DEAR DR. DONOHUE: My 50-year-old daughter has been diagnosed with fibromyalgia. She is in a great deal of pain, and medications have provided no relief. She has been told there is no cure. Exactly what is fibromyalgia? What causes it? – E.F.

ANSWER:
Fibromyalgia is a baffling illness whose two principal symptoms are pain and fatigue. The pain is body-wide, on both sides and above and below the waist. For diagnosis, the pain has to have been present for three or more months. The fatigue of this condition is overwhelming, so much so that the simplest of daily tasks becomes a formidable challenge. Patients also suffer from sleep that does not refresh, and they often find it difficult to concentrate.

Its cause remains a great unknown.

Specific tests for fibromyalgia don’t exist. However, tender points – areas on the body where finger pressure elicits pain out of proportion to the pressure applied – aid in making a diagnosis. There are 18 such points, and for a diagnosis, 11 should be present.

Other illnesses – such as rheumatoid arthritis, lupus, Sjogren’s syndrome and hepatitis, which have similar symptoms – have to be excluded, so testing for those conditions becomes part of the fibromyalgia workup.

Your daughter is right. No cure has been found, but sometimes symptoms improve on their own. Exercise is important. It sounds ridiculous to ask a person who is hurting and exhausted to exercise. At the start, exercise intensity can be modest, just walking. The goal is to extend exercise to 20 or 30 minutes of daily exercise and to pick up the tempo gradually.

The FDA has approved three medicines to ease fibromyalgia symptoms. They are Lyrica, Cymbalta and the newest, Savella.

The booklet on fibromyalgia provides more information on the illness and its treatments. Readers can obtain 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 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am inquiring about sebaceous cysts. During the past 20 years, I have had between eight and 10 of them on my back. They were removed surgically. My former family doctor, now retired, said there may be some prescription pills that can stop them from returning. I would like some insight from you. – W.M.

ANSWER:
Sebaceous cysts are also known as epidermal cysts. Often found on the back, they’re firm, round lumps that grow slowly. They can be pushed a little from side to side. Their cause is unknown.

If they’re inflamed or painful, they can be cut out without a lot of trouble, usually in the doctor’s office. The cyst wall must be taken too, or the cyst will return. Simply draining one of the pasty, greasy material contained inside doesn’t end the problem.

Everyone would love to know of a pill that prevents or gets rid of them. I don’t know of one, and I don’t believe there is one.

DEAR DR. DONOHUE: My friend’s toenails are white. What cause that? – E.B.

ANSWER:
Fungal infections of the nail often turn them white. Proof of fungal infections comes from a doctor examining scrapings of the nails with a microscope.

Many medicines are on the market for treatment of such an infection. Some can be painted on the nail – Penlac is an example. The success rate is not breathtaking. Oral prescription medicines are also available. They are expensive, and they don’t always work. Lots of people prefer to live in peace with such nail infections by ignoring them.

DEAR DR. DONOHUE: I have a friend who has nonstop hiccups. He has been under the care of several doctors, but no one can help him.

What causes hiccups? Is there a cure? He has them so bad he refuses to go out in public. – C.M.

ANSWER:
Hiccups are the involuntary contractions of the diaphragm muscle – the horizontal muscle that separates the chest from the abdomen. It’s the principal breathing muscle. What brings on the contractions often isn’t known, but sometimes it is a hidden condition that irritates the diaphragm or the vagus or phrenic nerves.

Your friend doesn’t have ordinary hiccups, the kind that last from minutes to hours and usually come from a distended stomach or one filled with gas from carbonated beverages. He has persistent, intractable hiccups, ones that last for months, even years. For his kind of hiccups, obscure causes have to be investigated – things like an abscess beneath the diaphragm and things that irritate the vagus or phrenic nerves. The search is arduous and includes lab tests, X-rays and scans.

Cures do exist for prolonged hiccupping. Medicines can sometimes stop them. Chlorpromazine, orally or infused into a vein, is one of them, as is metoclopramide. Seizure medicines – Dilantin, Depakote, Tegretol – have also had some success in suppressing hiccups

A number of invasive techniques can be used when medicines fail. The phrenic nerve – the nerve that serves the diaphragm – can be blocked or crushed. An implantable breathing pacemaker that controls the diaphragm by sending nerve messages through the phrenic nerve is another way to end intractable hiccups.

Readers, this isn’t the kind of hiccups that responds to many home remedies like swallowing a teaspoon of sugar. This kind of hiccups is in an entirely different league.

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.


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