How do I know if I should continue with chelation?
This is one of the most common questions asked of me. Often times the patient quotes their 24 hr urine Gd amount, and is disappointed if it is still high post-chelation (for example higher than 10 mcg per 24 hrs). DTPA can essentially always get Gd out of bone.
I also worry when patients continue to keep getting more chelations, well beyond 20 (50 +) and are still doing badly.
I always look at the combination of pre-chelation and post Ca-DTPA chelation urine (not other chelators). This tells me if DTPA is still removing more Gd than the native elimination. Clearly if the value post chelation is more than 4 times greater than pre-chelation then chelation is working from the perspective of removing Gd. If there is no greater amount of Gd postchelation, then chelation is not working for you. It should be noted that increased urine Gd post chelation may be observed with all macrocyclic agents, in addition to linear.
As I have written in a number of blogs, removing Gd is not the same as feeling better. This is why simultaneous management of the host response is nearly always essential.
The best indicator of whether chelation is working is if you are having more days of feeling better (or even hours) compared to how you were pre-chelation. As with many things (for example sCr) the trend-line is important, as comparing individual sessions is often inaccurate because there are a number of variables that can influence feeling better or worse (the weather for example). So, following chelation session 12, 13, 14 are you feeling better than you did following chelation sessions 7, 8, 9- if you are feeling distinctly better (for example clearly 3 additional days feeling better over a 3 week period between chelations) then chelation is still benefitting you, almost regardless of what urine Gd shows. If you are not finding a trend of feeling better; or worse, that further chelations are making you sicker, then what you are doing is not helping and should cease.
This usually means higher stage of treatment should be performed (see recent blog on stages of treatment).
Richard Semelka MD Consulting
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