Dr. Michael Powell: A Rheumatologist Treating Cpn in CFIDS, FM, Lupus and other "auto immune" disordersDr. Michael Powell: A Rheumatologist Treating Cpn in CFIDS, FM, Lupus and other "auto immune" disorders
I spoke with a rheumatologist in California, Dr. Michael Powell, who is cautiously using a combination of antibiotics in conjunction with standard therapeutics for the treatment of nanobacterium (including Cpn) in patients suffering from FM, CFS and autoimmune disorders. His results with this treatment program have been encouraging. He faxed me some examples of patient feedback forms, excerpts from which you can see below. Recovery is not instantaneous, but tends to occur over a 6 to 12 month period. The graphs of subjective improvement are drawn from visual analogue scores compiled during each visit. When summarized in this manner these data give a time-lapsed impression of the response to treatment. One of the interesting things he mentioned was in relation to negative patient serology for Cpn when other clinical signs lead him to suspect some involvement. Serologic assays for IgG, IgM and IgA are sent to confirm infection prior to treatment. He would like to see a positive serology in patients before engaging them in a combination antibiotic protocol, but recognizes that patients may not have antibody reactions. This may be due to the ability of intracellular organisms like Cpn to evade a humoral response (antibody production), immunoglobulin depletion, or other factors. In these cases, when there is a high index of suspicion for the infection without a humoral response, he tests the spouse of the partner for Cpn. He sees the "non-symptomatic" partner as a good indicator of Cpn in the patient, given the infectious nature of Cpn. Thus far, most spouses are positive when an ill family member is non-reactive. In our discussion Dr. Powell pointed out the many similarities between TB and Cpn. Both organisms can evade our immune system. Both organisms can be carried from the lungs, the original site of infection, and infect other tissues. Both require prolonged treatment with multiple drugs to eradicate the infection. Both are sensitive to stress levels. Optimal therapy is being evaluated at various research centers and new medications for Cpn are on the horizon (see activbiotics.com). INH and supplements for endotoxins- Dr. Powell finds most patients improve on a standard combination antibiotic protocol for Cpn. Rheumatologist have apparently been using doxycycline for many years with success for inflammatory arthritis but there is evidence that using doyxcycline in combination with rifampin is even more effective. Some patients plateau after about 8 months of treatment he has found variations in the treatment protocol have made a difference. One protocol he uses involves the use of NAC 600 mg twice daily, INH 300 mg once daily before breakfast, and metronidazole 500 mg twice daily pulsed with 5 days on and two weeks off. It is essential to start each agent separately and gradually increase the dose over weeks or months as tolerated. The use of Vitamin C 500 - 1000 mg four times daily (the half life of vitamin C is 30 minutes and little remains after 3 hours) to offset the release of toxins during therapy. B6 is important to control INH related peripheral neuropathy. Monthly laboratory evaluation of AST, ALT, Cr, and CBC are recommended for all who engage in this protocol. It is not uncommon for liver enzymes to show a mild elevation during the initial stages of treatment. Antibiotic therapy should be temporarily discontinued during periods of toxicity, should it arise. He emphasized the importance of insuring that yeast and fungal infections do not overgrow during protracted antibiotic use. He recommends the use of acidophillus, nystatin, diflucan, oregano oil, and/or grapefruit seed extract as needed to prevent secondary opportunistic infection during treatment. Covering for the possibility of yeast and fungal overgrowth during antibiotic therapy is essential. If diarrhea develops, stool must be evaluated for antibiotic associated diarrhea (C. difficile). This is not a simple protocol and it is best if it is guided by an experienced clinician who is familiar with the medications and methods of minimizing toxicity related to killing the nanobacterium. A link to Dr. Powells clinic may be found on our links page. Dr. Powell does do telephone consultations by arrangement and may be a resource for those who have had difficulty finding a Cpn knowledgeable doctor in their area. He requires an initial visit with a physical examination before initiating therapy (lab work can be performed prior to the initial visit to facilitate diagnosis and treatment), and monthly laboratory testing with monthly phone consults are then the norm. Treatment of related hormone imbalances in the thyroid system and nutritional support, temporary antidepressant support as needed, and sleeping medications are useful adjuncts to the antibiotic protocol. It is necessary for patients to have a primary care physician to monitor health matters that are unrelated to FM, CFS and autoimmune disease.
Comments on CAP variations from Dr. Michael PowellComments on CAP variations from Dr. Michael Powell
I asked Dr. Powell to comment directly on concerns that have been mentioned over time as to whether he uses the CAP with his new patients. I received his response a number of weeks ago but have had no time to put it together in a cogent context. But continued posts on these questions has mobilized me to get his comments to our readers here. But context is, as we say, everything. A problem with reading posts on a website such as www.cpnhelp.org is that one does not really have the whole context of that particular person's illness, medical history, the complexity of what is happening in their body as a result of more and more systems being affected by more than one thing going on. While it is perfectly fitting that our site here has it's mission focus of treating Cpn via combined antibiotic (and other relevant antichlamydial agents such as Vitamin D, tocotrienols, etc.), a physician is treating, hopefully, a patient rather than a bacterium. I'm a clinician myself, although a psychologist rather than a physician. One of the things that becomes clear is that the particular clinical population one sees, the kind of clinical practice you have, shapes your understanding of what's needed in order to help people. If you are curious and growing as a professional, you are always learning from the particular complexity of what you see in your patients: what helps them, what doesn't; how general approaches fit and don't fit; and how you need to go beyond the standard approach to respond to what's real, where the standard prescriptive algorithms "You must always do these things and these things only..." fails utterly to help those you must care for.A doctor who sees mostly patients with neurological problems related to chronic infection as from Cpn will get attuned to how those conditions respond and to the complex interactions of treatment with the rest of the person's health process. A physician who sees rheumatological patients learns what works well and what doesn't in that population, and the nuances of attuning treatment to the whole spectrum of patients, even to see the difference of patients who have the same disease label. A physician who sees a lot of complicated cases has two options as a professional. One is to learn to think more broadly and reject the formulaic, in order to account for and encompass, that complexity. The other is to narrow their viewpoint to the accepted practice and say, "Well I do this, I don't know about those other things." The latter is perfectly acceptable to my thinking, as we all need to know our professional limits. But I thank God for those who are willing to grasp the former position, such as Dr. Stratton, Dr. Wheldon, and Dr. Powell amongst others, and dig deeper into things. You see, I'm one of those complicated-type cases, and it has taken a nuanced and complex approach to get treated properly. I'd been sick so long and with so many different systems affected, and likely not just by Cpn, that it has taken a complex clinician to weed through the layers of debris, gradually clearing the tangled mess my health had become. Cpn and the CAP has been at the center of my treatment, hence my devotion to maintaining this website, but it has not been the only thing in my treatment, nor the only concern of my physician. Dr. Powell reflects below on the questions and concerns that have evolved for him through many years of treating Cpn and other infectious inflammatory conditions in his rheumatology practice. He was among the first physicians to use Dr. Stratton's protocol actively in his practice, and has a lot of cases under his belt using the CAP. And he found out about Dr. Stratton's work through his own researches and insistent curiosity. No websites were then available to inform him. That should tell you something about his intellect and curiosity. I think his questions are good ones for any of our readers to ask and consider. They might just help us broaden our thinking the way we hope that our physicians will be willing to broaden theirs. **********************************Dear Jim,Thank you for bringing these concerns to my attention. I am not opposed to treating infected people with antimicrobials. But I do think we all need to ask a few important questions before we start CAP. What is it we expect from CAP? What is CAP this month? Can we clear Cpn? Is Cpn like herpes viruses that can not be cleared, only pushed back? If one has an overgrowth of Cpn does that say something about their immune system? How many other infections does the average Cpn person have? Do you treat the viruses first or second? Could the viruses flare while you are stirring up die off reactions with antibiotics? Does the oxidative stress of these die off reactions have negative consequences to the immune system, neurological system and key infection opposing nutrient levels? For how long do we want to take antibiotics? These are reasonable questions to ask. It is important to understand that:1.) No one knows which CAP combination is optimal.2.) No one knows how long to treat. 3 months? 12 months? 3 years? Longer?3.) No one knows if the infection can be cleared...clearing every elementary body, every cryptic, every reticulocyte form? Is that a realistic expectation? 4.) No one knows how many other infections are present and whether it might be better to begin with those, such as by using antivirals, before starting CAP.5.) No one knows what impact genetics are playing in these infections and few people know how to compensate for genetic predisposing factors (e.g supporting methylation defects helps to oppose infection).People need to be realistic when they are considering CAP treatment and make sure they are not approaching these infections with the expectation that taking multiple antibiotics for a few months is going to restore their vitality. Please be sure to mention that you and I have seen CAP fail. I have seen antiviral therapy work tremendously well with some who have failed CAP. That means something. I have seen people recovering faster with sauna, Iodoral and infection-opposing nutrients (weeks rather than months) and that is why I may start with these. When people are done having die off with these measures, they tolerate antivirals and antibiotics better and can get back to working and living full lives faster. If someone comes to me with a 2/10 ratings of their energy and depleted levels of essential nutrients and hormones, the worst thing I can do is send their energy to 0/10 by increasing the demands on their system through premature initiation of antibiotic therapy. I have patients who say that the T3, Vitamin D and infrared sauna have had the largest impact on their health. Some patients respond best to antiviral medication while others respond best to NAC, Zithro, Flagyl. Some patients seem to respond better to NAC, Rifampin, Doxy, Nifedipine. Some patients do very well with IM or IV gammaglobulin if they are hypogammaglobulinemic. Last week I saw a gentleman who failed CAP and antiviral therapy, but he has returned to work feeling better in years after adding niacin therapy. A recent study from Harvard confirms the antibacterial and antiviral properties of niacin, but liver enzymes need to be watched if the dose is increased about the RDA. The doctor can not know in 2008 which modality will work best because we do not know who we are dealing with in terms of these mixed infections and varied genetic mutations.Starting treatment by restoring depleted nutrient levels before starting antibiotics is not a bad idea. Running into battle with your nutritional levels around your ankles is short sighted and likely to cost you more in than preparing properly and building a strong defense before going for the antibiotics and antivirals. I would be surprised if most of the people who dropped out after I recommended sauna actually tried sauna twice daily for 20 minutes as recommended. I have had so many patients swear by this benign method and I have seen recovery occur much faster for those who do daily sauna. Seriously, people tend to respond in weeks rather than months if they are doing daily sauna therapy.In summary, there is no proof that even 3 years of CAP will clear Cpn in humans. I have seen CAP work wonders for those whose illness is linked to Cpn or other polymorphic bacterial infections, which is why I continue to recommend this important therapy. It is wise to minimize antibiotic exposure as much as possible and most patients want to transition from antibiotics to infection opposing supplements as soon as possible. There is no test that can prove to the patient or the physician that Cpn or any other chronic infection is eradicated, so we are forced to use clinical symptoms as a guide. Herpes viruses persist forever, but when herpes is in remission people do not feel the infection. It may be that this is also true for Cpn. We believe the best way to address these infections and restore health is to begin by strengthening the immune system rather than stress the patient's system in the initial stages of treatment. We have tried it both ways and we have better results by starting treatment with measures that support methylation, restore depleted nutrients, increase body temperature and WBC function. Then when the die off from these measures has subsided, antivirals and antibiotics are discussed and can be started more safely. I can't say this enough times, there is no proof that you can ever clear these infections or even know how many different organisms are involved. Check the websites for Lyme, Mycoplasma and other occult infections...relapse is very common. That is why we think it is essential to build one's defenses and improve immune function as the primary focus of therapy. It is wishful thinking to presume that 6-12 months of CAP will restore health in most fatigued patients. If only it were that simple.Best regards,Michael Powell, D.O.