About to get a GBCA injection and nervous? Wisdom sense things to do.

I have addressed this subject before, but worth repeating, with slight modernizing modifications.

1. reasonably well hydrated before and after - do not drink too much to make you sick. Well hydrated in moderation.

2. pay attention to symptoms of GDD.

3. No intense exercise 2 days before to 3 days after GBCA injection. Preferably 1 week, both directions.

4. Mild walking exercise in the sunshine with sweating after GBCA injection is good.

5. No surgery within 3 weeks if avoidable, is wise.

6. Caution getting GBCA injection when your immune system is currently assaulted: high potency antibiotic use, severe infection,long Haul states. When hell calls forth another.

7. In general, stay calm. GDD and AHR to Gd are both relatively uncommon. Cytokine release from stress, creates a physiological milieu to develop a contrast reaction, since these are similar cytokine releases.

8. This only applies to individuals who develop severe acute hypersensitivity reaction (AHR) to the GBCA injection. I have not done very early chelation, but it makes maybe the most empiric sense. It takes probably two weeks for the immune system to develop an active strong surveillance for Gd. If you have a severe acute hypersensitivity reaction, in addition to steroids and antihistamines, chelation with Ca-DTPA within 2 days makes sense. I would do this approach right away when AHR has developed (this may be right after the MR study) and repeat the same 1 day after. That may be sufficient to avoid severe AHR morphing into GDD, as a number of AHR individuals do experience AHR transitioning into GDD. Strong immune reaction (this from vaccine data) takes about 2 weeks to develop, so early on, especially within 2 days of GBCA injection, Ca-DTPA chelation with steroid and antihistamine (the latter 2 the standard AHR treatment) should not result in severe Gd removal Flare. This Flare is maximal between 2 weeks to 3 months post GBCA injection, and generally I still prefer to avoid chelation during that window... but in select cases will chelate at 2 months.

Richard Semelka, MD