Dr. Jacob Teitelbaum

In CFS/FMS, especially given the severity of your illness, CMV and HHV-6 IgG titres over 4 would raise a concern of viral reactivation. Unfortunately, the Acyclovir at the dose you are taking would be fairly useless for this, as it is not high enough and it is not active against these 2 viruses. In my patients with suspected viral reactivation, I consider Valcyte for 6 months, following symptoms and titres. I also am adding Celebrex, which interestingly seems to enhance the antiviral effect, and the supplement Pro Boost 1 packet under the tongue 3 x day for 3-6 months.

I do NOT use lysine to suppress herpes in CFS/FMS/ME, as it works by depleting arginine (which is food for herpes) and the Arginine is critical for growth hormone production. Though I generally prefer natural options, in CFS/FMS/ME I prefer suppressing herpes outbreaks with the antiviral medication (Valtrex 500 mg at bedtime or 1 gm 4 x day at first sign of an outbreak)

In your case, your CMV IgM is also elevated suggesting an active acute viral infection rather than reactivation. If the CMV IgM stays elevated for 3 months or more, a severe immune dysfunction (beyond the normal one seen in CFS/FMS/ME) needs to be considered. Whether I would go with Valcyte now depends on your overall picture (how long has the CMV and EBV IgM been elevated, which EBV IgM antibody is elevated, Is the HHV 6 IgG over 4 or 1:640 or higher, did your symptoms flare in the last 6 weeks suggesting acute CMV or have they been steady suggesting chronic infection, etc). I likely would treat in your case

I would consider thyroid treatment regardless of the labs

If low blood pressure , irritable when hungry, lightheaded on standing (orthostatic intolerance) , HgBA1C level of 5.3 or lower, or 9 am fasting cortisol under 16 mg/dl is present I would consider adrenal support

I would check IgG 1-4 antibody levels to look for immune deficiency. If low, gamma globulin IV or even IM (the latter is much less expensive) can be very helpful for your overall CFS/FMS function and pain (may take 4 months to start working )

Treating with the entire SHINE protocol can be dramatically helpful to you overall , as well as for treating immune dysfunction and viral reactivation. See http://www.vitality101.com/shine

In response to further answers from Beverly Dr. Teitelbaum added:

It is key that the elevated PTH be addressed, as hyperparathyroidism will frequently cause FMS

I would consider a trial of Valcyte with Celebrex as the high CMV IgG suggests viral reactivation

Check a morning cortisol (fasting by 10 am). If under 16 mg/dl a trial of low dose cortef (15mg a day or less) is a consideration. This aacts VERY different than the high dose steroids. While checking the Morning cortisol, check a PTH, calcium , magnesium, ionized calcium, free and total testosterone, and HgBA1C and HHV6 IgG blood test. If insurance covers, consider an IgG 1-4 subset testing ( Immunoglobulin G, subclasses 1-4, serum” . Looks for antibody (immune) deficiencies). Also vitamin D levels (a 25 OHD and 1-25 OHD)