Book an Appointment with Dr. Satish Cuddapah

The Coagulation system, which is in our blood, is a reaction responsible for producing material which in normal non-pathologic states prevents excessive bleeding should a blood vessel be traumatized in any way. In patients with Chronic Fatigue Syndrome and/or Fibromyalgia, an excessive amount of a substance called soluble fibrin monomers (not blood clots!) are produced, which over time tends to form a coating along the inner walls of our blood vessels. This coating prevents oxygen, which normally travels from inside the blood vessel across the vessel wall to the muscles from occurring. Eventually this leads to chronic muscle oxygen deprivation which in turn leads to increased aches, pains, overall weakness, insomnia and brain fog.

In addition, the coating along the inner walls of the blood vessels also allows for chronic infections (that would otherwise be killed off by our immune system or antibiotics) to live and thrive within these “thickened” walls because these walls now provide a coat of armor to protect these infections from any harm, which is great for the infection but bad for the patient!

Routinely this can be checked by doing blood work; however, treatment of these thickened walls typically involves either natural oral therapies for a few months, or a trial of injectable heparin given twice daily.  Heparin has provided fairly noticeable improvement in pain, often being able to stop taking strong narcotic pain medications for good. Treatment of this condition typically unmasks previously hidden infections, therapy needs to be given fairly slowly to minimize what is called a die-off reaction from occurring, in which a patient experiences transient flu symptoms. This scenario can be avoided by your doctor dosing the heparin at a low amount and gradually increasing it as tolerated, getting lenty of rest, drinking plenty of fluids, and controling symptoms with Tylenol or Motrin.

Book an Appointment with Dr. Steven Lipschutz

Quercetin is a natural antioxidant found in red grapes, red apples, green tea, onions, and broccoli.  It belongs to a class of compounds called bioflavenoids, pigments found in thousands of plants. Quercetin is benefecial in reducing bladder irritation and improving the quality and duration of sleep. Quercetin is also believed to enhance visual performance, and has been claimed to improve upper respiratory symptoms in allergies and colds. This effect is thought to be the result of a stabilizing effect on the break-up of certain infection-fighting cells called mast cells. These cells contain histamine, which produces many of the symptoms that we associate with colds and allergies. In the presence of a chemical or biological irritant, these cells rupture and release their contents into the circulation at the site of irritation, producing pain, swelling, and increased secretion of fluids in the area.  Quercetin is believed to prevent the rupture of the cell walls of these inflammatory mast cells.

Now, for the first time, a placebo-controlled study has demonstrated the beneficial effects of a natural antioxidant on reducing illness.  Dr. David Neiman, a professor at Appalachian State University’s Department of Health, Leisure, and Exercise Science, conducted a 5 week study with 40 athletes to test the effects of Quercetin on the immune system under conditions of physical stress.  Half of the study group received 1,000 mg of Quercetin daily, while the other half received a placebo.  Three weeks into the study, the athletes rode a bicycle three hours a day for three days to the point of exhaustion. After the extreme exercise period, 45 percent of the placebo group reported illness, versus only 5 percent of the Quercetin group. Furthermore, an alertness test was given to both groups after the exercise period, where there was significant performance difference between the groups, with the Quercetin group able to maintain the ability to react to the alertness tests when exhausted.

This study specifically proves Quercetin’s  beneficial effect on health under conditions of physical stress. Dr. Nieman plans further studies in an attempt to define the benefits of Quercetin under conditions of mental stress as well. Fibromyalgia and CFIDS are characterized by unstable and overreactive immune responses, and the potential benefits for most of our patients through Quercetin are clear.

Book an Appointment with Dr. Satish Cuddapah

Too many of us in today’s society simply do not get enough sleep. Our bodies are designed to work optimally when we get at least 8-9 hours of quality sleep. Most of us only get  6-7 hours per night at best (doctors are especially guilty about this one!). However, poor sleep contributes chronically to numerous medical conditions. Most obvious of course are symptoms of brain fog and mental clarity that we’ve all experienced at some time or another when sleep deprived. Several key hormones are sustained at the required levels for optimum function only when we get the required amount of sleep.  Sleep apnea, a condition where one momentarily yet frequently stops breathing while asleep, causes repeated interruptions of sleep throughout the night, making sleep very “inefficient”. In the long term, this can lead to chronic depression, weight gain, slowed metabolism, high blood pressure, possible onset of diabetes, and abnormal hormone levels, especially growth hormone; which is a key hormone adults and children need to allow proper muscle tone and better cell endurance.

Treatment for these various sleep disorders depends on the type of abnormality contributing to poor quality sleep. A comon sleep test is called a sleep study, which is a test where one spends a night in a sleep center and brain wave activity is monitored by a physician to evaluate for underlying apnea (most people do not ever recollect having this condition since they are still in a deep sleep to remember momentarily stop breathing).  In addition, the Physician will evaluate to see if the patient is receiving all the needed stages of sleep including REM.  There are various treatments available to those suffering from sleep disorders.  Pharmaceutical, as well as natural therapies can be utilized with success. In addition, sleep hygiene is very important, including sleeping at consistent times each night and utilizing the bedroom for only sleep and intimate activity. Many of my patients, after having their sleep issues properly addressed note a 30-40% improvement in their overall well being which in turn improves their chronic medical issues.

Book an Appointment with Dr. Steven Lipschutz

Quercetin is a natural antioxidant found in red grapes, red apples, green tea, onions, and broccoli and belongs to a class of compounds called bioflavenoids, pigments found in thousands of plants. Quercetin is benefecial in reducing bladder irritation from various causes and improves the quality and duration of sleep for patients. Quercetin is also believed to enhance visual performance, and has been claimed to improve upper respiratory symptoms in allergies and colds. The effect is thought to be the result of a stabilizing effect on the break-up of certain infection-fighting cells called mast cells. These cells contain histamine, which produces many of the symptoms that we associate with colds and allergies. In the presence of a chemical or biological irritant, these cells rupture and release their contents into the circulation at the site of irritation, producing pain, swelling, and increased secretion of fluids in the area. Quercetin is believed to prevent the rupture of the cell walls of these inflammatory mast cells.

Now, for the first time, a placebo-controlled study has demonstrated the beneficial effects of a natural antioxidant on reducing illness.  Dr. David Neiman, a professor at Appalachian State University’s Department of Health, Leisure, and Exercise Science, conducted a 5 week study with 40 athletes to test the effects of quercetin on the immune system under conditions of physical stress.  Half of the study group received 1,000 mg of quercetin daily, and half received placebo.  Three weeks into the study, the athletes rode a bicycle three hours a day for three days to the point of exhaustion. After the extreme exercise period, 45 percent of the placebo group reported illness, versus only 5 percent of the quercetin group. Furthermore, an alertness test was given to both groups after the exercise period, and there was a significant performance difference between the groups, with the quercetin group able to maintain the ability to react to the alertness tests when exhausted.

This study specifically proves quercetin’s  beneficial effect on health under conditions of physical stress. Dr. Nieman plans further studies in an attempt to define the benefits of quercetin under conditions of mental stress as well. Fibromyalgia and CFIDS are characterized by unstable and overreactive immune responses, and the potential benefits for most of our patients through Quercetin are clear.

Book an Appointment with Dr. Spurlock

The Herxheimer Reaction was discovered by two German dermatologists (Jarisch & Herxheimer) when studying the reactions produced by treating syphilis with mercury.  The reaction is seen in 50% of primary syphilis patients and 90% of secondary syphilis patients.  It also has been seen in several other infectious treatment protocols for Lyme Disease, Candida albicans, CMV (cytomegalovirus), EBV (Epstein Barr Virus), Q fever and several other infections.  The Herxheimer reaction (also known as Jarisch-Herxheimer or herx) occurs when large quantities of toxins are released into the body as bacteria die, due to antibiotic treatment.

Typically the death of these bacteria and the associated release of endotoxins occur faster than the body can remove the toxins via the natural detoxification process performed by the kidneys and liver. It is manifested by fever, chills, headache, increased joint pain, myalgias (muscle aches), a drop in blood pressure, hives, and exacerbation of cutaneous (skin) lesions. Duration in syphilis is normally only a few hours but can be much longer in other diseases. The intensity of the reaction reflects the intensity of inflammation present.  The Herxheimer Reaction has shown an increase in inflammatory cytokines during the period of exacerbation, including tumor necrosis factor alpha, Interleukin-6 and Interleukin-8.

Worth noting is that hives and rash are sometimes mistaken for an allergic reaction. It is up to one’s physician to determine this, but with close observation and the use of medications such as Benedryl often prevents stopping antibiotics prematurely. In more severe cases of the Herxheimer Reaction, a reduction of the dosage or temporarily cessation of the treatment is an alternative.  Many times, patients think they have a bad reaction to an antibiotic, when in reality, they are actually having the Herxheimer reaction.

The timing, frequency and duration of the Herx reaction are individualistic and Herxheimer can occur within days to weeks after the onset of antibiotic therapy. In some patients they occur only once or twice (if at all) and with others continue throughout the course of treatment, usually lessening in severity. They can occur and are more often described in cycles (example: every 4 weeks) and have been reported to last from days to weeks.

It can be very beneficial to document these exacerbations. Some physicians use this as a guideline for treatment. Further it may help differentiate Herxheimer’s from the normal symptoms or progression of Lyme disease.
Herxheimer reactions can be very difficult on patients and affect compliance with therapy so supportive measures should be sought or utilized to lessen discomfort if needed. The use of aspirin, NSAIDs (non steroidal anti inflammatory drugs), pain medication, muscle relaxers, hot baths or others remedies can be appropriate. Of note, some have found Benedryl helpful even in the absence of rash or hives.  An herbal product, Burbur, has often been used with good success as well as Benicar (prescription blood pressure medication) in reducing Herxheimer reactions.

The good news is that the Herxheimer is thought to indicate that the antibiotics are indeed working and that following each worsening may bring about more improvement. However the lack of Herxheimer reaction should not cause anxiety if symptoms are improving.

Something often overlooked but can present with similar symptoms as a Herxheimer is Candida (yeast) infection. Treatment with acidophilus and, if needed, prescription medications such as Nystatin or Diflucan can be utilized.

Book an Appointment with Dr. Satish Cuddapah

Chronic yeast infections that affect multiple regions of the body are routinely overlooked when doctors approach patients with Chronic Fatigue Syndrome and/or Fibromyalgia. These infections typically occur when one’s immune system is compromised by this disease state and routinely caused by overuse of antibiotics and prednisone (steroids) to treat various inflammatory conditions. The yeast normally suppressed by one’s immune system and beneficial bacteria that may have been killed off by too much antibiotic use now have an opportunity to grow. Common symptoms of this condition include fatigue, muscle tenderness, diarrhea along with irritable bowel syndrome, premenstrual syndrome, and loss of sexual desire to name but a few. Lab tests to help doctors diagnose this condition are routinely inaccurate. Physicians most successful at making this diagnosis are by history and clinical exam.
 
Managing yeast involves dietary changes including avoiding free, refined sugar-containing products, breads, cheese, pasta, and potatoes. In addition, many times treatment with prescription antifungals is needed along with utilizing natural therapies such as oregano, uva ursi, and grapefruit and olive leaf extracts. The length of treatment will vary depending on the patient’s response but the usual duration is about 3 months.

Book an Appointment with Dr. Steven Lipschutz

Most of our patients have been to several medical specialists seeking help and treatment for their condition, and many have tried several holistic treatments, hoping to find relief.  The key to success in overcoming Fibromyalgia and Chronic Fatigue Syndrome is a comprehensive plan that addresses all the underlying isues that have overcome  previously healthy bodily functions.

The science and knowledge of conventional medicine is effective at treating acute and specific diseases, when there is one underlying cause and one treatment. The need for a different approach to chronic conditions is being acknowledged by the development of chronic care subspecialty disciplines, designed to improve medical care for complex, chronic problems like congestive heart failure and insulin-dependent diabetes. These are multifactorial medical problems requiring highly complex treatment plans. Similarly, our patients have multiple underlying causes and secondary body system malfunctions that have brought them to this point, and require a multitude of specific therapeutic interventions to correct them.

Recovery begins with nutritional support and sometimes repair of a yeast-infested gastrointestinal tract along with sleep disorders that must be corrected. The production of the Neuroendocrine system must be optimized and the imbalance of the immune system must be compensated, as it can result in impairment of many other organ systems. For some patients, chronic, smoldering infections must be treated, and can take a considerable amount of time. For others, a build-up of heavy metals in the body, or a heavy concentration of certain proteins, can be interfering with the natural passage of nutrients from the bloodstream into the tissues.

Book an Appointment with Dr. Arlyn LaBair

Many people with Fibromyalgia and Chronic Fatigue not only suffer from abnormalities of sleep architecture, but also from sleep apnea.  Using CPAP, also knows as continuous positive airway preassure therapy consistently and for longer periods of time appears to help patients with sleep apnea achieve better daytime alertness and normal functioning, according to the results of a study published in the June issue of Sleep.

“Evidence suggests that, to maintain treatment effects, nasal continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) needs to be used every night,” write Terri E. Weaver, PhD, RN, FAAN, from the University of Pennsylvania in Philadelphia, and colleagues. Many patients find it difficult to use CPAP due to problems like claustrophobia, restlessness (a subset of Restless Leg Syndrome), poorly fitting equipment, etc.

This study reiterates that our need for oxygen is number one, and getting low at night can compound the problems with sleep experienced in Fibro. Missing CPAP treatment for even 1 night can worsen daytime sleepiness, neuropsychologic performance and hypertension in patients that also have sleep apnea.

For more information on CPAP therapy, visit http://www.resmed.com/en-au/patients/treatment/treatment.html?menu=patients

Book an Appointment with Dr. Spurlock

Recently, an article in Parent’s Magazine talked about “Sugar Shock”.  The article portrayed basic healthy-sounding foods as being loaded with many more grams of sugar than what a normal person would suspect, especially in America.  You may believe that you are eating relatively healthy foods, when in reality; multiple grams of sugar have been added to enhance the flavor.  In fact, when European chefs come to America, they are “shocked” at the amount of sugar we use here in our recipes.  In contrast, when we go to Europe, we think their pastries are tasteless because they are not nearly as sweet as we are accustomed.  Food marketing in America has discovered that sugar greatly enhances the sales of almost all food.

As an example, whole wheat bread/bagels may contain added sugar.  You must read the labels carefully.  The issue is our taste buds may be so affected that they may not be able to tolerate the bitter taste of many green veggies.  The more added sugar in our diets, the less likely we are to eat grains, vegetables, fruits and dairy.  As it stands one third of American children are overweight, and as adults, these same children will have problems with diabetes, hypertension and high cholesterol, all of which increase the risk of heart disease.

We need to consider various options to sugar including 1) Instead of flavored yogurts, try plain yogurt with mix-ins (honey, fruit or raisins).  2) Instead of canned fruit, try chopping up fresh fruit.  3) Instead of maple syrup, try topping pancakes/waffles with preserves.  4) Instead of sweetened salad dressings, try Italian or Ranch.  5) Instead of barbeque sauce, try dry rubs or taco seasonings.

Sugar not only breeds ongoing yeast problems, but for those suffering with Fibromyalgia or Chronic Fatigue Syndrome sugar may help push Tryptophan into the brain, aiding the in the production of serotonin; however, it will also lead to weight gain.

Book an Appointment with Dr. Satish Cuddapah

There has been a lot of talk lately about Chromium Picolinate, a natural supplement that is growing in popularity. Chromium supplementation has been shown in several studies to reduce insulin resistance because it enhances your glucose metabolism. Insulin resistance is when the body has a diminished ability to utilize insulin to metabolize glucose. Insulin resistance is highly correlated with pre-diabetes, obesity, elevated cholesterol, and increased cardiovascular risks. In general, it can be difficult to meet the body’s recommended daily dietary intake of Chromium since most American diets contain very low amounts of chromium, and unfortunately, most of this is usually highly refined foods such as flour and sugar. In addition, absorption of chromium can be adversely affected by food and drug interactions, age, and stress, which makes it even more difficult for the body to ingest Chromium.

This is where Chromium Picolinate steps in. It can work in as little as 6-12 weeks, and its safety profile in long-term studies has been well established. Although multivitamins may contain chromium in the form of Chromium Chloride, this form can still be difficult to absorb. Chromium Picolinate is a more highly bio-available form so it absorbs much easier than Chromium Chloride. In addition, studies have shown when used as a part of a weight loss treatment program, it can be very helpful as it helps the body utilize its insulin more efficiently. Through our centers, Chromium Picolinate is available as Diaxinol, and may be a supplement worth discussing with your doctor to see if it may be right for you.