Interview with doctor ADAM BIERNACKI – internist dealing with among others treatment of tick-borne diseases as well as chronic ones
You are treating patients who are struggling with chronic diseases. Can Lyme Disease be a chronic disease?
Yes, Lyme disease can be chronic. I have patients who are mainly in this stage of Lyme disease. Earlier, they usually try to find the cause of their malaise for months or years, visiting many specialists along the way. Sometimes they come to me with previous tests confirming Lyme disease, and sometimes during a clinical interview it turns out that the patient once bitten a tick or otherwise could have been in contact with the Lyme spirochete. Then I commission diagnostics in this direction.
Blood tests, however, are not 100% effective, so how to diagnose chronic Lyme disease?
Indeed, blood tests can be unreliable in the diagnosis of Lyme disease. There are none that would confirm or rule out the disease one hundred percent, that is why every stage of conversation with the patient and an accurate clinical interview is so important. Sometimes the situation is very complicated and making a proper diagnosis is not easy, but together with the patient we try to stave off the intricate bundle of symptoms and go back in time, searching for the reason. Sometimes we come to the point of infection, eg. the patient recalls that a tick had bitten him years ago. Often it is impossible to determine exactly the time and place of exposure to the tick. Lyme tests are another diagnostic stage. It should be remembered, however, that not all people who are bitten by a tick carrying the spirochete of Borrelia will develop chronic Lyme disease. It depends on many factors, including how many bacteria the tick had in them and whether they were very active. Some will be able to defend themselves against them and the disease will not go into a chronic condition – for example, they have an efficient immune system or will receive antibiotics shortly after contact with the tick due to other infections or severe erythema on the skin. Sometimes, however, usually when there are any problems with resistance or the burden of other chronic diseases, they will become seriously ill. Considering the number of infected ticks in Poland, it is worth considering the solution proposed by ILADS (that is prophylactic administration of an antibiotic after tick bite – ed note) and carefully consider all the benefits and risks individually for each patient in case of such prophylaxis. In my opinion, the patient should be informed about this eventuality and have the opportunity to choose, because it gives a chance to avoid infection or reduce the intensity of symptoms if it comes to it anyway.
And if there is an infection and the disease is not diagnosed in time, what are the specific symptoms of late Lyme disease that can facilitate correct diagnosis?
Unfortunately, the symptoms are very diverse, similar to the symptoms of neurological, rheumatological and endocrine diseases, which causes that sometimes a few weeks or months of specialist diagnosis and often only after the exclusion of other diseases a test for Lyme disease is performed. Patients who reach me generally complain of chronic inflammation, the causes of which are unable to be determined. They often also struggle with immune system disorders. In addition, there are hormonal and metabolic disorders … Their condition is often very serious; sometimes it prevents them from functioning normally.
Lyme disease alone can cause such serious consequences, or should co-infections happen?
It is sometimes the case that Lyme disease is just a starting point: by interfering with the immune system, other bacteria and viruses, as well as parasites, easily attack the weakened organism. Sometimes, however, the tick simultaneously infects the patient with several pathogens, immediately causing a strong severity of symptoms.
How often do you meet patients infected by a tick with several pathogens at the same time?
Infections with several pathogens are not uncommon, but if you mention, for example, Bartonella or Babesia which are pathogens that cause the most frequent co-infections, they are not transmitted only by ticks. Bartonella can be infected eg from a cat. It does not necessarily have to be transmitted to the tick. There is also a large group of bacteria or viruses whose carriers may be ticks, but which people with Lyme disease can easily infect elsewhere due to the fact that Lyme disease, damaging its immune system, facilitates their access to the body and makes it susceptible for infections. Such infections in patients with Lyme disease often go into chronic conditions, sometimes causing many serious symptoms.
Do you mean Mykoplasma, Chlamydia …?
Among other things … Such bacteria and viruses that can be infected, for example from family, neighbors or at work, are many. The fact is that patients with chronic immunodeficiency have much more severe symptoms than those with efficient body defenses. Such bacteria can also cause chronic inflammation. Sometimes they can cause much more serious and severe symptoms than Lyme disease itself.
Therefore, in order to cure chronic Lyme disease, all this must be taken into account, that is, any possible infection with bacteria and viruses, which in healthy people could not cause serious symptoms, and in patients with Lyme disease can be a serious problem?
Yes. And it is especially important when the patient has symptoms that do not necessarily match Lyme disease, or which he had before the exposure to a tick. It may then turn out that Lyme disease has intensified the symptoms of the disease that existed before. Of course, if possible, you must also diagnose all co-infections.
And what if the symptoms of Lyme disease, coinfections and other infections overlap?
This may happen, but I would not demonize it, because generally associated antibiotic therapy (treatment with several antibiotics simultaneously) recommended by ILADS affects the majority of coinfections and other pathogens. An antibiotic does not choose a goal. It destroys all bacteria that are sensitive to a given antibiotic, unfortunately, by the way also those “good ones” (eg, bacterial flora in the intestines). It is necessary to disenchant the thinking that there are patterns that heal only one infection. The good news for the patient is that each set of antibiotics (we are talking about treatment according to ILADS recommendations) works in a multi-directional way. It is not that first you heal Lyme disease, then one co-infection, then the next and subsequent infection …
Unless we’re dealing with Babesia …
Babesia actually requires a different therapy. It is a protozoan. However, when treating a patient, first you have to focus on the goal that you can achieve most quickly. The idea is to reduce the amount of bacteria that exhaust the patient the most, eliminate the symptoms that worsen him most.
And only then take care of Babesia?
Babesia requires similar treatment as in the case of malaria. Unfortunately, medications for it are sometimes difficult to tolerate by the patient. They show high toxicity. Therefore, it seems right to get rid of other pathogens first so that the patient can gain strength before this difficult therapy. Nevertheless, the treatment method should in each case be determined individually depending on many factors, including the symptoms, general condition of the patient or tolerance to individual medications. When planning a therapy, you must also remember about antifungal and antiparasitic treatment. Very important is also a non-destructive, sensible diet taking into account the patient’s energy needs and possible food allergies, supplemented by intensive probiotic treatment.
Are herbs useful in the treatment of tick-borne diseases?
Yes, I think that herbal treatment is a good supplement to the therapy, but in my opinion, the choice of herbal treatment should be very individualized, tailored to the current condition of the patient. In therapy, I use schemes developed by Cowden and Buhner and my own diagram consisting of three preparations, which in addition to antibacterial activity has a strong immune system modulating action. Sometimes I use them before ordering a patient the antibiotic therapy, sometimes after its completion. Sometimes patients do not want or for various reasons can not use antibiotics at all, then they remain on the herbs themselves. For many, they turn out to be effective. However, I always advise to monitor the function of the body, that is, regular testing, because the patient has only one liver and two kidneys, and these herbal treatments are very intense (as well as antibiotics), and the doses of herbs used there are really large. Sometimes patients think that if they are using herbs, they are certainly not harmful. Meanwhile, these are really strong preparations and you need to be careful.
Do you combine antibiotic therapy with herbs?
I do not combine whole herbal patterns with antibiotics, because it seems to me that such treatment would be too intense. These are two different therapies. However, with antibiotics I recommend herbal preparations acting protective as a supplement, for example sylimarol for the liver.
What are the chances of patients having chronic Lyme disease and co-infections for complete recovery?
It all depends on what you understand by the term “recovery”.
Totally? Without any symptoms?
As for completely asymptomatic patients after treatment, it is difficult to determine their percentage. In the United States, a survey of 2018, covering 3,500 patients with confirmed chronic Lyme disease, appeared. 52 percent of patients after antibiotic treatment according to the standard IDSA recommendations (one antibiotic used for 21 days) reported improvement and reduction of symptoms. In my opinion, 70-80 percent of patients treated with combined antibiotic therapy or herbs feel improvement. There are asymptomatic patients in this group and people with significantly reduced symptoms, such as those that do not make it difficult to return to work or take up social roles. About 20-30 percent of patients have troublesome symptoms despite treatment. Perhaps even the infection itself is cured, and they either suffer from some additional infection that we can not find, or, for example, have genetic defects or other unrecognized chronic diseases, heavy metal intoxication, toxins … In any cases, these symptoms do not disappear despite treatment. One should then look for other causes of these ailments than tick-borne diseases. This generally applies to patients who have had severe symptoms for many years. In the vast majority of cases, however, even if it is not possible to completely resolve all the symptoms in a given patient, it manages to improve the quality of life.
Interview lead by Małgorzata Tadrzak-Mazurek