December 1, 2005

Dr. Buttar: Increase in Urination on TD-DMPS

Increase in Urniation
by Dr. Rashid Buttar

Recently, I was told of a doctor who was using TD-DMPS in many children but this doctor despite seeing good clinical results, became concerned after noting a few children who were appearing to be "incontinent". A few things need to be mentioned regarding this observation, most important of which is distinguishing this from true incontinence.

Our observation is that approximately 15% of children being treated with TD-DMPS in our practice have shown either an increase in or initiation of bed wetting and/or increased frequency of urination after treatment has been initiated. Urinary analysis as well as routine blood analysis looking at BUN and creatnine, have shown no changes associated with this observation. However, there appears to be an association with increased metal yield on fecal, urinary and RBC metal analysis noted shortly after this observation is noted.

In addition, the child is virtually always noted to have an increased desire to consume liquids and parents will comment that their child is drinking noticeably more than normal.

Initially, it was unclear as to what the observation indicated but these findings did not persist more than a few months in any of the children in whom we observed these findings. However, what we did notice was that within a few months, the children in whom we noticed these changes, were the ones that showed a more significant recovery milestone compared to those who did not exhibit this particular finding.

This transient observation of increased bed wetting and/or increase in voiding frequency based on the previously stated observations, is probably intuitively obvious by this point. However, for those that may need some further explanation, the self evident nature of the physiological response may be explained in a condensed manner, using a common theme I learned during by general surgery residency.

Some physicians may remember a little phrase during their surgical rotations which explained why facial lacerations were less prone to infection. The phrase "the solution to pollution is dilution" was something we used in surgery all the time, from explaining the high vascular supply of the face leading to lower incidence of wound infection, to the principal of irrigating wounds to prevent infection.

In essence, an effective method of dislodging and pulling the metals out with an effective chelator will cause an "increase" in circulating "pollution" (metals) which will induce the physiological response of increasing the desire to ingest water. This increase in water intake is "diluting" the "pollution". With increase in the water intake, there is "dilution" of the "pollution", thus providing the solution to the issue of toxicity. But with that "dilution", there is an increase in volume, resulting in an increase in the bodies need to void. The purpose of the renal system is to excrete waste and the "pollution" (metal) is waste that the body wants to eliminate. Thus, the increase in volume of fluid along with the natural physiological response for the body to eliminate a dislodged and mobilized substance that is detrimental (metals) will cause the observation we are discussing, specifically of increase in voiding.

As previously stated, I have never seen a child that we have treated go more than a few months before this observation of increased urinary voiding resolve. However, we have had numerous cases of children that were still in diapers or pull ups at the age of 6 or 7, experience these same changes, only to become completely potty trained within a few months of exhibiting this increase in voiding initially.

It is important to remember that all the findings are still being collected. For a physician, they must look at physiology and understand physiology, regardless of disease process they are treating. If physicians do look at physiology, then what appears to perhaps initially be a negative, will not be abandoned when in actuality, it is a positive. But to conclude that TD-DMPS causes incontinence without understanding the physiological response or why it's occurring may be misleading and may potentially lead parents to an unnecessary delay in treatment. Remember, science is noting more than an observation that has been used to postulate a hypothesis and then tested over and over again to see if the hypothesis holds water. That's all that we do.

My hope is that more and more physicians begin to use physiology as their guiding principal in treating patients but even more importantly, that they look to physiological principals in their initial approach to treating what ever disease they may encounter.

It is the principal that we use not only in our approach to autism but to cancer and heart disease as well and comprises the main focus of the 5 day AMESPA course that I teach, with the goal of changing the paradigm in medicine. Our goal, very simply is to take over 25% to 40% of the US health care market and we will be able to accomplish this because of our focus on the 5 toxicities and how to treat them, while using basic physiological principals as our guides in keeping us on the right course.

Rashid A. Buttar, DO, FAAPM, FACAM, FAAIM

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