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Introduction
Dr. Bob: And welcome to The Dr. Bob Show. I hope
you've had a healthy week. We appreciate your watching The
Dr. Bob Show, learning facts to make your life healthier and
happier and we hope you come back and watch this show every
week so that we can give you that health information that
you need. We're going to be spending most of the time on this
show taking about aches and pains, a condition called fibromyalgia
(much more common than people think) and of all the shows
that I've done, this is the one topic that I get more requests
to give more information on. We have an outstanding guest.
My guest is Dr. Fred Wolfe. Dr. Wolfe is a board-certified
rheumatologist and deals with fibromyalgia in his practice.
Hello, I'm Dr. Robert Overholt and I will be your host for
the next 30 minutes on The Dr. Bob Show. Later on in the show
we'll be talking about SVT. What type of fast heart rate does
that mean? What's the difference between migraine headaches
and tension headaches, and which one do I really have? What
are some of the causes of hoarseness? You may be surprised
of the cause of your hoarseness. And we will be talking about
other topics like at what age should you be worried about
getting coronary artery disease? So, you'll want to stay tuned.
We have huge amounts of information for you. and while you're
getting ready for The Dr. Bob Show remember, you should have
been exercising seven days a week at least 20 minutes, starting
the day off with a good breakfast of fruit and fiber, eight
hours sleep if you can, and most of all, laughter in your
life. Stay tuned-wonderful show ready for you.
Dr. Bob: We're talking with Dr. Fred Wolfe, board-certified
rheumatologist, and we're talking about a condition called
fibromyalgia. Do you ever wake up sort of stiff in the morning,
sort of achy, sort of like your muscles are stiff? A lot of
times people do that. Do you have fibromyalgia? Fred, welcome
to The Dr. Bob Show.
Dr. Wolfe: Thank you Bob.
Dr. Bob: Everybody aches a little bit. What is fibromyalgia?
Dr. Wolfe: Fibromyalgia is a specific disease where
there are specific areas called tender spots in the body that
hurt tremendously and it causes disability to the patient
in their daily functions.
Dr. Bob: When you say it hurts tremendously, we've
all had pain where we've fallen down, that type situation.
How do people describe this pain? How do you know if you have
this type pain?
Dr. Wolfe: The pain is described as all over, every
day, all the time. It's a draining pain. Patients will describe
it around the elbow as a constant burn with an ache that goes
up and down the arm but the burn is at the elbow and the ache
is in the muscles.
Dr. Bob: When you examine this patient, when you examine
the elbow and you examine the muscle, what do you find on
the physical exam?
Dr. Wolfe: The joint is fine. The joint moves very
well. There is no swelling in the joint but the tenderness
is around the areas where the muscles attach to the bone.
And these areas are the tender spots and they're located on
the inner and outer aspect of the elbow region.
Dr. Bob: Now, with fibromyalgia there are, as you
mentioned, tender spots.
Dr. Wolfe: Correct.
Dr. Bob: There's 10 or 11 spots that are classic?
Dr. Wolfe: Correct.
Dr. Bob: What are some of those spots?
Dr. Wolfe: Some of those spots are at the base of
the skull. However, these big muscles at the back of the shoulder
are called the trapezius muscles.
Dr. Bob: And you just sort of, you sort of, you sort
of get stiff or they just hurt like mad?
Dr. Wolfe: They hurt.
Dr. Bob: They hurt?
Dr. Wolfe: They truly hurt and while patients are
stiff, the pain is the big thing that drives them to see a
doctor.
Dr. Bob: Neck, shoulder, where else?
Dr. Wolfe: On the outer side of the hip, the inner
side of the knee. Again, it is not the joint. It is the area
around the joint where the muscles insert into the bone and
attach to the bone.
Dr. Bob: Now, when we, if we do a biopsy of those,
what do we find?
Dr. Wolfe: Absolutely nothing.
Dr. Bob: And that's…
Dr. Wolfe: Everything looks normal.
Dr. Bob: And one would think that you would see inflammation.
So, what stimulates… do we know what stimulates the nerve
fibers to say "ouch, I'm hurting?"
Dr. Wolfe: I wish we did. The cause, the etiology
of fibromyalgia is totally unknown.
Dr. Bob: Any lab work that's abnormal?
Dr. Wolfe: No laboratory tests are abnormal and that's
very important to remember because patients with early rheumatic
diseases such as rheumatoid arthritis or lupus arthritis have
abnormalities in the blood, but patients who have primary
fibromyalgia have no abnormalities in the blood at all.
Dr. Bob: Is it a diagnosis of exclusion or do you
go to those tender points and say, you know, "I understand
what's going on?"
Dr. Wolfe: The American College of Rheumatology has
tried to put together some criteria saying that you must have
six tender points that are specifically tender and you need
to have some alteration of sleep pattern and you need to have
the negative blood work up.
Dr. Bob: Now, when you say sleep pattern, what is
the sleep pattern of people with fibromyalgia?
Dr. Wolfe: People with fibromyalgia never go into
deep sleep.
Dr. Bob: Because of pain?
Dr. Wolfe: Good question. Whether they don't go into
sleep because of pain or whether they don't go into sleep
and that causes the pain is unknown. There is a lot of research
going on with the sleep centers to try to figure out which
is the chicken and which is the egg.
Dr. Bob: Now, frequently if a doctor hears a patient
say, "I ache all over" and they get blood work and
the blood work is normal, do they tend to say this is a psychological
problem and do a disservice to this patient or what's the
deal?
Dr. Wolfe: Well, doctors are human too. I hate to
inform you, but they are.
Dr. Bob: We have our frailties.
Dr. Wolfe: And if you can't find anything, then your
first impulse might be to say, "you're kinda crazy."
These patients are not crazy. Many of them are full-time workers
who are going to work. They do not produce as well because
they hurt but they are very active people. They're young mothers.
They are men in positions of stress in their job, women in
stress. So, it's not like you can say these people are crazy
sitting in a corner. And you have to be aware that something
else could be going on.
Dr. Bob: More frequent with older person? Younger
person?
Dr. Wolfe: More frequent in younger people.
Dr. Bob: Male or female?
Dr. Wolfe: More frequent in female.
Dr. Bob: And more… so, sort of young females?
Dr. Wolfe: Young mothers, females.
Dr. Bob: With children, without children?
Dr. Wolfe: Females. Originally described as young
mothers with children who have altered sleep patterns…if
you've got young children. And so, whether that sleep pattern
is what gets the trigger started or whether something else
is, we don't know.
Dr. Bob: Is there a good treatment available for this
illness?
Dr. Wolfe: There is treatment.
Dr. Bob: And that's what we're going to be talking
about. We're going to be talking about the type of treatment
that we have available for this very, very difficult problem.
But first, let's talk to a patient that's had fibromyalgia
and let's introduce you to how bad this can be.
Patient: I've had a lot of joint pain, muscle pain,
overwhelming fatigue, real bad sleep disturbance. It's chronic
pain. It's always there. It never goes away completely and
one day it may be in your shoulder. The next day it may be
in your hip. The next day it may be in your lower back. It
sort of moves around and some mornings I roll over and I don't
know if I'm going to be able to get up out of bed or not.
It makes it difficult to get through your day every day because
when I wake up in the morning, I'm very stiff and very sore
and it takes me quite a while to loosen up and be able to
motivate. And sometimes it makes it difficult getting dressed.
Sometimes I have difficulty getting in and out of the car
because my problems seem to center in my lower back and my
hips. It's painful to walk, sometimes. There are days where
you can't be comfortable sitting. You can't be comfortable
lying down. You can't be comfortable standing up and you just
sort of have to go from position to position, to position
to find some comfort and some peace. And it makes doing the
things that you used to do for yourself and didn't even think
about (like cooking dinner or washing dishes or handling laundry)
more difficult. You have to be creative to be able to do those
things. I had heard it called an invisible disability before
and it truly is invisible because you can't see the cause
for it and yet it's still there and it covers your life.
Dr. Bob: What an interesting story. If you have pain,
aches, muscle pains, you may have fibromyalgia and remember,
there is treatment available and that's what we're talking
about.
Dr. Fred Wolfe, treatment? What is the treatment for this
illness that has got muscle tender points, no positive laboratory
work, biopsies are negative, but fits into a regular pattern?
What's the treatment?
Dr. Wolfe: Treatment is a program of exercise, trying
to get them in a regular sleep pattern, and trying to get
them to develop a program for themselves of managing their
lifestyle. With the exercise, you start gradually and you
build.
Dr. Bob: Now what is gradual? When you tell somebody
let's do a little…you know…what is gradual exercise?
Dr. Wolfe: Well, some of my patients can start with
five minutes and then the pain gets very severe.
Dr. Bob: Muscle-lifting weights-or walking?
Dr. Wolfe: We're talking either one. Walking. We usually
start with stretching, very mild exercises, or we may start
with a one-pound weight that the patient can actually sit
and do. And they start with five repetitions and then they
go to six repetitions. They may do five minutes, six minutes
in the next week, seven minutes the next week, and gradually
build an exercise program that they can tolerate. They may
go up, up, up and then reach a plateau that they can't get
over for two months and then they can start up again.
Dr. Bob: It must be gratifying if somebody begins
to be able to do things like that that they weren't able to
do.
Dr. Wolfe: Many patients are and they're thrilled
and they're impressed with themselves that they can actually
do something for themselves and we like to encourage that
because that's part of modifying your life.
Dr. Bob: Now, do you see people, as they are gradually
increasing their exercise, that some of their pain goes away?
Dr. Wolfe: Yes. Very definitely and some of the patients
with an exercise program they've worked on may be on a treadmill
for an hour and have no trouble with pain and then Uncle George
or Aunt Petunia gets sick and they quit and the pain comes
back.
Dr. Bob: That's very, very… that's interesting.
Let's talk about sleep pattern. Where does sleep fit in this?
I know if we don't get enough rest, we don't feel good.
Dr. Wolfe: The thought is that these patients never
get into what is called "delta wave" or the really
deep sleep and therefore, perhaps, these muscles never relax
and that helps increase the pain. So you give them drugs to
help them get into that deep sleep. We're not talking about
painkilling drugs. We're not talking about addicting drugs.
We're talking about drugs that help patients get into a sleep
pattern.
Dr. Bob: Now, specific medications-what would you
use?
Dr. Wolfe: One that has been used across the country
for many years is a drug called Amitriptyline and this drug
is not addictive and does allow patients to get into a sleep
pattern. You may need this dose of the drug and as they get
better and start exercising, they can decrease the dose of
the drug. So, it's a program. The usual medicines for arthritis,
the anti-inflammatories like Motrin, Ibuprofen,
Naproxen-those don't work. You really have to get the exercise
and the sleep pattern, those two things. Many patients have
to make a change in their lifestyle to get the time to do
that.
Dr. Bob: How much sleep do you want this person to
get?
Dr. Wolfe: I would like six to eight hours. I would
be happy with six hours straight but be really happy with
eight.
Dr. Bob: Now, if we get six hours sleep, maybe eight
hours sleep, and we're exercising and we're increasing, what
do you expect out of this patient? How…what percent will
get better? What else do you have to do as they further treatment?
Dr. Wolfe: I would like to see those patients get
better, obviously, but I would say probably about half the
patients with whom we're working with the diagnosis of fibromyalgia
get significantly better as long as they are working with
the exercise program and taking medicine. That other 50%,
some of those even when they work hard, they can't get over
the hump and that's a very difficult group to us.
Dr. Bob: Does a psychiatrist help these-with biofeedback…
I'm thinking of some way where the mind begins to control
the body. What's the experience?
Dr. Wolfe: Good experiences with biofeedback. There
are physical therapists that can teach biofeedback. There
are psychologists that can teach biofeedback. Psychiatrists
have helped us with some of the medicines that help the brain
understand pain and again, you use this whole team approach
of the therapist to help with exercise. The biofeedback helps
with rest, and managing muscles with the medicines helps you
sleep and sometimes with a psychiatrist to help with pain
understanding.
Dr. Bob: Do you get rewarding stories when you spend
time with a patient like this that's got a devastating illness
and you help them through their life?
Dr. Wolfe: Of course, and you're really excited that
you see them and they're doing great and they come back and
they think you have really helped them and then again, something
happens. They fall off the wagon of exercise. They start taking
care of the twins that were just born to their daughter and
suddenly, it's like it's all coming back. Help me, I can't
stand it. To come back, I'm too busy.
Dr. Bob: Yeah, it's, it's a very frustrating illness.
Fred Wolfe, thank you for taking of your time to come and
teach us about this illness that is so pervasive and so many
people can be helped by it with a good understanding physician
like yourself. I've always enjoyed you on The Dr. Bob Show.
Dr. Wolfe: Thank you Bob.
Dr. Bob: Will you come back and can we talk about
osteoporosis?
Dr. Wolfe: I would be delighted to.
Dr. Bob: And I look forward to that time. What a wonderful
show! You stay tuned. We've got lot more information. We've
got another story to tell you about. But also we're going
to be coming back talking about causes of hoarseness. We'll
be talking about SVT. That's a type of fast heart rate. At
what age should you start worrying about coronary artery disease?
We've got a lot of information so you stay tuned. I've got
a lot to tell you.
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