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Lyme Disease

The Great Masquerader

First of all, it’s important to understand that there is no consensus in the medical community about how to test for, diagnose or treat Lyme disease. The Lyme patients who arrive at the office of any Lyme-treating physician typically do not have just the single infection of Lyme, Borrelia burgderfori (Bb). They usually have at least one, and sometimes as many as half a dozen other tick-borne infections (called co-infections) and a host of opportunistic infections such as Epstein Barr virus, yeast overgrowth, Mycoplasma and many others.

Video: Under Our Skin
A great video about Lyme Disease

Why it is called the Great Masquerader

Many people who have chronic Lyme (usually not treated immediately after infection, or with inadequate treatment remain sick for more than a year) are misdiagnosed with other things since the manifestations of Lyme can vary so widely. Some people may have all the symptoms, some people just one or two. The classic constellation of symptoms may include:
  • Fatigue – may be overpowering and debilitating
  • Sleep issues – either too much sleep or insomnia
  • Pain syndromes – joint pain, muscle pain, nerve pain, migraines
  • Neuropsychiatric – “brain fog,” mood swings, rages, depression, anxiety, OCD, neurosis, psychosis, loss of cognitive function
  • Gastrointestinal – an often-overlooked source of GI issues
  • Cardiac - heart block, other irregular heart rhythms and carditis
Less than 50% of Lyme patients remember a tick bite PMID 24749006, and among those who do, only about 10% get the classic bullseye rash. (Smith, 2002)
Most people aren’t tested for Lyme until the standard medical explanations have been thoroughly explored and exhausted without providing relief.

It’s a shapeshifter.

Literally. Bb has a mobile corkscrew form called a spirochete that can burrow through the tissues anywhere in the body. It can corkscrew into cells where it drops its cell wall.

This presents some difficulties:
  1. The antibiotics that work on the mobile form can’t make it inside cells. Different antibiotics are needed to reach inside cells.
  2. Regardless which antibiotics are used, the bacteria have dropped the outer coat proteins, so the antibodies the immune system produced to target and kill the spirochetes can’t recognize or bind to this cell-wall deficient form.
  3. In a stroke of eerie genius, the Borrelia organism can also coat itself in proteins and lipids from the host cell on its way in, effectively making it look like part of the body itself.
  4. Additionally, when Bb is presented with a threat such as antibiotics, it can enter a cyst/round body form that requires yet other antibiotics and help from different antibodies from the immune system to suppress the organism.
It’s complicated chasing down a bug that can produce an array of different outer surface proteins, each requiring a different immune response. It’s like a criminal with numerous disguises and detection-evasion skills.

Ticks – the dirty needles of the insect world.

This is Dr. Joseph Burrascano’s apt description of ticks. They don’t just carry Lyme. They carry dozens of microbes including bacteria, viruses, protozoa and other organisms.

Rocky Mountain Spotted Fever is carried by many different types of ticks including wood and dog ticks and can be fatal in a severe case if not promptly treated. The same is true of Powassan virus, Heartland virus, and a number of other emerging infections that are becoming more prevalent.

In addition to Bb, many patients are infected with other organisms when they are bitten by a tick. Common findings are Bartonella, Babesia, Mycoplasma and Rickettsial species, just to name a few. Occasionally we will find Tularemia or Brucella.

Patients with co-infections often have more severe and complex presentations. For those not fortunate enough to be treated promptly for Lyme upon infection, co-infections play a significant role in the symptom complex and can impact many body systems. In later stages, co-infections can be equally challenging as the Lyme itself to treat.

In chronic cases, we often treat multiple infections and downstream impacts on every body system. There is evidence for chronic persistence of each of these infections.

For more information about types of ticks and what they can carry visit https://www.lymedisease.org/types-of-ticks/

Testing

The most commonly used tests such as ELISA and Western Blot for Lyme rely on the body’s ability to produce antibodies. Those infected with Lyme have suppression of the B-lymphocytes, the white blood cells responsible for producing antibodies. Therefore, it is not at all unusual to see the sickest patients return negative antibody tests. In these cases we must use direct tests, meaning tests that look for the DNA of the microbe directly such as FISH, PCR and culture in samples taken from blood, urine, CSF, etc. Unfortunately, the sensitivity of all these tests is low.

The Western Blot has a much better sensitivity, but often isn’t ordered because the ELISA screening test misses over 50% of those who are actually infected.
  • Overall, the two-tiered system of testing for Lyme misses 56% of those infected. (Stricker 2007)
  • 52% of patients with chronic disease are negative by ELISA but positive by Western blot. (Donta 2002)
In our clinic, we always order the Western Blot and often order direct tests such as PCR or FISH as well. It’s not uncommon to have to run several tests before finding any evidence of infection.

The standard two-tiered testing espoused by the CDC and IDSA for surveillance of prevalence of the disease was NOT intended to be  adhered to as diagnostic criteria by clinicians. Please note the following excerpt from the MMWR 2007;56(23):573-576 CDC publication on the topic: For surveillance purposes, a reportable case of Lyme disease is defined as 1) physician-diagnosed erythema migrans >5 cm in diameter or 2) at least one objective late manifestation (i.e., musculoskeletal, cardiovascular, or neurologic) with laboratory evidence of infection with B. burgdorferi in a person with possible exposure to infected ticks. This surveillance case definition was developed for national reporting of Lyme disease; it is not intended to be used in clinical diagnosis.

By mainstream rationale, testing for Lyme is to be initiated with the ELISA, which has a sensitivity of approximately 50% as shown by published peer-reviewed studies. PMID: 8748261

Imagine if a screening test for HIV were only able to find 50% of the infected patients?! We would still have an AIDS epidemic on our hands.


Borrelia sensu strictu or Lyme disease in the strict definition.
The most frequently ordered tests on the market are only able to detect one strain, the B-31subtype of Borrelia burgderfori. The better tests are able to detect antibodies to Lyme caused by both the B-31 and the 297 strains of Borrelia burgderfori.

But wait, there are more!
Borrelia sensu lato or the larger Lyme family includes Borrelia afzelii and Borrelia garinii. These are transmitted by the hard bodied ticks of the Ixodes group, including Ixodes scapularis and Ixodes pacificus in the US, Ixodes ricinus in Europe, and Ixodes persulcatus in the Orient. In this age of easy global travel, we see many a patient who can clearly identify becoming ill while travelling abroad. We have to test specifically for these strains of Lyme sensu lato when there is a history of foreign travel.

Borrelia by any other name still feels like Lyme - The Relapsing Fever Group
There are other members of the Borrelia family that cause a Lyme–like illness known as Relapsing Fever. Like most things in the Lyme world, it’s hard to make sense of it all.

Lyme-like illness can be caused by members of the Borrelia family such as Borrelia hermsii, miyamotoi, parkeri, turicatae and others. These Borreliae are mainly carried by soft-bodied ticks of the genus Ornithodoros which can go a long time between blood meals, and can harbor these Relapsing Fever strains of Borrelia for years. These ticks, unlike hard-bodied ticks such as Ixodes feed very quickly, and can transmit infection in as little as 15 minutes. PMID: 18755384


Mice, chipmunks, squirrels and prairie dogs are important reservoir hosts for these strains of Borrelia, and many people become ill while staying in rustic cabins or camping where rodents are prevalent. Ticks can come out and feed on the cabin or tent dwellers at night. Since all tick saliva has anesthetic compounds in it, bites usually go unnoticed.

And then there is Borrelia recurrentis, which is transmitted by the body louse, and can therefore be spread from person to person by body lice. This bacterium also causes a Lyme-like illness the common symptoms of which include abdominal pain, fever, headache, confusion, vomiting, stiff neck, joint pain, and muscle aches. Linda Houhamdi, Didier Raoult, Excretion of Living Borrelia recurrentis in Feces of Infected Human Body Lice, The Journal of Infectious Diseases, Volume 191, Issue 11, 1 June 2005, Pages 1898–1906, https://doi.org/10.1086/429920

Be aware that in any area of the country or world ticks can transmit infections dangerous to humans of which Lyme is only one.

What to do if bit by a tick.

Proper removal of a tick:

  • Grasp as close to the skin as possible with tweezers and pull straight out.
  • Do not twist, poke, or otherwise aggravate the tick. Any agitation of the tick causes further regurgitation of infectious material from the midgut increasing the risk of infection.
  • Do not burn or cover with Vaseline


Save the tick for testing:

Igenex: https://igenex.com/product/tick-test/
Tick Report: https://www.tickreport.com/
Ticknology https://ticknology.org

Save tick in Ziploc bag or jar with a damp piece of paper towel or a green leaf.
Monitor area closely for any type of eruption. Be vigilant for any unusual symptoms.
Contact a Lyme-literate practitioner immediately if any symptoms occur.

Treatment for a tick bite

As previously stated, there is no consensus within the medical community about the proper approach to treatment of Lyme disease and the many associated infections. There is no cookbook approach, and no guidebook beyond what treatment should consist of immediately following a tick bite. Even on treatment of a tick bite the major factions in medicine disagree.

Therefore, before recommending any treatment, Dr. Barter will conduct thorough testing with reputable labs, discuss all available treatment options, and together with the patient decide the appropriate course for each person on an individual basis. Treatment may include:
  1. Herbals
  2. Pharmaceutical anti-microbials such as antibiotics, anti-malarial, anti-fungal, anti-viral or anti-parasitic medications as well as more advanced treatments
  3. Homeopathics such as LDI (Low Dose Immunotherapy) and other homeopathic preparations
  4. An aggressive detoxification regimen.
  5. An assertive immune support regimen.
  6. Appropriate systemic support for every body system – hormones, thyroid, digestion, sleep, musculoskeletal, cardiovascular, pulmonary.
  7. Appropriate treatment for co-infections is crucial and often-overlooked.
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