Avastin alone?

Further to a recent previous post.

3 months of TMZ 5/23 showed that chemo is not working for unmethylated GBM. The tumor is very active according to MRI comparison between July and September 2019. There was alot of swelling which is currently being reduced with 16 mg steroids per day in the past week. Speech has improved alot with this. Was told it is too close to previous radiation or surgery to have either done again.

2 weeks ago clonazepam was prescribed 10mg x 2 and Keppra increased to 1500mg x 2 and Phenytoin 300mg in the morning -  all of this is keeping seizures, twitches and focal seizures away.

Oncologist is going to start IV Avastin today and stop all treatment - asked if it was pallatiative but answer no it is not pallatiative treatment yet. Thought it was unusual to go ahead with Avastin by itself and not combine it with another chemo treatment such as lomustine?

Have been following cocktail since during radiation treatment back in April 2019 which I posted about in previous post. This includes daily chloroquine (155mg active ingredient); celebrex 200mg; metformin 500mg x 2; Atorvastatin; ramipril; ranitidine 75 mg; mebendazole; melatonin 20mg.

Also the usual daily supplements of mulitvitamin; 16 strain Probiotics; PSK; Maitake D; ; Mushroom supplement mix for brain (lions mane 300mg; bacopa 250 mg; reishi 150 mg; gotu kola 130 mg; ginko 120 mg); curcumin (longvida); vitamin D; ECG; Milk Thistle; Berberine; Boswellia; Resveratrol; Omega 3-6-9; Soy Falvonoids (geinistein)

Wondering if anyone has any experience of just Avastin being prescribed? I am wondering what is even the point in doing avastin alone? Appears to have more side effects and very little extra benefits, or OS? I was optimistic that Richard Geiber had Avastin and low dose TMZ but that doesnt seem to be on offer to us? Or any chemo alternative?

Very disappointing TMZ stupps protocol + cocktail did not seem to work. 

Alternative to Bosellia Wokvel?

I've seen previous posts explaining the rationale behind the recommendation of Boswellia (WokVel) preparation. However, this formulation is currently out of stock from all suppliers in my area (UK). I note from Ben Williams' book that the dose of boswellia used in the cited German trial (showing reduced oedema) was 4200 mg/day, which is much higher than the 999mg suggested on this site. What's the best alternative to WokVel, given that I am unable to source it? I assume that taking it alongside Celecoxib is tried-and-tested?

Request for choosing a suitable cocktail

Hi everybody and many thanks to Stephen for adding me to
this wonderful blog.

I have some questions regarding my father situation and it’s
a bit embarrassing cause we don’t have detailed information about the tumor as
many of you have, so I wonder if someone could kindly help me to choose the
best probable cocktail for him while I know that it is just a shot in the dark.

He is 69 years old and last year (March 2018) during working
with probably toxic glue he suddenly fainted out and later he had problem in
his stomach. We went through lots of colonoscopy and other procedures during a
year and he lost more than 10 kg. Finally (at September 2018) we had a MRI that
said low grade glioma (in the LT temporal)
is the first possibility. (I guess since his HDL and LDL cholesterol were 41
and 77 mg/dl in July 2018 the tumor was not aggressive at that time). We’d been
told that because of tumor location it is better to do nothing and just wait.

(I am suspicious about
Finasteride pill that he took for 3 years for his prostate and we recently switched
to Terazosin)

Then in December we had
the second MRI which shows a “51*47*24 mm heterogeneous mass with surrounding edema
and extension to hippocampus region and mass effect on the LT with mild mid
line shift”.

Then we went through a
painful process to decide whether we should take the risk of surgery and
finally we decided not to (which I am still doubtful about it). After a stereotactic
biopsy which only says this:

•  Microscopy:

Sections reveal fragments
of tissue including an astrocytic neoplasm. The cellularity is high. The cytologic
atypia include unclear hyperchromatism and some pleomorphism with scattered
cells having larger more hyperchromatic nuclie, occasional multinucleated. There
is rather extensive necrosis with prominent vascular and endothelial
proliferation.

• Diagnosis:

Astrocytoma, anaplastic
with necrosis (glioblastoma multiforme), left temporal and basal ganglia involvement. 

We started the temodal (120)+ radiotherapy (30 sessions) recently and now he
is in his second week.

He is taking 1 sodium
valproate 500, had around 25 dexamethasone (finished now), 3 phenytoin 100, 2 ranitidine!,
and 1 Terazosin a day.

I am trying to persuade
his Drs: to change ranitidine to cimetidine and maybe adding metformin (since he
had lost many weight I don’t know if they accept this and as someone mentioned
here metformin and cimetidine does not go well together. Am I right? But cutting
his carbohydrate too much is quiet hard so I still like metformin)

Also maybe chloroquine if
they accept.

-        
So the first silly question is that, if he goes well with the first cycle
can we say his tumor is methylated?

-        
Do you think Turmeric curcumin NovaSol could work as a replacement for
Longvida? Because of his weak stomach I thought soft gels might work better.  (https://www.amazon.com/Turmeric-Curcumin-NovaSOL-Bioperine
Softgels/dp/B018GQJQHM/ref=sr_1_2_s_it?s=hpc&ie=UTF8&qid=1533759320&sr=1-2&keywords=NovaSol%C2%AE&dpID=61EqNrydTdL&preST=_SX300_QL70_&dpSrc=srch)

-        
What would you suggest for such a vague situation for a cocktail or other
therapy? (  Ttf and vaccine are not available here)

I know most of information I said are useless but I thought it might help for some better guess. 

Many thanks in advance,

Sahel

The trembling of the hands and the change in facial expressions when falling asleep

My mom's hands are moving and her facial expressions change when she falls asleep and sometimes in a dream. She does not remember this. It looks a little scary.

Half a year my mother took valproic acid (Depakin) 500mg a day. However, a month ago an electroencephalogram showed the absence of an epileptic activity and we stopped taking it. Perhaps, the trembling of the hands and facial expressions when falling asleep increased.

What could this mean?

Bioavailability of WokVel Boswellia Serrata vs "ordinary" Boswellia Serrata?

Hi all,

I've read here that WokVel boswellia serrata has greater bioavailability than the "usual" boswellia formulation.  But I've not been able to find anything in the medical literature or on the WokVel website confirming this.  If I could replace the canonical dose of 4200 mg H15 BS/day with a smaller number of WokVel pills (what's listed on the supplements spreadsheet as three 333 mg WokVel capsules/day), that would make my husband really happy.  Anyone have any insight or citations to offer?

I did contact the WokVel company but they're oriented towards the business end, not end consumers, and my inquiry just resulted in an email asking about my business plans.

Salt Tablets

Hi Everyone
Given that my daughters normal blood pressure has always been on the lower end of the scale, i have been giving her some OTC salt tablets (600mg Sodium Chloride) 4-5 times a day to counteract the Trandolapril and the higher dose of Verapamil over the week surrounding chemo treatments.
In reading an article from the library (Thank you Stephen for giving me access to the library) titled;
Losartan versus Enalapril on celebral edema, it states that lab rats were given a high salt intake to accelerate the appearance of celebral edema.
It concludes that chronic treatment with the AT receptor blocker Losartan prevents the development of celebral edema, and causes manifest cerebral edema to disappear in salt loaded rats?
I am totally new to all of this, and i struggle to understand the medical and scientific interpretations, so i guess my question is;
By giving my daughter a salt supplement to counteract her angiotensin medications, could i in fact be escalating the risk of additional edema.
Any feedback greatly appreciated.
Regards
Martin

Treatment options post-RT/TMZ phase for IDH1 mutated, MGMT unmethylated GBM

Hi all,

I was diagnosed in late September with a GBM (frontal, left, with large cyst, IDH1 mutated, MGMT unmethylated), which was subsequently successfully operated (gross total resection) at the end of September. I guess as many/most here, I eventually stumbled across Ben William's book, the Glioblastoma Treatment options guide and ultimately this invaluable blog and community, which I have been studying and following closely since. I recently concluded the first phase of my treatment, following standard Stupp Protocol (6 weeks concomitant RT/TMZ) and am currently planning next steps (plus waiting for first post-RT MRI next week...).

While I did not get 'smart' in time to save my tumor material from being paraffined post-OP (unbelievably, this is still standard practice here in Germany in most hospitals), I did actively supplement my first phase of treatment with what I think is a reasonably aggressive 'cocktail' approach, including the following components:

--------------------------------------------------------------------------------------

Meds:
- Chloroquine, 1x 250mg
- Celebrex, 2x 200mg
- Disulfiram, 1x 250mg - 500mg (+4mg copper)
- Sativex (THC/CBD spray), ca. 3-4 sprays (approx. 15-20mg)

In general, I tolerated these medications without any major problems or side effects, with a few exceptions. Notably, towards the end of the treatment I developed some peripheral neuropathy in my left foot, which has now almost recovered, however (took around 3-4 weeks to recover). Nevertheless, it cause me to cease the Chloroquine and Disulfiram shortly before the end of my RT treatment phase. In addition, I found it a little hard to tolerate Sativex as I wasn't too keen on the psychoactive effect, which gave me some anxiety / mild panic attacks from time to time at night. As a result, I took it only for around 3 weeks or so.

Supplements:
- Berberine: 1000mg
- Boswellia Serrata: up to 4400mg (gradually increased dosage over course of RT to protect from Edema)
- CBD oil (8%), 5 drops (started after ceasing to take Sativex)
- PSP, 2100mg
- Curcumin (Longvida), 2000mg, increased to 3000mg towards end of treatment
- Green Tea Extract, 3625mg
- Lycopene, 20mg
- Matiake D-Fraction Pro, 65mg (3x 23 drops)
- Melatonin, 20mg
- Omega 3 DHA/EPA, 3528mg
- Probiotics, ca. 40bn units
- Pterstilbene, 250mg
- Resveratrol, 500mg
- Selenium, 200ug
- Silymarin, 1500mg
- Soy extract, 3750mg
- Vitamin D, 9000IU

In general, all of the above were well tolerated without side effects. I'd also like to mention I was able to avoid any kind of Edema / Cortisone use during my RT therapy, which I believe may have been at least in part facilitated by Boswellia in combination with Celebrex.


Other:
- Ketogenic diet, max 40 g Carbs per day; generally constant medium to high Ketone bodies when measuring. Started 1 week before RT, and continued to last day
- Caloric restriction, lost ca. 8 kilos in 6.5 weeks of RT, which I think equates approx. 600kcal or so in daily caloric restriction
- Daily morning smoothie, with variety of hopefully beneficial things like berries, broccoli sprouts, spirulina, tumeric powder, Matcha green tea, cocoa powder,  etc.
- Daily walks of ca. 1 hour to combat radiotherapy fatigue and keep fit

Ketogenic diet was somewhat difficult to maintain psychologically, but possible due to my partner's kind help in continuously seeking out new and often tasty dishes to keep things interesting. Caloric restriction much easier, since Temodal anyway caused me lack of appetite. I believe daily walks were very helpful to avoid RT fatigue, which affected me only in very minor way and much less than I expected.

--------------------------------------------------------------

NEXT STEPS & QUESTIONS

I am currently considering next steps, and having talked to various NOs and other Brain Tumor specialists, I am still not entirely convinced what the right way forward is. As expected, most doctors do not want to deviate from the Stupp Protocol (i.e. follow up the RT/TMZ phase with 6 months of 5/23 TMZ cycles). However, I am not convinced such a treatment would necessarily add much benefit in my case, since my tumor is MGMT unmethylated.

One of the leading specialists in Germany told me that the unmethylated MGMT status is irrelevant in the case of IDH1 mutated tumors like mine, since a study (NOA-4) showed that there was no significant difference in responsiveness  between MGMT methylated or unmethylated IDH1 tumors.

https://www.ncbi.nlm.nih.gov/pubmed/19901110

However, upon further research I stumbled across the following interesting study from China, which seems to suggest that IDH1 mutated tumors might in fact be particularly resistant to TMZ (3-10x more resistant in cell culture test). The study also notes that in China they observed relatively little additional benefit of TMZ cycles for the IDH1 mutated group of patients compared to RT alone, and the authors argue that survival benefits for IDH1 mutated tumors may simply be the result of a less invasive / more benign type of tumor relative to wildtype. It makes me wonder if the fact that MGMT doesn't seemingly play as big a role for IDH1 mutated tumors is simply the result of the fact that neither responds well to TMZ...:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4747376/

I'm therefore a bit hesitant to simply go ahead with TMZ therapy hoping for the best, and would like to consider other options.
One approach I am considering is Immunotherapy at the IOZK clinic in Cologne, which is not far from my house. However, because I don't have frozen tumor material, they would have to make a personalized vaccine using a liquid biopsy approach. This, in turn, could make the treatment even more unproven than vaccines anyway are even when made from tumor lysate. An additional option which could possible materialize down the road (but not yet, as no trials are running here presently to my knowledge) is to try to get hold of an IDH1 vaccine on a compassionate use basis.


My immediate next step is to see the MRI results next week, but I'd be very grateful for any advice on how to proceed from here. Especially, I'd like to try and resolve the following questions:

1. Would it be unwise to not do any additional TMZ cycles? Are there any obvious chemotherapy alternatives perhaps?

2. Would the immunotherapy using liquid biopsy at IOZK clinic be a good alternative for ongoing chemotherapy cycles? Would it be advisable to start this right away (i.e. without any additional TMZ cycles), or should I do some TMZ cycles first just to hedge my bets?

3. Any other recommendations in terms of maintenance strategies. E.g. what medication(s) could make a good maintenance therapy, without concurrent chemotherapy?


Thanks in advance for any comments, and wish you all a very happy and most importantly healthy 2018!

Best,
John

Boswellia for brain edema

Hello, I have started using WokVel Boswellia Serrata 333mg , 4 pills 3 times a day, in hopes of helping with possible
swelling after RT. That is still short of the 4200mg used in study, so maybe I should increase a bit. Been using it for 3 days.   My husband is currently taking only 1mg of decadron, and when NO has tried to increase it he gets in a very bad emotional state. Has anyone had success with Boswellia ?
Thank you!!

Celebrex control edema? also question about boswilla

Hi all,

I come from China,this blog is wonderful to help my GBM wife.I want to start with a quick question. Stephen,i saw in the library excel that celebrex can help reduce edema,but i can not find related study in the library, do you have it?

I read the study on boswilla serrata control edema pretty well, just want to confirm is that still the best way?

Regards
Roy

Anecdotal report on PD-1 treatment with nivolumab/Opdivo -- brain edema

On another thread on this blog, the topic came up of PD-1 agents causing brain edema (on the Gamma Delta T-cell thread).  As it wasn't directly applicable to that thread, I thought a new thread might be useful, for the consideration by others who might be considering anti-PD-1 agents (in this case, nivolumab/Opdivo).  Stephen W and I have been unable to find much published information on the incidence of brain edema with such agents, so I'm here publishing an individual experience that might be useful to others.

On my wife's research protocol, nivolumab was started simultaneously with the initial radiation Tx (so, standard /Stupp protocol+experimental nivolumab).  This might make sense in theory, but it made it difficult to distinguish whether her neurologic symptoms were from the PD-1 agent or the radiation.

Over the six-week period of radiation (daily M-F) she had very gradual worsening of neurologic function.  Since there didn't seem to be any obvious exacerbations around the time of her infustions (every 2 weeks), I attributed the changes to the radiation, and presumed she was more sensitive to radiation effects than most.  In retrospect, I was wrong, and the deterioration in function was mostly from brain edema from nivolumab.

The tumor was in the left parietal lobe, close enough to the speech center to cause some language difficulty at initial presentation.  The radiation Tx was "IMRT" meaning heavier radiation near the tumor bed than elsewhere, though no part of her brain was totally free from radiation.  She lost hair over about 60 percent of her scalp, more than I expected.

She developed a gradually worsening R visual field defect, and gradually developed R-sided neglect.  Also, gradually progressive unstable gait, and gradually worsening short-term memory, gradually worsening word-finding, gradually worsening confusion.  The overall picture was similar to early- to mid-course Alzheimer's.

The first post-tx MRI was a month after conclusion of radiation (with Opdivo infusions continuing every 2 weeks).  I was becoming alarmed that she didn't seem to be bouncing back after radiation stopped.
The MRI showed *severe* brain edema, all on the left side (tumor side).  There was uncal herniation, the kind of thing you might see shortly after severe head trauma.  The NO seemed shocked that she could still walk and talk and do reasonably well on a cursory neurologic exam.

A couple of infusions were skipped, and most of her symptoms gradualy improved.  However, focal motor seizures didn't improve.  These were very subtle in the first few weeks, but have become more obvious over time and required increasing Vimpat doses to control.

After skipping a couple of infusions in light of brain edema, she got more opdivo about a week or so ago, and all those symptoms got worse again after about 48 hours post-infusion.  MRI then showed edema similar to to the last MRI, but I'm quite sure edema had improved then worsened again.

So we're out of the study.

Trying to interpret the pattern of edema (all L-sided) is challenging.  It's possible the edema is from nivolumab doing it's job, killing off glioma cells in the left-side of the brain that hasn't showed up on any MRI.  But I don't think so.  I suspect she's having an auto-immune generalized brain effect, and that the edema is all L-sided because the radiation mostly impaired the blood-brain barrier throughout the left brain, allowing higher levels of the nivolumab antibody in all the tissues of the L brain.  It's impossible to know for sure, though.

Possibly, in retrospect, a lesson here might be that nivolumab should be started after the conclusion of radiation, and not concurrently.  Possibly a dose lower then 3mg/kq q 2 weeks would be better.  Nobody will know for sure until there's a lot more research and experience.

For the time being, there's no definite residual tumor tissue at all.  Realistically, she's rather likely to have recurrence at some point in the future.  So we're scoping out other clinical trials to pursue if/when that happens.

At the moment, we're interested in:
https://clinicaltrials.gov/ct2/show/NCT01454596
"CAR T Cell Receptor Immunotherapy Targeting EGFRvIII for Patients With Malignant Gliomas Expressing EGFRvIII"

This is, in part, because NIH/NCI is close to us in Maryland.  We're not yet sure her tumor does express EGFR, but we're pursuing that question.  We're also looking for other promising trials applicable to first recurrence after experimental nivolumab tx, even if geographically distant.  Suggestions welcome.  With any luck, we may have a lot of time before we need to enroll in another study.  Extensive cocktail continues.

Best wishes to the whole community,

Steve
stevemdfp at gmail dot com.

Effects of metformin treatment on glioma-induced brain edema

http://www.ajtr.org/files/ajtr0024896.pdf

"Finally, metformin treatment dose-dependently reduced glioma induced vascular permeability and cerebral edema in vivo in rats. Thus, our results suggested that metformin may protect endothelial cell tight junction, prevent damage to the blood brain barrier induced by brain tumor growth, and alleviate the formation of cerebral edema."

The rats were fed metformin dissolved in their daily drinking water.

Solumedrol for brain edema.

We are having problem with edema that is difficult to control. I am posting this for information for anybody else. Prof Pierre Yvess Dietrich just suggested to us solumedrol 250mg/day as iv for brain edema. He stated that it is more potent than dex for brain edema.

Melatonin for cerebral edema? Opinions?

My brother has a cerebral edema that is difficult to control. I'm trying to find some herbs supplements. What is your opinion on this?
http://www.ncbi.nlm.nih.gov/pubmed/24876075

My husband - introduction

Dear all,

In August 2015, my husband (he is 35) had terrible headaches, his vision was affected,  then left side weakness. So went to emergency and two tumors were found. In frontal lobe 64x41x54mm and in basal ganglias 16x22x15mm. The bigger one was resected and the smaller one was inoperable. 

After month he had radiotherapy with concomitant temozolomide.

After around two weeks after the RT he got hydrocephalus. 

Was given shunt, then got meningitis, shunt was removed. Fortunately, now he does not need shunt.

Whole December in hospital, he was in the intensive care unit with meningitis reaching CRP 300.

He survived.

After that he started taking Valcyte. He is not taking any chemotherapy, because for MGMT unmethylated Temodar would not work much.

His biopsy is:  GBM grade 4, GFAP posit, Olig2 posit, IDH1 negat, IDH2 negat, p53 wild type, Ki67 25%, MGMT unmethylated, EGFR not mutated, KRAS not mutated.

Now briefly:

The smaller tumor got bigger and bigger and was operated 18.7.2016. It turned out to be mainly cyst (doctors surprised), with only really small areas shining (being active). Right now he has 32mg of dexamethasone just after the operation.

The leftovers from bigger tumor - got now very very aggressive, it is diffused, inoperable. And I think there is not much time now left.

My questions:

1. which supplements I can give him here in hospital while on high does dexamethasone?

2. which supplements, drugs would you advise to add to our protocol to which we want to return when he is at home again?

Prescribed drugs:

Valcyte

Keppra

Then he takes (will give precise mgs when at home):

ReishiMax Glp(Nuskin) - 3 times higher recommended dos

Cordymax  (Nuskin) - 3 times higher recommended dose

LifePak (Nuskin) - multivitamin

MarineOmega  (Nuskin) - recommended dose

Curcumin  (LifeExtension) - 3 times a day

Boswellia (300mg) - 3 times a day

Resveratrol 250mg (250mg trans-resveratrol, 100mg Quercetin) - 2 times a day

Melatonin - 5mg before bed (will increase this to 10mg)

Chlorela - 2x a day

Serapeptase -2 capsules early in the morning

Betaglukan

Vitwmin D - 5000 UI once a week

Rick Simpson protocol (should we stop it as we will start with DC vaccines?)

Banerji protocol (Ruta + Calcarea)

Carcinosin 200C

peptides (whole content not revealed) for immune system

peptides with reishi, cordyceps and more (not revealed to us)

Epiquercican (Dr Rath) - 3 capsules a day (lysin, prolin, arginin, EGCG, ..)

probiotics

meditation

avoiding sugar, restricting meat

Can we add milk thistle?

Can we add aloe vera?

We were in Lithuania more than month ago. DC vaccines are ready from my husbands blood (not from his tumor). Day before first DC vaccine he will have tetanus shot to increase the better outcome of DC vaccines.

We also started to cooperate with one scientist at the oncology institute, he now has samples from his tumor. He is expert on mesenchymal stems cells and vaccines and nanoparticles, so we hope to get to some state-of-the-art treatment too.

Any help will be much appreciated. 

Wishing you all lot of strength in fighting this beast.

Hana

Corticosteroids (eg dexamethasone) and survival in GBM

Click here to view abstract

This study includes such names as Roger Stupp and Michael Weller on the author list, so cannot be taken lightly.

This paper consists of a retrospective human study and a mouse study.  The mouse study shows an antagonistic effect of dexamethasone on the efficacy of radiation (mouse survival was shorter when given dexamethasone with radiation compared to radiation alone).   An anti-VEGF antibody (similar to Avastin) was used in another group mice as an alternative means of edema control, and no interference with radiation was observed.

"Beyond the established adverse effect profile of protracted corticosteroid use, this analysis substantiates the request for prudent and restricted use of corticosteroids in glioblastoma."

Edema generated on flight?

Hi All, we arrived on Sunday to Duderstadt to get some treatment for my wife. Today I felt her a litle bit like disconnected also with some symthomps increased around her hemiparesia. Talked with out second line onchologyst, the one that supports cocktail approach, and told us this long flights (30 hs) may cause edema, added to the fatigue, jetlag a also taking in considerarion that her last surgery was on February 22nd, yes almost 2 weeks, this maybe the main reason of her current status. He reccomends to start 24mg daily to reduce edema.

You can call us crazy, but the situation really diserve it. Whenever I have time will post a briefly her story/fight.

Thanks for the inputs.

Dexamethasone vs. confusion

My wife is very confused lately - more so than usual. It's been about two weeks after the SoC of radiation and chemotherapy.

We have been trying to wean her of Dexamethasone so she's currently on 4mg in the morning and 2mg at night. But we're worried that her state of confusion is dampening her already dampened spirits.

I'm very wary of dexa - at our first hospital, the surgeon gave her a whopping 64mg a day, or 16 tabs. Her tumor wasn't considered "a time bomb" at the time but two weeks later, we rushed her to the hosptial as the tumor became very, very aggressive. I don't have anything to support this but I'm certain that the dexa had a hand in this as I feel it increased the glucose in her blood resulting in the growth. Our NO says there's little support for this.

Now, our new issue is that she was fine on 4/4 so we dropped her (per the NO) to 4/2 but her confusion has increased dramatically.

I'm trying to counter this is 2400mg of Boswellia (specifically http://www.amazon.com/Boswellia-Serrata-1200-Mg-Capsules/dp/B00C6B17VM) as well as turmeric and celebrex but it doesn't seem to be cutting it.

Questions

1. Are my fears of dexa over-blown?
2. If they are not, what alternatives do I have to the dexa?

Thanks in advance!

Swelling

What is the best thing to use for swelling/oedema? My dad uses now 16 mg dexamethasone a day, and is feeling fine when he uses it. But they want to temper down the dosage so they gave him a couple days a go half of the dosage a day: so 8 mg. He didn't go react well on it , so now they increased the dosage. But i know he can not take dexa for life becaus of side effects etc. so i am searching for the best brand of boswellia or other things
Any suggestions?