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Defining Nonplus
Conditions:
Different Symptoms, One Cause.
Much is known about the individual nonplus conditions. However, an
understanding of how these different conditions are related is not widely
grasped. There are four traits, which show why these ten conditions should
be grouped together and why it likely that they have the same underlying
cause.
Many of the nonplus conditions can cause a variety of
symptoms and others cause only one symptom. People who are unlucky enough
to have several nonplus conditions can wind up with dozens of different
symptoms. When a person learns that many of their different health
complaints are caused by one underlying problem it is usually accompanied by
a feeling of relief.
The four traits common to all of these conditions are:
1.
Shared symptoms and overlapping of conditions.
2. Method
of diagnosis.
3.
Treatment difficulty.
4. Guaifenesin as an effective treatment.
1. Shared symptoms
Of the nonplus conditions, three can be considered
core: Chronic Fatigue, Fibromyalgia and Irritable Bowel. This is because
they are the most common and may occur alone. The remaining nonplus
conditions can be considered satellite conditions. This is because they are
not as likely to occur alone but commonly attend one or all three of the
core nonplus conditions. If you have one or more of the core conditions then
you are likely to also have one or more of the satellite nonplus conditions.
Many books, websites and research that discuss the nonplus conditions
mention that they frequently occur together and some suggest a common
underlying mechanism is responsible for them.(1,2,3,4)
The symptoms within these conditions frequently overlap
as well. For example difficulty sleeping, muscle aches and problems with
memory and thinking are frequent in both chronic fatigue and fibromyalgia.
2. Similar method of diagnosis
Diagnosing nearly all of the nonplus conditions is
difficult for two reasons. First, many symptoms that are common in the
nonplus conditions are also present in several and possibly dozens of other
disorders. For example back pain and fatigue have many possible causes.
Second, no x-ray or laboratory test can detect the existence of the nonplus
conditions. The diagnosis for all nonplus conditions are based upon the
symptoms being experienced as well as the lack of positive medical tests
which rule out other disorders that could be responsible for the same
symptoms. This ruling out process may take many years. It is not uncommon
for a person to see dozens of doctors over a period of 4 or 5 or even 10
years before a nonplus condition is accurately diagnosed.
Some of the nonplus conditions are not difficult to
diagnose due to a symptom that is particularly unique. For example, restless
leg syndrome is easily diagnosed due to an uncontrollable urge to move the
legs.
One of the nonplus conditions, Ehlers-Danlos Syndrome
does have a known cause in a small percent of all cases. Ten percent of
Ehlers-Danlos Syndrome cases are due to a genetic defect.(5) I do not
recommend guaifenesin in cases where there is an identifiable cause.
Some people may claim that the tilt table test is a way
to positively identify neurally mediated hypotension. This is true in a
sense, but the test merely confirms the symptoms already described by the
patient. It does nothing to shed light on what is causing this symptom. The
diagnosis is still based upon the symptoms experienced by the patient. The
primary benefit of this test is that it objectively confirms the reality of
the patient’s subjective complaint. It is unfortunate that other symptoms
like fatigue, pain and digestive distress cannot be objectively confirmed by
physicians. If this were possible then sufferers of these conditions would
in some cases be treated with greater consideration..
The American College of Rheumatology has established
criteria for fibromyalgia that includes both a history of chronic widespread
pain in all four quadrants of the body and the presence of 9 of 18 “tender
points” on physical examination. It is not generally known that, “These
criteria were never intended to be strictly applied to individual patients
as diagnostic criteria, and it is widely acknowledged that many persons who
have the clinical diagnosis of fibromyalgia do not fulfill this definition.”
(6) When physicians do strictly apply these criteria the result is a
significant number of false negatives. This means some patients who actually
have fibromyalgia will show up negative based on these criteria and thus,
inaccurately be told that they do not have fibromyalgia.
An alternative to the 18 tender points is a procedure called mapping.
Mapping, a term used by Dr. St. Amand, acknowledges the historical and
modern findings that fibromyalgia is often associated with a bumpy feeling
under the skin that is often tender as well.(7) It was William Balfour of
Edinburgh who in 1816 first mentioned the occurrence of “indurated nodules”
associated with “rheumatism”.(8) It is now recognized by most doctors using
guaifenesin that these lumps and bumps occur not only with fibromyalgia but
are believed to be present in all of the nonplus conditions. Mapping is the
process of running fingers down the muscles of the body and charting where
the lumps and bumps are located. The bumps can feel like small pebbles or
larger hardened areas and swellings. The bumps may be easily felt and are
often sensitive, but can require an experienced doctor or therapist to be
found. It should be noted that the number and size of these swellings does
not seem to be directly related to the severity of the symptoms one
experiences.
These lumps and bumps do not include lymph nodes,
lipomas, cellulite or tight muscles. Mapping should not be used as a sole
means of diagnosis for any of the nonplus conditions.
3. Treatments have limited benefit
Many of the symptoms resulting from nonplus conditions
are not unusual. Fatigue, headaches, muscle aches and pains are almost
universal and there are many helpful treatments available depending upon the
source of the problem. Exercise, relaxation, soft tissue therapy,
adjustments and medications can control or eliminate these symptoms for most
people. However, when these symptoms and others are due to chronic fatigue,
fibromyalgia etc., not only is there no detectable reason for the pain,
common treatments provide little if any long-term relief and the overall
progression of various aches, pains, fatigue and digestive upset continues.
Even if one symptom is alleviated due to a specific treatment or disappears
for no reason at all, the other symptoms remain and new symptoms may arrive
at any time.
4. Guaifenesin eliminates the symptoms associated with these
conditions
When guaifenesin is used with specific therapeutic
steps, the symptoms of these conditions gradually decrease over time and are
often eliminated completely. This is a gradual process and while most people
will experience significant improvement within several weeks to several
months, complete recovery will take many years in most cases. Although no
treatment or therapy is 100% effective in all cases, it has been my
experience that guaifenesin helps the vast majority of people who use it
properly. It is safe, inexpensive and in most instances can gradually
eliminate all of the symptoms resulting from the nonplus conditions.
Unfortunately, most doctors who try guaifenesin on
their patients simply prescribe 2400mgs of guaifenesin daily-the amount
commonly used for expectorant purposes-and know nothing about the required
therapeutic steps of proper dosing, salicylate avoidance and carbohydrate
sensitivity. Symptom remission under these circumstances is highly
unlikely.
One underlying cause.
These four traits that the nonplus conditions share
indicate that they arise from one underlying cause.
- D. Veale, G. Kavanagh, J. F. Fielding, O.
Fitzgerald,
‘Primary fibromyalgia and the
irritable bowel syndrome: different expressions of a common pathogenetic
process.’, British Journal of Rheumatology, 1991,
Jun;30(3):220-2.
- Caralyn Davis-Arthritis Foundation, 2004, ‘What’s
In A Name: Fibro vs. CFS’.
http://www.arthritis.org/resources/news/news_fibro_cfs.asp Accessed
2004 Sept. 29.
-
Darlene A. Clarke-Ehlers-Danlos
National Foundation, (n.d.), ‘Learning
To Manage Fibromyalgia Syndrome’.
http://www.ednf.org/fibro.html
Accessed 2004 Sept. 17.
- Daniel Clauw, ‘Fibromyalgia’, Kelley’s Textbook
of Rheumatology, ed. Ruddy, Harris, Sledge, (Philadelphia: W.B.
Saunders, 2001), 418, 422-24.
- Ehlers-Danlos Support Group, 2004 Aug. 2,
‘Diagnosing Ehlers-Danlos Syndrome’.
http://www.ehlers-danlos.org/Info%20Sheets/diagnosing.htm
Accessed 2004 Sept. 11.
- Daniel Clauw, ‘Fibromyalgia’, Kelley’s Textbook
of Rheumatology, ed. Ruddy, Harris, Sledge, (Philadelphia: W.B.
Saunders, 2001), 417.
- Paul St. Amand, What Your Doctor May Not Tell
You About Fibromyalgia, (New York: Warner Books, 1999)
- W. S. C. Copeman, Textbook Of The Rheumatic
Diseases, (Edinburgh: E. & S. Livingstone LTD., 1964), 3.
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