PRESS RELEASE
November 4, 2010
MALADIES IN MEDICINE
Although the main reason for writing this piece is to elucidate the diagnosis and treatment of Tick Borne Diseases (TBD), I would like to firstly touch on other areas of concern, and then make a connection. In my thirty-one years of practicing medicine, in addition to a busy rural practice, I have also been interested and active in wellness, chelation and metal toxicity.
A recent report by Dr. John Ross concludes that more proactive measures have to be taken to decrease health care costs. In fact, a 1979 Canadian Task Force study on preventive health services delineated some of these activities. Coincidentally, it was at that time that I began the work of medicine in rural Cape Breton and incorporated periodic health exams as part of routine patient encounters. I attempted to bring this knowledge to the general public by authoring (over a four year period) the Body Owner’s Manuals. This endeavor lead to a comprehensive wellness approach and a soon to be launched on line wellness site. From a wellness perspective, one sees individuals who may require education in health promotion, illness and injury prevention, and self-care knowledge. This person only becomes a patient when they require professional treatment. Unfortunately, there has never been a fee code that recognizes and remunerates for preventive health services.
In 1990, I was the first physician to perform chelation therapy in Nova Scotia. Shortly thereafter, chelation therapy for vascular disease was banned by the Nova Scotia Medical Board without any valid reasons other than to possibly protect vested interests. For the past thirty years, chelation therapy has been performed around the world. I continued to administer this procedure with patients’ knowledge that it was preventive rather than curative. Although anecdotal, I have seen vascular disease improve to the point that chest pain from coronary artery disease was eliminated even when a patient was denied bypass and angioplasty due to the severity of their disease. Failed bypasses and angioplasties also responded well to chelation. I have also seen peripheral vascular disease reversed to the point that planned amputations were avoided. Despite persistent media reporting that this therapy is controversial and/or dangerous, several million treatments have been performed globally. Its safety can be verified by the fact that the National Institutes of Health, Duke University, and a traditional cardiologist at Mount Sinai, Miami have collaborated on a thirty million dollar Trial to Assess Chelation Therapy (TACT) using the same protocol taught by the American College for Advancement in Medicine (ACAM). I am proud to be one of ten research centres in Canada.
My interest in metal toxicity lead me to investigate the toxic effects of cigarette smoking on vascular disease and cancer. Of 220 subjects whose urine was analyzed for metal toxicity, 75% of those who smoked cigarettes had above reference range levels of cadmium, antimony and barium. Cadmium and antimony area used to decrease the time over which cigarette paper burns. Barium is used to whiten the paper. Both cadmium and antimony have been strongly implicated in causing hypertension and vascular disease. Cadmium has been listed as carcinogenic since 1993. Since these metals have such long half-lives, their effects may persist even after one discontinues cigarette smoking. Oral chelation therapy could easily reduce the metal burden in these individuals and likely deter the diseases they cause.
The reason I am addressing these subjects is to remind the public that wellness and chelation therapy have been available for many years. For various reasons, a personal wellness approach that would encourage people to be healthier and decrease health care costs has not occurred. For other reasons chelation therapy has been more denigrated than sought to be studied. I have no doubt that increased use of this treatment would save the public health system enormously by decreasing the need for angioplasty, by-pass and amputations.
What has happened over the past 20 years in the United States, and for a shorter time in Canada, regarding Lyme disease reminds me of what I have experienced in both wellness and chelation therapy. The hesitancy to diagnose and treat, the development of overly strict guidelines, and the intimidation of those who who suspect and would like to treat infections is like déjà vu.
This presentation is intended to inform the public, physicians and media about what I have learned regarding tick-borne diseases. My education has come from articles, books, a workshop by ACAM, and a conference by the International Lyme and Associated Diseases Society (ILADS). More importantly, my education has resulted from listening in great detail to many patients whose lives have been affected by these infections.
There is lots of biology behind tick-borne diseases. Migratory birds, and in particular the increased number of geese, carry infected ticks. These ticks are dropped off in fields and find hosts in rodents, rabbits and deer. They are then dropped on to grasses and ground to await transfer to a human. The increased population of ticks is also enhanced by climate change and decreased winter die off.
Ticks can harbor and transfer more than one infection to the same person. One of these infections is Borrelia, otherwise known as Lyme disease. The other possible infections are Bartonella, Babesia, Mycoplasma, Erllichia, Chlamydia and viruses. From my experience, Bartonella may be the most common of these possible infections.
Infected individuals usually are exposed from outdoor hobbies, recreation and work. Up to 50% of infected patients may not remember a bite, see a tick nor have a rash. They are usually previously healthy people who develop flu like illness (mild or severe) and then go on to have numerous symptoms affecting all body systems.
Testing for the different TBDs is unreliable. The ELISA anti-body test is for classic Lyme (borrelia) only and it is often false negative. It doesn’t help that in most jurisdictions only a positive result warrants the Western Blot test. It also doesn’t help that the Centre for Disease Control (CDC) and the Infectious Disease Society of America (IDSA) and its Canadian counterpart have dropped two bands from these tests which thereby often excludes infected patients by this misleading criteria. The ILADS physician’s group recommends using a combination of the IgM and IgG bands in the Western Blot test for Borrelia. DNA testing may be helpful in recognizing Bartonella and Babesia.
A complicating factor is that Borrelia can exist in different forms making it more difficult to treat. It may also alter the host’s immune system and thereby decrease an antibody response. Also of note is the fact that Babesia and Bartonella can be intraerythroctiic making their eradication more difficult.
Since a TBD is a clinical diagnosis, symptomatic presentation with testing being contributory but not definitive is seen as the best approach. If Bartonella is suspected, it should be treated first, or at least at the same time as another.
A trial treatment of antibiotics is helpful in the diagnosis of TBDs. A patient may become more ill for a short period of time from an appropriate antibiotic due to the release of toxins when bacteria are broken down. This is known as a Herx heimer reaction. On the other hand, the patient may initially get better from the antibiotic treatment. Either way, if an antibiotic is creating a reaction, an infection is quite likely. Uninfected individuals should have no response to an antibiotic.
Different TBDs can cause similar generalized symptoms such as chills/sweating; fatigue; brain fog; headaches and joint pain. Specific symptoms can help to clinically differentiate the main TBDs. Borrelia (early localized) tends to cause a bull’s eye rash (erythema migrans) at the tick bite area, flu like illness with fever, chills, and myalgia. This may progress (early disseminated) to secondary skin lesions, fatigue and malaise, headaches, neck stiffness, migratory joint/muscle/tendon pain, heart dysrhythmias, irritability, decreased memory, and testicular pain. Bartonella tends to cause a streaky or blotchy red rash, possibly itching and burning; fever, headache, malaise; and regional lymph node enlargement/tenderness. Babesia tends to cause a sudden onset of severe, drenching night sweats, severe headaches and fatigue.
Acute Borrelia can be treated with Doxycycline 200-400mg daily, Amoxicillin 500mg TID, or Biaxin 500mg BID. Acute Bartonella can be treated with Doxycycline 200-400mg daily, Levaquin 500mg OD, or Gentamycin I.V. Acute Babesia can be treated with Mepron 750mg BID or Malarone 250mg BID and Zithromax 250mg OD.
Chronic (i.e. infected more than one year) TBDs can be differentiated by asking about original acute presentations. Chronic (late stage persistent) Borrelia presents with fatigue, brain fog, memory loss, headaches, decreased cognition, word searching, slurred speech and large/symmetrical joint pain. Chronic Bartonella presents with fatigue, sleep disturbances, afternoon/evening sweats, brain fog, ice pick headaches, pressure behind eyes, recurrent sore throats and sinusitis, conjunctivitis, decreased vision, floaters, neck stiffness, decreased cognition, word searching, jaw pain, submandibular lymphadenitis, numbness around mouth, irritability, anxiety, antisocial behavior, numbness/tingling in fingers/toes, feeling hot inside without fever, pain/stiffness small joints, muscle pain/tenderness/fasciculations/tremors, costal margin pain/tenderness, abdominal pain and bloating, unprovoked low back pain, painful soles, generalized itching, crawling sensation under skin, subcutaneous tender nodules, photophobia, sonophobia, and tachycardia. Chronic Babesia presents with fatigue, heavy night sweats, sleep disturbances, pressure headaches, poor short term memory and concentration, blurred vision, dizziness, vertigo, difficulty with directions, getting lost in familiar places, depression, fear, nightmares, dry cough, air hunger, tinnitus, petechiae, heart palpitations, and tachycardia. Note that some symptoms overlap.
Chronic TBDs become more difficult to treat. One’s immune system is usually weakened and should be strengthened before treatment begins. Supplements such as multi vitamins/minerals, B complex, Vitamin C 1g, Vitamin D 1000 i.u., omega 3, co-enzyme Q10 and magnesium should be taken twice daily. They should be used for one to two weeks before treatment begins. Once treatment is initiated, a probiotic must be added to prevent gastrointestinal problems.
Chronic Borrelia can be treated with a combination of Biaxin 500mg BID and Plaquenil 200mg BID or Flagyl 500mg BID. In severe or poorly responsive cases, Rocephin 2g iv BID four days on and three days off may be required. Chronic Bartonella can be treated with Levaquin 500mg OD (watch for Achilles tendonitis) or Rifampin 300mg BID (do liver enzymes biweekly) with Doxycycline 200mg BID or Bactrim DS BID. Chronic Babesia can be treated with Mepron 750mg BID or Malarone 250mg BID with Zithromax 250mg OD. Artemesia annua is also helpful.
Other measures that are necessary to ensure a positive outcome are a healthy diet, exercise as tolerated, and no cigarette smoking nor alcohol consumption.
Because Borrelia can exist in different forms and because Babesia and Bartonella may be intracellular, total eradication of infectious organisms can be difficult and lengthy. The type of antibiotics may have to be changed. Eradication of one infectious agent may result in exacerbation of symptoms of another infection. Nevertheless, the ultimate goal is eradication of any existing TBDs and returning a person to their previous healthy status. This may take a considerable period of time but it is most gratifying to see how multiple symptoms will gradually be alleviated. Patients are often extremely grateful for being finally recognized for what they often see as the diagnosis but have been denied serious attempts at recognition and treatment.
Some issues need to be addressed. Ticks that are being tested for possible infections should be tested for at least the common TBDs, not just Borrelia. Other insects, especially fleas and mosquitoes, may also be transmitters. For patient testing, the two-tiered approach should be abandoned. Western Blot testing should be available for highly suspected cases even when an ELISA test is negative. DNA/PCR testing should be available for Bartonella and Babesia. The Vascular Endothelial Growth Factor (VEGF) test might help with Bartonella detection. Clinicians should be aware that TBDs could cause unidentified bright objects (UBOs) on MRIs and oligoclonal banding in CSF samples, creating confusion with multiple sclerosis. TBDs can cross the placenta and cause in utero infection. Bartonella can be transmitted through saliva. Borrelia, like syphilis, can be sexually transmitted. There is a distinct possibility that many patients may have been misdiagnosed with fibromyalgia, chronic fatigue syndrome, or MS when they may have a TBD. There is also a possibility that infected people may be donating blood. General practitioners should not be intimidated into not treating when they are very suspicious of the diagnosis. To tell a patient that a two to four week treatment should definitely have treated a possible TBD is as erroneous as stating that a cellulitis only requires a ten day oral antibiotic treatment. The sooner these infections are recognized and properly treated, the better the outcome. Many unrecognized, untreated, or under treated people have spent years in misery, lost work, burdening family members and creating financial hardship. Finally, Tick Borne Diseases are not controversial, they’re very complicated! They are here and unfortunately they can be difficult to recognize and treat. Like many other diseases, we physicians just have to learn, listen and try to help as much as we can.
Dr. C. Ben Boucher, BSC, MD