Hi,

Thanks for posting your query to me.

It is unfortunate to be suffering with these medical problems. I shall try to provide you with enough information which should be helpful to you.

Most of the symptoms that you have since 2009 can be part of fibromyalgia. However I am not sure if few other medical conditions such as thyroid disturbances, vitamin b-12 deficiency, depression, diabetes and so on have been ruled out. Systemic fungal infection is unlikely if you are not immunocompromised. The tests and investigations done so far can be helpful to me in this context. So I wish you to upload the results of investigations / tests done so far using the option provided on the right side of this page. In case you face difficulties while uploading, send the scanned reports to my attention (Attn: Dr.Prasad) by mail to YYYY@YYYY

I hope the ligament tear injury that you had is better now.

Few other symptoms mentioned that may not be related to fibromyalgia are as follows. I shall address those now.

1. Sneezing: Sneezing is most likely due to allergic cause. I hope this is not bothering you much. If yes, saline nasal drops / sprays and antihistamine drugs can be used whenever required. Steroid nasal preparations such as flixonase can be used briefly for frequent recurrence.

2. Dandruff: Dandruff is usually caused by Pityriasis simplex capillitii - a fungus. I am sure this may not be the cause of your wife's medical condition. Antifungal shampoo such as "Nizoral" should take care of it.

3. Constipation / gas and stomach pain: Indigestion, gastritis/reflux gastritis or irritable bowel can be a cause. Dietary and lifestyle changes and a brief course of pantoprazole taken under the guidance of your local physician can be useful. You may try this with the help of your local physician.

Awaiting your reply

Best Regards

---

Hi and thanks again,

I understand your apprehension. Presuming your general condition is fine and your immunity is intact, there is very, very less chances of this being a case of systemic fungal infection or any other infection. The reports can enlighten me if you have any other associated conditions.

I appreciate your efforts to consult me physically. Since you have been diagnosed to have fibromyalgia earlier, I am not accepting patients with fibromyalgia as there are better qualified experts like Rheumatologist treating it.

Awaiting your response

Best Regards

---

Dear XXXXXXX

Thanks for sending your report.

Tongue scraping suggests ORAL Candida albicans infection. Candidal infections are hard to treat, as one needs prolonged treatment and recurrences are common.
The report is a year old and if these lesions haven't changed characteristics, I presume you still could be suffering with oral candidiasis. You might need a repeat treatment with oral antifungal for 3-4 weeks.

I understand you are worried about systemic infections, especially fungal. It would have been good if you had uploaded other tests such as recent complete hemogram, blood sugars, thyroid function tests, vitamin B12 levels and so on.

As described in my first response that you do not seem to be suffering from an infection, I shall put forward a few points as evidences.
1. Fever is the most common symptom of infection. Absence of continuous / very frequent fever suggest that you DO NOT suffer an infection.
2. Systemic / disseminated fungal infection usually presents with other mucosal infection such as genital fungal infection, Urine examination and stool studies would reveal the organism if you were to be suffering with it.
3. Systemic / dissemination fungal infection is rarely present in a normal individual (with normal immunity). Your blood sugars and complete hemogram are indirect indicators of intact immunity. So if your recent hemogram and blood sugars are not affected severely, chances of systemic candidiasis are unlikely.

I hope you agree with me this time. Now, to determine the cause of your symptoms, we need to consider evaluating you. A few investigations that need to be looked at initially are:
1. Complete hemogram (hemoglobin, total leucocyte count, differential counts and erythrocyte sedimentation rate) blood sugars, thyroid function tests, etc.
2. Endoscopy - Gastroscopy / colonoscopy to rule out gastrointestinal pathology

In addition to these, you also need to consider restarting treatment of fibromyalgia. Selective serotonin reuptake inhibitors (SSRI) drugs may be helpful here.

I appreciate your efforts to consult me personally, however as the symptoms are related to multiple systems, you would need multidisciplinary approach consisting of a general physician, gastroenterologist, rheumatologist as well as clinical psychologist. You should be able to resolve your problems by working with these doctors closely.

Hope it is clear now and you find a XXXXXXX of hope. Do close this discussion if you are convinced with my response now.

All the best

Best Regards

---