My optometrist is amazing. Not only is she funny and sweet and always walks into the room with a smile, she’s just a damn good doctor. I knew she was a great doctor the day she said to me “I have to treat my Fibromyalgia patients more aggressively….” That was the day that I knew she understood. Today I’ve asked her to share a few thoughts on Fibromyalgia and eye health.
Years ago you made a comment to me about how you have to treat Fibro patients more aggressively than other patients. What differences do you see between the two? And in what ways do you treat the Fibro patients differently?
In my experience, patients with chronic pain, longstanding dry eye, and/or neurological pain are more likely to have sought treatment for their problem and were less successful with previous treatment when I see them. I know they are frustrated, angry and often defensive about their symptoms. They may be annoyed with their doctors and by the past treatments that were less than successful.
For these reasons, I tend to be more aggressive with my treatment plans to reduce the frustration and try to get things off to a solid start.
Do you have any thoughts on why some doctors are not accepting of Fibromyalgia? and/or they don’t see it as something that they have to treat differently?
Fibromyalgia and chronic pain are difficult to diagnose and treat. It often takes “to long” to obtain the diagnosis, and treatment often takes time to take effect. We have no pill, shot or surgery to help these patients quickly. Patients are frustrated and often depressed, and it makes sense that doctors feel frustrated and sad as well. It is a diagnosis of exclusion, one that requires other problems be ruled out, like autoimmune or anti-inflammatory conditions. Fibromyalgia is tough to diagnose and treat.
Doctors like making patients better. That is what we train to do. We do not receive training on how to counsel these patients in most cases. In some cases, these patients require more time and more office visits. Given the current state of insurance reimbursement and governmental requirements, this may be difficult for doctors to accommodate.
What can patients do to create a good relationship with their doctor? What should they avoid doing?
I appreciate patients that present with a list of goals for the visit. It makes communication more efficient for everyone. Following treatment instructions is key. I personally become frustrated with patients who present with a list of complaints but then do not take the recommended medications or follow-up as requested, and then then return saying they are not better.
While it is tempting to research your symptoms or illness on the internet, patients who think they know more than the doctor make a bad impression. This makes me crazy because I have to spend so much time arguing with the internet instead of examining and planning treatment. I do encourage discussion of various treatment options when the patient presents them to me saying, “I read about this treatment. Would this help me?”
Do you see any connections between Fibromyalgia and eye problems? If so, what types?
The most common thing I see is ocular surface disease (OSD), not because it is associated with Fibro but because it is so common in my practice. It is essentially inflammation of the eye, and causes redness, pain and eye fatigue. I do not see more retinal or optic nerve disorders with fibro, thankfully.
Have you found any treatments to be more beneficial than others to those with Fibromyalgia or other auto-immune disorders?
Patients with these disorders suffer from chronic pain and inflammation, which may be associated with OSD. I use my typical treatments but I will lean more towards treatments that address inflammation such as steroids more often.
What can we do to improve eye health?
Reducing near tasks using LEDs (cellphone, tablet, & computer use) to reduce OSD. Use blue light blockers when you must use devices. Use artificial tears when eyes are red and tired, and keep your glasses updated. Regular visits to your eye care practioner (OD or MD, as preferred) are important.
You highly suggest fish oil, is there such a thing as too much fish oil?
I just did a blog on this topic! The FDA says that you should not go over 3000mg (3g) per day unless directed by a physician due to increased risk of bleeding. My blog can be found on http://optometrytimes.modernmedicine.com/tag/odt-blog once it is published.
Is there any advice or anything that you’d like to tell my readers?
Keep an open mind and maintain a healthy lifestyle. Exercise if you can. I do not support eating white sugar, enriched white rice or bread in patients with Fibromyalgia or chronic pain issues. It increases inflammation.
I personally have tried both eastern and western medicine when I have had health issues that I did not feel were being addresses by traditional western medicine and it worked for me.
Now you can see why I love this doctor. It’s not often (at least in my area) that you find a doctor who is open minded about things like Fibromyalgia or even the use of alternative medicines. I’ve learned a lot from her. You can follow her posts at Optometry Times.