Fibromialgia: Lo que es y cómo se controla

¿Qué es la fibromialgia?
La fibromialgia es una condición que causa dolor en los músculos, articulaciones, ligamentos y tendones. El dolor ocurre en áreas llamadas lugares agudos. Los lugares sensibles más comunes son en frente de las rodillas, los codos, las articulaciones de las caderas y alrededor del cuello.
Fibrositis afecta al 5% de la población, incluyendo niños. Este desorden es hereditario, así que puede tener miembros de familia con síntomas similares.
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¿Cuáles son los síntomas de la fibromialgia?
El aumento de la sensibilidad del dolor es el síntoma mayor. Las personas que padecen este trastorno también presentan muchos otros síntomas. Los síntomas pueden irse y regresar.
Uno puede sufrir un dolor constante, pero la severidad del dolor puede aumentar en respuesta a la actividad, tensión, cambios de clima y otros factores. Puede tener un dolor profundo o un dolor que quema. Puede que tenga espasmos o endurecimientos musculares. Muchos personas tienen dolor migratorio (dolor que se mueve por el cuerpo).
La mayoría de personas que tienen Fibromialgia se sienten cansados o fatigados (sin energías). Esta fatiga puede ser leve o severa. Puede que tenga problemas al dormir, y esto puede añadir al nivel de fatiga que sufre.
Puede que sienta entumecimiento u hormigueo en partes de su cuerpo, o una sensación de que la sangre no llega bien a ciertas partes del cuerpo. Muchas personas sienten molestias con ciertos olores, luces brillantes, bullas fuertes y hasta medicinas. Es común tener dolor de cabeza y dolor en la mandíbula.
Además, uno puede tener los ojos secos o tener dificultad al enfocarse en los objetos. Pueden ocurrir problemas con el balance o mareos. Algunas personas sienten dolor de pecho, latidos de corazón rápidos o irregulares, o falta de respiración.
Los síntomas digestivos son comunes en la fibromialgia e incluyen dificultad al pasar comida, acidez, gas, dolor abdominal como calambres, y cambiando constantemente de la diarrea a la constipación.
Algunas personas se quejan de problemas con la orina, que incluyen el orinar con frecuencia, un fuerte deseo de orinar y dolor en el área de la vejiga. Las mujeres con fibromialgia muchas veces tienen síntomas pélvicos, como dolor, menstruaciones dolorosas, y dolor al tener relaciones sexuales.
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¿Por qué me siento deprimido?
La depresión o ansiedad puede ocurrir como resultado del dolor crónico y fatiga, o por la frustración que puede causar su condición. Es también posible que la falta de balance en los químicos del cerebro, causantes de la fibromialgia, pueden también causar la depresión y ansiedad.
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¿Y la fibromialgia causa daños permanentes?
No. Aunque la fibromialgia causa síntomas que pueden ser muy incómodos, sus músculos y órganos no son afectados permanentemente. Esta condición no amenaza la vida, pero es crónica. Aunque no exista una cura, puede hacer muchas cosas para sentirse mejor.
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¿Hay alguna medicina que puedo tomar para sentirme mejor?
Existen muchos medicamentos que ayudan a aliviar los síntomas de la fibromialgia. Muchas de estas medicinas (tal como la amitriptilina (nombre de marca: Elavil) o ciclobenzaprine (nombre de marca: Flexeril)) se toman antes de acostarse y mejoran su sueño. También ayudan a aliviar el dolor y los otros síntomas.
Probablemente empezará a notar los beneficios de los medicamentos en 6 u 8 meses. Cuando empiece a tomar la medicina, es común sentirse muy débil la mañana siguiente. Otros efectos secundarios posibles incluyen secedad de los ojos y la boca, pesadillas, constipación y aumento de apetito. Estos efectos secundarios son peores cuando recién empieza a tomar las medicinas pero mejoran con el tiempo.
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¿Qué más puedo hacer para aliviar mis síntomas?
Una de las mejores cosas que puede hacer es ejercicios aeróbicos de bajo impacto. Ejemplos de esta clase de ejercicios son natación, o ejercicios en agua, bicicleta estacionaria, y ejercicios en máquinas de ski. Puede que sea necesario empezar sus ejercicios en niveles bajos. Una buena cantidad al comienzo puede ser 5 minutos cada 2 días. Continúe incrementando la duración y frecuencia de los ejercicios hasta que esté ejercitando por lo menos de 30 a 60 minutos en un mínimo de 4 veces por semana. Una vez que ha llegado a este punto, puede considerar empezar a hacer ejercicios aeróbicos de alto impacto como caminar, correr o jugar tenis.
Por lo que sus síntomas de la fibromialgia se empeoran con la tensión y el mal sueño, es importante cortar toda la tensión posible de su vida y dormir todo el tiempo que su cuerpo sienta necesario. Poco antes de acostarse, evite las sustancias que causan problemas al dormir, como el alcohol y el café.
Existen otros cambios pequeños y simples que pueden ser útiles. Por ejemplo, trate de mantener un nivel de actividad constante todos los días. Muchas personas con fibromialgia tratan de hacer demasiado en días que se sienten mejor, lo que causa tener varios días de cansancio después. Si mantiene su nivel de actividad constante, puede no tener tantos días de cansancio.
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¿Cómo puedo aprender más?
En muchas ciudades, existen grupos de apoyo de personas con fibromialgia que pueden proveer información y ayuda. El Arthritis Foundation (La Fundación de la Artritis) también tiene alguna información que le puede interesar (teléfono: 800-283-7800; la dirección en el Internet: www.arthritis.org). Además, usted puede inscribirse para recibir un periódico sobre la fibromialgia através del Fibromyalgia Network (La Red en Fibromialgia) P.O. Box 31750, Tucson, AZ 85751-1750, (teléfono: 800-853-2929; la dirección en el Internet: www.fmnetnews.com).
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Characteristic images of deeply infiltrating rectosigmoid endometriosis on transvaginal and transrectal ultrasonography

Kaori Koga1, Yutaka Osuga1,3, Tetsu Yano1, Mikio Momoeda1, Osamu Yoshino1, Yasushi Hirota1, Koji Kugu1, Osamu Nishii1, Osamu Tsutsumi1,2 and Yuji Taketani1

1 Department of Obstetrics and Gynecology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 and 2 CREST Japan Science and Technology, 4-1-8 Honmachi, Kawaguchi 332-0012, Japan

Abstract
BACKGROUND: To evaluate the usefulness of transvaginal and transrectal ultrasonography for diagnosis and management of deeply infiltrating rectosigmoid endometriosis.
METHODS: A series of six patients (aged 32–39 years) with rectosigmoid endometriosis underwent transvaginal and transrectal ultrasonography. In three patients undergoing surgical resection of the intestine, the ultrasonographic findings were compared with macroscopic and microscopic findings. In one patient, sequential observations of the lesion using ultrasonography were conducted before and after medical treatment and following childbirth.
RESULTS: In all cases, the lesion was detected as a hypoechoic irregular-shaped area surrounded by a hyperechoic rim located posterior to the uterus, with size ranging from 18 x 17 to 29 x 28 mm in diameter. The comparison of the ultrasonographical findings with histology revealed that the hypoechoic irregular-shaped area corresponded to a layer of hypertrophic muscularis propria of the lesion, while the hyperechoic rim represented the layer including the mucosa, submucosa and serosa. In one patient, the lesion decreased in size and lost its central hypoechoic area after childbirth in association with pain relief.
CONCLUSIONS: Transvaginal and transrectal ultrasonography provides characteristic appearances for rectosigmoid endometriosis that correlate well with its histological findings.
The procedures would be useful in the management of rectosigmoid endometriosis.
Key words: endometriosis/rectum/ultrasound
V. Anaf, I. El Nakadi, Ph. Simon, J. Van de Stadt, I. Fayt, Th. Simonart, and J.-C. NoelPreferential infiltration of large bowel endometriosis along the nerves of the colonHum. Reprod., April 1, 2004; 19(4): 996 - 1002.
[Abstract] [Full Text] [PDF]
http://humrep.oxfordjournals.org/cgi/content/full/18/6/1328

Deep Endometriotic Lesions Impair Sexual Functioning

By Megan Rauscher
NEW YORK aPR 06, 2005 (Reuters Health) - Deep infiltrating endometriotic lesions of the uterosacral ligament often severely impair sexual health and functioning, according to a study conducted in Italy.
Dr. Simone Ferrero and colleagues from San Martino Hospital, University of Genoa, evaluated the sexual function of 299 women undergoing surgery for infertility, pelvic pain or adnexal masses. One hundred seventy had endometriosis and 129 did not (the controls).
As expected, the prevalence of deep dyspareunia was significantly higher among women with endometriosis (60.6%) relative to controls (34.9%), the authors report in the March issue of Fertility and Sterility.
"Interestingly," primary deep dyspareunia was much more common in women with endometriosis (57.3%) than in controls (37.8%) and "more than 50% of women with endometriosis have had deep dyspareunia during their entire sex lives."
It's also "interesting that communication about sex with the partner was significantly compromised in women with endometriosis," Dr. Ferrero noted in comments to Reuters Health.
The final study population with deep dyspareunia included 96 women with endometriosis -- 76 with and 20 without deep infiltrating endometriosis of the uterosacral ligament -- and 40 controls.
According to the study findings, women with deep infiltrating endometriosis of the uterosacral ligament had intercourse less often and had less satisfying orgasms, more frequent interruption of intercourse due to pain and felt less relaxed and fulfilled after intercourse, compared with the other two groups.
"Surprisingly," Dr. Ferrero said, "the presence of mono- or bilateral endometriotic lesions on the uterosacral ligaments did not affect the intensity of pain and the severity of sexual life impairment."
This is the first study to describe the abnormalities in sexual function of women with deep endometriotic lesions on the uterosacral ligament, according to Dr. Ferrero.
Several studies have shown that radical excision of endometriotic lesions can lessen the intensity of deep dyspareunia and improve the quality of sexual activity in these women, the investigators note in their report.
SOURCE:
Fertility and Sterility 2005;83:573-579.

ARDvark Blog: Medicare Patients’ Rights

ARDvark Blog: Medicare Patients’ Rights

Healthcare worker "conscience clause" expanding

In the latest case reflecting the healthcare worker "conscience clause" movement, a California appeals court has ruled in favor of doctors who refused to artificially inseminate a lesbian patient. Guadalupe Benitez filed a sexual orientation discrimination suit against the physicians at a women's clinic in San Diego for refusing to artificially inseminate her in 2000.
The details of the case are complex. The plaintiff says that when she first went to the clinic, the doctor she saw told her she could not inseminate her because her religious beliefs did not permit her to perform such a procedure on a gay person. According to Benitez, the doctor told her there was another doctor in the clinic who could perform the procedure. Benitez then underwent almost a year of tests, exams, and surgeries, only to be told she could not be inseminated at the clinic because of the religious beliefs of all of the staff members.
One of the pending legal questions is whether Benitez was denied the procedure because she was a lesbian or because she was unmarried. California law protects citizens from discrimination by businesses on the basis of sexual orientation, but not on the basis of marital status. The doctors' attorney is claiming that the decision was based on Benitez's marital status, but the plaintiff's attorney confirms that Benitez was told that the procedure could not be done because of her homosexuality.
The appeals court ruled in favor of the doctors on the grounds of protecting religious liberty.
Meanwhile, throughout the country, pharmacists continue to refuse to sell certain products to women because of the pharmacists' religious beliefs. Arkansas, Georgia, Mississippi, and South Dakota have passed laws allowing pharmacists to refuse to dispense emergency contraceptive drugs. Arizona, Arkansas, California, Georgia, Indiana, North Carolina, Rhode Island, South Dakota, Tennessee, Texas, Vermont, West Virginia, and Wisconsin have introduced legislation that would allow pharmacists to refuse to provide services. Only three states--Missouri, New Jersey, and West Virginia--have introduced legislation that would require pharmacists to fill prescriptions.
Emergency contrapceptive pills contain high doses of of the hormones that are found in regular contraceptive pills. Emergency contraceptives can delay ovulation and prevent fertilization, and--in some cases--prevent implantation. Wal-Mart led the way by refusing to sell emergency contraceptive pills, and then other retail outlets followed by giving their pharmacists the option to use a conscience clause to opt out of filling ecp prescriptions.
It isn't just emergency contraception that is being denied women, however. Pharmacists who are opposed to any artificial means of birth control are using the conscience clause to refuse to fill regular birth control prescriptions. Aside from the obvious fact that birth control pills, patches, and devices are legal in the United States, birth control pills are also prescribed to treat certain disorders, such as irregular menstrual periods, acne, endometriosis, and severe premenstrual syndrome. Women whose mothers or grandmothers had ovarian cancer may be given birth control pills to protect them from the disease.
And finally, though condoms are frequently sold at the pharmacy counter, we do not hear about American pharmacists' refusing to sell them, nor do we hear about an expansion of the conscience clause that would permit checkout staff to refuse to ring up condom purchases.
Source: MoJoBlog
http://www.motherjones.com/mojoblog/archives/2005/12/11-week/

Endorectal Ultrasonography in Predicting Rectal Wall Infiltration in Patients With Deep Pelvic Endometriosis

Dis Colon Rectum. 2006 Apr 5; [Epub ahead of print]
Related Articles,
Links
Endorectal Ultrasonography in Predicting Rectal Wall Infiltration in Patients With Deep Pelvic Endometriosis: A Modern Tool for an Ancient Disease.Bahr A, de Parades V, Gadonneix P, Etienney I, Salet-Lizee D, Villet R, Atienza P.Proctologie Medico-Interventionnelle, Groupe Hospitalier Diaconesses - Croix Saint Simon, Paris, France.

PURPOSE: This study evaluated the validity of endorectal ultrasonography in predicting rectal infiltration in patients with deep pelvic endometriosis.
METHODS: Patients were recruited consecutively in the Department of Surgical Gynecology of Diaconesses Hospital from April 1996 to July 2003. Inclusion criteria were the suspicion of deep pelvic endometriosis on the basis of outpatient history and/or clinical symptoms with a mass palpable on bimanual examination that might infiltrate the rectal wall. There were no exclusion criteria. Endorectal ultrasonography wasperformed by the same investigator with a 7.5-MHz to 10-MHz rigid probe, producing a 360 degrees view of the rectal wall and adjacent areas. We used surgical and histopathologic findings as the "gold standard" to evaluate the validity of endorectal ultrasonography.
RESULTS: This study was based on 37 patients (mean age, 35.8 (range, 26-46) years) who underwent surgery. The time between endorectal ultrasonography and surgery ranged from 4 to 529 (mean, 88.7) days. Eight patients had endometriosis nodules penetrating the rectal wall. Endorectal ultrasonography showed sensitivity, specificity, a positive predictive value, and a negative predictive value of 87.5, 97, 87.5, and 97 percent, respectively, in the diagnosis of infiltration of the rectal wall by endometriosis.
CONCLUSIONS: Endorectal ultrasonography is a reliable technique for visualizing rectal infiltration in patients with deep pelvic endometriosis. It should be more widely used by gynecologists because knowing about rectal infiltration before surgery is fundamental to defining the best possible surgical approach.
PMID: 16583293 [PubMed - as supplied by publisher]