At 350+ pages, this could scarcely be called a booklet. It had been awaiting my arrival because our mailman had been unable to wedge it through the mail slot.

As I flipped through my new booklet, encountering phrases like “you must,” “you should,”  “if you miss your deadline,” “restrictions,” and “you can appeal,” I couldn’t help but think again of Franz Kafka’s chilling novel The Trial, to which I’ve referred in the past when discussing our health care system.

Kafka’s everyman Josef K is arrested on an unspecified charge, and most of the book revolves around his difficulties appealing his case even though he never learns the nature of his crime or even if he did anything wrong at all. In the end, he is murdered by representatives of “the system.”

Two weeks earlier, I’d received what I thought was the same thick envelope and now felt a glimmer of shame. I hadn’t even opened it. And yet the new package, which out of guilt I did open, began with a curious command:  Your 2012 Evidence of Coverage (EOC) has changed. Please destroy the previous 2012 Evidence of Coverage package.

“Changed?” I asked myself. In just two weeks? And the directive wasn’t to discard or recycle, but to destroy. Sounded very John le Carré to me. Very Tinker, Tailor, Soldier, Spy.  My guess was that the suits in charge of my health insurance plan must have discovered some wildly dangerous sentence inadvertently inserted by a rogue employee, something like “We hereby agree to pay for all your expenses when you become ill.” I’ll bet some poor editor lost a job over that one. If I were CEO, I too would be ordering all evidence destroyed. And while I was destroying things, I’d get that editor as well.

As I glanced through my 350+ page booklet, printed on paper so cheap it made the phone book look upscale, I kept encountering phrases that could only be described as good cop/bad cop. You know the lingo from TV. Translated from its legal healthcare language, it goes something like this: “You can go to an emergency room, pal, but it better be a real emergency, and the emergency room doc had better say ‘this was an actual emergency’ or you, my fine friend, better have your checkbook ready. Is this clear?”

They don’t say it exactly like that in my oversized booklet, but it’s close enough.

Reading a few more “benefits booklets”
I decided to give myself the truly unpleasant task of reading several of these euphemistically titled “benefits booklets” to see if this self-serving misuse of our language was the norm. Each insurer’s booklet is available online. From the onset, they look very similar, written in a style best described as stilted.

The booklets are subdivided into sections and then into sub-sections, with lots of bullet points and an occasional reminder that “this is a legal document.” Because all these booklets sound so much alike, it did cross my mind that the whole booklet-preparation industry might have been outsourced to a single huge English-as-a-second-language country, perhaps a company in downtown Calcutta employing hundreds of otherwise unemployable attorneys, MBAs, and English majors.

I once did ask an attorney, “Who actually reads entire documents like these?” He answered too promptly for my liking, “Really only two people. The attorney in charge of writing it and the federal or class-action attorney preparing a lawsuit against it.”

At this point, I remind you of a mantra that should be engraved on your cerebral cortex. Repeat after me: Insurance companies exist to make a profit for their shareholders.  They achieve this by collecting your money and doing everything in their power to legally (and sometimes illegally) keep it for themselves. Any time you find yourself writing a check for your healthcare (or your storm-damaged roof or stolen bicycle) and muttering “But I thought I had insurance,” just recite your mantra. Your life will be easier.

Health insurance companies scrutinize every possible aspect of health care, from brain surgery to the set of crutches you received for your broken ankle. Then they create rules (remember, “this is a legal document”) so that you, and not they, pay for as much as possible (out-of-pocket expenses). They also want to accomplish all this without any of their senior management going to jail. As a preventive measure to avoid penitentiary time, the health insurance industry is one of the largest lobbying groups in Washington.

The appeals process: Josef K incarnate
An astonishing number of pages in each booklet are devoted to the appeals process if you feel you’ve been wronged. You’re protesting a bill you’ve received from your healthcare provider which, for reasons you don’t understand, your insurance company hasn’t paid and you seem stuck with. You resubmit the bill to your insurance company, with a note that reads, “Hey, you guys, pay this.” But the bill comes back marked “denied.” “Denied!” you bluster. “Denied!!” you expostulate. You call your health insurer, steam pouring out of your ears. “Well, ma’am,” you hear. “You can always appeal.”

The appeals pages review the ways that you can, step by pitiful step, attempt to plead your case. If you lose, such as in the case of a huge hospital bill that’s not covered, you lose big. Family homesteads have been known to disappear down the health care maw, these types of losses representing an enormous percentage of bankruptcies in the US. Most of the time, you’ll find you’ve been nickel-and-dimed by your insurance company until you realize you’ve spent a fecal-load of money on healthcare.

Whenever, in fact, your health insurer denies you a benefit, I (your doctor) receive a thick letter from your insurance company, small print on both sides of four pages. This format isn’t intended to save trees, but rather to discourage me from reading it. I get one or two such appeal letters daily.

They’re all about you and the struggle you face trying to get reimbursed for something that in all likelihood you do deserve. Some line item on your hospitalization, some treatment by your physical therapist, or some prescription that works just fine for you has shifted in a retooling of their legal document to “uncovered benefit” status and is now your financial responsibility.

The letter describes how I can participate in your appeal, hopefully by discouraging you from pursuing it, as doing so will involve me. If you want to move forward I’ll have to read the whole dreary letter, review your chart, and compose something in your defense. Basically, they want me to encourage you to suck it up and do nothing.

The final paragraph of these four-pagers (eight sides of written material) is always the same, providing the address of your state’s department of insurance to file a complaint. Given the number of government layoffs in Illinois, best not hold your breath when choosing that route. Click here to see photo of where your letter will likely go.

Drug formulary bonus booklet
Usually arriving in the same envelope as your “benefits booklet,” but as a separate booklet unto itself, is your 50-page Drug Formulary. This is meant to explain (but rarely manages to) why so many of your prescriptions are being denied when you go to a pharmacy and why so many require something called “prior authorization” from your doctor.

As I flip through it, I see endless incomprehensible tables and charts, with drugs subdivided into something called tiers, each with some footnote or another. The footnotes relate to quantity limits (the X number of pills per month I can prescribe, with you maintaining coverage), prior authorization requirements, step therapy (in which you are forced to try three crappy drugs before they’ll allow you the one your doctor thinks will work), and so forth.

The drugs themselves are loosely divided into “old” (generic, off patent, inexpensive, lower-case print) and “new” (brand name, expensive, lots of capital letters). As I scanned the drug formulary, I noted some of the allowable generic medications were so old I was surprised anyone was still prescribing them. These are medications your grandparents might have taken and although many of them are still quite useful, others are just sort of outdated. For example, paroxetine (Paxil) and amitriptyline (Elavil) are generic, have been around for decades, and are reasonably good antidepressants. It’s just that newer ones, like Lexapro and Viibryd, with more reliable clinical benefits and fewer side effects, are better.

With drug plans like these, most of the new drugs you see on TV will either be completely unavailable to you without a lengthy appeal or will require a substantial co-payment. If you’re financially well-off, shrugging your shoulders at a $75 co-pay because it’s less than you paid for wine at dinner last night, then you’re just fine. The med is yours. On the other hand, if you’re like most people your jaw will drop when you hear the cost of the co-pay and you’ll leave the drug with the pharmacist, hoping for the best with your ancient generic.

Of course you could always buy your meds, brand name or generic, from Canadian pharmacies, which (because the pharmaceutical industry is another lobbying behemoth) our government does its best to prevent. Not surprisingly, most US users of Canadian pharmacies have health insurance. In fact, they also have drug coverage–just not enough to cover the high co-pay for what they need. Interestingly, paying full price for a drug in Canada often comes to less money than using your health insurance with a high co-pay here in the US.

Patients occasionally ask why some brand-name drugs are covered by their insurance, albeit with a high co-pay, while other drugs for the same condition (basically the same type of drug) are not covered with any co-pay.

Please refer to the back page of your formulary, where the answer lies hidden. I quote: “Aetna (or Humana, or Cigna) receives rebates from drug manufacturers that may be taken into account in determining the Preferred Drug List.”

That this rebate largesse is strictly for their pleasure–not shared with you–appears in the next sentence. “Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions.”

In Chicago, aldermen go to jail for taking these types of “rebates” unless they’re willing to share them with ward committeemen.

I discovered that the very final sentence in virtually all these booklets sums it up, a great coda of US health care. Here it is: “Aetna (or Humana, or Blue Cross, or whoever) does not provide care or guarantee access to health care services.”

Instead, they build skyscrapers and fill them with employees working day and night to block you from getting well…and from getting reimbursed. And people wonder why I think so highly of the French healthcare system.

Let me end with Aetna’s very cryptic, ambiguous, elliptical, and Orwellian big-brotherly motto:

We want you to know.™
Read this slowly aloud, dropping your voice several octaves. Add three more periods at the end and it’s even spookier.

So for God’s sake, stay well,

David Edelberg, MD

What we now call mood disorders (including such familiar diagnoses as depression, anxiety/panic, obsessive thinking, and PTSD) Szasz felt were over-diagnosed, with physicians reaching for their prescription pads as quickly as Wyatt Earp drew his Colt at the OK Corral.

Situational anxieties, such as fear of dental work or flying, can certainly make their victims miserable. But even though over the years I’ve examined some pretty neglected teeth and witnessed more than one major airline passenger meltdown, I would never label sufferers mentally ill simply because their behavior goes against the accepted norm of how people should act.

Dental and airplane anxieties are currently classified in DSM-IV (the diagnostic manual of mental illness) as phobias, which seems to me seriously off the mark. A phobia is a persistent, abnormal, and irrational fear that truly (truly!) interferes with a person’s life, like the fear of open public spaces (agoraphobia) or closed ones (claustrophobia).

What might perpetuate the myth that dental and flying anxieties are forms of mild mental illness is the fact that medications used for mood disorders do work and are readily accepted (often with gratitude) by patients. A Xanax taken an hour before a root canal or boarding your flight does provide a reasonably useful Band-Aid, and many patients maintain a Xanax stash for just these occasions.

But despite the availability of helpful medications, what Szasz would say is that fears of dental work and flying are not particularly unreasonable…and they’re not phobias. In one survey of dental-phobics, most patients were fearful of pain because they’d experienced severe dental pain in the past.

Well, that’s certainly not irrational.

These people also feared dentists and hygienists (as a source of pain or doing unnecessary work), feared drug reactions, and feared “something going wrong.”

Virtually everyone with a fear of flying has seen photographs of godawful plane crashes, terrified at the thought of being five miles up in the air in a gasoline can with wings (though, statistically, driving is riskier).

Drug-free anxiety relief with ear acupuncture
If any of the above applies to you, and you’re not needle-phobic, you might consider ear acupuncture instead of drugs for your next dental work or flight. One recent research paper out of the Medical University of Vienna (Freud went there, by the way) showed a dramatic reduction in anxiety when ear acupuncture was performed the same day as the dental visit.

The ear as a site for acupuncture is one of the so-called microsystems of Chinese medicine, where an outline of all body parts and internal organs appears in one small area of the body. Other microsystems are the surfaces of the hands and feet, the back, and the scalp. One advantage of microsystem acupuncture is that the needles used are extremely small and barely felt.

After treatment, many practitioners tape very tiny metal beads to the same ear acupuncture points they’ve activated during the session. Simply pressing the bead between your thumb and forefinger is enough to replicate the needle’s action on your meridians and extend the clinical effect of your treatment. Later, you can cheerfully explain to your dentist/flight attendant/fellow passenger why you keep squeezing your ear, yawn a couple of times, and doze off.

Another advantage of ear acupuncture is the DIY component. Instead of Xanax, you can keep a tiny vial of beads in your medicine cabinet. No more of that vaguely guilty feeling you get when pill-popping, no more Xanax side effects (and there are more than a few). Just place a bead on a piece of tape and press it firmly on your ear point. In the long run– and this is the real advantage of using ear acupuncture–you’ll feel the emotional baggage of your dental visit or cross-country flight begin to lessen.

Ultimately, you’ll need neither Xanax nor the bead.

All the traditional Chinese medicine practitioners at WholeHealth Chicago are familiar with ear acupuncture for dental and flight anxieties. Since these treatments can be performed while you sit in a chair and don’t require any extensive diagnostic evaluation, if you want to try this on the way to your dentist or the airport, just call ahead to make sure we have a practitioner in the office.

You’ll be treated between scheduled patients, sit in a recliner for 15 to 20 minutes with the tiny needles in your ears, reading your book and sipping some herbal tea (or BYO Starbuck’s), and you’ll leave with some beads taped into place, all for just $25.

Unlike Xanax, you’ll be completely awake and alert, with no interference in whatever activity you’ve planned for later that day, like maybe your skydiving lesson.

Be well,

David Edelberg, MD

“That gut feeling.” We’ve all experienced it, but we may have difficulty describing the sensation. We sense or “know” something internally, feeling butterflies in our stomach, almost as if our entire intestinal tract were a second brain, low on reflective skills but high on intuitive ones.

During the past decade an incredible amount of worldwide research has been devoted to understanding the role of our intestinal brain in mood disorders (like depression and anxiety) and chronic digestive disturbances (like irritable bowel syndrome, or IBS).

We know mood disorders can be helped by raising serotonin levels in the brain, whether by medications (SSRI antidepressants such as Prozac, Lexapro, and Zoloft), supplements (St. John’s wort), or lifestyle choices (quality carbs, sunlight, exercise). However, recent research has shown that both mood disorders and IBS respond to the manipulation of intestinal serotonin, which can be modulated by making sure we have healthy amounts of so-called good bacteria in our intestines.

Each of us carries approximately 100 trillion bacteria in our gut (the same number as our national debt 100 years in the future?), made up of perhaps 1,000 different species. Left to themselves, these are good bacteria, living in gentle harmony with us and with each other. They evolved over millions of years as a source of energy and nutrition for the cells that line our intestines, and they actually support our immune systems to prevent both infections and cancer.

When everything is in healthful balance, we’re fine, but when we inadvertently insert a foreigner (like salmonella or shigella) or trigger an internal ecological catastrophe by taking a broad-spectrum antibiotic, the balance gets shifted and we get sick. Fortunately, in most cases the system corrects itself promptly, but really dangerous bacteria, such as antibiotic-induced C. Difficile, can be quite stubborn to kill off.

Belly flora affect mood
Doctors are just now beginning to realize that changes in bacterial flora can directly affect our mood. Some years ago, when the wide-ranging effects of brain chemicals (neurotransmitters) were first being appreciated, researchers were surprised by how much of the brain chemical serotonin was produced in the intestines. Later, as gastroenterologists explored the whys of the endlessly puzzling IBS, they discovered that serotonin could affect both mood and intestinal motility.

An imbalance of serotonin could determine whether your IBS was constipation-dominant or diarrhea-dominant, leading some gastroenterologists to opine that if IBS patients took enough Prozac, eventually their IBS would go away. Since more than 80% of the body’s serotonin is located in the intestines, the enough became elusive, though it’s true many people with IBS do respond to SSRI antidepressants.

And now for the latest: the most recent research is showing that the presence of good bacteria in your intestines directly contributes to serotonin production. Working initially with animal models (the ubiquitous lab rat), researchers at McMaster University in Ontario discovered that a change in the dominant bacteria population in the intestines could produce visible and measurable changes in a rat’s behavior–changes such as “more cautious vs less cautious” or “passive and fearful vs active and exploring.”  They report that these behavioral changes are attributable to measurable changes in serotonin.

How it plays out in humans
On a human clinical level this has very interesting possibilities. But before I go there, definite acknowledgement and praise needs to be given to all the naturopathic physicians, chiropractors, health food store clerks, persistent patients, and the nutritional supplement industry, since all have been touting the benefits of probiotics (good bacteria) to conventional physicians for decades.

I personally learned nothing about probiotics until I began working with alternative practitioners in the early 1990s. In fact, I’d had my very first taste of yogurt some years earlier while in medical school in London. Yogurt hadn’t yet achieved the status of being as widely available as it is today. I can literally see this moment in slo-mo: a very cute nursing student offering me a small spoonful from her cup. “What’s that?” I asked. She looked surprised. “You don’t have yogurt in the States? It’s made from bacteria.” “Bacteria!” My hand quickly blocked the spoon from getting any closer to my mouth. I half expected the breath coursing over her otherwise fetching nether lip to have a vaguely feculent tang.

I’d been trained to kill bacteria, not eat the stuff.

For years patients have asked their doctors if they should eat foods with live cultures, such as real yogurt (not yogurts with added sugar) and fermented vegetables like kim chee, or take probiotic supplements. They almost invariably received noncommittal shrugs. Now, after all these years, advertisements for probiotics like Align and Florastor appear in conventional medical journals. It’s been an uphill battle for the nutritional supplement industry to arrive here.

On a clinical level, we now know paying a reasonable amount of attention to your internal bacteria is important for your mood. Don’t get too obsessive about this, lying awake at night, wondering about the well-being of all 100 trillion of your fellow travelers.  But if you’re prone to depression and anxiety, a daily serving of high-bacteria yogurt might be a good idea. If you’ve got either type of IBS (constipation or diarrhea dominant), do the same.

If you’re sensitive to dairy, try a super-high concentration probiotic like Ther-Biotic Complete, one capsule daily.

Or…make your own fermented foods. One of my patients made a 2012 resolution to prepare foods like these cultured vegetables and enjoy a little bit every day to bolster her intestinal flora.

And remember: since a single antibiotic dose wipes out billions of good guys, use antibiotics only when absolutely necessary. And follow every course of antibiotics with probiotics in any of the forms discussed here to restore the beneficial community in your gut.

Be well,
David Edelberg MD

The short answer is “We welcome kids”. The longer answer is we’re here if your child has a problem and you want to see if an integrative approach will help.

None of us is a pediatrician and we really would prefer that your child have a primary care pediatrician or family practitioner for general check-ups, required immunizations, school physicals, acute illnesses, and making sure he or she is reaching all the appropriate developmental milestones.

We like to think we’re most useful when your son or daughter has a chronic health problem and your intuition is telling you there’s something more than your doctor’s instructions to refill that prescription…something more than the assurance that your child “will outgrow it.”

Here are some examples:
• You’ve been told your kid is inattentive in school and may have ADD. The school psychologist diagnoses ADD and sends your son to a psychiatrist, who sees him for 10 minutes, writes a prescription, and hints that he may need to take the drug forever. Some children certainly do need to be on ADD medication, but it’s also possible that a few simple lifestyle changes can quickly produce a calmer, sharper, and more attentive child.
• Your child has a rash that goes away only when you slather her with a cortisone cream. Your doctor doesn’t know why the rash is there and hopes it will go away eventually. Until then, just refill…
• Your kid’s behavior has changed, and not for the better. Reluctantly, you see a child psychiatrist who diagnoses depression and suddenly your nine-year-old is on Prozac. This disturbs you (it should).
• Your daughter gets one earache (or sore throat or cough) after another. One shelf of your medicine cabinet is filled with antibiotics. You’re not happy about all these drugs.
• Your child has a stomachache after meals. She’s eating next to nothing or, even worse, nothing but junk. “Tests” are negative and now a doctor is recommending your daughter pop Nexium (again, disturbing).
• Your kid complains of headaches…of joint pain…of not sleeping…of pimples and acne…of being too fat. You feel helpless.

We’re here to help
WholeHealth Chicago has a nice team of practitioners who deal with conditions like these. It’s handy that they all genuinely like kids and kids really seem to like them back. If you click below, be sure to take a look at the photos. How could kids not like practitioners like these?

• Casey Kelley, MD, is board certified in family medicine and has had far more formal training in pediatrics than anyone else at WholeHealth Chicago. Her special interest is functional medicine, which investigates the why behind a learning disability, a susceptibility to colds, or too many tummy aches.

• Dr. Sujatha Mannal is our center’s homeopath. Children really like homeopathic remedies: tiny white pellets that melt in their little rosebud mouths. Read a brief synopsis of homeopathy here. You’ve probably seen the displays of homeopathic remedies in places like Whole Foods, but you might not have known where to begin, which remedy to select for your child. That’s why Sujatha’s on our team.

• Drs Paul Rubin and Cliff Maurer are our chiropractic physicians. Kids experience a surprising number of musculoskeletal symptoms, including headaches and back and neck aching, that are too often dismissed as “growing pains” until the kids finally start keeping the pain to themselves (my youngest fibromyalgia patient was nine years old and when she talked about her pain with her mother in the room, it got quite emotional when she said, “I didn’t want to bother you any more with it, mommy”). Pediatric chiropractic is useful not only for treating chronic symptoms, but also for preventing future musculoskeletal problems.

• And finally (and totally vital to our team), nutritionists Marla Feingold and Seanna Tully. If you had any idea how often I’ve heard the phrase, “No wonder this child has (fill in a symptom)…did you hear what he eats at home and for school lunch every day?” Marla and Seanna know you love your kid, but just because your family is vegetarian doesn’t mean Twinkies and diet cola are a good idea. Spoiler alert: expect the Wrath of Khan from your child when you start to clean up his/her unhealthy eating. But know that it’s possible.

• I’d certainly add our lovely and capable Mari Stecker to this list. She’d be delighted to work with children if only she were capable of generating some enthusiasm among them for acupuncture. That said, when my son Ben was about nine, he had something (I forget what) that I knew acupuncture would truly help. It took some good marketing on my part to sell him on acupuncture, but being a good kid he agreed to a couple of sessions, even falling asleep during the second one. I think one of the major benefits of young Ben’s experience, however, came with the playground bragging rights (“needles sticking out of my chest!”).

I rather like kids myself, and the rumor that I prefer them breaded and fried is unfounded. But with a team like this…well, I was trained to take care of grown-ups and I’m just not needed here.

Be well,
David Edelberg, MD

PS: If you’re interested in a nice informal meeting with any of our practitioners I’d urge you and your children to attend our open house from 1 to 4 pm  Saturday, Jan 21. Free snacks and—please note–free ear acupuncture, just in case your son or daughter wants to give it a trial run.

Nobody wants to deal with cancer, but unfortunately as we all get older we enter the realm of increased cancer risk. Around age 30, when we finally shed the delusion that we’re not immortal, we start taking better care of ourselves. We stop smoking, eat healthier, exercise a bit, abandon skydiving as a hobby, and go in for the occasional check-up.

As far as cancer screening goes, women get mammograms and Pap smears, and after age 40 men get a PSA blood test that screens for prostate cancer. Over the past 30 years, millions of men have had their PSA repeatedly measured and sighed with relief when their results came back normal…or found themselves referred to a urologist when they did not. Good preventive medicine, right? Sounds reasonable, right? Now the bad news: having your PSA measured causes more trouble than it’s worth.

Many years ago, scientists discovered that certain cancers produced unique chemicals that could be detected by relatively simple blood tests. The chemicals were named “tumor markers” and initially were used to follow the success (or failure) of treatment for that specific cancer. One of these tumor markers—prostate-specific antigen–normally produced in very small amounts by healthy prostate glands, begins rising if prostate cancer is developing. However, PSA also rises in the presence of prostate infection, irritation, enlargement, and even recent ejaculation. Thus it’s not all that specific to cancer.

Armed with guidelines for “normal” PSA levels versus elevated “abnormal” ones, a virtual prostate cancer industry developed. Envision please an assembly line of men with elevated PSAs, riding along buttocks skyward, first undergoing a needle biopsy (you’d rather be in Philadelphia) and then passing through a bone scanner to check for cancer spread, and if none, onto surgical removal of their prostates.

Larger medical centers acquired da Vinci robotic devices to perform this surgery. Each da Vinci costs a hospital $1.5 million, plus another $300,000 to $500,000 annually in maintenance. Having sold more than 1,000 units, the company is a super high flyer on Wall Street. You’ll help offset the high price of the da Vinci when your $60,000 hospital bill arrives, not including your urologist’s fee (average income $400,000-$600,000 a year). The website of the seven-physician urology team at Henry Ford Hospital in Detroit credits themselves with more than 5,000 prostate removals using their da Vinci.

As a primary care physician, I myself dutifully ordered PSA testing on men coming in for their check-ups and occasionally measured my own as well. I began to learn which medical centers in town would fast-track their patients for (literally) next day surgery and which took a more conservative wait-and-see-if-the-PSA-goes-down approach. I also began hearing of more and more complications from surgery: lengthy hospital stays for infection, real problems with urinary incontinence and sexual dysfunction.

Was all this PSA testing really worth it?
On October 11, 2011, the US Preventive Services Task Force (USPSTF) officially announced “no.” An analysis of all the testing, all the surgery, and all the radiation concluded that the risks of PSA testing outweighed the benefits. There were simply too many surgical complications resulting from the removal of cancers that were never destined to harm anyone in the first place. It’s well known that prostate cancer is frequently a very slow-growing tumor. In fact, many older men harbor small and likely harmless prostate cancers that will never affect their health or longevity. In addition, many men who actually did die from prostate cancer had normal PSA levels during their routine screenings or had undetected spread of their cancer at the very time their prostates were being surgically removed.

This “no more PSA” news was not taken lightly by many urologists. While acknowledging that over-diagnosing and over-treating prostate cancer were indeed major concerns, they proposed that perhaps the one-size-fits-all approach–i.e., high PSA means immediate biopsy and prostate removal–could be modified by an approach called watchful waiting (doing nothing and re-testing PSA periodically). But this suggestion met with USPSTF objection, given that watchful waiting with frequently repeated PSA testing would incur unnecessary “PSA anxiety” of little useful purpose.

Better, implied the USPSTF, to just forget the whole PSA thing. If a patient is really worried about prostate cancer and wants the PSA test, OK, but doctors should no longer offer it routinely to their patients.

What’s ironic to me is that not once in the four (!) separate articles in JAMA this week discussing PSA did anyone mention prevention.

So here’s my recommendation for keeping your prostate healthy
Get a PSA test only if indeed you actually want one, but be aware of these risk issues. If you’re a (male) WholeHealth Chicago patient coming in for a check-up, I will ask if you want the test, but will no longer order it as a matter of course. If you answer, “Why are you asking me this?” I’ll assume you haven’t read this health tip and explain the statistics to you. And unless more news comes out to the contrary, I’ll not be having any more PSAs done on myself.

Let’s wrap up with a list of lifestyle changes you can make, each of which has been proven to reduce your prostate cancer risks:
1. Have a cup or two of coffee (regular or decaf) every day.
2. Have more orgasms (talk to your partner or your hand).
3. Exercise regularly.
4. Eat more tomatoes, especially cooked tomato sauces, which are high in lycopene.
5. Eat more fish or take a fish oil supplement.
6. Eliminate junky trans-fats, found in fast foods, snacks and other processed foods, and commercially prepared baked goods (e.g., doughnuts, cookies, pies).
7. Eat more green veggies, especially broccoli.
8. Take one of the several good prostate health supplements. I use Healthy Cells Prostate, but remind you that no supplement compares to bumping up your fish, broccoli, and tomato intake.

Be well,
David Edelberg, MD

The popular prescription hormone replacement therapy (HRT) of the day was, and still is, Premarin, which Chris reminded us was nothing more than the concentrated urine of pregnant horses (pregnant mare urine=Premarin). Alan Gaby would tell us, as only he could, that American women were “scarfing down hoss piss,” emphasizing that being piss also meant even the horse didn’t want it. Unless you have a strong stomach, don’t click to this web page, the ASPCA’s comments on Premarin and animal cruelty.

If you’re a women who still has her uterus, taking estrogen requires adding the second sex hormone, progesterone, to prevent uterine cancer. The popular progesterone product was, and still is, a synthetic molecule called Provera (medroxyprogesterone), and it’s currently available combined with Premarin into a single product, Prempro.

During that talk all those years ago, Dr Northrup was worried about Prempro because there was data emerging from Europe of increased breast cancer and stroke risks in women using it. From Big Pharma, nothing but denials were being published in the US.

Chris Northrup was taking no chances, though, sticking with bioidentical hormones for her patients.

Bioidentical means “biologically identical”
These hormones are manufactured (estrogen from soybeans, progesterone from the Mexican wild yam) so that the final molecule is identical to the one made by human females. By the way, bioidentical testosterone for both men and women is available as well, but you won’t find these available in the pharmacy of your local Walgreen’s or CVS. Each prescription for bioidentical hormones is made up individually at an independently owned compounding pharmacy.

Because no one can patent a human molecule, Big Pharma isn’t interested in developing or testing bioidentical hormones, and for this reason bioidenticals haven’t undergone the rigorous FDA requirements reserved for other prescription drugs. Mainly, Big Pharma regards bioidenticals as a most annoying competitor to its own hormones. In fact it’s tried all sorts of sneaky ploys to get them pulled from the market, including instigating a congressional ban on compounding pharmacies themselves.

It seemed counter-intuitive to Dr Northrup (and now, after prescribing bioidentical hormones for many years, to me as well) that the very same hormone a woman produces in her body would actually increase her cancer risk. In fact Chris mentioned that, in her own experience, there seemed a slightly smaller risk of breast cancer among bioidentical hormone users, noting that these impressions of her own patient population required larger studies to prove.

Stroke and blood clot have always been a problem with hormones as well. Doctors know that clots and strokes occur more frequently among birth control pill users, especially if they smoke. The same risk would likely apply for hormone replacement therapy of any stripe, synthetic or bioidentical.

Fast forward a decade
The controversial Women’s Health Initiative (WHI) study frightened everybody, doctors and patients alike, by showing an increased risk of breast cancer among Prempro users compared to non-users. But a couple of years later, when all the sturm und drang cleared, it turned out the WHI study had enough flaws (not the least inadvertently including some women who already had breast cancer) to suggest that instead of never again prescribing HRT, doctors could write Prempro prescriptions with certain caveats, among them regular breast examinations for users and that women should use it only as long as it took to get past menopause-related hot flashes.

What was really needed, and would simply never occur in the US because Big Pharma could not profit from the results, was a study using bioidentical hormones. However, the French health care system (essentially not-for-profit and which regular readers know I admire immensely) was willing to study synthetic vs bioidentical hormone replacement. They tracked almost 100,000 women in the E3n study and results have been published over the past several years.

The main points of the E3n study are extremely important to any woman contemplating or currently using hormone replacement of any kind:

• Different risks were associated with the different types of hormones used in the study. The US WHI study used only Prempro (horse estrogen plus medroxyprogesterone). The E3n study used only bioidentical estrogen but varied the type of progesterone, including bioidentical progesterone and medroxyprogesterone.
• There were increased breast cancer risks in all women taking estrogen replacement, but the main source of risk turned out to be less the estrogen than the progesterone type that had been selected. When bioidentical estrogen was combined with bioidentical progesterone, the risk of developing breast cancer was dramatically lower than when bioidentical estrogen was combined with medroxyprogesterone. Although taking bioidentical HRT did not protect women from developing breast cancer as Chris Northrup had hoped, what she observed way back then was correct: the risks were much lower with bioidenticals than when using Big Pharma hormones.
• Finally, unlike the WHI study using Prempro, there were no increased stroke or blood clot risks when using bioidentical hormones.

Some years back, Big Pharma had hoped Premarin would do more than help hot flashes. Untested evidence began to appear–that hormones might prevent osteoporosis, Alzheimer’s disease, heart disease, and strokes. With the exception of being useful for osteoporosis, the WHI study quashed hopes for prevention of everything else. There was a higher stroke and heart attack risk with Premarin (nothing significant about Alzheimer’s) and, now, from the E3n, no stroke or clot risks with bioidenticals.

Ultimately, hormone replacement is truly useful for just one condition: menopausal symptoms. Hot flashes and night sweats usually stop dead in their tracks when a women takes the dose of bioidentical hormones best for her (doses can vary quite widely). The route of administration–capsules vs creams–doesn’t make much difference and is your choice. At WholeHealth Chicago we prescribe both capsules and creams, including the new Wiley Protocol, which varies the hormone dose depending on the day of a woman’s cycle synchronized with phases of the moon (menses=moon, remember?).

I remain amazed by the gynecologists over at my nearby Goliath (Northwestern Memorial Hospital) who continue to give stern lectures about bioidenticals being “untested by the FDA” when women ask about them.

We hear all about this finger-wagging when these same women arrive at our center. The French E3n data is available for all physicians online, translated and ready to read, if only…

Be well,

David Edelberg, MD

Tucked away in the small-circulation medical journal Thyroid, whose readership is probably limited to endocrinologists specializing in thyroid disorders, there appeared an article about Hashimoto’s thyroiditis that really should have been published in a journal that every doctor reads, like JAMA or American Family Physician.

The autoimmune disorder Hashimoto’s thyroiditis is one of the most frequent causes of low-thyroid (hypothyroidism) conditions.

When you don’t have enough of the essential thyroid hormone, you’ll feel quite an assortment of symptoms, the most common by far being fatigue–a pervasive, 24/7 sense of never having enough energy to do the activities you enjoy. In fact, you may be so fatigued that your muscles actually feel weak.

Beyond fatigue, you may experience weight gain and have an impossible time trying to lose it. You might notice dry skin, dry hair, hair loss, and a peculiar thinning of the outer third of your eyebrows. You may feel mentally sluggish and constantly cold, even on a warm day. In the sack, your partner will shriek that your feet are like cakes of ice (and you really do prefer wearing socks to bed to keep your feet warm).

All this and more if you have low levels of thyroid hormone. You might notice puffiness around your eyes, your usually healthy glow replaced by a pasty complexion. You may be a bit constipated, and your periods have changed too. Having problems getting pregnant? Low thyroid can be involved. In people with severe hypothyroidism, this strange symptom occurs: your tongue actually feels too large for your mouth.

Tests for low thyroid
If you bring any or all of these symptoms to your doctor, any physician with a pulse will order a thyroid profile, a test that measures two thyroid hormones–T3 and T4–as well as a hormone from your pituitary gland that controls your thyroid, called TSH (thyroid-stimulating hormone).

With low thyroid, the T3 and T4 are low, the TSH (as your pituitary struggles valiantly to stimulate the thyroid) is high.

If your TSH is elevated and your T3/T4 low, your doctor might next order a test measuring anti-thyroid antibodies, which determines if Hashimoto’s thyroiditis is the cause of your underactive thyroid. Having your immune system create antibodies against any organ in your body is the very definition of an autoimmune disease. In this case these antibodies are targeting your thyroid—as though it were a sort of alien invader when it’s actually an utterly necessary part of your body.

Autoimmune disorders explained
We don’t know exactly what goes wrong with the immune systems of certain people, overwhelmingly women in a 20-to-1 ratio over men, but Hashimoto’s is one of several such autoimmune disorders, as are lupus, rheumatoid arthritis, and Sjögren’s syndrome.

It’s widely accepted that women’s immune systems are simply different from those of men, because the female immune system must adjust itself to the presence of a “foreign body” when a woman is pregnant.  Since half her embryo’s DNA is from a foreign source (dad), her immune system can’t simply reject this tissue or we’d never as a species be able to reproduce.

This difference in immunity somehow renders women more susceptible to all the autoimmune disorders, and Hashimoto’s thyroiditis is the most common.

Diagnosis
When your doctor sees your elevated TSH and your similarly elevated thyroid antibodies, look carefully and you may see a subtle flicker of personal pride flashing across her face—she’s made a diagnosis of Hashimoto’s. She knows the source of your fatigue and that once you’re taking thyroid replacement hormone (Synthroid, Armour thyroid, etc.) you’ll feel better.

Your doctor may need to adjust your dose over time, using your steadily declining TSH as a guideline. As you take your thyroid replacement hormone, your levels of TSH will go down. This is because your pituitary gland no longer must flog your thyroid to get it to produce its hormone. Your smart pituitary recognizes that the thyroid replacement is in your system and is doing its job.

When your TSH is down to a normal level, you’ll be pronounced well and told that you’ll need to remain on a thyroid hormone for the remainder of your current incarnation.

“Sorry! Not quite as simple as that,” proclaimed researchers from the Medical University of Vienna, Austria, in their Thyroid journal article. What they discovered (and this is why the article is so important) is that, in women, the presence of thyroid antibodies themselves–even if you have completely normal levels of T3/T4–can cause symptoms identical to those of low thyroid.

It’s the presence of these antibodies as the newly discovered cause of fatigue that led to today’s health tip title. This is a very important piece of news and leads to a couple of serious possibilities:
• If a woman has all the symptoms of low thyroid but has normal hormone levels and normal TSH, she should not be hearing any doctor say “Your thyroid tests are normal. Whatever’s causing your fatigue, it’s not your thyroid.”

Instead, she should have her thyroid antibodies measured. If they’re elevated, her doctor should seriously consider prescribing thyroid hormone despite her normal hormone levels, using as a gauge to determine the correct dose how she feels (called “clinical response”) rather than hormone level tests. Unfortunately, women seeing their doctors for fatigue will find that virtually no physician routinely measures these antibodies.

• A woman diagnosed with Hashimoto’s thyroiditis whose antibody levels are especially high may need a higher dose of thyroid hormone than usual. And anyone tracking the fluctuations of her TSH as a guide to adjusting her thyroid hormone dose may prescribe an erroneously low dose of thyroid hormone for her particular situation.

A woman with high antibody levels may feel better on such a high dose that her lab test would register “hyperthyroid,” meaning overactive thyroid. In the past, when this occurred, doctors would lower the thyroid dose, but this article suggests “not so fast…”

We’re talking huge numbers of mainly women in this situation. Low thyroid probably affects up to 20% of women as they enter their forties. Of these, half have no access to our health care system, so they simply remain undiagnosed and tired all the time.

For those with insurance, we’ve added another large group of fatigued women: those who have been to their doctors, had their thyroid hormones tested, and were told they were normal. This group should return pronto, this health tip in hand, and say, “Listen, doc, I want you to test my thyroid antibodies. Let me show you this article…”

Be well,
David Edelberg, MD

The total number of fibromyalgia patients worldwide is jaw-dropping and the situation is much worsened by the medical profession’s failure to adequately diagnose and sympathetically treat this virtual epidemic, displaying a medical sexism that’s hard to miss even if you’re not looking closely. The sexism I see is the result of a male-dominated healthcare system dealing with a condition that simply doesn’t follow the rules we learned in medical school.

And because fibromyalgia doesn’t follow the rules, its victims–virtually all women–get second-rate treatment from physicians. You’ll note I’ll always use the feminine pronoun in this article (as I did in the book) because of fibro’s profound gender inequality: 95% of people who have it are female, ranging in age from 8 to 80.

Fibromyalgia gets its start in a biochemically susceptible woman after a lengthy period of stress. Making matters much worse is that even after the initial stressors recede, her fibro pain persists. This occurs because of the stress of the pain itself combined with an unhelpful, unsympathetic, and sometimes overtly hostile medical profession.

Next year WholeHealth Chicago will celebrate its 17^th anniversary, and I mention this because I began seeing fibromyalgia patients from the very start of our clinic’s opening. Conservatively, I estimate I’ve diagnosed and treated more than 1,600 people with fibro. Fewer than 50 of these patients were men.

The women who came to our clinic in the early days were seeking something other than what they’d been hearing from their own physicians. In fact, a steady stream of our patients came to us by way of Northwestern Memorial Hospital’s Rheumatology Department, which for years told women (and taught generations of mis-educated Chicago rheumatologists) that there was “no such thing as fibromyalgia” before referring them to psychiatrists. Back in the mid-90s, many women first heard of fibromyalgia from their chiropractors or massage therapists, but then articles began to appear in popular magazines. These patients came to WholeHealth Chicago when they learned that our center combined conventional medicine with the then-new “alternative medicine,” rightly thinking that if mainstream medicine alone had nothing to offer then perhaps we did.

Seventeen years later, the situation has guardedly improved. Now we have three FDA-approved medications for fibromyalgia, documented effectiveness of alternative therapies (including supplements, herbs, chiropractic, and acupuncture), numerous articles in medical journals, fibro websites, and support groups. But still, after all these years, a majority of doctors (75%) feel uncomfortable making a diagnosis or initiating treatment.

Here’s why: Typically, when you arrive in your doctor’s office with a symptom (headache, tummy ache, weight loss, anything) he or she is trained to look for disease as the basis for your symptom. To hunt for disease, tests are ordered (blood tests, x-rays, and so forth). If everything comes back negative, your doctor can say “everything’s fine, your tests are normal,” and by ruling out the possibility of a disease being present he earnestly feel he’s done a good job.

The real flaw here is the doctor’s reluctance to make a firm commitment about your diagnosis without the confirmation of positive test results. Not feeling confident in making a diagnosis means he’s equally reluctant to initiate any effective treatment. With nothing “positive,” consciously or unconsciously doctors too often categorize the fibromyalgia patient as “another tired and complaining woman” and move on. Or the patient is sent to a psychiatrist or to a rheumatologist. Woe betide if you dare ask for a pain pill. In this case you’ll be categorized as “demonstrates drug-seeking behavior.”

Even though the pain is very real, fibromyalgia is not a disease. Your blood count is normal, tests for inflammation or an autoimmune disorder are negative. Even a muscle biopsy taken from an especially painful area will show normal muscle tissue, and thus fibro flies under the radar of diagnostic testing.

Instead, this non-disease fibromyalgia is diagnosed with two rarely used tools: taking a very detailed medical and personal history from the patient herself and performing a brief, hands-on, fibromyalgia-specific physical exam that tests for tender points.

Most doctors readily admit regret at not having enough time to listen to your biography–the story of your whole life–important as it may be to understanding how your fibro developed. And based on my own experience educating doctors on fibromyalgia, fewer than 10% actually know how to perform the tender-point physical exam. In fact, acknowledging that most doctors are inept at this test (which simply requires locating and compressing clearly identified and potentially tender areas with 10 pounds of fingertip pressure), the American College of Rheumatology eliminated it as part of fibro diagnosis. Done correctly, tender point testing does remain a valuable diagnostic tool.

More recently, I was involved with a huge online survey called WE FEEL (Women Expressing Fibromyalgia’s Effect on their Everyday Lives) that served as a catalyst to my finishing Healing Fibromyalgia.

Here are a few realities the fibro survey uncovered:

• Somewhere around 12 million American women suffer the daily pain of fibromyalgia, more women than are diagnosed with diabetes. This means possibly 8% of women in the US alone have fibro. When doctors tell me “we don’t see any fibro in our practice” I ask myself “Do they just not want to deal with fibro?” Worldwide fibro estimates are in the range of 200 million women.

• Of the 12 million US women with fibro, approximately 75% are unaware of their diagnosis, although I’d place the number closer to 90%. This is because many women with early or mild fibromyalgia think their widespread aching is just part of the aging process and don’t mention it to anyone. They’ve accepted “we can’t find anything wrong” and simply live with it.

• Statistically, a typical woman with fibromyalgia sees five physicians before she is properly diagnosed, all that time her pain growing steadily worse. Many give up at the second or third physician and suffer alone for years, often postponing medical help until their pain becomes unbearable (and more difficult to treat). Patients describe the “cold look” they get from doctors when they say, “I’ve been to other doctors and no one can find anything wrong with me.” From first perception of muscle aching (usually in neck and upper back) to actual diagnosis of fibromyalgia can be upward of five to 10 years (years!). No condition in all of medicine takes 5 to 10 years to diagnose except fibromyalgia.

• Women in the survey regularly reported not being taken seriously by their health care providers, by their families, or by their employers. Fibro pain affected all aspects of their lives: ability to work at a paying job and/or at home, to think clearly, to enjoy relationships. Most women kept their pain and fatigue to themselves, tired of hearing “But you don’t look sick” from everyone around them.

• And then there’s the treatment component: even after fibromyalgia is finally diagnosed and the doctor acknowledges a woman’s pain, chances are he simply will not prescribe adequate pain relief. Studies have repeatedly shown that when patients of both sexes experiencing equal pain seek help from a physician, the man virtually always receives better pain control than the woman. Men are prescribed pain meds, women get antidepressants. Women, being more articulate about their pain, are categorized as “whiners.” When a usually silent and stoic guy says he’s in pain, his (male) physician thinks “this is real” and prescribes accordingly.

For the past two years I’ve been giving talks on fibromyalgia to medical groups and I’m not happy with what I’ve found. I still actually hear doctors say, “There’s no such thing as fibro” and “Fibromyalgia is a woman’s way of having her husband do the housework.” The pharmaceutical reps for the three FDA-approved fibro drugs have told me they were unprepared for the degree of physician resistance (from both male and female physicians) and occasional outright hostility to the diagnosis of fibromyalgia and its treatment.

But we do have a pretty good idea why women get fibromyalgia
Fibromyalgia is not a disease and will never lead to something else, like arthritis. The word “fibromyalgia” will never appear on anyone’s death certificate. But it can surely derail your life.

At the very heart of fibromyalgia is the stress-buffering neurotransmitter serotonin. Already lower in women than men, among fibro women it’s low enough so they go  through life feeling like open wounds in a salt shaker world. When stress exceeds stress buffer, the muscles of a woman with fibro tighten up painfully in a fight-or-flight response and remain that way (more on this below).

To make matters worse, the nerve endings surrounding these muscles release excessive amounts of chemicals called pain modulators, which cause people with fibro to actually feel more discomfort/pain from any unpleasant stimulus (like being pinched) than other people. Plus, it lasts longer.

In medical terms, fibromyalgia is a syndrome of pain amplification and pain persistence. It’s a genetic susceptibility, and family members of a woman with fibro are more likely to have other low-serotonin disorders, including depression, anxiety, alcoholism, migraines, TMJ, irritable bowel, and chronic fatigue syndrome.

In other words, if your dad was alcoholic, your mom depressed, and you’re currently stressed out in an abusive relationship, fibromyalgia is in your cards unless you take some action now and deal yourself a new hand.

The three medications for fibro, which are far from perfect because of side effects, do address these essential fibro irregularities. Savella and Cymbalta raise levels of serotonin and norepinephrine, a second pain-reducing neurotransmitter. Lyrica reduces the release of pain transmitters from irritated nerve endings.

Many women can use the Six-Week Nearly Natural Cure presented in Healing Fibromyalgia to heal their fibro without drugs or doctors. It features supplements (which closely mimic the action of fibro prescription drugs, but without the side effects), self-care, and a range of healing therapy recommendations. And you’ve got to de-stress.

Why muscles are affected by stress that is central to fibro
Keep in mind that the stress-induced fight-or-flight response is designed to spur you to action in the face of extreme emergency, like fleeing a mugger or lifting a car off your child. You need muscles to do both.

For a biographical clue to the importance of muscles in fibro we need to explore a statistic that doctors are very uncomfortable addressing. Three separate surveys among fibromyalgia patients have shown that 25% of people with fibro were victims of physical, psychological, or sexual abuse as children or victims of sexual assault at any age.

If you can imagine the body posture of an eight-year-old girl as she hears the front door open and the footsteps of her rage-aholic father, you’ll get an understanding of how fibro is connected to the term “muscle memory,” which I devote an entire chapter to in my book. Decades later, father long dead, she encounters a highly stressful situation and her muscles remember what to do, seizing up under stress. That’s fibromyalgia.

Just three more points…
Because I was so miffed about the attitude of physicians toward fibromyalgia–especially with three quarters of them admitting not feeling comfortable either diagnosing or treating it–the last chapter of Healing Fibromyalgia is a gift to you that makes working with any doctor easier: it’s called the Physician’s Guide to Treating Fibromyalgia. Rather than shred your copy of the book to tear out this last chapter, we’re making it available on our website as a pdf file you can print and give to your doctor.

The chapter isn’t long (doctors prefer that) and it’s presented in a cookbook style (they like that, too) that lays out our protocols for treating fibro. If your doctor tosses the few pages back to you and says “Don’t bother me with that internet stuff,” find another doctor. These days it’s a buyer’s market, and the new book also provides internet resources helpful in finding a fibro-sensitive, fibro-educated physician.

Second, the fact that an estimated 200 million women around the world likely have fibromyalgia should stop you in your tracks. Probably in many cultures a woman suffering relentless widespread muscle pain is ignored, widespread pain being her lot in life–a bad incarnation or punishment for something she “deserves.” Consider, too, what I’ve already reported about US physicians ignoring US women with fibro. It’s not just women in some far-off land who have been suffering.

If fibromyalgia is essentially stress transformed into pain, there’s something seriously wrong with a planet on which a good percentage of half the occupants are under so much stress that their muscles lock up in pain. While writing Healing Fibromyalgia, I wanted to somehow measure, to grasp the degree of this stress. One day, in a single 24-hour period, I went through newspapers and read online and collected everything I could find relating to violence against women. I was not selective: African clitorectomies, Indian bride burning, and wage inequality at Wal-Mart were all included.

This experience, and I what found, is related in detail in the second-to-last chapter (penultimate to you English majors), entitled Women Under Siege, and that title alone gives you a pretty clear sense of my larger view of fibromyalgia.

Finally, if you can’t imagine there’s anything positive about fibro, here’s something: patients with fibromyalgia actually start feeling better almost immediately after gaining a thorough understanding of their condition, how it came about, and how they can get better. Acquisition of knowledge alone–no meds, no treatment, just “getting it,” understanding the why–will help your fibromyalgia.

And that’s what I intended with the book. By the time you finish reading it you’ll know more about fibro than 99% of practicing physicians.

Although I’d never classify Healing Fibromyalgia as a stocking stuffer to rival a turquoise Tiffany box, if you know someone with fibro or anyone concerned with women’s issues, the book, if I say so myself, makes a pretty good gift.

Be well,

David Edelberg, MD

How Do I Know If I Have Fibro? Take the Quiz

Even if you’ve already been diagnosed with fibromyalgia, take the quiz to gain a better understanding of fibro’s underpinnings. Because fibro is not a disease per se and offers your doctor no positive test results on which to confirm a diagnosis, 85% of women who have it go undiagnosed, often for years.

Part One

1.  95% of people with fibro are female—12 million in the US alone, which means more women have fibro than have diabetes.

Are you a woman?

Y     N

2.  Fibromyalgia is Greek for “muscle pain.” This is an achy sensation in the muscles, usually starting in your neck and upper back.

Do you carry your stress in your neck, shoulders, and/or upper back?

Y   N

3.  There are certain characteristics of muscle pain that are specific to fibro. The key word is “widespread.” Generally, fibro muscle pain starts in your neck, shoulders, and upper back and then spreads, although some women feel it first in their lower back and pelvis. Fibro pain is achy in nature, and though on some days certain areas can hurt more than others, fibro pain is not localized to any one area.

Is your muscle pain widespread?

Y   N

4.  The second most common symptom of fibro is fatigue, a real sense of tiredness, dragging through the day, having difficulty with work or household chores, crashing at night.

Do you suffer fatigue?

Y  N

5.  Sleep is a real problem for people with fibro. Patients have difficulty sleeping and often awaken unrefreshed, exhausted and stiff in the morning (“I feel old”), as if they haven’t slept at all.

Do you suffer from unrefreshing sleep and feel stiff and achy when you get up in the morning?

Y  N

6.  People with fibro also have trouble with focus and concentration, called fibro-fog. Simple activities, like balancing a checkbook, become real challenges.

Do you suffer from poor focus and/or concentration?

Y  N

7.  Stress exacerbates fibro.

Do your muscles hurt or feel achy most of the time, but especially when you’re stressed?

Y  N

8.  Another characteristic of fibro pain is duration, an achiness that’s been around at least three months. Again, some days worse than others.

Have you been in discomfort for three months or longer?   

Y   N

9.  Location of muscle pain is also a clue.

Are you feeling achy in your neck and upper back, on the front of your chest, in your lower back, in both hips, and on the insides of both knees?

Y   N

10.  People with fibro are prone to headaches. These may be tension headaches (a tight band-like headache over the eyes) and/or migraines (throbbing headaches usually on one side of your head, often accompanied by nausea and sensitivity to light).

Do you suffer frequent tension or migraine headaches?

Y   N

11.  Fibro can mimic other medical conditions, including the early stages of rheumatoid arthritis, lupus, osteoarthritis, hypothyroidism, severe vitamin D deficiency, and the impossible-to-pronounce polymyalgia rheumatica. A few blood tests can quickly rule out these possibilities.

Has your doctor ruled out other causes of your muscle pain?   

Y   N

12.  Fibro can also occur along with any chronic medical condition. Some people being treated for conditions like rheumatoid arthritis, lupus, or multiple sclerosis seem to reach a plateau with their therapy and get no better, because they have undiagnosed fibro.

If you have a chronic medical condition and are still in pain, has your doctor also considered fibromyalgia?

Y   N

13.  Many people being treated for chronic depression or anxiety meet all the criteria for fibro, but have never mentioned their other symptoms to their therapist. Also, many women with chronic pelvic pain who are being evaluated by their gynecologists for fibroids or endometriosis meet all the criteria for fibro.

Do you have a history of depression, anxiety, or chronic pelvic pain AND do you have widespread muscle achiness that you’ve never mentioned to your doctor or therapist?

Y   N

14.  Most people with fibro slog through their days doing only what’s absolutely necessary (and sometimes not even than much) and not able to do the things that bring them pleasure.

Do your symptoms interfere with your enjoyment of life? 

Y   N

15.  The average fibro patient suffers needlessly for five years (often longer) before learning she has fibro.

If you sought help for your symptoms, did you hear a variation of “We can’t find anything wrong with you–all your tests are normal”?                                         

Y   N

16.  Fibro almost always begins after a period of protracted physical or emotional stress.

During the months before your symptoms began, were you experiencing an unusual amount of stress in your life?

Y    N

17.  One of the saddest statistics about fibromyalgia is that 25% of patients were psychologically, physically, or sexually abused as children or experienced a sexual assault as young women (date rape).

Does any of this apply to you?

Y    N

18.  People with fibro are often sensitive to chemicals, feeling nausea or headaches with chemical smells and even perfumes. In addition, they frequently experience side effects from prescription drugs

Are you chemically sensitive?

Y    N

19.  Fibro patients often have chronic pelvic pain and painful intercourse. They’re frequently given such diagnoses as interstitial cystitis, endometriosis, or fibroids. Yet treatment for these conditions fails to bring relief.

Do you suffer from chronic pelvic pain or painful intercourse?

Y   N

KEY:

• If you answered yes to questions 3, 4, 5, and 8, you probably have fibromyalgia.

If you answered no to some of those questions but yes to any of the others, you’re at real risk for fibro.

Part Two

Although chronic muscle pain, exhaustion, poor sleep, and brain fog are the hallmarks of fibro and enough for anyone to endure, a majority of women later diagnosed with fibro first suffered a range of seemingly unrelated low-serotonin symptoms, which I call the fibromyalgia spectrum. For many woman later diagnosed with fibro, these symptoms actually appeared first, years before the widespread muscle pain of their fibro began.

Have you had or do you currently have any of the following low-serotonin symptoms (score 1 point for every yes answer)?

Migraine headaches

Y   N

Irritable bowel syndrome (episodes of bloating, constipation, diarrhea, cramping)

Y   N

Severe PMS (with mood swings)

Y   N

Restless legs at night

Y   N

Cold hands and feet

Y   N

Lightheadedness when standing up quickly

Y   N

Physical symptoms during periods of stress (headaches, stomach aches, TMJ)

Y   N

A tendency to gain weight, but not lose it, despite healthful diet and exercise

Y   N

An injury to your neck or spine from which you feel you’ve never completely recovered (e.g., a whiplash injury that “never seemed to go away”).

Y   N

A worsening of any of these symptoms with weather changes

Y   N

Do you regard yourself as unusually sensitive to the world? This can include being highly intuitive, overreacting to feeling slighted, or being emotionally/physically sensitive to colors, smells, tastes, and sensations–almost as if you’ve gone through life as a walking “open wound” in a world made of salt?

Y   N

Because the brain needs sunlight to make serotonin, fibro symptoms are often worse in winter, when levels of stress-buffering serotonin drop. This situation is also responsible for the depression of seasonal affective disorder (SAD).

Are your symptoms worse in winter and/or do you experience depression during dark winter months?                               

Y  N

Because your brain needs carbohydrates to manufacture serotonin, low-serotonin women often crave quickly absorbed “fast carbs” such as bread, chips, pasta, chocolate, and other sweets.

Do you crave fast carbs?

Y  N

Because serotonin levels are linked to estrogen levels, all low-serotonin disorders worsen when estrogen levels drop. These include one week before your period starts (PMS), the six weeks after delivering a baby (post partum depression), and during menopause.

Do any of your low-serotonin symptoms worsen during these times?

Y  N

Have you experienced any of these low-serotonin disorders: depression, anxiety/panic, obsessive thinking, compulsive behavior, social anxiety, phobias, eating disorders, post-partum depression?

Y   N

Low-serotonin disorders run through the women in families. Did anyone in your biological family—especially the women—have any of the conditions listed just above?               

Y  N

KEY:

If you answered yes to any of these Part 2 questions, it’s a clue that you’re more sensitive to the world than other women and most men. Understand that if you experience any period of sustained stress in the future, you are at risk for fibromyalgia as well as any of the symptoms listed above.