Director of the Fibromyalgia & Fatigue Centers, Inc. This is part 3 of a=
=20
3-part series written by Dr. Teitelbaum that he is releasing through his=20
newsletter and blogs.]
30 TOP TIPS FOR TREATING CFS & FIBROMYALGIA WHEN ALL ELSE FAILS (PART 3 O=
F=20
3)
In part 1 of this series=20
(http://www.endfatigue.com/health_articles_c/Cfs_fm-30_tips_for_treatment=
_when_all_else_fails_part_1.html),=20
I focused on the importance of rechecking the basics. In part 2, I discus=
sed=20
hormonal support and nutritional therapies. In each part I described 10 o=
f=20
my top 30 tips for treatment. In part 3, I talk about going after hidden=20
infections, and I give you my final 10 top tips for treatment!
GOING AFTER HIDDEN INFECTIONS
If you have strep throat or a bladder infection, it's easy for a doctor t=
o=20
collect the bacteria, put it in a culture dish, and figure out the type o=
f=20
bacteria that's causing the problem =E2=80=94 and treat it. But if you ha=
ve one or=20
more of the infections that are commonly seen in CFS and fibromyalgia =E2=
=80=94=20
antibiotic-sensitive, viral, parasite, and Candida infections =E2=80=94 t=
here aren't=20
any accurate tests for detection. That means these infections often need =
to=20
be treated empirically without lab confirmation, based solely on symptoms=
=20
and their response to treatment.
In earlier newsletter articles, I have discussed when to treat for hidden=
=20
antibiotic-sensitive infections=20
(http://www.endfatigue.com/health_articles_f-n/Infections-avoiding_and_tr=
eating_without_antibiotics.html)=20
and when to consider a trial of antivirals=20
(http://www.endfatigue.com/health_articles_f-n/Infections-treating_hidden=
_viral_infections_cfs.html).=20
In addition (and most importantly) aggressively treating Candida=20
(http://www.endfatigue.com/health_articles_f-n_2/Infections-candida_elimi=
nating_yeast_fungal_overgrowth.html)=20
is a crucial part of treatment for virtually everyone with CFS and=20
fibromyalgia. Those three articles supply the basis for treating infectio=
ns=20
directly, and are worth reading if you have persistent CFS/FMS. The quest=
ion=20
is what to do when you suspect hidden infections that you can't get rid o=
f.=20
This is the focus of today's article.
BEGIN WITH A BASIC
Before I get into the final top 10 tips, let me remind you of a basic. Ta=
ke=20
zinc 20-25 mg a day for 3-6 months. Zinc deficiency is the rule in CFS/FM=
S,=20
and will cause marked immune dysfunction =E2=80=94 which is easy to fix f=
or under=20
$10 total cost (for 100 tabs).
TREATMENTS FOR HIDDEN INFECTIONS
Note: As in each of the previous two installments, I've put an asterisk (=
*)=20
next to treatments that are self-care/non-prescription. The other treatme=
nts=20
require that you work with your doctor. Also, as I did before, I've liste=
d=20
treatments that require a blood test at the end of the article (a conveni=
ent=20
summary in case you want to do all those tests at one time).
(Continuing the "30 top tips" numbering at 21, as 1-20 are in Parts 1 & 2=
=20
...)
*21. ProBoost.
This powerful over-the-counter and natural immune stimulant is especially=
=20
helpful for viral infections. In a study on Epstein-Barr virus antibody=20
levels in CFS, ProBoost decreased levels by 70% =E2=80=94 and many patien=
ts felt a=20
lot better after taking it for three months. Dissolve the contents of one=
=20
packet under your tongue, 3 times a day. (If you swallow it, you waste it=
=E2=80=94=20
it needs to be absorbed under your tongue.) I recommend ProBoost not just=
=20
for folks with CFS, but for everyone=C3=A2=E2=82=AC=E2=84=A2s medicine ca=
binet. Taken at the=20
first sign of a cold or flu, it can very quickly knock out the infection.=
=20
For CFS, it takes about three months to have an effect.
22. Nizoral =E2=80=94 a prescription antifungal.
Have yeast symptoms persisted (e.g., sinusitis, nasal congestion, canker=20
sores =E2=80=94 also called apthous ulcers) despite taking Diflucan? Try =
Nizoral,=20
200 mg a day, for six weeks in case you're resistant to Diflucan. Take=20
adrenal support (e.g., Adrenal Stress End) with it as Nizoral lowers adre=
nal=20
levels (which can help anxiety and depression in the small percent of CFS=
=20
patients with elevated cortisols!).
*23. Sinusitis Nose Sprays.
For persistent sinusitis, use the non-prescription Silver Nose Spray (or =
can=20
add the prescription "Sinusitis Nose Spray" from ITC Pharmacy, 888-349-54=
33)=20
1-2 sprays in each nostril, twice a day. When added to Diflucan these spr=
ays=20
are =C3=82 a very effective treatment for eliminating sinusitis.
24. Gamma globulin (IM injection).
Treat with gamma globulin (e.g., Gammastan): 2 cc by intramuscular inject=
ion=20
(IM), once a week for 6 doses, or 4 cc every other week for 3 doses. (IM =
is=20
much less expensive than intravenous delivery.) This drug can be a=20
dramatically effective way to jump-start your immune system.
25. Antibiotics for SIBO (Small Intestinal Bacterial Overgrowth).
Consider SIBO if bowel symptoms (diarrhea, gas, bloating) persist despite=
=20
yeast treatments =E2=80=94 especially if the flatulence has a strong odor=
(learn=20
more about SIBO AT=20
http://www.endfatigue.com/health_articles_r-s/Stomach-sibo_an_easily_trea=
table_cause_spastic_colon.html).=20
You may benefit from a trial of Rifaximin, an effective antibiotic for SI=
BO=20
(and irritable bowel syndrome), because it stays in the gut and works in =
the=20
gut. Take 400 mg a day for 10 days.
If severe bowel symptoms persist, consider Alinia, 1 gm 2x a day for 10 t=
o=20
14 days. (The standard course of this antibiotic is 4 days, but that is=20
inadequate in CFS.)
Both of these antibiotics are expensive. A cheaper option to Rifaximin is=
=20
Neomycin, 500 mg 3x a day for 10 days. Rifaximin may be preferred because=
=20
Neomycin carries a small risk of kidney or hearing toxicity, but mainly i=
n=20
an elderly person who is on a high dose of it for years or a person with=20
kidney failure.=C3=82
An important point: SIBO is aggravated by underactive thyroid and is like=
ly=20
to recur unless thyroid function is optimized.
26. Amantadine (Symmetrel).
This old (and cheap!) prescription antiviral can be very helpful. But ami=
dst=20
the new antivirals that cost $15,000 to $20,000 a year, this pennies-a-da=
y=20
prescription medicine is often forgotten. Ask your doctor about a trial o=
f=20
this medication if you suspect a chronic viral infection. Added benefits?=
=20
Amantadine raises dopamine (think more energy) and lowers NMDA (think les=
s=20
pain)!
27. Isoprinosine.
Some find this antiviral quite helpful. However, it is not made or availa=
ble=20
in the U.S. You have to order it either from Canada or Ireland.
Other antivirals:
A) The antiviral Nexavir can be helpful. But I rarely use it as the price=
=20
has been jacked up dramatically, it is given by injection, and it stops=20
working as soon as the medication is stopped.
B) You can find information about checking for and treating HHV-6 with=20
Valcyte, and the use of other prescription antivirals, at=20
http://www.endfatigue.com/health_articles_f-n/Infections-treating_hidden_=
viral_infections_cfs.html.=20
I rarely use Valcyte though, and prefer the other treatments discussed in=
=20
this article.
*28. Monolaurin.
This natural, low-cost antiviral has been found to be effective in some=20
patients and is well worth a try for chronic viral infections.
29. Neurotoxin protocol.
You can read more about Richie Shoemaker=C3=A2=E2=82=AC=E2=84=A2s neuroto=
xin protocol at The=20
Environmental Illness Resource=20
(http://www.ei-resource.org/articles/chronic-fatigue-syndrome-articles/ne=
urotoxins-=11-treatment-information-sheet/).=20
It is also discussed in my book From Fatigued to Fantastic!
30. Antiviral IVs.
This treatment can be very effective when chronic viral infections are=20
suspected. They contain a special antiviral component derived from licori=
ce,=20
along with high-dose vitamin C. It is offered at the Fibromyalgia and=20
Fatigue Centers (http://www.fibroandfatigue.com/).
31. (A bonus tip.)
I know I said 30 treatments, but here is a bonus one. For those with pure=
=20
CFS without the widespread pain, or with such severe illness that they ar=
e=20
near housebound =E2=80=94 especially if low blood pressure, NMH or POTS a=
re=20
present =E2=80=94 the medications given to hyperactive children can be ve=
ry helpful.=20
These medications, which are amphetamines (Ritalin, Dexedrine or Adderall=
),=20
are overused in hyperactive children, but under used in CFS. They stabili=
ze=20
autonomic function and often help the post exertional fatigue and even he=
lp=20
shed the extra weight put on by CFS. So why is it last on my list? Becaus=
e=20
it is an amphetamine and potentially addictive. I find 5-12.5 mg is usual=
ly=20
optimal, though younger patients (under 30 years old) are more likely to=20
benefit from it (and oddly may need slightly higher doses). I recommend=20
keeping the dose under 20 mg/day (30 mg is the maximum I=C3=A2=E2=82=AC=E2=
=84=A2ll use) and once=20
an effective dose is found it should not be escalated. I have found=20
addiction to be uncommon at these lower doses =E2=80=94 just as it is unc=
ommon in=20
ADHD at low dose.
SUMMARY OF BLOOD TESTS
There are a number of blood tests used in the treatments discussed in thi=
s=20
three-part series. They are summarized below for your convenience:
* Ferritin (treatment no. 3)
* Anti-transglutaminase IgA and IgG antibody (treatment no. 7)
* Serum ammonia level (treatment no. 8)
* Fasting morning cortisol; DHEA-S (treatment no. 12)
* Pregnenolone (treatment no. 13)
* IGF-1 (treatment no. 14)
* Free and total testosterone (treatment no. 16)=20
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