Dr Wirostko Chat notes

[Guest guest]

I attended the " chat " with Dr Wirotsko Thurs pm. She is an

Opthamologist, practiing in Huntington, NY. Her father was involved

in the Road Back Antibiotic Protocol for numerous eye and systemic

diseases.

Patient questions followed by her response:

1) AP for Macular Degeneration?

Dr W: My father worked with erythromycin/doxycycline for

mac. deg. I'm familiar with work out of Boston where they think

there is a link between ARMD and chlamydia. There also may be a

connection with statins and lowering ESR/C reactive protein and

cholesterol. mainstream treatment is aimed at preventing new bad

blood vessels from growing (eg Macugen & Visudye/ treatment not a

cure).

2) Behcet's related eye problems cleared on treatment with

minocin/flagyl. My doc doubts that Behcet's involvement in eyes. Do

you find AP useful in treating above?

Dr W: I believe you are right. There is a hapotype

associated with B., partially genetically predisposed.

3) Dx: dry eye, keratoconjunctivitis, pvd, hyperopia. Tx is

Restasis, Erythromycin/Minocin. How might you treat?

Dr W: Similar, may use Tetracycline/Doxycycline. You may try

adding fish oil/Omega 3's.

4) Dx: Sjogren's. Have you seen patient's tear function

restored with AP/Restasis?

Dr W: Yes. Lid hygiene is very important, try warm

compresses at night, helps with Meibomian glands workd plus is

soothing. SS is believed to be a lymphocytic involvement of lacrimal

glands and conjunctiva. Doxy/Tetra/Minocin to keep glands going and

to reduce inflamation. Restasis/cyclosporin to decrease lymph count.

Erythromycin ungt HS. Restasis may take up to 3 months to work/ if

you stop, dryness will return. Try adding fish oils.

5) If AP works for wet form of MD, does Dr W work with other

doctors?

Dr W: Most eye MDs/retina docs will not rx AP as it is not

an accepted treatment. Many get around it by requesting AP for

Blepharitis, very accepted. AP for ARMD is still in trial/study

phase.

6) I came off all antibiotics in early '03. My eyes/sight since

have gradually gone downhill. The original problem leading to

rheumatic dx was a jaw infection that spread and couldn't be

cleared. I'm positive I still have residual problems in jaw. Maybe

the Minocin didn't reach it although I did do well otherwise. I am

thinking of trying MP. ? Comments?

Dr W: Yes, MP does seem to work for some people.Have

discuseed MP with many patients but have not rx'd. Benicar in high

doses is a concern. I have had great success in treating eye

problems with Zithromax.

I had a severe cytokine storm on Zith/Mino.

Dr W: together? You could try a low dose 3/week. Maybe

Benicar then.

I took them together for a persistant chest infection.

Dr W: Could try 75 mg 1 or 2 times/week as it has a long

half-life.

7) I have dry eye and sometimes feel like there is a large

grain of sand under the eyelid. My eye is red and produces a lot of

mucous.

Dr W: If the mucous is stringy, Try adding fish ois/Omega

3's, Tears/Refresh ungt HS. Humidfy environment. Have you had your

Thyroid checked?

8) Will Plaquenil cause blindness?

Dr W: Rarely. Can cause toxic maculopathy (changes in

macula), which at first cause colour perception changes. Need to

have an eye exam every 6 months, to include a dilated eye exam and

visual fields. If early changes seen, D/C Plaquenil. Even macular

damage is very rare at current doses, most likely is not reversible

though.

I left after an hour and 1/4...so may have been more.

Robyn