GDD Treatment: Multiple DTPA Chelations and Spacing, Identical Concept to Antibiotic Therapy
Multihance as a single agent lifetime exposure may be the best agent to suffer from GDD with - in many respects for similar reasons that Multihance is an agent which is among the least likely to result in NSF, despite being a linear agent.
Multihance is linear - the benefit for GDD is that DTPA removes a larger amount of linear agent than macrocyclic. Although DTPA can still remove macrocyclic agents.
Multihance has a small percentage that is eliminated in bile through the gastrointestinal tract, which is a safety valve especially for NSF.. but to some extent with GDD as well. The value of more routes of removal empirically makes sense.
Multihance has high thermodynamic stability. Crucial for safety from NSF. May also be helpful for GDD, but not crucial.
So as was observed in your case, within 1 year of administering Multihance as the precipitating agent for GDD, DTPA will cause an enormous amount of removal of Gd from your body. Since Gd is what is making you sick with GDD, empirically removing a lot of Gd is absolutely the crucial thing you want to have happen to get better.
With an enormous amount of Gd removal, it is always the case that the impetus for strong Flare is present. This is why in your case it was absolutely essential you receive our full current Frame drug regimen, otherwise the Flare would have been completely intolerable.
The majority of the Gd removed is from Gd reservoirs which are more accessible to removal, which is the skin and white cells in circulation. If an enormous amount of Gd is removed from skin, through the property of le Chatelier's principle (everything strives for equilibrium) with the reservoir of Gd is skin being depleted by chelation, Gd will move from bone to skin to re-equilibrate. This approach appears to become progressively greater from 4 weeks onward following chelation, but will of course commence fairly shortly after chelation. So skin burning 5-6 weeks after chelation is common, and informs us that too great an interval between chelation sessions has occurred.
Sweating is a natural effort by the body to remove unwanted, often toxic, antigens in the body. So night sweats is most likely the result of substantial amounts of Gd being re-equilibrated back to skin, and the skin's ecosystem striving to remove the Gd. So this is a good thing.
Finally, to briefly touch on the subject of number of chelations. For the great majority of sufferers the minimal number of Ca/Zn-DTPA chelation sessions is 5. A common interval that works well is 3 weeks, although a range from 1-4 weeks may work for some. To undergo 1 chelation session and expect durable relief, is virtually identical to the concept that if a person has a bone infection, that generally requires atleast 4 weeks of iv (that is oral is not 'strong' enough), and then stopping at 1 week and wondering why you are no better. In the antibiotic analogy a long enough course to kill the great majority of harmful bacteria has not occurred. For MRI it is because not enough cycles of "Gd removal - re-equilibration with Gd depletion from bone" has been allowed to occur. The huge problem for too short an antibiotic course is that the harmful bacteria left behind, has shown evidence of resistance to being killed by the antibiotic, and therefore this colony of bacteria can repopulate, and now the bacteria are largely resistant to the antibiotic. This disastrous situation is actually what is responsible for the widespread prevalence of antibiotic resistant bacteria - and why in some years many antibiotics may no longer be effective at all. It is not as much of a disaster for too few chelations, except that chelations do always result in immunologic memory re-ignition for Gd, which if a lot of Gd has been removed, acts as another mini-GBCA injection that can serve then to perpetuate and intensify GDD itself (a bad thing).
The intervals between administrations are also critical: for antibiotics it is generally simple: the maintenance of a relatively constant level of antibiotic concentration in the blood and body so as not to let up on the constant attack and destruction of the harmful bacteria. The intervals for DTPA chelation are not so critical, but range should be between 1 - 4 weeks, with 3 weeks working well for many. Too frequent chelations will cause a problem with serum electrolyte imbalance (which can be a huge problem), and too infrequent (5 weeks +) the symptoms from re-equilibration becoming severe. Symptoms occur both from the organ Gd is being detached from (bone) and where it is re-equilibrated to (skin). I have used the term Goldilocks principle for sensible balance and following the middle path.
There are some people who can do well with just 1 or 2 chelations, and it may well be that these individuals would have also done well with no chelations whatsoever and just following healthy diet and activities (eg:sauna) strategies for GDD. Having said that, with very minimal symptom GDD, even just removing a little Gd, and perhaps more importantly removing other toxic metals (such as lead), is not a bad idea.
Richard Semelka, MD