Dr. Jacob Teitelbaum's Column
...expert advice on CFS, Fibromyalgia and other Health Topics.
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Monday, October 3rd, 2011:
30 Top Tips for Treating CFS & Fibromyalgia When All Else Fails: Part III30 Top Tips for Treating CFS & Fibromyalgia When All Else Fails
by Jacob Teitelbaum MD
Part 3 of a 3-Part Series
In part 1 of this series, I focused on the importance of rechecking the basics. In part 2, I discussed hormonal support and nutritional therapies. In each part I described 10 of my top 30 tips for treatment. In part 3, I talk about going after hidden infections, and I give you my final 10 top tips for treatment!
Part 3: Going After Hidden Infections
If you have strep throat or a bladder infection, it's easy for a doctor to collect the bacteria, put it in a culture dish, and figure out the type of bacteria that's causing the problem — and treat it. But if you have one or more of the infections that are commonly seen in CFS and fibromyalgia — antibiotic-sensitive, viral, parasite, and Candida infections — there aren't any accurate tests for detection. That means these infections often need to be treated empirically without lab confirmation, based solely on symptoms and their response to treatment.
In earlier newsletter articles, I have discussed when to treat for hidden antibiotic-sensitive infections and when to consider a trial of antivirals. In addition (and most importantly) aggressively treating Candida is a crucial part of treatment for virtually everyone with CFS and fibromyalgia. Those three articles supply the basis for treating infections directly, and are worth reading if you have persistent CFS/FMS. The question is what to do when you suspect hidden infections that you can't get rid of. 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. Take zinc 20-25 mg a day for 3-6 months. Zinc deficiency is the rule in CFS/FMS, and will cause marked immune dysfunction — which is easy to fix for under $10 total cost (for 100 tabs).
Treatments for Hidden Infections
Note: As in each of the previous two installments, I've put an asterisk (*) next to treatments that are self-care/non-prescription. The other treatments require that you work with your doctor. Also, as I did before, I've listed treatments that require a blood test at the end of the article (a convenient 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 ...)
This powerful over-the-counter and natural immune stimulant is especially helpful for viral infections. In a study on Epstein-Barr virus antibody levels in CFS, ProBoost decreased levels by 70% — and many patients felt a lot better after taking it for three months. Dissolve the contents of one packet under your tongue, 3 times a day. (If you swallow it, you waste it — it needs to be absorbed under your tongue.) I recommend ProBoost not just for folks with CFS, but for everyone’s medicine cabinet. Taken at the first sign of a cold or flu, it can very quickly knock out the infection. For CFS, it takes about three months to have an effect.
22. Nizoral — a prescription antifungal.
Have yeast symptoms persisted (e.g., sinusitis, nasal congestion, canker sores — also called apthous ulcers) despite taking Diflucan? Try Nizoral, 200 mg a day, for six weeks in case you're resistant to Diflucan. Take adrenal support (e.g., Adrenal Stress End) with it as Nizoral lowers adrenal levels (which can help anxiety and depression in the small percent of CFS patients with elevated cortisols!).
*23. Sinusitis Nose Sprays.
For persistent sinusitis, use the non-prescription Silver Nose Spray (or can add the prescription "Sinusitis Nose Spray" from ITC Pharmacy, 888-349-5433) 1-2 sprays in each nostril, twice a day. When added to Diflucan these sprays are a very effective treatment for eliminating sinusitis.
24. Gamma globulin (IM injection).
Treat with gamma globulin (e.g., Gammastan): 2 cc by intramuscular injection (IM), once a week for 6 doses, or 4 cc every other week for 3 doses. (IM is much less expensive than intravenous delivery.) This drug can be a dramatically effective way to jump-start your immune system (which is why I flagged it using red italic type).
25. Antibiotics for SIBO (Small Intestinal Bacterial Overgrowth).
Consider SIBO if bowel symptoms (diarrhea, gas, bloating) persist despite yeast treatments — especially if the flatulence has a strong odor (learn more about SIBO). You may benefit from a trial of Rifaximin, an effective antibiotic for SIBO (and irritable bowel syndrome), because it stays in the gut and works in the gut. Take 400 mg a day for 10 days.
If severe bowel symptoms persist, consider Alinia, 1 gm 2x a day for 10 to 14 days. (The standard course of this antibiotic is 4 days, but that is inadequate in CFS.)
Both of these antibiotics are expensive. A cheaper option to Rifaximin is Neomycin, 500 mg 3x a day for 10 days. Rifaximin may be preferred because Neomycin carries a small risk of kidney or hearing toxicity, but mainly in an elderly person who is on a high dose of it for years or a person with kidney failure.
An important point: SIBO is aggravated by underactive thyroid and is likely to recur unless thyroid function is optimized.
26. Amantadine (Symmetrel).
This old (and cheap!) prescription antiviral can be very helpful. But amidst the new antivirals that cost $15,000 to $20,000 a year, this pennies-a-day prescription medicine is often forgotten. Ask your doctor about a trial of this medication if you suspect a chronic viral infection. Added benefits? Amantadine raises dopamine (think more energy) and lowers NMDA (think less pain)!
Some find this antiviral quite helpful. However, it is not made or available in the U.S. You have to order it either from Canada or Ireland. (Learn more about Isoprinosine.)
- The antiviral Nexavir can be helpful. But I rarely use it as the price has been jacked up dramatically, it is given by injection, and it stops working as soon as the medication is stopped.
- You can find information about checking for and treating HHV-6 with Valcyte, and the use of other prescription antivirals, by reading Treating Hidden Viral Infections in CFS/FMS Can Sometimes be a Cure. I rarely use Valcyte though, and prefer the other treatments discussed in this article.
This natural, low-cost antiviral has been found to be effective in some patients and is well worth a try for chronic viral infections.
29. Neurotoxin protocol.
30. Antiviral IVs.
This treatment can be very effective when chronic viral infections are suspected. They contain a special antiviral component derived from licorice, along with high-dose vitamin C. It is offered at the Fibromyalgia and Fatigue Centers.
31. (A bonus tip.)
I know I said 30 treatments, but here is a bonus one. For those with pure CFS without the widespread pain, or with such severe illness that they are near housebound — especially if low blood pressure, NMH or POTS are present — the medications given to hyperactive children can be very helpful. These medications, which are amphetamines (Ritalin, Dexedrine or Adderall), are overused in hyperactive children, but under used in CFS. They stabilize autonomic function and often help the post exertional fatigue and even help shed the extra weight put on by CFS. So why is it last on my list? Because it is an amphetamine and potentially addictive. I find 5-12.5 mg is usually optimal, though younger patients (under 30 years old) are more likely to benefit from it (and oddly may need slightly higher doses). I recommend keeping the dose under 20 mg/day (30 mg is the maximum I’ll use) and once an effective dose is found it should not be escalated. I have found addiction to be uncommon at these lower doses — just as it is uncommon in ADHD at low dose.
Summary of Blood Tests
There are a number of blood tests used in the treatments discussed in this 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)
Used with permission from Dr Jacob Teitelbaum's free newsletters-available at www.Vitality101.com
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