No pain, no gain. Flare and Gadolinium Deposition Disease (GDD). Flare confirms that the patient's condition is GDD and not something else.

One of the most common emails I get from patients, either getting chelation by me, some other practice, or just from global fear of getting chelation. Here is a current response I have made to a distant individual consulting me:

The majority of the bone pain is from Gd being removed from bone, and immune cells reacting to that movement. Could there be a component of steroids, possibly but minimal.

Flare is something that has to occur, as I have written on many occasions. You are using a number of strategies to minimize it: lower amount of chelator, steroid use, drip technique.

No pain, no gain, but you want to keep it in a tolerable range.

I did not add to this email, but chelating has to also be varied in interval based on when Flare is occuring. I have blogged on this before.

I have made a point to inform all subjects and also on many postings that Flare has to occur and it is of critical importance. It confirms two essential occurrences: 1. the diagnosis of GDD (if no Gd exposure then an entity like Lead Deposition Disease). All other possible diagnosis will not result in Flare and are either much, much worse, or much, much, much worse, such as ALS or other rarer catastrophic neurodegenerative diseases, and 2. that the chelator is working since the Flare reflecting immune cell reaction (primarily tissue resident memory T cells, but also a number of circulatory immune cells. If you have GDD and the treatment you are getting is not causing Flare then it is either not working or working poorly.

The best treatment for severe Flare is follow-up repeat chelation, possibly with low dose chelation and higher dose steroids - but this is a nuanced decision.

A number of individuals feel compelled to go to the ER - generally there is nothing they can do, but make things worse. Although iv steroid/ antihistamine does work. Or they feel compelled to contact me. I am ok with that, but when I envisage when I will stop chelating is when I get too many contacts from too many people complaining about Flare.

Immediate attention to Flare may be essential at times This is most often adequately managed with oral methylprednisolone (start with 4 mg, escalate to another 4 mg if needed( and antihistamine, Taking more steroids is only a short term fix, it is not a long term strategy. Long term this can result in steroid overuse conditions like Cushings.

An effective treatment for variant removal Flare, where symptoms are more evident at day 5-7, is to start the oral regimen at a lower level of steroids, taper to 4 mg (or 8 mg if needed) and this longer tail of lower steroids can be taken for 1 week (maybe up to the next chelation session). The long term treatment is nuanced repeat chelation.

One of my medical, and favorite, patients described this situation of GDD and effective chelation-related Flare with this analogy: GDD can be like a thorn imbedded in you, you can bandage it up so it is less severe, but it is still there and painful, and will be there forever. Chelation is like pulling the thorn out. It hurts like hell when you pull it out, but then it is done. My variant on this is actually GDD is like having 1000 thorns in you, and the only way to get better is to pull them out, and it has to be done in batches, and the removal does hurt. .. I have the famous scene of Steve Carell; in 40 yr old virgin, getting chest hair ripped off with him waxing... and him screaming out at one point "Kelly Clarkson" (which no doubt also helped her fame.

Also, leaving thorns in you predisposes to infection with thorns, and severe multitype additional immune system dysregulations with GDD.

Flare is a very good and important occurrence, but it does need to be mitigated, with approaches as I write above. But amount of Gd removed, interval between chelations, amount of chelator, amount of steroids and taper style, for a number of sufferers is like walking on the razor's edge. It is the way it is.

Richard Semelka, MD