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Flare-ups: Patient/Practitioner Management

Most patients will realise the importance of the healing crisis and will fret when nothing seems to be happening. Equally, when the crisis does occur, they may panic and think that the therapy isn't working or worse, that their disease is progressing. It is so important to be able to manage your patient through this process and educate the patient, so that they learn how to self-manage and to interpret accurately what exactly is happening. Many mistakes can be made by both the patient and practitioner around these periods, as the practitioner may be unsure of the type of reaction the patient is suffering from, and therefore not give appropriate advice, and the patient will interpret the symptoms negatively, reducing parts of the therapy.

The healing crisis, commonly referred to as a flare-up, may have a variety of unpleasant symptoms. The whole aim of the therapy is to increase the vitality of the body, so that it can discharge its toxic waste and rebuild. This discharge will occur through the eliminative organs (liver, genito-urinary tract, skin and mucous membranes), and symptoms will be seen in these organs, which will vary from mucus discharge (this may be inflammatory from toxic residues), spots/pimples/boils/dry skin, and most frequently in the digestive tract from the discharge of toxins via the bile system into the gastro-intestinal tract, which can cause nausea, diarrhoea, muscle spasms/pain. 

The body builds up a momentum over a period of time. This will vary from individual to individual; some patients respond within the first month, while others, particularly if they have had chemotherapy, can take five months before a flare-up occurs. The nature of each flare-up will also vary from person to person, but the patient will learn to identify their own specific symptoms, which will usually follow their unique pattern. For example, before a flare-up a patient may become emotionally unstable. Having experienced this several times, the patient may then recognise that a flare-up is about to happen. The patient will also be able to determine how the flare-up will progress and will know what steps to take to alleviate any discomfort and allow the therapy to continue. The frequency and intensity of each flare-up will lessen as time goes on.

From my experience of the flare-up, there are three broad categories of symptoms that may occur during this time: toxic reactions, detoxification reactions and healing inflammations. Being able to differentiate between them enables the practitioner and patient to manage each set of symptoms appropriately. As the body builds a momentum for healing, the patient will start to experience greater amounts of toxic release within the body. The symptoms of toxic release fall into the two categories of toxic and detoxification reactions.

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Toxic Reactions


Toxic reactions indicate toxins being pushed out of the cells, where they have been "safely" harboured for many years, into the systemic blood stream. The patient may feel foul and very toxic. They may experience headaches, nervous irritability (toxic residues of old drugs/nicotine/poisons etc. will irritate the nerve endings), mental and emotional instability, depression, an inability to concentrate or think logically (very difficult for the partner!), foul taste in the mouth with peculiar taints and odours, vivid memories from the past, possibly of traumatic situations which offers an opportunity to review a past event from a mature standpoint and so clear it; cravings for foods that are strictly forbidden (some authors suggest that these cravings are activated by the discharge of the toxins from that particular food into the system at that time - i.e. as you are discharging the toxic residues of chocolate, so you crave it), and joint and muscle pains. Muscle pain and tension may be particularly severe around the neck/shoulder and down the spine, as the shifting toxins can lodge in the muscle, creating inflammation.

Toxic symptoms are indicating to you that the liver needs additional help in filtering the toxicity from the blood stream. There is only one remedy for the toxic reaction, and that is more enemas. The patient is quick to understand this from the experience of the relief of symptoms which follows an enema. You have to be aware also that a toxic crisis can occur when the patient is eliminating a great deal of necrotic tumour tissue into the systemic circulation. Never is it more important to keep the additional enemas going through these crises. The patient must be made aware that it is dangerous to do more than 9 enemas daily over a prolonged period of say more than a few days, without taking additional juices. There is a risk of dehydration and electrolyte imbalance if too many enemas are sustained over a long period. In times of extreme toxic crisis the coffee enema may be taken at two hourly intervals over a 24 hour period, but the patient must take the additional juices.

Muscle tension and pain can be alleviated by the warm castor oil pack, which will increase circulation to the area and help to shift the toxicity lodged in the muscles.

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Detoxification Reactions


Detoxification symptoms relate quite simply to the symptoms of discharge of toxicity to the outside. Most of the symptoms will arise in the digestive tract, as this is the main route of elimination from the liver through the bile system into the duodenum and out via the colon. However, other symptoms may be felt in the other organs of elimination; foul smelling mucous discharge, skin eruptions, foul-smelling and dark urine, a greater than normal menstrual discharge, foul-smelling sweat. When these organs are carrying the additional burden, they may become prone to infection, and it is important that in the case of mucous discharge this is facilitated by using the castor oil pack over the affected areas (sinus, chest, colon area), so that infection does not set in.

When detoxification symptoms occur in the digestive tract, it can become quite difficult for the patient to maintain the therapy, as the range of symptoms in the digestive tract, as set out below, can inhibit both dietary intake and/or enemas.


NAUSEA, VOMITING, DIARRHOEA AND INFLAMMATION OF THE GASTRO-INTESTINAL TRACT
Nausea and vomiting

As the very alkaline toxic bile is discharged from the gall bladder, the patient may feel extremely nauseous, even suffering vomiting, and be unable to eat or keep anything down. Drinking copious amounts of peppermint tea will increase stomach acidity, which will mechanically flush and neutralise toxic bile from the stomach, limiting irritation to the lining. Alternatively, gruel, which is also very nourishing, will buffer either excess acidity or alkalinity, while at the same time line and protect the gastrointestinal tract against any inflammatory reaction to the caustic nature of some chemicals/toxins released. If the patient is complaining of excess acidity, then chamomile tea can replace the peppermint tea.  However, gruel is useful in both situations.

The patient may find that the nausea and vomiting worsen after an enema, and this is a prime area for a common mistake - that the enema is causing the bad reaction, and therefore they feel that they should stop the enemas for a while. The enema is actually causing the release of the toxic bile, it is assisting the liver in its role of elimination and therefore is acting in favour of the body and should not be stopped.  However, you can recommend to your patient that they take a small glass of gruel before and after the enema. This will mop up the toxic bile and help any nausea and sickness. Fortunately these detoxification reactions are short-lived (a few days) and the patient feels much restored after they have passed. If these measures are not sufficient to relieve the severity of the symptoms, and the patient is vomiting bile, then you may have to reduce the coffee enemas and replace with chamomile tea enemas, while increasing the intake of herb teas (peppermint or chamomile) and gruel.

However, you may see extreme toxic eliminations in the weakened patient or in the patient who has had chemotherapy where nothing (gruel, peppermint tea) seems to work. The juices, especially the green juice, cannot be kept down, and the patient is in a serious crisis of potential dehydration and weakening of their condition. Under these circumstances you will be looking to alleviate the whole detoxification process and your first priority will be to ensure that the patient is still taking some food. You may reduce the juices, partially or completely, and replace with 1/2 juice:1/2 gruel, or just peppermint tea and gruel. Juices may also be taken by enema, brought to body heat and retained for as long as possible (usually they will be well-absorbed in 15 minutes). The diet will consist of apple sauce, thin oatmeal porridge, mashed potato and the Hippocrates Soup. The enemas may be reduced, diluted with chamomile tea, or just consist of chamomile tea. You will need to use your common sense to do what is best for the patient and understand that pushing a debilitated patient to the point of damage and inability to undertake any of the therapy (even eating the modified diet) is bad patient management. 

Inflammation at the rectum
Toxins can cause caustic inflammation of the delicate mucous membranes which may be felt anywhere along the digestive tract, but particularly at the rectum, where it can directly interfere with the practice of the enemas. These caustic inflammations may worsen on the castor oil days, when greater amounts of toxic residue are being released. It is recommended that the patient either use a non-toxic suppository, such as Anusol, or liberally apply a baby barrier cream such as Desitin to the area to protect it from further insult and enable healing. It may be recommended to drink gruel if there are other areas of soreness along the tract.


Diarrhoea
This frequently accompanies the nausea and is due to irritation of the intestinal tract by the toxic release, causing spasms and diarrhoea. It is the body's defence mechanism to flush out toxic, irritating bile. At the outset it may be quite useful to recommend ¼ teaspoon of clay in peppermint tea along with 1/8th  teaspoon of potassium gluconate (to replace potassium losses) every 4 hours. The use of gruel will reduce caustic irritation and buffer the toxicity. The patient may notice that the green juices often "pass straight through" and complain that the juices seem to exacerbate the condition. You may recommend mixing the juices with gruel. If the diarrhoea is prolonged, then it will have adverse affects on the patient's health and electrolyte balance. You must watch this carefully and remember that the diet remains the most important part of the therapy at this stage, even at the expense of the juices and enemas.  Coffee enemas may be temporarily stopped (if the diarrhoea is excessive) or replaced by chamomile tea enemas, and the castor oil treatment will be put on hold.  Oatmeal with apple sauce or raw, grated apple often helps to alleviate diarrhoea as the high levels of pectin found in apples acts as an astringent, and will mop up excess fluid in the colon.


Problems in the Administering of Enemas
During periods of detoxification the patient may suffer additional bloating, gas and discomfort in the digestive system. This, once again, is the body's response to toxicity being eliminated through this channel.  However, it can cause problems with either the administration or retention of the enema. The toxic irritation in the gut creates a greater sensitivity to the enema and the colon may become hyper-active, creating either counter-spasms, making it difficult to either accept the enema or retain it, or, on the contrary, the colon will clutch the enema and the patient will have difficulty in releasing it. These symptoms, if the patient has had no prior difficulties in holding and releasing the enema, will indicate that greater amounts of toxicity are being released at this time. Several other symptoms may confirm this, such as the patient may wake in the early hours feeling very toxic and bloated (this indicates that additional toxicity is building during the enema-free period), and the first enema is very difficult to hold. The patient would be well advised to consider doing an additional enema during the night (say at 2 am) or taking a 500ml chamomile enema immediately prior to the first coffee enema and adding 2 teaspoons (10mls) of the potassium compound solution to it. This can be repeated for a few days, but the potassium can prove an irritant to the bowel, so it is not recommended for long-term application, only in crisis management. It is useful to remember not to hang or place the enema bucket too high, but to let the flow occur gently, which may alleviate some of the counter-spasms. If patients have taken medication in the past which would have directly affected the nervous system, then nervous symptoms in the gut may be more pronounced during these detoxification episodes.

HAEMORRHOIDS
Haemorrhoids are not caused by the enemas, but they may appear during the detoxification crisis. Traditionally, haemorrhoids are associated with back pressure from the liver, indicating liver stagnation/congestion. This seems a fair assessment when observing the exacerbation of haemorrhoids in certain patients during the detoxification crises. When the crisis is over, the haemorrhoids heal. For some patients this becomes one of their standard signs of the detoxification process. Many patients may make the mistake to stop the enemas, believing them to be the cause of the problem. The patient must be assured that this is not so and encouraged to use a soft catheter. If the haemorrhoids are painful, then Anusol suppositories may be used, and Desitin  will  alleviate any external haemorrhoidal pain and irritation from caustic burning.

DARK STOOLS
This is a very favourable sign, because it indicates increased efficiency in the bile system. The dark grey/green stool colour is  caused by a high concentration of bile and the chemical changes it has undergone.  If the stools are black, then the possibility of occult bleeding should not be overlooked.

COLD SORES AND FEVER BLISTERS
I have noticed that these are a common sign during detoxification, but may remain intermittent for many months during the healing process.

ORANGE TINGE TO THE SKIN
This is not technically a detoxification reaction, nor a toxic reaction, but generally occurs prior to a flare-up. The carrot juice is particularly efficient in drawing toxicity from the cells. From my observations the patient may suddenly take on this colour and then, when the crisis is over, resume their normal colour. It is possible that the cells are releasing more toxicity than can be eliminated by the liver (build-up due to increased vitality prior to elimination), which is held by the beta-carotene in a safe form. Following the flare-up, the toxins are removed and the complexion returns to normal.  

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The Healing Inflammation


The symptoms of the healing inflammation are quite different from toxic and detoxification reactions. They relate to the symptoms dealing with the resolution of body tissue integrity. This may involve current tissue regeneration or the healing of old injuries. Injury refers to any tissue trauma, whether it be physical (accident/break), bacterial (infection), disease process, chemical insult - in short any insult which has damaged tissue and has failed to heal completely. Scar tissue, old fractures or any area of damage will be revisited and healed. This process involves inflammation, redness and pain at the site before resolution.

The patient will remember old injuries or illnesses as they reappear, old scar tissue will inflame, previously broken bones will suddenly become sore with possible swelling as they heal. You cannot dictate which area is going to be healed next, the body will choose. In the cancer patient we are looking for healing reactions at the tumour site, so inflammation, redness, swelling and pain at the location is not necessarily a sign that the disease is progressing, but when experienced as part of the generalised flare-up (you will be looking for other symptoms to confirm this), can indicate immune activity and healing at that area. Subsequent reduction of tumour mass will confirm this.

In a full-blown healing crisis these reactions are usually accompanied by fever and general malaise, which is self-limiting. I have found that in many cases during the few days prior to a healing crisis the patient's  general energy/vitality seems much higher than usual. The healing crisis can last from 3 –10 days. A word of warning: if you misread the symptoms and suppress the crisis, you may have difficulty from that point onwards in securing another healing crisis.

In general terms, for the cancer patient on a strong detoxification plan, the first crisis may occur between days 5-10 and last probably around 2-3 days. However, I have found that this is not always the case and the patient will not have a healing reaction until the sixth/seventh week, with the heaviest reaction in the third/fourth month. In chemo patients you will not be looking for a reaction until the fifth/sixth month, and the flare-up may only comprise strong toxic and detoxification reactions rather than a healing inflammation. For the chemotherapy patient who comes through this period successfully, there may be an even stronger crisis at the 9th month. Many patients who have been very damaged with chemotherapy may slowly deteriorate from this point. This is not the cause of the detoxification therapy, but the inability of the body to respond. I have seen several patients with advanced cancer who have been given only 3-6 months to live by the medical profession, live up to 18 months, at home, doing the detoxification therapy and not requiring hospitalisation until the very end. Even patients with severe bone metastases suffered no pain throughout the therapy. 

Patient management during the healing inflammation is critical. The main areas of concern are fever and pain management.

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Fever


Fever often accompanies the healing inflammation. The practitioner must first rule out  infection or tumoural growth, as both these conditions will give rise to fever.

THE INFECTIOUS FEVER
In the case of infection, there will be accompanying symptoms to indicate a bacterial or viral component and, if possible, a culture should be taken to determine the cause.

Treatment:
It is important to treat infection appropriately:
  antibiotics if the infection is severe
  herbs such as Echinacea
  add hydrogen peroxide to the bath and rub the skin with a 2% solution after a hot bath
  add the juice of 6 lemons daily to the apple/carrot juice
  keep away from infectious people
  pay particular attention to the hygiene of the bathroom/kitchen


THE TUMOURAL FEVER  
A fever associated with tumoural activity is constant - day and night. The blood results may indicate tumoural progression, but there is usually little doubt with the practitioner when a fever is tumoural. There is no natural treatment for fever in this instance other than tepid bathing, cool compresses on the forehead and/or cool (not cold) enemas.

THE HEALING FEVER
Fever is an essential component of the total immune response. It activates and potentiates immune activity. In one standard medical text book I read that if fever was suppressed, then the illness was prolonged.  Without fever, the body may be unable to heal adequately. Fever helps destroy tumour tissue and therefore it is to be welcomed in any therapy whose aim is to enable healing.

The healing crisis fever will stay with the patient for several hours. A general pattern is for the fever to occur in the evening and break in the early hours of the morning. If the patient can tolerate the fever for around 5 hours, then it will be to his/her advantage. After this time the fever may be reduced by applying physical measures first, not medication.

Treatment:
Half hourly checks should be made on the patient's temperature. Do not allow the temperature to rise above 104°F (40°C). The following methods can be used to reduce the fever:
  Cool water enemas
  Cold compress/sponging
  Tepid bathing
  Cold drinks 
  If these methods are not effective and the temperature remains high or intolerable, then an  aspirin-based medication may be used.  Dr. Gerson's Pain Triad works well in these circumstances (1 Aspirin, 1 niacin x 50mg, 500mg vitamin C).

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Pain


Pain can arise from inflammation of damaged or healing tissue, tumoural inflammation or tumoural pressure.  The whole inflammatory process causes oedema, which presses on the nerves and surrounding structures, causing pain signals. In most cases any diseased or damaged area/joint of the body will inflame and after 2-3 reactions should be healed, so that joints enjoy normal movement. In the case of tumoural inflammation or growth, if this involves pressure on the spinal cord, brain or nervous system, then symptoms can worsen and medical intervention may have to be sought. However, under most circumstances, with the healing patient, it is best to adopt natural, physical methods for alleviating pain, avoiding the anti-inflammatory drugs, which act by inhibiting inflammation - the opposite of what the patient is trying to achieve.

1st line of treatment
  The coffee enema. The coffee enema will stimulate the liver to remove all inflammatory chemicals produced at the site of inflammation. These chemicals, if not removed, cause the formation of free radicals at the location, which sets up a vicious cycle inciting further inflammatory damage and perpetuating the cycle. Efficient removal of these toxins, facilitated by the coffee enema, relieves the pain dramatically. The coffee enema is also useful during an allergic reaction to clear excess histamine from the body.
  Castor oil packs may be used in cases of muscle tension, spasms/spastic spasms and bone pain. With bone pain, the muscles may contract around the area of pain and inflammation, due to both the release of toxins lodging in the muscles and as a defence by the body to protect the bone. The heated pack will assist in releasing the muscles and dispersing the toxins. 
  Clay packs are used in hot inflammatory pain, arthritis, joint pain, tumour inflammation and in oedemas. They can be used around the head in brain tumours and for headaches.
  Hydrotherapy/hot shower/tub - this is very useful in bone pain and may be taken 2-3 x/week or more often for the control of pain.  Hydrotherapy should never be done by the patient on his/her own. It must be remembered that it can reduce the blood pressure and, if fever is present, will increase it.  Never bathe in fluoridated water. 
  Lymphasizing - this is the method of increasing the flow of lymph and may either be achieved through gentle "stroking" of the body, the limbs and torso by a friend, or through gentle bouncing on a small trampoline. To have the patient gently bounced, like a baby, can bring relief from pain. Pain is often caused by fluid accumulation and just by moving the fluid, can alleviate the pain.
  TENS machine may be used to negate pain impulses. These units can be very useful and may be obtained through the doctor or hospital.


2nd line of treatment
The methods outlined above must not be disbanded when they appear to be ineffective. It is important that the patient understands their benefit and continues to support the body in these ways.  If pain persists, the treatments above may be combined with a relatively non-toxic treatment, using aspirin based preparations (Aspirin, Ibuprofen, Nurofen). It is often more effective to take 1-2 aspirin with 500mg of Vitamin C and 1 x 50mg niacin. The patient should take this with gruel and never on an empty stomach. As the therapy progresses these treatments become more effective, and will work eventually.


3rd line of treatment
If pain cannot be controlled by the above methods, then the patient may have to resort to the stronger pain relievers. Many patients may have such severe pain that they cannot even eat or do any part of the therapy. Clearly, this is not in the patient's best interest. Similarly, if tumoural inflammation is creating severe pain, then the patient may have to resort to steroid treatment to resolve the inflammation. This often occurs with patients suffering from brain metastases.

  Steroids - used to reduce inflammation, swelling and pain. They inhibit the healing process and should only be used if there is no other alternative at that stage.
  Narcotics - codeine, morphine are often prescribed to alleviate severe pain. These drugs almost paralyse the visceral nervous system (hence digestion is impaired), and reduce motility of the gastro-intestinal tract, causing constipation. Homoeopathic opium may be an effective alternative to narcotics.
  Non-steroidal anti-inflammatory drugs - these are more effective in the treatment of bone pain than the narcotics.


If a patient comes to you and is taking prescribed pain medication, do not discontinue this medication until you are into the detoxification therapy and then, if possible, under the guidance of the patient's GP, reduce the dose gradually.

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