Last week we looked at the fundamentals of Lyme disease and the different ways it can manifest. This week, diagnosis, treatment, and (first things last) prevention.
The antibodies your body makes in response to infection with the Lyme spirochete underlie the two most common diagnostic tests for Lyme disease. The first antibody test is the ELISA (enzyme-linked immunosorbent assay) test, which misses anywhere from 35% to 70% of Lyme infections.
By definition a screening test should have at minimum 95% sensitivity (that is, it will produce a correct result 95% of the time), and thus many professionals consider the ELISA an unacceptable first step in the commonly used Lyme two-step screening protocol. In fact, research into the poor performance of the ELISA supports the need for a confirmation test for people who receive either a positive or a negative ELISA test result. Given this landscape, you begin to see the serious diagnostic challenge for both patients and their physicians.
The second test is called the Western blot or immunoblot, and it uses a blood sample to check your body’s antibodies against certain proteins on the Lyme bacterium. These are noted as characteristic bands on the test result, which looks something like a barcode.
Results of the immunoblot are subjective. Using an experienced lab is essential, and the skill level of the person reading the test results matters too. That’s because some bands in the “barcode” are more specific for Lyme than others. To a trained reader, even one highly specific band is proof enough to deliver a positive test result.
Commercial immunoblot tests cover just one strain of the Lyme bug and leave out many Lyme bands. Lyme-specific labs like IGeneX include two strains and all the bands. The IGeneX test, which starts at $260, is not covered by insurance but is often necessary to secure a diagnosis.
Other tests are available, but we currently lack an easy, inexpensive, and effective test for the disease and its activity.
Generally, the sooner treatment is begun after the start of infection the higher the success rate. Most people with Lyme require treatment with antibiotics, staying on the drugs until their symptoms improve. People who are diagnosed and treated immediately after the tick bite are most likely to respond well to a 30-day course.
Those who have been sicker longer usually need a longer course of antibiotics, and most patients need to take two or three types because no single antibiotic effectively treats all forms of the bacteria and any accompanying co-infections.
While antibiotics are the mainstay, other herbs and supplements can help support the immune system, protect the body, and reduce side effects. Commonly used herbs include Andrographis, Cat’s Claw, Japanese Knotweed, Artemisia, and Sarsaparilla, to name just a few. Important supplements include probiotics, which protect the body’s good bacteria while antibiotics are being taken (antibiotics kill all bacteria, good and bad). This is one of the most important aspects of treating patients holistically. We work diligently to protect the good bacteria that make up your microbiome in order to safeguard the gut from disruptions, both now and later, from the long term use of antibiotics.
Other valuable supplements include InterFase, which helps break up Lyme’s protective biofilm, K-PAX Immune to support the immune system, B vitamins, vitamin C, and fish oil. There are many different approaches, each tailored to the patient and his or her particular needs.
One common reaction to starting antibiotic treatment is the Herxheimer reaction, “herxing” for short. It’s thought to be caused by bacterial toxins being released into the body as a result of antibiotics killing the bacteria. Herxing typically includes flu-like symptoms and/or an exacerbation of whatever symptoms (which are complex and unique to each individual) the Lyme patient is experiencing. Herxing can occur at the beginning of treatment and last a few days to a few weeks. Some patients notice that it recurs every month or so (often related to the menstrual period) and becomes less intense each time.
Changing antibiotics, adding a new antibiotic, adjusting an herbal regimen, and switching from herbs to antibiotics (or vice versa) can also cause a Herx, though it’s important to note that not everyone experiences this reaction. If you do, it may not be severe at all.
Functional Medicine approach to Lyme
Functional Medicine searches for the underlying cause of an illness. It’s not good enough to merely diagnose you with Lyme (or chronic fatigue or MS)–I want to know why. Why are you sick? Why do you have these symptoms? Where are the imbalances in the foundations of your system? Functional Medicine is a medical thought process that searches for the “why.” Conventional medicine is content with a diagnosis—for example, MS—followed by drugs, which are often harsh and cause a lot of their own side effects and detriments to your system. Conventional medicine never asks “why do you have MS?”
Functional Medicine says “You have MS, but why? What brought this on? Was it an infection like Lyme? Was it too much stress for too long? Was it an undiagnosed allergy to gluten?” And not only this, but what other parts of the system are thrown off because of this pathological process? Are your adrenals fatigued? Is the gut leaky? Is the psyche drained? Functional Medicine aims to fix these underlying problems and thus treat the disease itself…not simply mitigate the symptoms.
Lyme disease and other tickborne illnesses lend themselves nicely to a Functional Medicine approach. Every person with Lyme faces a unique set of challenges, which requires my team to look at each patient individually. There is no cookie-cutter approach to treating these infections. Functional Medicine looks at you through a holistic lens and asks: What are these infections doing to the patient? Joint pain? Brain fog? Dizziness? Headaches? Hot flashes? What is this Lyme doing to the body’s foundations: membranes, hormones, detox pathways, inflammation, and the like.
It’s not enough to just kill the bugs. We also must support your immune system, heal exhausted adrenal glands, and protect/rebuild your gut.
At WholeHealth Chicago we have a unique team approach to Lyme. Combine my Functional Medicine expertise with Seanna Tully’s nutrition and herbs and Sujatha Manal’s homeopathy just to start. Because our treatments are patient-tailored, we also call on acupuncture, massage, chiropractic, yoga, psychology, physical therapy, healing touch, and psychiatry. Our tool kit at WHC is large and diverse.
Lyme disease is everywhere. Though it’s most prevalent on the east coast and in Wisconsin and Michigan, the ticks that carry Lyme have been identified in every US state and around the world. A few prevention tips:
- You don’t need to be hiking in the woods to get a tick bite. Any place with vegetation can harbor ticks.
- When out walking, wear long sleeves and long pants, tuck pants into socks, and spray your clothing with DEET or Skin So Soft by Avon. Apply only to clothing–not to your skin.
- Do a thorough body check for ticks after being outside. Check your pet’s body too.
- Take a photo of any rash before it fades and show your doctor the picture immediately. Remember, though, you can have Lyme without any rash at all.
- Don’t wait to get treatment. In likely Lyme areas, up to 50% of ticks are infected. If your physician is uncertain how to treat you or is unsure if your symptoms require treatment at all, get a second or even third opinion.
In good health,
Casey Kelley, MD