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Why? And on what do you base your advice?
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I base it on clinical data and on personal experience.
Here's a quick explanation:
- Low dosages help to detect early sensitivity to the drug. They also help with the worms because of their nature. They also help with the problem of "balance" during a possible "competition for bioavailable space".
- A sudden increase of the low dosages to the full MAXIMUM dosage helps to prevent
parasite drug resistance.
- The bursts help because of the life cycle of the
parasites and because of the chance of liver damage due to drug use, which must always be considered.
Here's the why (partially):
Albendazole kills many types of worms, but it isn't very well absorbed by the body. Most of it is expelled practically unused (sometimes >80%). Because of this and due to some other factors, if a person is heavily infested, the worms that aren't killed will be "upset" by the effect of the Albendazole on their organisms. This will cause them to move crazily away by instinct. This is called "migration". If and when this happens, the results can be [and often are] FATAL. All of this is published data.
By logic, I thought then that if a very low dose approach should be started, two high risk factors could be prevented, heavy migration and drug sensitivity, which must always be accounted for. Drug sensitivity means a possible allergic reaction to the drug. Low dosages give the body time to "adapt" to the drug.
Because the worms tend to stay still when 'close' to a food source (it seems to be their nature - I've learned this from studying their behavior), if a very low dose of Albendazole is introduced into them, although they'll feel an effect, because of their nature they'll prefer to stay still and to 'wait it out', even if some will squirm a bit (this may explain the cramps and abdominal upsets that are sometimes felt, but I can't be sure of it).
Meanwhile, the low doses gradually "impair" them and affect their instincts, helping to keep them still even longer without knowing exactly what to do, while the drug increases its effect. This argument is a theory of mine, but it seems to be holding true to this day.
Afterwards, because the conditions are set properly, a sudden increase of the dosages to the very MAXIMUM shouldn't give any of the affected ones any chance to move anywhere because they're already 'stunned'. Therefore, they should die. Such sudden increase shouldn't affect the body either, because it's already adapted to the intake of the drug. The only reaction left would be the possible "herx" effect (the 'die-off'). The "bursts" should help there.
By using this logic I've always been successful, at least so far, in getting rid of different species of worms from heavily infested and even critical patients. I've never had a problem with the approach, but of course you must know that it still is a potentially dangerous one.
The low dosages shouldn't be kept for too long to prevent any of the worms from developing drug resistance. That'd be a nightmarish situation in itself.
After that, the reason for the bursts are mostly 'mechanical' and due to:
- The bodily responses to drugs, which is 'elastic'
- The life cycle of the parasites, which implies some time before eggs hatch
- The prevention of hepatotoxicity (liver damage) due to prolonged drug use
- The prevention of "herx" effects (giving the body time to eliminate toxins)
..and some other reasons I won't bore you with. The length of the 'bursts' (on-off cycles) MUST be very carefully considered, and the numbers vary depending on the patient and on the infestation(s).
Now some long and boring notes:
Albendazole is considered a "broad-spectrum" antihelminthic.
As such, it is supposed to attack different species of worms.
It's a published fact that while it does attack different species of worms, it does so with varying degrees of efficacy. This translates roughly into that it will kill some species right off, but it will only "hurt" others. Other species may be just "bothered" by it, upset, with stimuli enough to "migrate" (to wander about) into different parts of the organism. Check this example:
(
http://www.medscape.com/medline/abstract/11286203 )
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Ascariasis is one of the most common helminthic diseases. Its most feared complication is migration into the biliary tree. Some authors recommend immediate duodenoscopy in all cases of biliary migration, with sphincterotomy for the extraction of the parasites, and surgical extraction in case of intrahepatic ascariasis.
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[from Non-invasive management of
Ascaris lumbricoides biliary tact migration: a prospective study in 69 patients from Ecuador. - Medscape Newsletters / Trop Med Int Health. 2001; 6(2):146-50 (ISSN: 1360-2276)]
From observations I know that most worms are "lethargic", that means, they will try to stay "stuck" to a food source and just be there, in a state of "comfort", so to speak. I've seen this with my own eyes, so I can state it. But if they are forced by any reason to "migrate", the effects can be VERY dangerous, fatal even. For instance, a worm that is forced to migrate from the intestines into the peritoneal cavity may "dig" a hole right through the intestines. That's internal bleeding, hemorrage, and most possibly infection, leading to some kind of sepsis, not to mention the anguish and the pain. Believe me, nobody wants that: it's a doctor's nightmare.
If in turn the worms [are forced to] migrate to the brain, which sometimes they do, imagine the rest. Sometimes, as in the former example, they'll choose the "biliary tree" instead. As you see, it's a matter of blind luck to guess what the worms will do next [and why].
That's probably why most doctors are so cautious when it comes to treating worms, and it's my guess that that's why most will require rigorously specific identification of the species at hand before medicating, although I consider this an act of cowardice, while I understand their reasons.
From experience, most of the time that I've encountered people infested with parasites, upon microscopic examination of the stool by LIVE wet mounts, I've found not just one species of parasites, but several. This is a fact that for reasons that elude me continues to be, let's say.. "overlooked", by the scientific medical community.
In such cases, usually I'll find a PREVALENT species, meaning a species which prevails mostly in numbers against the others. That species is the one usually detected by the commercially available stool screenings, possibly because it's the one laying the greatest number of eggs. This isn't always necessarily true, but it generally is.
It makes sense that if you ingest a broad spectrum drug to kill parasites, the most prevalent species will have the highest instant number of dead worms, all conditions being equal. If Albendazole effectively kills that prevalent species, it may not kill the others so effectively. In that case, a "competition for balance" may ensue.
That "competition" means that you may replace your existing infestation by another to which Albendazole itself may be ineffective.
Low dosages at first can help prevent this, in a way, because the "balance" is gradually yet slowly changed in favor of the patient.
By knowing what to do, and when to do it, I think that most infestation situations should be resolved without a problem, but that's where experience comes in, in my opinion. I don't think that any amount of literature can tell a person what to do in a matter of minutes if and when facing an impending hyperinfestation; that's why I advise caution and the highest amount of information possible before even considering an approach.
As you see, this is a subject all on its own, and it's a rather complex AND DANGEROUS one. That's why I like Albendazole as a "warm up" drug when I can't identify ALL the other prevalent species at a given time, BUT, when used with extreme caution.
In my opinion, people should be very careful if they'll be self-medicating with anthelmintic drugs unless they know very well what they're doing, because it could all turn out to be a gamble, but that's not to say that they shouldn't be used, because I for one prefer taking my chances anytime against having a bunch of worms eat me inside out. However, I would advise not to act out of desperation, whenever possible, and to try to know as much as possible about the enemy within and the drug to use against it, when to use it, how to use it, why to use it, and the dosages and combinations that may be most effective.
I hope that explains my advice a little bit.