A full medical case history and examination is the first prerequisite, including a comprehensive personal and family history detailing all aspects of previous health problems and current status. Questions relating to diet, habits, emotional status, exercise, stress levels and a detailed listing of symptoms is part of this. A full physical examination is also required, most notably of all aspects of the circulatory and respiratory systems.

An electrocardiogram and chest X­ray might be required as well as a number of blood tests. Exercise tolerance tests may be used to see just how the functioning of the heart, lungs and circulation responds to activity. A commonly used procedure, before chelation therapy is started, and of major importance in establishing a 'before' picture of circulatory efficiency, is the use of what is known as bi­directional Doppler (sound wave) examination.

This is a painless, non­invasive use of sound waves (ultrasonic) which is used to investigate six major arterial sites which relate to circulation to the brain, as well as eight sites which relate to circulation to the legs. The Doppler equipment gives readings which tell the doctor running the tests three important pieces of information at each site:

1. It shows whether there is any turbulence which could relate to breakaway deposits of plaque, etc., which could be involved in production of a stroke.

2. It checks for any signs of capillary hardening in the brain, often associated with memory loss and age­related brain changes.

3. The major arteries are assessed for obstructions to normal flow of blood which could relate to over­burdened heart function or deficient circulation to the legs.

This sound­wave testing takes about an hour and all findings are recorded on charts so that later tests can be compared. This is also an excellent way for the patient to appreciate visually the degree of current circulatory difficulty.

Use of thermographically (heat) sensitive film allows areas of the body which are not receiving their full circulatory servicing to be photographed as a record which can be compared with the same region after treatment.

Among other tests, an initial one is performed (not for people with diabetes) after overnight fasting (14 hours without food). This test is usually done around mid­morning, the last food (or coffee or sugar) having been consumed around 9 pm the previous night. The fasting blood test gives an accurate idea of cholesterol levels as well as other key markers. Periodic monitoring of blood levels of cholesterol and other elements (giving evidence of levels of blood fats, carbohydrates, whether or not there is anaemia, infection, immune system problems, liver or kidney dysfunction, etc.) is made during the chelation treatment which can last for some months, with two or three infusions per week.

Depending upon the condition of the patient a blood sample may be required before each treatment, or periodically.

A 24­hour sample is required for assessment of normal urinary output of creatinine, a key guide as to kidney status. A periodic assessment is made of the creatinine levels of the urine as the series of chelation treatments progress, but this does not require collection of 24­hour samples. As with blood testing, the frequency of urine testing during a series of chelation infusions will vary, depending on the nature of the problem being treated and the health of the patient.

If there is any evidence that the kidneys could not be expected to deal efficiently with the elimination of EDTA during infusion, then the treatment series would be delayed or stopped until this factor had been dealt with appropriately. As we will see in a description of important research by Doctors McDonagh, Rudolph and Cheraskin later in this chapter, kidney dysfunction is often capable of being normalized by EDTA chelation therapy

A computerized dietary analysis (based on the filling in of lengthy questionnaires) of what the patient eats is often required so that comprehensive dietary and supplementation advice can be given to the person being chelated, to complement the treatment.

In addition, saliva, sweat and faeces may need to be tested for a variety of reasons, including assessment of what the patient's current metabolic and nutrient status is, how well foods are being digested and absorbed, etc. Whether such tests are needed will depend upon the individual problems being dealt with.

This non­invasive and inexpensive method is also sometimes used to provide an accurate indication of heavy metal toxicity as well as to give some idea of the current mineral status of the body. The findings from this and the other tests allow the doctor in charge to decide just what balance of minerals should be added to the basic EDTA infusion solution in order to obtain the best results.

Once it has been established that there is a problem which could benefit from EDTA infusion, a series of treatments are scheduled, either two or three times per week. Most chelation centres treat patients in a group setting.

A large room with appropriate seating (usually comfortable recliners) is all that is needed (not unlike a hairdressing or beauty salon). There are several advantages to this approach:

1. The mutual support of people having the same procedure is reassuring and encouraging. There will almost always be someone present who has had a number of infusions and who can give a personal account of what to expect.

2. The costs can be reduced, since fewer supervisory staff are required if patients are grouped together in this way.

3. During the 3 1/2 hours of the infusion the patient can read, doze, chat, watch TV, listen to a pep talk on diet or exercise from a clinician (this is a truly 'captive audience').

The infusion itself involves the insertion into a vein (usually in the hand or forearm, but sometimes the lower leg) of a needle which is attached to the container (hung on an adjustable stand), from which is drip­fed around half a litre of fluid over the 3 1/2 hours' duration of each treatment. This liquid usually contains 2 to 3 grams of EDTA and whatever additional minerals the doctor has decided will best help achieve a balanced blood content.

EDTA mixture

Among the other substances often placed in solution with the EDTA are a complex of B vitamins, vitamin C, magnesium (extremely useful for cardiovascular health) and heparin (an anti­coagulant, enough of which is sometimes used just to prevent any clotting at the injection site). Cranton suggests (Cranton and Frackelton, 1982) that since magnesium is a natural calcium antagonist and also the ion least likely to be removed by EDTA (see Chapter 4), and that it is relatively deficient in many people with cardiovascular and circulatory problems, it should be supplied with the chelation process. He suggests that the best way to do this is to use magnesium­EDTA, which would provide an efficient delivery system and thereby increase magnesium stores in the body.

When the infusion is being performed, the arm is kept stable as a rule by being taped to a padded board which rests on a cushion for comfort. It is usually quite possible (although it is not encouraged) for the patient to move around freely during treatment (to visit the toilet, for example) as long as the mobile infusion is wheeled alongside.

The rate at which the EDTA solution is dripped into the bloodstream can be varied but usually it is at a rate of one drop per second.

As a general rule, two, but sometimes three, treatments are given each week, and a total of anything from 20 (for relatively mild problems) to 30 infusions in all comprise one complete series.

On a number of occasions (sometimes at each visit) blood and urine testing (as well as other tests) may be carried out to ensure that kidney and other functions are operating sufficiently well to cope with the EDTA detoxification. This is obviously more important in elderly patients or anyone with compromised kidney function. In some instances where a great deal of circulatory pathology exists, follow­up series of chelation infusions might be encouraged, with many people showing benefits after up to 100 infusions.

The EDTA is eliminated from the body, 95 per cent via the kidneys and 5 per cent via the bile, along with the toxic metals and free ionic calcium which it has locked on to in its transit through the circulatory system.

In hospital settings, EDTA infusions have in the past been given daily for up to five days, followed by a two­day rest period for the kidneys. This protocol is now discouraged by the American medical group with the most experience of chelation, the American Academy of Medical Preventics.

General toxicity

Walker and Gordon (1982) inform us that EDTA is far safer than aspirin, digoxin, tetracyclin, ethyl alcohol or the nicotine from two cigarettes, in equivalent therapeutic doses. EDTA is used in thousands of food products (it is in most canned foods) and its toxicity is known to be extremely low.

In assessing the relative toxicity of a substance a therapeutic index is established. Firstly, the amount of the substance which would prove lethal to half the animals in an experimental setting is discovered by the gruesome process of increasing their intake until half of them die. This is the LD­50 measurement (LD for lethal dose). When this amount is divided by the amount required for a therapeutic effect we end with a number which is the therapeutic index.

The LD­50 of EDTA is 2000 milligrams per kilo of body weight, whether taken orally or intravenously. In comparison aspirin has a toxicity equal to 558 milligrams per kilo of body weight. So in general there is no need for concern as to general toxicity with EDTA usage, whether by mouth (see Chapter 9) or directly into the blood.