DEAR DR. DONOHUE: Please say something about fibromyalgia and what causes it. I have a friend who lives far from me, but we keep in touch by phone almost daily. She’s a wreck because of fibromyalgia. She’s having a very tough time running her house. She has five children. What can be done for it? – R.V.

ANSWER: Fibromyalgia is an illness in search of a cause. No one knows what the cause is. It’s a state of muscle pain, exhaustion and disturbed sleep. Affected people complain most about pain in the neck, shoulder, hip and extremity muscles. Their constant tiredness is partly the result of nonrefreshing sleep. They also have trouble concentrating and remembering.

The pain might be due to abnormal processing of pain signals in the brain. That’s one conjecture.

A special feature of fibromyalgia is tender points. They’re 18 body sites where slight finger pressure produces pain far in excess of the applied pressure. That’s one reason why some believe the brain amplifies incoming pain sensations.

Exercise is an important aspect of treatment. It has to be started at a low level and gradually increased. Water aerobics is a good way for fibromyalgia patients to get their muscles working again and keep them functioning even though they’re painful. Any kind of low-intensity exercise will fit the bill.

Small doses of the antidepressant medicine amitriptyline can often restore normal sleep and restore some energy to these people. Seizure medicines such as Lyrica, Topamax and Neurontin, again in low doses, can bring pain relief. Muscle relaxants, an obvious choice, don’t work by themselves. But when they’re used in combination with Celexa or Effexor, they’ve benefited some patients.

The fibromyalgia booklet presents the details of this puzzling illness. Readers can order a copy by writing: Dr. Donohue – No. 305, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am a retired teacher who has stayed active. Pelvic pain sent me to my gynecologist. She said I need more calcium. I am getting more even though I have to fight constipation as a result.

Now I am awakened by pelvic pain. Is there anything you can suggest? – F.C.

ANSWER: The causes of pelvic pain are numerous. I have picked one because, if it is the cause, you can treat the pain and get your calcium requirement without developing constipation.

Vulvodynia is a neglected cause of pelvic pain. The pain is a burning or an irritation felt at the vaginal opening and in the surrounding tissues. A suggested treatment is avoidance of foods with oxalate in them. Such foods include rhubarb, spinach, parsley, radishes, beets, bananas, pears, Brussels sprouts, green beans, eggplant, nuts, peanuts, purple grapes and blueberries.

Another way to lower body oxalate is to take calcium citrate, and it’s an excellent way of meeting calcium needs. The citrate interferes with oxalate absorption. Calcium citrate, unlike calcium carbonate, doesn’t present a constipation problem.

Vulvodynia is sort of a far-out suggestion on my part. If this treatment doesn’t eliminate the pain, you’ve got to go back to the doctor. Bad things, including cancer, can cause pelvic pain, so a second search is required.

DEAR DR. DONOHUE: I would appreciate it if you would give your opinion on incomplete bundle branch block, its implications and prognosis. Is there any remedy for it? – C.D.

ANSWER: The “bundles” are cables that bring the electric signal generated by the heart’s pacemaker to the heart’s lower, pumping chambers – the ventricles. When the ventricles receive the signal, they contract and pump blood into the body and into the lungs.

An incomplete bundle branch block means that there is an eye-blink delay in the signal’s arrival at the ventricles. It has no important implications. It will not shorten your life. There is no remedy, because none is needed.

DEAR DR. DONOHUE: A truck collided with my cousin, who was on a motorcycle. He was admitted through the emergency room to the hospital for observation. The observation wasn’t great. He died during the night. An autopsy showed he had a ruptured spleen. Isn’t this something that can be treated? – N.O.

ANSWER: The spleen is on the upper-left side of the abdomen, right next to the stomach. Trauma to the spleen can cause it to split apart. It’s a highly vascular organ, and bleeding from it can be brisk.

Ruptured spleens usually cause pain in the upper-left side of the abdomen. Ultrasounds and CT scans can reveal what’s going on.

Ruptured spleens are treatable. Once, it was customary to remove them. Now every effort is made to repair them. A technique that doesn’t involve surgery is angiographic embolization. A soft catheter is threaded to arteries supplying the spleen, and when the source of bleeding is identified, pellets are released that cause clot formation to stop bleeding.

I have made this sound straightforward and simple. Splenic rupture can be difficult to diagnose, and catastrophe can develop rapidly.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com