FREQUENTLY ASKED QUESTIONS ABOUT ANTIBIOTIC THERAPY
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Index
1. HOW DOES ANTIBIOTIC THERAPY DIFFER FROM CONVENTIONAL THERAPY?
Antibiotic therapy is based on the theory that inflammatory rheumatic diseases such as rheumatoid arthritis, scleroderma, lupus, juvenile rheumatoid arthritis, polymyositis, ankylosing spondylitis, etc. have an infectious cause such as mycoplasma and other bacterial L forms. Significant evidence supporting this theory has been published in medical literature for decades. The use of low dose antibiotics, particularly from the tetracycline or macrolide families, attack the disease process at its source, namely the infectious agent. In contrast to the treatment of ordinary, acute bacterial infections with faster growing bacteria, the bacterial forms which trigger the chronic infectious disease processes are much slower growing organisms; thus, the antibiotic protocols prescribed for treating the rheumatoid diseases are based on the use of long-term, low-dose antibiotics, usually given only three days per week - sometimes more frequently.
This therapy is equally effective in patients with severe and/or long-standing disease as it is in those with mild to moderate disease. Thomas McPherson Brown, M.D. (1906-1989), a well known rheumatologist who practiced in the Washington, D.C. area, pioneered this treatment over fifty years ago and successfully used it to treat over ten thousand patients during his lifetime.
In contrast, however, the toxic medications used by rheumatologists today in conventional therapy are prescribed to try and control or suppress symptoms rather than to eradicate the underlying bacterial infection, which is the root cause of the disease process. These more toxic drugs may or may not be effective. If they do work, it is only a matter of time before they either lose their effectiveness or the patient develops side effects, forcing him/her to discontinue usage of them. The patients often are left worse than before they ever started the medication.
The ultimate decision about whether this antibiotic therapy is appropriate for you should be made with advice from your physician. Treatment must be tailored to the individual patient. While this therapy is effective for the vast majority of rheumatoid patients, it does not always work for everyone. If treatment failure occurs, then other misdiagnosed medical problems must be investigated carefully, always keeping in mind that one can have more than one disease process as well as more than one diagnosis going on in one's body at the same time.
For example, toxic root canal teeth and Lyme Disease (caused by a spirochete) are two of the most commonly overlooked problems which can lead to treatment failure because they require separate treatment programs. In fact, if either of these two diagnoses is so much as suspected of being even a remote possibility, then appropriate testing should be done before starting any long term antibiotic protocol in order to prevent unnecessary complications with this therapy. [Lyme Disease is now associated with over 300 medical conditions including ALS; Alzheimer's disease; Parkinson's disease; MS; almost any inflammatory or degenerative central, autonomic, and peripheral neurological disturbance; fibromyalgia; IBS; eye inflammation; rheumatoid arthritis; scleroderma; lupus, etc. Patients need to be aware that current guidelines for testing Lyme often result in false negatives. Researcher Joanne Whitaker, M.D. has developed a more accurate test for Lyme Disease called the Q-RIBb test which actually looks for the cell wall deficient form of Borrelia Burgdorferi, rather than relying on detection of antibodies. This test is available from Central Florida Research, Inc. They accept billing for Medicare and most major insurance companies. Check their website for more information. www.centralfloridaresearch.com. The phone number is 863-956-3538.]
2. WHAT ANTIBIOTICS ARE USED AND WHAT IS THE DOSAGE?
Typically, patients with severe and/or long-standing disease are started with a series of daily intravenous clindamycin for five to seven days. (See Section 11.) The first two days, 300 mg. of clindamycin would be administered in 250 cc 0.9% saline dripped over a 50 to 60 minute period. (D5W is not used because of the yeast overgrowth found in a large percentage of these patients.) The third and fourth day 600 mg. is given, the fifth and subsequent days 900 mg. Some physicians build up to 1200 mg.
After the initial daily intravenous series, IVs may be administered once weekly, once every other week or as the physician determines for the individual patient. The IVs are continued until all lab figures return to normal, which can often take longer than a year, sometimes several years for patients with severe and/or long-standing disease. Lab results should then be monitored for several months longer, to be sure that the patient remains stable, before discontinuing the IVs.
Various modifications to the late Dr. Brown's original antibiotic protocol regarding the use of IV clindamycin have been made by some physicians currently treating rheumatoid patients today. Some physicians have reported success using clindamycin orally, or in intramuscular injections. Orally, the single dose is 1200 mg. once a week. For intramuscular injections, 300 mg to 600 mg. once a week. For sensitive patients, a local anesthetic may be applied to the injection site. However, simply changing the needle tip, after drawing the medication into the syringe and before injecting it, will avoid the problem of tissue irritation at the injection site, because it is the trace amount of medication on the tip of the needle that causes the tissue irritation.
[A. Robert Franco, M.D., a rheumatologist in Riverside, California who has years of experience in using this therapy, often prescribes a seven day series of IV clindamycin every five weeks for four cycles and then reassesses the patient's needs. In some of his patients. Dr. Franco has substituted oral Zithromax (azithromycin) 250 mg. twice daily for two days each week (Tues. & Thurs.) in combination with oral Minocin (Mon., Wed., & Fri.).] When the initial course of IVs is completed, patients begin oral therapy - minocycline (Minocin) or doxycycline (Vibramycin/Doryx) 100 mg. once or twice daily, or tetracycline 250 mg. to 500 mg. twice daily Monday, Wednesday and Friday. This intermittent therapy (also referred to as pulsing) is effective for most patients. More is not necessarily better; however, in some cases, five or even seven-day a week doses may be necessary for a limited time. The use of higher doses tends to make it more difficult to keep the intestinal tract in balance. Patients with mild to moderate disease are started with this same oral therapy, but often without the initial week-long series of IV clindamycin at the beginning. Erythromycin can be substituted for those patients sensitive to the tetracyclines.
Tetracycline is more apt to react with food and must be taken on an empty stomach. Some patients may need to take doxycycline with food, especially at first until their body gets used to it, although doxycycline is better absorbed apart from meals. Taking 3 or 4 ounces of a pharmaceutical grade aloe vera liquid shortly after taking the antibiotic has been found beneficial for those with sensitive stomachs. Reliable brands of aloe vera would include:
Coats International, 9660 Dilworth Road, TX 75243 - www.coatsaloe.com Phone 1-800-486-ALOE - liquid
Allied Pharmacy - Arlington, TX - 1-800-428-6331 (organic aloe) - capsules
None of the antibiotics in the tetracycline family (tetracycline, doxycycline, minocycline) should be taken at the same time with calcium supplements, including dairy products, or with any other minerals such as magnesium, iron, etc. which have the same chemical valance as calcium. Ask your pharmacist for advice here because it is known that other minerals can also have similar inhibiting effects as calcium does on the absorption out of the GI tract of all antibiotics in the tetracycline family.
Caution: Be sure to drink a full glass of water and to remain sitting upright for at least 30-45 minutes whenever taking any antibiotic in the tetracycline family in order to prevent esophageal injury. For this reason, do not take this medication immediately before going to bed at night, but remain sitting up long enough to be sure the pill reaches the stomach and does not remain stuck in the esophagus, where it might dissolve and cause painful esophageal burning and scarring.
Some reported sensitivities to the tetracycline drugs may be caused by the drug being introduced too rapidly and at too high a dose. A slow start, 50 mg. Monday and Friday then gradually building up to the standard dose (100 mg. once or twice Monday, Wednesday and Friday), can often avoid this allergic reaction.
Caution: Some oral generic tetracyclines have been found to be ineffective for this therapy.
For children under twelve with inflammatory rheumatic disease, EryPed (erythromycin), is prescribed in place of the tetracycline drugs, to avoid staining of teeth. The dosage is one teaspoon (200 mg.) three times a day for 15 to 21 days; then 200 mg. two times a day thereafter, seven days a week - taken with food. The patient is kept on this medication for three to six months after labs return to normal. If labs are still normal after this time, tapering of the drug may begin.
Caution: Erythromycin and clindamycin should not be taken together, according to the Nursing Drug Handbook, because erythromycin may block access of clindamycin to its site of action.
Caution: Patients should always inform their physician of adverse reactions to any of their medications.
Exacerbation of systemic lupus erythematosis has been reported in patients taking minocycline, as has transient lupus-like symptoms. However, while some physicians report they have not had a problem at the low doses used in this protocol, other physicians avoid the risk by prescribing erythromycin for their lupus patients - 333 mg. twice a day Monday, Wednesday and Friday - taken with food. For those patients with sensitive stomachs, Ery-Tabs may be prescribed. [As mentioned previously, taking three or four ounces of a pharmaceutical grade aloe vera shortly after taking the antibiotic, has been found beneficial for those with sensitive stomachs. ]
Note: A suspected 'causal' association between mycoplasma hominus and lupus was shown in Cassell GH, Clough W, Septic Arthritis and Bacteremia Due to Mycoplasma Resistant to Antimicrobial Therapy in a Patient with Systemic Lupus Erythematosus, Clin Infec Dis, 1992; 15:402-407, and mycoplasma hominus is known to be resistant to erythromycin, therefore necessitating the use of an antibiotic in the tetracycline family, with Minocin being the most effective. What might be happening, instead, is that the so-called 'lupus flare' is really another example of a Herxheimer reaction which is occurring. Therefore, possibly by reducing the dosage and/or frequency of Minocin, and by monitoring the situation closely with frequent, repeated lab testing, these precautionary measures might be sufficient to resolve this potential problem concerning the use of Minocin in treating lupus patients, before the situation can get too far out of control.
ANTI-INFLAMMATORIES: Reducing the inflammatory barrier is essential to allow penetration of the antibiotic. NSAIDS as well as aspirin preparations (preferably enteric coated) are used for this purpose. These drugs and the dosage will need to be tailored to the individual. All of them must be used with caution as they can cause serious side effects. (www.rxlist.com) Other products known to reduce inflammation and safer than NSAIDS include:
1. Cod liver oil (Kirkland's or Carlson's - both mercury free) - suggested dosage is 1 TB twice a day with 400 IU of vitamin E.
3. Wobenzyme-N- two tablets on an empty stomach three times a day to start - increasing to five tablets three times per day. The anti-inflammatory action is lost if there is food in the stomach.
In highly sensitized individuals, antihistamines and small doses of corticosteroids (less than 5 mg. a day) are helpful. 'To reduce the inflammatory barrier and allow penetration of the antibiotics, 1 to 5 mg of prednisone may be administered to the patient simultaneously with the antibiotic. Preferably no more than 10 mg. should be administered for flares. Larger doses when required should be given in short interrupted courses. It is of interest that the concomitant use of antibiotics with the steroids makes steroid withdrawal easier. The dosage of the drug must be kept low to avoid interfering with the immune system but high enough to reduce the hypersensitivity or allergic inflammatory reactions of the disease.' Dr. Thomas McPherson Brown in Antibiotic Treatment Plan.
INJECTING THE JOINT Thomas McPherson Brown, M.D. et al in Antimycoplasma Approach to the Mechanism and the Control of Rheumatoid Disease from Inflammatory Diseases and Copper, The Humana Press 1982 states: 'Intraarticular injections of clindamycin have been very effective when the reactive state of the joint is so intense that penetrance (of the antibiotic) is not achieved by the oral or IV route. The inflammation must be reduced in most instances for maximum clindamycin effect. The usual treatment plan for large joints, clindamycin 300 mg, plus dexamethasone 4 mg. A reduced amount of the same combination of these medications is used for smaller joints.'
3. IS THERE AN ADVANTAGE TO USING MINOCYCLINE (MINOCIN) OVER THE OTHER ANTIBIOTICS?
Yes, bacterial cell membranes are surrounded by a lipid layer (a water insoluble, fatty substance which surrounds the cell and provides it with fuel. As a means of resisting antibiotics, the cells increase the thickness of this lipid layer. Minocycline appears to have greater penetrating ability. It also has an extended spectrum of activity and stays in the system longer and at higher levels than tetracycline. HOWEVER, there are patients who have had excellent response using doxycycline and tetracycline.
4. ARE THERE ANY SIDE EFFECTS FROM USING ANTIBIOTICS?
The tetracycline antibiotics taken in low dose, intermittent fashion, can be used indefinitely without the build-up of tolerance to the drug and without the serious side effects of conventional drugs. However, as with all medications, side effects may be encountered. There have been some reports of dizziness when starting the Minocin that may be due to starting at too high a dose. This usually abates with time; however, it should be reported to your physician. Temporarily reducing the dosage of the Minocin may eliminate the dizziness.
The antibiotics can cause yeast infections, as do NSAIDS, steroids, methotrexate and the other drugs prescribed for these diseases. These drugs kill off the necessary good bacteria in the intestinal tract. Before starting this therapy, patients should be tested for candida immune-complexes, and if found, appropriate treatment should be prescribed. Conventional therapy would include anti-fungals such as Nystatin or Diflucan. Natural therapies would include diet, olive leaf extract along with slippery elm, L glutamine, and grapefruit seed extract. [See Section 13 for list of laboratories testing for candida immune-complexes.]
Reliable brands of olive leaf extract would include:
Seagate Products - www.seagateproducts.com - 1-888-505-4283
East Park Research - www.lef.org (distributor) - 1-800-544-4440
It is extremely important that patients take a good probiotic while on this therapy in sufficient quantity to replace the good bacteria destroyed by these drugs. Effective products include -
Natren's Healthy Trinity - www.natren.com or 1-866-462-8736
Metagenics Ultra Flora Plus - NEEDS - 1-800-634-1380
Culturelle by Klaire - www.needs.com Grainfields (www.grainfields.ca or www.agmfoods.com)
Diarrhea is listed as a side effect, especially with the clindamycin, but this has not been encountered at the dosage used in this therapy. Some patients' stomachs have become sensitized from medications prior to starting this therapy and may experience nausea. Taking the drug with food (no dairy products) may help. It has also been found helpful to start with a reduced dosage - 50 mg. once or twice a week for up to several months, gradually increasing to the recommended dose. Taking three or four ounces of a pharmaceutical grade aloe vera shortly after taking the antibiotic may be helpful for the nausea.
It is recommended that patients avoid direct sunlight while on these antibiotics.
5. WHAT IS HYPERPIGMENTATION?
Minocycline can cause discoloration of the skin anywhere on the body. This is called hyperpigmentation. Large daily doses of ascorbic acid (vitamin C) may prevent this phenomenon. (Bowles WH, Baylor College of Dentistry, Texas A&M University System Protection against minocycline pigment formation by ascorbic acid, J Esthet Dent, 10(4):182-6 1998)
Dr. A. Robert Franco, a rheumatologist practicing in Riverside, California, says that hyperpigmentation occurs in about 10% to 20% of patients taking minocycline (Minocin) on a daily basis and over one year. Occasionally it may appear earlier. It occurs less frequently with patients taking Minocin on a three times per week basis. It may be necessary to switch to another antibiotic. It is usually reversible after discontinuation of the medication, but fades slowly and sometimes not completely.
Dr. Pnina Langevitz in Israel has done three double-blind studies on the use of minocycline in rheumatoid arthritis with some patients on the medication over 5 years. The following is from Langevitz et al - Minocycline in Rheumatoid Arthritis; Isr. J. Med Sci 1996;32:327-330. 'We also observed skin hyperpigmentation in about one third of our patients as a late complication of the therapy. Minocycline related hyperpigmentation of the skin is a well known complication of this agent and can be subdivided into three categories. The first is characterized by dark black-blue macules localized at sites of cutaneous inflammation. . . . . . . . . . . The second type is a more diffuse hyperpigmentation, predominantly on the lower extremeties and on areas exposed to sunlight. . . . . . . . The third form of minocycline-induced hyperpigmentation is the 'muddy skin syndrome' Ð a dark brown-gray discoloration of the skin generalized over the body, less prominent in non exposed areas. The high incidence of skin hyperpigmentation in our group of patients is probably due to the longer follow-up period than that in other groups, and to sun exposure.' (Patients in this study were on 100 mg. of minocycline twice daily.)
6. WHAT CAN I EXPECT WHEN STARTING ANTIBIOTICS?
The return to health will normally be a slow, subtle process. In many cases, when treatment begins, the patient will temporarily experience a worsening of symptoms that can also cause a temporary increase in laboratory values. This is called the Jarisch-Herxheimer reaction. (See Section 7.) Flares will occur during the course of therapy, but over time, these flares will decrease in intensity and be spaced further apart until the infectious agent has been weakened to the point where the patient's immune system can take control. Patients have reported improvement of their symptoms, including depression, fatigue, memory, stiff and painful joints, muscle tone and strength, range of motion, dry, cracked or tight skin, bursitis, tendonitis, vaculitis due to inflammation, skin ulcers, swallowing difficulties and heartburn. Patients with RaynaudÕs symptoms have also experienced improvement.
The return to health will normally be a slow, subtle process. In most cases, when treatment begins, the patient will experience a temporary worsening of symptoms. This is called a Jarisch Herxheimer reaction. (See Section 7.) Laboratory results may also worsen temporarily. Flares will occur.
7. EXPLAIN THE JARISCH HERXHEIMER REACTION.
This drug-induced flare reaction may occur within hours, the next day or within the first weeks after the patient starts the antibiotics - or any time there is a change in antibiotic or dosage. It is caused by a die-off of organisms, which in turn create toxins that circulate in the body. This will often cause a temporary worsening of symptoms. Patients may experience a range of symptoms from mild fatigue and sleepiness to flu-like symptoms - chills, low grade fever, night sweats, muscle aches, aching and swollen joints, nausea, hives, skin rashes, depression and short term memory loss. Hives and rash are sometimes mistaken for an allergic reaction.
If the Herxheimer reaction is severe, the medication may be stopped and a small dose of prednisone (no more than 10 mg.) may be prescribed. When the flare subsides, the medication is re-introduced at a slow rate.
When this Herxheimer reaction occurs, it is a good indicator that the antibiotic is reaching its target - a very positive sign. The length of time for this reaction varies from patient to patient. About twenty percent of patients do not experience the Herxheimer reaction. Scleroderma patients seem to experience the Herxheimer reaction less often than RA patients.
Oxidative therapy may be useful in reducing these symptoms. Garth Nicholson, M.D., director of The Institute for Molecular Medicine in Huntington Beach, California recommends peroxide baths (four 16 oz. bottles of 3% hydrogen peroxide in 20 inch bath or Jacuzzi, with 2 cups of Epsom salt. Patients soak in hot water plus the Epsom salt for five minutes until pores are open, then add the peroxide solution. This should be repeated three times a week at bedtime. No vitamins should be taken 8 hours before bath. The peroxide can also be directly applied to the skin after a hot shower/tub. The peroxide should be left on for 5 minutes and then washed off.
Another useful suggestion from Dr. Nicholson - blend one whole lemon, then add 1 cup fruit juice or water and 1 tablespoon of olive oil. Strain and drink liquid.
Far-infrared saunas have also been found helpful in removing toxins from the body. Instructions for building an inexpensive far-infrared sauna can be found at www.mercola.com or www.drlwilson.com.
It is very important to drink adequate amounts of water to flush the toxins from the body - no less than two quarts a day. Water not only flushes the toxins out of the system, but lubricates the joints and carries nutrients to the cells. You also need to make sure you have two to three good size bowel movements daily. Should constipation be a problem, try taking a rounded teaspoon of pysillium (Metamucil or a generic) in 8 ounces of water, one to three times daily. Drinking warm prune juice on first arising in the morning is also helpful. If necessary, you may also add powdered vitamin C (to tolerance) to the prune juice.
Note: Scleroderma patients may have intestinal problems that involve lack of motility in the colon. If they need a fiber supplement for stool irregularities, they might do better with a product like Citrucel (methylcellulose). They should avoid products with the active ingredient pysillium.
8. IS DIET IMPORTANT?
What you eat and how well your body metabolizes that food is very important in keeping the immune system strong to fight disease. Basically, you need to increase vegetable intake such as broccoli, cabbage, beets, spinach, celery, cauliflower, brussel sprouts, carrots, swiss chard, kale, romaine lettuce, etc. -50% raw and preferably organic. Avoid fast foods, fried foods, sugar in all forms, soda pop (diet or regular), prepackaged foods, preservatives, artificial ingredients, white flour, white rice, etc.
Suggested reading on nutrition is listed at the end of this article.
Chronic disease patients (as well as the elderly) are usually found to be low in digestive enzymes and hydrochloric acid Ð both necessary for proper digestion of food. Supplementation is recommended along with a good multi-vitamin/mineral and essential fatty acids.
9. HOW LONG DOES IT TAKE BEFORE I START SEEING IMPROVEMENT?
The length of time a patient has had the disease and the strength of their immune system will determine the recovery time frame. Some patients see significant benefits in months, but for others it may take several years. Dr. Pnina Langevitz of Israel reported that the longer patients stayed on the antibiotics the greater improvement they experienced. Patients can safely remain on these antibiotics for years without building up resistance to them.
Enhancing the immune system through diet and supplements, drinking sufficient filtered water and proper daily elimination is vitally important not only to the process of achieving remission but also to maintain a remission.
10. CAN I EXPECT TO BE ABLE TO DISCONTINUE MEDICATION EVENTUALLY?
Some patients may find this treatment provides a permanent remission and no further medication is needed, but most will need to stay on a maintenance dose to keep the disease under control. If symptoms should return at any time a short course of 100 mg. of minocycline or doxycycline, or 500 mg to 1,000 mg. of tetracycline three times a day for three days will usually re-establish the remission for an indefinite period. For some patients a return to normal lab figures occurs before they reach a symptom free remission. For others the reverse is true - the symptoms leave first and then the lab figures return to normal.
11. WHY ARE THE IVs NECESSARY IN SEVERE OR LONG STANDING DISEASE?
In severe or long standing disease, or in very resistant cases, the oral route may be inadequate for the antibiotic to reach its target and suppress antigen formation. The intravenous clindamycin would then be required. The IV clindamycin jump-starts the therapy, eradicating long-standing microorganisms in the gut, respiratory tract and other areas, creating greater receptivity for the tetracycline drug.
IV clindamycin therapy is recommended in the treatment of all scleroderma patients from mild to severe. When lab figures return to normal, these patients may still require occasional IVs or a weekly dose of oral clindamycin to remain stable.
12. WHAT LAB TESTS SHOULD BE DONE TO MONITOR MY PROGRESS?
Laboratory tests are done to help in the diagnosis of the disease and to provide a baseline from which to measure progress after antibiotic therapy has begun. These include a complete blood count (CBC), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), antinuclear antibody (ANA), antistreptolysin-O titer (ASO), and mycoplasma complement fixation (MCF). These tests can be repeated at your doctorÕs discretion to follow your progress.
Testing for strep before starting this therapy is extremely important. According to Dr. Brown and others, running the ASO titer can produce a 'false negative.' In such cases, either the Anti-DNAse B (strep) test, also called the 'ADB' test, and/or the Streptozyme test would be better. All strep tests can yield false negative results, so the combination of both the ADB and the Streptozyme test may be necessary in certain patients. The reason for this is that the ASO test measures just one streptococcal enzyme, whereas the other strep tests measure several different streptococcal enzymes, thereby increasing the chances of detecting patients who are 'carriers' of strep. When active streptococcus is present, even at low levels, it must be treated.
If a patient had a history of strep, Dr. Brown would prescribe amoxicillin or ampicillin even in the absence of a positive titer. According to published research oral clindamycin is superior to either penicillin or other antibiotics because clindamycin best inhibits the 'encapsulated' form of streptococcus.
13. I HAVE BEEN ON 100 MG. OF MINOCYCLINE MONDAY, WEDNESDAY AND FRIDAY FOR SIX MONTHS AND HAVE SEEN NO RESPONSE. CAN I STILL EXPECT IMPROVEMENT?
Yes, however you should have some indication by this time that the antibiotic is working for you. Your doctor needs to do a little detective work at this point. Here are some things to check:
a. Laboratory tests should be run again. Often improvement in these tests will precede improvement of symptoms.
b. If you are on a generic minocycline, change manufacturers or switch to the brand name. Patients have discovered that not all generic minocycline or doxycycline is equivalent. Many physicians prescribe the brand name to avoid this risk.
c. Try a different antibiotic. All patients may not respond to minocycline or doxycline. Some physicians add Zithromax. If you are taking the minocycline Monday, Wednesday and Friday, the dose for the Zithromax is 250 mg. twice daily Tuesday and Thursday.
(Adding an anti-fungal may be necessary. There have been reports of success using the combination Minocin, Flagyl and Nystatin. The liver should be monitored closely when using anti-fungals.)
d. Try one antibiotic in the morning and a different one at night, or sequence them taking one for six weeks and then switching to another for six weeks.
e. If your disease is severe, long standing or very resistant, and you are only on oral antibiotics, you will need to add intravenous therapy.
f. Look for other sources of infection in the sinuses, allergies, root canals (www.altcorp.com), intestinal tract, etc. that may be impeding your progress and must be addressed for optimum benefit from this therapy. The first area to check is the intestinal tract for candida overgrowth and leaky gut. There are special labs that perform these tests:
Immuno-Science Lab in Beverly Hills, CA - candida
www.immuno-sci-lab.com or 1-800-950-4686
AAL Reference Laboratories, Inc. in Santa Ana, CA - candida
www.antibodyassay.com or 1-800-522-2611
Genova Diagnostics, Ashville, NC - candida and the lactulose mannitol test for leaky gut
www.gdx.net - 1-800-522-47
g. Were you tested for strep? If the results were positive, treatment should be prescribed. (See Section 12.) The strep organism can be very difficult to eradicate, so even after the titer returns to normal, the patient should be monitored for some time for recurrence. The goal of the therapy is to remove antigen wherever it may be found in the body in order to achieve optimum benefit from this therapy.
h. Are you deficient in antibody? Perhaps intravenous immunoglobulin is necessary.
i. Did your doctor have the mycoplasma test run? It should be run for the entire panel and not just for M. pneumoniae. The first test may be negative if the immune system is too weak to mount an antibody attack to the organism. Therefore, it is important to repeat the test within 3 to 6 months. If it is still negative, the medication should be changed. The tetracycline antibiotic still works in some instances of a negative reading. If the cause is viral the antibiotic therapy may fail. Additionally, the cause could be streptococcus infection compounded with a mycoplasma infection or vice versa.
Laboratories performing this special mycoplasma testing are listed on this web site in the section titled 'Information for You and Your Doctor'.
j. Are there hormonal imbalances that need correcting?
k. Chronic neurotoxins may be another reason for lack of response to this therapy. These toxins are low molecular weight, fat soluble toxins, sequestered in the adipose tissues of the body. Rather than being eliminated normally, they are reabsorbed and continue to be accumulated and circulated in the body. They impact the nervous system, the endocrine system and the immune system. (Patients report improvement in brain fog and ability to concentrate when these toxins are removed.) There is a vision test available on the net that can be taken to determine if neurotoxins are present. For more information visit Dr. Ritchie Shoemaker's site - www.chronicneurotoxins.com. Dr. Shoemaker has written a book on this subject titled 'Desperation Medicine'. [Note: Not all neurotoxins respond to the therapy developed by Dr. Shoemaker. Neurotoxins unresponsive to Dr. Shoemaker's protocol may be helped by the protocol of Dr. Patricia Kane. www.detoxxbook.com or www.bodybio.com
l. David E. Berg, director of Hemex Laboratories in Phoenix, AZ has discovered that a number of infections, including mycoplasmas, can trigger the blood clotting system to become active, preventing oxygen and antibiotics from reaching and destroying the pathogen. This is called hypercoagulation. The Hemex Lab ISAC panel can be run to determine if this is a problem. If this test is positive, appropriate blood thinning agents may be prescribed. For more information go to www.hemex.com or call 1-800-999-2568. Check with your physician for non-prescription agents that may be appropriate.
m. Consider testing for Lyme Disease which mimics so many rheumatic diseases. Refer to Sections 1 and 18 for more information on Lyme Disease.
If a patient has been experiencing improvement on this therapy and then notices that progress has stopped or he/she even seems to be regressing, the information in this section will aid their doctor in determining what is impeding that progress.
14. MY DOCTOR HAS TOLD ME TO STOP THE MINOCYCLINE (MINOCIN) BECAUSE OF A LOW WHITE BLOOD COUNT.
White blood cells are used to fight infection. A low white blood cell count is clinically called leukopenia. This occurs when there is a reduction in the normal number of circulating white blood cells in the blood stream. This condition involves the blood and the bone marrow. Patients may demonstrate a low white cell count before commencing the antibiotics. This can be due to the nature of their illness, or previous therapy such as methotrexate that causes suppression of white blood cells, platelets and red blood cells. This is caused by increased destruction or impaired production of these cells. Poor quality protein intake or digestion (impaired pancreatic enzyme or HCI production), inadequate trace mineral or essential fatty acid intake are other causes.
A blood test called the Carbon test is enormously helpful at determining the cause of the decreased WBC. The company Body Bio (888-320-8338) can provide a clinician that can perform the test in your area.
A doctor may be cautious and suggest that you cease the minocycline therapy. This is to check that this is not the trigger of the leukopenia. If the white count returns to normal then one can resume the minocycline and observe if the WBC count decreases again. If it decreases again it probably is not wise to continue with the Minocin.
The minocycline assists the body in clearing the infection and once the infectious trigger which stimulates the increased production of white blood cells is gone, the WBC will drop to its normal non-infectious level.
15. MY DOCTOR HAS ME ON METHOTREXATE. DO I STAY ON THIS MEDICATION ALONG WITH THE ANTIBIOTICS?
Physicians should be cautious about possible antagonism between drugs, which could cause severe side effects. Response to antibiotic therapy depends to a large degree on the strength of the immune system. Methotrexate is a toxic, immune-suppressing drug, and physicians most experienced in the use of this therapy take patients off the drug. Ideally, a six week wash out period is recommended between stopping the methotrexate and starting the antibiotic therapy.
However, if you are receiving benefit from the methotrexate, your physician may be reluctant to discontinue it. The antibiotic therapy can be started and then eventually gradually the patient is tapered off the drug. If you are receiving no benefit from the methotrexate, it should be discontinued.
16. IS THERE AN EXPLANATION FOR THE SHORT TERM MEMORY LOSS AND PERIODS OF DEPRESSION EXPERIENCED WITH THESE DISEASES?
Both short term memory loss and depression are components of the disease process itself. As the long term antibiotic treatment of the basic problem progresses, the depression lifts and the short term memory improves.
17. ARE THERE ANY OTHER THERAPIES THAT WOULD BE BENEFICIAL IN ADDITION TO THE ANTIBIOTICS?
Parasite, colon, and liver/gallbladder cleanses are not only recommended, but at times necessary to achieve optimum results from this therapy. Some patients may need to be tested for metal toxicity.
18. DOES THIS TREATMENT WORK FOR FIBROMYALGIA?
Mixed infection is not uncommon to some of these long term chronic diseases.
A. Robert Franco, M.D., rheumatologist and director of The Arthritis Center of Riverside, California, and Garth Nicholson, M.D. of the Institute of Molecular Medicine at Huntington Beach, CA., are finding strong evidence of mycoplasmal blood infections in a majority of their fibromyalgia patients. Other chronic infections may also be a source. They recommend long-term antibiotic therapy. www.thearthritiscenter.com/publications.htm and www.immed.org/illness/fatigue_illness_research.html
Eli Mordechai, PhD at Medical Diagnostic Lab in Mt. Laurel, NJ now believes the Lyme disease spirochete is the real culprit in most fibromyalgia patients because while their lab finds that Lyme disease patients often test positive for mycoplasma infections, the mycoplasma is most likely just a secondary, opportunistic infection in a patient suffering from 'late Lyme' disease. ('Late Lyme' is chronic Lyme disease which was not caught early and which has progressed to the late stage.)
Likewise, Dr. Lida Mattman, PhD, professor emeritus from Wayne State University in Detroit, MI., and author of the medical microbiology textbook entitled 'Cell Wall Deficient Forms: Stealth Pathogens', has reported finding the Lyme disease spirochete, Borrelia burgdorferi in 40% of the fibromyalgia patients she tested. Dr. Mattman stated that if streptococcus is present, it must be treated first before the Lyme is treated because Borrelia feeds on strep. In other words, the strep stimulates the growth of Borrelia. Furthermore, it is impossible to culture Borrelia whenever strep is present because strep is a faster growing bacterium and it will overgrow the culture medium as a 'contaminate', obscuring the presence of Borrelia.
It is important to use a lab that specializes in the diagnosis of Lyme disease. Lyme disease specialists recommend both Igenex Lab in Palo Alto, CA., www.igenex.comand Medical Diagnostic Lab in Mt. Laurel NJ., www.mdllab.com. However, patients should be aware that current guidelines used by these labs for testing for Lyme may produce false negatives. The testing done by Central Florida Research (mentioned in Section 1) should eliminate that possibility - centralfloridaresearch.com. The following websites are helpful:
www.ilads.org
www.igenex.com
www.mdllab.com
More information on Lyme Disease can be found at www.ilads.orf. There is also a discussion group for Lyme patients located at www.lymenet.org. The patients in this on-line group can help you find an experienced Lyme specialist who has a good track record in diagnosing and treating Lyme disease successfully. It is very important to select a Lyme specialist who is highly recommended by other Lyme patients, even if you must travel a great distance to do so. Lyme disease can cause a 'lupus-like' disease pattern as well as a 'multiple sclerosis-like' disease picture, in addition to triggering symptoms of fibromyalgia pain.
Another frequently overlooked cause of fibromyalgia pain is toxic root canals. The best website for information is www.altcorp.com, and it has links to other similar websites for information on dealing with toxic root canals. A good book on this topic is 'Root Canal Cover-Up Exposed!' by George Meinig, DDS. Dr. Meinig was the father of endodentistry earlier in the 20th century but now warns against the dangers of toxic root canal teeth. Dr. Jacob Teitelbaum's book 'From Fatigue to Fantastic' is an excellent resource for fibromyalgia patients. His web page is at www.endfatigue.com
19. GENERAL INFORMATION
a)From the Physicians' Desk Reference:
"Concurrent use of tetracycline may render oral contraceptives less effective."
"Minocin pellet-filled capsules, like other tetracycline-class antibiotics, can cause fetal harm when administered to a pregnant woman. . . . The use of drugs of the tetracycline class during tooth development (last half of pregnancy, infancy, and childhood to the age of 8 years) may cause permanent discoloration of the teeth (yellow-gray-brown)."
b) List of supplies need for intravenous infusion.
900 mg. vials of Cleocin or clindamycin
250cc 0.9%NS or lactated ringers. D5W should not be used because of the candida overgrowth found in these patients.
10cc syringe with 21 gauge needle to draw up medication and insert in delivery solution.
IV tubing set
IV needle or catheter (recommend 23gauge butterfly). Always ask for extras.
Tourniquet, antiseptic pads, bandaids, and tape (paper, silk, or adhesive). Sometimes these are available as an "IV start kit".
c) Before starting this therapy, ideally patients with these diseases should be checked for Ð
1 - yeast overgrowth in the intestinal tract,
2 - possible low levels of DHEA and testosterone
3 - insufficient essential fatty acids, and
4 - insufficient betaine hydrochloride and pepsin necessary for digestion
Revised April 2007
Our thanks to Dr. M. R. Coker-Vann, Ph.D.
Director, Arthritis Research Center
504 E. Diamond Ave.
Gathersburg, MD 20877
Phone: 301-216-1231
for her assistance in compiling the answers to the above questions. Dr. Coker-Vann was research director of Dr. Thomas McPherson Brown's Arthritis Institute at the time of his death in 1989.
Recommended reading:
The New Arthritis Breakthrough by Henry Scammell - Our book page
Scleroderma: The Proven Therapy that can Save Your Life by Henry Scammell - Our book page
Rheumatoid Arthritis, The Infection Connection by K. M. Poehlmann, PhD. - www.ra-infection-connection.com
Desperation Medicine by Ritchie Shoemaker, M.D. - www.chronicneurotoxins.com
Detoxify or Die by Sherry A. Rogers, M.D. - www.needs.com
The Maker's Diet by Jordan Rubin - www.makers-diet.net
Dr. Mercola's Total Health and Cookbook Program - Joseph Mercola, D.O. - www.mercola.com
All references to products are included solely for the convenience of the reader.
* IMPORTANT MESSAGE from A. Robert Franco, MD, Arthritis Center of Riverside, Riverside, California.
Dear Patients,
I often find that patients that come to see me for diagnosis and treatment for rheumatic diseases have already started on antibiotic treatment. Although this may be helpful to the patient, it would be best when applicable to have the appropriate work-up PRIOR to starting antibiotic treatment. I am referring especially to the mycoplasma and Chlamydia PCR test (generic fingerprint).
Antibiotics may render this test negative and thereby often making useless this great diagnostic tool, especially in view of the fact that patients will be obligated to use antibiotics for several years exposing themselves to some potential toxic side effects. If you have already started antibiotics, you should continue and consider going off for 4 weeks prior to your visit to the Arthritis Center of Riverside, or your physician's office where these tests may be done.
If it is possible to do the above, you will increase your chances of confirming the infectious cause of your rheumatic disease. Even more so by doing the test prior to initiating antibiotic treatment. Additionally, your insurance company will be more likely to authorize and pay for IV treatment if you have a positive mycoplasma PCR test.
I hope this information proves useful to you.
Sincerely, A. Robert Franco, MD