What Does Current Guidance Say On This Issue
NICE guidance on Lyme disease states that those without focal symptoms should receive 100mg oral doxycycline twice a day or 200mg once per day for 21 days. The first alternative to this is oral amoxicillin, 1g three times per day for 21 days and the second alternative is oral azithromycin, 500mg daily for 17 days.
What Are The Side Effects Of Lyme Disease Treatments
Antibiotics, like all medications, have the potential for side effects. Any antibiotic can cause skin rashes, and if an itchy red rash develops while on antibiotics, a patient should see their physician. Sometimes symptoms worsen for the first few days on an antibiotic. This is called a Herxheimer reaction and occurs when the antibiotics start to kill the bacteria. In the first 24 to 48 hours, dead bacterial products stimulate the immune system to release inflammatory cytokines and chemokines that can cause increased fever and achiness. This should be transient and last no more than a day or two after the initiation of antibiotics.
The most common side effect of the penicillin antibiotics is diarrhea, and occasionally even serious cases caused by the bacteria Clostridium difficile. This bacterial overgrowth condition occurs because antibiotics kill the good bacteria in our gut. It can be helpful to use probiotics to restore the good bacteria and microbiome balance.
The Chance Of Getting Lyme Disease
Not all ticks in England carry the bacteria that causes Lyme disease.
But it’s still important to be aware of ticks and to safely remove them as soon as possible, just in case.
Ticks that may cause Lyme disease are found all over the UK, but high-risk places include grassy and wooded areas in southern and northern England and the Scottish Highlands.
Ticks are tiny spider-like creatures that live in woods, areas with long grass, and sometimes in urban parks and gardens. They’re found all over the UK.
Ticks do not jump or fly. They attach to the skin of animals or humans that brush past them.
Once a tick bites into the skin, it feeds on blood for a few days before dropping off.
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Chronic Lyme Disease Or Postlyme Disease Syndrome
Following an episode of Lyme disease that is treated appropriately, some persons have a variety of subjective complaints . Some of these patients have been classified as having chronic Lyme disease or postLyme disease syndrome, which are poorly defined entities. These patients appear to be a heterogeneous group. Although European patients rarely have been reported to have residual infection with B. burgdorferi , this has yet to be substantiated either in a large series of appropriately treated European patients or in a study of North American patients. Residual subjective symptoms that last weeks or months also may persist after other medical diseases . It has also been recognized that the prevalence of fatigue and/or arthralgias in the general population is > 10% .
In areas of endemicity, coinfection with B. microti or the Ehrlichia species that causes HGE may explain persistent symptoms for a small number of these patients . Randomized controlled studies of treatment of patients who remain unwell after standard courses of antibiotic therapy for Lyme disease are in progress. To date, there are no convincing published data showing that repeated or prolonged courses of oral or iv antimicrobial therapy are effective for such patients. The consensus of the IDSA expert-panel members is that there is insufficient evidence to regard chronic Lyme disease as a separate diagnostic entity.
Type Of Clinician Overseeing Care
We asked patients to tell us the type of clinician overseeing their care. Choices included: family physicians, internists, rheumatologists, infectious disease specialists, and clinicians whose practice focused on tick-borne diseases . Very few patients selected an infectious disease specialist. Seventy-five percent of high responders and well patients report having their care overseen by an LLMD.
Physicians who treat Lyme disease as their primary focus might be expected to have better results than physicians who dont simply because volume of cases handled means a greater experience level. It is commonly recognized in medicine that volume of cases is associated with better treatment outcomes . Just as patients with cancer commonly seek out physicians who specialize in that area, perhaps patients with chronic Lyme disease should also.
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What Are The Risk Factors For Post Treatment Lyme Disease
Risk factors for Post Treatment Lyme Disease include:
- Delay in diagnosis
- Increased severity of initial illness
- Presence of neurologic symptoms
Increased severity of initial illness, the presence of neurologic symptoms, and initial misdiagnosis increase the risk of Post Treatment Lyme Disease. PTLD is especially common in people that have had neurologic involvement. The rates of Post Treatment Lyme Disease after neurologic involvement may be as high as 20% or even higher. Other risk factors being investigated are genetic predispositions and immunologic variables.
In addition to Borrelia burgdorferi, the bacteria that causes Lyme disease, there are several other tick-borne co-infections that may also contribute to more prolonged and complicated illness.
What Factors Determine How Patients Respond To Treatment
To find out what made some patient substantially improve or become well, we turned to our academic partners at the University of California at Los Angeles who specialize in artificial intelligence and machine learning. Their team looked at 215 features related to diagnostic factors, treatment approach, duration of individual antibiotics, alternative treatments, symptoms, type of clinician, and functional impairment to identify the 30 top predictive features for treatment response . Most of the top 30 features identified in their study related to chronic Lyme disease treatment , symptom severity , and type of clinician treating Lyme disease. We analyzed three of these factors associated with treatment response:
- Treatment approach
- Treatment durations
- Type of clinician overseeing the patients care
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Regulate Imbalances In Hormones Neurological Function
Methyl B12 is often given for neurological support and methylation support. In my experience, B12 in very high doses can help with some of the fatigue and brain fog experienced by chronic lyme patients. The methyl form of B12 also may help with the methylation process in the body, which is intricately involved with detoxification and glutathione production in the cell . Care must be taken, as rarely some may aggravate with methyl donors, such as methyl B12, methyl folate, SAMe. Often, we can get hints from methylation by assessing 24 hour levels of hormones and their metabolites as well.
Fish oil and systemic enzymes are then often used for cellular membranes and blood fluidity. Nutrient delivery is key in my experience, and is the main thing that improves the symptoms of brain fog and fatigue in the chronic lyme patient.
Assessment of hormones, especially thyroid and adrenal insufficiencies, is profoundly useful. There is some information on this page on bioidentical hormones, but in essence, we look often for cases of borderline or suboptimal adrenal hormones. This usually contributes to fatigue, for which supportive measures on stress, optimizing nutrition (diet as well as cellular nutrition, and helping to ensure that factors for hormone balance are in place can be useful.
For Memory Concentration And Focus
Improving memory is a challenge. In Lyme disease, short-term memory problems and word-retrieval problems are common. These often improve substantially with appropriate antibiotic therapy. Over time, most patients regain their cognitive function.
When memory is a problem, consider that this could due to a primary problem with attention or with mood. An individual who can’t focus won’t be able to remember because he/she didn’t “attend” to the item in the first place. This happens to all of us when we hear someone’s name at a party if we don’t focus on the name and perhaps make a mental association to the name to enhance memory storage, we will forget that name within minutes. Patients with depression often experience problems with memory and verbal fluency when the depression is resolved, the memory and verbal fluency typically resolve as well.
- Medications: Attention can be improved with certain medications, such as bupropion , atomoxetine , modafinil , or stimulants . Medications that temporarily slow cognitive decline in Alzheimer’s disease or memantine ) have not been studied in Lyme disease.
- There is some evidence that online brain training programs can enhance concentration or processing speed.
- Neurofeedback may be helpful in improving attention, as well as in improving sleep and reducing pain. This has been studied for migraines, fibromyalgia, and ADHD.
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Beyond Antibiotics: Newer Alternative Approaches To Chronic Lyme Disease Treatment
New treatments for chronic Lyme disease are continually emerging, as researchers and health care practitioners learn more about the infections, co-morbidities, and other problems commonly involved in the disease. Most Lyme disease specialists understand that chronic Lyme isnt just about a Borrelia burgdorferi bacterial infection, but rather, a complex of infections that cause systemic dysfunction in the body. Whats more, Lyme can be both a primary cause of illness or ancillary to other disease processes, and even make the afflicted susceptible to other diseases. Sometimes, it is simply the straw that breaks the camels back in an already weakened body thats battling other assaults.
Regardless, healing from chronic Lyme disease, for most, isnt just about eliminating pathogenic microbes. And because there are so many unidentified strains of Borrelia, Babesia, Bartonella and other Lyme-related microbes that are infecting people, researchers and doctors probably still dont know exactly what cocktail or mix of infections their patients are really dealing with. Add to that the fact that everyone is different with a unique biochemistry and set of comorbidities, and treatment becomes much more complex than simply assigning an antibiotic or two to whatever supposed infections patients are dealing with.
Transmission Of Bb Via Ixodes Spp Vectors
The black-legged ticks, Ixodes scapularis and Ixodes pacificus on the West Coast, are the primary vectors of Bb in the USA. In endemic areas, the proportion of Ixodes spp. ticks infected with Bb can be remarkably high. One recent survey of the pathogen burden of 197 Ixodes scapularis ticks collected from New York and Connecticut where LD is endemic, revealed 111 ticks were infected with Bb and 37 were co-infected with more than one human pathogen . The high pathogen burden is consistent with previous tick surveys in the same region . In contrast, the percent of infected ticks in other regions of the USA is much lower. In recently published surveys across California, for example, fewer than 5% of Ixodes spp. ticks were infected . Ixodes ticks sometimes carry multiple strains of Bb that may impact the course of disease in people that are co-infected. One tick survey showed that 39% of Ixodes ticks in North America are infected with multiple genotypes of Bb .
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What Did This Study Do
This network meta-analysis included 19 randomised controlled trials involving 2,532 people with erythema migrans due to Lyme disease. No trials were based in the UK most were from the United States or Europe.
Each trial compared two or three antibiotics. Doxycycline was the most frequently used antibiotic. A number of doses and treatment durations were represented. For example, treatment length for doxycycline ranged from 10 to 21 days. For the main analyses, doxycycline was used as the reference treatment.
Both direct and indirect data were extracted from the studies. This approach is helpful when there is a shortage of head to head research, but this, and the overall low quality of included studies means that results need to be treated with some caution.
Samento And Banderol: Uses And Research
Proponents of banderol and samento recommend them as alternatives to antibiotics, which are the standard treatments for Lyme disease. It’s said that these herbal remedies may help patients steer clear of the side effects sometimes associated with antibiotic use, such as gastrointestinal distress.
Supporters also say that banderol and samento aid in the treatment of Lyme disease by reducing chronic inflammation.
In addition, banderol and samento are sometimes used to control post-treatment Lyme disease syndrome . In people with PTLDS, symptoms linger long after they’ve completed a course of antibiotics. These symptoms include fatigue, muscle and joint pain, sleep disruption, and mood changes.
At this point, however, theres very little evidence to back up claims that banderol or samento can help treat Lyme disease. There is some research out there showing that a combination of samento and banderol may help knock out Borrelia burgdorferi, the bacterium responsible for Lyme disease. One study often pointed to, however, lacks rigorous peer review. Scientists have yet to confirm these findings or those of related research in clinical trials involving Lyme disease patients.
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What Are The Symptoms
The main feature of Lyme arthritis is obvious swelling of one or a few joints. While the knees are affected most often, other large joints such as the shoulder, ankle, elbow, jaw, wrist, and hip can also be involved. The joint may feel warm to the touch or cause pain during movement. Joint swelling can come and go or move between joints, and it may be difficult to detect in the shoulder, hip, or jaw. Lyme arthritis typically develops within one to a few months after infection.
Tobacco To Turn Off Ticks
Birds get ticks, too. The house finch has developed a strategy to fight ticks. A study in the Avian Biology journal has shown that breeding house finches use cigarette stubs to “proof” their nests. The nicotine wards off parasites, but sadly the neurotoxin can also have negative effects on the chicks.
Ticks – a plague for humans and animals alike
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Lowering Of Microbial Burden
Antibiotics may be recommended for this arm of treatment. If a patient has failed or not responded to antibiotic therapy for chronic lyme in the past, in my experience they still may respond if the other three arms of treatment are added in. Herbal options, and especially ozone therapy, are excellent first choices if not an acute case.
When using these options, risks such as allergy and upper gut irritation with the herbs is a discussion. With antibiotics, the risk of resistance, lower GI issues including serious cases of diarrhea, allergy, are concerns to be discussed. Because of such risks, and the fact that my own experiences been that herbal options are often just as effective although somewhat slower to have clear changes, herbal options are often considered first.
The herbal options that I prefer include much of the newer research that has been published on especially japanese knotweed, cryptolepsis, as well as various essential oils. The classic formulas such as cats claw, Buhner herbs are useful. I do find favorable results with the formulas from Beyond balance as well.
Occasionally though, in my experience, even though the chronic lyme patient is getting full detoxification support, Herxheimer like reactions still occur. In these cases there are many in the office treatments that can help to calm the inflammation based on the individual assessment.
When Should You Call Your Doctor
- A tick is attached to your body and you are unable to remove the entire tick.
- You have a circular red rash that expands over the course of several days, especially if you know you were recently exposed to ticks. You may also have flu-like symptoms, such as fatigue, headache, stiff neck, fever, chills, or body aches.
- You feel very tired or have joint pain , irregular heartbeats, severe headache, or neck pain.
- You are pregnant or nursing and you think you may have been exposed to ticks.
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Should You Use Antibiotics
Different antibiotics may be used to treat children and adults. The decision to take medicines for Lyme disease may be based on one or more of these factors:
- You have symptoms of Lyme disease, especially the red, circular rash, and a history of exposure to ticks in geographic regions where Lyme disease is known to occur.
- Blood tests show that you have antibodies to the Lyme disease bacteria in your blood, spinal fluid, or joint fluid.
- You are pregnant or breastfeeding and are bitten by a tick.
How Is It Treated
Facial palsy is treated with oral antibiotics and Lyme meningitis/radiculoneuritis can either be treated with oral or intravenous antibiotics, depending on severity . Most people with Lyme disease respond well to antibiotics and fully recover. Varying degrees of permanent nervous system damage may develop in people who do not receive treatment in the early stages of illness and who develop late-stage Lyme disease.
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What Is Lyme Carditis
Lyme carditis occurs when Lyme disease bacteria enter the tissues of the heart. This can interfere with the normal movement of electrical signals from the hearts upper to lower chambers, a process that coordinates the beating of the heart. The result is something physicians call heart block, which can vary in degree and change rapidly. Lyme carditis occurs in approximately one out of every hundred Lyme disease cases reported to CDC.
My Final Thoughts: What Works Best
In my experience, the best way to recover from chronic Lyme disease and the coinfections is using prolonged herbal or prescription antibiotics. As I mention above, this can include disulfiram. This usually means using herbal or prescription antibiotics for a year or more. The My Lyme Data study supports this point. The 2020 study did not specifically address if herbal antibiotics give good benefit. But the 2019 study does suggest 68% of people find herbal antibiotic protocols helpful. In addition, it helps to work with a practitioner who focuses their practice on treating chronic Lyme disease.
If you are considering using alternative therapies to heal from chronic Lyme, I suggest you use them as accessory treatments while using herbal or prescription antibiotics. In addition to these alternative therapies, recovery from Lyme may require
- repairing damaged cell energy factories called mitochondria .
As a starting point to determine when and how to address these various issues see the Ross Lyme Support Protocol.
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