Re: Maybe This information Would Be Helpful ???????

[Guest guest]

Krista ~

This I have taken off the FDA site, but not under implants

but under immunology/toxicology, I have highlighted a few and

pasted them here but will put the link at the bottom............:

Loveya ~ Dede Endocrine Disruption by Medical Device Materials Key words: estrogen disruption, uterotrophic assay, heat shock proteins, bisphenol A

CDRH is concerned with the potential for certain medical device materials to mimic or interfere with endogenous hormone actions. Because the hormone estrogen is a potent molecule having profound effects at remarkably low doses, assays are needed to assess the potential for harm from materials that may induce unwanted effects due to interference with normal estrogen homeostasis. OST scientists are collaborating with researchers at the Department of Biology, Washington University, on projects focused on improving the use of a key biomarker of exposure to estrogenic compounds and determining the characteristics of the estrogenic activity of bisphenol A, a plasticizer found in some medical devices.

Immunological Responses to Silicone Breast Implants

Key words: autoantibodies, silicone breast implants, immunopathology

Results from the rat model indicate that specific autoantibodies may be induced by certain biomaterials. The immune system recognizes a biomaterial-connective tissue protein association as altered-self or as foreign. OST scientists have demonstrated that medical grade silicone oil can stimulate serum autoantibodies against collagen and against DNA when this oil is injected into mammary tissues of rats. Autoantibody production against connective tissue proteins is an immune response that is consistent with reports from women with silicone breast implants. The results also demonstrated pathological changes in animals that may result from the autoimmune response and that silicone gel can migrate to distant anatomical sites or localize at the implantation site. This work has been presented at The FDA Science Forum, The American Association of Immunology, and The American Association of Biochemistry and Molecular Biology.

The implication from these findings is that leaked oil from a breast implant via leaching or with rupture might provide stimulus for the production of autoantibodies in clinical patients. Therefore, OST scientists evaluated autoantibody levels (in blinded experiments) in serum samples from 150 patients representing four groups: women with silicone implants without connective tissue disease, women with silicone implants with connective tissue disease (CTD), women with connective disease but no implants, and healthy women volunteers. Results from these experiments show in a statistically significant manner that elevated autoantibodies to collagen type I, collagen type II and anti-DNA were detected in serum of patients with CTD, CTD + silicone implants, and silicone implants without CTD.

Using two different assays, autoantibodies to connective tissue proteins (e.g., collagen) and to DNA and intranuclear proteins have been detected in women with silicone breast implants. Historically, there is a strong correlation between anti-nuclear antibodies and clinical symptoms of some autoimmune diseases. OST has documented serum immune responses in these patients with the goal of enhancing the ability to predict the likelihood of immunotoxic symptoms occurring in the presence of implants, including breast prostheses. This work has been presented to the Institute of Medicine.

Particulate Effects on Immunologic Function

Key words: particles, cytokines, wear and degradation, macrophages, standards, research

Wear and corrosion of implanted medical devices, such as dental and orthopedic prostheses,( I wonder why they left out breast implant?)may produce particulate debris which may lead to acute and chronic inflammatory responses in the host

In the in vitro assay, murine macrophage cells were exposed to particles or chemicals with and without bacterial lipopolysaccharide (LPS), which is a component of bacterial cell walls that mimics bacterial infections. The cells were then evaluated for cytotoxicity, production of nitric oxide (NO), tumor necrosis factor-alpha (TNF-a ) and interleukin-6 (IL-6), both inflammatory cytokines. NO is induced by LPS and is critically important in eradicating microorganisms associated with infections, but it can also be harmful by causing tissue injury and vascular collapse. OST studies showed that minute amounts of LPS, which could be associated with a bacterial infection at the site of an implanted device, induced a significant amount of TNF-a , IL-6 and NO production by macrophages

http://www.fda.gov/cdrh/ost/reports/fy98/IMMUNOTOX.HTMCheck out AOL Money Finance's list of the hottest products and top money wasters of 2007.

[Guest guest]

Very interesting, article Rogene. I didn't have a chance to read the

whole thing yet, but the first part caught my attention about how

under-active adrenals can lead to high levels of interferon which

leads to achiness, fatigue and brain fog (my 3 biggest symptoms.)

Anyone else know much about this?

Makes me think I really need to have my adrenals checked!

~Krista

>

> From Fatigued to Fantastic Newsletter

> Vol. 3, No. 3 (2000)--Vol 4, No. 1 (2001)

>

> Fighting Those Persistent Infections in CFIDS

> By Teitelbaum, M.D.

> Medical science has known for quite some time that Chronic Fatigue

Syndrome is associated with changes in the body's immune system. In

fact, the acronym " CFIDS " stands for " Chronic Fatigue And Immune

Dysfunction Syndrome. " This can result in your having several

different and unusual infections at one time. Many of these

infections need to be treated directly. Other infections will go away

on their own as your immune (defense) system comes back " on line " by

using our treatment protocol. In this article, I'll discuss some of

the more common, yet not usually thought of (in " regular " medicine),

infections.

> What Kind Of Infections Am I Most At Risk For?

> Although CFIDS of sudden onset often seems to be triggered by viral

infections (e.g., EBV, HHV-6, CMV), those infections, I suspect,

are " simmering " or no longer active in many cases. However, the body

acts as if they are. This may result in elevated interferon levels. I

suspect this was what triggered my CFIDS.

> The body produces interferon to fight viral infections. When a

cancer or hepatitis patient is injected with interferon, the patient

becomes achy, fatigued and brain-fogged. An under-active adrenal can

also cause interferon levels to become elevated. Because of this

elevation, it is more accurate to say that the body's immune system

is not functioning properly, than to say that it is underactive.

Indeed, in many ways, the immune system may be in overdrive and soon

exhaust itself. The immune system malfunctions in many other ways,

too, including decreasing the effectiveness of the body's " natural

killer " cells, which are an important defense mechanism.

> Many other recurrent or unusual infections can also occur because

of your malfunctioning immune system. Chronic sinus, bladder,

prostate and respiratory infections are common and are often treated

with repeated courses of antibiotics. The large amount of antibiotics

introduced into the system can cause a secondary yeast over-growth as

it changes the natural balance between the bowel's healthy bacteria

and yeast. The original immune dysfunction also contributes to the

yeast overgrowth. Although it is controversial, a theory held by many

physicians is that chronic overgrowth of yeast due to overuse of

antibiotics is a potential and strong trigger for chronic fatigue,

fibromyalgia and further immune dysfunction. What makes the theory

controversial is that no definitive tests exist to distinguish fungal

overgrowth from normal fungal levels. Also, many of the symptoms

ascribed to yeast overgrowth can also come from the many other

problems present in chronic fatigue syndrome and fibromya

> lgia. On the other hand, most doctors who try treating yeast in at

least three or four CFS patients see how well it works and keep using

it.

> CFIDS patients also frequently have bowel parasite infections.

Bowel parasites can cause severe allergic or sensitivity reactions,

which in turn can trigger fibromyalgia and fatigue. Often, a patient

will finally recover from long-standing and disabling fatigue within

a week or two after beginning treatment for bowel parasites.

> Many other CFS/FMS patients are left with disabling fatigue after a

bout with viral infections such as polio, HHV-6, CMV, or EB viral

infections. This fatigue also usually responds to the treatments

discussed in this newsletter. In addition, infections with unusual

organisms such as Rickettsia (e.g., Lymes Disease), chlamydia, and

mycoplasma may also be problematic.

> Yeast Overgrowth

> Everyone's immune system has strong spots, as well as weak spots.

Some people never get colds but have frequent bouts with athlete's

foot or other skin fungal infections. Others never get fungal

infections but tend to get colds. Many people seem to have a

diminished ability to fight off fungal infections.

> Fungi are very complex organisms. Fungal overgrowth may suppress

the body's immune system. The host body may also develop allergic

reactions to components of the yeast.

> This allergic reaction was suggested in a study which connects

Candida Albicans with Allergic Skin Dermatitis (Eczema). This study

was published in The Journal of Clinical Experimental Allergy back in

1993 (Vol. 23, pp. 332-339). It found that there is a significant

correlation between the body having antibodies to Candida and

Allergic Dermatitis/Eczema. In addition, we have found that

unexplained rashes that have lasted for many years often clear up

with antifungal treatment as well! Many physicians feel that yeast

overgrowth causes a generalized suppression of the immune system. In

other words, once the yeast gets the upper hand, it sets up a cycle

that further suppresses your body's defenses. Interestingly, a recent

Mayo Clinic study showed that most cases of chronic sinusitis seem to

be associated with a reaction to yeast in the sinuses - something I

proposed years ago. None the less, as I already noted, this theory is

controversial. Yeast are normal members of our body's " zoo.

> " They live in balance with bacteria - some of which are helpful

and healthy and some of which are detrimental and unhealthy. The

problems begin when this harmonious balance shifts and the yeast

begin to overgrow.

> As noted above, many things can prompt yeast to overgrow. One of

the most common causes is frequent antibiotic use. When the good

bacteria in the bowel are killed off by antibiotics (along with the

bad bacteria) the yeast no longer have competition and begin to

overgrow. The body is often able to rebalance itself after one or

several courses of antibiotics, but after repeated or long-term

courses - and especially if the body has an underlying immune

dysfunction - the yeast can get the upper hand.

> Other factors are also important. Studies have shown that animals

who are sleep deprived and/or have increased sugar intake develop

bowel yeast overgrowth. Many physicians feel that eating sugar

stimulates yeast overgrowth in people, as well. Sugar is food for

yeast. Yeast ferment sugar in order to grow and multiply. Yeast

overgrowth due to sugar overuse also seems to cause immune

suppression, which facilitates bacterial infections, which then

requires even more antibiotic use. Poor sleep also results in marked

suppression of your immune function.

> How Does One Know If They Have Yeast?

> There are no definitive tests for yeast overgrowth that will

distinguish yeast overgrowth from normal yeast growth in the body.

There is one test which may be useful, though. This is a Urine

Tartaric Acid test done by The Great Plains Lab in Kansas City,

Missouri, run by Shaw, Ph.D. Tartaric Acid is a waste product

of yeast growth. In fermenting wine, for example, it is critical to

remove the Tartaric Acid. Otherwise, the wine could be toxic to

people. Dr. Shaw has found elevations in Urine Tartaric Acid that

decrease with antifungal treatment in both CFIDS/FMS patients and

autistic children. Interestingly, both these illnesses often improve

with antifungals (specifically, Sporanox or Diflucan, plus Nystatin).

Dr. Shaw likes to use the Urine Tartaric Acid to decide when to treat

yeast overgrowth and to follow-up the effectiveness of treatment.

> In my experience, however, using Dr. Crook's Yeast Questionnaire

(available in my book, From Fatigued To Fantastic!) is still the most

reliable way to tell if a person is at risk of yeast overgrowth. If

the symptom score is over 140 points, I recommend treatment. In

addition, anyone who has been on recurrent or long-term antibiotic

use (especially Tetracycline for acne) or anyone who intermittently

has painful sores in different parts of the mouth that last for about

ten days at a time and who has CFIDS/FMS, should be treated with

antifungals. Bowel symptoms are some of the more overt symptoms that

are caused by yeast and I feel that most people who have " spastic

colon " have yeast overgrowth or parasites.

> How Is Yeast Treated?

> A number of very effective methods can be utilized to take care of

a yeast problem. Primary among the methods is to avoid sugar and

other sweets. One can enjoy one or two pieces of fruit a day, but

should not consume concentrated sugars such as juices, corn syrup,

jellies, pastry, candy or honey. Stay far away from soft drinks,

which have ten to twelve teaspoons of sugar in every twelve ounces.

This amount of sugar has been shown to markedly suppress immune

function for several hours. Be pre-pared to have withdrawal symptoms

for about one week when sugar is cut out of the diet. Several

excellent books have been written on the yeast controversy and offer

additional methods to try. One of the best books is The Yeast

Connection and the Woman by Crook, M.D., a physician who has

done a spectacular job advancing the understanding of CFIDS/FMS.

> Many patients have found that acidophilus (that is, milk bacteria,

a healthy bacteria for the bowel) helps restore balance in the bowel.

Acidophilus is found in yogurt with live and active yogurt cultures.

Indeed, one cup of yogurt a day can markedly diminish the frequency

of recurrent vaginal yeast infections. Acidophilus is also available

in capsule form. Although many claims are made for one type of

acidophilus being better than the other, I'm not sure this is so. I

usually recommend 3 to 6 billion units a day (1 unit = 1 bacteria) on

an empty stomach. If on antibiotics (not antifungals), take the

acidophilus at least 3 to 6 hours away from the antibiotic dose.

> Nystatin, an antifungal medication, has also been helpful in the

treatment of yeast overgrowth. Unfortunately, some fungi seem to be

resistant to Nystatin. In addition, Nystatin is poorly absorbed,

which means that it has little impact on the yeast outside of the

bowel. Other anti-fungal medications, such as Diflucan and Sporanox,

seem to be effective systemically (throughout the body) but they have

two main drawbacks. First, they are expensive, costing more than $450

to $900 for a two-month course. Second, any effective anti-fungal can

initially make the symptoms of yeast infection worse. Although

uncommon, Sporanox and Diflucan can also cause liver inflammation (as

can Advil and Tylenol). If you are taking Sporanox or Diflucan for

more than 6 to 12 weeks, I would consider intermittently checking

liver blood tests (ALT and AST). If you have preexisting active liver

disease, be cautious in using (or don't use) Sporanox or Diflucan. I

strongly recommend taking Lipoic Acid (a natural

> supplement which protects and helps heal the liver), 200mg a day,

whenever you take Sporanox or Diflucan. I also strongly recommend

Lipoic Acid for anyone with active liver disease (e.g., hepatitis) at

doses up to 1000mg to 3000mg a day as it may prevent and/or treat

cirrhosis.

> Natural Yeast Treatments

> Below, I have summarized the nonprescription part of the treatment

checklist that I use in my office.

> 1. Avoiding sweets is still the single most important thing. Using

Stevia as a sweetener is a wonderful substitute. Stevia is a safe,

natural remedy and you can use all you want. There are even cookbooks

for using Stevia (available from my office or 800-4STEVIA). A new

natural sweetner, Sweet Balance, also tastes good and is 12 times as

sweet as sugar. It is a natural product from the Lo Han fruit and

appears to be safe. Although it is 70% sugar (fructose), you only

need a small amount. Order it from 877-997-9338, my office at 800-333-

5287 or my Web site at www.endfatigue.com.

> 2. Acidophilus or Milk Bacteria can be very helpful. Take 3 to 6

billion units a day (a unit is the same as a bacteria). Do not take

acidophilus within 3 to 6 hours of an antibiotic. Take it either on

an empty stomach or with milk.

> 3. Caprylic Acid is another natural remedy that can be helpful. The

usual dose is 1800 to 3600mg a day with 1/3 of the dose being taken

at each meal. Unfortunately, it often causes an acid stomach with

a " funky " tasting reflux.

> 4. Oregano Oil - enteric coated oregano oil - 1 to 2 capsules, 2 to

3 times a day with food, may be more effective and better tolerated

than Caprylic Acid (both can cause stomach acid reflux).

> 5. Fresh Garlic, if you can handle it well, can also be very

effective. Daily, crush 1 to 3 garlic cloves in olive oil, add salt,

spread it on bread and eat it. It can be quite tasty and lethal to

whatever infections you have in your gut.

> 6. Olive Leaf 500mg, 2 to 4 capsules three times a day between

meals, can also be very helpful in treating yeast overgrowth.

> 7. Pau De Arco in either tea or capsule form is also helpful in

yeast suppression. Although I use Pau De Arco infrequently for yeast

over-growth, many people find that it can be helpful.

> 8. Grapefruit Seed Extract (e.g., Citrucidel) is a popular

treatment for yeast overgrowth and is well-tolerated.

> More Information On Yeast Treatments

> If symptoms of yeast are caused by an allergic or sensitivity

reaction to the yeast body parts, the symptoms may flare when mass

quantities of the yeast are suddenly killed off. This is called a

yeast " die-off " reaction. If you get this reaction, start your

treatment with acidophilus and a sugar-free diet for a few weeks

followed by oregano oil and/or olive leaf (1500mg to 2000mg, 3 times

a day between meals) before beginning Nystatin. Take Nystatin (by

mouth) in the form of 500,000-IU tablets or powder. I generally

recommend beginning with 1 tablet a day for 1 to 3 days, and

increasing by 1 tablet every 1 to 3 days (or slower if yeast " die-

off " is a problem) until 2 tablets 2 to 4 times a day is reached. If

you get nausea, take a lower dose. Take Nystatin, 4 to 8 tablets

daily, for 5 to 8 months. I add the Diflucan or Sporanox one month

after beginning the Nystatin. Take 200mg every morning for six weeks.

If symptoms flare, take just 100mg per morning for the first 3 to 14

days. I

> f symptoms recur after stopping the Diflucan or Sporanox, I

recommend continuing the medication for an additional 6 weeks at

200mg a day.

> Sporanox should be taken with food. If it is taken alone, its

absorption is greatly reduced. When taking Diflucan or Sporanox, DO

NOT use the antihistamines Seldane or Hismanal, Quinidine (a heart

medicine), cholesterol-lowering medications in the Mevacor family, or

the bowel medicine Propulcid. These can be fatal combinations! Also,

antacid medications (such as Tagamet, Axid, Zantac, and Pepcid)

prevent the proper absorption of Sporanox. At the high price of

Sporanox per dose, you will want to absorb every last bit of the

medication. If you need to be on an antacid medication, use Diflucan

instead of Sporanox. Unfortunately, a less expensive antifungal,

called Lamisil (at 250mg a day), does not seem to work very well for

candida yeast overgrowth (although it works well for nail

infections). I am currently trying patients on 500mg of Lamisil a day

to see if this dose works better.

> I feel that once the yeast has been effectively decreased and kept

that way for six to twelve months, it is safe to try to add small

amounts of sugar back into the diet. If symptoms recur, however, stop

the sugar again. Continuing to eat yogurt with live and active

acidophilus cultures (unless you are lactose-intolerant) or

continuing to take acidophilus capsules may also help.

> Many books on yeast overgrowth (including Dr. Crook's) advise

readers to avoid all yeast in the diet. This advice is based on the

theory that an allergic reaction to yeast is the cause of the

problem. The predominant yeast that seems to be involved in yeast

overgrowth is Candida Albicans, although I would not be surprised if

researchers discovered that many other kinds of fungal infections are

also involved. The yeast that is found in most foods (except beer and

cheese) is not closely related to candida.

> In my experience, trying to avoid all yeast in foods results simply

in a nutritionally inadequate diet and little benefit. Although a few

people do appear to have true allergies to the yeast in their food,

they number less than 10 percent of my patients with suspected yeast

overgrowth. These patients may benefit from the more strict diet in

Dr. Crook's book. Interestingly, once their adrenal insufficiency and

yeast overgrowth are treated, most people find that their allergies

and sensitivities to yeast and other food products seem to improve or

disappear.

> Nutritional deficiencies such as low zinc or low selenium may also

decrease resistance to yeast over-growth. A good multivitamin

supplement, as recommended in my last newsletter, should take care of

these deficiencies. This is further evidence that all the factors

involved in CFS are closely interrelated.

> The best thing that one can do to combat yeast overgrowth is to try

to avoid it in the first place. When you get an infection, begin

treating it naturally immediately. Hopefully, you can prevent it from

turning into a bacterial infection which might require an antibiotic.

Ask your doctor what measures you can take before resorting to

antibiotics. Many good over-the-counter remedies are available. A

knowledgeable pharmacist may also be a wealth of information. Your

local book or health food store has books on natural measures. Your

health food store proprietor can also steer you to appropriate

natural remedies. For examples of the many helpful measures that one

can take, see my newsletter article, Treating Infections Without

Antibiotics, page ___).

> If you find however, that you must take an antibiotic, all is not

lost. One can still lessen the severity of yeast overgrowth by

avoiding sweets and by either taking acidophilus capsules (again, not

within 3 to 6 hours of an antibiotic) or by eating one cup of yogurt

with live and active acidophilus cultures daily. Don't use the yogurt

(or milk) if you have sinusitis or pneumonia because the milk protein

thickens mucus and makes it hard for the body to fight these

infections.

> How Can One Tell If The Yeast Is Coming Back?

> It is normal for yeast symptoms to resolve after treatment. After 6

weeks on the Sporanox or Diflucan, patients are usually feeling a lot

better, but may have symptoms recur soon after stopping the

antifungal. In this case I would continue the Sporanox or Diflucan

for another 6 weeks, or as long as is needed, to keep the symptoms at

bay. More frequently, people will feel better after treatment and

stay feeling fairly well for a period of 6 to 24 months. At that

time, it is common to see a recurrence of symptoms, especially if one

is eating too much sugar or is taking antibiotics. The best marker

that I have found for yeast overgrowth would be a return of bowel

symptoms with gas, bloating and/or diarrhea or constipation. If these

symptoms persist for more than 2 weeks, especially if there is also

even a mild worsening of the FMS symptoms, it is very reasonable to

retreat yourself with 6 weeks of Nystatin and perhaps Sporanox or

Diflucan. In addition, I would also retreat if there's

> a recurrence of vaginal yeast or sinus infections. If re-treatment

resolves the symptoms, one may opt to repeat this regimen as often as

is needed (usually every 6 to 24 months). By using some of the

natural remedies listed above, however, you may be able to avoid

repeated use of these antifungals and the possible risk of becoming

resistant to them. Some patients also find that they need to stay on

the antifungals for extended periods of time (years) or the symptoms

will recur. When this is necessary, I add the natural remedies. I

will, however, also use the medications when needed. The main risk of

long-term use of the antifungals Sporanox and Diflucan would be liver

inflammation. If these medications are being used for extended

periods, consider checking liver tests (SGOT and SGPT) every 3 to 6

months and anytime that a severe flu-like feeling or worsening of

symptoms occur. As noted above, it is very important to take Lipoic

Acid 200mg a day when on Sporanox or Diflucan. Althoug

> h I am not aware of any studies using Lipoic Acid with antifungals,

in my experience I have seen no worrisome elevation on liver tests if

patients are using this natural substance while taking these

antifungals. As an alternative, instead of taking the antifungals

every day, many people find they can get long-term suppression of the

yeast by taking Sporanox or Diflucan 200mg twice a day, one day each

week (e.g., each Sunday).

> Help For Chronic Bladder Infections

> Although we will be discussing some unusual infections, CFIDS/FMS

patients also get more of the day-to-day variety of infections. These

include Urinary Tract (bladder) Infections (UTI). The main symptoms

of a UTI are discomfort (e.g., burning) when urinating (dysuria),

urgency (which is the feeling that you have to go very badly and

right away when there is not much urine there), and frequency with

low volume. These symptoms are also common in CFIDS/FMS patients in

the absence of bladder infections and, when severe, is called

Interstitial Cystitis. I would not label someone as having

Interstitial Cystitis unless this is the major symptom of their

CFIDS/FMS, because almost everyone with this illness has some urinary

urgency and frequency. Because bladder symptoms can be seen in both

UTI and CFIDS/FMS, it is important to have a urine culture done

before treatment with antibiotics to make sure that there is an

infection and not just muscle spasms in the bladder that are causing

these

> symptoms. If there is an infection, over 90% of the time it will be

E-coli. This bacteria is normally found in everyone's gut and, with

the exception of a few rare dangerous forms, is a healthy part of our

normal bowel bacteria. The problem occurs when the E-coli gets out of

the bowel where it belongs and into the bladder. Usually the bladder

will wash out most infections when the urine comes out. The E-coli

however, have little velcro-like projections that stick to the

bladder wall so that they can not be washed out by urination.

> Taking antibiotics will kill a bladder infection but will also kill

the healthy bacteria in the bowel. This sets one up for yeast

overgrowth and other problems. Because of this, unless there is fever

or back pain over the kidneys or a toxic feeling, it is reasonable to

try natural remedies for one to three days before going with the

antibiotics. One can start these treatments while waiting for the

urine culture to come back.

> What Natural Remedies Can Be Used For Bladder Infections?

> There are two excellent natural remedies that can keep the E-coli

from sticking to the bladder walls so they can be washed out. In

addition, taking vitamin C in high dose (e.g., 500 to 5000mg a day)

can acidify the urine, making it inhospitable to the bacteria.

Drinking a lot of water also helps to wash out the infection.

> The two natural remedies that keep the bacteria from sticking are:

> 1. Cranberries—Because approximately 20% of the female population

suffers from UTIs, several studies have been done looking at this

remedy. An early study of 44 female and 16 male patients with acute

bladder infections drank 16 oz. of cranberry juice a day for 15 days.

Of these patients, 53% had positive responses and another 20% showed

modest improvement. Six weeks after stopping the juice, 27 patients

did have persistent recurrent infections and 8 of these had no

symptoms. Seventeen patients had no symptoms and negative urine

cultures.

> In another study of elderly women (who are more likely to have

bladder infections), 153 women either received 10 oz. of cranberry

drink or placebo every day for 6 months. The group that got the

cranberry drink had 68% fewer bladder infections during that period.

In this study, the juice was sweetened with saccharin instead of

sugar. Other studies have also shown benefit using cranberry juice in

bladder infections.

> Significant benefits are achieved by using 6 to 16 oz. of cranberry

juice a day. Because cranberry juice has a lot of sugar and can

promote yeast overgrowth and aggravate other symptoms in CFIDS/FMS, I

think it is much better to use pure cranberry juice powder in capsule

or tablet form (standardized to contain 11% to 12% quinic acid). The

therapeutic dose is 1 to 2 capsules a day. Conversely, you can use

unsweetened cranberry juice and add Stevia as a natural sweetener. In

general, if one gives the usual cranberry juice cocktails a strength

of 1 unit - then, cranberry juice drinks have a strength of ½;

cranberry sauce a strength of ½; fresh or frozen cranberries are 4

times as potent; pure cranberry juice is 4 times as potent; and

cranberry juice capsules from unsweetened cranberry juice powders are

32 times as potent.

> Cranberries work to help bladder infections because they have a

chemical (proanthocyanidins) that prevents the bacteria from sticking

to the bladder wall. They may also decrease the risk of kidney stones

(although magnesium with B6 is much better for this), as well as

possibly reduce urine odor.

> D-Mannose - This is more effective than cranberry juice. Mannose is

a natural sugar (not the kind that causes symptoms or yeast

overgrowth) that is excreted promptly into the urine. Unfortunately

for the E-coli bacteria, the fingers that stick to the bladder wall

stick to the D-Mannose even better. When one takes a large amount of

D-Mannose, it spills into the urine, coating all the E-coli's

little " sticky fingers " so that the E-coli are literally washed away

with the next urination. The nice thing about the natural approach,

as opposed to antibiotics, is that the cranberries or D-Mannose will

not kill the healthy bacteria, thereby not bothering the normal

balance of bacteria in the bowel. In addition, the D-Mannose is

absorbed in the upper gut before it gets to the friendly E-coli that

are normally present in the colon. Because of this, it helps clear

the bladder without causing any other problems. In addition, the D-

Mannose even tastes good.

> The D-Mannose is quite safe, even for long-term use, although most

people will only need it for a few days. Those who have frequent

recurrent bladder infections may, however, choose to take it every

day. The usual dose of D- Mannose is 1/2 teaspoon every 2 to 3 hours,

while awake, to treat an acute bladder infection; and 1/4 to 1/2

teaspoon 3 to 4 times a day to prevent severe chronic bladder

infections. It is best taken dissolved in water. For those who get

bladder infections associated with sexual intercourse, one can take

1/2 teaspoon of D-Mannose 1 hour before and then just after

intercourse to prevent an infection. Remember, though, the D-Mannose

(and cranberries) only work in the 90% of bladder infections caused

by E-coli bacteria. D-Mannose is available from several sources:

> 1. The Tahoma Clinic Dispensary (253-850-5661), which is associated

with the well-known nutritional physician, V. , M.D.

> 2. The Biotech Company (800-345-1199).

> 3. My office (800-333-5287) or my Web site at www.endfatigue.com.

> The usual cost of D-Mannose is approximately $60 for 100 grams and

$35 for 50 grams. A 1/2 teaspoon is approximately 2 grams. One should

feel much better within 24 to 48 hours on D-Mannose. If not, see a

doctor for a urine culture (you may want to get the culture at the

first sign of infection) and consider antibiotic treatment after two

days if the culture is positive. Some evidence exists that

Macrodantin causes less yeast over-growth than do other antibiotics.

Even with other antibiotics, most bladder infections are knocked out

by one to three days of antibiotic use (instead of the old seven-day

regimen).

> Prostatitis

> Although women tend to be the ones plagued with bladder infections,

men don't get off unscathed either. It is very common in men with

CFIDS/FMS to have Prostatitis. Prostatitis is an inflammation or

infection of the prostate which is usually seen in younger men

between the ages of 20 and 50. It falls into three main categories:

> 1. " Bacterial " Prostatitis is a acute or chronic infection in the

gland that causes prostate swelling and discomfort.

> 2. Nonbacterial Prostatitis is when you feel swelling of the

prostate without being able to detect an infection. My suspicion is

that it is not uncommon for prostatitis to be associated with yeast

overgrowth or other infections that cannot be cultured (tested for).

> 3. Prostadynia is a general irritation of the prostate which causes

urinary burning, urgency and frequency but without there being any

infection or swelling of the prostate. This can come from a number of

causes including, I suspect, chronic spasm or tightening of the

muscles of the pelvic floor.

> The symptoms of chronic Prostatitis can come and go and be mild or

severe. The symptoms include:

> 1. Pain or tenderness in the area of the prostate. It is also

common to have burning on the tip of the penis.

> 2. Discomfort in the groin and, occasionally, lower back pain.

> 3. Urinary urgency and frequency with pain on urination.

> 4. Sometimes a slight penis discharge. If the discharge is cloudy

and larger than one drop, or even a large drop, it is most likely a

bacterial Prostatitis and I would then prescribe antibiotics. If a

discharge is present, I would also check to make sure that there is

not also a sexually transmitted disease (such as Chlamydia or

Gonorrhea) before beginning treatment.

> 5. Pain with ejaculation.

> If severe symptoms with fevers, chills and extreme fatigue are

present (symptoms of acute Prostatitis), antibiotics should be used.

The main treatment for bacterial Prostatitis consists of using the

antibiotics Tetracycline (e.g., Doxycycline), Cipro, or Sulfa

(Bactrim or Septra DS). Unfortunately, since it is hard for the

antibiotics to be absorbed into the prostate, the symptoms often

recur even after six weeks of treatment. If antibiotics are required,

use Doxycycline or Cipro because these may be effective against other

hidden infections that can cause CFIDS/FMS.

> Although there are a number of causes of Prostatitis, excess

caffeine, alcohol and spicy foods can also contribute to the

symptoms. Sitting for long periods while traveling (e.g., being a

truck driver) can also cause irritation of the prostate. Although

normal bacteria are common causes, a few bacteria transmitted through

sexual contact can also cause Prostatitis. Some feel that the main

psychological component of Prostatitis is shame.

> Bowel Parasite Infections

> A while back, the news focused our attention on Milwaukee because

of repeated fatal outbreaks of an infection by a bowel parasite

called Cryptosporidium. A cartoon even made the rounds showing

Mexican tourists being warned not to drink the water in Milwaukee!

Although this infection usually resolves on its own within a week or

two, it may persist in those with immune suppression. In fact, people

with acquired immune deficiency syndrome (AIDS) are particularly

susceptible and scores of Milwaukeens died from the Cryptosporidium

outbreaks.

> Unfortunately, in many places throughout the United States, the

water supply is contaminated, and parasites are no longer just a

Third World problem. Doctors frequently see cases of infection by

giardia, amoeba and numerous other bowel parasites. Parasitic

infections can mimic CFS and, in immune suppressed situations like

CFS, all parasites should be treated.

> Most laboratories miss the parasites when they do stool testing. I

initially tested for bowel parasites by sending my patients' stool

samples to a respected local lab. The tests kept coming back

negative, so I eventually stopped testing. Finally, I started doing

my own laboratory stool testing. Doing the test properly was very

time consuming, taking up to five hours per specimen. However,

processing it properly, my tests frequently turned out positive. In

my experience - and in that of other physicians as well - when you

treat a patient for parasites, the patient's fatigue and achiness

often improves dramatically.

> If you would like your stool tested, make sure that the lab

specializes in stool testing and that the sample is a purged

specimen. A purged stool specimen is watery and loose, brought about

by the use of one-and-a-half ounces of Fleet's Phospho-Soda (a

laxative). The purpose of the stool purge is to get the best possible

stool sample to check for bowel parasites and yeast. The laxative

washes the organisms off the walls of the intestines so that they can

be detected. The routine random tests performed in almost all

standard labs are generally not adequate or reliable. In speaking

with several lab technicians, I was told they had less than one hour

of training in looking for parasites—which they found to be useless.

In fact, during one of our " doctors' " poker games, I spoke with a

gastroenterologist friend who noted that during a certain bowel exam

he had performed, he saw a large number of parasites swimming in the

patient's large bowel. He removed a big glob consisting of nothing

> but mucus and parasites and sent it off to the major local

laboratory, just for confirmation of the infection and identification

of the parasite. Even this sample came back negative for parasites!

This is why I stress that stool testing must be done at a lab that

specializes in parasitology. Because two excellent labs are now

available to me to mail specimens to, I no longer have to do the

testing in my office. These labs are The Parasitology Center, Inc.

(480-777-1078) and The Great Smokies Diagnostic Laboratory (800-522-

4762).

> At this point, no consistently effective prescription medication is

available for Cryptosporidium infections. Artemisia annua, however,

is an effective herbal treatment. For most of my patients, I

recommend using 1,000 milligrams three times a day for twenty days.

Leo Galland, M.D., a parasite specialist, recommends a form of

Artemisia called tricyclin for many parasitic infections. He

recommends taking 2 tablets, 3 times a day after meals for six to

eight weeks. The cost of this antiparasitic herbal preparation is

about $30 for fifty tablets. See the treatment protocol below for

regimens for some other parasitic infections. The doctor who runs The

Parasitology Center also has a review article discussing which

natural remedies are effective against each type of parasite. Common

parasite treatment regimens also used in our office are on the

treatment checklist below.

> Antiparasitic Treatments

> 1. Flagyl (Metronidazole) – 750 mg, 3 times a day for 10 days,

followed by Yodoxin for many parasites. For Clostridium Difficile

take 250 mg, 4 times a day, or 500 mg, 3 times a day. It may cause

nausea and vomiting (uncomfortable but usually not worrisome). Do not

drink alcohol while on this medication as it will make you vomit. The

SR (sustained release) form is easier on the stomach (as is the brand-

name form). If you get numbness or tingling in your fingers (or it

worsens if you usually have it) stop the Flagyl.

> 2. Yodoxin (Iodoquinol) – 650 mg, 3 times a day, for 20 days after

Flagyl is completed.

> 3. Tinidazole – 2000 mg, once daily, for 3 consecutive days with

food (for Entamoeba Histolytica) – OR - 3 doses, each 2 weeks apart

(for Giardia or Dientamoeba Fragilis); Available at 's Pharmacy

(800-480-3432).

> 4. Humatin (Paromomycin) – 500 mg, 3 times a day, for 10 days (for

Cryptosporidium). For Blastocystis add Yodoxin.

> 5. Zithromax – 250 mg, once a day on an empty stomach for 10 days,

along with Bactrim, 1 tablet twice a day for 10 days (alternate

treatment for Cryptosporidium). Add Artemesia.

> 6. Bactrim DS - 1 tablet, twice a day, plus Yodoxin 650 mg, 3 times

a day with food for 10 days. Do not take Folic acid supplements

(e.g., B Complex or multivitamins) during these 10 days (for

Blastocystis).

> 7. Amphotericin B – 100 mg, two times a day, plus Tinidazole 500

mg, twice a day, plus Furoxone (Furazolidone) 1 tablet, twice a day.

Take these three together with food for 5 to 7 days (Amphotericin B

and Tinidazole are available from 's Pharmacy 800-480-3432)

(treatment for refractory Blastocystis).

> 8. Lactoferrin – 350 mg, 1 to 3 capsules at bedtime.

> 9. Multi-pure Water Filter - Most other filters (except for reverse

osmosis) are ineffective. (Available from Bren son, 410-224-

4877).

> 10. Artemesia Annua (a herbal antiparasitic) – 500 mg, 2 tablets, 3

times a day for 20 days.

> 11. Tricyclin (a herbal antiparasitic) - 2 tablets, 3 times a day,

after meals for 6 to 8 weeks (concentrated Artemesia).

> 12. Colostrum (mother's milk) - 3 capsules, 3 times a day, for 8 to

12 weeks. Then stop or use the lowest dose needed for symptoms. If

nausea or indigestion occurs, lower the dose to a comfortable level

for 1 to 2 weeks until it passes. Take on an empty stomach.

> 13. Quinacrine – 100 mg a day for 5 days. May be useful for empiric

therapy of suspected but not identified parasites (controversial).

> 14. Albendazole – 400 mg a day for 5 days. May be useful for

empiric therapy of suspected but not identified parasites.

> Filter Your Water

> Water filters can be very helpful in the fight against parasitic

infection. However, not all units are designed to filter out

parasites. For a water filter to remove parasites, it must have a

submicron solid carbon block filter. A good example is the Multi-pure

Filter. Check the Consumer's Digest and Consumer's Report for other

good units. Multi-pure Filters are available from Bren son at

888-801-8176 or 410-224-4877. He is a very reputable and

knowledgeable person and does not believe in " high pressure sales "

(again, I get no money from people or companies whose products I

recommend).

> When shopping around for a water filter, request the National

Sanitation Foundation (NSF) International Listing for the specific

unit you are considering. NSF is an independent not-for-profit

organization that tests and certifies drinking water treatment

products. The unit you buy should meet both NSF Health Effects

Standard 53 and NSF Aesthetics Standard 42, with Class I reduction of

chlorine and particulate matter. Any unit that does not meet both of

these standards, particularly the health standard, is not adequate.

To verify that a unit does meet these standards, call the NSF at 313-

769–8010.

> In addition to verifying that a water filter meets the NSF

standards, ask to see its Product Performance Data Sheet. Many states

require that this sheet be given to all prospective customers of

drinking water treatment devices.

> Ask about the range of contaminants that the unit can reduce under

NSF Health Effects Standard 53. Most units certified under Standard

53 list only turbidity and cyst reduction. The number of units that

also reduce pesticides, trihalomethanes, lead, and volatile organic

chemicals is very small. Make sure that the water filter you are

considering can remove the specific contaminants that concern you.

> Ask if the unit is licensed in such states as California, Colorado

and Wisconsin. These states have some of the toughest certification

procedures in the United States.

> Finally, ask about the unit's service cycle, which is stated in

gallons of water treated. Find out how often you will need to change

the filter and what the replacement filters cost.

> As the American water supply becomes more contaminated, parasitic

bowel infections will likely become more common. These infections, as

well as the overgrowth of yeast or toxic bacteria caused by

antibiotic use, contribute to feeling poorly.

> The Role Of Other Infections In CFIDS/FMS

> Many infections have been found in CFIDS. That people may have not

just one, but several of these simultaneously is significant. It

suggests that although these infections may be a trigger, in most

patients the immune system is suppressed and therefore they become a

setup for unusual infections that persist. These infections may

then " drag you down, " further suppressing your immune system.

> Fortunately, most people improve (and often get very healthy) by

simply treating the sleep, hormonal, nutritional and yeast problems.

Once these areas are treated, your body can usually eliminate any

persistent infections by itself. A subset, though, have infections

that need treatment with antivirals and/or antibiotics.

> How Can I Tell If I Need These Treatments?

> First, I would try the other approaches discussed in my From

Fatigued To Fantastic! book and newsletters. I would try these

treatments if symptoms persist:

> 1. Those with predominantly flu-like symptoms with debilitating

fatigue and little or no pain or fever are more likely to have an

underlying persistent viral infection (e.g., HHV-6, Epstein Barr,

CMV, etc.).

> 2. Those with fevers (i.e., anything over 98.6°F in this illness -

even 99°) and/or lung congestion, sinusitis, skin pustules or other

chronic bacterial infections seem more likely to have infections

(i.e., bacterial, Mycoplasma, or Chlamydia) that respond to special

antibiotics. Let's look at these two groups and how to approach them.

> HHV-6 And Other Viral Infections

> HHV-6 (Human Herpes Virus 6) is a virus that is related to the

Epstein Barr Virus (EB), Cytomegalovirus (CMV), and also to the

Herpes Viruses that causes cold sores and Genital Herpes. HHV-6 is

transmitted like the common cold and many people have had it, as well

as the EB Virus and the Cold Sore Virus by the time they are twenty

years old. The body usually gets rid of all of these viruses on its

own. Because of this, if you do routine (IGG) antibody testing,

almost everybody will be positive for EB and many for HHV-6 and CMV

viruses. However, the IGG test will not tell you if you have active

infections unless the IGM antibody is also positive (suggesting a new

infection). The IGM antibody is the one that increases in the first

six weeks of an infection. This is followed by an elevated IGG

antibody, which stays elevated your whole life and acts as your

body's surveillance system. All an elevated IGG means is that your

body has seen this infection and, if it sees it again, it's read

> y to knock it out quickly. This is how immunizations work. The

immunization creates the IGG antibody, so that instead of taking one

to two weeks to gear-up to fight the infection, your body can

eliminate that infection very quickly. Unfortunately, in CFIDS you

can have a chronic low-grade infection—even if your IGG antibody is

positive (elevated) - making the IGG antibody test for HHV-6, EB

Virus and CMV unreliable in CFIDS/FMS. In addition, the IGM antibody

will usually not be present in elevated levels in the low-grade

infections with these viruses that may be seen in CFIDS and FMS.

> What makes this important is that Valtrex at high-dose can

eliminate Epstein Barr virus, but will not work if active HHV-6 or

CMV infection is present. As I will discuss later, the only tests I

would rely on to diagnose active HHV-6 are " rapid cell cultures " or

PCR testing. Because some insurance companies are more likely to pay

for IGG than PCR testing, an argument can be made for checking IGG

antibodies first. If the EBV IGG is positive and HHV-6 and CMV IGG

are negative, one may choose to proceed with Valtrex 1000mg, 4 times

a day, for 6 months, without PCR testing. If the HHV-6 or CMV IGG

antibodies are positive, then check the CMV and/or HHV-6 PCR tests to

be sure they are negative.

> Tell Me More About HHV-6 And CFIDS

> Unfortunately there is no currently accepted standard treatment for

the HHV-6 Virus. Even though it is related to other Herpes viruses,

HHV-6 is resistant to Acyclovir, Valtrex, Famvir and the other

antivirals that are commonly used in Herpes infections. The only

antiviral known to be effective against HHV-6 is Ganciclovir. This

has significant side effects and has to be given intravenously and

possibly forever to maintain the antiviral effect. Unfortunately,

this is not a viable option in day-to-day life and has been only

moderately successful when used. The main doctor who has been using

Ganciclovir to treat HHV-6 in the United States is Joe Brewer, M.D.,

(816-531-1550) in Kansas City, Missouri. He found that 140 out of 207

CFIDS patients had positive HHV-6 cell cultures. Forty percent of

CFIDS patients were positive on their first test and 70% were

positive after three tests. This contrasts to 60 healthy patients he

checked in which none of the HHV-6 tests were positive. Culture

> s are more likely to be positive during acute flares of the

disease, when the viral level in the blood rises (see Page 9 for more

on HHV-6 PCR testing).

> As is often the case in CFIDS, there is conflicting data on

infections in Chronic Fatigue Syndrome. A recently published study

(Reeves WC, et al., Clin Infect Dis, 2000 July; 31 [1] pp48-52)

examined 26 patients with Chronic Fatigue Syndrome and 52 healthy

patients in Atlanta, Georgia, at the CDC. In this study, several

tests for HHV-6 and HHV-7 were done, including Polymerase Chain

Reaction (PCR). HHV-6 DNA was found in 11% of CFIDS patients and 28%

of healthy patients, suggesting that the HHV-6 was actually less

common in Chronic Fatigue Syndrome than in healthy patients. At this

time, as the conflicting data shows, although HHV-6 may be one of

many suspect infections in CFIDS, it is not yet clearly the cause of

this illness.

> When HHV-6 is present, it seems to infect the natural Killer Cells,

important cells in your body's defense (immune) system that are

critical in fighting infections. A number of studies have shown these

Killer Cells to be malfunctioning in CFIDS. HHV-6 infection does not

necessarily decrease the number of the natural Killer Cells but does

decrease their function. Natural Killer Cell function is described in

what is called Lytic Units—which means the ability of cells to lyse

or break down foreign invaders. An average person will have a Lytic

Unit level of 20 to 250 with over 80% of healthy patient being over

40 units. Dr. Brewer finds that in CFIDS the mean Natural Killer

Lytic Cell level is 12 units. Dr. Brewer uses Specialty Labs in

California for his Natural Killer Lytic Cell testing and finds that

the Lytic level stays the same on repeat testing and seems to be a

reliable test for Natural Killer Cell function testing in CFIDS.

Lytic unit levels will, however, decrease during flar

> es of symptoms. In Dr. Brewer's experience, this test is very

specific for CFIDS and Multiple Sclerosis. He has treated ten MS

patients and five CFIDS patients with the I.V. Ganciclovir. He found

that it helped to stabilize the MS patients. In the CFIDS patients,

two to three were much improved, one still had a positive viral

culture and one had a poor response. Unfortunately, maintaining

patients on I.V. Ganciclovir forever (as noted above) is not a viable

option. Fortunately, an oral pill form of Ganciclovir

(Valganciclovir) is currently being developed! It should be noted

that the HHV-6 virus is similar to CMV (Cytomegalovirus), and that

whatever is effective against one, tends to be effective for the

other. This is a helpful bit of information as we follow new research

looking for clues on how to eliminate HHV-6 infection.

> What Roles Does The Epstein Barr And Cytomegalovirus Play In CFIDS?

> Again, the roles of the EB and CMV viruses are not clear. It is not

uncommon for antibody levels of these viruses to be elevated in

Chronic Fatigue Syndrome. As noted above, it is not clear whether

this simply reflects a previous or ongoing infection with these

viruses. Research by a husband and wife team (the Glasers) at Ohio

State University, suggests that Epstein Barr Virus is still quite

active and playing a role in many patients with these infections. In

addition, work by Lerner, M.D., also suggests that EB Virus

and CMV are active as well. In speaking with Dr. Lerner's research

assistant, I found out that he has found EB Virus and CMV to both be

fairly common in patients with Chronic Fatigue Syndrome (with and

without pain). He found that about 20% had positive IGM and/or

elevated EA (early antigen) tests to the EB Virus with negative

Cytomegalovirus. Of these, two-thirds improved with high-dose Valtrex

(an oral antiviral). Despite my teasing and prodding, his associat

> e refused to give out the dose of Valtrex they prescribed because

Dr. Lerner does not want to be responsible for people using these

higher doses until he completes the double-blind trial that is

currently in progress. On the other hand, another study of his did

use 1000mg, 4 times a day, giving the antiviral for 6 months. It

takes about 3 to 4 months before patients start to improve and after

6 months people can stop the Valtrex without the symptoms coming

back. However, if there is no improvement in 6 months, consider it to

be a negative result. They also found that, as noted above, the IGM

is almost always negative using the reagents used in most labs. They

found that only Epstein Barr IGM antibody testing, using a reagent by

the Diasorin Company (800-328-1482), has been useful in showing a

significant number of positive tests. When we called the company, the

only lab in the Washington, D.C., area using it was at the NIH. The

company may, however, be able to give you the name of

> a lab near you that can do the test. What was fairly common,

though, (and present in most patients) was either positive tests for

Epstein Barr, CMV, or a combination of both as noted above. When CMV

or HHV-6 are present, the Valtrex is less likely to work because it

is not effective against these viruses.

> In another study done by Dr. Lerner (Infectious Diseases In

Clinical Practice, 1997; 6:110-117) he found that patients who had

elevated CMV IGG antibodies, but no significant evidence of

associated Epstein Barr virus (i.e., negative IGM and early antigen

(EA) antibody total less than 40), did improve with I.V. Ganciclovir

at 5mg per kg of body weight given every 12 hours I.V. for 30 days.

In this study 72% (13 of the 18 patients) improved markedly at the

end of a month without any significant side effects. As noted, an

oral form of Ganciclovir is currently in development as well. It

should be noted that 36% of the Chronic Fatigue Syndrome patients

that Dr. Lerner checked (18 out of 50) did turn out to have elevated

CMV antibodies (albeit IGG) in the absence of IGM and EA antibodies

to EB Virus (i.e., no evidence of active Epstein Barr Virus). It

should be noted, though, that 70% of healthy patients also had

positive IGGs to CMV (as per our discussion above) in the study and

appears

> that the overall level of the IGG was not much higher overall in

the Chronic Fatigue group than in the healthy controls. On the other

hand, the higher the level of CMV antibody in the Chronic Fatigue

group, the more likely they were to improve with the I.V. Ganciclovir.

> What this means is that patients with Chronic Fatigue Syndrome

don't necessarily have different blood tests for antibody levels than

healthy people for these viruses. However, if one has a higher level

rather than a lower level, one is more likely to improve with the

Ganciclovir. Previous research has not shown benefit from antiviral

therapies in CFS (Straus SE, et al., New England Journal of Medicine

1988; 319:1692-1698). Our experience using a fairly high dose of

Valtrex or Famvir (1500mg and 2250mg a day respectively) also showed

no significant improvement on these regimens after 6 weeks, at which

time we considered it to be ineffective. On the other hand, Dr.

Lerner's research is suggesting that perhaps we gave it for too short

a time and at too low a dose. When treating himself and a few other

patients, he used Valtrex by mouth at a dosage of 1000mg, 4 times a

day, for 6 months. Using the higher dosing and the extended period of

time, as well as separating out groups that have

> Epstein Barr Virus (sensitive to the oral Valtrex) without CMV or

HHV-6 (resistant to oral Valtrex but sensitive to I.V. Ganciclovir),

may make an important difference in making treatment effective. No

major Valtrex toxicity was seen. As noted above, a double-blind study

is currently in progress and we are beginning to try the higher dose

of Valtrex in the 15% of our patient population that have not

improved adequately and have positive EBV, and negative CMV and HHV-6

tests. We hope to give you follow-up information on the treatment's

effectiveness as soon as we know!

> In addition, Dr. Lerner suspects that these infections affect the

heart muscle contributing to much of your symptoms. I am not

convinced that this is the case because EKG changes are common in

CFS. This can occur because the autonomic (brain) dysfunction and

hormonal changes seen in CFS can cause these same EKG changes without

heart damage. Regardless, he found that these changes went away with

treatment (as has been our experience in treating Chronic Fatigue

Syndrome—patient's EKG changes improve even without antivirals). Dr.

Lerner is currently recruiting patients for a double-blind study

using the high-dose Valtrex. His phone number is 248-540-9688 in

Beverly Hills, Michigan.

> Does This Mean There Is Nothing We Can Do Now?

> Although there is no currently accepted specific treatment for the

CMV and HHV-6 viruses, there are still a number of things that may be

very helpful in fighting this infection.

> 1. Lithium tends to be antiviral and has been shown to decrease

pain in FMS patients when added to treatment with Elavil. Lithium is

commonly used in manic depressive illness and is a natural mineral

despite being sold by prescription. In high doses, it can cause some

neurologic symptoms and suppression of the thyroid gland, but these

can usually be treated by taking a small amount of Essential Fatty

Acids and thyroid hormone. Lithium might also worsen Restless Leg

Syndrome. Although we have no direct evidence of Lithium being an

effective antiviral against HHV-6, it may well be effective because

it works against a number of other viral infections. In our

experience, 200mg to 600mg a day seems to be the effective dose in

treating FMS patients. As noted above, I would check the thyroid

blood tests at 3 months, 6 months and then yearly (check a Free T4

and a Total T3 - not a TSH). A Lithium level should also be checked

at the same time to be sure that it not above the upper limit of

> normal. The level can be below the normal range, which is fine as

long as the treatment is effective. You may find that you can lower

the Lithium dose after you have been on it for several months.

> 2. Heparin (a blood thinner, see Page 12) also has antiviral

properties.

> 3. It is worth considering trials of high-dose Valtrex. It should

be noted that 1000mg, 3 times a day, is used for shingles in older

patients and appears to be quite safe. On the other hand, higher

dosing at 8 grams a day in AIDS patients did result in uncommon

(under 2%) life threatening problems. This is common even with day-to-

day drugs in AIDS patients (for example, regular sulfa antibiotics

have often resulted in severe toxicity in AIDS patients).

Nonetheless, we will be limiting the dose to 1 gram, 4 times a day,

in our practice. It is important to note that taking Tagamet and/or

Probenecid (Benemid) will raise the blood level of Valtrex. Tagamet

has powerful immune modifying properties and is very helpful in acute

cases of Epstein Barr (mono) infections. Because of this, we are

adding Tagament 300mg, 4 times a day (but not Probenecid), to the

Valtrex. As I noted, we are beginning this treatment with some of our

patients and will let you know what we find.

> Natural Remedies

> 1. Olive Leaf - This is an herbal which is known to have a wide

spectrum of anti-infectious activity. It has been shown to be

effective against the HHV-6 virus in the test tube. I have not,

however, seen studies testing its effect in human beings infected

with HHV-6. Nonetheless, a number of physicians have found that using

Olive Leaf in Chronic Fatigue Syndrome is very effective. There is

controversy over whether the form and source of the Olive Leaf is

critical. We recommend that you use a form that has at least 6%

Oleuropein, which is one of the most active antiviral components in

the Olive Leaf. Other components may be important and some people

also feel that you must use the Mediterranean Olive Leaf vs. the

American Olive Leaf. Other people argue that you should have a form

that is organically grown, without pesticides. At this point it is

not clear whether this is simply marketing or important in day-to-day

life. Nonetheless, I would be picky about the companies you buy the O

> live Leaf from. I would use one of these sources:

> a. My office (800-333-5287) or my Web site at www.endfatigue.com.

> b. Pacific Research Labs (800-325-7734). This is owned by R. J.

Marshall, Ph.D., who has done a fair bit of work treating CFIDS

patients with Olive Leaf. I will be describing the protocol that he

uses below.

> c. General Nutrition Centers (GNC).

> Dr. Marshall feels that during infections, the body becomes overly

acidic. He tests the morning urine specimens with pH paper (which is

very easy to do at home) and gives a shell extract, which raises the

body's alkalinity. He feels that having a normalized acid-base

balance in your body helps it to fight infections. He then adds his

form of Olive Leaf, called Infectostat (which also contains mushroom

extracts to stimulate the immune system), giving 3 to 4 capsules, 3

to 4 times a day, to help fight the infections. Usually, the patient

should start feeling better within four weeks on this protocol.

Although we have found it helpful in fighting colds and other common

respiratory infections, we are just starting to explore Olive Leaf's

use in a few of our patients who have not responded to standard

treatment and are still quite ill. We will let you know our

experience with this in an upcoming newsletter issue. My guess,

though, is that simply using regular (6% Oleuropein) Olive Leaf

> 500mg capsules, 3 to 4 capsules, 3 to 4 times a day between meals,

will probably be equally effective and cheaper for most people than

the expensive forms. How long one needs to take Olive Leaf in Chronic

Fatigue Syndrome is yet to be determined.

> Initially, a pharmaceutical company was developing the Oleuropein

in Olive Leaf as an antiviral. Because it gets bound to the blood

proteins, they thought that Oleuropein might not get to the tissues.

More importantly, Oleuropein is a natural product and therefore hard

to patent. Because of these problems, they stopped research on it.

Years later this research was rediscovered and explored further. In

addition to being an effective antiviral agent, Olive Leaf is

reported to be effective on a number of bacterial and yeast

infections as well. What is most exciting regarding the Olive Leaf is:

> a. That some doctors have found it to be effective in CFIDS, and

> b. That in tests against HHV-6 and CMV virus (remember that if

something is effective against one, it tends to be effective against

the other) the Olive Leaf extract did not just suppress the virus but

killed it. That is very promising.

> 2. Pro-Boost - Thymic Protein A (used to be called BioPro) - This

is the immune stimulant that I discussed in my newsletter, Vol. 2,

Issue 2. Although not a hormone, Pro-Boost mimics the natural hormone

produced by your Thymus - the gland which stimulates your immune

system. I find it to be extraordinarily effective in fighting common

infections of any kind that seem to pop up. For the more deep-seated

infections of CFIDS, the higher dose (1 packet, 3 times a day) will

likely be needed. Once the infection seems to be in check and you are

feeling better (i.e., after 6 weeks), you can taper down to the

lowest dose that maintains the effect.

> 3. IP6 - This natural immune stimulant is an extract of bran

(phytates). It is less expensive and is sometimes combined with

vitamin C. The dose of IP6 (available from many sources) is 5 to 8

grams a day. Do not take IP6 within 3 hours of vitamin/mineral

supplements.

> 4. MGN3 - This is a very concentrated mushroom extract, which has

been shown to stimulate Natural Killer Cell immune function. In one

study, it actually tripled Natural Killer Cell function—an effect

that, as the HHV-6 virus can suppress Natural Killer Cell function,

could be very powerful. Unfortunately, it is horribly expensive in

the recommended dose (250 mg capsules) of 2 to 4 capsules, 4 times a

day for 2 weeks, followed by 2 capsules, 2 times a day. Other

mushroom extracts are cheaper but may not be as effective.

> 5. Intravenous Vitamin C at high-dose (15gm to 50gm) has been

suggested to have antiviral effects in a number of other infections

and is often dramatically helpful in CFIDS when given in the I.V.

nutritional therapy called " Myers Cocktails " (see my newsletter, Vol.

3, Issue 3).

> 6. Lysine 1000 mg, 3 times a day - This amino acid protein is safe

and inexpensive (27¢ a day). It inhibits oral/genital herpes (by

depleting the Arginine the virus needs to grow). I do not know if it

also inhibits EBV, HHV-6 or CMV viral infections.

> I would take the combination of these together (as is affordable)—

perhaps leaving the MGN3 for later if needed, giving the treatment

for at least a 6 to 8 week trial to see if it's effective. If you are

feeling better at 6 weeks, you can then taper down the dose slowly as

long as the benefit is maintained. When able, you can wean yourself

off the treatments. If symptoms recur, go back up to the dose that

maintains the benefit or consider increasing the dose further. As we

are just starting to use this protocol in our patients, I do

appreciate your feedback on what has worked for you and what has not.

You can " vote " for what helped or didn't help you on our Web site at

www.endfatigue.com. You can also see other people's votes.

> In addition, your clotting system may be activated by several

infections making it difficult to eliminate them. Using the anti-

clotting treatments that we will discuss later can also make it

easier for your body to eradicate infections.

> Mycoplasma And Chlamydia

> Other infections have also been found to be very important in

CFIDS. Dr. Garth Nicolson and his wife, who were on-faculty at the

University of Texas Medical School at Houston and the Department of

Microbiology and Immunology at Baylor College of Medicine in Houston,

Texas, are the leading proponents of treatment of these infections.

Dr. Garth Nicolson was an endowed chair and department chairman at

the University of Texas, the M.D. Cancer Center in Houston,

Texas, and a Professor of Internal Medicine at the University of

Texas Medical School, also in Houston. Dr. Nicolson's wife had

Chronic Fatigue Syndrome years ago. They were surprised that her test

turned out to be positive for Mycoplasma fermentans (also known as

Mycoplasma fermentans incognitus). This Mycoplasma was found to be

resistant to the Penicillin- and Keflex-family antibiotics that most

doctors use, but was sensitive to long courses of Doxycycline and

Cipro. After an extended course of Doxycycline treatment,

> she was much better. The Nicolsons then went on to develop their

own tests for Mycoplasma using PCR testing. Dr. Nicolson tells me

that, in addition, when his step-daughter came home after serving in

Desert Storm, she came down with Gulf War Illness (GWI). They tested

hundreds of Gulf War veterans with GWI and 40% to 45% were positive

for Mycoplasma infections—almost all with Mycoplasma fermentans. This

has been confirmed by other labs and a large Veterns Aministration

study involving over 2,000 patients. In contrast to this, soldiers

who were not deployed to the Gulf during the war, had less than a 6%

incidence of being positive for these infections.

> Interestingly, the Nicolsons found that in patients with Chronic

Fatigue Syndrome or Fibromyalgia, approximately 70% (144 out of 203

patients) had a positive PCR test for one, or usually several

species, of Mycoplasma. When the Nicolsons tested 70 healthy

patients, only 6 patients (less than 9%) were positive for any of the

Mycoplasma species. This is a highly significant difference. Only 2

of these 70 healthy people were positive for Mycoplasma fermentans.

Similar results have been found by other doctors and have been

published.

> As we have said before, it is likely that there is a group of

underlying problems and not a single one that triggers CFIDS/FMS.

This applies to infections as well. This is why you can see tests be

positive for both viral and Mycoplasmal infections in so many people

with this disease. For Mycoplasma alone, when they checked for four

different types of Mycoplasma, over half of the 93 CFIDS patients

that were positive had more than one type of infection. Over 20% of

them had three out of the four Mycoplasma infections test positive.

The more infections that were positive, the worse the patient's

symptoms were and the longer they had had CFIDS/FMS.

> What Are Mycoplasma?

> Mycoplasma are an ancient bacteria that lacks cell walls and are

capable of invading a number of types of human cells. They can cause

a wide variety of human diseases. These organisms can cause the types

of symptoms seen in Chronic Fatigue Syndrome patients and, according

to Dr. Nicolson, tend to be immune suppressing. Unfortunately, they

cannot be readily cultured on a culture dish like regular bacteria.

In medicine, we have a bad habit on focusing on that which is easy to

test for and making believe that that which is hard to test for does

not exist. Because of this, bacterial infections such as pneumonia,

bladder infections and skin infections, where one bacteria on a cell

dish will rapidly turn into millions by the next day and be visible

to the human eye, get all our attention. Unfortunately, Mycoplasma,

which cannot be easily cultured, tends to be ignored. It's like the

old story about the little kid who was looking for his lost keys

under the street lamp one night. His frien

> ds came by and asked him what was going on. He told them and they

all looked for the keys under that light for about an hour. Finally,

exasperated, they looked at the friend and said, " Where did you lose

these keys? " The kid looked up and said, " Oh, about half a block down

the street. " They said, " Why are you looking for them here? " He

said, " Because there is a light here and I can see! " This is kind of

what it is like in medicine. If there is a test for something (such

as cholesterol and bacterial cultures) that is easy to do, we focus

our attention on that test and make believe that it finds the main

problem. Unfortunately, in CFIDS and FMS, this is not the case.

> The data suggests that many infections may trigger CFIDS/FMS or

that CFIDS and FMS may cause immune suppression—which then sets you

up to catch a whole bunch of different infections which your body has

trouble clearing. This is why it is important to treat all the

underlying processes simultaneously as I discuss in my From Fatigued

To Fantastic! book and newsletters.

> So, How Do You Look For These Infections?

> I had the honor of speaking with Konnie Knox, M.D., a major re-

searcher on HHV-6 testing in CFIDS/FMS, who uses a technique called

Rapid Cell Culture. She actually infects different test tube cells

with HHV-6, grows them, and then looks for signs of HHV-6 in the

cell. In her experience, one out of three CFIDS/FMS patients are

positive for active HHV-6 infection on the first blood test. When

multiple testing is done (e.g., three tests), 70% are positive. This

test is negative in the vast majority of people who are healthy. The

other main illness where the HHV-6 test is positive is Multiple

Sclerosis. At this time, HHV-6 Rapid Cell Culture and the PCR test at

Dr. Nicolson's lab (International Molecular Diagostics) are the only

HHV-6 test I order. For more information on Dr. Knox's work, go to

these Web sites: www.HHV-6.com and www.cnet.com. For the IMD website,

go to www.imd-lab.com.

> The Nicolsons use very sensitive PCR (Polymerase Chain Reaction)

testing to actually look for DNA specific to Mycoplasma, HHV-6, and

other infections. Unfortunately, those DNA pieces are so

microscopically small, that to look for just one is much worse than

looking for a " needle in a haystack. " With the PCR, if that

Mycoplasma gene sequence is found, the technique multiplies it like a

copying machine until millions of that sequence are present and can

be picked up by testing. Because of this, PCR testing is exquisitely

sensitive and can find the proverbial " needle in a haystack. " This

makes it very powerful and the only testing that I would recommend in

looking for these Mycoplasma and Chlamydia infections. As noted

above, IGG antibody testing is not reliable for Mycoplasma and

Chlamydia testing in CFS.

> Where Do I Get These Tests Done And Should I Have Them Done?

> The tests for HHV-6 and Mycoplasma each cost about $180 to $250. As

noted above, the only places that I would get the HHV-6 test done

(and the only tests I would do are PCR or viral culture testing) are

at the Wisconsin Viral Institute (414-774-0311) or Dr. Nicolson's

lab. I order all the lab testing for Mycoplasma and Chlamydia at the

Nicolson's lab, at International Molecular Diagnostics, 15162 Triton

Lane, Huntington Beach, CA 92649 (714-799-7177 ext. 202 or 204). The

lab's Web site is www.imdlab.com.

> I can almost guarantee that if you do the Mycoplasma or Chlamydia

tests at your local lab they will do the wrong tests and they will be

useless for hidden CFS infections. I have never seen one come back

with any useful information. What they usually do is check the

antibodies (usually for the wrong Mycoplasma infection) which simply

shows that you (like everybody else at some point in their life) have

had a Mycoplasma infection. It tells nothing about active infection

and, again, is useless. Be sure to do the PCR testing and do it at

one of the two labs discussed above. Dr. Nicolson has noted which

tests he recommends in CFS/FMS, their cost and instructions for the

lab. We have reprinted this information on the next page (Dr.

Nicolson's lab also does viral PCR testing for CMV, as well as HHV-6).

> Even at the best labs, it is not uncommon to have a false-negative

report (where you have the infection and it does not show up on the

test). Because of this, especially for HHV-6, multiple tests will

often need to be done. There are good arguments for not doing the

tests and simply going ahead and treating empirically with the

natural remedies discussed above for HHV-6, or for prescribing

Doxycycline or Cipro for an extended period of time (see below). If

you feel better after four months on the treatment, then you know you

are hitting an infection and you can always intermittently stop the

treatments to see how long you will need them. Also, there are many

infections that are not tested for with these tests that would be

effectively treated with the regimens that we are discussing. Many of

these are likely to be infections that we don't even know exist.

Because of this, if resources are limited, I some-times simply treat

the patient, based on clinical suspicion, without doing the

> tests.

> Testing does have its benefits. If the test is positive, I am

likely to treat more aggressively and it helps guide me on how long

to give the treatment. For example, if after four months you are not

better and the test is positive, I would be likely to go ahead and

increase dosing or change to a different antibiotic. If the test was

negative, I would be more likely to just stop treatment and suspect

that the infection is less likely. This argues in favor of doing the

tests. One simple thing to do is to go ahead and check with your

insurance company to see if they cover these tests. This may make

your decision much simpler. Unfortunately, I suspect that the way

that most labs draw and ship your blood sample may not be reliable

because, in our experience, we have had less than 10% of patient's

tests come back positive for HHV-6 cell culture and only a modest

percent come back positive for the Mycoplasma. For the PCR Mycoplasma

test, the blood has to be frozen (see boxed inset, Page 9

> ). If the blood is left at room temperature, most of the positive

samples become negative after one to two days.

> Mycoplasma testing is not as specific as HHV-6 testing is for

CFIDS/FMS/Multiple Sclerosis (i.e., it is positive in other

illnesses). For example, about half the patients with Rheumatoid

Arthritis are also found to be infected with treatable infections,

including Mycoplasma. This goes along with my, and other doctors'

experience, that Doxycycline is often effective in treating

Rheumatoid Arthritis. Interestingly, although Mycoplasma is common in

the environment, it usually is fairly noninvasive. It may simply be

that once your immune system is weakened, these infections can get

into cells where they don't belong. When that happens, even some of

the common ones that are considered noninfectious can wreak havoc.

When these infections repro-duce slowly, they tend to be low-grade,

chronic infections, as opposed to the acute and more prominent

symptoms seen with bacterial and viral infections that multiply and

divide rapidly.

> For CFS/ME or FMS or Autoimmune Disease Patients,

> The Institute for Molecular Medicine suggests the following lab

tests:

> (Codes are I.M.D. or CPT Codes)

> 1. Test Panel 1007 (CPT: 87798x3, 87581) Mycoplasma species panel

of 4 pathogenic mycoplasmas (M. fermentans, M. penumoniae, M.

hominis, M. penetrans) by PCR.

> Justification: Almost 60% of CFS/FMS and 50% of Rheumatoid

Arthritis (RA) and other autoimmune patients have one or more

intracellular, systemic mycoplasmal infections similar to those found

in a variety of chronic illnesses [Nicolson, et al., Mycoplasmal

infections in chronic illnesses: Fibromyalgia and Chronic Fatigue

Syndromes, Gulf War Illness, HIV-AIDS and Rheumatoid Arthritis;

Medical Sentinel 1999; 5:172-176]. Ultrasensitive and ultraspecific

mycoplasma tests can only be done by a small number of labs, most

university or government labs that have been trained by us under a

U.S. government contract.

> Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

(EDTA). The blood is collected, immediately mixed and placed on ice,

then shipped on wet ice or immediately flash frozen and shipped with

dry ice by courier (foreign shipments) to I.M.D. to arrive within 24-

36 hours. Cost=$250. (Note that other commercial labs charge $400-

600.)

> 2. Test 1006 (CPT: 87486) Chlamydia pneumoniae test by PCR.

Justification: Many CFS, FMS, MS, RA and other patients have this

systemic infection along with viral infection(s). We were among the

few labs that developed the molecular tests that are now done for

this type of infection. The other labs that use these procedures are

university labs.

> Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

(EDTA). The blood is collected, immediately mixed and placed on ice,

then shipped on wet ice or immediately flash frozen and shipped with

dry ice by courier to I.M.D. to arrive within 24-36 hours. Cost=$180.

(Note that other commercial labs charge $200-250.)

> 3. Test 07047 (CPT: 87476) Borrelia burgdorferi (Lyme Disease) test

by PCR.

> Justification: Many CFS, FMS and RA patients have this systemic

infection (diagnosed as Lyme Disease) along with other infection(s).

> Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

(EDTA). The blood is collected, immediately mixed and placed on ice,

then shipped on wet ice or immediately flash frozen and shipped with

dry ice by courier to I.M.D. to arrive within 24-36 hours. Cost=$180.

(Note that other commercial labs charge $200-250.)

> 4. Test 07039 (CPT: 87532) Human Herpes Virus 6 (HHV-6) test by

PCR.

> Justification: Many CFS and some FMS patients have this systemic

viral infection, and it should be tested for in any autoimmune

illness.

> Specimen Requirements: Collect blood in one (1) 5 cc Lavender-top

Plasma Tubes (EDTA), mixed and separate blood plasma by

centrifugation. The plasma is then shipped on wet ice or immediately

flash frozen and shipped with dry ice by courier to I.M.D. to arrive

within 24-36 hours. Cost=$180. (Note that other commercial labs

charge $200-350.)

> 5. Test 07034 (CPT: 87496) Cytomegalovirus (CMV) test by PCR.

> Justification: Many CFS and FMS patients have this systemic viral

infection, and it should be tested for in any autoimmune illness.

> Specimen Requirements: Collect blood in one (1) 5 cc Lavender-top

Plasma Tubes (EDTA), mixed and separate blood plasma by

centrifugation. The plasma is then shipped on wet ice or immediately

flash frozen and shipped with dry ice by courier to I.M.D. to arrive

within 24-36 hours. Cost=$180. (Note that other commercial labs

charge $200-300.)

> For the best price and highest quality, the above PCR specialty

tests for CFS/FMS patients can be ordered through International

Molecular Diagnostics, Inc., 15162 Triton Lane, Huntington Beach, CA

92649, U.S.A. Tel: 714-799-7177, ext. 202 (Client Services) or ext.

204 (Brant Blasingame). Order forms and additional information are

available upon request. They also offer testing for blood clotting

abnormalities (see below). Tests must be ordered by a physician. The

I.M.D. Web site is www.imd-lab.com. On this site you will find

additional information about testing and disease. The Institute for

Molecular Medicine Web site is www.immed.org. On this site you will

find publications and documents on CFS/ME, FMS, autoimmune diseases

and other chronic illnesses. Immediate fax-back information is

available 24 hours per day by calling our telephone number 714-903-

2900.

> Garth Nicolson, Adjunct Professor of Internal Medicine

> President and Chief Scientific Officer, The Institute for Molecular

Medicine

> —A nonprofit institute dedicated to discovering new diagnostic and

therapeutic solutions for chronic diseases—

> 15162 Triton Lane, Huntington Beach, CA 92649-1041, U.S.A. • Tel:

714-903-2900 • Fax: 714-379-2082

> So, What Is Prescribed For Mycoplasma And Chlamydia?

> Fortunately, Mycoplasma and Chlamydia infections are usually

sensitive to the right antibiotics. The antibiotics most likely to

effect these organisms are:

> 1. Doxycycline or Minocycline 100 mg, 2-3 times a day. These two

antibiotics are in the Tetracycline-family and should not be used in

children under eight years-old because they can cause permanent

staining of the teeth. They are very effective, though, against a

number of unusual organisms (e.g., Lymes Disease). They will

sometimes cause some stomach upset. If this occurs, take the medicine

with food and a full glass of water or lower the dose. Do not use

outdated/expired Tetracycline prescriptions—they can kill you!

> 2. Cipro (Ciprofloxacin) 750 mg, twice a day. Although expensive,

this is usually a well-tolerated antibiotic. It has a very wide range

of effectiveness against a large number of organisms. When treating

males, the Cipro (as well as the Doxycycline) has the additional

benefit of treating any hidden prostate infections. Do not take oral

magnesium within 6 hours of Cipro or you won't absorb the Cipro.

> 3. Zithromax 600 mg a day, taken with food, or Biaxin 500 mg, twice

a day, taken on an empty stomach. These are in the Erythro-mycin

family. Zithromax tends to be fairly well-tolerated. The Biaxin is

more likely to cause a bit of nausea in some patients, but it is

usually well-tolerated. Both are quite expensive. They may work

against infections missed by Doxycycline and Cipro.

> Although all of these antibiotics can be effective, it is not

uncommon for infections that are sensitive to the Erythromycin

antibiotics (#3 above) to be resistant to #1 and #2 above and vice-

versa. Therefore, it is best to try either Doxycycline or Cipro

first. If they are not effective, then try the Zithromax or Biaxin.

The antibiotic should be taken for at least 6 months. If there is no

improvement in 4 months, switch to or add the other antibiotic or

simply stop the treatment. It is helpful to check for low-grade

fevers. I am more likely to use antibiotics for CFIDS patients who

have temperatures over 98.6°F, even if it is only 98.8° (I consider

98.8° a fever because CFIDS/FMS patients usually have low body

temperatures). If you do have low-grade, chronic temperature

elevations, be sure that you monitor your temperatures during

treatment. If your temperature drops with the antibiotic, it suggests

that you do have one of these nonviral infections and the antibiotic

is helping. T

> his would encourage me to continue the antibiotic trial - even if

it takes up to 12 months to see an improvement in your symptoms.

> If you are clearly better, I would probably take the antibiotic for

at least 6 to 12 months. It can then be stopped. If symptoms recur,

keep repeating 6 to 8 week cycles until the symptoms stay gone. It

may take several years of treatment for the infection to be totally

eradicated. To put it in perspective, this is how long children often

take antibiotics for acne—which unfortunately, if not taken with anti-

fungals, can lead to yeast overgrowth and possibly trigger CFIDS. Be

sure to take Nystatin, 2 tablets, 2 times a day, while on the

antibiotics. Also, please be sure to use alternative birth control if

on " the pill. " Birth control pills may be ineffective while taking

antibiotics. In addition, anti-depressants, codeine, antacids, and

mineral supplements (e.g., magnesium) may block antibiotic

absorption. Take these at least three hours away from the antibiotic

(and don't take the antidepressant/codeine medications if they are

not clearly helping).

> It is very common to get die-off (Herxheimer) reactions which

include chills, fever, night sweats and general worsening of CFS/FMS

symptoms when the antibiotic first kills off the infection. These can

be severe and last for weeks. Dr. Nicolson encourages you " to be

patient and not abandon therapy prematurely, because few patients who

have been sick for years recover in less than one year of therapy...

[don't] be alarmed if some signs and symptoms occasionally return or

worsen. This is not unusual. Eventually you will be off antibiotics

or antivirals but you will need to continue various supplements to

maintain your immune system and general nutritional status. "

> Treatment for Bacterial, Mycoplasma, Chlamydia, E-coli, Bladder, Or

Other Infections

> (From the " Treatment Checklist " used in Dr. Teitelbaum's office. A

full list is available on Dr. Teitelbaum's Web site at

www.endfatigue.com.)

> The Mycoplasma, Chlamydia, E-Coli, bladder and other bacterial

infections usually take months to years to eradicate. It is common to

flare your symptoms (from the infection die-off) the first two weeks

of treatment. Take the antibiotics for six months and, if better,

then repeat six-week cycles till your symptoms stay gone.

Antidepressants, Neurontin, and/or Codeine may block the antibiotic's

effectiveness. Be sure to take Nystatin, 2 tablets twice a day, and

Acidophilus while on the antibiotics. If you have occasional low-

grade fever (i.e., if over 98.6° F), check your oral temperature

occasionally to see if the antibiotic reduces or eliminates the

fever. If so, stay on that antibiotic. Also, see Dr. Nicolson's Web

site at www.immed.org for additional information.

> Useful antibiotic treatment for the above infections include:

> 1. Cipro (ciprofloxacin) 750 mg, 2 times a day for 6 months. Do not

take magnesium products (e.g., Fibrocare, some antacids, Pro Energy,

or (Dr. Teitelbaum's) Foundation Formula™) within 6 hours of Cipro

because you won't absorb the Cipro.

> OR

> 2. Doxycycline (a tetracycline) 100 mg, 3 times a day for 6 months.

If symptoms recur when the Doxycycline is completed, keep repeating 6-

week courses until the symptoms stay resolved. Take Nystatin (at

least 2, twice a day) while on the antibiotic. Birth control pills

may not work while on Doxycycline. Do not take any expired

Doxycycline tablets (it's very dangerous).

> OR

> 3. Zithromax (azithromycin) 600 mg tablets, 1 tablet a day (take

with food if it bothers your stomach). Don't take magnesium-

containing products within six hours of the Zithromax.

> OR

> 4. Biaxin 500 mg, 2 times a day.

> 5. D-Mannose ½ to 1 teaspoon (2.5 grams), stirred in water, every 2

to 3 hours while awake, for 2 to 5 days for acute bladder infections

(may use long-term for chronic infections) caused by E-coli (this

causes approximately 90% of bladder infections). If not much better

in 24 hours, get a urine culture and consider an antibiotic. D-

Mannose is available from BioTech (800-345-1199), my Web

site's " Vitamin Shop " at www.endfatigue.com or my office (800-333-

5287).

> What About Yeast Overgrowth?

> Yeast overgrowth is an important concern. As I have mentioned

before, nothing is all good or all bad. Although cigarettes kill

hundreds of thousands of people each year, they can be helpful in

treating Parkinson's Disease or ulcerative colitis. Although

antibiotics can trigger CFIDS, they can also be helpful in treating

it. This makes it important to know when and how to use them. I

strongly recommend that my patients take antifungals while on any

antibiotics (e.g., Nystatin 500,000 unit tablets, 2 tablets, 2 to 3

times a day) to prevent yeast overgrowth. It is also reasonable to

add Oregano Oil and other natural antifungals. Two Nystatin twice a

day is what I usually prescribe. Using probiotics (healthy milk

bacteria-like acidophilus that helps your body) to compete with the

yeast can also help. I am concerned that if the acidophilus is taken

with the antibiotic, they may simply cancel each other out. Because

of this, I usually begin probiotics (Acidophilus or Lactobacillus in

a d

> ose of 3 to 6 billion units a day, taken on an empty stomach or

with milk) after one has completed the course of antibiotics. If you

are only taking the antibiotic once or twice a day, and can find a

time at least 6 to 8 hours away from another dose to take the

probiotic, it is reasonable to take it at that time. The entire daily

probiotic dose can also be taken at one time. If you find that you

still get yeast overgrowth, it may be necessary to use some of the

more potent prescription antifungals (Sporanox or Diflucan). Because

these can cause liver inflammation and are quite expensive, it may be

adequate to take 200mg of either of these, twice a day, one day each

week (e.g., take it every Sunday) instead of every day. As discussed

previously, be sure to take Lipoic acid 200 mg on any day you take

Sporanox or Diflucan, to decrease the risk of liver inflammation.

> What Role Does My Blood Clotting System Play In This?

> Work done by E. Berg, M.S., C.L.S. (N.C.A.), director of

Hemex Laboratories in Phoenix, Arizona (800-999-2568), has shown that

a number of infections can trigger our blood clotting system to

become active, thus setting up a low-level, chronic clotting cascade.

These infections include HHV-6, Mycoplasma, CMV and Chlamydia which

can trigger production of (IgA) antibodies against clot protective

proteins on blood vessel inner surfaces (called antiphospholipid

antibodies). One of these is the Beta 2 Glyco-protein 1 (anti B2GP1—

no, you are not going to be tested on this!). This then triggers the

clotting cascade. Once the clotting system is triggered, a product

called Soluble Fibrin Monomer (SFM) is made which is like the

polymers in plastic. The theory is that they create long thin sheets

of a teflon-like substance, similar to the scab that covers a cut,

but microscopic, which then coats the blood vessels. This makes it

hard for nutrients, oxygen, etc., to get in and out of the b

> lood vessels to the cells where they are needed. In summary, many

infections can cause the blood clotting system to activate, resulting

in a thin coating of Fibrin deposited on the blood vessels. This

prevents nutrients and oxygen from getting to the cells in your body.

> Why Would An Infection Trigger The Clotting System?

> Many infections (called anaerobic) do not survive well in the

presence of oxygen. One can theorize that these Mycoplasma (which may

be anaerobic) and other organisms may trigger the clotting system to

create a shell, which then acts like a suit of armor, protecting them

from oxygen, your body's defense system, and antibiotics. This would

explain why these infections could evolve a way to trigger the

clotting mechanism. The Fibrin armor preventing antibiotics from

getting to the infection could also explain why some people with

these infections may not respond to antibiotics. Indeed, some

physicians have found that the antibiotics work better once someone

has been on a blood thinner (which may dissolve the armor).

> This is an interesting theory, but how do we know this is going on?

Mr. Berg and others have done studies showing that the blood tests

that look for these clotting changes (called the ISAC panel -

available at Hemex labs) are abnormal in CFIDS/FMS patients while

being normal in most other patients. They use a criterion of two of

these tests needing to be abnormal to be considered positive. When

this was done, 50 of 54 CFIDS/FMS patients had abnormal tests (i.e.,

only 7.4% of the patients had normal blood tests). In healthy

patients, 22 out of 23 had normal blood tests (i.e., 96%). This means

the test is both very sensitive and specific, picking up people with

CFIDS and excluding healthy people. Our experience has shown that

almost everyone that we tested, who has CFIDS, has turned out to have

a positive ISAC panel. We have not personally sent in any tests on

healthy patients to see if this also occurs. Interestingly, this

panel is also positive in many people with unexplained infer

> tility (which can improve with Heparin) and may also be positive in

people with Multiple Sclerosis, Parkinsons, Autism, Inflammatory

Bowel Disease and some other illnesses. This suggests that this test

can be helpful in deciding whether to treat with blood thinners

(Heparin) in CFIDS/FMS.

> So, How Do I Treat The Clotting System?

> First of all, it is important to remember that using injections of

Heparin (the blood thinner) is still a controversial and experimental

treatment for CFIDS/FMS. We much prefer to use treatments that are as

safe as possible. Although Heparin is routinely used in the U.S.A. to

treat blood clots, using it to treat CFIDS/FMS is very new. Most of

the doctors that I have spoken with have only treated a few CFIDS/FMS

patients with Heparin and find that about half of these patients get

better with treatment. The treatment protocol, developed by

Couvaras, M.D. (602-996-2411), includes the following:

> 1. Remove wheat, alcohol and sugar from the diet, if possible.

> 2. Check the ISAC panel. If there are at least two abnormal

results, then begin treatment.

> 3. Give an antifungal for 14 days (he uses Lamisil 250mg a day—

which I find to be poorly effective. I would use 200 mg of Sporanox

or Diflucan instead).

> 4. Give standard Heparin 4000 to 8000 units by injection

subcutaneously (like an insulin shot) twice a day. A (possibly safer)

low molecular weight Heparin may also be used.

> 5. If the PA index (on the ISAC) is positive, add a baby Aspirin

(81mg) each day.

> 6. After being on Heparin for one week, Dr. Couvares repeats the

ISAC panel to adjust the dose of the Heparin and Aspirin. He feels

that the goal is to move all the blood tests into the normal range

but not past the normal range into blood-thinning (therapeutic)

levels. If the values are still abnormal or the patient is still

having symptoms, he then increases the Heparin dosage. If the PA

index (on the ISAC) is still high, he increases the Aspirin to twice

a day.

> 7. If the patient feels better after one month of Heparin, he then

switches to low-dose Coumadin (a blood thinner tablet—take 2 to 3 mg

a day) and then stops the Heparin after 4 to 5 days of being on the

Coumadin. Once the patient has been on the Coumadin for two weeks he

goes ahead and rechecks the ISAC panel to maintain the blood tests in

the normal range.

> 8. He also supplements patients with nutritional supplementation as

needed.

> In my practice, because the ISAC panel runs over $320, I check a

baseline ISAC panel but do not repeat the ISAC panels to adjust

therapy. Instead, while on Heparin, we check a PTT (a blood thinning

test) and platelets (a highly unusual, but potentially very dangerous

side effect of Heparin is a severe drop in platelet count, which can

cause life-threatening bleeding) every 3 days for the first 12 days

and then every 2 to 4 weeks while on Heparin. If the PTT is still

within the normal range and the patient is not better, we increase

the Heparin as high as 8000 units, twice a day (rarely we will go up

to 8000 units, 3 times a day) and then also increase the Aspirin to 2

a day. In comparison, hospital patients often require Heparin at 1000

units per hour (24,000 units a day) I.V., while most CFS/FMS patients

only need 4000 to 5000 units, 2 times a day (8000 to 10,000 units a

day). If the patient is feeling better, however, we simply leave them

at the initial dose. Most patients will f

> eel better at about the 10- to 14-day point if the Heparin is going

to help. At the end of 4 to 12 months, if the Heparin helps, we

switch to Coumadin (as noted above) and check an INR (International

Normalized Ratio), aiming to keep it below 1.3 while adjusting the

Coumadin to the optimum does. It is very important to know that most

medications can change the blood level of Coumadin and that anytime

anything is added to, or deleted from, your regimen (including

natural remedies) you need to recheck the INR 4 to 7 days later to

make sure that it is not going too high. Heparin and Coumadin are

powerful medicines and the main risk is bleeding. Although we are

using very low doses, which are usually very well-tolerated, one can

rarely see a life-threatening bleed occur. If you felt better on the

Heparin and then the symptoms come back on the Coumadin, you may need

to go back on the Heparin for several months to re-establish and

maintain the benefit. Occasionally, people will need to b

> e on the Heparin for an extended period, in which case the blood

tests (PTT and platelet count) should be checked every 2 to 4 weeks.

All of this being said, most people tolerate these treatments quite

well and many, many more people die from taking Aspirin (e.g., for

arthritis) than Heparin each year.

> In summary, there are a number of infections that can cause or

occur because you have CFIDS/FMS. Once they occur, they can trigger

the clotting cascade. This may keep the nutrients from getting to

your body and create a " suit of armor " for the viral and Mycoplasma

infections. Using a blood thinner can break down these armor coatings

that protect the infections from our treatment and allow nutrients to

get where they need to go. Many tests can help. The one that I use to

decide whether to use the Heparin blood thinner is the ISAC panel (at

Hemex Labs). Testing for infections may be helpful, but can be

expensive and less likely to effect my decision to treat. If you can

afford the tests and/or your insurance will pay for them, they are

worth checking and will make it easier to adjust therapy over time.

If you can't afford it, it is reasonable to treat empirically (i.e.,

without testing), except for high-dose Valtrex therapy. If you have

lung congestion and/or recurrent temperatures o

> ver 98.6°F, I would treat with the antibiotics. If you feel

chronically flu-like, I would consider the HHV-6 or (based on

testing) the high-dose Valtrex regimen. It is also reasonable to

treat with antibiotics and antivirals simultaneously - especially if

you are taking the anticoagulants.

> Chronic Sinusitis The Yeasty Beasties Revisited!

> As was mentioned years ago, we speculated that the chronic sinus

congestion seen in CFIDS/FMS could be caused by yeast overgrowth. A

recent interesting study from the Mayo Clinic Proceedings supports

this thought. In the study, researchers found that most people with

chronic sinus infections had fungal growth in their sinuses. They

felt that the inflammation was being caused by an immune (the body's

reaction) response to the fungus. This research is interesting

because more and more studies are showing that treating chronic

sinusitis with antibiotics doesn't really do much and that shorter

courses of treatment work just as well as the long courses. We find

that conservative treatment (see my newsletter article, Treatment Of

Respiratory Infections Without Antibiotics, Vol. 2, Issue 2) is more

effective than antibiotics for chronic sinusitis.

> It's good that medicine is finally starting to catch up with

reality. The report in The Mayo Clinic Proceedings noted

that, " fungus allergy was thought to be involved in less than 10% of

cases… our studies indicate, in fact, fungus is likely the cause of

nearly all of these problems and that it is not an allergic reaction

but an immune reaction. " In this study, the researchers studied 210

patients with chronic sinusitis. Using new methods to collect and

test sinus/nasal mucus they found fungus in 96% of patients.

> It's interesting to observe how medical research works. The

researchers are now working with different drug companies to set up

trials to test medications to control the fungus but feel that it

will be at least two years before any treatments will be available.

In my experience, though, these problems often respond dramatically

to either Sporanox or Diflucan - which, by no coincidence, are very

powerful antifungal agents. It is not clear why the researchers did

not simply try Sporanox or Diflucan. Un-fortunately, we find that the

obvious is often overlooked. This sometimes occurs as drug companies

seek to make more money by finding new drugs instead of using the old

things that are known to work. It is important to distinguish between

chronic sinusitis (which lasts for over three months) and acute

sinusitis (which usually has been going on for a few days and less

than a month). For these shorter attacks of sinusitis, bacteria are a

more common cause and antibiotics (combined with n

> atural remedies) can be helpful. Some researchers still continue to

argue that fungus is not a cause of chronic sinusitis. They note that

fungi are seen even in healthy noses (which is correct) but neglect

to discuss the immune changes that are also seen in these noses.

Because so many people have responded dramatically to antifungals in

the treatment of their chronic sinusitis, my suspicion is that the

Mayo Clinic researchers are probably correct. Wouldn't it be nice, if

instead of arguing about treatments while people stay sick, they

would just try the treatments to see if they worked!

> As you can see, your body's defenses being down plays a large role

in CFIDS/FMS. The good news is, that by treating the many underlying

infections common in CFIDS patients and by treating any hormonal and

nutritional deficiencies, you can bring your immune system back to a

healthy state!

> Important Points

> • An important component of CFS is disordered immune function,

which opens the door to repeated infections, repeated treatment with

antibiotics, and yeast overgrowth.

> • Treat yeast overgrowth by avoiding antibiotics and sweets. Many

patients have found Nystatin and other antifungal medications, such

as Diflucan and Sporanox, to be helpful. Acidophilus (milk bacteria)

and natural antifungals such as Caprylic acid and garlic are also

often useful.

> • Bowel parasites are common in CFS patients, whose symptoms often

respond dramatically to treatment. However, most labs do not

adequately detect parasites through stool testing. To get an accurate

test result, use one of the labs we recommended that specializes in

stool testing.

> • Treat Cryptosporidium with Artemesia annua or tricyclin (herbal

antiparasitics).

> • Treat constipation with Turkey Rhubarb (a herb).

> • Prevent parasitic infection by using a Multi-pure water filter

(available from 888-801-8176 or 410-224-4877)

> • If you have temperatures over 98.6°F and/or chronic lung

congestion, try long-term Cipro or Doxycycline (while on Nystatin).

> • If you have chronic flu-like symptoms, despite yeast and Cortef

treatment, consider the antiviral, immune stimulating protocol we

discussed.

>

[Guest guest]

Krista,

I agree, I think the adrenals are very much involved with our

diseases. Everything points to it. Especially when women have

normal blood tests on everything and the doctor says, " It's in your

head. " NOT!! They don't check adrenal hormones, as far as I know.

BUT, (and that's a big BUT) even if they do check the adrenal

hormones, they'll be doing the same exact thing they do with the

thyroid....and that is to tell you when your TSH falls in the normal

ranges, that you are okay, totally missing the idea that you may be

in what is considered a normal range for the human population, but

NOT normal for YOU. It all depends on what numbers you've been at

your whole life vs what they are at now.

Dr. talks about the problems associated with

misunderstanding adrenal issues in the 21st century in his book on

Adrenal Fatigue. It's becoming epidemic due to the amount of stress

we all live under, not only socially, but also physically from all of

the toxins we are now exposed to in our modern age, when those toxins

were not an issue centuries ago.

Yes, I agree that this is something that needs to be checked with us,

but the real problem comes in finding a medical professional that

really understands it and knows what to look for for proper

treatment. I've found it to be a frustrating challenge, so much so

that I think it's just easier to try to recover on my own using

natural, adrenal supportive treatments at home. They can and do

recover. That is the good news. It just takes time and the right

tools.

Patty

> >

> > From Fatigued to Fantastic Newsletter

> > Vol. 3, No. 3 (2000)--Vol 4, No. 1 (2001)

> >

> > Fighting Those Persistent Infections in CFIDS

> > By Teitelbaum, M.D.

> > Medical science has known for quite some time that Chronic

Fatigue

> Syndrome is associated with changes in the body's immune system. In

> fact, the acronym " CFIDS " stands for " Chronic Fatigue And Immune

> Dysfunction Syndrome. " This can result in your having several

> different and unusual infections at one time. Many of these

> infections need to be treated directly. Other infections will go

away

> on their own as your immune (defense) system comes back " on line "

by

> using our treatment protocol. In this article, I'll discuss some of

> the more common, yet not usually thought of (in " regular "

medicine),

> infections.

> > What Kind Of Infections Am I Most At Risk For?

> > Although CFIDS of sudden onset often seems to be triggered by

viral

> infections (e.g., EBV, HHV-6, CMV), those infections, I suspect,

> are " simmering " or no longer active in many cases. However, the

body

> acts as if they are. This may result in elevated interferon levels.

I

> suspect this was what triggered my CFIDS.

> > The body produces interferon to fight viral infections. When a

> cancer or hepatitis patient is injected with interferon, the

patient

> becomes achy, fatigued and brain-fogged. An under-active adrenal

can

> also cause interferon levels to become elevated. Because of this

> elevation, it is more accurate to say that the body's immune system

> is not functioning properly, than to say that it is underactive.

> Indeed, in many ways, the immune system may be in overdrive and

soon

> exhaust itself. The immune system malfunctions in many other ways,

> too, including decreasing the effectiveness of the body's " natural

> killer " cells, which are an important defense mechanism.

> > Many other recurrent or unusual infections can also occur because

> of your malfunctioning immune system. Chronic sinus, bladder,

> prostate and respiratory infections are common and are often

treated

> with repeated courses of antibiotics. The large amount of

antibiotics

> introduced into the system can cause a secondary yeast over-growth

as

> it changes the natural balance between the bowel's healthy bacteria

> and yeast. The original immune dysfunction also contributes to the

> yeast overgrowth. Although it is controversial, a theory held by

many

> physicians is that chronic overgrowth of yeast due to overuse of

> antibiotics is a potential and strong trigger for chronic fatigue,

> fibromyalgia and further immune dysfunction. What makes the theory

> controversial is that no definitive tests exist to distinguish

fungal

> overgrowth from normal fungal levels. Also, many of the symptoms

> ascribed to yeast overgrowth can also come from the many other

> problems present in chronic fatigue syndrome and fibromya

> > lgia. On the other hand, most doctors who try treating yeast in

at

> least three or four CFS patients see how well it works and keep

using

> it.

> > CFIDS patients also frequently have bowel parasite infections.

> Bowel parasites can cause severe allergic or sensitivity reactions,

> which in turn can trigger fibromyalgia and fatigue. Often, a

patient

> will finally recover from long-standing and disabling fatigue

within

> a week or two after beginning treatment for bowel parasites.

> > Many other CFS/FMS patients are left with disabling fatigue after

a

> bout with viral infections such as polio, HHV-6, CMV, or EB viral

> infections. This fatigue also usually responds to the treatments

> discussed in this newsletter. In addition, infections with unusual

> organisms such as Rickettsia (e.g., Lymes Disease), chlamydia, and

> mycoplasma may also be problematic.

> > Yeast Overgrowth

> > Everyone's immune system has strong spots, as well as weak spots.

> Some people never get colds but have frequent bouts with athlete's

> foot or other skin fungal infections. Others never get fungal

> infections but tend to get colds. Many people seem to have a

> diminished ability to fight off fungal infections.

> > Fungi are very complex organisms. Fungal overgrowth may suppress

> the body's immune system. The host body may also develop allergic

> reactions to components of the yeast.

> > This allergic reaction was suggested in a study which connects

> Candida Albicans with Allergic Skin Dermatitis (Eczema). This study

> was published in The Journal of Clinical Experimental Allergy back

in

> 1993 (Vol. 23, pp. 332-339). It found that there is a significant

> correlation between the body having antibodies to Candida and

> Allergic Dermatitis/Eczema. In addition, we have found that

> unexplained rashes that have lasted for many years often clear up

> with antifungal treatment as well! Many physicians feel that yeast

> overgrowth causes a generalized suppression of the immune system.

In

> other words, once the yeast gets the upper hand, it sets up a cycle

> that further suppresses your body's defenses. Interestingly, a

recent

> Mayo Clinic study showed that most cases of chronic sinusitis seem

to

> be associated with a reaction to yeast in the sinuses - something I

> proposed years ago. None the less, as I already noted, this theory

is

> controversial. Yeast are normal members of our body's " zoo.

> > " They live in balance with bacteria - some of which are helpful

> and healthy and some of which are detrimental and unhealthy. The

> problems begin when this harmonious balance shifts and the yeast

> begin to overgrow.

> > As noted above, many things can prompt yeast to overgrow. One of

> the most common causes is frequent antibiotic use. When the good

> bacteria in the bowel are killed off by antibiotics (along with the

> bad bacteria) the yeast no longer have competition and begin to

> overgrow. The body is often able to rebalance itself after one or

> several courses of antibiotics, but after repeated or long-term

> courses - and especially if the body has an underlying immune

> dysfunction - the yeast can get the upper hand.

> > Other factors are also important. Studies have shown that animals

> who are sleep deprived and/or have increased sugar intake develop

> bowel yeast overgrowth. Many physicians feel that eating sugar

> stimulates yeast overgrowth in people, as well. Sugar is food for

> yeast. Yeast ferment sugar in order to grow and multiply. Yeast

> overgrowth due to sugar overuse also seems to cause immune

> suppression, which facilitates bacterial infections, which then

> requires even more antibiotic use. Poor sleep also results in

marked

> suppression of your immune function.

> > How Does One Know If They Have Yeast?

> > There are no definitive tests for yeast overgrowth that will

> distinguish yeast overgrowth from normal yeast growth in the body.

> There is one test which may be useful, though. This is a Urine

> Tartaric Acid test done by The Great Plains Lab in Kansas City,

> Missouri, run by Shaw, Ph.D. Tartaric Acid is a waste

product

> of yeast growth. In fermenting wine, for example, it is critical to

> remove the Tartaric Acid. Otherwise, the wine could be toxic to

> people. Dr. Shaw has found elevations in Urine Tartaric Acid that

> decrease with antifungal treatment in both CFIDS/FMS patients and

> autistic children. Interestingly, both these illnesses often

improve

> with antifungals (specifically, Sporanox or Diflucan, plus

Nystatin).

> Dr. Shaw likes to use the Urine Tartaric Acid to decide when to

treat

> yeast overgrowth and to follow-up the effectiveness of treatment.

> > In my experience, however, using Dr. Crook's Yeast Questionnaire

> (available in my book, From Fatigued To Fantastic!) is still the

most

> reliable way to tell if a person is at risk of yeast overgrowth. If

> the symptom score is over 140 points, I recommend treatment. In

> addition, anyone who has been on recurrent or long-term antibiotic

> use (especially Tetracycline for acne) or anyone who intermittently

> has painful sores in different parts of the mouth that last for

about

> ten days at a time and who has CFIDS/FMS, should be treated with

> antifungals. Bowel symptoms are some of the more overt symptoms

that

> are caused by yeast and I feel that most people who have " spastic

> colon " have yeast overgrowth or parasites.

> > How Is Yeast Treated?

> > A number of very effective methods can be utilized to take care

of

> a yeast problem. Primary among the methods is to avoid sugar and

> other sweets. One can enjoy one or two pieces of fruit a day, but

> should not consume concentrated sugars such as juices, corn syrup,

> jellies, pastry, candy or honey. Stay far away from soft drinks,

> which have ten to twelve teaspoons of sugar in every twelve ounces.

> This amount of sugar has been shown to markedly suppress immune

> function for several hours. Be pre-pared to have withdrawal

symptoms

> for about one week when sugar is cut out of the diet. Several

> excellent books have been written on the yeast controversy and

offer

> additional methods to try. One of the best books is The Yeast

> Connection and the Woman by Crook, M.D., a physician who

has

> done a spectacular job advancing the understanding of CFIDS/FMS.

> > Many patients have found that acidophilus (that is, milk

bacteria,

> a healthy bacteria for the bowel) helps restore balance in the

bowel.

> Acidophilus is found in yogurt with live and active yogurt

cultures.

> Indeed, one cup of yogurt a day can markedly diminish the frequency

> of recurrent vaginal yeast infections. Acidophilus is also

available

> in capsule form. Although many claims are made for one type of

> acidophilus being better than the other, I'm not sure this is so. I

> usually recommend 3 to 6 billion units a day (1 unit = 1 bacteria)

on

> an empty stomach. If on antibiotics (not antifungals), take the

> acidophilus at least 3 to 6 hours away from the antibiotic dose.

> > Nystatin, an antifungal medication, has also been helpful in the

> treatment of yeast overgrowth. Unfortunately, some fungi seem to be

> resistant to Nystatin. In addition, Nystatin is poorly absorbed,

> which means that it has little impact on the yeast outside of the

> bowel. Other anti-fungal medications, such as Diflucan and

Sporanox,

> seem to be effective systemically (throughout the body) but they

have

> two main drawbacks. First, they are expensive, costing more than

$450

> to $900 for a two-month course. Second, any effective anti-fungal

can

> initially make the symptoms of yeast infection worse. Although

> uncommon, Sporanox and Diflucan can also cause liver inflammation

(as

> can Advil and Tylenol). If you are taking Sporanox or Diflucan for

> more than 6 to 12 weeks, I would consider intermittently checking

> liver blood tests (ALT and AST). If you have preexisting active

liver

> disease, be cautious in using (or don't use) Sporanox or Diflucan.

I

> strongly recommend taking Lipoic Acid (a natural

> > supplement which protects and helps heal the liver), 200mg a

day,

> whenever you take Sporanox or Diflucan. I also strongly recommend

> Lipoic Acid for anyone with active liver disease (e.g., hepatitis)

at

> doses up to 1000mg to 3000mg a day as it may prevent and/or treat

> cirrhosis.

> > Natural Yeast Treatments

> > Below, I have summarized the nonprescription part of the

treatment

> checklist that I use in my office.

> > 1. Avoiding sweets is still the single most important thing.

Using

> Stevia as a sweetener is a wonderful substitute. Stevia is a safe,

> natural remedy and you can use all you want. There are even

cookbooks

> for using Stevia (available from my office or 800-4STEVIA). A new

> natural sweetner, Sweet Balance, also tastes good and is 12 times

as

> sweet as sugar. It is a natural product from the Lo Han fruit and

> appears to be safe. Although it is 70% sugar (fructose), you only

> need a small amount. Order it from 877-997-9338, my office at 800-

333-

> 5287 or my Web site at www.endfatigue.com.

> > 2. Acidophilus or Milk Bacteria can be very helpful. Take 3 to 6

> billion units a day (a unit is the same as a bacteria). Do not take

> acidophilus within 3 to 6 hours of an antibiotic. Take it either on

> an empty stomach or with milk.

> > 3. Caprylic Acid is another natural remedy that can be helpful.

The

> usual dose is 1800 to 3600mg a day with 1/3 of the dose being taken

> at each meal. Unfortunately, it often causes an acid stomach with

> a " funky " tasting reflux.

> > 4. Oregano Oil - enteric coated oregano oil - 1 to 2 capsules, 2

to

> 3 times a day with food, may be more effective and better tolerated

> than Caprylic Acid (both can cause stomach acid reflux).

> > 5. Fresh Garlic, if you can handle it well, can also be very

> effective. Daily, crush 1 to 3 garlic cloves in olive oil, add

salt,

> spread it on bread and eat it. It can be quite tasty and lethal to

> whatever infections you have in your gut.

> > 6. Olive Leaf 500mg, 2 to 4 capsules three times a day between

> meals, can also be very helpful in treating yeast overgrowth.

> > 7. Pau De Arco in either tea or capsule form is also helpful in

> yeast suppression. Although I use Pau De Arco infrequently for

yeast

> over-growth, many people find that it can be helpful.

> > 8. Grapefruit Seed Extract (e.g., Citrucidel) is a popular

> treatment for yeast overgrowth and is well-tolerated.

> > More Information On Yeast Treatments

> > If symptoms of yeast are caused by an allergic or sensitivity

> reaction to the yeast body parts, the symptoms may flare when mass

> quantities of the yeast are suddenly killed off. This is called a

> yeast " die-off " reaction. If you get this reaction, start your

> treatment with acidophilus and a sugar-free diet for a few weeks

> followed by oregano oil and/or olive leaf (1500mg to 2000mg, 3

times

> a day between meals) before beginning Nystatin. Take Nystatin (by

> mouth) in the form of 500,000-IU tablets or powder. I generally

> recommend beginning with 1 tablet a day for 1 to 3 days, and

> increasing by 1 tablet every 1 to 3 days (or slower if yeast " die-

> off " is a problem) until 2 tablets 2 to 4 times a day is reached.

If

> you get nausea, take a lower dose. Take Nystatin, 4 to 8 tablets

> daily, for 5 to 8 months. I add the Diflucan or Sporanox one month

> after beginning the Nystatin. Take 200mg every morning for six

weeks.

> If symptoms flare, take just 100mg per morning for the first 3 to

14

> days. I

> > f symptoms recur after stopping the Diflucan or Sporanox, I

> recommend continuing the medication for an additional 6 weeks at

> 200mg a day.

> > Sporanox should be taken with food. If it is taken alone, its

> absorption is greatly reduced. When taking Diflucan or Sporanox, DO

> NOT use the antihistamines Seldane or Hismanal, Quinidine (a heart

> medicine), cholesterol-lowering medications in the Mevacor family,

or

> the bowel medicine Propulcid. These can be fatal combinations!

Also,

> antacid medications (such as Tagamet, Axid, Zantac, and Pepcid)

> prevent the proper absorption of Sporanox. At the high price of

> Sporanox per dose, you will want to absorb every last bit of the

> medication. If you need to be on an antacid medication, use

Diflucan

> instead of Sporanox. Unfortunately, a less expensive antifungal,

> called Lamisil (at 250mg a day), does not seem to work very well

for

> candida yeast overgrowth (although it works well for nail

> infections). I am currently trying patients on 500mg of Lamisil a

day

> to see if this dose works better.

> > I feel that once the yeast has been effectively decreased and

kept

> that way for six to twelve months, it is safe to try to add small

> amounts of sugar back into the diet. If symptoms recur, however,

stop

> the sugar again. Continuing to eat yogurt with live and active

> acidophilus cultures (unless you are lactose-intolerant) or

> continuing to take acidophilus capsules may also help.

> > Many books on yeast overgrowth (including Dr. Crook's) advise

> readers to avoid all yeast in the diet. This advice is based on the

> theory that an allergic reaction to yeast is the cause of the

> problem. The predominant yeast that seems to be involved in yeast

> overgrowth is Candida Albicans, although I would not be surprised

if

> researchers discovered that many other kinds of fungal infections

are

> also involved. The yeast that is found in most foods (except beer

and

> cheese) is not closely related to candida.

> > In my experience, trying to avoid all yeast in foods results

simply

> in a nutritionally inadequate diet and little benefit. Although a

few

> people do appear to have true allergies to the yeast in their food,

> they number less than 10 percent of my patients with suspected

yeast

> overgrowth. These patients may benefit from the more strict diet in

> Dr. Crook's book. Interestingly, once their adrenal insufficiency

and

> yeast overgrowth are treated, most people find that their allergies

> and sensitivities to yeast and other food products seem to improve

or

> disappear.

> > Nutritional deficiencies such as low zinc or low selenium may

also

> decrease resistance to yeast over-growth. A good multivitamin

> supplement, as recommended in my last newsletter, should take care

of

> these deficiencies. This is further evidence that all the factors

> involved in CFS are closely interrelated.

> > The best thing that one can do to combat yeast overgrowth is to

try

> to avoid it in the first place. When you get an infection, begin

> treating it naturally immediately. Hopefully, you can prevent it

from

> turning into a bacterial infection which might require an

antibiotic.

> Ask your doctor what measures you can take before resorting to

> antibiotics. Many good over-the-counter remedies are available. A

> knowledgeable pharmacist may also be a wealth of information. Your

> local book or health food store has books on natural measures. Your

> health food store proprietor can also steer you to appropriate

> natural remedies. For examples of the many helpful measures that

one

> can take, see my newsletter article, Treating Infections Without

> Antibiotics, page ___).

> > If you find however, that you must take an antibiotic, all is not

> lost. One can still lessen the severity of yeast overgrowth by

> avoiding sweets and by either taking acidophilus capsules (again,

not

> within 3 to 6 hours of an antibiotic) or by eating one cup of

yogurt

> with live and active acidophilus cultures daily. Don't use the

yogurt

> (or milk) if you have sinusitis or pneumonia because the milk

protein

> thickens mucus and makes it hard for the body to fight these

> infections.

> > How Can One Tell If The Yeast Is Coming Back?

> > It is normal for yeast symptoms to resolve after treatment. After

6

> weeks on the Sporanox or Diflucan, patients are usually feeling a

lot

> better, but may have symptoms recur soon after stopping the

> antifungal. In this case I would continue the Sporanox or Diflucan

> for another 6 weeks, or as long as is needed, to keep the symptoms

at

> bay. More frequently, people will feel better after treatment and

> stay feeling fairly well for a period of 6 to 24 months. At that

> time, it is common to see a recurrence of symptoms, especially if

one

> is eating too much sugar or is taking antibiotics. The best marker

> that I have found for yeast overgrowth would be a return of bowel

> symptoms with gas, bloating and/or diarrhea or constipation. If

these

> symptoms persist for more than 2 weeks, especially if there is also

> even a mild worsening of the FMS symptoms, it is very reasonable to

> retreat yourself with 6 weeks of Nystatin and perhaps Sporanox or

> Diflucan. In addition, I would also retreat if there's

> > a recurrence of vaginal yeast or sinus infections. If re-

treatment

> resolves the symptoms, one may opt to repeat this regimen as often

as

> is needed (usually every 6 to 24 months). By using some of the

> natural remedies listed above, however, you may be able to avoid

> repeated use of these antifungals and the possible risk of becoming

> resistant to them. Some patients also find that they need to stay

on

> the antifungals for extended periods of time (years) or the

symptoms

> will recur. When this is necessary, I add the natural remedies. I

> will, however, also use the medications when needed. The main risk

of

> long-term use of the antifungals Sporanox and Diflucan would be

liver

> inflammation. If these medications are being used for extended

> periods, consider checking liver tests (SGOT and SGPT) every 3 to 6

> months and anytime that a severe flu-like feeling or worsening of

> symptoms occur. As noted above, it is very important to take Lipoic

> Acid 200mg a day when on Sporanox or Diflucan. Althoug

> > h I am not aware of any studies using Lipoic Acid with

antifungals,

> in my experience I have seen no worrisome elevation on liver tests

if

> patients are using this natural substance while taking these

> antifungals. As an alternative, instead of taking the antifungals

> every day, many people find they can get long-term suppression of

the

> yeast by taking Sporanox or Diflucan 200mg twice a day, one day

each

> week (e.g., each Sunday).

> > Help For Chronic Bladder Infections

> > Although we will be discussing some unusual infections, CFIDS/FMS

> patients also get more of the day-to-day variety of infections.

These

> include Urinary Tract (bladder) Infections (UTI). The main symptoms

> of a UTI are discomfort (e.g., burning) when urinating (dysuria),

> urgency (which is the feeling that you have to go very badly and

> right away when there is not much urine there), and frequency with

> low volume. These symptoms are also common in CFIDS/FMS patients in

> the absence of bladder infections and, when severe, is called

> Interstitial Cystitis. I would not label someone as having

> Interstitial Cystitis unless this is the major symptom of their

> CFIDS/FMS, because almost everyone with this illness has some

urinary

> urgency and frequency. Because bladder symptoms can be seen in both

> UTI and CFIDS/FMS, it is important to have a urine culture done

> before treatment with antibiotics to make sure that there is an

> infection and not just muscle spasms in the bladder that are

causing

> these

> > symptoms. If there is an infection, over 90% of the time it will

be

> E-coli. This bacteria is normally found in everyone's gut and, with

> the exception of a few rare dangerous forms, is a healthy part of

our

> normal bowel bacteria. The problem occurs when the E-coli gets out

of

> the bowel where it belongs and into the bladder. Usually the

bladder

> will wash out most infections when the urine comes out. The E-coli

> however, have little velcro-like projections that stick to the

> bladder wall so that they can not be washed out by urination.

> > Taking antibiotics will kill a bladder infection but will also

kill

> the healthy bacteria in the bowel. This sets one up for yeast

> overgrowth and other problems. Because of this, unless there is

fever

> or back pain over the kidneys or a toxic feeling, it is reasonable

to

> try natural remedies for one to three days before going with the

> antibiotics. One can start these treatments while waiting for the

> urine culture to come back.

> > What Natural Remedies Can Be Used For Bladder Infections?

> > There are two excellent natural remedies that can keep the E-coli

> from sticking to the bladder walls so they can be washed out. In

> addition, taking vitamin C in high dose (e.g., 500 to 5000mg a day)

> can acidify the urine, making it inhospitable to the bacteria.

> Drinking a lot of water also helps to wash out the infection.

> > The two natural remedies that keep the bacteria from sticking are:

> > 1. Cranberries—Because approximately 20% of the female population

> suffers from UTIs, several studies have been done looking at this

> remedy. An early study of 44 female and 16 male patients with acute

> bladder infections drank 16 oz. of cranberry juice a day for 15

days.

> Of these patients, 53% had positive responses and another 20%

showed

> modest improvement. Six weeks after stopping the juice, 27 patients

> did have persistent recurrent infections and 8 of these had no

> symptoms. Seventeen patients had no symptoms and negative urine

> cultures.

> > In another study of elderly women (who are more likely to have

> bladder infections), 153 women either received 10 oz. of cranberry

> drink or placebo every day for 6 months. The group that got the

> cranberry drink had 68% fewer bladder infections during that

period.

> In this study, the juice was sweetened with saccharin instead of

> sugar. Other studies have also shown benefit using cranberry juice

in

> bladder infections.

> > Significant benefits are achieved by using 6 to 16 oz. of

cranberry

> juice a day. Because cranberry juice has a lot of sugar and can

> promote yeast overgrowth and aggravate other symptoms in CFIDS/FMS,

I

> think it is much better to use pure cranberry juice powder in

capsule

> or tablet form (standardized to contain 11% to 12% quinic acid).

The

> therapeutic dose is 1 to 2 capsules a day. Conversely, you can use

> unsweetened cranberry juice and add Stevia as a natural sweetener.

In

> general, if one gives the usual cranberry juice cocktails a

strength

> of 1 unit - then, cranberry juice drinks have a strength of ½;

> cranberry sauce a strength of ½; fresh or frozen cranberries are 4

> times as potent; pure cranberry juice is 4 times as potent; and

> cranberry juice capsules from unsweetened cranberry juice powders

are

> 32 times as potent.

> > Cranberries work to help bladder infections because they have a

> chemical (proanthocyanidins) that prevents the bacteria from

sticking

> to the bladder wall. They may also decrease the risk of kidney

stones

> (although magnesium with B6 is much better for this), as well as

> possibly reduce urine odor.

> > D-Mannose - This is more effective than cranberry juice. Mannose

is

> a natural sugar (not the kind that causes symptoms or yeast

> overgrowth) that is excreted promptly into the urine. Unfortunately

> for the E-coli bacteria, the fingers that stick to the bladder wall

> stick to the D-Mannose even better. When one takes a large amount

of

> D-Mannose, it spills into the urine, coating all the E-coli's

> little " sticky fingers " so that the E-coli are literally washed

away

> with the next urination. The nice thing about the natural approach,

> as opposed to antibiotics, is that the cranberries or D-Mannose

will

> not kill the healthy bacteria, thereby not bothering the normal

> balance of bacteria in the bowel. In addition, the D-Mannose is

> absorbed in the upper gut before it gets to the friendly E-coli

that

> are normally present in the colon. Because of this, it helps clear

> the bladder without causing any other problems. In addition, the D-

> Mannose even tastes good.

> > The D-Mannose is quite safe, even for long-term use, although

most

> people will only need it for a few days. Those who have frequent

> recurrent bladder infections may, however, choose to take it every

> day. The usual dose of D- Mannose is 1/2 teaspoon every 2 to 3

hours,

> while awake, to treat an acute bladder infection; and 1/4 to 1/2

> teaspoon 3 to 4 times a day to prevent severe chronic bladder

> infections. It is best taken dissolved in water. For those who get

> bladder infections associated with sexual intercourse, one can take

> 1/2 teaspoon of D-Mannose 1 hour before and then just after

> intercourse to prevent an infection. Remember, though, the D-

Mannose

> (and cranberries) only work in the 90% of bladder infections caused

> by E-coli bacteria. D-Mannose is available from several sources:

> > 1. The Tahoma Clinic Dispensary (253-850-5661), which is

associated

> with the well-known nutritional physician, V. , M.D.

> > 2. The Biotech Company (800-345-1199).

> > 3. My office (800-333-5287) or my Web site at www.endfatigue.com.

> > The usual cost of D-Mannose is approximately $60 for 100 grams

and

> $35 for 50 grams. A 1/2 teaspoon is approximately 2 grams. One

should

> feel much better within 24 to 48 hours on D-Mannose. If not, see a

> doctor for a urine culture (you may want to get the culture at the

> first sign of infection) and consider antibiotic treatment after

two

> days if the culture is positive. Some evidence exists that

> Macrodantin causes less yeast over-growth than do other

antibiotics.

> Even with other antibiotics, most bladder infections are knocked

out

> by one to three days of antibiotic use (instead of the old seven-

day

> regimen).

> > Prostatitis

> > Although women tend to be the ones plagued with bladder

infections,

> men don't get off unscathed either. It is very common in men with

> CFIDS/FMS to have Prostatitis. Prostatitis is an inflammation or

> infection of the prostate which is usually seen in younger men

> between the ages of 20 and 50. It falls into three main categories:

> > 1. " Bacterial " Prostatitis is a acute or chronic infection in the

> gland that causes prostate swelling and discomfort.

> > 2. Nonbacterial Prostatitis is when you feel swelling of the

> prostate without being able to detect an infection. My suspicion is

> that it is not uncommon for prostatitis to be associated with yeast

> overgrowth or other infections that cannot be cultured (tested

for).

> > 3. Prostadynia is a general irritation of the prostate which

causes

> urinary burning, urgency and frequency but without there being any

> infection or swelling of the prostate. This can come from a number

of

> causes including, I suspect, chronic spasm or tightening of the

> muscles of the pelvic floor.

> > The symptoms of chronic Prostatitis can come and go and be mild

or

> severe. The symptoms include:

> > 1. Pain or tenderness in the area of the prostate. It is also

> common to have burning on the tip of the penis.

> > 2. Discomfort in the groin and, occasionally, lower back pain.

> > 3. Urinary urgency and frequency with pain on urination.

> > 4. Sometimes a slight penis discharge. If the discharge is cloudy

> and larger than one drop, or even a large drop, it is most likely a

> bacterial Prostatitis and I would then prescribe antibiotics. If a

> discharge is present, I would also check to make sure that there is

> not also a sexually transmitted disease (such as Chlamydia or

> Gonorrhea) before beginning treatment.

> > 5. Pain with ejaculation.

> > If severe symptoms with fevers, chills and extreme fatigue are

> present (symptoms of acute Prostatitis), antibiotics should be

used.

> The main treatment for bacterial Prostatitis consists of using the

> antibiotics Tetracycline (e.g., Doxycycline), Cipro, or Sulfa

> (Bactrim or Septra DS). Unfortunately, since it is hard for the

> antibiotics to be absorbed into the prostate, the symptoms often

> recur even after six weeks of treatment. If antibiotics are

required,

> use Doxycycline or Cipro because these may be effective against

other

> hidden infections that can cause CFIDS/FMS.

> > Although there are a number of causes of Prostatitis, excess

> caffeine, alcohol and spicy foods can also contribute to the

> symptoms. Sitting for long periods while traveling (e.g., being a

> truck driver) can also cause irritation of the prostate. Although

> normal bacteria are common causes, a few bacteria transmitted

through

> sexual contact can also cause Prostatitis. Some feel that the main

> psychological component of Prostatitis is shame.

> > Bowel Parasite Infections

> > A while back, the news focused our attention on Milwaukee because

> of repeated fatal outbreaks of an infection by a bowel parasite

> called Cryptosporidium. A cartoon even made the rounds showing

> Mexican tourists being warned not to drink the water in Milwaukee!

> Although this infection usually resolves on its own within a week

or

> two, it may persist in those with immune suppression. In fact,

people

> with acquired immune deficiency syndrome (AIDS) are particularly

> susceptible and scores of Milwaukeens died from the Cryptosporidium

> outbreaks.

> > Unfortunately, in many places throughout the United States, the

> water supply is contaminated, and parasites are no longer just a

> Third World problem. Doctors frequently see cases of infection by

> giardia, amoeba and numerous other bowel parasites. Parasitic

> infections can mimic CFS and, in immune suppressed situations like

> CFS, all parasites should be treated.

> > Most laboratories miss the parasites when they do stool testing.

I

> initially tested for bowel parasites by sending my patients' stool

> samples to a respected local lab. The tests kept coming back

> negative, so I eventually stopped testing. Finally, I started doing

> my own laboratory stool testing. Doing the test properly was very

> time consuming, taking up to five hours per specimen. However,

> processing it properly, my tests frequently turned out positive. In

> my experience - and in that of other physicians as well - when you

> treat a patient for parasites, the patient's fatigue and achiness

> often improves dramatically.

> > If you would like your stool tested, make sure that the lab

> specializes in stool testing and that the sample is a purged

> specimen. A purged stool specimen is watery and loose, brought

about

> by the use of one-and-a-half ounces of Fleet's Phospho-Soda (a

> laxative). The purpose of the stool purge is to get the best

possible

> stool sample to check for bowel parasites and yeast. The laxative

> washes the organisms off the walls of the intestines so that they

can

> be detected. The routine random tests performed in almost all

> standard labs are generally not adequate or reliable. In speaking

> with several lab technicians, I was told they had less than one

hour

> of training in looking for parasites—which they found to be

useless.

> In fact, during one of our " doctors' " poker games, I spoke with a

> gastroenterologist friend who noted that during a certain bowel

exam

> he had performed, he saw a large number of parasites swimming in

the

> patient's large bowel. He removed a big glob consisting of nothing

> > but mucus and parasites and sent it off to the major local

> laboratory, just for confirmation of the infection and

identification

> of the parasite. Even this sample came back negative for parasites!

> This is why I stress that stool testing must be done at a lab that

> specializes in parasitology. Because two excellent labs are now

> available to me to mail specimens to, I no longer have to do the

> testing in my office. These labs are The Parasitology Center, Inc.

> (480-777-1078) and The Great Smokies Diagnostic Laboratory (800-522-

> 4762).

> > At this point, no consistently effective prescription medication

is

> available for Cryptosporidium infections. Artemisia annua, however,

> is an effective herbal treatment. For most of my patients, I

> recommend using 1,000 milligrams three times a day for twenty days.

> Leo Galland, M.D., a parasite specialist, recommends a form of

> Artemisia called tricyclin for many parasitic infections. He

> recommends taking 2 tablets, 3 times a day after meals for six to

> eight weeks. The cost of this antiparasitic herbal preparation is

> about $30 for fifty tablets. See the treatment protocol below for

> regimens for some other parasitic infections. The doctor who runs

The

> Parasitology Center also has a review article discussing which

> natural remedies are effective against each type of parasite.

Common

> parasite treatment regimens also used in our office are on the

> treatment checklist below.

> > Antiparasitic Treatments

> > 1. Flagyl (Metronidazole) – 750 mg, 3 times a day for 10 days,

> followed by Yodoxin for many parasites. For Clostridium Difficile

> take 250 mg, 4 times a day, or 500 mg, 3 times a day. It may cause

> nausea and vomiting (uncomfortable but usually not worrisome). Do

not

> drink alcohol while on this medication as it will make you vomit.

The

> SR (sustained release) form is easier on the stomach (as is the

brand-

> name form). If you get numbness or tingling in your fingers (or it

> worsens if you usually have it) stop the Flagyl.

> > 2. Yodoxin (Iodoquinol) – 650 mg, 3 times a day, for 20 days

after

> Flagyl is completed.

> > 3. Tinidazole – 2000 mg, once daily, for 3 consecutive days with

> food (for Entamoeba Histolytica) – OR - 3 doses, each 2 weeks apart

> (for Giardia or Dientamoeba Fragilis); Available at 's

Pharmacy

> (800-480-3432).

> > 4. Humatin (Paromomycin) – 500 mg, 3 times a day, for 10 days

(for

> Cryptosporidium). For Blastocystis add Yodoxin.

> > 5. Zithromax – 250 mg, once a day on an empty stomach for 10

days,

> along with Bactrim, 1 tablet twice a day for 10 days (alternate

> treatment for Cryptosporidium). Add Artemesia.

> > 6. Bactrim DS - 1 tablet, twice a day, plus Yodoxin 650 mg, 3

times

> a day with food for 10 days. Do not take Folic acid supplements

> (e.g., B Complex or multivitamins) during these 10 days (for

> Blastocystis).

> > 7. Amphotericin B – 100 mg, two times a day, plus Tinidazole 500

> mg, twice a day, plus Furoxone (Furazolidone) 1 tablet, twice a

day.

> Take these three together with food for 5 to 7 days (Amphotericin B

> and Tinidazole are available from 's Pharmacy 800-480-3432)

> (treatment for refractory Blastocystis).

> > 8. Lactoferrin – 350 mg, 1 to 3 capsules at bedtime.

> > 9. Multi-pure Water Filter - Most other filters (except for

reverse

> osmosis) are ineffective. (Available from Bren son, 410-224-

> 4877).

> > 10. Artemesia Annua (a herbal antiparasitic) – 500 mg, 2 tablets,

3

> times a day for 20 days.

> > 11. Tricyclin (a herbal antiparasitic) - 2 tablets, 3 times a

day,

> after meals for 6 to 8 weeks (concentrated Artemesia).

> > 12. Colostrum (mother's milk) - 3 capsules, 3 times a day, for 8

to

> 12 weeks. Then stop or use the lowest dose needed for symptoms. If

> nausea or indigestion occurs, lower the dose to a comfortable level

> for 1 to 2 weeks until it passes. Take on an empty stomach.

> > 13. Quinacrine – 100 mg a day for 5 days. May be useful for

empiric

> therapy of suspected but not identified parasites (controversial).

> > 14. Albendazole – 400 mg a day for 5 days. May be useful for

> empiric therapy of suspected but not identified parasites.

> > Filter Your Water

> > Water filters can be very helpful in the fight against parasitic

> infection. However, not all units are designed to filter out

> parasites. For a water filter to remove parasites, it must have a

> submicron solid carbon block filter. A good example is the Multi-

pure

> Filter. Check the Consumer's Digest and Consumer's Report for other

> good units. Multi-pure Filters are available from Bren son at

> 888-801-8176 or 410-224-4877. He is a very reputable and

> knowledgeable person and does not believe in " high pressure sales "

> (again, I get no money from people or companies whose products I

> recommend).

> > When shopping around for a water filter, request the National

> Sanitation Foundation (NSF) International Listing for the specific

> unit you are considering. NSF is an independent not-for-profit

> organization that tests and certifies drinking water treatment

> products. The unit you buy should meet both NSF Health Effects

> Standard 53 and NSF Aesthetics Standard 42, with Class I reduction

of

> chlorine and particulate matter. Any unit that does not meet both

of

> these standards, particularly the health standard, is not adequate.

> To verify that a unit does meet these standards, call the NSF at

313-

> 769–8010.

> > In addition to verifying that a water filter meets the NSF

> standards, ask to see its Product Performance Data Sheet. Many

states

> require that this sheet be given to all prospective customers of

> drinking water treatment devices.

> > Ask about the range of contaminants that the unit can reduce

under

> NSF Health Effects Standard 53. Most units certified under Standard

> 53 list only turbidity and cyst reduction. The number of units that

> also reduce pesticides, trihalomethanes, lead, and volatile organic

> chemicals is very small. Make sure that the water filter you are

> considering can remove the specific contaminants that concern you.

> > Ask if the unit is licensed in such states as California,

Colorado

> and Wisconsin. These states have some of the toughest certification

> procedures in the United States.

> > Finally, ask about the unit's service cycle, which is stated in

> gallons of water treated. Find out how often you will need to

change

> the filter and what the replacement filters cost.

> > As the American water supply becomes more contaminated, parasitic

> bowel infections will likely become more common. These infections,

as

> well as the overgrowth of yeast or toxic bacteria caused by

> antibiotic use, contribute to feeling poorly.

> > The Role Of Other Infections In CFIDS/FMS

> > Many infections have been found in CFIDS. That people may have

not

> just one, but several of these simultaneously is significant. It

> suggests that although these infections may be a trigger, in most

> patients the immune system is suppressed and therefore they become

a

> setup for unusual infections that persist. These infections may

> then " drag you down, " further suppressing your immune system.

> > Fortunately, most people improve (and often get very healthy) by

> simply treating the sleep, hormonal, nutritional and yeast

problems.

> Once these areas are treated, your body can usually eliminate any

> persistent infections by itself. A subset, though, have infections

> that need treatment with antivirals and/or antibiotics.

> > How Can I Tell If I Need These Treatments?

> > First, I would try the other approaches discussed in my From

> Fatigued To Fantastic! book and newsletters. I would try these

> treatments if symptoms persist:

> > 1. Those with predominantly flu-like symptoms with debilitating

> fatigue and little or no pain or fever are more likely to have an

> underlying persistent viral infection (e.g., HHV-6, Epstein Barr,

> CMV, etc.).

> > 2. Those with fevers (i.e., anything over 98.6°F in this illness -

> even 99°) and/or lung congestion, sinusitis, skin pustules or other

> chronic bacterial infections seem more likely to have infections

> (i.e., bacterial, Mycoplasma, or Chlamydia) that respond to special

> antibiotics. Let's look at these two groups and how to approach

them.

> > HHV-6 And Other Viral Infections

> > HHV-6 (Human Herpes Virus 6) is a virus that is related to the

> Epstein Barr Virus (EB), Cytomegalovirus (CMV), and also to the

> Herpes Viruses that causes cold sores and Genital Herpes. HHV-6 is

> transmitted like the common cold and many people have had it, as

well

> as the EB Virus and the Cold Sore Virus by the time they are twenty

> years old. The body usually gets rid of all of these viruses on its

> own. Because of this, if you do routine (IGG) antibody testing,

> almost everybody will be positive for EB and many for HHV-6 and CMV

> viruses. However, the IGG test will not tell you if you have active

> infections unless the IGM antibody is also positive (suggesting a

new

> infection). The IGM antibody is the one that increases in the first

> six weeks of an infection. This is followed by an elevated IGG

> antibody, which stays elevated your whole life and acts as your

> body's surveillance system. All an elevated IGG means is that your

> body has seen this infection and, if it sees it again, it's read

> > y to knock it out quickly. This is how immunizations work. The

> immunization creates the IGG antibody, so that instead of taking

one

> to two weeks to gear-up to fight the infection, your body can

> eliminate that infection very quickly. Unfortunately, in CFIDS you

> can have a chronic low-grade infection—even if your IGG antibody is

> positive (elevated) - making the IGG antibody test for HHV-6, EB

> Virus and CMV unreliable in CFIDS/FMS. In addition, the IGM

antibody

> will usually not be present in elevated levels in the low-grade

> infections with these viruses that may be seen in CFIDS and FMS.

> > What makes this important is that Valtrex at high-dose can

> eliminate Epstein Barr virus, but will not work if active HHV-6 or

> CMV infection is present. As I will discuss later, the only tests I

> would rely on to diagnose active HHV-6 are " rapid cell cultures " or

> PCR testing. Because some insurance companies are more likely to

pay

> for IGG than PCR testing, an argument can be made for checking IGG

> antibodies first. If the EBV IGG is positive and HHV-6 and CMV IGG

> are negative, one may choose to proceed with Valtrex 1000mg, 4

times

> a day, for 6 months, without PCR testing. If the HHV-6 or CMV IGG

> antibodies are positive, then check the CMV and/or HHV-6 PCR tests

to

> be sure they are negative.

> > Tell Me More About HHV-6 And CFIDS

> > Unfortunately there is no currently accepted standard treatment

for

> the HHV-6 Virus. Even though it is related to other Herpes viruses,

> HHV-6 is resistant to Acyclovir, Valtrex, Famvir and the other

> antivirals that are commonly used in Herpes infections. The only

> antiviral known to be effective against HHV-6 is Ganciclovir. This

> has significant side effects and has to be given intravenously and

> possibly forever to maintain the antiviral effect. Unfortunately,

> this is not a viable option in day-to-day life and has been only

> moderately successful when used. The main doctor who has been using

> Ganciclovir to treat HHV-6 in the United States is Joe Brewer,

M.D.,

> (816-531-1550) in Kansas City, Missouri. He found that 140 out of

207

> CFIDS patients had positive HHV-6 cell cultures. Forty percent of

> CFIDS patients were positive on their first test and 70% were

> positive after three tests. This contrasts to 60 healthy patients

he

> checked in which none of the HHV-6 tests were positive. Culture

> > s are more likely to be positive during acute flares of the

> disease, when the viral level in the blood rises (see Page 9 for

more

> on HHV-6 PCR testing).

> > As is often the case in CFIDS, there is conflicting data on

> infections in Chronic Fatigue Syndrome. A recently published study

> (Reeves WC, et al., Clin Infect Dis, 2000 July; 31 [1] pp48-52)

> examined 26 patients with Chronic Fatigue Syndrome and 52 healthy

> patients in Atlanta, Georgia, at the CDC. In this study, several

> tests for HHV-6 and HHV-7 were done, including Polymerase Chain

> Reaction (PCR). HHV-6 DNA was found in 11% of CFIDS patients and

28%

> of healthy patients, suggesting that the HHV-6 was actually less

> common in Chronic Fatigue Syndrome than in healthy patients. At

this

> time, as the conflicting data shows, although HHV-6 may be one of

> many suspect infections in CFIDS, it is not yet clearly the cause

of

> this illness.

> > When HHV-6 is present, it seems to infect the natural Killer

Cells,

> important cells in your body's defense (immune) system that are

> critical in fighting infections. A number of studies have shown

these

> Killer Cells to be malfunctioning in CFIDS. HHV-6 infection does

not

> necessarily decrease the number of the natural Killer Cells but

does

> decrease their function. Natural Killer Cell function is described

in

> what is called Lytic Units—which means the ability of cells to lyse

> or break down foreign invaders. An average person will have a Lytic

> Unit level of 20 to 250 with over 80% of healthy patient being over

> 40 units. Dr. Brewer finds that in CFIDS the mean Natural Killer

> Lytic Cell level is 12 units. Dr. Brewer uses Specialty Labs in

> California for his Natural Killer Lytic Cell testing and finds that

> the Lytic level stays the same on repeat testing and seems to be a

> reliable test for Natural Killer Cell function testing in CFIDS.

> Lytic unit levels will, however, decrease during flar

> > es of symptoms. In Dr. Brewer's experience, this test is very

> specific for CFIDS and Multiple Sclerosis. He has treated ten MS

> patients and five CFIDS patients with the I.V. Ganciclovir. He

found

> that it helped to stabilize the MS patients. In the CFIDS patients,

> two to three were much improved, one still had a positive viral

> culture and one had a poor response. Unfortunately, maintaining

> patients on I.V. Ganciclovir forever (as noted above) is not a

viable

> option. Fortunately, an oral pill form of Ganciclovir

> (Valganciclovir) is currently being developed! It should be noted

> that the HHV-6 virus is similar to CMV (Cytomegalovirus), and that

> whatever is effective against one, tends to be effective for the

> other. This is a helpful bit of information as we follow new

research

> looking for clues on how to eliminate HHV-6 infection.

> > What Roles Does The Epstein Barr And Cytomegalovirus Play In

CFIDS?

> > Again, the roles of the EB and CMV viruses are not clear. It is

not

> uncommon for antibody levels of these viruses to be elevated in

> Chronic Fatigue Syndrome. As noted above, it is not clear whether

> this simply reflects a previous or ongoing infection with these

> viruses. Research by a husband and wife team (the Glasers) at Ohio

> State University, suggests that Epstein Barr Virus is still quite

> active and playing a role in many patients with these infections.

In

> addition, work by Lerner, M.D., also suggests that EB Virus

> and CMV are active as well. In speaking with Dr. Lerner's research

> assistant, I found out that he has found EB Virus and CMV to both

be

> fairly common in patients with Chronic Fatigue Syndrome (with and

> without pain). He found that about 20% had positive IGM and/or

> elevated EA (early antigen) tests to the EB Virus with negative

> Cytomegalovirus. Of these, two-thirds improved with high-dose

Valtrex

> (an oral antiviral). Despite my teasing and prodding, his associat

> > e refused to give out the dose of Valtrex they prescribed because

> Dr. Lerner does not want to be responsible for people using these

> higher doses until he completes the double-blind trial that is

> currently in progress. On the other hand, another study of his did

> use 1000mg, 4 times a day, giving the antiviral for 6 months. It

> takes about 3 to 4 months before patients start to improve and

after

> 6 months people can stop the Valtrex without the symptoms coming

> back. However, if there is no improvement in 6 months, consider it

to

> be a negative result. They also found that, as noted above, the IGM

> is almost always negative using the reagents used in most labs.

They

> found that only Epstein Barr IGM antibody testing, using a reagent

by

> the Diasorin Company (800-328-1482), has been useful in showing a

> significant number of positive tests. When we called the company,

the

> only lab in the Washington, D.C., area using it was at the NIH. The

> company may, however, be able to give you the name of

> > a lab near you that can do the test. What was fairly common,

> though, (and present in most patients) was either positive tests

for

> Epstein Barr, CMV, or a combination of both as noted above. When

CMV

> or HHV-6 are present, the Valtrex is less likely to work because it

> is not effective against these viruses.

> > In another study done by Dr. Lerner (Infectious Diseases In

> Clinical Practice, 1997; 6:110-117) he found that patients who had

> elevated CMV IGG antibodies, but no significant evidence of

> associated Epstein Barr virus (i.e., negative IGM and early antigen

> (EA) antibody total less than 40), did improve with I.V.

Ganciclovir

> at 5mg per kg of body weight given every 12 hours I.V. for 30 days.

> In this study 72% (13 of the 18 patients) improved markedly at the

> end of a month without any significant side effects. As noted, an

> oral form of Ganciclovir is currently in development as well. It

> should be noted that 36% of the Chronic Fatigue Syndrome patients

> that Dr. Lerner checked (18 out of 50) did turn out to have

elevated

> CMV antibodies (albeit IGG) in the absence of IGM and EA antibodies

> to EB Virus (i.e., no evidence of active Epstein Barr Virus). It

> should be noted, though, that 70% of healthy patients also had

> positive IGGs to CMV (as per our discussion above) in the study and

> appears

> > that the overall level of the IGG was not much higher overall in

> the Chronic Fatigue group than in the healthy controls. On the

other

> hand, the higher the level of CMV antibody in the Chronic Fatigue

> group, the more likely they were to improve with the I.V.

Ganciclovir.

> > What this means is that patients with Chronic Fatigue Syndrome

> don't necessarily have different blood tests for antibody levels

than

> healthy people for these viruses. However, if one has a higher

level

> rather than a lower level, one is more likely to improve with the

> Ganciclovir. Previous research has not shown benefit from antiviral

> therapies in CFS (Straus SE, et al., New England Journal of

Medicine

> 1988; 319:1692-1698). Our experience using a fairly high dose of

> Valtrex or Famvir (1500mg and 2250mg a day respectively) also

showed

> no significant improvement on these regimens after 6 weeks, at

which

> time we considered it to be ineffective. On the other hand, Dr.

> Lerner's research is suggesting that perhaps we gave it for too

short

> a time and at too low a dose. When treating himself and a few other

> patients, he used Valtrex by mouth at a dosage of 1000mg, 4 times a

> day, for 6 months. Using the higher dosing and the extended period

of

> time, as well as separating out groups that have

> > Epstein Barr Virus (sensitive to the oral Valtrex) without CMV

or

> HHV-6 (resistant to oral Valtrex but sensitive to I.V.

Ganciclovir),

> may make an important difference in making treatment effective. No

> major Valtrex toxicity was seen. As noted above, a double-blind

study

> is currently in progress and we are beginning to try the higher

dose

> of Valtrex in the 15% of our patient population that have not

> improved adequately and have positive EBV, and negative CMV and HHV-

6

> tests. We hope to give you follow-up information on the treatment's

> effectiveness as soon as we know!

> > In addition, Dr. Lerner suspects that these infections affect the

> heart muscle contributing to much of your symptoms. I am not

> convinced that this is the case because EKG changes are common in

> CFS. This can occur because the autonomic (brain) dysfunction and

> hormonal changes seen in CFS can cause these same EKG changes

without

> heart damage. Regardless, he found that these changes went away

with

> treatment (as has been our experience in treating Chronic Fatigue

> Syndrome—patient's EKG changes improve even without antivirals).

Dr.

> Lerner is currently recruiting patients for a double-blind study

> using the high-dose Valtrex. His phone number is 248-540-9688 in

> Beverly Hills, Michigan.

> > Does This Mean There Is Nothing We Can Do Now?

> > Although there is no currently accepted specific treatment for

the

> CMV and HHV-6 viruses, there are still a number of things that may

be

> very helpful in fighting this infection.

> > 1. Lithium tends to be antiviral and has been shown to decrease

> pain in FMS patients when added to treatment with Elavil. Lithium

is

> commonly used in manic depressive illness and is a natural mineral

> despite being sold by prescription. In high doses, it can cause

some

> neurologic symptoms and suppression of the thyroid gland, but these

> can usually be treated by taking a small amount of Essential Fatty

> Acids and thyroid hormone. Lithium might also worsen Restless Leg

> Syndrome. Although we have no direct evidence of Lithium being an

> effective antiviral against HHV-6, it may well be effective because

> it works against a number of other viral infections. In our

> experience, 200mg to 600mg a day seems to be the effective dose in

> treating FMS patients. As noted above, I would check the thyroid

> blood tests at 3 months, 6 months and then yearly (check a Free T4

> and a Total T3 - not a TSH). A Lithium level should also be checked

> at the same time to be sure that it not above the upper limit of

> > normal. The level can be below the normal range, which is fine as

> long as the treatment is effective. You may find that you can lower

> the Lithium dose after you have been on it for several months.

> > 2. Heparin (a blood thinner, see Page 12) also has antiviral

> properties.

> > 3. It is worth considering trials of high-dose Valtrex. It should

> be noted that 1000mg, 3 times a day, is used for shingles in older

> patients and appears to be quite safe. On the other hand, higher

> dosing at 8 grams a day in AIDS patients did result in uncommon

> (under 2%) life threatening problems. This is common even with day-

to-

> day drugs in AIDS patients (for example, regular sulfa antibiotics

> have often resulted in severe toxicity in AIDS patients).

> Nonetheless, we will be limiting the dose to 1 gram, 4 times a day,

> in our practice. It is important to note that taking Tagamet and/or

> Probenecid (Benemid) will raise the blood level of Valtrex. Tagamet

> has powerful immune modifying properties and is very helpful in

acute

> cases of Epstein Barr (mono) infections. Because of this, we are

> adding Tagament 300mg, 4 times a day (but not Probenecid), to the

> Valtrex. As I noted, we are beginning this treatment with some of

our

> patients and will let you know what we find.

> > Natural Remedies

> > 1. Olive Leaf - This is an herbal which is known to have a wide

> spectrum of anti-infectious activity. It has been shown to be

> effective against the HHV-6 virus in the test tube. I have not,

> however, seen studies testing its effect in human beings infected

> with HHV-6. Nonetheless, a number of physicians have found that

using

> Olive Leaf in Chronic Fatigue Syndrome is very effective. There is

> controversy over whether the form and source of the Olive Leaf is

> critical. We recommend that you use a form that has at least 6%

> Oleuropein, which is one of the most active antiviral components in

> the Olive Leaf. Other components may be important and some people

> also feel that you must use the Mediterranean Olive Leaf vs. the

> American Olive Leaf. Other people argue that you should have a form

> that is organically grown, without pesticides. At this point it is

> not clear whether this is simply marketing or important in day-to-

day

> life. Nonetheless, I would be picky about the companies you buy the

O

> > live Leaf from. I would use one of these sources:

> > a. My office (800-333-5287) or my Web site at www.endfatigue.com.

> > b. Pacific Research Labs (800-325-7734). This is owned by R. J.

> Marshall, Ph.D., who has done a fair bit of work treating CFIDS

> patients with Olive Leaf. I will be describing the protocol that he

> uses below.

> > c. General Nutrition Centers (GNC).

> > Dr. Marshall feels that during infections, the body becomes

overly

> acidic. He tests the morning urine specimens with pH paper (which

is

> very easy to do at home) and gives a shell extract, which raises

the

> body's alkalinity. He feels that having a normalized acid-base

> balance in your body helps it to fight infections. He then adds his

> form of Olive Leaf, called Infectostat (which also contains

mushroom

> extracts to stimulate the immune system), giving 3 to 4 capsules, 3

> to 4 times a day, to help fight the infections. Usually, the

patient

> should start feeling better within four weeks on this protocol.

> Although we have found it helpful in fighting colds and other

common

> respiratory infections, we are just starting to explore Olive

Leaf's

> use in a few of our patients who have not responded to standard

> treatment and are still quite ill. We will let you know our

> experience with this in an upcoming newsletter issue. My guess,

> though, is that simply using regular (6% Oleuropein) Olive Leaf

> > 500mg capsules, 3 to 4 capsules, 3 to 4 times a day between

meals,

> will probably be equally effective and cheaper for most people than

> the expensive forms. How long one needs to take Olive Leaf in

Chronic

> Fatigue Syndrome is yet to be determined.

> > Initially, a pharmaceutical company was developing the Oleuropein

> in Olive Leaf as an antiviral. Because it gets bound to the blood

> proteins, they thought that Oleuropein might not get to the

tissues.

> More importantly, Oleuropein is a natural product and therefore

hard

> to patent. Because of these problems, they stopped research on it.

> Years later this research was rediscovered and explored further. In

> addition to being an effective antiviral agent, Olive Leaf is

> reported to be effective on a number of bacterial and yeast

> infections as well. What is most exciting regarding the Olive Leaf

is:

> > a. That some doctors have found it to be effective in CFIDS, and

> > b. That in tests against HHV-6 and CMV virus (remember that if

> something is effective against one, it tends to be effective

against

> the other) the Olive Leaf extract did not just suppress the virus

but

> killed it. That is very promising.

> > 2. Pro-Boost - Thymic Protein A (used to be called BioPro) - This

> is the immune stimulant that I discussed in my newsletter, Vol. 2,

> Issue 2. Although not a hormone, Pro-Boost mimics the natural

hormone

> produced by your Thymus - the gland which stimulates your immune

> system. I find it to be extraordinarily effective in fighting

common

> infections of any kind that seem to pop up. For the more deep-

seated

> infections of CFIDS, the higher dose (1 packet, 3 times a day) will

> likely be needed. Once the infection seems to be in check and you

are

> feeling better (i.e., after 6 weeks), you can taper down to the

> lowest dose that maintains the effect.

> > 3. IP6 - This natural immune stimulant is an extract of bran

> (phytates). It is less expensive and is sometimes combined with

> vitamin C. The dose of IP6 (available from many sources) is 5 to 8

> grams a day. Do not take IP6 within 3 hours of vitamin/mineral

> supplements.

> > 4. MGN3 - This is a very concentrated mushroom extract, which has

> been shown to stimulate Natural Killer Cell immune function. In one

> study, it actually tripled Natural Killer Cell function—an effect

> that, as the HHV-6 virus can suppress Natural Killer Cell function,

> could be very powerful. Unfortunately, it is horribly expensive in

> the recommended dose (250 mg capsules) of 2 to 4 capsules, 4 times

a

> day for 2 weeks, followed by 2 capsules, 2 times a day. Other

> mushroom extracts are cheaper but may not be as effective.

> > 5. Intravenous Vitamin C at high-dose (15gm to 50gm) has been

> suggested to have antiviral effects in a number of other infections

> and is often dramatically helpful in CFIDS when given in the I.V.

> nutritional therapy called " Myers Cocktails " (see my newsletter,

Vol.

> 3, Issue 3).

> > 6. Lysine 1000 mg, 3 times a day - This amino acid protein is

safe

> and inexpensive (27¢ a day). It inhibits oral/genital herpes (by

> depleting the Arginine the virus needs to grow). I do not know if

it

> also inhibits EBV, HHV-6 or CMV viral infections.

> > I would take the combination of these together (as is affordable)—

> perhaps leaving the MGN3 for later if needed, giving the treatment

> for at least a 6 to 8 week trial to see if it's effective. If you

are

> feeling better at 6 weeks, you can then taper down the dose slowly

as

> long as the benefit is maintained. When able, you can wean yourself

> off the treatments. If symptoms recur, go back up to the dose that

> maintains the benefit or consider increasing the dose further. As

we

> are just starting to use this protocol in our patients, I do

> appreciate your feedback on what has worked for you and what has

not.

> You can " vote " for what helped or didn't help you on our Web site

at

> www.endfatigue.com. You can also see other people's votes.

> > In addition, your clotting system may be activated by several

> infections making it difficult to eliminate them. Using the anti-

> clotting treatments that we will discuss later can also make it

> easier for your body to eradicate infections.

> > Mycoplasma And Chlamydia

> > Other infections have also been found to be very important in

> CFIDS. Dr. Garth Nicolson and his wife, who were on-faculty at the

> University of Texas Medical School at Houston and the Department of

> Microbiology and Immunology at Baylor College of Medicine in

Houston,

> Texas, are the leading proponents of treatment of these infections.

> Dr. Garth Nicolson was an endowed chair and department chairman at

> the University of Texas, the M.D. Cancer Center in

Houston,

> Texas, and a Professor of Internal Medicine at the University of

> Texas Medical School, also in Houston. Dr. Nicolson's wife had

> Chronic Fatigue Syndrome years ago. They were surprised that her

test

> turned out to be positive for Mycoplasma fermentans (also known as

> Mycoplasma fermentans incognitus). This Mycoplasma was found to be

> resistant to the Penicillin- and Keflex-family antibiotics that

most

> doctors use, but was sensitive to long courses of Doxycycline and

> Cipro. After an extended course of Doxycycline treatment,

> > she was much better. The Nicolsons then went on to develop their

> own tests for Mycoplasma using PCR testing. Dr. Nicolson tells me

> that, in addition, when his step-daughter came home after serving

in

> Desert Storm, she came down with Gulf War Illness (GWI). They

tested

> hundreds of Gulf War veterans with GWI and 40% to 45% were positive

> for Mycoplasma infections—almost all with Mycoplasma fermentans.

This

> has been confirmed by other labs and a large Veterns Aministration

> study involving over 2,000 patients. In contrast to this, soldiers

> who were not deployed to the Gulf during the war, had less than a

6%

> incidence of being positive for these infections.

> > Interestingly, the Nicolsons found that in patients with Chronic

> Fatigue Syndrome or Fibromyalgia, approximately 70% (144 out of 203

> patients) had a positive PCR test for one, or usually several

> species, of Mycoplasma. When the Nicolsons tested 70 healthy

> patients, only 6 patients (less than 9%) were positive for any of

the

> Mycoplasma species. This is a highly significant difference. Only 2

> of these 70 healthy people were positive for Mycoplasma fermentans.

> Similar results have been found by other doctors and have been

> published.

> > As we have said before, it is likely that there is a group of

> underlying problems and not a single one that triggers CFIDS/FMS.

> This applies to infections as well. This is why you can see tests

be

> positive for both viral and Mycoplasmal infections in so many

people

> with this disease. For Mycoplasma alone, when they checked for four

> different types of Mycoplasma, over half of the 93 CFIDS patients

> that were positive had more than one type of infection. Over 20% of

> them had three out of the four Mycoplasma infections test positive.

> The more infections that were positive, the worse the patient's

> symptoms were and the longer they had had CFIDS/FMS.

> > What Are Mycoplasma?

> > Mycoplasma are an ancient bacteria that lacks cell walls and are

> capable of invading a number of types of human cells. They can

cause

> a wide variety of human diseases. These organisms can cause the

types

> of symptoms seen in Chronic Fatigue Syndrome patients and,

according

> to Dr. Nicolson, tend to be immune suppressing. Unfortunately, they

> cannot be readily cultured on a culture dish like regular bacteria.

> In medicine, we have a bad habit on focusing on that which is easy

to

> test for and making believe that that which is hard to test for

does

> not exist. Because of this, bacterial infections such as pneumonia,

> bladder infections and skin infections, where one bacteria on a

cell

> dish will rapidly turn into millions by the next day and be visible

> to the human eye, get all our attention. Unfortunately, Mycoplasma,

> which cannot be easily cultured, tends to be ignored. It's like the

> old story about the little kid who was looking for his lost keys

> under the street lamp one night. His frien

> > ds came by and asked him what was going on. He told them and they

> all looked for the keys under that light for about an hour.

Finally,

> exasperated, they looked at the friend and said, " Where did you

lose

> these keys? " The kid looked up and said, " Oh, about half a block

down

> the street. " They said, " Why are you looking for them here? " He

> said, " Because there is a light here and I can see! " This is kind

of

> what it is like in medicine. If there is a test for something (such

> as cholesterol and bacterial cultures) that is easy to do, we focus

> our attention on that test and make believe that it finds the main

> problem. Unfortunately, in CFIDS and FMS, this is not the case.

> > The data suggests that many infections may trigger CFIDS/FMS or

> that CFIDS and FMS may cause immune suppression—which then sets you

> up to catch a whole bunch of different infections which your body

has

> trouble clearing. This is why it is important to treat all the

> underlying processes simultaneously as I discuss in my From

Fatigued

> To Fantastic! book and newsletters.

> > So, How Do You Look For These Infections?

> > I had the honor of speaking with Konnie Knox, M.D., a major re-

> searcher on HHV-6 testing in CFIDS/FMS, who uses a technique called

> Rapid Cell Culture. She actually infects different test tube cells

> with HHV-6, grows them, and then looks for signs of HHV-6 in the

> cell. In her experience, one out of three CFIDS/FMS patients are

> positive for active HHV-6 infection on the first blood test. When

> multiple testing is done (e.g., three tests), 70% are positive.

This

> test is negative in the vast majority of people who are healthy.

The

> other main illness where the HHV-6 test is positive is Multiple

> Sclerosis. At this time, HHV-6 Rapid Cell Culture and the PCR test

at

> Dr. Nicolson's lab (International Molecular Diagostics) are the

only

> HHV-6 test I order. For more information on Dr. Knox's work, go to

> these Web sites: www.HHV-6.com and www.cnet.com. For the IMD

website,

> go to www.imd-lab.com.

> > The Nicolsons use very sensitive PCR (Polymerase Chain Reaction)

> testing to actually look for DNA specific to Mycoplasma, HHV-6, and

> other infections. Unfortunately, those DNA pieces are so

> microscopically small, that to look for just one is much worse than

> looking for a " needle in a haystack. " With the PCR, if that

> Mycoplasma gene sequence is found, the technique multiplies it like

a

> copying machine until millions of that sequence are present and can

> be picked up by testing. Because of this, PCR testing is

exquisitely

> sensitive and can find the proverbial " needle in a haystack. " This

> makes it very powerful and the only testing that I would recommend

in

> looking for these Mycoplasma and Chlamydia infections. As noted

> above, IGG antibody testing is not reliable for Mycoplasma and

> Chlamydia testing in CFS.

> > Where Do I Get These Tests Done And Should I Have Them Done?

> > The tests for HHV-6 and Mycoplasma each cost about $180 to $250.

As

> noted above, the only places that I would get the HHV-6 test done

> (and the only tests I would do are PCR or viral culture testing)

are

> at the Wisconsin Viral Institute (414-774-0311) or Dr. Nicolson's

> lab. I order all the lab testing for Mycoplasma and Chlamydia at

the

> Nicolson's lab, at International Molecular Diagnostics, 15162

Triton

> Lane, Huntington Beach, CA 92649 (714-799-7177 ext. 202 or 204).

The

> lab's Web site is www.imdlab.com.

> > I can almost guarantee that if you do the Mycoplasma or Chlamydia

> tests at your local lab they will do the wrong tests and they will

be

> useless for hidden CFS infections. I have never seen one come back

> with any useful information. What they usually do is check the

> antibodies (usually for the wrong Mycoplasma infection) which

simply

> shows that you (like everybody else at some point in their life)

have

> had a Mycoplasma infection. It tells nothing about active infection

> and, again, is useless. Be sure to do the PCR testing and do it at

> one of the two labs discussed above. Dr. Nicolson has noted which

> tests he recommends in CFS/FMS, their cost and instructions for the

> lab. We have reprinted this information on the next page (Dr.

> Nicolson's lab also does viral PCR testing for CMV, as well as HHV-

6).

> > Even at the best labs, it is not uncommon to have a false-

negative

> report (where you have the infection and it does not show up on the

> test). Because of this, especially for HHV-6, multiple tests will

> often need to be done. There are good arguments for not doing the

> tests and simply going ahead and treating empirically with the

> natural remedies discussed above for HHV-6, or for prescribing

> Doxycycline or Cipro for an extended period of time (see below). If

> you feel better after four months on the treatment, then you know

you

> are hitting an infection and you can always intermittently stop the

> treatments to see how long you will need them. Also, there are many

> infections that are not tested for with these tests that would be

> effectively treated with the regimens that we are discussing. Many

of

> these are likely to be infections that we don't even know exist.

> Because of this, if resources are limited, I some-times simply

treat

> the patient, based on clinical suspicion, without doing the

> > tests.

> > Testing does have its benefits. If the test is positive, I am

> likely to treat more aggressively and it helps guide me on how long

> to give the treatment. For example, if after four months you are

not

> better and the test is positive, I would be likely to go ahead and

> increase dosing or change to a different antibiotic. If the test

was

> negative, I would be more likely to just stop treatment and suspect

> that the infection is less likely. This argues in favor of doing

the

> tests. One simple thing to do is to go ahead and check with your

> insurance company to see if they cover these tests. This may make

> your decision much simpler. Unfortunately, I suspect that the way

> that most labs draw and ship your blood sample may not be reliable

> because, in our experience, we have had less than 10% of patient's

> tests come back positive for HHV-6 cell culture and only a modest

> percent come back positive for the Mycoplasma. For the PCR

Mycoplasma

> test, the blood has to be frozen (see boxed inset, Page 9

> > ). If the blood is left at room temperature, most of the positive

> samples become negative after one to two days.

> > Mycoplasma testing is not as specific as HHV-6 testing is for

> CFIDS/FMS/Multiple Sclerosis (i.e., it is positive in other

> illnesses). For example, about half the patients with Rheumatoid

> Arthritis are also found to be infected with treatable infections,

> including Mycoplasma. This goes along with my, and other doctors'

> experience, that Doxycycline is often effective in treating

> Rheumatoid Arthritis. Interestingly, although Mycoplasma is common

in

> the environment, it usually is fairly noninvasive. It may simply be

> that once your immune system is weakened, these infections can get

> into cells where they don't belong. When that happens, even some of

> the common ones that are considered noninfectious can wreak havoc.

> When these infections repro-duce slowly, they tend to be low-grade,

> chronic infections, as opposed to the acute and more prominent

> symptoms seen with bacterial and viral infections that multiply and

> divide rapidly.

> > For CFS/ME or FMS or Autoimmune Disease Patients,

> > The Institute for Molecular Medicine suggests the following lab

> tests:

> > (Codes are I.M.D. or CPT Codes)

> > 1. Test Panel 1007 (CPT: 87798x3, 87581) Mycoplasma species panel

> of 4 pathogenic mycoplasmas (M. fermentans, M. penumoniae, M.

> hominis, M. penetrans) by PCR.

> > Justification: Almost 60% of CFS/FMS and 50% of Rheumatoid

> Arthritis (RA) and other autoimmune patients have one or more

> intracellular, systemic mycoplasmal infections similar to those

found

> in a variety of chronic illnesses [Nicolson, et al., Mycoplasmal

> infections in chronic illnesses: Fibromyalgia and Chronic Fatigue

> Syndromes, Gulf War Illness, HIV-AIDS and Rheumatoid Arthritis;

> Medical Sentinel 1999; 5:172-176]. Ultrasensitive and ultraspecific

> mycoplasma tests can only be done by a small number of labs, most

> university or government labs that have been trained by us under a

> U.S. government contract.

> > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> (EDTA). The blood is collected, immediately mixed and placed on

ice,

> then shipped on wet ice or immediately flash frozen and shipped

with

> dry ice by courier (foreign shipments) to I.M.D. to arrive within

24-

> 36 hours. Cost=$250. (Note that other commercial labs charge $400-

> 600.)

> > 2. Test 1006 (CPT: 87486) Chlamydia pneumoniae test by PCR.

> Justification: Many CFS, FMS, MS, RA and other patients have this

> systemic infection along with viral infection(s). We were among the

> few labs that developed the molecular tests that are now done for

> this type of infection. The other labs that use these procedures

are

> university labs.

> > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> (EDTA). The blood is collected, immediately mixed and placed on

ice,

> then shipped on wet ice or immediately flash frozen and shipped

with

> dry ice by courier to I.M.D. to arrive within 24-36 hours.

Cost=$180.

> (Note that other commercial labs charge $200-250.)

> > 3. Test 07047 (CPT: 87476) Borrelia burgdorferi (Lyme Disease)

test

> by PCR.

> > Justification: Many CFS, FMS and RA patients have this systemic

> infection (diagnosed as Lyme Disease) along with other infection

(s).

> > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> (EDTA). The blood is collected, immediately mixed and placed on

ice,

> then shipped on wet ice or immediately flash frozen and shipped

with

> dry ice by courier to I.M.D. to arrive within 24-36 hours.

Cost=$180.

> (Note that other commercial labs charge $200-250.)

> > 4. Test 07039 (CPT: 87532) Human Herpes Virus 6 (HHV-6) test by

> PCR.

> > Justification: Many CFS and some FMS patients have this systemic

> viral infection, and it should be tested for in any autoimmune

> illness.

> > Specimen Requirements: Collect blood in one (1) 5 cc Lavender-top

> Plasma Tubes (EDTA), mixed and separate blood plasma by

> centrifugation. The plasma is then shipped on wet ice or

immediately

> flash frozen and shipped with dry ice by courier to I.M.D. to

arrive

> within 24-36 hours. Cost=$180. (Note that other commercial labs

> charge $200-350.)

> > 5. Test 07034 (CPT: 87496) Cytomegalovirus (CMV) test by PCR.

> > Justification: Many CFS and FMS patients have this systemic viral

> infection, and it should be tested for in any autoimmune illness.

> > Specimen Requirements: Collect blood in one (1) 5 cc Lavender-top

> Plasma Tubes (EDTA), mixed and separate blood plasma by

> centrifugation. The plasma is then shipped on wet ice or

immediately

> flash frozen and shipped with dry ice by courier to I.M.D. to

arrive

> within 24-36 hours. Cost=$180. (Note that other commercial labs

> charge $200-300.)

> > For the best price and highest quality, the above PCR specialty

> tests for CFS/FMS patients can be ordered through International

> Molecular Diagnostics, Inc., 15162 Triton Lane, Huntington Beach,

CA

> 92649, U.S.A. Tel: 714-799-7177, ext. 202 (Client Services) or ext.

> 204 (Brant Blasingame). Order forms and additional information are

> available upon request. They also offer testing for blood clotting

> abnormalities (see below). Tests must be ordered by a physician.

The

> I.M.D. Web site is www.imd-lab.com. On this site you will find

> additional information about testing and disease. The Institute for

> Molecular Medicine Web site is www.immed.org. On this site you will

> find publications and documents on CFS/ME, FMS, autoimmune diseases

> and other chronic illnesses. Immediate fax-back information is

> available 24 hours per day by calling our telephone number 714-903-

> 2900.

> > Garth Nicolson, Adjunct Professor of Internal Medicine

> > President and Chief Scientific Officer, The Institute for

Molecular

> Medicine

> > —A nonprofit institute dedicated to discovering new diagnostic

and

> therapeutic solutions for chronic diseases—

> > 15162 Triton Lane, Huntington Beach, CA 92649-1041, U.S.A. • Tel:

> 714-903-2900 • Fax: 714-379-2082

> > So, What Is Prescribed For Mycoplasma And Chlamydia?

> > Fortunately, Mycoplasma and Chlamydia infections are usually

> sensitive to the right antibiotics. The antibiotics most likely to

> effect these organisms are:

> > 1. Doxycycline or Minocycline 100 mg, 2-3 times a day. These two

> antibiotics are in the Tetracycline-family and should not be used

in

> children under eight years-old because they can cause permanent

> staining of the teeth. They are very effective, though, against a

> number of unusual organisms (e.g., Lymes Disease). They will

> sometimes cause some stomach upset. If this occurs, take the

medicine

> with food and a full glass of water or lower the dose. Do not use

> outdated/expired Tetracycline prescriptions—they can kill you!

> > 2. Cipro (Ciprofloxacin) 750 mg, twice a day. Although expensive,

> this is usually a well-tolerated antibiotic. It has a very wide

range

> of effectiveness against a large number of organisms. When treating

> males, the Cipro (as well as the Doxycycline) has the additional

> benefit of treating any hidden prostate infections. Do not take

oral

> magnesium within 6 hours of Cipro or you won't absorb the Cipro.

> > 3. Zithromax 600 mg a day, taken with food, or Biaxin 500 mg,

twice

> a day, taken on an empty stomach. These are in the Erythro-mycin

> family. Zithromax tends to be fairly well-tolerated. The Biaxin is

> more likely to cause a bit of nausea in some patients, but it is

> usually well-tolerated. Both are quite expensive. They may work

> against infections missed by Doxycycline and Cipro.

> > Although all of these antibiotics can be effective, it is not

> uncommon for infections that are sensitive to the Erythromycin

> antibiotics (#3 above) to be resistant to #1 and #2 above and vice-

> versa. Therefore, it is best to try either Doxycycline or Cipro

> first. If they are not effective, then try the Zithromax or Biaxin.

> The antibiotic should be taken for at least 6 months. If there is

no

> improvement in 4 months, switch to or add the other antibiotic or

> simply stop the treatment. It is helpful to check for low-grade

> fevers. I am more likely to use antibiotics for CFIDS patients who

> have temperatures over 98.6°F, even if it is only 98.8° (I consider

> 98.8° a fever because CFIDS/FMS patients usually have low body

> temperatures). If you do have low-grade, chronic temperature

> elevations, be sure that you monitor your temperatures during

> treatment. If your temperature drops with the antibiotic, it

suggests

> that you do have one of these nonviral infections and the

antibiotic

> is helping. T

> > his would encourage me to continue the antibiotic trial - even if

> it takes up to 12 months to see an improvement in your symptoms.

> > If you are clearly better, I would probably take the antibiotic

for

> at least 6 to 12 months. It can then be stopped. If symptoms recur,

> keep repeating 6 to 8 week cycles until the symptoms stay gone. It

> may take several years of treatment for the infection to be totally

> eradicated. To put it in perspective, this is how long children

often

> take antibiotics for acne—which unfortunately, if not taken with

anti-

> fungals, can lead to yeast overgrowth and possibly trigger CFIDS.

Be

> sure to take Nystatin, 2 tablets, 2 times a day, while on the

> antibiotics. Also, please be sure to use alternative birth control

if

> on " the pill. " Birth control pills may be ineffective while taking

> antibiotics. In addition, anti-depressants, codeine, antacids, and

> mineral supplements (e.g., magnesium) may block antibiotic

> absorption. Take these at least three hours away from the

antibiotic

> (and don't take the antidepressant/codeine medications if they are

> not clearly helping).

> > It is very common to get die-off (Herxheimer) reactions which

> include chills, fever, night sweats and general worsening of

CFS/FMS

> symptoms when the antibiotic first kills off the infection. These

can

> be severe and last for weeks. Dr. Nicolson encourages you " to be

> patient and not abandon therapy prematurely, because few patients

who

> have been sick for years recover in less than one year of

therapy...

> [don't] be alarmed if some signs and symptoms occasionally return

or

> worsen. This is not unusual. Eventually you will be off antibiotics

> or antivirals but you will need to continue various supplements to

> maintain your immune system and general nutritional status. "

> > Treatment for Bacterial, Mycoplasma, Chlamydia, E-coli, Bladder,

Or

> Other Infections

> > (From the " Treatment Checklist " used in Dr. Teitelbaum's office.

A

> full list is available on Dr. Teitelbaum's Web site at

> www.endfatigue.com.)

> > The Mycoplasma, Chlamydia, E-Coli, bladder and other bacterial

> infections usually take months to years to eradicate. It is common

to

> flare your symptoms (from the infection die-off) the first two

weeks

> of treatment. Take the antibiotics for six months and, if better,

> then repeat six-week cycles till your symptoms stay gone.

> Antidepressants, Neurontin, and/or Codeine may block the

antibiotic's

> effectiveness. Be sure to take Nystatin, 2 tablets twice a day, and

> Acidophilus while on the antibiotics. If you have occasional low-

> grade fever (i.e., if over 98.6° F), check your oral temperature

> occasionally to see if the antibiotic reduces or eliminates the

> fever. If so, stay on that antibiotic. Also, see Dr. Nicolson's Web

> site at www.immed.org for additional information.

> > Useful antibiotic treatment for the above infections include:

> > 1. Cipro (ciprofloxacin) 750 mg, 2 times a day for 6 months. Do

not

> take magnesium products (e.g., Fibrocare, some antacids, Pro

Energy,

> or (Dr. Teitelbaum's) Foundation Formula™) within 6 hours of Cipro

> because you won't absorb the Cipro.

> > OR

> > 2. Doxycycline (a tetracycline) 100 mg, 3 times a day for 6

months.

> If symptoms recur when the Doxycycline is completed, keep repeating

6-

> week courses until the symptoms stay resolved. Take Nystatin (at

> least 2, twice a day) while on the antibiotic. Birth control pills

> may not work while on Doxycycline. Do not take any expired

> Doxycycline tablets (it's very dangerous).

> > OR

> > 3. Zithromax (azithromycin) 600 mg tablets, 1 tablet a day (take

> with food if it bothers your stomach). Don't take magnesium-

> containing products within six hours of the Zithromax.

> > OR

> > 4. Biaxin 500 mg, 2 times a day.

> > 5. D-Mannose ½ to 1 teaspoon (2.5 grams), stirred in water, every

2

> to 3 hours while awake, for 2 to 5 days for acute bladder

infections

> (may use long-term for chronic infections) caused by E-coli (this

> causes approximately 90% of bladder infections). If not much better

> in 24 hours, get a urine culture and consider an antibiotic. D-

> Mannose is available from BioTech (800-345-1199), my Web

> site's " Vitamin Shop " at www.endfatigue.com or my office (800-333-

> 5287).

> > What About Yeast Overgrowth?

> > Yeast overgrowth is an important concern. As I have mentioned

> before, nothing is all good or all bad. Although cigarettes kill

> hundreds of thousands of people each year, they can be helpful in

> treating Parkinson's Disease or ulcerative colitis. Although

> antibiotics can trigger CFIDS, they can also be helpful in treating

> it. This makes it important to know when and how to use them. I

> strongly recommend that my patients take antifungals while on any

> antibiotics (e.g., Nystatin 500,000 unit tablets, 2 tablets, 2 to 3

> times a day) to prevent yeast overgrowth. It is also reasonable to

> add Oregano Oil and other natural antifungals. Two Nystatin twice a

> day is what I usually prescribe. Using probiotics (healthy milk

> bacteria-like acidophilus that helps your body) to compete with the

> yeast can also help. I am concerned that if the acidophilus is

taken

> with the antibiotic, they may simply cancel each other out. Because

> of this, I usually begin probiotics (Acidophilus or Lactobacillus

in

> a d

> > ose of 3 to 6 billion units a day, taken on an empty stomach or

> with milk) after one has completed the course of antibiotics. If

you

> are only taking the antibiotic once or twice a day, and can find a

> time at least 6 to 8 hours away from another dose to take the

> probiotic, it is reasonable to take it at that time. The entire

daily

> probiotic dose can also be taken at one time. If you find that you

> still get yeast overgrowth, it may be necessary to use some of the

> more potent prescription antifungals (Sporanox or Diflucan).

Because

> these can cause liver inflammation and are quite expensive, it may

be

> adequate to take 200mg of either of these, twice a day, one day

each

> week (e.g., take it every Sunday) instead of every day. As

discussed

> previously, be sure to take Lipoic acid 200 mg on any day you take

> Sporanox or Diflucan, to decrease the risk of liver inflammation.

> > What Role Does My Blood Clotting System Play In This?

> > Work done by E. Berg, M.S., C.L.S. (N.C.A.), director of

> Hemex Laboratories in Phoenix, Arizona (800-999-2568), has shown

that

> a number of infections can trigger our blood clotting system to

> become active, thus setting up a low-level, chronic clotting

cascade.

> These infections include HHV-6, Mycoplasma, CMV and Chlamydia which

> can trigger production of (IgA) antibodies against clot protective

> proteins on blood vessel inner surfaces (called antiphospholipid

> antibodies). One of these is the Beta 2 Glyco-protein 1 (anti B2GP1—

> no, you are not going to be tested on this!). This then triggers

the

> clotting cascade. Once the clotting system is triggered, a product

> called Soluble Fibrin Monomer (SFM) is made which is like the

> polymers in plastic. The theory is that they create long thin

sheets

> of a teflon-like substance, similar to the scab that covers a cut,

> but microscopic, which then coats the blood vessels. This makes it

> hard for nutrients, oxygen, etc., to get in and out of the b

> > lood vessels to the cells where they are needed. In summary, many

> infections can cause the blood clotting system to activate,

resulting

> in a thin coating of Fibrin deposited on the blood vessels. This

> prevents nutrients and oxygen from getting to the cells in your

body.

> > Why Would An Infection Trigger The Clotting System?

> > Many infections (called anaerobic) do not survive well in the

> presence of oxygen. One can theorize that these Mycoplasma (which

may

> be anaerobic) and other organisms may trigger the clotting system

to

> create a shell, which then acts like a suit of armor, protecting

them

> from oxygen, your body's defense system, and antibiotics. This

would

> explain why these infections could evolve a way to trigger the

> clotting mechanism. The Fibrin armor preventing antibiotics from

> getting to the infection could also explain why some people with

> these infections may not respond to antibiotics. Indeed, some

> physicians have found that the antibiotics work better once someone

> has been on a blood thinner (which may dissolve the armor).

> > This is an interesting theory, but how do we know this is going

on?

> Mr. Berg and others have done studies showing that the blood tests

> that look for these clotting changes (called the ISAC panel -

> available at Hemex labs) are abnormal in CFIDS/FMS patients while

> being normal in most other patients. They use a criterion of two of

> these tests needing to be abnormal to be considered positive. When

> this was done, 50 of 54 CFIDS/FMS patients had abnormal tests

(i.e.,

> only 7.4% of the patients had normal blood tests). In healthy

> patients, 22 out of 23 had normal blood tests (i.e., 96%). This

means

> the test is both very sensitive and specific, picking up people

with

> CFIDS and excluding healthy people. Our experience has shown that

> almost everyone that we tested, who has CFIDS, has turned out to

have

> a positive ISAC panel. We have not personally sent in any tests on

> healthy patients to see if this also occurs. Interestingly, this

> panel is also positive in many people with unexplained infer

> > tility (which can improve with Heparin) and may also be positive

in

> people with Multiple Sclerosis, Parkinsons, Autism, Inflammatory

> Bowel Disease and some other illnesses. This suggests that this

test

> can be helpful in deciding whether to treat with blood thinners

> (Heparin) in CFIDS/FMS.

> > So, How Do I Treat The Clotting System?

> > First of all, it is important to remember that using injections

of

> Heparin (the blood thinner) is still a controversial and

experimental

> treatment for CFIDS/FMS. We much prefer to use treatments that are

as

> safe as possible. Although Heparin is routinely used in the U.S.A.

to

> treat blood clots, using it to treat CFIDS/FMS is very new. Most of

> the doctors that I have spoken with have only treated a few

CFIDS/FMS

> patients with Heparin and find that about half of these patients

get

> better with treatment. The treatment protocol, developed by

> Couvaras, M.D. (602-996-2411), includes the following:

> > 1. Remove wheat, alcohol and sugar from the diet, if possible.

> > 2. Check the ISAC panel. If there are at least two abnormal

> results, then begin treatment.

> > 3. Give an antifungal for 14 days (he uses Lamisil 250mg a day—

> which I find to be poorly effective. I would use 200 mg of Sporanox

> or Diflucan instead).

> > 4. Give standard Heparin 4000 to 8000 units by injection

> subcutaneously (like an insulin shot) twice a day. A (possibly

safer)

> low molecular weight Heparin may also be used.

> > 5. If the PA index (on the ISAC) is positive, add a baby Aspirin

> (81mg) each day.

> > 6. After being on Heparin for one week, Dr. Couvares repeats the

> ISAC panel to adjust the dose of the Heparin and Aspirin. He feels

> that the goal is to move all the blood tests into the normal range

> but not past the normal range into blood-thinning (therapeutic)

> levels. If the values are still abnormal or the patient is still

> having symptoms, he then increases the Heparin dosage. If the PA

> index (on the ISAC) is still high, he increases the Aspirin to

twice

> a day.

> > 7. If the patient feels better after one month of Heparin, he

then

> switches to low-dose Coumadin (a blood thinner tablet—take 2 to 3

mg

> a day) and then stops the Heparin after 4 to 5 days of being on the

> Coumadin. Once the patient has been on the Coumadin for two weeks

he

> goes ahead and rechecks the ISAC panel to maintain the blood tests

in

> the normal range.

> > 8. He also supplements patients with nutritional supplementation

as

> needed.

> > In my practice, because the ISAC panel runs over $320, I check a

> baseline ISAC panel but do not repeat the ISAC panels to adjust

> therapy. Instead, while on Heparin, we check a PTT (a blood

thinning

> test) and platelets (a highly unusual, but potentially very

dangerous

> side effect of Heparin is a severe drop in platelet count, which

can

> cause life-threatening bleeding) every 3 days for the first 12 days

> and then every 2 to 4 weeks while on Heparin. If the PTT is still

> within the normal range and the patient is not better, we increase

> the Heparin as high as 8000 units, twice a day (rarely we will go

up

> to 8000 units, 3 times a day) and then also increase the Aspirin to

2

> a day. In comparison, hospital patients often require Heparin at

1000

> units per hour (24,000 units a day) I.V., while most CFS/FMS

patients

> only need 4000 to 5000 units, 2 times a day (8000 to 10,000 units a

> day). If the patient is feeling better, however, we simply leave

them

> at the initial dose. Most patients will f

> > eel better at about the 10- to 14-day point if the Heparin is

going

> to help. At the end of 4 to 12 months, if the Heparin helps, we

> switch to Coumadin (as noted above) and check an INR (International

> Normalized Ratio), aiming to keep it below 1.3 while adjusting the

> Coumadin to the optimum does. It is very important to know that

most

> medications can change the blood level of Coumadin and that anytime

> anything is added to, or deleted from, your regimen (including

> natural remedies) you need to recheck the INR 4 to 7 days later to

> make sure that it is not going too high. Heparin and Coumadin are

> powerful medicines and the main risk is bleeding. Although we are

> using very low doses, which are usually very well-tolerated, one

can

> rarely see a life-threatening bleed occur. If you felt better on

the

> Heparin and then the symptoms come back on the Coumadin, you may

need

> to go back on the Heparin for several months to re-establish and

> maintain the benefit. Occasionally, people will need to b

> > e on the Heparin for an extended period, in which case the blood

> tests (PTT and platelet count) should be checked every 2 to 4

weeks.

> All of this being said, most people tolerate these treatments quite

> well and many, many more people die from taking Aspirin (e.g., for

> arthritis) than Heparin each year.

> > In summary, there are a number of infections that can cause or

> occur because you have CFIDS/FMS. Once they occur, they can trigger

> the clotting cascade. This may keep the nutrients from getting to

> your body and create a " suit of armor " for the viral and Mycoplasma

> infections. Using a blood thinner can break down these armor

coatings

> that protect the infections from our treatment and allow nutrients

to

> get where they need to go. Many tests can help. The one that I use

to

> decide whether to use the Heparin blood thinner is the ISAC panel

(at

> Hemex Labs). Testing for infections may be helpful, but can be

> expensive and less likely to effect my decision to treat. If you

can

> afford the tests and/or your insurance will pay for them, they are

> worth checking and will make it easier to adjust therapy over time.

> If you can't afford it, it is reasonable to treat empirically

(i.e.,

> without testing), except for high-dose Valtrex therapy. If you have

> lung congestion and/or recurrent temperatures o

> > ver 98.6°F, I would treat with the antibiotics. If you feel

> chronically flu-like, I would consider the HHV-6 or (based on

> testing) the high-dose Valtrex regimen. It is also reasonable to

> treat with antibiotics and antivirals simultaneously - especially

if

> you are taking the anticoagulants.

> > Chronic Sinusitis The Yeasty Beasties Revisited!

> > As was mentioned years ago, we speculated that the chronic sinus

> congestion seen in CFIDS/FMS could be caused by yeast overgrowth. A

> recent interesting study from the Mayo Clinic Proceedings supports

> this thought. In the study, researchers found that most people with

> chronic sinus infections had fungal growth in their sinuses. They

> felt that the inflammation was being caused by an immune (the

body's

> reaction) response to the fungus. This research is interesting

> because more and more studies are showing that treating chronic

> sinusitis with antibiotics doesn't really do much and that shorter

> courses of treatment work just as well as the long courses. We find

> that conservative treatment (see my newsletter article, Treatment

Of

> Respiratory Infections Without Antibiotics, Vol. 2, Issue 2) is

more

> effective than antibiotics for chronic sinusitis.

> > It's good that medicine is finally starting to catch up with

> reality. The report in The Mayo Clinic Proceedings noted

> that, " fungus allergy was thought to be involved in less than 10%

of

> cases… our studies indicate, in fact, fungus is likely the cause of

> nearly all of these problems and that it is not an allergic

reaction

> but an immune reaction. " In this study, the researchers studied 210

> patients with chronic sinusitis. Using new methods to collect and

> test sinus/nasal mucus they found fungus in 96% of patients.

> > It's interesting to observe how medical research works. The

> researchers are now working with different drug companies to set up

> trials to test medications to control the fungus but feel that it

> will be at least two years before any treatments will be available.

> In my experience, though, these problems often respond dramatically

> to either Sporanox or Diflucan - which, by no coincidence, are very

> powerful antifungal agents. It is not clear why the researchers did

> not simply try Sporanox or Diflucan. Un-fortunately, we find that

the

> obvious is often overlooked. This sometimes occurs as drug

companies

> seek to make more money by finding new drugs instead of using the

old

> things that are known to work. It is important to distinguish

between

> chronic sinusitis (which lasts for over three months) and acute

> sinusitis (which usually has been going on for a few days and less

> than a month). For these shorter attacks of sinusitis, bacteria are

a

> more common cause and antibiotics (combined with n

> > atural remedies) can be helpful. Some researchers still continue

to

> argue that fungus is not a cause of chronic sinusitis. They note

that

> fungi are seen even in healthy noses (which is correct) but neglect

> to discuss the immune changes that are also seen in these noses.

> Because so many people have responded dramatically to antifungals

in

> the treatment of their chronic sinusitis, my suspicion is that the

> Mayo Clinic researchers are probably correct. Wouldn't it be nice,

if

> instead of arguing about treatments while people stay sick, they

> would just try the treatments to see if they worked!

> > As you can see, your body's defenses being down plays a large

role

> in CFIDS/FMS. The good news is, that by treating the many

underlying

> infections common in CFIDS patients and by treating any hormonal

and

> nutritional deficiencies, you can bring your immune system back to

a

> healthy state!

> > Important Points

> > • An important component of CFS is disordered immune function,

> which opens the door to repeated infections, repeated treatment

with

> antibiotics, and yeast overgrowth.

> > • Treat yeast overgrowth by avoiding antibiotics and sweets. Many

> patients have found Nystatin and other antifungal medications, such

> as Diflucan and Sporanox, to be helpful. Acidophilus (milk

bacteria)

> and natural antifungals such as Caprylic acid and garlic are also

> often useful.

> > • Bowel parasites are common in CFS patients, whose symptoms

often

> respond dramatically to treatment. However, most labs do not

> adequately detect parasites through stool testing. To get an

accurate

> test result, use one of the labs we recommended that specializes in

> stool testing.

> > • Treat Cryptosporidium with Artemesia annua or tricyclin (herbal

> antiparasitics).

> > • Treat constipation with Turkey Rhubarb (a herb).

> > • Prevent parasitic infection by using a Multi-pure water filter

> (available from 888-801-8176 or 410-224-4877)

> > • If you have temperatures over 98.6°F and/or chronic lung

> congestion, try long-term Cipro or Doxycycline (while on Nystatin).

> > • If you have chronic flu-like symptoms, despite yeast and Cortef

> treatment, consider the antiviral, immune stimulating protocol we

> discussed.

> >

>

[Guest guest]

Patty- Yeah, that does worry me...that I'll spend all the time and

money to get tested, for them just to tell me that I'm normal! Right

now though, it really seems as if my symptoms are pointing towards my

adrenals being under-active. So, do you have any idea how the

implants mess up our hormones? I know there hasn't been a lot of (if

any) research on this, but I'm just curious to know if you've heard

anything.

Also, what type of natural adrenal treatments do you recommend? I

have a feeling I might be on my own on this so I should probably

figure out what would benefit me the most.

Thanks for all your help, Patty!

Love, Krista

ps. I just realized that Sandy posted the article (not Rogene,)

thanks Sandy!

> > >

> > > From Fatigued to Fantastic Newsletter

> > > Vol. 3, No. 3 (2000)--Vol 4, No. 1 (2001)

> > >

> > > Fighting Those Persistent Infections in CFIDS

> > > By Teitelbaum, M.D.

> > > Medical science has known for quite some time that Chronic

> Fatigue

> > Syndrome is associated with changes in the body's immune system.

In

> > fact, the acronym " CFIDS " stands for " Chronic Fatigue And Immune

> > Dysfunction Syndrome. " This can result in your having several

> > different and unusual infections at one time. Many of these

> > infections need to be treated directly. Other infections will go

> away

> > on their own as your immune (defense) system comes back " on line "

> by

> > using our treatment protocol. In this article, I'll discuss some

of

> > the more common, yet not usually thought of (in " regular "

> medicine),

> > infections.

> > > What Kind Of Infections Am I Most At Risk For?

> > > Although CFIDS of sudden onset often seems to be triggered by

> viral

> > infections (e.g., EBV, HHV-6, CMV), those infections, I suspect,

> > are " simmering " or no longer active in many cases. However, the

> body

> > acts as if they are. This may result in elevated interferon

levels.

> I

> > suspect this was what triggered my CFIDS.

> > > The body produces interferon to fight viral infections. When a

> > cancer or hepatitis patient is injected with interferon, the

> patient

> > becomes achy, fatigued and brain-fogged. An under-active adrenal

> can

> > also cause interferon levels to become elevated. Because of this

> > elevation, it is more accurate to say that the body's immune

system

> > is not functioning properly, than to say that it is underactive.

> > Indeed, in many ways, the immune system may be in overdrive and

> soon

> > exhaust itself. The immune system malfunctions in many other

ways,

> > too, including decreasing the effectiveness of the

body's " natural

> > killer " cells, which are an important defense mechanism.

> > > Many other recurrent or unusual infections can also occur

because

> > of your malfunctioning immune system. Chronic sinus, bladder,

> > prostate and respiratory infections are common and are often

> treated

> > with repeated courses of antibiotics. The large amount of

> antibiotics

> > introduced into the system can cause a secondary yeast over-

growth

> as

> > it changes the natural balance between the bowel's healthy

bacteria

> > and yeast. The original immune dysfunction also contributes to

the

> > yeast overgrowth. Although it is controversial, a theory held by

> many

> > physicians is that chronic overgrowth of yeast due to overuse of

> > antibiotics is a potential and strong trigger for chronic

fatigue,

> > fibromyalgia and further immune dysfunction. What makes the

theory

> > controversial is that no definitive tests exist to distinguish

> fungal

> > overgrowth from normal fungal levels. Also, many of the symptoms

> > ascribed to yeast overgrowth can also come from the many other

> > problems present in chronic fatigue syndrome and fibromya

> > > lgia. On the other hand, most doctors who try treating yeast in

> at

> > least three or four CFS patients see how well it works and keep

> using

> > it.

> > > CFIDS patients also frequently have bowel parasite infections.

> > Bowel parasites can cause severe allergic or sensitivity

reactions,

> > which in turn can trigger fibromyalgia and fatigue. Often, a

> patient

> > will finally recover from long-standing and disabling fatigue

> within

> > a week or two after beginning treatment for bowel parasites.

> > > Many other CFS/FMS patients are left with disabling fatigue

after

> a

> > bout with viral infections such as polio, HHV-6, CMV, or EB viral

> > infections. This fatigue also usually responds to the treatments

> > discussed in this newsletter. In addition, infections with

unusual

> > organisms such as Rickettsia (e.g., Lymes Disease), chlamydia,

and

> > mycoplasma may also be problematic.

> > > Yeast Overgrowth

> > > Everyone's immune system has strong spots, as well as weak

spots.

> > Some people never get colds but have frequent bouts with

athlete's

> > foot or other skin fungal infections. Others never get fungal

> > infections but tend to get colds. Many people seem to have a

> > diminished ability to fight off fungal infections.

> > > Fungi are very complex organisms. Fungal overgrowth may

suppress

> > the body's immune system. The host body may also develop allergic

> > reactions to components of the yeast.

> > > This allergic reaction was suggested in a study which connects

> > Candida Albicans with Allergic Skin Dermatitis (Eczema). This

study

> > was published in The Journal of Clinical Experimental Allergy

back

> in

> > 1993 (Vol. 23, pp. 332-339). It found that there is a significant

> > correlation between the body having antibodies to Candida and

> > Allergic Dermatitis/Eczema. In addition, we have found that

> > unexplained rashes that have lasted for many years often clear up

> > with antifungal treatment as well! Many physicians feel that

yeast

> > overgrowth causes a generalized suppression of the immune system.

> In

> > other words, once the yeast gets the upper hand, it sets up a

cycle

> > that further suppresses your body's defenses. Interestingly, a

> recent

> > Mayo Clinic study showed that most cases of chronic sinusitis

seem

> to

> > be associated with a reaction to yeast in the sinuses - something

I

> > proposed years ago. None the less, as I already noted, this

theory

> is

> > controversial. Yeast are normal members of our body's " zoo.

> > > " They live in balance with bacteria - some of which are

helpful

> > and healthy and some of which are detrimental and unhealthy. The

> > problems begin when this harmonious balance shifts and the yeast

> > begin to overgrow.

> > > As noted above, many things can prompt yeast to overgrow. One

of

> > the most common causes is frequent antibiotic use. When the good

> > bacteria in the bowel are killed off by antibiotics (along with

the

> > bad bacteria) the yeast no longer have competition and begin to

> > overgrow. The body is often able to rebalance itself after one or

> > several courses of antibiotics, but after repeated or long-term

> > courses - and especially if the body has an underlying immune

> > dysfunction - the yeast can get the upper hand.

> > > Other factors are also important. Studies have shown that

animals

> > who are sleep deprived and/or have increased sugar intake develop

> > bowel yeast overgrowth. Many physicians feel that eating sugar

> > stimulates yeast overgrowth in people, as well. Sugar is food for

> > yeast. Yeast ferment sugar in order to grow and multiply. Yeast

> > overgrowth due to sugar overuse also seems to cause immune

> > suppression, which facilitates bacterial infections, which then

> > requires even more antibiotic use. Poor sleep also results in

> marked

> > suppression of your immune function.

> > > How Does One Know If They Have Yeast?

> > > There are no definitive tests for yeast overgrowth that will

> > distinguish yeast overgrowth from normal yeast growth in the

body.

> > There is one test which may be useful, though. This is a Urine

> > Tartaric Acid test done by The Great Plains Lab in Kansas City,

> > Missouri, run by Shaw, Ph.D. Tartaric Acid is a waste

> product

> > of yeast growth. In fermenting wine, for example, it is critical

to

> > remove the Tartaric Acid. Otherwise, the wine could be toxic to

> > people. Dr. Shaw has found elevations in Urine Tartaric Acid that

> > decrease with antifungal treatment in both CFIDS/FMS patients and

> > autistic children. Interestingly, both these illnesses often

> improve

> > with antifungals (specifically, Sporanox or Diflucan, plus

> Nystatin).

> > Dr. Shaw likes to use the Urine Tartaric Acid to decide when to

> treat

> > yeast overgrowth and to follow-up the effectiveness of treatment.

> > > In my experience, however, using Dr. Crook's Yeast

Questionnaire

> > (available in my book, From Fatigued To Fantastic!) is still the

> most

> > reliable way to tell if a person is at risk of yeast overgrowth.

If

> > the symptom score is over 140 points, I recommend treatment. In

> > addition, anyone who has been on recurrent or long-term

antibiotic

> > use (especially Tetracycline for acne) or anyone who

intermittently

> > has painful sores in different parts of the mouth that last for

> about

> > ten days at a time and who has CFIDS/FMS, should be treated with

> > antifungals. Bowel symptoms are some of the more overt symptoms

> that

> > are caused by yeast and I feel that most people who have " spastic

> > colon " have yeast overgrowth or parasites.

> > > How Is Yeast Treated?

> > > A number of very effective methods can be utilized to take care

> of

> > a yeast problem. Primary among the methods is to avoid sugar and

> > other sweets. One can enjoy one or two pieces of fruit a day, but

> > should not consume concentrated sugars such as juices, corn

syrup,

> > jellies, pastry, candy or honey. Stay far away from soft drinks,

> > which have ten to twelve teaspoons of sugar in every twelve

ounces.

> > This amount of sugar has been shown to markedly suppress immune

> > function for several hours. Be pre-pared to have withdrawal

> symptoms

> > for about one week when sugar is cut out of the diet. Several

> > excellent books have been written on the yeast controversy and

> offer

> > additional methods to try. One of the best books is The Yeast

> > Connection and the Woman by Crook, M.D., a physician who

> has

> > done a spectacular job advancing the understanding of CFIDS/FMS.

> > > Many patients have found that acidophilus (that is, milk

> bacteria,

> > a healthy bacteria for the bowel) helps restore balance in the

> bowel.

> > Acidophilus is found in yogurt with live and active yogurt

> cultures.

> > Indeed, one cup of yogurt a day can markedly diminish the

frequency

> > of recurrent vaginal yeast infections. Acidophilus is also

> available

> > in capsule form. Although many claims are made for one type of

> > acidophilus being better than the other, I'm not sure this is so.

I

> > usually recommend 3 to 6 billion units a day (1 unit = 1

bacteria)

> on

> > an empty stomach. If on antibiotics (not antifungals), take the

> > acidophilus at least 3 to 6 hours away from the antibiotic dose.

> > > Nystatin, an antifungal medication, has also been helpful in

the

> > treatment of yeast overgrowth. Unfortunately, some fungi seem to

be

> > resistant to Nystatin. In addition, Nystatin is poorly absorbed,

> > which means that it has little impact on the yeast outside of the

> > bowel. Other anti-fungal medications, such as Diflucan and

> Sporanox,

> > seem to be effective systemically (throughout the body) but they

> have

> > two main drawbacks. First, they are expensive, costing more than

> $450

> > to $900 for a two-month course. Second, any effective anti-fungal

> can

> > initially make the symptoms of yeast infection worse. Although

> > uncommon, Sporanox and Diflucan can also cause liver inflammation

> (as

> > can Advil and Tylenol). If you are taking Sporanox or Diflucan

for

> > more than 6 to 12 weeks, I would consider intermittently checking

> > liver blood tests (ALT and AST). If you have preexisting active

> liver

> > disease, be cautious in using (or don't use) Sporanox or

Diflucan.

> I

> > strongly recommend taking Lipoic Acid (a natural

> > > supplement which protects and helps heal the liver), 200mg a

> day,

> > whenever you take Sporanox or Diflucan. I also strongly recommend

> > Lipoic Acid for anyone with active liver disease (e.g.,

hepatitis)

> at

> > doses up to 1000mg to 3000mg a day as it may prevent and/or treat

> > cirrhosis.

> > > Natural Yeast Treatments

> > > Below, I have summarized the nonprescription part of the

> treatment

> > checklist that I use in my office.

> > > 1. Avoiding sweets is still the single most important thing.

> Using

> > Stevia as a sweetener is a wonderful substitute. Stevia is a

safe,

> > natural remedy and you can use all you want. There are even

> cookbooks

> > for using Stevia (available from my office or 800-4STEVIA). A new

> > natural sweetner, Sweet Balance, also tastes good and is 12 times

> as

> > sweet as sugar. It is a natural product from the Lo Han fruit and

> > appears to be safe. Although it is 70% sugar (fructose), you only

> > need a small amount. Order it from 877-997-9338, my office at 800-

> 333-

> > 5287 or my Web site at www.endfatigue.com.

> > > 2. Acidophilus or Milk Bacteria can be very helpful. Take 3 to

6

> > billion units a day (a unit is the same as a bacteria). Do not

take

> > acidophilus within 3 to 6 hours of an antibiotic. Take it either

on

> > an empty stomach or with milk.

> > > 3. Caprylic Acid is another natural remedy that can be helpful.

> The

> > usual dose is 1800 to 3600mg a day with 1/3 of the dose being

taken

> > at each meal. Unfortunately, it often causes an acid stomach with

> > a " funky " tasting reflux.

> > > 4. Oregano Oil - enteric coated oregano oil - 1 to 2 capsules,

2

> to

> > 3 times a day with food, may be more effective and better

tolerated

> > than Caprylic Acid (both can cause stomach acid reflux).

> > > 5. Fresh Garlic, if you can handle it well, can also be very

> > effective. Daily, crush 1 to 3 garlic cloves in olive oil, add

> salt,

> > spread it on bread and eat it. It can be quite tasty and lethal

to

> > whatever infections you have in your gut.

> > > 6. Olive Leaf 500mg, 2 to 4 capsules three times a day between

> > meals, can also be very helpful in treating yeast overgrowth.

> > > 7. Pau De Arco in either tea or capsule form is also helpful in

> > yeast suppression. Although I use Pau De Arco infrequently for

> yeast

> > over-growth, many people find that it can be helpful.

> > > 8. Grapefruit Seed Extract (e.g., Citrucidel) is a popular

> > treatment for yeast overgrowth and is well-tolerated.

> > > More Information On Yeast Treatments

> > > If symptoms of yeast are caused by an allergic or sensitivity

> > reaction to the yeast body parts, the symptoms may flare when

mass

> > quantities of the yeast are suddenly killed off. This is called a

> > yeast " die-off " reaction. If you get this reaction, start your

> > treatment with acidophilus and a sugar-free diet for a few weeks

> > followed by oregano oil and/or olive leaf (1500mg to 2000mg, 3

> times

> > a day between meals) before beginning Nystatin. Take Nystatin (by

> > mouth) in the form of 500,000-IU tablets or powder. I generally

> > recommend beginning with 1 tablet a day for 1 to 3 days, and

> > increasing by 1 tablet every 1 to 3 days (or slower if yeast " die-

> > off " is a problem) until 2 tablets 2 to 4 times a day is reached.

> If

> > you get nausea, take a lower dose. Take Nystatin, 4 to 8 tablets

> > daily, for 5 to 8 months. I add the Diflucan or Sporanox one

month

> > after beginning the Nystatin. Take 200mg every morning for six

> weeks.

> > If symptoms flare, take just 100mg per morning for the first 3 to

> 14

> > days. I

> > > f symptoms recur after stopping the Diflucan or Sporanox, I

> > recommend continuing the medication for an additional 6 weeks at

> > 200mg a day.

> > > Sporanox should be taken with food. If it is taken alone, its

> > absorption is greatly reduced. When taking Diflucan or Sporanox,

DO

> > NOT use the antihistamines Seldane or Hismanal, Quinidine (a

heart

> > medicine), cholesterol-lowering medications in the Mevacor

family,

> or

> > the bowel medicine Propulcid. These can be fatal combinations!

> Also,

> > antacid medications (such as Tagamet, Axid, Zantac, and Pepcid)

> > prevent the proper absorption of Sporanox. At the high price of

> > Sporanox per dose, you will want to absorb every last bit of the

> > medication. If you need to be on an antacid medication, use

> Diflucan

> > instead of Sporanox. Unfortunately, a less expensive antifungal,

> > called Lamisil (at 250mg a day), does not seem to work very well

> for

> > candida yeast overgrowth (although it works well for nail

> > infections). I am currently trying patients on 500mg of Lamisil a

> day

> > to see if this dose works better.

> > > I feel that once the yeast has been effectively decreased and

> kept

> > that way for six to twelve months, it is safe to try to add small

> > amounts of sugar back into the diet. If symptoms recur, however,

> stop

> > the sugar again. Continuing to eat yogurt with live and active

> > acidophilus cultures (unless you are lactose-intolerant) or

> > continuing to take acidophilus capsules may also help.

> > > Many books on yeast overgrowth (including Dr. Crook's) advise

> > readers to avoid all yeast in the diet. This advice is based on

the

> > theory that an allergic reaction to yeast is the cause of the

> > problem. The predominant yeast that seems to be involved in yeast

> > overgrowth is Candida Albicans, although I would not be surprised

> if

> > researchers discovered that many other kinds of fungal infections

> are

> > also involved. The yeast that is found in most foods (except beer

> and

> > cheese) is not closely related to candida.

> > > In my experience, trying to avoid all yeast in foods results

> simply

> > in a nutritionally inadequate diet and little benefit. Although a

> few

> > people do appear to have true allergies to the yeast in their

food,

> > they number less than 10 percent of my patients with suspected

> yeast

> > overgrowth. These patients may benefit from the more strict diet

in

> > Dr. Crook's book. Interestingly, once their adrenal insufficiency

> and

> > yeast overgrowth are treated, most people find that their

allergies

> > and sensitivities to yeast and other food products seem to

improve

> or

> > disappear.

> > > Nutritional deficiencies such as low zinc or low selenium may

> also

> > decrease resistance to yeast over-growth. A good multivitamin

> > supplement, as recommended in my last newsletter, should take

care

> of

> > these deficiencies. This is further evidence that all the factors

> > involved in CFS are closely interrelated.

> > > The best thing that one can do to combat yeast overgrowth is to

> try

> > to avoid it in the first place. When you get an infection, begin

> > treating it naturally immediately. Hopefully, you can prevent it

> from

> > turning into a bacterial infection which might require an

> antibiotic.

> > Ask your doctor what measures you can take before resorting to

> > antibiotics. Many good over-the-counter remedies are available. A

> > knowledgeable pharmacist may also be a wealth of information.

Your

> > local book or health food store has books on natural measures.

Your

> > health food store proprietor can also steer you to appropriate

> > natural remedies. For examples of the many helpful measures that

> one

> > can take, see my newsletter article, Treating Infections Without

> > Antibiotics, page ___).

> > > If you find however, that you must take an antibiotic, all is

not

> > lost. One can still lessen the severity of yeast overgrowth by

> > avoiding sweets and by either taking acidophilus capsules (again,

> not

> > within 3 to 6 hours of an antibiotic) or by eating one cup of

> yogurt

> > with live and active acidophilus cultures daily. Don't use the

> yogurt

> > (or milk) if you have sinusitis or pneumonia because the milk

> protein

> > thickens mucus and makes it hard for the body to fight these

> > infections.

> > > How Can One Tell If The Yeast Is Coming Back?

> > > It is normal for yeast symptoms to resolve after treatment.

After

> 6

> > weeks on the Sporanox or Diflucan, patients are usually feeling a

> lot

> > better, but may have symptoms recur soon after stopping the

> > antifungal. In this case I would continue the Sporanox or

Diflucan

> > for another 6 weeks, or as long as is needed, to keep the

symptoms

> at

> > bay. More frequently, people will feel better after treatment and

> > stay feeling fairly well for a period of 6 to 24 months. At that

> > time, it is common to see a recurrence of symptoms, especially if

> one

> > is eating too much sugar or is taking antibiotics. The best

marker

> > that I have found for yeast overgrowth would be a return of bowel

> > symptoms with gas, bloating and/or diarrhea or constipation. If

> these

> > symptoms persist for more than 2 weeks, especially if there is

also

> > even a mild worsening of the FMS symptoms, it is very reasonable

to

> > retreat yourself with 6 weeks of Nystatin and perhaps Sporanox or

> > Diflucan. In addition, I would also retreat if there's

> > > a recurrence of vaginal yeast or sinus infections. If re-

> treatment

> > resolves the symptoms, one may opt to repeat this regimen as

often

> as

> > is needed (usually every 6 to 24 months). By using some of the

> > natural remedies listed above, however, you may be able to avoid

> > repeated use of these antifungals and the possible risk of

becoming

> > resistant to them. Some patients also find that they need to stay

> on

> > the antifungals for extended periods of time (years) or the

> symptoms

> > will recur. When this is necessary, I add the natural remedies. I

> > will, however, also use the medications when needed. The main

risk

> of

> > long-term use of the antifungals Sporanox and Diflucan would be

> liver

> > inflammation. If these medications are being used for extended

> > periods, consider checking liver tests (SGOT and SGPT) every 3 to

6

> > months and anytime that a severe flu-like feeling or worsening of

> > symptoms occur. As noted above, it is very important to take

Lipoic

> > Acid 200mg a day when on Sporanox or Diflucan. Althoug

> > > h I am not aware of any studies using Lipoic Acid with

> antifungals,

> > in my experience I have seen no worrisome elevation on liver

tests

> if

> > patients are using this natural substance while taking these

> > antifungals. As an alternative, instead of taking the antifungals

> > every day, many people find they can get long-term suppression of

> the

> > yeast by taking Sporanox or Diflucan 200mg twice a day, one day

> each

> > week (e.g., each Sunday).

> > > Help For Chronic Bladder Infections

> > > Although we will be discussing some unusual infections,

CFIDS/FMS

> > patients also get more of the day-to-day variety of infections.

> These

> > include Urinary Tract (bladder) Infections (UTI). The main

symptoms

> > of a UTI are discomfort (e.g., burning) when urinating (dysuria),

> > urgency (which is the feeling that you have to go very badly and

> > right away when there is not much urine there), and frequency

with

> > low volume. These symptoms are also common in CFIDS/FMS patients

in

> > the absence of bladder infections and, when severe, is called

> > Interstitial Cystitis. I would not label someone as having

> > Interstitial Cystitis unless this is the major symptom of their

> > CFIDS/FMS, because almost everyone with this illness has some

> urinary

> > urgency and frequency. Because bladder symptoms can be seen in

both

> > UTI and CFIDS/FMS, it is important to have a urine culture done

> > before treatment with antibiotics to make sure that there is an

> > infection and not just muscle spasms in the bladder that are

> causing

> > these

> > > symptoms. If there is an infection, over 90% of the time it

will

> be

> > E-coli. This bacteria is normally found in everyone's gut and,

with

> > the exception of a few rare dangerous forms, is a healthy part of

> our

> > normal bowel bacteria. The problem occurs when the E-coli gets

out

> of

> > the bowel where it belongs and into the bladder. Usually the

> bladder

> > will wash out most infections when the urine comes out. The E-

coli

> > however, have little velcro-like projections that stick to the

> > bladder wall so that they can not be washed out by urination.

> > > Taking antibiotics will kill a bladder infection but will also

> kill

> > the healthy bacteria in the bowel. This sets one up for yeast

> > overgrowth and other problems. Because of this, unless there is

> fever

> > or back pain over the kidneys or a toxic feeling, it is

reasonable

> to

> > try natural remedies for one to three days before going with the

> > antibiotics. One can start these treatments while waiting for the

> > urine culture to come back.

> > > What Natural Remedies Can Be Used For Bladder Infections?

> > > There are two excellent natural remedies that can keep the E-

coli

> > from sticking to the bladder walls so they can be washed out. In

> > addition, taking vitamin C in high dose (e.g., 500 to 5000mg a

day)

> > can acidify the urine, making it inhospitable to the bacteria.

> > Drinking a lot of water also helps to wash out the infection.

> > > The two natural remedies that keep the bacteria from sticking

are:

> > > 1. Cranberries—Because approximately 20% of the female

population

> > suffers from UTIs, several studies have been done looking at this

> > remedy. An early study of 44 female and 16 male patients with

acute

> > bladder infections drank 16 oz. of cranberry juice a day for 15

> days.

> > Of these patients, 53% had positive responses and another 20%

> showed

> > modest improvement. Six weeks after stopping the juice, 27

patients

> > did have persistent recurrent infections and 8 of these had no

> > symptoms. Seventeen patients had no symptoms and negative urine

> > cultures.

> > > In another study of elderly women (who are more likely to have

> > bladder infections), 153 women either received 10 oz. of

cranberry

> > drink or placebo every day for 6 months. The group that got the

> > cranberry drink had 68% fewer bladder infections during that

> period.

> > In this study, the juice was sweetened with saccharin instead of

> > sugar. Other studies have also shown benefit using cranberry

juice

> in

> > bladder infections.

> > > Significant benefits are achieved by using 6 to 16 oz. of

> cranberry

> > juice a day. Because cranberry juice has a lot of sugar and can

> > promote yeast overgrowth and aggravate other symptoms in

CFIDS/FMS,

> I

> > think it is much better to use pure cranberry juice powder in

> capsule

> > or tablet form (standardized to contain 11% to 12% quinic acid).

> The

> > therapeutic dose is 1 to 2 capsules a day. Conversely, you can

use

> > unsweetened cranberry juice and add Stevia as a natural

sweetener.

> In

> > general, if one gives the usual cranberry juice cocktails a

> strength

> > of 1 unit - then, cranberry juice drinks have a strength of ½;

> > cranberry sauce a strength of ½; fresh or frozen cranberries are

4

> > times as potent; pure cranberry juice is 4 times as potent; and

> > cranberry juice capsules from unsweetened cranberry juice powders

> are

> > 32 times as potent.

> > > Cranberries work to help bladder infections because they have a

> > chemical (proanthocyanidins) that prevents the bacteria from

> sticking

> > to the bladder wall. They may also decrease the risk of kidney

> stones

> > (although magnesium with B6 is much better for this), as well as

> > possibly reduce urine odor.

> > > D-Mannose - This is more effective than cranberry juice.

Mannose

> is

> > a natural sugar (not the kind that causes symptoms or yeast

> > overgrowth) that is excreted promptly into the urine.

Unfortunately

> > for the E-coli bacteria, the fingers that stick to the bladder

wall

> > stick to the D-Mannose even better. When one takes a large amount

> of

> > D-Mannose, it spills into the urine, coating all the E-coli's

> > little " sticky fingers " so that the E-coli are literally washed

> away

> > with the next urination. The nice thing about the natural

approach,

> > as opposed to antibiotics, is that the cranberries or D-Mannose

> will

> > not kill the healthy bacteria, thereby not bothering the normal

> > balance of bacteria in the bowel. In addition, the D-Mannose is

> > absorbed in the upper gut before it gets to the friendly E-coli

> that

> > are normally present in the colon. Because of this, it helps

clear

> > the bladder without causing any other problems. In addition, the

D-

> > Mannose even tastes good.

> > > The D-Mannose is quite safe, even for long-term use, although

> most

> > people will only need it for a few days. Those who have frequent

> > recurrent bladder infections may, however, choose to take it

every

> > day. The usual dose of D- Mannose is 1/2 teaspoon every 2 to 3

> hours,

> > while awake, to treat an acute bladder infection; and 1/4 to 1/2

> > teaspoon 3 to 4 times a day to prevent severe chronic bladder

> > infections. It is best taken dissolved in water. For those who

get

> > bladder infections associated with sexual intercourse, one can

take

> > 1/2 teaspoon of D-Mannose 1 hour before and then just after

> > intercourse to prevent an infection. Remember, though, the D-

> Mannose

> > (and cranberries) only work in the 90% of bladder infections

caused

> > by E-coli bacteria. D-Mannose is available from several sources:

> > > 1. The Tahoma Clinic Dispensary (253-850-5661), which is

> associated

> > with the well-known nutritional physician, V. ,

M.D.

> > > 2. The Biotech Company (800-345-1199).

> > > 3. My office (800-333-5287) or my Web site at

www.endfatigue.com.

> > > The usual cost of D-Mannose is approximately $60 for 100 grams

> and

> > $35 for 50 grams. A 1/2 teaspoon is approximately 2 grams. One

> should

> > feel much better within 24 to 48 hours on D-Mannose. If not, see

a

> > doctor for a urine culture (you may want to get the culture at

the

> > first sign of infection) and consider antibiotic treatment after

> two

> > days if the culture is positive. Some evidence exists that

> > Macrodantin causes less yeast over-growth than do other

> antibiotics.

> > Even with other antibiotics, most bladder infections are knocked

> out

> > by one to three days of antibiotic use (instead of the old seven-

> day

> > regimen).

> > > Prostatitis

> > > Although women tend to be the ones plagued with bladder

> infections,

> > men don't get off unscathed either. It is very common in men with

> > CFIDS/FMS to have Prostatitis. Prostatitis is an inflammation or

> > infection of the prostate which is usually seen in younger men

> > between the ages of 20 and 50. It falls into three main

categories:

> > > 1. " Bacterial " Prostatitis is a acute or chronic infection in

the

> > gland that causes prostate swelling and discomfort.

> > > 2. Nonbacterial Prostatitis is when you feel swelling of the

> > prostate without being able to detect an infection. My suspicion

is

> > that it is not uncommon for prostatitis to be associated with

yeast

> > overgrowth or other infections that cannot be cultured (tested

> for).

> > > 3. Prostadynia is a general irritation of the prostate which

> causes

> > urinary burning, urgency and frequency but without there being

any

> > infection or swelling of the prostate. This can come from a

number

> of

> > causes including, I suspect, chronic spasm or tightening of the

> > muscles of the pelvic floor.

> > > The symptoms of chronic Prostatitis can come and go and be mild

> or

> > severe. The symptoms include:

> > > 1. Pain or tenderness in the area of the prostate. It is also

> > common to have burning on the tip of the penis.

> > > 2. Discomfort in the groin and, occasionally, lower back pain.

> > > 3. Urinary urgency and frequency with pain on urination.

> > > 4. Sometimes a slight penis discharge. If the discharge is

cloudy

> > and larger than one drop, or even a large drop, it is most likely

a

> > bacterial Prostatitis and I would then prescribe antibiotics. If

a

> > discharge is present, I would also check to make sure that there

is

> > not also a sexually transmitted disease (such as Chlamydia or

> > Gonorrhea) before beginning treatment.

> > > 5. Pain with ejaculation.

> > > If severe symptoms with fevers, chills and extreme fatigue are

> > present (symptoms of acute Prostatitis), antibiotics should be

> used.

> > The main treatment for bacterial Prostatitis consists of using

the

> > antibiotics Tetracycline (e.g., Doxycycline), Cipro, or Sulfa

> > (Bactrim or Septra DS). Unfortunately, since it is hard for the

> > antibiotics to be absorbed into the prostate, the symptoms often

> > recur even after six weeks of treatment. If antibiotics are

> required,

> > use Doxycycline or Cipro because these may be effective against

> other

> > hidden infections that can cause CFIDS/FMS.

> > > Although there are a number of causes of Prostatitis, excess

> > caffeine, alcohol and spicy foods can also contribute to the

> > symptoms. Sitting for long periods while traveling (e.g., being a

> > truck driver) can also cause irritation of the prostate. Although

> > normal bacteria are common causes, a few bacteria transmitted

> through

> > sexual contact can also cause Prostatitis. Some feel that the

main

> > psychological component of Prostatitis is shame.

> > > Bowel Parasite Infections

> > > A while back, the news focused our attention on Milwaukee

because

> > of repeated fatal outbreaks of an infection by a bowel parasite

> > called Cryptosporidium. A cartoon even made the rounds showing

> > Mexican tourists being warned not to drink the water in

Milwaukee!

> > Although this infection usually resolves on its own within a week

> or

> > two, it may persist in those with immune suppression. In fact,

> people

> > with acquired immune deficiency syndrome (AIDS) are particularly

> > susceptible and scores of Milwaukeens died from the

Cryptosporidium

> > outbreaks.

> > > Unfortunately, in many places throughout the United States, the

> > water supply is contaminated, and parasites are no longer just a

> > Third World problem. Doctors frequently see cases of infection by

> > giardia, amoeba and numerous other bowel parasites. Parasitic

> > infections can mimic CFS and, in immune suppressed situations

like

> > CFS, all parasites should be treated.

> > > Most laboratories miss the parasites when they do stool

testing.

> I

> > initially tested for bowel parasites by sending my patients'

stool

> > samples to a respected local lab. The tests kept coming back

> > negative, so I eventually stopped testing. Finally, I started

doing

> > my own laboratory stool testing. Doing the test properly was very

> > time consuming, taking up to five hours per specimen. However,

> > processing it properly, my tests frequently turned out positive.

In

> > my experience - and in that of other physicians as well - when

you

> > treat a patient for parasites, the patient's fatigue and achiness

> > often improves dramatically.

> > > If you would like your stool tested, make sure that the lab

> > specializes in stool testing and that the sample is a purged

> > specimen. A purged stool specimen is watery and loose, brought

> about

> > by the use of one-and-a-half ounces of Fleet's Phospho-Soda (a

> > laxative). The purpose of the stool purge is to get the best

> possible

> > stool sample to check for bowel parasites and yeast. The laxative

> > washes the organisms off the walls of the intestines so that they

> can

> > be detected. The routine random tests performed in almost all

> > standard labs are generally not adequate or reliable. In speaking

> > with several lab technicians, I was told they had less than one

> hour

> > of training in looking for parasites—which they found to be

> useless.

> > In fact, during one of our " doctors' " poker games, I spoke with a

> > gastroenterologist friend who noted that during a certain bowel

> exam

> > he had performed, he saw a large number of parasites swimming in

> the

> > patient's large bowel. He removed a big glob consisting of

nothing

> > > but mucus and parasites and sent it off to the major local

> > laboratory, just for confirmation of the infection and

> identification

> > of the parasite. Even this sample came back negative for

parasites!

> > This is why I stress that stool testing must be done at a lab

that

> > specializes in parasitology. Because two excellent labs are now

> > available to me to mail specimens to, I no longer have to do the

> > testing in my office. These labs are The Parasitology Center,

Inc.

> > (480-777-1078) and The Great Smokies Diagnostic Laboratory (800-

522-

> > 4762).

> > > At this point, no consistently effective prescription

medication

> is

> > available for Cryptosporidium infections. Artemisia annua,

however,

> > is an effective herbal treatment. For most of my patients, I

> > recommend using 1,000 milligrams three times a day for twenty

days.

> > Leo Galland, M.D., a parasite specialist, recommends a form of

> > Artemisia called tricyclin for many parasitic infections. He

> > recommends taking 2 tablets, 3 times a day after meals for six to

> > eight weeks. The cost of this antiparasitic herbal preparation is

> > about $30 for fifty tablets. See the treatment protocol below for

> > regimens for some other parasitic infections. The doctor who runs

> The

> > Parasitology Center also has a review article discussing which

> > natural remedies are effective against each type of parasite.

> Common

> > parasite treatment regimens also used in our office are on the

> > treatment checklist below.

> > > Antiparasitic Treatments

> > > 1. Flagyl (Metronidazole) – 750 mg, 3 times a day for 10 days,

> > followed by Yodoxin for many parasites. For Clostridium Difficile

> > take 250 mg, 4 times a day, or 500 mg, 3 times a day. It may

cause

> > nausea and vomiting (uncomfortable but usually not worrisome). Do

> not

> > drink alcohol while on this medication as it will make you vomit.

> The

> > SR (sustained release) form is easier on the stomach (as is the

> brand-

> > name form). If you get numbness or tingling in your fingers (or

it

> > worsens if you usually have it) stop the Flagyl.

> > > 2. Yodoxin (Iodoquinol) – 650 mg, 3 times a day, for 20 days

> after

> > Flagyl is completed.

> > > 3. Tinidazole – 2000 mg, once daily, for 3 consecutive days

with

> > food (for Entamoeba Histolytica) – OR - 3 doses, each 2 weeks

apart

> > (for Giardia or Dientamoeba Fragilis); Available at 's

> Pharmacy

> > (800-480-3432).

> > > 4. Humatin (Paromomycin) – 500 mg, 3 times a day, for 10 days

> (for

> > Cryptosporidium). For Blastocystis add Yodoxin.

> > > 5. Zithromax – 250 mg, once a day on an empty stomach for 10

> days,

> > along with Bactrim, 1 tablet twice a day for 10 days (alternate

> > treatment for Cryptosporidium). Add Artemesia.

> > > 6. Bactrim DS - 1 tablet, twice a day, plus Yodoxin 650 mg, 3

> times

> > a day with food for 10 days. Do not take Folic acid supplements

> > (e.g., B Complex or multivitamins) during these 10 days (for

> > Blastocystis).

> > > 7. Amphotericin B – 100 mg, two times a day, plus Tinidazole

500

> > mg, twice a day, plus Furoxone (Furazolidone) 1 tablet, twice a

> day.

> > Take these three together with food for 5 to 7 days (Amphotericin

B

> > and Tinidazole are available from 's Pharmacy 800-480-3432)

> > (treatment for refractory Blastocystis).

> > > 8. Lactoferrin – 350 mg, 1 to 3 capsules at bedtime.

> > > 9. Multi-pure Water Filter - Most other filters (except for

> reverse

> > osmosis) are ineffective. (Available from Bren son, 410-224-

> > 4877).

> > > 10. Artemesia Annua (a herbal antiparasitic) – 500 mg, 2

tablets,

> 3

> > times a day for 20 days.

> > > 11. Tricyclin (a herbal antiparasitic) - 2 tablets, 3 times a

> day,

> > after meals for 6 to 8 weeks (concentrated Artemesia).

> > > 12. Colostrum (mother's milk) - 3 capsules, 3 times a day, for

8

> to

> > 12 weeks. Then stop or use the lowest dose needed for symptoms.

If

> > nausea or indigestion occurs, lower the dose to a comfortable

level

> > for 1 to 2 weeks until it passes. Take on an empty stomach.

> > > 13. Quinacrine – 100 mg a day for 5 days. May be useful for

> empiric

> > therapy of suspected but not identified parasites (controversial).

> > > 14. Albendazole – 400 mg a day for 5 days. May be useful for

> > empiric therapy of suspected but not identified parasites.

> > > Filter Your Water

> > > Water filters can be very helpful in the fight against

parasitic

> > infection. However, not all units are designed to filter out

> > parasites. For a water filter to remove parasites, it must have a

> > submicron solid carbon block filter. A good example is the Multi-

> pure

> > Filter. Check the Consumer's Digest and Consumer's Report for

other

> > good units. Multi-pure Filters are available from Bren son

at

> > 888-801-8176 or 410-224-4877. He is a very reputable and

> > knowledgeable person and does not believe in " high pressure

sales "

> > (again, I get no money from people or companies whose products I

> > recommend).

> > > When shopping around for a water filter, request the National

> > Sanitation Foundation (NSF) International Listing for the

specific

> > unit you are considering. NSF is an independent not-for-profit

> > organization that tests and certifies drinking water treatment

> > products. The unit you buy should meet both NSF Health Effects

> > Standard 53 and NSF Aesthetics Standard 42, with Class I

reduction

> of

> > chlorine and particulate matter. Any unit that does not meet both

> of

> > these standards, particularly the health standard, is not

adequate.

> > To verify that a unit does meet these standards, call the NSF at

> 313-

> > 769–8010.

> > > In addition to verifying that a water filter meets the NSF

> > standards, ask to see its Product Performance Data Sheet. Many

> states

> > require that this sheet be given to all prospective customers of

> > drinking water treatment devices.

> > > Ask about the range of contaminants that the unit can reduce

> under

> > NSF Health Effects Standard 53. Most units certified under

Standard

> > 53 list only turbidity and cyst reduction. The number of units

that

> > also reduce pesticides, trihalomethanes, lead, and volatile

organic

> > chemicals is very small. Make sure that the water filter you are

> > considering can remove the specific contaminants that concern you.

> > > Ask if the unit is licensed in such states as California,

> Colorado

> > and Wisconsin. These states have some of the toughest

certification

> > procedures in the United States.

> > > Finally, ask about the unit's service cycle, which is stated in

> > gallons of water treated. Find out how often you will need to

> change

> > the filter and what the replacement filters cost.

> > > As the American water supply becomes more contaminated,

parasitic

> > bowel infections will likely become more common. These

infections,

> as

> > well as the overgrowth of yeast or toxic bacteria caused by

> > antibiotic use, contribute to feeling poorly.

> > > The Role Of Other Infections In CFIDS/FMS

> > > Many infections have been found in CFIDS. That people may have

> not

> > just one, but several of these simultaneously is significant. It

> > suggests that although these infections may be a trigger, in most

> > patients the immune system is suppressed and therefore they

become

> a

> > setup for unusual infections that persist. These infections may

> > then " drag you down, " further suppressing your immune system.

> > > Fortunately, most people improve (and often get very healthy)

by

> > simply treating the sleep, hormonal, nutritional and yeast

> problems.

> > Once these areas are treated, your body can usually eliminate any

> > persistent infections by itself. A subset, though, have

infections

> > that need treatment with antivirals and/or antibiotics.

> > > How Can I Tell If I Need These Treatments?

> > > First, I would try the other approaches discussed in my From

> > Fatigued To Fantastic! book and newsletters. I would try these

> > treatments if symptoms persist:

> > > 1. Those with predominantly flu-like symptoms with debilitating

> > fatigue and little or no pain or fever are more likely to have an

> > underlying persistent viral infection (e.g., HHV-6, Epstein Barr,

> > CMV, etc.).

> > > 2. Those with fevers (i.e., anything over 98.6°F in this

illness -

>

> > even 99°) and/or lung congestion, sinusitis, skin pustules or

other

> > chronic bacterial infections seem more likely to have infections

> > (i.e., bacterial, Mycoplasma, or Chlamydia) that respond to

special

> > antibiotics. Let's look at these two groups and how to approach

> them.

> > > HHV-6 And Other Viral Infections

> > > HHV-6 (Human Herpes Virus 6) is a virus that is related to the

> > Epstein Barr Virus (EB), Cytomegalovirus (CMV), and also to the

> > Herpes Viruses that causes cold sores and Genital Herpes. HHV-6

is

> > transmitted like the common cold and many people have had it, as

> well

> > as the EB Virus and the Cold Sore Virus by the time they are

twenty

> > years old. The body usually gets rid of all of these viruses on

its

> > own. Because of this, if you do routine (IGG) antibody testing,

> > almost everybody will be positive for EB and many for HHV-6 and

CMV

> > viruses. However, the IGG test will not tell you if you have

active

> > infections unless the IGM antibody is also positive (suggesting a

> new

> > infection). The IGM antibody is the one that increases in the

first

> > six weeks of an infection. This is followed by an elevated IGG

> > antibody, which stays elevated your whole life and acts as your

> > body's surveillance system. All an elevated IGG means is that

your

> > body has seen this infection and, if it sees it again, it's read

> > > y to knock it out quickly. This is how immunizations work. The

> > immunization creates the IGG antibody, so that instead of taking

> one

> > to two weeks to gear-up to fight the infection, your body can

> > eliminate that infection very quickly. Unfortunately, in CFIDS

you

> > can have a chronic low-grade infection—even if your IGG antibody

is

> > positive (elevated) - making the IGG antibody test for HHV-6, EB

> > Virus and CMV unreliable in CFIDS/FMS. In addition, the IGM

> antibody

> > will usually not be present in elevated levels in the low-grade

> > infections with these viruses that may be seen in CFIDS and FMS.

> > > What makes this important is that Valtrex at high-dose can

> > eliminate Epstein Barr virus, but will not work if active HHV-6

or

> > CMV infection is present. As I will discuss later, the only tests

I

> > would rely on to diagnose active HHV-6 are " rapid cell cultures "

or

> > PCR testing. Because some insurance companies are more likely to

> pay

> > for IGG than PCR testing, an argument can be made for checking

IGG

> > antibodies first. If the EBV IGG is positive and HHV-6 and CMV

IGG

> > are negative, one may choose to proceed with Valtrex 1000mg, 4

> times

> > a day, for 6 months, without PCR testing. If the HHV-6 or CMV IGG

> > antibodies are positive, then check the CMV and/or HHV-6 PCR

tests

> to

> > be sure they are negative.

> > > Tell Me More About HHV-6 And CFIDS

> > > Unfortunately there is no currently accepted standard treatment

> for

> > the HHV-6 Virus. Even though it is related to other Herpes

viruses,

> > HHV-6 is resistant to Acyclovir, Valtrex, Famvir and the other

> > antivirals that are commonly used in Herpes infections. The only

> > antiviral known to be effective against HHV-6 is Ganciclovir.

This

> > has significant side effects and has to be given intravenously

and

> > possibly forever to maintain the antiviral effect. Unfortunately,

> > this is not a viable option in day-to-day life and has been only

> > moderately successful when used. The main doctor who has been

using

> > Ganciclovir to treat HHV-6 in the United States is Joe Brewer,

> M.D.,

> > (816-531-1550) in Kansas City, Missouri. He found that 140 out of

> 207

> > CFIDS patients had positive HHV-6 cell cultures. Forty percent of

> > CFIDS patients were positive on their first test and 70% were

> > positive after three tests. This contrasts to 60 healthy patients

> he

> > checked in which none of the HHV-6 tests were positive. Culture

> > > s are more likely to be positive during acute flares of the

> > disease, when the viral level in the blood rises (see Page 9 for

> more

> > on HHV-6 PCR testing).

> > > As is often the case in CFIDS, there is conflicting data on

> > infections in Chronic Fatigue Syndrome. A recently published

study

> > (Reeves WC, et al., Clin Infect Dis, 2000 July; 31 [1] pp48-52)

> > examined 26 patients with Chronic Fatigue Syndrome and 52 healthy

> > patients in Atlanta, Georgia, at the CDC. In this study, several

> > tests for HHV-6 and HHV-7 were done, including Polymerase Chain

> > Reaction (PCR). HHV-6 DNA was found in 11% of CFIDS patients and

> 28%

> > of healthy patients, suggesting that the HHV-6 was actually less

> > common in Chronic Fatigue Syndrome than in healthy patients. At

> this

> > time, as the conflicting data shows, although HHV-6 may be one of

> > many suspect infections in CFIDS, it is not yet clearly the cause

> of

> > this illness.

> > > When HHV-6 is present, it seems to infect the natural Killer

> Cells,

> > important cells in your body's defense (immune) system that are

> > critical in fighting infections. A number of studies have shown

> these

> > Killer Cells to be malfunctioning in CFIDS. HHV-6 infection does

> not

> > necessarily decrease the number of the natural Killer Cells but

> does

> > decrease their function. Natural Killer Cell function is

described

> in

> > what is called Lytic Units—which means the ability of cells to

lyse

> > or break down foreign invaders. An average person will have a

Lytic

> > Unit level of 20 to 250 with over 80% of healthy patient being

over

> > 40 units. Dr. Brewer finds that in CFIDS the mean Natural Killer

> > Lytic Cell level is 12 units. Dr. Brewer uses Specialty Labs in

> > California for his Natural Killer Lytic Cell testing and finds

that

> > the Lytic level stays the same on repeat testing and seems to be

a

> > reliable test for Natural Killer Cell function testing in CFIDS.

> > Lytic unit levels will, however, decrease during flar

> > > es of symptoms. In Dr. Brewer's experience, this test is very

> > specific for CFIDS and Multiple Sclerosis. He has treated ten MS

> > patients and five CFIDS patients with the I.V. Ganciclovir. He

> found

> > that it helped to stabilize the MS patients. In the CFIDS

patients,

> > two to three were much improved, one still had a positive viral

> > culture and one had a poor response. Unfortunately, maintaining

> > patients on I.V. Ganciclovir forever (as noted above) is not a

> viable

> > option. Fortunately, an oral pill form of Ganciclovir

> > (Valganciclovir) is currently being developed! It should be noted

> > that the HHV-6 virus is similar to CMV (Cytomegalovirus), and

that

> > whatever is effective against one, tends to be effective for the

> > other. This is a helpful bit of information as we follow new

> research

> > looking for clues on how to eliminate HHV-6 infection.

> > > What Roles Does The Epstein Barr And Cytomegalovirus Play In

> CFIDS?

> > > Again, the roles of the EB and CMV viruses are not clear. It is

> not

> > uncommon for antibody levels of these viruses to be elevated in

> > Chronic Fatigue Syndrome. As noted above, it is not clear whether

> > this simply reflects a previous or ongoing infection with these

> > viruses. Research by a husband and wife team (the Glasers) at

Ohio

> > State University, suggests that Epstein Barr Virus is still quite

> > active and playing a role in many patients with these infections.

> In

> > addition, work by Lerner, M.D., also suggests that EB

Virus

> > and CMV are active as well. In speaking with Dr. Lerner's

research

> > assistant, I found out that he has found EB Virus and CMV to both

> be

> > fairly common in patients with Chronic Fatigue Syndrome (with and

> > without pain). He found that about 20% had positive IGM and/or

> > elevated EA (early antigen) tests to the EB Virus with negative

> > Cytomegalovirus. Of these, two-thirds improved with high-dose

> Valtrex

> > (an oral antiviral). Despite my teasing and prodding, his associat

> > > e refused to give out the dose of Valtrex they prescribed

because

> > Dr. Lerner does not want to be responsible for people using these

> > higher doses until he completes the double-blind trial that is

> > currently in progress. On the other hand, another study of his

did

> > use 1000mg, 4 times a day, giving the antiviral for 6 months. It

> > takes about 3 to 4 months before patients start to improve and

> after

> > 6 months people can stop the Valtrex without the symptoms coming

> > back. However, if there is no improvement in 6 months, consider

it

> to

> > be a negative result. They also found that, as noted above, the

IGM

> > is almost always negative using the reagents used in most labs.

> They

> > found that only Epstein Barr IGM antibody testing, using a

reagent

> by

> > the Diasorin Company (800-328-1482), has been useful in showing a

> > significant number of positive tests. When we called the company,

> the

> > only lab in the Washington, D.C., area using it was at the NIH.

The

> > company may, however, be able to give you the name of

> > > a lab near you that can do the test. What was fairly common,

> > though, (and present in most patients) was either positive tests

> for

> > Epstein Barr, CMV, or a combination of both as noted above. When

> CMV

> > or HHV-6 are present, the Valtrex is less likely to work because

it

> > is not effective against these viruses.

> > > In another study done by Dr. Lerner (Infectious Diseases In

> > Clinical Practice, 1997; 6:110-117) he found that patients who

had

> > elevated CMV IGG antibodies, but no significant evidence of

> > associated Epstein Barr virus (i.e., negative IGM and early

antigen

> > (EA) antibody total less than 40), did improve with I.V.

> Ganciclovir

> > at 5mg per kg of body weight given every 12 hours I.V. for 30

days.

> > In this study 72% (13 of the 18 patients) improved markedly at

the

> > end of a month without any significant side effects. As noted, an

> > oral form of Ganciclovir is currently in development as well. It

> > should be noted that 36% of the Chronic Fatigue Syndrome patients

> > that Dr. Lerner checked (18 out of 50) did turn out to have

> elevated

> > CMV antibodies (albeit IGG) in the absence of IGM and EA

antibodies

> > to EB Virus (i.e., no evidence of active Epstein Barr Virus). It

> > should be noted, though, that 70% of healthy patients also had

> > positive IGGs to CMV (as per our discussion above) in the study

and

> > appears

> > > that the overall level of the IGG was not much higher overall

in

> > the Chronic Fatigue group than in the healthy controls. On the

> other

> > hand, the higher the level of CMV antibody in the Chronic Fatigue

> > group, the more likely they were to improve with the I.V.

> Ganciclovir.

> > > What this means is that patients with Chronic Fatigue Syndrome

> > don't necessarily have different blood tests for antibody levels

> than

> > healthy people for these viruses. However, if one has a higher

> level

> > rather than a lower level, one is more likely to improve with the

> > Ganciclovir. Previous research has not shown benefit from

antiviral

> > therapies in CFS (Straus SE, et al., New England Journal of

> Medicine

> > 1988; 319:1692-1698). Our experience using a fairly high dose of

> > Valtrex or Famvir (1500mg and 2250mg a day respectively) also

> showed

> > no significant improvement on these regimens after 6 weeks, at

> which

> > time we considered it to be ineffective. On the other hand, Dr.

> > Lerner's research is suggesting that perhaps we gave it for too

> short

> > a time and at too low a dose. When treating himself and a few

other

> > patients, he used Valtrex by mouth at a dosage of 1000mg, 4 times

a

> > day, for 6 months. Using the higher dosing and the extended

period

> of

> > time, as well as separating out groups that have

> > > Epstein Barr Virus (sensitive to the oral Valtrex) without CMV

> or

> > HHV-6 (resistant to oral Valtrex but sensitive to I.V.

> Ganciclovir),

> > may make an important difference in making treatment effective.

No

> > major Valtrex toxicity was seen. As noted above, a double-blind

> study

> > is currently in progress and we are beginning to try the higher

> dose

> > of Valtrex in the 15% of our patient population that have not

> > improved adequately and have positive EBV, and negative CMV and

HHV-

> 6

> > tests. We hope to give you follow-up information on the

treatment's

> > effectiveness as soon as we know!

> > > In addition, Dr. Lerner suspects that these infections affect

the

> > heart muscle contributing to much of your symptoms. I am not

> > convinced that this is the case because EKG changes are common in

> > CFS. This can occur because the autonomic (brain) dysfunction and

> > hormonal changes seen in CFS can cause these same EKG changes

> without

> > heart damage. Regardless, he found that these changes went away

> with

> > treatment (as has been our experience in treating Chronic Fatigue

> > Syndrome—patient's EKG changes improve even without antivirals).

> Dr.

> > Lerner is currently recruiting patients for a double-blind study

> > using the high-dose Valtrex. His phone number is 248-540-9688 in

> > Beverly Hills, Michigan.

> > > Does This Mean There Is Nothing We Can Do Now?

> > > Although there is no currently accepted specific treatment for

> the

> > CMV and HHV-6 viruses, there are still a number of things that

may

> be

> > very helpful in fighting this infection.

> > > 1. Lithium tends to be antiviral and has been shown to decrease

> > pain in FMS patients when added to treatment with Elavil. Lithium

> is

> > commonly used in manic depressive illness and is a natural

mineral

> > despite being sold by prescription. In high doses, it can cause

> some

> > neurologic symptoms and suppression of the thyroid gland, but

these

> > can usually be treated by taking a small amount of Essential

Fatty

> > Acids and thyroid hormone. Lithium might also worsen Restless Leg

> > Syndrome. Although we have no direct evidence of Lithium being an

> > effective antiviral against HHV-6, it may well be effective

because

> > it works against a number of other viral infections. In our

> > experience, 200mg to 600mg a day seems to be the effective dose

in

> > treating FMS patients. As noted above, I would check the thyroid

> > blood tests at 3 months, 6 months and then yearly (check a Free

T4

> > and a Total T3 - not a TSH). A Lithium level should also be

checked

> > at the same time to be sure that it not above the upper limit of

> > > normal. The level can be below the normal range, which is fine

as

> > long as the treatment is effective. You may find that you can

lower

> > the Lithium dose after you have been on it for several months.

> > > 2. Heparin (a blood thinner, see Page 12) also has antiviral

> > properties.

> > > 3. It is worth considering trials of high-dose Valtrex. It

should

> > be noted that 1000mg, 3 times a day, is used for shingles in

older

> > patients and appears to be quite safe. On the other hand, higher

> > dosing at 8 grams a day in AIDS patients did result in uncommon

> > (under 2%) life threatening problems. This is common even with

day-

> to-

> > day drugs in AIDS patients (for example, regular sulfa

antibiotics

> > have often resulted in severe toxicity in AIDS patients).

> > Nonetheless, we will be limiting the dose to 1 gram, 4 times a

day,

> > in our practice. It is important to note that taking Tagamet

and/or

> > Probenecid (Benemid) will raise the blood level of Valtrex.

Tagamet

> > has powerful immune modifying properties and is very helpful in

> acute

> > cases of Epstein Barr (mono) infections. Because of this, we are

> > adding Tagament 300mg, 4 times a day (but not Probenecid), to the

> > Valtrex. As I noted, we are beginning this treatment with some of

> our

> > patients and will let you know what we find.

> > > Natural Remedies

> > > 1. Olive Leaf - This is an herbal which is known to have a wide

> > spectrum of anti-infectious activity. It has been shown to be

> > effective against the HHV-6 virus in the test tube. I have not,

> > however, seen studies testing its effect in human beings infected

> > with HHV-6. Nonetheless, a number of physicians have found that

> using

> > Olive Leaf in Chronic Fatigue Syndrome is very effective. There

is

> > controversy over whether the form and source of the Olive Leaf is

> > critical. We recommend that you use a form that has at least 6%

> > Oleuropein, which is one of the most active antiviral components

in

> > the Olive Leaf. Other components may be important and some people

> > also feel that you must use the Mediterranean Olive Leaf vs. the

> > American Olive Leaf. Other people argue that you should have a

form

> > that is organically grown, without pesticides. At this point it

is

> > not clear whether this is simply marketing or important in day-to-

> day

> > life. Nonetheless, I would be picky about the companies you buy

the

> O

> > > live Leaf from. I would use one of these sources:

> > > a. My office (800-333-5287) or my Web site at

www.endfatigue.com.

> > > b. Pacific Research Labs (800-325-7734). This is owned by R. J.

> > Marshall, Ph.D., who has done a fair bit of work treating CFIDS

> > patients with Olive Leaf. I will be describing the protocol that

he

> > uses below.

> > > c. General Nutrition Centers (GNC).

> > > Dr. Marshall feels that during infections, the body becomes

> overly

> > acidic. He tests the morning urine specimens with pH paper (which

> is

> > very easy to do at home) and gives a shell extract, which raises

> the

> > body's alkalinity. He feels that having a normalized acid-base

> > balance in your body helps it to fight infections. He then adds

his

> > form of Olive Leaf, called Infectostat (which also contains

> mushroom

> > extracts to stimulate the immune system), giving 3 to 4 capsules,

3

> > to 4 times a day, to help fight the infections. Usually, the

> patient

> > should start feeling better within four weeks on this protocol.

> > Although we have found it helpful in fighting colds and other

> common

> > respiratory infections, we are just starting to explore Olive

> Leaf's

> > use in a few of our patients who have not responded to standard

> > treatment and are still quite ill. We will let you know our

> > experience with this in an upcoming newsletter issue. My guess,

> > though, is that simply using regular (6% Oleuropein) Olive Leaf

> > > 500mg capsules, 3 to 4 capsules, 3 to 4 times a day between

> meals,

> > will probably be equally effective and cheaper for most people

than

> > the expensive forms. How long one needs to take Olive Leaf in

> Chronic

> > Fatigue Syndrome is yet to be determined.

> > > Initially, a pharmaceutical company was developing the

Oleuropein

> > in Olive Leaf as an antiviral. Because it gets bound to the blood

> > proteins, they thought that Oleuropein might not get to the

> tissues.

> > More importantly, Oleuropein is a natural product and therefore

> hard

> > to patent. Because of these problems, they stopped research on

it.

> > Years later this research was rediscovered and explored further.

In

> > addition to being an effective antiviral agent, Olive Leaf is

> > reported to be effective on a number of bacterial and yeast

> > infections as well. What is most exciting regarding the Olive

Leaf

> is:

> > > a. That some doctors have found it to be effective in CFIDS,

and

> > > b. That in tests against HHV-6 and CMV virus (remember that if

> > something is effective against one, it tends to be effective

> against

> > the other) the Olive Leaf extract did not just suppress the virus

> but

> > killed it. That is very promising.

> > > 2. Pro-Boost - Thymic Protein A (used to be called BioPro) -

This

> > is the immune stimulant that I discussed in my newsletter, Vol.

2,

> > Issue 2. Although not a hormone, Pro-Boost mimics the natural

> hormone

> > produced by your Thymus - the gland which stimulates your immune

> > system. I find it to be extraordinarily effective in fighting

> common

> > infections of any kind that seem to pop up. For the more deep-

> seated

> > infections of CFIDS, the higher dose (1 packet, 3 times a day)

will

> > likely be needed. Once the infection seems to be in check and you

> are

> > feeling better (i.e., after 6 weeks), you can taper down to the

> > lowest dose that maintains the effect.

> > > 3. IP6 - This natural immune stimulant is an extract of bran

> > (phytates). It is less expensive and is sometimes combined with

> > vitamin C. The dose of IP6 (available from many sources) is 5 to

8

> > grams a day. Do not take IP6 within 3 hours of vitamin/mineral

> > supplements.

> > > 4. MGN3 - This is a very concentrated mushroom extract, which

has

> > been shown to stimulate Natural Killer Cell immune function. In

one

> > study, it actually tripled Natural Killer Cell function—an effect

> > that, as the HHV-6 virus can suppress Natural Killer Cell

function,

> > could be very powerful. Unfortunately, it is horribly expensive

in

> > the recommended dose (250 mg capsules) of 2 to 4 capsules, 4

times

> a

> > day for 2 weeks, followed by 2 capsules, 2 times a day. Other

> > mushroom extracts are cheaper but may not be as effective.

> > > 5. Intravenous Vitamin C at high-dose (15gm to 50gm) has been

> > suggested to have antiviral effects in a number of other

infections

> > and is often dramatically helpful in CFIDS when given in the I.V.

> > nutritional therapy called " Myers Cocktails " (see my newsletter,

> Vol.

> > 3, Issue 3).

> > > 6. Lysine 1000 mg, 3 times a day - This amino acid protein is

> safe

> > and inexpensive (27¢ a day). It inhibits oral/genital herpes (by

> > depleting the Arginine the virus needs to grow). I do not know if

> it

> > also inhibits EBV, HHV-6 or CMV viral infections.

> > > I would take the combination of these together (as is

affordable)—

> > perhaps leaving the MGN3 for later if needed, giving the

treatment

> > for at least a 6 to 8 week trial to see if it's effective. If you

> are

> > feeling better at 6 weeks, you can then taper down the dose

slowly

> as

> > long as the benefit is maintained. When able, you can wean

yourself

> > off the treatments. If symptoms recur, go back up to the dose

that

> > maintains the benefit or consider increasing the dose further. As

> we

> > are just starting to use this protocol in our patients, I do

> > appreciate your feedback on what has worked for you and what has

> not.

> > You can " vote " for what helped or didn't help you on our Web site

> at

> > www.endfatigue.com. You can also see other people's votes.

> > > In addition, your clotting system may be activated by several

> > infections making it difficult to eliminate them. Using the anti-

> > clotting treatments that we will discuss later can also make it

> > easier for your body to eradicate infections.

> > > Mycoplasma And Chlamydia

> > > Other infections have also been found to be very important in

> > CFIDS. Dr. Garth Nicolson and his wife, who were on-faculty at

the

> > University of Texas Medical School at Houston and the Department

of

> > Microbiology and Immunology at Baylor College of Medicine in

> Houston,

> > Texas, are the leading proponents of treatment of these

infections.

> > Dr. Garth Nicolson was an endowed chair and department chairman

at

> > the University of Texas, the M.D. Cancer Center in

> Houston,

> > Texas, and a Professor of Internal Medicine at the University of

> > Texas Medical School, also in Houston. Dr. Nicolson's wife had

> > Chronic Fatigue Syndrome years ago. They were surprised that her

> test

> > turned out to be positive for Mycoplasma fermentans (also known

as

> > Mycoplasma fermentans incognitus). This Mycoplasma was found to

be

> > resistant to the Penicillin- and Keflex-family antibiotics that

> most

> > doctors use, but was sensitive to long courses of Doxycycline and

> > Cipro. After an extended course of Doxycycline treatment,

> > > she was much better. The Nicolsons then went on to develop

their

> > own tests for Mycoplasma using PCR testing. Dr. Nicolson tells me

> > that, in addition, when his step-daughter came home after serving

> in

> > Desert Storm, she came down with Gulf War Illness (GWI). They

> tested

> > hundreds of Gulf War veterans with GWI and 40% to 45% were

positive

> > for Mycoplasma infections—almost all with Mycoplasma fermentans.

> This

> > has been confirmed by other labs and a large Veterns

Aministration

> > study involving over 2,000 patients. In contrast to this,

soldiers

> > who were not deployed to the Gulf during the war, had less than a

> 6%

> > incidence of being positive for these infections.

> > > Interestingly, the Nicolsons found that in patients with

Chronic

> > Fatigue Syndrome or Fibromyalgia, approximately 70% (144 out of

203

> > patients) had a positive PCR test for one, or usually several

> > species, of Mycoplasma. When the Nicolsons tested 70 healthy

> > patients, only 6 patients (less than 9%) were positive for any of

> the

> > Mycoplasma species. This is a highly significant difference. Only

2

> > of these 70 healthy people were positive for Mycoplasma

fermentans.

> > Similar results have been found by other doctors and have been

> > published.

> > > As we have said before, it is likely that there is a group of

> > underlying problems and not a single one that triggers CFIDS/FMS.

> > This applies to infections as well. This is why you can see tests

> be

> > positive for both viral and Mycoplasmal infections in so many

> people

> > with this disease. For Mycoplasma alone, when they checked for

four

> > different types of Mycoplasma, over half of the 93 CFIDS patients

> > that were positive had more than one type of infection. Over 20%

of

> > them had three out of the four Mycoplasma infections test

positive.

> > The more infections that were positive, the worse the patient's

> > symptoms were and the longer they had had CFIDS/FMS.

> > > What Are Mycoplasma?

> > > Mycoplasma are an ancient bacteria that lacks cell walls and

are

> > capable of invading a number of types of human cells. They can

> cause

> > a wide variety of human diseases. These organisms can cause the

> types

> > of symptoms seen in Chronic Fatigue Syndrome patients and,

> according

> > to Dr. Nicolson, tend to be immune suppressing. Unfortunately,

they

> > cannot be readily cultured on a culture dish like regular

bacteria.

> > In medicine, we have a bad habit on focusing on that which is

easy

> to

> > test for and making believe that that which is hard to test for

> does

> > not exist. Because of this, bacterial infections such as

pneumonia,

> > bladder infections and skin infections, where one bacteria on a

> cell

> > dish will rapidly turn into millions by the next day and be

visible

> > to the human eye, get all our attention. Unfortunately,

Mycoplasma,

> > which cannot be easily cultured, tends to be ignored. It's like

the

> > old story about the little kid who was looking for his lost keys

> > under the street lamp one night. His frien

> > > ds came by and asked him what was going on. He told them and

they

> > all looked for the keys under that light for about an hour.

> Finally,

> > exasperated, they looked at the friend and said, " Where did you

> lose

> > these keys? " The kid looked up and said, " Oh, about half a block

> down

> > the street. " They said, " Why are you looking for them here? " He

> > said, " Because there is a light here and I can see! " This is kind

> of

> > what it is like in medicine. If there is a test for something

(such

> > as cholesterol and bacterial cultures) that is easy to do, we

focus

> > our attention on that test and make believe that it finds the

main

> > problem. Unfortunately, in CFIDS and FMS, this is not the case.

> > > The data suggests that many infections may trigger CFIDS/FMS or

> > that CFIDS and FMS may cause immune suppression—which then sets

you

> > up to catch a whole bunch of different infections which your body

> has

> > trouble clearing. This is why it is important to treat all the

> > underlying processes simultaneously as I discuss in my From

> Fatigued

> > To Fantastic! book and newsletters.

> > > So, How Do You Look For These Infections?

> > > I had the honor of speaking with Konnie Knox, M.D., a major re-

> > searcher on HHV-6 testing in CFIDS/FMS, who uses a technique

called

> > Rapid Cell Culture. She actually infects different test tube

cells

> > with HHV-6, grows them, and then looks for signs of HHV-6 in the

> > cell. In her experience, one out of three CFIDS/FMS patients are

> > positive for active HHV-6 infection on the first blood test. When

> > multiple testing is done (e.g., three tests), 70% are positive.

> This

> > test is negative in the vast majority of people who are healthy.

> The

> > other main illness where the HHV-6 test is positive is Multiple

> > Sclerosis. At this time, HHV-6 Rapid Cell Culture and the PCR

test

> at

> > Dr. Nicolson's lab (International Molecular Diagostics) are the

> only

> > HHV-6 test I order. For more information on Dr. Knox's work, go

to

> > these Web sites: www.HHV-6.com and www.cnet.com. For the IMD

> website,

> > go to www.imd-lab.com.

> > > The Nicolsons use very sensitive PCR (Polymerase Chain

Reaction)

> > testing to actually look for DNA specific to Mycoplasma, HHV-6,

and

> > other infections. Unfortunately, those DNA pieces are so

> > microscopically small, that to look for just one is much worse

than

> > looking for a " needle in a haystack. " With the PCR, if that

> > Mycoplasma gene sequence is found, the technique multiplies it

like

> a

> > copying machine until millions of that sequence are present and

can

> > be picked up by testing. Because of this, PCR testing is

> exquisitely

> > sensitive and can find the proverbial " needle in a haystack. "

This

> > makes it very powerful and the only testing that I would

recommend

> in

> > looking for these Mycoplasma and Chlamydia infections. As noted

> > above, IGG antibody testing is not reliable for Mycoplasma and

> > Chlamydia testing in CFS.

> > > Where Do I Get These Tests Done And Should I Have Them Done?

> > > The tests for HHV-6 and Mycoplasma each cost about $180 to

$250.

> As

> > noted above, the only places that I would get the HHV-6 test done

> > (and the only tests I would do are PCR or viral culture testing)

> are

> > at the Wisconsin Viral Institute (414-774-0311) or Dr. Nicolson's

> > lab. I order all the lab testing for Mycoplasma and Chlamydia at

> the

> > Nicolson's lab, at International Molecular Diagnostics, 15162

> Triton

> > Lane, Huntington Beach, CA 92649 (714-799-7177 ext. 202 or 204).

> The

> > lab's Web site is www.imdlab.com.

> > > I can almost guarantee that if you do the Mycoplasma or

Chlamydia

> > tests at your local lab they will do the wrong tests and they

will

> be

> > useless for hidden CFS infections. I have never seen one come

back

> > with any useful information. What they usually do is check the

> > antibodies (usually for the wrong Mycoplasma infection) which

> simply

> > shows that you (like everybody else at some point in their life)

> have

> > had a Mycoplasma infection. It tells nothing about active

infection

> > and, again, is useless. Be sure to do the PCR testing and do it

at

> > one of the two labs discussed above. Dr. Nicolson has noted which

> > tests he recommends in CFS/FMS, their cost and instructions for

the

> > lab. We have reprinted this information on the next page (Dr.

> > Nicolson's lab also does viral PCR testing for CMV, as well as

HHV-

> 6).

> > > Even at the best labs, it is not uncommon to have a false-

> negative

> > report (where you have the infection and it does not show up on

the

> > test). Because of this, especially for HHV-6, multiple tests will

> > often need to be done. There are good arguments for not doing the

> > tests and simply going ahead and treating empirically with the

> > natural remedies discussed above for HHV-6, or for prescribing

> > Doxycycline or Cipro for an extended period of time (see below).

If

> > you feel better after four months on the treatment, then you know

> you

> > are hitting an infection and you can always intermittently stop

the

> > treatments to see how long you will need them. Also, there are

many

> > infections that are not tested for with these tests that would be

> > effectively treated with the regimens that we are discussing.

Many

> of

> > these are likely to be infections that we don't even know exist.

> > Because of this, if resources are limited, I some-times simply

> treat

> > the patient, based on clinical suspicion, without doing the

> > > tests.

> > > Testing does have its benefits. If the test is positive, I am

> > likely to treat more aggressively and it helps guide me on how

long

> > to give the treatment. For example, if after four months you are

> not

> > better and the test is positive, I would be likely to go ahead

and

> > increase dosing or change to a different antibiotic. If the test

> was

> > negative, I would be more likely to just stop treatment and

suspect

> > that the infection is less likely. This argues in favor of doing

> the

> > tests. One simple thing to do is to go ahead and check with your

> > insurance company to see if they cover these tests. This may make

> > your decision much simpler. Unfortunately, I suspect that the way

> > that most labs draw and ship your blood sample may not be

reliable

> > because, in our experience, we have had less than 10% of

patient's

> > tests come back positive for HHV-6 cell culture and only a modest

> > percent come back positive for the Mycoplasma. For the PCR

> Mycoplasma

> > test, the blood has to be frozen (see boxed inset, Page 9

> > > ). If the blood is left at room temperature, most of the

positive

> > samples become negative after one to two days.

> > > Mycoplasma testing is not as specific as HHV-6 testing is for

> > CFIDS/FMS/Multiple Sclerosis (i.e., it is positive in other

> > illnesses). For example, about half the patients with Rheumatoid

> > Arthritis are also found to be infected with treatable

infections,

> > including Mycoplasma. This goes along with my, and other doctors'

> > experience, that Doxycycline is often effective in treating

> > Rheumatoid Arthritis. Interestingly, although Mycoplasma is

common

> in

> > the environment, it usually is fairly noninvasive. It may simply

be

> > that once your immune system is weakened, these infections can

get

> > into cells where they don't belong. When that happens, even some

of

> > the common ones that are considered noninfectious can wreak

havoc.

> > When these infections repro-duce slowly, they tend to be low-

grade,

> > chronic infections, as opposed to the acute and more prominent

> > symptoms seen with bacterial and viral infections that multiply

and

> > divide rapidly.

> > > For CFS/ME or FMS or Autoimmune Disease Patients,

> > > The Institute for Molecular Medicine suggests the following lab

> > tests:

> > > (Codes are I.M.D. or CPT Codes)

> > > 1. Test Panel 1007 (CPT: 87798x3, 87581) Mycoplasma species

panel

> > of 4 pathogenic mycoplasmas (M. fermentans, M. penumoniae, M.

> > hominis, M. penetrans) by PCR.

> > > Justification: Almost 60% of CFS/FMS and 50% of Rheumatoid

> > Arthritis (RA) and other autoimmune patients have one or more

> > intracellular, systemic mycoplasmal infections similar to those

> found

> > in a variety of chronic illnesses [Nicolson, et al., Mycoplasmal

> > infections in chronic illnesses: Fibromyalgia and Chronic Fatigue

> > Syndromes, Gulf War Illness, HIV-AIDS and Rheumatoid Arthritis;

> > Medical Sentinel 1999; 5:172-176]. Ultrasensitive and

ultraspecific

> > mycoplasma tests can only be done by a small number of labs, most

> > university or government labs that have been trained by us under

a

> > U.S. government contract.

> > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> > (EDTA). The blood is collected, immediately mixed and placed on

> ice,

> > then shipped on wet ice or immediately flash frozen and shipped

> with

> > dry ice by courier (foreign shipments) to I.M.D. to arrive within

> 24-

> > 36 hours. Cost=$250. (Note that other commercial labs charge $400-

> > 600.)

> > > 2. Test 1006 (CPT: 87486) Chlamydia pneumoniae test by PCR.

> > Justification: Many CFS, FMS, MS, RA and other patients have this

> > systemic infection along with viral infection(s). We were among

the

> > few labs that developed the molecular tests that are now done for

> > this type of infection. The other labs that use these procedures

> are

> > university labs.

> > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> > (EDTA). The blood is collected, immediately mixed and placed on

> ice,

> > then shipped on wet ice or immediately flash frozen and shipped

> with

> > dry ice by courier to I.M.D. to arrive within 24-36 hours.

> Cost=$180.

> > (Note that other commercial labs charge $200-250.)

> > > 3. Test 07047 (CPT: 87476) Borrelia burgdorferi (Lyme Disease)

> test

> > by PCR.

> > > Justification: Many CFS, FMS and RA patients have this systemic

> > infection (diagnosed as Lyme Disease) along with other infection

> (s).

> > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> > (EDTA). The blood is collected, immediately mixed and placed on

> ice,

> > then shipped on wet ice or immediately flash frozen and shipped

> with

> > dry ice by courier to I.M.D. to arrive within 24-36 hours.

> Cost=$180.

> > (Note that other commercial labs charge $200-250.)

> > > 4. Test 07039 (CPT: 87532) Human Herpes Virus 6 (HHV-6) test by

> > PCR.

> > > Justification: Many CFS and some FMS patients have this

systemic

> > viral infection, and it should be tested for in any autoimmune

> > illness.

> > > Specimen Requirements: Collect blood in one (1) 5 cc Lavender-

top

> > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > centrifugation. The plasma is then shipped on wet ice or

> immediately

> > flash frozen and shipped with dry ice by courier to I.M.D. to

> arrive

> > within 24-36 hours. Cost=$180. (Note that other commercial labs

> > charge $200-350.)

> > > 5. Test 07034 (CPT: 87496) Cytomegalovirus (CMV) test by PCR.

> > > Justification: Many CFS and FMS patients have this systemic

viral

> > infection, and it should be tested for in any autoimmune illness.

> > > Specimen Requirements: Collect blood in one (1) 5 cc Lavender-

top

> > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > centrifugation. The plasma is then shipped on wet ice or

> immediately

> > flash frozen and shipped with dry ice by courier to I.M.D. to

> arrive

> > within 24-36 hours. Cost=$180. (Note that other commercial labs

> > charge $200-300.)

> > > For the best price and highest quality, the above PCR specialty

> > tests for CFS/FMS patients can be ordered through International

> > Molecular Diagnostics, Inc., 15162 Triton Lane, Huntington Beach,

> CA

> > 92649, U.S.A. Tel: 714-799-7177, ext. 202 (Client Services) or

ext.

> > 204 (Brant Blasingame). Order forms and additional information

are

> > available upon request. They also offer testing for blood

clotting

> > abnormalities (see below). Tests must be ordered by a physician.

> The

> > I.M.D. Web site is www.imd-lab.com. On this site you will find

> > additional information about testing and disease. The Institute

for

> > Molecular Medicine Web site is www.immed.org. On this site you

will

> > find publications and documents on CFS/ME, FMS, autoimmune

diseases

> > and other chronic illnesses. Immediate fax-back information is

> > available 24 hours per day by calling our telephone number 714-

903-

> > 2900.

> > > Garth Nicolson, Adjunct Professor of Internal Medicine

> > > President and Chief Scientific Officer, The Institute for

> Molecular

> > Medicine

> > > —A nonprofit institute dedicated to discovering new diagnostic

> and

> > therapeutic solutions for chronic diseases—

> > > 15162 Triton Lane, Huntington Beach, CA 92649-1041, U.S.A. •

Tel:

> > 714-903-2900 • Fax: 714-379-2082

> > > So, What Is Prescribed For Mycoplasma And Chlamydia?

> > > Fortunately, Mycoplasma and Chlamydia infections are usually

> > sensitive to the right antibiotics. The antibiotics most likely

to

> > effect these organisms are:

> > > 1. Doxycycline or Minocycline 100 mg, 2-3 times a day. These

two

> > antibiotics are in the Tetracycline-family and should not be used

> in

> > children under eight years-old because they can cause permanent

> > staining of the teeth. They are very effective, though, against a

> > number of unusual organisms (e.g., Lymes Disease). They will

> > sometimes cause some stomach upset. If this occurs, take the

> medicine

> > with food and a full glass of water or lower the dose. Do not use

> > outdated/expired Tetracycline prescriptions—they can kill you!

> > > 2. Cipro (Ciprofloxacin) 750 mg, twice a day. Although

expensive,

> > this is usually a well-tolerated antibiotic. It has a very wide

> range

> > of effectiveness against a large number of organisms. When

treating

> > males, the Cipro (as well as the Doxycycline) has the additional

> > benefit of treating any hidden prostate infections. Do not take

> oral

> > magnesium within 6 hours of Cipro or you won't absorb the Cipro.

> > > 3. Zithromax 600 mg a day, taken with food, or Biaxin 500 mg,

> twice

> > a day, taken on an empty stomach. These are in the Erythro-mycin

> > family. Zithromax tends to be fairly well-tolerated. The Biaxin

is

> > more likely to cause a bit of nausea in some patients, but it is

> > usually well-tolerated. Both are quite expensive. They may work

> > against infections missed by Doxycycline and Cipro.

> > > Although all of these antibiotics can be effective, it is not

> > uncommon for infections that are sensitive to the Erythromycin

> > antibiotics (#3 above) to be resistant to #1 and #2 above and

vice-

> > versa. Therefore, it is best to try either Doxycycline or Cipro

> > first. If they are not effective, then try the Zithromax or

Biaxin.

> > The antibiotic should be taken for at least 6 months. If there is

> no

> > improvement in 4 months, switch to or add the other antibiotic or

> > simply stop the treatment. It is helpful to check for low-grade

> > fevers. I am more likely to use antibiotics for CFIDS patients

who

> > have temperatures over 98.6°F, even if it is only 98.8° (I

consider

> > 98.8° a fever because CFIDS/FMS patients usually have low body

> > temperatures). If you do have low-grade, chronic temperature

> > elevations, be sure that you monitor your temperatures during

> > treatment. If your temperature drops with the antibiotic, it

> suggests

> > that you do have one of these nonviral infections and the

> antibiotic

> > is helping. T

> > > his would encourage me to continue the antibiotic trial - even

if

> > it takes up to 12 months to see an improvement in your symptoms.

> > > If you are clearly better, I would probably take the antibiotic

> for

> > at least 6 to 12 months. It can then be stopped. If symptoms

recur,

> > keep repeating 6 to 8 week cycles until the symptoms stay gone.

It

> > may take several years of treatment for the infection to be

totally

> > eradicated. To put it in perspective, this is how long children

> often

> > take antibiotics for acne—which unfortunately, if not taken with

> anti-

> > fungals, can lead to yeast overgrowth and possibly trigger CFIDS.

> Be

> > sure to take Nystatin, 2 tablets, 2 times a day, while on the

> > antibiotics. Also, please be sure to use alternative birth

control

> if

> > on " the pill. " Birth control pills may be ineffective while

taking

> > antibiotics. In addition, anti-depressants, codeine, antacids,

and

> > mineral supplements (e.g., magnesium) may block antibiotic

> > absorption. Take these at least three hours away from the

> antibiotic

> > (and don't take the antidepressant/codeine medications if they

are

> > not clearly helping).

> > > It is very common to get die-off (Herxheimer) reactions which

> > include chills, fever, night sweats and general worsening of

> CFS/FMS

> > symptoms when the antibiotic first kills off the infection. These

> can

> > be severe and last for weeks. Dr. Nicolson encourages you " to be

> > patient and not abandon therapy prematurely, because few patients

> who

> > have been sick for years recover in less than one year of

> therapy...

> > [don't] be alarmed if some signs and symptoms occasionally return

> or

> > worsen. This is not unusual. Eventually you will be off

antibiotics

> > or antivirals but you will need to continue various supplements

to

> > maintain your immune system and general nutritional status. "

> > > Treatment for Bacterial, Mycoplasma, Chlamydia, E-coli,

Bladder,

> Or

> > Other Infections

> > > (From the " Treatment Checklist " used in Dr. Teitelbaum's

office.

> A

> > full list is available on Dr. Teitelbaum's Web site at

> > www.endfatigue.com.)

> > > The Mycoplasma, Chlamydia, E-Coli, bladder and other bacterial

> > infections usually take months to years to eradicate. It is

common

> to

> > flare your symptoms (from the infection die-off) the first two

> weeks

> > of treatment. Take the antibiotics for six months and, if better,

> > then repeat six-week cycles till your symptoms stay gone.

> > Antidepressants, Neurontin, and/or Codeine may block the

> antibiotic's

> > effectiveness. Be sure to take Nystatin, 2 tablets twice a day,

and

> > Acidophilus while on the antibiotics. If you have occasional low-

> > grade fever (i.e., if over 98.6° F), check your oral temperature

> > occasionally to see if the antibiotic reduces or eliminates the

> > fever. If so, stay on that antibiotic. Also, see Dr. Nicolson's

Web

> > site at www.immed.org for additional information.

> > > Useful antibiotic treatment for the above infections include:

> > > 1. Cipro (ciprofloxacin) 750 mg, 2 times a day for 6 months. Do

> not

> > take magnesium products (e.g., Fibrocare, some antacids, Pro

> Energy,

> > or (Dr. Teitelbaum's) Foundation Formula™) within 6 hours of

Cipro

> > because you won't absorb the Cipro.

> > > OR

> > > 2. Doxycycline (a tetracycline) 100 mg, 3 times a day for 6

> months.

> > If symptoms recur when the Doxycycline is completed, keep

repeating

> 6-

> > week courses until the symptoms stay resolved. Take Nystatin (at

> > least 2, twice a day) while on the antibiotic. Birth control

pills

> > may not work while on Doxycycline. Do not take any expired

> > Doxycycline tablets (it's very dangerous).

> > > OR

> > > 3. Zithromax (azithromycin) 600 mg tablets, 1 tablet a day

(take

> > with food if it bothers your stomach). Don't take magnesium-

> > containing products within six hours of the Zithromax.

> > > OR

> > > 4. Biaxin 500 mg, 2 times a day.

> > > 5. D-Mannose ½ to 1 teaspoon (2.5 grams), stirred in water,

every

> 2

> > to 3 hours while awake, for 2 to 5 days for acute bladder

> infections

> > (may use long-term for chronic infections) caused by E-coli (this

> > causes approximately 90% of bladder infections). If not much

better

> > in 24 hours, get a urine culture and consider an antibiotic. D-

> > Mannose is available from BioTech (800-345-1199), my Web

> > site's " Vitamin Shop " at www.endfatigue.com or my office (800-333-

> > 5287).

> > > What About Yeast Overgrowth?

> > > Yeast overgrowth is an important concern. As I have mentioned

> > before, nothing is all good or all bad. Although cigarettes kill

> > hundreds of thousands of people each year, they can be helpful in

> > treating Parkinson's Disease or ulcerative colitis. Although

> > antibiotics can trigger CFIDS, they can also be helpful in

treating

> > it. This makes it important to know when and how to use them. I

> > strongly recommend that my patients take antifungals while on any

> > antibiotics (e.g., Nystatin 500,000 unit tablets, 2 tablets, 2 to

3

> > times a day) to prevent yeast overgrowth. It is also reasonable

to

> > add Oregano Oil and other natural antifungals. Two Nystatin twice

a

> > day is what I usually prescribe. Using probiotics (healthy milk

> > bacteria-like acidophilus that helps your body) to compete with

the

> > yeast can also help. I am concerned that if the acidophilus is

> taken

> > with the antibiotic, they may simply cancel each other out.

Because

> > of this, I usually begin probiotics (Acidophilus or Lactobacillus

> in

> > a d

> > > ose of 3 to 6 billion units a day, taken on an empty stomach or

> > with milk) after one has completed the course of antibiotics. If

> you

> > are only taking the antibiotic once or twice a day, and can find

a

> > time at least 6 to 8 hours away from another dose to take the

> > probiotic, it is reasonable to take it at that time. The entire

> daily

> > probiotic dose can also be taken at one time. If you find that

you

> > still get yeast overgrowth, it may be necessary to use some of

the

> > more potent prescription antifungals (Sporanox or Diflucan).

> Because

> > these can cause liver inflammation and are quite expensive, it

may

> be

> > adequate to take 200mg of either of these, twice a day, one day

> each

> > week (e.g., take it every Sunday) instead of every day. As

> discussed

> > previously, be sure to take Lipoic acid 200 mg on any day you

take

> > Sporanox or Diflucan, to decrease the risk of liver inflammation.

> > > What Role Does My Blood Clotting System Play In This?

> > > Work done by E. Berg, M.S., C.L.S. (N.C.A.), director of

> > Hemex Laboratories in Phoenix, Arizona (800-999-2568), has shown

> that

> > a number of infections can trigger our blood clotting system to

> > become active, thus setting up a low-level, chronic clotting

> cascade.

> > These infections include HHV-6, Mycoplasma, CMV and Chlamydia

which

> > can trigger production of (IgA) antibodies against clot

protective

> > proteins on blood vessel inner surfaces (called antiphospholipid

> > antibodies). One of these is the Beta 2 Glyco-protein 1 (anti

B2GP1—

> > no, you are not going to be tested on this!). This then triggers

> the

> > clotting cascade. Once the clotting system is triggered, a

product

> > called Soluble Fibrin Monomer (SFM) is made which is like the

> > polymers in plastic. The theory is that they create long thin

> sheets

> > of a teflon-like substance, similar to the scab that covers a

cut,

> > but microscopic, which then coats the blood vessels. This makes

it

> > hard for nutrients, oxygen, etc., to get in and out of the b

> > > lood vessels to the cells where they are needed. In summary,

many

> > infections can cause the blood clotting system to activate,

> resulting

> > in a thin coating of Fibrin deposited on the blood vessels. This

> > prevents nutrients and oxygen from getting to the cells in your

> body.

> > > Why Would An Infection Trigger The Clotting System?

> > > Many infections (called anaerobic) do not survive well in the

> > presence of oxygen. One can theorize that these Mycoplasma (which

> may

> > be anaerobic) and other organisms may trigger the clotting system

> to

> > create a shell, which then acts like a suit of armor, protecting

> them

> > from oxygen, your body's defense system, and antibiotics. This

> would

> > explain why these infections could evolve a way to trigger the

> > clotting mechanism. The Fibrin armor preventing antibiotics from

> > getting to the infection could also explain why some people with

> > these infections may not respond to antibiotics. Indeed, some

> > physicians have found that the antibiotics work better once

someone

> > has been on a blood thinner (which may dissolve the armor).

> > > This is an interesting theory, but how do we know this is going

> on?

> > Mr. Berg and others have done studies showing that the blood

tests

> > that look for these clotting changes (called the ISAC panel -

> > available at Hemex labs) are abnormal in CFIDS/FMS patients while

> > being normal in most other patients. They use a criterion of two

of

> > these tests needing to be abnormal to be considered positive.

When

> > this was done, 50 of 54 CFIDS/FMS patients had abnormal tests

> (i.e.,

> > only 7.4% of the patients had normal blood tests). In healthy

> > patients, 22 out of 23 had normal blood tests (i.e., 96%). This

> means

> > the test is both very sensitive and specific, picking up people

> with

> > CFIDS and excluding healthy people. Our experience has shown that

> > almost everyone that we tested, who has CFIDS, has turned out to

> have

> > a positive ISAC panel. We have not personally sent in any tests

on

> > healthy patients to see if this also occurs. Interestingly, this

> > panel is also positive in many people with unexplained infer

> > > tility (which can improve with Heparin) and may also be

positive

> in

> > people with Multiple Sclerosis, Parkinsons, Autism, Inflammatory

> > Bowel Disease and some other illnesses. This suggests that this

> test

> > can be helpful in deciding whether to treat with blood thinners

> > (Heparin) in CFIDS/FMS.

> > > So, How Do I Treat The Clotting System?

> > > First of all, it is important to remember that using injections

> of

> > Heparin (the blood thinner) is still a controversial and

> experimental

> > treatment for CFIDS/FMS. We much prefer to use treatments that

are

> as

> > safe as possible. Although Heparin is routinely used in the

U.S.A.

> to

> > treat blood clots, using it to treat CFIDS/FMS is very new. Most

of

> > the doctors that I have spoken with have only treated a few

> CFIDS/FMS

> > patients with Heparin and find that about half of these patients

> get

> > better with treatment. The treatment protocol, developed by

> > Couvaras, M.D. (602-996-2411), includes the following:

> > > 1. Remove wheat, alcohol and sugar from the diet, if possible.

> > > 2. Check the ISAC panel. If there are at least two abnormal

> > results, then begin treatment.

> > > 3. Give an antifungal for 14 days (he uses Lamisil 250mg a day—

> > which I find to be poorly effective. I would use 200 mg of

Sporanox

> > or Diflucan instead).

> > > 4. Give standard Heparin 4000 to 8000 units by injection

> > subcutaneously (like an insulin shot) twice a day. A (possibly

> safer)

> > low molecular weight Heparin may also be used.

> > > 5. If the PA index (on the ISAC) is positive, add a baby

Aspirin

> > (81mg) each day.

> > > 6. After being on Heparin for one week, Dr. Couvares repeats

the

> > ISAC panel to adjust the dose of the Heparin and Aspirin. He

feels

> > that the goal is to move all the blood tests into the normal

range

> > but not past the normal range into blood-thinning (therapeutic)

> > levels. If the values are still abnormal or the patient is still

> > having symptoms, he then increases the Heparin dosage. If the PA

> > index (on the ISAC) is still high, he increases the Aspirin to

> twice

> > a day.

> > > 7. If the patient feels better after one month of Heparin, he

> then

> > switches to low-dose Coumadin (a blood thinner tablet—take 2 to 3

> mg

> > a day) and then stops the Heparin after 4 to 5 days of being on

the

> > Coumadin. Once the patient has been on the Coumadin for two weeks

> he

> > goes ahead and rechecks the ISAC panel to maintain the blood

tests

> in

> > the normal range.

> > > 8. He also supplements patients with nutritional

supplementation

> as

> > needed.

> > > In my practice, because the ISAC panel runs over $320, I check

a

> > baseline ISAC panel but do not repeat the ISAC panels to adjust

> > therapy. Instead, while on Heparin, we check a PTT (a blood

> thinning

> > test) and platelets (a highly unusual, but potentially very

> dangerous

> > side effect of Heparin is a severe drop in platelet count, which

> can

> > cause life-threatening bleeding) every 3 days for the first 12

days

> > and then every 2 to 4 weeks while on Heparin. If the PTT is still

> > within the normal range and the patient is not better, we

increase

> > the Heparin as high as 8000 units, twice a day (rarely we will go

> up

> > to 8000 units, 3 times a day) and then also increase the Aspirin

to

> 2

> > a day. In comparison, hospital patients often require Heparin at

> 1000

> > units per hour (24,000 units a day) I.V., while most CFS/FMS

> patients

> > only need 4000 to 5000 units, 2 times a day (8000 to 10,000 units

a

> > day). If the patient is feeling better, however, we simply leave

> them

> > at the initial dose. Most patients will f

> > > eel better at about the 10- to 14-day point if the Heparin is

> going

> > to help. At the end of 4 to 12 months, if the Heparin helps, we

> > switch to Coumadin (as noted above) and check an INR

(International

> > Normalized Ratio), aiming to keep it below 1.3 while adjusting

the

> > Coumadin to the optimum does. It is very important to know that

> most

> > medications can change the blood level of Coumadin and that

anytime

> > anything is added to, or deleted from, your regimen (including

> > natural remedies) you need to recheck the INR 4 to 7 days later

to

> > make sure that it is not going too high. Heparin and Coumadin are

> > powerful medicines and the main risk is bleeding. Although we are

> > using very low doses, which are usually very well-tolerated, one

> can

> > rarely see a life-threatening bleed occur. If you felt better on

> the

> > Heparin and then the symptoms come back on the Coumadin, you may

> need

> > to go back on the Heparin for several months to re-establish and

> > maintain the benefit. Occasionally, people will need to b

> > > e on the Heparin for an extended period, in which case the

blood

> > tests (PTT and platelet count) should be checked every 2 to 4

> weeks.

> > All of this being said, most people tolerate these treatments

quite

> > well and many, many more people die from taking Aspirin (e.g.,

for

> > arthritis) than Heparin each year.

> > > In summary, there are a number of infections that can cause or

> > occur because you have CFIDS/FMS. Once they occur, they can

trigger

> > the clotting cascade. This may keep the nutrients from getting to

> > your body and create a " suit of armor " for the viral and

Mycoplasma

> > infections. Using a blood thinner can break down these armor

> coatings

> > that protect the infections from our treatment and allow

nutrients

> to

> > get where they need to go. Many tests can help. The one that I

use

> to

> > decide whether to use the Heparin blood thinner is the ISAC panel

> (at

> > Hemex Labs). Testing for infections may be helpful, but can be

> > expensive and less likely to effect my decision to treat. If you

> can

> > afford the tests and/or your insurance will pay for them, they

are

> > worth checking and will make it easier to adjust therapy over

time.

> > If you can't afford it, it is reasonable to treat empirically

> (i.e.,

> > without testing), except for high-dose Valtrex therapy. If you

have

> > lung congestion and/or recurrent temperatures o

> > > ver 98.6°F, I would treat with the antibiotics. If you feel

> > chronically flu-like, I would consider the HHV-6 or (based on

> > testing) the high-dose Valtrex regimen. It is also reasonable to

> > treat with antibiotics and antivirals simultaneously - especially

> if

> > you are taking the anticoagulants.

> > > Chronic Sinusitis The Yeasty Beasties Revisited!

> > > As was mentioned years ago, we speculated that the chronic

sinus

> > congestion seen in CFIDS/FMS could be caused by yeast overgrowth.

A

> > recent interesting study from the Mayo Clinic Proceedings

supports

> > this thought. In the study, researchers found that most people

with

> > chronic sinus infections had fungal growth in their sinuses. They

> > felt that the inflammation was being caused by an immune (the

> body's

> > reaction) response to the fungus. This research is interesting

> > because more and more studies are showing that treating chronic

> > sinusitis with antibiotics doesn't really do much and that

shorter

> > courses of treatment work just as well as the long courses. We

find

> > that conservative treatment (see my newsletter article, Treatment

> Of

> > Respiratory Infections Without Antibiotics, Vol. 2, Issue 2) is

> more

> > effective than antibiotics for chronic sinusitis.

> > > It's good that medicine is finally starting to catch up with

> > reality. The report in The Mayo Clinic Proceedings noted

> > that, " fungus allergy was thought to be involved in less than 10%

> of

> > cases… our studies indicate, in fact, fungus is likely the cause

of

> > nearly all of these problems and that it is not an allergic

> reaction

> > but an immune reaction. " In this study, the researchers studied

210

> > patients with chronic sinusitis. Using new methods to collect and

> > test sinus/nasal mucus they found fungus in 96% of patients.

> > > It's interesting to observe how medical research works. The

> > researchers are now working with different drug companies to set

up

> > trials to test medications to control the fungus but feel that it

> > will be at least two years before any treatments will be

available.

> > In my experience, though, these problems often respond

dramatically

> > to either Sporanox or Diflucan - which, by no coincidence, are

very

> > powerful antifungal agents. It is not clear why the researchers

did

> > not simply try Sporanox or Diflucan. Un-fortunately, we find that

> the

> > obvious is often overlooked. This sometimes occurs as drug

> companies

> > seek to make more money by finding new drugs instead of using the

> old

> > things that are known to work. It is important to distinguish

> between

> > chronic sinusitis (which lasts for over three months) and acute

> > sinusitis (which usually has been going on for a few days and

less

> > than a month). For these shorter attacks of sinusitis, bacteria

are

> a

> > more common cause and antibiotics (combined with n

> > > atural remedies) can be helpful. Some researchers still

continue

> to

> > argue that fungus is not a cause of chronic sinusitis. They note

> that

> > fungi are seen even in healthy noses (which is correct) but

neglect

> > to discuss the immune changes that are also seen in these noses.

> > Because so many people have responded dramatically to antifungals

> in

> > the treatment of their chronic sinusitis, my suspicion is that

the

> > Mayo Clinic researchers are probably correct. Wouldn't it be

nice,

> if

> > instead of arguing about treatments while people stay sick, they

> > would just try the treatments to see if they worked!

> > > As you can see, your body's defenses being down plays a large

> role

> > in CFIDS/FMS. The good news is, that by treating the many

> underlying

> > infections common in CFIDS patients and by treating any hormonal

> and

> > nutritional deficiencies, you can bring your immune system back

to

> a

> > healthy state!

> > > Important Points

> > > • An important component of CFS is disordered immune function,

> > which opens the door to repeated infections, repeated treatment

> with

> > antibiotics, and yeast overgrowth.

> > > • Treat yeast overgrowth by avoiding antibiotics and sweets.

Many

> > patients have found Nystatin and other antifungal medications,

such

> > as Diflucan and Sporanox, to be helpful. Acidophilus (milk

> bacteria)

> > and natural antifungals such as Caprylic acid and garlic are also

> > often useful.

> > > • Bowel parasites are common in CFS patients, whose symptoms

> often

> > respond dramatically to treatment. However, most labs do not

> > adequately detect parasites through stool testing. To get an

> accurate

> > test result, use one of the labs we recommended that specializes

in

> > stool testing.

> > > • Treat Cryptosporidium with Artemesia annua or tricyclin

(herbal

> > antiparasitics).

> > > • Treat constipation with Turkey Rhubarb (a herb).

> > > • Prevent parasitic infection by using a Multi-pure water

filter

> > (available from 888-801-8176 or 410-224-4877)

> > > • If you have temperatures over 98.6°F and/or chronic lung

> > congestion, try long-term Cipro or Doxycycline (while on

Nystatin).

> > > • If you have chronic flu-like symptoms, despite yeast and

Cortef

> > treatment, consider the antiviral, immune stimulating protocol we

> > discussed.

> > >

> >

>

[Guest guest]

Hi Krista,

Patty is right about docs not knowing how to treat adrenals. I've

been to several docs who can't answer questions and only seem to

address the adrenals if you're suffering from 's or

Cushing's...which you're not. As far as natural treatments, I was on

Adrenal Stress End from Dr. Kolb, yet my endocrinologist doc here

said to stop taking it because my urine and blood had normal

cortisol. No other doc seems comfortable treating them, except for

Mercola, who I see next week. I'll let you know what he says,

although I've already heard he prescribes a very small amount of DHEA

and pregnenelone.

Based on my experience, you're better off seeing a naturopath instead

of an endocrinologist because naturopaths understand and acknowledge

adrenal fatigue. Love, PH

> > > >

> > > > From Fatigued to Fantastic Newsletter

> > > > Vol. 3, No. 3 (2000)--Vol 4, No. 1 (2001)

> > > >

> > > > Fighting Those Persistent Infections in CFIDS

> > > > By Teitelbaum, M.D.

> > > > Medical science has known for quite some time that Chronic

> > Fatigue

> > > Syndrome is associated with changes in the body's immune

system.

> In

> > > fact, the acronym " CFIDS " stands for " Chronic Fatigue And

Immune

> > > Dysfunction Syndrome. " This can result in your having several

> > > different and unusual infections at one time. Many of these

> > > infections need to be treated directly. Other infections will

go

> > away

> > > on their own as your immune (defense) system comes back " on

line "

> > by

> > > using our treatment protocol. In this article, I'll discuss

some

> of

> > > the more common, yet not usually thought of (in " regular "

> > medicine),

> > > infections.

> > > > What Kind Of Infections Am I Most At Risk For?

> > > > Although CFIDS of sudden onset often seems to be triggered by

> > viral

> > > infections (e.g., EBV, HHV-6, CMV), those infections, I

suspect,

> > > are " simmering " or no longer active in many cases. However, the

> > body

> > > acts as if they are. This may result in elevated interferon

> levels.

> > I

> > > suspect this was what triggered my CFIDS.

> > > > The body produces interferon to fight viral infections. When

a

> > > cancer or hepatitis patient is injected with interferon, the

> > patient

> > > becomes achy, fatigued and brain-fogged. An under-active

adrenal

> > can

> > > also cause interferon levels to become elevated. Because of

this

> > > elevation, it is more accurate to say that the body's immune

> system

> > > is not functioning properly, than to say that it is

underactive.

> > > Indeed, in many ways, the immune system may be in overdrive and

> > soon

> > > exhaust itself. The immune system malfunctions in many other

> ways,

> > > too, including decreasing the effectiveness of the

> body's " natural

> > > killer " cells, which are an important defense mechanism.

> > > > Many other recurrent or unusual infections can also occur

> because

> > > of your malfunctioning immune system. Chronic sinus, bladder,

> > > prostate and respiratory infections are common and are often

> > treated

> > > with repeated courses of antibiotics. The large amount of

> > antibiotics

> > > introduced into the system can cause a secondary yeast over-

> growth

> > as

> > > it changes the natural balance between the bowel's healthy

> bacteria

> > > and yeast. The original immune dysfunction also contributes to

> the

> > > yeast overgrowth. Although it is controversial, a theory held

by

> > many

> > > physicians is that chronic overgrowth of yeast due to overuse

of

> > > antibiotics is a potential and strong trigger for chronic

> fatigue,

> > > fibromyalgia and further immune dysfunction. What makes the

> theory

> > > controversial is that no definitive tests exist to distinguish

> > fungal

> > > overgrowth from normal fungal levels. Also, many of the

symptoms

> > > ascribed to yeast overgrowth can also come from the many other

> > > problems present in chronic fatigue syndrome and fibromya

> > > > lgia. On the other hand, most doctors who try treating yeast

in

> > at

> > > least three or four CFS patients see how well it works and keep

> > using

> > > it.

> > > > CFIDS patients also frequently have bowel parasite

infections.

> > > Bowel parasites can cause severe allergic or sensitivity

> reactions,

> > > which in turn can trigger fibromyalgia and fatigue. Often, a

> > patient

> > > will finally recover from long-standing and disabling fatigue

> > within

> > > a week or two after beginning treatment for bowel parasites.

> > > > Many other CFS/FMS patients are left with disabling fatigue

> after

> > a

> > > bout with viral infections such as polio, HHV-6, CMV, or EB

viral

> > > infections. This fatigue also usually responds to the

treatments

> > > discussed in this newsletter. In addition, infections with

> unusual

> > > organisms such as Rickettsia (e.g., Lymes Disease), chlamydia,

> and

> > > mycoplasma may also be problematic.

> > > > Yeast Overgrowth

> > > > Everyone's immune system has strong spots, as well as weak

> spots.

> > > Some people never get colds but have frequent bouts with

> athlete's

> > > foot or other skin fungal infections. Others never get fungal

> > > infections but tend to get colds. Many people seem to have a

> > > diminished ability to fight off fungal infections.

> > > > Fungi are very complex organisms. Fungal overgrowth may

> suppress

> > > the body's immune system. The host body may also develop

allergic

> > > reactions to components of the yeast.

> > > > This allergic reaction was suggested in a study which

connects

> > > Candida Albicans with Allergic Skin Dermatitis (Eczema). This

> study

> > > was published in The Journal of Clinical Experimental Allergy

> back

> > in

> > > 1993 (Vol. 23, pp. 332-339). It found that there is a

significant

> > > correlation between the body having antibodies to Candida and

> > > Allergic Dermatitis/Eczema. In addition, we have found that

> > > unexplained rashes that have lasted for many years often clear

up

> > > with antifungal treatment as well! Many physicians feel that

> yeast

> > > overgrowth causes a generalized suppression of the immune

system.

> > In

> > > other words, once the yeast gets the upper hand, it sets up a

> cycle

> > > that further suppresses your body's defenses. Interestingly, a

> > recent

> > > Mayo Clinic study showed that most cases of chronic sinusitis

> seem

> > to

> > > be associated with a reaction to yeast in the sinuses -

something

> I

> > > proposed years ago. None the less, as I already noted, this

> theory

> > is

> > > controversial. Yeast are normal members of our body's " zoo.

> > > > " They live in balance with bacteria - some of which are

> helpful

> > > and healthy and some of which are detrimental and unhealthy.

The

> > > problems begin when this harmonious balance shifts and the

yeast

> > > begin to overgrow.

> > > > As noted above, many things can prompt yeast to overgrow. One

> of

> > > the most common causes is frequent antibiotic use. When the

good

> > > bacteria in the bowel are killed off by antibiotics (along with

> the

> > > bad bacteria) the yeast no longer have competition and begin to

> > > overgrow. The body is often able to rebalance itself after one

or

> > > several courses of antibiotics, but after repeated or long-term

> > > courses - and especially if the body has an underlying immune

> > > dysfunction - the yeast can get the upper hand.

> > > > Other factors are also important. Studies have shown that

> animals

> > > who are sleep deprived and/or have increased sugar intake

develop

> > > bowel yeast overgrowth. Many physicians feel that eating sugar

> > > stimulates yeast overgrowth in people, as well. Sugar is food

for

> > > yeast. Yeast ferment sugar in order to grow and multiply. Yeast

> > > overgrowth due to sugar overuse also seems to cause immune

> > > suppression, which facilitates bacterial infections, which then

> > > requires even more antibiotic use. Poor sleep also results in

> > marked

> > > suppression of your immune function.

> > > > How Does One Know If They Have Yeast?

> > > > There are no definitive tests for yeast overgrowth that will

> > > distinguish yeast overgrowth from normal yeast growth in the

> body.

> > > There is one test which may be useful, though. This is a Urine

> > > Tartaric Acid test done by The Great Plains Lab in Kansas City,

> > > Missouri, run by Shaw, Ph.D. Tartaric Acid is a waste

> > product

> > > of yeast growth. In fermenting wine, for example, it is

critical

> to

> > > remove the Tartaric Acid. Otherwise, the wine could be toxic to

> > > people. Dr. Shaw has found elevations in Urine Tartaric Acid

that

> > > decrease with antifungal treatment in both CFIDS/FMS patients

and

> > > autistic children. Interestingly, both these illnesses often

> > improve

> > > with antifungals (specifically, Sporanox or Diflucan, plus

> > Nystatin).

> > > Dr. Shaw likes to use the Urine Tartaric Acid to decide when to

> > treat

> > > yeast overgrowth and to follow-up the effectiveness of

treatment.

> > > > In my experience, however, using Dr. Crook's Yeast

> Questionnaire

> > > (available in my book, From Fatigued To Fantastic!) is still

the

> > most

> > > reliable way to tell if a person is at risk of yeast

overgrowth.

> If

> > > the symptom score is over 140 points, I recommend treatment. In

> > > addition, anyone who has been on recurrent or long-term

> antibiotic

> > > use (especially Tetracycline for acne) or anyone who

> intermittently

> > > has painful sores in different parts of the mouth that last for

> > about

> > > ten days at a time and who has CFIDS/FMS, should be treated

with

> > > antifungals. Bowel symptoms are some of the more overt symptoms

> > that

> > > are caused by yeast and I feel that most people who

have " spastic

> > > colon " have yeast overgrowth or parasites.

> > > > How Is Yeast Treated?

> > > > A number of very effective methods can be utilized to take

care

> > of

> > > a yeast problem. Primary among the methods is to avoid sugar

and

> > > other sweets. One can enjoy one or two pieces of fruit a day,

but

> > > should not consume concentrated sugars such as juices, corn

> syrup,

> > > jellies, pastry, candy or honey. Stay far away from soft

drinks,

> > > which have ten to twelve teaspoons of sugar in every twelve

> ounces.

> > > This amount of sugar has been shown to markedly suppress immune

> > > function for several hours. Be pre-pared to have withdrawal

> > symptoms

> > > for about one week when sugar is cut out of the diet. Several

> > > excellent books have been written on the yeast controversy and

> > offer

> > > additional methods to try. One of the best books is The Yeast

> > > Connection and the Woman by Crook, M.D., a physician

who

> > has

> > > done a spectacular job advancing the understanding of CFIDS/FMS.

> > > > Many patients have found that acidophilus (that is, milk

> > bacteria,

> > > a healthy bacteria for the bowel) helps restore balance in the

> > bowel.

> > > Acidophilus is found in yogurt with live and active yogurt

> > cultures.

> > > Indeed, one cup of yogurt a day can markedly diminish the

> frequency

> > > of recurrent vaginal yeast infections. Acidophilus is also

> > available

> > > in capsule form. Although many claims are made for one type of

> > > acidophilus being better than the other, I'm not sure this is

so.

> I

> > > usually recommend 3 to 6 billion units a day (1 unit = 1

> bacteria)

> > on

> > > an empty stomach. If on antibiotics (not antifungals), take the

> > > acidophilus at least 3 to 6 hours away from the antibiotic

dose.

> > > > Nystatin, an antifungal medication, has also been helpful in

> the

> > > treatment of yeast overgrowth. Unfortunately, some fungi seem

to

> be

> > > resistant to Nystatin. In addition, Nystatin is poorly

absorbed,

> > > which means that it has little impact on the yeast outside of

the

> > > bowel. Other anti-fungal medications, such as Diflucan and

> > Sporanox,

> > > seem to be effective systemically (throughout the body) but

they

> > have

> > > two main drawbacks. First, they are expensive, costing more

than

> > $450

> > > to $900 for a two-month course. Second, any effective anti-

fungal

> > can

> > > initially make the symptoms of yeast infection worse. Although

> > > uncommon, Sporanox and Diflucan can also cause liver

inflammation

> > (as

> > > can Advil and Tylenol). If you are taking Sporanox or Diflucan

> for

> > > more than 6 to 12 weeks, I would consider intermittently

checking

> > > liver blood tests (ALT and AST). If you have preexisting active

> > liver

> > > disease, be cautious in using (or don't use) Sporanox or

> Diflucan.

> > I

> > > strongly recommend taking Lipoic Acid (a natural

> > > > supplement which protects and helps heal the liver), 200mg a

> > day,

> > > whenever you take Sporanox or Diflucan. I also strongly

recommend

> > > Lipoic Acid for anyone with active liver disease (e.g.,

> hepatitis)

> > at

> > > doses up to 1000mg to 3000mg a day as it may prevent and/or

treat

> > > cirrhosis.

> > > > Natural Yeast Treatments

> > > > Below, I have summarized the nonprescription part of the

> > treatment

> > > checklist that I use in my office.

> > > > 1. Avoiding sweets is still the single most important thing.

> > Using

> > > Stevia as a sweetener is a wonderful substitute. Stevia is a

> safe,

> > > natural remedy and you can use all you want. There are even

> > cookbooks

> > > for using Stevia (available from my office or 800-4STEVIA). A

new

> > > natural sweetner, Sweet Balance, also tastes good and is 12

times

> > as

> > > sweet as sugar. It is a natural product from the Lo Han fruit

and

> > > appears to be safe. Although it is 70% sugar (fructose), you

only

> > > need a small amount. Order it from 877-997-9338, my office at

800-

> > 333-

> > > 5287 or my Web site at www.endfatigue.com.

> > > > 2. Acidophilus or Milk Bacteria can be very helpful. Take 3

to

> 6

> > > billion units a day (a unit is the same as a bacteria). Do not

> take

> > > acidophilus within 3 to 6 hours of an antibiotic. Take it

either

> on

> > > an empty stomach or with milk.

> > > > 3. Caprylic Acid is another natural remedy that can be

helpful.

> > The

> > > usual dose is 1800 to 3600mg a day with 1/3 of the dose being

> taken

> > > at each meal. Unfortunately, it often causes an acid stomach

with

> > > a " funky " tasting reflux.

> > > > 4. Oregano Oil - enteric coated oregano oil - 1 to 2

capsules,

> 2

> > to

> > > 3 times a day with food, may be more effective and better

> tolerated

> > > than Caprylic Acid (both can cause stomach acid reflux).

> > > > 5. Fresh Garlic, if you can handle it well, can also be very

> > > effective. Daily, crush 1 to 3 garlic cloves in olive oil, add

> > salt,

> > > spread it on bread and eat it. It can be quite tasty and lethal

> to

> > > whatever infections you have in your gut.

> > > > 6. Olive Leaf 500mg, 2 to 4 capsules three times a day

between

> > > meals, can also be very helpful in treating yeast overgrowth.

> > > > 7. Pau De Arco in either tea or capsule form is also helpful

in

> > > yeast suppression. Although I use Pau De Arco infrequently for

> > yeast

> > > over-growth, many people find that it can be helpful.

> > > > 8. Grapefruit Seed Extract (e.g., Citrucidel) is a popular

> > > treatment for yeast overgrowth and is well-tolerated.

> > > > More Information On Yeast Treatments

> > > > If symptoms of yeast are caused by an allergic or sensitivity

> > > reaction to the yeast body parts, the symptoms may flare when

> mass

> > > quantities of the yeast are suddenly killed off. This is called

a

> > > yeast " die-off " reaction. If you get this reaction, start your

> > > treatment with acidophilus and a sugar-free diet for a few

weeks

> > > followed by oregano oil and/or olive leaf (1500mg to 2000mg, 3

> > times

> > > a day between meals) before beginning Nystatin. Take Nystatin

(by

> > > mouth) in the form of 500,000-IU tablets or powder. I generally

> > > recommend beginning with 1 tablet a day for 1 to 3 days, and

> > > increasing by 1 tablet every 1 to 3 days (or slower if

yeast " die-

> > > off " is a problem) until 2 tablets 2 to 4 times a day is

reached.

> > If

> > > you get nausea, take a lower dose. Take Nystatin, 4 to 8

tablets

> > > daily, for 5 to 8 months. I add the Diflucan or Sporanox one

> month

> > > after beginning the Nystatin. Take 200mg every morning for six

> > weeks.

> > > If symptoms flare, take just 100mg per morning for the first 3

to

> > 14

> > > days. I

> > > > f symptoms recur after stopping the Diflucan or Sporanox, I

> > > recommend continuing the medication for an additional 6 weeks

at

> > > 200mg a day.

> > > > Sporanox should be taken with food. If it is taken alone, its

> > > absorption is greatly reduced. When taking Diflucan or

Sporanox,

> DO

> > > NOT use the antihistamines Seldane or Hismanal, Quinidine (a

> heart

> > > medicine), cholesterol-lowering medications in the Mevacor

> family,

> > or

> > > the bowel medicine Propulcid. These can be fatal combinations!

> > Also,

> > > antacid medications (such as Tagamet, Axid, Zantac, and Pepcid)

> > > prevent the proper absorption of Sporanox. At the high price of

> > > Sporanox per dose, you will want to absorb every last bit of

the

> > > medication. If you need to be on an antacid medication, use

> > Diflucan

> > > instead of Sporanox. Unfortunately, a less expensive

antifungal,

> > > called Lamisil (at 250mg a day), does not seem to work very

well

> > for

> > > candida yeast overgrowth (although it works well for nail

> > > infections). I am currently trying patients on 500mg of Lamisil

a

> > day

> > > to see if this dose works better.

> > > > I feel that once the yeast has been effectively decreased and

> > kept

> > > that way for six to twelve months, it is safe to try to add

small

> > > amounts of sugar back into the diet. If symptoms recur,

however,

> > stop

> > > the sugar again. Continuing to eat yogurt with live and active

> > > acidophilus cultures (unless you are lactose-intolerant) or

> > > continuing to take acidophilus capsules may also help.

> > > > Many books on yeast overgrowth (including Dr. Crook's) advise

> > > readers to avoid all yeast in the diet. This advice is based on

> the

> > > theory that an allergic reaction to yeast is the cause of the

> > > problem. The predominant yeast that seems to be involved in

yeast

> > > overgrowth is Candida Albicans, although I would not be

surprised

> > if

> > > researchers discovered that many other kinds of fungal

infections

> > are

> > > also involved. The yeast that is found in most foods (except

beer

> > and

> > > cheese) is not closely related to candida.

> > > > In my experience, trying to avoid all yeast in foods results

> > simply

> > > in a nutritionally inadequate diet and little benefit. Although

a

> > few

> > > people do appear to have true allergies to the yeast in their

> food,

> > > they number less than 10 percent of my patients with suspected

> > yeast

> > > overgrowth. These patients may benefit from the more strict

diet

> in

> > > Dr. Crook's book. Interestingly, once their adrenal

insufficiency

> > and

> > > yeast overgrowth are treated, most people find that their

> allergies

> > > and sensitivities to yeast and other food products seem to

> improve

> > or

> > > disappear.

> > > > Nutritional deficiencies such as low zinc or low selenium may

> > also

> > > decrease resistance to yeast over-growth. A good multivitamin

> > > supplement, as recommended in my last newsletter, should take

> care

> > of

> > > these deficiencies. This is further evidence that all the

factors

> > > involved in CFS are closely interrelated.

> > > > The best thing that one can do to combat yeast overgrowth is

to

> > try

> > > to avoid it in the first place. When you get an infection,

begin

> > > treating it naturally immediately. Hopefully, you can prevent

it

> > from

> > > turning into a bacterial infection which might require an

> > antibiotic.

> > > Ask your doctor what measures you can take before resorting to

> > > antibiotics. Many good over-the-counter remedies are available.

A

> > > knowledgeable pharmacist may also be a wealth of information.

> Your

> > > local book or health food store has books on natural measures.

> Your

> > > health food store proprietor can also steer you to appropriate

> > > natural remedies. For examples of the many helpful measures

that

> > one

> > > can take, see my newsletter article, Treating Infections

Without

> > > Antibiotics, page ___).

> > > > If you find however, that you must take an antibiotic, all is

> not

> > > lost. One can still lessen the severity of yeast overgrowth by

> > > avoiding sweets and by either taking acidophilus capsules

(again,

> > not

> > > within 3 to 6 hours of an antibiotic) or by eating one cup of

> > yogurt

> > > with live and active acidophilus cultures daily. Don't use the

> > yogurt

> > > (or milk) if you have sinusitis or pneumonia because the milk

> > protein

> > > thickens mucus and makes it hard for the body to fight these

> > > infections.

> > > > How Can One Tell If The Yeast Is Coming Back?

> > > > It is normal for yeast symptoms to resolve after treatment.

> After

> > 6

> > > weeks on the Sporanox or Diflucan, patients are usually feeling

a

> > lot

> > > better, but may have symptoms recur soon after stopping the

> > > antifungal. In this case I would continue the Sporanox or

> Diflucan

> > > for another 6 weeks, or as long as is needed, to keep the

> symptoms

> > at

> > > bay. More frequently, people will feel better after treatment

and

> > > stay feeling fairly well for a period of 6 to 24 months. At

that

> > > time, it is common to see a recurrence of symptoms, especially

if

> > one

> > > is eating too much sugar or is taking antibiotics. The best

> marker

> > > that I have found for yeast overgrowth would be a return of

bowel

> > > symptoms with gas, bloating and/or diarrhea or constipation. If

> > these

> > > symptoms persist for more than 2 weeks, especially if there is

> also

> > > even a mild worsening of the FMS symptoms, it is very

reasonable

> to

> > > retreat yourself with 6 weeks of Nystatin and perhaps Sporanox

or

> > > Diflucan. In addition, I would also retreat if there's

> > > > a recurrence of vaginal yeast or sinus infections. If re-

> > treatment

> > > resolves the symptoms, one may opt to repeat this regimen as

> often

> > as

> > > is needed (usually every 6 to 24 months). By using some of the

> > > natural remedies listed above, however, you may be able to

avoid

> > > repeated use of these antifungals and the possible risk of

> becoming

> > > resistant to them. Some patients also find that they need to

stay

> > on

> > > the antifungals for extended periods of time (years) or the

> > symptoms

> > > will recur. When this is necessary, I add the natural remedies.

I

> > > will, however, also use the medications when needed. The main

> risk

> > of

> > > long-term use of the antifungals Sporanox and Diflucan would be

> > liver

> > > inflammation. If these medications are being used for extended

> > > periods, consider checking liver tests (SGOT and SGPT) every 3

to

> 6

> > > months and anytime that a severe flu-like feeling or worsening

of

> > > symptoms occur. As noted above, it is very important to take

> Lipoic

> > > Acid 200mg a day when on Sporanox or Diflucan. Althoug

> > > > h I am not aware of any studies using Lipoic Acid with

> > antifungals,

> > > in my experience I have seen no worrisome elevation on liver

> tests

> > if

> > > patients are using this natural substance while taking these

> > > antifungals. As an alternative, instead of taking the

antifungals

> > > every day, many people find they can get long-term suppression

of

> > the

> > > yeast by taking Sporanox or Diflucan 200mg twice a day, one day

> > each

> > > week (e.g., each Sunday).

> > > > Help For Chronic Bladder Infections

> > > > Although we will be discussing some unusual infections,

> CFIDS/FMS

> > > patients also get more of the day-to-day variety of infections.

> > These

> > > include Urinary Tract (bladder) Infections (UTI). The main

> symptoms

> > > of a UTI are discomfort (e.g., burning) when urinating

(dysuria),

> > > urgency (which is the feeling that you have to go very badly

and

> > > right away when there is not much urine there), and frequency

> with

> > > low volume. These symptoms are also common in CFIDS/FMS

patients

> in

> > > the absence of bladder infections and, when severe, is called

> > > Interstitial Cystitis. I would not label someone as having

> > > Interstitial Cystitis unless this is the major symptom of their

> > > CFIDS/FMS, because almost everyone with this illness has some

> > urinary

> > > urgency and frequency. Because bladder symptoms can be seen in

> both

> > > UTI and CFIDS/FMS, it is important to have a urine culture done

> > > before treatment with antibiotics to make sure that there is an

> > > infection and not just muscle spasms in the bladder that are

> > causing

> > > these

> > > > symptoms. If there is an infection, over 90% of the time it

> will

> > be

> > > E-coli. This bacteria is normally found in everyone's gut and,

> with

> > > the exception of a few rare dangerous forms, is a healthy part

of

> > our

> > > normal bowel bacteria. The problem occurs when the E-coli gets

> out

> > of

> > > the bowel where it belongs and into the bladder. Usually the

> > bladder

> > > will wash out most infections when the urine comes out. The E-

> coli

> > > however, have little velcro-like projections that stick to the

> > > bladder wall so that they can not be washed out by urination.

> > > > Taking antibiotics will kill a bladder infection but will

also

> > kill

> > > the healthy bacteria in the bowel. This sets one up for yeast

> > > overgrowth and other problems. Because of this, unless there is

> > fever

> > > or back pain over the kidneys or a toxic feeling, it is

> reasonable

> > to

> > > try natural remedies for one to three days before going with

the

> > > antibiotics. One can start these treatments while waiting for

the

> > > urine culture to come back.

> > > > What Natural Remedies Can Be Used For Bladder Infections?

> > > > There are two excellent natural remedies that can keep the E-

> coli

> > > from sticking to the bladder walls so they can be washed out.

In

> > > addition, taking vitamin C in high dose (e.g., 500 to 5000mg a

> day)

> > > can acidify the urine, making it inhospitable to the bacteria.

> > > Drinking a lot of water also helps to wash out the infection.

> > > > The two natural remedies that keep the bacteria from sticking

> are:

> > > > 1. Cranberries—Because approximately 20% of the female

> population

> > > suffers from UTIs, several studies have been done looking at

this

> > > remedy. An early study of 44 female and 16 male patients with

> acute

> > > bladder infections drank 16 oz. of cranberry juice a day for 15

> > days.

> > > Of these patients, 53% had positive responses and another 20%

> > showed

> > > modest improvement. Six weeks after stopping the juice, 27

> patients

> > > did have persistent recurrent infections and 8 of these had no

> > > symptoms. Seventeen patients had no symptoms and negative urine

> > > cultures.

> > > > In another study of elderly women (who are more likely to

have

> > > bladder infections), 153 women either received 10 oz. of

> cranberry

> > > drink or placebo every day for 6 months. The group that got the

> > > cranberry drink had 68% fewer bladder infections during that

> > period.

> > > In this study, the juice was sweetened with saccharin instead

of

> > > sugar. Other studies have also shown benefit using cranberry

> juice

> > in

> > > bladder infections.

> > > > Significant benefits are achieved by using 6 to 16 oz. of

> > cranberry

> > > juice a day. Because cranberry juice has a lot of sugar and can

> > > promote yeast overgrowth and aggravate other symptoms in

> CFIDS/FMS,

> > I

> > > think it is much better to use pure cranberry juice powder in

> > capsule

> > > or tablet form (standardized to contain 11% to 12% quinic

acid).

> > The

> > > therapeutic dose is 1 to 2 capsules a day. Conversely, you can

> use

> > > unsweetened cranberry juice and add Stevia as a natural

> sweetener.

> > In

> > > general, if one gives the usual cranberry juice cocktails a

> > strength

> > > of 1 unit - then, cranberry juice drinks have a strength of ½;

> > > cranberry sauce a strength of ½; fresh or frozen cranberries

are

> 4

> > > times as potent; pure cranberry juice is 4 times as potent; and

> > > cranberry juice capsules from unsweetened cranberry juice

powders

> > are

> > > 32 times as potent.

> > > > Cranberries work to help bladder infections because they have

a

> > > chemical (proanthocyanidins) that prevents the bacteria from

> > sticking

> > > to the bladder wall. They may also decrease the risk of kidney

> > stones

> > > (although magnesium with B6 is much better for this), as well

as

> > > possibly reduce urine odor.

> > > > D-Mannose - This is more effective than cranberry juice.

> Mannose

> > is

> > > a natural sugar (not the kind that causes symptoms or yeast

> > > overgrowth) that is excreted promptly into the urine.

> Unfortunately

> > > for the E-coli bacteria, the fingers that stick to the bladder

> wall

> > > stick to the D-Mannose even better. When one takes a large

amount

> > of

> > > D-Mannose, it spills into the urine, coating all the E-coli's

> > > little " sticky fingers " so that the E-coli are literally washed

> > away

> > > with the next urination. The nice thing about the natural

> approach,

> > > as opposed to antibiotics, is that the cranberries or D-Mannose

> > will

> > > not kill the healthy bacteria, thereby not bothering the normal

> > > balance of bacteria in the bowel. In addition, the D-Mannose is

> > > absorbed in the upper gut before it gets to the friendly E-coli

> > that

> > > are normally present in the colon. Because of this, it helps

> clear

> > > the bladder without causing any other problems. In addition,

the

> D-

> > > Mannose even tastes good.

> > > > The D-Mannose is quite safe, even for long-term use, although

> > most

> > > people will only need it for a few days. Those who have

frequent

> > > recurrent bladder infections may, however, choose to take it

> every

> > > day. The usual dose of D- Mannose is 1/2 teaspoon every 2 to 3

> > hours,

> > > while awake, to treat an acute bladder infection; and 1/4 to

1/2

> > > teaspoon 3 to 4 times a day to prevent severe chronic bladder

> > > infections. It is best taken dissolved in water. For those who

> get

> > > bladder infections associated with sexual intercourse, one can

> take

> > > 1/2 teaspoon of D-Mannose 1 hour before and then just after

> > > intercourse to prevent an infection. Remember, though, the D-

> > Mannose

> > > (and cranberries) only work in the 90% of bladder infections

> caused

> > > by E-coli bacteria. D-Mannose is available from several sources:

> > > > 1. The Tahoma Clinic Dispensary (253-850-5661), which is

> > associated

> > > with the well-known nutritional physician, V. ,

> M.D.

> > > > 2. The Biotech Company (800-345-1199).

> > > > 3. My office (800-333-5287) or my Web site at

> www.endfatigue.com.

> > > > The usual cost of D-Mannose is approximately $60 for 100

grams

> > and

> > > $35 for 50 grams. A 1/2 teaspoon is approximately 2 grams. One

> > should

> > > feel much better within 24 to 48 hours on D-Mannose. If not,

see

> a

> > > doctor for a urine culture (you may want to get the culture at

> the

> > > first sign of infection) and consider antibiotic treatment

after

> > two

> > > days if the culture is positive. Some evidence exists that

> > > Macrodantin causes less yeast over-growth than do other

> > antibiotics.

> > > Even with other antibiotics, most bladder infections are

knocked

> > out

> > > by one to three days of antibiotic use (instead of the old

seven-

> > day

> > > regimen).

> > > > Prostatitis

> > > > Although women tend to be the ones plagued with bladder

> > infections,

> > > men don't get off unscathed either. It is very common in men

with

> > > CFIDS/FMS to have Prostatitis. Prostatitis is an inflammation

or

> > > infection of the prostate which is usually seen in younger men

> > > between the ages of 20 and 50. It falls into three main

> categories:

> > > > 1. " Bacterial " Prostatitis is a acute or chronic infection in

> the

> > > gland that causes prostate swelling and discomfort.

> > > > 2. Nonbacterial Prostatitis is when you feel swelling of the

> > > prostate without being able to detect an infection. My

suspicion

> is

> > > that it is not uncommon for prostatitis to be associated with

> yeast

> > > overgrowth or other infections that cannot be cultured (tested

> > for).

> > > > 3. Prostadynia is a general irritation of the prostate which

> > causes

> > > urinary burning, urgency and frequency but without there being

> any

> > > infection or swelling of the prostate. This can come from a

> number

> > of

> > > causes including, I suspect, chronic spasm or tightening of the

> > > muscles of the pelvic floor.

> > > > The symptoms of chronic Prostatitis can come and go and be

mild

> > or

> > > severe. The symptoms include:

> > > > 1. Pain or tenderness in the area of the prostate. It is also

> > > common to have burning on the tip of the penis.

> > > > 2. Discomfort in the groin and, occasionally, lower back pain.

> > > > 3. Urinary urgency and frequency with pain on urination.

> > > > 4. Sometimes a slight penis discharge. If the discharge is

> cloudy

> > > and larger than one drop, or even a large drop, it is most

likely

> a

> > > bacterial Prostatitis and I would then prescribe antibiotics.

If

> a

> > > discharge is present, I would also check to make sure that

there

> is

> > > not also a sexually transmitted disease (such as Chlamydia or

> > > Gonorrhea) before beginning treatment.

> > > > 5. Pain with ejaculation.

> > > > If severe symptoms with fevers, chills and extreme fatigue

are

> > > present (symptoms of acute Prostatitis), antibiotics should be

> > used.

> > > The main treatment for bacterial Prostatitis consists of using

> the

> > > antibiotics Tetracycline (e.g., Doxycycline), Cipro, or Sulfa

> > > (Bactrim or Septra DS). Unfortunately, since it is hard for the

> > > antibiotics to be absorbed into the prostate, the symptoms

often

> > > recur even after six weeks of treatment. If antibiotics are

> > required,

> > > use Doxycycline or Cipro because these may be effective against

> > other

> > > hidden infections that can cause CFIDS/FMS.

> > > > Although there are a number of causes of Prostatitis, excess

> > > caffeine, alcohol and spicy foods can also contribute to the

> > > symptoms. Sitting for long periods while traveling (e.g., being

a

> > > truck driver) can also cause irritation of the prostate.

Although

> > > normal bacteria are common causes, a few bacteria transmitted

> > through

> > > sexual contact can also cause Prostatitis. Some feel that the

> main

> > > psychological component of Prostatitis is shame.

> > > > Bowel Parasite Infections

> > > > A while back, the news focused our attention on Milwaukee

> because

> > > of repeated fatal outbreaks of an infection by a bowel parasite

> > > called Cryptosporidium. A cartoon even made the rounds showing

> > > Mexican tourists being warned not to drink the water in

> Milwaukee!

> > > Although this infection usually resolves on its own within a

week

> > or

> > > two, it may persist in those with immune suppression. In fact,

> > people

> > > with acquired immune deficiency syndrome (AIDS) are

particularly

> > > susceptible and scores of Milwaukeens died from the

> Cryptosporidium

> > > outbreaks.

> > > > Unfortunately, in many places throughout the United States,

the

> > > water supply is contaminated, and parasites are no longer just

a

> > > Third World problem. Doctors frequently see cases of infection

by

> > > giardia, amoeba and numerous other bowel parasites. Parasitic

> > > infections can mimic CFS and, in immune suppressed situations

> like

> > > CFS, all parasites should be treated.

> > > > Most laboratories miss the parasites when they do stool

> testing.

> > I

> > > initially tested for bowel parasites by sending my patients'

> stool

> > > samples to a respected local lab. The tests kept coming back

> > > negative, so I eventually stopped testing. Finally, I started

> doing

> > > my own laboratory stool testing. Doing the test properly was

very

> > > time consuming, taking up to five hours per specimen. However,

> > > processing it properly, my tests frequently turned out

positive.

> In

> > > my experience - and in that of other physicians as well - when

> you

> > > treat a patient for parasites, the patient's fatigue and

achiness

> > > often improves dramatically.

> > > > If you would like your stool tested, make sure that the lab

> > > specializes in stool testing and that the sample is a purged

> > > specimen. A purged stool specimen is watery and loose, brought

> > about

> > > by the use of one-and-a-half ounces of Fleet's Phospho-Soda (a

> > > laxative). The purpose of the stool purge is to get the best

> > possible

> > > stool sample to check for bowel parasites and yeast. The

laxative

> > > washes the organisms off the walls of the intestines so that

they

> > can

> > > be detected. The routine random tests performed in almost all

> > > standard labs are generally not adequate or reliable. In

speaking

> > > with several lab technicians, I was told they had less than one

> > hour

> > > of training in looking for parasites—which they found to be

> > useless.

> > > In fact, during one of our " doctors' " poker games, I spoke with

a

> > > gastroenterologist friend who noted that during a certain bowel

> > exam

> > > he had performed, he saw a large number of parasites swimming

in

> > the

> > > patient's large bowel. He removed a big glob consisting of

> nothing

> > > > but mucus and parasites and sent it off to the major local

> > > laboratory, just for confirmation of the infection and

> > identification

> > > of the parasite. Even this sample came back negative for

> parasites!

> > > This is why I stress that stool testing must be done at a lab

> that

> > > specializes in parasitology. Because two excellent labs are now

> > > available to me to mail specimens to, I no longer have to do

the

> > > testing in my office. These labs are The Parasitology Center,

> Inc.

> > > (480-777-1078) and The Great Smokies Diagnostic Laboratory (800-

> 522-

> > > 4762).

> > > > At this point, no consistently effective prescription

> medication

> > is

> > > available for Cryptosporidium infections. Artemisia annua,

> however,

> > > is an effective herbal treatment. For most of my patients, I

> > > recommend using 1,000 milligrams three times a day for twenty

> days.

> > > Leo Galland, M.D., a parasite specialist, recommends a form of

> > > Artemisia called tricyclin for many parasitic infections. He

> > > recommends taking 2 tablets, 3 times a day after meals for six

to

> > > eight weeks. The cost of this antiparasitic herbal preparation

is

> > > about $30 for fifty tablets. See the treatment protocol below

for

> > > regimens for some other parasitic infections. The doctor who

runs

> > The

> > > Parasitology Center also has a review article discussing which

> > > natural remedies are effective against each type of parasite.

> > Common

> > > parasite treatment regimens also used in our office are on the

> > > treatment checklist below.

> > > > Antiparasitic Treatments

> > > > 1. Flagyl (Metronidazole) – 750 mg, 3 times a day for 10

days,

> > > followed by Yodoxin for many parasites. For Clostridium

Difficile

> > > take 250 mg, 4 times a day, or 500 mg, 3 times a day. It may

> cause

> > > nausea and vomiting (uncomfortable but usually not worrisome).

Do

> > not

> > > drink alcohol while on this medication as it will make you

vomit.

> > The

> > > SR (sustained release) form is easier on the stomach (as is the

> > brand-

> > > name form). If you get numbness or tingling in your fingers (or

> it

> > > worsens if you usually have it) stop the Flagyl.

> > > > 2. Yodoxin (Iodoquinol) – 650 mg, 3 times a day, for 20 days

> > after

> > > Flagyl is completed.

> > > > 3. Tinidazole – 2000 mg, once daily, for 3 consecutive days

> with

> > > food (for Entamoeba Histolytica) – OR - 3 doses, each 2 weeks

> apart

> > > (for Giardia or Dientamoeba Fragilis); Available at 's

> > Pharmacy

> > > (800-480-3432).

> > > > 4. Humatin (Paromomycin) – 500 mg, 3 times a day, for 10 days

> > (for

> > > Cryptosporidium). For Blastocystis add Yodoxin.

> > > > 5. Zithromax – 250 mg, once a day on an empty stomach for 10

> > days,

> > > along with Bactrim, 1 tablet twice a day for 10 days (alternate

> > > treatment for Cryptosporidium). Add Artemesia.

> > > > 6. Bactrim DS - 1 tablet, twice a day, plus Yodoxin 650 mg, 3

> > times

> > > a day with food for 10 days. Do not take Folic acid supplements

> > > (e.g., B Complex or multivitamins) during these 10 days (for

> > > Blastocystis).

> > > > 7. Amphotericin B – 100 mg, two times a day, plus Tinidazole

> 500

> > > mg, twice a day, plus Furoxone (Furazolidone) 1 tablet, twice a

> > day.

> > > Take these three together with food for 5 to 7 days

(Amphotericin

> B

> > > and Tinidazole are available from 's Pharmacy 800-480-

3432)

> > > (treatment for refractory Blastocystis).

> > > > 8. Lactoferrin – 350 mg, 1 to 3 capsules at bedtime.

> > > > 9. Multi-pure Water Filter - Most other filters (except for

> > reverse

> > > osmosis) are ineffective. (Available from Bren son, 410-

224-

> > > 4877).

> > > > 10. Artemesia Annua (a herbal antiparasitic) – 500 mg, 2

> tablets,

> > 3

> > > times a day for 20 days.

> > > > 11. Tricyclin (a herbal antiparasitic) - 2 tablets, 3 times a

> > day,

> > > after meals for 6 to 8 weeks (concentrated Artemesia).

> > > > 12. Colostrum (mother's milk) - 3 capsules, 3 times a day,

for

> 8

> > to

> > > 12 weeks. Then stop or use the lowest dose needed for symptoms.

> If

> > > nausea or indigestion occurs, lower the dose to a comfortable

> level

> > > for 1 to 2 weeks until it passes. Take on an empty stomach.

> > > > 13. Quinacrine – 100 mg a day for 5 days. May be useful for

> > empiric

> > > therapy of suspected but not identified parasites

(controversial).

> > > > 14. Albendazole – 400 mg a day for 5 days. May be useful for

> > > empiric therapy of suspected but not identified parasites.

> > > > Filter Your Water

> > > > Water filters can be very helpful in the fight against

> parasitic

> > > infection. However, not all units are designed to filter out

> > > parasites. For a water filter to remove parasites, it must have

a

> > > submicron solid carbon block filter. A good example is the

Multi-

> > pure

> > > Filter. Check the Consumer's Digest and Consumer's Report for

> other

> > > good units. Multi-pure Filters are available from Bren son

> at

> > > 888-801-8176 or 410-224-4877. He is a very reputable and

> > > knowledgeable person and does not believe in " high pressure

> sales "

> > > (again, I get no money from people or companies whose products

I

> > > recommend).

> > > > When shopping around for a water filter, request the National

> > > Sanitation Foundation (NSF) International Listing for the

> specific

> > > unit you are considering. NSF is an independent not-for-profit

> > > organization that tests and certifies drinking water treatment

> > > products. The unit you buy should meet both NSF Health Effects

> > > Standard 53 and NSF Aesthetics Standard 42, with Class I

> reduction

> > of

> > > chlorine and particulate matter. Any unit that does not meet

both

> > of

> > > these standards, particularly the health standard, is not

> adequate.

> > > To verify that a unit does meet these standards, call the NSF

at

> > 313-

> > > 769–8010.

> > > > In addition to verifying that a water filter meets the NSF

> > > standards, ask to see its Product Performance Data Sheet. Many

> > states

> > > require that this sheet be given to all prospective customers

of

> > > drinking water treatment devices.

> > > > Ask about the range of contaminants that the unit can reduce

> > under

> > > NSF Health Effects Standard 53. Most units certified under

> Standard

> > > 53 list only turbidity and cyst reduction. The number of units

> that

> > > also reduce pesticides, trihalomethanes, lead, and volatile

> organic

> > > chemicals is very small. Make sure that the water filter you

are

> > > considering can remove the specific contaminants that concern

you.

> > > > Ask if the unit is licensed in such states as California,

> > Colorado

> > > and Wisconsin. These states have some of the toughest

> certification

> > > procedures in the United States.

> > > > Finally, ask about the unit's service cycle, which is stated

in

> > > gallons of water treated. Find out how often you will need to

> > change

> > > the filter and what the replacement filters cost.

> > > > As the American water supply becomes more contaminated,

> parasitic

> > > bowel infections will likely become more common. These

> infections,

> > as

> > > well as the overgrowth of yeast or toxic bacteria caused by

> > > antibiotic use, contribute to feeling poorly.

> > > > The Role Of Other Infections In CFIDS/FMS

> > > > Many infections have been found in CFIDS. That people may

have

> > not

> > > just one, but several of these simultaneously is significant.

It

> > > suggests that although these infections may be a trigger, in

most

> > > patients the immune system is suppressed and therefore they

> become

> > a

> > > setup for unusual infections that persist. These infections may

> > > then " drag you down, " further suppressing your immune system.

> > > > Fortunately, most people improve (and often get very healthy)

> by

> > > simply treating the sleep, hormonal, nutritional and yeast

> > problems.

> > > Once these areas are treated, your body can usually eliminate

any

> > > persistent infections by itself. A subset, though, have

> infections

> > > that need treatment with antivirals and/or antibiotics.

> > > > How Can I Tell If I Need These Treatments?

> > > > First, I would try the other approaches discussed in my From

> > > Fatigued To Fantastic! book and newsletters. I would try these

> > > treatments if symptoms persist:

> > > > 1. Those with predominantly flu-like symptoms with

debilitating

> > > fatigue and little or no pain or fever are more likely to have

an

> > > underlying persistent viral infection (e.g., HHV-6, Epstein

Barr,

> > > CMV, etc.).

> > > > 2. Those with fevers (i.e., anything over 98.6°F in this

> illness -

> >

> > > even 99°) and/or lung congestion, sinusitis, skin pustules or

> other

> > > chronic bacterial infections seem more likely to have

infections

> > > (i.e., bacterial, Mycoplasma, or Chlamydia) that respond to

> special

> > > antibiotics. Let's look at these two groups and how to approach

> > them.

> > > > HHV-6 And Other Viral Infections

> > > > HHV-6 (Human Herpes Virus 6) is a virus that is related to

the

> > > Epstein Barr Virus (EB), Cytomegalovirus (CMV), and also to the

> > > Herpes Viruses that causes cold sores and Genital Herpes. HHV-6

> is

> > > transmitted like the common cold and many people have had it,

as

> > well

> > > as the EB Virus and the Cold Sore Virus by the time they are

> twenty

> > > years old. The body usually gets rid of all of these viruses on

> its

> > > own. Because of this, if you do routine (IGG) antibody testing,

> > > almost everybody will be positive for EB and many for HHV-6 and

> CMV

> > > viruses. However, the IGG test will not tell you if you have

> active

> > > infections unless the IGM antibody is also positive (suggesting

a

> > new

> > > infection). The IGM antibody is the one that increases in the

> first

> > > six weeks of an infection. This is followed by an elevated IGG

> > > antibody, which stays elevated your whole life and acts as your

> > > body's surveillance system. All an elevated IGG means is that

> your

> > > body has seen this infection and, if it sees it again, it's read

> > > > y to knock it out quickly. This is how immunizations work.

The

> > > immunization creates the IGG antibody, so that instead of

taking

> > one

> > > to two weeks to gear-up to fight the infection, your body can

> > > eliminate that infection very quickly. Unfortunately, in CFIDS

> you

> > > can have a chronic low-grade infection—even if your IGG

antibody

> is

> > > positive (elevated) - making the IGG antibody test for HHV-6,

EB

> > > Virus and CMV unreliable in CFIDS/FMS. In addition, the IGM

> > antibody

> > > will usually not be present in elevated levels in the low-grade

> > > infections with these viruses that may be seen in CFIDS and

FMS.

> > > > What makes this important is that Valtrex at high-dose can

> > > eliminate Epstein Barr virus, but will not work if active HHV-6

> or

> > > CMV infection is present. As I will discuss later, the only

tests

> I

> > > would rely on to diagnose active HHV-6 are " rapid cell

cultures "

> or

> > > PCR testing. Because some insurance companies are more likely

to

> > pay

> > > for IGG than PCR testing, an argument can be made for checking

> IGG

> > > antibodies first. If the EBV IGG is positive and HHV-6 and CMV

> IGG

> > > are negative, one may choose to proceed with Valtrex 1000mg, 4

> > times

> > > a day, for 6 months, without PCR testing. If the HHV-6 or CMV

IGG

> > > antibodies are positive, then check the CMV and/or HHV-6 PCR

> tests

> > to

> > > be sure they are negative.

> > > > Tell Me More About HHV-6 And CFIDS

> > > > Unfortunately there is no currently accepted standard

treatment

> > for

> > > the HHV-6 Virus. Even though it is related to other Herpes

> viruses,

> > > HHV-6 is resistant to Acyclovir, Valtrex, Famvir and the other

> > > antivirals that are commonly used in Herpes infections. The

only

> > > antiviral known to be effective against HHV-6 is Ganciclovir.

> This

> > > has significant side effects and has to be given intravenously

> and

> > > possibly forever to maintain the antiviral effect.

Unfortunately,

> > > this is not a viable option in day-to-day life and has been

only

> > > moderately successful when used. The main doctor who has been

> using

> > > Ganciclovir to treat HHV-6 in the United States is Joe Brewer,

> > M.D.,

> > > (816-531-1550) in Kansas City, Missouri. He found that 140 out

of

> > 207

> > > CFIDS patients had positive HHV-6 cell cultures. Forty percent

of

> > > CFIDS patients were positive on their first test and 70% were

> > > positive after three tests. This contrasts to 60 healthy

patients

> > he

> > > checked in which none of the HHV-6 tests were positive. Culture

> > > > s are more likely to be positive during acute flares of the

> > > disease, when the viral level in the blood rises (see Page 9

for

> > more

> > > on HHV-6 PCR testing).

> > > > As is often the case in CFIDS, there is conflicting data on

> > > infections in Chronic Fatigue Syndrome. A recently published

> study

> > > (Reeves WC, et al., Clin Infect Dis, 2000 July; 31 [1] pp48-52)

> > > examined 26 patients with Chronic Fatigue Syndrome and 52

healthy

> > > patients in Atlanta, Georgia, at the CDC. In this study,

several

> > > tests for HHV-6 and HHV-7 were done, including Polymerase Chain

> > > Reaction (PCR). HHV-6 DNA was found in 11% of CFIDS patients

and

> > 28%

> > > of healthy patients, suggesting that the HHV-6 was actually

less

> > > common in Chronic Fatigue Syndrome than in healthy patients. At

> > this

> > > time, as the conflicting data shows, although HHV-6 may be one

of

> > > many suspect infections in CFIDS, it is not yet clearly the

cause

> > of

> > > this illness.

> > > > When HHV-6 is present, it seems to infect the natural Killer

> > Cells,

> > > important cells in your body's defense (immune) system that are

> > > critical in fighting infections. A number of studies have shown

> > these

> > > Killer Cells to be malfunctioning in CFIDS. HHV-6 infection

does

> > not

> > > necessarily decrease the number of the natural Killer Cells but

> > does

> > > decrease their function. Natural Killer Cell function is

> described

> > in

> > > what is called Lytic Units—which means the ability of cells to

> lyse

> > > or break down foreign invaders. An average person will have a

> Lytic

> > > Unit level of 20 to 250 with over 80% of healthy patient being

> over

> > > 40 units. Dr. Brewer finds that in CFIDS the mean Natural

Killer

> > > Lytic Cell level is 12 units. Dr. Brewer uses Specialty Labs in

> > > California for his Natural Killer Lytic Cell testing and finds

> that

> > > the Lytic level stays the same on repeat testing and seems to

be

> a

> > > reliable test for Natural Killer Cell function testing in

CFIDS.

> > > Lytic unit levels will, however, decrease during flar

> > > > es of symptoms. In Dr. Brewer's experience, this test is very

> > > specific for CFIDS and Multiple Sclerosis. He has treated ten

MS

> > > patients and five CFIDS patients with the I.V. Ganciclovir. He

> > found

> > > that it helped to stabilize the MS patients. In the CFIDS

> patients,

> > > two to three were much improved, one still had a positive viral

> > > culture and one had a poor response. Unfortunately, maintaining

> > > patients on I.V. Ganciclovir forever (as noted above) is not a

> > viable

> > > option. Fortunately, an oral pill form of Ganciclovir

> > > (Valganciclovir) is currently being developed! It should be

noted

> > > that the HHV-6 virus is similar to CMV (Cytomegalovirus), and

> that

> > > whatever is effective against one, tends to be effective for

the

> > > other. This is a helpful bit of information as we follow new

> > research

> > > looking for clues on how to eliminate HHV-6 infection.

> > > > What Roles Does The Epstein Barr And Cytomegalovirus Play In

> > CFIDS?

> > > > Again, the roles of the EB and CMV viruses are not clear. It

is

> > not

> > > uncommon for antibody levels of these viruses to be elevated in

> > > Chronic Fatigue Syndrome. As noted above, it is not clear

whether

> > > this simply reflects a previous or ongoing infection with these

> > > viruses. Research by a husband and wife team (the Glasers) at

> Ohio

> > > State University, suggests that Epstein Barr Virus is still

quite

> > > active and playing a role in many patients with these

infections.

> > In

> > > addition, work by Lerner, M.D., also suggests that EB

> Virus

> > > and CMV are active as well. In speaking with Dr. Lerner's

> research

> > > assistant, I found out that he has found EB Virus and CMV to

both

> > be

> > > fairly common in patients with Chronic Fatigue Syndrome (with

and

> > > without pain). He found that about 20% had positive IGM and/or

> > > elevated EA (early antigen) tests to the EB Virus with negative

> > > Cytomegalovirus. Of these, two-thirds improved with high-dose

> > Valtrex

> > > (an oral antiviral). Despite my teasing and prodding, his

associat

> > > > e refused to give out the dose of Valtrex they prescribed

> because

> > > Dr. Lerner does not want to be responsible for people using

these

> > > higher doses until he completes the double-blind trial that is

> > > currently in progress. On the other hand, another study of his

> did

> > > use 1000mg, 4 times a day, giving the antiviral for 6 months.

It

> > > takes about 3 to 4 months before patients start to improve and

> > after

> > > 6 months people can stop the Valtrex without the symptoms

coming

> > > back. However, if there is no improvement in 6 months, consider

> it

> > to

> > > be a negative result. They also found that, as noted above, the

> IGM

> > > is almost always negative using the reagents used in most labs.

> > They

> > > found that only Epstein Barr IGM antibody testing, using a

> reagent

> > by

> > > the Diasorin Company (800-328-1482), has been useful in showing

a

> > > significant number of positive tests. When we called the

company,

> > the

> > > only lab in the Washington, D.C., area using it was at the NIH.

> The

> > > company may, however, be able to give you the name of

> > > > a lab near you that can do the test. What was fairly common,

> > > though, (and present in most patients) was either positive

tests

> > for

> > > Epstein Barr, CMV, or a combination of both as noted above.

When

> > CMV

> > > or HHV-6 are present, the Valtrex is less likely to work

because

> it

> > > is not effective against these viruses.

> > > > In another study done by Dr. Lerner (Infectious Diseases In

> > > Clinical Practice, 1997; 6:110-117) he found that patients who

> had

> > > elevated CMV IGG antibodies, but no significant evidence of

> > > associated Epstein Barr virus (i.e., negative IGM and early

> antigen

> > > (EA) antibody total less than 40), did improve with I.V.

> > Ganciclovir

> > > at 5mg per kg of body weight given every 12 hours I.V. for 30

> days.

> > > In this study 72% (13 of the 18 patients) improved markedly at

> the

> > > end of a month without any significant side effects. As noted,

an

> > > oral form of Ganciclovir is currently in development as well.

It

> > > should be noted that 36% of the Chronic Fatigue Syndrome

patients

> > > that Dr. Lerner checked (18 out of 50) did turn out to have

> > elevated

> > > CMV antibodies (albeit IGG) in the absence of IGM and EA

> antibodies

> > > to EB Virus (i.e., no evidence of active Epstein Barr Virus).

It

> > > should be noted, though, that 70% of healthy patients also had

> > > positive IGGs to CMV (as per our discussion above) in the study

> and

> > > appears

> > > > that the overall level of the IGG was not much higher

overall

> in

> > > the Chronic Fatigue group than in the healthy controls. On the

> > other

> > > hand, the higher the level of CMV antibody in the Chronic

Fatigue

> > > group, the more likely they were to improve with the I.V.

> > Ganciclovir.

> > > > What this means is that patients with Chronic Fatigue

Syndrome

> > > don't necessarily have different blood tests for antibody

levels

> > than

> > > healthy people for these viruses. However, if one has a higher

> > level

> > > rather than a lower level, one is more likely to improve with

the

> > > Ganciclovir. Previous research has not shown benefit from

> antiviral

> > > therapies in CFS (Straus SE, et al., New England Journal of

> > Medicine

> > > 1988; 319:1692-1698). Our experience using a fairly high dose

of

> > > Valtrex or Famvir (1500mg and 2250mg a day respectively) also

> > showed

> > > no significant improvement on these regimens after 6 weeks, at

> > which

> > > time we considered it to be ineffective. On the other hand, Dr.

> > > Lerner's research is suggesting that perhaps we gave it for too

> > short

> > > a time and at too low a dose. When treating himself and a few

> other

> > > patients, he used Valtrex by mouth at a dosage of 1000mg, 4

times

> a

> > > day, for 6 months. Using the higher dosing and the extended

> period

> > of

> > > time, as well as separating out groups that have

> > > > Epstein Barr Virus (sensitive to the oral Valtrex) without

CMV

> > or

> > > HHV-6 (resistant to oral Valtrex but sensitive to I.V.

> > Ganciclovir),

> > > may make an important difference in making treatment effective.

> No

> > > major Valtrex toxicity was seen. As noted above, a double-blind

> > study

> > > is currently in progress and we are beginning to try the higher

> > dose

> > > of Valtrex in the 15% of our patient population that have not

> > > improved adequately and have positive EBV, and negative CMV and

> HHV-

> > 6

> > > tests. We hope to give you follow-up information on the

> treatment's

> > > effectiveness as soon as we know!

> > > > In addition, Dr. Lerner suspects that these infections affect

> the

> > > heart muscle contributing to much of your symptoms. I am not

> > > convinced that this is the case because EKG changes are common

in

> > > CFS. This can occur because the autonomic (brain) dysfunction

and

> > > hormonal changes seen in CFS can cause these same EKG changes

> > without

> > > heart damage. Regardless, he found that these changes went away

> > with

> > > treatment (as has been our experience in treating Chronic

Fatigue

> > > Syndrome—patient's EKG changes improve even without

antivirals).

> > Dr.

> > > Lerner is currently recruiting patients for a double-blind

study

> > > using the high-dose Valtrex. His phone number is 248-540-9688

in

> > > Beverly Hills, Michigan.

> > > > Does This Mean There Is Nothing We Can Do Now?

> > > > Although there is no currently accepted specific treatment

for

> > the

> > > CMV and HHV-6 viruses, there are still a number of things that

> may

> > be

> > > very helpful in fighting this infection.

> > > > 1. Lithium tends to be antiviral and has been shown to

decrease

> > > pain in FMS patients when added to treatment with Elavil.

Lithium

> > is

> > > commonly used in manic depressive illness and is a natural

> mineral

> > > despite being sold by prescription. In high doses, it can cause

> > some

> > > neurologic symptoms and suppression of the thyroid gland, but

> these

> > > can usually be treated by taking a small amount of Essential

> Fatty

> > > Acids and thyroid hormone. Lithium might also worsen Restless

Leg

> > > Syndrome. Although we have no direct evidence of Lithium being

an

> > > effective antiviral against HHV-6, it may well be effective

> because

> > > it works against a number of other viral infections. In our

> > > experience, 200mg to 600mg a day seems to be the effective dose

> in

> > > treating FMS patients. As noted above, I would check the

thyroid

> > > blood tests at 3 months, 6 months and then yearly (check a Free

> T4

> > > and a Total T3 - not a TSH). A Lithium level should also be

> checked

> > > at the same time to be sure that it not above the upper limit

of

> > > > normal. The level can be below the normal range, which is

fine

> as

> > > long as the treatment is effective. You may find that you can

> lower

> > > the Lithium dose after you have been on it for several months.

> > > > 2. Heparin (a blood thinner, see Page 12) also has antiviral

> > > properties.

> > > > 3. It is worth considering trials of high-dose Valtrex. It

> should

> > > be noted that 1000mg, 3 times a day, is used for shingles in

> older

> > > patients and appears to be quite safe. On the other hand,

higher

> > > dosing at 8 grams a day in AIDS patients did result in uncommon

> > > (under 2%) life threatening problems. This is common even with

> day-

> > to-

> > > day drugs in AIDS patients (for example, regular sulfa

> antibiotics

> > > have often resulted in severe toxicity in AIDS patients).

> > > Nonetheless, we will be limiting the dose to 1 gram, 4 times a

> day,

> > > in our practice. It is important to note that taking Tagamet

> and/or

> > > Probenecid (Benemid) will raise the blood level of Valtrex.

> Tagamet

> > > has powerful immune modifying properties and is very helpful in

> > acute

> > > cases of Epstein Barr (mono) infections. Because of this, we

are

> > > adding Tagament 300mg, 4 times a day (but not Probenecid), to

the

> > > Valtrex. As I noted, we are beginning this treatment with some

of

> > our

> > > patients and will let you know what we find.

> > > > Natural Remedies

> > > > 1. Olive Leaf - This is an herbal which is known to have a

wide

> > > spectrum of anti-infectious activity. It has been shown to be

> > > effective against the HHV-6 virus in the test tube. I have not,

> > > however, seen studies testing its effect in human beings

infected

> > > with HHV-6. Nonetheless, a number of physicians have found that

> > using

> > > Olive Leaf in Chronic Fatigue Syndrome is very effective. There

> is

> > > controversy over whether the form and source of the Olive Leaf

is

> > > critical. We recommend that you use a form that has at least 6%

> > > Oleuropein, which is one of the most active antiviral

components

> in

> > > the Olive Leaf. Other components may be important and some

people

> > > also feel that you must use the Mediterranean Olive Leaf vs.

the

> > > American Olive Leaf. Other people argue that you should have a

> form

> > > that is organically grown, without pesticides. At this point it

> is

> > > not clear whether this is simply marketing or important in day-

to-

> > day

> > > life. Nonetheless, I would be picky about the companies you buy

> the

> > O

> > > > live Leaf from. I would use one of these sources:

> > > > a. My office (800-333-5287) or my Web site at

> www.endfatigue.com.

> > > > b. Pacific Research Labs (800-325-7734). This is owned by R.

J.

> > > Marshall, Ph.D., who has done a fair bit of work treating CFIDS

> > > patients with Olive Leaf. I will be describing the protocol

that

> he

> > > uses below.

> > > > c. General Nutrition Centers (GNC).

> > > > Dr. Marshall feels that during infections, the body becomes

> > overly

> > > acidic. He tests the morning urine specimens with pH paper

(which

> > is

> > > very easy to do at home) and gives a shell extract, which

raises

> > the

> > > body's alkalinity. He feels that having a normalized acid-base

> > > balance in your body helps it to fight infections. He then adds

> his

> > > form of Olive Leaf, called Infectostat (which also contains

> > mushroom

> > > extracts to stimulate the immune system), giving 3 to 4

capsules,

> 3

> > > to 4 times a day, to help fight the infections. Usually, the

> > patient

> > > should start feeling better within four weeks on this protocol.

> > > Although we have found it helpful in fighting colds and other

> > common

> > > respiratory infections, we are just starting to explore Olive

> > Leaf's

> > > use in a few of our patients who have not responded to standard

> > > treatment and are still quite ill. We will let you know our

> > > experience with this in an upcoming newsletter issue. My guess,

> > > though, is that simply using regular (6% Oleuropein) Olive Leaf

> > > > 500mg capsules, 3 to 4 capsules, 3 to 4 times a day between

> > meals,

> > > will probably be equally effective and cheaper for most people

> than

> > > the expensive forms. How long one needs to take Olive Leaf in

> > Chronic

> > > Fatigue Syndrome is yet to be determined.

> > > > Initially, a pharmaceutical company was developing the

> Oleuropein

> > > in Olive Leaf as an antiviral. Because it gets bound to the

blood

> > > proteins, they thought that Oleuropein might not get to the

> > tissues.

> > > More importantly, Oleuropein is a natural product and therefore

> > hard

> > > to patent. Because of these problems, they stopped research on

> it.

> > > Years later this research was rediscovered and explored

further.

> In

> > > addition to being an effective antiviral agent, Olive Leaf is

> > > reported to be effective on a number of bacterial and yeast

> > > infections as well. What is most exciting regarding the Olive

> Leaf

> > is:

> > > > a. That some doctors have found it to be effective in CFIDS,

> and

> > > > b. That in tests against HHV-6 and CMV virus (remember that

if

> > > something is effective against one, it tends to be effective

> > against

> > > the other) the Olive Leaf extract did not just suppress the

virus

> > but

> > > killed it. That is very promising.

> > > > 2. Pro-Boost - Thymic Protein A (used to be called BioPro) -

> This

> > > is the immune stimulant that I discussed in my newsletter, Vol.

> 2,

> > > Issue 2. Although not a hormone, Pro-Boost mimics the natural

> > hormone

> > > produced by your Thymus - the gland which stimulates your

immune

> > > system. I find it to be extraordinarily effective in fighting

> > common

> > > infections of any kind that seem to pop up. For the more deep-

> > seated

> > > infections of CFIDS, the higher dose (1 packet, 3 times a day)

> will

> > > likely be needed. Once the infection seems to be in check and

you

> > are

> > > feeling better (i.e., after 6 weeks), you can taper down to the

> > > lowest dose that maintains the effect.

> > > > 3. IP6 - This natural immune stimulant is an extract of bran

> > > (phytates). It is less expensive and is sometimes combined with

> > > vitamin C. The dose of IP6 (available from many sources) is 5

to

> 8

> > > grams a day. Do not take IP6 within 3 hours of vitamin/mineral

> > > supplements.

> > > > 4. MGN3 - This is a very concentrated mushroom extract, which

> has

> > > been shown to stimulate Natural Killer Cell immune function. In

> one

> > > study, it actually tripled Natural Killer Cell function—an

effect

> > > that, as the HHV-6 virus can suppress Natural Killer Cell

> function,

> > > could be very powerful. Unfortunately, it is horribly expensive

> in

> > > the recommended dose (250 mg capsules) of 2 to 4 capsules, 4

> times

> > a

> > > day for 2 weeks, followed by 2 capsules, 2 times a day. Other

> > > mushroom extracts are cheaper but may not be as effective.

> > > > 5. Intravenous Vitamin C at high-dose (15gm to 50gm) has been

> > > suggested to have antiviral effects in a number of other

> infections

> > > and is often dramatically helpful in CFIDS when given in the

I.V.

> > > nutritional therapy called " Myers Cocktails " (see my

newsletter,

> > Vol.

> > > 3, Issue 3).

> > > > 6. Lysine 1000 mg, 3 times a day - This amino acid protein is

> > safe

> > > and inexpensive (27¢ a day). It inhibits oral/genital herpes

(by

> > > depleting the Arginine the virus needs to grow). I do not know

if

> > it

> > > also inhibits EBV, HHV-6 or CMV viral infections.

> > > > I would take the combination of these together (as is

> affordable)—

> > > perhaps leaving the MGN3 for later if needed, giving the

> treatment

> > > for at least a 6 to 8 week trial to see if it's effective. If

you

> > are

> > > feeling better at 6 weeks, you can then taper down the dose

> slowly

> > as

> > > long as the benefit is maintained. When able, you can wean

> yourself

> > > off the treatments. If symptoms recur, go back up to the dose

> that

> > > maintains the benefit or consider increasing the dose further.

As

> > we

> > > are just starting to use this protocol in our patients, I do

> > > appreciate your feedback on what has worked for you and what

has

> > not.

> > > You can " vote " for what helped or didn't help you on our Web

site

> > at

> > > www.endfatigue.com. You can also see other people's votes.

> > > > In addition, your clotting system may be activated by several

> > > infections making it difficult to eliminate them. Using the

anti-

> > > clotting treatments that we will discuss later can also make it

> > > easier for your body to eradicate infections.

> > > > Mycoplasma And Chlamydia

> > > > Other infections have also been found to be very important in

> > > CFIDS. Dr. Garth Nicolson and his wife, who were on-faculty at

> the

> > > University of Texas Medical School at Houston and the

Department

> of

> > > Microbiology and Immunology at Baylor College of Medicine in

> > Houston,

> > > Texas, are the leading proponents of treatment of these

> infections.

> > > Dr. Garth Nicolson was an endowed chair and department chairman

> at

> > > the University of Texas, the M.D. Cancer Center in

> > Houston,

> > > Texas, and a Professor of Internal Medicine at the University

of

> > > Texas Medical School, also in Houston. Dr. Nicolson's wife had

> > > Chronic Fatigue Syndrome years ago. They were surprised that

her

> > test

> > > turned out to be positive for Mycoplasma fermentans (also known

> as

> > > Mycoplasma fermentans incognitus). This Mycoplasma was found to

> be

> > > resistant to the Penicillin- and Keflex-family antibiotics that

> > most

> > > doctors use, but was sensitive to long courses of Doxycycline

and

> > > Cipro. After an extended course of Doxycycline treatment,

> > > > she was much better. The Nicolsons then went on to develop

> their

> > > own tests for Mycoplasma using PCR testing. Dr. Nicolson tells

me

> > > that, in addition, when his step-daughter came home after

serving

> > in

> > > Desert Storm, she came down with Gulf War Illness (GWI). They

> > tested

> > > hundreds of Gulf War veterans with GWI and 40% to 45% were

> positive

> > > for Mycoplasma infections—almost all with Mycoplasma

fermentans.

> > This

> > > has been confirmed by other labs and a large Veterns

> Aministration

> > > study involving over 2,000 patients. In contrast to this,

> soldiers

> > > who were not deployed to the Gulf during the war, had less than

a

> > 6%

> > > incidence of being positive for these infections.

> > > > Interestingly, the Nicolsons found that in patients with

> Chronic

> > > Fatigue Syndrome or Fibromyalgia, approximately 70% (144 out of

> 203

> > > patients) had a positive PCR test for one, or usually several

> > > species, of Mycoplasma. When the Nicolsons tested 70 healthy

> > > patients, only 6 patients (less than 9%) were positive for any

of

> > the

> > > Mycoplasma species. This is a highly significant difference.

Only

> 2

> > > of these 70 healthy people were positive for Mycoplasma

> fermentans.

> > > Similar results have been found by other doctors and have been

> > > published.

> > > > As we have said before, it is likely that there is a group of

> > > underlying problems and not a single one that triggers

CFIDS/FMS.

> > > This applies to infections as well. This is why you can see

tests

> > be

> > > positive for both viral and Mycoplasmal infections in so many

> > people

> > > with this disease. For Mycoplasma alone, when they checked for

> four

> > > different types of Mycoplasma, over half of the 93 CFIDS

patients

> > > that were positive had more than one type of infection. Over

20%

> of

> > > them had three out of the four Mycoplasma infections test

> positive.

> > > The more infections that were positive, the worse the patient's

> > > symptoms were and the longer they had had CFIDS/FMS.

> > > > What Are Mycoplasma?

> > > > Mycoplasma are an ancient bacteria that lacks cell walls and

> are

> > > capable of invading a number of types of human cells. They can

> > cause

> > > a wide variety of human diseases. These organisms can cause the

> > types

> > > of symptoms seen in Chronic Fatigue Syndrome patients and,

> > according

> > > to Dr. Nicolson, tend to be immune suppressing. Unfortunately,

> they

> > > cannot be readily cultured on a culture dish like regular

> bacteria.

> > > In medicine, we have a bad habit on focusing on that which is

> easy

> > to

> > > test for and making believe that that which is hard to test for

> > does

> > > not exist. Because of this, bacterial infections such as

> pneumonia,

> > > bladder infections and skin infections, where one bacteria on a

> > cell

> > > dish will rapidly turn into millions by the next day and be

> visible

> > > to the human eye, get all our attention. Unfortunately,

> Mycoplasma,

> > > which cannot be easily cultured, tends to be ignored. It's like

> the

> > > old story about the little kid who was looking for his lost

keys

> > > under the street lamp one night. His frien

> > > > ds came by and asked him what was going on. He told them and

> they

> > > all looked for the keys under that light for about an hour.

> > Finally,

> > > exasperated, they looked at the friend and said, " Where did you

> > lose

> > > these keys? " The kid looked up and said, " Oh, about half a

block

> > down

> > > the street. " They said, " Why are you looking for them here? " He

> > > said, " Because there is a light here and I can see! " This is

kind

> > of

> > > what it is like in medicine. If there is a test for something

> (such

> > > as cholesterol and bacterial cultures) that is easy to do, we

> focus

> > > our attention on that test and make believe that it finds the

> main

> > > problem. Unfortunately, in CFIDS and FMS, this is not the case.

> > > > The data suggests that many infections may trigger CFIDS/FMS

or

> > > that CFIDS and FMS may cause immune suppression—which then sets

> you

> > > up to catch a whole bunch of different infections which your

body

> > has

> > > trouble clearing. This is why it is important to treat all the

> > > underlying processes simultaneously as I discuss in my From

> > Fatigued

> > > To Fantastic! book and newsletters.

> > > > So, How Do You Look For These Infections?

> > > > I had the honor of speaking with Konnie Knox, M.D., a major

re-

> > > searcher on HHV-6 testing in CFIDS/FMS, who uses a technique

> called

> > > Rapid Cell Culture. She actually infects different test tube

> cells

> > > with HHV-6, grows them, and then looks for signs of HHV-6 in

the

> > > cell. In her experience, one out of three CFIDS/FMS patients

are

> > > positive for active HHV-6 infection on the first blood test.

When

> > > multiple testing is done (e.g., three tests), 70% are positive.

> > This

> > > test is negative in the vast majority of people who are

healthy.

> > The

> > > other main illness where the HHV-6 test is positive is Multiple

> > > Sclerosis. At this time, HHV-6 Rapid Cell Culture and the PCR

> test

> > at

> > > Dr. Nicolson's lab (International Molecular Diagostics) are the

> > only

> > > HHV-6 test I order. For more information on Dr. Knox's work, go

> to

> > > these Web sites: www.HHV-6.com and www.cnet.com. For the IMD

> > website,

> > > go to www.imd-lab.com.

> > > > The Nicolsons use very sensitive PCR (Polymerase Chain

> Reaction)

> > > testing to actually look for DNA specific to Mycoplasma, HHV-6,

> and

> > > other infections. Unfortunately, those DNA pieces are so

> > > microscopically small, that to look for just one is much worse

> than

> > > looking for a " needle in a haystack. " With the PCR, if that

> > > Mycoplasma gene sequence is found, the technique multiplies it

> like

> > a

> > > copying machine until millions of that sequence are present and

> can

> > > be picked up by testing. Because of this, PCR testing is

> > exquisitely

> > > sensitive and can find the proverbial " needle in a haystack. "

> This

> > > makes it very powerful and the only testing that I would

> recommend

> > in

> > > looking for these Mycoplasma and Chlamydia infections. As noted

> > > above, IGG antibody testing is not reliable for Mycoplasma and

> > > Chlamydia testing in CFS.

> > > > Where Do I Get These Tests Done And Should I Have Them Done?

> > > > The tests for HHV-6 and Mycoplasma each cost about $180 to

> $250.

> > As

> > > noted above, the only places that I would get the HHV-6 test

done

> > > (and the only tests I would do are PCR or viral culture

testing)

> > are

> > > at the Wisconsin Viral Institute (414-774-0311) or Dr.

Nicolson's

> > > lab. I order all the lab testing for Mycoplasma and Chlamydia

at

> > the

> > > Nicolson's lab, at International Molecular Diagnostics, 15162

> > Triton

> > > Lane, Huntington Beach, CA 92649 (714-799-7177 ext. 202 or

204).

> > The

> > > lab's Web site is www.imdlab.com.

> > > > I can almost guarantee that if you do the Mycoplasma or

> Chlamydia

> > > tests at your local lab they will do the wrong tests and they

> will

> > be

> > > useless for hidden CFS infections. I have never seen one come

> back

> > > with any useful information. What they usually do is check the

> > > antibodies (usually for the wrong Mycoplasma infection) which

> > simply

> > > shows that you (like everybody else at some point in their

life)

> > have

> > > had a Mycoplasma infection. It tells nothing about active

> infection

> > > and, again, is useless. Be sure to do the PCR testing and do it

> at

> > > one of the two labs discussed above. Dr. Nicolson has noted

which

> > > tests he recommends in CFS/FMS, their cost and instructions for

> the

> > > lab. We have reprinted this information on the next page (Dr.

> > > Nicolson's lab also does viral PCR testing for CMV, as well as

> HHV-

> > 6).

> > > > Even at the best labs, it is not uncommon to have a false-

> > negative

> > > report (where you have the infection and it does not show up on

> the

> > > test). Because of this, especially for HHV-6, multiple tests

will

> > > often need to be done. There are good arguments for not doing

the

> > > tests and simply going ahead and treating empirically with the

> > > natural remedies discussed above for HHV-6, or for prescribing

> > > Doxycycline or Cipro for an extended period of time (see

below).

> If

> > > you feel better after four months on the treatment, then you

know

> > you

> > > are hitting an infection and you can always intermittently stop

> the

> > > treatments to see how long you will need them. Also, there are

> many

> > > infections that are not tested for with these tests that would

be

> > > effectively treated with the regimens that we are discussing.

> Many

> > of

> > > these are likely to be infections that we don't even know

exist.

> > > Because of this, if resources are limited, I some-times simply

> > treat

> > > the patient, based on clinical suspicion, without doing the

> > > > tests.

> > > > Testing does have its benefits. If the test is positive, I am

> > > likely to treat more aggressively and it helps guide me on how

> long

> > > to give the treatment. For example, if after four months you

are

> > not

> > > better and the test is positive, I would be likely to go ahead

> and

> > > increase dosing or change to a different antibiotic. If the

test

> > was

> > > negative, I would be more likely to just stop treatment and

> suspect

> > > that the infection is less likely. This argues in favor of

doing

> > the

> > > tests. One simple thing to do is to go ahead and check with

your

> > > insurance company to see if they cover these tests. This may

make

> > > your decision much simpler. Unfortunately, I suspect that the

way

> > > that most labs draw and ship your blood sample may not be

> reliable

> > > because, in our experience, we have had less than 10% of

> patient's

> > > tests come back positive for HHV-6 cell culture and only a

modest

> > > percent come back positive for the Mycoplasma. For the PCR

> > Mycoplasma

> > > test, the blood has to be frozen (see boxed inset, Page 9

> > > > ). If the blood is left at room temperature, most of the

> positive

> > > samples become negative after one to two days.

> > > > Mycoplasma testing is not as specific as HHV-6 testing is for

> > > CFIDS/FMS/Multiple Sclerosis (i.e., it is positive in other

> > > illnesses). For example, about half the patients with

Rheumatoid

> > > Arthritis are also found to be infected with treatable

> infections,

> > > including Mycoplasma. This goes along with my, and other

doctors'

> > > experience, that Doxycycline is often effective in treating

> > > Rheumatoid Arthritis. Interestingly, although Mycoplasma is

> common

> > in

> > > the environment, it usually is fairly noninvasive. It may

simply

> be

> > > that once your immune system is weakened, these infections can

> get

> > > into cells where they don't belong. When that happens, even

some

> of

> > > the common ones that are considered noninfectious can wreak

> havoc.

> > > When these infections repro-duce slowly, they tend to be low-

> grade,

> > > chronic infections, as opposed to the acute and more prominent

> > > symptoms seen with bacterial and viral infections that multiply

> and

> > > divide rapidly.

> > > > For CFS/ME or FMS or Autoimmune Disease Patients,

> > > > The Institute for Molecular Medicine suggests the following

lab

> > > tests:

> > > > (Codes are I.M.D. or CPT Codes)

> > > > 1. Test Panel 1007 (CPT: 87798x3, 87581) Mycoplasma species

> panel

> > > of 4 pathogenic mycoplasmas (M. fermentans, M. penumoniae, M.

> > > hominis, M. penetrans) by PCR.

> > > > Justification: Almost 60% of CFS/FMS and 50% of Rheumatoid

> > > Arthritis (RA) and other autoimmune patients have one or more

> > > intracellular, systemic mycoplasmal infections similar to those

> > found

> > > in a variety of chronic illnesses [Nicolson, et al.,

Mycoplasmal

> > > infections in chronic illnesses: Fibromyalgia and Chronic

Fatigue

> > > Syndromes, Gulf War Illness, HIV-AIDS and Rheumatoid Arthritis;

> > > Medical Sentinel 1999; 5:172-176]. Ultrasensitive and

> ultraspecific

> > > mycoplasma tests can only be done by a small number of labs,

most

> > > university or government labs that have been trained by us

under

> a

> > > U.S. government contract.

> > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> > > (EDTA). The blood is collected, immediately mixed and placed on

> > ice,

> > > then shipped on wet ice or immediately flash frozen and shipped

> > with

> > > dry ice by courier (foreign shipments) to I.M.D. to arrive

within

> > 24-

> > > 36 hours. Cost=$250. (Note that other commercial labs charge

$400-

> > > 600.)

> > > > 2. Test 1006 (CPT: 87486) Chlamydia pneumoniae test by PCR.

> > > Justification: Many CFS, FMS, MS, RA and other patients have

this

> > > systemic infection along with viral infection(s). We were among

> the

> > > few labs that developed the molecular tests that are now done

for

> > > this type of infection. The other labs that use these

procedures

> > are

> > > university labs.

> > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> > > (EDTA). The blood is collected, immediately mixed and placed on

> > ice,

> > > then shipped on wet ice or immediately flash frozen and shipped

> > with

> > > dry ice by courier to I.M.D. to arrive within 24-36 hours.

> > Cost=$180.

> > > (Note that other commercial labs charge $200-250.)

> > > > 3. Test 07047 (CPT: 87476) Borrelia burgdorferi (Lyme

Disease)

> > test

> > > by PCR.

> > > > Justification: Many CFS, FMS and RA patients have this

systemic

> > > infection (diagnosed as Lyme Disease) along with other infection

> > (s).

> > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> > > (EDTA). The blood is collected, immediately mixed and placed on

> > ice,

> > > then shipped on wet ice or immediately flash frozen and shipped

> > with

> > > dry ice by courier to I.M.D. to arrive within 24-36 hours.

> > Cost=$180.

> > > (Note that other commercial labs charge $200-250.)

> > > > 4. Test 07039 (CPT: 87532) Human Herpes Virus 6 (HHV-6) test

by

> > > PCR.

> > > > Justification: Many CFS and some FMS patients have this

> systemic

> > > viral infection, and it should be tested for in any autoimmune

> > > illness.

> > > > Specimen Requirements: Collect blood in one (1) 5 cc Lavender-

> top

> > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > centrifugation. The plasma is then shipped on wet ice or

> > immediately

> > > flash frozen and shipped with dry ice by courier to I.M.D. to

> > arrive

> > > within 24-36 hours. Cost=$180. (Note that other commercial labs

> > > charge $200-350.)

> > > > 5. Test 07034 (CPT: 87496) Cytomegalovirus (CMV) test by PCR.

> > > > Justification: Many CFS and FMS patients have this systemic

> viral

> > > infection, and it should be tested for in any autoimmune

illness.

> > > > Specimen Requirements: Collect blood in one (1) 5 cc Lavender-

> top

> > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > centrifugation. The plasma is then shipped on wet ice or

> > immediately

> > > flash frozen and shipped with dry ice by courier to I.M.D. to

> > arrive

> > > within 24-36 hours. Cost=$180. (Note that other commercial labs

> > > charge $200-300.)

> > > > For the best price and highest quality, the above PCR

specialty

> > > tests for CFS/FMS patients can be ordered through International

> > > Molecular Diagnostics, Inc., 15162 Triton Lane, Huntington

Beach,

> > CA

> > > 92649, U.S.A. Tel: 714-799-7177, ext. 202 (Client Services) or

> ext.

> > > 204 (Brant Blasingame). Order forms and additional information

> are

> > > available upon request. They also offer testing for blood

> clotting

> > > abnormalities (see below). Tests must be ordered by a

physician.

> > The

> > > I.M.D. Web site is www.imd-lab.com. On this site you will find

> > > additional information about testing and disease. The Institute

> for

> > > Molecular Medicine Web site is www.immed.org. On this site you

> will

> > > find publications and documents on CFS/ME, FMS, autoimmune

> diseases

> > > and other chronic illnesses. Immediate fax-back information is

> > > available 24 hours per day by calling our telephone number 714-

> 903-

> > > 2900.

> > > > Garth Nicolson, Adjunct Professor of Internal Medicine

> > > > President and Chief Scientific Officer, The Institute for

> > Molecular

> > > Medicine

> > > > —A nonprofit institute dedicated to discovering new

diagnostic

> > and

> > > therapeutic solutions for chronic diseases—

> > > > 15162 Triton Lane, Huntington Beach, CA 92649-1041, U.S.A. •

> Tel:

> > > 714-903-2900 • Fax: 714-379-2082

> > > > So, What Is Prescribed For Mycoplasma And Chlamydia?

> > > > Fortunately, Mycoplasma and Chlamydia infections are usually

> > > sensitive to the right antibiotics. The antibiotics most likely

> to

> > > effect these organisms are:

> > > > 1. Doxycycline or Minocycline 100 mg, 2-3 times a day. These

> two

> > > antibiotics are in the Tetracycline-family and should not be

used

> > in

> > > children under eight years-old because they can cause permanent

> > > staining of the teeth. They are very effective, though, against

a

> > > number of unusual organisms (e.g., Lymes Disease). They will

> > > sometimes cause some stomach upset. If this occurs, take the

> > medicine

> > > with food and a full glass of water or lower the dose. Do not

use

> > > outdated/expired Tetracycline prescriptions—they can kill you!

> > > > 2. Cipro (Ciprofloxacin) 750 mg, twice a day. Although

> expensive,

> > > this is usually a well-tolerated antibiotic. It has a very wide

> > range

> > > of effectiveness against a large number of organisms. When

> treating

> > > males, the Cipro (as well as the Doxycycline) has the

additional

> > > benefit of treating any hidden prostate infections. Do not take

> > oral

> > > magnesium within 6 hours of Cipro or you won't absorb the Cipro.

> > > > 3. Zithromax 600 mg a day, taken with food, or Biaxin 500 mg,

> > twice

> > > a day, taken on an empty stomach. These are in the Erythro-

mycin

> > > family. Zithromax tends to be fairly well-tolerated. The Biaxin

> is

> > > more likely to cause a bit of nausea in some patients, but it

is

> > > usually well-tolerated. Both are quite expensive. They may work

> > > against infections missed by Doxycycline and Cipro.

> > > > Although all of these antibiotics can be effective, it is not

> > > uncommon for infections that are sensitive to the Erythromycin

> > > antibiotics (#3 above) to be resistant to #1 and #2 above and

> vice-

> > > versa. Therefore, it is best to try either Doxycycline or Cipro

> > > first. If they are not effective, then try the Zithromax or

> Biaxin.

> > > The antibiotic should be taken for at least 6 months. If there

is

> > no

> > > improvement in 4 months, switch to or add the other antibiotic

or

> > > simply stop the treatment. It is helpful to check for low-grade

> > > fevers. I am more likely to use antibiotics for CFIDS patients

> who

> > > have temperatures over 98.6°F, even if it is only 98.8° (I

> consider

> > > 98.8° a fever because CFIDS/FMS patients usually have low body

> > > temperatures). If you do have low-grade, chronic temperature

> > > elevations, be sure that you monitor your temperatures during

> > > treatment. If your temperature drops with the antibiotic, it

> > suggests

> > > that you do have one of these nonviral infections and the

> > antibiotic

> > > is helping. T

> > > > his would encourage me to continue the antibiotic trial -

even

> if

> > > it takes up to 12 months to see an improvement in your

symptoms.

> > > > If you are clearly better, I would probably take the

antibiotic

> > for

> > > at least 6 to 12 months. It can then be stopped. If symptoms

> recur,

> > > keep repeating 6 to 8 week cycles until the symptoms stay gone.

> It

> > > may take several years of treatment for the infection to be

> totally

> > > eradicated. To put it in perspective, this is how long children

> > often

> > > take antibiotics for acne—which unfortunately, if not taken

with

> > anti-

> > > fungals, can lead to yeast overgrowth and possibly trigger

CFIDS.

> > Be

> > > sure to take Nystatin, 2 tablets, 2 times a day, while on the

> > > antibiotics. Also, please be sure to use alternative birth

> control

> > if

> > > on " the pill. " Birth control pills may be ineffective while

> taking

> > > antibiotics. In addition, anti-depressants, codeine, antacids,

> and

> > > mineral supplements (e.g., magnesium) may block antibiotic

> > > absorption. Take these at least three hours away from the

> > antibiotic

> > > (and don't take the antidepressant/codeine medications if they

> are

> > > not clearly helping).

> > > > It is very common to get die-off (Herxheimer) reactions which

> > > include chills, fever, night sweats and general worsening of

> > CFS/FMS

> > > symptoms when the antibiotic first kills off the infection.

These

> > can

> > > be severe and last for weeks. Dr. Nicolson encourages you " to

be

> > > patient and not abandon therapy prematurely, because few

patients

> > who

> > > have been sick for years recover in less than one year of

> > therapy...

> > > [don't] be alarmed if some signs and symptoms occasionally

return

> > or

> > > worsen. This is not unusual. Eventually you will be off

> antibiotics

> > > or antivirals but you will need to continue various supplements

> to

> > > maintain your immune system and general nutritional status. "

> > > > Treatment for Bacterial, Mycoplasma, Chlamydia, E-coli,

> Bladder,

> > Or

> > > Other Infections

> > > > (From the " Treatment Checklist " used in Dr. Teitelbaum's

> office.

> > A

> > > full list is available on Dr. Teitelbaum's Web site at

> > > www.endfatigue.com.)

> > > > The Mycoplasma, Chlamydia, E-Coli, bladder and other

bacterial

> > > infections usually take months to years to eradicate. It is

> common

> > to

> > > flare your symptoms (from the infection die-off) the first two

> > weeks

> > > of treatment. Take the antibiotics for six months and, if

better,

> > > then repeat six-week cycles till your symptoms stay gone.

> > > Antidepressants, Neurontin, and/or Codeine may block the

> > antibiotic's

> > > effectiveness. Be sure to take Nystatin, 2 tablets twice a day,

> and

> > > Acidophilus while on the antibiotics. If you have occasional

low-

> > > grade fever (i.e., if over 98.6° F), check your oral

temperature

> > > occasionally to see if the antibiotic reduces or eliminates the

> > > fever. If so, stay on that antibiotic. Also, see Dr. Nicolson's

> Web

> > > site at www.immed.org for additional information.

> > > > Useful antibiotic treatment for the above infections include:

> > > > 1. Cipro (ciprofloxacin) 750 mg, 2 times a day for 6 months.

Do

> > not

> > > take magnesium products (e.g., Fibrocare, some antacids, Pro

> > Energy,

> > > or (Dr. Teitelbaum's) Foundation Formula™) within 6 hours of

> Cipro

> > > because you won't absorb the Cipro.

> > > > OR

> > > > 2. Doxycycline (a tetracycline) 100 mg, 3 times a day for 6

> > months.

> > > If symptoms recur when the Doxycycline is completed, keep

> repeating

> > 6-

> > > week courses until the symptoms stay resolved. Take Nystatin

(at

> > > least 2, twice a day) while on the antibiotic. Birth control

> pills

> > > may not work while on Doxycycline. Do not take any expired

> > > Doxycycline tablets (it's very dangerous).

> > > > OR

> > > > 3. Zithromax (azithromycin) 600 mg tablets, 1 tablet a day

> (take

> > > with food if it bothers your stomach). Don't take magnesium-

> > > containing products within six hours of the Zithromax.

> > > > OR

> > > > 4. Biaxin 500 mg, 2 times a day.

> > > > 5. D-Mannose ½ to 1 teaspoon (2.5 grams), stirred in water,

> every

> > 2

> > > to 3 hours while awake, for 2 to 5 days for acute bladder

> > infections

> > > (may use long-term for chronic infections) caused by E-coli

(this

> > > causes approximately 90% of bladder infections). If not much

> better

> > > in 24 hours, get a urine culture and consider an antibiotic. D-

> > > Mannose is available from BioTech (800-345-1199), my Web

> > > site's " Vitamin Shop " at www.endfatigue.com or my office (800-

333-

> > > 5287).

> > > > What About Yeast Overgrowth?

> > > > Yeast overgrowth is an important concern. As I have mentioned

> > > before, nothing is all good or all bad. Although cigarettes

kill

> > > hundreds of thousands of people each year, they can be helpful

in

> > > treating Parkinson's Disease or ulcerative colitis. Although

> > > antibiotics can trigger CFIDS, they can also be helpful in

> treating

> > > it. This makes it important to know when and how to use them. I

> > > strongly recommend that my patients take antifungals while on

any

> > > antibiotics (e.g., Nystatin 500,000 unit tablets, 2 tablets, 2

to

> 3

> > > times a day) to prevent yeast overgrowth. It is also reasonable

> to

> > > add Oregano Oil and other natural antifungals. Two Nystatin

twice

> a

> > > day is what I usually prescribe. Using probiotics (healthy milk

> > > bacteria-like acidophilus that helps your body) to compete with

> the

> > > yeast can also help. I am concerned that if the acidophilus is

> > taken

> > > with the antibiotic, they may simply cancel each other out.

> Because

> > > of this, I usually begin probiotics (Acidophilus or

Lactobacillus

> > in

> > > a d

> > > > ose of 3 to 6 billion units a day, taken on an empty stomach

or

> > > with milk) after one has completed the course of antibiotics.

If

> > you

> > > are only taking the antibiotic once or twice a day, and can

find

> a

> > > time at least 6 to 8 hours away from another dose to take the

> > > probiotic, it is reasonable to take it at that time. The entire

> > daily

> > > probiotic dose can also be taken at one time. If you find that

> you

> > > still get yeast overgrowth, it may be necessary to use some of

> the

> > > more potent prescription antifungals (Sporanox or Diflucan).

> > Because

> > > these can cause liver inflammation and are quite expensive, it

> may

> > be

> > > adequate to take 200mg of either of these, twice a day, one day

> > each

> > > week (e.g., take it every Sunday) instead of every day. As

> > discussed

> > > previously, be sure to take Lipoic acid 200 mg on any day you

> take

> > > Sporanox or Diflucan, to decrease the risk of liver

inflammation.

> > > > What Role Does My Blood Clotting System Play In This?

> > > > Work done by E. Berg, M.S., C.L.S. (N.C.A.), director

of

> > > Hemex Laboratories in Phoenix, Arizona (800-999-2568), has

shown

> > that

> > > a number of infections can trigger our blood clotting system to

> > > become active, thus setting up a low-level, chronic clotting

> > cascade.

> > > These infections include HHV-6, Mycoplasma, CMV and Chlamydia

> which

> > > can trigger production of (IgA) antibodies against clot

> protective

> > > proteins on blood vessel inner surfaces (called

antiphospholipid

> > > antibodies). One of these is the Beta 2 Glyco-protein 1 (anti

> B2GP1—

> > > no, you are not going to be tested on this!). This then

triggers

> > the

> > > clotting cascade. Once the clotting system is triggered, a

> product

> > > called Soluble Fibrin Monomer (SFM) is made which is like the

> > > polymers in plastic. The theory is that they create long thin

> > sheets

> > > of a teflon-like substance, similar to the scab that covers a

> cut,

> > > but microscopic, which then coats the blood vessels. This makes

> it

> > > hard for nutrients, oxygen, etc., to get in and out of the b

> > > > lood vessels to the cells where they are needed. In summary,

> many

> > > infections can cause the blood clotting system to activate,

> > resulting

> > > in a thin coating of Fibrin deposited on the blood vessels.

This

> > > prevents nutrients and oxygen from getting to the cells in your

> > body.

> > > > Why Would An Infection Trigger The Clotting System?

> > > > Many infections (called anaerobic) do not survive well in the

> > > presence of oxygen. One can theorize that these Mycoplasma

(which

> > may

> > > be anaerobic) and other organisms may trigger the clotting

system

> > to

> > > create a shell, which then acts like a suit of armor,

protecting

> > them

> > > from oxygen, your body's defense system, and antibiotics. This

> > would

> > > explain why these infections could evolve a way to trigger the

> > > clotting mechanism. The Fibrin armor preventing antibiotics

from

> > > getting to the infection could also explain why some people

with

> > > these infections may not respond to antibiotics. Indeed, some

> > > physicians have found that the antibiotics work better once

> someone

> > > has been on a blood thinner (which may dissolve the armor).

> > > > This is an interesting theory, but how do we know this is

going

> > on?

> > > Mr. Berg and others have done studies showing that the blood

> tests

> > > that look for these clotting changes (called the ISAC panel -

> > > available at Hemex labs) are abnormal in CFIDS/FMS patients

while

> > > being normal in most other patients. They use a criterion of

two

> of

> > > these tests needing to be abnormal to be considered positive.

> When

> > > this was done, 50 of 54 CFIDS/FMS patients had abnormal tests

> > (i.e.,

> > > only 7.4% of the patients had normal blood tests). In healthy

> > > patients, 22 out of 23 had normal blood tests (i.e., 96%). This

> > means

> > > the test is both very sensitive and specific, picking up people

> > with

> > > CFIDS and excluding healthy people. Our experience has shown

that

> > > almost everyone that we tested, who has CFIDS, has turned out

to

> > have

> > > a positive ISAC panel. We have not personally sent in any tests

> on

> > > healthy patients to see if this also occurs. Interestingly,

this

> > > panel is also positive in many people with unexplained infer

> > > > tility (which can improve with Heparin) and may also be

> positive

> > in

> > > people with Multiple Sclerosis, Parkinsons, Autism,

Inflammatory

> > > Bowel Disease and some other illnesses. This suggests that this

> > test

> > > can be helpful in deciding whether to treat with blood thinners

> > > (Heparin) in CFIDS/FMS.

> > > > So, How Do I Treat The Clotting System?

> > > > First of all, it is important to remember that using

injections

> > of

> > > Heparin (the blood thinner) is still a controversial and

> > experimental

> > > treatment for CFIDS/FMS. We much prefer to use treatments that

> are

> > as

> > > safe as possible. Although Heparin is routinely used in the

> U.S.A.

> > to

> > > treat blood clots, using it to treat CFIDS/FMS is very new.

Most

> of

> > > the doctors that I have spoken with have only treated a few

> > CFIDS/FMS

> > > patients with Heparin and find that about half of these

patients

> > get

> > > better with treatment. The treatment protocol, developed by

> > > Couvaras, M.D. (602-996-2411), includes the following:

> > > > 1. Remove wheat, alcohol and sugar from the diet, if possible.

> > > > 2. Check the ISAC panel. If there are at least two abnormal

> > > results, then begin treatment.

> > > > 3. Give an antifungal for 14 days (he uses Lamisil 250mg a

day—

> > > which I find to be poorly effective. I would use 200 mg of

> Sporanox

> > > or Diflucan instead).

> > > > 4. Give standard Heparin 4000 to 8000 units by injection

> > > subcutaneously (like an insulin shot) twice a day. A (possibly

> > safer)

> > > low molecular weight Heparin may also be used.

> > > > 5. If the PA index (on the ISAC) is positive, add a baby

> Aspirin

> > > (81mg) each day.

> > > > 6. After being on Heparin for one week, Dr. Couvares repeats

> the

> > > ISAC panel to adjust the dose of the Heparin and Aspirin. He

> feels

> > > that the goal is to move all the blood tests into the normal

> range

> > > but not past the normal range into blood-thinning (therapeutic)

> > > levels. If the values are still abnormal or the patient is

still

> > > having symptoms, he then increases the Heparin dosage. If the

PA

> > > index (on the ISAC) is still high, he increases the Aspirin to

> > twice

> > > a day.

> > > > 7. If the patient feels better after one month of Heparin, he

> > then

> > > switches to low-dose Coumadin (a blood thinner tablet—take 2 to

3

> > mg

> > > a day) and then stops the Heparin after 4 to 5 days of being on

> the

> > > Coumadin. Once the patient has been on the Coumadin for two

weeks

> > he

> > > goes ahead and rechecks the ISAC panel to maintain the blood

> tests

> > in

> > > the normal range.

> > > > 8. He also supplements patients with nutritional

> supplementation

> > as

> > > needed.

> > > > In my practice, because the ISAC panel runs over $320, I

check

> a

> > > baseline ISAC panel but do not repeat the ISAC panels to adjust

> > > therapy. Instead, while on Heparin, we check a PTT (a blood

> > thinning

> > > test) and platelets (a highly unusual, but potentially very

> > dangerous

> > > side effect of Heparin is a severe drop in platelet count,

which

> > can

> > > cause life-threatening bleeding) every 3 days for the first 12

> days

> > > and then every 2 to 4 weeks while on Heparin. If the PTT is

still

> > > within the normal range and the patient is not better, we

> increase

> > > the Heparin as high as 8000 units, twice a day (rarely we will

go

> > up

> > > to 8000 units, 3 times a day) and then also increase the

Aspirin

> to

> > 2

> > > a day. In comparison, hospital patients often require Heparin

at

> > 1000

> > > units per hour (24,000 units a day) I.V., while most CFS/FMS

> > patients

> > > only need 4000 to 5000 units, 2 times a day (8000 to 10,000

units

> a

> > > day). If the patient is feeling better, however, we simply

leave

> > them

> > > at the initial dose. Most patients will f

> > > > eel better at about the 10- to 14-day point if the Heparin is

> > going

> > > to help. At the end of 4 to 12 months, if the Heparin helps, we

> > > switch to Coumadin (as noted above) and check an INR

> (International

> > > Normalized Ratio), aiming to keep it below 1.3 while adjusting

> the

> > > Coumadin to the optimum does. It is very important to know that

> > most

> > > medications can change the blood level of Coumadin and that

> anytime

> > > anything is added to, or deleted from, your regimen (including

> > > natural remedies) you need to recheck the INR 4 to 7 days later

> to

> > > make sure that it is not going too high. Heparin and Coumadin

are

> > > powerful medicines and the main risk is bleeding. Although we

are

> > > using very low doses, which are usually very well-tolerated,

one

> > can

> > > rarely see a life-threatening bleed occur. If you felt better

on

> > the

> > > Heparin and then the symptoms come back on the Coumadin, you

may

> > need

> > > to go back on the Heparin for several months to re-establish

and

> > > maintain the benefit. Occasionally, people will need to b

> > > > e on the Heparin for an extended period, in which case the

> blood

> > > tests (PTT and platelet count) should be checked every 2 to 4

> > weeks.

> > > All of this being said, most people tolerate these treatments

> quite

> > > well and many, many more people die from taking Aspirin (e.g.,

> for

> > > arthritis) than Heparin each year.

> > > > In summary, there are a number of infections that can cause

or

> > > occur because you have CFIDS/FMS. Once they occur, they can

> trigger

> > > the clotting cascade. This may keep the nutrients from getting

to

> > > your body and create a " suit of armor " for the viral and

> Mycoplasma

> > > infections. Using a blood thinner can break down these armor

> > coatings

> > > that protect the infections from our treatment and allow

> nutrients

> > to

> > > get where they need to go. Many tests can help. The one that I

> use

> > to

> > > decide whether to use the Heparin blood thinner is the ISAC

panel

> > (at

> > > Hemex Labs). Testing for infections may be helpful, but can be

> > > expensive and less likely to effect my decision to treat. If

you

> > can

> > > afford the tests and/or your insurance will pay for them, they

> are

> > > worth checking and will make it easier to adjust therapy over

> time.

> > > If you can't afford it, it is reasonable to treat empirically

> > (i.e.,

> > > without testing), except for high-dose Valtrex therapy. If you

> have

> > > lung congestion and/or recurrent temperatures o

> > > > ver 98.6°F, I would treat with the antibiotics. If you feel

> > > chronically flu-like, I would consider the HHV-6 or (based on

> > > testing) the high-dose Valtrex regimen. It is also reasonable

to

> > > treat with antibiotics and antivirals simultaneously -

especially

> > if

> > > you are taking the anticoagulants.

> > > > Chronic Sinusitis The Yeasty Beasties Revisited!

> > > > As was mentioned years ago, we speculated that the chronic

> sinus

> > > congestion seen in CFIDS/FMS could be caused by yeast

overgrowth.

> A

> > > recent interesting study from the Mayo Clinic Proceedings

> supports

> > > this thought. In the study, researchers found that most people

> with

> > > chronic sinus infections had fungal growth in their sinuses.

They

> > > felt that the inflammation was being caused by an immune (the

> > body's

> > > reaction) response to the fungus. This research is interesting

> > > because more and more studies are showing that treating chronic

> > > sinusitis with antibiotics doesn't really do much and that

> shorter

> > > courses of treatment work just as well as the long courses. We

> find

> > > that conservative treatment (see my newsletter article,

Treatment

> > Of

> > > Respiratory Infections Without Antibiotics, Vol. 2, Issue 2) is

> > more

> > > effective than antibiotics for chronic sinusitis.

> > > > It's good that medicine is finally starting to catch up with

> > > reality. The report in The Mayo Clinic Proceedings noted

> > > that, " fungus allergy was thought to be involved in less than

10%

> > of

> > > cases… our studies indicate, in fact, fungus is likely the

cause

> of

> > > nearly all of these problems and that it is not an allergic

> > reaction

> > > but an immune reaction. " In this study, the researchers studied

> 210

> > > patients with chronic sinusitis. Using new methods to collect

and

> > > test sinus/nasal mucus they found fungus in 96% of patients.

> > > > It's interesting to observe how medical research works. The

> > > researchers are now working with different drug companies to

set

> up

> > > trials to test medications to control the fungus but feel that

it

> > > will be at least two years before any treatments will be

> available.

> > > In my experience, though, these problems often respond

> dramatically

> > > to either Sporanox or Diflucan - which, by no coincidence, are

> very

> > > powerful antifungal agents. It is not clear why the researchers

> did

> > > not simply try Sporanox or Diflucan. Un-fortunately, we find

that

> > the

> > > obvious is often overlooked. This sometimes occurs as drug

> > companies

> > > seek to make more money by finding new drugs instead of using

the

> > old

> > > things that are known to work. It is important to distinguish

> > between

> > > chronic sinusitis (which lasts for over three months) and acute

> > > sinusitis (which usually has been going on for a few days and

> less

> > > than a month). For these shorter attacks of sinusitis, bacteria

> are

> > a

> > > more common cause and antibiotics (combined with n

> > > > atural remedies) can be helpful. Some researchers still

> continue

> > to

> > > argue that fungus is not a cause of chronic sinusitis. They

note

> > that

> > > fungi are seen even in healthy noses (which is correct) but

> neglect

> > > to discuss the immune changes that are also seen in these

noses.

> > > Because so many people have responded dramatically to

antifungals

> > in

> > > the treatment of their chronic sinusitis, my suspicion is that

> the

> > > Mayo Clinic researchers are probably correct. Wouldn't it be

> nice,

> > if

> > > instead of arguing about treatments while people stay sick,

they

> > > would just try the treatments to see if they worked!

> > > > As you can see, your body's defenses being down plays a large

> > role

> > > in CFIDS/FMS. The good news is, that by treating the many

> > underlying

> > > infections common in CFIDS patients and by treating any

hormonal

> > and

> > > nutritional deficiencies, you can bring your immune system back

> to

> > a

> > > healthy state!

> > > > Important Points

> > > > • An important component of CFS is disordered immune

function,

> > > which opens the door to repeated infections, repeated treatment

> > with

> > > antibiotics, and yeast overgrowth.

> > > > • Treat yeast overgrowth by avoiding antibiotics and sweets.

> Many

> > > patients have found Nystatin and other antifungal medications,

> such

> > > as Diflucan and Sporanox, to be helpful. Acidophilus (milk

> > bacteria)

> > > and natural antifungals such as Caprylic acid and garlic are

also

> > > often useful.

> > > > • Bowel parasites are common in CFS patients, whose symptoms

> > often

> > > respond dramatically to treatment. However, most labs do not

> > > adequately detect parasites through stool testing. To get an

> > accurate

> > > test result, use one of the labs we recommended that

specializes

> in

> > > stool testing.

> > > > • Treat Cryptosporidium with Artemesia annua or tricyclin

> (herbal

> > > antiparasitics).

> > > > • Treat constipation with Turkey Rhubarb (a herb).

> > > > • Prevent parasitic infection by using a Multi-pure water

> filter

> > > (available from 888-801-8176 or 410-224-4877)

> > > > • If you have temperatures over 98.6°F and/or chronic lung

> > > congestion, try long-term Cipro or Doxycycline (while on

> Nystatin).

> > > > • If you have chronic flu-like symptoms, despite yeast and

> Cortef

> > > treatment, consider the antiviral, immune stimulating protocol

we

> > > discussed.

> > > >

> > >

> >

>

[Guest guest]

Hi Krista,

Patty is right about docs not knowing how to treat adrenals. I've

been to several docs who can't answer questions and only seem to

address the adrenals if you're suffering from 's or

Cushing's...which you're not. As far as natural treatments, I was on

Adrenal Stress End from Dr. Kolb, yet my endocrinologist doc here

said to stop taking it because my urine and blood had normal

cortisol. No other doc seems comfortable treating them, except for

Mercola, who I see next week. I'll let you know what he says,

although I've already heard he prescribes a very small amount of DHEA

and pregnenelone.

Based on my experience, you're better off seeing a naturopath instead

of an endocrinologist because naturopaths understand and acknowledge

adrenal fatigue. Love, PH

> > > >

> > > > From Fatigued to Fantastic Newsletter

> > > > Vol. 3, No. 3 (2000)--Vol 4, No. 1 (2001)

> > > >

> > > > Fighting Those Persistent Infections in CFIDS

> > > > By Teitelbaum, M.D.

> > > > Medical science has known for quite some time that Chronic

> > Fatigue

> > > Syndrome is associated with changes in the body's immune

system.

> In

> > > fact, the acronym " CFIDS " stands for " Chronic Fatigue And

Immune

> > > Dysfunction Syndrome. " This can result in your having several

> > > different and unusual infections at one time. Many of these

> > > infections need to be treated directly. Other infections will

go

> > away

> > > on their own as your immune (defense) system comes back " on

line "

> > by

> > > using our treatment protocol. In this article, I'll discuss

some

> of

> > > the more common, yet not usually thought of (in " regular "

> > medicine),

> > > infections.

> > > > What Kind Of Infections Am I Most At Risk For?

> > > > Although CFIDS of sudden onset often seems to be triggered by

> > viral

> > > infections (e.g., EBV, HHV-6, CMV), those infections, I

suspect,

> > > are " simmering " or no longer active in many cases. However, the

> > body

> > > acts as if they are. This may result in elevated interferon

> levels.

> > I

> > > suspect this was what triggered my CFIDS.

> > > > The body produces interferon to fight viral infections. When

a

> > > cancer or hepatitis patient is injected with interferon, the

> > patient

> > > becomes achy, fatigued and brain-fogged. An under-active

adrenal

> > can

> > > also cause interferon levels to become elevated. Because of

this

> > > elevation, it is more accurate to say that the body's immune

> system

> > > is not functioning properly, than to say that it is

underactive.

> > > Indeed, in many ways, the immune system may be in overdrive and

> > soon

> > > exhaust itself. The immune system malfunctions in many other

> ways,

> > > too, including decreasing the effectiveness of the

> body's " natural

> > > killer " cells, which are an important defense mechanism.

> > > > Many other recurrent or unusual infections can also occur

> because

> > > of your malfunctioning immune system. Chronic sinus, bladder,

> > > prostate and respiratory infections are common and are often

> > treated

> > > with repeated courses of antibiotics. The large amount of

> > antibiotics

> > > introduced into the system can cause a secondary yeast over-

> growth

> > as

> > > it changes the natural balance between the bowel's healthy

> bacteria

> > > and yeast. The original immune dysfunction also contributes to

> the

> > > yeast overgrowth. Although it is controversial, a theory held

by

> > many

> > > physicians is that chronic overgrowth of yeast due to overuse

of

> > > antibiotics is a potential and strong trigger for chronic

> fatigue,

> > > fibromyalgia and further immune dysfunction. What makes the

> theory

> > > controversial is that no definitive tests exist to distinguish

> > fungal

> > > overgrowth from normal fungal levels. Also, many of the

symptoms

> > > ascribed to yeast overgrowth can also come from the many other

> > > problems present in chronic fatigue syndrome and fibromya

> > > > lgia. On the other hand, most doctors who try treating yeast

in

> > at

> > > least three or four CFS patients see how well it works and keep

> > using

> > > it.

> > > > CFIDS patients also frequently have bowel parasite

infections.

> > > Bowel parasites can cause severe allergic or sensitivity

> reactions,

> > > which in turn can trigger fibromyalgia and fatigue. Often, a

> > patient

> > > will finally recover from long-standing and disabling fatigue

> > within

> > > a week or two after beginning treatment for bowel parasites.

> > > > Many other CFS/FMS patients are left with disabling fatigue

> after

> > a

> > > bout with viral infections such as polio, HHV-6, CMV, or EB

viral

> > > infections. This fatigue also usually responds to the

treatments

> > > discussed in this newsletter. In addition, infections with

> unusual

> > > organisms such as Rickettsia (e.g., Lymes Disease), chlamydia,

> and

> > > mycoplasma may also be problematic.

> > > > Yeast Overgrowth

> > > > Everyone's immune system has strong spots, as well as weak

> spots.

> > > Some people never get colds but have frequent bouts with

> athlete's

> > > foot or other skin fungal infections. Others never get fungal

> > > infections but tend to get colds. Many people seem to have a

> > > diminished ability to fight off fungal infections.

> > > > Fungi are very complex organisms. Fungal overgrowth may

> suppress

> > > the body's immune system. The host body may also develop

allergic

> > > reactions to components of the yeast.

> > > > This allergic reaction was suggested in a study which

connects

> > > Candida Albicans with Allergic Skin Dermatitis (Eczema). This

> study

> > > was published in The Journal of Clinical Experimental Allergy

> back

> > in

> > > 1993 (Vol. 23, pp. 332-339). It found that there is a

significant

> > > correlation between the body having antibodies to Candida and

> > > Allergic Dermatitis/Eczema. In addition, we have found that

> > > unexplained rashes that have lasted for many years often clear

up

> > > with antifungal treatment as well! Many physicians feel that

> yeast

> > > overgrowth causes a generalized suppression of the immune

system.

> > In

> > > other words, once the yeast gets the upper hand, it sets up a

> cycle

> > > that further suppresses your body's defenses. Interestingly, a

> > recent

> > > Mayo Clinic study showed that most cases of chronic sinusitis

> seem

> > to

> > > be associated with a reaction to yeast in the sinuses -

something

> I

> > > proposed years ago. None the less, as I already noted, this

> theory

> > is

> > > controversial. Yeast are normal members of our body's " zoo.

> > > > " They live in balance with bacteria - some of which are

> helpful

> > > and healthy and some of which are detrimental and unhealthy.

The

> > > problems begin when this harmonious balance shifts and the

yeast

> > > begin to overgrow.

> > > > As noted above, many things can prompt yeast to overgrow. One

> of

> > > the most common causes is frequent antibiotic use. When the

good

> > > bacteria in the bowel are killed off by antibiotics (along with

> the

> > > bad bacteria) the yeast no longer have competition and begin to

> > > overgrow. The body is often able to rebalance itself after one

or

> > > several courses of antibiotics, but after repeated or long-term

> > > courses - and especially if the body has an underlying immune

> > > dysfunction - the yeast can get the upper hand.

> > > > Other factors are also important. Studies have shown that

> animals

> > > who are sleep deprived and/or have increased sugar intake

develop

> > > bowel yeast overgrowth. Many physicians feel that eating sugar

> > > stimulates yeast overgrowth in people, as well. Sugar is food

for

> > > yeast. Yeast ferment sugar in order to grow and multiply. Yeast

> > > overgrowth due to sugar overuse also seems to cause immune

> > > suppression, which facilitates bacterial infections, which then

> > > requires even more antibiotic use. Poor sleep also results in

> > marked

> > > suppression of your immune function.

> > > > How Does One Know If They Have Yeast?

> > > > There are no definitive tests for yeast overgrowth that will

> > > distinguish yeast overgrowth from normal yeast growth in the

> body.

> > > There is one test which may be useful, though. This is a Urine

> > > Tartaric Acid test done by The Great Plains Lab in Kansas City,

> > > Missouri, run by Shaw, Ph.D. Tartaric Acid is a waste

> > product

> > > of yeast growth. In fermenting wine, for example, it is

critical

> to

> > > remove the Tartaric Acid. Otherwise, the wine could be toxic to

> > > people. Dr. Shaw has found elevations in Urine Tartaric Acid

that

> > > decrease with antifungal treatment in both CFIDS/FMS patients

and

> > > autistic children. Interestingly, both these illnesses often

> > improve

> > > with antifungals (specifically, Sporanox or Diflucan, plus

> > Nystatin).

> > > Dr. Shaw likes to use the Urine Tartaric Acid to decide when to

> > treat

> > > yeast overgrowth and to follow-up the effectiveness of

treatment.

> > > > In my experience, however, using Dr. Crook's Yeast

> Questionnaire

> > > (available in my book, From Fatigued To Fantastic!) is still

the

> > most

> > > reliable way to tell if a person is at risk of yeast

overgrowth.

> If

> > > the symptom score is over 140 points, I recommend treatment. In

> > > addition, anyone who has been on recurrent or long-term

> antibiotic

> > > use (especially Tetracycline for acne) or anyone who

> intermittently

> > > has painful sores in different parts of the mouth that last for

> > about

> > > ten days at a time and who has CFIDS/FMS, should be treated

with

> > > antifungals. Bowel symptoms are some of the more overt symptoms

> > that

> > > are caused by yeast and I feel that most people who

have " spastic

> > > colon " have yeast overgrowth or parasites.

> > > > How Is Yeast Treated?

> > > > A number of very effective methods can be utilized to take

care

> > of

> > > a yeast problem. Primary among the methods is to avoid sugar

and

> > > other sweets. One can enjoy one or two pieces of fruit a day,

but

> > > should not consume concentrated sugars such as juices, corn

> syrup,

> > > jellies, pastry, candy or honey. Stay far away from soft

drinks,

> > > which have ten to twelve teaspoons of sugar in every twelve

> ounces.

> > > This amount of sugar has been shown to markedly suppress immune

> > > function for several hours. Be pre-pared to have withdrawal

> > symptoms

> > > for about one week when sugar is cut out of the diet. Several

> > > excellent books have been written on the yeast controversy and

> > offer

> > > additional methods to try. One of the best books is The Yeast

> > > Connection and the Woman by Crook, M.D., a physician

who

> > has

> > > done a spectacular job advancing the understanding of CFIDS/FMS.

> > > > Many patients have found that acidophilus (that is, milk

> > bacteria,

> > > a healthy bacteria for the bowel) helps restore balance in the

> > bowel.

> > > Acidophilus is found in yogurt with live and active yogurt

> > cultures.

> > > Indeed, one cup of yogurt a day can markedly diminish the

> frequency

> > > of recurrent vaginal yeast infections. Acidophilus is also

> > available

> > > in capsule form. Although many claims are made for one type of

> > > acidophilus being better than the other, I'm not sure this is

so.

> I

> > > usually recommend 3 to 6 billion units a day (1 unit = 1

> bacteria)

> > on

> > > an empty stomach. If on antibiotics (not antifungals), take the

> > > acidophilus at least 3 to 6 hours away from the antibiotic

dose.

> > > > Nystatin, an antifungal medication, has also been helpful in

> the

> > > treatment of yeast overgrowth. Unfortunately, some fungi seem

to

> be

> > > resistant to Nystatin. In addition, Nystatin is poorly

absorbed,

> > > which means that it has little impact on the yeast outside of

the

> > > bowel. Other anti-fungal medications, such as Diflucan and

> > Sporanox,

> > > seem to be effective systemically (throughout the body) but

they

> > have

> > > two main drawbacks. First, they are expensive, costing more

than

> > $450

> > > to $900 for a two-month course. Second, any effective anti-

fungal

> > can

> > > initially make the symptoms of yeast infection worse. Although

> > > uncommon, Sporanox and Diflucan can also cause liver

inflammation

> > (as

> > > can Advil and Tylenol). If you are taking Sporanox or Diflucan

> for

> > > more than 6 to 12 weeks, I would consider intermittently

checking

> > > liver blood tests (ALT and AST). If you have preexisting active

> > liver

> > > disease, be cautious in using (or don't use) Sporanox or

> Diflucan.

> > I

> > > strongly recommend taking Lipoic Acid (a natural

> > > > supplement which protects and helps heal the liver), 200mg a

> > day,

> > > whenever you take Sporanox or Diflucan. I also strongly

recommend

> > > Lipoic Acid for anyone with active liver disease (e.g.,

> hepatitis)

> > at

> > > doses up to 1000mg to 3000mg a day as it may prevent and/or

treat

> > > cirrhosis.

> > > > Natural Yeast Treatments

> > > > Below, I have summarized the nonprescription part of the

> > treatment

> > > checklist that I use in my office.

> > > > 1. Avoiding sweets is still the single most important thing.

> > Using

> > > Stevia as a sweetener is a wonderful substitute. Stevia is a

> safe,

> > > natural remedy and you can use all you want. There are even

> > cookbooks

> > > for using Stevia (available from my office or 800-4STEVIA). A

new

> > > natural sweetner, Sweet Balance, also tastes good and is 12

times

> > as

> > > sweet as sugar. It is a natural product from the Lo Han fruit

and

> > > appears to be safe. Although it is 70% sugar (fructose), you

only

> > > need a small amount. Order it from 877-997-9338, my office at

800-

> > 333-

> > > 5287 or my Web site at www.endfatigue.com.

> > > > 2. Acidophilus or Milk Bacteria can be very helpful. Take 3

to

> 6

> > > billion units a day (a unit is the same as a bacteria). Do not

> take

> > > acidophilus within 3 to 6 hours of an antibiotic. Take it

either

> on

> > > an empty stomach or with milk.

> > > > 3. Caprylic Acid is another natural remedy that can be

helpful.

> > The

> > > usual dose is 1800 to 3600mg a day with 1/3 of the dose being

> taken

> > > at each meal. Unfortunately, it often causes an acid stomach

with

> > > a " funky " tasting reflux.

> > > > 4. Oregano Oil - enteric coated oregano oil - 1 to 2

capsules,

> 2

> > to

> > > 3 times a day with food, may be more effective and better

> tolerated

> > > than Caprylic Acid (both can cause stomach acid reflux).

> > > > 5. Fresh Garlic, if you can handle it well, can also be very

> > > effective. Daily, crush 1 to 3 garlic cloves in olive oil, add

> > salt,

> > > spread it on bread and eat it. It can be quite tasty and lethal

> to

> > > whatever infections you have in your gut.

> > > > 6. Olive Leaf 500mg, 2 to 4 capsules three times a day

between

> > > meals, can also be very helpful in treating yeast overgrowth.

> > > > 7. Pau De Arco in either tea or capsule form is also helpful

in

> > > yeast suppression. Although I use Pau De Arco infrequently for

> > yeast

> > > over-growth, many people find that it can be helpful.

> > > > 8. Grapefruit Seed Extract (e.g., Citrucidel) is a popular

> > > treatment for yeast overgrowth and is well-tolerated.

> > > > More Information On Yeast Treatments

> > > > If symptoms of yeast are caused by an allergic or sensitivity

> > > reaction to the yeast body parts, the symptoms may flare when

> mass

> > > quantities of the yeast are suddenly killed off. This is called

a

> > > yeast " die-off " reaction. If you get this reaction, start your

> > > treatment with acidophilus and a sugar-free diet for a few

weeks

> > > followed by oregano oil and/or olive leaf (1500mg to 2000mg, 3

> > times

> > > a day between meals) before beginning Nystatin. Take Nystatin

(by

> > > mouth) in the form of 500,000-IU tablets or powder. I generally

> > > recommend beginning with 1 tablet a day for 1 to 3 days, and

> > > increasing by 1 tablet every 1 to 3 days (or slower if

yeast " die-

> > > off " is a problem) until 2 tablets 2 to 4 times a day is

reached.

> > If

> > > you get nausea, take a lower dose. Take Nystatin, 4 to 8

tablets

> > > daily, for 5 to 8 months. I add the Diflucan or Sporanox one

> month

> > > after beginning the Nystatin. Take 200mg every morning for six

> > weeks.

> > > If symptoms flare, take just 100mg per morning for the first 3

to

> > 14

> > > days. I

> > > > f symptoms recur after stopping the Diflucan or Sporanox, I

> > > recommend continuing the medication for an additional 6 weeks

at

> > > 200mg a day.

> > > > Sporanox should be taken with food. If it is taken alone, its

> > > absorption is greatly reduced. When taking Diflucan or

Sporanox,

> DO

> > > NOT use the antihistamines Seldane or Hismanal, Quinidine (a

> heart

> > > medicine), cholesterol-lowering medications in the Mevacor

> family,

> > or

> > > the bowel medicine Propulcid. These can be fatal combinations!

> > Also,

> > > antacid medications (such as Tagamet, Axid, Zantac, and Pepcid)

> > > prevent the proper absorption of Sporanox. At the high price of

> > > Sporanox per dose, you will want to absorb every last bit of

the

> > > medication. If you need to be on an antacid medication, use

> > Diflucan

> > > instead of Sporanox. Unfortunately, a less expensive

antifungal,

> > > called Lamisil (at 250mg a day), does not seem to work very

well

> > for

> > > candida yeast overgrowth (although it works well for nail

> > > infections). I am currently trying patients on 500mg of Lamisil

a

> > day

> > > to see if this dose works better.

> > > > I feel that once the yeast has been effectively decreased and

> > kept

> > > that way for six to twelve months, it is safe to try to add

small

> > > amounts of sugar back into the diet. If symptoms recur,

however,

> > stop

> > > the sugar again. Continuing to eat yogurt with live and active

> > > acidophilus cultures (unless you are lactose-intolerant) or

> > > continuing to take acidophilus capsules may also help.

> > > > Many books on yeast overgrowth (including Dr. Crook's) advise

> > > readers to avoid all yeast in the diet. This advice is based on

> the

> > > theory that an allergic reaction to yeast is the cause of the

> > > problem. The predominant yeast that seems to be involved in

yeast

> > > overgrowth is Candida Albicans, although I would not be

surprised

> > if

> > > researchers discovered that many other kinds of fungal

infections

> > are

> > > also involved. The yeast that is found in most foods (except

beer

> > and

> > > cheese) is not closely related to candida.

> > > > In my experience, trying to avoid all yeast in foods results

> > simply

> > > in a nutritionally inadequate diet and little benefit. Although

a

> > few

> > > people do appear to have true allergies to the yeast in their

> food,

> > > they number less than 10 percent of my patients with suspected

> > yeast

> > > overgrowth. These patients may benefit from the more strict

diet

> in

> > > Dr. Crook's book. Interestingly, once their adrenal

insufficiency

> > and

> > > yeast overgrowth are treated, most people find that their

> allergies

> > > and sensitivities to yeast and other food products seem to

> improve

> > or

> > > disappear.

> > > > Nutritional deficiencies such as low zinc or low selenium may

> > also

> > > decrease resistance to yeast over-growth. A good multivitamin

> > > supplement, as recommended in my last newsletter, should take

> care

> > of

> > > these deficiencies. This is further evidence that all the

factors

> > > involved in CFS are closely interrelated.

> > > > The best thing that one can do to combat yeast overgrowth is

to

> > try

> > > to avoid it in the first place. When you get an infection,

begin

> > > treating it naturally immediately. Hopefully, you can prevent

it

> > from

> > > turning into a bacterial infection which might require an

> > antibiotic.

> > > Ask your doctor what measures you can take before resorting to

> > > antibiotics. Many good over-the-counter remedies are available.

A

> > > knowledgeable pharmacist may also be a wealth of information.

> Your

> > > local book or health food store has books on natural measures.

> Your

> > > health food store proprietor can also steer you to appropriate

> > > natural remedies. For examples of the many helpful measures

that

> > one

> > > can take, see my newsletter article, Treating Infections

Without

> > > Antibiotics, page ___).

> > > > If you find however, that you must take an antibiotic, all is

> not

> > > lost. One can still lessen the severity of yeast overgrowth by

> > > avoiding sweets and by either taking acidophilus capsules

(again,

> > not

> > > within 3 to 6 hours of an antibiotic) or by eating one cup of

> > yogurt

> > > with live and active acidophilus cultures daily. Don't use the

> > yogurt

> > > (or milk) if you have sinusitis or pneumonia because the milk

> > protein

> > > thickens mucus and makes it hard for the body to fight these

> > > infections.

> > > > How Can One Tell If The Yeast Is Coming Back?

> > > > It is normal for yeast symptoms to resolve after treatment.

> After

> > 6

> > > weeks on the Sporanox or Diflucan, patients are usually feeling

a

> > lot

> > > better, but may have symptoms recur soon after stopping the

> > > antifungal. In this case I would continue the Sporanox or

> Diflucan

> > > for another 6 weeks, or as long as is needed, to keep the

> symptoms

> > at

> > > bay. More frequently, people will feel better after treatment

and

> > > stay feeling fairly well for a period of 6 to 24 months. At

that

> > > time, it is common to see a recurrence of symptoms, especially

if

> > one

> > > is eating too much sugar or is taking antibiotics. The best

> marker

> > > that I have found for yeast overgrowth would be a return of

bowel

> > > symptoms with gas, bloating and/or diarrhea or constipation. If

> > these

> > > symptoms persist for more than 2 weeks, especially if there is

> also

> > > even a mild worsening of the FMS symptoms, it is very

reasonable

> to

> > > retreat yourself with 6 weeks of Nystatin and perhaps Sporanox

or

> > > Diflucan. In addition, I would also retreat if there's

> > > > a recurrence of vaginal yeast or sinus infections. If re-

> > treatment

> > > resolves the symptoms, one may opt to repeat this regimen as

> often

> > as

> > > is needed (usually every 6 to 24 months). By using some of the

> > > natural remedies listed above, however, you may be able to

avoid

> > > repeated use of these antifungals and the possible risk of

> becoming

> > > resistant to them. Some patients also find that they need to

stay

> > on

> > > the antifungals for extended periods of time (years) or the

> > symptoms

> > > will recur. When this is necessary, I add the natural remedies.

I

> > > will, however, also use the medications when needed. The main

> risk

> > of

> > > long-term use of the antifungals Sporanox and Diflucan would be

> > liver

> > > inflammation. If these medications are being used for extended

> > > periods, consider checking liver tests (SGOT and SGPT) every 3

to

> 6

> > > months and anytime that a severe flu-like feeling or worsening

of

> > > symptoms occur. As noted above, it is very important to take

> Lipoic

> > > Acid 200mg a day when on Sporanox or Diflucan. Althoug

> > > > h I am not aware of any studies using Lipoic Acid with

> > antifungals,

> > > in my experience I have seen no worrisome elevation on liver

> tests

> > if

> > > patients are using this natural substance while taking these

> > > antifungals. As an alternative, instead of taking the

antifungals

> > > every day, many people find they can get long-term suppression

of

> > the

> > > yeast by taking Sporanox or Diflucan 200mg twice a day, one day

> > each

> > > week (e.g., each Sunday).

> > > > Help For Chronic Bladder Infections

> > > > Although we will be discussing some unusual infections,

> CFIDS/FMS

> > > patients also get more of the day-to-day variety of infections.

> > These

> > > include Urinary Tract (bladder) Infections (UTI). The main

> symptoms

> > > of a UTI are discomfort (e.g., burning) when urinating

(dysuria),

> > > urgency (which is the feeling that you have to go very badly

and

> > > right away when there is not much urine there), and frequency

> with

> > > low volume. These symptoms are also common in CFIDS/FMS

patients

> in

> > > the absence of bladder infections and, when severe, is called

> > > Interstitial Cystitis. I would not label someone as having

> > > Interstitial Cystitis unless this is the major symptom of their

> > > CFIDS/FMS, because almost everyone with this illness has some

> > urinary

> > > urgency and frequency. Because bladder symptoms can be seen in

> both

> > > UTI and CFIDS/FMS, it is important to have a urine culture done

> > > before treatment with antibiotics to make sure that there is an

> > > infection and not just muscle spasms in the bladder that are

> > causing

> > > these

> > > > symptoms. If there is an infection, over 90% of the time it

> will

> > be

> > > E-coli. This bacteria is normally found in everyone's gut and,

> with

> > > the exception of a few rare dangerous forms, is a healthy part

of

> > our

> > > normal bowel bacteria. The problem occurs when the E-coli gets

> out

> > of

> > > the bowel where it belongs and into the bladder. Usually the

> > bladder

> > > will wash out most infections when the urine comes out. The E-

> coli

> > > however, have little velcro-like projections that stick to the

> > > bladder wall so that they can not be washed out by urination.

> > > > Taking antibiotics will kill a bladder infection but will

also

> > kill

> > > the healthy bacteria in the bowel. This sets one up for yeast

> > > overgrowth and other problems. Because of this, unless there is

> > fever

> > > or back pain over the kidneys or a toxic feeling, it is

> reasonable

> > to

> > > try natural remedies for one to three days before going with

the

> > > antibiotics. One can start these treatments while waiting for

the

> > > urine culture to come back.

> > > > What Natural Remedies Can Be Used For Bladder Infections?

> > > > There are two excellent natural remedies that can keep the E-

> coli

> > > from sticking to the bladder walls so they can be washed out.

In

> > > addition, taking vitamin C in high dose (e.g., 500 to 5000mg a

> day)

> > > can acidify the urine, making it inhospitable to the bacteria.

> > > Drinking a lot of water also helps to wash out the infection.

> > > > The two natural remedies that keep the bacteria from sticking

> are:

> > > > 1. Cranberries—Because approximately 20% of the female

> population

> > > suffers from UTIs, several studies have been done looking at

this

> > > remedy. An early study of 44 female and 16 male patients with

> acute

> > > bladder infections drank 16 oz. of cranberry juice a day for 15

> > days.

> > > Of these patients, 53% had positive responses and another 20%

> > showed

> > > modest improvement. Six weeks after stopping the juice, 27

> patients

> > > did have persistent recurrent infections and 8 of these had no

> > > symptoms. Seventeen patients had no symptoms and negative urine

> > > cultures.

> > > > In another study of elderly women (who are more likely to

have

> > > bladder infections), 153 women either received 10 oz. of

> cranberry

> > > drink or placebo every day for 6 months. The group that got the

> > > cranberry drink had 68% fewer bladder infections during that

> > period.

> > > In this study, the juice was sweetened with saccharin instead

of

> > > sugar. Other studies have also shown benefit using cranberry

> juice

> > in

> > > bladder infections.

> > > > Significant benefits are achieved by using 6 to 16 oz. of

> > cranberry

> > > juice a day. Because cranberry juice has a lot of sugar and can

> > > promote yeast overgrowth and aggravate other symptoms in

> CFIDS/FMS,

> > I

> > > think it is much better to use pure cranberry juice powder in

> > capsule

> > > or tablet form (standardized to contain 11% to 12% quinic

acid).

> > The

> > > therapeutic dose is 1 to 2 capsules a day. Conversely, you can

> use

> > > unsweetened cranberry juice and add Stevia as a natural

> sweetener.

> > In

> > > general, if one gives the usual cranberry juice cocktails a

> > strength

> > > of 1 unit - then, cranberry juice drinks have a strength of ½;

> > > cranberry sauce a strength of ½; fresh or frozen cranberries

are

> 4

> > > times as potent; pure cranberry juice is 4 times as potent; and

> > > cranberry juice capsules from unsweetened cranberry juice

powders

> > are

> > > 32 times as potent.

> > > > Cranberries work to help bladder infections because they have

a

> > > chemical (proanthocyanidins) that prevents the bacteria from

> > sticking

> > > to the bladder wall. They may also decrease the risk of kidney

> > stones

> > > (although magnesium with B6 is much better for this), as well

as

> > > possibly reduce urine odor.

> > > > D-Mannose - This is more effective than cranberry juice.

> Mannose

> > is

> > > a natural sugar (not the kind that causes symptoms or yeast

> > > overgrowth) that is excreted promptly into the urine.

> Unfortunately

> > > for the E-coli bacteria, the fingers that stick to the bladder

> wall

> > > stick to the D-Mannose even better. When one takes a large

amount

> > of

> > > D-Mannose, it spills into the urine, coating all the E-coli's

> > > little " sticky fingers " so that the E-coli are literally washed

> > away

> > > with the next urination. The nice thing about the natural

> approach,

> > > as opposed to antibiotics, is that the cranberries or D-Mannose

> > will

> > > not kill the healthy bacteria, thereby not bothering the normal

> > > balance of bacteria in the bowel. In addition, the D-Mannose is

> > > absorbed in the upper gut before it gets to the friendly E-coli

> > that

> > > are normally present in the colon. Because of this, it helps

> clear

> > > the bladder without causing any other problems. In addition,

the

> D-

> > > Mannose even tastes good.

> > > > The D-Mannose is quite safe, even for long-term use, although

> > most

> > > people will only need it for a few days. Those who have

frequent

> > > recurrent bladder infections may, however, choose to take it

> every

> > > day. The usual dose of D- Mannose is 1/2 teaspoon every 2 to 3

> > hours,

> > > while awake, to treat an acute bladder infection; and 1/4 to

1/2

> > > teaspoon 3 to 4 times a day to prevent severe chronic bladder

> > > infections. It is best taken dissolved in water. For those who

> get

> > > bladder infections associated with sexual intercourse, one can

> take

> > > 1/2 teaspoon of D-Mannose 1 hour before and then just after

> > > intercourse to prevent an infection. Remember, though, the D-

> > Mannose

> > > (and cranberries) only work in the 90% of bladder infections

> caused

> > > by E-coli bacteria. D-Mannose is available from several sources:

> > > > 1. The Tahoma Clinic Dispensary (253-850-5661), which is

> > associated

> > > with the well-known nutritional physician, V. ,

> M.D.

> > > > 2. The Biotech Company (800-345-1199).

> > > > 3. My office (800-333-5287) or my Web site at

> www.endfatigue.com.

> > > > The usual cost of D-Mannose is approximately $60 for 100

grams

> > and

> > > $35 for 50 grams. A 1/2 teaspoon is approximately 2 grams. One

> > should

> > > feel much better within 24 to 48 hours on D-Mannose. If not,

see

> a

> > > doctor for a urine culture (you may want to get the culture at

> the

> > > first sign of infection) and consider antibiotic treatment

after

> > two

> > > days if the culture is positive. Some evidence exists that

> > > Macrodantin causes less yeast over-growth than do other

> > antibiotics.

> > > Even with other antibiotics, most bladder infections are

knocked

> > out

> > > by one to three days of antibiotic use (instead of the old

seven-

> > day

> > > regimen).

> > > > Prostatitis

> > > > Although women tend to be the ones plagued with bladder

> > infections,

> > > men don't get off unscathed either. It is very common in men

with

> > > CFIDS/FMS to have Prostatitis. Prostatitis is an inflammation

or

> > > infection of the prostate which is usually seen in younger men

> > > between the ages of 20 and 50. It falls into three main

> categories:

> > > > 1. " Bacterial " Prostatitis is a acute or chronic infection in

> the

> > > gland that causes prostate swelling and discomfort.

> > > > 2. Nonbacterial Prostatitis is when you feel swelling of the

> > > prostate without being able to detect an infection. My

suspicion

> is

> > > that it is not uncommon for prostatitis to be associated with

> yeast

> > > overgrowth or other infections that cannot be cultured (tested

> > for).

> > > > 3. Prostadynia is a general irritation of the prostate which

> > causes

> > > urinary burning, urgency and frequency but without there being

> any

> > > infection or swelling of the prostate. This can come from a

> number

> > of

> > > causes including, I suspect, chronic spasm or tightening of the

> > > muscles of the pelvic floor.

> > > > The symptoms of chronic Prostatitis can come and go and be

mild

> > or

> > > severe. The symptoms include:

> > > > 1. Pain or tenderness in the area of the prostate. It is also

> > > common to have burning on the tip of the penis.

> > > > 2. Discomfort in the groin and, occasionally, lower back pain.

> > > > 3. Urinary urgency and frequency with pain on urination.

> > > > 4. Sometimes a slight penis discharge. If the discharge is

> cloudy

> > > and larger than one drop, or even a large drop, it is most

likely

> a

> > > bacterial Prostatitis and I would then prescribe antibiotics.

If

> a

> > > discharge is present, I would also check to make sure that

there

> is

> > > not also a sexually transmitted disease (such as Chlamydia or

> > > Gonorrhea) before beginning treatment.

> > > > 5. Pain with ejaculation.

> > > > If severe symptoms with fevers, chills and extreme fatigue

are

> > > present (symptoms of acute Prostatitis), antibiotics should be

> > used.

> > > The main treatment for bacterial Prostatitis consists of using

> the

> > > antibiotics Tetracycline (e.g., Doxycycline), Cipro, or Sulfa

> > > (Bactrim or Septra DS). Unfortunately, since it is hard for the

> > > antibiotics to be absorbed into the prostate, the symptoms

often

> > > recur even after six weeks of treatment. If antibiotics are

> > required,

> > > use Doxycycline or Cipro because these may be effective against

> > other

> > > hidden infections that can cause CFIDS/FMS.

> > > > Although there are a number of causes of Prostatitis, excess

> > > caffeine, alcohol and spicy foods can also contribute to the

> > > symptoms. Sitting for long periods while traveling (e.g., being

a

> > > truck driver) can also cause irritation of the prostate.

Although

> > > normal bacteria are common causes, a few bacteria transmitted

> > through

> > > sexual contact can also cause Prostatitis. Some feel that the

> main

> > > psychological component of Prostatitis is shame.

> > > > Bowel Parasite Infections

> > > > A while back, the news focused our attention on Milwaukee

> because

> > > of repeated fatal outbreaks of an infection by a bowel parasite

> > > called Cryptosporidium. A cartoon even made the rounds showing

> > > Mexican tourists being warned not to drink the water in

> Milwaukee!

> > > Although this infection usually resolves on its own within a

week

> > or

> > > two, it may persist in those with immune suppression. In fact,

> > people

> > > with acquired immune deficiency syndrome (AIDS) are

particularly

> > > susceptible and scores of Milwaukeens died from the

> Cryptosporidium

> > > outbreaks.

> > > > Unfortunately, in many places throughout the United States,

the

> > > water supply is contaminated, and parasites are no longer just

a

> > > Third World problem. Doctors frequently see cases of infection

by

> > > giardia, amoeba and numerous other bowel parasites. Parasitic

> > > infections can mimic CFS and, in immune suppressed situations

> like

> > > CFS, all parasites should be treated.

> > > > Most laboratories miss the parasites when they do stool

> testing.

> > I

> > > initially tested for bowel parasites by sending my patients'

> stool

> > > samples to a respected local lab. The tests kept coming back

> > > negative, so I eventually stopped testing. Finally, I started

> doing

> > > my own laboratory stool testing. Doing the test properly was

very

> > > time consuming, taking up to five hours per specimen. However,

> > > processing it properly, my tests frequently turned out

positive.

> In

> > > my experience - and in that of other physicians as well - when

> you

> > > treat a patient for parasites, the patient's fatigue and

achiness

> > > often improves dramatically.

> > > > If you would like your stool tested, make sure that the lab

> > > specializes in stool testing and that the sample is a purged

> > > specimen. A purged stool specimen is watery and loose, brought

> > about

> > > by the use of one-and-a-half ounces of Fleet's Phospho-Soda (a

> > > laxative). The purpose of the stool purge is to get the best

> > possible

> > > stool sample to check for bowel parasites and yeast. The

laxative

> > > washes the organisms off the walls of the intestines so that

they

> > can

> > > be detected. The routine random tests performed in almost all

> > > standard labs are generally not adequate or reliable. In

speaking

> > > with several lab technicians, I was told they had less than one

> > hour

> > > of training in looking for parasites—which they found to be

> > useless.

> > > In fact, during one of our " doctors' " poker games, I spoke with

a

> > > gastroenterologist friend who noted that during a certain bowel

> > exam

> > > he had performed, he saw a large number of parasites swimming

in

> > the

> > > patient's large bowel. He removed a big glob consisting of

> nothing

> > > > but mucus and parasites and sent it off to the major local

> > > laboratory, just for confirmation of the infection and

> > identification

> > > of the parasite. Even this sample came back negative for

> parasites!

> > > This is why I stress that stool testing must be done at a lab

> that

> > > specializes in parasitology. Because two excellent labs are now

> > > available to me to mail specimens to, I no longer have to do

the

> > > testing in my office. These labs are The Parasitology Center,

> Inc.

> > > (480-777-1078) and The Great Smokies Diagnostic Laboratory (800-

> 522-

> > > 4762).

> > > > At this point, no consistently effective prescription

> medication

> > is

> > > available for Cryptosporidium infections. Artemisia annua,

> however,

> > > is an effective herbal treatment. For most of my patients, I

> > > recommend using 1,000 milligrams three times a day for twenty

> days.

> > > Leo Galland, M.D., a parasite specialist, recommends a form of

> > > Artemisia called tricyclin for many parasitic infections. He

> > > recommends taking 2 tablets, 3 times a day after meals for six

to

> > > eight weeks. The cost of this antiparasitic herbal preparation

is

> > > about $30 for fifty tablets. See the treatment protocol below

for

> > > regimens for some other parasitic infections. The doctor who

runs

> > The

> > > Parasitology Center also has a review article discussing which

> > > natural remedies are effective against each type of parasite.

> > Common

> > > parasite treatment regimens also used in our office are on the

> > > treatment checklist below.

> > > > Antiparasitic Treatments

> > > > 1. Flagyl (Metronidazole) – 750 mg, 3 times a day for 10

days,

> > > followed by Yodoxin for many parasites. For Clostridium

Difficile

> > > take 250 mg, 4 times a day, or 500 mg, 3 times a day. It may

> cause

> > > nausea and vomiting (uncomfortable but usually not worrisome).

Do

> > not

> > > drink alcohol while on this medication as it will make you

vomit.

> > The

> > > SR (sustained release) form is easier on the stomach (as is the

> > brand-

> > > name form). If you get numbness or tingling in your fingers (or

> it

> > > worsens if you usually have it) stop the Flagyl.

> > > > 2. Yodoxin (Iodoquinol) – 650 mg, 3 times a day, for 20 days

> > after

> > > Flagyl is completed.

> > > > 3. Tinidazole – 2000 mg, once daily, for 3 consecutive days

> with

> > > food (for Entamoeba Histolytica) – OR - 3 doses, each 2 weeks

> apart

> > > (for Giardia or Dientamoeba Fragilis); Available at 's

> > Pharmacy

> > > (800-480-3432).

> > > > 4. Humatin (Paromomycin) – 500 mg, 3 times a day, for 10 days

> > (for

> > > Cryptosporidium). For Blastocystis add Yodoxin.

> > > > 5. Zithromax – 250 mg, once a day on an empty stomach for 10

> > days,

> > > along with Bactrim, 1 tablet twice a day for 10 days (alternate

> > > treatment for Cryptosporidium). Add Artemesia.

> > > > 6. Bactrim DS - 1 tablet, twice a day, plus Yodoxin 650 mg, 3

> > times

> > > a day with food for 10 days. Do not take Folic acid supplements

> > > (e.g., B Complex or multivitamins) during these 10 days (for

> > > Blastocystis).

> > > > 7. Amphotericin B – 100 mg, two times a day, plus Tinidazole

> 500

> > > mg, twice a day, plus Furoxone (Furazolidone) 1 tablet, twice a

> > day.

> > > Take these three together with food for 5 to 7 days

(Amphotericin

> B

> > > and Tinidazole are available from 's Pharmacy 800-480-

3432)

> > > (treatment for refractory Blastocystis).

> > > > 8. Lactoferrin – 350 mg, 1 to 3 capsules at bedtime.

> > > > 9. Multi-pure Water Filter - Most other filters (except for

> > reverse

> > > osmosis) are ineffective. (Available from Bren son, 410-

224-

> > > 4877).

> > > > 10. Artemesia Annua (a herbal antiparasitic) – 500 mg, 2

> tablets,

> > 3

> > > times a day for 20 days.

> > > > 11. Tricyclin (a herbal antiparasitic) - 2 tablets, 3 times a

> > day,

> > > after meals for 6 to 8 weeks (concentrated Artemesia).

> > > > 12. Colostrum (mother's milk) - 3 capsules, 3 times a day,

for

> 8

> > to

> > > 12 weeks. Then stop or use the lowest dose needed for symptoms.

> If

> > > nausea or indigestion occurs, lower the dose to a comfortable

> level

> > > for 1 to 2 weeks until it passes. Take on an empty stomach.

> > > > 13. Quinacrine – 100 mg a day for 5 days. May be useful for

> > empiric

> > > therapy of suspected but not identified parasites

(controversial).

> > > > 14. Albendazole – 400 mg a day for 5 days. May be useful for

> > > empiric therapy of suspected but not identified parasites.

> > > > Filter Your Water

> > > > Water filters can be very helpful in the fight against

> parasitic

> > > infection. However, not all units are designed to filter out

> > > parasites. For a water filter to remove parasites, it must have

a

> > > submicron solid carbon block filter. A good example is the

Multi-

> > pure

> > > Filter. Check the Consumer's Digest and Consumer's Report for

> other

> > > good units. Multi-pure Filters are available from Bren son

> at

> > > 888-801-8176 or 410-224-4877. He is a very reputable and

> > > knowledgeable person and does not believe in " high pressure

> sales "

> > > (again, I get no money from people or companies whose products

I

> > > recommend).

> > > > When shopping around for a water filter, request the National

> > > Sanitation Foundation (NSF) International Listing for the

> specific

> > > unit you are considering. NSF is an independent not-for-profit

> > > organization that tests and certifies drinking water treatment

> > > products. The unit you buy should meet both NSF Health Effects

> > > Standard 53 and NSF Aesthetics Standard 42, with Class I

> reduction

> > of

> > > chlorine and particulate matter. Any unit that does not meet

both

> > of

> > > these standards, particularly the health standard, is not

> adequate.

> > > To verify that a unit does meet these standards, call the NSF

at

> > 313-

> > > 769–8010.

> > > > In addition to verifying that a water filter meets the NSF

> > > standards, ask to see its Product Performance Data Sheet. Many

> > states

> > > require that this sheet be given to all prospective customers

of

> > > drinking water treatment devices.

> > > > Ask about the range of contaminants that the unit can reduce

> > under

> > > NSF Health Effects Standard 53. Most units certified under

> Standard

> > > 53 list only turbidity and cyst reduction. The number of units

> that

> > > also reduce pesticides, trihalomethanes, lead, and volatile

> organic

> > > chemicals is very small. Make sure that the water filter you

are

> > > considering can remove the specific contaminants that concern

you.

> > > > Ask if the unit is licensed in such states as California,

> > Colorado

> > > and Wisconsin. These states have some of the toughest

> certification

> > > procedures in the United States.

> > > > Finally, ask about the unit's service cycle, which is stated

in

> > > gallons of water treated. Find out how often you will need to

> > change

> > > the filter and what the replacement filters cost.

> > > > As the American water supply becomes more contaminated,

> parasitic

> > > bowel infections will likely become more common. These

> infections,

> > as

> > > well as the overgrowth of yeast or toxic bacteria caused by

> > > antibiotic use, contribute to feeling poorly.

> > > > The Role Of Other Infections In CFIDS/FMS

> > > > Many infections have been found in CFIDS. That people may

have

> > not

> > > just one, but several of these simultaneously is significant.

It

> > > suggests that although these infections may be a trigger, in

most

> > > patients the immune system is suppressed and therefore they

> become

> > a

> > > setup for unusual infections that persist. These infections may

> > > then " drag you down, " further suppressing your immune system.

> > > > Fortunately, most people improve (and often get very healthy)

> by

> > > simply treating the sleep, hormonal, nutritional and yeast

> > problems.

> > > Once these areas are treated, your body can usually eliminate

any

> > > persistent infections by itself. A subset, though, have

> infections

> > > that need treatment with antivirals and/or antibiotics.

> > > > How Can I Tell If I Need These Treatments?

> > > > First, I would try the other approaches discussed in my From

> > > Fatigued To Fantastic! book and newsletters. I would try these

> > > treatments if symptoms persist:

> > > > 1. Those with predominantly flu-like symptoms with

debilitating

> > > fatigue and little or no pain or fever are more likely to have

an

> > > underlying persistent viral infection (e.g., HHV-6, Epstein

Barr,

> > > CMV, etc.).

> > > > 2. Those with fevers (i.e., anything over 98.6°F in this

> illness -

> >

> > > even 99°) and/or lung congestion, sinusitis, skin pustules or

> other

> > > chronic bacterial infections seem more likely to have

infections

> > > (i.e., bacterial, Mycoplasma, or Chlamydia) that respond to

> special

> > > antibiotics. Let's look at these two groups and how to approach

> > them.

> > > > HHV-6 And Other Viral Infections

> > > > HHV-6 (Human Herpes Virus 6) is a virus that is related to

the

> > > Epstein Barr Virus (EB), Cytomegalovirus (CMV), and also to the

> > > Herpes Viruses that causes cold sores and Genital Herpes. HHV-6

> is

> > > transmitted like the common cold and many people have had it,

as

> > well

> > > as the EB Virus and the Cold Sore Virus by the time they are

> twenty

> > > years old. The body usually gets rid of all of these viruses on

> its

> > > own. Because of this, if you do routine (IGG) antibody testing,

> > > almost everybody will be positive for EB and many for HHV-6 and

> CMV

> > > viruses. However, the IGG test will not tell you if you have

> active

> > > infections unless the IGM antibody is also positive (suggesting

a

> > new

> > > infection). The IGM antibody is the one that increases in the

> first

> > > six weeks of an infection. This is followed by an elevated IGG

> > > antibody, which stays elevated your whole life and acts as your

> > > body's surveillance system. All an elevated IGG means is that

> your

> > > body has seen this infection and, if it sees it again, it's read

> > > > y to knock it out quickly. This is how immunizations work.

The

> > > immunization creates the IGG antibody, so that instead of

taking

> > one

> > > to two weeks to gear-up to fight the infection, your body can

> > > eliminate that infection very quickly. Unfortunately, in CFIDS

> you

> > > can have a chronic low-grade infection—even if your IGG

antibody

> is

> > > positive (elevated) - making the IGG antibody test for HHV-6,

EB

> > > Virus and CMV unreliable in CFIDS/FMS. In addition, the IGM

> > antibody

> > > will usually not be present in elevated levels in the low-grade

> > > infections with these viruses that may be seen in CFIDS and

FMS.

> > > > What makes this important is that Valtrex at high-dose can

> > > eliminate Epstein Barr virus, but will not work if active HHV-6

> or

> > > CMV infection is present. As I will discuss later, the only

tests

> I

> > > would rely on to diagnose active HHV-6 are " rapid cell

cultures "

> or

> > > PCR testing. Because some insurance companies are more likely

to

> > pay

> > > for IGG than PCR testing, an argument can be made for checking

> IGG

> > > antibodies first. If the EBV IGG is positive and HHV-6 and CMV

> IGG

> > > are negative, one may choose to proceed with Valtrex 1000mg, 4

> > times

> > > a day, for 6 months, without PCR testing. If the HHV-6 or CMV

IGG

> > > antibodies are positive, then check the CMV and/or HHV-6 PCR

> tests

> > to

> > > be sure they are negative.

> > > > Tell Me More About HHV-6 And CFIDS

> > > > Unfortunately there is no currently accepted standard

treatment

> > for

> > > the HHV-6 Virus. Even though it is related to other Herpes

> viruses,

> > > HHV-6 is resistant to Acyclovir, Valtrex, Famvir and the other

> > > antivirals that are commonly used in Herpes infections. The

only

> > > antiviral known to be effective against HHV-6 is Ganciclovir.

> This

> > > has significant side effects and has to be given intravenously

> and

> > > possibly forever to maintain the antiviral effect.

Unfortunately,

> > > this is not a viable option in day-to-day life and has been

only

> > > moderately successful when used. The main doctor who has been

> using

> > > Ganciclovir to treat HHV-6 in the United States is Joe Brewer,

> > M.D.,

> > > (816-531-1550) in Kansas City, Missouri. He found that 140 out

of

> > 207

> > > CFIDS patients had positive HHV-6 cell cultures. Forty percent

of

> > > CFIDS patients were positive on their first test and 70% were

> > > positive after three tests. This contrasts to 60 healthy

patients

> > he

> > > checked in which none of the HHV-6 tests were positive. Culture

> > > > s are more likely to be positive during acute flares of the

> > > disease, when the viral level in the blood rises (see Page 9

for

> > more

> > > on HHV-6 PCR testing).

> > > > As is often the case in CFIDS, there is conflicting data on

> > > infections in Chronic Fatigue Syndrome. A recently published

> study

> > > (Reeves WC, et al., Clin Infect Dis, 2000 July; 31 [1] pp48-52)

> > > examined 26 patients with Chronic Fatigue Syndrome and 52

healthy

> > > patients in Atlanta, Georgia, at the CDC. In this study,

several

> > > tests for HHV-6 and HHV-7 were done, including Polymerase Chain

> > > Reaction (PCR). HHV-6 DNA was found in 11% of CFIDS patients

and

> > 28%

> > > of healthy patients, suggesting that the HHV-6 was actually

less

> > > common in Chronic Fatigue Syndrome than in healthy patients. At

> > this

> > > time, as the conflicting data shows, although HHV-6 may be one

of

> > > many suspect infections in CFIDS, it is not yet clearly the

cause

> > of

> > > this illness.

> > > > When HHV-6 is present, it seems to infect the natural Killer

> > Cells,

> > > important cells in your body's defense (immune) system that are

> > > critical in fighting infections. A number of studies have shown

> > these

> > > Killer Cells to be malfunctioning in CFIDS. HHV-6 infection

does

> > not

> > > necessarily decrease the number of the natural Killer Cells but

> > does

> > > decrease their function. Natural Killer Cell function is

> described

> > in

> > > what is called Lytic Units—which means the ability of cells to

> lyse

> > > or break down foreign invaders. An average person will have a

> Lytic

> > > Unit level of 20 to 250 with over 80% of healthy patient being

> over

> > > 40 units. Dr. Brewer finds that in CFIDS the mean Natural

Killer

> > > Lytic Cell level is 12 units. Dr. Brewer uses Specialty Labs in

> > > California for his Natural Killer Lytic Cell testing and finds

> that

> > > the Lytic level stays the same on repeat testing and seems to

be

> a

> > > reliable test for Natural Killer Cell function testing in

CFIDS.

> > > Lytic unit levels will, however, decrease during flar

> > > > es of symptoms. In Dr. Brewer's experience, this test is very

> > > specific for CFIDS and Multiple Sclerosis. He has treated ten

MS

> > > patients and five CFIDS patients with the I.V. Ganciclovir. He

> > found

> > > that it helped to stabilize the MS patients. In the CFIDS

> patients,

> > > two to three were much improved, one still had a positive viral

> > > culture and one had a poor response. Unfortunately, maintaining

> > > patients on I.V. Ganciclovir forever (as noted above) is not a

> > viable

> > > option. Fortunately, an oral pill form of Ganciclovir

> > > (Valganciclovir) is currently being developed! It should be

noted

> > > that the HHV-6 virus is similar to CMV (Cytomegalovirus), and

> that

> > > whatever is effective against one, tends to be effective for

the

> > > other. This is a helpful bit of information as we follow new

> > research

> > > looking for clues on how to eliminate HHV-6 infection.

> > > > What Roles Does The Epstein Barr And Cytomegalovirus Play In

> > CFIDS?

> > > > Again, the roles of the EB and CMV viruses are not clear. It

is

> > not

> > > uncommon for antibody levels of these viruses to be elevated in

> > > Chronic Fatigue Syndrome. As noted above, it is not clear

whether

> > > this simply reflects a previous or ongoing infection with these

> > > viruses. Research by a husband and wife team (the Glasers) at

> Ohio

> > > State University, suggests that Epstein Barr Virus is still

quite

> > > active and playing a role in many patients with these

infections.

> > In

> > > addition, work by Lerner, M.D., also suggests that EB

> Virus

> > > and CMV are active as well. In speaking with Dr. Lerner's

> research

> > > assistant, I found out that he has found EB Virus and CMV to

both

> > be

> > > fairly common in patients with Chronic Fatigue Syndrome (with

and

> > > without pain). He found that about 20% had positive IGM and/or

> > > elevated EA (early antigen) tests to the EB Virus with negative

> > > Cytomegalovirus. Of these, two-thirds improved with high-dose

> > Valtrex

> > > (an oral antiviral). Despite my teasing and prodding, his

associat

> > > > e refused to give out the dose of Valtrex they prescribed

> because

> > > Dr. Lerner does not want to be responsible for people using

these

> > > higher doses until he completes the double-blind trial that is

> > > currently in progress. On the other hand, another study of his

> did

> > > use 1000mg, 4 times a day, giving the antiviral for 6 months.

It

> > > takes about 3 to 4 months before patients start to improve and

> > after

> > > 6 months people can stop the Valtrex without the symptoms

coming

> > > back. However, if there is no improvement in 6 months, consider

> it

> > to

> > > be a negative result. They also found that, as noted above, the

> IGM

> > > is almost always negative using the reagents used in most labs.

> > They

> > > found that only Epstein Barr IGM antibody testing, using a

> reagent

> > by

> > > the Diasorin Company (800-328-1482), has been useful in showing

a

> > > significant number of positive tests. When we called the

company,

> > the

> > > only lab in the Washington, D.C., area using it was at the NIH.

> The

> > > company may, however, be able to give you the name of

> > > > a lab near you that can do the test. What was fairly common,

> > > though, (and present in most patients) was either positive

tests

> > for

> > > Epstein Barr, CMV, or a combination of both as noted above.

When

> > CMV

> > > or HHV-6 are present, the Valtrex is less likely to work

because

> it

> > > is not effective against these viruses.

> > > > In another study done by Dr. Lerner (Infectious Diseases In

> > > Clinical Practice, 1997; 6:110-117) he found that patients who

> had

> > > elevated CMV IGG antibodies, but no significant evidence of

> > > associated Epstein Barr virus (i.e., negative IGM and early

> antigen

> > > (EA) antibody total less than 40), did improve with I.V.

> > Ganciclovir

> > > at 5mg per kg of body weight given every 12 hours I.V. for 30

> days.

> > > In this study 72% (13 of the 18 patients) improved markedly at

> the

> > > end of a month without any significant side effects. As noted,

an

> > > oral form of Ganciclovir is currently in development as well.

It

> > > should be noted that 36% of the Chronic Fatigue Syndrome

patients

> > > that Dr. Lerner checked (18 out of 50) did turn out to have

> > elevated

> > > CMV antibodies (albeit IGG) in the absence of IGM and EA

> antibodies

> > > to EB Virus (i.e., no evidence of active Epstein Barr Virus).

It

> > > should be noted, though, that 70% of healthy patients also had

> > > positive IGGs to CMV (as per our discussion above) in the study

> and

> > > appears

> > > > that the overall level of the IGG was not much higher

overall

> in

> > > the Chronic Fatigue group than in the healthy controls. On the

> > other

> > > hand, the higher the level of CMV antibody in the Chronic

Fatigue

> > > group, the more likely they were to improve with the I.V.

> > Ganciclovir.

> > > > What this means is that patients with Chronic Fatigue

Syndrome

> > > don't necessarily have different blood tests for antibody

levels

> > than

> > > healthy people for these viruses. However, if one has a higher

> > level

> > > rather than a lower level, one is more likely to improve with

the

> > > Ganciclovir. Previous research has not shown benefit from

> antiviral

> > > therapies in CFS (Straus SE, et al., New England Journal of

> > Medicine

> > > 1988; 319:1692-1698). Our experience using a fairly high dose

of

> > > Valtrex or Famvir (1500mg and 2250mg a day respectively) also

> > showed

> > > no significant improvement on these regimens after 6 weeks, at

> > which

> > > time we considered it to be ineffective. On the other hand, Dr.

> > > Lerner's research is suggesting that perhaps we gave it for too

> > short

> > > a time and at too low a dose. When treating himself and a few

> other

> > > patients, he used Valtrex by mouth at a dosage of 1000mg, 4

times

> a

> > > day, for 6 months. Using the higher dosing and the extended

> period

> > of

> > > time, as well as separating out groups that have

> > > > Epstein Barr Virus (sensitive to the oral Valtrex) without

CMV

> > or

> > > HHV-6 (resistant to oral Valtrex but sensitive to I.V.

> > Ganciclovir),

> > > may make an important difference in making treatment effective.

> No

> > > major Valtrex toxicity was seen. As noted above, a double-blind

> > study

> > > is currently in progress and we are beginning to try the higher

> > dose

> > > of Valtrex in the 15% of our patient population that have not

> > > improved adequately and have positive EBV, and negative CMV and

> HHV-

> > 6

> > > tests. We hope to give you follow-up information on the

> treatment's

> > > effectiveness as soon as we know!

> > > > In addition, Dr. Lerner suspects that these infections affect

> the

> > > heart muscle contributing to much of your symptoms. I am not

> > > convinced that this is the case because EKG changes are common

in

> > > CFS. This can occur because the autonomic (brain) dysfunction

and

> > > hormonal changes seen in CFS can cause these same EKG changes

> > without

> > > heart damage. Regardless, he found that these changes went away

> > with

> > > treatment (as has been our experience in treating Chronic

Fatigue

> > > Syndrome—patient's EKG changes improve even without

antivirals).

> > Dr.

> > > Lerner is currently recruiting patients for a double-blind

study

> > > using the high-dose Valtrex. His phone number is 248-540-9688

in

> > > Beverly Hills, Michigan.

> > > > Does This Mean There Is Nothing We Can Do Now?

> > > > Although there is no currently accepted specific treatment

for

> > the

> > > CMV and HHV-6 viruses, there are still a number of things that

> may

> > be

> > > very helpful in fighting this infection.

> > > > 1. Lithium tends to be antiviral and has been shown to

decrease

> > > pain in FMS patients when added to treatment with Elavil.

Lithium

> > is

> > > commonly used in manic depressive illness and is a natural

> mineral

> > > despite being sold by prescription. In high doses, it can cause

> > some

> > > neurologic symptoms and suppression of the thyroid gland, but

> these

> > > can usually be treated by taking a small amount of Essential

> Fatty

> > > Acids and thyroid hormone. Lithium might also worsen Restless

Leg

> > > Syndrome. Although we have no direct evidence of Lithium being

an

> > > effective antiviral against HHV-6, it may well be effective

> because

> > > it works against a number of other viral infections. In our

> > > experience, 200mg to 600mg a day seems to be the effective dose

> in

> > > treating FMS patients. As noted above, I would check the

thyroid

> > > blood tests at 3 months, 6 months and then yearly (check a Free

> T4

> > > and a Total T3 - not a TSH). A Lithium level should also be

> checked

> > > at the same time to be sure that it not above the upper limit

of

> > > > normal. The level can be below the normal range, which is

fine

> as

> > > long as the treatment is effective. You may find that you can

> lower

> > > the Lithium dose after you have been on it for several months.

> > > > 2. Heparin (a blood thinner, see Page 12) also has antiviral

> > > properties.

> > > > 3. It is worth considering trials of high-dose Valtrex. It

> should

> > > be noted that 1000mg, 3 times a day, is used for shingles in

> older

> > > patients and appears to be quite safe. On the other hand,

higher

> > > dosing at 8 grams a day in AIDS patients did result in uncommon

> > > (under 2%) life threatening problems. This is common even with

> day-

> > to-

> > > day drugs in AIDS patients (for example, regular sulfa

> antibiotics

> > > have often resulted in severe toxicity in AIDS patients).

> > > Nonetheless, we will be limiting the dose to 1 gram, 4 times a

> day,

> > > in our practice. It is important to note that taking Tagamet

> and/or

> > > Probenecid (Benemid) will raise the blood level of Valtrex.

> Tagamet

> > > has powerful immune modifying properties and is very helpful in

> > acute

> > > cases of Epstein Barr (mono) infections. Because of this, we

are

> > > adding Tagament 300mg, 4 times a day (but not Probenecid), to

the

> > > Valtrex. As I noted, we are beginning this treatment with some

of

> > our

> > > patients and will let you know what we find.

> > > > Natural Remedies

> > > > 1. Olive Leaf - This is an herbal which is known to have a

wide

> > > spectrum of anti-infectious activity. It has been shown to be

> > > effective against the HHV-6 virus in the test tube. I have not,

> > > however, seen studies testing its effect in human beings

infected

> > > with HHV-6. Nonetheless, a number of physicians have found that

> > using

> > > Olive Leaf in Chronic Fatigue Syndrome is very effective. There

> is

> > > controversy over whether the form and source of the Olive Leaf

is

> > > critical. We recommend that you use a form that has at least 6%

> > > Oleuropein, which is one of the most active antiviral

components

> in

> > > the Olive Leaf. Other components may be important and some

people

> > > also feel that you must use the Mediterranean Olive Leaf vs.

the

> > > American Olive Leaf. Other people argue that you should have a

> form

> > > that is organically grown, without pesticides. At this point it

> is

> > > not clear whether this is simply marketing or important in day-

to-

> > day

> > > life. Nonetheless, I would be picky about the companies you buy

> the

> > O

> > > > live Leaf from. I would use one of these sources:

> > > > a. My office (800-333-5287) or my Web site at

> www.endfatigue.com.

> > > > b. Pacific Research Labs (800-325-7734). This is owned by R.

J.

> > > Marshall, Ph.D., who has done a fair bit of work treating CFIDS

> > > patients with Olive Leaf. I will be describing the protocol

that

> he

> > > uses below.

> > > > c. General Nutrition Centers (GNC).

> > > > Dr. Marshall feels that during infections, the body becomes

> > overly

> > > acidic. He tests the morning urine specimens with pH paper

(which

> > is

> > > very easy to do at home) and gives a shell extract, which

raises

> > the

> > > body's alkalinity. He feels that having a normalized acid-base

> > > balance in your body helps it to fight infections. He then adds

> his

> > > form of Olive Leaf, called Infectostat (which also contains

> > mushroom

> > > extracts to stimulate the immune system), giving 3 to 4

capsules,

> 3

> > > to 4 times a day, to help fight the infections. Usually, the

> > patient

> > > should start feeling better within four weeks on this protocol.

> > > Although we have found it helpful in fighting colds and other

> > common

> > > respiratory infections, we are just starting to explore Olive

> > Leaf's

> > > use in a few of our patients who have not responded to standard

> > > treatment and are still quite ill. We will let you know our

> > > experience with this in an upcoming newsletter issue. My guess,

> > > though, is that simply using regular (6% Oleuropein) Olive Leaf

> > > > 500mg capsules, 3 to 4 capsules, 3 to 4 times a day between

> > meals,

> > > will probably be equally effective and cheaper for most people

> than

> > > the expensive forms. How long one needs to take Olive Leaf in

> > Chronic

> > > Fatigue Syndrome is yet to be determined.

> > > > Initially, a pharmaceutical company was developing the

> Oleuropein

> > > in Olive Leaf as an antiviral. Because it gets bound to the

blood

> > > proteins, they thought that Oleuropein might not get to the

> > tissues.

> > > More importantly, Oleuropein is a natural product and therefore

> > hard

> > > to patent. Because of these problems, they stopped research on

> it.

> > > Years later this research was rediscovered and explored

further.

> In

> > > addition to being an effective antiviral agent, Olive Leaf is

> > > reported to be effective on a number of bacterial and yeast

> > > infections as well. What is most exciting regarding the Olive

> Leaf

> > is:

> > > > a. That some doctors have found it to be effective in CFIDS,

> and

> > > > b. That in tests against HHV-6 and CMV virus (remember that

if

> > > something is effective against one, it tends to be effective

> > against

> > > the other) the Olive Leaf extract did not just suppress the

virus

> > but

> > > killed it. That is very promising.

> > > > 2. Pro-Boost - Thymic Protein A (used to be called BioPro) -

> This

> > > is the immune stimulant that I discussed in my newsletter, Vol.

> 2,

> > > Issue 2. Although not a hormone, Pro-Boost mimics the natural

> > hormone

> > > produced by your Thymus - the gland which stimulates your

immune

> > > system. I find it to be extraordinarily effective in fighting

> > common

> > > infections of any kind that seem to pop up. For the more deep-

> > seated

> > > infections of CFIDS, the higher dose (1 packet, 3 times a day)

> will

> > > likely be needed. Once the infection seems to be in check and

you

> > are

> > > feeling better (i.e., after 6 weeks), you can taper down to the

> > > lowest dose that maintains the effect.

> > > > 3. IP6 - This natural immune stimulant is an extract of bran

> > > (phytates). It is less expensive and is sometimes combined with

> > > vitamin C. The dose of IP6 (available from many sources) is 5

to

> 8

> > > grams a day. Do not take IP6 within 3 hours of vitamin/mineral

> > > supplements.

> > > > 4. MGN3 - This is a very concentrated mushroom extract, which

> has

> > > been shown to stimulate Natural Killer Cell immune function. In

> one

> > > study, it actually tripled Natural Killer Cell function—an

effect

> > > that, as the HHV-6 virus can suppress Natural Killer Cell

> function,

> > > could be very powerful. Unfortunately, it is horribly expensive

> in

> > > the recommended dose (250 mg capsules) of 2 to 4 capsules, 4

> times

> > a

> > > day for 2 weeks, followed by 2 capsules, 2 times a day. Other

> > > mushroom extracts are cheaper but may not be as effective.

> > > > 5. Intravenous Vitamin C at high-dose (15gm to 50gm) has been

> > > suggested to have antiviral effects in a number of other

> infections

> > > and is often dramatically helpful in CFIDS when given in the

I.V.

> > > nutritional therapy called " Myers Cocktails " (see my

newsletter,

> > Vol.

> > > 3, Issue 3).

> > > > 6. Lysine 1000 mg, 3 times a day - This amino acid protein is

> > safe

> > > and inexpensive (27¢ a day). It inhibits oral/genital herpes

(by

> > > depleting the Arginine the virus needs to grow). I do not know

if

> > it

> > > also inhibits EBV, HHV-6 or CMV viral infections.

> > > > I would take the combination of these together (as is

> affordable)—

> > > perhaps leaving the MGN3 for later if needed, giving the

> treatment

> > > for at least a 6 to 8 week trial to see if it's effective. If

you

> > are

> > > feeling better at 6 weeks, you can then taper down the dose

> slowly

> > as

> > > long as the benefit is maintained. When able, you can wean

> yourself

> > > off the treatments. If symptoms recur, go back up to the dose

> that

> > > maintains the benefit or consider increasing the dose further.

As

> > we

> > > are just starting to use this protocol in our patients, I do

> > > appreciate your feedback on what has worked for you and what

has

> > not.

> > > You can " vote " for what helped or didn't help you on our Web

site

> > at

> > > www.endfatigue.com. You can also see other people's votes.

> > > > In addition, your clotting system may be activated by several

> > > infections making it difficult to eliminate them. Using the

anti-

> > > clotting treatments that we will discuss later can also make it

> > > easier for your body to eradicate infections.

> > > > Mycoplasma And Chlamydia

> > > > Other infections have also been found to be very important in

> > > CFIDS. Dr. Garth Nicolson and his wife, who were on-faculty at

> the

> > > University of Texas Medical School at Houston and the

Department

> of

> > > Microbiology and Immunology at Baylor College of Medicine in

> > Houston,

> > > Texas, are the leading proponents of treatment of these

> infections.

> > > Dr. Garth Nicolson was an endowed chair and department chairman

> at

> > > the University of Texas, the M.D. Cancer Center in

> > Houston,

> > > Texas, and a Professor of Internal Medicine at the University

of

> > > Texas Medical School, also in Houston. Dr. Nicolson's wife had

> > > Chronic Fatigue Syndrome years ago. They were surprised that

her

> > test

> > > turned out to be positive for Mycoplasma fermentans (also known

> as

> > > Mycoplasma fermentans incognitus). This Mycoplasma was found to

> be

> > > resistant to the Penicillin- and Keflex-family antibiotics that

> > most

> > > doctors use, but was sensitive to long courses of Doxycycline

and

> > > Cipro. After an extended course of Doxycycline treatment,

> > > > she was much better. The Nicolsons then went on to develop

> their

> > > own tests for Mycoplasma using PCR testing. Dr. Nicolson tells

me

> > > that, in addition, when his step-daughter came home after

serving

> > in

> > > Desert Storm, she came down with Gulf War Illness (GWI). They

> > tested

> > > hundreds of Gulf War veterans with GWI and 40% to 45% were

> positive

> > > for Mycoplasma infections—almost all with Mycoplasma

fermentans.

> > This

> > > has been confirmed by other labs and a large Veterns

> Aministration

> > > study involving over 2,000 patients. In contrast to this,

> soldiers

> > > who were not deployed to the Gulf during the war, had less than

a

> > 6%

> > > incidence of being positive for these infections.

> > > > Interestingly, the Nicolsons found that in patients with

> Chronic

> > > Fatigue Syndrome or Fibromyalgia, approximately 70% (144 out of

> 203

> > > patients) had a positive PCR test for one, or usually several

> > > species, of Mycoplasma. When the Nicolsons tested 70 healthy

> > > patients, only 6 patients (less than 9%) were positive for any

of

> > the

> > > Mycoplasma species. This is a highly significant difference.

Only

> 2

> > > of these 70 healthy people were positive for Mycoplasma

> fermentans.

> > > Similar results have been found by other doctors and have been

> > > published.

> > > > As we have said before, it is likely that there is a group of

> > > underlying problems and not a single one that triggers

CFIDS/FMS.

> > > This applies to infections as well. This is why you can see

tests

> > be

> > > positive for both viral and Mycoplasmal infections in so many

> > people

> > > with this disease. For Mycoplasma alone, when they checked for

> four

> > > different types of Mycoplasma, over half of the 93 CFIDS

patients

> > > that were positive had more than one type of infection. Over

20%

> of

> > > them had three out of the four Mycoplasma infections test

> positive.

> > > The more infections that were positive, the worse the patient's

> > > symptoms were and the longer they had had CFIDS/FMS.

> > > > What Are Mycoplasma?

> > > > Mycoplasma are an ancient bacteria that lacks cell walls and

> are

> > > capable of invading a number of types of human cells. They can

> > cause

> > > a wide variety of human diseases. These organisms can cause the

> > types

> > > of symptoms seen in Chronic Fatigue Syndrome patients and,

> > according

> > > to Dr. Nicolson, tend to be immune suppressing. Unfortunately,

> they

> > > cannot be readily cultured on a culture dish like regular

> bacteria.

> > > In medicine, we have a bad habit on focusing on that which is

> easy

> > to

> > > test for and making believe that that which is hard to test for

> > does

> > > not exist. Because of this, bacterial infections such as

> pneumonia,

> > > bladder infections and skin infections, where one bacteria on a

> > cell

> > > dish will rapidly turn into millions by the next day and be

> visible

> > > to the human eye, get all our attention. Unfortunately,

> Mycoplasma,

> > > which cannot be easily cultured, tends to be ignored. It's like

> the

> > > old story about the little kid who was looking for his lost

keys

> > > under the street lamp one night. His frien

> > > > ds came by and asked him what was going on. He told them and

> they

> > > all looked for the keys under that light for about an hour.

> > Finally,

> > > exasperated, they looked at the friend and said, " Where did you

> > lose

> > > these keys? " The kid looked up and said, " Oh, about half a

block

> > down

> > > the street. " They said, " Why are you looking for them here? " He

> > > said, " Because there is a light here and I can see! " This is

kind

> > of

> > > what it is like in medicine. If there is a test for something

> (such

> > > as cholesterol and bacterial cultures) that is easy to do, we

> focus

> > > our attention on that test and make believe that it finds the

> main

> > > problem. Unfortunately, in CFIDS and FMS, this is not the case.

> > > > The data suggests that many infections may trigger CFIDS/FMS

or

> > > that CFIDS and FMS may cause immune suppression—which then sets

> you

> > > up to catch a whole bunch of different infections which your

body

> > has

> > > trouble clearing. This is why it is important to treat all the

> > > underlying processes simultaneously as I discuss in my From

> > Fatigued

> > > To Fantastic! book and newsletters.

> > > > So, How Do You Look For These Infections?

> > > > I had the honor of speaking with Konnie Knox, M.D., a major

re-

> > > searcher on HHV-6 testing in CFIDS/FMS, who uses a technique

> called

> > > Rapid Cell Culture. She actually infects different test tube

> cells

> > > with HHV-6, grows them, and then looks for signs of HHV-6 in

the

> > > cell. In her experience, one out of three CFIDS/FMS patients

are

> > > positive for active HHV-6 infection on the first blood test.

When

> > > multiple testing is done (e.g., three tests), 70% are positive.

> > This

> > > test is negative in the vast majority of people who are

healthy.

> > The

> > > other main illness where the HHV-6 test is positive is Multiple

> > > Sclerosis. At this time, HHV-6 Rapid Cell Culture and the PCR

> test

> > at

> > > Dr. Nicolson's lab (International Molecular Diagostics) are the

> > only

> > > HHV-6 test I order. For more information on Dr. Knox's work, go

> to

> > > these Web sites: www.HHV-6.com and www.cnet.com. For the IMD

> > website,

> > > go to www.imd-lab.com.

> > > > The Nicolsons use very sensitive PCR (Polymerase Chain

> Reaction)

> > > testing to actually look for DNA specific to Mycoplasma, HHV-6,

> and

> > > other infections. Unfortunately, those DNA pieces are so

> > > microscopically small, that to look for just one is much worse

> than

> > > looking for a " needle in a haystack. " With the PCR, if that

> > > Mycoplasma gene sequence is found, the technique multiplies it

> like

> > a

> > > copying machine until millions of that sequence are present and

> can

> > > be picked up by testing. Because of this, PCR testing is

> > exquisitely

> > > sensitive and can find the proverbial " needle in a haystack. "

> This

> > > makes it very powerful and the only testing that I would

> recommend

> > in

> > > looking for these Mycoplasma and Chlamydia infections. As noted

> > > above, IGG antibody testing is not reliable for Mycoplasma and

> > > Chlamydia testing in CFS.

> > > > Where Do I Get These Tests Done And Should I Have Them Done?

> > > > The tests for HHV-6 and Mycoplasma each cost about $180 to

> $250.

> > As

> > > noted above, the only places that I would get the HHV-6 test

done

> > > (and the only tests I would do are PCR or viral culture

testing)

> > are

> > > at the Wisconsin Viral Institute (414-774-0311) or Dr.

Nicolson's

> > > lab. I order all the lab testing for Mycoplasma and Chlamydia

at

> > the

> > > Nicolson's lab, at International Molecular Diagnostics, 15162

> > Triton

> > > Lane, Huntington Beach, CA 92649 (714-799-7177 ext. 202 or

204).

> > The

> > > lab's Web site is www.imdlab.com.

> > > > I can almost guarantee that if you do the Mycoplasma or

> Chlamydia

> > > tests at your local lab they will do the wrong tests and they

> will

> > be

> > > useless for hidden CFS infections. I have never seen one come

> back

> > > with any useful information. What they usually do is check the

> > > antibodies (usually for the wrong Mycoplasma infection) which

> > simply

> > > shows that you (like everybody else at some point in their

life)

> > have

> > > had a Mycoplasma infection. It tells nothing about active

> infection

> > > and, again, is useless. Be sure to do the PCR testing and do it

> at

> > > one of the two labs discussed above. Dr. Nicolson has noted

which

> > > tests he recommends in CFS/FMS, their cost and instructions for

> the

> > > lab. We have reprinted this information on the next page (Dr.

> > > Nicolson's lab also does viral PCR testing for CMV, as well as

> HHV-

> > 6).

> > > > Even at the best labs, it is not uncommon to have a false-

> > negative

> > > report (where you have the infection and it does not show up on

> the

> > > test). Because of this, especially for HHV-6, multiple tests

will

> > > often need to be done. There are good arguments for not doing

the

> > > tests and simply going ahead and treating empirically with the

> > > natural remedies discussed above for HHV-6, or for prescribing

> > > Doxycycline or Cipro for an extended period of time (see

below).

> If

> > > you feel better after four months on the treatment, then you

know

> > you

> > > are hitting an infection and you can always intermittently stop

> the

> > > treatments to see how long you will need them. Also, there are

> many

> > > infections that are not tested for with these tests that would

be

> > > effectively treated with the regimens that we are discussing.

> Many

> > of

> > > these are likely to be infections that we don't even know

exist.

> > > Because of this, if resources are limited, I some-times simply

> > treat

> > > the patient, based on clinical suspicion, without doing the

> > > > tests.

> > > > Testing does have its benefits. If the test is positive, I am

> > > likely to treat more aggressively and it helps guide me on how

> long

> > > to give the treatment. For example, if after four months you

are

> > not

> > > better and the test is positive, I would be likely to go ahead

> and

> > > increase dosing or change to a different antibiotic. If the

test

> > was

> > > negative, I would be more likely to just stop treatment and

> suspect

> > > that the infection is less likely. This argues in favor of

doing

> > the

> > > tests. One simple thing to do is to go ahead and check with

your

> > > insurance company to see if they cover these tests. This may

make

> > > your decision much simpler. Unfortunately, I suspect that the

way

> > > that most labs draw and ship your blood sample may not be

> reliable

> > > because, in our experience, we have had less than 10% of

> patient's

> > > tests come back positive for HHV-6 cell culture and only a

modest

> > > percent come back positive for the Mycoplasma. For the PCR

> > Mycoplasma

> > > test, the blood has to be frozen (see boxed inset, Page 9

> > > > ). If the blood is left at room temperature, most of the

> positive

> > > samples become negative after one to two days.

> > > > Mycoplasma testing is not as specific as HHV-6 testing is for

> > > CFIDS/FMS/Multiple Sclerosis (i.e., it is positive in other

> > > illnesses). For example, about half the patients with

Rheumatoid

> > > Arthritis are also found to be infected with treatable

> infections,

> > > including Mycoplasma. This goes along with my, and other

doctors'

> > > experience, that Doxycycline is often effective in treating

> > > Rheumatoid Arthritis. Interestingly, although Mycoplasma is

> common

> > in

> > > the environment, it usually is fairly noninvasive. It may

simply

> be

> > > that once your immune system is weakened, these infections can

> get

> > > into cells where they don't belong. When that happens, even

some

> of

> > > the common ones that are considered noninfectious can wreak

> havoc.

> > > When these infections repro-duce slowly, they tend to be low-

> grade,

> > > chronic infections, as opposed to the acute and more prominent

> > > symptoms seen with bacterial and viral infections that multiply

> and

> > > divide rapidly.

> > > > For CFS/ME or FMS or Autoimmune Disease Patients,

> > > > The Institute for Molecular Medicine suggests the following

lab

> > > tests:

> > > > (Codes are I.M.D. or CPT Codes)

> > > > 1. Test Panel 1007 (CPT: 87798x3, 87581) Mycoplasma species

> panel

> > > of 4 pathogenic mycoplasmas (M. fermentans, M. penumoniae, M.

> > > hominis, M. penetrans) by PCR.

> > > > Justification: Almost 60% of CFS/FMS and 50% of Rheumatoid

> > > Arthritis (RA) and other autoimmune patients have one or more

> > > intracellular, systemic mycoplasmal infections similar to those

> > found

> > > in a variety of chronic illnesses [Nicolson, et al.,

Mycoplasmal

> > > infections in chronic illnesses: Fibromyalgia and Chronic

Fatigue

> > > Syndromes, Gulf War Illness, HIV-AIDS and Rheumatoid Arthritis;

> > > Medical Sentinel 1999; 5:172-176]. Ultrasensitive and

> ultraspecific

> > > mycoplasma tests can only be done by a small number of labs,

most

> > > university or government labs that have been trained by us

under

> a

> > > U.S. government contract.

> > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> > > (EDTA). The blood is collected, immediately mixed and placed on

> > ice,

> > > then shipped on wet ice or immediately flash frozen and shipped

> > with

> > > dry ice by courier (foreign shipments) to I.M.D. to arrive

within

> > 24-

> > > 36 hours. Cost=$250. (Note that other commercial labs charge

$400-

> > > 600.)

> > > > 2. Test 1006 (CPT: 87486) Chlamydia pneumoniae test by PCR.

> > > Justification: Many CFS, FMS, MS, RA and other patients have

this

> > > systemic infection along with viral infection(s). We were among

> the

> > > few labs that developed the molecular tests that are now done

for

> > > this type of infection. The other labs that use these

procedures

> > are

> > > university labs.

> > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> > > (EDTA). The blood is collected, immediately mixed and placed on

> > ice,

> > > then shipped on wet ice or immediately flash frozen and shipped

> > with

> > > dry ice by courier to I.M.D. to arrive within 24-36 hours.

> > Cost=$180.

> > > (Note that other commercial labs charge $200-250.)

> > > > 3. Test 07047 (CPT: 87476) Borrelia burgdorferi (Lyme

Disease)

> > test

> > > by PCR.

> > > > Justification: Many CFS, FMS and RA patients have this

systemic

> > > infection (diagnosed as Lyme Disease) along with other infection

> > (s).

> > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> > > (EDTA). The blood is collected, immediately mixed and placed on

> > ice,

> > > then shipped on wet ice or immediately flash frozen and shipped

> > with

> > > dry ice by courier to I.M.D. to arrive within 24-36 hours.

> > Cost=$180.

> > > (Note that other commercial labs charge $200-250.)

> > > > 4. Test 07039 (CPT: 87532) Human Herpes Virus 6 (HHV-6) test

by

> > > PCR.

> > > > Justification: Many CFS and some FMS patients have this

> systemic

> > > viral infection, and it should be tested for in any autoimmune

> > > illness.

> > > > Specimen Requirements: Collect blood in one (1) 5 cc Lavender-

> top

> > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > centrifugation. The plasma is then shipped on wet ice or

> > immediately

> > > flash frozen and shipped with dry ice by courier to I.M.D. to

> > arrive

> > > within 24-36 hours. Cost=$180. (Note that other commercial labs

> > > charge $200-350.)

> > > > 5. Test 07034 (CPT: 87496) Cytomegalovirus (CMV) test by PCR.

> > > > Justification: Many CFS and FMS patients have this systemic

> viral

> > > infection, and it should be tested for in any autoimmune

illness.

> > > > Specimen Requirements: Collect blood in one (1) 5 cc Lavender-

> top

> > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > centrifugation. The plasma is then shipped on wet ice or

> > immediately

> > > flash frozen and shipped with dry ice by courier to I.M.D. to

> > arrive

> > > within 24-36 hours. Cost=$180. (Note that other commercial labs

> > > charge $200-300.)

> > > > For the best price and highest quality, the above PCR

specialty

> > > tests for CFS/FMS patients can be ordered through International

> > > Molecular Diagnostics, Inc., 15162 Triton Lane, Huntington

Beach,

> > CA

> > > 92649, U.S.A. Tel: 714-799-7177, ext. 202 (Client Services) or

> ext.

> > > 204 (Brant Blasingame). Order forms and additional information

> are

> > > available upon request. They also offer testing for blood

> clotting

> > > abnormalities (see below). Tests must be ordered by a

physician.

> > The

> > > I.M.D. Web site is www.imd-lab.com. On this site you will find

> > > additional information about testing and disease. The Institute

> for

> > > Molecular Medicine Web site is www.immed.org. On this site you

> will

> > > find publications and documents on CFS/ME, FMS, autoimmune

> diseases

> > > and other chronic illnesses. Immediate fax-back information is

> > > available 24 hours per day by calling our telephone number 714-

> 903-

> > > 2900.

> > > > Garth Nicolson, Adjunct Professor of Internal Medicine

> > > > President and Chief Scientific Officer, The Institute for

> > Molecular

> > > Medicine

> > > > —A nonprofit institute dedicated to discovering new

diagnostic

> > and

> > > therapeutic solutions for chronic diseases—

> > > > 15162 Triton Lane, Huntington Beach, CA 92649-1041, U.S.A. •

> Tel:

> > > 714-903-2900 • Fax: 714-379-2082

> > > > So, What Is Prescribed For Mycoplasma And Chlamydia?

> > > > Fortunately, Mycoplasma and Chlamydia infections are usually

> > > sensitive to the right antibiotics. The antibiotics most likely

> to

> > > effect these organisms are:

> > > > 1. Doxycycline or Minocycline 100 mg, 2-3 times a day. These

> two

> > > antibiotics are in the Tetracycline-family and should not be

used

> > in

> > > children under eight years-old because they can cause permanent

> > > staining of the teeth. They are very effective, though, against

a

> > > number of unusual organisms (e.g., Lymes Disease). They will

> > > sometimes cause some stomach upset. If this occurs, take the

> > medicine

> > > with food and a full glass of water or lower the dose. Do not

use

> > > outdated/expired Tetracycline prescriptions—they can kill you!

> > > > 2. Cipro (Ciprofloxacin) 750 mg, twice a day. Although

> expensive,

> > > this is usually a well-tolerated antibiotic. It has a very wide

> > range

> > > of effectiveness against a large number of organisms. When

> treating

> > > males, the Cipro (as well as the Doxycycline) has the

additional

> > > benefit of treating any hidden prostate infections. Do not take

> > oral

> > > magnesium within 6 hours of Cipro or you won't absorb the Cipro.

> > > > 3. Zithromax 600 mg a day, taken with food, or Biaxin 500 mg,

> > twice

> > > a day, taken on an empty stomach. These are in the Erythro-

mycin

> > > family. Zithromax tends to be fairly well-tolerated. The Biaxin

> is

> > > more likely to cause a bit of nausea in some patients, but it

is

> > > usually well-tolerated. Both are quite expensive. They may work

> > > against infections missed by Doxycycline and Cipro.

> > > > Although all of these antibiotics can be effective, it is not

> > > uncommon for infections that are sensitive to the Erythromycin

> > > antibiotics (#3 above) to be resistant to #1 and #2 above and

> vice-

> > > versa. Therefore, it is best to try either Doxycycline or Cipro

> > > first. If they are not effective, then try the Zithromax or

> Biaxin.

> > > The antibiotic should be taken for at least 6 months. If there

is

> > no

> > > improvement in 4 months, switch to or add the other antibiotic

or

> > > simply stop the treatment. It is helpful to check for low-grade

> > > fevers. I am more likely to use antibiotics for CFIDS patients

> who

> > > have temperatures over 98.6°F, even if it is only 98.8° (I

> consider

> > > 98.8° a fever because CFIDS/FMS patients usually have low body

> > > temperatures). If you do have low-grade, chronic temperature

> > > elevations, be sure that you monitor your temperatures during

> > > treatment. If your temperature drops with the antibiotic, it

> > suggests

> > > that you do have one of these nonviral infections and the

> > antibiotic

> > > is helping. T

> > > > his would encourage me to continue the antibiotic trial -

even

> if

> > > it takes up to 12 months to see an improvement in your

symptoms.

> > > > If you are clearly better, I would probably take the

antibiotic

> > for

> > > at least 6 to 12 months. It can then be stopped. If symptoms

> recur,

> > > keep repeating 6 to 8 week cycles until the symptoms stay gone.

> It

> > > may take several years of treatment for the infection to be

> totally

> > > eradicated. To put it in perspective, this is how long children

> > often

> > > take antibiotics for acne—which unfortunately, if not taken

with

> > anti-

> > > fungals, can lead to yeast overgrowth and possibly trigger

CFIDS.

> > Be

> > > sure to take Nystatin, 2 tablets, 2 times a day, while on the

> > > antibiotics. Also, please be sure to use alternative birth

> control

> > if

> > > on " the pill. " Birth control pills may be ineffective while

> taking

> > > antibiotics. In addition, anti-depressants, codeine, antacids,

> and

> > > mineral supplements (e.g., magnesium) may block antibiotic

> > > absorption. Take these at least three hours away from the

> > antibiotic

> > > (and don't take the antidepressant/codeine medications if they

> are

> > > not clearly helping).

> > > > It is very common to get die-off (Herxheimer) reactions which

> > > include chills, fever, night sweats and general worsening of

> > CFS/FMS

> > > symptoms when the antibiotic first kills off the infection.

These

> > can

> > > be severe and last for weeks. Dr. Nicolson encourages you " to

be

> > > patient and not abandon therapy prematurely, because few

patients

> > who

> > > have been sick for years recover in less than one year of

> > therapy...

> > > [don't] be alarmed if some signs and symptoms occasionally

return

> > or

> > > worsen. This is not unusual. Eventually you will be off

> antibiotics

> > > or antivirals but you will need to continue various supplements

> to

> > > maintain your immune system and general nutritional status. "

> > > > Treatment for Bacterial, Mycoplasma, Chlamydia, E-coli,

> Bladder,

> > Or

> > > Other Infections

> > > > (From the " Treatment Checklist " used in Dr. Teitelbaum's

> office.

> > A

> > > full list is available on Dr. Teitelbaum's Web site at

> > > www.endfatigue.com.)

> > > > The Mycoplasma, Chlamydia, E-Coli, bladder and other

bacterial

> > > infections usually take months to years to eradicate. It is

> common

> > to

> > > flare your symptoms (from the infection die-off) the first two

> > weeks

> > > of treatment. Take the antibiotics for six months and, if

better,

> > > then repeat six-week cycles till your symptoms stay gone.

> > > Antidepressants, Neurontin, and/or Codeine may block the

> > antibiotic's

> > > effectiveness. Be sure to take Nystatin, 2 tablets twice a day,

> and

> > > Acidophilus while on the antibiotics. If you have occasional

low-

> > > grade fever (i.e., if over 98.6° F), check your oral

temperature

> > > occasionally to see if the antibiotic reduces or eliminates the

> > > fever. If so, stay on that antibiotic. Also, see Dr. Nicolson's

> Web

> > > site at www.immed.org for additional information.

> > > > Useful antibiotic treatment for the above infections include:

> > > > 1. Cipro (ciprofloxacin) 750 mg, 2 times a day for 6 months.

Do

> > not

> > > take magnesium products (e.g., Fibrocare, some antacids, Pro

> > Energy,

> > > or (Dr. Teitelbaum's) Foundation Formula™) within 6 hours of

> Cipro

> > > because you won't absorb the Cipro.

> > > > OR

> > > > 2. Doxycycline (a tetracycline) 100 mg, 3 times a day for 6

> > months.

> > > If symptoms recur when the Doxycycline is completed, keep

> repeating

> > 6-

> > > week courses until the symptoms stay resolved. Take Nystatin

(at

> > > least 2, twice a day) while on the antibiotic. Birth control

> pills

> > > may not work while on Doxycycline. Do not take any expired

> > > Doxycycline tablets (it's very dangerous).

> > > > OR

> > > > 3. Zithromax (azithromycin) 600 mg tablets, 1 tablet a day

> (take

> > > with food if it bothers your stomach). Don't take magnesium-

> > > containing products within six hours of the Zithromax.

> > > > OR

> > > > 4. Biaxin 500 mg, 2 times a day.

> > > > 5. D-Mannose ½ to 1 teaspoon (2.5 grams), stirred in water,

> every

> > 2

> > > to 3 hours while awake, for 2 to 5 days for acute bladder

> > infections

> > > (may use long-term for chronic infections) caused by E-coli

(this

> > > causes approximately 90% of bladder infections). If not much

> better

> > > in 24 hours, get a urine culture and consider an antibiotic. D-

> > > Mannose is available from BioTech (800-345-1199), my Web

> > > site's " Vitamin Shop " at www.endfatigue.com or my office (800-

333-

> > > 5287).

> > > > What About Yeast Overgrowth?

> > > > Yeast overgrowth is an important concern. As I have mentioned

> > > before, nothing is all good or all bad. Although cigarettes

kill

> > > hundreds of thousands of people each year, they can be helpful

in

> > > treating Parkinson's Disease or ulcerative colitis. Although

> > > antibiotics can trigger CFIDS, they can also be helpful in

> treating

> > > it. This makes it important to know when and how to use them. I

> > > strongly recommend that my patients take antifungals while on

any

> > > antibiotics (e.g., Nystatin 500,000 unit tablets, 2 tablets, 2

to

> 3

> > > times a day) to prevent yeast overgrowth. It is also reasonable

> to

> > > add Oregano Oil and other natural antifungals. Two Nystatin

twice

> a

> > > day is what I usually prescribe. Using probiotics (healthy milk

> > > bacteria-like acidophilus that helps your body) to compete with

> the

> > > yeast can also help. I am concerned that if the acidophilus is

> > taken

> > > with the antibiotic, they may simply cancel each other out.

> Because

> > > of this, I usually begin probiotics (Acidophilus or

Lactobacillus

> > in

> > > a d

> > > > ose of 3 to 6 billion units a day, taken on an empty stomach

or

> > > with milk) after one has completed the course of antibiotics.

If

> > you

> > > are only taking the antibiotic once or twice a day, and can

find

> a

> > > time at least 6 to 8 hours away from another dose to take the

> > > probiotic, it is reasonable to take it at that time. The entire

> > daily

> > > probiotic dose can also be taken at one time. If you find that

> you

> > > still get yeast overgrowth, it may be necessary to use some of

> the

> > > more potent prescription antifungals (Sporanox or Diflucan).

> > Because

> > > these can cause liver inflammation and are quite expensive, it

> may

> > be

> > > adequate to take 200mg of either of these, twice a day, one day

> > each

> > > week (e.g., take it every Sunday) instead of every day. As

> > discussed

> > > previously, be sure to take Lipoic acid 200 mg on any day you

> take

> > > Sporanox or Diflucan, to decrease the risk of liver

inflammation.

> > > > What Role Does My Blood Clotting System Play In This?

> > > > Work done by E. Berg, M.S., C.L.S. (N.C.A.), director

of

> > > Hemex Laboratories in Phoenix, Arizona (800-999-2568), has

shown

> > that

> > > a number of infections can trigger our blood clotting system to

> > > become active, thus setting up a low-level, chronic clotting

> > cascade.

> > > These infections include HHV-6, Mycoplasma, CMV and Chlamydia

> which

> > > can trigger production of (IgA) antibodies against clot

> protective

> > > proteins on blood vessel inner surfaces (called

antiphospholipid

> > > antibodies). One of these is the Beta 2 Glyco-protein 1 (anti

> B2GP1—

> > > no, you are not going to be tested on this!). This then

triggers

> > the

> > > clotting cascade. Once the clotting system is triggered, a

> product

> > > called Soluble Fibrin Monomer (SFM) is made which is like the

> > > polymers in plastic. The theory is that they create long thin

> > sheets

> > > of a teflon-like substance, similar to the scab that covers a

> cut,

> > > but microscopic, which then coats the blood vessels. This makes

> it

> > > hard for nutrients, oxygen, etc., to get in and out of the b

> > > > lood vessels to the cells where they are needed. In summary,

> many

> > > infections can cause the blood clotting system to activate,

> > resulting

> > > in a thin coating of Fibrin deposited on the blood vessels.

This

> > > prevents nutrients and oxygen from getting to the cells in your

> > body.

> > > > Why Would An Infection Trigger The Clotting System?

> > > > Many infections (called anaerobic) do not survive well in the

> > > presence of oxygen. One can theorize that these Mycoplasma

(which

> > may

> > > be anaerobic) and other organisms may trigger the clotting

system

> > to

> > > create a shell, which then acts like a suit of armor,

protecting

> > them

> > > from oxygen, your body's defense system, and antibiotics. This

> > would

> > > explain why these infections could evolve a way to trigger the

> > > clotting mechanism. The Fibrin armor preventing antibiotics

from

> > > getting to the infection could also explain why some people

with

> > > these infections may not respond to antibiotics. Indeed, some

> > > physicians have found that the antibiotics work better once

> someone

> > > has been on a blood thinner (which may dissolve the armor).

> > > > This is an interesting theory, but how do we know this is

going

> > on?

> > > Mr. Berg and others have done studies showing that the blood

> tests

> > > that look for these clotting changes (called the ISAC panel -

> > > available at Hemex labs) are abnormal in CFIDS/FMS patients

while

> > > being normal in most other patients. They use a criterion of

two

> of

> > > these tests needing to be abnormal to be considered positive.

> When

> > > this was done, 50 of 54 CFIDS/FMS patients had abnormal tests

> > (i.e.,

> > > only 7.4% of the patients had normal blood tests). In healthy

> > > patients, 22 out of 23 had normal blood tests (i.e., 96%). This

> > means

> > > the test is both very sensitive and specific, picking up people

> > with

> > > CFIDS and excluding healthy people. Our experience has shown

that

> > > almost everyone that we tested, who has CFIDS, has turned out

to

> > have

> > > a positive ISAC panel. We have not personally sent in any tests

> on

> > > healthy patients to see if this also occurs. Interestingly,

this

> > > panel is also positive in many people with unexplained infer

> > > > tility (which can improve with Heparin) and may also be

> positive

> > in

> > > people with Multiple Sclerosis, Parkinsons, Autism,

Inflammatory

> > > Bowel Disease and some other illnesses. This suggests that this

> > test

> > > can be helpful in deciding whether to treat with blood thinners

> > > (Heparin) in CFIDS/FMS.

> > > > So, How Do I Treat The Clotting System?

> > > > First of all, it is important to remember that using

injections

> > of

> > > Heparin (the blood thinner) is still a controversial and

> > experimental

> > > treatment for CFIDS/FMS. We much prefer to use treatments that

> are

> > as

> > > safe as possible. Although Heparin is routinely used in the

> U.S.A.

> > to

> > > treat blood clots, using it to treat CFIDS/FMS is very new.

Most

> of

> > > the doctors that I have spoken with have only treated a few

> > CFIDS/FMS

> > > patients with Heparin and find that about half of these

patients

> > get

> > > better with treatment. The treatment protocol, developed by

> > > Couvaras, M.D. (602-996-2411), includes the following:

> > > > 1. Remove wheat, alcohol and sugar from the diet, if possible.

> > > > 2. Check the ISAC panel. If there are at least two abnormal

> > > results, then begin treatment.

> > > > 3. Give an antifungal for 14 days (he uses Lamisil 250mg a

day—

> > > which I find to be poorly effective. I would use 200 mg of

> Sporanox

> > > or Diflucan instead).

> > > > 4. Give standard Heparin 4000 to 8000 units by injection

> > > subcutaneously (like an insulin shot) twice a day. A (possibly

> > safer)

> > > low molecular weight Heparin may also be used.

> > > > 5. If the PA index (on the ISAC) is positive, add a baby

> Aspirin

> > > (81mg) each day.

> > > > 6. After being on Heparin for one week, Dr. Couvares repeats

> the

> > > ISAC panel to adjust the dose of the Heparin and Aspirin. He

> feels

> > > that the goal is to move all the blood tests into the normal

> range

> > > but not past the normal range into blood-thinning (therapeutic)

> > > levels. If the values are still abnormal or the patient is

still

> > > having symptoms, he then increases the Heparin dosage. If the

PA

> > > index (on the ISAC) is still high, he increases the Aspirin to

> > twice

> > > a day.

> > > > 7. If the patient feels better after one month of Heparin, he

> > then

> > > switches to low-dose Coumadin (a blood thinner tablet—take 2 to

3

> > mg

> > > a day) and then stops the Heparin after 4 to 5 days of being on

> the

> > > Coumadin. Once the patient has been on the Coumadin for two

weeks

> > he

> > > goes ahead and rechecks the ISAC panel to maintain the blood

> tests

> > in

> > > the normal range.

> > > > 8. He also supplements patients with nutritional

> supplementation

> > as

> > > needed.

> > > > In my practice, because the ISAC panel runs over $320, I

check

> a

> > > baseline ISAC panel but do not repeat the ISAC panels to adjust

> > > therapy. Instead, while on Heparin, we check a PTT (a blood

> > thinning

> > > test) and platelets (a highly unusual, but potentially very

> > dangerous

> > > side effect of Heparin is a severe drop in platelet count,

which

> > can

> > > cause life-threatening bleeding) every 3 days for the first 12

> days

> > > and then every 2 to 4 weeks while on Heparin. If the PTT is

still

> > > within the normal range and the patient is not better, we

> increase

> > > the Heparin as high as 8000 units, twice a day (rarely we will

go

> > up

> > > to 8000 units, 3 times a day) and then also increase the

Aspirin

> to

> > 2

> > > a day. In comparison, hospital patients often require Heparin

at

> > 1000

> > > units per hour (24,000 units a day) I.V., while most CFS/FMS

> > patients

> > > only need 4000 to 5000 units, 2 times a day (8000 to 10,000

units

> a

> > > day). If the patient is feeling better, however, we simply

leave

> > them

> > > at the initial dose. Most patients will f

> > > > eel better at about the 10- to 14-day point if the Heparin is

> > going

> > > to help. At the end of 4 to 12 months, if the Heparin helps, we

> > > switch to Coumadin (as noted above) and check an INR

> (International

> > > Normalized Ratio), aiming to keep it below 1.3 while adjusting

> the

> > > Coumadin to the optimum does. It is very important to know that

> > most

> > > medications can change the blood level of Coumadin and that

> anytime

> > > anything is added to, or deleted from, your regimen (including

> > > natural remedies) you need to recheck the INR 4 to 7 days later

> to

> > > make sure that it is not going too high. Heparin and Coumadin

are

> > > powerful medicines and the main risk is bleeding. Although we

are

> > > using very low doses, which are usually very well-tolerated,

one

> > can

> > > rarely see a life-threatening bleed occur. If you felt better

on

> > the

> > > Heparin and then the symptoms come back on the Coumadin, you

may

> > need

> > > to go back on the Heparin for several months to re-establish

and

> > > maintain the benefit. Occasionally, people will need to b

> > > > e on the Heparin for an extended period, in which case the

> blood

> > > tests (PTT and platelet count) should be checked every 2 to 4

> > weeks.

> > > All of this being said, most people tolerate these treatments

> quite

> > > well and many, many more people die from taking Aspirin (e.g.,

> for

> > > arthritis) than Heparin each year.

> > > > In summary, there are a number of infections that can cause

or

> > > occur because you have CFIDS/FMS. Once they occur, they can

> trigger

> > > the clotting cascade. This may keep the nutrients from getting

to

> > > your body and create a " suit of armor " for the viral and

> Mycoplasma

> > > infections. Using a blood thinner can break down these armor

> > coatings

> > > that protect the infections from our treatment and allow

> nutrients

> > to

> > > get where they need to go. Many tests can help. The one that I

> use

> > to

> > > decide whether to use the Heparin blood thinner is the ISAC

panel

> > (at

> > > Hemex Labs). Testing for infections may be helpful, but can be

> > > expensive and less likely to effect my decision to treat. If

you

> > can

> > > afford the tests and/or your insurance will pay for them, they

> are

> > > worth checking and will make it easier to adjust therapy over

> time.

> > > If you can't afford it, it is reasonable to treat empirically

> > (i.e.,

> > > without testing), except for high-dose Valtrex therapy. If you

> have

> > > lung congestion and/or recurrent temperatures o

> > > > ver 98.6°F, I would treat with the antibiotics. If you feel

> > > chronically flu-like, I would consider the HHV-6 or (based on

> > > testing) the high-dose Valtrex regimen. It is also reasonable

to

> > > treat with antibiotics and antivirals simultaneously -

especially

> > if

> > > you are taking the anticoagulants.

> > > > Chronic Sinusitis The Yeasty Beasties Revisited!

> > > > As was mentioned years ago, we speculated that the chronic

> sinus

> > > congestion seen in CFIDS/FMS could be caused by yeast

overgrowth.

> A

> > > recent interesting study from the Mayo Clinic Proceedings

> supports

> > > this thought. In the study, researchers found that most people

> with

> > > chronic sinus infections had fungal growth in their sinuses.

They

> > > felt that the inflammation was being caused by an immune (the

> > body's

> > > reaction) response to the fungus. This research is interesting

> > > because more and more studies are showing that treating chronic

> > > sinusitis with antibiotics doesn't really do much and that

> shorter

> > > courses of treatment work just as well as the long courses. We

> find

> > > that conservative treatment (see my newsletter article,

Treatment

> > Of

> > > Respiratory Infections Without Antibiotics, Vol. 2, Issue 2) is

> > more

> > > effective than antibiotics for chronic sinusitis.

> > > > It's good that medicine is finally starting to catch up with

> > > reality. The report in The Mayo Clinic Proceedings noted

> > > that, " fungus allergy was thought to be involved in less than

10%

> > of

> > > cases… our studies indicate, in fact, fungus is likely the

cause

> of

> > > nearly all of these problems and that it is not an allergic

> > reaction

> > > but an immune reaction. " In this study, the researchers studied

> 210

> > > patients with chronic sinusitis. Using new methods to collect

and

> > > test sinus/nasal mucus they found fungus in 96% of patients.

> > > > It's interesting to observe how medical research works. The

> > > researchers are now working with different drug companies to

set

> up

> > > trials to test medications to control the fungus but feel that

it

> > > will be at least two years before any treatments will be

> available.

> > > In my experience, though, these problems often respond

> dramatically

> > > to either Sporanox or Diflucan - which, by no coincidence, are

> very

> > > powerful antifungal agents. It is not clear why the researchers

> did

> > > not simply try Sporanox or Diflucan. Un-fortunately, we find

that

> > the

> > > obvious is often overlooked. This sometimes occurs as drug

> > companies

> > > seek to make more money by finding new drugs instead of using

the

> > old

> > > things that are known to work. It is important to distinguish

> > between

> > > chronic sinusitis (which lasts for over three months) and acute

> > > sinusitis (which usually has been going on for a few days and

> less

> > > than a month). For these shorter attacks of sinusitis, bacteria

> are

> > a

> > > more common cause and antibiotics (combined with n

> > > > atural remedies) can be helpful. Some researchers still

> continue

> > to

> > > argue that fungus is not a cause of chronic sinusitis. They

note

> > that

> > > fungi are seen even in healthy noses (which is correct) but

> neglect

> > > to discuss the immune changes that are also seen in these

noses.

> > > Because so many people have responded dramatically to

antifungals

> > in

> > > the treatment of their chronic sinusitis, my suspicion is that

> the

> > > Mayo Clinic researchers are probably correct. Wouldn't it be

> nice,

> > if

> > > instead of arguing about treatments while people stay sick,

they

> > > would just try the treatments to see if they worked!

> > > > As you can see, your body's defenses being down plays a large

> > role

> > > in CFIDS/FMS. The good news is, that by treating the many

> > underlying

> > > infections common in CFIDS patients and by treating any

hormonal

> > and

> > > nutritional deficiencies, you can bring your immune system back

> to

> > a

> > > healthy state!

> > > > Important Points

> > > > • An important component of CFS is disordered immune

function,

> > > which opens the door to repeated infections, repeated treatment

> > with

> > > antibiotics, and yeast overgrowth.

> > > > • Treat yeast overgrowth by avoiding antibiotics and sweets.

> Many

> > > patients have found Nystatin and other antifungal medications,

> such

> > > as Diflucan and Sporanox, to be helpful. Acidophilus (milk

> > bacteria)

> > > and natural antifungals such as Caprylic acid and garlic are

also

> > > often useful.

> > > > • Bowel parasites are common in CFS patients, whose symptoms

> > often

> > > respond dramatically to treatment. However, most labs do not

> > > adequately detect parasites through stool testing. To get an

> > accurate

> > > test result, use one of the labs we recommended that

specializes

> in

> > > stool testing.

> > > > • Treat Cryptosporidium with Artemesia annua or tricyclin

> (herbal

> > > antiparasitics).

> > > > • Treat constipation with Turkey Rhubarb (a herb).

> > > > • Prevent parasitic infection by using a Multi-pure water

> filter

> > > (available from 888-801-8176 or 410-224-4877)

> > > > • If you have temperatures over 98.6°F and/or chronic lung

> > > congestion, try long-term Cipro or Doxycycline (while on

> Nystatin).

> > > > • If you have chronic flu-like symptoms, despite yeast and

> Cortef

> > > treatment, consider the antiviral, immune stimulating protocol

we

> > > discussed.

> > > >

> > >

> >

>

[Guest guest]

Hi Krista,

Patty is right about docs not knowing how to treat adrenals. I've

been to several docs who can't answer questions and only seem to

address the adrenals if you're suffering from 's or

Cushing's...which you're not. As far as natural treatments, I was on

Adrenal Stress End from Dr. Kolb, yet my endocrinologist doc here

said to stop taking it because my urine and blood had normal

cortisol. No other doc seems comfortable treating them, except for

Mercola, who I see next week. I'll let you know what he says,

although I've already heard he prescribes a very small amount of DHEA

and pregnenelone.

Based on my experience, you're better off seeing a naturopath instead

of an endocrinologist because naturopaths understand and acknowledge

adrenal fatigue. Love, PH

> > > >

> > > > From Fatigued to Fantastic Newsletter

> > > > Vol. 3, No. 3 (2000)--Vol 4, No. 1 (2001)

> > > >

> > > > Fighting Those Persistent Infections in CFIDS

> > > > By Teitelbaum, M.D.

> > > > Medical science has known for quite some time that Chronic

> > Fatigue

> > > Syndrome is associated with changes in the body's immune

system.

> In

> > > fact, the acronym " CFIDS " stands for " Chronic Fatigue And

Immune

> > > Dysfunction Syndrome. " This can result in your having several

> > > different and unusual infections at one time. Many of these

> > > infections need to be treated directly. Other infections will

go

> > away

> > > on their own as your immune (defense) system comes back " on

line "

> > by

> > > using our treatment protocol. In this article, I'll discuss

some

> of

> > > the more common, yet not usually thought of (in " regular "

> > medicine),

> > > infections.

> > > > What Kind Of Infections Am I Most At Risk For?

> > > > Although CFIDS of sudden onset often seems to be triggered by

> > viral

> > > infections (e.g., EBV, HHV-6, CMV), those infections, I

suspect,

> > > are " simmering " or no longer active in many cases. However, the

> > body

> > > acts as if they are. This may result in elevated interferon

> levels.

> > I

> > > suspect this was what triggered my CFIDS.

> > > > The body produces interferon to fight viral infections. When

a

> > > cancer or hepatitis patient is injected with interferon, the

> > patient

> > > becomes achy, fatigued and brain-fogged. An under-active

adrenal

> > can

> > > also cause interferon levels to become elevated. Because of

this

> > > elevation, it is more accurate to say that the body's immune

> system

> > > is not functioning properly, than to say that it is

underactive.

> > > Indeed, in many ways, the immune system may be in overdrive and

> > soon

> > > exhaust itself. The immune system malfunctions in many other

> ways,

> > > too, including decreasing the effectiveness of the

> body's " natural

> > > killer " cells, which are an important defense mechanism.

> > > > Many other recurrent or unusual infections can also occur

> because

> > > of your malfunctioning immune system. Chronic sinus, bladder,

> > > prostate and respiratory infections are common and are often

> > treated

> > > with repeated courses of antibiotics. The large amount of

> > antibiotics

> > > introduced into the system can cause a secondary yeast over-

> growth

> > as

> > > it changes the natural balance between the bowel's healthy

> bacteria

> > > and yeast. The original immune dysfunction also contributes to

> the

> > > yeast overgrowth. Although it is controversial, a theory held

by

> > many

> > > physicians is that chronic overgrowth of yeast due to overuse

of

> > > antibiotics is a potential and strong trigger for chronic

> fatigue,

> > > fibromyalgia and further immune dysfunction. What makes the

> theory

> > > controversial is that no definitive tests exist to distinguish

> > fungal

> > > overgrowth from normal fungal levels. Also, many of the

symptoms

> > > ascribed to yeast overgrowth can also come from the many other

> > > problems present in chronic fatigue syndrome and fibromya

> > > > lgia. On the other hand, most doctors who try treating yeast

in

> > at

> > > least three or four CFS patients see how well it works and keep

> > using

> > > it.

> > > > CFIDS patients also frequently have bowel parasite

infections.

> > > Bowel parasites can cause severe allergic or sensitivity

> reactions,

> > > which in turn can trigger fibromyalgia and fatigue. Often, a

> > patient

> > > will finally recover from long-standing and disabling fatigue

> > within

> > > a week or two after beginning treatment for bowel parasites.

> > > > Many other CFS/FMS patients are left with disabling fatigue

> after

> > a

> > > bout with viral infections such as polio, HHV-6, CMV, or EB

viral

> > > infections. This fatigue also usually responds to the

treatments

> > > discussed in this newsletter. In addition, infections with

> unusual

> > > organisms such as Rickettsia (e.g., Lymes Disease), chlamydia,

> and

> > > mycoplasma may also be problematic.

> > > > Yeast Overgrowth

> > > > Everyone's immune system has strong spots, as well as weak

> spots.

> > > Some people never get colds but have frequent bouts with

> athlete's

> > > foot or other skin fungal infections. Others never get fungal

> > > infections but tend to get colds. Many people seem to have a

> > > diminished ability to fight off fungal infections.

> > > > Fungi are very complex organisms. Fungal overgrowth may

> suppress

> > > the body's immune system. The host body may also develop

allergic

> > > reactions to components of the yeast.

> > > > This allergic reaction was suggested in a study which

connects

> > > Candida Albicans with Allergic Skin Dermatitis (Eczema). This

> study

> > > was published in The Journal of Clinical Experimental Allergy

> back

> > in

> > > 1993 (Vol. 23, pp. 332-339). It found that there is a

significant

> > > correlation between the body having antibodies to Candida and

> > > Allergic Dermatitis/Eczema. In addition, we have found that

> > > unexplained rashes that have lasted for many years often clear

up

> > > with antifungal treatment as well! Many physicians feel that

> yeast

> > > overgrowth causes a generalized suppression of the immune

system.

> > In

> > > other words, once the yeast gets the upper hand, it sets up a

> cycle

> > > that further suppresses your body's defenses. Interestingly, a

> > recent

> > > Mayo Clinic study showed that most cases of chronic sinusitis

> seem

> > to

> > > be associated with a reaction to yeast in the sinuses -

something

> I

> > > proposed years ago. None the less, as I already noted, this

> theory

> > is

> > > controversial. Yeast are normal members of our body's " zoo.

> > > > " They live in balance with bacteria - some of which are

> helpful

> > > and healthy and some of which are detrimental and unhealthy.

The

> > > problems begin when this harmonious balance shifts and the

yeast

> > > begin to overgrow.

> > > > As noted above, many things can prompt yeast to overgrow. One

> of

> > > the most common causes is frequent antibiotic use. When the

good

> > > bacteria in the bowel are killed off by antibiotics (along with

> the

> > > bad bacteria) the yeast no longer have competition and begin to

> > > overgrow. The body is often able to rebalance itself after one

or

> > > several courses of antibiotics, but after repeated or long-term

> > > courses - and especially if the body has an underlying immune

> > > dysfunction - the yeast can get the upper hand.

> > > > Other factors are also important. Studies have shown that

> animals

> > > who are sleep deprived and/or have increased sugar intake

develop

> > > bowel yeast overgrowth. Many physicians feel that eating sugar

> > > stimulates yeast overgrowth in people, as well. Sugar is food

for

> > > yeast. Yeast ferment sugar in order to grow and multiply. Yeast

> > > overgrowth due to sugar overuse also seems to cause immune

> > > suppression, which facilitates bacterial infections, which then

> > > requires even more antibiotic use. Poor sleep also results in

> > marked

> > > suppression of your immune function.

> > > > How Does One Know If They Have Yeast?

> > > > There are no definitive tests for yeast overgrowth that will

> > > distinguish yeast overgrowth from normal yeast growth in the

> body.

> > > There is one test which may be useful, though. This is a Urine

> > > Tartaric Acid test done by The Great Plains Lab in Kansas City,

> > > Missouri, run by Shaw, Ph.D. Tartaric Acid is a waste

> > product

> > > of yeast growth. In fermenting wine, for example, it is

critical

> to

> > > remove the Tartaric Acid. Otherwise, the wine could be toxic to

> > > people. Dr. Shaw has found elevations in Urine Tartaric Acid

that

> > > decrease with antifungal treatment in both CFIDS/FMS patients

and

> > > autistic children. Interestingly, both these illnesses often

> > improve

> > > with antifungals (specifically, Sporanox or Diflucan, plus

> > Nystatin).

> > > Dr. Shaw likes to use the Urine Tartaric Acid to decide when to

> > treat

> > > yeast overgrowth and to follow-up the effectiveness of

treatment.

> > > > In my experience, however, using Dr. Crook's Yeast

> Questionnaire

> > > (available in my book, From Fatigued To Fantastic!) is still

the

> > most

> > > reliable way to tell if a person is at risk of yeast

overgrowth.

> If

> > > the symptom score is over 140 points, I recommend treatment. In

> > > addition, anyone who has been on recurrent or long-term

> antibiotic

> > > use (especially Tetracycline for acne) or anyone who

> intermittently

> > > has painful sores in different parts of the mouth that last for

> > about

> > > ten days at a time and who has CFIDS/FMS, should be treated

with

> > > antifungals. Bowel symptoms are some of the more overt symptoms

> > that

> > > are caused by yeast and I feel that most people who

have " spastic

> > > colon " have yeast overgrowth or parasites.

> > > > How Is Yeast Treated?

> > > > A number of very effective methods can be utilized to take

care

> > of

> > > a yeast problem. Primary among the methods is to avoid sugar

and

> > > other sweets. One can enjoy one or two pieces of fruit a day,

but

> > > should not consume concentrated sugars such as juices, corn

> syrup,

> > > jellies, pastry, candy or honey. Stay far away from soft

drinks,

> > > which have ten to twelve teaspoons of sugar in every twelve

> ounces.

> > > This amount of sugar has been shown to markedly suppress immune

> > > function for several hours. Be pre-pared to have withdrawal

> > symptoms

> > > for about one week when sugar is cut out of the diet. Several

> > > excellent books have been written on the yeast controversy and

> > offer

> > > additional methods to try. One of the best books is The Yeast

> > > Connection and the Woman by Crook, M.D., a physician

who

> > has

> > > done a spectacular job advancing the understanding of CFIDS/FMS.

> > > > Many patients have found that acidophilus (that is, milk

> > bacteria,

> > > a healthy bacteria for the bowel) helps restore balance in the

> > bowel.

> > > Acidophilus is found in yogurt with live and active yogurt

> > cultures.

> > > Indeed, one cup of yogurt a day can markedly diminish the

> frequency

> > > of recurrent vaginal yeast infections. Acidophilus is also

> > available

> > > in capsule form. Although many claims are made for one type of

> > > acidophilus being better than the other, I'm not sure this is

so.

> I

> > > usually recommend 3 to 6 billion units a day (1 unit = 1

> bacteria)

> > on

> > > an empty stomach. If on antibiotics (not antifungals), take the

> > > acidophilus at least 3 to 6 hours away from the antibiotic

dose.

> > > > Nystatin, an antifungal medication, has also been helpful in

> the

> > > treatment of yeast overgrowth. Unfortunately, some fungi seem

to

> be

> > > resistant to Nystatin. In addition, Nystatin is poorly

absorbed,

> > > which means that it has little impact on the yeast outside of

the

> > > bowel. Other anti-fungal medications, such as Diflucan and

> > Sporanox,

> > > seem to be effective systemically (throughout the body) but

they

> > have

> > > two main drawbacks. First, they are expensive, costing more

than

> > $450

> > > to $900 for a two-month course. Second, any effective anti-

fungal

> > can

> > > initially make the symptoms of yeast infection worse. Although

> > > uncommon, Sporanox and Diflucan can also cause liver

inflammation

> > (as

> > > can Advil and Tylenol). If you are taking Sporanox or Diflucan

> for

> > > more than 6 to 12 weeks, I would consider intermittently

checking

> > > liver blood tests (ALT and AST). If you have preexisting active

> > liver

> > > disease, be cautious in using (or don't use) Sporanox or

> Diflucan.

> > I

> > > strongly recommend taking Lipoic Acid (a natural

> > > > supplement which protects and helps heal the liver), 200mg a

> > day,

> > > whenever you take Sporanox or Diflucan. I also strongly

recommend

> > > Lipoic Acid for anyone with active liver disease (e.g.,

> hepatitis)

> > at

> > > doses up to 1000mg to 3000mg a day as it may prevent and/or

treat

> > > cirrhosis.

> > > > Natural Yeast Treatments

> > > > Below, I have summarized the nonprescription part of the

> > treatment

> > > checklist that I use in my office.

> > > > 1. Avoiding sweets is still the single most important thing.

> > Using

> > > Stevia as a sweetener is a wonderful substitute. Stevia is a

> safe,

> > > natural remedy and you can use all you want. There are even

> > cookbooks

> > > for using Stevia (available from my office or 800-4STEVIA). A

new

> > > natural sweetner, Sweet Balance, also tastes good and is 12

times

> > as

> > > sweet as sugar. It is a natural product from the Lo Han fruit

and

> > > appears to be safe. Although it is 70% sugar (fructose), you

only

> > > need a small amount. Order it from 877-997-9338, my office at

800-

> > 333-

> > > 5287 or my Web site at www.endfatigue.com.

> > > > 2. Acidophilus or Milk Bacteria can be very helpful. Take 3

to

> 6

> > > billion units a day (a unit is the same as a bacteria). Do not

> take

> > > acidophilus within 3 to 6 hours of an antibiotic. Take it

either

> on

> > > an empty stomach or with milk.

> > > > 3. Caprylic Acid is another natural remedy that can be

helpful.

> > The

> > > usual dose is 1800 to 3600mg a day with 1/3 of the dose being

> taken

> > > at each meal. Unfortunately, it often causes an acid stomach

with

> > > a " funky " tasting reflux.

> > > > 4. Oregano Oil - enteric coated oregano oil - 1 to 2

capsules,

> 2

> > to

> > > 3 times a day with food, may be more effective and better

> tolerated

> > > than Caprylic Acid (both can cause stomach acid reflux).

> > > > 5. Fresh Garlic, if you can handle it well, can also be very

> > > effective. Daily, crush 1 to 3 garlic cloves in olive oil, add

> > salt,

> > > spread it on bread and eat it. It can be quite tasty and lethal

> to

> > > whatever infections you have in your gut.

> > > > 6. Olive Leaf 500mg, 2 to 4 capsules three times a day

between

> > > meals, can also be very helpful in treating yeast overgrowth.

> > > > 7. Pau De Arco in either tea or capsule form is also helpful

in

> > > yeast suppression. Although I use Pau De Arco infrequently for

> > yeast

> > > over-growth, many people find that it can be helpful.

> > > > 8. Grapefruit Seed Extract (e.g., Citrucidel) is a popular

> > > treatment for yeast overgrowth and is well-tolerated.

> > > > More Information On Yeast Treatments

> > > > If symptoms of yeast are caused by an allergic or sensitivity

> > > reaction to the yeast body parts, the symptoms may flare when

> mass

> > > quantities of the yeast are suddenly killed off. This is called

a

> > > yeast " die-off " reaction. If you get this reaction, start your

> > > treatment with acidophilus and a sugar-free diet for a few

weeks

> > > followed by oregano oil and/or olive leaf (1500mg to 2000mg, 3

> > times

> > > a day between meals) before beginning Nystatin. Take Nystatin

(by

> > > mouth) in the form of 500,000-IU tablets or powder. I generally

> > > recommend beginning with 1 tablet a day for 1 to 3 days, and

> > > increasing by 1 tablet every 1 to 3 days (or slower if

yeast " die-

> > > off " is a problem) until 2 tablets 2 to 4 times a day is

reached.

> > If

> > > you get nausea, take a lower dose. Take Nystatin, 4 to 8

tablets

> > > daily, for 5 to 8 months. I add the Diflucan or Sporanox one

> month

> > > after beginning the Nystatin. Take 200mg every morning for six

> > weeks.

> > > If symptoms flare, take just 100mg per morning for the first 3

to

> > 14

> > > days. I

> > > > f symptoms recur after stopping the Diflucan or Sporanox, I

> > > recommend continuing the medication for an additional 6 weeks

at

> > > 200mg a day.

> > > > Sporanox should be taken with food. If it is taken alone, its

> > > absorption is greatly reduced. When taking Diflucan or

Sporanox,

> DO

> > > NOT use the antihistamines Seldane or Hismanal, Quinidine (a

> heart

> > > medicine), cholesterol-lowering medications in the Mevacor

> family,

> > or

> > > the bowel medicine Propulcid. These can be fatal combinations!

> > Also,

> > > antacid medications (such as Tagamet, Axid, Zantac, and Pepcid)

> > > prevent the proper absorption of Sporanox. At the high price of

> > > Sporanox per dose, you will want to absorb every last bit of

the

> > > medication. If you need to be on an antacid medication, use

> > Diflucan

> > > instead of Sporanox. Unfortunately, a less expensive

antifungal,

> > > called Lamisil (at 250mg a day), does not seem to work very

well

> > for

> > > candida yeast overgrowth (although it works well for nail

> > > infections). I am currently trying patients on 500mg of Lamisil

a

> > day

> > > to see if this dose works better.

> > > > I feel that once the yeast has been effectively decreased and

> > kept

> > > that way for six to twelve months, it is safe to try to add

small

> > > amounts of sugar back into the diet. If symptoms recur,

however,

> > stop

> > > the sugar again. Continuing to eat yogurt with live and active

> > > acidophilus cultures (unless you are lactose-intolerant) or

> > > continuing to take acidophilus capsules may also help.

> > > > Many books on yeast overgrowth (including Dr. Crook's) advise

> > > readers to avoid all yeast in the diet. This advice is based on

> the

> > > theory that an allergic reaction to yeast is the cause of the

> > > problem. The predominant yeast that seems to be involved in

yeast

> > > overgrowth is Candida Albicans, although I would not be

surprised

> > if

> > > researchers discovered that many other kinds of fungal

infections

> > are

> > > also involved. The yeast that is found in most foods (except

beer

> > and

> > > cheese) is not closely related to candida.

> > > > In my experience, trying to avoid all yeast in foods results

> > simply

> > > in a nutritionally inadequate diet and little benefit. Although

a

> > few

> > > people do appear to have true allergies to the yeast in their

> food,

> > > they number less than 10 percent of my patients with suspected

> > yeast

> > > overgrowth. These patients may benefit from the more strict

diet

> in

> > > Dr. Crook's book. Interestingly, once their adrenal

insufficiency

> > and

> > > yeast overgrowth are treated, most people find that their

> allergies

> > > and sensitivities to yeast and other food products seem to

> improve

> > or

> > > disappear.

> > > > Nutritional deficiencies such as low zinc or low selenium may

> > also

> > > decrease resistance to yeast over-growth. A good multivitamin

> > > supplement, as recommended in my last newsletter, should take

> care

> > of

> > > these deficiencies. This is further evidence that all the

factors

> > > involved in CFS are closely interrelated.

> > > > The best thing that one can do to combat yeast overgrowth is

to

> > try

> > > to avoid it in the first place. When you get an infection,

begin

> > > treating it naturally immediately. Hopefully, you can prevent

it

> > from

> > > turning into a bacterial infection which might require an

> > antibiotic.

> > > Ask your doctor what measures you can take before resorting to

> > > antibiotics. Many good over-the-counter remedies are available.

A

> > > knowledgeable pharmacist may also be a wealth of information.

> Your

> > > local book or health food store has books on natural measures.

> Your

> > > health food store proprietor can also steer you to appropriate

> > > natural remedies. For examples of the many helpful measures

that

> > one

> > > can take, see my newsletter article, Treating Infections

Without

> > > Antibiotics, page ___).

> > > > If you find however, that you must take an antibiotic, all is

> not

> > > lost. One can still lessen the severity of yeast overgrowth by

> > > avoiding sweets and by either taking acidophilus capsules

(again,

> > not

> > > within 3 to 6 hours of an antibiotic) or by eating one cup of

> > yogurt

> > > with live and active acidophilus cultures daily. Don't use the

> > yogurt

> > > (or milk) if you have sinusitis or pneumonia because the milk

> > protein

> > > thickens mucus and makes it hard for the body to fight these

> > > infections.

> > > > How Can One Tell If The Yeast Is Coming Back?

> > > > It is normal for yeast symptoms to resolve after treatment.

> After

> > 6

> > > weeks on the Sporanox or Diflucan, patients are usually feeling

a

> > lot

> > > better, but may have symptoms recur soon after stopping the

> > > antifungal. In this case I would continue the Sporanox or

> Diflucan

> > > for another 6 weeks, or as long as is needed, to keep the

> symptoms

> > at

> > > bay. More frequently, people will feel better after treatment

and

> > > stay feeling fairly well for a period of 6 to 24 months. At

that

> > > time, it is common to see a recurrence of symptoms, especially

if

> > one

> > > is eating too much sugar or is taking antibiotics. The best

> marker

> > > that I have found for yeast overgrowth would be a return of

bowel

> > > symptoms with gas, bloating and/or diarrhea or constipation. If

> > these

> > > symptoms persist for more than 2 weeks, especially if there is

> also

> > > even a mild worsening of the FMS symptoms, it is very

reasonable

> to

> > > retreat yourself with 6 weeks of Nystatin and perhaps Sporanox

or

> > > Diflucan. In addition, I would also retreat if there's

> > > > a recurrence of vaginal yeast or sinus infections. If re-

> > treatment

> > > resolves the symptoms, one may opt to repeat this regimen as

> often

> > as

> > > is needed (usually every 6 to 24 months). By using some of the

> > > natural remedies listed above, however, you may be able to

avoid

> > > repeated use of these antifungals and the possible risk of

> becoming

> > > resistant to them. Some patients also find that they need to

stay

> > on

> > > the antifungals for extended periods of time (years) or the

> > symptoms

> > > will recur. When this is necessary, I add the natural remedies.

I

> > > will, however, also use the medications when needed. The main

> risk

> > of

> > > long-term use of the antifungals Sporanox and Diflucan would be

> > liver

> > > inflammation. If these medications are being used for extended

> > > periods, consider checking liver tests (SGOT and SGPT) every 3

to

> 6

> > > months and anytime that a severe flu-like feeling or worsening

of

> > > symptoms occur. As noted above, it is very important to take

> Lipoic

> > > Acid 200mg a day when on Sporanox or Diflucan. Althoug

> > > > h I am not aware of any studies using Lipoic Acid with

> > antifungals,

> > > in my experience I have seen no worrisome elevation on liver

> tests

> > if

> > > patients are using this natural substance while taking these

> > > antifungals. As an alternative, instead of taking the

antifungals

> > > every day, many people find they can get long-term suppression

of

> > the

> > > yeast by taking Sporanox or Diflucan 200mg twice a day, one day

> > each

> > > week (e.g., each Sunday).

> > > > Help For Chronic Bladder Infections

> > > > Although we will be discussing some unusual infections,

> CFIDS/FMS

> > > patients also get more of the day-to-day variety of infections.

> > These

> > > include Urinary Tract (bladder) Infections (UTI). The main

> symptoms

> > > of a UTI are discomfort (e.g., burning) when urinating

(dysuria),

> > > urgency (which is the feeling that you have to go very badly

and

> > > right away when there is not much urine there), and frequency

> with

> > > low volume. These symptoms are also common in CFIDS/FMS

patients

> in

> > > the absence of bladder infections and, when severe, is called

> > > Interstitial Cystitis. I would not label someone as having

> > > Interstitial Cystitis unless this is the major symptom of their

> > > CFIDS/FMS, because almost everyone with this illness has some

> > urinary

> > > urgency and frequency. Because bladder symptoms can be seen in

> both

> > > UTI and CFIDS/FMS, it is important to have a urine culture done

> > > before treatment with antibiotics to make sure that there is an

> > > infection and not just muscle spasms in the bladder that are

> > causing

> > > these

> > > > symptoms. If there is an infection, over 90% of the time it

> will

> > be

> > > E-coli. This bacteria is normally found in everyone's gut and,

> with

> > > the exception of a few rare dangerous forms, is a healthy part

of

> > our

> > > normal bowel bacteria. The problem occurs when the E-coli gets

> out

> > of

> > > the bowel where it belongs and into the bladder. Usually the

> > bladder

> > > will wash out most infections when the urine comes out. The E-

> coli

> > > however, have little velcro-like projections that stick to the

> > > bladder wall so that they can not be washed out by urination.

> > > > Taking antibiotics will kill a bladder infection but will

also

> > kill

> > > the healthy bacteria in the bowel. This sets one up for yeast

> > > overgrowth and other problems. Because of this, unless there is

> > fever

> > > or back pain over the kidneys or a toxic feeling, it is

> reasonable

> > to

> > > try natural remedies for one to three days before going with

the

> > > antibiotics. One can start these treatments while waiting for

the

> > > urine culture to come back.

> > > > What Natural Remedies Can Be Used For Bladder Infections?

> > > > There are two excellent natural remedies that can keep the E-

> coli

> > > from sticking to the bladder walls so they can be washed out.

In

> > > addition, taking vitamin C in high dose (e.g., 500 to 5000mg a

> day)

> > > can acidify the urine, making it inhospitable to the bacteria.

> > > Drinking a lot of water also helps to wash out the infection.

> > > > The two natural remedies that keep the bacteria from sticking

> are:

> > > > 1. Cranberries—Because approximately 20% of the female

> population

> > > suffers from UTIs, several studies have been done looking at

this

> > > remedy. An early study of 44 female and 16 male patients with

> acute

> > > bladder infections drank 16 oz. of cranberry juice a day for 15

> > days.

> > > Of these patients, 53% had positive responses and another 20%

> > showed

> > > modest improvement. Six weeks after stopping the juice, 27

> patients

> > > did have persistent recurrent infections and 8 of these had no

> > > symptoms. Seventeen patients had no symptoms and negative urine

> > > cultures.

> > > > In another study of elderly women (who are more likely to

have

> > > bladder infections), 153 women either received 10 oz. of

> cranberry

> > > drink or placebo every day for 6 months. The group that got the

> > > cranberry drink had 68% fewer bladder infections during that

> > period.

> > > In this study, the juice was sweetened with saccharin instead

of

> > > sugar. Other studies have also shown benefit using cranberry

> juice

> > in

> > > bladder infections.

> > > > Significant benefits are achieved by using 6 to 16 oz. of

> > cranberry

> > > juice a day. Because cranberry juice has a lot of sugar and can

> > > promote yeast overgrowth and aggravate other symptoms in

> CFIDS/FMS,

> > I

> > > think it is much better to use pure cranberry juice powder in

> > capsule

> > > or tablet form (standardized to contain 11% to 12% quinic

acid).

> > The

> > > therapeutic dose is 1 to 2 capsules a day. Conversely, you can

> use

> > > unsweetened cranberry juice and add Stevia as a natural

> sweetener.

> > In

> > > general, if one gives the usual cranberry juice cocktails a

> > strength

> > > of 1 unit - then, cranberry juice drinks have a strength of ½;

> > > cranberry sauce a strength of ½; fresh or frozen cranberries

are

> 4

> > > times as potent; pure cranberry juice is 4 times as potent; and

> > > cranberry juice capsules from unsweetened cranberry juice

powders

> > are

> > > 32 times as potent.

> > > > Cranberries work to help bladder infections because they have

a

> > > chemical (proanthocyanidins) that prevents the bacteria from

> > sticking

> > > to the bladder wall. They may also decrease the risk of kidney

> > stones

> > > (although magnesium with B6 is much better for this), as well

as

> > > possibly reduce urine odor.

> > > > D-Mannose - This is more effective than cranberry juice.

> Mannose

> > is

> > > a natural sugar (not the kind that causes symptoms or yeast

> > > overgrowth) that is excreted promptly into the urine.

> Unfortunately

> > > for the E-coli bacteria, the fingers that stick to the bladder

> wall

> > > stick to the D-Mannose even better. When one takes a large

amount

> > of

> > > D-Mannose, it spills into the urine, coating all the E-coli's

> > > little " sticky fingers " so that the E-coli are literally washed

> > away

> > > with the next urination. The nice thing about the natural

> approach,

> > > as opposed to antibiotics, is that the cranberries or D-Mannose

> > will

> > > not kill the healthy bacteria, thereby not bothering the normal

> > > balance of bacteria in the bowel. In addition, the D-Mannose is

> > > absorbed in the upper gut before it gets to the friendly E-coli

> > that

> > > are normally present in the colon. Because of this, it helps

> clear

> > > the bladder without causing any other problems. In addition,

the

> D-

> > > Mannose even tastes good.

> > > > The D-Mannose is quite safe, even for long-term use, although

> > most

> > > people will only need it for a few days. Those who have

frequent

> > > recurrent bladder infections may, however, choose to take it

> every

> > > day. The usual dose of D- Mannose is 1/2 teaspoon every 2 to 3

> > hours,

> > > while awake, to treat an acute bladder infection; and 1/4 to

1/2

> > > teaspoon 3 to 4 times a day to prevent severe chronic bladder

> > > infections. It is best taken dissolved in water. For those who

> get

> > > bladder infections associated with sexual intercourse, one can

> take

> > > 1/2 teaspoon of D-Mannose 1 hour before and then just after

> > > intercourse to prevent an infection. Remember, though, the D-

> > Mannose

> > > (and cranberries) only work in the 90% of bladder infections

> caused

> > > by E-coli bacteria. D-Mannose is available from several sources:

> > > > 1. The Tahoma Clinic Dispensary (253-850-5661), which is

> > associated

> > > with the well-known nutritional physician, V. ,

> M.D.

> > > > 2. The Biotech Company (800-345-1199).

> > > > 3. My office (800-333-5287) or my Web site at

> www.endfatigue.com.

> > > > The usual cost of D-Mannose is approximately $60 for 100

grams

> > and

> > > $35 for 50 grams. A 1/2 teaspoon is approximately 2 grams. One

> > should

> > > feel much better within 24 to 48 hours on D-Mannose. If not,

see

> a

> > > doctor for a urine culture (you may want to get the culture at

> the

> > > first sign of infection) and consider antibiotic treatment

after

> > two

> > > days if the culture is positive. Some evidence exists that

> > > Macrodantin causes less yeast over-growth than do other

> > antibiotics.

> > > Even with other antibiotics, most bladder infections are

knocked

> > out

> > > by one to three days of antibiotic use (instead of the old

seven-

> > day

> > > regimen).

> > > > Prostatitis

> > > > Although women tend to be the ones plagued with bladder

> > infections,

> > > men don't get off unscathed either. It is very common in men

with

> > > CFIDS/FMS to have Prostatitis. Prostatitis is an inflammation

or

> > > infection of the prostate which is usually seen in younger men

> > > between the ages of 20 and 50. It falls into three main

> categories:

> > > > 1. " Bacterial " Prostatitis is a acute or chronic infection in

> the

> > > gland that causes prostate swelling and discomfort.

> > > > 2. Nonbacterial Prostatitis is when you feel swelling of the

> > > prostate without being able to detect an infection. My

suspicion

> is

> > > that it is not uncommon for prostatitis to be associated with

> yeast

> > > overgrowth or other infections that cannot be cultured (tested

> > for).

> > > > 3. Prostadynia is a general irritation of the prostate which

> > causes

> > > urinary burning, urgency and frequency but without there being

> any

> > > infection or swelling of the prostate. This can come from a

> number

> > of

> > > causes including, I suspect, chronic spasm or tightening of the

> > > muscles of the pelvic floor.

> > > > The symptoms of chronic Prostatitis can come and go and be

mild

> > or

> > > severe. The symptoms include:

> > > > 1. Pain or tenderness in the area of the prostate. It is also

> > > common to have burning on the tip of the penis.

> > > > 2. Discomfort in the groin and, occasionally, lower back pain.

> > > > 3. Urinary urgency and frequency with pain on urination.

> > > > 4. Sometimes a slight penis discharge. If the discharge is

> cloudy

> > > and larger than one drop, or even a large drop, it is most

likely

> a

> > > bacterial Prostatitis and I would then prescribe antibiotics.

If

> a

> > > discharge is present, I would also check to make sure that

there

> is

> > > not also a sexually transmitted disease (such as Chlamydia or

> > > Gonorrhea) before beginning treatment.

> > > > 5. Pain with ejaculation.

> > > > If severe symptoms with fevers, chills and extreme fatigue

are

> > > present (symptoms of acute Prostatitis), antibiotics should be

> > used.

> > > The main treatment for bacterial Prostatitis consists of using

> the

> > > antibiotics Tetracycline (e.g., Doxycycline), Cipro, or Sulfa

> > > (Bactrim or Septra DS). Unfortunately, since it is hard for the

> > > antibiotics to be absorbed into the prostate, the symptoms

often

> > > recur even after six weeks of treatment. If antibiotics are

> > required,

> > > use Doxycycline or Cipro because these may be effective against

> > other

> > > hidden infections that can cause CFIDS/FMS.

> > > > Although there are a number of causes of Prostatitis, excess

> > > caffeine, alcohol and spicy foods can also contribute to the

> > > symptoms. Sitting for long periods while traveling (e.g., being

a

> > > truck driver) can also cause irritation of the prostate.

Although

> > > normal bacteria are common causes, a few bacteria transmitted

> > through

> > > sexual contact can also cause Prostatitis. Some feel that the

> main

> > > psychological component of Prostatitis is shame.

> > > > Bowel Parasite Infections

> > > > A while back, the news focused our attention on Milwaukee

> because

> > > of repeated fatal outbreaks of an infection by a bowel parasite

> > > called Cryptosporidium. A cartoon even made the rounds showing

> > > Mexican tourists being warned not to drink the water in

> Milwaukee!

> > > Although this infection usually resolves on its own within a

week

> > or

> > > two, it may persist in those with immune suppression. In fact,

> > people

> > > with acquired immune deficiency syndrome (AIDS) are

particularly

> > > susceptible and scores of Milwaukeens died from the

> Cryptosporidium

> > > outbreaks.

> > > > Unfortunately, in many places throughout the United States,

the

> > > water supply is contaminated, and parasites are no longer just

a

> > > Third World problem. Doctors frequently see cases of infection

by

> > > giardia, amoeba and numerous other bowel parasites. Parasitic

> > > infections can mimic CFS and, in immune suppressed situations

> like

> > > CFS, all parasites should be treated.

> > > > Most laboratories miss the parasites when they do stool

> testing.

> > I

> > > initially tested for bowel parasites by sending my patients'

> stool

> > > samples to a respected local lab. The tests kept coming back

> > > negative, so I eventually stopped testing. Finally, I started

> doing

> > > my own laboratory stool testing. Doing the test properly was

very

> > > time consuming, taking up to five hours per specimen. However,

> > > processing it properly, my tests frequently turned out

positive.

> In

> > > my experience - and in that of other physicians as well - when

> you

> > > treat a patient for parasites, the patient's fatigue and

achiness

> > > often improves dramatically.

> > > > If you would like your stool tested, make sure that the lab

> > > specializes in stool testing and that the sample is a purged

> > > specimen. A purged stool specimen is watery and loose, brought

> > about

> > > by the use of one-and-a-half ounces of Fleet's Phospho-Soda (a

> > > laxative). The purpose of the stool purge is to get the best

> > possible

> > > stool sample to check for bowel parasites and yeast. The

laxative

> > > washes the organisms off the walls of the intestines so that

they

> > can

> > > be detected. The routine random tests performed in almost all

> > > standard labs are generally not adequate or reliable. In

speaking

> > > with several lab technicians, I was told they had less than one

> > hour

> > > of training in looking for parasites—which they found to be

> > useless.

> > > In fact, during one of our " doctors' " poker games, I spoke with

a

> > > gastroenterologist friend who noted that during a certain bowel

> > exam

> > > he had performed, he saw a large number of parasites swimming

in

> > the

> > > patient's large bowel. He removed a big glob consisting of

> nothing

> > > > but mucus and parasites and sent it off to the major local

> > > laboratory, just for confirmation of the infection and

> > identification

> > > of the parasite. Even this sample came back negative for

> parasites!

> > > This is why I stress that stool testing must be done at a lab

> that

> > > specializes in parasitology. Because two excellent labs are now

> > > available to me to mail specimens to, I no longer have to do

the

> > > testing in my office. These labs are The Parasitology Center,

> Inc.

> > > (480-777-1078) and The Great Smokies Diagnostic Laboratory (800-

> 522-

> > > 4762).

> > > > At this point, no consistently effective prescription

> medication

> > is

> > > available for Cryptosporidium infections. Artemisia annua,

> however,

> > > is an effective herbal treatment. For most of my patients, I

> > > recommend using 1,000 milligrams three times a day for twenty

> days.

> > > Leo Galland, M.D., a parasite specialist, recommends a form of

> > > Artemisia called tricyclin for many parasitic infections. He

> > > recommends taking 2 tablets, 3 times a day after meals for six

to

> > > eight weeks. The cost of this antiparasitic herbal preparation

is

> > > about $30 for fifty tablets. See the treatment protocol below

for

> > > regimens for some other parasitic infections. The doctor who

runs

> > The

> > > Parasitology Center also has a review article discussing which

> > > natural remedies are effective against each type of parasite.

> > Common

> > > parasite treatment regimens also used in our office are on the

> > > treatment checklist below.

> > > > Antiparasitic Treatments

> > > > 1. Flagyl (Metronidazole) – 750 mg, 3 times a day for 10

days,

> > > followed by Yodoxin for many parasites. For Clostridium

Difficile

> > > take 250 mg, 4 times a day, or 500 mg, 3 times a day. It may

> cause

> > > nausea and vomiting (uncomfortable but usually not worrisome).

Do

> > not

> > > drink alcohol while on this medication as it will make you

vomit.

> > The

> > > SR (sustained release) form is easier on the stomach (as is the

> > brand-

> > > name form). If you get numbness or tingling in your fingers (or

> it

> > > worsens if you usually have it) stop the Flagyl.

> > > > 2. Yodoxin (Iodoquinol) – 650 mg, 3 times a day, for 20 days

> > after

> > > Flagyl is completed.

> > > > 3. Tinidazole – 2000 mg, once daily, for 3 consecutive days

> with

> > > food (for Entamoeba Histolytica) – OR - 3 doses, each 2 weeks

> apart

> > > (for Giardia or Dientamoeba Fragilis); Available at 's

> > Pharmacy

> > > (800-480-3432).

> > > > 4. Humatin (Paromomycin) – 500 mg, 3 times a day, for 10 days

> > (for

> > > Cryptosporidium). For Blastocystis add Yodoxin.

> > > > 5. Zithromax – 250 mg, once a day on an empty stomach for 10

> > days,

> > > along with Bactrim, 1 tablet twice a day for 10 days (alternate

> > > treatment for Cryptosporidium). Add Artemesia.

> > > > 6. Bactrim DS - 1 tablet, twice a day, plus Yodoxin 650 mg, 3

> > times

> > > a day with food for 10 days. Do not take Folic acid supplements

> > > (e.g., B Complex or multivitamins) during these 10 days (for

> > > Blastocystis).

> > > > 7. Amphotericin B – 100 mg, two times a day, plus Tinidazole

> 500

> > > mg, twice a day, plus Furoxone (Furazolidone) 1 tablet, twice a

> > day.

> > > Take these three together with food for 5 to 7 days

(Amphotericin

> B

> > > and Tinidazole are available from 's Pharmacy 800-480-

3432)

> > > (treatment for refractory Blastocystis).

> > > > 8. Lactoferrin – 350 mg, 1 to 3 capsules at bedtime.

> > > > 9. Multi-pure Water Filter - Most other filters (except for

> > reverse

> > > osmosis) are ineffective. (Available from Bren son, 410-

224-

> > > 4877).

> > > > 10. Artemesia Annua (a herbal antiparasitic) – 500 mg, 2

> tablets,

> > 3

> > > times a day for 20 days.

> > > > 11. Tricyclin (a herbal antiparasitic) - 2 tablets, 3 times a

> > day,

> > > after meals for 6 to 8 weeks (concentrated Artemesia).

> > > > 12. Colostrum (mother's milk) - 3 capsules, 3 times a day,

for

> 8

> > to

> > > 12 weeks. Then stop or use the lowest dose needed for symptoms.

> If

> > > nausea or indigestion occurs, lower the dose to a comfortable

> level

> > > for 1 to 2 weeks until it passes. Take on an empty stomach.

> > > > 13. Quinacrine – 100 mg a day for 5 days. May be useful for

> > empiric

> > > therapy of suspected but not identified parasites

(controversial).

> > > > 14. Albendazole – 400 mg a day for 5 days. May be useful for

> > > empiric therapy of suspected but not identified parasites.

> > > > Filter Your Water

> > > > Water filters can be very helpful in the fight against

> parasitic

> > > infection. However, not all units are designed to filter out

> > > parasites. For a water filter to remove parasites, it must have

a

> > > submicron solid carbon block filter. A good example is the

Multi-

> > pure

> > > Filter. Check the Consumer's Digest and Consumer's Report for

> other

> > > good units. Multi-pure Filters are available from Bren son

> at

> > > 888-801-8176 or 410-224-4877. He is a very reputable and

> > > knowledgeable person and does not believe in " high pressure

> sales "

> > > (again, I get no money from people or companies whose products

I

> > > recommend).

> > > > When shopping around for a water filter, request the National

> > > Sanitation Foundation (NSF) International Listing for the

> specific

> > > unit you are considering. NSF is an independent not-for-profit

> > > organization that tests and certifies drinking water treatment

> > > products. The unit you buy should meet both NSF Health Effects

> > > Standard 53 and NSF Aesthetics Standard 42, with Class I

> reduction

> > of

> > > chlorine and particulate matter. Any unit that does not meet

both

> > of

> > > these standards, particularly the health standard, is not

> adequate.

> > > To verify that a unit does meet these standards, call the NSF

at

> > 313-

> > > 769–8010.

> > > > In addition to verifying that a water filter meets the NSF

> > > standards, ask to see its Product Performance Data Sheet. Many

> > states

> > > require that this sheet be given to all prospective customers

of

> > > drinking water treatment devices.

> > > > Ask about the range of contaminants that the unit can reduce

> > under

> > > NSF Health Effects Standard 53. Most units certified under

> Standard

> > > 53 list only turbidity and cyst reduction. The number of units

> that

> > > also reduce pesticides, trihalomethanes, lead, and volatile

> organic

> > > chemicals is very small. Make sure that the water filter you

are

> > > considering can remove the specific contaminants that concern

you.

> > > > Ask if the unit is licensed in such states as California,

> > Colorado

> > > and Wisconsin. These states have some of the toughest

> certification

> > > procedures in the United States.

> > > > Finally, ask about the unit's service cycle, which is stated

in

> > > gallons of water treated. Find out how often you will need to

> > change

> > > the filter and what the replacement filters cost.

> > > > As the American water supply becomes more contaminated,

> parasitic

> > > bowel infections will likely become more common. These

> infections,

> > as

> > > well as the overgrowth of yeast or toxic bacteria caused by

> > > antibiotic use, contribute to feeling poorly.

> > > > The Role Of Other Infections In CFIDS/FMS

> > > > Many infections have been found in CFIDS. That people may

have

> > not

> > > just one, but several of these simultaneously is significant.

It

> > > suggests that although these infections may be a trigger, in

most

> > > patients the immune system is suppressed and therefore they

> become

> > a

> > > setup for unusual infections that persist. These infections may

> > > then " drag you down, " further suppressing your immune system.

> > > > Fortunately, most people improve (and often get very healthy)

> by

> > > simply treating the sleep, hormonal, nutritional and yeast

> > problems.

> > > Once these areas are treated, your body can usually eliminate

any

> > > persistent infections by itself. A subset, though, have

> infections

> > > that need treatment with antivirals and/or antibiotics.

> > > > How Can I Tell If I Need These Treatments?

> > > > First, I would try the other approaches discussed in my From

> > > Fatigued To Fantastic! book and newsletters. I would try these

> > > treatments if symptoms persist:

> > > > 1. Those with predominantly flu-like symptoms with

debilitating

> > > fatigue and little or no pain or fever are more likely to have

an

> > > underlying persistent viral infection (e.g., HHV-6, Epstein

Barr,

> > > CMV, etc.).

> > > > 2. Those with fevers (i.e., anything over 98.6°F in this

> illness -

> >

> > > even 99°) and/or lung congestion, sinusitis, skin pustules or

> other

> > > chronic bacterial infections seem more likely to have

infections

> > > (i.e., bacterial, Mycoplasma, or Chlamydia) that respond to

> special

> > > antibiotics. Let's look at these two groups and how to approach

> > them.

> > > > HHV-6 And Other Viral Infections

> > > > HHV-6 (Human Herpes Virus 6) is a virus that is related to

the

> > > Epstein Barr Virus (EB), Cytomegalovirus (CMV), and also to the

> > > Herpes Viruses that causes cold sores and Genital Herpes. HHV-6

> is

> > > transmitted like the common cold and many people have had it,

as

> > well

> > > as the EB Virus and the Cold Sore Virus by the time they are

> twenty

> > > years old. The body usually gets rid of all of these viruses on

> its

> > > own. Because of this, if you do routine (IGG) antibody testing,

> > > almost everybody will be positive for EB and many for HHV-6 and

> CMV

> > > viruses. However, the IGG test will not tell you if you have

> active

> > > infections unless the IGM antibody is also positive (suggesting

a

> > new

> > > infection). The IGM antibody is the one that increases in the

> first

> > > six weeks of an infection. This is followed by an elevated IGG

> > > antibody, which stays elevated your whole life and acts as your

> > > body's surveillance system. All an elevated IGG means is that

> your

> > > body has seen this infection and, if it sees it again, it's read

> > > > y to knock it out quickly. This is how immunizations work.

The

> > > immunization creates the IGG antibody, so that instead of

taking

> > one

> > > to two weeks to gear-up to fight the infection, your body can

> > > eliminate that infection very quickly. Unfortunately, in CFIDS

> you

> > > can have a chronic low-grade infection—even if your IGG

antibody

> is

> > > positive (elevated) - making the IGG antibody test for HHV-6,

EB

> > > Virus and CMV unreliable in CFIDS/FMS. In addition, the IGM

> > antibody

> > > will usually not be present in elevated levels in the low-grade

> > > infections with these viruses that may be seen in CFIDS and

FMS.

> > > > What makes this important is that Valtrex at high-dose can

> > > eliminate Epstein Barr virus, but will not work if active HHV-6

> or

> > > CMV infection is present. As I will discuss later, the only

tests

> I

> > > would rely on to diagnose active HHV-6 are " rapid cell

cultures "

> or

> > > PCR testing. Because some insurance companies are more likely

to

> > pay

> > > for IGG than PCR testing, an argument can be made for checking

> IGG

> > > antibodies first. If the EBV IGG is positive and HHV-6 and CMV

> IGG

> > > are negative, one may choose to proceed with Valtrex 1000mg, 4

> > times

> > > a day, for 6 months, without PCR testing. If the HHV-6 or CMV

IGG

> > > antibodies are positive, then check the CMV and/or HHV-6 PCR

> tests

> > to

> > > be sure they are negative.

> > > > Tell Me More About HHV-6 And CFIDS

> > > > Unfortunately there is no currently accepted standard

treatment

> > for

> > > the HHV-6 Virus. Even though it is related to other Herpes

> viruses,

> > > HHV-6 is resistant to Acyclovir, Valtrex, Famvir and the other

> > > antivirals that are commonly used in Herpes infections. The

only

> > > antiviral known to be effective against HHV-6 is Ganciclovir.

> This

> > > has significant side effects and has to be given intravenously

> and

> > > possibly forever to maintain the antiviral effect.

Unfortunately,

> > > this is not a viable option in day-to-day life and has been

only

> > > moderately successful when used. The main doctor who has been

> using

> > > Ganciclovir to treat HHV-6 in the United States is Joe Brewer,

> > M.D.,

> > > (816-531-1550) in Kansas City, Missouri. He found that 140 out

of

> > 207

> > > CFIDS patients had positive HHV-6 cell cultures. Forty percent

of

> > > CFIDS patients were positive on their first test and 70% were

> > > positive after three tests. This contrasts to 60 healthy

patients

> > he

> > > checked in which none of the HHV-6 tests were positive. Culture

> > > > s are more likely to be positive during acute flares of the

> > > disease, when the viral level in the blood rises (see Page 9

for

> > more

> > > on HHV-6 PCR testing).

> > > > As is often the case in CFIDS, there is conflicting data on

> > > infections in Chronic Fatigue Syndrome. A recently published

> study

> > > (Reeves WC, et al., Clin Infect Dis, 2000 July; 31 [1] pp48-52)

> > > examined 26 patients with Chronic Fatigue Syndrome and 52

healthy

> > > patients in Atlanta, Georgia, at the CDC. In this study,

several

> > > tests for HHV-6 and HHV-7 were done, including Polymerase Chain

> > > Reaction (PCR). HHV-6 DNA was found in 11% of CFIDS patients

and

> > 28%

> > > of healthy patients, suggesting that the HHV-6 was actually

less

> > > common in Chronic Fatigue Syndrome than in healthy patients. At

> > this

> > > time, as the conflicting data shows, although HHV-6 may be one

of

> > > many suspect infections in CFIDS, it is not yet clearly the

cause

> > of

> > > this illness.

> > > > When HHV-6 is present, it seems to infect the natural Killer

> > Cells,

> > > important cells in your body's defense (immune) system that are

> > > critical in fighting infections. A number of studies have shown

> > these

> > > Killer Cells to be malfunctioning in CFIDS. HHV-6 infection

does

> > not

> > > necessarily decrease the number of the natural Killer Cells but

> > does

> > > decrease their function. Natural Killer Cell function is

> described

> > in

> > > what is called Lytic Units—which means the ability of cells to

> lyse

> > > or break down foreign invaders. An average person will have a

> Lytic

> > > Unit level of 20 to 250 with over 80% of healthy patient being

> over

> > > 40 units. Dr. Brewer finds that in CFIDS the mean Natural

Killer

> > > Lytic Cell level is 12 units. Dr. Brewer uses Specialty Labs in

> > > California for his Natural Killer Lytic Cell testing and finds

> that

> > > the Lytic level stays the same on repeat testing and seems to

be

> a

> > > reliable test for Natural Killer Cell function testing in

CFIDS.

> > > Lytic unit levels will, however, decrease during flar

> > > > es of symptoms. In Dr. Brewer's experience, this test is very

> > > specific for CFIDS and Multiple Sclerosis. He has treated ten

MS

> > > patients and five CFIDS patients with the I.V. Ganciclovir. He

> > found

> > > that it helped to stabilize the MS patients. In the CFIDS

> patients,

> > > two to three were much improved, one still had a positive viral

> > > culture and one had a poor response. Unfortunately, maintaining

> > > patients on I.V. Ganciclovir forever (as noted above) is not a

> > viable

> > > option. Fortunately, an oral pill form of Ganciclovir

> > > (Valganciclovir) is currently being developed! It should be

noted

> > > that the HHV-6 virus is similar to CMV (Cytomegalovirus), and

> that

> > > whatever is effective against one, tends to be effective for

the

> > > other. This is a helpful bit of information as we follow new

> > research

> > > looking for clues on how to eliminate HHV-6 infection.

> > > > What Roles Does The Epstein Barr And Cytomegalovirus Play In

> > CFIDS?

> > > > Again, the roles of the EB and CMV viruses are not clear. It

is

> > not

> > > uncommon for antibody levels of these viruses to be elevated in

> > > Chronic Fatigue Syndrome. As noted above, it is not clear

whether

> > > this simply reflects a previous or ongoing infection with these

> > > viruses. Research by a husband and wife team (the Glasers) at

> Ohio

> > > State University, suggests that Epstein Barr Virus is still

quite

> > > active and playing a role in many patients with these

infections.

> > In

> > > addition, work by Lerner, M.D., also suggests that EB

> Virus

> > > and CMV are active as well. In speaking with Dr. Lerner's

> research

> > > assistant, I found out that he has found EB Virus and CMV to

both

> > be

> > > fairly common in patients with Chronic Fatigue Syndrome (with

and

> > > without pain). He found that about 20% had positive IGM and/or

> > > elevated EA (early antigen) tests to the EB Virus with negative

> > > Cytomegalovirus. Of these, two-thirds improved with high-dose

> > Valtrex

> > > (an oral antiviral). Despite my teasing and prodding, his

associat

> > > > e refused to give out the dose of Valtrex they prescribed

> because

> > > Dr. Lerner does not want to be responsible for people using

these

> > > higher doses until he completes the double-blind trial that is

> > > currently in progress. On the other hand, another study of his

> did

> > > use 1000mg, 4 times a day, giving the antiviral for 6 months.

It

> > > takes about 3 to 4 months before patients start to improve and

> > after

> > > 6 months people can stop the Valtrex without the symptoms

coming

> > > back. However, if there is no improvement in 6 months, consider

> it

> > to

> > > be a negative result. They also found that, as noted above, the

> IGM

> > > is almost always negative using the reagents used in most labs.

> > They

> > > found that only Epstein Barr IGM antibody testing, using a

> reagent

> > by

> > > the Diasorin Company (800-328-1482), has been useful in showing

a

> > > significant number of positive tests. When we called the

company,

> > the

> > > only lab in the Washington, D.C., area using it was at the NIH.

> The

> > > company may, however, be able to give you the name of

> > > > a lab near you that can do the test. What was fairly common,

> > > though, (and present in most patients) was either positive

tests

> > for

> > > Epstein Barr, CMV, or a combination of both as noted above.

When

> > CMV

> > > or HHV-6 are present, the Valtrex is less likely to work

because

> it

> > > is not effective against these viruses.

> > > > In another study done by Dr. Lerner (Infectious Diseases In

> > > Clinical Practice, 1997; 6:110-117) he found that patients who

> had

> > > elevated CMV IGG antibodies, but no significant evidence of

> > > associated Epstein Barr virus (i.e., negative IGM and early

> antigen

> > > (EA) antibody total less than 40), did improve with I.V.

> > Ganciclovir

> > > at 5mg per kg of body weight given every 12 hours I.V. for 30

> days.

> > > In this study 72% (13 of the 18 patients) improved markedly at

> the

> > > end of a month without any significant side effects. As noted,

an

> > > oral form of Ganciclovir is currently in development as well.

It

> > > should be noted that 36% of the Chronic Fatigue Syndrome

patients

> > > that Dr. Lerner checked (18 out of 50) did turn out to have

> > elevated

> > > CMV antibodies (albeit IGG) in the absence of IGM and EA

> antibodies

> > > to EB Virus (i.e., no evidence of active Epstein Barr Virus).

It

> > > should be noted, though, that 70% of healthy patients also had

> > > positive IGGs to CMV (as per our discussion above) in the study

> and

> > > appears

> > > > that the overall level of the IGG was not much higher

overall

> in

> > > the Chronic Fatigue group than in the healthy controls. On the

> > other

> > > hand, the higher the level of CMV antibody in the Chronic

Fatigue

> > > group, the more likely they were to improve with the I.V.

> > Ganciclovir.

> > > > What this means is that patients with Chronic Fatigue

Syndrome

> > > don't necessarily have different blood tests for antibody

levels

> > than

> > > healthy people for these viruses. However, if one has a higher

> > level

> > > rather than a lower level, one is more likely to improve with

the

> > > Ganciclovir. Previous research has not shown benefit from

> antiviral

> > > therapies in CFS (Straus SE, et al., New England Journal of

> > Medicine

> > > 1988; 319:1692-1698). Our experience using a fairly high dose

of

> > > Valtrex or Famvir (1500mg and 2250mg a day respectively) also

> > showed

> > > no significant improvement on these regimens after 6 weeks, at

> > which

> > > time we considered it to be ineffective. On the other hand, Dr.

> > > Lerner's research is suggesting that perhaps we gave it for too

> > short

> > > a time and at too low a dose. When treating himself and a few

> other

> > > patients, he used Valtrex by mouth at a dosage of 1000mg, 4

times

> a

> > > day, for 6 months. Using the higher dosing and the extended

> period

> > of

> > > time, as well as separating out groups that have

> > > > Epstein Barr Virus (sensitive to the oral Valtrex) without

CMV

> > or

> > > HHV-6 (resistant to oral Valtrex but sensitive to I.V.

> > Ganciclovir),

> > > may make an important difference in making treatment effective.

> No

> > > major Valtrex toxicity was seen. As noted above, a double-blind

> > study

> > > is currently in progress and we are beginning to try the higher

> > dose

> > > of Valtrex in the 15% of our patient population that have not

> > > improved adequately and have positive EBV, and negative CMV and

> HHV-

> > 6

> > > tests. We hope to give you follow-up information on the

> treatment's

> > > effectiveness as soon as we know!

> > > > In addition, Dr. Lerner suspects that these infections affect

> the

> > > heart muscle contributing to much of your symptoms. I am not

> > > convinced that this is the case because EKG changes are common

in

> > > CFS. This can occur because the autonomic (brain) dysfunction

and

> > > hormonal changes seen in CFS can cause these same EKG changes

> > without

> > > heart damage. Regardless, he found that these changes went away

> > with

> > > treatment (as has been our experience in treating Chronic

Fatigue

> > > Syndrome—patient's EKG changes improve even without

antivirals).

> > Dr.

> > > Lerner is currently recruiting patients for a double-blind

study

> > > using the high-dose Valtrex. His phone number is 248-540-9688

in

> > > Beverly Hills, Michigan.

> > > > Does This Mean There Is Nothing We Can Do Now?

> > > > Although there is no currently accepted specific treatment

for

> > the

> > > CMV and HHV-6 viruses, there are still a number of things that

> may

> > be

> > > very helpful in fighting this infection.

> > > > 1. Lithium tends to be antiviral and has been shown to

decrease

> > > pain in FMS patients when added to treatment with Elavil.

Lithium

> > is

> > > commonly used in manic depressive illness and is a natural

> mineral

> > > despite being sold by prescription. In high doses, it can cause

> > some

> > > neurologic symptoms and suppression of the thyroid gland, but

> these

> > > can usually be treated by taking a small amount of Essential

> Fatty

> > > Acids and thyroid hormone. Lithium might also worsen Restless

Leg

> > > Syndrome. Although we have no direct evidence of Lithium being

an

> > > effective antiviral against HHV-6, it may well be effective

> because

> > > it works against a number of other viral infections. In our

> > > experience, 200mg to 600mg a day seems to be the effective dose

> in

> > > treating FMS patients. As noted above, I would check the

thyroid

> > > blood tests at 3 months, 6 months and then yearly (check a Free

> T4

> > > and a Total T3 - not a TSH). A Lithium level should also be

> checked

> > > at the same time to be sure that it not above the upper limit

of

> > > > normal. The level can be below the normal range, which is

fine

> as

> > > long as the treatment is effective. You may find that you can

> lower

> > > the Lithium dose after you have been on it for several months.

> > > > 2. Heparin (a blood thinner, see Page 12) also has antiviral

> > > properties.

> > > > 3. It is worth considering trials of high-dose Valtrex. It

> should

> > > be noted that 1000mg, 3 times a day, is used for shingles in

> older

> > > patients and appears to be quite safe. On the other hand,

higher

> > > dosing at 8 grams a day in AIDS patients did result in uncommon

> > > (under 2%) life threatening problems. This is common even with

> day-

> > to-

> > > day drugs in AIDS patients (for example, regular sulfa

> antibiotics

> > > have often resulted in severe toxicity in AIDS patients).

> > > Nonetheless, we will be limiting the dose to 1 gram, 4 times a

> day,

> > > in our practice. It is important to note that taking Tagamet

> and/or

> > > Probenecid (Benemid) will raise the blood level of Valtrex.

> Tagamet

> > > has powerful immune modifying properties and is very helpful in

> > acute

> > > cases of Epstein Barr (mono) infections. Because of this, we

are

> > > adding Tagament 300mg, 4 times a day (but not Probenecid), to

the

> > > Valtrex. As I noted, we are beginning this treatment with some

of

> > our

> > > patients and will let you know what we find.

> > > > Natural Remedies

> > > > 1. Olive Leaf - This is an herbal which is known to have a

wide

> > > spectrum of anti-infectious activity. It has been shown to be

> > > effective against the HHV-6 virus in the test tube. I have not,

> > > however, seen studies testing its effect in human beings

infected

> > > with HHV-6. Nonetheless, a number of physicians have found that

> > using

> > > Olive Leaf in Chronic Fatigue Syndrome is very effective. There

> is

> > > controversy over whether the form and source of the Olive Leaf

is

> > > critical. We recommend that you use a form that has at least 6%

> > > Oleuropein, which is one of the most active antiviral

components

> in

> > > the Olive Leaf. Other components may be important and some

people

> > > also feel that you must use the Mediterranean Olive Leaf vs.

the

> > > American Olive Leaf. Other people argue that you should have a

> form

> > > that is organically grown, without pesticides. At this point it

> is

> > > not clear whether this is simply marketing or important in day-

to-

> > day

> > > life. Nonetheless, I would be picky about the companies you buy

> the

> > O

> > > > live Leaf from. I would use one of these sources:

> > > > a. My office (800-333-5287) or my Web site at

> www.endfatigue.com.

> > > > b. Pacific Research Labs (800-325-7734). This is owned by R.

J.

> > > Marshall, Ph.D., who has done a fair bit of work treating CFIDS

> > > patients with Olive Leaf. I will be describing the protocol

that

> he

> > > uses below.

> > > > c. General Nutrition Centers (GNC).

> > > > Dr. Marshall feels that during infections, the body becomes

> > overly

> > > acidic. He tests the morning urine specimens with pH paper

(which

> > is

> > > very easy to do at home) and gives a shell extract, which

raises

> > the

> > > body's alkalinity. He feels that having a normalized acid-base

> > > balance in your body helps it to fight infections. He then adds

> his

> > > form of Olive Leaf, called Infectostat (which also contains

> > mushroom

> > > extracts to stimulate the immune system), giving 3 to 4

capsules,

> 3

> > > to 4 times a day, to help fight the infections. Usually, the

> > patient

> > > should start feeling better within four weeks on this protocol.

> > > Although we have found it helpful in fighting colds and other

> > common

> > > respiratory infections, we are just starting to explore Olive

> > Leaf's

> > > use in a few of our patients who have not responded to standard

> > > treatment and are still quite ill. We will let you know our

> > > experience with this in an upcoming newsletter issue. My guess,

> > > though, is that simply using regular (6% Oleuropein) Olive Leaf

> > > > 500mg capsules, 3 to 4 capsules, 3 to 4 times a day between

> > meals,

> > > will probably be equally effective and cheaper for most people

> than

> > > the expensive forms. How long one needs to take Olive Leaf in

> > Chronic

> > > Fatigue Syndrome is yet to be determined.

> > > > Initially, a pharmaceutical company was developing the

> Oleuropein

> > > in Olive Leaf as an antiviral. Because it gets bound to the

blood

> > > proteins, they thought that Oleuropein might not get to the

> > tissues.

> > > More importantly, Oleuropein is a natural product and therefore

> > hard

> > > to patent. Because of these problems, they stopped research on

> it.

> > > Years later this research was rediscovered and explored

further.

> In

> > > addition to being an effective antiviral agent, Olive Leaf is

> > > reported to be effective on a number of bacterial and yeast

> > > infections as well. What is most exciting regarding the Olive

> Leaf

> > is:

> > > > a. That some doctors have found it to be effective in CFIDS,

> and

> > > > b. That in tests against HHV-6 and CMV virus (remember that

if

> > > something is effective against one, it tends to be effective

> > against

> > > the other) the Olive Leaf extract did not just suppress the

virus

> > but

> > > killed it. That is very promising.

> > > > 2. Pro-Boost - Thymic Protein A (used to be called BioPro) -

> This

> > > is the immune stimulant that I discussed in my newsletter, Vol.

> 2,

> > > Issue 2. Although not a hormone, Pro-Boost mimics the natural

> > hormone

> > > produced by your Thymus - the gland which stimulates your

immune

> > > system. I find it to be extraordinarily effective in fighting

> > common

> > > infections of any kind that seem to pop up. For the more deep-

> > seated

> > > infections of CFIDS, the higher dose (1 packet, 3 times a day)

> will

> > > likely be needed. Once the infection seems to be in check and

you

> > are

> > > feeling better (i.e., after 6 weeks), you can taper down to the

> > > lowest dose that maintains the effect.

> > > > 3. IP6 - This natural immune stimulant is an extract of bran

> > > (phytates). It is less expensive and is sometimes combined with

> > > vitamin C. The dose of IP6 (available from many sources) is 5

to

> 8

> > > grams a day. Do not take IP6 within 3 hours of vitamin/mineral

> > > supplements.

> > > > 4. MGN3 - This is a very concentrated mushroom extract, which

> has

> > > been shown to stimulate Natural Killer Cell immune function. In

> one

> > > study, it actually tripled Natural Killer Cell function—an

effect

> > > that, as the HHV-6 virus can suppress Natural Killer Cell

> function,

> > > could be very powerful. Unfortunately, it is horribly expensive

> in

> > > the recommended dose (250 mg capsules) of 2 to 4 capsules, 4

> times

> > a

> > > day for 2 weeks, followed by 2 capsules, 2 times a day. Other

> > > mushroom extracts are cheaper but may not be as effective.

> > > > 5. Intravenous Vitamin C at high-dose (15gm to 50gm) has been

> > > suggested to have antiviral effects in a number of other

> infections

> > > and is often dramatically helpful in CFIDS when given in the

I.V.

> > > nutritional therapy called " Myers Cocktails " (see my

newsletter,

> > Vol.

> > > 3, Issue 3).

> > > > 6. Lysine 1000 mg, 3 times a day - This amino acid protein is

> > safe

> > > and inexpensive (27¢ a day). It inhibits oral/genital herpes

(by

> > > depleting the Arginine the virus needs to grow). I do not know

if

> > it

> > > also inhibits EBV, HHV-6 or CMV viral infections.

> > > > I would take the combination of these together (as is

> affordable)—

> > > perhaps leaving the MGN3 for later if needed, giving the

> treatment

> > > for at least a 6 to 8 week trial to see if it's effective. If

you

> > are

> > > feeling better at 6 weeks, you can then taper down the dose

> slowly

> > as

> > > long as the benefit is maintained. When able, you can wean

> yourself

> > > off the treatments. If symptoms recur, go back up to the dose

> that

> > > maintains the benefit or consider increasing the dose further.

As

> > we

> > > are just starting to use this protocol in our patients, I do

> > > appreciate your feedback on what has worked for you and what

has

> > not.

> > > You can " vote " for what helped or didn't help you on our Web

site

> > at

> > > www.endfatigue.com. You can also see other people's votes.

> > > > In addition, your clotting system may be activated by several

> > > infections making it difficult to eliminate them. Using the

anti-

> > > clotting treatments that we will discuss later can also make it

> > > easier for your body to eradicate infections.

> > > > Mycoplasma And Chlamydia

> > > > Other infections have also been found to be very important in

> > > CFIDS. Dr. Garth Nicolson and his wife, who were on-faculty at

> the

> > > University of Texas Medical School at Houston and the

Department

> of

> > > Microbiology and Immunology at Baylor College of Medicine in

> > Houston,

> > > Texas, are the leading proponents of treatment of these

> infections.

> > > Dr. Garth Nicolson was an endowed chair and department chairman

> at

> > > the University of Texas, the M.D. Cancer Center in

> > Houston,

> > > Texas, and a Professor of Internal Medicine at the University

of

> > > Texas Medical School, also in Houston. Dr. Nicolson's wife had

> > > Chronic Fatigue Syndrome years ago. They were surprised that

her

> > test

> > > turned out to be positive for Mycoplasma fermentans (also known

> as

> > > Mycoplasma fermentans incognitus). This Mycoplasma was found to

> be

> > > resistant to the Penicillin- and Keflex-family antibiotics that

> > most

> > > doctors use, but was sensitive to long courses of Doxycycline

and

> > > Cipro. After an extended course of Doxycycline treatment,

> > > > she was much better. The Nicolsons then went on to develop

> their

> > > own tests for Mycoplasma using PCR testing. Dr. Nicolson tells

me

> > > that, in addition, when his step-daughter came home after

serving

> > in

> > > Desert Storm, she came down with Gulf War Illness (GWI). They

> > tested

> > > hundreds of Gulf War veterans with GWI and 40% to 45% were

> positive

> > > for Mycoplasma infections—almost all with Mycoplasma

fermentans.

> > This

> > > has been confirmed by other labs and a large Veterns

> Aministration

> > > study involving over 2,000 patients. In contrast to this,

> soldiers

> > > who were not deployed to the Gulf during the war, had less than

a

> > 6%

> > > incidence of being positive for these infections.

> > > > Interestingly, the Nicolsons found that in patients with

> Chronic

> > > Fatigue Syndrome or Fibromyalgia, approximately 70% (144 out of

> 203

> > > patients) had a positive PCR test for one, or usually several

> > > species, of Mycoplasma. When the Nicolsons tested 70 healthy

> > > patients, only 6 patients (less than 9%) were positive for any

of

> > the

> > > Mycoplasma species. This is a highly significant difference.

Only

> 2

> > > of these 70 healthy people were positive for Mycoplasma

> fermentans.

> > > Similar results have been found by other doctors and have been

> > > published.

> > > > As we have said before, it is likely that there is a group of

> > > underlying problems and not a single one that triggers

CFIDS/FMS.

> > > This applies to infections as well. This is why you can see

tests

> > be

> > > positive for both viral and Mycoplasmal infections in so many

> > people

> > > with this disease. For Mycoplasma alone, when they checked for

> four

> > > different types of Mycoplasma, over half of the 93 CFIDS

patients

> > > that were positive had more than one type of infection. Over

20%

> of

> > > them had three out of the four Mycoplasma infections test

> positive.

> > > The more infections that were positive, the worse the patient's

> > > symptoms were and the longer they had had CFIDS/FMS.

> > > > What Are Mycoplasma?

> > > > Mycoplasma are an ancient bacteria that lacks cell walls and

> are

> > > capable of invading a number of types of human cells. They can

> > cause

> > > a wide variety of human diseases. These organisms can cause the

> > types

> > > of symptoms seen in Chronic Fatigue Syndrome patients and,

> > according

> > > to Dr. Nicolson, tend to be immune suppressing. Unfortunately,

> they

> > > cannot be readily cultured on a culture dish like regular

> bacteria.

> > > In medicine, we have a bad habit on focusing on that which is

> easy

> > to

> > > test for and making believe that that which is hard to test for

> > does

> > > not exist. Because of this, bacterial infections such as

> pneumonia,

> > > bladder infections and skin infections, where one bacteria on a

> > cell

> > > dish will rapidly turn into millions by the next day and be

> visible

> > > to the human eye, get all our attention. Unfortunately,

> Mycoplasma,

> > > which cannot be easily cultured, tends to be ignored. It's like

> the

> > > old story about the little kid who was looking for his lost

keys

> > > under the street lamp one night. His frien

> > > > ds came by and asked him what was going on. He told them and

> they

> > > all looked for the keys under that light for about an hour.

> > Finally,

> > > exasperated, they looked at the friend and said, " Where did you

> > lose

> > > these keys? " The kid looked up and said, " Oh, about half a

block

> > down

> > > the street. " They said, " Why are you looking for them here? " He

> > > said, " Because there is a light here and I can see! " This is

kind

> > of

> > > what it is like in medicine. If there is a test for something

> (such

> > > as cholesterol and bacterial cultures) that is easy to do, we

> focus

> > > our attention on that test and make believe that it finds the

> main

> > > problem. Unfortunately, in CFIDS and FMS, this is not the case.

> > > > The data suggests that many infections may trigger CFIDS/FMS

or

> > > that CFIDS and FMS may cause immune suppression—which then sets

> you

> > > up to catch a whole bunch of different infections which your

body

> > has

> > > trouble clearing. This is why it is important to treat all the

> > > underlying processes simultaneously as I discuss in my From

> > Fatigued

> > > To Fantastic! book and newsletters.

> > > > So, How Do You Look For These Infections?

> > > > I had the honor of speaking with Konnie Knox, M.D., a major

re-

> > > searcher on HHV-6 testing in CFIDS/FMS, who uses a technique

> called

> > > Rapid Cell Culture. She actually infects different test tube

> cells

> > > with HHV-6, grows them, and then looks for signs of HHV-6 in

the

> > > cell. In her experience, one out of three CFIDS/FMS patients

are

> > > positive for active HHV-6 infection on the first blood test.

When

> > > multiple testing is done (e.g., three tests), 70% are positive.

> > This

> > > test is negative in the vast majority of people who are

healthy.

> > The

> > > other main illness where the HHV-6 test is positive is Multiple

> > > Sclerosis. At this time, HHV-6 Rapid Cell Culture and the PCR

> test

> > at

> > > Dr. Nicolson's lab (International Molecular Diagostics) are the

> > only

> > > HHV-6 test I order. For more information on Dr. Knox's work, go

> to

> > > these Web sites: www.HHV-6.com and www.cnet.com. For the IMD

> > website,

> > > go to www.imd-lab.com.

> > > > The Nicolsons use very sensitive PCR (Polymerase Chain

> Reaction)

> > > testing to actually look for DNA specific to Mycoplasma, HHV-6,

> and

> > > other infections. Unfortunately, those DNA pieces are so

> > > microscopically small, that to look for just one is much worse

> than

> > > looking for a " needle in a haystack. " With the PCR, if that

> > > Mycoplasma gene sequence is found, the technique multiplies it

> like

> > a

> > > copying machine until millions of that sequence are present and

> can

> > > be picked up by testing. Because of this, PCR testing is

> > exquisitely

> > > sensitive and can find the proverbial " needle in a haystack. "

> This

> > > makes it very powerful and the only testing that I would

> recommend

> > in

> > > looking for these Mycoplasma and Chlamydia infections. As noted

> > > above, IGG antibody testing is not reliable for Mycoplasma and

> > > Chlamydia testing in CFS.

> > > > Where Do I Get These Tests Done And Should I Have Them Done?

> > > > The tests for HHV-6 and Mycoplasma each cost about $180 to

> $250.

> > As

> > > noted above, the only places that I would get the HHV-6 test

done

> > > (and the only tests I would do are PCR or viral culture

testing)

> > are

> > > at the Wisconsin Viral Institute (414-774-0311) or Dr.

Nicolson's

> > > lab. I order all the lab testing for Mycoplasma and Chlamydia

at

> > the

> > > Nicolson's lab, at International Molecular Diagnostics, 15162

> > Triton

> > > Lane, Huntington Beach, CA 92649 (714-799-7177 ext. 202 or

204).

> > The

> > > lab's Web site is www.imdlab.com.

> > > > I can almost guarantee that if you do the Mycoplasma or

> Chlamydia

> > > tests at your local lab they will do the wrong tests and they

> will

> > be

> > > useless for hidden CFS infections. I have never seen one come

> back

> > > with any useful information. What they usually do is check the

> > > antibodies (usually for the wrong Mycoplasma infection) which

> > simply

> > > shows that you (like everybody else at some point in their

life)

> > have

> > > had a Mycoplasma infection. It tells nothing about active

> infection

> > > and, again, is useless. Be sure to do the PCR testing and do it

> at

> > > one of the two labs discussed above. Dr. Nicolson has noted

which

> > > tests he recommends in CFS/FMS, their cost and instructions for

> the

> > > lab. We have reprinted this information on the next page (Dr.

> > > Nicolson's lab also does viral PCR testing for CMV, as well as

> HHV-

> > 6).

> > > > Even at the best labs, it is not uncommon to have a false-

> > negative

> > > report (where you have the infection and it does not show up on

> the

> > > test). Because of this, especially for HHV-6, multiple tests

will

> > > often need to be done. There are good arguments for not doing

the

> > > tests and simply going ahead and treating empirically with the

> > > natural remedies discussed above for HHV-6, or for prescribing

> > > Doxycycline or Cipro for an extended period of time (see

below).

> If

> > > you feel better after four months on the treatment, then you

know

> > you

> > > are hitting an infection and you can always intermittently stop

> the

> > > treatments to see how long you will need them. Also, there are

> many

> > > infections that are not tested for with these tests that would

be

> > > effectively treated with the regimens that we are discussing.

> Many

> > of

> > > these are likely to be infections that we don't even know

exist.

> > > Because of this, if resources are limited, I some-times simply

> > treat

> > > the patient, based on clinical suspicion, without doing the

> > > > tests.

> > > > Testing does have its benefits. If the test is positive, I am

> > > likely to treat more aggressively and it helps guide me on how

> long

> > > to give the treatment. For example, if after four months you

are

> > not

> > > better and the test is positive, I would be likely to go ahead

> and

> > > increase dosing or change to a different antibiotic. If the

test

> > was

> > > negative, I would be more likely to just stop treatment and

> suspect

> > > that the infection is less likely. This argues in favor of

doing

> > the

> > > tests. One simple thing to do is to go ahead and check with

your

> > > insurance company to see if they cover these tests. This may

make

> > > your decision much simpler. Unfortunately, I suspect that the

way

> > > that most labs draw and ship your blood sample may not be

> reliable

> > > because, in our experience, we have had less than 10% of

> patient's

> > > tests come back positive for HHV-6 cell culture and only a

modest

> > > percent come back positive for the Mycoplasma. For the PCR

> > Mycoplasma

> > > test, the blood has to be frozen (see boxed inset, Page 9

> > > > ). If the blood is left at room temperature, most of the

> positive

> > > samples become negative after one to two days.

> > > > Mycoplasma testing is not as specific as HHV-6 testing is for

> > > CFIDS/FMS/Multiple Sclerosis (i.e., it is positive in other

> > > illnesses). For example, about half the patients with

Rheumatoid

> > > Arthritis are also found to be infected with treatable

> infections,

> > > including Mycoplasma. This goes along with my, and other

doctors'

> > > experience, that Doxycycline is often effective in treating

> > > Rheumatoid Arthritis. Interestingly, although Mycoplasma is

> common

> > in

> > > the environment, it usually is fairly noninvasive. It may

simply

> be

> > > that once your immune system is weakened, these infections can

> get

> > > into cells where they don't belong. When that happens, even

some

> of

> > > the common ones that are considered noninfectious can wreak

> havoc.

> > > When these infections repro-duce slowly, they tend to be low-

> grade,

> > > chronic infections, as opposed to the acute and more prominent

> > > symptoms seen with bacterial and viral infections that multiply

> and

> > > divide rapidly.

> > > > For CFS/ME or FMS or Autoimmune Disease Patients,

> > > > The Institute for Molecular Medicine suggests the following

lab

> > > tests:

> > > > (Codes are I.M.D. or CPT Codes)

> > > > 1. Test Panel 1007 (CPT: 87798x3, 87581) Mycoplasma species

> panel

> > > of 4 pathogenic mycoplasmas (M. fermentans, M. penumoniae, M.

> > > hominis, M. penetrans) by PCR.

> > > > Justification: Almost 60% of CFS/FMS and 50% of Rheumatoid

> > > Arthritis (RA) and other autoimmune patients have one or more

> > > intracellular, systemic mycoplasmal infections similar to those

> > found

> > > in a variety of chronic illnesses [Nicolson, et al.,

Mycoplasmal

> > > infections in chronic illnesses: Fibromyalgia and Chronic

Fatigue

> > > Syndromes, Gulf War Illness, HIV-AIDS and Rheumatoid Arthritis;

> > > Medical Sentinel 1999; 5:172-176]. Ultrasensitive and

> ultraspecific

> > > mycoplasma tests can only be done by a small number of labs,

most

> > > university or government labs that have been trained by us

under

> a

> > > U.S. government contract.

> > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> > > (EDTA). The blood is collected, immediately mixed and placed on

> > ice,

> > > then shipped on wet ice or immediately flash frozen and shipped

> > with

> > > dry ice by courier (foreign shipments) to I.M.D. to arrive

within

> > 24-

> > > 36 hours. Cost=$250. (Note that other commercial labs charge

$400-

> > > 600.)

> > > > 2. Test 1006 (CPT: 87486) Chlamydia pneumoniae test by PCR.

> > > Justification: Many CFS, FMS, MS, RA and other patients have

this

> > > systemic infection along with viral infection(s). We were among

> the

> > > few labs that developed the molecular tests that are now done

for

> > > this type of infection. The other labs that use these

procedures

> > are

> > > university labs.

> > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> > > (EDTA). The blood is collected, immediately mixed and placed on

> > ice,

> > > then shipped on wet ice or immediately flash frozen and shipped

> > with

> > > dry ice by courier to I.M.D. to arrive within 24-36 hours.

> > Cost=$180.

> > > (Note that other commercial labs charge $200-250.)

> > > > 3. Test 07047 (CPT: 87476) Borrelia burgdorferi (Lyme

Disease)

> > test

> > > by PCR.

> > > > Justification: Many CFS, FMS and RA patients have this

systemic

> > > infection (diagnosed as Lyme Disease) along with other infection

> > (s).

> > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic Tube

> > > (EDTA). The blood is collected, immediately mixed and placed on

> > ice,

> > > then shipped on wet ice or immediately flash frozen and shipped

> > with

> > > dry ice by courier to I.M.D. to arrive within 24-36 hours.

> > Cost=$180.

> > > (Note that other commercial labs charge $200-250.)

> > > > 4. Test 07039 (CPT: 87532) Human Herpes Virus 6 (HHV-6) test

by

> > > PCR.

> > > > Justification: Many CFS and some FMS patients have this

> systemic

> > > viral infection, and it should be tested for in any autoimmune

> > > illness.

> > > > Specimen Requirements: Collect blood in one (1) 5 cc Lavender-

> top

> > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > centrifugation. The plasma is then shipped on wet ice or

> > immediately

> > > flash frozen and shipped with dry ice by courier to I.M.D. to

> > arrive

> > > within 24-36 hours. Cost=$180. (Note that other commercial labs

> > > charge $200-350.)

> > > > 5. Test 07034 (CPT: 87496) Cytomegalovirus (CMV) test by PCR.

> > > > Justification: Many CFS and FMS patients have this systemic

> viral

> > > infection, and it should be tested for in any autoimmune

illness.

> > > > Specimen Requirements: Collect blood in one (1) 5 cc Lavender-

> top

> > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > centrifugation. The plasma is then shipped on wet ice or

> > immediately

> > > flash frozen and shipped with dry ice by courier to I.M.D. to

> > arrive

> > > within 24-36 hours. Cost=$180. (Note that other commercial labs

> > > charge $200-300.)

> > > > For the best price and highest quality, the above PCR

specialty

> > > tests for CFS/FMS patients can be ordered through International

> > > Molecular Diagnostics, Inc., 15162 Triton Lane, Huntington

Beach,

> > CA

> > > 92649, U.S.A. Tel: 714-799-7177, ext. 202 (Client Services) or

> ext.

> > > 204 (Brant Blasingame). Order forms and additional information

> are

> > > available upon request. They also offer testing for blood

> clotting

> > > abnormalities (see below). Tests must be ordered by a

physician.

> > The

> > > I.M.D. Web site is www.imd-lab.com. On this site you will find

> > > additional information about testing and disease. The Institute

> for

> > > Molecular Medicine Web site is www.immed.org. On this site you

> will

> > > find publications and documents on CFS/ME, FMS, autoimmune

> diseases

> > > and other chronic illnesses. Immediate fax-back information is

> > > available 24 hours per day by calling our telephone number 714-

> 903-

> > > 2900.

> > > > Garth Nicolson, Adjunct Professor of Internal Medicine

> > > > President and Chief Scientific Officer, The Institute for

> > Molecular

> > > Medicine

> > > > —A nonprofit institute dedicated to discovering new

diagnostic

> > and

> > > therapeutic solutions for chronic diseases—

> > > > 15162 Triton Lane, Huntington Beach, CA 92649-1041, U.S.A. •

> Tel:

> > > 714-903-2900 • Fax: 714-379-2082

> > > > So, What Is Prescribed For Mycoplasma And Chlamydia?

> > > > Fortunately, Mycoplasma and Chlamydia infections are usually

> > > sensitive to the right antibiotics. The antibiotics most likely

> to

> > > effect these organisms are:

> > > > 1. Doxycycline or Minocycline 100 mg, 2-3 times a day. These

> two

> > > antibiotics are in the Tetracycline-family and should not be

used

> > in

> > > children under eight years-old because they can cause permanent

> > > staining of the teeth. They are very effective, though, against

a

> > > number of unusual organisms (e.g., Lymes Disease). They will

> > > sometimes cause some stomach upset. If this occurs, take the

> > medicine

> > > with food and a full glass of water or lower the dose. Do not

use

> > > outdated/expired Tetracycline prescriptions—they can kill you!

> > > > 2. Cipro (Ciprofloxacin) 750 mg, twice a day. Although

> expensive,

> > > this is usually a well-tolerated antibiotic. It has a very wide

> > range

> > > of effectiveness against a large number of organisms. When

> treating

> > > males, the Cipro (as well as the Doxycycline) has the

additional

> > > benefit of treating any hidden prostate infections. Do not take

> > oral

> > > magnesium within 6 hours of Cipro or you won't absorb the Cipro.

> > > > 3. Zithromax 600 mg a day, taken with food, or Biaxin 500 mg,

> > twice

> > > a day, taken on an empty stomach. These are in the Erythro-

mycin

> > > family. Zithromax tends to be fairly well-tolerated. The Biaxin

> is

> > > more likely to cause a bit of nausea in some patients, but it

is

> > > usually well-tolerated. Both are quite expensive. They may work

> > > against infections missed by Doxycycline and Cipro.

> > > > Although all of these antibiotics can be effective, it is not

> > > uncommon for infections that are sensitive to the Erythromycin

> > > antibiotics (#3 above) to be resistant to #1 and #2 above and

> vice-

> > > versa. Therefore, it is best to try either Doxycycline or Cipro

> > > first. If they are not effective, then try the Zithromax or

> Biaxin.

> > > The antibiotic should be taken for at least 6 months. If there

is

> > no

> > > improvement in 4 months, switch to or add the other antibiotic

or

> > > simply stop the treatment. It is helpful to check for low-grade

> > > fevers. I am more likely to use antibiotics for CFIDS patients

> who

> > > have temperatures over 98.6°F, even if it is only 98.8° (I

> consider

> > > 98.8° a fever because CFIDS/FMS patients usually have low body

> > > temperatures). If you do have low-grade, chronic temperature

> > > elevations, be sure that you monitor your temperatures during

> > > treatment. If your temperature drops with the antibiotic, it

> > suggests

> > > that you do have one of these nonviral infections and the

> > antibiotic

> > > is helping. T

> > > > his would encourage me to continue the antibiotic trial -

even

> if

> > > it takes up to 12 months to see an improvement in your

symptoms.

> > > > If you are clearly better, I would probably take the

antibiotic

> > for

> > > at least 6 to 12 months. It can then be stopped. If symptoms

> recur,

> > > keep repeating 6 to 8 week cycles until the symptoms stay gone.

> It

> > > may take several years of treatment for the infection to be

> totally

> > > eradicated. To put it in perspective, this is how long children

> > often

> > > take antibiotics for acne—which unfortunately, if not taken

with

> > anti-

> > > fungals, can lead to yeast overgrowth and possibly trigger

CFIDS.

> > Be

> > > sure to take Nystatin, 2 tablets, 2 times a day, while on the

> > > antibiotics. Also, please be sure to use alternative birth

> control

> > if

> > > on " the pill. " Birth control pills may be ineffective while

> taking

> > > antibiotics. In addition, anti-depressants, codeine, antacids,

> and

> > > mineral supplements (e.g., magnesium) may block antibiotic

> > > absorption. Take these at least three hours away from the

> > antibiotic

> > > (and don't take the antidepressant/codeine medications if they

> are

> > > not clearly helping).

> > > > It is very common to get die-off (Herxheimer) reactions which

> > > include chills, fever, night sweats and general worsening of

> > CFS/FMS

> > > symptoms when the antibiotic first kills off the infection.

These

> > can

> > > be severe and last for weeks. Dr. Nicolson encourages you " to

be

> > > patient and not abandon therapy prematurely, because few

patients

> > who

> > > have been sick for years recover in less than one year of

> > therapy...

> > > [don't] be alarmed if some signs and symptoms occasionally

return

> > or

> > > worsen. This is not unusual. Eventually you will be off

> antibiotics

> > > or antivirals but you will need to continue various supplements

> to

> > > maintain your immune system and general nutritional status. "

> > > > Treatment for Bacterial, Mycoplasma, Chlamydia, E-coli,

> Bladder,

> > Or

> > > Other Infections

> > > > (From the " Treatment Checklist " used in Dr. Teitelbaum's

> office.

> > A

> > > full list is available on Dr. Teitelbaum's Web site at

> > > www.endfatigue.com.)

> > > > The Mycoplasma, Chlamydia, E-Coli, bladder and other

bacterial

> > > infections usually take months to years to eradicate. It is

> common

> > to

> > > flare your symptoms (from the infection die-off) the first two

> > weeks

> > > of treatment. Take the antibiotics for six months and, if

better,

> > > then repeat six-week cycles till your symptoms stay gone.

> > > Antidepressants, Neurontin, and/or Codeine may block the

> > antibiotic's

> > > effectiveness. Be sure to take Nystatin, 2 tablets twice a day,

> and

> > > Acidophilus while on the antibiotics. If you have occasional

low-

> > > grade fever (i.e., if over 98.6° F), check your oral

temperature

> > > occasionally to see if the antibiotic reduces or eliminates the

> > > fever. If so, stay on that antibiotic. Also, see Dr. Nicolson's

> Web

> > > site at www.immed.org for additional information.

> > > > Useful antibiotic treatment for the above infections include:

> > > > 1. Cipro (ciprofloxacin) 750 mg, 2 times a day for 6 months.

Do

> > not

> > > take magnesium products (e.g., Fibrocare, some antacids, Pro

> > Energy,

> > > or (Dr. Teitelbaum's) Foundation Formula™) within 6 hours of

> Cipro

> > > because you won't absorb the Cipro.

> > > > OR

> > > > 2. Doxycycline (a tetracycline) 100 mg, 3 times a day for 6

> > months.

> > > If symptoms recur when the Doxycycline is completed, keep

> repeating

> > 6-

> > > week courses until the symptoms stay resolved. Take Nystatin

(at

> > > least 2, twice a day) while on the antibiotic. Birth control

> pills

> > > may not work while on Doxycycline. Do not take any expired

> > > Doxycycline tablets (it's very dangerous).

> > > > OR

> > > > 3. Zithromax (azithromycin) 600 mg tablets, 1 tablet a day

> (take

> > > with food if it bothers your stomach). Don't take magnesium-

> > > containing products within six hours of the Zithromax.

> > > > OR

> > > > 4. Biaxin 500 mg, 2 times a day.

> > > > 5. D-Mannose ½ to 1 teaspoon (2.5 grams), stirred in water,

> every

> > 2

> > > to 3 hours while awake, for 2 to 5 days for acute bladder

> > infections

> > > (may use long-term for chronic infections) caused by E-coli

(this

> > > causes approximately 90% of bladder infections). If not much

> better

> > > in 24 hours, get a urine culture and consider an antibiotic. D-

> > > Mannose is available from BioTech (800-345-1199), my Web

> > > site's " Vitamin Shop " at www.endfatigue.com or my office (800-

333-

> > > 5287).

> > > > What About Yeast Overgrowth?

> > > > Yeast overgrowth is an important concern. As I have mentioned

> > > before, nothing is all good or all bad. Although cigarettes

kill

> > > hundreds of thousands of people each year, they can be helpful

in

> > > treating Parkinson's Disease or ulcerative colitis. Although

> > > antibiotics can trigger CFIDS, they can also be helpful in

> treating

> > > it. This makes it important to know when and how to use them. I

> > > strongly recommend that my patients take antifungals while on

any

> > > antibiotics (e.g., Nystatin 500,000 unit tablets, 2 tablets, 2

to

> 3

> > > times a day) to prevent yeast overgrowth. It is also reasonable

> to

> > > add Oregano Oil and other natural antifungals. Two Nystatin

twice

> a

> > > day is what I usually prescribe. Using probiotics (healthy milk

> > > bacteria-like acidophilus that helps your body) to compete with

> the

> > > yeast can also help. I am concerned that if the acidophilus is

> > taken

> > > with the antibiotic, they may simply cancel each other out.

> Because

> > > of this, I usually begin probiotics (Acidophilus or

Lactobacillus

> > in

> > > a d

> > > > ose of 3 to 6 billion units a day, taken on an empty stomach

or

> > > with milk) after one has completed the course of antibiotics.

If

> > you

> > > are only taking the antibiotic once or twice a day, and can

find

> a

> > > time at least 6 to 8 hours away from another dose to take the

> > > probiotic, it is reasonable to take it at that time. The entire

> > daily

> > > probiotic dose can also be taken at one time. If you find that

> you

> > > still get yeast overgrowth, it may be necessary to use some of

> the

> > > more potent prescription antifungals (Sporanox or Diflucan).

> > Because

> > > these can cause liver inflammation and are quite expensive, it

> may

> > be

> > > adequate to take 200mg of either of these, twice a day, one day

> > each

> > > week (e.g., take it every Sunday) instead of every day. As

> > discussed

> > > previously, be sure to take Lipoic acid 200 mg on any day you

> take

> > > Sporanox or Diflucan, to decrease the risk of liver

inflammation.

> > > > What Role Does My Blood Clotting System Play In This?

> > > > Work done by E. Berg, M.S., C.L.S. (N.C.A.), director

of

> > > Hemex Laboratories in Phoenix, Arizona (800-999-2568), has

shown

> > that

> > > a number of infections can trigger our blood clotting system to

> > > become active, thus setting up a low-level, chronic clotting

> > cascade.

> > > These infections include HHV-6, Mycoplasma, CMV and Chlamydia

> which

> > > can trigger production of (IgA) antibodies against clot

> protective

> > > proteins on blood vessel inner surfaces (called

antiphospholipid

> > > antibodies). One of these is the Beta 2 Glyco-protein 1 (anti

> B2GP1—

> > > no, you are not going to be tested on this!). This then

triggers

> > the

> > > clotting cascade. Once the clotting system is triggered, a

> product

> > > called Soluble Fibrin Monomer (SFM) is made which is like the

> > > polymers in plastic. The theory is that they create long thin

> > sheets

> > > of a teflon-like substance, similar to the scab that covers a

> cut,

> > > but microscopic, which then coats the blood vessels. This makes

> it

> > > hard for nutrients, oxygen, etc., to get in and out of the b

> > > > lood vessels to the cells where they are needed. In summary,

> many

> > > infections can cause the blood clotting system to activate,

> > resulting

> > > in a thin coating of Fibrin deposited on the blood vessels.

This

> > > prevents nutrients and oxygen from getting to the cells in your

> > body.

> > > > Why Would An Infection Trigger The Clotting System?

> > > > Many infections (called anaerobic) do not survive well in the

> > > presence of oxygen. One can theorize that these Mycoplasma

(which

> > may

> > > be anaerobic) and other organisms may trigger the clotting

system

> > to

> > > create a shell, which then acts like a suit of armor,

protecting

> > them

> > > from oxygen, your body's defense system, and antibiotics. This

> > would

> > > explain why these infections could evolve a way to trigger the

> > > clotting mechanism. The Fibrin armor preventing antibiotics

from

> > > getting to the infection could also explain why some people

with

> > > these infections may not respond to antibiotics. Indeed, some

> > > physicians have found that the antibiotics work better once

> someone

> > > has been on a blood thinner (which may dissolve the armor).

> > > > This is an interesting theory, but how do we know this is

going

> > on?

> > > Mr. Berg and others have done studies showing that the blood

> tests

> > > that look for these clotting changes (called the ISAC panel -

> > > available at Hemex labs) are abnormal in CFIDS/FMS patients

while

> > > being normal in most other patients. They use a criterion of

two

> of

> > > these tests needing to be abnormal to be considered positive.

> When

> > > this was done, 50 of 54 CFIDS/FMS patients had abnormal tests

> > (i.e.,

> > > only 7.4% of the patients had normal blood tests). In healthy

> > > patients, 22 out of 23 had normal blood tests (i.e., 96%). This

> > means

> > > the test is both very sensitive and specific, picking up people

> > with

> > > CFIDS and excluding healthy people. Our experience has shown

that

> > > almost everyone that we tested, who has CFIDS, has turned out

to

> > have

> > > a positive ISAC panel. We have not personally sent in any tests

> on

> > > healthy patients to see if this also occurs. Interestingly,

this

> > > panel is also positive in many people with unexplained infer

> > > > tility (which can improve with Heparin) and may also be

> positive

> > in

> > > people with Multiple Sclerosis, Parkinsons, Autism,

Inflammatory

> > > Bowel Disease and some other illnesses. This suggests that this

> > test

> > > can be helpful in deciding whether to treat with blood thinners

> > > (Heparin) in CFIDS/FMS.

> > > > So, How Do I Treat The Clotting System?

> > > > First of all, it is important to remember that using

injections

> > of

> > > Heparin (the blood thinner) is still a controversial and

> > experimental

> > > treatment for CFIDS/FMS. We much prefer to use treatments that

> are

> > as

> > > safe as possible. Although Heparin is routinely used in the

> U.S.A.

> > to

> > > treat blood clots, using it to treat CFIDS/FMS is very new.

Most

> of

> > > the doctors that I have spoken with have only treated a few

> > CFIDS/FMS

> > > patients with Heparin and find that about half of these

patients

> > get

> > > better with treatment. The treatment protocol, developed by

> > > Couvaras, M.D. (602-996-2411), includes the following:

> > > > 1. Remove wheat, alcohol and sugar from the diet, if possible.

> > > > 2. Check the ISAC panel. If there are at least two abnormal

> > > results, then begin treatment.

> > > > 3. Give an antifungal for 14 days (he uses Lamisil 250mg a

day—

> > > which I find to be poorly effective. I would use 200 mg of

> Sporanox

> > > or Diflucan instead).

> > > > 4. Give standard Heparin 4000 to 8000 units by injection

> > > subcutaneously (like an insulin shot) twice a day. A (possibly

> > safer)

> > > low molecular weight Heparin may also be used.

> > > > 5. If the PA index (on the ISAC) is positive, add a baby

> Aspirin

> > > (81mg) each day.

> > > > 6. After being on Heparin for one week, Dr. Couvares repeats

> the

> > > ISAC panel to adjust the dose of the Heparin and Aspirin. He

> feels

> > > that the goal is to move all the blood tests into the normal

> range

> > > but not past the normal range into blood-thinning (therapeutic)

> > > levels. If the values are still abnormal or the patient is

still

> > > having symptoms, he then increases the Heparin dosage. If the

PA

> > > index (on the ISAC) is still high, he increases the Aspirin to

> > twice

> > > a day.

> > > > 7. If the patient feels better after one month of Heparin, he

> > then

> > > switches to low-dose Coumadin (a blood thinner tablet—take 2 to

3

> > mg

> > > a day) and then stops the Heparin after 4 to 5 days of being on

> the

> > > Coumadin. Once the patient has been on the Coumadin for two

weeks

> > he

> > > goes ahead and rechecks the ISAC panel to maintain the blood

> tests

> > in

> > > the normal range.

> > > > 8. He also supplements patients with nutritional

> supplementation

> > as

> > > needed.

> > > > In my practice, because the ISAC panel runs over $320, I

check

> a

> > > baseline ISAC panel but do not repeat the ISAC panels to adjust

> > > therapy. Instead, while on Heparin, we check a PTT (a blood

> > thinning

> > > test) and platelets (a highly unusual, but potentially very

> > dangerous

> > > side effect of Heparin is a severe drop in platelet count,

which

> > can

> > > cause life-threatening bleeding) every 3 days for the first 12

> days

> > > and then every 2 to 4 weeks while on Heparin. If the PTT is

still

> > > within the normal range and the patient is not better, we

> increase

> > > the Heparin as high as 8000 units, twice a day (rarely we will

go

> > up

> > > to 8000 units, 3 times a day) and then also increase the

Aspirin

> to

> > 2

> > > a day. In comparison, hospital patients often require Heparin

at

> > 1000

> > > units per hour (24,000 units a day) I.V., while most CFS/FMS

> > patients

> > > only need 4000 to 5000 units, 2 times a day (8000 to 10,000

units

> a

> > > day). If the patient is feeling better, however, we simply

leave

> > them

> > > at the initial dose. Most patients will f

> > > > eel better at about the 10- to 14-day point if the Heparin is

> > going

> > > to help. At the end of 4 to 12 months, if the Heparin helps, we

> > > switch to Coumadin (as noted above) and check an INR

> (International

> > > Normalized Ratio), aiming to keep it below 1.3 while adjusting

> the

> > > Coumadin to the optimum does. It is very important to know that

> > most

> > > medications can change the blood level of Coumadin and that

> anytime

> > > anything is added to, or deleted from, your regimen (including

> > > natural remedies) you need to recheck the INR 4 to 7 days later

> to

> > > make sure that it is not going too high. Heparin and Coumadin

are

> > > powerful medicines and the main risk is bleeding. Although we

are

> > > using very low doses, which are usually very well-tolerated,

one

> > can

> > > rarely see a life-threatening bleed occur. If you felt better

on

> > the

> > > Heparin and then the symptoms come back on the Coumadin, you

may

> > need

> > > to go back on the Heparin for several months to re-establish

and

> > > maintain the benefit. Occasionally, people will need to b

> > > > e on the Heparin for an extended period, in which case the

> blood

> > > tests (PTT and platelet count) should be checked every 2 to 4

> > weeks.

> > > All of this being said, most people tolerate these treatments

> quite

> > > well and many, many more people die from taking Aspirin (e.g.,

> for

> > > arthritis) than Heparin each year.

> > > > In summary, there are a number of infections that can cause

or

> > > occur because you have CFIDS/FMS. Once they occur, they can

> trigger

> > > the clotting cascade. This may keep the nutrients from getting

to

> > > your body and create a " suit of armor " for the viral and

> Mycoplasma

> > > infections. Using a blood thinner can break down these armor

> > coatings

> > > that protect the infections from our treatment and allow

> nutrients

> > to

> > > get where they need to go. Many tests can help. The one that I

> use

> > to

> > > decide whether to use the Heparin blood thinner is the ISAC

panel

> > (at

> > > Hemex Labs). Testing for infections may be helpful, but can be

> > > expensive and less likely to effect my decision to treat. If

you

> > can

> > > afford the tests and/or your insurance will pay for them, they

> are

> > > worth checking and will make it easier to adjust therapy over

> time.

> > > If you can't afford it, it is reasonable to treat empirically

> > (i.e.,

> > > without testing), except for high-dose Valtrex therapy. If you

> have

> > > lung congestion and/or recurrent temperatures o

> > > > ver 98.6°F, I would treat with the antibiotics. If you feel

> > > chronically flu-like, I would consider the HHV-6 or (based on

> > > testing) the high-dose Valtrex regimen. It is also reasonable

to

> > > treat with antibiotics and antivirals simultaneously -

especially

> > if

> > > you are taking the anticoagulants.

> > > > Chronic Sinusitis The Yeasty Beasties Revisited!

> > > > As was mentioned years ago, we speculated that the chronic

> sinus

> > > congestion seen in CFIDS/FMS could be caused by yeast

overgrowth.

> A

> > > recent interesting study from the Mayo Clinic Proceedings

> supports

> > > this thought. In the study, researchers found that most people

> with

> > > chronic sinus infections had fungal growth in their sinuses.

They

> > > felt that the inflammation was being caused by an immune (the

> > body's

> > > reaction) response to the fungus. This research is interesting

> > > because more and more studies are showing that treating chronic

> > > sinusitis with antibiotics doesn't really do much and that

> shorter

> > > courses of treatment work just as well as the long courses. We

> find

> > > that conservative treatment (see my newsletter article,

Treatment

> > Of

> > > Respiratory Infections Without Antibiotics, Vol. 2, Issue 2) is

> > more

> > > effective than antibiotics for chronic sinusitis.

> > > > It's good that medicine is finally starting to catch up with

> > > reality. The report in The Mayo Clinic Proceedings noted

> > > that, " fungus allergy was thought to be involved in less than

10%

> > of

> > > cases… our studies indicate, in fact, fungus is likely the

cause

> of

> > > nearly all of these problems and that it is not an allergic

> > reaction

> > > but an immune reaction. " In this study, the researchers studied

> 210

> > > patients with chronic sinusitis. Using new methods to collect

and

> > > test sinus/nasal mucus they found fungus in 96% of patients.

> > > > It's interesting to observe how medical research works. The

> > > researchers are now working with different drug companies to

set

> up

> > > trials to test medications to control the fungus but feel that

it

> > > will be at least two years before any treatments will be

> available.

> > > In my experience, though, these problems often respond

> dramatically

> > > to either Sporanox or Diflucan - which, by no coincidence, are

> very

> > > powerful antifungal agents. It is not clear why the researchers

> did

> > > not simply try Sporanox or Diflucan. Un-fortunately, we find

that

> > the

> > > obvious is often overlooked. This sometimes occurs as drug

> > companies

> > > seek to make more money by finding new drugs instead of using

the

> > old

> > > things that are known to work. It is important to distinguish

> > between

> > > chronic sinusitis (which lasts for over three months) and acute

> > > sinusitis (which usually has been going on for a few days and

> less

> > > than a month). For these shorter attacks of sinusitis, bacteria

> are

> > a

> > > more common cause and antibiotics (combined with n

> > > > atural remedies) can be helpful. Some researchers still

> continue

> > to

> > > argue that fungus is not a cause of chronic sinusitis. They

note

> > that

> > > fungi are seen even in healthy noses (which is correct) but

> neglect

> > > to discuss the immune changes that are also seen in these

noses.

> > > Because so many people have responded dramatically to

antifungals

> > in

> > > the treatment of their chronic sinusitis, my suspicion is that

> the

> > > Mayo Clinic researchers are probably correct. Wouldn't it be

> nice,

> > if

> > > instead of arguing about treatments while people stay sick,

they

> > > would just try the treatments to see if they worked!

> > > > As you can see, your body's defenses being down plays a large

> > role

> > > in CFIDS/FMS. The good news is, that by treating the many

> > underlying

> > > infections common in CFIDS patients and by treating any

hormonal

> > and

> > > nutritional deficiencies, you can bring your immune system back

> to

> > a

> > > healthy state!

> > > > Important Points

> > > > • An important component of CFS is disordered immune

function,

> > > which opens the door to repeated infections, repeated treatment

> > with

> > > antibiotics, and yeast overgrowth.

> > > > • Treat yeast overgrowth by avoiding antibiotics and sweets.

> Many

> > > patients have found Nystatin and other antifungal medications,

> such

> > > as Diflucan and Sporanox, to be helpful. Acidophilus (milk

> > bacteria)

> > > and natural antifungals such as Caprylic acid and garlic are

also

> > > often useful.

> > > > • Bowel parasites are common in CFS patients, whose symptoms

> > often

> > > respond dramatically to treatment. However, most labs do not

> > > adequately detect parasites through stool testing. To get an

> > accurate

> > > test result, use one of the labs we recommended that

specializes

> in

> > > stool testing.

> > > > • Treat Cryptosporidium with Artemesia annua or tricyclin

> (herbal

> > > antiparasitics).

> > > > • Treat constipation with Turkey Rhubarb (a herb).

> > > > • Prevent parasitic infection by using a Multi-pure water

> filter

> > > (available from 888-801-8176 or 410-224-4877)

> > > > • If you have temperatures over 98.6°F and/or chronic lung

> > > congestion, try long-term Cipro or Doxycycline (while on

> Nystatin).

> > > > • If you have chronic flu-like symptoms, despite yeast and

> Cortef

> > > treatment, consider the antiviral, immune stimulating protocol

we

> > > discussed.

> > > >

> > >

> >

>

[Guest guest]

Sandy,

Great article! I printed it out at a whopping 29 pages!Thanks for

posting it.

Bindi

[Guest guest]

PH- I found the adrenal stress end. I'm interested in trying it out.

How long did you take it for? Did you notice that you had any more

energy? Did you have any side effects or anything?

~Krista

> > > > >

> > > > > From Fatigued to Fantastic Newsletter

> > > > > Vol. 3, No. 3 (2000)--Vol 4, No. 1 (2001)

> > > > >

> > > > > Fighting Those Persistent Infections in CFIDS

> > > > > By Teitelbaum, M.D.

> > > > > Medical science has known for quite some time that Chronic

> > > Fatigue

> > > > Syndrome is associated with changes in the body's immune

> system.

> > In

> > > > fact, the acronym " CFIDS " stands for " Chronic Fatigue And

> Immune

> > > > Dysfunction Syndrome. " This can result in your having several

> > > > different and unusual infections at one time. Many of these

> > > > infections need to be treated directly. Other infections will

> go

> > > away

> > > > on their own as your immune (defense) system comes back " on

> line "

> > > by

> > > > using our treatment protocol. In this article, I'll discuss

> some

> > of

> > > > the more common, yet not usually thought of (in " regular "

> > > medicine),

> > > > infections.

> > > > > What Kind Of Infections Am I Most At Risk For?

> > > > > Although CFIDS of sudden onset often seems to be triggered

by

> > > viral

> > > > infections (e.g., EBV, HHV-6, CMV), those infections, I

> suspect,

> > > > are " simmering " or no longer active in many cases. However,

the

> > > body

> > > > acts as if they are. This may result in elevated interferon

> > levels.

> > > I

> > > > suspect this was what triggered my CFIDS.

> > > > > The body produces interferon to fight viral infections.

When

> a

> > > > cancer or hepatitis patient is injected with interferon, the

> > > patient

> > > > becomes achy, fatigued and brain-fogged. An under-active

> adrenal

> > > can

> > > > also cause interferon levels to become elevated. Because of

> this

> > > > elevation, it is more accurate to say that the body's immune

> > system

> > > > is not functioning properly, than to say that it is

> underactive.

> > > > Indeed, in many ways, the immune system may be in overdrive

and

> > > soon

> > > > exhaust itself. The immune system malfunctions in many other

> > ways,

> > > > too, including decreasing the effectiveness of the

> > body's " natural

> > > > killer " cells, which are an important defense mechanism.

> > > > > Many other recurrent or unusual infections can also occur

> > because

> > > > of your malfunctioning immune system. Chronic sinus, bladder,

> > > > prostate and respiratory infections are common and are often

> > > treated

> > > > with repeated courses of antibiotics. The large amount of

> > > antibiotics

> > > > introduced into the system can cause a secondary yeast over-

> > growth

> > > as

> > > > it changes the natural balance between the bowel's healthy

> > bacteria

> > > > and yeast. The original immune dysfunction also contributes

to

> > the

> > > > yeast overgrowth. Although it is controversial, a theory held

> by

> > > many

> > > > physicians is that chronic overgrowth of yeast due to overuse

> of

> > > > antibiotics is a potential and strong trigger for chronic

> > fatigue,

> > > > fibromyalgia and further immune dysfunction. What makes the

> > theory

> > > > controversial is that no definitive tests exist to

distinguish

> > > fungal

> > > > overgrowth from normal fungal levels. Also, many of the

> symptoms

> > > > ascribed to yeast overgrowth can also come from the many

other

> > > > problems present in chronic fatigue syndrome and fibromya

> > > > > lgia. On the other hand, most doctors who try treating

yeast

> in

> > > at

> > > > least three or four CFS patients see how well it works and

keep

> > > using

> > > > it.

> > > > > CFIDS patients also frequently have bowel parasite

> infections.

> > > > Bowel parasites can cause severe allergic or sensitivity

> > reactions,

> > > > which in turn can trigger fibromyalgia and fatigue. Often, a

> > > patient

> > > > will finally recover from long-standing and disabling fatigue

> > > within

> > > > a week or two after beginning treatment for bowel parasites.

> > > > > Many other CFS/FMS patients are left with disabling fatigue

> > after

> > > a

> > > > bout with viral infections such as polio, HHV-6, CMV, or EB

> viral

> > > > infections. This fatigue also usually responds to the

> treatments

> > > > discussed in this newsletter. In addition, infections with

> > unusual

> > > > organisms such as Rickettsia (e.g., Lymes Disease),

chlamydia,

> > and

> > > > mycoplasma may also be problematic.

> > > > > Yeast Overgrowth

> > > > > Everyone's immune system has strong spots, as well as weak

> > spots.

> > > > Some people never get colds but have frequent bouts with

> > athlete's

> > > > foot or other skin fungal infections. Others never get fungal

> > > > infections but tend to get colds. Many people seem to have a

> > > > diminished ability to fight off fungal infections.

> > > > > Fungi are very complex organisms. Fungal overgrowth may

> > suppress

> > > > the body's immune system. The host body may also develop

> allergic

> > > > reactions to components of the yeast.

> > > > > This allergic reaction was suggested in a study which

> connects

> > > > Candida Albicans with Allergic Skin Dermatitis (Eczema). This

> > study

> > > > was published in The Journal of Clinical Experimental Allergy

> > back

> > > in

> > > > 1993 (Vol. 23, pp. 332-339). It found that there is a

> significant

> > > > correlation between the body having antibodies to Candida and

> > > > Allergic Dermatitis/Eczema. In addition, we have found that

> > > > unexplained rashes that have lasted for many years often

clear

> up

> > > > with antifungal treatment as well! Many physicians feel that

> > yeast

> > > > overgrowth causes a generalized suppression of the immune

> system.

> > > In

> > > > other words, once the yeast gets the upper hand, it sets up a

> > cycle

> > > > that further suppresses your body's defenses. Interestingly,

a

> > > recent

> > > > Mayo Clinic study showed that most cases of chronic sinusitis

> > seem

> > > to

> > > > be associated with a reaction to yeast in the sinuses -

> something

> > I

> > > > proposed years ago. None the less, as I already noted, this

> > theory

> > > is

> > > > controversial. Yeast are normal members of our body's " zoo.

> > > > > " They live in balance with bacteria - some of which are

> > helpful

> > > > and healthy and some of which are detrimental and unhealthy.

> The

> > > > problems begin when this harmonious balance shifts and the

> yeast

> > > > begin to overgrow.

> > > > > As noted above, many things can prompt yeast to overgrow.

One

> > of

> > > > the most common causes is frequent antibiotic use. When the

> good

> > > > bacteria in the bowel are killed off by antibiotics (along

with

> > the

> > > > bad bacteria) the yeast no longer have competition and begin

to

> > > > overgrow. The body is often able to rebalance itself after

one

> or

> > > > several courses of antibiotics, but after repeated or long-

term

> > > > courses - and especially if the body has an underlying immune

> > > > dysfunction - the yeast can get the upper hand.

> > > > > Other factors are also important. Studies have shown that

> > animals

> > > > who are sleep deprived and/or have increased sugar intake

> develop

> > > > bowel yeast overgrowth. Many physicians feel that eating

sugar

> > > > stimulates yeast overgrowth in people, as well. Sugar is food

> for

> > > > yeast. Yeast ferment sugar in order to grow and multiply.

Yeast

> > > > overgrowth due to sugar overuse also seems to cause immune

> > > > suppression, which facilitates bacterial infections, which

then

> > > > requires even more antibiotic use. Poor sleep also results in

> > > marked

> > > > suppression of your immune function.

> > > > > How Does One Know If They Have Yeast?

> > > > > There are no definitive tests for yeast overgrowth that

will

> > > > distinguish yeast overgrowth from normal yeast growth in the

> > body.

> > > > There is one test which may be useful, though. This is a

Urine

> > > > Tartaric Acid test done by The Great Plains Lab in Kansas

City,

> > > > Missouri, run by Shaw, Ph.D. Tartaric Acid is a waste

> > > product

> > > > of yeast growth. In fermenting wine, for example, it is

> critical

> > to

> > > > remove the Tartaric Acid. Otherwise, the wine could be toxic

to

> > > > people. Dr. Shaw has found elevations in Urine Tartaric Acid

> that

> > > > decrease with antifungal treatment in both CFIDS/FMS patients

> and

> > > > autistic children. Interestingly, both these illnesses often

> > > improve

> > > > with antifungals (specifically, Sporanox or Diflucan, plus

> > > Nystatin).

> > > > Dr. Shaw likes to use the Urine Tartaric Acid to decide when

to

> > > treat

> > > > yeast overgrowth and to follow-up the effectiveness of

> treatment.

> > > > > In my experience, however, using Dr. Crook's Yeast

> > Questionnaire

> > > > (available in my book, From Fatigued To Fantastic!) is still

> the

> > > most

> > > > reliable way to tell if a person is at risk of yeast

> overgrowth.

> > If

> > > > the symptom score is over 140 points, I recommend treatment.

In

> > > > addition, anyone who has been on recurrent or long-term

> > antibiotic

> > > > use (especially Tetracycline for acne) or anyone who

> > intermittently

> > > > has painful sores in different parts of the mouth that last

for

> > > about

> > > > ten days at a time and who has CFIDS/FMS, should be treated

> with

> > > > antifungals. Bowel symptoms are some of the more overt

symptoms

> > > that

> > > > are caused by yeast and I feel that most people who

> have " spastic

> > > > colon " have yeast overgrowth or parasites.

> > > > > How Is Yeast Treated?

> > > > > A number of very effective methods can be utilized to take

> care

> > > of

> > > > a yeast problem. Primary among the methods is to avoid sugar

> and

> > > > other sweets. One can enjoy one or two pieces of fruit a day,

> but

> > > > should not consume concentrated sugars such as juices, corn

> > syrup,

> > > > jellies, pastry, candy or honey. Stay far away from soft

> drinks,

> > > > which have ten to twelve teaspoons of sugar in every twelve

> > ounces.

> > > > This amount of sugar has been shown to markedly suppress

immune

> > > > function for several hours. Be pre-pared to have withdrawal

> > > symptoms

> > > > for about one week when sugar is cut out of the diet. Several

> > > > excellent books have been written on the yeast controversy

and

> > > offer

> > > > additional methods to try. One of the best books is The Yeast

> > > > Connection and the Woman by Crook, M.D., a physician

> who

> > > has

> > > > done a spectacular job advancing the understanding of

CFIDS/FMS.

> > > > > Many patients have found that acidophilus (that is, milk

> > > bacteria,

> > > > a healthy bacteria for the bowel) helps restore balance in

the

> > > bowel.

> > > > Acidophilus is found in yogurt with live and active yogurt

> > > cultures.

> > > > Indeed, one cup of yogurt a day can markedly diminish the

> > frequency

> > > > of recurrent vaginal yeast infections. Acidophilus is also

> > > available

> > > > in capsule form. Although many claims are made for one type

of

> > > > acidophilus being better than the other, I'm not sure this is

> so.

> > I

> > > > usually recommend 3 to 6 billion units a day (1 unit = 1

> > bacteria)

> > > on

> > > > an empty stomach. If on antibiotics (not antifungals), take

the

> > > > acidophilus at least 3 to 6 hours away from the antibiotic

> dose.

> > > > > Nystatin, an antifungal medication, has also been helpful

in

> > the

> > > > treatment of yeast overgrowth. Unfortunately, some fungi seem

> to

> > be

> > > > resistant to Nystatin. In addition, Nystatin is poorly

> absorbed,

> > > > which means that it has little impact on the yeast outside of

> the

> > > > bowel. Other anti-fungal medications, such as Diflucan and

> > > Sporanox,

> > > > seem to be effective systemically (throughout the body) but

> they

> > > have

> > > > two main drawbacks. First, they are expensive, costing more

> than

> > > $450

> > > > to $900 for a two-month course. Second, any effective anti-

> fungal

> > > can

> > > > initially make the symptoms of yeast infection worse.

Although

> > > > uncommon, Sporanox and Diflucan can also cause liver

> inflammation

> > > (as

> > > > can Advil and Tylenol). If you are taking Sporanox or

Diflucan

> > for

> > > > more than 6 to 12 weeks, I would consider intermittently

> checking

> > > > liver blood tests (ALT and AST). If you have preexisting

active

> > > liver

> > > > disease, be cautious in using (or don't use) Sporanox or

> > Diflucan.

> > > I

> > > > strongly recommend taking Lipoic Acid (a natural

> > > > > supplement which protects and helps heal the liver), 200mg

a

> > > day,

> > > > whenever you take Sporanox or Diflucan. I also strongly

> recommend

> > > > Lipoic Acid for anyone with active liver disease (e.g.,

> > hepatitis)

> > > at

> > > > doses up to 1000mg to 3000mg a day as it may prevent and/or

> treat

> > > > cirrhosis.

> > > > > Natural Yeast Treatments

> > > > > Below, I have summarized the nonprescription part of the

> > > treatment

> > > > checklist that I use in my office.

> > > > > 1. Avoiding sweets is still the single most important

thing.

> > > Using

> > > > Stevia as a sweetener is a wonderful substitute. Stevia is a

> > safe,

> > > > natural remedy and you can use all you want. There are even

> > > cookbooks

> > > > for using Stevia (available from my office or 800-4STEVIA). A

> new

> > > > natural sweetner, Sweet Balance, also tastes good and is 12

> times

> > > as

> > > > sweet as sugar. It is a natural product from the Lo Han fruit

> and

> > > > appears to be safe. Although it is 70% sugar (fructose), you

> only

> > > > need a small amount. Order it from 877-997-9338, my office at

> 800-

> > > 333-

> > > > 5287 or my Web site at www.endfatigue.com.

> > > > > 2. Acidophilus or Milk Bacteria can be very helpful. Take 3

> to

> > 6

> > > > billion units a day (a unit is the same as a bacteria). Do

not

> > take

> > > > acidophilus within 3 to 6 hours of an antibiotic. Take it

> either

> > on

> > > > an empty stomach or with milk.

> > > > > 3. Caprylic Acid is another natural remedy that can be

> helpful.

> > > The

> > > > usual dose is 1800 to 3600mg a day with 1/3 of the dose being

> > taken

> > > > at each meal. Unfortunately, it often causes an acid stomach

> with

> > > > a " funky " tasting reflux.

> > > > > 4. Oregano Oil - enteric coated oregano oil - 1 to 2

> capsules,

> > 2

> > > to

> > > > 3 times a day with food, may be more effective and better

> > tolerated

> > > > than Caprylic Acid (both can cause stomach acid reflux).

> > > > > 5. Fresh Garlic, if you can handle it well, can also be

very

> > > > effective. Daily, crush 1 to 3 garlic cloves in olive oil,

add

> > > salt,

> > > > spread it on bread and eat it. It can be quite tasty and

lethal

> > to

> > > > whatever infections you have in your gut.

> > > > > 6. Olive Leaf 500mg, 2 to 4 capsules three times a day

> between

> > > > meals, can also be very helpful in treating yeast overgrowth.

> > > > > 7. Pau De Arco in either tea or capsule form is also

helpful

> in

> > > > yeast suppression. Although I use Pau De Arco infrequently

for

> > > yeast

> > > > over-growth, many people find that it can be helpful.

> > > > > 8. Grapefruit Seed Extract (e.g., Citrucidel) is a popular

> > > > treatment for yeast overgrowth and is well-tolerated.

> > > > > More Information On Yeast Treatments

> > > > > If symptoms of yeast are caused by an allergic or

sensitivity

> > > > reaction to the yeast body parts, the symptoms may flare when

> > mass

> > > > quantities of the yeast are suddenly killed off. This is

called

> a

> > > > yeast " die-off " reaction. If you get this reaction, start

your

> > > > treatment with acidophilus and a sugar-free diet for a few

> weeks

> > > > followed by oregano oil and/or olive leaf (1500mg to 2000mg,

3

> > > times

> > > > a day between meals) before beginning Nystatin. Take Nystatin

> (by

> > > > mouth) in the form of 500,000-IU tablets or powder. I

generally

> > > > recommend beginning with 1 tablet a day for 1 to 3 days, and

> > > > increasing by 1 tablet every 1 to 3 days (or slower if

> yeast " die-

> > > > off " is a problem) until 2 tablets 2 to 4 times a day is

> reached.

> > > If

> > > > you get nausea, take a lower dose. Take Nystatin, 4 to 8

> tablets

> > > > daily, for 5 to 8 months. I add the Diflucan or Sporanox one

> > month

> > > > after beginning the Nystatin. Take 200mg every morning for

six

> > > weeks.

> > > > If symptoms flare, take just 100mg per morning for the first

3

> to

> > > 14

> > > > days. I

> > > > > f symptoms recur after stopping the Diflucan or Sporanox, I

> > > > recommend continuing the medication for an additional 6 weeks

> at

> > > > 200mg a day.

> > > > > Sporanox should be taken with food. If it is taken alone,

its

> > > > absorption is greatly reduced. When taking Diflucan or

> Sporanox,

> > DO

> > > > NOT use the antihistamines Seldane or Hismanal, Quinidine (a

> > heart

> > > > medicine), cholesterol-lowering medications in the Mevacor

> > family,

> > > or

> > > > the bowel medicine Propulcid. These can be fatal

combinations!

> > > Also,

> > > > antacid medications (such as Tagamet, Axid, Zantac, and

Pepcid)

> > > > prevent the proper absorption of Sporanox. At the high price

of

> > > > Sporanox per dose, you will want to absorb every last bit of

> the

> > > > medication. If you need to be on an antacid medication, use

> > > Diflucan

> > > > instead of Sporanox. Unfortunately, a less expensive

> antifungal,

> > > > called Lamisil (at 250mg a day), does not seem to work very

> well

> > > for

> > > > candida yeast overgrowth (although it works well for nail

> > > > infections). I am currently trying patients on 500mg of

Lamisil

> a

> > > day

> > > > to see if this dose works better.

> > > > > I feel that once the yeast has been effectively decreased

and

> > > kept

> > > > that way for six to twelve months, it is safe to try to add

> small

> > > > amounts of sugar back into the diet. If symptoms recur,

> however,

> > > stop

> > > > the sugar again. Continuing to eat yogurt with live and

active

> > > > acidophilus cultures (unless you are lactose-intolerant) or

> > > > continuing to take acidophilus capsules may also help.

> > > > > Many books on yeast overgrowth (including Dr. Crook's)

advise

> > > > readers to avoid all yeast in the diet. This advice is based

on

> > the

> > > > theory that an allergic reaction to yeast is the cause of the

> > > > problem. The predominant yeast that seems to be involved in

> yeast

> > > > overgrowth is Candida Albicans, although I would not be

> surprised

> > > if

> > > > researchers discovered that many other kinds of fungal

> infections

> > > are

> > > > also involved. The yeast that is found in most foods (except

> beer

> > > and

> > > > cheese) is not closely related to candida.

> > > > > In my experience, trying to avoid all yeast in foods

results

> > > simply

> > > > in a nutritionally inadequate diet and little benefit.

Although

> a

> > > few

> > > > people do appear to have true allergies to the yeast in their

> > food,

> > > > they number less than 10 percent of my patients with

suspected

> > > yeast

> > > > overgrowth. These patients may benefit from the more strict

> diet

> > in

> > > > Dr. Crook's book. Interestingly, once their adrenal

> insufficiency

> > > and

> > > > yeast overgrowth are treated, most people find that their

> > allergies

> > > > and sensitivities to yeast and other food products seem to

> > improve

> > > or

> > > > disappear.

> > > > > Nutritional deficiencies such as low zinc or low selenium

may

> > > also

> > > > decrease resistance to yeast over-growth. A good multivitamin

> > > > supplement, as recommended in my last newsletter, should take

> > care

> > > of

> > > > these deficiencies. This is further evidence that all the

> factors

> > > > involved in CFS are closely interrelated.

> > > > > The best thing that one can do to combat yeast overgrowth

is

> to

> > > try

> > > > to avoid it in the first place. When you get an infection,

> begin

> > > > treating it naturally immediately. Hopefully, you can prevent

> it

> > > from

> > > > turning into a bacterial infection which might require an

> > > antibiotic.

> > > > Ask your doctor what measures you can take before resorting

to

> > > > antibiotics. Many good over-the-counter remedies are

available.

> A

> > > > knowledgeable pharmacist may also be a wealth of information.

> > Your

> > > > local book or health food store has books on natural

measures.

> > Your

> > > > health food store proprietor can also steer you to

appropriate

> > > > natural remedies. For examples of the many helpful measures

> that

> > > one

> > > > can take, see my newsletter article, Treating Infections

> Without

> > > > Antibiotics, page ___).

> > > > > If you find however, that you must take an antibiotic, all

is

> > not

> > > > lost. One can still lessen the severity of yeast overgrowth

by

> > > > avoiding sweets and by either taking acidophilus capsules

> (again,

> > > not

> > > > within 3 to 6 hours of an antibiotic) or by eating one cup of

> > > yogurt

> > > > with live and active acidophilus cultures daily. Don't use

the

> > > yogurt

> > > > (or milk) if you have sinusitis or pneumonia because the milk

> > > protein

> > > > thickens mucus and makes it hard for the body to fight these

> > > > infections.

> > > > > How Can One Tell If The Yeast Is Coming Back?

> > > > > It is normal for yeast symptoms to resolve after treatment.

> > After

> > > 6

> > > > weeks on the Sporanox or Diflucan, patients are usually

feeling

> a

> > > lot

> > > > better, but may have symptoms recur soon after stopping the

> > > > antifungal. In this case I would continue the Sporanox or

> > Diflucan

> > > > for another 6 weeks, or as long as is needed, to keep the

> > symptoms

> > > at

> > > > bay. More frequently, people will feel better after treatment

> and

> > > > stay feeling fairly well for a period of 6 to 24 months. At

> that

> > > > time, it is common to see a recurrence of symptoms,

especially

> if

> > > one

> > > > is eating too much sugar or is taking antibiotics. The best

> > marker

> > > > that I have found for yeast overgrowth would be a return of

> bowel

> > > > symptoms with gas, bloating and/or diarrhea or constipation.

If

> > > these

> > > > symptoms persist for more than 2 weeks, especially if there

is

> > also

> > > > even a mild worsening of the FMS symptoms, it is very

> reasonable

> > to

> > > > retreat yourself with 6 weeks of Nystatin and perhaps

Sporanox

> or

> > > > Diflucan. In addition, I would also retreat if there's

> > > > > a recurrence of vaginal yeast or sinus infections. If re-

> > > treatment

> > > > resolves the symptoms, one may opt to repeat this regimen as

> > often

> > > as

> > > > is needed (usually every 6 to 24 months). By using some of

the

> > > > natural remedies listed above, however, you may be able to

> avoid

> > > > repeated use of these antifungals and the possible risk of

> > becoming

> > > > resistant to them. Some patients also find that they need to

> stay

> > > on

> > > > the antifungals for extended periods of time (years) or the

> > > symptoms

> > > > will recur. When this is necessary, I add the natural

remedies.

> I

> > > > will, however, also use the medications when needed. The main

> > risk

> > > of

> > > > long-term use of the antifungals Sporanox and Diflucan would

be

> > > liver

> > > > inflammation. If these medications are being used for

extended

> > > > periods, consider checking liver tests (SGOT and SGPT) every

3

> to

> > 6

> > > > months and anytime that a severe flu-like feeling or

worsening

> of

> > > > symptoms occur. As noted above, it is very important to take

> > Lipoic

> > > > Acid 200mg a day when on Sporanox or Diflucan. Althoug

> > > > > h I am not aware of any studies using Lipoic Acid with

> > > antifungals,

> > > > in my experience I have seen no worrisome elevation on liver

> > tests

> > > if

> > > > patients are using this natural substance while taking these

> > > > antifungals. As an alternative, instead of taking the

> antifungals

> > > > every day, many people find they can get long-term

suppression

> of

> > > the

> > > > yeast by taking Sporanox or Diflucan 200mg twice a day, one

day

> > > each

> > > > week (e.g., each Sunday).

> > > > > Help For Chronic Bladder Infections

> > > > > Although we will be discussing some unusual infections,

> > CFIDS/FMS

> > > > patients also get more of the day-to-day variety of

infections.

> > > These

> > > > include Urinary Tract (bladder) Infections (UTI). The main

> > symptoms

> > > > of a UTI are discomfort (e.g., burning) when urinating

> (dysuria),

> > > > urgency (which is the feeling that you have to go very badly

> and

> > > > right away when there is not much urine there), and frequency

> > with

> > > > low volume. These symptoms are also common in CFIDS/FMS

> patients

> > in

> > > > the absence of bladder infections and, when severe, is called

> > > > Interstitial Cystitis. I would not label someone as having

> > > > Interstitial Cystitis unless this is the major symptom of

their

> > > > CFIDS/FMS, because almost everyone with this illness has some

> > > urinary

> > > > urgency and frequency. Because bladder symptoms can be seen

in

> > both

> > > > UTI and CFIDS/FMS, it is important to have a urine culture

done

> > > > before treatment with antibiotics to make sure that there is

an

> > > > infection and not just muscle spasms in the bladder that are

> > > causing

> > > > these

> > > > > symptoms. If there is an infection, over 90% of the time it

> > will

> > > be

> > > > E-coli. This bacteria is normally found in everyone's gut

and,

> > with

> > > > the exception of a few rare dangerous forms, is a healthy

part

> of

> > > our

> > > > normal bowel bacteria. The problem occurs when the E-coli

gets

> > out

> > > of

> > > > the bowel where it belongs and into the bladder. Usually the

> > > bladder

> > > > will wash out most infections when the urine comes out. The E-

> > coli

> > > > however, have little velcro-like projections that stick to

the

> > > > bladder wall so that they can not be washed out by urination.

> > > > > Taking antibiotics will kill a bladder infection but will

> also

> > > kill

> > > > the healthy bacteria in the bowel. This sets one up for yeast

> > > > overgrowth and other problems. Because of this, unless there

is

> > > fever

> > > > or back pain over the kidneys or a toxic feeling, it is

> > reasonable

> > > to

> > > > try natural remedies for one to three days before going with

> the

> > > > antibiotics. One can start these treatments while waiting for

> the

> > > > urine culture to come back.

> > > > > What Natural Remedies Can Be Used For Bladder Infections?

> > > > > There are two excellent natural remedies that can keep the

E-

> > coli

> > > > from sticking to the bladder walls so they can be washed out.

> In

> > > > addition, taking vitamin C in high dose (e.g., 500 to 5000mg

a

> > day)

> > > > can acidify the urine, making it inhospitable to the

bacteria.

> > > > Drinking a lot of water also helps to wash out the infection.

> > > > > The two natural remedies that keep the bacteria from

sticking

> > are:

> > > > > 1. Cranberries—Because approximately 20% of the female

> > population

> > > > suffers from UTIs, several studies have been done looking at

> this

> > > > remedy. An early study of 44 female and 16 male patients with

> > acute

> > > > bladder infections drank 16 oz. of cranberry juice a day for

15

> > > days.

> > > > Of these patients, 53% had positive responses and another 20%

> > > showed

> > > > modest improvement. Six weeks after stopping the juice, 27

> > patients

> > > > did have persistent recurrent infections and 8 of these had

no

> > > > symptoms. Seventeen patients had no symptoms and negative

urine

> > > > cultures.

> > > > > In another study of elderly women (who are more likely to

> have

> > > > bladder infections), 153 women either received 10 oz. of

> > cranberry

> > > > drink or placebo every day for 6 months. The group that got

the

> > > > cranberry drink had 68% fewer bladder infections during that

> > > period.

> > > > In this study, the juice was sweetened with saccharin instead

> of

> > > > sugar. Other studies have also shown benefit using cranberry

> > juice

> > > in

> > > > bladder infections.

> > > > > Significant benefits are achieved by using 6 to 16 oz. of

> > > cranberry

> > > > juice a day. Because cranberry juice has a lot of sugar and

can

> > > > promote yeast overgrowth and aggravate other symptoms in

> > CFIDS/FMS,

> > > I

> > > > think it is much better to use pure cranberry juice powder in

> > > capsule

> > > > or tablet form (standardized to contain 11% to 12% quinic

> acid).

> > > The

> > > > therapeutic dose is 1 to 2 capsules a day. Conversely, you

can

> > use

> > > > unsweetened cranberry juice and add Stevia as a natural

> > sweetener.

> > > In

> > > > general, if one gives the usual cranberry juice cocktails a

> > > strength

> > > > of 1 unit - then, cranberry juice drinks have a strength of

½;

> > > > cranberry sauce a strength of ½; fresh or frozen cranberries

> are

> > 4

> > > > times as potent; pure cranberry juice is 4 times as potent;

and

> > > > cranberry juice capsules from unsweetened cranberry juice

> powders

> > > are

> > > > 32 times as potent.

> > > > > Cranberries work to help bladder infections because they

have

> a

> > > > chemical (proanthocyanidins) that prevents the bacteria from

> > > sticking

> > > > to the bladder wall. They may also decrease the risk of

kidney

> > > stones

> > > > (although magnesium with B6 is much better for this), as well

> as

> > > > possibly reduce urine odor.

> > > > > D-Mannose - This is more effective than cranberry juice.

> > Mannose

> > > is

> > > > a natural sugar (not the kind that causes symptoms or yeast

> > > > overgrowth) that is excreted promptly into the urine.

> > Unfortunately

> > > > for the E-coli bacteria, the fingers that stick to the

bladder

> > wall

> > > > stick to the D-Mannose even better. When one takes a large

> amount

> > > of

> > > > D-Mannose, it spills into the urine, coating all the E-coli's

> > > > little " sticky fingers " so that the E-coli are literally

washed

> > > away

> > > > with the next urination. The nice thing about the natural

> > approach,

> > > > as opposed to antibiotics, is that the cranberries or D-

Mannose

> > > will

> > > > not kill the healthy bacteria, thereby not bothering the

normal

> > > > balance of bacteria in the bowel. In addition, the D-Mannose

is

> > > > absorbed in the upper gut before it gets to the friendly E-

coli

> > > that

> > > > are normally present in the colon. Because of this, it helps

> > clear

> > > > the bladder without causing any other problems. In addition,

> the

> > D-

> > > > Mannose even tastes good.

> > > > > The D-Mannose is quite safe, even for long-term use,

although

> > > most

> > > > people will only need it for a few days. Those who have

> frequent

> > > > recurrent bladder infections may, however, choose to take it

> > every

> > > > day. The usual dose of D- Mannose is 1/2 teaspoon every 2 to

3

> > > hours,

> > > > while awake, to treat an acute bladder infection; and 1/4 to

> 1/2

> > > > teaspoon 3 to 4 times a day to prevent severe chronic bladder

> > > > infections. It is best taken dissolved in water. For those

who

> > get

> > > > bladder infections associated with sexual intercourse, one

can

> > take

> > > > 1/2 teaspoon of D-Mannose 1 hour before and then just after

> > > > intercourse to prevent an infection. Remember, though, the D-

> > > Mannose

> > > > (and cranberries) only work in the 90% of bladder infections

> > caused

> > > > by E-coli bacteria. D-Mannose is available from several

sources:

> > > > > 1. The Tahoma Clinic Dispensary (253-850-5661), which is

> > > associated

> > > > with the well-known nutritional physician, V.

,

> > M.D.

> > > > > 2. The Biotech Company (800-345-1199).

> > > > > 3. My office (800-333-5287) or my Web site at

> > www.endfatigue.com.

> > > > > The usual cost of D-Mannose is approximately $60 for 100

> grams

> > > and

> > > > $35 for 50 grams. A 1/2 teaspoon is approximately 2 grams.

One

> > > should

> > > > feel much better within 24 to 48 hours on D-Mannose. If not,

> see

> > a

> > > > doctor for a urine culture (you may want to get the culture

at

> > the

> > > > first sign of infection) and consider antibiotic treatment

> after

> > > two

> > > > days if the culture is positive. Some evidence exists that

> > > > Macrodantin causes less yeast over-growth than do other

> > > antibiotics.

> > > > Even with other antibiotics, most bladder infections are

> knocked

> > > out

> > > > by one to three days of antibiotic use (instead of the old

> seven-

> > > day

> > > > regimen).

> > > > > Prostatitis

> > > > > Although women tend to be the ones plagued with bladder

> > > infections,

> > > > men don't get off unscathed either. It is very common in men

> with

> > > > CFIDS/FMS to have Prostatitis. Prostatitis is an inflammation

> or

> > > > infection of the prostate which is usually seen in younger

men

> > > > between the ages of 20 and 50. It falls into three main

> > categories:

> > > > > 1. " Bacterial " Prostatitis is a acute or chronic infection

in

> > the

> > > > gland that causes prostate swelling and discomfort.

> > > > > 2. Nonbacterial Prostatitis is when you feel swelling of

the

> > > > prostate without being able to detect an infection. My

> suspicion

> > is

> > > > that it is not uncommon for prostatitis to be associated with

> > yeast

> > > > overgrowth or other infections that cannot be cultured

(tested

> > > for).

> > > > > 3. Prostadynia is a general irritation of the prostate

which

> > > causes

> > > > urinary burning, urgency and frequency but without there

being

> > any

> > > > infection or swelling of the prostate. This can come from a

> > number

> > > of

> > > > causes including, I suspect, chronic spasm or tightening of

the

> > > > muscles of the pelvic floor.

> > > > > The symptoms of chronic Prostatitis can come and go and be

> mild

> > > or

> > > > severe. The symptoms include:

> > > > > 1. Pain or tenderness in the area of the prostate. It is

also

> > > > common to have burning on the tip of the penis.

> > > > > 2. Discomfort in the groin and, occasionally, lower back

pain.

> > > > > 3. Urinary urgency and frequency with pain on urination.

> > > > > 4. Sometimes a slight penis discharge. If the discharge is

> > cloudy

> > > > and larger than one drop, or even a large drop, it is most

> likely

> > a

> > > > bacterial Prostatitis and I would then prescribe antibiotics.

> If

> > a

> > > > discharge is present, I would also check to make sure that

> there

> > is

> > > > not also a sexually transmitted disease (such as Chlamydia or

> > > > Gonorrhea) before beginning treatment.

> > > > > 5. Pain with ejaculation.

> > > > > If severe symptoms with fevers, chills and extreme fatigue

> are

> > > > present (symptoms of acute Prostatitis), antibiotics should

be

> > > used.

> > > > The main treatment for bacterial Prostatitis consists of

using

> > the

> > > > antibiotics Tetracycline (e.g., Doxycycline), Cipro, or Sulfa

> > > > (Bactrim or Septra DS). Unfortunately, since it is hard for

the

> > > > antibiotics to be absorbed into the prostate, the symptoms

> often

> > > > recur even after six weeks of treatment. If antibiotics are

> > > required,

> > > > use Doxycycline or Cipro because these may be effective

against

> > > other

> > > > hidden infections that can cause CFIDS/FMS.

> > > > > Although there are a number of causes of Prostatitis,

excess

> > > > caffeine, alcohol and spicy foods can also contribute to the

> > > > symptoms. Sitting for long periods while traveling (e.g.,

being

> a

> > > > truck driver) can also cause irritation of the prostate.

> Although

> > > > normal bacteria are common causes, a few bacteria transmitted

> > > through

> > > > sexual contact can also cause Prostatitis. Some feel that the

> > main

> > > > psychological component of Prostatitis is shame.

> > > > > Bowel Parasite Infections

> > > > > A while back, the news focused our attention on Milwaukee

> > because

> > > > of repeated fatal outbreaks of an infection by a bowel

parasite

> > > > called Cryptosporidium. A cartoon even made the rounds

showing

> > > > Mexican tourists being warned not to drink the water in

> > Milwaukee!

> > > > Although this infection usually resolves on its own within a

> week

> > > or

> > > > two, it may persist in those with immune suppression. In

fact,

> > > people

> > > > with acquired immune deficiency syndrome (AIDS) are

> particularly

> > > > susceptible and scores of Milwaukeens died from the

> > Cryptosporidium

> > > > outbreaks.

> > > > > Unfortunately, in many places throughout the United States,

> the

> > > > water supply is contaminated, and parasites are no longer

just

> a

> > > > Third World problem. Doctors frequently see cases of

infection

> by

> > > > giardia, amoeba and numerous other bowel parasites. Parasitic

> > > > infections can mimic CFS and, in immune suppressed situations

> > like

> > > > CFS, all parasites should be treated.

> > > > > Most laboratories miss the parasites when they do stool

> > testing.

> > > I

> > > > initially tested for bowel parasites by sending my patients'

> > stool

> > > > samples to a respected local lab. The tests kept coming back

> > > > negative, so I eventually stopped testing. Finally, I started

> > doing

> > > > my own laboratory stool testing. Doing the test properly was

> very

> > > > time consuming, taking up to five hours per specimen.

However,

> > > > processing it properly, my tests frequently turned out

> positive.

> > In

> > > > my experience - and in that of other physicians as well -

when

> > you

> > > > treat a patient for parasites, the patient's fatigue and

> achiness

> > > > often improves dramatically.

> > > > > If you would like your stool tested, make sure that the lab

> > > > specializes in stool testing and that the sample is a purged

> > > > specimen. A purged stool specimen is watery and loose,

brought

> > > about

> > > > by the use of one-and-a-half ounces of Fleet's Phospho-Soda

(a

> > > > laxative). The purpose of the stool purge is to get the best

> > > possible

> > > > stool sample to check for bowel parasites and yeast. The

> laxative

> > > > washes the organisms off the walls of the intestines so that

> they

> > > can

> > > > be detected. The routine random tests performed in almost all

> > > > standard labs are generally not adequate or reliable. In

> speaking

> > > > with several lab technicians, I was told they had less than

one

> > > hour

> > > > of training in looking for parasites—which they found to be

> > > useless.

> > > > In fact, during one of our " doctors' " poker games, I spoke

with

> a

> > > > gastroenterologist friend who noted that during a certain

bowel

> > > exam

> > > > he had performed, he saw a large number of parasites swimming

> in

> > > the

> > > > patient's large bowel. He removed a big glob consisting of

> > nothing

> > > > > but mucus and parasites and sent it off to the major local

> > > > laboratory, just for confirmation of the infection and

> > > identification

> > > > of the parasite. Even this sample came back negative for

> > parasites!

> > > > This is why I stress that stool testing must be done at a lab

> > that

> > > > specializes in parasitology. Because two excellent labs are

now

> > > > available to me to mail specimens to, I no longer have to do

> the

> > > > testing in my office. These labs are The Parasitology Center,

> > Inc.

> > > > (480-777-1078) and The Great Smokies Diagnostic Laboratory

(800-

> > 522-

> > > > 4762).

> > > > > At this point, no consistently effective prescription

> > medication

> > > is

> > > > available for Cryptosporidium infections. Artemisia annua,

> > however,

> > > > is an effective herbal treatment. For most of my patients, I

> > > > recommend using 1,000 milligrams three times a day for twenty

> > days.

> > > > Leo Galland, M.D., a parasite specialist, recommends a form

of

> > > > Artemisia called tricyclin for many parasitic infections. He

> > > > recommends taking 2 tablets, 3 times a day after meals for

six

> to

> > > > eight weeks. The cost of this antiparasitic herbal

preparation

> is

> > > > about $30 for fifty tablets. See the treatment protocol below

> for

> > > > regimens for some other parasitic infections. The doctor who

> runs

> > > The

> > > > Parasitology Center also has a review article discussing

which

> > > > natural remedies are effective against each type of parasite.

> > > Common

> > > > parasite treatment regimens also used in our office are on

the

> > > > treatment checklist below.

> > > > > Antiparasitic Treatments

> > > > > 1. Flagyl (Metronidazole) – 750 mg, 3 times a day for 10

> days,

> > > > followed by Yodoxin for many parasites. For Clostridium

> Difficile

> > > > take 250 mg, 4 times a day, or 500 mg, 3 times a day. It may

> > cause

> > > > nausea and vomiting (uncomfortable but usually not

worrisome).

> Do

> > > not

> > > > drink alcohol while on this medication as it will make you

> vomit.

> > > The

> > > > SR (sustained release) form is easier on the stomach (as is

the

> > > brand-

> > > > name form). If you get numbness or tingling in your fingers

(or

> > it

> > > > worsens if you usually have it) stop the Flagyl.

> > > > > 2. Yodoxin (Iodoquinol) – 650 mg, 3 times a day, for 20

days

> > > after

> > > > Flagyl is completed.

> > > > > 3. Tinidazole – 2000 mg, once daily, for 3 consecutive days

> > with

> > > > food (for Entamoeba Histolytica) – OR - 3 doses, each 2 weeks

> > apart

> > > > (for Giardia or Dientamoeba Fragilis); Available at 's

> > > Pharmacy

> > > > (800-480-3432).

> > > > > 4. Humatin (Paromomycin) – 500 mg, 3 times a day, for 10

days

> > > (for

> > > > Cryptosporidium). For Blastocystis add Yodoxin.

> > > > > 5. Zithromax – 250 mg, once a day on an empty stomach for

10

> > > days,

> > > > along with Bactrim, 1 tablet twice a day for 10 days

(alternate

> > > > treatment for Cryptosporidium). Add Artemesia.

> > > > > 6. Bactrim DS - 1 tablet, twice a day, plus Yodoxin 650 mg,

3

> > > times

> > > > a day with food for 10 days. Do not take Folic acid

supplements

> > > > (e.g., B Complex or multivitamins) during these 10 days (for

> > > > Blastocystis).

> > > > > 7. Amphotericin B – 100 mg, two times a day, plus

Tinidazole

> > 500

> > > > mg, twice a day, plus Furoxone (Furazolidone) 1 tablet, twice

a

> > > day.

> > > > Take these three together with food for 5 to 7 days

> (Amphotericin

> > B

> > > > and Tinidazole are available from 's Pharmacy 800-480-

> 3432)

> > > > (treatment for refractory Blastocystis).

> > > > > 8. Lactoferrin – 350 mg, 1 to 3 capsules at bedtime.

> > > > > 9. Multi-pure Water Filter - Most other filters (except for

> > > reverse

> > > > osmosis) are ineffective. (Available from Bren son, 410-

> 224-

> > > > 4877).

> > > > > 10. Artemesia Annua (a herbal antiparasitic) – 500 mg, 2

> > tablets,

> > > 3

> > > > times a day for 20 days.

> > > > > 11. Tricyclin (a herbal antiparasitic) - 2 tablets, 3 times

a

> > > day,

> > > > after meals for 6 to 8 weeks (concentrated Artemesia).

> > > > > 12. Colostrum (mother's milk) - 3 capsules, 3 times a day,

> for

> > 8

> > > to

> > > > 12 weeks. Then stop or use the lowest dose needed for

symptoms.

> > If

> > > > nausea or indigestion occurs, lower the dose to a comfortable

> > level

> > > > for 1 to 2 weeks until it passes. Take on an empty stomach.

> > > > > 13. Quinacrine – 100 mg a day for 5 days. May be useful for

> > > empiric

> > > > therapy of suspected but not identified parasites

> (controversial).

> > > > > 14. Albendazole – 400 mg a day for 5 days. May be useful

for

> > > > empiric therapy of suspected but not identified parasites.

> > > > > Filter Your Water

> > > > > Water filters can be very helpful in the fight against

> > parasitic

> > > > infection. However, not all units are designed to filter out

> > > > parasites. For a water filter to remove parasites, it must

have

> a

> > > > submicron solid carbon block filter. A good example is the

> Multi-

> > > pure

> > > > Filter. Check the Consumer's Digest and Consumer's Report for

> > other

> > > > good units. Multi-pure Filters are available from Bren

son

> > at

> > > > 888-801-8176 or 410-224-4877. He is a very reputable and

> > > > knowledgeable person and does not believe in " high pressure

> > sales "

> > > > (again, I get no money from people or companies whose

products

> I

> > > > recommend).

> > > > > When shopping around for a water filter, request the

National

> > > > Sanitation Foundation (NSF) International Listing for the

> > specific

> > > > unit you are considering. NSF is an independent not-for-

profit

> > > > organization that tests and certifies drinking water

treatment

> > > > products. The unit you buy should meet both NSF Health

Effects

> > > > Standard 53 and NSF Aesthetics Standard 42, with Class I

> > reduction

> > > of

> > > > chlorine and particulate matter. Any unit that does not meet

> both

> > > of

> > > > these standards, particularly the health standard, is not

> > adequate.

> > > > To verify that a unit does meet these standards, call the NSF

> at

> > > 313-

> > > > 769–8010.

> > > > > In addition to verifying that a water filter meets the NSF

> > > > standards, ask to see its Product Performance Data Sheet.

Many

> > > states

> > > > require that this sheet be given to all prospective customers

> of

> > > > drinking water treatment devices.

> > > > > Ask about the range of contaminants that the unit can

reduce

> > > under

> > > > NSF Health Effects Standard 53. Most units certified under

> > Standard

> > > > 53 list only turbidity and cyst reduction. The number of

units

> > that

> > > > also reduce pesticides, trihalomethanes, lead, and volatile

> > organic

> > > > chemicals is very small. Make sure that the water filter you

> are

> > > > considering can remove the specific contaminants that concern

> you.

> > > > > Ask if the unit is licensed in such states as California,

> > > Colorado

> > > > and Wisconsin. These states have some of the toughest

> > certification

> > > > procedures in the United States.

> > > > > Finally, ask about the unit's service cycle, which is

stated

> in

> > > > gallons of water treated. Find out how often you will need to

> > > change

> > > > the filter and what the replacement filters cost.

> > > > > As the American water supply becomes more contaminated,

> > parasitic

> > > > bowel infections will likely become more common. These

> > infections,

> > > as

> > > > well as the overgrowth of yeast or toxic bacteria caused by

> > > > antibiotic use, contribute to feeling poorly.

> > > > > The Role Of Other Infections In CFIDS/FMS

> > > > > Many infections have been found in CFIDS. That people may

> have

> > > not

> > > > just one, but several of these simultaneously is significant.

> It

> > > > suggests that although these infections may be a trigger, in

> most

> > > > patients the immune system is suppressed and therefore they

> > become

> > > a

> > > > setup for unusual infections that persist. These infections

may

> > > > then " drag you down, " further suppressing your immune system.

> > > > > Fortunately, most people improve (and often get very

healthy)

> > by

> > > > simply treating the sleep, hormonal, nutritional and yeast

> > > problems.

> > > > Once these areas are treated, your body can usually eliminate

> any

> > > > persistent infections by itself. A subset, though, have

> > infections

> > > > that need treatment with antivirals and/or antibiotics.

> > > > > How Can I Tell If I Need These Treatments?

> > > > > First, I would try the other approaches discussed in my

From

> > > > Fatigued To Fantastic! book and newsletters. I would try

these

> > > > treatments if symptoms persist:

> > > > > 1. Those with predominantly flu-like symptoms with

> debilitating

> > > > fatigue and little or no pain or fever are more likely to

have

> an

> > > > underlying persistent viral infection (e.g., HHV-6, Epstein

> Barr,

> > > > CMV, etc.).

> > > > > 2. Those with fevers (i.e., anything over 98.6°F in this

> > illness -

> > >

> > > > even 99°) and/or lung congestion, sinusitis, skin pustules or

> > other

> > > > chronic bacterial infections seem more likely to have

> infections

> > > > (i.e., bacterial, Mycoplasma, or Chlamydia) that respond to

> > special

> > > > antibiotics. Let's look at these two groups and how to

approach

> > > them.

> > > > > HHV-6 And Other Viral Infections

> > > > > HHV-6 (Human Herpes Virus 6) is a virus that is related to

> the

> > > > Epstein Barr Virus (EB), Cytomegalovirus (CMV), and also to

the

> > > > Herpes Viruses that causes cold sores and Genital Herpes. HHV-

6

> > is

> > > > transmitted like the common cold and many people have had it,

> as

> > > well

> > > > as the EB Virus and the Cold Sore Virus by the time they are

> > twenty

> > > > years old. The body usually gets rid of all of these viruses

on

> > its

> > > > own. Because of this, if you do routine (IGG) antibody

testing,

> > > > almost everybody will be positive for EB and many for HHV-6

and

> > CMV

> > > > viruses. However, the IGG test will not tell you if you have

> > active

> > > > infections unless the IGM antibody is also positive

(suggesting

> a

> > > new

> > > > infection). The IGM antibody is the one that increases in the

> > first

> > > > six weeks of an infection. This is followed by an elevated

IGG

> > > > antibody, which stays elevated your whole life and acts as

your

> > > > body's surveillance system. All an elevated IGG means is that

> > your

> > > > body has seen this infection and, if it sees it again, it's

read

> > > > > y to knock it out quickly. This is how immunizations work.

> The

> > > > immunization creates the IGG antibody, so that instead of

> taking

> > > one

> > > > to two weeks to gear-up to fight the infection, your body can

> > > > eliminate that infection very quickly. Unfortunately, in

CFIDS

> > you

> > > > can have a chronic low-grade infection—even if your IGG

> antibody

> > is

> > > > positive (elevated) - making the IGG antibody test for HHV-6,

> EB

> > > > Virus and CMV unreliable in CFIDS/FMS. In addition, the IGM

> > > antibody

> > > > will usually not be present in elevated levels in the low-

grade

> > > > infections with these viruses that may be seen in CFIDS and

> FMS.

> > > > > What makes this important is that Valtrex at high-dose can

> > > > eliminate Epstein Barr virus, but will not work if active HHV-

6

> > or

> > > > CMV infection is present. As I will discuss later, the only

> tests

> > I

> > > > would rely on to diagnose active HHV-6 are " rapid cell

> cultures "

> > or

> > > > PCR testing. Because some insurance companies are more likely

> to

> > > pay

> > > > for IGG than PCR testing, an argument can be made for

checking

> > IGG

> > > > antibodies first. If the EBV IGG is positive and HHV-6 and

CMV

> > IGG

> > > > are negative, one may choose to proceed with Valtrex 1000mg,

4

> > > times

> > > > a day, for 6 months, without PCR testing. If the HHV-6 or CMV

> IGG

> > > > antibodies are positive, then check the CMV and/or HHV-6 PCR

> > tests

> > > to

> > > > be sure they are negative.

> > > > > Tell Me More About HHV-6 And CFIDS

> > > > > Unfortunately there is no currently accepted standard

> treatment

> > > for

> > > > the HHV-6 Virus. Even though it is related to other Herpes

> > viruses,

> > > > HHV-6 is resistant to Acyclovir, Valtrex, Famvir and the

other

> > > > antivirals that are commonly used in Herpes infections. The

> only

> > > > antiviral known to be effective against HHV-6 is Ganciclovir.

> > This

> > > > has significant side effects and has to be given

intravenously

> > and

> > > > possibly forever to maintain the antiviral effect.

> Unfortunately,

> > > > this is not a viable option in day-to-day life and has been

> only

> > > > moderately successful when used. The main doctor who has been

> > using

> > > > Ganciclovir to treat HHV-6 in the United States is Joe

Brewer,

> > > M.D.,

> > > > (816-531-1550) in Kansas City, Missouri. He found that 140

out

> of

> > > 207

> > > > CFIDS patients had positive HHV-6 cell cultures. Forty

percent

> of

> > > > CFIDS patients were positive on their first test and 70% were

> > > > positive after three tests. This contrasts to 60 healthy

> patients

> > > he

> > > > checked in which none of the HHV-6 tests were positive.

Culture

> > > > > s are more likely to be positive during acute flares of the

> > > > disease, when the viral level in the blood rises (see Page 9

> for

> > > more

> > > > on HHV-6 PCR testing).

> > > > > As is often the case in CFIDS, there is conflicting data on

> > > > infections in Chronic Fatigue Syndrome. A recently published

> > study

> > > > (Reeves WC, et al., Clin Infect Dis, 2000 July; 31 [1] pp48-

52)

> > > > examined 26 patients with Chronic Fatigue Syndrome and 52

> healthy

> > > > patients in Atlanta, Georgia, at the CDC. In this study,

> several

> > > > tests for HHV-6 and HHV-7 were done, including Polymerase

Chain

> > > > Reaction (PCR). HHV-6 DNA was found in 11% of CFIDS patients

> and

> > > 28%

> > > > of healthy patients, suggesting that the HHV-6 was actually

> less

> > > > common in Chronic Fatigue Syndrome than in healthy patients.

At

> > > this

> > > > time, as the conflicting data shows, although HHV-6 may be

one

> of

> > > > many suspect infections in CFIDS, it is not yet clearly the

> cause

> > > of

> > > > this illness.

> > > > > When HHV-6 is present, it seems to infect the natural

Killer

> > > Cells,

> > > > important cells in your body's defense (immune) system that

are

> > > > critical in fighting infections. A number of studies have

shown

> > > these

> > > > Killer Cells to be malfunctioning in CFIDS. HHV-6 infection

> does

> > > not

> > > > necessarily decrease the number of the natural Killer Cells

but

> > > does

> > > > decrease their function. Natural Killer Cell function is

> > described

> > > in

> > > > what is called Lytic Units—which means the ability of cells

to

> > lyse

> > > > or break down foreign invaders. An average person will have a

> > Lytic

> > > > Unit level of 20 to 250 with over 80% of healthy patient

being

> > over

> > > > 40 units. Dr. Brewer finds that in CFIDS the mean Natural

> Killer

> > > > Lytic Cell level is 12 units. Dr. Brewer uses Specialty Labs

in

> > > > California for his Natural Killer Lytic Cell testing and

finds

> > that

> > > > the Lytic level stays the same on repeat testing and seems to

> be

> > a

> > > > reliable test for Natural Killer Cell function testing in

> CFIDS.

> > > > Lytic unit levels will, however, decrease during flar

> > > > > es of symptoms. In Dr. Brewer's experience, this test is

very

> > > > specific for CFIDS and Multiple Sclerosis. He has treated ten

> MS

> > > > patients and five CFIDS patients with the I.V. Ganciclovir.

He

> > > found

> > > > that it helped to stabilize the MS patients. In the CFIDS

> > patients,

> > > > two to three were much improved, one still had a positive

viral

> > > > culture and one had a poor response. Unfortunately,

maintaining

> > > > patients on I.V. Ganciclovir forever (as noted above) is not

a

> > > viable

> > > > option. Fortunately, an oral pill form of Ganciclovir

> > > > (Valganciclovir) is currently being developed! It should be

> noted

> > > > that the HHV-6 virus is similar to CMV (Cytomegalovirus), and

> > that

> > > > whatever is effective against one, tends to be effective for

> the

> > > > other. This is a helpful bit of information as we follow new

> > > research

> > > > looking for clues on how to eliminate HHV-6 infection.

> > > > > What Roles Does The Epstein Barr And Cytomegalovirus Play

In

> > > CFIDS?

> > > > > Again, the roles of the EB and CMV viruses are not clear.

It

> is

> > > not

> > > > uncommon for antibody levels of these viruses to be elevated

in

> > > > Chronic Fatigue Syndrome. As noted above, it is not clear

> whether

> > > > this simply reflects a previous or ongoing infection with

these

> > > > viruses. Research by a husband and wife team (the Glasers) at

> > Ohio

> > > > State University, suggests that Epstein Barr Virus is still

> quite

> > > > active and playing a role in many patients with these

> infections.

> > > In

> > > > addition, work by Lerner, M.D., also suggests that EB

> > Virus

> > > > and CMV are active as well. In speaking with Dr. Lerner's

> > research

> > > > assistant, I found out that he has found EB Virus and CMV to

> both

> > > be

> > > > fairly common in patients with Chronic Fatigue Syndrome (with

> and

> > > > without pain). He found that about 20% had positive IGM

and/or

> > > > elevated EA (early antigen) tests to the EB Virus with

negative

> > > > Cytomegalovirus. Of these, two-thirds improved with high-dose

> > > Valtrex

> > > > (an oral antiviral). Despite my teasing and prodding, his

> associat

> > > > > e refused to give out the dose of Valtrex they prescribed

> > because

> > > > Dr. Lerner does not want to be responsible for people using

> these

> > > > higher doses until he completes the double-blind trial that

is

> > > > currently in progress. On the other hand, another study of

his

> > did

> > > > use 1000mg, 4 times a day, giving the antiviral for 6 months.

> It

> > > > takes about 3 to 4 months before patients start to improve

and

> > > after

> > > > 6 months people can stop the Valtrex without the symptoms

> coming

> > > > back. However, if there is no improvement in 6 months,

consider

> > it

> > > to

> > > > be a negative result. They also found that, as noted above,

the

> > IGM

> > > > is almost always negative using the reagents used in most

labs.

> > > They

> > > > found that only Epstein Barr IGM antibody testing, using a

> > reagent

> > > by

> > > > the Diasorin Company (800-328-1482), has been useful in

showing

> a

> > > > significant number of positive tests. When we called the

> company,

> > > the

> > > > only lab in the Washington, D.C., area using it was at the

NIH.

> > The

> > > > company may, however, be able to give you the name of

> > > > > a lab near you that can do the test. What was fairly

common,

> > > > though, (and present in most patients) was either positive

> tests

> > > for

> > > > Epstein Barr, CMV, or a combination of both as noted above.

> When

> > > CMV

> > > > or HHV-6 are present, the Valtrex is less likely to work

> because

> > it

> > > > is not effective against these viruses.

> > > > > In another study done by Dr. Lerner (Infectious Diseases In

> > > > Clinical Practice, 1997; 6:110-117) he found that patients

who

> > had

> > > > elevated CMV IGG antibodies, but no significant evidence of

> > > > associated Epstein Barr virus (i.e., negative IGM and early

> > antigen

> > > > (EA) antibody total less than 40), did improve with I.V.

> > > Ganciclovir

> > > > at 5mg per kg of body weight given every 12 hours I.V. for 30

> > days.

> > > > In this study 72% (13 of the 18 patients) improved markedly

at

> > the

> > > > end of a month without any significant side effects. As

noted,

> an

> > > > oral form of Ganciclovir is currently in development as well.

> It

> > > > should be noted that 36% of the Chronic Fatigue Syndrome

> patients

> > > > that Dr. Lerner checked (18 out of 50) did turn out to have

> > > elevated

> > > > CMV antibodies (albeit IGG) in the absence of IGM and EA

> > antibodies

> > > > to EB Virus (i.e., no evidence of active Epstein Barr Virus).

> It

> > > > should be noted, though, that 70% of healthy patients also

had

> > > > positive IGGs to CMV (as per our discussion above) in the

study

> > and

> > > > appears

> > > > > that the overall level of the IGG was not much higher

> overall

> > in

> > > > the Chronic Fatigue group than in the healthy controls. On

the

> > > other

> > > > hand, the higher the level of CMV antibody in the Chronic

> Fatigue

> > > > group, the more likely they were to improve with the I.V.

> > > Ganciclovir.

> > > > > What this means is that patients with Chronic Fatigue

> Syndrome

> > > > don't necessarily have different blood tests for antibody

> levels

> > > than

> > > > healthy people for these viruses. However, if one has a

higher

> > > level

> > > > rather than a lower level, one is more likely to improve with

> the

> > > > Ganciclovir. Previous research has not shown benefit from

> > antiviral

> > > > therapies in CFS (Straus SE, et al., New England Journal of

> > > Medicine

> > > > 1988; 319:1692-1698). Our experience using a fairly high dose

> of

> > > > Valtrex or Famvir (1500mg and 2250mg a day respectively) also

> > > showed

> > > > no significant improvement on these regimens after 6 weeks,

at

> > > which

> > > > time we considered it to be ineffective. On the other hand,

Dr.

> > > > Lerner's research is suggesting that perhaps we gave it for

too

> > > short

> > > > a time and at too low a dose. When treating himself and a few

> > other

> > > > patients, he used Valtrex by mouth at a dosage of 1000mg, 4

> times

> > a

> > > > day, for 6 months. Using the higher dosing and the extended

> > period

> > > of

> > > > time, as well as separating out groups that have

> > > > > Epstein Barr Virus (sensitive to the oral Valtrex) without

> CMV

> > > or

> > > > HHV-6 (resistant to oral Valtrex but sensitive to I.V.

> > > Ganciclovir),

> > > > may make an important difference in making treatment

effective.

> > No

> > > > major Valtrex toxicity was seen. As noted above, a double-

blind

> > > study

> > > > is currently in progress and we are beginning to try the

higher

> > > dose

> > > > of Valtrex in the 15% of our patient population that have not

> > > > improved adequately and have positive EBV, and negative CMV

and

> > HHV-

> > > 6

> > > > tests. We hope to give you follow-up information on the

> > treatment's

> > > > effectiveness as soon as we know!

> > > > > In addition, Dr. Lerner suspects that these infections

affect

> > the

> > > > heart muscle contributing to much of your symptoms. I am not

> > > > convinced that this is the case because EKG changes are

common

> in

> > > > CFS. This can occur because the autonomic (brain) dysfunction

> and

> > > > hormonal changes seen in CFS can cause these same EKG changes

> > > without

> > > > heart damage. Regardless, he found that these changes went

away

> > > with

> > > > treatment (as has been our experience in treating Chronic

> Fatigue

> > > > Syndrome—patient's EKG changes improve even without

> antivirals).

> > > Dr.

> > > > Lerner is currently recruiting patients for a double-blind

> study

> > > > using the high-dose Valtrex. His phone number is 248-540-9688

> in

> > > > Beverly Hills, Michigan.

> > > > > Does This Mean There Is Nothing We Can Do Now?

> > > > > Although there is no currently accepted specific treatment

> for

> > > the

> > > > CMV and HHV-6 viruses, there are still a number of things

that

> > may

> > > be

> > > > very helpful in fighting this infection.

> > > > > 1. Lithium tends to be antiviral and has been shown to

> decrease

> > > > pain in FMS patients when added to treatment with Elavil.

> Lithium

> > > is

> > > > commonly used in manic depressive illness and is a natural

> > mineral

> > > > despite being sold by prescription. In high doses, it can

cause

> > > some

> > > > neurologic symptoms and suppression of the thyroid gland, but

> > these

> > > > can usually be treated by taking a small amount of Essential

> > Fatty

> > > > Acids and thyroid hormone. Lithium might also worsen Restless

> Leg

> > > > Syndrome. Although we have no direct evidence of Lithium

being

> an

> > > > effective antiviral against HHV-6, it may well be effective

> > because

> > > > it works against a number of other viral infections. In our

> > > > experience, 200mg to 600mg a day seems to be the effective

dose

> > in

> > > > treating FMS patients. As noted above, I would check the

> thyroid

> > > > blood tests at 3 months, 6 months and then yearly (check a

Free

> > T4

> > > > and a Total T3 - not a TSH). A Lithium level should also be

> > checked

> > > > at the same time to be sure that it not above the upper limit

> of

> > > > > normal. The level can be below the normal range, which is

> fine

> > as

> > > > long as the treatment is effective. You may find that you can

> > lower

> > > > the Lithium dose after you have been on it for several months.

> > > > > 2. Heparin (a blood thinner, see Page 12) also has

antiviral

> > > > properties.

> > > > > 3. It is worth considering trials of high-dose Valtrex. It

> > should

> > > > be noted that 1000mg, 3 times a day, is used for shingles in

> > older

> > > > patients and appears to be quite safe. On the other hand,

> higher

> > > > dosing at 8 grams a day in AIDS patients did result in

uncommon

> > > > (under 2%) life threatening problems. This is common even

with

> > day-

> > > to-

> > > > day drugs in AIDS patients (for example, regular sulfa

> > antibiotics

> > > > have often resulted in severe toxicity in AIDS patients).

> > > > Nonetheless, we will be limiting the dose to 1 gram, 4 times

a

> > day,

> > > > in our practice. It is important to note that taking Tagamet

> > and/or

> > > > Probenecid (Benemid) will raise the blood level of Valtrex.

> > Tagamet

> > > > has powerful immune modifying properties and is very helpful

in

> > > acute

> > > > cases of Epstein Barr (mono) infections. Because of this, we

> are

> > > > adding Tagament 300mg, 4 times a day (but not Probenecid), to

> the

> > > > Valtrex. As I noted, we are beginning this treatment with

some

> of

> > > our

> > > > patients and will let you know what we find.

> > > > > Natural Remedies

> > > > > 1. Olive Leaf - This is an herbal which is known to have a

> wide

> > > > spectrum of anti-infectious activity. It has been shown to be

> > > > effective against the HHV-6 virus in the test tube. I have

not,

> > > > however, seen studies testing its effect in human beings

> infected

> > > > with HHV-6. Nonetheless, a number of physicians have found

that

> > > using

> > > > Olive Leaf in Chronic Fatigue Syndrome is very effective.

There

> > is

> > > > controversy over whether the form and source of the Olive

Leaf

> is

> > > > critical. We recommend that you use a form that has at least

6%

> > > > Oleuropein, which is one of the most active antiviral

> components

> > in

> > > > the Olive Leaf. Other components may be important and some

> people

> > > > also feel that you must use the Mediterranean Olive Leaf vs.

> the

> > > > American Olive Leaf. Other people argue that you should have

a

> > form

> > > > that is organically grown, without pesticides. At this point

it

> > is

> > > > not clear whether this is simply marketing or important in

day-

> to-

> > > day

> > > > life. Nonetheless, I would be picky about the companies you

buy

> > the

> > > O

> > > > > live Leaf from. I would use one of these sources:

> > > > > a. My office (800-333-5287) or my Web site at

> > www.endfatigue.com.

> > > > > b. Pacific Research Labs (800-325-7734). This is owned by

R.

> J.

> > > > Marshall, Ph.D., who has done a fair bit of work treating

CFIDS

> > > > patients with Olive Leaf. I will be describing the protocol

> that

> > he

> > > > uses below.

> > > > > c. General Nutrition Centers (GNC).

> > > > > Dr. Marshall feels that during infections, the body becomes

> > > overly

> > > > acidic. He tests the morning urine specimens with pH paper

> (which

> > > is

> > > > very easy to do at home) and gives a shell extract, which

> raises

> > > the

> > > > body's alkalinity. He feels that having a normalized acid-

base

> > > > balance in your body helps it to fight infections. He then

adds

> > his

> > > > form of Olive Leaf, called Infectostat (which also contains

> > > mushroom

> > > > extracts to stimulate the immune system), giving 3 to 4

> capsules,

> > 3

> > > > to 4 times a day, to help fight the infections. Usually, the

> > > patient

> > > > should start feeling better within four weeks on this

protocol.

> > > > Although we have found it helpful in fighting colds and other

> > > common

> > > > respiratory infections, we are just starting to explore Olive

> > > Leaf's

> > > > use in a few of our patients who have not responded to

standard

> > > > treatment and are still quite ill. We will let you know our

> > > > experience with this in an upcoming newsletter issue. My

guess,

> > > > though, is that simply using regular (6% Oleuropein) Olive

Leaf

> > > > > 500mg capsules, 3 to 4 capsules, 3 to 4 times a day between

> > > meals,

> > > > will probably be equally effective and cheaper for most

people

> > than

> > > > the expensive forms. How long one needs to take Olive Leaf in

> > > Chronic

> > > > Fatigue Syndrome is yet to be determined.

> > > > > Initially, a pharmaceutical company was developing the

> > Oleuropein

> > > > in Olive Leaf as an antiviral. Because it gets bound to the

> blood

> > > > proteins, they thought that Oleuropein might not get to the

> > > tissues.

> > > > More importantly, Oleuropein is a natural product and

therefore

> > > hard

> > > > to patent. Because of these problems, they stopped research

on

> > it.

> > > > Years later this research was rediscovered and explored

> further.

> > In

> > > > addition to being an effective antiviral agent, Olive Leaf is

> > > > reported to be effective on a number of bacterial and yeast

> > > > infections as well. What is most exciting regarding the Olive

> > Leaf

> > > is:

> > > > > a. That some doctors have found it to be effective in

CFIDS,

> > and

> > > > > b. That in tests against HHV-6 and CMV virus (remember that

> if

> > > > something is effective against one, it tends to be effective

> > > against

> > > > the other) the Olive Leaf extract did not just suppress the

> virus

> > > but

> > > > killed it. That is very promising.

> > > > > 2. Pro-Boost - Thymic Protein A (used to be called BioPro) -

> > This

> > > > is the immune stimulant that I discussed in my newsletter,

Vol.

> > 2,

> > > > Issue 2. Although not a hormone, Pro-Boost mimics the natural

> > > hormone

> > > > produced by your Thymus - the gland which stimulates your

> immune

> > > > system. I find it to be extraordinarily effective in fighting

> > > common

> > > > infections of any kind that seem to pop up. For the more deep-

> > > seated

> > > > infections of CFIDS, the higher dose (1 packet, 3 times a

day)

> > will

> > > > likely be needed. Once the infection seems to be in check and

> you

> > > are

> > > > feeling better (i.e., after 6 weeks), you can taper down to

the

> > > > lowest dose that maintains the effect.

> > > > > 3. IP6 - This natural immune stimulant is an extract of

bran

> > > > (phytates). It is less expensive and is sometimes combined

with

> > > > vitamin C. The dose of IP6 (available from many sources) is 5

> to

> > 8

> > > > grams a day. Do not take IP6 within 3 hours of

vitamin/mineral

> > > > supplements.

> > > > > 4. MGN3 - This is a very concentrated mushroom extract,

which

> > has

> > > > been shown to stimulate Natural Killer Cell immune function.

In

> > one

> > > > study, it actually tripled Natural Killer Cell function—an

> effect

> > > > that, as the HHV-6 virus can suppress Natural Killer Cell

> > function,

> > > > could be very powerful. Unfortunately, it is horribly

expensive

> > in

> > > > the recommended dose (250 mg capsules) of 2 to 4 capsules, 4

> > times

> > > a

> > > > day for 2 weeks, followed by 2 capsules, 2 times a day. Other

> > > > mushroom extracts are cheaper but may not be as effective.

> > > > > 5. Intravenous Vitamin C at high-dose (15gm to 50gm) has

been

> > > > suggested to have antiviral effects in a number of other

> > infections

> > > > and is often dramatically helpful in CFIDS when given in the

> I.V.

> > > > nutritional therapy called " Myers Cocktails " (see my

> newsletter,

> > > Vol.

> > > > 3, Issue 3).

> > > > > 6. Lysine 1000 mg, 3 times a day - This amino acid protein

is

> > > safe

> > > > and inexpensive (27¢ a day). It inhibits oral/genital herpes

> (by

> > > > depleting the Arginine the virus needs to grow). I do not

know

> if

> > > it

> > > > also inhibits EBV, HHV-6 or CMV viral infections.

> > > > > I would take the combination of these together (as is

> > affordable)—

> > > > perhaps leaving the MGN3 for later if needed, giving the

> > treatment

> > > > for at least a 6 to 8 week trial to see if it's effective. If

> you

> > > are

> > > > feeling better at 6 weeks, you can then taper down the dose

> > slowly

> > > as

> > > > long as the benefit is maintained. When able, you can wean

> > yourself

> > > > off the treatments. If symptoms recur, go back up to the dose

> > that

> > > > maintains the benefit or consider increasing the dose

further.

> As

> > > we

> > > > are just starting to use this protocol in our patients, I do

> > > > appreciate your feedback on what has worked for you and what

> has

> > > not.

> > > > You can " vote " for what helped or didn't help you on our Web

> site

> > > at

> > > > www.endfatigue.com. You can also see other people's votes.

> > > > > In addition, your clotting system may be activated by

several

> > > > infections making it difficult to eliminate them. Using the

> anti-

> > > > clotting treatments that we will discuss later can also make

it

> > > > easier for your body to eradicate infections.

> > > > > Mycoplasma And Chlamydia

> > > > > Other infections have also been found to be very important

in

> > > > CFIDS. Dr. Garth Nicolson and his wife, who were on-faculty

at

> > the

> > > > University of Texas Medical School at Houston and the

> Department

> > of

> > > > Microbiology and Immunology at Baylor College of Medicine in

> > > Houston,

> > > > Texas, are the leading proponents of treatment of these

> > infections.

> > > > Dr. Garth Nicolson was an endowed chair and department

chairman

> > at

> > > > the University of Texas, the M.D. Cancer Center in

> > > Houston,

> > > > Texas, and a Professor of Internal Medicine at the University

> of

> > > > Texas Medical School, also in Houston. Dr. Nicolson's wife

had

> > > > Chronic Fatigue Syndrome years ago. They were surprised that

> her

> > > test

> > > > turned out to be positive for Mycoplasma fermentans (also

known

> > as

> > > > Mycoplasma fermentans incognitus). This Mycoplasma was found

to

> > be

> > > > resistant to the Penicillin- and Keflex-family antibiotics

that

> > > most

> > > > doctors use, but was sensitive to long courses of Doxycycline

> and

> > > > Cipro. After an extended course of Doxycycline treatment,

> > > > > she was much better. The Nicolsons then went on to develop

> > their

> > > > own tests for Mycoplasma using PCR testing. Dr. Nicolson

tells

> me

> > > > that, in addition, when his step-daughter came home after

> serving

> > > in

> > > > Desert Storm, she came down with Gulf War Illness (GWI). They

> > > tested

> > > > hundreds of Gulf War veterans with GWI and 40% to 45% were

> > positive

> > > > for Mycoplasma infections—almost all with Mycoplasma

> fermentans.

> > > This

> > > > has been confirmed by other labs and a large Veterns

> > Aministration

> > > > study involving over 2,000 patients. In contrast to this,

> > soldiers

> > > > who were not deployed to the Gulf during the war, had less

than

> a

> > > 6%

> > > > incidence of being positive for these infections.

> > > > > Interestingly, the Nicolsons found that in patients with

> > Chronic

> > > > Fatigue Syndrome or Fibromyalgia, approximately 70% (144 out

of

> > 203

> > > > patients) had a positive PCR test for one, or usually several

> > > > species, of Mycoplasma. When the Nicolsons tested 70 healthy

> > > > patients, only 6 patients (less than 9%) were positive for

any

> of

> > > the

> > > > Mycoplasma species. This is a highly significant difference.

> Only

> > 2

> > > > of these 70 healthy people were positive for Mycoplasma

> > fermentans.

> > > > Similar results have been found by other doctors and have

been

> > > > published.

> > > > > As we have said before, it is likely that there is a group

of

> > > > underlying problems and not a single one that triggers

> CFIDS/FMS.

> > > > This applies to infections as well. This is why you can see

> tests

> > > be

> > > > positive for both viral and Mycoplasmal infections in so many

> > > people

> > > > with this disease. For Mycoplasma alone, when they checked

for

> > four

> > > > different types of Mycoplasma, over half of the 93 CFIDS

> patients

> > > > that were positive had more than one type of infection. Over

> 20%

> > of

> > > > them had three out of the four Mycoplasma infections test

> > positive.

> > > > The more infections that were positive, the worse the

patient's

> > > > symptoms were and the longer they had had CFIDS/FMS.

> > > > > What Are Mycoplasma?

> > > > > Mycoplasma are an ancient bacteria that lacks cell walls

and

> > are

> > > > capable of invading a number of types of human cells. They

can

> > > cause

> > > > a wide variety of human diseases. These organisms can cause

the

> > > types

> > > > of symptoms seen in Chronic Fatigue Syndrome patients and,

> > > according

> > > > to Dr. Nicolson, tend to be immune suppressing.

Unfortunately,

> > they

> > > > cannot be readily cultured on a culture dish like regular

> > bacteria.

> > > > In medicine, we have a bad habit on focusing on that which is

> > easy

> > > to

> > > > test for and making believe that that which is hard to test

for

> > > does

> > > > not exist. Because of this, bacterial infections such as

> > pneumonia,

> > > > bladder infections and skin infections, where one bacteria on

a

> > > cell

> > > > dish will rapidly turn into millions by the next day and be

> > visible

> > > > to the human eye, get all our attention. Unfortunately,

> > Mycoplasma,

> > > > which cannot be easily cultured, tends to be ignored. It's

like

> > the

> > > > old story about the little kid who was looking for his lost

> keys

> > > > under the street lamp one night. His frien

> > > > > ds came by and asked him what was going on. He told them

and

> > they

> > > > all looked for the keys under that light for about an hour.

> > > Finally,

> > > > exasperated, they looked at the friend and said, " Where did

you

> > > lose

> > > > these keys? " The kid looked up and said, " Oh, about half a

> block

> > > down

> > > > the street. " They said, " Why are you looking for them here? "

He

> > > > said, " Because there is a light here and I can see! " This is

> kind

> > > of

> > > > what it is like in medicine. If there is a test for something

> > (such

> > > > as cholesterol and bacterial cultures) that is easy to do, we

> > focus

> > > > our attention on that test and make believe that it finds the

> > main

> > > > problem. Unfortunately, in CFIDS and FMS, this is not the

case.

> > > > > The data suggests that many infections may trigger

CFIDS/FMS

> or

> > > > that CFIDS and FMS may cause immune suppression—which then

sets

> > you

> > > > up to catch a whole bunch of different infections which your

> body

> > > has

> > > > trouble clearing. This is why it is important to treat all

the

> > > > underlying processes simultaneously as I discuss in my From

> > > Fatigued

> > > > To Fantastic! book and newsletters.

> > > > > So, How Do You Look For These Infections?

> > > > > I had the honor of speaking with Konnie Knox, M.D., a major

> re-

> > > > searcher on HHV-6 testing in CFIDS/FMS, who uses a technique

> > called

> > > > Rapid Cell Culture. She actually infects different test tube

> > cells

> > > > with HHV-6, grows them, and then looks for signs of HHV-6 in

> the

> > > > cell. In her experience, one out of three CFIDS/FMS patients

> are

> > > > positive for active HHV-6 infection on the first blood test.

> When

> > > > multiple testing is done (e.g., three tests), 70% are

positive.

> > > This

> > > > test is negative in the vast majority of people who are

> healthy.

> > > The

> > > > other main illness where the HHV-6 test is positive is

Multiple

> > > > Sclerosis. At this time, HHV-6 Rapid Cell Culture and the PCR

> > test

> > > at

> > > > Dr. Nicolson's lab (International Molecular Diagostics) are

the

> > > only

> > > > HHV-6 test I order. For more information on Dr. Knox's work,

go

> > to

> > > > these Web sites: www.HHV-6.com and www.cnet.com. For the IMD

> > > website,

> > > > go to www.imd-lab.com.

> > > > > The Nicolsons use very sensitive PCR (Polymerase Chain

> > Reaction)

> > > > testing to actually look for DNA specific to Mycoplasma, HHV-

6,

> > and

> > > > other infections. Unfortunately, those DNA pieces are so

> > > > microscopically small, that to look for just one is much

worse

> > than

> > > > looking for a " needle in a haystack. " With the PCR, if that

> > > > Mycoplasma gene sequence is found, the technique multiplies

it

> > like

> > > a

> > > > copying machine until millions of that sequence are present

and

> > can

> > > > be picked up by testing. Because of this, PCR testing is

> > > exquisitely

> > > > sensitive and can find the proverbial " needle in a haystack. "

> > This

> > > > makes it very powerful and the only testing that I would

> > recommend

> > > in

> > > > looking for these Mycoplasma and Chlamydia infections. As

noted

> > > > above, IGG antibody testing is not reliable for Mycoplasma

and

> > > > Chlamydia testing in CFS.

> > > > > Where Do I Get These Tests Done And Should I Have Them Done?

> > > > > The tests for HHV-6 and Mycoplasma each cost about $180 to

> > $250.

> > > As

> > > > noted above, the only places that I would get the HHV-6 test

> done

> > > > (and the only tests I would do are PCR or viral culture

> testing)

> > > are

> > > > at the Wisconsin Viral Institute (414-774-0311) or Dr.

> Nicolson's

> > > > lab. I order all the lab testing for Mycoplasma and Chlamydia

> at

> > > the

> > > > Nicolson's lab, at International Molecular Diagnostics, 15162

> > > Triton

> > > > Lane, Huntington Beach, CA 92649 (714-799-7177 ext. 202 or

> 204).

> > > The

> > > > lab's Web site is www.imdlab.com.

> > > > > I can almost guarantee that if you do the Mycoplasma or

> > Chlamydia

> > > > tests at your local lab they will do the wrong tests and they

> > will

> > > be

> > > > useless for hidden CFS infections. I have never seen one come

> > back

> > > > with any useful information. What they usually do is check

the

> > > > antibodies (usually for the wrong Mycoplasma infection) which

> > > simply

> > > > shows that you (like everybody else at some point in their

> life)

> > > have

> > > > had a Mycoplasma infection. It tells nothing about active

> > infection

> > > > and, again, is useless. Be sure to do the PCR testing and do

it

> > at

> > > > one of the two labs discussed above. Dr. Nicolson has noted

> which

> > > > tests he recommends in CFS/FMS, their cost and instructions

for

> > the

> > > > lab. We have reprinted this information on the next page (Dr.

> > > > Nicolson's lab also does viral PCR testing for CMV, as well

as

> > HHV-

> > > 6).

> > > > > Even at the best labs, it is not uncommon to have a false-

> > > negative

> > > > report (where you have the infection and it does not show up

on

> > the

> > > > test). Because of this, especially for HHV-6, multiple tests

> will

> > > > often need to be done. There are good arguments for not doing

> the

> > > > tests and simply going ahead and treating empirically with

the

> > > > natural remedies discussed above for HHV-6, or for

prescribing

> > > > Doxycycline or Cipro for an extended period of time (see

> below).

> > If

> > > > you feel better after four months on the treatment, then you

> know

> > > you

> > > > are hitting an infection and you can always intermittently

stop

> > the

> > > > treatments to see how long you will need them. Also, there

are

> > many

> > > > infections that are not tested for with these tests that

would

> be

> > > > effectively treated with the regimens that we are discussing.

> > Many

> > > of

> > > > these are likely to be infections that we don't even know

> exist.

> > > > Because of this, if resources are limited, I some-times

simply

> > > treat

> > > > the patient, based on clinical suspicion, without doing the

> > > > > tests.

> > > > > Testing does have its benefits. If the test is positive, I

am

> > > > likely to treat more aggressively and it helps guide me on

how

> > long

> > > > to give the treatment. For example, if after four months you

> are

> > > not

> > > > better and the test is positive, I would be likely to go

ahead

> > and

> > > > increase dosing or change to a different antibiotic. If the

> test

> > > was

> > > > negative, I would be more likely to just stop treatment and

> > suspect

> > > > that the infection is less likely. This argues in favor of

> doing

> > > the

> > > > tests. One simple thing to do is to go ahead and check with

> your

> > > > insurance company to see if they cover these tests. This may

> make

> > > > your decision much simpler. Unfortunately, I suspect that the

> way

> > > > that most labs draw and ship your blood sample may not be

> > reliable

> > > > because, in our experience, we have had less than 10% of

> > patient's

> > > > tests come back positive for HHV-6 cell culture and only a

> modest

> > > > percent come back positive for the Mycoplasma. For the PCR

> > > Mycoplasma

> > > > test, the blood has to be frozen (see boxed inset, Page 9

> > > > > ). If the blood is left at room temperature, most of the

> > positive

> > > > samples become negative after one to two days.

> > > > > Mycoplasma testing is not as specific as HHV-6 testing is

for

> > > > CFIDS/FMS/Multiple Sclerosis (i.e., it is positive in other

> > > > illnesses). For example, about half the patients with

> Rheumatoid

> > > > Arthritis are also found to be infected with treatable

> > infections,

> > > > including Mycoplasma. This goes along with my, and other

> doctors'

> > > > experience, that Doxycycline is often effective in treating

> > > > Rheumatoid Arthritis. Interestingly, although Mycoplasma is

> > common

> > > in

> > > > the environment, it usually is fairly noninvasive. It may

> simply

> > be

> > > > that once your immune system is weakened, these infections

can

> > get

> > > > into cells where they don't belong. When that happens, even

> some

> > of

> > > > the common ones that are considered noninfectious can wreak

> > havoc.

> > > > When these infections repro-duce slowly, they tend to be low-

> > grade,

> > > > chronic infections, as opposed to the acute and more

prominent

> > > > symptoms seen with bacterial and viral infections that

multiply

> > and

> > > > divide rapidly.

> > > > > For CFS/ME or FMS or Autoimmune Disease Patients,

> > > > > The Institute for Molecular Medicine suggests the following

> lab

> > > > tests:

> > > > > (Codes are I.M.D. or CPT Codes)

> > > > > 1. Test Panel 1007 (CPT: 87798x3, 87581) Mycoplasma species

> > panel

> > > > of 4 pathogenic mycoplasmas (M. fermentans, M. penumoniae, M.

> > > > hominis, M. penetrans) by PCR.

> > > > > Justification: Almost 60% of CFS/FMS and 50% of Rheumatoid

> > > > Arthritis (RA) and other autoimmune patients have one or more

> > > > intracellular, systemic mycoplasmal infections similar to

those

> > > found

> > > > in a variety of chronic illnesses [Nicolson, et al.,

> Mycoplasmal

> > > > infections in chronic illnesses: Fibromyalgia and Chronic

> Fatigue

> > > > Syndromes, Gulf War Illness, HIV-AIDS and Rheumatoid

Arthritis;

> > > > Medical Sentinel 1999; 5:172-176]. Ultrasensitive and

> > ultraspecific

> > > > mycoplasma tests can only be done by a small number of labs,

> most

> > > > university or government labs that have been trained by us

> under

> > a

> > > > U.S. government contract.

> > > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic

Tube

> > > > (EDTA). The blood is collected, immediately mixed and placed

on

> > > ice,

> > > > then shipped on wet ice or immediately flash frozen and

shipped

> > > with

> > > > dry ice by courier (foreign shipments) to I.M.D. to arrive

> within

> > > 24-

> > > > 36 hours. Cost=$250. (Note that other commercial labs charge

> $400-

> > > > 600.)

> > > > > 2. Test 1006 (CPT: 87486) Chlamydia pneumoniae test by PCR.

> > > > Justification: Many CFS, FMS, MS, RA and other patients have

> this

> > > > systemic infection along with viral infection(s). We were

among

> > the

> > > > few labs that developed the molecular tests that are now done

> for

> > > > this type of infection. The other labs that use these

> procedures

> > > are

> > > > university labs.

> > > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic

Tube

> > > > (EDTA). The blood is collected, immediately mixed and placed

on

> > > ice,

> > > > then shipped on wet ice or immediately flash frozen and

shipped

> > > with

> > > > dry ice by courier to I.M.D. to arrive within 24-36 hours.

> > > Cost=$180.

> > > > (Note that other commercial labs charge $200-250.)

> > > > > 3. Test 07047 (CPT: 87476) Borrelia burgdorferi (Lyme

> Disease)

> > > test

> > > > by PCR.

> > > > > Justification: Many CFS, FMS and RA patients have this

> systemic

> > > > infection (diagnosed as Lyme Disease) along with other

infection

> > > (s).

> > > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic

Tube

> > > > (EDTA). The blood is collected, immediately mixed and placed

on

> > > ice,

> > > > then shipped on wet ice or immediately flash frozen and

shipped

> > > with

> > > > dry ice by courier to I.M.D. to arrive within 24-36 hours.

> > > Cost=$180.

> > > > (Note that other commercial labs charge $200-250.)

> > > > > 4. Test 07039 (CPT: 87532) Human Herpes Virus 6 (HHV-6)

test

> by

> > > > PCR.

> > > > > Justification: Many CFS and some FMS patients have this

> > systemic

> > > > viral infection, and it should be tested for in any

autoimmune

> > > > illness.

> > > > > Specimen Requirements: Collect blood in one (1) 5 cc

Lavender-

> > top

> > > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > > centrifugation. The plasma is then shipped on wet ice or

> > > immediately

> > > > flash frozen and shipped with dry ice by courier to I.M.D. to

> > > arrive

> > > > within 24-36 hours. Cost=$180. (Note that other commercial

labs

> > > > charge $200-350.)

> > > > > 5. Test 07034 (CPT: 87496) Cytomegalovirus (CMV) test by

PCR.

> > > > > Justification: Many CFS and FMS patients have this systemic

> > viral

> > > > infection, and it should be tested for in any autoimmune

> illness.

> > > > > Specimen Requirements: Collect blood in one (1) 5 cc

Lavender-

> > top

> > > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > > centrifugation. The plasma is then shipped on wet ice or

> > > immediately

> > > > flash frozen and shipped with dry ice by courier to I.M.D. to

> > > arrive

> > > > within 24-36 hours. Cost=$180. (Note that other commercial

labs

> > > > charge $200-300.)

> > > > > For the best price and highest quality, the above PCR

> specialty

> > > > tests for CFS/FMS patients can be ordered through

International

> > > > Molecular Diagnostics, Inc., 15162 Triton Lane, Huntington

> Beach,

> > > CA

> > > > 92649, U.S.A. Tel: 714-799-7177, ext. 202 (Client Services)

or

> > ext.

> > > > 204 (Brant Blasingame). Order forms and additional

information

> > are

> > > > available upon request. They also offer testing for blood

> > clotting

> > > > abnormalities (see below). Tests must be ordered by a

> physician.

> > > The

> > > > I.M.D. Web site is www.imd-lab.com. On this site you will

find

> > > > additional information about testing and disease. The

Institute

> > for

> > > > Molecular Medicine Web site is www.immed.org. On this site

you

> > will

> > > > find publications and documents on CFS/ME, FMS, autoimmune

> > diseases

> > > > and other chronic illnesses. Immediate fax-back information

is

> > > > available 24 hours per day by calling our telephone number

714-

> > 903-

> > > > 2900.

> > > > > Garth Nicolson, Adjunct Professor of Internal Medicine

> > > > > President and Chief Scientific Officer, The Institute for

> > > Molecular

> > > > Medicine

> > > > > —A nonprofit institute dedicated to discovering new

> diagnostic

> > > and

> > > > therapeutic solutions for chronic diseases—

> > > > > 15162 Triton Lane, Huntington Beach, CA 92649-1041,

U.S.A. •

> > Tel:

> > > > 714-903-2900 • Fax: 714-379-2082

> > > > > So, What Is Prescribed For Mycoplasma And Chlamydia?

> > > > > Fortunately, Mycoplasma and Chlamydia infections are

usually

> > > > sensitive to the right antibiotics. The antibiotics most

likely

> > to

> > > > effect these organisms are:

> > > > > 1. Doxycycline or Minocycline 100 mg, 2-3 times a day.

These

> > two

> > > > antibiotics are in the Tetracycline-family and should not be

> used

> > > in

> > > > children under eight years-old because they can cause

permanent

> > > > staining of the teeth. They are very effective, though,

against

> a

> > > > number of unusual organisms (e.g., Lymes Disease). They will

> > > > sometimes cause some stomach upset. If this occurs, take the

> > > medicine

> > > > with food and a full glass of water or lower the dose. Do not

> use

> > > > outdated/expired Tetracycline prescriptions—they can kill you!

> > > > > 2. Cipro (Ciprofloxacin) 750 mg, twice a day. Although

> > expensive,

> > > > this is usually a well-tolerated antibiotic. It has a very

wide

> > > range

> > > > of effectiveness against a large number of organisms. When

> > treating

> > > > males, the Cipro (as well as the Doxycycline) has the

> additional

> > > > benefit of treating any hidden prostate infections. Do not

take

> > > oral

> > > > magnesium within 6 hours of Cipro or you won't absorb the

Cipro.

> > > > > 3. Zithromax 600 mg a day, taken with food, or Biaxin 500

mg,

> > > twice

> > > > a day, taken on an empty stomach. These are in the Erythro-

> mycin

> > > > family. Zithromax tends to be fairly well-tolerated. The

Biaxin

> > is

> > > > more likely to cause a bit of nausea in some patients, but it

> is

> > > > usually well-tolerated. Both are quite expensive. They may

work

> > > > against infections missed by Doxycycline and Cipro.

> > > > > Although all of these antibiotics can be effective, it is

not

> > > > uncommon for infections that are sensitive to the

Erythromycin

> > > > antibiotics (#3 above) to be resistant to #1 and #2 above and

> > vice-

> > > > versa. Therefore, it is best to try either Doxycycline or

Cipro

> > > > first. If they are not effective, then try the Zithromax or

> > Biaxin.

> > > > The antibiotic should be taken for at least 6 months. If

there

> is

> > > no

> > > > improvement in 4 months, switch to or add the other

antibiotic

> or

> > > > simply stop the treatment. It is helpful to check for low-

grade

> > > > fevers. I am more likely to use antibiotics for CFIDS

patients

> > who

> > > > have temperatures over 98.6°F, even if it is only 98.8° (I

> > consider

> > > > 98.8° a fever because CFIDS/FMS patients usually have low

body

> > > > temperatures). If you do have low-grade, chronic temperature

> > > > elevations, be sure that you monitor your temperatures during

> > > > treatment. If your temperature drops with the antibiotic, it

> > > suggests

> > > > that you do have one of these nonviral infections and the

> > > antibiotic

> > > > is helping. T

> > > > > his would encourage me to continue the antibiotic trial -

> even

> > if

> > > > it takes up to 12 months to see an improvement in your

> symptoms.

> > > > > If you are clearly better, I would probably take the

> antibiotic

> > > for

> > > > at least 6 to 12 months. It can then be stopped. If symptoms

> > recur,

> > > > keep repeating 6 to 8 week cycles until the symptoms stay

gone.

> > It

> > > > may take several years of treatment for the infection to be

> > totally

> > > > eradicated. To put it in perspective, this is how long

children

> > > often

> > > > take antibiotics for acne—which unfortunately, if not taken

> with

> > > anti-

> > > > fungals, can lead to yeast overgrowth and possibly trigger

> CFIDS.

> > > Be

> > > > sure to take Nystatin, 2 tablets, 2 times a day, while on the

> > > > antibiotics. Also, please be sure to use alternative birth

> > control

> > > if

> > > > on " the pill. " Birth control pills may be ineffective while

> > taking

> > > > antibiotics. In addition, anti-depressants, codeine,

antacids,

> > and

> > > > mineral supplements (e.g., magnesium) may block antibiotic

> > > > absorption. Take these at least three hours away from the

> > > antibiotic

> > > > (and don't take the antidepressant/codeine medications if

they

> > are

> > > > not clearly helping).

> > > > > It is very common to get die-off (Herxheimer) reactions

which

> > > > include chills, fever, night sweats and general worsening of

> > > CFS/FMS

> > > > symptoms when the antibiotic first kills off the infection.

> These

> > > can

> > > > be severe and last for weeks. Dr. Nicolson encourages you " to

> be

> > > > patient and not abandon therapy prematurely, because few

> patients

> > > who

> > > > have been sick for years recover in less than one year of

> > > therapy...

> > > > [don't] be alarmed if some signs and symptoms occasionally

> return

> > > or

> > > > worsen. This is not unusual. Eventually you will be off

> > antibiotics

> > > > or antivirals but you will need to continue various

supplements

> > to

> > > > maintain your immune system and general nutritional status. "

> > > > > Treatment for Bacterial, Mycoplasma, Chlamydia, E-coli,

> > Bladder,

> > > Or

> > > > Other Infections

> > > > > (From the " Treatment Checklist " used in Dr. Teitelbaum's

> > office.

> > > A

> > > > full list is available on Dr. Teitelbaum's Web site at

> > > > www.endfatigue.com.)

> > > > > The Mycoplasma, Chlamydia, E-Coli, bladder and other

> bacterial

> > > > infections usually take months to years to eradicate. It is

> > common

> > > to

> > > > flare your symptoms (from the infection die-off) the first

two

> > > weeks

> > > > of treatment. Take the antibiotics for six months and, if

> better,

> > > > then repeat six-week cycles till your symptoms stay gone.

> > > > Antidepressants, Neurontin, and/or Codeine may block the

> > > antibiotic's

> > > > effectiveness. Be sure to take Nystatin, 2 tablets twice a

day,

> > and

> > > > Acidophilus while on the antibiotics. If you have occasional

> low-

> > > > grade fever (i.e., if over 98.6° F), check your oral

> temperature

> > > > occasionally to see if the antibiotic reduces or eliminates

the

> > > > fever. If so, stay on that antibiotic. Also, see Dr.

Nicolson's

> > Web

> > > > site at www.immed.org for additional information.

> > > > > Useful antibiotic treatment for the above infections

include:

> > > > > 1. Cipro (ciprofloxacin) 750 mg, 2 times a day for 6

months.

> Do

> > > not

> > > > take magnesium products (e.g., Fibrocare, some antacids, Pro

> > > Energy,

> > > > or (Dr. Teitelbaum's) Foundation Formula™) within 6 hours of

> > Cipro

> > > > because you won't absorb the Cipro.

> > > > > OR

> > > > > 2. Doxycycline (a tetracycline) 100 mg, 3 times a day for 6

> > > months.

> > > > If symptoms recur when the Doxycycline is completed, keep

> > repeating

> > > 6-

> > > > week courses until the symptoms stay resolved. Take Nystatin

> (at

> > > > least 2, twice a day) while on the antibiotic. Birth control

> > pills

> > > > may not work while on Doxycycline. Do not take any expired

> > > > Doxycycline tablets (it's very dangerous).

> > > > > OR

> > > > > 3. Zithromax (azithromycin) 600 mg tablets, 1 tablet a day

> > (take

> > > > with food if it bothers your stomach). Don't take magnesium-

> > > > containing products within six hours of the Zithromax.

> > > > > OR

> > > > > 4. Biaxin 500 mg, 2 times a day.

> > > > > 5. D-Mannose ½ to 1 teaspoon (2.5 grams), stirred in water,

> > every

> > > 2

> > > > to 3 hours while awake, for 2 to 5 days for acute bladder

> > > infections

> > > > (may use long-term for chronic infections) caused by E-coli

> (this

> > > > causes approximately 90% of bladder infections). If not much

> > better

> > > > in 24 hours, get a urine culture and consider an antibiotic.

D-

> > > > Mannose is available from BioTech (800-345-1199), my Web

> > > > site's " Vitamin Shop " at www.endfatigue.com or my office (800-

> 333-

> > > > 5287).

> > > > > What About Yeast Overgrowth?

> > > > > Yeast overgrowth is an important concern. As I have

mentioned

> > > > before, nothing is all good or all bad. Although cigarettes

> kill

> > > > hundreds of thousands of people each year, they can be

helpful

> in

> > > > treating Parkinson's Disease or ulcerative colitis. Although

> > > > antibiotics can trigger CFIDS, they can also be helpful in

> > treating

> > > > it. This makes it important to know when and how to use them.

I

> > > > strongly recommend that my patients take antifungals while on

> any

> > > > antibiotics (e.g., Nystatin 500,000 unit tablets, 2 tablets,

2

> to

> > 3

> > > > times a day) to prevent yeast overgrowth. It is also

reasonable

> > to

> > > > add Oregano Oil and other natural antifungals. Two Nystatin

> twice

> > a

> > > > day is what I usually prescribe. Using probiotics (healthy

milk

> > > > bacteria-like acidophilus that helps your body) to compete

with

> > the

> > > > yeast can also help. I am concerned that if the acidophilus

is

> > > taken

> > > > with the antibiotic, they may simply cancel each other out.

> > Because

> > > > of this, I usually begin probiotics (Acidophilus or

> Lactobacillus

> > > in

> > > > a d

> > > > > ose of 3 to 6 billion units a day, taken on an empty

stomach

> or

> > > > with milk) after one has completed the course of antibiotics.

> If

> > > you

> > > > are only taking the antibiotic once or twice a day, and can

> find

> > a

> > > > time at least 6 to 8 hours away from another dose to take the

> > > > probiotic, it is reasonable to take it at that time. The

entire

> > > daily

> > > > probiotic dose can also be taken at one time. If you find

that

> > you

> > > > still get yeast overgrowth, it may be necessary to use some

of

> > the

> > > > more potent prescription antifungals (Sporanox or Diflucan).

> > > Because

> > > > these can cause liver inflammation and are quite expensive,

it

> > may

> > > be

> > > > adequate to take 200mg of either of these, twice a day, one

day

> > > each

> > > > week (e.g., take it every Sunday) instead of every day. As

> > > discussed

> > > > previously, be sure to take Lipoic acid 200 mg on any day you

> > take

> > > > Sporanox or Diflucan, to decrease the risk of liver

> inflammation.

> > > > > What Role Does My Blood Clotting System Play In This?

> > > > > Work done by E. Berg, M.S., C.L.S. (N.C.A.), director

> of

> > > > Hemex Laboratories in Phoenix, Arizona (800-999-2568), has

> shown

> > > that

> > > > a number of infections can trigger our blood clotting system

to

> > > > become active, thus setting up a low-level, chronic clotting

> > > cascade.

> > > > These infections include HHV-6, Mycoplasma, CMV and Chlamydia

> > which

> > > > can trigger production of (IgA) antibodies against clot

> > protective

> > > > proteins on blood vessel inner surfaces (called

> antiphospholipid

> > > > antibodies). One of these is the Beta 2 Glyco-protein 1 (anti

> > B2GP1—

> > > > no, you are not going to be tested on this!). This then

> triggers

> > > the

> > > > clotting cascade. Once the clotting system is triggered, a

> > product

> > > > called Soluble Fibrin Monomer (SFM) is made which is like the

> > > > polymers in plastic. The theory is that they create long thin

> > > sheets

> > > > of a teflon-like substance, similar to the scab that covers a

> > cut,

> > > > but microscopic, which then coats the blood vessels. This

makes

> > it

> > > > hard for nutrients, oxygen, etc., to get in and out of the b

> > > > > lood vessels to the cells where they are needed. In

summary,

> > many

> > > > infections can cause the blood clotting system to activate,

> > > resulting

> > > > in a thin coating of Fibrin deposited on the blood vessels.

> This

> > > > prevents nutrients and oxygen from getting to the cells in

your

> > > body.

> > > > > Why Would An Infection Trigger The Clotting System?

> > > > > Many infections (called anaerobic) do not survive well in

the

> > > > presence of oxygen. One can theorize that these Mycoplasma

> (which

> > > may

> > > > be anaerobic) and other organisms may trigger the clotting

> system

> > > to

> > > > create a shell, which then acts like a suit of armor,

> protecting

> > > them

> > > > from oxygen, your body's defense system, and antibiotics.

This

> > > would

> > > > explain why these infections could evolve a way to trigger

the

> > > > clotting mechanism. The Fibrin armor preventing antibiotics

> from

> > > > getting to the infection could also explain why some people

> with

> > > > these infections may not respond to antibiotics. Indeed, some

> > > > physicians have found that the antibiotics work better once

> > someone

> > > > has been on a blood thinner (which may dissolve the armor).

> > > > > This is an interesting theory, but how do we know this is

> going

> > > on?

> > > > Mr. Berg and others have done studies showing that the blood

> > tests

> > > > that look for these clotting changes (called the ISAC panel -

> > > > available at Hemex labs) are abnormal in CFIDS/FMS patients

> while

> > > > being normal in most other patients. They use a criterion of

> two

> > of

> > > > these tests needing to be abnormal to be considered positive.

> > When

> > > > this was done, 50 of 54 CFIDS/FMS patients had abnormal tests

> > > (i.e.,

> > > > only 7.4% of the patients had normal blood tests). In healthy

> > > > patients, 22 out of 23 had normal blood tests (i.e., 96%).

This

> > > means

> > > > the test is both very sensitive and specific, picking up

people

> > > with

> > > > CFIDS and excluding healthy people. Our experience has shown

> that

> > > > almost everyone that we tested, who has CFIDS, has turned out

> to

> > > have

> > > > a positive ISAC panel. We have not personally sent in any

tests

> > on

> > > > healthy patients to see if this also occurs. Interestingly,

> this

> > > > panel is also positive in many people with unexplained infer

> > > > > tility (which can improve with Heparin) and may also be

> > positive

> > > in

> > > > people with Multiple Sclerosis, Parkinsons, Autism,

> Inflammatory

> > > > Bowel Disease and some other illnesses. This suggests that

this

> > > test

> > > > can be helpful in deciding whether to treat with blood

thinners

> > > > (Heparin) in CFIDS/FMS.

> > > > > So, How Do I Treat The Clotting System?

> > > > > First of all, it is important to remember that using

> injections

> > > of

> > > > Heparin (the blood thinner) is still a controversial and

> > > experimental

> > > > treatment for CFIDS/FMS. We much prefer to use treatments

that

> > are

> > > as

> > > > safe as possible. Although Heparin is routinely used in the

> > U.S.A.

> > > to

> > > > treat blood clots, using it to treat CFIDS/FMS is very new.

> Most

> > of

> > > > the doctors that I have spoken with have only treated a few

> > > CFIDS/FMS

> > > > patients with Heparin and find that about half of these

> patients

> > > get

> > > > better with treatment. The treatment protocol, developed by

>

> > > > Couvaras, M.D. (602-996-2411), includes the following:

> > > > > 1. Remove wheat, alcohol and sugar from the diet, if

possible.

> > > > > 2. Check the ISAC panel. If there are at least two abnormal

> > > > results, then begin treatment.

> > > > > 3. Give an antifungal for 14 days (he uses Lamisil 250mg a

> day—

> > > > which I find to be poorly effective. I would use 200 mg of

> > Sporanox

> > > > or Diflucan instead).

> > > > > 4. Give standard Heparin 4000 to 8000 units by injection

> > > > subcutaneously (like an insulin shot) twice a day. A

(possibly

> > > safer)

> > > > low molecular weight Heparin may also be used.

> > > > > 5. If the PA index (on the ISAC) is positive, add a baby

> > Aspirin

> > > > (81mg) each day.

> > > > > 6. After being on Heparin for one week, Dr. Couvares

repeats

> > the

> > > > ISAC panel to adjust the dose of the Heparin and Aspirin. He

> > feels

> > > > that the goal is to move all the blood tests into the normal

> > range

> > > > but not past the normal range into blood-thinning

(therapeutic)

> > > > levels. If the values are still abnormal or the patient is

> still

> > > > having symptoms, he then increases the Heparin dosage. If the

> PA

> > > > index (on the ISAC) is still high, he increases the Aspirin

to

> > > twice

> > > > a day.

> > > > > 7. If the patient feels better after one month of Heparin,

he

> > > then

> > > > switches to low-dose Coumadin (a blood thinner tablet—take 2

to

> 3

> > > mg

> > > > a day) and then stops the Heparin after 4 to 5 days of being

on

> > the

> > > > Coumadin. Once the patient has been on the Coumadin for two

> weeks

> > > he

> > > > goes ahead and rechecks the ISAC panel to maintain the blood

> > tests

> > > in

> > > > the normal range.

> > > > > 8. He also supplements patients with nutritional

> > supplementation

> > > as

> > > > needed.

> > > > > In my practice, because the ISAC panel runs over $320, I

> check

> > a

> > > > baseline ISAC panel but do not repeat the ISAC panels to

adjust

> > > > therapy. Instead, while on Heparin, we check a PTT (a blood

> > > thinning

> > > > test) and platelets (a highly unusual, but potentially very

> > > dangerous

> > > > side effect of Heparin is a severe drop in platelet count,

> which

> > > can

> > > > cause life-threatening bleeding) every 3 days for the first

12

> > days

> > > > and then every 2 to 4 weeks while on Heparin. If the PTT is

> still

> > > > within the normal range and the patient is not better, we

> > increase

> > > > the Heparin as high as 8000 units, twice a day (rarely we

will

> go

> > > up

> > > > to 8000 units, 3 times a day) and then also increase the

> Aspirin

> > to

> > > 2

> > > > a day. In comparison, hospital patients often require Heparin

> at

> > > 1000

> > > > units per hour (24,000 units a day) I.V., while most CFS/FMS

> > > patients

> > > > only need 4000 to 5000 units, 2 times a day (8000 to 10,000

> units

> > a

> > > > day). If the patient is feeling better, however, we simply

> leave

> > > them

> > > > at the initial dose. Most patients will f

> > > > > eel better at about the 10- to 14-day point if the Heparin

is

> > > going

> > > > to help. At the end of 4 to 12 months, if the Heparin helps,

we

> > > > switch to Coumadin (as noted above) and check an INR

> > (International

> > > > Normalized Ratio), aiming to keep it below 1.3 while

adjusting

> > the

> > > > Coumadin to the optimum does. It is very important to know

that

> > > most

> > > > medications can change the blood level of Coumadin and that

> > anytime

> > > > anything is added to, or deleted from, your regimen

(including

> > > > natural remedies) you need to recheck the INR 4 to 7 days

later

> > to

> > > > make sure that it is not going too high. Heparin and Coumadin

> are

> > > > powerful medicines and the main risk is bleeding. Although we

> are

> > > > using very low doses, which are usually very well-tolerated,

> one

> > > can

> > > > rarely see a life-threatening bleed occur. If you felt better

> on

> > > the

> > > > Heparin and then the symptoms come back on the Coumadin, you

> may

> > > need

> > > > to go back on the Heparin for several months to re-establish

> and

> > > > maintain the benefit. Occasionally, people will need to b

> > > > > e on the Heparin for an extended period, in which case the

> > blood

> > > > tests (PTT and platelet count) should be checked every 2 to 4

> > > weeks.

> > > > All of this being said, most people tolerate these treatments

> > quite

> > > > well and many, many more people die from taking Aspirin

(e.g.,

> > for

> > > > arthritis) than Heparin each year.

> > > > > In summary, there are a number of infections that can cause

> or

> > > > occur because you have CFIDS/FMS. Once they occur, they can

> > trigger

> > > > the clotting cascade. This may keep the nutrients from

getting

> to

> > > > your body and create a " suit of armor " for the viral and

> > Mycoplasma

> > > > infections. Using a blood thinner can break down these armor

> > > coatings

> > > > that protect the infections from our treatment and allow

> > nutrients

> > > to

> > > > get where they need to go. Many tests can help. The one that

I

> > use

> > > to

> > > > decide whether to use the Heparin blood thinner is the ISAC

> panel

> > > (at

> > > > Hemex Labs). Testing for infections may be helpful, but can

be

> > > > expensive and less likely to effect my decision to treat. If

> you

> > > can

> > > > afford the tests and/or your insurance will pay for them,

they

> > are

> > > > worth checking and will make it easier to adjust therapy over

> > time.

> > > > If you can't afford it, it is reasonable to treat empirically

> > > (i.e.,

> > > > without testing), except for high-dose Valtrex therapy. If

you

> > have

> > > > lung congestion and/or recurrent temperatures o

> > > > > ver 98.6°F, I would treat with the antibiotics. If you feel

> > > > chronically flu-like, I would consider the HHV-6 or (based on

> > > > testing) the high-dose Valtrex regimen. It is also reasonable

> to

> > > > treat with antibiotics and antivirals simultaneously -

> especially

> > > if

> > > > you are taking the anticoagulants.

> > > > > Chronic Sinusitis The Yeasty Beasties Revisited!

> > > > > As was mentioned years ago, we speculated that the chronic

> > sinus

> > > > congestion seen in CFIDS/FMS could be caused by yeast

> overgrowth.

> > A

> > > > recent interesting study from the Mayo Clinic Proceedings

> > supports

> > > > this thought. In the study, researchers found that most

people

> > with

> > > > chronic sinus infections had fungal growth in their sinuses.

> They

> > > > felt that the inflammation was being caused by an immune (the

> > > body's

> > > > reaction) response to the fungus. This research is

interesting

> > > > because more and more studies are showing that treating

chronic

> > > > sinusitis with antibiotics doesn't really do much and that

> > shorter

> > > > courses of treatment work just as well as the long courses.

We

> > find

> > > > that conservative treatment (see my newsletter article,

> Treatment

> > > Of

> > > > Respiratory Infections Without Antibiotics, Vol. 2, Issue 2)

is

> > > more

> > > > effective than antibiotics for chronic sinusitis.

> > > > > It's good that medicine is finally starting to catch up

with

> > > > reality. The report in The Mayo Clinic Proceedings noted

> > > > that, " fungus allergy was thought to be involved in less than

> 10%

> > > of

> > > > cases… our studies indicate, in fact, fungus is likely the

> cause

> > of

> > > > nearly all of these problems and that it is not an allergic

> > > reaction

> > > > but an immune reaction. " In this study, the researchers

studied

> > 210

> > > > patients with chronic sinusitis. Using new methods to collect

> and

> > > > test sinus/nasal mucus they found fungus in 96% of patients.

> > > > > It's interesting to observe how medical research works. The

> > > > researchers are now working with different drug companies to

> set

> > up

> > > > trials to test medications to control the fungus but feel

that

> it

> > > > will be at least two years before any treatments will be

> > available.

> > > > In my experience, though, these problems often respond

> > dramatically

> > > > to either Sporanox or Diflucan - which, by no coincidence,

are

> > very

> > > > powerful antifungal agents. It is not clear why the

researchers

> > did

> > > > not simply try Sporanox or Diflucan. Un-fortunately, we find

> that

> > > the

> > > > obvious is often overlooked. This sometimes occurs as drug

> > > companies

> > > > seek to make more money by finding new drugs instead of using

> the

> > > old

> > > > things that are known to work. It is important to distinguish

> > > between

> > > > chronic sinusitis (which lasts for over three months) and

acute

> > > > sinusitis (which usually has been going on for a few days and

> > less

> > > > than a month). For these shorter attacks of sinusitis,

bacteria

> > are

> > > a

> > > > more common cause and antibiotics (combined with n

> > > > > atural remedies) can be helpful. Some researchers still

> > continue

> > > to

> > > > argue that fungus is not a cause of chronic sinusitis. They

> note

> > > that

> > > > fungi are seen even in healthy noses (which is correct) but

> > neglect

> > > > to discuss the immune changes that are also seen in these

> noses.

> > > > Because so many people have responded dramatically to

> antifungals

> > > in

> > > > the treatment of their chronic sinusitis, my suspicion is

that

> > the

> > > > Mayo Clinic researchers are probably correct. Wouldn't it be

> > nice,

> > > if

> > > > instead of arguing about treatments while people stay sick,

> they

> > > > would just try the treatments to see if they worked!

> > > > > As you can see, your body's defenses being down plays a

large

> > > role

> > > > in CFIDS/FMS. The good news is, that by treating the many

> > > underlying

> > > > infections common in CFIDS patients and by treating any

> hormonal

> > > and

> > > > nutritional deficiencies, you can bring your immune system

back

> > to

> > > a

> > > > healthy state!

> > > > > Important Points

> > > > > • An important component of CFS is disordered immune

> function,

> > > > which opens the door to repeated infections, repeated

treatment

> > > with

> > > > antibiotics, and yeast overgrowth.

> > > > > • Treat yeast overgrowth by avoiding antibiotics and

sweets.

> > Many

> > > > patients have found Nystatin and other antifungal

medications,

> > such

> > > > as Diflucan and Sporanox, to be helpful. Acidophilus (milk

> > > bacteria)

> > > > and natural antifungals such as Caprylic acid and garlic are

> also

> > > > often useful.

> > > > > • Bowel parasites are common in CFS patients, whose

symptoms

> > > often

> > > > respond dramatically to treatment. However, most labs do not

> > > > adequately detect parasites through stool testing. To get an

> > > accurate

> > > > test result, use one of the labs we recommended that

> specializes

> > in

> > > > stool testing.

> > > > > • Treat Cryptosporidium with Artemesia annua or tricyclin

> > (herbal

> > > > antiparasitics).

> > > > > • Treat constipation with Turkey Rhubarb (a herb).

> > > > > • Prevent parasitic infection by using a Multi-pure water

> > filter

> > > > (available from 888-801-8176 or 410-224-4877)

> > > > > • If you have temperatures over 98.6°F and/or chronic lung

> > > > congestion, try long-term Cipro or Doxycycline (while on

> > Nystatin).

> > > > > • If you have chronic flu-like symptoms, despite yeast and

> > Cortef

> > > > treatment, consider the antiviral, immune stimulating

protocol

> we

> > > > discussed.

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Hi Krista,

I only took it for a month and it was immediately after surgery.

When I came back from Atlanta my doc here advised me to stop taking

it and put me on Adrecorp. I didn't take either long enough to

notice anything at all, good or bad. At the time I was frantic in

trying to find a doc who knew what was going on and as a result was

seeing three diff docs because one thought it was adrenals, another

said no, it was parasites and another just had a good reputation. As

a result, there were " too many chefs in the stew " ...so I was confused

by what to do or what to take. I don't really know what was helping

or hurting. Definitely Dr. Mercola knows about the adrenals and I'll

share what I find out. Love, PH

> > > > > >

> > > > > > From Fatigued to Fantastic Newsletter

> > > > > > Vol. 3, No. 3 (2000)--Vol 4, No. 1 (2001)

> > > > > >

> > > > > > Fighting Those Persistent Infections in CFIDS

> > > > > > By Teitelbaum, M.D.

> > > > > > Medical science has known for quite some time that

Chronic

> > > > Fatigue

> > > > > Syndrome is associated with changes in the body's immune

> > system.

> > > In

> > > > > fact, the acronym " CFIDS " stands for " Chronic Fatigue And

> > Immune

> > > > > Dysfunction Syndrome. " This can result in your having

several

> > > > > different and unusual infections at one time. Many of these

> > > > > infections need to be treated directly. Other infections

will

> > go

> > > > away

> > > > > on their own as your immune (defense) system comes back " on

> > line "

> > > > by

> > > > > using our treatment protocol. In this article, I'll discuss

> > some

> > > of

> > > > > the more common, yet not usually thought of (in " regular "

> > > > medicine),

> > > > > infections.

> > > > > > What Kind Of Infections Am I Most At Risk For?

> > > > > > Although CFIDS of sudden onset often seems to be

triggered

> by

> > > > viral

> > > > > infections (e.g., EBV, HHV-6, CMV), those infections, I

> > suspect,

> > > > > are " simmering " or no longer active in many cases. However,

> the

> > > > body

> > > > > acts as if they are. This may result in elevated interferon

> > > levels.

> > > > I

> > > > > suspect this was what triggered my CFIDS.

> > > > > > The body produces interferon to fight viral infections.

> When

> > a

> > > > > cancer or hepatitis patient is injected with interferon,

the

> > > > patient

> > > > > becomes achy, fatigued and brain-fogged. An under-active

> > adrenal

> > > > can

> > > > > also cause interferon levels to become elevated. Because of

> > this

> > > > > elevation, it is more accurate to say that the body's

immune

> > > system

> > > > > is not functioning properly, than to say that it is

> > underactive.

> > > > > Indeed, in many ways, the immune system may be in overdrive

> and

> > > > soon

> > > > > exhaust itself. The immune system malfunctions in many

other

> > > ways,

> > > > > too, including decreasing the effectiveness of the

> > > body's " natural

> > > > > killer " cells, which are an important defense mechanism.

> > > > > > Many other recurrent or unusual infections can also occur

> > > because

> > > > > of your malfunctioning immune system. Chronic sinus,

bladder,

> > > > > prostate and respiratory infections are common and are

often

> > > > treated

> > > > > with repeated courses of antibiotics. The large amount of

> > > > antibiotics

> > > > > introduced into the system can cause a secondary yeast over-

> > > growth

> > > > as

> > > > > it changes the natural balance between the bowel's healthy

> > > bacteria

> > > > > and yeast. The original immune dysfunction also contributes

> to

> > > the

> > > > > yeast overgrowth. Although it is controversial, a theory

held

> > by

> > > > many

> > > > > physicians is that chronic overgrowth of yeast due to

overuse

> > of

> > > > > antibiotics is a potential and strong trigger for chronic

> > > fatigue,

> > > > > fibromyalgia and further immune dysfunction. What makes the

> > > theory

> > > > > controversial is that no definitive tests exist to

> distinguish

> > > > fungal

> > > > > overgrowth from normal fungal levels. Also, many of the

> > symptoms

> > > > > ascribed to yeast overgrowth can also come from the many

> other

> > > > > problems present in chronic fatigue syndrome and fibromya

> > > > > > lgia. On the other hand, most doctors who try treating

> yeast

> > in

> > > > at

> > > > > least three or four CFS patients see how well it works and

> keep

> > > > using

> > > > > it.

> > > > > > CFIDS patients also frequently have bowel parasite

> > infections.

> > > > > Bowel parasites can cause severe allergic or sensitivity

> > > reactions,

> > > > > which in turn can trigger fibromyalgia and fatigue. Often,

a

> > > > patient

> > > > > will finally recover from long-standing and disabling

fatigue

> > > > within

> > > > > a week or two after beginning treatment for bowel parasites.

> > > > > > Many other CFS/FMS patients are left with disabling

fatigue

> > > after

> > > > a

> > > > > bout with viral infections such as polio, HHV-6, CMV, or EB

> > viral

> > > > > infections. This fatigue also usually responds to the

> > treatments

> > > > > discussed in this newsletter. In addition, infections with

> > > unusual

> > > > > organisms such as Rickettsia (e.g., Lymes Disease),

> chlamydia,

> > > and

> > > > > mycoplasma may also be problematic.

> > > > > > Yeast Overgrowth

> > > > > > Everyone's immune system has strong spots, as well as

weak

> > > spots.

> > > > > Some people never get colds but have frequent bouts with

> > > athlete's

> > > > > foot or other skin fungal infections. Others never get

fungal

> > > > > infections but tend to get colds. Many people seem to have

a

> > > > > diminished ability to fight off fungal infections.

> > > > > > Fungi are very complex organisms. Fungal overgrowth may

> > > suppress

> > > > > the body's immune system. The host body may also develop

> > allergic

> > > > > reactions to components of the yeast.

> > > > > > This allergic reaction was suggested in a study which

> > connects

> > > > > Candida Albicans with Allergic Skin Dermatitis (Eczema).

This

> > > study

> > > > > was published in The Journal of Clinical Experimental

Allergy

> > > back

> > > > in

> > > > > 1993 (Vol. 23, pp. 332-339). It found that there is a

> > significant

> > > > > correlation between the body having antibodies to Candida

and

> > > > > Allergic Dermatitis/Eczema. In addition, we have found that

> > > > > unexplained rashes that have lasted for many years often

> clear

> > up

> > > > > with antifungal treatment as well! Many physicians feel

that

> > > yeast

> > > > > overgrowth causes a generalized suppression of the immune

> > system.

> > > > In

> > > > > other words, once the yeast gets the upper hand, it sets up

a

> > > cycle

> > > > > that further suppresses your body's defenses.

Interestingly,

> a

> > > > recent

> > > > > Mayo Clinic study showed that most cases of chronic

sinusitis

> > > seem

> > > > to

> > > > > be associated with a reaction to yeast in the sinuses -

> > something

> > > I

> > > > > proposed years ago. None the less, as I already noted, this

> > > theory

> > > > is

> > > > > controversial. Yeast are normal members of our body's " zoo.

> > > > > > " They live in balance with bacteria - some of which are

> > > helpful

> > > > > and healthy and some of which are detrimental and

unhealthy.

> > The

> > > > > problems begin when this harmonious balance shifts and the

> > yeast

> > > > > begin to overgrow.

> > > > > > As noted above, many things can prompt yeast to overgrow.

> One

> > > of

> > > > > the most common causes is frequent antibiotic use. When the

> > good

> > > > > bacteria in the bowel are killed off by antibiotics (along

> with

> > > the

> > > > > bad bacteria) the yeast no longer have competition and

begin

> to

> > > > > overgrow. The body is often able to rebalance itself after

> one

> > or

> > > > > several courses of antibiotics, but after repeated or long-

> term

> > > > > courses - and especially if the body has an underlying

immune

> > > > > dysfunction - the yeast can get the upper hand.

> > > > > > Other factors are also important. Studies have shown that

> > > animals

> > > > > who are sleep deprived and/or have increased sugar intake

> > develop

> > > > > bowel yeast overgrowth. Many physicians feel that eating

> sugar

> > > > > stimulates yeast overgrowth in people, as well. Sugar is

food

> > for

> > > > > yeast. Yeast ferment sugar in order to grow and multiply.

> Yeast

> > > > > overgrowth due to sugar overuse also seems to cause immune

> > > > > suppression, which facilitates bacterial infections, which

> then

> > > > > requires even more antibiotic use. Poor sleep also results

in

> > > > marked

> > > > > suppression of your immune function.

> > > > > > How Does One Know If They Have Yeast?

> > > > > > There are no definitive tests for yeast overgrowth that

> will

> > > > > distinguish yeast overgrowth from normal yeast growth in

the

> > > body.

> > > > > There is one test which may be useful, though. This is a

> Urine

> > > > > Tartaric Acid test done by The Great Plains Lab in Kansas

> City,

> > > > > Missouri, run by Shaw, Ph.D. Tartaric Acid is a

waste

> > > > product

> > > > > of yeast growth. In fermenting wine, for example, it is

> > critical

> > > to

> > > > > remove the Tartaric Acid. Otherwise, the wine could be

toxic

> to

> > > > > people. Dr. Shaw has found elevations in Urine Tartaric

Acid

> > that

> > > > > decrease with antifungal treatment in both CFIDS/FMS

patients

> > and

> > > > > autistic children. Interestingly, both these illnesses

often

> > > > improve

> > > > > with antifungals (specifically, Sporanox or Diflucan, plus

> > > > Nystatin).

> > > > > Dr. Shaw likes to use the Urine Tartaric Acid to decide

when

> to

> > > > treat

> > > > > yeast overgrowth and to follow-up the effectiveness of

> > treatment.

> > > > > > In my experience, however, using Dr. Crook's Yeast

> > > Questionnaire

> > > > > (available in my book, From Fatigued To Fantastic!) is

still

> > the

> > > > most

> > > > > reliable way to tell if a person is at risk of yeast

> > overgrowth.

> > > If

> > > > > the symptom score is over 140 points, I recommend

treatment.

> In

> > > > > addition, anyone who has been on recurrent or long-term

> > > antibiotic

> > > > > use (especially Tetracycline for acne) or anyone who

> > > intermittently

> > > > > has painful sores in different parts of the mouth that last

> for

> > > > about

> > > > > ten days at a time and who has CFIDS/FMS, should be treated

> > with

> > > > > antifungals. Bowel symptoms are some of the more overt

> symptoms

> > > > that

> > > > > are caused by yeast and I feel that most people who

> > have " spastic

> > > > > colon " have yeast overgrowth or parasites.

> > > > > > How Is Yeast Treated?

> > > > > > A number of very effective methods can be utilized to

take

> > care

> > > > of

> > > > > a yeast problem. Primary among the methods is to avoid

sugar

> > and

> > > > > other sweets. One can enjoy one or two pieces of fruit a

day,

> > but

> > > > > should not consume concentrated sugars such as juices, corn

> > > syrup,

> > > > > jellies, pastry, candy or honey. Stay far away from soft

> > drinks,

> > > > > which have ten to twelve teaspoons of sugar in every twelve

> > > ounces.

> > > > > This amount of sugar has been shown to markedly suppress

> immune

> > > > > function for several hours. Be pre-pared to have withdrawal

> > > > symptoms

> > > > > for about one week when sugar is cut out of the diet.

Several

> > > > > excellent books have been written on the yeast controversy

> and

> > > > offer

> > > > > additional methods to try. One of the best books is The

Yeast

> > > > > Connection and the Woman by Crook, M.D., a

physician

> > who

> > > > has

> > > > > done a spectacular job advancing the understanding of

> CFIDS/FMS.

> > > > > > Many patients have found that acidophilus (that is, milk

> > > > bacteria,

> > > > > a healthy bacteria for the bowel) helps restore balance in

> the

> > > > bowel.

> > > > > Acidophilus is found in yogurt with live and active yogurt

> > > > cultures.

> > > > > Indeed, one cup of yogurt a day can markedly diminish the

> > > frequency

> > > > > of recurrent vaginal yeast infections. Acidophilus is also

> > > > available

> > > > > in capsule form. Although many claims are made for one type

> of

> > > > > acidophilus being better than the other, I'm not sure this

is

> > so.

> > > I

> > > > > usually recommend 3 to 6 billion units a day (1 unit = 1

> > > bacteria)

> > > > on

> > > > > an empty stomach. If on antibiotics (not antifungals), take

> the

> > > > > acidophilus at least 3 to 6 hours away from the antibiotic

> > dose.

> > > > > > Nystatin, an antifungal medication, has also been helpful

> in

> > > the

> > > > > treatment of yeast overgrowth. Unfortunately, some fungi

seem

> > to

> > > be

> > > > > resistant to Nystatin. In addition, Nystatin is poorly

> > absorbed,

> > > > > which means that it has little impact on the yeast outside

of

> > the

> > > > > bowel. Other anti-fungal medications, such as Diflucan and

> > > > Sporanox,

> > > > > seem to be effective systemically (throughout the body) but

> > they

> > > > have

> > > > > two main drawbacks. First, they are expensive, costing more

> > than

> > > > $450

> > > > > to $900 for a two-month course. Second, any effective anti-

> > fungal

> > > > can

> > > > > initially make the symptoms of yeast infection worse.

> Although

> > > > > uncommon, Sporanox and Diflucan can also cause liver

> > inflammation

> > > > (as

> > > > > can Advil and Tylenol). If you are taking Sporanox or

> Diflucan

> > > for

> > > > > more than 6 to 12 weeks, I would consider intermittently

> > checking

> > > > > liver blood tests (ALT and AST). If you have preexisting

> active

> > > > liver

> > > > > disease, be cautious in using (or don't use) Sporanox or

> > > Diflucan.

> > > > I

> > > > > strongly recommend taking Lipoic Acid (a natural

> > > > > > supplement which protects and helps heal the liver),

200mg

> a

> > > > day,

> > > > > whenever you take Sporanox or Diflucan. I also strongly

> > recommend

> > > > > Lipoic Acid for anyone with active liver disease (e.g.,

> > > hepatitis)

> > > > at

> > > > > doses up to 1000mg to 3000mg a day as it may prevent and/or

> > treat

> > > > > cirrhosis.

> > > > > > Natural Yeast Treatments

> > > > > > Below, I have summarized the nonprescription part of the

> > > > treatment

> > > > > checklist that I use in my office.

> > > > > > 1. Avoiding sweets is still the single most important

> thing.

> > > > Using

> > > > > Stevia as a sweetener is a wonderful substitute. Stevia is

a

> > > safe,

> > > > > natural remedy and you can use all you want. There are even

> > > > cookbooks

> > > > > for using Stevia (available from my office or 800-4STEVIA).

A

> > new

> > > > > natural sweetner, Sweet Balance, also tastes good and is 12

> > times

> > > > as

> > > > > sweet as sugar. It is a natural product from the Lo Han

fruit

> > and

> > > > > appears to be safe. Although it is 70% sugar (fructose),

you

> > only

> > > > > need a small amount. Order it from 877-997-9338, my office

at

> > 800-

> > > > 333-

> > > > > 5287 or my Web site at www.endfatigue.com.

> > > > > > 2. Acidophilus or Milk Bacteria can be very helpful. Take

3

> > to

> > > 6

> > > > > billion units a day (a unit is the same as a bacteria). Do

> not

> > > take

> > > > > acidophilus within 3 to 6 hours of an antibiotic. Take it

> > either

> > > on

> > > > > an empty stomach or with milk.

> > > > > > 3. Caprylic Acid is another natural remedy that can be

> > helpful.

> > > > The

> > > > > usual dose is 1800 to 3600mg a day with 1/3 of the dose

being

> > > taken

> > > > > at each meal. Unfortunately, it often causes an acid

stomach

> > with

> > > > > a " funky " tasting reflux.

> > > > > > 4. Oregano Oil - enteric coated oregano oil - 1 to 2

> > capsules,

> > > 2

> > > > to

> > > > > 3 times a day with food, may be more effective and better

> > > tolerated

> > > > > than Caprylic Acid (both can cause stomach acid reflux).

> > > > > > 5. Fresh Garlic, if you can handle it well, can also be

> very

> > > > > effective. Daily, crush 1 to 3 garlic cloves in olive oil,

> add

> > > > salt,

> > > > > spread it on bread and eat it. It can be quite tasty and

> lethal

> > > to

> > > > > whatever infections you have in your gut.

> > > > > > 6. Olive Leaf 500mg, 2 to 4 capsules three times a day

> > between

> > > > > meals, can also be very helpful in treating yeast

overgrowth.

> > > > > > 7. Pau De Arco in either tea or capsule form is also

> helpful

> > in

> > > > > yeast suppression. Although I use Pau De Arco infrequently

> for

> > > > yeast

> > > > > over-growth, many people find that it can be helpful.

> > > > > > 8. Grapefruit Seed Extract (e.g., Citrucidel) is a

popular

> > > > > treatment for yeast overgrowth and is well-tolerated.

> > > > > > More Information On Yeast Treatments

> > > > > > If symptoms of yeast are caused by an allergic or

> sensitivity

> > > > > reaction to the yeast body parts, the symptoms may flare

when

> > > mass

> > > > > quantities of the yeast are suddenly killed off. This is

> called

> > a

> > > > > yeast " die-off " reaction. If you get this reaction, start

> your

> > > > > treatment with acidophilus and a sugar-free diet for a few

> > weeks

> > > > > followed by oregano oil and/or olive leaf (1500mg to

2000mg,

> 3

> > > > times

> > > > > a day between meals) before beginning Nystatin. Take

Nystatin

> > (by

> > > > > mouth) in the form of 500,000-IU tablets or powder. I

> generally

> > > > > recommend beginning with 1 tablet a day for 1 to 3 days,

and

> > > > > increasing by 1 tablet every 1 to 3 days (or slower if

> > yeast " die-

> > > > > off " is a problem) until 2 tablets 2 to 4 times a day is

> > reached.

> > > > If

> > > > > you get nausea, take a lower dose. Take Nystatin, 4 to 8

> > tablets

> > > > > daily, for 5 to 8 months. I add the Diflucan or Sporanox

one

> > > month

> > > > > after beginning the Nystatin. Take 200mg every morning for

> six

> > > > weeks.

> > > > > If symptoms flare, take just 100mg per morning for the

first

> 3

> > to

> > > > 14

> > > > > days. I

> > > > > > f symptoms recur after stopping the Diflucan or Sporanox,

I

> > > > > recommend continuing the medication for an additional 6

weeks

> > at

> > > > > 200mg a day.

> > > > > > Sporanox should be taken with food. If it is taken alone,

> its

> > > > > absorption is greatly reduced. When taking Diflucan or

> > Sporanox,

> > > DO

> > > > > NOT use the antihistamines Seldane or Hismanal, Quinidine

(a

> > > heart

> > > > > medicine), cholesterol-lowering medications in the Mevacor

> > > family,

> > > > or

> > > > > the bowel medicine Propulcid. These can be fatal

> combinations!

> > > > Also,

> > > > > antacid medications (such as Tagamet, Axid, Zantac, and

> Pepcid)

> > > > > prevent the proper absorption of Sporanox. At the high

price

> of

> > > > > Sporanox per dose, you will want to absorb every last bit

of

> > the

> > > > > medication. If you need to be on an antacid medication, use

> > > > Diflucan

> > > > > instead of Sporanox. Unfortunately, a less expensive

> > antifungal,

> > > > > called Lamisil (at 250mg a day), does not seem to work very

> > well

> > > > for

> > > > > candida yeast overgrowth (although it works well for nail

> > > > > infections). I am currently trying patients on 500mg of

> Lamisil

> > a

> > > > day

> > > > > to see if this dose works better.

> > > > > > I feel that once the yeast has been effectively decreased

> and

> > > > kept

> > > > > that way for six to twelve months, it is safe to try to add

> > small

> > > > > amounts of sugar back into the diet. If symptoms recur,

> > however,

> > > > stop

> > > > > the sugar again. Continuing to eat yogurt with live and

> active

> > > > > acidophilus cultures (unless you are lactose-intolerant) or

> > > > > continuing to take acidophilus capsules may also help.

> > > > > > Many books on yeast overgrowth (including Dr. Crook's)

> advise

> > > > > readers to avoid all yeast in the diet. This advice is

based

> on

> > > the

> > > > > theory that an allergic reaction to yeast is the cause of

the

> > > > > problem. The predominant yeast that seems to be involved in

> > yeast

> > > > > overgrowth is Candida Albicans, although I would not be

> > surprised

> > > > if

> > > > > researchers discovered that many other kinds of fungal

> > infections

> > > > are

> > > > > also involved. The yeast that is found in most foods

(except

> > beer

> > > > and

> > > > > cheese) is not closely related to candida.

> > > > > > In my experience, trying to avoid all yeast in foods

> results

> > > > simply

> > > > > in a nutritionally inadequate diet and little benefit.

> Although

> > a

> > > > few

> > > > > people do appear to have true allergies to the yeast in

their

> > > food,

> > > > > they number less than 10 percent of my patients with

> suspected

> > > > yeast

> > > > > overgrowth. These patients may benefit from the more strict

> > diet

> > > in

> > > > > Dr. Crook's book. Interestingly, once their adrenal

> > insufficiency

> > > > and

> > > > > yeast overgrowth are treated, most people find that their

> > > allergies

> > > > > and sensitivities to yeast and other food products seem to

> > > improve

> > > > or

> > > > > disappear.

> > > > > > Nutritional deficiencies such as low zinc or low selenium

> may

> > > > also

> > > > > decrease resistance to yeast over-growth. A good

multivitamin

> > > > > supplement, as recommended in my last newsletter, should

take

> > > care

> > > > of

> > > > > these deficiencies. This is further evidence that all the

> > factors

> > > > > involved in CFS are closely interrelated.

> > > > > > The best thing that one can do to combat yeast overgrowth

> is

> > to

> > > > try

> > > > > to avoid it in the first place. When you get an infection,

> > begin

> > > > > treating it naturally immediately. Hopefully, you can

prevent

> > it

> > > > from

> > > > > turning into a bacterial infection which might require an

> > > > antibiotic.

> > > > > Ask your doctor what measures you can take before resorting

> to

> > > > > antibiotics. Many good over-the-counter remedies are

> available.

> > A

> > > > > knowledgeable pharmacist may also be a wealth of

information.

> > > Your

> > > > > local book or health food store has books on natural

> measures.

> > > Your

> > > > > health food store proprietor can also steer you to

> appropriate

> > > > > natural remedies. For examples of the many helpful measures

> > that

> > > > one

> > > > > can take, see my newsletter article, Treating Infections

> > Without

> > > > > Antibiotics, page ___).

> > > > > > If you find however, that you must take an antibiotic,

all

> is

> > > not

> > > > > lost. One can still lessen the severity of yeast overgrowth

> by

> > > > > avoiding sweets and by either taking acidophilus capsules

> > (again,

> > > > not

> > > > > within 3 to 6 hours of an antibiotic) or by eating one cup

of

> > > > yogurt

> > > > > with live and active acidophilus cultures daily. Don't use

> the

> > > > yogurt

> > > > > (or milk) if you have sinusitis or pneumonia because the

milk

> > > > protein

> > > > > thickens mucus and makes it hard for the body to fight

these

> > > > > infections.

> > > > > > How Can One Tell If The Yeast Is Coming Back?

> > > > > > It is normal for yeast symptoms to resolve after

treatment.

> > > After

> > > > 6

> > > > > weeks on the Sporanox or Diflucan, patients are usually

> feeling

> > a

> > > > lot

> > > > > better, but may have symptoms recur soon after stopping the

> > > > > antifungal. In this case I would continue the Sporanox or

> > > Diflucan

> > > > > for another 6 weeks, or as long as is needed, to keep the

> > > symptoms

> > > > at

> > > > > bay. More frequently, people will feel better after

treatment

> > and

> > > > > stay feeling fairly well for a period of 6 to 24 months. At

> > that

> > > > > time, it is common to see a recurrence of symptoms,

> especially

> > if

> > > > one

> > > > > is eating too much sugar or is taking antibiotics. The best

> > > marker

> > > > > that I have found for yeast overgrowth would be a return of

> > bowel

> > > > > symptoms with gas, bloating and/or diarrhea or

constipation.

> If

> > > > these

> > > > > symptoms persist for more than 2 weeks, especially if there

> is

> > > also

> > > > > even a mild worsening of the FMS symptoms, it is very

> > reasonable

> > > to

> > > > > retreat yourself with 6 weeks of Nystatin and perhaps

> Sporanox

> > or

> > > > > Diflucan. In addition, I would also retreat if there's

> > > > > > a recurrence of vaginal yeast or sinus infections. If re-

> > > > treatment

> > > > > resolves the symptoms, one may opt to repeat this regimen

as

> > > often

> > > > as

> > > > > is needed (usually every 6 to 24 months). By using some of

> the

> > > > > natural remedies listed above, however, you may be able to

> > avoid

> > > > > repeated use of these antifungals and the possible risk of

> > > becoming

> > > > > resistant to them. Some patients also find that they need

to

> > stay

> > > > on

> > > > > the antifungals for extended periods of time (years) or the

> > > > symptoms

> > > > > will recur. When this is necessary, I add the natural

> remedies.

> > I

> > > > > will, however, also use the medications when needed. The

main

> > > risk

> > > > of

> > > > > long-term use of the antifungals Sporanox and Diflucan

would

> be

> > > > liver

> > > > > inflammation. If these medications are being used for

> extended

> > > > > periods, consider checking liver tests (SGOT and SGPT)

every

> 3

> > to

> > > 6

> > > > > months and anytime that a severe flu-like feeling or

> worsening

> > of

> > > > > symptoms occur. As noted above, it is very important to

take

> > > Lipoic

> > > > > Acid 200mg a day when on Sporanox or Diflucan. Althoug

> > > > > > h I am not aware of any studies using Lipoic Acid with

> > > > antifungals,

> > > > > in my experience I have seen no worrisome elevation on

liver

> > > tests

> > > > if

> > > > > patients are using this natural substance while taking

these

> > > > > antifungals. As an alternative, instead of taking the

> > antifungals

> > > > > every day, many people find they can get long-term

> suppression

> > of

> > > > the

> > > > > yeast by taking Sporanox or Diflucan 200mg twice a day, one

> day

> > > > each

> > > > > week (e.g., each Sunday).

> > > > > > Help For Chronic Bladder Infections

> > > > > > Although we will be discussing some unusual infections,

> > > CFIDS/FMS

> > > > > patients also get more of the day-to-day variety of

> infections.

> > > > These

> > > > > include Urinary Tract (bladder) Infections (UTI). The main

> > > symptoms

> > > > > of a UTI are discomfort (e.g., burning) when urinating

> > (dysuria),

> > > > > urgency (which is the feeling that you have to go very

badly

> > and

> > > > > right away when there is not much urine there), and

frequency

> > > with

> > > > > low volume. These symptoms are also common in CFIDS/FMS

> > patients

> > > in

> > > > > the absence of bladder infections and, when severe, is

called

> > > > > Interstitial Cystitis. I would not label someone as having

> > > > > Interstitial Cystitis unless this is the major symptom of

> their

> > > > > CFIDS/FMS, because almost everyone with this illness has

some

> > > > urinary

> > > > > urgency and frequency. Because bladder symptoms can be seen

> in

> > > both

> > > > > UTI and CFIDS/FMS, it is important to have a urine culture

> done

> > > > > before treatment with antibiotics to make sure that there

is

> an

> > > > > infection and not just muscle spasms in the bladder that

are

> > > > causing

> > > > > these

> > > > > > symptoms. If there is an infection, over 90% of the time

it

> > > will

> > > > be

> > > > > E-coli. This bacteria is normally found in everyone's gut

> and,

> > > with

> > > > > the exception of a few rare dangerous forms, is a healthy

> part

> > of

> > > > our

> > > > > normal bowel bacteria. The problem occurs when the E-coli

> gets

> > > out

> > > > of

> > > > > the bowel where it belongs and into the bladder. Usually

the

> > > > bladder

> > > > > will wash out most infections when the urine comes out. The

E-

> > > coli

> > > > > however, have little velcro-like projections that stick to

> the

> > > > > bladder wall so that they can not be washed out by

urination.

> > > > > > Taking antibiotics will kill a bladder infection but will

> > also

> > > > kill

> > > > > the healthy bacteria in the bowel. This sets one up for

yeast

> > > > > overgrowth and other problems. Because of this, unless

there

> is

> > > > fever

> > > > > or back pain over the kidneys or a toxic feeling, it is

> > > reasonable

> > > > to

> > > > > try natural remedies for one to three days before going

with

> > the

> > > > > antibiotics. One can start these treatments while waiting

for

> > the

> > > > > urine culture to come back.

> > > > > > What Natural Remedies Can Be Used For Bladder Infections?

> > > > > > There are two excellent natural remedies that can keep

the

> E-

> > > coli

> > > > > from sticking to the bladder walls so they can be washed

out.

> > In

> > > > > addition, taking vitamin C in high dose (e.g., 500 to

5000mg

> a

> > > day)

> > > > > can acidify the urine, making it inhospitable to the

> bacteria.

> > > > > Drinking a lot of water also helps to wash out the

infection.

> > > > > > The two natural remedies that keep the bacteria from

> sticking

> > > are:

> > > > > > 1. Cranberries—Because approximately 20% of the female

> > > population

> > > > > suffers from UTIs, several studies have been done looking

at

> > this

> > > > > remedy. An early study of 44 female and 16 male patients

with

> > > acute

> > > > > bladder infections drank 16 oz. of cranberry juice a day

for

> 15

> > > > days.

> > > > > Of these patients, 53% had positive responses and another

20%

> > > > showed

> > > > > modest improvement. Six weeks after stopping the juice, 27

> > > patients

> > > > > did have persistent recurrent infections and 8 of these had

> no

> > > > > symptoms. Seventeen patients had no symptoms and negative

> urine

> > > > > cultures.

> > > > > > In another study of elderly women (who are more likely to

> > have

> > > > > bladder infections), 153 women either received 10 oz. of

> > > cranberry

> > > > > drink or placebo every day for 6 months. The group that got

> the

> > > > > cranberry drink had 68% fewer bladder infections during

that

> > > > period.

> > > > > In this study, the juice was sweetened with saccharin

instead

> > of

> > > > > sugar. Other studies have also shown benefit using

cranberry

> > > juice

> > > > in

> > > > > bladder infections.

> > > > > > Significant benefits are achieved by using 6 to 16 oz. of

> > > > cranberry

> > > > > juice a day. Because cranberry juice has a lot of sugar and

> can

> > > > > promote yeast overgrowth and aggravate other symptoms in

> > > CFIDS/FMS,

> > > > I

> > > > > think it is much better to use pure cranberry juice powder

in

> > > > capsule

> > > > > or tablet form (standardized to contain 11% to 12% quinic

> > acid).

> > > > The

> > > > > therapeutic dose is 1 to 2 capsules a day. Conversely, you

> can

> > > use

> > > > > unsweetened cranberry juice and add Stevia as a natural

> > > sweetener.

> > > > In

> > > > > general, if one gives the usual cranberry juice cocktails a

> > > > strength

> > > > > of 1 unit - then, cranberry juice drinks have a strength of

> ½;

> > > > > cranberry sauce a strength of ½; fresh or frozen

cranberries

> > are

> > > 4

> > > > > times as potent; pure cranberry juice is 4 times as potent;

> and

> > > > > cranberry juice capsules from unsweetened cranberry juice

> > powders

> > > > are

> > > > > 32 times as potent.

> > > > > > Cranberries work to help bladder infections because they

> have

> > a

> > > > > chemical (proanthocyanidins) that prevents the bacteria

from

> > > > sticking

> > > > > to the bladder wall. They may also decrease the risk of

> kidney

> > > > stones

> > > > > (although magnesium with B6 is much better for this), as

well

> > as

> > > > > possibly reduce urine odor.

> > > > > > D-Mannose - This is more effective than cranberry juice.

> > > Mannose

> > > > is

> > > > > a natural sugar (not the kind that causes symptoms or yeast

> > > > > overgrowth) that is excreted promptly into the urine.

> > > Unfortunately

> > > > > for the E-coli bacteria, the fingers that stick to the

> bladder

> > > wall

> > > > > stick to the D-Mannose even better. When one takes a large

> > amount

> > > > of

> > > > > D-Mannose, it spills into the urine, coating all the E-

coli's

> > > > > little " sticky fingers " so that the E-coli are literally

> washed

> > > > away

> > > > > with the next urination. The nice thing about the natural

> > > approach,

> > > > > as opposed to antibiotics, is that the cranberries or D-

> Mannose

> > > > will

> > > > > not kill the healthy bacteria, thereby not bothering the

> normal

> > > > > balance of bacteria in the bowel. In addition, the D-

Mannose

> is

> > > > > absorbed in the upper gut before it gets to the friendly E-

> coli

> > > > that

> > > > > are normally present in the colon. Because of this, it

helps

> > > clear

> > > > > the bladder without causing any other problems. In

addition,

> > the

> > > D-

> > > > > Mannose even tastes good.

> > > > > > The D-Mannose is quite safe, even for long-term use,

> although

> > > > most

> > > > > people will only need it for a few days. Those who have

> > frequent

> > > > > recurrent bladder infections may, however, choose to take

it

> > > every

> > > > > day. The usual dose of D- Mannose is 1/2 teaspoon every 2

to

> 3

> > > > hours,

> > > > > while awake, to treat an acute bladder infection; and 1/4

to

> > 1/2

> > > > > teaspoon 3 to 4 times a day to prevent severe chronic

bladder

> > > > > infections. It is best taken dissolved in water. For those

> who

> > > get

> > > > > bladder infections associated with sexual intercourse, one

> can

> > > take

> > > > > 1/2 teaspoon of D-Mannose 1 hour before and then just after

> > > > > intercourse to prevent an infection. Remember, though, the

D-

> > > > Mannose

> > > > > (and cranberries) only work in the 90% of bladder

infections

> > > caused

> > > > > by E-coli bacteria. D-Mannose is available from several

> sources:

> > > > > > 1. The Tahoma Clinic Dispensary (253-850-5661), which is

> > > > associated

> > > > > with the well-known nutritional physician, V.

> ,

> > > M.D.

> > > > > > 2. The Biotech Company (800-345-1199).

> > > > > > 3. My office (800-333-5287) or my Web site at

> > > www.endfatigue.com.

> > > > > > The usual cost of D-Mannose is approximately $60 for 100

> > grams

> > > > and

> > > > > $35 for 50 grams. A 1/2 teaspoon is approximately 2 grams.

> One

> > > > should

> > > > > feel much better within 24 to 48 hours on D-Mannose. If

not,

> > see

> > > a

> > > > > doctor for a urine culture (you may want to get the culture

> at

> > > the

> > > > > first sign of infection) and consider antibiotic treatment

> > after

> > > > two

> > > > > days if the culture is positive. Some evidence exists that

> > > > > Macrodantin causes less yeast over-growth than do other

> > > > antibiotics.

> > > > > Even with other antibiotics, most bladder infections are

> > knocked

> > > > out

> > > > > by one to three days of antibiotic use (instead of the old

> > seven-

> > > > day

> > > > > regimen).

> > > > > > Prostatitis

> > > > > > Although women tend to be the ones plagued with bladder

> > > > infections,

> > > > > men don't get off unscathed either. It is very common in

men

> > with

> > > > > CFIDS/FMS to have Prostatitis. Prostatitis is an

inflammation

> > or

> > > > > infection of the prostate which is usually seen in younger

> men

> > > > > between the ages of 20 and 50. It falls into three main

> > > categories:

> > > > > > 1. " Bacterial " Prostatitis is a acute or chronic

infection

> in

> > > the

> > > > > gland that causes prostate swelling and discomfort.

> > > > > > 2. Nonbacterial Prostatitis is when you feel swelling of

> the

> > > > > prostate without being able to detect an infection. My

> > suspicion

> > > is

> > > > > that it is not uncommon for prostatitis to be associated

with

> > > yeast

> > > > > overgrowth or other infections that cannot be cultured

> (tested

> > > > for).

> > > > > > 3. Prostadynia is a general irritation of the prostate

> which

> > > > causes

> > > > > urinary burning, urgency and frequency but without there

> being

> > > any

> > > > > infection or swelling of the prostate. This can come from a

> > > number

> > > > of

> > > > > causes including, I suspect, chronic spasm or tightening of

> the

> > > > > muscles of the pelvic floor.

> > > > > > The symptoms of chronic Prostatitis can come and go and

be

> > mild

> > > > or

> > > > > severe. The symptoms include:

> > > > > > 1. Pain or tenderness in the area of the prostate. It is

> also

> > > > > common to have burning on the tip of the penis.

> > > > > > 2. Discomfort in the groin and, occasionally, lower back

> pain.

> > > > > > 3. Urinary urgency and frequency with pain on urination.

> > > > > > 4. Sometimes a slight penis discharge. If the discharge

is

> > > cloudy

> > > > > and larger than one drop, or even a large drop, it is most

> > likely

> > > a

> > > > > bacterial Prostatitis and I would then prescribe

antibiotics.

> > If

> > > a

> > > > > discharge is present, I would also check to make sure that

> > there

> > > is

> > > > > not also a sexually transmitted disease (such as Chlamydia

or

> > > > > Gonorrhea) before beginning treatment.

> > > > > > 5. Pain with ejaculation.

> > > > > > If severe symptoms with fevers, chills and extreme

fatigue

> > are

> > > > > present (symptoms of acute Prostatitis), antibiotics should

> be

> > > > used.

> > > > > The main treatment for bacterial Prostatitis consists of

> using

> > > the

> > > > > antibiotics Tetracycline (e.g., Doxycycline), Cipro, or

Sulfa

> > > > > (Bactrim or Septra DS). Unfortunately, since it is hard for

> the

> > > > > antibiotics to be absorbed into the prostate, the symptoms

> > often

> > > > > recur even after six weeks of treatment. If antibiotics are

> > > > required,

> > > > > use Doxycycline or Cipro because these may be effective

> against

> > > > other

> > > > > hidden infections that can cause CFIDS/FMS.

> > > > > > Although there are a number of causes of Prostatitis,

> excess

> > > > > caffeine, alcohol and spicy foods can also contribute to

the

> > > > > symptoms. Sitting for long periods while traveling (e.g.,

> being

> > a

> > > > > truck driver) can also cause irritation of the prostate.

> > Although

> > > > > normal bacteria are common causes, a few bacteria

transmitted

> > > > through

> > > > > sexual contact can also cause Prostatitis. Some feel that

the

> > > main

> > > > > psychological component of Prostatitis is shame.

> > > > > > Bowel Parasite Infections

> > > > > > A while back, the news focused our attention on Milwaukee

> > > because

> > > > > of repeated fatal outbreaks of an infection by a bowel

> parasite

> > > > > called Cryptosporidium. A cartoon even made the rounds

> showing

> > > > > Mexican tourists being warned not to drink the water in

> > > Milwaukee!

> > > > > Although this infection usually resolves on its own within

a

> > week

> > > > or

> > > > > two, it may persist in those with immune suppression. In

> fact,

> > > > people

> > > > > with acquired immune deficiency syndrome (AIDS) are

> > particularly

> > > > > susceptible and scores of Milwaukeens died from the

> > > Cryptosporidium

> > > > > outbreaks.

> > > > > > Unfortunately, in many places throughout the United

States,

> > the

> > > > > water supply is contaminated, and parasites are no longer

> just

> > a

> > > > > Third World problem. Doctors frequently see cases of

> infection

> > by

> > > > > giardia, amoeba and numerous other bowel parasites.

Parasitic

> > > > > infections can mimic CFS and, in immune suppressed

situations

> > > like

> > > > > CFS, all parasites should be treated.

> > > > > > Most laboratories miss the parasites when they do stool

> > > testing.

> > > > I

> > > > > initially tested for bowel parasites by sending my

patients'

> > > stool

> > > > > samples to a respected local lab. The tests kept coming

back

> > > > > negative, so I eventually stopped testing. Finally, I

started

> > > doing

> > > > > my own laboratory stool testing. Doing the test properly

was

> > very

> > > > > time consuming, taking up to five hours per specimen.

> However,

> > > > > processing it properly, my tests frequently turned out

> > positive.

> > > In

> > > > > my experience - and in that of other physicians as well -

> when

> > > you

> > > > > treat a patient for parasites, the patient's fatigue and

> > achiness

> > > > > often improves dramatically.

> > > > > > If you would like your stool tested, make sure that the

lab

> > > > > specializes in stool testing and that the sample is a

purged

> > > > > specimen. A purged stool specimen is watery and loose,

> brought

> > > > about

> > > > > by the use of one-and-a-half ounces of Fleet's Phospho-Soda

> (a

> > > > > laxative). The purpose of the stool purge is to get the

best

> > > > possible

> > > > > stool sample to check for bowel parasites and yeast. The

> > laxative

> > > > > washes the organisms off the walls of the intestines so

that

> > they

> > > > can

> > > > > be detected. The routine random tests performed in almost

all

> > > > > standard labs are generally not adequate or reliable. In

> > speaking

> > > > > with several lab technicians, I was told they had less than

> one

> > > > hour

> > > > > of training in looking for parasites—which they found to be

> > > > useless.

> > > > > In fact, during one of our " doctors' " poker games, I spoke

> with

> > a

> > > > > gastroenterologist friend who noted that during a certain

> bowel

> > > > exam

> > > > > he had performed, he saw a large number of parasites

swimming

> > in

> > > > the

> > > > > patient's large bowel. He removed a big glob consisting of

> > > nothing

> > > > > > but mucus and parasites and sent it off to the major

local

> > > > > laboratory, just for confirmation of the infection and

> > > > identification

> > > > > of the parasite. Even this sample came back negative for

> > > parasites!

> > > > > This is why I stress that stool testing must be done at a

lab

> > > that

> > > > > specializes in parasitology. Because two excellent labs are

> now

> > > > > available to me to mail specimens to, I no longer have to

do

> > the

> > > > > testing in my office. These labs are The Parasitology

Center,

> > > Inc.

> > > > > (480-777-1078) and The Great Smokies Diagnostic Laboratory

> (800-

> > > 522-

> > > > > 4762).

> > > > > > At this point, no consistently effective prescription

> > > medication

> > > > is

> > > > > available for Cryptosporidium infections. Artemisia annua,

> > > however,

> > > > > is an effective herbal treatment. For most of my patients,

I

> > > > > recommend using 1,000 milligrams three times a day for

twenty

> > > days.

> > > > > Leo Galland, M.D., a parasite specialist, recommends a form

> of

> > > > > Artemisia called tricyclin for many parasitic infections.

He

> > > > > recommends taking 2 tablets, 3 times a day after meals for

> six

> > to

> > > > > eight weeks. The cost of this antiparasitic herbal

> preparation

> > is

> > > > > about $30 for fifty tablets. See the treatment protocol

below

> > for

> > > > > regimens for some other parasitic infections. The doctor

who

> > runs

> > > > The

> > > > > Parasitology Center also has a review article discussing

> which

> > > > > natural remedies are effective against each type of

parasite.

> > > > Common

> > > > > parasite treatment regimens also used in our office are on

> the

> > > > > treatment checklist below.

> > > > > > Antiparasitic Treatments

> > > > > > 1. Flagyl (Metronidazole) – 750 mg, 3 times a day for 10

> > days,

> > > > > followed by Yodoxin for many parasites. For Clostridium

> > Difficile

> > > > > take 250 mg, 4 times a day, or 500 mg, 3 times a day. It

may

> > > cause

> > > > > nausea and vomiting (uncomfortable but usually not

> worrisome).

> > Do

> > > > not

> > > > > drink alcohol while on this medication as it will make you

> > vomit.

> > > > The

> > > > > SR (sustained release) form is easier on the stomach (as is

> the

> > > > brand-

> > > > > name form). If you get numbness or tingling in your fingers

> (or

> > > it

> > > > > worsens if you usually have it) stop the Flagyl.

> > > > > > 2. Yodoxin (Iodoquinol) – 650 mg, 3 times a day, for 20

> days

> > > > after

> > > > > Flagyl is completed.

> > > > > > 3. Tinidazole – 2000 mg, once daily, for 3 consecutive

days

> > > with

> > > > > food (for Entamoeba Histolytica) – OR - 3 doses, each 2

weeks

> > > apart

> > > > > (for Giardia or Dientamoeba Fragilis); Available at 's

> > > > Pharmacy

> > > > > (800-480-3432).

> > > > > > 4. Humatin (Paromomycin) – 500 mg, 3 times a day, for 10

> days

> > > > (for

> > > > > Cryptosporidium). For Blastocystis add Yodoxin.

> > > > > > 5. Zithromax – 250 mg, once a day on an empty stomach for

> 10

> > > > days,

> > > > > along with Bactrim, 1 tablet twice a day for 10 days

> (alternate

> > > > > treatment for Cryptosporidium). Add Artemesia.

> > > > > > 6. Bactrim DS - 1 tablet, twice a day, plus Yodoxin 650

mg,

> 3

> > > > times

> > > > > a day with food for 10 days. Do not take Folic acid

> supplements

> > > > > (e.g., B Complex or multivitamins) during these 10 days

(for

> > > > > Blastocystis).

> > > > > > 7. Amphotericin B – 100 mg, two times a day, plus

> Tinidazole

> > > 500

> > > > > mg, twice a day, plus Furoxone (Furazolidone) 1 tablet,

twice

> a

> > > > day.

> > > > > Take these three together with food for 5 to 7 days

> > (Amphotericin

> > > B

> > > > > and Tinidazole are available from 's Pharmacy 800-480-

> > 3432)

> > > > > (treatment for refractory Blastocystis).

> > > > > > 8. Lactoferrin – 350 mg, 1 to 3 capsules at bedtime.

> > > > > > 9. Multi-pure Water Filter - Most other filters (except

for

> > > > reverse

> > > > > osmosis) are ineffective. (Available from Bren son,

410-

> > 224-

> > > > > 4877).

> > > > > > 10. Artemesia Annua (a herbal antiparasitic) – 500 mg, 2

> > > tablets,

> > > > 3

> > > > > times a day for 20 days.

> > > > > > 11. Tricyclin (a herbal antiparasitic) - 2 tablets, 3

times

> a

> > > > day,

> > > > > after meals for 6 to 8 weeks (concentrated Artemesia).

> > > > > > 12. Colostrum (mother's milk) - 3 capsules, 3 times a

day,

> > for

> > > 8

> > > > to

> > > > > 12 weeks. Then stop or use the lowest dose needed for

> symptoms.

> > > If

> > > > > nausea or indigestion occurs, lower the dose to a

comfortable

> > > level

> > > > > for 1 to 2 weeks until it passes. Take on an empty stomach.

> > > > > > 13. Quinacrine – 100 mg a day for 5 days. May be useful

for

> > > > empiric

> > > > > therapy of suspected but not identified parasites

> > (controversial).

> > > > > > 14. Albendazole – 400 mg a day for 5 days. May be useful

> for

> > > > > empiric therapy of suspected but not identified parasites.

> > > > > > Filter Your Water

> > > > > > Water filters can be very helpful in the fight against

> > > parasitic

> > > > > infection. However, not all units are designed to filter

out

> > > > > parasites. For a water filter to remove parasites, it must

> have

> > a

> > > > > submicron solid carbon block filter. A good example is the

> > Multi-

> > > > pure

> > > > > Filter. Check the Consumer's Digest and Consumer's Report

for

> > > other

> > > > > good units. Multi-pure Filters are available from Bren

> son

> > > at

> > > > > 888-801-8176 or 410-224-4877. He is a very reputable and

> > > > > knowledgeable person and does not believe in " high pressure

> > > sales "

> > > > > (again, I get no money from people or companies whose

> products

> > I

> > > > > recommend).

> > > > > > When shopping around for a water filter, request the

> National

> > > > > Sanitation Foundation (NSF) International Listing for the

> > > specific

> > > > > unit you are considering. NSF is an independent not-for-

> profit

> > > > > organization that tests and certifies drinking water

> treatment

> > > > > products. The unit you buy should meet both NSF Health

> Effects

> > > > > Standard 53 and NSF Aesthetics Standard 42, with Class I

> > > reduction

> > > > of

> > > > > chlorine and particulate matter. Any unit that does not

meet

> > both

> > > > of

> > > > > these standards, particularly the health standard, is not

> > > adequate.

> > > > > To verify that a unit does meet these standards, call the

NSF

> > at

> > > > 313-

> > > > > 769–8010.

> > > > > > In addition to verifying that a water filter meets the

NSF

> > > > > standards, ask to see its Product Performance Data Sheet.

> Many

> > > > states

> > > > > require that this sheet be given to all prospective

customers

> > of

> > > > > drinking water treatment devices.

> > > > > > Ask about the range of contaminants that the unit can

> reduce

> > > > under

> > > > > NSF Health Effects Standard 53. Most units certified under

> > > Standard

> > > > > 53 list only turbidity and cyst reduction. The number of

> units

> > > that

> > > > > also reduce pesticides, trihalomethanes, lead, and volatile

> > > organic

> > > > > chemicals is very small. Make sure that the water filter

you

> > are

> > > > > considering can remove the specific contaminants that

concern

> > you.

> > > > > > Ask if the unit is licensed in such states as California,

> > > > Colorado

> > > > > and Wisconsin. These states have some of the toughest

> > > certification

> > > > > procedures in the United States.

> > > > > > Finally, ask about the unit's service cycle, which is

> stated

> > in

> > > > > gallons of water treated. Find out how often you will need

to

> > > > change

> > > > > the filter and what the replacement filters cost.

> > > > > > As the American water supply becomes more contaminated,

> > > parasitic

> > > > > bowel infections will likely become more common. These

> > > infections,

> > > > as

> > > > > well as the overgrowth of yeast or toxic bacteria caused by

> > > > > antibiotic use, contribute to feeling poorly.

> > > > > > The Role Of Other Infections In CFIDS/FMS

> > > > > > Many infections have been found in CFIDS. That people may

> > have

> > > > not

> > > > > just one, but several of these simultaneously is

significant.

> > It

> > > > > suggests that although these infections may be a trigger,

in

> > most

> > > > > patients the immune system is suppressed and therefore they

> > > become

> > > > a

> > > > > setup for unusual infections that persist. These infections

> may

> > > > > then " drag you down, " further suppressing your immune

system.

> > > > > > Fortunately, most people improve (and often get very

> healthy)

> > > by

> > > > > simply treating the sleep, hormonal, nutritional and yeast

> > > > problems.

> > > > > Once these areas are treated, your body can usually

eliminate

> > any

> > > > > persistent infections by itself. A subset, though, have

> > > infections

> > > > > that need treatment with antivirals and/or antibiotics.

> > > > > > How Can I Tell If I Need These Treatments?

> > > > > > First, I would try the other approaches discussed in my

> From

> > > > > Fatigued To Fantastic! book and newsletters. I would try

> these

> > > > > treatments if symptoms persist:

> > > > > > 1. Those with predominantly flu-like symptoms with

> > debilitating

> > > > > fatigue and little or no pain or fever are more likely to

> have

> > an

> > > > > underlying persistent viral infection (e.g., HHV-6, Epstein

> > Barr,

> > > > > CMV, etc.).

> > > > > > 2. Those with fevers (i.e., anything over 98.6°F in this

> > > illness -

> > > >

> > > > > even 99°) and/or lung congestion, sinusitis, skin pustules

or

> > > other

> > > > > chronic bacterial infections seem more likely to have

> > infections

> > > > > (i.e., bacterial, Mycoplasma, or Chlamydia) that respond to

> > > special

> > > > > antibiotics. Let's look at these two groups and how to

> approach

> > > > them.

> > > > > > HHV-6 And Other Viral Infections

> > > > > > HHV-6 (Human Herpes Virus 6) is a virus that is related

to

> > the

> > > > > Epstein Barr Virus (EB), Cytomegalovirus (CMV), and also to

> the

> > > > > Herpes Viruses that causes cold sores and Genital Herpes.

HHV-

> 6

> > > is

> > > > > transmitted like the common cold and many people have had

it,

> > as

> > > > well

> > > > > as the EB Virus and the Cold Sore Virus by the time they

are

> > > twenty

> > > > > years old. The body usually gets rid of all of these

viruses

> on

> > > its

> > > > > own. Because of this, if you do routine (IGG) antibody

> testing,

> > > > > almost everybody will be positive for EB and many for HHV-6

> and

> > > CMV

> > > > > viruses. However, the IGG test will not tell you if you

have

> > > active

> > > > > infections unless the IGM antibody is also positive

> (suggesting

> > a

> > > > new

> > > > > infection). The IGM antibody is the one that increases in

the

> > > first

> > > > > six weeks of an infection. This is followed by an elevated

> IGG

> > > > > antibody, which stays elevated your whole life and acts as

> your

> > > > > body's surveillance system. All an elevated IGG means is

that

> > > your

> > > > > body has seen this infection and, if it sees it again, it's

> read

> > > > > > y to knock it out quickly. This is how immunizations

work.

> > The

> > > > > immunization creates the IGG antibody, so that instead of

> > taking

> > > > one

> > > > > to two weeks to gear-up to fight the infection, your body

can

> > > > > eliminate that infection very quickly. Unfortunately, in

> CFIDS

> > > you

> > > > > can have a chronic low-grade infection—even if your IGG

> > antibody

> > > is

> > > > > positive (elevated) - making the IGG antibody test for HHV-

6,

> > EB

> > > > > Virus and CMV unreliable in CFIDS/FMS. In addition, the IGM

> > > > antibody

> > > > > will usually not be present in elevated levels in the low-

> grade

> > > > > infections with these viruses that may be seen in CFIDS and

> > FMS.

> > > > > > What makes this important is that Valtrex at high-dose

can

> > > > > eliminate Epstein Barr virus, but will not work if active

HHV-

> 6

> > > or

> > > > > CMV infection is present. As I will discuss later, the only

> > tests

> > > I

> > > > > would rely on to diagnose active HHV-6 are " rapid cell

> > cultures "

> > > or

> > > > > PCR testing. Because some insurance companies are more

likely

> > to

> > > > pay

> > > > > for IGG than PCR testing, an argument can be made for

> checking

> > > IGG

> > > > > antibodies first. If the EBV IGG is positive and HHV-6 and

> CMV

> > > IGG

> > > > > are negative, one may choose to proceed with Valtrex

1000mg,

> 4

> > > > times

> > > > > a day, for 6 months, without PCR testing. If the HHV-6 or

CMV

> > IGG

> > > > > antibodies are positive, then check the CMV and/or HHV-6

PCR

> > > tests

> > > > to

> > > > > be sure they are negative.

> > > > > > Tell Me More About HHV-6 And CFIDS

> > > > > > Unfortunately there is no currently accepted standard

> > treatment

> > > > for

> > > > > the HHV-6 Virus. Even though it is related to other Herpes

> > > viruses,

> > > > > HHV-6 is resistant to Acyclovir, Valtrex, Famvir and the

> other

> > > > > antivirals that are commonly used in Herpes infections. The

> > only

> > > > > antiviral known to be effective against HHV-6 is

Ganciclovir.

> > > This

> > > > > has significant side effects and has to be given

> intravenously

> > > and

> > > > > possibly forever to maintain the antiviral effect.

> > Unfortunately,

> > > > > this is not a viable option in day-to-day life and has been

> > only

> > > > > moderately successful when used. The main doctor who has

been

> > > using

> > > > > Ganciclovir to treat HHV-6 in the United States is Joe

> Brewer,

> > > > M.D.,

> > > > > (816-531-1550) in Kansas City, Missouri. He found that 140

> out

> > of

> > > > 207

> > > > > CFIDS patients had positive HHV-6 cell cultures. Forty

> percent

> > of

> > > > > CFIDS patients were positive on their first test and 70%

were

> > > > > positive after three tests. This contrasts to 60 healthy

> > patients

> > > > he

> > > > > checked in which none of the HHV-6 tests were positive.

> Culture

> > > > > > s are more likely to be positive during acute flares of

the

> > > > > disease, when the viral level in the blood rises (see Page

9

> > for

> > > > more

> > > > > on HHV-6 PCR testing).

> > > > > > As is often the case in CFIDS, there is conflicting data

on

> > > > > infections in Chronic Fatigue Syndrome. A recently

published

> > > study

> > > > > (Reeves WC, et al., Clin Infect Dis, 2000 July; 31 [1] pp48-

> 52)

> > > > > examined 26 patients with Chronic Fatigue Syndrome and 52

> > healthy

> > > > > patients in Atlanta, Georgia, at the CDC. In this study,

> > several

> > > > > tests for HHV-6 and HHV-7 were done, including Polymerase

> Chain

> > > > > Reaction (PCR). HHV-6 DNA was found in 11% of CFIDS

patients

> > and

> > > > 28%

> > > > > of healthy patients, suggesting that the HHV-6 was actually

> > less

> > > > > common in Chronic Fatigue Syndrome than in healthy

patients.

> At

> > > > this

> > > > > time, as the conflicting data shows, although HHV-6 may be

> one

> > of

> > > > > many suspect infections in CFIDS, it is not yet clearly the

> > cause

> > > > of

> > > > > this illness.

> > > > > > When HHV-6 is present, it seems to infect the natural

> Killer

> > > > Cells,

> > > > > important cells in your body's defense (immune) system that

> are

> > > > > critical in fighting infections. A number of studies have

> shown

> > > > these

> > > > > Killer Cells to be malfunctioning in CFIDS. HHV-6 infection

> > does

> > > > not

> > > > > necessarily decrease the number of the natural Killer Cells

> but

> > > > does

> > > > > decrease their function. Natural Killer Cell function is

> > > described

> > > > in

> > > > > what is called Lytic Units—which means the ability of cells

> to

> > > lyse

> > > > > or break down foreign invaders. An average person will have

a

> > > Lytic

> > > > > Unit level of 20 to 250 with over 80% of healthy patient

> being

> > > over

> > > > > 40 units. Dr. Brewer finds that in CFIDS the mean Natural

> > Killer

> > > > > Lytic Cell level is 12 units. Dr. Brewer uses Specialty

Labs

> in

> > > > > California for his Natural Killer Lytic Cell testing and

> finds

> > > that

> > > > > the Lytic level stays the same on repeat testing and seems

to

> > be

> > > a

> > > > > reliable test for Natural Killer Cell function testing in

> > CFIDS.

> > > > > Lytic unit levels will, however, decrease during flar

> > > > > > es of symptoms. In Dr. Brewer's experience, this test is

> very

> > > > > specific for CFIDS and Multiple Sclerosis. He has treated

ten

> > MS

> > > > > patients and five CFIDS patients with the I.V. Ganciclovir.

> He

> > > > found

> > > > > that it helped to stabilize the MS patients. In the CFIDS

> > > patients,

> > > > > two to three were much improved, one still had a positive

> viral

> > > > > culture and one had a poor response. Unfortunately,

> maintaining

> > > > > patients on I.V. Ganciclovir forever (as noted above) is

not

> a

> > > > viable

> > > > > option. Fortunately, an oral pill form of Ganciclovir

> > > > > (Valganciclovir) is currently being developed! It should be

> > noted

> > > > > that the HHV-6 virus is similar to CMV (Cytomegalovirus),

and

> > > that

> > > > > whatever is effective against one, tends to be effective

for

> > the

> > > > > other. This is a helpful bit of information as we follow

new

> > > > research

> > > > > looking for clues on how to eliminate HHV-6 infection.

> > > > > > What Roles Does The Epstein Barr And Cytomegalovirus Play

> In

> > > > CFIDS?

> > > > > > Again, the roles of the EB and CMV viruses are not clear.

> It

> > is

> > > > not

> > > > > uncommon for antibody levels of these viruses to be

elevated

> in

> > > > > Chronic Fatigue Syndrome. As noted above, it is not clear

> > whether

> > > > > this simply reflects a previous or ongoing infection with

> these

> > > > > viruses. Research by a husband and wife team (the Glasers)

at

> > > Ohio

> > > > > State University, suggests that Epstein Barr Virus is still

> > quite

> > > > > active and playing a role in many patients with these

> > infections.

> > > > In

> > > > > addition, work by Lerner, M.D., also suggests that

EB

> > > Virus

> > > > > and CMV are active as well. In speaking with Dr. Lerner's

> > > research

> > > > > assistant, I found out that he has found EB Virus and CMV

to

> > both

> > > > be

> > > > > fairly common in patients with Chronic Fatigue Syndrome

(with

> > and

> > > > > without pain). He found that about 20% had positive IGM

> and/or

> > > > > elevated EA (early antigen) tests to the EB Virus with

> negative

> > > > > Cytomegalovirus. Of these, two-thirds improved with high-

dose

> > > > Valtrex

> > > > > (an oral antiviral). Despite my teasing and prodding, his

> > associat

> > > > > > e refused to give out the dose of Valtrex they prescribed

> > > because

> > > > > Dr. Lerner does not want to be responsible for people using

> > these

> > > > > higher doses until he completes the double-blind trial that

> is

> > > > > currently in progress. On the other hand, another study of

> his

> > > did

> > > > > use 1000mg, 4 times a day, giving the antiviral for 6

months.

> > It

> > > > > takes about 3 to 4 months before patients start to improve

> and

> > > > after

> > > > > 6 months people can stop the Valtrex without the symptoms

> > coming

> > > > > back. However, if there is no improvement in 6 months,

> consider

> > > it

> > > > to

> > > > > be a negative result. They also found that, as noted above,

> the

> > > IGM

> > > > > is almost always negative using the reagents used in most

> labs.

> > > > They

> > > > > found that only Epstein Barr IGM antibody testing, using a

> > > reagent

> > > > by

> > > > > the Diasorin Company (800-328-1482), has been useful in

> showing

> > a

> > > > > significant number of positive tests. When we called the

> > company,

> > > > the

> > > > > only lab in the Washington, D.C., area using it was at the

> NIH.

> > > The

> > > > > company may, however, be able to give you the name of

> > > > > > a lab near you that can do the test. What was fairly

> common,

> > > > > though, (and present in most patients) was either positive

> > tests

> > > > for

> > > > > Epstein Barr, CMV, or a combination of both as noted above.

> > When

> > > > CMV

> > > > > or HHV-6 are present, the Valtrex is less likely to work

> > because

> > > it

> > > > > is not effective against these viruses.

> > > > > > In another study done by Dr. Lerner (Infectious Diseases

In

> > > > > Clinical Practice, 1997; 6:110-117) he found that patients

> who

> > > had

> > > > > elevated CMV IGG antibodies, but no significant evidence of

> > > > > associated Epstein Barr virus (i.e., negative IGM and early

> > > antigen

> > > > > (EA) antibody total less than 40), did improve with I.V.

> > > > Ganciclovir

> > > > > at 5mg per kg of body weight given every 12 hours I.V. for

30

> > > days.

> > > > > In this study 72% (13 of the 18 patients) improved markedly

> at

> > > the

> > > > > end of a month without any significant side effects. As

> noted,

> > an

> > > > > oral form of Ganciclovir is currently in development as

well.

> > It

> > > > > should be noted that 36% of the Chronic Fatigue Syndrome

> > patients

> > > > > that Dr. Lerner checked (18 out of 50) did turn out to have

> > > > elevated

> > > > > CMV antibodies (albeit IGG) in the absence of IGM and EA

> > > antibodies

> > > > > to EB Virus (i.e., no evidence of active Epstein Barr

Virus).

> > It

> > > > > should be noted, though, that 70% of healthy patients also

> had

> > > > > positive IGGs to CMV (as per our discussion above) in the

> study

> > > and

> > > > > appears

> > > > > > that the overall level of the IGG was not much higher

> > overall

> > > in

> > > > > the Chronic Fatigue group than in the healthy controls. On

> the

> > > > other

> > > > > hand, the higher the level of CMV antibody in the Chronic

> > Fatigue

> > > > > group, the more likely they were to improve with the I.V.

> > > > Ganciclovir.

> > > > > > What this means is that patients with Chronic Fatigue

> > Syndrome

> > > > > don't necessarily have different blood tests for antibody

> > levels

> > > > than

> > > > > healthy people for these viruses. However, if one has a

> higher

> > > > level

> > > > > rather than a lower level, one is more likely to improve

with

> > the

> > > > > Ganciclovir. Previous research has not shown benefit from

> > > antiviral

> > > > > therapies in CFS (Straus SE, et al., New England Journal of

> > > > Medicine

> > > > > 1988; 319:1692-1698). Our experience using a fairly high

dose

> > of

> > > > > Valtrex or Famvir (1500mg and 2250mg a day respectively)

also

> > > > showed

> > > > > no significant improvement on these regimens after 6 weeks,

> at

> > > > which

> > > > > time we considered it to be ineffective. On the other hand,

> Dr.

> > > > > Lerner's research is suggesting that perhaps we gave it for

> too

> > > > short

> > > > > a time and at too low a dose. When treating himself and a

few

> > > other

> > > > > patients, he used Valtrex by mouth at a dosage of 1000mg, 4

> > times

> > > a

> > > > > day, for 6 months. Using the higher dosing and the extended

> > > period

> > > > of

> > > > > time, as well as separating out groups that have

> > > > > > Epstein Barr Virus (sensitive to the oral Valtrex)

without

> > CMV

> > > > or

> > > > > HHV-6 (resistant to oral Valtrex but sensitive to I.V.

> > > > Ganciclovir),

> > > > > may make an important difference in making treatment

> effective.

> > > No

> > > > > major Valtrex toxicity was seen. As noted above, a double-

> blind

> > > > study

> > > > > is currently in progress and we are beginning to try the

> higher

> > > > dose

> > > > > of Valtrex in the 15% of our patient population that have

not

> > > > > improved adequately and have positive EBV, and negative CMV

> and

> > > HHV-

> > > > 6

> > > > > tests. We hope to give you follow-up information on the

> > > treatment's

> > > > > effectiveness as soon as we know!

> > > > > > In addition, Dr. Lerner suspects that these infections

> affect

> > > the

> > > > > heart muscle contributing to much of your symptoms. I am

not

> > > > > convinced that this is the case because EKG changes are

> common

> > in

> > > > > CFS. This can occur because the autonomic (brain)

dysfunction

> > and

> > > > > hormonal changes seen in CFS can cause these same EKG

changes

> > > > without

> > > > > heart damage. Regardless, he found that these changes went

> away

> > > > with

> > > > > treatment (as has been our experience in treating Chronic

> > Fatigue

> > > > > Syndrome—patient's EKG changes improve even without

> > antivirals).

> > > > Dr.

> > > > > Lerner is currently recruiting patients for a double-blind

> > study

> > > > > using the high-dose Valtrex. His phone number is 248-540-

9688

> > in

> > > > > Beverly Hills, Michigan.

> > > > > > Does This Mean There Is Nothing We Can Do Now?

> > > > > > Although there is no currently accepted specific

treatment

> > for

> > > > the

> > > > > CMV and HHV-6 viruses, there are still a number of things

> that

> > > may

> > > > be

> > > > > very helpful in fighting this infection.

> > > > > > 1. Lithium tends to be antiviral and has been shown to

> > decrease

> > > > > pain in FMS patients when added to treatment with Elavil.

> > Lithium

> > > > is

> > > > > commonly used in manic depressive illness and is a natural

> > > mineral

> > > > > despite being sold by prescription. In high doses, it can

> cause

> > > > some

> > > > > neurologic symptoms and suppression of the thyroid gland,

but

> > > these

> > > > > can usually be treated by taking a small amount of

Essential

> > > Fatty

> > > > > Acids and thyroid hormone. Lithium might also worsen

Restless

> > Leg

> > > > > Syndrome. Although we have no direct evidence of Lithium

> being

> > an

> > > > > effective antiviral against HHV-6, it may well be effective

> > > because

> > > > > it works against a number of other viral infections. In our

> > > > > experience, 200mg to 600mg a day seems to be the effective

> dose

> > > in

> > > > > treating FMS patients. As noted above, I would check the

> > thyroid

> > > > > blood tests at 3 months, 6 months and then yearly (check a

> Free

> > > T4

> > > > > and a Total T3 - not a TSH). A Lithium level should also be

> > > checked

> > > > > at the same time to be sure that it not above the upper

limit

> > of

> > > > > > normal. The level can be below the normal range, which is

> > fine

> > > as

> > > > > long as the treatment is effective. You may find that you

can

> > > lower

> > > > > the Lithium dose after you have been on it for several

months.

> > > > > > 2. Heparin (a blood thinner, see Page 12) also has

> antiviral

> > > > > properties.

> > > > > > 3. It is worth considering trials of high-dose Valtrex.

It

> > > should

> > > > > be noted that 1000mg, 3 times a day, is used for shingles

in

> > > older

> > > > > patients and appears to be quite safe. On the other hand,

> > higher

> > > > > dosing at 8 grams a day in AIDS patients did result in

> uncommon

> > > > > (under 2%) life threatening problems. This is common even

> with

> > > day-

> > > > to-

> > > > > day drugs in AIDS patients (for example, regular sulfa

> > > antibiotics

> > > > > have often resulted in severe toxicity in AIDS patients).

> > > > > Nonetheless, we will be limiting the dose to 1 gram, 4

times

> a

> > > day,

> > > > > in our practice. It is important to note that taking

Tagamet

> > > and/or

> > > > > Probenecid (Benemid) will raise the blood level of Valtrex.

> > > Tagamet

> > > > > has powerful immune modifying properties and is very

helpful

> in

> > > > acute

> > > > > cases of Epstein Barr (mono) infections. Because of this,

we

> > are

> > > > > adding Tagament 300mg, 4 times a day (but not Probenecid),

to

> > the

> > > > > Valtrex. As I noted, we are beginning this treatment with

> some

> > of

> > > > our

> > > > > patients and will let you know what we find.

> > > > > > Natural Remedies

> > > > > > 1. Olive Leaf - This is an herbal which is known to have

a

> > wide

> > > > > spectrum of anti-infectious activity. It has been shown to

be

> > > > > effective against the HHV-6 virus in the test tube. I have

> not,

> > > > > however, seen studies testing its effect in human beings

> > infected

> > > > > with HHV-6. Nonetheless, a number of physicians have found

> that

> > > > using

> > > > > Olive Leaf in Chronic Fatigue Syndrome is very effective.

> There

> > > is

> > > > > controversy over whether the form and source of the Olive

> Leaf

> > is

> > > > > critical. We recommend that you use a form that has at

least

> 6%

> > > > > Oleuropein, which is one of the most active antiviral

> > components

> > > in

> > > > > the Olive Leaf. Other components may be important and some

> > people

> > > > > also feel that you must use the Mediterranean Olive Leaf

vs.

> > the

> > > > > American Olive Leaf. Other people argue that you should

have

> a

> > > form

> > > > > that is organically grown, without pesticides. At this

point

> it

> > > is

> > > > > not clear whether this is simply marketing or important in

> day-

> > to-

> > > > day

> > > > > life. Nonetheless, I would be picky about the companies you

> buy

> > > the

> > > > O

> > > > > > live Leaf from. I would use one of these sources:

> > > > > > a. My office (800-333-5287) or my Web site at

> > > www.endfatigue.com.

> > > > > > b. Pacific Research Labs (800-325-7734). This is owned by

> R.

> > J.

> > > > > Marshall, Ph.D., who has done a fair bit of work treating

> CFIDS

> > > > > patients with Olive Leaf. I will be describing the protocol

> > that

> > > he

> > > > > uses below.

> > > > > > c. General Nutrition Centers (GNC).

> > > > > > Dr. Marshall feels that during infections, the body

becomes

> > > > overly

> > > > > acidic. He tests the morning urine specimens with pH paper

> > (which

> > > > is

> > > > > very easy to do at home) and gives a shell extract, which

> > raises

> > > > the

> > > > > body's alkalinity. He feels that having a normalized acid-

> base

> > > > > balance in your body helps it to fight infections. He then

> adds

> > > his

> > > > > form of Olive Leaf, called Infectostat (which also contains

> > > > mushroom

> > > > > extracts to stimulate the immune system), giving 3 to 4

> > capsules,

> > > 3

> > > > > to 4 times a day, to help fight the infections. Usually,

the

> > > > patient

> > > > > should start feeling better within four weeks on this

> protocol.

> > > > > Although we have found it helpful in fighting colds and

other

> > > > common

> > > > > respiratory infections, we are just starting to explore

Olive

> > > > Leaf's

> > > > > use in a few of our patients who have not responded to

> standard

> > > > > treatment and are still quite ill. We will let you know our

> > > > > experience with this in an upcoming newsletter issue. My

> guess,

> > > > > though, is that simply using regular (6% Oleuropein) Olive

> Leaf

> > > > > > 500mg capsules, 3 to 4 capsules, 3 to 4 times a day

between

> > > > meals,

> > > > > will probably be equally effective and cheaper for most

> people

> > > than

> > > > > the expensive forms. How long one needs to take Olive Leaf

in

> > > > Chronic

> > > > > Fatigue Syndrome is yet to be determined.

> > > > > > Initially, a pharmaceutical company was developing the

> > > Oleuropein

> > > > > in Olive Leaf as an antiviral. Because it gets bound to the

> > blood

> > > > > proteins, they thought that Oleuropein might not get to the

> > > > tissues.

> > > > > More importantly, Oleuropein is a natural product and

> therefore

> > > > hard

> > > > > to patent. Because of these problems, they stopped research

> on

> > > it.

> > > > > Years later this research was rediscovered and explored

> > further.

> > > In

> > > > > addition to being an effective antiviral agent, Olive Leaf

is

> > > > > reported to be effective on a number of bacterial and yeast

> > > > > infections as well. What is most exciting regarding the

Olive

> > > Leaf

> > > > is:

> > > > > > a. That some doctors have found it to be effective in

> CFIDS,

> > > and

> > > > > > b. That in tests against HHV-6 and CMV virus (remember

that

> > if

> > > > > something is effective against one, it tends to be

effective

> > > > against

> > > > > the other) the Olive Leaf extract did not just suppress the

> > virus

> > > > but

> > > > > killed it. That is very promising.

> > > > > > 2. Pro-Boost - Thymic Protein A (used to be called

BioPro) -

>

> > > This

> > > > > is the immune stimulant that I discussed in my newsletter,

> Vol.

> > > 2,

> > > > > Issue 2. Although not a hormone, Pro-Boost mimics the

natural

> > > > hormone

> > > > > produced by your Thymus - the gland which stimulates your

> > immune

> > > > > system. I find it to be extraordinarily effective in

fighting

> > > > common

> > > > > infections of any kind that seem to pop up. For the more

deep-

> > > > seated

> > > > > infections of CFIDS, the higher dose (1 packet, 3 times a

> day)

> > > will

> > > > > likely be needed. Once the infection seems to be in check

and

> > you

> > > > are

> > > > > feeling better (i.e., after 6 weeks), you can taper down to

> the

> > > > > lowest dose that maintains the effect.

> > > > > > 3. IP6 - This natural immune stimulant is an extract of

> bran

> > > > > (phytates). It is less expensive and is sometimes combined

> with

> > > > > vitamin C. The dose of IP6 (available from many sources) is

5

> > to

> > > 8

> > > > > grams a day. Do not take IP6 within 3 hours of

> vitamin/mineral

> > > > > supplements.

> > > > > > 4. MGN3 - This is a very concentrated mushroom extract,

> which

> > > has

> > > > > been shown to stimulate Natural Killer Cell immune

function.

> In

> > > one

> > > > > study, it actually tripled Natural Killer Cell function—an

> > effect

> > > > > that, as the HHV-6 virus can suppress Natural Killer Cell

> > > function,

> > > > > could be very powerful. Unfortunately, it is horribly

> expensive

> > > in

> > > > > the recommended dose (250 mg capsules) of 2 to 4 capsules,

4

> > > times

> > > > a

> > > > > day for 2 weeks, followed by 2 capsules, 2 times a day.

Other

> > > > > mushroom extracts are cheaper but may not be as effective.

> > > > > > 5. Intravenous Vitamin C at high-dose (15gm to 50gm) has

> been

> > > > > suggested to have antiviral effects in a number of other

> > > infections

> > > > > and is often dramatically helpful in CFIDS when given in

the

> > I.V.

> > > > > nutritional therapy called " Myers Cocktails " (see my

> > newsletter,

> > > > Vol.

> > > > > 3, Issue 3).

> > > > > > 6. Lysine 1000 mg, 3 times a day - This amino acid

protein

> is

> > > > safe

> > > > > and inexpensive (27¢ a day). It inhibits oral/genital

herpes

> > (by

> > > > > depleting the Arginine the virus needs to grow). I do not

> know

> > if

> > > > it

> > > > > also inhibits EBV, HHV-6 or CMV viral infections.

> > > > > > I would take the combination of these together (as is

> > > affordable)—

> > > > > perhaps leaving the MGN3 for later if needed, giving the

> > > treatment

> > > > > for at least a 6 to 8 week trial to see if it's effective.

If

> > you

> > > > are

> > > > > feeling better at 6 weeks, you can then taper down the dose

> > > slowly

> > > > as

> > > > > long as the benefit is maintained. When able, you can wean

> > > yourself

> > > > > off the treatments. If symptoms recur, go back up to the

dose

> > > that

> > > > > maintains the benefit or consider increasing the dose

> further.

> > As

> > > > we

> > > > > are just starting to use this protocol in our patients, I

do

> > > > > appreciate your feedback on what has worked for you and

what

> > has

> > > > not.

> > > > > You can " vote " for what helped or didn't help you on our

Web

> > site

> > > > at

> > > > > www.endfatigue.com. You can also see other people's votes.

> > > > > > In addition, your clotting system may be activated by

> several

> > > > > infections making it difficult to eliminate them. Using the

> > anti-

> > > > > clotting treatments that we will discuss later can also

make

> it

> > > > > easier for your body to eradicate infections.

> > > > > > Mycoplasma And Chlamydia

> > > > > > Other infections have also been found to be very

important

> in

> > > > > CFIDS. Dr. Garth Nicolson and his wife, who were on-faculty

> at

> > > the

> > > > > University of Texas Medical School at Houston and the

> > Department

> > > of

> > > > > Microbiology and Immunology at Baylor College of Medicine

in

> > > > Houston,

> > > > > Texas, are the leading proponents of treatment of these

> > > infections.

> > > > > Dr. Garth Nicolson was an endowed chair and department

> chairman

> > > at

> > > > > the University of Texas, the M.D. Cancer Center in

> > > > Houston,

> > > > > Texas, and a Professor of Internal Medicine at the

University

> > of

> > > > > Texas Medical School, also in Houston. Dr. Nicolson's wife

> had

> > > > > Chronic Fatigue Syndrome years ago. They were surprised

that

> > her

> > > > test

> > > > > turned out to be positive for Mycoplasma fermentans (also

> known

> > > as

> > > > > Mycoplasma fermentans incognitus). This Mycoplasma was

found

> to

> > > be

> > > > > resistant to the Penicillin- and Keflex-family antibiotics

> that

> > > > most

> > > > > doctors use, but was sensitive to long courses of

Doxycycline

> > and

> > > > > Cipro. After an extended course of Doxycycline treatment,

> > > > > > she was much better. The Nicolsons then went on to

develop

> > > their

> > > > > own tests for Mycoplasma using PCR testing. Dr. Nicolson

> tells

> > me

> > > > > that, in addition, when his step-daughter came home after

> > serving

> > > > in

> > > > > Desert Storm, she came down with Gulf War Illness (GWI).

They

> > > > tested

> > > > > hundreds of Gulf War veterans with GWI and 40% to 45% were

> > > positive

> > > > > for Mycoplasma infections—almost all with Mycoplasma

> > fermentans.

> > > > This

> > > > > has been confirmed by other labs and a large Veterns

> > > Aministration

> > > > > study involving over 2,000 patients. In contrast to this,

> > > soldiers

> > > > > who were not deployed to the Gulf during the war, had less

> than

> > a

> > > > 6%

> > > > > incidence of being positive for these infections.

> > > > > > Interestingly, the Nicolsons found that in patients with

> > > Chronic

> > > > > Fatigue Syndrome or Fibromyalgia, approximately 70% (144

out

> of

> > > 203

> > > > > patients) had a positive PCR test for one, or usually

several

> > > > > species, of Mycoplasma. When the Nicolsons tested 70

healthy

> > > > > patients, only 6 patients (less than 9%) were positive for

> any

> > of

> > > > the

> > > > > Mycoplasma species. This is a highly significant

difference.

> > Only

> > > 2

> > > > > of these 70 healthy people were positive for Mycoplasma

> > > fermentans.

> > > > > Similar results have been found by other doctors and have

> been

> > > > > published.

> > > > > > As we have said before, it is likely that there is a

group

> of

> > > > > underlying problems and not a single one that triggers

> > CFIDS/FMS.

> > > > > This applies to infections as well. This is why you can see

> > tests

> > > > be

> > > > > positive for both viral and Mycoplasmal infections in so

many

> > > > people

> > > > > with this disease. For Mycoplasma alone, when they checked

> for

> > > four

> > > > > different types of Mycoplasma, over half of the 93 CFIDS

> > patients

> > > > > that were positive had more than one type of infection.

Over

> > 20%

> > > of

> > > > > them had three out of the four Mycoplasma infections test

> > > positive.

> > > > > The more infections that were positive, the worse the

> patient's

> > > > > symptoms were and the longer they had had CFIDS/FMS.

> > > > > > What Are Mycoplasma?

> > > > > > Mycoplasma are an ancient bacteria that lacks cell walls

> and

> > > are

> > > > > capable of invading a number of types of human cells. They

> can

> > > > cause

> > > > > a wide variety of human diseases. These organisms can cause

> the

> > > > types

> > > > > of symptoms seen in Chronic Fatigue Syndrome patients and,

> > > > according

> > > > > to Dr. Nicolson, tend to be immune suppressing.

> Unfortunately,

> > > they

> > > > > cannot be readily cultured on a culture dish like regular

> > > bacteria.

> > > > > In medicine, we have a bad habit on focusing on that which

is

> > > easy

> > > > to

> > > > > test for and making believe that that which is hard to test

> for

> > > > does

> > > > > not exist. Because of this, bacterial infections such as

> > > pneumonia,

> > > > > bladder infections and skin infections, where one bacteria

on

> a

> > > > cell

> > > > > dish will rapidly turn into millions by the next day and be

> > > visible

> > > > > to the human eye, get all our attention. Unfortunately,

> > > Mycoplasma,

> > > > > which cannot be easily cultured, tends to be ignored. It's

> like

> > > the

> > > > > old story about the little kid who was looking for his lost

> > keys

> > > > > under the street lamp one night. His frien

> > > > > > ds came by and asked him what was going on. He told them

> and

> > > they

> > > > > all looked for the keys under that light for about an hour.

> > > > Finally,

> > > > > exasperated, they looked at the friend and said, " Where did

> you

> > > > lose

> > > > > these keys? " The kid looked up and said, " Oh, about half a

> > block

> > > > down

> > > > > the street. " They said, " Why are you looking for them

here? "

> He

> > > > > said, " Because there is a light here and I can see! " This

is

> > kind

> > > > of

> > > > > what it is like in medicine. If there is a test for

something

> > > (such

> > > > > as cholesterol and bacterial cultures) that is easy to do,

we

> > > focus

> > > > > our attention on that test and make believe that it finds

the

> > > main

> > > > > problem. Unfortunately, in CFIDS and FMS, this is not the

> case.

> > > > > > The data suggests that many infections may trigger

> CFIDS/FMS

> > or

> > > > > that CFIDS and FMS may cause immune suppression—which then

> sets

> > > you

> > > > > up to catch a whole bunch of different infections which

your

> > body

> > > > has

> > > > > trouble clearing. This is why it is important to treat all

> the

> > > > > underlying processes simultaneously as I discuss in my From

> > > > Fatigued

> > > > > To Fantastic! book and newsletters.

> > > > > > So, How Do You Look For These Infections?

> > > > > > I had the honor of speaking with Konnie Knox, M.D., a

major

> > re-

> > > > > searcher on HHV-6 testing in CFIDS/FMS, who uses a

technique

> > > called

> > > > > Rapid Cell Culture. She actually infects different test

tube

> > > cells

> > > > > with HHV-6, grows them, and then looks for signs of HHV-6

in

> > the

> > > > > cell. In her experience, one out of three CFIDS/FMS

patients

> > are

> > > > > positive for active HHV-6 infection on the first blood

test.

> > When

> > > > > multiple testing is done (e.g., three tests), 70% are

> positive.

> > > > This

> > > > > test is negative in the vast majority of people who are

> > healthy.

> > > > The

> > > > > other main illness where the HHV-6 test is positive is

> Multiple

> > > > > Sclerosis. At this time, HHV-6 Rapid Cell Culture and the

PCR

> > > test

> > > > at

> > > > > Dr. Nicolson's lab (International Molecular Diagostics) are

> the

> > > > only

> > > > > HHV-6 test I order. For more information on Dr. Knox's

work,

> go

> > > to

> > > > > these Web sites: www.HHV-6.com and www.cnet.com. For the

IMD

> > > > website,

> > > > > go to www.imd-lab.com.

> > > > > > The Nicolsons use very sensitive PCR (Polymerase Chain

> > > Reaction)

> > > > > testing to actually look for DNA specific to Mycoplasma,

HHV-

> 6,

> > > and

> > > > > other infections. Unfortunately, those DNA pieces are so

> > > > > microscopically small, that to look for just one is much

> worse

> > > than

> > > > > looking for a " needle in a haystack. " With the PCR, if that

> > > > > Mycoplasma gene sequence is found, the technique multiplies

> it

> > > like

> > > > a

> > > > > copying machine until millions of that sequence are present

> and

> > > can

> > > > > be picked up by testing. Because of this, PCR testing is

> > > > exquisitely

> > > > > sensitive and can find the proverbial " needle in a

haystack. "

> > > This

> > > > > makes it very powerful and the only testing that I would

> > > recommend

> > > > in

> > > > > looking for these Mycoplasma and Chlamydia infections. As

> noted

> > > > > above, IGG antibody testing is not reliable for Mycoplasma

> and

> > > > > Chlamydia testing in CFS.

> > > > > > Where Do I Get These Tests Done And Should I Have Them

Done?

> > > > > > The tests for HHV-6 and Mycoplasma each cost about $180

to

> > > $250.

> > > > As

> > > > > noted above, the only places that I would get the HHV-6

test

> > done

> > > > > (and the only tests I would do are PCR or viral culture

> > testing)

> > > > are

> > > > > at the Wisconsin Viral Institute (414-774-0311) or Dr.

> > Nicolson's

> > > > > lab. I order all the lab testing for Mycoplasma and

Chlamydia

> > at

> > > > the

> > > > > Nicolson's lab, at International Molecular Diagnostics,

15162

> > > > Triton

> > > > > Lane, Huntington Beach, CA 92649 (714-799-7177 ext. 202 or

> > 204).

> > > > The

> > > > > lab's Web site is www.imdlab.com.

> > > > > > I can almost guarantee that if you do the Mycoplasma or

> > > Chlamydia

> > > > > tests at your local lab they will do the wrong tests and

they

> > > will

> > > > be

> > > > > useless for hidden CFS infections. I have never seen one

come

> > > back

> > > > > with any useful information. What they usually do is check

> the

> > > > > antibodies (usually for the wrong Mycoplasma infection)

which

> > > > simply

> > > > > shows that you (like everybody else at some point in their

> > life)

> > > > have

> > > > > had a Mycoplasma infection. It tells nothing about active

> > > infection

> > > > > and, again, is useless. Be sure to do the PCR testing and

do

> it

> > > at

> > > > > one of the two labs discussed above. Dr. Nicolson has noted

> > which

> > > > > tests he recommends in CFS/FMS, their cost and instructions

> for

> > > the

> > > > > lab. We have reprinted this information on the next page

(Dr.

> > > > > Nicolson's lab also does viral PCR testing for CMV, as well

> as

> > > HHV-

> > > > 6).

> > > > > > Even at the best labs, it is not uncommon to have a false-

> > > > negative

> > > > > report (where you have the infection and it does not show

up

> on

> > > the

> > > > > test). Because of this, especially for HHV-6, multiple

tests

> > will

> > > > > often need to be done. There are good arguments for not

doing

> > the

> > > > > tests and simply going ahead and treating empirically with

> the

> > > > > natural remedies discussed above for HHV-6, or for

> prescribing

> > > > > Doxycycline or Cipro for an extended period of time (see

> > below).

> > > If

> > > > > you feel better after four months on the treatment, then

you

> > know

> > > > you

> > > > > are hitting an infection and you can always intermittently

> stop

> > > the

> > > > > treatments to see how long you will need them. Also, there

> are

> > > many

> > > > > infections that are not tested for with these tests that

> would

> > be

> > > > > effectively treated with the regimens that we are

discussing.

> > > Many

> > > > of

> > > > > these are likely to be infections that we don't even know

> > exist.

> > > > > Because of this, if resources are limited, I some-times

> simply

> > > > treat

> > > > > the patient, based on clinical suspicion, without doing the

> > > > > > tests.

> > > > > > Testing does have its benefits. If the test is positive,

I

> am

> > > > > likely to treat more aggressively and it helps guide me on

> how

> > > long

> > > > > to give the treatment. For example, if after four months

you

> > are

> > > > not

> > > > > better and the test is positive, I would be likely to go

> ahead

> > > and

> > > > > increase dosing or change to a different antibiotic. If the

> > test

> > > > was

> > > > > negative, I would be more likely to just stop treatment and

> > > suspect

> > > > > that the infection is less likely. This argues in favor of

> > doing

> > > > the

> > > > > tests. One simple thing to do is to go ahead and check with

> > your

> > > > > insurance company to see if they cover these tests. This

may

> > make

> > > > > your decision much simpler. Unfortunately, I suspect that

the

> > way

> > > > > that most labs draw and ship your blood sample may not be

> > > reliable

> > > > > because, in our experience, we have had less than 10% of

> > > patient's

> > > > > tests come back positive for HHV-6 cell culture and only a

> > modest

> > > > > percent come back positive for the Mycoplasma. For the PCR

> > > > Mycoplasma

> > > > > test, the blood has to be frozen (see boxed inset, Page 9

> > > > > > ). If the blood is left at room temperature, most of the

> > > positive

> > > > > samples become negative after one to two days.

> > > > > > Mycoplasma testing is not as specific as HHV-6 testing is

> for

> > > > > CFIDS/FMS/Multiple Sclerosis (i.e., it is positive in other

> > > > > illnesses). For example, about half the patients with

> > Rheumatoid

> > > > > Arthritis are also found to be infected with treatable

> > > infections,

> > > > > including Mycoplasma. This goes along with my, and other

> > doctors'

> > > > > experience, that Doxycycline is often effective in treating

> > > > > Rheumatoid Arthritis. Interestingly, although Mycoplasma is

> > > common

> > > > in

> > > > > the environment, it usually is fairly noninvasive. It may

> > simply

> > > be

> > > > > that once your immune system is weakened, these infections

> can

> > > get

> > > > > into cells where they don't belong. When that happens, even

> > some

> > > of

> > > > > the common ones that are considered noninfectious can wreak

> > > havoc.

> > > > > When these infections repro-duce slowly, they tend to be

low-

> > > grade,

> > > > > chronic infections, as opposed to the acute and more

> prominent

> > > > > symptoms seen with bacterial and viral infections that

> multiply

> > > and

> > > > > divide rapidly.

> > > > > > For CFS/ME or FMS or Autoimmune Disease Patients,

> > > > > > The Institute for Molecular Medicine suggests the

following

> > lab

> > > > > tests:

> > > > > > (Codes are I.M.D. or CPT Codes)

> > > > > > 1. Test Panel 1007 (CPT: 87798x3, 87581) Mycoplasma

species

> > > panel

> > > > > of 4 pathogenic mycoplasmas (M. fermentans, M. penumoniae,

M.

> > > > > hominis, M. penetrans) by PCR.

> > > > > > Justification: Almost 60% of CFS/FMS and 50% of

Rheumatoid

> > > > > Arthritis (RA) and other autoimmune patients have one or

more

> > > > > intracellular, systemic mycoplasmal infections similar to

> those

> > > > found

> > > > > in a variety of chronic illnesses [Nicolson, et al.,

> > Mycoplasmal

> > > > > infections in chronic illnesses: Fibromyalgia and Chronic

> > Fatigue

> > > > > Syndromes, Gulf War Illness, HIV-AIDS and Rheumatoid

> Arthritis;

> > > > > Medical Sentinel 1999; 5:172-176]. Ultrasensitive and

> > > ultraspecific

> > > > > mycoplasma tests can only be done by a small number of

labs,

> > most

> > > > > university or government labs that have been trained by us

> > under

> > > a

> > > > > U.S. government contract.

> > > > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic

> Tube

> > > > > (EDTA). The blood is collected, immediately mixed and

placed

> on

> > > > ice,

> > > > > then shipped on wet ice or immediately flash frozen and

> shipped

> > > > with

> > > > > dry ice by courier (foreign shipments) to I.M.D. to arrive

> > within

> > > > 24-

> > > > > 36 hours. Cost=$250. (Note that other commercial labs

charge

> > $400-

> > > > > 600.)

> > > > > > 2. Test 1006 (CPT: 87486) Chlamydia pneumoniae test by

PCR.

> > > > > Justification: Many CFS, FMS, MS, RA and other patients

have

> > this

> > > > > systemic infection along with viral infection(s). We were

> among

> > > the

> > > > > few labs that developed the molecular tests that are now

done

> > for

> > > > > this type of infection. The other labs that use these

> > procedures

> > > > are

> > > > > university labs.

> > > > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic

> Tube

> > > > > (EDTA). The blood is collected, immediately mixed and

placed

> on

> > > > ice,

> > > > > then shipped on wet ice or immediately flash frozen and

> shipped

> > > > with

> > > > > dry ice by courier to I.M.D. to arrive within 24-36 hours.

> > > > Cost=$180.

> > > > > (Note that other commercial labs charge $200-250.)

> > > > > > 3. Test 07047 (CPT: 87476) Borrelia burgdorferi (Lyme

> > Disease)

> > > > test

> > > > > by PCR.

> > > > > > Justification: Many CFS, FMS and RA patients have this

> > systemic

> > > > > infection (diagnosed as Lyme Disease) along with other

> infection

> > > > (s).

> > > > > > Specimen Requirements: One (1) 5 cc Lavender-top Plastic

> Tube

> > > > > (EDTA). The blood is collected, immediately mixed and

placed

> on

> > > > ice,

> > > > > then shipped on wet ice or immediately flash frozen and

> shipped

> > > > with

> > > > > dry ice by courier to I.M.D. to arrive within 24-36 hours.

> > > > Cost=$180.

> > > > > (Note that other commercial labs charge $200-250.)

> > > > > > 4. Test 07039 (CPT: 87532) Human Herpes Virus 6 (HHV-6)

> test

> > by

> > > > > PCR.

> > > > > > Justification: Many CFS and some FMS patients have this

> > > systemic

> > > > > viral infection, and it should be tested for in any

> autoimmune

> > > > > illness.

> > > > > > Specimen Requirements: Collect blood in one (1) 5 cc

> Lavender-

> > > top

> > > > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > > > centrifugation. The plasma is then shipped on wet ice or

> > > > immediately

> > > > > flash frozen and shipped with dry ice by courier to I.M.D.

to

> > > > arrive

> > > > > within 24-36 hours. Cost=$180. (Note that other commercial

> labs

> > > > > charge $200-350.)

> > > > > > 5. Test 07034 (CPT: 87496) Cytomegalovirus (CMV) test by

> PCR.

> > > > > > Justification: Many CFS and FMS patients have this

systemic

> > > viral

> > > > > infection, and it should be tested for in any autoimmune

> > illness.

> > > > > > Specimen Requirements: Collect blood in one (1) 5 cc

> Lavender-

> > > top

> > > > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > > > centrifugation. The plasma is then shipped on wet ice or

> > > > immediately

> > > > > flash frozen and shipped with dry ice by courier to I.M.D.

to

> > > > arrive

> > > > > within 24-36 hours. Cost=$180. (Note that other commercial

> labs

> > > > > charge $200-300.)

> > > > > > For the best price and highest quality, the above PCR

> > specialty

> > > > > tests for CFS/FMS patients can be ordered through

> International

> > > > > Molecular Diagnostics, Inc., 15162 Triton Lane, Huntington

> > Beach,

> > > > CA

> > > > > 92649, U.S.A. Tel: 714-799-7177, ext. 202 (Client Services)

> or

> > > ext.

> > > > > 204 (Brant Blasingame). Order forms and additional

> information

> > > are

> > > > > available upon request. They also offer testing for blood

> > > clotting

> > > > > abnormalities (see below). Tests must be ordered by a

> > physician.

> > > > The

> > > > > I.M.D. Web site is www.imd-lab.com. On this site you will

> find

> > > > > additional information about testing and disease. The

> Institute

> > > for

> > > > > Molecular Medicine Web site is www.immed.org. On this site

> you

> > > will

> > > > > find publications and documents on CFS/ME, FMS, autoimmune

> > > diseases

> > > > > and other chronic illnesses. Immediate fax-back information

> is

> > > > > available 24 hours per day by calling our telephone number

> 714-

> > > 903-

> > > > > 2900.

> > > > > > Garth Nicolson, Adjunct Professor of Internal Medicine

> > > > > > President and Chief Scientific Officer, The Institute for

> > > > Molecular

> > > > > Medicine

> > > > > > —A nonprofit institute dedicated to discovering new

> > diagnostic

> > > > and

> > > > > therapeutic solutions for chronic diseases—

> > > > > > 15162 Triton Lane, Huntington Beach, CA 92649-1041,

> U.S.A. •

> > > Tel:

> > > > > 714-903-2900 • Fax: 714-379-2082

> > > > > > So, What Is Prescribed For Mycoplasma And Chlamydia?

> > > > > > Fortunately, Mycoplasma and Chlamydia infections are

> usually

> > > > > sensitive to the right antibiotics. The antibiotics most

> likely

> > > to

> > > > > effect these organisms are:

> > > > > > 1. Doxycycline or Minocycline 100 mg, 2-3 times a day.

> These

> > > two

> > > > > antibiotics are in the Tetracycline-family and should not

be

> > used

> > > > in

> > > > > children under eight years-old because they can cause

> permanent

> > > > > staining of the teeth. They are very effective, though,

> against

> > a

> > > > > number of unusual organisms (e.g., Lymes Disease). They

will

> > > > > sometimes cause some stomach upset. If this occurs, take

the

> > > > medicine

> > > > > with food and a full glass of water or lower the dose. Do

not

> > use

> > > > > outdated/expired Tetracycline prescriptions—they can kill

you!

> > > > > > 2. Cipro (Ciprofloxacin) 750 mg, twice a day. Although

> > > expensive,

> > > > > this is usually a well-tolerated antibiotic. It has a very

> wide

> > > > range

> > > > > of effectiveness against a large number of organisms. When

> > > treating

> > > > > males, the Cipro (as well as the Doxycycline) has the

> > additional

> > > > > benefit of treating any hidden prostate infections. Do not

> take

> > > > oral

> > > > > magnesium within 6 hours of Cipro or you won't absorb the

> Cipro.

> > > > > > 3. Zithromax 600 mg a day, taken with food, or Biaxin 500

> mg,

> > > > twice

> > > > > a day, taken on an empty stomach. These are in the Erythro-

> > mycin

> > > > > family. Zithromax tends to be fairly well-tolerated. The

> Biaxin

> > > is

> > > > > more likely to cause a bit of nausea in some patients, but

it

> > is

> > > > > usually well-tolerated. Both are quite expensive. They may

> work

> > > > > against infections missed by Doxycycline and Cipro.

> > > > > > Although all of these antibiotics can be effective, it is

> not

> > > > > uncommon for infections that are sensitive to the

> Erythromycin

> > > > > antibiotics (#3 above) to be resistant to #1 and #2 above

and

> > > vice-

> > > > > versa. Therefore, it is best to try either Doxycycline or

> Cipro

> > > > > first. If they are not effective, then try the Zithromax or

> > > Biaxin.

> > > > > The antibiotic should be taken for at least 6 months. If

> there

> > is

> > > > no

> > > > > improvement in 4 months, switch to or add the other

> antibiotic

> > or

> > > > > simply stop the treatment. It is helpful to check for low-

> grade

> > > > > fevers. I am more likely to use antibiotics for CFIDS

> patients

> > > who

> > > > > have temperatures over 98.6°F, even if it is only 98.8° (I

> > > consider

> > > > > 98.8° a fever because CFIDS/FMS patients usually have low

> body

> > > > > temperatures). If you do have low-grade, chronic

temperature

> > > > > elevations, be sure that you monitor your temperatures

during

> > > > > treatment. If your temperature drops with the antibiotic,

it

> > > > suggests

> > > > > that you do have one of these nonviral infections and the

> > > > antibiotic

> > > > > is helping. T

> > > > > > his would encourage me to continue the antibiotic trial -

> > even

> > > if

> > > > > it takes up to 12 months to see an improvement in your

> > symptoms.

> > > > > > If you are clearly better, I would probably take the

> > antibiotic

> > > > for

> > > > > at least 6 to 12 months. It can then be stopped. If

symptoms

> > > recur,

> > > > > keep repeating 6 to 8 week cycles until the symptoms stay

> gone.

> > > It

> > > > > may take several years of treatment for the infection to be

> > > totally

> > > > > eradicated. To put it in perspective, this is how long

> children

> > > > often

> > > > > take antibiotics for acne—which unfortunately, if not taken

> > with

> > > > anti-

> > > > > fungals, can lead to yeast overgrowth and possibly trigger

> > CFIDS.

> > > > Be

> > > > > sure to take Nystatin, 2 tablets, 2 times a day, while on

the

> > > > > antibiotics. Also, please be sure to use alternative birth

> > > control

> > > > if

> > > > > on " the pill. " Birth control pills may be ineffective while

> > > taking

> > > > > antibiotics. In addition, anti-depressants, codeine,

> antacids,

> > > and

> > > > > mineral supplements (e.g., magnesium) may block antibiotic

> > > > > absorption. Take these at least three hours away from the

> > > > antibiotic

> > > > > (and don't take the antidepressant/codeine medications if

> they

> > > are

> > > > > not clearly helping).

> > > > > > It is very common to get die-off (Herxheimer) reactions

> which

> > > > > include chills, fever, night sweats and general worsening

of

> > > > CFS/FMS

> > > > > symptoms when the antibiotic first kills off the infection.

> > These

> > > > can

> > > > > be severe and last for weeks. Dr. Nicolson encourages

you " to

> > be

> > > > > patient and not abandon therapy prematurely, because few

> > patients

> > > > who

> > > > > have been sick for years recover in less than one year of

> > > > therapy...

> > > > > [don't] be alarmed if some signs and symptoms occasionally

> > return

> > > > or

> > > > > worsen. This is not unusual. Eventually you will be off

> > > antibiotics

> > > > > or antivirals but you will need to continue various

> supplements

> > > to

> > > > > maintain your immune system and general nutritional status. "

> > > > > > Treatment for Bacterial, Mycoplasma, Chlamydia, E-coli,

> > > Bladder,

> > > > Or

> > > > > Other Infections

> > > > > > (From the " Treatment Checklist " used in Dr. Teitelbaum's

> > > office.

> > > > A

> > > > > full list is available on Dr. Teitelbaum's Web site at

> > > > > www.endfatigue.com.)

> > > > > > The Mycoplasma, Chlamydia, E-Coli, bladder and other

> > bacterial

> > > > > infections usually take months to years to eradicate. It is

> > > common

> > > > to

> > > > > flare your symptoms (from the infection die-off) the first

> two

> > > > weeks

> > > > > of treatment. Take the antibiotics for six months and, if

> > better,

> > > > > then repeat six-week cycles till your symptoms stay gone.

> > > > > Antidepressants, Neurontin, and/or Codeine may block the

> > > > antibiotic's

> > > > > effectiveness. Be sure to take Nystatin, 2 tablets twice a

> day,

> > > and

> > > > > Acidophilus while on the antibiotics. If you have

occasional

> > low-

> > > > > grade fever (i.e., if over 98.6° F), check your oral

> > temperature

> > > > > occasionally to see if the antibiotic reduces or eliminates

> the

> > > > > fever. If so, stay on that antibiotic. Also, see Dr.

> Nicolson's

> > > Web

> > > > > site at www.immed.org for additional information.

> > > > > > Useful antibiotic treatment for the above infections

> include:

> > > > > > 1. Cipro (ciprofloxacin) 750 mg, 2 times a day for 6

> months.

> > Do

> > > > not

> > > > > take magnesium products (e.g., Fibrocare, some antacids,

Pro

> > > > Energy,

> > > > > or (Dr. Teitelbaum's) Foundation Formula™) within 6 hours

of

> > > Cipro

> > > > > because you won't absorb the Cipro.

> > > > > > OR

> > > > > > 2. Doxycycline (a tetracycline) 100 mg, 3 times a day for

6

> > > > months.

> > > > > If symptoms recur when the Doxycycline is completed, keep

> > > repeating

> > > > 6-

> > > > > week courses until the symptoms stay resolved. Take

Nystatin

> > (at

> > > > > least 2, twice a day) while on the antibiotic. Birth

control

> > > pills

> > > > > may not work while on Doxycycline. Do not take any expired

> > > > > Doxycycline tablets (it's very dangerous).

> > > > > > OR

> > > > > > 3. Zithromax (azithromycin) 600 mg tablets, 1 tablet a

day

> > > (take

> > > > > with food if it bothers your stomach). Don't take magnesium-

> > > > > containing products within six hours of the Zithromax.

> > > > > > OR

> > > > > > 4. Biaxin 500 mg, 2 times a day.

> > > > > > 5. D-Mannose ½ to 1 teaspoon (2.5 grams), stirred in

water,

> > > every

> > > > 2

> > > > > to 3 hours while awake, for 2 to 5 days for acute bladder

> > > > infections

> > > > > (may use long-term for chronic infections) caused by E-coli

> > (this

> > > > > causes approximately 90% of bladder infections). If not

much

> > > better

> > > > > in 24 hours, get a urine culture and consider an

antibiotic.

> D-

> > > > > Mannose is available from BioTech (800-345-1199), my Web

> > > > > site's " Vitamin Shop " at www.endfatigue.com or my office

(800-

> > 333-

> > > > > 5287).

> > > > > > What About Yeast Overgrowth?

> > > > > > Yeast overgrowth is an important concern. As I have

> mentioned

> > > > > before, nothing is all good or all bad. Although cigarettes

> > kill

> > > > > hundreds of thousands of people each year, they can be

> helpful

> > in

> > > > > treating Parkinson's Disease or ulcerative colitis.

Although

> > > > > antibiotics can trigger CFIDS, they can also be helpful in

> > > treating

> > > > > it. This makes it important to know when and how to use

them.

> I

> > > > > strongly recommend that my patients take antifungals while

on

> > any

> > > > > antibiotics (e.g., Nystatin 500,000 unit tablets, 2

tablets,

> 2

> > to

> > > 3

> > > > > times a day) to prevent yeast overgrowth. It is also

> reasonable

> > > to

> > > > > add Oregano Oil and other natural antifungals. Two Nystatin

> > twice

> > > a

> > > > > day is what I usually prescribe. Using probiotics (healthy

> milk

> > > > > bacteria-like acidophilus that helps your body) to compete

> with

> > > the

> > > > > yeast can also help. I am concerned that if the acidophilus

> is

> > > > taken

> > > > > with the antibiotic, they may simply cancel each other out.

> > > Because

> > > > > of this, I usually begin probiotics (Acidophilus or

> > Lactobacillus

> > > > in

> > > > > a d

> > > > > > ose of 3 to 6 billion units a day, taken on an empty

> stomach

> > or

> > > > > with milk) after one has completed the course of

antibiotics.

> > If

> > > > you

> > > > > are only taking the antibiotic once or twice a day, and can

> > find

> > > a

> > > > > time at least 6 to 8 hours away from another dose to take

the

> > > > > probiotic, it is reasonable to take it at that time. The

> entire

> > > > daily

> > > > > probiotic dose can also be taken at one time. If you find

> that

> > > you

> > > > > still get yeast overgrowth, it may be necessary to use some

> of

> > > the

> > > > > more potent prescription antifungals (Sporanox or

Diflucan).

> > > > Because

> > > > > these can cause liver inflammation and are quite expensive,

> it

> > > may

> > > > be

> > > > > adequate to take 200mg of either of these, twice a day, one

> day

> > > > each

> > > > > week (e.g., take it every Sunday) instead of every day. As

> > > > discussed

> > > > > previously, be sure to take Lipoic acid 200 mg on any day

you

> > > take

> > > > > Sporanox or Diflucan, to decrease the risk of liver

> > inflammation.

> > > > > > What Role Does My Blood Clotting System Play In This?

> > > > > > Work done by E. Berg, M.S., C.L.S. (N.C.A.),

director

> > of

> > > > > Hemex Laboratories in Phoenix, Arizona (800-999-2568), has

> > shown

> > > > that

> > > > > a number of infections can trigger our blood clotting

system

> to

> > > > > become active, thus setting up a low-level, chronic

clotting

> > > > cascade.

> > > > > These infections include HHV-6, Mycoplasma, CMV and

Chlamydia

> > > which

> > > > > can trigger production of (IgA) antibodies against clot

> > > protective

> > > > > proteins on blood vessel inner surfaces (called

> > antiphospholipid

> > > > > antibodies). One of these is the Beta 2 Glyco-protein 1

(anti

> > > B2GP1—

> > > > > no, you are not going to be tested on this!). This then

> > triggers

> > > > the

> > > > > clotting cascade. Once the clotting system is triggered, a

> > > product

> > > > > called Soluble Fibrin Monomer (SFM) is made which is like

the

> > > > > polymers in plastic. The theory is that they create long

thin

> > > > sheets

> > > > > of a teflon-like substance, similar to the scab that covers

a

> > > cut,

> > > > > but microscopic, which then coats the blood vessels. This

> makes

> > > it

> > > > > hard for nutrients, oxygen, etc., to get in and out of the b

> > > > > > lood vessels to the cells where they are needed. In

> summary,

> > > many

> > > > > infections can cause the blood clotting system to activate,

> > > > resulting

> > > > > in a thin coating of Fibrin deposited on the blood vessels.

> > This

> > > > > prevents nutrients and oxygen from getting to the cells in

> your

> > > > body.

> > > > > > Why Would An Infection Trigger The Clotting System?

> > > > > > Many infections (called anaerobic) do not survive well in

> the

> > > > > presence of oxygen. One can theorize that these Mycoplasma

> > (which

> > > > may

> > > > > be anaerobic) and other organisms may trigger the clotting

> > system

> > > > to

> > > > > create a shell, which then acts like a suit of armor,

> > protecting

> > > > them

> > > > > from oxygen, your body's defense system, and antibiotics.

> This

> > > > would

> > > > > explain why these infections could evolve a way to trigger

> the

> > > > > clotting mechanism. The Fibrin armor preventing antibiotics

> > from

> > > > > getting to the infection could also explain why some people

> > with

> > > > > these infections may not respond to antibiotics. Indeed,

some

> > > > > physicians have found that the antibiotics work better once

> > > someone

> > > > > has been on a blood thinner (which may dissolve the armor).

> > > > > > This is an interesting theory, but how do we know this is

> > going

> > > > on?

> > > > > Mr. Berg and others have done studies showing that the

blood

> > > tests

> > > > > that look for these clotting changes (called the ISAC

panel -

> > > > > available at Hemex labs) are abnormal in CFIDS/FMS patients

> > while

> > > > > being normal in most other patients. They use a criterion

of

> > two

> > > of

> > > > > these tests needing to be abnormal to be considered

positive.

> > > When

> > > > > this was done, 50 of 54 CFIDS/FMS patients had abnormal

tests

> > > > (i.e.,

> > > > > only 7.4% of the patients had normal blood tests). In

healthy

> > > > > patients, 22 out of 23 had normal blood tests (i.e., 96%).

> This

> > > > means

> > > > > the test is both very sensitive and specific, picking up

> people

> > > > with

> > > > > CFIDS and excluding healthy people. Our experience has

shown

> > that

> > > > > almost everyone that we tested, who has CFIDS, has turned

out

> > to

> > > > have

> > > > > a positive ISAC panel. We have not personally sent in any

> tests

> > > on

> > > > > healthy patients to see if this also occurs. Interestingly,

> > this

> > > > > panel is also positive in many people with unexplained infer

> > > > > > tility (which can improve with Heparin) and may also be

> > > positive

> > > > in

> > > > > people with Multiple Sclerosis, Parkinsons, Autism,

> > Inflammatory

> > > > > Bowel Disease and some other illnesses. This suggests that

> this

> > > > test

> > > > > can be helpful in deciding whether to treat with blood

> thinners

> > > > > (Heparin) in CFIDS/FMS.

> > > > > > So, How Do I Treat The Clotting System?

> > > > > > First of all, it is important to remember that using

> > injections

> > > > of

> > > > > Heparin (the blood thinner) is still a controversial and

> > > > experimental

> > > > > treatment for CFIDS/FMS. We much prefer to use treatments

> that

> > > are

> > > > as

> > > > > safe as possible. Although Heparin is routinely used in the

> > > U.S.A.

> > > > to

> > > > > treat blood clots, using it to treat CFIDS/FMS is very new.

> > Most

> > > of

> > > > > the doctors that I have spoken with have only treated a few

> > > > CFIDS/FMS

> > > > > patients with Heparin and find that about half of these

> > patients

> > > > get

> > > > > better with treatment. The treatment protocol, developed by

> >

> > > > > Couvaras, M.D. (602-996-2411), includes the following:

> > > > > > 1. Remove wheat, alcohol and sugar from the diet, if

> possible.

> > > > > > 2. Check the ISAC panel. If there are at least two

abnormal

> > > > > results, then begin treatment.

> > > > > > 3. Give an antifungal for 14 days (he uses Lamisil 250mg

a

> > day—

> > > > > which I find to be poorly effective. I would use 200 mg of

> > > Sporanox

> > > > > or Diflucan instead).

> > > > > > 4. Give standard Heparin 4000 to 8000 units by injection

> > > > > subcutaneously (like an insulin shot) twice a day. A

> (possibly

> > > > safer)

> > > > > low molecular weight Heparin may also be used.

> > > > > > 5. If the PA index (on the ISAC) is positive, add a baby

> > > Aspirin

> > > > > (81mg) each day.

> > > > > > 6. After being on Heparin for one week, Dr. Couvares

> repeats

> > > the

> > > > > ISAC panel to adjust the dose of the Heparin and Aspirin.

He

> > > feels

> > > > > that the goal is to move all the blood tests into the

normal

> > > range

> > > > > but not past the normal range into blood-thinning

> (therapeutic)

> > > > > levels. If the values are still abnormal or the patient is

> > still

> > > > > having symptoms, he then increases the Heparin dosage. If

the

> > PA

> > > > > index (on the ISAC) is still high, he increases the Aspirin

> to

> > > > twice

> > > > > a day.

> > > > > > 7. If the patient feels better after one month of

Heparin,

> he

> > > > then

> > > > > switches to low-dose Coumadin (a blood thinner tablet—take

2

> to

> > 3

> > > > mg

> > > > > a day) and then stops the Heparin after 4 to 5 days of

being

> on

> > > the

> > > > > Coumadin. Once the patient has been on the Coumadin for two

> > weeks

> > > > he

> > > > > goes ahead and rechecks the ISAC panel to maintain the

blood

> > > tests

> > > > in

> > > > > the normal range.

> > > > > > 8. He also supplements patients with nutritional

> > > supplementation

> > > > as

> > > > > needed.

> > > > > > In my practice, because the ISAC panel runs over $320, I

> > check

> > > a

> > > > > baseline ISAC panel but do not repeat the ISAC panels to

> adjust

> > > > > therapy. Instead, while on Heparin, we check a PTT (a blood

> > > > thinning

> > > > > test) and platelets (a highly unusual, but potentially very

> > > > dangerous

> > > > > side effect of Heparin is a severe drop in platelet count,

> > which

> > > > can

> > > > > cause life-threatening bleeding) every 3 days for the first

> 12

> > > days

> > > > > and then every 2 to 4 weeks while on Heparin. If the PTT is

> > still

> > > > > within the normal range and the patient is not better, we

> > > increase

> > > > > the Heparin as high as 8000 units, twice a day (rarely we

> will

> > go

> > > > up

> > > > > to 8000 units, 3 times a day) and then also increase the

> > Aspirin

> > > to

> > > > 2

> > > > > a day. In comparison, hospital patients often require

Heparin

> > at

> > > > 1000

> > > > > units per hour (24,000 units a day) I.V., while most

CFS/FMS

> > > > patients

> > > > > only need 4000 to 5000 units, 2 times a day (8000 to 10,000

> > units

> > > a

> > > > > day). If the patient is feeling better, however, we simply

> > leave

> > > > them

> > > > > at the initial dose. Most patients will f

> > > > > > eel better at about the 10- to 14-day point if the

Heparin

> is

> > > > going

> > > > > to help. At the end of 4 to 12 months, if the Heparin

helps,

> we

> > > > > switch to Coumadin (as noted above) and check an INR

> > > (International

> > > > > Normalized Ratio), aiming to keep it below 1.3 while

> adjusting

> > > the

> > > > > Coumadin to the optimum does. It is very important to know

> that

> > > > most

> > > > > medications can change the blood level of Coumadin and that

> > > anytime

> > > > > anything is added to, or deleted from, your regimen

> (including

> > > > > natural remedies) you need to recheck the INR 4 to 7 days

> later

> > > to

> > > > > make sure that it is not going too high. Heparin and

Coumadin

> > are

> > > > > powerful medicines and the main risk is bleeding. Although

we

> > are

> > > > > using very low doses, which are usually very well-

tolerated,

> > one

> > > > can

> > > > > rarely see a life-threatening bleed occur. If you felt

better

> > on

> > > > the

> > > > > Heparin and then the symptoms come back on the Coumadin,

you

> > may

> > > > need

> > > > > to go back on the Heparin for several months to re-

establish

> > and

> > > > > maintain the benefit. Occasionally, people will need to b

> > > > > > e on the Heparin for an extended period, in which case

the

> > > blood

> > > > > tests (PTT and platelet count) should be checked every 2 to

4

> > > > weeks.

> > > > > All of this being said, most people tolerate these

treatments

> > > quite

> > > > > well and many, many more people die from taking Aspirin

> (e.g.,

> > > for

> > > > > arthritis) than Heparin each year.

> > > > > > In summary, there are a number of infections that can

cause

> > or

> > > > > occur because you have CFIDS/FMS. Once they occur, they can

> > > trigger

> > > > > the clotting cascade. This may keep the nutrients from

> getting

> > to

> > > > > your body and create a " suit of armor " for the viral and

> > > Mycoplasma

> > > > > infections. Using a blood thinner can break down these

armor

> > > > coatings

> > > > > that protect the infections from our treatment and allow

> > > nutrients

> > > > to

> > > > > get where they need to go. Many tests can help. The one

that

> I

> > > use

> > > > to

> > > > > decide whether to use the Heparin blood thinner is the ISAC

> > panel

> > > > (at

> > > > > Hemex Labs). Testing for infections may be helpful, but can

> be

> > > > > expensive and less likely to effect my decision to treat.

If

> > you

> > > > can

> > > > > afford the tests and/or your insurance will pay for them,

> they

> > > are

> > > > > worth checking and will make it easier to adjust therapy

over

> > > time.

> > > > > If you can't afford it, it is reasonable to treat

empirically

> > > > (i.e.,

> > > > > without testing), except for high-dose Valtrex therapy. If

> you

> > > have

> > > > > lung congestion and/or recurrent temperatures o

> > > > > > ver 98.6°F, I would treat with the antibiotics. If you

feel

> > > > > chronically flu-like, I would consider the HHV-6 or (based

on

> > > > > testing) the high-dose Valtrex regimen. It is also

reasonable

> > to

> > > > > treat with antibiotics and antivirals simultaneously -

> > especially

> > > > if

> > > > > you are taking the anticoagulants.

> > > > > > Chronic Sinusitis The Yeasty Beasties Revisited!

> > > > > > As was mentioned years ago, we speculated that the

chronic

> > > sinus

> > > > > congestion seen in CFIDS/FMS could be caused by yeast

> > overgrowth.

> > > A

> > > > > recent interesting study from the Mayo Clinic Proceedings

> > > supports

> > > > > this thought. In the study, researchers found that most

> people

> > > with

> > > > > chronic sinus infections had fungal growth in their

sinuses.

> > They

> > > > > felt that the inflammation was being caused by an immune

(the

> > > > body's

> > > > > reaction) response to the fungus. This research is

> interesting

> > > > > because more and more studies are showing that treating

> chronic

> > > > > sinusitis with antibiotics doesn't really do much and that

> > > shorter

> > > > > courses of treatment work just as well as the long courses.

> We

> > > find

> > > > > that conservative treatment (see my newsletter article,

> > Treatment

> > > > Of

> > > > > Respiratory Infections Without Antibiotics, Vol. 2, Issue

2)

> is

> > > > more

> > > > > effective than antibiotics for chronic sinusitis.

> > > > > > It's good that medicine is finally starting to catch up

> with

> > > > > reality. The report in The Mayo Clinic Proceedings noted

> > > > > that, " fungus allergy was thought to be involved in less

than

> > 10%

> > > > of

> > > > > cases… our studies indicate, in fact, fungus is likely the

> > cause

> > > of

> > > > > nearly all of these problems and that it is not an allergic

> > > > reaction

> > > > > but an immune reaction. " In this study, the researchers

> studied

> > > 210

> > > > > patients with chronic sinusitis. Using new methods to

collect

> > and

> > > > > test sinus/nasal mucus they found fungus in 96% of

patients.

> > > > > > It's interesting to observe how medical research works.

The

> > > > > researchers are now working with different drug companies

to

> > set

> > > up

> > > > > trials to test medications to control the fungus but feel

> that

> > it

> > > > > will be at least two years before any treatments will be

> > > available.

> > > > > In my experience, though, these problems often respond

> > > dramatically

> > > > > to either Sporanox or Diflucan - which, by no coincidence,

> are

> > > very

> > > > > powerful antifungal agents. It is not clear why the

> researchers

> > > did

> > > > > not simply try Sporanox or Diflucan. Un-fortunately, we

find

> > that

> > > > the

> > > > > obvious is often overlooked. This sometimes occurs as drug

> > > > companies

> > > > > seek to make more money by finding new drugs instead of

using

> > the

> > > > old

> > > > > things that are known to work. It is important to

distinguish

> > > > between

> > > > > chronic sinusitis (which lasts for over three months) and

> acute

> > > > > sinusitis (which usually has been going on for a few days

and

> > > less

> > > > > than a month). For these shorter attacks of sinusitis,

> bacteria

> > > are

> > > > a

> > > > > more common cause and antibiotics (combined with n

> > > > > > atural remedies) can be helpful. Some researchers still

> > > continue

> > > > to

> > > > > argue that fungus is not a cause of chronic sinusitis. They

> > note

> > > > that

> > > > > fungi are seen even in healthy noses (which is correct) but

> > > neglect

> > > > > to discuss the immune changes that are also seen in these

> > noses.

> > > > > Because so many people have responded dramatically to

> > antifungals

> > > > in

> > > > > the treatment of their chronic sinusitis, my suspicion is

> that

> > > the

> > > > > Mayo Clinic researchers are probably correct. Wouldn't it

be

> > > nice,

> > > > if

> > > > > instead of arguing about treatments while people stay sick,

> > they

> > > > > would just try the treatments to see if they worked!

> > > > > > As you can see, your body's defenses being down plays a

> large

> > > > role

> > > > > in CFIDS/FMS. The good news is, that by treating the many

> > > > underlying

> > > > > infections common in CFIDS patients and by treating any

> > hormonal

> > > > and

> > > > > nutritional deficiencies, you can bring your immune system

> back

> > > to

> > > > a

> > > > > healthy state!

> > > > > > Important Points

> > > > > > • An important component of CFS is disordered immune

> > function,

> > > > > which opens the door to repeated infections, repeated

> treatment

> > > > with

> > > > > antibiotics, and yeast overgrowth.

> > > > > > • Treat yeast overgrowth by avoiding antibiotics and

> sweets.

> > > Many

> > > > > patients have found Nystatin and other antifungal

> medications,

> > > such

> > > > > as Diflucan and Sporanox, to be helpful. Acidophilus (milk

> > > > bacteria)

> > > > > and natural antifungals such as Caprylic acid and garlic

are

> > also

> > > > > often useful.

> > > > > > • Bowel parasites are common in CFS patients, whose

> symptoms

> > > > often

> > > > > respond dramatically to treatment. However, most labs do

not

> > > > > adequately detect parasites through stool testing. To get

an

> > > > accurate

> > > > > test result, use one of the labs we recommended that

> > specializes

> > > in

> > > > > stool testing.

> > > > > > • Treat Cryptosporidium with Artemesia annua or tricyclin

> > > (herbal

> > > > > antiparasitics).

> > > > > > • Treat constipation with Turkey Rhubarb (a herb).

> > > > > > • Prevent parasitic infection by using a Multi-pure water

> > > filter

> > > > > (available from 888-801-8176 or 410-224-4877)

> > > > > > • If you have temperatures over 98.6°F and/or chronic

lung

> > > > > congestion, try long-term Cipro or Doxycycline (while on

> > > Nystatin).

> > > > > > • If you have chronic flu-like symptoms, despite yeast

and

> > > Cortef

> > > > > treatment, consider the antiviral, immune stimulating

> protocol

> > we

> > > > > discussed.

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Hi PH- I hear ya on too many cooks in the kitchen! I'm glad you are

seeing Dr. Mercola. I might just have to cave and talk hubby into

letting me see a naturopath. I know he's going to drag his feet on

it, so I'm going to have to be clever about the way I present the

idea to him. If I can talk him into it, I'm going to hold off on

purchasing any supplements for now. Maybe that's how I'll present it

to him....either I can keep guessing on which supplements to buy, or

just see a naturopath who will recommend the right supplements. :-)

Love, Krista

> > > > > > >

> > > > > > > From Fatigued to Fantastic Newsletter

> > > > > > > Vol. 3, No. 3 (2000)--Vol 4, No. 1 (2001)

> > > > > > >

> > > > > > > Fighting Those Persistent Infections in CFIDS

> > > > > > > By Teitelbaum, M.D.

> > > > > > > Medical science has known for quite some time that

> Chronic

> > > > > Fatigue

> > > > > > Syndrome is associated with changes in the body's immune

> > > system.

> > > > In

> > > > > > fact, the acronym " CFIDS " stands for " Chronic Fatigue And

> > > Immune

> > > > > > Dysfunction Syndrome. " This can result in your having

> several

> > > > > > different and unusual infections at one time. Many of

these

> > > > > > infections need to be treated directly. Other infections

> will

> > > go

> > > > > away

> > > > > > on their own as your immune (defense) system comes

back " on

> > > line "

> > > > > by

> > > > > > using our treatment protocol. In this article, I'll

discuss

> > > some

> > > > of

> > > > > > the more common, yet not usually thought of (in " regular "

> > > > > medicine),

> > > > > > infections.

> > > > > > > What Kind Of Infections Am I Most At Risk For?

> > > > > > > Although CFIDS of sudden onset often seems to be

> triggered

> > by

> > > > > viral

> > > > > > infections (e.g., EBV, HHV-6, CMV), those infections, I

> > > suspect,

> > > > > > are " simmering " or no longer active in many cases.

However,

> > the

> > > > > body

> > > > > > acts as if they are. This may result in elevated

interferon

> > > > levels.

> > > > > I

> > > > > > suspect this was what triggered my CFIDS.

> > > > > > > The body produces interferon to fight viral infections.

> > When

> > > a

> > > > > > cancer or hepatitis patient is injected with interferon,

> the

> > > > > patient

> > > > > > becomes achy, fatigued and brain-fogged. An under-active

> > > adrenal

> > > > > can

> > > > > > also cause interferon levels to become elevated. Because

of

> > > this

> > > > > > elevation, it is more accurate to say that the body's

> immune

> > > > system

> > > > > > is not functioning properly, than to say that it is

> > > underactive.

> > > > > > Indeed, in many ways, the immune system may be in

overdrive

> > and

> > > > > soon

> > > > > > exhaust itself. The immune system malfunctions in many

> other

> > > > ways,

> > > > > > too, including decreasing the effectiveness of the

> > > > body's " natural

> > > > > > killer " cells, which are an important defense mechanism.

> > > > > > > Many other recurrent or unusual infections can also

occur

> > > > because

> > > > > > of your malfunctioning immune system. Chronic sinus,

> bladder,

> > > > > > prostate and respiratory infections are common and are

> often

> > > > > treated

> > > > > > with repeated courses of antibiotics. The large amount of

> > > > > antibiotics

> > > > > > introduced into the system can cause a secondary yeast

over-

> > > > growth

> > > > > as

> > > > > > it changes the natural balance between the bowel's

healthy

> > > > bacteria

> > > > > > and yeast. The original immune dysfunction also

contributes

> > to

> > > > the

> > > > > > yeast overgrowth. Although it is controversial, a theory

> held

> > > by

> > > > > many

> > > > > > physicians is that chronic overgrowth of yeast due to

> overuse

> > > of

> > > > > > antibiotics is a potential and strong trigger for chronic

> > > > fatigue,

> > > > > > fibromyalgia and further immune dysfunction. What makes

the

> > > > theory

> > > > > > controversial is that no definitive tests exist to

> > distinguish

> > > > > fungal

> > > > > > overgrowth from normal fungal levels. Also, many of the

> > > symptoms

> > > > > > ascribed to yeast overgrowth can also come from the many

> > other

> > > > > > problems present in chronic fatigue syndrome and fibromya

> > > > > > > lgia. On the other hand, most doctors who try treating

> > yeast

> > > in

> > > > > at

> > > > > > least three or four CFS patients see how well it works

and

> > keep

> > > > > using

> > > > > > it.

> > > > > > > CFIDS patients also frequently have bowel parasite

> > > infections.

> > > > > > Bowel parasites can cause severe allergic or sensitivity

> > > > reactions,

> > > > > > which in turn can trigger fibromyalgia and fatigue.

Often,

> a

> > > > > patient

> > > > > > will finally recover from long-standing and disabling

> fatigue

> > > > > within

> > > > > > a week or two after beginning treatment for bowel

parasites.

> > > > > > > Many other CFS/FMS patients are left with disabling

> fatigue

> > > > after

> > > > > a

> > > > > > bout with viral infections such as polio, HHV-6, CMV, or

EB

> > > viral

> > > > > > infections. This fatigue also usually responds to the

> > > treatments

> > > > > > discussed in this newsletter. In addition, infections

with

> > > > unusual

> > > > > > organisms such as Rickettsia (e.g., Lymes Disease),

> > chlamydia,

> > > > and

> > > > > > mycoplasma may also be problematic.

> > > > > > > Yeast Overgrowth

> > > > > > > Everyone's immune system has strong spots, as well as

> weak

> > > > spots.

> > > > > > Some people never get colds but have frequent bouts with

> > > > athlete's

> > > > > > foot or other skin fungal infections. Others never get

> fungal

> > > > > > infections but tend to get colds. Many people seem to

have

> a

> > > > > > diminished ability to fight off fungal infections.

> > > > > > > Fungi are very complex organisms. Fungal overgrowth may

> > > > suppress

> > > > > > the body's immune system. The host body may also develop

> > > allergic

> > > > > > reactions to components of the yeast.

> > > > > > > This allergic reaction was suggested in a study which

> > > connects

> > > > > > Candida Albicans with Allergic Skin Dermatitis (Eczema).

> This

> > > > study

> > > > > > was published in The Journal of Clinical Experimental

> Allergy

> > > > back

> > > > > in

> > > > > > 1993 (Vol. 23, pp. 332-339). It found that there is a

> > > significant

> > > > > > correlation between the body having antibodies to Candida

> and

> > > > > > Allergic Dermatitis/Eczema. In addition, we have found

that

> > > > > > unexplained rashes that have lasted for many years often

> > clear

> > > up

> > > > > > with antifungal treatment as well! Many physicians feel

> that

> > > > yeast

> > > > > > overgrowth causes a generalized suppression of the immune

> > > system.

> > > > > In

> > > > > > other words, once the yeast gets the upper hand, it sets

up

> a

> > > > cycle

> > > > > > that further suppresses your body's defenses.

> Interestingly,

> > a

> > > > > recent

> > > > > > Mayo Clinic study showed that most cases of chronic

> sinusitis

> > > > seem

> > > > > to

> > > > > > be associated with a reaction to yeast in the sinuses -

> > > something

> > > > I

> > > > > > proposed years ago. None the less, as I already noted,

this

> > > > theory

> > > > > is

> > > > > > controversial. Yeast are normal members of our

body's " zoo.

> > > > > > > " They live in balance with bacteria - some of which

are

> > > > helpful

> > > > > > and healthy and some of which are detrimental and

> unhealthy.

> > > The

> > > > > > problems begin when this harmonious balance shifts and

the

> > > yeast

> > > > > > begin to overgrow.

> > > > > > > As noted above, many things can prompt yeast to

overgrow.

> > One

> > > > of

> > > > > > the most common causes is frequent antibiotic use. When

the

> > > good

> > > > > > bacteria in the bowel are killed off by antibiotics

(along

> > with

> > > > the

> > > > > > bad bacteria) the yeast no longer have competition and

> begin

> > to

> > > > > > overgrow. The body is often able to rebalance itself

after

> > one

> > > or

> > > > > > several courses of antibiotics, but after repeated or

long-

> > term

> > > > > > courses - and especially if the body has an underlying

> immune

> > > > > > dysfunction - the yeast can get the upper hand.

> > > > > > > Other factors are also important. Studies have shown

that

> > > > animals

> > > > > > who are sleep deprived and/or have increased sugar intake

> > > develop

> > > > > > bowel yeast overgrowth. Many physicians feel that eating

> > sugar

> > > > > > stimulates yeast overgrowth in people, as well. Sugar is

> food

> > > for

> > > > > > yeast. Yeast ferment sugar in order to grow and multiply.

> > Yeast

> > > > > > overgrowth due to sugar overuse also seems to cause

immune

> > > > > > suppression, which facilitates bacterial infections,

which

> > then

> > > > > > requires even more antibiotic use. Poor sleep also

results

> in

> > > > > marked

> > > > > > suppression of your immune function.

> > > > > > > How Does One Know If They Have Yeast?

> > > > > > > There are no definitive tests for yeast overgrowth that

> > will

> > > > > > distinguish yeast overgrowth from normal yeast growth in

> the

> > > > body.

> > > > > > There is one test which may be useful, though. This is a

> > Urine

> > > > > > Tartaric Acid test done by The Great Plains Lab in Kansas

> > City,

> > > > > > Missouri, run by Shaw, Ph.D. Tartaric Acid is a

> waste

> > > > > product

> > > > > > of yeast growth. In fermenting wine, for example, it is

> > > critical

> > > > to

> > > > > > remove the Tartaric Acid. Otherwise, the wine could be

> toxic

> > to

> > > > > > people. Dr. Shaw has found elevations in Urine Tartaric

> Acid

> > > that

> > > > > > decrease with antifungal treatment in both CFIDS/FMS

> patients

> > > and

> > > > > > autistic children. Interestingly, both these illnesses

> often

> > > > > improve

> > > > > > with antifungals (specifically, Sporanox or Diflucan,

plus

> > > > > Nystatin).

> > > > > > Dr. Shaw likes to use the Urine Tartaric Acid to decide

> when

> > to

> > > > > treat

> > > > > > yeast overgrowth and to follow-up the effectiveness of

> > > treatment.

> > > > > > > In my experience, however, using Dr. Crook's Yeast

> > > > Questionnaire

> > > > > > (available in my book, From Fatigued To Fantastic!) is

> still

> > > the

> > > > > most

> > > > > > reliable way to tell if a person is at risk of yeast

> > > overgrowth.

> > > > If

> > > > > > the symptom score is over 140 points, I recommend

> treatment.

> > In

> > > > > > addition, anyone who has been on recurrent or long-term

> > > > antibiotic

> > > > > > use (especially Tetracycline for acne) or anyone who

> > > > intermittently

> > > > > > has painful sores in different parts of the mouth that

last

> > for

> > > > > about

> > > > > > ten days at a time and who has CFIDS/FMS, should be

treated

> > > with

> > > > > > antifungals. Bowel symptoms are some of the more overt

> > symptoms

> > > > > that

> > > > > > are caused by yeast and I feel that most people who

> > > have " spastic

> > > > > > colon " have yeast overgrowth or parasites.

> > > > > > > How Is Yeast Treated?

> > > > > > > A number of very effective methods can be utilized to

> take

> > > care

> > > > > of

> > > > > > a yeast problem. Primary among the methods is to avoid

> sugar

> > > and

> > > > > > other sweets. One can enjoy one or two pieces of fruit a

> day,

> > > but

> > > > > > should not consume concentrated sugars such as juices,

corn

> > > > syrup,

> > > > > > jellies, pastry, candy or honey. Stay far away from soft

> > > drinks,

> > > > > > which have ten to twelve teaspoons of sugar in every

twelve

> > > > ounces.

> > > > > > This amount of sugar has been shown to markedly suppress

> > immune

> > > > > > function for several hours. Be pre-pared to have

withdrawal

> > > > > symptoms

> > > > > > for about one week when sugar is cut out of the diet.

> Several

> > > > > > excellent books have been written on the yeast

controversy

> > and

> > > > > offer

> > > > > > additional methods to try. One of the best books is The

> Yeast

> > > > > > Connection and the Woman by Crook, M.D., a

> physician

> > > who

> > > > > has

> > > > > > done a spectacular job advancing the understanding of

> > CFIDS/FMS.

> > > > > > > Many patients have found that acidophilus (that is,

milk

> > > > > bacteria,

> > > > > > a healthy bacteria for the bowel) helps restore balance

in

> > the

> > > > > bowel.

> > > > > > Acidophilus is found in yogurt with live and active

yogurt

> > > > > cultures.

> > > > > > Indeed, one cup of yogurt a day can markedly diminish the

> > > > frequency

> > > > > > of recurrent vaginal yeast infections. Acidophilus is

also

> > > > > available

> > > > > > in capsule form. Although many claims are made for one

type

> > of

> > > > > > acidophilus being better than the other, I'm not sure

this

> is

> > > so.

> > > > I

> > > > > > usually recommend 3 to 6 billion units a day (1 unit = 1

> > > > bacteria)

> > > > > on

> > > > > > an empty stomach. If on antibiotics (not antifungals),

take

> > the

> > > > > > acidophilus at least 3 to 6 hours away from the

antibiotic

> > > dose.

> > > > > > > Nystatin, an antifungal medication, has also been

helpful

> > in

> > > > the

> > > > > > treatment of yeast overgrowth. Unfortunately, some fungi

> seem

> > > to

> > > > be

> > > > > > resistant to Nystatin. In addition, Nystatin is poorly

> > > absorbed,

> > > > > > which means that it has little impact on the yeast

outside

> of

> > > the

> > > > > > bowel. Other anti-fungal medications, such as Diflucan

and

> > > > > Sporanox,

> > > > > > seem to be effective systemically (throughout the body)

but

> > > they

> > > > > have

> > > > > > two main drawbacks. First, they are expensive, costing

more

> > > than

> > > > > $450

> > > > > > to $900 for a two-month course. Second, any effective

anti-

> > > fungal

> > > > > can

> > > > > > initially make the symptoms of yeast infection worse.

> > Although

> > > > > > uncommon, Sporanox and Diflucan can also cause liver

> > > inflammation

> > > > > (as

> > > > > > can Advil and Tylenol). If you are taking Sporanox or

> > Diflucan

> > > > for

> > > > > > more than 6 to 12 weeks, I would consider intermittently

> > > checking

> > > > > > liver blood tests (ALT and AST). If you have preexisting

> > active

> > > > > liver

> > > > > > disease, be cautious in using (or don't use) Sporanox or

> > > > Diflucan.

> > > > > I

> > > > > > strongly recommend taking Lipoic Acid (a natural

> > > > > > > supplement which protects and helps heal the liver),

> 200mg

> > a

> > > > > day,

> > > > > > whenever you take Sporanox or Diflucan. I also strongly

> > > recommend

> > > > > > Lipoic Acid for anyone with active liver disease (e.g.,

> > > > hepatitis)

> > > > > at

> > > > > > doses up to 1000mg to 3000mg a day as it may prevent

and/or

> > > treat

> > > > > > cirrhosis.

> > > > > > > Natural Yeast Treatments

> > > > > > > Below, I have summarized the nonprescription part of

the

> > > > > treatment

> > > > > > checklist that I use in my office.

> > > > > > > 1. Avoiding sweets is still the single most important

> > thing.

> > > > > Using

> > > > > > Stevia as a sweetener is a wonderful substitute. Stevia

is

> a

> > > > safe,

> > > > > > natural remedy and you can use all you want. There are

even

> > > > > cookbooks

> > > > > > for using Stevia (available from my office or 800-

4STEVIA).

> A

> > > new

> > > > > > natural sweetner, Sweet Balance, also tastes good and is

12

> > > times

> > > > > as

> > > > > > sweet as sugar. It is a natural product from the Lo Han

> fruit

> > > and

> > > > > > appears to be safe. Although it is 70% sugar (fructose),

> you

> > > only

> > > > > > need a small amount. Order it from 877-997-9338, my

office

> at

> > > 800-

> > > > > 333-

> > > > > > 5287 or my Web site at www.endfatigue.com.

> > > > > > > 2. Acidophilus or Milk Bacteria can be very helpful.

Take

> 3

> > > to

> > > > 6

> > > > > > billion units a day (a unit is the same as a bacteria).

Do

> > not

> > > > take

> > > > > > acidophilus within 3 to 6 hours of an antibiotic. Take it

> > > either

> > > > on

> > > > > > an empty stomach or with milk.

> > > > > > > 3. Caprylic Acid is another natural remedy that can be

> > > helpful.

> > > > > The

> > > > > > usual dose is 1800 to 3600mg a day with 1/3 of the dose

> being

> > > > taken

> > > > > > at each meal. Unfortunately, it often causes an acid

> stomach

> > > with

> > > > > > a " funky " tasting reflux.

> > > > > > > 4. Oregano Oil - enteric coated oregano oil - 1 to 2

> > > capsules,

> > > > 2

> > > > > to

> > > > > > 3 times a day with food, may be more effective and better

> > > > tolerated

> > > > > > than Caprylic Acid (both can cause stomach acid reflux).

> > > > > > > 5. Fresh Garlic, if you can handle it well, can also be

> > very

> > > > > > effective. Daily, crush 1 to 3 garlic cloves in olive

oil,

> > add

> > > > > salt,

> > > > > > spread it on bread and eat it. It can be quite tasty and

> > lethal

> > > > to

> > > > > > whatever infections you have in your gut.

> > > > > > > 6. Olive Leaf 500mg, 2 to 4 capsules three times a day

> > > between

> > > > > > meals, can also be very helpful in treating yeast

> overgrowth.

> > > > > > > 7. Pau De Arco in either tea or capsule form is also

> > helpful

> > > in

> > > > > > yeast suppression. Although I use Pau De Arco

infrequently

> > for

> > > > > yeast

> > > > > > over-growth, many people find that it can be helpful.

> > > > > > > 8. Grapefruit Seed Extract (e.g., Citrucidel) is a

> popular

> > > > > > treatment for yeast overgrowth and is well-tolerated.

> > > > > > > More Information On Yeast Treatments

> > > > > > > If symptoms of yeast are caused by an allergic or

> > sensitivity

> > > > > > reaction to the yeast body parts, the symptoms may flare

> when

> > > > mass

> > > > > > quantities of the yeast are suddenly killed off. This is

> > called

> > > a

> > > > > > yeast " die-off " reaction. If you get this reaction, start

> > your

> > > > > > treatment with acidophilus and a sugar-free diet for a

few

> > > weeks

> > > > > > followed by oregano oil and/or olive leaf (1500mg to

> 2000mg,

> > 3

> > > > > times

> > > > > > a day between meals) before beginning Nystatin. Take

> Nystatin

> > > (by

> > > > > > mouth) in the form of 500,000-IU tablets or powder. I

> > generally

> > > > > > recommend beginning with 1 tablet a day for 1 to 3 days,

> and

> > > > > > increasing by 1 tablet every 1 to 3 days (or slower if

> > > yeast " die-

> > > > > > off " is a problem) until 2 tablets 2 to 4 times a day is

> > > reached.

> > > > > If

> > > > > > you get nausea, take a lower dose. Take Nystatin, 4 to 8

> > > tablets

> > > > > > daily, for 5 to 8 months. I add the Diflucan or Sporanox

> one

> > > > month

> > > > > > after beginning the Nystatin. Take 200mg every morning

for

> > six

> > > > > weeks.

> > > > > > If symptoms flare, take just 100mg per morning for the

> first

> > 3

> > > to

> > > > > 14

> > > > > > days. I

> > > > > > > f symptoms recur after stopping the Diflucan or

Sporanox,

> I

> > > > > > recommend continuing the medication for an additional 6

> weeks

> > > at

> > > > > > 200mg a day.

> > > > > > > Sporanox should be taken with food. If it is taken

alone,

> > its

> > > > > > absorption is greatly reduced. When taking Diflucan or

> > > Sporanox,

> > > > DO

> > > > > > NOT use the antihistamines Seldane or Hismanal, Quinidine

> (a

> > > > heart

> > > > > > medicine), cholesterol-lowering medications in the

Mevacor

> > > > family,

> > > > > or

> > > > > > the bowel medicine Propulcid. These can be fatal

> > combinations!

> > > > > Also,

> > > > > > antacid medications (such as Tagamet, Axid, Zantac, and

> > Pepcid)

> > > > > > prevent the proper absorption of Sporanox. At the high

> price

> > of

> > > > > > Sporanox per dose, you will want to absorb every last bit

> of

> > > the

> > > > > > medication. If you need to be on an antacid medication,

use

> > > > > Diflucan

> > > > > > instead of Sporanox. Unfortunately, a less expensive

> > > antifungal,

> > > > > > called Lamisil (at 250mg a day), does not seem to work

very

> > > well

> > > > > for

> > > > > > candida yeast overgrowth (although it works well for nail

> > > > > > infections). I am currently trying patients on 500mg of

> > Lamisil

> > > a

> > > > > day

> > > > > > to see if this dose works better.

> > > > > > > I feel that once the yeast has been effectively

decreased

> > and

> > > > > kept

> > > > > > that way for six to twelve months, it is safe to try to

add

> > > small

> > > > > > amounts of sugar back into the diet. If symptoms recur,

> > > however,

> > > > > stop

> > > > > > the sugar again. Continuing to eat yogurt with live and

> > active

> > > > > > acidophilus cultures (unless you are lactose-intolerant)

or

> > > > > > continuing to take acidophilus capsules may also help.

> > > > > > > Many books on yeast overgrowth (including Dr. Crook's)

> > advise

> > > > > > readers to avoid all yeast in the diet. This advice is

> based

> > on

> > > > the

> > > > > > theory that an allergic reaction to yeast is the cause of

> the

> > > > > > problem. The predominant yeast that seems to be involved

in

> > > yeast

> > > > > > overgrowth is Candida Albicans, although I would not be

> > > surprised

> > > > > if

> > > > > > researchers discovered that many other kinds of fungal

> > > infections

> > > > > are

> > > > > > also involved. The yeast that is found in most foods

> (except

> > > beer

> > > > > and

> > > > > > cheese) is not closely related to candida.

> > > > > > > In my experience, trying to avoid all yeast in foods

> > results

> > > > > simply

> > > > > > in a nutritionally inadequate diet and little benefit.

> > Although

> > > a

> > > > > few

> > > > > > people do appear to have true allergies to the yeast in

> their

> > > > food,

> > > > > > they number less than 10 percent of my patients with

> > suspected

> > > > > yeast

> > > > > > overgrowth. These patients may benefit from the more

strict

> > > diet

> > > > in

> > > > > > Dr. Crook's book. Interestingly, once their adrenal

> > > insufficiency

> > > > > and

> > > > > > yeast overgrowth are treated, most people find that their

> > > > allergies

> > > > > > and sensitivities to yeast and other food products seem

to

> > > > improve

> > > > > or

> > > > > > disappear.

> > > > > > > Nutritional deficiencies such as low zinc or low

selenium

> > may

> > > > > also

> > > > > > decrease resistance to yeast over-growth. A good

> multivitamin

> > > > > > supplement, as recommended in my last newsletter, should

> take

> > > > care

> > > > > of

> > > > > > these deficiencies. This is further evidence that all the

> > > factors

> > > > > > involved in CFS are closely interrelated.

> > > > > > > The best thing that one can do to combat yeast

overgrowth

> > is

> > > to

> > > > > try

> > > > > > to avoid it in the first place. When you get an

infection,

> > > begin

> > > > > > treating it naturally immediately. Hopefully, you can

> prevent

> > > it

> > > > > from

> > > > > > turning into a bacterial infection which might require an

> > > > > antibiotic.

> > > > > > Ask your doctor what measures you can take before

resorting

> > to

> > > > > > antibiotics. Many good over-the-counter remedies are

> > available.

> > > A

> > > > > > knowledgeable pharmacist may also be a wealth of

> information.

> > > > Your

> > > > > > local book or health food store has books on natural

> > measures.

> > > > Your

> > > > > > health food store proprietor can also steer you to

> > appropriate

> > > > > > natural remedies. For examples of the many helpful

measures

> > > that

> > > > > one

> > > > > > can take, see my newsletter article, Treating Infections

> > > Without

> > > > > > Antibiotics, page ___).

> > > > > > > If you find however, that you must take an antibiotic,

> all

> > is

> > > > not

> > > > > > lost. One can still lessen the severity of yeast

overgrowth

> > by

> > > > > > avoiding sweets and by either taking acidophilus capsules

> > > (again,

> > > > > not

> > > > > > within 3 to 6 hours of an antibiotic) or by eating one

cup

> of

> > > > > yogurt

> > > > > > with live and active acidophilus cultures daily. Don't

use

> > the

> > > > > yogurt

> > > > > > (or milk) if you have sinusitis or pneumonia because the

> milk

> > > > > protein

> > > > > > thickens mucus and makes it hard for the body to fight

> these

> > > > > > infections.

> > > > > > > How Can One Tell If The Yeast Is Coming Back?

> > > > > > > It is normal for yeast symptoms to resolve after

> treatment.

> > > > After

> > > > > 6

> > > > > > weeks on the Sporanox or Diflucan, patients are usually

> > feeling

> > > a

> > > > > lot

> > > > > > better, but may have symptoms recur soon after stopping

the

> > > > > > antifungal. In this case I would continue the Sporanox or

> > > > Diflucan

> > > > > > for another 6 weeks, or as long as is needed, to keep the

> > > > symptoms

> > > > > at

> > > > > > bay. More frequently, people will feel better after

> treatment

> > > and

> > > > > > stay feeling fairly well for a period of 6 to 24 months.

At

> > > that

> > > > > > time, it is common to see a recurrence of symptoms,

> > especially

> > > if

> > > > > one

> > > > > > is eating too much sugar or is taking antibiotics. The

best

> > > > marker

> > > > > > that I have found for yeast overgrowth would be a return

of

> > > bowel

> > > > > > symptoms with gas, bloating and/or diarrhea or

> constipation.

> > If

> > > > > these

> > > > > > symptoms persist for more than 2 weeks, especially if

there

> > is

> > > > also

> > > > > > even a mild worsening of the FMS symptoms, it is very

> > > reasonable

> > > > to

> > > > > > retreat yourself with 6 weeks of Nystatin and perhaps

> > Sporanox

> > > or

> > > > > > Diflucan. In addition, I would also retreat if there's

> > > > > > > a recurrence of vaginal yeast or sinus infections. If

re-

> > > > > treatment

> > > > > > resolves the symptoms, one may opt to repeat this regimen

> as

> > > > often

> > > > > as

> > > > > > is needed (usually every 6 to 24 months). By using some

of

> > the

> > > > > > natural remedies listed above, however, you may be able

to

> > > avoid

> > > > > > repeated use of these antifungals and the possible risk

of

> > > > becoming

> > > > > > resistant to them. Some patients also find that they need

> to

> > > stay

> > > > > on

> > > > > > the antifungals for extended periods of time (years) or

the

> > > > > symptoms

> > > > > > will recur. When this is necessary, I add the natural

> > remedies.

> > > I

> > > > > > will, however, also use the medications when needed. The

> main

> > > > risk

> > > > > of

> > > > > > long-term use of the antifungals Sporanox and Diflucan

> would

> > be

> > > > > liver

> > > > > > inflammation. If these medications are being used for

> > extended

> > > > > > periods, consider checking liver tests (SGOT and SGPT)

> every

> > 3

> > > to

> > > > 6

> > > > > > months and anytime that a severe flu-like feeling or

> > worsening

> > > of

> > > > > > symptoms occur. As noted above, it is very important to

> take

> > > > Lipoic

> > > > > > Acid 200mg a day when on Sporanox or Diflucan. Althoug

> > > > > > > h I am not aware of any studies using Lipoic Acid with

> > > > > antifungals,

> > > > > > in my experience I have seen no worrisome elevation on

> liver

> > > > tests

> > > > > if

> > > > > > patients are using this natural substance while taking

> these

> > > > > > antifungals. As an alternative, instead of taking the

> > > antifungals

> > > > > > every day, many people find they can get long-term

> > suppression

> > > of

> > > > > the

> > > > > > yeast by taking Sporanox or Diflucan 200mg twice a day,

one

> > day

> > > > > each

> > > > > > week (e.g., each Sunday).

> > > > > > > Help For Chronic Bladder Infections

> > > > > > > Although we will be discussing some unusual infections,

> > > > CFIDS/FMS

> > > > > > patients also get more of the day-to-day variety of

> > infections.

> > > > > These

> > > > > > include Urinary Tract (bladder) Infections (UTI). The

main

> > > > symptoms

> > > > > > of a UTI are discomfort (e.g., burning) when urinating

> > > (dysuria),

> > > > > > urgency (which is the feeling that you have to go very

> badly

> > > and

> > > > > > right away when there is not much urine there), and

> frequency

> > > > with

> > > > > > low volume. These symptoms are also common in CFIDS/FMS

> > > patients

> > > > in

> > > > > > the absence of bladder infections and, when severe, is

> called

> > > > > > Interstitial Cystitis. I would not label someone as

having

> > > > > > Interstitial Cystitis unless this is the major symptom of

> > their

> > > > > > CFIDS/FMS, because almost everyone with this illness has

> some

> > > > > urinary

> > > > > > urgency and frequency. Because bladder symptoms can be

seen

> > in

> > > > both

> > > > > > UTI and CFIDS/FMS, it is important to have a urine

culture

> > done

> > > > > > before treatment with antibiotics to make sure that there

> is

> > an

> > > > > > infection and not just muscle spasms in the bladder that

> are

> > > > > causing

> > > > > > these

> > > > > > > symptoms. If there is an infection, over 90% of the

time

> it

> > > > will

> > > > > be

> > > > > > E-coli. This bacteria is normally found in everyone's gut

> > and,

> > > > with

> > > > > > the exception of a few rare dangerous forms, is a healthy

> > part

> > > of

> > > > > our

> > > > > > normal bowel bacteria. The problem occurs when the E-coli

> > gets

> > > > out

> > > > > of

> > > > > > the bowel where it belongs and into the bladder. Usually

> the

> > > > > bladder

> > > > > > will wash out most infections when the urine comes out.

The

> E-

> > > > coli

> > > > > > however, have little velcro-like projections that stick

to

> > the

> > > > > > bladder wall so that they can not be washed out by

> urination.

> > > > > > > Taking antibiotics will kill a bladder infection but

will

> > > also

> > > > > kill

> > > > > > the healthy bacteria in the bowel. This sets one up for

> yeast

> > > > > > overgrowth and other problems. Because of this, unless

> there

> > is

> > > > > fever

> > > > > > or back pain over the kidneys or a toxic feeling, it is

> > > > reasonable

> > > > > to

> > > > > > try natural remedies for one to three days before going

> with

> > > the

> > > > > > antibiotics. One can start these treatments while waiting

> for

> > > the

> > > > > > urine culture to come back.

> > > > > > > What Natural Remedies Can Be Used For Bladder

Infections?

> > > > > > > There are two excellent natural remedies that can keep

> the

> > E-

> > > > coli

> > > > > > from sticking to the bladder walls so they can be washed

> out.

> > > In

> > > > > > addition, taking vitamin C in high dose (e.g., 500 to

> 5000mg

> > a

> > > > day)

> > > > > > can acidify the urine, making it inhospitable to the

> > bacteria.

> > > > > > Drinking a lot of water also helps to wash out the

> infection.

> > > > > > > The two natural remedies that keep the bacteria from

> > sticking

> > > > are:

> > > > > > > 1. Cranberries—Because approximately 20% of the female

> > > > population

> > > > > > suffers from UTIs, several studies have been done looking

> at

> > > this

> > > > > > remedy. An early study of 44 female and 16 male patients

> with

> > > > acute

> > > > > > bladder infections drank 16 oz. of cranberry juice a day

> for

> > 15

> > > > > days.

> > > > > > Of these patients, 53% had positive responses and another

> 20%

> > > > > showed

> > > > > > modest improvement. Six weeks after stopping the juice,

27

> > > > patients

> > > > > > did have persistent recurrent infections and 8 of these

had

> > no

> > > > > > symptoms. Seventeen patients had no symptoms and negative

> > urine

> > > > > > cultures.

> > > > > > > In another study of elderly women (who are more likely

to

> > > have

> > > > > > bladder infections), 153 women either received 10 oz. of

> > > > cranberry

> > > > > > drink or placebo every day for 6 months. The group that

got

> > the

> > > > > > cranberry drink had 68% fewer bladder infections during

> that

> > > > > period.

> > > > > > In this study, the juice was sweetened with saccharin

> instead

> > > of

> > > > > > sugar. Other studies have also shown benefit using

> cranberry

> > > > juice

> > > > > in

> > > > > > bladder infections.

> > > > > > > Significant benefits are achieved by using 6 to 16 oz.

of

> > > > > cranberry

> > > > > > juice a day. Because cranberry juice has a lot of sugar

and

> > can

> > > > > > promote yeast overgrowth and aggravate other symptoms in

> > > > CFIDS/FMS,

> > > > > I

> > > > > > think it is much better to use pure cranberry juice

powder

> in

> > > > > capsule

> > > > > > or tablet form (standardized to contain 11% to 12% quinic

> > > acid).

> > > > > The

> > > > > > therapeutic dose is 1 to 2 capsules a day. Conversely,

you

> > can

> > > > use

> > > > > > unsweetened cranberry juice and add Stevia as a natural

> > > > sweetener.

> > > > > In

> > > > > > general, if one gives the usual cranberry juice cocktails

a

> > > > > strength

> > > > > > of 1 unit - then, cranberry juice drinks have a strength

of

> > ½;

> > > > > > cranberry sauce a strength of ½; fresh or frozen

> cranberries

> > > are

> > > > 4

> > > > > > times as potent; pure cranberry juice is 4 times as

potent;

> > and

> > > > > > cranberry juice capsules from unsweetened cranberry juice

> > > powders

> > > > > are

> > > > > > 32 times as potent.

> > > > > > > Cranberries work to help bladder infections because

they

> > have

> > > a

> > > > > > chemical (proanthocyanidins) that prevents the bacteria

> from

> > > > > sticking

> > > > > > to the bladder wall. They may also decrease the risk of

> > kidney

> > > > > stones

> > > > > > (although magnesium with B6 is much better for this), as

> well

> > > as

> > > > > > possibly reduce urine odor.

> > > > > > > D-Mannose - This is more effective than cranberry

juice.

> > > > Mannose

> > > > > is

> > > > > > a natural sugar (not the kind that causes symptoms or

yeast

> > > > > > overgrowth) that is excreted promptly into the urine.

> > > > Unfortunately

> > > > > > for the E-coli bacteria, the fingers that stick to the

> > bladder

> > > > wall

> > > > > > stick to the D-Mannose even better. When one takes a

large

> > > amount

> > > > > of

> > > > > > D-Mannose, it spills into the urine, coating all the E-

> coli's

> > > > > > little " sticky fingers " so that the E-coli are literally

> > washed

> > > > > away

> > > > > > with the next urination. The nice thing about the natural

> > > > approach,

> > > > > > as opposed to antibiotics, is that the cranberries or D-

> > Mannose

> > > > > will

> > > > > > not kill the healthy bacteria, thereby not bothering the

> > normal

> > > > > > balance of bacteria in the bowel. In addition, the D-

> Mannose

> > is

> > > > > > absorbed in the upper gut before it gets to the friendly

E-

> > coli

> > > > > that

> > > > > > are normally present in the colon. Because of this, it

> helps

> > > > clear

> > > > > > the bladder without causing any other problems. In

> addition,

> > > the

> > > > D-

> > > > > > Mannose even tastes good.

> > > > > > > The D-Mannose is quite safe, even for long-term use,

> > although

> > > > > most

> > > > > > people will only need it for a few days. Those who have

> > > frequent

> > > > > > recurrent bladder infections may, however, choose to take

> it

> > > > every

> > > > > > day. The usual dose of D- Mannose is 1/2 teaspoon every 2

> to

> > 3

> > > > > hours,

> > > > > > while awake, to treat an acute bladder infection; and 1/4

> to

> > > 1/2

> > > > > > teaspoon 3 to 4 times a day to prevent severe chronic

> bladder

> > > > > > infections. It is best taken dissolved in water. For

those

> > who

> > > > get

> > > > > > bladder infections associated with sexual intercourse,

one

> > can

> > > > take

> > > > > > 1/2 teaspoon of D-Mannose 1 hour before and then just

after

> > > > > > intercourse to prevent an infection. Remember, though,

the

> D-

> > > > > Mannose

> > > > > > (and cranberries) only work in the 90% of bladder

> infections

> > > > caused

> > > > > > by E-coli bacteria. D-Mannose is available from several

> > sources:

> > > > > > > 1. The Tahoma Clinic Dispensary (253-850-5661), which

is

> > > > > associated

> > > > > > with the well-known nutritional physician, V.

> > ,

> > > > M.D.

> > > > > > > 2. The Biotech Company (800-345-1199).

> > > > > > > 3. My office (800-333-5287) or my Web site at

> > > > www.endfatigue.com.

> > > > > > > The usual cost of D-Mannose is approximately $60 for

100

> > > grams

> > > > > and

> > > > > > $35 for 50 grams. A 1/2 teaspoon is approximately 2

grams.

> > One

> > > > > should

> > > > > > feel much better within 24 to 48 hours on D-Mannose. If

> not,

> > > see

> > > > a

> > > > > > doctor for a urine culture (you may want to get the

culture

> > at

> > > > the

> > > > > > first sign of infection) and consider antibiotic

treatment

> > > after

> > > > > two

> > > > > > days if the culture is positive. Some evidence exists

that

> > > > > > Macrodantin causes less yeast over-growth than do other

> > > > > antibiotics.

> > > > > > Even with other antibiotics, most bladder infections are

> > > knocked

> > > > > out

> > > > > > by one to three days of antibiotic use (instead of the

old

> > > seven-

> > > > > day

> > > > > > regimen).

> > > > > > > Prostatitis

> > > > > > > Although women tend to be the ones plagued with bladder

> > > > > infections,

> > > > > > men don't get off unscathed either. It is very common in

> men

> > > with

> > > > > > CFIDS/FMS to have Prostatitis. Prostatitis is an

> inflammation

> > > or

> > > > > > infection of the prostate which is usually seen in

younger

> > men

> > > > > > between the ages of 20 and 50. It falls into three main

> > > > categories:

> > > > > > > 1. " Bacterial " Prostatitis is a acute or chronic

> infection

> > in

> > > > the

> > > > > > gland that causes prostate swelling and discomfort.

> > > > > > > 2. Nonbacterial Prostatitis is when you feel swelling

of

> > the

> > > > > > prostate without being able to detect an infection. My

> > > suspicion

> > > > is

> > > > > > that it is not uncommon for prostatitis to be associated

> with

> > > > yeast

> > > > > > overgrowth or other infections that cannot be cultured

> > (tested

> > > > > for).

> > > > > > > 3. Prostadynia is a general irritation of the prostate

> > which

> > > > > causes

> > > > > > urinary burning, urgency and frequency but without there

> > being

> > > > any

> > > > > > infection or swelling of the prostate. This can come from

a

> > > > number

> > > > > of

> > > > > > causes including, I suspect, chronic spasm or tightening

of

> > the

> > > > > > muscles of the pelvic floor.

> > > > > > > The symptoms of chronic Prostatitis can come and go and

> be

> > > mild

> > > > > or

> > > > > > severe. The symptoms include:

> > > > > > > 1. Pain or tenderness in the area of the prostate. It

is

> > also

> > > > > > common to have burning on the tip of the penis.

> > > > > > > 2. Discomfort in the groin and, occasionally, lower

back

> > pain.

> > > > > > > 3. Urinary urgency and frequency with pain on

urination.

> > > > > > > 4. Sometimes a slight penis discharge. If the discharge

> is

> > > > cloudy

> > > > > > and larger than one drop, or even a large drop, it is

most

> > > likely

> > > > a

> > > > > > bacterial Prostatitis and I would then prescribe

> antibiotics.

> > > If

> > > > a

> > > > > > discharge is present, I would also check to make sure

that

> > > there

> > > > is

> > > > > > not also a sexually transmitted disease (such as

Chlamydia

> or

> > > > > > Gonorrhea) before beginning treatment.

> > > > > > > 5. Pain with ejaculation.

> > > > > > > If severe symptoms with fevers, chills and extreme

> fatigue

> > > are

> > > > > > present (symptoms of acute Prostatitis), antibiotics

should

> > be

> > > > > used.

> > > > > > The main treatment for bacterial Prostatitis consists of

> > using

> > > > the

> > > > > > antibiotics Tetracycline (e.g., Doxycycline), Cipro, or

> Sulfa

> > > > > > (Bactrim or Septra DS). Unfortunately, since it is hard

for

> > the

> > > > > > antibiotics to be absorbed into the prostate, the

symptoms

> > > often

> > > > > > recur even after six weeks of treatment. If antibiotics

are

> > > > > required,

> > > > > > use Doxycycline or Cipro because these may be effective

> > against

> > > > > other

> > > > > > hidden infections that can cause CFIDS/FMS.

> > > > > > > Although there are a number of causes of Prostatitis,

> > excess

> > > > > > caffeine, alcohol and spicy foods can also contribute to

> the

> > > > > > symptoms. Sitting for long periods while traveling (e.g.,

> > being

> > > a

> > > > > > truck driver) can also cause irritation of the prostate.

> > > Although

> > > > > > normal bacteria are common causes, a few bacteria

> transmitted

> > > > > through

> > > > > > sexual contact can also cause Prostatitis. Some feel that

> the

> > > > main

> > > > > > psychological component of Prostatitis is shame.

> > > > > > > Bowel Parasite Infections

> > > > > > > A while back, the news focused our attention on

Milwaukee

> > > > because

> > > > > > of repeated fatal outbreaks of an infection by a bowel

> > parasite

> > > > > > called Cryptosporidium. A cartoon even made the rounds

> > showing

> > > > > > Mexican tourists being warned not to drink the water in

> > > > Milwaukee!

> > > > > > Although this infection usually resolves on its own

within

> a

> > > week

> > > > > or

> > > > > > two, it may persist in those with immune suppression. In

> > fact,

> > > > > people

> > > > > > with acquired immune deficiency syndrome (AIDS) are

> > > particularly

> > > > > > susceptible and scores of Milwaukeens died from the

> > > > Cryptosporidium

> > > > > > outbreaks.

> > > > > > > Unfortunately, in many places throughout the United

> States,

> > > the

> > > > > > water supply is contaminated, and parasites are no longer

> > just

> > > a

> > > > > > Third World problem. Doctors frequently see cases of

> > infection

> > > by

> > > > > > giardia, amoeba and numerous other bowel parasites.

> Parasitic

> > > > > > infections can mimic CFS and, in immune suppressed

> situations

> > > > like

> > > > > > CFS, all parasites should be treated.

> > > > > > > Most laboratories miss the parasites when they do stool

> > > > testing.

> > > > > I

> > > > > > initially tested for bowel parasites by sending my

> patients'

> > > > stool

> > > > > > samples to a respected local lab. The tests kept coming

> back

> > > > > > negative, so I eventually stopped testing. Finally, I

> started

> > > > doing

> > > > > > my own laboratory stool testing. Doing the test properly

> was

> > > very

> > > > > > time consuming, taking up to five hours per specimen.

> > However,

> > > > > > processing it properly, my tests frequently turned out

> > > positive.

> > > > In

> > > > > > my experience - and in that of other physicians as well -

> > when

> > > > you

> > > > > > treat a patient for parasites, the patient's fatigue and

> > > achiness

> > > > > > often improves dramatically.

> > > > > > > If you would like your stool tested, make sure that the

> lab

> > > > > > specializes in stool testing and that the sample is a

> purged

> > > > > > specimen. A purged stool specimen is watery and loose,

> > brought

> > > > > about

> > > > > > by the use of one-and-a-half ounces of Fleet's Phospho-

Soda

> > (a

> > > > > > laxative). The purpose of the stool purge is to get the

> best

> > > > > possible

> > > > > > stool sample to check for bowel parasites and yeast. The

> > > laxative

> > > > > > washes the organisms off the walls of the intestines so

> that

> > > they

> > > > > can

> > > > > > be detected. The routine random tests performed in almost

> all

> > > > > > standard labs are generally not adequate or reliable. In

> > > speaking

> > > > > > with several lab technicians, I was told they had less

than

> > one

> > > > > hour

> > > > > > of training in looking for parasites—which they found to

be

> > > > > useless.

> > > > > > In fact, during one of our " doctors' " poker games, I

spoke

> > with

> > > a

> > > > > > gastroenterologist friend who noted that during a certain

> > bowel

> > > > > exam

> > > > > > he had performed, he saw a large number of parasites

> swimming

> > > in

> > > > > the

> > > > > > patient's large bowel. He removed a big glob consisting

of

> > > > nothing

> > > > > > > but mucus and parasites and sent it off to the major

> local

> > > > > > laboratory, just for confirmation of the infection and

> > > > > identification

> > > > > > of the parasite. Even this sample came back negative for

> > > > parasites!

> > > > > > This is why I stress that stool testing must be done at a

> lab

> > > > that

> > > > > > specializes in parasitology. Because two excellent labs

are

> > now

> > > > > > available to me to mail specimens to, I no longer have to

> do

> > > the

> > > > > > testing in my office. These labs are The Parasitology

> Center,

> > > > Inc.

> > > > > > (480-777-1078) and The Great Smokies Diagnostic

Laboratory

> > (800-

> > > > 522-

> > > > > > 4762).

> > > > > > > At this point, no consistently effective prescription

> > > > medication

> > > > > is

> > > > > > available for Cryptosporidium infections. Artemisia

annua,

> > > > however,

> > > > > > is an effective herbal treatment. For most of my

patients,

> I

> > > > > > recommend using 1,000 milligrams three times a day for

> twenty

> > > > days.

> > > > > > Leo Galland, M.D., a parasite specialist, recommends a

form

> > of

> > > > > > Artemisia called tricyclin for many parasitic infections.

> He

> > > > > > recommends taking 2 tablets, 3 times a day after meals

for

> > six

> > > to

> > > > > > eight weeks. The cost of this antiparasitic herbal

> > preparation

> > > is

> > > > > > about $30 for fifty tablets. See the treatment protocol

> below

> > > for

> > > > > > regimens for some other parasitic infections. The doctor

> who

> > > runs

> > > > > The

> > > > > > Parasitology Center also has a review article discussing

> > which

> > > > > > natural remedies are effective against each type of

> parasite.

> > > > > Common

> > > > > > parasite treatment regimens also used in our office are

on

> > the

> > > > > > treatment checklist below.

> > > > > > > Antiparasitic Treatments

> > > > > > > 1. Flagyl (Metronidazole) – 750 mg, 3 times a day for

10

> > > days,

> > > > > > followed by Yodoxin for many parasites. For Clostridium

> > > Difficile

> > > > > > take 250 mg, 4 times a day, or 500 mg, 3 times a day. It

> may

> > > > cause

> > > > > > nausea and vomiting (uncomfortable but usually not

> > worrisome).

> > > Do

> > > > > not

> > > > > > drink alcohol while on this medication as it will make

you

> > > vomit.

> > > > > The

> > > > > > SR (sustained release) form is easier on the stomach (as

is

> > the

> > > > > brand-

> > > > > > name form). If you get numbness or tingling in your

fingers

> > (or

> > > > it

> > > > > > worsens if you usually have it) stop the Flagyl.

> > > > > > > 2. Yodoxin (Iodoquinol) – 650 mg, 3 times a day, for 20

> > days

> > > > > after

> > > > > > Flagyl is completed.

> > > > > > > 3. Tinidazole – 2000 mg, once daily, for 3 consecutive

> days

> > > > with

> > > > > > food (for Entamoeba Histolytica) – OR - 3 doses, each 2

> weeks

> > > > apart

> > > > > > (for Giardia or Dientamoeba Fragilis); Available at

's

> > > > > Pharmacy

> > > > > > (800-480-3432).

> > > > > > > 4. Humatin (Paromomycin) – 500 mg, 3 times a day, for

10

> > days

> > > > > (for

> > > > > > Cryptosporidium). For Blastocystis add Yodoxin.

> > > > > > > 5. Zithromax – 250 mg, once a day on an empty stomach

for

> > 10

> > > > > days,

> > > > > > along with Bactrim, 1 tablet twice a day for 10 days

> > (alternate

> > > > > > treatment for Cryptosporidium). Add Artemesia.

> > > > > > > 6. Bactrim DS - 1 tablet, twice a day, plus Yodoxin 650

> mg,

> > 3

> > > > > times

> > > > > > a day with food for 10 days. Do not take Folic acid

> > supplements

> > > > > > (e.g., B Complex or multivitamins) during these 10 days

> (for

> > > > > > Blastocystis).

> > > > > > > 7. Amphotericin B – 100 mg, two times a day, plus

> > Tinidazole

> > > > 500

> > > > > > mg, twice a day, plus Furoxone (Furazolidone) 1 tablet,

> twice

> > a

> > > > > day.

> > > > > > Take these three together with food for 5 to 7 days

> > > (Amphotericin

> > > > B

> > > > > > and Tinidazole are available from 's Pharmacy 800-

480-

> > > 3432)

> > > > > > (treatment for refractory Blastocystis).

> > > > > > > 8. Lactoferrin – 350 mg, 1 to 3 capsules at bedtime.

> > > > > > > 9. Multi-pure Water Filter - Most other filters (except

> for

> > > > > reverse

> > > > > > osmosis) are ineffective. (Available from Bren son,

> 410-

> > > 224-

> > > > > > 4877).

> > > > > > > 10. Artemesia Annua (a herbal antiparasitic) – 500 mg,

2

> > > > tablets,

> > > > > 3

> > > > > > times a day for 20 days.

> > > > > > > 11. Tricyclin (a herbal antiparasitic) - 2 tablets, 3

> times

> > a

> > > > > day,

> > > > > > after meals for 6 to 8 weeks (concentrated Artemesia).

> > > > > > > 12. Colostrum (mother's milk) - 3 capsules, 3 times a

> day,

> > > for

> > > > 8

> > > > > to

> > > > > > 12 weeks. Then stop or use the lowest dose needed for

> > symptoms.

> > > > If

> > > > > > nausea or indigestion occurs, lower the dose to a

> comfortable

> > > > level

> > > > > > for 1 to 2 weeks until it passes. Take on an empty

stomach.

> > > > > > > 13. Quinacrine – 100 mg a day for 5 days. May be useful

> for

> > > > > empiric

> > > > > > therapy of suspected but not identified parasites

> > > (controversial).

> > > > > > > 14. Albendazole – 400 mg a day for 5 days. May be

useful

> > for

> > > > > > empiric therapy of suspected but not identified parasites.

> > > > > > > Filter Your Water

> > > > > > > Water filters can be very helpful in the fight against

> > > > parasitic

> > > > > > infection. However, not all units are designed to filter

> out

> > > > > > parasites. For a water filter to remove parasites, it

must

> > have

> > > a

> > > > > > submicron solid carbon block filter. A good example is

the

> > > Multi-

> > > > > pure

> > > > > > Filter. Check the Consumer's Digest and Consumer's Report

> for

> > > > other

> > > > > > good units. Multi-pure Filters are available from Bren

> > son

> > > > at

> > > > > > 888-801-8176 or 410-224-4877. He is a very reputable and

> > > > > > knowledgeable person and does not believe in " high

pressure

> > > > sales "

> > > > > > (again, I get no money from people or companies whose

> > products

> > > I

> > > > > > recommend).

> > > > > > > When shopping around for a water filter, request the

> > National

> > > > > > Sanitation Foundation (NSF) International Listing for the

> > > > specific

> > > > > > unit you are considering. NSF is an independent not-for-

> > profit

> > > > > > organization that tests and certifies drinking water

> > treatment

> > > > > > products. The unit you buy should meet both NSF Health

> > Effects

> > > > > > Standard 53 and NSF Aesthetics Standard 42, with Class I

> > > > reduction

> > > > > of

> > > > > > chlorine and particulate matter. Any unit that does not

> meet

> > > both

> > > > > of

> > > > > > these standards, particularly the health standard, is not

> > > > adequate.

> > > > > > To verify that a unit does meet these standards, call the

> NSF

> > > at

> > > > > 313-

> > > > > > 769–8010.

> > > > > > > In addition to verifying that a water filter meets the

> NSF

> > > > > > standards, ask to see its Product Performance Data Sheet.

> > Many

> > > > > states

> > > > > > require that this sheet be given to all prospective

> customers

> > > of

> > > > > > drinking water treatment devices.

> > > > > > > Ask about the range of contaminants that the unit can

> > reduce

> > > > > under

> > > > > > NSF Health Effects Standard 53. Most units certified

under

> > > > Standard

> > > > > > 53 list only turbidity and cyst reduction. The number of

> > units

> > > > that

> > > > > > also reduce pesticides, trihalomethanes, lead, and

volatile

> > > > organic

> > > > > > chemicals is very small. Make sure that the water filter

> you

> > > are

> > > > > > considering can remove the specific contaminants that

> concern

> > > you.

> > > > > > > Ask if the unit is licensed in such states as

California,

> > > > > Colorado

> > > > > > and Wisconsin. These states have some of the toughest

> > > > certification

> > > > > > procedures in the United States.

> > > > > > > Finally, ask about the unit's service cycle, which is

> > stated

> > > in

> > > > > > gallons of water treated. Find out how often you will

need

> to

> > > > > change

> > > > > > the filter and what the replacement filters cost.

> > > > > > > As the American water supply becomes more contaminated,

> > > > parasitic

> > > > > > bowel infections will likely become more common. These

> > > > infections,

> > > > > as

> > > > > > well as the overgrowth of yeast or toxic bacteria caused

by

> > > > > > antibiotic use, contribute to feeling poorly.

> > > > > > > The Role Of Other Infections In CFIDS/FMS

> > > > > > > Many infections have been found in CFIDS. That people

may

> > > have

> > > > > not

> > > > > > just one, but several of these simultaneously is

> significant.

> > > It

> > > > > > suggests that although these infections may be a trigger,

> in

> > > most

> > > > > > patients the immune system is suppressed and therefore

they

> > > > become

> > > > > a

> > > > > > setup for unusual infections that persist. These

infections

> > may

> > > > > > then " drag you down, " further suppressing your immune

> system.

> > > > > > > Fortunately, most people improve (and often get very

> > healthy)

> > > > by

> > > > > > simply treating the sleep, hormonal, nutritional and

yeast

> > > > > problems.

> > > > > > Once these areas are treated, your body can usually

> eliminate

> > > any

> > > > > > persistent infections by itself. A subset, though, have

> > > > infections

> > > > > > that need treatment with antivirals and/or antibiotics.

> > > > > > > How Can I Tell If I Need These Treatments?

> > > > > > > First, I would try the other approaches discussed in my

> > From

> > > > > > Fatigued To Fantastic! book and newsletters. I would try

> > these

> > > > > > treatments if symptoms persist:

> > > > > > > 1. Those with predominantly flu-like symptoms with

> > > debilitating

> > > > > > fatigue and little or no pain or fever are more likely to

> > have

> > > an

> > > > > > underlying persistent viral infection (e.g., HHV-6,

Epstein

> > > Barr,

> > > > > > CMV, etc.).

> > > > > > > 2. Those with fevers (i.e., anything over 98.6°F in

this

> > > > illness -

> > > > >

> > > > > > even 99°) and/or lung congestion, sinusitis, skin

pustules

> or

> > > > other

> > > > > > chronic bacterial infections seem more likely to have

> > > infections

> > > > > > (i.e., bacterial, Mycoplasma, or Chlamydia) that respond

to

> > > > special

> > > > > > antibiotics. Let's look at these two groups and how to

> > approach

> > > > > them.

> > > > > > > HHV-6 And Other Viral Infections

> > > > > > > HHV-6 (Human Herpes Virus 6) is a virus that is related

> to

> > > the

> > > > > > Epstein Barr Virus (EB), Cytomegalovirus (CMV), and also

to

> > the

> > > > > > Herpes Viruses that causes cold sores and Genital Herpes.

> HHV-

> > 6

> > > > is

> > > > > > transmitted like the common cold and many people have had

> it,

> > > as

> > > > > well

> > > > > > as the EB Virus and the Cold Sore Virus by the time they

> are

> > > > twenty

> > > > > > years old. The body usually gets rid of all of these

> viruses

> > on

> > > > its

> > > > > > own. Because of this, if you do routine (IGG) antibody

> > testing,

> > > > > > almost everybody will be positive for EB and many for HHV-

6

> > and

> > > > CMV

> > > > > > viruses. However, the IGG test will not tell you if you

> have

> > > > active

> > > > > > infections unless the IGM antibody is also positive

> > (suggesting

> > > a

> > > > > new

> > > > > > infection). The IGM antibody is the one that increases in

> the

> > > > first

> > > > > > six weeks of an infection. This is followed by an

elevated

> > IGG

> > > > > > antibody, which stays elevated your whole life and acts

as

> > your

> > > > > > body's surveillance system. All an elevated IGG means is

> that

> > > > your

> > > > > > body has seen this infection and, if it sees it again,

it's

> > read

> > > > > > > y to knock it out quickly. This is how immunizations

> work.

> > > The

> > > > > > immunization creates the IGG antibody, so that instead of

> > > taking

> > > > > one

> > > > > > to two weeks to gear-up to fight the infection, your body

> can

> > > > > > eliminate that infection very quickly. Unfortunately, in

> > CFIDS

> > > > you

> > > > > > can have a chronic low-grade infection—even if your IGG

> > > antibody

> > > > is

> > > > > > positive (elevated) - making the IGG antibody test for

HHV-

> 6,

> > > EB

> > > > > > Virus and CMV unreliable in CFIDS/FMS. In addition, the

IGM

> > > > > antibody

> > > > > > will usually not be present in elevated levels in the low-

> > grade

> > > > > > infections with these viruses that may be seen in CFIDS

and

> > > FMS.

> > > > > > > What makes this important is that Valtrex at high-dose

> can

> > > > > > eliminate Epstein Barr virus, but will not work if active

> HHV-

> > 6

> > > > or

> > > > > > CMV infection is present. As I will discuss later, the

only

> > > tests

> > > > I

> > > > > > would rely on to diagnose active HHV-6 are " rapid cell

> > > cultures "

> > > > or

> > > > > > PCR testing. Because some insurance companies are more

> likely

> > > to

> > > > > pay

> > > > > > for IGG than PCR testing, an argument can be made for

> > checking

> > > > IGG

> > > > > > antibodies first. If the EBV IGG is positive and HHV-6

and

> > CMV

> > > > IGG

> > > > > > are negative, one may choose to proceed with Valtrex

> 1000mg,

> > 4

> > > > > times

> > > > > > a day, for 6 months, without PCR testing. If the HHV-6 or

> CMV

> > > IGG

> > > > > > antibodies are positive, then check the CMV and/or HHV-6

> PCR

> > > > tests

> > > > > to

> > > > > > be sure they are negative.

> > > > > > > Tell Me More About HHV-6 And CFIDS

> > > > > > > Unfortunately there is no currently accepted standard

> > > treatment

> > > > > for

> > > > > > the HHV-6 Virus. Even though it is related to other

Herpes

> > > > viruses,

> > > > > > HHV-6 is resistant to Acyclovir, Valtrex, Famvir and the

> > other

> > > > > > antivirals that are commonly used in Herpes infections.

The

> > > only

> > > > > > antiviral known to be effective against HHV-6 is

> Ganciclovir.

> > > > This

> > > > > > has significant side effects and has to be given

> > intravenously

> > > > and

> > > > > > possibly forever to maintain the antiviral effect.

> > > Unfortunately,

> > > > > > this is not a viable option in day-to-day life and has

been

> > > only

> > > > > > moderately successful when used. The main doctor who has

> been

> > > > using

> > > > > > Ganciclovir to treat HHV-6 in the United States is Joe

> > Brewer,

> > > > > M.D.,

> > > > > > (816-531-1550) in Kansas City, Missouri. He found that

140

> > out

> > > of

> > > > > 207

> > > > > > CFIDS patients had positive HHV-6 cell cultures. Forty

> > percent

> > > of

> > > > > > CFIDS patients were positive on their first test and 70%

> were

> > > > > > positive after three tests. This contrasts to 60 healthy

> > > patients

> > > > > he

> > > > > > checked in which none of the HHV-6 tests were positive.

> > Culture

> > > > > > > s are more likely to be positive during acute flares of

> the

> > > > > > disease, when the viral level in the blood rises (see

Page

> 9

> > > for

> > > > > more

> > > > > > on HHV-6 PCR testing).

> > > > > > > As is often the case in CFIDS, there is conflicting

data

> on

> > > > > > infections in Chronic Fatigue Syndrome. A recently

> published

> > > > study

> > > > > > (Reeves WC, et al., Clin Infect Dis, 2000 July; 31 [1]

pp48-

> > 52)

> > > > > > examined 26 patients with Chronic Fatigue Syndrome and 52

> > > healthy

> > > > > > patients in Atlanta, Georgia, at the CDC. In this study,

> > > several

> > > > > > tests for HHV-6 and HHV-7 were done, including Polymerase

> > Chain

> > > > > > Reaction (PCR). HHV-6 DNA was found in 11% of CFIDS

> patients

> > > and

> > > > > 28%

> > > > > > of healthy patients, suggesting that the HHV-6 was

actually

> > > less

> > > > > > common in Chronic Fatigue Syndrome than in healthy

> patients.

> > At

> > > > > this

> > > > > > time, as the conflicting data shows, although HHV-6 may

be

> > one

> > > of

> > > > > > many suspect infections in CFIDS, it is not yet clearly

the

> > > cause

> > > > > of

> > > > > > this illness.

> > > > > > > When HHV-6 is present, it seems to infect the natural

> > Killer

> > > > > Cells,

> > > > > > important cells in your body's defense (immune) system

that

> > are

> > > > > > critical in fighting infections. A number of studies have

> > shown

> > > > > these

> > > > > > Killer Cells to be malfunctioning in CFIDS. HHV-6

infection

> > > does

> > > > > not

> > > > > > necessarily decrease the number of the natural Killer

Cells

> > but

> > > > > does

> > > > > > decrease their function. Natural Killer Cell function is

> > > > described

> > > > > in

> > > > > > what is called Lytic Units—which means the ability of

cells

> > to

> > > > lyse

> > > > > > or break down foreign invaders. An average person will

have

> a

> > > > Lytic

> > > > > > Unit level of 20 to 250 with over 80% of healthy patient

> > being

> > > > over

> > > > > > 40 units. Dr. Brewer finds that in CFIDS the mean Natural

> > > Killer

> > > > > > Lytic Cell level is 12 units. Dr. Brewer uses Specialty

> Labs

> > in

> > > > > > California for his Natural Killer Lytic Cell testing and

> > finds

> > > > that

> > > > > > the Lytic level stays the same on repeat testing and

seems

> to

> > > be

> > > > a

> > > > > > reliable test for Natural Killer Cell function testing in

> > > CFIDS.

> > > > > > Lytic unit levels will, however, decrease during flar

> > > > > > > es of symptoms. In Dr. Brewer's experience, this test

is

> > very

> > > > > > specific for CFIDS and Multiple Sclerosis. He has treated

> ten

> > > MS

> > > > > > patients and five CFIDS patients with the I.V.

Ganciclovir.

> > He

> > > > > found

> > > > > > that it helped to stabilize the MS patients. In the CFIDS

> > > > patients,

> > > > > > two to three were much improved, one still had a positive

> > viral

> > > > > > culture and one had a poor response. Unfortunately,

> > maintaining

> > > > > > patients on I.V. Ganciclovir forever (as noted above) is

> not

> > a

> > > > > viable

> > > > > > option. Fortunately, an oral pill form of Ganciclovir

> > > > > > (Valganciclovir) is currently being developed! It should

be

> > > noted

> > > > > > that the HHV-6 virus is similar to CMV (Cytomegalovirus),

> and

> > > > that

> > > > > > whatever is effective against one, tends to be effective

> for

> > > the

> > > > > > other. This is a helpful bit of information as we follow

> new

> > > > > research

> > > > > > looking for clues on how to eliminate HHV-6 infection.

> > > > > > > What Roles Does The Epstein Barr And Cytomegalovirus

Play

> > In

> > > > > CFIDS?

> > > > > > > Again, the roles of the EB and CMV viruses are not

clear.

> > It

> > > is

> > > > > not

> > > > > > uncommon for antibody levels of these viruses to be

> elevated

> > in

> > > > > > Chronic Fatigue Syndrome. As noted above, it is not clear

> > > whether

> > > > > > this simply reflects a previous or ongoing infection with

> > these

> > > > > > viruses. Research by a husband and wife team (the

Glasers)

> at

> > > > Ohio

> > > > > > State University, suggests that Epstein Barr Virus is

still

> > > quite

> > > > > > active and playing a role in many patients with these

> > > infections.

> > > > > In

> > > > > > addition, work by Lerner, M.D., also suggests that

> EB

> > > > Virus

> > > > > > and CMV are active as well. In speaking with Dr. Lerner's

> > > > research

> > > > > > assistant, I found out that he has found EB Virus and CMV

> to

> > > both

> > > > > be

> > > > > > fairly common in patients with Chronic Fatigue Syndrome

> (with

> > > and

> > > > > > without pain). He found that about 20% had positive IGM

> > and/or

> > > > > > elevated EA (early antigen) tests to the EB Virus with

> > negative

> > > > > > Cytomegalovirus. Of these, two-thirds improved with high-

> dose

> > > > > Valtrex

> > > > > > (an oral antiviral). Despite my teasing and prodding, his

> > > associat

> > > > > > > e refused to give out the dose of Valtrex they

prescribed

> > > > because

> > > > > > Dr. Lerner does not want to be responsible for people

using

> > > these

> > > > > > higher doses until he completes the double-blind trial

that

> > is

> > > > > > currently in progress. On the other hand, another study

of

> > his

> > > > did

> > > > > > use 1000mg, 4 times a day, giving the antiviral for 6

> months.

> > > It

> > > > > > takes about 3 to 4 months before patients start to

improve

> > and

> > > > > after

> > > > > > 6 months people can stop the Valtrex without the symptoms

> > > coming

> > > > > > back. However, if there is no improvement in 6 months,

> > consider

> > > > it

> > > > > to

> > > > > > be a negative result. They also found that, as noted

above,

> > the

> > > > IGM

> > > > > > is almost always negative using the reagents used in most

> > labs.

> > > > > They

> > > > > > found that only Epstein Barr IGM antibody testing, using

a

> > > > reagent

> > > > > by

> > > > > > the Diasorin Company (800-328-1482), has been useful in

> > showing

> > > a

> > > > > > significant number of positive tests. When we called the

> > > company,

> > > > > the

> > > > > > only lab in the Washington, D.C., area using it was at

the

> > NIH.

> > > > The

> > > > > > company may, however, be able to give you the name of

> > > > > > > a lab near you that can do the test. What was fairly

> > common,

> > > > > > though, (and present in most patients) was either

positive

> > > tests

> > > > > for

> > > > > > Epstein Barr, CMV, or a combination of both as noted

above.

> > > When

> > > > > CMV

> > > > > > or HHV-6 are present, the Valtrex is less likely to work

> > > because

> > > > it

> > > > > > is not effective against these viruses.

> > > > > > > In another study done by Dr. Lerner (Infectious

Diseases

> In

> > > > > > Clinical Practice, 1997; 6:110-117) he found that

patients

> > who

> > > > had

> > > > > > elevated CMV IGG antibodies, but no significant evidence

of

> > > > > > associated Epstein Barr virus (i.e., negative IGM and

early

> > > > antigen

> > > > > > (EA) antibody total less than 40), did improve with I.V.

> > > > > Ganciclovir

> > > > > > at 5mg per kg of body weight given every 12 hours I.V.

for

> 30

> > > > days.

> > > > > > In this study 72% (13 of the 18 patients) improved

markedly

> > at

> > > > the

> > > > > > end of a month without any significant side effects. As

> > noted,

> > > an

> > > > > > oral form of Ganciclovir is currently in development as

> well.

> > > It

> > > > > > should be noted that 36% of the Chronic Fatigue Syndrome

> > > patients

> > > > > > that Dr. Lerner checked (18 out of 50) did turn out to

have

> > > > > elevated

> > > > > > CMV antibodies (albeit IGG) in the absence of IGM and EA

> > > > antibodies

> > > > > > to EB Virus (i.e., no evidence of active Epstein Barr

> Virus).

> > > It

> > > > > > should be noted, though, that 70% of healthy patients

also

> > had

> > > > > > positive IGGs to CMV (as per our discussion above) in the

> > study

> > > > and

> > > > > > appears

> > > > > > > that the overall level of the IGG was not much higher

> > > overall

> > > > in

> > > > > > the Chronic Fatigue group than in the healthy controls.

On

> > the

> > > > > other

> > > > > > hand, the higher the level of CMV antibody in the Chronic

> > > Fatigue

> > > > > > group, the more likely they were to improve with the I.V.

> > > > > Ganciclovir.

> > > > > > > What this means is that patients with Chronic Fatigue

> > > Syndrome

> > > > > > don't necessarily have different blood tests for antibody

> > > levels

> > > > > than

> > > > > > healthy people for these viruses. However, if one has a

> > higher

> > > > > level

> > > > > > rather than a lower level, one is more likely to improve

> with

> > > the

> > > > > > Ganciclovir. Previous research has not shown benefit from

> > > > antiviral

> > > > > > therapies in CFS (Straus SE, et al., New England Journal

of

> > > > > Medicine

> > > > > > 1988; 319:1692-1698). Our experience using a fairly high

> dose

> > > of

> > > > > > Valtrex or Famvir (1500mg and 2250mg a day respectively)

> also

> > > > > showed

> > > > > > no significant improvement on these regimens after 6

weeks,

> > at

> > > > > which

> > > > > > time we considered it to be ineffective. On the other

hand,

> > Dr.

> > > > > > Lerner's research is suggesting that perhaps we gave it

for

> > too

> > > > > short

> > > > > > a time and at too low a dose. When treating himself and a

> few

> > > > other

> > > > > > patients, he used Valtrex by mouth at a dosage of 1000mg,

4

> > > times

> > > > a

> > > > > > day, for 6 months. Using the higher dosing and the

extended

> > > > period

> > > > > of

> > > > > > time, as well as separating out groups that have

> > > > > > > Epstein Barr Virus (sensitive to the oral Valtrex)

> without

> > > CMV

> > > > > or

> > > > > > HHV-6 (resistant to oral Valtrex but sensitive to I.V.

> > > > > Ganciclovir),

> > > > > > may make an important difference in making treatment

> > effective.

> > > > No

> > > > > > major Valtrex toxicity was seen. As noted above, a double-

> > blind

> > > > > study

> > > > > > is currently in progress and we are beginning to try the

> > higher

> > > > > dose

> > > > > > of Valtrex in the 15% of our patient population that have

> not

> > > > > > improved adequately and have positive EBV, and negative

CMV

> > and

> > > > HHV-

> > > > > 6

> > > > > > tests. We hope to give you follow-up information on the

> > > > treatment's

> > > > > > effectiveness as soon as we know!

> > > > > > > In addition, Dr. Lerner suspects that these infections

> > affect

> > > > the

> > > > > > heart muscle contributing to much of your symptoms. I am

> not

> > > > > > convinced that this is the case because EKG changes are

> > common

> > > in

> > > > > > CFS. This can occur because the autonomic (brain)

> dysfunction

> > > and

> > > > > > hormonal changes seen in CFS can cause these same EKG

> changes

> > > > > without

> > > > > > heart damage. Regardless, he found that these changes

went

> > away

> > > > > with

> > > > > > treatment (as has been our experience in treating Chronic

> > > Fatigue

> > > > > > Syndrome—patient's EKG changes improve even without

> > > antivirals).

> > > > > Dr.

> > > > > > Lerner is currently recruiting patients for a double-

blind

> > > study

> > > > > > using the high-dose Valtrex. His phone number is 248-540-

> 9688

> > > in

> > > > > > Beverly Hills, Michigan.

> > > > > > > Does This Mean There Is Nothing We Can Do Now?

> > > > > > > Although there is no currently accepted specific

> treatment

> > > for

> > > > > the

> > > > > > CMV and HHV-6 viruses, there are still a number of things

> > that

> > > > may

> > > > > be

> > > > > > very helpful in fighting this infection.

> > > > > > > 1. Lithium tends to be antiviral and has been shown to

> > > decrease

> > > > > > pain in FMS patients when added to treatment with Elavil.

> > > Lithium

> > > > > is

> > > > > > commonly used in manic depressive illness and is a

natural

> > > > mineral

> > > > > > despite being sold by prescription. In high doses, it can

> > cause

> > > > > some

> > > > > > neurologic symptoms and suppression of the thyroid gland,

> but

> > > > these

> > > > > > can usually be treated by taking a small amount of

> Essential

> > > > Fatty

> > > > > > Acids and thyroid hormone. Lithium might also worsen

> Restless

> > > Leg

> > > > > > Syndrome. Although we have no direct evidence of Lithium

> > being

> > > an

> > > > > > effective antiviral against HHV-6, it may well be

effective

> > > > because

> > > > > > it works against a number of other viral infections. In

our

> > > > > > experience, 200mg to 600mg a day seems to be the

effective

> > dose

> > > > in

> > > > > > treating FMS patients. As noted above, I would check the

> > > thyroid

> > > > > > blood tests at 3 months, 6 months and then yearly (check

a

> > Free

> > > > T4

> > > > > > and a Total T3 - not a TSH). A Lithium level should also

be

> > > > checked

> > > > > > at the same time to be sure that it not above the upper

> limit

> > > of

> > > > > > > normal. The level can be below the normal range, which

is

> > > fine

> > > > as

> > > > > > long as the treatment is effective. You may find that you

> can

> > > > lower

> > > > > > the Lithium dose after you have been on it for several

> months.

> > > > > > > 2. Heparin (a blood thinner, see Page 12) also has

> > antiviral

> > > > > > properties.

> > > > > > > 3. It is worth considering trials of high-dose Valtrex.

> It

> > > > should

> > > > > > be noted that 1000mg, 3 times a day, is used for shingles

> in

> > > > older

> > > > > > patients and appears to be quite safe. On the other hand,

> > > higher

> > > > > > dosing at 8 grams a day in AIDS patients did result in

> > uncommon

> > > > > > (under 2%) life threatening problems. This is common even

> > with

> > > > day-

> > > > > to-

> > > > > > day drugs in AIDS patients (for example, regular sulfa

> > > > antibiotics

> > > > > > have often resulted in severe toxicity in AIDS patients).

> > > > > > Nonetheless, we will be limiting the dose to 1 gram, 4

> times

> > a

> > > > day,

> > > > > > in our practice. It is important to note that taking

> Tagamet

> > > > and/or

> > > > > > Probenecid (Benemid) will raise the blood level of

Valtrex.

> > > > Tagamet

> > > > > > has powerful immune modifying properties and is very

> helpful

> > in

> > > > > acute

> > > > > > cases of Epstein Barr (mono) infections. Because of this,

> we

> > > are

> > > > > > adding Tagament 300mg, 4 times a day (but not

Probenecid),

> to

> > > the

> > > > > > Valtrex. As I noted, we are beginning this treatment with

> > some

> > > of

> > > > > our

> > > > > > patients and will let you know what we find.

> > > > > > > Natural Remedies

> > > > > > > 1. Olive Leaf - This is an herbal which is known to

have

> a

> > > wide

> > > > > > spectrum of anti-infectious activity. It has been shown

to

> be

> > > > > > effective against the HHV-6 virus in the test tube. I

have

> > not,

> > > > > > however, seen studies testing its effect in human beings

> > > infected

> > > > > > with HHV-6. Nonetheless, a number of physicians have

found

> > that

> > > > > using

> > > > > > Olive Leaf in Chronic Fatigue Syndrome is very effective.

> > There

> > > > is

> > > > > > controversy over whether the form and source of the Olive

> > Leaf

> > > is

> > > > > > critical. We recommend that you use a form that has at

> least

> > 6%

> > > > > > Oleuropein, which is one of the most active antiviral

> > > components

> > > > in

> > > > > > the Olive Leaf. Other components may be important and

some

> > > people

> > > > > > also feel that you must use the Mediterranean Olive Leaf

> vs.

> > > the

> > > > > > American Olive Leaf. Other people argue that you should

> have

> > a

> > > > form

> > > > > > that is organically grown, without pesticides. At this

> point

> > it

> > > > is

> > > > > > not clear whether this is simply marketing or important

in

> > day-

> > > to-

> > > > > day

> > > > > > life. Nonetheless, I would be picky about the companies

you

> > buy

> > > > the

> > > > > O

> > > > > > > live Leaf from. I would use one of these sources:

> > > > > > > a. My office (800-333-5287) or my Web site at

> > > > www.endfatigue.com.

> > > > > > > b. Pacific Research Labs (800-325-7734). This is owned

by

> > R.

> > > J.

> > > > > > Marshall, Ph.D., who has done a fair bit of work treating

> > CFIDS

> > > > > > patients with Olive Leaf. I will be describing the

protocol

> > > that

> > > > he

> > > > > > uses below.

> > > > > > > c. General Nutrition Centers (GNC).

> > > > > > > Dr. Marshall feels that during infections, the body

> becomes

> > > > > overly

> > > > > > acidic. He tests the morning urine specimens with pH

paper

> > > (which

> > > > > is

> > > > > > very easy to do at home) and gives a shell extract, which

> > > raises

> > > > > the

> > > > > > body's alkalinity. He feels that having a normalized acid-

> > base

> > > > > > balance in your body helps it to fight infections. He

then

> > adds

> > > > his

> > > > > > form of Olive Leaf, called Infectostat (which also

contains

> > > > > mushroom

> > > > > > extracts to stimulate the immune system), giving 3 to 4

> > > capsules,

> > > > 3

> > > > > > to 4 times a day, to help fight the infections. Usually,

> the

> > > > > patient

> > > > > > should start feeling better within four weeks on this

> > protocol.

> > > > > > Although we have found it helpful in fighting colds and

> other

> > > > > common

> > > > > > respiratory infections, we are just starting to explore

> Olive

> > > > > Leaf's

> > > > > > use in a few of our patients who have not responded to

> > standard

> > > > > > treatment and are still quite ill. We will let you know

our

> > > > > > experience with this in an upcoming newsletter issue. My

> > guess,

> > > > > > though, is that simply using regular (6% Oleuropein)

Olive

> > Leaf

> > > > > > > 500mg capsules, 3 to 4 capsules, 3 to 4 times a day

> between

> > > > > meals,

> > > > > > will probably be equally effective and cheaper for most

> > people

> > > > than

> > > > > > the expensive forms. How long one needs to take Olive

Leaf

> in

> > > > > Chronic

> > > > > > Fatigue Syndrome is yet to be determined.

> > > > > > > Initially, a pharmaceutical company was developing the

> > > > Oleuropein

> > > > > > in Olive Leaf as an antiviral. Because it gets bound to

the

> > > blood

> > > > > > proteins, they thought that Oleuropein might not get to

the

> > > > > tissues.

> > > > > > More importantly, Oleuropein is a natural product and

> > therefore

> > > > > hard

> > > > > > to patent. Because of these problems, they stopped

research

> > on

> > > > it.

> > > > > > Years later this research was rediscovered and explored

> > > further.

> > > > In

> > > > > > addition to being an effective antiviral agent, Olive

Leaf

> is

> > > > > > reported to be effective on a number of bacterial and

yeast

> > > > > > infections as well. What is most exciting regarding the

> Olive

> > > > Leaf

> > > > > is:

> > > > > > > a. That some doctors have found it to be effective in

> > CFIDS,

> > > > and

> > > > > > > b. That in tests against HHV-6 and CMV virus (remember

> that

> > > if

> > > > > > something is effective against one, it tends to be

> effective

> > > > > against

> > > > > > the other) the Olive Leaf extract did not just suppress

the

> > > virus

> > > > > but

> > > > > > killed it. That is very promising.

> > > > > > > 2. Pro-Boost - Thymic Protein A (used to be called

> BioPro) -

> >

> > > > This

> > > > > > is the immune stimulant that I discussed in my

newsletter,

> > Vol.

> > > > 2,

> > > > > > Issue 2. Although not a hormone, Pro-Boost mimics the

> natural

> > > > > hormone

> > > > > > produced by your Thymus - the gland which stimulates your

> > > immune

> > > > > > system. I find it to be extraordinarily effective in

> fighting

> > > > > common

> > > > > > infections of any kind that seem to pop up. For the more

> deep-

> > > > > seated

> > > > > > infections of CFIDS, the higher dose (1 packet, 3 times a

> > day)

> > > > will

> > > > > > likely be needed. Once the infection seems to be in check

> and

> > > you

> > > > > are

> > > > > > feeling better (i.e., after 6 weeks), you can taper down

to

> > the

> > > > > > lowest dose that maintains the effect.

> > > > > > > 3. IP6 - This natural immune stimulant is an extract of

> > bran

> > > > > > (phytates). It is less expensive and is sometimes

combined

> > with

> > > > > > vitamin C. The dose of IP6 (available from many sources)

is

> 5

> > > to

> > > > 8

> > > > > > grams a day. Do not take IP6 within 3 hours of

> > vitamin/mineral

> > > > > > supplements.

> > > > > > > 4. MGN3 - This is a very concentrated mushroom extract,

> > which

> > > > has

> > > > > > been shown to stimulate Natural Killer Cell immune

> function.

> > In

> > > > one

> > > > > > study, it actually tripled Natural Killer Cell function—

an

> > > effect

> > > > > > that, as the HHV-6 virus can suppress Natural Killer Cell

> > > > function,

> > > > > > could be very powerful. Unfortunately, it is horribly

> > expensive

> > > > in

> > > > > > the recommended dose (250 mg capsules) of 2 to 4

capsules,

> 4

> > > > times

> > > > > a

> > > > > > day for 2 weeks, followed by 2 capsules, 2 times a day.

> Other

> > > > > > mushroom extracts are cheaper but may not be as

effective.

> > > > > > > 5. Intravenous Vitamin C at high-dose (15gm to 50gm)

has

> > been

> > > > > > suggested to have antiviral effects in a number of other

> > > > infections

> > > > > > and is often dramatically helpful in CFIDS when given in

> the

> > > I.V.

> > > > > > nutritional therapy called " Myers Cocktails " (see my

> > > newsletter,

> > > > > Vol.

> > > > > > 3, Issue 3).

> > > > > > > 6. Lysine 1000 mg, 3 times a day - This amino acid

> protein

> > is

> > > > > safe

> > > > > > and inexpensive (27¢ a day). It inhibits oral/genital

> herpes

> > > (by

> > > > > > depleting the Arginine the virus needs to grow). I do not

> > know

> > > if

> > > > > it

> > > > > > also inhibits EBV, HHV-6 or CMV viral infections.

> > > > > > > I would take the combination of these together (as is

> > > > affordable)—

> > > > > > perhaps leaving the MGN3 for later if needed, giving the

> > > > treatment

> > > > > > for at least a 6 to 8 week trial to see if it's

effective.

> If

> > > you

> > > > > are

> > > > > > feeling better at 6 weeks, you can then taper down the

dose

> > > > slowly

> > > > > as

> > > > > > long as the benefit is maintained. When able, you can

wean

> > > > yourself

> > > > > > off the treatments. If symptoms recur, go back up to the

> dose

> > > > that

> > > > > > maintains the benefit or consider increasing the dose

> > further.

> > > As

> > > > > we

> > > > > > are just starting to use this protocol in our patients, I

> do

> > > > > > appreciate your feedback on what has worked for you and

> what

> > > has

> > > > > not.

> > > > > > You can " vote " for what helped or didn't help you on our

> Web

> > > site

> > > > > at

> > > > > > www.endfatigue.com. You can also see other people's

votes.

> > > > > > > In addition, your clotting system may be activated by

> > several

> > > > > > infections making it difficult to eliminate them. Using

the

> > > anti-

> > > > > > clotting treatments that we will discuss later can also

> make

> > it

> > > > > > easier for your body to eradicate infections.

> > > > > > > Mycoplasma And Chlamydia

> > > > > > > Other infections have also been found to be very

> important

> > in

> > > > > > CFIDS. Dr. Garth Nicolson and his wife, who were on-

faculty

> > at

> > > > the

> > > > > > University of Texas Medical School at Houston and the

> > > Department

> > > > of

> > > > > > Microbiology and Immunology at Baylor College of Medicine

> in

> > > > > Houston,

> > > > > > Texas, are the leading proponents of treatment of these

> > > > infections.

> > > > > > Dr. Garth Nicolson was an endowed chair and department

> > chairman

> > > > at

> > > > > > the University of Texas, the M.D. Cancer Center

in

> > > > > Houston,

> > > > > > Texas, and a Professor of Internal Medicine at the

> University

> > > of

> > > > > > Texas Medical School, also in Houston. Dr. Nicolson's

wife

> > had

> > > > > > Chronic Fatigue Syndrome years ago. They were surprised

> that

> > > her

> > > > > test

> > > > > > turned out to be positive for Mycoplasma fermentans (also

> > known

> > > > as

> > > > > > Mycoplasma fermentans incognitus). This Mycoplasma was

> found

> > to

> > > > be

> > > > > > resistant to the Penicillin- and Keflex-family

antibiotics

> > that

> > > > > most

> > > > > > doctors use, but was sensitive to long courses of

> Doxycycline

> > > and

> > > > > > Cipro. After an extended course of Doxycycline treatment,

> > > > > > > she was much better. The Nicolsons then went on to

> develop

> > > > their

> > > > > > own tests for Mycoplasma using PCR testing. Dr. Nicolson

> > tells

> > > me

> > > > > > that, in addition, when his step-daughter came home after

> > > serving

> > > > > in

> > > > > > Desert Storm, she came down with Gulf War Illness (GWI).

> They

> > > > > tested

> > > > > > hundreds of Gulf War veterans with GWI and 40% to 45%

were

> > > > positive

> > > > > > for Mycoplasma infections—almost all with Mycoplasma

> > > fermentans.

> > > > > This

> > > > > > has been confirmed by other labs and a large Veterns

> > > > Aministration

> > > > > > study involving over 2,000 patients. In contrast to this,

> > > > soldiers

> > > > > > who were not deployed to the Gulf during the war, had

less

> > than

> > > a

> > > > > 6%

> > > > > > incidence of being positive for these infections.

> > > > > > > Interestingly, the Nicolsons found that in patients

with

> > > > Chronic

> > > > > > Fatigue Syndrome or Fibromyalgia, approximately 70% (144

> out

> > of

> > > > 203

> > > > > > patients) had a positive PCR test for one, or usually

> several

> > > > > > species, of Mycoplasma. When the Nicolsons tested 70

> healthy

> > > > > > patients, only 6 patients (less than 9%) were positive

for

> > any

> > > of

> > > > > the

> > > > > > Mycoplasma species. This is a highly significant

> difference.

> > > Only

> > > > 2

> > > > > > of these 70 healthy people were positive for Mycoplasma

> > > > fermentans.

> > > > > > Similar results have been found by other doctors and have

> > been

> > > > > > published.

> > > > > > > As we have said before, it is likely that there is a

> group

> > of

> > > > > > underlying problems and not a single one that triggers

> > > CFIDS/FMS.

> > > > > > This applies to infections as well. This is why you can

see

> > > tests

> > > > > be

> > > > > > positive for both viral and Mycoplasmal infections in so

> many

> > > > > people

> > > > > > with this disease. For Mycoplasma alone, when they

checked

> > for

> > > > four

> > > > > > different types of Mycoplasma, over half of the 93 CFIDS

> > > patients

> > > > > > that were positive had more than one type of infection.

> Over

> > > 20%

> > > > of

> > > > > > them had three out of the four Mycoplasma infections test

> > > > positive.

> > > > > > The more infections that were positive, the worse the

> > patient's

> > > > > > symptoms were and the longer they had had CFIDS/FMS.

> > > > > > > What Are Mycoplasma?

> > > > > > > Mycoplasma are an ancient bacteria that lacks cell

walls

> > and

> > > > are

> > > > > > capable of invading a number of types of human cells.

They

> > can

> > > > > cause

> > > > > > a wide variety of human diseases. These organisms can

cause

> > the

> > > > > types

> > > > > > of symptoms seen in Chronic Fatigue Syndrome patients

and,

> > > > > according

> > > > > > to Dr. Nicolson, tend to be immune suppressing.

> > Unfortunately,

> > > > they

> > > > > > cannot be readily cultured on a culture dish like regular

> > > > bacteria.

> > > > > > In medicine, we have a bad habit on focusing on that

which

> is

> > > > easy

> > > > > to

> > > > > > test for and making believe that that which is hard to

test

> > for

> > > > > does

> > > > > > not exist. Because of this, bacterial infections such as

> > > > pneumonia,

> > > > > > bladder infections and skin infections, where one

bacteria

> on

> > a

> > > > > cell

> > > > > > dish will rapidly turn into millions by the next day and

be

> > > > visible

> > > > > > to the human eye, get all our attention. Unfortunately,

> > > > Mycoplasma,

> > > > > > which cannot be easily cultured, tends to be ignored.

It's

> > like

> > > > the

> > > > > > old story about the little kid who was looking for his

lost

> > > keys

> > > > > > under the street lamp one night. His frien

> > > > > > > ds came by and asked him what was going on. He told

them

> > and

> > > > they

> > > > > > all looked for the keys under that light for about an

hour.

> > > > > Finally,

> > > > > > exasperated, they looked at the friend and said, " Where

did

> > you

> > > > > lose

> > > > > > these keys? " The kid looked up and said, " Oh, about half

a

> > > block

> > > > > down

> > > > > > the street. " They said, " Why are you looking for them

> here? "

> > He

> > > > > > said, " Because there is a light here and I can see! " This

> is

> > > kind

> > > > > of

> > > > > > what it is like in medicine. If there is a test for

> something

> > > > (such

> > > > > > as cholesterol and bacterial cultures) that is easy to

do,

> we

> > > > focus

> > > > > > our attention on that test and make believe that it finds

> the

> > > > main

> > > > > > problem. Unfortunately, in CFIDS and FMS, this is not the

> > case.

> > > > > > > The data suggests that many infections may trigger

> > CFIDS/FMS

> > > or

> > > > > > that CFIDS and FMS may cause immune suppression—which

then

> > sets

> > > > you

> > > > > > up to catch a whole bunch of different infections which

> your

> > > body

> > > > > has

> > > > > > trouble clearing. This is why it is important to treat

all

> > the

> > > > > > underlying processes simultaneously as I discuss in my

From

> > > > > Fatigued

> > > > > > To Fantastic! book and newsletters.

> > > > > > > So, How Do You Look For These Infections?

> > > > > > > I had the honor of speaking with Konnie Knox, M.D., a

> major

> > > re-

> > > > > > searcher on HHV-6 testing in CFIDS/FMS, who uses a

> technique

> > > > called

> > > > > > Rapid Cell Culture. She actually infects different test

> tube

> > > > cells

> > > > > > with HHV-6, grows them, and then looks for signs of HHV-6

> in

> > > the

> > > > > > cell. In her experience, one out of three CFIDS/FMS

> patients

> > > are

> > > > > > positive for active HHV-6 infection on the first blood

> test.

> > > When

> > > > > > multiple testing is done (e.g., three tests), 70% are

> > positive.

> > > > > This

> > > > > > test is negative in the vast majority of people who are

> > > healthy.

> > > > > The

> > > > > > other main illness where the HHV-6 test is positive is

> > Multiple

> > > > > > Sclerosis. At this time, HHV-6 Rapid Cell Culture and the

> PCR

> > > > test

> > > > > at

> > > > > > Dr. Nicolson's lab (International Molecular Diagostics)

are

> > the

> > > > > only

> > > > > > HHV-6 test I order. For more information on Dr. Knox's

> work,

> > go

> > > > to

> > > > > > these Web sites: www.HHV-6.com and www.cnet.com. For the

> IMD

> > > > > website,

> > > > > > go to www.imd-lab.com.

> > > > > > > The Nicolsons use very sensitive PCR (Polymerase Chain

> > > > Reaction)

> > > > > > testing to actually look for DNA specific to Mycoplasma,

> HHV-

> > 6,

> > > > and

> > > > > > other infections. Unfortunately, those DNA pieces are so

> > > > > > microscopically small, that to look for just one is much

> > worse

> > > > than

> > > > > > looking for a " needle in a haystack. " With the PCR, if

that

> > > > > > Mycoplasma gene sequence is found, the technique

multiplies

> > it

> > > > like

> > > > > a

> > > > > > copying machine until millions of that sequence are

present

> > and

> > > > can

> > > > > > be picked up by testing. Because of this, PCR testing is

> > > > > exquisitely

> > > > > > sensitive and can find the proverbial " needle in a

> haystack. "

> > > > This

> > > > > > makes it very powerful and the only testing that I would

> > > > recommend

> > > > > in

> > > > > > looking for these Mycoplasma and Chlamydia infections. As

> > noted

> > > > > > above, IGG antibody testing is not reliable for

Mycoplasma

> > and

> > > > > > Chlamydia testing in CFS.

> > > > > > > Where Do I Get These Tests Done And Should I Have Them

> Done?

> > > > > > > The tests for HHV-6 and Mycoplasma each cost about $180

> to

> > > > $250.

> > > > > As

> > > > > > noted above, the only places that I would get the HHV-6

> test

> > > done

> > > > > > (and the only tests I would do are PCR or viral culture

> > > testing)

> > > > > are

> > > > > > at the Wisconsin Viral Institute (414-774-0311) or Dr.

> > > Nicolson's

> > > > > > lab. I order all the lab testing for Mycoplasma and

> Chlamydia

> > > at

> > > > > the

> > > > > > Nicolson's lab, at International Molecular Diagnostics,

> 15162

> > > > > Triton

> > > > > > Lane, Huntington Beach, CA 92649 (714-799-7177 ext. 202

or

> > > 204).

> > > > > The

> > > > > > lab's Web site is www.imdlab.com.

> > > > > > > I can almost guarantee that if you do the Mycoplasma or

> > > > Chlamydia

> > > > > > tests at your local lab they will do the wrong tests and

> they

> > > > will

> > > > > be

> > > > > > useless for hidden CFS infections. I have never seen one

> come

> > > > back

> > > > > > with any useful information. What they usually do is

check

> > the

> > > > > > antibodies (usually for the wrong Mycoplasma infection)

> which

> > > > > simply

> > > > > > shows that you (like everybody else at some point in

their

> > > life)

> > > > > have

> > > > > > had a Mycoplasma infection. It tells nothing about active

> > > > infection

> > > > > > and, again, is useless. Be sure to do the PCR testing and

> do

> > it

> > > > at

> > > > > > one of the two labs discussed above. Dr. Nicolson has

noted

> > > which

> > > > > > tests he recommends in CFS/FMS, their cost and

instructions

> > for

> > > > the

> > > > > > lab. We have reprinted this information on the next page

> (Dr.

> > > > > > Nicolson's lab also does viral PCR testing for CMV, as

well

> > as

> > > > HHV-

> > > > > 6).

> > > > > > > Even at the best labs, it is not uncommon to have a

false-

> > > > > negative

> > > > > > report (where you have the infection and it does not show

> up

> > on

> > > > the

> > > > > > test). Because of this, especially for HHV-6, multiple

> tests

> > > will

> > > > > > often need to be done. There are good arguments for not

> doing

> > > the

> > > > > > tests and simply going ahead and treating empirically

with

> > the

> > > > > > natural remedies discussed above for HHV-6, or for

> > prescribing

> > > > > > Doxycycline or Cipro for an extended period of time (see

> > > below).

> > > > If

> > > > > > you feel better after four months on the treatment, then

> you

> > > know

> > > > > you

> > > > > > are hitting an infection and you can always

intermittently

> > stop

> > > > the

> > > > > > treatments to see how long you will need them. Also,

there

> > are

> > > > many

> > > > > > infections that are not tested for with these tests that

> > would

> > > be

> > > > > > effectively treated with the regimens that we are

> discussing.

> > > > Many

> > > > > of

> > > > > > these are likely to be infections that we don't even know

> > > exist.

> > > > > > Because of this, if resources are limited, I some-times

> > simply

> > > > > treat

> > > > > > the patient, based on clinical suspicion, without doing

the

> > > > > > > tests.

> > > > > > > Testing does have its benefits. If the test is

positive,

> I

> > am

> > > > > > likely to treat more aggressively and it helps guide me

on

> > how

> > > > long

> > > > > > to give the treatment. For example, if after four months

> you

> > > are

> > > > > not

> > > > > > better and the test is positive, I would be likely to go

> > ahead

> > > > and

> > > > > > increase dosing or change to a different antibiotic. If

the

> > > test

> > > > > was

> > > > > > negative, I would be more likely to just stop treatment

and

> > > > suspect

> > > > > > that the infection is less likely. This argues in favor

of

> > > doing

> > > > > the

> > > > > > tests. One simple thing to do is to go ahead and check

with

> > > your

> > > > > > insurance company to see if they cover these tests. This

> may

> > > make

> > > > > > your decision much simpler. Unfortunately, I suspect that

> the

> > > way

> > > > > > that most labs draw and ship your blood sample may not be

> > > > reliable

> > > > > > because, in our experience, we have had less than 10% of

> > > > patient's

> > > > > > tests come back positive for HHV-6 cell culture and only

a

> > > modest

> > > > > > percent come back positive for the Mycoplasma. For the

PCR

> > > > > Mycoplasma

> > > > > > test, the blood has to be frozen (see boxed inset, Page 9

> > > > > > > ). If the blood is left at room temperature, most of

the

> > > > positive

> > > > > > samples become negative after one to two days.

> > > > > > > Mycoplasma testing is not as specific as HHV-6 testing

is

> > for

> > > > > > CFIDS/FMS/Multiple Sclerosis (i.e., it is positive in

other

> > > > > > illnesses). For example, about half the patients with

> > > Rheumatoid

> > > > > > Arthritis are also found to be infected with treatable

> > > > infections,

> > > > > > including Mycoplasma. This goes along with my, and other

> > > doctors'

> > > > > > experience, that Doxycycline is often effective in

treating

> > > > > > Rheumatoid Arthritis. Interestingly, although Mycoplasma

is

> > > > common

> > > > > in

> > > > > > the environment, it usually is fairly noninvasive. It may

> > > simply

> > > > be

> > > > > > that once your immune system is weakened, these

infections

> > can

> > > > get

> > > > > > into cells where they don't belong. When that happens,

even

> > > some

> > > > of

> > > > > > the common ones that are considered noninfectious can

wreak

> > > > havoc.

> > > > > > When these infections repro-duce slowly, they tend to be

> low-

> > > > grade,

> > > > > > chronic infections, as opposed to the acute and more

> > prominent

> > > > > > symptoms seen with bacterial and viral infections that

> > multiply

> > > > and

> > > > > > divide rapidly.

> > > > > > > For CFS/ME or FMS or Autoimmune Disease Patients,

> > > > > > > The Institute for Molecular Medicine suggests the

> following

> > > lab

> > > > > > tests:

> > > > > > > (Codes are I.M.D. or CPT Codes)

> > > > > > > 1. Test Panel 1007 (CPT: 87798x3, 87581) Mycoplasma

> species

> > > > panel

> > > > > > of 4 pathogenic mycoplasmas (M. fermentans, M.

penumoniae,

> M.

> > > > > > hominis, M. penetrans) by PCR.

> > > > > > > Justification: Almost 60% of CFS/FMS and 50% of

> Rheumatoid

> > > > > > Arthritis (RA) and other autoimmune patients have one or

> more

> > > > > > intracellular, systemic mycoplasmal infections similar to

> > those

> > > > > found

> > > > > > in a variety of chronic illnesses [Nicolson, et al.,

> > > Mycoplasmal

> > > > > > infections in chronic illnesses: Fibromyalgia and Chronic

> > > Fatigue

> > > > > > Syndromes, Gulf War Illness, HIV-AIDS and Rheumatoid

> > Arthritis;

> > > > > > Medical Sentinel 1999; 5:172-176]. Ultrasensitive and

> > > > ultraspecific

> > > > > > mycoplasma tests can only be done by a small number of

> labs,

> > > most

> > > > > > university or government labs that have been trained by

us

> > > under

> > > > a

> > > > > > U.S. government contract.

> > > > > > > Specimen Requirements: One (1) 5 cc Lavender-top

Plastic

> > Tube

> > > > > > (EDTA). The blood is collected, immediately mixed and

> placed

> > on

> > > > > ice,

> > > > > > then shipped on wet ice or immediately flash frozen and

> > shipped

> > > > > with

> > > > > > dry ice by courier (foreign shipments) to I.M.D. to

arrive

> > > within

> > > > > 24-

> > > > > > 36 hours. Cost=$250. (Note that other commercial labs

> charge

> > > $400-

> > > > > > 600.)

> > > > > > > 2. Test 1006 (CPT: 87486) Chlamydia pneumoniae test by

> PCR.

> > > > > > Justification: Many CFS, FMS, MS, RA and other patients

> have

> > > this

> > > > > > systemic infection along with viral infection(s). We were

> > among

> > > > the

> > > > > > few labs that developed the molecular tests that are now

> done

> > > for

> > > > > > this type of infection. The other labs that use these

> > > procedures

> > > > > are

> > > > > > university labs.

> > > > > > > Specimen Requirements: One (1) 5 cc Lavender-top

Plastic

> > Tube

> > > > > > (EDTA). The blood is collected, immediately mixed and

> placed

> > on

> > > > > ice,

> > > > > > then shipped on wet ice or immediately flash frozen and

> > shipped

> > > > > with

> > > > > > dry ice by courier to I.M.D. to arrive within 24-36

hours.

> > > > > Cost=$180.

> > > > > > (Note that other commercial labs charge $200-250.)

> > > > > > > 3. Test 07047 (CPT: 87476) Borrelia burgdorferi (Lyme

> > > Disease)

> > > > > test

> > > > > > by PCR.

> > > > > > > Justification: Many CFS, FMS and RA patients have this

> > > systemic

> > > > > > infection (diagnosed as Lyme Disease) along with other

> > infection

> > > > > (s).

> > > > > > > Specimen Requirements: One (1) 5 cc Lavender-top

Plastic

> > Tube

> > > > > > (EDTA). The blood is collected, immediately mixed and

> placed

> > on

> > > > > ice,

> > > > > > then shipped on wet ice or immediately flash frozen and

> > shipped

> > > > > with

> > > > > > dry ice by courier to I.M.D. to arrive within 24-36

hours.

> > > > > Cost=$180.

> > > > > > (Note that other commercial labs charge $200-250.)

> > > > > > > 4. Test 07039 (CPT: 87532) Human Herpes Virus 6 (HHV-6)

> > test

> > > by

> > > > > > PCR.

> > > > > > > Justification: Many CFS and some FMS patients have this

> > > > systemic

> > > > > > viral infection, and it should be tested for in any

> > autoimmune

> > > > > > illness.

> > > > > > > Specimen Requirements: Collect blood in one (1) 5 cc

> > Lavender-

> > > > top

> > > > > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > > > > centrifugation. The plasma is then shipped on wet ice or

> > > > > immediately

> > > > > > flash frozen and shipped with dry ice by courier to

I.M.D.

> to

> > > > > arrive

> > > > > > within 24-36 hours. Cost=$180. (Note that other

commercial

> > labs

> > > > > > charge $200-350.)

> > > > > > > 5. Test 07034 (CPT: 87496) Cytomegalovirus (CMV) test

by

> > PCR.

> > > > > > > Justification: Many CFS and FMS patients have this

> systemic

> > > > viral

> > > > > > infection, and it should be tested for in any autoimmune

> > > illness.

> > > > > > > Specimen Requirements: Collect blood in one (1) 5 cc

> > Lavender-

> > > > top

> > > > > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > > > > centrifugation. The plasma is then shipped on wet ice or

> > > > > immediately

> > > > > > flash frozen and shipped with dry ice by courier to

I.M.D.

> to

> > > > > arrive

> > > > > > within 24-36 hours. Cost=$180. (Note that other

commercial

> > labs

> > > > > > charge $200-300.)

> > > > > > > For the best price and highest quality, the above PCR

> > > specialty

> > > > > > tests for CFS/FMS patients can be ordered through

> > International

> > > > > > Molecular Diagnostics, Inc., 15162 Triton Lane,

Huntington

> > > Beach,

> > > > > CA

> > > > > > 92649, U.S.A. Tel: 714-799-7177, ext. 202 (Client

Services)

> > or

> > > > ext.

> > > > > > 204 (Brant Blasingame). Order forms and additional

> > information

> > > > are

> > > > > > available upon request. They also offer testing for blood

> > > > clotting

> > > > > > abnormalities (see below). Tests must be ordered by a

> > > physician.

> > > > > The

> > > > > > I.M.D. Web site is www.imd-lab.com. On this site you will

> > find

> > > > > > additional information about testing and disease. The

> > Institute

> > > > for

> > > > > > Molecular Medicine Web site is www.immed.org. On this

site

> > you

> > > > will

> > > > > > find publications and documents on CFS/ME, FMS,

autoimmune

> > > > diseases

> > > > > > and other chronic illnesses. Immediate fax-back

information

> > is

> > > > > > available 24 hours per day by calling our telephone

number

> > 714-

> > > > 903-

> > > > > > 2900.

> > > > > > > Garth Nicolson, Adjunct Professor of Internal Medicine

> > > > > > > President and Chief Scientific Officer, The Institute

for

> > > > > Molecular

> > > > > > Medicine

> > > > > > > —A nonprofit institute dedicated to discovering new

> > > diagnostic

> > > > > and

> > > > > > therapeutic solutions for chronic diseases—

> > > > > > > 15162 Triton Lane, Huntington Beach, CA 92649-1041,

> > U.S.A. •

> > > > Tel:

> > > > > > 714-903-2900 • Fax: 714-379-2082

> > > > > > > So, What Is Prescribed For Mycoplasma And Chlamydia?

> > > > > > > Fortunately, Mycoplasma and Chlamydia infections are

> > usually

> > > > > > sensitive to the right antibiotics. The antibiotics most

> > likely

> > > > to

> > > > > > effect these organisms are:

> > > > > > > 1. Doxycycline or Minocycline 100 mg, 2-3 times a day.

> > These

> > > > two

> > > > > > antibiotics are in the Tetracycline-family and should not

> be

> > > used

> > > > > in

> > > > > > children under eight years-old because they can cause

> > permanent

> > > > > > staining of the teeth. They are very effective, though,

> > against

> > > a

> > > > > > number of unusual organisms (e.g., Lymes Disease). They

> will

> > > > > > sometimes cause some stomach upset. If this occurs, take

> the

> > > > > medicine

> > > > > > with food and a full glass of water or lower the dose. Do

> not

> > > use

> > > > > > outdated/expired Tetracycline prescriptions—they can kill

> you!

> > > > > > > 2. Cipro (Ciprofloxacin) 750 mg, twice a day. Although

> > > > expensive,

> > > > > > this is usually a well-tolerated antibiotic. It has a

very

> > wide

> > > > > range

> > > > > > of effectiveness against a large number of organisms.

When

> > > > treating

> > > > > > males, the Cipro (as well as the Doxycycline) has the

> > > additional

> > > > > > benefit of treating any hidden prostate infections. Do

not

> > take

> > > > > oral

> > > > > > magnesium within 6 hours of Cipro or you won't absorb the

> > Cipro.

> > > > > > > 3. Zithromax 600 mg a day, taken with food, or Biaxin

500

> > mg,

> > > > > twice

> > > > > > a day, taken on an empty stomach. These are in the

Erythro-

> > > mycin

> > > > > > family. Zithromax tends to be fairly well-tolerated. The

> > Biaxin

> > > > is

> > > > > > more likely to cause a bit of nausea in some patients,

but

> it

> > > is

> > > > > > usually well-tolerated. Both are quite expensive. They

may

> > work

> > > > > > against infections missed by Doxycycline and Cipro.

> > > > > > > Although all of these antibiotics can be effective, it

is

> > not

> > > > > > uncommon for infections that are sensitive to the

> > Erythromycin

> > > > > > antibiotics (#3 above) to be resistant to #1 and #2 above

> and

> > > > vice-

> > > > > > versa. Therefore, it is best to try either Doxycycline or

> > Cipro

> > > > > > first. If they are not effective, then try the Zithromax

or

> > > > Biaxin.

> > > > > > The antibiotic should be taken for at least 6 months. If

> > there

> > > is

> > > > > no

> > > > > > improvement in 4 months, switch to or add the other

> > antibiotic

> > > or

> > > > > > simply stop the treatment. It is helpful to check for low-

> > grade

> > > > > > fevers. I am more likely to use antibiotics for CFIDS

> > patients

> > > > who

> > > > > > have temperatures over 98.6°F, even if it is only 98.8°

(I

> > > > consider

> > > > > > 98.8° a fever because CFIDS/FMS patients usually have low

> > body

> > > > > > temperatures). If you do have low-grade, chronic

> temperature

> > > > > > elevations, be sure that you monitor your temperatures

> during

> > > > > > treatment. If your temperature drops with the antibiotic,

> it

> > > > > suggests

> > > > > > that you do have one of these nonviral infections and the

> > > > > antibiotic

> > > > > > is helping. T

> > > > > > > his would encourage me to continue the antibiotic

trial -

> > > even

> > > > if

> > > > > > it takes up to 12 months to see an improvement in your

> > > symptoms.

> > > > > > > If you are clearly better, I would probably take the

> > > antibiotic

> > > > > for

> > > > > > at least 6 to 12 months. It can then be stopped. If

> symptoms

> > > > recur,

> > > > > > keep repeating 6 to 8 week cycles until the symptoms stay

> > gone.

> > > > It

> > > > > > may take several years of treatment for the infection to

be

> > > > totally

> > > > > > eradicated. To put it in perspective, this is how long

> > children

> > > > > often

> > > > > > take antibiotics for acne—which unfortunately, if not

taken

> > > with

> > > > > anti-

> > > > > > fungals, can lead to yeast overgrowth and possibly

trigger

> > > CFIDS.

> > > > > Be

> > > > > > sure to take Nystatin, 2 tablets, 2 times a day, while on

> the

> > > > > > antibiotics. Also, please be sure to use alternative

birth

> > > > control

> > > > > if

> > > > > > on " the pill. " Birth control pills may be ineffective

while

> > > > taking

> > > > > > antibiotics. In addition, anti-depressants, codeine,

> > antacids,

> > > > and

> > > > > > mineral supplements (e.g., magnesium) may block

antibiotic

> > > > > > absorption. Take these at least three hours away from the

> > > > > antibiotic

> > > > > > (and don't take the antidepressant/codeine medications if

> > they

> > > > are

> > > > > > not clearly helping).

> > > > > > > It is very common to get die-off (Herxheimer) reactions

> > which

> > > > > > include chills, fever, night sweats and general worsening

> of

> > > > > CFS/FMS

> > > > > > symptoms when the antibiotic first kills off the

infection.

> > > These

> > > > > can

> > > > > > be severe and last for weeks. Dr. Nicolson encourages

> you " to

> > > be

> > > > > > patient and not abandon therapy prematurely, because few

> > > patients

> > > > > who

> > > > > > have been sick for years recover in less than one year of

> > > > > therapy...

> > > > > > [don't] be alarmed if some signs and symptoms

occasionally

> > > return

> > > > > or

> > > > > > worsen. This is not unusual. Eventually you will be off

> > > > antibiotics

> > > > > > or antivirals but you will need to continue various

> > supplements

> > > > to

> > > > > > maintain your immune system and general nutritional

status. "

> > > > > > > Treatment for Bacterial, Mycoplasma, Chlamydia, E-coli,

> > > > Bladder,

> > > > > Or

> > > > > > Other Infections

> > > > > > > (From the " Treatment Checklist " used in Dr.

Teitelbaum's

> > > > office.

> > > > > A

> > > > > > full list is available on Dr. Teitelbaum's Web site at

> > > > > > www.endfatigue.com.)

> > > > > > > The Mycoplasma, Chlamydia, E-Coli, bladder and other

> > > bacterial

> > > > > > infections usually take months to years to eradicate. It

is

> > > > common

> > > > > to

> > > > > > flare your symptoms (from the infection die-off) the

first

> > two

> > > > > weeks

> > > > > > of treatment. Take the antibiotics for six months and, if

> > > better,

> > > > > > then repeat six-week cycles till your symptoms stay gone.

> > > > > > Antidepressants, Neurontin, and/or Codeine may block the

> > > > > antibiotic's

> > > > > > effectiveness. Be sure to take Nystatin, 2 tablets twice

a

> > day,

> > > > and

> > > > > > Acidophilus while on the antibiotics. If you have

> occasional

> > > low-

> > > > > > grade fever (i.e., if over 98.6° F), check your oral

> > > temperature

> > > > > > occasionally to see if the antibiotic reduces or

eliminates

> > the

> > > > > > fever. If so, stay on that antibiotic. Also, see Dr.

> > Nicolson's

> > > > Web

> > > > > > site at www.immed.org for additional information.

> > > > > > > Useful antibiotic treatment for the above infections

> > include:

> > > > > > > 1. Cipro (ciprofloxacin) 750 mg, 2 times a day for 6

> > months.

> > > Do

> > > > > not

> > > > > > take magnesium products (e.g., Fibrocare, some antacids,

> Pro

> > > > > Energy,

> > > > > > or (Dr. Teitelbaum's) Foundation Formula™) within 6 hours

> of

> > > > Cipro

> > > > > > because you won't absorb the Cipro.

> > > > > > > OR

> > > > > > > 2. Doxycycline (a tetracycline) 100 mg, 3 times a day

for

> 6

> > > > > months.

> > > > > > If symptoms recur when the Doxycycline is completed, keep

> > > > repeating

> > > > > 6-

> > > > > > week courses until the symptoms stay resolved. Take

> Nystatin

> > > (at

> > > > > > least 2, twice a day) while on the antibiotic. Birth

> control

> > > > pills

> > > > > > may not work while on Doxycycline. Do not take any

expired

> > > > > > Doxycycline tablets (it's very dangerous).

> > > > > > > OR

> > > > > > > 3. Zithromax (azithromycin) 600 mg tablets, 1 tablet a

> day

> > > > (take

> > > > > > with food if it bothers your stomach). Don't take

magnesium-

> > > > > > containing products within six hours of the Zithromax.

> > > > > > > OR

> > > > > > > 4. Biaxin 500 mg, 2 times a day.

> > > > > > > 5. D-Mannose ½ to 1 teaspoon (2.5 grams), stirred in

> water,

> > > > every

> > > > > 2

> > > > > > to 3 hours while awake, for 2 to 5 days for acute bladder

> > > > > infections

> > > > > > (may use long-term for chronic infections) caused by E-

coli

> > > (this

> > > > > > causes approximately 90% of bladder infections). If not

> much

> > > > better

> > > > > > in 24 hours, get a urine culture and consider an

> antibiotic.

> > D-

> > > > > > Mannose is available from BioTech (800-345-1199), my Web

> > > > > > site's " Vitamin Shop " at www.endfatigue.com or my office

> (800-

> > > 333-

> > > > > > 5287).

> > > > > > > What About Yeast Overgrowth?

> > > > > > > Yeast overgrowth is an important concern. As I have

> > mentioned

> > > > > > before, nothing is all good or all bad. Although

cigarettes

> > > kill

> > > > > > hundreds of thousands of people each year, they can be

> > helpful

> > > in

> > > > > > treating Parkinson's Disease or ulcerative colitis.

> Although

> > > > > > antibiotics can trigger CFIDS, they can also be helpful

in

> > > > treating

> > > > > > it. This makes it important to know when and how to use

> them.

> > I

> > > > > > strongly recommend that my patients take antifungals

while

> on

> > > any

> > > > > > antibiotics (e.g., Nystatin 500,000 unit tablets, 2

> tablets,

> > 2

> > > to

> > > > 3

> > > > > > times a day) to prevent yeast overgrowth. It is also

> > reasonable

> > > > to

> > > > > > add Oregano Oil and other natural antifungals. Two

Nystatin

> > > twice

> > > > a

> > > > > > day is what I usually prescribe. Using probiotics

(healthy

> > milk

> > > > > > bacteria-like acidophilus that helps your body) to

compete

> > with

> > > > the

> > > > > > yeast can also help. I am concerned that if the

acidophilus

> > is

> > > > > taken

> > > > > > with the antibiotic, they may simply cancel each other

out.

> > > > Because

> > > > > > of this, I usually begin probiotics (Acidophilus or

> > > Lactobacillus

> > > > > in

> > > > > > a d

> > > > > > > ose of 3 to 6 billion units a day, taken on an empty

> > stomach

> > > or

> > > > > > with milk) after one has completed the course of

> antibiotics.

> > > If

> > > > > you

> > > > > > are only taking the antibiotic once or twice a day, and

can

> > > find

> > > > a

> > > > > > time at least 6 to 8 hours away from another dose to take

> the

> > > > > > probiotic, it is reasonable to take it at that time. The

> > entire

> > > > > daily

> > > > > > probiotic dose can also be taken at one time. If you find

> > that

> > > > you

> > > > > > still get yeast overgrowth, it may be necessary to use

some

> > of

> > > > the

> > > > > > more potent prescription antifungals (Sporanox or

> Diflucan).

> > > > > Because

> > > > > > these can cause liver inflammation and are quite

expensive,

> > it

> > > > may

> > > > > be

> > > > > > adequate to take 200mg of either of these, twice a day,

one

> > day

> > > > > each

> > > > > > week (e.g., take it every Sunday) instead of every day.

As

> > > > > discussed

> > > > > > previously, be sure to take Lipoic acid 200 mg on any day

> you

> > > > take

> > > > > > Sporanox or Diflucan, to decrease the risk of liver

> > > inflammation.

> > > > > > > What Role Does My Blood Clotting System Play In This?

> > > > > > > Work done by E. Berg, M.S., C.L.S. (N.C.A.),

> director

> > > of

> > > > > > Hemex Laboratories in Phoenix, Arizona (800-999-2568),

has

> > > shown

> > > > > that

> > > > > > a number of infections can trigger our blood clotting

> system

> > to

> > > > > > become active, thus setting up a low-level, chronic

> clotting

> > > > > cascade.

> > > > > > These infections include HHV-6, Mycoplasma, CMV and

> Chlamydia

> > > > which

> > > > > > can trigger production of (IgA) antibodies against clot

> > > > protective

> > > > > > proteins on blood vessel inner surfaces (called

> > > antiphospholipid

> > > > > > antibodies). One of these is the Beta 2 Glyco-protein 1

> (anti

> > > > B2GP1—

> > > > > > no, you are not going to be tested on this!). This then

> > > triggers

> > > > > the

> > > > > > clotting cascade. Once the clotting system is triggered,

a

> > > > product

> > > > > > called Soluble Fibrin Monomer (SFM) is made which is like

> the

> > > > > > polymers in plastic. The theory is that they create long

> thin

> > > > > sheets

> > > > > > of a teflon-like substance, similar to the scab that

covers

> a

> > > > cut,

> > > > > > but microscopic, which then coats the blood vessels. This

> > makes

> > > > it

> > > > > > hard for nutrients, oxygen, etc., to get in and out of

the b

> > > > > > > lood vessels to the cells where they are needed. In

> > summary,

> > > > many

> > > > > > infections can cause the blood clotting system to

activate,

> > > > > resulting

> > > > > > in a thin coating of Fibrin deposited on the blood

vessels.

> > > This

> > > > > > prevents nutrients and oxygen from getting to the cells

in

> > your

> > > > > body.

> > > > > > > Why Would An Infection Trigger The Clotting System?

> > > > > > > Many infections (called anaerobic) do not survive well

in

> > the

> > > > > > presence of oxygen. One can theorize that these

Mycoplasma

> > > (which

> > > > > may

> > > > > > be anaerobic) and other organisms may trigger the

clotting

> > > system

> > > > > to

> > > > > > create a shell, which then acts like a suit of armor,

> > > protecting

> > > > > them

> > > > > > from oxygen, your body's defense system, and antibiotics.

> > This

> > > > > would

> > > > > > explain why these infections could evolve a way to

trigger

> > the

> > > > > > clotting mechanism. The Fibrin armor preventing

antibiotics

> > > from

> > > > > > getting to the infection could also explain why some

people

> > > with

> > > > > > these infections may not respond to antibiotics. Indeed,

> some

> > > > > > physicians have found that the antibiotics work better

once

> > > > someone

> > > > > > has been on a blood thinner (which may dissolve the

armor).

> > > > > > > This is an interesting theory, but how do we know this

is

> > > going

> > > > > on?

> > > > > > Mr. Berg and others have done studies showing that the

> blood

> > > > tests

> > > > > > that look for these clotting changes (called the ISAC

> panel -

> > > > > > available at Hemex labs) are abnormal in CFIDS/FMS

patients

> > > while

> > > > > > being normal in most other patients. They use a criterion

> of

> > > two

> > > > of

> > > > > > these tests needing to be abnormal to be considered

> positive.

> > > > When

> > > > > > this was done, 50 of 54 CFIDS/FMS patients had abnormal

> tests

> > > > > (i.e.,

> > > > > > only 7.4% of the patients had normal blood tests). In

> healthy

> > > > > > patients, 22 out of 23 had normal blood tests (i.e.,

96%).

> > This

> > > > > means

> > > > > > the test is both very sensitive and specific, picking up

> > people

> > > > > with

> > > > > > CFIDS and excluding healthy people. Our experience has

> shown

> > > that

> > > > > > almost everyone that we tested, who has CFIDS, has turned

> out

> > > to

> > > > > have

> > > > > > a positive ISAC panel. We have not personally sent in any

> > tests

> > > > on

> > > > > > healthy patients to see if this also occurs.

Interestingly,

> > > this

> > > > > > panel is also positive in many people with unexplained

infer

> > > > > > > tility (which can improve with Heparin) and may also be

> > > > positive

> > > > > in

> > > > > > people with Multiple Sclerosis, Parkinsons, Autism,

> > > Inflammatory

> > > > > > Bowel Disease and some other illnesses. This suggests

that

> > this

> > > > > test

> > > > > > can be helpful in deciding whether to treat with blood

> > thinners

> > > > > > (Heparin) in CFIDS/FMS.

> > > > > > > So, How Do I Treat The Clotting System?

> > > > > > > First of all, it is important to remember that using

> > > injections

> > > > > of

> > > > > > Heparin (the blood thinner) is still a controversial and

> > > > > experimental

> > > > > > treatment for CFIDS/FMS. We much prefer to use treatments

> > that

> > > > are

> > > > > as

> > > > > > safe as possible. Although Heparin is routinely used in

the

> > > > U.S.A.

> > > > > to

> > > > > > treat blood clots, using it to treat CFIDS/FMS is very

new.

> > > Most

> > > > of

> > > > > > the doctors that I have spoken with have only treated a

few

> > > > > CFIDS/FMS

> > > > > > patients with Heparin and find that about half of these

> > > patients

> > > > > get

> > > > > > better with treatment. The treatment protocol, developed

by

> > >

> > > > > > Couvaras, M.D. (602-996-2411), includes the following:

> > > > > > > 1. Remove wheat, alcohol and sugar from the diet, if

> > possible.

> > > > > > > 2. Check the ISAC panel. If there are at least two

> abnormal

> > > > > > results, then begin treatment.

> > > > > > > 3. Give an antifungal for 14 days (he uses Lamisil

250mg

> a

> > > day—

> > > > > > which I find to be poorly effective. I would use 200 mg

of

> > > > Sporanox

> > > > > > or Diflucan instead).

> > > > > > > 4. Give standard Heparin 4000 to 8000 units by

injection

> > > > > > subcutaneously (like an insulin shot) twice a day. A

> > (possibly

> > > > > safer)

> > > > > > low molecular weight Heparin may also be used.

> > > > > > > 5. If the PA index (on the ISAC) is positive, add a

baby

> > > > Aspirin

> > > > > > (81mg) each day.

> > > > > > > 6. After being on Heparin for one week, Dr. Couvares

> > repeats

> > > > the

> > > > > > ISAC panel to adjust the dose of the Heparin and Aspirin.

> He

> > > > feels

> > > > > > that the goal is to move all the blood tests into the

> normal

> > > > range

> > > > > > but not past the normal range into blood-thinning

> > (therapeutic)

> > > > > > levels. If the values are still abnormal or the patient

is

> > > still

> > > > > > having symptoms, he then increases the Heparin dosage. If

> the

> > > PA

> > > > > > index (on the ISAC) is still high, he increases the

Aspirin

> > to

> > > > > twice

> > > > > > a day.

> > > > > > > 7. If the patient feels better after one month of

> Heparin,

> > he

> > > > > then

> > > > > > switches to low-dose Coumadin (a blood thinner tablet—

take

> 2

> > to

> > > 3

> > > > > mg

> > > > > > a day) and then stops the Heparin after 4 to 5 days of

> being

> > on

> > > > the

> > > > > > Coumadin. Once the patient has been on the Coumadin for

two

> > > weeks

> > > > > he

> > > > > > goes ahead and rechecks the ISAC panel to maintain the

> blood

> > > > tests

> > > > > in

> > > > > > the normal range.

> > > > > > > 8. He also supplements patients with nutritional

> > > > supplementation

> > > > > as

> > > > > > needed.

> > > > > > > In my practice, because the ISAC panel runs over $320,

I

> > > check

> > > > a

> > > > > > baseline ISAC panel but do not repeat the ISAC panels to

> > adjust

> > > > > > therapy. Instead, while on Heparin, we check a PTT (a

blood

> > > > > thinning

> > > > > > test) and platelets (a highly unusual, but potentially

very

> > > > > dangerous

> > > > > > side effect of Heparin is a severe drop in platelet

count,

> > > which

> > > > > can

> > > > > > cause life-threatening bleeding) every 3 days for the

first

> > 12

> > > > days

> > > > > > and then every 2 to 4 weeks while on Heparin. If the PTT

is

> > > still

> > > > > > within the normal range and the patient is not better, we

> > > > increase

> > > > > > the Heparin as high as 8000 units, twice a day (rarely we

> > will

> > > go

> > > > > up

> > > > > > to 8000 units, 3 times a day) and then also increase the

> > > Aspirin

> > > > to

> > > > > 2

> > > > > > a day. In comparison, hospital patients often require

> Heparin

> > > at

> > > > > 1000

> > > > > > units per hour (24,000 units a day) I.V., while most

> CFS/FMS

> > > > > patients

> > > > > > only need 4000 to 5000 units, 2 times a day (8000 to

10,000

> > > units

> > > > a

> > > > > > day). If the patient is feeling better, however, we

simply

> > > leave

> > > > > them

> > > > > > at the initial dose. Most patients will f

> > > > > > > eel better at about the 10- to 14-day point if the

> Heparin

> > is

> > > > > going

> > > > > > to help. At the end of 4 to 12 months, if the Heparin

> helps,

> > we

> > > > > > switch to Coumadin (as noted above) and check an INR

> > > > (International

> > > > > > Normalized Ratio), aiming to keep it below 1.3 while

> > adjusting

> > > > the

> > > > > > Coumadin to the optimum does. It is very important to

know

> > that

> > > > > most

> > > > > > medications can change the blood level of Coumadin and

that

> > > > anytime

> > > > > > anything is added to, or deleted from, your regimen

> > (including

> > > > > > natural remedies) you need to recheck the INR 4 to 7 days

> > later

> > > > to

> > > > > > make sure that it is not going too high. Heparin and

> Coumadin

> > > are

> > > > > > powerful medicines and the main risk is bleeding.

Although

> we

> > > are

> > > > > > using very low doses, which are usually very well-

> tolerated,

> > > one

> > > > > can

> > > > > > rarely see a life-threatening bleed occur. If you felt

> better

> > > on

> > > > > the

> > > > > > Heparin and then the symptoms come back on the Coumadin,

> you

> > > may

> > > > > need

> > > > > > to go back on the Heparin for several months to re-

> establish

> > > and

> > > > > > maintain the benefit. Occasionally, people will need to b

> > > > > > > e on the Heparin for an extended period, in which case

> the

> > > > blood

> > > > > > tests (PTT and platelet count) should be checked every 2

to

> 4

> > > > > weeks.

> > > > > > All of this being said, most people tolerate these

> treatments

> > > > quite

> > > > > > well and many, many more people die from taking Aspirin

> > (e.g.,

> > > > for

> > > > > > arthritis) than Heparin each year.

> > > > > > > In summary, there are a number of infections that can

> cause

> > > or

> > > > > > occur because you have CFIDS/FMS. Once they occur, they

can

> > > > trigger

> > > > > > the clotting cascade. This may keep the nutrients from

> > getting

> > > to

> > > > > > your body and create a " suit of armor " for the viral and

> > > > Mycoplasma

> > > > > > infections. Using a blood thinner can break down these

> armor

> > > > > coatings

> > > > > > that protect the infections from our treatment and allow

> > > > nutrients

> > > > > to

> > > > > > get where they need to go. Many tests can help. The one

> that

> > I

> > > > use

> > > > > to

> > > > > > decide whether to use the Heparin blood thinner is the

ISAC

> > > panel

> > > > > (at

> > > > > > Hemex Labs). Testing for infections may be helpful, but

can

> > be

> > > > > > expensive and less likely to effect my decision to treat.

> If

> > > you

> > > > > can

> > > > > > afford the tests and/or your insurance will pay for them,

> > they

> > > > are

> > > > > > worth checking and will make it easier to adjust therapy

> over

> > > > time.

> > > > > > If you can't afford it, it is reasonable to treat

> empirically

> > > > > (i.e.,

> > > > > > without testing), except for high-dose Valtrex therapy.

If

> > you

> > > > have

> > > > > > lung congestion and/or recurrent temperatures o

> > > > > > > ver 98.6°F, I would treat with the antibiotics. If you

> feel

> > > > > > chronically flu-like, I would consider the HHV-6 or

(based

> on

> > > > > > testing) the high-dose Valtrex regimen. It is also

> reasonable

> > > to

> > > > > > treat with antibiotics and antivirals simultaneously -

> > > especially

> > > > > if

> > > > > > you are taking the anticoagulants.

> > > > > > > Chronic Sinusitis The Yeasty Beasties Revisited!

> > > > > > > As was mentioned years ago, we speculated that the

> chronic

> > > > sinus

> > > > > > congestion seen in CFIDS/FMS could be caused by yeast

> > > overgrowth.

> > > > A

> > > > > > recent interesting study from the Mayo Clinic Proceedings

> > > > supports

> > > > > > this thought. In the study, researchers found that most

> > people

> > > > with

> > > > > > chronic sinus infections had fungal growth in their

> sinuses.

> > > They

> > > > > > felt that the inflammation was being caused by an immune

> (the

> > > > > body's

> > > > > > reaction) response to the fungus. This research is

> > interesting

> > > > > > because more and more studies are showing that treating

> > chronic

> > > > > > sinusitis with antibiotics doesn't really do much and

that

> > > > shorter

> > > > > > courses of treatment work just as well as the long

courses.

> > We

> > > > find

> > > > > > that conservative treatment (see my newsletter article,

> > > Treatment

> > > > > Of

> > > > > > Respiratory Infections Without Antibiotics, Vol. 2, Issue

> 2)

> > is

> > > > > more

> > > > > > effective than antibiotics for chronic sinusitis.

> > > > > > > It's good that medicine is finally starting to catch up

> > with

> > > > > > reality. The report in The Mayo Clinic Proceedings noted

> > > > > > that, " fungus allergy was thought to be involved in less

> than

> > > 10%

> > > > > of

> > > > > > cases… our studies indicate, in fact, fungus is likely

the

> > > cause

> > > > of

> > > > > > nearly all of these problems and that it is not an

allergic

> > > > > reaction

> > > > > > but an immune reaction. " In this study, the researchers

> > studied

> > > > 210

> > > > > > patients with chronic sinusitis. Using new methods to

> collect

> > > and

> > > > > > test sinus/nasal mucus they found fungus in 96% of

> patients.

> > > > > > > It's interesting to observe how medical research works.

> The

> > > > > > researchers are now working with different drug companies

> to

> > > set

> > > > up

> > > > > > trials to test medications to control the fungus but feel

> > that

> > > it

> > > > > > will be at least two years before any treatments will be

> > > > available.

> > > > > > In my experience, though, these problems often respond

> > > > dramatically

> > > > > > to either Sporanox or Diflucan - which, by no

coincidence,

> > are

> > > > very

> > > > > > powerful antifungal agents. It is not clear why the

> > researchers

> > > > did

> > > > > > not simply try Sporanox or Diflucan. Un-fortunately, we

> find

> > > that

> > > > > the

> > > > > > obvious is often overlooked. This sometimes occurs as

drug

> > > > > companies

> > > > > > seek to make more money by finding new drugs instead of

> using

> > > the

> > > > > old

> > > > > > things that are known to work. It is important to

> distinguish

> > > > > between

> > > > > > chronic sinusitis (which lasts for over three months) and

> > acute

> > > > > > sinusitis (which usually has been going on for a few days

> and

> > > > less

> > > > > > than a month). For these shorter attacks of sinusitis,

> > bacteria

> > > > are

> > > > > a

> > > > > > more common cause and antibiotics (combined with n

> > > > > > > atural remedies) can be helpful. Some researchers still

> > > > continue

> > > > > to

> > > > > > argue that fungus is not a cause of chronic sinusitis.

They

> > > note

> > > > > that

> > > > > > fungi are seen even in healthy noses (which is correct)

but

> > > > neglect

> > > > > > to discuss the immune changes that are also seen in these

> > > noses.

> > > > > > Because so many people have responded dramatically to

> > > antifungals

> > > > > in

> > > > > > the treatment of their chronic sinusitis, my suspicion is

> > that

> > > > the

> > > > > > Mayo Clinic researchers are probably correct. Wouldn't it

> be

> > > > nice,

> > > > > if

> > > > > > instead of arguing about treatments while people stay

sick,

> > > they

> > > > > > would just try the treatments to see if they worked!

> > > > > > > As you can see, your body's defenses being down plays a

> > large

> > > > > role

> > > > > > in CFIDS/FMS. The good news is, that by treating the many

> > > > > underlying

> > > > > > infections common in CFIDS patients and by treating any

> > > hormonal

> > > > > and

> > > > > > nutritional deficiencies, you can bring your immune

system

> > back

> > > > to

> > > > > a

> > > > > > healthy state!

> > > > > > > Important Points

> > > > > > > • An important component of CFS is disordered immune

> > > function,

> > > > > > which opens the door to repeated infections, repeated

> > treatment

> > > > > with

> > > > > > antibiotics, and yeast overgrowth.

> > > > > > > • Treat yeast overgrowth by avoiding antibiotics and

> > sweets.

> > > > Many

> > > > > > patients have found Nystatin and other antifungal

> > medications,

> > > > such

> > > > > > as Diflucan and Sporanox, to be helpful. Acidophilus

(milk

> > > > > bacteria)

> > > > > > and natural antifungals such as Caprylic acid and garlic

> are

> > > also

> > > > > > often useful.

> > > > > > > • Bowel parasites are common in CFS patients, whose

> > symptoms

> > > > > often

> > > > > > respond dramatically to treatment. However, most labs do

> not

> > > > > > adequately detect parasites through stool testing. To get

> an

> > > > > accurate

> > > > > > test result, use one of the labs we recommended that

> > > specializes

> > > > in

> > > > > > stool testing.

> > > > > > > • Treat Cryptosporidium with Artemesia annua or

tricyclin

> > > > (herbal

> > > > > > antiparasitics).

> > > > > > > • Treat constipation with Turkey Rhubarb (a herb).

> > > > > > > • Prevent parasitic infection by using a Multi-pure

water

> > > > filter

> > > > > > (available from 888-801-8176 or 410-224-4877)

> > > > > > > • If you have temperatures over 98.6°F and/or chronic

> lung

> > > > > > congestion, try long-term Cipro or Doxycycline (while on

> > > > Nystatin).

> > > > > > > • If you have chronic flu-like symptoms, despite yeast

> and

> > > > Cortef

> > > > > > treatment, consider the antiviral, immune stimulating

> > protocol

> > > we

> > > > > > discussed.

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

Hi Krista,

My husband was the same way but after seeing 20 different western

medicine docs who said I was fine when I clearly wasn't he began

changing his view. I persuaded him by trying to find one woman who

has completely recovered by going to a regular MD. I couldn't find

one.

It seemed that the women who spoke of recovery talked about diet and

detox and seeing naturopaths. Most regular docs are just going to

put a bandaid on symptoms or tell you it's all in your head if they

don't know what's wrong. Believe, me, I wasn't this way before.

There are many MDs in my family but knowing what I know now, they

just aren't taught enough about reversing disease, only masking

symptoms. It's not their fault entirely...they're good people who

want to help but just don't know how.

Naturopaths understand the role of toxins better and how the body's

various systems affect one another. They also believe in giving you

natural support rather than synthetic drugs. - PH

> > > > > > > >

> > > > > > > > From Fatigued to Fantastic Newsletter

> > > > > > > > Vol. 3, No. 3 (2000)--Vol 4, No. 1 (2001)

> > > > > > > >

> > > > > > > > Fighting Those Persistent Infections in CFIDS

> > > > > > > > By Teitelbaum, M.D.

> > > > > > > > Medical science has known for quite some time that

> > Chronic

> > > > > > Fatigue

> > > > > > > Syndrome is associated with changes in the body's

immune

> > > > system.

> > > > > In

> > > > > > > fact, the acronym " CFIDS " stands for " Chronic Fatigue

And

> > > > Immune

> > > > > > > Dysfunction Syndrome. " This can result in your having

> > several

> > > > > > > different and unusual infections at one time. Many of

> these

> > > > > > > infections need to be treated directly. Other

infections

> > will

> > > > go

> > > > > > away

> > > > > > > on their own as your immune (defense) system comes

> back " on

> > > > line "

> > > > > > by

> > > > > > > using our treatment protocol. In this article, I'll

> discuss

> > > > some

> > > > > of

> > > > > > > the more common, yet not usually thought of

(in " regular "

> > > > > > medicine),

> > > > > > > infections.

> > > > > > > > What Kind Of Infections Am I Most At Risk For?

> > > > > > > > Although CFIDS of sudden onset often seems to be

> > triggered

> > > by

> > > > > > viral

> > > > > > > infections (e.g., EBV, HHV-6, CMV), those infections, I

> > > > suspect,

> > > > > > > are " simmering " or no longer active in many cases.

> However,

> > > the

> > > > > > body

> > > > > > > acts as if they are. This may result in elevated

> interferon

> > > > > levels.

> > > > > > I

> > > > > > > suspect this was what triggered my CFIDS.

> > > > > > > > The body produces interferon to fight viral

infections.

> > > When

> > > > a

> > > > > > > cancer or hepatitis patient is injected with

interferon,

> > the

> > > > > > patient

> > > > > > > becomes achy, fatigued and brain-fogged. An under-

active

> > > > adrenal

> > > > > > can

> > > > > > > also cause interferon levels to become elevated.

Because

> of

> > > > this

> > > > > > > elevation, it is more accurate to say that the body's

> > immune

> > > > > system

> > > > > > > is not functioning properly, than to say that it is

> > > > underactive.

> > > > > > > Indeed, in many ways, the immune system may be in

> overdrive

> > > and

> > > > > > soon

> > > > > > > exhaust itself. The immune system malfunctions in many

> > other

> > > > > ways,

> > > > > > > too, including decreasing the effectiveness of the

> > > > > body's " natural

> > > > > > > killer " cells, which are an important defense mechanism.

> > > > > > > > Many other recurrent or unusual infections can also

> occur

> > > > > because

> > > > > > > of your malfunctioning immune system. Chronic sinus,

> > bladder,

> > > > > > > prostate and respiratory infections are common and are

> > often

> > > > > > treated

> > > > > > > with repeated courses of antibiotics. The large amount

of

> > > > > > antibiotics

> > > > > > > introduced into the system can cause a secondary yeast

> over-

> > > > > growth

> > > > > > as

> > > > > > > it changes the natural balance between the bowel's

> healthy

> > > > > bacteria

> > > > > > > and yeast. The original immune dysfunction also

> contributes

> > > to

> > > > > the

> > > > > > > yeast overgrowth. Although it is controversial, a

theory

> > held

> > > > by

> > > > > > many

> > > > > > > physicians is that chronic overgrowth of yeast due to

> > overuse

> > > > of

> > > > > > > antibiotics is a potential and strong trigger for

chronic

> > > > > fatigue,

> > > > > > > fibromyalgia and further immune dysfunction. What makes

> the

> > > > > theory

> > > > > > > controversial is that no definitive tests exist to

> > > distinguish

> > > > > > fungal

> > > > > > > overgrowth from normal fungal levels. Also, many of the

> > > > symptoms

> > > > > > > ascribed to yeast overgrowth can also come from the

many

> > > other

> > > > > > > problems present in chronic fatigue syndrome and

fibromya

> > > > > > > > lgia. On the other hand, most doctors who try

treating

> > > yeast

> > > > in

> > > > > > at

> > > > > > > least three or four CFS patients see how well it works

> and

> > > keep

> > > > > > using

> > > > > > > it.

> > > > > > > > CFIDS patients also frequently have bowel parasite

> > > > infections.

> > > > > > > Bowel parasites can cause severe allergic or

sensitivity

> > > > > reactions,

> > > > > > > which in turn can trigger fibromyalgia and fatigue.

> Often,

> > a

> > > > > > patient

> > > > > > > will finally recover from long-standing and disabling

> > fatigue

> > > > > > within

> > > > > > > a week or two after beginning treatment for bowel

> parasites.

> > > > > > > > Many other CFS/FMS patients are left with disabling

> > fatigue

> > > > > after

> > > > > > a

> > > > > > > bout with viral infections such as polio, HHV-6, CMV,

or

> EB

> > > > viral

> > > > > > > infections. This fatigue also usually responds to the

> > > > treatments

> > > > > > > discussed in this newsletter. In addition, infections

> with

> > > > > unusual

> > > > > > > organisms such as Rickettsia (e.g., Lymes Disease),

> > > chlamydia,

> > > > > and

> > > > > > > mycoplasma may also be problematic.

> > > > > > > > Yeast Overgrowth

> > > > > > > > Everyone's immune system has strong spots, as well as

> > weak

> > > > > spots.

> > > > > > > Some people never get colds but have frequent bouts

with

> > > > > athlete's

> > > > > > > foot or other skin fungal infections. Others never get

> > fungal

> > > > > > > infections but tend to get colds. Many people seem to

> have

> > a

> > > > > > > diminished ability to fight off fungal infections.

> > > > > > > > Fungi are very complex organisms. Fungal overgrowth

may

> > > > > suppress

> > > > > > > the body's immune system. The host body may also

develop

> > > > allergic

> > > > > > > reactions to components of the yeast.

> > > > > > > > This allergic reaction was suggested in a study which

> > > > connects

> > > > > > > Candida Albicans with Allergic Skin Dermatitis

(Eczema).

> > This

> > > > > study

> > > > > > > was published in The Journal of Clinical Experimental

> > Allergy

> > > > > back

> > > > > > in

> > > > > > > 1993 (Vol. 23, pp. 332-339). It found that there is a

> > > > significant

> > > > > > > correlation between the body having antibodies to

Candida

> > and

> > > > > > > Allergic Dermatitis/Eczema. In addition, we have found

> that

> > > > > > > unexplained rashes that have lasted for many years

often

> > > clear

> > > > up

> > > > > > > with antifungal treatment as well! Many physicians feel

> > that

> > > > > yeast

> > > > > > > overgrowth causes a generalized suppression of the

immune

> > > > system.

> > > > > > In

> > > > > > > other words, once the yeast gets the upper hand, it

sets

> up

> > a

> > > > > cycle

> > > > > > > that further suppresses your body's defenses.

> > Interestingly,

> > > a

> > > > > > recent

> > > > > > > Mayo Clinic study showed that most cases of chronic

> > sinusitis

> > > > > seem

> > > > > > to

> > > > > > > be associated with a reaction to yeast in the sinuses -

> > > > something

> > > > > I

> > > > > > > proposed years ago. None the less, as I already noted,

> this

> > > > > theory

> > > > > > is

> > > > > > > controversial. Yeast are normal members of our

> body's " zoo.

> > > > > > > > " They live in balance with bacteria - some of which

> are

> > > > > helpful

> > > > > > > and healthy and some of which are detrimental and

> > unhealthy.

> > > > The

> > > > > > > problems begin when this harmonious balance shifts and

> the

> > > > yeast

> > > > > > > begin to overgrow.

> > > > > > > > As noted above, many things can prompt yeast to

> overgrow.

> > > One

> > > > > of

> > > > > > > the most common causes is frequent antibiotic use. When

> the

> > > > good

> > > > > > > bacteria in the bowel are killed off by antibiotics

> (along

> > > with

> > > > > the

> > > > > > > bad bacteria) the yeast no longer have competition and

> > begin

> > > to

> > > > > > > overgrow. The body is often able to rebalance itself

> after

> > > one

> > > > or

> > > > > > > several courses of antibiotics, but after repeated or

> long-

> > > term

> > > > > > > courses - and especially if the body has an underlying

> > immune

> > > > > > > dysfunction - the yeast can get the upper hand.

> > > > > > > > Other factors are also important. Studies have shown

> that

> > > > > animals

> > > > > > > who are sleep deprived and/or have increased sugar

intake

> > > > develop

> > > > > > > bowel yeast overgrowth. Many physicians feel that

eating

> > > sugar

> > > > > > > stimulates yeast overgrowth in people, as well. Sugar

is

> > food

> > > > for

> > > > > > > yeast. Yeast ferment sugar in order to grow and

multiply.

> > > Yeast

> > > > > > > overgrowth due to sugar overuse also seems to cause

> immune

> > > > > > > suppression, which facilitates bacterial infections,

> which

> > > then

> > > > > > > requires even more antibiotic use. Poor sleep also

> results

> > in

> > > > > > marked

> > > > > > > suppression of your immune function.

> > > > > > > > How Does One Know If They Have Yeast?

> > > > > > > > There are no definitive tests for yeast overgrowth

that

> > > will

> > > > > > > distinguish yeast overgrowth from normal yeast growth

in

> > the

> > > > > body.

> > > > > > > There is one test which may be useful, though. This is

a

> > > Urine

> > > > > > > Tartaric Acid test done by The Great Plains Lab in

Kansas

> > > City,

> > > > > > > Missouri, run by Shaw, Ph.D. Tartaric Acid is a

> > waste

> > > > > > product

> > > > > > > of yeast growth. In fermenting wine, for example, it is

> > > > critical

> > > > > to

> > > > > > > remove the Tartaric Acid. Otherwise, the wine could be

> > toxic

> > > to

> > > > > > > people. Dr. Shaw has found elevations in Urine Tartaric

> > Acid

> > > > that

> > > > > > > decrease with antifungal treatment in both CFIDS/FMS

> > patients

> > > > and

> > > > > > > autistic children. Interestingly, both these illnesses

> > often

> > > > > > improve

> > > > > > > with antifungals (specifically, Sporanox or Diflucan,

> plus

> > > > > > Nystatin).

> > > > > > > Dr. Shaw likes to use the Urine Tartaric Acid to decide

> > when

> > > to

> > > > > > treat

> > > > > > > yeast overgrowth and to follow-up the effectiveness of

> > > > treatment.

> > > > > > > > In my experience, however, using Dr. Crook's Yeast

> > > > > Questionnaire

> > > > > > > (available in my book, From Fatigued To Fantastic!) is

> > still

> > > > the

> > > > > > most

> > > > > > > reliable way to tell if a person is at risk of yeast

> > > > overgrowth.

> > > > > If

> > > > > > > the symptom score is over 140 points, I recommend

> > treatment.

> > > In

> > > > > > > addition, anyone who has been on recurrent or long-term

> > > > > antibiotic

> > > > > > > use (especially Tetracycline for acne) or anyone who

> > > > > intermittently

> > > > > > > has painful sores in different parts of the mouth that

> last

> > > for

> > > > > > about

> > > > > > > ten days at a time and who has CFIDS/FMS, should be

> treated

> > > > with

> > > > > > > antifungals. Bowel symptoms are some of the more overt

> > > symptoms

> > > > > > that

> > > > > > > are caused by yeast and I feel that most people who

> > > > have " spastic

> > > > > > > colon " have yeast overgrowth or parasites.

> > > > > > > > How Is Yeast Treated?

> > > > > > > > A number of very effective methods can be utilized to

> > take

> > > > care

> > > > > > of

> > > > > > > a yeast problem. Primary among the methods is to avoid

> > sugar

> > > > and

> > > > > > > other sweets. One can enjoy one or two pieces of fruit

a

> > day,

> > > > but

> > > > > > > should not consume concentrated sugars such as juices,

> corn

> > > > > syrup,

> > > > > > > jellies, pastry, candy or honey. Stay far away from

soft

> > > > drinks,

> > > > > > > which have ten to twelve teaspoons of sugar in every

> twelve

> > > > > ounces.

> > > > > > > This amount of sugar has been shown to markedly

suppress

> > > immune

> > > > > > > function for several hours. Be pre-pared to have

> withdrawal

> > > > > > symptoms

> > > > > > > for about one week when sugar is cut out of the diet.

> > Several

> > > > > > > excellent books have been written on the yeast

> controversy

> > > and

> > > > > > offer

> > > > > > > additional methods to try. One of the best books is The

> > Yeast

> > > > > > > Connection and the Woman by Crook, M.D., a

> > physician

> > > > who

> > > > > > has

> > > > > > > done a spectacular job advancing the understanding of

> > > CFIDS/FMS.

> > > > > > > > Many patients have found that acidophilus (that is,

> milk

> > > > > > bacteria,

> > > > > > > a healthy bacteria for the bowel) helps restore balance

> in

> > > the

> > > > > > bowel.

> > > > > > > Acidophilus is found in yogurt with live and active

> yogurt

> > > > > > cultures.

> > > > > > > Indeed, one cup of yogurt a day can markedly diminish

the

> > > > > frequency

> > > > > > > of recurrent vaginal yeast infections. Acidophilus is

> also

> > > > > > available

> > > > > > > in capsule form. Although many claims are made for one

> type

> > > of

> > > > > > > acidophilus being better than the other, I'm not sure

> this

> > is

> > > > so.

> > > > > I

> > > > > > > usually recommend 3 to 6 billion units a day (1 unit =

1

> > > > > bacteria)

> > > > > > on

> > > > > > > an empty stomach. If on antibiotics (not antifungals),

> take

> > > the

> > > > > > > acidophilus at least 3 to 6 hours away from the

> antibiotic

> > > > dose.

> > > > > > > > Nystatin, an antifungal medication, has also been

> helpful

> > > in

> > > > > the

> > > > > > > treatment of yeast overgrowth. Unfortunately, some

fungi

> > seem

> > > > to

> > > > > be

> > > > > > > resistant to Nystatin. In addition, Nystatin is poorly

> > > > absorbed,

> > > > > > > which means that it has little impact on the yeast

> outside

> > of

> > > > the

> > > > > > > bowel. Other anti-fungal medications, such as Diflucan

> and

> > > > > > Sporanox,

> > > > > > > seem to be effective systemically (throughout the body)

> but

> > > > they

> > > > > > have

> > > > > > > two main drawbacks. First, they are expensive, costing

> more

> > > > than

> > > > > > $450

> > > > > > > to $900 for a two-month course. Second, any effective

> anti-

> > > > fungal

> > > > > > can

> > > > > > > initially make the symptoms of yeast infection worse.

> > > Although

> > > > > > > uncommon, Sporanox and Diflucan can also cause liver

> > > > inflammation

> > > > > > (as

> > > > > > > can Advil and Tylenol). If you are taking Sporanox or

> > > Diflucan

> > > > > for

> > > > > > > more than 6 to 12 weeks, I would consider

intermittently

> > > > checking

> > > > > > > liver blood tests (ALT and AST). If you have

preexisting

> > > active

> > > > > > liver

> > > > > > > disease, be cautious in using (or don't use) Sporanox

or

> > > > > Diflucan.

> > > > > > I

> > > > > > > strongly recommend taking Lipoic Acid (a natural

> > > > > > > > supplement which protects and helps heal the liver),

> > 200mg

> > > a

> > > > > > day,

> > > > > > > whenever you take Sporanox or Diflucan. I also strongly

> > > > recommend

> > > > > > > Lipoic Acid for anyone with active liver disease (e.g.,

> > > > > hepatitis)

> > > > > > at

> > > > > > > doses up to 1000mg to 3000mg a day as it may prevent

> and/or

> > > > treat

> > > > > > > cirrhosis.

> > > > > > > > Natural Yeast Treatments

> > > > > > > > Below, I have summarized the nonprescription part of

> the

> > > > > > treatment

> > > > > > > checklist that I use in my office.

> > > > > > > > 1. Avoiding sweets is still the single most important

> > > thing.

> > > > > > Using

> > > > > > > Stevia as a sweetener is a wonderful substitute. Stevia

> is

> > a

> > > > > safe,

> > > > > > > natural remedy and you can use all you want. There are

> even

> > > > > > cookbooks

> > > > > > > for using Stevia (available from my office or 800-

> 4STEVIA).

> > A

> > > > new

> > > > > > > natural sweetner, Sweet Balance, also tastes good and

is

> 12

> > > > times

> > > > > > as

> > > > > > > sweet as sugar. It is a natural product from the Lo Han

> > fruit

> > > > and

> > > > > > > appears to be safe. Although it is 70% sugar

(fructose),

> > you

> > > > only

> > > > > > > need a small amount. Order it from 877-997-9338, my

> office

> > at

> > > > 800-

> > > > > > 333-

> > > > > > > 5287 or my Web site at www.endfatigue.com.

> > > > > > > > 2. Acidophilus or Milk Bacteria can be very helpful.

> Take

> > 3

> > > > to

> > > > > 6

> > > > > > > billion units a day (a unit is the same as a bacteria).

> Do

> > > not

> > > > > take

> > > > > > > acidophilus within 3 to 6 hours of an antibiotic. Take

it

> > > > either

> > > > > on

> > > > > > > an empty stomach or with milk.

> > > > > > > > 3. Caprylic Acid is another natural remedy that can

be

> > > > helpful.

> > > > > > The

> > > > > > > usual dose is 1800 to 3600mg a day with 1/3 of the dose

> > being

> > > > > taken

> > > > > > > at each meal. Unfortunately, it often causes an acid

> > stomach

> > > > with

> > > > > > > a " funky " tasting reflux.

> > > > > > > > 4. Oregano Oil - enteric coated oregano oil - 1 to 2

> > > > capsules,

> > > > > 2

> > > > > > to

> > > > > > > 3 times a day with food, may be more effective and

better

> > > > > tolerated

> > > > > > > than Caprylic Acid (both can cause stomach acid

reflux).

> > > > > > > > 5. Fresh Garlic, if you can handle it well, can also

be

> > > very

> > > > > > > effective. Daily, crush 1 to 3 garlic cloves in olive

> oil,

> > > add

> > > > > > salt,

> > > > > > > spread it on bread and eat it. It can be quite tasty

and

> > > lethal

> > > > > to

> > > > > > > whatever infections you have in your gut.

> > > > > > > > 6. Olive Leaf 500mg, 2 to 4 capsules three times a

day

> > > > between

> > > > > > > meals, can also be very helpful in treating yeast

> > overgrowth.

> > > > > > > > 7. Pau De Arco in either tea or capsule form is also

> > > helpful

> > > > in

> > > > > > > yeast suppression. Although I use Pau De Arco

> infrequently

> > > for

> > > > > > yeast

> > > > > > > over-growth, many people find that it can be helpful.

> > > > > > > > 8. Grapefruit Seed Extract (e.g., Citrucidel) is a

> > popular

> > > > > > > treatment for yeast overgrowth and is well-tolerated.

> > > > > > > > More Information On Yeast Treatments

> > > > > > > > If symptoms of yeast are caused by an allergic or

> > > sensitivity

> > > > > > > reaction to the yeast body parts, the symptoms may

flare

> > when

> > > > > mass

> > > > > > > quantities of the yeast are suddenly killed off. This

is

> > > called

> > > > a

> > > > > > > yeast " die-off " reaction. If you get this reaction,

start

> > > your

> > > > > > > treatment with acidophilus and a sugar-free diet for a

> few

> > > > weeks

> > > > > > > followed by oregano oil and/or olive leaf (1500mg to

> > 2000mg,

> > > 3

> > > > > > times

> > > > > > > a day between meals) before beginning Nystatin. Take

> > Nystatin

> > > > (by

> > > > > > > mouth) in the form of 500,000-IU tablets or powder. I

> > > generally

> > > > > > > recommend beginning with 1 tablet a day for 1 to 3

days,

> > and

> > > > > > > increasing by 1 tablet every 1 to 3 days (or slower if

> > > > yeast " die-

> > > > > > > off " is a problem) until 2 tablets 2 to 4 times a day

is

> > > > reached.

> > > > > > If

> > > > > > > you get nausea, take a lower dose. Take Nystatin, 4 to

8

> > > > tablets

> > > > > > > daily, for 5 to 8 months. I add the Diflucan or

Sporanox

> > one

> > > > > month

> > > > > > > after beginning the Nystatin. Take 200mg every morning

> for

> > > six

> > > > > > weeks.

> > > > > > > If symptoms flare, take just 100mg per morning for the

> > first

> > > 3

> > > > to

> > > > > > 14

> > > > > > > days. I

> > > > > > > > f symptoms recur after stopping the Diflucan or

> Sporanox,

> > I

> > > > > > > recommend continuing the medication for an additional 6

> > weeks

> > > > at

> > > > > > > 200mg a day.

> > > > > > > > Sporanox should be taken with food. If it is taken

> alone,

> > > its

> > > > > > > absorption is greatly reduced. When taking Diflucan or

> > > > Sporanox,

> > > > > DO

> > > > > > > NOT use the antihistamines Seldane or Hismanal,

Quinidine

> > (a

> > > > > heart

> > > > > > > medicine), cholesterol-lowering medications in the

> Mevacor

> > > > > family,

> > > > > > or

> > > > > > > the bowel medicine Propulcid. These can be fatal

> > > combinations!

> > > > > > Also,

> > > > > > > antacid medications (such as Tagamet, Axid, Zantac, and

> > > Pepcid)

> > > > > > > prevent the proper absorption of Sporanox. At the high

> > price

> > > of

> > > > > > > Sporanox per dose, you will want to absorb every last

bit

> > of

> > > > the

> > > > > > > medication. If you need to be on an antacid medication,

> use

> > > > > > Diflucan

> > > > > > > instead of Sporanox. Unfortunately, a less expensive

> > > > antifungal,

> > > > > > > called Lamisil (at 250mg a day), does not seem to work

> very

> > > > well

> > > > > > for

> > > > > > > candida yeast overgrowth (although it works well for

nail

> > > > > > > infections). I am currently trying patients on 500mg of

> > > Lamisil

> > > > a

> > > > > > day

> > > > > > > to see if this dose works better.

> > > > > > > > I feel that once the yeast has been effectively

> decreased

> > > and

> > > > > > kept

> > > > > > > that way for six to twelve months, it is safe to try to

> add

> > > > small

> > > > > > > amounts of sugar back into the diet. If symptoms recur,

> > > > however,

> > > > > > stop

> > > > > > > the sugar again. Continuing to eat yogurt with live and

> > > active

> > > > > > > acidophilus cultures (unless you are lactose-

intolerant)

> or

> > > > > > > continuing to take acidophilus capsules may also help.

> > > > > > > > Many books on yeast overgrowth (including Dr.

Crook's)

> > > advise

> > > > > > > readers to avoid all yeast in the diet. This advice is

> > based

> > > on

> > > > > the

> > > > > > > theory that an allergic reaction to yeast is the cause

of

> > the

> > > > > > > problem. The predominant yeast that seems to be

involved

> in

> > > > yeast

> > > > > > > overgrowth is Candida Albicans, although I would not be

> > > > surprised

> > > > > > if

> > > > > > > researchers discovered that many other kinds of fungal

> > > > infections

> > > > > > are

> > > > > > > also involved. The yeast that is found in most foods

> > (except

> > > > beer

> > > > > > and

> > > > > > > cheese) is not closely related to candida.

> > > > > > > > In my experience, trying to avoid all yeast in foods

> > > results

> > > > > > simply

> > > > > > > in a nutritionally inadequate diet and little benefit.

> > > Although

> > > > a

> > > > > > few

> > > > > > > people do appear to have true allergies to the yeast in

> > their

> > > > > food,

> > > > > > > they number less than 10 percent of my patients with

> > > suspected

> > > > > > yeast

> > > > > > > overgrowth. These patients may benefit from the more

> strict

> > > > diet

> > > > > in

> > > > > > > Dr. Crook's book. Interestingly, once their adrenal

> > > > insufficiency

> > > > > > and

> > > > > > > yeast overgrowth are treated, most people find that

their

> > > > > allergies

> > > > > > > and sensitivities to yeast and other food products seem

> to

> > > > > improve

> > > > > > or

> > > > > > > disappear.

> > > > > > > > Nutritional deficiencies such as low zinc or low

> selenium

> > > may

> > > > > > also

> > > > > > > decrease resistance to yeast over-growth. A good

> > multivitamin

> > > > > > > supplement, as recommended in my last newsletter,

should

> > take

> > > > > care

> > > > > > of

> > > > > > > these deficiencies. This is further evidence that all

the

> > > > factors

> > > > > > > involved in CFS are closely interrelated.

> > > > > > > > The best thing that one can do to combat yeast

> overgrowth

> > > is

> > > > to

> > > > > > try

> > > > > > > to avoid it in the first place. When you get an

> infection,

> > > > begin

> > > > > > > treating it naturally immediately. Hopefully, you can

> > prevent

> > > > it

> > > > > > from

> > > > > > > turning into a bacterial infection which might require

an

> > > > > > antibiotic.

> > > > > > > Ask your doctor what measures you can take before

> resorting

> > > to

> > > > > > > antibiotics. Many good over-the-counter remedies are

> > > available.

> > > > A

> > > > > > > knowledgeable pharmacist may also be a wealth of

> > information.

> > > > > Your

> > > > > > > local book or health food store has books on natural

> > > measures.

> > > > > Your

> > > > > > > health food store proprietor can also steer you to

> > > appropriate

> > > > > > > natural remedies. For examples of the many helpful

> measures

> > > > that

> > > > > > one

> > > > > > > can take, see my newsletter article, Treating

Infections

> > > > Without

> > > > > > > Antibiotics, page ___).

> > > > > > > > If you find however, that you must take an

antibiotic,

> > all

> > > is

> > > > > not

> > > > > > > lost. One can still lessen the severity of yeast

> overgrowth

> > > by

> > > > > > > avoiding sweets and by either taking acidophilus

capsules

> > > > (again,

> > > > > > not

> > > > > > > within 3 to 6 hours of an antibiotic) or by eating one

> cup

> > of

> > > > > > yogurt

> > > > > > > with live and active acidophilus cultures daily. Don't

> use

> > > the

> > > > > > yogurt

> > > > > > > (or milk) if you have sinusitis or pneumonia because

the

> > milk

> > > > > > protein

> > > > > > > thickens mucus and makes it hard for the body to fight

> > these

> > > > > > > infections.

> > > > > > > > How Can One Tell If The Yeast Is Coming Back?

> > > > > > > > It is normal for yeast symptoms to resolve after

> > treatment.

> > > > > After

> > > > > > 6

> > > > > > > weeks on the Sporanox or Diflucan, patients are usually

> > > feeling

> > > > a

> > > > > > lot

> > > > > > > better, but may have symptoms recur soon after stopping

> the

> > > > > > > antifungal. In this case I would continue the Sporanox

or

> > > > > Diflucan

> > > > > > > for another 6 weeks, or as long as is needed, to keep

the

> > > > > symptoms

> > > > > > at

> > > > > > > bay. More frequently, people will feel better after

> > treatment

> > > > and

> > > > > > > stay feeling fairly well for a period of 6 to 24

months.

> At

> > > > that

> > > > > > > time, it is common to see a recurrence of symptoms,

> > > especially

> > > > if

> > > > > > one

> > > > > > > is eating too much sugar or is taking antibiotics. The

> best

> > > > > marker

> > > > > > > that I have found for yeast overgrowth would be a

return

> of

> > > > bowel

> > > > > > > symptoms with gas, bloating and/or diarrhea or

> > constipation.

> > > If

> > > > > > these

> > > > > > > symptoms persist for more than 2 weeks, especially if

> there

> > > is

> > > > > also

> > > > > > > even a mild worsening of the FMS symptoms, it is very

> > > > reasonable

> > > > > to

> > > > > > > retreat yourself with 6 weeks of Nystatin and perhaps

> > > Sporanox

> > > > or

> > > > > > > Diflucan. In addition, I would also retreat if there's

> > > > > > > > a recurrence of vaginal yeast or sinus infections. If

> re-

> > > > > > treatment

> > > > > > > resolves the symptoms, one may opt to repeat this

regimen

> > as

> > > > > often

> > > > > > as

> > > > > > > is needed (usually every 6 to 24 months). By using some

> of

> > > the

> > > > > > > natural remedies listed above, however, you may be able

> to

> > > > avoid

> > > > > > > repeated use of these antifungals and the possible risk

> of

> > > > > becoming

> > > > > > > resistant to them. Some patients also find that they

need

> > to

> > > > stay

> > > > > > on

> > > > > > > the antifungals for extended periods of time (years) or

> the

> > > > > > symptoms

> > > > > > > will recur. When this is necessary, I add the natural

> > > remedies.

> > > > I

> > > > > > > will, however, also use the medications when needed.

The

> > main

> > > > > risk

> > > > > > of

> > > > > > > long-term use of the antifungals Sporanox and Diflucan

> > would

> > > be

> > > > > > liver

> > > > > > > inflammation. If these medications are being used for

> > > extended

> > > > > > > periods, consider checking liver tests (SGOT and SGPT)

> > every

> > > 3

> > > > to

> > > > > 6

> > > > > > > months and anytime that a severe flu-like feeling or

> > > worsening

> > > > of

> > > > > > > symptoms occur. As noted above, it is very important to

> > take

> > > > > Lipoic

> > > > > > > Acid 200mg a day when on Sporanox or Diflucan. Althoug

> > > > > > > > h I am not aware of any studies using Lipoic Acid

with

> > > > > > antifungals,

> > > > > > > in my experience I have seen no worrisome elevation on

> > liver

> > > > > tests

> > > > > > if

> > > > > > > patients are using this natural substance while taking

> > these

> > > > > > > antifungals. As an alternative, instead of taking the

> > > > antifungals

> > > > > > > every day, many people find they can get long-term

> > > suppression

> > > > of

> > > > > > the

> > > > > > > yeast by taking Sporanox or Diflucan 200mg twice a day,

> one

> > > day

> > > > > > each

> > > > > > > week (e.g., each Sunday).

> > > > > > > > Help For Chronic Bladder Infections

> > > > > > > > Although we will be discussing some unusual

infections,

> > > > > CFIDS/FMS

> > > > > > > patients also get more of the day-to-day variety of

> > > infections.

> > > > > > These

> > > > > > > include Urinary Tract (bladder) Infections (UTI). The

> main

> > > > > symptoms

> > > > > > > of a UTI are discomfort (e.g., burning) when urinating

> > > > (dysuria),

> > > > > > > urgency (which is the feeling that you have to go very

> > badly

> > > > and

> > > > > > > right away when there is not much urine there), and

> > frequency

> > > > > with

> > > > > > > low volume. These symptoms are also common in CFIDS/FMS

> > > > patients

> > > > > in

> > > > > > > the absence of bladder infections and, when severe, is

> > called

> > > > > > > Interstitial Cystitis. I would not label someone as

> having

> > > > > > > Interstitial Cystitis unless this is the major symptom

of

> > > their

> > > > > > > CFIDS/FMS, because almost everyone with this illness

has

> > some

> > > > > > urinary

> > > > > > > urgency and frequency. Because bladder symptoms can be

> seen

> > > in

> > > > > both

> > > > > > > UTI and CFIDS/FMS, it is important to have a urine

> culture

> > > done

> > > > > > > before treatment with antibiotics to make sure that

there

> > is

> > > an

> > > > > > > infection and not just muscle spasms in the bladder

that

> > are

> > > > > > causing

> > > > > > > these

> > > > > > > > symptoms. If there is an infection, over 90% of the

> time

> > it

> > > > > will

> > > > > > be

> > > > > > > E-coli. This bacteria is normally found in everyone's

gut

> > > and,

> > > > > with

> > > > > > > the exception of a few rare dangerous forms, is a

healthy

> > > part

> > > > of

> > > > > > our

> > > > > > > normal bowel bacteria. The problem occurs when the E-

coli

> > > gets

> > > > > out

> > > > > > of

> > > > > > > the bowel where it belongs and into the bladder.

Usually

> > the

> > > > > > bladder

> > > > > > > will wash out most infections when the urine comes out.

> The

> > E-

> > > > > coli

> > > > > > > however, have little velcro-like projections that stick

> to

> > > the

> > > > > > > bladder wall so that they can not be washed out by

> > urination.

> > > > > > > > Taking antibiotics will kill a bladder infection but

> will

> > > > also

> > > > > > kill

> > > > > > > the healthy bacteria in the bowel. This sets one up for

> > yeast

> > > > > > > overgrowth and other problems. Because of this, unless

> > there

> > > is

> > > > > > fever

> > > > > > > or back pain over the kidneys or a toxic feeling, it is

> > > > > reasonable

> > > > > > to

> > > > > > > try natural remedies for one to three days before going

> > with

> > > > the

> > > > > > > antibiotics. One can start these treatments while

waiting

> > for

> > > > the

> > > > > > > urine culture to come back.

> > > > > > > > What Natural Remedies Can Be Used For Bladder

> Infections?

> > > > > > > > There are two excellent natural remedies that can

keep

> > the

> > > E-

> > > > > coli

> > > > > > > from sticking to the bladder walls so they can be

washed

> > out.

> > > > In

> > > > > > > addition, taking vitamin C in high dose (e.g., 500 to

> > 5000mg

> > > a

> > > > > day)

> > > > > > > can acidify the urine, making it inhospitable to the

> > > bacteria.

> > > > > > > Drinking a lot of water also helps to wash out the

> > infection.

> > > > > > > > The two natural remedies that keep the bacteria from

> > > sticking

> > > > > are:

> > > > > > > > 1. Cranberries—Because approximately 20% of the

female

> > > > > population

> > > > > > > suffers from UTIs, several studies have been done

looking

> > at

> > > > this

> > > > > > > remedy. An early study of 44 female and 16 male

patients

> > with

> > > > > acute

> > > > > > > bladder infections drank 16 oz. of cranberry juice a

day

> > for

> > > 15

> > > > > > days.

> > > > > > > Of these patients, 53% had positive responses and

another

> > 20%

> > > > > > showed

> > > > > > > modest improvement. Six weeks after stopping the juice,

> 27

> > > > > patients

> > > > > > > did have persistent recurrent infections and 8 of these

> had

> > > no

> > > > > > > symptoms. Seventeen patients had no symptoms and

negative

> > > urine

> > > > > > > cultures.

> > > > > > > > In another study of elderly women (who are more

likely

> to

> > > > have

> > > > > > > bladder infections), 153 women either received 10 oz.

of

> > > > > cranberry

> > > > > > > drink or placebo every day for 6 months. The group that

> got

> > > the

> > > > > > > cranberry drink had 68% fewer bladder infections during

> > that

> > > > > > period.

> > > > > > > In this study, the juice was sweetened with saccharin

> > instead

> > > > of

> > > > > > > sugar. Other studies have also shown benefit using

> > cranberry

> > > > > juice

> > > > > > in

> > > > > > > bladder infections.

> > > > > > > > Significant benefits are achieved by using 6 to 16

oz.

> of

> > > > > > cranberry

> > > > > > > juice a day. Because cranberry juice has a lot of sugar

> and

> > > can

> > > > > > > promote yeast overgrowth and aggravate other symptoms

in

> > > > > CFIDS/FMS,

> > > > > > I

> > > > > > > think it is much better to use pure cranberry juice

> powder

> > in

> > > > > > capsule

> > > > > > > or tablet form (standardized to contain 11% to 12%

quinic

> > > > acid).

> > > > > > The

> > > > > > > therapeutic dose is 1 to 2 capsules a day. Conversely,

> you

> > > can

> > > > > use

> > > > > > > unsweetened cranberry juice and add Stevia as a natural

> > > > > sweetener.

> > > > > > In

> > > > > > > general, if one gives the usual cranberry juice

cocktails

> a

> > > > > > strength

> > > > > > > of 1 unit - then, cranberry juice drinks have a

strength

> of

> > > ½;

> > > > > > > cranberry sauce a strength of ½; fresh or frozen

> > cranberries

> > > > are

> > > > > 4

> > > > > > > times as potent; pure cranberry juice is 4 times as

> potent;

> > > and

> > > > > > > cranberry juice capsules from unsweetened cranberry

juice

> > > > powders

> > > > > > are

> > > > > > > 32 times as potent.

> > > > > > > > Cranberries work to help bladder infections because

> they

> > > have

> > > > a

> > > > > > > chemical (proanthocyanidins) that prevents the bacteria

> > from

> > > > > > sticking

> > > > > > > to the bladder wall. They may also decrease the risk of

> > > kidney

> > > > > > stones

> > > > > > > (although magnesium with B6 is much better for this),

as

> > well

> > > > as

> > > > > > > possibly reduce urine odor.

> > > > > > > > D-Mannose - This is more effective than cranberry

> juice.

> > > > > Mannose

> > > > > > is

> > > > > > > a natural sugar (not the kind that causes symptoms or

> yeast

> > > > > > > overgrowth) that is excreted promptly into the urine.

> > > > > Unfortunately

> > > > > > > for the E-coli bacteria, the fingers that stick to the

> > > bladder

> > > > > wall

> > > > > > > stick to the D-Mannose even better. When one takes a

> large

> > > > amount

> > > > > > of

> > > > > > > D-Mannose, it spills into the urine, coating all the E-

> > coli's

> > > > > > > little " sticky fingers " so that the E-coli are

literally

> > > washed

> > > > > > away

> > > > > > > with the next urination. The nice thing about the

natural

> > > > > approach,

> > > > > > > as opposed to antibiotics, is that the cranberries or D-

> > > Mannose

> > > > > > will

> > > > > > > not kill the healthy bacteria, thereby not bothering

the

> > > normal

> > > > > > > balance of bacteria in the bowel. In addition, the D-

> > Mannose

> > > is

> > > > > > > absorbed in the upper gut before it gets to the

friendly

> E-

> > > coli

> > > > > > that

> > > > > > > are normally present in the colon. Because of this, it

> > helps

> > > > > clear

> > > > > > > the bladder without causing any other problems. In

> > addition,

> > > > the

> > > > > D-

> > > > > > > Mannose even tastes good.

> > > > > > > > The D-Mannose is quite safe, even for long-term use,

> > > although

> > > > > > most

> > > > > > > people will only need it for a few days. Those who have

> > > > frequent

> > > > > > > recurrent bladder infections may, however, choose to

take

> > it

> > > > > every

> > > > > > > day. The usual dose of D- Mannose is 1/2 teaspoon every

2

> > to

> > > 3

> > > > > > hours,

> > > > > > > while awake, to treat an acute bladder infection; and

1/4

> > to

> > > > 1/2

> > > > > > > teaspoon 3 to 4 times a day to prevent severe chronic

> > bladder

> > > > > > > infections. It is best taken dissolved in water. For

> those

> > > who

> > > > > get

> > > > > > > bladder infections associated with sexual intercourse,

> one

> > > can

> > > > > take

> > > > > > > 1/2 teaspoon of D-Mannose 1 hour before and then just

> after

> > > > > > > intercourse to prevent an infection. Remember, though,

> the

> > D-

> > > > > > Mannose

> > > > > > > (and cranberries) only work in the 90% of bladder

> > infections

> > > > > caused

> > > > > > > by E-coli bacteria. D-Mannose is available from several

> > > sources:

> > > > > > > > 1. The Tahoma Clinic Dispensary (253-850-5661), which

> is

> > > > > > associated

> > > > > > > with the well-known nutritional physician, V.

> > > ,

> > > > > M.D.

> > > > > > > > 2. The Biotech Company (800-345-1199).

> > > > > > > > 3. My office (800-333-5287) or my Web site at

> > > > > www.endfatigue.com.

> > > > > > > > The usual cost of D-Mannose is approximately $60 for

> 100

> > > > grams

> > > > > > and

> > > > > > > $35 for 50 grams. A 1/2 teaspoon is approximately 2

> grams.

> > > One

> > > > > > should

> > > > > > > feel much better within 24 to 48 hours on D-Mannose. If

> > not,

> > > > see

> > > > > a

> > > > > > > doctor for a urine culture (you may want to get the

> culture

> > > at

> > > > > the

> > > > > > > first sign of infection) and consider antibiotic

> treatment

> > > > after

> > > > > > two

> > > > > > > days if the culture is positive. Some evidence exists

> that

> > > > > > > Macrodantin causes less yeast over-growth than do other

> > > > > > antibiotics.

> > > > > > > Even with other antibiotics, most bladder infections

are

> > > > knocked

> > > > > > out

> > > > > > > by one to three days of antibiotic use (instead of the

> old

> > > > seven-

> > > > > > day

> > > > > > > regimen).

> > > > > > > > Prostatitis

> > > > > > > > Although women tend to be the ones plagued with

bladder

> > > > > > infections,

> > > > > > > men don't get off unscathed either. It is very common

in

> > men

> > > > with

> > > > > > > CFIDS/FMS to have Prostatitis. Prostatitis is an

> > inflammation

> > > > or

> > > > > > > infection of the prostate which is usually seen in

> younger

> > > men

> > > > > > > between the ages of 20 and 50. It falls into three main

> > > > > categories:

> > > > > > > > 1. " Bacterial " Prostatitis is a acute or chronic

> > infection

> > > in

> > > > > the

> > > > > > > gland that causes prostate swelling and discomfort.

> > > > > > > > 2. Nonbacterial Prostatitis is when you feel swelling

> of

> > > the

> > > > > > > prostate without being able to detect an infection. My

> > > > suspicion

> > > > > is

> > > > > > > that it is not uncommon for prostatitis to be

associated

> > with

> > > > > yeast

> > > > > > > overgrowth or other infections that cannot be cultured

> > > (tested

> > > > > > for).

> > > > > > > > 3. Prostadynia is a general irritation of the

prostate

> > > which

> > > > > > causes

> > > > > > > urinary burning, urgency and frequency but without

there

> > > being

> > > > > any

> > > > > > > infection or swelling of the prostate. This can come

from

> a

> > > > > number

> > > > > > of

> > > > > > > causes including, I suspect, chronic spasm or

tightening

> of

> > > the

> > > > > > > muscles of the pelvic floor.

> > > > > > > > The symptoms of chronic Prostatitis can come and go

and

> > be

> > > > mild

> > > > > > or

> > > > > > > severe. The symptoms include:

> > > > > > > > 1. Pain or tenderness in the area of the prostate. It

> is

> > > also

> > > > > > > common to have burning on the tip of the penis.

> > > > > > > > 2. Discomfort in the groin and, occasionally, lower

> back

> > > pain.

> > > > > > > > 3. Urinary urgency and frequency with pain on

> urination.

> > > > > > > > 4. Sometimes a slight penis discharge. If the

discharge

> > is

> > > > > cloudy

> > > > > > > and larger than one drop, or even a large drop, it is

> most

> > > > likely

> > > > > a

> > > > > > > bacterial Prostatitis and I would then prescribe

> > antibiotics.

> > > > If

> > > > > a

> > > > > > > discharge is present, I would also check to make sure

> that

> > > > there

> > > > > is

> > > > > > > not also a sexually transmitted disease (such as

> Chlamydia

> > or

> > > > > > > Gonorrhea) before beginning treatment.

> > > > > > > > 5. Pain with ejaculation.

> > > > > > > > If severe symptoms with fevers, chills and extreme

> > fatigue

> > > > are

> > > > > > > present (symptoms of acute Prostatitis), antibiotics

> should

> > > be

> > > > > > used.

> > > > > > > The main treatment for bacterial Prostatitis consists

of

> > > using

> > > > > the

> > > > > > > antibiotics Tetracycline (e.g., Doxycycline), Cipro, or

> > Sulfa

> > > > > > > (Bactrim or Septra DS). Unfortunately, since it is hard

> for

> > > the

> > > > > > > antibiotics to be absorbed into the prostate, the

> symptoms

> > > > often

> > > > > > > recur even after six weeks of treatment. If antibiotics

> are

> > > > > > required,

> > > > > > > use Doxycycline or Cipro because these may be effective

> > > against

> > > > > > other

> > > > > > > hidden infections that can cause CFIDS/FMS.

> > > > > > > > Although there are a number of causes of Prostatitis,

> > > excess

> > > > > > > caffeine, alcohol and spicy foods can also contribute

to

> > the

> > > > > > > symptoms. Sitting for long periods while traveling

(e.g.,

> > > being

> > > > a

> > > > > > > truck driver) can also cause irritation of the

prostate.

> > > > Although

> > > > > > > normal bacteria are common causes, a few bacteria

> > transmitted

> > > > > > through

> > > > > > > sexual contact can also cause Prostatitis. Some feel

that

> > the

> > > > > main

> > > > > > > psychological component of Prostatitis is shame.

> > > > > > > > Bowel Parasite Infections

> > > > > > > > A while back, the news focused our attention on

> Milwaukee

> > > > > because

> > > > > > > of repeated fatal outbreaks of an infection by a bowel

> > > parasite

> > > > > > > called Cryptosporidium. A cartoon even made the rounds

> > > showing

> > > > > > > Mexican tourists being warned not to drink the water in

> > > > > Milwaukee!

> > > > > > > Although this infection usually resolves on its own

> within

> > a

> > > > week

> > > > > > or

> > > > > > > two, it may persist in those with immune suppression.

In

> > > fact,

> > > > > > people

> > > > > > > with acquired immune deficiency syndrome (AIDS) are

> > > > particularly

> > > > > > > susceptible and scores of Milwaukeens died from the

> > > > > Cryptosporidium

> > > > > > > outbreaks.

> > > > > > > > Unfortunately, in many places throughout the United

> > States,

> > > > the

> > > > > > > water supply is contaminated, and parasites are no

longer

> > > just

> > > > a

> > > > > > > Third World problem. Doctors frequently see cases of

> > > infection

> > > > by

> > > > > > > giardia, amoeba and numerous other bowel parasites.

> > Parasitic

> > > > > > > infections can mimic CFS and, in immune suppressed

> > situations

> > > > > like

> > > > > > > CFS, all parasites should be treated.

> > > > > > > > Most laboratories miss the parasites when they do

stool

> > > > > testing.

> > > > > > I

> > > > > > > initially tested for bowel parasites by sending my

> > patients'

> > > > > stool

> > > > > > > samples to a respected local lab. The tests kept coming

> > back

> > > > > > > negative, so I eventually stopped testing. Finally, I

> > started

> > > > > doing

> > > > > > > my own laboratory stool testing. Doing the test

properly

> > was

> > > > very

> > > > > > > time consuming, taking up to five hours per specimen.

> > > However,

> > > > > > > processing it properly, my tests frequently turned out

> > > > positive.

> > > > > In

> > > > > > > my experience - and in that of other physicians as

well -

> > > when

> > > > > you

> > > > > > > treat a patient for parasites, the patient's fatigue

and

> > > > achiness

> > > > > > > often improves dramatically.

> > > > > > > > If you would like your stool tested, make sure that

the

> > lab

> > > > > > > specializes in stool testing and that the sample is a

> > purged

> > > > > > > specimen. A purged stool specimen is watery and loose,

> > > brought

> > > > > > about

> > > > > > > by the use of one-and-a-half ounces of Fleet's Phospho-

> Soda

> > > (a

> > > > > > > laxative). The purpose of the stool purge is to get the

> > best

> > > > > > possible

> > > > > > > stool sample to check for bowel parasites and yeast.

The

> > > > laxative

> > > > > > > washes the organisms off the walls of the intestines so

> > that

> > > > they

> > > > > > can

> > > > > > > be detected. The routine random tests performed in

almost

> > all

> > > > > > > standard labs are generally not adequate or reliable.

In

> > > > speaking

> > > > > > > with several lab technicians, I was told they had less

> than

> > > one

> > > > > > hour

> > > > > > > of training in looking for parasites—which they found

to

> be

> > > > > > useless.

> > > > > > > In fact, during one of our " doctors' " poker games, I

> spoke

> > > with

> > > > a

> > > > > > > gastroenterologist friend who noted that during a

certain

> > > bowel

> > > > > > exam

> > > > > > > he had performed, he saw a large number of parasites

> > swimming

> > > > in

> > > > > > the

> > > > > > > patient's large bowel. He removed a big glob consisting

> of

> > > > > nothing

> > > > > > > > but mucus and parasites and sent it off to the major

> > local

> > > > > > > laboratory, just for confirmation of the infection and

> > > > > > identification

> > > > > > > of the parasite. Even this sample came back negative

for

> > > > > parasites!

> > > > > > > This is why I stress that stool testing must be done at

a

> > lab

> > > > > that

> > > > > > > specializes in parasitology. Because two excellent labs

> are

> > > now

> > > > > > > available to me to mail specimens to, I no longer have

to

> > do

> > > > the

> > > > > > > testing in my office. These labs are The Parasitology

> > Center,

> > > > > Inc.

> > > > > > > (480-777-1078) and The Great Smokies Diagnostic

> Laboratory

> > > (800-

> > > > > 522-

> > > > > > > 4762).

> > > > > > > > At this point, no consistently effective prescription

> > > > > medication

> > > > > > is

> > > > > > > available for Cryptosporidium infections. Artemisia

> annua,

> > > > > however,

> > > > > > > is an effective herbal treatment. For most of my

> patients,

> > I

> > > > > > > recommend using 1,000 milligrams three times a day for

> > twenty

> > > > > days.

> > > > > > > Leo Galland, M.D., a parasite specialist, recommends a

> form

> > > of

> > > > > > > Artemisia called tricyclin for many parasitic

infections.

> > He

> > > > > > > recommends taking 2 tablets, 3 times a day after meals

> for

> > > six

> > > > to

> > > > > > > eight weeks. The cost of this antiparasitic herbal

> > > preparation

> > > > is

> > > > > > > about $30 for fifty tablets. See the treatment protocol

> > below

> > > > for

> > > > > > > regimens for some other parasitic infections. The

doctor

> > who

> > > > runs

> > > > > > The

> > > > > > > Parasitology Center also has a review article

discussing

> > > which

> > > > > > > natural remedies are effective against each type of

> > parasite.

> > > > > > Common

> > > > > > > parasite treatment regimens also used in our office are

> on

> > > the

> > > > > > > treatment checklist below.

> > > > > > > > Antiparasitic Treatments

> > > > > > > > 1. Flagyl (Metronidazole) – 750 mg, 3 times a day for

> 10

> > > > days,

> > > > > > > followed by Yodoxin for many parasites. For Clostridium

> > > > Difficile

> > > > > > > take 250 mg, 4 times a day, or 500 mg, 3 times a day.

It

> > may

> > > > > cause

> > > > > > > nausea and vomiting (uncomfortable but usually not

> > > worrisome).

> > > > Do

> > > > > > not

> > > > > > > drink alcohol while on this medication as it will make

> you

> > > > vomit.

> > > > > > The

> > > > > > > SR (sustained release) form is easier on the stomach

(as

> is

> > > the

> > > > > > brand-

> > > > > > > name form). If you get numbness or tingling in your

> fingers

> > > (or

> > > > > it

> > > > > > > worsens if you usually have it) stop the Flagyl.

> > > > > > > > 2. Yodoxin (Iodoquinol) – 650 mg, 3 times a day, for

20

> > > days

> > > > > > after

> > > > > > > Flagyl is completed.

> > > > > > > > 3. Tinidazole – 2000 mg, once daily, for 3

consecutive

> > days

> > > > > with

> > > > > > > food (for Entamoeba Histolytica) – OR - 3 doses, each 2

> > weeks

> > > > > apart

> > > > > > > (for Giardia or Dientamoeba Fragilis); Available at

> 's

> > > > > > Pharmacy

> > > > > > > (800-480-3432).

> > > > > > > > 4. Humatin (Paromomycin) – 500 mg, 3 times a day, for

> 10

> > > days

> > > > > > (for

> > > > > > > Cryptosporidium). For Blastocystis add Yodoxin.

> > > > > > > > 5. Zithromax – 250 mg, once a day on an empty stomach

> for

> > > 10

> > > > > > days,

> > > > > > > along with Bactrim, 1 tablet twice a day for 10 days

> > > (alternate

> > > > > > > treatment for Cryptosporidium). Add Artemesia.

> > > > > > > > 6. Bactrim DS - 1 tablet, twice a day, plus Yodoxin

650

> > mg,

> > > 3

> > > > > > times

> > > > > > > a day with food for 10 days. Do not take Folic acid

> > > supplements

> > > > > > > (e.g., B Complex or multivitamins) during these 10 days

> > (for

> > > > > > > Blastocystis).

> > > > > > > > 7. Amphotericin B – 100 mg, two times a day, plus

> > > Tinidazole

> > > > > 500

> > > > > > > mg, twice a day, plus Furoxone (Furazolidone) 1 tablet,

> > twice

> > > a

> > > > > > day.

> > > > > > > Take these three together with food for 5 to 7 days

> > > > (Amphotericin

> > > > > B

> > > > > > > and Tinidazole are available from 's Pharmacy 800-

> 480-

> > > > 3432)

> > > > > > > (treatment for refractory Blastocystis).

> > > > > > > > 8. Lactoferrin – 350 mg, 1 to 3 capsules at bedtime.

> > > > > > > > 9. Multi-pure Water Filter - Most other filters

(except

> > for

> > > > > > reverse

> > > > > > > osmosis) are ineffective. (Available from Bren

son,

> > 410-

> > > > 224-

> > > > > > > 4877).

> > > > > > > > 10. Artemesia Annua (a herbal antiparasitic) – 500

mg,

> 2

> > > > > tablets,

> > > > > > 3

> > > > > > > times a day for 20 days.

> > > > > > > > 11. Tricyclin (a herbal antiparasitic) - 2 tablets, 3

> > times

> > > a

> > > > > > day,

> > > > > > > after meals for 6 to 8 weeks (concentrated Artemesia).

> > > > > > > > 12. Colostrum (mother's milk) - 3 capsules, 3 times a

> > day,

> > > > for

> > > > > 8

> > > > > > to

> > > > > > > 12 weeks. Then stop or use the lowest dose needed for

> > > symptoms.

> > > > > If

> > > > > > > nausea or indigestion occurs, lower the dose to a

> > comfortable

> > > > > level

> > > > > > > for 1 to 2 weeks until it passes. Take on an empty

> stomach.

> > > > > > > > 13. Quinacrine – 100 mg a day for 5 days. May be

useful

> > for

> > > > > > empiric

> > > > > > > therapy of suspected but not identified parasites

> > > > (controversial).

> > > > > > > > 14. Albendazole – 400 mg a day for 5 days. May be

> useful

> > > for

> > > > > > > empiric therapy of suspected but not identified

parasites.

> > > > > > > > Filter Your Water

> > > > > > > > Water filters can be very helpful in the fight

against

> > > > > parasitic

> > > > > > > infection. However, not all units are designed to

filter

> > out

> > > > > > > parasites. For a water filter to remove parasites, it

> must

> > > have

> > > > a

> > > > > > > submicron solid carbon block filter. A good example is

> the

> > > > Multi-

> > > > > > pure

> > > > > > > Filter. Check the Consumer's Digest and Consumer's

Report

> > for

> > > > > other

> > > > > > > good units. Multi-pure Filters are available from Bren

> > > son

> > > > > at

> > > > > > > 888-801-8176 or 410-224-4877. He is a very reputable

and

> > > > > > > knowledgeable person and does not believe in " high

> pressure

> > > > > sales "

> > > > > > > (again, I get no money from people or companies whose

> > > products

> > > > I

> > > > > > > recommend).

> > > > > > > > When shopping around for a water filter, request the

> > > National

> > > > > > > Sanitation Foundation (NSF) International Listing for

the

> > > > > specific

> > > > > > > unit you are considering. NSF is an independent not-for-

> > > profit

> > > > > > > organization that tests and certifies drinking water

> > > treatment

> > > > > > > products. The unit you buy should meet both NSF Health

> > > Effects

> > > > > > > Standard 53 and NSF Aesthetics Standard 42, with Class

I

> > > > > reduction

> > > > > > of

> > > > > > > chlorine and particulate matter. Any unit that does not

> > meet

> > > > both

> > > > > > of

> > > > > > > these standards, particularly the health standard, is

not

> > > > > adequate.

> > > > > > > To verify that a unit does meet these standards, call

the

> > NSF

> > > > at

> > > > > > 313-

> > > > > > > 769–8010.

> > > > > > > > In addition to verifying that a water filter meets

the

> > NSF

> > > > > > > standards, ask to see its Product Performance Data

Sheet.

> > > Many

> > > > > > states

> > > > > > > require that this sheet be given to all prospective

> > customers

> > > > of

> > > > > > > drinking water treatment devices.

> > > > > > > > Ask about the range of contaminants that the unit can

> > > reduce

> > > > > > under

> > > > > > > NSF Health Effects Standard 53. Most units certified

> under

> > > > > Standard

> > > > > > > 53 list only turbidity and cyst reduction. The number

of

> > > units

> > > > > that

> > > > > > > also reduce pesticides, trihalomethanes, lead, and

> volatile

> > > > > organic

> > > > > > > chemicals is very small. Make sure that the water

filter

> > you

> > > > are

> > > > > > > considering can remove the specific contaminants that

> > concern

> > > > you.

> > > > > > > > Ask if the unit is licensed in such states as

> California,

> > > > > > Colorado

> > > > > > > and Wisconsin. These states have some of the toughest

> > > > > certification

> > > > > > > procedures in the United States.

> > > > > > > > Finally, ask about the unit's service cycle, which is

> > > stated

> > > > in

> > > > > > > gallons of water treated. Find out how often you will

> need

> > to

> > > > > > change

> > > > > > > the filter and what the replacement filters cost.

> > > > > > > > As the American water supply becomes more

contaminated,

> > > > > parasitic

> > > > > > > bowel infections will likely become more common. These

> > > > > infections,

> > > > > > as

> > > > > > > well as the overgrowth of yeast or toxic bacteria

caused

> by

> > > > > > > antibiotic use, contribute to feeling poorly.

> > > > > > > > The Role Of Other Infections In CFIDS/FMS

> > > > > > > > Many infections have been found in CFIDS. That people

> may

> > > > have

> > > > > > not

> > > > > > > just one, but several of these simultaneously is

> > significant.

> > > > It

> > > > > > > suggests that although these infections may be a

trigger,

> > in

> > > > most

> > > > > > > patients the immune system is suppressed and therefore

> they

> > > > > become

> > > > > > a

> > > > > > > setup for unusual infections that persist. These

> infections

> > > may

> > > > > > > then " drag you down, " further suppressing your immune

> > system.

> > > > > > > > Fortunately, most people improve (and often get very

> > > healthy)

> > > > > by

> > > > > > > simply treating the sleep, hormonal, nutritional and

> yeast

> > > > > > problems.

> > > > > > > Once these areas are treated, your body can usually

> > eliminate

> > > > any

> > > > > > > persistent infections by itself. A subset, though, have

> > > > > infections

> > > > > > > that need treatment with antivirals and/or antibiotics.

> > > > > > > > How Can I Tell If I Need These Treatments?

> > > > > > > > First, I would try the other approaches discussed in

my

> > > From

> > > > > > > Fatigued To Fantastic! book and newsletters. I would

try

> > > these

> > > > > > > treatments if symptoms persist:

> > > > > > > > 1. Those with predominantly flu-like symptoms with

> > > > debilitating

> > > > > > > fatigue and little or no pain or fever are more likely

to

> > > have

> > > > an

> > > > > > > underlying persistent viral infection (e.g., HHV-6,

> Epstein

> > > > Barr,

> > > > > > > CMV, etc.).

> > > > > > > > 2. Those with fevers (i.e., anything over 98.6°F in

> this

> > > > > illness -

> > > > > >

> > > > > > > even 99°) and/or lung congestion, sinusitis, skin

> pustules

> > or

> > > > > other

> > > > > > > chronic bacterial infections seem more likely to have

> > > > infections

> > > > > > > (i.e., bacterial, Mycoplasma, or Chlamydia) that

respond

> to

> > > > > special

> > > > > > > antibiotics. Let's look at these two groups and how to

> > > approach

> > > > > > them.

> > > > > > > > HHV-6 And Other Viral Infections

> > > > > > > > HHV-6 (Human Herpes Virus 6) is a virus that is

related

> > to

> > > > the

> > > > > > > Epstein Barr Virus (EB), Cytomegalovirus (CMV), and

also

> to

> > > the

> > > > > > > Herpes Viruses that causes cold sores and Genital

Herpes.

> > HHV-

> > > 6

> > > > > is

> > > > > > > transmitted like the common cold and many people have

had

> > it,

> > > > as

> > > > > > well

> > > > > > > as the EB Virus and the Cold Sore Virus by the time

they

> > are

> > > > > twenty

> > > > > > > years old. The body usually gets rid of all of these

> > viruses

> > > on

> > > > > its

> > > > > > > own. Because of this, if you do routine (IGG) antibody

> > > testing,

> > > > > > > almost everybody will be positive for EB and many for

HHV-

> 6

> > > and

> > > > > CMV

> > > > > > > viruses. However, the IGG test will not tell you if you

> > have

> > > > > active

> > > > > > > infections unless the IGM antibody is also positive

> > > (suggesting

> > > > a

> > > > > > new

> > > > > > > infection). The IGM antibody is the one that increases

in

> > the

> > > > > first

> > > > > > > six weeks of an infection. This is followed by an

> elevated

> > > IGG

> > > > > > > antibody, which stays elevated your whole life and acts

> as

> > > your

> > > > > > > body's surveillance system. All an elevated IGG means

is

> > that

> > > > > your

> > > > > > > body has seen this infection and, if it sees it again,

> it's

> > > read

> > > > > > > > y to knock it out quickly. This is how immunizations

> > work.

> > > > The

> > > > > > > immunization creates the IGG antibody, so that instead

of

> > > > taking

> > > > > > one

> > > > > > > to two weeks to gear-up to fight the infection, your

body

> > can

> > > > > > > eliminate that infection very quickly. Unfortunately,

in

> > > CFIDS

> > > > > you

> > > > > > > can have a chronic low-grade infection—even if your IGG

> > > > antibody

> > > > > is

> > > > > > > positive (elevated) - making the IGG antibody test for

> HHV-

> > 6,

> > > > EB

> > > > > > > Virus and CMV unreliable in CFIDS/FMS. In addition, the

> IGM

> > > > > > antibody

> > > > > > > will usually not be present in elevated levels in the

low-

> > > grade

> > > > > > > infections with these viruses that may be seen in CFIDS

> and

> > > > FMS.

> > > > > > > > What makes this important is that Valtrex at high-

dose

> > can

> > > > > > > eliminate Epstein Barr virus, but will not work if

active

> > HHV-

> > > 6

> > > > > or

> > > > > > > CMV infection is present. As I will discuss later, the

> only

> > > > tests

> > > > > I

> > > > > > > would rely on to diagnose active HHV-6 are " rapid cell

> > > > cultures "

> > > > > or

> > > > > > > PCR testing. Because some insurance companies are more

> > likely

> > > > to

> > > > > > pay

> > > > > > > for IGG than PCR testing, an argument can be made for

> > > checking

> > > > > IGG

> > > > > > > antibodies first. If the EBV IGG is positive and HHV-6

> and

> > > CMV

> > > > > IGG

> > > > > > > are negative, one may choose to proceed with Valtrex

> > 1000mg,

> > > 4

> > > > > > times

> > > > > > > a day, for 6 months, without PCR testing. If the HHV-6

or

> > CMV

> > > > IGG

> > > > > > > antibodies are positive, then check the CMV and/or HHV-

6

> > PCR

> > > > > tests

> > > > > > to

> > > > > > > be sure they are negative.

> > > > > > > > Tell Me More About HHV-6 And CFIDS

> > > > > > > > Unfortunately there is no currently accepted standard

> > > > treatment

> > > > > > for

> > > > > > > the HHV-6 Virus. Even though it is related to other

> Herpes

> > > > > viruses,

> > > > > > > HHV-6 is resistant to Acyclovir, Valtrex, Famvir and

the

> > > other

> > > > > > > antivirals that are commonly used in Herpes infections.

> The

> > > > only

> > > > > > > antiviral known to be effective against HHV-6 is

> > Ganciclovir.

> > > > > This

> > > > > > > has significant side effects and has to be given

> > > intravenously

> > > > > and

> > > > > > > possibly forever to maintain the antiviral effect.

> > > > Unfortunately,

> > > > > > > this is not a viable option in day-to-day life and has

> been

> > > > only

> > > > > > > moderately successful when used. The main doctor who

has

> > been

> > > > > using

> > > > > > > Ganciclovir to treat HHV-6 in the United States is Joe

> > > Brewer,

> > > > > > M.D.,

> > > > > > > (816-531-1550) in Kansas City, Missouri. He found that

> 140

> > > out

> > > > of

> > > > > > 207

> > > > > > > CFIDS patients had positive HHV-6 cell cultures. Forty

> > > percent

> > > > of

> > > > > > > CFIDS patients were positive on their first test and

70%

> > were

> > > > > > > positive after three tests. This contrasts to 60

healthy

> > > > patients

> > > > > > he

> > > > > > > checked in which none of the HHV-6 tests were positive.

> > > Culture

> > > > > > > > s are more likely to be positive during acute flares

of

> > the

> > > > > > > disease, when the viral level in the blood rises (see

> Page

> > 9

> > > > for

> > > > > > more

> > > > > > > on HHV-6 PCR testing).

> > > > > > > > As is often the case in CFIDS, there is conflicting

> data

> > on

> > > > > > > infections in Chronic Fatigue Syndrome. A recently

> > published

> > > > > study

> > > > > > > (Reeves WC, et al., Clin Infect Dis, 2000 July; 31 [1]

> pp48-

> > > 52)

> > > > > > > examined 26 patients with Chronic Fatigue Syndrome and

52

> > > > healthy

> > > > > > > patients in Atlanta, Georgia, at the CDC. In this

study,

> > > > several

> > > > > > > tests for HHV-6 and HHV-7 were done, including

Polymerase

> > > Chain

> > > > > > > Reaction (PCR). HHV-6 DNA was found in 11% of CFIDS

> > patients

> > > > and

> > > > > > 28%

> > > > > > > of healthy patients, suggesting that the HHV-6 was

> actually

> > > > less

> > > > > > > common in Chronic Fatigue Syndrome than in healthy

> > patients.

> > > At

> > > > > > this

> > > > > > > time, as the conflicting data shows, although HHV-6 may

> be

> > > one

> > > > of

> > > > > > > many suspect infections in CFIDS, it is not yet clearly

> the

> > > > cause

> > > > > > of

> > > > > > > this illness.

> > > > > > > > When HHV-6 is present, it seems to infect the natural

> > > Killer

> > > > > > Cells,

> > > > > > > important cells in your body's defense (immune) system

> that

> > > are

> > > > > > > critical in fighting infections. A number of studies

have

> > > shown

> > > > > > these

> > > > > > > Killer Cells to be malfunctioning in CFIDS. HHV-6

> infection

> > > > does

> > > > > > not

> > > > > > > necessarily decrease the number of the natural Killer

> Cells

> > > but

> > > > > > does

> > > > > > > decrease their function. Natural Killer Cell function

is

> > > > > described

> > > > > > in

> > > > > > > what is called Lytic Units—which means the ability of

> cells

> > > to

> > > > > lyse

> > > > > > > or break down foreign invaders. An average person will

> have

> > a

> > > > > Lytic

> > > > > > > Unit level of 20 to 250 with over 80% of healthy

patient

> > > being

> > > > > over

> > > > > > > 40 units. Dr. Brewer finds that in CFIDS the mean

Natural

> > > > Killer

> > > > > > > Lytic Cell level is 12 units. Dr. Brewer uses Specialty

> > Labs

> > > in

> > > > > > > California for his Natural Killer Lytic Cell testing

and

> > > finds

> > > > > that

> > > > > > > the Lytic level stays the same on repeat testing and

> seems

> > to

> > > > be

> > > > > a

> > > > > > > reliable test for Natural Killer Cell function testing

in

> > > > CFIDS.

> > > > > > > Lytic unit levels will, however, decrease during flar

> > > > > > > > es of symptoms. In Dr. Brewer's experience, this test

> is

> > > very

> > > > > > > specific for CFIDS and Multiple Sclerosis. He has

treated

> > ten

> > > > MS

> > > > > > > patients and five CFIDS patients with the I.V.

> Ganciclovir.

> > > He

> > > > > > found

> > > > > > > that it helped to stabilize the MS patients. In the

CFIDS

> > > > > patients,

> > > > > > > two to three were much improved, one still had a

positive

> > > viral

> > > > > > > culture and one had a poor response. Unfortunately,

> > > maintaining

> > > > > > > patients on I.V. Ganciclovir forever (as noted above)

is

> > not

> > > a

> > > > > > viable

> > > > > > > option. Fortunately, an oral pill form of Ganciclovir

> > > > > > > (Valganciclovir) is currently being developed! It

should

> be

> > > > noted

> > > > > > > that the HHV-6 virus is similar to CMV

(Cytomegalovirus),

> > and

> > > > > that

> > > > > > > whatever is effective against one, tends to be

effective

> > for

> > > > the

> > > > > > > other. This is a helpful bit of information as we

follow

> > new

> > > > > > research

> > > > > > > looking for clues on how to eliminate HHV-6 infection.

> > > > > > > > What Roles Does The Epstein Barr And Cytomegalovirus

> Play

> > > In

> > > > > > CFIDS?

> > > > > > > > Again, the roles of the EB and CMV viruses are not

> clear.

> > > It

> > > > is

> > > > > > not

> > > > > > > uncommon for antibody levels of these viruses to be

> > elevated

> > > in

> > > > > > > Chronic Fatigue Syndrome. As noted above, it is not

clear

> > > > whether

> > > > > > > this simply reflects a previous or ongoing infection

with

> > > these

> > > > > > > viruses. Research by a husband and wife team (the

> Glasers)

> > at

> > > > > Ohio

> > > > > > > State University, suggests that Epstein Barr Virus is

> still

> > > > quite

> > > > > > > active and playing a role in many patients with these

> > > > infections.

> > > > > > In

> > > > > > > addition, work by Lerner, M.D., also suggests

that

> > EB

> > > > > Virus

> > > > > > > and CMV are active as well. In speaking with Dr.

Lerner's

> > > > > research

> > > > > > > assistant, I found out that he has found EB Virus and

CMV

> > to

> > > > both

> > > > > > be

> > > > > > > fairly common in patients with Chronic Fatigue Syndrome

> > (with

> > > > and

> > > > > > > without pain). He found that about 20% had positive IGM

> > > and/or

> > > > > > > elevated EA (early antigen) tests to the EB Virus with

> > > negative

> > > > > > > Cytomegalovirus. Of these, two-thirds improved with

high-

> > dose

> > > > > > Valtrex

> > > > > > > (an oral antiviral). Despite my teasing and prodding,

his

> > > > associat

> > > > > > > > e refused to give out the dose of Valtrex they

> prescribed

> > > > > because

> > > > > > > Dr. Lerner does not want to be responsible for people

> using

> > > > these

> > > > > > > higher doses until he completes the double-blind trial

> that

> > > is

> > > > > > > currently in progress. On the other hand, another study

> of

> > > his

> > > > > did

> > > > > > > use 1000mg, 4 times a day, giving the antiviral for 6

> > months.

> > > > It

> > > > > > > takes about 3 to 4 months before patients start to

> improve

> > > and

> > > > > > after

> > > > > > > 6 months people can stop the Valtrex without the

symptoms

> > > > coming

> > > > > > > back. However, if there is no improvement in 6 months,

> > > consider

> > > > > it

> > > > > > to

> > > > > > > be a negative result. They also found that, as noted

> above,

> > > the

> > > > > IGM

> > > > > > > is almost always negative using the reagents used in

most

> > > labs.

> > > > > > They

> > > > > > > found that only Epstein Barr IGM antibody testing,

using

> a

> > > > > reagent

> > > > > > by

> > > > > > > the Diasorin Company (800-328-1482), has been useful in

> > > showing

> > > > a

> > > > > > > significant number of positive tests. When we called

the

> > > > company,

> > > > > > the

> > > > > > > only lab in the Washington, D.C., area using it was at

> the

> > > NIH.

> > > > > The

> > > > > > > company may, however, be able to give you the name of

> > > > > > > > a lab near you that can do the test. What was fairly

> > > common,

> > > > > > > though, (and present in most patients) was either

> positive

> > > > tests

> > > > > > for

> > > > > > > Epstein Barr, CMV, or a combination of both as noted

> above.

> > > > When

> > > > > > CMV

> > > > > > > or HHV-6 are present, the Valtrex is less likely to

work

> > > > because

> > > > > it

> > > > > > > is not effective against these viruses.

> > > > > > > > In another study done by Dr. Lerner (Infectious

> Diseases

> > In

> > > > > > > Clinical Practice, 1997; 6:110-117) he found that

> patients

> > > who

> > > > > had

> > > > > > > elevated CMV IGG antibodies, but no significant

evidence

> of

> > > > > > > associated Epstein Barr virus (i.e., negative IGM and

> early

> > > > > antigen

> > > > > > > (EA) antibody total less than 40), did improve with

I.V.

> > > > > > Ganciclovir

> > > > > > > at 5mg per kg of body weight given every 12 hours I.V.

> for

> > 30

> > > > > days.

> > > > > > > In this study 72% (13 of the 18 patients) improved

> markedly

> > > at

> > > > > the

> > > > > > > end of a month without any significant side effects. As

> > > noted,

> > > > an

> > > > > > > oral form of Ganciclovir is currently in development as

> > well.

> > > > It

> > > > > > > should be noted that 36% of the Chronic Fatigue

Syndrome

> > > > patients

> > > > > > > that Dr. Lerner checked (18 out of 50) did turn out to

> have

> > > > > > elevated

> > > > > > > CMV antibodies (albeit IGG) in the absence of IGM and

EA

> > > > > antibodies

> > > > > > > to EB Virus (i.e., no evidence of active Epstein Barr

> > Virus).

> > > > It

> > > > > > > should be noted, though, that 70% of healthy patients

> also

> > > had

> > > > > > > positive IGGs to CMV (as per our discussion above) in

the

> > > study

> > > > > and

> > > > > > > appears

> > > > > > > > that the overall level of the IGG was not much

higher

> > > > overall

> > > > > in

> > > > > > > the Chronic Fatigue group than in the healthy controls.

> On

> > > the

> > > > > > other

> > > > > > > hand, the higher the level of CMV antibody in the

Chronic

> > > > Fatigue

> > > > > > > group, the more likely they were to improve with the

I.V.

> > > > > > Ganciclovir.

> > > > > > > > What this means is that patients with Chronic Fatigue

> > > > Syndrome

> > > > > > > don't necessarily have different blood tests for

antibody

> > > > levels

> > > > > > than

> > > > > > > healthy people for these viruses. However, if one has a

> > > higher

> > > > > > level

> > > > > > > rather than a lower level, one is more likely to

improve

> > with

> > > > the

> > > > > > > Ganciclovir. Previous research has not shown benefit

from

> > > > > antiviral

> > > > > > > therapies in CFS (Straus SE, et al., New England

Journal

> of

> > > > > > Medicine

> > > > > > > 1988; 319:1692-1698). Our experience using a fairly

high

> > dose

> > > > of

> > > > > > > Valtrex or Famvir (1500mg and 2250mg a day

respectively)

> > also

> > > > > > showed

> > > > > > > no significant improvement on these regimens after 6

> weeks,

> > > at

> > > > > > which

> > > > > > > time we considered it to be ineffective. On the other

> hand,

> > > Dr.

> > > > > > > Lerner's research is suggesting that perhaps we gave it

> for

> > > too

> > > > > > short

> > > > > > > a time and at too low a dose. When treating himself and

a

> > few

> > > > > other

> > > > > > > patients, he used Valtrex by mouth at a dosage of

1000mg,

> 4

> > > > times

> > > > > a

> > > > > > > day, for 6 months. Using the higher dosing and the

> extended

> > > > > period

> > > > > > of

> > > > > > > time, as well as separating out groups that have

> > > > > > > > Epstein Barr Virus (sensitive to the oral Valtrex)

> > without

> > > > CMV

> > > > > > or

> > > > > > > HHV-6 (resistant to oral Valtrex but sensitive to I.V.

> > > > > > Ganciclovir),

> > > > > > > may make an important difference in making treatment

> > > effective.

> > > > > No

> > > > > > > major Valtrex toxicity was seen. As noted above, a

double-

> > > blind

> > > > > > study

> > > > > > > is currently in progress and we are beginning to try

the

> > > higher

> > > > > > dose

> > > > > > > of Valtrex in the 15% of our patient population that

have

> > not

> > > > > > > improved adequately and have positive EBV, and negative

> CMV

> > > and

> > > > > HHV-

> > > > > > 6

> > > > > > > tests. We hope to give you follow-up information on the

> > > > > treatment's

> > > > > > > effectiveness as soon as we know!

> > > > > > > > In addition, Dr. Lerner suspects that these

infections

> > > affect

> > > > > the

> > > > > > > heart muscle contributing to much of your symptoms. I

am

> > not

> > > > > > > convinced that this is the case because EKG changes are

> > > common

> > > > in

> > > > > > > CFS. This can occur because the autonomic (brain)

> > dysfunction

> > > > and

> > > > > > > hormonal changes seen in CFS can cause these same EKG

> > changes

> > > > > > without

> > > > > > > heart damage. Regardless, he found that these changes

> went

> > > away

> > > > > > with

> > > > > > > treatment (as has been our experience in treating

Chronic

> > > > Fatigue

> > > > > > > Syndrome—patient's EKG changes improve even without

> > > > antivirals).

> > > > > > Dr.

> > > > > > > Lerner is currently recruiting patients for a double-

> blind

> > > > study

> > > > > > > using the high-dose Valtrex. His phone number is 248-

540-

> > 9688

> > > > in

> > > > > > > Beverly Hills, Michigan.

> > > > > > > > Does This Mean There Is Nothing We Can Do Now?

> > > > > > > > Although there is no currently accepted specific

> > treatment

> > > > for

> > > > > > the

> > > > > > > CMV and HHV-6 viruses, there are still a number of

things

> > > that

> > > > > may

> > > > > > be

> > > > > > > very helpful in fighting this infection.

> > > > > > > > 1. Lithium tends to be antiviral and has been shown

to

> > > > decrease

> > > > > > > pain in FMS patients when added to treatment with

Elavil.

> > > > Lithium

> > > > > > is

> > > > > > > commonly used in manic depressive illness and is a

> natural

> > > > > mineral

> > > > > > > despite being sold by prescription. In high doses, it

can

> > > cause

> > > > > > some

> > > > > > > neurologic symptoms and suppression of the thyroid

gland,

> > but

> > > > > these

> > > > > > > can usually be treated by taking a small amount of

> > Essential

> > > > > Fatty

> > > > > > > Acids and thyroid hormone. Lithium might also worsen

> > Restless

> > > > Leg

> > > > > > > Syndrome. Although we have no direct evidence of

Lithium

> > > being

> > > > an

> > > > > > > effective antiviral against HHV-6, it may well be

> effective

> > > > > because

> > > > > > > it works against a number of other viral infections. In

> our

> > > > > > > experience, 200mg to 600mg a day seems to be the

> effective

> > > dose

> > > > > in

> > > > > > > treating FMS patients. As noted above, I would check

the

> > > > thyroid

> > > > > > > blood tests at 3 months, 6 months and then yearly

(check

> a

> > > Free

> > > > > T4

> > > > > > > and a Total T3 - not a TSH). A Lithium level should

also

> be

> > > > > checked

> > > > > > > at the same time to be sure that it not above the upper

> > limit

> > > > of

> > > > > > > > normal. The level can be below the normal range,

which

> is

> > > > fine

> > > > > as

> > > > > > > long as the treatment is effective. You may find that

you

> > can

> > > > > lower

> > > > > > > the Lithium dose after you have been on it for several

> > months.

> > > > > > > > 2. Heparin (a blood thinner, see Page 12) also has

> > > antiviral

> > > > > > > properties.

> > > > > > > > 3. It is worth considering trials of high-dose

Valtrex.

> > It

> > > > > should

> > > > > > > be noted that 1000mg, 3 times a day, is used for

shingles

> > in

> > > > > older

> > > > > > > patients and appears to be quite safe. On the other

hand,

> > > > higher

> > > > > > > dosing at 8 grams a day in AIDS patients did result in

> > > uncommon

> > > > > > > (under 2%) life threatening problems. This is common

even

> > > with

> > > > > day-

> > > > > > to-

> > > > > > > day drugs in AIDS patients (for example, regular sulfa

> > > > > antibiotics

> > > > > > > have often resulted in severe toxicity in AIDS

patients).

> > > > > > > Nonetheless, we will be limiting the dose to 1 gram, 4

> > times

> > > a

> > > > > day,

> > > > > > > in our practice. It is important to note that taking

> > Tagamet

> > > > > and/or

> > > > > > > Probenecid (Benemid) will raise the blood level of

> Valtrex.

> > > > > Tagamet

> > > > > > > has powerful immune modifying properties and is very

> > helpful

> > > in

> > > > > > acute

> > > > > > > cases of Epstein Barr (mono) infections. Because of

this,

> > we

> > > > are

> > > > > > > adding Tagament 300mg, 4 times a day (but not

> Probenecid),

> > to

> > > > the

> > > > > > > Valtrex. As I noted, we are beginning this treatment

with

> > > some

> > > > of

> > > > > > our

> > > > > > > patients and will let you know what we find.

> > > > > > > > Natural Remedies

> > > > > > > > 1. Olive Leaf - This is an herbal which is known to

> have

> > a

> > > > wide

> > > > > > > spectrum of anti-infectious activity. It has been shown

> to

> > be

> > > > > > > effective against the HHV-6 virus in the test tube. I

> have

> > > not,

> > > > > > > however, seen studies testing its effect in human

beings

> > > > infected

> > > > > > > with HHV-6. Nonetheless, a number of physicians have

> found

> > > that

> > > > > > using

> > > > > > > Olive Leaf in Chronic Fatigue Syndrome is very

effective.

> > > There

> > > > > is

> > > > > > > controversy over whether the form and source of the

Olive

> > > Leaf

> > > > is

> > > > > > > critical. We recommend that you use a form that has at

> > least

> > > 6%

> > > > > > > Oleuropein, which is one of the most active antiviral

> > > > components

> > > > > in

> > > > > > > the Olive Leaf. Other components may be important and

> some

> > > > people

> > > > > > > also feel that you must use the Mediterranean Olive

Leaf

> > vs.

> > > > the

> > > > > > > American Olive Leaf. Other people argue that you should

> > have

> > > a

> > > > > form

> > > > > > > that is organically grown, without pesticides. At this

> > point

> > > it

> > > > > is

> > > > > > > not clear whether this is simply marketing or important

> in

> > > day-

> > > > to-

> > > > > > day

> > > > > > > life. Nonetheless, I would be picky about the companies

> you

> > > buy

> > > > > the

> > > > > > O

> > > > > > > > live Leaf from. I would use one of these sources:

> > > > > > > > a. My office (800-333-5287) or my Web site at

> > > > > www.endfatigue.com.

> > > > > > > > b. Pacific Research Labs (800-325-7734). This is

owned

> by

> > > R.

> > > > J.

> > > > > > > Marshall, Ph.D., who has done a fair bit of work

treating

> > > CFIDS

> > > > > > > patients with Olive Leaf. I will be describing the

> protocol

> > > > that

> > > > > he

> > > > > > > uses below.

> > > > > > > > c. General Nutrition Centers (GNC).

> > > > > > > > Dr. Marshall feels that during infections, the body

> > becomes

> > > > > > overly

> > > > > > > acidic. He tests the morning urine specimens with pH

> paper

> > > > (which

> > > > > > is

> > > > > > > very easy to do at home) and gives a shell extract,

which

> > > > raises

> > > > > > the

> > > > > > > body's alkalinity. He feels that having a normalized

acid-

> > > base

> > > > > > > balance in your body helps it to fight infections. He

> then

> > > adds

> > > > > his

> > > > > > > form of Olive Leaf, called Infectostat (which also

> contains

> > > > > > mushroom

> > > > > > > extracts to stimulate the immune system), giving 3 to 4

> > > > capsules,

> > > > > 3

> > > > > > > to 4 times a day, to help fight the infections.

Usually,

> > the

> > > > > > patient

> > > > > > > should start feeling better within four weeks on this

> > > protocol.

> > > > > > > Although we have found it helpful in fighting colds and

> > other

> > > > > > common

> > > > > > > respiratory infections, we are just starting to explore

> > Olive

> > > > > > Leaf's

> > > > > > > use in a few of our patients who have not responded to

> > > standard

> > > > > > > treatment and are still quite ill. We will let you know

> our

> > > > > > > experience with this in an upcoming newsletter issue.

My

> > > guess,

> > > > > > > though, is that simply using regular (6% Oleuropein)

> Olive

> > > Leaf

> > > > > > > > 500mg capsules, 3 to 4 capsules, 3 to 4 times a day

> > between

> > > > > > meals,

> > > > > > > will probably be equally effective and cheaper for most

> > > people

> > > > > than

> > > > > > > the expensive forms. How long one needs to take Olive

> Leaf

> > in

> > > > > > Chronic

> > > > > > > Fatigue Syndrome is yet to be determined.

> > > > > > > > Initially, a pharmaceutical company was developing

the

> > > > > Oleuropein

> > > > > > > in Olive Leaf as an antiviral. Because it gets bound to

> the

> > > > blood

> > > > > > > proteins, they thought that Oleuropein might not get to

> the

> > > > > > tissues.

> > > > > > > More importantly, Oleuropein is a natural product and

> > > therefore

> > > > > > hard

> > > > > > > to patent. Because of these problems, they stopped

> research

> > > on

> > > > > it.

> > > > > > > Years later this research was rediscovered and explored

> > > > further.

> > > > > In

> > > > > > > addition to being an effective antiviral agent, Olive

> Leaf

> > is

> > > > > > > reported to be effective on a number of bacterial and

> yeast

> > > > > > > infections as well. What is most exciting regarding the

> > Olive

> > > > > Leaf

> > > > > > is:

> > > > > > > > a. That some doctors have found it to be effective in

> > > CFIDS,

> > > > > and

> > > > > > > > b. That in tests against HHV-6 and CMV virus

(remember

> > that

> > > > if

> > > > > > > something is effective against one, it tends to be

> > effective

> > > > > > against

> > > > > > > the other) the Olive Leaf extract did not just suppress

> the

> > > > virus

> > > > > > but

> > > > > > > killed it. That is very promising.

> > > > > > > > 2. Pro-Boost - Thymic Protein A (used to be called

> > BioPro) -

> > >

> > > > > This

> > > > > > > is the immune stimulant that I discussed in my

> newsletter,

> > > Vol.

> > > > > 2,

> > > > > > > Issue 2. Although not a hormone, Pro-Boost mimics the

> > natural

> > > > > > hormone

> > > > > > > produced by your Thymus - the gland which stimulates

your

> > > > immune

> > > > > > > system. I find it to be extraordinarily effective in

> > fighting

> > > > > > common

> > > > > > > infections of any kind that seem to pop up. For the

more

> > deep-

> > > > > > seated

> > > > > > > infections of CFIDS, the higher dose (1 packet, 3 times

a

> > > day)

> > > > > will

> > > > > > > likely be needed. Once the infection seems to be in

check

> > and

> > > > you

> > > > > > are

> > > > > > > feeling better (i.e., after 6 weeks), you can taper

down

> to

> > > the

> > > > > > > lowest dose that maintains the effect.

> > > > > > > > 3. IP6 - This natural immune stimulant is an extract

of

> > > bran

> > > > > > > (phytates). It is less expensive and is sometimes

> combined

> > > with

> > > > > > > vitamin C. The dose of IP6 (available from many

sources)

> is

> > 5

> > > > to

> > > > > 8

> > > > > > > grams a day. Do not take IP6 within 3 hours of

> > > vitamin/mineral

> > > > > > > supplements.

> > > > > > > > 4. MGN3 - This is a very concentrated mushroom

extract,

> > > which

> > > > > has

> > > > > > > been shown to stimulate Natural Killer Cell immune

> > function.

> > > In

> > > > > one

> > > > > > > study, it actually tripled Natural Killer Cell function—

> an

> > > > effect

> > > > > > > that, as the HHV-6 virus can suppress Natural Killer

Cell

> > > > > function,

> > > > > > > could be very powerful. Unfortunately, it is horribly

> > > expensive

> > > > > in

> > > > > > > the recommended dose (250 mg capsules) of 2 to 4

> capsules,

> > 4

> > > > > times

> > > > > > a

> > > > > > > day for 2 weeks, followed by 2 capsules, 2 times a day.

> > Other

> > > > > > > mushroom extracts are cheaper but may not be as

> effective.

> > > > > > > > 5. Intravenous Vitamin C at high-dose (15gm to 50gm)

> has

> > > been

> > > > > > > suggested to have antiviral effects in a number of

other

> > > > > infections

> > > > > > > and is often dramatically helpful in CFIDS when given

in

> > the

> > > > I.V.

> > > > > > > nutritional therapy called " Myers Cocktails " (see my

> > > > newsletter,

> > > > > > Vol.

> > > > > > > 3, Issue 3).

> > > > > > > > 6. Lysine 1000 mg, 3 times a day - This amino acid

> > protein

> > > is

> > > > > > safe

> > > > > > > and inexpensive (27¢ a day). It inhibits oral/genital

> > herpes

> > > > (by

> > > > > > > depleting the Arginine the virus needs to grow). I do

not

> > > know

> > > > if

> > > > > > it

> > > > > > > also inhibits EBV, HHV-6 or CMV viral infections.

> > > > > > > > I would take the combination of these together (as is

> > > > > affordable)—

> > > > > > > perhaps leaving the MGN3 for later if needed, giving

the

> > > > > treatment

> > > > > > > for at least a 6 to 8 week trial to see if it's

> effective.

> > If

> > > > you

> > > > > > are

> > > > > > > feeling better at 6 weeks, you can then taper down the

> dose

> > > > > slowly

> > > > > > as

> > > > > > > long as the benefit is maintained. When able, you can

> wean

> > > > > yourself

> > > > > > > off the treatments. If symptoms recur, go back up to

the

> > dose

> > > > > that

> > > > > > > maintains the benefit or consider increasing the dose

> > > further.

> > > > As

> > > > > > we

> > > > > > > are just starting to use this protocol in our patients,

I

> > do

> > > > > > > appreciate your feedback on what has worked for you and

> > what

> > > > has

> > > > > > not.

> > > > > > > You can " vote " for what helped or didn't help you on

our

> > Web

> > > > site

> > > > > > at

> > > > > > > www.endfatigue.com. You can also see other people's

> votes.

> > > > > > > > In addition, your clotting system may be activated by

> > > several

> > > > > > > infections making it difficult to eliminate them. Using

> the

> > > > anti-

> > > > > > > clotting treatments that we will discuss later can also

> > make

> > > it

> > > > > > > easier for your body to eradicate infections.

> > > > > > > > Mycoplasma And Chlamydia

> > > > > > > > Other infections have also been found to be very

> > important

> > > in

> > > > > > > CFIDS. Dr. Garth Nicolson and his wife, who were on-

> faculty

> > > at

> > > > > the

> > > > > > > University of Texas Medical School at Houston and the

> > > > Department

> > > > > of

> > > > > > > Microbiology and Immunology at Baylor College of

Medicine

> > in

> > > > > > Houston,

> > > > > > > Texas, are the leading proponents of treatment of these

> > > > > infections.

> > > > > > > Dr. Garth Nicolson was an endowed chair and department

> > > chairman

> > > > > at

> > > > > > > the University of Texas, the M.D. Cancer

Center

> in

> > > > > > Houston,

> > > > > > > Texas, and a Professor of Internal Medicine at the

> > University

> > > > of

> > > > > > > Texas Medical School, also in Houston. Dr. Nicolson's

> wife

> > > had

> > > > > > > Chronic Fatigue Syndrome years ago. They were surprised

> > that

> > > > her

> > > > > > test

> > > > > > > turned out to be positive for Mycoplasma fermentans

(also

> > > known

> > > > > as

> > > > > > > Mycoplasma fermentans incognitus). This Mycoplasma was

> > found

> > > to

> > > > > be

> > > > > > > resistant to the Penicillin- and Keflex-family

> antibiotics

> > > that

> > > > > > most

> > > > > > > doctors use, but was sensitive to long courses of

> > Doxycycline

> > > > and

> > > > > > > Cipro. After an extended course of Doxycycline

treatment,

> > > > > > > > she was much better. The Nicolsons then went on to

> > develop

> > > > > their

> > > > > > > own tests for Mycoplasma using PCR testing. Dr.

Nicolson

> > > tells

> > > > me

> > > > > > > that, in addition, when his step-daughter came home

after

> > > > serving

> > > > > > in

> > > > > > > Desert Storm, she came down with Gulf War Illness

(GWI).

> > They

> > > > > > tested

> > > > > > > hundreds of Gulf War veterans with GWI and 40% to 45%

> were

> > > > > positive

> > > > > > > for Mycoplasma infections—almost all with Mycoplasma

> > > > fermentans.

> > > > > > This

> > > > > > > has been confirmed by other labs and a large Veterns

> > > > > Aministration

> > > > > > > study involving over 2,000 patients. In contrast to

this,

> > > > > soldiers

> > > > > > > who were not deployed to the Gulf during the war, had

> less

> > > than

> > > > a

> > > > > > 6%

> > > > > > > incidence of being positive for these infections.

> > > > > > > > Interestingly, the Nicolsons found that in patients

> with

> > > > > Chronic

> > > > > > > Fatigue Syndrome or Fibromyalgia, approximately 70%

(144

> > out

> > > of

> > > > > 203

> > > > > > > patients) had a positive PCR test for one, or usually

> > several

> > > > > > > species, of Mycoplasma. When the Nicolsons tested 70

> > healthy

> > > > > > > patients, only 6 patients (less than 9%) were positive

> for

> > > any

> > > > of

> > > > > > the

> > > > > > > Mycoplasma species. This is a highly significant

> > difference.

> > > > Only

> > > > > 2

> > > > > > > of these 70 healthy people were positive for Mycoplasma

> > > > > fermentans.

> > > > > > > Similar results have been found by other doctors and

have

> > > been

> > > > > > > published.

> > > > > > > > As we have said before, it is likely that there is a

> > group

> > > of

> > > > > > > underlying problems and not a single one that triggers

> > > > CFIDS/FMS.

> > > > > > > This applies to infections as well. This is why you can

> see

> > > > tests

> > > > > > be

> > > > > > > positive for both viral and Mycoplasmal infections in

so

> > many

> > > > > > people

> > > > > > > with this disease. For Mycoplasma alone, when they

> checked

> > > for

> > > > > four

> > > > > > > different types of Mycoplasma, over half of the 93

CFIDS

> > > > patients

> > > > > > > that were positive had more than one type of infection.

> > Over

> > > > 20%

> > > > > of

> > > > > > > them had three out of the four Mycoplasma infections

test

> > > > > positive.

> > > > > > > The more infections that were positive, the worse the

> > > patient's

> > > > > > > symptoms were and the longer they had had CFIDS/FMS.

> > > > > > > > What Are Mycoplasma?

> > > > > > > > Mycoplasma are an ancient bacteria that lacks cell

> walls

> > > and

> > > > > are

> > > > > > > capable of invading a number of types of human cells.

> They

> > > can

> > > > > > cause

> > > > > > > a wide variety of human diseases. These organisms can

> cause

> > > the

> > > > > > types

> > > > > > > of symptoms seen in Chronic Fatigue Syndrome patients

> and,

> > > > > > according

> > > > > > > to Dr. Nicolson, tend to be immune suppressing.

> > > Unfortunately,

> > > > > they

> > > > > > > cannot be readily cultured on a culture dish like

regular

> > > > > bacteria.

> > > > > > > In medicine, we have a bad habit on focusing on that

> which

> > is

> > > > > easy

> > > > > > to

> > > > > > > test for and making believe that that which is hard to

> test

> > > for

> > > > > > does

> > > > > > > not exist. Because of this, bacterial infections such

as

> > > > > pneumonia,

> > > > > > > bladder infections and skin infections, where one

> bacteria

> > on

> > > a

> > > > > > cell

> > > > > > > dish will rapidly turn into millions by the next day

and

> be

> > > > > visible

> > > > > > > to the human eye, get all our attention. Unfortunately,

> > > > > Mycoplasma,

> > > > > > > which cannot be easily cultured, tends to be ignored.

> It's

> > > like

> > > > > the

> > > > > > > old story about the little kid who was looking for his

> lost

> > > > keys

> > > > > > > under the street lamp one night. His frien

> > > > > > > > ds came by and asked him what was going on. He told

> them

> > > and

> > > > > they

> > > > > > > all looked for the keys under that light for about an

> hour.

> > > > > > Finally,

> > > > > > > exasperated, they looked at the friend and said, " Where

> did

> > > you

> > > > > > lose

> > > > > > > these keys? " The kid looked up and said, " Oh, about

half

> a

> > > > block

> > > > > > down

> > > > > > > the street. " They said, " Why are you looking for them

> > here? "

> > > He

> > > > > > > said, " Because there is a light here and I can see! "

This

> > is

> > > > kind

> > > > > > of

> > > > > > > what it is like in medicine. If there is a test for

> > something

> > > > > (such

> > > > > > > as cholesterol and bacterial cultures) that is easy to

> do,

> > we

> > > > > focus

> > > > > > > our attention on that test and make believe that it

finds

> > the

> > > > > main

> > > > > > > problem. Unfortunately, in CFIDS and FMS, this is not

the

> > > case.

> > > > > > > > The data suggests that many infections may trigger

> > > CFIDS/FMS

> > > > or

> > > > > > > that CFIDS and FMS may cause immune suppression—which

> then

> > > sets

> > > > > you

> > > > > > > up to catch a whole bunch of different infections which

> > your

> > > > body

> > > > > > has

> > > > > > > trouble clearing. This is why it is important to treat

> all

> > > the

> > > > > > > underlying processes simultaneously as I discuss in my

> From

> > > > > > Fatigued

> > > > > > > To Fantastic! book and newsletters.

> > > > > > > > So, How Do You Look For These Infections?

> > > > > > > > I had the honor of speaking with Konnie Knox, M.D., a

> > major

> > > > re-

> > > > > > > searcher on HHV-6 testing in CFIDS/FMS, who uses a

> > technique

> > > > > called

> > > > > > > Rapid Cell Culture. She actually infects different test

> > tube

> > > > > cells

> > > > > > > with HHV-6, grows them, and then looks for signs of HHV-

6

> > in

> > > > the

> > > > > > > cell. In her experience, one out of three CFIDS/FMS

> > patients

> > > > are

> > > > > > > positive for active HHV-6 infection on the first blood

> > test.

> > > > When

> > > > > > > multiple testing is done (e.g., three tests), 70% are

> > > positive.

> > > > > > This

> > > > > > > test is negative in the vast majority of people who are

> > > > healthy.

> > > > > > The

> > > > > > > other main illness where the HHV-6 test is positive is

> > > Multiple

> > > > > > > Sclerosis. At this time, HHV-6 Rapid Cell Culture and

the

> > PCR

> > > > > test

> > > > > > at

> > > > > > > Dr. Nicolson's lab (International Molecular Diagostics)

> are

> > > the

> > > > > > only

> > > > > > > HHV-6 test I order. For more information on Dr. Knox's

> > work,

> > > go

> > > > > to

> > > > > > > these Web sites: www.HHV-6.com and www.cnet.com. For

the

> > IMD

> > > > > > website,

> > > > > > > go to www.imd-lab.com.

> > > > > > > > The Nicolsons use very sensitive PCR (Polymerase

Chain

> > > > > Reaction)

> > > > > > > testing to actually look for DNA specific to

Mycoplasma,

> > HHV-

> > > 6,

> > > > > and

> > > > > > > other infections. Unfortunately, those DNA pieces are

so

> > > > > > > microscopically small, that to look for just one is

much

> > > worse

> > > > > than

> > > > > > > looking for a " needle in a haystack. " With the PCR, if

> that

> > > > > > > Mycoplasma gene sequence is found, the technique

> multiplies

> > > it

> > > > > like

> > > > > > a

> > > > > > > copying machine until millions of that sequence are

> present

> > > and

> > > > > can

> > > > > > > be picked up by testing. Because of this, PCR testing

is

> > > > > > exquisitely

> > > > > > > sensitive and can find the proverbial " needle in a

> > haystack. "

> > > > > This

> > > > > > > makes it very powerful and the only testing that I

would

> > > > > recommend

> > > > > > in

> > > > > > > looking for these Mycoplasma and Chlamydia infections.

As

> > > noted

> > > > > > > above, IGG antibody testing is not reliable for

> Mycoplasma

> > > and

> > > > > > > Chlamydia testing in CFS.

> > > > > > > > Where Do I Get These Tests Done And Should I Have

Them

> > Done?

> > > > > > > > The tests for HHV-6 and Mycoplasma each cost about

$180

> > to

> > > > > $250.

> > > > > > As

> > > > > > > noted above, the only places that I would get the HHV-6

> > test

> > > > done

> > > > > > > (and the only tests I would do are PCR or viral culture

> > > > testing)

> > > > > > are

> > > > > > > at the Wisconsin Viral Institute (414-774-0311) or Dr.

> > > > Nicolson's

> > > > > > > lab. I order all the lab testing for Mycoplasma and

> > Chlamydia

> > > > at

> > > > > > the

> > > > > > > Nicolson's lab, at International Molecular Diagnostics,

> > 15162

> > > > > > Triton

> > > > > > > Lane, Huntington Beach, CA 92649 (714-799-7177 ext. 202

> or

> > > > 204).

> > > > > > The

> > > > > > > lab's Web site is www.imdlab.com.

> > > > > > > > I can almost guarantee that if you do the Mycoplasma

or

> > > > > Chlamydia

> > > > > > > tests at your local lab they will do the wrong tests

and

> > they

> > > > > will

> > > > > > be

> > > > > > > useless for hidden CFS infections. I have never seen

one

> > come

> > > > > back

> > > > > > > with any useful information. What they usually do is

> check

> > > the

> > > > > > > antibodies (usually for the wrong Mycoplasma infection)

> > which

> > > > > > simply

> > > > > > > shows that you (like everybody else at some point in

> their

> > > > life)

> > > > > > have

> > > > > > > had a Mycoplasma infection. It tells nothing about

active

> > > > > infection

> > > > > > > and, again, is useless. Be sure to do the PCR testing

and

> > do

> > > it

> > > > > at

> > > > > > > one of the two labs discussed above. Dr. Nicolson has

> noted

> > > > which

> > > > > > > tests he recommends in CFS/FMS, their cost and

> instructions

> > > for

> > > > > the

> > > > > > > lab. We have reprinted this information on the next

page

> > (Dr.

> > > > > > > Nicolson's lab also does viral PCR testing for CMV, as

> well

> > > as

> > > > > HHV-

> > > > > > 6).

> > > > > > > > Even at the best labs, it is not uncommon to have a

> false-

> > > > > > negative

> > > > > > > report (where you have the infection and it does not

show

> > up

> > > on

> > > > > the

> > > > > > > test). Because of this, especially for HHV-6, multiple

> > tests

> > > > will

> > > > > > > often need to be done. There are good arguments for not

> > doing

> > > > the

> > > > > > > tests and simply going ahead and treating empirically

> with

> > > the

> > > > > > > natural remedies discussed above for HHV-6, or for

> > > prescribing

> > > > > > > Doxycycline or Cipro for an extended period of time

(see

> > > > below).

> > > > > If

> > > > > > > you feel better after four months on the treatment,

then

> > you

> > > > know

> > > > > > you

> > > > > > > are hitting an infection and you can always

> intermittently

> > > stop

> > > > > the

> > > > > > > treatments to see how long you will need them. Also,

> there

> > > are

> > > > > many

> > > > > > > infections that are not tested for with these tests

that

> > > would

> > > > be

> > > > > > > effectively treated with the regimens that we are

> > discussing.

> > > > > Many

> > > > > > of

> > > > > > > these are likely to be infections that we don't even

know

> > > > exist.

> > > > > > > Because of this, if resources are limited, I some-times

> > > simply

> > > > > > treat

> > > > > > > the patient, based on clinical suspicion, without doing

> the

> > > > > > > > tests.

> > > > > > > > Testing does have its benefits. If the test is

> positive,

> > I

> > > am

> > > > > > > likely to treat more aggressively and it helps guide me

> on

> > > how

> > > > > long

> > > > > > > to give the treatment. For example, if after four

months

> > you

> > > > are

> > > > > > not

> > > > > > > better and the test is positive, I would be likely to

go

> > > ahead

> > > > > and

> > > > > > > increase dosing or change to a different antibiotic. If

> the

> > > > test

> > > > > > was

> > > > > > > negative, I would be more likely to just stop treatment

> and

> > > > > suspect

> > > > > > > that the infection is less likely. This argues in favor

> of

> > > > doing

> > > > > > the

> > > > > > > tests. One simple thing to do is to go ahead and check

> with

> > > > your

> > > > > > > insurance company to see if they cover these tests.

This

> > may

> > > > make

> > > > > > > your decision much simpler. Unfortunately, I suspect

that

> > the

> > > > way

> > > > > > > that most labs draw and ship your blood sample may not

be

> > > > > reliable

> > > > > > > because, in our experience, we have had less than 10%

of

> > > > > patient's

> > > > > > > tests come back positive for HHV-6 cell culture and

only

> a

> > > > modest

> > > > > > > percent come back positive for the Mycoplasma. For the

> PCR

> > > > > > Mycoplasma

> > > > > > > test, the blood has to be frozen (see boxed inset, Page

9

> > > > > > > > ). If the blood is left at room temperature, most of

> the

> > > > > positive

> > > > > > > samples become negative after one to two days.

> > > > > > > > Mycoplasma testing is not as specific as HHV-6

testing

> is

> > > for

> > > > > > > CFIDS/FMS/Multiple Sclerosis (i.e., it is positive in

> other

> > > > > > > illnesses). For example, about half the patients with

> > > > Rheumatoid

> > > > > > > Arthritis are also found to be infected with treatable

> > > > > infections,

> > > > > > > including Mycoplasma. This goes along with my, and

other

> > > > doctors'

> > > > > > > experience, that Doxycycline is often effective in

> treating

> > > > > > > Rheumatoid Arthritis. Interestingly, although

Mycoplasma

> is

> > > > > common

> > > > > > in

> > > > > > > the environment, it usually is fairly noninvasive. It

may

> > > > simply

> > > > > be

> > > > > > > that once your immune system is weakened, these

> infections

> > > can

> > > > > get

> > > > > > > into cells where they don't belong. When that happens,

> even

> > > > some

> > > > > of

> > > > > > > the common ones that are considered noninfectious can

> wreak

> > > > > havoc.

> > > > > > > When these infections repro-duce slowly, they tend to

be

> > low-

> > > > > grade,

> > > > > > > chronic infections, as opposed to the acute and more

> > > prominent

> > > > > > > symptoms seen with bacterial and viral infections that

> > > multiply

> > > > > and

> > > > > > > divide rapidly.

> > > > > > > > For CFS/ME or FMS or Autoimmune Disease Patients,

> > > > > > > > The Institute for Molecular Medicine suggests the

> > following

> > > > lab

> > > > > > > tests:

> > > > > > > > (Codes are I.M.D. or CPT Codes)

> > > > > > > > 1. Test Panel 1007 (CPT: 87798x3, 87581) Mycoplasma

> > species

> > > > > panel

> > > > > > > of 4 pathogenic mycoplasmas (M. fermentans, M.

> penumoniae,

> > M.

> > > > > > > hominis, M. penetrans) by PCR.

> > > > > > > > Justification: Almost 60% of CFS/FMS and 50% of

> > Rheumatoid

> > > > > > > Arthritis (RA) and other autoimmune patients have one

or

> > more

> > > > > > > intracellular, systemic mycoplasmal infections similar

to

> > > those

> > > > > > found

> > > > > > > in a variety of chronic illnesses [Nicolson, et al.,

> > > > Mycoplasmal

> > > > > > > infections in chronic illnesses: Fibromyalgia and

Chronic

> > > > Fatigue

> > > > > > > Syndromes, Gulf War Illness, HIV-AIDS and Rheumatoid

> > > Arthritis;

> > > > > > > Medical Sentinel 1999; 5:172-176]. Ultrasensitive and

> > > > > ultraspecific

> > > > > > > mycoplasma tests can only be done by a small number of

> > labs,

> > > > most

> > > > > > > university or government labs that have been trained by

> us

> > > > under

> > > > > a

> > > > > > > U.S. government contract.

> > > > > > > > Specimen Requirements: One (1) 5 cc Lavender-top

> Plastic

> > > Tube

> > > > > > > (EDTA). The blood is collected, immediately mixed and

> > placed

> > > on

> > > > > > ice,

> > > > > > > then shipped on wet ice or immediately flash frozen and

> > > shipped

> > > > > > with

> > > > > > > dry ice by courier (foreign shipments) to I.M.D. to

> arrive

> > > > within

> > > > > > 24-

> > > > > > > 36 hours. Cost=$250. (Note that other commercial labs

> > charge

> > > > $400-

> > > > > > > 600.)

> > > > > > > > 2. Test 1006 (CPT: 87486) Chlamydia pneumoniae test

by

> > PCR.

> > > > > > > Justification: Many CFS, FMS, MS, RA and other patients

> > have

> > > > this

> > > > > > > systemic infection along with viral infection(s). We

were

> > > among

> > > > > the

> > > > > > > few labs that developed the molecular tests that are

now

> > done

> > > > for

> > > > > > > this type of infection. The other labs that use these

> > > > procedures

> > > > > > are

> > > > > > > university labs.

> > > > > > > > Specimen Requirements: One (1) 5 cc Lavender-top

> Plastic

> > > Tube

> > > > > > > (EDTA). The blood is collected, immediately mixed and

> > placed

> > > on

> > > > > > ice,

> > > > > > > then shipped on wet ice or immediately flash frozen and

> > > shipped

> > > > > > with

> > > > > > > dry ice by courier to I.M.D. to arrive within 24-36

> hours.

> > > > > > Cost=$180.

> > > > > > > (Note that other commercial labs charge $200-250.)

> > > > > > > > 3. Test 07047 (CPT: 87476) Borrelia burgdorferi (Lyme

> > > > Disease)

> > > > > > test

> > > > > > > by PCR.

> > > > > > > > Justification: Many CFS, FMS and RA patients have

this

> > > > systemic

> > > > > > > infection (diagnosed as Lyme Disease) along with other

> > > infection

> > > > > > (s).

> > > > > > > > Specimen Requirements: One (1) 5 cc Lavender-top

> Plastic

> > > Tube

> > > > > > > (EDTA). The blood is collected, immediately mixed and

> > placed

> > > on

> > > > > > ice,

> > > > > > > then shipped on wet ice or immediately flash frozen and

> > > shipped

> > > > > > with

> > > > > > > dry ice by courier to I.M.D. to arrive within 24-36

> hours.

> > > > > > Cost=$180.

> > > > > > > (Note that other commercial labs charge $200-250.)

> > > > > > > > 4. Test 07039 (CPT: 87532) Human Herpes Virus 6 (HHV-

6)

> > > test

> > > > by

> > > > > > > PCR.

> > > > > > > > Justification: Many CFS and some FMS patients have

this

> > > > > systemic

> > > > > > > viral infection, and it should be tested for in any

> > > autoimmune

> > > > > > > illness.

> > > > > > > > Specimen Requirements: Collect blood in one (1) 5 cc

> > > Lavender-

> > > > > top

> > > > > > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > > > > > centrifugation. The plasma is then shipped on wet ice

or

> > > > > > immediately

> > > > > > > flash frozen and shipped with dry ice by courier to

> I.M.D.

> > to

> > > > > > arrive

> > > > > > > within 24-36 hours. Cost=$180. (Note that other

> commercial

> > > labs

> > > > > > > charge $200-350.)

> > > > > > > > 5. Test 07034 (CPT: 87496) Cytomegalovirus (CMV) test

> by

> > > PCR.

> > > > > > > > Justification: Many CFS and FMS patients have this

> > systemic

> > > > > viral

> > > > > > > infection, and it should be tested for in any

autoimmune

> > > > illness.

> > > > > > > > Specimen Requirements: Collect blood in one (1) 5 cc

> > > Lavender-

> > > > > top

> > > > > > > Plasma Tubes (EDTA), mixed and separate blood plasma by

> > > > > > > centrifugation. The plasma is then shipped on wet ice

or

> > > > > > immediately

> > > > > > > flash frozen and shipped with dry ice by courier to

> I.M.D.

> > to

> > > > > > arrive

> > > > > > > within 24-36 hours. Cost=$180. (Note that other

> commercial

> > > labs

> > > > > > > charge $200-300.)

> > > > > > > > For the best price and highest quality, the above PCR

> > > > specialty

> > > > > > > tests for CFS/FMS patients can be ordered through

> > > International

> > > > > > > Molecular Diagnostics, Inc., 15162 Triton Lane,

> Huntington

> > > > Beach,

> > > > > > CA

> > > > > > > 92649, U.S.A. Tel: 714-799-7177, ext. 202 (Client

> Services)

> > > or

> > > > > ext.

> > > > > > > 204 (Brant Blasingame). Order forms and additional

> > > information

> > > > > are

> > > > > > > available upon request. They also offer testing for

blood

> > > > > clotting

> > > > > > > abnormalities (see below). Tests must be ordered by a

> > > > physician.

> > > > > > The

> > > > > > > I.M.D. Web site is www.imd-lab.com. On this site you

will

> > > find

> > > > > > > additional information about testing and disease. The

> > > Institute

> > > > > for

> > > > > > > Molecular Medicine Web site is www.immed.org. On this

> site

> > > you

> > > > > will

> > > > > > > find publications and documents on CFS/ME, FMS,

> autoimmune

> > > > > diseases

> > > > > > > and other chronic illnesses. Immediate fax-back

> information

> > > is

> > > > > > > available 24 hours per day by calling our telephone

> number

> > > 714-

> > > > > 903-

> > > > > > > 2900.

> > > > > > > > Garth Nicolson, Adjunct Professor of Internal Medicine

> > > > > > > > President and Chief Scientific Officer, The Institute

> for

> > > > > > Molecular

> > > > > > > Medicine

> > > > > > > > —A nonprofit institute dedicated to discovering new

> > > > diagnostic

> > > > > > and

> > > > > > > therapeutic solutions for chronic diseases—

> > > > > > > > 15162 Triton Lane, Huntington Beach, CA 92649-1041,

> > > U.S.A. •

> > > > > Tel:

> > > > > > > 714-903-2900 • Fax: 714-379-2082

> > > > > > > > So, What Is Prescribed For Mycoplasma And Chlamydia?

> > > > > > > > Fortunately, Mycoplasma and Chlamydia infections are

> > > usually

> > > > > > > sensitive to the right antibiotics. The antibiotics

most

> > > likely

> > > > > to

> > > > > > > effect these organisms are:

> > > > > > > > 1. Doxycycline or Minocycline 100 mg, 2-3 times a

day.

> > > These

> > > > > two

> > > > > > > antibiotics are in the Tetracycline-family and should

not

> > be

> > > > used

> > > > > > in

> > > > > > > children under eight years-old because they can cause

> > > permanent

> > > > > > > staining of the teeth. They are very effective, though,

> > > against

> > > > a

> > > > > > > number of unusual organisms (e.g., Lymes Disease). They

> > will

> > > > > > > sometimes cause some stomach upset. If this occurs,

take

> > the

> > > > > > medicine

> > > > > > > with food and a full glass of water or lower the dose.

Do

> > not

> > > > use

> > > > > > > outdated/expired Tetracycline prescriptions—they can

kill

> > you!

> > > > > > > > 2. Cipro (Ciprofloxacin) 750 mg, twice a day.

Although

> > > > > expensive,

> > > > > > > this is usually a well-tolerated antibiotic. It has a

> very

> > > wide

> > > > > > range

> > > > > > > of effectiveness against a large number of organisms.

> When

> > > > > treating

> > > > > > > males, the Cipro (as well as the Doxycycline) has the

> > > > additional

> > > > > > > benefit of treating any hidden prostate infections. Do

> not

> > > take

> > > > > > oral

> > > > > > > magnesium within 6 hours of Cipro or you won't absorb

the

> > > Cipro.

> > > > > > > > 3. Zithromax 600 mg a day, taken with food, or Biaxin

> 500

> > > mg,

> > > > > > twice

> > > > > > > a day, taken on an empty stomach. These are in the

> Erythro-

> > > > mycin

> > > > > > > family. Zithromax tends to be fairly well-tolerated.

The

> > > Biaxin

> > > > > is

> > > > > > > more likely to cause a bit of nausea in some patients,

> but

> > it

> > > > is

> > > > > > > usually well-tolerated. Both are quite expensive. They

> may

> > > work

> > > > > > > against infections missed by Doxycycline and Cipro.

> > > > > > > > Although all of these antibiotics can be effective,

it

> is

> > > not

> > > > > > > uncommon for infections that are sensitive to the

> > > Erythromycin

> > > > > > > antibiotics (#3 above) to be resistant to #1 and #2

above

> > and

> > > > > vice-

> > > > > > > versa. Therefore, it is best to try either Doxycycline

or

> > > Cipro

> > > > > > > first. If they are not effective, then try the

Zithromax

> or

> > > > > Biaxin.

> > > > > > > The antibiotic should be taken for at least 6 months.

If

> > > there

> > > > is

> > > > > > no

> > > > > > > improvement in 4 months, switch to or add the other

> > > antibiotic

> > > > or

> > > > > > > simply stop the treatment. It is helpful to check for

low-

> > > grade

> > > > > > > fevers. I am more likely to use antibiotics for CFIDS

> > > patients

> > > > > who

> > > > > > > have temperatures over 98.6°F, even if it is only 98.8°

> (I

> > > > > consider

> > > > > > > 98.8° a fever because CFIDS/FMS patients usually have

low

> > > body

> > > > > > > temperatures). If you do have low-grade, chronic

> > temperature

> > > > > > > elevations, be sure that you monitor your temperatures

> > during

> > > > > > > treatment. If your temperature drops with the

antibiotic,

> > it

> > > > > > suggests

> > > > > > > that you do have one of these nonviral infections and

the

> > > > > > antibiotic

> > > > > > > is helping. T

> > > > > > > > his would encourage me to continue the antibiotic

> trial -

> > > > even

> > > > > if

> > > > > > > it takes up to 12 months to see an improvement in your

> > > > symptoms.

> > > > > > > > If you are clearly better, I would probably take the

> > > > antibiotic

> > > > > > for

> > > > > > > at least 6 to 12 months. It can then be stopped. If

> > symptoms

> > > > > recur,

> > > > > > > keep repeating 6 to 8 week cycles until the symptoms

stay

> > > gone.

> > > > > It

> > > > > > > may take several years of treatment for the infection

to

> be

> > > > > totally

> > > > > > > eradicated. To put it in perspective, this is how long

> > > children

> > > > > > often

> > > > > > > take antibiotics for acne—which unfortunately, if not

> taken

> > > > with

> > > > > > anti-

> > > > > > > fungals, can lead to yeast overgrowth and possibly

> trigger

> > > > CFIDS.

> > > > > > Be

> > > > > > > sure to take Nystatin, 2 tablets, 2 times a day, while

on

> > the

> > > > > > > antibiotics. Also, please be sure to use alternative

> birth

> > > > > control

> > > > > > if

> > > > > > > on " the pill. " Birth control pills may be ineffective

> while

> > > > > taking

> > > > > > > antibiotics. In addition, anti-depressants, codeine,

> > > antacids,

> > > > > and

> > > > > > > mineral supplements (e.g., magnesium) may block

> antibiotic

> > > > > > > absorption. Take these at least three hours away from

the

> > > > > > antibiotic

> > > > > > > (and don't take the antidepressant/codeine medications

if

> > > they

> > > > > are

> > > > > > > not clearly helping).

> > > > > > > > It is very common to get die-off (Herxheimer)

reactions

> > > which

> > > > > > > include chills, fever, night sweats and general

worsening

> > of

> > > > > > CFS/FMS

> > > > > > > symptoms when the antibiotic first kills off the

> infection.

> > > > These

> > > > > > can

> > > > > > > be severe and last for weeks. Dr. Nicolson encourages

> > you " to

> > > > be

> > > > > > > patient and not abandon therapy prematurely, because

few

> > > > patients

> > > > > > who

> > > > > > > have been sick for years recover in less than one year

of

> > > > > > therapy...

> > > > > > > [don't] be alarmed if some signs and symptoms

> occasionally

> > > > return

> > > > > > or

> > > > > > > worsen. This is not unusual. Eventually you will be off

> > > > > antibiotics

> > > > > > > or antivirals but you will need to continue various

> > > supplements

> > > > > to

> > > > > > > maintain your immune system and general nutritional

> status. "

> > > > > > > > Treatment for Bacterial, Mycoplasma, Chlamydia, E-

coli,

> > > > > Bladder,

> > > > > > Or

> > > > > > > Other Infections

> > > > > > > > (From the " Treatment Checklist " used in Dr.

> Teitelbaum's

> > > > > office.

> > > > > > A

> > > > > > > full list is available on Dr. Teitelbaum's Web site at

> > > > > > > www.endfatigue.com.)

> > > > > > > > The Mycoplasma, Chlamydia, E-Coli, bladder and other

> > > > bacterial

> > > > > > > infections usually take months to years to eradicate.

It

> is

> > > > > common

> > > > > > to

> > > > > > > flare your symptoms (from the infection die-off) the

> first

> > > two

> > > > > > weeks

> > > > > > > of treatment. Take the antibiotics for six months and,

if

> > > > better,

> > > > > > > then repeat six-week cycles till your symptoms stay

gone.

> > > > > > > Antidepressants, Neurontin, and/or Codeine may block

the

> > > > > > antibiotic's

> > > > > > > effectiveness. Be sure to take Nystatin, 2 tablets

twice

> a

> > > day,

> > > > > and

> > > > > > > Acidophilus while on the antibiotics. If you have

> > occasional

> > > > low-

> > > > > > > grade fever (i.e., if over 98.6° F), check your oral

> > > > temperature

> > > > > > > occasionally to see if the antibiotic reduces or

> eliminates

> > > the

> > > > > > > fever. If so, stay on that antibiotic. Also, see Dr.

> > > Nicolson's

> > > > > Web

> > > > > > > site at www.immed.org for additional information.

> > > > > > > > Useful antibiotic treatment for the above infections

> > > include:

> > > > > > > > 1. Cipro (ciprofloxacin) 750 mg, 2 times a day for 6

> > > months.

> > > > Do

> > > > > > not

> > > > > > > take magnesium products (e.g., Fibrocare, some

antacids,

> > Pro

> > > > > > Energy,

> > > > > > > or (Dr. Teitelbaum's) Foundation Formula™) within 6

hours

> > of

> > > > > Cipro

> > > > > > > because you won't absorb the Cipro.

> > > > > > > > OR

> > > > > > > > 2. Doxycycline (a tetracycline) 100 mg, 3 times a day

> for

> > 6

> > > > > > months.

> > > > > > > If symptoms recur when the Doxycycline is completed,

keep

> > > > > repeating

> > > > > > 6-

> > > > > > > week courses until the symptoms stay resolved. Take

> > Nystatin

> > > > (at

> > > > > > > least 2, twice a day) while on the antibiotic. Birth

> > control

> > > > > pills

> > > > > > > may not work while on Doxycycline. Do not take any

> expired

> > > > > > > Doxycycline tablets (it's very dangerous).

> > > > > > > > OR

> > > > > > > > 3. Zithromax (azithromycin) 600 mg tablets, 1 tablet

a

> > day

> > > > > (take

> > > > > > > with food if it bothers your stomach). Don't take

> magnesium-

> > > > > > > containing products within six hours of the Zithromax.

> > > > > > > > OR

> > > > > > > > 4. Biaxin 500 mg, 2 times a day.

> > > > > > > > 5. D-Mannose ½ to 1 teaspoon (2.5 grams), stirred in

> > water,

> > > > > every

> > > > > > 2

> > > > > > > to 3 hours while awake, for 2 to 5 days for acute

bladder

> > > > > > infections

> > > > > > > (may use long-term for chronic infections) caused by E-

> coli

> > > > (this

> > > > > > > causes approximately 90% of bladder infections). If not

> > much

> > > > > better

> > > > > > > in 24 hours, get a urine culture and consider an

> > antibiotic.

> > > D-

> > > > > > > Mannose is available from BioTech (800-345-1199), my

Web

> > > > > > > site's " Vitamin Shop " at www.endfatigue.com or my

office

> > (800-

> > > > 333-

> > > > > > > 5287).

> > > > > > > > What About Yeast Overgrowth?

> > > > > > > > Yeast overgrowth is an important concern. As I have

> > > mentioned

> > > > > > > before, nothing is all good or all bad. Although

> cigarettes

> > > > kill

> > > > > > > hundreds of thousands of people each year, they can be

> > > helpful

> > > > in

> > > > > > > treating Parkinson's Disease or ulcerative colitis.

> > Although

> > > > > > > antibiotics can trigger CFIDS, they can also be helpful

> in

> > > > > treating

> > > > > > > it. This makes it important to know when and how to use

> > them.

> > > I

> > > > > > > strongly recommend that my patients take antifungals

> while

> > on

> > > > any

> > > > > > > antibiotics (e.g., Nystatin 500,000 unit tablets, 2

> > tablets,

> > > 2

> > > > to

> > > > > 3

> > > > > > > times a day) to prevent yeast overgrowth. It is also

> > > reasonable

> > > > > to

> > > > > > > add Oregano Oil and other natural antifungals. Two

> Nystatin

> > > > twice

> > > > > a

> > > > > > > day is what I usually prescribe. Using probiotics

> (healthy

> > > milk

> > > > > > > bacteria-like acidophilus that helps your body) to

> compete

> > > with

> > > > > the

> > > > > > > yeast can also help. I am concerned that if the

> acidophilus

> > > is

> > > > > > taken

> > > > > > > with the antibiotic, they may simply cancel each other

> out.

> > > > > Because

> > > > > > > of this, I usually begin probiotics (Acidophilus or

> > > > Lactobacillus

> > > > > > in

> > > > > > > a d

> > > > > > > > ose of 3 to 6 billion units a day, taken on an empty

> > > stomach

> > > > or

> > > > > > > with milk) after one has completed the course of

> > antibiotics.

> > > > If

> > > > > > you

> > > > > > > are only taking the antibiotic once or twice a day, and

> can

> > > > find

> > > > > a

> > > > > > > time at least 6 to 8 hours away from another dose to

take

> > the

> > > > > > > probiotic, it is reasonable to take it at that time.

The

> > > entire

> > > > > > daily

> > > > > > > probiotic dose can also be taken at one time. If you

find

> > > that

> > > > > you

> > > > > > > still get yeast overgrowth, it may be necessary to use

> some

> > > of

> > > > > the

> > > > > > > more potent prescription antifungals (Sporanox or

> > Diflucan).

> > > > > > Because

> > > > > > > these can cause liver inflammation and are quite

> expensive,

> > > it

> > > > > may

> > > > > > be

> > > > > > > adequate to take 200mg of either of these, twice a day,

> one

> > > day

> > > > > > each

> > > > > > > week (e.g., take it every Sunday) instead of every day.

> As

> > > > > > discussed

> > > > > > > previously, be sure to take Lipoic acid 200 mg on any

day

> > you

> > > > > take

> > > > > > > Sporanox or Diflucan, to decrease the risk of liver

> > > > inflammation.

> > > > > > > > What Role Does My Blood Clotting System Play In This?

> > > > > > > > Work done by E. Berg, M.S., C.L.S. (N.C.A.),

> > director

> > > > of

> > > > > > > Hemex Laboratories in Phoenix, Arizona (800-999-2568),

> has

> > > > shown

> > > > > > that

> > > > > > > a number of infections can trigger our blood clotting

> > system

> > > to

> > > > > > > become active, thus setting up a low-level, chronic

> > clotting

> > > > > > cascade.

> > > > > > > These infections include HHV-6, Mycoplasma, CMV and

> > Chlamydia

> > > > > which

> > > > > > > can trigger production of (IgA) antibodies against clot

> > > > > protective

> > > > > > > proteins on blood vessel inner surfaces (called

> > > > antiphospholipid

> > > > > > > antibodies). One of these is the Beta 2 Glyco-protein 1

> > (anti

> > > > > B2GP1—

> > > > > > > no, you are not going to be tested on this!). This then

> > > > triggers

> > > > > > the

> > > > > > > clotting cascade. Once the clotting system is

triggered,

> a

> > > > > product

> > > > > > > called Soluble Fibrin Monomer (SFM) is made which is

like

> > the

> > > > > > > polymers in plastic. The theory is that they create

long

> > thin

> > > > > > sheets

> > > > > > > of a teflon-like substance, similar to the scab that

> covers

> > a

> > > > > cut,

> > > > > > > but microscopic, which then coats the blood vessels.

This

> > > makes

> > > > > it

> > > > > > > hard for nutrients, oxygen, etc., to get in and out of

> the b

> > > > > > > > lood vessels to the cells where they are needed. In

> > > summary,

> > > > > many

> > > > > > > infections can cause the blood clotting system to

> activate,

> > > > > > resulting

> > > > > > > in a thin coating of Fibrin deposited on the blood

> vessels.

> > > > This

> > > > > > > prevents nutrients and oxygen from getting to the cells

> in

> > > your

> > > > > > body.

> > > > > > > > Why Would An Infection Trigger The Clotting System?

> > > > > > > > Many infections (called anaerobic) do not survive

well

> in

> > > the

> > > > > > > presence of oxygen. One can theorize that these

> Mycoplasma

> > > > (which

> > > > > > may

> > > > > > > be anaerobic) and other organisms may trigger the

> clotting

> > > > system

> > > > > > to

> > > > > > > create a shell, which then acts like a suit of armor,

> > > > protecting

> > > > > > them

> > > > > > > from oxygen, your body's defense system, and

antibiotics.

> > > This

> > > > > > would

> > > > > > > explain why these infections could evolve a way to

> trigger

> > > the

> > > > > > > clotting mechanism. The Fibrin armor preventing

> antibiotics

> > > > from

> > > > > > > getting to the infection could also explain why some

> people

> > > > with

> > > > > > > these infections may not respond to antibiotics.

Indeed,

> > some

> > > > > > > physicians have found that the antibiotics work better

> once

> > > > > someone

> > > > > > > has been on a blood thinner (which may dissolve the

> armor).

> > > > > > > > This is an interesting theory, but how do we know

this

> is

> > > > going

> > > > > > on?

> > > > > > > Mr. Berg and others have done studies showing that the

> > blood

> > > > > tests

> > > > > > > that look for these clotting changes (called the ISAC

> > panel -

> > > > > > > available at Hemex labs) are abnormal in CFIDS/FMS

> patients

> > > > while

> > > > > > > being normal in most other patients. They use a

criterion

> > of

> > > > two

> > > > > of

> > > > > > > these tests needing to be abnormal to be considered

> > positive.

> > > > > When

> > > > > > > this was done, 50 of 54 CFIDS/FMS patients had abnormal

> > tests

> > > > > > (i.e.,

> > > > > > > only 7.4% of the patients had normal blood tests). In

> > healthy

> > > > > > > patients, 22 out of 23 had normal blood tests (i.e.,

> 96%).

> > > This

> > > > > > means

> > > > > > > the test is both very sensitive and specific, picking

up

> > > people

> > > > > > with

> > > > > > > CFIDS and excluding healthy people. Our experience has

> > shown

> > > > that

> > > > > > > almost everyone that we tested, who has CFIDS, has

turned

> > out

> > > > to

> > > > > > have

> > > > > > > a positive ISAC panel. We have not personally sent in

any

> > > tests

> > > > > on

> > > > > > > healthy patients to see if this also occurs.

> Interestingly,

> > > > this

> > > > > > > panel is also positive in many people with unexplained

> infer

> > > > > > > > tility (which can improve with Heparin) and may also

be

> > > > > positive

> > > > > > in

> > > > > > > people with Multiple Sclerosis, Parkinsons, Autism,

> > > > Inflammatory

> > > > > > > Bowel Disease and some other illnesses. This suggests

> that

> > > this

> > > > > > test

> > > > > > > can be helpful in deciding whether to treat with blood

> > > thinners

> > > > > > > (Heparin) in CFIDS/FMS.

> > > > > > > > So, How Do I Treat The Clotting System?

> > > > > > > > First of all, it is important to remember that using

> > > > injections

> > > > > > of

> > > > > > > Heparin (the blood thinner) is still a controversial

and

> > > > > > experimental

> > > > > > > treatment for CFIDS/FMS. We much prefer to use

treatments

> > > that

> > > > > are

> > > > > > as

> > > > > > > safe as possible. Although Heparin is routinely used in

> the

> > > > > U.S.A.

> > > > > > to

> > > > > > > treat blood clots, using it to treat CFIDS/FMS is very

> new.

> > > > Most

> > > > > of

> > > > > > > the doctors that I have spoken with have only treated a

> few

> > > > > > CFIDS/FMS

> > > > > > > patients with Heparin and find that about half of these

> > > > patients

> > > > > > get

> > > > > > > better with treatment. The treatment protocol,

developed

> by

> > > >

> > > > > > > Couvaras, M.D. (602-996-2411), includes the following:

> > > > > > > > 1. Remove wheat, alcohol and sugar from the diet, if

> > > possible.

> > > > > > > > 2. Check the ISAC panel. If there are at least two

> > abnormal

> > > > > > > results, then begin treatment.

> > > > > > > > 3. Give an antifungal for 14 days (he uses Lamisil

> 250mg

> > a

> > > > day—

> > > > > > > which I find to be poorly effective. I would use 200 mg

> of

> > > > > Sporanox

> > > > > > > or Diflucan instead).

> > > > > > > > 4. Give standard Heparin 4000 to 8000 units by

> injection

> > > > > > > subcutaneously (like an insulin shot) twice a day. A

> > > (possibly

> > > > > > safer)

> > > > > > > low molecular weight Heparin may also be used.

> > > > > > > > 5. If the PA index (on the ISAC) is positive, add a

> baby

> > > > > Aspirin

> > > > > > > (81mg) each day.

> > > > > > > > 6. After being on Heparin for one week, Dr. Couvares

> > > repeats

> > > > > the

> > > > > > > ISAC panel to adjust the dose of the Heparin and

Aspirin.

> > He

> > > > > feels

> > > > > > > that the goal is to move all the blood tests into the

> > normal

> > > > > range

> > > > > > > but not past the normal range into blood-thinning

> > > (therapeutic)

> > > > > > > levels. If the values are still abnormal or the patient

> is

> > > > still

> > > > > > > having symptoms, he then increases the Heparin dosage.

If

> > the

> > > > PA

> > > > > > > index (on the ISAC) is still high, he increases the

> Aspirin

> > > to

> > > > > > twice

> > > > > > > a day.

> > > > > > > > 7. If the patient feels better after one month of

> > Heparin,

> > > he

> > > > > > then

> > > > > > > switches to low-dose Coumadin (a blood thinner tablet—

> take

> > 2

> > > to

> > > > 3

> > > > > > mg

> > > > > > > a day) and then stops the Heparin after 4 to 5 days of

> > being

> > > on

> > > > > the

> > > > > > > Coumadin. Once the patient has been on the Coumadin for

> two

> > > > weeks

> > > > > > he

> > > > > > > goes ahead and rechecks the ISAC panel to maintain the

> > blood

> > > > > tests

> > > > > > in

> > > > > > > the normal range.

> > > > > > > > 8. He also supplements patients with nutritional

> > > > > supplementation

> > > > > > as

> > > > > > > needed.

> > > > > > > > In my practice, because the ISAC panel runs over

$320,

> I

> > > > check

> > > > > a

> > > > > > > baseline ISAC panel but do not repeat the ISAC panels

to

> > > adjust

> > > > > > > therapy. Instead, while on Heparin, we check a PTT (a

> blood

> > > > > > thinning

> > > > > > > test) and platelets (a highly unusual, but potentially

> very

> > > > > > dangerous

> > > > > > > side effect of Heparin is a severe drop in platelet

> count,

> > > > which

> > > > > > can

> > > > > > > cause life-threatening bleeding) every 3 days for the

> first

> > > 12

> > > > > days

> > > > > > > and then every 2 to 4 weeks while on Heparin. If the

PTT

> is

> > > > still

> > > > > > > within the normal range and the patient is not better,

we

> > > > > increase

> > > > > > > the Heparin as high as 8000 units, twice a day (rarely

we

> > > will

> > > > go

> > > > > > up

> > > > > > > to 8000 units, 3 times a day) and then also increase

the

> > > > Aspirin

> > > > > to

> > > > > > 2

> > > > > > > a day. In comparison, hospital patients often require

> > Heparin

> > > > at

> > > > > > 1000

> > > > > > > units per hour (24,000 units a day) I.V., while most

> > CFS/FMS

> > > > > > patients

> > > > > > > only need 4000 to 5000 units, 2 times a day (8000 to

> 10,000

> > > > units

> > > > > a

> > > > > > > day). If the patient is feeling better, however, we

> simply

> > > > leave

> > > > > > them

> > > > > > > at the initial dose. Most patients will f

> > > > > > > > eel better at about the 10- to 14-day point if the

> > Heparin

> > > is

> > > > > > going

> > > > > > > to help. At the end of 4 to 12 months, if the Heparin

> > helps,

> > > we

> > > > > > > switch to Coumadin (as noted above) and check an INR

> > > > > (International

> > > > > > > Normalized Ratio), aiming to keep it below 1.3 while

> > > adjusting

> > > > > the

> > > > > > > Coumadin to the optimum does. It is very important to

> know

> > > that

> > > > > > most

> > > > > > > medications can change the blood level of Coumadin and

> that

> > > > > anytime

> > > > > > > anything is added to, or deleted from, your regimen

> > > (including

> > > > > > > natural remedies) you need to recheck the INR 4 to 7

days

> > > later

> > > > > to

> > > > > > > make sure that it is not going too high. Heparin and

> > Coumadin

> > > > are

> > > > > > > powerful medicines and the main risk is bleeding.

> Although

> > we

> > > > are

> > > > > > > using very low doses, which are usually very well-

> > tolerated,

> > > > one

> > > > > > can

> > > > > > > rarely see a life-threatening bleed occur. If you felt

> > better

> > > > on

> > > > > > the

> > > > > > > Heparin and then the symptoms come back on the

Coumadin,

> > you

> > > > may

> > > > > > need

> > > > > > > to go back on the Heparin for several months to re-

> > establish

> > > > and

> > > > > > > maintain the benefit. Occasionally, people will need to

b

> > > > > > > > e on the Heparin for an extended period, in which

case

> > the

> > > > > blood

> > > > > > > tests (PTT and platelet count) should be checked every

2

> to

> > 4

> > > > > > weeks.

> > > > > > > All of this being said, most people tolerate these

> > treatments

> > > > > quite

> > > > > > > well and many, many more people die from taking Aspirin

> > > (e.g.,

> > > > > for

> > > > > > > arthritis) than Heparin each year.

> > > > > > > > In summary, there are a number of infections that can

> > cause

> > > > or

> > > > > > > occur because you have CFIDS/FMS. Once they occur, they

> can

> > > > > trigger

> > > > > > > the clotting cascade. This may keep the nutrients from

> > > getting

> > > > to

> > > > > > > your body and create a " suit of armor " for the viral

and

> > > > > Mycoplasma

> > > > > > > infections. Using a blood thinner can break down these

> > armor

> > > > > > coatings

> > > > > > > that protect the infections from our treatment and

allow

> > > > > nutrients

> > > > > > to

> > > > > > > get where they need to go. Many tests can help. The one

> > that

> > > I

> > > > > use

> > > > > > to

> > > > > > > decide whether to use the Heparin blood thinner is the

> ISAC

> > > > panel

> > > > > > (at

> > > > > > > Hemex Labs). Testing for infections may be helpful, but

> can

> > > be

> > > > > > > expensive and less likely to effect my decision to

treat.

> > If

> > > > you

> > > > > > can

> > > > > > > afford the tests and/or your insurance will pay for

them,

> > > they

> > > > > are

> > > > > > > worth checking and will make it easier to adjust

therapy

> > over

> > > > > time.

> > > > > > > If you can't afford it, it is reasonable to treat

> > empirically

> > > > > > (i.e.,

> > > > > > > without testing), except for high-dose Valtrex therapy.

> If

> > > you

> > > > > have

> > > > > > > lung congestion and/or recurrent temperatures o

> > > > > > > > ver 98.6°F, I would treat with the antibiotics. If

you

> > feel

> > > > > > > chronically flu-like, I would consider the HHV-6 or

> (based

> > on

> > > > > > > testing) the high-dose Valtrex regimen. It is also

> > reasonable

> > > > to

> > > > > > > treat with antibiotics and antivirals simultaneously -

> > > > especially

> > > > > > if

> > > > > > > you are taking the anticoagulants.

> > > > > > > > Chronic Sinusitis The Yeasty Beasties Revisited!

> > > > > > > > As was mentioned years ago, we speculated that the

> > chronic

> > > > > sinus

> > > > > > > congestion seen in CFIDS/FMS could be caused by yeast

> > > > overgrowth.

> > > > > A

> > > > > > > recent interesting study from the Mayo Clinic

Proceedings

> > > > > supports

> > > > > > > this thought. In the study, researchers found that most

> > > people

> > > > > with

> > > > > > > chronic sinus infections had fungal growth in their

> > sinuses.

> > > > They

> > > > > > > felt that the inflammation was being caused by an

immune

> > (the

> > > > > > body's

> > > > > > > reaction) response to the fungus. This research is

> > > interesting

> > > > > > > because more and more studies are showing that treating

> > > chronic

> > > > > > > sinusitis with antibiotics doesn't really do much and

> that

> > > > > shorter

> > > > > > > courses of treatment work just as well as the long

> courses.

> > > We

> > > > > find

> > > > > > > that conservative treatment (see my newsletter article,

> > > > Treatment

> > > > > > Of

> > > > > > > Respiratory Infections Without Antibiotics, Vol. 2,

Issue

> > 2)

> > > is

> > > > > > more

> > > > > > > effective than antibiotics for chronic sinusitis.

> > > > > > > > It's good that medicine is finally starting to catch

up

> > > with

> > > > > > > reality. The report in The Mayo Clinic Proceedings

noted

> > > > > > > that, " fungus allergy was thought to be involved in

less

> > than

> > > > 10%

> > > > > > of

> > > > > > > cases… our studies indicate, in fact, fungus is likely

> the

> > > > cause

> > > > > of

> > > > > > > nearly all of these problems and that it is not an

> allergic

> > > > > > reaction

> > > > > > > but an immune reaction. " In this study, the researchers

> > > studied

> > > > > 210

> > > > > > > patients with chronic sinusitis. Using new methods to

> > collect

> > > > and

> > > > > > > test sinus/nasal mucus they found fungus in 96% of

> > patients.

> > > > > > > > It's interesting to observe how medical research

works.

> > The

> > > > > > > researchers are now working with different drug

companies

> > to

> > > > set

> > > > > up

> > > > > > > trials to test medications to control the fungus but

feel

> > > that

> > > > it

> > > > > > > will be at least two years before any treatments will

be

> > > > > available.

> > > > > > > In my experience, though, these problems often respond

> > > > > dramatically

> > > > > > > to either Sporanox or Diflucan - which, by no

> coincidence,

> > > are

> > > > > very

> > > > > > > powerful antifungal agents. It is not clear why the

> > > researchers

> > > > > did

> > > > > > > not simply try Sporanox or Diflucan. Un-fortunately, we

> > find

> > > > that

> > > > > > the

> > > > > > > obvious is often overlooked. This sometimes occurs as

> drug

> > > > > > companies

> > > > > > > seek to make more money by finding new drugs instead of

> > using

> > > > the

> > > > > > old

> > > > > > > things that are known to work. It is important to

> > distinguish

> > > > > > between

> > > > > > > chronic sinusitis (which lasts for over three months)

and

> > > acute

> > > > > > > sinusitis (which usually has been going on for a few

days

> > and

> > > > > less

> > > > > > > than a month). For these shorter attacks of sinusitis,

> > > bacteria

> > > > > are

> > > > > > a

> > > > > > > more common cause and antibiotics (combined with n

> > > > > > > > atural remedies) can be helpful. Some researchers

still

> > > > > continue

> > > > > > to

> > > > > > > argue that fungus is not a cause of chronic sinusitis.

> They

> > > > note

> > > > > > that

> > > > > > > fungi are seen even in healthy noses (which is correct)

> but

> > > > > neglect

> > > > > > > to discuss the immune changes that are also seen in

these

> > > > noses.

> > > > > > > Because so many people have responded dramatically to

> > > > antifungals

> > > > > > in

> > > > > > > the treatment of their chronic sinusitis, my suspicion

is

> > > that

> > > > > the

> > > > > > > Mayo Clinic researchers are probably correct. Wouldn't

it

> > be

> > > > > nice,

> > > > > > if

> > > > > > > instead of arguing about treatments while people stay

> sick,

> > > > they

> > > > > > > would just try the treatments to see if they worked!

> > > > > > > > As you can see, your body's defenses being down plays

a

> > > large

> > > > > > role

> > > > > > > in CFIDS/FMS. The good news is, that by treating the

many

> > > > > > underlying

> > > > > > > infections common in CFIDS patients and by treating any

> > > > hormonal

> > > > > > and

> > > > > > > nutritional deficiencies, you can bring your immune

> system

> > > back

> > > > > to

> > > > > > a

> > > > > > > healthy state!

> > > > > > > > Important Points

> > > > > > > > • An important component of CFS is disordered immune

> > > > function,

> > > > > > > which opens the door to repeated infections, repeated

> > > treatment

> > > > > > with

> > > > > > > antibiotics, and yeast overgrowth.

> > > > > > > > • Treat yeast overgrowth by avoiding antibiotics and

> > > sweets.

> > > > > Many

> > > > > > > patients have found Nystatin and other antifungal

> > > medications,

> > > > > such

> > > > > > > as Diflucan and Sporanox, to be helpful. Acidophilus

> (milk

> > > > > > bacteria)

> > > > > > > and natural antifungals such as Caprylic acid and

garlic

> > are

> > > > also

> > > > > > > often useful.

> > > > > > > > • Bowel parasites are common in CFS patients, whose

> > > symptoms

> > > > > > often

> > > > > > > respond dramatically to treatment. However, most labs

do

> > not

> > > > > > > adequately detect parasites through stool testing. To

get

> > an

> > > > > > accurate

> > > > > > > test result, use one of the labs we recommended that

> > > > specializes

> > > > > in

> > > > > > > stool testing.

> > > > > > > > • Treat Cryptosporidium with Artemesia annua or

> tricyclin

> > > > > (herbal

> > > > > > > antiparasitics).

> > > > > > > > • Treat constipation with Turkey Rhubarb (a herb).

> > > > > > > > • Prevent parasitic infection by using a Multi-pure

> water

> > > > > filter

> > > > > > > (available from 888-801-8176 or 410-224-4877)

> > > > > > > > • If you have temperatures over 98.6°F and/or chronic

> > lung

> > > > > > > congestion, try long-term Cipro or Doxycycline (while

on

> > > > > Nystatin).

> > > > > > > > • If you have chronic flu-like symptoms, despite

yeast

> > and

> > > > > Cortef

> > > > > > > treatment, consider the antiviral, immune stimulating

> > > protocol

> > > > we

> > > > > > > discussed.

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>

[Guest guest]

PH- I'm going to include this in my presentation to my husband on why

I need to see a naturopath. :-)

Love, Krista

> > > > > > > >

> > > > > > > > Very interesting, article Rogene. I didn't have a

> chance

> > to

> > > > > read

> > > > > > > the

> > > > > > > > whole thing yet, but the first part caught my

attention

> > > about

> > > > > how

> > > > > > > > under-active adrenals can lead to high levels of

> > interferon

> > > > > which

> > > > > > > > leads to achiness, fatigue and brain fog (my 3

biggest

> > > > > symptoms.)

> > > > > > > > Anyone else know much about this?

> > > > > > > > Makes me think I really need to have my adrenals

> checked!

> > > > > > > > ~Krista

> > > > > > > >

> > > > > > > > --- In , dusty.com@

wrote:

> > > > > > > > >

> > > > > > > > > From Fatigued to Fantastic Newsletter

> > > > > > > > > Vol. 3, No. 3 (2000)--Vol 4, No. 1 (2001)

> > > > > > > > >

> > > > > > > > > Fighting Those Persistent Infections in CFIDS

> > > > > > > > > By Teitelbaum, M.D.

> > > > > > > > > Medical science has known for quite some time that

> > > Chronic

> > > > > > > Fatigue

> > > > > > > > Syndrome is associated with changes in the body's

> immune

> > > > > system.

> > > > > > In

> > > > > > > > fact, the acronym " CFIDS " stands for " Chronic Fatigue

> And

> > > > > Immune

> > > > > > > > Dysfunction Syndrome. " This can result in your having

> > > several

> > > > > > > > different and unusual infections at one time. Many of

> > these

> > > > > > > > infections need to be treated directly. Other

> infections

> > > will

> > > > > go

> > > > > > > away

> > > > > > > > on their own as your immune (defense) system comes

> > back " on

> > > > > line "

> > > > > > > by

> > > > > > > > using our treatment protocol. In this article, I'll

> > discuss

> > > > > some

> > > > > > of

> > > > > > > > the more common, yet not usually thought of

> (in " regular "

> > > > > > > medicine),

> > > > > > > > infections.

> > > > > > > > > What Kind Of Infections Am I Most At Risk For?

> > > > > > > > > Although CFIDS of sudden onset often seems to be

> > > triggered

> > > > by

> > > > > > > viral

> > > > > > > > infections (e.g., EBV, HHV-6, CMV), those infections,

I

> > > > > suspect,

> > > > > > > > are " simmering " or no longer active in many cases.

> > However,

> > > > the

> > > > > > > body

> > > > > > > > acts as if they are. This may result in elevated

> > interferon

> > > > > > levels.

> > > > > > > I

> > > > > > > > suspect this was what triggered my CFIDS.

> > > > > > > > > The body produces interferon to fight viral

> infections.

> > > > When

> > > > > a

> > > > > > > > cancer or hepatitis patient is injected with

> interferon,

> > > the

> > > > > > > patient

> > > > > > > > becomes achy, fatigued and brain-fogged. An under-

> active

> > > > > adrenal

> > > > > > > can

> > > > > > > > also cause interferon levels to become elevated.

> Because

> > of

> > > > > this

> > > > > > > > elevation, it is more accurate to say that the body's

> > > immune

> > > > > > system

> > > > > > > > is not functioning properly, than to say that it is

> > > > > underactive.

> > > > > > > > Indeed, in many ways, the immune system may be in

> > overdrive

> > > > and

> > > > > > > soon

> > > > > > > > exhaust itself. The immune system malfunctions in

many

> > > other

> > > > > > ways,

> > > > > > > > too, including decreasing the effectiveness of the

> > > > > > body's " natural

> > > > > > > > killer " cells, which are an important defense

mechanism.

> > > > > > > > > Many other recurrent or unusual infections can also

> > occur

> > > > > > because

> > > > > > > > of your malfunctioning immune system. Chronic sinus,

> > > bladder,

> > > > > > > > prostate and respiratory infections are common and

are

> > > often

> > > > > > > treated

> > > > > > > > with repeated courses of antibiotics. The large

amount

> of

> > > > > > > antibiotics

> > > > > > > > introduced into the system can cause a secondary

yeast

> > over-

> > > > > > growth

> > > > > > > as

> > > > > > > > it changes the natural balance between the bowel's

> > healthy

> > > > > > bacteria

> > > > > > > > and yeast. The original immune dysfunction also

> > contributes

> > > > to

> > > > > > the

> > > > > > > > yeast overgrowth. Although it is controversial, a

> theory

> > > held

> > > > > by

> > > > > > > many

> > > > > > > > physicians is that chronic overgrowth of yeast due to

> > > overuse

> > > > > of

> > > > > > > > antibiotics is a potential and strong trigger for

> chronic

> > > > > > fatigue,

> > > > > > > > fibromyalgia and further immune dysfunction. What

makes

> > the

> > > > > > theory

> > > > > > > > controversial is that no definitive tests exist to

> > > > distinguish

> > > > > > > fungal

> > > > > > > > overgrowth from normal fungal levels. Also, many of

the

> > > > > symptoms

> > > > > > > > ascribed to yeast overgrowth can also come from the

> many

> > > > other

> > > > > > > > problems present in chronic fatigue syndrome and

> fibromya

> > > > > > > > > lgia. On the other hand, most doctors who try

> treating

> > > > yeast

> > > > > in

> > > > > > > at

> > > > > > > > least three or four CFS patients see how well it

works

> > and

> > > > keep

> > > > > > > using

> > > > > > > > it.

> > > > > > > > > CFIDS patients also frequently have bowel parasite

> > > > > infections.

> > > > > > > > Bowel parasites can cause severe allergic or

> sensitivity

> > > > > > reactions,

> > > > > > > > which in turn can trigger fibromyalgia and fatigue.

> > Often,

> > > a

> > > > > > > patient

> > > > > > > > will finally recover from long-standing and disabling

> > > fatigue

> > > > > > > within

> > > > > > > > a week or two after beginning treatment for bowel

> > parasites.

> > > > > > > > > Many other CFS/FMS patients are left with disabling

> > > fatigue

> > > > > > after

> > > > > > > a

> > > > > > > > bout with viral infections such as polio, HHV-6, CMV,

> or

> > EB

> > > > > viral

> > > > > > > > infections. This fatigue also usually responds to the

> > > > > treatments

> > > > > > > > discussed in this newsletter. In addition, infections

> > with

> > > > > > unusual

> > > > > > > > organisms such as Rickettsia (e.g., Lymes Disease),

> > > > chlamydia,

> > > > > > and

> > > > > > > > mycoplasma may also be problematic.

> > > > > > > > > Yeast Overgrowth

> > > > > > > > > Everyone's immune system has strong spots, as well

as

> > > weak

> > > > > > spots.

> > > > > > > > Some people never get colds but have frequent bouts

> with

> > > > > > athlete's

> > > > > > > > foot or other skin fungal infections. Others never

get

> > > fungal

> > > > > > > > infections but tend to get colds. Many people seem to

> > have

> > > a

> > > > > > > > diminished ability to fight off fungal infections.

> > > > > > > > > Fungi are very complex organisms. Fungal overgrowth

> may

> > > > > > suppress

> > > > > > > > the body's immune system. The host body may also

> develop

> > > > > allergic

> > > > > > > > reactions to components of the yeast.

> > > > > > > > > This allergic reaction was suggested in a study

which

> > > > > connects

> > > > > > > > Candida Albicans with Allergic Skin Dermatitis

> (Eczema).

> > > This

> > > > > > study

> > > > > > > > was published in The Journal of Clinical Experimental

> > > Allergy

> > > > > > back

> > > > > > > in

> > > > > > > > 1993 (Vol. 23, pp. 332-339). It found that there is a

> > > > > significant

> > > > > > > > correlation between the body having antibodies to

> Candida

> > > and

> > > > > > > > Allergic Dermatitis/Eczema. In addition, we have

found

> > that

> > > > > > > > unexplained rashes that have lasted for many years

> often

> > > > clear

> > > > > up

> > > > > > > > with antifungal treatment as well! Many physicians

feel

> > > that

> > > > > > yeast

> > > > > > > > overgrowth causes a generalized suppression of the

> immune

> > > > > system.

> > > > > > > In

> > > > > > > > other words, once the yeast gets the upper hand, it

> sets

> > up

> > > a

> > > > > > cycle

> > > > > > > > that further suppresses your body's defenses.

> > > Interestingly,

> > > > a

> > > > > > > recent

> > > > > > > > Mayo Clinic study showed that most cases of chronic

> > > sinusitis

> > > > > > seem

> > > > > > > to

> > > > > > > > be associated with a reaction to yeast in the

sinuses -

> > > > > something

> > > > > > I

> > > > > > > > proposed years ago. None the less, as I already

noted,

> > this

> > > > > > theory

> > > > > > > is

> > > > > > > > controversial. Yeast are normal members of our

> > body's " zoo.

> > > > > > > > > " They live in balance with bacteria - some of

which

> > are

> > > > > > helpful

> > > > > > > > and healthy and some of which are detrimental and

> > > unhealthy.

> > > > > The

> > > > > > > > problems begin when this harmonious balance shifts

and

> > the

> > > > > yeast

> > > > > > > > begin to overgrow.

> > > > > > > > > As noted above, many things can prompt yeast to

> > overgrow.

> > > > One

> > > > > > of

> > > > > > > > the most common causes is frequent antibiotic use.

When

> > the

> > > > > good

> > > > > > > > bacteria in the bowel are killed off by antibiotics

> > (along

> > > > with

> > > > > > the

> > > > > > > > bad bacteria) the yeast no longer have competition

and

> > > begin

> > > > to

> > > > > > > > overgrow. The body is often able to rebalance itself

> > after

> > > > one

> > > > > or

> > > > > > > > several courses of antibiotics, but after repeated or

> > long-

> > > > term

> > > > > > > > courses - and especially if the body has an

underlying

> > > immune

> > > > > > > > dysfunction - the yeast can get the upper hand.

> > > > > > > > > Other factors are also important. Studies have

shown

> > that

> > > > > > animals

> > > > > > > > who are sleep deprived and/or have increased sugar

> intake

> > > > > develop

> > > > > > > > bowel yeast overgrowth. Many physicians feel that

> eating

> > > > sugar

> > > > > > > > stimulates yeast overgrowth in people, as well. Sugar

> is

> > > food

> > > > > for

> > > > > > > > yeast. Yeast ferment sugar in order to grow and

> multiply.

> > > > Yeast

> > > > > > > > overgrowth due to sugar overuse also seems to cause

> > immune

> > > > > > > > suppression, which facilitates bacterial infections,

> > which

> > > > then

> > > > > > > > requires even more antibiotic use. Poor sleep also

> > results

> > > in

> > > > > > > marked

> > > > > > > > suppression of your immune function.

> > > > > > > > > How Does One Know If They Have Yeast?

> > > > > > > > > There are no definitive tests for yeast overgrowth

> that

> > > > will

> > > > > > > > distinguish yeast overgrowth from normal yeast growth

> in

> > > the

> > > > > > body.

> > > > > > > > There is one test which may be useful, though. This

is

> a

> > > > Urine

> > > > > > > > Tartaric Acid test done by The Great Plains Lab in

> Kansas

> > > > City,

> > > > > > > > Missouri, run by Shaw, Ph.D. Tartaric Acid is

a

> > > waste

> > > > > > > product

> > > > > > > > of yeast growth. In fermenting wine, for example, it

is

> > > > > critical

> > > > > > to

> > > > > > > > remove the Tartaric Acid. Otherwise, the wine could

be

> > > toxic

> > > > to

> > > > > > > > people. Dr. Shaw has found elevations in Urine

Tartaric

> > > Acid

> > > > > that

> > > > > > > > decrease with antifungal treatment in both CFIDS/FMS

> > > patients

> > > > > and

> > > > > > > > autistic children. Interestingly, both these

illnesses

> > > often

> > > > > > > improve

> > > > > > > > with antifungals (specifically, Sporanox or Diflucan,

> > plus

> > > > > > > Nystatin).

> > > > > > > > Dr. Shaw likes to use the Urine Tartaric Acid to

decide

> > > when

> > > > to

> > > > > > > treat

> > > > > > > > yeast overgrowth and to follow-up the effectiveness

of

> > > > > treatment.

> > > > > > > > > In my experience, however, using Dr. Crook's Yeast

> > > > > > Questionnaire

> > > > > > > > (available in my book, From Fatigued To Fantastic!)

is

> > > still

> > > > > the

> > > > > > > most

> > > > > > > > reliable way to tell if a person is at risk of yeast

> > > > > overgrowth.

> > > > > > If

> > > > > > > > the symptom score is over 140 points, I recommend

> > > treatment.

> > > > In

> > > > > > > > addition, anyone who has been on recurrent or long-

term

> > > > > > antibiotic

> > > > > > > > use (especially Tetracycline for acne) or anyone who

> > > > > > intermittently

> > > > > > > > has painful sores in different parts of the mouth

that

> > last

> > > > for

> > > > > > > about

> > > > > > > > ten days at a time and who has CFIDS/FMS, should be

> > treated

> > > > > with

> > > > > > > > antifungals. Bowel symptoms are some of the more

overt

> > > > symptoms

> > > > > > > that

> > > > > > > > are caused by yeast and I feel that most people who

> > > > > have " spastic

> > > > > > > > colon " have yeast overgrowth or parasites.

> > > > > > > > > How Is Yeast Treated?

> > > > > > > > > A number of very effective methods can be utilized

to

> > > take

> > > > > care

> > > > > > > of

> > > > > > > > a yeast problem. Primary among the methods is to

avoid

> > > sugar

> > > > > and

> > > > > > > > other sweets. One can enjoy one or two pieces of

fruit

> a

> > > day,

> > > > > but

> > > > > > > > should not consume concentrated sugars such as

juices,

> > corn

> > > > > > syrup,

> > > > > > > > jellies, pastry, candy or honey. Stay far away from

> soft

> > > > > drinks,

> > > > > > > > which have ten to twelve teaspoons of sugar in every

> > twelve

> > > > > > ounces.

> > > > > > > > This amount of sugar has been shown to markedly

> suppress

> > > > immune

> > > > > > > > function for several hours. Be pre-pared to have

> > withdrawal

> > > > > > > symptoms

> > > > > > > > for about one week when sugar is cut out of the diet.

> > > Several

> > > > > > > > excellent books have been written on the yeast

> > controversy

> > > > and

> > > > > > > offer

> > > > > > > > additional methods to try. One of the best books is

The

> > > Yeast

> > > > > > > > Connection and the Woman by Crook, M.D., a

> > > physician

> > > > > who

> > > > > > > has

> > > > > > > > done a spectacular job advancing the understanding of

> > > > CFIDS/FMS.

> > > > > > > > > Many patients have found that acidophilus (that is,

> > milk

> > > > > > > bacteria,

> > > > > > > > a healthy bacteria for the bowel) helps restore

balance

> > in

> > > > the

> > > > > > > bowel.

> > > > > > > > Acidophilus is found in yogurt with live and active

> > yogurt

> > > > > > > cultures.

> > > > > > > > Indeed, one cup of yogurt a day can markedly diminish

> the

> > > > > > frequency

> > > > > > > > of recurrent vaginal yeast infections. Acidophilus is

> > also

> > > > > > > available

> > > > > > > > in capsule form. Although many claims are made for

one

> > type

> > > > of

> > > > > > > > acidophilus being better than the other, I'm not sure

> > this

> > > is

> > > > > so.

> > > > > > I

> > > > > > > > usually recommend 3 to 6 billion units a day (1 unit

=

> 1

> > > > > > bacteria)

> > > > > > > on

> > > > > > > > an empty stomach. If on antibiotics (not

antifungals),

> > take

> > > > the

> > > > > > > > acidophilus at least 3 to 6 hours away from the

> > antibiotic

> > > > > dose.

> > > > > > > > > Nystatin, an antifungal medication, has also been

> > helpful

> > > > in

> > > > > > the

> > > > > > > > treatment of yeast overgrowth. Unfortunately, some

> fungi

> > > seem

> > > > > to

> > > > > > be

> > > > > > > > resistant to Nystatin. In addition, Nystatin is

poorly

> > > > > absorbed,

> > > > > > > > which means that it has little impact on the yeast

> > outside

> > > of

> > > > > the

> > > > > > > > bowel. Other anti-fungal medications, such as

Diflucan

> > and

> > > > > > > Sporanox,

> > > > > > > > seem to be effective systemically (throughout the

body)

> > but

> > > > > they

> > > > > > > have

> > > > > > > > two main drawbacks. First, they are expensive,

costing

> > more

> > > > > than

> > > > > > > $450

> > > > > > > > to $900 for a two-month course. Second, any effective

> > anti-

> > > > > fungal

> > > > > > > can

> > > > > > > > initially make the symptoms of yeast infection worse.

> > > > Although

> > > > > > > > uncommon, Sporanox and Diflucan can also cause liver

> > > > > inflammation

> > > > > > > (as

> > > > > > > > can Advil and Tylenol). If you are taking Sporanox or

> > > > Diflucan

> > > > > > for

> > > > > > > > more than 6 to 12 weeks, I would consider

> intermittently

> > > > > checking

> > > > > > > > liver blood tests (ALT and AST). If you have

> preexisting

> > > > active

> > > > > > > liver

> > > > > > > > disease, be cautious in using (or don't use) Sporanox

> or

> > > > > > Diflucan.

> > > > > > > I

> > > > > > > > strongly recommend taking Lipoic Acid (a natural

> > > > > > > > > supplement which protects and helps heal the

liver),

> > > 200mg

> > > > a

> > > > > > > day,

> > > > > > > > whenever you take Sporanox or Diflucan. I also

strongly

> > > > > recommend

> > > > > > > > Lipoic Acid for anyone with active liver disease

(e.g.,

> > > > > > hepatitis)

> > > > > > > at

> > > > > > > > doses up to 1000mg to 3000mg a day as it may prevent

> > and/or

> > > > > treat

> > > > > > > > cirrhosis.

> > > > > > > > > Natural Yeast Treatments

> > > > > > > > > Below, I have summarized the nonprescription part

of

> > the

> > > > > > > treatment

> > > > > > > > checklist that I use in my office.

> > > > > > > > > 1. Avoiding sweets is still the single most

important

> > > > thing.

> > > > > > > Using

> > > > > > > > Stevia as a sweetener is a wonderful substitute.

Stevia

> > is

> > > a

> > > > > > safe,

> > > > > > > > natural remedy and you can use all you want. There

are

> > even

> > > > > > > cookbooks

> > > > > > > > for using Stevia (available from my office or 800-

> > 4STEVIA).

> > > A

> > > > > new

> > > > > > > > natural sweetner, Sweet Balance, also tastes good and

> is

> > 12

> > > > > times

> > > > > > > as

> > > > > > > > sweet as sugar. It is a natural product from the Lo

Han

> > > fruit

> > > > > and

> > > > > > > > appears to be safe. Although it is 70% sugar

> (fructose),

> > > you

> > > > > only

> > > > > > > > need a small amount. Order it from 877-997-9338, my

> > office

> > > at

> > > > > 800-

> > > > > > > 333-

> > > > > > > > 5287 or my Web site at www.endfatigue.com.

> > > > > > > > > 2. Acidophilus or Milk Bacteria can be very

helpful.

> > Take

> > > 3

> > > > > to

> > > > > > 6

> > > > > > > > billion units a day (a unit is the same as a

bacteria).

> > Do

> > > > not

> > > > > > take

> > > > > > > > acidophilus within 3 to 6 hours of an antibiotic.

Take

> it

> > > > > either

> > > > > > on

> > > > > > > > an empty stomach or with milk.

> > > > > > > > > 3. Caprylic Acid is another natural remedy that can

> be

> > > > > helpful.

> > > > > > > The

> > > > > > > > usual dose is 1800 to 3600mg a day with 1/3 of the

dose

> > > being

> > > > > > taken

> > > > > > > > at each meal. Unfortunately, it often causes an acid

> > > stomach

> > > > > with

> > > > > > > > a " funky " tasting reflux.

> > > > > > > > > 4. Oregano Oil - enteric coated oregano oil - 1 to

2

> > > > > capsules,

> > > > > > 2

> > > > > > > to

> > > > > > > > 3 times a day with food, may be more effective and

> better

> > > > > > tolerated

> > > > > > > > than Caprylic Acid (both can cause stomach acid

> reflux).

> > > > > > > > > 5. Fresh Garlic, if you can handle it well, can

also

> be

> > > > very

> > > > > > > > effective. Daily, crush 1 to 3 garlic cloves in olive

> > oil,

> > > > add

> > > > > > > salt,

> > > > > > > > spread it on bread and eat it. It can be quite tasty

> and

> > > > lethal

> > > > > > to

> > > > > > > > whatever infections you have in your gut.

> > > > > > > > > 6. Olive Leaf 500mg, 2 to 4 capsules three times a

> day

> > > > > between

> > > > > > > > meals, can also be very helpful in treating yeast

> > > overgrowth.

> > > > > > > > > 7. Pau De Arco in either tea or capsule form is

also

> > > > helpful

> > > > > in

> > > > > > > > yeast suppression. Although I use Pau De Arco

> > infrequently

> > > > for

> > > > > > > yeast

> > > > > > > > over-growth, many people find that it can be helpful.

> > > > > > > > > 8. Grapefruit Seed Extract (e.g., Citrucidel) is a

> > > popular

> > > > > > > > treatment for yeast overgrowth and is well-tolerated.

> > > > > > > > > More Information On Yeast Treatments

> > > > > > > > > If symptoms of yeast are caused by an allergic or

> > > > sensitivity

> > > > > > > > reaction to the yeast body parts, the symptoms may

> flare

> > > when

> > > > > > mass

> > > > > > > > quantities of the yeast are suddenly killed off. This

> is

> > > > called

> > > > > a

> > > > > > > > yeast " die-off " reaction. If you get this reaction,

> start

> > > > your

> > > > > > > > treatment with acidophilus and a sugar-free diet for

a

> > few

> > > > > weeks

> > > > > > > > followed by oregano oil and/or olive leaf (1500mg to

> > > 2000mg,

> > > > 3

> > > > > > > times

> > > > > > > > a day between meals) before beginning Nystatin. Take

> > > Nystatin

> > > > > (by

> > > > > > > > mouth) in the form of 500,000-IU tablets or powder. I

> > > > generally

> > > > > > > > recommend beginning with 1 tablet a day for 1 to 3

> days,

> > > and

> > > > > > > > increasing by 1 tablet every 1 to 3 days (or slower

if

> > > > > yeast " die-

> > > > > > > > off " is a problem) until 2 tablets 2 to 4 times a day

> is

> > > > > reached.

> > > > > > > If

> > > > > > > > you get nausea, take a lower dose. Take Nystatin, 4

to

> 8

> > > > > tablets

> > > > > > > > daily, for 5 to 8 months. I add the Diflucan or

> Sporanox

> > > one

> > > > > > month

> > > > > > > > after beginning the Nystatin. Take 200mg every

morning

> > for

> > > > six

> > > > > > > weeks.

> > > > > > > > If symptoms flare, take just 100mg per morning for

the

> > > first

> > > > 3

> > > > > to

> > > > > > > 14

> > > > > > > > days. I

> > > > > > > > > f symptoms recur after stopping the Diflucan or

> > Sporanox,

> > > I

> > > > > > > > recommend continuing the medication for an additional

6

> > > weeks

> > > > > at

> > > > > > > > 200mg a day.

> > > > > > > > > Sporanox should be taken with food. If it is taken

> > alone,

> > > > its

> > > > > > > > absorption is greatly reduced. When taking Diflucan

or

> > > > > Sporanox,

> > > > > > DO

> > > > > > > > NOT use the antihistamines Seldane or Hismanal,

> Quinidine

> > > (a

> > > > > > heart

> > > > > > > > medicine), cholesterol-lowering medications in the

> > Mevacor

> > > > > > family,

> > > > > > > or

> > > > > > > > the bowel medicine Propulcid. These can be fatal

> > > > combinations!

> > > > > > > Also,

> > > > > > > > antacid medications (such as Tagamet, Axid, Zantac,

and

> > > > Pepcid)

> > > > > > > > prevent the proper absorption of Sporanox. At the

high

> > > price

> > > > of

> > > > > > > > Sporanox per dose, you will want to absorb every last

> bit

> > > of

> > > > > the

> > > > > > > > medication. If you need to be on an antacid

medication,

> > use

> > > > > > > Diflucan

> > > > > > > > instead of Sporanox. Unfortunately, a less expensive

> > > > > antifungal,

> > > > > > > > called Lamisil (at 250mg a day), does not seem to

work

> > very

> > > > > well

> > > > > > > for

> > > > > > > > candida yeast overgrowth (although it works well for

> nail

> > > > > > > > infections). I am currently trying patients on 500mg

of

> > > > Lamisil

> > > > > a

> > > > > > > day

> > > > > > > > to see if this dose works better.

> > > > > > > > > I feel that once the yeast has been effectively

> > decreased

> > > > and

> > > > > > > kept

> > > > > > > > that way for six to twelve months, it is safe to try

to

> > add

> > > > > small

> > > > > > > > amounts of sugar back into the diet. If symptoms

recur,

> > > > > however,

> > > > > > > stop

> > > > > > > > the sugar again. Continuing to eat yogurt with live

and

> > > > active

> > > > > > > > acidophilus cultures (unless you are lactose-

> intolerant)

> > or

> > > > > > > > continuing to take acidophilus capsules may also help.

> > > > > > > > > Many books on yeast overgrowth (including Dr.

> Crook's)

> > > > advise

> > > > > > > > readers to avoid all yeast in the diet. This advice

is

> > > based

> > > > on

> > > > > > the

> > > > > > > > theory that an allergic reaction to yeast is the

cause

> of

> > > the

> > > > > > > > problem. The predominant yeast that seems to be

> involved

> > in

> > > > > yeast

> > > > > > > > overgrowth is Candida Albicans, although I would not

be

> > > > > surprised

> > > > > > > if

> > > > > > > > researchers discovered that many other kinds of

fungal

> > > > > infections

> > > > > > > are

> > > > > > > > also involved. The yeast that is found in most foods

> > > (except

> > > > > beer

> > > > > > > and

> > > > > > > > cheese) is not closely related to candida.

> > > > > > > > > In my experience, trying to avoid all yeast in

foods

> > > > results

> > > > > > > simply

> > > > > > > > in a nutritionally inadequate diet and little

benefit.

> > > > Although

> > > > > a

> > > > > > > few

> > > > > > > > people do appear to have true allergies to the yeast

in

> > > their

> > > > > > food,

> > > > > > > > they number less than 10 percent of my patients with

> > > > suspected

> > > > > > > yeast

> > > > > > > > overgrowth. These patients may benefit from the more

> > strict

> > > > > diet

> > > > > > in

> > > > > > > > Dr. Crook's book. Interestingly, once their adrenal

> > > > > insufficiency

> > > > > > > and

> > > > > > > > yeast overgrowth are treated, most people find that

> their

> > > > > > allergies

> > > > > > > > and sensitivities to yeast and other food products

seem

> > to

> > > > > > improve

> > > > > > > or

> > > > > > > > disappear.

> > > > > > > > > Nutritional deficiencies such as low zinc or low

> > selenium

> > > > may

> > > > > > > also

> > > > > > > > decrease resistance to yeast over-growth. A good

> > > multivitamin

> > > > > > > > supplement, as recommended in my last newsletter,

> should

> > > take

> > > > > > care

> > > > > > > of

> > > > > > > > these deficiencies. This is further evidence that all

> the

> > > > > factors

> > > > > > > > involved in CFS are closely interrelated.

> > > > > > > > > The best thing that one can do to combat yeast

> > overgrowth

> > > > is

> > > > > to

> > > > > > > try

> > > > > > > > to avoid it in the first place. When you get an

> > infection,

> > > > > begin

> > > > > > > > treating it naturally immediately. Hopefully, you can

> > > prevent

> > > > > it

> > > > > > > from

> > > > > > > > turning into a bacterial infection which might

require

> an

> > > > > > > antibiotic.

> > > > > > > > Ask your doctor what measures you can take before

> > resorting

> > > > to

> > > > > > > > antibiotics. Many good over-the-counter remedies are

> > > > available.

> > > > > A

> > > > > > > > knowledgeable pharmacist may also be a wealth of

> > > information.

> > > > > > Your

> > > > > > > > local book or health food store has books on natural

> > > > measures.

> > > > > > Your

> > > > > > > > health food store proprietor can also steer you to

> > > > appropriate

> > > > > > > > natural remedies. For examples of the many helpful

> > measures

> > > > > that

> > > > > > > one

> > > > > > > > can take, see my newsletter article, Treating

> Infections

> > > > > Without

> > > > > > > > Antibiotics, page ___).

> > > > > > > > > If you find however, that you must take an

> antibiotic,

> > > all

> > > > is

> > > > > > not

> > > > > > > > lost. One can still lessen the severity of yeast

> > overgrowth

> > > > by

> > > > > > > > avoiding sweets and by either taking acidophilus

> capsules

> > > > > (again,

> > > > > > > not

> > > > > > > > within 3 to 6 hours of an antibiotic) or by eating

one

> > cup

> > > of

> > > > > > > yogurt

> > > > > > > > with live and active acidophilus cultures daily.

Don't

> > use

> > > > the

> > > > > > > yogurt

> > > > > > > > (or milk) if you have sinusitis or pneumonia because

> the

> > > milk

> > > > > > > protein

> > > > > > > > thickens mucus and makes it hard for the body to

fight

> > > these

> > > > > > > > infections.

> > > > > > > > > How Can One Tell If The Yeast Is Coming Back?

> > > > > > > > > It is normal for yeast symptoms to resolve after

> > > treatment.

> > > > > > After

> > > > > > > 6

> > > > > > > > weeks on the Sporanox or Diflucan, patients are

usually

> > > > feeling

> > > > > a

> > > > > > > lot

> > > > > > > > better, but may have symptoms recur soon after

stopping

> > the

> > > > > > > > antifungal. In this case I would continue the

Sporanox

> or

> > > > > > Diflucan

> > > > > > > > for another 6 weeks, or as long as is needed, to keep

> the

> > > > > > symptoms

> > > > > > > at

> > > > > > > > bay. More frequently, people will feel better after

> > > treatment

> > > > > and

> > > > > > > > stay feeling fairly well for a period of 6 to 24

> months.

> > At

> > > > > that

> > > > > > > > time, it is common to see a recurrence of symptoms,

> > > > especially

> > > > > if

> > > > > > > one

> > > > > > > > is eating too much sugar or is taking antibiotics.

The

> > best

> > > > > > marker

> > > > > > > > that I have found for yeast overgrowth would be a

> return

> > of

> > > > > bowel

> > > > > > > > symptoms with gas, bloating and/or diarrhea or

> > > constipation.

> > > > If

> > > > > > > these

> > > > > > > > symptoms persist for more than 2 weeks, especially if

> > there

> > > > is

> > > > > > also

> > > > > > > > even a mild worsening of the FMS symptoms, it is very

> > > > > reasonable

> > > > > > to

> > > > > > > > retreat yourself with 6 weeks of Nystatin and perhaps

> > > > Sporanox

> > > > > or

> > > > > > > > Diflucan. In addition, I would also retreat if

there's

> > > > > > > > > a recurrence of vaginal yeast or sinus infections.

If

> > re-

> > > > > > > treatment

> > > > > > > > resolves the symptoms, one may opt to repeat this

> regimen

> > > as

> > > > > > often

> > > > > > > as

> > > > > > > > is needed (usually every 6 to 24 months). By using

some

> > of

> > > > the

> > > > > > > > natural remedies listed above, however, you may be

able

> > to

> > > > > avoid

> > > > > > > > repeated use of these antifungals and the possible

risk

> > of

> > > > > > becoming

> > > > > > > > resistant to them. Some patients also find that they

> need

> > > to

> > > > > stay

> > > > > > > on

> > > > > > > > the antifungals for extended periods of time (years)

or

> > the

> > > > > > > symptoms

> > > > > > > > will recur. When this is necessary, I add the natural

> > > > remedies.

> > > > > I

> > > > > > > > will, however, also use the medications when needed.

> The

> > > main

> > > > > > risk

> > > > > > > of

> > > > > > > > long-term use of the antifungals Sporanox and

Diflucan

> > > would

> > > > be

> > > > > > > liver

> > > > > > > > inflammation. If these medications are being used for

> > > > extended

> > > > > > > > periods, consider checking liver tests (SGOT and

SGPT)

> > > every

> > > > 3

> > > > > to

> > > > > > 6

> > > > > > > > months and anytime that a severe flu-like feeling or

> > > > worsening

> > > > > of

> > > > > > > > symptoms occur. As noted above, it is very important

to

> > > take

> > > > > > Lipoic

> > > > > > > > Acid 200mg a day when on Sporanox or Diflucan. Althoug

> > > > > > > > > h I am not aware of any studies using Lipoic Acid

> with

> > > > > > > antifungals,

> > > > > > > > in my experience I have seen no worrisome elevation

on

> > > liver

> > > > > > tests

> > > > > > > if

> > > > > > > > patients are using this natural substance while

taking

> > > these

> > > > > > > > antifungals. As an alternative, instead of taking the

> > > > > antifungals

> > > > > > > > every day, many people find they can get long-term

> > > > suppression

> > > > > of

> > > > > > > the

> > > > > > > > yeast by taking Sporanox or Diflucan 200mg twice a

day,

> > one

> > > > day

> > > > > > > each

> > > > > > > > week (e.g., each Sunday).

> > > > > > > > > Help For Chronic Bladder Infections

> > > > > > > > > Although we will be discussing some unusual

> infections,

> > > > > > CFIDS/FMS

> > > > > > > > patients also get more of the day-to-day variety of

> > > > infections.

> > > > > > > These

> > > > > > > > include Urinary Tract (bladder) Infections (UTI). The

> > main

> > > > > > symptoms

> > > > > > > > of a UTI are discomfort (e.g., burning) when

urinating

> > > > > (dysuria),

> > > > > > > > urgency (which is the feeling that you have to go

very

> > > badly

> > > > > and

> > > > > > > > right away when there is not much urine there), and

> > > frequency

> > > > > > with

> > > > > > > > low volume. These symptoms are also common in

CFIDS/FMS

> > > > > patients

> > > > > > in

> > > > > > > > the absence of bladder infections and, when severe,

is

> > > called

> > > > > > > > Interstitial Cystitis. I would not label someone as

> > having

> > > > > > > > Interstitial Cystitis unless this is the major

symptom

> of

> > > > their

> > > > > > > > CFIDS/FMS, because almost everyone with this illness

> has

> > > some

> > > > > > > urinary

> > > > > > > > urgency and frequency. Because bladder symptoms can

be

> > seen

> > > > in

> > > > > > both

> > > > > > > > UTI and CFIDS/FMS, it is important to have a urine

> > culture

> > > > done

> > > > > > > > before treatment with antibiotics to make sure that

> there

> > > is

> > > > an

> > > > > > > > infection and not just muscle spasms in the bladder

> that

> > > are

> > > > > > > causing

> > > > > > > > these

> > > > > > > > > symptoms. If there is an infection, over 90% of the

> > time

> > > it

> > > > > > will

> > > > > > > be

> > > > > > > > E-coli. This bacteria is normally found in everyone's

> gut

> > > > and,

> > > > > > with

> > > > > > > > the exception of a few rare dangerous forms, is a

> healthy

> > > > part

> > > > > of

> > > > > > > our

> > > > > > > > normal bowel bacteria. The problem occurs when the E-

> coli

> > > > gets

> > > > > > out

> > > > > > > of

> > > > > > > > the bowel where it belongs and into the bladder.

> Usually

> > > the

> > > > > > > bladder

> > > > > > > > will wash out most infections when the urine comes

out.

> > The

> > > E-

> > > > > > coli

> > > > > > > > however, have little velcro-like projections that

stick

> > to

> > > > the

> > > > > > > > bladder wall so that they can not be washed out by

> > > urination.

> > > > > > > > > Taking antibiotics will kill a bladder infection

but

> > will

> > > > > also

> > > > > > > kill

> > > > > > > > the healthy bacteria in the bowel. This sets one up

for

> > > yeast

> > > > > > > > overgrowth and other problems. Because of this,

unless

> > > there

> > > > is

> > > > > > > fever

> > > > > > > > or back pain over the kidneys or a toxic feeling, it

is

> > > > > > reasonable

> > > > > > > to

> > > > > > > > try natural remedies for one to three days before

going

> > > with

> > > > > the

> > > > > > > > antibiotics. One can start these treatments while

> waiting

> > > for

> > > > > the

> > > > > > > > urine culture to come back.

> > > > > > > > > What Natural Remedies Can Be Used For Bladder

> > Infections?

> > > > > > > > > There are two excellent natural remedies that can

> keep

> > > the

> > > > E-

> > > > > > coli

> > > > > > > > from sticking to the bladder walls so they can be

> washed

> > > out.

> > > > > In

> > > > > > > > addition, taking vitamin C in high dose (e.g., 500 to

> > > 5000mg

> > > > a

> > > > > > day)

> > > > > > > > can acidify the urine, making it inhospitable to the

> > > > bacteria.

> > > > > > > > Drinking a lot of water also helps to wash out the

> > > infection.

> > > > > > > > > The two natural remedies that keep the bacteria

from

> > > > sticking

> > > > > > are:

> > > > > > > > > 1. Cranberries—Because approximately 20% of the

> female

> > > > > > population

> > > > > > > > suffers from UTIs, several studies have been done

> looking

> > > at

> > > > > this

> > > > > > > > remedy. An early study of 44 female and 16 male

> patients

> > > with

> > > > > > acute

> > > > > > > > bladder infections drank 16 oz. of cranberry juice a

> day

> > > for

> > > > 15

> > > > > > > days.

> > > > > > > > Of these patients, 53% had positive responses and

> another

> > > 20%

> > > > > > > showed

> > > > > > > > modest improvement. Six weeks after stopping the

juice,

> > 27

> > > > > > patients

> > > > > > > > did have persistent recurrent infections and 8 of

these

> > had

> > > > no

> > > > > > > > symptoms. Seventeen patients had no symptoms and

> negative

> > > > urine

> > > > > > > > cultures.

> > > > > > > > > In another study of elderly women (who are more

> likely

> > to

> > > > > have

> > > > > > > > bladder infections), 153 women either received 10 oz.

> of

> > > > > > cranberry

> > > > > > > > drink or placebo every day for 6 months. The group

that

> > got

> > > > the

> > > > > > > > cranberry drink had 68% fewer bladder infections

during

> > > that

> > > > > > > period.

> > > > > > > > In this study, the juice was sweetened with saccharin

> > > instead

> > > > > of

> > > > > > > > sugar. Other studies have also shown benefit using

> > > cranberry

> > > > > > juice

> > > > > > > in

> > > > > > > > bladder infections.

> > > > > > > > > Significant benefits are achieved by using 6 to 16

> oz.

> > of

> > > > > > > cranberry

> > > > > > > > juice a day. Because cranberry juice has a lot of

sugar

> > and

> > > > can

> > > > > > > > promote yeast overgrowth and aggravate other symptoms

> in

> > > > > > CFIDS/FMS,

> > > > > > > I

> > > > > > > > think it is much better to use pure cranberry juice

> > powder

> > > in

> > > > > > > capsule

> > > > > > > > or tablet form (standardized to contain 11% to 12%

> quinic

> > > > > acid).

> > > > > > > The

> > > > > > > > therapeutic dose is 1 to 2 capsules a day.

Conversely,

> > you

> > > > can

> > > > > > use

> > > > > > > > unsweetened cranberry juice and add Stevia as a

natural

> > > > > > sweetener.

> > > > > > > In

> > > > > > > > general, if one gives the usual cranberry juice

> cocktails

> > a

> > > > > > > strength

> > > > > > > > of 1 unit - then, cranberry juice drinks have a

> strength

> > of

> > > > ½;

> > > > > > > > cranberry sauce a strength of ½; fresh or frozen

> > > cranberries

> > > > > are

> > > > > > 4

> > > > > > > > times as potent; pure cranberry juice is 4 times as

> > potent;

> > > > and

> > > > > > > > cranberry juice capsules from unsweetened cranberry

> juice

> > > > > powders

> > > > > > > are

> > > > > > > > 32 times as potent.

> > > > > > > > > Cranberries work to help bladder infections because

> > they

> > > > have

> > > > > a

> > > > > > > > chemical (proanthocyanidins) that prevents the

bacteria

> > > from

> > > > > > > sticking

> > > > > > > > to the bladder wall. They may also decrease the risk

of

> > > > kidney

> > > > > > > stones

> > > > > > > > (although magnesium with B6 is much better for this),

> as

> > > well

> > > > > as

> > > > > > > > possibly reduce urine odor.

> > > > > > > > > D-Mannose - This is more effective than cranberry

> > juice.

> > > > > > Mannose

> > > > > > > is

> > > > > > > > a natural sugar (not the kind that causes symptoms or

> > yeast

> > > > > > > > overgrowth) that is excreted promptly into the urine.

> > > > > > Unfortunately

> > > > > > > > for the E-coli bacteria, the fingers that stick to

the

> > > > bladder

> > > > > > wall

> > > > > > > > stick to the D-Mannose even better. When one takes a

> > large

> > > > > amount

> > > > > > > of

> > > > > > > > D-Mannose, it spills into the urine, coating all the

E-

> > > coli's

> > > > > > > > little " sticky fingers " so that the E-coli are

> literally

> > > > washed

> > > > > > > away

> > > > > > > > with the next urination. The nice thing about the

> natural

> > > > > > approach,

> > > > > > > > as opposed to antibiotics, is that the cranberries or

D-

> > > > Mannose

> > > > > > > will

> > > > > > > > not kill the healthy bacteria, thereby not bothering

> the

> > > > normal

> > > > > > > > balance of bacteria in the bowel. In addition, the D-

> > > Mannose

> > > > is

> > > > > > > > absorbed in the upper gut before it gets to the

> friendly

> > E-

> > > > coli

> > > > > > > that

> > > > > > > > are normally present in the colon. Because of this,

it

> > > helps

> > > > > > clear

> > > > > > > > the bladder without causing any other problems. In

> > > addition,

> > > > > the

> > > > > > D-

> > > > > > > > Mannose even tastes good.

> > > > > > > > > The D-Mannose is quite safe, even for long-term

use,

> > > > although

> > > > > > > most

> > > > > > > > people will only need it for a few days. Those who

have

> > > > > frequent

> > > > > > > > recurrent bladder infections may, however, choose to

> take

> > > it

> > > > > > every

> > > > > > > > day. The usual dose of D- Mannose is 1/2 teaspoon

every

> 2

> > > to

> > > > 3

> > > > > > > hours,

> > > > > > > > while awake, to treat an acute bladder infection; and

> 1/4

> > > to

> > > > > 1/2

> > > > > > > > teaspoon 3 to 4 times a day to prevent severe chronic

> > > bladder

> > > > > > > > infections. It is best taken dissolved in water. For

> > those

> > > > who

> > > > > > get

> > > > > > > > bladder infections associated with sexual

intercourse,

> > one

> > > > can

> > > > > > take

> > > > > > > > 1/2 teaspoon of D-Mannose 1 hour before and then just

> > after

> > > > > > > > intercourse to prevent an infection. Remember,

though,

> > the

> > > D-

> > > > > > > Mannose

> > > > > > > > (and cranberries) only work in the 90% of bladder

> > > infections

> > > > > > caused

> > > > > > > > by E-coli bacteria. D-Mannose is available from

several

> > > > sources:

> > > > > > > > > 1. The Tahoma Clinic Dispensary (253-850-5661),

which

> > is

> > > > > > > associated

> > > > > > > > with the well-known nutritional physician,

V.

> > > > ,

> > > > > > M.D.

> > > > > > > > > 2. The Biotech Company (800-345-1199).

> > > > > > > > > 3. My office (800-333-5287) or my Web site at

> > > > > > www.endfatigue.com.

> > > > > > > > > The usual cost of D-Mannose is approximately $60

for

> > 100

> > > > > grams

> > > > > > > and

> > > > > > > > $35 for 50 grams. A 1/2 teaspoon is approximately 2

> > grams.

> > > > One

> > > > > > > should

> > > > > > > > feel much better within 24 to 48 hours on D-Mannose.

If

> > > not,

> > > > > see

> > > > > > a

> > > > > > > > doctor for a urine culture (you may want to get the

> > culture

> > > > at

> > > > > > the

> > > > > > > > first sign of infection) and consider antibiotic

> > treatment

> > > > > after

> > > > > > > two

> > > > > > > > days if the culture is positive. Some evidence exists

> > that

> > > > > > > > Macrodantin causes less yeast over-growth than do

other

> > > > > > > antibiotics.

> > > > > > > > Even with other antibiotics, most bladder infections

> are

> > > > > knocked

> > > > > > > out

> > > > > > > > by one to three days of antibiotic use (instead of

the

> > old

> > > > > seven-

> > > > > > > day

> > > > > > > > regimen).

> > > > > > > > > Prostatitis

> > > > > > > > > Although women tend to be the ones plagued with

> bladder

> > > > > > > infections,

> > > > > > > > men don't get off unscathed either. It is very common

> in

> > > men

> > > > > with

> > > > > > > > CFIDS/FMS to have Prostatitis. Prostatitis is an

> > > inflammation

> > > > > or

> > > > > > > > infection of the prostate which is usually seen in

> > younger

> > > > men

> > > > > > > > between the ages of 20 and 50. It falls into three

main

> > > > > > categories:

> > > > > > > > > 1. " Bacterial " Prostatitis is a acute or chronic

> > > infection

> > > > in

> > > > > > the

> > > > > > > > gland that causes prostate swelling and discomfort.

> > > > > > > > > 2. Nonbacterial Prostatitis is when you feel

swelling

> > of

> > > > the

> > > > > > > > prostate without being able to detect an infection.

My

> > > > > suspicion

> > > > > > is

> > > > > > > > that it is not uncommon for prostatitis to be

> associated

> > > with

> > > > > > yeast

> > > > > > > > overgrowth or other infections that cannot be

cultured

> > > > (tested

> > > > > > > for).

> > > > > > > > > 3. Prostadynia is a general irritation of the

> prostate

> > > > which

> > > > > > > causes

> > > > > > > > urinary burning, urgency and frequency but without

> there

> > > > being

> > > > > > any

> > > > > > > > infection or swelling of the prostate. This can come

> from

> > a

> > > > > > number

> > > > > > > of

> > > > > > > > causes including, I suspect, chronic spasm or

> tightening

> > of

> > > > the

> > > > > > > > muscles of the pelvic floor.

> > > > > > > > > The symptoms of chronic Prostatitis can come and go

> and

> > > be

> > > > > mild

> > > > > > > or

> > > > > > > > severe. The symptoms include:

> > > > > > > > > 1. Pain or tenderness in the area of the prostate.

It

> > is

> > > > also

> > > > > > > > common to have burning on the tip of the penis.

> > > > > > > > > 2. Discomfort in the groin and, occasionally, lower

> > back

> > > > pain.

> > > > > > > > > 3. Urinary urgency and frequency with pain on

> > urination.

> > > > > > > > > 4. Sometimes a slight penis discharge. If the

> discharge

> > > is

> > > > > > cloudy

> > > > > > > > and larger than one drop, or even a large drop, it is

> > most

> > > > > likely

> > > > > > a

> > > > > > > > bacterial Prostatitis and I would then prescribe

> > > antibiotics.

> > > > > If

> > > > > > a

> > > > > > > > discharge is present, I would also check to make sure

> > that

> > > > > there

> > > > > > is

> > > > > > > > not also a sexually transmitted disease (such as

> > Chlamydia

> > > or

> > > > > > > > Gonorrhea) before beginning treatment.

> > > > > > > > > 5. Pain with ejaculation.

> > > > > > > > > If severe symptoms with fevers, chills and extreme

> > > fatigue

> > > > > are

> > > > > > > > present (symptoms of acute Prostatitis), antibiotics

> > should

> > > > be

> > > > > > > used.

> > > > > > > > The main treatment for bacterial Prostatitis consists

> of

> > > > using

> > > > > > the

> > > > > > > > antibiotics Tetracycline (e.g., Doxycycline), Cipro,

or

> > > Sulfa

> > > > > > > > (Bactrim or Septra DS). Unfortunately, since it is

hard

> > for

> > > > the

> > > > > > > > antibiotics to be absorbed into the prostate, the

> > symptoms

> > > > > often

> > > > > > > > recur even after six weeks of treatment. If

antibiotics

> > are

> > > > > > > required,

> > > > > > > > use Doxycycline or Cipro because these may be

effective

> > > > against

> > > > > > > other

> > > > > > > > hidden infections that can cause CFIDS/FMS.

> > > > > > > > > Although there are a number of causes of

Prostatitis,

> > > > excess

> > > > > > > > caffeine, alcohol and spicy foods can also contribute

> to

> > > the

> > > > > > > > symptoms. Sitting for long periods while traveling

> (e.g.,

> > > > being

> > > > > a

> > > > > > > > truck driver) can also cause irritation of the

> prostate.

> > > > > Although

> > > > > > > > normal bacteria are common causes, a few bacteria

> > > transmitted

> > > > > > > through

> > > > > > > > sexual contact can also cause Prostatitis. Some feel

> that

> > > the

> > > > > > main

> > > > > > > > psychological component of Prostatitis is shame.

> > > > > > > > > Bowel Parasite Infections

> > > > > > > > > A while back, the news focused our attention on

> > Milwaukee

> > > > > > because

> > > > > > > > of repeated fatal outbreaks of an infection by a

bowel

> > > > parasite

> > > > > > > > called Cryptosporidium. A cartoon even made the

rounds

> > > > showing

> > > > > > > > Mexican tourists being warned not to drink the water

in

> > > > > > Milwaukee!

> > > > > > > > Although this infection usually resolves on its own

> > within

> > > a

> > > > > week

> > > > > > > or

> > > > > > > > two, it may persist in those with immune suppression.

> In

> > > > fact,

> > > > > > > people

> > > > > > > > with acquired immune deficiency syndrome (AIDS) are

> > > > > particularly

> > > > > > > > susceptible and scores of Milwaukeens died from the

> > > > > > Cryptosporidium

> > > > > > > > outbreaks.

> > > > > > > > > Unfortunately, in many places throughout the United

> > > States,

> > > > > the

> > > > > > > > water supply is contaminated, and parasites are no

> longer

> > > > just

> > > > > a

> > > > > > > > Third World problem. Doctors frequently see cases of

> > > > infection

> > > > > by

> > > > > > > > giardia, amoeba and numerous other bowel parasites.

> > > Parasitic

> > > > > > > > infections can mimic CFS and, in immune suppressed

> > > situations

> > > > > > like

> > > > > > > > CFS, all parasites should be treated.

> > > > > > > > > Most laboratories miss the parasites when they do

> stool

> > > > > > testing.

> > > > > > > I

> > > > > > > > initially tested for bowel parasites by sending my

> > > patients'

> > > > > > stool

> > > > > > > > samples to a respected local lab. The tests kept

coming

> > > back

> > > > > > > > negative, so I eventually stopped testing. Finally, I

> > > started

> > > > > > doing

> > > > > > > > my own laboratory stool testing. Doing the test

> properly

> > > was

> > > > > very

> > > > > > > > time consuming, taking up to five hours per specimen.

> > > > However,

> > > > > > > > processing it properly, my tests frequently turned

out

> > > > > positive.

> > > > > > In

> > > > > > > > my experience - and in that of other physicians as

> well -

> > > > when

> > > > > > you

> > > > > > > > treat a patient for parasites, the patient's fatigue

> and

> > > > > achiness

> > > > > > > > often improves dramatically.

> > > > > > > > > If you would like your stool tested, make sure that

> the

> > > lab

> > > > > > > > specializes in stool testing and that the sample is a

> > > purged

> > > > > > > > specimen. A purged stool specimen is watery and

loose,

> > > > brought

> > > > > > > about

> > > > > > > > by the use of one-and-a-half ounces of Fleet's

Phospho-

> > Soda

> > > > (a

> > > > > > > > laxative). The purpose of the stool purge is to get

the

> > > best

> > > > > > > possible

> > > > > > > > stool sample to check for bowel parasites and yeast.

> The

> > > > > laxative

> > > > > > > > washes the organisms off the walls of the intestines

so

> > > that

> > > > > they

> > > > > > > can

> > > > > > > > be detected. The routine random tests performed in

> almost

> > > all

> > > > > > > > standard labs are generally not adequate or reliable.

> In

> > > > > speaking

> > > > > > > > with several lab technicians, I was told they had

less

> > than

> > > > one

> > > > > > > hour

> > > > > > > > of training in looking for parasites—which they found

> to

> > be

> > > > > > > useless.

> > > > > > > > In fact, during one of our " doctors' " poker games, I

> > spoke

> > > > with

> > > > > a

> > > > > > > > gastroenterologist friend who noted that during a

> certain

> > > > bowel

> > > > > > > exam

> > > > > > > > he had performed, he saw a large number of parasites

> > > swimming

> > > > > in

> > > > > > > the

> > > > > > > > patient's large bowel. He removed a big glob

consisting

> > of

> > > > > > nothing

> > > > > > > > > but mucus and parasites and sent it off to the

major

> > > local

> > > > > > > > laboratory, just for confirmation of the infection

and

> > > > > > > identification

> > > > > > > > of the parasite. Even this sample came back negative

> for

> > > > > > parasites!

> > > > > > > > This is why I stress that stool testing must be done

at

> a

> > > lab

> > > > > > that

> > > > > > > > specializes in parasitology. Because two excellent

labs

> > are

> > > > now

> > > > > > > > available to me to mail specimens to, I no longer

have

> to

> > > do

> > > > > the

> > > > > > > > testing in my office. These labs are The Parasitology

> > > Center,

> > > > > > Inc.

> > > > > > > > (480-777-1078) and The Great Smokies Diagnostic

> > Laboratory

> > > > (800-

> > > > > > 522-

> > > > > > > > 4762).

> > > > > > > > > At this point, no consistently effective

prescription

> > > > > > medication

> > > > > > > is

> > > > > > > > available for Cryptosporidium infections. Artemisia

> > annua,

> > > > > > however,

> > > > > > > > is an effective herbal treatment. For most of my

> > patients,

> > > I

> > > > > > > > recommend using 1,000 milligrams three times a day

for

> > > twenty

> > > > > > days.

> > > > > > > > Leo Galland, M.D., a parasite specialist, recommends

a

> > form

> > > > of

> > > > > > > > Artemisia called tricyclin for many parasitic

> infections.

> > > He

> > > > > > > > recommends taking 2 tablets, 3 times a day after

meals

> > for

> > > > six

> > > > > to

> > > > > > > > eight weeks. The cost of this antiparasitic herbal

> > > > preparation

> > > > > is

> > > > > > > > about $30 for fifty tablets. See the treatment

protocol

> > > below

> > > > > for

> > > > > > > > regimens for some other parasitic infections. The

> doctor

> > > who

> > > > > runs

> > > > > > > The

> > > > > > > > Parasitology Center also has a review article

> discussing

> > > > which

> > > > > > > > natural remedies are effective against each type of

> > > parasite.

> > > > > > > Common

> > > > > > > > parasite treatment regimens also used in our office

are

> > on

> > > > the

> > > > > > > > treatment checklist below.

> > > > > > > > > Antiparasitic Treatments

> > > > > > > > > 1. Flagyl (Metronidazole) – 750 mg, 3 times a day

for

> > 10

> > > > > days,

> > > > > > > > followed by Yodoxin for many parasites. For

Clostridium

> > > > > Difficile

> > > > > > > > take 250 mg, 4 times a day, or 500 mg, 3 times a day.

> It

> > > may

> > > > > > cause

> > > > > > > > nausea and vomiting (uncomfortable but usually not

> > > > worrisome).

> > > > > Do

> > > > > > > not

> > > > > > > > drink alcohol while on this medication as it will

make

> > you

> > > > > vomit.

> > > > > > > The

> > > > > > > > SR (sustained release) form is easier on the stomach

> (as

> > is

> > > > the

> > > > > > > brand-

> > > > > > > > name form). If you get numbness or tingling in your

> > fingers

> > > > (or

> > > > > > it

> > > > > > > > worsens if you usually have it) stop the Flagyl.

> > > > > > > > > 2. Yodoxin (Iodoquinol) – 650 mg, 3 times a day,

for

> 20

> > > > days

> > > > > > > after

> > > > > > > > Flagyl is completed.

> > > > > > > > > 3. Tinidazole – 2000 mg, once daily, for 3

> consecutive

> > > days

> > > > > > with

> > > > > > > > food (for Entamoeba Histolytica) – OR - 3 doses, each

2

> > > weeks

> > > > > > apart

> > > > > > > > (for Giardia or Dientamoeba Fragilis); Available at

> > 's

> > > > > > > Pharmacy

> > > > > > > > (800-480-3432).

> > > > > > > > > 4. Humatin (Paromomycin) – 500 mg, 3 times a day,

for

> > 10

> > > > days

> > > > > > > (for

> > > > > > > > Cryptosporidium). For Blastocystis add Yodoxin.

> > > > > > > > > 5. Zithromax – 250 mg, once a day on an empty

stomach

> > for

> > > > 10

> > > > > > > days,

> > > > > > > > along with Bactrim, 1 tablet twice a day for 10 days

> > > > (alternate

> > > > > > > > treatment for Cryptosporidium). Add Artemesia.

> > > > > > > > > 6. Bactrim DS - 1 tablet, twice a day, plus Yodoxin

> 650

> > > mg,

> > > > 3

> > > > > > > times

> > > > > > > > a day with food for 10 days. Do not take Folic acid

> > > > supplements

> > > > > > > > (e.g., B Complex or multivitamins) during these 10

days

> > > (for

> > > > > > > > Blastocystis).

> > > > > > > > > 7. Amphotericin B – 100 mg, two times a day, plus

> > > > Tinidazole

> > > > > > 500

> > > > > > > > mg, twice a day, plus Furoxone (Furazolidone) 1

tablet,

> > > twice

> > > > a

> > > > > > > day.

> > > > > > > > Take these three together with food for 5 to 7 days

> > > > > (Amphotericin

> > > > > > B

> > > > > > > > and Tinidazole are available from 's Pharmacy

800-

> > 480-

> > > > > 3432)

> > > > > > > > (treatment for refractory Blastocystis).

> > > > > > > > > 8. Lactoferrin – 350 mg, 1 to 3 capsules at

bedtime.

> > > > > > > > > 9. Multi-pure Water Filter - Most other filters

> (except

> > > for

> > > > > > > reverse

> > > > > > > > osmosis) are ineffective. (Available from Bren

> son,

> > > 410-

> > > > > 224-

> > > > > > > > 4877).

> > > > > > > > > 10. Artemesia Annua (a herbal antiparasitic) – 500

> mg,

> > 2

> > > > > > tablets,

> > > > > > > 3

> > > > > > > > times a day for 20 days.

> > > > > > > > > 11. Tricyclin (a herbal antiparasitic) - 2 tablets,

3

> > > times

> > > > a

> > > > > > > day,

> > > > > > > > after meals for 6 to 8 weeks (concentrated Artemesia).

> > > > > > > > > 12. Colostrum (mother's milk) - 3 capsules, 3 times

a

> > > day,

> > > > > for

> > > > > > 8

> > > > > > > to

> > > > > > > > 12 weeks. Then stop or use the lowest dose needed for

> > > > symptoms.

> > > > > > If

> > > > > > > > nausea or indigestion occurs, lower the dose to a

> > > comfortable

> > > > > > level

> > > > > > > > for 1 to 2 weeks until it passes. Take on an empty

> > stomach.

> > > > > > > > > 13. Quinacrine – 100 mg a day for 5 days. May be

> useful

> > > for

> > > > > > > empiric

> > > > > > > > therapy of suspected but not identified parasites

> > > > > (controversial).

> > > > > > > > > 14. Albendazole – 400 mg a day for 5 days. May be

> > useful

> > > > for

> > > > > > > > empiric therapy of suspected but not identified

> parasites.

> > > > > > > > > Filter Your Water

> > > > > > > > > Water filters can be very helpful in the fight

> against

> > > > > > parasitic

> > > > > > > > infection. However, not all units are designed to

> filter

> > > out

> > > > > > > > parasites. For a water filter to remove parasites, it

> > must

> > > > have

> > > > > a

> > > > > > > > submicron solid carbon block filter. A good example

is

> > the

> > > > > Multi-

> > > > > > > pure

> > > > > > > > Filter. Check the Consumer's Digest and Consumer's

> Report

> > > for

> > > > > > other

> > > > > > > > good units. Multi-pure Filters are available from

Bren

> > > > son

> > > > > > at

> > > > > > > > 888-801-8176 or 410-224-4877. He is a very reputable

> and

> > > > > > > > knowledgeable person and does not believe in " high

> > pressure

> > > > > > sales "

> > > > > > > > (again, I get no money from people or companies whose

> > > > products

> > > > > I

> > > > > > > > recommend).

> > > > > > > > > When shopping around for a water filter, request

the

> > > > National

> > > > > > > > Sanitation Foundation (NSF) International Listing for

> the

> > > > > > specific

> > > > > > > > unit you are considering. NSF is an independent not-

for-

> > > > profit

> > > > > > > > organization that tests and certifies drinking water

> > > > treatment

> > > > > > > > products. The unit you buy should meet both NSF

Health

> > > > Effects

> > > > > > > > Standard 53 and NSF Aesthetics Standard 42, with

Class

> I

> > > > > > reduction

> > > > > > > of

> > > > > > > > chlorine and particulate matter. Any unit that does

not

> > > meet

> > > > > both

> > > > > > > of

> > > > > > > > these standards, particularly the health standard, is

> not

> > > > > > adequate.

> > > > > > > > To verify that a unit does meet these standards, call

> the

> > > NSF

> > > > > at

> > > > > > > 313-

> > > > > > > > 769–8010.

> > > > > > > > > In addition to verifying that a water filter meets

> the

> > > NSF

> > > > > > > > standards, ask to see its Product Performance Data

> Sheet.

> > > > Many

> > > > > > > states

> > > > > > > > require that this sheet be given to all prospective

> > > customers

> > > > > of

> > > > > > > > drinking water treatment devices.

> > > > > > > > > Ask about the range of contaminants that the unit

can

> > > > reduce

> > > > > > > under

> > > > > > > > NSF Health Effects Standard 53. Most units certified

> > under

> > > > > > Standard

> > > > > > > > 53 list only turbidity and cyst reduction. The number

> of

> > > > units

> > > > > > that

> > > > > > > > also reduce pesticides, trihalomethanes, lead, and

> > volatile

> > > > > > organic

> > > > > > > > chemicals is very small. Make sure that the water

> filter

> > > you

> > > > > are

> > > > > > > > considering can remove the specific contaminants that

> > > concern

> > > > > you.

> > > > > > > > > Ask if the unit is licensed in such states as

> > California,

> > > > > > > Colorado

> > > > > > > > and Wisconsin. These states have some of the toughest

> > > > > > certification

> > > > > > > > procedures in the United States.

> > > > > > > > > Finally, ask about the unit's service cycle, which

is

> > > > stated

> > > > > in

> > > > > > > > gallons of water treated. Find out how often you will

> > need

> > > to

> > > > > > > change

> > > > > > > > the filter and what the replacement filters cost.

> > > > > > > > > As the American water supply becomes more

> contaminated,

> > > > > > parasitic

> > > > > > > > bowel infections will likely become more common.

These

> > > > > > infections,

> > > > > > > as

> > > > > > > > well as the overgrowth of yeast or toxic bacteria

> caused

> > by

> > > > > > > > antibiotic use, contribute to feeling poorly.

> > > > > > > > > The Role Of Other Infections In CFIDS/FMS

> > > > > > > > > Many infections have been found in CFIDS. That

people

> > may

> > > > > have

> > > > > > > not

> > > > > > > > just one, but several of these simultaneously is

> > > significant.

> > > > > It

> > > > > > > > suggests that although these infections may be a

> trigger,

> > > in

> > > > > most

> > > > > > > > patients the immune system is suppressed and

therefore

> > they

> > > > > > become

> > > > > > > a

> > > > > > > > setup for unusual infections that persist. These

> > infections

> > > > may

> > > > > > > > then " drag you down, " further suppressing your immune

> > > system.

> > > > > > > > > Fortunately, most people improve (and often get

very

> > > > healthy)

> > > > > > by

> > > > > > > > simply treating the sleep, hormonal, nutritional and

> > yeast

> > > > > > > problems.

> > > > > > > > Once these areas are treated, your body can usually

> > > eliminate

> > > > > any

> > > > > > > > persistent infections by itself. A subset, though,

have

> > > > > > infections

> > > > > > > > that need treatment with antivirals and/or

antibiotics.

> > > > > > > > > How Can I Tell If I Need These Treatments?

> > > > > > > > > First, I would try the other approaches discussed

in

> my

> > > > From

> > > > > > > > Fatigued To Fantastic! book and newsletters. I would

> try

> > > > these

> > > > > > > > treatments if symptoms persist:

> > > > > > > > > 1. Those with predominantly flu-like symptoms with

> > > > > debilitating

> > > > > > > > fatigue and little or no pain or fever are more

likely

> to

> > > > have

> > > > > an

> > > > > > > > underlying persistent viral infection (e.g., HHV-6,

> > Epstein

> > > > > Barr,

> > > > > > > > CMV, etc.).

> > > > > > > > > 2. Those with fevers (i.e., anything over 98.6°F in

> > this

> > > > > > illness -

> > > > > > >

> > > > > > > > even 99°) and/or lung congestion, sinusitis, skin

> > pustules

> > > or

> > > > > > other

> > > > > > > > chronic bacterial infections seem more likely to have

> > > > > infections

> > > > > > > > (i.e., bacterial, Mycoplasma, or Chlamydia) that

> respond

> > to

> > > > > > special

> > > > > > > > antibiotics. Let's look at these two groups and how

to

> > > > approach

> > > > > > > them.

> > > > > > > > > HHV-6 And Other Viral Infections

> > > > > > > > > HHV-6 (Human Herpes Virus 6) is a virus that is

> related

> > > to

> > > > > the

> > > > > > > > Epstein Barr Virus (EB), Cytomegalovirus (CMV), and

> also

> > to

> > > > the

> > > > > > > > Herpes Viruses that causes cold sores and Genital

> Herpes.

> > > HHV-

> > > > 6

> > > > > > is

> > > > > > > > transmitted like the common cold and many people have

> had

> > > it,

> > > > > as

> > > > > > > well

> > > > > > > > as the EB Virus and the Cold Sore Virus by the time

> they

> > > are

> > > > > > twenty

> > > > > > > > years old. The body usually gets rid of all of these

> > > viruses

> > > > on

> > > > > > its

> > > > > > > > own. Because of this, if you do routine (IGG)

antibody

> > > > testing,

> > > > > > > > almost everybody will be positive for EB and many for

> HHV-

> > 6

> > > > and

> > > > > > CMV

> > > > > > > > viruses. However, the IGG test will not tell you if

you

> > > have

> > > > > > active

> > > > > > > > infections unless the IGM antibody is also positive

> > > > (suggesting

> > > > > a

> > > > > > > new

> > > > > > > > infection). The IGM antibody is the one that

increases

> in

> > > the

> > > > > > first

> > > > > > > > six weeks of an infection. This is followed by an

> > elevated

> > > > IGG

> > > > > > > > antibody, which stays elevated your whole life and

acts

> > as

> > > > your

> > > > > > > > body's surveillance system. All an elevated IGG means

> is

> > > that

> > > > > > your

> > > > > > > > body has seen this infection and, if it sees it

again,

> > it's

> > > > read

> > > > > > > > > y to knock it out quickly. This is how

immunizations

> > > work.

> > > > > The

> > > > > > > > immunization creates the IGG antibody, so that

instead

> of

> > > > > taking

> > > > > > > one

> > > > > > > > to two weeks to gear-up to fight the infection, your

> body

> > > can

> > > > > > > > eliminate that infection very quickly. Unfortunately,

> in

> > > > CFIDS

> > > > > > you

> > > > > > > > can have a chronic low-grade infection—even if your

IGG

> > > > > antibody

> > > > > > is

> > > > > > > > positive (elevated) - making the IGG antibody test

for

> > HHV-

> > > 6,

> > > > > EB

> > > > > > > > Virus and CMV unreliable in CFIDS/FMS. In addition,

the

> > IGM

> > > > > > > antibody

> > > > > > > > will usually not be present in elevated levels in the

> low-

> > > > grade

> > > > > > > > infections with these viruses that may be seen in

CFIDS

> > and

> > > > > FMS.

> > > > > > > > > What makes this important is that Valtrex at high-

> dose

> > > can

> > > > > > > > eliminate Epstein Barr virus, but will not work if

> active

> > > HHV-

> > > > 6

> > > > > > or

> > > > > > > > CMV infection is present. As I will discuss later,

the

> > only

> > > > > tests

> > > > > > I

> > > > > > > > would rely on to diagnose active HHV-6 are " rapid

cell

> > > > > cultures "

> > > > > > or

> > > > > > > > PCR testing. Because some insurance companies are

more

> > > likely

> > > > > to

> > > > > > > pay

> > > > > > > > for IGG than PCR testing, an argument can be made for

> > > > checking

> > > > > > IGG

> > > > > > > > antibodies first. If the EBV IGG is positive and HHV-

6

> > and

> > > > CMV

> > > > > > IGG

> > > > > > > > are negative, one may choose to proceed with Valtrex

> > > 1000mg,

> > > > 4

> > > > > > > times

> > > > > > > > a day, for 6 months, without PCR testing. If the HHV-

6

> or

> > > CMV

> > > > > IGG

> > > > > > > > antibodies are positive, then check the CMV and/or

HHV-

> 6

> > > PCR

> > > > > > tests

> > > > > > > to

> > > > > > > > be sure they are negative.

> > > > > > > > > Tell Me More About HHV-6 And CFIDS

> > > > > > > > > Unfortunately there is no currently accepted

standard

> > > > > treatment

> > > > > > > for

> > > > > > > > the HHV-6 Virus. Even though it is related to other

> > Herpes

> > > > > > viruses,

> > > > > > > > HHV-6 is resistant to Acyclovir, Valtrex, Famvir and

> the

> > > > other

> > > > > > > > antivirals that are commonly used in Herpes

infections.

> > The

> > > > > only

> > > > > > > > antiviral known to be effective against HHV-6 is

> > > Ganciclovir.

> > > > > > This

> > > > > > > > has significant side effects and has to be given

> > > > intravenously

> > > > > > and

> > > > > > > > possibly forever to maintain the antiviral effect.

> > > > > Unfortunately,

> > > > > > > > this is not a viable option in day-to-day life and

has

> > been

> > > > > only

> > > > > > > > moderately successful when used. The main doctor who

> has

> > > been

> > > > > > using

> > > > > > > > Ganciclovir to treat HHV-6 in the United States is

Joe

> > > > Brewer,

> > > > > > > M.D.,

> > > > > > > > (816-531-1550) in Kansas City, Missouri. He found

that

> > 140

> > > > out

> > > > > of

> > > > > > > 207

> > > > > > > > CFIDS patients had positive HHV-6 cell cultures.

Forty

> > > > percent

> > > > > of

> > > > > > > > CFIDS patients were positive on their first test and

> 70%

> > > were

> > > > > > > > positive after three tests. This contrasts to 60

> healthy

> > > > > patients

> > > > > > > he

> > > > > > > > checked in which none of the HHV-6 tests were

positive.

> > > > Culture

> > > > > > > > > s are more likely to be positive during acute

flares

> of

> > > the

> > > > > > > > disease, when the viral level in the blood rises (see

> > Page

> > > 9

> > > > > for

> > > > > > > more

> > > > > > > > on HHV-6 PCR testing).

> > > > > > > > > As is often the case in CFIDS, there is conflicting

> > data

> > > on

> > > > > > > > infections in Chronic Fatigue Syndrome. A recently

> > > published

> > > > > > study

> > > > > > > > (Reeves WC, et al., Clin Infect Dis, 2000 July; 31

[1]

> > pp48-

> > > > 52)

> > > > > > > > examined 26 patients with Chronic Fatigue Syndrome

and

> 52

> > > > > healthy

> > > > > > > > patients in Atlanta, Georgia, at the CDC. In this

> study,

> > > > > several

> > > > > > > > tests for HHV-6 and HHV-7 were done, including

> Polymerase

> > > > Chain

> > > > > > > > Reaction (PCR). HHV-6 DNA was found in 11% of CFIDS

> > > patients

> > > > > and

> > > > > > > 28%

> > > > > > > > of healthy patients, suggesting that the HHV-6 was

> > actually

> > > > > less

> > > > > > > > common in Chronic Fatigue Syndrome than in healthy

> > > patients.

> > > > At

> > > > > > > this

> > > > > > > > time, as the conflicting data shows, although HHV-6

may

> > be

> > > > one

> > > > > of

> > > > > > > > many suspect infections in CFIDS, it is not yet

clearly

> > the

> > > > > cause

> > > > > > > of

> > > > > > > > this illness.

> > > > > > > > > When HHV-6 is present, it seems to infect the

natural

> > > > Killer

> > > > > > > Cells,

> > > > > > > > important cells in your body's defense (immune)

system

> > that

> > > > are

> > > > > > > > critical in fighting infections. A number of studies

> have

> > > > shown

> > > > > > > these

> > > > > > > > Killer Cells to be malfunctioning in CFIDS. HHV-6

> > infection

> > > > > does

> > > > > > > not

> > > > > > > > necessarily decrease the number of the natural Killer

> > Cells

> > > > but

> > > > > > > does

> > > > > > > > decrease their function. Natural Killer Cell function

> is

> > > > > > described

> > > > > > > in

> > > > > > > > what is called Lytic Units—which means the ability of

> > cells

> > > > to

> > > > > > lyse

> > > > > > > > or break down foreign invaders. An average person

will

> > have

> > > a

> > > > > > Lytic

> > > > > > > > Unit level of 20 to 250 with over 80% of healthy

> patient

> > > > being

> > > > > > over

> > > > > > > > 40 units. Dr. Brewer finds that in CFIDS the mean

> Natural

> > > > > Killer

> > > > > > > > Lytic Cell level is 12 units. Dr. Brewer uses

Specialty

> > > Labs

> > > > in

> > > > > > > > California for his Natural Killer Lytic Cell testing

> and

> > > > finds

> > > > > > that

> > > > > > > > the Lytic level stays the same on repeat testing and

> > seems

> > > to

> > > > > be

> > > > > > a

> > > > > > > > reliable test for Natural Killer Cell function

testing

> in

> > > > > CFIDS.

> > > > > > > > Lytic unit levels will, however, decrease during flar

> > > > > > > > > es of symptoms. In Dr. Brewer's experience, this

test

> > is

> > > > very

> > > > > > > > specific for CFIDS and Multiple Sclerosis. He has

> treated

> > > ten

> > > > > MS

> > > > > > > > patients and five CFIDS patients with the I.V.

> > Ganciclovir.

> > > > He

> > > > > > > found

> > > > > > > > that it helped to stabilize the MS patients. In the

> CFIDS

> > > > > > patients,

> > > > > > > > two to three were much improved, one still had a

> positive

> > > > viral

> > > > > > > > culture and one had a poor response. Unfortunately,

> > > > maintaining

> > > > > > > > patients on I.V. Ganciclovir forever (as noted above)

> is

> > > not

> > > > a

> > > > > > > viable

> > > > > > > > option. Fortunately, an oral pill form of Ganciclovir

> > > > > > > > (Valganciclovir) is currently being developed! It

> should

> > be

> > > > > noted

> > > > > > > > that the HHV-6 virus is similar to CMV

> (Cytomegalovirus),

> > > and

> > > > > > that

> > > > > > > > whatever is effective against one, tends to be

> effective

> > > for

> > > > > the

> > > > > > > > other. This is a helpful bit of information as we

> follow

> > > new

> > > > > > > research

> > > > > > > > looking for clues on how to eliminate HHV-6 infection.

> > > > > > > > > What Roles Does The Epstein Barr And

Cytomegalovirus

> > Play

> > > > In

> > > > > > > CFIDS?

> > > > > > > > > Again, the roles of the EB and CMV viruses are not

> > clear.

> > > > It

> > > > > is

> > > > > > > not

> > > > > > > > uncommon for antibody levels of these viruses to be

> > > elevated

> > > > in

> > > > > > > > Chronic Fatigue Syndrome. As noted above, it is not

> clear

> > > > > whether

> > > > > > > > this simply reflects a previous or ongoing infection

> with

> > > > these

> > > > > > > > viruses. Research by a husband and wife team (the

> > Glasers)

> > > at

> > > > > > Ohio

> > > > > > > > State University, suggests that Epstein Barr Virus is

> > still

> > > > > quite

> > > > > > > > active and playing a role in many patients with these

> > > > > infections.

> > > > > > > In

> > > > > > > > addition, work by Lerner, M.D., also suggests

> that

> > > EB

> > > > > > Virus

> > > > > > > > and CMV are active as well. In speaking with Dr.

> Lerner's

> > > > > > research

> > > > > > > > assistant, I found out that he has found EB Virus and

> CMV

> > > to

> > > > > both

> > > > > > > be

> > > > > > > > fairly common in patients with Chronic Fatigue

Syndrome

> > > (with

> > > > > and

> > > > > > > > without pain). He found that about 20% had positive

IGM

> > > > and/or

> > > > > > > > elevated EA (early antigen) tests to the EB Virus

with

> > > > negative

> > > > > > > > Cytomegalovirus. Of these, two-thirds improved with

> high-

> > > dose

> > > > > > > Valtrex

> > > > > > > > (an oral antiviral). Despite my teasing and prodding,

> his

> > > > > associat

> > > > > > > > > e refused to give out the dose of Valtrex they

> > prescribed

> > > > > > because

> > > > > > > > Dr. Lerner does not want to be responsible for people

> > using

> > > > > these

> > > > > > > > higher doses until he completes the double-blind

trial

> > that

> > > > is

> > > > > > > > currently in progress. On the other hand, another

study

> > of

> > > > his

> > > > > > did

> > > > > > > > use 1000mg, 4 times a day, giving the antiviral for 6

> > > months.

> > > > > It

> > > > > > > > takes about 3 to 4 months before patients start to

> > improve

> > > > and

> > > > > > > after

> > > > > > > > 6 months people can stop the Valtrex without the

> symptoms

> > > > > coming

> > > > > > > > back. However, if there is no improvement in 6

months,

> > > > consider

> > > > > > it

> > > > > > > to

> > > > > > > > be a negative result. They also found that, as noted

> > above,

> > > > the

> > > > > > IGM

> > > > > > > > is almost always negative using the reagents used in

> most

> > > > labs.

> > > > > > > They

> > > > > > > > found that only Epstein Barr IGM antibody testing,

> using

> > a

> > > > > > reagent

> > > > > > > by

> > > > > > > > the Diasorin Company (800-328-1482), has been useful

in

> > > > showing

> > > > > a

> > > > > > > > significant number of positive tests. When we called

> the

> > > > > company,

> > > > > > > the

> > > > > > > > only lab in the Washington, D.C., area using it was

at

> > the

> > > > NIH.

> > > > > > The

> > > > > > > > company may, however, be able to give you the name of

> > > > > > > > > a lab near you that can do the test. What was

fairly

> > > > common,

> > > > > > > > though, (and present in most patients) was either

> > positive

> > > > > tests

> > > > > > > for

> > > > > > > > Epstein Barr, CMV, or a combination of both as noted

> > above.

> > > > > When

> > > > > > > CMV

> > > > > > > > or HHV-6 are present, the Valtrex is less likely to

> work

> > > > > because

> > > > > > it

> > > > > > > > is not effective against these viruses.

> > > > > > > > > In another study done by Dr. Lerner (Infectious

> > Diseases

> > > In

> > > > > > > > Clinical Practice, 1997; 6:110-117) he found that

> > patients

> > > > who

> > > > > > had

> > > > > > > > elevated CMV IGG antibodies, but no significant

> evidence

> > of

> > > > > > > > associated Epstein Barr virus (i.e., negative IGM and

> > early

> > > > > > antigen

> > > > > > > > (EA) antibody total less than 40), did improve with

> I.V.

> > > > > > > Ganciclovir

> > > > > > > > at 5mg per kg of body weight given every 12 hours

I.V.

> > for

> > > 30

> > > > > > days.

> > > > > > > > In this study 72% (13 of the 18 patients) improved

> > markedly

> > > > at

> > > > > > the

> > > > > > > > end of a month without any significant side effects.

As

> > > > noted,

> > > > > an

> > > > > > > > oral form of Ganciclovir is currently in development

as

> > > well.

> > > > > It

> > > > > > > > should be noted that 36% of the Chronic Fatigue

> Syndrome

> > > > > patients

> > > > > > > > that Dr. Lerner checked (18 out of 50) did turn out

to

> > have

> > > > > > > elevated

> > > > > > > > CMV antibodies (albeit IGG) in the absence of IGM and

> EA

> > > > > > antibodies

> > > > > > > > to EB Virus (i.e., no evidence of active Epstein Barr

> > > Virus).

> > > > > It

> > > > > > > > should be noted, though, that 70% of healthy patients

> > also

> > > > had

> > > > > > > > positive IGGs to CMV (as per our discussion above) in

> the

> > > > study

> > > > > > and

> > > > > > > > appears

> > > > > > > > > that the overall level of the IGG was not much

> higher

> > > > > overall

> > > > > > in

> > > > > > > > the Chronic Fatigue group than in the healthy

controls.

> > On

> > > > the

> > > > > > > other

> > > > > > > > hand, the higher the level of CMV antibody in the

> Chronic

> > > > > Fatigue

> > > > > > > > group, the more likely they were to improve with the

> I.V.

> > > > > > > Ganciclovir.

> > > > > > > > > What this means is that patients with Chronic

Fatigue

> > > > > Syndrome

> > > > > > > > don't necessarily have different blood tests for

> antibody

> > > > > levels

> > > > > > > than

> > > > > > > > healthy people for these viruses. However, if one has

a

> > > > higher

> > > > > > > level

> > > > > > > > rather than a lower level, one is more likely to

> improve

> > > with

> > > > > the

> > > > > > > > Ganciclovir. Previous research has not shown benefit

> from

> > > > > > antiviral

> > > > > > > > therapies in CFS (Straus SE, et al., New England

> Journal

> > of

> > > > > > > Medicine

> > > > > > > > 1988; 319:1692-1698). Our experience using a fairly

> high

> > > dose

> > > > > of

> > > > > > > > Valtrex or Famvir (1500mg and 2250mg a day

> respectively)

> > > also

> > > > > > > showed

> > > > > > > > no significant improvement on these regimens after 6

> > weeks,

> > > > at

> > > > > > > which

> > > > > > > > time we considered it to be ineffective. On the other

> > hand,

> > > > Dr.

> > > > > > > > Lerner's research is suggesting that perhaps we gave

it

> > for

> > > > too

> > > > > > > short

> > > > > > > > a time and at too low a dose. When treating himself

and

> a

> > > few

> > > > > > other

> > > > > > > > patients, he used Valtrex by mouth at a dosage of

> 1000mg,

> > 4

> > > > > times

> > > > > > a

> > > > > > > > day, for 6 months. Using the higher dosing and the

> > extended

> > > > > > period

> > > > > > > of

> > > > > > > > time, as well as separating out groups that have

> > > > > > > > > Epstein Barr Virus (sensitive to the oral Valtrex)

> > > without

> > > > > CMV

> > > > > > > or

> > > > > > > > HHV-6 (resistant to oral Valtrex but sensitive to

I.V.

> > > > > > > Ganciclovir),

> > > > > > > > may make an important difference in making treatment

> > > > effective.

> > > > > > No

> > > > > > > > major Valtrex toxicity was seen. As noted above, a

> double-

> > > > blind

> > > > > > > study

> > > > > > > > is currently in progress and we are beginning to try

> the

> > > > higher

> > > > > > > dose

> > > > > > > > of Valtrex in the 15% of our patient population that

> have

> > > not

> > > > > > > > improved adequately and have positive EBV, and

negative

> > CMV

> > > > and

> > > > > > HHV-

> > > > > > > 6

> > > > > > > > tests. We hope to give you follow-up information on

the

> > > > > > treatment's

> > > > > > > > effectiveness as soon as we know!

> > > > > > > > > In addition, Dr. Lerner suspects that these

> infections

> > > > affect

> > > > > > the

> > > > > > > > heart muscle contributing to much of your symptoms. I

> am

> > > not

> > > > > > > > convinced that this is the case because EKG changes

are

> > > > common

> > > > > in

> > > > > > > > CFS. This can occur because the autonomic (brain)

> > > dysfunction

> > > > > and

> > > > > > > > hormonal changes seen in CFS can cause these same EKG

> > > changes

> > > > > > > without

> > > > > > > > heart damage. Regardless, he found that these changes

> > went

> > > > away

> > > > > > > with

> > > > > > > > treatment (as has been our experience in treating

> Chronic

> > > > > Fatigue

> > > > > > > > Syndrome—patient's EKG changes improve even without

> > > > > antivirals).

> > > > > > > Dr.

> > > > > > > > Lerner is currently recruiting patients for a double-

> > blind

> > > > > study

> > > > > > > > using the high-dose Valtrex. His phone number is 248-

> 540-

> > > 9688

> > > > > in

> > > > > > > > Beverly Hills, Michigan.

> > > > > > > > > Does This Mean There Is Nothing We Can Do Now?

> > > > > > > > > Although there is no currently accepted specific

> > > treatment

> > > > > for

> > > > > > > the

> > > > > > > > CMV and HHV-6 viruses, there are still a number of

> things

> > > > that

> > > > > > may

> > > > > > > be

> > > > > > > > very helpful in fighting this infection.

> > > > > > > > > 1. Lithium tends to be antiviral and has been shown

> to

> > > > > decrease

> > > > > > > > pain in FMS patients when added to treatment with

> Elavil.

> > > > > Lithium

> > > > > > > is

> > > > > > > > commonly used in manic depressive illness and is a

> > natural

> > > > > > mineral

> > > > > > > > despite being sold by prescription. In high doses, it

> can

> > > > cause

> > > > > > > some

> > > > > > > > neurologic symptoms and suppression of the thyroid

> gland,

> > > but

> > > > > > these

> > > > > > > > can usually be treated by taking a small amount of

> > > Essential

> > > > > > Fatty

> > > > > > > > Acids and thyroid hormone. Lithium might also worsen

> > > Restless

> > > > > Leg

> > > > > > > > Syndrome. Although we have no direct evidence of

> Lithium

> > > > being

> > > > > an

> > > > > > > > effective antiviral against HHV-6, it may well be

> > effective

> > > > > > because

> > > > > > > > it works against a number of other viral infections.

In

> > our

> > > > > > > > experience, 200mg to 600mg a day seems to be the

> > effective

> > > > dose

> > > > > > in

> > > > > > > > treating FMS patients. As noted above, I would check

> the

> > > > > thyroid

> > > > > > > > blood tests at 3 months, 6 months and then yearly

> (check

> > a

> > > > Free

> > > > > > T4

> > > > > > > > and a Total T3 - not a TSH). A Lithium level should

> also

> > be

> > > > > > checked

> > > > > > > > at the same time to be sure that it not above the

upper

> > > limit

> > > > > of

> > > > > > > > > normal. The level can be below the normal range,

> which

> > is

> > > > > fine

> > > > > > as

> > > > > > > > long as the treatment is effective. You may find that

> you

> > > can

> > > > > > lower

> > > > > > > > the Lithium dose after you have been on it for

several

> > > months.

> > > > > > > > > 2. Heparin (a blood thinner, see Page 12) also has

> > > > antiviral

> > > > > > > > properties.

> > > > > > > > > 3. It is worth considering trials of high-dose

> Valtrex.

> > > It

> > > > > > should

> > > > > > > > be noted that 1000mg, 3 times a day, is used for

> shingles

> > > in

> > > > > > older

> > > > > > > > patients and appears to be quite safe. On the other

> hand,

> > > > > higher

> > > > > > > > dosing at 8 grams a day in AIDS patients did result

in

> > > > uncommon

> > > > > > > > (under 2%) life threatening problems. This is common

> even

> > > > with

> > > > > > day-

> > > > > > > to-

> > > > > > > > day drugs in AIDS patients (for example, regular

sulfa

> > > > > > antibiotics

> > > > > > > > have often resulted in severe toxicity in AIDS

> patients).

> > > > > > > > Nonetheless, we will be limiting the dose to 1 gram,

4

> > > times

> > > > a

> > > > > > day,

> > > > > > > > in our practice. It is important to note that taking

> > > Tagamet

> > > > > > and/or

> > > > > > > > Probenecid (Benemid) will raise the blood level of

> > Valtrex.

> > > > > > Tagamet

> > > > > > > > has powerful immune modifying properties and is very

> > > helpful

> > > > in

> > > > > > > acute

> > > > > > > > cases of Epstein Barr (mono) infections. Because of

> this,

> > > we

> > > > > are

> > > > > > > > adding Tagament 300mg, 4 times a day (but not

> > Probenecid),

> > > to

> > > > > the

> > > > > > > > Valtrex. As I noted, we are beginning this treatment

> with

> > > > some

> > > > > of

> > > > > > > our

> > > > > > > > patients and will let you know what we find.

> > > > > > > > > Natural Remedies

> > > > > > > > > 1. Olive Leaf - This is an herbal which is known to

> > have

> > > a

> > > > > wide

> > > > > > > > spectrum of anti-infectious activity. It has been

shown

> > to

> > > be

> > > > > > > > effective against the HHV-6 virus in the test tube. I

> > have

> > > > not,

> > > > > > > > however, seen studies testing its effect in human

> beings

> > > > > infected

> > > > > > > > with HHV-6. Nonetheless, a number of physicians have

> > found

> > > > that

> > > > > > > using

> > > > > > > > Olive Leaf in Chronic Fatigue Syndrome is very

> effective.

> > > > There

> > > > > > is

> > > > > > > > controversy over whether the form and source of the

> Olive

> > > > Leaf

> > > > > is

> > > > > > > > critical. We recommend that you use a form that has

at

> > > least

> > > > 6%

> > > > > > > > Oleuropein, which is one of the most active antiviral

> > > > > components

> > > > > > in

> > > > > > > > the Olive Leaf. Other components may be important and

> > some

> > > > > people

> > > > > > > > also feel that you must use the Mediterranean Olive

> Leaf

> > > vs.

> > > > > the

> > > > > > > > American Olive Leaf. Other people argue that you

should

> > > have

> > > > a

> > > > > > form

> > > > > > > > that is organically grown, without pesticides. At

this

> > > point

> > > > it

> > > > > > is

> > > > > > > > not clear whether this is simply marketing or

important

> > in

> > > > day-

> > > > > to-

> > > > > > > day

> > > > > > > > life. Nonetheless, I would be picky about the

companies

> > you

> > > > buy

> > > > > > the

> > > > > > > O

> > > > > > > > > live Leaf from. I would use one of these sources:

> > > > > > > > > a. My office (800-333-5287) or my Web site at

> > > > > > www.endfatigue.com.

> > > > > > > > > b. Pacific Research Labs (800-325-7734). This is

> owned

> > by

> > > > R.

> > > > > J.

> > > > > > > > Marshall, Ph.D., who has done a fair bit of work

> treating

> > > > CFIDS

> > > > > > > > patients with Olive Leaf. I will be describing the

> > protocol

> > > > > that

> > > > > > he

> > > > > > > > uses below.

> > > > > > > > > c. General Nutrition Centers (GNC).

> > > > > > > > > Dr. Marshall feels that during infections, the body

> > > becomes

> > > > > > > overly

> > > > > > > > acidic. He tests the morning urine specimens with pH

> > paper

> > > > > (which

> > > > > > > is

> > > > > > > > very easy to do at home) and gives a shell extract,

> which

> > > > > raises

> > > > > > > the

> > > > > > > > body's alkalinity. He feels that having a normalized

> acid-

> > > > base

> > > > > > > > balance in your body helps it to fight infections. He

> > then

> > > > adds

> > > > > > his

> > > > > > > > form of Olive Leaf, called Infectostat (which also

> > contains

> > > > > > > mushroom

> > > > > > > > extracts to stimulate the immune system), giving 3 to

4

> > > > > capsules,

> > > > > > 3

> > > > > > > > to 4 times a day, to help fight the infections.

> Usually,

> > > the

> > > > > > > patient

> > > > > > > > should start feeling better within four weeks on this

> > > > protocol.

> > > > > > > > Although we have found it helpful in fighting colds

and

> > > other

> > > > > > > common

> > > > > > > > respiratory infections, we are just starting to

explore

> > > Olive

> > > > > > > Leaf's

> > > > > > > > use in a few of our patients who have not responded

to

> > > > standard

> > > > > > > > treatment and are still quite ill. We will let you

know

> > our

> > > > > > > > experience with this in an upcoming newsletter issue.

> My

> > > > guess,

> > > > > > > > though, is that simply using regular (6% Oleuropein)

> > Olive

> > > > Leaf

> > > > > > > > > 500mg capsules, 3 to 4 capsules, 3 to 4 times a day

> > > between

> > > > > > > meals,

> > > > > > > > will probably be equally effective and cheaper for

most

> > > > people

> > > > > > than

> > > > > > > > the expensive forms. How long one needs to take Olive

> > Leaf

> > > in

> > > > > > > Chronic

> > > > > > > > Fatigue Syndrome is yet to be determined.

> > > > > > > > > Initially, a pharmaceutical company was developing

> the

> > > > > > Oleuropein

> > > > > > > > in Olive Leaf as an antiviral. Because it gets bound

to

> > the

> > > > > blood

> > > > > > > > proteins, they thought that Oleuropein might not get

to

> > the

> > > > > > > tissues.

> > > > > > > > More importantly, Oleuropein is a natural product and

> > > > therefore

> > > > > > > hard

> > > > > > > > to patent. Because of these problems, they stopped

> > research

> > > > on

> > > > > > it.

> > > > > > > > Years later this research was rediscovered and

explored

> > > > > further.

> > > > > > In

> > > > > > > > addition to being an effective antiviral agent, Olive

> > Leaf

> > > is

> > > > > > > > reported to be effective on a number of bacterial and

> > yeast

> > > > > > > > infections as well. What is most exciting regarding

the

> > > Olive

> > > > > > Leaf

> > > > > > > is:

> > > > > > > > > a. That some doctors have found it to be effective

in

> > > > CFIDS,

> > > > > > and

> > > > > > > > > b. That in tests against HHV-6 and CMV virus

> (remember

> > > that

> > > > > if

> > > > > > > > something is effective against one, it tends to be

> > > effective

> > > > > > > against

> > > > > > > > the other) the Olive Leaf extract did not just

suppress

> > the

> > > > > virus

> > > > > > > but

> > > > > > > > killed it. That is very promising.

> > > > > > > > > 2. Pro-Boost - Thymic Protein A (used to be called

> > > BioPro) -

> > > >

> > > > > > This

> > > > > > > > is the immune stimulant that I discussed in my

> > newsletter,

> > > > Vol.

> > > > > > 2,

> > > > > > > > Issue 2. Although not a hormone, Pro-Boost mimics the

> > > natural

> > > > > > > hormone

> > > > > > > > produced by your Thymus - the gland which stimulates

> your

> > > > > immune

> > > > > > > > system. I find it to be extraordinarily effective in

> > > fighting

> > > > > > > common

> > > > > > > > infections of any kind that seem to pop up. For the

> more

> > > deep-

> > > > > > > seated

> > > > > > > > infections of CFIDS, the higher dose (1 packet, 3

times

> a

> > > > day)

> > > > > > will

> > > > > > > > likely be needed. Once the infection seems to be in

> check

> > > and

> > > > > you

> > > > > > > are

> > > > > > > > feeling better (i.e., after 6 weeks), you can taper

> down

> > to

> > > > the

> > > > > > > > lowest dose that maintains the effect.

> > > > > > > > > 3. IP6 - This natural immune stimulant is an

extract

> of

> > > > bran

> > > > > > > > (phytates). It is less expensive and is sometimes

> > combined

> > > > with

> > > > > > > > vitamin C. The dose of IP6 (available from many

> sources)

> > is

> > > 5

> > > > > to

> > > > > > 8

> > > > > > > > grams a day. Do not take IP6 within 3 hours of

> > > > vitamin/mineral

> > > > > > > > supplements.

> > > > > > > > > 4. MGN3 - This is a very concentrated mushroom

> extract,

> > > > which

> > > > > > has

> > > > > > > > been shown to stimulate Natural Killer Cell immune

> > > function.

> > > > In

> > > > > > one

> > > > > > > > study, it actually tripled Natural Killer Cell

function—

> > an

> > > > > effect

> > > > > > > > that, as the HHV-6 virus can suppress Natural Killer

> Cell

> > > > > > function,

> > > > > > > > could be very powerful. Unfortunately, it is horribly

> > > > expensive

> > > > > > in

> > > > > > > > the recommended dose (250 mg capsules) of 2 to 4

> > capsules,

> > > 4

> > > > > > times

> > > > > > > a

> > > > > > > > day for 2 weeks, followed by 2 capsules, 2 times a

day.

> > > Other

> > > > > > > > mushroom extracts are cheaper but may not be as

> > effective.

> > > > > > > > > 5. Intravenous Vitamin C at high-dose (15gm to

50gm)

> > has

> > > > been

> > > > > > > > suggested to have antiviral effects in a number of

> other

> > > > > > infections

> > > > > > > > and is often dramatically helpful in CFIDS when given

> in

> > > the

> > > > > I.V.

> > > > > > > > nutritional therapy called " Myers Cocktails " (see my

> > > > > newsletter,

> > > > > > > Vol.

> > > > > > > > 3, Issue 3).

> > > > > > > > > 6. Lysine 1000 mg, 3 times a day - This amino acid

> > > protein

> > > > is

> > > > > > > safe

> > > > > > > > and inexpensive (27¢ a day). It inhibits oral/genital

> > > herpes

> > > > > (by

> > > > > > > > depleting the Arginine the virus needs to grow). I do

> not

> > > > know

> > > > > if

> > > > > > > it

> > > > > > > > also inhibits EBV, HHV-6 or CMV viral infections.

> > > > > > > > > I would take the combination of these together (as

is

> > > > > > affordable)—

> > > > > > > > perhaps leaving the MGN3 for later if needed, giving

> the

> > > > > > treatment

> > > > > > > > for at least a 6 to 8 week trial to see if it's

> > effective.

> > > If

> > > > > you

> > > > > > > are

> > > > > > > > feeling better at 6 weeks, you can then taper down

the

> > dose

> > > > > > slowly

> > > > > > > as

> > > > > > > > long as the benefit is maintained. When able, you can

> > wean

> > > > > > yourself

> > > > > > > > off the treatments. If symptoms recur, go back up to

> the

> > > dose

> > > > > > that

> > > > > > > > maintains the benefit or consider increasing the dose

> > > > further.

> > > > > As

> > > > > > > we

> > > > > > > > are just starting to use this protocol in our

patients,

> I

> > > do

> > > > > > > > appreciate your feedback on what has worked for you

and

> > > what

> > > > > has

> > > > > > > not.

> > > > > > > > You can " vote " for what helped or didn't help you on

> our

> > > Web

> > > > > site

> > > > > > > at

> > > > > > > > www.endfatigue.com. You can also see other people's

> > votes.

> > > > > > > > > In addition, your clotting system may be activated

by

> > > > several

> > > > > > > > infections making it difficult to eliminate them.

Using

> > the

> > > > > anti-

> > > > > > > > clotting treatments that we will discuss later can

also

> > > make

> > > > it

> > > > > > > > easier for your body to eradicate infections.

> > > > > > > > > Mycoplasma And Chlamydia

> > > > > > > > > Other infections have also been found to be very

> > > important

> > > > in

> > > > > > > > CFIDS. Dr. Garth Nicolson and his wife, who were on-

> > faculty

> > > > at

> > > > > > the

> > > > > > > > University of Texas Medical School at Houston and the

> > > > > Department

> > > > > > of

> > > > > > > > Microbiology and Immunology at Baylor College of

> Medicine

> > > in

> > > > > > > Houston,

> > > > > > > > Texas, are the leading proponents of treatment of

these

> > > > > > infections.

> > > > > > > > Dr. Garth Nicolson was an endowed chair and

department

> > > > chairman

> > > > > > at

> > > > > > > > the University of Texas, the M.D. Cancer

> Center

> > in

> > > > > > > Houston,

> > > > > > > > Texas, and a Professor of Internal Medicine at the

> > > University

> > > > > of

> > > > > > > > Texas Medical School, also in Houston. Dr. Nicolson's

> > wife

> > > > had

> > > > > > > > Chronic Fatigue Syndrome years ago. They were

surprised

> > > that

> > > > > her

> > > > > > > test

> > > > > > > > turned out to be positive for Mycoplasma fermentans

> (also

> > > > known

> > > > > > as

> > > > > > > > Mycoplasma fermentans incognitus). This Mycoplasma

was

> > > found

> > > > to

> > > > > > be

> > > > > > > > resistant to the Penicillin- and Keflex-family

> > antibiotics

> > > > that

> > > > > > > most

> > > > > > > > doctors use, but was sensitive to long courses of

> > > Doxycycline

> > > > > and

> > > > > > > > Cipro. After an extended course of Doxycycline

> treatment,

> > > > > > > > > she was much better. The Nicolsons then went on to

> > > develop

> > > > > > their

> > > > > > > > own tests for Mycoplasma using PCR testing. Dr.

> Nicolson

> > > > tells

> > > > > me

> > > > > > > > that, in addition, when his step-daughter came home

> after

> > > > > serving

> > > > > > > in

> > > > > > > > Desert Storm, she came down with Gulf War Illness

> (GWI).

> > > They

> > > > > > > tested

> > > > > > > > hundreds of Gulf War veterans with GWI and 40% to 45%

> > were

> > > > > > positive

> > > > > > > > for Mycoplasma infections—almost all with Mycoplasma

> > > > > fermentans.

> > > > > > > This

> > > > > > > > has been confirmed by other labs and a large Veterns

> > > > > > Aministration

> > > > > > > > study involving over 2,000 patients. In contrast to

> this,

> > > > > > soldiers

> > > > > > > > who were not deployed to the Gulf during the war, had

> > less

> > > > than

> > > > > a

> > > > > > > 6%

> > > > > > > > incidence of being positive for these infections.

> > > > > > > > > Interestingly, the Nicolsons found that in patients

> > with

> > > > > > Chronic

> > > > > > > > Fatigue Syndrome or Fibromyalgia, approximately 70%

> (144

> > > out

> > > > of

> > > > > > 203

> > > > > > > > patients) had a positive PCR test for one, or usually

> > > several

> > > > > > > > species, of Mycoplasma. When the Nicolsons tested 70

> > > healthy

> > > > > > > > patients, only 6 patients (less than 9%) were

positive

> > for

> > > > any

> > > > > of

> > > > > > > the

> > > > > > > > Mycoplasma species. This is a highly significant

> > > difference.

> > > > > Only

> > > > > > 2

> > > > > > > > of these 70 healthy people were positive for

Mycoplasma

> > > > > > fermentans.

> > > > > > > > Similar results have been found by other doctors and

> have

> > > > been

> > > > > > > > published.

> > > > > > > > > As we have said before, it is likely that there is

a

> > > group

> > > > of

> > > > > > > > underlying problems and not a single one that

triggers

> > > > > CFIDS/FMS.

> > > > > > > > This applies to infections as well. This is why you

can

> > see

> > > > > tests

> > > > > > > be

> > > > > > > > positive for both viral and Mycoplasmal infections in

> so

> > > many

> > > > > > > people

> > > > > > > > with this disease. For Mycoplasma alone, when they

> > checked

> > > > for

> > > > > > four

> > > > > > > > different types of Mycoplasma, over half of the 93

> CFIDS

> > > > > patients

> > > > > > > > that were positive had more than one type of

infection.

> > > Over

> > > > > 20%

> > > > > > of

> > > > > > > > them had three out of the four Mycoplasma infections

> test

> > > > > > positive.

> > > > > > > > The more infections that were positive, the worse the

> > > > patient's

> > > > > > > > symptoms were and the longer they had had CFIDS/FMS.

> > > > > > > > > What Are Mycoplasma?

> > > > > > > > > Mycoplasma are an ancient bacteria that lacks cell

> > walls

> > > > and

> > > > > > are

> > > > > > > > capable of invading a number of types of human cells.

> > They

> > > > can

> > > > > > > cause

> > > > > > > > a wide variety of human diseases. These organisms can

> > cause

> > > > the

> > > > > > > types

> > > > > > > > of symptoms seen in Chronic Fatigue Syndrome patients

> > and,

> > > > > > > according

> > > > > > > > to Dr. Nicolson, tend to be immune suppressing.

> > > > Unfortunately,

> > > > > > they

> > > > > > > > cannot be readily cultured on a culture dish like

> regular

> > > > > > bacteria.

> > > > > > > > In medicine, we have a bad habit on focusing on that

> > which

> > > is

> > > > > > easy

> > > > > > > to

> > > > > > > > test for and making believe that that which is hard

to

> > test

> > > > for

> > > > > > > does

> > > > > > > > not exist. Because of this, bacterial infections such

> as

> > > > > > pneumonia,

> > > > > > > > bladder infections and skin infections, where one

> > bacteria

> > > on

> > > > a

> > > > > > > cell

> > > > > > > > dish will rapidly turn into millions by the next day

> and

> > be

> > > > > > visible

> > > > > > > > to the human eye, get all our attention.

Unfortunately,

> > > > > > Mycoplasma,

> > > > > > > > which cannot be easily cultured, tends to be ignored.

> > It's

> > > > like

> > > > > > the

> > > > > > > > old story about the little kid who was looking for

his

> > lost

> > > > > keys

> > > > > > > > under the street lamp one night. His frien

> > > > > > > > > ds came by and asked him what was going on. He told

> > them

> > > > and

> > > > > > they

> > > > > > > > all looked for the keys under that light for about an

> > hour.

> > > > > > > Finally,

> > > > > > > > exasperated, they looked at the friend and

said, " Where

> > did

> > > > you

> > > > > > > lose

> > > > > > > > these keys? " The kid looked up and said, " Oh, about

> half

> > a

> > > > > block

> > > > > > > down

> > > > > > > > the street. " They said, " Why are you looking for them

> > > here? "

> > > > He

> > > > > > > > said, " Because there is a light here and I can see! "

> This

> > > is

> > > > > kind

> > > > > > > of

> > > > > > > > what it is like in medicine. If there is a test for

> > > something

> > > > > > (such

> > > > > > > > as cholesterol and bacterial cultures) that is easy

to

> > do,

> > > we

> > > > > > focus

> > > > > > > > our attention on that test and make believe that it

> finds

> > > the

> > > > > > main

> > > > > > > > problem. Unfortunately, in CFIDS and FMS, this is not

> the

> > > > case.

> > > > > > > > > The data suggests that many infections may trigger

> > > > CFIDS/FMS

> > > > > or

> > > > > > > > that CFIDS and FMS may cause immune suppression—which

> > then

> > > > sets

> > > > > > you

> > > > > > > > up to catch a whole bunch of different infections

which

> > > your

> > > > > body

> > > > > > > has

> > > > > > > > trouble clearing. This is why it is important to

treat

> > all

> > > > the

> > > > > > > > underlying processes simultaneously as I discuss in

my

> > From

> > > > > > > Fatigued

> > > > > > > > To Fantastic! book and newsletters.

> > > > > > > > > So, How Do You Look For These Infections?

> > > > > > > > > I had the honor of speaking with Konnie Knox, M.D.,

a

> > > major

> > > > > re-

> > > > > > > > searcher on HHV-6 testing in CFIDS/FMS, who uses a

> > > technique

> > > > > > called

> > > > > > > > Rapid Cell Culture. She actually infects different

test

> > > tube

> > > > > > cells

> > > > > > > > with HHV-6, grows them, and then looks for signs of

HHV-

> 6

> > > in

> > > > > the

> > > > > > > > cell. In her experience, one out of three CFIDS/FMS

> > > patients

> > > > > are

> > > > > > > > positive for active HHV-6 infection on the first

blood

> > > test.

> > > > > When

> > > > > > > > multiple testing is done (e.g., three tests), 70% are

> > > > positive.

> > > > > > > This

> > > > > > > > test is negative in the vast majority of people who

are

> > > > > healthy.

> > > > > > > The

> > > > > > > > other main illness where the HHV-6 test is positive

is

> > > > Multiple

> > > > > > > > Sclerosis. At this time, HHV-6 Rapid Cell Culture and

> the

> > > PCR

> > > > > > test

> > > > > > > at

> > > > > > > > Dr. Nicolson's lab (International Molecular

Diagostics)

> > are

> > > > the

> > > > > > > only

> > > > > > > > HHV-6 test I order. For more information on Dr.

Knox's

> > > work,

> > > > go

> > > > > > to

> > > > > > > > these Web sites: www.HHV-6.com and www.cnet.com. For

> the

> > > IMD

> > > > > > > website,

> > > > > > > > go to www.imd-lab.com.

> > > > > > > > > The Nicolsons use very sensitive PCR (Polymerase

> Chain

> > > > > > Reaction)

> > > > > > > > testing to actually look for DNA specific to

> Mycoplasma,

> > > HHV-

> > > > 6,

> > > > > > and

> > > > > > > > other infections. Unfortunately, those DNA pieces are

> so

> > > > > > > > microscopically small, that to look for just one is

> much

> > > > worse

> > > > > > than

> > > > > > > > looking for a " needle in a haystack. " With the PCR,

if

> > that

> > > > > > > > Mycoplasma gene sequence is found, the technique

> > multiplies

> > > > it

> > > > > > like

> > > > > > > a

> > > > > > > > copying machine until millions of that sequence are

> > present

> > > > and

> > > > > > can

> > > > > > > > be picked up by testing. Because of this, PCR testing

> is

> > > > > > > exquisitely

> > > > > > > > sensitive and can find the proverbial " needle in a

> > > haystack. "

> > > > > > This

> > > > > > > > makes it very powerful and the only testing that I

> would

> > > > > > recommend

> > > > > > > in

> > > > > > > > looking for these Mycoplasma and Chlamydia

infections.

> As

> > > > noted

> > > > > > > > above, IGG antibody testing is not reliable for

> > Mycoplasma

> > > > and

> > > > > > > > Chlamydia testing in CFS.

> > > > > > > > > Where Do I Get These Tests Done And Should I Have

> Them

> > > Done?

> > > > > > > > > The tests for HHV-6 and Mycoplasma each cost about

> $180

> > > to

> > > > > > $250.

> > > > > > > As

> > > > > > > > noted above, the only places that I would get the HHV-

6

> > > test

> > > > > done

> > > > > > > > (and the only tests I would do are PCR or viral

culture

> > > > > testing)

> > > > > > > are

> > > > > > > > at the Wisconsin Viral Institute (414-774-0311) or

Dr.

> > > > > Nicolson's

> > > > > > > > lab. I order all the lab testing for Mycoplasma and

> > > Chlamydia

> > > > > at

> > > > > > > the

> > > > > > > > Nicolson's lab, at International Molecular

Diagnostics,

> > > 15162

> > > > > > > Triton

> > > > > > > > Lane, Huntington Beach, CA 92649 (714-799-7177 ext.

202

> > or

> > > > > 204).

> > > > > > > The

> > > > > > > > lab's Web site is www.imdlab.com.

> > > > > > > > > I can almost guarantee that if you do the

Mycoplasma

> or

> > > > > > Chlamydia

> > > > > > > > tests at your local lab they will do the wrong tests

> and

> > > they

> > > > > > will

> > > > > > > be

> > > > > > > > useless for hidden CFS infections. I have never seen

> one

> > > come

> > > > > > back

> > > > > > > > with any useful information. What they usually do is

> > check

> > > > the

> > > > > > > > antibodies (usually for the wrong Mycoplasma

infection)

> > > which

> > > > > > > simply

> > > > > > > > shows that you (like everybody else at some point in

> > their

> > > > > life)

> > > > > > > have

> > > > > > > > had a Mycoplasma infection. It tells nothing about

> active

> > > > > > infection

> > > > > > > > and, again, is useless. Be sure to do the PCR testing

> and

> > > do

> > > > it

> > > > > > at

> > > > > > > > one of the two labs discussed above. Dr. Nicolson has

> > noted

> > > > > which

> > > > > > > > tests he recommends in CFS/FMS, their cost and

> > instructions

> > > > for

> > > > > > the

> > > > > > > > lab. We have reprinted this information on the next

> page

> > > (Dr.

> > > > > > > > Nicolson's lab also does viral PCR testing for CMV,

as

> > well

> > > > as

> > > > > > HHV-

> > > > > > > 6).

> > > > > > > > > Even at the best labs, it is not uncommon to have a

> > false-

> > > > > > > negative

> > > > > > > > report (where you have the infection and it does not

> show

> > > up

> > > > on

> > > > > > the

> > > > > > > > test). Because of this, especially for HHV-6,

multiple

> > > tests

> > > > > will

> > > > > > > > often need to be done. There are good arguments for

not

> > > doing

> > > > > the

> > > > > > > > tests and simply going ahead and treating empirically

> > with

> > > > the

> > > > > > > > natural remedies discussed above for HHV-6, or for

> > > > prescribing

> > > > > > > > Doxycycline or Cipro for an extended period of time

> (see

> > > > > below).

> > > > > > If

> > > > > > > > you feel better after four months on the treatment,

> then

> > > you

> > > > > know

> > > > > > > you

> > > > > > > > are hitting an infection and you can always

> > intermittently

> > > > stop

> > > > > > the

> > > > > > > > treatments to see how long you will need them. Also,

> > there

> > > > are

> > > > > > many

> > > > > > > > infections that are not tested for with these tests

> that

> > > > would

> > > > > be

> > > > > > > > effectively treated with the regimens that we are

> > > discussing.

> > > > > > Many

> > > > > > > of

> > > > > > > > these are likely to be infections that we don't even

> know

> > > > > exist.

> > > > > > > > Because of this, if resources are limited, I some-

times

> > > > simply

> > > > > > > treat

> > > > > > > > the patient, based on clinical suspicion, without

doing

> > the

> > > > > > > > > tests.

> > > > > > > > > Testing does have its benefits. If the test is

> > positive,

> > > I

> > > > am

> > > > > > > > likely to treat more aggressively and it helps guide

me

> > on

> > > > how

> > > > > > long

> > > > > > > > to give the treatment. For example, if after four

> months

> > > you

> > > > > are

> > > > > > > not

> > > > > > > > better and the test is positive, I would be likely to

> go

> > > > ahead

> > > > > > and

> > > > > > > > increase dosing or change to a different antibiotic.

If

> > the

> > > > > test

> > > > > > > was

> > > > > > > > negative, I would be more likely to just stop

treatment

> > and

> > > > > > suspect

> > > > > > > > that the infection is less likely. This argues in

favor

> > of

> > > > > doing

> > > > > > > the

> > > > > > > > tests. One simple thing to do is to go ahead and

check

> > with

> > > > > your

> > > > > > > > insurance company to see if they cover these tests.

> This

> > > may

> > > > > make

> > > > > > > > your decision much simpler. Unfortunately, I suspect

> that

> > > the

> > > > > way

> > > > > > > > that most labs draw and ship your blood sample may

not

> be

> > > > > > reliable

> > > > > > > > because, in our experience, we have had less than 10%

> of

> > > > > > patient's

> > > > > > > > tests come back positive for HHV-6 cell culture and

> only

> > a

> > > > > modest

> > > > > > > > percent come back positive for the Mycoplasma. For

the

> > PCR

> > > > > > > Mycoplasma

> > > > > > > > test, the blood has to be frozen (see boxed inset,

Page

> 9

> > > > > > > > > ). If the blood is left at room temperature, most

of

> > the

> > > > > > positive

> > > > > > > > samples become negative after one to two days.

> > > > > > > > > Mycoplasma testing is not as specific as HHV-6

> testing

> > is

> > > > for

> > > > > > > > CFIDS/FMS/Multiple Sclerosis (i.e., it is positive in

> > other

> > > > > > > > illnesses). For example, about half the patients with

> > > > > Rheumatoid

> > > > > > > > Arthritis are also found to be infected with

treatable

> > > > > > infections,

> > > > > > > > including Mycoplasma. This goes along with my, and

> other

> > > > > doctors'

> > > > > > > > experience, that Doxycycline is often effective in

> > treating

> > > > > > > > Rheumatoid Arthritis. Interestingly, although

> Mycoplasma

> > is

> > > > > > common

> > > > > > > in

> > > > > > > > the environment, it usually is fairly noninvasive. It

> may

> > > > > simply

> > > > > > be

> > > > > > > > that once your immune system is weakened, these

> > infections

> > > > can

> > > > > > get

> > > > > > > > into cells where they don't belong. When that

happens,

> > even

> > > > > some

> > > > > > of

> > > > > > > > the common ones that are considered noninfectious can

> > wreak

> > > > > > havoc.

> > > > > > > > When these infections repro-duce slowly, they tend to

> be

> > > low-

> > > > > > grade,

> > > > > > > > chronic infections, as opposed to the acute and more

> > > > prominent

> > > > > > > > symptoms seen with bacterial and viral infections

that

> > > > multiply

> > > > > > and

> > > > > > > > divide rapidly.

> > > > > > > > > For CFS/ME or FMS or Autoimmune Disease Patients,

> > > > > > > > > The Institute for Molecular Medicine suggests the

> > > following

> > > > > lab

> > > > > > > > tests:

> > > > > > > > > (Codes are I.M.D. or CPT Codes)

> > > > > > > > > 1. Test Panel 1007 (CPT: 87798x3, 87581) Mycoplasma

> > > species

> > > > > > panel

> > > > > > > > of 4 pathogenic mycoplasmas (M. fermentans, M.

> > penumoniae,

> > > M.

> > > > > > > > hominis, M. penetrans) by PCR.

> > > > > > > > > Justification: Almost 60% of CFS/FMS and 50% of

> > > Rheumatoid

> > > > > > > > Arthritis (RA) and other autoimmune patients have one

> or

> > > more

> > > > > > > > intracellular, systemic mycoplasmal infections

similar

> to

> > > > those

> > > > > > > found

> > > > > > > > in a variety of chronic illnesses [Nicolson, et al.,

> > > > > Mycoplasmal

> > > > > > > > infections in chronic illnesses: Fibromyalgia and

> Chronic

> > > > > Fatigue

> > > > > > > > Syndromes, Gulf War Illness, HIV-AIDS and Rheumatoid

> > > > Arthritis;

> > > > > > > > Medical Sentinel 1999; 5:172-176]. Ultrasensitive and

> > > > > > ultraspecific

> > > > > > > > mycoplasma tests can only be done by a small number

of

> > > labs,

> > > > > most

> > > > > > > > university or government labs that have been trained

by

> > us

> > > > > under

> > > > > > a

> > > > > > > > U.S. government contract.

> > > > > > > > > Specimen Requirements: One (1) 5 cc Lavender-top

> > Plastic

> > > > Tube

> > > > > > > > (EDTA). The blood is collected, immediately mixed and

> > > placed

> > > > on

> > > > > > > ice,

> > > > > > > > then shipped on wet ice or immediately flash frozen

and

> > > > shipped

> > > > > > > with

> > > > > > > > dry ice by courier (foreign shipments) to I.M.D. to

> > arrive

> > > > > within

> > > > > > > 24-

> > > > > > > > 36 hours. Cost=$250. (Note that other commercial labs

> > > charge

> > > > > $400-

> > > > > > > > 600.)

> > > > > > > > > 2. Test 1006 (CPT: 87486) Chlamydia pneumoniae test

> by

> > > PCR.

> > > > > > > > Justification: Many CFS, FMS, MS, RA and other

patients

> > > have

> > > > > this

> > > > > > > > systemic infection along with viral infection(s). We

> were

> > > > among

> > > > > > the

> > > > > > > > few labs that developed the molecular tests that are

> now

> > > done

> > > > > for

> > > > > > > > this type of infection. The other labs that use these

> > > > > procedures

> > > > > > > are

> > > > > > > > university labs.

> > > > > > > > > Specimen Requirements: One (1) 5 cc Lavender-top

> > Plastic

> > > > Tube

> > > > > > > > (EDTA). The blood is collected, immediately mixed and

> > > placed

> > > > on

> > > > > > > ice,

> > > > > > > > then shipped on wet ice or immediately flash frozen

and

> > > > shipped

> > > > > > > with

> > > > > > > > dry ice by courier to I.M.D. to arrive within 24-36

> > hours.

> > > > > > > Cost=$180.

> > > > > > > > (Note that other commercial labs charge $200-250.)

> > > > > > > > > 3. Test 07047 (CPT: 87476) Borrelia burgdorferi

(Lyme

> > > > > Disease)

> > > > > > > test

> > > > > > > > by PCR.

> > > > > > > > > Justification: Many CFS, FMS and RA patients have

> this

> > > > > systemic

> > > > > > > > infection (diagnosed as Lyme Disease) along with

other

> > > > infection

> > > > > > > (s).

> > > > > > > > > Specimen Requirements: One (1) 5 cc Lavender-top

> > Plastic

> > > > Tube

> > > > > > > > (EDTA). The blood is collected, immediately mixed and

> > > placed

> > > > on

> > > > > > > ice,

> > > > > > > > then shipped on wet ice or immediately flash frozen

and

> > > > shipped

> > > > > > > with

> > > > > > > > dry ice by courier to I.M.D. to arrive within 24-36

> > hours.

> > > > > > > Cost=$180.

> > > > > > > > (Note that other commercial labs charge $200-250.)

> > > > > > > > > 4. Test 07039 (CPT: 87532) Human Herpes Virus 6

(HHV-

> 6)

> > > > test

> > > > > by

> > > > > > > > PCR.

> > > > > > > > > Justification: Many CFS and some FMS patients have

> this

> > > > > > systemic

> > > > > > > > viral infection, and it should be tested for in any

> > > > autoimmune

> > > > > > > > illness.

> > > > > > > > > Specimen Requirements: Collect blood in one (1) 5

cc

> > > > Lavender-

> > > > > > top

> > > > > > > > Plasma Tubes (EDTA), mixed and separate blood plasma

by

> > > > > > > > centrifugation. The plasma is then shipped on wet ice

> or

> > > > > > > immediately

> > > > > > > > flash frozen and shipped with dry ice by courier to

> > I.M.D.

> > > to

> > > > > > > arrive

> > > > > > > > within 24-36 hours. Cost=$180. (Note that other

> > commercial

> > > > labs

> > > > > > > > charge $200-350.)

> > > > > > > > > 5. Test 07034 (CPT: 87496) Cytomegalovirus (CMV)

test

> > by

> > > > PCR.

> > > > > > > > > Justification: Many CFS and FMS patients have this

> > > systemic

> > > > > > viral

> > > > > > > > infection, and it should be tested for in any

> autoimmune

> > > > > illness.

> > > > > > > > > Specimen Requirements: Collect blood in one (1) 5

cc

> > > > Lavender-

> > > > > > top

> > > > > > > > Plasma Tubes (EDTA), mixed and separate blood plasma

by

> > > > > > > > centrifugation. The plasma is then shipped on wet ice

> or

> > > > > > > immediately

> > > > > > > > flash frozen and shipped with dry ice by courier to

> > I.M.D.

> > > to

> > > > > > > arrive

> > > > > > > > within 24-36 hours. Cost=$180. (Note that other

> > commercial

> > > > labs

> > > > > > > > charge $200-300.)

> > > > > > > > > For the best price and highest quality, the above

PCR

> > > > > specialty

> > > > > > > > tests for CFS/FMS patients can be ordered through

> > > > International

> > > > > > > > Molecular Diagnostics, Inc., 15162 Triton Lane,

> > Huntington

> > > > > Beach,

> > > > > > > CA

> > > > > > > > 92649, U.S.A. Tel: 714-799-7177, ext. 202 (Client

> > Services)

> > > > or

> > > > > > ext.

> > > > > > > > 204 (Brant Blasingame). Order forms and additional

> > > > information

> > > > > > are

> > > > > > > > available upon request. They also offer testing for

> blood

> > > > > > clotting

> > > > > > > > abnormalities (see below). Tests must be ordered by a

> > > > > physician.

> > > > > > > The

> > > > > > > > I.M.D. Web site is www.imd-lab.com. On this site you

> will

> > > > find

> > > > > > > > additional information about testing and disease. The

> > > > Institute

> > > > > > for

> > > > > > > > Molecular Medicine Web site is www.immed.org. On this

> > site

> > > > you

> > > > > > will

> > > > > > > > find publications and documents on CFS/ME, FMS,

> > autoimmune

> > > > > > diseases

> > > > > > > > and other chronic illnesses. Immediate fax-back

> > information

> > > > is

> > > > > > > > available 24 hours per day by calling our telephone

> > number

> > > > 714-

> > > > > > 903-

> > > > > > > > 2900.

> > > > > > > > > Garth Nicolson, Adjunct Professor of Internal

Medicine

> > > > > > > > > President and Chief Scientific Officer, The

Institute

> > for

> > > > > > > Molecular

> > > > > > > > Medicine

> > > > > > > > > —A nonprofit institute dedicated to discovering new

> > > > > diagnostic

> > > > > > > and

> > > > > > > > therapeutic solutions for chronic diseases—

> > > > > > > > > 15162 Triton Lane, Huntington Beach, CA 92649-1041,

> > > > U.S.A. •

> > > > > > Tel:

> > > > > > > > 714-903-2900 • Fax: 714-379-2082

> > > > > > > > > So, What Is Prescribed For Mycoplasma And

Chlamydia?

> > > > > > > > > Fortunately, Mycoplasma and Chlamydia infections

are

> > > > usually

> > > > > > > > sensitive to the right antibiotics. The antibiotics

> most

> > > > likely

> > > > > > to

> > > > > > > > effect these organisms are:

> > > > > > > > > 1. Doxycycline or Minocycline 100 mg, 2-3 times a

> day.

> > > > These

> > > > > > two

> > > > > > > > antibiotics are in the Tetracycline-family and should

> not

> > > be

> > > > > used

> > > > > > > in

> > > > > > > > children under eight years-old because they can cause

> > > > permanent

> > > > > > > > staining of the teeth. They are very effective,

though,

> > > > against

> > > > > a

> > > > > > > > number of unusual organisms (e.g., Lymes Disease).

They

> > > will

> > > > > > > > sometimes cause some stomach upset. If this occurs,

> take

> > > the

> > > > > > > medicine

> > > > > > > > with food and a full glass of water or lower the

dose.

> Do

> > > not

> > > > > use

> > > > > > > > outdated/expired Tetracycline prescriptions—they can

> kill

> > > you!

> > > > > > > > > 2. Cipro (Ciprofloxacin) 750 mg, twice a day.

> Although

> > > > > > expensive,

> > > > > > > > this is usually a well-tolerated antibiotic. It has a

> > very

> > > > wide

> > > > > > > range

> > > > > > > > of effectiveness against a large number of organisms.

> > When

> > > > > > treating

> > > > > > > > males, the Cipro (as well as the Doxycycline) has the

> > > > > additional

> > > > > > > > benefit of treating any hidden prostate infections.

Do

> > not

> > > > take

> > > > > > > oral

> > > > > > > > magnesium within 6 hours of Cipro or you won't absorb

> the

> > > > Cipro.

> > > > > > > > > 3. Zithromax 600 mg a day, taken with food, or

Biaxin

> > 500

> > > > mg,

> > > > > > > twice

> > > > > > > > a day, taken on an empty stomach. These are in the

> > Erythro-

> > > > > mycin

> > > > > > > > family. Zithromax tends to be fairly well-tolerated.

> The

> > > > Biaxin

> > > > > > is

> > > > > > > > more likely to cause a bit of nausea in some

patients,

> > but

> > > it

> > > > > is

> > > > > > > > usually well-tolerated. Both are quite expensive.

They

> > may

> > > > work

> > > > > > > > against infections missed by Doxycycline and Cipro.

> > > > > > > > > Although all of these antibiotics can be effective,

> it

> > is

> > > > not

> > > > > > > > uncommon for infections that are sensitive to the

> > > > Erythromycin

> > > > > > > > antibiotics (#3 above) to be resistant to #1 and #2

> above

> > > and

> > > > > > vice-

> > > > > > > > versa. Therefore, it is best to try either

Doxycycline

> or

> > > > Cipro

> > > > > > > > first. If they are not effective, then try the

> Zithromax

> > or

> > > > > > Biaxin.

> > > > > > > > The antibiotic should be taken for at least 6 months.

> If

> > > > there

> > > > > is

> > > > > > > no

> > > > > > > > improvement in 4 months, switch to or add the other

> > > > antibiotic

> > > > > or

> > > > > > > > simply stop the treatment. It is helpful to check for

> low-

> > > > grade

> > > > > > > > fevers. I am more likely to use antibiotics for CFIDS

> > > > patients

> > > > > > who

> > > > > > > > have temperatures over 98.6°F, even if it is only

98.8°

> > (I

> > > > > > consider

> > > > > > > > 98.8° a fever because CFIDS/FMS patients usually have

> low

> > > > body

> > > > > > > > temperatures). If you do have low-grade, chronic

> > > temperature

> > > > > > > > elevations, be sure that you monitor your

temperatures

> > > during

> > > > > > > > treatment. If your temperature drops with the

> antibiotic,

> > > it

> > > > > > > suggests

> > > > > > > > that you do have one of these nonviral infections and

> the

> > > > > > > antibiotic

> > > > > > > > is helping. T

> > > > > > > > > his would encourage me to continue the antibiotic

> > trial -

> > > > > even

> > > > > > if

> > > > > > > > it takes up to 12 months to see an improvement in

your

> > > > > symptoms.

> > > > > > > > > If you are clearly better, I would probably take

the

> > > > > antibiotic

> > > > > > > for

> > > > > > > > at least 6 to 12 months. It can then be stopped. If

> > > symptoms

> > > > > > recur,

> > > > > > > > keep repeating 6 to 8 week cycles until the symptoms

> stay

> > > > gone.

> > > > > > It

> > > > > > > > may take several years of treatment for the infection

> to

> > be

> > > > > > totally

> > > > > > > > eradicated. To put it in perspective, this is how

long

> > > > children

> > > > > > > often

> > > > > > > > take antibiotics for acne—which unfortunately, if not

> > taken

> > > > > with

> > > > > > > anti-

> > > > > > > > fungals, can lead to yeast overgrowth and possibly

> > trigger

> > > > > CFIDS.

> > > > > > > Be

> > > > > > > > sure to take Nystatin, 2 tablets, 2 times a day,

while

> on

> > > the

> > > > > > > > antibiotics. Also, please be sure to use alternative

> > birth

> > > > > > control

> > > > > > > if

> > > > > > > > on " the pill. " Birth control pills may be ineffective

> > while

> > > > > > taking

> > > > > > > > antibiotics. In addition, anti-depressants, codeine,

> > > > antacids,

> > > > > > and

> > > > > > > > mineral supplements (e.g., magnesium) may block

> > antibiotic

> > > > > > > > absorption. Take these at least three hours away from

> the

> > > > > > > antibiotic

> > > > > > > > (and don't take the antidepressant/codeine

medications

> if

> > > > they

> > > > > > are

> > > > > > > > not clearly helping).

> > > > > > > > > It is very common to get die-off (Herxheimer)

> reactions

> > > > which

> > > > > > > > include chills, fever, night sweats and general

> worsening

> > > of

> > > > > > > CFS/FMS

> > > > > > > > symptoms when the antibiotic first kills off the

> > infection.

> > > > > These

> > > > > > > can

> > > > > > > > be severe and last for weeks. Dr. Nicolson encourages

> > > you " to

> > > > > be

> > > > > > > > patient and not abandon therapy prematurely, because

> few

> > > > > patients

> > > > > > > who

> > > > > > > > have been sick for years recover in less than one

year

> of

> > > > > > > therapy...

> > > > > > > > [don't] be alarmed if some signs and symptoms

> > occasionally

> > > > > return

> > > > > > > or

> > > > > > > > worsen. This is not unusual. Eventually you will be

off

> > > > > > antibiotics

> > > > > > > > or antivirals but you will need to continue various

> > > > supplements

> > > > > > to

> > > > > > > > maintain your immune system and general nutritional

> > status. "

> > > > > > > > > Treatment for Bacterial, Mycoplasma, Chlamydia, E-

> coli,

> > > > > > Bladder,

> > > > > > > Or

> > > > > > > > Other Infections

> > > > > > > > > (From the " Treatment Checklist " used in Dr.

> > Teitelbaum's

> > > > > > office.

> > > > > > > A

> > > > > > > > full list is available on Dr. Teitelbaum's Web site

at

> > > > > > > > www.endfatigue.com.)

> > > > > > > > > The Mycoplasma, Chlamydia, E-Coli, bladder and

other

> > > > > bacterial

> > > > > > > > infections usually take months to years to eradicate.

> It

> > is

> > > > > > common

> > > > > > > to

> > > > > > > > flare your symptoms (from the infection die-off) the

> > first

> > > > two

> > > > > > > weeks

> > > > > > > > of treatment. Take the antibiotics for six months

and,

> if

> > > > > better,

> > > > > > > > then repeat six-week cycles till your symptoms stay

> gone.

> > > > > > > > Antidepressants, Neurontin, and/or Codeine may block

> the

> > > > > > > antibiotic's

> > > > > > > > effectiveness. Be sure to take Nystatin, 2 tablets

> twice

> > a

> > > > day,

> > > > > > and

> > > > > > > > Acidophilus while on the antibiotics. If you have

> > > occasional

> > > > > low-

> > > > > > > > grade fever (i.e., if over 98.6° F), check your oral

> > > > > temperature

> > > > > > > > occasionally to see if the antibiotic reduces or

> > eliminates

> > > > the

> > > > > > > > fever. If so, stay on that antibiotic. Also, see Dr.

> > > > Nicolson's

> > > > > > Web

> > > > > > > > site at www.immed.org for additional information.

> > > > > > > > > Useful antibiotic treatment for the above

infections

> > > > include:

> > > > > > > > > 1. Cipro (ciprofloxacin) 750 mg, 2 times a day for

6

> > > > months.

> > > > > Do

> > > > > > > not

> > > > > > > > take magnesium products (e.g., Fibrocare, some

> antacids,

> > > Pro

> > > > > > > Energy,

> > > > > > > > or (Dr. Teitelbaum's) Foundation Formula™) within 6

> hours

> > > of

> > > > > > Cipro

> > > > > > > > because you won't absorb the Cipro.

> > > > > > > > > OR

> > > > > > > > > 2. Doxycycline (a tetracycline) 100 mg, 3 times a

day

> > for

> > > 6

> > > > > > > months.

> > > > > > > > If symptoms recur when the Doxycycline is completed,

> keep

> > > > > > repeating

> > > > > > > 6-

> > > > > > > > week courses until the symptoms stay resolved. Take

> > > Nystatin

> > > > > (at

> > > > > > > > least 2, twice a day) while on the antibiotic. Birth

> > > control

> > > > > > pills

> > > > > > > > may not work while on Doxycycline. Do not take any

> > expired

> > > > > > > > Doxycycline tablets (it's very dangerous).

> > > > > > > > > OR

> > > > > > > > > 3. Zithromax (azithromycin) 600 mg tablets, 1

tablet

> a

> > > day

> > > > > > (take

> > > > > > > > with food if it bothers your stomach). Don't take

> > magnesium-

> > > > > > > > containing products within six hours of the Zithromax.

> > > > > > > > > OR

> > > > > > > > > 4. Biaxin 500 mg, 2 times a day.

> > > > > > > > > 5. D-Mannose ½ to 1 teaspoon (2.5 grams), stirred

in

> > > water,

> > > > > > every

> > > > > > > 2

> > > > > > > > to 3 hours while awake, for 2 to 5 days for acute

> bladder

> > > > > > > infections

> > > > > > > > (may use long-term for chronic infections) caused by

E-

> > coli

> > > > > (this

> > > > > > > > causes approximately 90% of bladder infections). If

not

> > > much

> > > > > > better

> > > > > > > > in 24 hours, get a urine culture and consider an

> > > antibiotic.

> > > > D-

> > > > > > > > Mannose is available from BioTech (800-345-1199), my

> Web

> > > > > > > > site's " Vitamin Shop " at www.endfatigue.com or my

> office

> > > (800-

> > > > > 333-

> > > > > > > > 5287).

> > > > > > > > > What About Yeast Overgrowth?

> > > > > > > > > Yeast overgrowth is an important concern. As I have

> > > > mentioned

> > > > > > > > before, nothing is all good or all bad. Although

> > cigarettes

> > > > > kill

> > > > > > > > hundreds of thousands of people each year, they can

be

> > > > helpful

> > > > > in

> > > > > > > > treating Parkinson's Disease or ulcerative colitis.

> > > Although

> > > > > > > > antibiotics can trigger CFIDS, they can also be

helpful

> > in

> > > > > > treating

> > > > > > > > it. This makes it important to know when and how to

use

> > > them.

> > > > I

> > > > > > > > strongly recommend that my patients take antifungals

> > while

> > > on

> > > > > any

> > > > > > > > antibiotics (e.g., Nystatin 500,000 unit tablets, 2

> > > tablets,

> > > > 2

> > > > > to

> > > > > > 3

> > > > > > > > times a day) to prevent yeast overgrowth. It is also

> > > > reasonable

> > > > > > to

> > > > > > > > add Oregano Oil and other natural antifungals. Two

> > Nystatin

> > > > > twice

> > > > > > a

> > > > > > > > day is what I usually prescribe. Using probiotics

> > (healthy

> > > > milk

> > > > > > > > bacteria-like acidophilus that helps your body) to

> > compete

> > > > with

> > > > > > the

> > > > > > > > yeast can also help. I am concerned that if the

> > acidophilus

> > > > is

> > > > > > > taken

> > > > > > > > with the antibiotic, they may simply cancel each

other

> > out.

> > > > > > Because

> > > > > > > > of this, I usually begin probiotics (Acidophilus or

> > > > > Lactobacillus

> > > > > > > in

> > > > > > > > a d

> > > > > > > > > ose of 3 to 6 billion units a day, taken on an

empty

> > > > stomach

> > > > > or

> > > > > > > > with milk) after one has completed the course of

> > > antibiotics.

> > > > > If

> > > > > > > you

> > > > > > > > are only taking the antibiotic once or twice a day,

and

> > can

> > > > > find

> > > > > > a

> > > > > > > > time at least 6 to 8 hours away from another dose to

> take

> > > the

> > > > > > > > probiotic, it is reasonable to take it at that time.

> The

> > > > entire

> > > > > > > daily

> > > > > > > > probiotic dose can also be taken at one time. If you

> find

> > > > that

> > > > > > you

> > > > > > > > still get yeast overgrowth, it may be necessary to

use

> > some

> > > > of

> > > > > > the

> > > > > > > > more potent prescription antifungals (Sporanox or

> > > Diflucan).

> > > > > > > Because

> > > > > > > > these can cause liver inflammation and are quite

> > expensive,

> > > > it

> > > > > > may

> > > > > > > be

> > > > > > > > adequate to take 200mg of either of these, twice a

day,

> > one

> > > > day

> > > > > > > each

> > > > > > > > week (e.g., take it every Sunday) instead of every

day.

> > As

> > > > > > > discussed

> > > > > > > > previously, be sure to take Lipoic acid 200 mg on any

> day

> > > you

> > > > > > take

> > > > > > > > Sporanox or Diflucan, to decrease the risk of liver

> > > > > inflammation.

> > > > > > > > > What Role Does My Blood Clotting System Play In

This?

> > > > > > > > > Work done by E. Berg, M.S., C.L.S. (N.C.A.),

> > > director

> > > > > of

> > > > > > > > Hemex Laboratories in Phoenix, Arizona (800-999-

2568),

> > has

> > > > > shown

> > > > > > > that

> > > > > > > > a number of infections can trigger our blood clotting

> > > system

> > > > to

> > > > > > > > become active, thus setting up a low-level, chronic

> > > clotting

> > > > > > > cascade.

> > > > > > > > These infections include HHV-6, Mycoplasma, CMV and

> > > Chlamydia

> > > > > > which

> > > > > > > > can trigger production of (IgA) antibodies against

clot

> > > > > > protective

> > > > > > > > proteins on blood vessel inner surfaces (called

> > > > > antiphospholipid

> > > > > > > > antibodies). One of these is the Beta 2 Glyco-protein

1

> > > (anti

> > > > > > B2GP1—

> > > > > > > > no, you are not going to be tested on this!). This

then

> > > > > triggers

> > > > > > > the

> > > > > > > > clotting cascade. Once the clotting system is

> triggered,

> > a

> > > > > > product

> > > > > > > > called Soluble Fibrin Monomer (SFM) is made which is

> like

> > > the

> > > > > > > > polymers in plastic. The theory is that they create

> long

> > > thin

> > > > > > > sheets

> > > > > > > > of a teflon-like substance, similar to the scab that

> > covers

> > > a

> > > > > > cut,

> > > > > > > > but microscopic, which then coats the blood vessels.

> This

> > > > makes

> > > > > > it

> > > > > > > > hard for nutrients, oxygen, etc., to get in and out

of

> > the b

> > > > > > > > > lood vessels to the cells where they are needed. In

> > > > summary,

> > > > > > many

> > > > > > > > infections can cause the blood clotting system to

> > activate,

> > > > > > > resulting

> > > > > > > > in a thin coating of Fibrin deposited on the blood

> > vessels.

> > > > > This

> > > > > > > > prevents nutrients and oxygen from getting to the

cells

> > in

> > > > your

> > > > > > > body.

> > > > > > > > > Why Would An Infection Trigger The Clotting System?

> > > > > > > > > Many infections (called anaerobic) do not survive

> well

> > in

> > > > the

> > > > > > > > presence of oxygen. One can theorize that these

> > Mycoplasma

> > > > > (which

> > > > > > > may

> > > > > > > > be anaerobic) and other organisms may trigger the

> > clotting

> > > > > system

> > > > > > > to

> > > > > > > > create a shell, which then acts like a suit of armor,

> > > > > protecting

> > > > > > > them

> > > > > > > > from oxygen, your body's defense system, and

> antibiotics.

> > > > This

> > > > > > > would

> > > > > > > > explain why these infections could evolve a way to

> > trigger

> > > > the

> > > > > > > > clotting mechanism. The Fibrin armor preventing

> > antibiotics

> > > > > from

> > > > > > > > getting to the infection could also explain why some

> > people

> > > > > with

> > > > > > > > these infections may not respond to antibiotics.

> Indeed,

> > > some

> > > > > > > > physicians have found that the antibiotics work

better

> > once

> > > > > > someone

> > > > > > > > has been on a blood thinner (which may dissolve the

> > armor).

> > > > > > > > > This is an interesting theory, but how do we know

> this

> > is

> > > > > going

> > > > > > > on?

> > > > > > > > Mr. Berg and others have done studies showing that

the

> > > blood

> > > > > > tests

> > > > > > > > that look for these clotting changes (called the ISAC

> > > panel -

> > > > > > > > available at Hemex labs) are abnormal in CFIDS/FMS

> > patients

> > > > > while

> > > > > > > > being normal in most other patients. They use a

> criterion

> > > of

> > > > > two

> > > > > > of

> > > > > > > > these tests needing to be abnormal to be considered

> > > positive.

> > > > > > When

> > > > > > > > this was done, 50 of 54 CFIDS/FMS patients had

abnormal

> > > tests

> > > > > > > (i.e.,

> > > > > > > > only 7.4% of the patients had normal blood tests). In

> > > healthy

> > > > > > > > patients, 22 out of 23 had normal blood tests (i.e.,

> > 96%).

> > > > This

> > > > > > > means

> > > > > > > > the test is both very sensitive and specific, picking

> up

> > > > people

> > > > > > > with

> > > > > > > > CFIDS and excluding healthy people. Our experience

has

> > > shown

> > > > > that

> > > > > > > > almost everyone that we tested, who has CFIDS, has

> turned

> > > out

> > > > > to

> > > > > > > have

> > > > > > > > a positive ISAC panel. We have not personally sent in

> any

> > > > tests

> > > > > > on

> > > > > > > > healthy patients to see if this also occurs.

> > Interestingly,

> > > > > this

> > > > > > > > panel is also positive in many people with

unexplained

> > infer

> > > > > > > > > tility (which can improve with Heparin) and may

also

> be

> > > > > > positive

> > > > > > > in

> > > > > > > > people with Multiple Sclerosis, Parkinsons, Autism,

> > > > > Inflammatory

> > > > > > > > Bowel Disease and some other illnesses. This suggests

> > that

> > > > this

> > > > > > > test

> > > > > > > > can be helpful in deciding whether to treat with

blood

> > > > thinners

> > > > > > > > (Heparin) in CFIDS/FMS.

> > > > > > > > > So, How Do I Treat The Clotting System?

> > > > > > > > > First of all, it is important to remember that

using

> > > > > injections

> > > > > > > of

> > > > > > > > Heparin (the blood thinner) is still a controversial

> and

> > > > > > > experimental

> > > > > > > > treatment for CFIDS/FMS. We much prefer to use

> treatments

> > > > that

> > > > > > are

> > > > > > > as

> > > > > > > > safe as possible. Although Heparin is routinely used

in

> > the

> > > > > > U.S.A.

> > > > > > > to

> > > > > > > > treat blood clots, using it to treat CFIDS/FMS is

very

> > new.

> > > > > Most

> > > > > > of

> > > > > > > > the doctors that I have spoken with have only treated

a

> > few

> > > > > > > CFIDS/FMS

> > > > > > > > patients with Heparin and find that about half of

these

> > > > > patients

> > > > > > > get

> > > > > > > > better with treatment. The treatment protocol,

> developed

> > by

> > > > >

> > > > > > > > Couvaras, M.D. (602-996-2411), includes the following:

> > > > > > > > > 1. Remove wheat, alcohol and sugar from the diet,

if

> > > > possible.

> > > > > > > > > 2. Check the ISAC panel. If there are at least two

> > > abnormal

> > > > > > > > results, then begin treatment.

> > > > > > > > > 3. Give an antifungal for 14 days (he uses Lamisil

> > 250mg

> > > a

> > > > > day—

> > > > > > > > which I find to be poorly effective. I would use 200

mg

> > of

> > > > > > Sporanox

> > > > > > > > or Diflucan instead).

> > > > > > > > > 4. Give standard Heparin 4000 to 8000 units by

> > injection

> > > > > > > > subcutaneously (like an insulin shot) twice a day. A

> > > > (possibly

> > > > > > > safer)

> > > > > > > > low molecular weight Heparin may also be used.

> > > > > > > > > 5. If the PA index (on the ISAC) is positive, add a

> > baby

> > > > > > Aspirin

> > > > > > > > (81mg) each day.

> > > > > > > > > 6. After being on Heparin for one week, Dr.

Couvares

> > > > repeats

> > > > > > the

> > > > > > > > ISAC panel to adjust the dose of the Heparin and

> Aspirin.

> > > He

> > > > > > feels

> > > > > > > > that the goal is to move all the blood tests into the

> > > normal

> > > > > > range

> > > > > > > > but not past the normal range into blood-thinning

> > > > (therapeutic)

> > > > > > > > levels. If the values are still abnormal or the

patient

> > is

> > > > > still

> > > > > > > > having symptoms, he then increases the Heparin

dosage.

> If

> > > the

> > > > > PA

> > > > > > > > index (on the ISAC) is still high, he increases the

> > Aspirin

> > > > to

> > > > > > > twice

> > > > > > > > a day.

> > > > > > > > > 7. If the patient feels better after one month of

> > > Heparin,

> > > > he

> > > > > > > then

> > > > > > > > switches to low-dose Coumadin (a blood thinner tablet—

> > take

> > > 2

> > > > to

> > > > > 3

> > > > > > > mg

> > > > > > > > a day) and then stops the Heparin after 4 to 5 days

of

> > > being

> > > > on

> > > > > > the

> > > > > > > > Coumadin. Once the patient has been on the Coumadin

for

> > two

> > > > > weeks

> > > > > > > he

> > > > > > > > goes ahead and rechecks the ISAC panel to maintain

the

> > > blood

> > > > > > tests

> > > > > > > in

> > > > > > > > the normal range.

> > > > > > > > > 8. He also supplements patients with nutritional

> > > > > > supplementation

> > > > > > > as

> > > > > > > > needed.

> > > > > > > > > In my practice, because the ISAC panel runs over

> $320,

> > I

> > > > > check

> > > > > > a

> > > > > > > > baseline ISAC panel but do not repeat the ISAC panels

> to

> > > > adjust

> > > > > > > > therapy. Instead, while on Heparin, we check a PTT (a

> > blood

> > > > > > > thinning

> > > > > > > > test) and platelets (a highly unusual, but

potentially

> > very

> > > > > > > dangerous

> > > > > > > > side effect of Heparin is a severe drop in platelet

> > count,

> > > > > which

> > > > > > > can

> > > > > > > > cause life-threatening bleeding) every 3 days for the

> > first

> > > > 12

> > > > > > days

> > > > > > > > and then every 2 to 4 weeks while on Heparin. If the

> PTT

> > is

> > > > > still

> > > > > > > > within the normal range and the patient is not

better,

> we

> > > > > > increase

> > > > > > > > the Heparin as high as 8000 units, twice a day

(rarely

> we

> > > > will

> > > > > go

> > > > > > > up

> > > > > > > > to 8000 units, 3 times a day) and then also increase

> the

> > > > > Aspirin

> > > > > > to

> > > > > > > 2

> > > > > > > > a day. In comparison, hospital patients often require

> > > Heparin

> > > > > at

> > > > > > > 1000

> > > > > > > > units per hour (24,000 units a day) I.V., while most

> > > CFS/FMS

> > > > > > > patients

> > > > > > > > only need 4000 to 5000 units, 2 times a day (8000 to

> > 10,000

> > > > > units

> > > > > > a

> > > > > > > > day). If the patient is feeling better, however, we

> > simply

> > > > > leave

> > > > > > > them

> > > > > > > > at the initial dose. Most patients will f

> > > > > > > > > eel better at about the 10- to 14-day point if the

> > > Heparin

> > > > is

> > > > > > > going

> > > > > > > > to help. At the end of 4 to 12 months, if the Heparin

> > > helps,

> > > > we

> > > > > > > > switch to Coumadin (as noted above) and check an INR

> > > > > > (International

> > > > > > > > Normalized Ratio), aiming to keep it below 1.3 while

> > > > adjusting

> > > > > > the

> > > > > > > > Coumadin to the optimum does. It is very important to

> > know

> > > > that

> > > > > > > most

> > > > > > > > medications can change the blood level of Coumadin

and

> > that

> > > > > > anytime

> > > > > > > > anything is added to, or deleted from, your regimen

> > > > (including

> > > > > > > > natural remedies) you need to recheck the INR 4 to 7

> days

> > > > later

> > > > > > to

> > > > > > > > make sure that it is not going too high. Heparin and

> > > Coumadin

> > > > > are

> > > > > > > > powerful medicines and the main risk is bleeding.

> > Although

> > > we

> > > > > are

> > > > > > > > using very low doses, which are usually very well-

> > > tolerated,

> > > > > one

> > > > > > > can

> > > > > > > > rarely see a life-threatening bleed occur. If you

felt

> > > better

> > > > > on

> > > > > > > the

> > > > > > > > Heparin and then the symptoms come back on the

> Coumadin,

> > > you

> > > > > may

> > > > > > > need

> > > > > > > > to go back on the Heparin for several months to re-

> > > establish

> > > > > and

> > > > > > > > maintain the benefit. Occasionally, people will need

to

> b

> > > > > > > > > e on the Heparin for an extended period, in which

> case

> > > the

> > > > > > blood

> > > > > > > > tests (PTT and platelet count) should be checked

every

> 2

> > to

> > > 4

> > > > > > > weeks.

> > > > > > > > All of this being said, most people tolerate these

> > > treatments

> > > > > > quite

> > > > > > > > well and many, many more people die from taking

Aspirin

> > > > (e.g.,

> > > > > > for

> > > > > > > > arthritis) than Heparin each year.

> > > > > > > > > In summary, there are a number of infections that

can

> > > cause

> > > > > or

> > > > > > > > occur because you have CFIDS/FMS. Once they occur,

they

> > can

> > > > > > trigger

> > > > > > > > the clotting cascade. This may keep the nutrients

from

> > > > getting

> > > > > to

> > > > > > > > your body and create a " suit of armor " for the viral

> and

> > > > > > Mycoplasma

> > > > > > > > infections. Using a blood thinner can break down

these

> > > armor

> > > > > > > coatings

> > > > > > > > that protect the infections from our treatment and

> allow

> > > > > > nutrients

> > > > > > > to

> > > > > > > > get where they need to go. Many tests can help. The

one

> > > that

> > > > I

> > > > > > use

> > > > > > > to

> > > > > > > > decide whether to use the Heparin blood thinner is

the

> > ISAC

> > > > > panel

> > > > > > > (at

> > > > > > > > Hemex Labs). Testing for infections may be helpful,

but

> > can

> > > > be

> > > > > > > > expensive and less likely to effect my decision to

> treat.

> > > If

> > > > > you

> > > > > > > can

> > > > > > > > afford the tests and/or your insurance will pay for

> them,

> > > > they

> > > > > > are

> > > > > > > > worth checking and will make it easier to adjust

> therapy

> > > over

> > > > > > time.

> > > > > > > > If you can't afford it, it is reasonable to treat

> > > empirically

> > > > > > > (i.e.,

> > > > > > > > without testing), except for high-dose Valtrex

therapy.

> > If

> > > > you

> > > > > > have

> > > > > > > > lung congestion and/or recurrent temperatures o

> > > > > > > > > ver 98.6°F, I would treat with the antibiotics. If

> you

> > > feel

> > > > > > > > chronically flu-like, I would consider the HHV-6 or

> > (based

> > > on

> > > > > > > > testing) the high-dose Valtrex regimen. It is also

> > > reasonable

> > > > > to

> > > > > > > > treat with antibiotics and antivirals simultaneously -

> > > > > especially

> > > > > > > if

> > > > > > > > you are taking the anticoagulants.

> > > > > > > > > Chronic Sinusitis The Yeasty Beasties Revisited!

> > > > > > > > > As was mentioned years ago, we speculated that the

> > > chronic

> > > > > > sinus

> > > > > > > > congestion seen in CFIDS/FMS could be caused by yeast

> > > > > overgrowth.

> > > > > > A

> > > > > > > > recent interesting study from the Mayo Clinic

> Proceedings

> > > > > > supports

> > > > > > > > this thought. In the study, researchers found that

most

> > > > people

> > > > > > with

> > > > > > > > chronic sinus infections had fungal growth in their

> > > sinuses.

> > > > > They

> > > > > > > > felt that the inflammation was being caused by an

> immune

> > > (the

> > > > > > > body's

> > > > > > > > reaction) response to the fungus. This research is

> > > > interesting

> > > > > > > > because more and more studies are showing that

treating

> > > > chronic

> > > > > > > > sinusitis with antibiotics doesn't really do much and

> > that

> > > > > > shorter

> > > > > > > > courses of treatment work just as well as the long

> > courses.

> > > > We

> > > > > > find

> > > > > > > > that conservative treatment (see my newsletter

article,

> > > > > Treatment

> > > > > > > Of

> > > > > > > > Respiratory Infections Without Antibiotics, Vol. 2,

> Issue

> > > 2)

> > > > is

> > > > > > > more

> > > > > > > > effective than antibiotics for chronic sinusitis.

> > > > > > > > > It's good that medicine is finally starting to

catch

> up

> > > > with

> > > > > > > > reality. The report in The Mayo Clinic Proceedings

> noted

> > > > > > > > that, " fungus allergy was thought to be involved in

> less

> > > than

> > > > > 10%

> > > > > > > of

> > > > > > > > cases… our studies indicate, in fact, fungus is

likely

> > the

> > > > > cause

> > > > > > of

> > > > > > > > nearly all of these problems and that it is not an

> > allergic

> > > > > > > reaction

> > > > > > > > but an immune reaction. " In this study, the

researchers

> > > > studied

> > > > > > 210

> > > > > > > > patients with chronic sinusitis. Using new methods to

> > > collect

> > > > > and

> > > > > > > > test sinus/nasal mucus they found fungus in 96% of

> > > patients.

> > > > > > > > > It's interesting to observe how medical research

> works.

> > > The

> > > > > > > > researchers are now working with different drug

> companies

> > > to

> > > > > set

> > > > > > up

> > > > > > > > trials to test medications to control the fungus but

> feel

> > > > that

> > > > > it

> > > > > > > > will be at least two years before any treatments will

> be

> > > > > > available.

> > > > > > > > In my experience, though, these problems often

respond

> > > > > > dramatically

> > > > > > > > to either Sporanox or Diflucan - which, by no

> > coincidence,

> > > > are

> > > > > > very

> > > > > > > > powerful antifungal agents. It is not clear why the

> > > > researchers

> > > > > > did

> > > > > > > > not simply try Sporanox or Diflucan. Un-fortunately,

we

> > > find

> > > > > that

> > > > > > > the

> > > > > > > > obvious is often overlooked. This sometimes occurs as

> > drug

> > > > > > > companies

> > > > > > > > seek to make more money by finding new drugs instead

of

> > > using

> > > > > the

> > > > > > > old

> > > > > > > > things that are known to work. It is important to

> > > distinguish

> > > > > > > between

> > > > > > > > chronic sinusitis (which lasts for over three months)

> and

> > > > acute

> > > > > > > > sinusitis (which usually has been going on for a few

> days

> > > and

> > > > > > less

> > > > > > > > than a month). For these shorter attacks of

sinusitis,

> > > > bacteria

> > > > > > are

> > > > > > > a

> > > > > > > > more common cause and antibiotics (combined with n

> > > > > > > > > atural remedies) can be helpful. Some researchers

> still

> > > > > > continue

> > > > > > > to

> > > > > > > > argue that fungus is not a cause of chronic

sinusitis.

> > They

> > > > > note

> > > > > > > that

> > > > > > > > fungi are seen even in healthy noses (which is

correct)

> > but

> > > > > > neglect

> > > > > > > > to discuss the immune changes that are also seen in

> these

> > > > > noses.

> > > > > > > > Because so many people have responded dramatically to

> > > > > antifungals

> > > > > > > in

> > > > > > > > the treatment of their chronic sinusitis, my

suspicion

> is

> > > > that

> > > > > > the

> > > > > > > > Mayo Clinic researchers are probably correct.

Wouldn't

> it

> > > be

> > > > > > nice,

> > > > > > > if

> > > > > > > > instead of arguing about treatments while people stay

> > sick,

> > > > > they

> > > > > > > > would just try the treatments to see if they worked!

> > > > > > > > > As you can see, your body's defenses being down

plays

> a

> > > > large

> > > > > > > role

> > > > > > > > in CFIDS/FMS. The good news is, that by treating the

> many

> > > > > > > underlying

> > > > > > > > infections common in CFIDS patients and by treating

any

> > > > > hormonal

> > > > > > > and

> > > > > > > > nutritional deficiencies, you can bring your immune

> > system

> > > > back

> > > > > > to

> > > > > > > a

> > > > > > > > healthy state!

> > > > > > > > > Important Points

> > > > > > > > > • An important component of CFS is disordered

immune

> > > > > function,

> > > > > > > > which opens the door to repeated infections, repeated

> > > > treatment

> > > > > > > with

> > > > > > > > antibiotics, and yeast overgrowth.

> > > > > > > > > • Treat yeast overgrowth by avoiding antibiotics

and

> > > > sweets.

> > > > > > Many

> > > > > > > > patients have found Nystatin and other antifungal

> > > > medications,

> > > > > > such

> > > > > > > > as Diflucan and Sporanox, to be helpful. Acidophilus

> > (milk

> > > > > > > bacteria)

> > > > > > > > and natural antifungals such as Caprylic acid and

> garlic

> > > are

> > > > > also

> > > > > > > > often useful.

> > > > > > > > > • Bowel parasites are common in CFS patients, whose

> > > > symptoms

> > > > > > > often

> > > > > > > > respond dramatically to treatment. However, most labs

> do

> > > not

> > > > > > > > adequately detect parasites through stool testing. To

> get

> > > an

> > > > > > > accurate

> > > > > > > > test result, use one of the labs we recommended that

> > > > > specializes

> > > > > > in

> > > > > > > > stool testing.

> > > > > > > > > • Treat Cryptosporidium with Artemesia annua or

> > tricyclin

> > > > > > (herbal

> > > > > > > > antiparasitics).

> > > > > > > > > • Treat constipation with Turkey Rhubarb (a herb).

> > > > > > > > > • Prevent parasitic infection by using a Multi-pure

> > water

> > > > > > filter

> > > > > > > > (available from 888-801-8176 or 410-224-4877)

> > > > > > > > > • If you have temperatures over 98.6°F and/or

chronic

> > > lung

> > > > > > > > congestion, try long-term Cipro or Doxycycline (while

> on

> > > > > > Nystatin).

> > > > > > > > > • If you have chronic flu-like symptoms, despite

> yeast

> > > and

> > > > > > Cortef

> > > > > > > > treatment, consider the antiviral, immune stimulating

> > > > protocol

> > > > > we

> > > > > > > > discussed.

> > > > > > > > >

> > > > > > > >

> > > > > > >

> > > > > >

> > > > >

> > > >

> > >

> >

>