What are the symptoms of gout?

Gout often presents with sudden “flares” or attacks of very severe pain often in the big toe, ankle, and even the knee. Often the joint affected by gout will also turn red (erythema) and will swell in size. Often, only one joint is affected, however it is possible to have gout cause pain in many joints at the same time. Gout attacks tend to occur most often at night.

The pain from gout is often extreme. Pain and swelling are usually the worst in the first part of the gout attack. Symptoms will often improve within a few days to a few weeks. Once the body is able to stop the inflammatory process the joint will resume its normal size and the pain will stop. There are several treatments that can be performed to help the body in healing a joint that is under attack from gout. If you or a loved one is dealing with gout and need help please reach out to our office by clicking here.


What is Gout?

Gout is a type of arthritis. Gout will often appear by causing pain, swelling, and even warmth in the joints. The classic finding in Gout is when, it affects the big toe. It often happens in people who have a very high level of uric acid in their blood. Uric acid is produced when the body breaks down certain types of foods. Uric acid will often form sharp needle-like crystals that form in the joints especially the large toe and will often be painful. These crystals can even form inside the tubes that we use to transport urine from the kidneys to the bladder. These crystals are often referred to as “kidney stones” and will often cause pain and stop with the flow of urine.


Fibromyalgia & Sleep Apnea A Deadly Connection

People with fibromyalgia often also have sleep apnea (this happens if a person stops breathing for a few moments when sleeping) or restless legs syndrome (an uncontrollable urge to move your legs especially when attempting to sleep). Like many painful conditions, sleep problems many times are triggers of fibromyalgia. If you have one or both of these problems, it would be wise to get a formal sleep evaluation to confirm the diagnosis. Sleep apnea is a deadly disease and many times leads to heart attack (cardiac arrest) due to the stress the illness puts on the heart. If you think you might have sleep apnea and are not sure what to do next contact our office and we will help you. Sleep Apnea is often a deadly disease.


Conditions Often Confused for Fibromyalgia

When determining whether a person’s symptoms are related to fibromyalgia or due to another condition the process is often lengthy in some cases complex. Many illnesses often cause generalized muscle aches and even fatigue as well as many of the other common symptoms of fibromyalgia.

It’s often important to realize that fibromyalgia will occur in people suffering from rheumatoid arthritis, systemic lupus erythematosus, osteoarthritis, and other illnesses (below). When this is the case, it can be difficult to determine symptoms of chronic pain and fatigue are caused by fibromyalgia or another condition. This will require a consultation with a physician who is trained to help patients with fibromyalgia.

Conditions Confused with Fibromyalgia

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) – Rheumatoid arthritis is a chronic illness that often will cause inflammation of the joints, pain, swelling, and even deformity of the joints. Lupus is another chronic, inflammatory disorder of connective tissue that affects multiple organ systems.
Both rheumatoid arthritis and lupus share symptoms with fibromyalgia they will often have other features that are not seen in people with fibromyalgia, including inflammation of connective tissue that lines the spaces between bones and joints.

Hypothyroidism – The decreased activity of the thyroid gland (hypothyroidism) will often cause fatigue, disturbance of sleep, as well as generalized aches very similar to those seen in fibromyalgia. Blood tests to measure thyroid function can be conducted to help exclude hypothyroidism. However, there are many endocrine disorders especially increased activity of the parathyroid glands known as hyperparathyroidism that will often cause symptoms similar to fibromyalgia.

Osteoarthritis – Osteoarthritis causes joint stiffness, tenderness, often pain, and even potential deformity of the joint. Osteoarthritis most commonly occurs in older people. We can differentiate osteoarthritis from fibromyalgia usually based upon a person’s medical history, physical examination, and even x-ray results. For example, with osteoarthritis x-rays will often show degenerative joint changes that are will not be present in fibromyalgia.

Muscle inflammation (myositis) — this muscle disease is often due to metabolic abnormalities also known as metabolic myopathy. These are a set of conditions that can cause muscle fatigue often with weakness, but usually does not the widespread pain pattern seen in fibromyalgia. We will often test patients with myositis as they will typically have abnormal levels of muscle enzymes.

Neurologic disorders – This includes disorders of the brain and often spinal cord and of nerves outside the spine. A detailed neurologic examination will help in determining if fibromyalgia could be from a neurologic disease. Some patients with fibromyalgia will have evidence of nerve damage and these nerves should be treated and function restored.

If you are someone who is concerned that you may have fibromyalgia or a related condition we can help you, click here to contact us. It is important that you are taken seriously and the cause of your symptoms is found.



  • Soft tissue and Muscle pain — The most common symptom of fibromyalgia is widespread chronic and persistent pain especially of the muscle and tendons. Many times when pain is felt in muscles and soft tissues there may be no visible abnormalities in the area. Often the pain is described as a “deep” muscular “aching”, “soreness” and “stiffness.” This can occur with burning and or throbbing. Many patients may feel numbness, tingling, and “crawling” sensations of the arms and legs. Muscle pain is always present, and will often vary in the level of intensity and can be aggravated by conditions like anxiety, stress, poor sleep, mild exertion, and often exposure to cold and or damp weather. People will often describe their symptoms as feeling kind of like when they have the flu.
  • Areas of Pain — Pain may often be located in specific areas, very often the neck and shoulders, this is very common in the early part of the disease. Multiple regions will eventually be involved, with many patients describing pain in the neck, middle and lower back, arms and legs, and chest wall. The areas referred to as “tender points” will often feel painful with mild to moderate pressure. Patients suffering with fibromyalgia often feel as if their joints are swollen, however often there will be no visible inflammation of the joint — unlike forms of arthritis.
  • Headaches that occur in a repeating pattern, including migraines
  • Irritable bowel (IBS) symptoms, especially frequent abdominal pain and episodes of diarrhea, constipation, and often cycles of both.
  • Painful bladder syndrome — bladder pain and urinary urgency (feeling like you have to go right now) and frequency (having to go often) are present without an infection
  • Temporomandibular joint (TMJ) syndrome — usually presents as limited jaw movement with clicking, snapping, and or popping sounds when opening or closing the mouth. This is also associated with pain of the facial and jaw muscles in or around the ear.
  • Sleep disturbances and Fatigue — Chronic fatigue (feeling tired) occurs in about 90 percent of people later diagnosed with fibromyalgia. Most people describe having unusually unrefreshing and nonrestorative sleep. The also report having difficulty falling asleep many times waking up repeatedly during the night and this leading associated with a feeling of exhaustion upon awakening
  • Anxiety and Depression — People with fibromyalgia also often have depression with or without anxiety and are more likely to develop both later in life. This is also true of many chronic pain conditions. It is important to realize that fibromyalgia is not simply a physical manifestation of depression and the two are separate illnesses.

If you are someone suffering from fibromyalgia and need assistance click here to reach out to us. There have been many breakthroughs recently to help those suffering with fibromyalgia.


What is ankylosing spondylitis?

Ankylosing spondylitis is an illness that causes stiffness and pain in the neck, back, and many times in the hips and the heel of the foot. The illness often begins by causing inflammation around the bones and joints of spine. Later, the illness may cause the bones and joints of the spine to fuse together. This joining of the joints stops them from performing their function and results in decreased movement of the spine.

Symptoms of ankylosing spondylitis:
The most common symptom in the spinal pain — neck pain, back pain. Often symptoms may include:

●Symptoms that may start in early adulthood

●Symptoms appear slowly

●Usually symptoms are present for 3 months or greater

●The pain is often worse after resting, especially the first thing in the morning. People often feel as if they are “locked up” and have to get moving to feel better.

●Pain is often worse during bad weather, due to changes in barometric pressure

●Pain in important joints — hips or shoulders

●Swelling in other joints of the body — elbows, ankles and knees

●Feeling low energy and often tired (fatigue)

●Inflammation in part of the eye – this may cause eye pain and blurry vision.

●Fractures around the spinal cord – Ankylosing spondylitis can often makes lead to fractures of neck or back. This can occur even from a fall or small accident.

If not treated the person’s spine will often become less flexible. This results in difficulty in bending forward to put on shoes. The illness often will lead to a “hunchback” appearance over time.

●Inflammation of the intestines — may feel bloated (usually minor)

Testing for Ankylosing Spondylitis

There is not just one test for ankylosing spondylitis. In order to diagnose ankylosing spondylitis from your symptoms, performing an exam, and reviewing imaging tests (like X-rays) . We sometimes might perform blood tests, as well.

Treating Ankylosing Spondylitis

The goal of treatment of ankylosing spondylitis is to relieve the symptoms, starting with pain. There are new cutting edge treatments that may help with restoring the joints allowing a return to normal activities, and potentially stop the condition from causing further damage.

Working with a qualified physical therapist will often help increase function. During this time the physical therapist will work on your posture. This can stop a “hunchback” posture from forming.

There are many medications that can treat ankylosing spondylitis These basics include:

●NSAIDs (anti inflammatory medications) – This group of medicines includes ibuprofen ( aka Advil or Motrin) and often naproxen (aka Aleve and Naprosyn). NSAIDs will often help relieve minor pain and some stiffness. Often these medications may need to be supplemented with additional pain relieving medications and treatments.

●Other medicines – There are other medicines that can help treat symptoms and keep ankylosing spondylitis from getting worse. Your doctor or nurse will decide which medicines are best for you.

There have been many exciting case reports of improvements with the use of stem cell like products (regenerative medicine). Case reports have even show that these advanced treatments have helped some with severe ankylosing spondylitis.

It is very important that if the bones in your spine have fused together enough, you may be at risk of serious neck and back injury. It is important to determine if this is the case and take precautions until treatment can start.

If you or a loved one is dealing with ankylosing spondylitis and needs help reach out to our office by clicking here.


Causes of Fibromyalgia

While the exact cause of fibromyalgia is unknown. Research has shown some interesting facts that indicates that the cause likely lays in the balance of the autonomic nervous system. The nervous system that runs important things like our heart beat, breathing and many things we don’t commonly think about. Various physical factors (such as infection or injury) may play a role in causing symptoms, although if not properly treated patients can report a lifelong history of chronic pain.

With fibromyalgia, the muscles and tendons are overly irritated by many painful stimuli. This could to be due to an increased perception of pain, a phenomenon often called “central sensitization.” Many times other conditions also develop as a result of central sensitization, including irritable bowel syndrome (IBS); chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS); headaches; pelvic and bladder pain; and even jaw and facial pain.

While there we are still learning how or why central sensitization occurs in many people, the most explanation suggests that it may be related to genetic component. People with a parent and or a sibling with fibromyalgia have a greater chance of developing it as well. In many cases, stressors such as infection (eg, Lyme disease or viral disease), illnesses that cause joint inflammation (eg, rheumatoid arthritis or systemic lupus erythematosus (SLE), physical trauma, and sleep disturbances will often trigger fibromyalgia.

Brain imaging studies in people with fibromyalgia have shown changes in areas of brain function. Research is continuing, many factors that lead to chronic pain in fibromyalgia are becoming understood. There are many treatments that can help fibromyalgia. If you or someone you love is suffering from fibromyalgia and need assistance please contact us by clicking here.



The Tender Points of Fibromyalgia

Fibromyalgia is likely on of the most misused and misunderstood diagnosis in medicine. So let’s set it straight today. Fibromyalgia is a group of pain disorders that affect connective tissues, including the muscles, ligaments (tough bands of tissue that connect the ends of bones), and tendons (attach muscles to bones). It is a condition that causes widespread muscle pain (also called a “myalgia”) and extreme tenderness in many areas of the body. Patients often will also experience fatigue (feeling tired), sleep disturbances, headaches, and even mood disturbances which often show up as depression and anxiety. Research is ongoing but we are beginning to understand the cause and improvements have been made in diagnosing fibromyalgia. There are still many things about fibromyalgia that are not clear.

For the United States, fibromyalgia affects approximately 8 percent of people and is the most common cause of musculoskeletal pain in women between 20 and 55 years. Fibromyalgia is more common in women than men.


What is complex regional pain syndrome?

Complex regional pain syndrome (CRPS) is a condition that causes pain, swelling, and many other symptoms. CPRS usually occurs in just one part of the body, such as an arm or leg. Although there are a small percentage of patients can have symptoms on both the right and left side of their body. For example, Right and Left leg.

Many time CRPS will occur in the an extremity such as a hand or foot.

CRPS often starts after a bone fracture, injury (such as a sprain), surgery, or a stroke. Most people who have CRPS often have pain that is more severe than what most doctors would expect from the injury, surgery, or other medical problem. In some cases, especially in children, CRPS can start without an injury or surgery.

Here are the symptoms of complex regional pain syndrome (CPRS):

Symptoms of CRPS can include:

●Pain – The pain can be burning, tingling, throbbing, or aching. It is also usually severe. In many cases patients may have pain from normal touch this is referred to as allodynia.

●Being sensitive to touch or cold, or not feeling touch or pain normally.

●Swelling in the body part with CRPS

●Difficulty moving the body part with CRPS due to pain, swelling, and or stiffness

●Shaking or muscle spasm in the body part affected by CRPS

●Skin changes – includes changes in skin thickness, temperature, very commonly color of skin changing, or sweating more or less than usual.

●Changes in the way the hair and nails develop and grow

Often, the first symptoms of CRPS include pain, redness, and swelling of the affected area. Usually the area with CRPS will feel warm initially, but later will often change from warm to cold. In some patients, they will feel cold initially.

How do you test for complex regional pain syndrome?

There is not just one test to diagnose CRPS. Often we can block the affected nerve to that area to see if it could be the cause of the pain.

The doctor or nurse will do an exam and ask questions. He or she can usually tell if a person has CRPS from the symptoms, medical history, and exam.

If we are not sure if a person has CRPS, we might order imaging tests such as a bone scan, X-ray, or MRI. These tests can show changes to the bones, joints, or skin that are often caused by CRPS.

Occasionally we will do tests that measure skin temperature, sweating, and often nerve sensitivity. These tests can help determine if there is a neuropathy that could be causing the CPRS.

How complex regional pain syndrome is treated:

Treatment for CRPS is different for each person. Depending on the cause of the CPRS different treatments may be needed to see what works best.

Treatments for CRPS include:

●Turning off nerves (usually by injections) that may be causing the CPRS to occur

●Placement of pain “pace-makers” that turn off painful stimulation to one area of the body.

●Physical therapy to perform exercises and stretches, and keep the body part with CRPS mobile and functional.

●Taking medicines to relieve pain – These can be prescription or over-the-counter pain relieving medicines.

●Injections (shots) of numbing or pain-relieving medicines

●Pain-relieving medicine given in the spine

●Devices to help stop nerve signals of pain

Complex Regional Pain Syndrome can it be prevented?

There have been case reports of vitamin C usually given IV after breaking a bone or having surgery might help prevent CRPS. Unfortunately, it is not clear. Occasionally, we offer IV therapy to correct deficits during the healing stages of CPRS.

If you are concerned about having CPRS or are looking for help please contact our office by clicking here.


Why Is My Neuropathy Worse At Night?

For many patients who are dealing with neuropathy pain, finding answers may often be hard to come by due to lack of adequate testing. Questions such as “why is my neuropathy worse at night?” can only be answered by understanding how much the autonomic nervous system is damaged. Our nervous system is combined of two parts: the somatic nervous system (SNS) and the Autonomic Nervous system (ANS).

The autonomic nervous system is very important. The ANS supplies smooth muscle and glands, and influences the function of our internal organs. The ANS is a nervous system that acts largely unconsciously and regulates bodily functions, such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. The best way to see this system in action is when you get startled or sense there is danger you will often receive a fight-or-flight response. Think about how your body changes if you become suddenly aware of a threat, that is your ANS at work.

Autonomic Nervous System Testing for Neuropathy

Before treating any form of neuropathy it is wise to perform a comprehensive, autonomic nervous test. This is very useful to determine the cause of the neuropathy and uncover hidden disease.

Testing the autonomic nervous system can identify clinical disorders and uncover major illness and other hidden diseases, such as:

  • Sudden Death
  • Silent Heart Attack
  • Hypertension (high blood pressure
  • Cardiac Autonomic Neuropathy (problems with heart rate and rhythm)
  • Vascular Abnormalities (problems with blood vessels)
  • Orthostatic Hypotension (feeling dizzy or lightheaded when standing suddenly)
  • Syncope (passing out)

Why it is important to test your Autonomic Nervous System (ANS):

According to Published Studies:

  • Nerve damage to the nerves around the heart occurs in about 17% of patients with type 1 diabetes and about 22% of people with type 2 diabetes.
  • Some research has indicated that in patients with ANS dysfunction that has symptoms, 25% to 50% die within 1 to 5 years of diagnosis. It is very important to determine how far the neuropathy has gone and if it has affected the heart and blood vessels.
  • A patient’s history and physical examination often don’t show problems with the autonomic nervous system (ANS).

It is recommended that all patients with Diabetes receive screening. The specific recommendations are that screening for problems with the Autonomic nervous system should be performed at the diagnosis of Type 2 Diabetes and after the diagnosis of type 1 Diabetes according to the 2005 ADA Standard of Diabetes Care

People with diabetes may have problems with the nerves around their heart and this can cause severe heart problems and sudden death, surveys show that only 2% of people with diabetes are tested for ANS neuropathy

If you have neuropathy and have not been tested please reach out to our office we would be happy to help you on your road to recovery and defeating neuropathy.