Dear Dr. Roach: Is Lyrica a safe type of medication for fibromyalgia? I am worried about side-effects and interactions with other medicines.
L.M.
Fibromyalgia is a chronic disorder whose hallmark symptoms include disordered sleep, pain and fatigue. Treatment can include, among other strategies, careful attention to sleep and exercise, and often medication. Antidepressants such as amitriptyline are first-line treatments, since they may change the way the body perceives pain, which, in turn, may be the underlying cause of fibromyalgia. However, these medicines have many side- effects that limit their effectiveness. There are various other treatments that have been evaluated, including pregabalin (Lyrica). Pregabalin was shown in a 2010 review of multiple studies to be effective at helping improve pain, sleep quality and quality of life.
All medicines have side-effects, and the most common for pregabalin are foot swelling, dizziness and feeling sleepy. Most of the known drug interactions tend to worsen the side-effects of sleepiness and dizziness. However, when considering the other medications used for fibromyalgia and their attendant side-effects, pregabalin is considered relatively safe. The goal is always to balance the benefits and the risks, and only you and your doctor can decide whether the fibromyalgia symptoms are worth a trial.
Dear Dr. Roach: For no reason I can find, one side of my lips or my tongue will swell, or sometimes both lips or my whole tongue. If I take an antihistamine like Benadryl, the swelling will go down. I watch what I eat and haven't found a singular food that causes it.
N.M.
Swelling of the lips and tongue is an important symptom that needs urgent evaluation. The most worrisome cause is angioedema (meaning swelling from blood vessels), which can be related to medications, especially the blood pressure agents, but it also can be a hereditary type.
Antihistamines are sometimes used to prevent the swelling, but a thorough evaluation needs to be done first. Your regular doctor is the place to start, but an expert in allergy and immunology is likely to have more experience and may be necessary.
Dr. Roach Writes: I recently wrote a long column on planning end-of-life decisions, including a DNR order, but I apologize that I never explained clearly what that meant. 鈥淒NR鈥� stands for 鈥渄o not resuscitate,鈥� meaning that if a person stops breathing and the heart stops beating, no attempt to restart it or breathe for the person artificially should be made.聽 A person can consider a DNR order at any time; however, it is especially important for a person with a severe illness who is not expected to improve.
An advance directive (that is, telling your health-care team what to do if you are incapacitated) can be absolute: Do not resuscitate under any conditions. They also can be written in such a way that it allows your physician to attempt resuscitation if there is a good chance that it might be successful but to refrain from the attempt if, in the judgment of your attending physician, there is no reasonable chance of a recovery.
Although a living will and its companion, a durable power of attorney for health care (called a representation agreement in sa国际传媒) can be done without an attorney, an experienced attorney in the field can help ensure that your wishes are written the way you want them to be.
Dear Dr. Roach: I was diagnosed with fatty liver. Can you please tell me if this can be reversed, or if it is progressive?
M.K.
Fatty liver can have many causes, but it is much more common in people who are overweight or have diabetes (or both). Weight loss (even modest loss) and good control of diabetes can help reverse it. Alcohol use is another big cause, and abstinence is recommended for those with fatty liver. Fatty liver should be followed to see if it progresses to liver fibrosis.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
