When will all the 'experts' agree that Gadolinium Deposition Disease exists, and separately that DTPA chelation is an optimal treatment. Short answer: Never.

Aristotle is attributed as saying that opinion lies in the vast wasteland between ignorance and knowledge. What has stimulated my interest in writing this blog now is information/ observations from various sources. On a recent Erin Burnett broadcast she reported a recent survey amongst Americans that 10% of the public believe the world is flat. I recently perused an article contesting that Contrast Media (Iodine contrast used in Ct induced acute kidney injury (CM- AKI) does not exist at all (I thought it was settled several years back with an article described CM-AKI as the 4th most common cause of kidney failure), now some fellers write it doesn't exist. This denial then correction on CM-AKI existence is a repeated theme over the years. Just to let you know briefly my opinion: CM-AKI is real, it is most serious in the group with eGFR 30-60, and the highest risk group is when the renal dysfunction is due to a sudden shock to the entire body system (major trauma, other cause for renal injury such as chemotherapy or antibiotics). So that is the opininion that moist approximates fact.

I think one of the most useful observations for dealing with denials of the obvious, is verbalized at the beginning of the last episode of the third season of the White Lotus, where the chief Buddhist monk is preaching about ' the search for resolution'. The bottom line, there is no resolution, and once you learn to accept that, then you will live with less stress and more harmony. I have used the acronym GBSYS to describe 'expert' deniers, recently. You can look up in earlier blogs what this means. If 10% of the public think the world is flat, I am not going to argue with them, I will simply ignore them.

So, I will give you two scenarios of current era;'experts' and you can try to figure out who I am referring to. (this is a little intellectual challenge for you)

One GDD denier, wrote a paper in 2017 and showed that 2/5 (40%) of descendents (dead people) who had received prior GBCAs had Gd present in the nuclei of neurons (note that many articles describe Gd in the brain, but most of the Gd is in the extracellular space and not in cells, and the principle cells in the brain, that do everything are neurons, so Gd in the nuclei of neurons is a big deal). Then recently had published an article showing with Gadavist, that spontaneous elimination of the body occurs for 3 months (it does not go on to say that this does not mean all the Gd is out of the body, what it means is the rest of the Gd is now deposited in organ tissue). I liked the article, I would have liked it a lot more if they chelated everyone at 3 months with Ca-DTPA to see what the post chelation urine numbers were. So let us summarize: you have written Gd actually is present in the nuclei of brain cells, and Gd stays in the body a long time.... and yet no one is sick from it? Really? Are you stupid or are you taking the rest of us as stupid? At about the same time as the Gadavist hanging around in the body paper, a large paper from South Korea showed that individuals with Parkinson's Disease were much more likely to have received a GBCA injection than those who never received a GBCA. Now to calm everyone down, the incidence of Parkinson's following a GBCA was still small, about 1 in 10,000, which is the exact number I use for the incidence of GDD for all comers.

One Gd toxicity agree-er, but DTPA chelation is important denier, has observed online that DTPA may remove Gd from the blood but not from the tissues. How then do you explain that after 2 months Gd is no longer apparent in blood samples, and yet for essentially all GBCA agents (except Prohance and Dotarem) when even urine Gd is close to 0, typical numbers for Gd post Ca-DTPA chelation removal amounts are from 25- 100 mcg/ 24 hrs? If chelation only removes Gd from blood then those numbers should also be close to 0. So obviously DTPA removes Gd from tissues This is my note: It is especially important to bolus inject DTPA to emulate how the Gd (GBCA) was administered in the first place. So you would have to be a moron or a liar to think that DTPA removes only Gd from blood. Both commonly co-exist: moron and liar.

This should be the subject of another global update, essentially reminder about everything, but I was sent by a GDD sufferer a message sent to that second Bogwan that her daughter was getting chelation but the Gd numbers remained high, and she was getting more symptoms, fasciculations or something. So they decided to stop chelation. So I do not know the details but there may be general confusion on the point I have made many times.

Gd in 24 hr urines remains high for a prolonged period of time post Ca-DTPA chelation because it reflects le Chatelier's principle of 'everything strives to be in equilibrium'. Chelation primarily removes Gd from soft tissues (including brain) and over the course of weeks Gd moves from bone back to soft tissue. This is the main means of getting Gd out of bone. So Gd remains high on postchelation urines until the bone repository of Gd starts to be depleted. In general when Gd starts dropping from 25 mcg/ 24 hrs (which can be stable for atleast 5 chelations) down to 3-5 mcg/24 hrs is one of the features I look for to recommend to the GDD sufferer to look at pausing/ stopping chelation. So many individuals interpret Gd remaining high as some kind of failure, and I think the mom in this case thought this reflected Gd was just being stirred up. Well if this is 24 hr urine Gd that is high, clearly then you must know this means that Gd is leaving the body in a large amount and not just being stirred up. So infact the opposite is true of what she suspected. You actually want to see high Gd in post chelation urine for at least 5 chelations because this means you are depleting the total body Gd content, by Gd leaving the largest repository, bone, going to soft tissue and then being removed with the next chelation. This is actually the best case scenario, lots of Gd is continuing to be removed.. So controlling Flare is done by the use of steroids as I describe, or alternatively decreasing the amount of DTPA that is being administered.

There are probable a number of readers who are not too familiar with rating the level of accomplishment stature of experts. As I have reported before, my scholarship accomplishment for my career is #10 in MRI, # 14 in medical imaging, and in the top 0.05% of all scholars in all subjects.. the individuals I reference above, I have not looked up their scholar GPS rating, but I am quite certain they are not in the top 100 in their specialty, most likely not even close. So to use tennis terms, I would be like Roger Federer, and they would be like high school tennis team players.

So will all these and other 'experts' agree that GDD exists, or DTPA chelation is an (currently the) optimal treatment.... 10% of people think the world is flat, now a new group of dufuses say that CM-AKI does not exist.... so no, there will never be agreement by all 'experts'. And I am fine that there is no resolution, it is a reflection of the human condition. The only issue I do have, is I feel sorry for the unfortunate sods and GDD sufferers who they, or their family, think that these deniers are right. It is not the folly of the Bogwans that disturb me- you think the earth is flat, fine. But I also try not to suffer to much for what their ignorance afflicts: it is sad and tragic when people avoid getting correct treatment because they listened to GBSYS individuals.

Richard Semelka, MD