Dear friends, I´m a Czech MD living now in Argentina, Misiones Province, close to the Iguazú Waterfalls. Years ago I met here a Swiss couple. The lady is big, fatty and strong woman - an A type. Two years ago I noted that she had moved in a little bit strange manner. I supposed coxarthritis and something with the L-column. Yes, I was right, but I was told that moreover she had sufferd from FM for 37 years. That explained me her behaviour sometimes very unpleasant. She was known as the Swiss witch in the pueblo. Although I dedicated almost exclusively to ank.spondylitis (AS), I tried to do something for her. I applied a battery of physiatric treatments every day and after one month she was OK. That happened 20 months ago and she still holds. Then the family brought me some of RA patients and the effects was similar - of course, no one can repair already destroyed joints, but the disease progress stopped and the doses of remedies have been substantially reduced. Then other FMs with same results lasting months. Due to those results the family is now beeing built up a spa just for both AS and FM. My medical approach to the FM is a "total war". That means that for not knowing the cause of FM I point against majority of the symptoms. Let´s repeat what we know from the pathophysiological viewpoint: 1. Serotonin concentration is low.. 2. P substance in the cerebrospinal liquid is high 3. Interleukin-2 level is higher 4. Muscle metabolism is normal, but the Mg2+ y ATP content is low 5. Impairment of form and reactivity of capillars 6. Impairment of brain blood circulation - hypoxia of the brain 7. NMDA receptors easily activables 8. Low GH (growth hormone) 9. High concentration of TBARs (a marker of lipid peroxidation) 10. High correlation between xanth-OX activity and pain 11. Lab test - normal A lot of dates, inconsistent, but explaining a lot and giving possibilities to act. What has been proved and more-less worked (except of remedies): anaesthesia of tender points, DMSO application, aloe extract, GH administration, swimming, yoga, magnetotherapy, transcerebral electrostimulation with microAmp currents, massages, exercises... BUT everything alone. What we should reach: 1. Analgesia of tender points 2. Increased serotonin concentration 3. Reduction of P-substance concentration 4. Suppression of the interleukin-2 production 5. Increased leveles of Mg2+ and ATP in muscles 6. Improvement of capillar reactivity - to open them 7. Block the NMDA receptors 8. Increased insulin-like growth factor 1 (IGF- 1) level 9. Reduction of the TBARs concentration 10. Block the xanth-OX activity 11. Sleep improvement comes alone together with better mood and modifies substantially the pain perception. How to do that: 1. Analgesic action - DD or interferential currents, TENS, ELFO with Lidocain, DMSO with local analgesics 2. Serotonin - MGtherapy, diet 3. P substance - capsaicin in oil or gel - USforesis (US=ultrasono) 4. Interleukin-2 - MGtherapy 5. ATP - diet - vitamins B1,2,3,6,12 + folic acid 6. Capillars + oxygenation - CO2, MGtherapy 7. NMDA receptors - MGtherapy 8. Mg2+ + Zn2+ - diet + ELFO with Mg2+ 9. IGF-1 - MGtherapy 10. TBARs - diet with high levels of vitamins C and E 11. Xanth-OX - allopurinol 12. Myofascial methods, massages, swimming, excersising. 13. Using nice subtropical environment with possibility to share joys and troubles among the patients. Exactly those methods I have used and will be used in the spa. This letter is NO ADVERTISING, simply a message that wants let you know that there is something in the world what is destinated for you. Dr. Jiri Jerabek, Ph.D.