Treatment Fatigue

Question:

Please talk about treatment fatigue in general, in particular, what are your options if your body cannot tolerate antibiotics, maybe the liver function is limited?

Dr. Neil NathanAnswer from Dr. Neil Nathan:

By “treatment fatigue” I assume you mean that a specific patient cannot tolerate ongoing standard doses of antibiotics. I would like to address a broader view of this problem, since what it is really addressing is how capable the individual is of mobilizing their immune system (with the aid of antibiotics) to kill the infecting organisms (Lyme, Bartonella, Babesia, Ehrlichia, Mycoplasma, etc.), and then how capable it is to remove those dead organisms and toxins from the body. This requires the coordinated workings of the organs of detoxification: the liver, intestines, lymphatic system, kidneys, skin, lungs, and spleen, along with the immune system, to do this properly.

By its very nature, Lyme disease weakens the immune system, often profoundly, and compromises the ability of these organs to do their jobs properly. The longer the individual has been wrestling with Lyme disease, the weaker these systems get. Part of our job, as Lyme-literate specialists, is to attempt to evaluate all of these components, to create a treatment plan. While we have some tests that can help us in doing so, most of these tests are somewhat limited, and we often have to observe how our patients respond to our treatments to get a better picture.

When we treat Lyme, we often start with an antibiotic and herbal/detoxification approach, but some of our most compromised patients cannot tolerate this at first. This means that before we start antibiotics (either medications or herbal) we may have to first build up our patients’ bodies. Patients who have been ill for a long time usually have weakened adrenal, thyroid, and sex hormone systems, as well as depleted neurotransmitters. Many have heavy metal toxicity and/or mold toxicity, or multiple chemical sensitivities, or allergies, or difficulty with methylation chemistry as well. We may have to start with those systems and build them up before even thinking about detoxification or using antibiotics. Liver function is only one aspect that we must consider. Often we find that gentler approaches, such as homeopathic remedies, can help us get started.

Each patient is different. Each requires that we delve into their unique chemistry to try to find an approach that they can tolerate before we proceed with antibiotics.

Dr. Neil Nathan is a gifted physician who is passionate about healing. Since he loves to learn, he considers himself  “always a student’, and gets fired up about learning new approaches that might work for his patients. Never satisfied to just learn superficially, when something grabs Neil’s attention, he will research and study with the person who really KNOWS how to do it, so he can maximize its clinical benefits. He is the author of On Hope and Healing: For Those Who Have Fallen Through the Medical Cracks, and a contributor to  Insider Secrets For Treating Fibromyalgia: 12 Top Experts. You can find Dr. Nathan at Gordon Medical Associates in both Santa Rosa and Fort Bragg.

Treatment: Antibiotics or Herbs?

Question:

Is it possible to effectively treat Lyme disease and co-infections without antibiotics?  Is the immune system able to wipe it out if given the right support?

Dr. Eric GordonAnswer from Dr. Eric Gordon:

I would say unequivocally, maybe. The difficulty goes to the heart of the Lyme war between ILADS  and the IDSA. Since active Lyme is a clinical diagnosis, which means it is determined by the patient’s history and current symptoms, we can’t really say how many people diagnosed with Lyme have Lyme, or other infectious or toxin caused diseases.  If you look at symptom lists, the overlap with other illnesses is huge.

My answer is yes, I have read reports of people treated with herbs, and their symptoms and their CD57 tests have normalized. In my practice,  I often start with herbal treatments, but almost always use antibiotics at some point in the therapy. The biggest issue is not drugs vs. herbs, but rather the underlying toxicity of the person, and whether or not their immune system can manage inflammation.  I have had several patients who had severe “Herx’s” to herbs and yet did well on antibiotics.

I do believe the immune system can deal with Lyme if given the right support.  Many people remain asymptomatic despite tick bites and positive Western Blot tests. Is the Lyme gone, or just suppressed? We just don’t know whether you can wipe out Lyme once it has taken hold in the body. Hopefully when we have better tests and culture methods we will be able to be sure the bugs are gone after treatment. Till then, we can look for a robustly normal CD57 of greater than 160, repeatedly negative IgM Western Blots, and normalization of any previously elevated or depressed immune markers  with clearing of symptoms as our best guide to a cure.

Some of the markers we use come from Dr. Ritchie Shoemaker’s work.  C4a (Split Complement C4a) is an inflammatory marker that is a part of the complement immune system, and is commonly elevated while Lyme is active. This test is only run at National Jewish Hospital’s Advanced Diagnostic Laboratories , though some other labs will draw your blood and send the sample to NJH.

The complement system is a group of proteins that move freely through your bloodstream.  The proteins work with your immune system and play a role in the development of inflammation.

Each complement activates inflammatory responses, with spillover of effect from the innate immune response to acquired immune response and hematologic parameters.

These short-lived products are re-manufactured rapidly, such that an initial rise of plasma levels is seen within 12 hours of exposure to biotoxins, and sustained elevation is seen until definitive therapy is initiated.  Normal Range0-2830 ng/ml

Dr. Ritchie Shoemaker

VIP (Vasoactive Intestinal Polypeptide) is low in many with chronic Lyme.

Vasoactive intestinal polypeptide (VIP) is a neuroregulatory hormone with receptors in the hypothalamus.  This hormone/cytokine regulates peripheral cytokine responses, pulmonary artery pressures, and inflammatory responses throughout the body.

Low VIP levels … leads to unusual shortness of breath, especially in exercise.  To date, every multiple chemical sensitivity patient Shoemaker has seen (over 500) have had low VIP.  VIP plays a role similar to MSH in regulating inflammatory responses.

With respect to the digestive system, VIP seems to induce smooth muscle relaxation (lower esophageal sphincter, stomach, gallbladder), stimulate secretion of water into pancreatic juice and bile, and cause inhibition of gastric acid secretion and absorption from the intestinal lumen, which can lead to chronic, watery diarrhea.  Normal Range23-63 pg/mL

Dr. Ritchie Shoemaker

MSH (Melanocyte Stimulating Hormone) is also low in almost all of our Lyme patients.

Alpha melanocyte stimulating hormone (MSH) has multiple anti-inflammatory and neurohormonal regulatory functions, exerting regulatory control on peripheral cytokine release, as well as on both anterior and posterior pituitary function.

…. (low level)  means increased susceptibility to mold illness, ongoing fatigue, pain, hormone abnormalities, mood swings, and much more.  MSH is a hormone, called a regulatory neuropeptide, and it controls many other hormones, inflammation pathways, and basic defenses against invading microbes.  Without MSH, bad things happen; chronic sleep disorders with non-restful sleep develop, and endorphin production is reduced, so chronic pain follows. Normal Range35-81 pg/mL

Dr. Ritchie Shoemaker

Dr. Eric Gordon is the founder of  Gordon Medical Associates. What Dr. Gordon emphasizes is listening to his patients. “I believe my patients. Their description of what is going on in their body is the most accurate way we have to assess what is going on with them. I interpret the information they present, and blend it with laboratory results and imaging and other tests to determine a protocol that is customized to their condition.”