The land of chronic Lyme
Everything works sometimesEric Gordon MDgordonmd@gordonmedical.com
Does chronic Lyme exist
Multiple animal models demonstratingborreliadespite previous antibiotic therapyWe see persistentIgMantibodies with and withoutIgGantibodies in patients with symptoms that revert to negativeIgMstatus with antibiotic treatment and symptom resolutionMultiple studies demonstratingborreliapersistence in humans despite antibiotic therapyOur experience of positive Lyme cultures after prolonged antibiotic therapy
Then why does IDSA insist that it doesn’t
Lyme culture was not commercially available and it is an extremely fastidious organismPatients have multiple complaints that provoke the “psychological reflex” in physiciansOther than a tendency to lowwbccounts patients have normal labs ordered by most doctors includingsedrate andCrp
Then why does IDSA insist that it doesn’t
Several studies showing no “significant “ improvement with repeated 1-2 month courses of antibioticsFallon study showing minimal improvement with 6 months ofrocephin(ceftriaxone)Stridency of patients with unexplained chronic complex symptoms and normal tests and “normal” PE who are referred to Infectious disease specialists by doctors and family
Problem of standard Western Blot testing
Chronic patients often have negativeIgGWestern Blots (WB) and “false “ positiveIgMWBLabcorpand Quest WB’s have low sensitivity and are especially poor outside of new EnglandWe don' t know the number of people who have Lyme who have a failure to develop antibodies
Problem of standard Western Blot testing
WB testing bands Decided at conference held by CDC in Dearborn , Michigan in 1994. TheIgGcriteria were based on a paper from 1993 by Dressler, Whalen, Reinhardt andSteere. They looked at WB's from several dozen well characterized Lyme patients with strong immune responses and found that by requiring 5 out of 10IgGbands the WB could be highly specific but did lose some sensitivity
Problem of standard Western Blot testing
IgMcriteria were developed from othersimilar papersonly2 of3IgMbands are necessary . The firstIgMbands that show up are 41, 22-25 , and39.41 is to theflagellarprotein and is notspecific to LymeThe CDC has decided that sinceIgMis an acute event you should ignore it starting 6 weeks after infection
Problem of standard Western Blot testing
Earlysub-therapeutictreatment can interfere with the immune response leading to negative antibodytestsManypeople who relapse after antibiotic treatment aresero-negative till after retreatmentSome people with culture positive Lyme disease areseronegative by WB even though they were positive when firstdiagnosed years earlierSometimesthey aresero-negativebecause all the antibody is tied up in immunecomplexes
Lyme specific bands according to ILADS and our clinical judgment
31=OspA22-25 =OspC34=OspB18,39,83-94CDC criteria leave out 31 and 34 even though they are specific for Lyme disease because they tend to show up later in the disease and this wasn't the population Dressleret alstudied.31 isOspAwhich is the antigen used in the early Lymevaccines (Osp=Outer surface protein)
Everybody is right but nobody trusts each other
Chronic Lyme exists and sometimes antibiotics helpPeople develop autoimmune diseases and sometimes removing the trigger helps(Lyme )IDSA studies only include patients who fit CDC criteria-circular reasoningSometimes antibiotics don’t help and make people worseUnneeded antibiotics cause severedysbiosisPICC line infections do happen
Testing limitations and controversiesAdvanced laboratory Systems (ALS)
Need to be off all treatment for 4 weeks and best to draw in afternoon when symptomaticInitialdarkfieldexam then 10-14 day culture and repeatdarkfieldif negative another 8 week and if needed another 8 weeks of cultureIf positivedarkfieldthenborreliaspecific staining and if desired PCR for species100% negatives on controls7% false negatives in patientsB Garini found in high % of cultures done inSapilab leading to claims of contamination. This is not same location as ALS lab.
Testing limitations and controversiesiSpot
Melisa test evaluating T cell reactivity measuring Interferon gamma production after exposure to Lyme antigensMain problem is lots of false negatives but at least they identify themBecause in chronic patients there is high percentage of poor T cell Interferon gamma production after stimulation byphytohemagglutininas a screening testPharmasan.com
Testing limitations and controversiesprovoked urine testing
IDSA –unprovenRequires oral or IM antibiotic provocationMeasures Lyme antigen in urineIgenex.com
Testing limitations and controversiesDNA PCR testing
IDSA –unprovenDNA may remain but non-viable and non-infectiousMilford Medical labBorreliaburgdorferi, andBorreliamiyamotoiIgenexlab
Complicating issues
Mold and other neurotoxinsCo-infectionsBiochemical individuality (genetics andepigenetics)DysbiosisHeavy metalsEMFPsycheStructuralDentalBiofilms
Mold
Always suspect when you thinkbabesiaand especially when pain and brain fog are out of proportion and especially when intermittentRealtimelabmycotoxinpanel $700 initialfollowup$200Best to collect urine in the AM after sauna or several days of GlutathioneDr Brewer uses CSM but also charcoal andbentonitefortricotheceneandaflatoxinToxins2014, 6, 66-80; doi:10.3390/toxins6010066
Mold
Dr Shoemaker –Visual Contrast Study for neurotoxicity, markers of innate immunity C4a, VIP ,MSH, VEGF. TGF-beta-1, CD4CD25++,Remove from exposure and use binders then nasal VIP when other markers are correctedHe prefersCholestyramine(CSM)Please see Dr Shoemakers website Survivingmold.com
Neurotoxins
Mold,Babesia, LymeLipophyllic-use intestinal bindersCholestyramine,welchol,chitosan, charcoal,bentonite,zeoliteStart slow – moving toxins can cause symptomsRemove from exposure
Co-infections
Bartonella,Babesia,EhrlichiaProtomyxomarheumatica?MycoplasmapneumoniaChlamydia PneumoniaRickettsia’sTularemia, Q fever (CoxiellaBurnetii)ParasitesViruses-EBV, HHV6,CMV, Coxsackie
Parasites
If any clinical hint, treat parasites first, and repeatedly, if any clinical response.Multiple herbal treatmentsBiltricidefor flukes, tapewormsIvermectinfor microfilariaPyrantelpamoatefor hookworms and roundwormsAlbendazole- roundworms, tapeworms and flukesAlinia- for everything -caution
Biochemical individualityepigeneticsand genetics
Methylationcycle- MTHFR Ben Lynch et al, Glutathione –VonKonynberg,Nathan –order phenotype testing from Vitamindiagnostics.comHLA-DR per Ritchie Shoemaker 04-3-53 and 11-5-51 etc some correlation with sicker patients- defects in antibody presentation or toxin problems
Biochemical individualityepigeneticsand genetics
Celiac and gluten sensitivityPorphyria- spot urine when symptomaticKryptopyrroluriaMast cell activationCytochromep450 variationsOxalate –Susan Owens lowoxalates.com
Heavy Metals
Mercury , Lead, Arsenic, CadmiumAluminumHair analysisQuicksilver –hair, serum, and urineDMPS,CaEDTAchallenge test- make sure glutathione is adequate and patient not too toxicDMSA
EMF
Check house and workRemove toxins and strengthen membrane integrityDecrease inflammationRichard Conrad—ConradBiologic.comStetzerelectric.com
Psyche
Not psychologicalBugs effect nervous systemAmplification of your normal neurotic qualitiesSensitization to all inputLoss of social supportTherapy that the patient can receive - have different modalitiesAnnie Hopper , Ashok Gupta, others
Structural issues andDetox
Inflammation + structural dysfunction = pain and a good place for bugs and toxins to accumulateNeed osteopath, chiropractor, physical therapist, massage therapistAcupuncture, FSM (frequency specificmicrocurrent)Scenar, laser, ,photonstimetc.Sauna, colonics, bathsRectal ozoneDiet, diet, nutrition, diet, trace minerals ,diet
Dental
Chronic infections-wisdom teeth sites, root canalsNeed ICAT –plain films will miss infectionTMJMercuryGalvanic testing when metal is present
Biofilms
planktonicforms are where we look for the bugs but it but they live inbiofilmsComplex structures-hi inCa,Mg, FeDon’t try to destroy them too earlyEDTA, Enzymes, SilverCosterton, J. W youtube.com/watch?v=M_DWNFFgHbE
Bottom line
Listen and look closely at your patientIf robust and recent onset of symptoms feel free to use antibiotics but consider herbal treatments first if you feel infection has been there for more than 6-12 months. Less antibiotics the better.Sensitive and sick for a long time- start slow and don’t think you can’t mess them up with energetic or herbal therapies
Treatment
Always useprobioticsandsaccharomycesboulardiJoin ILADS and readBurrascanoand HorowitzDo an ILADSpreceptorshipStart slow and believe your patients
TreatmentsAntibiotics
Oral –Hi doseDoxycyclineandrifampinwithmacrolidesandhydrochloroquineOmnicef300mg two bid withmacrolidesBactrimDS bid withrifampin300mg bid +/-macrolidesor justrifampin300mg bid +/-macrolidesMacrolides-Zithromax250-600mg andBiaxin1000mgqdusually withhydrochloroquineAll of these can and should be modified to patient tolerance especiallyrifampin(cytP450 issues) UseBiaxininstead ofZithromaxwithrifampinMetronidizole,Tindamax(cyst busters)
TreatmentIV antibiotics 3days out of 7
Standard therapyRocephin2 gm bid remember to addActigal300mg bidMy preference isClaforan4 gmtidMany other options best to discuss with experienced cliniciansOccasionally if no response tocephalosporinsVancomycin1 gm q12 hours with trough levels between 10-20 is effective (Bartonella)I almost always addArgentyn23, 30cc per day for its synergistic effectPulse therapy and consider Doxy ,macrolides,Rifampin,Tinidizole, and be extra cautious withquinolones
Other IV therapies
Ozone Dr DavidMinkoffand also hi pressure ozone per Dr Robert Rowan and DrWoitzel,Zotzmannin Germany makes a machineH2O2 2.5-5cc of 3% with 10cc DMSO in 250-500cc D5W withMnandMgClto protect veins per DrBrodieUVB treatmentsIVhomeopathicsto helpdetoxIV silver to augment antibioticsIVPhosphatidylcholine,phenylbutyrateand glutathione fordetox
TreatmentBasic Herbal list
Nutramedix---Samento, Banderol,Cumanda,EnulaClassical Pearls- Lightening and Thunder pearlsDr Zhang- HHByron White –A-L, A-Bart , A-Bab, A-MycoBeyond balance BB-1, Bab-1&2, Bart-1Dr Buhner- Japaneseknotwood, cats claw,sidaacuta,cryptolepsis
Immune Support
GcMAF-measureNagalaseat health diagnostics- oral andinjectableformsVitD – check 25 and 1-25VitDLDN –low dosenaltrexoneHerbs
Energetic treatments
Multiple Vega and subsequent devices for diagnosis and treatmentFrequency generating machines such as Doug coil, pulsedtechnologies.com, many othersBiophotontherapies –DrWoitzelin Germany and JohanBoswinkelin Netherlands
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