Diagnosed with Crohn's disease at age 13, in 1976 with MS at age 23, and Rheumatoid Arthritis in 1986; MS symptoms for 4 yrs b4 dx. No CRAB/interferons for MS. Only IVSM PRN. Treat w/diet, exercise, prednisone daily (5mg in AM, 5mg before dinner) and supplements.
January 17, 2012 - FDA approves Voraxaze to treat patients with toxic methotrexate levels Helps lower high blood levels of the chemotherapy drug
The U.S. Food and Drug Administration today approved Voraxaze (glucarpidase) to treat patients with toxic levels of methotrexate in their blood due to kidney failure.
Methotrexate is a commonly used cancer chemotherapy drug normally eliminated from the body by the kidneys. However, patients receiving high doses of methotrexate may develop kidney failure.
Voraxaze is an enzyme that rapidly reduces methotrexate levels by breaking the chemotherapy drug down to a form that can be eliminated from the body. Voraxaze is administered directly into a patient’s vein (intravenously).
“Prolonged exposure to high levels of methotrexate can result in kidney and liver damage, severe mouth sores, damage to the lining of the intestine, skin rashes, and death due to low blood counts,” said Richard Pazdur, M.D., director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research. “Voraxaze is an important new treatment option for cancer patients aimed at preventing these toxicities associated with sustained high levels of methotrexate.”
Voraxaze has an orphan drug designation, given to therapies indicated for rare or specific disease populations.
A single clinical study of 22 patients evaluated the effectiveness of Voraxaze. All patients received Voraxaze treatment. The study considered treatment a success if the methotrexate level fell below a critical level within 15 minutes and stayed below the critical level for eight days. Ten of the 22 patients achieved this standard. Although not all patients experienced this result, Voraxaze eliminated 95 percent of the methotrexate in all patients.
A separate clinical study evaluated the safety of Voraxaze in 290 patients experiencing problems clearing methotrexate from their blood.
The most common side effects observed in greater than one percent of patients in the clinical study were low blood pressure (hypotension), headache, nausea, vomiting, flushing, and abnormal sensation (paraesthesia).
Voraxaze is marketed by BTG International Inc., West Conshohocken, Pa.
Lupus is a chronic inflammatory disease that can affect various parts of the body, especially the skin, joints, blood, and kidneys. Nick Cannon, Mariah Carey's husband has just been diagnosed with Lupus Nephritis, one of several forms of Lupus.
Lupus and Men
In order to live your best life with lupus, you will want to know as much as you can about the disease, how it may affect you, and how to manage the symptoms. This section offers information on lupus, as well as coping strategies and suggestions to help you. The LFA has additional information and resources on every aspect of lupus at lupus.org. Also, the archive section of the Lupus Now®magazine Web site, at lupusnow.org, includes an advice column for men, called “Ask Dr. Paul,” as well as articles on lupus from the men’s perspective.
Yes, Men Can Have Lupus!
The first thing you may discover is that many people are surprised when they learn you have lupus. A lot of misinformation exists about lupus—including the incorrect belief that lupus only occurs in women. Lupus can occur in anyone, male or female, of any age, including children, teenagers, and adults. We do not yet fully understand what causes lupus, but we do know that having lupus does not diminish your levels of testosterone, or affect your ability to perform sexually, or to become a father. However, medication side effects can play a role in these issues.
The second discovery you may make is that it can be difficult to find information on lupus in men. It is true that many sources of lupus information will seem to be addressed to women. This is because the disease is more often seen in females than males (approximately nine of every 10 cases of lupus will be in females of child-bearing age). However, the disease is the same—and is treated similarly—in both sexes. The Internet can be a great source of information on the disease, its symptoms, treatments, and prognosis, but be sure you are using reputable sources, such as government sites (.gov), educational institution sites (.edu), and of course the LFA’s Web site, lupus.org.
Understanding Lupus
It is not easy to understand a disease with symptoms that are so varied and often invisible. Here are some facts about lupus that may help you explain the disease to family, friends, and co-workers:
Lupus is an autoimmune disease that causes inflammation and tissue damage to the body.
Lupus is a chronic disease, which means that you will have lupus for the rest of your life.
Lupus is not contagious. You cannot “catch” it from someone or “give” it to someone.
Lupus is not like or related to cancer.
Lupus is not like or related to HIV or AIDS.
Lupus can cause a mild skin rash or achy joints, or can affect organs inside the body.
Lupus is unpredictable. Symptoms can appear, disappear, and change.
Lupus can range from mild to life-threatening and should always be treated by a doctor.
With good medical care, most people with non-organ-threatening lupus can lead a full life.
Causes of Lupus
No one knows what causes lupus. Researchers believe that lupus is caused by a combination of genetics (heredity), hormones, and environmental factors that act to “trigger” the illness or bring on a flare. Some known triggers are:
ultraviolet (UV) light from the sun, tanning beds, or fluorescent lights
drugs which make a person more sensitive to the sun; for example, sulfa drugs such as Bactrim® and Septra® (trimethoprim-sulfamethoxazole) and tetracycline drugs such as minocycline (Minocin®)
penicillin or other antibiotic drugs, such as amoxicillin (Amoxil®), ampicillin (Ampicillin Sodium ADD-Vantage®), and cloxacillin (Cloxapen®)
viral or bacterial infections
physical stress, such as injury, illness, or surgery
emotional stress, such as divorce, illness, or death in the family
vaccinations containing live virus
Treating Lupus
Most people with lupus will be treated by a rheumatologist, who is a specialist in diseases of the immune system, as well as joint and muscle complications. The rashes or lesions from cutaneous (skin) lupus may require treatment from a dermatologist. However, other specialists may be necessary, such as a nephrologist, who specializes in kidney problems; a cardiologist, who specializes in heart problems; or a neurologist, who specializes in problems that affect the brain and nervous system.
Family Life
In time you will learn to adapt to the new life you have with lupus, but those around you also will need to adjust to your new way of living. You can help them in many ways. First and foremost is good communication. When you share information about the illness, how it affects you, and its treatment, you will help to lessen everyone’s fears and concerns. Also helpful is the knowledge that the course of lupus is unpredictable, so there may be times when you feel well enough to take part in planned activities and other times when you have to cancel those plans. Try to pace yourself with a sensible schedule that includes time for being active every day, as much as you are able, and time for extra rest when you need it. Most of all, make time for what really matters, say “no” to what isn’t as important, and leave the rest for tomorrow—or the next day.
Build a Support Network
A network of friends, co-workers, and neighbors can give the same kind of valuable support as family members. But in order to give support, these acquaintances need to have some understanding of the nature of lupus. Let them know what to expect when the disease is active, don’t be hesitant about asking for help, and do accept help that is offered! At times you may find that your friends are not sure how to treat you. This is usually because they don’t know very much about lupus or how it affects you. Do your best to educate them, and be patient. Accept that some people are not comfortable when faced with illness in others.
Intimacy Between Partners
Sexual interest may be affected by the symptoms of lupus, by the medications used to treat lupus, and by clinical depression that can occur in those with chronic illness. But it is possible to keep intimacy and tenderness between partners. Good communication with your partner can help you deal with negative self-perceptions or feelings of rejection. Couples may also wish to work with a licensed therapist for additional guidance.
Fertility Concerns
Men with lupus are not less masculine, and do not experience impotence (erectile dysfunction) more than those without lupus. However, there is a connection between impotence or infertility and medications—in particular, cyclophosphamide (Cytoxan®). Before you begin taking any medications, talk to your doctor about how they may affect you.
Lupus in the Workplace
The workplace is another area that may need special consideration when you have been diagnosed with lupus. Many people with lupus are able to continue to work, although they may need to make changes in their work environment. Flexible work hours, job-sharing, avoiding the sun—especially between 10 a.m. and 4 p.m.—and telecommuting may help you to keep working.
You may be concerned that telling your employer about your lupus diagnosis might call into question your effectiveness in your job, or might cause your employer to think you are no longer a desirable employee. In confronting these work-related issues, you should refer to the Americans with Disabilities Act (ADA), which says an employer may not discriminate against a qualified individual with a disability or chronic illness.
If the physical and/or mental demands of your job become overwhelming or are causing your lupus symptoms to become active, you might benefit from changing to another job, or switching to part-time hours. In some cases, your doctor may feel that the best choice for your health is that you stop working altogether. If you do need to stop working, your employer may offer short-term and/or long-term disability benefits. Also be sure to find out about services available through local, state, and federal government organizations, such as the Social Security Disability Insurance, and nonprofit agencies. The LFA can provide you with resources and additional information.
Emotional Well-being
The unpredictability of lupus, with the many symptoms that come and go, the unexpected flares and remissions, and the uncertainty of what each day will bring, can contribute to feelings of unhappiness, frustration, or anger. Usually these feelings subside with time as you learn to adjust to having lupus.
In some cases, though, these negative feelings can be overwhelming and long-lasting. This can be an indication of clinical depression. Symptoms of clinical depression include:
feelings of helplessness or hopelessness
inability to concentrate
problems with memory and recalling information
indecisiveness
thoughts of suicide
Although clinical depression can occur as a symptom of having lupus, it is a separate illness that should be taken seriously.
Clinical depression generally improves with a combination of psychotherapy and medication. You should not feel embarrassed or hesitant about asking your doctor for a referral to a psychiatrist, psychologist, or therapist. Psychotherapy, under the guidance of a trained professional, can help you learn to understand your feelings, your illness, and your relationships, and can help you learn ways to cope more effectively with stress. Ask for a recommendation for a trained therapist who can help you work through the psychological aspects of living with a chronic and unpredictable disease like lupus. For additional information, please refer to the LFA Patient Education Series information, Lupus and Clinical Depression, in the Learn about Lupus section of the LFA website.
Living with Lupus
We encourage you to reach out to other men who, like you, are learning to live and cope with lupus. You can connect with other men with lupus on the LFAonline message boards at lupus.org; in the “Ask Dr. Paul” column in the LFA’s magazine, Lupus Now®; and through the LFA network of chapters and support groups, at lupus.org/chapters.
You can find additional lupus information in the LFA Patient Education Series,Understanding Lupus, Living with Lupus, Coping with Lupus, and How Lupus Affect the Body in the Learn about Lupus Section of the LFA website (lupus.org) .
Live Your Best Life With Lupus
Learn all you can about lupus.
Be patient as you explain to family, friends, and co-workers how lupus affects you.
Talk to your doctor if you have questions about lupus, your medications and their side effects, and lifestyle changes that will help you.
Take your medications as prescribed, and tell your doctor about any side effects.
Try to do something physically active each day.
Don’t feel guilty about needing rest and a stress-free environment.
Don’t be afraid to ask for help.
Focus on what you can do, not what you cannot do.
If lupus symptoms prevent you from your usual activities, find new ways to relax, exercise, spend time with loved ones, and enjoy life.
If you think you are experiencing symptoms of clinical depression, talk to your doctor.
Connect with other men who understand what you’re going through.
The foods eaten by most Westerners today bear little resemblance to the foods our hunter-gatherer ancestors ate. And our lifestyles are equally non-reflective of our roots. Our bodies evolved to weather the cycles of feast and famine; to accumulate body fat easily in order to make it through times when food was scarce. But the famine never comes now, so all we have is the feast. And feast upon feast upon feast adds up to a LOT of extra body fat.
The documentary points out that 68 percent of U.S. adults are now overweight or obese.
Hunter-gatherers consumed foods with high nutrition and low calories. Today, most Americans are getting the converse—high calories and low nutrition. Many are overfed, yet starving to death. Their bodies are accumulating fat and pollutants from intentional AND unintentional contaminants in our food supply, causing their biological systems to shut down and be vulnerable to a variety of chronic diseases.
Adding to the caloric excess is an exercise deficit.
As a culture, we've gotten away from farms and moved to cities, adopting an indoor lifestyle that expends far fewer calories. Instead of walking, we ride in cars. Instead of running from tigers, we chase cursors around a screen. We have completely lost touch with where our food comes from and what goes into creating it. Our very relationship with food has changed, and not for the better.
Are You Addicted to Additives?
Processed food has become a multi-billion dollar industry that dangles the carrot of "convenience." However, the price you pay for convenience is your very health and vitality. Hungry For Change exposes the dark side of the food industry's marketing plan—namely, the addition of certain chemicals that secretly can get you addicted and make you a perpetual customer (they hope). You can probably already see the parallels with the tobacco industry that, in the 1960s, began increasing the nicotine level in cigarettes, which kept smokers coming back for more.
One example of an addictive food additive is MSG (monosodium glutamate), which is added to 80 percent of all flavored foods. MSG excites the part of your brain that's in charge of your fat programs. MSG is what's known as an excitotoxin, but it's also used to fatten up mice for scientific study. Yes, MSG is the perfect obesity drug. If you want to achieve your ideal body weight and health, avoid MSG at all costs.
Artificial Sweeteners: The Worst of the Worst
Sweeteners, both artificial and sugar-derived, top the list of addictive additives. But artificial sweeteners are the absolute WORST things you can put in your body. Consider aspartame, sold under the brand names NutraSweet and Equal. Diet cola, which often combines aspartame and caffeine, is the perfectly addictive beverage. These two agents create a very unique but deadly combination of excitotoxins that kill off your brain cells. However, before they do so, they go out with a bang by giving you something akin to a buzz. It's the perfect plan to get you to go back to the store to buy another soda. And maybe a supersized soda—after all, it has ZERO calories, no matter how much you consume!
But not so fast. You are sipping your way into a trap.
Studies now show that, in spite of their zero-calorie status, many artificial sweeteners actually cause weight GAIN because they stimulate your body to crave carbohydrates. But weight gain may be the least of your worries. Aspartame causes formaldehyde to build up in your brain, which results in all sorts of potentially serious medical problems, including:
Frontal lobe inflammation
Visual disturbances
Migraines
A syndrome similar to multiple sclerosis
Seizures
Cognitive problems
Chronic fatigue syndrome and fibromyalgia
Symptoms similar to Parkinson's disease
Symptoms similar to attention deficit disorder
In fact, pilots' associations are aware of the visual disturbances and caution pilots to avoid using aspartame due to its potential to compromise their ability to pilot a plane.
The food industry claims that aspartame is safe. However, if you look at the studies that claim to support aspartame's safety, you will see that 90 percent of them were funded by the food and beverage industry. When you examine independent aspartame studies, it's a totally different story. Ninety percent of those have found serious health problems related to aspartame. The FDA merely evaluates the studies that the industry submits—it doesn't have a team of researchers conducting those studies itself, contrary to what you might think.
Feeding Your Child Sugar Can Be a Highly Addictive Habit
American children are consuming about ten times as much sugar as they were a century ago, especially in the form of fructose (primarily in the form of high fructose corn syrup). Fructose is the average American's largest source of calories. This comes as no surprise, as it's highly addictive. The prevalence of fructose in the Western diet is a very significant factor driving today's obesity epidemic.
You'll find high fructose corn syrup in an alarming number of everyday products—bread, salad dressing, pasta sauce, infant formula, and nearly all processed foods. In these highly concentrated, highly refined forms, fructose can have some very serious metabolic effects that wreak havoc on your body and make it difficult to escape the addictive cycle. Because it's so energy-dense, putting HFCS in your body is like putting jet fuel into an automobile engine—you'll burn it out.
When you consume something so high in sugar, your pancreas must secrete large amounts of insulin to bring down your bloodsugar level. And all of that sugar is turned into fat so it can be stored. Insulin is in fact a fat-producing hormone. But the problems from sugar don't stop there.
Sugar is a drug. It causes a beta-endorphin rush in your brain, stimulating the production of morphine-like chemicals. When you're feeling down or under stress, it's natural to want to eat foods that lift your mood. Sugar fits the bill as a "comfort food," given its morphine-like physiological effects. And like any drug, your body can become habituated, meaning you will require more sugar over time to get the same sugar high.
Sugar is actually is similar to cocaine in many respects.
Both are highly refined, chemically manipulated agents that are derived from natural, harmless plants—it's the extremely concentrated forms that are dangerous and addictive to your body. Cocaine is made from coca leaves, which are not in and of themselves harmful and have been used nutritionally for hundreds of years in South Americai. If you want to be healthy, you MUST take control of your sugar intake so that it doesn't take control over you.
Diets Don't Work
Dietsreally don't work. Although most people have heard this admonition before, many are still unable to resist the temptation. "Dieting" is a multi-million dollar industry itself and does some powerful marketing to lure you in. However, studies are clear that 90 to 95 percent of dieters gain back the weight they lose, and THEN some. Dieting is a temporary fix… do you want to be temporarily healthy? Of course not! You want to be permanently healthy. So, you have to make some permanent lifestyle changes.
Every time you lose weight by dieting, your body will be triggered into trying to protect you from the effects of another "famine" in the future, so it will add some extra body fat as insurance. You may lose 10 pounds on a diet, but you'll gain back 15 or 20. Dieting is a physiologically flawed concept and sets you up for failure.
Fake-Foods of the Western World
People of vastly different cultures and environments thrive on all sorts of diets, from high fat and high protein to high carbohydrate; some mostly animal products and others largely vegetarian. Yet, as varied as native diets are, most native populations have very low rates of chronic disease when compared with Americans and other Western cultures. Eskimos thrive on diets rich in animal fat and muscle and organ meats, but tropical natives thrive on abundant fresh plants, fish and fruit. Yet both cultures are healthy!
So what's the common denominator?
Native diets consist mostly of natural, whole foods (whether plant- or animal-based) rather than processed foods that come in a box or a can. Americans are eating overcooked, overprocessed and chemically manipulated fake foods, instead of REAL foods.
Native diets, in general, are largely made up of whole vegetables, fruits, nuts, seeds, and meats. Not cooked down, refined, dehydrated and reconstituted, boxed-up pretend foods that aren't really foods at all. Eating wisely requires a gradual transition toward the consumption of natural, whole foods that are unaltered by a lab. The closer to nature a food is, the more nutritious it will be. A change away from the cultural "norm" won't be accomplished over night. Start gradually. As good foods are added into your diet, bad foods will eventually be crowded out.
Four Other Critical Factors for Achieving Optimal Health
Choosing which foods to eat is important, but other lifestyle factors must be addressed as well. Besides making better food choices, there are four other key factors you must consider if you want to achieve your optimal level of health.
Exercise: Exercise creates the same mood-elevating chemicals that sugar does—but with positive metabolic effects. Exercise helps metabolize your stress hormones, reduces hunger, improves sleep, strengthens bones and joints, and causes your body to release growth hormone—and many other health benefits.
Detoxification/Cleansing: As you burn off body fat, you must also detoxify, because most chemicals are lipophilic (fat-loving) and are lodged in fat cells. If you don't do something to remove these toxins from your body while losing weight, toxins can be reabsorbed into your bloodstream and potentially cause health problems.
Fortunately, your body will detoxify itself if there is no toxicity coming in. Chlorophyll-rich foods such as organic green vegetables, gelatinous plant foods like aloe and chia seeds, seaweeds, chlorella, cilantro and parsley can help with this. Make sure to drink plenty of pure water, as this is essential to your body's cleansing processes. Juicing may also be of benefit. Avoid all chemicals, additives, and preservatives. If a product's shelf life is longer than your life, don't eat it!
Sleep: Sleep allows your body to repair and rebuild. Deep sleep is a great way to neutralize stress hormones. Stress increases fluid retention—you can gain two pounds in body fluids just from one night of poor sleep due to stress.
Stress Management: Stress changes your body chemistry, and will prompt you to eat, out of your body's not knowing what else to do. It's one of your body's ways of protecting you. Stress raises your levels of cortisol and epinephrine, which can result in weight gain. If you don't believe this, just talk to anyone taking prednisone, a pharmaceutical steroid similar to cortisol. They often gain 20 to 30 pounds, no matter what they're eating.
My favorite overall tool to manage stress is EFT (Emotional Freedom Technique), which is like acupuncture without the needles. It's a handy tool for unloading emotional baggage quickly and painlessly, and so easy that children can learn it. And it's FREE! Also free, laughter is great medicine because it decreases stress chemicals and pain.
Another powerful tool for creating positive change in your life is visualization, which is the "language" of the subconscious. When you create a visual image of how you'd like to look or feel, your subconscious will understand and begin to help you by making the needed biochemical and neurological changes.
These are just some of the suggestions that will help you along your way. I recommend taking the time to watch Hungry for Change, which offers you even more information than what I've presented above. Remember that if you treat your body well, it will return the favor.
I want to bring your attention to this 2010 report by Dr. Mercola which includes 2 You Tube Videos that I hope you will find as interesting as I did. Also, please visit http://roadback.org where thousands of patients have reported success using antibiotics for lessening of swollen joints and better quality of life for conditions such as:
Rheumatoid arthritis affects about 1 percent of our population and at least two million Americans have definite or classical rheumatoid arthritis. This number has increased in recent years, as in 2010 about 2.5 percent of white women developed RA.
It is a much more devastating illness than previously appreciated. Most patients with rheumatoid arthritis have a progressive disability.
The natural course of rheumatoid arthritis is quite remarkable in that less than 1 percent of people with the disease have a spontaneous remission. Some disability occurs in 50-70 percent of people within five years after onset of the disease, and half will stop working within 10 years. The annual cost of this disease in the U.S. is estimated to be over $1 billion.
This devastating prognosis is what makes this novel form of treatment so exciting, as it has a far higher likelihood of succeeding than the conventional approach.
Over the years I have treated over 3,000 patients with rheumatic illnesses, including SLE, scleroderma, polymyositis and dermatomyositis.
Approximately 15 percent of these patients were lost to follow-up for whatever reason and have not continued with treatment. The remaining patients seem to have a 60-90 percent likelihood of improvement on this treatment regimen.
This level of improvement is quite a stark contrast to the typical numbers quoted above that are experienced with conventional approaches, and certainly a strong motivation to try the protocol I discuss below.
RA Can Be More Deadly than Heart Disease
There is also an increased mortality rate with this disease. The five-year survival rate of patients with more than thirty joints involved is approximately 50 percent. This is similar to severe coronary artery disease or stage IV Hodgkin's disease.
Thirty years ago, one researcher concluded that there was an average loss of 18 years of life in patients who developed rheumatoid arthritis before the age of 50.
Most authorities believe that remissions rarely occur. Some experts feel that the term "remission-inducing" should not be used to describe ANY current rheumatoid arthritis treatment, and a review of contemporary treatment methods shows that medical science has not been able to significantly improve the long-term outcome of this disease.
Dr. Brown Pioneered a Novel Approach to Treat RA
I first became aware of Doctor Brown's protocol in 1989 when I saw him on 20/20 on ABC. This was shortly after the introduction of his first edition of his book, The Road Back. Unfortunately, Dr. Brown died from prostate cancer shortly after the 20/20 program so I never had a chance to meet him.
My application of Dr. Brown's protocol has changed significantly since I first started implementing it. Initially, I rigidly followed Dr. Brown's work with minimal modifications to his protocol. About the only change I made was changing Tetracycline to Minocin. I believe I was one of the first physicians who recommended the shift to Minocin and most people who use his protocol now use Minocin.
In 1939, Dr. Sabin, the discoverer of the polio vaccine, first reported chronic arthritis in mice caused by a mycoplasma. He suggested this agent might cause human rheumatoid arthritis. Dr. Brown worked with Dr. Sabin at the Rockefeller Institute.
Dr. Brown was a board certified rheumatologist who graduated from Johns Hopkins medical school. He was a professor of medicine at George Washington University until 1970 where he served as chairman of the Arthritis Institute in Arlington, Virginia. He published over 100 papers in peer reviewed scientific literature.
He was able to help over 10,000 patients when he used this program, from the 1950s until his death in 1989, and clearly far more than that have been helped by other physicians using this protocol.
He found that significant benefits from the treatment require, on average, about one to two years.
I have treated nearly 3000 patients and find that the dietary modification I advocate, which I started to integrate in the early 1990's, accelerates the response rate to several months. I cannot emphasize strongly enough the importance of this aspect of the program.
Still, the length of therapy can vary widely.
In severe cases, it may take up to 30 months for patients to gain sustained improvement. One requires patience because remissions may take up to 3 to 5 years. Dr. Brown's pioneering approach represents a safer, less toxic alternative to many conventional regimens and results of the NIH trial have finally scientifically validated this treatment.
The dietary changes are absolutely an essential component of my protocol. Dr. Brown's original protocol was notorious for inducing a Herxheimer, or worsening of symptoms, before improvement was noted. This could last two to six months. Implementing my nutrition plan resulted in a lessening of that reaction in most cases.
When I first started using his protocol for patients in the late '80s, the common retort from other physicians was that there was "no scientific proof" that this treatment worked. Well, that is certainly not true today. A review of the bibliography will provide over 200 references in the peer-reviewed medical literature that supports the application of Minocin in the use of rheumatic illnesses.
In my experience, nearly 80 percent of people do remarkably better with this program. However, approximately 5 percent continue to worsen and require conventional agents, like methotrexate, to relieve their symptoms.
Scientific Proof for this Approach
The definitive scientific support for minocycline in the treatment of rheumatoid arthritis came with the MIRA trial in the United States. This was a double blind randomized placebo controlled trial done at six university centers involving 200 patients for nearly one year. The dosage they used (100 mg twice daily) was much higher and likely less effective than what most clinicians currently use.
They also did not employ any additional antibiotics or nutritional regimens, yet 55 percent of patients improved. This study finally provided the "proof" that many traditional clinicians demanded before seriously considering this treatment as an alternative regimen for rheumatoid arthritis.
Dr. Thomas Brown's effort to treat the chronic mycoplasma infections believed to cause rheumatoid arthritis is the basis for this therapy. Dr. Brown believed that most rheumatic illnesses respond to this treatment. He and others used this therapy for SLE, ankylosing spondylitis, scleroderma, dermatomyositis and polymyositis.
Dr. Osler was one of the most well respected and prominent physicians of his time (1849- 1919), and many regard him as the consummate physician of modern times. An excerpt from a commentary on Dr. William Osler provides a useful perspective on application of alternative medical paradigms:
"Osler would caution us against the arrogance of believing that only our current medical practices can benefit the patient. He would realize that new scientific insights might emerge from as yet unproved beliefs. Although he would fight vigorously to protect the public against frauds and charlatans, he would encourage critical study of whatever therapeutic approaches were reliably reported to be beneficial to patients. "
Factors Associated with Your Success on this Program
There are many variables associated with an increased chance of remission or improvement.
The younger you are, the greater your chance for improvement
The more closely you follow the nutrition plan, the more likely you are to improve and the less likely you are to have a severe flare-up. I now offer the Nutritional Typing Test for free, so please do not skip this essential step.
Smoking seems to be negatively associated with improvement
The longer you have had the illness and the more severe the illness, the more difficult it seems to treat
Revised Antibiotic-Free Approach
Although I used a revision of his antibiotic approach for nearly ten years, my particular prejudice is to focus on natural therapies. The program that follows is my revision of this protocol that allows for a completely drug-free treatment of RA, which is based on my experience of treating over 3000 patients with rheumatic illnesses in my Chicago clinic.
If you are interested in reviewing or considering Dr. Brown's antibiotic approach, I have included a summary of his work and the evidence for it in the appendix.
Crucial Lifestyle Changes
Improving your diet using a combination of my nutritional guidelines, nutritional typing is crucial for your success. In addition, there are some general principles that seem to hold true for all nutritional types and these include:
Eliminating sugar, especially fructose, and most grains. For most people it would be best to limit fruit to small quantities
Eating unprocessed, high-quality foods, organic and locally grown if possible
Eating your food as close to raw as possible
Getting plenty high-quality animal-based omega-3 fats. Krill oil seems to be particularly helpful here as it appears to be a more effective anti inflammatory preparation. It is particularly effective if taken concurrently with 4 mg of Astaxanthin, which is a potent antioxidant bioflavanoid derived from algae
Astaxanthin at 4 mg per day is particularly important for anyone placed on prednisone as Astaxanthin offers potent protection against cataracts and age related macular degeneration
Early Emotional Traumas are Pervasive in Those with RA
With the vast majority of the patients I treated, some type of emotional trauma occurred early in their life, before the age their conscious mind was formed, which is typically around the age of 5 or 6. However, a trauma can occur at any age, and has a profoundly negative impact.
If that specific emotional insult is not addressed with an effective treatment modality then the underlying emotional trigger will continue to fester, allowing the destructive process to proceed, which can predispose you to severe autoimmune diseases like RA later in life.
In some cases, RA appears to be caused by an infection, and it is my experience that this infection is usually acquired when you have a stressful event that causes a disruption in your bioelectrical circuits, which then impairs your immune system.
This early emotional trauma predisposes you to developing the initial infection, and also contributes to your relative inability to effectively defeat the infection.
Vitamin D Deficiency Rampant in Those with RA
The early part of the 21st century brought enormous attention to the importance and value of vitamin D, particularly in the treatment of autoimmune diseases like RA.
From my perspective, it is now virtually criminal negligent malpractice to treat a person with RA and not aggressively monitor their vitamin D levels to confirm that they are in a therapeutic range of 65-80 ng/ml.
This is so important that blood tests need to be done every two weeks, so the dose can be adjusted to get into that range. Most normal-weight adults should start at 10,000 units of vitamin D per day.
Low Dose Naltrexone
One new addition to the protocol is low-dose Naltrexone, which I would encourage anyone with RA to try. It is inexpensive and non-toxic and I have a number of physician reports documenting incredible efficacy in getting people off of all their dangerous arthritis meds.
Although this is a drug, and strictly speaking not a natural therapy, it has provided important relief and is FAR safer than the toxic drugs that are typically used by nearly all rheumatologists.
Nutritional Considerations
Limiting sugar is a critical element of the treatment program. Sugar has multiple significant negative influences on your biochemistry. First and foremost, it increases your insulin levels, which is the root cause of nearly all chronic disease. It can also impair your gut bacteria.
In my experience if you are unable to decrease your sugar intake, you are far less likely to improve. Please understand that the number one source of calories in the US is high fructose corn syrup from drinking soda. One of the first steps you can take is to phase out all soda, and replace it with pure, clean water.
Exercise for Rheumatoid Arthritis
It is very important to exercise and increase muscle tone of your non-weight bearing joints. Experts tell us that disuse results in muscle atrophy and weakness. Additionally, immobility may result in joint contractures and loss of range of motion (ROM). Active ROM exercises are preferred to passive.
There is some evidence that passive ROM exercises increase the number of white blood cells (WBCs) in your joints.
If your joints are stiff, you should stretch and apply heat before exercising. If your joints are swollen, application of ten minutes of ice before exercise would be helpful.
The inflamed joint is very vulnerable to damage from improper exercise, so you must be cautious. People with arthritis must strike a delicate balance between rest and activity, and must avoid activities that aggravate joint pain. You should avoid any exercise that strains a significantly unstable joint.
A good rule of thumb is that if the pain lasts longer than one hour after stopping exercise, you should slow down or choose another form of exercise. Assistive devices are also helpful to decrease the pressure on affected joints. Many patients need to be urged to take advantage of these. The Arthritis Foundation has a book, Guide to Independent Living, which instructs patients about how to obtain them.
Of course, it is important to maintain good cardiovascular fitness as well. Walking with appropriate supportive shoes is another important consideration.
It's Important to Control Your Pain
One of the primary problems with RA is controlling pain. The conventional treatment typically includes using very dangerous drugs like prednisone, methotrexate, and drugs that interfere with tumor necrosis factor, like Enbrel.
The goal is to implement the lifestyle changes discussed above as quickly as possible, so you can start to reduce these toxic and dangerous drugs, which do absolutely nothing to treat the cause of the disease.
However pain relief is obviously very important, and if this is not achieved, you can go into a depressive cycle that can clearly worsen your immune system and cause the RA to flare.
Safest Anti-Inflammatories to Use for Pain
Clearly the safest prescription drugs to use for pain are the non-acetylated salicylates such as:
Salsalate
Sodium salicylate
Magnesium salicylate (i.e., Salflex, Disalcid, or Trilisate).
They are the drugs of choice if there is renal insufficiency as they minimally interfere with anticyclooxygenase and other prostaglandins.
Additionally, they will not impair platelet inhibition in those patients who are on an every-other-day aspirin regimen to decrease their risk for stroke or heart disease.
Unlike aspirin, they do not increase the formation of products of lipoxygenase-mediated metabolism of arachidonic acid. For this reason, they may be less likely to cause hypersensitivity reactions. These drugs have been safely used in patients with reversible obstructive airway disease and a history of aspirin sensitivity.
They are also much gentler on your stomach than the other NSAIDs and are the drug of choice if you have problems with peptic ulcer disease. Unfortunately, all these benefits are balanced by the fact they may not be as effective as the other agents and are less convenient to take. You need to take 1.5-2 grams twice a day, and tinnitus, or ringing in your ear, is a frequent side effect.
You need to be aware of this complication and know that if tinnitus does develop, you need to stop the drugs for a day and restart with a dose that is half a pill per day lower. You can repeat this until you find a dose that relieves your pain and doesn't cause any ringing in your ears.
If the Safer Anti-Inflammatories aren't Helping, Try This Next…
If the non-acetylated salicylates aren't helping there are many different NSAIDs to try. Relafen, Daypro, Voltaren, Motrin, Naprosyn. Meclomen, Indocin, Orudis, and Tolectin are among the most toxic or likely to cause complications. You can experiment with them, and see which one works best for you.
If cost is a concern, generic ibuprofen can be used at up to 800 mg per dose. Unfortunately, recent studies suggest this drug is more damaging to your kidneys.
If you use any of the above drugs, though, it is really important to make sure you take them with your largest meal as this will somewhat moderate their GI toxicity and the likelihood of causing an ulcer.
Please beware that they are much more dangerous than the antibiotics or non-acetylated salicylates.
You should have an SMA blood test performed at least once a year if you are on these medications. In addition, you must monitor your serum potassium levels if you are on an ACE inhibitor as these medications can cause high potassium levels. You should also monitor your kidney function. The SMA will show any liver impairment the drugs might be causing.
These medications can also impair prostaglandin metabolism and cause papillary necrosis and chronic interstitial nephritis. Your kidney needs vasodilatory prostaglandins (PGE2 and prostacycline) to counterbalance the effects of potent vasoconstrictor hormones such as angiotensin II and catecholamines. NSAIDs decrease prostaglandin synthesis by inhibiting cyclooxygenase, leading to unopposed constriction of the renal arterioles supplying your kidney.
Warning: These Drugs Massively Increase Your Risk for Ulcers
The first non-aspirin NSAID, indomethacin, was introduced in 1963. Now more than 30 are available. Relafen is one of the better alternatives as it seems to cause less of an intestinal dysbiosis. You must be especially careful to monitor renal function periodically. It is important to understand and accept the risks associated with these more toxic drugs.
Every year, they do enough damage to the GI tract to kill 2,000 to 4,000 people with rheumatoid arthritis alone. That is ten peopleEVERY DAY. At any given time, 10 to 20 percent of all those receiving NSAID therapy have gastric ulcers.
If you are taking an NSAID, you are at approximately three times greater risk for developing serious gastrointestinal side effects than those who don't.
Approximately 1.2 percent of patients taking NSAIDs are hospitalized for upper GI problems, per year of exposure. One study of patients taking NSAIDs showed that a life-threatening complication was the first sign of ulcer in more than half of the subjects.
Researchers found that the drugs suppress production of prostacyclin, which is needed to dilate blood vessels and inhibit clotting. Earlier studies had found that mice genetically engineered to be unable to use prostacyclin properly were prone to clotting disorders.
Anyone who is at increased risk of cardiovascular disease should steer clear of these medications. Ulcer complications are certainly potentially life-threatening, but, heart attacks are a much more common and likely risk, especially in older individuals.
How You Can Tell if You are at Risk for NSAID Side Effects
Risk factor analysis can help determine if you will face an increased danger of developing these complications. If you have any of the following, you will likely to have a higher risk of side effects from these drugs:
Old age
Peptic ulcer history
Alcohol dependency
Cigarette smoking
Concurrent prednisone or corticosteroid use
Disability
Taking a high dose of the NSAID
Using an NSAID known to be more toxic
Prednisone
The above drug class are called non steroidal anti inflammatories (NSAIDs). If they are unable to control the pain, then prednisone is nearly universally used. This is a steroid drug that is loaded with side effects.
If you are on large doses of prednisone for extended periods of time, you can be virtually assured that you will develop the following problems:
Osteoporosis
Cataracts
Diabetes
Ulcers
Herpes reactivation
Insomnia
Hypertension
Kidney stones
You can be virtually assured that every time you take a dose of prednisone your bones are becoming weaker. The higher the dose and the longer you are on prednisone, the more likely you are to develop the problems.
However, if you are able to keep your dose to 5 mg or below, this is not typically a major issue.
Typically this is one of the first medicines you should try to stop as soon as your symptoms permit.
Beware that blood levels of cortisol peak between 3 and 9am. It would, therefore, be safest to administer the prednisone in the morning. This will minimize the suppression on your hypothalamic-pituitary-adrenal axis.
You also need to be concerned about the increased risk of peptic ulcer disease when using this medicine with conventional non-steroidal anti-inflammatories. If you are taking both of these medicines, you have a 15 times greater risk of developing an ulcer!
If you are already on prednisone, it is helpful to get a prescription for 1 mg tablets so you can wean yourself off the prednisone as soon as possible. Usually you can lower your dose by about 1 mg per week. If a relapse of your symptoms occurs, then further reduction of the prednisone is not indicated.
How Do You Know When to Stop the Drugs?
Unlike conventional approaches to RA, my protocol is designed to treat the underlying cause of the problem. So eventually the drugs that you are going to use during the program will be weaned off.
The following criteria can help determine when you are in remission and can consider weaning off your medications: *
A decrease in duration of morning stiffness to no more than 15 minutes
No pain at rest
Little or no pain or tenderness on motion
Absence of joint swelling
A normal energy level
A decrease in your ESR to no more than 30
A normalization of your CBC. Generally your HGB, HCT, & MCV will increase to normal and your "pseudo"-iron deficiency will disappear
ANA, RF, & ASO titers returning to normal
If you discontinue your medications before all of the above criteria are met, there is a greater risk that the disease will recur.
If you meet the above criteria, you can try to wean off your anti-inflammatory medication and monitor for flare-ups. If no flare-ups occur for six months, then discontinue the clindamycin.
If the improvements are maintained for the next six months, you can then discontinue your Minocin and monitor for recurrences. If symptoms should recur, it would be wise to restart the previous antibiotic regimen.
Evaluation to Determine and Follow RA
If you have received evaluations and treatment by one or more board certified rheumatologists, you can be very confident that the appropriate evaluation was done. Although conventional treatments fail miserably in the long run, the conventional diagnostic approach is typically excellent, and you can start the treatment program discussed above.
If you have not been evaluated by a specialist then it will be important to be properly evaluated to determine if indeed you have rheumatoid arthritis.
Please be sure and carefully review Appendix Two, as you will want to confirm that fibromyalgia is not present.
Beware that arthritic pain can be an early manifestation of 20-30 different clinical problems.
These include not only rheumatic disease, but also metabolic, infectious and malignant disorders. Rheumatoid arthritis is a clinical diagnosis for which there is not a single test or group of laboratory tests which can be considered confirmatory.
Criteria for Classification of Rheumatoid Arthritis
Morning Stiffness - Morning stiffness in and around joints lasting at least one hour before maximal improvement is noted.
Arthritis of three or more joint areas - At least three joint areas have simultaneously had soft-tissue swelling or fluid (not bony overgrowth) observed by a physician. There are 14 possible joints: right or left PIP, MCP, wrist, elbow, knee, ankle, and MTP joints.
Arthritis of hand joints - At least one joint area swollen as above in a wrist, MCP, or PIP joint.
Symmetric arthritis - Simultaneous involvement of the same joint areas (as in criterion 2) on both sides of your body (bilateral involvement of PIPs, MCPs, or MTPs) is acceptable without absolute symmetry. Lack of symmetry is not sufficient to rule out the diagnosis of rheumatoid arthritis.
Rheumatoid Nodules - Subcutaneous nodules over bony prominences, or extensor surfaces, or in juxta-articular regions, observed by a physician. Only about 25 percent of patients with rheumatoid arthritis develop nodules, and usually as a later manifestation.
Serum Rheumatoid Factor - Demonstration of abnormal amounts of serum rheumatoid factor by any method that has been positive in less than 5 percent of normal control subjects. This test is positive only 30-40 percent of the time in the early months of rheumatoid arthritis.
You must also make certain that the first four symptoms listed in the table above are present for six or more weeks. These criteria have a 91-94 percent sensitivity and 89 percent specificity for the diagnosis of rheumatoid arthritis.
However, these criteria were designed for classification and not for diagnosis. The diagnosis must be made on clinical grounds. It is important to note that many patients with negative serologic tests can have a strong clinical picture for rheumatoid arthritis.
Your Hands are the KEY to the Diagnosis of RA
In a way, the hands are the calling card of rheumatoid arthritis. If you completely lack hand and wrist involvement, even by history, the diagnosis of rheumatoid arthritis is doubtful. Rheumatoid arthritis rarely affects your hips and ankles early in its course.
The metacarpophalangeal joints, proximal interphalangeal and wrist joints are the first joints to become symptomatic. Osteoarthritis typically affects the joints that are closest to your fingertips (DIP joints) while RA typically affects the joints closest to your wrist (PIP), like your knuckles.
Fatigue may be present before your joint symptoms begin, and morning stiffness is a sensitive indicator of rheumatoid arthritis. An increase in fluid in and around your joint probably causes the stiffness. Your joints are warm, but your skin is rarely red.
When your joints develop effusions, hold them flexed at 5 to 20 degrees as it is likely going to be too painful to extend them fully.
Radiological Changes
Radiological changes typical of rheumatoid arthritis on PA hand and wrist X-rays, which must include erosions or unequivocal bony decalcification localized to, or most marked, adjacent to the involved joints (osteoarthritic changes alone do not count).
Note: You must satisfy at least four of the seven criteria listed. Any of criteria 1-4 must have been present for at least 6 weeks. Patients with two clinical diagnoses are not excluded. Designations as classic, definite, or probable rheumatoid arthritis, are not to be made.
Laboratory Evaluation
The general initial laboratory evaluation should include a baseline ESR, CBC, SMA, U/A, 25 hydroxy D level and an ASO titer. You can also draw RF and ANA titers to further objectively document improvement with the therapy. However, they seldom add much to the assessment.
Follow-up visits can be every two to four months depending on the extent of the disease and ease of testing.
The exception here would be vitamin D testing which should be done every two weeks until your 25 hydroxy D level is between 65 and 80 ng/ml.
Many patients with rheumatoid arthritis have a hypochromic, microcytic CBC that appears very similar to iron deficiency, but it is not at all related. This is probably due to the inflammation in the rheumatoid arthritis impairing optimal bone marrow utilization of iron.
It is important to note that this type of anemia does NOT respond to iron and if you are put on iron you will get worse, as the iron is a very potent oxidative stress. Ferritin levels are generally the most reliable indicator of total iron body stores. Unfortunately it is also an acute phase reactant protein and will be elevated anytime the ESR is elevated. This makes ferritin an unreliable test in patients with rheumatoid arthritis.
If you are in the US, then Lab Corp is the lab of choice.
Vitamin D Dose Recommendations
Age
Dosage
Below 5
35 units per pound per day
Age 5 - 10
2500 units
Adults
5000 units
Pregnant Women
5000 units
WARNING:
There is no way to know if the above recommendations are correct. The ONLY way to know is to test your blood. You might need 4-5 times the amount recommended above. Ideally your blood level of 25 OH D should be 60ng/ml.
