Dos And Donts Of Getting Help
If you think you may have this syndrome, experts suggest these tips:
Donât assume. Tell your doctor your symptoms, and let her check you.
Donât rush to a specialist. For an accurate diagnosis, start with a primary care doctor, says Eugene Shapiro, MD. He’s a professor of pediatrics, epidemiology, and investigative medicine at Yale School of Public Health.
Do take your antibiotic as prescribed. Even if you feel better, continue the course. Itâs 4 weeks of medications at most. Some experts believe stopping the drugs before your prescription ends may cause symptoms to linger.
Do find experts who can help your symptoms. Ask your doctor if it would be worth your while to visit naturopaths, traditional Chinese medicine doctors, psychologists, or other experts. Many medical centers have complementary and alternative medicine experts on site.
Considerations While On Lyme Treatment
Antibiotics can wipe out beneficial intestinal flora, leading to a wide variety of additional health problems. It is important to take probiotics while on antibiotics to maintain a healthy balance of gut bacteria. Furthermore, antibiotics may interact with other drugs, supplements or food. The National Institutes of Healths MedLinePlus website gives information about drug interactions.
Common Conditions Requiring Medication Treatment For Lyme Disease
Lyme disease requires medication treatment. If you don’t take proper medication, your condition can get much worse. It is important to continue seeing your doctor, even if you are feeling better, until your doctor says you are free of the disease. Be sure to share if you are getting new symptoms or have found your symptoms are not improving.
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What To Try If You Have Failed Years Of Antibiotics
In my practice for those that have failed years of regular antibiotics I offer two persister oriented regimes. Both of these regimens have some published clinical evidence of benefit. One regimen I offer is a Horowitz dapsone persister regimen. The other option I offer is a disulfiram only regimen or a disulfiram combination regimen . You can read more details about how to take both of these regimens in
Iv Antibiotic Regimen: Cephalosporin Plus Azole Plus Liposomal Cinnamon Clove And Oregano
- ceftriaxone 2 gm IV 2 times a day for 4 days on and 3 days off
- tinidazole 500 mg taken orally 1 pill 2-3 times a day for 4 days on and 3 days off in 7-day cycles
- liposomal cinnamon, clove, and oregano capsules 1 pill 2 times a day
- Various antibiotics can be used as IV. I use this one most commonly because it is the easiest to administer and one of the lowest cost IV regimens. The ceftriaxone is given in a syringe and injected over 10 minutes. This is also a pulse dose regimen . Ceftriaxone could be given daily instead as 2 gm IV 1 time a day.
- I have found various pulse dose regimens of tinidazole to work. These include 2 weeks on and 2 weeks off or in the regimen seen here.
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Tetracycline Plus Macrolide Plus Grapefruit Seed Extract Plus Japanese Knotweed
- doxycycline 100 mg 2 pills 2 times a day
- clarithromycin 500 mg 1 pill 2 times a day
- grapefruit seed extract 250 mg 1 pill 2 times a day.
- Japanese knotweed½ tsp 3 times a day
- Tetracyclines and macrolides both block protein production by binding to the protein production apparatus in germs called ribosomes. But they each bind to a different part of the ribosome improving the blockade of protein production.
- Japanese knotweed is added here to treat persister Lyme. It also may treat growing Lyme and can lower inflammation cytokines.
What Treatment Approach Did Well Patients And High Responders Use
We asked patients what their treatment approach was and listed four options a) antibiotics, b) alternative treatments, c) both antibiotics and alternative treatments, and d) no treatment at all. High treatment response was most closely associated with the use of antibiotics compared to patients who were using alternative treatments alone or forgoing treatment altogether. Treatment with antibiotics for Lyme disease was far higher among well patients and high responders compared to non-responders .
As you can see in the chart below, many patients who were taking antibiotics were also taking herbal supplements, which can be antimicrobial . So it is possible that there was a synergistic effect between antibiotics and herbal supplements.
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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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Questions To Ask Your Veterinarian
If your dog has a positive Lyme test but no symptoms of the disease or protein in the urine, ask your veterinarian why he or she is recommending treatment. Experts currently recommend against antibiotic therapy under these circumstances because the dogs immune system is holding the bacteria in check and antibiotics are unable to eliminate the infection.
Dogs who have contracted Lyme disease do not develop prolonged, protective immunity and can be reinfected at a later date. Talk to your veterinarian about how best to prevent future infections. Options include measures to prevent the ticks that carry Lyme disease from biting your dog and Lyme vaccination.
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.
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History And Physical Examination
The clinical diagnosis of Lyme disease can be straightforward in patients with a history of tick exposure and the characteristic finding of an erythema migrans rash.12 The CDC has defined erythema migrans rash as an expanding red macule or papule that must reach at least 5 cm in size .11 According to the Infectious Diseases Society of America guidelines, erythema migrans rash is the only clinical manifestation sufficient to make the diagnosis of Lyme disease in the absence of laboratory confirmation.20 Although one study concluded that primary care physicians in a Lyme diseaseendemic area of France correctly identified erythema migrans in 72 percent of patients,22 the study was limited by lack of complete clinical information for the participants.
A number of conditions resemble erythema migrans however, the rapid and prolonged expansion of an erythematous lesion is unique to erythema migrans.11 Lesions most often occur at anatomic sites that are unusual for cellulitis and other conditions that mimic erythema migrans therefore, a complete skin examination should be performed before excluding erythema migrans.20
Why This Is Important
The use and duration of antibiotics for chronic Lyme disease treatment is controversial because there is no biomarker that can determine whether the Lyme bacteria has been eradicated in CLD patients. Patients are often told that either chronic Lyme disease does not exist or that it is incurable. If this were true, we would not expect more well and substantially improved patients to be taking antibiotics. Instead, we might have expected the percentage of people using antibiotics to be roughly the same among the patient subgroups.
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The Treatment Of Early Lyme Disease
Christie Choo-Kang, PharmD, BCPSNephrology and Renal Transplant Clinical SpecialistBoston Medical Center
Eileen Tang, PharmD Candidate 2011College of Pharmacy and Allied Health Professions, St. John’s UniversityNew York, New York
Arun Mattappallil, PharmD Candidate 2011College of Pharmacy and Allied Health Professions, St. John’s UniversityNew York, New York
Lyme disease, also known as Lyme borreliosis, is the most common vector-transmitted illness in the United States.1,2 The disease was first recognized in 1975 in a number of children in Lyme, Connecticut, who were initially diagnosed with juvenile rheumatoid arthritis because of overlapping signs and symptoms.1 In 1982, Willy Burgdorfer, PhD, discovered that a spirochete isolated from Ixodes scapularis, a deer tick, was the same spirochete found in patients with Lyme disease.
Confirmed cases of Lyme disease are defined as erythema migrans greater than 5 cm in diameter or one or more objective late manifestations of Lyme disease with laboratory confirmation in patients with possible exposure to ticks. Healthy People 2010 set a goal of a 44% decrease in the incidence of Lyme disease by 2010. Since 2000, the CDC has contributed more than $3.5 million per year for new research on Lyme disease.2
Herbal And Prescription Antimicrobials By Function
Be aware the doses I provide below are for adults. These same prescriptions can be used with children but have lower doses. For pediatric dosing, talk with your family physician or pediatrician. Tetracyclines can be used in children under eight, but there is a risk of tooth staining. This staining seems not to be an issue if they are used for a month or less.
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How Do Patients Respond To Treatment
We looked at patients with chronic Lyme diseasethose who remained ill for six or more months following treatment with antibiotics for Lyme disease . The first thing we did was identify different patients as well, high responders, low responders, or non-responders. Well patients responded positively to a survey question asking if they were well or remained ill. Those who remained ill were asked whether their condition had changed as a result of treatment. Those who said they were unchanged or worse were categorized as non-responders. Patients who said that they were better or worse following treatment, were asked how much better or worse. Those who had improved substantially were deemed high responders.
59% of patients had improved with treatment and 42% were either well or high responders. The focus of our study was on this latter group. You might wonder whether 42% response is considered good compared to other drugs. Heres what the prior head of GlaxoSmithKline said about treatment effectiveness rates of drugs in general .
The vast majority of drugs more than 90 per cent only work in 30 or 50 per cent of the people. Drugs out there on the market work, but they dont work in everybody. Dr. Allen Roses, GlaxoSmithKline
So you can see that a 42% rate of substantial improvement is within the range of most drugs on the market.
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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Lyme Has Two Growth States
Research published in 2015 shows that Lyme has two different growth states. There is a growing phase of the germs and there is a persister phase. Think of the persisters as germs that are in hibernation. These persisters – hibernating phase germs – ignore regular standard antibiotics we traditionally use to treat Lyme.
The Truth About Antibiotic Treatments
Until recently, many doctors in Canada tended to prescribe only one round of antibiotics, irrespective of the stage of infection. However, current research suggests that a single course of antibiotics is often insufficient for treating Lyme disease, especially if the infection has been untreated for several months.
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Treatment For Erythema Migrans
People treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Early diagnosis and proper antibiotic treatment of Lyme disease can help prevent late Lyme disease.
Treatment regimens listed in the following table are for the erythema migrans rash, the most common manifestation of early Lyme disease. These regimens may need to be adjusted depending on a persons age, medical history, underlying health conditions, pregnancy status, or allergies. Consult an infectious disease specialist regarding individual patient treatment decisions.
|100 mg, twice per day orally||N/A|
|500 mg, three times per day orally||N/A|
|500 mg, twice per day orally||N/A|
|4.4 mg/kg per day orally, divided into 2 doses||100 mg per dose|
|50 mg/kg per day orally, divided into 3 doses||500 mg per dose|
|30 mg/kg per day orally, divided into 2 doses||500 mg per dose|
*When different durations of antibiotics are shown to be effective for the treatment of Lyme disease, the shorter duration is preferred to minimize unnecessary antibiotics that might result in adverse effects, including infectious diarrhea and antimicrobial resistance.
NOTE: For people intolerant of amoxicillin, doxycycline, and cefuroxime, the macrolide azithromycin may be used, although it is less effective. People treated with azithromycin should be closely monitored to ensure that symptoms resolve.
Herbal And Rx Antimicrobials That Treat Persisters
This is a newer area in Lyme treatment. To help justify these various antimicrobial options, I describe the experimental basis behind my recommendations. These options are ones I am using with various degrees of success in my Seattle practice. They all have either laboratory experiments supporting their use or published human experiments.
Laboratory-Based Experiment Options
Here is a list of prescription and herbal medicine options shown in lab experiments to kill persisters that I am incorporating into my treatments of Lyme and/or Bartonella.
- Disulfiram – work slowly up to 4 to 5 mg/kg body weight 1 time a day.
- Methylene Blue 50 mg 2 times a day.
- Liposomal Oregano, Cinnamon, and Clove Oils 1 capsule 2 times a day.
- Cryptolepis 5 ml 3 times a day.
- Japanese Knotweed½ tsp 3 times a day – start at ¼ tsp 1 time a day and then increase after two weeks to ½ tsp 3 times a day.
- Cats Claw 30 drops 2 times a day.
Human-Based Experiment Options
Here is a list of prescription medications shown in human experiments to help with persister Lyme.
- Disulfiram – work slowly up to 4 to 5 mg/kg body weight 1 time a day.
- Dapsone – work up to 100 mg or 200 mg 1 time a day.
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Treating Lyme Disease While Pregnant
Treatment for pregnant women with Lyme disease is similar to that of non-pregnant adults. However, certain antibiotics, such as doxycycline should not be used as it can affect your unborn child.
Research shows that there are no life-threatening effects on the child when a pregnant woman receives appropriate antibiotic treatment for Lyme disease.
Notes On Serological Tests
For patients with illness lasting over a month, only IgG testing should be performed . A positive IgM test alone is not sufficient to diagnose current disease in these patients.
Due to antibody persistence, a positive serological test cannot distinguish between active and past infection.
- should not be done as a test of cure
- cannot be used to measure treatment response
The EIA test:
- may yield false-positive results when used as a stand-alone test
- may cross-react with antibodies to commensal or pathogenic spirochetes
- there may be some viral infections for certain autoimmune diseases
Macrolide Plus Quinine Derivative Plus Azole Plus Methylene Blue
- azithromycin 500 mg 1 pill 1 time a day
- hydroxychloroquine 200 mg 1 pill 2 times a day
- metronidazole 500 mg 1 pill 2 or 3 times a day
- methylene blue 50 mg 2 times a day
- Since azithromycin is not as effective as other macrolides like clarithromycin, hydroxychloroquine is used to increase the effectiveness.
- Tinidazole could be substituted for the metronidazole because it may remove biofilms more effectively.
- Methylene Blue can treat persister Lyme.