Top10MD Blog


 3 months ago    Leave a comments (0)

With kids heading off to camp this summer and families headed to the mountains or camping outdoors ticks can be a problem if not a life-long problem if infected with Lyme Disease or other tick related diseases. “It’s a good idea to take preventive measures against ticks year-round, be extra vigilant during the months of April-September when ticks are most active,” says Dr. Jeffery West Ticks transmit over ten diseases to humans and pets. Some of these diseases can be debilitating for the rest of you or your child’s life; it’s important to seek immediate care. Early recognition and treatment decrease the risk of serious complications later on.

Approximately 300,000 people in the United States are diagnosed with Lyme disease yearly; while only 30,000 of these are estimated to be reported to the CDC by state health departments. Ninety-six percent of Lyme disease cases come from 13 states.


  • Avoid direct contact with ticks
  • Avoid wooded and brushy areas with high grass and leaf litter
  • Walk in the center of trails


  • Use repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours.
  • Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.
  • Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5% permethrin. It remains protective through several washings. Pre-treated clothing is available and may be protective longer.


  • Bathe or shower as soon as possible after coming indoors to wash off and more easily find ticks that are crawling on you.
  • Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
  • Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs.
  • Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors.
  • If the clothes are damp, additional time may be needed.
  • If the clothes require washing first, use hot water. Cold and medium temperature water will not kill ticks effectively. If the clothes cannot be washed in hot water, tumble dry on low heat for 90 minutes or high heat for 60 minutes. The clothes should be warm and completely dry.


  • Remove the tick as quickly as possible, do not wait for it to detach.
  • Use a fine-tipped tweezers. Grasp the tick as close to the skin as possible, and pull straight up with steady pressure. Then thoroughly clean the bite (and your hands) with rubbing alcohol and soap and water.
  • Kill the tick without touching it and throw it away. If you develop a rash or fever following exposure, see a doctor immediately.


  • Fever/chills: With all tickborne diseases, patients can experience fever at varying degrees and time of onset.
  • Aches and pains: Tickborne disease symptoms include a headache, fatigue, and muscle aches. With Lyme disease, you may also experience joint pain. The severity and time of onset of these symptoms can depend on the disease and the patient’s personal tolerance level.
  • Rash: Lyme disease, southern tick-associated rash illness (STARI), Rocky Mountain spotted fever (RMSF), ehrlichiosis, and tularemia can result in distinctive rashes:
    • In Lyme disease, the rash may appear within 3-30 days, typically before the onset of fever. The Lyme disease rash is the first sign of infection and is usually a circular rash called erythema migrans or EM. This rash occurs in approximately 70-80% of infected persons and begins at the site of a tick bite. It may be warm but is not usually painful. Some patients develop additional EM lesions in other areas of the body several days later.
    • The rash of (STARI) is nearly identical to that of Lyme disease, with a red, expanding “bull’s eye” lesion that develops around the site of a lone star tick bite. Unlike Lyme disease, STARI has not been linked to any arthritic or neurologic symptoms.
    • The rash seen with Rocky Mountain spotted fever (RMSF) varies greatly from person to person in appearance, location, and time of onset. About 10% of individuals with RMSF never develop a rash. Most often, the rash begins 2-5 days after the onset of fever as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles and spreads to the trunk. It sometimes involves the palms and soles. The red to purple, spotted (petechial) rash of RMSF is usually not seen until the sixth day or later after onset of symptoms and occurs in 35-60% of patients with the infection.
  • In the most common form of tularemia, a skin ulcer appears at the site where the organism entered the body. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.
  • 30% of patients and up to 60% of children, ehrlichiosis can cause a rash. The appearance of the rash ranges from macular to maculopapular to petechial and may appear after the onset of fever.

Tickborne diseases can result in mild symptoms treatable at home to severe infections requiring hospitalization. Although easily treated with antibiotics, these diseases can be difficult for physicians to diagnose. However, early recognition and treatment of the infection decrease the risk of serious complications. Seek medical advice immediately if you have been bitten by a tick and experience any of the symptoms described here.


  • Anaplasmosis is transmitted to humans by tick bites primarily from the blacklegged tick.
  • Babesiosis is caused by microscopic parasites that infect red blood cells. Most human cases of babesiosis are caused by Babesia microtiBabesia microti is transmitted by the blacklegged tick.
  • Borrelia mayonii infection has recently been described as a cause of illness in the upper Midwestern United States. It has been found in blacklegged ticks. Borrelia mayonii is a new species and is the only species besides B. burgdorferi known to cause Lyme disease in North America.
  • Borrelia miyamotoi infection has recently been described as a cause of illness in the U.S. It is transmitted by the blacklegged tick and has a range like that of Lyme disease.
  • Colorado tick fever is caused by a virus transmitted by the Rocky Mountain wood tick. It occurs in the Rocky Mountain states at elevations of 4,000 to 10,500 feet.
  • Ehrlichiosis is transmitted to humans by the lone star tick, found primarily in the south central and eastern U.S.
  • Heartland virus infection has been identified in eight patients in Missouri and Tennessee as of March 2014. Studies suggest that Lone Star ticks may transmit the virus. It is unknown if the virus may be found in other areas of the U.S.
  • Lyme disease is transmitted by the blacklegged tick in the northeastern U.S. and upper Midwestern U.S. and the western blacklegged tick along the Pacific coast.
  • Powassan disease is transmitted by the blacklegged tick and the groundhog tick. Cases have been reported primarily from northeastern states and the Great Lakes region.
  • Rickettsia parkeri rickettsiosis is transmitted to humans by the Gulf Coast tick.
  • Rocky Mountain spotted fever (RMSF) is transmitted by the American dog tick, Rocky Mountain wood tick, and the brown dog tick in the U.S. The brown dog tick and other tick species are associated with RMSF in Central and South America.
  • STARI (Southern tick-associated rash illness) is transmitted via bites from the lone star tick, found in the southeastern and eastern U.S.
  • Tickborne relapsing fever (TBRF) is transmitted to humans through the bite of infected soft ticks. TBRF has been reported in 15 states: Arizona, California, Colorado, Idaho, Kansas, Montana, Nevada, New Mexico, Ohio, Oklahoma, Oregon, Texas, Utah, Washington, and Wyoming and is associated with sleeping in rustic cabins and vacation homes.
  • Tularemia is transmitted to humans by the dog tick, the wood tick, and the lone star tick. Tularemia occurs throughout the U.S.
  • 364D rickettsiosis is transmitted to humans by the Pacific Coast tick. This is a new disease that has been found in California.

Dr. Jeffery West is a Rockwall Otolaryngologist specializing in allergies and ENT surgery. Board Certified by the American Board of Otolaryngologists, Dr. West is Medical Director of Lakeside Allergy ENT with offices in Rockwall, Forney, and Wylie Texas. Named Top10MD in 2016 – an honor only 1-in-3 doctors succeeds within the United States. To schedule a consultation with Dr. Jeff West, click on his profile or call his office at 972-398-1131.


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 9 months ago    Leave a comments (0)

You can’t think clearly, confusion proves it difficult to describe your symptoms– Fibromyalgia may be the culprit. If you are having trouble sleeping and upon waking it feels as if you have the flu. If you’re tired, exhausted, and your body hurts all over. After pushing yourself, day after day lab tests show no diagnosis, and you feel like a hypochondriac. You might have what 3-5% of the population have– fibromyalgia.

Fibromyalgia means widespread pain in the muscles, tendons, and ligaments. Fibromyalgia symptoms differ from one patient to another, with many symptoms being connected. For example, patients who are unable to sleep at night may have severe fatigue during the day, feel depressed, and have difficulty concentrating.

Although muscles hurt throughout the body the pain is intensified by the way the nervous system processes pain. Those who suffer from fibromyalgia may feel as if they have pulled their muscles or have near constant cramps.

Symptoms of Fibromyalgia

  • Muscle pain, cramping, and weakness
  • Difficulty sleeping
  • Fatigue
  • Digestive disorders
  • Difficulty concentrating/confusion
  • Chronic Headaches
  • Itchy or burning skin
  • Pain

Fibromyalgia pain has been described as deep muscular aching, shooting, throbbing, stabbing, or deep burning. Muscles in the head, neck, shoulders and lower back may hurt the worst and feel tight and strained. For most, pain and stiffness are most severe in the mornings.


  • Patients with fibromyalgia may feel weak and their limbs heavy. Even the smallest tasks require every bit of effort as energy is drained starting the moment they way up. Fatigue from fibromyalgia can be incapacitating and cause many to be unable to work.

Memory and Concentration

  • Similar to brain fog, difficulty in concentrating and retaining information is an everyday hindrance for those with fibromyalgia. This symptom makes it difficult to work and retain a job.

Sleep Disorders

  • Many with fibromyalgia find falling and staying asleep at night extremely difficult. The lack of deep refreshing sleep causes them to wake up feeling as though they have a severe case of the flu.

Digestive Disorders

  • Digestive issues are found in at least 50 percent of fibromyalgia patients. These symptoms may include constipation, diarrhea, abdominal pain and bloating, and nausea; the primary symptoms associated with Irritable Bowel Syndrome.

Chronic Headaches

  • Another symptom found in at least 50 percent of fibromyalgia patients is chronic headaches or migraines. Many symptoms can be so severe they are debilitating to the patient.

Other Symptoms

There are some common additional symptoms such as sensitivity to bright lights, irregular heart beat or palpitations, nasal congestion, dizziness, profuse sweating, acid reflux, and an irritable bladder. Fibromyalgia can occur in people of all ages, and both genders. Symptoms of fibromyalgia are chronic but fluctuate daily and throughout the day. There are treatments available, and FDA approved medications for those who suffer from fibromyalgia.

If you or a family member is suffering from pain and/or has been diagnosed with fibromyalgia, perhaps it’s time to schedule an appointment with a board certified Dallas Texas Rheumatologist today.

Dr. Scott Zashin is a respected Texas Fibromyalgia Doctor/Specialist in Dallas. He is dual board-certified by the American Board of Rheumatology and the American Board of Internal Medicine. Dr. Zashin is the Medical Director of Dallas Rheumatology conveniently located in Dallas, TX. For more information on fibromyalgia, pain relief and getting back to feeling great, call today to schedule a time to meet with Dr. Zashin 214-363-2812.


 12 months ago    Leave a comments (0)

Lupus is an autoimmune disease that can damage any part of the body including the skin, joints, organs inside the body. Lupus causes swelling and inflammation, along with signs and symptoms that usually last longer than six weeks. Some cases have only a few mild symptoms, and others have many, more severe symptoms. According to the Lupus Foundation of America, 90% of all cases are women, with the disease being two to three times more prevalent in women of color.

With lupus, our immune system can’t tell the difference between viruses, bacteria, germs, and other foreign invaders and our body’s own healthy tissues. Therefore, the body starts attacking and destroying healthy tissue. Normally, our immune system produces proteins called antibodies that would protect our body from these invaders. But with lupus, our immune system doesn’t perform correctly causing inflammation, pain, and damage in various parts of the body.

What are the Symptoms?

The symptoms usually start when you are a young adult, but can start anywhere from the teens to the 30s.

Lupus can cause flare-ups and periods of remission, which can sometimes make it difficult to diagnose, as many dismiss the early signs.

Some common symptoms of Lupus are:

  • Fatigue
  • Unexplained fever
  • Skin rash
  • Kidney inflammation
  • Painful joints
  • Gastrointestinal problems
  • Thyroid problems
  • Hair loss
  • Dry Mouth and Eyes
  • Osteoporosis
  • Depression

Early symptoms can be similar to many other conditions, so having them does not necessarily mean you have lupus. If you are concerned about symptoms you have, make an appointment with a board certified Rheumatologist to discuss your health.

Dr. Scott Zashin is a respected and published Dallas Rheumatologist. He is dual board-certified by the American Board of Rheumatology and the American Board of Internal Medicine. Dr. Zashin is the Medical Director of Dallas Rheumatology. For more information on getting back to feeling great visit his website or call today to schedule your initial consultation 214-363- 2812.


 1 year ago    Leave a comments (0)

Surgeries that some consider routine can still sometimes cause serious complications. No matter how straightforward you think your surgery might be, you still want to be in the absolute best surgical hands.

Today, your surgeon and hospital are especially important for procedures that are new or complex or even routine. You should be concerned and research but your surgeon and the hospital for that matter as most errors happen in a hospital setting according to John Hopkins report in May noting the third leading cause of death is medical errors. In your search for the best surgeon one indicator is how often your surgeon performs the procedure you’re seeking. For example, a study by researchers at New Hampshire’s Dartmouth-Hitchcock Medical Center of people undergoing surgery for pancreatic cancer found that annual death rates were nearly four times higher for those treated by surgeons who performed the fewest operations.

With that being said, how should you choose a surgeon, someone with whom you’ll be sharing some of your most personal information and entrusting with life-and-death decisions? Communication with your surgeon is essential.

Ask your prospective surgeon these questions before going under…

Are you board certified, and is your certification current?

  • Look for a surgeon who has the necessary board certification(s), necessary training, and has maintained their certification(s) in the specialty they are practicing.

Is this surgery necessary?

  • Avoiding surgery entirely is the only sure way to avoid a surgical complication; understanding the effectiveness of the surgery and having exhausted alternatives you then need to compare the results of your alternatives with the possible risks of the surgery. 

What are your success, failure, and complication rates?

  • Not all surgeons are willing to be upfront with this information, but a good surgeon will.

What is your experience with this surgery?

  • Ask your surgeon how many of these procedures he or she has performed and compare that number with other surgeons performing the same procedure. The best surgeon is not necessarily the busiest surgeon; it’s about avoiding the surgeon who has not performed the procedure as much or as often or as well.

What’s the hospital’s infection rate?

  • Seventeen states now make that information public, and many hospitals report their rates voluntarily. Kudos to them! After asking these questions and others relating to your needs, likes, and dislikes, do your homework and make your choice. Your final decision could be one of the most important you’ll make for you and your family.

To locate a Top10MD Surgeon you can trust visit and schedule your appointment today.


 1 year ago    Leave a comments (0)

Platelet-rich plasma – PRP therapy may be an answer to the aches and pains of getting older. “There comes a time when bending down, walking up the steps, and unscrewing jars are not the easiest things to do,” says Dr. Joseph Cleaver. Arthritis is one of the main culprits of pain and worsens as time passes. In some cases, doctors have seen where arthritis begins to destroy your joints. With age, we may be wiser, but our bodies do start to fail us– it doesn’t have to leave you inactive and debilitated. Previously, the only relief for patients was either icing the joint in pain or scheduling a total joint replacement. Today, joint rejuvenation is possible with Platelet-rich plasma therapy.

There are over 360 joints in our body with the most common joints being the knee, shoulder, and ankle joints. We also have joints in our fingers, wrist, and toes. We all have them; therefore, we are all susceptible to arthritis. Arthritis of the joints causes inflammation and pain. Millions of people in the United States have wear and tear arthritis, also known as osteoarthritis. In the beginning stages, it’s manageable. As the disease progress, the cartilage thins and breaks down. Once your cartilage is gone, you cannot get it back. It causes your bones to rub together which leads to excruciating pain; once arthritis reaches this stage, the only option for treatment was a joint replacement. Now there may be an answer through Platelet-rich plasma or PRP.

Platelet-rich plasma has been used to treat sports injuries for many years with minimal side effects or allergic reactions; this is possible because the plasma is rich in rejuvenating “growth factors” comes from you. Being able to take something from your body to treat the wear and tear of arthritis sounds like a good idea, what you may not know is that your body has its own natural healing ability. Being able to use your body’s healing process along with the assistance of medicine is bringing about some pretty amazing results. Your Functional Medicine or Integrated Medicine doctor begins by drawing your blood. After a blood draw, the concentrated platelets and plasma that contain the rejuvenating substances from the rest of the blood. Once the Platelet Rich Plasma is ready, your doctor will inject it into the joint.

Platelet-rich plasma has both healing properties and has shown beneficial. The problem with arthritis is the inflammation that occurs. Platelet-rich plasma should help to inhibit the inflammation and possibly slow the process of osteoarthritis. The plasma stimulates the growth of new cartilage cells as well as the natural lubricating process. When the joints are properly lubricated, they improve function. One of the greatest benefits is the possibility of decreasing the pain.

Joint pain lowers our quality of life. When you are unable to move and do activities, it can be frustrating. Having arthritis, no longer has to keep you from enjoying life. Joint restoration is giving people their life back and restoring joint health. If you are suffering from the consequences of arthritis, perhaps it’s time to look at Platelet-rich plasma therapy.

Dallas Functional Medicine Specialist and Rheumatologist Joseph Cleaver MD is double boarded by the American Board of Anti-Aging, Functional & Regenerative Medicine and the American Board of Internal Medicine. Also, he has achieved certification by the ABAARM in Advanced Metabolic Endocrinology. Dr. Cleaver is the co-founder of Paradigm Wellness Medical Group conveniently located in Dallas, TX. For more information on nutritional health, bio-identical hormone replacement therapy, and longevity and preventative medicine, visit Dr. Cleaver’s website Paradigm Wellness at or call today to schedule a consultation 888.244.6493 ext. 101.


 1 year ago    Leave a comments (0)

Gout is a common and treatable form of Arthritis affecting more than 2 million Americans caused by deposits of uric acid — a white, odorless crystal that accumulates in the body and causes redness and swelling of the joints. Attacks come on suddenly and are painful, lasting 3 to 10 days. Most people believe Gout only affects the big toe. Though Gout is common in the big toe, it often affects other areas. 

Gout Can Affect

  • Ankles
  • Big Toe
  • Elbows
  • Fingers
  • Heels
  • Insteps
  • Knees
  • Wrists

Symptoms Include

  • Heat
  • Pain
  • Redness
  • Stiffness in joints.
  • Swelling

While occurring in men and women of all ages, it rarely occurs in women before menopause. One way to obtain a diagnosis of is to remove fluid from an affected joint and examine it for the presence of uric acid. The diagnosis can also be confirmed by clinical criteria and imaging studies. Finding an elevated uric acid does not mean you have gout. First, the uric acid level in the blood may be normal even when gout is present. Second, a high level of uric acid in the blood by itself does not necessarily signify the presence of gout.

Medications and diet may trigger gout attacks. Certain substances in drugs and food can increase levels of uric acid in the blood. Diuretics such as Lasix® and hydrochlorothiazide, which are used to treat high blood pressure and edema (fluid retention), can increase the risk of gout attacks. Aspirin also increases uric acid levels and can worsen attacks.

Foods with high purine levels also increase uric acid levels in the blood. So changing your diet may help to prevent attacks. Avoiding sweetbreads, herring, mussels and sardines can be helpful. So, too, can avoiding alcoholic beverages, especially beer, dark wines and champagne. Results of a study published in the New England Journal of Medicine indicate that a diet that includes dairy products and vegetables may help to prevent gout. Obesity and overeating or “bingeing” have been associated with gout, so maintaining a reasonable weight may also be a preventative measure.

If frequent gout attacks persist despite icing the area and elevating the joint, changes in medications or diet it may be time to visit a Rheumatologist to diagnose you accurately and prescribe medication to prevent flare-ups. These medications may include colchicine, Benemid® (probenecid) or Zyloprim® (allopurinol) or Uloric.

Dr. Scott Zashin is a respected and published Dallas Rheumatologist. He is dual board-certified by the American Board of Rheumatology and the American Board of Internal Medicine. Dr. Zashin is the Medical Director of Dallas Rheumatology. For more information on getting back to feeling great visit his website or call today to schedule your initial consultation 214-363- 2812.


 1 year ago    Leave a comments (0)



 2 years ago    Leave a comments (0)

Rheumatoid Arthritis is a chronic autoimmune inflammatory disorder affecting your joints and may cause pain in your hands, feet, knees, shoulders, neck, elbows and hips.

Know Your Level of Disease Activity

Rheumatoid arthritis or RA affects approximately 1 percent of the population translating to more than 2 million Americans yearly, with a 5:2 ratio of women to men. RA strikes many people in the prime of their lives and most often affects people in their early 30s – 60s. Rheumatoid arthritis is different than osteoarthritis. RA causes considerably more inflammation than osteoarthritis. It is considered an autoimmune disorder– meaning that the body’s immune system reacts against itself. Inflammation from RA may result in swelling, pain, and subsequent damage to the joints. Unlike osteoarthritis, RA affects the entire body. People diagnosed with RA often complain of extreme fatigue and a general sense of malaise.

RA can range in severity from manageable to mildly debilitating to completely disabling. Early diagnosis is important in slowing the progression of joint damage as damage can sometimes occur in as few as six months of the disease’s onset. Some common medications, which have been used for years to treat RA, include Plaquenil, Azulfidine, Methotrexate, Arava and Minocycline. Minocycline is not FDA approved but has been useful for patients with mild disease. These medications may be all that is needed to treat mild RA and may be sufficient for patients with moderate to severe RA.

Medications for Rheumatoid Arthritis

If you read magazines or watch television, you will most likely see advertisements for newer medications to treat Rheumatoid arthritis. Some examples include injectable biologics such as Enbrel, Humira, Remicade, Simponi, Cimzia, Rituxan, Orencia,and Actemra as well as oral Xeljanz. These anti-inflammatory medications have been miracles for some patients who have moderate to severe RA. But, on the other hand, these medications can also have potential side effects in some patients, which include but not limited to serious infections, some types of cancers, and other risks. Just because you have a diagnosis of RA, does not mean that that you need to take these medications. Whenever you’re prescribed a new drug, it is good to ask the doctor, do you feel that the benefits of taking these medications outweigh the potential risks?

Am I a Candidate for Medications?

If you’re newly diagnosed with RA, there is no way to know for sure whether or not you will develop damage and deformity in your joints and might benefit from aggressive management. On the other hand, your Rheumatologist should be able to tell you if you are at increased risk of joint damage and might benefit from medication. Know your level of disease activity. Ask your Rheumatologist if they feel you are in remission or have mild, moderate, or severe RA activity?

Most patients with mild disease activity do not go on to damage their joints and do not need biologics or Xeljanz.

Do I Have a Mild, Moderate or Severe Case or RA?

There are many tools Rheumatologists use to determine your disease activity.  Examples include:

  • DAS Score – This is a number that is calculated based on your pain, how many tender and swollen joints you have and a lab test called the sedimentation rate (ESR) or C-Reactive Protein (CRP) Based on the number, your doctor can classify you as having no disease activity (or remission) low, moderate or high disease activity.
  • HAQ Score – This score is entirely based on your symptoms and your level of function.
  • VECTRA Blood Test – This is a new blood test that measures 12 markers of inflammation and will give you a number that corresponds to low, moderate, and high disease activity. It’s expensive, but currently the company that sells the test caps patient charges around $25.
  • Imaging 
    • Plain Radiographs – If your doctor feels you have signs or symptoms of active RA, and there is already damage on your plain x-rays, then most likely you will be classified as having moderate to severe activity.
    • Ultrasound ­– Some doctors are using ultrasound in their office to look for early joint damage. The doctor doing the test must have a lot of experience with this technique to use if effectively.
    • MRI – Doctors may order this test to look for early damage. Word of caution! Radiologists who read these films sometimes comment on findings that may not be clinically significant. Your Rheumatologist in response to an MRI report may feel the need to be overly aggressive in their management and in some cases may not be warranted.

Know Your Body & Educate Yourself!

Always consider a second opinion if there is a question about diagnosis and treatment of your RA. RA is a chronic condition, and most patients take medications for a long time that may have potential risks. If you’ve recently been diagnosed with RA or arthritis or have been suffering from the disease for some time now, consider reading “Arthritis without Pain; the miracle of TNF blockers,” by Laurie Hesser and Dr. Scott Zashin to learn more. It’s easier to manage a disease process when you understand it.

Dr. Scott Zashin is a respected Dallas Fort Worth Texas Rheumatologist. He is duel board certified by the American Board of Rheumatology and the American Board of Internal Medicine. Dr. Zashin is the Medical Director of Dallas Rheumatology. Some of the above information about rheumatoid arthritis is from his and Laurie Hesser’s book Arthritis Without Pain, a comprehensive guide for patients considering or undergoing treatment with the TNF blockers Enbrel®, Remicade®, or Humira®. All rights reserved. For more information on rheumatoid arthritis, pain relief and getting back to feeling great visit his website: or call today to schedule a time to meet with Dr. Zashin 214-363-2812 personally.

Arthritis Foundation on how doctors measure disease activity.

Disclosure: Dr. Zashin currently or has been in the past, a speaker or consultant to some the manufacturers of the products mentioned in this blog.


 2 years ago    Leave a comments (0)

Low Dose Naltrexone or LDN is a new treatment for fibromyalgia and pain from other autoimmune/inflammatory conditions and its inexpensive! Dallas Rheumatologist Dr. Scott Zashin shares his thoughts.

Pain Free

Naltrexone HCL is an FDA approved medication that has been used for a long time to treat patients addicted to pain medications. In 2009, a small study was published by doctors at Stanford University (Younger and Mackey) showing that using very low doses of naltrexone helped relieve pain in patients with Fibromyalgia.

In this study, patients took 4.5 mg of naltrexone daily (50 mg is the standard dose used to treat narcotic addiction) and after 8 weeks they had reduced pain and fatigue. Other symptoms that often accompany fibromyalgia such as sleep problems, gastrointestinal complaints and headaches also improved. The authors followed up this study with a slightly larger randomized double blind placebo controlled trial published in Arthritis and Rheumatism 2013 and found that LDN had a beneficial effect on fibromyalgia pain and concluded that the medication is “inexpensive, safe and well tolerated. Additional studies were recommended to fully determine the efficacy of the medication.”

In a review published in the Clinical Rheumatology 2014 doctors Younger, Parkitny and McClain concluded that LDN is a promising treatment for not only fibromyalgia but chronic pain conditions that have inflammation. These include Chrohns disease, multiple sclerosis and CRPS (complex regional pain syndrome).They postulate that its benefit is due to its anti-inflammatory effect on the central nervous system via action on microglial cells.

Currently no pharmaceutical company manufactures naltrexone in the low doses used to help pain. As a result, your doctor will need to write you a prescription that you must take to a pharmacy that has expertise in compounding medications. Many of the larger pharmacies such as CVS and Walgreens will not offer this service. While the recommended dose is 4.5 mg, the starting dose may range anywhere from 0.5 mg to 1.5 mg and is slowly increased over a period of 3 to 8 weeks. The medicine is often taken in the evening one hour before bedtime. Initially, symptoms may get worse before they get better. Sometimes sleep disturbances such as vivid dreams can occur when taken at night possibly due to an increase in endorphin release. If this is the case, taking the medication in the morning may help. Standard dose naltrexone has been reported to elevate liver function tests. While LDN may be less likely to elevate liver tests, it makes sense to monitor liver function tests periodically especially if one is taking other medications that may elevate liver function tests. In this regard, patients with preexisting liver or kidney issues may require additional evaluation before treatment with LDN. In addition, because it is a narcotic inhibitor, it can negate the effect of opiate based pain relievers.

In summary, the use of LDN for chronic disorders is considered experimental and the long term safety of LDN is unknown. That being said, the doctors who published the review of LDN in the Clinical Rheumatology Journal concluded that LDN is a “promising treatment approach for chronic pain conditions thought to involve inflammatory processes. The clinical data supporting its use are very preliminary and more research is needed before the treatment approach can be widely recommended.”

If you or a family member is suffering from pain and/or has been diagnosed with fibromyalgia, perhaps its time to schedule an appointment with a board certified Dallas Texas Rheumatologist today.

Dr. Scott Zashin is a respected Texas fibromyalgia Doctor/Specialist in Dallas. He is duel board certified by the American Board of Rheumatology and the American Board of Internal Medicine. Dr. Zashin is the Medical Director of Dallas Rheumatology conveniently located in Dallas, TX. The above information about fibromyalgia is from his arthritis book: Arthritis Without Pain, a comprehensive guide for patients considering or undergoing treatment with the TNF blockers Enbrel®, Remicade®, or Humira®. All rights reserved. For more information on fibromyalgia, pain relief and getting back to feeling great visit his website: or call today to schedule a time to meet with Dr. Zashin 214-363-2812.


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