Lyme Disease and Tickborne Illness
Dr. Tichauer is currently the only ILADS certified “Lyme-Literate” Physician in the Rogue Valley. He received a prestigious Lyme specialty fellowship training in addition to mentoring with other well-known doctors more than a decade ago. Since that time, he has dedicated his practice to successfully understanding and treating chronic Lyme disease.
Many of the patients seen for Lyme Disease at our clinic have been to numerous health care providers seeking a diagnosis and explanation for their illness. At Bear Creek Naturopathic Clinic, we understand the struggle to find a knowledgeable physician able to offer successful treatment for your symptoms. Described as “the great imitator”, Lyme disease can produce a huge array of debilitating and functionally disruptive symptoms which are frequently misdiagnosed or attributed to a neuro-emotional cause.
Originally discovered in 1982 in Lyme, Connecticut, Lyme disease has been the most under-diagnosed and least understood illnesses of the 21st century. Categorized as the fastest spreading vector-borne illness in the country, the CDC estimates that there are up to 300,000 newly acquired cases per year, making Lyme an epidemic larger than AIDS, West Nile Virus and Avian Flu combined.
Lyme disease is classically defined as an infection caused by the spirochete bacteria, Borrelia burgdorferi (Bb); although, many other species of Borrelia can cause similar symptoms such as Relapsing Fever Borrelia (RFB). With over 5 subspecies of Borrelia burgdorferi and over 100 strains in the US and 300 strains worldwide, the diversity of the genus is thought to contribute to both the difficulty of obtaining an accurate diagnosis as well as maintaining long term remission.
In as many as 70% of cases, Lyme disease is accompanied by other co-infected tick-borne organisms that commonly require different natural antimicrobial or antibiotic therapies. The presence of these co-morbid infections can complicate and prolong treatment duration and is frequently a reason for prior treatment failure when left undiagnosed.
The primary route of transmission is from an infected blacklegged (deer) tick which can produce the characteristic Erythema Migrans rash. Traditionally described as a “bulls-eye” in appearance, the rash infrequently shows this classic appearance and is more commonly solid pink to red. Studies show, however, that only about 30-40% of newly acquired cases have any rash at all, so this is not a requirement for diagnosis.
On the West Coast in particular, infections are often acquired from the poppy-seed sized nymphs (due to the Western Fence Lizard, a preferred host for adult ticks, which has a protein in its blood that destroys the Lyme bacteria). For this reason, many people likely scratch the tick off unknowingly. It is estimated that fewer than 50% of people, and as little as 15% in some cases, recall ever having a tick bite at all! Ticks such as the lone star and dog tick, can carry other infectious agents such as Ehrlichia, Anaplasma, Rickettsia, Babesia and possibly Bartonella.
Other suspected routes of transmission include sexual transmission and possibly other vectors such as mosquitoes, mites and even spiders. Much of this data is, however, empirical and still being investigated. Since spirochetes travel in the bloodstream, it is possible to acquire a Lyme infection through a blood transfusion. Likewise, Lyme contracted during pregnancy has risks to the unborn child since the bacteria can be transmitted to the fetus. While data is not clear on the risk posed to the child, stillbirth or other medical complications have been correlated to infections in pregnancy. Currently, there is insufficient data to link Lyme transmission to breast-feeding.
Lyme disease can manifest with a wide array of symptoms ranging from fatigue and joint pain to serious cardiac and debilitating neurologic problems. The initial infection will often cause flu-like symptoms 7-21 day after acquiring the illness. This frequently progresses to involve fatigue, fevers, headaches, chills, joint and muscle pain and swollen lymph nodes. If left untreated or if inadequately treated, chronic and potentially more serious symptoms may develop.
A (partial) list of symptoms for the most common tick-borne diseases includes:
- Gradual onset/worsening of initial symptoms
- Multisystem involvement almost always (i.e. joint pain + fatigue + cognitive issues, etc)
- Migratory joint pain
- Stiff joints and loud crepitus/cracking with motion, especially neck.
- Headaches are often in the back of the head and are commonly associated with a stiff and painful neck.
- Afternoon fevers often with subnormal temps in AM.
- Moderate to severe fatigue and poor stamina/endurance.
- Symptoms seem to flare in 4 week cycles
- Muscle fasciculations/twitching and weakness
- Paresthesia/numbness and nerve pain; cranial nerve dysfunction affecting sensory organs such as visual acuity, smell, sound and balance.
- Sleep disturbance
- Bladder irritation and urgency
- Hypersensitivity to light and sound
- Chest pain; cardiac abnormalities especially racing heart and premature beats
- Neuropsychiatric symptoms – irritability, depression, anxiety, panic, mood swings that mimic bipolarity, rage and OCD
- Cognitive dysfunction causing short term memory loss, difficulty with word finding, conversational skills and executive function/problem solving skills.
- Gradual onset of illness; occasionally light sweats
- Disproportionately strong neurologic symptoms with more central nervous system involvement and peripheral neuropathic symptoms than musculo-skeletal symptoms
- Neuropsychiatric symptoms including rage, disorientation, hallucination and other more serious adjustment order issues.
- Crawling, burning sensations on body.
- GI upset, sore/burning sole of feet, AM fevers, swollen lymph nodes.
- Subcutaneous nodules on limbs, striations that appear as stretch marks in “odd” areas of the body like the thighs, low back and arms.
- Headaches that are severe ice-pick or stabbing in sensation; migraine level head pain.
- Elevated VEGF in some causing sensation of burning skin and feeling overheated.
- Rapid relapse in symptoms if treatment ended too soon.
- Abrupt onset of initial illness with high fevers, rigors and sweating, especially at night and often drenching; shaking chills
- Fatigue, global headaches that can feel like a ‘band’ that is creating severe pressure/squeezing.
- Dizziness, vertigo, tinnitus, chest pain, racing heart; labile or uncontrolled blood pressure.
- Severe muscle aching more than joint pain.
- Air hunger, dry cough, chronic sore throat
- Severe sleep disorders often with weird dreams or nightmares; severe anxiety, fear or panic
- Anemia and red blood cell rupture/hemolysis
- Very severe Lyme symptoms and poor response of Lyme to otherwise appropriate treatment
Ehrilichia and Anaplasma:
- Rapid onset of initial illness with fever.
- Headaches described as sharp and knife-like and behind eyes
- Low white blood cells and platelets
- Abdominal and/or right upper quadrant pain; often with unexplained elevations of liver enzymes
- Muscle pain, not joint pain which can be mild or severe
- Rapid response to treatment
- Gradual onset, may have sweats and symptoms that worsen with exercise
- Extreme fatigue and neurologic dysfunction, metabolic disturbances and immune dysregulation
- Extreme myalgia and skin sensitivity.
- Severe joint pain that is not migratory.
- Overlap symptoms with Lyme
- Other potential “co-infections” which may be transmitted from an infected tick include Chlamydia pneumoniae, Coxiella (Q-Fever), Brucella, Tularensis, Rocky Mountain Spotted Fever and Rickettsia typhi, nematodes, and many known (and likely unknown) viral and parasitic/protozoal organisms.
Many people continue to have symptoms beyond their original treatment course. Commonly referred to as chronic Lyme disease, this can be due to many potential reasons including inadequate treatment duration following infection, inappropriate medication(s) or therapies and still undiagnosed or untreated co-infections. All of these issues can be properly addressed by taking a careful history, re-examining lab data, creating symptom correlates and, at times, assessing response to a targeted natural or pharmaceutical trial.
Unfortunately, there is also the little understood phenomena called post-treatment Lyme syndrome which refers to those patients that continue to have lingering symptoms despite appropriate treatment. This is a problem that, for unknown reasons, afflicts women almost twice as frequently as men. It is important to distinguish this type of illness from chronic Lyme disease although both share certain common features including persistence of the Borrelia bacteria and immune dysfunction. Unique to post-treatment Lyme syndrome, however, is the autoimmune-like nature of the illness which creates a chronic inflammatory response.
Whether chronic Lyme or post-treatment Lyme syndrome, it is important to deal with the underlying cause of your health condition in order to properly resolve it. Each condition can cause debilitating fatigue, mood related disorders such as depression, bipolar disorder and panic as well as persistent pain, muscle twitching, weakness, hormonal dysregulation, urinary symptoms, nerve sensitivity, numbness, tingling and visual disturbance. Left untreated, more serious concerns such as Lyme carditis, blood clots and strokes, multiple sclerosis, dementia/Alzheimer’s disease, and ALS become long term concerns.
Having successfully managed hundreds of Lyme patients, Dr. Tichauer has created an effective system for both diagnosing and treating each of these two chronic subgroups.
It is very common to hear of people suffering from a constellation of signs and functional symptoms which are left unexplained even after visits to numerous doctors and specialists. With many clinicians focusing on a part rather than the whole, diagnoses can be given out of exclusion or end up vague and describing the symptom itself such as “reactive arthritis”, “mixed connective tissue disorder”, “abnormality of the autonomic nervous system” , “unspecified immune dysfunction”, fibromyalgia and chronic fatigue syndrome. And, when it is not possible to label the illness accordingly, it is often diagnosed as psychological or delusional in nature.
While a tick bite can be an important clue, most people have no recollection of ever being bitten. Additionally, standard lab testing is primarily effective only at diagnosing acute, not chronic Lyme disease. It is estimated that the standard two-tier test recommended by the Center for Disease Control (CDC) may miss up to 90% of chronic Lyme disease cases and is, at best, no better than a coin flip in the end. The established diagnostic criteria for this test was never intended to effectively diagnose Lyme in human hosts but was instead designed as an epidemiologic tool to track the spread of Lyme disease.
Additionally, there is widespread lack of education amongst healthcare providers regarding the presence and geographical distribution of Lyme which many people still consider rare and isolated to New England. Denying that Lyme disease could even be a consideration, many physicians ignore the possibility altogether.
It should be emphasized that no test can replace the ability of an astute and well trained lyme-literate physician to make a clinical diagnosis based on history and symptoms. Lab testing for Lyme disease requires a physician that can appropriately interpret and understand the results. Having viewed thousands of lab results, Dr. Tichauer can help you to understand the difference between exposure, prior (effective or ineffective) treatment and active infection, as well as considerations for the “stage” of the illness.
For the initial diagnosis and re-assessment of a new patient, Dr. Tichauer commonly uses IGeneX. Either a traditional Western Blot or the more modernized Immunoblot can be used for this purpose. Testing for DNA in blood and serum can also be done to provide additional support.
Monitoring treatment success and assessing for treatment plan changes are often done with other labs that assess more ‘currently active’ lab markers.
Co-infection testing is determined based on the types of presenting symptoms either at the initial visit or after assessing initial response to treatment and changes to relevant lab markers. The most modern, well-validated and evidence-based labs are chosen to assist in making this assessment.
After a diagnosis is established, the standard of care in the treatment of Lyme disease involves prescription antibiotic therapy, ideally lasting 3-6 weeks. Unfortunately, unless this medication is provided soon after the tick-bite (ideally within 1-2 months for acute illness), conventional treatment frequently proves inadequate. Either left with unresolved symptoms or relapsing within 6 months, many people will continue to suffer with lingering physical dysfunction and a wide range of potential functional complaints. Dismissed as Post Treatment Lyme Syndrome or psychosomatic, up to 20% of initially treated patients will be left struggling with these still unresolved, sometimes debilitating problems.
Once established in the body, the bacteria can utilize many different strategies to optimize its own survival. These evasive maneuvers help it to resist treatment with antimicrobial agents and prevent immune recognition and destruction. This is one of the reasons why the sensitivity of traditional testing is 50% or less in chronic Lyme disease. Some of these more well understood strategies include but are not limited to:
- Formation of biofilms allows colonies to thrive safely away from the threat of immune attack or medications designed to kill it.
- Extra DNA, known as plasmids, provide the ability for the bacteria to change surface proteins; thereby, shielding it from immune recognition and reducing antibiotic efficacy.
- Altering its own morphology, Borrelia can transform into cell-wall deficient types (L-form), cystic states (round bodies) and metabolically inactive forms (persister cells). Present in chronic Lyme, each of these presentations needs to be addressed uniquely through targeted therapy.
- Residing in low oxygenated regions of the body with poor blood flow, such as joint spaces and ligamentous tissue, reducing immune efficiency and preventing medication from reaching high enough levels to eradicate the infection.
- Borrelia contains molecular mechanisms designed to disable an effective innate immune response and alter our bodies into generating an in-effective (TH2) inflammatory immune response.
Having successfully managed hundreds of patients, Dr. Tichauer has developed an understanding of how to best evaluate and treat patients with chronic Lyme disease. Key to this process is recognizing that everyone is unique and any therapy must be designed around each person’s individual case.
The first step to success is identifying whether a patient’s symptoms are due to an active infectious process or if they are secondary to a chronic inflammatory response syndrome (CIRS). While each scenario is ultimately due to the presence of the Borrelia bacteria or its associated proteins, the treatment approach taken for each situation is vastly different.
The second step is developing an understanding of what I call the “four principle elements” involved in chronic Lyme. I call this stacking the deck in your favor! The four components include:
- Knowing what infections are present. Over 60% of chronic Lyme cases involve more than one tick-borne organism. Given the overlap in symptoms, practitioner experience is essential in helping you to know what to test for and/or empirically treat. This also includes opportunistic viral illness, parasites and protozoal infection.
- Know your immune system. Perhaps the most challenging and least linear field in medicine, functional immunology has been one of the main focuses of personal education for Dr. Tichauer and is a topic that he has lectured on many times. Ultimately, the statement he tells patients is that, “your immune system can work for or against you.” Examining cytokines, the different types of immune cells, immunoglobulin status, indicators of inflammation type, autoimmune markers and immune functionality are all key to understanding how to best approach each patient.
- Know your exposures. Environmental illness is, unfortunately, becoming a big topic in medicine as we continually expose ourselves to an increasingly toxic world. Heavy metals, solvents, mold toxins, herbicides, pesticides, artificial foods and colors and radiofrequencies all contribute to immune dysfunction and mitochondrial problems with energy production. Toxic emotions from relationship issues or work dissatisfaction would also be included in this category. Commonly, one or more of these stressors will either precede the onset and development of illness and/or be a factor in why symptoms continue to persist despite appropriate treatment.
- Know yourself. Co-morbid conditions, unique to each person, are also big factors in resolving chronic Lyme. Overall, these issues represent underlying obstacles to restoring health. These numerous possibilities can ultimately be identified through a good medical history and adequate testing. Examples of problems in this category include:
- Nutritional deficiencies due to poor diet or digestive problems or constant low-grade inflammation from (non-histamine) immune reactions to foods (IgG and/or IgA).
- Genetic problems can underlie problems with detoxification, immune recognition/response (HLA genes) and neurotransmitter status.
- Prior existing illness such as diabetes, heart disease, autoimmune conditions, obesity, neurologic, apnea, mood disorders, gastrointestinal problems or endocrine/hormonal imbalance.
- Long-term structural problems or damage to our bodies from injury can affect how the nervous system communicates to our cells and can create scar tissue which becomes a reservoir for infections like Borrelia.
- Mental/Emotional/Spiritual dysfunction can suppress our ability to heal. Unhappiness, no matter what the source, may hamper your capacity to fully recover or attain your true potential.
Following an office visit with Dr. Tichauer and a lab assessment, it can be determined how to best begin the healing process that will ultimately lead you on your path toward health.
The uniquely individualized, multi-system integrative approach developed by Dr. Tichauer can dramatically increase the likelihood of both an accurate diagnosis and successful treatment. With more than 10 years as a Lyme specialist and over 15 years of practice in functional medicine, Dr. Tichauer commands a broad knowledge of both conventional and complementary medical therapies. If you are suffering from life-altering chronic symptoms, call us today at 541-770-5563 to schedule either an appointment or a free 15 minute consultation with Dr. Tichauer. It’s time to get the answers and the treatment you deserve.