Over the years, a variety of health professionals have developed terms or phrases to denote seemingly unique clinical combinations of symptoms and signs. A disorder or syndrome does not necessarily exist simply because it has been described in the medical literature. Some have stood the test of time, others overlap with syndromes described by different specialists, and additional terms may be favored by a single practitioner advocating a “cause.” This chapter reviews conditions that have overlapping features with fibromyalgia but are not yet regarded as full-blown, legitimate disorders by organized medicine. When Dr. Fine first met Wanda, she was a basket case. Wanda had canceled three prior appointments because smells from a new carpet had made her sick, Med fly agricultural spraying 30 miles away prevented her from getting out of bed, and she developed a severe headache when her neighbors’ house was being painted. She almost passed out in the elevator going to Dr. Fine’s office because somebody was smoking. Wanda had been to three allergists, who obtained normal skin tests and blood tests. Desperate, she traveled to Mexico, where “immune rejuvenating” injections were administered, and to Texas, where a clinical ecologist sequestered her in a pollution-free, environmentally safe quonset hut for a month. There she received daily colonies, antiyeast medication, and vitamin shots, to no avail. Dr. Fine elicited a history of aching, sleep disorder, a “leaky gut,” muscle pains, fatigue, and a spastic colon. His physical examination and mental status examination revealed evidence of anxiety, obsessive-compulsive tendencies, and fibromyalgia tender points. Wanda was treated with fluoxetine (Prozac) for pain and obsessive behavior, buspirone (Buspar), for anxiety during the day, and trazodone (Desyrel), a tricyclic, to help her sleep at night. She was referred to a psychologist who worked to improve Wanda’s socialization skills and encouraged her to go out rather than be a prisoner in her own home. Wanda is slowly improving but will need many months of therapy. Self-reported environmental sensitivities are observed in 15 percent of Americans.
Fighting antimicrobial resistance: Status paper with action points by organized medicine academic guild