2012 Lyme Disease Fast Pearls For Optimal Treatment
Part Three In Reducing Treatment Failure
By James Schaller, M.D., M.A.R.
I am currently writing an updated tick and flea infection text to help the many fine healers and patients seeking the newest knowledge and the best tailored care. It has over 300 pages of references alone. Below is a small sample of the points from this textbook. When one studies emerging infections, it is impossible to finish learning. I continually update my positions every season.
I stand on the shoulders of at least 500 authors and medical professionals, and while I might not always agree with their positions, they push you to find critical new information.
It should be noted that a negative finding, such as the discovery that a certain type of treatment fails, is always very useful. A poor treatment leads to increased illness over time, even if in the initial months it appears to be useful.
Please consider these points below. My goal is not to have you agree 100%, but to have you ponder these issues.
- 99% of probiotics are very poor. Fifteen years ago I clung to a few preferred probiotics, due to the usual seduction—many strains at high colony numbers. I had health care workers take high doses of these probiotics, after which they stopped for 5 days and I did a stool culture. Every stool sample yielded the same result: a total lack of the good bacteria required for health. These brands would not prevent a C. difficile bacterial infection of the intestines—a real problem. No one should ever be given an antibiotic for any duration, 2 weeks or 2 months, without top probiotics. I mention this in more detail in my first Babesia textbook, The Diagnosis and Treatment of Babesia. Simply, if no number or other further designation follows the name of the bacteria, it is a strain with no proof it can bind and proliferate in the 30 feet of intestine. Also, having only one strain of good bacteria is like having one finger. Some of this information was available in the 1980's.
Some probiotics with no specified strains have been used in research to decrease intestinal disease. For example, they merely refer to an "acidophilus." I would see these as possibly of use since in a study of patients in the real world they appear to offer a benefit, even though they may have sub-optimal strains.
In summary, I would suggest antibiotics never be used without top quality carefully selected probiotics—the duration of antibiotic use does not matter. There is always some unknown risk.
- Always start one treatment at a time, and do not add or increase two things in the same day. Years ago the chairman of a famous Ivy League medical department and the editor of the top pediatric journal asked me to write on dosing medication to decrease side effects. All treatment of any kind needs to be isolated. You should typically add only one new treatment at a time, and no more than one new thing in a day. Further, if you increase a dose, it is regarded as a new treatment. Therefore, if you start three things and do not feel right, get a rash or cannot work because of the treatment, you have no idea how to tailor it. Why? You have three possible causes for your problem. Being told to "grin and bear" it is not very caring and it is not tailored care. If we can tailor a suit, we can tailor biochemical interventions.
- Being more moral than the DEA. Some patients need strong treatments to keep their job or function in school. These may include medicines for sleep, anxiety, focus, pain or depression. Some options are traditional medications that are controlled substances. These can all be made into transdermal treatments, or treatments that go through the skin. Some may reject these as "unnatural" perhaps because they have not been used carefully because some healers do not understand that in an infected or inflamed brain these medications cannot be dosed in "routine suggested ways."
Further, if a patient has depression, restlessness and trouble with concentration, do you know which of these should be handled first? I strongly suggest depression is always treated before anxiety, and anxiety before focus defects. If you do not do this carefully and with close communication between the patient and the healer, you can commit chemical battery.
Other options for depression, anxiety, focus or pain may be called "functional, integrative or alternative medicine." Some of these are very effective, but can fail with neurological infection or brain inflammation. For example, SAM-e is an exceptional anti-depressant, but St. Johns Wort is normally ineffective in serious depression. No single school of medicine has all the answers. Therefore, my appeal is to be open to what works. "Natural" options are often profoundly useful. However, in some areas we have very limited natural options, and I am not going to lie to a patient and oversell an alternative medicine option that usually is ineffective. Some health care workers are excited about one type of treatment. I am excited when Mrs. Jones or Mr. Smith experience help from a wide range of possible treatments, and the labs show the treatment is actually working. Each patient comes before any type of pet treatment.
- Bartonella is no footnote and is more common than Lyme. Many years ago when I first got involved in the super specialty of tick and flea infection medicine, no one took Bartonella seriously. It was presented as an easy to kill infection, and of no real concern. It was rarely discussed at infection medicine meetings, in guidelines or infection textbooks. (I noticed the same thing after publishing four books on Babesia—the parasite books I purchased only had two pages on this serious infection).
When I published the most recent book on Bartonella, it showed that Bartonella did not have two or three skin patterns, but vast numbers. This was a fully new and massively expanded diagnostic tool based on reading the world literature and examining heavily infected patients. I was also surprised that no one was looking for the chemicals altered by the presence of Bartonella and the dynamic of these chemicals when both Babesia and Bartonella are present. You can read this in the latter sections of my textbook, Babesia 2009 Update.
This year a new human Bartonella species was added to the over thirty five Bartonella species publically published in Genetic Data banks. It was discovered and highlighted by the talented veterinarian researcher Edward Breitschwerdt. He has said things more clearly than the ideas I was pondering in 2005, while doing most of my Bartonella book reading. He has said simply, but with devastating and highly useful clarity that Bartonella testing is terrible, the treatments are poor, it is typically found on the outside of red blood cells, and the current research on Bartonella is pathetic—one study at NIH. If this was not enough, he said in 2011 "Bartonella is carried by more vectors than any infection on the earth." So it is hardly a backdoor "co-infection." Indeed, this month Bartonella was literally shown to alter human DNA. The implications of this possibility are staggering, and may support what I reported six years ago—Bartonella is not killed simply or easily. My appeal is simple: treating it like a footnote infection is outdated and harmful.
Finally, based on the position above that Bartonella has the largest number of vectors in nature, perhaps Lyme is the "co-infection."
- The treatments for Bartonella are based on terribly outdated testing or are very experimental without real proof by indirect and advanced direct testing. I am embarrassed to admit that six years ago I felt you could rule out Bartonella by a simple antibody test—an IgM and an IgG. When only one species was being tested for in North America, it was also easy to ignore that other Bartonella species infect humans. Further, in 2005 I was amazed to learn how much Bartonella suppresses immunity. It lowers fevers and at times drops antibodies for many common tick and flea borne infections. Further, we found that most proposed treatments in traditional and integrative medicine at best stun Bartonella, and do not cure or even drop body load much. Treatments that are promoted because patients "feel better" are not clear proof. Patients feel better for 100 reasons, and that is not science, it is psychotherapy. Many healers treating Bartonella are using good treatment options, but they do not know how to use indirect and direct testing to confirm effectiveness. This means treatment variables are chaotic, and at times treatments are mixed up like a stew. This approach is very dangerous because Bartonella can cause literal death, in addition to injuring every organ twenty different ways (based on a review of the world literature).
- The best treatment for you is not merely one intervention type. You should never be treated by only one school of healing or one philosophy of healing. Too many healers are only using the options that are rooted in their training. The treatment of tick infections involves many types of medicine and affects many body systems. Therefore healers need to know many types of medicine. Many types of healing can be of use. But I also believe in each school of healing some parts are not of use in treating tick and flea borne infections. One reason I have had to learn so many types of medicine over the last two decades is that my education was obviously only a starting point as a healer. I have had to try so many credible treatments of different types because that offered the best help to patients. No one type of treatment works for all the facets of tick and flea borne infections. One has to have a broad range of options.
- Treatment forever with poor monitoring might be cheap but it is very inadequate care. Currently I drive the cheapest car I could find. If a huge SUV hits me, I am toast. What is the point of the illustration? You get what you pay for. If someone is seeing 20 or more patients a day, that is hardly going to allow them to adjust and tune many facets of your treatment. Tick infections hit virtually every part of the body. So a healer has to know many systems of the body—hormones, inflammation, nutrients, improving functionality quickly, compounding medicine, preventing cancer and preventing clots. Further, they must understand that these infections can impact any organ or human body chemical system.
- The bite you see is rarely the first bite. While it is well known that the more common stages of biting ticks are very hard to see, what is not appreciated is that, based on animal studies, any rash may be a sign of a past bite that occurred 1, 5, or 20 years earlier. Further, more advanced and informed lab tests, showing the biochemical domino effect of tick infections over years, are often very abnormal in people reporting symptoms from a "first bite."
- The diagnosis of tick and flea infections is dirty, confusing and hardly easy. For example, what do you think when the Lyme ELISA is negative, only the IgG 23 "fingerprint" Lyme infection band on the Western Blot is positive, and a PCR for Lyme is positive? That does not fit some formulas proposed in emerging infection medicine. Further, in traditional medicine, a diagnosis is made by an excellent history and interview of the patient followed by a physical exam—labs merely support the diagnosis. That is one reason I noted the dermatology differences in vast numbers of highly infected Bartonella patients compared to uninfected normal patients. Bartonella alters blood vessels and skin tissue in perhaps over eighty skin markings. When I started my discovery on vast numbers of published and unpublished skin signs, only two to three patterns were discussed. Now, slowly, people are mentioning and posting images of Bartonella that have never existed as "Bartonella images" in the 100 years since its discovery.
The current proposed test for Lyme disease is the ELISA. Only if it is positive does one consider any further testing. While the ELISA is a tool, it is not perfect, and the number of clearly sick patients with tick and flea borne infections I have seen with a negative ELISA concerns me. Even if it were 90% sensitive, or even 97% sensitive, is that safe? And what do you do when the ELISA changes from positive to negative (or vice versa) without any medical intervention? As I said, diagnosis is messy in emerging infections, and that is reality. For a physician to keep their insurance contract, they have to order the least number of tests possible—it is like a source of pride and skill. Amusingly, medical board members, appointed as a reward for involvement in political medicine, are acting for insurance companies by both an excess dependence on one lab test to diagnose, and they often call more complete lab testing which shows positive findings "wasted labs" and "bad medicine."
If it is good enough for MAYO, HOPKINS, and the CLEVELAND CLINIC it is surely good enough for any passionate clinician who wants to do a good and thorough job. No one would dare attack an Ivy League physician for ordering extra labs.
- Lyme does not exist alone and never has existed alone inside the main infectious tick, the Ixodes tick. Looking for "Lyme disease" is 1980's medicine. I will not waste time discussing all the diverse infectious agents that are carried inside the Ixodes tick. With each year the number of viruses, bacteria and bacteria species, or protozoa discovered increases. Of course, those labs used as the main diagnostic tools are many years behind the infections inside Ixodes ticks.
- The new wave of Lyme disease or Babesia infection mockery is both naive and unkind to patients. Tick infections are emerging infections. Emerging means no one has the foundation to be cocky. Some believe physicians are only useful when they "reassure" patients they do not have any of the hundred possible species and variants of the infectious agents carried in an Ixodes tick. Since more and more of the population is moving away from traditional allopathic (MD) medicine, perhaps this is not a good issue to mock. One can suggest a course of action for any infection if they wish. But the notion of utter mastery shows a lack of insight into the many dirty ways these infection clusters exist after a few bites by the Ixodes tick over a few years. Amusingly, one researcher mentioned to me she found tapeworm DNA in an Ixodes tick. I do not think she or I feel you can get a tapeworm from a tick bite, but if you can find tapeworm DNA inside the gut of a tick, you can find virtually anything.
- The loss of insight and an increase in rigidity is sometimes the first symptom of a significant infection volume which comes with brain and body inflammation. One danger in some people is they have no idea they are losing productivity or insight, because that awareness comes from the higher and more advanced areas of the brain. Self-reflection is an advanced type of brain function, and it can be impaired if more than a small area of the brain is infected and inflamed. Once someone has this problem they may never be willing to be examined.
- Chronic tick infections over years drop anti-inflammation chemicals and increase inflammation chemicals with serious results. When one's body is chronically inflamed, some other things start to happen. One's vulnerability to autoimmunity increases and depending on which type of autoimmunity, one can become disabled or die. Further, one can have an increase in allergies. These can be allergies to foods, synthetic medicines, and at times even herbs. Finally, one can also become highly sensitive to volatile chemicals, and it requires immense work to maintain a work, school or living location free of synthetic chemicals.
- Routine treatments to reverse systemic and deeply entrenched inflammation are generally trivial and ineffective. If you read a book on lowering inflammation you will see the same twenty options that are listed in other books or journal articles. Unfortunately these do not work when dealing with immense long term chronic inflammation secondary to a series of missed tick and flea-borne infections. We have some options for this problem, but they are outside the realm of this short article.
- The dose that causes misery is not required for effective killing. Some healers feel you should never feel an effective antibiotic, and others feel you are not getting any benefit unless you feel terrible. As the Greeks and Calvin said, perhaps the best position is the middle way. If a medication seems to be having an effect that causes discomfort which is not a side effect, what is wrong with lowering it to a dose just below the level of discomfort? I am almost embarrassed to raise this issue, but do so because it is a common issue.
- Very advanced pharmacology is needed to address depression, irritability, anxiety, rage, fatigue, insomnia, cognitive deficits and agitation which are hardly rare with tick and flea infections left untreated for a significant period of time. This is very important and few physicians are familiar with the dosing for these infections and the common presence of inflammation in the brain which causes these problems. For example, we suggest all capsules and tablets should never be started over the 1/4th mark of the smallest option. But the end effective dose may be profoundly high. These are not primary psychiatric disorders, but disorders secondary to infections, infection debris and inflammation of the brain.
James Schaller is a full-time study/research physician who treats hard to help patients from almost every state, Canada, Europe and all Continents but the polar ice caps. He has been voted by physicians as a Best Physician in the top 5% and rated similarly by patients in an award given November/2011.
He is the author of seven tick and flea infection books, 31 books in total and 27 peer-reviewed top journal articles. Some of these articles and infection textbook entries are on Babesia, Lyme and Bartonella.
Copyright © 2011 James Schaller, M.D. All rights reserved (version 18). This may be posted for free only if in a supportive positive manner. No one may profit from this material or sell it unless it is a minimal fee to cover copy and print costs. It can be translated into any language for free with no need to seek permission from the author.