Some Causes ?

Discussion in 'Fibromyalgia Main Forum' started by selma, Dec 25, 2002.

  1. selma

    selma New Member


    This post was originally Jaimy's Post from a while ago.


    What is tested in FMS/CFIDS (long.....print out b4 reading) 05/12/02 03:22 PM
    Innovative Treatment in Chronic Fatigue Syndrome, Fibromyalgia Syndrome, and Chronic Illness
    ImmuneSupport.com

    05-07-2002
    By Carol Ann Ryser, M.D., presented on February 15, 2002, at the American Academy of Environmental Medicine meeting in St. Louis, Missouri.

    Intoduction

    Evaluating the fatigue patient is a great challenge to the clinician researcher, health care professional. This requires a broad and interpretative view of disease and a psychosocial sensitivity and astuteness of mental health disorder as well as a good ongoing relationship with the patient with a capacity to listen to all the issues. The phenomena of Chronic Fatigue Syndrome remains a major focus for researchers and clinicians. Statistics show this complex disease on the rise and has been observed for over a century:

    Overview

    Understanding the inter-relatedness of HHV-6 , Chronic Illness and Coagulation is the key to diagnosis and treatment.

    Incidence of CFS

    • 1989-1993 disability claims: over 360% for men; 557% for women

    • Regional statistic incidences 600/100,000 (Cheyney 1997)

    1994-CDC established 2 criteria:

    Part #1 - all four parts must be met

    Part #2 - 4/8 criteria

    80% of patients are women,white, over age 30

    Theories of CFS/FMS

    1. Psychiatric Disorders, Ray 1995

    2. Infections accumulate in the body and overwhelm the immune system

    3. Nutritional Deficiencies IBS, Leaky Gut Syndrome

    4. Environmental Toxins

    5. Infections

    a. Viral

    b. Bacterial

    c. Fungal

    d. Parasite

    6. Coagulation Defect

    7. Trauma/Accidents

    8. Stress

    9. Environmental Toxins (Mercury)

    Viral Infections

    Virus Herpes Simplex virus-1 (HSV-1)

    Herpes simplex virus-2 (HSV-2)

    Varicella-zoster virus-3 (VZV)

    Epstein-Barr virus-4 (EBV)

    Cytomegalo virus-5 (CMV)

    Human herpes virus-6 (HHV-6)

    Human herpes virus-7 (HHV-7)

    Human herpes virus-8 (HHV-8) Disease

    Oral Herpes (fever blisters)

    Genital Herpes

    Chicken pox, Shingles

    Infectious mononucleosis

    “Mono-like” illness, infections in immune compromised patients

    Roseola, “mono-like” illness, associated with MS & CFS

    “Mono-like” illness, pityriasis rosea

    Kaposi’s sarcoma

    Chronic Illness: CFS

    MODEL:

    1. A coagulation protein defect leads to a hypercoagulation state when the patient is subjected to a pathogen, trauma, toxins.

    2. Excess thrombin (IIa) generation converts FIB to soluble fibrin monomer (SFM) causing fibrin(oid) deposition.

    Accumulation of fibrin on EC (endothelial cell) surfaces block oxygen/nutrients from entering tissues and cells creating focal ischemia. Blood viscosity increases (slows) blood flow resulting in endocrine (HPA Axis) sleep disorder, CNS (central nervous system) dysfunction, decreased blood volume, fatigue, decrease in heart stroke volume, lowered BP, and lowered immune stem function, and malfunction of the adrenal glands.

    Hypercoagulation State Infectious Disease State

    1. Stress – The way we react, mentally, emotionally, and physically to demands of life. Stress creates: 1) physical symptoms, i.e. fatigue which requires more nutrients; (2) increases adrenaline-causing platelets to stick together decreasing oxygen to the medulla. Deaths from infectious disease 1980-1992 are up 58% (the number 3 killer with heart disease and cancer being the number 1 and 2 killers). Eliminate HIV and all other infectious diseases have risen by 22%. Immune System

    • A healthy immune system is a very important part of maintaining one’s health and well-being

    • The immune system is important for protection against infections, cancer surveillance inside the body, and maintaining a healthy balance of most of our bodies’ functions.

    • A compromised immune system or inadequate immune response may lead to serious infections

    Components of the immune system

    1. Humoral Immunity

    2. Cell-mediated Immunity (CMI)

    3. Phagocytic cells

    4. Natural Killer cells

    Overactive Immune System

    I. Over Active Immune Disorders

    •Asthma

    •Urticaria (hives)

    •Rhinitis

    •Allergies

    Auto Immune Disease:

    •Multiple Sclerosis

    •Type I Diabetes

    • Psoriasis

    • Scleroderma

    • Lupus Erythematosus

    • ITP

    • Rheumatoid Arthritis

    •Autism

    • Juvenile Diabetes

    • Uveitis

    • Alzheimer’s Disease

    • Lou Gehrig’s Disease

    • Rheumatoid Arthritis

    • Epileptic Seizures

    • Atopic Dermatitis Inflammatory Diseases:

    • Fibromyalgia

    • Crohn’s Disease • Celiac Disease

    • Irritable Bowel

    • Ulcerative Colitis Under active Immune System

    II. Under Active Immune Disorders • Infections: parasites, fungal, bacterial, viral

    • HIV, Hepatitis B/C , Shingles, Sinusitus

    • Cancer, CMV, Tuberculosis

    • Other viruses

    Complement in Immunity

    Complement:

    1. Host defense against infection

    a. Opsonization

    b. Chemotaxis and activation of leukocytes

    c. Lysis of bacteria and cells

    2. Interface between innate and adaptive immunity

    3. Augmentation of antibody Response

    4. Enhancement of Immunologic Memory

    3. Disposal of Waste

    Clearance of immune complexes from tissue Clearance of apotosis cells

    Conditions affected by Viral Infection

    • Heart Disease

    • Obesity

    • Arthritis

    • Aging

    • Diminished water quality

    • Day care

    • International Travel

    • Many chronic illnesses

    SEPSIS: New Concepts in Research by Lilly

    • Sepsis is the leading cause of death in the United States in the non Coronary intensive care unit.

    • Sepsis is the 11th cause of death over all

    • During 10 year intervals the CDC reported 139% increase in the incidence of Sepsis.

    1. Increased procoagulant activity and reduced anticoagulant activity

    2. Impaired fibrinolysis

    3. System inflammation

    4. Role of indigeous activated Protein C in Sepsis

    Coagulation in CFS/FMS

    Etologies of Activation:

    • Viruses

    • Vaccines

    • Stress

    • Surgery

    • Toxins

    • Bacterial

    • Traumas

    Arthritis

    Disease

    CFS/FMS

    RA

    Gulf War

    Scleroderma

    MS

    Lupus

    Crohn’s

    Ulcerative Colitis

    Psoriasis

    Sjogren‘s

    Vaculitis

    Reiter Syndrome

    Hasimoto Disease

    Graves Disease

    Polymyalgia Rheumatica

    Etiologies

    Staph

    Strep

    Lymes

    Veneral Disease

    Virus HHV6, 8, HIV,

    Nanobacteria

    Candidiasis

    Fungus

    Bacteria

    Mycoplasma

    Rickettsiosis

    Tuberculosis

    Chlamydia

    Hepatitis B, C

    Brucella

    Viruses Links to Cancer

    A growing concern in both Allopathic and Alternative Medicine in that a link exists between viruses and cancer.

    Virus Cancer

    HHV-8 Kaposa Sarcoma HPV Cervical, vulva, and Vaginal Cancer

    Virus Cancer EBV Nasopharyndeal Carcinoma, Burketts Lymphoma, B Cell lymphoma Hodgkins Disease Breast Cancer

    Hepatitis B Hepatocarcinoma

    Mycoplasma

    Mycoplasma is a particle of bacterial DNA and lacks the organnelles and a cell wall required to process its own growth needs. The mycoplasms universally infects all humans. When triggered, it reverts to its crystalline structure It will kill the host cells: Fibromyalgia, Lupus, Wegener’s Disease, Sarcoidosis, Alzheimer’s, Rheumatiod Arthritis, etc. Mycoplasma is dependent on preformed sterols from host cells and causes further damage

    Disease Patterns of Association

    • Endometrium of the Uterus

    • Psoriosis

    • Migraines

    • Fibromyalgia

    • Psoriatic Arthritis and Rheumatoid Arthritis

    • Encephalitis

    • Atypical pneumonia/Chronic Sinusitis

    CFIDS Criteria

    • Clinically evaluated persistent or relapsing chronic fatigue Requires

    1. Not the result of ongoing exercise

    2. Results in significant reduction in functioning

    3. Not alleviated by rest

    4. Is of new or definite onset

    • Four or more of the following symptoms persistent or reoccurring during six or more consecutive months:

    • Short-term memory loss

    • tender cervical or axillary lymp nodes/swelling/pain

    • muscle weakness

    • multi joint pain/arthalgia

    • headaches

    • sleep disturbance

    • post exertional malaise

    • recurrent sore throat

    CFIDS Symptoms

    Other Symptoms:

    • Respiratory distress/allergies

    • Vitamin B deficiency/magnesium, calcium,etc.

    • Milk sensitivity/food sensitivities/chemical sensitivities

    • Menstrual complaints, i.e., PMS

    • Bad breath

    • Raynaud’s phenomenon, cold extremities

    • Low grade fever, chills, sweating

    • Impairment in short-term memory or concentration

    • Anxiety, depression, seizures, insomnia,

    • Neuroirritability

    • Hypotension, dizziness, poor balance

    Other symptoms:

    • Chronic use of antibiotics can be a precursor of CFS

    • Pain - Fibromyalgia (exhaustion/fatigue)

    • Irritable Bowel Syndrome – gas/constipation, GERD, pain, nausea

    • Poor immune system

    • Chronic bladder infections

    • Chronic infections – bacterial, yeast, cold & flu

    • Dehydration/Dryness, heat/chill intolerance

    • Skin conditions – rashes, etc.

    • Rapid onset of osteoporosis

    CFIDS Physical

    General Exam

    • Pallor of skin

    • Lymphadenopathy

    • Coldness of extremities

    • Decrease hair – legs

    • Atypical pigmentation

    • Puffy face

    • Coated tongue

    • Lethargic, stooped gate

    • Raynaud’s Phenomenon

    • Problems with nails

    Neurological Exam

    • Hyper reflexes

    • Poor Balance

    • Dizziness

    • Muscle weakness

    • Hypotension

    Neurological Symptoms

    • Impaired mental capacities

    • Altered personalities

    • Mood liability

    • Sleep disturbance

    • Unstable Autonomic Nervous System

    • Headaches, poor vision

    • “Allergic tension fatigue syndrome”

    Fibromyalgia Criteria as defined by the American College of Rheumatology

    1. Wide spread pain which lasts 3 months: Pain in trigger points: neck, back, chest, arms and legs, bilateral pain, spine, cervical, thorasic, lumbar, and chest walls.

    2. Trigger points: stimulation of points that create shooting pain.

    3. Recurrent use of nonspecific antibiotics.

    Daniel Wallace, MD, UCLA, found abnormalities Of 3 cytokines, IL-1, IL-8, IL-6, cause severe Widespread pain, fatigue and disturbed sleep. Cytokines are small signaling materials produced by immune system to alter functions of other cells. Toxin released from infection activity causes liver cells to produce IL-1, Il-6 and other cytokines. Cytokines interact with nerves that travel to the brain which signals down the spinal cord, causing amplified pain signals. IL-6 is related to fatigue and impaired concentration.

    Innovations in Treatment

    Suggested Treatment Protocol for CFS/FMS

    1. Dietary

    2. Lab Orders, Baseline Studies

    3. ISAC Panel should have 2-4 abnormal results for treatment

    4. Activation of coagulation Anticoagulants: Heparin, Lovenox, Coumadin

    5. If the ISAC Panel results are negative, there should be NO treatment

    Hereditary hypofibrinolysis Heredity hypofibrinolysis defects or abnormalities: impaired fibrinolysis, impaired or slowed disolving of fibrin and/or thrombosis. High PAI-1, high Lp(a), high homocysteine.

    6. Heparin, SQ, weight adjusted basis from 4000-7000 units standard Heparin BID 4000

    130 lbs: 5000

    180lbs: 6-7000

    >200 lbsIf Platelet Activation Index is positive, then give 81mg Aspirin daily. Bromelase

    Repeat ISAC Panel every of 4-6 weeks on Heparin therapy to document changes in values. Continue checking, 1 month, 6 months, 1 year after stopping treatment. Check CBC, Sed rate, Platelets, PTT

    Lovenox: 15u SQ Bid Wt 100-150 lb.

    15u & 30u SQ 150-170 lb.

    30u Bid SQ 170-200 lb.

    Plus keep the patient on heparin for minimum of 3-9 months. After 3-9 months, move therapy to Coumadin if genetic deficit exists with an overlap of 4-5 days of heparin.

    7. Coagulation Defects

    • For elevated Lp(a): Nicotinic acid (IHN) HEXANICOTINATE (IHN) is the niacin of choice

    • Estrogen (physiologic doses) & tamoxifen in females with Breast Cancer

    • Testosterone is reported to lower Lp(a) in males.

    • The statins are ineffective L-proline and L-lysine have been shown to prevent Lp(a) from binding Lipids

    • Ascorbic Acid (Vitamin C) may lower Lp(a) levels

    • Beta Carotene: 15 mg (25,000) hs

    • SAMe: 600-800 mg. Daily

    • Alpha Lipoic Acid: 900 mg daily

    • EFA – omega 3,6,9 Balanced 4000-8000 mg/day

    • Vitamin E 400-800 IU units daily

    • No Flush Niacin 600-1200 mg/day

    • For elevated PAI-1: Angiotensin converting enzyme ACE inhibitors vasotec

    • Other factors have been reported to decrease PAI-1 activity:(blood sugar, lipids)

    Homocysteine (HC) is an intermediary step in the formation of certain amino acids including Methionene and Cysteine.

    Treatment of Homocysteine:

    A. Vitamin B12 1-5 mg per week IM or spray

    B. Folic acid: 1 mg– 5 mg per day po

    C. Vitamin B6 (pyridoxine): 100 mg po

    D. Acetyl Cysteine: 600 mg daily (Resbid)

    E. Use Cardio Basics which contains lysine, proline, carnitine, B12,B6,Vitamin C & E 8. Active HHV-6/EBV/CMV Chronic Infection

    Transfer Factor Plus and Transfer Factor Polyvalent Immune Peptide

    Formula 560 – Transfer Factor specific for HHV-6/CMV

    Formula 540 – Transfer Factor specific for EBV

    9. Tissue plasminogen activator (tPA) is a recombinant protein used in fibrinolytic therapy of acute myocardial infarction 10.TUMERIC 150 mg po bid for elivated fibrinogen

    Treatment of Hypercoagulation State

    Heparin: (USP Heparin or Lovenox) Heparin is a TH2 TH1, shifter

    Occasional: Local irritation, hypersensitivity, chills, fever, urticaria Rare: asthma, rhinitis, lacrimation, headaches, nausea, vomiting, amaphylactoid reaction (may be in severe Sepsis Anaphylactiod)

    Minimal Side Effects: bleeding and nosebleeds, blood in stools or urine Protamine sulfate – (reverses side effects) Vit. K 20 mg 1 xweekly Helps bruising

    Contraindications: thrombocytopenia

    General Observations

    Patients in Chronic Illness – by Carol Ann Ryser MD

    1. Increased allergy, rashes, histamine reactions

    2. History of Irritable Bowel Syndrome 3. History of chronic respiratory symptoms

    4. 100% of patients have infections

    5. 100% of patients have been diagnosed with anxiety/depression

    6. In Fibromyalgia all have been on NSAIDS or pain medication

    7. Hormone deficiency is common in older population

    8. 85-90% of patients have abnormal CD8, CD4 T cells, B cells and low Natural Killer Cells.

    9. Nutritional deficiencies are common: B12, etc.

    10. Disease, especially CFS/FMS are pre-dated by surgery, loss, birth of a child, accidents, or significant stress.

    11. 90% of patients with chronic illnesses are dehydrated and complains of dryness.

    12. CFS/FMS patients have decreased blood volume with degenerative changes in joints, low electrolytes, and coagulation defect

    13. Dehydration with increase histamine reaction exacerbates the immune system dysfunction and contribute to symptoms

    14. Histamine – prominent in allergies, asthma, peptic ulcers, cystitis (especially in FMS)

    15. Environmental toxins contribute to chronic illness

    16. Cognitive dysfunction is present in 90%

    17. CFS/FMS patients have decreased blood volume with degenerative changes in joints, low electrolytes, and coagulation defect

    18. Dehydration with increase histamine reaction exacerbates the immune system dysfunction and contribute to symptoms

    19. Essential fatty acid deficiency occur due to diet, such as increase CBH low fat EFA are necessary to maintain the integrity of the cell wall

    20. Inadequate protein intake leads to degenerative diseases, vitamin deficiencies Thyroid dysfunction and malfunctioning immune system.

    21. Patients who are severely ill will not have activation of coagulation system or Positive PCR until treatment is started with Heparin and treatment of infection

    22. No thrombocytopenia seen in Heparin tx.

    23. The treatment process is cyclic and somewhat chaotic the first six months

    24. Heparin side effects are minimal. 3 patients with pork allergies plus pain at site of injection

    25. The shorter the duration of illness, the quicker the response to treatment

    26. Patients are to be monitored closely first year and follow up as needed there after.

    27. Pain medications, antidepressants, other drugs can be stopped after several months of tx.

    28. Can have GH deficiency at any age

    29. HPA axis dysregulation is reason for many of the patients symptoms

    30. Treatment with GH should NOT started until infections are treated. Use low dosage of GH

    Additional Treatment of Chronic Viral Infections

    NUTRITION AND IMMUNE SYSTEM

    NADH 5 mg, po 2x daily on empty stomach Quercetin 500 mg 3x daily with meals up to 1000 Multiple Vitamin/Mineral 1-2x daily Fiber (Bios Life) 2-3x daily One Step Antioxident and liver cleanser 1-2x daily ProBiotics 3x daily L-Tyrosine 500 mg. BID Co-Enzyme Q10 120 mg daily Olive Leaf Extract Antiviral 1-2x daily Lipoic Acid 300 mg tid SAMe 400mg up to 800 mg daily

    ANTIBIOTICS/ANTIVIRAL

    Biaxin Valtrex Ganciclovar Zithromax Valycte Inuflor (use with antibiotics) Acyclovir Other treatment as indicated

    Immune Enhancement Drugs

    NALTREXONE Naltrexone is a pure opiate antagonist. Not helpful in alcohol addiction but in opiate addiction. Can cause hepatotoxicity, if used in 5x the amount in diseased livers. There is no development of tolerance or dependence.

    Naltrexone 3 mg – at bedtime causes brief blockage of opiate (endorphin receptors) and is believed to produce a prolonged up regulation of vital elements of the immune system by causing an increase in endorphin production (i.e. higher levels of beta-endorphins and metenkephalin levels). It also has been shown to increase natural killer cells and other healthy defenses against HIV/Aids/CFS, Multiple Sclerosis, Rheumatoid Arthritis, Lupus, Psoriasis, and some cancers (prostate, colorectal cancer, pancreatic, carcinoma, carcinoid, Hodgkin’s, and non-Hodgkin’s Lymphoma, lymphocytic leukemia. This requires a prescription and has to be in compounded form. See Dr. Ryser for data on this. WARNING: Do not take Naltrexone with narcotic medications-codeine-morphine, etc. Naltrexone is available from:

    King’s Pharmacy, Lawrence, Kansas, (785) 843-4516/F (785) 843-5723 Bigelow’s Pharmacy, New York, (212) 533-2700/F (212) 228-8107

    Anti Viral Drugs VALTREX (Valacyclovir) Severe Thrombotic Thrombocytopenic Purpura, increased clotting RX: Maintenance 1 gram daily TX: HIV- Varicella Zoster (Shingles), HIV-herpes (Genital Herpes) FAMCICLOVIR (Famvir) Rare: headaches, nausea, diarrhea TX: HIV, Herpes Zoster

    TAMIFLU – start within 24 – 48 hours Rare: nausea, vomiting TX A and B influenza RELENZA – start within 30 hours Rare: nasal/throat discomfort, bronchial spasms in asthma TX: A and B influenza ACYCLOVIR (Zovirax) Concentrate in phagocytes and fibroblasts Rare: GI disturbance, fatigue, headaches, rash, encephalopathy, tremor, hallucinations, seizures, coma, abnormal hepatic function, lethargy, agitation RX: Maintenance 400 mg BID TX: HSV, Varicella Zoster, Aerobic pos and neg organisms, non HIV viral infections, Mycobacteria, gram + and neg organisms, Chlamydia AMANTADINE (Symmetrel) Rare: Anorexia, nausea, peripheral edema, nervousness, anxiety, CNS, confusion, difficulty concentrating, seizures TX: viral influenza, prevention can be used as prophylaxis GANCICLOVIR (Cytovene) Frequent neutropenia, thrombocytopenia Occasional neurological symptoms, toxicity, anemia, fever, rash Rare: nausea, vomiting, arrhythmia, psychiatic disturbance, seizures, hypoglycemia, diarrhea, renal toxicity TX by IV: CMV, AIDS Valcyte – Oral Ganciclovir

    Anti Fungal

    FLAGYL (Metronidazole) Rare: headaches, nausea, dizzy, diarrhea, rhinitis TX: Fungal, gram + and neg anerobic bacteria, protozal parasites

    DIFLUCAN (Fluconazole) Note: Hypogycemia, coumadin toxicity, Theophylline toxicity Occasional: diarrhea, headaches, dizzy, nausea, reaction to Paxil SSRI TX: Fungal, candidiasis

    Laboratory Tests for Evaluation of Chronic Illness

    Diagnostic Tests:

    Chemzymes Miscellaneous: Lipid Panel Urine Organic Acid Cholesterol Chest X-ray/Scan Triglycerides Urinary Amino Acid HDL Toxic Metals LDL Environmental Toxins Lipoprotein A Fibrinogen Dental: Homeocysteine Infections CRP Gum Disease UA Culture Mercury Fasting glucose & insulin Gingivitis 2 hour PP glucose & insulin Ac1 Hb Infection PCR:

    HIV Candidiasis Hepatitis A.B.C. Herpes I, II Mycoplasma PCR EBV M. Fermentans M. Genitalia CMV M. Pneumoniae HHV6 M. Penetrans Spirochetes M. Genitalia Nanobacteria Chlamydia Pneumoniae PCR Coxsackie H-Pylori Rickettisial Borellia Fungal Brain Assessment Immune CT Scan NK Cells – CD4, etc. PET Scan Complement Psychological Eval. TNF 1 Alpha Cogno Meter/Brain IL1, IL2, IL6, etc. Cognitive Function Brain Map MRI

    Vascular EKG Doppler EBT – Heart Coronary

    CBC: Hormones: WBC DHEA LVM Estradiol MON Progesterone HCT Testosterone Hb Thyroid/Thyroid Antibodies Sed Rate Cortisol – 24 hour Test Platelet GH – Stim test Protime IGF-1 APTT 24 hr. urinary GH

    Autoimmune Tests:

    RA ANA Lupus Sjogren’s Syndrome Multiple Sclerosis Liver Autoimmune profile Aptotosis function of cells

    Cancer Screen:

    AMAS cancer screen CA125 etc.

    Antibody Studies:

    EBV HHV6 CMV

    HEMEX Clotting Cascade Hereditary Thrombosis ISAC – Immune System of Coagulation Anti B2GI Panel vWF Antigen Platelets APTT Protime

    GI Workup:

    Yeast Bacteria Parasites Dysbiosis

    Bibliography

    Adams, R.N., C.W., Poston, S.J., Buh, Sidhu, Y.S., Vipond, Ti, Inflammation Vasculites in Multiple Sclerosis, Journal of the Neurological Science (1985) 69:269-283

    Battmer, M.D., Robert E., The Hormone Book-Natural Blueprint of a Younger You

    Bihari, M.D., An Interview with Doctor Bihari – Naltrexone-Triples the Natural Killer Cell Activity and Stops Aids Progression, Routine Health News, January 1996 by Keep Hope Alive

    Berg, M.D., D., Berg, M.D., L.H., Souvarar, J., Harrison, H., Chronic Fatigue Syndrome and/or Fibromyalgin as a Variation of Anti Phosphalipid Antibody Syndrome (APS), 10 p. 1-4, Blood Coagulation and Fibrinalysis (1999) 10:435-438

    Berg, M.D., D., Berg, M.D., L.H., Courvaran, J., Harrison, H., Chronic Fatigue Syndrome and/or Fibromyalgin as a Variation of Anti Phosphalipid Antibody Syndrome; an Explanatory Model and Approach to Laboratory Diagnosis Blood Coagulation and Fibromyalgia (1999) 10:435-438

    Berg, M.S., C.I.S. (NCA), D., Components and Defects in Coagulation System, New Practitioner Forum, Vol. 3 #2, June 1992 pp 62-71

    Bock, M.D., Kenneth and Salier, Nellie, The Road to Immunity, How to Survive and Thrive in a Toxic World

    Bock, M.D., Kenneth, Transfer Factor and Its Clinical Application, International Journal of Integrated Medicine, Vol. 2, #4, July/August 2000, p44-49

    Condemi, M.D., John J., Update on Allergy and Immunology, Annals of Internal Medicine, Vol. 125 #9, November 1996, Review of Urticaria, Angio NeuroticEdema and the AntiPhospholipid Antibody Syndrome

    Elkins, M.D., Rita, Transfer Factor-Nature’s State of the Art Immune Fortifier

    Ewald, PhD., Paul, Plague Time: How Stealth Infection Causes Cancer, Heart Disease, and Other Deadly Ailments

    Ewald, PhD., Paul, A New Germ Theory

    Ghen, D.O., PhD, Michael J., Moore, M.D., MPH, FAAEP, C. Barton, Implications of Adrenal Insufficiency, International Journal of Integrative Medicine: Vol. 2 #6, Nov./Dec. 2000

    Gordon, R., Michalewiski, A.J., Nguyen, J., Guptan, S., Starr, A., Critical Motor Potential Alteration in Chronic Fatigue Syndrome, International Journal of Medicine, 1999, Nov. 4 (5) p 493-9

    Hannan, K.L., Berg, D.E., Weijer, W. Baremz, Harrison, H.H., Berg, L.H., Roming, R., and Nichols, D., Activation of the Coagulation System in Gulf War Illness: a Potential Pathophysciologic Look with Chronic Fatigue Syndrome-a Laboratory Approach to Diagnosis, Blood Coagulation and Fibrinalysis 2000, Vol. 11 No. 7, p673 Hennen, PhD., William J., Enhanced Transfer Factor: The Super Supplement Combination for Optimal Immune Function

    Hennen, PhD., William J., Transfer Factor-Natural Immune Booster

    Hennen, PhD., William J., Fibromyalgia: A Nutritional Approach

    Immune System - Mechanism of Action, Lupus 5 October, 96 p 343-558 Special Issue – 7th International Symposium on Anti Phospholipid Antibodies, New Orleans, LA, October 9-13, 1996

    Jon, Anton, Maherse, Wagen, Chronic Fatigue Syndrome: the Physiology of People on the Low End of the Spectrum of Physical Activity, Clinical Science (1999) 97:611-613, The Biochemical and the Medical Research Society 1997

    Knox, PhD., Konstance K., Abnormally High Incidence of Human Herpes Virus 6 Associated with Chronic Fatigue Syndrome, The Journal of Degenerative Diseases, p 5-8

    Knox, PhD., Konstance K. Brewer, M.D., Joseph H., Henry, James M., Harrington, Daniel J., and Carrigan, Donald, Human Herpes Virus 6 and Multiple Sclerosis: Systemic Active Infection in Patients with Early Disease, Clinical Infectious Diseases, 2000:31:894-903

    Landon, Alan, L., Jessop, Carol, Lenette, Evelyn, Lenze, and Jay A., Chronic Fatigue Syndrome: Clinical Conditions Associated with Immune Activation, The Lancet Vol. 338, September 21, 1991

    McCully, Kevin K., Natelson, Benjamin H., Impaired Oxygen-Delivery to Muscle in Chronic Fatigue Syndrome, Clinical Science (1999) 97:603-608

    Mycoplasma Infections in Chronic Illnesses: Fibromyalgia and CFS, Gulf War Illness, HIV Aides and Rheumatoid Arthritis, Medical Sentinel Vol. 4 #5, Sept./Oct. 1999

    Nastabla, M., Haier, J., Nicholson, G.L., Multiple Mycoplasmal Infections Detected in Blood of Patients with Chronic Fatigue Syndrome and/or Fibromyalgia Syndrome, Cline, Eur J., Microbial Infections (1999) 18:859-865

    Nicolson, et al, Diagnosis and Integrative Treatment of Intracellular Bacterial Infection in Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness, Rheumatoid Arthritis and Other Chronic Illnesses, Clinical Practice of Alternative Medicine

    Laboratories Used for Testing

    AAL Laboratory – Antibody Assay, Immune Functions, NK Cells, Hormones, Cortisol (800-522-26) Great Plains Laboratory – Amino Acid, Organic Acid (913-341-8949) Great Smokies – Parasites, Fatty Acid, metal toxicity, Dysbiosis (800-522-4762) HEMEX Laboratory – Coagulation Cascade (800-999-2568) Immuno Laboratory – Leaky Gut, Candidiasis, Wheat/Gluten Antibodies, H-pylori (800-231-9197) Immunosciences Laboratory – Lung Antibodies, Mycoplasms, NK Cells, Cytokines (310-657-1077) International Molecular Diagnostics – PCA Mycoplasma, Chlamydia , CMV (888-882-8838) Lab 1 – General Laboratory – Sed Rate, Free T3, Free T4, TSH, Routine Cultures (800-646-7788) ONCO Laboratory – Cancer Screen (617-536-0850) Serammune Laboratory – Toxins, Environmental/Foods (800-553-5472) SpectraCell Laboratory – Vitamin/Mineral/AA/Cardiovascular Profile (800-227-5227) ViraCor Diagnostic Labs – HHV6 www.hhv6.com (800-305-5198) Medical Diagnostic Labs LLC – PCR, infectious disease testing www.mdlab.com (877-269-0080) Doctors Data - metal toxicity www.doctorsdata.com (800-323-2784)

    Credits for this presentation:

    Richard Cook: IV Therapy, blood draws, billing

    Diana Smith, RN: patient care and my girl Friday

    Raymond Foster: patient co-ordination, office triage Michael Ryser: organization, writing and creator of this slide presentation

    Joe Brewer MD for his pioneer work with infectious disease and Transfer Factors

    David Berg, MS, C.I.S., Hemex Labs, for his work with Coagulation Defect

    This information is (c) 2002 Dr. Carol Ann Ryser. All rights reserved. Address correspondence to:

    Carol Ann Ryser, M.D.

    5308 East 115th Street

    Kansas City, MO 64137





    Innovative Treatment in Chronic Fatigue Syndrome, Fibromyalgia Syndrome, and Chronic Illness
    ImmuneSupport.com

    05-07-2002
    By Carol Ann Ryser, M.D., presented on February 15, 2002, at the American Academy of Environmental Medicine meeting in St. Louis, Missouri.

    Intoduction

    Evaluating the fatigue patient is a great challenge to the clinician researcher, health care professional. This requires a broad and interpretative view of disease and a psychosocial sensitivity and astuteness of mental health disorder as well as a good ongoing relationship with the patient with a capacity to listen to all the issues. The phenomena of Chronic Fatigue Syndrome remains a major focus for researchers and clinicians. Statistics show this complex disease on the rise and has been observed for over a century:

    Overview

    Understanding the inter-relatedness of HHV-6 , Chronic Illness and Coagulation is the key to diagnosis and treatment.

    Incidence of CFS

    • 1989-1993 disability claims: over 360% for men; 557% for women

    • Regional statistic incidences 600/100,000 (Cheyney 1997)

    1994-CDC established 2 criteria:

    Part #1 - all four parts must be met

    Part #2 - 4/8 criteria

    80% of patients are women,white, over age 30

    Theories of CFS/FMS

    1. Psychiatric Disorders, Ray 1995

    2. Infections accumulate in the body and overwhelm the immune system

    3. Nutritional Deficiencies IBS, Leaky Gut Syndrome

    4. Environmental Toxins

    5. Infections

    a. Viral

    b. Bacterial

    c. Fungal

    d. Parasite

    6. Coagulation Defect

    7. Trauma/Accidents

    8. Stress

    9. Environmental Toxins (Mercury)

    Viral Infections

    Virus Herpes Simplex virus-1 (HSV-1)

    Herpes simplex virus-2 (HSV-2)

    Varicella-zoster virus-3 (VZV)

    Epstein-Barr virus-4 (EBV)

    Cytomegalo virus-5 (CMV)

    Human herpes virus-6 (HHV-6)

    Human herpes virus-7 (HHV-7)

    Human herpes virus-8 (HHV-8) Disease

    Oral Herpes (fever blisters)

    Genital Herpes

    Chicken pox, Shingles

    Infectious mononucleosis

    “Mono-like” illness, infections in immune compromised patients

    Roseola, “mono-like” illness, associated with MS & CFS

    “Mono-like” illness, pityriasis rosea

    Kaposi’s sarcoma

    Chronic Illness: CFS

    MODEL:

    1. A coagulation protein defect leads to a hypercoagulation state when the patient is subjected to a pathogen, trauma, toxins.

    2. Excess thrombin (IIa) generation converts FIB to soluble fibrin monomer (SFM) causing fibrin(oid) deposition.

    Accumulation of fibrin on EC (endothelial cell) surfaces block oxygen/nutrients from entering tissues and cells creating focal ischemia. Blood viscosity increases (slows) blood flow resulting in endocrine (HPA Axis) sleep disorder, CNS (central nervous system) dysfunction, decreased blood volume, fatigue, decrease in heart stroke volume, lowered BP, and lowered immune stem function, and malfunction of the adrenal glands.

    Hypercoagulation State Infectious Disease State

    1. Stress – The way we react, mentally, emotionally, and physically to demands of life. Stress creates: 1) physical symptoms, i.e. fatigue which requires more nutrients; (2) increases adrenaline-causing platelets to stick together decreasing oxygen to the medulla. Deaths from infectious disease 1980-1992 are up 58% (the number 3 killer with heart disease and cancer being the number 1 and 2 killers). Eliminate HIV and all other infectious diseases have risen by 22%. Immune System

    • A healthy immune system is a very important part of maintaining one’s health and well-being

    • The immune system is important for protection against infections, cancer surveillance inside the body, and maintaining a healthy balance of most of our bodies’ functions.

    • A compromised immune system or inadequate immune response may lead to serious infections

    Components of the immune system

    1. Humoral Immunity

    2. Cell-mediated Immunity (CMI)

    3. Phagocytic cells

    4. Natural Killer cells

    Overactive Immune System

    I. Over Active Immune Disorders

    •Asthma

    •Urticaria (hives)

    •Rhinitis

    •Allergies

    Auto Immune Disease:

    •Multiple Sclerosis

    •Type I Diabetes

    • Psoriasis

    • Scleroderma

    • Lupus Erythematosus

    • ITP

    • Rheumatoid Arthritis

    •Autism

    • Juvenile Diabetes

    • Uveitis

    • Alzheimer’s Disease

    • Lou Gehrig’s Disease

    • Rheumatoid Arthritis

    • Epileptic Seizures

    • Atopic Dermatitis Inflammatory Diseases:

    • Fibromyalgia

    • Crohn’s Disease • Celiac Disease

    • Irritable Bowel

    • Ulcerative Colitis Under active Immune System

    II. Under Active Immune Disorders • Infections: parasites, fungal, bacterial, viral

    • HIV, Hepatitis B/C , Shingles, Sinusitus

    • Cancer, CMV, Tuberculosis

    • Other viruses

    Complement in Immunity

    Complement:

    1. Host defense against infection

    a. Opsonization

    b. Chemotaxis and activation of leukocytes

    c. Lysis of bacteria and cells

    2. Interface between innate and adaptive immunity

    3. Augmentation of antibody Response

    4. Enhancement of Immunologic Memory

    3. Disposal of Waste

    Clearance of immune complexes from tissue Clearance of apotosis cells

    Conditions affected by Viral Infection

    • Heart Disease

    • Obesity

    • Arthritis

    • Aging

    • Diminished water quality

    • Day care

    • International Travel

    • Many chronic illnesses

    SEPSIS: New Concepts in Research by Lilly

    • Sepsis is the leading cause of death in the United States in the non Coronary intensive care unit.

    • Sepsis is the 11th cause of death over all

    • During 10 year intervals the CDC reported 139% increase in the incidence of Sepsis.

    1. Increased procoagulant activity and reduced anticoagulant activity

    2. Impaired fibrinolysis

    3. System inflammation

    4. Role of indigeous activated Protein C in Sepsis

    Coagulation in CFS/FMS

    Etologies of Activation:

    • Viruses

    • Vaccines

    • Stress

    • Surgery

    • Toxins

    • Bacterial

    • Traumas

    Arthritis

    Disease

    CFS/FMS

    RA

    Gulf War

    Scleroderma

    MS

    Lupus

    Crohn’s

    Ulcerative Colitis

    Psoriasis

    Sjogren‘s

    Vaculitis

    Reiter Syndrome

    Hasimoto Disease

    Graves Disease

    Polymyalgia Rheumatica

    Etiologies

    Staph

    Strep

    Lymes

    Veneral Disease

    Virus HHV6, 8, HIV,

    Nanobacteria

    Candidiasis

    Fungus

    Bacteria

    Mycoplasma

    Rickettsiosis

    Tuberculosis

    Chlamydia

    Hepatitis B, C

    Brucella

    Viruses Links to Cancer

    A growing concern in both Allopathic and Alternative Medicine in that a link exists between viruses and cancer.

    Virus Cancer

    HHV-8 Kaposa Sarcoma HPV Cervical, vulva, and Vaginal Cancer

    Virus Cancer EBV Nasopharyndeal Carcinoma, Burketts Lymphoma, B Cell lymphoma Hodgkins Disease Breast Cancer

    Hepatitis B Hepatocarcinoma

    Mycoplasma

    Mycoplasma is a particle of bacterial DNA and lacks the organnelles and a cell wall required to process its own growth needs. The mycoplasms universally infects all humans. When triggered, it reverts to its crystalline structure It will kill the host cells: Fibromyalgia, Lupus, Wegener’s Disease, Sarcoidosis, Alzheimer’s, Rheumatiod Arthritis, etc. Mycoplasma is dependent on preformed sterols from host cells and causes further damage

    Disease Patterns of Association

    • Endometrium of the Uterus

    • Psoriosis

    • Migraines

    • Fibromyalgia

    • Psoriatic Arthritis and Rheumatoid Arthritis

    • Encephalitis

    • Atypical pneumonia/Chronic Sinusitis

    CFIDS Criteria

    • Clinically evaluated persistent or relapsing chronic fatigue Requires

    1. Not the result of ongoing exercise

    2. Results in significant reduction in functioning

    3. Not alleviated by rest

    4. Is of new or definite onset

    • Four or more of the following symptoms persistent or reoccurring during six or more consecutive months:

    • Short-term memory loss

    • tender cervical or axillary lymp nodes/swelling/pain

    • muscle weakness

    • multi joint pain/arthalgia

    • headaches

    • sleep disturbance

    • post exertional malaise

    • recurrent sore throat

    CFIDS Symptoms

    Other Symptoms:

    • Respiratory distress/allergies

    • Vitamin B deficiency/magnesium, calcium,etc.

    • Milk sensitivity/food sensitivities/chemical sensitivities

    • Menstrual complaints, i.e., PMS

    • Bad breath

    • Raynaud’s phenomenon, cold extremities

    • Low grade fever, chills, sweating

    • Impairment in short-term memory or concentration

    • Anxiety, depression, seizures, insomnia,

    • Neuroirritability

    • Hypotension, dizziness, poor balance

    Other symptoms:

    • Chronic use of antibiotics can be a precursor of CFS

    • Pain - Fibromyalgia (exhaustion/fatigue)

    • Irritable Bowel Syndrome – gas/constipation, GERD, pain, nausea

    • Poor immune system

    • Chronic bladder infections

    • Chronic infections – bacterial, yeast, cold & flu

    • Dehydration/Dryness, heat/chill intolerance

    • Skin conditions – rashes, etc.

    • Rapid onset of osteoporosis

    CFIDS Physical

    General Exam

    • Pallor of skin

    • Lymphadenopathy

    • Coldness of extremities

    • Decrease hair – legs

    • Atypical pigmentation

    • Puffy face

    • Coated tongue

    • Lethargic, stooped gate

    • Raynaud’s Phenomenon

    • Problems with nails

    Neurological Exam

    • Hyper reflexes

    • Poor Balance

    • Dizziness

    • Muscle weakness

    • Hypotension

    Neurological Symptoms

    • Impaired mental capacities

    • Altered personalities

    • Mood liability

    • Sleep disturbance

    • Unstable Autonomic Nervous System

    • Headaches, poor vision

    • “Allergic tension fatigue syndrome”

    Fibromyalgia Criteria as defined by the American College of Rheumatology

    1. Wide spread pain which lasts 3 months: Pain in trigger points: neck, back, chest, arms and legs, bilateral pain, spine, cervical, thorasic, lumbar, and chest walls.

    2. Trigger points: stimulation of points that create shooting pain.

    3. Recurrent use of nonspecific antibiotics.

    Daniel Wallace, MD, UCLA, found abnormalities Of 3 cytokines, IL-1, IL-8, IL-6, cause severe Widespread pain, fatigue and disturbed sleep. Cytokines are small signaling materials produced by immune system to alter functions of other cells. Toxin released from infection activity causes liver cells to produce IL-1, Il-6 and other cytokines. Cytokines interact with nerves that travel to the brain which signals down the spinal cord, causing amplified pain signals. IL-6 is related to fatigue and impaired concentration.

    Innovations in Treatment

    Suggested Treatment Protocol for CFS/FMS

    1. Dietary

    2. Lab Orders, Baseline Studies

    3. ISAC Panel should have 2-4 abnormal results for treatment

    4. Activation of coagulation Anticoagulants: Heparin, Lovenox, Coumadin

    5. If the ISAC Panel results are negative, there should be NO treatment

    Hereditary hypofibrinolysis Heredity hypofibrinolysis defects or abnormalities: impaired fibrinolysis, impaired or slowed disolving of fibrin and/or thrombosis. High PAI-1, high Lp(a), high homocysteine.

    6. Heparin, SQ, weight adjusted basis from 4000-7000 units standard Heparin BID 4000

    130 lbs: 5000

    180lbs: 6-7000

    >200 lbsIf Platelet Activation Index is positive, then give 81mg Aspirin daily. Bromelase

    Repeat ISAC Panel every of 4-6 weeks on Heparin therapy to document changes in values. Continue checking, 1 month, 6 months, 1 year after stopping treatment. Check CBC, Sed rate, Platelets, PTT

    Lovenox: 15u SQ Bid Wt 100-150 lb.

    15u & 30u SQ 150-170 lb.

    30u Bid SQ 170-200 lb.

    Plus keep the patient on heparin for minimum of 3-9 months. After 3-9 months, move therapy to Coumadin if genetic deficit exists with an overlap of 4-5 days of heparin.

    7. Coagulation Defects

    • For elevated Lp(a): Nicotinic acid (IHN) HEXANICOTINATE (IHN) is the niacin of choice

    • Estrogen (physiologic doses) & tamoxifen in females with Breast Cancer

    • Testosterone is reported to lower Lp(a) in males.

    • The statins are ineffective L-proline and L-lysine have been shown to prevent Lp(a) from binding Lipids

    • Ascorbic Acid (Vitamin C) may lower Lp(a) levels

    • Beta Carotene: 15 mg (25,000) hs

    • SAMe: 600-800 mg. Daily

    • Alpha Lipoic Acid: 900 mg daily

    • EFA – omega 3,6,9 Balanced 4000-8000 mg/day

    • Vitamin E 400-800 IU units daily

    • No Flush Niacin 600-1200 mg/day

    • For elevated PAI-1: Angiotensin converting enzyme ACE inhibitors vasotec

    • Other factors have been reported to decrease PAI-1 activity:(blood sugar, lipids)

    Homocysteine (HC) is an intermediary step in the formation of certain amino acids including Methionene and Cysteine.

    Treatment of Homocysteine:

    A. Vitamin B12 1-5 mg per week IM or spray

    B. Folic acid: 1 mg– 5 mg per day po

    C. Vitamin B6 (pyridoxine): 100 mg po

    D. Acetyl Cysteine: 600 mg daily (Resbid)

    E. Use Cardio Basics which contains lysine, proline, carnitine, B12,B6,Vitamin C & E 8. Active HHV-6/EBV/CMV Chronic Infection

    Transfer Factor Plus and Transfer Factor Polyvalent Immune Peptide

    Formula 560 – Transfer Factor specific for HHV-6/CMV

    Formula 540 – Transfer Factor specific for EBV

    9. Tissue plasminogen activator (tPA) is a recombinant protein used in fibrinolytic therapy of acute myocardial infarction 10.TUMERIC 150 mg po bid for elivated fibrinogen

    Treatment of Hypercoagulation State

    Heparin: (USP Heparin or Lovenox) Heparin is a TH2 TH1, shifter

    Occasional: Local irritation, hypersensitivity, chills, fever, urticaria Rare: asthma, rhinitis, lacrimation, headaches, nausea, vomiting, amaphylactoid reaction (may be in severe Sepsis Anaphylactiod)

    Minimal Side Effects: bleeding and nosebleeds, blood in stools or urine Protamine sulfate – (reverses side effects) Vit. K 20 mg 1 xweekly Helps bruising

    Contraindications: thrombocytopenia

    General Observations

    Patients in Chronic Illness – by Carol Ann Ryser MD

    1. Increased allergy, rashes, histamine reactions

    2. History of Irritable Bowel Syndrome 3. History of chronic respiratory symptoms

    4. 100% of patients have infections

    5. 100% of patients have been diagnosed with anxiety/depression

    6. In Fibromyalgia all have been on NSAIDS or pain medication

    7. Hormone deficiency is common in older population

    8. 85-90% of patients have abnormal CD8, CD4 T cells, B cells and low Natural Killer Cells.

    9. Nutritional deficiencies are common: B12, etc.

    10. Disease, especially CFS/FMS are pre-dated by surgery, loss, birth of a child, accidents, or significant stress.

    11. 90% of patients with chronic illnesses are dehydrated and complains of dryness.

    12. CFS/FMS patients have decreased blood volume with degenerative changes in joints, low electrolytes, and coagulation defect

    13. Dehydration with increase histamine reaction exacerbates the immune system dysfunction and contribute to symptoms

    14. Histamine – prominent in allergies, asthma, peptic ulcers, cystitis (especially in FMS)

    15. Environmental toxins contribute to chronic illness

    16. Cognitive dysfunction is present in 90%

    17. CFS/FMS patients have decreased blood volume with degenerative changes in joints, low electrolytes, and coagulation defect

    18. Dehydration with increase histamine reaction exacerbates the immune system dysfunction and contribute to symptoms

    19. Essential fatty acid deficiency occur due to diet, such as increase CBH low fat EFA are necessary to maintain the integrity of the cell wall

    20. Inadequate protein intake leads to degenerative diseases, vitamin deficiencies Thyroid dysfunction and malfunctioning immune system.

    21. Patients who are severely ill will not have activation of coagulation system or Positive PCR until treatment is started with Heparin and treatment of infection

    22. No thrombocytopenia seen in Heparin tx.

    23. The treatment process is cyclic and somewhat chaotic the first six months

    24. Heparin side effects are minimal. 3 patients with pork allergies plus pain at site of injection

    25. The shorter the duration of illness, the quicker the response to treatment

    26. Patients are to be monitored closely first year and follow up as needed there after.

    27. Pain medications, antidepressants, other drugs can be stopped after several months of tx.

    28. Can have GH deficiency at any age

    29. HPA axis dysregulation is reason for many of the patients symptoms

    30. Treatment with GH should NOT started until infections are treated. Use low dosage of GH

    Additional Treatment of Chronic Viral Infections

    NUTRITION AND IMMUNE SYSTEM

    NADH 5 mg, po 2x daily on empty stomach Quercetin 500 mg 3x daily with meals up to 1000 Multiple Vitamin/Mineral 1-2x daily Fiber (Bios Life) 2-3x daily One Step Antioxident and liver cleanser 1-2x daily ProBiotics 3x daily L-Tyrosine 500 mg. BID Co-Enzyme Q10 120 mg daily Olive Leaf Extract Antiviral 1-2x daily Lipoic Acid 300 mg tid SAMe 400mg up to 800 mg daily

    ANTIBIOTICS/ANTIVIRAL

    Biaxin Valtrex Ganciclovar Zithromax Valycte Inuflor (use with antibiotics) Acyclovir Other treatment as indicated

    Immune Enhancement Drugs

    NALTREXONE Naltrexone is a pure opiate antagonist. Not helpful in alcohol addiction but in opiate addiction. Can cause hepatotoxicity, if used in 5x the amount in diseased livers. There is no development of tolerance or dependence.

    Naltrexone 3 mg – at bedtime causes brief blockage of opiate (endorphin receptors) and is believed to produce a prolonged up regulation of vital elements of the immune system by causing an increase in endorphin production (i.e. higher levels of beta-endorphins and metenkephalin levels). It also has been shown to increase natural killer cells and other healthy defenses against HIV/Aids/CFS, Multiple Sclerosis, Rheumatoid Arthritis, Lupus, Psoriasis, and some cancers (prostate, colorectal cancer, pancreatic, carcinoma, carcinoid, Hodgkin’s, and non-Hodgkin’s Lymphoma, lymphocytic leukemia. This requires a prescription and has to be in compounded form. See Dr. Ryser for data on this. WARNING: Do not take Naltrexone with narcotic medications-codeine-morphine, etc. Naltrexone is available from:

    King’s Pharmacy, Lawrence, Kansas, (785) 843-4516/F (785) 843-5723 Bigelow’s Pharmacy, New York, (212) 533-2700/F (212) 228-8107

    Anti Viral Drugs VALTREX (Valacyclovir) Severe Thrombotic Thrombocytopenic Purpura, increased clotting RX: Maintenance 1 gram daily TX: HIV- Varicella Zoster (Shingles), HIV-herpes (Genital Herpes) FAMCICLOVIR (Famvir) Rare: headaches, nausea, diarrhea TX: HIV, Herpes Zoster

    TAMIFLU – start within 24 – 48 hours Rare: nausea, vomiting TX A and B influenza RELENZA – start within 30 hours Rare: nasal/throat discomfort, bronchial spasms in asthma TX: A and B influenza ACYCLOVIR (Zovirax) Concentrate in phagocytes and fibroblasts Rare: GI disturbance, fatigue, headaches, rash, encephalopathy, tremor, hallucinations, seizures, coma, abnormal hepatic function, lethargy, agitation RX: Maintenance 400 mg BID TX: HSV, Varicella Zoster, Aerobic pos and neg organisms, non HIV viral infections, Mycobacteria, gram + and neg organisms, Chlamydia AMANTADINE (Symmetrel) Rare: Anorexia, nausea, peripheral edema, nervousness, anxiety, CNS, confusion, difficulty concentrating, seizures TX: viral influenza, prevention can be used as prophylaxis GANCICLOVIR (Cytovene) Frequent neutropenia, thrombocytopenia Occasional neurological symptoms, toxicity, anemia, fever, rash Rare: nausea, vomiting, arrhythmia, psychiatic disturbance, seizures, hypoglycemia, diarrhea, renal toxicity TX by IV: CMV, AIDS Valcyte – Oral Ganciclovir

    Anti Fungal

    FLAGYL (Metronidazole) Rare: headaches, nausea, dizzy, diarrhea, rhinitis TX: Fungal, gram + and neg anerobic bacteria, protozal parasites

    DIFLUCAN (Fluconazole) Note: Hypogycemia, coumadin toxicity, Theophylline toxicity Occasional: diarrhea, headaches, dizzy, nausea, reaction to Paxil SSRI TX: Fungal, candidiasis

    Laboratory Tests for Evaluation of Chronic Illness

    Diagnostic Tests:

    Chemzymes Miscellaneous: Lipid Panel Urine Organic Acid Cholesterol Chest X-ray/Scan Triglycerides Urinary Amino Acid HDL Toxic Metals LDL Environmental Toxins Lipoprotein A Fibrinogen Dental: Homeocysteine Infections CRP Gum Disease UA Culture Mercury Fasting glucose & insulin Gingivitis 2 hour PP glucose & insulin Ac1 Hb Infection PCR:

    HIV Candidiasis Hepatitis A.B.C. Herpes I, II Mycoplasma PCR EBV M. Fermentans M. Genitalia CMV M. Pneumoniae HHV6 M. Penetrans Spirochetes M. Genitalia Nanobacteria Chlamydia Pneumoniae PCR Coxsackie H-Pylori Rickettisial Borellia Fungal Brain Assessment Immune CT Scan NK Cells – CD4, etc. PET Scan Complement Psychological Eval. TNF 1 Alpha Cogno Meter/Brain IL1, IL2, IL6, etc. Cognitive Function Brain Map MRI

    Vascular EKG Doppler EBT – Heart Coronary

    CBC: Hormones: WBC DHEA LVM Estradiol MON Progesterone HCT Testosterone Hb Thyroid/Thyroid Antibodies Sed Rate Cortisol – 24 hour Test Platelet GH – Stim test Protime IGF-1 APTT 24 hr. urinary GH

    Autoimmune Tests:

    RA ANA Lupus Sjogren’s Syndrome Multiple Sclerosis Liver Autoimmune profile Aptotosis function of cells

    Cancer Screen:

    AMAS cancer screen CA125 etc.

    Antibody Studies:

    EBV HHV6 CMV

    HEMEX Clotting Cascade Hereditary Thrombosis ISAC – Immune System of Coagulation Anti B2GI Panel vWF Antigen Platelets APTT Protime

    GI Workup:

    Yeast Bacteria Parasites Dysbiosis

    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
    This information is (c) 2002 Dr. Carol Ann Ryser. All rights reserved. Address correspondence to:

    Carol Ann Ryser, M.D.

    5308 East 115th Street

    Kansas City, MO 64137


    [This Message was Edited on 05/12/2002]

    [This Message was Edited on 05/12/2002]







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    [This Message was Edited on 12/25/2002]