Save Yourself from Fibromyalgia

A patient, Mrs. H., wrote me this letter and had sought my medical advice, it reads:

“Dear doctor, I woke up on a Monday morning experiencing pain all over my body. I was rushed to the hospital as I was in severe pain and could not turn my neck sideways. It was like a stiff neck.

“It started in my wrist, radiating to my fingers and slowly made its way up to my elbow and felt bad. I have been experiencing burning and tingling sensation in my hands and my feet. I was sent home when I initially had symptomatic relief.

“My doctor ran some tests, including the test for rheumatoid arthritis — they came back negative. I now have pain in my feet like a crushing sensation, especially in the mornings, back and hip pain and pain in my knee and ankle. My husband thinks it requires local massager/traditional bone doctor. What could be wrong with me?”

I replied her, telling her to send all her test results and the medication she was on. In one of the test results, there was a provisional diagnosis of fibromyalgia, which was in keeping with all her features.

I informed her that I agreed with the provisional diagnosis of the physician and told her to go for a second opinion consultation with a specialist.

Fibromyalgia is a disorder characterised by widespread musculoskeletal pain accompanied by fatigue, stiffness, sleep disturbance, memory and mood issues. It is pain in the fibrous tissues and muscles.

Fibromyalgia is a chronic condition, meaning it lasts a long time — possibly a lifetime. However, it may be comforting to know that fibromyalgia is not a progressive disease.

It is never fatal, and it will not cause damage to the joints, muscles, or internal organs. In many people, the condition does improve over time.

For unknown reasons, between 80 and 90 per cent of those diagnosed with fibromyalgia are women; however, men and children can also be affected.

Risk factors: Some risk factors that can either make fibromyalgia more likely, or act as a trigger for the condition, include: physical trauma (damage to the body’s tissues), psychological trauma (an incident that causes emotional damage, such as the death of a loved one), a viral infection (such as hepatitis B, hepatitis C or HIV/AIDS), and malaria.

Other risk factors are: being depressed, metabolic disturbances such as an hypothyroidism — when the thyroid gland does not produce enough of the thyroid hormone; inflammatory disorders such as rheumatoid arthritis — a condition that causes joint pain and stiffness, among others.

Symptoms: The symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time, with no single triggering event.

The symptoms are listed below: chronic muscle pain, muscle spasms, or tightness, fatigue (extreme tiredness), decreased energy, insomnia or waking up feeling just as tired as when you went to sleep, stiffness upon waking or after staying in one position for too long, itchy/burning sensation on the skin.

Other symptoms are difficulty remembering, concentrating, and performing simple mental tasks, abdominal pain, tension or migraine headaches, jaw and facial tenderness, feeling anxious or depressed, numbness or tingling in the face, arms, hands, legs, or feet, increase in urinary urgency or frequency (irritable bladder), reduced tolerance for exercise and muscle pain after exercise, a feeling of swelling (without actual swelling) in the hands and feet.

Treatment

There is no total cure for fibromyalgia, but treatment eases the symptoms and improves the quality of life. As fibromyalgia has a number of different symptoms, no single treatment will work for all of them.

A variety of treatments — normally a combination of medication and lifestyle changes — will improve the quality of life.

Analgesic/pain killers: such as Paracetamol, can be used to treat pain. If Paracetamol is not effective, a stronger pain killer, such as Codeine or Tramadol can improve pain and may also help one to function better in one’s daily activities.

Antidepressant medicines for fibromyalgia are not prescribed specifically to treat depression. They are used to boost the levels of certain neurotransmitters. Neurotransmitters are chemicals that carry messages to and from the brain. A new anti convusulatant is also used in treating fibromyalgia.

Sleeping pills and muscle relaxants are also adjuvant in the treatment of fibromyalgia.

Exercise, relaxation, and better sleeping habits also improve the quality of life.

In conclusion, fibromyalgia can make sleeping difficult. The following advice may help if fibromyalgia is affecting sleep: Go to bed and get up at the same time every night and morning; try to relax before bed, avoid caffeine, nicotine and alcohol before going to bed; avoid eating a heavy meal late at night.

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Sinusitis: Causes, symptoms and management (2)

February 12, 2014 by Rotimi Adesanya Leave a Comment

       

| credits: File copy

Last week, I sensitised the general population to how debilitating sinus infections can be or how much we suffer as a result. Sinusitis, or a sinus infection, occurs when the sinuses and nasal passages become inflamed and swollen.

Acute sinusitis could last up to four weeks, while chronic sinusitis typically lasts more than four weeks and occurs more than four times in a year. I used a photograph to illustrate the names and locations of the sinuses on the head.

This concluding part will be on the examination, investigations, treatment and prevention of sinusitis.

Physical examination: A thorough physical examination will involve the doctor pressing the forehead and cheekbones to check for tenderness (pain) and other signs of sinusitis, including yellow to yellow-green nasal discharge. The doctor will also check the inside of the nostrils, using a device with a bright light to check the mucus and look for any structural abnormalities.

Investigations: X-Rays: X-rays are readily available though not 100 per cent Accurate.

Computed tomography: Computed tomography scan is the best method for viewing the paranasal sinuses

 Endoscopy: Nasal endoscopy, or rhinoscopy, involves the insertion of a flexible tube with a fibre-optic light on the end into the nasal passage. Endoscopy is also used for treating sinusitis.

Treatment

Fluids

-Drinking plenty of fluids and getting lots of rest when needed is still the best bit of advice to ease the discomforts of the common cold.

-Spicy or pepper soup does, indeed, help congestion and aches. The hot steam from the soup may be its chief advantage, although other ingredients in the soup may have anti-inflammatory effects.

-In fact, any hot beverage may have similar soothing effects from steam. Ginger tea, fruit juice, and hot tea with honey and lemon may all be helpful.

Steam and nasal saline sprays

-Inhaling steam two to four times a day is extremely helpful, costs nothing, and requires no expensive equipment. The patient should sit comfortably and lean over a bowl of boiling hot water while covering the head and the bowl with a towel so the steam remains under the cloth. The steam should be inhaled continuously for 10 minutes. A mentholated or other aromatic preparation may be added to the water.

-Use a humidifier.

-Nasal Wash: A nasal wash can be helpful for removing mucus from the nose and relieving sinusitis symptoms. A saline (salt water) solution can be purchased in a spray bottle at a drug store or made at home.

Drug treatment of sinusitis

Non-prescription pain relievers such as acetaminophen and ibuprofen can help mild-to-moderate pain symptoms.

Nutrition and supplements can help prevent the allergic reactions that are a major cause of allergic sinusitis. Vitamin C and Vitamin B6 help prevent inflammation and excessive histamine levels, while zinc strengthens overall immunity.

 Decongestants may help relieve congestion, but they do not cure sinusitis.

Antihistamines can dry the mucus and sometimes worsen the condition. Cough or cold medication is not recommended for children younger than age four.

Steroids are also effective both orally and intra-  nasally.

 Antibiotic drugs are used to treat bacterial, not viral, infections. Unfortunately, because of the overuse and improper use of antibiotics, many types of bacteria no longer respond to antibiotic treatment.

Allergy shots (immunotherapy) to help prevent the disease from returning

Surgery

Surgery can unblock the sinuses when drug therapy is not effective or if there are other complications, such as structural abnormalities or fungal sinusitis.

Surgery to enlarge the sinus opening and drain the sinuses may also be needed.

An ENT specialist (also known as an otolaryngologist) normally performs this surgery.

Prevention

The best way to prevent sinusitis is to avoid cold and influenza. If you are unable to avoid them, the next best way to prevent sinusitis is to effectively treat cold and influenza.

Colds and flu are spread primarily when an infected person coughs or sneezes near someone else. A very common method for transmitting a cold is by shaking hands. Everyone should always wash their hands before eating and after going outside.

Influenza Vaccine: Doctors recommend that people receive annual influenza vaccination.

-Concluded

Sinusitis: Causes, symptoms and management

February 5, 2014 by Rotimi Adesanya

 credits: File copy

A young man shared this story with me during a medical mission on an island in Epe, Lagos. He has been sent by the community health worker to our diabetes and hypertension screening. His test was within normal range and he was counselled on the need to be referred to a secondary facility for treatment. He later opened up and told me his medical history.

The man’s story: “I am 38 years old and I have suffered from chronic sinusitis my entire life. As a child, I was always going to the paediatrician, but as soon as one infection cleared up, another would start and it has been this way ever since.

“I was scheduled for surgery by ENT surgeon but declined due to fear. I have had allergy injections thrice a week for my whole life. I’m allergic to pet, dust mite, groundnut and mould. Of course, irritants like smoke, air pollution and smells of chemical substances make life even worse.

“I’m constantly on antibiotics, steroids, nasal spray, and allergy medication. My sinus infections often turn into bronchitis (lung infection) and this last time, into viral pneumonia. I cough constantly, lose sleep, miss work, and catch any virus going around. Now, I’ve been diagnosed with migraine and cluster headaches that are triggered by the sinus headaches. All this has made me become frustrated.”

This piece is to sensitise the general population to how debilitating sinus infections can be or how much we suffer as a result.

Sinusitis, or a sinus infection, occurs when the sinuses and nasal passages become inflamed and swollen (as illustrated in the picture). Acute sinusitis can last up to four weeks, while chronic sinusitis typically lasts more than four weeks and occurs more than four times in a year.

Causes

Acute sinusitis can be caused by upper respiratory tract viral infection, such as the common cold; or bacterial/fungal infections, allergies, and environmental irritants.

Chronic sinusitis can result from recurring episodes of acute sinusitis or it can be caused by other health conditions such as asthma and allergic rhinitis, immune disorders, or structural abnormalities in the nose, such as deviated septum or nasal polyps.

 Enlarged adenoids, cleft palate and tumours can also lead to chronic sinusitis.

Risk factors

-Young children are prone to colds and may have between eight and 12 bouts every year. Smaller nasal and sinus passages make children more vulnerable; while ear infections such as otitis media are also associated with sinusitis. Nevertheless, true sinusitis is very rare in children under nine years of age.

-The elderly are at specific risk for sinusitis. Their nasal passages tend to dry out with age. In addition, the cartilage supporting the nasal passages weakens, causing airflow changes. They also have diminished cough and gag reflexes and weakened immune systems

-People with asthma or allergies are at higher risk for non-infectious inflammation in the sinuses. The risk for sinusitis is higher in patients with severe asthma.

-Some hospitalised patients are at higher risk for sinusitis, particularly those with head injuries, or those whose conditions require insertion of tubes through the nose. Again, those who breathe aided by mechanical ventilators, and those whose immune system have been weakened are all susceptible to sinusitis.

-People who experience changes in atmospheric pressure, such as while flying, climbing high altitudes, or swimming, risk sinus blockage and therefore an increased risk of developing sinusitis

-Air pollution from industrial chemicals, cigarette smoke, or other pollutants can damage the cilia responsible for moving mucus through the sinuses.

General symptoms

Sinus symptoms are very common during a cold or the flu, but in most cases, they are due to the effects of the infecting virus and resolve when the infection does. Nasal congestion or discharge, itchy nose, eyes, facial pain or pressure, cough or scratchy throat, fever, diminished or absent sense of smell, recurrent sneezing, sinus headache,  migraine and or cluster headaches, ear pain or pressure, dental pain, bad breath, fatigue, are common symptoms of sinusitis.

Symptoms indicating medical emergency

Eyes may be red, bulging, or painful if the sinus infection occurs around the eyes. Swelling and drooping eyelid, loss of eye movement (possible orbital infection, which is in the eye socket), development of severe headache, altered vision, a soft swelling over the bone (indicative of bone infection) are all signs that you should see your doctor immediately.

 

To be concluded.

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