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TICK- BORN DISEASE: DIAGNOSIS and TREATMENT

Posted Jan 23 2011 9:06am
FROM THE TOWNSEND LETTER FOR DOCTORS http://www.townsendletter.com/July2010/savechildren0710.html
 Saving Our Children: Evaluation and Management of Pediatric Tick-Borne Diseases
                                                         

                                                            Dr. Ann Corson
by Scott Forsgren                                                                 
Dr. Ann Corson had nearly 20 years of experience as a primary care doctor when she was faced with one of her most complex and challenging medical cases: her only child was literally dying from an unidentified illness without clear answers. It took three years for her to more fully understand the illness that was ravaging her son's body. It was then that Dr. Corson realized "how totally inadequate my 'ivory-tower' medical education had been regarding tick-borne diseases." As a result of her own son's personal struggles with Lyme disease, Dr. Corson has emerged as one of the most respected Lyme-literate medical doctors in the field.

After discovering the etiology of her child's mysterious illness, Dr. Corson feverishly read the scientific literature and studied with respected Lyme clinicians Joseph Burrascano, MD, and Charles Ray Jones, MD. She started her own practice devoted solely to the treatment of tick-borne diseases (TBDs). Her mission has become to help "those mothers who otherwise would have to watch their children slowly decay without knowledgeable doctors."

Dr. Corson quickly recognized that the clinical challenges presented by chronic tick-borne disease patients are incredibly complex and require a multidisciplinary, holistic approach. Over the years, it became apparent that allopathic medicine did not offer a complete solution. As a result, she has incorporated treatment strategies into her practice from many different healing disciplines. Helping patients attain the improvements they are striving for requires a willingness to think beyond the boundaries of that which is understood today. Consideration must be given to those things that will only be more widely accepted in the future.

In her presentation at the LIA Foundation "From Roadblocks to Recovery" event in June 2009, Dr. Corson shared her approach to the evaluation and management of pediatric tick-borne diseases.

"Ticks are cesspools of disease," she noted. Besides Borrelia burgdorferi, ticks harbor numerous other organisms that are pathogenic and result in considerable health challenges in humans. Some of these include other Borrelia species, Babesia microti, Babesia duncani, Ehrlichia chaffeensis, Anaplasma phago­cytophilum, Bartonella henselae, Bartonella quintana, Mycoplasma fermentans and other Mycoplasma species, Rickettsia rickettsii, Coxiella burnetii, Francisella tularensis, viruses such as HHV-6,nematodes, and possibly many other organisms. These are just the ones that are known today; in reality, the list may be much longer.

Approach

In the evaluation of a patient with TBD, a full history is obtained, including risk factors, a complete medical history including the medical history of the mother, and a social and family history. A detailed physical exam is performed. Laboratory evaluation includes assays for TBDs, a full medical work-up, and appropriate imaging studies.

Once a patient has been evaluated, management of the illness may include diet; environmental changes such as mold remediation or reduction of exposures to electromagnetic fields (EMFs); use of the German biological model of homotoxicology to modulate the immune system and support organ regulation and drainage; and various antimicrobial compounds, including allopathic, homeopathic, or herbal options. Patients may also be referred to other practitioners for osteopathic work, acupuncture, chiropractic neurology or other chiropractic interventions, other types of body work, and psychological counseling.

Risk factors for TBDs include any known tick attachments, rashes, living in an endemic area, proximity to reservoir animals such as deer or mice, travel to infested areas, family members or pets with known TBDs, and a mother's risk factors both before and during pregnancy. Maternal health at the time of conception and any complications of the pregnancy are important factors in evaluating a child with suspected TBD.

Evaluation

Birth history looks at factors such as term length, type of delivery (spontaneous vaginal delivery, C-section, or forceps-assisted birth), any delivery complications such as meconium staining of the amniotic fluid, Apgar score (a test to assess the health of newborn children), and any congenital abnormalities. Next, the neonatal course (first 12 weeks of life) is evaluated by reviewing blood sugar control, body temperature control, hyperbilirubinemia (an elevated level of bilirubin which may present with jaundice), difficulties in sucking, and history of immunizations. Factors of interest when the child is an infant include whether the child was breast-fed or bottle-fed, colic issues, sleeping problems, frequent infections, trauma, and developmental milestones. From toddler to school age, Dr. Corson looks at history of illnesses, trauma, problems with sleep, developmental delays, socialization, play behavior, gastrointestinal issues, food intolerances, environmental exposures, dental problems, and immunization history. During elementary school, consideration is given to illnesses, trauma, sleep issues, social behavior in school, learning problems, orthodontic issues, neuropsychiatric symptoms or personality changes, medication reactions, and environmental exposures. Tick bites or tick exposures are always considered and highly suggestive of possible TBD.

Dr. Corson further evaluates past surgical history, traumas, especially head injuries, dietary history, family dynamics, psychological traumas, and family history. She considers such factors as living in a home that may have a wet basement or going to school in a building suspected of having had water intrusions, as both of these could indicate mold as a possible cofactor in the illness. Electromagnetic field (EMF) exposure is another factor in the course of illness.

It is important to know why the parents believe the child is sick and to fully understand the entire chronology of the illness. At times, the seemingly unimportant detail helps assemble the often complex puzzle pieces necessary to arrive at a diagnosis.

Symptoms

A long list of symptoms must be reviewed, including generalized symptoms such as fevers, day or night sweats, cold or clammy hands or feet, and weight gain or loss.

Central nervous system (CNS) symptoms are evaluated by looking at developmental milestones both in gross and fine motor development, language delays, processing speed, attention, working memory, dyslexia, cranial neuropathies, and ophthalmologic abnormalities. Headache frequency, duration, location, time of day, and intensity are evaluated. Borrelia headaches are commonly suboccipital (between the skull and first vertebra), whereas headaches resulting from Babesia tend to be frontal or behind the eyes. Balance is observed.

Peripheral nervous system symp­toms include numbness; tingling; itching; stinging; stabbing; burning; shooting pains; crawling sensations; hypersensitivity to noise, light, odors, or touch; and painful radiculopathies (nerve problems at the root of a nerve which manifest in an extremity). Clues to these symptoms may be seen in an infant who does not want to be held, or a child being unable to tolerate the feeling of clothing tags or certain fabrics, not wanting to have hair washed due to scalp sensitivity, or being overwhelmed in environments with high sensory input such as parties.

A number of symptoms related to the head, eyes, ears, nose, and throat (HEENT) may be present. Scalp tenderness, lesions or pimples, or other sore spots are often observed. Ear pain, redness of the outer ears especially in the afternoon, tinnitus (which may often be described as "crickets"), and hearing abnormalities are not uncommon. Eyes may be red, itch, burn, tear, have discharge, or have problems with tracking an object. Lazy eye is often observed, as are eye alignment issues such as strabismus or sixth cranial nerve palsy, or drooping eyelids known as ptosis. Floaters may be present. Sensitivity to light, known as photophobia, may also present. Sinus congestion, runny nose, postnasal drip, or sneezing may be involved. If nasal symptoms are worse after eating, this may be a sign of food allergies. Mold exposure can lead to runny nose presentations. Patients may have fever blisters or canker sores in the mouth. Other HEENT symptoms include tongue soreness, teeth sensitivity, enamel problems, cavities, changes in taste or smell, sore throats that may be chronic or intermittent, hoarseness, difficulties swallowing, and swollen or enlarged lymph nodes. Neck symptoms may include soreness or stiffness, muscle spasms or "cricks," cracking or creaking, and restriction in range of motion.

Lung symptoms of interest include shortness of breath, air hunger, intermittent sighing, and cough. Cough may be day or night, wet or dry, and may be cyclic. Often times, sighing or a dry cough are related to Babesia coinfection. Cardiac symptoms may appear, such as heart palpitations (including skipping or racing feelings) and pain in the chest, chest wall, or ribs.

Abdominal symptoms include problems with appetite, food cravings, nausea, acid reflux, heartburn, gas, belching, bloating, cramping, and abdominal pain. Stool color may be brown, tan, green, or black. Stool frequency may be affected. Consistency of stool may be dry, moist, runny, or mushy. The child may strain and have hemorrhoids, rectal bleeding, or mucus in the stool. Stool odor is another often-observed change. Dr. Corson says: "We talk about poop a lot in my office; it's just that important."

Genitourinary symptomsmanifest as delay in toilet training; bed wetting; loss of bladder control; painful urination; awakening at night to urinate; bladder pain; hesitancy; urgency; frequent urination; incomplete emptying of the bladder; and pelvic, genital, or testicular pain. Babesia may be a factor in bladder symptoms.

Skin manifestationsmay include neonatal acne, eczema, seborrhea, hemangioma birth marks, difficult-to-manage diaper rashes, skin rashes of all kinds, erythema migrans (EM) rashes, and reddish changes in skin coloration at the back of the neck also known as "stork bite."

Joints may be stiff and crack or pop. Pain is often intermittent, cyclical, and migratory. Migratory joint pain is a common characteristic of TBDs. On one day, the patient's left knee may hurt, while the next day it may be the right. Joint symptoms often worsen with exercise. Foot pain upon rising is a common sign of Bartonella. Morning stiffness suggests mold exposure. Muscle manifestations may include lowered or increased tone, pain, spasms, cramping, morning foot pain on first steps, morning body stiffness, and twitching.

Children often prefer sedentary activities or need to rest after school or play as they may not have the energy or stamina for something more active. Sleep is often challenged, and patients experience difficulty falling or staying asleep, frequent awakenings, nightmares, night terrors, sleep walking, and difficulty arising in the morning. Nightmares and night terrors are often present with Bartonella.

Psychiatric signs may be irritability, mood swings, increased emotionality, tantrums, anger or rage attacks, frustra­tion intolerance, physical aggres­siveness, separation anxiety, new onset phobias, anxiety, panic attacks, depression with or without thoughts of suicide, obsessive-compulsive disorder (OCD), and personality changes. Panic attacks may be the result of Babesia, while self-mutilating behaviors may be associated with Bartonella. Neurological symptoms may present as tics, seizures, lowered or increased muscle tone, motor or sensory abnormalities, gross lack of muscle coordination, neuropathies, neuralgias, vertigo, and motion sickness.

It is difficult for many to imagine that one disease could present with so many widely varied symptoms, and yet it is not uncommon to see children with TBDs present with dozens of these symptoms.

Physical Examination

A physical examination is a key part of Dr. Corson's evaluation of a patient potentially challenged with TBD. Vital signs are evaluated, though these are generally normal. Tongue size, color, coating, edges, and sublingual veins are evaluated. Red crescents in the pharynx are often observed. Tonsils, teeth, gums, ears, and eyes are investigated. Halitosis may be present.

In the neck area, range of motion and head posture are observed. Thyroid and lymph nodes are examined. Lungs are evaluated for abnormal breathing sounds or excursion of the chest wall. Heart murmurs and rhythms are listened for. Peripheral pulses are felt. The abdomen is palpated for enlarged organs and areas of tenderness.

In evaluating the musculoskeletal system, soreness is evaluated along the neck and spine. Trigger points, shins, and thigh muscles are assessed. Muscle twitches, or fasciculations, may be present.

The skin often holds many clues in TBDs. Dr. Corson stresses that every part of the body must be evaluated and that parents are often surprised by what she finds on their children. Hands and feet are evaluated. These may be cold or warm, clammy, or sweaty. The scalp, finger- and toenails, and anus are examined. Multiple hemangioma birthmarks may be observed in gestational cases of TBDs. Rashes of all kinds are often visible. These may include EM rashes or Bartonella rashes, which are often seen as striae; that is, bands, stripes, or lines that look much like stretch marks.

Neurological evaluation consists of a review of cranial nerves and extraocular muscles, looking for abnormal movements or tracking abnormalities. Motor strength and tone are evaluated, as are balance and gait. Reflexes, speech, and language are assessed. Behavior, appropriateness, attentiveness, and interactions with parents and siblings are key factors in a psychological evaluation.

Dr. Corson looks for the possibility that mold may be a factor in the child's illness. Mold may be found in the home, school, or even car. For some patients, mold exposure is a very significant component of the overall illness, as mycotoxins produce a number of symptoms. Improvement is often observed through either remediating the moldy environment or removing the child from the environment entirely.

An emerging theory in the puzzle of chronic illness is that biologically incompatible frequencies, or frequencies that are not supportive of human health, may have damaging effects. These EMFs come from numerous sources, such as cordless phones, microwaves, wireless Internet devices, and cellular phones. EMFs should be eliminated or reduced where possible. Televisions and computers should not be present in the bedroom. Video game use should be entirely eliminated.

Clearly, there are many physical clues that may support a diagnosis of TBDs in a patient. Nonetheless, doctors must open their eyes and look before they will find. Fortunately, for patients of Dr. Corson, the physical examination is thorough and often telling.

Laboratory Testing

A physical examination may yield clues that may lead Dr. Corson to further consideration of TBDs. In addition to a thorough physical examination, laboratory tests are used to evaluate additional indicators that may support a diagnosis.

Dr. Corson first orders a full panel of TBD testing from IGeneX in Palo Alto, California. This includes tests for Borrelia burgdorferi via western blot and PCR (polymerase chain reaction) as well as testing for common coinfections such as Bartonella, Babesia, Ehrlichia, and Anaplasma. A CD57 panel is ordered from LabCorp to evaluate a subset of natural killer cells that are known to be suppressed in chronic Lyme disease. Results of the CD57 often correlate clinically with the severity of the disease presentation. Dr. Corson believes that Clongen and Fry Labs are useful as well.

Medical Diagnostic Laboratories (MDL) is used to evaluate the patient for other related infections. Epstein-Barr virus (EBV), human herpes virus type 6 (HHV-6), cytomegalovirus (CMV), and herpes simplex viruses types 1 and 2 (HSV-1 and -2) are types of herpes viruses that are often activated in patients with chronic Lyme disease due to the immunosuppressive nature of the illness. Chlamydia pneumoniae and Mycoplasma species are evaluated. The presence of any of these infections is important when defining the treatment protocol for the patient.

Sulfates are tested using a urinary dipstick. Some patients will exhibit high levels of sulfates, which may be the result of genetic influences, inadequacies of liver detoxification pathways, past sulfa antibiotic use, or simply eating meat from animals that were fed sulfa antibiotics to enhance their growth.

A complete blood count (CBC) as well as a comprehensive metabolic profile (CMP) are run to evaluate basic components of the immune system, functioning of organs such as the liver and kidneys, and electrolyte and fluid balance.

When blood urea nitrogen is high and iron is low, Dr. Corson suspects Babesia. When alanine aminotransferase (ALT) is slightly elevated and white blood cell (WBC) count is low, she considers Ehrlichia. She has found that CBCs often show neutropenia, lymphopenia, or a reversal of the normal lymphocyte/neutrophil ratio.

Human leukocyte antigen (HLA) testing is performed based on the work of Ritchie Shoemaker, MD. The HLA panel provides specific insights as to the patient's ability to remove biotoxins effectively from the body. About one-quarter of the general population will be found to have genetic types that would increase the likelihood of more severe illness if exposed to biotoxins produced from Lyme disease or molds. Some patients are "multisusceptible" types, meaning that they are susceptible to both Lyme and mold biotoxins. In patients with chronic Lyme disease, the percentage of those evaluated who express genetic issues in this area is much higher than in the general population.

Dr. Corson runs tests to investigate the possibility of autoimmunity as a piece in the illness puzzle, as the immune system often becomes dysregulated when a patient has chronic Lyme disease. She evaluates whether hypercoagulation is a factor; it is not uncommon for the blood to become thickened, which protects the organisms and makes treatment more difficult.

It has long been known that toxicity is a significant factor in chronic illness. Heavy metal toxicity is a common finding in many patients. A stool analysis is performed to look for pathogenic bacteria, parasites, yeast, and levels of beneficial probiotic bacteria, as well as to evaluate whether the patient may have leaky gut syndrome. Food allergy panels are performed, as eliminating allergenic food items is often a key part of the approach to treatment.

When the baby is born, PCR testing is ideally performed on the first urine, the cord blood, the placenta, and the foreskin to evaluate for the presence of infection with Borrelia burgdorferi. Thereafter, PCR testing is performed monthly on the urine.

In terms of imaging studies, a brain SPECT (single photon emission computed tomography) scan is often helpful. These can, however, be normal even in children who are significantly impaired. When the SPECT scan is abnormal, this is a very significant finding. The Amen Clinics look at both perfusion (blood flow) and metabolism at rest and with concentration in their SPECT scans.

Often, these laboratory tests provide important clues to Dr. Corson as to the potential causes of illness. However, testing for TBD is still in its infancy, and better diagnostic tools are desperately needed. As a result, it is important to look beyond laboratory testing alone and to evaluate the patient in other ways.

Pathophysiology

Pathophysiology is the study of changes in function within the body that result from a disease process. In TBDs, the list of these changes is potentially a very long one.

Multiple infections lead to multisystem organ damage. The nervous system is heavily affected in TBD. Herpesviruses, Chlamydia, Mycoplasma, and many other infections heavily affect the course of the illness. Borrelia is clearly the ringleader in chronic Lyme disease. It opens the door to many other infections, which are then able to invade the body and take up residence.

Dysbiosis (microbial imbalance) of the gut is a common finding. The mucosal lining of the gastrointestinal tract often harbors infection. It is a known site for the formation of biofilms. Leaky gut is commonly present in children with TBDs, as is intolerance to gluten. The GALT (gastrointestinal-associated lymphoid tissue) is a key component of the immune system, protecting the body from invaders. In many patients, the GALT is often found to be dysregulated, thus impairing the proper functioning of the immune system throughout the body. According to Dr. Corson, cleaning up the gut is one of the first things that must be done before moving forward with treatment.

Liver detoxification abnormalities are almost always present. These may be in the methylation or sulfation pathways and are often genetically influenced – such as in patients with a methylenetetrahydrofolate reductase (MTHFR) defect or problems with other detoxification pathways. Levels of homocysteine and methionine may be abnormal.

Systemic inflammation is often observed. Lipid abnormalities may be present. Cytokine imbalances may be the result of a confused immune system's attempting to respond to foreign items. These imbalances must be corrected to reduce inflammation. The immune system must then be upregulated to respond to specific targeted pathogens.

Blood vessels may be inflamed in what is known as vasculitis. The blood itself may become thickened due to the overproduction of fibrin. Bone marrow becomes dysfunctional, and as a result the patient may have low platelets (thrombocytopenia), neutrophils (neutropenia), or lymphocytes (lymphocytopenia). This further affects the body's ability to mount an effective immune response to address chronic infections. Anemia may be present.

Autoimmunity is unfortunately another common finding in chronic Lyme disease. As the immune system becomes dysregulated, autoimmune responses become more common. Autoimmunity may be in part the result of molecular mimicry, a process through which the infections are able to look like normal tissues in the body and cause the immune system to incorrectly recognize self vs. foreign invader. Autoimmunity to the thyroid is very common in patients with TBDs. This can be evaluated by looking at thyroglobulin antibodies and thyroid peroxidase (TPO) antibodies. Anticardiolipin antibodies are used to evaluate autoimmunity to the interior lining of the blood vessels, while myelin basic protein antibodies give clues to autoimmunity to nerve tissue. Antigliadin antibodies suggest an immune response to gluten as a result of leaky gut syndrome or congenital abnormality. Antinuclear antibodies are evaluated, and a rheumatoid factor (RF) is often ordered. Both are indicators of autoimmune activity.

Changes are often present in the CNS. Oxidative stress levels may be elevated. Glutathione levels are often depressed. There may be changes in the metabolism of homocysteine and methionine. Important detoxification pathways such as methylation and sulfation are often impaired, which leads to elevated levels of both ammonia and sulfates. Autonomic and peripheral nervous systems can be severely affected, resulting in neurally mediated hypotension, postural orthostatic tachycardia syndrome (POTS), or even "Bell's palsy" of the gut.

Biotoxins are often elevated, resulting from both exposure to external sources of biotoxins and from toxins created from the microbes that live within infected patients. In chronic Lyme disease, these water- and fat-soluble toxins may be the result of indoor mold exposures and infection with Borrelia, Babesia, and other microbes.

Biotoxins increase the production of inflammatory cytokines which in turn upregulate systemic inflammation and lead to a worsening of symptoms. Insulin resistance increases, lipid profiles deteriorate, and levels of VEGF (vascular endothelial growth factor) and PAI-1 (plasminogen activator inhibitor type 1) are altered. Leptin receptors are damaged, which leads to weight gain. Key regulating hormones in the body such as MSH (melanocyte stimulating hormone) and VIP (vasoactive intestinal peptide) become deficient. All hormonal systems of the body are negatively and significantly affected by the presence of biotoxins.

Hormonal dysfunction is present in almost all chronic Lyme disease patients, even children. Insulin and leptin resistance develop. Thyroid insufficiency is often present. There are deficiencies in sex hormones. The renin-angiotensin system is affected, resulting in problems with blood pressure and fluid balance. Abnormalities in antidiuretic hormone (ADH) lead to retention of fluids. Adrenal glands are often stressed or entirely exhausted.

Heavy metal toxicity, such as that resulting from mercury, aluminum, or arsenic exposure, is almost always a factor in chronic illness. In children, this may be related to vaccinations, wherein mercury and aluminum are used as preservatives. Many over-the-counter medications contain aluminum. Very few people recognize that factory-farmed chicken is high in arsenic. Children, especially the first born, can acquire heavy metal toxicity from their mothers in utero.

Dr. Corson has found that patients often have a history of past physical, emotional, or psychological trauma. These factors, though not pleasant, must be considered and dealt with in order to return the child to a state of wellness.

Management – Restoring Effective Function

The management of TBD is complex and requires the consideration of many factors. Just as Dr. Corson thoroughly evaluates each child through history, physical examination, and laboratory testing, she creates an equally thorough treatment program, which optimizes the outcome of each child she cares for. It is only through addressing the many factors involved in chronic TBDs that notable improvements are realized.

Diet is a key part of approaching chronic illness. Paleolithic dietary principles are often appropriate. Organic grass-fed meats, wild-caught fish, fruits, vegetables, and tree nuts are good options, whereas grains, legumes, cow dairy products, refined sugars, and processed oils are best avoided. In many cases, avoidance of gluten, cow dairy, sugar, and yeast are necessary. Individual dietary restrictions are introduced based on food-allergy testing. It is important for the child to have a diet with the least possible risk of allergic reaction, as the immune system is already overburdened and inappropriately responding.

The living environment must be carefully considered. This includes home, school or day care, car, and any other environment where the child spends time. Each of these must be evaluated for the presence of mold. Biotoxin-binding substances such as cholestyramine may be necessary. Algae and homeopathic products are often helpful. Avoidance of environments with toxic exposures is a key to recovery.

EMFs should be investigated, and every possible approach to minimizing these biologically incompatible frequencies should be implemented. This may include removing televisions, computers, and electrical toys; turning off circuit breakers in the child's bedroom at night; removing cordless phones and wireless devices from the home; and avoiding cellular phones.

Dr. Corson incorporates the concepts of German biological medicine and homotoxicology in her practice. This involves an assessment of where the patient is within six phases of disease development. The earlier stages are excretion, inflammation, and deposition. With each further stage, the disease process becomes more deeply seated in the body. As the illness progresses, it moves to the later stages, which are impregnation, degeneration, and neoplasm. Dr. Corson's goal is to identify the child's current stage and then to move him back toward the earlier stages of the homotoxicology model using the principles of German biological medicine. Restoration of patient vitality through rebuilding of vital heat and energy, or chi, is the first step.

The health and function of the extracellular matrix is of crucial significance. The matrix provides structural support to cells and is critical in both bringing nutrients into cells and supporting the removal of toxins from them. It must be cleared of biofilm formations, toxicity, and infection. Many functions in the body are supported through communication that occurs throughout the tissues in the matrix. As these are often impaired, the matrix must be a focus of treatment.

Metabolic function of the GALT is evaluated and corrected. Many children have leaky gut syndrome whereby the bowel lining has increased permeability and allows larger-than-expected particles into the bloodstream, thus creating an undesired immune response. Biofilms in the gut must be broken up while simultaneously removing infections and any dysbiotic microorganisms. The gastrointestinal tract must be repopulated with both prebiotics and probiotics in order to bring healthy balance to the bacteria. The flow of material and the mechanical activity of the digestive system must also be optimized.

It is critical for the liver to function optimally in order to return a child to wellness. There are often detoxification defects in methylation and sulfation pathways. These may be genetic in origin or acquired, but can be bypassed with appropriate therapies. Toxicity and infections both significantly affect liver function. The flow of bile and gallbladder function must be improved in order to support an effective overall detoxification program. Dr. Corson finds that the liver will often improve dramatically once the toxic load from dysfunctional intestines is removed. Thus, any attempts to improve liver function are often not successful until the toxic load of the gastrointestinal tract is addressed.

The mucosal-associated lymphoid tissue (MALT) is evaluated. This includes the sinuses and the lungs. Often, biofilms present in the sinuses create a haven for infections that further stress the patient's overall system. Allergic responses are often upregulated. Head, neck, and chest lymphatics may be congested.

The function of the bone marrow is considered, given that the bone marrow is the source of red blood cells, white blood cells, and platelets. The more normal the immune cells produced by the bone marrow, the better the child's immune system can respond to the many infections and toxins present.

The CNS is a common source of symptoms for patients with Lyme disease. Dr. Corson works to lower oxidative stress, which affects the CNS. Levels of ammonia and sulfates are examined, and appropriate interventions are put in place. Both the myelin sheath and cell membranes need repair.

Various systems in the body have regulatory effects on other systems. Optimization of one system leads to beneficial effects on the other. For example, neuroimmunology is a field that looks at the interactions between the nervous system and the immune system. Neuroendocrinology considers the interactions between the nervous system and the endocrine, or hormonal, system. The neurovascular system considers how the nerves control the caliber of blood vessels. Often hypercoagulation is a factor that must be addressed in order to effectively treat chronic infections.

In managing patients with TBDs, Dr. Corson generally uses a cycle of release, provoke, release, provoke, release. She comments: "The effective management of tick-borne disease is not unlike peeling an onion. There are many layers to the problem that must be addressed over the course of the treatment."

Management – Therapeutic Tools and Medications

There are a number of different tools that Dr. Corson uses in the management of TBDs. She finds that since many things have gone wrong in the bodies of people dealing with these diseases, it takes many different approaches and therapies to return a patient to vitality.

Spagyric homeopathic remedies and herbal medicines can be very helpful. She states: "Pekana products are incredibly magical medicines." She uses spagyric products from Energetix as well. Nestmann has a number of useful homeopathic remedies. Medications that modulate or balance the immune system are often helpful. Syntrion and San Pharma have created homeopathic preparations of metabolic products from common fungi and bacteria that regulate and modulate the immune system. Syntrion offers cellular reprogramming medicines that are incredibly effective. Nosodes from Energetix and Deseret Biologicals can be beneficial tools. Researched Nutritionals has a "wonderful range of transfer factors" that help deal with the various infections commonly present in TBD patients.

Nutritional supplementation is generally necessarily to provide the body with the building blocks to support optimal function. The nutritional supplementation aspect of the recovery program is synergistically interwoven with the homeopathic and immune-modulating medications.

A fresh organic diet with grass-fed meats and sprouted grains is recommended. In fact, "A good diet is always the first place to start," according to Dr. Corson. A multivitamin with trace minerals and magnesium serves as a foundational item. Essential fatty acids are generally required. For children, DHA, phosphatidyl serine, glycerphosphocholine (GPC), and phosphatidyl choline are most appropriate. For adolescents and adults, EPA or DHA are generally suggested.

In support of appropriate methylation, activated coenzyme forms of B vitamins such as folinic acid, methyl-B12, P5P, and even BH4 are considered. Antioxidants of all kinds are often necessary. These include vitamin C, vitamin D, vitamin E, R-lipoic acid and specific cerebral antioxidants such as Cerebro PTC from MarcoPharma and Fibroboost from Allergy Research Group.

Specific consideration is given to mitochondrial energy production within cells and the use of specific nutrients to "resuscitate" energy-producing capabilities. These include CoQ10, NAC, acetyl-L-carnitine, D-ribose, R-lipoic acid, organic acid homochords (Lactiplus, Citiplus, and Formiplus from Pekana), and Researched Nutritionals NT Factor Energy.

Dr. Corson uses a multitude of advanced nutritional creams available from Health Pro Labs which can be highly effective, especially in children. Several that she has found to be beneficial include molybdenum, orthinine, folinic acid with TMG or folinic acid with TMG and B12, B12, CoQ10, vitamin D3, vitamin C, taurine, melatonin, GABA, GABA with theanine, R-lipoic acid, niacin, glutathione, "Cognitive Therapy," "MS," "Autistique," magnesium citrate, and magnesium sulfate.

The importance of probiotics cannot be overstated, as these are critical not only in fighting yeast infections but also in addressing pathogenic bacteria in the gut. Klaire Labs Ther-Biotic, Researched Nutritionals Prescript-Assist, MarcoPharma's Ba-Co-Flor, and Theralac are good options. Nutrients to repair the gastrointestinal tract include glutamine, Syntrion's SyCol, Tyler's Permeability Factors, deglycerinated licorice (DGL), and aloe.

Heavy metal binders include PectaSol, chlorella, Energetix's Arctic Alginate, Modifilan, BodyGuard Supreme from Supreme Nutrition Products, and Klaire Labs Interfase Plus. For removing vaccination stress, homeopathics from Energetix and Pekana are helpful.

Management – Antimicrobial Therapies

Though Dr. Corson does not believe that allopathic medicine alone holds the keys to recovery from the complexities of TBD, she does believe that there is a place and a time for allopathic treatment options in a well-planned protocol. She follows the treatment guidelines set forth by the International Lyme and Associated Diseases Society (ILADS) in her practice.

For the treatment of Borrelia, a cell-wall antibiotic such as a penicillin or cephalosporin along with an intracellular antibiotic such as a macrolide or tetracycline is used. Plaquenil, Flagyl, or Tindamax may be added along with a cell-wall drug and intracellular drug in order to address the cyst form of the infection.

For Bartonella, doxycycline and a macrolide drug, doxycycline and Rifampin, Bactrim and Rifampin, or a quinolone drug may be used. For Babesia, Mepron, macrolides, Plaquenil, Artemisinin, or Bactrim may be helpful. Macrolides or quinolones may be used for Mycoplasma, while macrolides or Rifampin may be used for Chlamydia.

In looking towards nonallopathic antimicrobial options, Dr. Corson utilizes many of the antimicrobial herbs from the Cowden Support Program. These include NutraMedix Cumanda, Samento, Quina, Banderol, Mora, and Enula. She incorporates homeopathic and herbal antibiotics and antivirals from numerous companies that utilize traditional Native American, South American, European, and Asian traditions to target infections such as CMV, Epstein-Barr virus, HHV-6, HSV-1, HSV-2, Mycoplasma, Babesia, and Chlamydia. The key is that all these tools are used in an integrative manner.

Beyond restoring function, using therapeutic tools, and implementing an appropriate antimicrobial strategy, Dr. Corson may suggest a number of other therapies. Cranial osteopathy is invaluable whenever there is any history of trauma. Chiropractic neurology can assist in rehabilitating the brain and rewiring neural circuits. Chiropractic care and acupuncture can be useful interventions. Lymphatic drainage via machines such as the Lymphstar Pro or through lymphatic massage can support the removal of toxic wastes. Physical exercise and rehabilitation are appropriate, but only to tolerance and only when the patient is able.

Treatment Caveats

Dr. Corson has observed a number of important caveats along the way. She believes that any child who becomes ill after a tick bite needs a full evaluation for the presence of coinfections. She further states that any child who becomes ill after a tick bite and was only treated with 3 to 4 weeks of oral antibiotics has most likely been inadequately treated. Often, inadequate treatment makes future treatment more difficult.

Neurological or neuro­psychiatric symptoms are often the first and only signs of infection. They are also the most common indication of persistent infection after inadequate treatment.

Summary

It becomes clear rather quickly that the evaluation and management of TBD is a complex and evolving area of medicine. From a review of symptoms to a physical evaluation, and consideration of laboratory findings, to a restoration of function using various therapeutic tools including the incorporation of antimicrobial therapies, TBD management is far from straightforward.

Dr. Corson's son graduated from Franklin and Marshall College with honors in Philosophy last May and will be starting graduate school at the University of St. Andrews in Scotland in September. He is nearing the end of his seventh year of a successful multidisciplinary treatment for TBDs.

It takes someone with a deep passion for healing to have an impact on children and their families. Fortunately for many, that "someone" has been found in Dr. Corson.

About Dr. Corson

Dr. Corson obtained her BA in biology from Franklin & Marshall College in Lancaster, Pennsylvania. She spent two years in graduate school at Penn State's Hershey Medical School working towards a PhD in neuroanatomy before entering medical school at the University of Pennsylvania School of Medicine in Philadelphia, where she earned her MD degree in 1982.

Dr. Corson did her internship in internal medicine and had residency training in neurology at the Pennsylvania Hospital before completing a residency in family practice at Abington Memorial Hospital in Abington, Pennsylvania. She is board certified in the practice of family medicine and has 27 years of primary-care experience in emergency medicine, occupational health, and family practice.

Dr. Corson has been a member of ILADS since 2003. She has studied with Burrascano and Jones in their offices, thanks to grants provided by ILADS and Turn the Corner Foundation.

Her practice in Chester County, Pennsylvania, is devoted full time to the treatment of patients suffering from Lyme and associated TBDs. Working with hundreds of such patients has provided Dr. Corson with the difficult yet enlightening experience that makes her a recognized expert in the field.

Resources

Amen Clinics: http://www.amenclinics.com/ .

Allergy Research Group: http://www.allergyresearchgroup.com/ .

BioResource Inc. is the importer of Pekana, Syntrion, and SanPharma: http://www.bioresourceinc.com/ .

Clongen Laboratories LLC: http://www.clongen.com/ .

Deseret Biologicals: http://www.desbio.com/ .

EcoNugenics (Pectasol): http://www.econugenics.com/ .

Energetix: http://www.goenergetix.com/ .

Fry Laboratories LLC: http://www.frylabs.com/ .

Health Pro Labs: http://www.healthprolabs.com/ .

IGeneX, Inc.: http://www.igenex.com/ .

Integrative Therapeutics, Inc. (Tyler): http://www.integrativeinc.com/ .

International Lyme and Associated Diseases Society: http://www.ilads.org/ .

Klaire Labs: http://www.klaire.com/ .

Marco Pharma International LLC: http://www.marcopharma.net/ .

Medical Diagnostic Laboratories LLC: http://www.mdlab.com/ .

Modifilan: http://www.modifilan.com/ .

NutraMedix: http://www.nutramedix.com/ .

Researched Nutritionals: http://www.researchednutritionals.com/ .

Supreme Nutrition Products: http://www.supremenutritionproducts.com/ .

Theralac: http://www.theralac.com/ .

Turn the Corner Foundation: http://www.turnthecorner.org/ .

Disclaimer: This article is not intended to serve as individual medical advice. All statements made are general in nature and should be discussed with a licensed health-care practitioner.

Scott Forsgren is the editor and founder of BetterHealthGuy.com, where he shares his 12-year journey through a chronic illness, diagnosed as Lyme disease only after eight years of searching for answers. Scott can be reached at Scott@BetterHealthGuy.com .

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