Dr. Jerold J. Fadem, M.D.

A few things:

1) Once an adult sprains the ankle, it is always going to be easier than "baseline" to re-sprain it. You MAY need to wear an ankle brace when you walk as a possible fall preventative.

2) Do you have a connective tissue disease associated with "loose or weak tendons" (Ehlers danlos, Marfans, etc.)? These are associated with ankle -- or other joint -- sprains and other problems (unlikely, but need to get a better history from you and ideally examine you for tendon laxity -- if you can make your thumb bend back to touch the forearm, you have "tendon laxity" -- and MAYBE a connective tissue problem like Marfans, etc.).

Now I DOUBT you have this problem -- as these diseases are NOT common -- and you probably would have had prior and/or other problems that brought you to the attention of a doctor, but as I don't know your history, it would be a "rule out."

3) You DEFINITELY need to find out WHY you are falling repeatedly! This is a potentially serious or even fatal problem (especially if you hit your head or break a hip).

COMMON reasons for repeated falling include:

1) Neurological problems: That could cause weakness, imbalance, or dizziness/vertigo, which could be centered in the brain (like an old stroke or a tumor), inner ear (like Menieres or other causes of vertigo) neck -- like spinal stenosis -- or spine, from arthritis and/or degenerative disc disease.
2) Orthostasis: Where your blood pressure drops upon standing (common in older people, especially if on a blood pressure medicine or diuretic).
3) Foot drop: If you tend to "stub" the involved foot when you walk (this could result from an old stroke, a spine problem, or nerve degeneration)
4) In older folks (I don't know your age), there may be more than just one underlying problem that results in repeated falling, so a complete history and physical exam is MANDATORY before you have a worse complication than just a sprained ankle!

Steroids may be needed for an exacerbation, especially if oxygen, bronchodilators, and maybe anticholinergics and/or antibiotics do not work. USUALLY, once the exacerbation has resolved, the steroids are stopped (or weaned off) as long as the patient tolerates it without deteriorating.

Sometimes COPD that is severe (like in a patient on chronic oxygen) MAY require daily steroid therapy (at the lowest does that works). But this is only when standard medications like bronchodilators and anticholinergics don't work well enough; then a steroid trial may be helpful. Then, the patient's clinical course will dictate whether daily steroids are needed chronically.

The possibilities include the following:

1) Stomach problems like gastritis, gastric ulcer (with or without H. Pylorii infection); gastric emptying problems, gastric outlet syndrome (where the stomach can't empty due to an intrinsic obstruction or an abdominal MASS impinging on the stomach or bowel).

2) Duodenal problems: Peptic ulcer (H. Pylorii infection), obstruction (from something intrinsic to the bowel -- like scarring, inflammation, or tumor; or something outside the bowel --like an enlarged liver, pancreatic dz, abdominal tumor, etc.)

3) Gall bladder problems: Usually meaning gallstones, or chronic biliary disease

4) Pancereatic dz: Like chronic pancreatitis, pancreatic cancer, pancreatic pseudocyst, etc.

5) Liver dz: Hepatitis/cirrhosis, fatty liver, tumor

6) Kidney dz: People with significant renal insufficiency may be nauseated.

7) Small bowel problems: Like Crohn's Dz or tumor

8) Metabolic problems: Hypercalcemia, hypokalemia, adrenal insufficiency, etc.

8) Medications: ANY drug could potentially cause nausea!!

The MOST COMMON cause of chronic fever, especially if more than 6 weeks have elapsed and NO CAUSE is found, is found "FUO" (FEVER OF UNKNOWN ORIGIN). But this is only after common causes are ruled out, like urinary, abdominal, or lung infections have been ruled out, and there is no drug on board that can cause fever (called "DRUG FEVER").

IF all these common and easily diagnosed and treated diseases have been ruled out, then you need to look for the 3 main causes of FUO: infection< tumor, collagen vascular DZ.

1) INFECTION: TB, AIDS, ENDOCARDITIS (infection of heart valve) and abdominal/liver/lung/kidney abscess/infection needs to be looked for (IF the patient is from out of the country, malaria, typhoid, and TB may need to be ruled out depending on what country the patient is coming from).

2) TUMOR: Usually meaning LYMPHOMA/LEUKEMIA, but other solid tumors -- lung, liver, kidney, breast, colon, pancreatic, etc. -- can rarely do this, too, and may need to looked for, depending on the clinical scenario and whether the patient has any focal symptoms that may be a clue to the source of the problem.

3) CVD: like lupus, rheumatoid arthritis, vasculitis (like giant cell arteritis, polymyalgia rheumatica, polyarteritis, ANCA vasculitis)

Depending on the results of the preliminary tests and the clinical context -- blood tests, blood cultures, sed rate, CXR, urine cultures, and maybe abdominal imaging -- these all need to be considered. If one knew what drug appears to be suppressing the fever, like an antibiotic, NSAID/Tylenol, or steroids, this might clue one in to the source of the problem. If an antibiotic seems to be suppressing the fever, then there probably is an infection going on and blood cultures (OFF ANTIBIOTICS), urine cultures, CXR -- all need to be done. Imaging studies like CT or MRI may be indicated if there are focal symptoms or history or physical exam (or a blood test) suggests where the source is.

The DX of fibromyalgia is a CLINICAL DX, meaning there is NO TEST that shows it and ALL tests and physical exam are NORMAL. It is a CLINICAL DIAGNOSIS made by a competent physician and hinges on what your SYMPTOMS are. SX include the following:

1) Aches/pains in ALL FOUR QUADRANTS of the body, meaning pains/aches in the RIGHT UPPER EXTREMITY/SHOULDER/UPPER BACK/NECK, LEFT UPPER EXTREMITY/SHOULDER/UPPER BACK/NECK and in the R LOWER BACK/HIP/BUTTOCKS/THIGH/ LEG, and LEFT LOWER BACK/HIP/BUTT/THIGH, and leg, sometimes referred to as "shoulder-hip girdle" aches and pains.

2) TRIGGER POINTS in multiple areas, especially tender spots located commonly in the neck, traps, upper back, shoulders, and proximal extremities

3) SLEEP DISORDER

4) More common in WOMEN, usually under 40-50 years old

5) May be associated with irritable bowel, migraine, anxiety, and depression

6) ALL BLOOD TESTS, X-RAYS, and IMAGING TESTS ARE NORMAL, and the PHYSICAL EXAM IS NORMAL (EXCEPT for TRIGGER POINTS), but there is NO swelling, redness, rash, joint findings, or muscle weakness present.

7) BETTER SLEEP, EXERCISE, and MAYBE a medication like NSAIDS (i.e., IBUPROFEN), low dose ELAVIL at night, or LYRICA (if more severe and fails the previous 2 drugs), and opiates -- e.g., TRAMADIL -- MAY be needed if all else fails and the patient is still having daily moderate to severe pain that interferes with her quality of life, job, or relationships at the lowest dose necessary to just "take the edge off" of the pain.

But the drug will NOT be expected to eliminate the pain, and the patient must be advised of this and made clear that becoming totally pain-free is probably NOT a realistic goal of taking the drug. The patient must be warned of potential habituation/addiction if the dose and/or frequency is too high (especially if there is an underlying psych problem or prior drug problem).

A certified SPEECH THERAPIST -- pediatric if possible -- is the BEST you can do for your son if you think the problem is not just some temporary problem that will resolve as he gets older.

NO. Dengue is spread by the bite of an infected insect. But it may not present (or become symptomatic) until a patient comes into the USA from an endemic area, like AFRICA.

Yes. Even in ADULTS there are eye diseases that may be hereditary in certain (but not all) cases, like glaucoma and macular degeneration, which are the two most common causes of hereditary blindness in adulthood.

Personally, if it is not huge in size, not hard to get to, you have no fever, rash, shortness of breath, N/V, headache, back or joint pains, you can eat and drink normally, you don't feel "sick," you don't have any underlying medical problems, you can easily get to it, and you have no problem with sharp objects, THEN you MIGHT try to drain it yourself with a needle or small, sharp knife. I KNOW I would try this FIRST, but I am a doctor and self-draining a boil is very acceptable. Of course, this may sound like medical heresy as I know the medical mainstream will tell you to go to your doctor -- and doing that would almost NEVER be wrong! So, if you already have a doctor, I am definitely on board with that if it is not a problem for you, you can quickly get in, and you have health insurance (or don't mind paying cash if you don't), etc.

But, IF it is large, hard to get to, you have a lot of pain and/or fever and/or you don't feel well, then you could also go to an "URGENT CARE CENTER" for I&D or even an ED for I&D (incision and drainage) if you are really sick. But you would probably be in for a long wait!

Once a boil is completely drained and then lightly washed with soap and water daily (and you have no underlying disease that could predispose you to infection and/or complications like diabetes or AIDS, or if you have some other underlying immune deficiency), it will heal quickly as MOUTH lesions do heal more quickly than other areas of the body!

1) Definitely avoid ANY food or drink that causes sx -- like alcohol, acidic drinks like orange juice, or any food that causes sx, i.e, fatty/fried foods inhibit gastric emptying -- so this would predispose you to acid reflux, as the acid produced by your stomach when you eat a meal has nowhere to go -- except up your esophagus -- ERGO, HEARTBURN!!

Also, avoid DRUGS that can cause or exacerbate reflux. NSAIDS or certain blood pressure drugs like calcium blockers can relax the lower esophageal sphincter and allow acid to get up in your esophagus. Also, any CNS active drug can lower sphincter pressure and worsen reflux -- opiates, antidepressants, anxiolytics, etc.

2) Weight loss WILL REDUCE REFLUX, BUT TAKES TIME and DEDICATION.

3) NOT EATING LATE and ELEVATING the head of your bed MIGHT reduce nocturnal sx via the effect of simple GRAVITY (I have a brick under each leg of my bed so my bed is elevated about 5 inches and does reduce nocturnal sx).

4) If you are still having sx more than a couple of times a week, then you may need a drug -- H2 Blockers like famotodine or ranitidine -- once or twice a day will prob take care of milder sx.

5) IF you STILL have frequent episodes, a PPI drug -- lke Nexium or omeprazole, etc. (which are now over-the-counter) -- MAY be needed for short courses, as there are probably some serious but pretty rare complications of chronic PPI therapy like renal disease, osteroporosis, B12 deficiency, magnesium deficiency, etc. But remember that bad reflux can lead to esophagitis, stricture (scarring of the esophagus that can BLOCK FOOD from getting into your stomach, GI bleeding, and esophageal cancer).

IF you STILL have bad reflux (i.e., bad or frequent sx most days of the week) have tried ALL of the lifestyle changes, and the drugs taken intermittently don't help optimally, then you are left with either of 2 options: DAILY PPI, which means taking a drug like omeprazole or Nexium every day;

OR

seeing a surgeon and being evaluated for a NISSEN FUNDIPLICATION, where they go in and tighten the lower esophageal SPHINCTER to prevent acid getting up in your esophagus.

Personally, if I failed all else and still had frequent and bad sx, I would take DAILY PPI therapy -- Nexium, opeprazole, etc. -- and take preventative oral B12 and magnesium IF you will be on LONG-TERM PPI therapy.

IF you develop any SWALLOWING problems, you MUST see a GI specialist and have an UPPER ENDOSCOPY to r/o cancer or stricture and be MONITORED periodically for kidney problems, osteoporosis, B12 and mag deficiency, etc.

I assume you were in an ENDEMIC AREA -- Africa, South America, or some other "3rd world country" that lacks proper sanitation. If you REALLY have Typhoid Fever (most likely with positive blood cultures for SALMONELLA TYPHI bacteria), then you MUST take an antibiotic (like CIPRO of ZITHROMAX) that is active against the Typhoid bacteria. But it still may take for 2-4 weeks for you to get completely well. But this should do the trick if the bacteria is SENSITIVE to your antibiotic.

But, if you still have a very prolonged FEVER and are feeling sick, then you need to check for ANTIBIOTIC RESISTANCE, and maybe have a CT scan of the abdomen to r/o an ABSCESS that might require surgical drainage. This would be a scenario where the blood cultures reveal bacteria SENSITIVE to the antibiotic you are on, but you still have fever. An abdominal ABSCESS may not respond to just antibiotics, even though the bacteria shows sensitivity to your antibiotic. In this type of case, you must look for ABSCESS and drain it if it is found.

As for your SYMPTOMS, you may need to take Tylenol or an NSAID for the fever and headaches. As even proper antibiotic therapy will TAKE TIIME to get you well. But be SURE your antibiotic is active against SALMONELA TYPHI -- assuming THAT is what you have (again, this is usually proven with POSITIVE BLOOD CULTURES WITH ANTIBIOTIC SENSITIVITIES).

First of all, stop all caffeine, cold medicines, illicit drugs(ie-cocaine, amphetamine, etc) and alcohol(all of which can cause irregular heart beats and/or irregular heart rhythm.)

it is important to also see your doctor for a complete history and physical, with blood tests for thyroid function, electrolytes, CBC, liver and kidney function tests, and EKG with a long rhythm strip. (Also, anxiety is well known to cause episodic sensations of "palpitations" and/or irregular rhythm, but no cardiac abnormality or rhythm irregularity may be found.)

But, if your "irregular beats" don't appear while being tested, there may be no diagnosis made as cardiac dysrhythmias can be very episodic, fleeting, and unpredictable(and some irregular beats can be totally asymptomatic).

If no abnormalities are found and no definite diagnoses are made, and you continue having irregular beats(especially if you have any feeling of faintness, passing out, weakness, shortness of breath, or chest pain), you may need to see a cardiologist(or cardiac electrophysiologist) and have further evaluation--possibly including prolonged cardiac rhythm monitoring--long enough to hopefully pick up any irregularity, if present. Cardiac stress testing and/or echocardiogram MAY also be indicated depending on history, cardiac risk factors, cardiac physical findings, and results of EKG.

From a conceptual perspective in evaluating any cardiac irregularity or abnormal beats, it is important to answer 2 major questions:

1) Is there is any intrinsic heart disease present(ie-is there disease of the heart muscle, valves, conducting system, or coronary arteries, and

2) What type and where do the irregular beats originate, ie--are they coming from the atria(ie--the "top" chambers of the heart, which tend to be less serious) or the ventricles(ie- the "bottom" heart chambers), which tend to be more serious and possibly even life threatening.

Once it is found what type and where the abnormal beats or irregularity originates, and if there is underlying intrinsic heart disease present, proper recommendations and therapy can be formulated.

As the symptoms of the flu can be non-specific(fever, myalgias, sore throat, malaise, anorexia, headache, etc) be sure it really is the "flu"-!!-ie, which can be proven by having your doctor perform a simple blood test.

Influenza is due to Type A and Type B viruses that change their antigenicity frequently(which is why we have to get vaccinated yearly to try to prevent the type of flu that is current.) Again, these can be diagnosed with simple blood tests.

Unfortunately, After a week of illness(assuming it really is influenza), there is probably no effective treatment to kill the virus and shorten the duration of illness(but if caught in the first couple of days, there ARE treatments, like Tamiflu, that is effective against a certain type of flu and can reduce the length of illness )

So, if a patient is not seen until after a week of illness, we usually have to resort to using measures to reduce SYMPTOMS, ie--rest, Fluids, ibuprofen or Tylenol to prevent dehydration and reduce fever, sore throat, and the aches and pains that are commonly associated with the flu.

Also, remember that there are many infections that can present like the flu. Thus it is important to see your MD and be examined and tested(and other infections can be looked for and hopefully ruled out--ie, bacterial pneumonia, strep pharyngitis, mono, meningitis, etc.

Additionally, if there has been recent TRAVEL to "3rd world countries(Africa, S America, etc), diseases like malaria, hepatitis, TB, etc can be acquired abroad, and then can become symptomatic when back in the USA.

Further, it is well known that certain very serious BACTERIAL superinfections can come on after a week or more of the flu, including Staph pneumonia and pneumococcal pneumonia, both of which can be life threatening(especially in the very young and very old)

Again, all of these conditions can be looked for and ruled out by having your doctor perform a complete history and physical along with certain blood tests and maybe a chest x-ray(if there is higher fever, chills, cough, productive sputum, chest pain, physical exam signs, etc)

Finally, assuming influenza is diagnosed properly and no complications or serious organ dysfunction has intervened, then rest, plenty of fluids, anti-inflammatory drugs(and maybe other helpful symptomatic medicines) will reduce symptoms until your son's own immune system can fight off the flu within the next week or so.

Yes--breo ellipta is DEFINITELY INDICATED for LONG TERM TREATMENT of COPD (but it can also be used for SHORT TERM TREATMENT of ASTHMA until other asthma medicines have "kicked in")

Your sx could be due to any of the following:

1) ANEMIA(which can occur with surgery due to blood loss)

2) INFECTION--incuding post-appendicitis intra-abdominal or liver abscess, urinary tract infection, pneumoina, etc(most of these would likely be associated with concomitant fever and focal sx, but not all the time--especially when the patient is older)

3) HYPERG:LYCEMIA/DIABETES--sometines diabetes or elevated blood sugars can be instigated or exacerbated by infections(like appendicitis) or surgery

4) ANOREXIA and/or REDUCED FLUID INTAKE--if you are not eating/drinking normally for some reason, this can cause dehydration, low blood pressure, ortrhostatic hypotension, weakness and loss of energy, etc

5) Be sure it is not due to some NEW DRUG that YOU MAY HAVE BEEN STARTED ON(ie--anti-hypertersives, antibiotics, etc)

6) also, intercurrent CARDIAC or RENAL insufficiency/failure brought on by infection and/or surgery can cause weakness, fatigue, depression, etc

A good HISTORY and PHYSICAL done by an experienced clinician, and a few simple tests, would usually be able to determine the cause(s) and any necessary treatment.

You should take him to see a pediatric ENDOCRINOLOGIST where he initially will be evaluated for any congenital or acquired disease or condition causing abnormal short stature.

If all of these are ruled out, and it is determined that he is definitely falling behind where his predicted height should be, he MAY be a candidate for GROWTH HORMONE THERAPY.

As he is probably still pre-pubertal at age 10, NOW is definitely the time to do this while his bones still respond to the beneficial effects of GROWTH HORMONE.

The MAIN effect of insulin on the body is to LOWER THE BLOOD SUGAR level(though it also has a lot of other physiologic effects on the body).

It sounds like your mother has been placed on 4 daily doses of REGULAR(short acting) INSULIN. Each dose of this will last about 4-6 hours, and thus needs to given 4 times daily--depending on the blood sugar level.

Once she is stabilized, and depending on whether she has Type 1 or Type 2 diabetes, she could be switched to 2 daily doses of MIXED insulin, each of which usually includes a combination of regular(short acting) insulin, and longer acting insulin.

Also, if she has Type 2 diabetes and gets over any "stress" that may have set it off(ike infection, surgery, etc) she MIGHT be able to be switched to ORAL hypoglycemic medicine--but this needs to be done very carefully.

But if she has Type 1 diabetes, she will need insulin regardless.

Pregablin is indicated and FDA approved for diabetic neuropathy. But, the TYPE of SYMPTOMS one has will determine whether or not it may help:

Thus symptoms like numbness or tingling will likely NOT improve with pregabalin, but sx of burning and pain may well improve with the medication.

You FIRST need to be evaluated by a good Internist, neurologist, or geriatrican for objective memory loss (and possible other associated neurological abnormalities) with a COMPLETE HISTORY and PHYSICAL and NEUROLOGICAL EXAM.

This includes any history of head injury, concussion, alcohol use, or illicit drug use--all of which can cause memory loss. Also, multiple small brain infarcts can cause memory loss--this is usually seen in older patients with concomitant vascular risk factors like high blood pressure, diabetes, smoking, etc.

Also, some prescribed MEDICATIONS(pain meds, anti-epilieptic drugs, anti-anxiety meds, etc) can cause memory loss and may need to be stopped.

Then you will need your thyroid and B12 blood levels checked, along with a few other simple blood tests. Any MEDICATION you might be on also needs to be evaluated for effects on your memory. Also, older men can develop memory loss when TESTOSTERONE levels decline("male menopause") after the age of 35-40 or so.

Lastly, a brain MRI or CT scan is USUALLY NOT indicated without any additional neurological findings(other than some mild short term memory loss). But a brain imaging scan may be needed depending on the results of your HISTORY, PHYSICAL, NEURO EXAM, and BLOOD TESTS.

Treatment will probably hinge on the results of your work-up and whther you have any REVERSIBLE or curable causes--like hypothyroidism, B12 deficiency, and any causative agents like head injury/concussion, certain medications, alcohol, etc.

Jaundice in adults is usually from some LIVER or BILIARY tract problem(hepatitis, cirrhosis, gall stones, pancreatic disease, etc); but also occasionally from some BLOOD disease that causes hemolysis(where the red blood cells are being destroyed) or wherew the bone marrow is not functioning properly)

There also is an uncommon syndrome(Gilbert's) where a patient may develop mild jaundice with some stressful physical or medical event. This is a totally benign condition with no significant liver or blood abnormalities. The jaundice will disappear once the instigating event resolves.