A cross on our door, fibromyalgia

It is quiet in my house at last. For the first time this week everybody is at school. The flu visited our house and I did not like it at all. It spanked my poor son, Little Latte. High fever, consumptive cough, a little delirium . . . It made for an interesting weekend with a soundtrack of nebulizer. Little Macchiato made out better. The flu was kinder to her. Nasty cough, low grade temp, sore throat. She kinda has a smoker's voice. Dr. Iced Mama has been swallowing Alleve and Tylenol by the bucket around the clock. I'm not sure how I feel.

I'm irritated with you, though patients! My poor husband had to go to five pharmacies to get Tamiflu for my febrile, wheezing, tachypneic, tachycardic, asthmatic son. Each of the pharmacists he saw told him a similar tale: shelves were cleaned out by healthy people last spring who wanted Tamiflu "just in case." Thanks for that on behalf of mothers everywhere with sick, at risk kids.

But back to just being grateful. We were spared the worst. During plague epidemics in the Middle Ages front doors were marked with a cross to signify that plague was in the house. Healthy people recoiled in horror, as they should! Who knew how it was transmitted? Nobody! What was to be done for victims? IV fluids? No! Ale or broth. Blech. I'll take normal saline. Blood-letting instead of antibiotics. Awful buboes and not much orally available for pain. Lack of decent anti-pyretics. No oxygen for the hypoxic.

Thank you for stopping by "Interlude with the Plague".

While I was awake in the wee hours Sunday night with my poor Little Latte, watching Spongebob, I was gobsmacked at how lucky I am. My sick baby sipped apple juice and sucked on his nebs. I have back-up. IVF, abx, O2, nebs.....whatever he needed. Fortunately all he needed this time was apple juice, Spongebob, prednisone (my dear friend), and albuterol. It makes me wonder. How agonizing to watch a child die for lack of IV fluids.

It still happens. For the sake of potable water 100,000 people died last year from cholera-induced diarrhea in 2004. For WATER. Understand that? There are hundreds of thousands of people in the world who don't have safe water! Who cares how the hell your water tastes? You won't die from your tap. You can drink it.

Or can you? The New York Times did a great piece a few weeks ago about water in these United States. EPA enforcement of the Clean Water Act has been less than ideal, and by "less than ideal" I mean pretty scarily bad at times.

Clean Water Laws Are Neglected, at a Cost of Suffering

Sure, drinking the water in your state might not give you cholera, but it might give you leukemia. Good Lord. Leave it to the United States to find a really serious way to screw up water. We can take your bacteria- and parasite- infested water, sterilize it, and make EVEN MORE DANGEROUS. This is unnerving. I'm all for public health care as an option, however, if we can't make WATER safe, for crying out loud . . .

(Deep breath.)

PalMD had an interesting post about fibromyalgia recently. It's worth a read:

Fibromyalgia, alternative medicine, and other bad ideas

Fibromyalgia is a vexing problem. It's not as vexing as it was way back in its heyday, like 10 years ago when rheumatologists and GPs were overrun with achy people, usually women, who all had the latest disease publicized by Big Pharma for whatever the drug du jour was at the time. For a time oh, Lord, how I dreaded seeing it on my schedule. Fully 2/3rds of the patients who purported to have it waived disability paperwork in my face, demanded narcotics, Soma, and refused to consider physical therapy, exercise, non-addictive medication, antidepressants or anything else. Then their sisters came in with the same diagnosis. And their neighbors. And babysitters, then dogs.

That's not such a problem anymore. Who can afford the copays for the Cadillac drugs Pharma is pushing for fibromyalgia now? HR departments aren't too sympathetic. Your disability insurer isn't fond of the diagnosis, either. I had a fair number of patients who called me shopping from the mall, or vacationing in Hilton Head, indignant that their disability claim for fibromyalgia was turned down. Boohoo, baby. I have ladies with breast cancer getting CHEMO working full-time. Suck it up. Especially when you wave your FMLA papers right under my nose and rip up the 90 prescriptions for Flexeril I've written.

But then there's that last 1/3. I still see them, and I wince still when they're on my schedule, but for vastly different reasons. They're miserable. They ache. They try everything I suggest, or by the time I see them they've already done everything. Twice. They come in all shapes and sizes. Many of them valiantly get up for work or school every day and desperately want to keep working. They take care of families and once the kids are in bed they crawl under the covers and try not to move. Medicine works for a few weeks, months. Yoga works for a while. Flexeril takes the edge off, but only a little. Heat helps. Cold helps, then it doesn't. Vacation is good for a few days, then the ache returns. They try massage; accupuncture; special diets; meditation . . . name it.

Are they depressed? Hell yes! Who wouldn't be? I'm depressed for them. I dread going in the exam room, seeing those searching eyes, haunted, looking for help. Anything. I twitch over my prescription pad. Should I give some narcotics just for a few hours of relief? What should I do? What do you do? These poor women--almost always women--have been to chiropractors, massage therapists, homopathatic doctors, integrative docs, naturopaths, dentists--everything! They're out of money for their "specials" and have to come back to little old me, and anyway, the other stuff only worked about as well as anything a boring old stuffy regular doctor like me prescribed. Works for a while, then peters out.

What is wrong with them? Hell if anybody with an MD knows! We do know that the severity of whatever this is--or whatever constellation of disorders it is made up of--waxes and wanes normally. Is anything we do helpful? So far the GOOD evidence for any intervention is pretty weak. Anything?

Good question. Perhaps you read about homeopathy and fibromyalgia? PalMD recalls the tooth fairy:

"Dr. Harriet Hall would remind us of Tooth Fairy Science. We can measure all of the important data about the tooth fairy, including average get per tooth, average age of visitee, etc, but if we forget to question the fairy's existence, we have failed to ask the most important question. It may be true that an RCT showed improvement in fibromyalgia patients using homeopathy, but since homeopathy is water, there is no reason to expect causality, and the results may be better explained by some other phenomenon."

If your data can't swim with the sharks get it out of the water.

I am so sad for these poor people. I have little to offer besides a little of this, a little of that, a sympathetic ear, and a strong shoulder. I'm a lot easier on the wallet, though, than the fibromyalgia tooth fairy, and just about as effective.