoy these. And, if you do, please let others know about them. The more people who learn the truth about fibro, the better it will be for EVERYONE who has it, AND for those who care for them.

Kevin White, MD, PhD

See my webpage

Buy my book

Heriot Bay - Song by Kevin White

To add a little music to this page, this is a song I wrote about the decreasing numbers of killer whales (orcas) off the coast of British Columbia. This song is on my CD, which is available at
http://wortleyroadbooks.com/Store/tabid/1523/CategoryID/27/List/1/catpagesize/0/Level/1/ProductID/301/Language/en-US/Default.aspx

I hope you enjoy the song.

Does Thinking about Exercise Burn Calories? Tips on How to Build Your Exercise Routine

Did you know that just THINKING about exercising actually burns calories? It really does! The problem is... that it doesn’t burn very many of them. For example, it won’t even come CLOSE to burning off that extra large slice of chocolate cream pie you want... unless, of course, you only THINK about having the pie.

“What about if I eat the pie and think about spinach?” you ask.

Seriously, man! If you’re thinking about spinach while eating chocolate cream pie, you are in deep psychological doo-doo!

Psychotic episodes aside... if you have fibro and want to start some sort of exercise routine, whether it be to increase your strength or endurance or cardiovascular fitness; or to improve your sleep; or to lose weight; or just to piss your couch-potato partner off - you have to do more than just think about it.

But you DO need to think about it. Or, more specifically, you need to think about issues like HOW you’re going to do it, WHERE and WHEN, as well as WHAT you are going to do, and WHICH Speedo or bikini you’re going to wear.

As a world expert in fibromyalgia who just last week somehow managed to put a sweater on both backwards AND inside out and not notice it for 3 full hours (that damn laundry tag kept tickling my chin), let me give you some tips:

TIP #1: DON’T CHOOSE DODGEBALL!

... or kick-boxing; or bull riding; or bull fighting; or rugby. In other words, don’t try any exercise that involves you being hit, punched, kicked, gored or otherwise pulverized. Don’t even shadow box: accept that, at least starting out, your shadow will probably kick the living snot out of you.

Not only that. But because of the impact of feet against hard earth, you probably shouldn’t even run... or jog... unless you can somehow swing it to run in some low-gravity environment like the moon... or Charlie Sheen’s bedroom.

No! Instead, select a nice, non-contact sport like swimming or low-impact aerobics or professional ice hockey.

And DON’T bungee jump!  Why not? Because it FREAKS ME OUT!!!

TIP #2: DON’T STUFF CHOPSTICKS UP YOUR NOSE!!!

Don’t you remember that Monte Python skit, where the guy kept complaining about how much it hurt when he stuffed chopsticks up his nose? Well DON’T DO IT!!!

And don’t do any exercise you hate doing either. Take me for example. For whatever reason, I’ve always hated working my upper body. As a young man, I was a very serious competitive runner – track, cross-country, running from police... hey! I did it all. But when it came to me and upper body exercises... well, I was the ONLY dumbbell I EVER got close to. Why? Because I HATED them!

“Why?” you ask. WHO THE #@*& CARES?  I just did. I had the upper body physique of a spaghetti noodle, but no matter how many times people looked at me and rolled their eyes, or otherwise subtly insinuated that I needed to bulk up by calling me a pathetic dweeb, I still totally forgot working out anything that didn’t have a foot attached to it.

So choose some exercise you enjoy... or think you’ll enjoy... or at least won’t absolutely abhor.

TIP #3: DON’T RUN ON THE MOON!

In case ANY of you ARE considering it, DON’T start calling around trying to get permission to run on the moon (or Charlie Sheen’s bedroom), despite the low gravity. Why? (What’s with all the WHY’s?)

BECAUSE IT WON’T BE CONVENIENT FOR YOU!  Make sure that whatever exercise you choose to do will be convenient enough that it’s no real bother for you to get where you need to go and do what you need to do. If you want to ice skate but live 23 miles outside Las Vegas... uh uh! It ain’t happenin’!  Or want to walk around the university track when the university is 10 miles the other side of town and you need photo ID and a small envelope of weed to give the guy at the security desk to gain admission... again... it ain’t happenin’! 

What about just walking outdoors? Great! But if you live at the top of a 400-foot hill or anywhere where it snows 13 months a year, like Canada (but seriously folks, it only snows 12 months a year up here), or where the temperature gets upwards of 200 degrees, like Charlie Sheen’s bedroom... you’d better come up with something else. Maybe walk when it’s nice outside, but use a treadmill or arrange a drive to the nearest indoor mall when the weather turns nasty.

Whatever you choose - the more likeable and convenient the exercise is for you, the more likely you actually will start it and keep up with it... which is the WHOLE BLOODY POINT!

TIP #4: MAKE SURE YOU WEAR YOUR BEST SPEEDO!

Or bikini! Or not... but whatever you wear, make sure it’s both comfortable for you and good for whatever exercise you are doing.

Never wear stuff that’s too tight, even if you’ve got the best booty in town, because it restricts blood flow to those all important MUSCLES you’re trying to exercise. Show off that fabulous booty of yours LATER!

If you are walking, don’t chintz out on shoes. In fact, don’t chintz out on shoes even if you’re not walking. Take care of your feet... you just MIGHT need them some day.

And if you want to bicycle, wear a bloody helmet!  (Though, I ask you, WHY do sky-divers wear helmets? Think about that for a second. Goggles, okay. But a helmet???)

TIP #5: DON’T BORROW YOUR KID’S TRICYCLE!

Or anything that Grandpa Jake used to use when he was a teenager still trying to impress Grandma’s twin sister.

No. Make sure that whatever equipment you use is in good working order and appropriate for your size, weight and complexion. If, for example, you want to bicycle, have someone who knows modern bicycles (NOT Grandpa Jake) take a look at it to make sure that everything is oiled and moving right and not about to fall off when you’re barrelling down a 40-degree hill with no brakes. And make sure that the seat is high enough so your knees don’t knock your teeth loose every time you peddle.

Ditto with your treadmill or whatever other new-fangled contraption (as Grandpa Jake calls it) you decide to use. 

TIP #6: WIMP OUT!

I mean it. Totally wimp out! I want you to start with such a small amount of exercise you need to be Sherlock Holmes to find it.  We’re talking microscopic!  We’re talking tweezers! We’re talking flea-circus!

Well, no... not really. But DO start with a ridiculously small amount, and continue this for about three weeks, at least 3 -5 times per week, BEFORE increasing it.

“WHY so little?”you ask the man in the backwards, inside-out sweater. Because I want you develop the HABIT of exercising before it starts hurting.

“WHY three weeks?” Because, research shows, that’s how long it is for a new habit to become engrained... and because I said so. And I’m the man in the backwards, inside-out sweater.

I literally used to tell patients that, for the first three weeks, I just wanted them to change into their exercise clothes, drive to the mall or gym or whatever, look at the place, and then drive home.  Again, what’s important at that stage is NOT the exercise, per se, but the HABIT of exercising. Make sure the habit is strong FIRST, and only THEN start strengthening yourself.

TIP #7: WIMP OUT AGAIN!!!

What I mean is, once you do start to increase the amount you are exercising each time, make sure you increase SLOOOOOOOOOWLY.  I’m talking snail-walking slow! Grass-growing slow! Doctors’ waiting-room slow! Politicians-actually-fulfilling-a-campaign-promise slow! (Well... maybe not THAT slow.) 

My point is for you to increase the exercise slowly enough that you don’t start hurting so much you have to stop exercising and start all over again. A little discomfort is fine, but it should be as little as possible. Agony is NOT therapeutic. You’re not in a race here. There is no Fibro Olympics!  (Could you imagine... we could start out with the bed to bathroom sprint!)

AN EXAMPLE

I once had an elderly patient who wanted to start walking through her neighbourhood; at the time, she didn’t walk outside the home AT ALL. Since it was late spring and there were several months of nice weather ahead (we hoped, but this is Canada, so you just never know), I told her just to start by picking up the mail from her mailbox, which was at the end of her walkway, perhaps 20 feet from her front door. She started by asking the mailman (a kindly young man who knew she was hurting) to stop bringing her mail right to her door. She then started picking up her own mail, and did nothing more walking than this, for three weeks, wearing a nice pair of running shoes she’d bought years ago and hardly ever worn.

After those first three weeks, she started walking to the neighbour’s mailbox (though she SWEARS that she had NOTHING to do with the package of Anthrax they received).  Then a week later, to the next neighbours’ mailbox. Once a week, after the first three weeks were up, she walked one house further. Eventually, as she started feeling stronger, she started adding two houses at a time; and then three houses at a time.

Within 6 months, she was walking around the block... and feeling better. Not perfect... but better. And walking was something she now looked forward to.  And she now could go out with her family when they went shopping at the mall or to rob the local bank. She’d stop and rest often, while they mulled around various stores or planned their getaway. But she was now able to participate. And this all started with telling her mailman just to stop bringing the mail right to her door.

So again, what did she do to achieve this success?

(1) She didn’t choose dodge ball or any other exercise that was going to maim or dismember her. She chose walking, a safe activity in at least 14% of cities worldwide. (2) She didn’t stuff chopsticks up her nose or force herself to do any exercise she hated; she chose a practical exercise that she thought she would enjoy, and that (3) was NOT on the moon, but right outside her front door. (4) She elected NOT to wear a Speedo or string bikini, but DID make sure to wear good running shoes. (5) She needed no tricycle or other equipment that needed fine tuning, but DID start her exercise in late spring when the weather was starting to be nice and the pathway to her mailbox was no longer icy or snow-covered or covered in hibernating bears. (6) She wimped out, like I’d instructed her to, and started with a 40-foot round-trip walk, once a day; and (7) wimped out again by not increasing her walk for the first three weeks, until picking up her mail was a well-ingrained habit. Then and only then did she start to increase her walks in length, but only slowly and in small increments. And then, as the 8^th and last item in my list of tips, she allowed herself to...

TIP #8: PIG OUT!

I told her to reward herself every time she met a goal she’d set for herself. Now, if she’d been really overweight and trying to lose weight, I wouldn’t have suggested that she pig out with food, but maybe by buying some small thing she’d wanted for awhile or by inviting that nice young mailman in so she could see HIS Speedo.

As it turns out, what she REALLY wanted was a nice big slice of chocolate cream pie! And she didn’t even have to think about that one.

Kevin White, MD, PhD

See my webpage

Buy my book

Herbals & Gerbils - Fibromyalgia, Doctors & Herbal Remedies

I once had a doctor quite verbal

About how he HATED all herbals.

I told him “I see...

But this stuff is for me.

I don’t CARE it’s not tested on gerbils.”

Face it... doctors can be REALLY pig-headed.  Hey! I can say that, because I am one... and I’m really pig-headed about that.

But aren’t they though? You walk into their office and sit down and wait for a day and a half in your underwear to ask them what they think about this new preparation of green mould tea you’ve been drinking for 6 weeks, pleased as punch that it seems to be working... you’re feeling better, and stronger and more good looking... and even taller... and then once you tell him (or her) about your new-found remedy, he (or she) goes absolutely ballistic on you.

“You’re drinking WHAT????”

And you feel like you’ve just admitted to micro-waving your children.

And then the good doctor goes on to talk about doubled-blinded, randomized placebo-controlled trials, and statistical-significance, and type 1 and type 2 error, and placebo effects, and radishes, and sex in cartoons on TV... and you realize that Doc is REALLY losing it.

Here’s the scoop.  Most alternative therapies are unproven, at least relative to the standards that are required for most drugs... but that does NOT mean they don’t work.

Let’s start by talking about what a randomized placebo-controlled trial (sometimes called a randomized clinical trial) is. It’s typically just a study in which people with a particular health condition are randomly selected either to get some real drug (maybe a pill or a liquid, or maybe an injection), or to get a fake pill or liquid or injection that looks and tastes and smells and plays guitar EXACTLY the same... so no one but some little guy wearing black-rimmed glasses and a toupee working in secret in a small pharmacy in Chicago knows who’s getting what. And no one knows until the study is over, so then researchers can look and see who got better and who didn’t without people’s knowledge of what they were or weren’t taking screwing everything up.

Okay. Perfect. We now KNOW if something works or not. But first of all... do we? Because drugs are invariably tested several times, and invariably they DON’T work in Pittsburgh when they DID work in Los Angeles and Toronto and Paris and your Cousin Harvey’s basement. So which study do you believe? Maybe the guys in Pittsburgh are the only ones who know what the heck they’re doing!  Or maybe the drug works GREAT for the full duration of the 12-week study, and then everyone drops DEAD in week 13.

“Sorry... the study ended last week.”

My point is that even randomized placebo-controlled trials (sometimes called RCTs) aren’t perfect.

Now back to herbals and other controversial alternative therapies like physiotherapy and occupational therapy and counselling. Can we truly give placebo physiotherapy?  “Hey! I may or may not give you physio, and you won’t know it and I won’t know it until the end of 12 weeks!”  Would that WORK? 

How about surgery?  “I may or may not remove your brain tumour, and I'll be operating with my eyes closed.” “Sure Doc, sign me up.”

The fact is that many very well-accepted treatments will NEVER pass the scrutiny of the randomized placebo-controlled clinical trial (sometimes called Frieda). Does that mean THEY don’t work?

“Let’s close the surgery department down because we’ve got no placebo.”

Of COURSE not! And the same is true of herbals and magnets and massage and chiropractic and therapeutic touch and bananas and other treatments that may make your doctor rage and rant. Most of these treatments will never meet the same level of scientific proof as that little pink pill... but that doesn’t mean they don’t work. Many, many drugs we use today once WERE herbal remedies... that have now been ‘PERFECTED’ by purifying them, perhaps modifying them, and then wrapping them in a tasty candy coating, strange name and big price. 

Besides, many of these alternative therapies HAVE been tested, to as high a degree as modern scientific methods will allow... and HAVE been found to be better than mock treatments. Herbals... sure; some of them have been tested and have been shown to be more effective than placebo. We can’t be entirely sure people on ‘placebo’ didn’t get the same ingredients as the magic herb in their diet or somewhere else... but hey! That’s inevitable to some degree. Magnets... YES. Several studies have demonstrated the benefits of magnetic fields on pain. Will little magnets tucked into your Speedo work? I don’t know. But at least the principle of using magnetic fields to treat pain has been tested.  And therapeutic touch... which isn’t touching at all and sounds like complete hooey... actually was proven to speed up wound healing. Go figure!

And what about this damned placebo effect anyway? Some doctors say: “it’s all just a placebo effect.” But if you feel better, WHO THE HECK CARES?  So long as I can afford it and it isn’t hurting me, I don’t care if it’s just mind over matter. If I feel better in my mind... that STILL matters!

I’ve always told people... just be a smart consumer. More specifically:

#1: If something seems too good to be true... it probably is!
If some remedy touts being able to make your pain and fatigue go away forever, and cure you of cancer, diabetes, heart disease, rabies and foot fungus... AND make you 3 inches taller, ten times sexier, and 47.2361% smarter... that’s PROBABLY too good to be true.  

#2. Don't sell the farm 
In general, don’t buy any treatment you have to remortgage your house for, unless the therapist is really, REALLY hot! Seriously, though, if you want to try something out, okay. But buy a small amount to see how it works first. Don't buy a year's supply for 30% before you've had a trial of it. What happens, for example, if you're allergic.  In fact, with creams, I always recommend you apply only a small amount over a very small area of your skin (that you can see, like your arm) to make sure you're not allergic before liberally gooping it on.

#3. Talk to others who’ve tried it whom you trust. 
Find out what their experiences have been. And now that we have Twitter and FaceBook and Linked In and whatever else, you have even more sources to go to. But exercise caution believing people you've never met other than on-line. There's something about you knowing how to get to someone's house that will make them that much more honest.

 #4. And ask your pharmacist.
Despite our big heads, doctors don't actually know as much about drugs and herbals remedies as pharmacists. We understand the diseases to be treated MUCH better (we hope). But pharmacists have YEARS of training in drugs, whereas how drugs work and what side effects they have are only a part of what doctors learn. Ditto of therapists and therapy, nutritionists and diet, etc.  

And otherwise, just use common sense.  And maybe, just maybe, once your doctor sees how well you're doing and stops chattering on about caramel popcorn, how educational the Gong Show used to be, and the horrific plight of monkeys on Mars, he (or she) will come around too.

Kevin White, MD, PhD

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Buy my award-winning book

SO WHAT ABOUT VALENTINE’S DAY?

Well here we are. We’ve just survived the holidays of December, pitched the tree or put away the menorah just in time to avoid setting the house on fire... and we’re right back looking at another holiday.

Sure... Valentine’s Day isn’t a day off. You don’t cook turkey. No one is breaking into your home via the chimney. There’s no Valentine’s Day parade, discounting long lines to wedding chapels in Nevada and that cheesy wax museum in Niagara Falls. And if family members start arriving at your door on February 14^th asking for entrance, it is legal to shoot them in at least 17 countries worldwide. But it’s a big day nonetheless, says every card, flower and confection shop around the world... and so you’ve GOT to get ready.

But what do you do and how do you prepare if you have fibromyalgia, and your idea of a romantic evening has been reduced from wearing a string bikini or Speedo and making passionate love on a Spanish beach as the sun goes down to wearing Ben Gay and leaving a 6-word note for your partner, written in red crayon, that says “I’ve gone to bed early”?

And what do you WISH your partner would do for YOU on V-Day?

Given that I’m a typical male, and therefore have as much notion of true romance as a turtle in heat, I am inquiring of you, my readers:

Again, what do YOU do, what your partners do for you, and what do you WISH your partners and other loved ones would do for you to celebrate International Flowers and Chocolate Day.

Just post a comment to this blog. It’s fun and easy. You’ll be giving helpful info to other readers. You could win fabulous prizes (but probably not). AND YOU JUST NEVER KNOW – it might just so happen that a former friend of your partner’s Uncle Bert reads it, intends to notify Uncle Bert to let him know how to save HIS marriage, but types in the wrong email address and contacts your partner by mistake, who then reads this blog, puts two and two together and somehow comes up with the strange notion to actually do something nice on Valentine’s Day, and you end up having your Valentine’s Day wishes come true after all.

Hey! It COULD happen!

So help me out and POST YOUR COMMENTS PLEASE!!!!

Thanks.

Kevin White, MD, PhD

www.thefibrofog.com

MERCY REPORT #2 – DR. WHITE RANTS ABOUT THE 'NEW CRITERIA' FOR FIBRO

Do you know what Rheumatology is? It’s pronounced room-a-tol-oh-jee. I used to think it was the study of claustrophobia... you know, people who can’t get enough ‘room’. But no – rheumatology is the study of the rheumatic diseases.

“Isn’t rheumatics how air brakes work?” you ask.

No, Grasshopper. THAT is pneumatics. Rheumatic diseases refer to arthritis and rheumatism.

“Oh great!” you sigh. “How many ‘rheums’ does this bozo have?”

It’s simple, my young Padawan. Arthritis refers to pain in joints; and rheumatism is pain in muscles and other soft tissues like tendons.  Anyway... it turns out that Rheumatologists (that’s just rheumatology misspelled) and Neurologists (nerve doctors) are slugging it out over who gets to treat fibro... and neither group wants it.  The Rheumatologists point out that, though fibromyalgia USED to be considered a form of muscular rheumatism, recent research now indicates that it is, in fact, a disease of the brain and nerves. On the other hand, Neurologists point out that it was rheumatologists who first came up with this wacky condition in the first place. “So you take it. No, you take it. No, you take it. No you take it.” And so on.

Meanwhile, anaesthesiologists who run pain clinics point out that most fibro patients have pain just about everywhere... “So where the HECK do I put the fricken needle?”

And veterinarians... well, they haven’t weighed in on the issue yet.

But now there’s great news for all these specialists! Now, NONE of them have to see you.

Why?

Because new, IMPROVED diagnostic criteria have just been published that do away with the classic tender point examination, which has been the mainstay of diagnosis since 1990. Now, instead of any doctor taking the time to actually examine you, all that’s needed is a questionnaire that asks you if you hurt and then asks you where.

It’s even fun. The questionnaire gives you 19 different choices where you might hurt... your left upper leg, your right upper leg, your left lower leg, your right lower leg... and so on. And once you’ve finished you move on to rate the severity of your fatigue, waking unrefreshed and cognitive problems. Then, finally you’re asked if you have headaches, lower belly pain or cramps, or depression. It’s kind of like ordering at a Chinese restaurant. “I’ll take numbers 5, 8, 14 and 17, some won ton soup, and, oh, those cute little almond cookies.”

Once you’ve ordered, you then get to find out if you have fibro or not, by adding this to that and this to that and multiplying everything by your old Aunt Edna’s bra size and Voila! You get a score that either says ‘Yes, you have fibro” or “No, you have rabies.”

It’s so simple. You can be diagnosed in the waiting room, just by filling out the questionnaire yourself, BEFORE the doctor sees you. And if your hands are so bad you can’t hold onto a pen... no worries! You usually have to wait so long anyway, by the time you’re seen you can probably form life-time friendships with other people waiting, or trace each other's geneology back 17 generations to find out that you're distantly related... and then maybe they’ll fill the questionnaire out for you. And all without the doctor ever touching you.

What’s next - an even newer version for on-line use?  Hey, they could make that one even simpler... just one question:  “Do you feel like shit?”

 “Congratulations! You have fibro!”

And now you don’t even have to go into the doctor’s office to fill out the questionnaire in the waiting room.

Magnificent!!!

But I hate these new criteria, and here’s why...

First, if all you need is a questionnaire, specialists will no longer have to see you. And if specialists no longer have to see you, they will MISS other problems that often co-exist with fibromyalgia. Just where oh where on that questionnaire do you indicate that your fricken nose has fallen off? The fact is that people with fibromyalgia are at increased risk of having a host of other rheumatic conditions, like osteoarthritis, rheumatoid arthritis and lupus. And if you don’t have those things, you might have treatable localized conditions like shoulder or hip bursitis or carpal tunnel syndrome or tendonitis of the heel that could be fixed with a simple shoe insert. But if no one examines you, NO ONE WILL KNOW.

And second... who’ll believe you? If you have trouble making your family doctor believe you NOW, even after a specialist has confirmed that you have fibro, how will it be for you if you go in saying you diagnosed yourself on an on-line shopping channel, or while cruising porn sites?

Now, to be fair, many Rheumatologists are still happy to see you, though I've seen more and more start saying No; and a small percentage of Neurologists, who generally call themselves functional Neurologists, see fibro patients too. And the new questionnaire was supposedly created only for research purposes; mind you, the same can be said of the old criteria, and they became the gold standard for diagnosis. And the new questionnaire is not INTENDED for self-administration, though I'm sure it's only a matter of time before it is.

But I'm still concerned. WHAT the heck was WRONG with the old criteria anyway? And how do these criteria improve anything? My fear is that many specialists will see these new criteria, that require no physical examination to confirm fibro, as another reason they don't need to see you; and more doctors in general will see them as yet another reason to justify calling fibro a non-physical disease, despite a mountain of evidence now proving otherwise.

And whatever criteria you use, THAT'S pronounced STU-PID!!!

Kevin White, MD, PhD

www.thefibrofog.com

JUST RELAX WHILE I HURT YOU! (ARE WE DOCTORS STUPID, OR WHAT?)

Don’t you find it funny how doctors, especially specialists, ask you to “Relax” just before or while doing something that you and they both know is going to cause you extreme pain?  They push on your leg.  You yelp and jump. They twist your arm 270 degrees and wrap it around your head three times. You scream!

“Now Mrs. Thomas.  I need you to relax,” says the oh-so-kind-and-compassionate doctor.

“And I need you to shove this ball point pen from my purse five inches up your nose,” you think sweetly.

The truth is… most of us doctors are severely socially impaired, or just plain stupid. We’ve forgotten what it’s like to interact with normal human beings under normal circumstances. We stick a giant-sized popsicle stick down your throat and tell you to say “Ahhhhhh.”  Like… what the heck ELSE could you say?  We have immobilized your tongue with a stick that’s covered in splinters.

“Say Philadelphia.”

“Ah ah ah ah ah.”

We ask you to breath in -  “Then out.  Then in.  Then out.  Then in.  Now Hold it.” - while we listen intently through our stethoscopes for 14 minutes and you’re turning blue. We ask you to touch your nose.  Then our finger.  Then your nose. Then our finger. And back and forth again and again and again and again. Like… what the HECK is that all about?

We ask you if you'd mind having a couple of medical students come in and examine you... and then, before you even have a chance to answer, the room fills up with 26 juveniles in white coats and sneakers, all drooling.

And then we ask you to relax when we’re about to perform a rectal or pelvic exam. 

Yeah… sure.

Diagnosing fibromyalgia is not as hard as you have been led to believe (i.e., there’s no reason you should have to wait 6 years and see 15 specialists before someone figures it out). There are relatively few things that make someone ache all over.  A flu will do this… but it goes away usually in a few days to a few weeks. Listening to a political debate may do this, but this usually ceases when you finally give up and switch channels to watch The Cake Boss.

No… if you sincerely ache all over, and have done so for months or years, then fibromyalgia is quite likely. Your doctor certainly should suspect it. Not to say that you couldn’t have something else too.  Fibro CAN co-exist with other conditions, and these conditions MUST be recognized to maximize your likelihood of doing well.

But fibromyalgia is not a diagnosis of exclusion.  It is not what you have because the doctor has examined you and gotten several tests and X-rays and nothing else shows… “So it must be fibromyalgia.” Fibromyalgia is diagnosed when the doctor asks you what bothers you, finds out you have generalized musculoskeletal pain, debilitating fatigue and sleeplessness, and then examines you.

The specific examination finding he or she should be looking for is diffuse body tenderness.  Relatively light touch, when he or she pushes down on your skin with a thumb, will cause you pain… often quite severe pain. There are 18 specific body points the doctor or other health care professional will be examining.  These are called the fibromyalgia tender points. Some experts have recently called for these points to be abandoned, but I think this is a BAD idea (as I’ll comment further in a later blog).

Some doctors like to talk about ‘control points’.  Their contention is that, if you are tender at these so-called control points, in addition to the fibromyalgia tender points, this means you are just tender everywhere and, in their minds, faking it.  But this is, to use the scientific term, baloney. Most patients with fibromyalgia are diffusely tender, not just at the specific 18 points.  Tenderness at control points just means that you are tender at these points too. This should be obvious to anyone who understands the underlying cause of fibromyalgia (which is now known to be dysfunction of the central pain processing centre in the midbrain), which excludes MOST doctors your insurance company will send you to.

So… fibro is diagnosed by the history of chronic widespread pain and tenderness, especially tenderness at a majority of these 18 specific points.  NOT by exclusion. And almost all people with FM have debilitating fatigue and non-refreshing sleep… in addition to a constellation of other symptoms which many but not all people with fibro have - like headaches and migraine headaches, crampy abdominal pain, pain when you pee, numbness and tingling and other funny sensations, sensitivity to hot and cold and light and sound and chemicals and smells and silly long lists; and problems with concentration and... and... and... and... oh yeah - MEMORY!

To diagnose fibro, then, your doctor must…

1.                 Listen to your story… what symptoms you have.

2.                 Examine you, especially examining for diffuse body tenderness, especially at these 18 fibromyalgia tender points.

3.                 Make sure you don’t have something else as well, which might accompany fibro like arthritis, tendonitis or bursitis.

How does your doctor make sure you don’t have something else?  He or she must…

1.                 Listen to your story… what symptoms you have.

2.                 Examine you, especially examining your muscles, bones, joints, tendons, ligaments and bursae, as well as your neurological system, your skin and other organ systems.

3.                 Consider further testing, like blood or urine tests, X-rays or other imaging techniques, if he or she feels that some other conditions still are suspect, based upon your symptoms and physical findings.

There's a pattern here... I just KNOW it!

Listening to you and examining you are the two most crucial steps in diagnosing the cause(s) of your symptoms.  Lab tests and X-rays are secondary and, essentially, meaningless unless the first two essential steps have been taken.

So… “Relax while I hurt you.”

"Yeah... sure, Doc!"  Now WHERE did I put that fricken' pen?

Kevin White, MD, PhD

www.thefibrofog.com