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The Traditional Western Blot Test

Posted on May 15, 2017 in Blog |

The following is an excerpt written by Dr. B.Robert Mozayeni included in our book Lyme Savvy: Treatment Insights for Lyme Patients and Practitioners. In2008, when I looked at Borrelia Western blots I gave it sort of a 3 or 4 out of 10 in terms of how confident I would be in the result if I saw a positive. There are some Western blots so glaringly positive that no one would argue them. That is part of the problem with the test. The result produced is along a spectrum of potential levels of confidence with great variability of clinical context. You can have a couple of weak bands and to a really sick patient with no other answers – those results can justify their treatment. To a healthy patient, the same results would be interpreted as negative or normal. Context is always important, not only for interpretation of test results, but for choice and timing of treatment. Great — but what if you get the wrong treatment because you have Bartonella causing weak positive bands on the Borrelia Western blot? Then you are going to have only a temporary improvement and a relapse. Then Lyme doctors will start telling you “we can temporarily get you better but we cannot fix you.” Usually, as much as they may try, they don’t actually know the cause; or they do know and may not have the right treatment. If you see only IgM-positive bands on the Lyme Western blot, then you definitely need to test for co-infections, especially Bartonella. The Borrelia Western blot scores a 3 or 4 out of 10 in terms of my general confidence level because it is an indirect test, looking at antibody responses to a germ. There is nothing better than actually directly detecting a germ such as by detecting its DNA signature or at least its unique proteins encoded by the DNA. Then you can be sure you have that microbe. Unfortunately, a sensitive and specific test like this has not been available for Borrelia. Lately, some companies have developed enrichment culture methods. This is encouraging but fraught with pitfalls for potential contamination. We need more...

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Lyme, Borrelia, Bartonella, Protozoa

Posted on May 14, 2017 in Blog |

The following is an excerpt Dr. Mozayeni wrote from our book Lyme Savvy: Treatment Insights for Lyme Patients and Practitioners I think when Borrelia is present, it tends to be associated with joint pain and sometimes joint swelling because the lining of the joints is very vascular; it is getting its nourishment from the vessels of connective tissue. The lining itself of the joints is the synovium and the synovial tissue is highly vascular. That is why there is a lot of action and a lot of symptoms related to synovial inflammation with all of these chronic infections, Bartonella and Protozoa included. Given this new perspective, the question then becomes: How does this realization shift the diagnostic and therapeutic emphasis? You have to look at Bartonella with the best available test. You have to look at the Protozoa with the best available test, and You have to understand – It is a far stronger form of evidence when you have molecular proof of these infections using these new tests than having a few antibody bands on a Western blot. We need to use molecular tests to succeed more with our therapies. Share...

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Traditional Tick Bite Treatment

Posted on May 13, 2017 in Blog |

The following is an excerpt written by Dr. B. Robert Mozayeni from our book Lyme Savvy: Treatment Insights for Lyme Patients and Practitioners. Traditional Tick Bite Treatment Diagnosis for Lyme Disease is not simple and neither is treatment. Let’s move out three months from the original tick bite and classic ECM rash. Now we have a patient who is ill and the antibody tests are still not clearly positive. In the meanwhile, that person has already had the standard two weeks of doxycycline because a practitioner wanted to allay the patient’s concerns even though the Western blot done in the beginning was negative. Let’s assume the Western blot has slightly changed, but not in any way that convinces anyone. In other words, they might have one new IgG band or maybe the total antibody, or the EIA, is now slightly positive or weakly positive. Now we have this symptom complex and it is not clear. In other words, there is no other explanation and we cannot prove it is from the original event. At this point, doctors who believe that only a two-week protocol is necessary to start calling this post-Lyme syndrome. They may not call it that until it is a few more months out. They might give the person up to 30 days of doxycycline. They might even add another antibiotic if that didn’t work. But to those who believe antibiotics are uniformly 100% effective against Borrelia there is no other explanation other than calling the problems the patients is experiencing post-Lyme syndrome. Other physicians are apt to believe it is common sense that this patient still has Lyme Disease because the patient originally had the tick bite with the diagnostic ECM rash. At this point, because there is no other explanation, we need to simply intensify or extend the treatment for chronic Borreliosis. The point to make about this debate is it can exist only in the absence of good information. You can have this argument over what it is and what it isn’t because you really don’t have any way to disprove or prove either theory. So people argue over whose evidence is bigger and...

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Case Study: The Tick Bite Wasn’t Lyme

Posted on May 1, 2017 in Blog |

Lynn’s journey began during a family football game on Thanksgiving Day, 2006. She pulled a tick off her arm later in afternoon. Two weeks later, Lynn developed a fever and back pain. She had no rash. She thought she had the flu. She mentioned the tick bite to her physician, but he assured her it was too early to see any symptoms of Lyme Disease. Nevertheless, he gave her 28 days of Doxycycline. She returned a month later, still complaining of vertigo and back pain. “You are anemic. You need to eat more protein.” One afternoon, during a trip to the shopping mall, she had to lean down and place one hand on the floor and one on the wall to keep the world from spinning. The doctor treated her for an ear infection. They ran the ELISA test twice, both returned negative. Two months after her tick bite, Lynn’s personality was completely flat. A small group of girlfriends had flown from Texas to surprise her for her birthday. All she wanted to do was sleep. She couldn’t understand the jokes her girlfriends were giggling about. By the end of January, she was in the Emergency Room with such fatigue she couldn’t catch her breath. She was jumbling her words, her speech slurred. This 34-year old mother of two toddlers was showing signs of a stroke. A CT scan revealed peri-carditis. She was sent to a cardiologist, then a neurologist, and an endocrinologist. She visited nationally acclaimed medical centers in the Midwest, Florida and Virginia. She said they told her they don’t know how to treat your Lyme, but we can tell you how to eat differently. “Become a vegan,” one physician suggested. From January through April, 2007, Lynn didn’t drive because of the vertigo and because she had gotten lost while driving the three blocks between her home and her daughter’s school. Significant memory loss followed. Her church started bringing dinners over because she was burning dinner every night. “I would forget I was even cooking any food,” Shannon admitted. Two years after her tick bite, Lynn tested positive for Bartonella in Dr. Mozayeni’s office. Her brain and...

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Testing and Diagnosing for Lyme

Posted on May 1, 2017 in Blog |

The following is an excerpt written by Dr. B. Robert Mozayeni from our book Lyme Savvy: Treatment Insights for Lyme Patients and Practitioners Blood Test for Lyme At the time of the tick bite and the rash, if someone has never been exposed to Borrelia before, they will not have antibodies to the Borrelia microbe. It takes usually six to twelve weeks to see antibodies to Borrelia. These antibodies initially develop as Ig-M, within two to four weeks and then later as Ig-G within six to 12 weeks or more. To evaluate a tick bite, the first test we do is the Western blot test. It should be done within a week or two before the exposure causes antibodies. This is to determine what the baseline antibody level was before the bite. It does not yet reflect antibodies produced as a result of a Borrelia exposure. Typically, three months later one re-tests for Borrelia by the Western Blot to see if there has been a change in the antibody response between the initial and the 12-week post-bite test. Bayesian Probability Decision Making I want to make an important point here: Many clinicians and patients don’t understand it takes time (weeks) to produce antibodies. I have seen many errors of diagnosis being made when the clinical history was classic for Lyme Disease and strongly diagnostic. When you have a high probability of Lyme Disease before any testing, that probability cannot be altered by the result of a negative test because the prior probability was so high. This is called Bayesian probability decision-making. It is the standard clinicians should use to make decisions. Lately, Bayesian adaptive clinical trials have become the leading edge method for conducting clinical research. It is all about probabilities. You have to know what your prior probability was before an event occurs in order to gauge whether or not that event really matters in your adjusted probability after an outcome is observed. In the case of a clear-cut tick exposure, ECM rash and Borrelia, you can be certain you have Lyme and a negative test result should not change your mind. In numerous consultations, I encountered physicians...

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