1. The land of chronic Lyme
Everything works sometimes
Eric Gordon MD

2. Does chronic Lyme exist
Multiple animal models demonstrating borrelia despite previous antibiotic therapy
We see persistent IgM antibodies with and without IgG antibodies in patients with symptoms that revert to negative IgM status with antibiotic treatment and symptom resolution
Multiple studies demonstrating borrelia persistence in humans despite antibiotic therapy
Our experience of positive Lyme cultures after prolonged antibiotic therapy

3. Then why does IDSA insist that it doesn’t
Lyme culture was not commercially available and it is an extremely fastidious organism
Patients have multiple complaints that provoke the “psychological reflex” in physicians
Other than a tendency to low wbc counts patients have normal labs ordered by most doctors including sed rate and Crp

4. Then why does IDSA insist that it doesn’t
Several studies showing no “significant “ improvement with repeated 1-2 month courses of antibiotics
Fallon study showing minimal improvement with 6 months of rocephin (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

5. Problem of standard Western Blot testing
Chronic patients often have negative IgG Western Blots (WB) and “false “ positive IgM WB
Labcorp and Quest WB’s have low sensitivity and are especially poor outside of new England
 We don' t know the number of people who have Lyme who have a failure to develop antibodies

6. Problem of standard Western Blot testing
      WB testing bands   Decided at conference held by CDC in Dearborn , Michigan  in  The IgG criteria were based  on a paper from 1993 by Dressler, Whalen, Reinhardt and Steere . They looked at WB's from several dozen well characterized Lyme patients with strong immune responses and found that by requiring 5 out of 10 IgG bands the WB could be highly specific but did lose some sensitivity

7. Problem of standard Western Blot testing
IgM criteria were developed from other similar papers only 2 of 3 IgM bands are necessary . The first IgM bands that show up are 41, , and is to the flagellar protein and is not specific to Lyme The CDC has decided that since IgM is an acute event you should ignore it starting 6 weeks after infection

8. Problem of standard Western Blot testing
Early sub-therapeutic treatment can interfere with the immune response leading to negative antibody tests
Many people who relapse after antibiotic treatment are sero-negative till after retreatment
Some people with culture positive Lyme disease are sero negative by WB even though they were positive when first diagnosed years earlier
Sometimes they are sero-negative because all the antibody is tied up in immune complexes    

9. Lyme specific bands according to ILADS and our clinical judgment
              31= OspA                22-25 = OspC              34= OspB         , 39, CDC 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 Dressler et al studied. 31 is OspA which is the antigen used in the early Lyme vaccines ( Osp=Outer surface protein)

10. Everybody is right but nobody trusts each other
Chronic Lyme exists and sometimes antibiotics help
People develop autoimmune diseases and sometimes removing the trigger helps(Lyme )
IDSA studies only include patients who fit CDC criteria-circular reasoning
Sometimes antibiotics don’t help and make people worse
Unneeded antibiotics cause severe dysbiosis
PICC line infections do happen

11. Testing limitations and controversies Advanced laboratory Systems (ALS)
Need to be off all treatment for 4 weeks and best to draw in afternoon when symptomatic
Initial darkfield exam then day culture and repeat darkfield if negative another 8 week and if needed another 8 weeks of culture
If positive darkfield then borrelia specific staining and if desired PCR for species
100% negatives on controls
7% false negatives in patients
B Garini found in high % of cultures done in Sapi lab leading to claims of contamination. This is not same location as ALS lab.

12. Testing limitations and controversies iSpot
Melisa test evaluating T cell reactivity measuring Interferon gamma production after exposure to Lyme antigens
Main problem is lots of false negatives but at least they identify them
Because in chronic patients there is high percentage of poor T cell Interferon gamma production after stimulation by phytohemagglutinin as a screening test
Pharmasan.com

13. Testing limitations and controversies provoked urine testing
IDSA –unproven
Requires oral or IM antibiotic provocation
Measures Lyme antigen in urine
Igenex .com

14. Testing limitations and controversies DNA PCR testing
IDSA –unproven
DNA may remain but non-viable and non-infectious
Milford Medical lab Borrelia burgdorferi, and Borrelia miyamotoi
Igenex lab

15. Complicating issues Mold and other neurotoxins Co-infections
Biochemical individuality (genetics and epigenetics)
Dysbiosis
Heavy metals
EMF
Psyche
Structural
Dental
Biofilms

16. Mold
Always suspect when you think babesia and especially when pain and brain fog are out of proportion and especially when intermittent
Realtime lab mycotoxin panel $700 initial followup $200
Best to collect urine in the AM after sauna or several days of Glutathione
Dr Brewer uses CSM but also charcoal and bentonite for tricothecene and aflatoxin Toxins 2014, 6, 66-80; doi: /toxins

17. 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 corrected
He prefers Cholestyramine (CSM)
Please see Dr Shoemakers website Survivingmold.com

18. Neurotoxins Mold, Babesia, Lyme Lipophyllic-use intestinal binders
Cholestyramine, welchol, chitosan, charcoal, bentonite, zeolite
Start slow – moving toxins can cause symptoms
Remove from exposure

19. Co-infections Bartonella, Babesia, Ehrlichia Protomyxoma rheumatica ?
Mycoplasma pneumonia
Chlamydia Pneumonia
Rickettsia’s
Tularemia, Q fever (Coxiella Burnetii)
Parasites
Viruses-EBV, HHV6,CMV, Coxsackie

20. Albendazole- roundworms, tapeworms and flukes
Parasites
If any clinical hint, treat parasites first, and repeatedly, if any clinical response.
Multiple herbal treatments
Biltricide for flukes, tapeworms
Ivermectin for microfilaria
Pyrantel pamoate for hookworms and roundworms
Albendazole- roundworms, tapeworms and flukes
Alinia- for everything -caution

21. Biochemical individuality epigenetics and genetics
Methylation cycle- MTHFR Ben Lynch et al, Glutathione –Von Konynberg ,Nathan –order phenotype testing from Vitamindiagnostics.com
HLA-DR per Ritchie Shoemaker and etc some correlation with sicker patients- defects in antibody presentation or toxin problems

22. Biochemical individuality epigenetics and genetics
Celiac and gluten sensitivity
Porphyria- spot urine when symptomatic
Kryptopyrroluria
Mast cell activation
Cytochrome p450 variations
Oxalate –Susan Owens lowoxalates.com

23. Heavy Metals Mercury , Lead, Arsenic, Cadmium Aluminum Hair analysis
Quicksilver –hair, serum, and urine
DMPS, CaEDTA challenge test- make sure glutathione is adequate and patient not too toxic
DMSA

24. EMF Check house and work
Remove toxins and strengthen membrane integrity
Decrease inflammation
Richard Conrad—ConradBiologic.com
Stetzerelectric.com

25. Psyche Not psychological Bugs effect nervous system
Amplification of your normal neurotic qualities
Sensitization to all input
Loss of social support
Therapy that the patient can receive - have different modalities
Annie Hopper , Ashok Gupta, others

26. Structural issues and Detox
Inflammation + structural dysfunction = pain and a good place for bugs and toxins to accumulate
Need osteopath, chiropractor, physical therapist, massage therapist
Acupuncture, FSM (frequency specific microcurrent) Scenar, laser, ,photon stim etc.
Sauna, colonics, baths
Rectal ozone
Diet, diet, nutrition, diet, trace minerals ,diet

27. Dental Chronic infections-wisdom teeth sites, root canals
Need ICAT –plain films will miss infection
TMJ
Mercury
Galvanic testing when metal is present

28. Biofilms
planktonic forms are where we look for the bugs but it but they live in biofilms
Complex structures-hi in Ca,Mg, Fe
Don’t try to destroy them too early
EDTA, Enzymes, Silver
Costerton, J. W youtube.com/watch?v=M_DWNFFgHbE

29. Bottom line Listen and look closely at your patient
If 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

30. Treatment Always use probiotics and saccharomyces boulardi
Join ILADS and read Burrascano and Horowitz
Do an ILADS preceptorship
Start slow and believe your patients

31. Treatments Antibiotics
Oral –Hi dose Doxycycline and rifampin with macrolides and hydrochloroquine
Omnicef 300mg two bid with macrolides
Bactrim DS bid with rifampin 300mg bid +/- macrolides or just rifampin 300mg bid +/- macrolides
Macrolides-Zithromax mg and Biaxin 1000mg qd usually with hydrochloroquine
All of these can and should be modified to patient tolerance especially rifampin (cytP450 issues) Use Biaxin instead of Zithromax with rifampin
Metronidizole, Tindamax (cyst busters)

32. Treatment IV antibiotics 3days out of 7
Standard therapy Rocephin 2 gm bid remember to add Actigal 300mg bid My preference is Claforan 4 gm tid Many other options best to discuss with experienced clinicians Occasionally if no response to cephalosporins Vancomycin 1 gm q12 hours with trough levels between is effective (Bartonella) I almost always add Argentyn 23, 30cc per day for its synergistic effect Pulse therapy and consider Doxy , macrolides , Rifampin, Tinidizole, and be extra cautious with quinolones

33. Other IV therapies
Ozone Dr David Minkoff and also hi pressure ozone per Dr Robert Rowan and Dr Woitzel , Zotzmann in Germany makes a machine
H2O cc of 3% with 10cc DMSO in cc D5W with Mn and MgCl to protect veins per Dr Brodie
UVB treatments
IV homeopathics to help detox
IV silver to augment antibiotics
IV Phosphatidylcholine ,phenylbutyrate and glutathione for detox

34. Treatment Basic Herbal list
Nutramedix---Samento, Banderol, Cumanda, Enula
Classical Pearls- Lightening and Thunder pearls
Dr Zhang- HH
Byron White –A-L, A-Bart , A-Bab, A-Myco
Beyond balance BB-1, Bab-1&2, Bart-1
Dr Buhner- Japanese knotwood, cats claw, sida acuta, cryptolepsis

35. Immune Support
GcMAF -measure Nagalase at health diagnostics- oral and injectable forms
Vit D – check 25 and 1-25 Vit D
LDN –low dose naltrexone
Herbs

36. Energetic treatments
Multiple Vega and subsequent devices for diagnosis and treatment
Frequency generating machines such as Doug coil, pulsedtechnologies.com, many others
Biophoton therapies –Dr Woitzel in Germany and Johan Boswinkel in Netherlands