Sarcoidosis Answers for Physicians, Nurses and Patients

Here at SarcInfo, between 2002 and 2004, we identified the cause of Sarcoidosis, and successfully trialled a curative antimicrobial therapy. During 2005 and 2006 the US FDA designated the antibiotics Clindamycin and Minocycline as Orphan Products in the treatment of Sarcoidosis, and studies are ongoing elsewhere.

For information about this breakthrough, please post your questions at the current study-site, or the Autoimmunity Research Foundation.
 
This archive of the historic study is maintained by volunteers from the Foundation. The material here provides useful background, but much of it is now out-of-date.

** Patient Tutorials **

 Click here to read "WHY DID I GET SARCOIDOSIS? WHY ME? 

  Click here to read "REMISSION IN SARCOIDOSIS"  

 How a Pathologist can see Bacteria causing Sarcoidosis 

"How does Doctor measure my ACE, and my D-metabolites?"

 Weaning from Prednisone

 Protecting your eyes in Sarcoidosis

Vit.D and Calcium in Sarcoidosis

Hypervitaminosis D Symptoms    The SarcInfo F.A.Q.

Medical Abbreviations          CBC Radio Show

Protocol Phase 1-First 3 months

 

** Papers for Physicians **

Antibacterial Therapy induces Remission 

Implications for Autoimmune Disease 
(Here is Fulltext preprint)

Antibacterial mechanisms for ARBs 

Antibiotics in Sarcoidosis- The 1st Year 

Rationale for abx in Sarcoidosis 

1,25-D and Angiotensin II

"New Treatments Emerge.."

Jarisch-Herxheimer in Sarcoidosis

Vit.D and Calcium in Sarcoidosis

Protocol Phase 1-First 3 months

The NIH ACCESS Study finds Sarcoidosis does not go away - Click here to see, and print, the brochure


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 Fatigue
Author: Caroline (---.win.org)
Date:   05-13-02 16:11

Hello...I just saw on the evening news that Procrit (for the fatigue of cancer) is in testing for treatment of fatigue in CFS patients. If this drug proves helpful for CFS sufferers, I wonder if will help sarc patients also? In one segment one woman recounted how she was able to clean the house AND work a full 8 hour day!! I would be happy to have the strength to clean for an hour straight.

Maybe you have seen the commercial for it? A gentleman wants to take his grandson to look for a 'big boy bed' and is too tired until he begins taking Procrit. It increases red blood cell production -- maybe sarc fatigue is not from low levels or anemia?

To have energy, what a novel idea! As an aside, I am currently trying histamine for fatigue. Caroline

 
 Re: Fatigue
Author: Admin (---.cu27.vnnyca.adelphia.net)
Date:   05-13-02 17:34

Caroline, Fatigue is the single most common complaint of sarcoid patients. But the fatigue of sarcoidosis has nothing to do with fatigue caused by kidney failure, which is what Procrit is designed to improve. Unless you have kidney failure mimicking that which is associated with chemotherapy, and I sincerely hope that you have no such affliction, Procrit is very unlikely to be of any help whatsoever.

Prof. Om Sharma has written an editorial describing the fatigue found in sarcoid patients. His paper, "Fatigue and sarcoidosis" is unfortunately not available on the web, but you can get a copy from your local med library.

The fatigue of sarcoidosis is of biochemical in origin. It is mediated by chemicals released from the macrophages in the inflammed tissue, and, IMO, it will not be responsive to a hematopoetic agent such as erythropoietin (Procrit).

Fatigue resulting from chemotherapy in Cancer is reviewed in the paper "The measurement, causes and effective management of cancer-related fatigue"

..Trevor..

 
 Re: Fatigue
Author: Caroline (---.win.org)
Date:   05-13-02 21:08

In another topic you mention finding a full writing available at the local medical library. Where does one begin a search for a 'medical library'?
Caroline

 
 Re: Fatigue
Author: Admin (---.cu27.vnnyca.adelphia.net)
Date:   05-13-02 21:18

Caroline, sometimes your specialist can help you find the medical library he/she uses. This is especially true if he/she is located at a teaching hospital. Failing that, any University with a medical department has a med library. Sometimes they are hard to find, like at UCLA, but almost all of them allow visitors from the community, or membership for nominal fees. You can't borrow magazines, but you can photocopy them.

..Trevor..

 
 Re: Fatigue
Author: Belinda (---.dsl.rcsntx.swbell.net)
Date:   05-14-02 08:49

Trevor,

I have visited a couple of medical libraries in the past few years. In the states, any medical school associated with a state university will probably have a library which will welcome you. That is because they are funded by tax dollars.

It's a good idea to call the medical school library to see whether they will allow community members access to their collection and how that works. Visitors are usually required to sign in at the front desk and wear a badge. Medical schools usually have a large campus in metropolitan areas, so it will be easier if you also ask for library hours, directions to the building and non-student parking before you go.

When you sign in at the front desk, ask for instructions for using the library's journal collection and the copy machine. You usually need small bills to purchase a copying card. Turn in your identification badge before you leave.

Belinda

P.S. Print out all the information about the references to articles you want before you go. Having those in your hands makes finding the articles easier.

 
 Re: Fatigue
Author: Rainey (66.137.171.---)
Date:   05-23-02 14:51

Hello, I've been taking pred for five years and Imuran for four years. Can the Imuran cause the fatigue? Can it also cause reduced kidney function, I have a appt with a Nephrologist in June because of the kidney function. Have been trying to find out what could cause this. I know that high amount of asprin can effect your kidneys, and of course the Sarc. Guess I find out in a few weeks, maybe. You have a very informative site and I really enjoy it.
Rainey

 
 Re: Fatigue
Author: Cher (144.138.225.---)
Date:   05-24-02 10:43

Hi Rainey,
Personally I have never tried Imuran but I know that since before my diagnosis I have suffered from extreme Fatigue. I was told at one stage that I probably had Chronic Fatigue Syndrome but that was quite a few years before dx.
I also know that Steroids can especially do all sorts of harm to the kidneys & liver.
I used to do alot of overtime at work but that stopped about 3 years before dx. I now have trouble doing my 8 hour shifts & am constantly thinking about going part time, night shifts knock me out for a good week & that is only after 2 of them, (it's only the debt I am in that keeps me going, I can't bare the thought of giving up my home). Unfortunately I do have to take alot of time off work (but here in Australia we get paid sick leave (14 days a year) & we can also use our annual leave if we have a Dr's certificate) luckily I have yet to have any time off without pay because we get paid vacation leave of at least 4 weeks every year.
After all that my point is that you are not alone, my friends that i have met through Sarc can all attest to the fact that Fatigue is one of the symptoms that we all have in common.
So Cheers & stay positive ...
Cher

 
 Re: Fatigue
Author: Marilyn (---.nas.onetel.net.uk)
Date:   11-12-03 22:13

I was diagnosed in 1985 with Liver sarcoid...fortunately by the time all tests were finished I had gone into remission so was never on steroids....however the constant and worsening fatigue has been terrible.Last year my eyes got it...sarcoid uveitis with cystoid macular oedema.steroid eyedrops brought on raised eye pressure so drops for glaucoma..I self medicated with extra vitamin C and E plus a spray of Lutein and within a few months am now off all medication.
I also have early osteoporosis and am taking a calcium,magnesium, vit D and boron tablet plus other suppliments recommended by a nutritionist.
I am wondering if the anti bacterial antibiotics would be useful for the ever worsening fatigue,aches and pains etc. Has anyone tried it under medical care? The NHS hospital in london which I attend has never mentioned this treatment, although they did offer me blood infusions which I refused.
I live on the southcoast near Brighton , I wonder if anyone knows of an MD/( nutritionist ) qualified to help. Many thanks in advance ..........Marilyn

 
 Re: Fatigue
Author: Pippit (---.aep.bellsouth.net)
Date:   11-13-03 00:28

Marilyn,

You have come to the right place for help. Benicar (an ARB which also controls inflammation) will be very helpful to get things under control. Start this for 2 weeks by itself at 40 mgs. 3 times a day (every 6-8 hours) and I think you'll be pleasantly surprised at how much better you feel.

In Sarcoidosis Vitamin D levels are likely to be too high and make the symptoms worse, so you should take all sources of vitamin D and calcium out of your diet. Calcium and Vitamin D supplements are not good for you either. These will actually make you flair worse. It is better to stay out of the sun for awhile too as the vitamin D from the sun is something sarcoidosis patients are particularly sensitive to.

It is possible that the steroid eye drops affected your bones even though they were local. Obviously your eyes reacted immediately in an adverse way. It doesn't take much steroid to cause side-effects.

Minocycline should be started at 25 or 50 mgs. every other day once you've been taking the correct dosage of Benicar for two weeks. This will start to kill the bacteria that are at the root of the disease and you'll temporarily feel worse ( referred to as Herxheimer) but don't panic; this is just temporary and only signifies that the toxins released by the dead bacteria are flushing out of your body. You can look at it like when you have an immunization and you get a little bit of toxin in your system but it goes away. This is what's supposed to happen and is not an allergic reaction. It means it's working. The Benicar will make this alot less intense by putting up a blockade, and if you find that the herx is getting too much for you you can take the Benicar slightly closer together and that should help.

Meanwhile take a look at the papers for doctors and patients on the front page and print them out for your doctor. This will give him a basis for which to prescribe these medications to you and describe the science showing how and why this works.

Once bacteria is imbedded in the cells of your immune system at a level that causes Sarcoidosis the only way to truly get rid of them is with these antibiotics. You should see results fairly quickly but the entire result takes time just as any medication does, so be patient. Part 2 is when Azithromycin is added but that's awhile down the road. Trevor has discovered that the two antibiotics work especially well together.

Read through the posts of others and you can track our success for yourself, and if your doctor is willing have him look through the site as well.

I've been on this about a month now and I have much more energy, almost all my pain has gone away, I breathe better, and I'm more alert. Before I started this protocol I was in bed all day every day. Now I only have to take naps at times, and sleep more the first few days after I increase my dose.

Please let us know how it goes with your doctor and if he has any questions Trevor, or I, or one of the nurses will be glad to help.

Pippit

 
 Re: Fatigue
Author: bpeck (---.co.us.ibm.com)
Date:   11-13-03 04:55

Pippit:
Do the abx make you sleepy (as opposed to fatigued).?
Barb


Pippit wrote:
Now I only have to take naps at times, and sleep more the first few days after I increase my dose.

 
 Re: Fatigue
Author: Pippit (---.aep.bellsouth.net)
Date:   11-13-03 17:09

Barb,

Sometimes sleepy but sometimes the fatigue does come back when I'm having more herx. I recently went up on my dosage of Minocycline from 50 to 75 mgs. and I have been having some more fatigue and a little achiness in my shoulders and my lungs. But the interesting thing is that when the herx wears off I feel more rested and energetic than before.

I feel so much better than I did in the beginning!

I hope your experience is going well too.

Pippit

 
 Re: Fatigue
Author: Marilyn (---.nas.onetel.net.uk)
Date:   11-13-03 23:43

pippit.....Thank you for replying, GU3 is not too far away so I will appreciate the name of the doctor you may know of....have you seen this doctor yourself?....Marilyn

 
 Re: Fatigue
Author: Pippit (---.aep.bellsouth.net)
Date:   11-14-03 00:24

Marilyn,

Did you get my e-mail? I live far away from there but this doctor was recommended by someone who has been on this sort of treatment. Provide him the information about Trevor's protocol, especially the paper above about dosing issues, and ask him to impliment it in its entirety.

Let us know how it goes

You're taking the first important step towards getting well.

Pippit

 
 Re: Fatigue
Author: Margo (---.dsl.intrex.net)
Date:   11-16-03 18:39

Pippit,

I think you are mistaken in your recommendation to remove sources of calcium from the diet. Sarc patients should avoid vitamin D in the diet.

The recommendation is to remove vitamin D from the diet, including dietary supplements that contain vitamin D and calcium, and milk enriched with vitamin D. Dairy products that are not enriched with Calcium or Vitamin A are okay, as long as there is no Vitamin D added to them.

My daughter, who is unable to tolerate dairy foods, takes calcium supplements (which contain NO vitamin D). She doesn't consume enough other food sources of calcium to get her 1500mg a day.

Margo

 
 Re: Fatigue
Author: Sue (---.ssa.gov)
Date:   11-18-03 10:02

Pippit,

Just wanted to comment on your reply above. I've been taking the Minocin for about 5 months now, I take 100mg with the 40 mg of Benicar, should be moving up to 150 this week. But what I wanted to say is that my shoulders are really where I get a lot of herx, especially my left shoulder. When I went to JHU here in Baltimore I learned that the lungs actually extend up into the shoulders so I wonder if it is actually the lungs or the shoulders. I get some energy spurts now and I'm able to clean house but that fatigue always comes back. I tried Xmas shopping on Sunday, for about 2 hrs. and paid dearly on Monday. In the beginning before I was diagnosed, I had terrible stabbing pains and I have not had them for months until yesterday. They were in my left ribcage and I was in tears it was so severe. Fortunately they did not last for very long. Have you experienced that? It seems my left side is always the worse. Today I'm just weak, and especially the shoulders. Sometimes the fatigue is like I'm unable to carry myself up a flight of stairs but other days its like a weakness affecting, again, my shoulders and neck. Do you feel the same?

Sue

 
 Re: Fatigue
Author: Pippit (---.asm.bellsouth.net)
Date:   11-18-03 15:40

Hi Sue,

Are you taking the Benicar ever 6-8 hours? I am finding that I sometimes have to take it slightly more often than that or cut back slightly on the antibiotic. I also have noticed that if I take a teaspoon of lemon juice when my herx gets really bad it acts as an antedote within 5 minutes or so. I also tend to have it in my left shoulder but I think the inflammation may be in alot of places. It's just that some areas hurt worse than others.

I used to have stabbing pains in my chest and sometimes in my lungs when taking a deep breath, but that was just in the beginning, and the Benicar got rid of it. They may be herx if you are having them now on a higher dosage of antibiotics. I think Trevor would recommend not going up to 150 mgs. if you're having these types of symptoms. (He can add to this or elaborate if he needs to). I think he usually tells people to make sure they are having no herx before moving up to a higher dose.

I do sometimes have fatigue such as what you're referring to but recently I seem to have the opposite. I right now seem to be having nervous energy.

Pippit

 
 Re: Fatigue
Author: Kevan (---.pacificinsight.com)
Date:   11-19-03 12:36

Hi Pippit
Strange that you mention nervous energy. Just recently, only over the last 2 weeks i have had an unusual amount of nervous energy. I have never had this symptom before and i felt like I couldn’t settle down and relax because of this nervous energy. My wife even commented on my constant fidgeting “like I was nervous” . However, today its back to fatigue again.
Ive been on the minocin for about 9 months and I do not take any arbs.

Is this recent symptom for you?

Regards
kev

 
 Re: Fatigue
Author: Pippit (---.asm.bellsouth.net)
Date:   11-19-03 21:11

Kev,

Yes, it is recent for me too. It seems worse when I'm motivated to do something and have to hold off. I'm a highly motivated person as it is and now that I have energy again I don't quite know where to put it. Maybe it's just an adjustment process, and hopefully a sign of progress. I guess it is better than having fatigue all the time. I have a feeling of wanting to do everything right now. What seems to help that dissipate is to be highly engaged with people in deep conversation or working intensively on a project with others. That keeps me more focused. I think it can be channeled into alot of productivity if the conditions are right. I feel that I am much more aware of subtle nuances that I might not have been when my Sarc was worse. This is a double-edged sword and I guess could best be described as a heightening of all the senses. I don't think I would want the fatigue back but there are times when I wish I could turn the awareness down a bit.

Pippit

 
 Re: Fatigue
Author: Kevan (---.pacificinsight.com)
Date:   11-20-03 08:39

Hi Pipit
Yes, that’s exactly how I am. I too am highly motivated and I was a very high energy type of person needing lots of stimulation. I still get lots of fatigue but it is broken up more frequently with short periods of this nervous energy. This is a new thing and I take it as a good sign. I find I get very stressed when I get the energy. I get tight knots in the back of my neck. I believe its because I want to make use of it, run, bike, hike, socialise, be normal in other words. But I am scared in case I make myself feel ill and so spoil the moment. How ever, in spite of the physiological issues I am glad of the increase in energy. I can describe it as having more energy to do light house duties but not enough for long walks that I dearly miss. It is an improvement.

Regards
kev

 
 Re: Fatigue
Author: Karen (---.mtnk.rnc.net.cable.rogers.com)
Date:   11-20-03 11:19

I cut virtually all sugars ( except for fruit and honey added to my cereal) out of my diet and I stay away from all preservatives and additives to food, and my energy levels have soared. I can recommend that you give this a try, as it can only be beneficial to your health, anyway. I also try and eat as much organic food as I can and steam and bake mostly, as opposed to microwaving and BBQing. Access Dr Mercola's site and see what he has to say as well.

I hope all of your energy levels will soon be right up there, too!

 
 Re: Fatigue
Author: Donna (---.jan.bellsouth.net)
Date:   11-20-03 14:31

When I get up in the morning I have energy, but as the day goes on I get to where all I want to do is sit. I see so many things around me that need to be done, but don't have enough energy to complete them (I have fallen behind in my cleaning). My muscles seem to do okay for awhile, but get very tired after about 3 hrs of working. When I get home from work and sit down....I seem to fall asleep almost immediately. I have tried hot tea and coffee doesn't agree with me, but it does not even help. I feel so frustrated with myself.

Any suggestions?
Donna

 
 Re: Fatigue
Author: Admin (---.vnnyca.adelphia.net)
Date:   11-20-03 16:44

Donna,
Random thoughts:
Are you still on Benicar 40mg every 6-8hours? Maybe you should lower your minocycline? Are you strong enough to try Z+M yet? Have you tried frequent hot (very weak) Jasmine green teas (Trader Joe's brand or Dynasty brand)? Are you getting a good daily complement of vitamins and minerals?

..Trevor..

 
 Re: Fatigue
Author: Pippit (---.aep.bellsouth.net)
Date:   11-21-03 00:39

Donna,

Rosemary also helps if you put alot of it into your cooking.

Pippit

 
 Re: Fatigue
Author: Donna (---.jan.bellsouth.net)
Date:   11-21-03 07:35

Trevor,

I'm still on the Benicar, 30 mg every 8 hrs. When I tried to go to the 40 mg my blood pressure dropped really low and I did not feel good. My minocin is back up to 100 mg, although I opened up the capsule and tilted the dosage some (a little) this last week. My doctor does not want me backing down to 50 mg minocin again (I told him that he is rushing me to much.) My heximer is not as bad as it was the first 8 wks. It shows up in my muscles, breathing and some abdominal pain (not as bad now). This weekend I had pain in & behind my right breast that would come and go. I have learned to check for swollen lymph nodes (they come and go).

I do not take any supplements at all. I used to be able to take 1/4 of a B-Complex 50 mg tablet, now they make me sick feeling and very nervous. Vitamins C & E do not agree with me either. The doctor gave me some slow release iron tablets, usually they make me feel much better, but lately I have felt worse after I take them (this is puzzling). I try to eat well, but its tough (dinner - good, breakfast and lunch - not real good). I stay away from fast food as much as possible. Should I be taking a multivitamin supplement? I will try the Jasmine green tea.

Pippit I will try the Rosemary, but could you send me an e-mail and describe how you use it in cooking. I'm not familar with Rosemary.

Donna

 
 Re: Fatigue
Author: Admin (---.vnnyca.adelphia.net)
Date:   11-21-03 08:00

Donna,
There is no difference in blood pressure effect between 30mg and 40mg of Benicar. That is in the FDA data. It is pretty clear to me that the benicar is not doing a complete blockade on you yet, and it seems that as you get towards complete blockade you go unstable.

This is probably because your minocycline dosage is waaaaay to high. If Doc is concerned about this why doesn't he call me? I answer every call from Docs, and I get quite a few. I would advise Doc to let you stop the minocycline for a while and get stable on the benicar.

Iron (ferritin) is accreted into activated sarcoid macrophages. Provided you get a reasonably balanced diet you are only messing with nature by trying to supplement iron. The anemia your Doc sees is common in inflammatory disease, and it is because the ferritin is accreted onto activated inflamatory macrophages. Iron and Folic Acid have a role in the immune system, and are best not supplemented in immune disease. Note that Folic Acid is in 'enriched' flour - use wholemeal for a while...

..Trevor..

 
 Re: Fatigue
Author: Caroline (---.win.org)
Date:   12-01-03 21:35

hi pippit,
i just read your post of 11-18. you said lemon juice is helpful to you. i might be wrong but i think lemon juice is an electrolyte. do you think your electrolytes are possibly low? we are supposed to drink so much water, sometimes low lytes are an end result? this is purely speculation on my part. i know drinks such as pedialite rezlly perk up my grandkids when they are feeling poorly.
caroline

 
 Re: Fatigue
Author: Pippit (---.asm.bellsouth.net)
Date:   12-02-03 12:56

Hi Caroline,

Not as far as I know. I think it works by cutting back the level of antibiotic in your system. I had provided a link sometime back in the thread called Tribulations of Being on Minocycline where this remedy was suggested to reduce Herx. I've seen it a number of places. It is usually recommended to mix olive oil and lemon juice but I find the lemon juice by itself works just as well (usually). The last really bad herx I had it didn't touch it. I'm not sure why.

Pippit

 
 Re: Fatigue
Author: Meg (---.115.74.164.euc.wi.charter.com)
Date:   12-02-03 21:10

Hi Caroline,

Good thinking, but I don't believe that lemon juice contains any of the usual electrolytes. You might consider the fact the Pedialyte is loaded with refined sugar which may account for the perky grandkids!

Meg

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Historical perspective on Sarcoidosis:


  1. The John's Hopkins Vasculitis Center: Prednisone Side Effects (incl. PHOTOS and PHOTOGRAPHS)
  2. Steroid-Treated patients Have higher risk of Cardiac problems
  3. "Evidence Growing That Inhaled Steroids, Like Steroid Pills, Can Cause Bone Loss"
  4. "Corticosteroids contribute to the prolongation of the disease by delaying resolution"
  5. "No data to suggest that corticosteroid therapy alters long-term disease progression"
  6. Cochrane Review - "Oral and Inhaled Corticosteroids have no discernible effect on lung function"
  7. Prednisone Improves Symptoms but not Lung Function in Sarcodiosis
  8. There is no conclusive evidence that corticosteroids affect the development of irreversible pulmonary damage
  9. Clinical Guideline For Treatment Of Arthritis Pain
  10. Angiotensin II receptor on BALF macrophages from Japanese patients with active sarcoidosis

Go to the Sarcoidosis Information Discussion Info Message Board Forum

Sarcoidosis


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