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Lyme Complex: Taxonomy and Treatment

Lyme Complex: Taxonomy and Treatment

A Dialogue between Eric Gordon, MD, and Wayne Anderson, ND

Consult your doctor before using any of the treatments found within this site.

The interview below is from 2013, and our understanding of Lyme and Coinfections has evolved, so there may be changes in how the doctors now look at diagnosis and treatment. 

Eric and Wayne by Maggie Perkins 2017

A Dialogue between Eric Gordon, MD, and Wayne Anderson, ND: An interview with Nancy Faass, MSW, MPH

This information is drawn from two discussions on Lyme and the coinfections, conversations involving Eric Gordon, Wayne Anderson, and Nancy Faass.

Taxonomy

Nancy Faass: Let’s talk about the biology. Given that Lyme and most of the coinfections are intracellular, what are the difficulties in testing and treatment? Are there special challenges that grow out of the fact that they are among the smallest living organisms on earth?

Dr. AndersonYes, what we know about the organism [borrelia] is that it goes through different phases – the spirochetal phase, a cell-wall-deficient phase, and a cystic phase. It has genetic complexities that allow it to adapt to different environments, different stresses; it can go dormant, it can take advantage of the patient’s weakness, it can hide in poorly circulated areas.

Nancy Faass:  At one point I think you mentioned that it can take on stealth forms in which it mimics our own immune components.

Dr. Anderson:  A study was done at the Rocky Mountain Institute in which they dyed the spirochete red, and they dyed the lymphocyte cell green. The red spirochete, which you can see in a video, enters the green white blood cell and comes out green. They felt that the spirochete did take on our own cell material for a few of its growth cycles. It was dramatic to see that actually happen.

Dr. Gordon: One of the ways borrelia evades the immune system is to become intracellular. For example, it can internalize into endothelial cells that line the blood vessels. Lyme lives in biofilms and among fibroblasts. It gets into nerve tissue, it’s definitely in the interstitial space, and it lives in the intercellular spaces and in connective tissue. Babesia is an intracellular parasite that lives inside red blood cells, among other places. Most of the other coinfections such as rickettsia, chlamydia, and mycoplasma are intracellular.

Multiphased Testing

Nancy Faass:  Tell us more about the challenges in testing.

Dr. GordonThe CDC has had the criteria of first doing an ELISA, which is a kind of screening immune test for Lyme, and then doing the Western blots only if that was positive. The problem is that we know from real studies, from good data, that the ELISA is going to be negative in about 50% of the people, even those with acute Lyme infections. If you go to any conventional doctor, the first thing they’ll do is an ELISA, and if that’s negative, they will not proceed with any further testing. The ELISA is a method of doing an antibody test, but it’s not very sensitive to Lyme.

Then the next test that they do is the IgG and the IgM. That’s really where we see things differently than the infectious disease doctors, who say that the IgM becomes positive in the first few weeks of the infection and goes away after a month to three months. This is a pattern that’s seen in many, many illnesses, but not in 100% of them. So when an infectious disease doctor sees a positive IgM, they say that is a false positive.

Nancy Faass:  If it’s beyond that initial infectious period?

Dr. GordonRight. If you’ve been sick for a year and the only thing that you have on the LabCorp or Quest testing is a positive IgM and you’re referred to an infectious disease doctor, whatever your symptoms may be, they will see that as a false-positive Lyme test.

Dr. Anderson: And this is on a Western blot test.

Dr. Gordon  – which is still considered “the test.” The important piece here is that what people treating Lyme have seen over the last 30 years is that Lyme patients have a pattern of IgM positivity with chronic infection. How high the IgG is determines whether they think it’s acute or chronic, or whether it’s just old.

In the mainstream, the criterion is that Lyme is a clinical diagnosis. It’s based on signs and symptoms, not on the lab test. If you have a young person who has a persistent knee effusion, like a swollen knee, that looks like Lyme to them. But if you go in and you hurt all over and you can’t sleep and you’re depressed and you have these odd pains in your joints, they’ll just think that you need Prozac or Cymbalta. They just don’t believe that people with multiple symptoms across multiple organ systems have Lyme disease.

If patients have persistent infection and persistent symptoms after they’ve been treated for a month with antibiotics, then they define that as post-Lyme syndrome, which is an autoimmune disease. The point is that they’re probably correct in some patients, but it’s very few in our experience.

Nancy Faass:  How often are multiple symptoms indicative of the coinfections as well?

Dr. GordonHugely. That’s one of the things that I’ve learned from Wayne over the years.

Western Blot Reagents

Dr. Anderson: Also, not all Western blots are the same. The reagents used in a standardly manufactured Western blot by LabCorp or Quest are very weak, and their sensitivity is very weak. So, very often they’ll be falsely negative. In contrast, IGeneX, which has developed their reagents to be much more sensitive to these pathogens, gets many more positive findings on their tests. Conventional infectious disease doctors have discounted IGeneX because the tests are so often positive that the infectious disease community believes these reagents have been overly sensitized, producing an excessive number of false positives. They’ll discount an IGeneX test and use the LabCorp or Quest test as the valid test.

The New Culture Test

GMA note: the Lyme Culture test is no longer available. 

Dr. GordonThe culture test is just amazing. The culture is actually what allowed Dr. Burrascano to do his early work so effectively. He was working with Dr. MacDonald, a pathologist, who would culture his patient’s blood and see the microbe, so he knew that he was actually treating Lyme.

The test is currently available – it went on the market in October 2011. It’s from Advanced Laboratory Services, in Pennsylvania. This is a culture, so when you get a positive answer, a positive test is as 100% as anything can be in medicine. A positive test is real. Right now they’ve sent it out to three universities to reproduce their results, because they’re trying to get FDA approval for it, so maybe eventually it will be insurance covered. In the test they take your blood, look at it under a dark field, and if they see any spirochetes, they stain them. If they don’t see any, and they usually don’t, they put the samples in the culture medium for about ten days to two weeks and then look again. If they don’t see anything that time, they put it away for another two months, because this is what we call a very fastidious organism. It’s hard to grow and you have very few in your bloodstream. That’s what has always been the difficulty.

If you have sepsis, there are tons of bacteria floating around in your bloodstream. But with a chronic infection like Lyme disease there are very, very few in the bloodstream; they’re all hiding. So this test allows us to grow maybe the two or three spirochetes that may be in that vial of blood [even though they may not initially be visible].

With this culture test, if it’s positive, you know the patient has Lyme. There are still probably people walking around who have a positive test but who don’t have significant symptoms. But if someone has symptoms and a positive test, I feel much better about being very aggressive in treating them, if they can tolerate aggressive treatment. [Lack of definitive testing] often stopped me in the past, because so many people are hurt by inappropriate use of antibiotics. That’s why the herbs have become so important to us, because we saw the fallout from treating people for long periods of time. In many people, for example, gut flora is destroyed.

The Lyme Holy Wars

Dr. Anderson: One thing that happened over the last ten years is that our alternative treatment interventions have improved significantly. We now have many choices of nonantibiotic treatments. Initially we only treated for ehrlichia and Lyme. Then babesia was identified, and then bartonella; relatively speaking, those are fairly recent phenomena. I first became aware of babesia around 1997 and bartonella in 2002. And I think in the last ten years we’ve also begun to understand the mechanism of action better, because we were functioning under the infectious disease model, which Eric can articulate nicely, having dealt with it in hospital settings in his training.

Dr. GordonThat is why we have what I call the Lyme Holy Wars to this day – because we keep talking as if we were speaking the same language as the infectious disease doctors, and they think we’re crazy. And for good reason – for example, often we didn’t have a culture to prove that the pathogen was actually there. Today, since we have Advanced Labs, we do have a culture, but before that we were looking at test results for antibodies and arguing about what they meant. The idea that we were treating for “bartonella-like organisms” would make an infectious disease doctor’s hair stand on end – because they are taught that if you cannot find the microbe on a gram stain under a microscope and you cannot grow it from the bloodstream, then you do not know what you’re treating. Unless the person is dying in front of you, you do not treat. So the idea that we were putting people on IV antibiotics sometimes for months for an “infection” that we couldn’t identify for certain – based on clinical symptoms – was heresy and still is heresy to the infectious disease community. I think that is a big part of the problem.

There is another point that is so important: we don’t know what we are treating most of the time when people are being treated for “chronic Lyme.” Yes, Lyme is often involved, babesia is often involved, bartonella-like organisms, whatever they may be, are involved, and the Protomyxzoa rheumatica that Dr. Fry is talking about, perhaps that is present. Parasites are also a factor for so many of these patients, and maybe there are other parasites that we’re not aware of – so all these factors are present.

One of the issues that I want to mention is the idea that most infectious disease the average doctor deals with – strep throats, pneumonias, and other conditions for which they use antibiotics – send out “coherent signals,” meaning that the bacterium does something very predictable and the body responds in a way that is fairly predictable, so the symptoms and the tests align predictably. If a hundred people get pneumonia, most of them will have the same signs on the X-rays, the blood count will change in the same direction, so it’s coherent, predictable, and everyone is happy.

For chronic Lyme we are not dealing with that kind of predictability. In the first few weeks of the infection Lyme may be similar to these other “infectious diseases” and have a clear, predictable interaction with the body, meaning that it will create x symptoms and the body will react in yways. However, once the infection has been present for a while, those patterns fall apart. It becomes a very, very individual disease, a condition in which the issues are, what’s wrong with your body, what’s out of balance, and what is the strength of that particular species, subspecies, or infectious bacteria that you’ve got. And then the dance begins.

Dr. Anderson: We could say these are “functional infectious diseases” as opposed to the type that Eric just mentioned, which are more predictable. These are diseases that affect the cells’ function. They don’t destroy cells, they don’t create abscesses and big pockets of infection. They can in some people, but generally speaking they’re just reducing the functional capacity of the cells, which results in the symptomatic presentation. Consequently, each person will, as Eric said, have a slightly different symptomatic presentation because the bacteria are going to the weak spot for that person. One of the things I tell my patients is, Never compare yourself to anyone else who has Lyme disease, because you’re going to be different; and the horror stories that you hear from other people might not pertain to you, because it’s going to affect your level of function differently than its going to affect someone else’s. So, it always goes after the individual’s strengths and weaknesses. In our discussion here about the pros and cons of antibiotics versus herbal medicines, it’s really a fool’s errand because everything has to be filtered through the individual patient – what is best for them in response to the history, the physical, all of the tools that we have to assess the patient. It becomes, not a philosophical difference between herbs and antibiotics, but a matter of appropriateness for that particular patient. Having said that, we’re going to simplify it and try to come up with pros and cons to antibiotics and herbs.

Dr. GordonI remind patients, Just as you cannot predict your illness, your response to therapy is going to be individual.

Antibiotics or Herbal Therapy?

Nancy Faass:  Which patients tend to do well with one treatment choice or the other – IV antibiotics or low-dose botanicals?

Dr. Anderson: The 80% of patients who have more dominant coinfection presentations always do better on the herbs. The 20% of Lyme patients who have very dominant, aggressive Lyme presentations do better on more aggressive antibiotic treatment. And always, very early cases do better on aggressive antibiotic treatment.

Nancy Faass:  Oral or IV, or both?

Dr. Anderson: Well, in an early case you can always start with oral. But in a very aggressive case our tendency is to use IVs in a more flexible way; not the rigid dosing of the past, but in relation to the patient’s tolerance. In new cases, the antibiotic treatment is always best because we want to nip it in the bud, and that’s often oral initially. Once the Lyme is identified as a significant pathogen, the kind that makes people really sick quickly, then we fairly quickly go to IV so that we can get aggressive with it and match its aggressiveness. Again, that’s in a small percentage of people.

Nancy Faass:  And by significance, do you mean primarily neurological symptoms?

Dr. Anderson: Yes, encephalopathy, meningitis – fevers, tremors, seizure-like experiences, terrible migraine headaches – patients with these very severe neurological presentations would go quickly to antibiotics, and IVs would be a consideration. When it comes to treating borrelia we go right to the IV. There’s so much better penetration into the body with the IV.

Overall, though, I need to emphasize that our use of antibiotics in general is way down. I use maybe one-fifth of the antibiotics that I used ten years ago. Our need to use antibiotics is much lower because the herbal treatments have become so much more effective that we can rely on them and not use antibiotics as the sole treatment protocol.

Dr. GordonAntibiotics have so many different effects on the physiology. We’ve become aware of this because we see the canaries in the coal mine. Yet human resilience is amazing. This culture test has made me more aggressive when I’m facing someone who is very sick and can tolerate antibiotics. When I push the antibiotics aggressively, pulsing it – just doing it for three or four days a week – I’m getting results in people who’ve been sick for years, or even decades. The results are amazing. I haven’t seen this kind of response before because I was hesitant to expose patients to this kind of intervention if I wasn’t positive they had Lyme. Often interpreting the Western blot is like reading tea leaves: they rarely give you an actual positive; often they are inconclusive.

Pattern Recognition

Nancy Faass:  Generally speaking, in many research studies there are probably three or four major response patterns. For example, do you test for methylation before you go in this direction or that? If someone methylates poorly, would you immediately start thinking herbs rather than antibiotics? Do you see patterns forming that tend to guide you

Dr. Anderson: Absolutely. This is the art of it, which I feel we have honed over the years in identifying the patient who has other problems. Lyme, basically, is like the ringleader: it allows other opportunistic infections to take advantage of the patient, because it is immune-suppressive. Lots of other opportunistic organisms are enabled to proliferate, and that can happen in the gut, they can be parasitic, fungal, or opportunistic bacteria. They can compromise metabolic action like methylation. Oxalate metabolism is a fascinating new aspect of the picture. There are so many of these patterns – patterns that are metabolic and pathogen-related, immune-suppressive, or autoimmune. We’ve become very sensitive to them and try to identify them, and pave the way by treating them before getting too aggressive with antibiotics.

Dr. GordonI think the herbs are safer to start with, but if people have a methylation issue, you can make them just as sick with an herb as you can with an antibiotic. The beauty of the herbs is that they often are balancing, they’re not just killing. Many, many people like the Byron White formulas. There is also a practitioner, Dr. Heiner Fruehauf, who does Chinese medicine in Portland, who has put together some wonderful herbal combinations. This is the same concept that Byron White uses to support the patient while you’re trying to reduce the bacterial load – support the body, but don’t overwhelm the system. That’s the beauty of the herbs. But if someone has a metabolic problem, you can throw them into a mess, because most of the people who really are sick cannot modulate cytokine levels. They may not have enough glutathione, which happens when methylation isn’t working, but it can happen for lots of other reasons as well. We try to predict the underlying problems by how the patient reacts to their environment.

Pre-treatment Therapies

Nancy Faass:  Generally speaking, in many research studies there are probably three or four major response patterns. For example, do you test for methylation before you go in this direction or that? If someone methylates poorly, would you immediately start thinking herbs rather than antibiotics? Do you see patterns forming that tend to guide you

Dr. Anderson: What we did wrong for years, going back 15 years, was to go right into antibiotic treatment. What we do right, now, is we look at all these other aspects. We try to clean up the gut, work on the liver, deal with a lymphatic system that is congested. So we’re looking for all these other issues so we can support the patient. Consequently, the amount of treatment they need for their actual infection is much less. When we get to the point where we’re treating the infection, we don’t have all these other issues pulling on that person’s energy, taking away from the person’s vitality. Now their immune system can respond in a much more efficient way when we give it a specific antimicrobial.

The real take-home of all of this is that the herbal medicines have given us so many more tools. They have supported our patients in a way that has made us realize all these other metabolic and pathogenic issues are there, because we see them getting better when we treat with herbal medicines for fungal infections or for parasitic infections. Then we can gradually improve the patient’s health, so that now we can treat their infections in a much more aggressive way. Many of my patients don’t need antibiotics at all. I can get them all the way through the process herbally. If I can effectively peel off the layers in an efficient way, a certain percentage of patients never need to use antibiotics, because their infection really was not the main issue. It was all the other problems. Then the infection becomes minimal when the other issues are improved.

Dr. GordonInitially, we were seduced by the effectiveness of the antibiotics because they were amazing. I was treating very sick people with chronic pain. Working with Wayne, I discovered that these people who I thought had chronic pain because of an injury looked like his patients who had chronic Lyme – and then they began to respond to his treatment, so I started to realize that this was a very complex question.

Eventually we both decided to walk away from the IV antibiotics. We live in an area where there are some other practitioners with excellent reputations who had been doing IV antibiotics incessantly. So we used them, but we had great trepidation, great hesitancy about them because we saw the failures. We saw people who were on IV antibiotics literally for years in some cases and weren’t any better, so we realized that it wasn’t a panacea. The whole issue was confusing and still is; there are some folks for whom IV antibiotics are magic. They may have been sick for five to ten years and you put them on the right IV antibiotics and six weeks, eight weeks, three months later, they’re getting better and better. Now, that’s not the majority, but there are enough of these cases to make it clear that IV antibiotics aren’t evil.

Dr. Anderson: Treatment protocol using antibiotics can be effective for many people, but it has to be the right treatment at the right time. If it’s done too early, then it can disrupt the patient’s symptoms and create confusion in the immune system. When done at the right time, the patient can improve. The nature of the disruption is fairly individual. It’s easy to get lost in a case, trying to differentiate a herx response from a toxic reaction from an outcome that’s actually useful and therapeutic. Clearly some herx responses are excessive, and others show that you’ve chosen the right course. There are subtleties with all these responses in relation to any variable.

Dr. GordonWe are tending to use more IVs because we are now using them for shorter periods of time. So, we’re finding that we can avoid having to place picc lines and central lines. Also the price of the IV antibiotic, at least the price of Rocephin, has come way down. Unfortunately, the rest are still fairly expensive.

Dr. GordonUntil we started using the Byron White herbal formulas, we didn’t really get strong response. Since then we’re finding that more and more of them are very useful. The way I use them is to lower the load, so we save our IV antibiotics for when the person is most likely to respond to it. In some cases, patients come into the office with a history that strongly suggests acute Lyme disease in the past, but they have never been treated with a real course of antibiotics (especially a real course of IV antibiotics). If they are robust and strong and don’t have chemical sensitivities, we might use the IV antibiotics sooner rather than later.

Dr. Anderson: That’s assuming they don’t have a dominant coinfection or parasitic infection that needs to be dealt with first.

Timing

Dr. GordonUnfortunately, it is often the case that patients need other things done first.

Dr. Anderson: One of the factors we always have to keep in mind with any treatment is timing, and I think it is even more important with the use of IV antibiotics. Everything is about timing for the individual patient. IV antibiotics can be a devastatingly bad treatment if they are given at the wrong time. Yet for that same patient, if you improve their detox, knock down their coinfections, and redo that same treatment, they may respond fabulously to it.

Outliers

Dr. GordonThis is all case dependent. Many of the people we treat are outliers, but we learn from those outliers, the most sensitive people – they are the ones who teach us the most. We have to remember that they are still a tiny percentage, and if we treated everybody like we treat them, we would do harm to the stronger people.

With the stronger people, you can get rid of this infection and it will be gone. One of the challenges we have to remember is that millions of people get Lyme disease, and yet we don’t know how many people are chronically ill from Lyme disease. I know personally a large number of people, from when I lived in upstate New York, who had acute Lyme disease and went on antibiotics (some just a short course of antibiotics), and 20 years later still appear to be fine. Again, if we did cultures on all of them, I can’t promise you that they would be 100% well.

Many of the sickest people find us through the Internet. They are helping to lead the charge to make Lyme an illness that is better understood, because their bodies work a little differently than most of us. This is a very challenging disease.

Oral Antibiotics

Dr. GordonI try to avoid oral antibiotics except for people with acute infection. If somebody comes in with a longtime history of Lyme disease, I try to dissuade them from oral antibiotics. If they really want to do it, it’s their body, but I will explain my reasoning. However, my experience has been that people can sometimes be on oral antibiotics for six months, and they’ll improve. However, if they have been sick for a long time, they rarely get totally well. We eventually need IV antibiotics.

Now that we have the herbs, we often find that we can lower the bacterial load and strengthen the body without using oral antibiotics. Occasionally, the infection is predominantly in the gut. There are people for whom Lyme or bartonella infections seem to really go to the gut, and perhaps in those people the oral antibiotics are a good choice. But you get enough penetration of the intestinal wall and stomach with the IVs that they are probably still the better way to go. We can use less drug, for less time, and with a much stronger effect. That being said, I still use a fair amount of oral antibiotics, but my use of these drugs has been rapidly diminishing over the last two years.

Botanical Protocols

Dr. Anderson: That’s been my experience, too. One of the main reasons that I’ve moved away from oral antibiotic use but still keep the IV antibiotics in my toolbox is because of the effectiveness of herbal treatment. I’ve experimented with all the different herbal protocols. I’ve done the Buhner protocol, the Cowden protocol, Susan McCamish’s products – they all have their strengths and weaknesses, and they’re all good. I don’t want to be disparaging about any of them. I find that a practitioner needs to choose a protocol and really learn it, so that they can evaluate the effect of that particular protocol. For me, the protocol of choice involves the Byron White formulas. I found that they are so highly specific to each of these infections that my patients got a predictable therapeutic benefit from them. As to why I use less oral antibiotics, I can get most of the benefit I see in oral antibiotics from the Byron White formulas, which includes knocking down the coinfections. For many people, that’s all they need. Occasionally I’ll follow A-BAB [an herbal formula for babesia] with a little Mepron just to make sure I got it all, or I might give an antibiotic such as rifampin for a bartonella patient after A-BART just to be sure I got it all; but most of the time I’m using those oral protocols for a month, in contrast to six months of Mepron in the past.

In short, the Byron White formulas and the herbal protocols have enabled me to whittle down the microbial load so that when I am ready to address the Lyme, everything else is out of the way and I can just go for it. I go for the Lyme after it has become vulnerable. I see Lyme as the godfather in the back room protected by its little gangsters, babesia, bartonella, ehrlichia, and mycoplasma. Sometimes you have to kill off the gangsters to get to the godfather. But once the godfather is exposed, you’ve got to go in there with the big guns to knock it out. So, that’s what the herbal protocols have done for me – they have enabled me to use much less oral antibiotics. They enable me to work up to the point where borrelia now is more vulnerable, and the IVs then can be used as Eric said, for a shorter period of time.

Dr. GordonI think part of Wayne’s experience with the herbal formulas reflects his long training and thinking as a homeopath – how carefully he listens to what’s happening with the patient. I use a lot of different herbals, because I’m just never sure what’s going to work for the individual. I don’t have a lot of patience, so I’ll use an herbal for a few weeks and if I’m not getting anywhere, I’ll move on to another one pretty quickly.

At this point I use more of Lee Cowden’s herbs than I use of Byron White’s. Each of these approaches has its own value, but you must get to know them; they’re different, very different. I often do a trial dosage. If I don’t get a good response, I’ll give the patient trials of various other remedies to see what begins to shift their symptoms. One of the benefits of the herbs is that you can use them in exceptionally small doses.

Etiology

Dr. GordonWhat keeps people sick is only sometimes the infectious agent. Most of the time there is a combination of an inborn error – some genetic problem in how they metabolize either a novel chemical in the environment or an antibiotic, or a problem in their detox pathway. They may have an enzyme that operates at 70% of efficiency, which is generally no problem if you’re just living your life. But once someone has chronic infection and inflammation, when we add an herb or a drug to try to kill off the infection, suddenly we have a lot of dead and dying cells and a lot of inflammatory chemicals floating around, overwhelming that particular detox pathway. Actually there are an unknown number of little detox pathways. For example, people talk about the cytochrome p450 as just one. I think there are 26 of them, but the variations among those 26 are innumerable given the different SNPs [single nucleotide polymorphisms] and the genetic variations of them. That’s just one small aspect of how the system works.

Individual Sensitivities

Dr. GordonWhat I want to emphasize is that I have patients who wind up on antibiotics because they can’t tolerate the herbs, which has always amazed me. The first time I saw it I was so embarrassed. I was just barely treating a woman with herbs, and every time I did she would develop massive edema and feel terrible. Then she went to see Dr. Steve Harris, who is a wonderful physician, and he put her on three antibiotics at the same time and she did much better. I had worried that if I gave her antibiotics, I was going to do great harm. So, prediction is not always possible.

Conundrums

Dr. Anderson: I think herbs have a very broad effect with multiple alkaloids, whereas antibiotics often have a single mechanism of action, targeting one RNA synthesis or one cell-wall process.

Dr. GordonWe discovered that Rocephin doesn’t only kill pathogens, it also changes the glutamate ratios in the brain. So sometimes when people are getting better mentally, maybe it has nothing to do with killing bacteria; it’s what the Rocephin is doing to the glutamate level in the brain. Susan Owens, who’s doing work with oxalates and autism, pointed out to me the other day that antibiotics affect cell membrane transporters, so God knows what else they’re doing to us, good and bad.

I’ve operated under the idea that the antibiotics were specific, but just two weeks ago I had someone whose symptoms were so very babesia-like – sweats and bizarre things like tachycardia. Yet with a little rifampin (which I usually use to treat bartonella), the symptoms all went away. Maybe it was just bartonella, but she had all the symptoms that we always associate with babesia.

Dr. Anderson: I’ve had many patients who sound similar. We know that there are over a hundred different types of babesia organisms and they vary in how aggressive they are. There are very aggressive babesia organisms; there are very weak babesia organisms that will never be a problem. To use a metaphor, if you can knock off the godfather, many of these lesser little gangsters fall away.

Dr. GordonSo, you’re saying, get the immune system functioning better by lowering the bacterial load, and then the body can take care of the rest.

Dr. Anderson: The immune system can take care of the rest.

Cycling and Pulsing

Dr. GordonThe approach we’re talking about involves cycling and pulsing. Dr. Burrascano differentiates between the two. My interpretation is that he’s pulsing when he’s treating for a few days a week, and he’s cycling when he has patients go on and off antibiotics completely. I now do pulsing quite a bit, especially with the IVs, using about 3 days of IV antibiotics with 4 days off. Then we repeat that and then cycle that pulsing protocol – for example, using a particular protocol for three weeks and off for one week, two weeks, or three weeks.

Different doctors have different regimens. Although we think of this as an illness for which you cannot treat two people the same way, obviously you can, because many of these people are treated very successfully. But I still think that the patients who are showing up in our office tend to be the people for whom that doesn’t work. We still find that we have to customize the protocol, tailor it to their needs. Then it also depends on the toxicity that is produced – or the lack of toxicity that’s produced, so hopefully we don’t get them sick. But if they get sick from the drug, the goal is to support them better, and treat them less. One of the things that Wayne has been really big on lately is sometimes using very low doses.

Cycling has allowed me to get away from using an approach I hated, which was trying to cheerlead people through painful despair while they were being treated. Sometimes people will persist despite feeling terrible. They will get better, but not always. I would rather not take a chance, because sometimes people don’t recover from those experiences, at least not easily.

Using cycling means putting people on a protocol for three weeks, six weeks, maybe even eight weeks, but once they plateau, stop. Then give them one, two, three weeks off the treatment or longer, depending on their response and where they are in treatment, waiting for the infection to come back and begin to get active again.

These intracellular infections are not like the strep and the staph that we’ve always treated, which have very rapid reproductive rates and are busy reproducing, so if you throw the drug at them, they’re going to die. The microbes can just stop reproducing. They not only go into the cyst form, but they just plain stop being metabolically active. They enter what we call persister states. Sometimes they don’t even do that; they just stop reproducing, and then your antibiotic is not going to be very effective. It doesn’t matter how high the level of the antibiotic gets; stop treating them and wait a few weeks, and the levels of the microbe will begin to come back and then you can treat for it again. This allows you to treat with much less toxicity to the patient, much less damage to gut flora, and a better chance of having a healthy patient at the other end.

Low-Dose Therapy

Dr. Anderson: Ten or fifteen years ago I thought it was my job to make my patient as sick as I could. The worse they felt, the more they herxed [experienced a Herxheimer reaction], the better I was doing my job. I would put somebody on my protocol, I would keep them on that protocol, and I wouldn’t let up. I was their cheerleader – I was trying to get them through it, and that was the goal. Get them through four months of cipro treatment or six months of Mepron and zithro treatment.

I’ve had my eyes opened by David Marks (one of the past presidents of ILADS) and his experience of curing himself of ALS on very low doses of Rocephin. From that point on I started considering low-dose therapy as a possible treatment protocol. For many of my very sensitive patients who cannot tolerate full doses of Rocephin, I’ll do a quarter dose; I’ll do 500 mg and maybe never get over 1,000 mg (where the top end is two grams twice a day). For that individual a thousand milligrams may be just right. It interacts with the infection in a way that the die-off occurs at a lower level and is tolerated by the patient. That doesn’t mean that we’re not doing lots of preparation before that patient is ready to experiment with that protocol. But another way to reduce toxicity is lowering the dose and individualizing that dose. I give my patients flexibility to go up in increments of 500 milligrams if they tolerate it each time. If not, they reduce the dose and titrate it, to find the range that works for them.

Higher Dosages

Dr. GordonAnother option is to go higher. Other doctors have taught us that in the right patient, we can give even higher doses. It’s all about that patient’s ability to detox and the resilience and capacity of their immune system. So many people, because they have such a high viral load and metal toxicity and God knows what, their inflammatory pathways don’t modulate as they should. The severe herx occurs when the body doesn’t quiet the inflammatory cascade. It’s not necessarily the pathogen creating the herx – it’s your own immune system, but your immune system can kill you. That’s how you die from anthrax; the anthrax doesn’t kill you, it’s your immune system that kills you while it’s busy killing the anthrax. The inflammation is additive.

Bodywork

Dr. GordonAnother point – almost everyone who has been sick for a long time needs bodywork. But the problem is, if they get bodywork, they’ll be sick for a week because they’re full of toxins. They need very gentle detox baths – the Epsom salts baths and other types of detox baths are all helpful. They need touching: either good osteopathy or cranial, frequency specific microcurrent work, but it has to be done by people who understand that they cannot move fast until they find out what the patient can tolerate. Even the gentlest treatments get the lymph to begin flowing, and then these patients can become terribly ill.

The Herx

Dr. GordonFor me, the beauty of the herbs is that they support the patient as well as reduce the microbial load – supporting function using the herbs, rather than taking the unidirectional approach of an antibiotic.

Dr. Anderson: I mentioned that in the past the worse I made someone feel, the better I thought I was doing my job, and that that was the goal of treatment. Now I have the absolute polar opposite response: I feel that if I increase people’s symptoms too much, it’s counterproductive if it causes disruption in an immune system that is already having a hard time figuring things out. That’s why herbal medicine can be so incredible. Almost always, the information you get from herbal medicine is useful in helping you determine what the next step should be. In contrast, with antibiotics, often you’re dealing with side effects, and there are some undesirable side effects in antibiotics.

Sometimes it’s hard to evaluate a patient’s response – are they having a therapeutic herx response, or is this a side effect? I began to realize that using antibiotics, much of my time was spent trying to sort that out. It wasn’t moving me forward in relation to what the next step would be. Herbal treatments are exactly the opposite: they give me more information about how that person’s body is engineered – how their detox system works and how their immune system works. That gets me to the next step in terms of how to treat them in a more efficient and effective way.

With the Byron White formulas, I can be so specific that I can actually challenge a patient effectively. I may suspect that they have babesia and not really know; at present, the only way to really know is in response to a specific provoking treatment. If they respond appropriately in a babesia-like way, then that is as good as it gets today, in terms of understanding that this person has a babesia-like infection that needs to be treated. From a challenge perspective the herbs enable me to rule in or out whether this is the appropriate treatment for a particular pathogen. Herbal therapy also gives me the ability to vary the dosage and titrate the dosage to determine which herbs will be effective and what dosage works for that person.

Layering

Dr. Anderson: We’re never just dealing with one thing here – we’re dealing with all of them all the time. But I think that the immune system is prioritizing for us. The symptoms that a patient presents are in response to the system’s recognition of what its greatest challenge is and its efforts to deal with it. So it puts forth a dominant symptom presentation. The goal is to match that symptom presentation with the right herbal formula. Usually it is related to one particular infection or overgrowth, even though there is a whole cornucopia of infectious agents present. If you can determine what is affecting the immune system the most, then you can unlayer it. I think the treatment of the chronic infections is related to timing and layering.

In 80% of the people we see, the primary issues are babesia and bartonella, and Lyme is secondary. If you clear the babesia and bartonella, then the Lyme is vulnerable, and we can target it.

With these cases, you might use the metaphor of Lyme as the godfather in the back room. Babesia and bartonella are like little minions out there doing the dirty work. They’re like tag team wrestlers. The immune system is fighting with one, and just as it’s trying to pin it, the other infection jumps in and smashes you over the head with a chair. The weakened one crawls off to get strong again, and now you’re fighting with this strong one. There’s a back-and-forth quality to symptoms, in a progression over time. You can often hear it in a patient’s history: symptom patterns that suggest a dominant babesia period and then a dominant bartonella period, for example. These kinds of sequential patterns can occur and persist over a period of years. It depends on the strength of that specific babesia organism and the strength of that particular bartonella organism, as well as the patient’s health.

In some cases, bartonella and babesia might not be the first thing we treat. We both agree that we’ve got to treat for parasites, we’ve got to look at metabolic factors and detox, we’ve got to look at all these things before we go after babesia and bartonella. On A-BAB and A-BART, if I can get somebody up to 30 drops twice a day, very generally speaking, then they tend to be ready for the next thing. Very often in the process of gradually increasing the dose of A-BART and A-BAB, they’ll flip into a different symptom presentation, and then I will change the remedy and reduce the dosage for both babesia and bartonella, little by little. The herbal remedies are useful in part because they inform the approach. As Eric said, they support the body and various systems of the body. They can strengthen the immune system and move it forward and make it more efficient.

In 20% of patients, Lyme seems to be the dominant factor. These are people who need to be treated for borrelia first – people whose symptoms of babesia and bartonella go away when you treat for the borrelia. The time range on herbal treatment can be anywhere from one or two months to six months, depending on how quickly a patient can progress through the protocol. Individual response is so varied, it’s hard to generalize.

An Individualized Approach

Dr. Gordon: When it comes to training, we learn from brilliant people who are highly focused on one particular system. The problem for patients is, if you have an issue that can be solved by that system and you go to them, you’ll get better. But if you don’t, you’ll just get frustrated. We’ve seen many people who have been to five or even ten clinics before they show up here. It’s not that we fix them all, by any means; it’s the fact that we’re willing to look beyond any one approach. We don’t have a fixed model; rather, we bring as many approaches to the table as possible, based on the patient’s need.

Eric Gordon MD - Spring 2020
Eric D. Gordon, M.D.
Medical Doctor/Founder and Medical Director of Gordon Medical/President of Gordon Medical Research
Eric D. Gordon, MD, President of Gordon Medical Research Center (GMRC), is the founder and owner of Gordon Medical Associates (GMA) in the San Francisco Bay area, specializing in complex chronic illness. In addition to clinical practice (40+ years), Dr. Gordon is engaged in clinical research. In 2007-2009, he created a series of medical symposia, bringing together leading international medical researchers and cutting-edge clinicians focusing on ME/CFS, Lyme disease, autoimmune diseases and autism. The collaboration of an innovative medical practice with a university research center has been his lifelong dream. Combining forces with Dr. Robert Naviaux and his research into metabolomics, mitochondrial function, and chronic inflammatory disease is now bringing this dream to life. In 2016 Dr. Gordon was co-author with Dr. Naviaux on a groundbreaking study, “Metabolic Features of Chronic Fatigue Syndrome”, published in the Proceedings of the National Academy of Science (PNAS). Dr. Gordon is a medical advisor to Tec Bioscience, and GMA is a collection site for the Lyme Disease Biobank, providing patient samples to researchers studying Lyme disease and tick-borne infections.

Erik Gordon, MD

Dr. Gordon is founder and medical director of Gordon Medical Associates in Santa Rosa and San Rafael. He holds a medical degree from Albany Medical College, performed his family practice residency in New York State, and also has a degree in chemistry from Queens College. His professional memberships include the American College of Advancement in Medicine, International Lyme and Associated Diseases Society (ILADS), and Orthomolecular Health Medicine. Dr. Gordon’s practice focuses on the treatment of chronic illness, including autoimmune diseases, autism, chronic fatigue syndrome, and Lyme. He is first and foremost a private practice physician, and his deep respect for the biochemical individuality of his patients is at the heart of his approach.

Wayne Anderson, ND
Wayne Anderson, N.D.
Naturopathic Doctor/Independent Practitioner
“Patient care must integrate mind and body, incorporating the strengths of alternative and conventional medicine, and tailoring a program that recognizes the uniqueness of each person.” For more than 25 years, Dr. Anderson has known that his patients are partners in the process of learning about and treating their illness, whether they choose conventional or alternative medicine or a combination of both. He listens to understand each patient’s strengths and challenges and improve his effective interaction with them. He sees every person as complex, integrated, and unique, and believes that treatment should optimize health and well-being.

Wayne Anderson, ND

Dr. Anderson holds a degree in naturopathic medicine from National College of Naturopathic Medicine in Portland, Oregon, and additional broad-based training in health and medicine. For the first two decades of his practice, Dr. Anderson worked in a busy community-based family medical center in a region in which Lyme was endemic. As he became aware of the prevalence of chronic Lyme disease and related conditions, he realized the important part that they can play in chronic illness. In 2002, Dr. Anderson left family practice to work with Eric Gordon, MD, and focus on the treatment of Lyme disorders using leading-edge therapies from both conventional and integrative medicine.

Gordon Medical Associates 

Gordon Medical is internationally recognized for successful treatment of elusive medical conditions. Initial successes included the management of fibromyalgia, heavy metal toxicity, and Lyme disease, as well as autoimmune diseases and environmentally and chemically triggered illness. GMA providers were also early proponents of bioidentical hormone balancing, the treatment of toxic mold disorders, and innovative approaches to autism. Today their approach to complementary medicine reflects a comprehensive system of many disciplines. Patients come not only from the greater San Francisco area, but the entire country, and around the world. The individualized care provided addresses a wide range of health issues from Lyme disease and chronic fatigue to chronic pain.

Nancy Faass, MSW, MPH, is a writer and editor in San Francisco who has worked on more than 45 books for publishers that include Elsevier, Harper, McGraw-Hill, Mosby, and others. Director of the Writers’ Group, she also provides articles, white papers, and writing for the Web. For more information, contact info@HealthWritersGroup.com.

Originally published in the Townsend LetterJuly 2013

Consult your doctor before using any of the treatments found within this site.

The interview below is from 2013, and our understanding of Lyme and Coinfections has evolved, so there may be changes in how the doctors now look at diagnosis and treatment.

Copyright 2013 Townsend Letter
All rights reserved.

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