DEAR DR. DONOHUE: I haven’t any energy to do even routine things like washing clothes, ironing and cleaning the house. I am not depressed. My doctor says I have fibromyalgia, but my husband says there is no such thing. Is there? – V.V.

ANSWER: Most doctors subscribe to the reality of fibromyalgia. It makes the body ache all over and drains people’s energy. Reputable investigators diagnose it, and reputable institutions have devised criteria to define it. In addition to pain and tiredness, most fibromyalgia patients have “tender points.” Those are 18 precise anatomical spots where light finger pressure evokes discomfort.

In addition to the above, some fibromyalgia patients are quite sensitive to heat, cold, noise or bright lights.

Your husband might not believe fibromyalgia exists because there is no test, X-ray or scan that can unequivocally prove that it is the cause of people’s symptoms.

Although doctors cannot order a test to prove fibromyalgia’s presence, they do have to order tests to prove that other conditions are not the cause of symptoms. An underactive thyroid gland and rheumatoid arthritis are two illnesses that can present symptoms similar to those of fibromyalgia. There are tests that establish the diagnoses of these conditions.

Fibromyalgia is not without hope or without treatment. Amitriptyline is one treatment. It is an antidepressant, but it is not used in fibromyalgia to alleviate depression. It is given in low doses to restore normal sleep cycles to fibromyalgia patients. Sleep disruption is another consequence of this illness. Exercise is mandatory. It starts out very modestly with only five minutes of walking and then increases walking time and difficulty as a person responds.

If readers would like to learn more about fibromyalgia, they can obtain a copy of the pamphlet on that topic by writing: Dr. Donohue – No. 305, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: What is bronchitis? My doctor says I have it. I have been coughing but feel well otherwise. The doctor gave me a mouth spray to use. It works. I thought bronchitis was due to cigarette smoking. I have never smoked. What is the cause? – B.H.

ANSWER: There are two kinds of bronchitis. Chronic bronchitis comes mostly from cigarette smoking. It’s the familiar smoker’s cough. Cigarette smoke irritates airways. They fill with mucus. The irritated, mucus-filled airways trigger a cough that is there day in and day out forever and ever.

Acute bronchitis is a different story. This is your variety. It makes a person cough and bring up yellow phlegm. Viruses are the usual causes of acute bronchitis. A spray that opens airways and encourages the drainage of mucus from those airways helps people clean their lungs. Cough suppressants, such as guaifenesin (Robitussin), are often routinely given to diminish the number and forcefulness of coughing spells.

If the cough lingers, then bacterial infections are suspected. In those cases, antibiotics are justified.

The whole confusion about acute bronchitis could be eliminated by calling it a chest cold.

DEAR DR. DONOHUE: I am 82. I have high blood pressure, but not too high. My doctor has me taking blood pressure medicine. I hate taking medicine. Does someone my age need to take medicine for mild high blood pressure? – K.P.

ANSWER: There are no age limits for blood pressure treatment. Medicines that lower blood pressure prevent strokes, heart attacks, heart failure and artery hardening. The goal of treatment is to lower the blood pressure to 140/90 or less without creating any medicine-related symptoms.

I am on the same side as your doctor.

DEAR DR. DONOHUE: My mom was raised on a farm, and she constantly spoke about tapeworms. She would never serve rare meat. She cooked it through and through. She has been dead for 20 years, and, since she has gone, I have never heard anyone else speak of tapeworms. Are they still with us? – K.R.

ANSWER: Tapeworms are alive and well throughout the world. Here, partly because of changes in how pigs and cows are fed and partly because of meat inspection, tapeworm infections are all but a rarity.

The beef tapeworm begins its life when a human eats undercooked meat that contains tapeworm cysts. In the stomach, the tapeworm sheds its cyst shell. Each day it grows longer and longer and can eventually reach a length of 32 feet (10 meters). It finds the human digestive tract a virtual paradise. The temperature suits it. The host provides it with food. All in all, it enjoys a good life.

Symptoms from beef tapeworms can be so few that most infected people never know they are infected. When they spot parts of the worm in their stools, revulsion drives them to the doctor, who can prescribe a highly effective medicine.

The pork tapeworm can have a potentially more serious story. If a human happens to eat pork containing pork tapeworm cysts, the life cycle of the pork tapeworm mirrors that of the beef tapeworm. If, however, a human happens to eat pork tapeworm eggs, then real trouble can ensue. In the human intestine, the eggs mature into larvae. The larvae can penetrate the intestinal wall and find their way to distant places — muscles, heart, eyes and brain. At those locations they curl up into fetal positions to form cysts.

That condition is cysticercosis (SIS-tuh-sir-COE-suss). It is a dangerous illness, depending on how many cysts have formed, where they have formed and whether they affect the function of the tissues or organs they have infiltrated.

Even today it is safest to ask for and to prepare meat well-done.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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