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 Food and Drug Administration has approved three medicines to ease fibromyalgia symptoms. They are Lyrica, Cymbalta and the newest, Savella.
The booklet on fibromyalgia provides more information on this baffling illness and its treatments. Readers can obtain a copy by writing: Dr. Donohue — No. 305W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
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: My stomach sags around the belly button. My doctor says it’s an umbilical hernia. There’s no discomfort or pain. Will 100 sit-ups a day fix this? — L.W.
ANSWER: A thousand sit-ups a day will not fix it. Sit-ups could make it worse. Only surgery can fix it. Any exercise that increases pressure within the abdomen can make the hernia protrude more. If this bothers you, get a surgeon’s opinion.
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.
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