Tularemia is a rare, potentially fatal disease with 180 reported cases in 2014, 314 in 2015, and 230 in 2016. The graph below demonstrates reported cases from 1950-2016.
Will stop Dapsone.
Continue Plaquenil- 1 pill twice per day
Continue the Minocycline - once per day
Once finished the Itaconazole will switch to Vorconazole 3 times per week
Leucorvorin (folinic) - once per day
Clarinex- allergies (but I've been on this for a couple of years because it's shown to help with Lyme.)
*New medication for the Francisella tularensis Cipro will pulse 7 days per month for next 4 months (Since you have had in past without any issues) But make sure you increase Vitamin C and Magnesium while taking. Ciprofloxacin is a fluoroquinolone. Levaquin is also in this category. Fluoroquinolones now have a "black box" warning for tendon rupture and tendinitis. The Vitamin C and (specifically chelated) magnesium will help protect against that. I promise you...if your PCP puts you on a fluoroquinolone, they're not going to tell you about possible tendon rupture or how to protect against it.
*New Cholestyramine powder wait until you finish the Cipro will start with 4 grams (1 scoop or packet) on an empty stomach and work up to 2-4 times per day. A little fun fact about cholestyramine is that it is EXCELLENT for lowering cholesterol with ZERO side effects. Why don't they give it anymore? Because patients weren't compliant. It's easier to pop a pill. With this, you have to take it on an empty stomach, wait 30 minutes to eat which will activate it, and then you can't take any other meds for 90 minutes. You have to do that 4 times a day.
CBD oil. Start with low dose and increase gradually. - recommend Charlotte's Web Hemp Oil. (You can look at that brand here.) - usually dosed 2-3 times per day - start with low dose - range is between 2mg - 25mg - 2-5 milligrams is good place to start and increase. If tolerated you can increase beyond 25mg twice per day. Should help with pain, anxiety, and boosting immune system. I had been taking CBD oil inconsistently. This is not what people think it is, so don't freak out. If you have issues with the fact that people take cannabis or hemp oil, I highly encourage you to watch the docuseries "The Sacred Plant" which explains the amazing benefits of the drug we were led to believe is the gateway drug to all others. It is an amazing plant that can treat almost any disease.
Start Beyond Balance Toxease GL this stays all the time helps push die off and toxins out see hand out. After 7 days add in MC-PZ see hand out for directions on working up.
Once finished Methyl Guard (or which ever MTHFR support you have will switch to Methyl Pro B -complex with 10 Mg of Methyl Folate.
Continue Kidney Stone support and when finished current product its helpful to rotate a bottle of DesBio Gallbladder Liver Meridian Opener - Adults: start with 1-10 drops under the tongue, 3 times daily finish the whole bottle.
Will get new labs before move and will follow up as directed.
Medications attached to this encounter:
• Cholestyramine 4 GM Oral Packet Sig: Take 2 packets (8 grams) by mouth 2 times per day mixed with water or non-carbonated drink.
• Ciprofloxacin HCl (Cipro) 500 MG Oral Tablet Sig: Take 1 tablet (500 mg) by mouth every 12 hours for 7 days per month x 4 months.
• Hydroxychloroquine Sulfate 200 MG Oral Tablet Sig: 1 PO BID
• Itraconazole 100 MG Oral Capsule Sig: 1 PO QD
• Leucovorin Calcium 15 MG Oral Tablet Sig: 1 PO QD
• Minocycline HCl 100 MG Oral Capsule Sig: 1 PO QD
• Voriconazole 200 MG Oral Tablet Sig: 1 PO QD