Lyme Disease in Depth – Joseph J. Burrascano, Jr., MD Sept. 25, 2013~ Patient’s Notes

Thank you Vanessa Holden for taking such great notes from this conference and sharing them with us!

Why am I still sick?

Lyme disease
Co-Infections
Immune System Dysfunction
Toxins
Hormones

What Lyme? Which one or ones?

Borrelia can be sneaky – change over time. Adapt over time.
Birds, reptiles, mammals are carriers. Adapt to their environment

100 more genes than syphilis, Falsenfeld 1971
Pachner – infested mouse. Different Bb in brain than in blood/body.

Rapid transmissions of pathogens

W. Burgdorfer: 5-10% ticks have Lyme. can get it in minutes as it’s in tick saliva

Serologic testing insensitive

All based on only 1-2 lab strains. 71 % missed.

Sensitivity of ELISA: 29-68%

Beware of test results. – highly inaccurate

Lyme Elisa – 18% accurate

Western Blot – commercial kits sensitivity 46-50%

Reference tests – no more than 80% – reading is highly subjective.

Test affected by lab variables
Reagent concentration
Temperature

Why Borrelia can cause Chronic Infection?

Shifts form
Lose cell wall
Cell wall deficient.
Cystic Morphologies

Spinal fluid, temporary antibiotics. Sequesters in tissues and hidden collagen bundles.
Different antibiotics attack different strains
Lower doses and some meds don’t penetrate
Can survive within cells – they protect Bb and means of dissemination
Produces a protective biofilm

Granular Borrelia – vary in size from little to big
Cystic form
In ligaments
Biofilm formation – bundles

Complex 3-dimensional structure that expands and hardens.
Soaked in Chlorine – still didn’t die!
Channel like structures
Rearrangements over time – one or more antibiotics help – borrelia not static, very slow growth, double in days to weeks.
The slower the growth, the slower time it takes to kill.

Lyme – 4 week cycle: dormant, active, dormant.
Antibiotics kill when active
Periods of dormancy/latency – no division but continued production of toxic products

Epitope switching allows evasions of immune response.
Changes appearance so immune system doesn’t recognize

Treat Lyme

Engineer regimens
Different antibiotics must be combined. Borrelia live inside cell and outside cell – need combo to combat this
Cover fluids as well as deep tissues
Cover morphologic forms – spirals, ribosomal and cystic
Cefuroximine + clarythromycin + tindazole

Dosages:

Critical to achieve therapeutic drug levels as resistance and treatment failures are likely –
this varies patient to patient
Must measure peak and trough antibiotic levels whenever possible

Amoxicillin: from 1500 to 3000 mg + add probenecid 1500 mg a day
Doxycycline: 300 mg per day didn’t clear it – never worked

Need to discuss with doctor, especially if you change doctors:
Blood antibiotic levels
Choosing antibiotics
Which co-infections?
Can I cover 1 pathogen with my antibiotic regimen?
Will it cover spiral, CWD and cystic forms of Bb?
Has patient had it in past?
Side effects, allergy

Antibiotics – Route of Administration

Placebos didn’t work
Orals –
IV – most effective

Abnormal spinal fluid
Synovitis with high ESR
Ill more than 1 year
Over 60 yrs old
Acute in 1st trimester of pregnancy
Acute carditis
Immune deficiency
Prior use of steroids

Standard therapy – 7 days a week

Pulse therapy – 3 days in a row, 4 days off – allows for double dose, higher doses

36+ hours – to affect with CFTX
Takes Bb longer to recover

Safer, Heparin lock possible, less costly, better lifestyle for patient

Herxheimer Reactions

Inflammatory response
Current symptoms flare, old ones reappear, new ones arise
Difficult to distinguish between allergy and toxicity
Last 2+ days up to several weeks
Recur every 4 weeks as long as infection is active
May see leucopenia

The worse the Herxheimer reaction:

The more ill the patients
longer duration of illness
debilitated
in puberty
severe neurological conditions
chemically sensitive individuals
elderly

If treat with overly aggressive antibiotics – scare the patient
Too gentle – borrelia become antibiotic resistant
best to do: interrupt treatment for a few days and rest

Managing Herxheimer Reactions:

Push fluids
Alkalinize: water with lemon, trisalts, Alka Seltzer Gold
Vitamin C

Binders: bentonite, activated charcoal, micro chitosan, cholestyramine

Hot baths with 4-6 cups Epsom salts + baking soda

Duration of treatment:

Extended courses needed
Early studies with oral meds
Amoxicillin 17% cure after one month, 67% after 5 months duration
Same with IV – 6 weeks IV
If get thru 4 weeks Herx… If bad, go 8 weeks
Follow 4 week cycle

Minimum 6 weeks to bracket one cycle.
Continue to treat until 4 week cycles stop!

Can we Cure Chronic Lyme?

No foolproof “cure” and relapses occur
Get to where treatment is no longer necessary – where function
6-12 week course and stop – depends on patient/doctor

May not eliminate every spirochete. Get to the point where the immune system is able to fend off.

Banderol/samento – biofilm busters. Then antibiotics kill
Boluke, nattokinsase – enzymes
Chelation out the divalentcations – not proven in patients

Co-Infections in Lyme

Live for 2 years in dirt and drink blood from the variety of wild and domestic animals
Attach to rodents etc

West Nile from Tick Bite
Borrelia
Babesia
Bartonella
Anaplasmosis
Ehrlichia
Rickettsia
Tualemia
Mycoplasma
Old viruses can reactivate EBV, HSV, HHV-6, 7, 8 CMV
Parvo, bornavirus
Viruses
Intestinal parasitic infections
MARcons
Nematodes
Protomyxoa rheumatic
Fungi, etc
Q fever
Brucella

Co-Infection Guide

Lyme
Bartonella
Babesia
Erhlichia/anaplasma
Mycoplasma

Lyme – multi system: no sweats, 4 week cycles, slow relapse, joint involvement, afternoon fevers, Bb antibodies

Bartonella – light senstivitiy, anxiety, insomnia, overactive CNS, stomach upset, blood vessels, AM fevers, swollen lymph glands, elevated VFGF

Babesia – abrupt onset, sweats day and night, cycle 5-7 days, headaches, migraine like, air hunger, circulation in lungs, thick blood, cough, severe lyme symptoms, vertigo, feel off balance like on boat, temperature any time

Anaplasma- rash, high fever, sore muscles, low WBC, elevated liver function tests, numbness/tingling, eye-stab headaches, muscles sore
Co-Infection Table (slide – I didn’t get it all but when we see slide you’ll get the rest)

Ehrlichia – relapse gradual
Mycoplasma – relapse gradual

 

Bartonella-Like Organism

More prevalent in Northeast than borrelia. Different than tualemia “cat scratch fever”
CSD tests insensitive – 80% miss
Galaxy Diagnostics PCR better – still not accurate

CNS (central nervous system) out of proportion to physical. Encephalapathic, irritable, anxiety, seizures, rashes, red bumps form scabs, look like stretch marks (linear)
Treat Bartonella-Like Organism

Levoquin – which irritates brain and tendons. To counteract this take pycnogenol, Vitamin C and magnesium shots

Fluroquinalones first choice to treat
Erythromycin family don’t work – inhibit Levoquin
Erythromycin + tetracycline + rifampin + CW or Bactrim

Babesia

13 strains. Problem with diagnosis
No tests better than 30% accuracy

Combo therapy:

Mepron or malarone + Artemisian
Erythromycin + artemesian
Coartem – success with
IV – clindamycin

Ehrlichia/Anaplasma + Rocky Mountain Spotted Fever

Acute and chronic form
Headaches, joints

Doxycycline – 200 mg at least 2 weeks (oral or IV)
Macrolides and rifampin 2nd choice
Partial response to fluroquinalones – not recommended as sole treatment!

Mycoplasma

Not sure of source
Seen in immune-suppressed
See with unrelenting fatigue – autonomic dysfunction, pain syndromes
Tests are awful (inaccurate)

How to treat:

Treat with anti-virals. Treat tick-borne disease and correct immune deficiencies unless high viral titers, persistent or significant IgM
4 months – Byron White helps

Immune Dysfunction 1

Bb immune suppressive. Inhibits B + T cells and decrease NK cells. Difficult to clear Lyme and co-infections

Immune Dysfunction 2

Causes defective B-cell signaling
Shut down immune system
Constant flu-like feeling
Hormone receptor blockade
Inhibition of detox pathways

Defect regulation results in autoimmunity
Food sensitivities, new allergies, environmental sensitivities
System more fragile.
Stress, surgery, plane flight, sleep deprivation can all set this off

Fixing Immunity

B-cells make IgG – if low treat with IVIG
T cells – can test blood/skin “Mitogen Stimulation Assays”

If deficient – use vaccines and transfer factors, promote sound sleep and exercise program

If B-cell overactive:

Avoid foods that are sensitizing, take Vitamin D, herbals
High vitamin D can help

Caution: Turmeric/Curcumin can cause GI ulcers – can cause blood thickening, so use only a small amount. Ok in your ‘curry in a hurry’ but be careful.
Toxins:

Overload
Excessive exposure – industrial, seafood, accidental
Decreased Excretion – MTHFR defect results in decreased glutathione
Chronic inflammation
Lifestyle – inability to move (exercise) so build up in body
Excessive sensitivity to toxins
Genetic sensitivity to biological toxins – mold, staph, marine toxins

To treat MTHFR – folic acid, glutathione

Detoxification:

Eliminate excessive exposure – mold, nasal staph, seafood, environmental, biological toxins
Folic acid – methyl B-12
Administer glutathione directly via IV
Binding agents
Sweating, pooping, peeing
Heavy metals – chelation plus the above

Sauna – sweat – raises body temperature. Dr. B. feels exercise and hot tub better way

Hormone Dysfunction

Low thyroid, adrenal and sex hormones – replacement doses
Hormone receptor blockade occurs in Lyme

Treat Hormone Dysfunction:

Replace all deficiencies
Treat underlying infections, detox, treat dysfunction to address:
Inflammatory
Autonomic neuropathy
Lifestyle
Diet
Sleep
Ideal weight
Exercise

Permanent Damage:

Nervous System – weakness, pain, poor balance, coordination, myelineal/nerves)

Autonomic: pain, gut dysfunction, weakness, poor stamina, light headedness, swelling, rapid pulse, blood pool in veins, musculoskeletal system
Bb infections can weaken collagen and elastic fibers
Impaired healing
Inability to get appropriate rehab

Healing Nerve Damage

IVIG – expensive – $15,000 per dose

Helps remyelination – heals fine, unmyelinated fibers
These damaged fibers are the cause of intractable and severe neurological pain as well as autonomic neuropathy.

Moderate cytokine store (anti inflammatory without being immune suppressive)

r-lipoic acid – 150 mg 2 times daily if tolerated (nausea)
CordyMax (Pharmanex) – 6 a day – comes from coryceps mushroom
NT Factor – 6 a day (helps mitochondria to heal) – brand he likes: Research Nutrition
High dose CoQ-10 (Pharmanex nano CoQ-10) – 4 a day or 400 mg conventional type daily
Methyl B12 injections – 25 mg daily for several weeks, then taper off to 3 times a week

Dermal nerve biopsy – shows decreased number of fibers and their disruption

Healing Soft Tissues

Diathermy – dilates capillaries, breaks up rouleaux, improves blood flow, may have membrane healing effects

Great for headaches, even migraines

Appropriate massage
Body mechanics
Stretching but only after heating e.g. after hot yoga
Gentle chiropractic care and physical therapy, acupuncture
Nutrition
Vitamin C, pycnogenol, Vitamin D

Some feel worse after massage, as spreads toxins. Swedish is gentle, Acupuncture has helped, very dependent on the practitioner

Vitamin C doesn’t work without pycnogenol (1 mg. per pound of body weight). Vitamin C dose to bowel tolerance

Required Supportive Measures

Low glycemic diet, low fat diet
No alcohol
No high dose steroids or other immune suppressive unless already on antibiotic regimen
Key nutritional supplements
Exercise
Enforced rest
Sounds sleep
Psychological and emotional support for patient, family and care givers

Nutritional Supplements

Probiotics
Kefir, bifudus, lactobacillus, soil-based organisms (rotate or mix several types)
Multi vitamin with minerals
NT factor
Co-Q10
Vitamin D
Essential fatty acids (krill oil plus borage or coconut)
Magnesium – begin antibiotic first, then start magnesium MagTagSR
Trsansfer factors specific for Lyme
CordyMax
Methyl B12 (if not mercury toxic)

Exercise

To enhance t-cell function

Whole body program, exercising every muscle group every time.
Body sculpting program – gentle with free weights or machines – 2-3 pound weights, many repetitions, 45-60 minutes
Aerobics not allowed at all! (decreases t-cells)
Good slow progressive
Finish with stretches
Hot bath/sauna, nap immediately
Separate several days in between. Rest on days not exercising
Start out once a week. As strength improves, increase weight and resistance but high repetitions. As stamina improves, exercise more often, never daily

Enforced Rest

Don’t get overtired
Take break before mid-afternoon energy sag
Mid day breaks
Sleep

Brain Hypoglycemia – awaken with adrenaline, shaky feeling.. Treat with 1 tbls coconut oil at bedtime – stops shakiness (coconut oil lasts in system for 8 hrs)
Tooth decay and Lyme – which came first chicken or egg? Not sure.. Gums show disease e.g. heart disease…

Vaccine – not likely. No lasting immune memory and not protect against co-infections. Can get Lyme multiple times.

Rife – some give off radiation, Dr. B doesn’t like them but said he knows some people have had good success with them.

Sexual transmission – proven in animals, no way to tell in humans





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