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The journey to recovery using Inflammation Therapy (IT) is a slow process without a fixed timetable. Both patients and physicians should be aware this treatment is not a quick fix, nor can it be, due to the fact that immune system reactions must be regulated so symptoms remain tolerable.

One experienced patient finally realized “it’s not so much the ending of this as the pathway to health and healing. I am much more relaxed now and enjoying my journey…to take it all as steps in the journey....instead of thinking that the goal is to hurry to get to the top of antibiotics.”

Recovery of health is usually as gradual as the original decline into disease and disability. Initially there may be instances of temporarily lessening pain and/or improved functioning, which may seem somewhat insignificant, given past experiences of waxing and waning disease. Over time, these pain-free episodes and improved functioning may become more enduring. The eventual, cumulative effect of treatment is that the patient should regain ability and health.
 
Suddenly, patients will realize they are doing something they could not do before, such as walking without pain. As these experiences accumulate and become more extensive, patients may continue to be surprised at the state of ‘normalcy’ they achieve. Many eventually reach a higher level of functioning and reliable health than before treatment.
 
Patients have often been sick a long time and have adapted to illness as their ‘normal’ state. During Inflammation Therapy, in addition to Herxheimer reactions, there is a slow course toward recovery, defined as full health – not simply how patients felt before their diagnosis. This is a healthy state that can initially seem unfamiliar to people who have been living with chronic disease.
 
 
Symptoms
 
No matter what their diagnosis is, patients usually react similarly to Inflammation Therapy. Patients should avoid equating symptoms to disease. Symptoms are a reflection of the body’s innate response to try to correct an imbalance and to eliminate toxins. For example, the symptoms of food poisoning are very unpleasant but are extremely effective in rapidly eliminating toxins.
 
When patients describe how ‘sick’ they are, they are usually talking about symptoms. But loss of function, either determined by clinical or laboratory findings or the capacity to perform physical or mental tasks, is the determinant of ‘sickness’.
 
Recognizing the difference between symptoms and loss of function will allay patients’ anxieties while they proceed through the ‘healing crisis’ that IT provokes.
 
Patients need encouragement that they are killing bacteria safely and doing well when they report Herxheimer reactions. Physicians who have experienced Herxheimer reactions themselves will be able to reassure patients that “this too shall pass”,

It’s also important to help patients identify the positive changes that have occurred but which are often ignored by the tendency to focus on symptoms.
 
Recovery goals change as progress continues
 
BrianBikeRace”My long-standing GI symptoms were not dealt with until late in my recovery, beginning about year three. I took a ‘big picture’ view that as long as my symptoms were generally improving, I was doing great.
 
“I often took my doctor a list of problems that had been improving since my last visit. Otherwise, it may be difficult for the doctor to understand why, when you've had so much progress early on, you are still eager to remain on the therapy.
 
“My assessments of progress got much more detailed as time went on. Early on, I was concerned about fatigue and full-body burning pain. Later on, I was concentrating on reducing the number and intensity of aching twinges in my wrists, tibia and ankles. I began assessing my range of motion in problem areas and slow retreat of peripheral neuropathy, something I would not have thought of as goals early in my recovery, when I was concerned with pain, lack of energy, ability to breathe and mental clarity. Your doctor may have a similar perception and perhaps may not realize how ill you actually were and how much recovery you can make with the proper therapy.” ~ Belinda Fenter
 
Symptom resolution
 
Patients have reported resolution of a wide range of chronic symptoms, including pain, allergies, psychological symptoms and endocrine imbalance.
 
Some tissue damage (e.g., neuropathy, fibrosis) seems to require longer treatment. The extent of possible tissue remodeling is not yet known but will become apparent as patients continue Inflammation Therapy.

 Length of treatment
 
There is no way of knowing how long treatment will be necessary because there are so many variables (e.g., length of illness, location of infection and tissue damage, type of bacteria, etc.). Progress isn’t linear and it's best not to have any fixed expectation of how long treatment will take. Return to full function is a gradual process.
 
Eventually patients will have used all the antibiotic combinations for varying periods of time and repeated them until there is no immune system reaction. It may take years to get to that point, but symptom resolution is usually profound well before that. Being on the therapy becomes less complicated as time goes by and the inflammation is reduced.
 
Once the total bacterial load is below what the immune system can handle, patients start making quick gains, feeling somewhat better at baseline and significantly better during non-herx intervals.
 
 
The effectiveness of Inflammation Therapy may vary in patients depending on various factors:
1. Patient's prior exposure to the antibiotics
2. The strength or weakness of the patient's immune system
3. The species of bacteria present
4. Concomitant health problems (e.g., chronic kidney failure)
5. Concomitant infections (e.g., fungal, viral)
6. Medications being taken by the patient
 
The length of time of treatment is probably going to be less than the length of deterioration without the correct treatment. It’s helpful to realize that all palliative medication is prescribed for life and chronically ill patients keep adding medications as their quality of life gradually declines.
 
Relaxing restrictions
 
As healing progresses and symptoms improve, restrictions on light and vitamin D can be relaxed. Monitor 25-D to ensure it remains below 30ng/ml and let symptoms guide the level of light restriction.
 

Treatment end markers
 
We don't advise discontinuing Inflammation Therapy until all antibiotic combinations have been used. The goal is not simply to feel good but to have regained as much health as possible. Treatment effectiveness is evaluated using several measures. Optimal results include:
• Resolution of systemic symptoms
• Return of physical function
• Absence of immune system reactions to treatment medications
• All lab markers normal
• Resolution of inflammation indicated on CT and MRI imaging
 
Patients may wish to continue treatment indefinitely to manage their disease even if optimal results are not obtained.

Pace of therapy
Most patients with Th1/Th17 inflammation have been ill a long time and many are very eager to get well. But the recovery process cannot be hurried because it requires killing the intracellular bacteria that are the underlying cause of chronic inflammatory diseases and maintaining tolerable herxing. Slow and steady wins the race.
 
The goal of Inflammation Therapy is to kill the intracellular bacteria in a safe way that is sustainable, both mentally and physically, for the length of what is usually a treatment of several years. No matter how eager patients are to get well, it is rarely a good idea to try to push the process.
 
Killing the bacteria causes Herxheimer reactions that usually provide a good guide for the pace of treatment. It’s important not to increase the antibiotics too quickly or do anything else that might cause the immune system to kill too many bacteria in a short period of time (e.g., increasing tissue perfusion with hot baths or strenuous exercise) because this could result in intolerable symptoms.
 
Trying to speed up therapy could:
 
• lead to intolerable Herxheimer reactions which could even require emergency treatment, setting progress back to recover from the episode.

• be so wearing, physically or mentally, as to cause discouragement.

• result in a failure to kill all the susceptible bacteria.
 
Patients shouldn’t push symptoms close to the edge of intolerable with dosage increases or a new antibiotic. Always leave a margin for safety.
 
It’s not a race, not a race,
slow, slow, slow the pace
 
These suggestions will help patients to be one of those who make it to the finish line and get well in the safest and smoothest manner, without getting side tracked and delayed:
 
1. Allow new antibiotics two weeks to 'kick in' before increasing the dose.
 
2. Stay at each dose level at least three times. A dose may ‘kick in’ suddenly and unexpectedly after several times at the same dose.
 
3. If still experiencing intolerable symptoms at any time during the interval, stay at the dose longer.
 
4. Don't make changes if symptoms are stable when you have plans that you don't want to have to cancel or when you have some other factor that will be debilitating (like extra stress, activity, an infection or difficult menses etc.).
 
5. If in doubt, always choose the more cautious action.
 
6. If necessary, try pausing therapy to help determine what symptoms are disease baseline (pre-therapy) and what are Herxheimer reactions. Note: Some patients do NOT feel better with a short break and need the antibiotic/s to keep symptoms manageable.
 
Finding the optimal and safest pace to succeed with Inflammation Therapy is a matter of trial and error. There are times when increasing antibiotics, for example, dampens the immune system response. And there is a disadvantage in being too cautious and going too slowly since bacteria could repopulate tissues already cleared by one antibiotic.
 
The one exception, however, is patients with ALS (Lou Gehrig's disease) who have a fast progressing illness and need to push the envelope of immune system reactions to kill bacteria as quickly as possible.
 
Fibrosis healing
 
When the immune system fails to deal with a pathogen it encases the diseased (infected) tissue in collagen. Angiotensin II is known to accelerate the deposition of collagen into tissue. This is part of the body's immune response. Long-term deposition of collagen leads to fibrosis (falsely called 'scar' tissue).
 
Deposition of collagen to encase pathogens which have escaped the immune system is one of the last lines of defense of the body.
 
Fibrosis (collagen) is thought to be permanent, but that may be incorrect. This article says liver fibrosis is reversible in humans.
 
Patients who have significant fibrosis may have ongoing low levels of pathogens to deal with for quite some time because it is believed bacteria are revealed as collagen is remodeled. And, as the immune system becomes more competent it may eliminate bacterial species which it could not deal with during earlier months or years of recovery.
 
Fatigue resolution
 
“The energy level does get better, but not until after significant time devoted to recovery. It took me 18 months before I realized I had *hope* of feeling like I had reliable energy on a regular basis.
 
“There's nothing for me to compare with the energy I have now -- unless I go back *at least* 20 years, probably longer. While I was active back then, I don't think I had this much energy. I should mention that I walk six miles daily and work out with hand weights for exercise.
 
“In addition to my research work and taking care of my family, in the past couple of weeks, I've been repairing/renovating a house my parents own, and I spent at least 6-7 hours a day in 90-something degree heat, doing manual labor such as using a chain saw to cut tree limbs and tree stumps, doing carpentry work like hammering and chiseling wood and heavy-duty cleaning. This is so far beyond where I was 3+ years ago that it's hard to compare or discuss, since back then I spent so much time resting or lying around because of fatigue and pain. I was also using supplemental oxygen, which is now only a notation for my medical history. I had trouble grasping with my right hand and I had paresthesia, lack of normal sensation, on most of my right side.
 
“Remember that fatigue is a *disease symptom* as well as a Herx symptom. Fatigue was one of my longest-lasting disease symptoms. Once it began to lift (which as I said, took about 18 months on the treatment), it still took another year to have the energy I **expected to have**. Now, there just aren't enough hours in the day.
 
“Every single day, I marvel at how wonderful it is to be able to rely on my body's energy and strength, and on my mind as well! I never thought I would be at this point because I would have been happy and grateful settling for much less of a recovery.” - Belinda Fenter