On Whining, Malingering, Pain and Chronic Fatigue

.

From reading a few blog comments and e-mails, it has come to my attention that I am an ignorant, insensitive, jaded, callous lout, altogether poorly educated on the subject of chronic pain.

*sob*

You people are damaging my self esteem. I may need counseling. In fact, the horror of the psychological damage you have inflicted upon me with these unwarranted attacks may preclude me from living a productive life ever again, and indeed, may render me a psychological invalid.

I need a Xanax and an application for Social Security Disability, STAT. While you’re at it, call me a waaaaaambulance and take me to the ER, because oh, the humanity!

I am neither callous, nor jaded. Neither am I uneducated or ignorant, or intolerant of the views of others. (Wipe the spittle off your monitor before reading this, BlackHawk. In the IQ Derby, you will always finish out of the money if I am in the field).

I offer this as proof of my overall sunny personality and compassion for my fellow man. I cried when Old Yeller died. I even dig the occasional – gasp – chick flick. I like puppies, long walks on the beach, sunsets and children.

I’m also a firm believer in adequate pain management. A good friend will be delivering a pain-management lecture at the Texas EMS Conference this fall, advocating far more aggressive pain management than most EMTs currently practice. I contributed in small part to the development of that lecture.

Lest you think I know not whereof I speak, I’ll share a couple of personal details with you.

I used to have these symptoms. I’m not the only one. Turns out, my problem wasn’t chronic fatigue syndrome, it was sleep apnea. But before I was diagnosed, I knew all about chronic headaches, muscle pain, severe fatigue and walking around all day in a mental fog.

Hell, I fell asleep at red lights, people. I used to arrive at work, and have absolutely no recollection how I got there.

Luckily, I discovered the source of my problems, and got effective treatment. I’m no longer a menace to the highways, despite the opinions of the legally sanctioned extortionists at the Woodworth, LA Police Department.

I also have a condition known as meralgia paresthetica. Imagine having the lateral aspect of your left thigh feel numb, yet also feel as if someone has scrubbed it with a wire barbecue brush, then doused it with kerosene. Then set it aflame. Maybe tried to beat out the flames with a Louisville slugger wrapped in barbed wire. Want to start a fight with me? Just slap me on the left thigh. If you want to win the fight, all you need do is just lightly brush that area with your fingertips.

This condition was caused by my big fat gut pressing on my lateral femoral cutaneous nerve. There are things you can do to help alleviate the symptoms, like avoiding restrictive clothing and tight belts, and doing more sitting than standing.

I work on my feet all day long. When I worked full time on the rig, I wore a Batman utility belt with various EMS accoutrements, and they held up those oh-so-soft EMS cargo pants we wear. Pain is as much a part of my daily landscape as shaving in the morning.

Now you can imagine my daily life. I tell you this not to arouse sympathy, but to give you some perspective on my stated opinions. I’m lucky, in that my two maladies were easily identifiable and treatable: wear a CPAP machine, and lose weight.

I don’t go to the ER to seek help for these conditions, because they are not emergencies. They are chronic medical problems, just like fibromyalgia and chronic fatigue syndrome are chronic medical problems.

If you have fibromyalgia or chronic fatigue syndrome, you have my sympathies.

If you insist on using EMS or the Emergency Department as the primary means of treating those maladies, you have my everlasting scorn and disrespect. If YOU want sympathy, you will find it somewhere between Shit and Syphilis in the dictionary.

For every patient who truly has chronic fatigue syndrome or fibromyalgia, there are twenty others who have either self-diagnosed or been handed the diagnosis by a compliant doctor as a panacea for constant whining.

For every child truly afflicted with ADHD, there are twenty others on Ritalin and Strattera who actually suffer from Chronic Hickory Deficiency.

I propose a new syndrome for addition to the ICD-9-CM, or perhaps the DSM IV, one much easier to prove or disprove than fibromyalgia or chronic fatigue syndrome. I think I’ll call it COWMAS: Chronic Oxygen-Wasting Malingering Asshole Syndrome. It has a certain ring, don’t you think?

On my Emergency Department nursing assessment form, the blocks for drug allergies and the pain scale come well before the block for past medical history.

If I have written Toradol, Tylenol, Ultram, Ibuprofen, Aspirin in the Allergies section and entered a 10 on the Pain Scale, 90% of the time I know what I’m going to be writing next in the Medical History section: fibromyalgia.

That’s just the way it is.

Some people got my point in the previous posts. Others didn’t. Some of the private e-mails I got did nothing but reinforce the drama queen stereotype.

So I’ll say this before I immolate the corpse of this dead, battered horse and scatter the ashes:

If you suffer from chronic fatigue syndrome or fibromyalgia, your efforts would be better served by writing an open letter to your fellow sufferers rather than whining on my blog about my insensitivity. I’ll even get you started with a title:

Fibromyalgia vs Chronic Oxygen-Wasting Malingering Asshole Syndrome: The Differential Diagnosis

If you go the to ER once a month or more for your symptoms, it ain’t fibromyalgia.