Fibromyalgia

I found this article published in the Korea Herald, Friday, October 12, 2012, as very interesting. The article got a lot of space on page 5 of the physical newspaper with an article on the sharp increase in breast cancer among Korean women as taking the most space. Fibromyalgia is something that was rarely discussed just a few years ago, but in the past few years the autoimmune disease is rather widely known and commonly discussed. In my home church of about 60 members, I can quickly name four women who have it, and I will add that I don't know the health situation of probably one-half of the church. That's dramatically higher than the estimated 2%, or 1.4 people in our congregation, who are guestimated to have fibromyalgia within the American population.

I'm always comparing autoimmune diseases, looking for similarities and in how they differ, because all diseases are a result of some, but varying, imbalance(s) and if the imbalance can be found, it can be altered by careful food selection and a change in lifestyle. This does not mean the disease can be forever cured but in many instances, the disease can be managed or completely subdued with a carefully restructured lifestyle. Another article "Fibromyalgia" by Leslie Arnold, MD, gives evidence that fibromyalgia is the result of reduced neurotransmitters norepinephrine and serotonin creating an abnormal central nervous system response. Comparing reduced neurotransmitters with two other autoimmune diseases having reduced neurotransmitters creates an interesting comparison. Both Parkinson's disease and Tourette's syndrome have deficiencies and/or misfirings of the neurotransmitters dopamine and serotonin.

The common factor for these three diseases is serotonin, which is a mood neurotransmitter. Without proper levels of serotonin, a person could feel very anxious and depressed. Add anxiety and depression to low levels of norepeinephrine, which controls pain, cognition, mood and movement, and the outcome is moody depression in pain aka fibromyalgia. Or, add anxiety and depression to low levels of dopamine, which controls regulation of movement, emotional response, and pain and the outcome is frozen expressionless depression aka Parkinson's and also Tourette's by neurotransmitter definition but I wouldn't call their bodies "frozen" but rather impaired by jerks, another type of movement disorder.

In any case, on the anthropological level, this article, by its inclusion in the newspaper and getting such a large area of print, is making clear that there is a rising problem within society, and although medical science cannot pinpoint the exact cause of the problem, there are treatments and lifestyle methods to treat the disease. BTW, I find this picture very interesting also, especially as the picture is of a man supposedly suffering from fibromyalgia whereas the majority of sufferers are women (80%).

 

The article: Fibromyalgia

 

Fibromyalgia commonly occurs in adult women aged between 20 and 60 years old. There are broad areas of the body that are painful and there is chronic pain in the musculoskeletal pain. Patients often complain of fatigue, sleep disturbance and sub-chronic spasticity, irritable bowel syndrome, edema, poor circulation in the fingers or extremities, anxiety and depression and loss of function. An important characteristic of the pain is pressure pain, which occurs when a certain part of the body is pressed. Fibromyalgia may temporarily alleviate but it is a chronic condition. Treatment may improve the symptoms but the condition often lasts for several years.

Cause

The cause of fibromyalgia is not yet known. It is thought that trauma, or several emotional stressors such as divorce or loss of spouse, contributes to the condition. It is also believed to be associated with sleep disturbances. Recent studies have suggested the association with imbalances in neurotransmitters, abnormal amino acids in the blood, abnormal oxygen use of tissues and viral infection. The cause of fibromyalgia has not yet been found from investigations and tests, so patients are often told that there are no known problems with their condition.

Symptoms patients feel:

●Painful areas on the body and a feeling of fatigue even without doing hard work.

●Areas on the body which show pressure pain

●Stiffness and a lack of feeling refreshed in the morning

●Light sleeping

●Tingling or changes in sensation

●Headache and dizziness

●Anxiety or depression

●Abdominal pain and frequent diarrhea or constipation

●Decreased concentration or memory problems

●Skin rashes or itchiness

Diagnosis
*American College of Rheumatology Diagnostic Criteria (1999)

●The diagnosis is made by exclusion of other conditions

●At least 11 out of the 18 pressure points are painful to pressure and this pain should continue for at least 3 months. There should be pain in the right and left side, the lower and upper body, neck and the lower back musculoskeletal system.

●Decreased movement due to musculoskeletal pain.

●Disturbances and sleep and not feeling refreshed after sleep.

●Temporary joint spasticity in the morning

●Decreased tolerance to cold or high humidity

Treatment

Treatment requires the patient to engage in regards and emotional modification, so the most important aspect of treatment is patient education.

Drugs such as amitriptyline, cyclobenzaprin, NSAIDs can be used, as well as cognitive behavioral therapy.

Local anesthetic injections at pressure pain spots and heat therapy can be effective, depending on the patient.

Medications are also used to help people sleep deeper. The patient should not feel dizziness or stagger when waking up in the morning. The symptoms start to improve after treatment for 4 to 6 weeks.

Sleep disturbance or lack of sleep can make the symptoms worse so it is important to develop regular sleeping habits. Patients should go to bed at a set time and avoid taking naps during the day.

Light cardiovascular exercises are helpful but strenuous exercises can worsen the symptoms.

Support and education

The patient needs to understand about the characteristics of the condition and will need support and understanding from their families.

Patients should be aware that physical, emotional and environmental stressors could contribute to their pain and fatigue. Therefore, it is important that they make appropriate lifestyle adjustments. Patients should avoid worrying too much about their symptoms and should try to relax the mind and the body.

By Cha Hoon-suk

The author is a doctor at the Division of Rheumatology at Samsung Medical Center and a professor of Sungkyunkwan University school of Medicine. ― Ed.

Bone Development and the Growing Child

source

The study of forensics, an aspect of anthropology, provides an internal perspective on the development of the human body; from birth until death years later, marked changes are documented in the bones and cartilage for the deciphering of the forensics specialist. Though I have never formally studied forensics, the random books I have read have provided a look at the human skeleton that even my nurse mother and nurse friends are surprised at. Humans in death, according to forensics, tell the story of their broader experiences, their diet and their development in life.

When the human infant is born, and sometimes quite forcibly with the use of forceps, care must be given to protect the child’s fragile head. Unlike the human adult, babies’ craniums are three unfused plates which fold in slightly on themselves so the large head can pass through the birth canal (Scheve 2012). Babies, in fact, are born with about 300 different bones and cartilage elements, and many of these fragments will eventually fuse together to form adult bones, of which human adults have 206 (ibid). Because babies have so many parts that will fuse, their bodies are more flexible, are softer, and therefore are more susceptible to slight bumps or injuries than the body of an older baby of two, whose three cranial plates have almost completely fused[1], or a child of six whose patella are beginning to join together and ossify, that is, harden into bones (Medical MultiMEDIA Group 2009-2011). Jean Auel (2002) in her anthropological fiction on Neanderthals compared a Neanderthal newborn baby with its hard head and fused neck and the baby’s ability to crawl, even walk, and follow its mother in pursuit of milk with the Homo sapien infant that was weak, fragile and needed care in lifting its wobbly head. According to Jean Auel, Neanderthals were much like baby animals at birth and their bones were already ossified to give them the strength and mobility to seek food and to flee from threat or enemy. Homo sapiens, on the other hand, were a unique group of creatures that were intelligent, linguistically capable but helpless, although the Neanderthals did observe that the helplessness gradually disappeared.

At birth human babies have many sesamoid cartilage embedded in tendons, and which are primarily located at joints—the wrists, hands, feet, and of course the knees where various sesamoid cartilage gather (Coutsoukis 1995-2007). After six or so months, babies begin to crawl around and fall on their knees and not damage the knee caps as their knee caps are still a soft collection of cartilage. By the age of six most of the cartilage has gathered and formed and from age six to twelve the kneecaps are ossifying (ibid). No more will the growing child fall on knees and not be hurt. Patella injuries are painful and damaging, but by the age of three and four the children have been stretched in growth and their center of balance is now in the midriff and no longer are they top-heavy with an upper body, out-of-balance center of balance. Children beyond age four rarely fall from a poor center of gravity, and so their kneecap development, as well as other sesamoid ossification, is harmonious with their kinesthetic development. Just an aside, forensics specialist use the kneecap development as one of the keys in determining skeletal age, gender and even sometimes race. In the instance of age, the knee cap reaches its maximal thickness of 6 mm (0.24 in) at 30 years of age (Wikipedia 3 Oct 2012), and so forensics anthropologists can determine age by the development, or lack of, by studying the patella.

Just as the cranium is fragile, so is the infant’s chest cavity. The infant has soft bone structure, which allowed it great fetal-position flexibility within the womb, but out in the real world of hard knocks, the baby is at a disadvantage and pressure upon its weak chest could cause great damage. According to Human Anatomy (2011), the sternum in the infant consists of two cartilaginous bars, which fuse and ossify over time. As the sternum is not fused at birth, neither are the ribs. The cartilaginous joinings for the clavicles appear at the age of six months but rarely unite with other centers on the sternum except in old age. Likewise, the first of four cartilaginous joints for joining the first four ribs (on each side) appear at six months for the first rib, at seven months for the second and third ribs, and at about one year of age for the fourth rib. At puberty, these four ribs and the sternum unite with each other. Then on the xiphoid process, the lowest small segment on the sternum, a cartilaginous joining appears between the fifth and the eighteenth year of life; this joining will never completely ossify (Human Anatomy 2011). Protecting the fragile chest cavity in an infant, therefore, is an imperative as the protective ribs are only a lightweight frame and, until ossification begins, pressure or blows to the chest could damage or kill. Forensics scientists, in understanding chest injuries and the age of the child, and even the age of when old injuries took place, see “documentation” of abuse, neglect or injury by studying the sternum and ribs of the injured rib cage.

An example of this is provided by Clea Koff (2004) in her book Bone Woman.  Clea tells how she as a forensics anthropologist opened mass graves in Rwanda, Bosnia, Croatia and Kosova, where thousands were victims of genocide. Her job was to document by the skeletal remains, by the remnants of clothing on the bodies and the contents of pockets, what was the identity of each victim, from small infant (some unborn) to the aged and decrepit elderly. By studying primarily the head and its sutures for gender and age, the hip bones to tell gender, the sternum and patella to confirm age or even tell age when necessary, Clea Koff provided evidence for the UN Tribunal that charged the afore-mentioned countries with genocide and war-time atrocities. According to Clea, the victims were “telling” of their diet (she noted malnutrition and diseases of infection in some skeletons), their development (the bones clearly stated their age, and after puberty, also their gender), and she documented the fractures which could readily be classed as blunt or sharp weapon injuries, and the scratches, impressions and punctures which clearly pointed to the type of weapons used—knives, shovels or other common tools.

People theoretically know that babies are fragile, but when looking at the structure of the bones from a forensics point of view, the truth about just how fragile and especially why infants are so fragile in their first months becomes obvious. As bones ossify and gain strength and sturdiness, the developing body needs less protection and can participate in the more rough-and-tumble of activity and sports. I do not remember where I read this, but bones in the teens and early twenties are lighter weight than in later years. Bones thicken, but why I do not know. Is it because of age and typically with the increase of age there is an increase of weight and so the body needs to “protect” itself to handle the greater weight stress load, or is the thickening just a phenomenon of isoblasts and isoclasts perpetually functioning to tear down and recreate bone? The Internet did not provide this answer, but someday I do plan to take a forensics class or two, just for the knowledge, and then maybe I will get the answer. What I do know, however, is that the ossification of bones from birth takes about 20 years to complete (Nemous Foundation 1995-2012) and with ossified bones instead of loose cartilage floating, the body is strengthened but at the cost of loss of flexibility.


Bibliography

Auel, J. (2002). The clan of the cave bears. New York: Bantam Books.

Coutsoukis, P. (1995-2007). The sesamoid bone. Human Anatomy. Retrieved from http://www.theodora.com/anatomy/the_sesamoid_bones.html.

Human Anatomy (2011). Sternum: Chest bone. MANanatomy. Retrieved from http://www.mananatomy.com/body-systems/skeletal-system/sternum-chest-bone.

Koff, C. (2004). The bone woman: A forensic anthropologist’s search for truth in the mass graves of Rwanda, Bosnia, Croatia and Kosovo. New York: Random House.

Manheim, M.H. (2000). The bone lady: Life as a forensic anthropologist. New York: Penguin Books.          

Medical MultiMEDIA Group LLC (2009-2011). An algorithm for the treatment of painful bipartite patella. Othropod. Retrieved from http://www.eorthopod.com/content/an-algorithm-for-the-treatment-of-painful-bipartite-patella.

Nemous Foundation. (1995-2012). Bones, muscles and joints. KidsHealth from Nemous. Retrieved from http://kidshealth.org/parent/general/body_basics/bones_muscles_joints.html?tracking=P_RelatedArticle#.

Scheve, T. (2012) Do babies have kneecaps? Fit & Health. Retrieved from http://health.howstuffworks.com/human-body/systems/musculoskeletal/babies-kneecaps1.htm.

Wikipedia (3 October 2012). Patella in Wikipedia. Retrieved from http://en.wikipedia.org/wiki/Patella.

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[1] The sutures that fuse or hold the cranial plates together remain strong up to around the mid-sixties or seventies when the sutures begin to break apart. The elderly, for this reason, also must take more caution to prevent head injuries as the brain is not as protected by the solid cranium anymore (Manheim 2000).