Burrascano Notes from March 21st talk

Mar 30 2011
 

Video geeft heel goed de stand der kennis weer

Consultancy lab Dr. Burrascano:  Advanced Laboratory Services

Meer kennis (Alleen Burrascano deel)

basics diagnosis and treatment

PLEASE NOTE:  Because the presentation was so dense and rich with information, there may be some info that was left out.




Dr.  Burrascano has treated over 10,000 patients with Lyme since early ‘80s.


 
“It is up to you. Learn as much as possible. Do as much as possible. Have a positive attitude.”
Dr. Burrascano’s definition of Lyme Disease“Lyme disease is the illness that results from the bite of an infected deer tick; it’s not one germ.”
 Stages of Lyme
Early Lyme – I
Disseminated Lyme – II Chronic Lyme – III -for one or more years – immune system breakdown and its consequences -co-infections become important -serologic tests less reliable -treatment must be more aggressive and of longer duration
The sicker you are, the less reliable the tests; lyme burrows deeper and is no longer easily detected in blood
CD-57 test – the one test that shows how long Lyme has been present (See more blow regarding CD57)
Tick Bites
Only 17% recall having a tick bite (Texas Dept of Health) Only 36% recall a rash Only 50% have positive western blot Co-infections: tests are even less sensitive
Ticks: nature’s “dirty needles”; a tick lives for 2 years
Co-infected patients: more ill, more difficult to treat; Lyme treatments do not treat Babesia, Bartonella, or viruses.
**Dr. Burrascano says he has never seen a patient without co-infections. 

Sorting Out Co-InfectionsLyme, Bartonella, Babesia, Ehrlichia, Mycoplamsa
Lyme – Gradual onset, no sweats, 4 week cycles, multisystem, afternoon fevers
It is important to take your temperature several times a day (record in journal)
Babesia – Cycles every few days, makes everything worse
Ehrlichia – Sharp headaches behind eyes, low WBC, elevated liver function
Mycoplasma – Made worse with exercise, aka “Chronic Fatigue Germ”, major fatigue, neurological disfunction, found in the sickest and poorest responding; have the worst CD-57 tests
ELISA test – mostly useless; use Western Blot Spinal Tap – only 9% have + csf PCRs – 60% sensitivity at best because germ doesn’t stay in blood LDA – 30% sensitivity

Why Igenex?
Dr. B has no affiliation with them, no professional relationship with them, etc…
If a test is commercialized to be sold as a test kit, it must follow narrow CDC restrictions and guidelines. (Ironically, these restrictions were a result of the Lyme vaccine debacle.)
Most Lyme tests are commercial. Commercial Lyme tests miss 75% of cases.
Based on double-blind government proficiency tests, IGenex did well.


CD-57 COUNT (tracks a type of white blood cell)
Lower counts seen in chronic Lyme Only Lyme (not co-infections) makes CD-57 low
The CD-57 reading does not change *during* treatment … until Bb is controlled. Then it quickly changes.
Predicts a relapse if low when antibiotics end
The CD-57 test must be done by LabCorp’s method (using the “normal is >200” scale) <20 – severe illness 20 – 60 most common for chronic patients > 60 Lyme activity minimal > 120 – relapse not likely

Why Are Chronic Lyme Patients So Sick?
-High spirochete load (perhaps multiple bites) -Protective niches in the body and biofilms allow Bb to evade the immune system and antibiotics -Immune suppression and immune evasion
Biofilms are a protective layer
Lyme germs live in different forms: Spirochete – surrounded by a cell wall Spiroplast – balls up, has no cell wall Cystic form – has hard outer shell
Lyme germs can live *inside* a human cell, inside the vacule
Doxycycline – can get into the cell Erithromycin – can get into the cell Rocephin – does not kill germs inside vacule 

Treatment - Back to Basics
Form a therapeutic alliance with your Dr.; should be able to have “meeting of the minds”

Pharmacology -It is *critical* that you achieve therapeutic drug levels – this varies from patient to patient -Antibiotics – you *must* have extra-cellular and intra-cellular meds as Bb can live in and out of cells -Antobiotics – must act on blood & tissues

Spirochete forms: Penicillins, Cephalosporins, Primaxin, Vancomycin,
Spiroplast/L form:  no cell wall Tetracyclines, Erythromycin
Cyst: Metronidazole, Tinidazole, Rifampin
Spirochete B. burgdorferi – needs sustained levels L form – Tetracyclines, need a spike in blood levels Cystic – Metronidazole, sustained levels for 2 weeks +
Antibiotic combinations are necessary Intracellular and extracellular Blood and tissue
Intravenous therapy is most effective Intramuscular Penicillin effective as well
Indications For Intravenous Therapy -illness for more than one year -prior use of steroids -documented immune deficiency -abnormal spinal fluid -synovitis with high ESR -age over 60 -failure or intolerance of oral therapy 

Typical  Regimen
Oral
Cefuroxime + Clarithromycin Augmentin XR + Telithromycin

Injection BicillinLA + Clarithromycin
Intravenous Clarithromycin + Telithromycin Vancomycin + Clarithromycin
-high doses needed -combination usually necessary -check for co-infections -rotate treatments
Rate of recovery dependent on germ; stronger drug will not speed recovery.
Find a regimen that works and stick with it Change when you’ve reached a plateau Treatments: at least 4-6 weeks before changes
Relapses
-relapses occur; retreatment needed -repeated and/or prolonged antibiotic therapy

Aggressive supportive therapy also necessary: Sleep cycleFood Supplements Detoxing

As symptoms wind down, DO NOT cut dosage! Resistance develops that way.
Progressively increase exercise program -exercise is vital and required -not exercising will increase risk of relapse
If CD-57 is not normal at end of treatment, continue treatment or there will be relapse   
Prognosis -May not cure infections, may need open-ended maintenance therapy
What to Watch For: Signs of persistence; continued fevers Four week cycles of ailments Migrating symptoms Positive PCR or urine LDA
If you have not relapsed in 3 years, you never will.
What if you’re not sure you’re over it? Low grade fever still present Signs of recurrent four-week cycles Migrating pain Low CD-57 counts
  Bartonella The Bartonella co-infection with Lyme seems to be clinically different that “cat scratch”. Instead, they are Bartonella-like organisms; more prevelent that Borrelia in some ticks
Clinical Clues EncephalopathyIrritability AnxietyStomach liningInsomniaRashesAM feversNight sweatsTender skin nodules
Bartonella treatment:Levaquin Fluoroquinolones
Erithromycins don’t kill this Rifampin & Metronidazole may be alternatives 1 – 3 months of treatment

Piroplasms – Babesia Is a parasite
SymptomsNight sweatsAir hungerAn occasional coughPersistent migraine-like headacheA vague sense of imbalance without true vertigoEncephalopathyFatigue

Babesia TreatmentNot treated with antiobiotics
Azithromycine & Mepron Malarone Coartem – Antimalarial for Babesia (new)
  Ehrlichia HeadachesMuscle soreness Persistent leucopenia (low WBC)
TreatmentDoxycycline 1st choice


Mycoplasms“Chronic fatigue” germ Ubiquitious in environment (in dust, for example) Treatment is difficult
Worms New species of nematodes in 63 – 75% of patients from Massachusetts
Fatigue Lives in lungs mainly (Dr. Eva Sapi, Dr. Larry Klapow – research)

An open mind is important!!

Biofilms Dental plaque is an example Gel-like substance in which germs can embed Biolfilms in the gut are implicated in many digestive diseases & possibly food allergies and mal-absorption
Biofilm busters: Banderol plus Samento Enzymes
Methylation Cycle Key component of metabolism Need to bring up methylation cycle This cycle can be blocked when chronically ill 75% of Lyme patients responded better after  treating


Crazy or Is It Lyme? Cytokines – mediators of inflammation, are activated. When this occurs in the CNS, it triggers diversion of tryptophan into kynurenine Result: depression, neuropathy, fog brain, “crazy” perception


Bornavirus Autism-related? Distant cousin to Rabies and distemper Brain is the site of infection Does not damage nerve cells but blocks cell function Brain fog, fatigue leads to depression
Treatment: Antiviral Amantading 65 – 70% success rate
  XMRV Xenotropic Murine Leukemia Virus Virus – is gamaretrovirus, 1st isolated in prostate cancer 68 out of 101 CFIDS samples contained XMRV XMRV is found on only 3% of healthy samples XMRV is also found present in cases of: MS, ALS, Parkinsons, Autism, Fibromyalgia Lyme patients who did not recover: 1005 of them had XMRV
Does it prevent a full recovery from Lyme? Is it found in ticks?
Dr. Judy Mikovits

Treatment – XMRV Retrovirus is cousin to HIV -be sure there is not excessive cortisol and DHT -consider adding antivirals AZT, tenofovir, raltegravir

Basic Advice
NO steroids or other immune suppressives!
No smoking at all No alcohol (makes germs stronger, weakens immune system) Clean diet: low carb, low glycemic index, high quality proteins Maintain hydration (Lyme patients become dehydrated quickly, sense of thirst is altered) May need mineral supplements

ENFORCED REST
You are NOT allowed to get tired Take a break before afternoon lag Work and school – Go in later, leave earlier, take a midday break, take Wednesdays off Rest on days off No caffeine, no stimulants Home should be quiet, comfortable, non-toxic Nap if needed!! If you need to sleep late, do it!!

Exercise Program
Body sculptingGentle with free weights, exercising all muscles; very light or no weights NO AEROBICS Each body sculpting session 45 min; 60 minutes preferred Begin with good progressive warm-up Take a hot shower or bath afterward and go to bed. Lie quietly if you cannot sleep. Never exercise daily Total rest on off days As strength improves, increase weight and resistance but maintain high number of repetitions As stamina improves, exercise more, but NEVER daily.

  Nutritional Supplements

Probiotics  

Multivitamins w/minerals
CoQ10 or ubiquinone
NT-factor or “ATP fuel” ATP Fuel
Vitamin D – maintain upper-normal levels
Essential Fatty Acids
Magnesium

Methyl B-12  http://www.mcguffpharmacy.com
B complex
Transfer Factors
Detoxify


FIR Saunas: Helpful to excrete organic toxins








DEET does not work!! Use Premethrin!
(Developed in cooperation with the U.S. Military, government agencies, universities and others; this Sawyer Clothing repellent offers superior protection from disease-carrying biting insects. The active ingredient, Permethrin is a synthetic molecule similar to those found in natural pyrethrum which is taken from the Chrysanthemum flower. Not only does this product repel insects, but will actually kill ticks, mosquitoes, chiggers, mites and more than 55 other kinds of insects. Sawyer Permethrin repellent is for use on your clothing, tents and other gear. A single application lasts up to six weeks and will remain effective even if you wash the garment once a week. Permethrin is odorless when dry, and during the drying process it tightly bonds with the fibers of the treated garment, it will not stain or damage clothing, fabrics, plastics, finished surfaces, or any of your outdoor gear. Try our two easy-to-use treatment methods: aerosol spray and NEW soak system. Both methods provide protection from mosquitoes and ticks through 6 launderings.)




And the most important part.......

 
Live with a healthy attitude; 
Lose “poor me”, lose anger

 
Do not become “Lyme obsessed”
Pursue other interests and distractions
Enjoy friends and family
Cuddle with your pets



I want to thank you my friend for taking these wonderful notes for me and for all of you!  
Thank you Heather Shirkey!
Dr. Burrascano shared some of the latest in the Lyme realm: 
  • Bartonella is one of the most difficult to treat.
  • Lyme testing is done with the B31 strain which was a lab strain and has never been in a human. It was derived from a tick and had never tasted human blood. This is part of why lab testing is so inaccurate.
  • There are 263 references in Dr. Horowitz book that support the persistence of infection.
  • Borrelia is thousands of times less sensitive to antibiotics than syphilis.
  • Ticks cannot survive drying out; moisture is their friend.
  • If there were no deer, ticks would move to other large animals. Reducing the deer population does not work as a way to reduce ticks. Birds also carry ticks and the flyways for birds overlap endemic areas for Lyme.
  • Borrelia garinii has been found in North America. Borrelia andersonii and Borrelia americana have been found in Florida. Borrelia lonestari has been found in the Southeast.
  • There is a significant Borrelia problem in Africa and it can be transmitted within minutes of a tick attachment.
  • It takes a temperature of 17 below zero to kill a tick. 
  • Borrelia has the most complex genetic makeup of any known bacteria.
  • Ebola, HIV, and Borrelia have all been tested in the Space Lab.
  • Symptoms change with Borrelia every few days and more obviously every 4 weeks. This is due to epitope switching. The body sees the infection is gone and a new infection is present. IgM keeps coming up again.
  • Borrelia secretes blebs which can lead to false positive ANA's. The DNA in blebs can be shared between Borrelia via gene exchange.
  • Transfection is when segments of Borrelia incorporate into our own human DNA. The human then makes Borrelia proteins. Part of the problem becomes our own body making more Borrelia proteins.
  • Borrelia garinii is more likely to produce a larger EM rash. A skin presentation known as acrodermatitis chronica atrophicans (ACA) is associated with Borrelia garinii and occasionally with Borrelia afzelii.
  • CSF testing for Borrelia is 91% inaccurate according to Dr. Patricia Coyle of SUNY Stony Brook. 
  • Borrelia miyamotoi may produce GI symptoms. It seems to have a 2.5 week cycle instead of a 4-5 weeks cycle. 
  • Band 18 and 100 on a Western Blot are often the result of a European Borrelia strain.
  • American blood tests are poor at picking up European strains.
  • Spiral Borrelia can segment and result in 20 or more new spirochetes.
  • 5-10% of ticks have Borrelia in the mouth parts which allows for rapid transmission in some cases. 24-48 hour timeframe for transmission was based on rabbits and is not reality.
  • Relapsing fever may be transmitted in as little as one minute. Other infections can be transmitted in minutes with regurgitation transmission. Tick feces can get rubbed into a wound and cause infection.
  • Borrelia BR91 strain is found in mosquitoes. It could be that a mosquito is squashed and germs are rubbed into a wound. This has not been proven but is a theoretical possibility. Sand flies and horse flies may be sources of transmission of infection.
  • Some are exploring Borrelia protease possibly for diagnostics, vaccinations, or treatment with protease inhibitors. 
  • Borrelia inhibits B cells, T cells, and NK cell maturation. CD56 NK cells mature to CD57. Borrelia inhibits the maturation to CD57. 
  • We have both innate and adaptive immunity. Innate is related to B cells which create IgM. Adaptive is associated with T cells. T cells signal the shutdown of B cells which then shifts the immune response from IgM to IgG. Borrelia stops the shutdown of B cells which means that we keep creating IgM that is ineffective at killing Borrelia. This continued response of the innate immune system results in cytokine storms.
  • Steroids make Lyme worse and prevent the development of IgG antibodies. Allows the continued production of ineffective IgM. Steroids increase the number of spirochetes in tissues. 
  • Borrelia can affect the gut. In one study, Borrelia was found in 10 of 10 studied. Coinfections also impact the gut. 37% in a separate study had a single pathogen; 24% had 2; and 8% had 3. Some of the pathogens identified included Bartonella, H. Pylori, Mycoplasma fermentans, and Borrelia.
  • In studies by Eva Sapi, Doxycycline reduced spirochetes but increases the round body forms. Flagyl notably reduced both spirochetes and round body forms. Tigecycline and Tinidazole reduced both forms notably as well. With biofilms, only Tinidazole appears to reduce organisms. 
  • Is Lyme an ongoing infection or autoimmunity? There is an overlap. Plaquenil or IVIG can be helpful. 
  • Band 31 is cross reactive with neural tissue as are 34 and 41. There may be a relationship between these bands and positive anti neural antibodies.
  • When people have neuropathy, a skin biopsy may show that the nerves are wiped out. This can be helped with IVIG. 
  • A team is working on myelin staining of the nerves in the skin which is a more sensitive way to evaluate. It is accurate enough to get coverage for IVIG which can run $15,000 per week for 6 months to 1 year. This technology should be available as a skin punch biopsy by the end of the year.
  • When nerves are involved, test for mycotoxins and heavy metals. IVIG may help in 80% of cases. Other options for nerve healing include R Alpha Lipoic Acid, Pharmanex Cordymax, high dose CoQ10, NT Factor, and MB12. Cordymax has helped in patients with Parkinson's.
  • IVIG stops cytokine storms without suppressing the immune system. 
  • Ticks are nature's dirty needle.
  • Nematodes (worms) have been found in ticks. Filaria were found by Dr. Sapi from the Onchocercidae family; specifically Acanthocheilonema. 22% of nymphs and 30% of adults had these worms.
  • There was some discussion with the attendees around Babesia duncani being one potential cause for anxiety and it seemed that some have observed this connection.
  • Bartonella lives mainly in the RBCs. There are at least 30 species. They are treatment resistant. No one regimen works. They have been found in gastric biopsy and in a biopsy of striae commonly seen with Bartonella.
  • They can be intravascular and intracellular. They may be in or on the surface of the RBCs. 
  • Advanced Labs prepares the blood with hyaluronic acid before the culture to release bacteria that are adherent to the red blood cells.
  • Some veterinarians recognize that Bartonella may not be curable in animals.
  • Some of the medications are inhibitory but may not be "cidal" (killing). 
  • For Bartonella, Levaquin is by far the best (though does have side effects that can be long-term). 
  • Combinations for intravascular and intracellular properties are needed.
  • Fluoroquinolones work in both spaces but there have been resistant strains documented.
  • Macrolides only work intracellularly. Ketek may be the best. It was his favorite Lyme drug but can be toxic and may not be easy to get anymore. Tetracyclines are a poor choice. Gentamycin is effective but not in the CSF and can also be toxic. No amount of Doxycycline will work. Bartonella develop resistance to antibiotics very quickly. Resistance may occur quickly to Zithromax when used alone.
  • Some combinations for Bartonella may include Augmentin plus Levaquin, Ceftriaxone plus Ketek or Biaxin, Doxycycline plus Ketek or Biaxin, Rifampin plus Ketek or Biaxin. 
  • Cell wall drug + fluoroquinolone or ribosomal drug + Rifampin would be a triple drug regimen.
  • In some cases, Gentamicin may be added but is not used alone.
  • For Bartonella, 3-4 months of antibiotic treatment is a minimum.
  • Some effects of Bartonella may be counteracted with L-Arginine. Some Bartonella lead to elevated VEGF which can be measured serially to track treatment progress.
  • Bartonella may be immunosuppressive like Tularemia. Acai has been helpful. 
  • Intranasal IL-12 and intranasal synthetic TLR4 may be helpful therapeutics.
  • Overstimulation of the immune system can result in tissue injury. It is more about modulation than stimulation. 
  • Transfer factors can be very helpful as can stimulation of the cholingeric anti-inflammatory pathway with Galantamine. Galantamine upregulates IFN-a and downregulates IL-6. Anisodamine and Puerarin may also be helpful. Huperzine A and Curcumin may also help with the stimulation of the anti-inflammatory pathway. 
  • Transfer Factors are good modulators and help to control overreactions.
  • Mepron is poorly absorbed. Need a blood level in the low 20s to have much effect. In some cases, had to use much higher doses to get those levels. Babesia also develops drug resistance. Coartem, Sulfa drugs, Zithromax, or Flagyl may need to be added. Blood level test can be done through Quest.
  • Some new research is being done using gamma globulin into the spinal canal for people with ALS via a port. It has been a small sample of 7-9 patients, but all have stabilized.
  • There is Lyme-induced ALS which may be autoimmune and there is genetic ALS where there is early death of motor neurons. These are not the same condition.
  • IM Bicillin can be a very good option for Lyme treatment.
  • Cytokine mediated inflammation is a dilemma. If you start with lower doses of drugs, you may have a higher incidence of drug resistance. You have to treat aggressively and then get a Herx. If the herx is not tolerable, then stopping the treatment entirely to allow recovery from the herx is a better option than lower doses. 
  • Labcorp has several offices that do the CD57. In his clinical days, the results were very reliable. That may not be the case with several testing sites if the results are not consistent. The IGeneX CD57 is likely to be more consistent. The number is not as important as the percentage. 
  • Stonybrook does a Western Blot that is covered by insurance. They do report CDC bands only, but you can ask for reporting of all bands.
  • Even the advanced Bartonella testing at Galaxy Labs may only detect 20-30% of Bartonella infections
- See more at: http://www.betterhealthguy.com/integrativetherapies#sthash.heKbR7m9.dpuf
Dr. Burrascano shared some of the latest in the Lyme realm: 
  • Bartonella is one of the most difficult to treat.
  • Lyme testing is done with the B31 strain which was a lab strain and has never been in a human. It was derived from a tick and had never tasted human blood. This is part of why lab testing is so inaccurate.
  • There are 263 references in Dr. Horowitz book that support the persistence of infection.
  • Borrelia is thousands of times less sensitive to antibiotics than syphilis.
  • Ticks cannot survive drying out; moisture is their friend.
  • If there were no deer, ticks would move to other large animals. Reducing the deer population does not work as a way to reduce ticks. Birds also carry ticks and the flyways for birds overlap endemic areas for Lyme.
  • Borrelia garinii has been found in North America. Borrelia andersonii and Borrelia americana have been found in Florida. Borrelia lonestari has been found in the Southeast.
  • There is a significant Borrelia problem in Africa and it can be transmitted within minutes of a tick attachment.
  • It takes a temperature of 17 below zero to kill a tick. 
  • Borrelia has the most complex genetic makeup of any known bacteria.
  • Ebola, HIV, and Borrelia have all been tested in the Space Lab.
  • Symptoms change with Borrelia every few days and more obviously every 4 weeks. This is due to epitope switching. The body sees the infection is gone and a new infection is present. IgM keeps coming up again.
  • Borrelia secretes blebs which can lead to false positive ANA's. The DNA in blebs can be shared between Borrelia via gene exchange.
  • Transfection is when segments of Borrelia incorporate into our own human DNA. The human then makes Borrelia proteins. Part of the problem becomes our own body making more Borrelia proteins.
  • Borrelia garinii is more likely to produce a larger EM rash. A skin presentation known as acrodermatitis chronica atrophicans (ACA) is associated with Borrelia garinii and occasionally with Borrelia afzelii.
  • CSF testing for Borrelia is 91% inaccurate according to Dr. Patricia Coyle of SUNY Stony Brook. 
  • Borrelia miyamotoi may produce GI symptoms. It seems to have a 2.5 week cycle instead of a 4-5 weeks cycle. 
  • Band 18 and 100 on a Western Blot are often the result of a European Borrelia strain.
  • American blood tests are poor at picking up European strains.
  • Spiral Borrelia can segment and result in 20 or more new spirochetes.
  • 5-10% of ticks have Borrelia in the mouth parts which allows for rapid transmission in some cases. 24-48 hour timeframe for transmission was based on rabbits and is not reality.
  • Relapsing fever may be transmitted in as little as one minute. Other infections can be transmitted in minutes with regurgitation transmission. Tick feces can get rubbed into a wound and cause infection.
  • Borrelia BR91 strain is found in mosquitoes. It could be that a mosquito is squashed and germs are rubbed into a wound. This has not been proven but is a theoretical possibility. Sand flies and horse flies may be sources of transmission of infection.
  • Some are exploring Borrelia protease possibly for diagnostics, vaccinations, or treatment with protease inhibitors. 
  • Borrelia inhibits B cells, T cells, and NK cell maturation. CD56 NK cells mature to CD57. Borrelia inhibits the maturation to CD57. 
  • We have both innate and adaptive immunity. Innate is related to B cells which create IgM. Adaptive is associated with T cells. T cells signal the shutdown of B cells which then shifts the immune response from IgM to IgG. Borrelia stops the shutdown of B cells which means that we keep creating IgM that is ineffective at killing Borrelia. This continued response of the innate immune system results in cytokine storms.
  • Steroids make Lyme worse and prevent the development of IgG antibodies. Allows the continued production of ineffective IgM. Steroids increase the number of spirochetes in tissues. 
  • Borrelia can affect the gut. In one study, Borrelia was found in 10 of 10 studied. Coinfections also impact the gut. 37% in a separate study had a single pathogen; 24% had 2; and 8% had 3. Some of the pathogens identified included Bartonella, H. Pylori, Mycoplasma fermentans, and Borrelia.
  • In studies by Eva Sapi, Doxycycline reduced spirochetes but increases the round body forms. Flagyl notably reduced both spirochetes and round body forms. Tigecycline and Tinidazole reduced both forms notably as well. With biofilms, only Tinidazole appears to reduce organisms. 
  • Is Lyme an ongoing infection or autoimmunity? There is an overlap. Plaquenil or IVIG can be helpful. 
  • Band 31 is cross reactive with neural tissue as are 34 and 41. There may be a relationship between these bands and positive anti neural antibodies.
  • When people have neuropathy, a skin biopsy may show that the nerves are wiped out. This can be helped with IVIG. 
  • A team is working on myelin staining of the nerves in the skin which is a more sensitive way to evaluate. It is accurate enough to get coverage for IVIG which can run $15,000 per week for 6 months to 1 year. This technology should be available as a skin punch biopsy by the end of the year.
  • When nerves are involved, test for mycotoxins and heavy metals. IVIG may help in 80% of cases. Other options for nerve healing include R Alpha Lipoic Acid, Pharmanex Cordymax, high dose CoQ10, NT Factor, and MB12. Cordymax has helped in patients with Parkinson's.
  • IVIG stops cytokine storms without suppressing the immune system. 
  • Ticks are nature's dirty needle.
  • Nematodes (worms) have been found in ticks. Filaria were found by Dr. Sapi from the Onchocercidae family; specifically Acanthocheilonema. 22% of nymphs and 30% of adults had these worms.
  • There was some discussion with the attendees around Babesia duncani being one potential cause for anxiety and it seemed that some have observed this connection.
  • Bartonella lives mainly in the RBCs. There are at least 30 species. They are treatment resistant. No one regimen works. They have been found in gastric biopsy and in a biopsy of striae commonly seen with Bartonella.
  • They can be intravascular and intracellular. They may be in or on the surface of the RBCs. 
  • Advanced Labs prepares the blood with hyaluronic acid before the culture to release bacteria that are adherent to the red blood cells.
  • Some veterinarians recognize that Bartonella may not be curable in animals.
  • Some of the medications are inhibitory but may not be "cidal" (killing). 
  • For Bartonella, Levaquin is by far the best (though does have side effects that can be long-term). 
  • Combinations for intravascular and intracellular properties are needed.
  • Fluoroquinolones work in both spaces but there have been resistant strains documented.
  • Macrolides only work intracellularly. Ketek may be the best. It was his favorite Lyme drug but can be toxic and may not be easy to get anymore. Tetracyclines are a poor choice. Gentamycin is effective but not in the CSF and can also be toxic. No amount of Doxycycline will work. Bartonella develop resistance to antibiotics very quickly. Resistance may occur quickly to Zithromax when used alone.
  • Some combinations for Bartonella may include Augmentin plus Levaquin, Ceftriaxone plus Ketek or Biaxin, Doxycycline plus Ketek or Biaxin, Rifampin plus Ketek or Biaxin. 
  • Cell wall drug + fluoroquinolone or ribosomal drug + Rifampin would be a triple drug regimen.
  • In some cases, Gentamicin may be added but is not used alone.
  • For Bartonella, 3-4 months of antibiotic treatment is a minimum.
  • Some effects of Bartonella may be counteracted with L-Arginine. Some Bartonella lead to elevated VEGF which can be measured serially to track treatment progress.
  • Bartonella may be immunosuppressive like Tularemia. Acai has been helpful. 
  • Intranasal IL-12 and intranasal synthetic TLR4 may be helpful therapeutics.
  • Overstimulation of the immune system can result in tissue injury. It is more about modulation than stimulation. 
  • Transfer factors can be very helpful as can stimulation of the cholingeric anti-inflammatory pathway with Galantamine. Galantamine upregulates IFN-a and downregulates IL-6. Anisodamine and Puerarin may also be helpful. Huperzine A and Curcumin may also help with the stimulation of the anti-inflammatory pathway. 
  • Transfer Factors are good modulators and help to control overreactions.
  • Mepron is poorly absorbed. Need a blood level in the low 20s to have much effect. In some cases, had to use much higher doses to get those levels. Babesia also develops drug resistance. Coartem, Sulfa drugs, Zithromax, or Flagyl may need to be added. Blood level test can be done through Quest.
  • Some new research is being done using gamma globulin into the spinal canal for people with ALS via a port. It has been a small sample of 7-9 patients, but all have stabilized.
  • There is Lyme-induced ALS which may be autoimmune and there is genetic ALS where there is early death of motor neurons. These are not the same condition.
  • IM Bicillin can be a very good option for Lyme treatment.
  • Cytokine mediated inflammation is a dilemma. If you start with lower doses of drugs, you may have a higher incidence of drug resistance. You have to treat aggressively and then get a Herx. If the herx is not tolerable, then stopping the treatment entirely to allow recovery from the herx is a better option than lower doses. 
  • Labcorp has several offices that do the CD57. In his clinical days, the results were very reliable. That may not be the case with several testing sites if the results are not consistent. The IGeneX CD57 is likely to be more consistent. The number is not as important as the percentage. 
  • Stonybrook does a Western Blot that is covered by insurance. They do report CDC bands only, but you can ask for reporting of all bands.
  • Even the advanced Bartonella testing at Galaxy Labs may only detect 20-30% of Bartonella infections
- See more at: http://www.betterhealthguy.com/integrativetherapies#sthash.heKbR7m9.dpuf
  • Bartonella is one of the most difficult to treat.
  • Lyme testing is done with the B31 strain which was a lab strain and has never been in a human. It was derived from a tick and had never tasted human blood. This is part of why lab testing is so inaccurate.
  • There are 263 references in Dr. Horowitz book that support the persistence of infection.
  • Borrelia is thousands of times less sensitive to antibiotics than syphilis.
  • Ticks cannot survive drying out; moisture is their friend.
  • If there were no deer, ticks would move to other large animals. Reducing the deer population does not work as a way to reduce ticks. Birds also carry ticks and the flyways for birds overlap endemic areas for Lyme.
  • Borrelia garinii has been found in North America. Borrelia andersonii and Borrelia americana have been found in Florida. Borrelia lonestari has been found in the Southeast.
  • There is a significant Borrelia problem in Africa and it can be transmitted within minutes of a tick attachment.
  • It takes a temperature of 17 below zero to kill a tick. 
  • Borrelia has the most complex genetic makeup of any known bacteria.
  • Ebola, HIV, and Borrelia have all been tested in the Space Lab.
  • Symptoms change with Borrelia every few days and more obviously every 4 weeks. This is due to epitope switching. The body sees the infection is gone and a new infection is present. IgM keeps coming up again.
  • Borrelia secretes blebs which can lead to false positive ANA's. The DNA in blebs can be shared between Borrelia via gene exchange.
  • Transfection is when segments of Borrelia incorporate into our own human DNA. The human then makes Borrelia proteins. Part of the problem becomes our own body making more Borrelia proteins.
  • Borrelia garinii is more likely to produce a larger EM rash. A skin presentation known as acrodermatitis chronica atrophicans (ACA) is associated with Borrelia garinii and occasionally with Borrelia afzelii.
  • CSF testing for Borrelia is 91% inaccurate according to Dr. Patricia Coyle of SUNY Stony Brook. 
  • Borrelia miyamotoi may produce GI symptoms. It seems to have a 2.5 week cycle instead of a 4-5 weeks cycle. 
  • Band 18 and 100 on a Western Blot are often the result of a European Borrelia strain.
  • American blood tests are poor at picking up European strains.
  • Spiral Borrelia can segment and result in 20 or more new spirochetes.
  • 5-10% of ticks have Borrelia in the mouth parts which allows for rapid transmission in some cases. 24-48 hour timeframe for transmission was based on rabbits and is not reality.
  • Relapsing fever may be transmitted in as little as one minute. Other infections can be transmitted in minutes with regurgitation transmission. Tick feces can get rubbed into a wound and cause infection.
  • Borrelia BR91 strain is found in mosquitoes. It could be that a mosquito is squashed and germs are rubbed into a wound. This has not been proven but is a theoretical possibility. Sand flies and horse flies may be sources of transmission of infection.
  • Some are exploring Borrelia protease possibly for diagnostics, vaccinations, or treatment with protease inhibitors. 
  • Borrelia inhibits B cells, T cells, and NK cell maturation. CD56 NK cells mature to CD57. Borrelia inhibits the maturation to CD57. 
  • We have both innate and adaptive immunity. Innate is related to B cells which create IgM. Adaptive is associated with T cells. T cells signal the shutdown of B cells which then shifts the immune response from IgM to IgG. Borrelia stops the shutdown of B cells which means that we keep creating IgM that is ineffective at killing Borrelia. This continued response of the innate immune system results in cytokine storms.
  • Steroids make Lyme worse and prevent the development of IgG antibodies. Allows the continued production of ineffective IgM. Steroids increase the number of spirochetes in tissues. 
  • Borrelia can affect the gut. In one study, Borrelia was found in 10 of 10 studied. Coinfections also impact the gut. 37% in a separate study had a single pathogen; 24% had 2; and 8% had 3. Some of the pathogens identified included Bartonella, H. Pylori, Mycoplasma fermentans, and Borrelia.
  • In studies by Eva Sapi, Doxycycline reduced spirochetes but increases the round body forms. Flagyl notably reduced both spirochetes and round body forms. Tigecycline and Tinidazole reduced both forms notably as well. With biofilms, only Tinidazole appears to reduce organisms. 
  • Is Lyme an ongoing infection or autoimmunity? There is an overlap. Plaquenil or IVIG can be helpful. 
  • Band 31 is cross reactive with neural tissue as are 34 and 41. There may be a relationship between these bands and positive anti neural antibodies.
  • When people have neuropathy, a skin biopsy may show that the nerves are wiped out. This can be helped with IVIG. 
  • A team is working on myelin staining of the nerves in the skin which is a more sensitive way to evaluate. It is accurate enough to get coverage for IVIG which can run $15,000 per week for 6 months to 1 year. This technology should be available as a skin punch biopsy by the end of the year.
  • When nerves are involved, test for mycotoxins and heavy metals. IVIG may help in 80% of cases. Other options for nerve healing include R Alpha Lipoic Acid, Pharmanex Cordymax, high dose CoQ10, NT Factor, and MB12. Cordymax has helped in patients with Parkinson's.
  • IVIG stops cytokine storms without suppressing the immune system. 
  • Ticks are nature's dirty needle.
  • Nematodes (worms) have been found in ticks. Filaria were found by Dr. Sapi from the Onchocercidae family; specifically Acanthocheilonema. 22% of nymphs and 30% of adults had these worms.
  • There was some discussion with the attendees around Babesia duncani being one potential cause for anxiety and it seemed that some have observed this connection.
  • Bartonella lives mainly in the RBCs. There are at least 30 species. They are treatment resistant. No one regimen works. They have been found in gastric biopsy and in a biopsy of striae commonly seen with Bartonella.
  • They can be intravascular and intracellular. They may be in or on the surface of the RBCs. 
  • Advanced Labs prepares the blood with hyaluronic acid before the culture to release bacteria that are adherent to the red blood cells.
  • Some veterinarians recognize that Bartonella may not be curable in animals.
  • Some of the medications are inhibitory but may not be "cidal" (killing). 
  • For Bartonella, Levaquin is by far the best (though does have side effects that can be long-term). 
  • Combinations for intravascular and intracellular properties are needed.
  • Fluoroquinolones work in both spaces but there have been resistant strains documented.
  • Macrolides only work intracellularly. Ketek may be the best. It was his favorite Lyme drug but can be toxic and may not be easy to get anymore. Tetracyclines are a poor choice. Gentamycin is effective but not in the CSF and can also be toxic. No amount of Doxycycline will work. Bartonella develop resistance to antibiotics very quickly. Resistance may occur quickly to Zithromax when used alone.
  • Some combinations for Bartonella may include Augmentin plus Levaquin, Ceftriaxone plus Ketek or Biaxin, Doxycycline plus Ketek or Biaxin, Rifampin plus Ketek or Biaxin. 
  • Cell wall drug + fluoroquinolone or ribosomal drug + Rifampin would be a triple drug regimen.
  • In some cases, Gentamicin may be added but is not used alone.
  • For Bartonella, 3-4 months of antibiotic treatment is a minimum.
  • Some effects of Bartonella may be counteracted with L-Arginine. Some Bartonella lead to elevated VEGF which can be measured serially to track treatment progress.
  • Bartonella may be immunosuppressive like Tularemia. Acai has been helpful. 
  • Intranasal IL-12 and intranasal synthetic TLR4 may be helpful therapeutics.
  • Overstimulation of the immune system can result in tissue injury. It is more about modulation than stimulation. 
  • Transfer factors can be very helpful as can stimulation of the cholingeric anti-inflammatory pathway with Galantamine. Galantamine upregulates IFN-a and downregulates IL-6. Anisodamine and Puerarin may also be helpful. Huperzine A and Curcumin may also help with the stimulation of the anti-inflammatory pathway. 
  • Transfer Factors are good modulators and help to control overreactions.
  • Mepron is poorly absorbed. Need a blood level in the low 20s to have much effect. In some cases, had to use much higher doses to get those levels. Babesia also develops drug resistance. Coartem, Sulfa drugs, Zithromax, or Flagyl may need to be added. Blood level test can be done through Quest.
  • Some new research is being done using gamma globulin into the spinal canal for people with ALS via a port. It has been a small sample of 7-9 patients, but all have stabilized.
  • There is Lyme-induced ALS which may be autoimmune and there is genetic ALS where there is early death of motor neurons. These are not the same condition.
  • IM Bicillin can be a very good option for Lyme treatment.
  • Cytokine mediated inflammation is a dilemma. If you start with lower doses of drugs, you may have a higher incidence of drug resistance. You have to treat aggressively and then get a Herx. If the herx is not tolerable, then stopping the treatment entirely to allow recovery from the herx is a better option than lower doses. 
  • Labcorp has several offices that do the CD57. In his clinical days, the results were very reliable. That may not be the case with several testing sites if the results are not consistent. The IGeneX CD57 is likely to be more consistent. The number is not as important as the percentage. 
  • Stonybrook does a Western Blot that is covered by insurance. They do report CDC bands only, but you can ask for reporting of all bands.
  • Even the advanced Bartonella testing at Galaxy Labs may only detect 20-30% of Bartonella infections. - See more at: http://www.betterhealthguy.com/integrativetherapies#sthash.heKbR7m9.dpuf
  • Dr. Burrascano shared some of the latest in the Lyme realm: 2014

    Bartonella is one of the most difficult to treat.

    Lyme testing is done with the B31 strain which was a lab strain and has never been in a human. It was derived from a tick and had never tasted human blood. This is part of why lab testing is so inaccurate

    There are 263 references in Dr. Horowitz book that support the persistence of infection

    Borrelia is thousands of times less sensitive to antibiotics than syphilis.

    Ticks cannot survive drying out; moisture is their friend.

    If there were no deer, ticks would move to other large animals. Reducing the deer population does not work as a way to reduce ticks. Birds also carry ticks and the flyways for birds overlap endemic areas for Lyme.

    Borrelia garinii has been found in North America. Borrelia andersonii and Borrelia americana have been found in Florida. Borrelia lonestari has been found in the Southeast.

    There is a significant Borrelia problem in Africa and it can be transmitted within minutes of a tick attachment

    It takes a temperature of 17 below zero to kill a tick.

    Borrelia has the most complex genetic makeup of any known bacteria.

    Ebola, HIV, and Borrelia have all been tested in the Space Lab.

    Symptoms change with Borrelia every few days and more obviously every 4 weeks. This is due to epitope switching. The body sees the infection is gone and a new infection is present. IgM keeps coming up again.

    Borrelia secretes blebs which can lead to false positive ANA's. The DNA in blebs can be shared between Borrelia via gene exchange.

    Transfection is when segments of Borrelia incorporate into our own human DNA. The human then makes Borrelia proteins. Part of the problem becomes our own body making more Borrelia proteins.

    Borrelia garinii is more likely to produce a larger EM rash. A skin presentation known as acrodermatitis chronica atrophicans (ACA) is associated with Borrelia garinii and occasionally with Borrelia afzelii.

    CSF testing for Borrelia is 91% inaccurate according to Dr. Patricia Coyle of SUNY Stony Brook.

    Borrelia miyamotoi may produce GI symptoms. It seems to have a 2.5 week cycle instead of a 4-5 weeks cycle. 

    Band 18 and 100 on a Western Blot are often the result of a European Borrelia strain.

    American blood tests are poor at picking up European strains.

    Spiral Borrelia can segment and result in 20 or more new spirochetes.

    5-10% of ticks have Borrelia in the mouth parts which allows for rapid transmission in some cases. 24-48 hour timeframe for transmission was based on rabbits and is not reality.

    Relapsing fever may be transmitted in as little as one minute. Other infections can be transmitted in minutes with regurgitation transmission. Tick feces can get rubbed into a wound and cause infection.

    Borrelia BR91 strain is found in mosquitoes. It could be that a mosquito is squashed and germs are rubbed into a wound. This has not been proven but is a theoretical possibility. Sand flies and horse flies may be sources of transmission of infection.

    Some are exploring Borrelia protease possibly for diagnostics, vaccinations, or treatment with protease inhibitors. 

    Borrelia inhibits B cells, T cells, and NK cell maturation. CD56 NK cells mature to CD57. Borrelia inhibits the maturation to CD57. 

    We have both innate and adaptive immunity. Innate is related to B cells which create IgM. Adaptive is associated with T cells. T cells signal the shutdown of B cells which then shifts the immune response from IgM to IgG. Borrelia stops the shutdown of B cells which means that we keep creating IgM that is ineffective at killing Borrelia. This continued response of the innate immune system results in cytokine storms.

    Steroids make Lyme worse and prevent the development of IgG antibodies. Allows the continued production of ineffective IgM. Steroids increase the number of spirochetes in tissues. 

    Borrelia can affect the gut. In one study, Borrelia was found in 10 of 10 studied. Coinfections also impact the gut. 37% in a separate study had a single pathogen; 24% had 2; and 8% had 3. Some of the pathogens identified included Bartonella, H. Pylori, Mycoplasma fermentans, and Borrelia.

    In studies by Eva Sapi, Doxycycline reduced spirochetes but increases the round body forms. Flagyl notably reduced both spirochetes and round body forms. Tigecycline and Tinidazole reduced both forms notably as well. With biofilms, only Tinidazole appears to reduce organisms. 

    Is Lyme an ongoing infection or autoimmunity? There is an overlap. Plaquenil or IVIG can be helpful. 

    Band 31 is cross reactive with neural tissue as are 34 and 41. There may be a relationship between these bands and positive anti neural antibodies

    When people have neuropathy, a skin biopsy may show that the nerves are wiped out. This can be helped with IVIG. 

    A team is working on myelin staining of the nerves in the skin which is a more sensitive way to evaluate. It is accurate enough to get coverage for IVIG which can run $15,000 per week for 6 months to 1 year. This technology should be available as a skin punch biopsy by the end of the year.

    When nerves are involved, test for mycotoxins and heavy metals. IVIG may help in 80% of cases. Other options for nerve healing include R Alpha Lipoic Acid, Pharmanex Cordymax, high dose CoQ10, NT Factor, and MB12. Cordymax has helped in patients with Parkinson's.

    IVIG stops cytokine storms without suppressing the immune system.

    Ticks are nature's dirty needle.

    Nematodes (worms) have been found in ticks. Filaria were found by Dr. Sapi from the Onchocercidae family; specifically Acanthocheilonema. 22% of nymphs and 30% of adults had these worms.

    There was some discussion with the attendees around Babesia duncani being one potential cause for anxiety and it seemed that some have observed this connection.

    Bartonella lives mainly in the RBCs. There are at least 30 species. They are treatment resistant. No one regimen works. They have been found in gastric biopsy and in a biopsy of striae commonly seen with Bartonella.

    They can be intravascular and intracellular. They may be in or on the surface of the RBCs. 

    Advanced Labs prepares the blood with hyaluronic acid before the culture to release bacteria that are adherent to the red blood cells.

    Some veterinarians recognize that Bartonella may not be curable in animals.

    Some of the medications are inhibitory but may not be "cidal" (killing).

    For Bartonella, Levaquin is by far the best (though does have side effects that can be long-term). 

    Combinations for intravascular and intracellular properties are needed.

    Fluoroquinolones work in both spaces but there have been resistant strains documented.

    Macrolides only work intracellularly. Ketek may be the best. It was his favorite Lyme drug but can be toxic and may not be easy to get anymore. Tetracyclines are a poor choice. Gentamycin is effective but not in the CSF and can also be toxic. No amount of Doxycycline will work. Bartonella develop resistance to antibiotics very quickly. Resistance may occur quickly to Zithromax when used alone.

    Some combinations for Bartonella may include Augmentin plus Levaquin, Ceftriaxone plus Ketek or Biaxin, Doxycycline plus Ketek or Biaxin, Rifampin plus Ketek or Biaxin. 

    Cell wall drug + fluoroquinolone or ribosomal drug + Rifampin would be a triple drug regimen.

    In some cases, Gentamicin may be added but is not used alone.

    For Bartonella, 3-4 months of antibiotic treatment is a minimum.

    Some effects of Bartonella may be counteracted with L-Arginine. Some Bartonella lead to elevated VEGF which can be measured serially to track treatment progress.

    Bartonella may be immunosuppressive like Tularemia. Acai has been helpful. 

    Intranasal IL-12 and intranasal synthetic TLR4 may be helpful therapeutics.

    Overstimulation of the immune system can result in tissue injury. It is more about modulation than stimulation. 

    Transfer factors can be very helpful as can stimulation of the cholingeric anti-inflammatory pathway with Galantamine. Galantamine upregulates IFN-a and downregulates IL-6. Anisodamine and Puerarin may also be helpful. Huperzine A and Curcumin may also help with the stimulation of the anti-inflammatory pathway. 

    Transfer Factors are good modulators and help to control overreactions.

    Mepron is poorly absorbed. Need a blood level in the low 20s to have much effect. In some cases, had to use much higher doses to get those levels. Babesia also develops drug resistance. Coartem, Sulfa drugs, Zithromax, or Flagyl may need to be added. Blood level test can be done through Quest.

    Some new research is being done using gamma globulin into the spinal canal for people with ALS via a port. It has been a small sample of 7-9 patients, but all have stabilized

    There is Lyme-induced ALS which may be autoimmune and there is genetic ALS where there is early death of motor neurons. These are not the same condition.

    IM Bicillin can be a very good option for Lyme treatment.

    Cytokine mediated inflammation is a dilemma. If you start with lower doses of drugs, you may have a higher incidence of drug resistance. You have to treat aggressively and then get a Herx. If the herx is not tolerable, then stopping the treatment entirely to allow recovery from the herx is a better option than lower doses. 

    Labcorp has several offices that do the CD57. In his clinical days, the results were very reliable. That may not be the case with several testing sites if the results are not consistent. The IGeneX CD57 is likely to be more consistent. The number is not as important as the percentage. 

    Stonybrook does a Western Blot that is covered by insurance. They do report CDC bands only, but you can ask for reporting of all bands.

    Even the advanced Bartonella testing at Galaxy Labs may only detect 20-30% of Bartonella infections.

     

    Dr. Burrascano shared some of the latest in the Lyme realm: 
    • Bartonella is one of the most difficult to treat.
    • Lyme testing is done with the B31 strain which was a lab strain and has never been in a human. It was derived from a tick and had never tasted human blood. This is part of why lab testing is so inaccurate.
    • There are 263 references in Dr. Horowitz book that support the persistence of infection.
    • Borrelia is thousands of times less sensitive to antibiotics than syphilis.
    • Ticks cannot survive drying out; moisture is their friend.
    • If there were no deer, ticks would move to other large animals. Reducing the deer population does not work as a way to reduce ticks. Birds also carry ticks and the flyways for birds overlap endemic areas for Lyme.
    • Borrelia garinii has been found in North America. Borrelia andersonii and Borrelia americana have been found in Florida. Borrelia lonestari has been found in the Southeast.
    • There is a significant Borrelia problem in Africa and it can be transmitted within minutes of a tick attachment.
    • It takes a temperature of 17 below zero to kill a tick. 
    • Borrelia has the most complex genetic makeup of any known bacteria.
    • Ebola, HIV, and Borrelia have all been tested in the Space Lab.
    • Symptoms change with Borrelia every few days and more obviously every 4 weeks. This is due to epitope switching. The body sees the infection is gone and a new infection is present. IgM keeps coming up again.
    • Borrelia secretes blebs which can lead to false positive ANA's. The DNA in blebs can be shared between Borrelia via gene exchange.
    • Transfection is when segments of Borrelia incorporate into our own human DNA. The human then makes Borrelia proteins. Part of the problem becomes our own body making more Borrelia proteins.
    • Borrelia garinii is more likely to produce a larger EM rash. A skin presentation known as acrodermatitis chronica atrophicans (ACA) is associated with Borrelia garinii and occasionally with Borrelia afzelii.
    • CSF testing for Borrelia is 91% inaccurate according to Dr. Patricia Coyle of SUNY Stony Brook. 
    • Borrelia miyamotoi may produce GI symptoms. It seems to have a 2.5 week cycle instead of a 4-5 weeks cycle. 
    • Band 18 and 100 on a Western Blot are often the result of a European Borrelia strain.
    • American blood tests are poor at picking up European strains.
    • Spiral Borrelia can segment and result in 20 or more new spirochetes.
    • 5-10% of ticks have Borrelia in the mouth parts which allows for rapid transmission in some cases. 24-48 hour timeframe for transmission was based on rabbits and is not reality.
    • Relapsing fever may be transmitted in as little as one minute. Other infections can be transmitted in minutes with regurgitation transmission. Tick feces can get rubbed into a wound and cause infection.
    • Borrelia BR91 strain is found in mosquitoes. It could be that a mosquito is squashed and germs are rubbed into a wound. This has not been proven but is a theoretical possibility. Sand flies and horse flies may be sources of transmission of infection.
    • Some are exploring Borrelia protease possibly for diagnostics, vaccinations, or treatment with protease inhibitors. 
    • Borrelia inhibits B cells, T cells, and NK cell maturation. CD56 NK cells mature to CD57. Borrelia inhibits the maturation to CD57. 
    • We have both innate and adaptive immunity. Innate is related to B cells which create IgM. Adaptive is associated with T cells. T cells signal the shutdown of B cells which then shifts the immune response from IgM to IgG. Borrelia stops the shutdown of B cells which means that we keep creating IgM that is ineffective at killing Borrelia. This continued response of the innate immune system results in cytokine storms.
    • Steroids make Lyme worse and prevent the development of IgG antibodies. Allows the continued production of ineffective IgM. Steroids increase the number of spirochetes in tissues. 
    • Borrelia can affect the gut. In one study, Borrelia was found in 10 of 10 studied. Coinfections also impact the gut. 37% in a separate study had a single pathogen; 24% had 2; and 8% had 3. Some of the pathogens identified included Bartonella, H. Pylori, Mycoplasma fermentans, and Borrelia.
    • In studies by Eva Sapi, Doxycycline reduced spirochetes but increases the round body forms. Flagyl notably reduced both spirochetes and round body forms. Tigecycline and Tinidazole reduced both forms notably as well. With biofilms, only Tinidazole appears to reduce organisms. 
    • Is Lyme an ongoing infection or autoimmunity? There is an overlap. Plaquenil or IVIG can be helpful. 
    • Band 31 is cross reactive with neural tissue as are 34 and 41. There may be a relationship between these bands and positive anti neural antibodies.
    • When people have neuropathy, a skin biopsy may show that the nerves are wiped out. This can be helped with IVIG. 
    • A team is working on myelin staining of the nerves in the skin which is a more sensitive way to evaluate. It is accurate enough to get coverage for IVIG which can run $15,000 per week for 6 months to 1 year. This technology should be available as a skin punch biopsy by the end of the year.
    • When nerves are involved, test for mycotoxins and heavy metals. IVIG may help in 80% of cases. Other options for nerve healing include R Alpha Lipoic Acid, Pharmanex Cordymax, high dose CoQ10, NT Factor, and MB12. Cordymax has helped in patients with Parkinson's.
    • IVIG stops cytokine storms without suppressing the immune system. 
    • Ticks are nature's dirty needle.
    • Nematodes (worms) have been found in ticks. Filaria were found by Dr. Sapi from the Onchocercidae family; specifically Acanthocheilonema. 22% of nymphs and 30% of adults had these worms.
    • There was some discussion with the attendees around Babesia duncani being one potential cause for anxiety and it seemed that some have observed this connection.
    • Bartonella lives mainly in the RBCs. There are at least 30 species. They are treatment resistant. No one regimen works. They have been found in gastric biopsy and in a biopsy of striae commonly seen with Bartonella.
    • They can be intravascular and intracellular. They may be in or on the surface of the RBCs. 
    • Advanced Labs prepares the blood with hyaluronic acid before the culture to release bacteria that are adherent to the red blood cells.
    • Some veterinarians recognize that Bartonella may not be curable in animals.
    • Some of the medications are inhibitory but may not be "cidal" (killing). 
    • For Bartonella, Levaquin is by far the best (though does have side effects that can be long-term). 
    • Combinations for intravascular and intracellular properties are needed.
    • Fluoroquinolones work in both spaces but there have been resistant strains documented.
    • Macrolides only work intracellularly. Ketek may be the best. It was his favorite Lyme drug but can be toxic and may not be easy to get anymore. Tetracyclines are a poor choice. Gentamycin is effective but not in the CSF and can also be toxic. No amount of Doxycycline will work. Bartonella develop resistance to antibiotics very quickly. Resistance may occur quickly to Zithromax when used alone.
    • Some combinations for Bartonella may include Augmentin plus Levaquin, Ceftriaxone plus Ketek or Biaxin, Doxycycline plus Ketek or Biaxin, Rifampin plus Ketek or Biaxin. 
    • Cell wall drug + fluoroquinolone or ribosomal drug + Rifampin would be a triple drug regimen.
    • In some cases, Gentamicin may be added but is not used alone.
    • For Bartonella, 3-4 months of antibiotic treatment is a minimum.
    • Some effects of Bartonella may be counteracted with L-Arginine. Some Bartonella lead to elevated VEGF which can be measured serially to track treatment progress.
    • Bartonella may be immunosuppressive like Tularemia. Acai has been helpful. 
    • Intranasal IL-12 and intranasal synthetic TLR4 may be helpful therapeutics.
    • Overstimulation of the immune system can result in tissue injury. It is more about modulation than stimulation. 
    • Transfer factors can be very helpful as can stimulation of the cholingeric anti-inflammatory pathway with Galantamine. Galantamine upregulates IFN-a and downregulates IL-6. Anisodamine and Puerarin may also be helpful. Huperzine A and Curcumin may also help with the stimulation of the anti-inflammatory pathway. 
    • Transfer Factors are good modulators and help to control overreactions.
    • Mepron is poorly absorbed. Need a blood level in the low 20s to have much effect. In some cases, had to use much higher doses to get those levels. Babesia also develops drug resistance. Coartem, Sulfa drugs, Zithromax, or Flagyl may need to be added. Blood level test can be done through Quest.
    • Some new research is being done using gamma globulin into the spinal canal for people with ALS via a port. It has been a small sample of 7-9 patients, but all have stabilized.
    • There is Lyme-induced ALS which may be autoimmune and there is genetic ALS where there is early death of motor neurons. These are not the same condition.
    • IM Bicillin can be a very good option for Lyme treatment.
    • Cytokine mediated inflammation is a dilemma. If you start with lower doses of drugs, you may have a higher incidence of drug resistance. You have to treat aggressively and then get a Herx. If the herx is not tolerable, then stopping the treatment entirely to allow recovery from the herx is a better option than lower doses. 
    • Labcorp has several offices that do the CD57. In his clinical days, the results were very reliable. That may not be the case with several testing sites if the results are not consistent. The IGeneX CD57 is likely to be more consistent. The number is not as important as the percentage. 
    • Stonybrook does a Western Blot that is covered by insurance. They do report CDC bands only, but you can ask for reporting of all bands.
    • Even the advanced Bartonella testing at Galaxy Labs may only detect 20-30% of Bartonella infections
    - See more at: http://www.betterhealthguy.com/integrativetherapies#sthash.heKbR7m9.dpuf