Importance of Ramping up (Escalating) and Cooling down (Tapering) in Treating GDD.... and everything else in life. Critical for individuals with multiple GBCA injections and GDD.

Intuitively we understand this in exercise, you start with warming up and when you are finishing you cool down. Also it is clearly understood with a number of drugs that tapering is critical to avoid severe reactions, including seizures and death. Tapering is well understood in steroid use, benzodiazepines, narcotic drugs, ETOH. Likely though, to a greater or lesser extent this is true of all drugs, and probably by extension everything else in life.

The principle is quite simple and obvious, the greater the effect something has on the body, the greater the reaction will be to taking it in, and stopping taking it. Both directions the process must be slow, because the body likes homeostasis, and too rapid flux of anything (like serum sodium) can cause rapid collapse of everything in the body.

Everything in moderate. The Goldilocks principle. Slow and steady wins the race. Many of these observations are likely ancient, maybe many thousands of years old - because they are based on human (or animal) observation.

With experience, I have learned this ancient wisdom for treating GDD, especially those who have had multiple GBCA injections.

On the surface one may think, these individuals have a lot of Gd in them and the Gd is making them sick, let us get it out as much as possible to get them healthy again. But this is the wrong thing to do.

Why?

Because of a few factors, their body has acclimatized too, even if it a horrible climate, to contending with a lot of Gd imbedded in the tissues. Since chelation will remove a lot of Gd (because there is so much there) there will suddenly be an enormous flux of Gd out of tissues and Gd into the vascular system. Both of which are a shock to the system. This can result in a Gd Removal Flare of astronomic severity// and/or a re-equilibration Flare of astronomical severity. The re-equilibration Flare in individuals with multiple GBCA injections may start becoming severe at 10 days post chelation, rather than the standard 21 days post chelation.

So it is imperative to escalate up the amount of chelation, and start out with at least full dose chelator, combined with full taper of steroids and antihistamines. Note that I have always written about the tapering of steroids. In some individuals one may not get to full dose till 20 or more chelations are performed.

As treatment goes along the amount of chelator should go up to standard dose (but not exceed it) while decreasing the amount of steroids.

Over recent months, I have considered the back-end of chelation: shouldn't the amount of chelator start tapering down, as one plans to stop chelation? Yes this should happen, but I have presently come to the conclusion that this cool down is already happening.. Individuals should stop chelating when the amount of Gd left in their bodies is at a manageable level that they are not significantly sick from it. As more chelations are done, there is less Gd left in the body, so this cool down phase is naturally occuring

In general, the less amount of Gd in your body, the shorter the period of escalating chelation. However in those with especially severe sensitivity to Gd, they too may need a longer escalation phase, because even small amounts of Gd movement may cause severe Flare. In general though for many who have had few GBCA injections only the first chelation serves as the escalation phase. But there is nuance to everything..... water polo looks like it should be really easy, swimming around and throwing a ball in a GD net. But to do anything well takes skill and experience and nuance. And I would argue this is probably more important for you when it refers to your life or death, than a sport you like to watch.

So, I return to the principles I have frequently emphasized and are the mainstay of chelation.... and everything else in life. Careful wisdom thought. The Goldilocks principle of the middle path.

Richard Semelka, MD