this is long but interesting, i'd like anyone's imput on guyers' plan for treating our DD, Paul Mark in KY Interview with Dale Guyer, M.D., on Treating Chronic Fatigue Syndrome & Fibromyalgia: ImmuneSupport.com 07-18-2003 over 3 millioin annual visitors to the website 3,000 plus CFS research articles and abstracts and items Dale Guyer, M.D., is the Medical Director of the Advanced Medical Center in Indianapolis, Indiana. The Advanced Medical Center is a multidisciplinary treatment facility which emphasizes a holistic basis. The center utilizes the collective expertise, a naturopathic physician, and is currently in the process of creating a unique spa like environment and personalized training exercise facility to effectively help individual patients navigate an optimal health experience by incorporating the best avenues of mind, body, and spirit. In this interview, we have asked Dr. Guyer to comment specifically on some of the therapeutic avenues he has found most helpful in adjunctively treating Chronic Fatigue Syndrome (CFS) and fibromyalgia (FM) and to clarify what Dr. Guyer refers to as "the multi-factorial contributory etiologies in dealing with this complex medical diagnosis." ImmuneSupport.com: Dr. Guyer, when we last spoke with you, you had commented on an innovative new approach to the treatment of Chronic Fatigue Syndrome in those patients who had a strong viral contribution to their illness. Can you give us an update on your experience with that treatment approach and what you are learning by your experience? Dr. Guyer: In my collective experience to date, the additive utilization of the Intraveneous Insulin Potentiation Therapy with low dose antiviral medicines has been nearly a godsend for individuals who have not generally responded to the relatively broad array of conventional and even unconventional therapies. Most patients in my experience will notice a benefit after the first one or two treatments, although a collective maximum response usually will take 8-10 treatments. Since we look at Insulin Potentiation Therapy as a way to augment or amplify the results of other types of therapies, we are finding added benefit by coupling existing therapies to the insulin potentiated antiviral approach. Therefore, given that he also had high levels on PCR analysis of the HHV-6 virus, we opted to combine the Insulin Potentiation Therapy with the IV antiviral medicine Cidofavir and in addition co-administered with the IPT regimen. He experienced a near complete resolution of symptoms in three treatments, and follow up PCR analysis showed zero levels of circulating virus. This treatment was completed in September, and he remains symptom-free at the time of this writing (May 2003). ImmuneSupport.com: This does indeed seem like a promising new therapy, especially in the context of the broader base approaches you have found useful that you had previously discussed in your last interview. Let’s take a few moments to discuss some of the individual facets that in your experience have been primary contributors to the ongoing CFS and FM syndrome and what you are finding to be currently most effective. The first issue that often comes up is the challenge with getting regular sleep or getting quality sleep. What sorts of therapies have you found most effective for CFS ? Dr. Guyer: To date, some of the better treatments I have found for this problem always they involve an incorporation of the common sense inclusions such as proper diet, and non aerobic exercise tailored to the severity of their CFS. It should be noted that given researchers have proven that CFS patients can be permanmently damaged at the ‘cell level” by and do not tolerate aerobic exercise, due to the lack of blood cortisol/oxygen levels getting to the mitochrondria of the cell in CFS. Often times many patients do not respond to the usual array of sleep medicines and other concoctions or need additional therapy to more broadly support their sleep quality In that context, my favorite formulation is a compounded preparation that I have done by Hopewell Pharmacy in New Jersey. In this I combine Tryptophan 500 mg, 5-HTP 125 mg, and Melatonin 2.5 mg per capsule. The patient usually takes 2-4 at night 30 minutes before bed. In my experience, this has been an enormous help in helping to stabilize sleep quality. It also has a favorable fact in decreasing pain by augmentation of the Serotonin pathway. ImmuneSupport.com: It sounds like these therapies are very helpful as an adjunct to stabilizing sleep. In addition, what have you found to be the most useful in improving overall energy status in fighting fatigue in these patients? Dr. Guyer: To enhance energy level, some of the best adjunctive therapies I have found to date include the intravenous vitamin therapies in which the patient receives through an intravenous infusion a mixture of Trace Minerals, Glutathione, ATP, Magnesium, Complex, Vitamin B12, and other additions depending on clinical need. In addition, we will often teach our patients to do their own intramuscular injections, and the best formulation I have evolved over time that I feel has given the best clinical results in my practice is a specialized Vitamin B12 injection as a combination of Heptaminol. This also I have compounded by Hopewell Pharmacy and it includes trace amounts of the mineral Selenium to help with the immune system, ATP and AMP to help with the energy system, Vitamin B12, and a special injectable formulation of Potassium and Magnesium Aspartate. Generally I have patients use this formulation in the following scenario: 1-2 cc IM daily for 2 weeks, 3 times a week for 2 weeks, and twice weekly for 2 weeks, and then on an as needed basis thereafter. In addition, I found combinations of the oral supplements Enada 1-4 daily coupled oral Potassium and Magnesium Aspartate to be very helpful. Obviously, in addition of course, we need to look at the underlying etiologies as well as we evolve a more clear diagnostic picture as individualized to the patient, and these of course will include items I previously mentioned in terms of evaluating for toxin overload, metabolic problems, nutritional deficiency, hormone imbalance, sub clinical hypothyroidism, and chronic infections to name a few. ImmuneSupport.com: On the topic of the immune system, what adjunctive therapies are you observing to be the most promising? Dr. Guyer: For those who have a chronic viral infection, the combination I have liked mostly is the oral antiviral medicine,, I have been using Isoprinosine 500 mg 2-6 daily as an immune system adjunct. This is a semi natural preparation that is manufactured by Newport Pharmaceuticals in Ireland, and at this point and time it is unavailable by prescription in the United States, but is easy to obtain with a doctor’s prescription from Canadian pharmacies (Rivex Pharmacy in Aurora, Ontario). In addition, non drug approaches for each of the patients I have them take Transfer Factor - often 2-6 tablets daily, and also NT Factor and Immunplus (milk whey protein isolate) which have anti viral properties. ImmuneSupport.com: Thank you for your tips on immune system augmentation. One of the common issues particularly associated with the fibromyalgia spectrum of this complex are the chronic pain symptoms. What are some avenues you have found useful in that regard? Dr. Guyer: On the topic of chronic pain, which is a predominant complication for many sufferers, it is important to engineer a specific regimen that aids the individual patient in efficaciously getting out of the chronic pain cycle. When this is established, it obviously is more favorable to creating circumstances for continued progress in more optimal health. some of the prescription medicines I have found particularly helpful such as low dose Lithium. This I generally use at about 150-300 mg daily which is significantly less than average doses used to treat neuropsychiatric problems, and at these low doses I have never seen any patient have side effects.. In addition, Dextromethorphan at low doses particularly at night are often helpful, Immune Support.com: Thank you for sharing your insights and some of the elements of chronic pain management that you have found very successful. One of the other problems we often see relates to the mood disorders that plague sufferers of chronic fatigue and fibromyalgia syndromes. What are some elements that you have seen useful in helping to support a person in these challenging situations? Dr. Guyer: Many of the other components I previously mentioned while usually contribute positively to helping the patient manage these symptoms, primarily the Insulin Potentiation Therapy I have seen for those who tend to be chronically depressed is wonderfully effective, and historically it had to have been well known that the insulin treatments were some of the very first therapies available in conjunction with electroconvulsive shock therapy for the treatment of depression. It was actually quite by accident that a psychiatrist I believe in the 1930’s was treating a patient for depression with Insulin Therapy who also happened to have an advanced terminal cancer. Not only did her depression go away but her cancer went into complete remission and hence was born one of the initial observations of the potential role of Insulin Potentiation Therapy as an anti cancer adjunct. The other components of the anxiety depression problem often relate to the hormonal balance. Many patients with a deficient or a sub clinically deficient thyroid status will often be depressed and anxious, and as those elements are treated and improved often with thyroid replacement therapy, that patient will feel immensely better. In many instances, I have seen patients who have been chronically fatigued for 20-30 years and had tried various antidepressants over that time with minimal results, respond remarkably to replacement doses of Armour Thyroid or Sustained Release Micronized T3 (the active thyroid hormone - this is also compounded by Hopewell Pharmacy). Also, I have seen very good success particularly with anxiety using the Alpha-Stim which is an FDA approved electrical device that can be used by the patient at home. It has portable electrodes that can be adhesively applied to the scalp and treated 20-30 minutes per day. It tends to be very helpful for chronic pain, chronic and acute pain issues as well as anxiety and depression, in addition to improving sleep for many patients, and I have seen very good success with this therapy, and the good news is that for many patients their insurance will actually cover this ongoing therapy. (You can look up information on the Alpha-Stim unit at ImmuneSupport.com and at Alpha-Stim.com). ImmuneSupport.com: Thank you for your collected insights on that topic. Another area of challenge for the patient revolves around the irritable bowel symptoms, poor digestion, gas and bloating particularly after eating, and general overall poor nutrient absorption. What are some of the things you have noted seem to be primary contributors to such problems, and what are the things in your experience that seem to be most helpful? Dr. Guyer: Indeed I think the digestive - and for that matter the detoxification system, are often the crux or limiting pieces that get in the way of significant healing, and of course when someone does not digest and absorb effectively their cellular nutrient profiles are going to be inherently deficient. Secondly, most people need to supplement with digestive enzymes and tailor to the dosing amount that improves overall function and reduces the irritable bowel complaints. In addition, some people of course will need to take small amounts of hydrochloric acid as their own stomach hydrochloric acid output is diminished () Also, most patients have alterations of the intestinal ecology and will need supplementation of probiotic bacteria, and sometimes initially at least many patients will need a broad array of different types of probiotics, and so often times initially for the first several weeks I will have patients take 3 or 4 different brands which different spectrums of biologically active probiotic bacteria. Also of course, there will often tend to be yeast overgrowth especially in those who have ever been on any kind of antibiotic therapy, and to help in that sense it is often beneficial to do a comprehensive digestive stool analysis (Great Smokey Diagnostic Laboratory performs such analyses). If yeast organisms are noted on the comprehensive digestive stool analysis, a sensitivity analysis can be completed that will show what antifungal medicine or natural compound the organisms are sensitive to. Some people will often require multiple antifungal drugs to be categorically effective. One of my favorite regimens, at least from the natural world, is Oregano Oil. This always seems to offer improvement in most patients. Where I find that incomplete, I will usually use combinations of Diflucan and Nystatin, Again, this needs to be prepared by a compounding pharmacy and often several weeks of therapy will be required. ImmuneSupport.com: Dr. Guyer, we very much appreciate your taking the time to share some of your insights with our readers. One final question would be, what therapies have you seen recently that you are beginning to incorporate in your practice that you anticipate will show significant promise in adjunctively treating Chronic Fatigue Syndrome? Dr. Guyer: I have been particularly interested in Dr. Shoemaker’s work with the hormone MSH. He had been kind enough to discuss the efforts of his research with me on several occasions, and indeed it is intriguing that MSH is often an overlooked hormone in medical therapeutics as there are several thousand published studies on this hormone that can be viewed on the National Library of Congress database. It seems to possess significant immunomodulatory and antiinflammatory activity and we are initially starting a first phase on using intranasal MSH adjunctively with 3 patients, and I am anxious to see how they will do with this relatively new therapy. In addition, I have been particularly pleased with the glandular therapies especially in injectable form particularly for the adrenal and mesenchyme preparations, and the long term benefits in rehabilitation potential at the cellular level seem to be significant and probably to some degree represent a therapeutic option that is fairly close to the promise of stem cell therapy. Therefore, I would first like to approach the symptoms with natural therapy such as Enteric-Coated Peppermint Oil for the bowel spasm, and that can be used on an as needed basis. The only side effect I have ever seen from this preparation is that it can make your stool smell like peppermint but invariably that tends not to be necessarily a negative outcome. Dale Guyer, M.D., is the Medical Director of the Advanced Medical Center in Indianapolis, Indiana. The Advanced Medical Center is a multidisciplinary treatment facility which emphasizes a holistic basis. The center utilizes the collective expertise of an oriental medicine doctor, a naturopathic physician, and is currently in the process of creating a unique spa like environment and personalized training exercise facility to effectively help individual patients navigate an optimal health experience by incorporating the best avenues of mind, body, and spirit. In this interview, we have asked Dr. Guyer to comment specifically on some of the therapeutic avenues he has found most helpful in adjunctively treating Chronic Fatigue Syndrome (CFS) and fibromyalgia (FM) and to clarify what Dr. Guyer refers to as "the multi-factorial contributory etiologies in dealing with this complex medical diagnosis.Dr. Guyer: To enhance energy level, some of the best adjunctive therapies I have found to date include the intravenous vitamin therapies in which the patient receives through an intravenous infusion a mixture of Vitamin C, Trace Minerals, Glutathione, ATP, AMP, Magnesium, Calcium, B Complex, Vitamin B12, and other additions depending on clinical need. It is also important when using systemic antifungal agents such as Diflucan to be sure to check periodic liver functions, although I must say in the hundreds of patients I have treated, I have never seen one patient have any problems or complications with these specific medical regimens. Of course, in our patients we are also supporting liver detoxification with products such as Ultra Clear, Milk Thistle Extract, Phosphatidylcholine and so forth.