FAQ Category: General

Fibromyalgia (also known as fibromyalgia syndrome or FMS) is a chronic pain condition affecting many parts of the body. Muscle, joint, and bone pain is usually present along with a host of other signs and symptoms. Sleep disturbance causes a disruption of growth hormone (GH) that is normally released during sleep. A lack of sleep and decreased GH adds to the problem of pain and fatigue.

At the same time, there appears to be a dysregulation of the nervous system. People with FMS often register pain with stimuli that would not be painful in other individuals. This effect is called central sensitization.

Drug therapy is aimed at stopping the symptoms by regulating the nervous system. There are several groups of drugs available for the treatment of FMS. These include antidepressants and nonopioid analgesics (pain relievers). Stronger, opioid analgesics do not seem to be very helpful.

This year (2007), the FDA approved the use of one drug specifically for FMS: pregabalin. This is an agent normally used for patients with seizures. It appears to work by reducing the release of several neurotransmitters that send pain messages to the nervous system.

Most often, drugs are used in combination with one another. Each patient responds differently to various medications. Your physician will help you find the right drug or mix of medications that is best for you.

Experts advise using a management approach to this condition. Drug therapy should be part of an overeall plan that also includes diet, exercise, and counseling.

Behavioral therapy and psychologic support seem to be a key part of successful management for FMS. Many patients are also helped by alternative medicine such as chiropractic care, acupuncture, and reiki, shiatsu, or other massage techniques.

Breaking any surgery down into two or more operations is called a staged procedure. There are advantages and disadvantages to doing a spinal fusion this way.

The biggest advantage is reducing the length of time you as the patient are under anesthesia. Many studies have shown that the longer you are in the operating room, the greater your risk for infection and other complications.

Many steps are taken before, during, and after surgery to guard against infection. The hospital has an entire department dedicated to infection control. Specific standards and procedures apply to each operating room. Even air flow into the room is monitored.

Hospital protocol also requires that traffic in and out of the operating suite must be limited. Any hardware, implants, or other devices inserted into the patient come under strict guidelines. They must be sterile and unopened until right before they are placed in the body. Preventive antibiotics are also given before the procedure.

It’s still true that despite all attempts to prevent infection, some patients may develop such a complication. Postoperative infections are often delayed, sometimes until months later.

In some cases, the patient develops another infection such as pneumonia or urinary tract infection that travels to the site of the implanted hardware. It is difficult, if not impossible, to prevent this type of problem from happening.

A person with achondroplasia, or an achondroplastic dwarf, is a person who is on average, less than four feet, four inches tall. Their limbs (arms and legs) are short, not in proportion with their trunk. They usually have a large head, flattened nose, and a curved spine and legs, as their most obvious signs.

The dwarfism is caused by a gene passed down from a parent.

Gout may be indirectly associated with menopause because it occurs more often as adults get older. When women are affected, it is usually after age 50 and especially after menopause.

The direct link may be between estrogen and urate crystals. The crystals which are formed as a result of gout are deposited around the tendons and joints. Estrogen hormone seems to prevent the formation of these crystals. Estrogen levels drop after menopause, which may increase a woman’s risk of gout.

Women have two other risk factors for gout. One is the fact that osteoarthritis of the small joints of the hand is more common among women. Loss of normal joint cartilage and smooth moving surfaces increases the risk of gout.

Women are also more likely to need diuretics (water pills). The use of diuretics appears to be linked with a higher incidence of gout. Women tend to retain urate more than men do. Elevted urate levels in the blood can (but doesn’t always) lead to gout.

Mobilization and manipulation are two methods used by physical therapists, osteopathic physicians, and chiropactors. The treatment technique is designed to restore the normal joint position and biomechanics.

Mobilization is a back-and-forth oscillatory movement. The clinician physically moves the joint within the available joint motion. Mobilization can be divided into four grades.

Grade I is a small movement at the beginning of the joint motion. This is done to help reduce painful symptoms. Grade II is a larger amplitude of movement but still done within the joint range of motion.

During Grade III mobilization, the doctor or therapist moves the joint right up to the end of the available motion. In Grade IV, all the slack in the joint is taken up. Then the oscillation occurs at the very end of the available range of motion. This is a way to stretch the joint capsule and the surrounding soft tissues.

Manipulation is a thrust technique. It is done at the end range of joint motion. The patient has no control over the joint motion during a manipulation. Manipulation is also meant to restore full and pain free motion.

The decision to use mobilization versus manipulation is based on several factors. The patient’s diagnosis is important. Age and general health are also factors. Older adults with brittle bones from osteoporosis may not be able to tolerate a manipulation but can benefit from mobilization. Each patient is evaluated individually when making this treatment decision.

It’s not uncommon for a cancer diagnosis to be delayed. Sometimes it’s because of patient-related issues. In other cases, there may be physician-related delays. Many people question whether delayed treatment decreases their chances for a cure.

Some of the answers to your questions really depend on the type of cancer. Diseases such as ovarian and bladder cancer are biologically aggressive. Death can occur after only a brief period of symptoms.

Other cancers such as soft tissue or bone sarcome are highly curable. The result doesn’t depend on length of symptoms. The outcomes are linked with the type of tumor (high-grade versus low-grade).

The presence of metastases (cancer spread) at the time of diagnosis is also linked with a poor prognosis. The length of symptoms before diagnosis does not predict survival or outcome.

Sarcoma is a type of cancer that affects the connective or supportive tissue. Sarcomas occur in bone, cartilage, fat, muscle, blood vessels, or soft tissues. There isn’t a simple screening test for this type of cancer.

Sarcoma is referred to as a nonscreenable cancer. Metastases or spread can occur long before the person has any noticeable symptoms of cancer recurrence.

This is one reason why patients should keep their regularly scheduled appointments with the oncologist. Blood tests and imaging studies can help detect cancer recurrence sooner than later. Any change in health status or new symptoms should be reported right away. Any suspicious mass, swelling, or pain must be evaluated by the doctor.

At the same time, encourage your sister to participate in cancer tests for those cancers that are screenable. You should do so, also. Some cancers may not be life-threatening, but they can result in serious complications.

In the case of bone cancer, surgery to remove the tumor can be very disfiguring. Early detection and treatment is still the best way to prevent such problems.

Scientists haven’t perfected it yet, but they have developed new bone substitute materials that can be used effectively. Not everyone is a good candidate for these products. Surgeons must choose their patients and products carefully.

But when it’s a good match, bone graft substitutes can be very helpful. First the material must be osteoconductive. This means it is able to help form new bone growth. A three-dimensional (3-D) scaffold is made on which and in which bone can form.

The bone graft substitute provides this scaffold. During bone ingrowth, new blood vessels form. Bone forming cells migrate or move into the bone graft substitute. New bone growth fills in the open spaces.

The size of the pores is important. Researchers have found that bone ingrowth occurs best when the size is between 150 and 500 um. The size has to be just right to avoid filling in with soft tissue and scar tissue instead of bone.

Sometimes the bone graft material fills in open defects in the bone. In other cases, it is used to extend across a fracture site. In all cases, it is used with other means of stabilizing the bone. For example, metal plates, screws, or wires may be used to stabilize the bone while healing takes place.

Your bones are made to withstand and absorb a lot of shock. Different bones are built different ways according to what their job is in your body. Although we can’t say why you didn’t break anything in your accident, the most common fractures in an arm are from falling and putting your hand out to stop yourself from the fall.

When people put their arm out to break their fall, the weight of their body falls entirely on that one arm. When this happens, the arm not only absorbs the shock of the fall, it absorbs the weight of your body, which is likely too much of a stress load for it to bear.

Bites of any kind can be very dangerous. Bites from humans are often the worst. Careful cleansing of the wound is extremely important. A tetanus shot may be needed. Often antibiotics are used to prevent infection.

A medical examination may be advised. Call your family physician and describe what happened. Be prepared to describe the wound. Tell the nurse what you have done to treat it so far.

If you don’t have a regular doctor, consider going to one of the local clinics that take walk-in patients. Visits to the emergency department can be very expensive and are not really needed for this type of injury.

Although the incidence of rickets did drop drastically, it is making a come back. This is due to people not going out in the sun and not eating vitamin D rich foods. Breastfed babies should, on their pediatrician’s advice, be receiving vitamin D supplements because the vitamin does not pass through breast milk. When babies start to eat solid foods, those foods rich in vitamin D should be introduced into their diet. As people eat or drink more junk food or soda, this increase the risk of vitamin D deficiency because the junk and soda takes the place of healthier alternatives.

With education and proper nutrition, we might see rickets become less common again.

Different groups of people need varying amounts of nutrients and vitamins for many reasons. The most common reason is physical growth. For example, as a child grows, he or she generally needs more nutrients than an adult who is not growing.

For vitamin D, the recommendations are divided into infants, children and adults to age 50, adults between 50 and 70, and adults over 70 years.

Infants who are bottle-fed should be receiving a formula that is fortified with vitamin D; this is at least 40 IU (international units) per 100 calories of formula. Breast-fed babies should receive a vitamin D supplement the first few months of their life, usually 200 IU per day. Children and adult to age 50 need about 200 IU per day, over 50 to 70 years old need 400 IU per day, and over 70 need 600 IUs per day.

People who cover their skin for cultural reasons, who are homebound and don’t go outside, or who have dark skin pigmentation should be particularly aware of taking in the daily requirements.

Yes, it’s possible to overdose on vitamin D; it’s rarely a good idea to take in too much of anything, no matter how good it is. If you have too much vitamin D, you can develop vitamin D toxicity. Symptoms can include nausea, vomiting, constipation, weakness, poor appetite, and weight loss.

The highest amounts suggested are no more than 1000 IU for children under 1 year and no more than 2000 IU for anyone else.

Chronic itching can be a severe problem. Sometimes the itch can be tracked down, other times it can’t. However, even if the cause is found, it isn’t always treatable.

In order to help your doctor understand how your chronic itch is affecting your life, you might want to keep a log or diary in which you record when you are itching, what you were doing when it began, and what you did to deal with it.

This type of log serves a few purposes. First, it will show your doctor how often you are experiencing the itching. When a patient tells a doctor that something is happening often or a lot, there is room for interpretation. If you have a log that shows that the itching occurred X number of times in the week and that it lasted X number of hours, that is something more concrete.

Second, the log may help you identify something that you hadn’t noticed before by showing you a pattern. Finally, the log can show your doctor how the itching is affecting your life. For example, if the itching is waking you up at night or preventing you from sleeping, this can cause other problems in your life, including health issues.

See if the two of you can work together as a team to figure out how best to help you.

The causes of chronic itching are not clearly understood. What your mother likely has is post herpetic neuralgia, which seems to happen in about 40 percent of people who have shingles. The nerve endings where the shingles rash was continue to cause itching and pain long after the shingles lesions have gone.

While it isn’t possible to guess what your mother’s doctor was considering, it isn’t unusual for a patient with a severe chronic itch to be given an antidepressant to try to relieve the itch. Studies have shown that some medications that are meant for other problems, such as antidepressants and anti-seizure medications, sometimes work well for itching and pain.

Both osteoarthritis (OA) and rheumatoid arthritis (RA) are types of arthritis, causing pain in the joints. The reason for the swelling is different, however.

In OA, the cartilage, or soft connective tissue in the joint, deteriorates or breaks down. This causes the joints to lose the cushioning and the joints begin to rub together. OA is often called the wear-and-tear arthritis because it happens most often in the weigh-bearing joints like the hips and knees. RA is caused by the tissue in the joint getting swollen and inflamed. This causes the pain and the redness and swelling that you may see. It can happen in any joint, not just weight-bearing ones.

Unfortunately, osteoarthritis, or OA, is not curable yet. Treatment focuses on relieving the symptoms and keeping the joints as usable as possible. If you have OA, your doctor may prescribe medications such as anti-inflammatories or pain killers. It may also be suggested that you make some lifestyle changes if needed. If you are overweight, this can cause extra stress on your joints, so losing weight may be recommended. Exercise can help keep your joints as mobile as possible and some people get relief from heat or cold compresses. In some cases, your doctor could refer you for physiotherapy.

In severe cases, surgery to replace the affected joint is an option.

One of the best and most available sources of vitamin D is the sun, this is true. Vitamin D is also available in many fortified foods, such as milk and dairy products, and it occurs naturally in foods like egg yolks, salmon, tuna, tofu, and oats, just to name a few.

Being careful of sun exposure is a smart way to reduce the risk of skin cancer. However, some sunshine, in moderation, can be helpful. Studies have shown that a baby who goes into the sun wearing just a diaper only needs 30 minutes of sun exposure per week to get enough of the vitamin, while a fully clothed child, without a hat, only needs 2 hours in the whole week.

Children under 1 year old should have 400 IU (international units) of vitamin D per day. Children older than 1 and adults under 50 should have 200 IU per day, adults over 50 should have 400 IU per day, and those over 70 years should have 600 IU per day. A 75 g serving of cooked or canned salmon provides 608 IU of vitamin D, while 3/4 cup of yogurt with fruit provides 233 IU.

Having a physician who is aware of the potential adverse effects of certain psychotropic medications is very helpful. He or she can monitor drug levels and bone mineral density (BMD). Periodic testing of bone density every one or two years may be advised.

Good nutrition and exercise are also very important. If your sister smokes, that can be an additional risk factor. A calcium-rich diet along with calcium and vitamin D supplementation has been shown to help.

It may be helpful to consult with a nutrition counselor to get the best advise for your sister. Her age, general health, weight, and current medications will be considered in planning the best program of prevention. Speak to her doctor about your concerns, and ask if a referral might be a good idea.

Antacids can be helpful in managing the uncomfortable symptoms of heart burn. But if someone is taking them too often, medical attention may be needed. There may be other, more effective medications that can be used. Or there may be a more serious problem causing the symptoms.

Gastroesophageal reflux disease often referred to as GERD is the most common cause of heartburn. This condition can be aggravated by certain foods (chocolate, peppermints) or drinks with caffeine. The use of estrogen therapy can also influence GERD. Obesity is another risk factor for heartburn.

In postmenopausal women, heartburn can be a sign of heart problems and shouldn’t be ignored. And as you suspected, some antacids can cause bone problems. Watch out for antacids that contain aluminum compounds. The aluminum binds with phosphate. Not enough phosphate in the system can cause bone disease. This should be avoided in someone with known bone loss from osteoporosis.

A medical evaluation may be the best way to approach this problem. It may not be enough to just stop using antacids or to switch to a different kind. It may be best to find out the underlying cause of the problem and treat that instead of just managing the symptoms with antacids.