FAQs: Mapping

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1. Why is it important to map the left thigh?
2. Does Dr. St. Amand map all areas that hurt?
3. How often does Dr. St. Amand map his patients?
4. What do the left thigh lumps feel like?
5. Why does my left thigh still hurt once it has cleared?
6 If my left thigh has cleared, why am I finding new lumps and/or swelling in my body?
7. What will my map look like when I am clearing?
8. What will my map look like if I am blocking?
9. Why are my maps changing so slowly now that I've been on the protocol for a while?
10. Which tendons commonly swell when cycling?
11. If my map is clear, why do I still have cycles and/or symptoms?
12. Where can I find a blank body map and symptom checklist?
13. Who can map me?
14. What is mapping and how is it done?


1. Why is it important to map the left thigh?

Dr. St. Amand’s  has identified that 100% of his adult patients have significant palpable lumps in the left thigh.  These clear within a month when the patient is on the proper dose of guaifenesin.  Therefore, these lumps are the earliest and most reliable indicator to help determine when a patient has reached the proper dose of guaifenesin. top

2. Does Dr. St. Amand map all areas that hurt?
No. Dr. St. Amand only marks abnormalities that he can palpate, not a patient's pain. The amount of pain a patient feels does not depend upon the size of their lumps. Small lumps can produce a lot of pain if they are pressing on a nerves. Some patients have a high pain threshold, and report very little pain, even if their lumps are as widespread as someone who reports substantial pain. Pain tolerance is inherited and varies greatly.  Many fibromyalgics are also taking multiple medications that obscure pain sensation.. top

3. How often does Dr. St. Amand map his patients?
Dr. St. Amand maps a patient before he or she starts guaifenesin. Then, after one month, he does the initial re-map. It is at this session that he raises the patient's dose if the left thigh has not cleared.

Frequency following this initial remap depends on several things. If the patient's left thigh is clear, his or her dose is established and there is no hurry to remap. At this point he might typically see this patient again in two months just to confirm progress.

If, however, the patient's left thigh is still involved, and his or her dose has been raised, Dr. St. Amand would re-map again monthly until the proper dose is established.

Once we have ascertained the proper dose for a patient, intervals vary. Some people need or want more reassurance of progress, others feel confident to continue without blocking and wish to return in 3 or 4 months. Eventually we see patients once a year, or whenever they might wish to be remapped. top


4. What do the left thigh lumps feel like?

The lumps in the left thigh that are important to determining dosage are found along the outside of the thigh in the vastus lateralis and on the top in the rectus femoris. These lumps are long, about 18-24 inches in the vastus lateralis, and an average of seven smaller lumps along the course of  the rectus femoris. top

5. Why does my left thigh still hurt once it has cleared?

There is a nerve running through the thigh that begins in the uppermost, slightly posterior side of the hip where the ligaments and tendons are quite slow to clear. Pressure on the nerve sends pain down the thigh into the same areas where the muscles have already cleared. Remember that while the surface of the thigh may have no palpable areas left in it, there are still areas in the hip that can put pressure on nerves. In addition, the undersides of muscles, tendons and ligaments may still have areas of swelling. top

6. If my left thigh has cleared, why am I finding new lumps and/or swelling in my body?

It’s a normal part of the clearing process for lumps to swell and shrink and come and go. When a lump is being actively worked on, it often swells with fluid, then shrinks again when the cycle ends. Lumps often go through repeated cycles before they are completely gone, so you may experience cycling in the same location more than once. This is a normal part of reversal and does not indicate you are blocking or on too low a dose. However, if you continue to see more lumps and bumps and are feeling progressively worse you should do a blocking test. top

7. What will my map look like when I am clearing?

If you are clearing, your lumps will become progressively softer, smaller, and more mobile. Larger lumps, such as those around the hips and the tops of the shoulders, often break up into smaller lumps before disappearing. Although they will come and go, the overall trend is toward smaller and fewer lumps.

If you are on the correct dose of guaifenesin the lesions on the front and side of your left thigh should be completely gone after one month. top

8. What will my map look like if I am blocking?

When a person blocks, their map shows an overall increase in the size and number of lesions. Lesions in the shoulder muscles are particularly likely to re-grow when a person blocks. This is very different from the normal swelling/shrinking and moving around that lumps do when you are cycling. With normal cycling, there is an overall trend towards smaller, fewer, softer, more mobile lumps. When someone blocks, the overall trend is towards larger, harder, more widespread lumps. top

9. Why are my maps changing so slowly now that I've been on the protocol for a while?
This is normal. Clearing slows down later in the protocol as you begin to cycle tendons and ligaments. These structures receive less blood flow than muscles. Therefore, it takes longer for them to clear than the lumps in muscles. Maps change very slowly later in the protocol compared to maps done earlier in the protocol. top
10. Which tendons commonly swell when cycling?

Tendons can swell anywhere. However, swollen tendons are especially common in the right upper arm (the deltoid tendon), the front of the right ankle, and often the soles of the feet. They often swell 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. top

12. If my map is clear, why do I still have cycles and/or symptoms?

A map only shows the lumps and bumps that can be felt. There are many other structures affected by fibromyalgia that are too deep to feel. In addition, the mapper can only feel the lumps on the tops of your muscles. Others are located on the edges and underside but cannot be felt. These areas continue to cycle even after the obvious lumps have cleared up. Another possibility is that since even healthy people have small lumps and bumps from everyday wear and tear, if your map is completely clear, your mapper may be using a different technique than Dr. St. Amand uses.

Also, guaifenesin cannot reverse damage done by osteoarthritis. Nor does it ease the symptoms of other medical problems. If you have another condition that causes pain for example, guaifenesin will not reduce or eliminate that pain. However, people with multiple medical problems in addition to fibromyalgia can still benefit from the relief guaifenesin provides from the symptoms caused by their fibromyalgia. top

13. Where can I find a blank body map and symptom checklist?
A copy is posted on our website. Body Map and Symptom Checklist

14. Who can map me?
Although there are medical doctors in addition to Dr. St. Amand who follow the protocol and are willing to map, their numbers are few. Some people discover their own doctors are willing to learn if they are asked. Others may feel uncomfortable, but there are alternatives. Massage and physical therapists, chiropractors and others who work with their hands may be willing to learn if you ask. Some fibromyalgics even find family members to map them. Others map their own left thighs, although most report this is difficult to do. top

A list of practitioners is available at:
Fibromyalgia Treatment Center, Doctors and Practitioners

15. What is mapping and how is it done?
A map is a diagram of the human body that shows the size, location and hardness of a patient’s “lumps and bumps” of fibromyalgia. These lumps and bumps are nodules in the muscles that are characteristic of the syndrome. In addition to the lumps in muscles, tendons and ligaments can swell. Such swellings are also mapped.

Mapping is a tool to determine whether a person has reached his or her cycling dose. Maps are also done to monitor progress on the protocol and to detect blocking.

The mapper feels for the contracted portions of muscles, tendons and ligaments and draws them onto a blank map. Dr. St. Amand uses darker markings to indicate hard lumps, and lighter markings to indicate those that are softer. top

A video or DVD that teaches how to map can be ordered from:
Fibromyalgia Treatment Center, Books, Tapes, and CDs


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