iv DTPA chelation in those who received >10 GBCA injections. Nuanced strategy.

Individuals who have received a large number of GBCA injections.. there are some who received 50 or more. They are in a special situation of having a lot of Gd retained in their body, the bulk of which has to be removed for them to get their lives back to at least 80% of what they were at; while at the same time standard chelation may remove nearly as much Gd, that the body sees it almost like another GBCA injection.... I may have to repeat, this is not 'stirring the Gd up in your body' if a lot of Gd is coming out in the urine- this is Gd being removed. Some people may have consistently > 200 mcg/24 hr post chelation, if they have had in the range of 50 GBCA injection. This is a good thing, if they can tolerate it, moist can't. Below is a nuanced description of what to do:

If you are receiving full dose Ca-DTPA day 1, full dose Zn DTPA day 2, and doing this weekly, because you have received something like 50 GBCA injections you are effectively mobilizing in your body a full GBCA injection each time. Fine if a person can handle it, because now the direction of the GBCA is out through the kidneys, but you may be then in a constant state of Gd removal Flare days 1-4, then combined with Gd re-equilibration Flare days 5-7.

I think with the amount of Gd you had in you, for a period of time if you can tolerate it, then that is fine because you are removing a lot of Gd. But now it seems to me it is too much and you need to back off.

You should start with just 1 of the DTPAs as a single dose every 2 weeks... it may even have to be 1/2 dose. You could alternate to see also how your body does with Zn or Ca.. so two times just Zn-DTPA every 2 weeks, then 2 times Ca-DTPA. This may even need to be stretched to every 3 weeks - but it depends how severe the re-equilibration, late onset, Flare is.

I know you are on other immune dampening drugs, but I am not sure if you have also been taking methylprednisolone. This may need to be added in , at least on the days of chelation.

I do not know how to interpret serum (s) Gd on its own. TIme of sampling is highly critical, in that it must be standardized to make any sense. Such as very time sampled 1 hour after chelation. The time curve of serum Gd has never been established post chelation, it is likely a long logarithmic decline. Although this tells you how much Gd you have remobilized into the circulation, it does not tell you how much is coming out. That is why I like the 24 hr urine pre- and post-chelation. Now pairing sGd with urine would give you combined information on how much is mobilized in the blood and then how much is excreted... But that would be fascinating as a research study.. I prefer to just know how much is coming out.

At some point. I may want to try on myself if I was in your situation, HOPO, butI would want to be more stabilized before trying this, with the above iv DTPA strategy.  This for convenience and cost.

Final note, going cold turkey with the amount of Gd in you would be a re-equilibration nightmare.

Many people eliminating Gd in too massive an amount feel like they are going to die... but they don't. Through the course of removing massive amounts of Gd probably in the end will have been a good thing... simply because you have so much Gd in you... that needs to come out. Right now, back off in the amount of chelator you are using, as I describe above. Probably the concept of tapering at the projected end of chelation also would make sense, to avoid too massive re-equilibration Flare. For the present,,: 1. do not go cold turkey, but 2. use lower amounts of chelator to maintain Gd removal and 3. to avoid eliciting too massive Flare reactions. This is a very nuanced approach.

Richard Semelka, MD