Frequently Asked questions About the
Guaifenesin Treatment  
Revised July 11, 2006

See More Resources for further information

Contents:
What can I expect the doctor to do when treating me with Guaifenesin?
How do I know if I'm progressing (What is 'Mapping')?
It seems to me that mapping doesn't have any therapeutic benefit, how important is mapping?
How often should I be mapped?
What if my doctor doesn't do the mapping?
What do the lumps feel like & where are they?
Would one expect the map of a child or teenager to show the usual lumps and bumps that are present in adults?
What about the pea, pearl-size (or "pebbling") or washboard lumps; are they FMS too?
I heard that the left thigh lumps should disappear in the fist month of treatment; is that true?
I heard that the tendons & ligaments are the last to clear; is that true?
How can I map the left thigh area myself since the lump is said to be hard to feel sitting up?
Can you explain a little more about how to map (mapping guide)?
Where can I view the Body's muscle system online?
It's 6 weeks since my last map and there is no change.  Am I blocking?
How can I be sure I'm not blocking (Blocking Test Instructions)?
My map used to change much more dramatically when I first started taking Guai but now it doesn't change as much between maps.  Is something wrong?
I know my dose & I've been progressing but my last map showed I didn't progress this time; what should I do?
Why shouldn't I just start at a high dose to reverse more quickly?
If I can stand a higher dose, does it speed the reversal?
How bad will my pain get?
Should I lower my dose whenever the pain gets really bad?
The pain of purging tendons and ligaments is intractable; What can I do?
Can I be on the right dose if I haven't cycled hard but I'm getting better?
I started guaifenesin at lowest dose & cycled effectively but I've felt incredibly good for over two weeks now, so I'm wondering if I'm blocking or should increase my dose?
When should I increase my dose?
When can I expect good days?
How does it feel to block?
How can I be sure I'm not blocking (Blocking Test Guidelines)?
How can I tell if the Guaifenesin is working?

I'm changing my guai product; how should I go about it?
What is a cycle?
How long are cycles?
Is there a general rule about salicylate sensitivity?
What areas take the longest to clear?
What other symptoms can I expect to encounter during the treatment?
My urine has not changed color or odor since I started taking guaifenesin. Does this mean I'm not cycling?
How can I tell if I am cycling or if I have the flu or another infection?
Will I still experience flares (caused by all sorts of things, like allergies and weather) in addition to the cycling from Guai?
I heard the first few months of guaifenesin treatment could be painful. Can you recommend anything to ease the discomfort?
I'm worried about how much Tylenol/Panadol I'm taking. What can it do to me?
What can I do to help the guaifenesin work in my body? 
Does the Guaifenesin protocol detoxify?

Do I need to change my diet to avoid phosphates in food?

Is it the guaifenesin or the FMS causing the rash?

What non-medicinal forms might help reduce constant muscle tension?

Do I need to stop taking Guai before surgical procedures?
 

(includes Exercise Tips for Beginners)

and more....

What can I expect the doctor to do when treating me with guaifenesin?
Any doctor normally begins by taking a typical, detailed medical history of a patient and family illnesses; s/he should know every medication you take.  S/he should also attempt to determine if you have symptoms of hypoglycemia or Insulin Resistance which impact FMS in important ways.  If your doctor doesn't do mapping you can either attempt to do so yourself or find someone who can help you.  Lumps and bumps on the muscular surface is said to be diagnostic of FMS by Dr St Amand.  Then, because people can have FMS as well as other medical problems, your doctor should do a basic work up that includes a blood count to rule out  infections or; a thyroid test called TSH (although some say this isn't always  indicative of faulty thyroid metabolism) and if you are a woman over 50 years of age, a SED rate and a basic arthritis panel is a good idea.  

"It was William Balfour of Edinburgh who in 1816 first mentioned the occurrence of "indurated nodules" associated with "rheumatism.  It is now recognized by most doctors using guaifenesin that these lumps and bumps occur not only with fibromyalgia but are believed to be present in all of the nonplus conditions.  Mapping is the process of running fingers down the muscles of the body and charting where the lumps and bumps are located."
(Dr Penniston, Pg 28, The Guaifenesin Guide -  out of print.  Please see Pg 39 in the new edition titled, Fibromyalgia, Chronic Fatigue & Irritable Bowel: Treating Symptoms Treating Cause  By Gregory K. Penniston, D.C.  In this book Dr. Penniston explains how and why the different treatments that are commonly used can be of help. He also explains that these treatments are limited because they do not treat the underlying cause of these conditions. The little known medication, guaifenesin, does appear to treat the underlying cause in many people. Dr. Penniston explains why guaifenesin works and how to best use it.)

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How do I know if I'm progressing (What is 'Mapping')?
A good way to follow your improvement with this treatment is to have someone regularly map you.  Don't use the 11 out of 18 tender points to diagnose FMS since our whole body is tender, if not all the time, at least during a flare.  Instead use the mapping procedure; map the lumps on your  body by feel, noting location and degree of hardness and transpose them to scale on the outline of the human body, . Ignore the fact that they don't hurt because whether they do or not, is not an indication of anything.  It is their existence and size that is important.  This becomes your basis for comparison with future maps to show progress or lack of.  Mapping is the only 'objective' evidence we have that shows the progressive clearing of the affected muscles and tendons, and sometimes it can help detect early on that blocking by some hidden salicylate or other issue is occurring.  Once a map has shown initial improvement, any regression of that improvement will be obvious over time.

When you see a map that does not improve (not everyone's map changes quickly so give it a bit of time.  They may increase and then diminish in size while in the midst of clearing.  The main thing is that, if you are not feeling any progress, your map doesn't begin to show decreasing amounts and size of lumps over time.  If progress is not noted, you need to begin a rigorous search for products containing salicylates and if any products (or activities) are found to be suspect, they should be eliminated (see under The Salicylate Issue heading in side panel for help).   Check your next map for improvement.  It is also a good idea to keep a diary/journal to record symptoms, noting pain and  emotional factors.  It has been reported by several that stress, emotional and physical, significantly retarded their clearing process.  Strong clearing cycles following such periods are not uncommon.  Keeping a diary is an  important adjunct to this treatment, helping to interpret the maps and determine actions to take.   In fact many people prefer symptom changes to be their guide.
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It seems to me that mapping does not have any therapeutic benefit, but provides progress reports; how important is the mapping?
It's considered vitally important by Dr St Amand, to titrate your dose, to indicate your progress and that you are not blocking with a product containing salicylates but it has no therapeutic benefit.  However, many people interpret symptoms as indicative of purging/clearing or not and do not depend on mapping. 

"...One can find someone who maps and attempt to determine the dose at which the lumps and bumps start to change.  When using mapping for this purpose I believe that a sudden increase in the lumps may be a more common finding initially that a decrease, yet either change may indicate the correct dose has been reached."
(Dr Penniston, Pg 67, The Guaifenesin Guide - Now out of print.  Please see Pg 85 in the new edition titled Fibromyalgia, Chronic Fatigue & Irritable Bowel: Treating Symptoms Treating Cause  By Gregory K. Penniston, D.C.  In this book Dr. Penniston explains how and why the different treatments that are commonly used can be of help. He also explains that these treatments are limited because they do not treat the underlying cause of these conditions. The little known medication, guaifenesin, does appear to treat the underlying cause in many people. Dr. Penniston explains why guaifenesin works and how to best use it.)
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How often should I be mapped?
Monthly till dosage is ascertained.  After therapeutic dosage is confirmed, three, then six, and finally to twelve months are good markers but not essential if your journal notes ongoing improvement.  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.  All larger lumps can break up into smaller lumps so be sure not to misinterpret these as new lumps or redeposits.
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What if my doctor doesn't do the mapping? 
It is quite possible that your doctor will not be familiar with the mapping techniques that are used to follow the progress of reversal.  You should either map yourself or find a chiropractor, massage therapist, or physiotherapist willing to learn the procedure and take charge of your mapping. They already know what a normal muscle is supposed to feel like and will not have difficulty learning the simple process of mapping. You can purchase a videotape that demonstrates the mapping techniques on a real patient or you can follow these mapping instructions.

"The Guaifenesin Protocol -- The Diagnosis and Treatment of Fibromyalgia" & the "Mapping Demonstration" videotapes are available from the Fibromyalgia Treatment Center site.

Although you may not be able to do a complete map on yourself, you may be able to do a modified one by paying careful attention to several areas of your muscles that feel hard and lumpy to you, and follow them over time enabling you to note improvements in that way.
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What do the lumps feel like & where are they?
They 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".

They are usually round or oval swellings e.g, in the trapezii at the top of the shoulders, in the neck when the head is bent forward and in the shoulder blade areas as large rounded, hard beads especially easily when the shoulders are rounded forward. In the lower back you might be able to feel the bulging spasm of lumbar muscles and the rounded lesions overlying the sacroiliac areas.  The left thigh contains lumps that are purported to clear in the first month of treatment on a therapeutic dose without blocking with salicylates but we've found that not everyone does.  Click here for further information regarding that.

We are told that tendons pop up everywhere, most often the right lateral shoulder (the deltoid tendon), almost always the front of the right ankle and quite frequently the soles of the feet. They appear very often on the outside of the lower legs, the left more than the right. The inguinal ligaments in the groin are usually swollen for part of their length only, the left more than the right and more often in women than men.
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Would one expect the map of a child or teenager to show the usual lumps and bumps that are present in adults?
Dr. St. Amand explains this difference between young children before puberty's map and those who are going through their growing change, or just left it, the teens and young adults:  "When born, the young under 12 store lots of phosphates so their maps are going to look pretty bad. But during their very rapid growing period, puberty, the phosphates that would have been stored are instead used to create new bone growth. A lot of what had been deposited is taken out of storage too and used for bone growth. So a teenage map will look better. However by the time they are in their early twenties, their maps will once again begin to look quite bad.  So if you look at the teenage years as a time of clearing for your children, a time where they don't complain much about symptoms if at all, you'll understand why their maps look better then the children 12 and under.  Bone growth uses a LOT of phosphates. "(GG archives, March 30, 2002)
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What about the pea, pearl-size ("pebbling") or washboard lumps?
Don't seek out tiny pebbles and think that lipomas, fibromas and fatty deposits are FM because they are definitely not.

Small lumps as above could be FMS lumps of course but without a doctor, MT 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.  Lipomas usually need to be diagnosed by a physician or MT.
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I heard that the left thigh lumps should disappear in the first month of treatment; is that true?
If you follow the standard protocol as written that is the supposed outcome.

GG tends to ignore the left thigh and focuses on symptoms instead but even on a lower than standard starting dose the left thigh could clear for some.

Even with those following the standard protocol the left thigh does not always clear in a month of a therapeutic dose.  If it does it is an indication that one has reached their therapeutic dose but if it doesn't, it is NOT an indication that one hasn't.  Other indications are also relevant.  Maps showing clearing in other areas also indicate a therapeutic dose has been reached.

The left thigh swellings are long & linear, running down the outer as well as the front of the left thigh.

Outer left thigh = vastus lateralis = 1 x 18 - 24 inches long; 
Front left thigh = Rectus femoris = 2 or 3 x 8-12 inches long large, smooth swellings NOT small, rounded lesions.

Be sure that your mapper is not including the left hip area; sometimes that does not clear for years. Only the muscle portion counts for the anticipated, early reversal; see:   
http://www.rad.washington.edu/atlas2/vastuslateralis.html
and:
http://www.rad.washington.edu/atlas2/rectusfemoris.html

Map this before you begin the protocol and you may see it begin to break up within the first month on a therapeutic dose (individual) and be cleared by the end of a month.  Members of Guai-Support have reported otherwise stating that it often has taken them longer to clear the above muscles in the left thigh. 

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 consider that you might not be purging and need to raise your dose. You cannot feel these lumps easily, or maybe at all, while sitting up. 
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I have heard that the tendons & ligaments are the last to clear; is that true?
"Tendons and ligaments are often the last to clear so always expect aches and pains of considerable duration in those regions." (archives: June 29, 1999, Paul St Amand, DOC,GUAI: mapping)

"Although I think we respond so individually to this medication that it is not possible to say for sure when anything will happen, tendons and ligaments are said to often be the last to clear and can cause a lot more pain than heretofore experienced with one's usual guai purging." (archives: April 29, 2004, Tesa Marcon, Guai Tendons and ligaments)
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Has anyone on the protocol for a while experienced left thigh lumps coming back?
The long & linear swellings, running down the outer as well as the front of the left thigh (outside= vastus lateralis; front = Rectus femoris may begin to break up when 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 each mapping then all is well.
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How can I map the left thigh area myself since the lump is said to be hard to feel sitting up?
Tesa suggests: Lay down on your right side and run your left hand down and your thigh. You shoud be able to feel it like that if you press firmly enough. Not too deep but stronger than a gentle massage (see explanation in next Q&A) or get a spouse/partner, family member or friend to help you.  Once you have established that they thigh lumps are breaking up, or indeed any lumps anywhere on your body, you can be sure you are cycling and don't need to be checking them out all the time but keep a close eye on products you use to be assured that you do not block your medication.  Get mapped, or map yourself about once a month to start but you can peg that back as time passes.

Kathy Jebbia suggests: Sit on the floor with your legs directly under you. In order words, butt to heels & hamstrings to calves. That position makes the thigh really taut instead of mushy so all of the lumps stick out more. Lots 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 laying 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. Then 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 guage 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.
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Can you explain a little more about how to map?
My doctor maps me according to the information he gained from watching Dr. St. Amand’s mapping tape and according to discussions with Dr. St. Amand.  He marks a body map with a pencil as he works and compares the body map with previous ones to determine my progress.  He uses the pressure one would use for a massage – not a deep tissue massage, but stronger than a gentle massage.  When mapping muscles, he uses a gliding action as if ironing but when he maps tendons and ligaments he uses more of a rolling motion with his hand slightly cupped as if he were trying to grasp the tissue and figure out how wide it is. 

1.  First, I sit on the examining table and my doctor maps my head area using both of his hands on each side of my face, starting in front of the ears where the temporal and mandibular joints meet (the TMJ spot) and moving toward my nose while feeling for deposits under the cheekbones.  He then maps along and under the lower jaw followed by the sides of my neck. 

2.  Once the head area is complete, he moves to the back of my neck where he checks along the hairline, down the neck tendons, and then down the entire length of the spinal cord to the coccyx. 

3.  Next, he moves to the shoulders, examining the back, top and front.  He then checks the collarbone area extending down into the pectoral muscles. 

4.  Then, using both hands, he maps each arm from front to back from the shoulder down to and including the hands and fingers. 

5.  The tops of the thighs and the entire lower legs are mapped next using both hands, followed by the top, bottom, and sides of the feet, including the toes..  
 
6.  Next, I lie down on my back on the examining table with my knees raised while the doctor checks the ligaments connecting the hip to the pubic bone.  He also examines the abdominal muscles. 

7.  He then moves to either side of my hips concentrating on the outer areas.  He pays greater attention to the left hip as it tends to be more affected than the right.  He pays particular attention to the vastus lateralis and rectus femoris muscles of the quadriceps.  These muscles are the first to clear (usually within the first month of treatment once the cycling dose is determined.)  Don’t be surprised if the left thigh is particularly tender to the touch. 

8.  He continues down the sides of both legs and then moves to the hamstrings in the backs of the thighs.  The right hamstring muscles usually show more lesions than the left. 

9.  After the backs of the thighs are checked, I roll on my left side keeping my knees bent while the doctor reexamines the area for any lesions that he hadn’t previously felt.  Lesions are usually present on both sides with the left side showing larger lesions.  Females, however, express greater pain on the right side than the left. 

10. Now I roll onto my right side with my knees bent while he reexamines that side.  He again concentrates on the muscles of the left thigh to make sure you are on the right dosage. 

11.  Once the mapping is done, my doctor compares my new map to previous ones to make sure that I am progressing.  If I want, he makes me a copy of the map that I can keep.

Thanks Sandra (Member of Guai-Support)

Where can I see the body's muscle system online?

View Body Muscle System 
          and/or
Upper Extremity Muscle Atlas
Lower Extremity Muscle Atlas

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It's 6 weeks since my last map and there is no change.  Am I blocking?
Every three months is often enough after dose has been establish.  A 6-week interval is not necessarily enough time for differences to be noted in maps. This is particularly true the further along you are in the protocol.
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How Can I Be Sure I'm Not Blocking; Blocking Test Guidelines

My map used to change much more dramatically when I first started taking Guai but now it doesn't change as much between maps.  Is something wrong?
Early in the protocol (ie, the first few months), you will typically see dramatic changes in your map because large deposits are being cleared from muscles (i.e., the famed 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.  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.
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I know my dose & I've been progressing but my last map showed I didn't progress this time; what should I do?
At all times during your treatment, mapping can be beneficial but changes become progressively more subtle as one improves.  When only a few areas remain to be cleared, only tiny improvements may be felt, as more difficult tissues such as the tendons are now being purged. because these structures have poorer blood supplies, guaifenesin penetration is much slower.
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See How often should I be mapped.  If other signs make you concerned that you may not be progressing you could very well be blocking.  Check your product's ingredients again.   Ensure that one of them hasn't been reformulated to contain salicylates.  GG members please always report a possible blocking situation to Wendy so we can check their products for them.  These notifications will also provide the very necessary opportunity for the Sal-Free^TM Products catalogue to be updated for the benefit of everyone.
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Why shouldn't I just start at a high dose to reverse more quickly?
Think in terms of a garden hose with the spigot shut.  No guaifenesin or perhaps too little would be analogous to keeping the faucet shut.  Nothing happens, no reversal begins, even if you are within the need for 1/16th more guaifenesin to attain your minimum, effective dosage.  At this point, anything introduced into the water pipes 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 something adequately (we think it is phosphate) but the body continues to produce it thus creating an excess which is tucked away wherever seems safest at the time.

Now, take a barely adequate dose of guaifenesin and improvement will follow, albeit slowly. Now, open the kidney faucet wider and wider with a progressively larger dose of guaifenesin and the phosphate elimination will indeed speed up albeit with progressively more distress to you.  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 excess phosphates 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 faucet 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. That is why the drug has no apparent side effects, even at high doses. All of this varies for each of us and, apparently, genetics determine how efficient our kidneys are with this process. 

Thus, a 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.  Raise by small increments to find your exact dose.  You can continue raising past your lowest therapeutic dose as suits you but if you begin to suffer too much lower again to your lowest therapeutic dose, or to somewhere between that and your current distressing dose.  Slow responders might well try that.  Discuss with your doctor if you wish.  
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If I can stand a higher dose, does it speed reversal?
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; and that dose that 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 high all the time.

Everyone has to determine his or her own cycling dose; you determine this by titration of Guaifenesin. The lowest dose that your body will cycle at is your therapeutic dose.  Then, there is another dose, the highest dose the kidneys can handle which still allows purging; this is also unique and represents that level of guaifenesin beyond which your kidneys can go no faster, and taking more will not speed things at all, and will not produce any increase in symptoms.

Beyond this dose you may no longer recognize cycles, as your blood levels will be higher all the time, waiting for the kidneys to catch up on the excretion process.  But between the lowest cycling dose and the highest dose there is room to adjust your dose so that you clear faster.  It is recommended that someone only increase their dose after they have been on guaifenesin for a long time and have begun to experience many consecutive 'good days'.  Before that, increasing the dose is confusing and difficult for many, as you have not had sufficient time to understand how your body cycles and to make subtle distinctions between cycling symptoms and possible blocking symptoms.  Also, after you have cleared more, you can tolerate a higher dose without feeling as severe cycling symptoms from it, but in the beginning this is not a wise tactic to take.

You can also increase your dose of guaifenesin to verify that you're not blocking.  When you increase, if you hurt more, you are not blocked, since even 10 tablets per day would do nothing if one were blocked.  If you raise the dose and feel no difference, you are either blocked or have reached your renal (kidney’s) limit.  See Blocking Test as there are exceptions.
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How bad will my pain get?
It should be no more than 'significant but tolerable'.  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.  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.  
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Should I lower my dose whenever the pain gets really bad?
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 which is causing you too much pain.
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The pain of purging tendons and ligaments is intractable; What can I do?
Dr. St. Amand said about this issue: "The initial amount needed to clear the thigh but may not be quite sufficient to dig deeply into tendons and ligaments with any degree of speed. We have stressed that whenever a patient feels he or she has leveled off in clearing, first recheck products for sources of salicylates that have slipped in on replacement purchases. Next, increase the dosage by one tablet. If that makes one decidedly worse, there is no blocking and there is a choice to  return to the previous lower dosage if they cannot handle that much pain or stay at the higher level and go for a speeded reversal."

And another time he suggested: "For those of you who suffer so long and hard, try something.  Quit guaifenesin for a week. You will easily retrieve any lost time within a couple of days back on the product.  In about two or three days, you should feel somewhat better. You will not be pulling much out of tissues and should certainly not put anything back in so rapidly (especially after one year on the drug)."  

(It might take some a little longer to experience a lessening of  pain especially if you are a slow responder.....Tesa)

Also: "Tendons and ligaments are indeed the last to go as are some of the joints. At that point, even our maps seem to show slowing down but each ligament or tendon that lets go is a victory of major proportions. When one cuts a 'cord' on a piece of meat, tendon or ligament, there barely appears any blood.  It is much more difficult to get guaifenesin into these relatively bloodless areas.  In the end however barring past injury and scarring, these resistant lesion also disappear."

You can also try raising your dose by small increments of Guai liquid (such as Naldecon Senior EX [1/2 tsp = 100 mg]), quick-acting compounded capsules (QACC) or quick- acting compounded topical cream (QACTC).   Try that weekly to find out what precise dosage you can handle. 

Sometimes increasing your dose above your normal cycling dose will lessen pain.   It is no guarantee but it does sometimes help.  

Try heat compresses, massage, stretching, exercise, walking etc..

You might choose to take stronger pain medication during this time also (see a health care professional for guidance)

Information re Medications
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Can I be on the right dose if I haven't cycled hard but I'm getting better?
Yes, some people do.  If you feel you are making progress, having better days, then don't worry about how hard you cycled.  Some don't experience exacerbation at the outset.  In that case wait to ensure you can ascertain you are actually in recovery (i.e., consistently feeling added improvement or setting into a pattern cycling (good and bad days) before considering raising your dose.  It's unlikely you will have to.
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I started guaifenesin at the lowest dose & cycled effectively but I've felt incredibly good for over two weeks now so I'm wondering if I am blocking or should increase my dose?
If you've cycled effectively then you can stay there. So long as you experienced changes in  your symptoms as outlined in the Basic Treatment Protocol document you stay at that dose.  If you suspect you can tolerate the symptoms, you can increase by low doses 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 disease 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.  Back To Top

When should I increase my dose?
Follow the titration process outlined in the Basic Guai Treatment Protocol Guide till you reach your lowest therapeutic dose (LTD).  Once attaining your LTD, your dose is your dose.  There is no need to increase.  However, if you would like to speed up your reversal, you may.  Remember to stay at your LTD until good days begin to accumulate. 
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When can I expect good days?
It's a very individual process.  If you are following the standard protocol with Q+LA guai you might go a long time without good days although it is possible that you'll experience some good days within a month to a few months.  If you are following the GG guide using QA guai you should begin to notice some changes in your condition within the month.  It is possible in both cases that you may notice just moments of feeling better at first. 

The standard protocol notes that there are a couple of terms to describe the cycling of various people: "fast responders" and "slow responders". Slow responders usually require higher doses of guaifenesin to cycle into recovery from symptoms; the term 'fast responders' refers to cycling at the lower doses, 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'.  So recognizing 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.  If you seem to go too long before experiencing good days it might be time to double check your guai product/type and dose are the right ones for you.  Perhaps check out the Basic Treatment  and Troubleshooting Progress documents for insight and be sure to write to the mailing list for help and support.

If you are using a QA guai and following the broader guidelines of the GG, or Dr Penniston most people experience changes of some sort fairly quickly.

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How does it feel to block?
See Sal-FAQ.
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How can I be sure I’m not blocking?
See Sal-FAQ.
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How can I tell if the guaifenesin is working?
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, previous symptoms are often reproduced, and one can experience pain and emotional disturbances similar to their previous ones but in reverse, and sometimes more intensely, as the entire process is accelerated. Generally, if you're feeling worse, you're getting better.  The standard protocol says that one should aim for the classic, 'significant but tolerable' exacerbation of symptoms.  GG, and Dr Penniston, also include the 'sweet spot', significant symptom changes for better or worse (some may get better while others get worse, or vice versa) or a feeling of improvement.

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.  Back To Top

I'm changing my guai product; how should I go about it?
There is no right or wrong way to switch between brands or types, as we cannot know in advance what your cycling dose will be on the new one. However, there are some general guidelines to help you.

If you are switching from a long-acting guai to a quick-acting guai, we usually advise taking a break from guaifenesin before retitrating from a low dose once again. This is only useful however if you are still cycling regularly.

If you are still cycling regularly, it is best to take a guai break till the cycling (exacerbation/purging) you have currently been experiencing abates and then retitrate from a low dose once again. This time frame will vary from person to person; one person could theoretically restart in a few days while someone else might have to wait 2 weeks or, rarely, longer. Your starting dose and how much you increase by will depend on what guai you are switching too and which format you choose to follow (Click here to see our Basic Treatment Instructions for details).

If you have stopped noticeably cycling it becomes very difficult to know when to restart. It is much better to simply change the product and restart immediately at a 1/3 of your LA dose and keep in touch with GG so that we can help you move up or down as seems necessary. If you decide to take a break it will be a long time before you start to feel worse again and your improvement will have regressed quite a bit by then. You would need to monitor your condition very carefully and it isn't advisable.

If you are switching from one LA to another LA product or from QA to another QA product follow the guidelines above as products vary (Re LA; currently there are only ready-made combination long-acting with short-acting guai but there is also the option of compounded products.) Click here for further information regarding guaifenesin products types and brands.

Suggestions:

Get a new map done *before* each increase and/or record your symptoms.

Whatever method you use, don't rush the titration. Give your body time to respond so you can note any changes, whether it be in your symptoms or your maps.

Further information:

Guaifenesin Product Troubleshooter 

LA or QA Guai:  Which Kind is Right for Me?

What is a cycle?
A cycle is when you feel worse than usual followed by a period of feeling better than usual.  According to the guaifenesin theory, 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 some symptoms exacerbate for awhile.  You may feel worse all over.   When the kidneys catch up, the cycle ends, and you feel better for awhile.  Then another cycle begins again.  Cycling does not damage your kidneys.

Note: Please consider that this response mirrors what is called the Jarisch- Herxheimer (J-H), "a phenomena originally observed in the treatment of syphilis, but later found in other illness. In general terms, it is described as a temporary increase of symptoms when anti-syphilitic drugs (antibiotics) are administered. What is known or speculated about Lyme disease herxheimers are based heavily on the reactions seen in syphilis. This is due to the fact both diseases are caused by a bacteria known as a spirochete, the former being Treponema pallidum, the latter Borrelia burgdoferi (B.b). However the herxheimer reactions in Lyme disease are not identical to those seen in syphilis, especially in terms of timing, frequency and duration as noted below.

In Lyme disease it is thought that the cause of herxheimers are the result of endotoxin release, that is toxin(s) within the spirochete that are released as the B.b are killed or broken down. This may be a result of the toxin(s) itself or the body's immune response to such."

Thus 'Cycling' may very well indicate that one is (actually or also?) experiencing a J-H (herx) response.  Perhaps purging excess phosphates, and thus correcting the metabolism, allows the immune system to kill a multitude of pathogens which it was heretofore too sluggish to do?  Click here for more on this issue.

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How long are cycles?
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. 
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Is there a general rule about salicylate sensitivity?
It's hard to pin down but here is a rather general idea:
Low-dose = fast responder = very sal-sensitive
High-dose = slow responder = less sal-sensitive
Remember that this is a general guide only.  Be patient.
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What areas take the longest to clear?
"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 pediatric 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  
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What other symptoms can I expect to encounter during the treatment?
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 odor. Urine may be deep yellow or brown and stronger; many people also report the onset of white matter 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 unique to guaifenesin reversal (fortunately). Vaginal secretions turn acidic and can irritate. This is normal for the protocol. Also, fibromyalgia symptoms 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 they 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. So in the beginning it may be wise to cut back on the 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. 
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My urine has not changed colour or odour since I started taking guaifenesin. Does this mean I'm not cycling?
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 color, 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 then it may be a good additional guide. 
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How can I tell if I am cycling or if I have the flu or another infection?
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.
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Will I still experience flares (caused by all sorts of things, like allergies and weather) in addition to the cycling from Guai?
Cycle merely indicates the ups and downs of one's experience thus, in essence, flare actually means the same thing, i.e., cycling in and out of bad days. The protocol theorizes that before guai the cycling is progressively from bad to worse and after starting guai it switches to progressively from  bad to better.  We have also been told that all 'bad' days are purging after we start guai but I personally think, having listened to many people publicly and privately over the years, that stressful situations do actually stall purging for some people, in some situations, and thus our bodies will be experiencing symptoms caused by the 'stressor'.  If you've been prone to exacerbation from certain triggers such as the weather, food sensitivities, allergies, etc., it may be some time before Guai has purged you to the extent that these experiences begin to diminish and thus are quite apart from a recovery purge exacerbation. They will also only diminish insofar as they are caused by FMS and Guai works well for you. There may be other causes to some of your symptoms so if they don't diminish you should continue checking out other causes/treatments.

I heard the first few months of guaifenesin treatment could be painful. Can you recommend anything to ease the discomfort?
You're right. Cycling on guaifenesin can be tough. Try to get by with the least pain killer medications that you can but don't make your life miserable.  Talk to your health care professional for help when necessary.  Here is a link that may help you: Information re Medications.

Warm baths help a lot, and some find Epsom salt baths ease muscle pain.  Often, 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.  Ice is typically used when there is nerve entrapment, or nerve involvement. The heat soothes muscle involvement.

Taurine, an amino acid that deals with the perception of pain may be useful. 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.

Rest a lot when you can and ask list members for suggestions also.
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What non-medicinal forms might help reduce constant muscle tension?
Heat and/or combinations: Heating pads, hot shower/bath, stretch in warm (not hot tub), hot baths, epsom salt bath, hot packs before other techniques such as electrical stimulation, massage.  Stretch in the shower... (see Yoga)
Breathing: Learning various breathing techniques facilitates the relaxation of muscles, including pre-natal class breathing. Breathing exercises either by itself or in combination with gentle stretches, gentle massage, meditation, gentle everything.
Stretching should be done frequently throughout the day.
Changing positions Frequently:  Move before your muscle stiffen up.  Remaining in one position for too long is a killer. Set your computer at work to send you a task every 15 minutes that tells you to change positions (carry a kitchen timer, set your watch if you can) (if sitting then stand, if standing then sit, if walking then stop and stretch) you get the picture.
Yoga: Some classes give Hot Yoga which is a blend of heat, breathing and stretching. (room is about 30+ degrees Celcius or 85 to 90 degrees Fahrenheit). One yoga pose to do in the hot shower is to stand with legs spread, parallel to tub, toes pointing inward, head pointed towards the shower curtain. (won't work with shower door) Cross your arms in front of you (hands to opposite elbows) and roll down with legs straight releasing/relaxing in your back. Do not force anything just go down are far as you can then let go in your back, breathe and relax into the pose keeping your legs straight. To come out point toes normally and come up rag doll. If your worried about safety, put some bath mats down. **see note below**
Progressive Relaxation: Tense/Release all parts of body moving up from feet to skull.
Massage: Make sure to tell the therapist what feels comfortable to you. Also trigger point massage therapy.
Self Massage: try using tennis balls in a sock and lean back against them to put pressure on the spots that are tense.
Hellerwork: see archives: 22-apr-2002 subject FMS Mapping/Hellerwork)
Meditation: Nothing to do, Nowhere to go. Guided meditation can be relaxing from beginning. The true practice of mediation takes discipline and when fully accomplished one becomes aware of Being.  This is by nature blissful. 
Reiki: Relax and let your higher self prioritize your healing efforts for you. Reiki (pronounced ray-key) is a laying-on of hands energy healing technique. Based on ancient wisdom it was developed in Japan by a Buddhist monk named Usui Sensei in the late 1700s and early 1800s. It has been described as a form of Shinto/Buddhist Qigong. Besides the potential of healing the body, as a Buddhist practice it can be used to lead one to transcend the ego and see "Reality". Search the net for more information.
QiGong: Qi Gong (Chi Kung) has been used by the Chinese for thousands of years as a way to promote self-healing, rejuvenation, and longevity. Easier to learn than Tai Chi, Qi Gong can be practiced by almost any age or fitness level. Practitioners generally experience increased stamina, better digestion, improved circulation, more restful sleep, balanced internal energy and reduced stress and anxiety. With regular practice you will learn to feel and increase your life-force energy while dissolving energy blockages. One of the benefits of Qi Gong is enhanced resistance to disease. Search the net for more information.
Relaxing Music, Candles, Fountain  All of these can be accomplished while in the shower or in your bath (do not bring electrical components into the bath enclosure with you - electrical shock hazard)
Magnets:  Many people relate healing and relaxation from magnets.
Danielle in Northern Ontario: ** My Two-Cents About Yoga ** Yoga is about the relationship between mind and body. It is YOUR body and never mind anything else other than what your body tells you, you can do. You don't HAVE TO do anything in Yoga. Go very slowly into the poses, listen to what your body is telling you, hold as long as you are comfortable, use supports (your own leg, foot or arm) or use a wall if balance is a problem. Yoga is not like dance steps, they are poses that align mind and body. I often modify the poses to suit myself, or pass up on poses that I don't feel comfortable doing and a good teacher will commend you for that. Do what you know feels OK and never mind what your neighbour is doing.

Do I need to stop taking Guai before surgical procedures?

You won't be able to take anything on the day of surgery but otherwise it should be fine.  Guai's effect on the plateletes is small & does not last very long.  That is contrary to Aspirin's effects  which last the life of the platelet, or longer than a week.  It means that there is no need to discontinue guaifenesin before surgery.  Always discuss the medication you are taking with the anaesthetist and the surgeon.

I'm worried about how much Tylenol/Panadol I'm taking. What can it do to me?
Tylenol/Panadol should not be taken for more than a few days at a time. Tylenol is implicated in kidney cancer. In England the number one way of committing suicide is by swallowing a bottle of Tylenol. 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.
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What can I do to help the guaifenesin work in my body?
Get as much rest as you can, avoid stresses, ensure you are not blocking with salicylates and stay in touch with a support group.  Exercise is also a significant factor because when muscles are exercised, they build many more mitochondria, which accelerate our clearing.  Dormant muscles lose their mitochondria.  The more mitochondria we have in our muscles, the better, almost exponentially. 
Beginners Exercise Tips
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Will sitting in a steam room or sauna speed my recovery?
While steam rooms/saunas and massages do aid phosphate elimination somewhat, they are not significant factors. 

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Guaifenesin Treatment
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