Inside Lyme Podcast with Dr. Daniel Cameron

Lyme and PANS: A Critical Connection in TeenagersAt just 16, my patient found herself facing a complex and overwhelming set of symptoms. What began as ordinary teenage stress evolved into something far more debilitating—raging outbursts, severe compulsions, motor and vocal tics, and memory problems. Her academic performance plummeted, and her social life disintegrated. Diagnosed with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), she and her family embarked on a challenging journey for answers.PANS, a condition characterized by the sudden onset of severe neuropsychiatric symptoms, is often triggered by infections or autoimmune responses. These symptoms include obsessive-compulsive behaviors, severe anxiety, and a wide array of neurological issues. In my patient's case, the impact was profound, disrupting nearly every aspect of her life.A Frustrating Treatment JourneyHer school quickly implemented a 504 plan to accommodate her needs, but even with these supports, she struggled to attend classes regularly. The academic gaps widened, and the isolation grew. Initially, her treatment focused on intravenous immunoglobulin (IVIG) therapy, a standard approach for PANS aimed at modulating the immune system. Unfortunately, despite several courses of IVIG, her symptoms persisted, leading to a sense of despair for both her and her family.The Lyme Disease ConnectionIt wasn't until the family explored further that they discovered a potential link between Lyme disease and PANS. Lyme disease, transmitted by ticks and caused by the Borrelia burgdorferi bacterium, is notorious for its wide range of symptoms, many of which can overlap with neuropsychiatric disorders. When Lyme disease enters the picture, it can trigger or exacerbate PANS, leading to an even more complicated clinical scenario.Upon testing, my patient was diagnosed with Lyme disease and a co-infection, which had gone undetected. The realization that these infections were contributing to her PANS symptoms was a breakthrough. She began antibiotic therapy, which is often essential in treating Lyme disease, especially when co-infections are involved. Over time, this approach started to pay off—her symptoms gradually improved, the rage outbursts and compulsions became less frequent, and her cognitive function began to recover. 

Chronic Lyme disease, characterized by persistent symptoms that can linger for months or even years, is a growing concern for both patients and healthcare providers. Traditionally, Lyme disease has been seen as a straightforward infection—diagnosed early, treated with antibiotics, and resolved. However, for a significant number of people, Lyme disease can evolve into a chronic condition, marked by ongoing fatigue, pain, and cognitive issues. But what if much of this chronic suffering could be prevented? Recent insights suggest that the progression to chronic Lyme disease might be mitigated, or even prevented, by focusing on several key factors. This approach is similar to how we prevent other chronic diseases like type 2 diabetes or heart disease: through early detection and appropriate treatment. **The Importance of Early Diagnosis and Treatment** One of the most critical steps in preventing chronic Lyme disease is the early diagnosis and treatment of the infection. When a patient presents with a tick bite or early symptoms of Lyme disease, such as the characteristic erythema migrans rash, it's vital to begin treatment promptly. Early intervention with antibiotics like doxycycline can significantly reduce the risk of the infection progressing to a chronic stage. Moreover, it's essential to maintain a vigilant follow-up process. Even after initial treatment, patients should be asked to return for evaluation if symptoms persist or recur. Lyme disease can sometimes be insidious, with symptoms reappearing after what seems like successful treatment. Regular follow-ups allow healthcare providers to monitor the patient's progress and catch any signs of relapse early. **Look for Co-Infections** Co-infections are another critical factor in the progression of Lyme disease to a chronic condition. Ticks often carry more than just Borrelia burgdorferi, the bacteria responsible for Lyme disease—they can also transmit other pathogens like Babesia, Bartonella, and Anaplasma. These co-infections can complicate the clinical picture and may require different treatments. It's important to test for and consider co-infections, especially if a patient's symptoms do not resolve with standard Lyme treatment. Addressing all possible infections early on can prevent the persistence and worsening of symptoms. **Consider Retreatment** In cases where initial treatment does not fully resolve the symptoms, it may be necessary to consider retreatment. Clinical judgment plays a crucial role here. While some cases of Lyme disease respond well to the standard course of antibiotics, others may require a more prolonged or alternative treatment approach. Retreatment should be considered for patients who continue to experience significant symptoms, particularly if they show signs of ongoing infection or co-infections. **Follow-Up Care is Crucial** Consistent follow-up care is essential in managing Lyme disease and preventing its progression to a chronic state. Even after symptoms appear to have resolved, patients should be monitored for any signs of recurrence or new symptoms. Chronic Lyme disease can sometimes develop months or even years after the initial infection, making long-term follow-up a key component of care. **Environmental Awareness and Preventive Measures**  **Raising Awareness and Improving Access to Care** 

The likely reason for relapse is failure to eradicate the spirochete completely with a two-week course of intravenous ceftriaxone therapy,” wrote Drs. Logigian, Kaplan, and Steere in their seminal 1990 paper on chronic neurologic Lyme disease. This observation remains as relevant today as it was over three decades ago, highlighting a persistent challenge in the treatment of Lyme disease: the difficulty in fully eliminating the Borrelia burgdorferi bacterium, which can lead to relapse or persistent symptoms even after what is considered adequate treatment.In chronic Lyme disease, or what is often referred to as Post-Treatment Lyme Disease Syndrome (PTLDS), patients continue to suffer from symptoms such as fatigue, pain, and cognitive difficulties long after completing the standard antibiotic courses. This condition has sparked considerable debate within the medical community. Some experts believe that ongoing symptoms are due to lingering effects of the initial infection, while others propose that they may be due to an active, persistent infection that was not fully eradicated by the initial treatment.The 1990 study by Logigian, Kaplan, and Steere explored these possibilities by examining patients who had been treated with a two-week course of intravenous ceftriaxone. Despite this treatment, some patients either relapsed or failed to recover fully, leading the authors to speculate that the spirochete might not have been completely eradicated. This concept has been supported by subsequent studies suggesting that Borrelia burgdorferi can persist in the body in a dormant state, possibly shielded within tissues where antibiotics have limited penetration.More recent research has further explored the idea of persistent infection. Studies have shown that Borrelia burgdorferi can form biofilms—complex communities of bacteria that are more resistant to antibiotics. These biofilms could potentially harbor bacteria that re-emerge after the initial course of antibiotics is completed, leading to the recurrence of symptoms.Moreover, the nature of Lyme disease itself complicates treatment. The bacterium Borrelia burgdorferi can exist in multiple forms—spirochete, round-body, and biofilm—which might require different antibiotics or treatment approaches to fully eradicate. This complexity may explain why some patients do not respond to the standard treatment regimen.For patients like mine, who experience a relapse after standard treatment, the journey can be frustrating and disheartening. The initial hope of recovery is replaced by confusion and concern when symptoms return or persist. This situation emphasizes the need for ongoing research into more effective treatment strategies for chronic Lyme disease, including longer antibiotic courses, combination therapies, and alternative treatments that address the different forms the bacterium can take.The challenge of treating chronic Lyme disease also raises important questions about the broader healthcare system's approach to this condition. There is a pressing need for more awareness among healthcare providers, more research funding to explore the underlying mechanisms of persistent infection, and better support systems for patients navigating the complexities of this illness.In conclusion, the issue of relapse in Lyme disease treatment is not just a clinical problem but also a deeply personal one for patients who struggle to regain their health. It highlights the importance of individualized treatment approaches, ongoing patient support, and the continuous pursuit of knowledge to develop more effective treatments for this complex and often misunderstood disease. 

My patient recovered from her chronic illness after receiving early aggressive treatment, a result that underscores the importance of this approach in managing Lyme disease. Chronic illness resulting from Lyme disease is one of the most compelling reasons I advocate for early aggressive treatment. Lyme disease is not just a simple infection; if left inadequately treated, it can lead to a range of severe and persistent conditions. Chronic neurologic Lyme disease can cause debilitating symptoms such as cognitive impairments, severe headaches, and neuropathy. POTS (Postural Orthostatic Tachycardia Syndrome) and PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) are other serious complications that can significantly disrupt a patient's life, leading to symptoms like dizziness, rapid heart rate, and sudden behavioral changes. Lyme arthritis, another potential outcome, can cause long-term joint pain and swelling, making daily activities difficult. Lyme carditis, which affects the heart, can lead to dangerous complications, including heart block and arrhythmias. Neuropsychiatric Lyme, involving mood disorders, anxiety, and cognitive dysfunction, adds an additional layer of complexity to the patient's condition, affecting mental health and overall quality of life. Given the high stakes, early aggressive treatment becomes not just an option but a necessity. By intervening quickly and with a comprehensive treatment plan, we can reduce the risk of these chronic manifestations taking hold. In my experience, starting treatment early—often before the full spectrum of symptoms has developed—can make a significant difference in the patient's prognosis. This approach also involves treating potential co-infections like Babesia and Bartonella from the outset, even if they haven't been fully confirmed. These co-infections can complicate the clinical picture and contribute to the persistence of symptoms if not addressed early. By being proactive and thorough, we can give patients the best chance of a full recovery and prevent the long-term complications that make Lyme disease so challenging. Ultimately, early aggressive treatment is about more than just addressing an infection; it's about preventing the transition from an acute illness to a chronic, life-altering condition. It's about giving patients the opportunity to regain their health and quality of life as quickly as possible, without the lingering fear of ongoing or worsening symptoms. The success of this approach with my patients reinforces its importance and validates the need for a proactive, comprehensive strategy in treating Lyme disease.  

When I first began treating Lyme disease, I adopted an “escalation” approach. This method involved starting with a standard course of doxycycline, typically lasting a month, and then observing how the patient responded. If the symptoms persisted or if I suspected that a co-infection might be present, I would escalate the treatment—adding or changing medications as needed. This approach was cautious and reactive, focusing on adjusting the treatment plan based on the patient's progress over time. However, through years of experience and patient outcomes, I've shifted my strategy to what I now call an “early aggressive” treatment approach. Rather than waiting to see if symptoms persist or worsen, I take proactive steps right from the start.  I start treatment as soon as possible after initial symptom onset to give patients the best chance of minimizing a chronic illnessI maintain a low threshold for switching therapies when there is breakthrough disease activity (clinical relapses and/or continued illness) -- this may help prevent chronic illnessIf a patient has an inadequate (subtherapeutic) treatment response to a antibiotic, choose another antibiotic with a different mechanism of action. If I suspect a co-infection with Babesia, I start treatment with atovaquone right away. This is crucial because Babesia requires different treatment than Lyme disease and can significantly impact recovery if not addressed early. Similarly, if Bartonella is a possibility, I begin treatment early, even if I'm not sure of the exact source.Similarly, if I suspect Bartonella, another common co-infection, I begin treatment early, even if I haven't confirmed whether the infection was transmitted by a tick or a cat. Bartonella can cause a range of symptoms that complicate Lyme disease, and early intervention can prevent the condition from becoming more severe or chronic. This “early aggressive” approach represents a significant shift from the more traditional, wait-and-see methods. The reasoning behind this shift is rooted in the understanding that Lyme disease and its co-infections can be relentless and complex, with symptoms that vary widely among patients. By addressing potential complications head-on and without delay, I've seen much better patient outcomes. Recovery times are often shorter, and the risk of developing chronic symptoms is reduced. Moreover, this approach is not just about quicker recovery—it's also about improving the overall patient experience. Lyme disease can be a devastating condition, both physically and emotionally. The uncertainty and frustration that come with prolonged illness can take a significant toll on a patient's mental health and quality of life. By being proactive and addressing all possible aspects of the disease early, I can provide my patients with a clearer path to recovery and reduce the likelihood of prolonged suffering. In summary, my move to an “early aggressive” treatment strategy has been shaped by my commitment to providing the best possible care for my patients. This approach allows me to tackle Lyme disease and its co-infections more effectively, offering patients a better chance at a swift and complete recovery. It's about being proactive, thorough, and responsive to the complex nature of tick-borne illnesses, ensuring that no stone is left unturned in the quest to restore my patients' health.

The treatment landscape for Lyme disease has undergone significant evolution over the years, offering a wider array of options to manage this multifaceted illness. When I first began treating Lyme disease in 1987, the primary antibiotic prescribed was doxycycline. This choice was driven by doxycycline's effectiveness not only against Lyme disease itself but also against co-infections such as Ehrlichia and Anaplasmosis. These co-infections, often transmitted by the same ticks that carry Lyme, present additional challenges in patient management. However, when patients couldn't tolerate doxycycline due to side effects or failed to respond to the treatment, rifampin emerged as a viable alternative. For pediatric patients, the treatment approach required special consideration. amoxicillin was commonly used to avoid the risk of dental staining associated with doxycycline, which can be a concern for growing children. However, the limitation of amoxicillin lies in its inability to combat co-infections like Ehrlichia or Anaplasmosis. Over time, other antibiotics related to amoxicillin, such as Pen VK, IM Bicillin, Omnicef, and Ceftin, became available. Of these, Ceftin (cefuroxime axetil) is notably the only one FDA-approved specifically for Lyme disease, reinforcing its role in the treatment regimen. When dealing with neurologic Lyme disease, which can involve the central nervous system and present with symptoms such as memory loss, cognitive difficulties, and neuropathy, the approach often necessitates more aggressive treatment. Intravenous (IV) antibiotics like ceftriaxone (Rocephin) and Claforan were preferred due to their ability to cross the blood-brain barrier, a crucial factor in effectively treating neurological manifestations. These IV antibiotics are essential for some patients, particularly those with severe or persistent symptoms, but they are not without risks. The use of PICC lines for IV administration carries potential complications, including infections and blood clots. Interestingly, in my experience, many patients with chronic neurologic Lyme have shown significant improvement with oral antibiotics, allowing them to avoid the complexities and risks associated with IV treatments. For patients who are allergic to or unable to tolerate doxycycline, or for those who are sun-sensitive—a common side effect of doxycycline—Zithromax (azithromycin) and Biaxin (clarithromycin) have emerged as effective alternatives. These antibiotics belong to the macrolide class and have shown efficacy comparable to doxycycline in the majority of clinical studies, offering additional options for patient care. In the treatment of co-infections like Bartonella, the approach becomes more nuanced. Bartonella, initially identified as the causative agent of cat scratch fever, has been a subject of ongoing debate in the context of Lyme disease. This bacterium is traditionally associated with transmission through cat scratches, where the bacteria are introduced under the skin from cat saliva or flea feces. However, there is growing evidence suggesting that Bartonella may also be transmitted via tick bites, complicating the clinical picture for Lyme disease patients. In treating suspected Bartonella co-infections, I have employed antibiotics from the doxycycline, Zithromax, and rifampin families, drawing on research related to cat scratch fever. Additionally, I have used Bactrim (trimethoprim-sulfamethoxazole) in some cases. However, I generally avoid fluoroquinolones like ciprofloxacin due to their association with severe side effects, including joint pain, tendonitis, and tendon ruptures. Babesia, another common co-infection found in Lyme disease patients, requires a different treatment approach altogether. Babesia is a parasite that infects red blood cells, causing symptoms similar to malaria. For treating Babesia, I often prescribe atovaquone, availa

Since opening my Lyme disease practice in 1987, I've witnessed significant changes in how we diagnose and treat this complex illness. Early on, I prescribed doxycycline for Lyme disease and Ehrlichia. However, my first three patients in 1987 did not respond to doxycycline, so I referred one to Boston for further consultation. They returned with a recommendation for amoxicillin, marking the first major shift in my treatment approach. By 1990, I had started prescribing intravenous ceftriaxone (Rocephin), based on emerging reports of its effectiveness in chronic neurologic Lyme disease. This adjustment was influenced by reports from doctors Dr. Logigian, Kaplan and Steere, who documented treatment of chronic neurologic Lyme disease cases. I added azithromycin (marked as Zithromax in the USA) and clarithromycin (marketed as Biaxin I the USA) into my practice, based on emerging reports of its effectiveness. My practice changed again when Dr. Krause and colleagues reported the presence of Babesia, a parasite found in the same ticks that carry Lyme disease. At the time, treating Babesia was challenging, as the available regimen of clindamycin and quinine was difficult for patients to tolerate. The introduction of alternative treatments like atovaquone (Mepron) combined with azithromycin provided a more tolerable option, and I began prescribing these, particularly for patients who were not improving with other antibiotics. Over the years, I've adapted my practice to include longer treatment durations and combination antibiotic therapies, especially in cases of chronic or persistent Lyme disease. I've also incorporated treatments for co-infections like Bartonella, which was initially thought to be associated with cat scratches but is now recognized as a potential tick-borne illness. In addition to antibiotics, I've kept a close eye on new developments, such as the use of disulfiram (Antabuse) and double-dose dapsone, which has been explored by Dr. Horowitz for its potential benefits in treating chronic Lyme disease. While I have not yet adopted these treatments extensively, I remain open to new evidence-based approaches. The concept of biofilms and persisters—bacteria that survive despite standard treatment—has also influenced my practice. The persister hypothesis borrowed from research on other persistent infections like tuberculosis, suggest that longer or more aggressive treatment may be necessary for some patients. While antibiotics remain the cornerstone of my treatment approach, I also recognize the role of alternative therapies for some patients. I collaborate with alternative medicine practitioners when needed, ensuring that every patient receives a comprehensive and closely monitored treatment plan. I continue to share my experiences and insights through writing and social media, fostering dialogue and contributing to the ongoing conversation about Lyme disease treatment.

My patient's understanding of Lyme disease and its complexities was incomplete. Although he was familiar with nymphal ticks, he lacked awareness about adult ticks, which also play a crucial role in transmitting Lyme disease. He knew about the Bull's-eye erythema migrans rash, a clear sign of early Lyme disease, but was unaware of the other types of rashes associated with chronic Lyme disease or different tick-borne infections. He had heard of early Lyme disease but didn't realize that chronic Lyme disease could develop if the infection isn't treated adequately. While he knew about Post-Treatment Lyme Disease Syndrome (PTLDS), he didn't understand that PTLDS might be related to a persistent infection rather than just residual symptoms after treatment. He was aware of the recommendation to take a single dose of doxycycline to prevent an erythema migrans rash, but didn't know that this approach isn't proven to prevent other serious manifestations of Lyme disease, such as Lyme arthritis, Lyme carditis, or neurological Lyme disease. Although he understood the basics of the two-tier laboratory test for Lyme disease, he was not informed that Lyme disease often remains a clinical diagnosis due to the limitations of current testing. Furthermore, he didn't grasp the importance of identifying and managing co-infections. For example, he didn't realize that Babesia, a common co-infection, can't be treated with doxycycline alone and requires specific antiparasitic medications. He was also unaware of the potential for treatment failures and relapses, which complicate the management of Lyme disease and its co-infections. Closing these gaps in public health information is essential for improving patient outcomes. Providing thorough education on these topics can empower patients to recognize symptoms, understand treatment options, and make informed decisions about their healthcare."

Preventing Chronic Lyme Disease: Insights from 37 Years of ExperienceAs a Lyme disease expert, preventing chronic illness associated with Lyme disease has been a primary focus of my practice for the past 37 years. Despite early intervention and comprehensive care, some patients still find themselves battling long-term, debilitating symptoms. This post outlines the strategies and lessons I've learned over the years in my mission to prevent chronic Lyme disease.Understanding the Challenges of Lyme DiseaseLyme disease is a complex and often misunderstood condition. It can manifest in a variety of symptoms, which differ widely from patient to patient. These symptoms can range from mild to severe and can affect multiple body systems, making diagnosis and treatment particularly challenging. Even when Lyme disease is caught early and treated with antibiotics, some patients continue to suffer from persistent symptoms, leading to what is often referred to as chronic Lyme disease.Early and Accurate Diagnosis: The First Line of DefenseOne of the most critical steps in preventing chronic Lyme disease is ensuring an early and accurate diagnosis. Lyme disease is primarily a clinical diagnosis, meaning that it should be based on a patient's symptoms and history rather than relying solely on test results. This is because the standard two-tiered testing approach can miss early or late-stage infections.In my experience, comprehensive evaluations are essential, especially for patients with persistent symptoms. This includes not only testing for Lyme disease but also for co-infections like Babesia, Bartonella, and Ehrlichia, which are often transmitted by the same ticks that carry Lyme disease. These co-infections can complicate the clinical picture and require different treatment approaches.Tailored Treatment Plans: No One-Size-Fits-All ApproachNot all patients respond to standard treatment protocols. While a typical course of antibiotics might be effective for some, others may require extended treatment or a combination of therapies to address the varying stages of the infection. Monitoring each patient's progress is crucial, and being willing to adjust treatment plans based on their response is key to preventing chronic symptoms from developing.Patient Education and Support: Empowering Patients for Better OutcomesEducating patients about the potential for chronic symptoms, even after early treatment, is vital. Patients need to be aware that symptoms can recur and that it's important to seek medical attention promptly if they do. This awareness can prevent the disease from progressing to a chronic state and can help patients manage their health more effectively.Continuous support from healthcare providers is also essential. Chronic illness can be isolating, and having a supportive medical team can make a significant difference in a patient's journey. This support can take many forms, including regular follow-up appointments, providing resources for symptom management, and offering encouragement and reassurance.Holistic Care and Immune Support: Addressing the Whole PatientIncorporating supportive therapies and focusing on overall immune system health can significantly improve outcomes for patients with Lyme disease. A holistic approach to care, which addresses both physical and mental health, can help mitigate the progression of chronic Lyme disease. This might include therapies such as physical therapy, nutritional support, and mental health counseling to address the wide-ranging impacts of the disease. 

My patient took a "bury-your-head-in-the-sand" viewpoint toward Lyme disease, which did not help him. He had been ill for over two years, suffering from severe fatigue, brain fog, poor sleep, headaches, poor concentration, irritability, neck pain, chest pain, palpitations, stomach pains, and joint pain. He remained ill despite having been evaluated by a number of specialists to rule out other illnesses. He was reluctant to consider Lyme disease or tick-borne infection without a positive test. His condition significantly affected his quality of life, and he experienced increasing frustration as each specialist he consulted was unable to identify the cause of his symptoms. Despite his worsening condition, he was hesitant to pursue a diagnosis of Lyme disease due to a lack of definitive test results and a belief that it was unlikely without a positive test or known tick bite. His family, concerned about his deteriorating health, encouraged him to reconsider his reluctance and seek treatment for Lyme disease. After much persuasion, he agreed to undergo treatment. He was successfully treated with doxycycline followed by a combination of Zithromax and Malarone for Lyme disease with Babesia coinfection. The improvement in his symptoms was remarkable; his fatigue, brain fog, and other symptoms began to resolve. He is now kicking himself for taking that "bury-your-head-in-the-sand" viewpoint and not considering Lyme disease earlier. His experience underscores the importance of considering Lyme disease as a potential diagnosis in patients with persistent, unexplained symptoms, even in the absence of a positive test or known tick bite. Early intervention and treatment can prevent prolonged suffering and lead to significant improvements in health.

Unfortunately, there simply isn't a one-size-fits-all treatment protocol for patients infected with Lyme disease and/or co-infections. This is why it's critical for physicians treating Lyme disease to invest time with patients, thoroughly understand their medical history, and closely monitor symptoms and treatment response. With that in mind, there are currently two different treatment approaches for Lyme disease. The Infectious Disease Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS) have each published their own set of evidence-based treatment guidelines. IDSA guidelines recommend a short course of antibiotics, typically 14 to 30 days. IDSA argues that the Borrelia burgdorferi bacteria do not persist in a patient beyond this timeframe and that lingering symptoms are the result of an ongoing immune response and not an active infection. It also cites scientific evidence claiming treatments beyond 30 days are ineffective, unnecessary, and even dangerous. IDSA physicians will stop treatment after 30 days, even if symptoms remain. They advise an additional 30 days of treatment recommended for patients with Lyme arthritis.  On the contrary, ILADS offers its own scientific data to show that a additional treatment with antibiotics is required to eradicate the bacteria. ILADS recognizes that a month of treatment may be sufficient for patients in the acute stage of Lyme disease, but in cases where the spirochete has disseminated and the disease has advanced, a 30-day treatment regimen is inadequate. ILADS guidelines recommend additional antibiotics until a patient's symptoms have been resolved. Treating Lyme disease in its advanced stage can be complicated based on the complexity of the organism itself, differences in each patient's immune system, the length of time infected, and the possible presence of other co-infections transmitted by the same tick. There are several choices in treating Lyme disease, which include oral, intravenous, and intramuscular antibiotic options. Other options may include sequential antibiotic therapy, higher doses of antibiotics, taking antibiotics for a longer period of time, a combination of antibiotics, retreatment, as well as diagnosing and treating co-infections. Some specific antibiotics used in treating Lyme disease are doxycycline, minocycline, amoxicillin, cefuroxime, azithromycin, and clarithromycin. Other tests include measures of blood counts, chemistries, liver function tests, ANA, dsDNA, RF, TSH, free T3, free T4, ESR may be helpful at ruling out other conditions.  Referral to specialist might help to rule out other conditions.  I find shared decision with my patient helpful. I also find follow-up helpful to assess my patient's response to treatment to rule out other conditions. There are additional protocols that may also aid in treating Lyme disease, such as avoiding alcohol, simple and processed sugars, exercising as tolerated, counseling for a Jarisch-Herxheimer reaction, managing symptoms, monitoring and reducing the risk of an adverse event, and reducing stress. However, there is a chance of side effects such as Clostridium difficile-associated diarrhea (CDAD). Probiotic have been prescribed with the hope of reducing the risk of developing CDAD.   

My Lyme disease patient was afraid of seeking treatment for Lyme disease. She was not alone. She is not alone. I will explore the stigma surrounding Lyme disease, the impact on patients, and treatments. One of the main hurdles is the fear of the diagnosis itself.Lyme disease manifests in various stages with symptoms ranging from mild to severe and can become a chronic condition if not diagnosed and treated promptly. If not diagnosed and treated promptly.  Patients are aware that being diagnosed with Lyme disease can lead to skepticism from both the public and healthcare providers. This skepticism can result in delayed treatment and inadequate care, exacerbating the patient's suffering. Some articles and reports have been dismissive of compelling evidence that demonstrates Lyme disease as a complex chronic condition. This bias contributes to the harmful stereotype of chronic Lyme sufferers as hypochondriacs, individuals who are excessively preoccupied with their health without a legitimate medical reason. Such portrayals undermine the seriousness of this disease and invalidate the experience of those suffering from it. The portrayal of Lyme disease sufferers as hypochondriacs leads to significantstigma within healthcare settings. Healthcare providers may be influenced by this bias, leading them to dismiss patient's symptoms or attribute them to psychological causes rather than exploring a potential Lyme disease diagnosis. Patients may feel isolated, misunderstood, and reluctant to seek further medical help due to previous negative experiences. The development and implementation of new treatments for Lyme disease often face harsher criticism compared to treatments for other chronic diseases. This criticism stems from a combination of skepticism about the chronic nature of Lyme disease and concerns over the long term use of antibiotics. Despite evidence supporting the efficacy of extended antibiotic therapy, in some chronic Lyme cases, these treatments are frequently scrutinized and dismissed. This hesitancy to embrace new treatments limits options for patients and hinders progress in managing the disease effectively. A significant aspect of the controversy surrounding Lyme disease treatment is the debate over antibiotic therapy. Recent reporting Critics highlight potential side effects and the risk of antibiotic resistance, suggesting that patients should endure their symptoms rather than pursue long term antibiotic treatment. This perspective fails to acknowledge the debilitating nature of chronic Lyme disease and the potential benefits that some patients experience from prolonged antibiotic therapy. The dismissal of chronic Lyme disease and a reluctance to support extended antibiotic treatment has profound consequences for patients suffering from chronic symptoms such as fatigue, joint pain, neurologic issues, and cognitive impairment. Patients are left with limited options. The suggestion that patients should endure their symptoms without adequate treatment disregards the impact of this disease on their quality of life. Addressing the stigma and challenges in Lyme disease treatment requires a multifaceted approach. It is crucial to acknowledge Lyme disease as a complex chronic condition and to validate the experience of those suffering from it.  By fostering a more compassionate and evidence-based perspective, we can improve the diagnosis, treatment, and overall care for Lyme disease patients. Healthcare providers, media, and policy makers must work together to reduce stigma, support research into new treatments, and ensure the patients receive the comprehensive care they need.

Welcome! Today, we're discussing the top causes of treatment delays for Lyme disease that I've encountered in my practice." Case Study: An 18-Month Struggle One of my patients was ill for 18 months. She had a tick bite and an atypical rash. Her ELISA titer was positive for Lyme disease, but she had only two IgG western blot bands. Despite multiple evaluations, Lyme disease was considered but dismissed after a negative test. She presented with Chronic Neurologic Lyme and Postural Orthostatic Tachycardia Syndrome (POTS) and required extensive treatment due to these delays. Fortunately, she improved after treatment, but the delay made her recovery more challenging. Top Causes of Treatment Delays Here are the top causes of treatment delays I see in my practice: 1.  Absence of a Tick Bite: Many patients don't recall being bitten by a tick, leading to delays in considering Lyme disease.2.  Absence of a Rash: Not all Lyme disease patients develop a rash, which can cause misdiagnosis.3.  Atypical Rash: Only one in four Lyme disease cases present with the classic bull's eye pattern.4.  Equivocal or Negative Tests for Lyme: Inconsistent or negative test results can lead to delays in diagnosis.5.  Equivocal or Negative Tests for Co-Infections: Co-infections like Babesia may not be detected, complicating diagnosis.6.  Dismissal as Another Illness: Symptoms may be mistaken for chronic fatigue, fibromyalgia, gastroparesis, or other conditions.7.  Inadequate Public Health Information: Lack of awareness and information can lead to delays in seeking appropriate care.8.  Poor Understanding of the Signs and Symptoms of Lyme Disease: Misinterpretation of symptoms by both patients and healthcare providers.9.  Stigma Associated with the Diagnosis of Lyme Disease: Fear of stigma can prevent patients from seeking a diagnosis.10.  Difficulties Finding a Doctor Who Will Treat Lyme Disease: Limited access to Lyme-literate doctors can delay treatment.11.  Reliance on Symptomatic Treatment or Alternative Treatments: Focusing on symptomatic relief without considering Lyme disease.12.  Reluctance of Professionals to Consider Lyme Disease: Some healthcare providers are hesitant to diagnose Lyme disease. Addressing the Challenges Addressing these challenges requires raising awareness, improving diagnostic methods, and ensuring better access to doctors experienced in treating Lyme disease. Patients and healthcare providers need to be informed about the varied presentations and complexities of Lyme disease. Conclusion Understanding the causes of treatment delays helps us improve the timely diagnosis and treatment of Lyme disease. If you or someone you know is experiencing unexplained symptoms, consider consulting a doctor experienced in treating Lyme disease. Thank you for watching, and stay tuned for more insights on Lyme disease.

What is a common-sense approach to testing for Tick-borne infection. I focus on the most common infections that I see a Lyme disease infection. I order a Lyme disease test as well as test for infections like Ehrlichia, Anaplasmosis, and Babesia. I don't typically order Mycoplasma or Chlamydia unless there is evidence that there's active infection.  I order an ELISA test, which is also called Lyme titer.  I also order a western blot and IgG and IgM test. These are test where you need two out of three bands IgM bands. You need five out of 10 IgG bands to be called positive by the CDC criteria. These are bands that were identified and in 1994 at a consensus meeting in Dearborn Michigan.  These markers are protein that have been identified in Lyme disease infections.  For example, the 41 kDa band represents a protein contained in the tail of a spirochete. I have not been ordering a C6 peptide or VlsE protein tests for Lyme disease as they are not as reliable as I would like.  None of these tests for Lyme disease are all that sensitive in my experience.  I have often had to use clinical judgement to diagnose and treat Lyme disease. I also order IgG and IgM tests for co-infections with Babesia, Bartonella, Anaplasmosis, and Ehrlichia. I have not found PCR tests for these co-infections as helpful as I would like. I have found a blood smear for Babesia not helpful if a patient has been sick more than 2 weeks.   Some doctors have assumed Bartonella tests have been positive due to exposure to fecal matter from mites living on cats. I can't be sure the cause of positive tests for Bartonella in patients with Lyme disease.  I don't typically ordered labs for infections such as tularemia or Brucellosis despite concerns by some of my colleagues. I have found treatment for Lyme disease would take care of these infections if they were present. I typically do not sent bloods to a specialty lab if someone's on a budget. I also do not send bloods to these labs if I am going to treat clinically.   I also order extensive testing to rule other illnesses like a CBC, comprehensive metabolic profile, ANA, RA, thyroid, sed rate, vitamin B12 and D.    I may order a free T4 and free T3 if I am considering a thyroid condition.  I have found ANA frustrating as most of the ANA tests are false positive. A positive dsDNA supports the diagnosis of lupus. My patients don't typically have three other conditions that would support the diagnosis of Lupus. I refer my patients to see a rheumatologist if there is a need to rule out lupus. I typical order blood test for a tick-borne illness four weeks or 4 to 6 weeks after onset of their illness to increase the chances that I might get a positive test.  I have had to use clinical judgement to treat a tick-borne infection if my patient is sick for less than 4 weeks or if I suspect a false negative test,

Welcome! Today, we'll explore the top ten symptoms of Lyme disease that I've encountered in my practice, highlighting the case of a patient who experienced them. Case Study: A 34-Year-Old Man's Journey He was a 34-year-old man who had been chronically ill for 14 months. He had seen his primary care physician and various specialists, but multiple conditions were ruled out. Despite some improvement with symptomatic treatments, he couldn't work and struggled to care for his family. He didn't realize his symptoms were consistent with Lyme disease and a tick-borne co-infection. Top Ten Lyme Disease Symptoms Here are the top ten Lyme disease symptoms I've seen in my practice: 1. Exhaustion: Severe fatigue that doesn't improve with rest.2. Poor Sleep: Trouble falling asleep, staying asleep, or feeling rested.3. Impaired Concentration: Difficulty focusing and memory problems.4. Headaches: Persistent and severe headaches.5. Mood Disturbance: Irritability, anxiety, depression, and mood swings.6. Neck Pain: Stiffness and pain in the neck.7. Postural Orthostatic Tachycardia Syndrome (POTS): Lightheadedness, rapid heartbeat upon standing.8. Nausea and Constipation: Gastrointestinal issues.9. Sensitivity to Light, Sound, Heat, and Cold: Heightened sensitivity to environmental stimuli.10. Joint Pain and Numbness: Migratory joint pain and tingling or numbness in the hands and feet. Additional Symptoms He also experienced:- Distorted vision and pain behind his eyes- Chest and back pain- Ringing in his ears (tinnitus)- Night sweats and air hunger- Testicle pain He thought his head pressure was related to sinusitis, but ENT evaluations and a CT scan were negative. He attributed his exhaustion to chronic fatigue syndrome and poor concentration to fatigue and poor sleep. He didn't connect his sensitivity to light, sound, heat, and cold to his illness. He couldn't understand the cause of his irritability, sadness, anxiety, and despair. He didn't know that his lightheadedness, nausea, and constipation could be linked to an autonomic immune response to Lyme disease. He also didn't realize that the burning in his hands and feet and migratory joint pain were related to his illness. Treatment and Recovery His chronic illness resolved with a combination of Malarone and Zithromax after failing a course of doxycycline. This case highlights the importance of recognizing the diverse and often unexpected symptoms of Lyme disease. Conclusion Understanding these symptoms can help in the early diagnosis and effective treatment of Lyme disease. If you or someone you know has unexplained symptoms, consider consulting a Lyme-literate doctor. Thank you for watching, and stay tuned for more insights on Lyme disease.

Welcome! Today, we're discussing the unexpected and unusual presentations of Lyme disease that I've encountered in my practice.Case Study: Unexplained Foot Pain One of my patients experienced severe foot pain, even while walking to the bathroom. A podiatrist diagnosed him with plantar fasciitis, and he tried various treatments including icing, NSAIDs, stretching, iontophoresis, shoe inserts, and cortisone injections. Despite these efforts, his foot pain persisted. In addition to foot pain, he suffered from exhaustion, poor sleep, impaired concentration, neck and back pain, mood disturbances, palpitations, lightheadedness, migratory pains, and sensitivity to light and sound. Remarkably, his foot pain and other symptoms resolved following treatment for Lyme disease. Expected Lyme Disease Presentations In my practice, the expected presentations of Lyme disease include:- Erythema migrans- Bell's palsy- Chronic Neurologic Lyme disease- Neuropsychiatric Lyme- Postural Orthostatic Tachycardia Syndrome (POTS)- Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)- Lyme carditis- Lyme arthritis Unusual Lyme Disease Presentations However, I've also encountered several unusual presentations of Lyme disease that resolved with treatment. These include:- Thumb pain- Intermittent blue color of the hands and feet- Distorted vision and floaters- Uveitis- Atypical seizures- Temporomandibular joint (TMJ) disorder- Tinnitus- Movement disorders- ALS-like and MS-like presentations- Parkinsonian symptoms- Dementia- Gastroparesis- Mold sensitivity- Small intestinal bacterial overgrowth (SIBO)- Mast cell activation syndrome (MCAS)- Ehlers-Danlos syndrome (EDS)- Median arcuate ligament syndrome (MALS)- Fibromyalgia- Chronic fatigue syndrome- Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)- Functional and somatic disorders- Anxiety, depression, OCD, and ADHD The Challenge of Diagnosis It can be challenging to determine whether Lyme disease is the cause of these unusual presentations, as patients may have multiple conditions. Proper diagnosis and treatment are crucial for resolving these complex symptoms. Conclusion Understanding the wide range of Lyme disease presentations helps us better identify and treat this complex illness. If you or someone you know has unexplained symptoms, consider consulting a Lyme-literate doctor. Thank you for watching, and stay tuned for more insights on Lyme disease.

Welcome! Today, we're discussing my concerns with a single dose of doxycycline for a tick bite. Case Study: Ineffective Prophylactic Treatment I had a patient who took a single 200 mg dose of doxycycline within 24 hours of removing an engorged tick, thinking it would prevent Lyme disease. Unfortunately, seven months later, he was chronically ill with Lyme disease. He never developed a rash, and his lab tests for Lyme disease were negative. He eventually resolved his chronic illness with doxycycline followed by a combination of atovaquone and azithromycin. Co-Infections and Their Impact Ticks can harbor multiple infections, not just Lyme disease. In the Northeast, common co-infections include Ehrlichia, Anaplasmosis, Babesia, and Bartonella. These can lead to acute and chronic illnesses such as Lyme arthritis, Lyme carditis, chronic neurologic Lyme, Postural Orthostatic Tachycardia Syndrome (POTS), and Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). The Need for Effective PreventionEffective prevention following a tick bite remains a challenge. One study found that a ten-day antibiotic course failed to prevent Lyme disease. Another study suggested that a single 200 mg dose of doxycycline could be effective if taken within 72 hours of a deer tick bite in endemic areas.However, a single dose of doxycycline hasn't been shown to prevent common Lyme disease manifestations like Lyme arthritis, Lyme carditis, Lyme meningitis, POTS, or PANS. It also doesn't prevent co-infections such as Babesia. Concerns with Single Dose ProphylaxisA single dose of doxycycline raises several concerns. It may prevent the erythema migrans rash, which is crucial for early diagnosis and treatment. It might also prevent a positive test result needed to confirm Lyme disease early.Discussing Treatment Options I discuss with my patients the risks of prophylactically treating with a single dose of doxycycline versus not treating at all. I've seen patients return with acute and chronic neurological symptoms after a single dose of doxycycline.I generally follow two approaches. Some patients are monitored closely without treatment and followed up after a month to check for any signs of Lyme disease or co-infections. Blood tests can be helpful in these cases. Other patients are treated for 3 to 4 weeks with a follow-up to assess the outcome.  Patients and their families unfamiliar with Lyme disease are more likely to opt for monitoring. Those with prior experience with Lyme disease often agree to antibiotic treatment with follow-up. Conclusion We need a preventive measure that effectively prevents both acute and chronic manifestations of Lyme disease and its co-infections. Although we're not there yet, understanding these challenges helps us move closer to effective solutions. Thank you for watching, and stay tuned for more insights on Lyme disease.

Welcome! Today, we're exploring the key milestones in Lyme disease research and treatment.I had a 57-year-old patient who remained chronically ill after being diagnosed and treated for Lyme disease. He didn't realize that a persistent tick-borne infection could explain his chronic illness. He was treated with a combination of azithromycin and atovaquone for the persistent infection, and today, he is doing well.He was surprised that, despite the milestones in Lyme disease research, he wasn't aware that a persistent infection could lead to his chronic illness. So, let's take a closer look at these milestones.1. 1977: Discovery of Lyme DiseaseOur story begins in 1977 in Lyme, Connecticut. A cluster of children and adults were diagnosed with what was initially thought to be juvenile rheumatoid arthritis. This event marked the identification of Lyme disease as a distinct illness and the start of modern Lyme disease awareness."2. 1982: Discovery of the Bacterium Responsible for Lyme DiseaseIn 1982, Dr. Willy Burgdorfer identified Borrelia burgdorferi, the bacterium responsible for Lyme disease. This discovery was a major milestone, enabling more precise identification and treatment of the disease. 3. 1990: Recognition of Chronic Lyme DiseaseBy 1990, chronic Lyme disease, with its long-term and persistent symptoms, was officially recognized. This led to more comprehensive treatment protocols and increased awareness of the disease's chronic nature.4. 1995: Discovery of Babesia microtiIn 1995, Babesia microti was identified as a co-infection transmitted by the same ticks that carry Lyme disease. This highlighted the complexity of tick-borne illnesses and the need for integrated treatment approaches. 5. 2000: Publication of IDSA and ILADS GuidelinesThe year 2000 saw the publication of treatment guidelines by both the Infectious Disease Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS). These guidelines showcased different approaches to treating Lyme disease, marking another significant milestone. 6. Ongoing Research and Future Milestones Research is ongoing, and we look forward to future milestones that could lead to breakthroughs in diagnosis and treatment. Studies on biofilms, persisters, and tick-borne co-infections may enable doctors to develop treatment plans that significantly improve patient outcomes.ConclusionUnderstanding these milestones helps us appreciate the progress made in the fight against Lyme disease. With continued research and dedication, we move closer to effective management and potential cures. Thank you for watching, and stay tuned for more insights on Lyme disease." 

Welcome! Today, we're discussing the treatment of Babesia and Lyme disease, focusing on real patient experiences and effective treatment strategies.I had a patient who remained chronically ill six months after treating for Lyme disease. Despite exhaustive evaluations, she was still symptomatic. Her antibody tests came back positive for Babesia, although her thick smear and PCR were negative. She believed Babesia was asymptomatic since it wasn't seen in her red blood cells, but she was very symptomatic. Babesia is a parasite transmitted by the same deer ticks that carry Lyme disease. Some patients have Babesia parasites visible in their red blood cells under a microscope, usually seen at the onset of the illness for one to two weeks. In some cases, especially in the elderly or immunocompromised, the parasite can persist longer, leading to severe illness requiring intensive care." Some Babesia patients don't experience acute, life-threatening illness and might not have visible parasites in blood smears. Instead, positive antibody tests for Babesia, such as IgM and IgG for Babesia microti or Babesia duncani, can indicate the presence of the infection. I've seen positive Babesia duncani tests even on the east coast, suggesting the need for further research. I've had patients who, despite negative tests, improved after Babesia treatment. These patients often failed treatments for Lyme disease, Anaplasmosis, Ehrlichia, and Bartonella for months or years, unaware that Babesia could be a co-infection. For Babesia treatment, I avoid quinine and clindamycin due to their higher rate of side effects. Instead, I recommend atovaquone combined with azithromycin, which is more tolerable. Atovaquone is marketed as Malarone and Mepron in the USA. Malarone is a pill, while Mepron is a thick yellow liquid. Malarone is generally less expensive and more convenient. Malarone also comes in a pediatric dose, making it easier to tolerate for patients with an upset stomach or those concerned about a Herxheimer reaction. I usually prescribe 30 days of atovaquone, longer than the 10 days suggested by some studies, as my patients often aren't treated at the onset of their Babesia infection." I combine atovaquone with azithromycin and discuss the risks of azithromycin versus untreated Babesia. If necessary, I consult a cardiologist to rule out prolonged QT interval and treat for the same duration as atovaquone." If a patient can't take azithromycin or if there's a possibility of co-infection with Anaplasmosis or Ehrlichia, I may substitute doxycycline. For patients failing atovaquone with azithromycin, tafenoquine (Arakoda) has been introduced as an alternative. Although it's currently difficult to obtain, it has shown some success in persistent Babesia cases." Atovaquone is often covered by prescription plans, and services like GoodRx can reduce the cost to less than $80 in some communities. This makes it a viable option for many patients. Conclusion Treating Babesia is often overlooked in patients with recurrent or prolonged illnesses. With ongoing research and new treatments, there's hope for better management and outcomes for patients with Babesia and Lyme disease. Thanks for watching, and stay tuned for more insights on managing tick-borne diseases."

Persistent Tick-Borne InfectionA patient came to me with Post Treatment Lyme Disease Syndrome (PTLDS) after completing a four-week course of treatment for Lyme disease. Despite the treatment, she continued to suffer from headaches, fatigue, sleep disturbances, memory problems, and joint or muscle pain. She was diagnosed with PTLDS, and her condition was largely dismissed as a chronic immune response. Initially, she believed that PTLDS was purely an immune response. However, she didn't know that PTLDS could also be caused by a persistent tick-borne infection. After a year of living with PTLDS, she was treated for Lyme disease and a co-infection with Babesia using a combination of Zithromax and Malarone. This treatment resolved her PTLDS symptoms. History and Debate:The medical community has long debated the nature of chronic Lyme disease. In 2000, some doctors published guidelines that questioned the existence of chronic Lyme disease as a distinct condition, leading many to believe there was no evidence supporting chronic Lyme disease.In contrast, in 2004, I collaborated with colleagues in the International Lyme and Associated Diseases Society (ILADS) to publish guidelines affirming the existence of chronic Lyme disease. Despite this, the debate continues, with doctors divided over the existence and causes of chronic Lyme disease. Current Perspectives: Some doctors now acknowledge that Lyme disease and other tick-borne illnesses can lead to chronic conditions, referring to it as Post Treatment Lyme Disease Syndrome (PTLDS). However, they often describe PTLDS as resulting from an immunologic process, without being informed of the possibility of a persistent infection.Clinical Observations: In my practice, I've seen patients with PTLDS who improved after being treated for persistent infections. This suggests that in some cases, ongoing symptoms may be due to an unresolved tick-borne infection rather than solely an immune response.Conclusion: The case of my patient, who found relief through additional treatment for persistent Lyme disease and a co-infection, highlights the importance of considering persistent infections in patients with PTLDS. While the medical community remains divided, it's crucial to explore all potential causes of chronic symptoms to provide the best care for patients.

Case Study 1: Missed Co-InfectionI had a patient who didn't get better after a month of doxycycline for Lyme disease. Six months later, she was still sick. It turned out that the deer tick bite also transmitted Babesia, a co-infection. After treating her with azithromycin and atovaquone, she recovered successfully.Case Study 2: Unrecognized TransmissionAnother patient unknowingly had Babesia and donated blood. The recipient of the blood transfusion developed Babesia as a result.Rising Awareness of BabesiaAs we enter another summer, it's important to recognize that Babesia is an increasing concern as a tick-borne pathogen. The first case of babesiosis caused by the B. microti parasite was identified in 1969 in a person who had vacationed in Massachusetts. Research by Krause and colleagues in 1998 found that 24 out of 46 untreated Babesia-infected subjects had Babesia DNA in their blood for an average of 82 days.Serious Health RisksBabesia can lead to serious health issues, including atrial fibrillation, noncardiogenic pulmonary edema, and anemia. In New York, between 1982 and 1991, seven people with Babesia died. On Nantucket Island, another patient developed pancarditis and died.Chronic IllnessI've seen patients remain chronically ill until they were treated for Babesia. This highlights the importance of considering Babesia in patients who don't respond to standard Lyme disease treatments. Transmission RisksBabesia can be transmitted through blood transfusions and, though rare, from a pregnant mother to her unborn child. Pregnant women should take extra precautions to avoid tick bites and exposure to infected animals. If infection occurs, immediate medical attention is crucial to protect both the mother and baby.Treatment OptionsTreating Babesia typically involves a combination of antimicrobial medications. The standard treatment includes atovaquone and azithromycin. Clindamycin and quinine are also used but have more side effects. Recently, a new drug called tafenoquine has been introduced for patients who relapse after standard treatment. According to a study by researchers at the Yale School of Public Health, adding tafenoquine can be a lifesaver for vulnerable patients.Treatment ManagementThese treatments can effectively reduce the parasite load in the blood and alleviate symptoms. It's important for patients to complete the full course of treatment to prevent relapse and ensure the parasite is fully eradicated. For patients with weakened immune systems or the elderly, longer or repeated courses of treatment may be necessary.ConclusionBeing vigilant about Babesia, especially in patients who don't respond to Lyme disease treatments, can make a significant difference. Proper diagnosis and treatment are crucial for effective management and recovery.

I had a patient who was quite reluctant to consider antibiotic treatment for Lyme disease after being unabIe to tolerate his initial treatment.  He was able to tolerate treatment by starting.   with a lower dose of antibiotics. I have patients with issues with gastroparesis, leaky gut, diarrhea, candida, yeast, constipation, and irritable bowel that has made it difficult to tolerate antibiotics.  I have patients who have had a Herxheimer reaction after an antibiotic for another conditions. A Herxheimer reaction also known as Jarisch-Herxheimer reaction (JHR) is a transient clinical phenomenon that occurs in patients infected by spirochetes who undergo antibiotic treatment.  I have patients who cannot swallow pills and others who cannot tolerate liquids. I refer my patients to specialists as needed to determine if there is another underlying cause for their difficulties with medications.  I refer to gastroenterologist if rule out other causes for stomach problems. I refer to other specialists to rule out an autonomic disorder as a cause for their stomach issues. I also have patients who are still sick after changes in their diet and alternative medicine.  I review the risk of antibiotics against the risk of remaining sick with Lyme disease.  Some of these patients are still unwilling to consider antibiotics.  I advise my patients to avoid alcohol and processed sugars.Here are a few treatment options I have incorporated in my practice for those willing to be treated. I introduce treatment slowly. I start out with single therapy rather than combination therapy.  I have started patients with 50 mg of doxycycline instead of 100 mg. I have started with 25 mg of doxycycline at times with a liquid formulation.  I  have lowerd the dose of cefuroxime from 500 twice a day to 250 twice a day. I have prescribed Zithromax 250 every other day or every third day as Zithromax has a long half-life. I have lower the liquid atovaquone at 750 mg twice a day to atovaquone at 250 mg twice a day or a pediatric dose of atovaquone at 62.5 twice a day. The lower doses of atovaquone are available in an oral form combined with proguanil. I have start with once a day for some patient.  I typically raise the dose if tolerated. I find the lower doses helpful in some patient without having to increase the dose. I have not found intravenous ceftriaxone as helpful as I would like. IV ceftriaxone enters the stomach through the circulatory system leaving me with the same gastrointestional issues. Moreover, intravenous ceftriaxone is not the treatment of choice for tick-borne co-infections.I follow by patients starting at one month to determine if they are tolerating the lower dose and to determine their response to treatment.  I advise my patient to contact me if they are having problem with tolerating the lower dose to work out a solution. 

Lyme Disease and Your DogWelcome to our educational series on Lyme disease. Today, we'll discuss how to protect yourself and your loved ones, including your pets, from tick-borne diseases.Let's start with a story. One of my patients took precautions by using DEET and wearing clothes treated with pyrethrum. He also had a dog that wore a tick collar and was checked for ticks regularly. Despite this, he woke up with a deer tick attached.Ticks can carry several diseases, not just Lyme disease. These include Ehrlichia, Anaplasmosis, Babesia, and the Powassan virus. It's crucial to be aware of these risks."Many patients use DEET, recommended by the CDC, for tick prevention. However, DEET is more effective against mosquitoes. I've had patients report tick bites despite using DEET."Pyrethrum is another option. It can be applied to clothing, but not directly to the skin. It's effective, but can cause side effects like dizziness and headaches. Also, its effectiveness decreases with washing." Risks with DogsDogs can increase your risk of tick exposure. They can pick up ticks outside and bring them into your home. Even with tick prevention measures, ticks can still be a problem.I recommend using a dust vac on furniture before sitting next to your dog. This can help reduce the risk of ticks in your home."It's best to avoid letting your dog sleep in your bed. Ticks can leave your dog and bite you without you noticing."Special Concerns for Pregnant WomenPregnant women need to be especially careful. Tick bites can pose risks to both mother and baby. Avoiding tick bites is crucial, and if you do get bitten, consult your doctor immediately."Practical AdviceHere are some practical tips:1. Use a dust vac on furniture before sitting with your dog.2. Avoid letting your dog into the bedroom.3. Perform regular tick checks on yourself and your pets after spending time outdoors.4. Pregnant women should consult their doctor if bitten by a tick." Conclusion While dogs are wonderful companions, they can increase your risk of tick exposure. By taking these precautions, you can protect yourself and your loved ones from tick-borne diseases. Thanks for watching, and stay tuned for more tips on staying safe from Lyme disease. 

This ebook is available on Dr.  Daniel Cameron's website at https://danielcameronmd.com/lyme-books/ His print book, ebook and audio book are available on Amazon.  https://www.amazon.com/Experts-Guide-Navigating-Lyme-disease-ebook/dp/B0C6H3T542?ref_=ast_author_mpbCall his office at 914-666-4665 if you would like to make an appointment.You can also follow his Lyme disease science blogs on his website https://danielcameronmd.com/lyme-science-blog/

This ebook is available on Dr.  Daniel Cameron's website at https://danielcameronmd.com/lyme-books/ His print book, ebook and audio book are available on Amazon.  https://www.amazon.com/Experts-Guide-Navigating-Lyme-disease-ebook/dp/B0C6H3T542?ref_=ast_author_mpbCall his office at 914-666-4665 if you would like to make an appointment.You can also follow his Lyme disease science blogs on his website https://danielcameronmd.com/lyme-science-blog/

This ebook is available on Dr.  Daniel Cameron's website at https://danielcameronmd.com/lyme-books/ His print book, ebook and audio book are available on Amazon.  https://www.amazon.com/Experts-Guide-Navigating-Lyme-disease-ebook/dp/B0C6H3T542?ref_=ast_author_mpbCall his office at 914-666-4665 if you would like to make an appointment.You can also follow his Lyme disease science blogs on his website https://danielcameronmd.com/lyme-science-blog/

This ebook is available on Dr.  Daniel Cameron's website at https://danielcameronmd.com/lyme-books/ His print book, ebook and audio book are available on Amazon.  https://www.amazon.com/Experts-Guide-Navigating-Lyme-disease-ebook/dp/B0C6H3T542?ref_=ast_author_mpbCall his office at 914-666-4665 if you would like to make an appointment.You can also follow his Lyme disease science blogs on his website https://danielcameronmd.com/lyme-science-blog/

The 988 Suicide & Crisis Lifeline, available by simply dialing 988, is a 24-hour, toll-free, confidential suicide prevention helpline available to anyone in suicidal crisis or emotional distress. When someone calls the helpline, his or her call is routed to the nearest crisis center. The Lifeline's national network, consisting of more than 250 local crisis centers, provides crisis counseling and mental health referrals day and night.This ebook is available on Dr.  Daniel Cameron's website at https://danielcameronmd.com/lyme-books/ His print book, ebook and audio book are available on Amazon.  https://www.amazon.com/Experts-Guide-Navigating-Lyme-disease-ebook/dp/B0C6H3T542?ref_=ast_author_mpbCall his office at 914-666-4665 if you would like to make an appointment.You can also follow his Lyme disease science blogs on his website https://danielcameronmd.com/lyme-science-blog/

This ebook is available on Dr.  Daniel Cameron's website at https://danielcameronmd.com/lyme-books/ His print book, ebook and audio book are available on Amazon.  https://www.amazon.com/Experts-Guide-Navigating-Lyme-disease-ebook/dp/B0C6H3T542?ref_=ast_author_mpbCall his office at 914-666-4665 if you would like to make an appointment.You can also follow his Lyme disease science blogs on his website https://danielcameronmd.com/lyme-science-blog/

This ebook is available on Dr.  Daniel Cameron's website at https://danielcameronmd.com/lyme-books/ His print book, ebook and audio book are available on Amazon.  https://www.amazon.com/Experts-Guide-Navigating-Lyme-disease-ebook/dp/B0C6H3T542?ref_=ast_author_mpbCall his office at 914-666-4665 if you would like to make an appointment.You can also follow his Lyme disease science blogs on his website https://danielcameronmd.com/lyme-science-blog/

This ebook is available on Dr.  Daniel Cameron's website at https://danielcameronmd.com/lyme-books/ His print book, ebook and audio book are available on Amazon.  https://www.amazon.com/Experts-Guide-Navigating-Lyme-disease-ebook/dp/B0C6H3T542?ref_=ast_author_mpbCall his office at 914-666-4665 if you would like to make an appointment.You can also follow his Lyme disease science blogs on his website https://danielcameronmd.com/lyme-science-blog/

This girl with Lyme disease contracted COVID-19.  She subsequently developed long COVID.  She was a participant in Survey of more than 900 individuals with a history of Lyme disease.  The first published paper can be found athttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10044022/

Dr. Cameron discusses Babesia in his new ebook "An Expert's Guide on Navigating Lyme disease."  This book summarizes his understanding of Lyme disease based on his first 600 Lyme disease science blogs and 35+ years of treating Lyme disease patients. The book includes over 200 published Lyme disease cases. Support his work by buying a copy of his ebook. His  ebook is only available on his website at https://danielcameronmd.com/store-navigating-lyme-disease/Or call Dr. Cameron's office at 914-666-4665.

This is a free audio addressing clinical presentations from Dr. Cameron's e-book. "An Expert's Guide on Navigating Lyme disease."  This book summarizes his understanding of Lyme disease based on his first 600 Lyme disease science blogs and 35+ years of treating Lyme disease patients. The book includes over 200 published Lyme disease cases. Support his work by buying a copy of his ebook. His  ebook is only available on his website at https://danielcameronmd.com/store-navigating-lyme-disease/Or call Dr. Cameron's office at 914-666-4665.

Dr. Cameron discusses Babesia in his new ebook "An Expert's Guide on Navigating Lyme disease."  This book summarizes his understanding of Lyme disease based on his first 600 Lyme disease science blogs and 35+ years of treating Lyme disease patients. The book includes over 200 published Lyme disease cases. Support his work by buying a copy of his ebook. His  ebook is only available on his website at https://danielcameronmd.com/store-navigating-lyme-disease/Or call Dr. Cameron's office at 914-666-4665.

Dr. Cameron discusses Pediatric Lyme disease in his new ebook "An Expert's Guide on Navigating Lyme disease."  This book summarizes his understanding of Lyme disease based on his first 600 Lyme disease science blogs and 35+ years of treating Lyme disease patients. The book includes over 200 published Lyme disease cases. Support his work by buying a copy of his ebook. His  ebook is only available on his website at https://danielcameronmd.com/store-navigating-lyme-disease/Or call Dr. Cameron's office at 914-666-4665.

Dr. Cameron recorded a meet the author discussion of his new ebook "A Expert's Guide on Navigating Lyme disease."   This book summarizes his understanding of Lyme disease based on his first 600 Lyme disease science blogs and 35+ years of treating Lyme disease patients. The book includes over 200 published Lyme disease cases. Support his work by buying a copy of his ebook. His  ebook is only available on his website at https://danielcameronmd.com/store-navigating-lyme-disease/Or call Dr. Cameron's office at 914-666-4665.

This is a free audio addressing pain from Dr. Cameron's e-book. "An Expert's Guide on Navigating Lyme disease."  This book summarizes his understanding of Lyme disease based on his first 600 Lyme disease science blogs and 35+ years of treating Lyme disease patients. The book includes over 200 published Lyme disease cases. Support his work by buying a copy of his ebook. His  ebook is only available on his website at https://danielcameronmd.com/store-navigating-lyme-disease/Or call Dr. Cameron's office at 914-666-4665.

Dr. Cameron discusses Neuropsychiatric Lyme disease in his new ebook "An Expert's Guide on Navigating Lyme disease."  This book summarizes his understanding of Lyme disease based on his first 600 Lyme disease science blogs and 35+ years of treating Lyme disease patients. The book includes over 200 published Lyme disease cases. Support his work by buying a copy of his ebook. His  ebook is only available on his website at https://danielcameronmd.com/store-navigating-lyme-disease/Or call Dr. Cameron's office at 914-666-4665.

Dr. Daniel Cameron released his e-book January 13, 2023. This book summarizes Dr. Cameron's understanding of Lyme disease based on his first 600 Lyme disease science blogs and 35+ years of treating Lyme disease patients. The book includes over 200 published Lyme disease cases. There is also space at the end of this book to share readers comments and engage with Dr. Daniel Cameron. His ebook is available only his website at www.DanielCameronMD.com.

This case highlights the findings from a COVID-19 & Lyme Survey.HIGHLIGHTSFindings: This cross-sectional study reveals a high symptom burden in 1,168 individuals with a history of Lyme Disease. The GSQ-30 measure of symptom burden for 616 individuals with a history of Lyme disease who were vaccinated against COVID-19 was significantly lower than the symptom burden for the 552 who were not vaccinated.Here are are a few of the case of individuals with Lyme disease who described side effects.CASE 1:“After about a week, I began to experience extreme fatigue, difficulties with my lungs (finding it harder to breathe), and heart palpitations. I also struggled to walk any distance as my body would become tired very quickly (these were symptoms I had not experienced for about four years since the start of my Lyme disease treatment).”CASE 2:“… got extremely ill, felt like the Lyme and babesia was activated and became as strong as it was before I began treatment (and I was very, very sick by then).”CASE 3:“… severe cognitive issues, arm/leg numbness, rage due to light and sound, purple legs sitting and laying down, no short-term memory, speech stuttering, severe word search, muscle weakness, balance, coordination, double blurred vision, dizziness, heavy head, like my head is balancing on a broomstick, and it is a medicine ball, headache around the base of my neck/skull, weight loss, severe fatigue. I would say my pain and fatigue symptoms were 3-4/10 and now they are 8-9/10. The cognitive/ speech/vision/memory problems and purple legs are post-vaccine.”more see blog at https://danielcameronmd.com/side-effects-covid-19-vaccines-lyme-disease/

These two cases highlight the findings from a COVID-19 & Lyme SurveyQuestion: What is the clinical presentation of someone with a history of Lyme disease who have contracted a COVID-19 infection?Findings: This cross-sectional Survey reveals a high symptom burden in 1168 individuals with a history of Lyme Disease. The symptom burden was the highest for the 288 individuals with a history of Lyme disease and a COVID-19 infection. Nearly one in five individuals with a history of COVID-19 and Lyme disease developed long COVID. Twenty were hospitalized.Meaning: Individuals with a history of Lyme disease and COVID-19 have a high symptom burden and are at increased risk of hospitalization and long COVID.

Dr. Cameron describes five individuals who shared their experiences with Lyme disease without having had contracted COVID-19 or taking the COVID-19 vaccine at the time of completing the survey. Their experiences highlight the findings from a COVID-19 and Lyme Disease Survey of 1,168 individuals, ages 12 and older, all with a history of Lyme disease.

 In this episode, Dr. Cameron will be discussing the case of a 21-year-old soldier who was dismissed from active duty after failing treatment for multiple illnesses including Lyme disease.The case was first described by Melanson and colleagues in a paper entitled “The Epistemic Fallacy: Unintended Consequences of Empirically Treating (Clinically Diagnosed) Chronic Lyme Disease in a Soldier.”1“A 21-year-old, Division 1 student athlete patient presented with heart palpitations and frequent unprovoked adrenaline rushes,” wrote the authors. His symptoms were initially dismissed as stress.

In this episode, Dr. Cameron will be discussing the case of a 26-year-old man who was diagnosed with mono-arthritis after his clinical evaluation overlooked the possibility of Lyme disease.

“An 80-year-old patient was admitted to the hospital after a fall, and subsequently developed an acute confused state requiring transfer to a neuropsychiatric unit,” writes Karrasch and colleagues in the journal Ticks and Tick-borne Diseases. [1]

In this episode, Dr. Cameron will be discussing the case of a 64-year-old woman with central nervous system involvement of the brain.The case was first described by Mullholand and colleagues in the British Medical Journal in a paper entitled “Central nervous system involvement of anaplasmosis.” 1A 64-year-old woman was hospitalized with a 24-hour history of confusion and lethargy. The following morning, her lethargy had worsened and she developed subjective fever, mild headache, nausea, vomiting and increased confusion, according to the authors.

Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing a case which examines the diagnostic value of a lumbar puncture in Lyme neuroborreliosis.The case was first described by Portales-Castillo and colleagues in the journal Cureus in a paper entitled “To Lumbar Puncture or Not to Lumbar Puncture.” The authors presented a case of “early disseminated Lyme neuroborreliosis with manifestations of facial palsy and painful radiculoneuritis as determined by clinical and serological criteria.”¹A 61-year-old woman was admitted to the hospital with an inability to close her left eye and an odd sensation on part of her face. She presented with erythematous raised circled rash and swelling on the base of the index finger of her right hand.

Welcome to another Inside Lyme Podcast with your host Dr. Daniel Cameron. In this episode, Dr. Cameron will be discussing the case of a 71-year-old woman who was initially diagnosed with Ehrlichia, a tick-borne illness but later developed Guillain-Barré Syndrome.

Drs. Horowitz and Cameron review the first results of the Lyme disease and COVID-19 survey.    We would appreciate your help in sharing your experience with Lyme disease  during this pandemic even if you have not had COVID-19 or taken the COVID-19 vaccine.   Here is the link to the Lyme disease and COVID-19 vaccine https://danielcameronmd.com/lyme-disease-covid-survey/You can hear more about these cases through his blogs, social media, and YouTube. Sign up for our newsletter to keep up with these cases.How to Connect with Dr. Daniel Cameron:Check out his website: https://www.DanielCameronMD.com/Call his office: 914-666-4665Email him: DCameron@DanielCameronMD.com Send him a request:  https://danielcameronmd.com/contact-daniel-cameron-md/Like him on Instagram: https://www.instagram.com/drdanielcameron/Join his Facebook group: https://www.facebook.com/danielcameronmd/Follow him on Twitter: https://twitter.com/DrDanielCameronSign up for his newsletter: https://www.DanielCameronMD.com/Subscribe and ring the bell: https://www.youtube.com/user/danielcameronmd/ Leave a review on iTunes or wherever else you get your podcasts.We, of course, hope you'll join the conversation, connect with us and other readers, ask questions, and share your insights. Dr. Cameron is a Lyme disease expert and the author "Inside Lyme: An expert's guide to the science of Lyme disease." He has been treating adolescents and adults for more than 30 years.Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.

In this episode, Dr. Cameron will be discussing the case of a 66-year-old man with Bannwarth syndrome with urinary retention in early Lyme disease.“Physicians need to be aware of the rare neurological manifestations of [Lyme neuroborreliosis] … Prompt diagnosis and treatment with antibiotics can reduce unnecessary imaging, patient anxiety, and, most importantly, avert debilitating complications.”Omotosho and colleagues described this case in an article entitled “A Unique Case of Bannwarth Syndrome in Early Disseminated Lyme Disease.”  Omotosho YB, Sherchan R, Ying GW, Shayuk M. A Unique Case of Bannwarth Syndrome in Early Disseminated Lyme Disease. Cureus. Apr 25 2021;13(4):e14680. doi:10.7759/cureus.14680You can hear more about these cases through his blogs, social media, and YouTube. Sign up for our newsletter to keep up with these cases.How to Connect with Dr. Daniel Cameron:Check out his website: https://www.DanielCameronMD.com/Call his office: 914-666-4665Email him: DCameron@DanielCameronMD.com Send him a request:  https://danielcameronmd.com/contact-daniel-cameron-md/Like him on Instagram: https://www.instagram.com/drdanielcameron/Join his Facebook group: https://www.facebook.com/danielcameronmd/Follow him on Twitter: https://twitter.com/DrDanielCameronSign up for his newsletter: https://www.DanielCameronMD.com/Subscribe and ring the bell: https://www.youtube.com/user/danielcameronmd/ Leave a review on iTunes or wherever else you get your podcasts.We, of course, hope you'll join the conversation, connect with us and other readers, ask questions, and share your insights. Dr. Cameron is a Lyme disease expert and the author "Inside Lyme: An expert's guide to the science of Lyme disease." He has been treating adolescents and adults for more than 30 years.Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.