Interview with Dr. Dale Guyer

Discussion in 'Fibromyalgia Main Forum' started by Slayadragon, Apr 11, 2007.

  1. Slayadragon

    Slayadragon New Member

    Hi All,

    People occasionally ask me about my doctor, but I have not experienced his full range of treatments.

    I thus thought I'd copy an interview with him on the ImmuneSupport site here on the board, so that those interested in him wouldn't miss it. (I don't check the news part of this site very often, and thus tend to miss out on a lot myself.)

    Dr. Guyer says in this article that he has used Valcyte on 30 patients, and he told me in mid-March that he'd used it on 35 patients. It thus seems that this interview must have been within the past couple of months. (I note this because at one point another interview with him was distributed by ProHealth a couple of years after it was conducted---thus serving as a source of confusion since his treatment approach evolves quickly as he gathers new experiences and information.)

    I'm not trying to persuade people to see him (he's undoubtedly not right for everybody), but if anyone does make an initial phone or in-person appointment, be sure to reference my name. The cost then would be something like $275 (compared to something like $450 without a referral).

    Note that although patients who refer others also get a discount on an appointment, this is a one-time thing. I've referred someone in the past, and so it would not apply to me. (In other words, I'm not selling anything!)

    Best, Lisa


    ***


    Dale Guyer, MD, Discusses the Integrative and Molecular Treatment of Chronic Fatigue Syndrome and Fibromyalgia

    by Dr. Dale Guyer, MD
    ImmuneSupport.com

    04-05-2007

    Dr. Dale Guyer, MD, is a family physician and the Director of The Advanced Medical Center located in Indianapolis, Indiana,* where patients are offered a unique blend of traditional and integrative therapies for a number of health-related issues, with a focus on ME-CFS and FM.

    In the following Q&A Dr. Guyer explains his holistic, evidence-based approach to testing and treatment - which involves use of selected pharmaceutical drugs as an additive to appropriate nutritional support and other measures "to normalize a complex internal bio-chemical milieu."

    Question: Dr. Guyer, do you see many patients with Chronic Fatigue Syndrome and Fibromyalgia?

    Dr. Guyer: Yes, I have seen probably several hundred patients who have been given this diagnostic category.

    Q: How do you go about treating a patient with a weakened immune system?

    Dr. Guyer: Generally, these individuals require a detailed laboratory analysis to evaluate what components of their immune system are out of balance. For example many individuals have depleted Natural Killer Cell Function and imbalances in the TH1 and the TH2 immune responses. Additionally I like to see a baseline analysis for RNase-L, apoptosis, 2-5A-Synthetase, alpha-interferon, and associated lab work to get a more complete picture.

    Ultimately, strategies to improve immune system function would include anything that supports overall body health. An essential focus, in my experience, is to identify chronic infections and work to reduce immune burden - either with nutraceutical or anti-infective medication as clinically warranted.

    I also rely heavily on natural immune modulators such as transfer factor, probiotics,** and immune supporting herbals.

    Q: What are the most effective treatments you have found for supporting and strengthening the immune system?

    Dr. Guyer: After the evaluation from a laboratory analysis I can determine what areas of weakness or imbalance lie within the immune system, and an appropriate treatment regimen is then detailed. Sometimes prescription medicines, such as TagametR and/or the opiate-blocking drug naltrexone are useful adjunctive therapies.

    Q: If a patient’s primary complaint is devastating fatigue, what test do you perform to try to determine the cause?

    Dr. Guyer: This is certainly a broad question and a common focus, as most [CFS and FM] patients fit this category. Unfortunately, there are no simplistic answers. Almost always in these cases there is a complex interplay of many causative factors - in terms of:

    n Chronic infections which could be fungal, bacterial, viral, even parasitic,

    n Toxin exposure such as mercury, cadmium, aluminum, and lead,

    n Digestive dysfunction and poor absorption,

    n Coagulation abnormalities,

    n Metabolism abnormalities,

    n Immune system dysfunction,

    n Food allergies,

    n And significant endocrine or hormonal abnormalities - especially for thyroid, adrenal, testosterone, DHEA [a type of hormone produced primarily by the adrenal glands] and growth hormone.

    Therefore, selectively from the patient history and past medical record, I am able to take that information and determine which types of tests would be most appropriate for the individual, and then from those results determine an appropriate treatment course.

    Q: What might a comprehensive treatment program include for a patient whose main symptoms are those typical of Chronic Fatigue Syndrome?

    Dr. Guyer: In a general sense that would depend, of course, on the laboratory analysis [so that] the physician - myself in this case - would know specifically what types of problems we are dealing with.

    n As indicated above, the CFS patients I have seen almost always have immune dysfunction.

    n In addition, most are nutritionally depleted, so we often utilize intravenous vitamin therapies for replacement, adjunctively adding in Vitamin B12 shots of which we use a special formulation with high dose Hydroxycobalamin that includes Glutathione to help with the body’s energy reserves. For more recalcitrant cases, I will utilize a special version of vitamin B12 which includes trace minerals, selenium, and potassium-magnesium aspartate in injectable form.

    n Also, most of these people will have a sub-clinical low thyroid function and adrenal problems, which need to be addressed pharmaceutically and/or nutritionally.

    n They often have detoxification impairments and evidence of heavy metal toxicity.

    n They almost always have chronic infections that I treat as noted above,

    n And, especially for the Fibromyalgia patients, chronic pain and sleep issues must be dealt with. In that context, I use special topical pharmaceutical preparations that utilize a special gel, which penetrates into painful areas to relieve discomfort and support healing.

    I also work on reestablishing normal sleep patterns, which can be simple in terms of deficiencies of calcium or magnesium - or hormonal, such as deficiencies of melatonin or thyroid. Some patients respond to a simple therapeutic regimen such as a combination of 5-HTP and tryptophan, which we have formulated for patients by a compounding pharmacy.

    Q: How do you feel about treating a patient with heavy metal toxicity?

    Dr. Guyer: In my experience, 90 percent of patients with FM and CFS will always have elevated toxic metals, as determined by a provocative challenge test. Most commonly this is mercury, but often other metals such as lead, cadmium, and arsenic can be present as well. Some patients will have many types of metal exposure depending on their functional detoxification efficiency, as well as the historical component of exposure.

    In any event, it has been my experience that it is absolutely important to work on the detoxification of heavy metals, and of course, the detoxification of the entire body. In addition, supportive detoxification therapy such as massage therapy and lipoceutical glutathione [L-Glutathione], and intravenous glutathione, high dose vitamin C, and infrared saunas all tend to be selectively and additively helpful.

    Q: Where do you think traditional pharmacological interventions fail in patients with CFS and FM? What do you think of antibiotic therapies for such patients?

    Dr. Guyer: In general, conventional medicine often fails to recognize CFS and FM. Unfortunately, those patients often get relegated to a category suggesting that all of their problems are purely psychological, which is far from the case.

    It does, however, lead the patient to a frustrating position - as few doctors are well-versed in the appropriate treatment of these illnesses. Unfortunately, the few therapies that are provided from a pharmacological basis and conventional medicine are often no more than symptomatic cover ups. In a general sense they are medicines prescribed to ease pain, to improve sleep, and reduce depression; all of which can be helpful, but none of which get to the core of the problem.

    As for antidepressants specifically, many of my patients have stated that when their other doctors have put them on antidepressants, it only helps them to “feel better about feeling bad,” but never really improved their functional status.

    As for antibiotic therapies for such patients, I have seen those to be dramatically helpful. There are usually subtle clues to delineate which patients are going to benefit most, such as those who tend to have elevated viral antibodies, including the Epstein-Barr virus [Human Herpesvirus-4], HHV6 [Human Herpesvirus-6], and CMV [cytomegalovirus, a member of the herpesvirus family].

    Other good candidates are those who obviously have a positive serum analysis on a PCR screen [to detect presence of infectious organisms] for viruses, bacteria, or fungal organisms. The selection of the antibiotics has to be specifically tailored to the individual in terms of tolerance and the nature of the organism being treated. And sometimes the dose needs to be adjusted or varied over time and even changed to different pharmaceutical regimes.

    All in all, I have found these therapies [pharmacological] to be very effective additively, not as a stand-alone therapy without appropriate nutritional support and other efforts to normalize a complex internal bio-chemical milieu in order to be totally effective.

    Q: What are the main mistakes you have noticed among patients who self-treat with vitamins and supplements?

    Dr. Guyer: Generally, the frustrating challenges are that many of the supplements that are available over-the-counter are often of poor quality and the wrong combination. So the patients who have not had the luxury of the clinical training, background, or experience often engage in a hit or miss proposition, and sometimes feel a little better but often times feel worse.

    To make the matter more of an insurmountable challenge, most doctors are ill-equipped from an educational standpoint to be able to specifically recommend avenues for the patient to navigate through nutritional supplementation successfully.

    Q: Do you have any theories about the causes and development of Chronic Fatigue Syndrome?

    Dr. Guyer: I generally feel that the name “Chronic Fatigue Syndrome” is not particularly diagnostically helpful since it just tends to imply that a person is fatigued for a period of several months, and it erodes their ability to live their normal life.

    If these patients have sleep disturbance and pain in addition to severe fatigue, they often get lumped into the Fibromyalgia camp. As a diagnostic label it carries meaning, but in terms of describing what is really going on physiologically, it is not of much help.

    In my experience, these people who acquired these diagnoses have a complex interplay of many different elements as discussed above, relating to nutritional dysfunction, environmental sensitivities, toxin accumulation, chronic infections, normal human aging issues, excess stress, depleted hormone levels, and of course, the basic genetic structure with which they came into the world which may have areas of weakness that have made them vulnerable, given the right set of circumstances, to the emergence of these symptomatic patterns.

    Q: Any additional comments of advice regarding the value of a holistic approach to help in healing?

    Dr. Guyer: One particular element of advice would be the Latin phrase ‘caveat emptor’ or “buyer beware.” There seems to be a lot of media hype regarding “fluffy information,” most of which is not particularly helpful to patients.

    On the other hand, there are enormous amounts of clinical data and very high quality products available that truly do make a profound difference in one’s overall health. So the value of the holistic approach is exceedingly high. Unfortunately, modern medicine in its current state has not yet learned to fully recognize that reality.

    However, the medicine of the future will make a more integrated effort to bring into the play the entire body, mind, and spirit connection to facilitate a patient achieving their optimal health potential. That will include elements of psychological services, structural attention through adjustments such as chiropractic and osteopathic techniques, as well as the biochemistry of a nutritionally based doctor who can reestablish the normal internal chemical balance for each individual patient.

    Q: What are some of the newer avenues you are finding useful to treat Chronic Fatigue Syndrome in your practice?

    Dr. Guyer: In the subset of patients with clinical documentation of chronic viral infection, the selective use of anti-viral agents has emerged as an effective adjunct. While oral agents such as acyclovir, FamvirR and ValtrexR often have good benefit, the recent utilization of ValcyteR [valganciclovir] has been a significant step forward.

    To date I have treated about 30 patients with ValcyteR and most have demonstrated very encouraging results. In the future I hope to be able to put this collective data together, as I believe it could be a significant help to others.

    ____
    * The Advanced Medical Center in Indianapolis, Indiana, was founded in 1997 by Dr. Guyer. New patients are welcome. For more information, including glossaries explaining some of the therapies, nutritionals and tests mentioned, visit http://www.daleguyermd.com, or call (317) 580-9355. To listen to a detailed lecture on CFIDS/FMS, log onto Dr. Guyer’s website.
    ** For more information on transfer factor and probiotics, see recent articles in the ImmuneSupport.com Library such as "Transfer Factor and the Importance of a Healthy Immune System" and "What You Should Know About Probiotics and Prebiotics."

    (c) 2007 Pro Health, Inc., and ImmuneSupport.com. All rights reserved.

    Note: This information has not been evaluated by the FDA and is not meant to prevent, diagnose, treat, or cure any condition, illness, or disease. It is very important that you make no change in your healthcare plan or regimen without researching and discussing it in collaboration with your professional healthcare team.


    [This Message was Edited on 04/11/2007]
  2. cherylsue

    cherylsue Member

    I picked up on the Naltrexone, as well. It was suggested to me by a college friend, a doctor practicing in California. A colleague of hers recovered from CFS by taking LDN Naltrexone. There is a compounding pharmacy in Aurora, Il that makes it. My friend say she'd RX it for me if my doctors were not interested.

    Dr. Papernik said it came out about 5 years ago, but hadn't proved statistically significant. I did a search here on the board. Some members felt it did help some, another said it made her worse. I had emailed Dr. Teitelbaum and he said he used to use it on his patients, but stopped because he did not feel it was helpful. Dr. Enlander in New York uses it on his patients, but he is neutral about its effectiveness.

    LDN Naltrexone works on the TH1 and TH2 shifts, so I think it matters if your CFS is bacterial or viral. It is used for Multiple Sclerosis patients. There is a website on LDN Naltrexone. I had researched it last fall.

    Since Lisa hasn't mentioned it in her strategic plan with Dr. Guyer, I assumed he no longer was using it as well. It's hard to tell when that ProHealth interview was done. CFS research and protocols are moving pretty fast. Even Dr. Cheney has changed his protocol. A few years can make a big difference.

    Although LDN naltrexone is relatively cheap, I decided not to use it because there just wasn't more evidence beyond anecdotal reports. I didn't want to do any harm, so I went with the more tried and true - Nexavir. However, I may be wrong. I am just waiting for more info.

    CherylSue
  3. Slayadragon

    Slayadragon New Member

    Hi mezombie,

    If you've made it here, then I'm guessing you're feeling better and thinking about treatment. (I do worry about you.)

    Anyway, note that Dr. Guyer goes out of his way to specifically mention parasites in this article. That suggests to me that he's willing to try to treat them, at least in some cases.

    I hope you're doing okay.

    Best, Lisa

  4. BobinGermany

    BobinGermany New Member

    Any doctor that uses "incentives", etc to get customers worries me. Also, if the doctor truly cares about treating people more than making money you would not need to mention a name in order to get a reasonable price to begin with. Why is it that these "specialists" charge sometimes 100 to 1000 percent too much and then make incentives to get customers? When you go to a conventional doctor you don't bargain on price. And you are not asked to provide new customers. Makes one wonder? As for anti-depressants, nofool was correct again in my opinion.
    Food for thought....

    God Bless,
    Bob
    [This Message was Edited on 04/11/2007]
  5. mezombie

    mezombie Member

    Or it could mean that I'm so frustrated at my relapse that I'm doing stupid things like posting on this message board because I can't see how things can get much worse. Of course, they can, and spending time on the computer will only make that come true. Thanks for reminding me.

    There's a doctor whose practice is very similar to Dr. Guyer's very near me. If I was to choose that route, I'd go to him. As I've posted before, it's important to me to have whoever treats me be close by.

    I've made some progress on identifying other potential treatment sources, such as Lyme Literate M.D.s (as they are very familiar with parasites) as well as doctors specializing in the treatment of HIV/AIDS (because they are experienced at treating Toxoplasmosis).

    I have yet to get the EEG. For some strange reason, the facility that houses the testing machinery won't bring it to me.

    I finally managed to take a shower yesterday. No, I am not doing well. I'm still very weak and all the flu-like symptoms as well as the neurological ones are flaring to beat the band. Progress is slow. I'm no longer living in my bed sustained by water and powerbars. I'm now able to move my body from one flat surface to another, and even sit up a bit. But I'm exhausted and resting or sleeping most of the time.

    Thanks for your concern. I've got the situation under control. I may not be addressing it the way you would, and I hope you can respect that.

  6. Slayadragon

    Slayadragon New Member

    Of course I can respect that!!! I didn't mean to be pushy and am really glad that you've found other options. I didn't recall your saying you wanted a doctor to be nearby, and you seemed so frustrated and unhappy about the toxo the last time we talked about it (i.e. "my kingdom for someone who will treat this") that it made me want to help. (Offering unsolicited help---if only occasionally---is a flaw of mine that I should try harder to control.)

    Sorry.....

    Best, Lisa
  7. zipk

    zipk New Member

    Hi CS:

    I found it interesting to say that regarding naltexone working to balance Th1 and Th2 depends on whether one has bacterial vs viral infection..

    Is this because each infection you mentioned effects Th1 or Th2? Could you explain that?

    Thanks,
    Zip
  8. Elisa

    Elisa Member

    Thanks Lisa!

    He is a very well spoken doctor with an exceptional understanding of the factors at play - I am truly impressed.

    Has he been able to help? If so, what has he suggested/prescribed for you (supplements TFS etc) that you think others may benefit from - knowing, of course, we're all different...

    Just looking for options - that's my source of hope.

    Thanks,

    Elisabeth
  9. Slayadragon

    Slayadragon New Member

    Hi Elisabeth,

    Sorry to be so long getting back to you.

    I just revised my bio to give detailed info about my whole treatment history.

    Hopefully that will answer your question...

    Best, Lisa

  10. Slayadragon

    Slayadragon New Member

    bumping for Kingneptune
  11. KingNeptune11

    KingNeptune11 New Member

    Lisa,

    I appreciate your help......I come and go with this board over the years, most of the time I dont post.......You seem to do much better with all of the "personalities" on this site, but I often get caught up in good arguments......LOL

    I applaude your patience and kindness.......You have a kind heart.........Please make sure you are getting enough rest, I notice many people tend to keep you busy.......John