††††††††††††People have been managing chronic Lyme disease for over 25 years. The options for treating these complex patients has changed significantly over that time. Pioneers like Sam Donta, Richard Horowitz, Kenneth Liegner, Joseph Burrascano and others have worked with thousands of ill people trying desperately to get them better.
††††††††††††The first and simplest approach for those diagnosed with a chronic tick-borne illness was to use the antibiotic doxycycline alone for 2-3 months or longer. Some recommended antibiotics until the symptoms had resolved and then for another 4 weeks to try and clear the infection for good.
††††††††††††After this, practitioners shifted to regimens using combination antibiotics. The combination was intended to cover different forms of the primary organism Borrelia burgdorferi. This bacterium has the potential to adapt and shift from spirochete to the cyst form to a cell-wall deficient form when under pressure from antibiotics or the immune system. The master herbalist Stephen Buhner has written that B. burgdorferi has many more than 3 forms.
††††††††††††Other antibiotics were also used to cover common co-infections also picked up from ticks and these include species of Bartonella, Babesia, Mycoplasma, Rickettsial, Ehrlichia and others.
††††††††††††Some providers used the same 3 antibiotics month after month, year after year waiting for improvement. Others change the regimen every few months as the personís status and symptomatology change or based on test results. Antifungals like nystatin and probiotics are often used with a variety of supplements. The regimens can be complicated and expensive.
††††††††††††There is an infectious disease specialist at MGH who uses an Intravenous form of the antibiotic Rocephin for 2-3 months. Many have started with oral antibiotics and then used IV options with oral for those that didnít respond adequately.
††††††††††††The use of long-term antibiotics has always been controversial. Some respond well and some donít. The patients that donít improve on antibiotics can hit a plateau and not respond well to other treatment options. The same way that chemotherapy regimens select for the most aggressive resistant cancer cells, long-term antibiotics tend to leave only the most difficult ďpersister cellsĒ to clear.
††††††††††††To avoid long-term antibiotics, some have used antibiotics and then switched to herbals. Others only use natural options exclusively that include combination herbals, colloidal silver, monolaurin, etc. with liver support, immune support, mineral support, GI support and other treatments. Itís common for a chronic Lyme patient to be on 10-20 supplements or more.
††††††††††††Over the past couple of years, we have entered a new era in Lyme management. This era brings new approaches that are relatively well researched with higher rates of success.
††††††††††††Richard Horowitz has managed over 13,000 chronic Lyme patients by his account. It is incredibly difficult to sort out and manage the underlying issues for this group and he deserves credit for his body of work. His newest, latest regimen includes combination antibiotics with the addition of a novel antimicrobial called dapsone plus multiple probiotics, several biofilm busters and other supplements. It is a difficult regimen for patients to maintain, but he reports high levels of success.
††††††††††††Kenneth Leigner has been using a fascinating option: Anatabuse/disulfiram. This drug was originally developed as a deterrent to alcohol intake, but has antibiotic, antinflammatory, biofilm-busting and other useful qualities. In an interview recently, Richard Horowitz said that disulfiram might be the most likely single option to provoke a Herxheimer reaction. (This type of reaction reflects an increase in symptoms when organisms from of a chronic infection are killed off and provoke an immune/inflammatory response.)
††††††††††††Is disulfiram the best single option? Is this what Lyme practitioners have hoped for all this time? Time will tell.
††††††††††††I have one patient who has been sick for about 20 years referred to me by the Dean Center. By the time I saw him in the office a couple of years ago, he was understandably frustrated. He had worked with a variety of providers in the mainstream and alternative worlds with minimal benefit. He was disabled and unable to work. I introduced some other options, trying to improve his status but these also had little benefit.
††††††††††††About a year ago, we discussed magnet therapy as an option. Like most people that have gone through these battles, he was willing to do just about anything to get his life back, but also skeptical there would be any benefit. I know of four practitioners north of Boston who use magnets for complex patients and I would be lying if I said I understood well how it works. The majority of people with chronic tick-borne infections who have tried this therapy have improved, so I recommended it to him. He went for visits about every 2 weeks and within 3-4 months he was about 80% better. Nothing he had tried over the years had had anywhere near this level of success.
††††††††††††Time may show that a PEMF (pulsed electromagnetic field) device is the single best option for those with chronic tick-borne infections. PEMFs, according to†pulsecenters.com, are ďa donating source of energy that helps the body repair/regenerate/rebuild, enhancing the functionality of cells.Ē One PEMF device is called AmpCoil and, like Drs. Horowitz and Leigner above, the company that makes AmpCoil is trying to prove via research and evidence that their option has benefit. The early trials of AmpCoil have demonstrated a 91% success rate after 3-4 months of one hour sessions three days a week.
††††††††††††Data can obviously be cooked and manipulated to serve a purpose. I reviewed the AmpCoil data and the patients in their trial were the ďsickest of the sick.Ē About 70% of the patients who completed the program were able to return to work or full-time school after going through the program. If you think PEMF sounds like a bogus, new age approach, realize that PEMFs are part of mainstream medicine as well. In 1998, the FDA approved PEMF therapy for urinary incontinence and muscle stimulation and then in 2004, the FDA approved the modality to help heal certain types of fractures.
††††††††††††I have been working with chronic, complex patients for over 15 years. I have pursued each of the above regimens and strategies (except dapsone) over that time. If a new patient came in and there was a question of chronic tick-borne infections, I would go through an initial process that included labs, analysis via†complexhealthsolutions.com†and other individualized assessments.
††††††††††††If the most likely explanation for the personís health problems was chronic tick-borne infections, at this point, I would either: (1) start antibiotics to see how they respond. (I have had a minority of patients respond well to 2-3 month courses of antibiotics); (2) do a trial of disulfiram–starting at a low dose–especially to see if they Herx; or (3) get them in for magnet therapy or AmpCoil.
Andrew Lenhardt, MD