Blog from 7/2009; Fibromyalgia and Chronic Fatigue: Scott Rollins, MD's Solving the Mystery!

Dr. Scott Rollins, who you see as one of the four other professionals so far on Lumigrate, presented "Fibromyalgia and Chronic Fatigue" at the Integrative Medicine Center of Western Colorado (IMC of WC) on Wednesday evening to a completely full room (and our recording devices).  Half of the people who attended had fibromyalgia and the other half were there to learn more as they have a family member who has it.  So if you or someone you know have chronic fatigue and/or fibromyalgia, we hope this overview of his presentation can be helpful.  We also hope that physicians who are struggling with how to treat patients presenting will utilize Lumigrate now and increasingly in the future to obtain valid, progressive information.  

Dr. Rollins' history is unique: He graduated from the family practice residency program at St. Mary's Hospital in Grand Junction in 1994, so is certified by the American Board of Family Medicine.  He and a partner share a family practice in a rural town about 45 minutes from Grand Junction, where they rotate weekly being on or off.   I've treated many of these patients as an occupational therapist and they are people who appreciate eating well and working on their health through supplements and using pharmaceuticals when necessary and appropriate.  So perhaps his way of treating patients was a teaming of his knowledge and beliefs with theirs, which when you think about it, is the core belief of Lumigrate!  In 2004 he was awarded Colorado Familiy Physician of the Year.  His style of practice gravitated toward integrating concepts about nutrition and supplements, which are major components of 'anti-aging', and in 2008 he became certified by the American Board of Anti-Aging and Regenerative Medicine.  He is the medical director of the IMC of WC.  For more information, their link is below.  I also am providing you with a short list of excellent books an websites in case you want to know where to go from here.   

What follows here is the overview of his presentation, and Lumigrate will have a more complete version of this in the near future. If you register here (with username and password) you'll receive an email when important information about Lumigrate occurs. 

While it might be undesirable to have a 'label' or 'diagnosis', know 'what it is' becomes imperative to proper treatment.  It's important to know the difference between chronic fatigue syndrome (CFS), fibromyalgia syndrome (FMS), and myofascial pain syndrome (MPS).  And here's Dr. Rollins' streamlined approach:

• Severe fatigue and insomnia which is not relieved with rest = CFS
• Add diffuse muscle pain = FMS
• If it's specific area of muscle pain = MPS

The American College of Rheumatology criteria for the diagnosis of FMS is the standard of the industry and we direct you there for more details about the tender points used to diagnose and much more detail if you wish.  Mitochondrial and hypothalamic dysfunction seems to be a common denominator, leading to alterations in hormone production, sleep, autonomic control and energy production.  If a person has FMS or CFS, treatment needs to address cellular energy, sleep, hormones, nutrition, infections and immune dysfunction, and pain management.  Dr. Rollins' approach at the IMC of WC has the benefit of a model of 'integrative medicine', drawing on allopathy (in this case he's an M.D., but it could be a D.O/osteopath), homeopathy, acupuncture and Oriental medicine, massage, and psychology.  (Chiropractics also can be part of integrative medicine teams, as well as other disciplines.)  His presentation of his understanding and treatment of FMS and CFS clearly demonstrates his integration of the complementary practices of his IMC teammates and he frequently referenced what he has learned from patients as well.

Treatment goals should be to

• Restore energy production with nutrition, sleep control, hormonal supplementation.
• Eliminate energy drains such as infections and stress.
• Allow hypothalamus to “reset” and muscle to “relax"

Resless legs syndrome is a frequent issue for people with fibromyalgia.  The sleep cycle is frequently dysrupted and the brain doesn't get to regenerate.  Typically, people began having symptoms after a physically or emotionally stressful event, and if you think 'whole-istically', the two are inseparable (brain or mind and body).  So treatment needs to be as well.  His approach to treatment is an array of foods, supplements and herbs to nourish and treat the body, as well as gentle exercise and pharmaceuticals. 

Key in treatment are the adrenal glands, which produce epinephrine (adrenalin) -- the “fight-or-flight" hormone.  So one very stressful event or a long time of lower level stressors of modern life (combined with improper nutritional support for being under stress chronically), causes disruption of this part of the adrenal axis ('axis' of adrenal, pituitary, hypothalamus) leading to hot or cold sweats, low blood pressure spells and panic attacks. Intervention at this stage could keep someone from continuing into more problems, but unfortunately people don't know this -- consumers as well as many medical providers.   None of every 10 people who have FMS are women, and most of those are entering or are in middle-age, so the combination of normally decreasaing hormones combined with the added depletion and disruption of the hormone system from stress takes a toll.  Looking at the cascade of hormone dysfunction that comes when the 'adrenal axis' is upset -- thyroid, estrogen, DHEA, pregnenolone, progesterone. 

Cortisol is the hormone that helps maintain our blood sugar, blood pressure, and regulate our immune system, and levels in the body can double or triple under stress, so this is a major player with these causing and therefore treating these medical conditions.  Treatment can include testing and addressing the support and treatment of cortisol.  How do you know if you have low cortisol?  Not responding well to stress, or 'crashing' after a stressful event are symptoms.  Also, being hyper-sensitive to stimulants such as caffeine or thyroid medications can be tip-offs for patients and doctors to look for. 

Treatment then involves a lot of 'rebuilding' of the adrenal system, which sometime requires treatment with a prescription medication for a several months or more, and then supplementing nutrition for an extended period of time.  Restoring the sleep cycle is critical and again can be addressed with supplementing nutrition as well as prescription medications.  Restoring hormones: thyroid (and looking beyond TSH when doing testing and treatment, including T3; Lumigrate's video by Dr. Rollins is available to you as a resource to learn more as well as our 'products' area for that video which routes you to books and products recommended in the video).   Gonadal hormones, such as estrogen, progesterone, and testosterone also are typically affected:   testosterone levels commonly are low in men and women with fibromyalgia.  Hormones are very interrelated and have a cascade which can become a  'domino' effect when something happens at the beginning to set things awry.  The original stressful events, sometimes years before, have led to this lengthy, complex cascade which makes it difficult for most people and doctors to figure out.  

It is important to note that here are many controversies with hormone replacement, mostly due to past use of hormones in high doses, wrong ratios, or synthetic “look-alike” drugs that stimulate hormone receptors but are not bioidentical.  Dr. Rollins uses only bioidentical hormones (chemical structure is 100% identical to the human molecule) in the proper ratio and dose to simulate normal, healthy human hormone levels.  (Refer to links and books below for more information and please 'stay tuned' to Lumigrate.com, as we have Dr. Rollins' seminar on bioidentical hormones in development to bring you most likely in PDF/readable and printed format in the very near future, as there is quite a lot of interest in this area which he is a board-certified specialist!) 

Pain management.  Again, alternative as well as pharmaceutical interventions are used.  This is where the massage therapist fits in, for example; heat therapy, etc.    Using a smaller amount of more things frequently has better benefit and less side effects (including addiction) as using a higher dose of fewer things.  The 'mix' of pills and powders I take can appear complex and excessive until you understand what each one of them is for and know that the goal in the long run has been to be changing that up and move away from medications and to more natural supplements and then reducing that as able as well -- and that IS what is happening, I am happy to say, but it takes time and conscientious effort. 

Many physicians who do not specialize in treating pain might treat fibromyalgia pain with medications typically used for acute pain (such as what are used for fractures, surgeries, dental work) which can lead to detrimental secondary effects.  I attended a training last night about the best treatment practices for chronic pain patients last night and will bring a summary of that information to you next.  This area is a real place of interest for the medical consumers with chronic pain as well as physicians, so we're taking advantage of learning opportunities which coincided in Grand Junction this week and hope to shine the light on what physicians' stresses and concerns are in this area as well. And we're really listening to pain patient's input here (in our forum area) and on our facebook page (facebook.com/lumigrate [1]).   With the fibromyalgia population, physicians possibly are 'inheriting' patients that come to them NOT on the best path with their medications and hormonal support and therefore are emotionally labile (tearful, angry), which gives them an impression about patients with fibromyalgia.  So part of our goal with Lumigrate with the topic of pain is to set both providers and consumers up with resources to better navigate treatment so both can be successful at the end of the day.

Nutrition:  Here's where to start:  Do what anyone who is being proactive about nutrition does: Lots of vegetables and fruits (but not so much alone if you follow Dr. Wilson's advise), omega 3 fatty acids, eliminate caffeine and simple carbohydrates, eat smaller and more frequent meals, have lean animal products and preferable grass fed and natural or organic, and limit or eliminate alcohol.  Dr. Rollins presents it as 'what to focus on doing rather than on what NOT to', which makes it more pleasant and easy to digest (pun intended).  Often, these changes will help address the candida yeast problems which are at play in people with these disorders, and there are supplements and medications that can be utilized as well.  A good probiotic, for instance -- see reference and link below as well as Lumigrate's products area for guidance, such as Dr. Lepisto's 'Food Allergies' or 'Detox and Cleansing.'  Food allergies that people are frequently unaware of, as they are IgG food allergies which have not been as well-known in the allopathic world, are frequently at play.  Lumigrate's video on the topic is one resource to learn more. 

Chronic illness and chronic pain impact psychological well being of people and the systems around them.  Spiritual wellness and simple 'happiness' have an integral part in wellness, and sometimes adding a member to your team to provide expertise in these areas (psychologist, family therapist, minister) can be an integral part of the treatment of FMS and CFS. 

I hope this overview has been helpful to you at this time and we do look forward to bringing you more details from Dr. Rollins and his integrative medicine team in the near future.  The links and resources we suggest you can access at this time for more information are:

Yeast questionnaire based on Dr William Crook’s work (http://www.yeastconnection.com/pdf/yeastfullsurv.pdf [2]). 

Dr. Crook's book  The Yeast Connection and Woman’s Health. (You can access Amazon.com through this website's 'Products' area)

Hormone replacement: www.imcwc.com/library/blog [3]. 

Adrenal Fatigue: Book by James L. Wilson, ND, DC, Ph.D (see recent, previous blog on Lumigrate.com about this book and author at www.lumigrate.com/blog [4])

Chronic Fatigue and Fibromyalgia: Jacob Teitelbaum, MD (see recent, previous blog at www.lumigrate.com/blog [4] about this author and his books and website.   There is an excellent questionaire which provides a treatment plan for you AND for your physician as guidance and suggestions)

Book (which we all call 'the green book'): Fibromyalgia and Chronic Myofascial Pain; A Survival Manual, by Devin Starlanyl and Mary Ellen Copeland.