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Posted: Thu Oct 4th, 2007 00:46 |
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How To Manage Immunopathology (immune system reactions)
Immunopathology and its management will vary depending on many individual factors. Management of immunopathology is learned through personal experience. Each member must take responsibility for learning how to independently assess and manage immunopathology.
Tolerable symptoms is the ideal
The aim or the key is for you to achieve and maintain tolerable symptoms (physically, mentally, and emotionally) and acceptable blood tests by adjustment of your meds dosing and schedule as suited individually to you within the guidelines by managing all aspects of MP (adjusting your meds, avoiding light and vitamin D, palliating symptoms appropriately, etc.)
By being pushed to the limit of the tolerable immune response, your body is working to capacity. Adequate rest, hydration, pain/anxiety control and nutrition are important aspects to facilitate recovery.
Gaining independence with medication management
Phase One is the training ground for you to get the feel of your immune response (immunopathology) symptoms and to gain personal experience in managing all aspects of the MP (meds, light exposure, vitamin D avoidance, palliative medication). Please print out a copy so you can check all precautions and instructions regularly.
In phase one, it's a good idea to experiment with minocycline and Benicar to see how they work for you. Extend the mino dosing schedule to every 72 hours to see if more immunopathology can be provoked. And conversely, when symptoms peak (not necessarily intolerable), reduce or stop the mino dose to see if that dampens symptoms. You could also try taking lower-dose minocycline every six or 12 hours to see if mino has an anti-flammatory effect for you. When a symptom approaches intolerable try an extra Benicar to see if that measure is effective to quell the symptom. The resulting information can be added to your personal tool kit and could come in handy in the future if symptoms become intolerable.
It is important that you become independent in medication management during phase one. This skill will carry you smoothly through phases two and three. When you have learned to manage on a day-to-day basis, you will be equipped to handle a crisis if it occurs.
Adjusting MP meds helps define intolerable
For those who have learned to tolerate high level symptoms it can be difficult to define symptoms as tolerable or intolerable. Experience is gained by adjusting your meds to feel the difference, and to learn to protect yourself against sliding into intolerable immunopathology.
Personal tool kit
We recommend that each member put together their own personal toolkit list of effective adjustments and techniques based on their experience of when and how the MP meds affect them.
Your tool kit will remind you what has worked for you so that you can independently implement the options immediately and can stay calm, which also has an effect on the symptoms. You will soon gain confidence in your ability to manage your symptoms quickly.
Ask for assistance in your progress report
It's important that you post your progress regularly to get expert support regarding managing immunopathology from study site Staff.
You will be assisted, if needed, in determining your options to use to achieve and maintain tolerable immunopathology. By posting regularly, Staff can often tell if you are heading towards problems and need to adjust your medications.
Ask for help before you take any action that is unfamiliar to you.
As long as you are on the protocol, continue to post regularly to maximize your chances of success. You will receive feedback from members and Staff. Continue to read the site and review pertinent materials because new important information is being posted all the time.
Use the standard reporting format
It's important that you include all the basic information requested in the standard format to give moderators a quick and concise picture of your current situation so they can provide an accurate response.
Provide adequate information
You may be asked for more details to help Staff understand what is happening and respond accurately. It is important that you report all pertinent details, even those that might seem embarrassing.
If symptoms become intolerable
Most people are caught by surprise by the ferocity of the immunopathology once their innate immune system is made partly functional again by the Benicar. It is not the power of the drugs which you are observing, it is the power of the immune system, and the size of the extremely heavy load of this pathogenic Microbiota which Homo sapiens has accumulated, over the ages, and which has proliferated to epidemic proportions under the conditions created by 20th Century man...
..Trevor..
If symptoms are approaching intolerable, assess your natural light exposure, assess your symptoms and use your personal tool kit to be sure symptoms are not due to other factors besides immunopathology (sun exposure, lack of rest, exercise, diet, etc) that can be modified to reduce symptoms asap.
The recommended first step when symptoms have gone past tolerable is to increase Benicar. Do not wait. Take an extra oral 40mg immediately. A hot drink (sugar-free chocolate or weak tea) will help the pill reach the stomach quickly.
Chewing the tablet and placing it under the tongue will promote faster absorption and quicker symptom relief. See How to make Benicar act faster.
If an extra oral or sublingual dose of Benicar does not work, do not assume that increasing Benicar to every 3-4 hours will not work.
If intolerable symptom/s persist, increase oral 40mg Benicar to every three or fours hours around the clock (set an alarm and use a dosette to avoid error). Continue until symptoms are tolerable.
During a 'crisis' situation, an extra 20mg of Benicar may be taken sublingually with each every three or four hour oral Benicar dose.
If increasing Benicar does not reduce intolerable symptoms enough, you may need to adjust your antibiotics. Review all options in My immune response/symptoms are too strong. What should I do? Try the options one at a time. Do not hesitate to use any of the med adjustments suitable to you.
As always, if our information does not provide the answer for you (be sure to click on all the links), please ask before you take action.
Continue all supportive measures....light avoidance, rest, good nutrition, adequate hydration, palliative meds as needed.
See also:
How to achieve tolerable immune system reactions in Phase two and three
Last edited on Wed Jan 23rd, 2008 18:24 by Foundation Staff
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Posted: Thu Oct 4th, 2007 00:50 |
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How to adjust MP meds to manage immunopathology
First assess your symptoms and use your personal tool kit to be sure symptoms are not due to other factors besides immunopathology (sun exposure, lack of rest, exercise, diet, etc) that can be modified to reduce symptoms.
Do not make more than one change at a time. Assess first, then make another change if needed.
To decrease symptoms
-Increase Benicar for immediate relief....see When and why should I vary my Benicar schedule? and BenicarQuiklink
-Decrease the dose of one antibiotic
-Decrease the dose of all antibiotics
-Stop one antibiotic
-Stop all antibiotics
-Shorten the time between one antibiotic dose
-Shorten the time between all antibiotics (see the phases two and three forum for details)
-Lengthen the time between the doses of one antibiotic to 72 hours
-Lengthen the time between the doses of all antibiotics to 72 hours
-Change the time of taking one antibiotic
-Change the time of taking all antibiotics
-Alternate the antibiotic ramping schedule
-Take low-dose, high frequency minocycline.....see Why and when do you recommend taking minocycline frequently?
-Add an antibiotic
-Change the antibiotic combination (see info in the phases two and three forum)
-Try Quercetin (after phase one)
-Increase an antibiotic dose...see Increasing the antibiotic dose
Changing antibiotic combinations
A change of combination for an interim period may be required as the best management to change the level and focus of immunopathology.
If you notice a downslide into more constant inflammatory symptoms, change the antibiotics combination to regain the modulatory effect.
Change the antibiotic dose
Staying at the same dose level won't necessarily hold the symptoms static. If you notice a downslide into more constant inflammatory symptoms, change the dosing level to regain the modulatory effect. See If antibiotics are effective at very low doses, why do we ramp up the dose?
Increase the antibiotic dose
If other meds adjustments are not helpful, this can be an indication that the immune system has stopped responding to that dose level and it may be time to increase the antibiotic/s. Another way to tell, can be that you have used every other symptom relieving adjustment and increasing is the only one left to try.
This may seem counterintuitive but for some, an increase in symptoms signals a need to increase antibiotic/s.
If you increase the antibiotic/s and the increased dose begins to bring the symptoms to intolerable instead of getting better, take Benicar every 4 hours and or take a dose of mino 25mg as soon as required to modulate the immune system. See When to increase antibiotics
If immunopathology has slowed
When you have achieved the maximum dosing level of any antibiotic combination, the immunopathology may slow and or stop to indicate time to change combination. You may also extend the schedule to see if this increases immunopathology. Due to decreased liver and/or kidney function (which may be unrecognized, especially in the elderly), antibiotics may be excreted more slowly and not be eliminated before the next dose.
As explained in Why have you changed the starting dose of minocycline?, the antibiotic dose needs to be changed a significant amount to alter the immune system response. Dr Marshall has said, "The body/immune system can 'get used to' a dose level and can stop responding."
To increase immunopathology
-Lengthen the time between the doses of one antibiotic to 72 hours
-Lengthen the time between the doses of all antibiotics to 72 hours
-Increase an antibiotic dose....see Increasing Tips
-Add an antibiotic
-Change the antibiotic combination (see info in the phases two and three forum)
See also:
Why isn't the MP working? What am I doing wrong?
Is there a right pace for the most effective healing on the Marshall Protocol?
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Posted: Thu Oct 4th, 2007 01:20 |
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Personal tool kit
Until you become experienced, it is a good idea to have a list to check thru when you experience immune system reactions. This list will be your personal tool kit to help you manage immunopathology.
Keep the list handy (on the wall or the refrigerator) so that you can use it when you know that you need something to relieve symptoms but you are not sure what you have used before and what is still available to use yet.
You may need a supportive person to remind you to check your tool kit or check the list for you.
Following are some of the items for you to put in your tool kit. You may add more to the list and change the order to suit yourself.
Assess each of the following:
Assess all symptoms (may be helpful to rate from 1 to 10)
Is my Benicar dose due (keep water and extra meds with you at all times)
Is my mino dose due (keeping a note and an alarm is helpful)
Do I need to take my palliative medication
Do I need a change in dosing or schedule
Do I need to take any of my meds now
Do I need to chart daily for clarity (see links to charts below)
Do I need to reduce light or sun exposure
Am I diligently avoiding light, wearing my glasses, protection
Heat / climate changes
Exposure to toxins
Diet changes: something I ate or drank
Stress /changes in circumstances
Rx meds / changes or additions
OTC supplements/ any changes or additions
Am I tired
Do I need to rest or sleep
Have I reassessed family and social obligations and expectations
Do I understand and accept my own limitations
Have I addressed any needed changes
Have I been clear with others about what I can or cannot do
Have I clearly asked for support and assistance where I need to, each time I need to
Have I avoided making commitments that are not necessary for recovery
Am I over-heated, not warm enough
Adequate hydration/ cool drinks. Keep water close by
Do whatever is necessary to maintain your comfort
eg: Use airconditioners, fans, take frequent cool showers, cool drinks/warm drinks
Have I eaten regularly
Do I need to eat now
What do I feel like eating that will be good for me
Do I need any help with bowel function
Do I need probiotics
Am I anxious Do I need to take my Rx anxiety or pain meds
Am I in pain Do I need to take my pain medication
Am I depressed? Do I need to talk to my doctor about this
Do I need some social contact by phone, private message, email etc.
Do I need some quiet time
What can I do or ask for myself that will be helpful
What will make me feel relieved/comfortable
What can I do to pamper yourself
What commitments can I cancel
Do I need to contact my Doctor
Have I posted and asked for help
-Check one point at a time, assessing precautions and options.
-Do not hesitate to use any of the meds adjustments. you are gaining experience, learning cause and effect.
-Achieving tolerable symptoms is the aim
~Aussie Barb ~
If you need further temporary relief of your symptoms, contact your doctor or pharmacist for advice about palliative medications. Any medications that are not on the list of Medications to Avoid are okay to take to relieve intolerable symptoms.
Charting can help assess symptoms
Quick-Scan Charts:
http://www.carouselcharts.com/JHR_tracking1.pdf
http://www.carouselcharts.com/JHR_tracking2.pdf
Click here for a two page PDF graphic of JRFoutin personal interpretation of the toolkit that may be of interest to you while you do the MP.
Related FAQs:
Adjusting MP meds
My immune reaction is too strong. What should I do?
How can I identify immunopathology (Herx)?
Immunopathology Tutorial
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Posted: Thu Oct 4th, 2007 21:14 |
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How to assess symptoms
Assessing 'intolerable' immunopathology symptoms is a subjective measurement.
Listen to your body and chart your symptoms.
Review this checklist to help determine what is happening.
Has a signature symptom/s gotten worse?
Do I have new symptoms?
Have my symptoms reached a plateau approaching intolerable?
Are familiar symptoms different?
Has there been a window of change for the better?
Have symptoms slowly been getting worse?
Have symptoms become constant?
Have I had increased natural light exposure recently?
How long had my mino dose stayed the same?
Does Mino make me feel better for some time after taking it = modulating symptoms?
Does Mino increase symptoms quickly which then settle on the 2nd or 3rd day?
Define tolerable
Ask yourself: "if a well person suddenly came down with my symptoms today what would s/he feel like doing?"
Possible answers:
1.  Go to work and tough it out, but stay low and go right home and rest after work.
2.  Call in sick and crawl into bed for the day, maybe some OTC considered.
3.  Call the Doctor for an appointment, OTC won't cut this.
4.  Go to Dr office and just have them move me into any available time slot, or call and tell them to admit me to the hospital. It's that bad.
5.  Have family member call ambulance, critical systems are unstable enough to wonder if life will continue. ~ JRFoutin.
Define your functional level
For those who have had high level symptoms it can be difficult to define the symptoms as tolerable or intolerable. Experience is gained by adjusting the meds to feel the difference, and to learn to protect oneself against sliding into intolerable immunopathology.
Basic ADLs (activities of daily living) (e.g., dressing, eating, ambulating, toileting, hygiene)
IADLs (instrumental activities of daily living) (e.g., shopping, housework, cooking, transportation)
Immunopathology may cause objective symptoms
Abnormal lab work or EKG tracing may reveal unacceptable silent immunopathology. In that case, monitor these signs regularly and use them as a guide to gauge pace of therapy.
Meds may need to be adjusted when
-there is a small window of feeling better that signals an impending increase in symptoms
-there is a steady increase in symptoms
-a signature symptom/s flares signaling an impending flare
-lab work is outside the acceptable range
Members' experiences
-It's hard for me to tell when I need to ramp my abx dose up, as I don't really have a wane in symptoms, I seem to just get weaker and feel worse. I guess maybe that should be my clue, but it's so gradual and subtle, it makes it harder. Then when I do ramp up I feel so much better for the first few times, it's hard to notice that I'm about to get really slammed by intolerable herx. ~Pam
-I also herx just as you described! I feel pretty crummy ALL of the time, and it's difficult to discern the right time to go up. I have found that looking back over my journal really helps me to analyze the slight downward trend when it's my immune system taking over, and I need more abx to temper it. Of course, I usually get hit with more intense symptoms of other kinds, but knowing that I can take extra BEni. and mino. gives me reassurance. As you said, the weakness is one of my biggest signs, too. This along with the blackness when standing (although I have that at other times too). But the two together seem to be a sign for me, and sometimes my right ear gets that clogged feeling when my immune system is struggling.
Also as I look back over my journal I do see that there is that small window of time, maybe an afternoon or evening when my symptoms feel a little better, before I start the downward spiral. ~Jill
See How to adjust MP meds
Last edited on Wed Feb 13th, 2008 03:56 by Foundation Staff
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Posted: Fri Oct 5th, 2007 11:14 |
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When To Increase Antibiotics
If immunopathology has slowed
When you have achieved the maximum response level of an antibiotic at a dose level, the immunopathology will slow and or stop indicating it is time to increase.
If symptoms have changed
Anecdotal evidence suggests that sometimes after immunopathology being tolerable for some time, the symptoms may change and go into a downturn of constant intolerable tiredness weakness, etc not relieved by the usual adjustments of the meds. This can be a sign that the immune system has stopped responding to that dose level and it may be time to increase. Caution: do not use this option with the second phase 2 antibiotic.
If immunopathology has increased
It is the immune system which is doing the bacteria-killing in the MP, not the drugs. Immune system efficiency may increase at any time causing tolerable immunopathology symptoms or a change in character of symptoms that makes them intolerable. This may occur suddenly or be the result of a slow slide to intolerable. It often occurs after a small window of feeling better or when you have been at the same dose of antibiotic/s for a long time with tolerable symptoms.
This may indicate the need to increase antibiotic/s to regain their modulatory effect and dampen the immune system response. This may include the need to add or change antibiotics. Be alert for 'signal to increase' symptom/s that feel different than your usual immune response symptoms throughout the cycle. You will get to know these symptoms, and you will know they are telling you it is time to increase the antibiotic dose.
Those who have had this experience found the symptoms following an increase in antibiotics were a relief to the intolerable nature of the symptoms they experienced before the antibiotic increase.
Do not rush into an increase. Increasing any of the antibiotics when you are in this situation is a bit of a risk. This should be an individual decision made ONLY from your own sure experience or intuition that this may be helpful to you.
To decide if symptoms indicate it is time to increase the antibiotics, make sure you have tried all the usual options and meds adjustments to dampen symptoms first.
If symptoms escalate with the increase
If you have tried all other options to dampen symptoms, do not be afraid to try an antibiotic increase. If the increase in mino dose begins to bring immunopathology to intolerable, going back to the reduced mino dose should slow it up again.
If symptoms continue to escalate, they can usually be dampened with low-dose, high frequency minocycline. See Why and when do you recommend taking minocycline frequently?
Is there a right pace for the most effective healing on the Marshall Protocol?
Members' experiences
-Without changing anything else, my back pain, chest pain, trouble breathing,muscle burning and fatigue was as high as it had been before starting phase 1. I increased Benicar, started taking naps again, got more help at home etc. but I did not want to go back down the narcotic road. My MD suggested quickly ramping the antibiotic (with the idea that I was too long at each dose) which seemed scary but it turned out to be the right solution. As usual severe night sweats changing sheets and clothes at least 4-5 times per night but the pain subsided as did the fatigue. ~sslouis
-I'm really glad I ramped. It settled down the total weakness, heavy chest, blackness when standing. Now I'm having the usual symptoms of increased abx: more intense headache, some arrhythmia (but not intolerable, and better with increased Beni frequency for a few doses), tight muscles throughout body, usual sore skull, tight neck muscles, burning calves, plugged right ear, tinnitis occasionally, stiff hands, usual fatique, dizziness on and off - especially with activity. ~Jill
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Posted: Sat Oct 6th, 2007 18:06 |
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Alternating the ramping schedule
When ramping antibiotic/s, you may manage well with the first dose of an increase but then get a significant symptoms with the second or third dose even without an increase. Alternating doses may keep symptoms tolerable.
For example, if 50mg Minocycline seems too strong, when it's time for the next dose (2-3 days), go back down to 25mg. In 2 days (or 3 days) when the next dose is due, go back up to 50mg.
If symptoms allow, stay at 50mg until you feel you can ramp up to 75mg. If symptoms flare to much, take 50mg when it's time for the next dose and continue alternating doses as before.
This alternating of antibiotic doses while ramping can also be done with phase 2 and 3 antibiotics.
When you can feel the immunopathology it is already at a level where your body is working hard to process. Our recommendation for safety and efficacy is to choose the tolerable dose level and stay with it.
The rocking between dose levels is ok to do once or twice to stabilise on a dose level if it is necessary for intolerable symptoms, but not a good idea to continue.. we recommend not rocking doses on a continuous basis because most immune systems will not continue to respond positively. can often lead to a runaway situation. Slow and steady wins this race
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Posted: Wed Oct 17th, 2007 00:46 |
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What to do when immunopathology (immune system reaction) is too strong
First, assess your symptoms and use your personal tool kit to be sure symptoms are not due to other factors besides immunopathology (sun exposure, lack of rest, exercise, diet, etc) that can be modified to reduce symptoms.
Cardiac symptoms
If your intolerable symptoms include rapid heart rate, slow heart rate, syncopal episodes, chest pain or irregular rhythm, heart skipping beats or palpitations, see When should I be concerned about my cardiac symptoms?
Respiratory symptoms
If your intolerable symptoms include sudden shortness of breath, increased shortness of breath or throat tightening, see What should I know about respiratory immunopathology?
If your symptoms seem urgent
If you have an urgent symptom, take immediate, appropriate action to control symptoms (see below) and then contact your doctor to let him know what is happening, what you are doing with the medications and why. Your doctor may contact Dr. Marshall if s/he has any concerns..
If you are not sure what to do and symptoms allow, ask for assistance in the forum for Urgent Problems Only before you adjust any medications.
Follow your instincts. Seek help or call for emergency assistance if you think you need it. If you are not thinking clearly or worried, ask someone to stay with you and help you problem solve. Do not drive yourself to the hospital.
Managing non-urgent intolerable symptoms
If any of your symptoms are moving towards or have become intolerable, it is essential that you make adjustments immediately. See How to assess symptoms
Step by step options:
1. Benicar is always the first step
Are you taking Benicar 40mg every six hours around the clock? A hot drink (sugar-free chocolate or weak tea) will help the pill reach the stomach quickly.
Symptoms may be relieved temporarily by increasing to 40mg every four hours around the clock (set an alarm) or by varying Benicar dosing.
You can take an extra half tablet (20mg) of Benicar any time.
Chewing and then putting Benicar under your tongue (sublingual) promotes faster absorption and relief. See How to make Benicar act faster. You can do this each time you take an oral Benicar dose.
In a 'crisis', you can increase oral (40mg) and sublingual (20mg) Benicar to every 3 hours around the clock.
If you are on Benicar only, see I just started Benicar. Why do I feel worse?
In most cases, an increase in Benicar dosing reduces symptoms. For a few, Benicar 40mg every eight hours or a smaller dose more frequently such as 20mg every 2 or 3 or 4 hours works better to maintain tolerable symptoms.
If adjusting your Benicar does does not help, consider the following options.
2. Minocycline adjustment.
* Decrease and continue minocycline.
* Extend mino from the every other day dosing out to 3 days, or longer. You can take it sooner if the immunopathology reaction starts to increase too much.
* Stop mino for a while. You can take it again if the immunopathology reaction starts to increase too much.
*Take single dose of mino 25mg. This may be enough to dampen symptoms. Folks on 75-100mg of mino should try a 50mg dose.
For some, the immune system may stay 'turned on' with too low a dose of mino or with no mino. If intolerable symptoms continue,
*Try low-dose, high frequency mino Take mino 25mg every 6 hours or every 12 hours or daily (or 50mg every 12 hours or daily for those on higher doses). The lowest recommended dose is 25mg. See Why and when do you recommend taking minocycline frequently? for details.
Note: When using this option, phase 2/3 members will need to stop their 2nd and 3rd antibiotics. See How to achieve tolerable immune system reactions in Phase two and three.
Note: While taking Benicar, the maximum total minocycline recommended daily is 100mg. (you may take/require less)
If symptoms become intolerable after increasing mino, they may be dampened by adjusting the Benicar dosing, or if necessary by taking the lower mino dose again.
When symptoms are again tolerable, mino dosing can be extended gradually (by the hour if needed) out to 24 hours and then 48 hours. When symptoms have settled back and you feel like you can tolerate a little more you can increase the mino to the next dose level.
If you have experience adjusting minocycline to dampen immunopathology, do what has worked for you before with regard to mino dose and schedule (see your personal tool kit to manage immune system reactions) but do consider that occasionally what worked in the past may change.
* Alternate ramping doses (click here)
3. Increase antibiotics (click here)
For some, the immune system may stay 'turned on' when there is a need to increase or change the antibiotic/s.
Before trying increasing the dose, since it could backfire unless you already have experience that this might work, consider whether you have been having an increase in symptoms due to other factors (light, stress, exercise, diet change, etc) that can be modified to reduce symptoms. Also assess if you could take palliative medication to minimize these symptoms first.
Having tried all avenues as above to dampen symptoms, notice how long your antibiotics dosing level has stayed the same. Sometimes a change in symptoms occurs causing a plateau or discomfort which indicates an increased antibiotics dose or a change of antibiotics combination is required.
4. In Phase 2 & 3 any of these options may be used with the 2nd and 3rd antibiotics:
-can be stopped
-schedules extended
-dose decreased
-dose increased (click here)
-the combination changed
If you are in the second or third phase of the MP and and you need more specific advice, see the Information Posts at the top of the Phases Two and Three Forum
When dividing atibiotics, see How do I divide the antibiotics when the capsules only come in XXmg? Caution: Be sure to measure the dose carefully, by shaking the FULL contents of the capsule out to divide accurately.
5. Quercetin taken around the clock may be helpful once you are established on MP. It is usually not helpful in the first few months.
6. Gauifenesin may also help to damp inflammation a bit, as well as liquefy mucus. Use a product that does not contain any other ingredients.You might find a slight surge of symptoms during "withdrawal" from periods of intense guaifenesin use. See Guaifenesin
Don't ever hesitate to make these adjustments to keep all symptoms at a tolerable level for you.
If symptoms persist and you are concerned do not hesitate to contact your Doctor.
7. Develop a personal tool kit to manage immune system reactions so you will be prepared next time symptoms flare.
Be sure this basic safety net is in place:
-Diligent avoidance of light, heat and vitamin D
-Extra Benicar 40mg doses sublingually as required
-Rx anxiety med to take
-Oxygen set up (if respiratory symptoms)
-Send for support and emergency care if or before you need it
-Rest and distraction
-Dr Rx steroid available (if it's been recommended and ordered)
-Notify doctor
Do not 'push' the intolerable. Dr Marshall wrote: There is no point in pushing your body too hard, and you might do damage to it. There is no need to keep the pedal flat-to-the-floor, this is an endurance race, not a sprint." You will not be slowing your healing by keeping symptoms tolerable. See Is there a right pace for the most effective healing on the Marshall Protocol?
Palliate symptoms
Attitude influences the perception of symptoms. (click here)
Remember that the secret of success on the MP is being able to keep the immunopathology to a tolerable level for as long as it takes to kill off the bacteria so there is a role for palliation. Adjusting your MP meds will help you to ascertain whether you then need to implement further palliative measures within the guidelines.
*A steroid inhaler (puffer) is okay if respiratory symptoms are urgent. See Use of inhalers and nebulizers
* Reduce pain with meds or other techniques. See Pain Control
* Reduce anxiety with meds or other techniques. See How can I control my anxiety?
* Palliate symptoms if adjusting MP meds was ineffective. See:
I’ve developed a rash/itching/skin problem. What should I do?
I think I have a bladder infection. What should I do?
What should I do for liver or gallbladder pain?
I’ve developed rectal bleeding. What should I do?
I’m constipated. What should I do?
I have diarrhea. What should I do?
What should I do for my stomach problem?
What can I do for my nosebleeds?
What causes swelling?
I have insomnia and fatigue. What should I do?
It's important to gain independance with medication management
Phase one is the period during which you will gain experience in adjusting your MP meds to maintain tolerable immunopathology. It is important that you become independant in medication management during phase one. This skill will carry you amoothly through phase two and three. When you have learned to manage on a day-to-day basis, you will be equipped to handle a crisis if it occurs.
Be sure to click on all the links in this document.
Controlling intolerable symptoms with limited steroid use
It is much better to control symptoms with your increased Benicar and antibiotic adjustments, but, should you ever be in an urgent situation - if your Dr agrees, using Rx steroid eye drops, a nasal spray (beclomethasone dipropionate/Beconase), a topical steroid lotion/cream, or a steroid puffer (inhaler) can also assist in slowing intolerable immunopathology by suppressing the immune response. If necessary, you may use any of these sparingly. Discontinue their use as soon as symptoms become tolerable.
Related information:
How To Identify Immunopathology (Herx)
How to manage immunopathology
How to adjust MP meds
Is it an allergy or is it an immune system reaction?
Information for Emergency Room personnel
Last edited on Sun Oct 5th, 2008 06:12 by Foundation Staff
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Posted: Wed Oct 17th, 2007 11:27 |
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When to take low-dose, high-frequency minocycline
How minocycline works
"The MP antibiotics weaken the bacteria, allowing the immune system to kill them. But the same antibiotics that block the ability of the bacterial ribosome to create proteins, and thus weaken them, also have a modulatory effect on the immune system itself. This has never been defined in any papers I have seen, but is likely when we consider that most of the antibiotics have come from a parasitic source - mino from a strep mutant, etc. It would be folly to assume they have no effect on the host.
The exact reason why high-dose, and high-frequency, minocycline behave differently from low-dose, pulsatile minocycline is still elusive. The best guess I can give right now is that demeclocycline was originally isolated from a Strep mutant species, and minocycline is minimally modified from demeclocycline only by the substitution of a chlorine with a methyl group. I am thinking it is possible the body's innate immune system sees the antibiotic as being pathogenic in some way, and reacts accordingly, reducing its ability to kill the intra-phagocytic bactera. This is more of a problem at high dose antibiotics."
Dr. Marshall, PhD
Minocycline use as an NSAIDs
According to Guidelines for the Management of Rheumatoid Arthritis minocycline is used as a DMARD (Disease Modifying Anti-Rhuematic Drug), NOT for it's anti-infective properties. The dose they use is 100mg twice daily. In this lengthy document only one short paragraph is allocated to the use of 'tetracyclines'. It cites one study that demonstrated improvement with the use of minocycline but states "further research is necessary to define the exact role of tetracyclines in the treatment of RA. By "improvement", they mean fewer symptoms of inflammation.
Minocycline, as most rheumatologists know, has an anti-inflammatory effect at standard doses.http://tinyurl.com/dxuw2 The usual palliative dose to reduce Rheumatoid Arthritis symptoms is 100mg twice daily. It is not known just how minocycline works to reduce inflammation and pain but it is commonly ordered as an NSAIDs (non-steroidal anti-inflammatory drug) by rheumatologists in conjunction with other palliative pain medications. This palliative use for pain reduction is the only accepted use of minocycline by the American Rheumatology Asssociation. The antibiotic effect of minocycline is thought to be irrelevant to rheumatic diseases because they are not accepted to be caused by intracellular bacteria.
Dr. Marshall’s pathogenesis of Th1 inflammation describes how intracellular bacteria triggers the abnormal immune system response that causes many inflammatory symptoms, including joint pain. Minocycline’s antibacterial action weakens the intracellular bacteria only when the tissue level of minocycline is falling (decaying) between doses. It is then that the immune system is able to identify and kill the intracellular bacteria. If the tissue level remains high as it does in the standard dosing, little intracellular antibacterial action is evident although some persons will report adverse symptoms to the standard dose of minocycline that are highly suggestive of a immunopathology and undiagnosed Th1 inflammation.
Dr. McPherson Brown’s Roadback protocol is based on the same premise that intracellular bacteria cause RA and it uses Minocin 100mg every other day. This allows the minocycline tissue level to fall and weaken the bacteria. For many people, that has been an effective method to kill intracellular bacteria (as evidenced by immune system reactions) and reduce inflammation to some degree. Most people, however, do not consider it a cure and do not have complete resolution of their RA symptoms.
The Marshall pathogenesis describes how Benicar blocks angiotensin to allow the immune system to function normally and thus much more effectively kill the intracellular bacteria that are weakened by the decaying minocycline in the tissues. This can result in unexpected immune system reactions that are too severe to tolerate.
Stopping or reducing the minocycline often stops the immunopathology.
When immunopathology continues without minocycline
But sometimes, the immune system continues to function very effectively, killing large amounts of intracellular bacteria even without minocyline in the tissues. In that case, we have learned that by using frequent, minocycline dosing, minocycline functions in its role as an NSAID. This is because maintaining a constant level of minocycline in the tissues doesn’t weaken the bacteria and this usually relieves the intolerable immunopathology. Minocycline elicits the maximum immune system response as its tissue concentration decays away to zero, so increasing mino frequency, although seeming counter-intuitive, actually dampens immune system reactions best.
The Benicar blockade is continued for its own unique anti-inflammatory effect and a low dose of 25mg of minocycline taken every six or 12 hours is most often a high enough dose to maintain a constant tissue level and thus relieve intolerable Herxheimer symptoms. Dr Marshall suggest keeping to a maximum of 100mg minocycline total per day with Benicar.
The frequent mino dosing is a temporary palliative measure. As soon as the intolerable immunopathology subsides, the interval between doses is gradually lengthened to eventually reach the desired every 48 hours interval.
In short:
-High dose, frequent minocycline acts as a palliative, mild NSAID in inflammatory diseases.
-Low dose, pulsed minocycline weakens intracellular bacteria and is especially effective when a Benicar blockade is in place.
-Low dose, frequently dosed minocycline can act as an NSAID to relieve an intolerable immunopathology.
How can I determine when frequent Minocycline dosing is most likely to reduce immunopathology?
When uncertain what to do when trying to reduce symptoms, it is probably best to first try reducing the Minocycline dose and/or delaying the next dose before trying frequent mino dosing.
If that doesn't seem to be working and you find your symptoms remain intolerable, you can always take a dose of Minocycline, and then, if you choose, try the option of frequent mino dosing.
Frequent Mino may not reduce symptoms if your immune reaction on the two days following a dose of minocycline is:
a) not very different from one day to the next
b) lacks a consistent pattern
c) or is strongest at the beginning and end of the 48 hour cycle.
In these cases, frequent Mino might help at first but then may cause increased symptoms later (possibly different symptoms than experienced before).
Your reaction pattern (first day vs. second day) may change over time as well – you should always judge by your current pattern.
For people whose immune system reaction starts within a few hours after a dose of Minocycline and is stronger on the first day (first 24 hours)
- taking frequent Mino may be unlikely to reduce a reaction that is too strong and may increase symptoms.
- reducing or delaying your next Minocycline dose may be more likely to reduce your reaction.
For people who find their symptoms are significantly stronger on the second or third day after taking a dose of Minocycline
- frequent Mino dosing may help reduce symptoms when they are too strong
- take Mino 25mg every 6 hours
- or take Mino every 12 hours
- or take Mino daily
- (for those already on higher Mino doses) take 50mg every 12 hours or daily
Note: The above conclusions were based on reports of 26 members and their patterns were quite consistent, though there were occasional exceptions. For instance, some people could reduce their reaction by lowering and/or delaying their Minocycline dose -- even though they reacted more on the second day. And frequent Mino dosing helped some people with fairly constant reactions.
Using low-dose, high frequency minocyline to palliate the prednisone weaning process
This same antiinflammatory effect of frequent minocycline dosing may be needed to reduce the increased inflammation that sometimes occurs during the steroid weaning process despite the use of a tight Benicar blockade.
How to resume every other day dosing
When symptoms are tolerable, lengthen the interval between doses to 12 hours, then to 24 hours, then to every 48 hours. Then ramp back up to the former mino dose.
Related information:
What should I know about Minocycline?
How To Manage Immunopathology
What to do when immunopathology (immune system reaction) is too strong
Immunodepression and Anti-Inflammatory Activity of Antibacterial Agents
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Posted: Sat Nov 10th, 2007 05:20 |
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Quercetin
What is quercetin?
Quercetin is a popular nutritional supplement in the flavonoid family. Flavonoids are a group of water-soluble plant pigments, some 4,000 strong, that color many of the plant world’s flowers, leaves and stems. Quercetin is found naturally in the colorful parts of many plants such as green and black tea, red wine, apples, red onions, green peppers, tomatoes, blueberries, blackberries, bilberries, parsley, olive oil, raspberries, red grapes, citrus fruits, cherries, green leafy vegetables, beans and broccoli. Quercetin is considered an antioxident, an anti-histamine, a phytoestrogen and an anti-inflammatory agent.
How does quercetin work?
Quercetin inhibits part of the inflammatory cascade. It has a well-documented direct action on the second most important protein involved in the bacterial pathogenesis Dr. Marshall has described for the Th1 diseases, I-kappaB kinase.
Quercetin has a direct unique chemical action in conjunction with Benicar. It is acting as a drug, not a supplement.
Quercetin is a kinase inhibitor and it binds to many (if not all) of the kinases. Quercetin has the capability of inhibiting the I-kappaB kinases which phosphorylate Nuclear Factor-kappaB (the dimer protein which migrates to the phagocyte nucleus). This causes the mRNA which encodes the Th1 cytokine release to be generated. I-kappaB and NuclearFactor-kappaB are at the heart of the Th1 inflammatory reaction. It is this action on I-kappaB kinase which is synergistic with Benicar, which also acts on NuclearFactor-kappaB, but by a different pathway. Quercetin is therefore synergistic with the NF-kappaB-calming actions of Benicar.
The most important action of Quercetin, the one that gives it the synergy with Benicar in Th1 diseases, is the ability to inhibit I-kappaB kinase.
It is this synergistic action with the anti-inflammatory effects of Benicar which can reduce some immunopathology, especially fatigue, muscle pain and mind-fog.
Is quercetin safe?
"Quercetin is not an essentially safe drug, like Benicar, as Q has a dose-related effect on the body. It binds kinases, and has effects on the body's enzymes way beyond the suppression of NuclearFactor-kappaB that is its desirable effect.
There is no standard dose of quercetin that is known to be safe. No one knows what long-term adverse effects high doses may have, or how they may interact with other medications, although quercetin is known to reduce the effectiveness of quinolone antibiotics and may interact negatively with the cyclospines, felodipine and estradiol. No clear toxicity has been identified and no side effects have been reported.
Quercetin is an OTC rememdy. It has not been safety-tested by the FDA. The FDA does not keep a file of adverse drug reactions involving quercetin.” ..Trevor..
Why should I use quercetin?
The use of quercetin is optional with the Marshall Protocol. Its use may be explored by those who need to reduce intolerable immune system symptoms, especially neurological, but it should be discontinued when immunopathology palliation is no longer needed.
Our recommendation is to use quercetin only if needed to manage an occasional episode of excessive immunopathology
When should I use quercetin?
Do not use Quercetin in phase one
Some folks have reported that during the earliest days of the MP when Benicar is effecting many powerful hormonal changes, the addition of Quercetin is either not effective or makes the symptoms worse. Therefore, we do not recommend the use of Quercetin to reduce the initial symptoms of adjusting to Benicar.
At later stages of the MP, many report some palliative effect from quercetin, with reduction in some immunopathology symptoms.
Quercetin may be taken routinely only if it is needed to keep symptoms tolerable. You can also take it only occasionally when your immunopathology symptoms are worse.
"Quercetin is purely palliative. It does not improve bug killing, it just makes some of the symptoms less acute. Do not use it unless it is giving you enough palliation to make up for possibly reduced bug killing." ..Trevor..
How much quercetin should I take?
Quercetin is not an essentially safe drug, like Benicar, as Q has a dose-related effect on the body. It binds kinases, and has effects on the body's enzymes way beyond the suppression of NuclearFactor-kappaB that is its desirable effect.
We recommend taking a lower dose of quercetin than the manufacturer suggests......200mg every 8 hours. You will have to divide the capsules contents to obtain the correct dose because quercetin is usually available in only two sizes-400mg or 500mg.
"If you feel you absolutely must use larger doses, then you are in unchartered territory. I always recommend increasing the Benicar frequency rather than increase quercetin. IMO, there is less risk that way and the risk has been closely studied by the FDA."..Trevor..
If quercetin in needed to manage your symptoms to tolerable, be sure to take it regularly for several days to determine the response. A few folks have needed to use it for longer periods when other measures failed to control immunopathology.....that's okay.
What kind of quercetin should I use?
A combination product with other supplements added should not be used. Only pure quercetin with no added supplements is recommended.
Because quercetin absorption can vary, depending on its source, bromelain is sometimes added to improve absorption. Bromelain has powerful, unknown effects in the body. Do not use a quercetin product that contains bromelain.
Only use pure quercetin with no other supplements added. Check the label to make sure there is nothing but pure quercetin in the bottle. Most of the bottles labeled "Quercetin" in your local health food store are full of other flavonoids as well, including some which could be harmful.
Some quercetin products have added Vitamin C to enhance its antioxidant actions. If this is the only product you can find, you may take it, providing your intake of Vitamin C does not exceed 1,000mg per day.
The addition of routine stabilizers is okay.
Where can I get quercetin?
In the USA pure quercetin can often be purchased OTC at your local health store. It is available online at:
http://www.iherb.com/quercetin.html
http://www.natureslife.com/Products/C&Flavonoids/Quercitin.htm
http://www.good-earth.com/solaray-quercetin-500-mg--90-capsules.html
For other sources of quercetin, scroll down to next post.
What else should I know about quercetin?
Apart from the immediate relief of symptoms, it may take a few days, - maybe up to a week to feel an overall bigger difference.
There have been no reports of problems in taking the antibiotics, Benicar and quercetin together.
If quercetin upsets your stomach, try the Soloray brand and/or take it with food. Otherwise, it's fine to take it on an empty stomach.
Quercetin is also a potent inhibitor of the digestive enzyme CYP2C8 (P450 2C8) and therefore quercetin cannot be used by anyone taking chloroquine.
Warfarin (Coumadin) is metabolized by P450 2C8 so you need to seek advice if you are using Warfarin BEFORE taking Quercetin. Paclitaxil, retinoic acid, and arachidonic acid are also metabolized by this enzyme. Check with your pharmacist if you have any questions.
Ask your pharmacist to check whether any other drugs and supplements you are using rely on CYP2C8 for clearance from your bloodstream. Rifampin and Trimethoprim (an ingredient in Bactrim) are both reliant upon the 2C8 enzymes Again, ask your pharamcist or doctor for advice.
Benicar does not use the P450 metabolism, so it's absorption and clearance are not affected.
Possible Sources of Pure Quercetin
The manufacturer NaturesLife makes 400mg capsules and they are available just about anywhere. $16.95 for 100 capsules (approx. a months supply)
http://www.natureslife.com/Products/C&Flavonoids/Quercitin.htm
Other online sources:
http://www.iherb.com/quercetin.html
http://www.affordablenatureslife
http://www.dynamune.com
http://www.good-earth.com/solaray-quercetin-500-mg--90-capsules.html
Life Extension Foundation > Quercetin, 500 Mg 100 Capsules <Q > shipping info
DNStog: >>
Being one who dislikes dividing capsules, I was delighted to find two brands of supplements that make plain Quercetin in 250 mg. doses.
Thorne makes Quercetin called Quercetone and Pure Encapsulations makes pure Quercetin. this site that carries both brands. http://www.ourkidsasd.com
Regards..Donna
International sources
For those who need to import Quercetin, please see this MP.com thread for important information about credible sources:
http://tinyurl.com/7bxs6
I found only two reliable ways of purchasing Quercetin in Europe in the doses you recommend (200/250 mg):
1. from the US:
http://www.freedavitamins.com/
Advantages: easy purchasing through the website, shipping costs are quoted before the order is placed, USPS shipping, no problems with customs since the bottle clearly states "dietary supplement" and does not suggest any medical conditions to use this for (which is when customs might refuse it), slightly cheaper than source # 2 if no custom charges apply (any products under the value of 22 € are tax-free if imported into the E.U.), 50 mg - tablets, so dose can be titrated easily without having to divide capsules (which might make this interesting for U.S. MPers also) and for Jewish MPers: kosher product. Disadvantage: it took them one week to process the order (maybe faster if you phone them ?), parcel took another week to arrive.
2. from Europe:
http://www.pureinfo.at
European distributor for pure encapsulations (e.g. Quercetin 250 mg) Doctors and Chemists can order directly, private people can either look up a list of drugstores selling pure encapsulation products or they can get any drugstore to order products from this distributor. ~Syd
International customers: Beware of extra DHL shipping costs if the company does not mail. Ask regarding the method of shipping. Make sure of POSTING. Members have had trouble with shipments sent by Courier which incurred an unavoidable very high extra charge.
World Clock
XE.com - The Universal Currency Converter ®
Quercetin for Aussies: Available in 200mg capsules
from:
Compoundia
Australian Compounding Pharmacy
16 St Mangos Lane
Docklands VIC 3008
email : bertfrigo@compoundia.com
Website http://www.compoundia.com
Phone 03 96702882
Fax 03 9670-9615
You can contact them by email and / or phone.
---------------------------
or
Quercetin Jarrow Formula. 500mg x 100 caps
from the Life Extension Foundation > Quercetin, 500Mg x 100 Capsules <Q > shipping info
Payment can be made by Visa/Master/Bank card.
You can place your order either at the LEF website and it will be automatically forwarded
or you can order directly by
e-mail lepac@connect.com.fj
Ph(679)6520546
Fax(679)6520547
All orders to Australia & New Zealand are posted from Fiji Office by normal Air Parcel Post and takes about 1 week.
Life Extension Office hours are from 9AM to 5PM (Fiji Time) we are 2 hrs ahead of Sydney.
Mar09: $Aus 190 for 6 bottles x 100 caps 500mg shipped. emailed first to identify myself then phoned Fiji with order details...took 2 weeks.
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