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Framework for managing the stages of recovery

  • Draft #8: in work here: https://mpkb.org/home/devel/framework
  • Added indexing to paragraphs to facilitate text flow while providing locations to link into comments.
  • Note: I'd like to add some text about how the “bigger hammer mentality must die”… hammer (bug-killing) v.s. sustainable pace (reserves left for healing)… – Paul has promised to add words here: Pulsed low-dose antibiotics.
  • This document does not stand alone (at this time.) The links to other KB articles are essential for the practitioner to develop a deeper understanding of the science and the clinical application.

Foundational Principles of the Marshall Protocol

100.a. The Marshall ProtocolA curative medical treatment for chronic inflammatory disease. Based on the Marshall Pathogenesis.'s effectiveness for reversing chronic inflammatory disease is based on the following three foundational principles:

100.b. 1. Using a immune-stimulatory drug to allow the body to restore and maintain natural innate immune function.

100.c. 2. Avoiding or minimizing inflammatory damage from Immunopathology through careful monitoring of signs and symptoms, and adjusting treatment to maintain a sustainable pace.

100.d. 3. Tracking of overall innate immune responseThe body's first line of defense against intracellular and other pathogens. According to the Marshall Pathogenesis the innate immune system becomes disabled as patients develop chronic disease. through recognized stages of illness and recovery as an essential tool in monitoring and adjusting treatment.

100.e. [Stick cartoon strip illustrating stages here]

Stages of Recovery

101.a. Below is discussed the recovery process stage by stage using the nomenclature of the recovery document. Note: within the framework of recovery, stage 1 describes a pre-illness state, and therefore is not included here.

Stage 2: Diagnosis & Preparation

102.a. Prior to commencement of the Marshall Protocol there is a persistent, often sub-clinical, state of illness. Stage 2 is characterized by symptoms consistent with a down-regulated innate immune response, indicating a Th1 Spectrum Disorder, frequently diagnosed as autoimmuneA condition or disease thought to arise from an overactive immune response of the body against substances and tissues normally present in the body in nature.

102.b. The first step in treatment is to evaluate the current level of disease using a thorough review of symptom history, laboratory tests, and an inventory of current palliative use.

102.c. [Create checklist forms to attach for doctors to use.]

102.d. A thorough inventory and a strategic, yet flexible plan for weaning non-MP treatments is critical to successful treatment. Most palliative medications should be continued when starting the treatment to maintain stability. However, it is essential to identify any medications currently being taken that must be discontinued prior to starting the treatment due to their potential to cause an adverse event when combined with the innate immune stimulation of the 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. .

102.e. [Managing IP illustration… include list of items that increase/decrease IP … picture of a balance with pans]

Stage 3: Assisting & Managing the Innate Immune Response

103.a. Stage 3 starts with the introduction of olmesartan (Benicar), which acts on multiple receptors to provide both stimulation of the immune response and palliation of symptoms.

103.b. Olmesartan is taken throughout all stages of recovery. When taken consistently and frequently enough, olmesartan provides palliation and essential protection from inflammatory damage. For this purpose, the minimal frequency for dosing olmesartan is every 6 hours, but during stages of increased 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. it has been found to be therapeutic taken every 4-5 hours. During exceptional periods of inflammation, a dosing frequency of every 3 hours may be required.

103.c. The minimum olmesartan dosing level necessary to provide essential protection from inflammatory damage has been clinically demonstrated to be 40mg of Benicar (or generic equivalent) taken every 6 hours. However, for some individuals starting the protocol, the olmesartan dose, but not frequency, may at times need to be reduced because immune-stimulatory effects overwhelm the anti-inflammatory effect.

103.d. Only when stability on the olmesartan has been achieved, should the strategy for weaning from as many palliatives as possible be applied. There are special instructions for weaning from corticosteroids.This weaning process must be carefully managed to prevent an adverse event during the weaning process.

103.e. It is critical to monitor closely (1) dosing of all medications, (2) symptoms, and (3) aggravating factors during stage 3.

103.f. Personal daily logs are encouraged and frequent summaries posted in standard format as a progress report in the support forums assists with the task of close monitoring. Reviewing these posted reports over time provides deeper insight into individual response to both treatment and lifestyle factors. Aggravating lifestyle factors that can increase symptom levels include food reactions, stress, heat exposure, changes in physical activity levels, inadequate light protection, dehydration, and inadequate rest.

103.g. During the course of treatment, on occasion, it may be necessary to add or increase palliatives for a period of time to continue to maintain a tolerable level of IP symptoms. (See: Managing immunopathology (IP).)

103.h. Only when tolerable symptom stability has been achieved following weaning of as many palliatives as possible should additional immune stimulation be introduced using pulsed, low-dose antibiotics. Antibiotics assist the innate immune system in targeting the pathogenic microbiotaThe bacterial community which causes chronic diseases - one which almost certainly includes multiple species and bacterial forms., but do not replace the need for restored immune function in order to recover from the disease process.

Important: Antibiotic dose levels are never to be increased until the need for any temporary measures of palliation, such as more frequent olmesartan or other palliative medications has been reduced, and extra symptom management measures can be discontinued.

103.i. The antibiotic minocycline is the first antibiotic introduced once the need for additional immune stimulation is evident. Minocycline's effectiveness is based on both immune stimulatory and palliative actions.

103.j. In stage 3, if the immune response is too strong, the reduction or discontinuation of minocycline typically provides significant relief. The goal of weaning off any remaining palliatives should be kept as a high priority as treatment continues.

103.k. Only when symptoms levels are negligible at the maximum dose of minocycline taken every 48 hours should the innate immune response be further stimulated by adding other short-acting antibiotics (Bactrim DS (co-trimoxazole), clindamycin, demeclocycline (Declomycin)).

Stage 4: Managing Partially Restored Innate Immune Response

104.a. In stage 4, 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. is no longer driven exclusively by medication dosing as the partially restored innate immune system begins to drive the level of immunopathology response. The best marker that is currently available to support identifying this shift in response is the lowering of serum 25D to a value below 12 ng/mL.

104.b. Management of immunopathology symptoms will require even greater skill than in stage 3. (See: Managing immunopathology (IP).)

104.c. As the immune system more effectively recognizes and clears previously unaddressed pathogenic microbiota, the antibiotic doses often must be lowered or discontinued for a time to maintain a safe and tolerable level of immunopathology. However, more ill patients may need to continue certain antibiotics, particularly minocycline, in cases where their palliative effects are stronger than their IP generating effects.

Stage 5: Managing Fully Restored Innate Immune Response

105.a. The transition from stage 4 to stage 5 may not be easy to identify. The key signal is that olmesartan's immunostimulatory role is no longer dose modulated as the body's own immune response is in full control of the pace of the immunopathology.

105.b. In stage 5 taking more olmesartan brings greater relief from immunopathology symptoms because of it's palliative and anti-inflammatory effects. There will likely be periods during stage 5 where an every 3 hour dosing of olmesartan will be the best approach to keeping immunopathology symptoms tolerable. (See also: The over-exuberant Stage-Five immune response.)

105.c. After an initial period of strong stage 5 immune response, baseline symptoms eventually reach a consistently tolerable level. At this point it is wise to wean down all palliatives added during this period and allow the body to adjust to a new, healthier homeostasis before re-introducing antibiotics for additional immune stimulation.

105.d. The strength and target of your immune response will vary as you continue in stage 5, requiring preparation for unexpected immunopathology at any point. The frequency of stronger immunopathology in this final stage of recovery could be compared to slowly decreasing waves that mainly reduce in intensity until full recovery is achieved.

105.e. Recognizing the transitions through these stages of recovery can only be assessed on a case by case basis. For whose activities of daily living have been hampered by the disease process (prior to and during the MP) may find that some functionality begins to be restored early in the stages of recovery. However, there are also those who only find significant function restoration after working through various periods of strong immunopathology during stage 5.

home/devel/framework.txt · Last modified: 07.04.2022 by 127.0.0.1
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