Golder N Wilson MD

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Map & DirectionsDirections3608 Preston Rd Ste 125Plano, TX 75093 Write a ReviewWrite Review

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AKA: Wilson Golder N MD PA
Categories: Physicians & Surgeons, Mental Health Services, Physical Therapists, Physicians & Surgeons, Dermatology, Physicians & Surgeons, Endocrinology, Diabetes & Metabolism, Physicians & Surgeons, Family Medicine & General Practice, Physicians & Surgeons, Gastroenterology (Stomach & Intestines), Physicians & Surgeons, Gynecologic Oncology, Physicians & Surgeons, Gynecology, Physicians & Surgeons, Internal Medicine, Physicians & Surgeons, Neurology, Physicians & Surgeons, Obstetrics, Physicians & Surgeons, Obstetrics And Gynecology, Physicians & Surgeons, Orthopedics, Physicians & Surgeons, Pain Management, Physicians & Surgeons, Pediatrics, Physicians & Surgeons, Psychiatry, Physicians & Surgeons, Rheumatology (Arthritis)

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Phone: (214) 797-0031

Address: 3608 Preston Rd Ste 125, Plano, TX 75093

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Golder N Wilson MD

General Practitioners

Arthritis
Fibromyalgia
Joint preservation strategies. Although very difficult as this older man can attest, wear and tear osteoarthritis from joint-tissue flexibility and fragility is best combatted by “wise” exercise that chooses joint-protective activities like swimming, cycling, and low-weight-lifting over jogging. Remaining active is crucial with supine (recumbent bicycles, floor routines) or aquatic exercise best tolerated by those with severe dizziness and/or skeletal pain. Physical therapists, massage, and appropriately gentle chiropractors are helpful in guiding build-up of core-strength and protective muscles around joints (see DNA discussion describing the many muscle-related gene changes that are being found in EDS),4,5 It is essential to minimize cycles of inactivity that can exacerbate POTS, chronic fatigue or fibromyalgia, shown by the many EDS patients who first seek medical attention after being bedridden from illness, trauma, or surgery. Bracing susceptible joints--waist bands for back/sacroiliac constraint, shoe/arch supports for feet—plus strategies to help blood return (support hose) are helpful, and weight gain that is understandable in those with pain and fatigue is a major contributor to joint wear-and-tear. The RICE ( R est, I ce, C ompression, E levation) approach to injury can minimize ongoing joint damage, and attention to joint pain (growing pains usually occur at night) or injury/skeletal deformity with prompt orthopedic referral can optimize function.
Rheumatology
Rheumatology and pain management. Rheumatologists (e. g., Drs. Chowdhry, Dao, Rezazadeh, Syeda in DFW) are often the first to suspect EDS and are helpful in separating autoimmune from osteoarthritis by documenting autoimmune (ANA, anti-phospolipid, Sjogren antibodies) or susceptibility markers (HLA B27 with ankylosing spondylitis) that may warrant a trial of immunosuppressive medicines like Humira. Although 10% of my EDS patients have one of more of these markers, their predominant wear-and-tear osteoarthritis rarely responds to immunosuppressive medicines. Joint pain and instability are the most refractory problems in EDS and the depression without prior history experienced by a national pain expert during a year of back pain2 should be heeded by anyone caring for these patients. Fibromyalgia is a frequent symptomatic diagnosis because most complain of muscle tenderness, spasms, and aches (“whole body pain”) that in my personal experience are difficult to separate from arthritis and tendonitis. Ibuprofen and other NSAIDS are effective for joint pain but problematic in people with IBS. Celebrex and Flexeril are mentioned by many, but all medicines require cautious introduction and titration due to the intolerances and atypical responses mentioned above. It is important to remember that NSAIDS are more effective than narcotics in treating pain although the latter can lessen perceived distress, a likely factor in addiction.
Pediatric Care
I have spent 42 years in academic medicine doing general pediatrics and genetics, becoming an endowed full professor of pediatrics during 14 years at UT Southwestern Medical Center and Children’s Medical Center of Dallas.
Primary Care
I offered to review the history and physical findings of Ms. Jane Doe on July 14, 2020 as she requested after becoming concerned about symptoms of Ehlers-Danlos syndrome (EDS). I would emphasize that this review is for information only and cannot be taken as a medical diagnosis. I perform this information service as part of my ongoing clinical scholarship on EDS that aims at better recognition of this complex disorder. I hope that Ms. Doe and her physicians will become more informed about EDS from this letter and its attachments, that they will help her primary care and subspecialty physicians consider EDS and its many complications in their management plans.
Constipation
Irritable Bowel Syndrome
IMPRESSION: My overall impression is that the findings listed by Ms. Doe using my standard forms fit the pattern of arthritis-adrenaline disorder (AAD)* as a category and Ehlers-Danlos syndrome (EDS—classical type) as a particular condition based on my prior 1900+ EDS evaluations. She is 35 years old and reports 40 of 80 typical findings by history (higher than 70% of my female EDS patients of that age) and 18 of 40 on physical (higher than 60% of my female EDS patients).* These findings include joint hypermobility with subluxations and joint-muscle pain, skin fragility, pelvic pooling/menorrhagia, headaches and other neuromuscular symptoms, and the dysautonomia that can lead to irritable bowel syndrome (IBS), postural orthostatic tachycardia syndrome (POTS), and mast cell activation disorder (MCAD)—see her entries on the attached standard forms to appreciate all of her findings. My impression suggests that she has a medical disorder that can cause anxiety from POTS and depression from pain and activity limitation rather than a psychiatric disorder or hypochondriasis.
Diarrhea

Gynecology
In 2003, I began a private practice and continued academic work at the Texas Tech University Health Science Centers in Amarillo (Professor of Pediatrics, Obstetrics & Gynecology) and Lubbock (Clinical Professor of Pediatrics), now continuing the latter appointment to help with laboratory administration and genetic education. I emphasized research early in my career and was the first to report cloning of human DNA with my fellowship mentor Roy Schmickel in 1978, going on to conduct NIH-funded laboratory research on ribosomal RNA genes and peroxisomal disorders before focusing on clinical work in 1996.
Obstetrics
Endometriosis
Miscellaneous. Many patients have dry and itchy eyes, treated with lubricating and anti-allergic drops. They often have dry/scaly skin, transient rashes, eczema, and hives, the former perhaps related to frequent FLG gene mutations5 in EDS that were first associated with ichthyosis vulgaris (common fish-like skin), the latter three to mast cell activation. Most can manage with lotions and primary care for the atopic symptoms; need for dermatology has been rare. Bladder issues include interstitial cystitis, frequency, incontinence, and frequent urinary infections, and gynecology visits for discussion of dyspareunia and birth control regulation of menorrhagia with eventual endometriosis should be encouraged. Pelvic prolapse can occur with age and/or multiparity and vulvodynia can be severe in some women. Conventional medications for depression and anxiety can be helpful, especially if these disorders are recognized as secondary and the many medical therapies described above are also instituted.
Pregnancy

Gastroenterology
Nutrition strategies. Low bowel motility/IBS is benefitted by smaller, more frequent meals, lower dairy/gluten, enzyme supplements like BetaGest or Vitazyme, and probiotics. Dietary and gastroenterology consultation should be considered since hiatal hernia, food intolerance similar to celiac disorder, and inflammation provoking gastritis, esophagitis, or Crohn diagnoses can occur. Supplements including vitamins (D at 2000 units, B12 at 1 milligram, C at 1 gram daily in addition to B complex) will offset frequent malabsorption and others may be needed to rectify low iron, ferritin, thyroid levels (post Hashimoto thyroiditis) that are common in EDS. Some find chondroitin-glucosamine preparations (e. g., Osteobiflex) and magnesium to be helpful among many anecdotal remedies for osteoarthritis. The chronic fatigue that can occur from IBS is greatly exacerbated by POTS, managed first by hydration (8-10 glasses of fluid per day), salt (absent hypertension), and high protein (to maximize intravascular volume and brain circulation). Mast cell activation ensures many dietary intolerances that are periodic and poorly identified by skin or antibody testing.
Interstitial Cystitis

Neurology
N eurosurgery, neurology. Recurrent daily headaches including exacerbating of pain with sneezing or abdominal pressure can indicate increased intracranial pressure caused by Chiari deformation (acquired in EDS and different from the congenital Chiari malformation occurs in spina bifida). Upright head MRI with cervical extension-flexion studies are needed to recognize the low-lying or herniated cerebellar tonsils associated with Chairi and the craniocervical instability that along with cervical disc changes can cause severe occipital and neck pain in EDS. This is one of many areas where websites like EDS awareness—www.chronicpainpartners.com, www.ehlers-danlos.com, www.ednf.org, local EDS sites (e. g., Dallas, Houston, Austin) can direct patients to national experts familiar with EDS (e.g., neurosurgeon Dr. Greenfield in New York). Experience with EDS is important because neurosurgery may cause cerebrospinal fluid leaks from fragile dura, the low intracranial pressure being as devastating as high (pseudotumor cerebri, empty sella) from Chiari. Migraines often occur, sometimes diagnosed as occipital neuralgia, many EDS patients experiencing several types of headaches even in the absence of Chiari. Neurologists may collaborate in therapy for headaches and the frequent neuropathies (carpal tunnel, thoracic outlet syndromes) that occur, able to document frequent small fiber neuropathy if an EDS-dysautonomia (AAD) diagnosis is in doubt. The many EDS patients (>150) I am discovering with mitochondrial DNA changes or mutations formerly associated with muscle disease (myopathy)5 may justify more invasive tests like muscle biopsy, but none have chosen this procedure so far.
Carpal Tunnel Syndrome

Depression
Anxiety

Endocrinologist

Thyroid

MRI
IMPRESSION: My impression is that the findings reported by Ms. Doe are consistent with a moderate form of Ehlers-Danlos syndrome (EDS), her hypermobility and skin findings with scarring being most typical of the classical cEDS type. She did report headaches that can indicate increased intracranial hypertension/Chiari deformation or cranio-cervical instability that are more common in EDS-- she may wish to have upright MRI studies with neck flexion/extension to exclude these complications. In her 35 years Ms. Doe has not developed the facial changes, the bowel/blood vessel/uterine ruptures, or the lethal complications during pregnancies that can be seen in vascular and other severe forms of EDS.

Orthopedics
Orthopedics. Negative outcomes have followed surgeries for joint “tightening” or replacement, so conservative management by orthopedists familiar with EDS (e. g., Dr. Humeniuk in DFW) is important along with knowledge of EDS complications like plica band, avascular regions from injury, or deformations from gravitational and other forces on lax tissue (kyphosis, pectus, scoliosis, disc herniation/degeneration, toeing-in, flat foot). Injections and steroids should be used with caution because they can augment the lower bone density, compression, and stress fractures that are common in EDS.
Neurosurgery

Dermatology
Eczema
Rashes

Physical Therapists

Physical Therapy
I feel that common forms of EDS belong to an arthritis-adrenaline disorder (AAD) category that involves a central process of articulo-autonomic dysplasia with reciprocal articular laxity and dysautonomia as diagrammed in the attachment. Tissue laxity/lower body blood pooling stimulates adrenaline to restore brain circulation with one stroke, the autonomic imbalance producing small fiber neuropathy and weak muscle fibers to increase tissue laxity with the other. This cycle implies universal therapies for EDS and related disorders that include 1) joint protection, physical therapy, and exercise strategies to build core strength/muscle protection that will constrain hypermobility and joint instability; 2) hydration, vitamin supplement, lower gluten-lactose and other nutritional strategies to curb fight-or-flight adrenergic stimulation; and 3) medication therapies coordinated by subspecialists who are familiar with these skeletal and autonomic complications (see attached therapy information).
Neck Pain
Back Pain

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