The interval between chelations likely is also very important. In our original peer-reviewed article on chelation with DTPA we looked at 4 week and 1 week intervals and found that both were acceptable.
With more experience, it seems that time interval may need to be tailored to the individual, based on a few factors:
1. how soon after GBCA injection and GDD development is the treatment planned.
2. how the patient is responding to the schedule they are on.
In general in patients who have GDD for less than 6 months, and certainly around 3 months, experience has shown that in a counter-intuitive way, short interval treatments make the patient feel much worse, because of the spiraling up of the Flare reaction. As addressed in a number of earlier blogs, this is because their immune system is on high alert, so recreating a GBCA with the chelator stimulates an already highly activated immune system. This impulse for massive reaction to chelation can be off-set by an extended hypersensitivity protocol (eg:FRAME), and this may change this formulation to allow shorter intervals. But attention to patient response is crucial.
Attention should be paid to how the patient is responding to chelation: i) too short intervals may spiral up the Flare reaction to an intolerable level. ii) too lengthy intervals, especially in the early treatment phase may show break-through of symptoms later in the period between chelations. What is observed in this setting is that the patient is fine and somewhat better for the first 3 weeks after chelation but in the fourth week the symptoms start returning with a vengeance. Why does this occur?
My theory for this relates to the natural re-equilibration that occurs when one reservoir is diminished, and the imbalance of equilibration is then re-established. So, the skin and skin substrate and intravascular cell content of Gd is most accessible, so this is the largest reservoir to respond to chelation, followed by other soft organs, and then by bone. Removing Gd from skin then, Gd from sources like bone then get eliminated in urine (as an ongoing process) but through re-equilibration (le Chatelier's principle) some Gd moves back to the skin, and presumably the brain. This probably is best managed by changing the chelation cycle from every 4 or 5 weeks to every 2 or 3 weeks. But important to see how the patient is responding.
Pay attention to the interval between chelations!
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Richard Semelka, MD. Consulting