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My Girlfriend Is A Hypochondriac That Gets Sick A Lot.
Question: my girlfriend is a hypochondriac that gets sick a lot. She has been diagnosed with depression, mononucleosis, urinary tract infections, vaginal infections (group B strep) (bacterial vaginosis) (yeast infections) (protozoan parasite) and more health issues than I can keep track of. I've been in the office with her when many of these diagnosis have been given, and I know her pain is real. I think her immune system is out to lunch, so to speak. She has not been able to maintain functional homeostasis for at least the past 7 years. I feel helpless. I think she has a serious immune system problem that every doctor she sees doesn't take seriously because of the odds involved with immune system problems. I know the odds are low, but she has not been able to work for many years because of these chronic illnesses. Thus here I am looking for answers. My number one question is what has to happen for a doctor to take the time to investigate her immune functionality?
thanks,
JP
thanks,
JP
my girlfriend is a hypochondriac that gets sick a lot. She has been diagnosed with depression, mononucleosis, urinary tract infections, vaginal infections (group B strep) (bacterial vaginosis) (yeast infections) (protozoan parasite) and more health issues than I can keep track of. I've been in the office with her when many of these diagnosis have been given, and I know her pain is real. I think her immune system is out to lunch, so to speak. She has not been able to maintain functional homeostasis for at least the past 7 years. I feel helpless. I think she has a serious immune system problem that every doctor she sees doesn't take seriously because of the odds involved with immune system problems. I know the odds are low, but she has not been able to work for many years because of these chronic illnesses. Thus here I am looking for answers. My number one question is what has to happen for a doctor to take the time to investigate her immune functionality?
thanks,
JP
thanks,
JP
Brief Answer:
Immunologic tests are done if certain patterns are noticed- detailed answer below
Detailed Answer:
Hello,
I carefully read your question and understand with the frustration you are having related to your girlfriend health issues.
Immune deficiency is a possible diagnosis even though the odds are low. On the other hand there are specific characteristics that the doctor looks for before they consider a diagnosis of immune deficiency.
Almost all the infections you have mentioned above are common infection that happen to people with normal immune function as well and especially in women.
Immune deficiency would cause repeat infections of a certain type depending on the kind of the immune deficiency. Some are more prone to bacterial infection that would cause them to have more pneumonia and other serious infections. Some would be more sensitive to infections where immunglobulines are needed like viral infections that in these cases may be fatal infections and very difficult to control. She would be hospitalized often due to severity of infections.
If she gets common infections that are easily and successfully treated outpatient, no weight loss, then very likely she does not have immune deficiency.
It is not recommended to have extensive examinations and tests for patients that are not found to have complaints or physical evidence of something serious because this would feed their need for investigations and it will not improve their understanding of their health situation.
Still there are a few basic tests that can be done routinely to make sure she is in good health like CBC, ERS, HIV test, TSH and FT4 and basic metabolic profile. If she is over 21 years of age she needs regular pap smears as well.
If a patient has problems with depression they might have many fears related to their health as well and also might have low threshold for symptoms and be prone to experience things more intense then other patients would. Supportive therapy (listening to her and being a good friend to her), healthy and active lifestyle, counseling and medications for depression will help control these as well.
I hope this answers to your question and is helpful to you. Let me know if I can assist you further.
Kind regards,
Dr. Antoneta Zotaj, General and Family Physician
Immunologic tests are done if certain patterns are noticed- detailed answer below
Detailed Answer:
Hello,
I carefully read your question and understand with the frustration you are having related to your girlfriend health issues.
Immune deficiency is a possible diagnosis even though the odds are low. On the other hand there are specific characteristics that the doctor looks for before they consider a diagnosis of immune deficiency.
Almost all the infections you have mentioned above are common infection that happen to people with normal immune function as well and especially in women.
Immune deficiency would cause repeat infections of a certain type depending on the kind of the immune deficiency. Some are more prone to bacterial infection that would cause them to have more pneumonia and other serious infections. Some would be more sensitive to infections where immunglobulines are needed like viral infections that in these cases may be fatal infections and very difficult to control. She would be hospitalized often due to severity of infections.
If she gets common infections that are easily and successfully treated outpatient, no weight loss, then very likely she does not have immune deficiency.
It is not recommended to have extensive examinations and tests for patients that are not found to have complaints or physical evidence of something serious because this would feed their need for investigations and it will not improve their understanding of their health situation.
Still there are a few basic tests that can be done routinely to make sure she is in good health like CBC, ERS, HIV test, TSH and FT4 and basic metabolic profile. If she is over 21 years of age she needs regular pap smears as well.
If a patient has problems with depression they might have many fears related to their health as well and also might have low threshold for symptoms and be prone to experience things more intense then other patients would. Supportive therapy (listening to her and being a good friend to her), healthy and active lifestyle, counseling and medications for depression will help control these as well.
I hope this answers to your question and is helpful to you. Let me know if I can assist you further.
Kind regards,
Dr. Antoneta Zotaj, General and Family Physician
Above answer was peer-reviewed by :
Dr. Raju A.T
Brief Answer:
Immunologic tests are done if certain patterns are noticed- detailed answer below
Detailed Answer:
Hello,
I carefully read your question and understand with the frustration you are having related to your girlfriend health issues.
Immune deficiency is a possible diagnosis even though the odds are low. On the other hand there are specific characteristics that the doctor looks for before they consider a diagnosis of immune deficiency.
Almost all the infections you have mentioned above are common infection that happen to people with normal immune function as well and especially in women.
Immune deficiency would cause repeat infections of a certain type depending on the kind of the immune deficiency. Some are more prone to bacterial infection that would cause them to have more pneumonia and other serious infections. Some would be more sensitive to infections where immunglobulines are needed like viral infections that in these cases may be fatal infections and very difficult to control. She would be hospitalized often due to severity of infections.
If she gets common infections that are easily and successfully treated outpatient, no weight loss, then very likely she does not have immune deficiency.
It is not recommended to have extensive examinations and tests for patients that are not found to have complaints or physical evidence of something serious because this would feed their need for investigations and it will not improve their understanding of their health situation.
Still there are a few basic tests that can be done routinely to make sure she is in good health like CBC, ERS, HIV test, TSH and FT4 and basic metabolic profile. If she is over 21 years of age she needs regular pap smears as well.
If a patient has problems with depression they might have many fears related to their health as well and also might have low threshold for symptoms and be prone to experience things more intense then other patients would. Supportive therapy (listening to her and being a good friend to her), healthy and active lifestyle, counseling and medications for depression will help control these as well.
I hope this answers to your question and is helpful to you. Let me know if I can assist you further.
Kind regards,
Dr. Antoneta Zotaj, General and Family Physician
Immunologic tests are done if certain patterns are noticed- detailed answer below
Detailed Answer:
Hello,
I carefully read your question and understand with the frustration you are having related to your girlfriend health issues.
Immune deficiency is a possible diagnosis even though the odds are low. On the other hand there are specific characteristics that the doctor looks for before they consider a diagnosis of immune deficiency.
Almost all the infections you have mentioned above are common infection that happen to people with normal immune function as well and especially in women.
Immune deficiency would cause repeat infections of a certain type depending on the kind of the immune deficiency. Some are more prone to bacterial infection that would cause them to have more pneumonia and other serious infections. Some would be more sensitive to infections where immunglobulines are needed like viral infections that in these cases may be fatal infections and very difficult to control. She would be hospitalized often due to severity of infections.
If she gets common infections that are easily and successfully treated outpatient, no weight loss, then very likely she does not have immune deficiency.
It is not recommended to have extensive examinations and tests for patients that are not found to have complaints or physical evidence of something serious because this would feed their need for investigations and it will not improve their understanding of their health situation.
Still there are a few basic tests that can be done routinely to make sure she is in good health like CBC, ERS, HIV test, TSH and FT4 and basic metabolic profile. If she is over 21 years of age she needs regular pap smears as well.
If a patient has problems with depression they might have many fears related to their health as well and also might have low threshold for symptoms and be prone to experience things more intense then other patients would. Supportive therapy (listening to her and being a good friend to her), healthy and active lifestyle, counseling and medications for depression will help control these as well.
I hope this answers to your question and is helpful to you. Let me know if I can assist you further.
Kind regards,
Dr. Antoneta Zotaj, General and Family Physician
Above answer was peer-reviewed by :
Dr. Raju A.T
So basically she has to get very sick to get better, is what you're telling me? I don't disagree that supporting her emotionally is best, but it's not enough. She can't be active because of the pain she lives with every day. Whether you believe it to be psychosomatic or not, the pain is very real to her.
"feed their need for investigations"
I advise refraining from this type of language, not just with me, but in the future. Think about why: she is in pain, cannot be active physically because of the pain(I acknowledge this is a serious problem for treatment, particularly due to how good exercise is for depression), and doctors have this attitude of wanting nothing more to do with the patient. Can you see how this creates a frustrating situation for the patient and the ones that care about the patient?
"feed their need for investigations"
I advise refraining from this type of language, not just with me, but in the future. Think about why: she is in pain, cannot be active physically because of the pain(I acknowledge this is a serious problem for treatment, particularly due to how good exercise is for depression), and doctors have this attitude of wanting nothing more to do with the patient. Can you see how this creates a frustrating situation for the patient and the ones that care about the patient?
So basically she has to get very sick to get better, is what you're telling me? I don't disagree that supporting her emotionally is best, but it's not enough. She can't be active because of the pain she lives with every day. Whether you believe it to be psychosomatic or not, the pain is very real to her.
"feed their need for investigations"
I advise refraining from this type of language, not just with me, but in the future. Think about why: she is in pain, cannot be active physically because of the pain(I acknowledge this is a serious problem for treatment, particularly due to how good exercise is for depression), and doctors have this attitude of wanting nothing more to do with the patient. Can you see how this creates a frustrating situation for the patient and the ones that care about the patient?
"feed their need for investigations"
I advise refraining from this type of language, not just with me, but in the future. Think about why: she is in pain, cannot be active physically because of the pain(I acknowledge this is a serious problem for treatment, particularly due to how good exercise is for depression), and doctors have this attitude of wanting nothing more to do with the patient. Can you see how this creates a frustrating situation for the patient and the ones that care about the patient?
Brief Answer:
Pain is real in the patient no mater the origin (physical or not)- more information is needed on the pain to understand its origin and possible treatment- explanations below
Detailed Answer:
Hello,
I understand that this is a very difficult situation for you and your girlfriend. The pain being physical or not, it does feel real to the patient, this is something that is quite true. What i wanted to say with "feed the need for investigations" is that it is found that when patients require investigations but the doctor does not find enough evidence by the history or examination that these investigations will help in diagnosis of a certain condition, having the investigations done will not help the patient, actually it affects them for worse and they will require even more extensive examinations which will make their fears and concerns worse. It seems that at the moment they feel good they are having the examinations but as soon as no clear diagnosis comes out with them they get more anxious about their health.
it is spoken very little of the pain in the first email, it was mostly spoken of infections. Pain can really affect the patient and the daily activities so i understand it is frustrating for her and for you as well. On the other hand there are several conditions that might cause pain and a good history of the pain itself (for how long, where exactly it is, what triggers the pain and what makes it worse, if it is associated with other symptoms like redness or swelling of joints, fever, fatigue, weight loss or other possible symptoms) are important to determine the cause.
I would like to hear more about her pain problems and the characteristics as asked above, to better understand the cause of them and give advice related to the pain.
Most of the time, around 85% of the patients are diagnosed based on the history and physical exam and tests and other examinations are needed in a small number of patients and as guided by history and physical examination.
Please feel free to reply to this message with some information on the pain she is experiencing, treatments she is taking for the depression and any other information that you think would be of help.
Thank you for your reply and i hope to hear soon from you.
Kind regards,
Dr. Antoneta Zotaj, General and Family Physician
Pain is real in the patient no mater the origin (physical or not)- more information is needed on the pain to understand its origin and possible treatment- explanations below
Detailed Answer:
Hello,
I understand that this is a very difficult situation for you and your girlfriend. The pain being physical or not, it does feel real to the patient, this is something that is quite true. What i wanted to say with "feed the need for investigations" is that it is found that when patients require investigations but the doctor does not find enough evidence by the history or examination that these investigations will help in diagnosis of a certain condition, having the investigations done will not help the patient, actually it affects them for worse and they will require even more extensive examinations which will make their fears and concerns worse. It seems that at the moment they feel good they are having the examinations but as soon as no clear diagnosis comes out with them they get more anxious about their health.
it is spoken very little of the pain in the first email, it was mostly spoken of infections. Pain can really affect the patient and the daily activities so i understand it is frustrating for her and for you as well. On the other hand there are several conditions that might cause pain and a good history of the pain itself (for how long, where exactly it is, what triggers the pain and what makes it worse, if it is associated with other symptoms like redness or swelling of joints, fever, fatigue, weight loss or other possible symptoms) are important to determine the cause.
I would like to hear more about her pain problems and the characteristics as asked above, to better understand the cause of them and give advice related to the pain.
Most of the time, around 85% of the patients are diagnosed based on the history and physical exam and tests and other examinations are needed in a small number of patients and as guided by history and physical examination.
Please feel free to reply to this message with some information on the pain she is experiencing, treatments she is taking for the depression and any other information that you think would be of help.
Thank you for your reply and i hope to hear soon from you.
Kind regards,
Dr. Antoneta Zotaj, General and Family Physician
Above answer was peer-reviewed by :
Dr. Raju A.T
Brief Answer:
Pain is real in the patient no mater the origin (physical or not)- more information is needed on the pain to understand its origin and possible treatment- explanations below
Detailed Answer:
Hello,
I understand that this is a very difficult situation for you and your girlfriend. The pain being physical or not, it does feel real to the patient, this is something that is quite true. What i wanted to say with "feed the need for investigations" is that it is found that when patients require investigations but the doctor does not find enough evidence by the history or examination that these investigations will help in diagnosis of a certain condition, having the investigations done will not help the patient, actually it affects them for worse and they will require even more extensive examinations which will make their fears and concerns worse. It seems that at the moment they feel good they are having the examinations but as soon as no clear diagnosis comes out with them they get more anxious about their health.
it is spoken very little of the pain in the first email, it was mostly spoken of infections. Pain can really affect the patient and the daily activities so i understand it is frustrating for her and for you as well. On the other hand there are several conditions that might cause pain and a good history of the pain itself (for how long, where exactly it is, what triggers the pain and what makes it worse, if it is associated with other symptoms like redness or swelling of joints, fever, fatigue, weight loss or other possible symptoms) are important to determine the cause.
I would like to hear more about her pain problems and the characteristics as asked above, to better understand the cause of them and give advice related to the pain.
Most of the time, around 85% of the patients are diagnosed based on the history and physical exam and tests and other examinations are needed in a small number of patients and as guided by history and physical examination.
Please feel free to reply to this message with some information on the pain she is experiencing, treatments she is taking for the depression and any other information that you think would be of help.
Thank you for your reply and i hope to hear soon from you.
Kind regards,
Dr. Antoneta Zotaj, General and Family Physician
Pain is real in the patient no mater the origin (physical or not)- more information is needed on the pain to understand its origin and possible treatment- explanations below
Detailed Answer:
Hello,
I understand that this is a very difficult situation for you and your girlfriend. The pain being physical or not, it does feel real to the patient, this is something that is quite true. What i wanted to say with "feed the need for investigations" is that it is found that when patients require investigations but the doctor does not find enough evidence by the history or examination that these investigations will help in diagnosis of a certain condition, having the investigations done will not help the patient, actually it affects them for worse and they will require even more extensive examinations which will make their fears and concerns worse. It seems that at the moment they feel good they are having the examinations but as soon as no clear diagnosis comes out with them they get more anxious about their health.
it is spoken very little of the pain in the first email, it was mostly spoken of infections. Pain can really affect the patient and the daily activities so i understand it is frustrating for her and for you as well. On the other hand there are several conditions that might cause pain and a good history of the pain itself (for how long, where exactly it is, what triggers the pain and what makes it worse, if it is associated with other symptoms like redness or swelling of joints, fever, fatigue, weight loss or other possible symptoms) are important to determine the cause.
I would like to hear more about her pain problems and the characteristics as asked above, to better understand the cause of them and give advice related to the pain.
Most of the time, around 85% of the patients are diagnosed based on the history and physical exam and tests and other examinations are needed in a small number of patients and as guided by history and physical examination.
Please feel free to reply to this message with some information on the pain she is experiencing, treatments she is taking for the depression and any other information that you think would be of help.
Thank you for your reply and i hope to hear soon from you.
Kind regards,
Dr. Antoneta Zotaj, General and Family Physician
Above answer was peer-reviewed by :
Dr. Raju A.T
She has all the symptoms of pelvic floor syndrome, vaginal and abdominal pain on a daily basis, nausea, spurts of dizziness. She says she can feel it as high as her mid back and up to her ribs on her front side, perhaps as high as the lowest thoracic vertebra.
My earlier question was not rhetorical:
So basically she has to get very sick to get better, is what you're telling me?
If it's immune deficiency of some kind. The answer seems to be yes this seems to be a crack that many may fall through. If not my girlfriend, then one with actual immune deficiency problems is likely to become very sick before getting the attention they need.
"What i wanted to say with "feed the need for investigations" is that it is found that when patients require investigations but the doctor does not find enough evidence by the history or examination that these investigations will help in diagnosis of a certain condition, having the investigations done will not help the patient, actually it affects them for worse"
I'm not sure it could be worse. I honestly don't know how she keeps going back to the doctor looking for answers, but truth is that doctors don't know how to treat hypochondriacs correctly yet. The sooner you acknowledge this as fact, the sooner you can actually help these people. The sooner you stop giving reasons why you can't treat it, the sooner you can move on to actually working on ways to fix it. Unfortunately, there are no such thing as "hypochondria fundraisers." They don't exist. Cystic Fibrosis and MS and ALS take all the fame while hypochondriacs, well fuck em. Why? Tell me please. It seems to me that the entire medical community just doesn't care about these people. I see it in words and in actions, by doctors and nurses. They want no part of it.
My earlier question was not rhetorical:
So basically she has to get very sick to get better, is what you're telling me?
If it's immune deficiency of some kind. The answer seems to be yes this seems to be a crack that many may fall through. If not my girlfriend, then one with actual immune deficiency problems is likely to become very sick before getting the attention they need.
"What i wanted to say with "feed the need for investigations" is that it is found that when patients require investigations but the doctor does not find enough evidence by the history or examination that these investigations will help in diagnosis of a certain condition, having the investigations done will not help the patient, actually it affects them for worse"
I'm not sure it could be worse. I honestly don't know how she keeps going back to the doctor looking for answers, but truth is that doctors don't know how to treat hypochondriacs correctly yet. The sooner you acknowledge this as fact, the sooner you can actually help these people. The sooner you stop giving reasons why you can't treat it, the sooner you can move on to actually working on ways to fix it. Unfortunately, there are no such thing as "hypochondria fundraisers." They don't exist. Cystic Fibrosis and MS and ALS take all the fame while hypochondriacs, well fuck em. Why? Tell me please. It seems to me that the entire medical community just doesn't care about these people. I see it in words and in actions, by doctors and nurses. They want no part of it.
She has all the symptoms of pelvic floor syndrome, vaginal and abdominal pain on a daily basis, nausea, spurts of dizziness. She says she can feel it as high as her mid back and up to her ribs on her front side, perhaps as high as the lowest thoracic vertebra.
My earlier question was not rhetorical:
So basically she has to get very sick to get better, is what you're telling me?
If it's immune deficiency of some kind. The answer seems to be yes this seems to be a crack that many may fall through. If not my girlfriend, then one with actual immune deficiency problems is likely to become very sick before getting the attention they need.
"What i wanted to say with "feed the need for investigations" is that it is found that when patients require investigations but the doctor does not find enough evidence by the history or examination that these investigations will help in diagnosis of a certain condition, having the investigations done will not help the patient, actually it affects them for worse"
I'm not sure it could be worse. I honestly don't know how she keeps going back to the doctor looking for answers, but truth is that doctors don't know how to treat hypochondriacs correctly yet. The sooner you acknowledge this as fact, the sooner you can actually help these people. The sooner you stop giving reasons why you can't treat it, the sooner you can move on to actually working on ways to fix it. Unfortunately, there are no such thing as "hypochondria fundraisers." They don't exist. Cystic Fibrosis and MS and ALS take all the fame while hypochondriacs, well fuck em. Why? Tell me please. It seems to me that the entire medical community just doesn't care about these people. I see it in words and in actions, by doctors and nurses. They want no part of it.
My earlier question was not rhetorical:
So basically she has to get very sick to get better, is what you're telling me?
If it's immune deficiency of some kind. The answer seems to be yes this seems to be a crack that many may fall through. If not my girlfriend, then one with actual immune deficiency problems is likely to become very sick before getting the attention they need.
"What i wanted to say with "feed the need for investigations" is that it is found that when patients require investigations but the doctor does not find enough evidence by the history or examination that these investigations will help in diagnosis of a certain condition, having the investigations done will not help the patient, actually it affects them for worse"
I'm not sure it could be worse. I honestly don't know how she keeps going back to the doctor looking for answers, but truth is that doctors don't know how to treat hypochondriacs correctly yet. The sooner you acknowledge this as fact, the sooner you can actually help these people. The sooner you stop giving reasons why you can't treat it, the sooner you can move on to actually working on ways to fix it. Unfortunately, there are no such thing as "hypochondria fundraisers." They don't exist. Cystic Fibrosis and MS and ALS take all the fame while hypochondriacs, well fuck em. Why? Tell me please. It seems to me that the entire medical community just doesn't care about these people. I see it in words and in actions, by doctors and nurses. They want no part of it.
Brief Answer:
Pelvic pain, possible causes and investigations
Detailed Answer:
Hello again,
Pelvic pain in most of the patients is related to a physical condition and only a few patients have it from nonphysical conditions.
It first needs to be examined with a gynaecological exam and according to the gynaecological exam fi dings need might come for other tests like vaginal ultrasound, cervical samples for chlamydia and gonorrhoea, etc. Pap smear is routinely done to rule out any tumours of the cervix.
Common causes of pelvic floor pain are the pelvic inflammatory disease that needs to be ruled out and also Endometriosis. Sometimes laparoscopic examination of the pelvic area (this is through a camera inserted through a tube) to rule out adherences is needed. Adherences can happen with infections like pelvic inflammatory disease and endometriosis as well and may cause severe pains that might be felt in the abdominal area and in the back.
If all these tests come out normal the psychogenic causes are likely and treatment with good support, counselling and medications for anxiety and depression are maintain therapy. The patient needs to be followed up regularly to evaluate her response to treatment and decide on further steps. a good and trustworthy relationship with the treating medical staff is important to help her improve.
Hope this answers your question. Let me know if I can assist further.
Kind regards,
Dr Antoneta Zotaj,
General and Family Physician
Pelvic pain, possible causes and investigations
Detailed Answer:
Hello again,
Pelvic pain in most of the patients is related to a physical condition and only a few patients have it from nonphysical conditions.
It first needs to be examined with a gynaecological exam and according to the gynaecological exam fi dings need might come for other tests like vaginal ultrasound, cervical samples for chlamydia and gonorrhoea, etc. Pap smear is routinely done to rule out any tumours of the cervix.
Common causes of pelvic floor pain are the pelvic inflammatory disease that needs to be ruled out and also Endometriosis. Sometimes laparoscopic examination of the pelvic area (this is through a camera inserted through a tube) to rule out adherences is needed. Adherences can happen with infections like pelvic inflammatory disease and endometriosis as well and may cause severe pains that might be felt in the abdominal area and in the back.
If all these tests come out normal the psychogenic causes are likely and treatment with good support, counselling and medications for anxiety and depression are maintain therapy. The patient needs to be followed up regularly to evaluate her response to treatment and decide on further steps. a good and trustworthy relationship with the treating medical staff is important to help her improve.
Hope this answers your question. Let me know if I can assist further.
Kind regards,
Dr Antoneta Zotaj,
General and Family Physician
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Brief Answer:
Pelvic pain, possible causes and investigations
Detailed Answer:
Hello again,
Pelvic pain in most of the patients is related to a physical condition and only a few patients have it from nonphysical conditions.
It first needs to be examined with a gynaecological exam and according to the gynaecological exam fi dings need might come for other tests like vaginal ultrasound, cervical samples for chlamydia and gonorrhoea, etc. Pap smear is routinely done to rule out any tumours of the cervix.
Common causes of pelvic floor pain are the pelvic inflammatory disease that needs to be ruled out and also Endometriosis. Sometimes laparoscopic examination of the pelvic area (this is through a camera inserted through a tube) to rule out adherences is needed. Adherences can happen with infections like pelvic inflammatory disease and endometriosis as well and may cause severe pains that might be felt in the abdominal area and in the back.
If all these tests come out normal the psychogenic causes are likely and treatment with good support, counselling and medications for anxiety and depression are maintain therapy. The patient needs to be followed up regularly to evaluate her response to treatment and decide on further steps. a good and trustworthy relationship with the treating medical staff is important to help her improve.
Hope this answers your question. Let me know if I can assist further.
Kind regards,
Dr Antoneta Zotaj,
General and Family Physician
Pelvic pain, possible causes and investigations
Detailed Answer:
Hello again,
Pelvic pain in most of the patients is related to a physical condition and only a few patients have it from nonphysical conditions.
It first needs to be examined with a gynaecological exam and according to the gynaecological exam fi dings need might come for other tests like vaginal ultrasound, cervical samples for chlamydia and gonorrhoea, etc. Pap smear is routinely done to rule out any tumours of the cervix.
Common causes of pelvic floor pain are the pelvic inflammatory disease that needs to be ruled out and also Endometriosis. Sometimes laparoscopic examination of the pelvic area (this is through a camera inserted through a tube) to rule out adherences is needed. Adherences can happen with infections like pelvic inflammatory disease and endometriosis as well and may cause severe pains that might be felt in the abdominal area and in the back.
If all these tests come out normal the psychogenic causes are likely and treatment with good support, counselling and medications for anxiety and depression are maintain therapy. The patient needs to be followed up regularly to evaluate her response to treatment and decide on further steps. a good and trustworthy relationship with the treating medical staff is important to help her improve.
Hope this answers your question. Let me know if I can assist further.
Kind regards,
Dr Antoneta Zotaj,
General and Family Physician
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
"Sometimes laparoscopic examination of the pelvic area (this is through a camera inserted through a tube) to rule out adherences is needed. Adherences can happen with infections like pelvic inflammatory disease and endometriosis as well and may cause severe pains that might be felt in the abdominal area and in the back."
She had this surgery many years ago, they didn't find endometriosis. However, in reading a wiki article after searching "wiki adhesion in urethra" I found that the surgery itself may have caused adhesions, which is a bit of a catch 22.
Is there any therapy for adhesions? I think we're getting somewhere because sometimes when we go to the doctor, they say "you have blood in your urine" but then sometimes the cultures come back negative.
Thank you for taking this seriously.
She had this surgery many years ago, they didn't find endometriosis. However, in reading a wiki article after searching "wiki adhesion in urethra" I found that the surgery itself may have caused adhesions, which is a bit of a catch 22.
Is there any therapy for adhesions? I think we're getting somewhere because sometimes when we go to the doctor, they say "you have blood in your urine" but then sometimes the cultures come back negative.
Thank you for taking this seriously.
"Sometimes laparoscopic examination of the pelvic area (this is through a camera inserted through a tube) to rule out adherences is needed. Adherences can happen with infections like pelvic inflammatory disease and endometriosis as well and may cause severe pains that might be felt in the abdominal area and in the back."
She had this surgery many years ago, they didn't find endometriosis. However, in reading a wiki article after searching "wiki adhesion in urethra" I found that the surgery itself may have caused adhesions, which is a bit of a catch 22.
Is there any therapy for adhesions? I think we're getting somewhere because sometimes when we go to the doctor, they say "you have blood in your urine" but then sometimes the cultures come back negative.
Thank you for taking this seriously.
She had this surgery many years ago, they didn't find endometriosis. However, in reading a wiki article after searching "wiki adhesion in urethra" I found that the surgery itself may have caused adhesions, which is a bit of a catch 22.
Is there any therapy for adhesions? I think we're getting somewhere because sometimes when we go to the doctor, they say "you have blood in your urine" but then sometimes the cultures come back negative.
Thank you for taking this seriously.
Brief Answer:
Surgery is the only way to treat adhesions but certain things can help prevent recurrence.
Detailed Answer:
Hello,
It is true that surgery is a cause of the adhesions. Unfortunately the only way to treat them is with surgery again. There are a few things the doctor needs to be aware while having the surgery this time to reduce the risk for adhesions.
If she had an open surgery years ago (laparotomy), meaning she had a big open wound where the surgeon operated from, this increases the risk for adhesions. This time she can have laparoscopy (which consists of a few small incisions and insertion of a camera), this is the surgical approach with less risk for adhesions.
Also it is important that the surgery is done by a doctor that has experience in treating adhesions so he can cause minimal damage and scar tissue during the surgery.
There is also a film (wax like material that absorbs in a week time) that the doctors can put in between where cut and cleaning is done so to prevent the cut areas to adhere again.
On the other hand it is important for her to rule out pelvic inflammatory disease because it is a cause of adhesions and most patients do not have other symptoms other then pain. Pelvic exam and cervical samples for chlamydia and gonorrhea are important workup in this case. If she has pelvic inflammatory disease and you treat the adhesions surgically they will come back and there is no point of just treating adhesions.
So there is no other way to treat adhesions other then with surgery which even though is a risk in itself for the adhesions, if done with caution this risk will be decreased.
I hope this helps answer your query. Let me know if I can assist you further.
I wish quick healing to your girlfriend.
Kind regards,
Dr. Antoneta Zotaj, General and Family Physician
Surgery is the only way to treat adhesions but certain things can help prevent recurrence.
Detailed Answer:
Hello,
It is true that surgery is a cause of the adhesions. Unfortunately the only way to treat them is with surgery again. There are a few things the doctor needs to be aware while having the surgery this time to reduce the risk for adhesions.
If she had an open surgery years ago (laparotomy), meaning she had a big open wound where the surgeon operated from, this increases the risk for adhesions. This time she can have laparoscopy (which consists of a few small incisions and insertion of a camera), this is the surgical approach with less risk for adhesions.
Also it is important that the surgery is done by a doctor that has experience in treating adhesions so he can cause minimal damage and scar tissue during the surgery.
There is also a film (wax like material that absorbs in a week time) that the doctors can put in between where cut and cleaning is done so to prevent the cut areas to adhere again.
On the other hand it is important for her to rule out pelvic inflammatory disease because it is a cause of adhesions and most patients do not have other symptoms other then pain. Pelvic exam and cervical samples for chlamydia and gonorrhea are important workup in this case. If she has pelvic inflammatory disease and you treat the adhesions surgically they will come back and there is no point of just treating adhesions.
So there is no other way to treat adhesions other then with surgery which even though is a risk in itself for the adhesions, if done with caution this risk will be decreased.
I hope this helps answer your query. Let me know if I can assist you further.
I wish quick healing to your girlfriend.
Kind regards,
Dr. Antoneta Zotaj, General and Family Physician
Above answer was peer-reviewed by :
Dr. Remy Koshy
Brief Answer:
Surgery is the only way to treat adhesions but certain things can help prevent recurrence.
Detailed Answer:
Hello,
It is true that surgery is a cause of the adhesions. Unfortunately the only way to treat them is with surgery again. There are a few things the doctor needs to be aware while having the surgery this time to reduce the risk for adhesions.
If she had an open surgery years ago (laparotomy), meaning she had a big open wound where the surgeon operated from, this increases the risk for adhesions. This time she can have laparoscopy (which consists of a few small incisions and insertion of a camera), this is the surgical approach with less risk for adhesions.
Also it is important that the surgery is done by a doctor that has experience in treating adhesions so he can cause minimal damage and scar tissue during the surgery.
There is also a film (wax like material that absorbs in a week time) that the doctors can put in between where cut and cleaning is done so to prevent the cut areas to adhere again.
On the other hand it is important for her to rule out pelvic inflammatory disease because it is a cause of adhesions and most patients do not have other symptoms other then pain. Pelvic exam and cervical samples for chlamydia and gonorrhea are important workup in this case. If she has pelvic inflammatory disease and you treat the adhesions surgically they will come back and there is no point of just treating adhesions.
So there is no other way to treat adhesions other then with surgery which even though is a risk in itself for the adhesions, if done with caution this risk will be decreased.
I hope this helps answer your query. Let me know if I can assist you further.
I wish quick healing to your girlfriend.
Kind regards,
Dr. Antoneta Zotaj, General and Family Physician
Surgery is the only way to treat adhesions but certain things can help prevent recurrence.
Detailed Answer:
Hello,
It is true that surgery is a cause of the adhesions. Unfortunately the only way to treat them is with surgery again. There are a few things the doctor needs to be aware while having the surgery this time to reduce the risk for adhesions.
If she had an open surgery years ago (laparotomy), meaning she had a big open wound where the surgeon operated from, this increases the risk for adhesions. This time she can have laparoscopy (which consists of a few small incisions and insertion of a camera), this is the surgical approach with less risk for adhesions.
Also it is important that the surgery is done by a doctor that has experience in treating adhesions so he can cause minimal damage and scar tissue during the surgery.
There is also a film (wax like material that absorbs in a week time) that the doctors can put in between where cut and cleaning is done so to prevent the cut areas to adhere again.
On the other hand it is important for her to rule out pelvic inflammatory disease because it is a cause of adhesions and most patients do not have other symptoms other then pain. Pelvic exam and cervical samples for chlamydia and gonorrhea are important workup in this case. If she has pelvic inflammatory disease and you treat the adhesions surgically they will come back and there is no point of just treating adhesions.
So there is no other way to treat adhesions other then with surgery which even though is a risk in itself for the adhesions, if done with caution this risk will be decreased.
I hope this helps answer your query. Let me know if I can assist you further.
I wish quick healing to your girlfriend.
Kind regards,
Dr. Antoneta Zotaj, General and Family Physician
Above answer was peer-reviewed by :
Dr. Remy Koshy
thanks for the information.
"On the other hand it is important for her to rule out pelvic inflammatory disease because it is a cause of adhesions and most patients do not have other symptoms other then pain. Pelvic exam and cervical samples for chlamydia and gonorrhea are important workup in this case. If she has pelvic inflammatory disease and you treat the adhesions surgically they will come back and there is no point of just treating adhesions."
this has all been done but no doctor has yet to inform her of potential adhesions.
This seems like a very real possibility to me because she often complains of feeling like something "broke open" while urinating causing a massive "pressure release."
How do we get a live doctor to take this seriously? She has an appointment in XXXXXXX in a few weeks and I want to be prepared.
"On the other hand it is important for her to rule out pelvic inflammatory disease because it is a cause of adhesions and most patients do not have other symptoms other then pain. Pelvic exam and cervical samples for chlamydia and gonorrhea are important workup in this case. If she has pelvic inflammatory disease and you treat the adhesions surgically they will come back and there is no point of just treating adhesions."
this has all been done but no doctor has yet to inform her of potential adhesions.
This seems like a very real possibility to me because she often complains of feeling like something "broke open" while urinating causing a massive "pressure release."
How do we get a live doctor to take this seriously? She has an appointment in XXXXXXX in a few weeks and I want to be prepared.
thanks for the information.
"On the other hand it is important for her to rule out pelvic inflammatory disease because it is a cause of adhesions and most patients do not have other symptoms other then pain. Pelvic exam and cervical samples for chlamydia and gonorrhea are important workup in this case. If she has pelvic inflammatory disease and you treat the adhesions surgically they will come back and there is no point of just treating adhesions."
this has all been done but no doctor has yet to inform her of potential adhesions.
This seems like a very real possibility to me because she often complains of feeling like something "broke open" while urinating causing a massive "pressure release."
How do we get a live doctor to take this seriously? She has an appointment in XXXXXXX in a few weeks and I want to be prepared.
"On the other hand it is important for her to rule out pelvic inflammatory disease because it is a cause of adhesions and most patients do not have other symptoms other then pain. Pelvic exam and cervical samples for chlamydia and gonorrhea are important workup in this case. If she has pelvic inflammatory disease and you treat the adhesions surgically they will come back and there is no point of just treating adhesions."
this has all been done but no doctor has yet to inform her of potential adhesions.
This seems like a very real possibility to me because she often complains of feeling like something "broke open" while urinating causing a massive "pressure release."
How do we get a live doctor to take this seriously? She has an appointment in XXXXXXX in a few weeks and I want to be prepared.
Sorry that I forgot to list some things that might be important:
she was diagnosed with poly cystic ovarian syndrome many years ago. this likely only increases the pain, and also gives the live doctors something on which to blame her pain.
her menstrual cycle has never ever been consistent ever since she was a teenager. she has tried numerous types of birth control including the pill and the shot, though I'm not sure exactly which treatments she has had regarding this. Nothing has ever helped in this regard. When she first got her period as a teen, she could not stop bleeding and she had to go to the doctor. They put her on the pill at age 14(?) and it stopped the bleeding, but she claims to never have had a consistent menstrual cycle in her lifetime.
I've heard of, but have never thoroughly investigated, something called "the hurting syndrome" which causes the menstrual cycle of one to vary depending on environmental issues; to come and go in unison with other females' menstrual cycles that are close to the patient.
Perhaps this information could help us.
she was diagnosed with poly cystic ovarian syndrome many years ago. this likely only increases the pain, and also gives the live doctors something on which to blame her pain.
her menstrual cycle has never ever been consistent ever since she was a teenager. she has tried numerous types of birth control including the pill and the shot, though I'm not sure exactly which treatments she has had regarding this. Nothing has ever helped in this regard. When she first got her period as a teen, she could not stop bleeding and she had to go to the doctor. They put her on the pill at age 14(?) and it stopped the bleeding, but she claims to never have had a consistent menstrual cycle in her lifetime.
I've heard of, but have never thoroughly investigated, something called "the hurting syndrome" which causes the menstrual cycle of one to vary depending on environmental issues; to come and go in unison with other females' menstrual cycles that are close to the patient.
Perhaps this information could help us.
Sorry that I forgot to list some things that might be important:
she was diagnosed with poly cystic ovarian syndrome many years ago. this likely only increases the pain, and also gives the live doctors something on which to blame her pain.
her menstrual cycle has never ever been consistent ever since she was a teenager. she has tried numerous types of birth control including the pill and the shot, though I'm not sure exactly which treatments she has had regarding this. Nothing has ever helped in this regard. When she first got her period as a teen, she could not stop bleeding and she had to go to the doctor. They put her on the pill at age 14(?) and it stopped the bleeding, but she claims to never have had a consistent menstrual cycle in her lifetime.
I've heard of, but have never thoroughly investigated, something called "the hurting syndrome" which causes the menstrual cycle of one to vary depending on environmental issues; to come and go in unison with other females' menstrual cycles that are close to the patient.
Perhaps this information could help us.
she was diagnosed with poly cystic ovarian syndrome many years ago. this likely only increases the pain, and also gives the live doctors something on which to blame her pain.
her menstrual cycle has never ever been consistent ever since she was a teenager. she has tried numerous types of birth control including the pill and the shot, though I'm not sure exactly which treatments she has had regarding this. Nothing has ever helped in this regard. When she first got her period as a teen, she could not stop bleeding and she had to go to the doctor. They put her on the pill at age 14(?) and it stopped the bleeding, but she claims to never have had a consistent menstrual cycle in her lifetime.
I've heard of, but have never thoroughly investigated, something called "the hurting syndrome" which causes the menstrual cycle of one to vary depending on environmental issues; to come and go in unison with other females' menstrual cycles that are close to the patient.
Perhaps this information could help us.
Brief Answer:
Detailed answer below
Detailed Answer:
Hello,
Patients with the polycystic ovarian syndrome (PCOS) have irregular menstrual periods but don't generally have pelvic pain (they tend to have back-pain rather), so the pain is not likely to be justified with PCOS diagnosis. Pills (contraception) can be taken but the moment you stop them the periods start to be irregular again. She may also find it difficult to conceive, there is specific treatment that stimulates the ovaries and helps increase the chances to conceive if the patient desires pregnancy.
Adhesions cannot be diagnosed other then with the laparoscopy which at the same time if it identifies them can also treat them (it is both diagnostic and therapeutic). The doctors can not know for sure if adhesions are present or not till they do the laparoscopy. If she has had vaginal and pelvic infections previously and now has pelvic pain, adhesions due to pelvic inflammatory disease can be the cause.
When she goes to see the doctor she should expect the doctor to do a gynaecological exam and a pap smear and according to the findings in the gynecological exam (if there is tenderness when moving her cervix or pain in bimanual examination the doctor might need to ask for cervical samples to rule out infection due to chlamydia and gonorrhoea and also may ask for a transvaginal ultrasound. These are the basic examinations that are needed to investigate pelvic pain. A urinalysis may also be performed in the office. Interstitial cystitis needs to be ruled out as the cause of the pelvic pain as well.
Depending on the results of these investigations the doctor should be able to rule out some diagnosis or have evidence of certain conditions and diagnosis. You can discuss with the doctor the risk for adhesions as the cause of the pain and if there is a way to rule it out.
These are to investigate for physical causes of the pelvic pain. If all the tests and examinations come out normal then psychogenic pelvic pain can be considered and treated with amitryptiline or citalopram (SSRI) or a combination of both can be started, as well as good follow up and counselling.
As for the "hurting syndrome," it is not a term used in medical literature, it might probably be a term used by patients when they explain their symptoms. It is well recognized through the term "chronic pain syndrome" which includes pain that lasts for more than 3-6 months and in the case of the pelvic pain the structural problems as explained above should be ruled out first.
I hope this helps answer your questions. Let me know if I can assist further.
I wish her quick healing.
Kind regards,
Dr Antoneta Zotaj,
General and Family Physician
Detailed answer below
Detailed Answer:
Hello,
Patients with the polycystic ovarian syndrome (PCOS) have irregular menstrual periods but don't generally have pelvic pain (they tend to have back-pain rather), so the pain is not likely to be justified with PCOS diagnosis. Pills (contraception) can be taken but the moment you stop them the periods start to be irregular again. She may also find it difficult to conceive, there is specific treatment that stimulates the ovaries and helps increase the chances to conceive if the patient desires pregnancy.
Adhesions cannot be diagnosed other then with the laparoscopy which at the same time if it identifies them can also treat them (it is both diagnostic and therapeutic). The doctors can not know for sure if adhesions are present or not till they do the laparoscopy. If she has had vaginal and pelvic infections previously and now has pelvic pain, adhesions due to pelvic inflammatory disease can be the cause.
When she goes to see the doctor she should expect the doctor to do a gynaecological exam and a pap smear and according to the findings in the gynecological exam (if there is tenderness when moving her cervix or pain in bimanual examination the doctor might need to ask for cervical samples to rule out infection due to chlamydia and gonorrhoea and also may ask for a transvaginal ultrasound. These are the basic examinations that are needed to investigate pelvic pain. A urinalysis may also be performed in the office. Interstitial cystitis needs to be ruled out as the cause of the pelvic pain as well.
Depending on the results of these investigations the doctor should be able to rule out some diagnosis or have evidence of certain conditions and diagnosis. You can discuss with the doctor the risk for adhesions as the cause of the pain and if there is a way to rule it out.
These are to investigate for physical causes of the pelvic pain. If all the tests and examinations come out normal then psychogenic pelvic pain can be considered and treated with amitryptiline or citalopram (SSRI) or a combination of both can be started, as well as good follow up and counselling.
As for the "hurting syndrome," it is not a term used in medical literature, it might probably be a term used by patients when they explain their symptoms. It is well recognized through the term "chronic pain syndrome" which includes pain that lasts for more than 3-6 months and in the case of the pelvic pain the structural problems as explained above should be ruled out first.
I hope this helps answer your questions. Let me know if I can assist further.
I wish her quick healing.
Kind regards,
Dr Antoneta Zotaj,
General and Family Physician
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Brief Answer:
Detailed answer below
Detailed Answer:
Hello,
Patients with the polycystic ovarian syndrome (PCOS) have irregular menstrual periods but don't generally have pelvic pain (they tend to have back-pain rather), so the pain is not likely to be justified with PCOS diagnosis. Pills (contraception) can be taken but the moment you stop them the periods start to be irregular again. She may also find it difficult to conceive, there is specific treatment that stimulates the ovaries and helps increase the chances to conceive if the patient desires pregnancy.
Adhesions cannot be diagnosed other then with the laparoscopy which at the same time if it identifies them can also treat them (it is both diagnostic and therapeutic). The doctors can not know for sure if adhesions are present or not till they do the laparoscopy. If she has had vaginal and pelvic infections previously and now has pelvic pain, adhesions due to pelvic inflammatory disease can be the cause.
When she goes to see the doctor she should expect the doctor to do a gynaecological exam and a pap smear and according to the findings in the gynecological exam (if there is tenderness when moving her cervix or pain in bimanual examination the doctor might need to ask for cervical samples to rule out infection due to chlamydia and gonorrhoea and also may ask for a transvaginal ultrasound. These are the basic examinations that are needed to investigate pelvic pain. A urinalysis may also be performed in the office. Interstitial cystitis needs to be ruled out as the cause of the pelvic pain as well.
Depending on the results of these investigations the doctor should be able to rule out some diagnosis or have evidence of certain conditions and diagnosis. You can discuss with the doctor the risk for adhesions as the cause of the pain and if there is a way to rule it out.
These are to investigate for physical causes of the pelvic pain. If all the tests and examinations come out normal then psychogenic pelvic pain can be considered and treated with amitryptiline or citalopram (SSRI) or a combination of both can be started, as well as good follow up and counselling.
As for the "hurting syndrome," it is not a term used in medical literature, it might probably be a term used by patients when they explain their symptoms. It is well recognized through the term "chronic pain syndrome" which includes pain that lasts for more than 3-6 months and in the case of the pelvic pain the structural problems as explained above should be ruled out first.
I hope this helps answer your questions. Let me know if I can assist further.
I wish her quick healing.
Kind regards,
Dr Antoneta Zotaj,
General and Family Physician
Detailed answer below
Detailed Answer:
Hello,
Patients with the polycystic ovarian syndrome (PCOS) have irregular menstrual periods but don't generally have pelvic pain (they tend to have back-pain rather), so the pain is not likely to be justified with PCOS diagnosis. Pills (contraception) can be taken but the moment you stop them the periods start to be irregular again. She may also find it difficult to conceive, there is specific treatment that stimulates the ovaries and helps increase the chances to conceive if the patient desires pregnancy.
Adhesions cannot be diagnosed other then with the laparoscopy which at the same time if it identifies them can also treat them (it is both diagnostic and therapeutic). The doctors can not know for sure if adhesions are present or not till they do the laparoscopy. If she has had vaginal and pelvic infections previously and now has pelvic pain, adhesions due to pelvic inflammatory disease can be the cause.
When she goes to see the doctor she should expect the doctor to do a gynaecological exam and a pap smear and according to the findings in the gynecological exam (if there is tenderness when moving her cervix or pain in bimanual examination the doctor might need to ask for cervical samples to rule out infection due to chlamydia and gonorrhoea and also may ask for a transvaginal ultrasound. These are the basic examinations that are needed to investigate pelvic pain. A urinalysis may also be performed in the office. Interstitial cystitis needs to be ruled out as the cause of the pelvic pain as well.
Depending on the results of these investigations the doctor should be able to rule out some diagnosis or have evidence of certain conditions and diagnosis. You can discuss with the doctor the risk for adhesions as the cause of the pain and if there is a way to rule it out.
These are to investigate for physical causes of the pelvic pain. If all the tests and examinations come out normal then psychogenic pelvic pain can be considered and treated with amitryptiline or citalopram (SSRI) or a combination of both can be started, as well as good follow up and counselling.
As for the "hurting syndrome," it is not a term used in medical literature, it might probably be a term used by patients when they explain their symptoms. It is well recognized through the term "chronic pain syndrome" which includes pain that lasts for more than 3-6 months and in the case of the pelvic pain the structural problems as explained above should be ruled out first.
I hope this helps answer your questions. Let me know if I can assist further.
I wish her quick healing.
Kind regards,
Dr Antoneta Zotaj,
General and Family Physician
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
"The doctors can not know for sure if adhesions are present or not till they do the laparoscopy. If she has had vaginal and pelvic infections previously and now has pelvic pain, adhesions due to pelvic inflammatory disease can be the cause."
Thank you for this. I appreciate all the time you have put into this case and I think this may help us figure things out.
I will leave you alone now as I am out of information and questions.
JP
Thank you for this. I appreciate all the time you have put into this case and I think this may help us figure things out.
I will leave you alone now as I am out of information and questions.
JP
"The doctors can not know for sure if adhesions are present or not till they do the laparoscopy. If she has had vaginal and pelvic infections previously and now has pelvic pain, adhesions due to pelvic inflammatory disease can be the cause."
Thank you for this. I appreciate all the time you have put into this case and I think this may help us figure things out.
I will leave you alone now as I am out of information and questions.
JP
Thank you for this. I appreciate all the time you have put into this case and I think this may help us figure things out.
I will leave you alone now as I am out of information and questions.
JP
Brief Answer:
It's a pleasure
Detailed Answer:
Hello,
It is a pleasure to assist you.
I wish you all the best and your girlfriend good health.
Kind regards,
Dr Antoneta Zotaj,
General and Family Physician
It's a pleasure
Detailed Answer:
Hello,
It is a pleasure to assist you.
I wish you all the best and your girlfriend good health.
Kind regards,
Dr Antoneta Zotaj,
General and Family Physician
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Brief Answer:
It's a pleasure
Detailed Answer:
Hello,
It is a pleasure to assist you.
I wish you all the best and your girlfriend good health.
Kind regards,
Dr Antoneta Zotaj,
General and Family Physician
It's a pleasure
Detailed Answer:
Hello,
It is a pleasure to assist you.
I wish you all the best and your girlfriend good health.
Kind regards,
Dr Antoneta Zotaj,
General and Family Physician
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
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