DEAR READER: Polymyalgia rheumatica (PMR) is an inflammatory disorder that results in widespread muscle aches, pains and stiffness of the hips, shoulders, thighs, upper arms and neck, fatigue, anemia, malaise and unintentional weight loss. Symptoms experienced are the result of mild inflammation of the joints and surrounding tissue. Stiffness can worsen following periods of inactivity, such as after a night’s sleep or sitting for too long.

The condition is thought to be related to an immune-system arthritic disorder that customarily goes away on its own in a year or two. Initially, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) might control the side effects. Long-term use of NSAIDs can include intestinal bleeding, hypertension, renal insufficiency, fluid retention and more. Beyond that, medication such as corticosteroids and self-help measures can go a long way toward dealing with the discomfort. The downside to long-term steroid use is possible hypertension, osteoporosis, diabetes, weight gain and cataracts.

Self-help includes a nutritious diet rich in fresh fruits and vegetables, lean meats, whole grains, calcium and vitamin D. The latter two recommendations can be satisfied through supplements. The daily recommendation for calcium in people over 50 is 1,200 milligrams per day with 600 to 800 international units (IU) of vitamin D. Exercise, primarily low-impact movement such as swimming, riding a stationary bicycle or walking, will go a long way toward reducing the pain.

Risk factors include age, race, gender and those diagnosed with giant cell arteritis. Older adults, primarily those 70 and older, are affected, and women are twice as likely as men to develop the disorder. No one is immune; however, Caucasians, Scandinavians and people from Northern Europe are most at risk. Finally, giant cell arteritis is a condition in which the temporal arteries and other areas of the body become swollen and inflamed. Almost 50 percent of all people diagnosed with giant cell arteritis are found to have polymyalgia, and up to 20 percent of those with polymyalgia develop giant cell arteritis.

Diagnosis can be made through laboratory testing that may include a rheumatoid factor, sedimentation rate, C-reactive protein, platelet and red-blood-cell counts. The only way to rule out giant cell arteritis is through biopsy from the scalp artery at the temple.

To provide related information, I am sending you copies of my Health Reports “Fibromyalgia” (a related topic) and “Managing Chronic Pain.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

For some dumb reason, I stopped taking it, and last year I had another strange episode: This time, it was strong pains in my breasts. It felt as though I was lactating, but I knew I could not be. Again, I had many doctor visits and also underwent a sophisticated mammogram. I was told I had fibromyalgia, because I also had aches and muscle pains. I disagreed with the diagnosis and began researching on my own.

We had gotten a new dog four months earlier, and, after talking to friends, I decided to stay away from the dog. Sure enough, I began feeling better. Then I told my boss at work, a female, about the strange breast pain, and she immediately told me that I must be allergic to the dog because her little boy had similar reactions to his new dog. His underarms swelled up painfully. I was elated to solve this!

We returned the dog to the shelter, and I was immediately tested for allergies. I was allergic to cats and dogs, not to mention many grasses, molds, trees and house dust. I will never stop taking my daily antihistamine, and I have been feeling great ever since restarting it.

DEAR READER: I have printed your letter because I find it interesting that you say you have joint, muscle and breast pain due to allergies.

Most allergies cause itchy, watery, red eyes; a runny nose and/or congestion; coughing, wheezing or other asthma-like symptoms; skin rashes, hives or swelling. The type of symptoms experienced depends on the allergen and how you came into contact with it. Pet dander, for example, is typically inhaled, so skin manifestations, while possible, are not generally seen.

I am unable to find any reliable scientific evidence that shows that any allergen, let alone pet dander, can cause joint, muscle or breast pain. I was able to find personal testimonies that claimed these symptoms due to allergies, but there is nothing to substantiate the claims. Perhaps this is something that should be further investigated by the medical and scientific communities.

I am not in any way dismissing your claims. I am simply stating that at this point there is no hard evidence to back up the claims. The fact that you have experienced relief by taking a daily antihistamine is compelling nonetheless.

To provide related information, I am sending you a copy of my Health Report “Allergies.” Other readers who would like a copy should send a self-addressed stamped envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

When I ask him if he warmed up before playing, he demonstrates his stretching routine by whipping his upper body back and forth. Clearly, this routine isn’t working.

Golfers exert a huge amount of effort, repetitively pounding on specific joints (usually on one side of the body). Among other ailments, this can lead to “golfer’s elbow.”

Warming up your joints is essential. Slow stretching lubricates the joints and warms the muscles surrounding them, to prevent tearing of ligaments, tendons, and other soft tissues.

To prevent injury, golfers should do exercises to strengthen the muscles supporting the joints used in golfing. That means they should do exercises to strengthen their shoulders, arms, wrists, legs, knees, ankles, abdominals and low back.

Many of our clients are golfers who compete in weekend tournaments without any preparation — and then wonder why, at the end of two grueling days, they are so sore they can barely move.

Golfers should straighten up, too. Good posture is key to achieving a great golf swing, and it is important to spinal health.

Golf also requires spinal flexibility, so try some yoga. You might be surprised at the improvements they bring to your game.

And if you still have pain after you play, visit a chiropractor. Chiropractors have extensive training in the biomechanics of human movement, so if after playing you feel pain in specific joints or muscles, you probably need those joints adjusted.

People don’t normally think of chiropractic for elbows and knees, but chiropractic is very effective in mobilizing smaller joints and relieving pain.

Your chiropractor can not only treat those repetitive stress injuries but can possibly redirect your swing pattern, improving your game while getting you out of pain.

Monica S. Nowak, DC
The Chiropractic Center of Canaan
Monica Nowak, DC and Peter Markowicz, DC
176 Ashley Falls Road
Canaan, CT 06018
860-824-0748

In 1955, at the age of 2, I contracted polio. I was immediately put in isolation in a children’s hospital, where I remained for several weeks in casts and braces. My left leg was drastically crooked and atrophied in a short amount of time.

I have since overcome most of the setbacks, but in 1985, I was diagnosed with post-polio syndrome. It was like a recrippling and decay of all my energy. Since then, I have gotten progressively worse. I have educated myself by reading much material, visiting polio clinics and attending support groups, so I feel quite knowledgeable on the subject.

My mother and sister now claim they too suffered from polio and have PPS. They were never hospitalized, never had any visible signs, and had no lingering fevers from initial exposure. They have gone for almost 50 years not claiming this. Now, as they age, they want sympathy for their “supposed” polio devastation, and I am furious. They’re claiming I’m not compassionate and think I want the “glory” all to myself.

My dad and older sister never claimed the illness, so how could anyone even want to make such an unsubstantiated claim? Is the theory possible, even without visible signs? My goodness, I would never wish this crooked body and pain-filled life on anyone. It doesn’t make sense to me. I know the entire family did have a fever in 1955, but the germ passed through everyone as diarrhea. My mother now has arthritis, and my sister has bad feet. Do they really have a claim?

DEAR READER: The polio virus can be transmitted through contaminated food or water, or through direct contact with a person infected with the virus. So anyone in close proximity to you at the time you contracted it could have also become infected. And large majorities of people are never aware they’ve become infected, because some people develop a nonparalytic form of the disease. They might experience initial symptoms of fatigue, muscle spasms, meningitis, fever, sore throat and more that can last up to 10 days.

As you are aware, PPS can develop decades after the diagnosis has been made. It can be characterized by a weakening of muscles previously affected and in muscles that were not previously affected. Some patients may develop mild symptoms; others may suffer from joint degeneration, scoliosis and more.

A diagnosis of PPS is made only if certain criteria are met. This includes documented evidence of a positive diagnosis of paralytic polio followed by an extended period (typically 15 years or more) of improvement or stability. Symptoms must begin gradually but be progressive and persistent, lasting for at least one year. Other possible causes need to be ruled out before a diagnosis of PPS can be given.

There are several risk factors for developing PPS. These include experiencing severe symptoms following the initial infection; if the initial infection were acquired as an adolescent or adult; achieving drastic recovery (especially following severe symptoms); and performing physical activities to the point of exhaustion or fatigue.

Once diagnosed with post-polio syndrome, people should be monitored for complications. Severe muscle weakness may result in increased falls. Prolonged inactivity and immobility also increase the risk of developing osteoporosis. Combined with the risk of falling, broken bones may become a major concern. People with weakness of the muscles involved in chewing, swallowing and breathing also need to be especially watchful for signs and symptoms of malnutrition, dehydration, pneumonia and acute respiratory failure. People who experienced weakness of these muscles during the initial infection are more likely to experience these symptoms than those who developed weakness of the arms and/or legs.

You appear to be in a no-win situation. Your mother and sister are convinced they suffer from PPS, and unless they are willing to undergo confirmatory testing, you will likely never convince them otherwise. I don’t know their medical histories, but based on your information, it does not seem likely that they had polio. Even if they did, it was likely so mild that it caused few or no symptoms. This drastically decreases their risks of developing PPS. I don’t understand their comments that you are seeking all the “glory” in regards to your polio status. There is nothing glorious about living with deformity and pain. Both arthritis and foot pain have other, more common causes.

I believe your efforts will be better spent continuing with the positive attitude you are exhibiting, staying abreast of new treatments, attending support groups, and visiting clinics where you can help victims of the disease learn to cope.

DEAR READER: The pain of fibromyalgia is widespread and can be felt throughout the body. Symptoms vary from person to person and can include joint stiffness, sleep disorders, fatigue, widespread pain and a great deal more. Herein lies the problem, because every symptom can be tied in to other disorders, making it difficult to diagnose.

There is no X-ray testing or laboratory work to confirm or rule out fibromyalgia. Rather, the history a patient presents to his or her physician, coupled with a hands-on examination, will likely tell the story.

Treatment commonly begins with over-the-counter remedies such as ibuprofen, aspirin or naproxen sodium, advancing to prescription medications such as gabapentin, tricyclic antidepressants, SSRIs (selective serotonin reuptake inhibitors) and narcotics. The downside to narcotics is their addictive qualities, which appear to control one condition while replacing it with another damaging one. Physical therapy and an exercise program might be an appropriate addition to more conservative methods. Water aerobics, deep breathing exercises, massage, chiropractic manipulation, acupuncture, yoga and even counseling might teach a patient methods of successfully dealing with the constant pain. There are options. Therefore, it is important that you enlist the services of a physician well versed in the treatment of fibromyalgia. Don’t give up. The condition is an unpleasant, exhausting one but there is help.

To provide related information, I am sending you a copy of my Health Report “Fibromyalgia.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.