Dr. Jerold J. Fadem, M.D.

A couple of possible reasons:

1) Your doc is not totally sure of the diagnosis(as fibromyalgia usually involves MUSCLES rather than JOINTS)--and there are some other diseases that can be mistaken for fibro, i.e., Polymyalgia Rheumatica--which usually has a very high ESR (Erythrocyte Sedimentation Rate) or Rheumatoid arthritis, or Lupus, etc.

2) Your doc is sure of the Dx, but is not expert in the TREATMENT of fibromyalgia--as there is no cure, there is no guaranteed treatment, and various treatments may have to be on a "trial and error" basis until a regimen for you seems to work.

But, I agree, usually a good Internal medicine doc can take care of patients with fibromyalgia.

Yes, you need to see a GI specialist(or a good Internal Medicine doctor) and be evaluated for Celiac Disease(otherwise known as "gluten-sensitve enteropathy"--meaning that a substance in WHEAT and a few other grains called GLUTEN-- that when eaten can result in an immune or inflammatory condition in the cells/tissues lining the small bowel. This then can cause dysfunction of these cells/tissues in the small bowel which results in symptoms like diarrhea and cramps, and can even progress to malabsorption of food constituents like fats, fat soluble nutrients, and even iron. This can result in weight loss, iron deficiency anemia, fat soluable vitamin deficiency, etc. Thee patients can even suffer mood disorders, bone thinning, and can even be associated with other auto-immune disorders.

Elimination of ALL foods containing GLUTEN will usually cure or markedly improve the problem. But you MUST be very vigilant about what you eat as GLUTEN is in MANY processed foods--not just in obvious wheat or grain products like breads, cakes, cookies, and cereals.

So one MUST check every LABEL of any food(especially processed or canned/packaged foods) to be 100% certain there is no GLUTEN contained within.

There are some easily done BLOOD TESTS that can help make the diagnosis. But GI specialists may want to perform an UPPER ENDOSCOPY with BIOPSY of the small bowel mucosa(lining) and then have a pathologist look at the specimen under the microscope to see if the typical findings of celiac sprue are present.

There are other diseases that can cause the same or similar sx and must be ruled out(ie--lactose intolerance, inflammatory bowel dz, pancreatic exocrine deficiency, etc).

But the "clinical gold standard" is resolution of all of your symptoms with a GLUTEN FREE DIET.

Plenty of fluids, acetaminophen, and/or NSAIDS (like children's Motrin/ibuprofen) can help prevent dehydration and reduce fever, aches/pains, and sore throat. The thing to remember is that with good supportive care at home, your child will get over this very common viral disease and be as good as new in a few days or weeks!

Yes--ALL OPIATES (and Oxycontin is one of them called OXYCODONE--which is produced in a LONG ACTING formulation that is then marketed as OXYCONTIN) can cause nausea and/or vomiting and/or a common "queasy" feeling that may result in a lack of desire to eat. It also commonly cause constipation--especially in older people.

This symptom is frrequently seen in a syndrome called "PROCTALGIA FUGAX"--which translates to "FLEETING RECTAL PAIN"--or also known as "LEVATOR MUSCLE SPASM"(the levator is a muscle in the rectum that can go into spasm intermittently and can cause intermittent, short-lived, moderate to severe pain in the rectum.

But, other more serious conditions must be looked for and ruled out--such as proctitis, prostatitis, rectal/colon cancer. Thus you may need to undergo a SIGMOIDOSCOPY, PROSTATE EXAM, and maybe even rectal or distal colonic manometry where ther pressures in the rectum/distal colon can be measured and correlated with clinical sx.

The first step is to make 100% certain you do not have any condition(like hyperthyroidism, malabsorption, illicit drug abuse, depression/anxiety, or some other GI, inflammatory, malignant, or metabolic disorder) resulting in wt loss or inability to maintain a "normal" weight.

Once this is ruled out, and your condition is perceived to be severe, abnormal, and "life altering", then you might consider talking to your doctor about the pros and cons of taking drugs that MAY help gain weight(ie--anabolic steroids, certain anti-histamines, or even THC--which is not uncommonly given to cancer or very ill AIDS patients with marked weight loss in order to stimulate the appetite and help gain weight(THC--tetra hydro cannabinol--is the consituent of marijuana that can make one "high" and may give one "the munchies."

Obviously, these drugs(with the exception of an anti-histamine like PERIACTIN) are not "mainstream" or commonly used UNLESS there is such a severe, pathological, abnormal amount of weight loss(or inability to gain weight for optimal health) in which the physician and patient concur that the BENEFIT of one of these appetite stimulants significantly outweighs the RISK.

Lastly, it must be considered that some people are just "constitutionally" very thin due to genetic or other reasons but are NOT really ill or unhealthy or diseased in any way. Thus the "thinness" really is a "cosmetic" issue and NOT a "health issue." And thus if it is merely a "cosmetic issue," then the use of any drug with potentionally harmful effects may not be "medically indicated."

Assuming it was your "bad cholesterol--or LDL" that was found to be very high (and NOT your "good cholesterol--or HDL"), then you could START by doing the following:

1) exercise--and just walking 20-30 minutes a few times a week may help
2) low animal fat diet--especially cutting down on or eliminating animal products like beef, pork, liver, eggs, etc
3) reducing CALORIES and LOSING WEIGHT-- especially eliminating foods derived from ANIMALS--meat, butter, whole mild, ice cream, etc--that may help you lose weight and thus lower the cholesterol (it must also be noted that REDUCING "CARBOHYDRATES"--especially the "bad carbs" like sugar, processed wheat products, dairy products, potatoes, pasta, cakes, cookies, crackers, candies, and other "junk food" will frequently result in weight loss and consequent reduction in the LDL or "bad cholesterol")
4) take OTC capsules containing PLANT STEROLS that may help reduce the LDL (the "bad cholesterol')

If the above are done for 3-6 months, then a f/u LIPID PROFILE (triglycerides, LDL cholesterol, and HDL cholesterol) can be re-measured and see if you achieved your cholesterol reduction goal. But if not, and you have 2 or more "cardiac risk factors," diabetes, or a history of a heart attack or stroke, then your doctor will talk to you about starting a LIPID LOWERING medicine--like one of the STATINS--which are very effective at LDL cholesterol reduction, but also have some detrimental effects that you and your doctor could discuss and weight the "pros and cons."

Lastly, remember that the GOAL of all this is to INCREASE YOUR LONGEVITY by REDUCING VASCULAR EVENTS (like heart attack and stroke). Thus lowering the LDL cholesterol, is just one of many determinants of your overall long term health as well as your "vascular risk" and must be considered in context with your overall health objectives.

Yes — violent coughing can very RARELY cause a retinal tear or detachment — and very myopic people may be predisposed because of stretching and thinning of the retinal tissue. I strongly suggest taking him to see an ophthalmologist ASAP!

Buy a decent WRIST BP MONITOR from CVS or WALGREENS, etc. Pay about $40-$50 for a decent one, and then follow directions and measure your BP in both your R and L arms, and also while sitting and standing. Whatever arm has the HIGHEST measurement is the one to pay most attention to. You want your BP to AVERAGE 120-125/70-80 or LESS (the monitor will be able to give you an AVERAGE measurement). The monitor will also measure your pulse rate.

Being overweight (i.e., TOO FAT) IS THE USUAL ASSOCIATION (OR CAUSE) of the "metabolic syndrome." There is a HUGE and GROWING epidemic of this in the USA (in KIDS as well as ADULTS) due to lack of exercise, too much junk food, too much computer games/use with the associated sedentary lifestyle, etc.

Yes, by DILUTING "spicy food irritants" and increasing the "pH" of the stomach, it MAY reduce sx. But, you may also have GERD, GASTRITIS, or ULCER dz -- which may all need lifestyle changes and/or medication to reduce GASTRIC ACID (and antibiotics if you have ULCER disease associated with H. Pylori infection).

The most common causes of CHRONIC diarrhea are MANY -- a few of the most common are:

-IRRITIBLE BOWEL syndrome
-DRUGS/MEDICATIONS (antibiotics/LAXATIVES/certain artificial sweeteners/etc. -- but ANY DRUG must be considered in the right setting)
-INFECTIONS -- Giardia, worms, antibiotic associated diarrhea (caused by C. Difficile)
-INFLAMMATION -- Crohn's or Ulcerative colitis
-LAXATIVE ABUSE
-ENDOCRINE -- hyperthryoidism or diabetes
-MALABSORPTION -- pancreatic exocrine deficiency (where not enough enzyme is secreted into the bowel to be able to absorb fat/nutrients)

It also must be said that the DEFINITION of true "diarrhea" is the STOOL VOLUME -- and NOT just having "loose" stools. So, >400cc of stool per day is considered true "diarrhea." Anything LESS than that is not abnormal (ASSUMING THE PERSON IS EATING/DRINKING; AS IF THE PERSON IS NOT EATING/DRINKING, DEFECATION MAY BE REDUCED OR STOPPED NO MATTER WHAT THE CAUSE).

STOP eating/drinking anything with LACTOSE in it!! Which generally means avoiding foods derived from DAIRY products (i.e., including milk. cheese, ice cream, yogurt, etc.). You can usually find LACTOSE-FREE foods to eat and thus avoid the problem.

Yes, BCPs are only about 96%-99% effective, although MISSING taking the pill is a frequent cause of "pill failure."

You probably got salt water with or without dextrose (sugar), or just sugar water alone.

Dandruff is A FORM OF "seborrheic dermatitis"--and can be treated by OTC DANDRUFF SHAMPOOS OR SHAMPOOS THAT CONTAIN "TARS"--WHICH IMPROVE THE SEBORRHEIC DERMATITIS.

Flu shots may NOT actually prevent the Flu--but frequently REDUCE the severity of Flu if you get it--and also probably reduce the DEATH RATE from the Flu

This could be a sign of bladder, kidney, urethral, vaginal, or cervical infection, or even a kidney or ureteral stone. Obviously, having more information about your age and certain risk factors or predispositions would narrow down the possibilities. YES, I strongly recommend seeing a doctor and having urine testing and also having a good physical and pelvic exam.

Yes, HIGH BP CAN lead to nose bleeds (i.e., epistaxis) and also bleeding into the BRAIN. So, this might be a MEDICAL EMERGENCY if the nose bleed is associated by HIGH BP!

ABSOLUTELY!!!!!!! Fortunately, nowadays children with the most likely type of leukemia have EXCELLENT cure rates with chemo!!