Fibromyalgia

Fibromyalgia –A Most Misunderstood Disease

David J Zeiger, D.O.

 

“Ladies and Gentlemen of the audience ,after being seen and evaluated by multiple medical specialists, poked and probed with  every conceivable standard diagnostic medical test, the esteemed  medical committee’s summary diagnosis for your symptoms of diffuse multiple  muscle pain , joint pains ,  fatigue and flu-like feelings of ‘no known cause’  over these past 6 months to several years is ………..FIBROMYALGIA!!” “You are awarded a lifetime of symptomatic pharmaceutical treatment escalating towards multiple drug dependancy!!”

 

Does this scene sound familiar? Have you or loved ones, coworkers experienced this scenario?

 

 Fibromyalgia is a set of symptoms or syndrome, still in search of a cause. This is much akin to insomnia, the cause of which can range from restless legs syndrome to hyperthyroidism. It crosses all socioeconomic barriers. This disease affects about 5 million women and men a year with the ratio of women to men about 8 to 1.

 

The deep muscular and joint pains begin insidiously, often following a bout of the flu. The muscle aches and joint pain progresses in both intensity and oftentimes migratory pattern across the body over succeeding months. The pain can come and go with out warning affecting one side preferentially then the next then both sides. Sleep becomes erratic when even the slightest physical exertion rudely disrupts ones attempt at restful slumber. Unable to find respite from this deep internal physical torture the patient becomes more and more fatigued, irritable, moody and finally depressed.

 

There are key elements to many a patient with fibromyalgia. These salient features share much in common with other well described medical conditions that have often been found to have fairly clearly defined symptoms ,physical signs and most  importantly, medical laboratory findings. So, once other diseases are ruled out, one is then left with the orphan disease of the neuromusculoskeletal system; fibromyalgia.

 

In my years of studying this disease and treating patients I have found the following a few important factors in a patient’s history that gives me a very good clinical suspicion that the patient has fibromyalgia and not some other disease such as systemic lupus.

 

The patient is more often a female than a male in their mid 20’s-late 30’s. There is a history of recurrent ear, strep throat or even acne for which they have been administered several courses of antibiotics over the years from early adolescence to mid teens. Diet has favored fast foods, high carbohydrates; low protein there is often a time urgency pattern in their lifestyle of many years. About 75% of women have a history of physical, emotional and or sexual abuse. Finally, the abrupt onset of their fibromyalgia often follows a severe bout of flu, upper respiratory infection and or   major physical or emotional life trauma.

 

Neuromuscular Pain

 

Establishing what does and does not hurt is challenging at times. Pain can come from muscle both deep and superficial, tendon, ligament, joint capsule even bone. A thorough orthopedic and neurological exam is essential. Many times I’ve been referred a patient with what was initially presented to me as intractable fibromyalgia was later discovered  to be a series of muscles acting on skeletal joints biomechanically imbalanced.  In other words, some muscle groups were tighter on one side of a joint than the other pulling the joint slightly out of it‘s proper biomechanical alignment thus affecting nerves , arteries , veins and other muscles associated with it. Using acupuncture, osteopathic manipulation, massage, physical therapy, Chinese herbs, homeopathic medicines and supplements will help decrease muscle pain and inflammation and restore proper musculoskeletal alignment.Overstretched ligaments also can be a source for such intractable pain. By making the proper diagnosis, if this is the case ,then ligament regeneration injection technique has been very useful refer readers to my August 2002 article on this subject in Conscious Choice magazine*.

 

Immune Dysregulation

 

Bacterial, viral, parasitical and ameba infections can create inflammation and send neurotoxins from the gut into the musculoskeletal system causing muscle spasm and pain. Antiinflammatory treatments, either medication ie ibuprofen or natural substances ie ginger may not be effective as stand alone treatments. Many patients with a history of recurrent antibiotic use often have weakened gastrointestinal immune system and in addition may have picked up through restaurant food, ie sushi, microbial invaders like entameba histolytica. This parasite has been shown in certain genetically susceptible patients to activate an immune response that promotes inflammation within the connective tissue of the musculoskeletal system. By checking for salivary antibodies to these parasites as well as for other components of a healthy gastrointestinal immune system I have been able to track and treat another element in the clinical picture of this disease process. Probiotics like lactobacillus acidophilus and an Ayurvedic medicinal food Chaywanprash are part of a program used to restore the ecology of the gastrointestinal immune system.

 

 

Thyroid Adrenal Dysfunction

 

Time urgency –feeling that uncontrollable need that one must run ‘hither or yon’ to have self fulfillment stresses out the thyroid and adrenal gland. These master regulatory glands are interdependent on each other and need to be for proper support and balance of one’s neuroendocrine immune system. Here, I will refer the reader to my article in the October 2002 Issue of Conscious Choice magazine*. In short physical or emotional stress will release the hormone cortisol from the adrenal gland. If the stress does not let up after 10 days then more cortisol is produced and this will shift the immune system to begin producing chemicals that create inflammation and pain in the body. At the same time food fuels like carbohydrates are burned faster, thyroid hormone that tell the cell to produce energy will be decreased and even estrogen and testosterone hormone levels will fluctuate. The person will experience emotional highs and lows as well as deep internal sense of fatigue-‘like your battery has run down’. The most accurate testing for tissue levels of these hormones is through salivary not blood testing. Depression, is often used as the key clinical diagnosis for fibromyalgia –in my clinical experience it is often found to be a ‘subclinical depressed’ thyroid –adrenal function. Mitochondria, those energy forming organelles within cells, are also damaged many times from recurrent antibiotic usage.

Treatment then is aimed at not only re- regulating these master glands but also helping to restore cellular mitochondrial function which will often relieve this cornerstone symptom. Natural as well as synthetic hormone therapy, acupuncture, homeopathic medicines and key essential nutrient supplementation programs accomplish this goal.

 

 

Psychological Software

 

How an infant, child or adult is able to deal with the stresses of living is unique to the situation in which that individual finds themselves in. We are a product of our external and internal environments. What starts out as potential can be allowed to blossom or suppressed. Working with a well trained psychological counselor can be an enormous aide in helping to reestablish the ‘software programing’ that guides us in coping in a healthy way with life’s various psycho-emotional stressors. I will often refer patients to a well trained psychotherapist to work in concert with my integrative medical plan. Homeopathic and nutritional supplementation programs offer a non –pharmaceutical support for a person with such psycho-emotional issues ie guilt, grief, anxiety during the healing process.

 

 Combining a thorough integrative medical approach crossing many disciplines will offer the patient with fibromyalgia a life of hope, health and infinite possibilities.

 

 To Life and Good Health,

 

David J Zeiger,D.O.

 

Dr David Zeiger is board certified Family Physician in private practice. He specializes in Integrative Medicine treating chronic/acute illness ie IBS, Allergies, CFIDS/Fibromyalgia, Woman’s and Men’s  health Issues, Diabetes, Hypertension, Thyroid-Adrenal Syndrome, and Neuromuscular Pain Management; using Acupuncture, Osteopathic Medicine, Functional Nutritional Medicine, Homeopathy/Homotoxicology, Neural Therapy, and Ligament Regeneration Therapy

Contact: David J Zeiger, D.O., healthWorks-Integrative Medical Clinic 1165 N Clark St Suite 608 /Chicago Ill 60610 312-255-9444/9446 FX, E-mail; zeigerd@healthWorks imc.com

The above is intended for educational purposes only and is not intended to replace proper medical diagnosis or treatment.

*

Estrogen Toxicity Part 1

Estrogen metabolism, in women and in some men, play’s a key role in the regulation of health and disease. Research over the past 5 years has found that the way estrogen is metabolized-broken down in the liver and either recycled or eliminated through the small intestine, will trigger chemical events in cells that have a marked disease  potential. We see this in such health problems as endometriosis, obesity, PMS, infertility, osteoporosis as well as cancer of the breast , uterus etc.

Estrogen, progesterone, testosterone, DHEA and cortisone are ‘cousins’ of one another beginning with Cholesterol the ‘grandmother’ of all steroid hormones. The proper balance of these hormones is very important to maintaining ones health and hopefully preventing disease. Let’s look at some interesting facts today.

         80% OF WOMEN IN COMPLAIN OF PMS      20-50% OF WOMEN HAVE FIBROIDS

         80-90% OF WOMEN EXPERIENCE PERIMENOPAUSAL SYMPTOMS              

         PREMENOPAUSAL BREAST CANCER HAS INCREASED BY 30% IN THE LAST 30 YEARS   

         90% OF WOMEN HAVE MENOPAUSAL SYMPTOMS

         OSTEOPOROSIS EFFECTS MORE THAN 45% OF WOMEN OVER AGE 50

         HYSTERECTOMY AND BREAST SURGERY ARE THE MOST COMMON SURGERIES DONE IN MOST HOSPITALS

         HEART DISEASE AND BREAST CANCER IS INCREASING IN U.S. WOMEN

Women’s Health In 2002

These statistics do not hold for most of the women in other countries, due to lifestyle and dietary factors. This simple fact alone negates that there is not a pure genetic predisposition to these diseases as one has been led to believe. In contemporary medical dogma when 50% or more of a given population has a disorder and conventional medical science does not have a readily specific answer for it is “unofficially” considered “with in the norm”.

Today’s patients are increasingly more self-educated about their health and are not satisfied with accepting a “normative” explanation for any malady that affects their health and happiness. Nor should they!

Within the past decade more research has been directed at understanding and measuring the minuscule levels of these hormones –chemicals in our bodies that communicate important pieces of information between the cells of the various organs in our body. These chemical messengers tell our body how to respond to stress, how to heal after trauma or infection, control our cravings for carbohydrate, regulate our body fat , even alert us to potential problems that could threaten  our the health like cancer.

Measuring for Hormones

Physicians have relied on the results of blood testing for everything from bacterial infections to infertility. The inherent limitations of these tests are well known, yet often not addressed.  In the case of hormone analysis there are a number of important factors that make serum (blood) testing poorly representative of the actual amount of ‘tissue levels’ of hormone affecting adipose (fat) cell, breast, uterus, skin, brain etc.

A blood test of serum hormones mostly measures the amount of wrapped up or medically speaking ‘bound’ hormone (sex hormone binding globulin-SHBG). This is not representative of the true amount of free or ‘unbound ‘hormone available to tissues. Serum testing therefore has some inherent limitations in providing clinically useful information.

Salivary measurement of steroid hormones provides the following advantages. IT measures the ‘free’-unbound active hormone, there is no SHBG found in saliva, salivary levels of hormones correlate well with unbound serum hormone levels, collection is easier and in the case of either a menstruating or menopausal woman a more accurate representation of the individual’s actual levels of estrogen and progesterone can be evaluated prior to hormone replacement therapy if so is required.

Sources of Estrogen

If our current measurements of estrogen levels are suspect then are women in menopause for example deficient in estrogen as previously thought? The answer would surprise you –NO! In most situations current clinical research for the past decade has documented that majority of women especially in the United States are in relative predominance of estrogen to progesterone levels in their bodies. This is due in part to a physiological lack of progesterone production, the presence of xenoestrogens (chemicals, a  majority  of which  come from plastic waste, that compete with and mimic your own estrogen) and estrogen augmentation. The key sources of such added estrogen is the effect of stress which increases estrogen production through elevated cortisol levels from the adrenal gland, the over use of birth control pills and finally the presence of low dose estrogen (as well as testosterone, dhea, even progesterone) found ‘hidden’ in about 80% of the over- the- counter cosmetics ie facial creams, lipstick, toners, foundation etc!

Biologically there are three principle Estrogens: Estriol-highest amount in pregnancy Estrone –made in fat tissue and Estradiol-made by the ovary. The function of estrogen:

Growth of endometrial tissue Growth of follicle into egg Growth of breast tissue

 Support vaginal tissue  Develop sex characteristics  Stores fat

 will decrease metabolism by interfering with thyroid metabolism

Progesterone is made by the ovary after ovulation as well as to some extent by the adrenal gland. Progesterone functions as:

  Promotes gestation  Natural diuretic Uses fat for energy   

 Natural antidepressant  Restores sex drive  Promotes cell differentiation

 Decreases estrogen induced overgrowth of cells-ie potential cancer cells

 Symptoms of Excess Estrogen

 BREAST TENDERNESS  DEPRESSION, FATIGUE, POOR CONCENTRATION

 ENDOMETRIOSIS  FIBROCYSTIC BREAST  PMS

 FIBROIDS  WATER RETENTION AND BLOATING

 FAT GAIN AROUND HIPS AND THIGHS  BREAST AND UTERINE CANCER

Note: the above comes directly off the Premarin™ package insert.

What does Progesterone excess cause??  The same symptoms as estrogen excess!

Provera™ is a progestin, not biologically nor chemically the same as progesterone. It was created back in the 1950’s to decrease the cancer promoting effect of estrogens. However, among it’s major long-term effects are the following: Promotes endometrial shedding-bleeding, no positive effects on gestation and is a teratogenic –causes birth defects, CREATES PROGESTERONE DEFICIENCY, increases sodium and water retention, depression, weight gain, hair loss and breast tenderness.

What Are the Results of Hormonal Imbalance?

 PMS  Fibroids  Endometriosis  Breast pain  Perimenopause  Menopause

 Osteoporosis  Breast, Uterine and Ovarian Cancer  Infertility

Hormone Balance –The Next Step

Getting a baseline measurement of your hormone levels prior to beginning management of any problem that could be hormonally related is a good starting point. Ask your health practioner about salivary hormone testing. One of the most reliable salivary testing laboratories is Diagnos-Techs™Inc. www.diagnostechs.com.

Even if your cosmetics state they are free of any animal products and are all natural etc check with a physician who does salivary hormone testing to make sure you are not inadvertently dosing yourself unnecessarily with hormones.

Nutritional Basics

Diets high in cruciferous vegetables like broccoli contain indole -3 -carbinol. This naturally occurring substance has been found to favor estrogen breakdown into non carcinogenic forms and improve on the proper elimination of excess amounts of estrogen. Lignans found in flax seed  as well as soy isoflavones will also help to regulate and normalize hormone production and detoxification.

Chasteberry , an herb, will help to normalize progesterone levels in the presence of  estrogen dominance. Femmorhagia™ ,by Orthomolecular contains a high potency standardized extract along with dong quai, yarrow, Ladies Mantle and Motherwort. Salivary hormone testing has confirmed this effect.

In the next article I will discuss the issues of acquired obesity, osteoporosis, heart disease and cancer. I will also present possible therapeutic options available through a thorough integrative medical approach to improve your chances of avoiding as well as treating these diseases.

To life and good health,

David J Zeiger, D.O.

Hello world!

This is my first blog. So in the interests of ‘just getting something out there’ I thought it be appropriate for me to first introduce myself. Yes , this is repeated on my About page for future reference. So again , Hello .. I will be making my first offical blog post in the next week. If in the meantime you have any questions , information , thoughts etc  please subscribe and forward these on to me.

I am an Integrative Physician board certified in Family Practice ,practicing for 20 years in  Chicago. I have studied ,explored  and applied a variety of wholistic medical therapies and philosophies for over 30 years.My earliest studies began in humanistic and transpersonal psychology  at the California Institute of Transpersonal Psychology  in the mid 70’s . Over time this lead me into sleep research specifically sleep apnea ,at the Stanford Sleep Center working  for 4 years with Christian Guilminault,M.D., William Dement, M.D. and others.

The mind-body dynamic intrigued me so much that I was instinctively drawn  to the philosophy of medical healing developed by Andrew Taylor Still,M.D. the founder of Osteopathic Medicine.

After completing my residency in family practice I worked  almost 90 plus hours a week in a HMO clinic . It was here that I began family medicine from clinic to hospital ,urgent care to  even house calls. I was delivering babies, doing general pediatrics , in office gynaecology, internal medicine and osteopathic manipulation . I would see typically 40-60 patients a day.I was on call usually every 4-5 weekend  from Friday until Monday morning and delivering 4-5 babies a month!  Even with that heavy of a clinic schedule I would manage to spend about 15 -30 minutes with every patient .This was unheard of even to this day of HMO medicine. My naiveté of the health care system  in the HMO model was replaced rapidly as I sat on patient chart reviews mandated by HMO insurance carriers and carried out by their hired ‘hitmen/women’ . I will cover this in more detail in my blogs  later .    It was there I  decided that medical care has a moral imperative to root out the cause of disease and not just treat symptoms . It is my personal belief that a physician’s primary role is to aid in helping  nature heal if not cure disease  ,to think outside the standard western  medical paradigm and by whatever positive  reasonable means available, palliate the pain and suffering of the individual while maintaining  the dignity and quality of the indiviudal’s life .Over the last 20 years I have traveled and studied with many truly dedicated ‘healers’ of many of the healing professions.

This blog is dedicated to the thousands of  women and men healers be they physicians , nurses, acupuncturists, nutritionists , homeopaths, reiki , massage therapists , physical therapists around the world   that work so tiresly  providing  health guidance and alternative healthcare options  to millions of people .In turn this blog  is a forum  for anyone with a sincere  interest in learning about the latest advances in integrative medicine. In the course of my years of practice I have and am actively learning about new  therapeutic approaches from around the world. I network with hundreds of  health care providers daily via internet and am on a number of professional health care /integrative medical listserves. I hope my posts will provide an interactive exchange  of questions and ideas  on ways one can optimize their health ,resolving their dis-ease without always resorting to BIG PHARMA .

I do encourage controversy . There is an old Zen saying that was shared with me before I went to medical school, “the greatest sin is to have desire and no hope”!

May the soul that is healed help heal the world

David Zeiger,D.O.FAAFP