Transcript Biofilms, Methylation & Heavy Metal Detoxification in Lyme

Raj Patel, MD
Education:
MS-Rutgers University
MD – Robert Wood Johnson Medical School
Residency-Family Medicine
Post Graduate studies in Autism Spectrum Disorders & Lyme Disease
Research:
Ampligen-CFIDS (Hemispherx Pharmaceutical)
Clinical:
20+ years clinical experience
Active member of Defeat Autism Now (DAN)
Active member of International Lyme and Associated Diseases Society (ILADS)
Raj Patel, MD
Medical Options for Wellness
570 Price Avenue, #200
Redwood City, CA 94063
650-474-2130
http://www.DrRajPatel.net
Raj Patel, MD
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Lyme Disease
Overview
Fastest growing vector borne infection
CDC estimated 24,000 cases in 2002 with the CDC itself admitting reported
cases represent less than 10% of all cases.
2013 CDC estimates 300,000 new cases annually
Raj Patel, M.D.
Reported Cases of Lyme Disease, United States, 1995-2009
National Surveillance case definition revised in 2008 to include probable cases;
details at http://www.cdc.gov/ncphi/disss/nndss/casedef/lyme_disease_2008.htm
Raj Patel, M.D.
Vector Life Cycle
www.cdc.gov/ncidod/dvbid/lyme/ld_transmission.htm
Raj Patel, M.D.
Raj Patel, M.D.
Lyme Disease
Overview
Tick bites frequently transmit multiple infections:
Borrelia
Ehrlichia/Anaplasma
Babesia and other piroplasms
Bartonella like organisms
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Lyme Disease
Overview (con’t)
Other possible coinfections to consider in differential diagnosis:
Bacteria - Mycoplasma, Chlamydia, RMSF, Tularemia, Q-Fever
Parasites - Filarasis, Amebiasis, Giardiasis, …
Viruses – EBV, CMV, HHV6, XMRV, Borna virus, Powassan virus, …
Transmission: Ticks
Mosquitos, Fleas, Rodents
Transplacental
Breast milk
Sexual
Raj Patel, M.D.
Lyme Disease
Lyme Disease Symptoms
Symptom presentation typically mixed depending on mix of infections present
Classic Symptoms Associated with Borrelia
Starts gradually with flu-like symptoms
Multi system involvement when disseminated
Migratory arthralgias that evolve into arthritis
Occipital headaches with neck stiffness
Fatigue
Four week cycle of symptom flare-ups
EM rash (bulls-eye)
Raj Patel, M.D.
Lyme Disease
Classic Symptoms Associated with Babesia
Rapid onset of symptoms (cyclic high fevers, severe headaches, & sweats esp.
at night)
Air hunger
Dull global headaches
Prominent fatigue with exercise intolerance
Symptoms cycle every 4-7 days
Hypercoagulable states
Raj Patel, M.D.
Lyme Disease
Classic Symptoms Associated with Bartonella like organisms
CNS symptoms prominent (anxiety, agitation, insommnia, seizures, outbursts
and anti-social behavior)
Lymphadenopathy
Soles tender esp. in morning
Striae (hyperpigmented stretch marks)
Elevated VEGF (vascular endothelial growth factor) useful marker to follow
response to treatment.
Raj Patel, M.D.
Lyme Disease
Classic Symptoms Associated with Ehrlichia / Anaplasma
Myalgias
Sharp knife like headaches behind eyes
Low WBC count
Elevated liver enzymes
Raj Patel, M.D.
Raj Patel, M.D.
Lyme Western Blot Testing
Raj Patel, M.D.
Grier, T. Laboratory Tests. Lyme Times. Summer 2004:21-25
Lyme Western Blot Testing in
Chronic Lyme Disease
Overview:
Reasons for seronegativity-Test done too early
Antibiotics given early
Early use of steroids
B. burgdorferi not present in blood (it may be in
tissues as cell wall deficient form)
Immuno-deficiency
Presence of non-Borrelia burgdorferi species
Lyme WB should be used for screening. The College of American
Pathologists (CAP) found that ELISA tests have poor sensitivity for
screening purposes. (Bakken 1997)
Raj Patel, M.D.
What To Do If You Get A Tick Bite
1.
See a doctor immediately. The sooner treatment is started the better the results
are.
2. Go to www.lymediseaseassociation.org for a list of lyme literate MDs (LLMD).
Otherwise, take a copy of the ILADS treatment guidelines with you for your
doctor http://www.ilads.org/files/ILADS_Guidelines.pdf
3. Save the tick. Laboratories can test the tick for the presence of lyme and
associated coinfections.
4. If a rash develops take photographs. It may help your doctor in making the
diagnosis
5. Laboratories vary in terms of the depth of lyme testing provided. Dr. Patel
prefers to use the following:
Igenex
www.Igenex.com
1-800-832-3200
Stony Brook Laboratories
http://www.path.sunysb.edu/labsvs/tickpics/TICKpic.htm
1-631-444-3824
Clongen Laboratories
www.Clongen.com
1-301-916-0173
Raj Patel, M.D.
Testing and Treatment After Tick Bite
Testing
PCR (blood and Serum) for Lyme, Ehrlichia, Bartonella, Babesia,
Mycoplasma especially early in course of infection
FISH, PCR, or blood smear for Babesia
FISH or PCR for Bartonella
Western-Blot not useful. Take 2-6 weeks to turn positive
Treatment:
IDSA: Rx within 72 hours with Doxycycline 200 mg (4mg/kg) one time dose
if age >8 years. No treatment recommended for < 8 years unless
symptoms warrant it.
ILADS: No specific Rx. Use clinical judgement based on geographical
location, type of tick, if engorged, and method of removal.
Burrascano Guidelines: Treat 28 days regardless of age.
Raj Patel, M.D.
Two Standards of Care
IDSA (Infectious Diseases Society of America)
Denies existence of chronic Lyme disease.
Requires serological evidence for treatment (positive PCR or IgM on WB)
Treatment restricted to 2-3 weeks of single antibiotic
(typically Doxycycline 100mg BID)
“…unproven and very improbable assumption that chronic B. burgdorferi infection can occur in the absence of
antibodies against B. burgdorferi in serum.”
“patients who remain seronegative, despite continuing symptoms for 6-8 weeks, are unlikely to have Lyme
disease…”
“To date there is no convincing biologic evidence for the existence of symptomatic chronic B. burgdorferi
infection among patients after receipt of recommended treatment regimens for Lyme disease.”
“Retreatment is not recommended unless relapse is shown by reliable objective measures.”
Clinical Practice Guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006 Nov 1;43(9):1089-134. Epub
2006 Oct 2
Raj Patel, M.D.
Two Standards of Care
ILADS (International Lyme and Associated Diseases Society)
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“Since there is currently no definitive test for Lyme disease, laboratory
results should not be used to exclude an individual from treatment.
Lyme disease is a clinical diagnosis and tests should be used to support
rather than supersede the physician’s judgment.
The early use of antibiotics can prevent persistent, recurrent and refractory
Lyme disease.
The duration of therapy should be guided by clinical response, rather than
by an arbitrary (i.e., 30 days) treatment course.
The practice of stopping antibiotics to allow for delayed recovery is not
recommended for persistent Lyme disease. In these cases, it is reasonable
to continue treatment for several months after clinical and laboratory
abnormalities have begun to resolve and symptoms have disappeared.”
Evidence Based Guidelines for the Management of Lyme Disease. The International Lyme and Associated Diseases Society.
Expert Rev. Anti-infect. Ther.2(1), Suppl. (2004)
Raj Patel, M.D.
Medical Literature
False Seronegativity in Lyme well documented
…chronic lyme disease cannot be excluded by the absence of antibodies against B. burgdorferi.”
Dattwyler RJ, Volkman DJ, Luft BJ, Halperin JJ, Thomas J, Golightly MG. Seronegative Lyme Disease. Dissociation of specific
T- and B- lymphocyte responses to Borrelia burgdorferi. N Engl J Med. 1988 Dec 1;319(22):1441-6.
“Greater than 70% of patients with chronic Lyme disease were seronegative by CDC criteria.
Donta ST. Tetracycline therapy for chronic Lyme disease. Clin Infect Dis 1997 Jul;25 Suppl 1:S52-6.
“Lyme borreliosis patients who have live spirochetes in body fluids have low or negative levels of borrelial
antibodies in their sera.”
Tylewska-Wierzbanowska S, Chmielewski T. Limitation of serological testing for Lyme borreliosis: evaluation of ELISA and
western blot in comparison with PCR and culture methods. Wien Klm Wochenschr. 2002 Jul 31;114(13-14);601-5.
“Seronegative patients in the study had higher rates of positive CSF PCR”
Keller TL, Halperin JJ, Whitman M. PCR detection of Borrelia burgdorferi DNA in cerebrospinal fluid of Lyme neuroborreliosis
patients. Neurology. 1992 Jan;42(1):32-42.
Raj Patel, M.D.
Protecting Yourself
Ticks:
Year round threat with Spring and Summer being prime time
Carried by deer as well as other animals to your yard
Mice become carriers when infected ticks feed on them.
Subsequently, when non-infected ticks feed they
become infected
Found in cool moist areas, around shrubs and woody areas, tall
grass, and around the edge of yards
Ticks prefer moist skin folds:
Back of neck
Inside part of elbows and knees
Hairlines
In and around ears
Raj Patel, M.D.
Protecting Yourself
Keep your pets protected:
Particularly susceptible, frequently bringing deer ticks into your
house
Use Frontline or K9 Advantix monthly for cats and dog
Use Damminix tubes to reduce deer ticks by more than 90%
(tubes filled with cottton treated with Permethrin)
Raj Patel, M.D.
Protecting Yourself
Minimize Exposure:
Yard Prevention
Yard prevention very important
Keep lawn mowed, cut down brushy areas, & clear away leaves
Trim trees to ensure adequate sunshine
Creating a 3 ft. wide wood chip or gravel border and stone wall can
reduce ticks by 50%
Hiking Precautions
Walk in middle of trails
Wear light colored clothing
Wear gloves, hat, long sleeves
Use Deet type repellent on exposed skin
Use Permethrin tick repellent on clothing
Check yourself thoroughly afterwards
After possible exposure take clothing and
place in dryer at high heat for 15
minutes to kill ticks left behind
Raj Patel, M.D.
Lyme Disease vs. Mold Illness
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Symptoms overlap greatly (fatigue, cognitive
dysfunction, GI symptoms, arthralgias, myalgias,
paresthesias, & mood changes)
Both trigger a Chronic Inflammatory Response
with similar laboratory abnormalities.
Coexistence of these conditions present unique
challenges especially in lyme and mold
susceptible or multi-susceptible individuals.
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Tips on Treating Lyme and Mold Illness
6 Steps:
1. Eliminate exposure to WDB.
2. Reduce biotoxin load and inflammation
with Cholestyramine
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Tips on Treating Lyme and Mold Illness
3. Identify and treat underlying infections
a. GFCFSF diet
b. Probiotics
c. Minimize inflammation by supporting
excretion of biotoxins (CSM, exercise,
fluids, anti-inflammatory agents)
d. Support energy levels (sleep, rest,
mitochondrial and endocrine support)
e. Go SLOW!
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Tips on Treating Lyme and Mold Illness
4. Treat MARCONS
5. Correct all inflammatory markers (C4a,
MMP9, VEGF, ADH, TGFb1)
6. Treat with VIP (if unable to tolerate VIP,
look for occult infections or hidden mold
exposure.)
Raj Patel, MD
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*17 Reasons Lyme Patients Don’t Get Well
1. All co-infections have not been
successfully identified and eradicated
2. Immune Dysfunction
-autoimmune
-immune deficiency
3. Inflammation
-calm inflammatory response
-frequently triggered by infections/toxins
-address pain
*Why Can’t I Get Better?
Richard Horowitz, MD
ISBN-10: 1-250-01940-0
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*17 Reasons Lyme Patients Don’t Get Well
4. Toxicity
-heavy metals
-environmental illness
-mold/mycotoxins
-EMF
5. Allergies/Sensitivities
6. Nutritional/Enzyme Deficiencies
7. Mitochondrial dysfunction
8. Psychological dysfunction
-depression
-anxiety
-PTSD
-Abuse
*Why Can’t I Get Better?
Richard Horowitz, MD
ISBN-10: 1-250-01940-0
Raj Patel, MD
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*17 Reasons Lyme Patients Don’t Get Well
9. Neurological dysfunction
10.Endocrine disorders
-Thyroid
-Adrenal
-Testosterone
11.Sleep disturbances
-Stage 4
-Sleep Apnea
12. Autonomic dysfunction
13. GI disorders (Ehrlichia, Tularemia, Rickettsia,
Borrelia species, Celiac, HHV6)
*Why Can’t I Get Better?
Richard Horowitz, MD
ISBN-10: 1-250-01940-0
Raj Patel, MD
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*17 Reasons Lyme Patients Don’t Get Well
14. Liver dysfunction
15. Pain
16. Deconditioning
*Why Can’t I Get Better?
Richard Horowitz, MD
ISBN-10: 1-250-01940-0
Raj Patel, MD
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THANK YOU
Raj Patel, MD
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