FAQ Category: General

Children with Lyme disease can go through several stages. By the time it’s diagnosed, your child has probably gone through Stage I. In the first stage there may be a skin rash called erythema migrans. Fatigue, headache, muscle and joint pain, and swollen lymph nodes are reported in about half of all affected individuals.

Symptoms occur within days to weeks of the tick bite. Not all children show initial symptoms. About one-third of affected children have no early symptoms. Only about 10 per cent of the children with Lyme disease go to stage 2. This occurs weeks to months after the tick bite or after stage 1. The heart, nervous system, and musculoskeletal system are affected in stage 2 disease.

Stage 3 occurs months to years after the tick bite. This advanced stage of the disease is more likely to develop in children who aren’t treated with antibiotics early on. Some patients who are treated still develop chronic neurologic and/or musculoskeletal problems. Chronic arthritis is the most common long-standing problem with Lyme disease.

But the good news is that early treatment usually results in complete resolution of the symptoms. In 90 per cent of the people affected by Lyme disease, symptoms go away completely with antibiotic treatment.

However, anyone with Lyme disease can get it again. Precautions for outdoor protection must be used each time the child or adult is outdoors in areas where Lyme disease is present.

Any job with repetitive physical demands can take its toll on the human body. If you do the same motion over and over long enough, eventually the body will develop problems.

When the job exceeds the physical ability of the worker, painful symptoms occur. This kind of problem is referred to as overuse syndrome. As you’ve observed, not everyone develops overuse syndrome or after the same amount of stress.

Scientists aren’t sure why there’s such a difference from person to person. It could be linked to age, physical condition, and even gender. For instance, studies show that women are more susceptible to this type of cumulative trauma. In fact, slim women are the most likely to develop problems related to the physical demands of a job.

Attitude may have something to do with it. Psychologic disorders such as depression and anxiety seem to be linked with another overuse condition called Fibromyalgia syndrome (FMS). Research hasn’t been able to show if the psychologic problems occur as a result of the condition or are the cause of the problem.

Studies from around the world show that fibromyalgia syndrome (FMS) occurs everywhere. Up to four per cent of the population has FMS. All age groups are affected. The one thing that’s the same worldwide is gender. Women are much more likely to have FMS compared to men.

Older women and women of low socioeconomic status seem to have the most severe cases. Scientists aren’t sure why this is so. Slim women seem to have more problems, too. It’s possible the demands of their jobs exceeds their physical ability causing symptoms and disability.

So far research doesn’t support the idea that American women with their higher socioeconomic status (compared to many other countries) is a risk factor. More studies are needed to find a single cause of FMS. Most likely, risk factors are multifactorial.

Crohn’s disease (CD) is an inflammatory bowel disease. CD can affect any portion of the intestine from the mouth to the anus. It can cause inflammation inside the intestine, but can also cause problems in other parts of the body.

The joints are often affected. A form of arthritis develops called enteropathic arthritis. Polyarthritis (involving more than one joint) or sacroiliitis (arthritis of the lower spine and pelvis) occurs in about 25 per cent of patients with CD. In rare cases, these conditions can lead to ankylosing spondylitis of the spine.

Whether one or more joint is affected, the enteropathic arthritis seems to come and go with the disease process. Symptoms of joint pain and swelling may occur 1 to 2 weeks before bowel symptoms start. With proper medical treatment of the CD, there is no permanent joint deformity.

Pain in the low back and hip are also possible with CD. The pain is referred from inflammation of the intestines. The exact mechanism isn’t clear but it appears that complex interactions between the nervous system and the immune system may be the trigger.

Your daughter should contact the physician who is treating her CD and let him or know of these new symptoms. Early identification of the problem and early treatment can make a difference.

Many people with HIV infection have no symptoms for years. The most common early symptoms may include weight loss, fevers, and night sweats. Cough or shortness of breath may also develop when the lungs are involved.

Dry skin, new rashes, and changes in the nails may be seen. But all of these symptoms can be seen with other diseases, too. A group of complaints is more common with HIV infection than any one symptom.

Reactive arthritis is one form of arthritis that has been linked with HIV infection. Reactive arthritis associated with HIV is often the result of Reiter’s syndrome. Reiter’s syndrome includes three main problems: conjunctivitis of the eye, joint arthritis, and urethritis.

Reiter’s syndrome occurs in response to infection. Most cases occur in young men and are believed to result from venereal-acquired infections. Other infections such as gastroenteritis from food affect both men and women.

Anyone who is HIV-positive should be followed carefully by his or her doctor. New symptoms that persist should be evaluated sooner than later. Early intervention is best to reduce short-term discomfort and long-term problems.

Delayed effects of radiation should always be considered before having a joint replacement. Soft tissue fibrosis and muscle contracture are both possible long-term side effects. Muscle weakness and atrophy can affect your rehab and recovery.

The area that was irradiated makes a difference, too. Your risk of problems after a total hip replacement are greater if your pelvic and hip areas were irradiated.

Research in this area is limited. A small number of cases of post-radiation lymphoma patients have been reported. Loosening of the femoral stem in uncemented implants suggests the need for a cemented component.

Talk to your orthopedic surgeon about your concerns. He or she may have some experience with other patients in similar circumstances to help guide you.

The expression disease mongering was first used by the now deceased journalist Lynn Payer in 1992. She wrote a book entitled Disease-mongers: How Doctors, Drug Companies, and Insurers are Making You Feel Sick.

Disease mongerers describes the idea of convincing healthy or slightly ill people that they are really sick. Some experts refer to this as the selling of sickness. The purpose is to increase the number of people in need of treatment. The benefit is to those who market and/or who sell treatment.

The way this is done is to take a common symptom such as back pain and turn it into a disease that requires treatment. In some cases a normal body function is portrayed as though something could be wrong.

Disease mongerers advocate that all pain, discomfort, or perceived illness requires treatment.

Antibiotics are still used in the case of bacterial infections. Septic arthritis is one of those conditions for which antibiotics are prescribed. Most septic arthritis is caused by a staph (bacterial) infection.

The overuse of antibiotics for viral infections has resulted in bacteria becoming resistant to many of the antibiotics currently available. Young children, older adults, and anyone with a poor immune system are advised to take antibiotics for bacterial infections.

The doctor uses lab tests to identify the specific bacteria present. The antibiotic is prescribed based on the results of these tests. Early detection and treatment is important to prevent serious problems later. Joint infection can cause joint destruction with pain and loss of motion and function.

Before taking an antibiotic you can ask your doctor to confirm for you the presence and type of bacteria being treated.

A diagnosis of septic arthritis means the joint was infected. Usually the infection starts somewhere else and travels to the joint. Most likely the bacteria is transported via the blood stream.

Only about one-quarter of the patients diagnosed with septic arthritis report a history of trauma or injury. Most of these patients recall an incident within the last month that could be considered an injury leading to septic arthritis.

Infection from other problems such as tuberculosis or gonorrhea can also cause septic arthritis. Gonorrhea is a sexually transmitted infection. It is the most common cause of septic arthritis in young adults (under the age of 30).

In some cases, the infectious cause of septic arthritis remains unknown. Other patients report a history of an insult such as a human bite, arthroscopy, or recent joint replacement.

Family history is a risk factor for osteoporosis. Age is actually considered a much greater risk factor. Age and menopause combined for women increases the risk even more. A personal history of past osteoporotic fractures can increase the chances of having another bone break by as much as five times.

Scientists are starting to look at the environmental factors of industrialized countries such as the United States. For example, although every woman goes through menopause, differences in the number of women affected by osteoporosis occur from country to country.

The differences cannot be explained just on the basis of decreased estrogen. Countries with the highest amount of osteoporosis also have a high rate of heart disease. They also have the highest intake of carbohydrates, fat, protein, salt, and caffeine.

There are other known risk factors for both men and women. For men, low levels of testosterone and a history of prostate cancer can contribute to the development of osteoporosis. For women, cancer treatment that affects the ovaries and a thin, small-framed body type increase the risk of osteoporosis.

For both men and women, osteoporosis prevention is an important part of good health care. An adequate diet or supplementation of calcium and vitamin D are required. Daily weight-bearing exercise is encouraged. Limiting (or eliminating) tobacco use and drinking alcohol in moderation are also recommended.

New medications are now available to help reduce the bone loss and number of fractures linked with decreased bone density. See your doctor for an evaluation of your risk for osteoporosis, and plan a strategy now for prevention that you can stick to for the rest of your life.

More and more studies on the health benefits of Tai Chi are coming out every day. Tai Chi is an ancient Chinese martial art. It is a form of moving meditation. Soft, flowing movements are done in order and with precision.

Chi refers to energy. Tai Chi allows the energy to move the muscles, bones and tendons in slow, co-ordinated movements. The body is never pushed to its own physical limitations or extremes.

There are very few studies done just on the use of Tai Chi just with fibromyalgia. An uncontrolled study of fibromyalgia patients before and after Tai Chi has shown improvements in mood, physical function, pain, and fatigue.

Uncontrolled means there was only one group of participants. They all had fibromyalgia. They all did Tai Chi. In a controlled study there would be a second group who don’t do Tai Chi. These two groups are needed for a comparison of results.

Fibromyalgia syndrome (FMS) is a poorly understood condition that causes widespread muscle pain and fatigue along with many other symptoms. Symptoms are often made worse by too much physical activity, including overstretching.

Exercise does seem to help patients with FMS. Studies show that people with FMS who are aerobically fit have fewer symptoms than those who are deconditioned.

Real-time ultrasound has shown that blood circulation to the affected areas is often greatly decreased while at rest. During exercise, when circulation should normally increase to the muscles just the opposite happens. Circulation is decreased even more.

In general, the level of muscular activity in fibromyalgia is high, even when the body is sitting or reclining. During daily activities such as cleaning or cooking, the muscles used for these activities are at a higher level of activity than the muscles of a normal person doing the same tasks.

When the activity is over and the person with FMS is resting, those same muscles continue to repeat the activity over and over. This occurs at a lower intensity so no there’s no outward movement.

What can you do to avoid increased symptoms with exercise? First, expect some amount of increase in pain, soreness, and stiffness. This may last a few weeks. It should be tolerable. Try to keep going. Start out slow but steady. Increase the duration and intensity of exercise by small amounts day by day or week by week.

A pool therapy program or aquatics class may be the best way to get started. The warm water supports the body and may help improve blood flow to the muscles. The key is to begin with a level of exercise you can tolerate and go from there. If you miss several days in a row, back off to a prior level of intensity. Slowly build up again.

Sometimes women who are very active in sports or running have very few menstrual cycles or stop having a menstrual cycle altogether. This latter condition is called amenorrhea.

Studies show that active females who are amenorrheic are at increased risk for injury, especially stress fractures. Military and civilian women engaged in repetitive, vigorous, weight-bearing activities have the highest rate of injury.

Prolonged periods of amenorrhea (10 months or more) is a good predictor of injury. Putting girls on birth control hormone to regulate their cycles is one way to manage this problem. There doesn’t appear to be a link between birth control pills and stress fractures.

However, Depo-Provera, an injectable form of birth control can lower bone mineral density. Given once every three months, this form of hormone regulation may increase the risk of stress fractures of the legs.

According to a recent study of female Marine Corps recruits, there was no association between Depo-Provera use and injuries of any kind to the lower extremities. More studies between birth control hormone methods and risk of injury are needed to settle this question.

Gout is caused by sodium urate crystal deposits in the joint. Usually the big toe is affected but other joints can be affected. The exact cause of the accumulation of these crystals isn’t clear. It’s likely a genetic defect in purine metabolism is the problem.

Urate crystals over the joint surfaces set up an inflammatory response. Joint destruction can occur. By the time a gouty flare-up occurs, microscopic damage has already been done.

Measuring the blood level of urate helps identify the patient’s baseline and gives a goal for treatment. Studies show that deposits in the joint rarely clear up when the serum urate level is seven (7 mg/dL) or more.

The goal is to reduce this below six (below five is even better). Levels 10 or higher indicate the gout is getting worse. Urate levels of eight or nine reflect a slower progression of disease.

Lowering serum urate levels can be done with a combination of lifestyle changes and medication. Patients are still advised to reduce calories and alcohol intake. High-sugar fast foods are to be avoided. Finding the right medication and most effective dosage can be a challenge but is a very important part of controlling the disease and its destructive effects.

Gout is a chronic condition that can get much worse without proper care. It can affect more than the joints — kidney failure is a cause of death in 20 per cent of patients with gout.

Removing fluid from the joint is called aspiration. With this procedure, you’ll get relief from the acute joint pain. The doctor can confirm the diagnosis and test for any infection. All three of these benefits make aspiration a valuable treatment and diagnostic tool.

A wait-and-see approach is not really advised. By the time gout crystals are present, microscopic damage has been done to the joint. And these crystals are a tip off that the disease has been going on for quite a while without you knowing about it.

Early, consistent treatment is the best approach. Keeping serum urate levels low will help prevent kidney damage. Diet and nutrition and medications are important features of treatment. Results are disappointing with anything less.

With more than six million women affected by this condition, many researchers, doctors, and patients are looking for some answers. New ideas and information are reported every year. Research to date suggests a link with the autonomic nervous system (ANS).

The ANS control automatic functions like breathing, heart rate, body temperature, and blood pressure. Since the majority of patients with fibromyalgia are women, there is a strong suspicion that hormonal activity is a major influence.

Some researchers have shown a possible connection with thyroid function. Others have identified a enteric or “gut” (gastrointestinal) cause. Some experts link past emotional or physical trauma to a delayed onset of symptoms. Most recently there has been some indication that spinal deformities can trigger this condition. It’s also possible that there are many different individual causes.

The National Fibromyalgia Research Association has more information on this condition and the latest research findings. You can contact them by phone (1-800-574-3468) or go to their web site: www.nfra.net.

The National Fibromyalgia Association (NFA) offers general information about the condition along with updates on research as they are published. You can access their materials on-line at: http://www.fmaware.org. They also publish a magazine and a newsletter for patients.

With no cure for fibromyalgia, managing symptoms through changes in lifestyle is a key approach to this condition. The NFA offers advice and suggestions on how to live well with FM. Sometimes medications can be helpful. See what the NFA has to say about drugs. Talk with your doctor about what might work best for you.

Fibromyalgia can cause mild to severe loss of function and disability. A physical or occupational therapist can help you learn how to conserve energy and improve your ability to accomplish daily tasks. Exercise is a key feature of management for this condition.

You may need to make some changes at work to allow you to continue working. The NFA also provides many resources to help patients maximize their chances for success. Changes in diet and nutrition seem to help some patients. You can find out more about this topic from the NFA, your physician, and/or a nutritionist in your area.

Finally, research studies and clinical trials are ongoing. The NFA and the National Fibromyalgia Research Association (NFRA) updated information on the latest findings. You can access the NFRA on-line at http://www.nfra.net.

Sore muscles may result from a build of lactic acid in a muscle from a strenuous workout. If you exercise so intensely that you breathe hard, your muscles can’t get enough oxygen. As a result, lactic acid accumulates in your muscle fibers causing soreness.

There may be some ways of preventing or reducing sore muscles. Drinking plenty of clear liquids (especially water) before, during, and after your workout may help. The idea is that by drinking lots of fluids, you are flushing the lactic acid out of the muscles and into the bloodstream to be washed away.

Stretching before, during, and after your workout may also help. If you are sore, doing a five to 10 minute type of warm-up or a series of exercises with light weights a day or two after the big workout may reduce your soreness.

Nutritionists advise eating a bit more protein to replenish protein stores. You can do this right after intense exercise and for a few days when the soreness starts.

Regular training without long lapses between is really the best approach. Research shows that training increases your body’s lactate threshold. In other words, if you stick with a regular exercise routine, it takes more intense exercise over a longer period of time to get sore.

When you are just beginning or starting back to an exercise program after inactivity, intensity should be hard enough to increase your breathing. It shouldn’t be so intense you are breathless or exhausted. People who are not as fit actually achieve good training effects at lower intensities compared to a more aerobically fit adult.

A well-trained speed skater is used to using muscles anaerobically in short bursts of speed. Anaerobic means the muscle is working so hard and so fast, it can’t get the blood supply it needs to maintain oxygen levels.

Any one can exercise in this way for short periods of time. In the untrained individual, anaerobic use of muscles often results in stiff and sore muscles a day or two later. Trained athletes can exercise anaerobically for longer periods of time, but eventually the muscles will fatigue from a lack of oxygen.

Human movement engineers study the body and the way it moves. They analyze strength, power, and efficiency during various activities. A recent study of ski-skaters using different body positions showed that some positions can generate greater speed, though usually at the expense of power.

One of these positions is the deep crouch. Speed skaters are very used to using this position and may have an advantage in doing so. The deep crouch position cannot be sustained in ski-skating for long periods of time but can improve time in the short run.

With training, the athlete may be able to stay in a low body position longer. As a speed skater, you may already have the advantage here. It’s possible you’ll be able to use this skill right away to shave seconds off your time.

METs or Metabolic Equivalent of the Task may still be a good way to judge your activity level. It was originally designed based on young, healthy men with a total body fat (TBF) level of 10 per cent.

Depending on how much you weigh and your own TBF level, METs may be more appropriate now than before your weight loss. Researchers have discovered that using the MET system with overweight or obese adults actually underestimates the energy used for an activity. Overweight or obese individuals may end up working at a level too high for them when using METs.

An alternate method is the rate of perceived exertion or RPE. You may have seen the RPE chart posted in your gym. Sometimes this is called the Borg scale. Three to five on a scale from zero to 10 is equal to moderate to heavy exercise.

One other method to use is a percentage of the maximum heart rate adjusted for age. This is called the predicted maximum heart rate or PMHR. The formula for this is 220 – your age in years. For a 20 year old this would be 220 – 20 = 200.

Moderate activity is often reported as 60 to 65 per cent of your maximum heart rate. This may vary from person to person depending on general health or presence of conditions such as diabetes, heart disease, or obesity. You may want to consult with your physician before using this method to guide your workout.