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Aussie Barb
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Posted: Mon Nov 1st, 2004 05:11 |
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DaveW wrote: The longer I am on the MP, the more that I realize how important it is to understand it - to a depth that permits a deep personal conviction regarding its value and validity. Such conviction is essential to carry a patient through the many challenges it poses.
My experience would temp me to give the following advice to those considering the MP; "If you don't understand MP well, and feel a strong belief in its validity and potential - don't even try it".
- DaveW
Thank You Dave.. good quote..
am glad to see you have the Benicar & the herxing & the depression more towards where they ought to be.... 
Barb...
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Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| Depression| 24+ years not Dx| MP Aug04| ABC of MP| MP Search|
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DaveW
Member
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Posted: Sun Nov 7th, 2004 17:50 |
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Weekly update
This week I ramped up to 100 mg (from 50 mg) of mino for the first time. The increase in herx was considerable, but tolerable.
Herx symptoms included common symptoms of soreness and pains in my jaw and teeth, and sore achy muscles all over, short transient pains all over, and a slight constant headache. It also included increased difficulty concentrating, increased fatigue, and increased depression. I am quite happy in the perception that the herx is now occurring, as it should.
Bowels are responding ever more naturally, and I have experienced small windows when concentration (my most tenacious unyielding symptom), may have actually improved slightly. I also experience occasional feelings and emotional stability that have been foreign to me for several years. This gives me hope.
Speculation
From my experience over the past few weeks, I have realized that the adjustment to benicar takes at least several weeks (at least for me). I originally thought I had adjusted to it within a week, but I did notice changes in my response to the MP over several subsequent weeks (which I attributed to the mino, and/or the reduction in total bacterial load).
Then, when I had to stop benicar (due to an interruption in supply), I experienced many unpleasant re-adjustments to its absence. Then, upon recommencing it - it took several weeks to get me back to where I had left off before discontinuation.
I have come to realize, that the adjustment may be so long that I may still be adjusting.
I suspect that the dysregulation of body chemistry and hormones (due to systemic inflammation from the CWD), does not correct itself (or find a new homeostasis) quickly. I also suspect that as the total bacterial load decreases, the body chemistry keeps adjusting in response to the changing levels of inflammation.
Due to unreliable supply, I have never taken benicar at a dosage of more than 40 mg every 8 hrs (with quercetin). I can tell that my body begins increasing inflammation before each dose. If I ever get a reliable source in higher dosage, I can only speculate on what further positive adjustments may occur if I increased the dosage to 40 mg every 6 hrs, and maintain more constant lower inflammation levels.
Re: The Canadian Special Access Program (SAP)
I am Canadian, and have been working on getting access to benicar through an SAP application, submitted by my Doctor to Health Canada.
This application has now dragged on for many weeks. We sent in the form (after considerable time and care in filling it in as completely as possible).
Health Canada then requested that my Doctor send in more information and research regarding its safety and its use for this purpose (reducing inflammation in fibromyalgia), as well as justifying that there were no suitable substitutes for benicar that are available in Canada. A great deal of time and effort was spent researching the best response we could put together. We faxed in 24 pages of articles and links in response to this request.
Then, Health Canada requested a list of all the treatments we had already tried (without success), to ensure all standard approaches were exhausted and futile. Again, a great deal of time and effort went into listing the many dozens of unsuccessful approaches attempted over my 18 years with the disease. It also included test results that repeatedly indicated inflammation, and other experiences that clearly indicated a bacterial infestation. This was faxed in three weeks ago, and my Doctor has yet to get a response from them. He has tried to phone them at least twice, but gets wrapped up in an unending labyrinth of computer generated messages and instructions.
I will be going to see him for an update again tomorrow. I am so thankful for my Doctor's support on this, but he is extremely busy, and this has created such a hassle for him. He just doesn't have the time to keep chasing them - but I suspect if he does not, they will just let it fall by the wayside, which would set up a bad precendent for future SAP applications by other Doctors.
I have an appointment to see my Doctor again tomorrow for an update (and to gently request that he "keep on them", until we get a reply). I will post an update regarding any further news or developments.
Keep strong!
- DaveW
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MP Aug14/04,Pre-MP D=19.6,1,25D=37 ratio 1.89 P2>12/27/04.Back to P1 fall/05.Back to P2 05/06. 21 yrs neuro-lyme not dx til 11/05. OlmesTR 40 mg/7hrs. Major: Weakness,IBS-C,pain,bad sleep,anxiety,depression,cognitive focus,memory,CMV,epilepsy & osteo
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Foundation Staff
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Posted: Sun Nov 7th, 2004 19:18 |
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Dave says,"I suspect that the dysregulation of body chemistry and hormones (due to systemic inflammation from the CWD), does not correct itself (or find a new homeostasis) quickly. I also suspect that as the total bacterial load decreases, the body chemistry keeps adjusting in response to the changing levels of inflammation.
Dave,
I think that is exactly what many fail to realize or have enough respect for. When you think how powerful this secosteroid hormone, 1,25-D, is and how many other hormones have a relationship with it, is it any wonder why our poor bodies are so confused as the level keeps going up briefly and then down a bit more as we proceed on the MP. Thanks for summing it up so well.
On behalf of your fellow Canadians, thanks also, for being so tenacious about getting Benicar under your national health program. Your results probably will set a precedent. Some of us here in the States are having trouble with our insurance companies not wanting to follow docs orders. The ostensible reason is safety but we know that they are really concerned about the increased cost. It will take some time, I'm afraid, to convince them that the long-term costs of treating these diseases by other means is huge in comparison.
Best,
Meg
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DaveW
Member
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Posted: Mon Nov 15th, 2004 03:27 |
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Weekly Update
I am still awaiting news regarding my Doctor's SAP application to Health Canada. I will report either acceptance or denial of the application, as soon as I get the news myself.
Nothing too profound to report this week. I took my second 100 mg dose of mino on Friday. I have noticed a stronger than usual level of muscle cramps, which can occur from simply holding a muscle in the same position for a few mins (such as holding a telephone). I have also noticed an increased level of achiness in my back and muscles, with my back also having a higher than normal degree of itchiness.
Concentration has again deteriorated, with depression and anxiety also being higher this week. I am also still struggling with my appetite, and a high level of fatigue.
It seems that it is when I am tired and feeling overwhelmed, that I am my most vulnerable to food cravings. It seems that the food gives me the ability to relax and concentrate (for perhaps an hour). This makes me wonder about whether my brain is getting sufficient energy to operate properly. The food fix may provide an increase in blood sugar that could provide temporary relief. I have no idea of whether this is true, but it does describe the nature of my cravings and the experience of the relief provided by the food fix.
One day at a time!
- DaveW
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MP Aug14/04,Pre-MP D=19.6,1,25D=37 ratio 1.89 P2>12/27/04.Back to P1 fall/05.Back to P2 05/06. 21 yrs neuro-lyme not dx til 11/05. OlmesTR 40 mg/7hrs. Major: Weakness,IBS-C,pain,bad sleep,anxiety,depression,cognitive focus,memory,CMV,epilepsy & osteo
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Reenie
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Posted: Mon Nov 15th, 2004 15:45 |
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Hi Dave,
You may want to try eating as in the Insulin Resistant Diet. This controls blood sugar and insulin to keep it steady thruout the day, by spacing out and limiting carbs and eating only low and moderate glycemic ones.
The other alternative is a more low carb diet, but I do better on the IR Diet. Here's the link:
http://www.marshallprotocol.com/forum27/1287.html
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Aussie Barb
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Posted: Mon Nov 15th, 2004 16:06 |
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Dave, Hi,
how often are you taking your mino?
you sound to be herxing uncomfortably? do you need a day off or maybe better to drop the dose every 2nd or 3rd time to give you a break? what do you think?
it would be better if you had an ensured Benicar supply.. does your sig line say you are taking it sometimes TID and some QID? Q6H would help you more of course. I hope you can soon get a constant source.
Barb ...
PS Dave.. are you only on mino once a week? that in itself may be a problem too.. let us know and we'll see what we can work out for you so you can feel a bit better ..? xox B
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Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| Depression| 24+ years not Dx| MP Aug04| ABC of MP| MP Search|
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DaveW
Member
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Posted: Mon Nov 15th, 2004 23:23 |
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Reenie and Barb,
Thank you both for your replies. An insulin resistant diet may be very helpful here Reenie. Thanks for the link!
Barb, I take my mino once a week (on Fridays) in an effort to avoid the most debilitating herx while I am working. After I take a few doses at a given dosage (and the herx declines somewhat), then I start taking a second dose mid week.
I think your observations are astute - I suspect I am experiencing a higher level of herx (due to my recent ramping from 50 to 100 mg). In hindsight, perhaps a ramping to 75 mg for a few weeks may have been a wiser choice. I ramped up too fast once before. You'd think I would have learned something! Can I blame this on my macho gender (and get away with it)?
- DaveW
P.S. As soon as I acquire a dependable supply (and I am working on it), I plan to up my dosage of benicar to 40 mg - 4 times per day. I suspect that may be a considerable help in itself.
Take care.....and keep up the great work you two!
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MP Aug14/04,Pre-MP D=19.6,1,25D=37 ratio 1.89 P2>12/27/04.Back to P1 fall/05.Back to P2 05/06. 21 yrs neuro-lyme not dx til 11/05. OlmesTR 40 mg/7hrs. Major: Weakness,IBS-C,pain,bad sleep,anxiety,depression,cognitive focus,memory,CMV,epilepsy & osteo
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Aussie Barb
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Posted: Tue Nov 16th, 2004 09:52 |
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Dave,
re : "I suspect I am experiencing a higher level of herx (due to my recent ramping from 50 to 100 mg). In hindsight, perhaps a ramping to 75 mg for a few weeks may have been a wiser choice. "
are you going to drop back to 75mg then to give yourself a better time ? ... IMO you may find it a better choice..
Thanks Dave  Wishing you the best, & Take care, Barb ...
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Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| Depression| 24+ years not Dx| MP Aug04| ABC of MP| MP Search|
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DaveW
Member
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Posted: Tue Nov 16th, 2004 14:59 |
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Barb,
I think that dropping back to 75 mg is good advice. However, I have some holidays coming up in about a month, and it is my hope to have acclimated to 100 mg mino by then - so I can take my first dosage of zithromyacin while on holidays (When the somewhat unpredictable first response would not pose so great of a threat). My next break at work will not occur until May. For this reason, I am pushing the pace of the ramping somewhat.
However, even with this consideration, I may still drop back to 75 mg. My current herx level is difficult to take. At the same time, the suffering is bittersweet.
Thx for the good advice. You pegged it exactly by recognizing my pace was too fast for comfort!
Take care!
- DaveW
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MP Aug14/04,Pre-MP D=19.6,1,25D=37 ratio 1.89 P2>12/27/04.Back to P1 fall/05.Back to P2 05/06. 21 yrs neuro-lyme not dx til 11/05. OlmesTR 40 mg/7hrs. Major: Weakness,IBS-C,pain,bad sleep,anxiety,depression,cognitive focus,memory,CMV,epilepsy & osteo
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Aussie Barb
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Posted: Tue Nov 16th, 2004 17:45 |
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Dave.
I believe we have had this conversation before  quite a while back..
"you are a tiger for punishment" as they say.... and what I say is
Aussie Barb wrote: Taking Care:
Most of us have been so accustomed to being so unwell pre MP, that we consider quite considerable herxing is all bearable and managable because of the stoic strength we have built up, especially when we think MP is getting us somewhere.....
MP makes our body work as hard as we push it to... and there is no hurry.. it is best ie more comfortable for us (& our Family) & safer to go a little slower so it is not so hard on us all.
In MP if we push too hard, the somewhere we think we are going to, gets further away.
Phase 1 is a training ground for learning to manage the meds and herxes in a safe manner, ready for the much bigger phase 2...
Dave, especially as you have limited Benicar..... whatever you choose, choose for You, Ok?
Best for Dave, Barb ...
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Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| Depression| 24+ years not Dx| MP Aug04| ABC of MP| MP Search|
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DaveW
Member
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Posted: Sun Nov 21st, 2004 15:01 |
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Weekly Update
The MP (and herx reactions) seem to be proceeding as would be expected. I did drop back to a 75 mg dose from 100 mg this week (to accommodate a demanding schedule). I will likely ramp back up to 100 mg again next Friday.
I have noticed that in recent weeks, my cold hands and feet (which I experienced during my first two months on the MP), has now largely resolved itself.
Depression and anxiety levels have seemed to reduce slightly over the past week. Concentration and memory are still not improving.
Regarding my Doctor's SAP application to Health Canada
My Doctor and I have been waiting for several weeks for the decision of the SAP program in response to an application by my Doctor to access benicar. My Doctor is taking next week off, so I contacted the SAP program myself this week with an email (in hopes of getting a decision before his week off).
Note: Before approving, what the SAP program seemed to want to know is:
What disease you have, and what conventional treatments have been tried (unsuccessfully) to treat this disease?
Whether the drug requested is safe?
Evidence, research or articles showing that the drug requested is useful for the disease being treated.
A justification that the drug requested has no suitable (available) substitutes.
____________________________________________________
The email I sent to the SAP program, summarized all the above information that had previously been submitted (as outlined above), and requested approval.
In response to my letter, I was told that for purposes of privacy - the SAP application from my Doctor does not normally disclose the name of the patient. Therefore, I should consult my Doctor to get an update on the progress of the SAP application.
Their response reiterated that all of the above information (and the SAP application itself), must be submitted by your Doctor. I have the impression that they do not wish to communicate directly with the patients involved. This (unfortunately) requires a considerable amount of work for your Doctor.
I attempted to do as much of the footwork and compiling as I could to minimize the time required by my Doctor to fulfill these requests. Still, it has been quite an imposition on his time. It appears to be a very slow bureaucratic process.
My response to Health Canada was to simply thank them for the quick response, to acknowledge the need for privacy, and to announce that I would await to hear their response from my Doctor. So.....we are all waiting again.
I do expect a decision within the next couple weeks, and I will report it as soon as I receive it.
Personal Observations and Speculation
I am coming to realize, that for me - the ingestion of food reduces herx. I am entertaining the idea that the food may actually cause a low level of inflammation that protects the CWD bacteria - thereby reducing my herx reaction.
I also have the suspicion that there is a "zone" of low level inflammation that I unconsciously seek - as that is where I feel best.
If inflammation gets too low, herx becomes unpleasant. This drives me to eat, which reduces the herx and makes me feel better (temporarily).
This may be an unconscious learned response that I have been conditioned into over many years. I have no idea if other people have the same herx reducing response to food, or if they might also unconsciously use food to control herx.
I am not certain yet of the above, and I also suspect that there are likely more variables that also play a part in my food cravings. I will continue to observe my symptoms and reactions to see if the above hypothesis holds true.
It is interesting that we may have behaviours that we do unconsciously, and that we may not even fully understand the reasons for those behaviours.
Have a great week!
- DaveW
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MP Aug14/04,Pre-MP D=19.6,1,25D=37 ratio 1.89 P2>12/27/04.Back to P1 fall/05.Back to P2 05/06. 21 yrs neuro-lyme not dx til 11/05. OlmesTR 40 mg/7hrs. Major: Weakness,IBS-C,pain,bad sleep,anxiety,depression,cognitive focus,memory,CMV,epilepsy & osteo
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Kate D.
inactive member
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Posted: Mon Nov 22nd, 2004 02:56 |
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Gosh Dave,
I'm glad it's you who are trying to obtain Benicar through Canada's SAP and not me. I couldn't have answered all those questions adequately and my doctor wouldn't be willing to do all that work for an "experiment."
I hope it is approved and that others of us can eventually take advantage of the program. For me it's still International Pharmacy. I have had to get my Ultram from there recently too (it's not available in Canada either).
I think you are wise to think ahead about planning to start Phase 2 when you have some time off from work. I'm still on Phase 1 but recently had a 5-day herx during which I was bedbound. My husband is a touring musician, but luckily he was home for this episode. It made me realize that I have to be really careful and schedule dose increases accordingly.
I was also hoping to start Phase 2 during the holidays, but I don't know if I will make it.
- Kate D.
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Lyme diag. 2004, IBS diag. 1997, ill since 1996, some symptoms 30+ years. MP since July 2004, Phase 2 since Jan 2005. Benicar 40 mg q6h. Ultram for pain, probiotics. Starting D values: 1,25 D = 46, 25 D = 11.
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DaveW
Member
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Posted: Sun Nov 28th, 2004 16:26 |
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Weekly Update
Nothing too profound. I have been experiencing some increased jaw pain once again as part of the herx.
I also have a feeling in my head that could be described as a combination of pressure, a slight headache and cognitve difficulties. This is not the first time I have experienced this symptom, but it is the first time I have described it. It reminds me somewhat of a hang-over, while in other ways it is like a bad head cold. I am wondering how many other folks experience this symptom?
Observations
I have also come to realize that we do not allow ourselves to feel progress on the MP for quite some time. Although many specific symptoms do decrease and fade away, we do not in general feel any better - because we won't permit it! As soon as we start experiencing less herx/inflammation - we up the dosage of antibiotics, which keeps us in the "just tolerable zone" of herx and inflammation.
I think this dynamic requires that we have an in-depth understanding of how and why the MP works - or else we would intuitively think it is not doing us any good (or perhaps even that it is "not right for us" because we often feel even worse than normal, if/when we ramp too quickly).
Re: SAP Application
I have no further news on the SAP application, as my Doctor was away this past week. I may not hear any news for another week, as he is likely to be extremely busy during his first week back. These things seem to move so incredibly slow.
Regards,
- DaveW
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MP Aug14/04,Pre-MP D=19.6,1,25D=37 ratio 1.89 P2>12/27/04.Back to P1 fall/05.Back to P2 05/06. 21 yrs neuro-lyme not dx til 11/05. OlmesTR 40 mg/7hrs. Major: Weakness,IBS-C,pain,bad sleep,anxiety,depression,cognitive focus,memory,CMV,epilepsy & osteo
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DaveW
Member
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Posted: Sun Dec 5th, 2004 05:16 |
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Weekly Update
Everything is going as it should. My herx (on 100 mg) is starting to decrease (after several doses).
It never ceases to amaze me - how many bizarre symptoms herx can create. This week I got a sharp transient pain that felt like a very hot wire touched across the top of my stomach (or just under my chest). It comes without warning, and disappears within a minute.
I have no further news on the SAP application submitted by my Doctor yet.
Have a good week ((((Good Folks)))
- DaveW
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MP Aug14/04,Pre-MP D=19.6,1,25D=37 ratio 1.89 P2>12/27/04.Back to P1 fall/05.Back to P2 05/06. 21 yrs neuro-lyme not dx til 11/05. OlmesTR 40 mg/7hrs. Major: Weakness,IBS-C,pain,bad sleep,anxiety,depression,cognitive focus,memory,CMV,epilepsy & osteo
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Reenie
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Posted: Mon Dec 6th, 2004 00:46 |
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DaveW says, "My herx (on 100 mg) is starting to decrease (after several doses)"
I didn't herx on 100mg of mino, but then had herxing about once/week, for awhile. Then, I got to the point that I don't have any herxing at all. I'm the same on both days, mino dosing and not.
You may want to stay on 100mg for awhile, to see if this happens to you too.
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DaveW
Member
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Posted: Sun Dec 12th, 2004 16:55 |
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Weekly Update
I am continuing with 100 mino on Tuesdays and on Fridays - waiting for the herx to decline so I can commence Stage II. Unfortunately, I sense that this may take a while.
Interestingly, my herx is no less on the third day than on the second. In fact, at any dosage of mino - for me, the herx have usually lasted about five days before a significant decline occurs.
After a dose, my herx does not get strong for 12 to 24 hours. Then, it seems to be more severe in the evenings, and especially when I eat less. Notwithstanding these daily fluctuations, the herx level then seems decline very slowly for about five days, and then tapers off more quickly.
I am thankful for the herx (or rather, for what it indicates), but I have never been sure if I should take the mino every 48 hrs - or wait five days between doses until the herx declines. The only potential disadvantage to the latter approach, is that it may result in a significant delay in my ramping progress.
My approach to date has been to compromise. By taking mino on Tuesdays and Fridays, I am taking it with alternating three and four days intervals.
Re: My Doc's SAP application
I saw my Doc on Friday to prompt him to send in another request for an update on the progress of his application to access benicar (from Health Canada), on my behalf. The constant delays and lack of communication has deflated my optimism.....but never say never.
Re: My Doc seems to be getting "on board"
I was very pleased to hear that My Doc is starting another three or four of his patients on the MP (but with diovan rather than benicar - mostly due to the difficulties of getting benicar in Canada). He is aware that diovan is greatly inferior to benicar, but I think he perceives the diovan is better than nothing. I understand his reasoning. Some of his patients may not even own a computer, and may not be able to afford benicar even if they could access it.
If/when he gets time, he mentioned that he would like to spend some more time researching the MP information in the Doctor's forum at the MP site. The down side is, if he does it when gets time - it may never happen.
He is receptive, cooperative, intelligent and caring - and I am so lucky to have him!
Unfortunately, he told me he was not taking any new patients (as he is already run off his feet, and it is very true).
I am hoping that the (anticipated) successes he will witness administering the MP may increase the receptiveness of other local Doctors in the area.
Regards,
- DaveW
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MP Aug14/04,Pre-MP D=19.6,1,25D=37 ratio 1.89 P2>12/27/04.Back to P1 fall/05.Back to P2 05/06. 21 yrs neuro-lyme not dx til 11/05. OlmesTR 40 mg/7hrs. Major: Weakness,IBS-C,pain,bad sleep,anxiety,depression,cognitive focus,memory,CMV,epilepsy & osteo
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Posted: Sun Dec 12th, 2004 19:53 |
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Dave,
My suggestion would be to increase mino 100mg to every other day (or M-W-Fr) so that you can add Z over the Holidays as was your original goal. Have you yet purchased the NoIR sunglasses that block more infrared rays for outdoor use or are you still using only the 40%?
I commend your doctor for wanting to help other patients with the Marshall Protocol. But I fear these patients will not be successful because they are not using Benicar and, without access to MP.com, may not understand the importance of avoiding all forms of Vitamin D. Please remind your doctor that if these patients fail, they were not really on the MP.
Best,
Meg
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DaveW
Member
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Posted: Sun Dec 12th, 2004 20:21 |
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Hi (((Meg))),
Thanks for the response. I still only have the 40% NoIRs, but I am outside for perhaps 20 mins per day, and most days it is dark during my 10 min trip to work, and dark again for my trip home. (This is winter in Canada...try not to be too envious!).
I have 90% NoIRs, but they are size medium and I get headaches from them. I am not sure if it is because they let too much light in the sides, or because my eyes must strain to see when I have them on.
I am still planning to get a pair of large 90% NoIRs for next summer. They will be the fifth pair I have purchased.
I will remind my doc that his patients are not really on the MP with diovan. I also have fears that his patients may not succeed without his getting support from the MP sites, and I doubt he has time to do the research necessary or to solicit the support he needs to know how to respond to the inevitable struggles his patients will experience.
I wish that somehow he could open a dialogue with Dr Marshall (and with you) - to get the door open to his consulting for advice.
My best regards Meg,
- DaveW
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MP Aug14/04,Pre-MP D=19.6,1,25D=37 ratio 1.89 P2>12/27/04.Back to P1 fall/05.Back to P2 05/06. 21 yrs neuro-lyme not dx til 11/05. OlmesTR 40 mg/7hrs. Major: Weakness,IBS-C,pain,bad sleep,anxiety,depression,cognitive focus,memory,CMV,epilepsy & osteo
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Aussie Barb
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Posted: Sun Dec 12th, 2004 21:19 |
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Dear Dave
I don't know if it is only me who is confused about the (90)% you have listed re your NoIRs... so I have posted the details from the NoIR website. The glasses for MP are the 10% for inside and 2% for outside & some like to have 40%. best, Barb ...
 NoIR 40% Light Amber
 NoIR 10% Medium Amber
 NoIR 2% Dark Amber
Percents (%) represent amount of visible light transmitted through each lens.
Fit-Over Sizing: 100 series Small, 700 series Medium, 900 series Large
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Barb: Dx Inflammatory Disease Endocrine Imbalance 2003| Depression| 24+ years not Dx| MP Aug04| ABC of MP| MP Search|
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Posted: Sun Dec 12th, 2004 22:29 |
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Dave,
Probably at this point in time, clinicians will need to carefully screen potential MP patients for interest and ability in pursuing, on their own, the details and support necessary to succeed with the MP. It takes a lot of motivation to educate yourself, change your lifestyle and accept that you will feel worse before you feel better. I'm not sure anyone could do it without access to the information and support (if needed) on MP.com or SarcInfo.
I know of at least one practitioner who will not prescribe Benicar until the patient brings the NoIR sunglasses into the office. Some are considering a consent form to ensure compliance with all aspects of the MP because it is so much more than just Benicar and minocycline.
Best,
Meg
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