I first read about the approach of treating fibromyalgia by using TVAM (Transvascular Autonomic Modulation) in an article on the Synergy Health blog. You can find that article by clicking HERE. The article talked about how closely the symptoms of fibro mimic those of autonomic dysfunction,which is a malfunctioning of the nervous system. Dr. Arata now believes that many of those who have fibromyalgia, also have small fiber neuropathy. Reading this article left me intrigued, and I was craving more information. I contacted Dr. Arata, and he was generous enough to answer a few questions I had and allow me to post them here for all of you. Below you'll find our questions and answers:
TFF: Do you have any theories on what causes Fibromyalgia?
Dr. Arata: "At least for a portion of patients it appears to be an inflammatory autonomic neuropathy. As to what sets that off it is helpful to step back and think in general terms. Most chronic illness, particularly inflammatory ones, can be traced back to antecedents and triggers. Antecedents include things like genetics and exposures. Triggers are stressful events that occur just before disease onset. These can be emotional, trauma, infection etc. Intestinal permeability and SIBO are likely culprits for what sets off Fibro."
TFF: What led to the conclusion that many with Fibro also have SFN?
Dr. Arata: "I am not sure what lead the researchers to study the nerve fibers. It likely was similar to my experience working with MS patients. The overwhelming number of patients with autonomic symptoms was to hard to ignore. I didn’t have a neurology background which helped. I think in many cases it contributes to an elephant in the room phenomenon as the autonomic piece is often neglected."
TFF: How is the TVAM procedure performed?
Dr. Arata: "It is an endovascular procedure. That means “within the vessel”. In this case it is inside the central veins. A balloon is inflated to stimulate the nerves associated with the vein."
TFF: Are there any risks or possible side-effects to the TVAM procedure?
Dr. Arata: "I have submitted a manuscript looking at the safety of the technique. In 145 patients there were no procedural complications. At 30 days two skin infection developed and one blood clot occurred."
TFF: Will TVAM also help the muscle pain and joint stiffness that a Fibro sufferer deals with?
Dr. Arata: "Improved autonomic tone can decrease the intensity of pain felt. Stiffness also may improve. Treatment is not just limited to the TVAM procedure. For example magnesium helps some patients with those symptoms. Targeted use of supplements play a big role in my practice."
TFF: How long have you been performing the TVAM procedure?
Dr. Arata: "I have treated approximately 200 patients with TVAM over the last year."
TFF: How many Fibro patients have you done this procedure on, and what is your success rate thus far?
Dr. Arata: "All treated patients have autonomic dysfunction. Associated conditions are quite diverse. There have been about a dozen with Fibro. Response is seen in most but can vary in intensity. The patient with Fibro last week responded quite well."
TFF: Do the affects of the procedure last a lifetime, or is it something that needs to be done every so often?
Dr. Arata: "With such a new procedure it is very difficult to say much about durability. Treatment improved fatigue and cognition best. These two symptoms make lifestyle changes very difficult. I firmly believe the best treatment for any chronic disease is lifestyle. You have to be able to transform yourself and thats a tall order when you are seriously fatigued."
TFF: I had read that you are the only doctor currently performing the TVAM procedure. Are there any plans to educate other physicians on the procedure, to where this becomes a widely offered treatment?
Dr. Arata: "I will be speaking to physicians in Sicily in March. There is a group of Italian physicians who have been involved with CCSVI and similarly were troubled by the theory. They also concluded that the treatment response had to be something other than relief of vessel obstruction. I am very excited to share ideas with them."
TFF: Approximately how much is the procedure? Are insurance companies covering the cost, or is it all out of pocket?
Dr. Arata: "Most insurance companies are covering treatment so in many cases the out of pocket expense is very little. It really depends upon an individuals plan."
TFF: If someone travels out of state to come to you for the procedure, how long would they need to plan to be there?
Dr. Arata: "Consultation, treatment and follow up occur over three days. A day of travel on each end may be required depending on local."
TFF: If you have any research data supporting your work and would be willing to link it, I'd be happy to include that.
Dr. Arata: "I have one publication in print so far. Several others are currently under editorial review. This article describes the treatment effect on blood pressure. BP serves as a marker of sympathetic tone. It was the first objective evidence of treatment response. Click HERE to see the publication in print.
Dr. Arata is the primary care physician and co-founder of Synergy Health, a medical center located in Newport Beach, CA. Dr. Arata has been at the forefront of research efforts focused on establishing the link between neurodegenerative disease and autonomic dysfunction. I'd like to thank Dr. Arata again, for taking time out of his busy schedule to chat with me.