Dr. St. Amand's treatment of patients with uricosuric agents requires more than simply prescribing the medications.

1. He begins by taking a typical, detailed medical history of the patient and family illnesses, as far back as can be remembered; he should know every medication you take. And he will try to determine if you have symptoms of hypoglycaemia, which impact on the disease of FMS in important ways.


2. Second, he does a physical examination where the patient's muscles and tendons are systematically examined by palpation to determine which areas are most affected by the disease. This process is called "mapping", which he says is also diagnostic of the disease when he finds the affected muscles.


3. Then, because people can have FMS as well as other medical problems, he does a few simple blood tests:

• a basic work up that includes a blood count to rule out anaemia or infectious process;


• a thyroid test called TSH,


• if you are a woman over 50 years of age, he does a SED rate and a basic arthritis panel.

The best way to follow your improvement with this treatment is to have someone regularly map you. Dr. St. Amand does not use 11 out of 18 tender points to diagnose Fibromyalgia, since he learned his whole body was tender during a flare.

Instead, he "maps" the entire person by feeling the lumps and bumps of Fibromyalgia and drawing them to size on an outline of the human body, noting location and degree of hardness. This becomes the road map and baseline for comparison at future visits to show progress. Mapping is the only objective evidence we have that shows the progressive clearing of the affected muscles and tendons, and can detect early on if blocking by some hidden Salicylate is occurring. Once a map has shown initial improvement, any regression of that improvement will be obvious.

When the doctor sees a map that does not improve, or one that begins to show increasing lumps, two things may happen:

• a rigorous search for products containing Salicylates is made and the offending products, if any, are eliminated;


• the Guaifenesin dosage may be raised as well, until improvement occurs in the map.


• Patients are asked to keep a calendar or journal in which they record their symptoms with attention to pain and the many emotional factors. Stress such as emotional and illness will significantly retard the clearing process. Strong clearing cycles following such periods are not uncommon. Journalising is an important adjunct to this treatment, helping to interpret the maps and determine actions to take.

How important is the mapping?

Mapping is vitally important to indicate your progress and that you are not blocking with a product containing Salicylates. It has no therapeutic benefit.

Dr. St. Amand maps patients at every visit, monthly till dosage is ascertained. After therapeutic dosage is confirmed, appointments are gradually stretched out - first to three, then six, and finally to twelve months. Lumps and bumps should get progressively smaller, softer, or more mobile. Some of the larger areas, such as those at the hips or tops of the shoulders, will often split into one or two smaller areas.

What if my doctor doesn't do the mapping?

Lumps can be smooth or cement like, soft or hard. When they begin to purge they contain fluid and at that point they can feel "mushy". The usual lumps that Dr St. Amand maps, are the round or oval swellings.

Don't seek out tiny pebbles and think that lipomas, fibromas and fatty deposits are FM when they are assuredly not. Small lumps like these could be FM lumps of course, but without a doctor or other knowledgeable person to confirm what they are, it is best not to include them in maps.
Don't be concerned about them not diminishing re mapping. One can ignore most of them and map those that Dr St. Amand has outlined on page 163 in his book "What Your Doctor may NOT Tell You About FIBROMYALGIA." Lipomas usually need to be diagnosed by a physician or MT.

Yes. In Dr St Amand's experience, before Guai, the left thigh is invariably involved and the right somewhat rarely, usually only on the lower front part.

• Outer left thigh = vastus lateralis = 1 x 18 - 24 inches long, linear swellings, running down the outer as well as the front of the left thigh


• Front left thigh = Rectus femoris = 2 or 3 x 8-12 inches long large, smooth swellings NOT small, rounded lesions.

If you have already begun the protocol and are concerned about your dose, check this area out.
Is the lump there? What size is it? Is it broken up into smaller lumps?

There are usually exceptions to every rule and a few members have reported that their right thigh was the one to be worse and/or break up first. Or even other areas. This is all so individual. If you've been on the protocol for some time and still have large, especially longish, lumps running down your left thigh you can at least be sure that you are not purging and need to raise your dose. You cannot feel these lumps easily, or maybe at all, while sitting up.
The left thigh remains Dr St. Amand's very best guide as to the onset of reversal.

The long & linear swellings, running down the outer as well as the front of the left thigh (outside= vastus lateralis; front = Rectus femoris are a radar for whether you have reached your therapeutic dose. Other (smaller) lumps in the thigh will dissolve in time and while they remain they don't indicate anything more than any lump in any other location of the body. Smallish lumps can arise and dissolve during cycling. Keep focused on the whole body situation. If lumps are diminishing overall at each mapping, then all is well.

Tesa suggests: Lay down on your right side and run your left hand down and up your thigh. You sold be able to feel it like that if you press firmly enough (see explanation in next Q&A) or get a spouse/partner, family member or friend to help you. Once you have established that the thigh lumps are breaking up, or indeed any lumps anywhere on your body are breaking up, you can be sure you are cycling and don't need to be checking them out all the time. Keep a close eye on products you use to be assured that you do not block your medication.

Kathy Jebbia suggests sitting on the floor with your legs directly under you, butt to heels & hamstrings to calves. This position makes the thigh really taut instead of mushy so all the lumps stick out a great deal more. Dr. St. Amand said my left thigh was clear, but when I did this position, I could still feel a lot of lumps.

Chris Bialowas suggests if you can't get into the above position, try lying on your back in bed with your hip and knee bent. This stretches the quads muscle and makes the lumps easy to feel. Use some sal-free lotion and run your 2nd, 3rd and 4th fingers down the muscle belly. This is my nightly routine after my bath.

Gloria Hutson suggests if you can't feel your lumps on your left thigh, sit in a chair with your leg relaxed. Then try to pinch the top left thigh muscle all up and down the length of the muscle. See how much you can pinch.

Now find someone who doesn't have FMS to be a guinea pig for you. Have them sit in a chair with the leg relaxed. See how much of their thigh you can pinch. You are going to notice a BIG difference if your own left thigh muscle hasn't cleared yet. Their muscle will be very soft for the whole length but yours will be rock hard making it difficult to even grab 1/2".
When we first start Guai, this muscle will be one long narrow rope of hardness yet when we finally find our clearing dose, it will begin to soften and finally soften completely in 30 days. You can also do this with the muscle that runs down the outside of the left thigh, as this too will clear in 30 days at your correct purging dose.
Before I started Guai, I had incredibly "toned" thigh muscles (or so I thought). It turned to flab in no time at my cycling dose. I can easily pinch over 2" now. I couldn't even do a 1/2-inch before Guai. Use this pinch test as a gauge to finding your cycling dose. Follow the protocol titration process exactly as outlined in Dr. St. Amand's book checking your thigh every 30 days as you get ready to up your dose again.

Anne Louise suggests she has found a way of describing what she feels when mapping herself that has also helped several buddies find their lumps and bumps. She slides the pads of her fingers over a muscle with fairly strong pressure, but not so strong it hurts. She feels two kinds of lumps (others may feel something different). She is feeling for something that lies 1/4" or more under the skin. First, she feels small lumps, like gravel, just below the skin. Then, she can also feel something more subtle and deeper down. It feels to her like a very thin, cheap shoulder pad, or maybe a thin little sachet, lying right on the surface of the muscle.

Dr St Amand says, that the "amount of pressure he exerts in looking for bumps and lumps, if you will, is about the same amount of pressure in massaging someone you care for."

Pros & Cons Whether you find someone to map you or not, it's a very good idea to focus on how you feel and notice all the exacerbations you experience over time. It's possible to hit your dose and relax while you purge the phosphates. There are quite a lot of people who don't get mapped albeit is certainly best to get mapped. Keep a notation on your pocket calendar or computer, some code you understand, to track your cycles or lack of them. Using numbers to represent pain levels is not the best idea. What is a "four" day now will mean something different as you get better, though some have used this system successfully.

Diary Long entries are not necessary. A typical day's notes might read: "a.m.-not as stiff -slept 7 hours p.m. able to take walk night: back bad, right knee swollen-took darvocet-relief." Then, as you look back you will see if some things have disappeared completely, like a knee that hurt off and on; if you are sleeping better, using fewer pain medications, if you can exercise a bit more. Then you should see some patterns emerging and some progress over time. You need to feel some improvement to know that you are cycling, even though it might be subtle. If you are unsure then there is no substitute for mapping. It is essential to find your correct dose as soon as possible so that you don't end up raising your dose too high and suffering more than is necessary.

Dr. St. Amand maps his patients every three months, and doesn't feel that a 6-week interval is necessarily enough time for differences to be noted in maps. This is particularly true the further along you are in the protocol.

Early in the protocol (i.e. the first few months), you will typically see a dramatic change in your map because large deposits are being cleared from muscles (e.g. the left thigh). As you progress in the treatment, you begin to clear a lot of internal stuff that can't be detected on a map. So you shouldn't be discouraged if your map clearing slows down. Realize you are clearing things that can't be palpated. As long as your maps aren't getting worse (i.e. new large deposits), then you needn't worry.

At all times during your treatment, re-mapping is very important, since changes become progressively more subtle. When only a few areas remain to be cleared, only tiny improvements may be felt as more difficult tissues, e.g. the tendons are last being purged because these structures have poorer blood supplies. Guaifenesin penetration is much slower.
If other signs make you concerned that you may not be progressing, you could very well be blocking. Check the ingredients of your products again. Ensure that one of them hasn't been reformulated to contain Salicylates.
In New Zealand, please always report a possible blocking situation to Megan Parker so products can be checked and the list on the website may be updated for the benefit of everyone.

Let's try explaining about purging and the effects of higher and lower doses of Guaifenesin. First, think in terms of a garden hose with the spigot shut. No Guaifenesin or too little would be analogous to keeping the tap shut. Nothing happens, no reversal begins, even if you are only just outside attaining your minimum, effective dosage of Guaifenesin. At this point, anything introduced into the water hose merely accumulates for lack of outlet sources.

This is the process of developing FMS and of getting progressively worse. The kidneys are unable to eliminate the waste adequately (we think it is phosphate) but the body continues to produce the waste and just keeps accumulating the excesses and tucking it away wherever it seems safest at the time.

Now, take a barely adequate dose of Guaifenesin and improvement will follow, albeit slowly. Now, open the kidney tap wider and wider with a progressively larger dose of Guaifenesin and the phosphate elimination will indeed speed up. However, there comes a time when you have turned the handle all the way and the flow is at maximum. Added doses will no longer do anything beneficial - you have reached your individual capacity. This translates into increasing your dose for these reasons:

1. If the increase in dosage causes an increase in any of your symptoms or an increase in your cycle frequency, you are indeed pulling stuff out of tissues faster.


2. You are not blocked.


3. The kidneys have not reached capacity.

Now, take more than your maximum-benefit capacity - nothing further should happen. Since you cannot open the tap any wider (cannot increase excretion further), you will neither pull more out of the bloodstream nor more out of cells. Only the excess Guaifenesin is excreted, unaccompanied by any greater amounts of phosphate. This is why the drug has no apparent side effects, even at high doses. All of this varies for each of us and genetics determine how efficient our kidneys work with this process.

For example: Dr. St. Amand's wife weighs about 120 lbs. She had to take eight tablets = 4800 mg of Guaifenesin to obtain reversal. However, she wondered over the years if she needed quite that much and gradually cut down to five tablets = 3000 mg, holding there for months.
Gradually, however, she began to have more aches and pains, until the doctor finally mapped her. Lo and behold, she had reversed a good part of her benefits. She immediately increased to eight tablets again, and within three weeks she had cleared much of the new debris out.
In fact, her dose could be seven or six tablets but they are not going to bother to find out - the drug remains safe. She is only one of about 10 patients Dr St Amand treats who needs such large doses, but she required huge doses of the older drug Anturane, as well.

Thus, Dr St Amand’s rule of thumb remains. Raise the dose and if you hurt worse, you are not blocked, and your kidneys can do a bit more. Raise the dose and nothing different happens, you are probably at capacity or blocked. Many patients raise their doses by 300 mg. at a time, just to find their nearly-exact dose. As he keeps mapping and they keep improving, he holds them at that dose, until they ask to move again, whereupon he raises by another 1/2 tablet, making them worse and again holds there. Thus, stoic people who want to go faster can certainly raise their dosages by 300mg or 600mg every ten-day period and see what happens. Some very slow responders might well try that. Talk it over with your doctor.

If you didn't have long-term intolerable pain with Fibromyalgia before you began Guaifenesin, you shouldn't have it during reversal. It may be annoying, even disturbing, but it should not be more than you can handle. This is one reason why it is so important to follow the initial titration of your dose of Guaifenesin very carefully, and exactly as described in the protocol. Impatience at this stage might cause you to increase your dose too quickly, and overshoot your minimum cycling dose, resulting in greater pain and symptoms of reversal than you need to experience to successfully reverse the disease.

If you are at your correct cycling dose you cannot lower and still reverse the symptoms. You can only lower your dose if you have raised beyond your cycling dose. You can go back to any dose between your cycling dose and the one that is causing you too much pain.

The answer is - yes and no. There are two important dosage levels to recognize:

• the dose at which you begin cycling - this is your lowest cycling dose


• the dose where if you go beyond what your kidneys can handle, you will not get better faster, but you may hurt all the time from blood levels being continually high.

Yes, some people do. If you feel you are making progress, having better days, then don't worry about how hard you cycle.

If you've cycled effectively then you can stay there. So long as you got worse then you stay at that dose. If you suspect you can tolerate the symptoms, you can increase by 300 mg/day for each 10-day period and see what happens. If it's too much, simply decrease again and stay there. If your dose is too low, you will cycle (just as you did while the syndrome was getting worse) but you will be getting worse over time. If your dose is correct, you will cycle but you will be getting better over time.

Your dose is your dose. There is no need to increase. However, if you would like to speed up your reversal, you may. See instructions above. Remember to stay at your lowest cycling dose until good days begin to accumulate.

It's a very individual process, but probably don't expect a day in which you feel significantly better for at least a month, and in some cases, several months. Perhaps you may notice just moments of feeling better in the first few months.

There are a couple of terms we use to describe the cycling of various people: "fast responders" and "slow responders". Slow responders require more medication to cycle, and need to continue increasing their dose until they do.

The term 'fast responders' refers to cycling at the lowest possible dose of 300 bid, in long and sometimes almost continuous cycles. This is a useful category for people to recognize, because fast responders will often go very long periods of time initially without 'good days' as referred to in the protocol. So recognising that one is a 'fast responder' may make it easier to appreciate the nature of their reversal process, and that they will be purging almost continuously maybe for weeks/months without a let up. It is especially helpful to be mapped, so that you can be assured that you are indeed improving even though you may not feel very well yet.

See Questions and facts about Salicylates.

See questions and facts about Salicylates.

Reversal of Fibromyalgia is a cyclical process. The theory is that some abnormal deposit, probably phosphates, is withdrawn from the cells of the muscles, tendons, joints, brain, intestinal tissues, endocrine glands, and many other sites. As these reversals occur, all previous symptoms are reproduced, and patients experience pain and emotional disturbances similar to their previous ones but in reverse, and sometimes more intensely, as the entire process is accelerated. In other words, if you're feeling worse, you're getting better. We aim for feeling significantly, but tolerably worse. This indicates in a subjective way that the Guaifenesin is working. Many people also report feeling discomfort and pain in areas they had never noticed symptoms in previously. Also, the reversal symptoms often will move about from area to area. You may feel uncomfortable for weeks on end, but usually it is something different every few days or weeks.

A cycle is when you feel worse than usual followed by a period of feeling better than usual. It is produced when the Guaifenesin "asks" the kidneys to "flush" more phosphates from cells in the body into the bloodstream. The flow of phosphates exceeds the kidney's capacity, blood levels rise and you feel worse for awhile. When the kidneys catch up, the cycle ends, and you feel better for awhile. Then another cycle begins. Cycling does not damage your kidneys.

There is no particular duration of cycles. It’s very individual. Your treatment cycles will be as unique as your Fibromyalgia symptoms have been. Try to log them by keeping a symptoms journal. You'll be able to tell more by listening to your own body than comparing it to someone else's.

Low-dose = fast responder = very sal-sensitive High-dose = slow responder = less sal-sensitive Remember that this is a general guide only. Be patient.

"Tendons seem the first hit with the exception of the left side of the neck (Sternomastoid muscle), left upper shoulder blade (before the right) in 96% of the children's maps we have just reviewed for the paediatric book. Thus these are among the FIRST HIT and will be among the LAST TO LEAVE. The LEFT HIP/THIGH area was present in 75% of the kids - also a LATE REVERSER. The feet, top, sides and bottom, right deltoid tendon more than left are also LATE CLEARERS." - Dr. St. Amand

Everyone reacts differently to the reversal process. Generally, you'll experience the same Fibromyalgia symptoms you've had all along. The surprises come when things show up that you didn't recognize as symptoms of Fibromyalgia the first time they were experienced and sometimes you were not focused on some symptoms at all, or they were subtle, and now they seem like new symptoms.

It's usual to experience increased pain and/or fatigue when the treatment is begun, but some people have even felt better initially. Urine and sweat may have a noticeably different and perhaps stronger odour. Urine may be deep yellow or brown and stronger. Many people also report the onset of white matter, frothiness or bubbles, which is sometimes accompanied by burning at urination. You may notice odd skin rashes, some hair loss, a burnt taste in your mouth, pimples, gunky eyes, and an acidic-smelling perspiration (fortunately) unique to Guaifenesin reversal. Vaginal secretions turn acidic and can irritate. This is normal for the protocol. Also, the symptoms of Fibromyalgia you experienced before taking Guaifenesin may become worse. There is a greater need for sleep at first, as the body begins to repair itself.

Eventually, many people notice they have more energy and the times between flares get longer. It is important to remember that these signs and symptoms are NOT side effects of Guaifenesin. They are from the phosphates being released by the Guaifenesin, and are a good sign, although it won't feel like it at the time. Headaches are very common on the first reversal cycle. There are some "ouch spots" on the back of the neck you can find with moderate pressure, on the hairline. Several people who have had blood analyses report that their liver enzymes were high, perhaps due to the heavy-duty waste disposal going on in the kidneys, but there is no damage or undue stress to the liver or kidneys.

In the beginning, many things can make the cycling harder, as you work to increase the blood flow and accelerate the body’s ability to clear. Some of these things might be exercise, massages, chiropractic work, physical therapy, etc. If you are feeling much worse initially, and doing some of these things, it may be confusing trying to determine what are cycling symptoms and how these other things are affecting it.

Therefore, in the beginning it may be wise to cut back on other treatment modalities until you can determine your true cycling dose and your body’s responses. Once you have a better understanding of how your reverse cycles feel for you, you will be able to add these other modalities back, and have a clearer understanding of what activities affect you in what ways. Once you have this baseline, you can better add other helpful activities back into your routines and benefit from them by understanding how to regulate the amounts. Don't try to rush your reversal. It took a long time for your body to get this way. The kidneys can't clean it up overnight.

Sometimes Guaifenesin is working on large deposits that release vast quantities of phosphates as huge myofascial lumps dissolve. Your body can handle only so much at one time. Excess debris forms temporary deposits in various places, even on the teeth sometimes, until the kidneys catch up with processing the phosphates. Expect plateaus in the reversal process. Allow your body to find your best pace. It will eliminate the waste material as efficiently as it can. If you get discouraged, read the Success Stories web page or post how you feel to Guai-Support. Although we will all react differently, we've all been through this, and we can listen and support you as you go through it.

No. Phosphates are excreted mainly in the urine, but also in the stool, in sweat, tears and saliva. Don’t concentrate on your urine. Many things affect the colour, pungency and pH of urine, such as exercise, diet, medications, fluid intake, and hormones. You cannot accurately assume anything about your reversal by studying it. If however the changes are paralleled by exacerbation of some other symptoms as well and you become familiar with this pattern of cycling, then it may be a good additional guide to when you are cycling.

Sometimes Fibromyalgia features slight temperature rises but usually below 100 degrees. Most remain in the normal range. A temperature above 100.4 degrees Fahrenheit (38 degrees C) usually signifies an infection. Generalized aching of FM is different from the sudden viral dispersal via the blood stream in the initial phases of the flu, but the aching is similar. Both situations steal ATP from muscles and other tissues.

You're right. The first few cycles on Guaifenesin can be tough. Try to get by with the usual pain combinations such as Tylenol/Panadol(Aus) or a NSAID. Warm baths help a lot, and some find Epsom salt baths ease muscle pain. If you need more relief, turn to darvocet-N. Codeine or vicodin are a last resort. Often, a heating pad on stiff achy muscles is helpful; ice applied to areas of tendonitis reduces the pain significantly. The application of heat and ice may also be therapeutic as they both increase the blood flow to the affected areas, thus assisting the clearing process. Rest a lot when you can.

One GG member takes Taurine, an amino acid that deals with the perception of pain. You can get tested for the amino acid level. The source of this info is in the 1989 Journal of Rheumatology, in Jon Russell's paper on Serum Amino Acids in FMS. The Taurine part is NOT in the abstract. You have to read the full text to find this gem. Consider ice or heat packs, as well. Ice is typically used when there is nerve entrapment, or nerve involvement. The heat soothes muscle involvement.

Tylenol/Panadol should not be taken for more than a few days at a time. Tylenol is implicated in kidney cancer. As to damage, only liver tests can tell you the answer. Dr St Amand has had patients who have elevated liver enzymes on a normal dose of Advil, and others who take three times as much Advil as they should and have no damage. One should, of course, take as little as possible, but when in horrendous pain, as little as possible can be a lot. The best answer is to have regular blood work and if you see elevated liver enzymes, back off. Liver damage can be permanent or transitory. Discuss with your Health Care Professional.

What can I do to help the Guaifenesin work in my body?

While steam rooms/saunas and massages do aid phosphate elimination somewhat, they are not significant factors.

It is important to realize that Guaifenesin is not a cure for Fibromyalgia, but only a treatment. Dr St Amand says you will need to take it for the rest of your life, or you will regress as the phosphates accumulate in your cells.

You will not get well in a week. Pick a dose and ride it out, and you will get better in time. About two months at the proper dosage reverses at least one year of accumulated disease. Thus, the longer you have had Fibromyalgia, the longer it will take to clear the symptoms completely. Should X-rays show joint damage, these findings will remain permanently, although the pain may lessen or disappear entirely.

Dr. St. Amand says Fibromyalgia is very progressive, albeit cyclical. Fibromyalgia cycles with bad and good days at first. Progressively more places are recruited, anywhere in the body, until one merely cycles from bad to worse. Most people with FMS have had many lesser symptoms prior to the final insult that precipitates all-out Fibromyalgia. Viruses, accidents and horrible stress can all be the final straw. Fibromyalgia is, after all, an energy deprivation disease at the cellular level. Dr St Amand also says that FMS is the early stages of Osteoarthritis.

You are cycling. It's the hardest part of treatment with Guaifenesin. Waiting for good days is very hard but much harder when you have had a taste of good days, of hours without pain, without fatigue; when you have had a taste of a "normal" day without paying the price for it the next day.

When you feel yourself slipping back into the pain and fatigue, and you don't know how long it will last, you may feel discouraged. Of course, it ALWAYS seems to happen just when you're getting ready to do something, or HAVE to do something. You feel like your body is betraying you, like you're going back into hell.

You must remember you are cycling, and the very meaning of cycling is that it comes, and it goes. Soon it will happen just once a year, then once every two years, and then one day it will have been your last cycle.

Remember that if you are responding to Guai then you are getting better. Do everything in your power to focus on other things, and stay active, alert and interesting. Believe you will get well. If you have FMS you will cycle. Some from good to bad days, some from bad to worse, some worse to more worse. But you will get well.

You may give your doctor this web site address. You may print the contents of this web site and take them to your doctor. You may download the same material from the Guai-Support File List (see treatment info in g/lines). You may ask Dr. St. Amand's office to snail mail a packet of information. One physician converted to Guaifenesin usage may mean 100 or so people helped. If the doctor is also willing to accept referrals for this protocol, please give Dr. St. Amand's office a name and address so they can add his or her name to our nationwide list.

The PDR does not limit Guaifenesin to 600 mg. twice per day. Patients with chronic sinusitis, bronchitis, emphysema, asthma etc. are started on 1200 mg. twice per day. You could also supplement your RX Guaifenesin with OTC tablets. See the Guai Cycling Market Place and the Guai-Sources FAQ

Persist respectfully but firmly. At least one group member has found the hardest part of taking the drug is the disbelief in its use for Fibromyalgia. Her doctors claimed it helped no-one. However, we have found everyone who is on the correct dosage and not blocking with Salicylates has cycled. The member told her doctors she made the commitment to stay on Guaifenesin for the duration, and they reluctantly wrote the prescription. Sometimes she had to ask more than once.

Print out information you feel is relevant to your FMS and the treatment. We suggest the Info for Physicians web page and any others you find informative. Highlight sections that parallel your own situation. Include testimonials about the effectiveness of the therapy. Some are included on the Success Stories web page. Take the information to your doctor before or during your next appointment. This may work better than asking your physician to read an entire book. If that doesn't work, consider finding a doctor who is willing to help you.

See Guai Doctor Registry on the International Guai-support website or Dr. St. Amand's list;
and, in New Zealand, contact Megan or Jacqui

Southern Cross In New Zealand has many plans. Normally your doctor will prescribe and write a prescription, which usually is covered. Check with your representative.

Attack the cause of the depression with Guaifenesin. Hopefully, no antidepressants will be needed as good days begin to appear, but some people need them. As a very general rule, the earliest symptoms will be the last to go and visa versa. Unfortunately the brain is slower at releasing deposits since it readily picks up debris being released from other areas until the kidneys get it all out of the bloodstream. Getting strings of good days under your belt will help you tolerate the bad ones until clearing. If you are thinking of suicide, know that lots of us have also considered it. You must tell someone immediately. WE MEAN NOW, before you read the rest of this page. Then see your doctor as soon as possible.

Additionally, new research has shown that the some of the new class of antidepressants, the SSRIs, may not only relieve depression, but assist in pain control. See a doctor familiar with the management of these drugs if you suspect that you could benefit from them. But always re-evaluate your need for medications as you recover from the FMS.

Guaifenesin doesn't cause weight gain or loss. Fibromyalgia can cause weight gain, because there is a block to energy formation. Food is converted to some heat, but the remainder is converted to fat. So the Guaifenesin itself will not cause weight loss, but a cessation or decrease in intensity of FMS symptoms may. Also, medications some doctors prescribe for FMS can cause weight gain, but weight gain is so common in Fibromyalgia that it may occur whether or not drugs are used. See the Low Carb Strict Diet in the Hypoglycaemia & The Hypoglycaemia Diet FAQ for weight loss help.

It depends on whether you were still triturating your dose, still cycling quite a lot, if you'd reached a time of general absence of symptoms and if you'd been on your ideal lowest cycling dose or higher. Generally, you should start at the same dose at which you stopped, but if you had raised your dose beyond your ideal cycling dose to speed things up and have been off a long while, then you may find it best to start again at the lower dose. If in doubt, post your Guaifenesin history on the ListServ, and we'll try to help you.

That shortness of breath feeling is very common in people with FMS. The interesting thing is that it often comes in fairly short bursts such as 10-20 breaths. It is as though one cannot get a deep enough breath, with a satisfying amount of air. It always occurs at rest and is easily relieved by becoming active. It is so much a part of the FMS that, for you to "relive" it now as you begin your reversal sounds like it, too, is beginning to cycle. If, however, it persists more than a few breaths, and is not promptly relieved by getting up and moving around, you should use common sense and have it evaluated by a MD, as all symptoms are not due to FMS symptoms or Guaifenesin reversal.

The cause is probably more from the brain than a direct sensation from the lungs. One possibility is that we with Fibromyalgia have insufficient energy formation. That energy in the form of the metabolite, ATP, is formed with an aerobic mechanism (oxygen needed). It might well be that the brain, sensing the lack of energy, tries to push the process of ATP formation with added intake of air. The proof that the respiratory tree is not in trouble is that merely walking or becoming active promptly relieves the situation and does not make it worse as a lung problem would.

Celebrate! And keep Guai'ing! With most people, Guaifenesin therapy seems to result in control of symptoms. When your symptoms are gone and you have resumed activities, it is time to try cutting down or stopping your other medications. Try this only after consulting with your health care professional. At this time, Dr. St. Amand says you will need a maintenance dose of Guaifenesin forever. Your maintenance dose is the lowest dose at which you cycled.

If you don't become completely symptom-free, it may be due to another condition you have, but you will be a lot more comfortable without the FMS symptoms.

The Guaifenesin is no longer pulling phosphates out of the cells where the body stashed it. Instead, the maintenance dose prevents the phosphates building up again and creating symptoms.

Guaifenesin is not a cure for FMS and will work only while you are taking it, like all medications that control something, like blood pressure, or blood sugar, or thyroid medications. If you stop taking it when you are controlled, you will no longer be controlled. The phosphates will build back up, and your FMS will come back.

However, some people, once they are cleared out, can stop the Guaifenesin, and it comes back very slowly, or may come back later in life. These people had borderline symptoms and maybe an accident tipped them into it. They're like someone who can quit blood pressure medications after losing weight, but they have the gene, and any stress will bring it back. In this group, we are by and large, people who have had FMS all our lives, badly, and we are the kind who would need to take the medication forever.

There is no detoxification occurring in the reversal of FMS using Guaifenesin. If toxins were involved, there would be tests for FMS, and there aren't. However it is possible that other conditions such as low-grade infections exist because of the FMS, in which case if they would possibly begin to clear as the FMS reversed.

Yes. Dr. St. Amand says they're similiar to Fibromyalgia, and many other doctors these days agree. The diagnosis depends on the first symptoms you went to the doctor with. If your major complaint was pain, you were probably told you had MPS; if your major complaint was fatigue, you were probably told you had CFS.

We think that patients with a higher pain threshold have more fatigue and less pain; patients in the middle have a mix of both, and some patients, with a lower pain threshold have mostly pain, but are tired too. However, pain is a poorly understood, very subjective phenomenon, so we do not have a good understanding of its many variations from person to person.

Trigger points and tender points will go away with Guaifenesin. Dr. St. Amand believes myofascial pain is part of FMS, and that the tendons and tendon sheaths it affects take longer to clear than muscles, because they have less blood flow. But they will clear up. He has agreed to disagree with Dr. Devin Starlanyl on this, as she believes they are different conditions. He does not.

Dr. St. Amand says he has have never seen a case of chronic candidiasis no matter what the serum titre might be. He believes that, similar to the Epstein Barr Virus (EBV), these titres merely tell us someone has built antibodies against some particular virus, or yeast etc. These levels will rise and fall with as little provocation as a common cold. Candida tests are notoriously inaccurate, too. The "Candida" diet is perfect for chronic hypoglycaemia and, Dr St Amand thinks, therein lies the benefit. Incidentally, the Candida diet is nearly identical to the strict hypoglycaemia diet.

The diagnosis of yeast and parasites is not always reliable. If it is confirmed, yes, but Dr St Amand thinks it odd that he sees none of these and thus puts his patients on Guaifenesin without further diagnostic work. Don't undergo the treatments simultaneously, because you may not be able to know which helped you.

Many members of GG report that taking Acidophilus, the bacteria from yoghurt that keeps the diarrhoea away, in capsule form works well. Buy it at the health food store. Only buy the kind that is refrigerated and keep it in the refrigerator. Acidophilus will prevent a yeast infection. Immodium is also said to be OK.

Claudia Marek, Dr St Amand’s assistant, also recommends using boric acid capsules intravaginally for yeast infections. These are not systemic, so you do not kill off the beneficial intestinal flora that is normal. Take size 0 gelatine capsules (available from pharmacies and health food stores) and fill them with boric acid powder from the pharmacy. Some pharmacies will even do this for you. Use them intravaginally twice a day for a week. If you need to, you can follow this with twice a week when necessary, if you get yeast frequently or premenstrually. Dr. Willems says that even women with vulvodynia can use them and he feels that they are the best treatment for vaginal yeast infections.

Caffeine has no effect on the Guaifenesin whatsoever. However, those with hypoglycaemia (and about 40% of females with FMS are also hypoglycaemic), can't have the caffeine. For folks without hypoglycaemia it is OK.

No. Phosphates are in every bite of food. You just can't avoid them. Those of us with FMS have an excess of some elements, including intracellular phosphates, which our body does not excrete properly. But this is not based on the intake, because the numbers are so huge. For example, we take in 100 million phosphates a day, and maybe 1,000 of those are causing the problem. The most we could avoid by cutting dietary intake might be 500. This is some kind of example of what it would be like.

Dr St Amand says that you can’t avoid enough of them to make a difference. The numbers are just so overwhelming. The Guaifenesin zeros in right at the spot in the kidney and tells it to unload more phosphates - it is just a tiny channel, but the correct one, to get some of the balance back.

In her book Dr. Devin Starlanyl suggested that one might want to avoid colas which are high in phosphates. Dr. St. Amand does not tell patients to do this. A large study of Guaifenesin users showed no real difference in those who avoided colas vs. those who did not. (Only sugar and caffeine-free ones for you folks with hypoglycaemia, of course.)

If your skin is just dry, prescription strength Lac Hydrin is wondrous. There is an over the counter Lac Hydrin 5 which also works well. They are the strongest alpha hydroxy you can get and do a great job. Aquafor is good too. If you have an itchy rash in the folds of skin, or where you can see something other than just flakes, use a Salicylate-free cortisone cream. Do not use an ointment, as it will make this skin worse. Rub it in well three times a day. Use it with caution on the face, only as much as you need to clear the rash.

Biopsies of skin in 22 fibromyalgics reported in early 1998 showed disintegration of mast cells under the skin; these cells release histamine. It also showed the accumulation of immunoglobulin G in the dermis. These are the probable causes of the various rashes, hives, and itching we so frequently see in FM.

There is no doubt that phosphates are excessive in the skin as well, but the reason for dermal malfunction is the same as in muscles, brain etc. The accumulated phosphate decreases energy formation, ATP. It is the same all over. Much of the body and its cells are in difficulty.

Fibromyalgia can also cause itching, and the Guaifenesin will make it worse. The other thing you could do is changing your sheets. Sometimes they do not get rinsed completely in the laundry, being bulky, and soap remains behind. You may want to try changing detergents (unless you just did, which may be the problem) or at least double rinsing big loads. That is, of course, if the rash is not just plain old FM doing its FM thing.

You might want to try the old-fashioned bath using baking soda or bicarbonate of soda, a mild base; the opposite of phosphoric acid. Also a bag of oats in the bath might help.

First, if your test for mercury levels was done with your hair, Dr. St. Amand puts little trust in the results. But yes, you may begin your Guaifenesin treatment without fear of side effects. The mercury levels, even if truly abnormal, could wait, but you should work with your own doctor on this decision. Purge with Guaifenesin until you improve. If you begin to get the good days Guaifenesin should provide, you would know the mercury was not a causative factor. Far down the line, when you are getting long periods of good days, you could retest the same sites and spot any differences in mercury levels.

Most often Guaifenesin helps your body rid itself of protein-like material in the eyes (especially in the morning). It is what the group not-so-affectionately calls "morning gunk". These symptoms also seem to cycle with the purging. You can use saline eye drops or other non-mediated eye drops to decrease the irritation and flush the eye.

You may not have titrated to your correct dose and you may have been blocking. You might like to try Guaifenesin again but this time with the information now available at this web site & the support of the Guai-Support members.

Yes. You would not cycle if you did not have Fibromyalgia.

Dr St Amand says he’s seen no liver involvement or problems. Guaifenesin has been around in some form for 70 years and in this form for over 20. The liver is not involved with excretion or elimination of phosphates. In fact, the liver is one of the few parts of the body NOT involved in FMS, nor does Guaifenesin affect the liver.

You must decide this for yourself. A couple of months off Guaifenesin aren't going to matter a great deal in the end however. You might like to read about the Low Carb Strict Diet in the Hypoglycaemia & The Hypoglycaemia Diet FAQ for weight loss help.

Dr St. Amand suggests you ask what is the disturbed function they are trying to cleanse and advises that you see an internist or gastrointestinal specialist for a blood liver test called "ALT" if you haven't already done so. If it is normal he says to forget about your "fatty liver" or liver disease & above all, be sure no one does you more harm than good. He also says no herb will help the liver.

You do not need extra water with the Guaifenesin as it is used in this protocol. This instruction is meant for the chronic lung patients who take it to thin mucous, or if it is prescribed as an expectorant for a cold or allergy. The FM folks do not need to increase their water or fluid intake unless urinating is painful because of strong urine. Increasing your fluid intake might ease this a bit. Normal intake of fluid should be at least 2 litres per day - more in a hotter climate.

Guaifenesin has a very short half-life, a short span of action on the body. It is very quickly excreted, unlike some drugs, which can stay in your system a number of days, or some substances that never leave. This is why you should divide your dose into two, about 12 hours apart.

A few people divide their dose in three and find that works for them. But if you were to take all of your daily dose at one time, half of your day your body would be without the benefit of the action of Guaifenesin on the kidneys, and you would slow, or stop your recovery.

Yes, of course, but we don't recommend it unless you absolutely need to stop for something important you have to do and you can't do so while cycling. Also if you need or to begin titurating your dose again, due to not being sure you are at the correct dose. Some who stop, go into a flare.

Guaifenesin does not usually cause constipation, but many other medications can. You might add some roughage such as Konsyl, sugar-free Metamucil, Senokot (be sure it is 'sennosides'), Psyllium husks, etc. Others have reported excellent results by taking magnesium supplements orally, carefully adjusting the dosage to bowel tolerance to avoid irritating existing IBS symptoms (members see archives).

As with all medications and vitamins or minerals taken regularly, be careful that the ones you choose do not contain hidden Salicylates. If symptoms continue, you would be wise to consult with your health care professional. A last resort would be an herbal laxative as a one-time treatment.

Although not often, Guaifenesin can cause nausea. First check to see if it could be another medication that's causing the nausea or see if it helps to take it with food. If not, stop the Guaifenesin and see if the nausea stops.

Then, if it does stop, re-start the Guaifenesin and see if the nausea comes back the same way. If it does and you're using the tablet form of Guaifenesin, try putting each tablet in a gelatine capsule so that it is not exposed to the stomach.

If IBS has been a part of your FMS symptoms before starting Guaifenesin, then it may well cycle during the reversal process, causing nausea and other gastrointestinal symptoms. Determining whether your symptoms are due to Guaifenesin, or exacerbation of IBS symptoms due to reverse cycling may require some careful observation on your part.

Yes! Stress does make everything worse, including FM. Stress can also slow the process of reversal. However, stress does not block Guaifenesin.
Dr St. Amand describes it like this, "I think the best way to look at the problem of slowed reversal at times, is the analogy to a cheque account. One must have reserves in order to write a cheque. The process of FM reversal is to build energy (ATP) back up in our energy bank. Any expenditure of energy will draw on the account, at times in excess. Thus, as we all know, someone with FM cannot handle heavy exercise until such time as the bank is at a safe level."
"Emotional stress is not much different," he continues. "The brain burns more energy ounce for ounce than any other tissue even though muscles by sheer bulk burn a lot more. Stress will draw on the account and, if one is at a marginal reserve level, that person could draw down below a point wherein symptoms are precipitated and the reversal process slowed."

When you have FMS and are taking Guaifenesin, a massage can cause soreness even if your muscles are not deconditioned. Guaifenesin loosens the phosphates and a massage will loosen them even more, releasing more phosphates into your bloodstream, which results in soreness. Similar results can occur from overdoing physical activity, or engaging in too much bodywork in general.

Your tolerance for these sorts of activities may be decreased in the initial stages of reversal, and may even confuse you as to what is causing your symptoms. It may be wise to curtail these extras until you have a clearer picture of how you cycle.

Yes the protocol is the same. For children (or older folks who can't swallow pills) there are paediatric sprinkles you can sprinkle on foods. Check the Guai Sources web page for more info.

Back in the dark ages, when FM was even less understood, a researcher did a famous study where he deprived "normal" people of sleep and found that they "developed" the tender points of FM. For many years this tale held up, but over the years many tried to duplicate this study and could not.

It is now generally accepted that the original study must have been flawed, and that normal people going without sleep will not develop FMS. Our poor sleep is because we have FM. This thought is hearkening back to those original concepts. In fact, the first wave of research on FM all focused on various sleep studies (Modolfsky, Hench, Yunnus, Smythe, etc.). This is the origin of giving people with FMS sleeping medications in the hope they will improve.

It can definitely be the cause of palpitations and benign heart arrhythmias but not fibrillation.

If the numbness comes and goes and is not the same in both legs, then it is most undoubtedly FM. If it is steady, unchanging day and night, and is the same on both legs, such as up to the knees, then it needs to be evaluated promptly.

Vitamin E 800 mg at bedtime is supposed to help with leg cramps and restless legs. Some people report a lessening of leg cramps with the addition of magnesium supplements to their diets as well.

This bad taste is the body's too acidic saliva, common in FMS.

Yes, since both may be part of Fibromyalgia. What is commonly labelled "plantar fasciitis", when palpated correctly, turns out to be mostly segments of plantar tendons. As such, they are actually due to tendonitis, a common component of FM. Raynaud's has been attributed to the relatively high nor-epinephrine (catecholamines) found in some people with FM. It causes constriction of small finger vessels when exposed to the cold. Both should resolve with proper treatment for FM.

None of these illnesses causes the other; they merely accentuate the dilemma. Often, the FMS symptoms will not improve as dramatically when there are other untreated illnesses.

Always keep in mind that, if we are correct, FM is an energy-deprivation disease due to inadequate formation of the currency of bodily energy, ATP. Demands for more energy, any kind of energy, be it autoimmune, hypo- or hyperthyroidism, common cold, surgery, injury, dental cleaning etc., will make a demand on reserves for healing the acute process over the needs of the chronic one. Thus, in effect, one robs Peter to pay Paul but poor Peter was already destitute. To appreciate the best benefits, have a thorough physical exam to rule out other illnesses.

Dr St Amand says the enzyme, if such is the problem, would probably not be correctable orally. Enzymes are very large proteins with many amino acids. They would be digested, as are all protein foods. They would never reach the kidneys to insert themselves for benefit. Correction would take a genetic change. He goes on to say that he suspects we would all opt to stay on good, old, safe Guaifenesin rather than monkey around with our genes.

It is commonly accepted that there is no kind of permanent damage in FMS.

However, Dr St. Amand believes Fibromyalgia is the beginning of Osteoarthritis, which is considered permanent and which the Guaifenesin protocol will not reverse once it has occurred (although often the pain is lessened or stopped altogether by the treatment).