Dale Guyer, M.D., on Treating Chronic Fatigue Syndrome & Fibromyalgia: “Covering the Bases & Peeling Back the Layers of the Onion” 06-13-2006 Interview: ImmuneSupport.com: Dr. Guyer, let’s discuss some of the factors that in your experience are primary contributors to ongoing Chronic Fatigue Syndrome and fibromyalgia, and what treatments you are finding to be most effective. A common primary issue is the challenge of getting regular, quality sleep. What therapies have you found most helpful for CFS and FM? Dr. Guyer: To date, some of the better treatments I have found for this problem always involve an incorporation of exercise and proper diet, or at least exercise as tolerated, but 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 for me at a pharmacy. I combine tryptophan (500 mg), 5-HTP (125 mg), and melatonin (2.5 mg) per capsule. The patient usually takes 2-4 capsules at night 30 minutes before bed. In my experience, this has been an enormous help in helping to stabilize sleep quality. The second thing that I have been overwhelmingly impressed with is a special natural wool mattress pad, and like most therapeutic options, I tried it on myself prior to recommending it for patients. Even though I do not have CFS, I have noticed my sleep quality and that of my wife has been significantly better since using the mattress pad. Even more importantly, I have seen improvement in many of my FM patients who have had enormous difficulty attaining quality sleep despite trying some of the more promising sleep aids on the market. ImmuneSupport.com: It sounds like these therapies are helpful adjuncts for stabilizing sleep. In addition, what have you found to be 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 intravenous vitamin therapies in which the patient receives, through an intravenous infusion, a mixture of vitamin C, trace minerals, glutathione, NADH, ATP, AMP, magnesium, calcium, B 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. I have this compounded by a 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 NADH coupled with buffered vitamin C and oral potassium and magnesium aspartate to be very helpful. Obviously, we also need to look at the underlying etiologies as we evolve a more clear diagnostic picture individualized to the patient, and these will include evaluating for toxin overload, metabolic problems, nutritional deficiency, hormone imbalance, subclinical 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, Famvir, which will often need to be continued for several weeks at a time. In addition, I have been using Isoprinosine 500 mg (2-6 daily) as an immune system adjunct. In addition, I have these patients take nutritional supplements that support the immune system including undenatured whey protein. This combined effort approaches and supports the immune system from multiple directions. ImmuneSupport.com: One of the common issues - particularly associated with fibromyalgia syndrome, are the chronic pain symptoms. What are some avenues you have found useful in that regard? Dr. Guyer: For chronic pain, a predominant complication for many sufferers, it is important to engineer a specific regimen that helps the individual patient in efficaciously getting out of the chronic pain cycle. When this is established, continued progress in more optimal health is possible. One inclusion that I previously mentioned is the special natural wool mattress pad, which I have found is very helpful for many sufferers in reducing some of the chronic nighttime pain. In addition, there are 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, and for those who have chronic pain and low energy, Ritalin in low doses I have often found very helpful. In addition, in our office we use combinations of Neural Therapy and trigger point injections very effectively (for those interested in learning more about Neural Therapy, refer to www.NeuralTherapy.com). Immune Support.com: Regarding the mood disorders that frequently plague CFS and FM sufferers, what is useful in helping to support a person in these challenging situations? Dr. Guyer: Many of the other components I previously mentioned will usually help a patient manage these symptoms, primarily Insulin Potentiation Therapy [to read about Insulin Potentiation Therapy, please visit http://www.immunesupport.com/library/showarticle.cfm/id/4485/searchtext/4485/] For those who tend to be chronically depressed, I believe this therapy is wonderfully effective. Other components of the anxiety-depression problem often relate to hormonal balance. Many patients with a deficient or a subclinically 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 who tried various antidepressants with minimal results respond remarkably to replacement doses of Armour Thyroid or Sustained Release Micronized T3 (the active thyroid hormone). Also, I have seen very good success, particularly with anxiety, using the Alpha-Stim SCS, 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 for 20-30 minutes daily. It tends to be very helpful for insomnia issues as well as anxiety and depression, in addition to improving sleep for many patients. I have seen very good success with this therapy, and for many patients, their insurance will actually pay for it. With these issues, one must also look ‘situationally’ and often there are life circumstances which contribute to ongoing chronic depression and anxiety. This can be one of the tougher problems to navigate as many individuals, while willing to be treated for perceived biochemical anomalies with nutrients and medicines, are often reluctant to pursue getting help and support for some of their emotional needs. Therefore, I try to provide an open and supportive forum for patients to discuss their feelings and to encourage working with a process that is uplifting for them. For many this will be working with a well-trained counselor, or it may be dialogues with their spiritual leader (like a church pastor or rabbi), or it may be merely walking their dog every evening. We all have personal uplifting things we turn to in our lives, whether musical (my favorite is “Amazing Grace” sung by Elvis Presley), or hobbies, or other outlets that help infuse us with a sense of purpose, faith and hope. In any event, it is important to define what those are to each person and include them in the overall treatment plan. ImmuneSupport.com: Other problems CFS and FM patients experience are irritable bowel symptoms, poor digestion, gas and bloating (particularly after eating), and overall poor nutrient absorption. What are some of the primary contributors to such problems, and what treatments have you found to be most helpful? Dr. Guyer: I think the digestive - and for that matter the detoxification system, are often the crux or obstacles 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. Therefore, first I like to approach the symptoms with natural therapy such as enteric-coated peppermint oil for bowel spasms, which can be used on an as-needed basis. Secondly, most people need to supplement with digestive enzymes and tailor to the dosing amount that improves overall function and reduces bowel complaints. In addition, some people 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 for the first several weeks I will have patients take 3 or 4 different brands which provide different spectrums of biologically active probiotic bacteria. Also, there will often tend to be yeast overgrowth, especially in those who have ever been on any kind of antibiotic therapy. It is often beneficial to do a comprehensive digestive stool analysis (Great Smokies 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. One of my favorite regimens, at least from the natural options, is oregano oil. Where I find that approach incomplete, I will usually use combinations of Diflucan and Nystatin, and if that is ineffective, I add Amphotericin. Again, this needs to be prepared by a compounding pharmacy and often several weeks of therapy will be required. It is also important when using systemic antifungal agents such as Diflucan to be sure to periodically check on liver functions, although I must say in the hundreds of patients I have treated, I have never seen any problems or complications with these specific medical regimens. However, in our patients, we also support liver detoxification with products including milk thistle extract and phosphatidylcholine. ImmuneSupport.com: Thank you for your time and insights, Dr. Guyer. One final question - what newer therapies are you beginning to use in your practice that you believe show significant promise for adjunctively treating CFS and FM? Dr. Guyer: I have been particularly interested in Dr. Shoemaker’s work with the hormone MSH. He has been kind enough to discuss 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 anti-inflammatory 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. _____________________________________________________ SOURCE: ImmuneSupport.com 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. Editor’s Note: For additional information, contact Dr. Guyer through his website at www.DaleGuyerMD.com.