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Dr. Lowe How to Prepare Patient-to-Patient Fibromyalgia Research Foundation
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It is now possible for clinicians other than those on our treatment team to properly guide patients through our metabolic rehabilitation. When guided properly, patients whose fibromyalgia syndrome is underlain by hypothyroidism and/or thyroid hormone resistance stand a good chance of markedly improving or recovering. The clinician must be thoughtful, conscientious, and clinically-oriented. Also, the clinician's fibromyalgia patients must be committed to cooperating during the process of metabolic rehabilitation. Clinicians and patients can use metabolic rehabilitation properly because the reference textbook and guide to clinical care is now available. The title of the book is The Metabolic Treatment of Fibromyalgia. All clinicians who want to use metabolic rehabilitation should have and study this book. And all patients undergoing the treatment should use the book. Patients should also have a copy of the self-help book titled Your Guide to Metabolic Health. Managed
Care: An
Obstacle Managed care is an obstacle to fibromyalgia patients improving or recovering. The managed care system does not permit what is necessary for improvement or recovery. Our discussions with clinician who work under the managed care system convince us that the clinicians sincerely want to help their fibromyalgia patients. Our protocol, however, requires a reorientation that most clinicians are either unwilling or unable to make. One of the main reason is the managed care system. Most physicians now practice under the dictates of managed care. Managed care restricts the time and attention clinicians can give to their patients. Many people today believe that through managed care, insurance companies have short changed patients on quality care. But it is important to realize that it's patients themselves who've chosen managed care rather than traditional quality medical insurance. Clinicians who work under the dictates of managed care simply cannot reorient and adopt a manner of case management that enables them to properly use our treatment protocol. And in fairness to these clinicians and the insurance industry, patients who've chosen managed care type insurance shouldn't expect their insurance policies to cover services such as metabolic rehabilitation. Rehabilitation type treatment demands far more time and attention from the clinicians than managed care allows. Managed care policies are the most stripped down insurance coverage available. The policies are intended to provide only the absolute minimal care possible. That's why they are so inexpensive compared to traditional quality medical insurance. It is simply unrealistic of patients to expect such policies to provide coverage for metabolic rehabilitation. In contrast, our services are often largely covered by many of our patients' traditional major medical insurance. Abbreviating Our
Protocol: A Common Some clinicians and their fibromyalgia patients have tried to get the benefits of our metabolic rehabilitation without going through it properly. In most cases, they've tried to abbreviate the treatment. Usually, their intention is to make the treatment process more convenient for them. During the early years while we were developing and refining our treatment, we tried various abbreviated treatment protocols. They didn't work well, if they worked at all. Nowadays, we include each component of our treatment protocol because trial and error and systematic testing showed us one thing---leaving out any component of the protocol compromises the likelihood of a successful therapeutic outcome. For each patient under our care, we include every component of the protocol. We do so because we insist on the highest possible success rate. We owe this to patients under our care, and we pride ourselves on helping as many patients as possible markedly improve or completely recover. We maintain a high success rate by entering clinical relationships only with patients who're committed to do whatever is necessary to improve or recover. That means our patients must commit to go through the complete process of metabolic rehabilitation. We decline to enter clinical relationships with patients who aren't able or willing to make this commitment. Essential Elements of Our Protocol The must fundamental part of our treatment
protocol is to repeatedly measure the patient's fibromyalgia status, graph it, and adjust
the treatment based on this quantification. We use several objective measures of
fibromyalgia status. We obtain scores for the measures at baseline (the initial
evaluation) and again at each subsequent evaluation. Our subjective judgment of the
patient's status is important in making therapeutic decisions, but our decisions are
primarily data-driven by the patient's scores on the objective measures. We post the
scores as data points to line graphs. The trend of the data points in the line graphs
informs us of the patient's changing status. The scores and the line graphs are the
backbone of our protocol. They provide coherence that unites the different features of the
protocol. This enables us, as treatment progresses, to exercise progressively greater
control over the patient's fibromyalgia status. Our knowledge of the patient's status at any time in the treatment can't be reduced entirely to objective measures. We must exercise good clinical judgment. Some changes in the patient are hard to quantify, but they're obvious to us when we're familiar with the individual patient. (These changes include such phenomena as a brightness to the eyes, replacing a previously dull, listless appearance.) For the most favorable outcome for the patient, we must note these changes and calculate them into our assessment of the patient's fibromyalgia status. To ignore or otherwise exclude such phenomena from patient assessment would be to forfeit one of the richest sources of data for making sound clinical judgments. The changes typically signify improving patient status; failure of the changes to occur may indicate the need to alter the treatment in some way. When we consider the changes in conjunction with objective measures, the judgments can contribute substantially to proper clinical decisions. Most Common Mistakes Clinicians Make Most clinicians who've unsuccessfully used our protocol have based their therapeutic decisions mainly on the patient's occasional description of how she's feeling. With this method, the clinician can exercise little or no control over the patient's fibromyalgia symptoms. The patient's status must be quantified through objective measures and then monitored and manipulated based on these measures. Our research colleague Dr. Alan J. Reichman, a Houston family physician, equates this requirement to the proper management of a patient with hypertension. A patient's blood pressure may be extraordinarily high. But the patient may not be aware of the high blood pressure and not show outward signs of it. Only by measuring the patient's blood pressure can the clinician get sufficient knowledge of the patient's status to make proper treatment decisions. Cooperation by the Patient One reason that a small percentage of patients haven't improved or recovered with our treatment is that they simply didn't cooperated. We don't say this to sidestep problems with our treatment and blame the patient. The reality is that for a number of reasons, a minority of patients truly don't cooperate. Patients come to mind who simply wouldn't complete the necessary forms at regular intervals, despite repeated explanations that these were essential to a good treatment outcome. Other patients have refused to cooperate with instructions that were essential to their improvement. The four instructions have been to take nutritional supplements, exercise to tolerance, get physical treatment, and stop narcotic and tranquilizing medications. Among our patients, reasons for lack of
cooperation have included extreme self-indulgence, an adamant belief that taking a pill
should be sufficient, passive-aggressive tendencies, and low frustration tolerance due to
personal philosophy rather than a psychological effect of fibromyalgia. Such tendencies
are self-sabotaging and can doom some patients to fail at many life ventures--including
the use of our protocol. When such patients don't improve or recover, it's usually the
result of their failure to collaborate and cooperate with the clinician. Form of Thyroid Hormone Used Despite a widespread belief, in the past, we haven't used T3 with every patient. Some people have erroneously interpreted what they call the "Lowe protocol." They think our protocol simply entails a patient taking plain T3 in fairly high dosages--period. In reality, we may start some hypothyroid patients' treatment with desiccated thyroid (Armour Thyroid). We do, however, start virtually all patients with T3 if they are euthyroid. Euthyroid means they have normal thyroid function test results, including a normal result on the TRH stimulation test. We must switch some hypothyroid patients to T3 because they do not benefit from T4 alone or desiccated thyroid. Regardless of the form of thyroid hormone a patient of ours may use, merely taking thyroid hormone is not the essence of our treatment protocol. The most fundamental part of our treatment is repeated objective measures of fibromyalgia status considered in light of subjective assessments. Our protocol also invariably includes other features. For example, patients must stop medications that are impeding their metabolism, and they must engage in lifestyle practices (such as a wholesome diet, nutritional supplements, and exercise to tolerance) that favor normal metabolism. Other Metabolism-Impeding Factors Not all fibromyalgia patients require the use of thyroid hormone to improve or recover. Some patients have the signs and symptoms of fibromyalgia due to other factors that impede normal metabolism. The other factors can include nutritional deficiencies, deconditioning, an deficiency of adrenal or other hormones, and the use of beta-blocking drugs (such as Tenormin and propranolol). The signs and symptoms generated by such factors can be eliminated by treatment that corrects, compensates for, or eliminates the factors. As researchers, the approach we prefer is the precise identification of a causative factor and intervention that effectively deals with it. In a clinical setting, however, many patients improve or recover due to undetermined components of sweeping lifestyle changes under the umbrella of a holistic health regimen. Nutritional supplementation is an essential part of such change, as described by Professor Linus Pauling, Dr. Jonathan Wright, Dr. Alan Gabby, Dr. Jacob Teitelbaum, Dr. Raphael Kellman, Dr. Norman Levin, and others. Even for patients whose improvement critically depends on the use of thyroid hormone, nutritional supplements and exercise to tolerance are also critical to a favorable outcome. We require patients under our care to use nutritional supplements and to exercise to tolerance. These practices are essential for significant improvement, and they are necessary to the safety of patients taking thyroid hormone. Musculoskeletal Care For some patients, fibromyalgia status--especially pain scores-- significantly improves only after these patients undergo effective treatment for musculoskeletal problems. Most patients have myofascial (muscle and its connective tissues) trigger points that will respond to appropriate myofascial therapy. Many also have spinal conditions that require spinal manipulation or mobilization. Many fibromyalgia patients' musculoskeletal problems are resistant to local treatment before metabolic therapy. Afterward, however, most patients are normally responsive to appropriate musculoskeletal treatment. For learning proper self-care for myofascial trigger points, we recommend the recent book by Dr. Devin Starlanyl and Mary Ellen Copeland (Starlanyl, D. and Copeland, M.E.: Fibromyalgia and Myofascial Pain Syndrome: A Survival Manual. Oakland CA, New Harbinger Publications, 1996.). For spinal manipulative therapy, we recommend that patients consult clinicians trained and experienced in its use, particularly chiropractic physicians. Emotional Problems It is now well-established that emotional "disturbance" in fibromyalgia patients results from, rather than causes, the fibromyalgia. Regardless, patients often struggle to maintain emotional equilibrium during fibromyalgia, or they must work to clear away after recovery, emotional problems that resulted from from the experience of being fibromyalgia patients. If necessary, we recommend that the patient enlist the help of a professional mental health practitioner—but only one who is knowledgeable about, and sympathetic to, fibromyalgia patients.
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