When I first started treating Lyme disease back in the early 1990s, our scientific understanding was that the bacteria, Borrelia burgdorferi, had a cell wall form which was responsive to cell wall drugs like penicillins and cephalosporins; an intracellular form, responsive to intracellular antibiotics (tetracyclines, macrolides, quinolones); and cystic forms, otherwise known as cell wall deficient forms/L-forms/S-forms/round bodies. I published in a scientific abstract, during the 12th International Conference on Lyme Disease and Other Spirochetal and Tickborne Disorders, April 1999, the first article on the use of Flagyl/metronidazole for the treatment of chronic Lyme disease, based on work that I did with Dr Martin Atkinson Barr.
Metronidazole Therapy in the Treatment of Chronic Lyme Disease. Horowitz, R.I., M.D. 12th International Conference on Lyme Disease and Other Spirochetal and Tick-Borne Disorders, April 9-10, 1999. New York, New York.
We didn’t know at the time that metronidazole hit the cystic forms of Borrelia, and Dr. Brorson confirmed that approximately six months later in a scientific publication. So for years, I was combining a cell wall drug (Ceftin, Omnicef, Bicillin injections, IV Rocephin), finding that longer acting antibiotics like Bicillin were effective when mixed with Plaquenil (hydroxychloroquine) and/or Flagyl for the round body forms of Borrelia (Plaquenil also was also shown to be effective in hitting the cystic forms of Borrelia, according to Dr. Brorson), along with an intracellular drug like Zithromax.
Bicillin Therapy and Lyme Disease: A Retrospective Study of the Safety and Efficacy of High Dose Intramuscular Bicillin in the Treatment of Chronic resistant Lyme Disease. Horowitz, R.I., M.D. 12th International Conference on Lyme Disease and Other Spirochetal and Tick-Borne Disorders, April 9-10, 1999. New York, New York
This was effective in helping patients, but many times, patients relapsed shortly after stopping treatment due to persistent infection and required herbal therapies to reduce their symptoms and/or help some of them stay in remission.
Chronic Persistent Lyme Borreliosis: PCR Evidence of Chronic Infection Despite Extended Antibiotic Therapy- A Retrospective Review Horowitz R.I., M.D. Abstract, 13th Annual International Scientific Conference on Lyme Disease and other Tick-Borne Disorders. Hartford, Connecticut, March 25-26,2000.
Then over the years, one by one I found overlapping sources of inflammation with downstream effects that were keeping my patients ill. First it was co-infections, especially Babesia. Joe Burrascano encouraged me to publish my findings (thank you, Joe!). We found Babesia microti in both ticks and in my patients. One of my patients who was in a wheelchair for five years unable to walk, began to ambulate for the first time after taking 10 days of Mepron and Zithromax. The abstracts are listed below.
Babesiosis in Upstate New York: PCR and RNA Evidence of Co-Infection with Babesia Microti Among Ixodidae Ticks in Dutchess County, NY. Horowitz, R.I., M.D. 12th International Conference on Lyme Disease and Other Spirochetal and Tick-Borne Disorders, April 9-10, 1999. New York, New York
Atovaquone and Azithromycin Therapy: A New Treatment Protocol for Babesiosis in Co-Infected Lyme Patients. Horowitz, R.I., M.D. 11th International Conference on Lyme Disease and Other Spirochetal and Tick-Borne Disorders, April 25-26, 1998. New York, New York.
Chronic Lyme Disease: A Symptom Complex of Multiple Co-Infections: New Diagnostic & Treatment Protocols. Horowitz, R.I., M.D. 12th International Conference on Lyme Disease and Other Spirochetal and Tick-Borne Disorders, April 9-10, 1999. New York, New York.
Lyme Disease and Babesiosis: New Therapeutic Options for Chronic Persistent Disease. Horowitz R.I., M.D.. Abstract, 13th Annual International Scientific Conference on Lyme Disease and other Tick-Borne Disorders. Hartford, Connecticut, March 25-26,2000.
Mefloquinine and Artemesia: A Prospective Trial of Combination Therapy in Chronic Babesiosis Horowitz R.I., M.D. Abstract, 13th Annual International Scientific Conference on Lyme Disease and other Tick-Borne Disorders. Hartford, Connecticut, March 25-26,2000.
High Dose Trimethoprim-Sulfamethoxazole Therapy: A Useful Adjunct to Combination Therapy in the Treatment of Resistant Babesiosis. Horowitz, R.I., M.D. 12th International Conference on Lyme Disease and Other Spirochetal and Tick-Borne Dis-orders, April 9-10, 1999. New York, New York
Then after discovering Babesia was playing an important role in keeping patients ill, we found that Bartonella was doing the same. A patient who couldn’t speak for years, who had been to a major university hospital and told that she had an ‘atypical migraine’ began talking for the first time in several years after giving her tetracyclines and a quinolone when we found she had Bartonella! This was 21 years ago! We are still finding Bartonella is playing a major role in keeping our patients ill, with new species being discovered all the time. The abstracts below discuss the problems with testing and treatment for Bartonella, back in 2003:
Bartonella Henselae: Limitations of Serological Testing: Evaluation of Elisa and Polymerase Chain Reaction Testing In a Cohort of Lyme Disease Patients and Implications for Treatment. Horowitz R.I., M.D. et.al. Abstract, 16th International Scientific Conference on Lyme Disease & Other Tick-Borne Disorders. Hartford, Connecticut, June 2003.
Borrelia Burgdorferi & Bartonella Henselae: A Study Comparing Tetracyclines In Combination with Quinolones in Co-Infected Patients. Horowitz R.I., M.D. et.al. Abstract, 16th International Scientific Conference on Lyme Disease & Other Tick-Borne Disorders. Hartford, Connecticut, June 2003.
And if it wasn’t Babesia and Bartonella, we then found atypical Mycoplasma species contributing to ongoing inflammation:
Mycoplasma Infections in Chronic Lyme Disease: A Retrospective Analysis of Co-Infection and Persistence Demonstrated by PCR Analysis Despite Long Term Antibiotic Treatment. Horowitz R.I., M.D. et.al. Abstract, 16th International Scientific Conference on Lyme Disease & Other Tick-Borne Disorders. Hartford, Connecticut, June 2003.
Chronic Lyme Disease: A Symptom Complex of Multiple Co-Infections: New Diagnostic & Treatment Protocols. Horowitz, R.I., M.D. 12th International Conference on Lyme Disease and Other Spirochetal and Tick-Borne Disorders, April 9-10, 1999. New York, New York.
So year after year, we kept discovering new factors that were contributing to chronic illness, whether it was heavy metal toxicity or mold…
A Prospective Study of Heavy Metal Exposure Among Lyme Disease Patients with Chronic Persistent Symptomatology: Implications for Treatment. Horowitz R.I., M.D. et.al. Abstract, 16th International Scientific Conference on Lyme Disease & Other Tick-Borne Disorders. Hartford, Connecticut, June 2003.
Or an increase in the acidic byproducts from infections contributing to Herxheimer reactions:
Effects of Shifting the Acid-Base Balance Among Lyme Patients during Jarish Herxheimer Flares: A Small Prospective Study. Horowitz R.I., M.D. et.al. Abstract, 16th International Scientific Conference on Lyme Disease & Other Tick-Borne Disorders. Hartford, Connecticut, June 2003.
Or finding that we needed to protect our pregnant patients because of maternal-fetal transmission and chronic persistence of Borrelia:
Lyme Disease and Pregnancy: Implications of Chronic Infection, PCR Testing and Prenatal Treatment. Horowitz R.I. et.al. Abstract, 16th International Scientific Conference on Lyme Disease & Other Tick-Borne Disorders. Hartford, Connecticut, June 2003.
That is how I developed the 16-point MSIDS model (Multiple Systemic Infectious Disease Syndrome). One by one, I kept finding overlapping factors that contributed to my patient’s chronic illness, some of them causing inflammation directly (infections, toxins, imbalances with the microbiome with or without mast cell activation, vitamin and mineral deficiencies, sleep disorders) or downstream effects of the inflammation (mitochondrial dysfunction, POTS/dysautonomia, autoimmunity, pain syndromes, physical deconditioning, hormonal dysregulation, liver dysfunction, and/or neuropsychiatric illness).
I published the results of my findings on the MSIDS model in Healthcare in 2018, as well as in my NY Times Bestseller, ‘Why Can’t I Get Better? Solving the Mystery of Lyme and Chronic Disease’ and National Bestseller ‘How Can I Get Better? An Action Plan for Treating Chronic LD and Resistant Illness’.
Horowitz, R.I.; Freeman, P.R. Precision Medicine: The Role of the MSIDS Model in Defining, Diagnosing, and Treating Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome and Other Chronic Illness: Part 2. Healthcare 2018, 6, 129. https://www.ncbi.nlm.nih.gov/pubmed/30400667
Why Can’t I Get Better? Richard Horowitz, M.D. HC ISBN-13: 978-1-250-01940-0 ISBN-10: 1-250-01940-0 6 1/8 9 ¼ ● 526 pages EISBN-13: 978-1-250-03848-7
How Can I Get Better? Richard Horowitz, M.D. HC ISBN 978-1-250-07054-8 (hardcover) ISBN 978-1-250-11144-9 (e-book)
What saddens me looking back at all of my work and publications, is that I was outlining the factors keeping my 13,000 + patients ill over 20 years ago, and we are still debating whether Lyme is a chronic persistent infection; the role of co-infections like Babesia and Bartonella in chronic illness; whether Borrelia can be transmitted from mother to child, or whether functional medicine approaches are helpful, and should be the new standard of care. I know that advances in the field of medicine can be slow, but considering the significant increase in the number of affected individuals who are sick and suffering from chronic Lyme disease and associated infections, in large part due to vector-borne infections rising with climate change, when mixed with blatant disregard for published science by certain key organizations…this situation has left us in a medical-political quagmire that has effectively stifled comprehensive patient care. Dr. Ken Liegner accurately described this situation many years ago when he said, “In the fullness of time, the mainstream handling of chronic Lyme disease will be viewed as one of the most shameful episodes in the history of medicine because elements of academic medicine, elements of government and virtually the entire insurance industry have colluded to deny a disease.”