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From the Townsend Letter
July 2013

Lyme Complex: Taxonomy and Treatment
A Dialogue between Eric Gordon, MD, and Wayne Anderson, ND
interviewed by Nancy Faass
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Pretreatment Therapies
Dr. Anderson: What we did wrong for years, going back 15 years, was to go right into antibiotic treatment. What we do right, now, is we look at all these other aspects. We try to clean up the gut, work on the liver, deal with a lymphatic system that is congested. So we're looking for all these other issues so we can support the patient. Consequently, the amount of treatment they need for their actual infection is much less. When we get to the point where we're treating the infection, we don't have all these other issues pulling on that person's energy, taking away from the person's vitality. Now their immune system can respond in a much more efficient way when we give it a specific antimicrobial.

The real take-home of all of this is that the herbal medicines have given us so many more tools. They have supported our patients in a way that has made us realize all these other metabolic and pathogenic issues are there, because we see them getting better when we treat with herbal medicines for fungal infections or for parasitic infections. Then we can gradually improve the patient's health, so that now we can treat their infections in a much more aggressive way. Many of my patients don't need antibiotics at all. I can get them all the way through the process herbally. If I can effectively peel off the layers in an efficient way, a certain percentage of patients never need to use antibiotics, because their infection really was not the main issue. It was all the other problems. Then the infection becomes minimal when the other issues are improved.

Dr. Gordon: Initially, we were seduced by the effectiveness of the antibiotics because they were amazing. I was treating very sick people with chronic pain. Working with Wayne, I discovered that these people who I thought had chronic pain because of an injury looked like his patients who had chronic Lyme – and then they began to respond to his treatment, so I started to realize that this was a very complex question.
Eventually we both decided to walk away from the IV antibiotics. We live in an area where there are some other practitioners with excellent reputations who had been doing IV antibiotics incessantly. So we used them, but we had great trepidation, great hesitancy about them because we saw the failures. We saw people who were on IV antibiotics literally for years in some cases and weren't any better, so we realized that it wasn't a panacea. The whole issue was confusing and still is; there are some folks for whom IV antibiotics are magic. They may have been sick for five to ten years and you put them on the right IV antibiotics and six weeks, eight weeks, three months later, they're getting better and better. Now, that's not the majority, but there are enough of these cases to make it clear that IV antibiotics aren't evil.

Dr. Anderson: Treatment protocol using antibiotics can be effective for many people, but it has to be the right treatment at the right time. If it's done too early, then it can disrupt the patient's symptoms and create confusion in the immune system. When done at the right time, the patient can improve. The nature of the disruption is fairly individual. It's easy to get lost in a case, trying to differentiate a herx response from a toxic reaction from an outcome that's actually useful and therapeutic. Clearly some herx responses are excessive, and others show that you've chosen the right course. There are subtleties with all these responses in relation to any variable.

Dr. Gordon: We are tending to use more IVs because we are now using them for shorter periods of time. So, we're finding that we can avoid having to place picc lines and central lines. Also the price of the IV antibiotic, at least the price of Rocephin, has come way down. Unfortunately, the rest are still fairly expensive.

Dr. Gordon: Until we started using the Byron White herbal formulas, we didn't really get strong response. Since then we're finding that more and more of them are very useful. The way I use them is to lower the load, so we save our IV antibiotics for when the person is most likely to respond to it. In some cases, patients come into the office with a history that strongly suggests acute Lyme disease in the past, but they have never been treated with a real course of antibiotics (especially a real course of IV antibiotics). If they are robust and strong and don't have chemical sensitivities, we might use the IV antibiotics sooner rather than later.

Dr. Anderson: That's assuming they don't have a dominant coinfection or parasitic infection that needs to be dealt with first.

Dr. Gordon: Unfortunately, it is often the case that patients need other things done first.

Dr. Anderson: One of the factors we always have to keep in mind with any treatment is timing, and I think it is even more important with the use of IV antibiotics. Everything is about timing for the individual patient. IV antibiotics can be a devastatingly bad treatment if they are given at the wrong time. Yet for that same patient, if you improve their detox, knock down their coinfections, and redo that same treatment, they may respond fabulously to it.

Dr. Gordon: This is all case dependent. Many of the people we treat are outliers, but we learn from those outliers, the most sensitive people – they are the ones who teach us the most. We have to remember that they are still a tiny percentage, and if we treated everybody like we treat them, we would do harm to the stronger people.
With the stronger people, you can get rid of this infection and it will be gone. One of the challenges we have to remember is that millions of people get Lyme disease, and yet we don't know how many people are chronically ill from Lyme disease. I know personally a large number of people, from when I lived in upstate New York, who had acute Lyme disease and went on antibiotics (some just a short course of antibiotics), and 20 years later still appear to be fine. Again, if we did cultures on all of them, I can't promise you that they would be 100% well.
Many of the sickest people find us through the Internet. They are helping to lead the charge to make Lyme an illness that is better understood, because their bodies work a little differently than most of us. This is a very challenging disease.

Oral Antibiotics
Dr. Gordon: I try to avoid oral antibiotics except for people with acute infection. If somebody comes in with a longtime history of Lyme disease, I try to dissuade them from oral antibiotics. If they really want to do it, it's their body, but I will explain my reasoning. However, my experience has been that people can sometimes be on oral antibiotics for six months, and they'll improve. However, if they have been sick for a long time, they rarely get totally well. We eventually need IV antibiotics.
Now that we have the herbs, we often find that we can lower the bacterial load and strengthen the body without using oral antibiotics. Occasionally, the infection is predominantly in the gut. There are people for whom Lyme or bartonella infections seem to really go to the gut, and perhaps in those people the oral antibiotics are a good choice. But you get enough penetration of the intestinal wall and stomach with the IVs that they are probably still the better way to go. We can use less drug, for less time, and with a much stronger effect. That being said, I still use a fair amount of oral antibiotics, but my use of these drugs has been rapidly diminishing over the last two years.

Botanical Protocols
Dr. Anderson: That's been my experience, too. One of the main reasons that I've moved away from oral antibiotic use but still keep the IV antibiotics in my toolbox is because of the effectiveness of herbal treatment. I've experimented with all the different herbal protocols. I've done the Buhner protocol, the Cowden protocol, Susan McCamish's products – they all have their strengths and weaknesses, and they're all good. I don't want to be disparaging about any of them. I find that a practitioner needs to choose a protocol and really learn it, so that they can evaluate the effect of that particular protocol. For me, the protocol of choice involves the Byron White formulas. I found that they are so highly specific to each of these infections that my patients got a predictable therapeutic benefit from them. As to why I use less oral antibiotics, I can get most of the benefit I see in oral antibiotics from the Byron White formulas, which includes knocking down the coinfections. For many people, that's all they need. Occasionally I'll follow A-BAB [an herbal formula for babesia] with a little Mepron just to make sure I got it all, or I might give an antibiotic such as rifampin for a bartonella patient after A-BART just to be sure I got it all; but most of the time I'm using those oral protocols for a month, in contrast to six months of Mepron in the past.
In short, the Byron White formulas and the herbal protocols have enabled me to whittle down the microbial load so that when I am ready to address the Lyme, everything else is out of the way and I can just go for it. I go for the Lyme after it has become vulnerable. I see Lyme as the godfather in the back room protected by its little gangsters, babesia, bartonella, ehrlichia, and mycoplasma. Sometimes you have to kill off the gangsters to get to the godfather. But once the godfather is exposed, you've got to go in there with the big guns to knock it out. So, that's what the herbal protocols have done for me – they have enabled me to use much less oral antibiotics. They enable me to work up to the point where borrelia now is more vulnerable, and the IVs then can be used as Eric said, for a shorter period of time.

Dr. Gordon: I think part of Wayne's experience with the herbal formulas reflects his long training and thinking as a homeopath – how carefully he listens to what's happening with the patient. I use a lot of different herbals, because I'm just never sure what's going to work for the individual. I don't have a lot of patience, so I'll use an herbal for a few weeks and if I'm not getting anywhere, I'll move on to another one pretty quickly.
At this point I use more of Lee Cowden's herbs than I use of Byron White's. Each of these approaches has its own value, but you must get to know them; they're different, very different. I often do a trial dosage. If I don't get a good response, I'll give the patient trials of various other remedies to see what begins to shift their symptoms. One of the benefits of the herbs is that you can use them in exceptionally small doses.

Dr. Gordon: What keeps people sick is only sometimes the infectious agent. Most of the time there is a combination of an inborn error – some genetic problem in how they metabolize either a novel chemical in the environment or an antibiotic, or a problem in their detox pathway. They may have an enzyme that operates at 70% of efficiency, which is generally no problem if you're just living your life. But once someone has chronic infection and inflammation, when we add an herb or a drug to try to kill off the infection, suddenly we have a lot of dead and dying cells and a lot of inflammatory chemicals floating around, overwhelming that particular detox pathway. Actually there are an unknown number of little detox pathways. For example, people talk about the cytochrome p450 as just one. I think there are 26 of them, but the variations among those 26 are innumerable given the different SNPs [single nucleotide polymorphisms] and the genetic variations of them. That's just one small aspect of how the system works.

Individual Sensitivities
Dr. Gordon: What I want to emphasize is that I have patients who wind up on antibiotics because they can't tolerate the herbs, which has always amazed me. The first time I saw it I was so embarrassed. I was just barely treating a woman with herbs, and every time I did she would develop massive edema and feel terrible. Then she went to see Dr. Steve Harris, who is a wonderful physician, and he put her on three antibiotics at the same time and she did much better. I had worried that if I gave her antibiotics, I was going to do great harm. So, prediction is not always possible.

Dr. Anderson: I think herbs have a very broad effect with multiple alkaloids, whereas antibiotics often have a single mechanism of action, targeting one RNA synthesis or one cell-wall process.

Dr. Gordon: We discovered that Rocephin doesn't only kill pathogens, it also changes the glutamate ratios in the brain. So sometimes when people are getting better mentally, maybe it has nothing to do with killing bacteria; it's what the Rocephin is doing to the glutamate level in the brain. Susan Owens, who's doing work with oxalates and autism, pointed out to me the other day that antibiotics affect cell membrane transporters, so God knows what else they're doing to us, good and bad.
I've operated under the idea that the antibiotics were specific, but just two weeks ago I had someone whose symptoms were so very babesia-like – sweats and bizarre things like tachycardia. Yet with a little rifampin (which I usually use to treat bartonella), the symptoms all went away. Maybe it was just bartonella, but she had all the symptoms that we always associate with babesia.

Dr. Anderson: I've had many patients who sound similar. We know that there are over a hundred different types of babesia organisms and they vary in how aggressive they are. There are very aggressive babesia organisms; there are very weak babesia organisms that will never be a problem. To use a metaphor, if you can knock off the godfather, many of these lesser little gangsters fall away.

Dr. Gordon: So, you're saying, get the immune system functioning better by lowering the bacterial load, and then the body can take care of the rest.

Dr. Anderson: The immune system can take care of the rest.

Cycling and Pulsing
Dr. Gordon: The approach we're talking about involves cycling and pulsing. Dr. Burrascano differentiates between the two. My interpretation is that he's pulsing when he's treating for a few days a week, and he's cycling when he has patients go on and off antibiotics completely. I now do pulsing quite a bit, especially with the IVs, using about 3 days of IV antibiotics with 4 days off. Then we repeat that and then cycle that pulsing protocol – for example, using a particular protocol for three weeks and off for one week, two weeks, or three weeks.
Different doctors have different regimens. Although we think of this as an illness for which you cannot treat two people the same way, obviously you can, because many of these people are treated very successfully. But I still think that the patients who are showing up in our office tend to be the people for whom that doesn't work. We still find that we have to customize the protocol, tailor it to their needs. Then it also depends on the toxicity that is produced – or the lack of toxicity that's produced, so hopefully we don't get them sick. But if they get sick from the drug, the goal is to support them better, and treat them less. One of the things that Wayne has been really big on lately is sometimes using very low doses.
Cycling has allowed me to get away from using an approach I hated, which was trying to cheerlead people through painful despair while they were being treated. Sometimes people will persist despite feeling terrible. They will get better, but not always. I would rather not take a chance, because sometimes people don't recover from those experiences, at least not easily.
Using cycling means putting people on a protocol for three weeks, six weeks, maybe even eight weeks, but once they plateau, stop. Then give them one, two, three weeks off the treatment or longer, depending on their response and where they are in treatment, waiting for the infection to come back and begin to get active again.
These intracellular infections are not like the strep and the staph that we've always treated, which have very rapid reproductive rates and are busy reproducing, so if you throw the drug at them, they're going to die. The microbes can just stop reproducing. They not only go into the cyst form, but they just plain stop being metabolically active. They enter what we call persister states. Sometimes they don't even do that; they just stop reproducing, and then your antibiotic is not going to be very effective. It doesn't matter how high the level of the antibiotic gets; stop treating them and wait a few weeks, and the levels of the microbe will begin to come back and then you can treat for it again. This allows you to treat with much less toxicity to the patient, much less damage to gut flora, and a better chance of having a healthy patient at the other end.

Low-Dose Therapy
Dr. Anderson: Ten or fifteen years ago I thought it was my job to make my patient as sick as I could. The worse they felt, the more they herxed [experienced a Herxheimer reaction], the better I was doing my job. I would put somebody on my protocol, I would keep them on that protocol, and I wouldn't let up. I was their cheerleader – I was trying to get them through it, and that was the goal. Get them through four months of cipro treatment or six months of Mepron and zithro treatment.
I've had my eyes opened by David Marks (one of the past presidents of ILADS) and his experience of curing himself of ALS on very low doses of Rocephin. From that point on I started considering low-dose therapy as a possible treatment protocol. For many of my very sensitive patients who cannot tolerate full doses of Rocephin, I'll do a quarter dose; I'll do 500 mg and maybe never get over 1,000 mg (where the top end is two grams twice a day). For that individual a thousand milligrams may be just right. It interacts with the infection in a way that the die-off occurs at a lower level and is tolerated by the patient. That doesn't mean that we're not doing lots of preparation before that patient is ready to experiment with that protocol. But another way to reduce toxicity is lowering the dose and individualizing that dose. I give my patients flexibility to go up in increments of 500 milligrams if they tolerate it each time. If not, they reduce the dose and titrate it, to find the range that works for them.


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