RE: where can i find the FAQs ?

[Guest guest]

Hi there, can somebody point me to the FAQs. I'm obviously looking in the

wrong place.

thanks...

~Leonie

www.rheumatic.org/faq.htm

[Guest guest]

Leonie, hope this helps:

Eva

FREQUENTLY ASKED QUESTIONS ABOUT ANTIBIOTIC THERAPY

also in Spanish (courtesy Lucy Riebling)

and in German (courtesy Achim Görner)

and in Portuguese (courtesy Gualter Verissimo)

and in Korean (courtesy Yoon Jae Ho) 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. 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.centralfloridar esearch.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. 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, Garland, TX - www.coatsaloe. com Ð 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 hav! e been f ound 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. McPherson Brown in Antibiotic Treatmen! t Plan.

INJECTING THE JOINT 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.comGrainfields (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 gra! de 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. 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. 6. 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.chronicneurotox ins.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. Kane.

www.detoxxbook. com or www.bodybio. com l. 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.hemes.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. 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.thearthritiscen ter.com/publicat ions.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 th! e diagno sis 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 -

centralfloridaresea rch.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

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. 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). " 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. 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 Ð Ritchie Shoemaker, M.D. - www.chronicneurotox ins.com

Detoxify or Die by Sherry A. , M.D. - www.needs.com

The Maker's Diet by Jordan Rubin - www.makers-diet. net

Dr. Mercola's Total Health and Cookbook Program - ph Mercola, D.O. -

www.mercola. com

All references to products are included solely for the convenience of the

reader. * IMPORTANT MESSAGE from A. 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. Franco, MD

---------------------------------

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> Leonie, hope this helps:

> Eva

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> Hi Eva, thanks for this...