Archive for the ‘Eye Issues’ Category

Human Bartonellosis: An Underappreciated Public Health Problem?

https://www.mdpi.com/2414-6366/4/2/69

Trop. Med. Infect. Dis. 2019, 4(2), 69; https://doi.org/10.3390/tropicalmed4020069

Human Bartonellosis: An Underappreciated Public Health Problem?

Published: 19 April 2019
(This article belongs to the Special Issue Recent Advancements on Arthropod-Borne Infectious Diseases)

Abstract

Bartonella spp. bacteria can be found around the globe and are the causative agents of multiple human diseases. The most well-known infection is called cat-scratch disease, which causes mild lymphadenopathy and fever. As our knowledge of these bacteria grows, new presentations of the disease have been recognized, with serious manifestations. Not only has more severe disease been associated with these bacteria but also Bartonella species have been discovered in a wide range of mammals, and the pathogens’ DNA can be found in multiple vectors. This review will focus on some common mammalian reservoirs as well as the suspected vectors in relation to the disease transmission and prevalence. Understanding the complex interactions between these bacteria, their vectors, and their reservoirs, as well as the breadth of infection by Bartonella around the world will help to assess the impact of Bartonellosis on public health. View Full-Text

tropicalmed-04-00069-g001
Figure 1  The Clinical Manifestations of Bartonellosis
Excerpt from full-text
Known diseases caused by Bartonella infections include:
  • Carrion’s disease
  • cat-scratch disease
  • chronic lymphadenopathy
  • trench fever
  • chronic bacteraemia
  • culture-negative endocarditis
  • bacilliary angiomatosis
  • bacilliary peliosis
  • vasculitis
  • uveitis [1,2,4,6,7,9,10,11].
Recently, Bartonella infections have been linked to more diverse manifestations such as:
  • hallucinations
  • weight loss
  • muscle fatigue
  • partial paralysis
  • pediatric acute-onset neuropsychiatric syndrome (PANS)
  • other neurological manifestations [6,8,10].

A few case studies have also documented Bartonella in tumors, particularly vasoproliferative and those of mammary tissue [12,13,14]. The potential involvement of this pathogen in breast tumorigenesis is both disconcerting and warrants significantly more research.

Bartonella spp. are zoonotic pathogens transmitted from mammals to humans through a variety of insect vectors including the sand fly, cat fleas, and human body louse [4,5]. New evidence suggests that ticks, red ants, and spiders can also transmit Bartonella [15,16,17,18]. Bed bugs have been implicated in the transmission cycle of B. quintana and have been artificially infected [19]. B. quintana was found in bed bug feces for up to 18 days postinfection [19]. The diversity of newly discovered Bartonella species, the large number and ecologically diverse animal reservoir hosts, and the large spectrum of arthropod vectors that can transmit these bacteria among animals and humans are major causes for public health concern.

Regarding ticks….

3.2. Arachnids (Spiders and Ticks)

Over the last 10 years, the topic of ticks transmitting Bartonella species has been widely debated. Evidence exists to support the transmission of Bartonella through many different species of ticks.

Ixodid ticks, also known as hard ticks, appear to be the main type of tick associated with these bacteria. Tick cell lines have been used to show that Bartonella can replicate and survive within:

  • Amblyoma americanum (Lone Star Tick)
  • Rhipicephalus sanguineus (Brown Dog Tick)
  • Ixodes scapularis cells [77] (Deer Tick)

In California, questing ticks of

  • Ixodes pacificus (Western Black legged Tick)
  • Dermacentor occidentalis (Pacific Coast Tick)
  • Dermacentor variabilis (American Dog Tick)

were collected when in the adult and nymphal stages and tested for Bartonella by PCR for the citrate synthase gene. [78]. All types of ticks were found to contain Bartonella DNA, although in varying percentages and locations. These data alone do not prove that ticks can transmit Bartonella spp. Bacteria; however, the results do show Bartonella DNA occurring naturally in these wild ticks.

In Palestine,

  • Hyalomma spp. (Genus of hard-bodied tick) found in Asia, Europe, & North and South Africa.
  • Haemphysalis spp. (The Asian Long-horned tick is an example)
  • Rhipicephalusspp. (Hard-bodied tick native to tropical Africa)

ticks were collected from domestic animals and tested by PCR for the Bartonella intergenic transcribed spacer (ITS) region [38]. These ticks were infected with 4 strains of Bartonella: B. rochalimae, B. chomelii, B. bovis, and B. koehlerae [38]. While this study tested a collection of ticks found on domestic animals, the results suggest that individuals in close contact with these animals should be aware of the potential for transmission through tick bites.

In a sampling of ticks (Ixodes scapularis and Dermacentor variabilis) and rodents (Peromyscus leucopus) from southern Indiana, the midgut contents of the tick species and rodent blood were analyzed by 16S sequencing. Bartonella was present in a moderate percentage (26% in D. variabilis and 13.3% in I. scapularis) of larvae and nymphs of both tick species, even those scored as unengorged, but was present in the majority (97.8%) of the rodents tested [79].
A survey of ticks from 16 states in the U.S. revealed that the overall prevalence of Bartonella henselae in Ixodes ticks was 2.5% [80].
Interestingly, the highest rate of both Borrelia spp. (63.2%) and B. henselae (10.3%) was found in Ixodes affinis ticks collected from North Carolina.
Ixodes ricinus has been the focus of studies that support tick transmission of Bartonella spp. in Europe. This is because I. ricinus is an important vector for tick-borne diseases in Europe [81]. I. ricinus have been collected in the larval, nymphal, and adult stages in Austria [82]. The analyses revealed that 2.1% of all ticks were infected with Bartonella spp., with the highest rate in ticks derived from Vienna (with a 7.5% infection rate), and that adult ticks had a higher prevalence than other stages [82].
B. henselae, B. doshiae, and B. grahamii DNA were amplified, and this was the first study to find Bartonella-infected ticks in Austria [82].
A recent One Health perspective review on Bartonella indicated that the overall presence of Bartonella in ticks (combining evidence from multiple surveillance studies) was approx. 15% [83].
B. henselae DNA has also been isolated from I. ricinus removed from an infected cat. However, whether the cat gave the tick Bartonella or vice versa cannot be established, so the vector competence of these ticks for transmission cannot be determined [30].
A lab in France has studied the relationship between I. ricinus and Bartonella transmission. One study focused on the ability of ticks to maintain infection from one life stage to the next and tested a vertical transmission from adults to eggs. The authors used B. henselae and found that a transstadial transmission was possible and that a transovarial transmission was not likely [84]. The researchers also supplied evidence to support the vector competency of I. ricinus by amplifying B. henselae DNA from the salivary glands of infected ticks and by amplifying DNA from blood 72 h after infected ticks fed through an artificial system [84]. Although the evidence strongly suggests the ability of ticks to transmit these bacteria, the system employed artificial means for feeding; therefore, one major critique has been that it is not representative of a natural blood meal from a host.
To address this issue, another experiment was performed to the assess vector competency of I. ricinus to transmit Bartonella birtlesii [85]. Mice were infected with B. birtlesii through an intravenous injection via a tail vein, and once mice were infected, naïve ticks were fed on the mice and kept for 3 months to molt. Nymphal ticks were shown to transmit B. birtlesii to naïve mice, and adult ticks were shown to infect blood through a feeder method [85]. B. birtlesii was identified in the blood of the recipient mice through PCR and immunofluorescence [85]. This evidence strongly supports the transmission of these bacteria by ticks. However, the limitation is that this only supports I. ricinus’ ability to transmit a very specific strain of Bartonella, B. birtlesii, which is not linked to human disease.
Concerns such as these related to vector competence and transmission can only be quelled by repeated studies utilizing multiple strains of Bartonella and differing tick species.
An interesting case study provided evidence of spiders transmitting Bartonella. A mother and two sons suffered from neurological symptoms following bites suspected from woodlouse hunter spiders [18]. Bartonella henselae DNA was amplified from the blood of the family as well as from a woodlouse and a woodlouse hunter spider near the family’s home [18]. It cannot be determined if the family contracted the bacteria from the woodlouse or the woodlouse hunter spider or if the lice and spiders contracted the bacteria from the family. This case study points to the importance for diagnosticians to test for bacterial infections after suspected arachnid bites. It also emphasizes the lack of knowledge on the possible vectors that transmit Bartonella as well as the range of manifestations by infection with Bartonella.

___________________

**Comment**

I think we can safely state that Bartonella IS an under appreciated health problem.

 

 

Eye Problems in Tick-borne Diseases Other Than Lyme

http://danielcameronmd.com/eye-problems-tick-borne-diseases-lyme/

EYE PROBLEMS IN TICK-BORNE DISEASES OTHER THAN LYME

“Why should an ophthalmologist have a good understanding of Lyme diagnosis and treatment?” asks Sathiamoorthi [1], from the Mayo Clinic, in an article published in the Current Opinion in Ophthalmology. “Vision-threatening ophthalmic manifestations are relatively common in Lyme disease (LD) and Rocky Mountain spotted fever.”

by Daniel J. Cameron, MD MPH

“Knowledge of systemic and ophthalmic manifestations combined with an understanding of the epidemiology of disease vectors is crucial for the diagnosis of tick-borne diseases,” she explains.

While manifestations may be present with LD and Rocky Mountain spotted fever, ocular involvement is rare in other tick-borne diseases such as babesiosis, tick-borne relapsing fever, Powassan encephalitis, ehrlichiosis, anaplasmosis, and Colorado tick fever, Sathiamoorthi points out.

However, the true prevalence of ocular involvement due to tick-borne illnesses is unknown. Limitations with testing can make it difficult to identify patients. “It is crucial to know who is appropriate to test in order to avoid false positive results.” If an individual has been symptomatic for only a short period of time, they “may not have detectable serum IgM antibodies to the causative organism because it takes time for this immune response to develop.”

It can also be difficult to determine the cause of the ocular complaints if there is evidence of more than one tick-borne illness.

“One case report [2] describes a patient with optic neuritis and orbital myositis who had serologic evidence of HME [Human Monocytic Ehrlichioisis], Borrelia burgdorferi, and Babesia,” cites Sathiamoorthi.

There are more than one species of ticks associated with ocular findings, as well. According to Sathiamoorthi, those include Ornithodoros genus, Dermacentor variabilis Ambylomma americanum, Ixodes scapularis, and Dermacentor andersonii.

Sathiamoorthi advises doctors to “carefully generate a reasonable differential based on clues in the medical and social history regarding exposures and risks.”

“Patients who are most likely to have ophthalmic Lyme disease,” explains Sathiamoorthi, “are those with ocular manifestations commonly associated with Lyme disease (i.e. Bells palsy, cranial nerve palsies and keratitis); tick exposure in Lyme endemic regions; other signs/symptoms of late Lyme disease (i.e. inflammatory arthritis, carditis, acrodermatitis chronica atrophicans rash, encephalopathy and meningitis); and negative syphilis testing.”

Read more on eye problems in tick-borne diseases in “A growing list of eye problems in Lyme disease.”

References:

1. Sathiamoorthi S, Smith WM. The eye and tick-borne disease in the United States. Curr Opin Ophthalmol. 2016;27(6):530-537.
2. Pendse S, Bilyk JR, Lee MS. The ticking time bomb. Surv Ophthalmol. 2006;51(3):274-279.

 

Case Series: Bartonella & Ocular Manifestations

https://www.ncbi.nlm.nih.gov/pubmed/30852734

2019 Mar 9. doi: 10.1007/s10792-019-01096-7. [Epub ahead of print]

Bartonella henselae- and quintana-associated uveitis: a case series and approach of a potentially severe disease with a broad spectrum of ocular manifestations.

Abstract

PURPOSE:

To evaluate the clinical manifestations of intraocular inflammation associated with Bartonella infection and describe the assessment and management of patients with cat-scratch disease (CSD).

METHODS:

This is a retrospective review of the clinical records of patients diagnosed with Bartonella henselae and Bartonella quintana intraocular inflammation from 2011 to 2018 in the Department of Ocular Inflammations and Infections of the University Eye Clinic of Ioannina (Greece). An analysis of the current literature concerning Bartonella-related intraocular infections was also carried out.

RESULTS:

This is a retrospective study of 13 patients (7 males and 6 females) with a mean age of 39.2 years that were diagnosed with unilateral intraocular inflammation, except one case with bilateral affection, attributed to Bartonella (either henselae or quintana). Twelve (12) patients (92.3%) had a positive history of traumatic cat contact. The main ocular clinical findings with regard to the type of uveitis included neuroretinitis in 5 eyes (38.5%), vasculitis in 3 eyes (23.1%), iridocyclitis in 2 eyes (15.4%), intermediate uveitis in 2 eyes (15.4%), posterior uveitis in 1 eye (7.7%), panuveitis in 2 eyes (15.4%), retinochoroiditis in 2 eyes (15.4%), vitritis in 1 eye (7.7%), peripheral choroidal granuloma in 1 eye (7.7%). Immunoglobulin (Ig) G was positive in all cases. All patients were treated with antibiotics (mainly rifampicin, doxycycline and azithromycin). The visual acuity was noted to be improved in all patients after treatment, but some of them experienced disturbing complications.

CONCLUSION:

CSD may manifest with various ocular pathological findings. Taking into consideration the increasing frequency of infections by B. henselae and B. quintana, clinicians should always incorporate CSD in the differential diagnosis of such presentations of uveitis. Educating vulnerable groups (children, immunosuppressed, etc.) and also general population, the appropriate preventing measures can contribute in limiting the risk of infection.

______________

**Comment**

While this study showed a high percentage with cat contact, many have become infected with Bartonella who were completely healthy and had no contact with cats:  https://madisonarealymesupportgroup.com/2019/03/02/skin-inflammation-nodules-letting-the-cat-out-of-the-bag/  I include links after the abstract.

Also, Bartonella can cause severe psychiatric symptoms:  https://madisonarealymesupportgroup.com/2019/03/24/cat-scratch-disease-caused-teens-schizophrenia-like-symptoms-report-says/

More on Bartonella & ocular manifestations:  https://madisonarealymesupportgroup.com/2018/09/06/ocular-manifestations-of-bartonellosis/

https://madisonarealymesupportgroup.com/2017/10/23/opthalmic-manifestations-of-bartonella-infection/

https://madisonarealymesupportgroup.com/2017/07/21/bartonella-and-neuroretinitis/

https://madisonarealymesupportgroup.com/2018/07/10/bartonella-henselae-neuroretinitis-in-patients-without-cat-scratch/

Bartonella Treatment:  https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/

More on Bartonella:  https://madisonarealymesupportgroup.com/2019/02/27/advanced-imaging-found-bartonella-around-pic-line/  Slides within link.  Links included to give to Dr. Ericson’s research on Bartonella.

The Endocannabinoid System and the Important Role It Plays in Human Health

https://articles.mercola.com/sites/articles/archive/2019/02/10/endocannabinoid-system-role-in-human-health.aspx?

Published on Feb 5, 2019

Natural health expert and Mercola.com founder Dr. Joseph Mercola interviews Carl Germano, a board-certified nutritionist and phytocannabiniods expert, on how the endocannabinoid system influences human health.
February 10, 2019
By Dr. Mercola

STORY AT-A-GLANCE

  • Cannabinoid receptors in the human body were discovered in the 1990s, which in turn led to the realization that we make compounds in our body — endogenous cannabinoids — that influence these receptors
  • Endocannabinoid deficiency has been identified in people who have migraines, fibromyalgia, irritable bowel syndrome, inflammatory and neurological conditions and a variety of treatment-resistant conditions
  • While CBD has gained the most attention, CBD alone cannot fully support your body’s endocannabinoid system (ECS). You need the other phytocannabinoids and terpenes as well
  • Hemp has been outlawed in the U.S. since 1938. The latest Farm Bill, signed into law at the end of 2018, makes it legal again; hemp oil with full-spectrum phytocannabinoids may benefit a wide range of health problems
  • There’s an intimate relationship between your ECS and your omega-3 status. Omega-3 fats make your cannabinoid receptors more active, and are used as backbone structures to produce cannabinoids in your body

Hemp has been outlawed in the U.S. since 1938. Thankfully, the latest Farm Bill signed into law at the end of 2018 makes it legal. In this interview, board-certified clinical nutritionist and expert on phytocannabinoids, Carl Germano, discusses the exciting implications of this change.

Now, there’s a difference between cannabidiol (CBD) products made from hemp and those made from marijuana. While many mistakenly believe hemp and marijuana are interchangeable, they’re actually two different plants.

“Both are considered Cannabis sativa by genus and species, but that’s where the similarity ends,” Germano explains. “Hemp has been cultivated for many reasons for the past few thousand years — food, clothing, fiber and fuel. The plant itself contains naturally occurring active compounds called phytocannabinoids, of which CBD is just one of them.

Marijuana, on the other hand, has been cultivated for its primary phytocannabinoid, tetrahydrocannabinol (THC). While it has recreational value at small levels, it does have medicinal value.

Nevertheless, many decades ago, hemp got dumped into the definition of marijuana. Hemp was unjustly placed into the Controlled Substances Act (CSA), which kind of hampered its access, its ability to have U.S. farmers grow it, or to have even medical or academic institutions study it.

We’ve been in the Dark Ages for decades. Thanks to Israel and Europe, who’ve championed all the research, we’ve [discovered] the cannabinoid system in the body called the Endocannabinoid System (ECS).

Trump did sign a Farm Bill that finally deregulates hemp. It takes it out of the CSA … It gives the rights of farmers to grow it. It will open up the doors for academic and medical institutions to study it. It will give consumers access to [what is] probably the most important botanical we have on this planet.”

Why Whole Hemp May Be Better Than Isolated CBD

The hemp plant contains over 100 different phytocannabinoids, of which CBD is one. And while hemp has now been taken off the CSA, CBD is still under the jurisdiction of the U.S. Food and Drug Administration (FDA), which is responsible for the labeling of supplements and enforcing the Dietary Supplement Health and Education Act (DSHEA).

“With the passage of the Dietary Supplement Health and Education Act (DSHEA), you have several things against CBD. First, CBD was not in commerce prior to 1994, so it could not be grandfathered as a dietary supplement, yet hemp oil has been in commerce prior to 1994, so we’re OK there.

Secondly, DSHEA states that if you want to submit a new dietary ingredient application, you can do so and petition the FDA for an ingredient to be classified as a dietary supplement.

Well, if you were to do that today, you would get rejected immediately because the other part of DSHEA states that if Big Pharma takes a natural ingredient and makes a drug that gets approved, it’s hands-off to the dietary supplement industry.

GW Pharmaceuticals has two drugs using isolated purified CBD in it. Therefore, we’ve got several strikes against putting CBD on the front panel, calling it a dietary supplement, and I say, why bother? Because the story is much bigger than CBD, both clinically, scientifically and legally.”

Hemp oil is a food that happens to have CBD in it. But while CBD may not be legally advertised on the label, CBD-containing hemp products can be labeled as having phytocannabinoids — the class of compounds to which CBD belongs. While CBD has gained the most attention, CBD alone cannot fully support your body’s endocannabinoid system (ECS). You need the other phytocannabinoids and terpenes, which are very complementary to the phytocannabinoids, as well.

“Those of us in botanical medicine understand that the sum of all the parts of the plant is greater than any one single ingredient,”Germano says. “Let’s face it. There’s more than one ginsenoside in ginseng. There’s more than one curcuminoid in curcumin. There’s more than one isobutylamide in Echinacea. There’s more than one ginkgolide in ginkgo.

Well, there’s more than just one phytocannabinoid in hemp. Back in 2011, Dr. Ethan Russo in the British Journal of Pharmacology1 … wrote about the entourage effect of all the phytocannabinoids and terpenes needing to be present to give rise to full clinical, meaningful benefit …

While CBD may be the most dominant phytocannabinoid in hemp, the others are there in minor in number, but they are not minor in the body as they all participate in nourishing, supporting the ECS, which is the bigger story.”

Understanding Your ECS

While the discovery of the ECS is fairly recent, genetically it dates back over 600 million years.2Cannabinoid receptors in the human body were discovered in the 1990s, which in turn led to the realization that we make compounds in our body — endogenous cannabinoids — that influence these receptors.

It was also discovered that the ECS orchestrates communication between other bodily systems, such as your respiratory, digestive, immune and cardiovascular systems. The ECS does this via receptors found in every organ, including your skin.

“Your ECS is like the conductor of the orchestra. The orchestra are our organ systems. We cannot be healthy, we cannot be well if our ECS does not function well,” Germano says.

“Your body produces cannabinoids similar structurally to the cannabinoids found in cannabis. Your body feeds off of them. If you don’t produce enough to feed every single receptor, various conditions and various illnesses will ensue.”

Two Types of Endocannabinoid Receptors Have Been Identified

There are two primary ECS receptors: cannabinoid receptor type 1 (CB1) and cannabinoid receptor type 2 (CB2). While CB1 is typically thought of as being primarily in the brain and CB2 primarily in the immune system, both types of receptors are in fact found throughout your body.

One of the two cannabinoids your body produces is called anandamide — a nod to the word “ananda,” the Sanskrit word for “bliss,” as it attaches to the same CB1 receptors that THC attaches to. The other, 2-arachidonoylglycerol (2-AG), is found throughout your body.

“The ECS has been the subject of many scholarly textbooks … Quite frankly, this is something that should be taught from high school to college to medical school. Unfortunately, because of the stigma attached to cannabinoids … less than 13 percent [of medical schools in the U.S.] are teaching the ECS.

I say, ‘Are you insane? This is like saying that for the next 70 years we will not teach the cardiovascular system, as if it never existed.’ We now have to dismantle this medical travesty … The whole thing is about education. This is critical and crucial to our health and well-being.

We have to dismantle the stigma, and we have to start educating ourselves to understand that the ECS is probably one of the most important medical discoveries in quite some time. Understanding the enormity of this system and what it does and what it influences throughout the entire human body.”

Low Endocannabinoid Levels Result in Ill Health

With age, our bodies tend to become less efficient in creating the compounds needed for optimal health, and this holds true for anandamide and 2-AG as well. According to Germano, these two cannabinoids can actually be used as biological markers for certain illnesses and conditions.

Endocannabinoid deficiency has been identified in people who have migraines, fibromyalgia, irritable bowel syndrome, inflammatory and neurological conditions and a variety of treatment-resistant conditions. Germano also cites a paper3 in Translational Psychiatry, which found low anandamide levels are a statistically positive indicator for stress-induced anxiety.

They’ve also discovered there’s an intimate relationship between your ECS and your omega-3 status.4As it turns out, omega-3 fats make your cannabinoid receptors more active, and are used as backbone structures to produce cannabinoids in your body.

What do we see in people who have low omega-3 status? We see the same things we see in people who are endocannabinoid deficient: pain, inflammation, stress, anxiety, depression and so on. It is a perfect marriage between omega-3s and phytocannabinoids, which act like a multivitamin for the ECS.

But it doesn’t stop there. Look at bones … the reason we give post-menopausal women estrogen is because it influences the cells that build up bone, osteoblasts, and the cells that break down bone, osteoclasts. What does this have to do with the ECS?

We now know that if you stimulate the CB1 receptors, you start to stimulate the brain-to-bone communication by slowing down the brain from releasing bone-breaking compounds, like norepinephrine. Then when you stimulate the CB2 receptors, it increases osteoblasts, the bone makers, and decreases osteoclasts, the bone breakers.”

Top conditions associated with low cannabinoid levels include:
  • Pain, inflammation and inflammatory conditions
  • Stress, anxiety and insomnia
  • Ocular health
  • Bone health
  • Neurological conditions

“These are all conditions that can be suitably treated with phytocannabinoids,” Germano says. “These are conditions that we see in people who are endocannabinoid-deficient.”

Running Dramatically Boosts Anandamide Level

While runner’s high is typically attributed to the release of endorphins, running also dramatically increases anandamide in the body, and anandamide not only targets the CB1 receptor, but it also influences opioid and endorphin receptors. Not surprisingly then, the higher an individual’s anandamide level, the better they report feeling.

“That makes sense, because anandamide hits the receptors in the brain that are involved in reward and mood,” Germano says. “We also understand that the cannabinoids we produce are quite promiscuous.

They certainly touch the CB1 and CB2 receptors, but they [affect] other receptors as well, [such as] the 5-hydroxytryptamine (5-HT3) receptors, peroxisome proliferator-activated receptors (PPAR), gamma-aminobutyric acid (GABA) receptors, and receptors that control inflammation, pain, reward, anxiety and things of that nature.”

A paper5 published in PLOS ONE also details how various nutrients (such as omega-3 fats), drugs, exercise, chiropractic care, massage and acupuncture influence the function of your ECS.

Your Endocannabinoid System — A Key Player in Inflammation

Curcumin, boswellia, fish oil and quercetin are all well-recognized anti-inflammatory nutrients, but none can compare to what cannabinoids can do, Germano says, especially when the full spectrum is used.

As noted in a 2014 paper6 in Current Opinions in Clinical Nutrition and Metabolic Care, the ECS is an emerging key player in inflammation, because it’s intertwined with all of the inflammatory pathways, including the eicosanoid ones that omega-3 fish oils influence.

Germano also cites other research showing that targeting the ECS can ease both inflammatory and neuropathic pain, and describe how cannabinoids act as analgesics. According to Germano:

“You cannot contend with any inflammatory condition unless you’re supporting the ECS. They can be used interchangeably; phytocannabinoids along with curcumin and boswellia and fish oils would be remarkable, as they are complementary to each other by doing different things.

Again, we must address the ECS in any inflammatory condition, whether it be irritable bowel syndrome or injuries — even inflammation in the brain, which is one of the hallmarks of all neurological diseases. In 2003, the United States government got issued a patent on the neuroprotective effects of cannabinoids.

At that time, while the government has been telling us that phytocannabinoids are like lysergic acid diethylamide (LSD) and heroin — [meaning they] have no medical value — they go out and get a patent on the medical value.

But that was followed up, and there are many papers that talk all about the anti-inflammatory effects in the brain and in the nervous system, of these cannabinoids … There is nothing else like supporting the ECS with phytocannabinoids.”

Your Endocannabinoid System Also Plays a Key Role in Your Gut Health

You’re probably familiar with the fact that there’s a strong connection between not only your brain and your gut, but also your immune system. The importance of this triad in health and disease prevention cannot be overstated. Your gut not only is your largest immune organ, it’s also your second brain, containing hundreds of millions of neurons.

“We now understand how the gut is involved with communicating with the brain and the immune system, because it has brain cells and immune cells in it,” Germano says. In the middle of this trio is your ECS. It is actually the orchestrator of this tri-directional communication. According to Germano, researchers have also discovered the ECS controls:

  • Motility in the gut
  • Intestinal inflammation
  • Abdominal pain
  • Gut permeability
  • Tolerance to antigens

The ECS also reduces the activity of the stress pathways, including the hypothalamic-pituitary-adrenal (HPA) pathways. Anandamide, specifically, participates in the immunological response in the gut. What’s more, there’s also communication occurring between your endocannabinoid system and your gut microbiome (the bacteria in your gut).

Clinical Applications for Hemp Products

Again, a full-spectrum oil is actually far preferable to product in which CBD has been isolated. Germano cites a 2015 Israeli paper, which compared full-spectrum oil against isolated CBD, and found the full-spectrum oil was in fact clinically superior.

As for dosing, most of the literature demonstrates efficacy of CBD in the several hundred milligram range — but that is for “single magic bullet” isolated CBD. Preclinical studies and any clinicians are reporting that efficacy can be achieved with much lower doses when using a ful spectrum oil — some in the 10 to 25mg CBD range.

“Since CBD is the most dominant cannabinoid in hemp, when you extract oil from hemp, you do have much, much higher levels of CBD naturally in the oil as compared to the rest of the phytocannabinoid family. Providing 10 to 25 mg of CBD is the sweet spot for most conditions in the trade — especially when used with other synergistic ingredients …

People are responding quite remarkably, which [suggests] you don’t need a lot to jump-start the body’s ECS. Quite frankly, when we look at the bell-shaped curve with the isolates, the higher the dose, sometimes you decrease the effectiveness … When you use a full-spectrum oil and you’re getting the other important phytocannabinoid and terpene components, this is superior, and I’ll tell you why.

People have been focusing on CBD, which is the wrong message. It’s the myopic message. Think about it, CBD does not attach to the CB1 or CB2 receptors. If anything, CBD supports the CB1 receptors by preventing the breakdown of anandamide in our bodies and anandamide hits the CB1 receptor.

What about the CB2 receptor that controls inflammatory cycling, pain signaling, insulin sensitivity and bone building? CBD does nothing for that, so we need something of a CB2 agonist. A perfect partner to CBD would be another phytocannabinoid called beta caryophyllene. Luckily, the family of other phytocannabinoids in a full-spectrum oil contains other phytocannabinoids that complement to what CBD is not doing as well.

We must get off this single magic bullet bandwagon. We must appreciate the full gamut of all these phytocannabinoids as a whole, and that they complement each other, because CBD is not the answer to support the ECS as a whole.”

As with most things, too much can backfire. While CBD cannot kill you, using CBD isolate in too high amounts can reduce its effectiveness. Such problems are far less likely when using a full-spectrum oil.

“I don’t foresee anybody really overdosing on the standard dosages that we’re recommending,” Germano says. “Nor when we look at the data that’s been published, up to 1,500 mg of CBD chronically administered over time show that it was well-tolerated, minimal to no adverse reactions on physiological function, psychological functioning and other parameters in the body, including blood pressure. So, CBD is quite well-tolerated in humans.”

Hemp Oil for Sleep

Aside from inflammation and pain, another area where a full-spectrum hemp oil can be beneficial is to improve sleep and treat insomnia. Germano recommends using a full-spectrum oil in a dose that provides 25 mg of CBD.

“CBD at that range does a number of things. No. 1, it reduces excitability in the brain. It can reduce glutamate toxicity and any excitatory conditioning. Secondly, CBD is involved in various neurotransmitters that are involved with a normal sleep cycle.

While it has a calming effect and helps to establish a normal sleep cycle, it’s not necessarily a sedative. You can use it with melatonin. You can use it with lavender. You can use it with chamomile and passionflower, what have you. I would do that towards the latter part of the day, at least an hour or two before bedtime. Lower doses of CBD are more stimulating, so to speak, and more upregulating.”

How the New Law Can Improve Quality of Hemp Products

In the past, prior to the signing of the new Farm Bill, the leaf, flower and bud of the hemp plant could not be used in the production of CBD-rich hemp oil. The oil had to be pulled from the stalk and stem of the plant only — the less concentrated part. With the new law, all parts of the plant can be used, which will make processing easier and more economical, as the cannabinoids are more concentrated in the leaves, flowers and buds.

The law also makes it legal to grow hemp in in every state, so if you wanted to, you could grow it in your backyard. This is something I’m definitely considering, as you can easily juice the whole plant or add it to smoothies.

“Growing it for yourself would be wonderful,” Germano says. “It is a weed. It has a short period of harvest. It grows very rapidly — July, August and September. Yes, the whole plant can be used rather than just extracting the oils from it. All the phytocannabinoids and lipids are found in the oils, but the leaf can be juiced and put into smoothies as well …

In terms of growing and processing it, it’s a rather easy plant to grow, because it is a weed. When we talk about the raw plant, a lot of these cannabinoids are in their acidic form. CBD is in CBDA, cannabidiol acid, form. To convert it to its useable form, the acid has to be decarboxylated.

So, while you may benefit from a lot of the phytocannabinoids [in the raw plant], it’s going to be reliant on your body’s ability to process it from the acidic forms that are in there. Exposure to heat, light, moisture and air will decarboxylate a lot of them as well. The more you process it yourself, the more useable some of those phytocannabinoids will be.

[To process it], you can take the leaf, flower and bud. You can blend it and store it in the refrigerator. Over a day or two of exposure to heat, air, light and moisture, it’ll decarboxylate to some extent and you’ll benefit more from that. How much do you get? Appreciable amounts of CBD may be difficult with just juicing alone …

I don’t want to misquote myself and say the wrong thing, but probably an ounce or two [of raw plant] would do the trick as a healthy plant beverage. Again, you don’t need a lot to jump-start your body’s ECS. It’s not a numbers game. Small doses, you would definitely respond to.”

How to Identify a High-Quality Hemp Product

If you’re not growing your own, attributes to look for when shopping for a hemp product include:

Organic Kosher-certified
Non-GMO Verified pesticide and herbicide free
Full-spectrum phytocannabinoids Grown from certified seeds and not hybrids with marijuana

“I look for companies that are doing the right thing also. That is, they don’t mention CBD on the front panel or quantify it in the Supplement Fact box. Responsible companies talk about phytocannabinoids,” Germano says.

They talk about hemp oil. They talk about nourishing the endocannabinoid system. This is a superior story to just CBD. Those are the more reputable companies that are telling the right story, [and not just talking about] isolated CBD.”

More Information About Endocannabinoid System

Germano has written a book about the endocannabinoid system called, “Road to Ananda: The Simple Guide to the Endocannabinoid System, Phytocannabinoids and Hemp,” (www.roadtoananda.com) which is due out shortly. I am very proud to have written the forward to this book as it is a great resource. Definitely pick up a copy if you want to learn more about this fascinating topic.

“I’m ecstatic to announce that the person who wrote the introduction to the book is Raphael Mechoulam, the father of cannabinoid research and who was involved in the discovery of the endocannabinoid system.

He is well-known in the scholarly circles. There are certainly plenty of scholarly work out there, but we need to get this message, this story, which is enormous, out to the layman and practitioner out there who is really unaware still,” Germano says.

“I’ve been in this industry for over 35 years. I’m a clinical nutritionist by trade. I have not seen any natural compounds this clinically relevant since the inception of this industry. I can tell you that targeting the endocannabinoid system, supporting it, will dominate medicine and nutrition of the next couple of decades.

There are also topical applications for phytocannabinoids, because, again, our skin is one of our largest organs. It also has five to 10 times more cannabinoids in it than we have in our brain. The CB1 and CB2 receptors are there as well.

There are three targeted areas for topical applications. One, obviously, is pain and inflammation, because the CB2 receptors are there that control that. That is something that will blow away any of these compounds in the marketplace today for topical pain relief.

Then we know that certain cannabinoids strangle the sebaceous gland for acne. Certain cannabinoids also influence age spot development and antiaging. [There are] some very interesting things going on in the topical application area.

When we look at the global picture of what is the subcutaneous endocannabinoid system doing, it’s helping to maintain normal cell proliferation, differentiation and immune competence. Oncologists are going to be interested in that aspect.”

_________________

**Comment**

If you are a Lyme/MSIDS patient you should see yourself ALL over this article.  We struggle with pain, inflammation, gut issues (motility, permeability, antigen tolerance, pain/inflammation), neurological issues, & insomnia.  Many experience ocular & bone issues as well.  It will be interesting to observe the topical applications of this since so many have pain.

It’s quite amazing that our government has gotten away with pigeon-holing this wonderful plant into the same category as heroin and marijuana for decades.  Hopefully, we will see pricing begin to fall as currently, cost is high.

The article, and indeed everything I’ve read, stresses that full-spectrum CBD is crucial.

For more:  https://madisonarealymesupportgroup.com/2019/02/09/webinar-cbd-craze-health-or-hype/

My entire family has found CBD oil to help with both sleep and pain.  I give the brand we’ve had success with here:  https://madisonarealymesupportgroup.com/2019/01/16/ldn-cbd/  (I am not affiliated with ANY companies).  It is potent.  The company has other strengths as well.

UH Study Shows Hawaii Kids More Vulnerable to Bartonella

http://www.hawaiinewsnow.com/2019/01/17/uh-study-cat-scratch-disease-three-times-more-prevalent-hawaii-keiki-than-mainland-kids/

Cat scratch disease: It’s rare, but a UH study says Hawaii kids are more vulnerable

Cat scratch disease: It’s rare, but a UH study says Hawaii kids are more vulnerable
UH and Kapiolani doctors are warning about cat scratch disease.

Symptoms include fever and swollen lymph nodes. UH and Kapiolani Medical Center doctors studied 18 children who got severe reactions.

“These were children who had infections of their spleen, liver, meningitis, encephalitis. involvement of their eye. Some even developed bone lesions so it was a significant illness in these children,” said Dr. Jessica Kosut, a pediatric hospitalist.

Sarah Pacheco got a mild form of the illness years ago when her new kitten, Kipling, scratched her arm.

“I had just gotten a kitten and they play and you are bound to get scratched, but I noticed I lost my voice completely,” she said.

Cat scratch disease is still rare. Doctors think Hawaii’s humid climate, outdoor lifestyle and higher feral cat population could be partly to blame.

“I don’t think it’s cats that are in people’s homes, but it can be, but a couple of the children that we took care of described playing with cats that were out in the neighborhood and one child was hiding cats in his closet to keep them a secret from his mother,” said Dr. Kosut.

Doctors say cat scratch disease is treatable. Just make sure your cat doesn’t have fleas and doesn’t play with feral cats, and you don’t have to kick out your kitty.

“I’m definitely a fan of cats and I wouldn’t say that this should discourage anyone from getting cats or adopting cats. I just want providers to be aware of it,” said Dr. Johnson.

__________________
**Comment**
Cat Scratch Disease (CSD) or Bartonella IS NOT RARE!  And while some develop fever and swollen lymph nodes, it presents in a million different ways – some purely psychological.
And cats aren’t the only things transmitting it.

http://townsendletter.com/July2015/bartonellosis0715_3.html
Mode of Transmission: Arthropod vectors including fleas and flea feces, biting flies such as sand flies and horn flies, the human body louse, mosquitoes, and ticks; through bites and scratches of reservoir hosts; and potentially from needles and syringes in the drug addicted. Needle stick transmission to veterinarians has been reported. There is documentation that cats have received it through blood transfusion. 3.2% of blood donors in Brazil were found to carry Bartonella in their blood. Bartonella DNA has been found in dust mites. Those with arthropod exposure have an increased risk, as well as those working and living with pets that have arthropod exposure. 28% of veterinarians tested positively for Bartonella compared with 0% of controls. About half of all cats may be infected with Bartonella – as high as 80% in feral cats and near 40% of domestic cats. In various studies dogs have close to a 50% rate as well. Evidence now suggests it may be transmitted congenitally from mother to child – potentially leading to birth defects.

I’m glad they mentioned:
  • infections of their spleen & liver
  • meningitis
  • encephalitis
  • involvement of the eye
  • bone lesions
Because, these are the things crossing my desk on a daily basis.
Bartonella is prolific, tenacious, and can cause severe illness, and many LLMD’s consider it a major coinfection of Lyme.
To read more about the organism and successful treatments:  https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/
For more:  
  • Heart involvement –
  • Eye involvement –
  • Neurological involvement –
https://madisonarealymesupportgroup.com/2019/02/04/from-cat-scratch-disease-to-bartonellosis/  A table within this article states Bart can cause hallucinations.
  • Skull & bone infections
https://www.ncbi.nlm.nih.gov/pubmed/19303175  Besides the case report of a woman with osteomyelitis, the study states a literature review identified 51 other cases of osteomyelitis associated with cat scratch disease, 14 of those confirmed by PCR.
  • Thoracic involvement –
  • Cancer

https://madisonarealymesupportgroup.com/2019/01/02/bartonella-langerhans-cell-histiocytosis-cancer/

  • Chronic abdominal pain, esophageal heartburn, purpuric skin rash, mesenteric adenitis (swollen lymph nodes inside the abdomen)   

https://www.lymediseaseassociation.org/images/NewDirectory/Studies-Papers/Fried_Bartonella-2002.pdf

  • Granulomas & bony lesions

https://madisonarealymesupportgroup.com/2018/07/05/cat-scratch-disease-in-a-1-5-year-old-girl-case-report/

  • Rheumatological involvement –

https://madisonarealymesupportgroup.com/2018/05/09/rheumatological-presentation-of-bartonella-koehlerae-henselae-a-case-report-chiropractors-please-read/   Please note the joint popping with each articulation and continual joint subluxation issue.

  • Can turn off antibodies to Lyme, Babesia, Ehrlichia, Anaplasma, and even itself

http://www.townsendletter.com/July2009/ed_lyme0709.html  Dr. Shaller feels that due to this, Bartonella should be considered in ALL initial consults.

I’m going to stop at this point as I’m growing weary.  The question begs to be asked:
Does this look rare to you?

 

 

Erratic Eye Jerks in Child with Lyme

https://www.ncbi.nlm.nih.gov/pubmed/30655046

2019 Jan 14. pii: S0929-693X(18)30263-X. doi: 10.1016/j.arcped.2018.11.013. [Epub ahead of print]

Opsoclonus in a child with neuroborreliosis: Case report and review of the literature.

Abstract

Opsoclonus consists of massive erratic rapid eye jerks. They may occur in isolation or in association with myoclonus and ataxia, i.e., opsoclonus-myoclonus syndrome (OMS). We report the case of a 9-year-old girl who suffered from headaches for several days and was shown to have opsoclonus and left peripheral facial palsy. Work-up excluded the diagnosis of neuroblastoma, but CSF analysis showed aseptic meningitis, and serology for Borrelia burgdorferi (Lyme) was positive. The outcome was favorable with complete regression of symptoms after treatment with ceftriaxone 2g/day for 3 weeks. Although rare, the diagnosis of Lyme neuroborreliosis must be raised in the presence of isolated opsoclonus, particularly if the clinical picture is incomplete and if other features, such as peripheral facial palsy and pleocytosis in the CSF, are present.

___________________

**Comment**

To see what Opsoclonus looks like:

Again, researchers shouldn’t be writing that this manifestation is “rare,” because nobody’s truly keeping track of this.  For decades folks have been undiagnosed due to horrifically abysmal testing that misses half of all cases.  

Facial palsy and aseptic meningitis are huge clues for Lyme

Aseptic meningitis is when the lining of the brain becomes inflamed.  In this case, due to a Borrelia burgdorferi (Bb) infection.  This explains the headaches.

577px-Brain_and_Nearby_StructuresBy Alan Hoofring  https://visualsonline.cancer.gov/details.cfm?imageid=4279, Public Domain, https://commons.wikimedia.org/w/index.php?curid=34938301

As the picture shows, the meninges cover the entire brain so the headache caused by this is going to cover the entire head.  This is what I personally had that took years of antibiotics to rid.  I wondered if there would ever be a day without this type of headache.

I’ve spoken with many Lyme/MSIDS patients who have had exactly the same thing.  It is not rare.  The pain is unbelievable, and ONLY treatment took it away.  Ibuprophen will not touch this Mother one little bit.  CBD, systemic enzymes, NOTHING will touch this if you have a Bb infection.  The infection must be dealt with first.

For those of you with this presentation, please also consider Chiari, especially if you’ve had this type of headache for some time:  https://madisonarealymesupportgroup.com/2016/04/02/chiari/  Within a week I met numerous Lyme/MSIDS patients with a Chiari diagnosis.

Lyme/MSIDS can cause numerous other eye issues:

https://madisonarealymesupportgroup.com/2017/07/21/growing-list-of-eye-problems-in-lyme-disease/  The authors described patients with tick-transmitted diseases presenting with the following ophthalmologic findings:

  • Follicular conjunctivitis
  • Periorbital edema and mild photophobia
  • Bell’s palsy, cranial nerve palsies and Horner syndrome
  • Argyll Robertson pupil
  • Keratitis
  • Optic neuritis, papilledema, papillitis and neuroretinitis
  • Myositis of extraocular muscles and dacryoadenitis
  • Episcleritis, anterior and posterior scleritis
  • Anterior, intermediate, posterior and panuveitis
  • Retinal vasculitis, cotton wool spots and choroiditis
  • Retinitis, macular edema and endophthalmitis
Now add Opsoclonus to this growing list

https://madisonarealymesupportgroup.com/2015/09/16/bizarre-symptoms-msids/

https://madisonarealymesupportgroup.com/2018/08/08/dr-jay-davidson-video-on-nematodes-in-the-eye/

 

 

 

 

Acute Transverse Myelitis – A Clinical Manifestation of Lyme (That Nobody Has a Clue About Prevalence)

https://www.ncbi.nlm.nih.gov/pubmed/30622896

2018 Dec 29;15:e00479. doi: 10.1016/j.idcr.2018.e00479. eCollection 2019.

Acute transverse myelitis – A rare clinical manifestation of Lyme neuroborreliosis.

Abstract

Acute transverse myelitis (ATM) is a rare, potentially devastating neurological syndrome that has variety of causes, infectious being one of them. Lyme disease (LD) is the most common vector borne zoonosis in the United States (U.S.). While neurologic complications of LD are common, acute transverse myelitis is an exceedingly rare complication.

We present a case of a previously healthy 25-year-old man who presented with secondary erythema migrans, aseptic meningitis and clinical features of transverse myelitis including bilateral lower extremity motor and sensory deficits manifesting as weakness and numbness, urinary retention and constipation.

Despite negative serum antibodies against Borrelia burgdoferi, cerebrospinal fluid (CSF) was positive for Borrelia burgdorferi PCR.

Following treatment with methylprednisolone and ceftriaxone, he attained complete recovery apart from neurogenic bladder necessitating intermittent self-catheterization. We report rare manifestation of a common disease and emphasize the importance of considering LD in the differential diagnosis of acute transverse myelitis, particularly in residents of endemic areas.

__________________

**Comment**

Nobody has a CLUE about how often anything is occurring in Lyme/MSIDS, when testing misses over half of all cases and folks are commonly misdiagnosed or undiagnosed for years.  Again, because words mean things, and research has been used against patients for over 40 years, a more accurate statement would be, “This is the first recorded case of ATM caused by Lyme Disease.”  And remember, just because something isn’t on record doesn’t mean it hasn’t happened.  Important distinction.

According to https://myelitis.org/living-with-myelitis/disease-information/afm/

The predominant presentation is weakness that may affect the limbs, face, oral or eye muscle. Weakness varies greatly ranging from subtle to very severe. AFM may result in total paralysis, partial paralysis, or weakness of just one limb. The combination of paralysis and how individuals present are widely variable. The limbs or muscle structures of individuals with AFM appear weak, flaccid, or limp and are not spastic as seen in classic cases of transverse myelitis. Since it is markedly the gray matter of the spinal cord that is inflamed in individuals with AFM, sensory, bowel and bladder functions can remain intact, however there are individuals that have both upper and lower motor neuron involvement.

The enterovirus (EV-D68) has been suspect in many of these cases however, it has not been definitively proven that it is this particular virus that has caused the paralysis,(1) although several cases of AFM occurred at around the same time as an outbreak of the EV-D68 virus.(2)

There has been a spike in AFM:  https://madisonarealymesupportgroup.com/2018/10/19/rise-in-acute-flaccid-myelitis-cases-and-the-link-to-vaccinations/

Within the above link, you will learn there are numerous theories on what causes AFM including viruses & vaccinations.  Lyme/MSIDS patients often have viral involvement, and reactivation of Lyme has been documented after vaccinations:  https://madisonarealymesupportgroup.com/2017/12/02/scottish-doctor-gives-insight-on-lyme-msids/, as well as Bartonella:  https://madisonarealymesupportgroup.com/2016/04/24/gardasil-and-bartonella/

https://madisonarealymesupportgroup.com/2016/11/07/connection-of-acute-flaccid-myelitis-and-vaccinations/  In this article, James Lyons Weiler states:

The US press has been pushing a view of acute flaccid paralysis as a mysterious condition of unknown etiology (unknown cause). Checking the scientific literature, however, tells us that AFP is most often Guillain Barre Syndrome (GBS), a condition that appears on the National Vaccine Injury Compensation Program as a “Table Condition” – i.e., one that the US HHS has no defense against when parents file in the NVICP for compensation for GBS as a vaccine injury in their children.  https://madisonarealymesupportgroup.com/2018/12/07/acute-flaccid-paralysis-is-most-often-guillain-barre-syndrome/

GBS is also often a player with Lyme/MSIDS:  https://madisonarealymesupportgroup.com/2019/01/09/transverse-myelitis-guillain-barre-associated-with-bartonella/

https://madisonarealymesupportgroup.com/2017/07/14/clinical-association-lyme-disease-and-guillain-barre/  In Dr. Waisbren’s book, Treatment of Chronic Lyme Disease, the majority of his 51 cases of chronic Lyme had high EBV titers.  He also states,

“As will be seen in other cases, the Epstein-Barr virus may be a candidate for a co-infection associated with LD.”  

Waisbren often treated this co-infected patients that had EBV with 1000mg of Valtrex three times a day with good success.  He also used gamma globulin (4cc twice a week).

So Lyme/MSIDS patients are at the top of the list for AFM for numerous reasons.  Personally, I had a MRI at one point due to the excruciating pain in my spine and occipital headaches.  This pain was unrelenting.  Borrelia burgdorferi (Bb) loves the brain and spinal column.  Many viruses hang out in the spine.  The MRI showed nothing abnormal and I was sent home with the same pain I came with.  While I believe proper antimicrobial treatment to be imperative, what finally relieved this pain for me was MSM:  https://madisonarealymesupportgroup.com/2018/03/02/dmso-msm-for-lyme-msids/

Along with swelling in the spine, patients can have brain swelling as well.  Within one week, I met 3 Lyme patients with Chiari, another supposed “rare” condition:  https://madisonarealymesupportgroup.com/2016/04/02/chiari/  While Chiari is often caused by structural defects in the brain and spinal cord that occur during fetal development, it can also be caused due to injury, exposure to harmful substances, or infection. 

When you study the Bb organism, along with the numerous coinfections, spine and brain swelling makes complete sense and needs to be studied further:  https://madisonarealymesupportgroup.com/2016/02/13/lyme-disease-treatment/

There is so much research begging to be done, yet main stream medicine wants to wrap Lyme into a pretty box with a bow on top.  Again, if there is any box involved with Lyme/MSIDS, it’s Pandora’s.