26y/f. Housewife,3 son live C/o Irregular menstruation peroid and mild abdomen pain since 6 month. Already PS done since 3 years ago. No h/o dm htn thyroid Vital normal Wt 63kg Mild paller Thyroid normal Hb 9.3 No anxity Rx dx

WHAT IS FIBROMYALGIA? Fibromyalgia is a disorder that causes aches and pain all over the body. It is a chronic (ongoing) condition of pain, stiffness, and usually fatigue. The symptoms sometimes get better and at other times get worse, but you will likely keep having symptoms for months to years. Although the illness can cause a lot of discomfort, it does not damage your joints, muscles, or other tissues, and it does not shorten your life. Fibromyalgia affects several million people in the US. It is usually diagnosed in middle age although symptoms may start at an earlier age. It affects women more often than men. Although it is uncommon, it does sometimes occur in children. WHAT IS THE CAUSE? What fibromyalgia is exactly, or what causes it, is not known. Fibromyalgia has been linked to: Emotional or physical stress Anxiety Depression Traumatic events such as a car accident Infections or other illness Lack of restful sleep Women who have a family member with fibromyalgia are more likely to have it themselves. It is not known if this is due to hereditary or environmental factors. Researchers are working to find possible causes of the symptoms. One theory is that fibromyalgia causes a lower pain threshold. This may be because the brain has gotten more sensitive to the chemicals that send pain signals, or there are more of these chemicals than normal. WHAT ARE THE SYMPTOMS? Pain is the main symptom. The aches, pains, and stiffness may be different day to day or week to week. The pain may move from one part of the body to another. It is most common in the neck, chest, arms, legs, hips, and back. Other common symptoms are: Tiredness Headaches Problems with the digestive system, especially trouble swallowing, abdominal pain, an upset stomach, or diarrhea You may have: Trouble sleeping Problems with thinking and remembering things Depression Anxiety Dizziness or lightheadedness Painful menstrual periods Restless legs People with fibromyalgia are tender throughout the body. The tenderness is most noticed at specific places on the neck, shoulders, back, hips, arms, and legs. These places are called tender points. These points hurt when pressure is put on them. The symptoms may get worse when you exert yourself too much or when the weather is damp and cold. Younger adults with fibromyalgia are more likely to have chronic headaches or anxiety. Their symptoms may get worse more easily from weather, mental stress, or poor sleep. HOW IS IT DIAGNOSED? Your healthcare provider will ask about your symptoms and medical history and examine you. Your provider will look for places that are tender. There is no one test that diagnoses fibromyalgia. However, you may have blood tests to make sure you don’t have any conditions that cause symptoms similar to fibromyalgia, such as rheumatoid arthritis. HOW IS IT TREATED? The most successful treatment is a healthy diet, regular exercise, and rest. Your diet should include a large variety of fruits and vegetables. These foods provide trace elements and minerals that help the muscles. Also, the fiber in fruits and vegetables helps the digestive system. Exercise affects the levels of many biochemicals in the body, particularly in the nervous system. This may be why symptoms of fibromyalgia often get better if you exercise regularly. Because much of the pain of fibromyalgia is in the muscles and joints, you should begin an exercise program gradually. Ask your healthcare provider or a physical therapist for an exercise plan. Include good warm-ups and cool-downs. Do types of exercise that do not hurt your joints. Rest is as important as diet and exercise. Make sure you get enough restful sleep. In the evening avoid stimulating foods and drinks (such as coffee and soft drinks with caffeine) and certain medicines (for example, decongestants). If diet, exercise, and rest do not relieve your symptoms, your healthcare provider may prescribe medicine to help relieve some of the symptoms. There is no medicine that can cure fibromyalgia. However, some medicines may help some of the symptoms, such as: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, for pain (NSAIDs, such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason.) Muscle relaxants to help prevent muscle spasm and strain caused by the pain Antidepressants, which may help you sleep better and may also help relieve pain Medicine for depression or pain caused by problems with nerves Your provider can help to find other ways to reduce your pain and tiredness, such as heat, biofeedback, or massage therapy. HOW CAN I TAKE CARE OF MYSELF? Get regular exercise, according to your healthcare provider's recommendations. A lack of physical activity can worsen your pain. Eat a healthy diet that includes a lot of whole grains, fruits, and vegetables. Healthy foods will give you energy, help you feel better, aid your digestion, and help you avoid other health problems. Nutritional supplements may be helpful for some people, but talk to your healthcare provider before using supplements. Practice good sleep habits. Work to establish a regular, night-time sleep pattern. Make sure you get enough sleep every night. If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking. Avoid doing too much at one time. Break up daily activities with periods of rest. Treat painful areas with a heating pad on a low setting or an ice pack wrapped in a towel, whichever works best for you. Some people find that switching between heat and cold is helpful. Try to practice new ways to react to pain and manage stress. For example, try relaxation exercises or meditation. A therapist may be able to help with this. If your provider recommended or prescribed medicine, take it exactly as directed. Ask your provider how soon the medicine should start helping you feel better. Let your provider know if it has helped. If it hasn’t, you may need a different dose or a different medicine. Keep your follow-up appointments. It is helpful to you and your provider to keep track of how your symptoms change over time and whether your treatments are helping your symptoms. Note exercise,stretching and massage can prescribed according to area involved. Neck or back or arms or legs or combined.There may be many other apporaches to this problem apart form physiotherapy

Patient with facial trauma Having sinus tachycardia with hypertension See the monitor, Just start NTG infusion but BP not comes down BP around 180/110 continue 8-10 hours No any history oh CAD,HTN,DM Kindly suggest

patient21year old suffering from pain in abdomen with irregular menstruation and sudden wait loss monoxide negetive and USG shows rt ovarian cyst upto 4.8×3.8cm pls suggest your best opinion

A patient age 27 male came in my clinic along with sympyoms as follows *a lypoma develope on the fore arm right side ,and another is on right lumber region *complain since 3 years *no any pain,burning,and ithing *spogy EASELY moveble *mentally anger *like, sweet,meat, *hot patient *stool NAD *sleep normal *dreem lassivius *familiar history ,NAD__grandefather,cardiac , resently heart operated please doctors advice good treatement