My name is Matt Hangen and I'm a Christian Humanitarian worker in West Africa. I'm knew to Reactive Arthritis, just being diagnosed in July of 2011.  My wife Grace and I train people how to drill water wells in a small country called Togo. I'm 28, worked actively outside 6 days a week with nationals there, and while heavy (6'3" 280lbs) ran 3 miles, 3 days a week. I'd suffered from intestinal problems for nearly a year after having dysentery from eating food in villages. I was improperly treated with an insufficient dose of metronidazole and had reoccurring diarrhea. The third week of June this year I had a mild count of Entameoba Coli and started on metronidazole (2grams a day for 3 days) based on the council of a local doctor. Five days later the dysentery was back and extreme so I contacted an American RN in Togo. She suggested restarting the treatment, but said that it should be taken for 6-10 days and based on my size I should take 3grams a day (this medication alone made me feel worse than the dysentery). Around day 4 (7 days into the dysentery)  my left index finger began to swell and became very painful. I went to the doctor and was told it was a form of staff infection that is common there so I was started on amoxicillin. A few days later my left eye turned red and began to swell. I went back to the doctor and was told that it was conjunctivitis and was given eye drops. By this time two toes on my left foot had began to swell and became painful as well. Within two days both of my eyes were almost completely swollen shut (my left with a blister on it), my finger was three times it's normal size, and I awoke to agony in my right knee and so much pain in my left toes that I couldn't stand. We then decided to make the 7 hour trip South to a hospital that has an American doctor  on staff (Togo has no good hospitals) and by the time I arrived I had to be transported in a wheelchair. The doctor (a GP) went over my symptoms, noticed I'd developed a rash on my right knee and left foot, and within an hour came back saying he believed it was Reactive Arthritis (my dad, great uncle, and uncle have Ankylosing spondylitis). He started treating the dysentery and initially started Ibuprofen as an ant inflammatory. By the following day (July 7), my right knee had doubled in size and I was in agony. Three days into the hospital he'd began treatment with prednisone (80mg) and indocin (150mg). A week later both ankles, both knees, toes on both feet, left index finger, right middle finger, clavicle/shoulder, and feet arches were agonizingly painful. I was on morphine and two other pain medications to cope with the pain I was in. The doctor then upped my prednisone to 160mg a day and indocin to 225mg a day. Three days into this dosage and after aspirating my right knee I got my first break from pain and was able for the first time in over ten days to walk with a walker. We began to arrange flights to return to the U.S. and began the process of contacting a Rheumatologist. The inflammation seemed to withdraw from the 19th until the day we flew out, the 26th. I began having a lot of blood in my BM's around this time, felt weak, and continued to suffer from insomnia and a racing heart. On the 26th the pain and inflammation returned to it's maximum level for 6 hours but then withdrew, leaving massive fluid build up in my feet and calves. The 30 hours of travel home did not help this. When we arrived we saw a GP within 3 days and had blood work done, my SED rate was still 75%, the level it'd been at for over a month.  We began to taper off the prednisone and awaited a response from my Father's rheumatologist, after explaining our situation to his nurse. We were told to expect at least $1500 in expenses to do testing and to see the doctor.
   We, unfortunately, don't have health insurance and have an income of $22,000 a year, so we registered with a income-based health clinic in hopes that we could see someone who participated in their program. The GP there took me off the indocin because of the bleeding (no taper) and put me on Arthrotec 75 and said there was a children's rheumatologist in their program and that we'd see him within the month. A day later I was back bed-ridden, packed in ice, in agony without pain medication. Two days later we received a call from my dad's rheumatologist saying we had an appointment the following day if we wanted it (we'd been told 6 weeks initially). We arrived and he confirmed the diagnosis based on symptoms, the hospital records, and family history. He did blood work in-house and then scheduled methotrexate injections for treatment. He believes what I have is resistant to NSAIDS. We went to pay and he waved the cost. My father's rheumatologist told us to step down the prednisone again (we were at 100mg) to 40 mg. I did this and again fell into intense pain (knees, ankles, hands, feet, shoulder) and had to be packed in with ice for 5 hours before it let up. We were told to step back up to 60mg, which I'v continued to take for the last week.
   The waves of intense inflammation have continued to cycle for over a week, the longest attack lasting 12 hours. I go from limping, to a cane, to crutches, to a walker, to confined to bed sometimes all in one day.On the flight home, 3 weeks ago, I read your book and have since then drastically changed my diet. I'm currently focusing on eating fresh broccoli, sweet potatoes, spinach, blueberries, plain chicken, yogurt and have cut out nearly all refined sugar, tomatoes, eggs, table salt, anything fried, caffeine, soft drinks, corn, and processed/fast food. I've noticed a huge difference when I break the rules and am beginning to see more moderate cycles of attacks as I focus on eating more anti-inflammatory foods. I just received my second methotrexate injection yesterday and will be stepping down again on prednisone to 50mg tomorrow (August 14).
      We are hopeful that by combining the Methotrexate injections and eliminating food sensitivities/allergens discovered through fasting and the ALCAT test that my Reactive Arthritis will be manageable enough to return to doing aid work in Africa next year. You can learn more about what we do at www.waterfortogo.org. Thanks for reading through the long introduction!   

Here are a response I sent to Matt, that I am posting here in case others might be in a similar situation:

My heart goes out to you and to your wife.  It isn’t easy to go through what you have experienced and are still experiencing and it is also very hard on those closest to us.

Assuming all infection is now out of your body, what is left is your food and chemical triggers, which even if you didn’t have them before, are one of the side effects of so much intestinal disruption.  It is good that you have already identified many of them, as evidenced by how much better you feel when you avoid the problem foods you know of thus far.  Given that you are still going into inflammatory cycles, there are probably several triggers you have not yet identified.  Keeping a food and activity diary may help you figure out what these triggers are.  Often patterns that are hard to spot at the time become more obvious when looking over weeks or months of journal entries.

You can also work with the fasting/selective reintroduction or highly limited diet (known safe foods only)/selective reintroduction methods of testing for problem foods (explained in my book), to see what others you can find that way.  The fewer the triggers remaining, the easier it becomes to find what is left.

Do you know if you are HLA B27 positive?  Given that ankylosing spondylitis runs in your family, if you have this particular genetic susceptibility, your recovery from reactive arthritis will also likely require doing more things “right” to switch your system from disease mode back into health mode.  One of the biggest things I have noticed is important for long term success with ankylosing spondylitis is to get and keep your pH into neutral range (around pH 7).  Usually after a big physical stress and after any heavy pain, our bodies go acidic, which helps fuel and sustain inflammatory reactions.  This may end up being important for you as well.

If you sign up for me newsletter at Conquering Arthritis.com, you will eventually get some newsletters addressing pH balance the body. 

I also have a Youtube video on how to check body pH.  http://www.youtube.com/watch?v=L6bXnFFukvA

I don’t know of any scholarship or fee reduction program for the alcat test, but I will forward you letter to the man that works mostly closely with me there, to see if Cell Science Systems (the company that offer the ALCAT test) has some program that I don’t know about or know of some other program.

The least amount of testing I usually recommend is Comprehensive Wellness III $675 (150 foods, 10 food additives, 10 food colorings, 20 molds, 10 environmental chemicals) because sometimes the information in those extra panels is highly valuable in the quest to get well.  Of course, getting tested for everything that you can be tested for is even better, because they more you know about what is and is not triggering your inflammation, the easier it is to heal.

All my best to you.