Managing immunopathology (IP)

Patients' goal during the MP should be to maintain tolerable immunopathology as they get well. In cases where IP (also known as herx) is becoming intolerable, certain strategies are available including:

• Reduce or stop antibiotics – Typically, reducing or stopping one or more antibiotics is the most effective way to manage immunopathologyA temporary increase in disease symptoms experienced by Marshall Protocol patients that results from the release of cytokines and endotoxins as disease-causing bacteria are killed.. Many patients find that as their nuclear receptorIntracellular receptor proteins that bind to hydrophobic signal molecules (such as steroid and thyroid hormones) or intracellular metabolites and are thus activated to bind to specific DNA sequences which affects transcription. function stabilizes, their immune response becomes more active and their immunopathology may increase. At this point, they may need to reduce or stop antibiotics while staying on olmesartanMedication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor. Also known by the trade name Benicar. alone. This occurs as a result of improved immune function and is not a sign that a patient is ”getting worse.”
• Adjust olmesartan (Benicar) - Taking more frequent or higher dosages - or less frequent and lower dosages - of olmesartan is often effective at managing immunopathology. Taking olmesartan sublingually (under the tongue) can provide immediate relief.
• More frequent minocycline – Contrary to intuition, minocyclineBacteriostatic antibiotic used by Marshall Protocol patients. often has less effect on symptoms when taken in more frequent doses.
• Take palliative medications – A range of symptom-specific palliative medications can be relied upon in the case of intolerable immunopathology.

Note that three forms of IP are particularly life-threatening and should be handled with an abundance of caution: cardiac immunopathology, neurological immunopathology, and respiratory immunopathology. Patients who are concerned about any of these or other symptoms should not hesitate to call their physician.

The primary goal of the MP is not to be on a certain combination or dosage of antibiotics. Rather, patients should strive to achieve and maintain tolerable physical and mental immunopathology (IP). Failure to take the requisite precautions against intolerable IP, including sensible dosing of antibiotics and proper light avoidance, can mean putting one's very life in jeopardy. Patients are required to take responsibility for the choices they make, which ensure their IP is at a tolerable level.

To this end, it's important that patients learn which strategies work for them. Phase One is an excellent time for this.

Learning early the key ways to assess immunopathology will help address symptoms proactively.

Those who have had to bear strong disease symptoms may have more difficulty defining the line between tolerable and intolerable IP symptoms. A cautious approach is best.

Is a set of symptoms worthy of a trip to the emergency room? It depends. Patients with intolerable immunopathology (IP) are advised to first assess the severity of their symptoms. Sometimes patients can make adjustments immediately to improve intolerable symptoms.

The following kinds of IP, and the examples of intolerable symptoms which sometimes accompany them, are life-threatening, and should be taken very seriously:

• cardiac immunopathology – slow or rapid heart rate, syncopal (fainting) episodes, chest pain, irregular rhythm, heart skipping beats, or palpitations
• neurological immunopathology – strong feelings of wanting to hurt oneself or others
• respiratory immunopathology – sudden or increased shortness of breath, throat tightening

Patients should never hesitate to make adjustments to keep all symptoms at a tolerable level. The following are a list of adjustments or strategies patients can use to limit the amount of immunopathology (IP) at any one time. Patients should always try to provide themselves a margin for error such that their symptoms aren't continually on the brink of intolerable. Patients should try to learn which of these strategies are most effective at controlling IP.

Note that patients weaning from corticosteroids face the prospect of particularly strong IP and may need to be familiar with these strategies as much as anyone in later stages of the MP.

If these strategies don't work, patients should call their physician.

Typically, the single most effective way to manage immunopathology is to lower one's antibiotics (but do not lower minocycline below 25 mg). At some point in the Protocol, many patients find their immune system becomes much more active and immunopathology symptoms may increase. At this point, there may be a need to reduce or stop antibiotics, while staying on olmesartan alone. This is completely expected and is consistent with the stages of illness and recovery.

No one feels excited about lowering their antibiotics. However, rather than being a sign of “treatment failure,” the need to reduce antibiotics is actually a result of improved immune function.

Later, antibiotics may be resumed, but this might not be possible for many months. There is no requirement that patients reach the maximum dosages for all antibiotics or do all antibiotic combinations in order to complete the Protocol. Note that patients can make progress on olmesartan alone.

In this same vein, patients who notice a downslide into more constant inflammatory symptoms can swap out a stronger, longer-lasting antibiotic (often ZithromaxBacteriostatic antibiotic used by Marshall Protocol patients. Has relatively long half-life.) in order to feel better.

Taking more frequent or higher doses, or less frequent and lower doses, of olmesartan (Benicar)Medication taken regularly by patients on the Marshall Protocol for its ability to activate the Vitamin D Receptor. is often effective at managing immunopathology. Olmesartan has two actions: an anti-inflammatory effect and an immune-stimulating effect. For this reason, most Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis. patients – roughly 80% or so – experience either feel substantially better or worse when taking olmesartan. Knowing which kind of patient a person is can help decide which course to take in case of intolerable immunopathology. It is important to experiment during times of relative well-being to see which strategy is most successful.

A potent anti-inflammatory, olmesartan decreases levels of Nuclear Factor Kappa B, a protein that stimulates the release of inflammatory cytokinesAny of various protein molecules secreted by cells of the immune system that serve to regulate the immune system. - proteins that generate pain and fatigue.

Olmesartan has been shown to be safe in higher than typical doses. As a temporary replacement for standard dosing for olmesartan, which is 40mg every six hours, patients can:

• take 40mg of olmesartan every four hours or more frequently; some patients have reported a benefit from taking olmesartan as frequently as every three hours
• lower the dose to 20mg every four to six hours, but only if that reduces symptoms

When in a crisis, never discontinue Benicar, or increase the dosing interval beyond 6 hours.

Also, there is the option of taking Benicar sublingually, that is, under one's tongue. Some people in the midst of a crisis situation have found it helpful to combine 40mg oral doses at the regular time with an additional 20mg of sublingual Benicar (at minimum three hour intervals) around the clock.

Swallowed olmesartan, which in non-emergency situations is preferred, usually takes between 90 and 300 minutes to be absorbed by the GI tract, depending on whether the stomach is full. Chewing and then putting Benicar under one's tongue can drastically cut the amount of time it takes for the medication to be absorbed.

The sublingual route of medication administration uses the thin epithelium and rich network of capillaries on the underside of the tongue to gain rapid absorption and drug action. Drugs absorbed from the sublingual route have a rapid effect since they enter the bloodstream directly without being metabolized by the liver or being affected by gastric and intestinal enzymes.

Note that the FDA has not approved sublingual use of olmesartan and it is uncertain what effect its routine use would have on local soft tissues and tooth enamel. Also, it is not recommended to routinely use sublingual administration of Benicar during the protocol since swallowed Benicar is distributed in a manner that is considered more effective for maintaining the reduction of body-wide inflammationThe complex biological response of vascular tissues to harmful stimuli such as pathogens or damaged cells. It is a protective attempt by the organism to remove the injurious stimuli as well as initiate the healing process for the tissue. levels.

A Vitamin D Receptor agonist, olmesartan turns on the immune response, which can lead to immunopathology. Ideally, a Marshall Protocol patient would take 40 mg of olmesartan 4-6 times a day, but if that seems to be too much to tolerate, a patient should work with their physician to decide upon whether it would be prudent to take lower or less frequent doses of olmesartan.

A patient or physician should never stop olmesartan in a crisis situation unless they know exactly what they are doing.

Another successful strategy for managing strong immunopathology (IP) is to adjust the dosing frequency of minocycline. Some patients notice that lowering their dose of minocycline helps.

On the other hand, like many antibiotics, minocycline partially suppresses the immune system in the hours after it is taken. In fact, the very rationale for taking pulsed doses of antibiotics is that the immune system is most effective and generates the most IP when the concentration of the drug is lowest.

Patients have had success adjusting minocycline in a variety of ways. Note that the lowest and highest recommended doses for minocycline are 25mg and 100mg, respectively.

• If taking lower doses of minocycline, try 25mg every 6, 12, or 24 hours. Note the advice on how to divide a dose.
• If taking higher doses of minocycline, try 50mg every 12 or 24 hours.

This “frequent minocycline” option is more likely to be palliative if the patient typically has less immunopathology symptoms during the first 6 to 24 hours after taking a dose of minocycline and more IP toward the end of the 48 hours

When symptoms are again tolerable, minocycline dosing can be extended gradually (by the hour if needed) out to 24 hours and then 48 hours. When symptoms have settled back and you feel like you can tolerate a little more you can increase the mino to the next dose level.

Other options worth considering:

• Stop minocycline for a while with the idea that you will resume if the IP becomes too strong.
• Extend minocycline from every other day dosing out to three days or longer.

Please note: minocycline is not palliative for all people. For some, increased frequency of minocycline results in more immunopathology. This is more likely to be the case if one experiences less immunopathology toward the end of the 48 hours between doses.

A range of symptom-specific palliative medications can be relied upon in the case of intolerable immunopathology.

• eye medications
• mental and neurological – anti-anxiety agents and antidepressants; sleep medications
• pain medication
• respiratory – corticosteroids; nebulizers; bronchodilator inhalers; steroid inhalers

Note that many of these medications, especially steroids, can interfere with recovery. It would be much better, if possible, to control symptoms with your increased Benicar and antibiotic adjustments. Discontinue the use of these medications as soon as symptoms become tolerable.

Quercetin taken around the clock may be helpful once a patient has been established on MP. It is usually not helpful in the first few months.

The expectorant guaifenesin may help dampen inflammation a bit as well as liquefy mucus. Use a product that does not contain any other ingredients. One might find a slight surge of symptoms during “withdrawal” from periods of intense guaifenesin use.

Patients need to determine which strategies are effective for them, so that they will be prepared the next time symptoms flare. In addition to the strategies previously mentioned, patients may want to know how to:

• send for support and emergency care
• notify their doctor

Also, it makes sense to get to know and have at the ready a printed copy of the Hospitals and Emergencies Information Sheet.

It is not as if Benicar won't bind to patients' Vitamin D ReceptorA nuclear receptor located throughout the body that plays a key role in the innate immune response. if they don't have the proper attitude. But, a positive attitude about the MP does color the perception of one's symptoms. Patients who are able to or choose to see their immunopathology as serving a purpose in their recoveries seem to do much better.

My mantra with my MP patients is “Great, you are effectively eliminating the bugs and their toxins and with such a safe therapy (no IVs etc) and it will pass.” I think every practitioner using the MP should do it so they can confidently reassure their patients and/or anticipate the reactions that they will likely experience.

I also, during follow up, identify the positive changes that have occurred but which are often ignored by the tendency of patients to focus on their symptoms.

Greg Blaney, MD

Another key part of having a positive attitude is resisting the temptation to complete the MP in world record time. This is sometimes very hard for certain patients, especially those with obsessive compulsive tendencies, to accept.

There is no point in pushing your body too hard, and you might do damage to it. There is no need to keep the pedal flat-to-the-floor, this is an endurance race, not a sprint.”

Trevor Marshall, PhD

It's important that you post your progress regularly to get expert support regarding managing immunopathology (IP) from the study site's Staff.

Patients will be assisted, if needed, in determining the options to use to achieve and maintain tolerable IP. By posting regularly, Staff can often tell if patients are heading towards problems and need to adjust their medications.

Patients should ask for help before they take any action that is unfamiliar to them.

Patients whose posts are not responded to should PM (private message) or email one of the moderators. Sending a PM can be done by clicking on the “new messages” link in the top right of any MarshallProtocol.com or CureMyTh1.org web page.

I think it might worth a try for you to try palliating with frequent mino doses. After a 3 week break from minocycline, I started taking 25mg mino every 24 hours for a few days and then upped it to every 12 hours after a few days. I did this for 3 weeks and then went to 50mg minocycline once every 24 hours for a month. About 20 days on this dose, I suddenly had the best 6 days I've had in years…far from perfect, but it felt amazing. After this, I gradually added a few hours to my minocycline dosing each time, until I was at 50mg every 48 hours and now I'm tolerating it.

PoochyMama, MarshallProtocol.com