Fibro Treatment Protocol

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http://www.drwong.info/drw-fibro.htm

Fibromyalgia; its Root Cause of Pain - Fibrosis. with Treatment Protocols for Recovery.

By: Wong N.D., Ph.D.,Member World Sports Medicine Hall of Fame

When speaking on fibromyalgia, physicians at conferences talk about the depression, the unrelenting pain, the extreme fatigue and the mood swings. As for treatments; they speak of antidepressants, narcotic painkillers and eventually vitamin supplementation. In other words, they are speaking on the results of the fibromyalgia and on minimizing the symptoms of those results. No one, I repeat, no one speaks on the root cause of fibromyalgia; the reason why this disease is called "Fibro" myalgia in the first place! That root cause is fibrosis: fibrosis that has grown into the body's voluntary muscles and its micro circulation.In this brief piece I will outline the most successful treatment plan for Fibromyalgia to date. Having seen FMS treated here in the states, having spoken to leading researchers in Germany on FMS, and having spoken to hundreds and hundreds of Fibro Myalgia patients; I have not seen any treatment protocol work as well as this one to restore full function, strength and mostly pain-free range of motion. It is so rare for FMS patients to be virtually pain and fatigue free that I believe it is a moral imperative that this multi dimensional approach and its rational be shared with the rest of the health care community.

In 1990 I became a Chronic Fatigue / FMS patient myself. It was then that my search began for something to make performance of the activities of daily life and getting through the workday easier. The breakthrough came with a realization as to

The source of the pain in FMS and The source of the fatigue.

Once this concept was grasped, treatment plans were devised to address the issues involved. The performance and application of these plans are not easy and they are not without some discomfort. However, for those FMS patients who truly seek to get better, the treatment will work.

Here though we need to address an issue that is sure to cause some controversy. As most of us who have dealt with FMS patients know some of the patients do not really want to get better. They are achieving secondary gain and seek to continue manipulating their families or manifesting their attention getting Munchausen's Syndrome. For those patients there is no hope. They will doctor hop, criticizing doctor A to doctor B, they will complain loudly that nothing is working for them while not taking an active role in their healing. For these patients I have nothing to offer. This program is for those patients who do want to take an active role in their well being and truly want to get back into the game of life.

(Realization #1) Where does the Fibro in Fibromyalgia come from and what does it do?

This is the least looked at question in FMS! OK, we call the condition "Fibrotic Muscle Pain" syndrome. (For the layman, that's what Fibromyalgia means). Have we ever addressed the fibrin component of this condition? We've danced around it acknowledging that the masses of fibrin do appear on contractile tissue. We squeeze them, manipulate them, attempt to Rolf them and basically tear or realign them, but why are they there? What physiological condition precipitated their existence? And more importantly, can that condition be reversed and in turn reduce the Fibrotic component.

Why am I concentrating so much on the fibrotic aspect of this condition? Easy - it's what causes the pain and what causes the pain medications not to work! Most of us have been baffled as to why the strongest of pain medications don't seem to scratch the surface of the unrelenting pain FMS sufferers have. This leads many in the allopathic community to think that the pain is strictly psychosomatic. Growing too much fibrin (scar tissue) on contractile (muscle) tissue binds down that tissue causing a localized ischemia. Just as the ischemic pain from an MI (Myocardial Infarction or heart attack) cannot be dealt with by applying pain medication; the pain meds do nothing to relieve the ischemia caused pain in FMS patients! This condition is made worse because the micro circulation to the effected areas are "clogged", plugged if you will, with fibrin (the same scaring effect that forms the matrix for arteriosclerosis in the larger blood vessels). To relieve the pain of ischemia, ATP production in the effected tissues must be increased to provide for anaerobic respiration of the cells during the period of oxygen depletion. Then things must be done to increase oxygen levels so that full aerobic respiration of the cells is restored!

But first, why is the fibrin there in the first place? While Max Wolf, MD, Ph.D. (x7) was teaching at Fordam and researching at Columbia, he came to an interesting discovery most of us are only partially familiar with. This author of the first medical textbook on endocrinology found that old age begins at 27 (most of us learned that in physio). This is triggered by a down turn in the body's production of proteolytic enzymes. Aside from their familiar but secondary role in digestion, proteolytic enzymes have four primary functions in mammals:

First line of defense against inflammation. Enzymes cleave Circulating Immune Complexes it sees as being excessive in number or exogenous to the body. Balances the bodies repair mechanism preventing excessive fibrin from being deposited in wounds, fractures and across joints or moving parts. Cleans the blood of necrotic debris and excesses of fibrin. Modulates immune function as an adaptogen. (1,2).

In the States the notion still exists that enzymes are too large of a protein to be absorbed whole. Studies and clinical experience in Europe over the last 40 years show that they are absorbed and they are absorbed well. (2). We have no trouble believing that salmonella can be absorbed whole and salmonella is 5 times larger then the largest enzyme!

Women (who comprise 60+% of FMS patients) seem to suffer more from fibrotic conditions than men do. This can be due to estrogen dominance. Estrogen is a known fibrinogenic agent and has been found to be the spark that induces fibrotic conditions of the breast, ovaries and uterus. These days everyone male and female seems to be estrogen dominant. Estrogen "pollution" from farm and industrial chemicals, insecticides and petroleum fumes mark the greatest contributors. Also, more and more people are increasing their estrogen load by consuming soy with its isoflavones, which strengthen the effect of the body's own estradiol. (3,4,5). Oral supplements such as DIM (Diindolylmethane), Maca and topical creams of natural Mexican yam progesterone are used to reduce estrogen dominance. Unbalanced fibrin deposition is seen in various conditions including Fibrocystic Breast Disease (FBD) and postoperative scar tissue formation in seniors. Though it has been known since the 50's that Chymotrypsin and Trypsin were fibrinolytic and as such are used to fight Deep Vein Thrombosis, it was a study on the European use of proteolytic enzymes in the treatment of FBD that caught my eye. In these peer reviewed studies on FBD, 124 women in group #1 received systemic proteolytic enzymes 10 tablets twice a day, 123 women in group #2 received the same amount of systemic enzymes plus 1000 iu of Vitamin E, these were then compared to a control group (#3). In 6 weeks of treatment, the women in group #1 (the enzyme only group) 65% were symptom free and ultrasound studies found these women to be clear of FBD. In group #2 (the vitamin E and enzyme group) the results were even better with 85% of the subjects being free and clear of the FBD and it's symptoms. Other studies using different systemic proteolytic enzymes produced much the same results. (6,7).

Systemic enzyme preparations are widely used across Europe and Asia to reduce edema and prevent postoperative scar tissue build up in those who have had surgery. (8). That being the case, would these combination enzyme products work at reducing the fibrin that binds down muscle bundles and lyse, or eat away, the fibrin clogs that are closing off the microcirculation? (9).

So we have a disease based on multidimensional problems coming together to create a multidimensional problem. The beginnings of a treatment plan seem to be jelling.

Decrease estrogen dominance. Increase enzymic action in the body.

Indeed, that seemed to work. Within 3 to 6 weeks, the few patients who used the topical progesterone creams did lower their estrogen dominance (as tested by saliva). Also, they reported much lower pain levels and freer movement. But they were still extremely fatigued. This led to the second revelation.

While not all FMS patients have an Epstein-Barr Virus (EBV or Mononucleosis) infection, I believe that in Vivo muscle biopsy studies would show that like EVB, patients, they had dramatically reduced numbers of mitochondria and nuclei in their muscle cells. This result directly affects how much ATP the body manufactures as most of the body is dependent on muscle produced ATP. While an in Vivo biopsy study would be interesting in terms of measuring the fibrin, nuclei and mitochondria in the most painful areas during the course of treatment, I don't think that many researchers would want to do such a study and, that enough FMS patients would volunteer to put themselves through the added pain of such a thing. What could be done to increase the numbers of nuclei and mitochondria in muscles and thereby increase ATP production? Also, how do you support ATP production in the mean time? These answers come from Exercise Physiology. While exercise studies have been done with FMS patients in the past, the results seemed to show no improvement and a general deepening of the pain and fatigue. The researches mostly used cardio vascular or high intensity forms of exercise to train the test subjects. Aerobics (Cardio Vascular Pulmonary exercise) or Nautilus type High Intensity Training (HIT) were poor choices of exercise to use with FMS patients for two reasons 1) they use up too much energy leaving the test subject with no reserve. 2) Cardio Vascular capacity has no bearing at all on the performance of ones Activities of Daily Living (ADL's)! Think about it. All ADL's are strength tasks and exercise physiology classifies them as being so. CVP exercise only has a bearing on ADL's with Chronic Obstructive Pulmonary Disease patients.

It is widely known in Exercise Physiology, that Progressive Resistance Exercise (PRE) builds large numbers of mitochondria and nuclei as a normal response to the work. PRE can be done in short bouts (sets) with relatively large rest segments in-between, (2 to 5 min.) and therefore will not drain a patient of their energy reserves. PRE has a direct bearing on the patient's performance of their ADL's in everything from arising from bed or the toilet to blow drying their hair or lifting a skillet. While the emphasis in Physical Therapy has always been in developing endurance in patients, strength must always precede endurance. If not, what is there to endure? The sorriest sight in rehab wards is seeing a PT trying to coax a little old lady down the corridor while she leans heavily on her walker. Would it not be better on the body and easier on the patient if PRE work for the pelvis and lower extremities were done prior to attempting the endurance walk down the hall? Physiological law of Specificity of Exercise states that - "Performance of a task only builds limited strength in that task". That is why sports medicine has the principle: "don't play to get into shape - get into shape to play".

What type of PRE mode of training is best to use with these patients? We need to get back to basics. Here, the work of Philip Rasch Ph.D. is the guiding light. Dr. Rasch (who headed the Naval Human performance Laboratory in the 60's and 70's) found that the natural ratio of the body is to have 70% of the lower extremities (LE) and pelvis muscles push and 70% of the torso and upper extremity (UE) muscles pull. Watch a baby while crawling; uppers pull and lowers push. Therefore, if you found the most effective pushing exercise for the pelvis and LE's and the most effective pulling exercise for the torso and UE's you would have worked 70% of the muscles of each with just two exercises! The only thing Rasch had left was to strengthen the midsection for torso and pelvic stabilization. Those principles formed the basis for the Marine physical fitness test.

This limitation of work to three PRE exercises done twice a week does not excessively drain patient's energy reserves. Within 8 weeks, not only will there be improvements in strength and performance in ADL's but more importantly, increases in the number of mitochondria and nuclei. If during this early period, supplementation with Ribose is done to the tune of some 5 gms. tid or qid, then the ischemic tissues will be better fed to produce ATP. (10). Under no circumstances should a patient do more than 3 sessions of PRE work a week. Overtraining degrades immune function. Although more exercises can be added as the patient becomes better able in energy to do them.

There is one further positive effect. Exercise physiology teaches that for every increase in muscle tone there is a 40 % increase in vascularization. This increase in the number of microcirculation pathways and of the lumen of the existing blood vessels vastly improves circulation of oxygenated blood to the effected areas! Combine that with the fibrinolytic action of the Vitalzym enzymes eating away at the restrictive bonds overlaying muscle, plus the unclogging effect the enzymes have on fibrin closing up the micro circulation and you have well fed and oxygenated tissue that is free of pain.

Basic Treatment Protocol:(For the laymen: sid = once a day, bid = two times a day, tid = three times a day, qid = four times a day).

Oral Supplements;Vitalzym - 3 to 5 capsules tid.Magnesium - (to reduce spasm, night cramps and nervous leg syndrome) 400mg with each meal and 400 - 800 before bed. Ribose - 5 gms. tid or qid.

To reduce estrogen dominance in general:DIM - 2 capsules bid or tid.

To reduce estrogen dominance in women;Natural progesterone cream for women - 1 measured application bid 12 hours apart.

To reduce estrogen dominance in men;Natural progesterone cream for men - ½ measured dose sid.

Men and Women can also take:Pharmaceutical grade Maca - 1 scoop bid.

Male and female patients also need to have free testosterone levels tested and their T levels raised to those of a normal man or woman of 20. This greatly increases both physical strength, mental drive and is the greatest anti depressant yet known. The DIM and pharmaceutical grade maca will ensure that none of the testosterone is converted into estrogen as will the progesterone creams. The fastest progression in FMS patients I've seen are in those who have been administered testosterone regularly.

Exercise:Work is to be done with a resistance equaling 70 to 80% of the patients 1 Rep Max (1RM) for that exercise. The first week the patient performs 5 reps on each set. The second week 6, the third week 7. At week four the resistance is increased by 10 lb. and the reps return to 5 to begin another progression. Low repetitions with heavy resistance builds strength faster than the medium numbers of reps with medium weights the bodybuilders use. These patients are strength training not bodybuilding, the principles are very very different; if in doubt consult a degreed Exercise Physiologist (NOT a physical therapist). Low resistance and many repetitions builds endurance but does nothing to truly enhance strength and does nothing to increase the numbers of mitochondria.

Leg presses - 3 sets of 5 to7 repetitions. Shoulder width or wider stance with the feet outwardly rotated some 40 degrees.

Front Pulldown - 3 sets of 5 to 7 repetitions. Hands are supinated facing the patient (Chin Up grip). Hand placement is shoulder width and the bar is brought down to just below the chin. Use this grip only as the pronated wide grip pulldown that is standard for bodybuilding has only half of the Range of Motion (ROM) and IS very injurious to the rotator cuff. There are 60 to 80 degrees of ROM in the Frontal Plane with the bodybuilding (Pull Up) grip while there is 120 to 160 degrees of ROM in the sagittal plane with the proper supinated (Chin Up) grip. For many biomechanical reasons too lengthy to go into detail here the Chin Up grip is a superior and much safer exercise.

Crunch Sit Up - 3 sets to failure (muscle spasm felt in the superior layers of the Rectus Abdominis). orAbdominal Machine - 3 sets of 5 to 7 repetitions.

This program is absolutely safe, non-invasive and produces results within weeks. Initially for the first 2 to 3 weeks, exercise muscle soreness may add to the pains patients have to deal with, but usually the anti-inflammatory effect enzymes and magnesium mitigate that wonderfully. The patient needs to be encouraged to stick with the protocol. Positive results are usually had in 6 to 8 weeks. The patient must continue on their exercise and supplements for the effects to continue. All of the supplements named here are safe to take for life. This protocol can be combined with what ever other treatment the physician deems needed. The only precaution that needs to be given is to watch the Pro time on patients using any of the prescription based blood thinners along with the Vitalzym as the enzymes enhance their action. Be well.

References:

1) Wolf, M., Ransberger K.; Enzymtherapie, Vienna, 19712) Enzymes a drug of the Future by Dr.'s Wrba and Pecher. Published in Munichby Eco Med. 1) Breinholt V, et al.; Estrogenic activity of flavonoids in mice. The importance of estrogen receptor distribution, metabolism and bioavailability. Food Chem Toxicol 2000 Jul; 38(7): 555-564.2) Casanova M, et al; Developmental effects of dietary phytoestrogens in Sprague-Dawley rats and interactions of genistein and daidzein with rat estrogen receptors alpha and beta in vitro. Toxicol Sci 1999 Oct; 51(1): 236-244.3) Stahl S, et al; Phytoestrogens act as estrogen agonists in an estrogen responsive pituitary cell line. Toxicol Appl Pharmacol 1998 Sep; 152(1): 41-48. 4) Shceef W.: Gutartige Veranderungen der Weiblichen Brust. Therapiewoche (1985) 50, 5090.5) Kee WH. Tan SL, Lee V. Salmon YM. The treatment of breast engorgement with Serrapeptase (Danzen): a randomized double blind controlled trial. Singapore Med J. 1989:30(l):48-54.Carillo A. R.: Klinische Untersuchung eines enzymatischen Entzundungshemmers in der Ufallchiurgie. Arztl Praxis 24 (1972) 2307.6) Edington D. W., Edgerton V.R.: The Biology of Physical Activity. Houghton Mifflin Company 1976. 63-64.7) Ernst E., Matrai A.: Oral therapy with proteolytic enzymes for modifying the blood rheology. Klin. Wscht. 65 (1987), 994.8) Pliml W, et al; Effects of ribose on exercise induced ischaemia in stable coronary artery disease. Lancet 1092 Aug 340, 507-508.