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The Current State of Testing and Treating for Lyme Disease in Ontario

Lately, I have been receiving many requests to do community lectures on Lyme Disease. I thought I would share a small portion of what I speak about in my lectures here.

The topic of ticks and Lyme disease (LD) is very controversial.  In this article, I am going to be as informative as I can be with a limited word count while remaining rather neutral in my discussions. This article is targeted for those new to the world of Lyme, not necessarily for the advanced Lyme patient.

 

Let’s start by defining the term LD as it can be used in one of two ways. It can refer only to the infection caused by the Borrelia burgdorferi bacteria, or it can be used as an umbrella term to describe not only the symptoms caused by B. burgdorferi, but also to those caused by common infections that get transmitted alongside B. burgdorferi, from the tick to the human host (eg. Bartonella, Babesia, Rickettsia, etc).

 

Most of what you hear about LD is acute Lyme, meaning the symptoms that develop within 30 days after a tick bite, however, what we are seeing more of is chronic LD. Acute LD symptoms include: joint pain, fatigue, fever, muscle aches (flu-like symptoms). Chronic LD occurs when acute LD is missed or treated ineffectively. Symptoms include: heart palpitations, chest pain, extreme fatigue, hot flashes, arthritis, nervous system symptoms, migraines, rage, cognitive dysfunction, etc. It is commonly referred to as the great imitator because it mimics diseases like MS, arthritis, fibromyalgia, dementia, hypothyroidism.

 

How can Lyme disease be missed?

  1. Current Ontario testing is two-tiered, meaning first your blood sample is tested with an ELISA, if it comes back positive, that result needs to be confirmed, so it is run through a Western blot. Both tests require an immune reaction to be mounted against the infection. That reaction can take 7-30 days to mount, which means if you have the blood test performed too early, the results will come back negative, resulting in a false negative and no treatment given.
  2. The B. burgdorferi bacteria can hide from the immune system. It is shaped like a spiral, giving the bacteria improved motility, and power to corkscrew its way out of the bloodstream and into organs, cells, and extracellular matrix. The bacteria can also create what is called a “biofilm”; a protective coating of polysaccharides, proteins, and metals, that effectively shield the infection from an immune response and theoretically, also from being treated effectively by short term antibiotic use.
  3. The saliva of the tick contains immunosuppressant molecules, Salp15, a feeding-induced tick salivary protein that inhibits white blood cell activation and proliferation by binding to T cells. Since the blood test for LD requires an immune response, the bacteria can evade detection in blood testing. This is also called a false negative.

 

How can Lyme disease treatment be unsuccessful?

  1. Current Ontario treatment guidelines recommend using 7-10 days of oral doxycycline to treat an infection. As you have read about in the paragraph above, the bacteria can create a protective barrier, shielding it from the harmful antibiotics. It also has the ability to live inside human cells, which also allow it to evade treatment. It can stay in hiding for long periods of time.
  2. The bacteria can exist in several different forms/life stages, not all of which are effectively treated by doxycycline: spirochete, spheroplast, cystic form. Sometimes a combination of antibiotics (herbal or pharmaceutical) is required.

 

A lot of physicians are facing irritated patients because they refuse to prescribe longer than 10 days of antibiotics. There is a reason for your physicians’ hesitancy, so please don’t be irritated with them. The College of Physicians and Surgeons could reprimand them, or even revoke their license if they find physicians are making recommendations that do not follow guidelines. Secondly, we are facing a future of antibiotic resistance. We only have so many antibiotics, and bacteria are beginning to become resistant even to our heaviest hitters. If we want to reduce or slow the rise of antibiotic-resistant infections, we must minimize our use of antibiotics. It is best to work with a Lyme Literate Doctor,  Lyme Aware Doctor or naturopathic doctor. You can find a list of these on ILADs website (ilads.org), or by contacting LymeOntario.

 

When being diagnosed with (or without) LD, it is important your healthcare provider take into consideration more than just your blood results, make sure they also take into consideration:

  1. History of tick bites
  2. Presence of bullseye rash (also known as erythema migrans – EM) within 7 days of a bite. This rash will only appear in approx. 50% of tick bites. According to the CDC, diagnosis of LD should not be based solely on the appearance of EM.
  3. Totality of symptoms; consider filling out the Horowitz Questionnaire, if you are unsure if your symptoms are related to LD or not.

 

Dr. Brenda Tapp ND

Peterborough Centre of Naturopathic Medicine

Oncology Association of Naturopathic Physicians