Commentary: A presentation I did in Norway in 2014 was recently posted to Youtube.  The talk discussed the clinical presentation of Lyme Disease and associated co-infections, as well as the various diagnostic and therapeutic options available. Extensive scientific references on the diagnosis and treatment of different tick borne infections was discussed, including bacterial infections such as Lyme disease, Ehrlichia, Anaplasma, Bartonella, Mycoplasma, Chlamydia, Rocky Mountain Fever (RMSF), Typhus, Tularemia, Q-Fever, Brucellosis, Tick paralysis, and other new borrelia species, such as B. miyamotoi. There was discussion on tick-borne parasitic diseases such as Babesiosis and other piroplasms, and the expanding number of new viral infections being found in ticks, including the Heartland virus, Powassan encephalitis and other viral encephalopathies. Classical medical treatments was discussed for each infection, including side effects, drug interactions, and laboratory follow-up. This session also illustrated how different co-infections may contribute to chronic symptomatology in patients previously treated for Lyme disease.

Commentary: An important update on Rocky Mountain Spotted Fever was recently released by MedScape in collaboration with Casey Barton Behravesh MS, DVM, DrPH, DACVPM, who is Chief of the Epidemiology Activity in the Rickettsial Zoonoses Branch, Division of Vector-borne Diseases within the CDC. Since RMSF has nonspecific symptoms early on in the illness, and can be fatal if not properly treated with doxycycline, they  evaluated the safety of doxycycline in children. The new research shows that it is safe to use short courses of doxycycline in children at any age, without risk of tooth staining, and is "first line care for the treatment of suspected rickettsial infections at any ages". Here is an excerpt of the release from the CDC with accompanying scientific references: 

"I'm Dr Casey Barton Behravesh, with the Rickettsial Zoonoses Branch at the Centers for Disease Control and Prevention (CDC). I am here to discuss Rocky Mountain spotted fever(RMSF) and the new research on doxycycline showing that it is safe to use in children at any age. First, let's review some clinical characteristics of this serious disease. RMSF is caused by Rickettsia rickettsii, an intracellular bacterium transmitted through the bite of an infected tick. Early manifestations, within the first 4 days of illness, are typically nonspecific, with such symptoms as fever, headache, myalgia, and gastrointestinal illness. However, RMSF progresses rapidly to severe illness. Around 2-5 days after illness onset, a macular rash may develop on the wrists and ankles before spreading centrally. After day 5, illness severity increases dramatically with the development of late-stage petechial rash as well as hypotension and respiratory distress. Permanent, life-altering sequelae may result from vascular damage during acute illness, leading to neurologic deficits (such as hearing loss, paralysis, and encephalopathy) and the need to amputate extremities. Owing to the rapid progression of this disease, empiric treatment with doxycycline, the frontline drug for treatment of RMSF, is critical for anyone at any age and should be initiated in patients with suspected RMSF before laboratory diagnosis is obtained. Delay of doxycycline treatment past day 5 of illness is associated with increased risk for hospitalization and death. Death can occur rapidly in patients who do not receive appropriate treatment. The average time from onset of symptoms to death is only 8 days. Between 2008 and 2012 in the United States, 13,635 cases of RMSF were reported.[1] About 6% of cases were among children younger than 10 years of age; however, this same age group represented almost one quarter of all deaths. Children younger than 10 years are five times as likely to die from RMSF compared with any other age group. Therefore, we looked at data from a 2012 national survey of clinicians on prescribing practices for suspected RMSF. We found that 80% of responding clinicians correctly selected doxycycline as the treatment of choice for suspected RMSF in patients aged 8 years or older; however, only 35% correctly chose doxycycline as the treatment of choice for suspected RMSF in children younger than 8 years of age.[2] This points to a concerning gap in the treatment of pediatric RMSF. We suspect that one reason for the hesitation to prescribe doxycycline to pediatric patients is the warning about dental staining on all tetracycline-class antibiotics. Doxycycline, a newer tetracycline antibiotic, binds less readily to calcium during tooth development and has not been shown to cause tooth discoloration. Confidence in an antibiotic's safety is essential in clinicians' prescribing practices, so CDC scientists conducted a study to evaluate the potential for tooth staining in pediatric RMSF patients treated with doxycycline. In 2013, the CDC conducted a retrospective review of children in a community with high rates of RMSF.[3] We compared children who had received doxycycline before the age of 8 years in the treatment of suspected RMSF with children who had never received doxycycline. Licensed dentists, blinded to exposure status, performed quantitative and qualitative evaluations of tooth color and enamel hypoplasia. The study showed no evidence of subjective tetracycline-like staining, no difference in the rate of enamel defects, and no difference in tooth shade between the children who had received doxycycline and those who had not. This study provides the best evidence to date that short courses of doxycycline do not cause dental staining when given to children under the age of 8 years. Doxycycline is the first-line therapy for the treatment of suspected rickettsial infections in patients of all ages, recommended by the CDC as well as the American Academy of Pediatrics (AAP).[4] The current label allows for the use of doxycycline in pediatric patients with RMSF because other antibiotics are not likely to be effective for treatment. However, clearer language on the drug label is needed to avoid hesitation in prescribing life-saving doxycycline to children and to reinforce CDC and AAP recommendations for the treatment of RMSF. Despite the current label warning, it is important for healthcare providers to know that doxycycline has not been shown to cause tooth staining in the dose and duration used to treat rickettsial diseases. Early administration of doxycycline in adults and children can prevent severe illness and save lives".

  1. Adams DA, Jajosky RA, Ajani U, et al; Centers for Disease Control and Prevention (CDC). Summary of notifiable Diseases--United States, 2012. MMWR Morb Mortal Wkly Rep. 2014;61:1-121. Abstract
  2. Zientek J, Dahlgren FS, McQuiston JH, Regan J. Self-reported treatment practices by healthcare providers could lead to death from Rocky Mountain spotted fever. 2014;164:416-418.
  3. Todd S, Dahlgren F, Traeger M, et al. No evidence of tooth staining following doxycycline administration in children for treatment of Rocky Mountain spotted fever. J Pediatr. 2015;166:1246-1251. Abstract
  4. Committee on Infectious Diseases; American Academy of Pediatrics, Pickering L, Baker C, Kimberlin D, Long S. Red Book: 2012 Report of the Committee on Infectious Diseases. Elk Grove Village, IL; American Academy of Pediatrics; 2012: 620-625 

06/4/15 More information on RMSF can be found on the CDC web site:

Commentary: Lyme disease is spreading worldwide. Many Canadian patients have told me that their health authorities are struggling to understand the true prevalence of Lyme disease in Canada, with many health care providers denying the existence of the disease in their country. It is known that Lyme disease and associated tick-borne diseases can spread through wild birds dispersing ticks and acting as reservoirs for the disease. In this study just published in the International Journal of Acarology, 31% of the ticks from 21 species of birds in far Western Canada tested positive by PCR for Borrelia burgdorferi. In this study, two different ticks, Ixodes pacificus and Ixodes spinipalpis, both played a role in enzootic transmission cycle. Lyme disease is spreading through Canada through avian transmission, and "because songbirds widely disperse Lyme disease vector ticks, primary health providers and the general public must be vigilant that outdoors people may be bitten by B. burgdorferi-infected ticks throughout far-western Canada".

07/15 Infection Prevalence of Borrelia burgdorferi in Ticks Collected from Songbirds in Far-Western Canada, Scientific Research Publishing Inc.

Commentary: Cardiac complications are well known in Lyme disease. It frequently causes chest pain and palpitations, and occasionally can cause heart block with Lyme carditis, which can be fatal. Rarely, patients will develop a cardiomyopathy, where the heart muscle becomes weak, leading to severe congestive heart failure. That was the case with Dr Neil Spector, an MD who developed Lyme disease, and had difficulty getting diagnosed because of insensitive blood tests, along with denial of the disease by the medical profession in his home state. I discuss Lyme and cardiomyopathy on pages 272-275 of "Why Can't I Get Better?", in chapter 10, Lyme and Mitochondrial Dysfunction.

6/1/15 Lyme Disease | NC Now | UNC-TV, North Carolina Now

Commentary: Mary Beth Pfeiffer from the Poughkeepsie Journal published an article on the upcoming IDSA guidelines for the diagnosis and treatment of Lyme disease, which focuses on panel members and conflicts of interest. "Raging controversy over Lyme treatment guidelines in large part led the federal Institute of Medicine in 2011 to publish standards for developing medical guidelines that were fair and unbiased. The 2006 Lyme guidelines had been questioned in 2008 by then-Connecticut Attorney General Richard Blumenthal, now a U.S. senator, who alleged panel members had "undisclosed financial interests .... in Lyme disease diagnostic tests, patents and consulting arrangements with insurance companies;" as a result, he said, the panel "improperly ignored or minimized consideration of alternative medical opinion" on chronic Lyme disease...The Institute of Medicine said the controversy was "illustrative" of the need for a uniform process across diseases, involving doctors, patients and scientists with diverse viewpoints. Its report made clear that conflicts of interest could lead to bias by, among others, "specialty societies, which might benefit or whose members might gain from guideline recommendations." The recent ILADS guidelines which were published in a peer reviewed medical journal, strictly followed IOM recommendations. 

There is concern that the new IDSA guidelines are not following IOM recommendations, since patient groups have pointed out that members of the existing panel are the same authors from the prior guidelines, who deny the existence of chronic Lyme, with ongoing conflicts on interest, including receiving government or private research grants for the development of Lyme testing. Lyme testing is known to be unreliable, and "because tests fail early on — which mainstream scientists acknowledge — and the rash does not always occur, such endorsements lead to undiagnosed cases".

The 2010 IDSA review panel was "split on whether to discourage clinical diagnosis", but missed diagnosis can not only lead to chronic disability, it can also result in fatal outcomes. This was illustrated in the recent demise of Joseph Elone, a local Poughkeepsie High School student, who had a negative ELISA test for Lyme disease, and died several weeks later from disseminated Lyme. The scientific literature shows unreliable blood tests, persistence of borrelia despite short term treatment, with peer reviewed clinical trials demonstrating the benefit of longer term antibiotic therapies. I have included a link to an extended commentary on this article from the Poughkeepsie Journal, listing some of the most important scientific references on the diagnosis and testing for Lyme disease, that must be reviewed by the IDSA guidelines committee. It is incumbent on health care providers to review the past and present scientific research, and use their best clinical judgment in treating their patients. It is also incumbent on the IDSA panel to review up to date scientific literature, without conflicts of interest, so that we have guidelines that can be relied upon to help the millions suffering with diagnosed and undiagnosed tick-borne diseases. I would like to thank Mary Beth Pfeiffer and the Poughkeepsie Journal editorial staff for their ongoing excellent and comprehensive coverage on the politics surrounding Lyme disease.

6/1/15 Click here for full commentary & link to Poughkeepsie Journal article/video

Commentary: This scientific article follows up on the research done by Dr Zhang at Johns Hopkins discussing Borrelia burgdorferi causing drug-tolerant persister cells. As per Dr Sharma and Dr Hu: "In other chronic infections, the presence of drug-tolerant persisters has been linked to recalcitrance of the disease. In this study, we examined the ability of B. burgdorferi to form persisters. Killing of growing cultures of B. burgdorferi with antibiotics used to treat the disease was distinctly biphasic, with a small subpopulation of surviving cells. Upon regrowth, these cells formed a new subpopulation of antibiotic-tolerant cells, indicating that these are persisters rather than resistant mutants. The level of persisters increased sharply as the culture transitioned from exponential to stationary phase. Combinations of antibiotics did not improve killing. 

Daptomycin, a membrane-active bactericidal antibiotic, killed stationary phase cells, but not persisters. Mitomycin C, an anti-cancer agent that forms adducts with DNA, killed persisters and eradicated both growing and stationary cultures of B. burgdorferi. Finally, we examined the ability of pulse-dosing an antibiotic to eliminate persisters. After addition of ceftriaxone, the antibiotic was washed away, surviving persisters were allowed to resuscitate, and antibiotic was added again. Four pulse-doses of ceftriaxone killed persisters, eradicating all live bacteria in the culture".

This article implies that pulse dose antibiotics with Daptomycin, Mitomycin and Rocephin may be helpful in culture. Limitations of this research includes the choice of medications used, as well as not being an in vitro study. Other limitations include Mitomycin being a cancer drug not commonly used in Lyme disease and the study doesn't address bacteria that are difficult to kill in the intracellular compartment, in biofilm colonies and in cystic forms, or those bacteria that may be deep in tissues where antibiotics don't penetrate well. This is an encouraging study however, as researchers are finally admitting that persister cells exist in Lyme disease as they do in other chronic infectious diseases. Co-infections, such as Babesia, Bartonella were also not addressed in this study, and the majority of my patients who are chronically ill have multiple overlapping co-infections, and improve once those co-infections are adequately treated. Further studies are needed to evaluate combination and pulse therapies in Lyme disease, as well as evaluating combination therapies for associated co-infections. 

6/2015 Borrelia burgdorferi, the causative agent of Lyme disease, forms drug-tolerant persister cells, Antimicrobial Agents and Chemotherapy

Commentary: Ticks are out in full force this year, especially on Cape Cod and Martha's Vineyard, so education and prevention of tick-borne diseases is essential. We also need to have local health departments check ticks regularly for changing patterns of co-infections, as diseases like Tularemia are now being found in high numbers of ticks on the Cape. Unless a health care provider was made aware of the risk for a disease like Tularemia from a local tick bite, it would not normally be an infection most doctors would consider in their differential diagnosis if a patient came in with fatigue, fever, swollen lymph nodes, and a headache. "There have been perhaps 130 cases of tularemia on the Vineyard over the last 15 years, accounting for about 10 per cent of nationally reported cases. Symptoms typically include an ulcer at the site of the infection, swollen lymph glands, fever, chills, headache and exhaustion". Other manifestations of Tularemia include oculoglandular manifestations (conjunctivitis and swollen lymph nodes) as well as a typhoidal form that can cause diarrhea. Several tick-borne infections like Borrelia hermsii (relapsing fever), Ehrlichiosis and Rocky Mountain Spotted Fever can also cause diarrhea, (with other G.I. manifestations), acting as "great imitators", so health care providers need to be on the alert for atypical manifestations of tick-borne illnesses.  Many patients that I see with Lyme-MSIDS who have been sick for years suffer from Lyme and multiple tick-borne infections simultaneously, accounting in part for the failure of short term therapies. I discuss Tularemia and its various manifestations on pages 128 to 130 of "Why Can't I Get Better?".

5/21/15 Education Key to Stop Tick-Borne Illnesses (White Clothes Help Too), by Alex Elvin, Vineyard Gazette

Commentary: This scientific article by Jeanne Lenzer, associate editor of The BMJ, USA, discusses potential conflicts of interest that exist within the CDC, and how these conflicts may affect their recommendations. After revelations that the CDC is receiving some funding from industry, Jeanne Lenzer investigates how it might have affected the organization's decisions. "T he CDC does receive millions of dollars in industry gifts and funding, both directly and indirectly, and several recent CDC actions and recommendations have raised questions about the science it cites, the clinical guidelines it promotes, and the money it is taking.... funding of CDC took a turn in 1983, when the CDC was authorized to accept external “gifts” from industry and other private parties".              These conflicts of interest were not widely disseminated until now. How was this information received by medical leaders? "Industry funding of the CDC has taken many doctors, even some who worked for CDC, by surprise. Philip Lederer, an infectious diseases fellow at Massachusetts General Hospital and Brigham and Women’s Hospital in Boston, Massachusetts, and a former CDC epidemic intelligence service officer, told The BMJ he was “saddened” to learn of industry funding".

Professional reactions to the news include Neil Calman, president and chief executive of the Institute for Family Health in New York, a large community health center network with over half a million patient visits a year. He said "The institute has relied on CDC guidance largely because of its prestige as an independent agency, free of industry relationships". Calman toldThe BMJ, “Industry funding undermines trust and introduces a bias in the presentation of results and treatment recommendations that is deplorable for a government agency. If the allegations of industry funding and influence are true, we will have to look very carefully at recommendations we are following now and those made in the future by the CDC.” Calman said, “Industry claims their scientific methodology ensures their studies are unbiased—just as the CDC claims money doesn’t affect their recommendations. Yet multiple studies clearly—and repeatedly—show that who sponsors a study, or issues a guideline, makes a difference.” We certainly have seen this problem exist in guideline development with regards to Lyme and associated tick-borne disorders. We need to get federal bill H.R. 789 passed through Congress, so that there is the creation of an independent scientific committee which will objectively look at the science regarding the insensitivity of diagnostic Lyme testing, while reviewing the peer reviewed science showing persistence of borrelia and associated co-infections. Expanded insurance coverage may then be available for those suffering from undiagnosed and/or inadequately treated tick-borne disorders.

5/15/15 Centers for Disease Control and Prevention: protecting the private good?, BMJ

Commentary: Lyme disease rates are reaching epidemic proportions in North America, and Canadian doctors are reporting an increased number of Lyme cases in British Columbia. "In the past five years, the number of patients seeking treatment for Lyme disease has increased exponentially at our office, and is many times greater than those reported by public health officials. We are treating more cases of Lyme disease in Vernon than are reported every year in the entire province of B.C.".The CDC has publicly stated that they underestimated the number of cases of Lyme disease by 10 fold several years ago, and we are now seeing a similar situation with health care providers in B.C.  We need a national strategy for improving the diagnosis and treatment of Lyme and associated tick-borne disorders, like H.R. 789, that is presently before Congress. A similar bill was passed through Canada last year.

5/24/15 Natural Medicine: Lyme disease in the limelight, by Denise DeMonte, Vernon Morning Star

Dr. Holly Ahern published an excellent op-ed in a local NY newspaper, discussing the controversies regarding the diagnosis and treatment of Lyme disease. Doctors are divided on the best approach for patients with chronic symptoms who have failed classical therapy. I have found that tick-borne co-infections and multi factorial causes on the MSIDS map are often responsible for persistent symptoms. The new bill that is before Congress, H.R. 789, will help bring researchers, scientists, clinicians and patients together to review present diagnostic and treatment methods, fund new research and hopefully bridge the scientific divide between the IDSA and ILADS. In the middle of an epidemic, it's high time

for the medical community to stop taking sides in a debate, take a hard look at the large body of research showing poor sensitivity of testing and persistence of Lyme and associated co-infections, while working together for the benefit of those suffering with tick-borne disorders.

5/24/15 Commentary: Diagnosis, treatment of Lyme Disease controversial,

Commentary: For more information on the recent federal Lyme bill, here is the press release from Congressman Chris Gibson on the passage of H.R. 789, The Tick-Borne Disease Research Accountability and Transparency Act. As per Congressman Gibson:  "This is outstanding news for Upstate New York and for the more than 300,000 Americans suffering from Lyme disease and a host of related illnesses like babesiosis, ehrlichiosis, and Rocky Mountain spotted fever”. “Ticks are an increasingly dangerous presence in our communities, causing a litany of health problems that often go untreated or undetected. This situation is exacerbated by the dated treatment guidelines in use by the Centers for Disease Control and a lack of coordinated research by federal regulators, both of which have kept patients waiting for treatments and left them in the lurch financially when insurers refuse to pay for healthcare costs. Our bill will bring relief to a long-suffering population, especially our chronic Lyme sufferers".

We are grateful to Congressman Gibson for all of his hard work in helping to get this bill passed.

5/21/15 Gibson Lyme legislation added to 21st Century Cures Act, passes House committee, Congressman Gibson Press Release

Commentary: The Poughkeepsie Journal reported today on the Lyme research bill moving ahead in Congress. "The Tickborne Disease Research Accountability and Transparency Act was adopted into a larger medical research bill by the House Energy and Commerce Committee Thursday. In a distinct display of bipartisan cooperation, the larger "21st Century Cures Act" was unanimously approved by the committee's members". This bill will ensure that Lyme physicians and patient advocates have a seat at the table to help improve outcomes in those with "chronic or persistent symptoms, infections and co-infections". I have seen Lyme disease and multiple co-infections (like Babesia, Bartonella and Mycoplasma species) persist in patients despite standard treatment, causing disabling symptoms. Although the data is published in the peer reviewed medical literature and reported at international medical conferences, the politics surrounding Lyme disease and a lack of proper communication between scientists and clinicians have impeded progress. I agree with Dr Leigner that this bill is a major step forward, and that the bill "would level the playing field for researchers, clinicians and patients who have battled chronic Lyme disease in the face of federal denials of its existence". Thanks to John Ferro and the PJ team for their continued coverage of the science and politics of Lyme disease.

5/21/15 With bipartisan support, Lyme research bill moves forward, John Ferro, Poughkeepsie Journal

Commentary: I recently received confirmation from Congressman Chris Gibson that the text of H.R. 789, the Tick-Borne Disease Research Accountability and Transparency Act, is set to be included in a must-pass legislative package. The House Energy and Commerce Committee are marking up the 21st Century Cures package, where the bill will be included in Chairman Upton's Manager's Amendment. This is very good news. We are way overdue for research monies to get better diagnostic testing, while expanding treatment options for patients suffering with persistent tick-borne infections. This bill will also establish a scientific review panel to take a look at the emerging science of borrelia and associated tick-borne infections. I would like to thank Congressman Chris Gibson for his hard work and compassion in helping to get this landmark Lyme bill passed. Please share the good news and encourage your local representatives to support the bill.

Commentary: I just returned from the Bay Area Lyme Foundation's charity event. LymeAid 2015 raised $600,000 for research projects to find a cure for Lyme disease. There were Hollywood celebrities, philanthropists, scientists and patients present. I was asked to sing my tick song, affectionately called by one of the attendees "The Lyme Anthem", and for the first (and probably the last time) was the opening act for Huey Lewis and the News (who are fabulous in concert!). There is a video present on the site with photos of the gala. A large thanks goes out to Sherry and Laird Cagan who hosted the event at their home, and Linda Giampa and Bonnie Crater, co-founders of the Bay Area Lyme Foundation for organizing the event. Many wonderful and warm people came together to help find a cure for this devastating disease. Scroll down on the site to see all of the photos and videos.

5/19/15 Bay Area Lyme Foundation's LymeAid® Brings Celebrities and Scientists Together To Help Accelerate Medical Breakthroughs for Lyme Disease, PR NewsWire

5/17/15 Dr. Horowitz Singing the Lyme Anthem, Laura J. Szewcyk

5/19/15 Dr. Horowitz Singing the Lyme Anthem, Bay Area Foundation 

Commentary: I will be speaking at a two day scientific conference on Lyme and associated tick-borne disorders in Antwerp, Belgium, on Saturday/Sunday, September 12th and 13th, 2015. This conference will address the latest up to date information on Lyme and co-infections, and will include a comprehensive medical review of the scientific literature, with up to date classical and integrative treatments for those suffering with persistent disease. The conference will be in English and is open to both patients and health care professionals. I hope to see you there!

5/19/15 Lyme Conference 2015: September 12 & 13th, Antwerpen, Belgium

Commentary: Babesiosis is a parasitic tick-borne co-infection contributing to chronic persistent illness in patients with Lyme disease. It has been found throughout the US, as well as in  Europe and China. A recent study published in Parasites and Vectors, studied Ixodes ricinus ticks in Danish domestic dogs to determine whether humans in Denmark are exposed to Babesiosis. "A total of 661 ticks (Ixodes spp.) were collected from 345 Danish domestic dogs during April-September 2011 and pooled, one sample per dog. DNA was extracted from each sample and examined by PCR and sequencing for Rickettsia spp., Borrelia burgdorferi sensu lato, Bartonella spp., Francisella tularensis, Candidatus Neoehrlichia mikurensis, and Babesia spp. In total, 34% of the samples were positive for tick-borne microorganisms potentially pathogenic to humans: Rickettsia spp. were detected in 16% of the pools, with 79% being R. helvetica. Borrelia burgdorferi sensu lato was found in 15%, with the main species identified as Borrelia afzelii (39%). Likewise, 8% of the samples were positive for Babesia spp. (Babesia microti, 82%; Babesia venatorum (‘EU1’), 18%). Lastly, 1% of the samples tested positive for Candidatus Neoehrlichia mikurensis, and 0.6% for Bartonella spp. No ticks were found to be infected with Francisella tularensis". The conclusion of the article is that Babesia is present in Denmark, and "confirms I. ricinus as a vector of multiple pathogens of public health concern". A similar study was done by the Vermont Department of Health several years ago, when they found that 16 % of the dogs in Vermont had been exposed to the malaria like parasite. Babesiosis is spreading worldwide and is a major health concern. Regular vector-based surveillance of dogs and ticks is essential in order to determine the rising incidence of Lyme and associated co-infections.

5/8/15 Babesia spp. and other pathogens in ticks recovered from domestic dogs in Denmark, Parasites & Vectors

Commentary: The Red Cross is providing Babesiosis-free blood to hospitals in a few states. Why aren't more hospitals ordering blood tested for this tick-borne disease, and why might this matter? Babesiosis is the number one tick-borne parasitic co-infection contributing to chronic illness in my patients. Sixteen years ago in my Hudson Valley medical practice, I uncovered my first case of stealth Babesiosis. A patient of mine with chronic Lyme disease who was paralyzed in a wheelchair for approximately 5-6 years complained during her appointment of drenching night sweats and day sweats. I did a differential diagnostic work-up and sent out her blood for Babesia testing. When it returned positive, I started her on Mepron and Zithromax, one of the newer treatment regimens for Babesia (Clindamycin and Quinine was the classic protocol until that time). Although she had failed years of classical antibiotics for her Lyme disease and complained of severe ongoing symptoms, she walked for the first time in years after 10 days of Mepron and Zithromax. I subsequently informed my local health department of my findings, and decided to have local ticks provided by Dr Rick Ostfeld from the Institute for Ecosystems Studies in Millbrook, N.Y, tested for Babesia. It turned out that we did in fact have Babesiosis in the Hudson Valley, but only a few percentage of these local ticks contained this malaria like parasite. I reported my findings of Babesiosis in the Hudson Valley at the Lyme Disease Foundation's (LDF's) International Scientific Conference in NYC (Horowitz, R,I., Osfeldt, R.  Babesiosis in Upstate NY: PCR and RNA Evidence of Co-Infection with Babesia Microti Among Ixodidae Ticks in Dutchess County, N.Y. Abstract, 12th International Scientific Conference on Lyme Disease and Other Spirochetal Disorders. April 1999, NYC). Now,16 years later, over 40% of the ticks in the Hudson Valley are testing positive for Lyme and Babesia, with increasing rates of transmission of both organisms simultaneously (Co-Infection of Blacklegged Ticks with Babesia microti and Borrelia burgdorferi Is Higher than Expected and Acquired from Small Mammal Hosts, Ostfeld, R., et al. June 18, 2014; The result of this increased infection rate in ticks and in humans, is that the blood supply in the United States is now contaminated. How badly contaminated is the blood supply?

"A recent test of 115,000 blood donations from Minnesota, Wisconsin, and parts of New England showed about 460—or about four in 1,000—samples indicated babesia contamination...Currently, there is no FDA-approved test for the parasite, though many are in development, meaning that blood collectors depend on a questionnaire to determine the safety of a donor" according to this report in the Daily Beast . 

Babesiosis can be acquired through a tick bite, a blood transfusion or through maternal-fetal transmission, and can be fatal in the very young or elderly with a compromised immune system. Not all hospitals are testing for it before giving blood to patients. Really? Is there a solution? "There is babesia-free blood available from the American Red Cross, but only hospitals in a couple states are ordering it. The reason so many choose to take a gamble with their patients’ well being? Money, of course". “The problem is most hospitals don’t do that because it costs them an additional charge for us to do the testing,” Susan Stramer, the American Red Cross’ vice president of scientific affairs, said in a recent interview. “It really leaves the rest of the patient population vulnerable.” This means that until the FDA mandates testing, or until hospitals can be reimbursed for testing from federal agencies, hospitals won’t incorporate screening blood for babesiosis as part of what Stramer calls their “standard of care.”

Screening the blood for Babesia is essential if we are to prevent unnecessary deaths, but we face a complex situation. One of the classic tests done for Babesiosis is the Giemsa stain. This may not be positive unless the level of parasitemia is greater than 5% in the blood. There are also multiple strains of Babesia that I am finding in my patients. I have had patients with negative LabCorp test results for Babesia microti, but they test positive for another strain of Babesia, Babesia WA-1. I have found B. duncani in my patients from the entire northeast seaboard (Florida to Maine), and reported these results at the ILADS International Lyme Conference in Toronto several years ago. The results of LabCorp testing was that we did 137 total tests at the Hudson Valley Healing Arts Center between June 2010 and July 2011, and 26/137 patients tested positive (19%) with patients testing positive from Hamlin, Maine to Winter Park, Florida. I discussed these results with Ben Beard from the CDC, as well as Dr Peter Krause, when I was at the Harvard Lyme conference last year, explaining how Babesia is spreading and how we need to expand the testing. My approach is to do a Babesia panel with an IFA for B.microti and Babesia duncani/WA-1, as well as a Babesia FISH test (RNA) and occasionally a PCR (DNA) test to find the malaria like parasite. One test can be negative and the other positive, so a Babesia panel approach is often necessary. I use the Horowitz-MSIDS screening questionnaire as a first step to screen for Babesia by focusing on symptoms such as fevers, day sweats, night sweats, flushing, chills, air hunger and an unexplained cough. These symptoms should be incorporated into the questionnaire used before donating blood, since the classical symptoms of Babesiosis discussed in text books (high fevers, hemolytic anemia, low platelet counts (thrombocytopenia), elevated liver functions and renal failure) may not be present in patients who are co-infected with Lyme and Babesia unless they are immune compromised (lacking a spleen), or have a underlying severe medical condition like congestive heart failure. Different strains of Babesia also cause different clinical manifestations (Babesia divergens in Europe may present more often with classical symptoms), so we need to expand our testing and notions about Babesia, if we are to protect patients and the blood supply.

One way to help remedy this situation would be for Lyme patients and Lyme groups to ask their regional hospitals to order babesia-free blood from the American Red Cross (and create an on-line listing of those hospitals who are willing to participate), and shouldn't we all petition the FDA to mandate testing and require reimbursement of hospitals from the federal government? We need to improve the standard of care for all Americans. This is especially important since "with babesiosis cases multiplying tenfold in just a few years and showing no signs of slowing, receiving a blood transfusion becomes an increasingly dangerous gamble. And it’s a gamble scientists have been warning us about since at least 2006" and one danger I've been reporting since 1999.

5/8/15 Hospitals Knowingly Dispense Poisoned Blood, The Daily Beast

Commentary: I spoke at Binghamton University's Lyme Awareness Day, and over 400 people turned out for the event. It was presented by Binghamton University's Lyme and Tick-Borne Disease Research program (guest speakers included Dr Bahgat Sammakia, PhD, Vice President of Research at Binghamton University; Dr Ralph Garruto, PhD, Professor of Biomedical Anthropology; Dr John Darcy, PhD, research associate, Department of Anthropology; Dr Steven Bock and myself).  The conference was sponsored by Southern Tier Lyme Support, who did a great job organizing the event. Both health professional and patients were present as I spoke for over two hours on the diagnosis and treatment of Lyme and associated tick-borne infections. I focused on how global warming trends are increasing emerging infections like Lyme, gave extensive scientific references on the problems with serology and persistence, and discussed how the 16 point MSIDS model can help patients suffering with chronic illness. The lecture may be available on You Tube in the near future. Fox news covered the conference, and here is a short video and article from Fox 40, WICZ:

5/9/15 BU Holds Lyme Disease Conference, Fox40,

Commentary: Peter Pepe created this animated You Tube Video of the Ballad of the Deer Tick as a gift to share with everyone. Peter is an exceptionally talented multimedia production designer, who is experienced in the creation of corporate video, documentaries and business productions for education and entertainment. He has won four national awards for production excellence, and helped me to produce a You Tube presentation on Lyme disease for the Belgian government last year, when I was asked to present on Lyme, tick-borne co-infections, and the MSIDS model. When I asked Peter what he wanted to share with everyone regarding his gift to the Lyme community, he said:

"I created this in your honor as a gift to share with everyone. When I think of you, I’m reminded of my favorite quote: 'I think the purpose of life is to be useful, to be responsible, to be honorable, to be compassionate. It is, after all, to matter: to count, to stand for something, to have made some difference that you lived at all'. Leo Rosten.

Peter adds "It is important to share your God-given talents to help others, because it will make the world a better place for everyone". Working with Peter has been a joy and privilege for me and I am greatly appreciative of all the time and effort he put into doing this animated production.

Here are the links for the animated version of the Ballad of the Deer Tick and presentation to the Belgian government to share with everyone, with the iTunes and CD baby versions:  

5/2/15 Ballad Of A Deer Tick, Richard Horowitz, YouTube

Commentary: Melissa Crabtree is a singer/songerwriter friend, and she encouraged me to get my song about Lyme disease on iTunes and CDBaby for Lyme Awareness month. I wrote "The Ballad of the Deer Tick" several years ago in a cafe while driving through Shelburne Falls, Massachusetts. Shortly after I returned from vacation, Daryl Hall was in my office, so I decided to pull out my guitar and sing it for him to see what he thought. He had a good laugh and told me that we should record it in his studio in Pawling, N.Y. for an upcoming Lyme benefit we were doing. I thought he meant I was going to record it alone, but when I got to his studio, Daryl started playing his guitar, singing backup and laying down tracks on the Hammond organ, and his lead guitarist and bassist, T. Bone Wolk, sang, played guitar and laid down mandolin tracks! The post production editing was by the very talented Peter Moshay. It was an amazing experience. We performed "The Ballad of the Deer Tick" live in NYC for a Lyme benefit concert for the Turn the Corner Foundation when I was honored as Humanitarian of the Year. Here are the links for the song for those of you who would like it as a ringer for your phone, to sing to as you're getting your Bicillin shots, or simply to pick you up whenever you feel a bit down. Daryl told me he can't listen to it too much, because he can't get it out of his head. I'm very appreciative to Daryl for his generosity in helping to produce this song professionally with T Bone and Peter. Enjoy.

5/8/15 Ballad of the Deer Tick - Single, by Dr. Richard Horowitz, ITunes

Commentary: I will be speaking at the University of Binghamton on Saturday, May 9th, for Lyme Awareness Day. It is being presented by Binghamton University's Lyme and Tick-Borne Disease Research Program. It will be from 8 am to 6 pm at Binghamton University's Innovative Technology Complex. Speakers will include Dr Steven Bock, MD, Dr Bahgat Sammakia, PhD, Vice President of Research, Binghamton University , Dr Ralph Garruto, PhD, Professor of Biomedical Anthropology and Bob Giguere, from IgeneX laboratories. I will be speaking on Lyme disease and co-infections and how to use the MSIDS model in chronic persistent disease. For details and to register for free admission, please contact the Southern Tier Lyme Support group.

5/7/15 Lyme disease conference this weekend in Binghamton, by Jeff Murray, stargazette

Commentary: I did an interview about Lyme disease and associated tick-borne infections for Fox News Health Talk. Dr Manny Alvarez and I discussed the signs and symptoms of Lyme and co-infections, problems with testing and persistence, prevention, as well as the politics of Lyme disease. I would like to thank Fox News and Dr Manny for helping to educate the public and raise awareness.

5/6/15 The Lyme disease debate: Can the condition be chronic?,

Commentary: Dr Judith Miklossy has recently published an article on the relationship of spirochetal infections and Alzheimer's disease (AD). This is a study based on historical evidence of how syphilis (another spirochetal infection) also causes slowly progressive dementia. "These historic observations enable us to conclude that chronic spirochetal infections can cause dementia and reproduce the defining hallmarks of AD. They represent further evidence in support a causal relationship between various spirochetal infections and AD. They also indicate that local invasion of the brain by these helically shaped bacteria reproduce the filamentous pathology characteristic of AD. Chronic infection by spirochetes, and co-infection with other bacteria and viruses should be included in our current view on the etiology of AD. Prompt action is needed as AD might be prevented".

This report is just one of many published peer reviewed scientific references by Dr Miklossy and Dr Alan McDonald on the role of spirochetal infections and dementia. There is also evidence that environmental toxins can cause inflammation in the brain and lead to Alzheimer's type plaques (see the psychology today blog that I did on how environmental chemicals adversely affect physical and mental health). Using the MSIDS model to address multiple causes of inflammation, including persistent infections and toxins, is essential if we are to get to the root cause of some of the global health problems that we face in the 21st century.

4/16/2015 Historic evidence to support a causalrelationship between spirochetalinfections and Alzheimer’s disease, Judith Miklossy, Frontiers in Agin Neuroscience

Commentary: Lyme disease can affect everyone, even cartoon characters. Harley Quinn, one of the characters from Batman, has participated in the Lyme challenge, and her photo is below. Arleen, who was the voice of Harley Quinn (the best selling female character in comics) has suffered with Lyme for years due to inadequate testing. Multiple systemic symptoms, including searing neuropathic pain has been her companion for years, and yet, when I met her, I was struck by her warmth, sharp wit, and courageous heart. Perhaps Arleen's courage and perseverance truly makes her "The Superhero World's Most Successful Woman". Her full story can be found on The first line of her dialogue in the 1992 episode of the animated Batman series was a premonition of her life to come. "It is to laugh, huh, Mistah J?", she says to the Joker, which in this context means "Ain't that the truth". Her story is one episode among millions of those affected with tick-borne disease. Although her cartoon character "expressed a syncophantic devotion to superhero fiction's preeminent bad guy", it appears that "the bad guy" has now changed names. Arleen has had to be a superhero to put up with the chronic debilitating pain and we send her love and best wishes on her healing journey. This is a clip of her in her prime.

5/4/15 YouTube: Paul Dini - "Days of Our Lives" scene that inspired "Harley Quinn" character from "Batman"

Commentary: May is Lyme Awareness month and there is good news for Lyme patients who have continued to suffer despite short term treatment. New, more sensitive tests are on the horizon, science is confirming persistence of borrelia in animal and human studies (Hodzic E, Barthold SW (2014) Resurgence of Persisting Non-Cultivable Borrelia burgdorferi following Antibiotic Treatment in Mice. PLoS ONE 9(1): e86907; A. Marques et al. Xenodiagnosis to detect Borrelia burgdorferi infection: A first-in-human study. Clinical Infectious Diseases DOI: 10.1093/cid/cit939, 2014), recent research out of Johns Hopkins is addressing new treatment for Borrelia persisters (Feng J, Auwaerter PG, Zhang Y (2015) Drug Combinations against Borrelia burgdorferi Persisters In Vitro: Eradication Achieved by Using Daptomycin, Cefoperazone and Doxycycline. PLoS ONE 10(3): e0117207. doi:10.1371/journal.pone.0117207) and the politics surrounding Lyme is shifting, so that practitioners are prescribing longer term antibiotics, helping prior short term treatment failures. As per my interview in the Poughkeepsie Journal, "the winds are starting to change". Many well known chronic diseases have already been shown to have a link with Lyme and borrelia species, including Chronic Fatigue Syndrome, Fibromyalgia, autoimmune diseases, including Lupus, Rheumatoid Arthritis, and MS, as well as Alzheimer's and psychiatric diseases. This is briefly discussed in this article in the Poughkeepsie Journal, and in pages 487-514 in my book, "Why Can't I Get Better? Solving the Mystery of Lyme and Chronic Disease", I have included hundreds of scientific references on these topics, which show how Lyme and associated tick-borne diseases can affect the body and mimic other diseases. Below is a short list of references on this topic:

Complaints attributed to chronic Lyme disease: depression or fibromyalgia?: Berman DS, Wenglin BD; Am J Med. 1995 Oct;99(4):440.

Pain, fatigue, depression after borreliosis. Antibiotics used up--what next?
Woessner R, Treib: MMW Fortschr Med. 2003 Sep 18;145(38):45-8

Post-Lyme syndrome and chronic fatigue syndrome. Neuropsychiatric similarities and differences. Gaudino EA, Coyle PK, Krupp LB. Arch Neurol. 1997 Nov;54(11):1372-6

Rheumatoid factor correlates with antibody titer against Borrelia Garinii (genospecies of Bb). Kologrivova EN et al. Intensity of the production of rheumatoid factor in patients with different degrees of sensitization to B. garinii antigens. Zh Mikrobiol Epidemiol Immunobiol.2005 Mar-Apr;(2):80-3

Wilder RL, Crofford LJ. Do infectious agents cause rheumatoid arthritis? Clin Orthop 1991 Apr(265):36-41

Goebel KM, et al. Acquired transient autoimmune reactions in Lyme arthritis: correlation between rheumatoid factor and disease activity. Scand J Rheumatol Supp.. 1998;75:314-7

Marshall V. Multiple sclerosis is a chronic central nervous system infection by a spirochetal agent. Med Hypotheses, 1988 Feb, 25:2, 89-92

Fritzsche M. Chronic Lyme borreliosis at the root of MS-is a cure with antibiotics attainable? Med Hypotheses. 2005;64(3):438-48

Weigelt W, Schneider T, Lange R. Sequence homology between spirochete flagellin and human myelin basic protein. Immunol Today 1992 Jul;13(7):279-80

Ryskova O, et al. Lyme Borreliosis—incidence of serum anti-myelin antibodies. Epidemiol Mikrobiol Immunol. 2002 Apr;5(2):60-5

Neuroinflammation in Lyme neuroborreliosis affects amyloid metabolism. AUTHORS: Mattsson N, Bremell D, Anckarsater R, Blennow K, Anckarsater H, Zetterberg H, Hagberg; BMC Neurol. 2010 Jun 22;10(1):51

MacDonald, A. Concurrent Neocortical Borreliosis and Alzheimer’s Disease: Demonstration of a Spirochetal Cyst Form. Ann NY Acad Sci. 1988. 468-470

MacDonald A. Spirochetal cyst forms in neurodegenerative disorders,…hiding in plain sight. Med Hypotheses (2006)

Lyme neuroborreliosis and dementia. J Alzheimers Dis. 2014;41(4):1087-93. doi: 10.3233/JAD-130446. Blanc, Philippi, Cretin B1, Kleitz C2, Berly L2, Jung B1, Kremer S3, Namer IJ4, Sellal F5, Jaulhac B6, de Seze J7.

Approximately 75% of health care costs and 70% of deaths in the United States are due to chronic disease. Lyme is in epidemic proportion in the US, where the CDC has revised their estimates for the number of Lyme disease cases, where more than 300,000 patients per year are affected, and Lyme is known as the "great imitator". Isn't it time to do a comprehensive investigation into the role of Lyme and tick-borne diseases in chronic illness?

5/3/15 Future looks brighter for Lyme disease care, by John Ferro, Poughkeepsie Journal

Commentary: May is Lyme Awareness month, and I will be speaking at Western Connecticut State University on Tuesday, May 12th, at 7 pm on Lyme disease and the MSIDS model. The title of the talk is "Why Can't We Get Better? From Symptoms to Solutions". There will be a book signing before and after the event. I hope to see you there.

5/12/15 Dr. Richard Horowitz, Lyme Disease: Why Can't We Get Better? From Symptoms to Solutions, Lyme Connection Health Fair

Commentary: The Norvect Lyme and Vector-Borne diseases conference will be taking place on May 30th and 31st in Oslo, Norway. I was a speaker at last years inaugural conference, and it was a wonderful event. If you have never seen Norway, and want a great vacation and educational experience to get some of the most up to date information on tick-borne diseases, this is a great opportunity. I hope you can attend.

4/25/15 The NorVect Conference 5/30 & 5/31 2015, Invitation  /  Program

Commentary: The IDSA is in the process of redoing their Lyme disease guidelines, which are outdated. Patients were encouraged to write to the IDSA and share what is important to them, and did several surveys, the most recent one to determine

what patients view as important treatment outcomes in Lyme disease. These results were included in comments submitted by to the IDSA on behalf of 67 patient organizations. Please click on the link below to read the survey results. The stories and comments speak volumes about the ongoing suffering of those with Lyme and tick-borne disorders. Congratulations to for giving a clear and powerful voice to those who have not been heard.

4/24/15 IDSA Lyme disease survey results out! What’s important to patients?, by LymePolicyWonk,
Commentary: I would like to invite everyone to a groundbreaking Lyme awareness event taking place in June in Dutchess County. Writers, actors, directors and producers Mary Stuart Masterson (Fried Green Tomatoes, Benny & Joon) and Jeremy Davidson (Salt, Royal Pains, Army Wives) are bringing Lyme disease awareness to the stage at The Bardavon Opera House, Poughkeepsie, NY, on June 8th at 7:00pm. This presentation is based on a true story of one person's struggle with this devastating disease and will conclude with my doing a Q & A following the performance. I met Mary Stuart and Jeremy several months ago when they asked me to preview the piece at the Hudson Opera House, and I was deeply touched by this emotionally powerful theatrical production. The suggested donation for the show is only $6. Please come and meet the actors and directors, learn about tick-borne diseases, and show your support for this family who have had their lives transformed by Lyme disease. I hope to see you all there for this important event!

4/22/15 The Little Things, Docudrama, 7pm June 8th at The Bardavon Opera House

Commentary: A study from researchers from China and the University of Maryland has discovered a new tick-borne infection. Dr Stephen Dumler, MD, helped identify the new bacterial species, called Anaplasma capra. "The symptoms of A capra infection include fever, headache, and tiredness, dizziness and muscle aches (similar to other Anaplasma infections)....Because no one knew the bacteria existed, no one has looked for it, and it is not clear how widespread it is. The researchers successfully treated the infection with antibiotics, particularly doxycycline.

The discovery of this new bacteria is part of a growing international problem with ticks and emerging infections. In the last decade, we have seen an increase in the number of new bacterial infections in ticks, such as Borrelia miyamotoi, and other relapsing fever bacteria, like Borrelia bissettii. Borrelia miyamotoi was discovered in up to 4% of New England residents (NEJM), and B. bissettii was recently implicated as a human pathogen in Mendocino County, California (Girard YA, Fedorova N, Lane RS. Genetic diversity of Borrelia burgdorferi and detection of B. bissettii-like DNA in serum of north-coastal California residents. J Clin Microbiol. 2011;49:945–54). Overall, there has been a worldwide increase in the incidence of new Borrelia infections in the last 10 years, with 15 new species (1990-2010). These species include in the USA: B. burgdorferi sensu strictu, Borrelia sensu latu, and Borrelia kurtenbachii species; in  Europe: Borrelia afzelii (ACA), Borrelia garinii (neuroborreliosis), B. spielmani (early skin disease), B. valaisana, B. lusitanea, and B. bavariensis; in Asia, B. japonica, B. turdi, B. tanukii, B.yangtze; in North America, Borrelia andersonii; in the southern U.S, B. americanum, and B. carolinensis; and in the Pacific U.S, B. bissettii. We have also seen an expansion of viral infections in ticks in the last few years, such as the recently discovered Heartland and Bourbon viruses, and Powassan virus.

This new Anaplasma species joins the tick-transmitted bacteria of the genera Neorickettsia, Anaplasma, and Ehrlichia.  Ehrlichiosis includes HSE (N. sennetsu), HGA (A. phagocytophilum), HME (E. chaffeensis), HEE (E. ewingii) and HWME (E. Wisconsin-Minn), As is the case with Anaplasma capra, there are no specific tests for all of these species (i.e.,E. ewingii: Human Babesiosis and Ehrlichiosis-Current Status. Shah, J., Horowitz, R., Eur Infect Dis, Vol 6, Issue 1, Spring 2012), so patients may become ill without an apparent etiology . Anaplasma species may also be transmitted by blood transfusion (Annen, K., et al. Two cases of Transfusion-Transmitted Anaplasma phagocytophilum. American Journal of Clinical Pathology. 2012 Apr;137(4):562-5). It is therefore imperative that our surveillance efforts for tick-borne diseases include regularly testing ticks for novel infections, both in the US and worldwide, as the number and type of these infections is rapidly expanding.

4/22/15 Substantial health threat: Never-before-seen tick-borne disease, Science Daily

Commentary: I did an interview for the Lyme Connection that describes the MSIDS model and explains how tick-borne diseases are affecting millions of Americans. This interview also discusses some of the newer scientific research on borrelia and co-infections. I will be discussing the MSIDS model in detail at the Lyme conference and Health Fair at Western Connecticut State University on May 12th at 7 pm, as we discuss going from symptoms to solutions. Here is the online interview:

4/15 Meet the Lyme Disease Experts, Interview with Dr. Horowitz, Lyme Connection
Commentary: Have you taken the Lyme challenge? My office staff did!

2015 Lyme Disease Challenge - Spread Hope

Donate Today - Take a Bite out of Lyme Through Research & Education

Commentary: There are many potential mechanisms to explain persistence of borrelia after standard antibiotic therapies, including gene recombination, where borrelia can modify its surface antigen VlsE, and non-expressed vls, in gene cassettes, creating different outer surface antigens, helping to avoid immune recognition (Variable VlsE Is Critical for Host Reinfection by the Lyme Disease Spirochete. Rogovskyy AS, et al. PLoS ONE 8(4): e61226. as well as recent studies that have identified a number of genes and pathways that shed light on the mechanisms of persister formation or survival. Persisters are a small fraction of quiescent bacterial cells that survive lethal antibiotics but can re grow leading to post-treatment relapse. Examples include TB, syphilis, endocarditis, brucellosis, and biofilm infections (including Lyme disease). Mechanisms of persistence also include toxin–antitoxin molecules, DNA repair or protection, phosphate metabolism, anti-oxidative defense and macromolecule degradation (Persisters, persistent infections and the Yin–Yang model, Ying Zhang; Emerging Microbes and Infections (2014) 3, e3; doi:10.1038/emi.2014.3). We also have the problem of borrelia changing form between cell wall and cystic forms (cell wall deficient forms) and going into the intracellular compartments, where certain antibiotics may not penetrate well, with known treatment failures due to persistence of borrelia sequestering in antibiotically privileged sites. This includes the skin/fibroblasts (Klempner), eye (Preac-Mursic, Meier), ligamentous tissue (Haupl), joints (Priem, Bradley, Fitzpatrick), CNS (Coyle, Leigner), endothelial cells and macrophages (Ma et al, Infect Immun 1991 Feb;59(2):671-8; Malawista SE et al, J Immunol 1993 Feb 1;150(3):909-15) as well as biofilms (Sapi, McDonald). Novel approaches to eliminating persister cells are therefore necessary if we are to find a more effective treatment for Lyme disease. In this article recently published in PLoS one biology, researchers hypothesize that sequential antibiotic treatments with frequent rotations and fluctuating environments may help to reduce resistant bacterial populations. H. pylori is one example where sequential treatments have been effective. We have used combination therapies and sequential treatments in our clinic for years, combined with addressing the 16 points on MSIDS map, and find this approach to be useful (but not necessarily curative), where the majority of patients improve. Some of the newer drug regimens identified by Dr Ying Zhang from John Hopkins University may also have greater efficacy in combination and in sequential treatments (Feng J, Auwaerter PG, Zhang Y (2015) Drug Combinations against Borrelia burgdorferi Persisters In Vitro: Eradication Achieved by Using Daptomycin, Cefoperazone and Doxycycline. PLoS ONE 10(3): e0117207. doi:10.1371/journal.pone.0117207). Further studies of antibiotic rotations and sequential treatments need to be performed in Lyme patients with persistent symptoms to identify more effective therapies. 

4/8/15 Using a Sequential Regimen to Eliminate Bacteria at Sublethal Antibiotic Dosages, PLOS | Biology

Commentary: Katina Makris is a fellow health care practitioner, who went through a difficult battle getting diagnosed and treated for Lyme disease. She describes part of her journey in this article published in Every Day Health, and in her new book: Healing Lyme Disease, Body, Mind & Spirit. Katrina will be joining me and Dr Tom Francescott at the Omega Institute in Rhinebeck, N.Y. on June 26th-28th, to do a 3 day workshop on Lyme and associated tick-borne disorders. The conference will discuss the latest scientific updates on Lyme, with a focus on healing body, mind and spirit with classical and integrative techniques. Last year's conference was a great success, and included a fun Saturday evening ceremony with music. Scholarships are available this year for you (and your favorite health care provider) to attend the conference. Please spread the word and come to learn about Lyme disease while empowering yourself and your loved ones.

4/6/15 Surviving Lyme Disease and a Missed Diagnosis, by Katina Makris, Everyday Health

4/6/15 Living Well With Lyme Disease: June 26-28, Workshops, Omega

Commentary: I was interviewed by People magazine about Lyme and associated tick-borne diseases after Canadian singer Avril Lavigne's recent bout with Lyme disease. For those who missed seeing the live interview, the link is below. Congratulations to People for highlighting the importance of Lyme, as a rapidly spreading epidemic. Ticks are containing multiple bacterial, parasitic and viral infections, and education and prevention of tick-borne infections is essential if we are to effectively combat this growing health threat.  

4/2/15 Avril Lavigne Suffers from Lyme Disease: Things to Know about the Illness, People Magazine

Commentary: The etiology of the skin lesions in Morgellon's disease and its relationship with Lyme disease has been a debated medical topic for years. A recent article published in BMJ Dermatology by Middelveen et al has found an association with tick-borne infection. According to the authors "all patients in our study group demonstrated histological evidence of epithelial spirochetal infection". This article follows a recent NY Times article on singer/songwriter Joni Mitchell having been diagnosed with Morgellon's disease. Most researchers until now, including the CDC, have been "unable to identify a infectious source for the patients" and have labeled those with MD as having a pure psychiatric condition with "delusional parasitosis". I discuss Morgellon's disease on pages 161-162 of my book "Why Can't I Get Better?".

4/1/15 What is Morgellons? Singer Joni Mitchell's Disputed Diagnosis, by Catherine Saint Louis, Well

Commentary: The NY Post ran a follow-up story today on Avril Lavigne and her bout with Lyme disease. I am quoted towards the end of the article. I had discussed in the interview many of the 16 points on the MSIDS map that can cause chronic illness, highlighting those which could be responsible for ongoing fatigue and lightheadedness like POTS/dysautonomia and hypoglycemia with blood sugar swings, which I commonly see in my patients, but these were not included in the article due to lack of space. P.ease see pages 68-70 and pages 76-77 of "Why Can't I Get Better?" to see a more complete differential diagnostic list of overlapping conditions responsible for these symptoms.

4/1/15 Avril Lavigne diagnosed with Lyme disease: ‘I thought I was dying’, by Bryan Hood,

Commentary: I will be interviewed tomorrow morning by People Magazine on Avril Lavigne and her health crisis with Lyme disease. You can watch the interview live at 8:30am or at a later date on ‘People Now’, Online People Magazine. See the links below:

4/1/15 Avril Lavigne Opens Up About Her Health Crisis: 'I Was Bedridden for 5 Months', by Gilian Telling, People Magazine

Commentary: My Vermont, Northeastern and Canadian patients may have an interesting answer for their tick-borne diseases: Maple syrup! This article which was just published in an environmental journal discusses an interesting finding: Phenolic compounds in maple syrup potentiate antibiotic susceptibility of certain bacteria while reducing biofilm formation. If they could make a sugar free version, we could have award winning gluten free waffles and syrup for a borrelia busting breakfast!

3/27/15  Polyphenolic Extract from Maple Syrup Potentiates Antibiotic Susceptibility and Reduces Biofilm Formation of Pathogenic Bacteria, Maisuria VB, et al., Appl Environ Microbiology 2015, PubMed

Commentary: Dr Zhang from John Hopkins University just published an important article in PLoS One on innovative drug combinations for the treatment of Lyme disease.  "Of studied drugs, daptomycin was the common element in the most active regimens when combined with doxycycline plus either beta-lactams (cefoperazone or carbenicillin) or an energy inhibitor (clofazimine). Daptomycin plus doxycycline and cefoperazone eradicated the most resistant microcolony form of B. burgdorferi persisters and did not yield viable spirochetes upon subculturing, suggesting durable killing that was not achieved by any other two or three drug combinations. These findings may have implications for improved treatment of Lyme disease, if persistent organisms or detritus are responsible for symptoms that do not resolve with conventional therapy. Further studies are needed to validate whether such combination antimicrobial approaches are useful in animal models and human infection". Research monies and grants are now needed ASAP to test out these drug combinations in clinical practice in order to relieve the suffering of those with Lyme-MSIDS.

3/25/15 Drug Combinations against Borrelia burgdorferi Persisters In Vitro: Eradication Achieved by Using Daptomycin, Cefoperazone and Doxycycline, PLOSOne

Commentary: Oposums are our friends when it comes to Lyme disease. Research by the Cary Institute of Ecosystem Studies in Millbrook did a study on different types on mammals and the infection rates in ticks in the same area.  "Opossums can eat or remove as much as 96 percent of the ticks that land on them. Research also suggests the immune system of opossums is fairly effective at fighting off the disease, so even the ticks that do survive a visit to an opossum are less likely to acquire the disease". The next time you see an opossum, say thank you.

3/16/15 Opossums: Where Lyme disease goes to die, by John Ferro, Poughkeepsie Journal

Commentary: A novel viral tick-borne illness has been identified in the Midwest by the CDC, called the "Bourbon virus". This virus took the life of a Kansas man in 2014, and was associated with hematological abnormalities resembling Anaplasmosis, Ehrlichiosis, Rickettsial infections and The Heartland Virus (low white cell counts, low platelet counts and elevated liver functions). The patient died of cardio-respiratory complications with shock and ARDS (Acute respiratory distress syndrome), which is a rare complication of other tick-borne disorders, such as Babesiosis, and the relapsing fever spirochete, Borrelia miyamotoi. As per the CDC report: "The discovery of Bourbon virus, in addition to recent discoveries of tick-associated Heartland and severe fever with thrombocytopenia syndrome viruses, suggests that the public health burden of these pathogens has been underestimated".

2/22/15 Novel Thogotovirus Associated with Febrile Illness and Death, United States, 2014, CDC, Emerging Infectious Diseases

Commentary: Global warming is having an effect on ticks. A new study from the Cary Institute of Ecosystems Studies in Millbrook was released this week, that due to global warming trends, ticks with Lyme disease and co-infections are emerging earlier in the spring. The ticks have 3 life cycles: larvae, nymphs, and adults, and the article states that nymphal ticks pose a greater risk than larvae, since larval ticks do not contain Borrelia burgdorferi. It has been shown however that adult female ticks can transmit other borrelia species to their larvae, such as Borrelia miyamotoi, the relapsing fever spirochete. Borrelia miyamotoi is the first borrelia species to be transmitted transovarially, and 6-73% of the larvae from infected female deer ticks have been shown to be infected. The incubation period for relapsing fever is usually 5-15 days, and has an acute onset with non-specific symptoms which could be confused with a viral infection, including high fevers (up to 104) with chills and sweats, headaches, muscle and joint pains, and nausea, vomiting and a cough. Symptoms typically last 2-9 days and then recur. Any severe "flu-like illness" which recurs should raise the clinical suspicion of a tick-borne disorder like relapsing fever. I discuss tick-borne relapsing fever spirochetes, Borrelia hemsii and Borrelia miyamotoi, on pages 124-126 of my book "Why Can't I Get Better?". 

2/17/15 Study warns that ticks with Lyme are emerging earlier in spring, by John Ferro, Poughkeepsie Journal

Commentary: This report from John Ferro of the Poughkeepsie Journal discusses the discrepancy between funding for Lyme disease research and public health care costs. He reminds us that the recent study on desloratidine was not done with a clinical trial and therefore "its findings are suggestive at best". The lack of adequate funding for research is clearly hurting our abilities to help find a cure. Lyme bill, HR 4701, introduced by Congressman Chris Gibson, which passed the House of Representatives, now needs to be passed through the Senate to get increased funding for research.

2/14/15 Lyme: Are bacteria (or research) being starved to death?, by John Ferro, Poughkeepsie Journal

Commentary: A new study done at Stanford University, funded by the Bay Area Lyme foundation, found that antihistamines like Clarinex (desloratidine) may have the ability to control a borrelia infection by blocking the transport of essential minerals like manganese, which are essential for the bacteria's metabolic activity. Although there are no controlled clinical studies to date, a trial of desloratidine needs to be done to evaluate this novel therapeutic approach to controlling the disease.

2/10/15 NEWS: Can Claritin help cure Lyme disease?Press release from Bay Area Lyme Foundation,

Commentary:  Patients diagnosed with Chronic Fatigue Syndrome (CFS/M.E.) comprise up to 2.5 million Americans. How does a health care provider make the diagnosis?  

"The Diagnosis requires three core symptoms: Fatigue and reduction in pre-illness levels of activity that last for more than six months, the post-exertion worsening, and sleep that is un refreshing despite exhaustion. Also, patients must have at least one other symptom: Cognitive impairment, sometimes described as "brain fog," or what's called orthostatic intolerance — meaning symptoms improve when lying down and patients find it hard to stay upright for long". Lyme disease patients often complain of exactly the same symptoms of fatigue, unrefreshed sleep and cognitive impairment, with many having low blood pressure and autonomic dysfunction (see chapters 2, 12, 13, and 14 in "Why Can't I Get Better?, on the Horowitz 16 point differential diagnostic map, Lyme and the Brain, Lyme and Sleep Disorders, and Lyme and Autonomic Nervous System Dysfunction/POTS) . The Institute of Medicine (IOM) is now going to call this syndrome a new name: Systemic Exertion Intolerance Disease, or SEID. This name is meant to validate the severity of the disease, which is an excellent first step, but unfortunately, it does not help patients to get to the source of why they are ill, as there is no blood test for SEID. Dr. Ellen Wright Clayton who chaired the IOM panel stated that the reason for the  change of name is that "These patients have real symptoms. They deserve real care." I agree with her, but many patients who have come to me after suffering for years with a prior diagnosis of CFS or "SEID", usually have suffered with Lyme-MSIDS. They have up to 16 overlapping factors keeping them ill and the majority get better with my treatment. Lets shift the paradigm for chronic disease diagnosis and treatment for the millions who suffer with "SEID", and stop ignoring tick-borne disorders with MSIDS as factors contributing to their underlying disease process.

2/10/15 Seeking to redefine chronic fatigue syndrome, advisory group urges new name, better diagnosis, by Lauran Neergaard, U.S. News

Commentary: The You Tube video that I recently posted in French, was kindly sent over by Nelly Pointis with English subtitles. It highlights some of the problems with the diagnosis and treatment of Lyme disease in France, and how a young man was diagnosed with a psychiatric illness despite having had an EM rash and being paralyzed from the waist down. A highly esteemed infectious disease physician in Paris, Dr Christian Perrone, finally made the diagnosis. This short You Tube video is a perfect example of how the two tiered testing many physicians use for diagnosing Lyme disease could have led to a life long debilitating illness in this young man. Bravo Christian!

2/7/15 Lyme disease on French national TV, Posted by Nelly Pointis

Commentary: Want to improve your brain and stay healthy? A recent article in the WSJ confirmed an old adage: "Use it, or lose it". A growing body of research recently discovered that mental and physical exercise can decrease the risk of getting dementia, and help neurological diseases like Parkinson's. They specifically found five factors to be important in maintaining our physical and mental health: "eating a healthy diet (at least three to four servings of fruits and vegetables a day); maintaining a normal weight; limiting alcohol to about a glass of wine a day; not smoking, and walking at least 2 miles a day, biking 10 miles a day or engaging in some other regular, vigorous physical exercise". This article is an excellent reminder that dementia in some form is affecting approximately 15% of the American population over 70, and gives us practical suggestions to improve our chances of staying healthy. We should all try and follow this advice. The article however does not discuss the effects of infections like Lyme disease and environmental toxins on brain health, which have both been shown to have adverse effects on the central nervous system. Similarly, many abnormalities on the MSIDS map, such as food allergies and sensitivities, GI dysfunction with dysbiosis, mineral and vitamin deficiencies, hormone and mitochondrial dysfunction, sleep disorders, autonomic nervous system dysfunction, as well functional medicine abnormalities (with inadequate detoxification) can adversely impact neurological functioning. Perhaps if we were to use the 16 point MSIDS model as a way of screening for underlying imbalances in our health, combined with our present health care screening practices (while incorporating the 5 point health plan discussed above), we would further improve our chances of living longer, healthier lives

2/6/15 Our Amazingly Plastic Brains, by Norman Doidge, The Wall Street Journal

Commentary: A new study on Lyme disease published in PLoS one by researchers at the John Hopkins University School of Medicine found that many more patients are in fact suffering with symptoms of chronic Lyme disease that previously suspected: "Some patients report symptoms lasting for weeks, months or years beyond completion of the original antibiotic regimen. There is no approved therapy for these patients and the magnitude of the problem in the U.S. population has never been systematically studied. The Centers for Disease Control and Prevention (CDC) estimates 10 percent to 20 percent of those treated for Lyme disease with the recommended two-to-four week course of antibiotics continue to have symptoms. But, in the new study, the researchers found that more than 63 percent of those treated for Lyme disease had at least one PTLDS-related diagnosisa rate 36 percentage points higher than those who did not have Lyme disease". This study suggests "that a prolonged illness associated with the disease is more widespread and serious in some patients than previously understood".

This John Hopkins study also highlighted how these Lyme disease patients with a prolonged illness increased the burden of costs for our health care system. Study author Emily Adrion, MSc looked at the actual costs of treating patients in the year following their Lyme diagnosis and “regardless of what you call it, our data show that many people who have been diagnosed with Lyme disease are in fact going back to the doctor complaining of persistent symptoms, getting multiple tests and being retreated... The researchers found that, on average, people with Lyme disease cost the system $2,968 more than matched controls...and they cost the healthcare system about $1 billion a year".

Prior published scientific studies showed even higher health care costs for treating Lyme disease. In one study, conducted in 2006 by Zhang and colleagues and adjusted in 2013 for inflation, the researchers found that the mean annual cost of illness was $20,502 per year per patient for late Lyme disease, year after year after year (Source: Zhang, X., Meltzer, M.I., Pena, C.A., Hopkins, A.B., Wroth, L., and Fix, A.D. (2006) Economic Impact of Lyme Disease, Emerging Infectious Diseases, 12(4), 653 – 660. Adj. for inflation 2006 - 13).

This article highlights the existence of long term health problems and an increased burden of health care costs post treatment for Lyme disease. I agree with Dr Aucott that these patients are suffering a debilitating illness and that we should stop debating the existence of long term problems. However, I disagree with his statement that "No one really knows what to do with them". I have seen over 12,000 chronically ill Lyme patients during the past 28 years, and patients with chronic symptoms after classical treatment for Lyme disease have multi factorial causes for their illness. I call this syndrome Lyme-MSIDS, and it has been outlined extensively in my book "Why Can't I Get Better? Solving the Mystery of Lyme and Chronic Disease". MSIDS stands for Multiple Systemic Infectious Disease Syndrome, and represents sixteen potential overlapping medical problems contributing to persistent symptoms in the Lyme patient. 

The first point on the MSIDS map is infections. Ticks are now containing multiple bacterial, viral and parasitic infections which can be transmitted simultaneously with Borrelia burgdorferi, the agent of Lyme disease. Patients infected with Lyme disease and associated co-infections (especially Babesia) are much sicker and resistant to standard therapies. Patients with Lyme-MSIDS also have evidence of associated immune dysfunction, inflammation, environmental toxins and heavy metal burdens, detoxification problems, nutritional deficiencies, hormonal abnormalities, sleep disorders, mitochondrial dysfunction, food allergies and sensitivities, deconditioning and imbalances in their autonomic nervous system (the part of the body that controls the heart rate, blood pressure and digestive system). All of these factors can keep the patient chronically ill. As long as we continue to hold onto a commonly held belief in medicine, called Pasteur’s postulate, that there is “one cause for one illness”, we will be denying patients effective care. The term “chronic Lyme disease” or "PTLD" needs to be redefined as Lyme-MSIDS to more accurately reflect the multiple underlying etiologies responsible for persistent symptoms. Its time for a paradigm shift, where we stop denying the extensive published scientific research on Lyme disease (highlighted in my book) and the work of hundreds of dedicated health care professionals treating patients with Lyme disease who have had success using this multi factorial model.   

2/5/15 Lyme Disease Costs Up to $1.3 Billion Annually to Treat, Study Finds, Infection Control Today

Commentary: This article just published in the Journal of Clinical Allergy and Immunology again highlights the importance of probiotics. Peanut allergies have been rising in the US, and can be fatal. A new study from researchers at Murdoch Children's research institute found that combining oral immunotherapy against peanuts with a probiotic containing Lactobacillus rhamnosus, increased tolerance and decreased severe reactions to the allergen. I discuss Lactobacillus rhamnosus and probiotics and the need to optimize bowel health on pages 242-243 of my book "Why Can't I Get Better?", under the chapter on Lyme, Functional Medicine and Nutritional Therapies. Food allergies and sensitivities are one of the points on the 16 point MSIDS map that may contribute to inflammatory cytokine production, contributing to chronic symptoms in the Lyme patient. Working with the microbiome of the gut is the one of the next great frontiers in medicine.

1/31/15 Fatal peanut allergies could be cured with probiotic bacteria: researchers, Medical Daily, Raw Story

Commentary: Ticks contain multiple bacterial, parasitic and viral infections, and several tick-borne infections are also known to be transmitted by blood transfusions, such as Babesiosis and Anaplasmosis. This article by Dr Ed Breitschwerdt, highlights a new risk for blood transfusions, as Bartonella species are now being found in the blood supply. "This study documents for the first time that Bartonella spp. bacteremia occurs in asymptomatic blood donors", and since "negative serology does not rule out Bartonella spp. infection in healthy subjects" we may not be effectively screening the blood supply for these organisms.  This presents a new potential danger as  "Bartonella species are blood-borne, re-emerging organisms, capable of causing prolonged infection with diverse disease manifestations, from asymptomatic bacteremia to chronic debilitating disease and death", and "this pathogen can survive for over a month in stored blood". As tick-borne infections continue to spread worldwide, we must focus on prevention, and find methods to effectively screen the blood supply for these new emerging pathogens. 

1/15/15 Bartonella spp. bacteremia in blood donors from Campinas, Brazil, PubMed

Commentary: This article discusses the importance of the microbiome in chronic disease. New research is now showing that certain bacteria may contribute to autoimmune manifestations, such as RA. Previous studies with fecal transplantation have shown promise with resistant C. difficile infection, glucose intolerance, and weight loss, and bacteria have also been linked to asthma, inflammatory bowel disease, irritable bowel and GI cancers. The microbiome is one of the new frontiers in medicine to explore for chronic diseases. I discuss the importance of the microbiome in pages 387-400 of my book, in Chapter 16, Lyme and Gastrointestinal Health.

1/12/15 Joint Pain, From the Gut, by David Kohn, The Atlantic

Commentary: Lyme disease and Alzheimer's disease can both cause cognitive difficulties with dementia. In this article published in the Journal of Alzheimer's disease, two groups of patients were identified with dementia. Among a group of 20 patients studied, 7/20 patients had Lyme in their central nervous system, and stabilized or improved their cognitive status with antibiotics. Looking for treatable causes of cognitive difficulties is essential as we deal with an expanding Lyme and Alzheimer's disease epidemic. Unfortunately the present 2 tiered system of Lyme testing is not sensitive enough to pick up all cases of Lyme disease (or associated borrelia infections) in the central nervous system, nor are spinal taps just using antibody and PCR assays (PCR  tests are not sensitive enough to pick up all infections, and antibody-antigen complexes in the CNS may also be present, decreasing our ability to detect Lyme). Using brain MRI's with FDG-PET scans, combined with Tau, p-tau, and Aβ42 concentrations in the CSF may be helpful in differentiating the two diseases. We can also use the score on the MSIDS questionnaire with bands on the Western Blot as an initial screening tool to help determine the probability of suffering from Lyme. Both diseases however may also be present. Dr Judith Miklossy published an excellent article in the Journal of Neuroinflammation in 2011 entitled "Alzheimer's disease: a neurospirochetosis", where she applied Koch's postulate to prove that there is a probable causal relationship between neurospirochetosis and Alzheimer's disease(

When we apply the MSIDS map, other causes of cognitive problems can include viral encephalitis, metabolic abnormalities (ammonia..), hypothyroidism, vitamin deficiencies, heavy metal burdens and other environmental toxins, inflammation, POTS, and other tick-borne diseases. Creating a differential diagnosis is essential if we are to discover possible multi factorial causes of dementia and cognitive problems in our patients.  Pages 77-78 of "Why Can't I Get Better" discuss some of the common differential diagnoses seen in cognitive disorders, and pages 266-267 also discusses the role of mitochondrial dysfunction in neurological disease.

2014 Lyme neuroborreliosis and dementia,

Commentary: This article by Malcolm Gladwell in the New Yorker magazine discusses where health care reform in our country has gone wrong. It gives an overview of how the health care system in the United States was influenced by institutions and vested interests and discusses the need for not just focusing on our problems, but on solutions. This is a discussion we urgently need to have, but the conversation needs to be broadened. Recent figures point to 70% of our deaths and 75% of our health care costs being due to chronic disease. The role of chronic diseases impacting the state of our health care can be seen when reviewing the data from the CDC:

  • As of 2012, about half of all adults—117 million people—have one or more chronic health conditions. One of four adults has two or more chronic health conditions (Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:130389. DOI:
  • Seven of the top 10 causes of death in 2010 were chronic diseases. Two of these chronic diseases—heart disease and cancer—together accounted for nearly 48% of all deaths (Centers for Disease Control and Prevention. Death and Mortality. NCHS FastStats Web site.
  • Eighty-four percent of all health care spending in 2006 was for the 50% of the population who have one or more chronic medical conditions (Robert Wood Johnson Foundation. Chronic Care: Making the Case for Ongoing Care. Princeton, NJ: Robert Wood Johnson Foundation; 2010:16.

If diseases like Lyme disease, Alzheimer's disease and autism are on the rise, contributing to both suffering and an increased burden of health care costs for chronic disease, why are we not allocating more of our precious health care resources to address these growing problems? Lorraine Johnson did a recent blog on where she notes the inequity with funding for Lyme disease compared to other diseases. She found that "the annual incidence of Lyme disease is now 1.5 times more than the estimated number of cases of breast cancer and six times higher than the annual incidence of HIV/AIDS. However, federal funding of Lyme disease has been meager...While Lyme disease occurs six times more often annually than HIV/AIDS, it receives less than 1% of the funding allotted to HIV/AIDS by the National Institutes of Health (

We already have diseases like CFS/M.E. which have been estimated to affect up to 2.5% of the non-elderly adult population, costing billions of dollars every year ( According to the National Pain and Fibromyalgia Association, more than 100 million Americans are in pain every year with an annual price tag of more than 65 billion dollars ( Why are so many patients in pain? Could it be that Lyme disease and co-infections as well as environmental toxins are contributing to a significant number of these cases of fatigue, cognitive issues and pain syndromes? See my blog in Psychology today regarding the scientific data on whether some of these diseases may in fact be preventable: (

Why are we not looking into the etiology of these diseases, and focusing more on prevention, instead of spending billions of health care dollars just treating symptoms? The MSIDS model discussed in detail in my book leads us to the next essential paradigm shift in health care. We must go from the "one cause, one disease" model taught in medical school (Pasteur's postulate), to a patient centered model where prevention and getting to multi factorial sources of a problem is addressed. This model (with a reference to my book) was recently discussed in an excellent scientific review article on Lyme disease published in the International Journal of Family medicine: (

Lets have a discussion about health care in our country, but lets look at the bigger picture regarding the multi factorial etiologies of chronic disease and get to the source of the problem. That is a discussion worth having if we are to move health care reform in the right direction.

1/12/15  The Bill: Steven Brill on how health-care reform went wrong, By Malcolm Gladwll, The New Yorker

Commentary: Lorraine Johnson, JD, MBA, Chief Executive Officer for just released an updated blog on the 2 standards of care for Lyme disease. This is a good overview of the present state of our guidelines, and discusses some of the problems with the present two-tiered testing, and how chronic Lyme disease impairs the quality of life of affected patients. Because there are two standards of care in Lyme disease, patients should be advised of the benefits and risks associated with both treatment approaches and engage in shared medical decision making with their physicians that recognizes the importance of patient values and preferences in decisions that impact quality of life. Shared decision making is a collaborative process by which patients and their providers make healthcare decisions together, taking into account the best scientific evidence available, clinical judgment, and  the patient’s values, preferences, and circumstances". A hard copy with an overview of the guidelines and associated scientific references can be downloaded from this site for those who wish to share it with health care providers or policy makers.

1/7/15  LYMEPOLICYWONK: Two Standards of Care Revisited: Should Lyme Patients Have A Choice?,

Commentary: This article on Lyme disease and Babesiosis was just published in PLoS ONE. Dr Peter Krause and a team of researchers demonstrated in the laboratory that the frequency of Babesia microti infected ticks is higher when fed on white footed mice that are co-infected with both Lyme and Babesia, than on mice just infected with B. microti alone.This article follows recent scientific observations published by Dr Rick Ostfeld earlier this year in PLoS ONE, that the rate of co-infection with Babesiosis and Lyme is higher than expected in small mammals 

( These two articles confirm what  I have been seeing in clinical practice for almost two decades: Babesiosis is rising, and is a common co-infection seen in my chronically ill patients. Once Babesia is adequately treated, many patients who have failed classical Lyme treatments will clinically improve. These articles however do not address the rising rates of other strains of Babesia, such as Babesia duncani/WA-1, that I have been finding in patients coming to me from the east coast, from Florida all the way to Maine. When I recently met with Dr Ben Beard from the CDC, I explained that I had been finding positive Babesia duncani/WA-1 titers in my patients, using laboratories such as Quest and LabCorp, when the Babesia microti titers were negative. These patients responded well to anti-malarial therapies, and we would have missed this other Babesia infection, had I had not cast a larger net for other Babesia species. I let Dr Beard know that I would be happy to work together for the benefit of our Lyme community, and encouraged the CDC to start monitoring for other strains of Babesia. Babesia can be deadly in the very young and elderly whom are immunosuppressed; it can also be transmitted from mother to fetus, and Babesia has now found its way into the blood supply. We need to be paying much more attention to Babesiosis. A comprehensive review of Babesia can be found in my book "Why Can't I Get Better?" in chapter five: Lyme and Other Co-infections.

12/29/14 Borrelia burgdorferi Promotes the Establishment of Babesia microti in the Northeastern United States, PLOS One

Commentary: Borrelia burgdorferi has been shown to have different pleomorphic forms in different culture conditions. The bacteria's ability to change forms, exist in biofilms, and penetrate deep into tissues where antibiotic penetration is low, are some of the mechanisms which allow the bacteria to evade the immune system and persist. This article supports treatment regimens for borrelia that address all of the different morphologic forms i.e., cell wall forms, cystic forms (L-forms, S-forms, CWD forms...), while addressing borrelia in the  intracellular compartments and biofilms.

12/27/14 Morphological and biochemical features of Borrelia burgdorferi pleomorphic forms, Microbiology

Commentary: New tick-borne co-infections are regularly being discovered. Ticks contain many different bacterial infections (Ehrlichia, Anaplasma, Bartonella, Borrelia species like Borrelia miyamotoi, rickettsial infections, Tularemia...), parasitic infections (like Babesia species) as well as viral infections (Powassan virus, Heartland virus, and the newly discovered Bourbon virus). This article recently published in PLoS ONE, discusses the isolation of a new virus found in lone star ticks, called Tacaribe virus. Viral RNA was discovered in up to 11.2% of ticks in Florida. Although the risk of transmission is not yet known, this article highlights the importance of testing tick reservoir hosts on a regular basis for changing patterns of infection. Testing and treating chronically ill patients for co-infections are an important part of the MSIDS model.

12/23/14 Isolation of Tacaribe Virus, a Caribbean Arenavirus, from Host-Seeking Amblyomma americanum Ticks in Florida, PLOSone

Commentary: The NY Times just published an article on the recently discovered “Bourbon virus” that killed a farmer in Kansas.  “The virus was a type of thogotovirus, part of a larger family known as orthomyxoviruses. Its nearest relatives are found in Eastern Europe, Africa and Asia...Those viruses are spread by ticks and mosquitoes. The medical mystery began late last spring, when the patient was admitted to the hospital with a high fever, muscle aches and loss of appetite. He worked outdoors and often had tick bites”. Researchers at the CDC are not certain about the rate of transmission of this virus by ticks and mosquitos, but this virus joins the list of other growing viral tick-borne threats such as the Powassan virus and Heartland virus in the US, and TBE in Europe.

12/23/14  Mysterious Virus That Killed a Farmer in Kansas Is Identified, By Denise Grady, New York Times

Commentary: Jill Auerbach,chairperson of the Hudson Valley Lyme Disease Association, was recently on HVNN discussing the implications of the Governor signing the Lyme bill into law. Jill has been a longtime advocate and educator on issues concerning Lyme and associated tick-borne diseases in the Hudson Valley and beyond.  As Jill likes to say: "What is the problem? Its the ticks of course!" As this epidemic spreads across the US and the rest of the world, apart from finding medical solutions for patients suffering from this complex illness, we need to also remember to address the imbalances in our ecosystem exacerbating the problem.  Thank you Jill for all your contributions over so many years. 

12/20/14  Cuomo Signs Lyme Disease Bill, by Roger Conner, Hudson Valley News Network

Commentary: There has been considerable debate among scientists regarding the exact time necessary for transmission of Lyme disease after a tick bite. Prior research suggested an attachment time of 48 hours was necessary to transmit Borrelia burgdorferi. An article recently published in the International Journal of Medicine addresses this issue with regard to different species of borrelia and other tick-borne co-infections. "A literature review has determined that in animal models, transmission can occur in < 16 hours, and studies have found systemic infection and the presence of spirochetes in the tick salivary glands prior to feeding, which could result in cases of rapid transmission. A European study documented six cases of culture-confirmed infection where tick attachment was <6 hours.

Also, there is evidence that spirochete transmission times and virulence depend upon the tick and Borrelia species". The conclusion of this paper is that "The claims that removal of ticks within 24 hours or 48 hours of attachment will effectively prevent LB are not supported by the published data, and the minimum tick attachment time for transmission of LB in humans has never been established...these factors support anecdotal evidence that Borrelia infection can occur in humans within a short time after tick attachment...therefore LB infection can never be excluded after a tick bite irrespective of the estimated duration of attachment time." Certain viral infections in ticks can be deadly, as is the case with the Powassan virus, which can be transmitted in as little as 15 minutes. Other tick-borne infections may also be rapidly transmitted in ticks that have fed. Tick-borne infections are growing in number and virulence worldwide, and we need a comprehensive global health plan to prevent serious tick-borne illnesses. Expanding educational efforts to our homes, schools, camps and doctors offices, and teaching about ticks and prevention strategies, are important first steps if we are to prevent suffering, disability and keep down rising health care costs.

12/19/14 Lyme borreliosis: a review of data on transmission time after tick attachment, PMC US National Library of Medicine

Commentary: A new study implicating sexual transmission of Lyme disease has been published in the open access journal F1000 Research. "

The current study, which confirms and expands a preliminary report published in The Journal of Investigative Medicine, was a collaborative effort by an international team of scientists...In the study, researchers tested semen samples and vaginal secretions from three groups of people: control subjects without evidence of Lyme disease, individual patients who tested positive for Lyme disease, and couples engaging in unprotected sex who tested positive for the disease.

As expected, all of the control subjects tested negative for Borrelia burgdorferi in cultures of semen samples or vaginal secretions. In contrast, twelve of thirteen patients with Lyme disease had positive cultures for Borrelia burgdorferi in their genital secretions". This research is strongly suggestive of sexual transmission. Further research is needed however to determine the actual risk of transmission in an infected individual, since couples living in Lyme endemic areas may still have been exposed to the bacterium (and similar strains) through a tick bite.

12/19/14  Expanded Study Confirms that Lyme Disease May Be Sexually Transmitted, Digital Journal

Commentary: This article on Governor Cuomo signing the Lyme bill just appeared in the Poughkeepsie Journal. Lyme disease is a complex illness which is rapidly spreading across the US and Europe, with insensitive blood tests. Multiple borrelia species, parasitic species (like Babesia), and viruses (i.e., Powasssan virus, Heartland virus and the newly discovered "Bourbon virus") are causing widespread illness. This law is an important first step as health care providers search for answers to help our sick patients.

12/18/14  Cuomo signs bill safeguarding Lyme treatments, by John Ferro, Poughkeepsie Journal

Commentary: A new tick-borne virus, the "Bourbon virus" is being invested by the CDC after the death of a Kansas man. This virus caused multi organ failure and is difficult to diagnose early on in the illness, as it causes non-specific symptoms, confusing it with other less dangerous viral infections. This new tick-borne virus joins the rank of other bacterial, parasitic and viral infections found in ticks. I have found that the majority of the patients coming to me with Lyme-MSIDS have multiple overlapping chronic persistent infections, as one of the primary reasons they remain ill. New scientific information is constantly being discovered about tick-borne infections, and the NY law recently signed by Governor Cuomo, helps health care providers in the trenches look for answers for their patients without fear of retribution. We need to rapidly address these new evolving threats coming from ticks if we are to adequately protect our communities.

12/17/14 New tick-borne virus discovered after the death of Kansas man, by Shannon Halligan, KSHB Kansas City

Commentary: Governor Andrew Cuomo just signed the Lyme bill into law. This is major step forward in getting patients suffering from tick-borne disorders the help that they desperately need. I want to thank Governor Cuomo, Assemblymember Didi Barrett, Senator Terry Gipson, Senator Kemp Hannon, Congressmen Chris Gibson and Sean Patrick Maloney and US Senator Chuck Schumer for their support, as well as thanking the Lyme community for their hard work!

12/17/14 Governor enacts Barrett's Lyme bill, Assemblywoman Didi Barrett Press Release

Commentary: There was an article published in Slate magazine several days ago, which misrepresented both the science and suffering of patients with Lyme disease, and the doctors who treat them. The timing of the article coincides with the Lyme bill awaiting signature by Governor Cuomo. This response by Lorraine Johnson, JD, MBA, Executive director of, is an excellent summary of the science and politics of Lyme disease. Poor sensitivity  of recommended Lyme testing combined with an unacceptably high failure rate of IDSA treatment protocols (discussed in this blog), are a recipe for widespread disability and suffering among the American people. We urgently need a scientific forum where doctors, patient advocates, scientists, insurers, and politicians come together to solve the health care crisis that is before us.  

12/13/14 responds to Slate’s “Lyme-Illiterate” article, LymePolicyWonk Blog

12/9/14 Lyme-Illiterate: New York is about to change its medical misconduct law to protect quacks, By Brian Palmer, Slate magazine

Commentary: The Canadian Senate has passed a comprehensive bill on Lyme disease for the first time. The bill "calls on the government to call a conference of provincial and territorial ministers, medical experts and representatives of patient groups to develop a comprehensive Lyme disease strategy.The strategy would include a national program to track rates of infections, and establish guidelines for preventing infections and diagnosing and treating them when they occur". We have a similar bill awaiting passage in the US Senate. Congressman Chris Gibson, recently introduced Lyme bill HR 4701, which unanimously passed the House of Representatives, and now awaits signature by the Senate. We hope our Senators will take prompt action on this bill, as Lyme disease is spreading in epidemic proportion across the US, raising health care costs while causing long term disability. We heartily congratulate Elizabeth May, the Canadian government, and the Canadian Lyme groups for passage of this bill!

12/12/14 Private member's bill on Lyme disease gets final approval, The Canadian Press

Commentary: I wrote an article in Bottom Line Health on the role of tick borne co-infections  and persistent illness in Lyme disease. I have found that co-infections are one of the primary reasons that patients fail classical treatments. This article discusses some of the most common tick-borne infections, such as Babesia, Ehrlichia/Anaplasma and Bartonella, but due to a limited word count, I was not able to discuss in detail the role of newer borrelia species like Borrelia miyamotoi, tick-borne viruses like the Heartland virus and Powassan virus, and other bacterial infections like rickettsial infections (RMSF, Q-fever), Tularemia, etc. I discuss in detail tick-borne co-infections in chapters 4 and 5 of my book, "Why Can't I Get Better".

12/12/14 When It's Not Just Lyme, Bottom Line Health

Commentary: This NY Times article was just published about the role of guidelines in health care, and applies to the 2 standards of care for the diagnosis and treatment of Lyme disease (The IDSA and ILADS guidelines). The IDSA guidelines have not been updated since 2006, and do not contain the most up to date scientific research. In "The Analysis of Overall Level of Evidence Behind Infectious Diseases Society of America Practice Guidelines, by Dong Heun Lee, MD and Ole Vielemeyer, MD", published in the Archives of Internal Medicine in 2011 (Arch Intern Med. 2011;171(1):18-22), they analyzed the strength of recommendation and overall quality of evidence behind 41 IDSA guidelines released between January 1994 and May 2010 and concluded that “more than half of the current recommendations of the IDSA are based on level III evidence only (opinion). Until more data from well-designed controlled clinical trials become available, physicians should remain cautious when using current guidelines as the sole source guiding patient care decisions”.On the other hand, the ILADS guidelines that were just published in a peer reviewed medical journal this past year, used a rigorous evidence assessment scheme (called GRADE), that were recommended by the Institute of Medicine (IOM), incorporating both up to date peer reviewed science with patient preferences. The IDSA guidelines do not work in clinical practice for those Lyme patients suffering from chronic persistent symptoms, and the recent CDC data published in 2013 showed that over 50% of physicians do not treat Lyme Disease using IDSA guidelines, and treat for longer periods than one month, consistent with ILADS guidelines.  The author points out in this NY Times opinion piece that "We have to get smarter about how we try to improve medical care. I believe the next phase of quality improvement will be a move away from homogenizing care and toward personalizing it..". The Lyme-MSIDS model described in my  book "Why Can't I Get Better?" is an example of personalized medicine. There are up to 16 overlapping medical conditions which can simultaneously impact a patients health, and no two patients are exactly the same. Addressing individual variations in an illness through doing a comprehensive history and physical, laboratory evaluation and differential diagnosis, while applying the 16 point MSIDS map, helps the majority of my patients suffering from chronic tick-borne illness to improve their health. Although guidelines can be useful, a "one size fits all" model simply does not work in the practice of medicine.

12/10/14 Don't Homogenize Health Care, by Sandeep Jauhar, New York Times

Commentary: "Assemblymember Didi Barrett (D – Columbia, Dutchess) announced that legislation she authored that would expand treatment options for patients suffering from Lyme and other tick-borne illnesses has been delivered to Governor Cuomo (A.7558/S.7854)... Under state law, the governor has until December 17 to act on the bill.

The bill unanimously passed both houses of the legislature". We thank Assemblymember Barrett and other members of the NY State Assembly and Senate for caring about the plight of Lyme patients whose lives have been destroyed by this debilitating disease. We urgently need to create scientific forums on Lyme and associated tick-borne diseases at the state and federal levels, where doctors, researchers, scientists, insurers and politicians come together to discuss the most up to date scientific research and find solutions for this spreading epidemic which is destroying the lives of patients in the US and across the world.

12/10/14 Barrett encourages the governor to sign important Lyme Bill, Didi Barrett NY State Assembly

Commentary: My friend Joy Devins just released her Lyme book, entitled: “Lyme Whisperer: The Secret’s Out", and lets you in on her “secret” and defiant “conversations” with Borrelia. The book offers hope with a humorous twist for those that need it most, the Lyme community. Join Joy as she offers her voice in the fight against Lyme. Her book is available at

12/8/14  Lyme Whisperer: The Secret's Out

Commentary: WAMC public radio did an interview today with our local Congressmen, discussing Lyme and tick-borne illness. "Hudson Valley Congressmen Chris Gibson, a Republican, and Sean Patrick Maloney, a Democrat, have teamed up to urge Governor Cuomo to sign legislation the state legislature passed in June that would essentially expand treatment options for patients suffering from Lyme and other tick-borne illnesses". 

12/4/14 HV Congressmen Call On NY Governor To Sign Lyme Bill, WAMC Northeast Public Radio

Commentary: U.S. Representatives Chris Gibson (R-Kinderhook) and Sean Patrick Maloney (D-Cold Spring) issued a statement Tuesday urging Governor Cuomo to sign a bill into law that would give physicians the freedom to treat chronically ill patients with Lyme disease according to either of the two recognized standards of care. "The Patients' Rights/Doctor Protection Bill makes common-sense improvements to state regulations, putting treatment decisions in the hands of physicians and instituting guidelines to help our state fight this public health scourge," Gibson said. "I respectfully call on Governor Cuomo to sign this bill into law".

12/2/14 Gibson, Maloney push Cuomo to sign Lyme bill, by John Ferro, Poughkeepsie Journal

Commentary: The benefits of a Mediterranean Diet have been well established, including decreased mortality and lowered risk for chronic diseases. This study examined whether the Mediterranean diet was associated with longer telomere length, which is a biomarker for aging, and concluded that "greater adherence to the Mediterranean diet was associated with longer telomeres". The importance of a proper diet and exercise program in maintaining health is crucial. I discuss the Mediterranean diet and its beneficial effects for patients with Lyme-MSIDS on page 378 of my book (chapter fifteen, Lyme and  allergies).

12/2/14 Mediterranean diet and telomere length in Nurses' Health Study: population based cohort study, thebmj

Commentary: This review article on Chronic Lyme disease in the International Journal of Family Medicine was just released. It gives a good overview of the complexity of borrelia infections, poor sensitivity of testing, persistence, role of co-infections and the need for Family physicians to work within a multidimensional chronic disease construct to help patients suffering from CLD. The MSIDS model discussed in my book is such a multidimensional construct, and the Lyme-MSIDS questionnaire can help physicians in different sub specialities screen for Lyme as a multi systemic illness. The scientific research discussed in this article, as well as the hundreds of peer reviewed scientific references referenced in my book and in the recently published ILADS guidelines, should allow those in charge of our health care system to become better informed. Lyme disease is the most common vector-borne disease in the US and Europe, and is a rapidly spreading global health threat. We need to carefully to listen to science, bound by compassion for sick and suffering patients, in order to find logical and cost effective solutions for this emerging epidemic.

11/24/14 Relevance of Chronic Lyme Disease to Family Medicine as a Complex Multidimensional Chronic Disease Construct: A Systematic Review, International Journal of Family Medicine

Commentary: Dr Willy Burgdorfer, who discovered the Lyme disease spirochete (named after him), passed away yesterday.  We are grateful for all of his efforts over the years to help with this devastating illness. When you go on the link for the web site below, there is an interview with Willy from the documentary Under Our Skin.

11/17/14 News: Discover of Lyme disease microbe dies at 82,

Commentary: I did an interview with Dr. Amy Myers on the Autoimmune Summit today. For those who would like to listen in on updated information on Lyme and autoimmune disease, pleae click on the link is below:

11/15/14  Video: Lyme Disease and Autoimmunity, The Autoimmune Summit

Commentary: Dr Holly Ahern wrote an op-ed in the Poughkeepsie Journal about the controversies surrounding Lyme disease. She compares the situation to the early days of HIV/AIDS where the epidemic spiraled out of control and patients were left to suffer. I recently met with one of the heads of the CDC to review this burgeoning problem, and discussed the role of co-infections keeping patients ill and how we could more effectively work together. That conversation was continued with Dr Peter Krause at the recent Harvard conference that I attended in Boston this past weekend, where he discussed the persistence of Babesia and how persistent DNA is indicative of chronic infection. Dr Alan Steere also discussed the IDSA and ILADS perspectives at the Massachusetts General Hospital conference. These meetings herald the beginning of a shift in the scientific community where the two groups are opening a dialogue and starting to come together.

11/9/14  Valley View: Lyme is most misunderstood disease since AIDS, Holly Ahern, Poughkeepsie Journal

Commentary: Congressman Chris Gibson spoke to the Poughkeepsie Journal after winning the 19th Congressional district. He said he was "humbled by the win" and "most immediately, I will be working with the Senate to ensure passage of my Lyme Disease bill so we can get that bill signed into law by the President".  We are fortunate to have caring politicians like Congressman Gibson helping our country with the emerging epidemic of tick-borne disorders.

11/5/14 Gibson wins 19th Congressional District, by Nina Schutzman, Poughkeepsie Journal

Commentary: A scientific article was just released from John Hopkins discussing a new method to identify antibiotic susceptibility testing for borrelia. The authors discuss how Borrelia can persist in the body through cystic forms and in biofilm colonies, explaining ongoing symptoms. This methodology may help to identify novel antibiotics for B. burgdorferi persisters.

11/3/14 An Optimized SYBR Green I/PI Assay for Rapid Viability Assessment and Antibiotic Susceptibility Testing for Borrelia burgdorferi, PLOS One

Commentary: The Poughkeepsie Journal reported on Governor Cuomo "wanting to sign the Lyme bill", stating that "My kids have had it. I lost a dog because of it. It's a terrible disease." Lyme is spreading in epidemic proportion in the northeast, and this bill will help patients get the care that they need.

10/29/14 Cuomo: 'I want to sign the Lyme bill', Emily Steward, Poughkeepsie Journal

Commentary: Assemblymember Didi Barrett just released a You Tube video explaining the seriousness of the problem of Lyme disease in New York State. She is joined by Senator Chuck Schumer in urging Governor Andrew Cuomo to sign into legislation bill A. 7558B which would expand treatment options for those suffering from Lyme disease.

“New York State is at the center of this very serious public health issue,” stated Assemblymember Didi Barrett. “We need Governor Andrew Cuomo to stand up and show that New York will lead in protecting people suffering from chronic Lyme....

10/24/14 Video: Assemblymember Barrett Calls on Cuomo to Sign Lyme Bill, Youtube

10/24/14 Press Release

Commentary: Different Babesia species are spreading worldwide. In this recent study published in Clinical Microbiology and Infection, 3 different species of Babesia (microti, divergens, and EU-1) were discovered in patients in Belgium, where B. microti infections had not previously been suspected. We have also been finding different Babesia species apart from B. microti, such as Babesia WA-1 (duncani) in our patients from the East Coast. In 2011, I reported at the ILADS international conference in Toronto, a study we performed on 137 patients using LabCorp testing for Babesia WA-1, where we found that 26/137 patients (19%) tested positive for Babesia WA-1 from Winter Park, Florida up to Hamlin, Maine. This species is usually reported only from patients on the West Coast. Tick-borne co-infections are spreading, and this article highlights the need for physicians to regularly test patients for multiple species of Babesia if they present with malarial-like symptoms without a clear etiology.

10/12/14 A retrospective serological survey on human babesiosis in Belgium,

Commentary: Tick-borne diseases are climbing in Maine. Anaplasmosis and Babesiosis cases are rising, and the first case of Eastern Equine Encephalitis (EEE) has now been reported. In Vermont, 10% of the ticks were found to contain EEE, and it has also been found in mosquitos and mammals in New Hampshire and Massachusetts.

"EEE is a more serious disease than West Nile Virus (WNV) and carries a high mortality rate for those who contract the serious encephalitis form of the illness. Symptoms may include high fever, severe headache, stiff neck, and sore throat. There is no specific treatment for the disease, which can lead to seizures and coma". Tick-borne encephalitis viruses, like the Powassan virus, have also been shown to be increasing in New York. With the rise of multiple tick-borne bacteria, viruses and parasites in the northeast, and the important role that these co-infections play in keeping Lyme-MSIDS patients ill, the need for increased education, prevention, and research to improve  diagnostic and treatment regimens is essential.

10/11/14 Maine reports dozens more anaplasmosis cases compared to 2013, by Robert Herriman, Outbreak News Today

Commentary: An important gene sequencing project was just completed for the apicoplast genome of Babesia microti. The nuclear and mitochondrial genomes had previously been sequenced. Babesia is the number one parasitic co-infection keeping my Lyme-MSIDS patients ill, and due to the number of different strains and their ability to suppress the immune system (including the ability to clear other parasites), it is important to find answers for this parasitic infection. Once Babesia is properly diagnosed and treated, many patients improve. As per the authors: "The potent activity of drugs such as azithromycin and clindamycin against B. microti indicates that the apicoplast plays an essential role during the parasite intraerythrocytic life cycle. Targeting the apicoplast- and nuclear-encoded functions important for apicoplast maintenance and replication may help identify and design novel, potent and safer therapies for the treatment of human babesiosis". We urgently need research monies dedicated for this important project.

10/3/14 Sequence and Annotation of the Apicoplast Genome of the Human PathogenBabesia microti, PLoS One

Commentary: Maine is endemic for Lyme and tick-borne diseases, yet there is no funded state laboratory to check ticks for known infections spreading throughout the Northeast. Maine now has a referendum before voters to fund a bond to monitor human health threats related to ticks and other insects, as the state lacks adequate federal resources to monitor this growing problem. This is an important issue being voted on by Maine residents, as Lyme and associated tick-borne diseases have the potential to significantly affect the health of patients and negatively impact the state's economy. In another state just to the south, the Vermont Department of Health reported several years back that 16% of the dogs had contracted Lyme disease in Vermont. When I testified at a Congressional hearing for the Vermont House and Senate last year on Lyme disease, I showed them data that the CDC considers a infection rate in dogs over 5% to be "an emerging epidemic", and if 16% of Vermont residents had contracted Lyme, it would cost approximately 1 billion dollars out of their 5 billion dollar health care budget. Keeping that in mind, an 8 million dollar bond is a small price to pay for protecting the health of state residents, and monitoring an epidemic that is driving up health care costs.

9/30/14 Supporters say new lab needed by Lyme disease, other tests, By Keith Edwards,

Commentary: A scientific panel in Sag Harbor recently met to discuss the growing problem of Lyme and associated tick-borne diseases on Long Island.  Dr Steven Schutzer from the Rutgers-NJ Medical School commented on the unreliability of blood tests, and Dr Benjamin Lutz from Stonybrook discussed the lagging research, difficulty with creating a vaccine, and how insurance companies are needing to step up and provide better coverage for the disease."Despite improvements in recognizing Lyme, Dr. Schutzer said better tests are needed and researchers are working to provide them. Because Lyme is a slow developing disease—it can take 12 weeks to create a measurable lab culture—it is essential that more blood tests are developed". Dr Luft commented "insurance companies are shirking their responsibility in providing coverage, governments are failing to invest enough in research and drug manufacturers are unwilling to take the risk of developing new tests and drugs". We need more scientific forums where researchers, scientists, clinicians in the field, patients and insurers can meet to discuss the growing problem of tick-borne diseases.

Dr Luft from Stonybrook mentions in this interview that "we are stymied as to how to go forward" with treatment for chronic persistent disease, yet many clinicians in the field who have seen thousands of Lyme patients such as myself, have found solutions. Once Lyme is treated in combination with treatment for co-infections such as Babesia, while addressing the other 16 points on the MSIDS map described in detail in my book (such asimmune dysfunction, inflammation, environmental toxins and heavy metal burdens, detoxification problems, nutritional deficiencies, hormonal abnormalities, sleep disorders, mitochondrial dysfunction, food allergies and sensitivities, as well as deconditioning and imbalances in the autonomic nervous system), many patients get better. I will be on a physician panel at the upcoming Harvard conference on Lyme disease in November with Dr Steere and researchers from the CDC, where I will be sharing this perspective in patient care, explaining the need to have a paradigm shift using a multi factorial health care model to improve outcomes in those suffering from chronic tick-borne illness. I will also be presenting a 21/2 day workshop at the Kripalu Institute in the Berkshires onDecember 5th-7th, 2014, called "Beyond Lyme and Other Chronic Illnesses: Reclaiming our Health and Well- Being", where physicians, patients and interested family members are invited to participate in a fun, educational program on how to heal from Lyme and associated tick-borne disorders, as well as how to maintain and improve our present health using the 16 point MSIDS model ".

9/23/14 Panel talks ticks in Sag harbor, The Sagharbor Express

Commentary: The Lyme community recently lost one of its most lovely, kind, and brightest individuals, as Lis Heininger passed away from complications from tick-borne illness. We send blessings to her family during their time of grieving. Liz was truly an inspiration to all who knew her, and we will miss her.

9/29/14 In Memory of Elisabeth Hudson Heininger

Commentary: A silent vigil recently took place in front of the NY Times, where patients and activists gathered to protest the media silence surrounding Lyme disease. I would like to thank Jessica Bernstein and for helping to raise awareness of the dangers of tick-borne diseases, and the consequences of not adequately addressing this epidemic.

9/23/14 New Yorkers Call Lyme Disease the New Plague, by Jessica Bernstein, Truthout

Commentary: Congressman Chris Smith of N.J. comments on the recent passage of Lyme bill HR 4701 through the House, and encourages the Senate to move the bill forward to help those suffering with this terrible illness. "Passage of the Tick-Borne Disease Research Accountability and Transparency Act is a great step forward for chronic Lyme patients, especially those who have suffered for decades with this debilitating disease — only to be told that their illness doesn't exist. These patients received overwhelming support in the House of Representatives with passage of the first-ever legislation identifying chronic Lyme and providing a mechanism that will provide real answers on the appropriate treatment. It is my hope that HR 4701 will move forward in the Senate and help foster a broad, expanding effort to fight a dreaded disease that threatens hundreds of thousands of people".

Please contact your local Senator regarding Lyme bill HR 4701, and ask them to support this crucial legislation. Lyme and associated tick-borne disorders are severely impacting the health and economics of our country, and better research and treatments are desperately needed.

9/23/14 SMITH: Major step forward in aiding Lyme victims, by Chris Smith, Asbury Park Press

Commentary: This report by the EARPC confirms prior reports by the CDC and Environmental Protection Agency that we are constantly being exposed to a wide variety of toxins in the environment. Many environmental chemicals act as foreign based estrogens which have been linked to various forms of cancer, and Harvard recently reported on the relationship of some of these chemicals with rising rates of autism.

The Lyme-MSIDS patients who come to see me often test positive for a variety of heavy metals (especially mercury, lead, arsenic, cadmium and aluminum), and some of my sickest patients are also testing positive for mold toxins. Chronic infections and toxins, combined with an inability to properly detoxify chemicals, are some of the most important points on the 16 point MSIDS map keeping many patients ill. These factors may also be responsible for the rising rates of certain chronic diseases like Alzheimer's. Please read the article below, and then the blog that I did a while ago for Psychology Today, on whether dementia and ADHD are preventable diseases...We need a much broader approach to health care, which includes chronic infections and toxins, if we are to stem the tide of chronic illness in the US and the world. 

9/21/14 206 Million Pounds of Chemicals Hit Our Waterways in One Year, by Brian Stalard, Nature World News

12/28/13 Are ADHD and Dementia Preventable Diseases?, Richard Horowitz, MD, Psychology Today Blog

Commentary: Blood transfusion transmission of tick-borne infections such as Babesia, Anaplasma and certain relapsing fever spirochetes have previously been reported in the medical literature. The relapsing fever spirochete, Borrelia miyamotoi has now been found to be transmitted by blood transfusion in mice, increasing the possibility of transfusion transmission in humans. B. miyamotoi is the newest tick-borne infection rapidly spreading across the US. A recent Yale study showed that 4% of people living in New England had been exposed to B. miyamotoi, and as we do not yet have a reliable commercially available test, relapsing fever spirochetes can be added to our list of growing infections that pose a potential health threat to our blood supply.

9/23/14  Blood transfusion transmission of the tick-borne relapsing fever spirocheteBorrelia miyamotoi in mice, Transfusion

Commentary: I'm speaking on 9/16 at the CALRB symposium on tick-borne disorders in Hartford, Connecticut, on the relapsing fever spirochete Borrelia miyamotoi. This organism is now prevalent in ticks, and in certain parts of the US, is being transmitted as often as the Lyme disease spirochete, Borrelia burgdorferi. The relapsing fever spirochete B. miyamotoi has recently been found to be cultivable in a special culture medium (MKP-F) and resistant to complement killing, increasing its pathogenesis. B. miyamotoi joins the list of other common tick-borne co-infections now infecting humans, and may be playing a role in contributing to seronegative persistent disease among certain chronically ill patients.

The relapsing fever spirochete Borrelia miyamotoi is cultivable in a modified Kelly-Pettenkofer medium, and is resistant to human complement, Parasites & Vectors

Commentary: Here is the C-span link to the speeches made by members of the House on Lyme bill HR 4701. Congressman Chris Gibson, Congressman Sean Maloney and Congressman Chris Smith made powerful, impressive and passionate speeches on the effect of Lyme disease in the United States, so do not miss watching it!

Congressman Gibson Press Release         Tick-borne Disease Research Transparency and Accountability Act of 2014

Commentary: I just did an interview in the August issue of the Chronogram magazine. It discusses the Lyme-MSIDS model and its applicability for many chronic diseases of the 21st century, and why some people don't get better from Lyme. Paradigms shift slowly, but chronic infections and toxins need to be addressed if we are to help solve the mystery of rising rates of chronic diseases in this country.

8/1/14 Lyme Lessons, by Wendy Kagan, Chronogram

Commentary: More good news. Lyme bill, HR 4701, July 23, 2014 version, was passed with voice vote out of the Energy and Commerce Committee today. Congressman Chris Gibson introduced this Lyme bill into Congress, and here are some of the essential points of the bill: "The bipartisan legislation forms an interagency working group consisting of federal agencies and non-federal partners, including experienced Lyme physicians and patient advocates with a broad spectrum of scientific viewpoints. The working group is tasked with ensuring coordination among federal agencies to maximize research priorities. H.R. 4701 requires the Secretary of Health and Human Services to consult with the working group to submit a strategic plan to Congress within three years that includes benchmarks to measure progress. The plan must include a proposal for improving outcomes of Lyme disease and other tick-borne diseases, including progress related to chronic or persistent symptoms, infections, and co-infections. 

I am very grateful to  Congressman Gibson for his hard work in getting this bill into Congress. It gives us a chance to effectively deal with the health threat of Lyme and associated tick-borne diseases that are rapidly spreading across our country and the world. Please feel free to send Congressman Gibson a word of thanks on his home page if you feel so moved:

7/30/14  House committee approves Gibson Lyme legislation, U.S. Congressman Chris Gibson Press Release

Commentary: New Standard of Care Guidelines for treating Lyme and other Tick-borne illnesses were just released today from ILADS. They are able to be accessed on line in the August 2014 journal Expert Review of Anti-infective Therapy. These guidelines highlight the need for individualized patient care. As per the lead author, Dr Daniel Cameron: " ILADS is the first organization to issue guidelines on Lyme disease which comply with the standards set by the Institute of Medicine for developing trustworthy protocols. The document provides a rigorous review of the pertinent medical literature and contains recommendations for Lyme disease treatment based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. This review format is used by other well-respected medical organizations including the Cochrane Collaboration and the World Health Organization. ILADS’ GRADE-based analyses discovered research studies guiding current treatment protocols were of very low quality; and, the regimens based on these randomized controlled trials often failed.  “For this reason, we moved away from designating a fixed duration for antibiotic therapy for tick borne illnesses and instead encourage clinicians to tailor therapy based on the patient’s response to treatment,” noted Dr. Cameron. Lorraine Johnson, a co-author of the study also commented: "The guidelines encourage shared medical decision making and taking patient values into consideration". This has certainly been a missing piece in other published guidelines.  

Guidelines represent years of hard work by Dr Cameron, Dr Maloney and Lorraine Johnson, and I applaud their efforts in getting these important guidelines published.

7/30/14  Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease, Informa Healthcare I will be on Fox and Friends tomorrow morning at 6:20 am discussing Lyme and tick-borne disorders. Hoping that you can tune in!

7/25/14  Tips to protect your family from Lyme disease, Fox News

Commentary: Vermont's governor recently signed into law a bill protecting doctors who treat Lyme patients according to ILADS guidelines. Rachel Nevitt, married to Senator David Zucherman from Vermont (who initially introduced the bill), discusses in a 30 minute television interview her experience with Lyme disease. She covers a broad range of topics including Lyme's pleomorphic symptoms, its effects on her family, how it is spreading in epidemic proportion throughout the state of Vermont, the politics of Lyme disease, and the level of denial among the medical community resulting in so much unnecessary suffering. I am shown briefly in this interview when I was testifying several years ago before the Vermont Congress on the science of Lyme disease, and Dr Steven Phillips is highlighted in this film discussing the research supporting the ILADS perspective on the unreliability of testing and persistence. There is a one minute pause in the middle of the video, so please be patient as the video is worth watching in its entirety.

Rachel compares the Lyme disease epidemic to the AIDS epidemic, and puts out a call to action before history repeats itself once again. She discusses the IDSA/ILADS controversy in detail and how doctors need to take patients seriously, and look at the scientific research for themselves, so they can see what the science really says. Her humor, wisdom, and strength to rise up and deal with the challenge of a chronic illness will resonate with many who have had this debilitating disease.


Commentary: Is there a way to live a longer and healthier life? In this report, scientific research is presented on the effects of meditation on slowing the aging process. We know that there are protective caps on the end of our chromosomes, called telomeres, and when they get too short, there are problems with cell division which can lead to premature aging. There is an enzyme, called telomerase, whose job it is to protect and rebuild telomeres.  "Lab studies show that the stress hormone cortisol reduces the activity of telomerase, while oxidative stress and inflammation -- the physiological fallout of psychological stress -- appear to erode telomeres directly".  High levels of cortisol and inflammation are also seen in patients who suffer from Lyme-MSIDS. Although I often speak to my patients about the benefits of meditation, this study gives us another reason to find some time for regular practice every day. Since "age-related conditions from osteoarthritis, diabetes and obesity to heart disease, Alzheimer's and stroke have all been linked to short telomeres", perhaps its time for all of us to regularly get to the meditation cushion. I discuss the scientific benefits of meditation in chapter 20 (Meditation, Mind training, and Medicine) of my book "Why Can't I Get Better? Solving the Mystery of Lyme and Chronic Disease".

7/10/14  Can meditation really slow aging?, by Jo Marchant, CNN Health

Commentary: Dr Robert Bransfield just published an article on the incidence of Lyme disease among children with autism spectrum disorder. "This paper proposes that some children with an autism spectrum disorder (ASD) in the United States have undiagnosed Lyme disease and different testing criteria used by commercial laboratories may be producing false negative results". Lyme is the great imitator, and multiple infections have been linked in the medical literature to ASD. Both Lyme and ASD have immune dysregulation, and it is known that systemic infections (such as Bb, Bartonella, and viral infections) with associated inflammation can affect chronic neurodegeneration (Perry et al. Nature Reviews Immunology 7, 161-167, Feb 2007). Some french doctors belonging to Chronimed in France have similarly discovered that Borrelia burgdorferi has been found in children with ASD in Europe. Dr Phillipe Raymond showed evidence this past June at the Lyme Sans Frontier conference in Strasbourg, France, that certain children treated with antibiotics like Zithromax reversed their ASD. Harvard University and the University of California also recently published on the role of environmental toxins in ASD. Chronic infections and toxins are important parts of the MSIDS model, since treating them often leads to clinical improvement in my patients. These 2 factors must be addressed as important underlying causes of chronic disease worldwide.

6/16/14 Divergent opinions of proper Lyme disease diagnosis and implications for children co-morbid with autism spectrum disorder, Medical Hypotheses

Commentary: Legendary singer and songwriter Jesse Colin Young recently spoke publicly about his struggles with chronic Lyme and tick-borne disorders. The recounting of his personal journey  illustrates what so many so go through with this illness. As per Jesse: "Many lives and families have been destroyed by this disease. It not only makes you hurt, but it makes you crazy". Please read how an American music icon struggled with Lyme, regained his health, and why he wants to raise awareness at this time.

7/9/14 Jesse Colin Young Exclusive: Legendary Singer & Songwriter Talks About His Plight With Lyme Disease,

Commentary: This post is an urgent message from NY Lyme groups regarding the recent bill that was passed by the NY State Assembly and Senate. Physicians must have the freedom to choose between the two standards of care that are presently available, so that they can use their best clinical judgement to help those afflicted with this terrible disease. If you live in New York, or have friends or relatives in NY, please have them go to the web site below and send a message to the Governor letting him know about your experience with Lyme and associated tick-borne diseases.


Commentary: Chronic disease accounts for approximately 75% of the health care costs and 70% of the deaths in the United States. One of those diseases, Alzheimer's disease (AD), is predicted to triple in incidence within the next 30 years.  In the following article, Dr Alan McDonald describes the relationship between spirochetes and Alzheimer's disease. Researchers such as Dr McDonald and Dr Judith Miklossy from Switzerland have found Lyme spirochetes present in biopsies of the brains of Alzheimer's patients, and hypothesize that chronic spirochetal infections (from Lyme disease and spirochetes in the mouth) in combination with biofilms may play a role in the pathogenesis of Alzheimer's.

Please read the 3 links below. The first is a transcript summary of the recent London conference where Dr McDonald spoke on spirochetes and their relationship to AD. The second link discusses a scientific article published in the journal of Alzheimer's Disease where french researchers in Strasbourg recently discovered that Lyme disease was responsible for Alzheimer's in over 1% of demented patients screened in their study. The third link is a blog that I wrote for Psychology Today a few months ago discussing how infections and toxins both may play a role in driving dementia and AD. Chronic infections and toxins (in the context of a multi factorial 16 point MSIDS model) are underlying etiological agents in chronic disease that need to be addressed if we are to tackle the health challenges facing us in the 21st century. 


3/7/14 Accepted by IOS Press, Lyme Neuroborreliosis and Dementia

12/28/13 Are ADHD and Dementia Preventable Diseases?, by Richard Horowitz, MD, Psychology Today

Commentary: I would like to thank Sherry and all of the members of the Bay Area Lyme Foundation for helping to arrange and coordinate the interview on the Today show. The Bay Area Lyme Foundation has been an important voice in helping patients with chronic Lyme disease not only in California, but across the US. Among their accomplishments, they have helped fund and establish a center at Stamford University for tick-borne disorders that is actively doing important scientific research. I would also like to thank Kathie-Lee, Hoda and the producers at NBC and The Today Show.  I have already received comments from people on Facebook that the interview was helpful in clarifying the symptoms of chronic Lyme disease, and families who were sick and not knowing where to turn, are now seeking help. National reporting of this information is imperative considering the scope of the epidemic, its ability to mimic different diseases, and its devastating effects on the health of our communities. For those who didn't have a chance to see the live interview, here is the link:

7/2/14  Chronic Lyme disease: What you need to know, symptoms, prevention, Today Show, Kathie Lee & Hoda

Commentaire: Apres avoir analyse plusieurs filets de saumon, la revue 60 millions de consammateurs denonce leur teneur inquietante en metaux lourds comme l'arsenic, notamment dans les produits bio. Je trouve les metaux lourdes chez la plupart de mes patients, et ca peux contribuer aux symptomes de Lyme-MSIDS. Il est evident de plus en plus que les polluants de l'environment entre dans notre corps, et il faut consider le detoxification comme une partie essentiel de notre plan de sante.

(English: This french revue found arsenic in salmon that was caught from Ireland, Scotland, Chili, the Feroe Islands, and Norway, and found it even in 4/6 "wild caught salmon" from the Pacific. The scientific literature is proving that more and more environmental pollutants are entering into our body, even from so called "organic" sources. These toxins contribute to symptoms in some of my Lyme-MSIDS patients, and we should consider detoxification as an essential part of our health plan).

6/29/14  Arsenic : des saumons bio pointés du doigt, Medisite

Commentary: A new study conducted at University of California, Davis, just published in Environmental Health Perspectives ( reports that children with ASD (autism spectrum disorder) were more likely than other children to have mothers who were exposed during pregnancy to airborne pesticides from agriculture in California. In addition, exposure to agricultural pesticides in pregnancy was also linked to other types of developmental delay among children. Developmental delays included taking extra time to reach communication, social or motor skill milestones. The study was made possible since California maps and reports agricultural pesticide use, allowing the researchers to examine the course of exposure for the mothers of almost 1,000 children. New York maintains a registry as well but many states do not have a pesticide registry.

In the new study, about a third of mothers had lived within a mile of fields treated with pesticides, most commonly organophosphates, and their children were 60 percent more likely to have ASD than children of non-exposed mothers. Autism risk was also increased with exposure to pyrethroid insecticides, as was the risk for developmental delay. Carbamate pesticides were linked to developmental delay but not to ASDs.  Time of exposure to some pesticides mattered (before conception or in the third trimester were most vulnerable times), but for other pesticides, the effect was the same no matter when during pregnancy the developing fetus was exposed. Eliminating pesticide exposure at home, and integrating basic detoxification techniques (such as increased fluids, fiber, exercise, sauna with sweating, targeted supplements for liver detox, etc)  especially in the months before pregnancy make good sense in light of studies such as this one. Scientific studies need to be performed on using different detoxification techniques during pregnancy to evaluate their efficacy and safety in reducing illness in the developing fetus, considering known exposure risks and the rising rates of autism in the US. I discuss the effects of environmental toxins and the importance of detoxification for good health in my book, “Why Can’t I Get Better: Solving the Mystery of Lyme Disease & Chronic Illness, in chapter 8 on Lyme and Environmental Toxins, and specific detoxification techniques are discussed in chapter 9, Lyme, Functional Medicine and Nutritional Therapies.

Neurodevelopmental Disorders and Prenatal Residential Proximity to Agricultural Pesticides: The CHARGE Study, EHP

Commentary: I just finished presenting at a 3 day workshop at the Omega Institute in Rhinebeck, N.Y., called "Living Well with Lyme Disease". Naturopathic doctors Dr Tom Francescott and Katina Makris were co-presenters with me, and it was an amazing experience. The conference was an blend of lecture, discussion groups, meditation, visualization techniques, drumming and singing, as we discussed the mind/body/emotional and spiritual aspects of healing from Lyme disease. Health care providers and patients came from all over the US and Canada to attend the workshop, and the sharing and love was palpable. We opened the conference on Friday night, and this photo shows the three of us on stage, right after the Poughkeepsie Journal published the article that the Lyme bill in NYS was on its way to be signed by the governor.


Commentary: Patients from Texas come to me with symptoms consistent with tick-borne diseases, after being told that there is no Lyme disease in their state. In this article published in Parasites and Vectors, researchers from Texas A&M, Texas State University and the University of Texas found that 45% of the ticks collected in Texas contained Borrelia burgdorferi, the agent of Lyme disease. These findings refute previous discussion and speculation that Lyme disease is relatively non-existent in the southern United States. Lyme disease is spreading worldwide and should be considered in the differential diagnosis of patients suffering from fatiguing/musculoskeletal illness with cognitive difficulties.

6/22/14 New Texas A&M study finds Lyme disease present, likely to stay in Texas, The Rancher -

4/25/14  Implications of climate change on the distribution of the tick vector Ixodes scapularis and risk for Lyme disease in the Texas-Mexico transboundary region, Parasites & Vectors

Commentary: The Poughkeepsie Journal reported today that the Lyme bill protecting patient and doctor rights is headed to our NY Governor for his signature. Local state representatives Assemblywoman Didi Barrett and Senator Terry Gipson were sponsors of the bill, with L.I. Senator Kemp Hannon having introduced the final version that was approved yesterday by both the Senate and Assembly. Congressman Chris Gibson has also been involved in helping patients with tick-borne disorders, and has a bill that is presently before Congress to help improve research and treatment options for those suffering from Lyme and associated diseases.  I am very grateful to our local representatives for taking the time to understand the complexities of tick-borne disorders and I congratulate our NY State Assembly and Senate for their hard work in passing the bill.

I have seen many patients from the Hudson Valley affected by Lyme and associated tick-borne diseases who were only given short courses of antibiotics, and who subsequently went on to develop chronic debilitating symptoms. My experience with treating over 12,000 chronically ill individuals over the past 27 years is that borrelia can establish a chronic persistent infection, as can Babesia, Bartonella and Mycoplasma infections. I have found that by simultaneously treating Lyme and associated co-infections, while addressing underlying inflammation, immune dysfunction, hormonal dysregulation, autonomic dysfunction, environmental toxicities and detoxification problems, as well as food allergies/sensitivities, vitamin and mineral deficiencies and mitochondrial dysfunction (addressing the 16 points on the MSIDS map), that many patients who were told that they had to live with their debilitating symptoms often got better. This approach is explained in detail in my NY Times best seller, "Why Can't I Get Better? Solving the Mystery of Lyme and Chronic Disease". Lyme is the number one vector borne spreading epidemic spreading worldwide, and this bill is an important first step to give doctors the right to use more flexible treatment protocols for Lyme and associated tick-borne diseases, ensuring better and more appropriate access to health care.

6/19/14 Bill protecting longer Lyme treatments heads to Cuomo, by John Ferro, Poughkeepsie Journal

Commentary: Jessica Bernstein and Dr Dennis Bernstein did an article on the preponderance of women with Lyme disease and how this disease is spreading across the US. This article profiles a film maker, Sini Anderson, her struggle with Lyme, and the need for better testing and insurance coverage. The article highlights the number of women being affected, and the need for a comprehensive support system to help women who are too sick to advocate for themselves. I have reached out to insurance companies in the past to meet with them and help create guidelines that would improve the diagnosis and treatment of complex tick-borne illness, and lower health care costs. This took place recently, and also at the Congressional public forum sponsored by Congressman Chris Gibson 2 years ago.

6/19/14 Lyme Disease Is a Feminist Issue: An Interview With Sini Anderson, by Dennis J Bernstein, Truthout

Commentary: This article on the Senate initiative on Lyme disease appeared in today's Poughkeepsie Journal. I would like to echo Congressman Chris Gibson's comments, in thanking the Senator Kemp Hannon, other Senate leaders in passing the bill. "I want to express my appreciation to Sen. Kemp Hannon and his fellow members of the Task Force on Lyme for working decisively to bring relief to thousands of patients across upstate New York," said Rep. Chris Gibson, R-Kinderhook. "This legislation makes common-sense improvements to state regulations, putting treatment decisions in the hands of physicians who treat Lyme and other tick-borne illnesses..." As per Congressman Gibson, treatment decisions for a complex disease such as Lyme-MSIDS can not be comprehensively covered in insurance company guidelines, and are best left to the clinical judgement of treating physicians. As this epidemic continues to spread, I look forward to working with insurance company leaders to help expand cost effective treatment options for Lyme and associated tick-borne diseases.

6/19/14 Lyme disease action needed, Senate urges Health Department, by Joseph Spector, Poughkeepsie Journal

The New York State Senate Task Force on Lyme and Tick-Borne Diseases today released a report and legislation that provides a comprehensive set of recommendations for research, prevention, diagnosis and treatment of tick-borne illnesses. The legislation also ensures that doctors acting in their patients’ best interests are not unjustly targeted for professional misconduct.

I would like to thank the NY State Assembly and Senate for taking the time to understand the issues, and for their hard work in helping to find solutions for those suffering from Lyme and associated diseases.  I would specifically like to thank our local state representatives, Didi Barrett and Senator Terry Gipson, who initially introduced the bill into the Assembly and Senate, as well as our local Congressman Chris Gibson, who strongly supported the passage of this bill.  Congressman Gibson is also sponsoring a federal bill on Lyme and associated diseases that has bipartisan support, and that President Obama would like to see on his desk..... We are very fortunate to have such good people working as our state and federal representatives. Finally, I would like to send out a thank you to all the patients, families and friends for your perseverance and support, and to everyone involved who helped to make this a success. Congratulations everyone. After being approved in the Senate, the new bill will be voted on again tomorrow in the Assembly.


Commentary: The NYS Assembly just approved an amendment to the bill which previously passed unanimously (A7558-B; Assemblywoman Barrett). This bill has now been amended to be identical to the bill passed yesterday in the NY State Senate (S7854;Senator Hannon). This bill which protects physicians who recommend or provide treatments for Lyme and other tick-borne diseases that are "not universally accepted by the medical profession" will become law once it is approved by Governor Andrew Cuomo.

6/19/14 Bill A07558-B Text, New York State Assembly

Commentary: Dr Rick Ostfeld at the Cary Institute for Ecosystems Studies just published a study on the co-infection rate of nymphal ticks with Babesia in Dutchess County. I was the first doctor to discover Babesia 15 years ago in our area after a young woman in a wheelchair with drenching night sweats and resistant Lyme symptoms got out of her wheelchair for the first time after being treated with Mepron and Zithromax (a classical Babesia treatment). In this study, Dr Ostfeld found "significant deviations of levels of co-infection in questing nymphs, most notably 83% more co-infection with Babesia microti and Borrelia burgdorferi than predicted by chance alone. Co-infections involving A. phagocytophilum were less common, and fewer co-infections of A. phagocytophilum and B. microti than predicted by chance were observed in both questing nymphs and larvae fed on small mammals". Babesia has increased in our area since it was first discovered years ago, and we find co-infections with Babesia often accounting for resistant symptoms in our chronic Lyme patients. This study highlights the high risk of infection of these two organisms simultaneously with a tick bite. Health care providers should ask patients with resistant Lyme symptoms whether they suffer from day sweats, night sweats (occasionally drenching), chills, air hunger (shortness of breath) and an unexplained cough, as these are classic symptoms for Babesiosis.

6/18/14  Co-Infection of Blacklegged Ticks with Babesia microti and Borrelia burgdorferiIs Higher than Expected and Acquired from Small Mammal Hosts, PLOS One

Commentary: The Lyme bill goes before the NY State Assembly today. Here is the NY Senate web site to read the new task force report & recommendations to address Lyme and tick-borne diseases. Please read the comments by the Senators on the task force. They clearly recognize that this is an epidemic, that a comprehensive plan is necessary, and that the practice of medicine needs to be left in the hands of treating physicians caring for their patients. Senator Marchione says about the bill:

“I represent Columbia County which has some of the highest reported cases of Lyme Disease not just in New York State, but the United States. I have listened to heart-wrenching stories from my constituents who are living with – and struggling with – Lyme Disease and the serious physical, emotional, psychological and financial devastation that it has caused them and their families. While the state Legislature should not be practicing medicine, we can, and should, ensure that pioneering and courageous doctors taking a proactive approach to treating Lyme Disease are not unfairly targeted by the Office of Professional Medical Conduct. Doctors shouldn’t be threatened with investigations or possible loss of their license to practice medicine just because they put their patients first. Passage of a legislative remedy that will help protect doctors, sponsored by my colleague Senator Hannon, along with other bipartisan recommendations from our Task Force report, should be at the top of Albany’s must-do list before session concludes.”

I am very appreciative of the hard work of our legislative body and Senator Hannon to get this bill passed.

6/18/14  New Task Force Report & Recommendations to Address Lyme and Tick-Borne Diseases, New York Senate

Commentary: Lyme disease is spreading worldwide. In this study recently published in Infection, Genetics and Evolution, scientists have confirmed that Ixodes scapularis ticks from across five Midwestern States contain multiple infectious agents apart from Lyme disease, including newer Borrelia species, such as Borrelia miyamotoi, and other Babesia species, such as Babesia odocoilei.  These organisms can be simultaneously transmitted with one tick bite, and we do not have reliable blood tests for all of these bacteria and parasites. These infections can therefore go undetected and lead to a "Lyme-like illness". The MSIDS model discussed in my book discusses in detail how the majority of patients affected with Lyme disease suffer from overlapping co-infections, contributing to chronic persistent illness. 

6/18/14  Increased diversity of zoonotic pathogens and Borrelia burgdorferi strains in established versus incipient Ixodes scapularis populations across the Midwestern United States, ScienceDirect

Commentary: Dr SH Lee, Dr Tom Moorcroft and Dr Katherine Lantsman published a paper in the International Journal of Molecular Sciences which showed the presence of borrelia in the blood of ambulatory patients during the winter months when the likelihood of a new bite and infection is rare. The authors found evidence of both Lyme disease and the relapsing fever spirochete Borrelia miyamotoi by PCR in the blood of patients. This scientific report illustrates the usefulness of a sensitive PCR assay in detecting spirochetal infections that may go undetected by other methodologies, and highlights the fact that other borrelia species such as B. miyamotoi are rapidly spreading, and may be associated with a persistent infection with Lyme disease. I have found that multiple tick-borne co-infections are the rule and not the exception in the Lyme-MSIDS patients who come to see me.

"With this newly developed method, we found 14 ambulatory patients with spirochetemia containing 25–50 borrelial cells per mL of whole blood in a month of deep winter inthe Northeast of the U.S.A. when tick activity in the region was minimal. We conclude that these patients represented undiagnosed cases of “Lyme and related borreliosis” or persistent infection of“Lyme and related borreliosis” after standard antibiotic treatments failed to eradicate the causative agents from the infected tissues. A sensitive and reliable laboratory test for the infectious agents of “Lyme and related borreliosis” should be available in the hospital laboratories located in the disease-endemic communities to diagnose these cases for timely and appropriate treatment".

6/17/14  DNA Sequencing Diagnosis of Off-Season Spirochetemia with Low Bacterial Density in Borrelia burgdorferi andBorrelia miyamotoi Infections, International Journal of Molecular Sciences

Commentary: Alain Marty, depute de la region de Mosellle en France, veut aider ceux qui sont atteintes de la maladie de Lyme. C'est une bonne nouvelle pour la France:  "Il est primordial que l’Europe engage une réflexion sur le développement préoccupant de la maladie de Lyme et les actions nécessaires afin de juguler ses effets sur la santé publique et de combattre les menaces transfrontalières. Il est également primordial que les financements et moyens de recherche, visant à développer des tests de dépistages fiables, de nouveaux traitements et les recherches vaccinales, soient effectifs. Enfin, il est important d’inscrire cette maladie comme « grande cause nationale 2015 » afin de mieux sensibiliser la population et le corps médical".

6/17/14  Mon soutien aux personnes atteintes de la maladie de Lyme

Commentary: Dr Holly Ahern has written an insightful opinion piece for the Poughkeepsie Journal on the present politics of Lyme disease. As she explains in her article, there is abundant peer-reviewed scientific evidence (confirmed by clinical experience by many ILADS physicians), that persistent borrelia and co-infections are in part responsible for ongoing symptoms in chronically ill individuals. Patients are suffering tremendously from Lyme and associated tick-borne diseases, and these infections are spreading in epidemic proportion. Physicians must be allowed to use their best clinical judgement to treat patients for this debilitating illness without fear of retribution from medical boards, especially because the IDSA guidelines promulgated by insurance companies do not work in clinical practice for patients with persistent disease. A CDC survey published last year also showed that over 50% of physicians in the United States do not follow IDSA guidelines, but instead follow the peer reviewed published ILADS guidelines, because they are more effective in clinical practice for their sick patients.

Dr Ahern appropriately calls for an updated review of the present guidelines, and this should be done in a scientific forum where doctors, researchers, scientists, politicians, health advocates and insurers come together to discuss the rapidly changing science of Lyme and associated co-infections. I have found that the multifactorial MSIDS model is better suited for these chronically ill patients with complex presentations.

6/14/14  Views: Give Lyme victims same rights as other patients, by Holly Ahern, Poughkeepsie Journal

Commentary: Bartonella species, as well as other tick-borne diseases such as Lyme disease, are known to cause eye problems. In this study, patients who underwent cataract surgery, were found to be infected with several different tick-borne pathogens. 4.6% of cataract patients were positive by antibody testing for Bartonella, and approximately 2% of those patients who were seronegative for Bartonella had evidence of an undescribed Bartonella species by DNA analysis (PCR) in their eye. Serological studies showed that Borrelia burgdorferi sensu lato was also found to be positive in 34.8% of patients with cataracts. The study concluded that "serological studies have shown that antibodies to B. burgdorferi sensu lato and Bartonella sp. are detected significantly more frequently in patients with cataracts in comparison with the control group". We know that oxidative stress is a major factor in chronic disease, and fungi, bacteria, viruses, protozoa, and systemic and autoimmune diseases may all cause inflammation that can affect the eye and result in cataract surgery.

Bacterial tick-borne diseases caused by Bartonella spp., Borrelia burgdorferi sensu lato, Coxiella burnetii, and Rickettsia spp. among patients with cataract surgery, Medical Science - Monitor

Commentary: Lyme disease without a classical EM rash may be missed by presently available testing. This is the stage of the disease when it is curable. A study at Columbia University is examining SpiroFind, a test developed in the Netherlands, to measure immunological signs of early infection, compared to established tests that look for markers that develop after the infection has been present for a number of weeks. Inflammatory molecules called cytokines are produced in both early and late disease, and researchers have recently identified some specific markers that may help to identify early borrelia infection. The article outlining the science of this approach was published in PLoS ONE 9(4): e93243. Serum Inflammatory Mediators as Markers of Human Lyme Disease Activity. Soloski MJ, Crowder LA, Lahey LJ, Wagner CA, Robinson WH, et al.

4/16/14 New Lyme test gets study, by John Ferro, Poughkeepsie Journal

Commentary: Environmental pollutants have recently been shown to be linked to autism in a new Harvard University study.  "Several studies have been done linking the disorder to metals and other exhaust pollutants in the air, but new Harvard University research is the first nationwide study.The results are especially startling because Utah has both one of the nation's highest autism rates and pollution levels during winter inversions. According to the U.S. Centers for Disease Control, one in 47 Utah children is afflicted with autism, compared to one in 210 in Alabama, which has the best rate. According to the Utah Registry of Autism and Developmental Disabilities, the number of Utah 8-year-olds with autism has come close to tripling since 2002". As per the study recently linking pesticides and autism rates, this study concluded that "exposure in the womb to diesel, lead, manganese, mercury, methylene chloride and an overall measure of metals was "significantly associated with autism spectrum disorder," with the highest association from exposure to diesel exhaust". This study joins others in showing the effects of environmental pollutants on our health and the health of our future generations. I discuss environmental toxins and methods of detoxification in chapter 8 and 9 of my book. The majority of my patients who are tested for heavy metals show evidence of exposure to mercury and lead. We urgently need to do scientific studies looking at the role of detoxification and nutritional supplementation on prevention and treatment of emerging diseases such as autism, Alzheimer's disease, cancer and Lyme-MSIDS.

3/16/14  Harvard draws link between autism and air pollution, by Caleb Wamock, Daily Herald

Commentary: Prior scientific studies have shown an association between borrelia and Alzheimer's disease (AD), as well as inflammation and AD, but multi factorial etiologies have not been considered to play a role in the disease process. This article was just published in the European Journal of Neurology, and supports the multi factorial MSIDS model discussed in my book, where multiple overlapping infections increase the burden of chronic disease. The authors found that the infectious burden (bacterial burden and viral burden) with CMV, HSV-1, B. burgdoferi (Lyme disease), Chlamydia pneumoniae, and H. pylori were independently associated with AD after adjusting for age, gender, education, APOE genotype and various co morbidities. The conclusion of the study was that infection and inflammation  play a role in the etiopathogenesis of AD. Multiple factors on the 16 point MSIDS map increase inflammation (such as various infections, environmental toxins and heavy metals, food allergies/sensitivities, zinc deficiency, sleep deprivation, and imbalances in the microbiome) and should be assessed in future studies to evaluate the risk for AD.

6/9/14  A study on the association between infectious burden and Alzheimer's diseaseEuropean Journal of Neurology
Commentary: I was interviewed this past weekend at the Strasbourg Lyme conference by France 3, one of the national TV stations in France. For those who do not speak french, the crux of the interview was that tick-borne testing is not reliable, and that better up to date scientific information needs to be made available to physicians to help them diagnose tick-borne disorders. One patient who is in a wheelchair due to chronic Lyme disease is interviewed regarding her experience with the diagnosis and treatment. She suffers with chronic pain and has difficulty walking and going to school. She unfortunately has had the same experience that many patients do in the US. She went undiagnosed for a long period of time and now is struggling to get her life back.

6/9/14  Maladie de Lyme : la France en retard ?, Alsace France 3

Commentary: I just returned home to the US after lecturing in Strasbourg, France. There were approximately 500 patients and another 150 health care providers who attended the 3 day symposium which was organized by Lyme Sans Frontieres at the Palais de Congres in Strasbourg. I did a comprehensive training for 8 hours (in french) on day one of the conference for health care providers, followed by training on Lyme and the MSIDS model during the next two days. There were many excellent speakers, including Dr Eva Sapi from the US (biologist), Dr Walter Berghoff (internist, Germany), Dr Wolfang Klemann (GP, Germany), Dr Viviane Schaller (biologist, France), Bernard Christophe (pharmacist, France) as well as doctors from the Chronimed group in France who specialize in Lyme and autism (Dr Phillipe Bottero, Dr Phillipe Raymond, and Dr Louis Teulières). The french physicians have had extensive experience treating autism (ASD) with antibiotics, and discussed how treating Lyme and associated bacterial infections have led to clinical successes in some ASD patients who were unable to get help with other medical approaches. They are presently involved in a multi center study of autism throughout France.

My book was also released in french this past weekend through Thierry Souccar publishing. I signed several hundred copies for the public, and I gave signed copies of the book to the Archbishop of Strasbourg, the mayor of Strasbourg and a local government official, Armand Jung, Conseiller General du Bas-Rhin, who was giving a copy to the French Minister of Heath, Marisol Touraine. I spoke to them about working in partnership to help stem the epidemic of tick-borne diseases that are spreading throughout France and Europe. There are photos on the site below showing highlights of the conference:

Commentary: Joshua Cutler discusses his experience with Lyme disease in this interview on Truthout. He had seen approximately 32 doctors before getting a diagnosis, and had been diagnosed with Chronic Fatigue Syndrome, Fibromyalgia and anxiety, before getting properly diagnosed with a tick-borne disorder. I heard exactly the same stories from patients in France who attended the Lyme conference in Strasbourg 2 days ago. The NY State politicians are looking at changing the laws in NY, as they recently did in Vermont, so that Josh's experience does not happen to others.

6/8/14  Truthout Interviews Joshua Cutler on Lyme Disease and the IDSA, By Ted Asregadoo,Truthout

Commentary: Spirochetes were recently discovered in fossilized ticks, offering possible insights into the evolutionary history of Lyme disease. Although spirochetes have been with us for a long history of time, what has changed over time are the development newer strains of borrelia like Borrelia miyamotoi, and an increase in the number of tick-borne co-infections (like Babesia, Bartonella, and different tick-borne viruses) that are now found in ticks, leading to chronic persistent illness.

6/6/14  Lyme bacterium's possible ancestor found in ancient tick, by Rachel Nuwer, Nature

Commentary: This message is from Senator Terry Gipson, asking for help for those suffering from Lyme disease. He is calling on the State Senate Health Committee to move his legislation, S.5520B, out of committee, and onto the floor for a vote. I know Terry personally, and appreciate all of his hard work on this important issue.

6/6/14  Email from New York State Senator Terry Gipson - I need your help fighting Lyme
Commentary: Michigan is highly endemic for Lyme disease, and yet some doctors are still unaware of the signs and symptoms of the disease, leaving people to suffer for long periods of time. I have had entire families come from Michigan and see me for Lyme treatment after going for years without a proper diagnosis. My book is sitting next to her in this video clip (even though we have never met), and I can only hope that she is actively working with her doctor using the book and the 16 point MSIDS map to discover the underlying etiologies driving her chronic symptoms.

6/6/14  Lyme disease in Mich: "Robs you of life as you know it", by Peter Ross, WZZM13

Christian presented with me at the Belgian Senate last month to help educate politicians on the emerging threat of tick-borne disorders. We met again in Oslo this past week. He discussed the problems with testing for tick-borne disorders, and how organisms may evade the immune system. He is also aware of the politics surrounding Lyme disease worldwide.  He quotes Virginia law which states that physicians must inform patients on the unreliability of the presenting testing for Lyme disease.  His article is an excellent overview of the growing number of organisms now being found in ticks (including a brand new organism isolated in Switzerland, Candidatus Neoehrlichia mikurensis) and he makes the case that a multi factorial model (such as the MSIDS model I discuss in my book) is needed, as there are now multiple overlapping infections ( bacteria, viruses and parasites) responsible for chronic persistent illness.

6/3/14  Lyme and associated tick-borne diseases: global challenges in the context of a public health threat, by Christian Perronne, frontiers

Commentary: CBS News in NY just reported on one of the newer tick-borne diseases that is on the rise: the Heartland virus. The Heartland virus is transmitted from the bite of the Lone Star tick, Ambylomma Americanum (which is in NY) and can cause a flu-like illness with fever, fatigue, headaches and muscle/joint pain. It can be mistaken for another tick-borne disease, Ehrlichiosis/Anaplasmosis, as blood tests may look similar (low white cell counts, low platelet counts and elevated liver function tests). There is no reliable blood test nor treatment for this tick-borne viral infection. The Heartland and Powassan viruses are two newer tick-borne viral infections that are spreading, and can be transmitted simultaneously with other tick-borne bacterial and parasitic infections, like Lyme disease and Babesiosis, increasing the risk of morbidity and mortality. Commentary: Christian Perrone, PhD, MD has just published an excellent article in Frontiers in Cellular and Infection Microbiology on the global challenges of Lyme disease as a public health threat. He is Professor of Infectious and Tropical Diseases at the Faculty of Medicine Ile-de-France Ouest, and President of the Communicable diseases commission at the High Council for Public Health in France. He is also Vice-President of the European Advisory Group of Experts on Immunization at the World Health Organization, and is the author or co-author of 218 scientific publications.

6/1/14  Deadly New Tick-Borne Illness ‘The Heartland Virus’ Is On The Rise, CBS New York

Commentary: Cathy Rubin gives a overview of the Norwegian Lyme conference that took place this past week. Doctors and patients came from all over the world to hear the most up to date research, diagnostics and treatments for tick-borne disorders. She includes quotes from presenters at the Norvect conference that encapsulate some of the essential information shared.

5/31/14 The Global Search for Education: Ticks - More from Norway, CMRubinWorld

Commentary: This article by Jessica Bernstein appeared in Truth-Out, discussing how hundreds of irate Lyme patients recently protested in front of the IDSA headquarters in "a desperate attempt to change IDSA policies that prevent them from receiving care". Patients who come to see me often report that they have been to multiple physicians before receiving a diagnosis, leading to months and/or years of unnecessary health care costs and suffering.

Although this article describes the frustration of many Lyme patients and lists scientific references on persistence of borrelia, it does not include the most recent scientific evidence showing the persistence of Lyme disease in animals and humans, nor does it discuss the multiple borrelia species now being found in ticks that can account for seronegative disease. I also have discovered that tick-borne co-infections are often playing a role in persistent illness, as well as multiple factors on the Lyme-MSIDS map (discussed in my book). We are the midst of a worldwide spreading epidemic, and it is crucial that all parties come to the table immediately (scientists, researchers, clinicians, insurance companies and politicians), in order to find solutions which will lower the burden of health care costs associated with chronic illness, while relieving the suffering of patients with Lyme and associated tick-borne disorders.

Commentary: The Poughkeepsie Journal Editorial Board just published another opinion piece on the need for the NY State Senate to pass Lyme bill S5520B. This bill gives physicians the right to treat patients according to their best clinical judgement, using either of the two recognized guidelines for the diagnosis and treatment of Lyme disease.

"With precious time remaining, state senators must see the wisdom of joining their Assembly colleagues in helping those suffering from Lyme disease...In some cases, (patients) can't even get help from their doctors.The situation is outrageous; it can be fixed".

Click the following links for more information:

Bill S5520B-2013 - Authorizes long term antibiotic treatment for certain patients with Lyme disease  / NYS Health Committee

To contact Chairman Kemp Hannon: write to The Capitol Room 420, Albany, NY 12247 /518-455-2200 /

5/29/14  State must help doctors in Lyme fight, Poughkeepsie Journal

Commentary: I did a one hour video interview on Lyme and associated tick-borne infections with Sarah Edelson-Hiner, the president of Bottom Line publications. It is now online and available for viewing. We had a lively conversation about the growing epidemic of tick-borne diseases, the inadequacy of testing, and how Lyme can imitate many different illnesses. I also discussed some of the most important points on the MSIDS map which help individuals regain their health. Please click on the link below to register for this free web cast.

6/1/14  Lyme Disease & Other Tick-Borne Diseases Webcast, Bottom Line Publications

Commentary: I participated in a webinar on thyroid disease with host Suzie Cohen, RPh. She brought together 32 different experts from across the world to discuss different aspects of thyroid disease. I did a one hour segment on Lyme and associated co-infections, and some of the endocrine abnormalities seen in people with tick-borne disorders. My interview will be aired on June 7th. This webinar is free, but you need to sign up. If anyone wants to register and/or have a copy of the presentations, the links are below:

Your link to the registration page looks like:

Your link to the order form looks like:

Commentary: I did a scientific presentation on Lyme disease and associated tick-borne disorders for the Belgian government several weeks ago. Lyme and associated co-infections are spreading throughout Europe, and I have had Belgian patients come to my clinic seeking help after they were unable to receive effective treatment.

Here is the You Tube video of my presentation for the Belgian Senate. This video contains a detailed overview of the Lyme-MSIDS map, and contains scientific references illustrating the difficulties surrounding the diagnosis and treatment of tick-borne disorders. Please feel free to share this video with your friends and family.


YouTube Video

Commentary: The Oklahoma State Department of Health has confirmed the state's first case and death from the Heartland virus, transmitted by the Lone Star tick, Ambylomma americanum. The Heartland virus was first identified in Missouri in 2009, and the Oklahoma case is the tenth person confirmed with the virus and the second person to die from it. 

The Heartland virus has a clinical presentation similar to Ehrlichiosis, with symptoms including fever, fatigue, headaches, muscle aches, loss of appetite, nausea, bruising easily and diarrhea. There is no routine testing available for the Heartland virus, although it will produce low white cell counts (leukopenia), low platelet counts (thrombocytopenia) and elevated liver function tests (transaminitis), similar to Ehrlichiosis.  The Heartland virus does not respond to antibiotics like doxycycline (as in the case of Ehrlichia and Anaplasma), so education and prevention of tick bites is essential to prevent increased morbidity and mortality.

5/27/14  First Heartland Virus case, death in Oklahoma confirmed,

Commentary: There is a bill before the Massachusetts legislature that would help expand coverage for treatment of Lyme disease.  "A report released this week says insurance coverage of long-term antibiotic treatment of chronic Lyme disease would only increase insurance policies by about 13 cents...The information from the state Center for Health Information and Analysis on Thursday is considered to be a major step for House Bill 989, which would require insurance carriers to provide coverage for antibiotic treatment lasting beyond 28 days when it is determined by a physician to be medically necessary. Passage of the bill would also require insurance coverage for diagnostic testing for the tick-borne disease." 

This bill is an important step in helping people with Lyme disease. Many patients are unable to afford long term treatment, and insurers have generally relied upon restrictive guidelines, resulting in a shifting of the burden of care to the patient and state.

5/24/14  Study: Cost of expanded Lyme disease care is low  - 13 cents per insurance policy, by Elaine Thompson, News

Commentary: A study recently published in the journal Science may hold the key for both the prevention and treatment of Babesiosis. Scientists seeking a vaccine against malaria (which is a similar parasite to Babesia) have developed a promising new approach intended to imprison the disease-causing parasites inside the red blood cells they infect. The researchers said on Thursday an experimental vaccine based on this idea protected mice in five trials, and Phase I clinical trials testing the vaccine in humans could begin within a year and a half. Doctors from the U.S. National Institutes of Health pinpointed a protein, dubbed PfSEA-1, that the parasites need in order to escape from inside red blood cells they infect as they cause malaria. The researchers then found that antibodies sent by the body's immune system to take action against this protein managed to trap the parasites inside the red blood cells, blocking the progression of the disease. This could theoretically be applied to Babesiosis, which is one of the tick-borne illnesses frequently responsible for chronic persistent symptoms in my patients.

5/23/14  New vaccine approach imprisons malaria parasite in blood cells, Fox News

Commentary: In this Omega video, I discuss diagnosing Lyme disease. Many people are confused as to whether they suffer from CFS/M.E., Fibromyalgia, or an unspecified autoimmune disorder. I discuss in this video the 6 signs and symptoms that point towards a tick-borne illness.

5/23/14  Living Well With Lyme Disease - Conference at the Omega Institute, Rhinebeck, NY, June 20-22

Commentary: It is good that Babesia is being recognized by the mainstream press now, although I first discovered Babesia in the Hudson Valley, N. Y. over 15 years ago!  Patients with resistant Lyme symptoms were coming in with night sweats, day sweats, chills, and occasionally "air hunger"  and a cough, and I discovered the presence of Babesia microti. This article discusses a different strain of Babesia, known as Babesia divergens, which has been found primarily in Europe, and is known to cause a type of anemia, where the red blood cells burst apart (hemolytic anemia). This type of anemia is not common in patients that I see that are co-infected with Lyme and Babesia microti. I am now finding another strain of Babesia in my patients from the Northeast, known as Babesia WA-1/duncani, that is not mentioned in the article. Several years ago I reported at the International Lyme conference in Toronto that up to 19% of my patients with Babesia were testing positive through LabCorp for Babesia duncani. Standard tests for Babesia are not reliable (such as the Giemsa stain, IFA's, and PCR's), and testing only for one strain of Babesia, may miss other strains. This malaria type parasite frequently contributes to persistent illness in my Lyme patients, and should be considered in any patient with unexplained fever, sweats and chills where other etiologies have been ruled out (see page 68 of my book).

Commentary: The Vermont Governor just signed the Lyme disease treatment bill into law. The Vermont legislature is cognizant of the debilitating effects that Lyme and tick-borne diseases have had on Vermonters, and now have given doctors the right to use their best clinical judgement to treat patients without fear of reprisal.


Commentary: Plusieurs personnes m'ont demandé comment on peut savoir si on est atteint de la maladie de Lyme. Cette vidéo explique les 6 signes et symptômes souvent associés aux borrélioses. J’espère vous voir à Strasbourg pour le colloque sur la maladie de Lyme. Mon livre va sortir en français et sera disponible pour cette conférence (des dédicaces sont prévues).

French video 2: Les 6 signes et symptomes que vos maux peux etre du a la maladie de Lyme

Press Release:  Congressman Chris Gibson (NY-19) has authored bipartisan legislation to require the National Institutes of Health (NIH) and Centers for Disease Control (CDC) to audit available research on vector-borne diseases like Lyme disease.

H.R. 4701, the Vector-Borne Disease Research Transparency and Accountability Act of 2014, would form working groups on at least two high-incidence diseases to develop a scientific framework on how to move forward to fill gaps in research and patient care.

The working groups would include relevant federal officials, non-federal physicians who treat Lyme, non-federal scientists, researchers, members of the patient community, and additional members appointed by Congress to ensure a diversity of perspectives and balanced representation..... (read more)

5/22/14  Congressman Chris Gibson Press Release

Commentary: The Poughkeepsie Journal Editorial Board has taken a strong stand in the fight against Lyme disease. This editorial discusses why they support doctors and patients rights to choose their treatment options for Lyme and associated tick-borne diseases: "Outdated and disputed diagnostic and treatment guidelines prevent many of those afflicted from receiving evidenced-based treatment options that could mean the difference between a healthy life and one of chronic pain and progressive disability....Since the majority of Lyme disease reports come from about a dozen states and New York is one of them, states not only have a right but an obligation to take their own actions if and when necessary. And here it is necessary...Legislation in Albany at least would protect doctors who believe long-term therapy is the way to go. This legislation, sponsored by state Assemblywoman Didi Barrett, D-Hudson, has passed the Assembly...What Barrett, Gipson and others are proposing shouldn't be considered radical, but responsible".

5/21/14  Doctors need help in Lyme fight, Poughkeepsie Journal

Commentary: Pour les Francophones, à voir ce soir, mardi 20 mai, sur France 5 : "La maladie de Lyme, quand les tiques attaquent" à 20h35. Un film de Chantal Perrin sur la maladie de Lyme qui se répand partout dans le monde, et plus spécialement en ce moment en Europe et en France. La maladie de Lyme est considérée comme "un grand imitateur" et ce film montre les problèmes de diagnostic rencontrés par les patients français, pourquoi les gens restent malades et parle également des problèmes socio-politiques empêchant la recherche d'avancer. Dites à vos amis et à votre famille de le regarder, c'est une histoire qui doit être partagée !

Dans ce film, je parle de la maladie de Lyme que je détaille aussi longuement dans un livre à paraître le 12 juin chez Thierry Souccar Editions : Soigner la maladie de Lyme et les maladies chroniques inexpliquées. Cet ouvrage traite également de mon approche pour soigner les personnes atteintes de la maladie de Lyme et qui restent malades malgré les traitements courts et classiques.  

Commentary:  We are in the middle of a worldwide epidemic of Lyme and associated tick-borne diseases. Chantal Perrin is a documentary filmmaker from France who traveled across the globe to track Lyme disease in the US, France, parts of Europe and Africa. In this revealing documentary being released today throughout Europe, she tells the story of how people across the world are getting sick, and how our health care systems continue to deny the existence of this growing medical threat, leading to widespread suffering and disability.

I have patients with Lyme and associated tick-borne disorders who come to see me from Canada, Belgium, France, Switzerland, Austria, Holland, England, Norway, Australia, New Zealand and Mexico, as they are unable to get effective care in their country. I am featured in this film and interviewed in both my medical practice in the United States, as well as in France where I am lecturing to doctors and patients on the diagnosis and treatment of Lyme and associated co-infections, discussing how to use the MSIDS model to treat chronic persistent disease. Dr Rick Ostfeld from the Cary Institute, and Dr Eva Sapi from the University of New Haven are also interviewed in this film, as are physicians and researchers from across the world.

This film highlights the politics of Lyme disease, the unreliability of testing, the rapidly spreading and multisystemic nature of tick-borne illness, and how worldwide research is being hampered by socio-political economic challenges. The film makes it clear that patients are suffering as the scientific community battles about the etiology and treatment of this disease, and that "we rapidly need to come to a clear scientific consensus, not a consensus of denial".

Please feel free to share this film with your family and friends. It is an important work with a story that desperately needs to be told.

5/20/14 LYME DISEASE: A SILENT EPIDEMIC  (vimeo - entire film), Produced by France 5 Public Network and Grand Angle, Directed by Chantel Perrin

Commentary: Tick borne diseases are spreading throughout the United States, Canada, and Europe. This is the unfortunate story of a French-Canadian woman from Quebec who saw many physicians without ever receiving a proper diagnosis and had to come to the United States for treatment. I often hear the same stories. Lyme disease is rapidly spreading worldwide and is poorly recognized, due to its protean nature, as well as the poor sensitivity of the blood tests for Borrelia burgdorferi and associated borrelia species.

5/18/14  Lyme disease diagnosis a battle in Quebec, patients say, CBC News

Commentary: Cathy Rubin will be joining me in Oslo next week for the International Norvect conference on Lyme and associated tick-borne disorders. In this article in the Huffington Post, she interviews me and other speakers at the conference as to how we should be prioritizing tick-borne research. I discuss the need for more accurate and earlier detection methods with better treatment strategies, since Lyme and associated co-infections are often implicated in persistent illness. We also need to broaden research to look at the multifactorial causes of chronic disease. Chronic disease accounts for at least 75% of our health care costs and 70% of the deaths in the United States. The MSIDS model that I use in my practice has been clinically useful in finding and treating multiple sources of inflammation in chronically ill individuals, helping them improve their health.

The vaccination strategies that I discuss (and didn't have room to include in the article) relates to vaccination of mice against different tick-borne pathogens to help prevent the cycle of transmission to humans and pets, as well as looking into a "tick-spit" vaccine where antibodies would prevent tick attachment and the subsequent ability to transmit multiple pathogens with one tick bite (i.e., bacteria, viruses and parasites like Babesia that are often responsible for chronic illness).

5/18/14  The Global Search for Education: Ticks - Research We Need, by C.M. Rubin, HuffPost

Commentary: John Ferro of the Poughkeepsie Journal reports on the Lyme bill before the NY Senate, that just passed the Assembly unanimously on May 12th.

Please consider contacting your state Senators and let them know about your experience with Lyme and associated tick-borne disorders. They need to hear from you, so they understand the impact of this disease on you and your family.

5/19/14  Bill protecting longer Lyme treatments is before Senate, by John Ferro, Poughkeepsie Journal

Commentary: Dr Brian Fallon, Dr Rick Ostfeld of the Cary Institute, and Jill Auerbach, chairwoman of the Hudson Valley Lyme Disease Association presented information at a local forum in Poughkeepsie on the risks of Lyme disease. We thank John Ferro and the Poughkeepsie Journal for their continued coverage of this important topic.

5/16/14  Lyme forum: Small steps can reduce big risks, by John Ferro, Poughkeepsie Journal

Commentary: This is the official release from Assemblywoman Didi Barrett on the legislation which passed the NYS Assembly to improve the care of Lyme disease patients. We are grateful for all of her hard work on behalf of the Lyme community.

5/13/14  Legislation to Improve the Care of Lyme Disease Patients Passes Assembly, New York State Assembly

Commentary: The Dutchess County Medical Society decided to cancel the Lyme conference scheduled for this Friday. Local and federal politicians, including Congressman Gibson's office, are looking into why the DCMS canceled such an important event. Since Dutchess County is at the epicenter of this emerging epidemic, we hope they will consider rescheduling the event in the near future with a comprehensive program addressing the multifaceted nature of this illness. You can contact the Dutchess County Medical Society at if you wish to get more information about scheduled events.

5/13/14  Dutchess County Medical Society Lyme Conference Scheduled for Friday 5/16/14 cancelled

Commentary: Lyme disease has been believed to be rare or non-existent in southern states. Dr Kerry Clark, from the University of North Florida, recently found that 42 percent of patients from southern states tested positive for some Lyme borrelia species, including infection with B. burgdorferi, B. americana and B. andersonii. These findings expand the geographical distribution of Lyme, and confirm the rapidly expanding epidemic of tick-borne disease seen across the US and Europe.

The different borrelia species discovered in the southern states may also not be picked up by commonly used two-tiered testing protocols (like B. miyamotoi), resulting in patients being misdiagnosed with diseases such as Chronic Fatigue Syndrome, Fibromyalgia, or Autoimmune disorders like MS. Science is rapidly expanding our understanding of Lyme and associated tick-borne disease, and we must let go of old paradigms if we are to effectively deal with the enormous health challenge that is before us.

5/13/14  UNF Professor Discovers Two Lyme Disease Bacteria Previously Unknown to Infect Human Patients, Infection Control Today

Commentary: The NYS bill that  authorizes long term antibiotics for certain patients with Lyme disease, and provides that physicians shall not be subject to disciplinary action for such treatment, passed the NYS Assembly yesterday, by a vote of 133 to 0. Assemblywoman Didi Barrett introduced the bill, who has been a strong advocate for the Lyme community. New York follows on the heels of Vermont, who recently passed a similar bill through their legislative body. 

May 12, 2014  Bill A07558

Commentary: I did a radio interview with Dr Pat and Katina Makris at the TBDA gala in NYC last week. We discuss building bridges to help people suffering with chronic tick-borne illness.

May 1, 2014, Dr. Pat Radio Show

Commentary: It appears Lyme disease has made its way into Texas. Although believed to be a rare disease in the Lone Star State, Dr. Maria Esteve-Gassent, a research professor at Texas A and M University, found that 25% of the ticks tested were positive for Borrelia burgdorferi. I have patients from Texas who have come to see me because they were unable to find physicians who believed that they were sick with Lyme. They were told that the disease didn't exist in Texas. Health departments in each state need to regularly test ticks and follow the infection rates for borrelia species (including the relapsing fever spirochete, Borrelia miyamotoi) as well as associated co-infections like Babesia, which are rapidly changing. What was true several years ago, is not necessarily true now., Researched Nurtitionals

Commentary: New research from Yale confirms that Borrelia miyamotoi, the relapsing fever spirochete, has spread throughout New England. Four percent of the patients tested had evidence of this Lyme-like organism. B. miyamotoi does not test positive by standard blood tests for Borrelia burgdorferi and could explain negative testing for patients with clinical symptoms suggestive of Lyme disease who respond to antibiotics. Ten percent of the patients in the study from the New England area also tested positive for Lyme disease, which is significantly higher than the 0,3% rate of infection discussed in the Hook study by the CDC several years ago.

Lyme disease and B. miyamotoi are rapidly spreading, as are associated tick-borne co-infections such as Babesia microti, Babesia WA-1/duncani, Anaplasmosis, Ehrlichiosis, Bartonellosis and rickettsial infections. These infections are responsible for persistent symptoms in my patients with Lyme-MSIDS, and can be fatal in immunocompromised individuals. B. miyamotoi can also be responsible for disseminated intravascular coagulation (DIC) and hemmorhage, inflammation of the heart (myocarditis) with arrythymias, a meningoencephalitis, as well as fetal morbidity and mortality. Patients with PTLD who have not improved with standard therapies, immunocompromised patients as well as pregnant women need to be screened for these associated tick-borne infections.

5/8/14 Yale researchers identify extent of new tick-borne infection, by Yale University, ECN Magazine

Commentary: Author CM Rubin discusses the growing problem of tick-borne infections in Scandinavian countries, and how the politics of Lyme disease have affected patients access to medical care. I will be speaking at this conference on the role co-infections and the how the MSIDS model can help with persistent illness.

4/30/14  The Global Search for Education: Ticks - World's Leading Scientists Will Meet in Oslo, C.M. Rubin, CMRubinWorld

Commentary: Patients suffering from Lyme and associated tick-borne diseases often have difficulty coping with their illness. Here is the story of how one Lyme sufferer finds inner piece when living with the challenges of Lyme and chronic illness:

Commentary: This picture of myself with Congressman Chris Gibson was taken during the Light on Lyme event in Rosendale, N.Y. on May 4th. Congressman Gibson talked about his new Lyme bill that is presently before the House, that will establish funds for research for Lyme and associated tick-borne disorders. The bill will create a committee with a diversity of scientific perspectives at the table, which will address among other issues: a comprehensive review of the literature, and relevant and diverse emerging scientific areas that will help advance clinical practice. Lyme organizations will have a voice at the table, and it is important for Lyme Advocacy organizations and thought leaders to come together to support this bill. Congressman Gibson also sent his representative Steve Bulger to speak at the Greene County Lyme forum that took place on May 5th, at Greenville High School the next day. I was there with Dr Holly Ahern, Chris Fisk from the Lyme Action Network, and Dr Ronald Stram. I spoke on the Lyme-MSIDS model and how it could be effectively used for persistent illness in Lyme, and its applicability to other diseases. The auditorium was packed, and when I asked people in the audience to raise their hands if they had Lyme, the majority raised their hands.  I didn't know the epidemic had spread so significantly north of the Hudson Valley. The stories that I heard from patients of being misdiagnosed and still suffering was an eye opening experience, and although other Congressional leaders were invited, Congressman's Gibson's representative was the only one who attended.

Please support Congressman Gibson in his fight to help our country with Lyme and associated tick-borne diseases. There will be a fundraiser for him next Wednesday at the

Halpern residence, 550 Albany Post Road, New Paltz, N.Y. Come and meet the Congressman and find out why we need more people like him serving our country.

For more information, please contact Kate at 518‐742‐0044 or rsvp at  

Vermont Health Care bill passes: When medicine and politics collide
Commentary: Lyme health care comes back to Vermont. The Lyme bill protecting doctors just passed the Vermont Senate, after previously passing the House. Once it is signed into law by the Governor, the medical community will have the ability to choose to follow either of the recognized guidelines (such as ILADS guidelines), without the threat of disciplinary action by the medical boards. 

Lyme disease is highly endemic in Vermont. A recent study by the Vermont Dept of Health showed that 16% of the dogs in Vermont have Lyme disease, and many patients who are suffering and disabled have had to leave the state for treatment because of the adverse medico-political climate. This bill gives health care providers the ability to follow their best clinical judgment without fear of reprisal. Vermont joins other states such as Rhode Island, Connecticut, Massachusetts, New Hampshire, and California in passing legislation protecting physicians and supporting ILADS guidelines. 

This legislation is an excellent step forward, but it is not enough. If we want to stop the suffering of people with Lyme disease, and simultaneously lower our health care costs, we must stop being in denial. The scientific literature clearly shows that Lyme and co-infection testing is inadequate and that borrelia and some co-infections persist, making people ill. We want to be smart and compassionate when dealing with an epidemic in our midst that is harming the American people, and significantly increasing health care costs and disability. The Zhang study which was published in 2006 showed that it cost over $20,000 per person, per year to treat chronic Lyme (adjusted for inflation), while early diagnosis and treatment cost $1658 per patient for Lyme disease, if caught in the early stages. Lyme is a multisystemic illness, and if we were to properly educate patients about prevention, as well as the disease and its clinical manifestations, we could lower disability and health care costs. One way to accomplish this is within our health care system is broader use of the questionnaire that I have developed to screen patients for Lyme and associated diseases. If a patient were to fill out the questionnaire while waiting to see their health care provider, it would inform them if they suffer from a multisystemic illness, leading to proper testing and the establishment of a differential diagnosis. 

Vermont knew they had to take action, because the good people of Vermont were becoming disabled, and had to leave their state to get care. You can try and fix the health care system by making care “affordable”, but the Vermont politicians also had to fix “unhealthy” health care policies that were hurting people and driving up health care costs.

5/1/14  Supporters celebrate final vote on Lyme bill, Burlington Free Press

Commentary: The World Health Organization (WHO) recently had World Health Day, where they highlighted the serious and increasing threat of vector-borne diseases, with the slogan “Small bite, big threat”.  "More than half the world’s population is at risk from diseases such as malaria, dengue, leishmaniasis, Lyme disease, schistosomiasis, and yellow fever, carried by mosquitoes, flies, ticks, water snails and other vectors. Every year, more than one billion people are infected and more than one million die from vector-borne diseases".

We need to have a concerted effort on the part of our governments and health care authorities to tackle the emerging threat of these vector borne diseases. Vector-borne illness increases morbidity and mortality, while significantly increasing health care costs. A comprehensive approach to prevention and early detection is essential, and the MSIDS questionnaire in my book can help health care providers determine if the patient suffers from a multisystemic illness due to Lyme and associated tick-borne diseases, where earlier intervention can be beneficial.

4/2/14 World Health Day 2014: Preventing vector-borne diseases, World Health Organization Media centre

Commentary: Changes in the wildlife population have recently been found to increase the incidence of Bartonella infections. This is similar to prior research showing that a change in the types and numbers of predators in our environment can contribute to the increased incidence of Lyme disease. We must pay better attention to the (im)balance of our ecosystem if we hope to control the spread of Lyme and associated tick-borne infections.

4/29/14 Decrease In Large Wildlife Populations Drives Increase In Zoonotic Diseases, source:

1/11/14 Study questions link between increases in Lyme disease and deer, by Patrick Durkin, Wisconsin State Journal

Commentary: In order to gain a better understanding of the issues involved in Lyme infection and testing, the Allentown Family Health Examiner spoke with Dr. Philip M. Tierno, Jr., clinical professor of pathology and microbiology at NYU Langone Medical Center. The conversation is presented here.

4/22/14 'I saw firsthand the spirochetes': An exclusive interview with Dr. Philip Tierno, Theresa O'Brien,

Commentary: Who knew that "parasitic arachnids can and are surviving in the 49th state?" Just when you thought you could escape tick-borne infections by going to a colder climate

4/22/14 Dog ticks a growing concern in Alaska, The Associated Press

Commentary: I will be speaking at the upcoming Norwegian conference on Lyme and Associated Tick-borne diseases in Oslo, on May 26th-27th. Researchers, scientists and clinicians from across the world will be coming together to share the latest research on vector-borne diseases. Please see the link below for more information and to sign up for the conference:

4/18/14 Conference Website

Commentary: I had recently posted on the spread of Borrelia miyamotoi, the relapsing fever spirochete, across the US. It is now being found in Canada. In this study,B. miyamotoi was detected in blacklegged ticks from all provinces except Newfoundland, although the infection prevalence was low (<1%). B. miyamotoi infection can cause a viral-like illness, and imitate the symptoms of Lyme disease. It should be considered in patients with a Lyme-like illness that are seronegative on standard tests for Borrelia burgdorferi.Commentary: May is Lyme awareness month. I will be speaking about the role of tick-borne co-infections in Lyme disease at The Linda, WAMC's Performing Arts Studio, in Albany, N.Y. on Saturday, May 3rd. There will be a book signing after the event. My good friend and colleague Dr Ronald Stram is hosting the event, and he will have Dr Carsten Nicolaus come from Germany to discuss new integrative protocols for Lyme and associated tick-borne disorders. The event details are listed below. Please click on the link for more information and to register for the event (there are less than 75 seats left).

4/15/14  The prevalence of Borrelia miyamotoi infection, and co-infections with other Borrelia spp. in Ixodes scapularis ticks collected in Canada, Parasites & Vectors

DATE: Saturday, May 3, 2014

11:00am – 12:30pm Presentation & Roll-Out of NEW Protocols with Dr. Nicolaus and Dr. Stram
12:30 pm – 1:00pm Interactive Panel Discussion- Q&A Session with Stram Center staff

1:00 pm - 1:30pm Presentation "Why Can't I Get Better? The Role of Tick-Borne Co-infections and Inflammation in Lyme Disease" by Dr. Horowitz

1:30 pm – 2:00pm Refreshments, book signing, and mingling with the doctors and their teams.

LOCATION: The Linda: WAMC’s Performing Arts Studio, 339 Central Ave, Albany, NY 12206.
Please register online or call the Stram Center for Integrative Medicine, 518.689.2244.

Click here for more information

Commentary: The Poughkeepsie Journal, our local NY newspaper, just won the most awards in the NY News Publishers Association history..16!

This was in part due to Mary Beth Pfeiffer, an investigative news reporter, and her excellent coverage of Lyme and tick-borne diseases, as well as John Ferrro and other members of the Poughkeepsie Journal staff. Congratulations PoJo for helping uncover the hidden truths about Lyme disease and educating the public. 

4/10/14   Journal wins most awards in history of N.Y. industry group, Poughkeepsie Journal

4/3/14   This link outlines the broad range of topics covered on Lyme and tick-borne diseases by the Journal

Commentary: An article just appeared in the Huffington Post on the documented spread of Lyme disease across the US, Europe, Australia and Asia. Paul Mead, M.D, M.P.H., chief of epidemiology and surveillance for CDC's Lyme disease program is quoted as saying that "we know that routine surveillance only gives us part of the picture, and that the true number of illnesses is much greater. This new preliminary estimate confirms that Lyme disease is a tremendous public health problem in the United States...".

4/9/14  Lyme Disease Threat in Surprising Places, by Jonathan Galland, Huffpost

Commentary: Here on the New York state level, the politicians are on top of the ticks. Lee and I just met with Senator Terry Gipson and discussed with him the dangers of tick-borne diseases. He gets it. Here is a picture of the 3 of us together. He is working on getting more funding for tick-borne research among other projects to help Dutchess County.

Congressman Chris Gibson, Senator Kirsten Gillibrand, Senator Chuck Schumer, Senator Terry Gipson (state) and Assemblywoman Didi Barrett (state) with the Governor are now among the growing numbers of politicians letting New Yorkers know about the dangers of Lyme and associated tick-borne diseases. Congratulations to our politicians that have heard the cries of the people suffering from Lyme and associated tick-borne illness.

Also in the news, Governor Andrew Cuomo has a few things to say to the ticks.

4/9/14  Cuomo to ticks: Drop dead*, by Steve Orr, Democrat  Chronicle 

Commentary: Borrelia miyamotoi, a relapsing fever spirochete, has been discovered in the spinal fluid of an 80 year old New Jersey woman who was ill. This is the third "official" case of B. miyamotoi reported in the US. Researchers in this article estimate that 12 to 18 percent of coastal New Englanders have been infected with the Lyme bacteria, Borrelia burgdorferi, and between 1 and 3 percent of people have likely been infected with its lesser-known cousin, B. miyamotoi. We do not have widely available commercial methods to diagnose this relapsing fever spirochete. Dr Sam Telford is quoted in the article as saying "This latest research suggests that those who have symptoms of Lyme disease, but whose blood doesn't test positive for Lyme, may actually be infected with B. miyamotoi". I agree with Dr Telford. This infection could explain the negative blood tests seen among those with a Lyme-like illness who respond to antibiotics, apart from the poor sensitivity of the two tiered testing presently being used to diagnose Lyme disease. Further research is required to determine if B. miyamotoi can cause the same borrelia specific bands on a Western blot that we see with Lyme disease.

4/6/14   Scientists discover unnamed disease carried by deer ticks, by Thomas Leskin,

1/17/13 Human Borrelia miyamotoi Infection in the United States, The New England Journal of Medicine

1/17/13 Meningoencephalitis from Borrelia miyamotoi in an Immunocompromised Patient, The New England Journal of Medicine

Commentary: This article was just released in Vector-Borne and Zoonotic Diseases, describing the rates of infection for Lyme and associated co-infections in Dutchess and Putnam Counties, N.Y. The rates of infection for Lyme disease in Ixodes scapularis ticks were 55%, followed by A. phagocytophilum (18.2%), Deer Tick Virus (DTV, 3.4%), Babesia microti (3.2%), and E. chaffeensis (1.5%). Infection with two pathogens occurred in 13.3% of ticks, and 10 ticks were infected with three combinations of three pathogens.

I am pleased to see that research is being done to evaluate ticks for associated co-infections, but the authors did not test for either Borrelia miyamotoi, the relapsing fever spirochete which is a new spreading borrelia species, or Babesia WA-1, a common Babesia species seen in my patients. Borrelia miyamotoi has been found in prior published scientific studies to be in 10-20 % of ticks in the Northeast. This organism causes a Lyme-like illness and will not be picked up on standard testing, explaining why certain patients may present with a clinical picture of Lyme disease with negative tests, yet respond positively to antibiotics.

Regarding Babesia duncani,  I presented at an international Lyme conference in Toronto in 2011 on Babesia, and reported that LabCorp titers for Babesia duncani were positive in 19% of my patients who were coming from different parts of the northeast (Winter Park, Florida all the way up to Maine). This parasitic infection should be included in future studies. Also, the rates of Babesia microti infection reported in this article are significantly lower than the rate of infection found recently in Dutchess County, N.Y. by one of the authors of the article, Dr Rick Ostfeld. When I first reported Babesia to the NY State Health Department back in the late 1990's, the ticks from the Cary Institute had an infection rate of several percent. Recent conversations with Dr Ostfeld confirmed that he found up to a 41% rate of co-infection with Babesia in Ixodes scapularis ticks in Millbrook, N.Y. This is very different than the 3.2% rate reported in this article, which could be misleading (see the figures on Babesia on pages 140-141 of my book). This large variation could be due to several factors including the rates of co-infection in Putnam County, as well as an inadequate sampling size across different regions of the counties. 

4/1/14  The Prevalence of Zoonotic Tick-Borne Pathogens in Ixodes Scapularis Collected in the Hudson Valley, New York State, Vector-Borne & Zoonotic Diseases

Commentary: A new Lyme test to detect early disease, called SpiroFind, is being evaluated by researchers at Columbia University. Present antibody testing misses approximately half of the patients with an early infection, when the disease is potentially curable. The test relies on the presence of inflammatory molecules called cytokines, which are produced during the infection. These cytokines are responsible for many of the clinical manifestations of Lyme disease, and are discussed in detail in my book in chapter seven, Lyme and Inflammation (pages 185-201).

4/3/14  New Lyme Test Gets Study, by Karl Rabe, Poughkeepsie Journal 

Commentary: A study of over 3,000 patients with chronic Lyme disease was just published in an open access medical journal on March 27th. It was a joint effort of and Prof. Jennifer Mankoff at Carnegie Mellon University. The survey used standard questions developed by the Centers for Disease Control and Prevention (CDC) and found that compared to the general population, patients with chronic Lyme disease have high disability and unemployment rates. Lyme disease is highly endemic in NY, and the most recent figures on the NY State Health Dept web site is that 22.4% of New Yorkers are currently disabled (2010 figures). How many of those who are disabled in NY are due to undiagnosed and untreated Lyme disease? I will discuss this issue tomorrow as well as the politics of Lyme disease on WAMC public radio with Alan Chartok at 1 pm.

4/2/14  LDO Publishes Largest Study of Chronic Lyme Disease Ever Conducted; Patients Suffer Poor Quality of Life & High Rates of Disability and Unemployment, PRWEB

4/3/14  WAMC's Alan Chartock in Conversation with Dr. Richard Horowitz on Lyme Disease, WAMC Public Radio

Commentary: Babesia species are spreading worldwide and B. microti has now been discovered in France and in Australia. Babesia is responsible for increased severity of illness in many of the Lyme patients who come to my office. I discuss Babesia in detail in Chapter five of my book, Lyme and other Co-infections, pages 134-154.

3/27/14   Identification of Parasitic Communities within European Ticks Using Next-Generation Sequencing, PLOS

3/24/14  Molecular confirmation of the first autochthonous case of human babesiosis in Australia using a novel primer set for the beta-tubulin gene, Paparini A, et al,

Commentary: This article discuss new cases of the Heartland virus being found in different parts of the US. This is a viral infection spread by the Lone Star Tick, which causes an illness nearly identical to Ehrlichiosis, but which is unresponsive to antibiotics.

3/27/14    CDC finds more cases of Heartland virus, by Truman Lewis, Consumer Affairs

Commentary: Dr Brian Fallon from Columbia University presented new research last night that shows that the Lyme spirochete can persist after antibiotic therapies. This research joins numerous published peer review scientific articles that support persistence ofBorrelia burgdorferi in patients with ongoing symptoms despite seemingly "adequate" antibiotic therapy. A list of scientific references on the unreliability of blood tests for Lyme, as well as studies on persistence can be found in the reference section of my book, pgs 487-514.

3/27/14  Antibiotics don't always kill Lyme, studies say, by John Ferro, Poughkeepsie Journal

Commentary: The Washington State Department of Health is conducting a study looking at the range and distribution of tick species in the state and the potential disease risks they pose. This is an excellent initiative which should be done on a regular basis throughout the United States by health departments to track the spread of emerging tick-borne diseases. When such studies were done in NY and Vermont in the past few years,  it showed a rapid rise in the incidence of not only Lyme disease, but associated tick-borne diseases, such as Anaplasma, Babesia, the relapsing fever borrelia, Borrelia miyamotoi, and the Powassan virus.

3/25/14  Tick tally time: send ticks for identification to help track disease risk in state, Washington State Department of Health

Commentary: This article was just published in Macleans, and gives an in depth view on how the Lyme epidemic is affecting the Canadian people and their health care providers. I am also interviewed in this article. It discuss my views on how Lyme is symptomatic of an even deeper medical crisis: the inability for us to deal with chronic diseases which account for 70 per cent of our deaths, and the lion’s share of our health care costs.  I will be discussing this problem further on WAMC public radio next Thursday at 1 p.m. with Alan Chartok during an interview on "In Conversation"

3/24/14  The Truth About Lyme Disease, by Anne Kingston, Macleans

Commentary: The article that appeared in today's Poughkeepsie Journal reported that ticks appear to have no negative impact on the health or life span of mice, underscoring the need to find other ways to control the animal population that spreads Lyme and other tick-borne diseases. Although the article reported that ticks are not born with Borrelia burgdorferi, the agent responsible for Lyme disease, and must pick up the disease from their hosts, that is not the case for another Lyme-like illness that is rapidly spreading across the United States: Relapsing fever, due to Borrelia miyamotoi. This is a new emerging borrelia species, and is the first borrelia species to be transmitted transovarially, meaning it can be passed on directly from the mother tick to the larvae, without requiring the tick feed on a blood meal from a host, such as a mouse. The researchers at the Cary Institute did not check the ticks for this borrelia species, but it has already been found in Dutchess County based on a study performed by Tokarz in 2009, and was recently discovered to have spread across the United States, as far west as San Francisco. We need to do more research into this new emerging borrelia species, as we do not have reliable blood tests to detect it, and it can cause a Lyme-like illness with or without EM rashes with associated inflammation in the heart and brain (myocarditis, meningoencephalitis), and can even lead to strokes, bleeding disorders, and fetal death with premature abortion. I discuss Borrelia miyamotoi and other tick-borne co-infections in my recently released book from St Martin's press: "Why Can't I Get Better? Solving the Mystery of Lyme and Chronic Disease". The rising rate of co-infections such as B. miyamotoi, Babesiosis and the Powassan virus in Dutchess County is alarming. We should be examining the ticks now for this new emerging borrelia species as well as other tick-borne co-infections, and educate our health professionals on the protean manifestations of these illnesses, before more individuals have to suffer the disabling consequences of undiagnosed and untreated tick-borne illness.

3/23/14   Ticks don't harm mice, study finds, meaning Lyme threat is not decreasedby John Ferro, Poughkeepsie Journal

Commentary: Washington State University (WSU) veterinary college sent out an alert today, reminding people of an uncommon and potentially fatal threat from ticks that is usually overlooked: Tick paralysis. The illness occurs when certain species of ticks inject potent toxins from their salivary glands into the host, producing a rapidly progressing total paralysis that can lead to death. Removing the offending tick and providing supportive care can be curative. More than 60 species of ticks worldwide have been identified as toxin producers. I discuss Tick paralysis in my book under Chapter 4: Lyme and Common Tick-Borne Bacterial Infections.

3/19/14  WSU Veterinary College warns animal owners of tick paralysis, WSU News

5/18/12  'Tick paralysis' strikes girl, 2, by Shantal Parris Riley, Poughkeepsie Journal

Commentary: This article on Tick Paralysis was just published in the medical journal Neurology. It describes the clinical manifestations in detail, and differential diagnoses to consider, such as Guillain-Barre syndrome.

3/18/14   Child Neurology: Tick paralysis - A diagnosis not to miss, Neurology

Commentary: Patients with clinical Lyme disease may not all be infected by the Lyme disease spirochete Borrelia burgdorferi, but in fact by other related bacteria, such as Borrelia miyamotoi and a new, as yet unnamed spirochete according to a paper just published this month in the International Journal of Molecular Sciences. 

This could explain why some patients present with the clinical symptoms of Lyme disease, but fail to test positively on standard two-tiered testing and why they remain ill. Expanded research on the role of these diverse bacteria and associated tick-borne pathogens (such as Babesia, Bartonella and Mycoplasma species) are essential to further our understanding of how we can help those afflicted with Lyme-MSIDS.

3/11/2014  Detection of Borreliae in Archived Sera from Patients with Clinically Suspect Lyme Disease, Int. J. Mol. Sci.

Commentary: The Vermont legislature just passed Lyme bill H123, which acknowledges the severity of chronic Lyme disease, the role of co-infections in chronic illness, and the need for individualized treatment according to ILADS guidelines. The bill also contains language that protects health care practitioners from disciplinary action from the Vermont board of medical practice for diagnosing and treating tick-borne diseases according to ILADS guidelines, allowing practitioners to treat according to their best clinical judgement. This is a huge political step forward, and Vermont now joins a growing number of other states who have passed doctor protection laws. The passage of this bill is in accordance with a recent CDC study showing that over 50% of physicians in the United States diagnose and treat Lyme disease according to ILADS guidelines, not IDSA guidelines.

Lyme disease is increasingly widespread in Vermont and has become endemic in the State, contributing to rising health care costs and disability. I have personally seen many Vermonters who had to leave their state to get treated for tick-borne infections because of their physicians fear of reprisal from medical boards. I testified in front of the Vermont Senate and House last year on this bill, and presented the science behind the diagnosis and treatment of Lyme and associated tick-borne infections . I applaud the Vermont legislature for taking the time to understand the science behind the illness, and helping patients get the care that they so desperately need. The bill unanimously passed 140 to 0.  

3/11/2014  H.123 An act relating to Lyme disease and other tick-borne illnesses, VT State Legislature

Commentary: Patients with Lyme disease with chronic, resistant neurological symptoms, including encephalopathy and neuropathy, should be tested for Bartonella. These intracellular bacteria can be one of the persistent bacterial co-infections seen in Lyme-MSIDS patients. This article discusses 2 pathogenic species of Bartonella not previously reported, and the role of birds as a vector in spreading the illness. There are 30 Bartonella species/subspecies and 17 have been associated with human infections. This article highlights the role of migratory birds as a reservoir and/or mechanical vector for spreading many different infections (borrelia, anaplasma, bartonella, rickettsia, and tick-borne encephalitis virus) worldwide, and the fact that many of these species/strains are pathogenic (and not easily detected on standard commercial laboratory testing!). Future research needs to be done on Lyme-MSIDS patients to determine all of the different bacteria, viruses and parasites contributing to ongoing illness.

3/1/2014  Bartonella henselae and B. koehlerae DNA in Birds, CDC

Commentary: Scientific reports are emerging that new mechanisms for food allergies related to tick-bites have appeared in hundreds of adults across the US. The bite from the lone star tick can cause a rare allergy to eating beef and dairy, leading to delayed allergic reactions. This is called an Alpha-Gal allergy. Symptoms range from hives to full blown anaphylaxis, and highlight the need to practice proper tick-prevention strategies, as well as considering tick-bites in the differential diagnosis in patients with unexplained severe allergic reactions . I discuss this allergy in my book on page 395, in the chapter on Lyme and gastrointestinal health, and the role of food allergies and resistant Lyme symptoms are discussed in chapter 15 of my book, Lyme and allergies.

2/28/2014  Tick bites could lead to severe food allergies, by Ian Reitz, WMSM

Commentary: I have been finding high burdens of heavy metals such as mercury and lead in my Lyme-MSIDS patients for years. These heavy metals may contribute to ongoing symptoms, and detoxification can be effective in relieving resistant symptoms in certain individuals . Although larger fish such as tuna and swordfish are known to contain higher levels of mercury, the Maine Department of Marine Resources just reported high levels in Maine lobsters, leading to closure of the harvesting site for several years.

Lyme disease patients with chronic persistent symptoms despite antibiotics should be checked for heavy metal burdens as well as other environmental toxins. The role of heavy metals in Lyme disease is discussed in pages 198-200 in my book, as well as in chapter 8, Lyme and environmental toxins.

2/27/2014  Mercury contamination in Penobscot River lobsters known for 8 yrs, by Scott Dolan/Tom Bell, Portland Press Harold

Commentary: A novel method to control the spread of Lyme disease is being developed. Using a bait vaccine in mice, after one year, there was a drop in Lyme in the nymphal ticks by 23%, and after five years, the presence of Lyme dropped by 75%. I look forward to local and state health departments implementing this and other integrated strategies (such as tick-killing  fungi) in highly endemic areas.

2/25/2014  The Global Search For Education: Ticks - Breaking the Transmission Cycle of Lyme Disease, by C.M. Rubin, Huff Post

Commentary: The tick-borne relapsing fever bacteria, Borrelia miyamotoi, which causes a Lyme-like illness, has now been proven to have spread across the United States. Previous studies showed B. miyamotoi present in ticks in the Northeast, and now it is being found in California. Medical researchers in the San Franscisco area recently found that ticks were infected with both Borrelia burgdorferi and Borrelia miyamotoi in nearly every park they examined. The findings raise the question of whether B. miyamotoi has gone undetected in California residents, and whether a significant proportion of people who test negative for Lyme disease, have acquired a different borrelia spirochete, accounting for their Lyme-like illness. I discuss B. miyamotoi and its clinical manifestations on pages 124-126 of my book. A commercially available blood test to diagnose B. miyamotoi was just recently released, and needs to be validated in clinical practice:.

2/18/2014    Stanford study says ticks may cause double trouble, by Rob Jordan, Stanford News

2/15/2014    Lyme Bacteria & Borrelia Miyamotoi Can Be Reliably Diagnosed by DNA Sequencing, Milford Hospital Pathologist Announced

Commentary: The Cooper hawk in Ontario, Canada is the first raptor to join the ranks of birds (like songbirds) involved in the spread of Lyme disease. Researchers believe that the hawk is a reservoir host for the bacteria, as they found larvae infected with Borrelia burgdorferi on the hawk. They also identified 5 species of ticks on Vancouver Island able to transmit Lyme disease, with a higher infection rate than previously suspected. This information helps put in perspective the rising numbers of Lyme cases seen in Canada.

2/9/2014    Vancouver Island hawk is first to be found with ticks carrying Lyme bug, by Amy Smart, The Vancouver Sun

Commentary: A collaborative effort of an international team of scientists, researchers and clinicians have found evidence of Borrelia burgdorferi in semen samples and vaginal secretions from patients with Lyme disease. Considering the spirochetal nature of the bacteria, further research needs to be quickly performed by the scientific community to elucidate the actual risk of transmission, especially in light of the expanding number of new cases of Lyme disease in the United States.

1/25/2014    Lyme Disease May Be Sexually Transmitted, Study Suggests, PRweb

Commentary: Canadian politicians are frequently hearing from Southern Canadian patients about their struggles with Lyme disease. This disease can only be cured at the early stages, and otherwise can go on to cause chronic incapacitating symptoms. I agree with the need for countries to develop a national strategy to diagnose and treat tick-borne illness. Tick-borne diseases are rapidly spreading worldwide, mimic other illnesses, and can result in disability and increase health care costs. I have patients who have had to travel from Canada to see me, because they were unable to get help in their own country for their disabling symptoms.

Elizabeth May (Green): Bill to create a national Lyme disease strategy (C-442), (Scroll to #3) by Andrea Hill, Edmonton Journal

Commentary: A new commercially available PCR test is now available for Lyme disease and Borrelia miyamotoi. If clinically validated, this would be an important step forward in testing, as we have not had reliable tests for both organisms. Borrelia miyamotoi can cause a Lyme-like illness, and 10-20% of the ticks in the northeast may contain this organism.
Ticks are able to transmit Borrelia miyamotoi transovarially (directly from the mother to the eggs) so the larvae can be infected without the ticks feeding on a blood meal. This increases the probability of widespread infection in the population. No commercially available blood test has been available to date for Borrelia miyamotoi. Tick-borne relapsing fever with Borrelia hermsii and B. miyamotoi, and their clinical presentations are discussed in my book on pages 124-126.

1/15/2014    LymeDisease Bacteria and Borrelia Miyamotoi Can Be Reliably Diagnosed byDNA Sequencing, Milford Hospital Pathologist Announced, Business Wire

Commentary: This controversial article just published in describes the similarities of the Lyme epidemic to the AIDS epidemic, and encourages governments across the world to come together so that history doesn't repeat itself.

1/14/2014   From AIDS to Lyme: Will We Let History Repeat Itself?, by Jessica Bernstein, Truthout

Commentary: Lyme disease can cause neurological presentations that mimic ALS. There are a small percentage of cases of ALS linked to a Lyme infection that can be helped with antibiotics. I discuss this in chapter twelve of my book, Lyme and the Brain.

1/7/2014   Lyme Disease –Induced Polyradiculopathy Mimicking Amyotrophic Lateral Sclerosis, by Ahmet Z. Burakgazi, MD, International Journal of Neuroscience

Commentary: This is also my experience, that so many individuals suffer for long periods of time with an "undiagnosed" case of Lyme. We need better medical education for health care practitioners so that they understand the protean manifestations of Lyme and associated tick-borne diseases.

1/11/2014    Overcoming Agony of 14 Years of an Undetected Disease and Seeking Her Moment, New York Times

Commentary: I have had patients travel to see me from Australia for Lyme disease, because they were unable to get properly diagnosed and treated in their own country. More and more international communities are finally recognizing that this is a worldwide epidemic. Australia is taking steps to form a national clinical advisory group to address this growing problem.

1/7/2014   Tweed Lyme disease sufferers closer to recognition, by Alina Rylko, My Daily News. Australia

Commentary: I did an interview in Public Health Alert which discusses some of the broad issues regarding Lyme, co-infections and chronic illness.

1/2014    Why Can't I Get Better? Solving the Mystery of Lyme and Chronic Disease, Public Health Alert

OR,, Wild Condor's World

Commentary: Worldwide epidemic alert: Lyme disease increased 1000% in Scotland over the past decade.

1/6/14   Scientists and doctors unite to defeat tick bite disease, Herald Scotland

Commentary: Tick-borne co-infections play an important role in keeping patients chronically ill with Lyme-MSIDS. Bartonella, or "cat scratch" disease, is one of the co-infections responsible for resistant neurological symptoms. Bartonella is described in detail in chapter four of my book "Why Can't I Get Better? Solving the Mystery of Lyme and Chronic Disease", under Lyme and Common Tick-Borne Bacterial Infections.

12/05/13    Bartonella is Everywhere, So Why Don’t We Know More About It?, by Stephanie Soucheray, North Carolina Health News

Commentary:  Three recent deaths from cardiac complications have highlighted Lyme disease as a potentially fatal illness, but it should be noted that patients may also die from neurological complications of Lyme disease such as a meningoencephalitis (an infection or inflammation of the meninges, and encephalitis, which is an infection or inflammation of the brain), as well as psychiatric manifestations (see the Poughkeepsie Journal article below). Other tick-borne infections however are also claiming lives, and are not as well known or reported. According to a recent study by the Massachusetts Department of Public Health, more people died from tick-borne co-infections in Massachusetts last year than Lyme disease. Babesiosis claimed the lives of five people in Massachusetts, and four individuals died of Anaplasmosis in 2012. Individuals who present with a severe febrile, flu-like illness in Lyme endemic areas should therefore be promptly evaluated by their health care provider. Details regarding the diagnosis and appropriate treatment of these potentially life threatening tick-borne co-infections are found in my book "Why Can't I Get Better? Solving the Mystery of Lyme and Chronic Disease", in chapter four: Lyme and Common Tick-Borne Bacterial Infections, and chapter five: Lyme and other Co-infections: Parasitic, Viral and Fungal Infections Neurological complications of Lyme disease can be found in chapter twelve, Lyme and the Brain.

12/22/13    Tick bite can be deadly, by Cynthia McCormick, Cape Cod Times

12/22/13    Death data show no links to Lyme disease, by Mary Beth Pfeiffer, Poughkeepsie Journal

12/23/13    Warning issues after Beacon father is 1 of 3 killed by Lyme disease heart condition, by Mary Beth Pfeiffer, Poughkeepsie Journal

Commentary:  Three deaths were recently reported from heart inflammation due to Lyme disease. Fatal Lyme carditis is rare, but recent case reports outline the need to heighten screening and treatment for tick-borne infections, especially in patients with new and acute cardiac symptoms. I have only seen a handful of cases with 3rd degree heart block during the last 26 years, and they all favorably responded to antibiotic therapy, avoiding the need for a permanent pacemaker.

Three Sudden Cardiac Deaths Associated with Lyme Carditis — United States, November 2012–July 2013

MMWR Weekly, December 13, 2013 / 62(49);993-996

Synopsis: Symptomatic infection of the heart is rare in recognized Lyme disease cases and usually resolves promptly with appropriate antibiotic therapy. Nonetheless, cardiac involvement occasionally can cause life-threatening cardiac conduction abnormalities. During November 2012–July 2013, one woman and two men (ranging in age from 26 to 38 years) from high-incidence Lyme disease states experienced sudden cardiac death and, on postmortem examination, were found to have evidence of Lyme carditis. Donated corneas from two decedents had been transplanted to three recipients before the diagnosis of Lyme disease was established, but no evidence of disease transmission was found. Although death from Lyme carditis is rare, it should be considered in cases of sudden cardiac death in patients from high-incidence Lyme disease regions.

What are the implications for public health practice?

Pathologists and medical examiners should be aware that Lyme carditis can be a cause of sudden cardiac death. All suspected cases of fatal Lyme carditis should be reported to state or local public health authorities, and the cases should be investigated. Physicians and health-care providers should ask patients with suspected Lyme disease about cardiac symptoms, and conversely, ask patients with acute, unexplained cardiac symptoms about possible tick exposure and symptoms of Lyme disease. Clinicians should encourage all patients to practice recommended tick bite prevention strategies.

12/12/13    Three die suddenly from rare Lyme disease complication, by Maggie Fox, NBCNEWS

12/13/13    3 heart cases, deaths tied to Lyme disease, By Beth Daley, The Boston Globe

Third Degree Heart Block
  Picture & Description - Courtesy of CDC, Center for Disease Control