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The Fibromyalgic Syndrome
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FIBROMYALGIA is a
complex, cyclic and chronic disease. It is different from other illnesses as it
does not affect one particular type of cell or part of the body. Instead, it is
manifested by a myriad of apparently unrelated symptoms. In addition there are
an almost endless number of combinations, with daily variations. Each patient's
prime complaints are different, and patients find it difficult to pinpoint
exactly when the symptoms began. With the progression of the disease, there are
conditions which are in common to all patients: fibromyalgia affects family,
professionnal life, relationships, disturbs the mental state.
The most common symptoms are the
following:
Central Nervous System:
fatigue, irritability, nervousness, anxieties, depression, impaired memory and
concentration ("fibrofog"), apathy, insomnia, frequent awakening during the
night, non-restorative sleep, blurring of vision, dizziness, vertigo or
imbalance, headaches, migraines.
Musculoskeletal: generalized
pain and stiffness in muscles, tendons and ligaments, which are often worse on
waking in the morning. Pains can assume any form and intensity, such as
throbbing, burning, stabbing, stinging, grabbing, or any combination of these.
Injured or old operative sites are often most affected. Temporomandibular joint
pain is common, associated with difficult chewing, and excruciating facial and
head pain originating in the neck (generalized headaches, or neck-occiput, or
half-head). In addition there are excruciating pains in the ankles. Joint pains
with or without swelling are frequent (elbows, wrists, fingers, knees). Muscles
can often be seen twitching, and the restless leg syndrome can make it
impossible to find a comfortable spot. Patients also complain of feelings like
electrical impulses in their muscles, and general weakness.
Gastro-intestinal: in
60% of the cases, irritable bowel syndrome (IBS) includes gas, bloating,
constipation, diarrhea, (alternance diarrhea-constipation), abdominal cramps.
Occasionally nausea, stomach pain and burning, hyperacidity and abnormal tastes
occur.
Genito-urinary: 65%
of the women have genito-urinary pains. Vulvodynia (or vulvar pain syndrome),
in 15% of the cases, includes vaginal spasms or cramps, raw, irritated, burning
vaginal lips (vulvitis) or opening (vestibulitis) and painful intercouse
(dyspareunia). In 25% of the cases, pungent, concentrated urine, frequent
urination, bladder spasms, burning urination (dysuria) with or without repeated
bladder infections and chronic interstitial cystitis are frequent
manifestations. Intense pre-menstrual syndrome (PMS) and uterine cramps are
often presenting symptoms. All symptoms of fibromyalgia are worse
premenstrually.
Dermatological: crawling
feelings, electric vibrations, prickling, itching, rashes (many varieties with
or without itching: hives, red blotches, tiny bumps or blisters, eczema,
neurodermatitis, seborrheic dermatitis), burning and sometimes swollen and
hot-itching palms and soles of feet, dry skin, super-sensitivity to touch, or
flushing sometimes with heavy sweating. Chipping and breaking of fingernails,
hair of poor quality, splitting ends, hair that falls out prematurely and slow
growth. Patients often describe intense itching, that can occur anywhere, and
is usually worse at night. The skin can also display dermatographia.
Miscellaneous Symptoms:
excessive nasal congestion and mucus; irritated tongue, dry mouth, abnormal
tastes (bad, scalded or metallic); transient ringing in the ears or swishing
sounds (tinnitus); numbness of hands, feet or face, and tingling anywhere; leg
or foot cramps; low grade fevers; greater susceptibility to infections and
allergies; heightened sensitivity to sounds, lights, odors or chemicals;
swelling of eyelids and hands in the morning; weight gain; dry eyes with
itching or burning and blurred vision; skipping heartbeats (palpitations);
occasionally hypoglycemia syndrome with sugar craving.
All the cells of all the body tissues may be affected. All the symptoms, varied
as they may be, are connected to one single disease: FIBROMYALGIA . They
have all the same cause.
One medication, GUAIFENESIN,
will cause all the symptoms to resolve completely.
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When was the term FMS first
used?
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FIBROMYALGIA was officially declared a syndrome by the World Health
Organisation in the Copenhagen Declaration on the 1.1.1993. It was declared the
most common cause of widespread chronic muscle pain.
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The incidence of people
suffering from FMS
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3% to 5% of the general population suffer from FIBROMYALGIA.
FMS exists in all ethnic groups in all parts of the world. 85%
of the fibromyalgics are women, while 15% are men. That means that
in Israel at least 200 000 people suffer from FMS, and at least 170,000 are
women. Rheumatologists report that fibromyalgia is the most common disorder
they see.
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The genetic aspects of FMS. At
what age can it become symptomatic?
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FIBROMYALGIA is a genetic disease which is inherited. An entire family can be
affected by the disease, for instance a mother and her two girls. When the two
parents have the disease, the children are affected as well (pediatric
fibromyalgia). Doctor R. Paul St. Amand has treated members of a family which
spanned three generations including a two-year-old girl, as well as patients
who became symptomatic only in their seventies. One of my patients developed
the disease at the age of 80. This age spread would be impossible to explain
with only one defective gene. Therefore it seems there is a multigenetic cause
of fibromyalgia. The number of affected genes, and the spectrum from milder
genes (recessive) to more harmful (dominant) ones, permit all types of
combinations that determine at what stage in life fibromyalgia is expressed and
the severity of the symptoms. In those who have only minor defects in the amino
acid sequences of the genes responsible, fibromyalgia may never fully manifest.
Since 85% of fibromyalgia patients are women, it is axiomatic that at least one
gene is on the X chromosome.
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What can induce the symptoms?
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Depending upon the degree of genetic influence, variable
levels of trauma can precipitate fibromyalgia in patients: a trigger
such as an accident, an infection, any type of surgery, even dental
interventions, or a stress. But these triggers that can jump-start the illness
are not its fundamental cause.
As well, it is noticed that painful areas of tenderness are often superimposed
at the sites of previous injuries or surgery; it is a fact but not a cause.
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The metabolic aspects of FMS
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The role of phosphate
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FIBROMYALGIA is a metabolic disease. The inability to form adequate energy in
the affected tissues explains the entire spectrum of the illness. The various
defective genes adversely alter the renal handling of PHOSPHATE.
Fibromyalgia is caused by an abnormality in phosphate excretion by the kidneys
due to a genetic defect. In people with the defective genes there is, at birth,
a minuscule retention of phosphate, which ultimately overcomes the ability of
bones to dispose of that element.
The resulting gradual phosphate accumulation becomes system-wide and later
reaches critical levels in certain tissues, particularly in muscles and
tendons. In the company of calcium, the phosphate in excess enters cells.
Together, they initiate metabolic changes that produce the symptoms of
fibromyalgia.
The mechanism of retention of a biochemical substance within the cells
themselves, causes metabolic malfunction that results in an inability to
produce energy. Cells utilize energy in the form of
adenosine triphosphate (ATP), to perform metabolic chores and the
other crucial tasks that are vital to our existence. Retention of phosphate
interferes with energy formation in affected cells.
The function of the cell is compromised. If there is insufficient energy,
"nothing works right".
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The role of calcium
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To maintain electrical equilibrum inside the cell, the two negative charges of
each phosphate ion are counterbalanced by two positive charges of calcium.
Whenever excess phosphate builds up in cells, excess calcium does too. Calcium
has a very important function inside all cells.
Calcium normally is present inside the cell in the endoplasmic reticulum,
the cell's storage bin. When a stimulus arrives, the request for action is
signaled to the endoplasmic reticulum, which releases calcium into the main
fluid chamber of the cell, the cytosol .
The amount released is just sufficient to perform the desired task, no more and
no less. Calcium is the final battery terminal, the ultimate agent that says to
a cell: "Do it! Do it!" The cell is instructed to act and to continue
performing until calcium signaling stops. To stop this signal, cells have
enzyme pumps using ATP as source of energy (as any function performed by the
body) either to pump back calcium into storage in the endoplasmic reticulum or
to extrude it from the cells.
Since energy needs are poorly met in fibromyalgia because of
insufficient ATP, calcium accumulates in the cytosol where it should
not be any more, where it is no longer needed. As a result of phosphate in
excess in cells, affected tissues are in constant stimulation, yet continue in
their excessive effort to function day and night to the point of exhaustion.
When we examine patients with fibromyalgia, we feel numerous lumps and bumps in
the muscles, tendons, and ligaments. The areas we palpate are in a contracted
state twenty-four hours a day.
Only calcium is able to provide this continual stimulation in the cytosol of a
cell. This occurs in all the affected areas of the body. Body cells are
designed to rest between metabolic functions. It is this lack of rest, or a
lower quality of rest, that results in all the symptoms of fibromyalgia.
In various degrees, it affects, or will affect all the cells of the body.
In summary, phosphate excesses greatly impedes the formation of adequate energy
(ATP). This dysfunction leads to an
excess of calcium that stimulates the cell to keep working.
The ensuing cellular malfounction is actually an overworking and
energy-deprived syndrome. The lack of ATP
explains the disturbance that debilitates what was once a smoothly functioning
human body. Only restoration of normal ATP
production can reverse this errant metabolism.
GUAIFENESIN is designed to restore energy production by releasing the body from
a biochemical blockade which is genetic in origin and specifically targets the
kidney.
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The findings on muscle biopsy
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Biopsies on trapezial lesions in fibromyalgics have been performed. There are
marked differences from control biopsies obtained in healthy individuals.
Decreases of 70% in ATP and 21% in
phosphocreatine, the reservoir for high-energy phosphates were discovered.
Significantly, not all fibers within a given specimen are affected. This
confirms that there is no innate defect in the muscle itself. Another study
found lowered ATP levels in the red
blood cells of fibromyalgics.
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Laboratory results
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Multiple biological studies give us a large picture of the damage in
fibromyalgia. Researchers have concluded that there is also a problem within
tissues which produce hormones, neurotransmitters, and other molecules and
chemicals.
Most of these are found to be significantly higher or lower, on average, when
compared to normal controls. Scientists have reported significantly low levels
of growth hormone; insulin-like growth factor I; serotonin; free ionic calcium;
calcitonin; free urinary cortisol; certain amino acids; neuropeptide Y; T cells
counts and their faulty activation; and thyroid stimulating hormone (TSH).
On the other hand, there are higher levels of certain factors such as:
prolactin; substance P; angiotensin converting enzyme; and in one study,
hyaluronic acid. Skin biopsies have shown an excess of cytokines and
immunoglobulin G in the dermis. It can be seen how many different tissues and
systems must be affected to alter so many laboratory results.
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Blood tests
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There is not one specific laboratory test to
confirm the FIBROMYALGIA. No scans or X rays can detect it. Yet a
detailed history from the patient will unveil the chronology of the cyclic
symptoms that provide the diagnosis. It is easily confirmed by the many
abnormalities in muscles, tendons, and ligaments revealed by a detailed
examination (mapping).
The mapping, method of palpating the body, seeking out swellings (lumps and
bumps) within muscles, tendons and ligaments. They will be marked on a drawing.
It is the only system that confirms the disease, validates patient complaints,
makes it easy to find the proper GUAIFENESIN dosage and confirms, by successive
mappings and drawings, the regression of the disease.
GUAIFENESIN "cleans" the lumps and bumps. The ESR (erythrocyte sedimentation
rate) is normal in fibromyalgia, as it is not an inflammatory disease. An
abnormal ESR with an authentic FMS needs to be investigated.
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FMS associated with other
illnesses
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In more than 20% of the cases, fibromyalgia is associated with
other diseases, such as rheumatic and systemic illnesses with
various immunologic abnormalities (Behcet disease, systemic lupus
erythematosus, Crohn disease, ulcerative colitis, Sjögren's syndrome...),
hyperparathyroidism, hypothyroidism, Hashimoto's thyroiditis, etc.
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FMS and hypoglycemia
(fibroglycemia)
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The HYPOGLYCEMIC syndrome is a separate entity that
can be induced or intensified by fibromyalgia. 40% of female and 20% of male
fibromyalgics have hypoglycemia or carbohydrate intolerance.
The combination of both conditions is called FIBROGLYCEMIA.
Symptoms of hypoglycemia overlap those of fibromyalgia.
Acute hypoglycemic symptoms
are easy to identify.
They generally occur within three or four hours after eating, and are also
common in the middle of the night: panic attacks, shaking of the hands or body,
sudden onset of sweating, hunger, headaches, heart palpitations or rhythm
irregularities, severe anxieties, dizziness or syncope. However, not all acute
symptoms occur in every patient with hypoglycemia.
The chronic hypoglycemic
symptoms are more generalized ones. These are symptoms
which may be present all the time irrespective of the blood sugar level.
They occur not from sudden falls of blood sugar and the counterregulatory
hormones, but from the metabolic fatigue caused by hypoglycemia. Headaches are
felt like a low rubber band around the head. As well, fatigue, irritability,
nervousness, flushing, impaired memory and concentration, tight muscles,
abdominal pain, bloating, gas, and diarrhea.
It should be pointed out that the patient may notice that eating relieves the
symptoms while there is an exacerbation with hunger.
Most fibromyalics repetitively yield to their carbohydrate cravings throughout
the day in a futile attempt to produce energy. Since sugars and starches are
quickly converted to glucose in the process of digestion, the body prefers them
for fuel. Unfortunately, for the carbohydrate-craving fibromyalgics, each
supply quickly saturates their systems with glucose molecules that cause the
pancreas to release large amount of insulin.
Insulin surges lower the blood sugar by driving it mainly into muscles, but
also into fat cells, the liver, and most other areas of the body. In addition,
and that is our particular concern, this hormone causes an
increase in renal reabsorption of phosphate, and also drives it into various
cells; therefore, frequent releases of insulin will intensify the
symptoms of fibromyalgia.
The symptoms of hypoglycemia are then compounded with those of fibromyalgia,
and the result further aggravates the fibromyalgia. Those patients face a
serious metabolic problem. Dietary modification becomes essential.
There can be no compromise, otherwise their symptoms will be exacerbated even
if GUAIFENESIN works efficiently. Hypoglycemia must be treated concurrently.
Elimination of sugar and starches prevents the wide fluctuations of blood
sugar, and subsequently the noxious insulinic peaks.
Patients with fibromyalgia were found to have an impaired ability to activate
the hypothalamic pituitary portion of the hypothalamic-pituitary-adrenal axis
as well as the sympathoadrenal system, leading to reduced corticotropin and
epinephrine (adrenaline) responses to hypoglycemia.
The impairment of these neuroendocrine systems in fibromyalgics may even more
explain the overlap in signs and symptoms between fibromyalgia and
hypoglycemia.
There are no restrictions on diet, unless there is fibroglycemia.
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Chronic Fatigue Syndrome (CFS)
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CHRONIC FATIGUE SYNDROME is the same disease as fibromyalgia, with the same
genetic disorder.
For most patients, both labels, fibromyalgia and chronic fatigue syndrome,
apply at various times during their illness.
For others, one symptom may always be more prevalent than another.
There is no case of pure chronic fatigue syndrome.
When a careful history is taken and a proper examination conducted, including
body mapping, it is quite clear that both conditions exist
simultaneously. All the symptoms, although not with the same
intensity, and findings such as palpable changes in muscles, tendons, and
ligaments, meet the criteria for fibromyalgia.
We are therefore dealing with a single condition that presents itself
differently, generally dependent on an individual's pain threshold and on the
areas predominantly affected. When patients have extremely high pain
thresholds, fatigue is their dominant complaint. Careful questioning can elicit
the symptoms of irritable bowel, bladder or vulvar pain as well as
musculoskeletal complaints that seem mild to patients when compared to their
fatigue, depression and cognitive dysfunction.
Depending on the severity of a brain cycle,
fibromyalics suffer from short-term memory loss; they cannot
remember things they have just been told, nor can they remember where they have
left things.
This and the fact that their sense of direction is disrupted cause patients to
get lost even in places they know very well.
They often forget what they are doing or saying in the middle of a task.
Reasoning and deduction range from difficult to impossible. Patients cannot
read because they cannot absorb the material, follow a plot, or remember the
names of characters.
They completely forget appointments and things they were supposed to do, and
cannot remember whether or not they have paid their bills. During these brain
cycles, patients become oversensitive to noise, bright lights, smells, and
other external stimuli.
They cry easily and become frustrated and angry at the slightest provocation.
It is vital to recognize that all these cognitive impairments and emotional
over-reactions are a normal part of fibromyalgia experienced to some degree by
those who suffer from the disease.
Chronic fatigue syndrome and patients who complain primarily of pain, are
successfully treated with GUAIFENESIN.
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FMS and osteoarthritis
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Fibromyalgia is described as a non-articular disease, but joint pains with or
without swelling, redness and heat are frequent. No permanent damage occurs
until much later, when calcium phosphate crystals form in joints, the last of
the body's relatively safe storage sites. If
fibromyalgia is improperly treated, it will ultimately lead to osteo-arthritis
(O. A.).
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Why is FMS a cyclic disease?
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Tissue swelling
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We map these abnormal lesions (lumps and bumps) on the patient's map. It
indicates areas that are tender because they are swollen. Swelling occurs in
the tendons and ligaments but mostly in muscles, and these swollen areas press
on nerves.
Because any given area can be closer to nerve endings than another, small
swellings can sometimes hurt much more than larger areas of involvement. Pain
also varies greatly depending on a person's ability to tolerate it.
These painful areas can move from one area of the body to another, causing the
pain to vary from day to day, or it can remain almost constant in certain
areas.
90 to 95% of the tissue swelling is simply water
that has collected under considerable pressure. All the fibromyalgic cells are
continuously accumulating water, excess phosphate, calcium, and other
chemicals.
The extra fluid entring the ailing cells causes swelling, increases pressure
and pain, thereby producing larger lumps and bumps. When some of the water is
extruded, the lumps and bumps appear to become somewhat smaller and the pain
decreases.
Depending on the amount drained from a given site or from numerous sites, the
bloodstream may suffer varying degrees of flooding.
This depends on the capacity of the kidneys to eliminate the phosphates.
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The major role of the kidneys
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The urine is the most important route for elimination.
The kidneys control the level of phosphate in the blood. The blood transports
phosphate to the kidney, which is then filtered through the glomerulus and
passes through the kidney tubule.
It can also be transferred directly from the blood to the kidney cells and then
into the tubule. Phosphate can then pass directly out into the urine, or be
reabsorbed from the primitive urine - the urine flowing in the proximal tubules
- into the cells of the tubule, then into the kidney cells and from there back
into the bloodstream. Kidney cells can therefore retain or eliminate phosphates
according to the body needs.
Fibromyalgic kidneys cannot excrete phosphate rapidly into the
urine. This is due to a genetically defective enzyme which
interferes with the normal physiological process. This results in a rise in the
blood phosphate level. The body will not tolerate phosphate accumulation in the
blood as it is a reciprocal to calcium.
Thus if phosphate rises, the calcium must necessarily fall, and the body does
not tolerate this either. The four parathyroid glands in the neck then respond
by secreting parathormone (PTH) which attempts to maintain serum calcium levels
at a constant level.
As phosphate cannot be excreted in the urine, nor be stored in the bloodstream,
a certain quantity is transferred to the bones. When they become saturated,
phosphate is pumped into cells around the body.
At that point water enters the cells to dilute the concentration of phosphate
and its accompanying mineral calcium, avoiding crystallization. Swelling
occurs, and the entire sequence is repeated.
It appears as if the disease starts all over again, and most of the symptoms
resume, not only from the places that are being cleaned out. Each
cycle ends when that is all that can be done metabolically for the time being.
Some tissues are initially only sporadically affected.
Energy deprivation is initially cyclic. Each cycle is followed by a rest
period. The permanence of the symptoms depends on the quality and the duration
of these rest periods. After a variable period of time, more lumps and bumps
appear.
Symptoms get worse as the excess of phosphate slows down the generators and
energy production becomes permanently defective. Rest periods will be shorter
and shorter.
The duration of the disease determines the extent of
involvement.
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How GUAIFENESIN affects FMS? How
does the healing process occur?
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GUAIFENESIN works at the kidney level, on the cells of the proximal tubules.
The mechanism by which GUAIFENESIN purges the body of phosphate resembles a tap
that drains the kidneys of noxious substances.
This is analogous to the water system in homes. Let us imagine a central tap
equiped with its filter (the kidney).
This drains a main water pipe (the blood system) in which is pouring out
thousands of small reservoirs (the fibromyalgic cells) that have collected rain
water.
When the central tap is turned on, it pulls out under pressure some water from
the entire system of the small reservoirs into the main water pipe, which will
bring the water to the filter.
Ultimately, the small reservoirs are lowered by the amount we use in our home,
no matter how great the distance between the reservoirs and the filter may be.
Fibromyalgics have totally intact kidneys except for one problem. The renal
cell accepts the phosphate coming from the blood, and then either retains it or
excretes it into the urine, depending on the body needs, and on the ability of
the renal tubular cells to excrete them into the urine.
These actions are each controlled by different enzymes. Normally
an enzyme is present in the renal tubular cell, which excretes the phosphate
into the urine. In fibromyalgia this enzyme is defective. There is a
possibility that the enzyme allowing entry of phosphate from the bloodstream
into the glomerule filters, or from the bloodstream directly into the tubular
cells, is also defective.
Fibromyalgics are unable to open their taps - the holes of their filters - wide
enough to excrete all the accumulating metabolic debris, especially the
phosphate.
This debris will be reabsorbed into the blood, and forced to be reintroduced in
the affected fibromyalgic cells, and possibly in other cells in the body,
producing a vicious cycle.
GUAIFENESIN assists the kidneys to excrete phosphate. Excess phosphate
interrupts normal energy (ATP) production in the fibromyalgic cells.
If the kidneys purge the excess phosphate, the cells will again produce all of
the ATP required. The ATP-controlled pumps will again pump calcium, stored in
abnormal sites, into regular calcium stores or into the bloodstream.
The cells will no longer be hyperactive 24 hours a day. The cells will once
again be able to rest, thereby restoring their functional energy systems.
GUAIFENESIN helps the kidneys to open wide their taps, and to excrete the
phosphate into the urine.
GUAIFENESIN is able to remove the metabolic debris out of the tissues, one
batch of debris after the other, once the kidney is able to eliminate them into
the urine.
Due to the action of GUAFENISIN, the excess phosphate and metabolites are
dumped into the bloodstream. These excess metabolites are presented to the
kidneys, but although the kidneys are now functioning at full capacity in their
attempt to eliminate the excess phosphate, they are unable to excrete the
phosphates immediately due to the load presented to
them. The blood therefore deposits the metabolites back, all over the body.
This produces generalized flu-like aching and most of the other symptoms. But
if it appears to be a "deja vu" phenomenon
repeating itself - as it is before treatment - this time there is an acute
exacerbation.
GUAIFENESIN treatment reverses the entire process of FMS in a
more intense cyclic progressive fashion. This is due to a rapid
attack on multiple areas simultaneously.
A rest period follows, a few good hours, a few good days. Suddenly, the
symptoms return as more cellular debris is mobilized and the next perceptible
attack begins.
Reversal of the disease reproduces and intensify most past symptoms and may
cause some new or long-forgotten ones to surface. The intensity of early cycles
may cause the patient concern during the initial weeks or months of treatment.
These symptoms are not GUAIFENESIN side effects. They are useful necessities.
Each of these cycles represents an improvement in the patients' condition. As
the treatment progresses, the patients become aware of the changing nature of
their disease. They learn that attacks will be milder and far more bearable, as
fewer areas are left to purge.
Though the initial reversal cycles might have attacked ten to twenty places at
one time, later reversals may work on only one or two sites simultaneously.
That alone greatly diminishes the severity of the subsequent attacks. In
addition, purging phases become progressively further apart, resulting in
relatively milder remissions.
The healing process may be compared to a bouncing ball; the up-and-down
symptoms slowly ease, and the palpable lumps and bumps soften, break, and
eventually clear.
| Fibrokur provides an unique and effective treatment of Fibromyalgia (FMS) and Chronic Fatigue Syndrome (CFS). | The treatment of Fibromyalgia, a chronic disease, is undertaken by using Guaifenesin, medication that has changed the lives of thousands of fibromyalgics all over the world, and especially in Israel. There is no treatment currently available that is as safe or has enjoyed such a high level of success. The Fibromyalgia treatment from Doctor Norbert Kurland is effective on the painful muscles, tendons and joints (muskuloskeletal troubles), on the nervous system troubles, such as fatigue, depression, anxiety, sleeping disorder, and cognitive dysfunction such as impaired memory and concentration, on the gastro-intestinal (irritable bowel symptoms - IBS) and genito-urinary (vulvodynia, dysuria) symptoms.
Fibrokur covers Israel, France, U.S.A., Canada, Belgium, Switzerland, G.B., Italy, Spain, Portugal and Denmark. |
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