Podcast 31 - Lyme Disease

Transcription

Chad Edwards: This is Dr. Chad Edwards and you’re listening to podcast number 31 of Against the Grain.
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Chad: Are you tired and fatigued? Are you frustrated with doctors because they just don’t seem to listen? Do you want to fix your pain without surgery? If you answered yes to any of these questions then we are the clinic for you. We offer Tulsa prolotherapy, PRP, or platelet-rich plasma therapy and stem cell injections, IV nutritional therapies, bioidentical hormone replacement therapy and functional medicine to get you back on track to optimal health. Call our clinic at 918-935-3636 or visit our website at www.revolutionhealth.org to schedule your appointment today.
Male: Welcome to Against the Grain podcast with Dr. Chad Edwards where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories, from real patients, to help you on your way to a healthy lifestyle. Get ready, because we’re about to go Against the Grain.
Marshall Morris: Hello, hello. This is the incredibly tall Marshall Morris here and today I’m joined by Dr. Chad Edwards who believes that 80% of the medical recommendations are crap, technically speaking here. He is the author of the book Revolutionize Your Health With Customized Supplements and he served in the US army for 23 years as both an enlisted soldier, and as an officer, as a physician. He graduated from medical school at Oklahoma State University and he is the founder of revolutionhealth.org, and this podcast Against the Grain. Thanks so much Dr. Chad Edwards.
Chad: Marshall Morris, you are a rock star.
Marshall: [laughs] I try not to mess up that introduction because you do have quite the accolades here, but really your focus is this podcast and helping other people, reaching a broader group of people that are having the same symptoms and issues across the country.
Chad: Yes, that’s exactly right. Obviously we started this podcast because we wanted to let people know that there are other ways to approach things, and there’s another method than just the traditional inside the box, here’s your problem, here’s your pill, have a good day. We’re trying to educate people across the board on all different kinds of things. We talk about hormones, we talk about Tulsa prolotherapy stuff, muscular skeleton pain. Today, this is a topic that– I don’t want to say I stumbled on to by accident, but I had patients that came to me that– certainly, some of these issues were not my wheelhouse, so was not the expert in this stuff, but they came to me with these problems and conditions, and who was I going to send them to? I didn’t have somebody, say, for some well know experts on the East coast, or something like that. I had to do the best I could, and I had to do a bunch of research. That don’t make me the expert today, that’s my disclaimer, but I’ve got some experience and as I’ve looked through the literature, learned a lot about this stuff.
Marshall: Okay, so let’s get into today’s hot topic.
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Male: Hot topic.
Marshall: What are we talking about Dr. Chad?
Chad: Today is Lyme disease.
Marshall: I know it’s Lyme disease. In Oklahoma, I think it’s ticks that carry Lyme disease. Is that right?
Chad: Yes, well across the board. The borrelia burgdorferi is the name of the bacteria that traditionally has caused Lyme disease. Now we’ve since have identified a couple of other bacteria that can cause the disease related symptoms. Interestingly you mentioned, and this is a tick born illness, meaning you get bit by a tick that carries the borrelia burgdorferi– there’s a couple of different ticks that carry it. You get bit by a tick– there’s different thoughts. Some people will say you have to have the tick on you for a number of hours before you can transmit it. I think there’s a lot of controversy with this topic in– Some people would say that Chronic Lyme disease, which we’ll talk a little bit about, doesn’t really exist, that it’s just like Rocky Mountain spotted fever.
You get the bacteria, it causes you to be sick, you take antibiotics, it goes away, you’re done. I have seen way too many patients that it just wasn’t that simple. They got bit by a tick whether they knew it or not, they had a rash, whether or not they had a rash, and now they’ve got a whole host of these symptoms. We’ll do some testing and sometimes it’s a slam dunk, yes, this is no question, Lyme disease, and sometimes we’ll do a test just a little bit more gray. I really want to delve a little bit deeper into the testing and where the criteria for this testing came from, because it really changes how you have to view Lyme disease and its diagnosis and how you follow it. That’s really one of the big issues with this condition Tulsa prolotherapy.
Marshall: What are a couple of things that might indicate that I have Lyme disease? How would I know?
Chad: Yes, so I think it’s important to start with the acute phase of Lyme disease. So first you have to be exposed, you have to have had a tick bite. Now you don’t have to know that you had a tick bite. We’re not aware of any other method of transmission, save for maybe like a blood transfusion, or something like that, but we can’t tell– We don’t think it’s transmitted sexually, but there is a question about that in some people’s minds. Syphilis is a spirochaete, that’s the kind of bacteria that borrelia, or Lyme disease, is, and clearly syphilis is spread– you can communicate that sexually, so there’s a question of can you transmit this sexually, and I’m not aware of any confirmed cases, but there may be some out there, I just don’t know.
So some symptoms. You got to be exposed. It’s also important to understand, the adult tick, it’s a certain size and usually you can see it pretty well, but there’s also these nymphs, these ticks, and they can transmit it as well, and they’re like these seed ticks, and insects, or, well arthropods, these insects and spiders, and ticks, they have different phases of their life, and they go through different stages, and nymph is one of them for a tick, and so there are these little bitty seed ticks, the head of a pin. They’re really, really small, and they may be very, very difficult to see, and they can transmit the bacteria, so you may never really even see a tick bite.
One of the most classic symptoms associated with Lyme disease is a rash called erythema migrans, and that is a circular rash and that is supposed to represent the bacteria spreading through the tissue, or through the skin, in a circular, or almost a bull’s-eye, or targeted lesion around the tick bite. Again, I guess, today is where we’re recording these podcasts, I’m telling all my stories. Last summer I was out with a buddy and I was kind of in my dress clothes, and he was like, “Hey, come out with me.”
Actually it was Brian and we were in his back yard, and he’s got some woods behind him, he’s like, “Come out, we were going to go collect some firewood.” So I go out there in my dress shoes and I’m collecting firewood, remember we’re in jeans, and I get back home and the next day I have a tick on my inner leg. I pulled the tick off in like two days later, a day later, or something. I’ve got this rash, it’s a little bit soar, red rash around that thing, and I call one of my physician buddies and I was just like, “You know I got this thing. I was bitten by a tick. I don’t really know,” and she a functional medicine doctor. In fact her name is Dr. Bette Bischoff and she is absolutely phenomenal. Her website, if you wanted to look her up, she’s in Tulsa, is Your Best Life Tulsa prolotherapy.
Just Google her, she’s amazing. So I called her, and she’s the one I trusted with this, and she said that– She is such Lyme-phobic, she was like, “Here’s a 28 day prescription for antibiotics. Just take it, don’t worry about it, deal with the consequence of the antibiotics later.” I was like, “Okay.” That went away and I was fine. I haven’t had a problem or symptom since, but I had this rash. Now that rash only shows up 50% to 80% of the time. That means 20% to 50% of the people– and there’s different statistics out there, some people would say it’s even less than that, but half the time you don’t even get a rash. So, you may not see the tick, you may not get a rash, so what do you get?
Well you get the stink, the crud, so you can have fever, you can have headaches, you can have joint pains, neck stiffness, heart palpitations. It’s all these vague kind of things, so some people could think, “I just have the flu,” especially, didn’t get a rash, didn’t see a tick, “I have all these symptoms, I must have had the flu.” The difference is most of the cases of Lyme disease are usually in the summer because that’s when people are out in the woods more, we get more tick bites and things like that. Ticks aren’t out when it’s-20, so you’re not going to get Lyme disease if it’s -20 outside. Those are some of the symptoms that you can get, so it’s this very, very vague presentation in the acute phase, coupled with you may not have a known exposure, and certainly here in Oklahoma– I had a patient that went to see, I believe it was her rheumatologist, and she literally had every possible criteria both clinically, meaning her symptoms, and her laboratory diagnosis. She had every one of them, 100% of them, and her rheumatologist looked at her and said, “Well, I know this looks like Lyme disease, but it can’t be Lyme disease because we don’t have Lyme disease in Oklahoma.”
Marshall: [laughs]
Chad: When she told me that story my jaw hit he floor. They didn’t have Lyme disease and lime Connecticut period in 1974 or five, whenever they diagnosed it initially. In theory we didn’t have it then. No one had identified it. So we as physicians need to be vigilant that just because we don’t know it doesn’t mean it doesn’t exist. And it’s just maddening that we can be so dogmatic as to say, well we don’t have that here so I can’t do that. You can get punched in the face and say well, that guy is not mad at me so it couldn’t have been a fist in my face. I mean give me a break. If it walks like a duck, quacks like a duck, you know consider it maybe a duck. I’m just saying. You don’t need to go to medical school to figure that one out Tulsa prolotherapy.
Marshall: So I maybe have one or none of these symptoms and the next step is to go in and see my physician.
Chad: Yes and again you got to be careful about what physician you see because not everyone believes in this process. In some you might go see your doctor and think well I may have been exposed, I may have these symptoms, it’s very vague, I have some headaches or fever or something and they may or may not treat you at all and then they may give you this like a 10 day course of antibiotics. Again this is where it gets really, really tricky and really controversial. Because there’s a lot of controversy that says you treat for two weeks and that’s sufficient. I can tell you from my experience that I don’t believe that the number of patients that I’ve seen with Lyme disease, are crazy and they took a round of antibiotics and it wasn’t sufficient. They went back and their doctor was like well, I don’t know what to do. Are they saying they’re making it up?
It’s– we literally prescribe, like in our last podcast, we literally prescribe proton pump inhibitors for years and years and years, but we won’t treat a patient with suspected Lyme disease for more than two weeks. I mean it just doesn’t make sense to me. We’re not consistent with this as thematically or we minimize our medical treatment and we– I would argue we over treat some patients and way, way, way under treat some patients. And I think Lyme disease– many Lyme disease patients fall in this category. So we spend most of that time talking about acute Lyme disease but then you can also have this chronic Lyme disease which is also known as post lime syndrome and there’s again a lot of controversy about this stuff and a lot of it has to do with the diagnosis. And how do we diagnose true Lyme disease and have you been exposed? And so I think the next thing to do is to go through preventing Lyme disease and the testing of Lyme disease and I think it would be a good thing to do after the break Tulsa prolotherapy.
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Marshall: All right and we are back and we we’re talking about Lyme disease and identification and the testing of it is grounds for some controversies. So Dr. Edwards, begin getting us into a lot of different clinics and hospitals they’ll actually test for this and why it’s a big deal.

Chad: Yes, that and it certainly is a big deal and I remember when I first started looking at it and testing for Lyme disease, I had a patient that came to me that wanted a test by igenex. A lot of controversy with igenex but they wanted this lab test and I was like I’ll get it but I don’t know that I know how to interpret it and then so I tried to be as candid with them as I could and the interesting thing to me is so many physicians will refuse and they’ll say I’m not going to get that test, its hard wash. Well, what do you care? The patients’ asking for it, they’re willing to pay for it. It’s not an insurance deal. What do you care? I mean its offensive. It could I’m so freaking high horsed about it. I mean it’s really maddening and it really irritates a lot of patients and I don’t understand it. But regardless, so this patient came in. I didn’t know how to interpret the test and– but the patient said hey I want this thing and I was like well, all right. I don’t know if I can help you with it but there you go.
Now I try to educate them because we’re supposed to know more about this than the patient does. So I got this test. The– and the– we’ll talk about what it means in a minute. But you know your standard physician, they’re going to– the patient goes to– before I started doing functional medicine, a patient came to me and said, I think I got Lyme disease. Then I’m going to say okay, let’s go ahead and get some blood tests and we’re going to check antibodies. And this is established by most insurance companies and it came about – these diagnostic criteria came about because of epidemiologic data by the CDC. So the Centre of Disease Control said out, “Here’s the criteria that we’re going to use to follow who has Lyme disease and it’s an Elisa test or an anti body test, serum, blood antibody test and if that is positive then as of screening test, so screening test are supposed to have a high level of sensitivity.” Sensitivity means that we catch almost everybody that’s got it. But it may catch some others as well. So it’s not specific to Lyme disease but we want to make sure we catch everybody.
Then we do a specific test with the western blot test and that’s a specific lab test where they– I think it’s like a gel electric for instance. It’s probably the best way to describe it and they put the proteins or the blood in these little wells that run electricity through it and it migrates to this gel at certain rates depending on the size of the proteins and we’re looking for these certain killer Dolton sizes of proteins and then we look at these patterns. And they’ll show up as burns in this gel. And then based on what we see, then we’ll see that’s a positive western blot or not. If you don’t have a positive antibody test, because again that sensitive test, is supposed to catch everybody. And then we do the more specific confirmation test. And that’s exactly how we diagnose HIV. We use a sensitive anti body test and then we confirm with the western blot because its– you may have a positive antibody test but that doesn’t mean you have the disease. You got to get the confirmation test and since that’s very specific to that disease, they will say okay. This was a false positive test because you don’t have this. That’s how that western blot is used.
So the problem is that they have looked at studies where patients had culture positive nerves. We draw your blood out. We culture it out and the bacteria grows. So that can’t happen unless you have the bacteria. Of the ones that grew, only 30 to 70% wide range, 30 to 70%of those patients were antibody negative. They didn’t have antibodies against the bacteria. So remember the screening test is supposed to be very sensitive. It’s supposed to catch everybody. 30% and certainly not 70%, that doesn’t – that doesn’t qualify as criteria as a screening test. It’s ridiculous to use that as a screening test. And most doctors don’t understand that. A lot of patients don’t understand that and so we’ll get these antibody tests and you were in the past, I would look at this and say this okay well your antibodies are negative, so you don’t have Lyme disease.
To me it’s pure crap like 80% of medical recommendations are crap. That’s part of it. So if the antibodies are negative they won’t go on to do the western blot. Now the other thing about the western blot test is there’s two different antibodies that we’re looking at. We’re looking at an IGM western blot and an IGG western blot. We’re looking at two different sections. And there’re two different antibodies that your body makes. The IGM comes out faster after an immunologic exposure. In other words, you get any kind of antigen whether it’s the flu bacteria, anything and your immune system has to mount the response. IGM is the first one that comes out. Then you make this more specific through a series of immunologic components. You start making IGG antibodies which are much more specific to that specific antigen.
And– but that, the IGG process takes time. IGM’s much quicker, it doesn’t stay in your system as long and then you have the IGG that comes on. So we’re looking at IGM and IGG on our western blot. Now the CDC criteria for this epidemiologic stuff says that you have to have two bands positive on your IGM or five bands positive on your IGG. If you don’t have two and five and there’re specific bands that they look at on that Western Blot which is those little bands we talked about going through the jaw. If you don’t have that then they say it’s a negative test. Now the interesting thing, and I talked with Dr. Crist. He’s a Lyme disease expert out of Missouri, and I actually talked with him about this and one of the things that he consistently says is, if a patient has at least one of these specific bands, 97 out of a hundred of those patients with one band positive get better on antibiotics.
Now that’s not diagnostic. That doesn’t mean they had Lyme disease. And I think it’s important to make that distinction, but they got better. Your patient came to you with a problem. You tested for something. You treated them for it, and they got better. Well okay, at the end of the day that’s my job; to make that patient better. Not to sit there and argue with them about, well this is or is not this diagnosis. Now I’m not an advocate of willy-nilly throwing out antibiotics. Any question listen to the upper respiratory antibiotic podcast, there was I think number 12 or something like that. So I’m not a fan of just willy-nilly giving antibiotics, and they certainly have risks, but chronic Lyme disease these patients with these kinds of problems already feel awful. They’re sick. They’ve got issues. And if I look at them and say, “This is not Lyme disease. I have no option for you.” Well what good am I doing there?
And again I don’t want to over-diagnosis Lyme disease, but I’ve seen it so frequently and we have treated them and they’ve gotten better just like Dr. Crist said. That would mean that they are quote cured. We haven’t resolved all their issues, but they got better. They improved. So we still need to work to try and get them back to optimal health, but looking at these tests you’ve got– and the other thing is that the standard labs that are used in the past wouldn’t report the actual bands. They just said western blot positive, western blot negative. All on that criteria that was set by the CDC that was never intended to be diagnostic criteria. So I didn’t have the opportunity to make a decision myself based on the actual data.
Somebody else was interpreting this for me. So one of the reasons that I like IGeneX is because I get the actual data, and then I can make a decision based on their clinical information. And one of the interesting things is we look at someone that has been exposed to Lyme disease or were concerned about Lyme disease, the diagnosis is by criteria is clinical. And one of the statements that I read, cytologic testing can be used to support a clinically suspected case but is not diagnostic by itself. So you don’t want to take a patient that feels a hundred percent great get testing and they’ve got it and then you say, “Well you’ve got Lyme disease.” But there are a hundred percent perfect. It’s a clinical picture confirmed by laboratory data and we have to be careful about how we interpret that data.
Marshall: Not the other way around?
Chad: Correct.
Marshall: Okay. So the testing, it sounds like the quality of the testing or the way that it’s interpreted is a little bit up in the air. It’s may be the way that it’s done or the way that the doctors are interpreting it, is potentially because they don’t know a lot about it. Now you’re a very learned professional Dr. Edwards, but you didn’t know when you had your first patients coming to you with Lyme disease. You had to go learn about it. Maybe it’s not a hot topic in medical school that you’re learning about. That’s not one of the first things that you are learning there. So it’s upon the doctor to educate themselves on these types of things in these topics that you bring it up. Now for all the listeners what are some of the things that they can do? What are the ways to have that conversation with their doctor, “Hey maybe this isn’t going about the right way, maybe I want another test.” What what should they be asking?
Chad: So I think you’re going to get a lot of kickback if you go to your doctor and say I want an IGeneX Lyme disease test. I can almost guarantee you you’re going to get a lot of kickback. For one, the doctor has to have an account with that lab if the doctor is going to order it. Sometimes a patient will– some labs will just accept a physician order, but they kind of set the account with the patient. Sometimes that occurs, but if you’re in a large organization you not may have the liberty to create an account with that lab. And there are several specialty lab testing companies that you have to create an account like that. So they may not be at liberty to do that. Then they may not agree with it.
And there are some studies that will suggest that some of these specialized Lyme disease testing is no better than the others. And you have to look at the data behind that. And what questions were they asking? What was the patient population? Again you’re talking about something that’s very controversial to begin with. So your patient selection to say that, yes this is Lyme disease or no it’s not, it’s like it’s two gray things that you’re trying to evaluate and say, “No this one’s more gray than that one.” So that didn’t work. It’s a very, very gray– there’s not a black-and-white answer to this. There’s not. And I don’t think any physician can say that it is a black and white issue. Especially when you take something like that patient that I mentioned earlier that had every criteria possible and a rheumatologist ordered it because it’s not in Oklahoma that it can’t be Lyme disease and there are confirmed cases of Lyme disease in Oklahoma. So the ticks don’t stop at the mason-dixon line.
Marshall: So in closing here and understanding it, patients they should feel empowered. Do you do some of this research? And if nothing else be able to go on to some of these studies and look up these different testing facilities that they can research, where are these labs coming from? Or what is this information behind these labs? How have they arrived at the quality of these labs in the past so that they can talk to their doctors about it?
Chad: Well I think the lab offers a service and they have to have a clear, it’s identification number I forget the name or what it stands for, but you have to be clear certified lab. You have to have a number so there’s controls that are on those kinds of things in order to offer that kind of testing. And it’s through that scientific process that the lab knows what they’re doing and there’s a medical director of course with every lab. But it’s the way they present and interpret the data that some of the other labs are not providing. And so if you don’t like the way that lab was run through your lab then ask the question. We’re not talking about doing surgery. We’re not talking about doing something that’s of potential harm.
We’re talking about gathering information. So there’s no harm in that. It’s how you interpret that data that could be potentially harmful. Or the way you apply that data to a therapy. So we’re not talking about anything that can cause any harm in the first dictum of medicine of course is first do no harm. So we’re not talking about something that’s going to mess somebody up. Just don’t refuse to try and help that patient even if it’s the way that they want to be helped. We have to get patient buy-in. We have to be on their side and on their team. And I think so often it’s like the doctor versus the patient, the patient versus the doctor. We got to break that paradigm.
Let’s support the patient in the ways that aren’t hurting them. If they come in and they say I need a 500 Lortab and hydrocodone percocet, well okay now I have to prevent them from harming themselves. But we’re talking about collecting information. I just fail to see how that’s harmful. So if your doctor isn’t doing that then seek out a functional medicine physician or you can go to ILADS I-L-A-D-S. It’s of the society’s on Lyme disease, and you can find an ILADS certified physician. I am not, but I’ve worked with Lyme disease a fair amount and I’m open minded to– I just want these patients to get better. So however I can do that in a way that’s not harmful, then let’s do that.
Marshall: So to all of the doctors, continue to have the patient at the forefront. And if all they’re asking for is to be educated on what their symptoms are or the potential of having a disease, you should empower and enable them to be able to do that. And for all the patients if your doctor or physician or family care practitioner is not giving you those things there’s groups like revolutionhealth.org that you can seek out.
Chad: You got it.
Marshall: Thank you so much Dr. Edwards.
Chad: Thanks Marshall. Always appreciate you.
Marshall: BAM.
Male: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week we will be going Against the Grain.
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