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Aug 6 12 2:11 PM

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Could someone refer me to a site where I can see that this protocol has not worked? I have great respect for Dr. Cahill and feel like I need information if I am not going to follow his recommendation. Thank you.

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#2 [url]

Aug 8 12 4:40 AM

Hi gibby - no I haven't.  I have decided to take my report and script in to my dr. to discuss options since I'm not sure what to do.  Part of me wants to take advantage of Cahill's experience...I can't imagine that he would continue to prescribe something if there were numerous failed treatments.  And wouldn't you contact him if it didn't work?  I certainly would.  So I am just waiting for my report (I asked them to mail it)  I also have a very demanding work week and didn't want to start yet.  I have a really hard time taking medications.  Best of luck to you. 

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#3 [url]

Aug 8 12 4:41 AM

I think that those of us who have been ill for a long time are concerned that Cahills "first round" might cause antibiotic resistance. Plus we are assuming that our infections have become invasive based on our symptoms and length of infection and therefor require the tissue drug in addition to a stronger/longer dose of paramomycin.

(and we dont want to have to keep incurring the expense of traveling to NY. )

Get it done, move on. 

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#4 [url]

Aug 8 12 4:53 AM

 I have read a few of Cahills patients who were not well after his intial treatment. A few of them I found on and a few on other sites.  What was notable was that none of them went back to Cahill for re-examinations or even called for stronger doses. They just assumed he was not able to help them and moved on to something else. 

During our appointment Cahill did not mention any specifics about treatment success. The day after the examination I got my diagnosis directly from his secretary Joan and she told me she would fax my pharmacy the prescription. I was only able to speak with Cahill directly after I requested. 

I can imagine a lot of his patients don't make that extra phone call or if they do they might not think to ask the questions that would alert them to the fact that his first line of treatment is 80% successful and that they may need further medications. He only says come back in 3-6 weeks after your meds to check that the parasite has been eliminated. I suspect many do not have the funds to do so, and make their own assumptions. 

I actually spoke with a friend of the family a few weeks ago who was sick for many years and finally was directed to Cahill by her chiropractor. This was three years ago. She said it took her 6 months to a year to feel better but that she wasn't 100%. I asked her if she went back to Cahill to make sure the infection was gone..."no"; she assumed it worked because she feels so much better.  I wonder though if she got rid of the infection completely or if there was/is another symbiotic parasite involved. 


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#5 [url]

Aug 8 12 5:02 AM

I will have to order the report too.  I am on the protozoa forum curezone as well.  I am hesitant to take the RX's because of my candida battle, but I have to follow through now.  I finally got a diagnosis, paid all that $ for Cahill, and so I am going along with the treatment.  Where did you see his first line of protocal is 80%?  I'd say that's pretty good.  Worth a try.

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#6 [url]

Aug 8 12 5:07 AM

  Where did you see his first line of protocal is 80%?  I'd say that's pretty good.  Worth a try.


I asked him. 
Yes I think thats pretty good odds but I've seen higher percentages for the combined meds- like somewhere around 90-97%.  Then again i've seen different percentages noted in many different studies. 

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#8 [url]

Aug 8 12 5:29 AM

Entamoeba Drug Treatment and Resistance

Emetine was first demonstrated to be an effective amoebicide in 1912 97. A miscellany of drugs in addition to emetine have since been reported to be effective to various degrees. Metronidazole has become the drug of choice following recognition of its amoebicidal properties in the mid-1960s.

Emetine (or dehydroemetine) hydrochloride is a potent tissue amoebicide. Although it continues to be a life-saving drug in appropriate situations, this drug does have serious side effects 97. The drug is slowly excreted into the gut and urine, allowing high concentrations to build up in the liver, heart, and other viscera. To illustrate, emetine may be detectable in urine 40 days after the termination of treatment. Emetine is administered by daily intramuscular or deep subcutaneous injections for a maximum of 10 days, with local pain and tenderness at the sites of injection being common. If given orally, the drug usually causes vomiting, and very little is absorbed. Given intravenously, it is dangerously cardiotoxic 97.

There is evidence that multidrug resistance transporters may be involved in emetine and colchicine accumulation in a drug-resistant selected line, because uptake was lower in the resistant line and verapamil increased drug accumulation to that seen in the parental line920. Six P-glycoprotein-like genes have been cloned: four are expressed in a drug-resistant line, and there is differential expression 72.

The synthetic 5-nitroimidazole metronidazole, on the other hand, is remarkably safe in comparison to emetine and is now the recommended drug for the treatment of amoebiasis. It is also effective against a wide range of anaerobic bacteria 64 because of similar low-redox-activating enzymes. Oral doses of metronidazole are readily absorbed and can be found in most body fluids with few side effects. It is now so widely used both therapeutically and prophylactically for numerous major and minor ailments that exposure of Entamoeba to this drug worldwide is guaranteed. Inappropriate short-term exposure and exposure to sublethal levels of metronidazole are normally prescribed for prophylaxis and are precisely the conditions under which drug resistance is induced 208.

Indeed, using stepwise incremental increases in drug dose, we have induced metronidazole resistance in two axenic lines of E. histolytica 167. Parasites of strains HM-I:IMSS (isolated from a rectal ulcer from an adult male in Mexico City in 1967) and HTH-56:MUTM (established in culture from an amoebic abscess from an adult in Bangkok in 1992) currently grow in our laboratory in 10 μM metronidazole, a concentration of drug which is normally lethal to parasites in vitro 68. A minimum lethal dose for this strain has been reported as 11.6 μM over 72 h, and a 50% inhibitory dose of 29.7 μM has been reported, while the reported susceptibility of the HK-9 strain ranges from a 50% effective dose of 2 μM to a lethal dose of 11.6 μM over 100 h 167. Expression of the iron-containing SOD was increased three- to five-fold in metronidazole-resistant parasites, and a second SOD activity disappeared 167. Unlike in Giardia and Trichomonas, PFOR activity did not decrease significantly. The work with the iron-containing SOD has been confirmed at the gene expression level by Wassmann et al. 227, with parasites resistant to 40 μM metronidazole; peroxiredoxin expression was also increased, and ferredoxin 1 expression was decreased.

Unique in that it is effective both in the bowel lumen and in tissues, metronidazole has been reported to eradicate only up to 50% of luminal infections 191. This statement has support from a study of 36 patients with amoebic liver abscess for whom the hepatic lesions were cleared; but 20 were recolonized in the intestine, 16 asymptomatically. This was ascribed to the pharmacokinetics of metronidazole cycling in the liver and the action of metronidazole against trophozoites but not invariable eradication of cysts, creating E. histolytica carrier states 9093. These figures are considerably higher than generally published, although no single treatment has claims of 100% efficacy; 90% success after 5 to 10 days of metronidazole treatment is regarded as adequate by some workers. Alternatively, other workers have regarded that this level of efficacy suggests resistance and the need for multiple drug treatment 157. Because the organism is difficult to culture axenically from patients, there are insufficient reliable data regarding resistance levels, although a recent study indicates decreased susceptibility in clinical isolates from Chandigarh (R. Sehgal, unpublished data). Therefore, current recommendations suggest the use of metronidazole or tinidazole plus the luminal amoebicide diloxanide furoate or iodoquinol, with other combinations (including paromomycin, tetracycline, and chloroquine) depending on the severity of the infection and site, i.e., whether it is intraluminal, invasive, or abscessed 157191. Iodoquinol and diloxanide furoate have unknown mechanisms of action 93. Like diloxanide furoate, paromomycin is poorly absorbed. There are no reports of the very high levels of resistance to metronidazole found in Trichomonas or Giardia.

Similar to the interpretation of pathogenic versus nonpathogenic strains or species ofEntamoeba, coupled with treatment failure due to resistance, there is disagreement over which cases should receive treatment. Clearly, anyone with serious disease requires adequate treatment with the available drugs. It has been strongly argued that metronidazole should not be used prophylactically to preserve the usefulness and potency of the drug 76208218. Sargeaunt 170 is quite adamant that only E. histolytica is pathogenic, obviating the need to treat E. dispar carriers, while Diamond and Clark 48caution against witholding treatment from asymptomatic individuals because E. histolytica has been found in these carriers. Burchard 28 advises treatment of E. histolytica only, but that all cyst passers be treated in the absence of differentiation. Results of a treatment and placebo trial in Mexico were interpreted to mean that money spent treating carriers in this country could be better spent on treating cases of amoebic disease 66. All these opinions appear to be correct in their context, in the absence of adequate funds and new, effective antiprotozoal drugs, and in lieu of eradication.

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#9 [url]

Aug 8 12 5:31 AM

If you see Cahill you will also need to request a copy of your diagnosis and labs otherwise they will not send them. His secretary Joan made me feel like I was asking for a big favor when I requested these. Odd.

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#10 [url]

Aug 8 12 5:43 AM

Is she the foreign lady? 

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#12 [url]

Aug 8 12 7:26 AM

Hi Isabelle,

I have a couple of questions for you. You said earlier that you are having your whole family treated at the same time. Did all of you have histolytica, and how many of you had symptoms?

If there are silents carriers in your family, what are their medication, do they have the same dosage as you? Did EH show only in rectal smears or did it show in stool antigen test also?

As I've learnt Dr. Cahill seems to be the EH guru and I would love to have some background info for the doctors office in case my husband has this and will be treated. He could be silent carrier as he only has mild symptoms that could also be caused by something else entirely. 

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#13 [url]

Aug 8 12 7:28 AM

Drug Found for Parasite That Is Major Cause of Death Worldwide

ScienceDaily (May 20, 2012) — Research by a collaborative group of scientists from UC San Diego School of Medicine, UC San Francisco and Wake Forest School of Medicine has led to identification of an existing drug that is effective against Entamoeba histolytica. This parasite causes amebic dysentery and liver abscesses and results in the death of more than 70,000 people worldwide each year.

Using a high-throughput screen for drugs developed by the research team, they discovered that auranofin -- a drug approved by the US Food and Drug Administration 25 years ago for rheumatoid arthritis -- is very effective in targeting an enzyme that protects amebae from oxygen attack (thus enhancing sensitivity of the amebae to reactive oxygen-mediated killing).

The results of the work, led by Sharon L. Reed, MD, professor in the UCSD Departments of Pathology and Medicine and James McKerrow, MD, PhD, professor of Pathology in the UCSF Sandler Center for Drug Discovery, will be published in the May 20, 2012 issue of Nature Medicine.

Entamoeba histolytica is a protozoan intestinal parasite that causes human amebiasis, the world's fourth leading cause of death from protozoan parasites. It is listed by the National Institutes of Health as a category B priority biodefense pathogen. Current treatment relies on metronidazole, which has adverse effects, and potential resistance to the drug is an increasing concern.

"Because auranofin has already been approved by the FDA for use in humans, we can save years of expensive development," said Reed. "In our studies in animal models, auranofin was ten times more potent against this parasite than metronidazole."

In a mouse model of amebic colitis and a hamster model of amebic liver abscess, the drug markedly decreased the number of parasites, damage from inflammation, and size of liver abscesses.

"This new use of an old drug represents a promising therapy for a major health threat, and highlights how research funded by the National Institutes of Health can benefit people around the world," said Reed. The drug has been granted "orphan-drug" status (which identifies a significant, newly developed or recognized treatment for a disease which affects fewer than 200,000 persons in the United States) and UC San Diego hopes to conduct clinical trials in the near future.

Additional contributors to the study include first author Anjan Debnath, Shamila S. Gunatilleke and James H. McKerrow, UCSF Sandler Center for Drug Discovery; Derek Parsonage and Leslie B. Poole, Wake Forest School of Medicine; Rosa M. Andrade, Chen He, Eduardo R. Cobo and Ken Hirata, UC San Diego School of Medicine; Steven Chen and Michelle R. Arkin, UCSF; Guillermina García-Rivera, Esther Orozco and Máximo B. Martínez, Instituto Politécnico Nacional, Mexico City; and Amy M. Barrios, University of Utah, Salt Lake City.

This work was supported by the Sandler Foundation and US National Institute of Allergy and Infectious Diseases grant 5U01AI077822-02, with additional support from R01 GM050389.

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#14 [url]

Aug 8 12 12:38 PM

As you may have read, I too was diagnosed with E. His by Dr. Cahill last week! Still taking it all in- hard to believe I have a diagnosis other than Blasto!
I am hesitant about taking his prescription of Paromomcin & Doxycycline, apparently prescribed for less invasive infection. I am asking for your advice/suggestions on treatment. I may have knocked my #'s down a bit from the CDD cocktail that I took in May but its unlikely my infection is less invasive & don't want to take any chances. Also, my report from Cahill says 3 +-  ?? Like IloveIsabelle says, it seems most of the people cured have taken other protocols- Briboy and Shrimpy! IloveIsabelle: If you posted what your taking- can you refer me to that? I'm really interested in going in that direction (strong doses for invasive infection). Most of my doctors are close minded unless it is absolutely prescribed that way by FDA. I worked with a dr in the UK to get the CDD meds prescribed. So any suggestions on which protocol & how you are able to get them from your doctors are greatly appreciated. I have one doc who is an absolute moran- but as long as I have the research -she may be willing to prescribe what I need. I was thinking about getting Tinidazole along with taking Cahills script (para & doxy).
I'm hoping to avoid experimenting on different combos that might not work and risk getting candida- want to just go for the kill & be done with this!
Thank U for your help!!!!

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#15 [url]

Aug 8 12 1:12 PM

Jlynne, omg!  I'm the same as you.  I got diagnosed by him this week, got meds yesterday, but didn't take anything yet.  I also asked for some diflo to take alongside, and he had no problem giving that to me as well.  I will start this week.  I also am very confused.  I have been told that Cahill gives low dosages and is stubborn about it.  I don't think I have an invasive form, as I am not really ill, but I've had something going on for 4 years.  He finally diagnosed it, although when I read about EH, doesn't seem like it's me at all....?  anyway, I was told that para and doxy are not right and Shrimpy said I need to take Tinidazole  and up my dosages.  left me so confused about this!!!! 
How are you handling your doxy and paromyciin?  You able to tolerate it?

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#16 [url]

Aug 8 12 4:04 PM

Paromo kills flora which is needed for the bug to feed on. The longer it is given, the better. Tinidazole is metronidazole without the side effects, and therefore pretty cool stuff. Doxy...meh. It generally not very helpful in gastro-bugs. 
Amoxicillin is interesting, too, since it seems that most resistance genes that bugs have do not work with that, meaning you cannot really get resistance to amoxy, unless the bugs use efflux pumps.
A real killer is nitazoxanide, too. 

But seriously, you need to be sure what you have so you can take the AB that fits. I prefer my MM test, since it even told me that whatever I have is resistant against neomycin and penicillin already. 

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#17 [url]

Aug 8 12 8:49 PM

Hey Gibby!
What is diflo? No I haven't started yet either. I think I need to take the tinidazole since that is for the tissues. I believe the standard treatment is that & para. I thought I heard his 2nd line of treatment is the tinidazole, para & doxycycline? I was considering asking him to prescribe his second line for me but when you say he is stubborn- does that mean others have already tried that-?? yes it seems those who have gotten well have all up'ed the dosages. I want to get on the medicine but am willing to wait until I'm sure I have the best possible meds/dose. It seems like no one has an answer to why he prescribes what he does (first round). I don't think there was a reply to Tillys question on that above.
Same as you I was shocked he found this in me- didn't think it really matched up with my symptoms either.

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#18 [url]

Aug 9 12 3:38 AM

Jylynn, where will you get the Tinidazole?  Will you go to your regular doctor?  I have thought about this constanly and can't come up with a solution.  If I take this to my regular doctor they will just say, let Cahill prescribe it.
Shrimpy's idea is to just take it all and be done with it, not to be on this any more than you should, so do it right the first time (after what he's been through) and is trying to save time.  His regular doc will do anything he asks, so no problem getting more medication.
I am not nearly as sick as he was, so maybe I don't need it.  I called and talked to his sleepy elderly secretary yesterday.  She said, start to take the meds to see how I tolerate, then we go from there.  She says that combo are very good results.. Brian said that if it doesn't work, he then ups the Para dosage, and gives the Tinadazole.   He also said that it works like 80% of the time, or 85?   I do really think I should have the Tinidazole since it's in and out of the tissues.....has to be.  He told me I had lots of mucus and inflamation when he was doing the, that didn't sound good to me.
I don't have the report like you, but I will get a copy of it.  Another person on the protozoa forum has followed shrimpy's protocal.   Did he say anything like that at your exam?
  Diflocam is antifungal to prevent a yeast infection.  I've had those, and they are stubborn and nasty.  Always a must to take along with antibiotics.   If you are prone to them, just ask, he has no problem prescribing it alongside.  Brian said, he will NOT prescribe the Tindazole at first.

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#19 [url]

Aug 14 12 6:51 AM

Best wishes to iloveisabelle, gibby and graymuse...thinking of you all.  Graymuse, when you talked to Dr. Cahill did you talk at all about whether the doxy acts as a tissue drug?

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