In both, “Difficult to Diagnose ” and “Difficult to Treat” Illness, suspect Chronic Lyme Disease or Tick Borne Illness.

     Lyme disease, the name given for the infectious Borrelia Bergdorferi bacteria carried on ticks was first discovered in Lyme, Connecticut. Traditionally, we have been taught that Lyme disease comes from a known tick bite from an endemic area, causing a “bulls-eye” rash and results in arthritis-like symptoms. While this description may occur, it is not the norm. It is believed that less than 50% of people recall any tick bite at all or experience a characteristic rash. Ticks carrying the bacteria, Borrelia Burgdorferi have now been found in all 50 states of the US. The symptoms of Lyme may range from a chronic anxiety or insomnia to full blown neurological illness such as paralysis, chronic migraines or pain.    

     What we know as “Lyme Disease” is actually a complex presentation of multiple infections. The ticks that carry Borrelia may also carry Bartonella, Babesia, Erlichia, or Mycoplasma. Because a person who contracts Borrelia also will have at least one of these co-infections, instead of Lyme, I will refer to this as “Tick-Borne Disease” or TBD. The individual presentation is highly variable and depends on a number of factors, including the existence of co-infections such as Babesiosis, Bartonella, Erlichia, Mycoplasma, Mold, Candida and/or the presence of chronic viral infection such as XMRV, HHV6, EBV, Borna Virus, CMV, a and Herpes Zoster.  Once the person is infected with a tick borne bacteria, the immune system in its attempt to fight the  bacteria, is depressed and the person becomes susceptible to viral infection, parasitic infection or opportunistic infection such as Candida. Therefore, you can see how the presentation of  “Lyme” would vary greatly.

     I became interested in treating Lyme after seeing patients for many years with similar presentations. These were the patients that got slightly better but didn’t respond well to naturopathic medicine and required constant treatment. A typical “Lyme” patient presented a myriad of the following: recurring lymph node swelling, brain fog, chronic fatigue, some degree of insomnia, “sensitivity” to alcohol, foods, supplements and or chemicals, anxiety and/or depression, recurring infections such as cold, flu or vaginal infections, candida symptoms, headaches, sensitivity to light and/or sound and intolerance to stress. Females often experience an exacerbation of their symptoms before or during their menses, while pregnant and with oral contraceptive hormones. Many patients have symptoms intensify or reappear with physical and emotional stress, if sleep deprived, after exercise, in a hot bath, after alcohol consumption, with fasting (hypoglycemia) or dehydration. Humidity, low barometric pressure, elevation, cold or rainy weather can illicit a worsening of symptoms. Some will experience a cyclical pattern of symptoms that intensify every 3-4 weeks. It is also common for all the symptoms to begin after a trauma of some type such as a motor vehicle accident or physical injury.

     After I began testing for Lyme, I realized most of these patients had tick-borne infections. I sought out a well known ND, in the field of integrative infectious disease, Wayne Anderson and completed both a preceptorship and 4 month internship. Now I suspect infectious disease as a root cause of illness in the patients who are “Hard to Diagnose or Treat”.

     Medical knowledge of TBD is minimal and most clinicians miss diagnosing it due to the limitations of the currently available tests. Without adequate diagnostic tests to demonstrate active infection with B. burgdorferi, or the co-infections, it is difficult to determine who has the disease, whether the treatment is being effective and when the disease has been “cured” the end point of treatment. The gold standard for testing is through a laboratory, IGENEX who use the most effective testing methodolgies: Western Blot, PCR and FISH. Therefore, the diagnosis of TBD is primarily a clinical determination based on symptom presentation. The Stricker panel or CD-57 CD4/CD8 panel may be used as a screening test for the presence of Lyme and/or XMRV virus. Currently, the CD57 natural killer cells are reduced in the presence of active Borrelia and/or XMRV infection.  An experience Lyme doctor is needed to make this distinction. The expected range for the CD57 is above 60. Above 200 indicates no exposure to Lyme.

     Treatment of TBD consists of three main objectives:

1.Modulation of the immune system

2.Killing the dominant pathogen

3.Detoxification – supporting the detoxification pathways to handle the die-off of the organism primarily through the kidneys, bowel and liver.

     Where treating TBD gets complicated is the many layers of treatment that is often required. Treating functional disturbances and immunity may require addressing the following issues:

•Methylation for DNA repair and cell detoxification

•Krypopyrolluria, a defect in heme metabolism resulting in deficiency of B6 and zinc,

•Heavy metal toxicity,

•Hormonal, thyroid and adrenal deficiency

•Gluten or other food intolerance

•Chronic pain

•Nutrient deficiencies,

•Bile insufficiency

•Lymphatic, Kidney, Liver support

•Dental infections or structural imbalance

•Gut infections: bacterial, fungal, parasitic

•Viral infection

•Lifestyle stress and emotional imbalance.

•Psychological trauma

•Sleep

     My approach to treating chronic infection requires a thorough interview and testing based on the patients symptomatic picture. The patients presenting symptoms will indicate where treatment needs to begin. Treatment for TBD can vary from naturopathic herbal formulas to antibiotics and pharmaceuticals depending on sensitivity of the patient, pathogen load, detoxification capacity, level of fatigue, symptom presentation and patient preference. In my experience, treating the infections as a layered process allows the patients immune system to be the guide resulting in a less stressful, more effective treatment approach.