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Lyme Disease and Associated Infections UPDATE 2020
    Diagnosis and Treatment

Over fifteen years ago I saw a woman who had just recently discovered a tick on her chest. In the several days after she had removed the tick, she developed a "bull's eye" rash at the bite site—a circular reddened ring with a clear center. She lived in a rural area outside of Seattle and came to my office not only because of the rash but because she felt a bit ill. Her history and rash was classical for Lyme disease. As there was no reliable blood test at that time that can reliably show up a several day old Lyme infection, I made the diagnosis entirely on these clinical grounds and prescribed a month of doxycycline, an antibiotic in the tetracycline family. Her rash cleared and she felt her healthy self again, but much more importantly she did not go on to develop Chronic or Disseminated Lyme Disease.

A TICK BITE AND BULLS EYE'S RASH IS NOT REQUIRED

I wish the majority of my Lyme patients were as easy to diagnose and treat as this woman. Unfortunately, most of these patients show up at my office many months if not several years later and do not remember ever having been bit by tick or ever developing a rash. Less than half of those diagnosed with Lyme disease can document these telltale signs. They do not remember the bite because it was on part of the body they could not easily see (or the tick fell off before discovering it) or it could have been a tick in its nymph form, a baby tick so to speak, hardly the size of the head of a pin and very hard to see. And many Lyme patients (less than 50%)simply never get the bulls eye rash or even erethema migrans, a spreading uniformly red rash—another rash characteristic of Lyme.

However, many of these Lyme patients certainly remember the approximate onset when they began to not feel well, and with my questioning, they can usually trace a pattern of emerging symptoms and gradual health deterioration that lead me to suspect underlying Lyme disease and/or one or more of the associated infections caused by other organisms transmitted through the tick bite along with Lyme—Babesia, Bartonella, Erlichia, Mycoplasma and others. Incidentally, Lyme, Bartonella, and Erlichia are bacteria and Babesia (like Malaria) is a parasite.

CHRONIC LYME, THE GREAT MASQUERADER

How these infections affect our health, the symptoms they cause and the conditions they mimic are both fascinating and frightening. I have seen many ill patients over the forty years I have been in practice—those who came to me long after having been diagnosed with and having suffered from a chronic illness such as Chronic Fatigue Syndrome, Fibromyalgia, Rheumatoid Arthritis, Migraine, Multiple Sclerosis, Lupus, Sjogren's Syndrome, Undifferentiated Autoimmune syndrome, Alzheimers or other Dementias, Vulvadynia, Interstitial Cystitis, Plantar Fasciitis, and many others. Many of these patients also turned out to have Lyme disease and/or one or more of the associated infections.

I have seen those who had been diagnosed with a common mental or psychiatric disorder such as Depression, Bipolar Syndrome, Anxiety Disorder, ADD, and others, and many of these patients as well have had Lyme disease and associated infections contributing to or causing their mental/emotional dysfunction. There are patients with acute episodes of optic neuritis, Bell's palsy (facial paralysis) or uveitis who actually have Lyme disease.

And of course there are all of those patients I have seen who had not been given an official name for their ailments but who simply were not well—those with fatigue, joint and muscle pains, headache, stiff neck, numbness and tingling, night sweats, recurrent fevers, recurrent flu and other respiratory infections, heart arrhythmia/palpitations, mental deterioration (foggy brain, memory problems, concentration difficulty, cognitive dysfunction), sleep disorders, mood disorders (depression, anxiety, anger control issues), ringing in the ears, equilibrium difficulties, and stomach and bowel complaints such as nausea, diarrhea, abdominal pain. The list goes on and on. (For a more detailed discussion of the signs and symptoms of Lyme disease and associated infections, visit one or more of the following websites: www.ILADS.org or www.lymedisease.org or www.lymediseaseassociation.org or www.Igenex.com.

In some of these patients, the treatment of Lyme completely reverses their previously diagnosed conditions or unnamed ailments, and in some their chronic conditions, though not cured, are greatly ameliorated. It is truly gratifying to see the ever-escalating downhill course of these patients change toward the better. Incidentally, some Lyme patients are quite ill and medically disabled whereas others may have isolated persistent or recurring symptoms and may not seem to be all that sick.

WHY DOCTORS MISS THE DIAGNOSIS OF LYME DISEASE

These Lyme and associated disease patients have not been diagnosed before coming to my office for a variety of reasons: Their doctors were likely not aware that these patients' histories and symptom constellations fit the Lyme or coinfection picture. (For probably the first fifteen years of my practice, I was not aware of the myriad symptoms and masquerading conditions that Lyme and the associated diseases can cause.) Until a doctor develops a special interest in tick-borne illness or reads a compelling journal article or book written by a Lyme literate practitioner or even non-medical writer who has written a book about his/her personal experience with these infections, he/she may likely overlook Lyme in a patient complaining of very characteristic symptoms, particularly if chronic symptoms. Or it may be a medical meeting where a lecture or workshop is offered by a Lyme literate physician or one that subscribes to the practices of ILADS (International Lyme and Associated Diseases Society) that awakens a doctor to the challenging and fascinating world of Lyme disease and its associated infections. Without such exposure or until standard medical educators incorporate this vital knowledge into their curriculums, doctors are destined to miss one of the most important diagnoses of patients that visit his/her office. I know that in the past I missed the Lyme diagnosis of many of these patients. Lyme and associated infections were simply off my radar.

TICKS AND LYME DO NOT RECOGNIZE COUNTY AND STATE BORDERS

And then there are other reasons patients are not diagnosed. Many doctors are not aware that Lyme disease is in every state in the USA, and is, in fact, nearly worldwide. Contrary to the general idea that most medical professionals have had for decades (but this is slowly changing) that Lyme is limited to certain endemic areas such as the New England and the Northeast, or Wisconsin/Minnesota, the fact is, Lyme carrying ticks have been identified in every state, and patients have contracted Lyme disease in every state. One reason for such wide dissemination of Lyme and co-infection carrying ticks is that it is not just deer, but rodents, larger mammals, and birds carry ticks carry ticks across county and state borders. (It is infuriating to hear local government officials declare that their county has no Lyme disease when in fact neighboring counties have documented cases of Lyme. As if these tick carrying animals and birds know where the county and state borders lie.

Some doctors are aware of Lyme disease and its symptoms, but are under the false notion that their particular locale is Lyme free and so if their patient has not been traveling out of that locale, then Lyme tests will commonly not be considered. And if by chance Lyme tests happen to be run, co-infections caused by Babesia, Bartonella, and Erlichia are rarely run. Until several years ago, the official l CDC report stated that approximately 30,000 plus Lyme cases were diagnosed yearly in the US. Yet the year later the estimate climbed to 300,000 cases yearly. This sizeable increase does not mean that hundreds of thousands of new Lyme cases suddenly appeared. It means clearly means better recognition (and reporting). And it is thought that this number is a low estimate due still to under recognition (and under reporting). Lyme is known to be the number one vector borne illness in the US.

UNHELPFUL AND MISLEADING LYME TESTS (the most common ones ordered)

Another reason for doctors missing the diagnosis of Lyme disease is that even if they might suspect Lyme, many doctors are not ordering the best tests or in fact are ordering tests that have a built-in weakness to miss the diagnosis. Unfortunately, the most common tests ordered by doctors happen to be those tests that miss far too often: the Lyme ELISA IgM/IgG (Enzyme-Linked Immunosorbent Assay) and the Western Blot IgM and IgG. These two tests are the FDA approved and CDC (Center for Disease Control) recommended two tier testing. The big problem here is that these tests together have an unacceptably high rate of false negatives. (False negative, of course, means that the test does not show up the infection, yet the patient has the infection.) Together these two tests can miss the diagnosis of Lyme up to 60% of the time, according to recent studies. The Western Blot misses it less than the ELISA but still has an unacceptably high rate of false negatives. In spite knowing the weakness of this standard two-tier testing method, some of my patients ask that I run these tests because their insurance covers them. When the tests do show up Lyme, I believe the results (particularly if the patients clinical evaluation points to Lyme disease). However, if the tests are negative, I consider them unhelpful and recommend more accurate testing methods.

REASONS WHY THE STANDARD TWO TIER LYME TESTING METHOD FAILS TO SHOW UP LYME DISEASE

  1. being run too early in the course of the infection

  2. being run after having been on antibiotics for too long a period of time just prior to the blood draw

  3. being run on patients who have suppressed immune systems who are unable to produce the antibodies that these tests measure. Some of the more ill chronic Lyme patients test negative due to this reason. The immune system can be suppressed by Lyme itself and/or by coinfections such as Babesiosis, Bartonellosis, Mycoplasma, Rickettsiosis or others.

  4. being run on patients who may have the immune competence to produce antibodies but who don't have freely circulating antibodies to measure (the antibodies are bound up in immune complexes) and it is these freely circulating antibodies that need to be present (and elevated) for the tests to be positive. Some of the more ill and chronic Lyme patients test negative for this reason.

  5. being run at labs whose cultures and methodologies are not optimal

  6. being run on patients who have Lyme disease caused by strains of Lyme the ELISA and Western Blot tests are not designed to detect. Most Lyme Western Blots test only for the Borrelia Burgdorferi strain B-31 (a few labs also add the strain 297). However, there are 8 strains currently that can be tested, any one of which can be causing their Lyme disease. How can a doctor declare with any genuine sense of assurance that you do not have Lyme disease if the lab test that has been run tests only one strain of Lyme when there are seven more strains the test does not assess, any one of which could be causing your illness? One major reason of course is the doctors lack of knowledge that these standard Lyme tests are so limited.

  7. being run on patients who have the Tick-Borne Relapsing Fever (TBRF) variant of Lyme. Although this infection can produce the symptoms and clinical picture very close to or sometimes even identical to classical Lyme disease, the standard Lyme disease tests will not pick this up. Testing specifically for these "variant" strains of Lyme should be done.

  8. being run on a person who may not have Lyme disease but who has one or more other tick-borne infections with similar presentations of Lyme such as Babesiosis, Bartonellosis, Erlichosis to name just a few. If the standard two-tier Lyme test that your doctor orders is negative, if this doctor is not "Lyme literate", he/she may not even think to order coinfection tests.

  9. If all the Lyme bacteria have left the blood stream (they prefer the lower oxygen environment in the tissues), and if they have been out of the blood stream for more than several months, then the antibodies that had previously been made will have biodegraded (and no longer be present for the test to measure. The immune cells (confined to the blood stream) that make these antibodies against Lyme can no longer "see" them and therefore are not producing the antibodies that the blood test measures.

  10. If the Lyme bacteria are in predominantly the cyst form (and not the spirochete form) or if the majority of the Lyme bacteria are "hiding" within biofilms, the antibody tests will likely be falsely negative, because in both these instances the Lyme is evading immune detection.

If you or your doctor suspects Lyme disease and he/she is willing to test you for Lyme and the ELISA is negative, he or she may inform you confidently that you do not have Lyme and that you do not even qualify for the Lyme Western Blot test (the two tier "rule"). If the ELISA test happens to be positive, then you do qualify for the Western Blot test. However, if that is also negative you will likely be told just as confidently that you do not have Lyme disease. And this may come from the mouth of even a board-certified infectious disease specialist. You will likely need to find a more informed or less biased doctor in order to be evaluated fairly. I say "biased" because I have heard from too many patients that their doctors portray a condescending attitude toward patients who think they might have Lyme disease. Too many doctors believe that Lyme disease is just the latest fad for patients who tend to self-diagnose. What these doctors should remember is that Lyme disease is the number one vector borne illness in the United States. It is not a fad, and these patients might be right.

BETTER LYME TESTS

When I order Lyme tests for my patients, I prefer the Lyme Immunoblot from Igenex Lab in Milpitas, California. (There may be other labs who will soon have this test available, but for now, I believe only Igenex offers it. And I will disclose here that I have no financial relationship with Igenex.) The Immunoblot has many distinct advantages—to the degree that I no longer order the Lyme Western Blot. Cutting to the chase, it simply has far less false negatives than the Western Blot (which as you know means it misses the diagnosis far less) because not only does it assess for eight strains of Lyme but also utilizes much improved methodology. This new methodology also reduces false positives.

The eight strains tested on the Lyme Immunoblot are: B. burgdorferi B31, B. burgdorferi 297, B. mayoni, B. californiensis, B. afzelii, B. garinii, B. spielmani, and B. valaisiana, (For all of these tests, the "B." stands for Borrelia.) I will also frequently order Igenex's Tick Borne Relapsing Fever (TBRF) Immunoblot if the Lyme Immunoblot is negative. The TBRF Immunoblot tests for B. miyamotoi, B. hermsii, B.turicate, and TBRF Borrelia species.

If the patient's immune system is suppressed (is unable to produce enough antibodies for the Immunoblot tests to be reliable), I will order the PCR (the DNA) test for Lyme or the PCR/DNA test for TBRF. The PCR test does not depend upon antibody production. It is the direct identification of the DNA from Lyme, TBRF or whichever infection is being tested. It depends on simply the presence of the DNA in the blood sample and enough copies of it (for which amplification methods are sometimes required—something not all labs do well). A positive PCR is unfortunately not considered the gold standard test for Lyme as it is for other infections. It has been asserted that the Lyme PCR could be a false positive, picking up remnant DNA from dead Lyme bacteria where there is no longer an active infection. This argument does not hold much weight as it has been demonstrated that dead DNA does not remain in the circulation very long. It is biodegraded by the body's scavenger white blood cells.

A positive Lyme PCR, even if every other Lyme test comes back negative, gives me enormous confidence that Lyme is present and active. However, PCR/DNA tests have a higher rate of false negatives than the antibody tests (even at Igenex and other reliable labs), and so a negative PCR result, unfortunately does not rule out these infections.

By the way, to determine if the humoral arm of the immune system (the one that produces antibodies) is suppressed, your doctor can order at most any medical lab (or patients can actually order themselves at such online labs as www.mymedlab.com). The test I order is Quantitative Immunoglobulins IgA, IgG and IgM. If, for example, the IgM is low, it could very well lead to the suspicion that a Lyme IgM Western Blot or Lyme IgM Immunoblot that is negative could very likely be a false negative. If a patient is unable to enlist enough IgM "soldiers" into the immune army, then there will very likely be insufficient IgM "specialists" to train to seek out Lyme bacteria. This test could be negative in patient with Lyme disease. If I had the results of the Quantitative Immunoglobulin tests prior to ordering Lyme and co infection test, and say they were low, I might not order the tests that rely on antibody production (at least as my first line testing). I might prefer to run Lyme and coinfection PCR tests or the IgX Spot tests (see below). The urine PCR and antigen tests for Lyme would be other options.

Igenex now offers the IGX Spot for Lyme (and for Bartonella) which depends upon T Lymphocyte (cell mediated immunity) recognition of these bacteria. This test may show up the infections very early before antibodies to Lyme are able to show up, or in those whose antibody levels are suppressed, or in those whose PCR tests are negative. It can also be particularly useful in chronic/late Lyme when the other tests are not showing any positives. Igenex also offers a RNA--FISH test (Florescent In Situ Hybridization) for Babesia and Bartonella. This test will sometimes show up these infections when the antibody and PCR tests do not.

EVEN THE BEST TESTS CAN MISS THE DIAGNOSIS: LYME DISEASE AND COINFECTIONS ARE PRIMARILY CLINICAL DIAGNOSES

Even utilizing what I believe to be the most accurate lab tests for these infections, yet even these tests may not show up Lyme or co infections. Lab tests are not 100% reliable to rule out diseases. Doctors understand this, but in order to diagnose Lyme disease in a patient, he/she must first suspect it—for which an intimate knowledge of the signs and symptoms of Lyme disease are required. If 1.) we can rule out the other diseases that may have similar signs and symptoms of Lyme or 2.) treat those other conditions the patient may have and if there is still a convincing Lyme picture, and 3.) if Lyme blood and urine tests are negative, then we must make a clinical diagnosis (applies to co-infections too).

It is common in medicine for doctors to make clinical diagnoses—when lab tests do not support the diagnosis and all the other information at hand (history, symptoms, physical exam and other non-laboratory diagnostic modalities) points to Lyme, we make a clinical diagnosis. But this practice is less common in doctors at large when it comes to Lyme disease.

When I make a clinical diagnosis of Lyme disease and then prescribe treatment, although it is a "therapeutic trial" (like all treatments), it is also a "diagnostic trial" (if the treatment works then our clinical diagnosis has likely been correct!). Doctors have made clinical diagnoses forever and still do. However, most doctors are hesitant to utilize this option when it comes to Lyme disease. They have made the decision (unreasonably) that for this condition (unless it is a new tick bite with a bull eye rash), they must rely solely on the lab results (and lab tests that unfortunately are not the best).

KINESIOLGY TESTING: AUTONOMIC RESPONSE TESTING AND QUANTUM REFLEX ANALYSIS

It is quite a challenge to figure out what is causing someone to be chronically unwell and often medically disabled, particularly someone who has seen five to ten specialists and has had nearly every medical test there is, including the best tests at specialized laboratories. As you now understand, a very careful and detailed history is paramount and may provide the only substantial clues. Here is where the art of medicine comes into play!!!

However, there are other tools I utilize that assist me, not only in diagnosis, but in establishing what treatment will be most effective and best tolerated. What has become increasingly important in my practice is the utilization of kinesiology testing, a form of muscle testing. I use specifically the Autonomic Response Testing (ART) technique as well as the Quantum Reflex Analysis (QRA) technique. With such techniques we are able to actually "ask" the body 1.) What the current issues are (infections, toxicities, deficiencies, interference fields or blockages), 2.) What treatments will be effective for these conditions I find, and 3.) What treatments will or not be compatible with the person being tested (will they cause side effects or create new problems).

ART and QRA have given me an enormous advantage in both diagnosis and treatment and I consider them important modalities. Like laboratory tests these systems are not 100% accurate, however, the results are consistent and reliable enough that I would hesitate to exclude this modality in most of my patient evaluations. When the muscle testing correlates with what I have learned about the patient through history, exam and lab tests, it gives me more confidence that I am on the correct diagnostic path. In my muscle testing screening I will commonly find conditions that I had not yet considered and frequently will order labs to confirm those conditions, and I find a remarkable degree of correlation. It took me over twenty-five years of practicing integrative medicine to accept the validity of muscle testing (thank you Pam Alboher, PhD ), and I feel so fortunate to be utilizing this tool as it has made me a better doctor.

BRIEF TREATMENT OVERVIEW OF THE CHRONIC LYME PATIENT

Chronic Lyme and co-infected patients require several layers of treatment. I utilize an integrated approach often combining pharmacologic, nutritional, herbal, hormonal, and immune enhancing treatments. The treatment requires not only anti-microbial agents (prescription or herbal antibiotics) but also biofilm disrupters so that the antimicrobial agents can access their targets. Lyme and other organism live in colonies behind or rather inside of protective shields that they synthesize to protect themselves from "hostile" elements (such as anti-microbial agents and immune system cells). Without biofilm disruptors, the anti-microbial agents and immune cells have difficulty reaching their targets. I also prescribe "binders" that bind Lyme and other microbial toxins and carry them out with the stool. Reducing the body burden of microbial toxins is what can help reduce inflammation in the body (lessening the severity of many kinds of symptoms) and prevent or lessen Herxheimer or "die off" symptoms. (When killing bugs, they can release more toxins than they have already been releasing and make you feel worse than you already feel—which is called "herxing" or "die off")

There are other detoxification measures besides binders that can lessen die off and make the treatment smoother: I will often include such approaches as: homeopathic drainage and herbal remedies that support the detoxification organs (bowel, liver, kidneys, lymphatics), methylation support and oral glutathione (intravenous glutathione when needed). We utilize herbal formulas (many which contain anti-inflammatory agents like curcumin) to counter the inflammatory cytokines that mediate many of the Lyme and die off symptoms.

Many patients require nutritional supplementation to replace the deficiencies induced by Lyme—one of which is severe zinc depletion. A state of insufficient zinc will readily disarm white blood cells, the very cells responsible for fighting Lyme and other infections. Yet it is tricky as Lyme requires zinc. Vitamin B12 and magnesium are also commonly deficient in Lyme patients. I often run lab tests to determine if there are deficiencies and will prescribe what is deficient. In some patients I administer the nutrients intravenously.

We now know that Lyme is capable of inducing Kryptopyrroluria (KPU), which is also known as Hemopyrrollactamuria (HPL). KPU/HPL is a primary mechanism by which one becomes depleted of zinc, manganese, biotin, chromium, vitamin B-6 , molybdenum and other critical nutrients. Not only will these deficiencies impair immune function, but along with impairment of the production of heme, they will render dysfunctional the methylation cycle and other pathways that facilitate the detoxification of lead, mercury and other toxins—which suppress immune function and can cause other widespread adverse effects. KPU/HPL is not limited to chronic Lyme patients by any means, but its incidence is estimated to be about 80% in these patients. When you realize that just zinc alone is required for over 300 biochemical reactions in the body, it is not so difficult to comprehend why Lyme patients are often so compromised and why nutrient supplementation is so important.

Such deficiencies, toxins and metabolic disruptions unattended can explain why Lyme treatment confined exclusively to antibiotics or non-pharmacologic/herbal anti microbial agents alone will often lead to unsatisfactory outcomes. A foundation of detoxification measures, nutritional repletion, heavy metal detoxification (when needed) , and body-wide metabolic and mitochondrial repair as well as adrenal support measures) usually needs to be laid in order for efforts toward microbe elimination or control to be successful. Chronic Lyme patients may also require other endocrine/hormone support including thyroid, estrogen, progesterone, testosterone, and melatonin. And many require pain strategies, and there are several non-pharmacologic approaches that work quite well.

Many of these patients also need measures to enhance the quality and duration of sleep. Without adequate and restorative sleep, healing from chronic Lyme and coinfections will be very difficult. Sometimes simple remedies will do the job, sometimes prescription sleep medications are required. Sometime sleep apnea needs to be addressed. One commonly overlooked measure to help sleep is the reduction of electromagnetic fields and microwave (cell phone, WiFi, etc.) radiation that is polluting bedrooms (see www.safelivingtechnologies.ca). And it is exceedingly common in these Lyme disease patients that they also are suffering from mold/mycotoxin illness and/or parasites and worms. Not only to these conditions present with their own (and sometimes similar) symptoms to Lyme and coinfections, but if they go unrecognized and untreated, they can often sabotage the success of Lyme treatment.

Most Lyme and coinfection patients require some diet counseling—the elimination of certain foods (such as gluten and/or dairy) that may be putting a strain on the immune and other systems of the body. Some Lyme patients find that a paleo-type diet works best or "anti- inflammatory diet". Physical therapy may be required to prevent the de-conditioning that frequently happens with an exhausting illness, and some need counseling and anti-depressant/anti-anxiety medications to help them cope. Adjunctive therapies such as sauna (Lyme does not like excess heat), hyperbaric oxygen (Lyme does not like high oxygen environments) and some electro-frequency treatments have all helped Lyme patients, some remarkably.

There are always new developments in the treatment of Lyme and the understanding of this very clever organism (it has the most complex genome of any known bacteria). In recent years we have learned about Persister Lyme. With daily treatment week after week with anti-microbial agents (antibiotics and/or anti-microbial herbs), some Lyme organisms morph from their spirochete form into Persister cells that are resistant to the anti-microbial agents. Yet, we have developed "pulsed" treatment programs to counter these "Persister" Lyme organisms). By pulsing the treatment, for example using the antimicrobial agents for three consecutive weeks followed a week without these agents (an Off week) , the Persister cells will realize that the previous hostile environment of anti-microbial agents is now gone ("the coast is clear") and will morph back into the spirochete form—their preferred form. But then immediately after the Off week, the anti-microbial agents are started up again to attack the spirochetes--which are susceptible to the anti-microbial agents. It is a cat and mouse chase. Such a three-weeks On, one-week Off schedule is just one example of a pulsing regimen.

Spirochetes can morph into cysts as well which are resistant to most of the anti-microbial agents. However, there are antibiotics that are "cyst busters" that we incorporate into the treatment plan when the timing is right for them.

DISULFIRAM: OLD MEDICATION NOW A NEW LYME TREATMENT

One of the newer treatments for Lyme, the medication Disulfiram, has come to our attention through researchers at Stanford University (Dr Jayakumar Rajadas and his team and from the clinical work of Ken Liegner, MD from New York and Daniel Kinderlehrer, MD of Denver. This is a medication that has been in use over sixty years as aversion therapy for alcoholics. (It is also known as Antabuse.) However, the researchers discovered that compared with all the known antibiotics for Lyme, even the strongest agents known, Disufiram was many fold times more effective in killing Lyme bacteria, in all of its forms and even intracellularly.

Dr Liegner has treated some of his most difficult Lyme (and Babesia) patients, those who have been on and off treatment with oral and intravenous antibiotics for years and unable to stay well without having to go back on treatment. With Disulfiram treated patients (and only an approximately three to four-month treatment) he has seen the majority of these patients achieve a sustained remission. His first patient has been free of relapses for over two years now. He and Dr Kinderlehrer both feel this old medication, now repurposed for this off-label use for Lyme disease, could be a game changer.

We are still in the learning phases of how to best utilize this medication for Lyme disease and over time expect that we will refine the protocol for it and better document its effectiveness. It is considered a generally safe medication with rare serious side effects. Close monitoring of any side effects and running liver and other blood tests every few weeks (more or less frequently depending on the individual) is required for continued safe use. I now have recently begun to prescribe Disulfiram for my most difficult Lyme and Babesia patients, those who have had inadequate responses to a prolonged and sometimes aggressive integrated treatment program. I hope to achieve the same success as Drs Liegner and Kinderlehrer. (See my Disulfiram for Lyme and Babesiosis article).

IN CONCLUSION

Chronic Lyme disease and its co-infections may be the underlying causes of one's chronic or recurring multiple symptoms and poor health. These infections may also be an underlying cause of such established diagnoses as Chronic Fatigue Syndrome, Fibromyalgia, many other conditions as well a host of troubling symptoms and poor health that have no official diagnosis. There is often no history of a preceding tick bite or bull's eye rash. Otherwise competent doctors, even infectious disease specialists, will commonly miss this diagnosis and the diagnosis of Lyme co-infections.

There are many ways to test for Lyme disease and co-infections. Some laboratory tests are rather unproductive and others very useful. However, even the best tests at the best laboratories can miss the diagnosis. Therefore, a very careful history and a health professional's intimate knowledge of Lyme and co-infection symptoms are indispensable. What further increases diagnostic acumen (and treatment success) is the utilization of such tools as Autonomic Response Testing and Quantum Reflex Analysis—kinesiology/muscle testing techniques.

Although Lyme disease has stolen the show regarding tick borne illness, some co-infections can be just as significant as Lyme and even harder to treat successfully. It is essential for doctors to consider co-infections in any Lyme patient because not only do they need to be recognized and treated for the best outcome, but the successful treatment of Lyme may sometimes be dependent on the recognition and treatment of a co-infection such as Babesiosis.

Successful treatment for chronic Lyme disease and co-infections requires an integrated approach that not only targets the infective organisms and their biofilms, restores nutritional and hormone deficiencies, enhances immune competence and detoxification pathways, and restores normal sleep. Medication, nutritional and herbal support, detoxification protocols, counseling, adjunctive modalities, and, I must say, perseverance are all part of what can achieve the best outcomes.

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