ILADS 2013 - San Diego Conference Takeaways

This blog entry summarizes some of the notes I took at the ILADS conference in San Diego in October 2013. As there were many concurrent sessions, the below does not reflect the overall nature of the ILADS event, but rather the specific interest in topics that most resonated with me. Thus, this may be a more integrative or alternative view of the event than others may have experienced. It was a superb weekend with many great practitioners and healers to learn from. It was my 8th ILADS conference! The full event or individual sessions are available for purchase as videos or DVDs at the ILADS site at http://www.ilads.org.  The CD with all of the provided conference presentation slides is also available here and is an excellent resource.

The event was held at Paradise Point in San Diego.  I have to say that I really enjoyed spending the time in San Diego.  The weather was great.  After so many of these events, it was almost like a family reunion.  I attended several of the lectures, but I also skipped several in order to be able network with people and learn more about the exhibitors, etc. that were present.  I often find some of the most interesting things I learn come from conversations had in the hallway.  While I don't know the official count of attendees, I can say the event was quite large and it is always exciting to see the growth of interest in Lyme over time.  When I first started going to the event eight years ago, it didn't seem nearly as big as it is today.  People are starting to listen.  Many great doctors and healers are working hard to bring us new solutions and better treatment options.  

Disclaimer: Nothing in this text is intended to serve as medical advice. All medical decisions should be made only with the guidance of your own personal licensed medical authority.

Disclaimer: This information was taken as notes during the conference and may not represent the exact statements of the speakers. Errors and/or omissions may be present.

Note: As this information may be updated as any errors are found, I kindly request that you link to this single source of information rather than copying the content below. If any updates or corrections are made, this will help to ensure that anyone reading this is getting the most current and accurate information. 

I had been looking forward to reading Dr. Horowitz' new book "Why Can't I Get Better?: Solving the Mystery of Lyme and Chronic Disease".  I'm just starting into it, but it looks like it is going to be a treasure for those of us recovering from Lyme.  I'm very grateful for this new source of information from one of the top doctors in the field.

 Samuel M. Shor MD spoke on "Hyperbaric Oxygen Therapy in the Management of Lyme Disease".

• There are soft shell and hard shell units available, but soft shell units cannot go to the depths of the hard shell units. 
• 1 ATA is sea level. 3 ATA is 66 feet below sea level; a hard shell unit can go to this level where soft shell units can only go to about 1.3 ATA. 
• HBOT therapy can provide the body with 22 times more oxygen.
• Stimulates over 5,000 genes. Increases growth factors, reduces swelling, promotes the growth of neural pathways, activates sleeping neurons, increases ATP, and downregulates inflammation. 
• Dormant mitochondria produce 2 ATP; whereas after HBOT, 36 ATP may be produced.
• VEGF increases which is associated with improved blood flow.
• Stem cells may be stimulated.
• HBOT may have an antimicrobial impact being both bacteriostatic and in some cases bacteriocidal for anaerobic infections and even some aerobic. HBOT may create a toxic environment for Borrelia.
• Interleukins, TNF-alpha, and others improve.
• If one has a genetic predisposition to biotoxin-associated illness, HBOT may improve outcomes. 
• 1.5-2.0 ATA may support detoxification. 2.4 ATA may have antimicrobial effects and support reducing inflammation. 
• HBOT may help minimize Herxheimer reactions.

Amiram Katz MD spoke on "IVIG Treatment for Autoimmune Issues in Lyme Disease".

• He believes that chronic Lyme is an autoimmune disease.
• IVIG is not indicated for Lyme disease itself though can be beneficial for people with Lyme.
• May be the only safe immune-modulating treatment in the presence of infection.
• Has worked with 5,000 patients with Lyme disease; though IVIG is given for complications of Lyme and not for Lyme itself.
• IVIG is a blood product.
• IVIG contains IgG and small amounts of IgA.
• Over 10,000 donors are pooled in one batch of IVIG.
• 200 grams per month is generally needed.
• One unit of blood is 2.5 grams of IgG.
• Prolonged antibiotic treatment can suppress immunoglobulin production due to the impact on gastrointestinal flora.
• Buzzing sensations often experienced in people with Lyme may be related to the ganglia.
• IVIG cay help some with heart issues when the issue is related to ANS (autonomic nervous system) dysregulation. 

Dan Kinderlehrer MD spoke on "Endocrine Disorders in Lyme Disease Complex".

• He explores many other issues beyond Lyme proper. He looks at endocrine issues, food sensitivities, neurotoxins, methylation, biofilms, coagulation issues, GI problems, and other microbial infestations.
• His general strategy is to build a foundation, suppress infections, and maintain homeostasis.
• Numerous endocrine abnormalities are often present including low T3, elevated reverse T3, low testosterone, low growth hormone, increased cytokines, elevated cortisol, low DHEA, and others.
• The hypothalamus and pituitary are involved in several endocrine issues. The hypothalamus may be involved in low VIP where the pituitary may be involved in lowering of several key items such as ADH, growth hormone, TSH, ACTH, MSH, and others.
• When looking at adrenals, acute stress may lead to elevated cortisol where prolonged stress leads to decreased cortisol and DHEA.
• Fatigue, malaise, depression, salt cravings, and immune suppression can be the result of adrenal imbalance.
• Adrenals can be treated with salt, electrolytes, low dose hydrocortisone, DHEA, pregnenolone, glandular products, nutrients, and herbs.
• Can be many types of hypothyroidisms. Can be autoimmune. Some have lower conversion of T4 to T3, elevated reverse T3, or adrenal insufficiency. It is always best to fix the adrenals first. Uses T3 with some T4 to support the thyroid.
• Hypothyroid symptoms can be intolerance to cold, weight gain, dry skin, not being able to sweat, constipation, immune suppression, and low body temperature.
• Has found that 1/3 of his patients have diabetes insipidus which is related to excessive thirst and excretion of diluted urine. The kidneys are unable to conserve water. Can be related to low ADH. The pituitary produces ADH, Oxytocin, and MSH.
• When we drink caffeine, this tells the body not to release ADH; alcohol does the same. In some cases, desmopressin may be used to increase ADH and allow the body to conserve fluids. Pituitary support such as glandulars or Pituitrophin from Standard Process may be helpful.
• Testosterone deficiency is very common in Lyme. Low T may be associated with decreased bone density, decreased muscle mass, increased body fat, growth of breasts in males, anemia, and general frailty.

 Benjamin Asher MD spoke on "Ear, Nose, and Throat Manifestations of Lyme Disease".

•  Sudden deafness can be related to Borrelia in some patients. Could also be viral or vascular.
• Tinnitus has been associated with Lyme disease.
• Many symptoms related to balance, hearing, and ringing in the ears can be related to Borrelia.

Andreas M Kogelnik MD spoke on "Clinical Research Networks: A Needed Paradigm for Understanding Chronic Diseases".

• Works with patients with CFS/ME, Lyme, and autism.
• Worked at Stanford and later founded Open Medicine Institute.
• Clearly something is going on here that mainstream medicine has left behind.
• He uses Information Technology, Social Technology, and Biotechnology to create a Health Revolution.
• Uses social networking to engage with patients on a large scale.
• Created OpenMedNet to bring together physicians, patients, diagnostic companies, drug manufacturers, and others. 
• They have done this work previously in CFS/ME and now are doing it with Lyme and autism. 
• Collect data on practices, patients, treatments, etc.
• Numerous projects underway: HLA gene study, outcome studies, Lyme and CFS study, gene expression study, protein study, and others. 

Neil Nathan MD spoke on "Evaluation and Treatment of Viral Infections, Parasites, and Chlamydia Pneumoniae".

• Dr. Nathan is a practitioner that I highly respect as a healer. If you have not read his books, take a look at them here. 
• His lecture was thought provoking and an entirely different way of looking at infections than what many people currently consider. Rather than killing microbes, it is about bioreconstitution. It is a full 180 degree shift from what has been done to date.
• Some infectious disease doctors suggest that there are no chronic viral infections, yet EBV, CMV, or HHV-6 can be recurrent events.
• The lungworm as identified by Dr. Klapow (Varestrongylus Klapowi) may play a role in people with Multiple Chemical Sensitivity (MCS).
• Testing for various infections can be done today, but there is variation in how the results are interpreted. A positive result may not indicate if the infection is old, active, or chronic.
• False negative results can occur due to a weakened immune system, and testing is not available for all species of a specific type of organism.
• Pathogens such as EBV may activate endogenous human retroviruses (HERVs).
• A number of different viral infections may be relevant such as herpes, enteroviruses, Parvovirus B19, attenuated measles, Coxsackie, and various retroviruses.
• We will likely not find one agent that explains CFS/ME. It will not be that simple.
• With HHV-6, 82% of people with Hashimoto's have evidence of exposure to the virus.
• Numerous enteroviruses are known such as polio virus, Coxsackie A and B, echovirus. Enteroviruses can be related to ulcerations of the mouth. Treatment options may include IVIG, interferon, ProBoost, ImmunoPro, Immunovir, and Equilibrant.
• Acyclorir, Valtrex, Famvir, and Valcyte may be used. Have relatively few side effects. 15% of people do really well with these and a trial may be indicated.
• Other options may include transfer factors, GcMAF, frequency-specific microcurrent, artesunate, Byron White A-V, and monolaurin. GcMAF is an exciting new option in the toolbox.
• Nagalase cleaves Gc protein off of the surface of a monocyte. Vitamin D connects to Gc protein and transforms monocytes into macrophages.
• GcMAF revolutionized the treatment of chronic fatigue when caused by viral illness. Dr. Kenny de Meirleir reports a 60-70% success with GcMAF. Dr. Nathan has noted 30-40% of his patients improve with GcMAF.
• Microbes such as viruses and some bacteria increasing nagalase are an attempt by the organisms to bypass the immune system.
• Found that dosing of GcMAF in people with Lyme often has to be very low and slowly working up. A dose is ideally given that is below the amount that the person reacts to with any symptoms. We don't want to engage an over-active immune system. Treatment is often 15-40 weeks. Editor note: This treatment can be very difficult if not done correctly and should never be done without a doctor.
• With GcMAF, generally monitor D 25 and D 1,25, calcium, calcitriol, nagalase, and CD57. Dr. Bradstreet has found that low CD57 often responds well to treatment). CD57 may represent other issues beyond just Borrelia; such as viruses. While bad in Lyme, it may be a good marker for GcMAF potential benefit. Nagalase is checked every 3-4 months. Once nagalase has come back to the normal range, GcMAF therapy is generally stopped and no longer needed.
• There are injectable versions of GcMAF, two probiotic versions MAF878 and MAF314, as well as homeopathic options. In some, both the injectable and oral versions may be used.
• Chlamydia pneumoniae (CPn) has been associated with atherosclerosis. A CPn herxheimer response can last for days and may be related to secondary porphyria. Porphyrin may be the main toxin that the body is reacting to. 
• Consider CPn with prolonged herxes with nausea, vomiting, anxiety, or depression. May also be associated with atypical MS.
• CPn may play a role in pneumonia, encephalitis, arthritis, mycoarditis, Guillain-Barre, coronary artery disease, and MS.
• Has been found in ticks, but transmission from a tick has not been confirmed.
• http://www.cpnhelp.org has more information on treatment options.
• Varestrongylus klapowi is known as lungworm and appears to be a roundworm. It is a pulmonary roundworm of less than 1 millimeter in size. It can also live in the sinuses.
• While not commercially available yet, there may be a test for this in the future. In research, the organism can be looked for under a microscope after a sinus wash.
• The organism may make acetylcholinesterase and may play a role in MCS. The worm may become agitated and create a poison in the system. In a group of 100 with MCS, 94% were positive for the organism.
• We are a complex ecosystem called a biome. Many organisms are involved in making the immune system stronger and more tolerant. Lactobacillus, Bifidobacteria, E. coli, H. Pylori, and Mycobacterium tuberculosis may be beneficial in keeping the immune system optimally functioning.
• The same can be argued of parasites such as malaria, certain types of hookworms, rat tapeworm, certain types of roundworms, and pork whipworm. Viruses such as EBV and Hepatitis A may also be have roles in immune tolerance.
• When you have a relationship with some of these microbes, the result may be a better immune system.
• Mentioned the book "An Epidemic of Absence" by Moises Velasquez-Manoff where he states "The immune system that finds itself without microbial pressure grows jumpy (allergies) and turns against the self (autoimmunity)."
• Probiotics and transfer factors can be helpful in supporting the reconstitution of the immune system. Fecal transplantation and specific Low-Dose Antigen therapy may also be beneficial. Some now swab C-section babies with vaginal secretions in order to support the immune system.
• A very high percentage of people show a degree of mold toxicity when doing urinary mycotoxin testing with RealTime Labs. Many patients have no current mold exposure but may have had it years ago. It is possible that molds colonize in the sinuses, gut, skin, lungs, and possibly dental cavitations. Mold toxicity is a big piece in a very significant portion of Lyme patients.
• One may have mold toxicity and may also have mold allergy. Each of these may need to be treated separately in order to fully address mold illness.
• Dr. Nathan likes the Borrelia culture test from Advanced Labs and feels that it has revolutionized the ability to diagnose Lyme disease.
• Colloidal silver may potentiate the effects of antibiotics. It can be a good adjunct for Lyme disease treatment and possibly for mold as well such as when mold has colonized the sinuses. 

Kristine Gedroic MD lectured on "Utilizing Herbs and Homeopathics in Management of Tick-Borne Diseases". Her talk with one of my favorites and information packed. What I captured in my notes during the talk was only a portion of all of the information shared. For those interested, I suggest watching the video as it was superb.

• Detoxification has to consider cellular, matrix, and membrane detoxification. 
• Utilizing matrix drainage remedies has brought her practice to a new level.
• Considers the person's constitution in determining what protocol may work best for them. This can be done with Traditional Chinese Medicine or German Biological Medicine approaches. These are associated to the depth of the deposition of the disease or how deep in the system the disease process has become.
• Pekana MUNDIPUR can help the liver and the gallbladder and it drains through the biliary tree.
• Beyond Balance IMN-V is one of her favorite products for viral stress.
• You are wasting your time treating if you don't tell your patients to avoid sugar and flour.
• Likes Klaire brand probiotics.
• Syntol AMD is a product that works well in people with previous fungal dysbiosis.
• When patients say that they cannot take minerals, Schuessler Cell Salts are often a good option to better utilize the minerals that are in the diet. Pekana DALEKTRO-N is like cell salts.
• The body is a flow system and it has a tremendous inertia to flow towards health. They key is to remove roadblocks and allow the body to re-right itself.
• Detoxification analogy of a faucet, sink, and drain. When you add antibiotics (faucet), you need to open the drain as much as possible.
• For cellular detoxification, liver, kidney, lymphatic, and blood cleansing, she likes Beyond Balance TOX EASE GL, Beyond Balance TOX-EASE, Energetix Pure Body Clear, NutraMedix Burbur, NutraMedix Parsley, and NutraMedix Pinella.
• The extracellular matrix plays three main roles, transport of nutrients and toxins, storage for items being transported, and supporting intercellular communication.
• The body is like a sponge and becomes more toxic over time. The sponge needs to be rung out.
• Pekana, Energetix, DesBio, and Soluna have good options for supporting matrix detoxification.
• Pekana VISCUM can be a miracle for people with peripheral neuropathy.
• Syntrion SyDetox supports phase 2 detoxification in the liver. It can be a great support for people on Rocephin.
• Membrane detoxification consists of approaches consistent with the PK protocols. These are generally later protocols and are restorative. Consists of Phosphatidyl Cholone, 5-MTHF (Leucovorin), Reduced Glutathione, and oral/IV butyrate.
• It is very difficult to kill and to restore at the same time.
• Butyrate has anti-inflammatory effects and can also be anti-fungal, antiviral, and may help with cold hands and feet.
• Binders may include bentonite clay, activated charcoal, Microchitosan, Zeolite, Beyond Balance TOX-EASE II, Beyond Balance ENV-RD-1, Byron White Detox 2, and chlorella.
• Borrelia antimicrobials may include Byron White A-L Complex, Byron White A-BIO (may help Ehrlichia, Rickettsia), Beyond Balance BB-1, Beyond Balance BB-2, DesBio LYM, Samento, DesBio Borrelia homeopathic, Aurum Arsenicum.
• Has found that when treating biofilms in her protocols, herbal dosing often goes from twice daily to once daily.
• Energetix Drainage Tone supports the spleen in addition to its drainage properties.
• Bartonella antimicrobials may include Beyond Balance BAR-1 or BAR-2, Byron White A-BART, Byron White A-MYCO, or Houttuynia.
• When seeing bacteria adherent to the red blood cells on a Fry test, Beyond Balance BAR-1 may be a good option.
• Babesia antimicrobials may include Byron White A-BAB, Beyond Balance BAB-1/BAB-2/BAB-3, Artemisinin, Cryptolepis, or Enula.
• With Beyond Balance, 4 capsules of BFM-P are equivalent to 1 capsule of the standard BFM-1 product. These have been found helpful in her experience in dealing with biofilms.
• For Tularemia, Byron White A-TULA may be a good option.
• For Rocky Mountain Spotted Fever, Byron White A-RMSF may be a good option.
• With DesBio Series remedies, finds than 85% of patients do better going from vial 10 to 1 than from vial 1 to 10.
• For Mycoplasma or Chlamydia, Beyond Balance BAR-1, Byron White A-MYCO, DesBio Mycoplasma Series Kit, or DesBio Chlamydia Series Kit may be helpful.
• For viruses, Beyond Balance IMN-V, Byron White EBH6, Byron White A-V, Energetix Mono-Chord, Energetix HZ-Chord, DesBio Coxsackie Series, or Lomatium may be helpful.
• For Protomyxzoa rheumatica, Beyond Balance BAB-2 or PZ, Byron White A-P.
• For parasites, Byron White A-P, DesBio VER, DesBio DiaVerm, Energetix Amoeba-Chord, Energetix Para-Chord, Beyond Balance Parazomin.
• For biofilm support, Beyond Balance BFM-1, Serrapeptase, Interfase Plus, AST Exclzyme, Beyond Balance BAB-2, Byron White A-P. In her experience, the most effective product is Beyond Balance BFM-1. One may start with something such as Serrapeptase or AST Exclzyme and move up to Beyond Balance BFM as it can be very strong. May give Beyond Balance BFM at the same time as drainage remedies and then follow 20 minutes later with antimicrobial herbs.
• For hypercoagulation, Syntrion SyCircue, San Pharma Mucor, BodyBio PhosChol, Sodium Potassium Butyrate, Calcium Magnesium Butyrate, Nattokinase, or Lumbrokinase may be helpful.
• For GI dysbiosis, a paleolithic diet is considered. Probiotics, Vital Nutrients Repair Nutrients, and other herbal or homeopathic options may be considered.
• Supporting the nervous system may include Pekana PSY-STABIL, Pekana VISCUM, Syntrion SyDetox, Syntrion SyCircue, Pekana DALEKTRO-N (like cell salts) / BodyBio E-LYTE / Wright Salt, BodyBio Balance Oil, or Phosphatidylcholine may be helpful. 
• In general, people often take too much fish oil, and seed oils may be better.
• For Herxheimer reactions, increase drainage, NutraMedix Parsley, Burbur, Pinella, Alka Seltzer Gold, Alkabase, Magnesium Carbonate, Potassium Bicarbonate, lemon water, Low Dose Naltrexone (LDN). She noted that they have reduced the incidence of Herxheimer reactions by 75% in their office with appropriate drainage remedies and German Biological Medicine approaches.
• Some of the Klaire Labs probiotics contain strep strains and should be used carefully with PANDAS/PANS patients.
• Pekana and Energetix products can generally be mixed together; Soluna cannot be. 

Charles V. Burton MD spoke on "A Neurosurgeon's View of Ethics in the Treatment of Tick-Borne Disease".

• Dr. Burton is a neurosurgeon, medical director, and long-term medical ethicist. He heads the Association for Medical Ethics in the United States. 
• Lesions of the brain "classic for MS" are not classic for MS and can be the result of tick-borne disease.
• Are tick-borne infections a natural occurrence or the result of something created by humans?
• John Loftus looked at classified documents and found that Nazi criminals were given immunity by the United States to provide services.
• Erich Traub was a Nazi that worked with ticks, fleas, and other insects.
• 1948 - Fort Dietrich Bioweapons Lab at Plum Island.
• John Aucott has been quoted as saying, "I cannot think of another disease that has elicited so much vitriol, controversy, and ugly politics."
• The practice of all medicine is the balance between risk and benefit.
• Mike Osterholm PhD has suggested that doctors treating Lyme are dangerous quacks.
• Research being done into nanoantibiotics that can target infected cells. This doesn't create antibiotic resistance. 
• Antibiotic delivery systems may evolve that deliver medications into the bone marrow instead of using PICC lines and similar tools.
• There is light on the horizon.

Christine Green MD spoke on "Rocky Mountain Spotted Fever and Other Rickettsial Infections".

• RMSF has a 3% mortality within 9 days.
• Higher concentration in the Southeast but is in 49/50 states.
• More common in April to September.
• Loves the endothelium.
• Doxycycline is drug of choice.

Joe Brewer MD spoke on "Mycotoxins and Chronic Fatigue Syndrome". This was one of my favorite talks as I've been personally impacted by mold and also feel it is one of the very commonly overlooked issues in many people still struggling with illness.

• RealTime Laboratories has a urinary mycotoxin test.
• Mold is discussed in the Bible in Leviticus 14:43-48. "If the defiling mold reappears in the house after the stones have been torn out and the house scraped and plastered, the priest is to go and examine it and, if the mold has spread in the house, it is a persistent defiling mold; the house is unclean. It must be torn down--its stones, timbers and all the plaster--and taken out of the town to an unclean place."
• Molds have chitin.
• They obtain nutrients by secreting enzymes that decay plant materials.
• Grow as tubular filaments called hyphae.
• Indoor mold growth is related to water intrusion or water damage.
• Substrate for mold are plant-based materials like wood, paper, wallpaper, dry wall, ceiling tiles, etc.
• Need mold spores, a food source, and a moisture source to results in a mold problem.
• Stachybotrys is the most famous of the pathogenic molds. It is a toxic black mold. Rarely found outdoors. It produces many mycotoxins; trichothecene toxins. 
• Stachy is not readily airborne so you generally won't find it in air samples. It is better found in dust samples such as the ERMI.
• Mycotoxins are secondary metabolites. They are not essential for the mold to maintain life but give a competitive advantage over other molds and bacteria for a food source. 
• Humans get caught in the cross-fire. 
• Gliotoxin is important but not yet testable. Candida species make gliotoxin. 
• Chaetonium very nasty bad boy. It makes two mycotoxins and is extremely toxic. 
• Mycotoxins bind to DNA and RNA, alter protein synthesis, increase oxidative stress, deplete antioxidants, alter cell membrane function, act as potent mitochondrial toxins, and alter apoptosis. 
• 112 patients in CFS study. Of 112, over 90% had history of exposure to water damaged buildings at some point in time. ½ also had a Lyme diagnosis. Found aflatoxin in 12%, ochratoxin in 83%, and trichothecene in 44%. The most common combination was ochratoxin combined with trichothecene as observed in 23%. 9% had the "mold trifecta". Can read more at http://www.mdpi.com/2072-6651/5/4/605
• Chronic Fatigue Syndrome consists of immune dysregulation, abnormal cytokines, autoimmune features, and immune deficiency. Cognitive issues, CNS issues, endocrine issues, oxidative stress, and mitochondrial dysfunction are common. 
• When considering mycotoxins in the context of CFS, mycotoxins can lead to neurologic abnormalities, endocrine abnormalities, immune dysregulation, oxidative stress, and mitochondrial dysfunction. There is notable overlap.
• Mycotoxins in the body may be the result of external exposure, re-exposure, or internal mold. Mycotoxins may be excreted via the kidneys into the urine or via the liver/bile into the feces. The problem here is that there can be reabsorption in the GI tract that leads to enterohepatic recirculation meaning that the toxins never leave the body. Sweating is another great tool for detoxification.
• Basic treatment consists of reducing the input which may mean removal from the environment or antifungal drugs including nasal sprays), a mycotoxin binder, increased sweating, and increasing detoxification clearance with the use of glutathione.
• Antifungals may include Itraconazole, Voriconazole, or Posaconazole. Fluconazole will not work with the higher fungi. Mycafungin or Capsofungin may be used. Topical Amphotericin B.
• Binders may include cholestyramine, activated charcoal, chitosan, bentonite, or glucomannan. He seemed to like charcoal.
• Within the body, molds can colonize the sinuses. May directly treat with antifungals in the sinuses as a nasal spray. 
• There can be a biofilm layer in the sinuses that contain organisms that produce mycotoxins.
• Mentioned a device called "Nasa Touch" which can be used with Amphotericin B, Itraconazole, EDTA, corticosteroids to reduce inflammation, and antibiotics such as Mupirocin.
• Editor note: I spoke with another doctor at the event that mentioned that cholestyramine is a good binder for ochratoxin but may not be as helpful for some of the others. 

Natalie A. Cherry PhD spoke on "Key Findings from the NCSU Bartonella Research Program". 

• She is associated with the Galaxy Diagnostics Lab which does testing for Bartonella.
• It is a gram negative, intracellular, vector-borne pathogen.
• It is slow growing, immune evasive, and antibiotic resistant.
• Considered a stealth pathogen.
• 28 sub species.
• Common ones include Bartonella henselae (cat scratch), Bartonella bacilliformis (Carrion's), and Bartonella quintanta (Trench fever).
• Numerous Bartonella species can use humans as accidental hosts. 
• Fleas, ticks, lice, and biting flies may all carry Bartonella.
• Cats, dogs, and rabbits may be hosts.
• Needle sticks may pose possible transmission risk.
• People that are in the immunosuppressed population may be at higher risk for infection. This may include HIV, pregnancy, age, stress, and RX immunosuppressive drugs.
• Bartonella bacilliformis is common in the Andes region of Peru due to sandflies.
• Any system in the body can be compromised by Bartonella infections.
• Can lead to vasculitis, endocarditis, thyroiditis, myalgia, and many other symptoms.
• Macrophages may harbor Bartonella which may cause Bartonella to localize to areas of tissue injury.
• In terms of lab testing, high false negative results are common with IFA or PCR testing.
• They have a growth medium called BAPGM or Bartonella Alpha-Proteobacteria Growth Medium which grows the Bartonella and then is used for PCR testing. 
• Called Bartonella ePCR and is 4 times more sensitive than PCR testing alone.  http://www.galaxydx.com/web/enrichmentpcr/ 

A question and answer session of several practitioners took place and a few interesting points were: 

• Dr. Brewer is working on a mycotoxin clearing protocol that includes an intranasal protocol. They are collecting data on the protocol.
• You can give cholestyramine and charcoal together. It has been suggested that these may bind different types of mycotoxins.
• Dr. Gray in Arizona has combined 2-4 binders concurrently for mold illness. 
• Dehumidifiers and HEPA filters may be helpful.
• Saccharomyces boulardii and Lactobacillus rhamnosus may have a role in assisting in the resolution of mycotoxin illnesses.
• Some lipomas have been found to have mycotoxins within them. 
• For Bartonella testing, Galaxy Diagnostics suggests being off of any antimicrobial treatments for 2 weeks before a test to optimize the results.
• Bartonella appears to be a chronic disease process.
• Robert Mozayeni MD in Maryland and Edward Breitschwerdt DVM are both experts in the field of Bartonella. 

Todd C. Thoring ND and Steve J. Harris MD spoke on "Optimizing Patient Outcome: Diagnostics and Integrative Treatment". 

• Many people are familiar with BLt ad Crypto-Plus products that were previously available through Clinical Response Formulas. These are now being offered by Researched Nutritionals as two new antimicrobial tinctures.
• Pasteur had a more conventional perspective; Bechamp a more naturopathic one.
• There are pounds of bacteria in our guts. 
• We have more viral cells than human cells.
• May treat with an intracellular drug for a few weeks before doing a Western Blot to kill Borrelia and expose it to the immune system. Then recheck IgM a week after stopping.
• A number of herbal options may be used for provocation to see how one response to treatment which may provide insights as to whether or not Borrelia is a potential. BLt, Crypto-Plus, Garlic, Coptis, Samento, Beyond Balance BB-1, or Byron White A-L Complex.
• Chemicals are only partially involved in healing.
• Need to consider when to shoot and when to retreat.
• Testing for detoxification includes liver function (Phase 1 and 2), methylation, sulphur, ammonia, mycotoxin vulnerability, digestive function, kidney and lung function, skin health.
• Testing for endocrine health includes thyroid, HPA axis, adrenals, and sex hormones.
• Correcting hypothyroid states helps to fight infections.
• Every tick-borne disease patient has a viral load. 
• Olive leaf, BLt, and lomatium may be helpful for supporting the body against viruses. Note lomatium can lead to a full body rash.
• For supporting the immune system, transfer factors (including Researched Nutritionals LymPlus), thymus extracts, astragalus, probiotics, low-dose naltrexone (LDN), and vitamins and minerals may be used.
• For adrenal and mitochondrial support, NT Factor, ATP Fuel, RibosCardio, adaptogenic herbs, glandulars, homeopathics, and low dose hydrocortisone may be considerations.
• In people that feel better, but still have positive test results, an ongoing question is whether to pick a fight or to build our defenses? 
• BLt has been observed to be helpful for people with Borrelia and Bartonella, possibly Mycoplasma, and viruses. It may modulate inflammation, reduce Herxheimer responses, support the immune system, and improve digestion. 
• BLt consists of Boneset, Lomatium, Teasel, and other herbs.
• Some have found that Boneset may be helpful with Bartonella.
• Smilax is an endotoxin binder and may support reduction of Herxheimer responses.
• Red Root supports the spleen and lymphatic systems.
• Stillingia may support the lymphatic system and detoxification.
• Cryptolepis alone is generally used short-term.
• Cryptolepis is in an antimicrobial blend called Crypto-Plus. 
• There is no known resistance to Cryptolepis and it can be a good option for malaria.
• With Lomatium (which is a component of Crypto-Plus), one can get a full body, Measles-like rash. It is best to go slowly. The rash may be more likely to happen when one is also on Lumbrokinase or Nattokinase.
• Cryptolepis can lead to bloody noses. Caution needs to be considered when using Coumadin or other blood thinners.  

Norton L. Fishman MD spoke on "Biofilms and Coagulopathies".

• In terms of dealing with illness: The universe is big; give it back to the universe.
• This is not an antibiotic disease. It is an integrative, ecological, environmental, unique-to-each-person disease.
• Biofilm formation is a key survival strategy. 
• Biofilms are structured communities of organisms. 
• Evasion + Resistance = Persistence.
• The majority of bacteria can survive in a hostile environment when encased by polysaccharides (biofilm).
• Single-celled organisms create communities which then have properties of multi-cellular organisms.
• Can evade the immune system and render antibiotics ineffective.
• Therapeutic models are based on "swimmers"; not "stickers".
• 20% of a biofilm is the microbes within it.
• These microbes communicate via quorum sensing.
• Resistance to antimicrobial therapy and evasion of host immune defense are keys to persistence of Lyme-related infections.
• Persister cells are a small number of cells that remain and can form new colonies. They do not have resistance but they evade. Persisters are designated drivers to restart the system.
• Bacteria in biofilm are tenacious survivalists as opposed to being aggressively virulent.
• There is more bacteria in us than there is "us".
• Some think that when you get old, you are supposed to be sick and lousy. Dr. Fishman says, "Bologna".
• He does not think you can "cure" Lyme in eradicating every last organism, but you can "heal" and return to normal, healthy function.
• He asked if anyone had ever been "cured" of Chicken Pox and pointed out that while you don't have symptoms, if you are stressed in adulthood and develop Shingles, that is the same virus that initially caused the Chicken Pox. So while it was still in the body, it did not result in dis-ease until the body was under stress.
• There are a few key strategies for dealing with biofilms:
• Enzymatic disruption - Nattokinase, Serrapeptase, Bromelain, Lumbrokinase/Boluoke, Wobenzyme, Beyond Balance BFM-1
• Chemical disruption - fresh garlic, NAC
• Metal chelators - Disodium EDTA as in Interfase Plus, Lactoferrin (binds iron). Lactoferrin is not an issue for those with milk allergy. It is anti-inflammatory, antiviral, antifungal, and antibacterial.
• Quorum sensing / Interfere with Group Activities - green tea EGCG, resveratrol from Japanese Knotweed
• For persisters, pulsing therapies with Metronidazole, Tinidazole, or Rifampin may be useful.
• Has been shown that quorum sensing may be suppressed with low dose Zithromax. Long-term, low-dose maintenance macrolide therapy may be useful.
• Coagulation is activated by inflammation; inflammation may result from cytokines created by the immune system in an attempt to respond to infection.
• Infections are recognized by the innate immune system and lead to a cascade of cytokines and resulting inflammation. 
• Inflammation-activated coagulation further affects inflammation.
• The activation of coagulation and fibrin deposition is a consequence of inflammation and serves to contain invading entities. 
• Infections -> Cytokines -> Inflammation -> Coagulation
• Prothombin -> Thrombin -> Fibrin
• ISAC panel is the Immune System Activation of Coagulation and can provide insights as to coagulation abnormalities.
• Heparin is one commonly used treatment. It is also anti-inflammatory, anti-metastatic, and anti-angiogenic.
• Lovenox is a low molecular weight heparin. 
• Boluoke is another option often considered when approaching coagulation therapy. 

Sunjya K. Schweig MD spoke on "The Lyme and Gut Connection: The Role of Diet and Gastrointestinal Health in Treating Lyme Disease". 

• Addressing the gut can address systemic inflammation and improve immunity.
• Tick-borne diseases are directly harmful to the GI system from top to bottom.
• 70% of the immune system is in the gut.
• Tick-borne diseases can cause significant inflammation, leaky gut, pain, and reflux.
• Bartonella is a known cause of H. Pylori negative gastritis; can lead to Bell's Palsy of the gut.
• Mycoplasma has been isolated in gut biopsies and can lead to increase of cytokines and increased inflammation.
• Our modern diet contributes to inflammation as it negatively impacts the microbiota.
• Gut inflammation potentiates systemic inflammation.
• Chronic Fatigue Syndrome consists of altered intestinal microbiota, leaky gut, mucosal barrier issues, and altered mucosal immunity with a loss of tolerance to GI pathogens.
• Leaky gut is a central player. Stress, toxins, antibiotics, infections, fungi, Candida, and food allergies/sensitivities play a role.
• The increase of intestinal permeability mirrors the opening of the blood-brain barrier.
• Leaky gut allows larger than expected molecules of undigested foods, bacteria, parasites, toxins, Candida, and other fungi into the bloodstream.
• In celiac disease (HLA DQ2 or DQ8), gluten causes the tight junctions to open which leads to inflammation and production of antibodies produced that create an autoimmune phenomenon.
• The "4R" program is Remove, Replace, Reinoculate, and Repair. Allergens and pathogens are removed. Digestive enzymes and HCl are replaced. Beneficial flora is reinoculated. GI tract and mucosal lining are repaired.
• Common GI pathogens include H. Pylori, Cryptosporidium, Entameoba Histolytica/Coli/Hartmanni, Giardia, Dientamoeba Fragilis, Blastocystis Hominis, and Salmonella.
• The number of bacteria in and on us outnumbers our cells by 10 times.
• Stress and emotions can change the gut microbiota.
• Probiotics can be very helpful; including fermented foods. Can inhibit NF-kB, help intestinal barrier, support SIgA, modulate inflammation, reduce cytokines, and outcompete pathogens. Saccharomyces boulardii is not killed by antibiotics and may help to reduce yeast overgrowth. 
• Probiotics can decrease IL-8.
• The goal is to restore the ecosystem.
• Diet can be both hard work and the missing link.
• Gluten is a problem for many, if not most, of us. You have to be binary about it; you cannot be wishy-washy.
• The books Wheat Belly and Grain Brain are both excellent.
• For gluten sensitivity testing, can test IgA, IgG as well as looking at DQ2 and DQ8 HLA types which are associated with Celiac disease.
• Cyrex or EnteroLab are good options for testing.
• It has been said that a single gluten exposure can cause inflammation that last up to six months.
• Anti-Inflammatory diets such as those promoted by Singleton or McFadzean can be useful. Glycemic load and blood sugar balance are really important for inflammation. Insulin is one of the most inflammatory molecules in the human body.
• Common pro-inflammatory foods include grains, red meat, citrus, soy, legumes, nightshades, dairy, processed foods, and sugar.
• University of Wisconsin Anti-Inflammatory Diet
• Paleo Diet is one of the best ways to eat. Removes foods that have been introduces relatively recently. Focus is on fruits, vegetables, nuts, seeds, berries, and protein. Paleo is not as strict as GAPS. Good reference from Practical Paleo book. 
• GAPS diet is one of the most aggressive. It is one of the most effective healing diets but very hard to stick to. Created by Natasha Campbell-McBride MD. Eliminates grains. Removes specific saccharides that are difficult to digest and may promote yeast overgrowth and leaky gut. Focus is on fermented foods and bone broths. Allows gradual introduction of dairy.
• SIBO - small intestinal bowel overgrowth - there should not be a lot of bacteria in the small intestines. When there are, foods are fermented in the small intestine. Can be evaluated with a breath test or Urine Organic Acids looking for bacteria dysbiosis. There are both antibiotic and herbal treatment options.
• Body Ecology Diet - focus is on yeast, detoxification, cleansing, and juicing.
• Key supplements that may support healing the gut include: probiotics and fermented foods, fish oil, glutamine, bone broth, gelatin, vitamin A, butyrate, digestive enzymes, ox bile, HCl, bitters, zinc carnosine, marshmallow, and slippery elm.
• The gut is both a source of and a solution for inflammation.
• Healing the gut will have far reaching benefits.

In other Q&A discussions, I learned the following from the panel: 

• In pregnancy, when Zithromax and Amoxicillin are used, the odds of transmission to the child appears to be quite low; possibly less than 1%. With 1 antibiotic, the risk goes up to 25%. With no antibiotics, it appears to be around 50%.
• Breast feeding may be an option while on antibiotics; should be discussed with your doctor.
• A Western Blot in children younger than 15 months is showing the mom's antibodies; not the child's response.
• Dr. Steve Harris mentioned that in young children, there is the potential for eradicating the infections.
• Asymptomatic children may become symptomatic around age 8 or at puberty. 
• For biotoxins, cholestyramine, bentonite clay, and charcoal are often good options. These may work for mycotoxins as well.
• With the RealTime urinary mycotoxins testing, it is "remarkable and a little bit scary" how often mycotoxins are being found in patients.
• Alletess Labs can do IgG titers to 5 molds - Aspergillus, Pencillium, Candida, Mucor, and Stachybotrys. When IgG levels are high, this may indicate colonization; particularly in the sinuses.
• Dr. Steve Harris commented that the physical exam is very important. He often observes a Hoffmann reflex where you flick the middle finger and may observe movement or a twitch of the second finger or thumb. This is a sign of nervous system irritability. It is similar to the Babinski reflex; which is positive less often. Hyperreflexia is common. 
• Babesia may be a factor in an enlarged spleen observed on physical exam.
• Dr. Ken Liegner palpates the IT bands and the inserts of muscles into joints for tenderness.
• Dr. Dan Cameron uses a symptom scoring form to get additional insights into what may be happening with his patients.
• In terms of Herxheimer reactions, you do not want to create a lot of inflammation in the motor neurons in people with neurological symptoms.
• Mepron can be used with Malarone. Mepron with a macrolide is better than Mepron alone. Mepron used alone has the potential for leading to Babesia resistance.
• C6 testing is not better than a standard ELISA test. It was developed on European strains.
• Viracor may be a good lab for Mycoplasma and Chlamydia pneumoniae testing.
• In ALS, Babesia may be a common co-factor.
• It takes between 6-12 months of IV to see improvement in severe neurological cases of Lyme.
• IV is often better for neurological Lyme; oral for muscle and joint presentations. Some may need a combination of both.

Disclaimer: While I attempted to accurately represent the statements of the various speakers, it is possible that the above contains errors or inaccuracies. If you have any corrections to the content listed above, please Contact Me.