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Dr. Jay Goldstein's Rapid Remission ME/CFS Treatments.

knackers323

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@Hip and others I tried the nitroglycerin up to 20mg on about four occasions and haven't got any benefit from it. Does that mean I can rule it out or should I continue to try?

I get the impression Goldstein says that if they are going to work they will on the first attempt.?
 

zzz

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@Hip and others I tried the nitroglycerin up to 20mg on about four occasions and haven't got any benefit from it. Does that mean I can rule it out or should I continue to try?
Yes, especially with nitroglycerin, I think that's the case.
I get the impression Goldstein says that if they are going to work they will on the first attempt.?
Based on a thorough reading of his books and my own experience, I would say that the most powerful drugs generally work on the first attempt. One of the reasons Dr. Goldstein used this criterion was that his patients were almost all from out of town or out of the country, and with more than 140 drugs that he could try, he had a limited time to spend on each one. So he wanted to quickly find the ones that were the most important for each patient's recovery. (He also had a specific algorithm for which drugs to try in which order, so he rarely had to go through a huge number of drugs for a single patient. Obviously, he couldn't go through 140 drugs in just a few days.)

Initially, I tried the same approach for myself. But after I found that none of his top drugs had a noticeable effect on me after a single dose, I went back and gave them a longer trial - something that Dr. Goldstein typically did not have the luxury of doing. So it turns out that gabapentin, which was Dr. Goldstein's #1 drug and did absolutely nothing for me after one dose, has become one of the two most helpful of all his medications (the other being chlorzoxazone). Similarly, one dose of nimodipine did absolutely nothing. But a second dose the next day relieved all my ME/CFS symptoms for a few hours. It was one of those experiences that reminds you that you've forgotten what "normal" means. It was incredible. Further doses of nimodipine did not have the same effect, but it's still a helpful drug. (A higher dose, as Dr. Goldstein recommends, would probably be more effective, but it's too expensive for me.) Finally, Hydergine (at 1 mg 3x/day) did absolutely nothing for a couple of months, until suddenly it kicked in with huge amounts of energy. It's a tricky one, as 2.5 mg/day does nothing, but 3 mg/day gives me too much energy. I'm still trying to find the right balance there.

There's so much in Dr. Goldstein's protocol. It takes a lot of patience to find the right drugs, and the right dosing for each. But I have found (as did Dr. Goldstein and so many of the people he treated) that such patience pays off enormously.
 

Tammy

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Did Dr. Goldstein always test the different samples with the gel rubbed on the forearm? For the ones that he did.............how was that done? Did he crush pills and mix with gel because it seems to me that you would get a different reaction with gel vs. oral. Sorry if this has been discussed.
 
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has anyone tried effox, I'm interested in trying it to increase blood flow to my brain?
I really believe if you search enough and work hard enough and raise enough funding you will find a cure. I found it in tracheostomy which used to be the gold standard for sleep apnea and was more common in the past before the advent of these cpap machines and I had a trach and miraculously I had clarity for the first time in 8 years.
 

Thomas

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@zzz @Hip thank you for this amazing thread. I've long been interested in trying to find a way to duplicate Goldstein's protocol. I'm a patient of Byron Hyde (who is not a treating physician) and he is good friends with Dr. Goldstein and has long sung his praises of a doctor who was way ahead of his time and knew more about "chemopharmacology" (as he put it) than anyone else.

I'm just so brain fogged and on an energy decline that being able to navigate this is quite tough at the moment, but I'm slowly inching more towards commencement of this plan.

I wonder, did any or many of the patients that Dr. Goldstein successfully treated suffer from severe cognitive deficits (very poor memory, heavy heavy fog, very slow processing, scattered and slow speech, loss of personality, autistic like features) and related symptoms?

Also, I have associated hyper mobility issues and a host of other weird dry/red skin problems and allergies and reactions etc. I'm curious if other patients who were helped by him also had these issues as well? Oh I've also had life long IBS which is directly related to my nervous system and response to stimuli like chemicals, social interaction, anticipation etc. as well as diet.

I've also been confirmed to have CIRS under the Shoemaker guidelines of biotoxin illness...

I guess what I'm trying to ask is if your familiar with success of his protocol on addressing patients with a multitude of symptoms from almost of every body system?

Just an aside, I heard from Dr. Hyde today via email that Dr. Goldstein is quite ill and being taken care of by his wife. This was sad to hear as the more I learn of him the more respect and admiration I have for him as he seemed relentless in the pursuit of minimizing patient suffering from this hideous illness.

Oh one more thing. I remember reading that Dr Goldstein once said back when rTMS (transcranial magnetic stimulation) was first emerging that he believed this therapy held great promise for neurosomatic disorders in assisting the brain to reset. But this was early on before the technology really emerged by which point he was retired. rTMS has also interested me but it also seems like if done wrong things can really mess up. Curious if you have any further insight to this as well?

Thank you again :)
 

Wayne

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I remember reading that Dr Goldstein once said back when rTMS (transcranial magnetic stimulation) was first emerging that he believed this therapy held great promise for neurosomatic disorders in assisting the brain to reset.
Hi @Thomas,

Whenever I think of Jay Goldstein's work, I also think about a remarkable post that was made on this forum a few years ago. The poster related how he had achieved a complete remission from all of his symptoms for four days using neurofeedback. Unfortunately, a followup session undid all his improvements. Given your interest in this area, I think you would find his post rather fascinating.

Starcycle's 4-Day Remission
 

zzz

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Did Dr. Goldstein always test the different samples with the gel rubbed on the forearm?
Almost all of his tests were done directly with pills. The gel form was typically used only when oral administration either didn't work at all for a given drug, or when the gel form simply worked a lot faster. Dr. Goldstein's decision tree can be found on page 458 of Betrayal by the Brain; @MNC kindly reproduced an early version of it in this post (with some useful added commentary). The drugs in the center column are the main profiling drugs, and are used to determine which types of drugs the patient is most likely to respond to. Of these, in the book version, amantadine, ketamine, lidocaine, Neurontin, and guaifenesin are shown to be used externally in a PLO gel. Neurontin (gabapentin) and guaifenesin (extended-release Mucinex) are also available in pill form, and this is what Dr. Goldstein used for long-term treatments. For the others, IV administration was required, and Dr. Goldstein often administered guaifenesin by IV as well.
For the ones that he did.............how was that done?
I don't think that Dr. Goldstein specifically says how these were prepared, but considering that he used all of these frequently, I would imagine that he relied on a compounding pharmacy, which could produce these gels easily. He definitely knew enough pharmacology to try these out on his own, along with various nasal sprays and eyedrops, as he details on pages 54-55 of Tuning the Brain.
Where do you get these drugs?
This was detailed in an earlier post, but since this thread is getting a bit long, I'll repeat the information here:
By the way, in terms of cheaply trying out several of Dr Goldstein's best drugs for treating ME/CFS, United Pharmacies (UK website here) is a very good place to buy these drugs, because in most cases this pharmacy sells drugs in small units of just 10 pills. Often just 10 pills can be enough to work out whether a particular drug has benefits for you or not, or whether it has side effects that make that particular drug unviable for you.
They're a great pharmacy, and they ship to every state in the U.S. except Oregon - which happens to be where I live. (Their agent is apparently located here.) Three other excellent pharmacies that I've used a lot are Brandmedicines.com, Goldpharma, and Mimaki Family Pharmacy. The last one often has drugs that no one else has, while at the same time it often doesn't carry the more common medications.
Also very good is AllDayChemist.com. Some people have reported receiving spam from various places after ordering from this pharmacy, so it might be a good idea to use a disposable email address if you order from them.

Ordering from a reputable pharmacy such as these is key. With pharmacies of unknown reputation, you never know if you'll get anything at all, or if you do, if it will be real or counterfeit. As you might expect, counterfeit drugs can be extremely dangerous. And of course anyone using prescription medications not under the supervision of a doctor had better know as much as a well-informed doctor about the medication, its side effects and what to do if they occur, and its drug interactions, or disastrous results could possibly ensue.

Although it is technically illegal to import any prescription drugs into the U.S. from any other country, the U.S. government currently permits people to import a 90 day supply of prescription drugs without a problem. I have never had a shipment stopped by Customs, and most of them even name the drug on the package. However, the ban on scheduled drugs (e.g., benzodiazepines) is enforced. The only scheduled drug that Dr. Goldstein uses regularly is ketamine, though he finds it extremely useful. Due to the law, there are no reputable sources of ketamine among these pharmacies. Web sites that claim to sell ketamine are usually scams. For both health and legal reasons, I would strongly advise everyone to avoid even trying to get ketamine without a valid prescription, and to use a licensed pharmacy in their own country.
@zzz @HipI've long been interested in trying to find a way to duplicate Goldstein's protocol.
Fortunately, it is possible to do so using just Dr. Goldstein's books, as one of the main purposes of his writing them was to allow any physician to use his protocol. The deeper technical material gives scientifically-minded readers enough of an understanding of neurosomatic medicine in general (the branch of medicine founded by Dr. Goldstein) to extend the practice of neurosomatic medicine beyond the specific drugs and protocols that Dr. Goldstein used. As I have indicated, I have found his protocols to be immensely helpful in treating my illness. The books benefit tremendously from a second reading, as I would describe them as being written in a somewhat holographic style; each part assumes some knowledge of all the rest. This can make a first reading rather daunting.
I'm a patient of Byron Hyde (who is not a treating physician) and he is good friends with Dr. Goldstein and has long sung his praises of a doctor who was way ahead of his time and knew more about "chemopharmacology" (as he put it) than anyone else.
I was unaware that Dr. Hyde and Dr. Goldstein were good friends. Dr. Hyde certainly has a solid reputation in the ME/CFS community, and an endorsement from him certainly means a lot.
I'm just so brain fogged and on an energy decline that being able to navigate this is quite tough at the moment, but I'm slowly inching more towards commencement of this plan.

I wonder, did any or many of the patients that Dr. Goldstein successfully treated suffer from severe cognitive deficits (very poor memory, heavy heavy fog, very slow processing, scattered and slow speech, loss of personality, autistic like features) and related symptoms?
Oh yes, many of them. He includes the case reports of many of these in both Betrayal by the Brain and Tuning the Brain. The reports he includes describe many miraculous recoveries, with people able to return to work.
Also, I have associated hyper mobility issues and a host of other weird dry/red skin problems and allergies and reactions etc. I'm curious if other patients who were helped by him also had these issues as well?
For the hypermobility and skin problems, it's not clear. I don't recall cases of these being described in his books. But he also indicates in the Forward to Tuning the Brain that there is much, much more than he has put in his books. At one point, he says, "I shall more fully describe the actual treatment of neurosomatic disorders in my next book, Brain Static: Case Studies in Neurosomatic Medicine." Unfortunately, this book was never published, and it appears that Dr. Goldstein's illness has prevented its completion.

As for allergies and reactions, Dr. Goldstein's approach is extremely effective, as I can testify from personal experience. He identified the cause of central sensitivity, which is still being debated today in the rest of medicine, and from his writings, he made clear which treatments work for this. Since I have had tremendous hypersensitivity problems, I have tried these treatments, and sure enough, they work, although they take time. Most of page 367 in Tuning the Brain is devoted to explaining this mechanism, and once the mechanism is understood, the treatments become evident.
Oh I've also had life long IBS which is directly related to my nervous system and response to stimuli like chemicals, social interaction, anticipation etc. as well as diet.
Dr. Goldstein devotes a whole chapter to the treatment of IBS in Betrayal by the Brain. Hypersensitivities, which are extremely common in ME/CFS, are covered in the section above. A large proportion of Dr. Goldstein's drugs worked on hypersensitivities, either directly or indirectly. For example, on page 93 of Betrayal by the Brain, he describes a woman with fibromyalgia and lupus who was treated in his office for the first time with a combination of four medications:
She felt more energetic, her tender points were gone, and she had much more mental clarity. I asked her to take walk to test her exercise intolerance and when she returned she stated that for the first time in seventeen years she could walk in the sun without symptoms of photosensitivity.
Not bad for a first visit! But Dr. Goldstein continues:
Over the next three months all signs of lupus resolved and her anti-ds DNA test became negative.
I discuss this case in a little more detail in this post.
I guess what I'm trying to ask is if your familiar with success of his protocol on addressing patients with a multitude of symptoms from almost of every body system?
Well, these were exactly the people who came to see him - the cases that were hardest to treat, the people who had been to often dozens of doctors with no results, including to many specialists. In his time, Dr. Goldstein was known as "the end of the line". He was the doctor you went to when everyone else had failed. People who have not read his books or don't understand his work often think that he used a purely neurological approach. But if so, he would have been a neurologist, and of course that approach is quite limited. Instead, he invented the field of neurosomatic medicine, which uses an integrated neuroendocrineimmune approach, as these three systems actually are tightly integrated in the body. But as you can tell from the titles of his later books, he saw the core symptoms originating from the brain. He had great success with this approach; by the time Tuning the Brain was first printed, shortly before his retirement, he estimated that he could help all but two three percent of those patients who came to see him become asymptomatic, or nearly so. As he treated 20,000 patients during his career, this was a lot of people, although his success rate only began to approach what I described in the mid 1990s.

To give a sense of the power of his treatments, I'll include a brief quote from the bottom of page 73 in Tuning the Brain:
Usually, in cases like this, I perform what I term a "resurrection". Mrs. Jones arrives by ambulance in a hospital bed where she has been confined for months or years (take your pick). That day will be, I'm sure, my only crack at her. I can usually get Mrs. Jones ambulatory, often with intravenous medications, by the end of the day, so that she can walk into my office on her next visit.
Who today can do this?
Just an aside, I heard from Dr. Hyde today via email that Dr. Goldstein is quite ill and being taken care of by his wife. This was sad to hear as the more I learn of him the more respect and admiration I have for him as he seemed relentless in the pursuit of minimizing patient suffering from this hideous illness
Yes, unfortunately, I have heard this as well. And my respect for him continues to increase with time, too. Part I of Tuning the Brain is autobiographical and very revealing; I think that it's worth the price of the book alone. It closes with a haunting quote from his wife:
In summary, Jay is a good man who has given his life to his patients for little reward. I truly hope that the contributions he has made to better the lives of patients will not be forgotten once he has gone.
This was written in 2003.
Oh one more thing. I remember reading that Dr Goldstein once said back when rTMS (transcranial magnetic stimulation) was first emerging that he believed this therapy held great promise for neurosomatic disorders in assisting the brain to reset. But this was early on before the technology really emerged by which point he was retired. rTMS has also interested me but it also seems like if done wrong things can really mess up. Curious if you have any further insight to this as well?
I haven't heard of any areas where this has caused significant problems, although my knowledge of this field is minimal. However, I think that this field is still in its infancy, and that there is much that can potentially be discovered in this area.
 
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Thomas

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@zzz thank you for that informative response. I'm curious, what were your most troubling ME/CFS symptoms before discovering Dr. Goldstein's work?

I also notice that Dr. Goldstein isn't shy with dosages of certain meds. For example he seems to use therapeutic or full doses for some of the psychoactive meds like Wellbutrin and Effexor. I kind of like the go hard or go home approach to meds because I have no patience lol. It's very difficult for me to stick to a one month titration to optimal dosage. Unless I really react to the med but feel it still may work if I go in a little more slowly.

I'd be interested to know if Dr. Goldstein had any insight into the 1 or 2 % of his patients for which nothing worked for them. It would be easier to look at that group versus the remaining 18,000 or so that we're helped. I wonder if there were certain symptoms or family histories or pre-illness health and energy levels or common comorbidities that he was able to determine or comment. I dunno just a curiosity.

Thanks again.
 

Thomas

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@zzz

I assume Dr Goldstein is no longer able to see patients?

Will buy top 5 meds on Goldsteins list and try them all for 2-3 days.

Will update with results within next few weeks.

P.S. AVOID taking Nitroglycerin or any other nitrates whilst on Viagra.
That's correct. He's long retired and is now in poor health.
 

Rebecca2z

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However, as you may have gathered, I had a major relapse eight years later, a day after some minor surgery. And tolerance to nitroglycerin or isosorbide dinitrate can develop quickly; it never worked the same for me. However, some people are able to derive great benefits from it for long periods of time.
@zzz , If Rituxan hadn't worked for me I would do nitroglycerin or isosorbide dinitrate in a heart beat. I am sorry to hear you relapsed. I am a little worried this will all be taken from me, what a cruel cruel world this would be if that happened.
I honestly feel like I have been released from heavy chains. I am so free from all that suffering. I don't want this to go away. The only up side would be I am totally convinced there is certainly something going on and it 'ain't ' in my head
Hearing your story and your still hanging in here, and helping others is inspiring. I am happy you shared this.
 

knackers323

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@zzz

I assume Dr Goldstein is no longer able to see patients?

Will buy top 5 meds on Goldsteins list and try them all for 2-3 days.

Will update with results within next few weeks.

P.S. AVOID taking Nitroglycerin or any other nitrates whilst on Viagra.
Jon

How have you gone with it?

I have been having some success with lamotrigine. Anyone tried this?

Don't know how far it will take me. Anyone who has the book know what would be the next mad for me try if lamotrigine gives benefit?
 

Jon_Tradicionali

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Jon

How have you gone with it?

I have been having some success with lamotrigine. Anyone tried this?

Don't know how far it will take me. Anyone who has the book know what would be the next mad for me try if lamotrigine gives benefit?
Yes,

Started isosorbide dinitrate last night. Took one 40mg tablet and head was throbbing and felt heavy after a few hours so I went to sleep.

Also started naphazoline and Nimodipine a few days prior with no apparent effect.

I'll be taking all three in conjunction today and will report back.

What effects has lamotrigine had on you?
 

knackers323

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Much more energy and either as a consequence or directly a better mood. Let us know how you get on.

So anyone who has the book know what I should try next?
 

zzz

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@zzz thank you for that informative response. I'm curious, what were your most troubling ME/CFS symptoms before discovering Dr. Goldstein's work?
Energy problems, dysautonomia and sleep problems.
I also notice that Dr. Goldstein isn't shy with dosages of certain meds. For example he seems to use therapeutic or full doses for some of the psychoactive meds like Wellbutrin and Effexor. I kind of like the go hard or go home approach to meds because I have no patience lol. It's very difficult for me to stick to a one month titration to optimal dosage. Unless I really react to the med but feel it still may work if I go in a little more slowly.
For many people, these doses work fine. For people who are known to be sensitive to certain types of medications, just because a medication is on Dr. Goldstein's list doesn't mean it can't cause a sensitivity reaction. For these people, taking things a bit slower is often the best way to go.
I'd be interested to know if Dr. Goldstein had any insight into the 1 or 2 % of his patients for which nothing worked for them. It would be easier to look at that group versus the remaining 18,000 or so that we're helped. I wonder if there were certain symptoms or family histories or pre-illness health and energy levels or common comorbidities that he was able to determine or comment.
Basically, Dr. Goldstein said that he just hadn't found the right drugs for them yet. He started off with a much lower success rate in the early 1990s; by the time Betrayal by the Brain was published in 1996, he was up to 95%. In 2003, in Tuning the Brain, he mentioned the 97% or 98% that you refer to. Over time, he just kept getting more successful.
I have been having some success with lamotrigine. Anyone tried this?
I know that @Hip has had great success with lamotrigine, but anyone using this drug needs to be aware of its dangers. Dr. Goldstein stated that he never had a major adverse drug reaction among any of his patients. However, that's because he knew all his drugs intimately, including how to administer them, how they acted pharmacologically, and how to reverse their actions if necessary.

Lamotrigine can be particularly dangerous because it causes Stevens-Johnson syndrome in approximately 1 out of 1200 cases, and this syndrome is fatal about 10% of the time. If you use lamotrigine, you need to be very familiar with the signs of SJS, and get emergency help immediately if symptoms develop. Lamotrigine can also cause ordinary rashes and fever independently, so you need to learn the difference between these. This drug is also highly addictive. Unless you have excellent pharmacological expertise (which I believe @Hip does) and know as much about drugs as a good doctor, I would strongly advise staying away from lamotrigine. An excellent second choice for reducing glutamate presynaptic release is chlorzoxazone, which is much more benign, and which Dr. Goldstein described as being "surprisingly effective". I have been taking chlorzoxazone for many months, and it's one of my two most effective medicines (along with gabapentin) from Dr. Goldstein. Chlorzoxazone is safe enough that a half-size dose is available OTC in Canada. People should have their liver enzymes monitored if on it long term, however.
Started isosorbide dinitrate last night. Took one 40mg tablet and head was throbbing and felt heavy after a few hours so I went to sleep.
That's four times the dose that gave me the long remission I described at the beginning of this thread. More is not always better. With larger doses, the vasodilating effects of the nitrates may well overwhelm their neurological effects, leading one to believe that they're not effective, or not as effective as they could be.

The standard dose for sublingual nitroglycerin is 0.4 mg. Dr. Goldstein used a tenth of that to test his patients' receptivity to nitroglycerin, as he said that most responding patients require very low doses. If he got a partial response, he would increase the dose by 0.04 mg until the he reached 0.4 mg or the response leveled off - usually the latter. For responding patients, he would then prescribe a nitroglycerin patch that would release up to 0.6 mg/hour of nitroglycerin.
So anyone who has the book know what I should try next?
Well, it's not as simple as that. If it were, we'd all be better by now. Ideally, you would work with a doctor who had read and understood the books, or you would at least read and understand the books yourself. (Both books are very important.) Otherwise, you're just shooting in the dark, although a number of people have gotten lucky and had success this way.

In any case, gabapentin was Dr. Goldstein's #1 oral drug, and one of the first drugs he would try. He would typically start out at the lowest dose, namely 100 mg 3x/day.
@zzz would this product match up with Goldstein's Naphazoline? It's .1% Naphazoline HCL but also contains a preservative. http://www.amazon.ca/Alcon-Naphcon-...e=UTF8&qid=1427830236&sr=8-2&keywords=naphcon
Yes, it would. You can also get these drops from Goldpharma for half the price.
 

zzz

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Dr. Goldstein's Resurrection Cocktail

In a recent post in this thread, I quoted the following short passage from Tuning the Brain:
Usually, in cases like this, I perform what I term a "resurrection". Mrs. Jones arrives by ambulance in a hospital bed where she has been confined for months or years (take your pick). That day will be, I'm sure, my only crack at her. I can usually get Mrs. Jones ambulatory, often with intravenous medications, by the end of the day, so that she can walk into my office on her next visit.
To those of us who aren't even as sick as the patients he describes, such a "resurrection" sounds pretty miraculous. For the many people who experienced it, it felt like nothing short of a miracle, and the word "miracle" was frequently heard around Dr. Goldstein's office.

But what exactly did Dr. Goldstein use to perform his "resurrections"? Unfortunately, in typical Goldstein style, he doesn't go into any further details at this point. Nor is the word "resurrection" even mentioned in the rest of the book, or in any of his other books. At first glance, then, it would now appear that we are at a dead end.

However, Dr. Goldstein did write a description of these resurrections in an article he posted on his Web site, entitled “Tiptoe Through The Treatments: A Brief Guide To Some of What's New Since Betrayal by The Brain." As the article's title implies, it was written between the publication of Betrayal by the Brain and Tuning the Brain. And although much of what is in the article is superseded by what was published in Tuning the Brain, there are various bits and pieces of information that appear in this article and nowhere else.

Dr. Goldstein's Web site disappeared shortly after his retirement in 2003. However, thanks to his dedicated followers, "Tiptoe Through The Treatments" can still be found in various places. Among the more reliable sources is Erica Verrillo's Web site. Erica Verrillo is probably best known at the author of Chronic Fatigue Syndrome: A Treatment Guide (2nd Edition), which is considered by many to be the best treatment guide currently available for ME/CFS.

"Tiptoe Through The Treatments" lists a number of drugs in alphabetical order that Dr. Goldstein started using after the publication of Betrayal by the Brain. Among them is ketamine. In the second half of the description of ketamine, there appears the complete list of ingredients for Dr. Goldstein's resurrection cocktail:
Ketamine is one component of my "resurrection cocktail," for patients who have been bedridden for more than a year and whom I may only see once. The others are IV ascorbate, IV lidocaine, IV thyrotropin- releasing hormone (which raises all biogenic amines plus acetylcholine), Nimotop, and Neurontin...
As is made clear in the text immediately preceding the quote above in Tuning the Brain, Dr. Goldstein always tried the naphazoline eyedrops first, as sometimes they made the resurrection cocktail unnecessary.

So at this point we have all the ingredients. It is also worth noting, in Dr. Goldstein's words, the power of some of the ingredients. For ketamine:
The best single agent for CFS/FMS and all other neurosomatic disorders. Known best as an NMDA receptor antagonist (the NMDA receptor is one of the several receptors for the excitatory amino acid glutamate), it increases dopamine in the limbic system, a very important objective in CFS. I administer it by slow intravenous infusion or in PLO gel for transdermal (through the skin) absorption. The intravenous route is more effective, but transdermal application can be done daily, and if effective, can obviate peaks and valleys and need for IVs. I have seen no cases of Ketamine abuse among my patients.
For IV lidocaine:
In addition to its actions mentioned in Betrayal by the Brain, it also acts as an NMDA antagonist. It is the second best treatment. I have given it about a thousand times without a serious adverse drug reaction. Patients have come with great difficulty from other states or countries with the common lament of "If you can't help me I'm going to kill myself' (I hear this about twice a week). At least two patients, achieving complete symptomatic relief with IV lidocaine, returned home and could not find a physician or nursing service to administer it. Since they could not move to southern California, they were again bedridden and had to crawl to the bathroom. Not able to live this way any longer, they committed suicide, a worse outcome than the lidocaine toxicity, which never happens. Many physicians will not prescribe any of the medications I use, even if they help their patients a lot. Some medium-sized cities have not one physician who will care for CFS patients. I must treat them from afar, a hazardous practice medicolegally.
Now we have a list of all the ingredients in the resurrection cocktail. But what were the amounts of each, and how were they prepared? "Tiptoe Through The Treatments" is silent on these issues.

Back to Tuning the Brain. On page 369, in the section entitled "Lamotrigine" (which actually has only five sentences about lamotrigine), there is the following sentence:
Ketamine may be combined in the same IV bag with lidocaine, ascorbate, MgSO(4), and Ca gluconate.
And:
Lidocaine is almost tied with ketamine for effectiveness in neurosomatic disorders and can be used daily, if necessary, by the IV route.
Now for the doses of the individual drugs. First, ketamine. On page 60 of Tuning the Brain:
I give ketamine by slow intravenous infusion in normal saline at a dose of 0.5 mg/kg (Schmid RL et al, 1999).
On page 347:
My experience coincides with the literature: Ketamine, when properly administered, does not cause hallucinations or impairment of cognitive functioning (Schmidt RL et al., 1999). The intravenous dosage I use, less than 2.5 micrograms/kg per minute, does not produce plasma levels greater than 50 mcg/ml...I administer 25 to 100 mg of ketamine in 500 ml normal saline over three hours or so, adjusting the rate to the patient's side effects, which should be minimal. If Intravenous ketamine (or lidocaine) is infused too rapidly (even with midazolam), the results will often be poor, and sometimes the patient will no longer respond to the drug (Sorenson J et al, 1997). In the typical patient, an infusion of ketamine has a beneficial effect lasting up to a week.
Lidocaine dosing is describe on page 46 of Betrayal by the Brain:
I find IV lidocaine 200 to 300 mg in 500 ml of normal saline to be a rapidly effective analgesic in FMS patients.The effects sometimes last for days or weeks, perhaps by inducing long-term potentiation (see p. 65), and often global symptoms are improved. About half of my patients respond to this treatment after being refractory to all oral agents. IV lidocaine... has the unusual property of greater symptom relief and duration of action with each successive use, plateauing after four infusions, and lasting three to seven days.
Although Dr. Goldstein refers specifically to fibromyalgia here, he considers that all CFS patients with considerable muscle pain have fibromyalgia.

Dosing for ascorbic acid is described on page 132 of Betrayal by the Brain:
Administration of ascorbic acid is done in doses of 25 to 50 grams diluted in half-normal saline or Ringer's lactate over a period of about 90 minutes. It is beneficial to add 500 mg of calcium gluconate since ascorbic acid is a calcium chelator and could possibly lower serum calcium.
From the beginning of that paragraph:
Adding magnesium sulfate is recommended because ascorbic acid can cause magnesium shifts from extracellular to intracellular compartments.
In other words, the magnesium is actually optional, but the presence of ascorbic acid can cause it to be absorbed more effectively. In this environment, no more than one gram of magnesium should be used, and that much only in people who are known to tolerate magnesium well.

Now we have all the ingredients, but what about the fluid? According to Dr. Goldstein, all of these ingredients can be combined in one 500 ml bag. However, normal saline is recommended for ketamine and lidocaine, while half normal saline or Ringer's lactate is recommended for ascorbate, due to its high osmolality. In this case, the osmolality of the ascorbate is the controlling factor, and Dr. Goldstein would use half normal saline or Ringer's lactate for the combination. The infusion time should be three hours in order to avoid unwanted side effects.

For thyrotropin-releasing hormone, Dr. Goldstein used an intravenous injection of 500 mcg, as described on page 62 of Tuning the Brain. The dose of nimodipine (Nimotop) used is one 30 mg tablet, while the dose of gabapentin (Neurontin) used is 100 to 300 mg, typically in capsule form.

So now we have all the ingredients of the resurrection cocktail. Here they are, along with their doses, as used sequentially:
  • Naphazoline eyedrops, 0.1% solution, one drop in each eye
  • 500 ml of half normal saline or Ringer's lactate, administered over three hours, and containing the following:
    • Ketamine in a dose of 25 to 100 mg
    • Lidocaine in a dose of 200 to 300 mg
    • Ascorbic acid in a dose of 25 to 50 grams
    • Calcium gluconate in a dose of 500 mg
    • (Optional) Magnesium in a dose of up to one gram
  • Thyrotropin-releasing hormone (TRH) administered as an IV injection of 500 mcg
  • Nimodipine in the form of one 30 mg tablet
  • Gabapentin in a dose of 100 to 300 mg, typically in capsule form
I believe that this is the first time that the complete formula and dosage of Dr. Goldstein's resurrection cocktail has been published outside of his office, as it involves a number of references from two of his books plus one unpublished article.

Once again, I would like to emphasize that this cocktail helped most of the very sickest bed bound ME/CFS patients get on their feet and walking in a matter of hours. And although there were a substantial minority who did not attain that level of recovery, it can be reasonably inferred that many of them had substantial improvements nonetheless.

This cocktail is not a cure, of course. It was used simply to get people to a high functioning level very quickly. To maintain that level, it was usually necessary to administer some of the regular treatments described in Betrayal by the Brain and Tuning the Brain.

The publication of this resurrection cocktail is intended to give people hope. For those people with this illness who are in dire straights (of whom there are far too many), this list can be taken to their doctors, along with the primary sources as well, if possible. Unfortunately, as Dr. Goldstein indicates, very few doctors would consider even the lidocaine portion of this cocktail, much less the whole thing. Great persistence would be needed in finding a doctor who would be willing to administer this cocktail. In any case, it is extremely important for reasons that Dr. Goldstein noted that the IV infusion be done over a period of a full three hours.

If ketamine is the only deal breaker in this cocktail, the formula should work almost as well without it.

Many (if not most) doctors would take one look at this formula and say, "This is crazy!" Such a verdict would not surprise Dr. Goldstein. Going back to the April 18, 1989 issue of The Los Angeles Times, entitled Chronic Fatigue: A Mystery Unravels:
Dr. Jay Goldstein of Anaheim Hills has spent the last five years researching and treating patients with chronic fatigue syndrome, a debilitating disease characterized by incapacitating exhaustion and a range of other perplexing symptoms. Explaining his theory... Goldstein pauses. "You know," the family practitioner says, "some very respected physicians will tell you I am crazy."
And as my dear late grandmother would say, "So there you are."
 
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JPV

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I've lived in Los Angeles since 1984. I got sick in the early 90's and saw dozens of specialist, over the next 10 years, all to no avail.

I can't express how pissed off I am that I lived so close to his practice but never heard of Dr. Goldstein until just recently.
 
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