Bone pain dominant GDD. A slightly different beast, requiring more chelation sessions with DTPA than most other variants.

Bone pain dominant is a variant of GDD, that behaves differently than other dominances. The critical aspect is that it generally requires more chelation sessions to get near full recovery. I generally describe that following GBCA injection, one needs at least 5 chelationsper GBCA injection to achieve near cure. So 1 GBCA injection, 5 chelations. With dominant bone involvement generally more chelation sessions are more needed. This is especially true if the underlying bone involvement also has a preceding complication of prior major injury, surgery, and especially of the spine. The ratio may end up being more like 10 chelations for 1 GBCA injection.

My opinion is this reflects that bone is the largest and most durable reservoir in Gd, and with prior bone complications, more Gd may be retained in bone. So rather than my estimate of 1-2% Gd retained at year 1 post GBCA, it may be more like 5% or even 10% if especially complicated bone disease/ surgery is present.

With bone involvement, re-equilibration is often the best method of extracting Gd from bone. This means that after the first 5 (to 10) chelations spaced 2-4 weeks apart, increasing the interval between chelations to every 3 months, allows for more time for Gd to move from bone back to soft tissues. Some of this movement also results in actual renal removal as well - which is critically beneficial

One other interesting phenomenon is that rib involvement is extremely common, and especially along the right lower rib margin, that can simulate liver of gallbladder disease..

A final important point of bone involvement is that its removal is not linear, like sand trickling through the waste of an hour glass, but more chunk-like, like icebergs breaking of a glacier. So one has to expect that intermittently, out-of-the-blue a more significant Flare occurs, which is generally the result of more Gd being present in 24 hr urine post chelation.

So bad news, it takes longer to get significant relief from bone disease. The good news, is that bone involvement generally has less overall decrease in quality of life than other dominances - such as brain, hearing, eyes, balance, and skin. and involvement generally is easier to live with.

Richard Semelka, MD