|
DAVID A. EDWARDS, MD, H.M.D.
LTD PRACTICE LIMITED TO INTEGRATIVE MEDICINE |
615 Sierra Rose Drive, Suite 3
Reno, NV 89511 (775) 828-4055 Fax (775) 828-4255 |
|
INFORMED CONSENT FOR ULTRAVIOLET BLOOD IRRADIATION THERAPY |
|
I hereby give my consent to Dr. David A. Edwards and the staff of Bio Health Center to administer Ultraviolet Blood Irradiation Therapy (UVBI Therapy), scientifically referred to as Extra-Corporeal Photophoresis. I have been informed and understand that this method involves removing a small volume of my own blood (average = 1.5cc/pound body weight to a maximum of 250cc's) under sterile conditions, briefly exposing that blood to selected frequencies of Ultraviolet Light and re-infusing the blood back into the body. The blood is also treated with a very small amount of temporary acting anti-coagulant (heparin). I understand that UVBI is currently approved by the U.S.F.D.A. for treating certain forms of lymph cancer and psoriasis.
I understand that UVBI therapy is used clinically as both a specific (ie psoriasis, lymph cancer) and non-specific (chronic infections, chronic fatigue, auto-immune diseases, scleroderma, etc.) immune modulating therapy. Certain forms of cancer, auto-immune diseases, infections and tissue transplant rejection have all been published as benefiting from Photophoretic UVB therapy. I understand that the nonspecific use of UVBI is "investigational" and is therefore NOT COVERED BY MEDICARE OR MEDICAID and MAY NOT BE COVERED by private insurance. I have also been informed that the combination of UVBI therapy with another type of bio-oxidative treatment (hydrogen peroxide, ozone) is commonly used and will require a separate informed consent if my treatment includes this method. I understand that the fees for UVBI therapy DO NOT COVER the costs of any additional bio-oxidative therapy. I understand that UVBI therapy is usually administered once or twice weekly for a series (10 to 20) of treatments, depending on the condition being treated. I understand that the side effects of UVBI therapy include minor bruising at the injection site, potential minor bleeding from the heparin, mild temporary "healing reactions" (low grade fever, minor muscle aches or joint aches), potential for secondary infection, possible prescription drug-UVBI interaction (ie sulfa drugs, tetracyclines, phenothiazines) and the rare possibility of photoallergy in the case of allergy to sunlight. I have notified my physician of ALL PRESCRIPTION MEDICATIONS I am currently taking prior to UVBI therapy being administered. I also understand that I am to STOP any and all antioxidant supplements (ie vitamins A,C,E, beta-Carotene, Coenzyme Q10, Lipoic acid, Proanthocyanidins, etc.) 24 hours BEFORE AND AFTER receiving UVBI therapy.
I have READ, UNDERSTAND AND CONSENT to the above.
Signature:
Date:
Witness:
