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Transcripts-5/22/00
Fibromyalgia with Dr. Barry Waters
InsightHostKJ> Howdy Dr Waters
DrWaters> Hello everyone
InsightHostKJ> Thanks for coming and right on time!
InsightHostKJ> Who wants the first question?
InsightHostKJ> Go ahead Trans
TRANSAM> What kind of inner ear damage can arth do?
DrWaters> I'm not familiar with that. NSAID's effect the inner ear. Arthritis effects the middle ear. Arthritis effecting the inner ear would be very rare.
InsightHostKJ> could arthritis in the middle ear cause dizziness?
DrWaters> Arthritis of middle ear would not cause dizziness.
DrWaters> Who here has FMS (fibromyalgia), since that's our topic.
InsightHostKJ> I think most of us here with FMS have it secondary to RA...
DrWaters> You still get credit and sympathy.
InsightHostKJ> How common is it to get FMS with RA?
DrWaters> Very common for RA and FMS together.
InsightHostKJ> Do we know why?
DrWaters> Any painful condition can disrupt sleep and cause FMS.
InsightHostKJ> So if we ease the pain and sleep better the FMS symptoms will subside?
DrWaters> FMS is probably a set of symptoms that can be caused by many things. When there is intense inflammation people feel tired and achy and those are the same symptoms as FMS.
DrWaters> When people are in pain and sleep quality is poor the get FMS symptoms.
DrWaters> Treating the pain of RA will help sleep quality and will help the FMS symptoms.
DrWaters> Treating the inflammation in some alleviates the FMS symptoms.
DrWaters> We like to refer to FMS in RA mainly when the inflammation is controlled so we need another diagnosis to explain the pain.
Donna> where are the trigger points for FMS?
DrWaters> For a map of trigger points you might want to go to mmrwellness.com or get the Arthritis Foundation brochure. In summary, they are the trapezius folds, upper sternum, shoulder blades, sides of elbows and knees and the sacroiliac areas.
InsightHostKJ> How are you currently treating FMS?
DrWaters> We treat FMS with exercise, sleep hygeine and sometimes anti-depressants.
InsightHostKJ> What if you are unable to exercise?
DrWaters> No one is unable to exercise unless they are paralyzed from the neck down.
InsightHostKJ> So very
true.
Guest58> For RA, is it better to be on azulfidine with low-dose prednisone, or move to
MTX?
DrWaters> The Rx of RA is very individualized. For some AZA + pred would be better or safer then MTX alone, for others it would be the opposite.
Dee> Since I cam in late could you tell me what FMS stands for and what it is. Thank you.
DrWaters> Fibromyalgia.
DrWaters> There are probably many diseases that cause the symptoms we call FMS.
InsightHostKJ> With many different causes?
DrWaters> Sleep disorders, chronic infections, spinal stenosis, muscle disease, low-grade
non-speciific autoimmune diseases - all can be called FMS if we're unable to fine the "real", so-to-speak, diagnosis.
InsightHostKJ> spinal stenosis? I wouldn't think of that causing FMS symptoms
DrWaters> Patients with CERVICAL spinal stenosis have symptoms that mimic FMS.
InsightHostKJ> okay
Betty> So many of us suffer from interrupted sleep patterns. What is sleep hygiene?
DrWaters> Good sleeping habits. Going to bed and waking up at similar times each day. Avoiding caffeine and other stimulants late in the day. Sleeping in a dark, quiet room with an unannoying spouse.
InsightHostKJ> so divorce should be considered a treatment option? LOL
DrWaters> Since it's the men who snore I won't answer that.
DrWaters> Think how stupid the whole alarm clock thing is. Why do we force our bodies to to wake up before they are ready?
Betty> What if we follow good sleep hygiene and still can't get a good night's sleep?
DrWaters> We try natural things like exercise earlier in day, hot baths,
massaage, watching baseball games, first.
DrWaters> If they fail, then we try medication, usually antidepressants, but sometimes tranquilizers like Restoril or Ambien or
Sonnata.
DrWaters> Watching the Florida Marlins can make anyone fall asleep.
InsightHostKJ> But does it mean you think we are depressed if you give us an antibepressant?
DrWaters> No, not at all. If you were depressed you wouldn't laugh at my quips. The same chemicals in the brain are low in depression as in sleep disorders, so often the same med's can be used to treat them. It's like if I give you penicillin for strp throat I'm not accusing you of having syphyllis.
DrWaters> Anti-depressants increase serotonin and that seems to be low in many with sleeping problems. That's why nonsedating med's like Prozac and Paxil can often improve sleep.
InsightHostKJ> OK...makes sense...go ahead Dee
Dee> My husband says that I moan and groan everytime I turn over. I don't wake up and don't know that I am doing that. Would that be classified as not getting a good nights rest?
DrWaters> Yes, Dee, definitely. That's why in patients with bad RA we often use long acting pain medication. It's been shown that giving RA patients proper pain medication improves sleep quality and most everything else.
Betty> Is there a connection then between FMS/Arthritis and sleep problems?
DrWaters> Very much so, they go hand-in-hand.
Dee> Can you give me some names of "long acting pain medications"?
DrWaters> Oxycontin, MS-Contin, Duragesic patches.
JBug> Whats the difference between Oxycontin & Percocet?
DrWaters> Oxycontin is the same oxycodone in a sustained release matrix.
Betty> What determines if long-lasting pain killers are in order?
DrWaters> Like, maybe how bad your pain is! Or how bad your sleep is! Or how bad your deformities or joint inflammation, if we want to get picky!
Betty> Then why are doctors so reluctant to provide this medication?
DrWaters> Because they are dumb.
InsightHostKJ> good answer Dr Waters
Betty> Can I quote you?
DrWaters> Just don't use my name.
InsightHostKJ> LOL
InsightHostKJ> Why is flexeril sometimes used to treat FMS?
DrWaters> Flexeril is actually very similar to the antidepressant Elavil and that's why it works.
DrWaters> You don't want to ask about weight lifting even?
InsightHostKJ> Does that help FMS?
DrWaters> Yes. I've had good success with that in SOME patients. Obviously its not for everyone.
InsightHostKJ> What is the best exercise for someone with FMS in your opinion?
DrWaters> A COMBINATION of exercises that involves as many different muscle groups as possible and mixes aerobics and muscle strengthening.
DrWaters> It has to be FUN or you won't stick with it.
swimmer> My left ankle has mostly fused on its own. It hurts somewhat when walking on it, but the worst pain is at night when I go to bed. Why does it hurt so much once all weight bearing is off of it? It feels like an intense cramp for almost 2 hours?
DrWaters> This is a a poorly understood phenomenon. That's why many RA patients need bedtime pain medication.
DrWaters> Sometimes splinting helps.
InsightHostKJ> What kind of ankle splint could you wear to bed? We were discussing that the other night
DrWaters> Usually a plastic orthotic to limit ankle movement works best.
swimmer> I noticed today while napping, with shoes on, the pain was less intense
swimmer> so, should I see my orthopedic foot surgeon for a splint?
DrWaters> Usually a plastic orthotic to limit ankle movement works best.
DrWaters> Yes, that's definitely the person to talk to.
JR> Is there any orthotic which will protect foot jointsa and nodule to permit some running for a former marathoner, or should I jusat stay on the bike?
DrWaters> I don't know much about that. Unless there is a fairly severe deformity or marked inflammation it should be possible.
JR> Ok, thanks. It has been possible, off and on, but only at limited levels
DrWaters> Try the stair machine, much more exercise per foot strike. It works for me.
swimmer> care to petition my insurance for enbrel Dr. Waters?
DrWaters> Call TV stations, congressmen, newspapers, etc. With every correspondence send a copy to Insurance company. They usually give in.
Betty> In what area of the country do you practice? Are you taking new patients?
DrWaters> I'm in Broward county FL, but who would want a doctor who can't spell?
IndyRon> If he can help, I do
Guest6> As long as you spell RX's correctly...........
DrWaters> Your priorities are screwed up.
JR> Doesn't matter as long as the prescriptions are ok
Betty> At least you seem willing to listen to your patients
swimmer> how important is weight control when dealing with arthritis?
swimmer> are more patients that you see overweight, or underweight
DrWaters> Mainly for knee arthritis, otherwise, not overly important.
swimmer> ankles?
DrWaters> Not ankles, not feet. Explain that one? But it's true.
DrWaters> More RA are NOT overweight.
I<i>nsightHostKJ> Don't put too many of them on Pred huh? LOL
DrWaters> I do, but also sign them up at the gym.
InsightHostKJ> LOL..slave driver
DrWaters> I try not to use pred in pudgy types. Being chubby a little I'm sensitive to that.
InsightHostKJ> it seems to make us chubby types chubbier while not doing much to those skinny folks
Meli> hehehe... nothing worse than being told to lose weight and then being given meds that give you the munchies... 'tis a bit cruel
swimmer> or having joints that prevent you from exercising
InsightHostKJ> LOL Meli..so true
DrWaters> It's still a big problem though, so I don't want to minimize it. KJ is right.
InsightHostKJ> Dr Waters...how much longer do you want to continue? I know you probably have charts to do
DrWaters> I really got to go. I worked super hard today so I have only 4 charts left. One new patient I saw today has had RA for years and is only on Prednisone. It was so sad.
DrWaters> OK, bye everyone. See you all next month!
InsightHostKJ> Thanks so much for coming
Betty> Thank you
Donna> Thank you Dr. Waters
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