The use of acupuncture is proving so successful in the Air Force that a class about “battlefield acupuncture” is scheduled to commence in the New Year. Physicians deploying to Iraq and Afghanistan will soon be adding acupuncture to their list of medical remedies. Auricular acupuncture (acupuncture of the ear) is the primary technique that will be taught. This method can alleviate wide ranges of pain (even unbearable, sharp chronic pain) for days at a time. Patients who have been suffering in a daze of drug-induced sleep as their only means at pain reduction can begin to emerge from that state into fuller consciousness without pain.

Individuals treated with acupuncture report greater reductions in pain both immediately after the first and last treatments, and one week after the last treatment. It is important to have acupuncture treatments consistently for the treatment of chronic pain. Another reason acupuncture may work so well for wounded troops is because it is deemed especially effective in regard to pain caused by motion. Acupuncture is a safe form of treatment for people with chronic neck pain and offers clear clinical advantages over conventional massage or prescribed medication in the reduction of pain and improvement of mobility. It doesn’t just attack the symptom as drugs do but, rather, the cause of the pain, thus improving the patient’s range of motion and sense of well-being.

Acupuncture can also reduce anxiety, something many wounded troops deal with daily. Battlefield acupuncture has been effective among patients suffering from a combination of combat wounds and psychological injury. Auricular acupuncture, in particular, is known to help patients relax, de-stress, and can greatly improve a patient’s sleep pattern. Lastly, this practice is well suited to military bases and physicians on the go because it requires no bulky equipment, and can provide quick relief.

For more information on Battlefield Acupuncture please contact Pacific College of Oriental Medicine at (800) 729-0941.

Ira Zunin, MD, MBA, MPH

Ira Zunin, MD, MPH, MBA offers a global, strategic perspective as to why he has made a priority of forming partnerships with insurers and employers to advance his integrative practice model for disabling pain: “We know we can spend a decade in the legislature trying to fight for one small thing. This is an opportunity to solve big problems which big payers know they have and create a lot of latitude for integrative medicine.”

Zunin’s base is his Manakai O Malama integrative center on the island of Oahu. Since it’s founding in 2002, the clinic has had over 100,000 patient visits to its array of practitioners. (See “Clinical Services” in the table). In 2005, the Zunin’s team partnered with Hawaii Medical Services Association (HMSA), the island’s Blue Cross Blue Shield carrier, and two workman’s compensation firms for an integrative pain pilot that targets a costly, disabled population .

Hawaii Blues Plan funded the pilot

“We viewed this as a chance to study a comprehensive biopsychosocial intervention,” states Zunin, an Integrator adviser.

Hawaii Blues Plan funded the pilot

“We viewed this as a chance to study a comprehensive biopsychosocial intervention,” states Zunin, an Integrator adviser. The program is family, community and group-based. Zunin adds that the approach particularly sought to “interrupt the pattern of social isolation” often found in such a population. Group process might shift the “pattern of suffering.” Working with families might increase positive secondary gains. The emphasis was on mind-body strategies which might reduce “pain-related depression that can contribute to suffering.”

Among the complementary and alternative
components included are the use of Feldenkrais and Yoga, humor, acupuncture in a
group-delivery model, and diverse mind-body therapies including a
program with elements of the mind-body stress reduction programs
developed by Jon Kabat-Zinn, PhD.

Outcomes: anxiety, disability, opiate use down

Zunin reports that “the outcomes have been great.” Among those found were:

• Quality of life Scores for the 33 who completed all of the 12 weeks improved on all standardized, subjective measures, with particular advances in diminishing anxiety.

• Disability Of the 64% who had been disabled or partially disabled in the prior 12 months, 85% returned to gainful activity or were cleared to work. 100% of those who returned to gainful activity were still “gainfully engaged” at one-year follow-up.

• Opiate use Of the 79% who had been under high level opiate analgesics during the 12 months prior, 97% had reductions in use of 25% or more, 81% of 50% or more and 50% had 100% reductions on high level opiate use. At one year follow-up, 100% of those who substantially-reduced opiates remained off of them.

Zunin, reports that these positive outcomes have led to a discussions
with HMSA to make the program a covered benefit, and with the Veteran’s
Administration about expanding the program and offering it to vets.

The carrot and stick values of the group intervention

Zunin believes that the group-method of service delivery was a significant factor in achieving these positive outcomes. “The thing about pain and extreme obesity is that they are socially isolating. So, on one side” – what Zunin called the “carrot” – “you are interrupting this pattern.” He adds that he felt that acupuncture in a group model can particularly help: “There is something energetic that occurs as a group.”

Then Zunin explains how he believes that group-focused treatment also has a “stick” dimension to it. Reflects Zunin: “The other side of the group ethic is the stick. In this population, you typically have people who have learned to manipulate one provider after another. They spot that manipulation in each other and whomp each other for it when it comes up.” In short, the counseling from a fellow-patient may be much more direct and to the point than that from the patient’s doctor.

Zunin described plans for modifying the program from lessons learned in this round. First, Zunin anticipates screening all participants at the first 4 weeks. This would give a chance to “graduate” some of the quick responders and to remove some from the program who are clearly not engaged. In both cases, costs would be saved. Zunin also anticipates producing the three 4-week sessions as “chapters” with more of a thematic continuity.

Zunin, who founded the Hawaii State Consortium for Integrative Health Care, continues to believe that pilots such as this, which analyze outcomes of whole systems of care, in partnership with insurers or other payers is the way to transform the system. Says Zunin: “The contribution I would like to see to our shared field is to lighten the path to rapid change.”

For another article on Zunin’s work, please see (Zunin on CAM-IM Clinical Services in Healthy Living “Age Targeted” Communities, April 24, 2006).

Comment: Zunin’s comments about the value of the group reminded me of the astonishingly positive outcomes of the group-focused programs delivered to Chrysler employees onsite (Chrysler Expands Group-Focused Integrative Pain Partnership with Henry Ford Health System CAM Group, July 23, 2007; and Chrysler’s Health Leaders on Their Integrative Health Pilot Projects, February 26, 2008). Zunin agreed that there may be something in the individualized nature of the experience of pain which makes it particularly susceptible to group mind-body interventions.

To the extent that this may be true, our health professional educational programs must begin to train professionals to participate in and help lead these group interventions. The training in delivering such programs is essentially, as the fundamental, economic law of clinical decision-making seems to be that practitioners of all stripes are most likely to recommend services that they, themselves are equipped to provide.

Kudos to Zunin for having the vision to put this together and see it through this round. I agree with his strategic sense that these kinds of projects are the best way to light the path to quicker uptake of integrative practices.

I recently came across a study comparing glucosamine versus acetaminophen. Researchers from Madrid, Spain, compared the benefit of glucosamine sulfate versus acetaminophen (Tylenol) on the symptoms of knee osteoarthritis during a 6-month treatment course. Patients were randomly assigned to receive oral glucosamine sulfate 1,500 mg once daily, acetaminophen 3 gm a day, or placebo. There were more responders to glucosamine sulfate (39%) and acetaminophen (33%) than to placebo (21%). Safety was good, and was comparable among groups. The findings of this study indicate that glucosamine sulfate is more effective than placebo and more or as effective as acetaminophen in treating knee osteoarthritis symptoms.

Dr. Sahelian Comments: Acetaminophen works quicker to relieve pain, but can cause harm to the liver, even at doses of one gram a day. I do not think it is a good drug to be taken long term for a chronic condition such as osteoarthritis. There is a possibility that if glucosamine is combined with chondroitin and other nutrients or herbs it may be more beneficial than by itself. I wonder how many years it will take for the American Board of Family Medicine to include natural supplements as options in their multiple choice questions and answers.

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When my oldest child was 7 and had to have a shot to go back to school, he too underwent genital examination and was extremely uncomfortable. I asked the doctor if it was necessary. He said yes. I asked until what age it was necessary. He said until adulthood. Then he went on to say that oftentimes little girls are so uncomfortable that they have to transfer out to a female pediatrician. In the late 60s and early 70s, my mother found a pediatrician who also forced me to remove all my underclothes, lay on my back and spread my legs so that he could spread my vagina with his hands and get a “good look”. I never remember a visit forgoing this experience until I was well into my teens. No explanation was ever given to me, and my “panic attacks” prior to the visit were considered to be quite ridiculous. L B, Miami Springs, Florida…..Thank you for calling attention to this subject and for sending in photocopies from a medical textbook on physical examination of infants and children. It emphasizes that it isn’t essential that the child be completely undressed during the course of the examination only the part of the body being examined and that direct visualization of the vagina and cervix aren’t considered part of the ordinary physical examination.

Our advice would be for parents to avoid “well children” general examinations; to save doctor visits for times that something specific seems to be wrong, and then ask the doctor to only examine the relevant body part. If your child has something wrong with his plumbing requiring that his genitalia be examined, it would be wise for you to explain beforehand that the doctor is going to have a look at it and why, and perhaps for you to demonstrate it yourself so that your child is not taken by surprise. Of course make sure to always be present. If your child clearly doesn’t want it, never force or restrain him.

Researchers studying 22 patients who underwent a procedure known as stapled haemorrhoidectomy found that persistent severe pain and faecal urgency were side effects in a “disturbingly high” proportion of patients.

In all, 31 per cent of the individuals studied had pain and faecal urgency which persisted for up to 15 months after their operations.

The results were so evident that the randomised trial was suspended so that doctors could investigate what went wrong.

In four out of five cases, no medical reason other than the haemorrhoidectomy could be found (Lancet, 2000; 356: 730-3).

* In a recent study, one third of 773 individuals involved in a road accident as a driver, bicycle rider or pedestrian experienced some level of anxiety, depression, fear of travel or post traumatic stress disorder (PTSD) 3 to 12 months later and, in most cases, persisted. After one year, about half the group had phobic travel anxiety, nearly 60 per cent had general anxiety, and half were diagnosed with PTSD (Am J Psychiatry, 2001; 158: 1231-8).

* New research in nearly 1300 men suggests that, during a severe asthma attack, men are less likely than women to notice the symptoms of the attack. The reason for this is unclear, but it may be that men perceive less discomfort because of greater lung size and muscle strength, or because they generally develop asthma at an earlier age than women. Men also tend to only seek medical attention when symptoms are too severe to ignore, the researchers noted (Ann Emerg Med, 2001; 38: 123-8).

* What’s lurking in that paddling pool? Physicians in Canada have found the first outbreak of a new type of Pseudomonas infection called ‘hot foot syndrome’. This discovery was made when 40 children, aged 2 to 15, developed intense pain in the soles of their feet within 40 hours of using the same wading pool. A hot, red swelling began after a few hours, along with pain so severe that the children were unable to stand up. Three children were given oral cephalexin (an antibiotic) while the others were treated with cold compresses, analgesics and foot elevation. In all cases, the condition resolved within 14 days, although it recurred in three children after they revisited the same pool (N Engl J Med, 2001; 345: 335-8).

How often do you think about your kidneys? Probably never. For most of us, the kidneys are yet another set of organs which quietly do their job day after day without incidence. Yet if the kidneys malfunction or fail for any reason, our health is profoundly affected. Kidneys are involved with several vital bodily functions. They help to remove waste and excess fluid from the body, they filter the blood and they control the body’s pH balance. They also take part in maintaining the balance of essential nutrients and in regulating blood pressure.Stone formation in the urinary tract the kidneys, ureters, bladder and urethra has been recognised for thousands of years. Although we think of kidney stones as purely a result of modern diets and lifestyle, they have been found among prehistoric remains in Egypt and western Europe. From Hippocratic manuscripts it is evident that kidney stones were a common phenomenon in ancient Greece. But during the last few decades, the pattern and rate of the disease have changed markedly. In the past, stone formation was almost exclusively in the bladder, whereas today most stones form in the kidney and upper urinary tract. As many as 10 per cent of men and 3 per cent of women get kidney stones, most of whom are over 30 (New Eng J Med, 1993; 328: 884-5). The incidence of kidney stones has been steadily increasing, paralleling the rise in other diseases associated with the poor Western diet, such as heart disease, gallstones, high blood pressure, diabetes and cancer.

In a healthy individual, urine is usually saturated to the limit with calcium oxalate, uric acid and phosphates. Normally, with the secretion of protective factors and a balanced pH in the body, these compounds remain in solution and are excreted in the urine. But, if these protective factors are overwhelmed or an imbalance in pH occurs, small particles or “crystals” may separate from solution and build up in the kidney increasing the risk of stone formation. About 80 per cent of all stones are composed of calcium oxalate, either on its own or with a nucleus of calcium phosphate (known as apatite). Uric acid accounts for about 5 per cent of stones and struvite for about 15 per cent.

Environment vs heredity

As one study elegantly illustrated, it’s likely that the environment plays as great a part as heredity in any individual’s risk of developing kidney stones. In this general health survey of 2,500 middle aged men, a family history was significantly more common among stone formers than among controls, most prominent through the male line. However, an increased tendency was also noted among the wives of those with a family history of stones even if they had no family history of stone forming themselves (Br J Urol, 1979; 51: 249-52).

The case for environment over heredity is also underscored by ongoing research in space. Astronauts are generally at the peak of physical health. One would not expect them to fall prey to metabolic disorders. But space flight induces many physiological changes, among which are changes in the mineral balance of the body. An astronaut’s diet is likely to contain less fluid, energy, protein, potassium, phosphorus and magnesium all known risk factors in stone formation (J Urol, 1997; 158: 2305-10). For astronauts, osteoporosis is the major risk from these changes they lose approximately one per cent of their bone mass per month during space flights. But they are also at greater risk of forming kidney stones (J Urol, 1993; 150: 803-7), adding important evidence to the association between environment, lifestyle and kidney stones.

Conventional solutions

For a long time, the best approach offered to patients was surgery to remove large, painful stones. Smaller stones were, and still are, treated with a number of different types of drugs, such as the thiazide diuretic chlorthalidone, which reduces urine calcium concentrations. These drugs have a host of side effects, including hypotension (hence their use in the treatment of high blood pressure), impotence, skin rashes and photosensitivity. They also alter the body’s balance of important minerals, such as potassium and magnesium, and may therefore, ironically, end up increasing the risk of stone formation (Acta Urologica Belgica, 1994; 62: 25-9). Another popular medication is calcium citrate, a highly soluble calcium salt whose formation decreases urinary concentrations of free calcium.

Within the last two decades, a form of ultrasound treatment known as extracorporeal shock wave lithotripsy (ESWL) has been used to shatter stones, making their fragments easier to “pass” through the urine. The treatment is performed on a day patient basis, with NSAIDs used for pain relief. Anti biotics are often given prophylactically since bacteria, which are found in more than 30 per cent of stones, can be released into the kidney when the stones are shattered, increasing the risk of post procedure infection (Acta Urologica Jap, 1992; 38: 999-1003).

Although hailed as a revolution in the treatment of kidney stones, the risks of ESWL are probably underestimated. Most patients experience internal bleeding, which can range from a tiny haemorrhage to major bleeding requiring transfusion. Immediately after the procedure, blood flow to the kidneys can be drastically altered; usually it declines, but in about 8 per cent of cases blood pressure in the kidney rises, causing kidney hypertension (RH Hepinstall, Pathology of the Kidney, Boston, Massachusetts: Little, Brown & Co, 1992: 1592).

There is evidence that ESWL can affect the ability of the kidneys to filter out impurities efficiently (J Endourol, 1994; 8: 15-19). Other studies have shown irreversible kidney damage from the procedure (Nephron, 1993; 63: 242-3) and there has been one case of fatal kidney failure afterwards (Lancet, 1994; 344: 757-8). Damage to the kidney is reportedly in the range of 63 to 85 per cent (Am J Radiol, 1985; 145: 305-13; Radiology, 1987; 163: 531-4).

But perhaps most dispiriting of all is that ESWL doesn’t cure the problem. In a French study, computed tomography scans performed two years after a group of patients had undergone lithotripsy showed that 40 per cent had a recurrence of stones and 25 per cent had scarring (Nephrologie, 1993; 14: 305-7).

This recurrence rate is not much different from what you could expect if you never had the procedure. In an observational study of the natural history of stone formation among 2,322 men, 42 per cent of patients experienced a recurrence of kidney stones (Acta Med Scand, 1975; 197: 439-45). Perhaps even more interesting was that 94.5 per cent of all stones passed spontaneously, suggesting that the need for aggressive medical action may be overstated. These researchers concluded that environment played a greater part in stone formation than family history an important point when considering treatment since there are so many beneficial changes in diet and lifestyle which those at risk can make.

Environmental factors

A number of environmental influences contribute to the risk of stone formation. People living in, or even just visiting, a warm or hot climate have an elevated chance of developing kidney stones (Med Trop, 1997; 57: 431-5; Am J Epidemiol, 1996; 143: 487-95). A sunny climate means greater risk of dehydration and lower urine output. This leads to an imbalance in urine volume and the concentration of those compounds which form stones.

Cadmium is among the most toxic metals in our environment, contributing to a wide range of diseases. It is particularly toxic to the kidneys. Of 38 men and women working in a battery factory, nearly half were shown to have kidney stones (Isr J Med Sci, 1992; 28: 578-83). Another study found that copper workers had a 18.5 per cent prevalence of upper urinary tract stone disease associated with a very significant hypercalciuria (too much calcium in the urine) (Urology, 1978; 11: 462-5).

But perhaps the greatest influence is the environment inside your body, as controlled by your diet.

Vegetarians as a group seem to have a lower risk of kidney stones (Eur Urol, 1982; 8: 334-9). Meat increases intestinal calcium absorption and thus the risk of abnormally high concentrations of calcium in the urine. This risk appears to be mainly a consequence of meat’s high content of sulphur containing amino acids (J Nutr Sci Vitaminol (Tokyo), 1990; 36: 105-16). The metabolic by products of meat digestion also include oxalate and uric acid, both of which are implicated in kidney stones.

Not all studies, however, have found an association between eating meat and forming stones. In a randomised, controlled trial of a kidney stone prevention diet, low in animal protein and high in fibre, patients were divided into two groups one with dietary intervention and advice to increase fluid intake, and one which was given the latter advice only. The researchers found that a high fibre, low protein diet had no real advantages over the simple advice to increase fluid intake alone (Am J Epidemiol, 1996; 144: 25-33). Another study found that it was not whether or not individuals ate meat that made the difference, but whether they included fresh fruit and vegetables in their diet. Among meat eaters, those who eat more fruits and vegetables have a lower incidence of kidney stones (Urol Res, 1975; 3: 61-6).

The calcium debate

Dr Gary Curhan and his team from the Harvard School of Public Health in Boston have led the way in dietary research into kidney stones. Two studies by Dr Curhan have challenged the old presumption that lowering calcium intake will reduce the risk of forming stones. The first was a prospective study of 45,619 men aged 40 to 75, who had no history of kidney stones. During four years of follow up, 505 cases of new, symptomatic kidney stones arose. The researchers found several dietary links. The higher the intake of animal protein, the greater the risk of kidney stones, whereas a greater intake of potassium and fluid diminished the risk (N Eng J Med, 1993; 328: 833-8).

But the most dramatic result found was that those with the highest dietary calcium intake were at no greater risk of developing stones than the population as a whole. In fact, a higher intake of dietary calcium was strongly associated with a reduced risk of kidney stones. Individual foods high in calcium, such as skim or low fat milk, cottage or ricotta cheese and yoghurt, were found to be protective, as were non dairy sources of calcium, such as oranges and broccoli. These findings led the authors to conclude that the routine restriction of calcium rich foods for stone formers had no basis.

As an explanation for their surprising results, the researchers propose that a lot of calcium in the diet is protective due to its effect on oxalate absorption. With more calcium, oxalate absorption is reduced (meaning less is excreted in urine) whereas when calcium intake is restricted, oxalate absorption goes up leading to more oxalate in the urine.

In 1997, Dr Curhan analysed an even larger cohort this time of women with no previous kidney stones and found very similar results with a surprising twist (Ann Int Med, 1997; 126: 497-504). Among the 91,731 women studied, 864 cases of kidney stones were documented over 12 years, and once again dietary calcium was found to be protective. However, researchers also observed that the intake of supplemental calcium actually elevated the risk of stone formation. All calcium, it appears, is not equal. The opposing effects of different types of calcium found in this study may have something to do with timing: if calcium supplements are taken at the same time that oxalate is consumed in the diet.

Most recently, another team of researchers in the US studied 1,309 women aged between 20 and 92 years. They were able to rule out such factors as hypertension, bone mineral density, high oxalate food consumption, fractures, ascorbic acid from food supplements and even geography as being significantly associated with stone formation. Instead, the most significant factor was dietary calcium; stone formers consumed almost 250 mg less calcium per day than women without stones. They also had a lower energy intake (Am J Epidemiol, 1998; 147: 914-20).

Encouragingly, while family history has been shown to increase the relative risk of forming kidney stones by two and a half times (particularly in men), family history alone is not enough to reduce the protective effect of dietary calcium (J Am Soc Nephrol, 1997; 8: 1568-73). Indeed, more calcium rich foods may be the best protection against hereditary stones.

Subtle damage to the kidneys can take place over a number of years without producing any painful symptoms. A first sign that something is wrong is often the formation of kidney stones. While this condition is often derided with humour (many men say it’s the closest they’ll ever get to labour pains), kidney stones are no joke. They can damage the kidney, obstructing the passage of urine and leading to infection. While most humans can survive with one kidney or with each one working at sub optimum levels why take the chance? Simple lifestyle modifications can make the difference between functioning adequately and functioning optimally.

Since then, much more evidence has come to light of alternative remedies that may be highly beneficial to sufferers of this condition.

Homoeopathy
Paloondo, a plant found in Mexico and Southern California, was used by the Aztecs for inflammatory rheumatoid-arthritic conditions and has been found to be useful for RA in homoeopathic potencies. Euretin and Paloon-don-Dragées, two patented medicines made in Austria and licensed in the European Union, have shown evidence of success.

Paloondon-Dragées has undergone a placebo-controlled Hahnemannian proving – the basic homoeopathic experiment in which a remedy is tested to determine whether it can produce the symptoms it is meant to cure – and was indeed found to produce arthromuscular rheumatism (Homoeother rheumatisch Leiden Paloondo, 1970, 6: 241-5.)

Nutritional therapy
Bromelain, an enzyme obtained from the pineapple plant (Ananas comosus), can be effective in reducing the amount of inflammation associated with RA and the dose of steroids needed to manage it.

Twenty-five patients with stage II or III RA were able to taper their steroid dosages down to small maintenance doses of enteric-coated bromelain. Joint swelling was also substantially reduced in most patients (Penn Med J, 1964, 67: 27-30).

Ayurvedic medicine
This Indian system of medicine has long used the yellow pigment – called curcumin – derived from the turmeric plant (Curcuma longa) to treat joint inflammation.

In one double-blind study, RA patients were given either curcumin or phenylbutazone, a non-steroidal anti-inflammatory drug (NSAID). Those taking the turmeric showed similar improvements in duration of morning stiffness, walking and joint swelling compared with those taking the NSAID, but without the substantial side-effects usually seen with the drug (Ind J Med Res, 1980; 71: 632-4).

Chinese medicine
Two experimental studies have shown that the root of the Chinese medicinal herb Lei gong teng (Tripterygium wilfordii) is usually effective to some degree for both RA and ankylosing spondylitis (J Trad Chin Med, 1983, 3: 125-9; Chin Med J, 1989, 102: 327-32).

Herbal medicine
A herbal remedy made from the Yucca plant has also been shown to be helpful in easing the symptoms of RA.

In an American study involving Desert Pride Herbal Food Tablets (containing Yucca plant saponin extract), 149 RA patients were given either the Yucca saponin extract or placebo for one week to 15 months. At the end of the trial, 61 per cent had less pain, swelling and stiffness compared with 22 per cent of those taking the placebo. Some improved within days or weeks whereas some took several months or more (J Appl Nutr, 1975; 27: 45-50).

Osteopathy
Good osteopathic care can modify the course of RA and even bring about a remission. Once the acute inflammation has subsided, this should include heat, friction, hot wetpacks, stretching, exercise, support and careful passive articulation of the affected joints (Br J Gen Pract, 1993: 15-8).

Dietary therapy
A Norwegian study showed that a change to a vegetarian diet normalised dietary fatty acids and reduced the inflammation seen in RA.

The patients were allowed to consume only vegetable soups, vegetable juices, garlic and herbal teas for the first 10 days. Thereafter, the diet was gluten-free, and meat was allowed only sparingly on every second day. For the first three months, citrus, salt, refined sugar, tea, coffee, cocoa, cola, strong spices, alcohol, milk and milk products were strictly forbidden (Bartram T, Bartram’s Encyclopaedia of Herbal Medicine, London: Robinson Publishing, 1998: 372).

Harald Gaier
Harald Gaier is a registered homoeopath, naturopath and osteopath.

My own discipline is the Alexander Technique. I would say that there is a compressing and discoordinating impulse that affects the whole body when a person is anxious, depressed or in pain. It is possible that she is making her symptoms worse by her body use, for example in compressing her viscera and impairing her circulation. L. G., The Complementary Health Centre, Exeter.The lady can certainly be helped with homoeopathy. There are insufficient data given in your report, but one remedy Cocculus springs to mind. P. J. L., homoeopath, Gravesend.

Re L. R. ‘s problem with Reynaud’s and erythromyalgia: she could try Sulphur 30 twice daily, an over the counter remedy. A. M, homoeopath, Bridport.

Apart from improved diet supplements, I have had excellent results in prescribing Dr. Madus’ Oligoplex Preparations “Secal corn” oplex. Relief is usually apparent after a few days. J. S., registered naturopath, London.

I would suggest that she considers the Bach Flower Remedies for the emotional side (and possibly underlying causes) of her problems. I would suggest the following: Gorse, Olive, Scleranthus, Star of Bethlehem, Crab Apple and Willow. J. W., Romford, Essex.

We would only add that L. R. (and any others of you out there looking for relief from chronic pain) only investigate these possibilities with the help of a trained therapist or centre with several different therapies on offer. That way, if one discipline doesn’t seem to help, the therapist can suggest an alternative.

The lead article in a recent edition of the Journal of Chronic Fatigue Syndrome is titled “Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia — the Results of a Randomized, Double-Blind, Placebo-Controlled Study”! After decades of hard work by hundreds of researchers in the field, we have progressed to the point where effective treatment is now available for these illnesses! In our study, over 90 percent of patients improved with treatment.

In the average patient, after two years of treatment, the average improvement in quality of life was 90 percent. Pain decreased by over 50 percent on average. Many patients no longer even qualified for the diagnosis of CFS or fibromyalgia after treatment! Interestingly, many of the same principles for treating fibromyalgia also apply to myofascial pain syndrome

That the vast majority of patients improved significantly in the active group while there was minimal improvement in the placebo group proves two very important things. The first is that these are very treatable diseases. The second is that anyone who now says that these illnesses are not real or are all in your head are clearly both wrong and unscientific. The full text of the studies can be seen at www.vitality101.com.

A new day is dawning in how CFS/fibromyalgia/MPS will be treated. In support of our work, an editorial in the April, 2002 journal of a major multidisciplinary medical society for pain management in United States noted “the comprehensive and aggressive metabolic approach to treatment detailed in the Teitelbaum study are all highly successful approaches and make fibromyalgia a very treatment responsive disorder. The study by Dr. Teitelbaum et al. and years of clinical experience make this approach an excellent and powerfully effective part of the standard of practice for treatment of people who suffer from fibromyalgia and myofascial pain syndrome.”

It is important to recognize that these syndromes can be caused and aggravated by a large number of different triggers. When all these different contributing factors are looked for, and treated effectively, patients improved significantly and often get well!

What is causing these illnesses?
As we noted above, CFS/FMS/MPS is not a single illness. Our study has shown that it is a mix of many different processes that can be triggered by many causes. Some of you had your illness caused by any of a number of infections. In this situation, you can often give the time that your illness began almost to the day. This is also the case in those of you who had an injury (sometimes very mild) that was enough to disrupt your sleep and trigger this process. In others the illness had a more gradual onset. This may have been associated with hormonal deficiencies (e.g. low thyroid, estrogen, testosterone, cortisone, etc.) despite normal blood tests. In others, it may be associated with chronic stress, antibiotic use with secondary yeast overgrowth, and/or nutritional deficiencies. Indeed, we have found well over 100 common causes of, and factors that contribute to, these syndromes.

What these processes have in common is that most of them can suppress a major control center in your brain called the hypothalamus. This center controls sleep, your hormonal system, temperature, and blood flow / blood pressure. When you don’t sleep deeply, your immune system also stops working properly and you’ll be in pain. When we realized this, the myriad symptoms seen in CFS/fibromyalgia suddenly made sense. It also gave us a way to effectively treat you!

Four main categories of problems need to be treated.
A half-century of work by Dr. Janet Travell, the White House physician for Presidents Kennedy and Johnson and author of the Trigger Point Manual showed that the same problems caused by hypothalamic suppression resulted in muscles getting stuck in the shortened position. Chronic muscle shortening then causes myofascial and fibromyalgia pain. As she laid the groundwork for effective treatments these processes, our research team dedicated our published study to her memory. These are the four key areas that need to be treated for Chronic Fatigue syndrome, fibromyalgia and muscle pain to resolve:

1–Disordered sleep. Most patients with these illnesses find that they are unable to get 7-8 hours of deep sleep a night without taking medications. In part, this occurs because hypothalamic function is critical to deep sleep. Unfortunately, many of the most common sleep medications actually aggravate the sleep problems by decreasing the amount of time spent in deep sleep. For patients to get well, it is critical that they take enough of the correct sleep medications to get 8 to 9 hours sleep at night! These medications include Ambien, Desyrel, Klonopin, Xanax, Soma and, if you don’t have Restless Leg Syndrome, Flexeril and/or Elavil. In addition, natural remedies can help sleep. An excellent one (which I developed -Revitalizing Sleep Formula by Enzymatic Therapy — 100 percent of my royalty for all products I develop is donated to charity) includes theanine, Jamaican Dogwood, wild lettuce, valerian, passionflower, and hops. Other natural sleep aids include Calcium, Magnesium, 5-HTP (100-300mg), and melatonin (3/10-1mg). Some patients find that over-the-counter antihistamines such as doxylamine (Unisom for sleep) or Benadryl can also help. In the first six months of treatment, it is not uncommon to sometimes need to take even six to eight different products simultaneously to get 8 hours of sleep at night. After 6-18 months of feeling well, most people can come off of most sleep (and other) medications. I’m starting to believe that, to offer a margin for safety during periods of stress, it may be wise to stay on 1/2 to 1 tablet of a sleep medication for the rest of your life. Your doctor may initially be uncomfortable with this. Nonetheless, our experience with over 2000 patients and 2 research studies have found this approach to be safe and critical to people getting well. When one recognizes that CFS/FMS is a hypothalamic sleep disorder — not poor sleep hygiene — this approach makes sense. Otherwise, it is as if your doctor would immediately try to stop blood pressure or diabetes medicines every time the patient was doing better!

2–Hormonal deficiencies. The hypothalamus is the main control center for most of the glands in your body. Most of the normal ranges for our blood tests were not developed in the context of hypothalamic suppression or these syndromes. Because of this (and for a number of other reasons) it is usually necessary, albeit controversial, to treat with thyroid, adrenal (very low dose cortef; DHEA), and ovarian and testicular hormones — despite normal blood tests! These hormones have been found to be reasonably safe when used in low doses. Growth hormone has also been shown to be helpful in fibromyalgia. We don’t use it because, unfortunately, it can cost over $15,000 a year and is given by injection. Fortunately, there may be a cheaper way to raise your low growth hormone. Most growth hormone is made during deep sleep. This may be another reason why getting 8 to 9 hours of deep-sleep a night can be critical!

3–Unusual infections. Many studies have shown immune system dysfunction in FMS/CFS. Although there are many causes of this, I suspect that poor sleep is a major contributor. The immune dysfunction can result in many unusual infections. These include viral infections (e.g. –HHV-6, CMV, and EBV), parasites and other bowel infections, infections sensitive to long-term treatment with the antibiotics Cipro and Doxycycline (e.g. mycoplasma, chlamydia, Lyme’s, etc) and fungal infections. Although the latter is controversial, both our study and another recent placebo-controlled study found treating with an antifungal to be very helpful with the symptoms seen in these syndromes. Avoiding sweets (stevia is OK) and taking Acidophilus Pearls (healthy milk bacteria –2 pearls twice a day for 5 months) can be very helpful. We often also add prescription antifungals as well.

4–Nutritional supplementation. Because the western diet has been highly processed, nutritional deficiencies are a common problem. In addition, bowel infections can cause poor absorption, and the illness itself can cause increased nutritional needs. The most important nutrients include: a) vitamins — especially the B vitamins (most at 25-50 mg/day), vitamin B12 (50-3000mcg/day), antioxidants (e.g. — vitamin C and E). b) Minerals — especially magnesium, zinc, and selenium and c) amino acids (proteins). To replace the 25 – 35 tablets that people needed to take, I developed a good tasting product that contains 50 key nutrients in 1 capsule and 1 scoop of a good tasting powder taken daily. It is called “ Energy Revitalization System” by Enzymatic Therapy, and is available at health food stores or on my web site.

There are many other treatments available as well. Although space does not allow for a full discussion of these in this article, I discuss them at length in my book “From Fatigued to Fantastic!” and at my www.Vitality101.com website (click on the “Treatment Protocol” link on the bottom left for detailed instructions on treatments for each of these problems).

So can I make my pain go away?
Fibromyalgia and Myofascial Pain and associated nerve entrapments are now very responsive to treatment! In many cases, they usually will improve dramatically and often even go away if you simply get the eight hours of sleep a night I discuss above, take the vitamin powder, take thyroid hormone, and treat the underlying yeast infections. Other patients require the more thorough evaluation and treatment. Localized myofascial pain also requires an evaluation for structural causes.

Aspirin family medications (including ibuprofen) are not very effective for most Fibromyalgia and Myofascial Pain patients. I avoid Tylenol because it can markedly deplete a critical antioxidant (glutathione). Helpful natural treatments include the “End Pain” formula, an herbal remedy that includes Boswellia, Willow bark, and cherry. This combination can be more effective than Celebrex and Motrin and are much safer. I recommend 1-4 tablets three times a day. Although some effect can be seen immediately, improvement continues to build over six months. At that time, the dose can be lowered . The medications I find to be most helpful for myofascial pain include Celebrex (celecoxib) and Skelaxin (which are not sedating) and Neurontin, Baclofen, Zanaflex, and Ultram which can be sedating. Lidocaine patches and creams creating a mixture of medications can also be highly effective for local areas of pain without significant side effects. There are many other medications and other effective ways to treat pain as well. These can be used to help keep you comfortable while we go after the pain’s underlying causes.

How do I go about getting well?

My best-selling book “From Fatigued to Fantastic” has been dramatically updated, It will supply you and your physician with all the information that you need to get treated effectively. It also contains the full text of our, double blind, placebo-controlled study which proves that effective pain treatment is now available.

Because determining which treatments are needed by any given individual and then teaching them how to use them can be very difficult and time consuming (even for doctors that are very skilled in treating these syndromes — a new patient visit in my office usually takes at least four hours of my “one on one” time), I’ve created a sophisticated computer program on my website (www.endfatigue.com) that is like a computerized CFS/Fibromyalgia specialist! It can analyze your history and lab tests to tailor a treatment protocol to your case using both natural and prescription therapies. The good thing about it being a computer program is that it has both the time and ability to guide almost everyone with these syndromes back to health!

In addition, our website also contains:
1 — copies of both of our research studies demonstrating effective treatment for these illnesses. The first one, published in 1995, was an open (not placebo-controlled) study in which over 90 percent of patients improved. The second is the placebo-controlled study I’ve discussed above. Feel free to make copies of this study for your physicians, friends, and for anybody in the news media you think might be interested.
2 — a referral list of over 700 health care professionals (with an area for patient comments) who asked to be listed. If you have (or are) a good health care provider who uses a significant part of our protocol, please encourage them to go on our site and add their name to our list. Because we do not know many of the health care professionals who asked to be on our list, please add your comments about the ones you are familiar with. This will help to let people know who are the “diamonds” versus the “lumps of coal”. I would recommend you begin with the separate list of practitioners have done my 2 day workshops for health care professionals (both physicians and non-physicians).

3–a question, answer, and comments area.
4–a section or you can vote for which of over 200 treatments helped or didn’t help. You can also see how others voted, and their comments.
5 — a shop where you can order supplements or books
6 — articles of interest, and more.

The purpose of our web site is to supply, in one place, all of the resources that you need in order to get well.

How can I get treated if I don’t have much money?
Although some of the treatments for these syndromes can be very expensive, it is often possible to do the treatment protocol in an affordable manner. The key tests that are needed include the blood count (CBC), ESR, general chemistry, free T4 level (thyroid test), vitamin B12, iron, and DHEA-S level. Although many other tests can be very helpful, one can often rely on symptoms alone to make the other treatment decisions. The following medications and supplements can be found fairly inexpensively, and will often be helpful. The vitamin powder can be adequate for basic nutritional support. Flexeril and Elavil, although more likely than some other medications to cause side effects, are inexpensive. Desyrel and Klonopin, in generic form, are also reasonably priced. These four can be very helpful for sleep, and your doctor is likely to be comfortable prescribing the first three of these. Thyroid, cortef, DHEA, and estrogen, can also be found for a fairly low price. For infections, nystatin and tetracycline are also inexpensive. Most drug companies offer medications for free to those who cannot afford them. Although many of the other treatments can often be very helpful, these inexpensive ones may be enough to help you get well.