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Lyme Disease Treatment Issues

Lyme Disease Treatment Issues

Q&A from the conference "Putting Lyme Behind You"

From Eric Gordon, MD

In 2011, Gordon Medical sponsored a conference with Dr. Joseph Burrascanno, MD, which included a panel Q&A with GMA practitioners after the talk. We had so many questions it was impossible to answer them all. That need led to the start of our blog, Unravelling Complex Chronic Illness.

Even though the Q&A was from some years ago, and knowledge about Lyme Disease has changed during that time, you may still find some of these answers from Dr. Gordon helpful.

Always be sure to check with your doctor before making any changes to your treatment.

Autonomic Nervous System and the Hypo-Pituitary Adrenal System.

Please explain the physiological dynamics of what is going wrong with the autonomic nervous system and the hypo-pituitary adrenal system. With a history of dysnomia related to babesia, although the babesia may be gone, I still have Neurally Mediated Hypotension, high BP (blood pressure), POTS (postural orthostatic tachycardia), temperature problems, sleep off and on, it often takes until 5 AM to fall asleep, 8 years post-function adrenal collapse.

From the GMA Staff

We have written about factors predisposing to infection, the “total load” and the cycle of maladaptive responses that can follow Lyme and tick-borne diseases.  In fact, these problems also are common among chronic fatigue (syndrome or not) patients, people suffering from long-term stress and others who are chronically-ill.

Our questioner comments that after the infection has been treated, his (let’s assume) adrenal, autonomic, and other symptoms persist.

There are several possibilities we should acknowledge: First, the infection may still be active, just “underground.”  Please, though, do not assume that freedom from all symptoms is the only sign of cure!

Secondly, the patient’s infection, and the many stresses it caused in his life, may well have weakened his “constitution” and produced these symptoms in the spiral of consequences earlier addressed.

Thirdly, these same problems could have been latent in the patient before the infection – could have been the reason the infection became rooted and caused him trouble in the first place.  That “8 years post-adrenal collapse” is tantalizing; we don’t know if that was before or after his infection had started.

Neurally Mediated Hypotension (NMH) is an interesting diagnosis.  First described at Johns Hopkins, it has been widely accepted.  Researchers have shown patients’ blood pressure drops excessively when they are passively tipped from lying down to an upright position (called the “tilt-table test”).  But is the problem really “autonomic?”

In fact, all the symptoms of NMH are identical to those of adrenal insufficiency.  What’s more, successful treatments of NMH specifically cover for adrenal problems.  Indeed, a synthetic adrenal steroid (Florinef or fludrocortisone) is the first-line treatment used – in addition to a high-salt diet, which also compensates for low adrenal function.  Researchers say their patients’ adrenals are normal, but never specify on what test(s) they base this assertion.

Remember, conventional Endocrinologists don’t believe there is any such thing as “adrenal fatigue” or in this case, “functional adrenal collapse.”  However, experience indicates the condition indeed exists and this is supported by Drs. Jonathan Wright, James Wilson and many other practitioners.  Before believing the “NMH” patient has anything other than adrenal fatigue, we’d like to see his 24-hour adrenal steroid profile.

Do his temperature problems support the hypothesis that his autonomic nervous system is weak?  It would be far more successful to ask instead whether this patient is capable of activating his thyroid pre-hormone T4.  You know why?  Not only is such an issue, called “Non-Thyroidal Illness,” quite well defined and rather common, we can easily test it.  We have but to draw blood for total T3 and total Reverse-T3 and calculate their ratio.  We ought to test the whole panel of thyroid hormones if that’s not been done already.  Most docs, though, test only a standard panel, which omits both tT3 and RT3.

Here’s what happens: Our body adapts to stress by slowing down the metabolism – the rate at which we produce and use up energy.  This is a defense designed to keep us alive longer when we are hurt, as by infections (like Lyme and Babesia).  This is partly mediated by the hypothalamic-pituitary axis, as our questioner points out.  Another aspect of the stress response occurs in the cells of our body.  They “choose” to not activate the pre-hormone T4 into the active form, T3.  Instead, our cells make T4 into RT3, which is known to further block T3 production and can have anti-thyroid effects.  It could be  expected that Lyme and tick-borne disease (TBD) victims will have a persistently low ratio of T3 to RT3.  If so, they are “stuck” in a maladaptive response resulting in “functional” hypothyroidism (NTI).  Fortunately, this can be corrected with biologically simple treatment.

We agree that basal body temperature is not exclusively a test of thyroid function.  No, low body temps show a lower metabolic rate and many factors put-in on that.  While the thyroid gland is  the “thermostat” of the metabolism, the adrenals are the furnace.  Low adrenals will result in low body temperature as well.  Your levels of steroid sex hormones influence your body temperature, too (remember birth control using a thermometer?).  Of course, illness and nutritional deficiencies can also lower the metabolism and cause low body temps.

The complex condition of Lyme disease may aggravate other latent health problems.  For example, 40% of Americans carry the genetic program for insulin resistance (IR).  Lyme and TBD patients often have to stop their exercise routine, which makes trouble for those with IR.  An elegantly simple Swedish research project showed reduced activity significantly worsens insulin sensitivity – after only 3 weeks, they needed twice the insulin to keep their blood sugar the same as it had been when they were exercising.  Insulin resistance can cause lots of the same symptoms we associate with TBD.

With these few issues we might be able to explain all of the symptoms bothering the writer of this question.  If this were not the case, we’d have to act like clinicians: Listen to our patient, ask questions, examine him, use the laboratory skillfully, and assess our data.  Discuss options with the patient and fix what we’ve found.  Then, we need to re-assess and find out what else needs to be fixed!  It is an on-going project.  When patiently pursued – and both the patient and the practitioner are included here – good results usually crown the effort.

Dysautonomia, Biotoxins, and Lyme

I have a long term lyme patient who has recovered from most of her lyme symptoms with the exception of intermittent hypo tension 80/40 with pulse in the 40’s known as autonomic insufficiency or pots or dysautonomia. For years when she has a lyme flare she will experience strabismus. I am convinced that ocular damage is from the lyme and is part of the etiology for her flares as well as the dysautonomia. None the less researching this subject quickly makes one realize that it is complex with many suspected etiologies. I have started her on florinef .1 mg for now. So anyone have any other pearls of wisdom? She has been on cortef for years low dose. Her endocrinologist did not check with me and also put her on cortef so she got a 30 mg dose for a month or so, of course she felt great. I have had her consult with a cardiologist, endocrinologist as well as neurologist. They just kind of threw up their hands especially with a ” lyme dx” in the mixture. I will consult next week again with her neurologist in an effort to co-manage this case but may get left holding the bag as I usually do in trying to treat lyme patients. Anyway I would appreciate tips on treating this common problem with our Lyme patients.

Have her check her VCS (visual  contrast sensitivity) at a time when she is well, and again when she is symptomatic.

Changes in the results may indicate she may be having a mold exposure, or exposure to a multitude of antigens which are triggering her innate immune response, no longer self correcting since her Lyme disease caused dysregulation. It would be good to also check her C4a (Complement 4 anaphylatoxin), MMP-9 (Matrix metallopeptidase 9), VEGF (Vascular endothelial growth factor), TGF beta-1 (Transforming growth factor beta-1) when she is symptomatic. Run that group again when she is asymptomatic, and add VIP (Vasoactive intestinal polypeptide) and MSH (Alpha melanocyte stimulating hormone). You can find information about these tests at Lab Tests and information about how to order them, and where at Lab Orders.

This is Ritchie Shoemaker’s work and it can be confusing because it has lots of acronyms for uncommon and multifunctional immune modulators. There are other parts of his protocol but just the VCS online, and MMP-9, TGFbeta-1, and VIP will let you know if further work up will be useful.

I have been using Dr Grubb’s protocols for dysautonomia for years, they are good band aids but don’t address the core problem. Ritchie’s protocols don’t work for every patient but they do help us better treat our “post Lyme” patients and a lot of the active Lyme patients who “herx” yet never improve.

Ritchie will be presenting his latest work in Santa Rosa on Oct 22nd and 23rd, (2011) and we will be helping him to give people an explanation of the fundamental concepts and terminology he uses.

I have struggled for years to apply his approach. Like many original thinkers there are steps in his process that are like air to him, leaving the rest of us stumbling in the dark. We have worked with him to address this issue, so that he can better teach people how to really use his work. Other practitioners from our offices who also use Shoemaker protocols will be present to answer questions.

Learning to use Ritchie’s approach has improved the lives of many of my patients. Better understanding of persistent immune activation allows me to make better choices for my patients care.

Biotoxin Pathyway
Hypersensitive Patients

What is your experience with hypersensitive patients who tend to react to many treatments both herbal and chemical?

From the GMA Staff:

We need first to understand the patient’s “total load.”  You remember hearing about the straw that broke the camel’s back?  If the camel weren’t already loaded to his maximum, that little straw would have done no harm whatsoever.  Like the proverbial camel, people in our society carry varying amounts of many types of stressful loads every day.  However, we should consider more than just their load.

The “camel’s” health is also an important factor.  Dromedaries that are hypothyroid, malnourished, have bad bones, muscle problems, suffer sleep deprivation or are otherwise ill can’t carry as much as healthy camels.  Buff, healthy adults handle health challenges far better than the physiologically weaker ones.

These two concepts are important for all fields of medicine.  In Psychiatry, docs were puzzled about post-traumatic stress disorder after Viet Nam: Why, they wondered, could a Company of soldiers all have the same brutal experience (of one sort or another) but only one man would develop PTSD?  They found the man had previously endured many awful experiences – he was already carrying his maximum load and combat was one “insult” too many.  In Surgery, younger healthier patients survive trauma vastly better than older, depleted people.  In Infectious Diseases we see the same thing: Far more infirm or debilitated people are stricken than the hale and hearty.

Some healthy people just pull the “short straw” in any health problem, from cancer to Lyme disease but statistically, people who are more vulnerable – get sick first and stay sick longer.  Claude Bernard famously called this overall ability to resist, this “health gestalt” the “terrain” and Louis Pasteur called it the “milieu” but call it what you will, it is all the same.

Humans who cannot easily carry their total loads are vulnerable to a number of seemingly harmless things.  It has been noted that allergic people had more thyroid problems than one might expect;  When their thyroid trouble is truly corrected, the allergy symptoms often vanish.  This is an example; there is so much more!  All sorts of nutritional, hormonal and lifestyle factors play in.  The history of stressful experiences is very important, as it is in PTSD.  These problems will “snowball.”

By that, we mean there is a “feed-forward” loop of positive-feedback in which one problem makes several others worse, which in turn make the first problem worse – along with many more.  You get the idea.  The increasing severity and number of allergic reactions puzzles most doctors: Why, they wonder, are these people so bothered by “harmless” things?

As their sensitivities spread, patients feel worse and get more stressed; they can no longer eat a number of nutritious foods.  They don’t sleep well, which adds to their stress.

Mast Cell Cytology by Raya the Vet - NIH Image Gallery
Mast Cell Cytology by Raya the Vet - NIH Image Gallery

Being stressed, their body doesn’t efficiently activate their thyroid hormone (“Wilson’s thyroid syndrome”) and their adrenal glands are taxed, ultimately fatigued (as described by the other Dr. Wilson).  Stress worsens insulin resistance.

Because insulin is pro-inflammatory, the chronic low-grade inflammation due to allergy and hypersensitivity is amplified dangerously.  People become more vulnerable to infections and a small inoculum of a weakly-virulent organism can hit them like a thunderbolt.  Doctors are puzzled; how can people fall victim to such a minor challenge?

They cycle downward in a continuing spiral of inflammation, immune sensitization and altered hormone and neurotransmitter balance as the body tries to maintain some semblance of “order.”  Inflammation and elevated cytokines (little chemical messengers of the immune system) are associated with fibromyalgia and vascular disease.  People feel fatigued and depressed for valid biochemical reasons.

Fibromyalgia may manifest itself as various uncomfortable syndromes like multiple chemical sensitivity, interstitial cystitis, TMJ, chronic pain syndromes and more.  Chronic stress leads patients to develop “maladaptive hyper-vigilance”; they are on edge, anxious and will be “set-off” by reactions they once considered minor annoyances.  Understandably, they feel as if nothing is safe for them.

Patients with these problems “fall through the cracks” in our system of medical diagnosis.  Many doctors rely on comfortable standard protocols that can’t address these issues.  They often aren’t familiar with research that explains how this all comes about.  Both doctors and patients alike are prone to wrongly attribute the sources of their symptoms – and why not?  It is a confusing blur of suffering with overlapping input from multiple systems, including immune, endocrine and nervous systems.

People should also realize they risk becoming mistrustful of all treatments, fearing they are useless, or too strong – or too likely to cause reactions.  After a while, it is hard to believe that any treatment that feels badly can be good, but consider the “die-off” reaction!  Sometimes discomfort even proves a treatment is well-directed.  It also hurts to reduce a fracture but that has to be done for successful healing.

Accurate diagnosis is truly important and our modern laboratory would make us the envy of every physician who has ever walked the Earth.  Usually our tests reveal patients have multiple problems, though.  How can we apply this unprecedented amount of clinical information?

Enter the true working-relationship between the practitioner and patient: The experiences and preferences of both are essential to formulating a successful working plan.  What will be implemented?

However it is approached, to whatever issue it is first addressed, there are two goals of treatment:

  • To reduce the patient’s total load of problems and
  • To strengthen him or her.

Reducing the total load can be easy – like getting rid of the cat when you are allergic to it.   Nobody wants to “off” their cat; they’d rather get rid of the doctor who told them to do it!  It is easy to put dust covers on your bedding.  Most people are willing to change their diet – but it is hard and often more allergies develop.

Yes, in our experience, most chronically-ill patients are multiply hypersensitive.  This can be helped many different ways, which can be generalized as “strengthening.”  Endocrine interventions can be useful: Supplying nutrition and precursors to the adrenals improves energy, restores a sense of competency and peace and improves tolerance for stress.  Correcting thyroid hormone problems restores energy; improves sleep; clears up allergy symptoms like chronic hives and “sinus” and more.  Balancing sex hormones – well, you get the idea.

naturopathic_doctors_principles

Lifestyle measures are remarkably useful.  Nutritional support is often vital.  Drugs may have their place, especially when well-selected and integrated into an overall approach.

There are many ways to address multiply-hypersensitive patients.  The physician must be methodical and open both to inspiration and negotiation.  It is essential to inspire the patient’s confidence, as above.  Many people are just so tired of trying, they’ll get discouraged at the first misstep – and in such a complex disease state, missteps inevitably occur!

In summary, chronically ill, multiply-sensitive patients can be helped and can be cured.  They often present, however, the “Masters’ level” challenge.  An integrated approach, accounting for aspects both of the body and the mind/spirit has given the best results.

Lyme and Rheumatoid Arthritis

If Lyme turns into CFS or arthritis, do you stop the Lyme treatment and just treatment the arthritis?

DR. GORDON:

No.  That’s an absolute no.  No, no, no, no.

I mean that’s something I think is important, I can just say for myself I first began to treat rheumatologic diseases with antibiotics before I knew that Lyme was such a major player, that people have been treating rheumatologic diseases, especially rheumatoid arthritis, with antibiotics since the late 1940s.  Thomas Brown started that and we have to remember that when wondering about rheumatic disease. So, you really need to keep treating the Lyme aggressively if you have symptoms from it. And there are people, I have patients who develop what looks like rheumatoid arthritis by all the lab tests.

Rheumatoid factor is elevated, the whole nine yards, but they keep responding to the antibiotics.  And their joints stay preserved as long as we keep them on the antibiotics, so something else is happening.  And it doesn’t necessarily need to be the anti-inflammatory antibiotics, which I think is the important point, is that we’re treating the bug.  For some reason we’re not eradicating the bug, and that’s where alternative therapies I think come in, maybe using more neural therapy.  I mean this is something that I’m interested in, is if you listen to Dietrich Klinghardt, the concept that if we have a joint that remains inflamed and it doesn’t keep moving around, that’s where we should be treating the joint:  inject the antibiotics right into the joint, inject ozone right into the joint.

Interviewer:

There’s another question here, it says:  Discuss post-Lyme, specifically autoimmune which presents as rheumatoid arthritis, and is this especially non-responsive to antibiotics?

DR. GORDON:

Well if it’s especially non-responsive to antibiotics then I would be looking to what else is going on.  Are there heavy metals?  Are there other toxins?

An interesting concept is to consider would be more local treatment because what happens is that when you have inflammation you have poor blood flow to the area, so the drugs you’re giving don’t get there.

Interviewer:

You also have patients who are immobile.  They’re not moving around, they’re not active.

DR. GORDON:

Right, just like the infection will limit blood flow.  I mean that’s what bugs do. They shut off the blood flow and they shut off the drainage, and so by bringing the antibiotics or other therapies directly locally, injecting into the joint and around the joint, you can open up blood flow as well as the delivery of medication to the area that needs it, so that’s something that we think about.  But again you always have to look at heavy metals and toxins when people aren’t responding.  You know, what else is inflaming your immune system, because you have to remind people that autoimmune disease merely means that you have a dysfunctional immune system but we don’t know why.

It doesn’t tell you anything else other than that.  People think autoimmune disease is a diagnosis like Lyme, and it’s not.  Autoimmune disease is more like being told you have chronic fatigue.

Interviewer:

Yes, it’s a syndrome, more like.

DR. GORDON:

Yes, it’s a collection of symptoms hung together….  There’s specific testing and there’s changes to the cells blah blah blah, but we know practically, I don’t want to say nothing, but we know practically nothing as to the etiology because that….people don’t pay attention to that as they should, and so what we see clinically is that when we either treat heavy metals, treat other toxins that are affecting the immune system or kill the bugs, these autoimmune diseases get better.  Not always but sometimes.

They should also often be checking for Chlamydia with a rheumatologic disease and Mycoplasma, but sometimes it’s not going to work, and I think that’s what they have to understand is that at some point we just keep trying.

Parkinson’s and Lyme

I have Lyme, and have received extensive treatment. I now have been diagnosed with Parkinson’s, which does respond to dopamine. Can Lyme imitate Parkinson’s?

The short answer is yes. Lyme can cause or imitate many different types of problems in the nervous system. It can cause or worsen tremors, movement disorders, seizures, cognitive problems, paralysis of specific nerves, etc. Parkinson’s is not primarily an inherited condition, but is caused by inflammatory factors, toxins, and other triggers in the external and internal environment. We have seen patients with Parkinson’s disease whose symptoms have improved, sometimes dramatically, with Lyme treatment and other patients that do not improve much with treatment.

Lyme can cause Parkinson’s in a person with the right genetic and environmental risks and exposures. Parkinson’s is probably a result of inflammation in the brain resulting in destruction of dopamine producing cells.

Treating the Lyme will help reduce inflammation. If the Lyme is gone dormant or quiescent, and the Parkinson symptoms persist, treatment with IV phospholipids and glutathione will help the Parkinson’s. Multiple other supportive measures are useful, including structural and nutritional treatments to reestablish a normal balance of immune function. Heavy metal toxicity is often an inciting cause of Parkinson’s and a cause of failure of antibiotic therapy in chronic Lyme.

There is no one treatment for persistent Lyme. Long term antibiotics may be needed, especially for severe neurologic symptoms. You need to have your Lyme status reevaluated to make a better decision on what to do next.

Dopamine is not a long term solution for Parkinson’s. It is an effective band-aid.

Treating Post Lyme Disease

In treating Post Lyme Disease, what strategies do you recommend after long-term oral or IV antibiotics?

The term “Post Lyme Syndrome” (PLS) is most often used by conventional doctors who believe any Lyme symptoms persisting after 4-6 weeks of antibiotics are caused not by lingering infection, but rather by autoimmune-like inflammation that was triggered by the infection. Post Lyme Syndrome does exist, but one must be careful to distinguish it from the more common scenario of partially treated Lyme disease and co-infections. If one has thoroughly treated Lyme AND all co-infections (often co-infections are missed) until there is no further improvement on antibiotics, and no relapse after stopping antibiotics, then one may be dealing with a true PLS.

Some of our patients with PLS have seen improvements with immune modulating therapies (such as low dose naltrexone (LDN), particle rich plasma, etc), detoxification therapies, nutritional therapies and other treatments. And many people who have finished a long course of antibiotics choose to go on herbal medicines or use electromagnetic therapies for months to years afterwards to prevent recurrence of the tick borne infection symptoms. There is no way to know for sure if Lyme disease or other chronic bacterial infections can ever be completely eliminated, so some sort of a maintenance regimen is often used.

Ototoxicity and Hearing Loss

Could you speak to Ototoxicity (toxicity to the auditory nerves) of the antibiotics used to treat Lyme? My neurologist cannot tell if hearing loss is caused by Lyme or antibiotic use.

If ototoxicity is present, I do not know how to be sure if it is due to antibiotics versus infection of the 8th cranial nerve.  Not all antibiotics are considered ototoxic, and even those that are will not cause problems for every patient. The toxicity from antibiotics is probably mediated by oxidant stress, and this may also be the cause of some of the damage by infection, as well.  Individuals have varying ability to manage oxidative stress. With that in mind, checking glutathione adequacy, methylation pathway tests, as well as evaluating the other detox pathways and your heavy metal burden would be helpful.  All of these problems will make ototoxicity more likely whatever the stressor of the system.  Treatment of these metabolic problems will often improve ototoxicity.

I would also get a good evaluation by a cranial osteopath.  Occasionally osteopathic cranial manipulation will mitigate some of the tinnitus.

Consult your physician for a more complete workup of your toxic load in order to support your ability to deal with any toxicity, as well as the infection.

Exercise and Lyme

Dr. Burrascano says to do no aerobic exercise, what about moderate walking.? Is it good for the spirit?

Dr. Burrascano’s advice about avoiding aerobic exercise does not preclude long walks. He is warning against pushing yourself to get the endorphin rush that many athletic people love. Walking is fine as long as you are not exhausted when you finish, or do not feel more tired the next day. Limit activity to a level that doesn’t wear you out. Do not use your memory of what you used to do to guide you. Be aware of what feels good in your present condition. A stressed body will not heal from a chronic infection. If your walk is all you can do for that day, you did too much. Start slowly and incrementally. Increase by 1-3 minutes as you are able and you will regain your health. Push yourself, and you will stay stuck in the exertion and crash pattern. This inhibits immune function and adrenal recovery. Slow but regular physical exercise will increase muscle mass and help modulate your inflammatory response.

The point of this message is that aerobic exercise can temporarily deplete the immune system, which can make Lyme disease harder to treat. This lowered immunity is demonstrated by the well documented fact that marathon runners have increased susceptibility to viruses in the days following races. Some people with milder cases of Lyme do feel fine after aerobic exercise. Listen to your body and speak to your doctor. If you feel invigorated after aerobic exercise, then it may be fine for you.  If you feel more tired or stressed after aerobic exercise, then it probably is not serving you. There are many other kinds of gifts for the spirit. If aerobic exercise makes you sick, then it may be better to find a different kind of uplifting activity.

Can I walk every day if I am able to besides doing the exercise that Dr. Burrascano suggested?

Yes. I agree with Dr. Burrascano that exercise is important in the healing process. I suspect that he and I would agree that if you exercise to the point of feeling exhausted afterwards, and that if that exhaustion lasts a day or more, (what we refer to as post exertional malaise), that amount of exercise is not healthy for that individual. The key point here is that a patient with Lyme disease is using so much energy to fight their infection(s) that they must no overdo in exercise, or they risk compromising the healing process. Having said that, in addition to the specific program recommended by Dr. Burrascano, I am a proponent of any form of low impact exercise that is well tolerated. It’s all about balance, and moderation, and listening to your body about what you can and can’t do. As long as you don’t overdo, exercise can be quite beneficial.

Naltrexone to Help Improve Immune Function?

What is your opinion on the drug Naltrexone to help improve immune function?

Naltrexone is increasingly being used to treat autoimmune diseases, such as Multiple Sclerosis, Crohn’s disease, and Rheumatoid Arthritis. However, the phrase “improve immune function” is a bit more vague than many people realize. The immune system as a whole is very complex. Improvement in one area of immune function may not generalize, so I don’t see Low Dose Naltrexone (commonly abbreviated LDN) as having universal value here. I have seen improvement in my Lyme patients in the areas of cognitive difficulties (brain fog, impaired focus, memory, and concentration), and improvement in some patients with generalized pain. The usual dosage of LDN is 3-4.5mg taken at bedtime, but some of my more sensitive patients cannot tolerate it at all, even at very low doses. Since Naltrexone is a narcotic antagonist  (we use it in much larger doses to treat heroine overdoses), it can not be taken safely by patients on narcotic medications.

Arnica for Pain?

Please comment on the use of Arnica for pain?

Homeopathy and herbs

Arnica, taken homeopathically, either by oral use (often in the “dosage” of 30c) or in topical form, can be helpful in pain relief, especially for muscle pain. It is gentle and very well tolerated. It may be particularly useful in those with post-exertional malaise, used before and/or after exercise. Homeopathic remedies are, as a rule, quite well tolerated, even by our most sensitive patients. As with most homeopathic remedies, if arnica is the right remedy for that patient, patients will often notice immediate improvement. If it is not the right remedy, then they will experience no change at all.

Infrared Sauna?

What about the use of infrared sauna?

Infrared (IR) sauna is used to help detoxify the body and to improve circulation.  Many persistent organic toxins (e.g. plastics, pesticides), heavy metals (e.g. lead), ammonia, and other toxins are eliminated through sweat. One study found that any type of sweating produced similar benefits, whether it was exercise, traditional steam sauna, IR sauna, etc.  However, some people think that IR sauna is of particular benefit.  In our experience, IR sauna helps many people. Sensitive people must be careful to start with only 5 – 10 minutes and at lower temperatures, such as 95 – 100 degrees.  If sauna use makes you “crash” it should not be used, or used for less time, and at a lower temperature.  Eventually some people can work up to 30+ minutes at temperatures of 120-135 degrees three times per week. You must be careful to stay hydrated before, during, and after being in the sauna. It may also be important to replace certain minerals and salts that are lost in sweat, such as magnesium and potassium. Sauna use can be a very helpful piece of a comprehensive detox program.

Connection between Belief System and Immune System

What kind of connection do you see, if any, with an individual’s belief system and the function or susceptibility of their immune system?

Experiences treating multiply-sensitive patients shows they are tough; tougher than tough.  They can have great results, though it won’t often be simple to get them there.  Much will depend on the issue raised in part by this question – the connection with belief system.  In matters of such chronic illness, motivation and inspiration are vital partners with diagnostics and therapeutics.  The 19thCentury value of “gumption” is an important therapeutic attitude for both of the partners, patient and physician!  The reasons are complex and sometimes require some psychology.

Yes, the psyche influences the immune system.  There is no question; many good studies have shown this.  There is even a medical journal titled Psychoneuroimmunology.  Depression, grieving and all sorts of emotional distress adversely influence the immune system and its ability to resist disease and even death.  Are there simpler aspects to this?  Louise Hay believes the allergic patient has an underlying belief that the world is not safe for him.  That fits; his immune system – charged to protect him – reacts to harmless things as though they were dangerous.  What other unconscious thoughts contribute to such problems, and can raising our thoughts to awareness help correct the trouble?

Emotional Boundaries and Lyme

Do emotional boundaries play a key role in the development of Lyme?

Emotions play a role in all illness.  The immune system is not separate from our emotions.  Neurotransmitters (such as serotonin, dopamine, and norepinephrine) also act on white blood cells.  Many cytokines, the chemicals that white blood cells release to communicate with each other, also act in the nervous system.  The division between emotional states and physical states is a function of our mind’s need to categorize the world.  It is not an accurate description of the world.

With this being said, we will return to the question:  Do your emotional boundaries play a role in the development of Lyme?  I think as suggested above, it will play a role. However, there are many people who have the inability to set interpersonal boundaries, but that is not enough to let Lyme infections overwhelm us.  Most of us are emotionally wounded in some way, and Lyme and the coinfections will exacerbate our underlying tendencies, but millions of us who have had trouble saying “no,” myself included, have successfully cleared Lyme.  Emotions and proper boundaries are important, but to label them as key in the development of chronic Lyme or any chronic illness is to misunderstand the rich interrelationships of life.  They are a problem for all illness and are permissive but not causative.

Tick
Does Igenex Labs Test for Coinfections?

From GMA Staff

Igenex Labs does test for many of the tick borne coinfections, including a variety of tests for Borrelia burgdorferi (Lyme disease), Babesia microti and Babesia duncani, Human Monocytic Ehrlichia and Anaplasma Phagocytophila, Bartonella henselae, and Rickettsia species (Rocky Mountain spotted fever, Mediterranean spotted fever, Boutonneuse fever, Israeli spotted fever, Astrakhan fever, Indian tick typhus, Murine typhus, Cat flea rickettsiosis, flea-borne typhus.)

Tests for each pathogen may be done by PCRantibody, and in some cases, FISH. These tests are available individually, and as panels. Igenex has also recently added CD57 Natural Killer Cell testing.

Babesiosis is like malaria with the symptoms of acute disease being fever, chills, vomiting and fatigue.   It is usually self-limiting except in Lyme patients and those who have undergone splenectomy.   There are two forms of Ehrlichiosis:  Anaplasma phagocytophila (HGE)  and HME (Human Monocytic Ehrlichiosis).  HGE is primarily on the East coast, upper Midwest and California. HME is primarily in the Southeast, lower Midwest and Southwest, with cases reported in CA, NJ, NY, and WI.   These acute diseases may have symptoms of fever, chills, vomiting and fatigue and require prompt antibiotics.   Subclinical forms of these diseases may be present in patients with Lyme disease.

You can also send ticks to be tested for all of the above infections. This testing can be useful when you  find a tick attached, and you want to determine whether or not it could have passed any of these infections to you. It is estimated that up to 20% of the ticks with Lyme disease may have one of these other diseases.

While Igenex Labs tests many coinfections that can be found in patients with Lyme disease, there are other possible coinfections that they do NOT test for. Viral infections such as HHV-6Epstein Barr Virus (EBV), and Cytomegalovirus (CMV) may not be problems in people with healthy immune systems, but may be a problems in those with compromised immunity. Mycoplasma,  Chlamydia  and Helicobacter pyloriinfections may be found. Many chronically ill patients have problems with yeast and fungal infections. Some patients with chronic Lyme disease have tested positive for the new retrovirus, XMRV. Patients with Lyme disease can carry a wide variety of other infection, some of which are not treated by the antibiotics used for Lyme disease.

If you have symptoms that are not resolving on Lyme treatment, you should discuss with your practitioner whether you need further testing to see whether other infections  are involved in your case. Because Lyme disease can suppress your immune system, it can make you vulnerable to a variety of infections that might not otherwise be a health problem.

How Do You Know if You Really Have Lyme Disease?

Why do patient symptoms vary so much? Everyone seems to have different symptoms so how can we be sure we all have Lyme disease?

There is virtually no illness in which a specific disease manifests the exact same way in everyone who has that disease. For example, if a woman goes through menopause, she may experience primarily hot flashes or night sweats, or she may have difficulty sleeping, or low energy, or mood swings, or depression, or vaginal dryness, or decreased libido, or difficulties with focus, memory, and concentration, or some combination of all of these.

Lyme disease is much more complicated than menopause, and it is not surprising that it can present in many different forms. It is so varied, in fact, that we often call it the “great masquerader.” And, of course, we are often not only dealing with the Lyme spirochete, Borrelia burgdorferi, but also with the the accompanying co-infections which include Bartonella, Babesia, Ehrlichia, and Mycoplasma. If that were not complicated enough, the weakened immune system produced by the Lyme infection(s) allows for other opportunistic infections which had been latent in the patient to show up as well, including Epstein-Barr virus, Cytomegalovirus, HHV6 (Human Herpes Virus 6), and Chlamydia pneumoniae, among others.

I hope this explains why symptoms vary so extensively. The second aspect to this question is even more difficult: how can we be sure that any individual truly has Lyme disease and all that entails? The most accurate answer is that certainty is very difficult to come by. Our tests are not as accurate as we would like, and we base a great deal of our treatment plan around how our patient responds to our presumed diagnosis and treatment. Improvement in our patients may take weeks or months to occur. This leaves us frequently uncertain about our decisions and choices, but hopeful that the choices were the right ones for that individual. It would be wonderful if we could bring a great deal more scientific analysis to the table, but at this moment we have to make do with what we have.

If an individual requires certainty to make these difficult choices, they may be faced with waiting a long time to decide on a treatment plan, and if that individual does have Lyme disease and associated co-infections, waiting is likely to lead to a significant progression of their illness.

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.

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