Fibromyalgia

LeahJet, ASN, RN · Jun 12, 2007

But ER is still not the proper place for Alledged FM pts. They need a pain control doctor. ER is totally inappropiate for people with FM to go to to try to control their pain. We relieve pain. Chronic problems need a specialist. Not ER

You are exactly right, Tom.

I once triaged someone that said she was in "end stage Fibromyalgia".

No joke.

caroladybelle, BSN, RN · Jun 12, 2007

But ER is still not the proper place for Alledged FM pts. They need a pain control doctor. ER is totally inappropiate for people with FM to go to to try to control their pain. We relieve pain. Chronic problems need a specialist. Not ER

This is I believe, a major point.

There are alot of people out there with painful medical conditions and autoimmune diseases. Some go to the their MD as scheduled, give nonmedication therapies a legitimate trial, change diet and behavior, and find that they need fewer meds to cope. These are rare vistors to the ER.

There are also those, that will not see their MD appropriately, will not give other therapies a reasonable trial, will not change diet or behavior and give excuses as to why they "cannot" try therapies other than narcotics.

I have had my bowel resected since 19 from another issue, and then developed ulcerative colitis 5 years later in the remainder. Yet I have I only once been hospitalized from it. I take no narcotics for it, even though the autoimmune effects from the disease attack and swell joints. I get plenty of rest, restrict from my diets foods that flare the disorder. I drink plenty of fluids, even though it is inconvenient to get up to the bathroom so often. I take regular exercise but do not overexert myself. And I do not wait for things to get severely out of control before calling my MD.

But I deal often with those having severe abdominal pain....after getting dehydrated, eating large boxes of popcorn and other abrasive foods, not resting, overindulging in alcohol, etc. And they will be demanding morphine push..."because it doesn't work for them any other way", be allergic to everything else, and be sneaking corn chips while on their "bowel rest" diet. And every one will tell the staff, "But YOU just don't know how painful IBD can be" as they get their disability paperwork signed, and get the pain shot before going down to smoke.

Yes, there are many people that have disorders that are painful. But some use those disorders as an excuse and there are others try to live with the disease and succeed in spite of them. The former tend to drive the ER nuts because the ER is NO PLACE to deal with chronic disorders.

teeituptom, BSN, RN · Jun 12, 2007

Even after reading all of these emails from people who suffer from "fibro", or know someone who suffers from it, you can still claim that they are hypochondriacs? That's a little insensitive, in my humble opinion.
There are many illnesses that we now know to be diseases that years ago simply were not recognized by the medical community, let alone the public in general. I would think that depression would be a good example of this.

I dont think its insensitive, and afterall hypochondriasis is a disease

Yvette Acute ER RN · Jun 13, 2007

I have had all over body pain since I was 18, I am now 41. I have given myself two ulcers from Motrin use, and am able to control severe attacks with ultram... This is a very sensitive issue for me as I have worked as an ER nurse for 10 years and EVERY nurse and doc I work with feels FM is a wastebasket diagnosis. So I have said NOTHING to anyone and suffer in silence. I have had the ANA test, no rheumatoid titer, and my primary at one point decided I had narcolepsy (FOR GODS SAKE) despite my assertions that the reason I kept falling asleep was because I could not sleep greater than 2 hours without waking in excruciating pain. He actually said "what you are describing sounds like fibrositis," so I looked it up. It was the old term for fibromyalgia! (My eyes are watering as I write this) So I wonder, do I have this elusive FM (even though no medical professional I associate with believes in it) or are my fingers swelling from mental suggestion? Mind you, I work like an animal and am perpetual motion (I am quite slim) and work aches are quite different from my chronic pain, and I find that this quandary I am in is very depressing. So there is a testimonial for you.

Funny how I can write this and yet not tell a soul!

Jenzee · Jun 13, 2007

I dont think its insensitive, and afterall hypochondriasis is a disease

So you truly believe all of the people with this DX are hypochondriacs?

teeituptom, BSN, RN · Jun 13, 2007

So you truly believe all of the people with this DX are hypochondriacs?

That was written in response to.

But to answer your question Yes.

dnw826 · Jun 13, 2007

Ummm I don't know if I would call those "fashoinable" diagnosis. I have MVP with regurg. and have some trouble with hypoglycemia. I am not diabetic but if I do not eat right my blood sugar crashes and I end up passed out somewhere on the floor or in the ER. This RARELY happenes now that I am an adult (like once in 5 years) but when I was a kid and didn't understand it happened a lot. Responses like yours are what stop people like me from seeking treatment when having a problem.
Pls. explain your feelings about MVP. I mean it is dx by an echo. do you not believe that it can cause problems or you just have trouble with the dx in general?? Do you have the same feelings with MVP with regurg.?

I agree. My ex-MIL had MVP and fibromyalgia. She is in real, true, pain constantly. I have worked with the patients after the pain meds or the hypochondriacs. But I would hate to turn into someone who feels no sympathy and rolls my eyes at people regardless of presentation and situation because of a diagnosis.

I have a *long* list of medical history problems. Crazy stuff. I feel incredibly judged when I have to list it off for new docs/nurses because you know that a lot of them are just going "yeah, right!". It is sad that now I suppose even healthcare professionals are so cold about people's ailments.

Fibromyalgia is REAL. People suffer. Just because some people will lie or make something up for drugs does not make the suffering of people with Fibromyalgia any less real. That can go for a lot of other issues, too.

What a shame!

granite109 · Jul 20, 2007

Oh, the joy of FM!! what a hot topic, but something that should be addressed. It seems apparent that there are real instances of FM, often with prior injury. In my youthful idealism, I would like to believe that we are nurses identify and are compassionate to those patients. It is not our place to judge, but to treat.

That being said, I have noticed, anecdotally, a correlation with many, not all, FM patients: caucasian, female, pale skin, slightly overweight, empty nester, often a homemaker. History of low grade depression and perimenopausal, and a bad IV stick, you know, that pasty, kinda chubby skin with that extra subQ layer for no reason (not obese) and no visible veins. (Think back now, I'll bet you agree!)

I know this is general and sounds judgemental, but it is not intended to be, bear with me here. It appears that there are patients with legit pain issues. They may autoimmune (lupus, MS, RA)age (osteoarthritis), or injury related, and they may be FM. On the other hand, I have seen the above pattern. Is it possible (on a limb here), that there is a body or congenital type that we don't recognize, that causes FM symptoms. There appears to be a general type here that have these symptoms. Unfortunately, docs often generalize with the dx and we need to have a broader look at the patient and investigate it further. Perhaps a new diagnosis would be in order. It would make a great research study. Any thoughts anyone?

gr8rnpjt, RN · Jul 20, 2007

Oh, the joy of FM!!
I know this is general and sounds judgemental,
that there is a body or congenital type that we don't recognize, that causes FM symptoms. . Any thoughts anyone?

You mean like the elusive "gay" gene? I am sure you really did not mean to sound judgemental but it would be if you were talking about other conditions. I just wish people would realize that this is something real, the pain is real. But it is a chronic condition, and I honestly can't see why someone with FM would end up admitted and/or in the ER. But as far as a certain body type, I think that is a bit much. Too much stereotyping going on here and that is what I take exception to.

granite109 · Jul 20, 2007

My sincerest apologies for coming of offensively-that was absolutely not my intent!!! In fact, my intention was just the opposite. There have been studies correlating male pattern baldness to heart disease, apple shaped bodies have higher incidences of MIs, etc. I have noticed a pattern. Is it possible that there is more to the picture and certain traits correlate to certain conditions and symptoms? Mediterranean women actually were the first to have Kaposi's Sarcoma. Not a generalization, but a statistically relevant correlation. Light skinned people get more skin cancer, African Americans have a higher risk for HTN. I am NOT talking about the elusive gay gene, and I take exception to that reference. I am not calling anyone a hypochondriac, as many others have, in fact I am making an apparently weak attempt to advocate. I am merely stating a pattern I have seen where I work-for real. It was not intended to be derogatory. So many people with FM get blown off, perhaps there is more to the story and a new diagnosis is in order. Is it possible that because most sufferers are women that the research is not being done? I have seen similar traits in my patients and I wonder if there is more to the story. Perhaps I did not articulate it properly, but similarities in patients are noteworthy. I am sorry if you disagree.

granite109 · Jul 20, 2007

OK, this is an old thread, but I feel a need to clarify, so please indulge me. My first post on this thread was apparently inflammatory. That was the opposite of my intention, so my apologies for my inability to express myself.

So....let's take 3 of my described traits and hypothetically theorize. I have noticed that many of my patients are women and homemakers and generally 35-45. (Even if inaccurate, just go with me here for academic purposes) Is it possible that there is an agent in the home that the victims are exposed to, causing the symptoms? For example, let's say that in 1985, Proctor and Gamble, Kraft, or whoever, came up with a new, innovative product. You know, stain remover, tongue tattoos, hand lotion, whatever...this new product is all the rage. Everybody has it. Now, 22 years later, there are a bunch of 47 year old women with fibromyalgia. Is it possible that the common products used by homemakers of the day caused these problems? Maybe it's in the fast food fries or the milk or the bottled water or the pesticides used on the fruit and veggies, who knows?

Epidemiologically speaking, similarities MUST be observed and the patient must be described accurately. Trends in symptoms CANNOT be ignored. Why are most FM sufferers women? Is there a hormonal component? Yes, you will proclaim my ignorance again, but we know that PMDD is caused by the hormonal drop just prior to menses. Perhaps all of the female FM sufferers were on the pill and it is a late side effect. Perhaps they all had an epidural an intrapartum. Who knows? Why aren't there an equal number of male sufferers? Is testosterone a factor?

My point in my original post was that I have seen a trend. In my small microcosm of the universe, I have seen the same thing over and over again. Maybe it's just a coincidence, but that's what research is for. I have MVP and hypoglycemia (DM runs rampant in my family). However, I feel that the FM diagnosis is inadequately studied, which is a disservice to the patient. A lot of FM symptoms are chicken or the egg issues, and we need to study more. It's the only way to make progress and help our patients. So, I stand by my position on demographic similarites. When diagnosing a patient, we must look at the whole picture and maybe we can perform a root cause analysis and maybe even find a cure! Let's hope!

teeituptom, BSN, RN · Jul 21, 2007

I guess if you wake up with FM pain, bad enough, you may just wish you were.....
dead.

No I will just know Im really living, and I just now woke up a little while ago. Boy am I really alive.