DEAR DR. DONOHUE: I am a 43-year-old mother of three children, and I also teach school. Since last spring, I have lost all energy, and my muscles seem to hurt all over. I have consulted three doctors. None has found anything wrong with me or my tests. The last doctor has suggested fibromyalgia. I am scheduled to see him again in three weeks. I know nothing about this illness, and I wonder how it’s treated. Please summarize for me. — L.J.

ANSWER: Fibromyalgia is an elusive condition. It’s defined as widespread body pain, an ache-all-over feeling, just like you describe. Accompanying symptoms include disturbed sleep and fatigue. No lab test, X-ray or scan discloses anything amiss. One aid to diagnosis is tender points, specific body sites where finger pressure elicits pain far out of proportion to the pressure applied.

No one has a definite answer about what’s going on. One popular explanation is that people with fibromyalgia perceive pain with heightened sensitivity because of an imbalance of brain chemicals and a misfiring of brain nerves. Disturbed sleep is another consequence of these disorders.

Often the first treatment for fibromyalgia is an antidepressant. It’s given not so much to relieve depression — although fibromyalgia is a depressing situation — but to restore normal brain cell communication and normal brain chemistry to dampen the brain’s magnified perception of pain. Savella and Cymbalta are such antidepressants that are approved for the treatment of fibromyalgia. Another medicine often prescribed is Lyrica, a drug whose primary purpose is seizure control. Heat and massage might decrease pain.

Exercise is an essential part of treatment. It sounds absurd to ask someone in pain to exercise, but a carefully graded exercise program goes a long way toward restoring normal feeling. You can start with something as simple as a walk. Increase the time, the pace and the frequency of walking until you are finally doing 30 minutes a day at a brisk clip.

The fibromyalgia booklet explains in greater detail this condition and how it’s approached. Readers can obtain a copy by writing: Dr. Donohue — No. 305, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am interested in Limbrel to treat osteoarthritis. My family physician never had heard of it and neither had my pharmacist. Can you offer specific information on it and how to obtain it? — V.R.

ANSWER: Limbrel isn’t a medicine. It’s a “medical food.” It contains substances (flavonoids) that have anti-inflammatory and pain-easing properties. It is regulated by the Food and Drug Administration but doesn’t require the stringent scrutiny that drugs do. A manufacturer doesn’t have to prove the effectiveness of a medical food. All the same, a prescription is required. I can’t tell you how effective it is. It hasn’t been on the market all that long. It appears to be quite safe, however.

Your pharmacist can contact the manufacturer, Primus Pharmaceuticals.

If you want to try it, I’m sure your doctor would agree to write a prescription for you.

DEAR DR. DONOHUE: I am a diabetic and have been on insulin for five years. I had to learn for myself what is the appropriate dose of insulin to control my blood sugar. However, as time has passed, my numbers have gotten more out of control, and I am on various other medicines. I have heard that some medications cause blood sugar numbers to rise. Are just the numbers rising or is the blood sugar volume increasing also? — T.B.

ANSWER: The blood sugar numbers indicate the amount of sugar in a certain volume of blood. In the United States, that amount of sugar is expressed as milligrams in a deciliter of blood. A deciliter is about one-tenth of a quart. In Canada, the blood sugar amount is expressed as millimoles in a liter of blood. A liter is a little larger than a quart. Both milligrams and millimoles represent the amount of sugar in the blood. They are units of weight, like ounces and pounds.

Niacin, mentioned in your letter, can raise blood sugar for some users.

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. Readers may also order health newsletters from www.rbmamall.com.

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