Maybe your wife’s friend is a piece of work, but this pattern doesn’t send up any red flags to me. An occasional bout of fun is a lot different from sustained work. It could be that she’d bail out early from a week-long party just as easily as she bails out of a week’s worth of working.
One of the things that vexes the diagnosis of a multitude of illness is the waxing/waning of symptoms. For years I struggled with getting a diagnosis for my tic disorder because whenever I was in front of the doctor, I just happened to not have any tics. I could have “faked” them just to make it worth my while to be there, but then I would have been “faking” the disorder. It was only until my condition progressed to a certain (borderline embarassing) point that I was finally able to get a doctor to see that I had a problem. Before then, I had tons of people telling me it was all in my head. Making a mountain out of a molehill.
Depression is also variable. When I was under the gray cloud, my symptoms would always get worse on the back end of the week versus the front. Sleep deficit combined with accumulation of stress plus the impending doom of the weekend. There are also monthly flunctuations to content with.
Even terminal cancer patients have good and bad days. Judge at your own risk.
This reminds me of the discussion of ADHD in another thread.
We need to distinguish between conditions and actual diseases - those conditions that we can test for and actually prove - AIDS/HIV positive, tuberculosis, appendicitis, nut allergies, smallpox, arthritis, death. You can perform specific tests and point to specific items - reaction to antibodies, inflamation of joints, fluid and inflamation in lungs, specific reaction when substances are inserted into a skin area, etc.
Then there are conditions like ADHD, lupus, fibromyalgia, etc. - there are definitely people who have something wrong, but the only diagosis is a checklist against an established array of symptoms - joint pain, check; runs around and bounces off walls like a crazy little boy, check; claims to hear voices, check; etc. Check yes on an array of subjective questions in the right pattern, and here’s you diagnosis.
It’s not to say the condition does not exist. It obviously seems to for some people. It may be mainly psychosomatic, or it may simply be a cause we haven’t found yet. (See the controversy over Zamboni and MS; if he’s right, it’s an incredibly simple cause that eluded some fo the best minds in research.)
However, if there’s no specific test to prove a condition, anyone could claim to have it or to be (mis) diagnosed with it. It falls into the category of “best guess”. I suppose the other interesting point is that without a specific cause, there’s no guarantee a treatment works or if it instead falls into the category of “placebo”.
I see. So here is a thought experiment: Test people for fibromyalgia by putting them under specific work loads and measuring muscle pH reduction. If the pH reduction exceeds a specified threshold, conclude that the patient has fibromyalgia.
Do you know why this hypothetical test is not used? I don’t know myself, but I have a feeling the problem is that you would actually be testing how sedentary the person is; that people who are more active generally have higher lactate thresholds than people who are less active; and that people with FM are generally less active than your typical person.
Observing that a group of fibromyalgia sufferers reach their fatigue threshold faster and under less load than a similar control group is interesting in that it provides avenues of investigation for root causes, but there is no way it can be considered diagnostic on an individual basis - there is no baseline, and the results only show up as a statistical result. But it does show that there is a statistically significant difference between FM sufferers and the control population (showing that there something causing the effect), and maybe it will lead to a further discovery that will be either diagnostic or point to treatments.
Tracer - what I mean to say is that these people have very large collections of whatever the item of obsession is. That is, they have ten cats, rooms full of beanie babies, walls decorated in Wicca stuff in every room, etc. And yes, you may also know someone who is totally normal with a boxcar worth of beanie babies, but I would still suggest this is abnormal behavior. If people know what hobby you are into just by looking at you from down the street, I’d suggest there might be a problem.
monstro - if observed under a short time period, I would agree that one couldn’t make the assumption that the symptoms aren’t waxing and waning. This girl in question has been friends with my wife for over a decade. I don’t claim my views apply to every patient, but this is the hueristic I use, because the real depressed people often won’t show for parties because they are self conscious or seeing other people having a good time bums them out. The simple fact you would say “the impending doom of the weekend” sounds like something a real depressed person would say. “The impending doom of the workweek” is what someone who is lazy or hates their job would say.
I don’t diagnose or treat fibroyalgia or rheumatologic conditions, but I will say that prednisone will make a LOT of people feel better, even (or especially) if they don’t have fibromyalgia. It suppresses most inflammation and it has been a mainstay for treatment of many rheumatological conditions (many of which I suspect get labelled and treated as fibromyalgia).
I have a very down to earth friend (who is no shirker) who was plagued by goofy symptoms (including chronic fatigue) which no one could figure out. Until she saw a rheumatologist who somehow figured out she had myositis (despite no muscle pain). She was treated with prednisone to great effect, back to her normal self, except now contending with side effects from prednisone. I have no doubt someone else might have labeled her fibromyalgia or chronic fatigue syndrome or whatever. She might have been treated the same way and had the same results. To this day I wonder how confident they were of their myositis diagnosis, or even if it makes a difference.
Long story short, I personally think that fibromyalgia straddles the no man’s land between rhuematology and psychiatry, and whether or not it is “real” , it is now a large wastebasket catching up lots of people who have atypical presentations of other diseases and, yes, many malingerers.
My family doctor sure thinks so. My wife went to see him with some vague complaint. He said it might just be fibromyalgia. He didn’t think so, but there was a simple test. He prescribed something–I think it was prednisone. He said that if it really were fibromyalgia, the symptoms would disappear overnight. They didn’t, she stopped taking the drug and the symptom gradually dissipated.
If taking a dose of prednisone (or whatever the drug was) cured fibromyalgia overnight, I wonder why EVERY doctor wouldn’t just prescribe a dose of prednisone and watch the symptoms disappear??? :dubious:
My own doctor, who I think is a first rate genius, having worked as an engineer at Livermore National Labs, etc. thinks fibromyalgia is not a real disease. She is one skeptical lady. The reason I asked her is that I have a client with that diagnosis who was in a rear end accident while completely disabled from fibromyalgia (no, it didn’t cause the fibromyalgia). Her disability insurance company actually paid for two years of fibromyalgia disability after sending her to a specialist to verify she has the disease. I’m going to go with the insurance company, which could have just as easily excluded fibromyalgia as a disability. If they think it is real, then it is. They are monetarily interested and benefited if it is not.
Seems to me that the insurance company has to go by what the courts and the state insurance regulators decide. And the interests of the courts and regulators are not necessarily the same as those of the insurance company.
Absolutely. A bunch of folks who are basically accountants are clearly much more qualified to diagnose diseases than someone who went to medical school. No contest.
It may be better to think of fibromyalgia less as “a disease” than as “a symptom complex.” It is a chronic pain syndrome and the thing about chronic pain syndromes is that they are often self-pertpetuating. They also travel with a variety of mental health issues in both directions. The brain is integral in pain perception and the neurotransmitters involved in mental health also impact pain perception. Screw up those receptors in one way and no shock they can act screwy in other ways too.
Once someone is in chronic pain it is hard to treat.
Lupus is a real disease no doubt, but it is also one of those catch all diseases that folks with idiopathic symptoms tend to get labeled with. My exwife was diagnosed with lupus, her biggest complaint was chronic leg pain, cramps and seizures. The seizures were caused by drug withdrawal as she would take massive amounts of opiats, soma and one other thing I can’t rememeber and then suddenly stop when she went back to work as a critical care nurse. The siezures were alwasy toward the end of her shift on her third day back at work.
I have no doubt the leg cramps were from dehydraton. She eventualy died of a drug overdose,
The point is, insurance companies don’t pay for treatment of “Multi-colored swamp ass fever” because it’s not a real disease.
They pay for (quite a LOT actually) treatment for fibromyalgia; this indicates it is accepted by them as legitimate - even though they are financially invested in finding reasons to NOT treat bogus diseases.
Insurance companies pay for lots of stupid stuff. Look no farther than that chiropractic adjustments for things that chiropractic adjustments are clearly shown to not work for which are covered by many insurance plans. Using what label an insurance company will accept as your gold standard is using a very silly metric.
Which is not me arguing that fibromyalgia isn’t “real.” It is real - as a grab bag for chronic somewhat diffuse muscular pain syndromes of unclear etiology. It needs treatment and treatment should be covered. Depending on the indidual such treatment may be more focused on the mental health aspects of the condition or on physical therapy or increased exercise or on pain management or on reducing dependency on some sorts of pain medicines. Usually more than one focus is required.
Lupus OTOH is no grab bag catch all and has very specific lab tests in addition to clinical findings to support its diagnoisis. An n of 1 ex wife being labelled with lupus who had a variety of other issues going on either means that she was being treated by an idiot who did not know what lupus is, or that she had lupus and she had many other problems, like drug addiction, which seem to have been her more serious and undertreated disease.
No, they don’t pay for treatment of “Multi-colored swamp ass fever” because the courts and regulators don’t make them. If they declined to pay for treatment, and insureds started filing lawsuits and regulatory complaints, and the courts and regulators decided in favor of the insureds, then they would start paying.
Insurance companies pay based on the law of large numbers. Sometime these numbers are affected by risk of lawsuit.
For example, In a car acc it is sometimes cheaper to pay $2,000 for a fake back claim than to pay $25,000 to challenge it in court and still have the risk of loss at trial.
So if you follow the money you will find there is a reason for seemingly ridiculous practices.
