Eric Gordon MD Chronic Lyme

Report
The land of chronic Lyme
Everything works sometimes
Eric Gordon MD
[email protected]
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
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
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
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
Problem of standard Western Blot
testing
•
WB testing bands Decided at conference
held by CDC in Dearborn , Michigan in
1994. 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
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, 22-25 , and
39.
41 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
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
Lyme specific bands according to ILADS
and our clinical judgment
•
31= OspA
22-25 = OspC
34= OspB
18, 39, 83-94
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)
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
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 10-14 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.
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
Testing limitations and controversies
provoked urine testing
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IDSA –unproven
Requires oral or IM antibiotic provocation
Measures Lyme antigen in urine
Igenex .com
Testing limitations and controversies
DNA PCR testing
• IDSA –unproven
• DNA may remain but non-viable and noninfectious
• Milford Medical lab Borrelia burgdorferi, and
Borrelia miyamotoi
• Igenex lab
Complicating issues
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Mold and other neurotoxins
Co-infections
Biochemical individuality (genetics and epigenetics)
Dysbiosis
Heavy metals
EMF
Psyche
Structural
Dental
Biofilms
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: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 corrected
• He prefers Cholestyramine (CSM)
• Please see Dr Shoemakers website
Survivingmold.com
Neurotoxins
• Mold, Babesia, Lyme
• Lipophyllic-use intestinal binders
• Cholestyramine, welchol, chitosan, charcoal,
bentonite, zeolite
• Start slow – moving toxins can cause
symptoms
• Remove from exposure
Co-infections
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Bartonella, Babesia, Ehrlichia
Protomyxoma rheumatica ?
Mycoplasma pneumonia
Chlamydia Pneumonia
Rickettsia’s
Tularemia, Q fever (Coxiella Burnetii)
Parasites
Viruses-EBV, HHV6,CMV, Coxsackie
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
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 04-3-53 and
11-5-51 etc some correlation with sicker
patients- defects in antibody presentation or
toxin problems
Biochemical individuality
epigenetics and genetics
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Celiac and gluten sensitivity
Porphyria- spot urine when symptomatic
Kryptopyrroluria
Mast cell activation
Cytochrome p450 variations
Oxalate –Susan Owens lowoxalates.com
Heavy Metals
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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
EMF
• Check house and work
• Remove toxins and strengthen membrane
integrity
• Decrease inflammation
• Richard Conrad—ConradBiologic.com
• Stetzerelectric.com
Psyche
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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
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
Dental
• Chronic infections-wisdom teeth sites, root
canals
• Need ICAT –plain films will miss infection
• TMJ
• Mercury
• Galvanic testing when metal is present
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
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
Treatment
• Always use probiotics and saccharomyces
boulardi
• Join ILADS and read Burrascano and Horowitz
• Do an ILADS preceptorship
• Start slow and believe your patients
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 250-600mg 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)
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 10-20 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
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
• H2O2 2.5-5cc of 3% with 10cc DMSO in 250-500cc
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
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
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
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

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