ILADS 2014 Washington DC Conference Takeaways

Details: Created: October 24, 2014; Last Updated: November 18, 2014

This blog entry summarizes some of the notes I took at the ILADS conference in Washington DC in October 2014. 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 9th 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.

When I first went to an ILADS meeting in 2006, it was a relatively small event. Times have changed! You might get run down in the hallways now with all the people that attend this event. I'm guessing it was close to 600 people. It is a great feeling to see so many people interested in going to a conference for an imaginary disease.

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.

The conference started with a video from Attorney General and Senator Blumenthal thanking everyone for being present at the ILADS event and sharing his passion for Lyme disease as it has touched friends and co-workers in his life.

Robert Mozayeni MD was first up and he spoke on "Bartonella: Science and Clinical Considerations in Lyme Disease". He is the Chief Medical Officer of Galaxy Diagnostics. He shared:

Bartonella is prevalent in Lyme and beyond; especially with neurological and neuro-psychiatric presentations and treatment failures.
It is a small vessel inflammatory disease.
Traditional Bartonella treatment such as Doxycycline and Rifampin may not be successful.
Cats, fleas, or other insect exposures can lead to a Bartonella-only infections; relatively common.
Bartonella may contribute to false positive IgM Western Blots.
It is a gram-negative proteobacteria with a 22-24 hour division time.
If there is an immediate relapse when stopping antibiotics, that is generally not from Bartonella.
It is found in erythrocytes, endothelial cells, microglial cells, macrophages, CD34 stem cells, and bone marrow stem cells.
Cats, rodents, dogs, wildlife, ruminants, and human beings can all be affected.
Cats are the most likely and common reservoir.
There is evidence for tick transmission.
Ask patients about cats and fleas.
Has found Bartonella lasting decades.
Bartonella gets into the vascular system: endovascular and endothelial.
Leads to inflammation, fibrin, biofilms, and flow impairment.
Microvascular interruption leads to symptoms; often psych symptoms.
Can cause disconnection syndrome and mild cognitive impairment.
Small vessel disease is the big pink elephant in the room of medicine and almost always present with inflammation.
Need to improve circulation, reduce inflammation, and treat biofilms.
Mild cognitive impairment, executive dysfunction, working memory impairment, mood lability, and processing speed delays may be observed.
Non-CNS symptoms: peripheral migratory neuropathy, POTS, dysautonomia, fasiculations (twitches), tremors, muscle pain (myalgia), joint pains (arthralgia), headaches, fatigue, decreased stamina, low pulse/pressure.
Blood concentration in cats is 1 million fold higher than in humans or dogs.
Triple blood culture is done over several days for best possible results.
Estimates that the BAPGM test platform is 80-90% sensitive. Not sure yet as to the best times for collection.
If negative results and there is still a risk, repeat the culture.
Bartonella suppresses the immune system.
Antibodies develop and disappear with treatment.
Serologies are generally not helpful prior to treatment.
It is not normal to have significant antibodies with Bartonella.
In one study, they had a 41% culture positive rate.
62% had antibody or culture positive response.
Gestational transfer is possible; but not probable.
Liver cysts often resolve with treatment.
A pitfall in treatment is related to the adrenals. Adrenal issues must be diagnosed and managed.
The single biggest reason for the failure of Rifampin therapy is that it induces more rapid metabolism of sterol hormones.
Will lead to a Herx and severe symptoms from adrenal depletion while on Rifampin. Rifampin is a Cytochrome P450 3A4 inducer and can put the patient into adrenal crisis.
Hypothyroidism may need to be clinically diagnosed. T3 often helps.
He often uses Biaxin for 1 month and then adds Rifampin.
He has never had to treat a Bartonella patient with IV.
Borrelia antibiotics may push Bartonella further into the cells.
There have been cases of persistence after long-term antibiotic therapy.
Positive IgM Western Blots may normalize with treatment.
Can be mild liver function test elevation, mild decrease in WBC, C4a elevation, higher IFA+, and mildly elevated or normal hsCRP.
Antibody response prior to treatment is unusual.
Relapse rates appear to be low.

Joseph Annibali MD from Amen Clinics spoke on the "Role of Brain SPECT Imaging in Diagnosing and Treating Lyme Disease". I personally found this exciting to see more medical doctors accepting that Lyme is real. He shared:

He has a daughter with chronic Lyme disease.
She had a dog and horses with Lyme.
She was diagnosed by Dr. Sam Shor MD.
SPECT scan looks at brain blood flow.
It is a snapshot at the given moment.
70% of those with Lyme with cognitive symptoms will show global hypoperfusion on a SPECT.
It is not Lyme specific; can be encephalitis, toxins, drug abuse, or other causes.
MRI is anatomy; SPECT is functional.
Over-activity of the limbic system in a SPECT scan may be related to inflammation.
Mono (EBV) may impact the immune system and make one more prone to tick-borne infections.
Tremendous inflammation can be seen during a Herx response on a SPECT.
Lamictal is an anti-convulsant and brain stabilizer.

Stephen Phillips MD spoke on "Brucellosis". He shared:

Muscle pain, creaking and cracking, fever, malaise, sweats, arthralgia, back pain, chills, significant weight loss, fatigue, headache, and other symptoms can present with Brucella.
Elevated CRP, Elevated ESR (sed rate), and anemia may present.
Lyme disables many from their career; Brucella disables you from every aspect of your life. It is incapacitating.
Underdiagnosed illness.
There is a range of symptoms as with many zoonotic infections.
It is a gram-negative intracellular microbe.
It becomes the puppet master of the cell.
Unpasteurized dairy, animal exposures to body fluids, hunters, and laboratory exposures by aerosolization are common sources of infection.
Humans are dead end hosts though transplacental, breast milk, and sexual transmission have occurred in the literature.
12.8% of cases happen in the winter; 78% in spring and summer.
It has been isolated from ticks and fleas for 60 years.
Transmission has been demonstrated with lice and blood-sucking insects in nature.
It is not as hard to culture as Borrelia, but very close.
It is slow growing; takes weeks for a culture positive with frequent false negatives.
Bone marrow would be the best culture source.
PCR is useful but new strains are commonly found.
Chronic cases are often seronegative.
ELISA and Agglutination Antibody testing are the most common; complement fixation testing is available in Europe and is better but not available in the US.
Streptomycin, Gentamicin, Doxycycline, Rifampin, Bactrim, or quinolones may be used.
It is resistant to Ceftriaxone.
Earlier treatment results in better outcomes.
Single agent treatments don't work.
Treatment less than six weeks results in high failure rates.
Herxes can be severe or fatal.
Aminoglycosides may be used for 3 weeks with Doxycycline or Doxycycline and Rifampin for 6 weeks.
Aminoglycoside and Doxycycline combination is more effective.
Streptomycin is equivalent to Gentamicin in terms of effectiveness.
There is no agreed upon curative treatment for chronic Brucellosis.
It has blebs, L-forms, and biofilms.
Levamisole is an antiparasitic and immune potentiator.
Antibiotics plus Levamisole were better than antibiotics alone; though Levamisole can cause autoimmune disease and was taken off the market in 1999.
Ivermectin may be a good replacement for Levamisole and does potentiate immunity.
Vitamin C may help.
Polyporus umbellatus (mushroom) reverses Brucella induced immune anergy and activated macrophages.
Gamma interferon is the principle cytokine involved in the protective response; no studies have been done.
In a study with 3 groups of Brucella patients, the first group had Interferon Alpha, second had Levamisole, and third had conventional antibiotics. Groups 1 and 2 had clinical improvement and immune response. Group 1 did better than Group 2. Group 3 had no change.
Liposomes mimic cell membranes and the immune system sees them as a foreign invader and gobbles them up. This can be used to enhance drug delivery and improve the outcome of some medications.
Anionic (negative), Cationic (positive), or neutral.
Liposomal Gentamicin study eliminated infection from monocytes; was 20 times more effective than free Gentamicin with reduced side effects.
Would like liposomal aminoglycosides to be available.
Brucella is related to Bartonella.
True Brucella infection is not as common as Bartonella.
Aminoglycosides may be a helpful option for Bartonella.

Susan Swedo MD spoke on "PANDAS/PANS and Other Acute Onset Neuropsychiatric Syndromes". This is a topic I am particularly interested in as strep is a big player with some children on the ASD spectrum. She shared:

PANDASNetwork.org is a good sit with lots of relevant information on PANDAS/PANS.
There is an upcoming article on diagnosis and treatment with IVIG, plasmapheresis, and antibiotics.
Post-Strep Autoimmune Encephalitis of the Basal Ganglia is a better name for it.
The bug is long gone by the time the children have the problems.
Antibiotic treatment impacts other co-infections but not the initiator of the event.
Post-infectious autoimmune response.
Antibodies against Strep attack the normal tissue.
It is an abrupt onset OCD, relapsing/remitting.
Starts at 6.5 +/- 3 years for tics and 7.4 +/- 2.7 years for OCD.
Boys outnumber girls 2.6:1.
OCD, tics, and ADHD are the triad.
Criteria - OCD, acute onset, prepubertal onset, choreiform movements.
PANS - Pediatric Acute Neuropsychiatric Syndrome - acute onset, OCD plus at least 2 sets of other symptoms - separation anxiety, panic, anxiety, OR emotional lability and irritability OR behavioral aggression OR motor and/or sensory abnormalities.
May have anorexia with body image distortions.
Urinary frequency urgency at onset is a hallmark.
Correlations with handwriting changes.
Behavioral regression - crawling, playing with toys from a few years ago, etc.
Treatment of Strep reduces OCD and Strep symptoms.
Cefdinir has been shown helpful; Zithromax appears helpful.
PANDAS is uncommon but not rare.
500mg Zithromax 1-2 times a week or 250mg daily have been considered.
Penicillin is preferred as it does not impact the gut microbiome but has a shorter half-life and doses cannot be missed.
Non-PANDAS OCD does not seem to respond to IVIG and plasmapheresis.
Treatment choices - wait for the body to clear the antibodies (as long as they don't get another infection; tincture of time and prophylactic antibiotics; no destruction of the brain), IVIG, plasmapheresis.
Dramatic improvement may be maintained with adequate prophylaxis.

Robert Bransfield MD spoke on "Sleep Disorders Impacting Lyme". He shared:

What starts an illness may be different than what perpetuates it.
Chronic stress reduction and restorative sleep improve overall recovery.
Lack of sleep leads to buildup of beta amyloid.
Non-restorative sleep can lead to fatigue, cognitive impairments, emotional impairments, pain sensitivity, and immune dysfunction.
Sleep is important for early inflammatory response.
There can be a blunted Th1 response when sleep-derived.
100% of Lyme patients had sleep problems of one type or another in a study.
Lack of restorative sleep pushes one towards a chronic inflammatory state.
Delta sleep triggers growth hormone release which impacts other hormones and immunity.
Trazadone and Lyrica for sleep are top considerations.
Best in promoting delta sleep is Gamma Hydroxybutyrate.
Belsomra works against orexin (which is wake-promoting).
Avoid computers late in the day.
Avoid fluids late in the day.
Have some white noise.

In a Q&A or from other discussions, I had the following notes:

50% of indoor/outdoor cats may carry Bartonella and it can be found in their saliva.
The primer set with Galaxy Diagnostics is as broad as they can make it to cover many different types of Bartonella.
Dr. Bransfield felt that marijuana improves delta sleep but carries other problems with it.
Liposomal artemisinin may be helpful for Brucella. Brucella is heme-dependent and requires iron. Liposomal artemisinin should be of some value. Oregano and Thyme oils may be helpful for Brucella.
PANS can be triggered by Lyme, flu, Mycoplasma, Strep, etc.
Strep is resistant to Zithromax in some areas of the country. Augmentin may be helpful. May need antibiotics when starting college or military as it is another time of higher risk for reinfection.
Bartonella infects bone marrow stem cells. Nitric oxide production (arginine, peanut butter, Lumbrokinase, etc.) may be helpful. Ketogenic diet may be helpful.
Sleep may be impacted by the moon cycles, fluid changes in the body. Lunar cycles impact gravitational pull.

Many of the breakout sessions I attended were a Case Study format. It is not possible to capture all the details of the presented case studies. Thus the notes are based on ideas or comments that stood out during the lectures and not intended to capture the full discussion.

Neil Nathan MD gave a lunch lecture on "A Practical Approach to the Treatment of Chronic Viral Infections in Lyme Disease". He shared:

Mold plates can be a helpful initial screening tool for environmental mold in the home.
50% of what grows may be pathogenic; 50% may not be. The plates need to be analyzed.
Treating viruses directly early in the recovery is not very effective.
Often need to address mold first, then Lyme, then viruses.
Common viruses are Herpes viruses, Enteroviruses, Parvovirus B19, attenuated Measles, Retroviruses, and Coxsackie.
Viruses may be treated with RX Acyclovir, Valtrex, Famvir, or Valcyte.
Other options include Transfer Factor, GcMAF, Frequency-Specific Microcurrent, Artesunate, Beyond Balance IMN-V or IMN-V-II, Byron White A-V, Monolaurin, low dose interferon, IV C, low dose Rituxan, homeopathics, Immunovir, Olive Leaf Extract, or Grapefruit Seed Extract.
Transfer Factors act like antibodies and bind to antigens. They augment the Th1 response (which deals with infection).
Transfer Factors flag an antigen to the immune system.
Transfer Factors can be a helpful way to support the body against viruses if used throughout the overall treatment.
Some may need to use a transfer factor less frequently such as every 3 days or even once every 2-4 weeks. Often works up to 2 daily for 18 months or longer.
His favorite is Transfer Factor Plasmyc (this is also my favorite and one I take daily) and LymPlus.
Nagalase is mostly the result of viruses.
The viral layer is generally what comes at the end of treatment.
If nagalase is 1.5 or above, this may be a good treatment candidate for GcMAF.
Experience has shown that low and slow is the way to go with GcMAF.
Goleic is a stronger version which may not be ideal for many patients as GcMAF is already often too strong for this patient population in many cases and needs to be very slowly introduced.
Bravo probiotic can be a very good option; though is not as good as the injection.
He likes Chinese Skullcap as an antiviral. Houttuynia, Isatis, Lomatium, and various mushrooms may also be helpful.
He mentioned work that is being done in research with Dr. Robert Naviaux and a drug called Suramin which may reboot inflammation. They are working with Dr. Naviaux to study this potential further.
He postulated that it could be that the body shuts down methylation to slow down the viruses and that by adding methylation support, we may be helping the viruses or undoing the innate wisdom of the body. This was one of the most insightful, thought-provoking things I heard at the conference.
I am a huge fan of Dr. Nathan's work and think that he's a super practitioner and healer.

Dan Kinderlehrer MD spoke on "Evaluation of Complex Patients with Tick-Borne Illness". He shared:

When a CD57 is below 20, he believes there may be active Babesia. Otherwise, he does not find CD57 to be helpful.
Why do we make rT3 (reverse T3)? Maybe it is a body wisdom. rT3 may be an indicator of being sick. Maybe it is telling us to slow down and T3 may be the wrong thing to do.
Coinfection testing is better for Ehrlichia, Anaplasma, and Rickettsia; not as good for Babesia and Bartonella.
8 capsules of HCl is what Jonathan Wright suggests you need to get what the stomach should have created.
Emotional stress is a top reason for relapse.
50% of his patients are gluten sensitive.
Surgical procedures may use Dexamethasone as part of the procedure unknowingly which could have negative effects.

Wayne Anderson ND spoke on "Parasites". He shared:

In chronic Lyme, once the immune system is suppressed, numerous confounding issues may present.
All labs are inadequate for parasites testing.
Did 100 Diagnos-Techs tests and found that many people had IgA positive test results.
Lyme may create immune suppression that increases one's predisposition to parasites.
Parasites are with us at times for a reason; not all parasites are bad.
Constipation is often related to larger parasites; looser stool may be related to smaller parasites.
Lyme patients do not get better until constipation is improved. If one is constipated, Herxheimer reactions will be worse.
For constipation, magnesium to bowel tolerance, C, hydration, trace minerals, avoiding gluten and food allergens, colonics, coffee enemas, cutting out drugs or supplements that may be interfering, high dose probiotics, castor oil packs, digestive enzymes, improving dysbiosis, non-constipating binders such as Chlorella or Modified Citrus Pectin, short term use of laxatives, and aloe may be helpful options.
Four reasons for constipation include lack of stomach acid or digestive enzymes, lack of bile salts, inflammation of the small bowel from bacteria, mold, fungal, or parasitic overgrowth, and neurological disconnection.
Abdominal tenderness increases his suspicion for parasites.
Dosages are variable and should be based on tolerance.
Can mix and match RX and herbal options; pulse and cycle.
Generic forms of Alinia are NOT the same as the brand, and sensitive patients need the real thing.
Albendazole and Biltricide need to be alternated.
Byron White A-P has a small laxative effect. If the patient becomes more constipated, it could be a confirmation of parasites. Can also use A-P to tonify the gut.
Gamma Rizol up to 30 drops twice daily may be used.
When the first thing a patient says is "Help me with my pain", Bartonella comes to the top of the list.
When there is a bloating abdomen, parasites or mold may be a concern.
Parasites and bacteria can lead to smelly stools; mold not as much.
HLA 1-5 is a predisposition to hypothalamic dysregulation.
Homocysteine < 5 is important related to methylation.
Alinia is not great on Babesia but often will help whittle it down.

Neil Nathan MD spoke on Methylation. He shared:

When a patient has a fried CNS and is jerking, this is often Bartonella and mold.
"Babonella" is a new term that suggests both Bartonella and Babesia that may require treatment.
Finds increasingly that CD57 does not help and does not know what it really means. Mold patients will have a low CD57; it is not specific.
He likes a system called LENS for the nervous system. It has velcro bands that are places around the head to measure brain waves in 21 different areas. Looking for perfusion and puts a small signal to reboot that area of the brain. It is one of his favorite tools and works best once other major things are addressed.
LDA is a subdermal injection every 2 months that calms down the immune system. It can take 3 years to calm down someone with MCS.
Essentiale N (Phos Choline) IV can be great for detoxification and for sensitive people that are detox compromised.
Visual Contrast Sensitivity (VCS) testing - A and B rows are normal on everyone. C, D, E is the real test. A positive result can be related to mold, Lyme, or mercury.
Annie Hopper's Limbic Retraining Course (http://www.dnrsystem.com/) is a fabulous program to desensitize the limbic system and can be helpful for MCS patients.
Chemical sensitivity is often a clue to the lungworm; a roundworm known as Varestrongylus klapowi. The nematode may make mimics of acetylcholinesterase which poisons the nervous system.
No allergic reaction acts as fast as what is seen in his patients with MCS; can be instant.
Worms in the lungs and sinus area become highly irritated when exposed to certain chemicals.
94% of 100 people tested with MCS had evidence of the lungworm in nasal washes.
It was shown that within 1 minute, acetylcholinesterase levels were 20 times higher after exposing the worm to Tide.
They recently had the first patient where the worm was entirely eradicated and are working on a protocol with ASL Pharmacy on a nasal spray.
Emotional and spiritual healing are often a key to real progress and breaking through thresholds.
At a certain point, a patient cannot imagine being well. It is like 40 years of wandering the desert to learn how to be free (or healthy).
If you cannot envision getting well, you cannot get well. Use affirmations.
Talk about what it is like to get well.
Once the habit sinks in, you have to change the habit, regain the spirit, and find what makes your life meaningful.
You cannot recover by just getting rid of bugs.
Write a positive statement in 3 different tenses.
I Neil am....
You Neil are....
He Neil is.... healthy, relaxed, and comfortable.
It is not enough to do "I am".
10 times a day for 90 days.

Kristine Gedroic MD is a practitioner I have the highest of respect for. She's amazing. She talked on "The Hard to Treat Patients" and shared:

The terrain is the setup for the infections making us ill.
Bitemporal headaches are often Bartonella.
She likes the Fry Labs Specialty stain testing.
CD57 is not the best tracker of just Borrelia. They do often track it and find then when starting to treat parasites, there can be a 30-40 point jump in CD57 in a month in some people. Has seen this with Byron White A-P.
She take the CD57 as a marker of the synergy between Borrelia and parasites.
She often times is not treating Lyme at all when it makes a big jump.
Psy-Stabil is helpful for anxiety.
Improving the integrity of the cell membrane can often erase many symptoms.
SyCircue may help with cold fingers and toes and hypercoagulation; it works well for sensitive patients to decongest the matrix.
Fats nourish the nervous system.
We need raw materials for healing.
Inversion of the cell membrane is involved in anti-phospholipid syndrome.
We need good source of linoleic and alpha-linoleic acid.
Omega 6 to Omega 3 ratio should be 4:1.
Fish oil pushed too hard can be PRO-inflammatory.
We need good sources of Omega 6 as well.
Cytokine storms start at the cell membrane; repairing that helps with inflammation.
BodyBio can run interpretation of cell wall testing.
Fats associated with biofilms make lipid wraps that act like rebar going through the cells that can distort the cell anatomy.
Antibiotics are a mitochondrial toxin; they create fatigue the longer the patient is on them.
We need to get on and off antibiotics as fast as possible.
Several good books by Thomas Seyfried are worth exploration.
You have to either slow down the faucet or open up the drain.
They often do antibiotics for the primary symptom-producing bug and herbs for other microbial coverage.
Frontal headaches may be Babesia.
65% of infections today involve biofilms; make microbes 1000 times more resistant to antibiotics.
Membrane Stabilization Therapy can be very helpful; she created a "Power Drink" with a number of healthful fats. It is a good source of fat including Phos Choline, Balance Oil, Omega 6 / Omega 3 and also electrolytes.
IV butyrate, Phos Choline, Leucovorin, and reduced glutathione is another way to improve the cell membrane stability.
You must put in minerals or you will not release heavy metals.
Phos Choline will download toxins from the membrane but not from the matrix.
Soluna remedies can be great but also can be provoking in some.
Ox bile emulsifies the bile and is wonderful for addressing biofilms.
Is the magnitude of a Herx equivalent to the degree of infection or the terrain and cellular membrane dysregulation?
Is constitution the same as membrane stability?
Consider restorative therapies before antimicrobials.

William V. Padula OD spoke on "Neuro Visual Processing Affected by a Tick-Borne Event". He shared:

Lyme and vision are both brain-processing events.
He uses lenses and prisms to affect brain processing.
Brain stem, mid-brain, and thalamus are involved in visual processing.
Tick-borne disease can distort special information and lead to a midline shift.
Vision therapy is not the way to go to address spatial visual processing issues and can further embed the dysfunction.

Richard Horowitz MD shared the following on "Relapsing Fever Borrelia":

Borrelia miyamotoi has no reliable test.
Could explain persistent symptoms.
Borrelia hermsii, Borrelia turicatae, and Borrelia parkeri can cause relapsing fever.
Found in United States, Canada, and Europe.
5-15 day onset, 105 fever, chills, sweats, headaches, myalgias, arthralgias, nausea, and vomiting.
Symptoms last 2-9 days and then recur.
100 species of Borrelia in the United States and 300 worldwide.
First one to be transmitted transovarially - mother tick can transmit to eggs without feeding on a mouse or deer.
Miyamotoi was found in .7 to 7.5% of ticks in California in one study. It was found to be as common as Borrelia burgdorferi.
2-10% of ticks transmitting Lyme contain Borrelia miyamotoi.
Antibody testing for Borrelia burgdorferi is not effective for Borrelia miyamotoi.
Similar frequency of infection to Anaplasmosis and Babesiosis.
Unusual infection that can even lead to strokes.
Macular rashes, diffuse petechiae, erythema multiforme.
EM rash can be from Borrelia miyamotoi.
Testing - Wright Giemsa stain, Western Blots, cultures, PCRs, and monoclonal antibodies.
Can be fatal.
Fetal death and spontaneous abortion may occur.
Tetracyclines, Rocephin, or Penicillins may be used.
27% of several hundred patients had Borrelia hermsii in 2013.
Beyond Balance BB-2 may be helpful for some.

Edward Yost MD spoke on "Pain Management in Lyme" and shared:

Chronic pain in society impact 11-55% of people.
Opioid therapy often leads to addiction.
Doctors often risk their license with long-term pain medications and long-term antibiotics.
Treatments for pain in people with Lyme may include narcotics, antidepressants, anti-seizure medications, and interventional pain procedures.
40% of chronic low back pain may be bacterial in nature. Augmentin for 1 year was effective in reducing pain. 67.5% still had pain vs. 94% of placebo group after 1 year.
With chronic pain, pain begets pain, and we become more sensitive to far less stimuli.
Only use localized steroids while on antibiotic treatment for Lyme disease.
Constant pain is a fight or flight scenario and removing the pain may increase the immune response.
Zygapophyseal joint pain may utilize diagnostic nerve blocks or interarticular injections and can provide immediate relief that lasts for 90 minutes and also gives options for future treatment.
Radiofrequency ablation can resolve pain for 3-24 months and decrease narcotic use by 50%.
Patients may get depleted dopamine from chronic pain conditions.
Sleep solves a lot of chronic pain.
Short-action opioids lead to withdrawal.
Can easily overdose on fat-soluble opioids.
Methadone is often helpful but has a 36-hour potential for respiratory depressions (there is an iPhone app that helps to manage this).
Methadone metabolism may be impacted by Rifampin, Protease inhibitors, Ketoconazole, and Fluconazole.
Cipro increases methadone and have to cut the dosing.
Narcotics may reduce the immune response.
Short acting narcotics are a poor choice.
Go after NMDA (dextramethorphan).
Amantadine is dopinergic and has NMDA activity.
Consult and interventional pain doctor for diagnostic blocks or radiofrequency ablations.
No steroids please.

Neil Nathan MD presented "Got Methylation" and shared:

Methylation is adding a carbon atom with 3 hydrogens to another molecule.
It is essential for energy production, gene regulation, detoxification, DNA and histone synthesis, maintenance of cell membranes and myelination.
Methylation issues are found in nearly every patient.
The end product of methylation is glutathione.
No other substance is more important than glutathione.
Methylation is also important for building neurotransmitters (melatonin is methylated serotonin; norepinepherine becomes epinepherine), hormones, and redox reactions.
Infections are disruptors of methylation.
Nutrient deficiencies (magnesium, zinc, B6, and B12) are critical co-factors in methylation.
Environmental toxicity (mercury, lead, arsenic) impacts methylation.
Genetic mutations (SNPs such as MTHFR and CBS) are expressed as a result of stress or infection.
Methionine -> SAMe -> SAH -> homocysteine -> methionine.
TMG or Betaine can convert to DMG and go directly back from homocysteine to methionine.
They use hydroxy-B12 in their protocol. If you take methyl-B12, the body stops creating it as a result of a negative feedback loop. It shuts down the process. Can be good for some; bad for some.
If you take glutathione, the body will stop making it. Can be a double-edged sword.
You have to be aware that you can shut down the normal creation.
Amy Yasko was one of the first to talk about methylation in the 1990's in her work with autism, neurodegenerative diseases, and CFS. These are all the same problem presenting at different ages.
Rich van Konynenburg recognized that all of the abnormalities in CFS and Fibromyalgia could be tied back to methylation.
He created a Simplified Methylation Protocol that was given to 51 patients with CFS and Fibromyalgia - 20% got well and almost everyone got much butter.
Energy levels, sleep, and cognition increased while pain decreased over time on the Simplified Methylation Protocol.
Health Diagnostics has a very good profile for methylation that looks at exactly what is happening; not the genetic potential that may or may not be expressed.
In their study, initially glutathione in the serum was low. After 3 months, it increased 96.6%. After 9 months, all were in the normal range. SAMe levels were initially low, and 90% improved in 3 months.
The protocol uses FolaPro or Quatrefolic, Hydroxy-B12, Phos Serine, and a multivitamin from Yasko.
Average improvement was seen in 5.6 weeks.
Side effects of methylation - as the body begins to methylate, it may release toxins into the body faster than it can get rid of them.
It is common to need to give less methylation support and less often in many cases.
Many need to start with one dose every 3-4 days.
Side effects are almost immediate; benefits take longer.
Do not use folic acid. Do not use Cyanocobalamin (B12). 5-MTHF should be the only form used.
The SNPs do not matter that much and it is not very helpful to know what they are.
You can reverse all of the SNP expression with this protocol.
SNPs are genetic potential but do not illuminate what is expressed.
You can only find that by measuring the methylation parameters; Health Diagnostics testing.
It is best to look directly (what's actually happening) rather than indirectly (SNPs).
There is another side to the story.
Bob Naviaux MD wrote a paper on cell danger response.
We may stop methylating to prevent infectious agents from methylating. It may be intentional and an adaptive response of the body.
Methylation support may be favorable for the microbes.
At what point in the treatment is the right point to treat methylation? Generally, not early.

Joseph Brewer MD spoke on "Chronic Mycotoxin Illness" and shared:

Mycotoxins are not necessary for the function of the fungal organism but provide a competitive advantage.
There are 300-400 different mycotoxin compounds.
They are mainly toxic to bacteria (think antibiotics).
Several types are toxic to humans and animals.
Chaetomium is very common and when found, Stachybotrys is generally present as well.
Fusarium gets on grains and foods and makes 20 different mycotoxins.
Aflatoxin, Ochratoxin, and Trichothecenes are measurable with a urine test.
In 112 CFS patients, 93% had at least one mycotoxin present on urine assay.
Illness after exposure, symptoms, neurologic features, endocrine abnormalities, immune dysregulation, oxidative stress, and mitochondrial dysfunction are reported in both CFS and mycotoxin illness.
Mycotoxins are immunosuppressive and increase susceptibility to illness after a tick exposure.
All aspects of the immune system are suppressed.
Several immune suppressants used in medicine are derived from molds; Cyclosporin from Tolypocladium and Mycophenolate from Penicillium.
Drugs used clinically to suppress the immune system can be found in water-damaged homes.
Input/Output Model - input of mycotoxins into the body, external ongoing exposure and re-exposure to buildings, and internal ongoing colonization. Output is via the kidneys to the urine or liver/bile to the fecal route, and sweat. With fecal excretion, there is reabsorption that occurs in the colon.
Initial exposure may lead to symptoms. Internal mold (such as in the sinuses) may lead to chronic symptoms. Chronic mycotoxins may lead to a positive urine mycotoxin assay. Ongoing exposures lead to accentuated symptoms.
Predominant location for colonization is sinuses.
Fungi readily form biofilm.
Direct treatment of the sinuses with intranasal antifungals often leads to improvement.
Mycotoxins themselves have been found in nasal washings.
No trichothecenes have been found in people without mold exposures.
Molds form biofilms as well; increased production of mycotoxins occurs in biofilms.
Intranasal therapies are used to break up the biofilms (with EDTA and surfactants such as polysorbate 80), to reduce the bacteria that contribute to the biofilms (such as Staph; Mupirocin has a dual role as it addresses Staph and breaks up biofilms), and to address the fungal colonization (with Amphotericin, Itraconazole, or Nystatin).
With treatment, systemic die-off reactions can occur.
Amphotericin and Nystatin are not systemically absorbed.
Treatment of molds with Amphotericin B leads to increased gliotoxin (mycotoxin) production.
151 patients used Chelating PX with Amphotericin once daily. The duration of therapy was > 6 months.
Twice a day was too high for most to tolerate.
62% continued therapy for longer than 6 months.
If therapy was continued for > 6 months, 94% experienced improvement (25-50% improvement in symptoms; 1/3 are back to normal).
34% discontinued treatment; 13% had systemic die-off.
58% of the total improved and that went to 98% in those that continued therapy > 6 months.
In those that stopped treatment, 5 of 6 had a relapse.
2/3 of the patients went > 6 months without significant adverse effects. Of those that remained on therapy, 94% improved clinically; correlated with reduced mycotoxin output.
1/3 of patients developed local adverse effects that led to discontinuation of therapy.
Systemic adverse effects were identified in 13% but only 3% stopped therapy as a result.
Relapse was common in those that had to discontinue therapy.
Has now seen some that treated 1 year and then discontinued and thus far remain well.
Future options may include intranasal itraconazole, intranasal Nystatin, liposomal Amphotericin, and Micafungin.
For biofilm, Mupirocin and other combinations are being explored.
Currently has 80 patients on intranasal Nystatin. Has seen virtually no nasal irritation; identical die-off reactions and improvement.
There is a 35% change of side effects. If you tolerate the intransasal Amphotericin long-term, the chances of getting better are 95%.

The following were some of the key things that I took away from a Q&A session:

Dr. Horowitz mentioned that Babesia and Bartonella are the most difficult to treat.
Borrelia miyamotoi should be covered with Borrelia burgdorferi treatment in theory but it is unclear how effective the treatment will be in multiply infected patients; there may be a lowering of the load but not full elimination of infection.
Dr. Brewer mentioned that hypersensitivity in patients often reduces with treatment of mycotoxins.
Real Time Labs can do testing on nasal washings; same process as the urine test. Dr. Brewer does not do fungal cultures as they do not seem to be that helpful.
Sauna or liposomal glutathione may be used before the urine collection to increase the mycotoxins in the urine.
Liposomal glutathione may be used for one week followed by the urine collection on the 7th day. In sensitive patients that cannot handle the glutathione, stop as soon as they become symptomatic.
Negative test results in the urine mycotoxin testing could be that the person has a different mycotoxin than what can be tested for currently.
Nasal probiotics is not something that has been explored.
Patients MUST address external exposure of they will get re-exposed and recolonized.
Vision therapy was very good in the 20th century but is not a 21st century option. A neurological event such as Lyme is more of a visual processing imbalance than a muscle issue.
There is a transfusion risk with relapsing fever; Anaplasma and Babesia as well.
Dead DNA is generally cleared from the body in 42 hours according to Dr. Horowitz; thus, a positive PCR test is indication of a living bug.

Wayne Anderson ND spoke on "MUSES Syndrome - Low Level CO Exposure and Chemical Sensitivities" and shared:

Lyme can be the initiator of a response that turns on genetic predisposition and that can continue to run even if the Lyme has been eliminated.
MUSES presents with a chemical sensitivity with hypersensitivities to senses.
Low levels of carbon monoxide can build up in tissues and attach to the heme molecule which is later liberated and reabsorbed into the tissue unless you have enough oxygen to displace it.
MUSES patients are often untreatable until you displace the carbon monoxide.
Carbon monoxide can bind preferentially to the liver and spleen.
Any burning flame (stoves, exhaust, smokers).
Menstrual cycles lead to increased CO as a result of heme breakdown.
Interest in ANY parts per million of CO if exposure over a long period of time; will hold in the tissues if inadequately oxygenated.
Keynote symptom is sensory changes - hyperacusis, photophobia, smelling a cigarette 3 blocks away, skin sensitivity.
It can persist over decades.
MUSES - Multi Sensory Sensitivity Syndrome
People often prefer no spicy foods.
Sensitivity to hot and cold or vibration such as footsteps.
Low body temperatures.
Testing is done by capturing the last breath blown into a bag and measuring with a meter in a specific way.
Oxygen concentrators may be used as a treatment to provide the body with more O2.
http://mcsrr.org/

Dr. Anderson also spoke on "Histamine Metabolism" and shared:

Histamine metabolism can significantly impact inflammation.
Hyperhistaminemia may be Mast cell degranulation or Activation Disorder or Histamine Intolerance.
Can be a lack of DAO enzyme.
Histamine high foods may need to be reduced.
Histamine may build up.
DAO clears cell membrane, mucous membranes, and blood vessels.
Drugs that suppress DAO may lead to increased histamine.
Bacteria produce histamine (Editor's note: Including some probiotics).
Diarrhea often dominant; histamine held in mast cells where it accumulates to be released in an emergency.
Itchy skin problems; Fibromyalgia may be related to histamine.
Patient looks like a migraine patient with asthma or facial flushing, rashes, diarrhea/IBS, rapid transit, poor absorption, allergic to everything, and too much stomach acid.
If you give Betaine HCl to these patients, and they get worse, it may be a histamine issue.
Upon waking, they feel fine and get worse with each meal. They often skip meals and eat only at the end of the day.
There are more mast cells in the gut than anywhere else in the body.
Intracellular histamine - methylation issues may be a contributor to elevation. Magnesium and B6 may help.
If people are extra sensitive to alcohol, consider histamine metabolism.
Some foods have histamine and some are histamine-releasing.
Mast cell stabilizers include Ketotifen (effective but 1 in 5 do not tolerate the sedation), Chromolyn (good histamine blocker; also known as Gastrocrom), Quercetin.
Think toxins and histamine in people that cannot tolerate any medications.
Babesia often leads to anxiety and depression; Bartonella more manic ups and downs.
Sugar is an activator of histamine.
Fermented foods can be a problem for people with histamine issues.

Neil Nathan MD spoke on "Mycotoxins and MCS". He shared:

An electrical sensation in the spine is a tip off for mold.
There is a block in the methylation arena that leads to high SAH and high Adenosine that may be helped in some with Acyclovir which moves adenosine into ATP. It may take 2-3 months for the block to resolve.
Mold and Bartonella produce similar clinical pictures due to similar cytokine patterns. It is difficult to differentiate between the two; sees lots of hyperactive states.
KPU may be a consideration in patients that are inappropriately depressed. Magnesium, zinc, B6/P5P may be used.
Chlamydia pneumoniae is important.
Secondary porphyria may make some very sensitive to antibiotics. When you give antibiotics to someone with secondary porphyria, they may have what looks like a Herx but does not go away in 2-3 days; stays much longer.
Coined the term "Babonella" for Babesia and Bartonella which often come together.
There is a Bartonella/Babesia dance with the immune system bouncing back and forth with the public enemy of the day.
Uses both mold plate testing and the Mycometrics ERMI.
Transfer factors are often used in the background for a year or two.
Colloidal silver augments any antibiotic or antifungal with which it is given. Argentyn 23 is a good product.
Real Time Labs urinary mycotoxin testing has been major league help in teasing apart what may be wrong with the patient.
Cholestyramine is more for ochratoxin.
If one feels worse with charcoal, it may not be a tight bond and may be re-releasing toxins in the system.
For mycotoxins, the Real Time Labs urinary mycotoxin testing with glutathione challenge is the go to test. The VCS test from survivingmold.com is often helpful. Shoemaker labs such as VIP (only from ARUP Component Labs) and other markers often helpful.
You must ensure that you are no longer in a toxic mold environment.
First you have to bind the toxins. For trichothecenes and aflatoxin, charcoal, clay, chlorella may be helpful. Start slowly. For ochratoxin, Cholestyramine or Welchol are used.
Next, the focus is on killing mold in the sinuses. Biofilms may be addressed with BEG spray, EDTA, or ASL Pharmacy compounded solutions. Amphotericin B, Ketoconazole, or Nystatin sprays may be used as antifungal agents.
Finally, GI or other colonization is considered. For systemic biofilms, Beyond Balance MC-BFM may be used or Interfase Plus. Sporanox or Ketoconazole may be used.
Argentyn 23 may be used nasally and orally.
Diet changes include limiting carbohydrates.
Mold toxins prevent the body from making normal levels of VIP. It is a major regulator of the neuro-endocrine and immune system and controls inflammation. If you cannot make it, inflammation rages out of control.
They used to think that you had to respond to VIP in the first several weeks but have found that it will often still reboot the entire system beyond that.

Kristine Gedroic MD spoke on "Challenges of the Hard to Treat Patient" and shared:

Most chronically ill patients have virtually all of the coinfections, methylation issues, mold, and more.
You have to decide how to prioritize.
Membrane stabilizing therapy helps those that are so terrain-toxicated that you cannot get traction with any other type of treatment.
IV antibiotics damage cell membranes and membrane-stabilizing therapy may be needed afterwards.
Mold can be present or prior exposure and can be a colonizing presence that creates their own toxins in the body.
She likes the Fry Labs Advanced Stain.
Has liked a product called HepatoThera Forte for liver support.
Uses Byron White A-P and Beyond Balance MC-BAB-2 for Protomyxzoa patients.
Prometol (wheat germ oil) and Phosphatidylcholine may be helpful for membrane stabilization.
Prometol helps to support myelin production.
Viscum can be great for detoxifying the nervous system.
Cholestyramine may pull out electrolytes, minerals, and essential fats. It may make neuropathy or general nutritional status worse with longer-term use.
They often use Flagyl at the end of treatment for cysts and other protozoa.
Flagyl used orally can be problematic if also using tinctures, etc. with alcohol content.
Some example approaches to treatment may be to incorporate Beyond Balance MC-BFM with Byron White A-L Complex and/or A-P and Pekana drainage remedies. An alternate might be Beyond Balance BB-1 or BB-2 with BAB-2 or PARAZOMIN.
Soluna Polypathik is a stronger version of Viscum.
Diet is huge; all clients are gluten free. American wheat is nobody's friend.
Sugar results in cleaving of fatty acids at cell membranes.
Cage free eggs may be helpful for some. The brain is 50% cholesterol. Egg yolk is the best source of choline.
Oral phenylbutyrate has been helpful for some patients in treating fungal infections.
Lots of toxins are stuck in the cell wall membrane and are replaced with Phosphatidylcholine IV therapies.
Phosphatidylcholine helps to detoxify heavy metals; minerals are also needed to support metal detoxification.

The following notes were captured from Q&A sessions with several participating speakers.

Dr. Wayne Anderson mentioned that he starts Ketotifen at night with a sleep aid. It is worked up slowly and then small amounts before meals. As you use Ketotifen, it has a lasting stabilizing effect as the membranes become more stable.
For really sensitive people, minerals, electrolytes, cell salts, gut repair, GAPS diet may be appropriate.
Dr. Neil Nathan has worked with the Shoemaker Protocol for many years. VIP has been the most clinically useful.
Cholestyramine is helpful for ochratoxin but is not a good global toxin binder. TFG-b1 and C4a are non-specific markers of inflammation. They can go up with Borrelia, Bartonella, Babesia, mold, and other stressors.
A-BART, A-MYCO, A-RMSF may be helpful; it is surprising how many people have Rickettsias.
Beyond Balance BAR-1 is a favorite formula for epierythrocytic bacteria often identified on the Fry Labs testing. BAR-2 works well for resistant Chlamydia pneumoniae and Mycoplasma. Zithromax and Rifampin may be used for Bartonella. Doxycycline and Zithromax may be used for Borrelia and Bartonella.
Dr. Nathan likes sauna therapy but it does mobilize mold toxins and other toxins so people can get sick of they are overdoing it; time should be titrated.
Dr. Anderson discussed Calcium EDTA and Sodium EDTA. Calcium EDTA may be helpful for inflammation of vessels. Sodium EDTA in water may be used orally but does not get absorbed into the blood. Calcium EDTA suppositories may be helpful.
Dr. Anderson considers parasites to be the cause of food allergies; especially when the food allergies are universal (to many foods).
Dr. Anderson has not had one patient that has ever sat in his office that tolerated gluten.
Dr. Anderson may use Actigal for gallbladder and bile support based on the color of the stool. Want to have dark brown stool.
Phosphatidylcholine assists in emulsifying biofilms and appears to be anti-infective.
Pekana apo-HEPAT supports Phase 1; Syntrion SyDetox supports Phase 2 liver detoxification.

Charles Ray Jones MD spoke on "Brain on Fire: Infection-Induced Autoimmune Encephalitis" and shared:

"If the mind doesn't want to know, the eyes will never see."
Has seen over 10,000 children with Lyme.
An EM rash is a rare entity.
The duration of attachment that leads to potential infection can be in minutes.
The Western Blot is not a test for Lyme disease but for serological exposure to the Lyme bacteria.
Advanced Labs Borrelia Culture is a very helpful tool.
NeuroScience has a nice test for T-cell sensitization called MY Lyme Immune I.D.
There is a lot of "dumbness" associated with Lyme (not meaning patients but meaning how Lyme is perceived and approached).
PANDAS / PANS - sudden personality changes. Can go into demonic type activity. Psychosis, emotional lability, rage, anxiety, separation anxiety, bedtime fears, rituals, issues with food, deterioration in cognitive functioning, and hyperactivity may present.
90% of our genetic makeup was created by microorganisms. Lyme, Mycoplasma, Herpes viruses, Candida may be important in the development of PANDAS / PANS.
Measles vaccine-induced autism has been reversible with IVIG therapy.
We are all bugs.
Once we make antibodies to an infectious agents, we will make antibodies to ourselves.
Children with PANDAS / PANS are often ANA positive.
Strep, Lyme, tick-borne microbes, Mycoplasma pneumoniae, Candida, and other viruses and organisms can all trigger autoimmune encephalitis.
Eradication of the infectious agent that leads to the autoimmune process must be considered. If that does not stop the condition, IVIG may be added.
IVIG replaces IgG in immune deficiency and modulates the autoimmune process. Often needs to be higher dose as lower dose may stimulate T cells to make more anti-neuronal antibodies.
Success requires both eradication of the infection and reversing the autoimmune process.
Plasmapheresis alone does not work.
One can get severe Herxheimer reactions with high-dose IVIG but it is absolutely necessary in many cases.
Dr. Jones is working to start a charitable trust for IVIG treatment access. Lots of children are waiting in the wings to get treatment.
PANS is PANDAS without strep.

The final Q&A session shared the following:

Lactoferrin and Xylitol may be useful biofilm agents according to comments from Dr. Shor and Dr. Jemsek's work. Stevia has biofilm activity.
Babesia duncani is often more difficult to treat than Babesia microti.
If you have Babesia, you don't just have Babesia.
IV vitamin C is not a great treatment for Lyme according to Dr. Steve Harris, but it does have other benefits.
Dr. Stricker mentioned a dozen porphyria patients that likely already have porphyria but it came out when they got Lyme; may have abdominal and skin issues. Many drugs that are used for Lyme are on the avoid list for this patient sub-population. Often porphyria gets better when Lyme is treated. There is a urine test for porphyria from LabCorp and Quest.
Histamine testing is available from Health Diagnostics and Research Institute.
Morgellons is associated with Lyme per Dr. Stricker and one should treat for Lyme. There is a parasitic component as well and antiparasitic treatment can be helpful.
Dr. Horowitz does test MTHFR and also looks at B12, folic acid, methylmalonic acid, and homocysteine levels. High methylmalonic acid may suggest a need for methyl B12 or hydroxy B12 if overmethylated. High homocysteine may indicate a need for B6, B12, or activated folic acid. May also use SAMe or TMG in some patients. Some may overmethylate and not tolerate methyl B12 or may have another block and may need to explore Yasko, 23andme, Doctor's Data, or Genova testing.
Grapefruit seed extract or Flagyl may be helpful for Borrelia cysts.
Byron White EBH6 may be helpful for viral reactivation.
Diatomaceous earth was mentioned as an option that may help some children with autism or PANS or help with parasite burdens in adults.
HBOT stimulates nerve stem cell functions and helps with traumatic brain injury and PTSD.
Dr. Horowitz mentioned that some believe that there can be reactivation of Babesia with HBOT. Dr. Shor suggested that there was study done with HBOT and malaria that did not see this finding and that his Babesia patients improve with HBOT.
Dr. Horowitz mentioned that penicillins, cephalosporins, and macrolides are generally safe for pregnancy. Macrolides do not cross the placenta. The preference is to have the patient on antibiotics during pregnancy if they have Lyme to prevent possible transmission. If starting antibiotics in the first trimester using Category B drugs, every child has been fine. There is a risk/benefit that has to be considered.
There was a concern expressed if one is not breast feeding as the child is not getting colostrum, but there may be risk of transfer of infection as well.
Dr. Jones mentioned that if a mom has Lyme and wants to breast feed, they should be on antibiotics. Intrauterine transfer can be avoided if on two antibiotics. 50/50 chance if on none; 25% if on 1; less than 1% if on 2.
All organisms can be transmitted through the breast milk.
Dr. Jones supports vaccinations being separated out and live virus vaccines after 3 years old; no bundled vaccines.
Milford Labs offers a test for Borrelia miyamotoi.
Bee venom may be helpful for some. Dr. Dietrich Klinghardt is the world expert. May help with peripheral neuropathy and pain. Greg Lee mentioned that there can be big Herxheimer responses even with nasal bee venom.
100-200 billion probiotic organisms is a moderate dose. 1 trillion is a high dose per Dr. Steve Harris. Suggested best to rotate brands and strains.
In a quite ill patient with high CD57, consider coinfections. Dr. Stricker mentioned that there is a lot about CD57 that we do not know.
Dr. Stricker mentioned the possibility of sexual transmission and that Borrelia has been found in semen and vaginal secretions.
Horowitz mentioned reverse sleep cycle clearing/normalizing after Babesia and parasite treatment.

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.

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BetterHealthGuy.com is intended to share my personal experience in recovering from my own chronic illness. Information presented is based on my journey working with my doctors and other practitioners as well as things I have learned from conferences and other helpful resources. As always, any medical decisions should be made only with the guidance of your own personal medical authority. Everyone is unique and what may be right for me may not be right for others.