Batch

Hey Bridge, Interesting observation and great question. Over the last 9 years providing outreach on the benefits of vitamin D3 at a minimum of 10,000 IU/day plus Omega-3 fish oil and the vitamin D3 cofactors as an effective CH preventative, we've discovered situations similar to yours. We've found that infections (viral, bacterial and fungal), allergic reactions, trauma and surgery all contribute to an increase in the frequency, severity and duration of CH even when taking vitamin D3 at a dose of 10,000 IU/day. Digging into the causality, it appears that any medical condition that triggers inflammation and activates the immune system, consumes serum 25-Hydroxy Vitamin D3 [25(OH)D3] rapidly frequently leaving too little serum 25(OH)D to prevent CH. The best course of action for bacterial infections is to take an antibiotic. The big problem in doing this is nearly all antibiotics are indiscriminate, so kill off the friendly colonies of bacteria living in our GI tract called the microbiome. As the microbiome plays a key roll in our immune system, keeping it healthy is important. Accordingly, we've found that it's best to start a course of probiotic ASAP after treatment with the antibiotic is complete. We've also found that increasing the vitamin D3 dose in a range from 15,000 IU/day up to 25,000 IU/day elevates serum 25(OH)D sufficiently to counter most viral infections. 6 to 8 grams a day of vitamin C is also helpful in combating viral, bacterial and fungal infections. Hope this helps explain your observation. Take care and please keep us posted V/R, Batch

Hey Ryan, Understand the cluster headache beast has been jumping ugly on the back of your eye and side of your face on one side of your head. If you want to stop this beast from doing a scrum inside your head and get back on the playing field, I've sent you a PM with the "How To." Take care and please keep us posted. V/R, Batch

Hey Jeler, Thanks for the feedback on your CH and lab data. What brand/type of vitamin D3 are you taking? Having worked with over 100 CHers a year taking this regimen since December of 2010, your best bet is to continue your present dosing with this regimen and test again in 3 months. It's important to ask your PCP/GP to order labs for your 25(OH)D, calcium and PTH to get a good sensing of your calcium homeostasis. Take care, V/R, Batch

Hey Kat, The liquid softgel vitamin D3 will work just fine. There's no need for additional calcium as long as you're taking the Kirkland brand Adult 50+ Mature Multi. It is formulated with 230 mg of calcium and coupled with normal dietary calcium, you should be OK. Remember to double the magnesium dose to 800 mg/day during the 12-Day accelerated vitamin D3 loading schedule. Split the dose to 400 mg magnesium in the morning with breakfast and the other 400 mg with the evening meal. Doing this should reduce the probability of osmotic diarrhea. Take care and please keep us posted. V/R, Batch

Hey Kat, I'll echo CHfather's comment to start the anti-inflammatory regimen now. You'll need a round of labs for your serum 25(OH)D, calcium and PTH after 30 days on this regimen anyway. We can reverse engineer your 25(OH)D3 results to come up with an estimate of your starting concentration. I'm in the process of updating the posted version of this treatment protocol on my webpage at VitaminDWiki at the following link with a change in the suggested type/brand of vitamin D3 from the oil-based liquid softgel 5,000 IU vitamin D3 formulations to the Bio-Tech D3-50 50,000 IU water soluble vitamin D3 capsules. http://www.vitamindwiki.com/tiki-download_wiki_attachment.php?attId=7708 I and many other CHers have found the Bio-Tech D3-50 to be faster acting with a higher bioequivalence than the liquid softgel formulations at the same dose. What this means is more CHers respond faster to this treatment protocol. The following photo illustrates the supplements I take. You can order these supplements from amazon.com and iherb.com whichever has the best price. I'd like to point out that at 22 cents per capsule taken once a week, the cost of this form of vitamin D3 is ~ 3 cents/day. Two of the 5,000 IU liquid softgels cost 12 cents a day. Dosing with the Bio-Tech D3-50 is different when it comes to the maintenance dose. I've been taking one (1) of the Bio-Tech D3-50 capsules a week. I think this is a good starting maintenance dose after the 12-Day accelerated vitamin D3 loading schedule illustrated in the following notional graphic. As you can see, the 12-Day vitamin D3 loading schedule at 50,000 IU/day for 12 days elevates serum 25(OH)D far more rapidly than just taking a maintenance dose of 10,000 IU/day which can take a month or more to elevate your 25(OH)D to a therapeutic level capable of preventing your CH. Taking the 12-Day accelerated loading schedule means you elevate your serum 25(OH)D to a therapeutic level faster for the expected reduction in CH frequency or complete cessation of CH symptoms. You may need to lower the vitamin D3 maintenance dose following the 30 day labs by adding an additional day or more between doses from one 50,000 IU capsule a week to one capsule every 8, 9 or 10 days. The key is frequent lab tests until you reach a stable dose and 25(OH)D response as you'll see in the following charts of my labs for 25(OH)D, calcium and PTH over the last 3 years. My PCP has no problems with my 25(OH)D3 concentrations this high as long as my serum calcium remains within its normal reference range. As you can see, it has. It's normal for PTH to be at the low end of its normal reference range when serum 25(OH)D is above 100 ng/mL. What you need to avoid is taking the PTH to zero by pushing your 25(OH)D too high like > 190 ng/mL. Like anything else, if the parathyroid glands sense there's no need to produce the PTH, they will eventually stop expressing this hormone and that would not be good. Regarding the efficacy of this regimen in preventing the other TACs, I don't have any concrete data. That said, as these TACs share much of the same pathogenesis with Calcitonin Gene-Related Peptide (CGRP) and Substance P (SP) playing major roles in neurogenic inflammation and nociception (pain) common to All TACs including CH, it's not unreasonable to expect vitamin D3 and its cofactors will help lower the frequency, severity and duration of the other TACs like it does for CH by down-regulating the expression of these two neuroactive peptides. There's really no harm in trying. Regarding the anti-inflammatory regimen acting as a CH abortive, it's really a matter of response times. We expect abortives like subcutaneous sumatriptan succinate to abort a CH in a matter of 5 to 10 minutes and nasal spray of same in 10 to 20 minutes. A single oral dose of 50,000 IU of vitamin D3 can produce a marked reduction in CH frequency in as little as 12 hours so it's more a preventative than abortive. That said, several of us are working on an inhaled formulation of micellized (water soluble) vitamin D3 nano mist or nasal spray as a potential abortive. It's too soon to tell, but I suspect this method of administration will be faster acting in terms of reducing CH frequency and possibly aborting CH. I hope this covers your questions. Please keep us posted as you start this regimen. Take care, V/R, Batch

Hey Darren, Zookah gave you the best advice. Your healthcare system in Canada does not cover routine 25(OH)D lab test unless there's a potential medical emergency. You can try telling your PCP/GP or neurologist you're taking 50,000 IU/day vitamin D3 and want to make sure it's not causing hypercalcemia, a.k.a., vitamin D3 intoxication/toxicity. If your PCP/GP is on the ball, he'll order a lab test of your serum calcium as well. If that doesn't work, you can order a DIY 25(OH)D home blood spot test kit from GrassrootsHealth at the following link. They will ask you to join their D*Action program and register (it's free). The D*Action program tracks people taking vitamin D3 with a questionnaire and 25(OH)D lab tests. The charge for the home 25(OH)D lab test is $65 USD. I've used it many times and keep a D*Action test kit on my desk at all times. https://grassrootshealth.net/project/order-home-test-kit/ The assay method used for this DIY home test for 25(OH)D is called LC-MS/MS (liquid chromatography dual mass spectroscopy). This is the only assay method I suggest as it's capable of measuring total 25(OH)D serum concentrations up to 512 ng/mL, where the DiaSorin assay method, chemiluminescent immunoassay (CLIA) is only good up to 117.4 ng/mL. This is important as many CHers need to elevate their serum 25(OH)D above 120 ng/mL to experience a CH pain free response to this regimen. Regarding the safety of the anti-inflammatory regimen including the 12-Day accelerated vitamin D3 loading schedule... It's very safe. I've been providing information outreach on the this regimen since December of 2010. I estimate over 2000 CHers have started this regimen since then and I've yet to see a CHer report hypercalcemia as a result of following this CH preventative treatment protocol. The anti-inflammatory regimen is so safe I also have the rest of my family including three grand kids on this regimen and none of them have CH. The kids get a vitamin D3 dose of 50 IU per pound of body weight per day. For reference, I've had to take average doses of vitamin D3 up to 40,000 IU/day due to allergic reactions to pollen and mold spores in order to remain CH pain free. This has driven my 25(OH)D well above the 100 ng/mL upper limit of the normal reference range for this lab test as you'll see in the following chart of my lab results for 25(OH)D, calcium and PTH over the last 3 years. My PCP is OK with my 25(OH)D serum concentration this high as long as my serum calcium remains within its normal reference range... and as you can see, it has. I'm 75, in good health, and I don't take any Rx medications. It appears you've read enough about this treatment protocol to know that you'll need a second set of labs for your serum 25(OH)D, calcium and PTH when you've been on this regimen for at least 30 days. This is one of the reasons it's very helpful to have your PCP/GP or neurologist working with you in a team effort as you start this regimen. Accordingly, it may be helpful if you download a copy of the treatment protocol at the following link and take it to your PCP/GP or neurologist when you ask for the 25(OH)D lab test. http://www.vitamindwiki.com/tiki-download_wiki_attachment.php?attId=7708 It's interesting to note that readers of my web page at VitaminDWiki.com have downloaded over 34,000 copies of the above treatment protocol since I put it up online in January of 2017. When you have the results from this second set of labs in hand, please try to take the online survey of CHers taking this regimen. I'm using the results as part of a study to help neurologists and headache specialists become aware of the benefits of this treatment protocol so more CHers can experience the wonderful sensation of CH pain free life. To start this survey, click on the following link: http://www.esurveyspro.com/Survey.aspx?id=fb8a2415-629f-4ebc-907c-c5ce971022f6 Thanks, take care and please keep us posted. V/R, Batch

Hey Jost, Thanks for the feedback and sorry you're having a rough time. I'll be updating my web page at VitaminDWiki as soon as I get some feedback on the protocol update from a few vitamin D3 experts and neurologists who treat CHers and migraineurs with vitamin D3. I've been to Phoenix in the August time frame, so don't envy your situation with the temperature. Infections and allergies consume serum 25(OH)D rapidly, frequently leaving too little remaining to prevent CH or migraines. The best course of action reported by many CHers when they encounter infections is to load vitamin D3 for 3 to 4 days and increase their vitamin C intake to at least 6 grams/day. Allergies require a week to 10-day course of a first-generation antihistamine like Benadryl (Diphenhydramine HCL) taken at 25 mg every four hours throughout the day. (Loading vitamin D3 = taking a loading dose of 50,000 IU/day vitamin D3 for a few days to elevate serum 25(OH)D3 rapidly to a therapeutic serum concentration). The following notional graphic illustrates the advantage of a 12-Day accelerated vitamin D3 loading schedule over just taking a maintenance dose of vitamin D3. By "loading" you get to a therapeutic 25(OH)D3 serum concentration in 12 days where taking only a maintenance dose of 10,000 IU/day vitamin D3 could take upwards of one to two months to start experiencing a favorable response to this regimen with respect to CH or a viral infection. Unlike bacterial infections that require an appropriate antibiotic, there are no silver bullets for viral infections. Accordingly, in the case of a viral infection (colds and flu) bumping the vitamin D3 and vitamin C doses is the best and safest course of action. Taking these vitamins helps your body's immune system resolve a viral infection faster and more effectively. Taking an antibiotic for a viral infection is not only ineffective, antibiotics by their very nature are indiscriminate, so also kill off the friendly colonies of bacteria living in the GI tract called the microbiome. As most of our immune systems reside in the GI tract, keeping the microbiome "happy" is prudent. If your doctor has prescribed an antibiotic, be sure to start a course of probiotic as soon as you've completed the antibiotic. Regarding migraine headache... The basic anti-inflammatory regimen supplements as illustrated in the following photo by brand and maintenance dose help many migraineurs starting this regimen prevent their migraine headaches. Most of us taking the Bio-Tech D3-50 water soluble (micellized) 50,000 IU vitamin D3 capsules have found one (1) D3-50 capsule a week is an effective maintenance dose. It's always a good idea to see your PCP/GP or neurologist for lab tests of your serum 25(OH)D, calcium and PTH. Without knowing your 25(OH)D serum concentration, you're shooting in the dark at an appropriate vitamin D3 loading dose or where you are with respect to target 25(OH)D serum concentrations. For example, data from the online survey for CHers and other sources for migraineurs indicate the following mean 25(OH)D serum concentrations resulting in a significant reduction in headache frequency or complete cessation of headache symptoms. For practical purposes, the following 25(OH)D3 concentrations become the initial targets when starting this treatment protocol. Mean 25(OH)D Serum Concentration among Episodic CHers - 80 ng/mL Mean 25(OH)D Serum Concentration among Chronic CHers - 90 ng/mL Mean 25(OH)D Serum Concentration among Migraineurs - 120 ng/mL The following normal distribution of 25(OH)D3 lab test results from the online survey harvest in July of 2018 tells an important story CHers and Migraineurs need to understand. The green normal distribution curve illustrates the mean 25(OH)D3 serum concentration response of 80 ng/mL to an average vitamin D3 dose of 10,000 IU/day. What this also indicates is half of the CHers (Episodic and Chronic) responding to this regimen needed a higher 25(OH)D3 concentration for a favorable response. The blue S-shaped sigmoid curve illustrates the cumulative probability. As it's clear from the 25(OH)D responses, up to half of CHers starting this regimen, took a higher maintenance dose of vitamin D3 than 10,000 IU/day to experience a favorable response. That makes the blue sigmoid curve a reasonable dose response curve. In simple terms, a higher vitamin D3 dose results in a higher 25(OH)D3 serum concentration needed for a favorable CH response. For reference and regarding safety of vitamin D3 doses > 10,000 IU/day and high 25(OH)D serum concentrations > 100 ng/mL (250 nmol/L), I've maintained my serum 25(OH)D between 130 ng/mL and 188 ng/mL over the last three years due to allergic reactions to pollen and mold spores with no problems. My PCP is ok with my 25(OH)D serum concnetrations this high as long as my serum calcium remains within its normal reference range. As you'll see in the following chart of my lab results... it has. Besides a higher 25(OH)D serum concentration between 120 ng/mL and 150 ng/mL, most migraineurs will need some or all of the following supplements for a pain free response. o 300 to 900 mg/day CoQ10 (300 mg 3 times a day). CoQ10 is a must for CHers and migraineurs if taking statins o 3 to 6 grams/day liposomal vitamin C (1000 to 2000 mg with breakfast, lunch and dinner) o 1000 to 2000 mg/day Turmeric (Curcumin). o Probiotic with a high colony forming count containing a variety of Lactobacillus acidophilus, Lactobacillus plantarum, Bifidobacterium bifidum, and Streptococcus thermophilus. o 300 to 600 mg/day Alpha-Lipoic Acid (ALA) o 500 mg/day Resveratrol o 500 mg/day Quercetin o 3 to 6 grams/day L-Lysine I take the first three of these supplements daily for good health and to keep my 75 year-old heart ticking. Regarding oxygen therapy. Too many neurologists and most PCP/GPs have never treated a patient with CH so are unfamiliar with the Standards of Care recommended interventions (abortives and preventatives) for CH that list oxygen therapy as the first abortive of choice at 15 liters/minute. The rest have been brainwashed by the Big Pharmas that oxygen therapy is ineffective for cluster and migraine headache and that the very expensive patented pharmaceuticals (read sumatriptan succinate [Imitrex] and its derivatives) are very effective. What you need to do is print out the EFNS guidelines on the treatment of cluster headache and other trigeminal-autonomic cephalalgias by the God Squad of neurologists, expert in treating patients with CH and who are also members of the ICHD 3 working groups for CH and other TACs. They include: A. May, M. Linde, P. Sandor, S. Evers and P. Goadsby. You can download a copy at the following link and take it to your neurologist when you ask for an Rx for oxygen therapy as an abortive for your CH. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1468-1331.2006.01566.x You can also download and print out the following link for: Treatment of Cluster Headache: The American Headache Society Evidence-Based Guidelines. https://www.ncbi.nlm.nih.gov/pubmed/27432623 Results and Recommendations: For acute treatment, sumatriptan subcutaneous, zolmitriptan nasal spray and high flow oxygen remain the treatments with a Level A recommendations. I hope this slayed all the dragons making it difficult for you to control your CH and MH... Take care and please keep us posted. V/R, Batch

Brain on Fire, Great idea, wrong audience. I teamed up with two Top Gun heavy hitter neurologists from American Headache Society, Dr. Deborah Friedman, MD, MPH, FAAN and Dr. David Dodick, MD in 2009 to overturn the CMS non-coverage determination that prevents Medicare beneficiaries from obtaining oxygen therapy as an abortive for cluster headache. We assembled what we thought was significant body of medical evidence attesting to the efficacy and safety of oxygen therapy as a CH abortive. It included all the known studies, papers by Dr. Lee Kudrow, MD and other noted neurologists with hundreds of years accumulated experience with oxygen therapy as an effective abortive for patients with CH. Unfortunately, the unelected, monkey-ass bureaucrats at CMS/OCSQ (Center for Clinical Standards and Quality) rule the roost when it comes to non-coverage determinations. They wouldn't listen to real medical evidence and logic if it was coming from the burning bush or bit them on the ass. They methodically disqualified every study provided for not adhering to all the latest rules of medical evidence then pronounced there was insufficient medical evidence to reverse the existing non-coverage determination for home oxygen therapy for Medicare and Medicaid beneficiaries with CH. Congress and your local representatives? NFW! The probability of finding meaningful support for our cause in Congress in the form of favorable legislation for oxygen therapy, ranks right up there with finding a snowflake in hell. As soon as most politicians are elected they get a lobotomy followed by a chemical memory eraser. They have only one goal after being elected... Getting re-elected. Re-election requires money and you'll never guess who fills re-election campaign war chests with the most money. The Pharmaceuticals/Health Products industries lead by the Big Pharmas to the tune of $4.2 Trillion dollars spent on Congress over the last 20 years. https://www.opensecrets.org/lobby/top.php?indexType=i&showYear=a And, of course, the Big Pharmas don't like anything used in healthcare if its not patented for profit. Oxygen is a USP so cannot be patented. Big Pharma's solution to this problem is to have their K street lobbyists write legislation for Congress that makes it difficult to obtain home medical oxygen. This legislation is written vaguely so as to allow government agencies like HHS and their minions at CMS to write regulations making it more difficult for a physician to prescribe oxygen therapy than an Rx for opiates. Their final hammer is to make coverage determinations on what medical treatments CMS will cover. Our only solution it to go to the top and the Twitter-in-Chief, President Trump. The best way to do this is to contact the White House at the following link. https://www.whitehouse.gov/contact/ It will give you the option of "Contact the President" or "Help with a Federal Agency." Select the second option, fill in the blanks then in the final blank "What would you like to say" start out with the regulations governing home oxygen therapy for cluster headache sufferers are too restrictive to the point Medicare and Medicaid beneficiaries with cluster headache are not covered. Point out that President Trump made a promise to the American people he would help cut the red tape and restrictive regulations that make things like home oxygen therapy so costly and difficult to obtain. Give your own story in your own words like how you're forced to use Triptans like Imitrex costing $900/month for the nine shots per month covered under Medicare as an abortive but the estimated $100/month for home oxygen therapy is not covered. The average cluster headache sufferer has three of these terribly painful headaches a day, 90 a month, yet Medicare will only cover relief for 9 of these terrible headaches a month with Imitrex. Home oxygen therapy would cost much less at $90 to $100 per month and could be used for all cluster headaches not just 9 a month with Imitrex, then be forced to suffer agonizing pain during 80 more of these cluster headaches without any relief. Ask why an expensive pharmaceutical like Imitrex is covered as a cluster headache abortive for Medicare and Medicaid beneficiaries, yet USP oxygen is not. Ask if existing legislation and regulations governing coverage for home oxygen therapy has been influenced by Big Pharma to their advantage in the market place? The simple solution is to make home oxygen therapy an OTC item. This would eliminate burdensome regulations, increase competition and ultimately lower the cost of home oxygen therapy. The savings at HHS/CMS would also be huge as a large part of the CMS budget is spent administering prescriptions for oxygen and the durable medical equipment associated with home oxygen therapy for Americans with COPD. The American Lung Association (ALA) thinks there may be as many as 24 million American adults living with COPD and that doesn't count Americans with Bronchitis or Emphysema who also need supplemental oxygen. Again, use your own words. If one or two up to maybe five CHers go to this White House website and complain about home oxygen therapy, it's likely nothing will happen. If the number of hits goes above 50, they have tracking systems that will flag this topic. Then the odds of meaningful action go up big time. Take care... and Take Action. V/R, Batch

Hey RSG, CH Father gave you the right link for the anti-inflammatory regimen treatment protocol at http://www.vitamindwiki.com/tiki-download_wiki_attachment.php?attId=7708 I've made a couple changes since I posted that 2017 version. In July of 2018, I switched brands and type of vitamin D3 from the Nature's Bounty oil-based 5000 IU liquid softgels to the Bio-Tech D3-50 50,000 IU water soluble (micellized) vitamin D3. I've found the Bio-Tech D3-50 to be faster acting and more potent in elevating serum 25(OH)D than the oil-based formulations. Data from the online survey of CHers taking this regimen now supports a longer accelerated vitamin D3 loading schedule from 12-Days at 50,000 IU/day vitamin D3 to 14-Days at 50,000 IU/day. This change increases the total loading dose of vitamin D3 from 600,000 IU to 700,000 IU spread over 14 days at 50,000 IU/day for episodic CHers and 16 days for chronic CHers. This also results in a new initial target serum concentration from 80 ng/mL to 90 ng/mL for episodic CHers and from 80 ng/mL to 100 ng/mL for chronic CHers. The initial vitamin D3 maintenance dose of vitamin D3 is now 15,000 IU/day. These loading schedules and maintenance doses apply to the oil-based liquid softgel vitamin D3 formulations, If you follow my lead and that of several other CHers who switched to the Bio-Tech D3-50 50,000 IU vitamin D3 capsules as I have, the loading and maintenance doses will be different as follows. If you're an episodic CHer start this regimen with the 12-Day loading schedule at 50,000 IU/day (one of the Bio-Tech D3-50 capsules a day for 12 days) then fall back to a new initial maintenance dose with the Bio-Tech D3-50 of one (1) capsule a week. If you're a chronic CHer, start this regimen with a 14-Day accelerated vitamin D3 loading schedule (one of the Bio-Tech D3-50 capsules a day for 14 days) then fall back to a new initial maintenance dose with the Bio-Tech D3-50 of one (1) capsule a week. If you do the math, 50,000 IU divided by 7 days comes to roughly 7,000 IU/day as the maintenance dose with the Bio-Tech D3-50. Due to the increased potency of the Bio-Tech D3-50 compared to the oil-based liquid softgel vitamin D3 formulations at the same dose, this equates to an equivalent of 15,000 IU/day of the liquid softgel vitamin D3 formulations. With either type of vitamin D3, if you haven't experienced a favorable response or complete cessation of CH symptoms by the end of the loading cycle, increase the loading period by two days at 50,000 IU/day for two days then drop back to the maintenance dose. If there's still no response, within three days of the additional loading doses, you may be experiencing an allergic reaction to airborne of food borne allergens. These allergic reactions can be subclinical with no outward or obvious symptoms. In this case, start a week to 10-day course of a first-generation antihistamine like Benadryl (Diphenhydramine HCL) at 25 mg every four hours throughout the day. Just be careful and not drive as this much Diphenhydramine will make you drowsy. If you need to drive during the day, wait until you're home for the day then take 50 mg of Benadryl as you walk through the door, and another 50 mg at bedtime. If there's no response to the Benadryl after five days, discontinue as an allergy is not the likely culprit preventing a favorable response to this regimen. It's important to take all of the vitamin D3 cofactors and conutrients illustrated in the following photo. In particular, it's best to double the magnesium dose from 400 mg/day to 800 mg/day while loading vitamin D3. Take 400 mg of magnesium in the morning with breakfast and the other 400 mg in the evening with dinner. Doing this will help avoid osmotic diarrhea. The Kirkland brand Adult 50+ Mature Multi is also very important as it's formulated with most of the vitamin D3 cofactors. It just doesn't have enough magnesium or any vitamin K2 complex (MK4 and MK7). At 22 cents per capsule taken at a maintenance dose of one (1) capsule a week, the Bio-Tech D3-50 is also the least expensive form of vitamin D3 at 3 cents/day. The Nature's Bounty has a price of 6 cents per 5000 IU vitamin D3 liquid softgel or 12 cents/day for the 10,000 IU maintenance dose. It is very important to see your PCP/GP or neurologist for lab tests of your serum 25(OH)D, calcium and PTH 30 days after start of regimen. As long as you're CH pain free or have experienced a significant reduction in the frequency of your CH and your serum calcium concentration is within its normal reference range, your actual 25(OH)D serum concentration doesn't really matter. Hope all this makes sense. I'll be publishing a revised version of this treatment protocol on VitaminDWiki as soon as a few key vitamin D3 experts and physicians have had an opportunity to comment on the new protocol. Take care and please keep us posted. V/R, Batch

I'm booked... See you there. This should be a hoot! V/R, Batch

Hey DM, If the CH beast is still jumping ugly, I'd take a 50,000 IU loading dose for 4 to 5 days then drop back to a new maintenance dose of 15,000 IU/day. If there's no joy after a couple days at a maintenance dose of 15,000 IU/day, take two more days loading dose of 50,000 IU/day then drop back to 15,000 IU/day as the maintenance dose. Slow and sure is fine for a train going up grade, but not for taking vitamin D3 to prevent CH. Cut to the chase and elevate your serum 25(OH)D as fast as possible to get the CH pain free response. Glad to see you're taking the Kirkland brand Adult 50+ Mature Multi. Among its vitamin D3 cofactors is boron. Boron plays a very special role in this regimen by down-regulating 24-Hydroxylase, the enzyme that hydroxylates vitamin D3 to 1,24,25(OH)3D3. This is a genetically inactive vitamin D3 metabolite the body breaks down and eliminates in urine so down-regulating this enzyme prevents the needless loss of serum 25(OH)D. Take care and please keep us posted. V/R, Batch

Freud, Providing information outreach on RA is a little out of my comfort zone... That said, as it falls in the autoimmune category, RA should respond to vitamin D3 therapy. The only question is how high to take the vitamin D3 dose/25(OH)D response, how much the cofactors need to be increased and any additional conutrients specific to RA that may be needed. The anti-inflammatory regimen is a good place to start, but the target 25(OH)D may be well North of 120 ng/mL, like 180 ng/mL for RA. I say this as I've been there at 188 ng/mL and it depressed my PTH as expected which is good. The only issue is being careful not to depress PTH to zero as we need the parathyroids to continue functioning and not shutdown. The reason for this is simple, we need PTH to maintain calcium homeostasis that maintains serum calcium within its normal reference range. In this case, I pushed my PTH down to 10 pg/mL when the normal reference range is 14 to 64 pg/mL as you'll see in my lab results. This is no different than taking prednisone at too high a dose for too long. The adrenal glands produce the steroids aldosterone and cortisol that are essential for normal healthy physiology. If we take too much prednisone for too long, the adrenals say WTF. Why should I make aldosterone and cortisol when there's so much prednisone floating around... so they shut down. That poses a big problem when you stop taking prednisone and the reason why it is absolutely essential to taper off steroids gradually or only take steroids in short burst doses or week to 10-day tapers. I'm a pragmatist when it comes to preventing CH with vitamin D3 therapy... The expected result of taking the anti-inflammatory regimen is a CH pain free response. Accordingly, I take as much vitamin D3 as needed to stop my CH. This allows me to maintain a very good quality of life, in excellent health, free of terrible CH pain. My lab results for 25(OH)D, calcium and PTH in the following chart are a good example. On the 1st of March, 2018, I increased my vitamin D3 dose to 40,000 IU/day in anticipation of a heavy Alder tree pollen fall in April. On 20 March I had my labs done and my 25(OH)D was 188 ng/mL. As I was CH pain free I dropped the dose to 25,000 IU/day. As you can see, my serum calcium was still within its normal reference range and PTH was low. In early June, I suffered a major insult from mold spores that triggered an onerous allergic reaction (allergic rhinitis) with a flood of histamine. Histamine can make nearly every CH intervention ineffective... so the CH beast jumped ugly. An electrician had ripped out wall board to replace a 50-year-old fuse box in the house in Pelican, AK were we stay while salmon fishing each summer. Unbeknownst to me, there was a half-inch layer of mold in the wall space from years of roof leaks. Within 24 hours of the electrician's work, the stirred up mold spores had the CH beast jumping ugly at night for the first time in many years. Two days of vitamin D3 at 50,000 IU/day and 25 mg of Benadryl (Diphenhydramine HCL) every four hours had no effect. Fortunately, I had welder's oxygen available and I made a couple of my Redneck oxygen reservoir bags out of clean kitchen trash bags, so the CH hits were more of an annoyance that anything else. However, as we were getting up around 04:30 each morning to get an early start fishing, the lack of sleep had me on edge. Rather than trying to sneak up on a therapeutic response taking loading doses of 50,000 IU/day, I took 100,000 IU/day for two days. The night after the second dose of 100,000 IU/day vitamin D3, I slept CH pain free so I dropped the vitamin D3 dose back to 40,000 IU/day for the rest of my two-week stay in Pelican. I estimate my serum 25(OH)D concentration was around 175 ng/mL in June when the CH beast jumped ugly due to the allergic reaction to the mold spores. That should give you an idea how bad an allergic reaction can be to a CHer. On 1 July 2018, I switched to the Bio-Tech D3-50 50,000 IU water soluble (micellized) form of vitamin D3 taking one of the Bio-Tech D3-50 capsules every 5 days (120 hours) for an average daily dose of 10,000 IU/day. When I had my next set of labs on 12 October 2018, I expected my 25(OH)D serum concentration would have dropped from 188 ng/mL to at least 170 ng/mL. When it came back at 181 ng/mL, I was a bit surprised. As I was blissfully CH pain free, I decided it was time for one of by 25(OH)D burn down tests so stopped taking any supplemental vitamin D3, but I continued taking all the cofactors and conutrients. My 25(OH)D serum concentration was 136 ng/mL at my next set of labs on 14 January 2019, 95 days later, for a monthly 25(OH)D burn rate of 14.2 ng/mL.. As I was still CH pain free, I decided to try taking one Bio-Tech D3-50 water soluble capsules a week for an average daily vitamin D3 intake of 7,142 ng/day. At my next set of labs a little over 3 months later on 26 April 2019, the results came back at 152 ng/mL, so it was very clear the Bio-Tech D3-50 was more potent in terms of elevating/maintaining 25(OH)D serum concentration at the same dose as the oil-based liquid softgel vitamin D3 formulations. I'll cover a lot more about this regimen at the Patient Conference in Dallas. Looking forward to seeing all of you there. V/R, Batch

I get a deep clean every 3 months. I've done this for the last five years... Smartest decision I've made in that time frame. Gingivitis is an infection that can easily trigger a CH cycle for episodic CHers and increase CH frequency for chronic CHers. Unless you're among the lucky few who don't have toenail fungus, the following may help. A constant fungal infection can also trigger CH during in-cycle times. Coating the affected toenails with Vicks Vapo Rub or soaking toes in a 50:50 mixture of Listerine and white vinegar can work wonders. Vicks works for some as it contains antifungal ingredients such as camphor and eucalyptus oil. Listerine contains thymol and menthol that act as anti-fungal agents. When combined with the acetic acid in vinegar which lowers pH below where fungus survives, this combination works great. It's best to use an extra large finger cot with either method to keep the therapeutic agents on the infected area and not on sheets or carpets. Soak a tissue in the Listerine and vinegar mix, wrap it around the toe then roll on a large finger cot. A hot soak in Borax or Epson Salt can also be effective. It worked great on my horse's hoofs. Take care, V/R, Batch

Brian, Meeting other CHers for the first time at a CHer gathering like this is a very special thing... Just knowing you're not alone with this disorder is reason enough to attend. The really interesting thing is you'll meet a CHer you've never met at an event like this and in a few minutes talking with them, it will seem like you've known them for many years. I'll be there with the latest data from the online survey. Take care, V/R, Batch

Hey DM, How much vitamin D3 have you been taking as a maintenance dose? As you'll see in the following graphic a 25(OH)D response of 70 to 74.6 ng/mL is within the average response range for a vitamin D3 maintenance dose of 10,000 IU/day. The 25(OH)D response to dose of 10,000 IU/day vitamin D3 is illustrated in the following graphic of 25(OH)D lab results from the online survey of 257 CHers taking this regimen. It's displayed as normal distribution. If you're still getting hit by CH at this dose, follow the treatment protocol as it says to titrate (incrementally increase) the vitamin D3 dose until you reach a CH pain free status. Rationale: 10,000 IU/day vitamin D3 is sufficient for 80% of CHes in preventing their CH. The other 20% need a higher vitamin D3 dose or they've an infection or allergy cooking away. Infections and allergies consume available vitamin D3 rapidly. This could be the culprit keeping this regimen from preventing your CH. As suggested, taking Benadryl (Diphenhydramine), an antihistamine, can help in some cases if an allergy is the problem. Getting back to the need for a higher serum 25(OH)D concentration and titration... The fastest way to titrate the vitamin D3 dose is with two to four days at a loading dose of 50,000 IU/day then fall back to a maintenance dose of 15,000 IU/day. If there's no joy after two to three days at the new maintenance dose, repeat the loading dose for two more days then drop back to a maintenance dose of 20,000 IU/day. Feedback from several CHers who started taking the Bio-Tech D3-50 50,000 IU water soluble (micellized) form of vitamin D3 indicate this form of vitamin D3 is faster acting and more effective in preventing CH than the oil-based liquid softgel vitamin D3 formulations... Bottom line, it may help you arrive at a CH pain free status by switching to the Bio-Tech D3-50. I've been taking it since July of last year at a dose of one (1) Bio-Tech D3-50 capsule a week. This has maintained my 25(OH)D up around 150 ng/mL. The response rate to this regimen reported by CHers taking the online survey during the first 6 months of 2019 has been impressive. 90% of CHers starting this regimen are experiencing a significant reduction in the frequency of their CH in the first 30 days. If this increase in efficacy from 80% to 90% continues, I'm of the opinion it's the Bio-Tech D3-50 that's responsible. Take care and please keep us posted. V/R, Batch