Amsterdam TBD Training Course

Clinical Studies and Treatment
Options in
Lyme-MSIDS

Amsterdam TBD Training Course
June 19th, 2019

Dr Richard Horowitz, Medical director HVHAC
Board certified internal medicine

Member, HHS Tick-Borne Disease Working Group 2017-2019
Co-chair, HHS Other Tick-borne Diseases and Co-infections 2017-2019

[email protected], www.cangetbetter.com
https://www.facebook.com/drrichardhorowitz

The material contained in this slide
presentation is the property of Dr Richard I

Horowitz
Any reproduction or use of this material

requires the author’s permission

Disclaimer: The views expressed
in this presentation do not

represent the views of the Tick
Borne Disease Working Group,

HHS or the United States
© 2019 Richard I. Horowitz, M.D.

Teaching Objectives

◼ Role of co-infections in persistent chronic illness in
patients with Lyme disease (i.e., patient with Babesia
who walked out of a wheelchair with Babesia
treatment, patient who couldn’t speak until
Bartonella was adequately treated)

◼ Necessity of checking all 16 points on the MSIDS map
to determine overlapping etiologies which are
responsible for persistent symptoms

◼ Importance of treating the 3 I’s: Infection,
Inflammation and Immune Dysfunction while working
on balancing hormones, getting patients to sleep,
healing the gut, opening up the detox pathways

Evaluate all of the Sources of Inflammation

◼ Multiple overlapping etiologies on the MSIDS map
contribute to the sickness syndrome :

-1) Chronic infections: ↑ inflammation and ↑ immune dysregulation
(the 3 I’s), also affecting mitochondrial function w/CDR
-2) Dysbiosis of intestinal bacteria (Weiss G, et al. Lactobacilli and bifidobacteria

induce differential interferon-β profiles in dendritic cells. Cytokine. 2011 Nov; 56(2): 520-30

-3) Sleep disorders (↑ IL-6)
-4) Food allergies and sensitivities (IgG), ↑ cytokines, ? MCAS
-5) Heavy metals & mold with detoxification problems
-6) Nutritional deficiencies (vit’s, minerals, ie Zinc, Mag, Cu)
-7) Hormonal imbalances (low T, low adrenal function..)
-8) Autonomic Nervous System Dysfunction/POTS
-9) Neuropsych: PTSD + limbic dysfunction (inf’s, toxins, trauma)
None of these factors were adeq addressed in the double blind studies

Most Important Points on the MSIDS Map to
Evaluate in Resistant Patients

◼ Chronic undiagnosed and inadequately treated infections
(Babesia, Bartonella, other IC inf’s…)

◼ Lack of sleep ↑ fatigue, CNS + musculoskeletal sx (↑ IL-6)
◼ Food allergies/sensitivities with leaky gut/Candida/MCAS
◼ Environmental toxins (mold, heavy metals) and

detoxification problems with associated nutritional
deficiencies and lack of adequate glutathione
◼ Hormonal abnormalities (adrenal, sex hormones)
◼ Autonomic nervous system dysfunction (POTS)
◼ Neuropsych issues, PTSD
◼ Mitochondrial dysfunction w/ ongoing CDR

Case 1: Seizures, Syncope, Drenching
Sweats & Weight Loss

◼ PMH: 15 year old female, PMH significant for a one year
history of extreme fatigue, severe migratory joint pain,
requiring high doses of morphine sulfate (which didn’t
control the pain), drenching sweats, uncontrolled seizures
(on Depakoate, but failed other seizure medication),
frequent episodes of passing out (syncope) and pre-
syncope. Patient is wheelchair bound and unable to walk.

◼ Unable to eat, bathe or go to the bathroom on her own,
and Lost significant amounts of weight, poor appetite.
Saw over 8 physicians (GP, Neurology, Infectious Disease)
with no diagnosis.

Case 1: Seizures, Syncope, Drenching
Sweats & Weight Loss

◼ Flies up to see me in a wheelchair from southern US

◼ Physical exam: Sitting BP 90/60, pulse 82 and regular.
Standing BP drops to ? 70’s/ 50’s after several minutes
(difficult to hear either the systolic or diastolic pressure)
with a pulse rate of 124 BPM. Feels like she is going to
pass out

◼ PE is otherwise unremarkable except for tender joints to
palpation (no redness or swelling) & patient has “stretch
marks” which appeared in the last year. Never gained
weight (she lost significant amounts of weight and was
never obese).

Bartonella rashes

Case 1: Seizures, Syncope, Drenching
Sweats & Weight Loss

◼ Treatment: Based on migratory pain (Lyme), drenching
night sweats (probable Babesia), stretch marks (probable
Bartonella), and low BP standing with a greater than 30
BPM increase in heart rate with pre-syncope
(POTS/Dysautonomia), she was placed on doxycycline 200
mg 2 X per day, rifampin 300 mg 2 X per day, Plaquenil
200 mg 2 X per day, Malarone 100/250 mg, two 2 X per
day with Artemesia SOD 3 X per day, Nystatin tablets
500,000 units, 2 twice a day, as well as Florinef 0.1 mg
with a high salt diet and a minimum of 2-3 litres of fluid
per day

Case 1: Seizures, Syncope, Drenching
Sweats & Weight Loss

◼ Laboratory: returned positive for Lyme specific bands on
the Western Blot, + Babesia WA-1/duncani titers

◼ Clinical Course: Patient returned one month later. Was
walking out of her wheelchair, seizure free (Depakote was
tapered), off her narcotics and pain free. Is now able to
eat on her own, and go to the bathroom on her own. No
further episodes of syncope. Went to a Broadway play in
NYC and is now “going out to parties with her friends”

◼ Take home message: The clinical history and physical
exam made the diagnosis, indpt of labs

Case 2: Depression, Seizures, Urinary and
Bowel Dysfunction & Drenching Sweats

◼ PMH: Larry, 45 yo old male. PMH significant for allergies
(allergic rhinitis) since childhood, osteitis pubis
(inflammation of the pubic bones, requiring pelvic
surgery), a torn meniscus of his left knee, and a history of
Lyme disease. He had been sick for nearly thirteen years
and had seen multiple physicians for his illness, which
started with grand mal seizures; his initial workup at a
major medical center in New York City did not reveal a
cause for his seizures. Instead, he was told that they were
“idiopathic”. Depakote was inadequate in controlling his
seizures.

Depression, Seizures, Urinary and Bowel
Dysfunction & Drenching Sweats

◼ Significant PMH: several tick bites on Cape Cod, at which
point he developed other symptoms. These included
drenching night sweats, teeth- chattering chills,
recalcitrant insomnia with associated restless leg
syndrome and nocturia (getting up to urinate at least five
times per night), irritable bowel symptoms, with
alternating constipation and diarrhea (in the bathroom for
up to 4 hours/day trying to move his bowels), light and
sound sensitivity, fatigue, joint pain and low- back pain,
neuropathy, severe memory and concentration problems,
overwhelming depression.

Depression, Seizures, Urinary and Bowel
Dysfunction & Drenching Sweats

◼ Testing: ELISA neg, W. Blot 23kdA +

◼ We sent off for a full range of blood tests: CBC, CMP w/
mineral levels, PSA, vitamin levels (B12, folate,
methylmalonic acid, & homocysteine), co-infection panel
(Babesia microti and duncani, Bartonella, Mycoplasma,
Chlamydia, RMSF, Q fever, tularemia and Brucella, EBV,
CMV, HHV- 6, and West Nile). We also tested
immunoglobulin levels & subclasses, complement studies,
an antigliadin antibody/TTG with a food allergy panel (IgE
and IgG), ANA, RF, ESR (sedimentation rate), cytokine
panel and high- sensitivity C-Reactive protein (HS- CRP)

Depression, Seizures, Urinary and Bowel
Dysfunction & Drenching Sweats

◼ Further testing: Endocrine studies: thyroid, growth
hormone, and sex hormones. He was also sent home with
a salivary adrenal test kit to check his adrenal hormones,
and a 6 hour urine DMSA challenge, to check for a heavy
metal burden.

◼ Results: positive Babesia (IFA, FISH, B. duncani), probable
Bartonella, possible Brucella (low level titers), positive
heavy metal burden, neutropenia (neg heme eval), food
sensitivities, orthostatic changes/tachycardia with
standing

◼ Treatment for Babesia/Bart (M+Z+Septra), salt/fluids,
Florinef, glutathione were helpful, but inadequate



Adrenal Failure/ANS Dys(f)/POTS

◼ Refused trial of Cortef, secondary to side effects
previously experienced in the hospital for low back pain

◼ Trial of Adrenal glandular (Adrenal Complex), with
increased salt, fluids, Florinef for low BP and low cortisol
levels

◼ Within one week, symptoms present for almost 13 years
almost completely disappeared (fatigue, pain, insomnia,
bowel and bladder problems, mood disorder..).
Antibiotics were able to be DC’d.

◼ Take home message: One or two points on the Lyme-
MSIDS map may be the key to healing!

Case 3: Crohn’s Disease & MSIDS

◼ PMH: James, 36 yo W/M, PMH significant for Crohn’s
disease. Hx multiple tick-bites over the years. Has been on
steroids on and off with 6-MP for frequent episodes of
diarrhea, cramping and occasional blood

◼ Symptoms: apart from Crohn’s symptoms, complains of
fatigue, migratory muscle and joint pain, paresthesias
that come and go, mild memory and concentration
problems, intermittent night sweats & chills

◼ Testing: + Lyme Western Blot (IgM 23/41), Positive
Mycoplasma, + Babesia WA-1/duncani, mineral
deficiencies (zinc, magnesium), food sensitivities

ALCAT Food Sensitivity Profile

Crohn’s Disease & MSIDS

◼ Treatment: Rotated through different Lyme and Babesia

regimens (which also covered Mycoplasma), replaced
minerals, and had James strictly avoid sensitive foods.
Given supplements with glutamine, arabinogalactans and
quercetin (GI support), ellagic acid, watercress, NAC
(Hepatic support), and curcurmin, bioflavanoids (cytokine
balance) with LDN 4.5 mg HS

◼ Clinical response: was able to get off steroids and 6-MP,

bowels normalized, symptoms of Lyme and Babesia
resolved. On herbs without a relapse. Feels fine as long as
he avoids his sensitive foods. No more Crohn’s symptoms.

Case 4: Early Menopause & FMS?

◼ Linda: 30 yo W/F, CC: several year history of chronic
fatigue, joint and muscle pain, headaches, memory and
concentration problems, chills, occasionally drenching
night sweats, irregular menses

◼ PMH: foreign travel (Mexico), but no history of malaria.
Prior physicians ruled out TB and NHL with a CXR, and
TFT’s were WNL.

◼ Other differential diagnoses: Babesia, other piroplasms,
other parasites (malaria), hormonal failure, autoimmune
disorders, panic disorder, Brucella..

Clinical Course

◼ Babesia testing returned positive. Rotated through
Mepron, Zithromax, Septra DS, Plaquenil, and nystatin for
the first month. Placed on a sugar free/yeast free
hypoglycemic diet with triple probiotics for bowel
support. Definite improvement in the mid day fatigue on
the hypoglycemic diet, with a mild reduction in the night
sweats with Babesia treatment.

◼ Fatigue, joint & muscle pain, memory problems also
improved, but patient persisted with resistant symptoms,
especially symptoms of night sweats. She was rotated
through a classical regimen of a cell wall/cystic/IC drug
regimen with treatment for Babesia with minimal help.
What was the key?

2 Etiologies: Brucella/Babesia testing
+

Clinical Course

◼ Effective treatment: Double intracellular regimen with
doxycycline, rifampin, Plaquenil, nystatin and babesia
medication (malarone, herbs). Drug levels of babesia
medications can be reduced with rifampin, and higher
levels of malarone are usually necessary to achieve a
clinical response

◼ After 6 months on this regimen, the patient was almost
100% back to normal

◼ Take home message: Evaluate all of the differential
diagnostic possibilities. Multiple overlapping co-infections
can be present driving resistant symptomatology in the
Lyme-MSIDS patient

Case 5: Ulcers, ↑ Lymph nodes,
Retroperitoneal Fibrosis & Renal Failure

◼ Steven: 40 yo BM who came to my medical office from
Georgia. He had been sick for the previous 4 years.
Multiple evaluations at major medical centers could not
find an etiology for his sx.

◼ PMH/SH: HTN, hyperlipidemia and weight gain. Recently
diagnosed w/ retroperitoneal fibrosis with renal failure,
requiring stents in his kidneys. Unknown etiology.
Worked as a chef.

◼ CC: severe fatigue, headaches, night sweats, loss of libido,
joint and muscle pains, and memory and concentration
problems. Developed painful ulcers on his lower
extremities which would come and go

Painful Ulcers Lower Extremities

Ulcers, Lymph Nodes, Retroperitoneal Fibrosis
& Renal Failure

◼ Work-up: He had been seen by his primary care doctor, a
rheumatologist, dermatologist, and gastroenterologist.
Biopsy & culture of his lymph nodes and ulcers w/ a
thorough GI evaluation failed to reveal a cause of his
symptoms

◼ He was initially diagnosed with inflammatory bowel
disease, with the ulcers ostensibly representing a case of
a painful skin lesion characteristic of ulcerative colitis (?
pyoderma gangrenosum). However there was no
inflammation found on his colonoscopy. He was placed on
steroids without significant relief

Ulcers, Lymphadenopathy, Retroperitoneal
Fibrosis & Renal Failure

◼ Positive Testing on the MSIDS map: Lyme disease (IgG
Western Blot), babesiosis (Babesia IFA), low adrenal
function, and a very low testosterone level (below 200).
He also had metabolic syndrome, with a HbA1c of 5.7 (he
had elevated blood sugars, blood pressure, and
cholesterol, which increased his cardiovascular risk at a
young age, especially with low testosterone).

◼ What was the clue to his ulcers and retroperitoneal
fibrosis? His social history. He was a chef, and when asked
in detail about his work, he regularly skinned rabbits.

Ulcero-Glandular Tularemia

Ulcero-Glandular
Tularemia/Lyme/Babesia

◼ Clinical course: He was given Plaquenil, doxy, & rifampin,
with intramuscular (IM) bicillin injections for his bacterial
infections and high- dose Malarone with artemisia for his
babesiosis. He was then switched to IV Rocephin with
Plaquenil, Mepron, Zithromax, and Septra. He noticed a
significant improvement in symptoms. His ulcers
completely cleared up, his retroperitoneal fibrosis
improved, and his lymph nodes decreased in size.

◼ He was placed on a low carb, low cholesterol diet, & given
Clomid and Arimidex for his low T. He lost 30 lbs, BP, chol
& HbA1c ↓ to normal, and his testosterone normalized.
Recent CT abdomen: N!

Case Presentation # 6: Herbs, Hormones &
Heavy Metals

◼ 55 yo W/F, PMH signif: Low IgG levels, osteoporosis,
Hashimotos/hypothyroidism, POTS (+ HUT), Mild OSA,
IBS, Diastolic dys(f) on TEE, low MSH, ADH, & Hx Lyme (+
Blot/PCR, EM rash), Babesia duncani (IFA, PCR),
Bartonella (PCR), Ehrlichia, exposure to B. afzeli/garini
(Europe)

◼ Ill in 1991, given doxy for EM rash, never took it

◼ 1994: Repeat EM rash, costochondritis, w/ ↑ fatigue,
brain fog, SOB.

◼ Official diagnosis and treatment years later. Took doxy→
severe Herx, with headaches, tremors

◼ Other tests: + Tilt table, tachycardia, low IgG levels

Herbs, Hormones & Heavy Metals

◼ 2001: Saw LLMD: diagnosed with Lyme, Babesia, Ehrlichia,
Mycoplasma. M+Z→↑ sweats, ↑ LFT’s.

◼ Herxed w/ Levaquin, Rifampin, no help with Lariam,
artemesinin. Hg fillings removed, improved, but still sick.
IV Rocephin administered 2003: felt better, relapsed
within 1 month off.

◼ Saw rheumatology 2008: ruled out for AI dx.

◼ Present symptoms 5/2014: nt sweats, fatigue++, needs

to nap 2-5 hrs/day, hair loss, swollen gl’s, chest pain, air
hunger, rare palpit’s, knee + hip pain (not migratory),
severe HA’s, mild paresthesias, blurry vision (c+g), occ
vertigo

Herbs, Hormones & Heavy Metals

◼ Present symptoms (cont’d): Severe short term memory
problems, anxiety++, insomnia w/frequent awakening,
sleeps 6 hrs/nt.

◼ Environmental hx: ? Mold exposure
◼ Family hx: Mother w/breast Ca, A fib/CVA
◼ ROS: Osteoporosis; Flares w/almost all meds
◼ Labs: Western Blot: +/- 23/39 Kda, ++ 31 Kda, Lyme PCR +,

exposure to B. afzeli and garini (Neuroscience), Babesia
PCR +, B. duncani 1:640+, Bartonella PCR +
◼ P.E.: Sitting BP/pulse: 128/80, pulse 60 BPM/reg

Standing BP/pulse: 110/84, pulse ↑ 88 BPM

Herbs, Hormones & Heavy Metals

◼ Lab testing from intial H&P: + heavy metals (Hg, Pb,
Doctors Data), MTHFR+, + mycotoxins (Real Time labs,
ochratoxins), ↓ GSH, ↓ MSH, ↓ ADH, ↓ IgG (total,
subclasses 1 + 3), low cortisol am (salivary DHEA/cortisol
test, Labrix), TTG +

◼ Tx: MARCONS spray w/ mold protocol (PC, GSH, NAC,
ALA, clay/charcoal w/saunas..), Florinef 0.1 mg for POTS
& Cortef 5 mg in am w/adrenal support, Cedax 400 mg/d,
Malarone, TCM protocol w/Artemesia (failed multiple
AB’s past w/severe flares w/IC meds), gluten free diet

◼ Clinical Response 1 mo: Felt great!!!, 100% better
w/adrenal support/tx POTS, detox support, diet

Take Home Points: MSIDS Model
Overlapping Etiologies

◼ Infections: A cell wall drug/TCM protocol was effective
when flares occurred w/IC medication

◼ Diet: hypoglycemic diet/gluten free diet helped sx

◼ Dysautonomia/POTS was interfering with treatment.
Florinef with increased salt and fluids helped fatigue,
palpitations, dizziness

◼ Endocrine: Adrenal dysfunction contributed to fatigue.
Huge improvement w/Cortef (largest shift)

◼ Detoxification: Mold toxins, heavy metals were present.
GSH significantly helped fatigue & memory, as did
detoxification for mold

Case 7: Sick for 15 Years w/MVA’s

◼ 49 y.o. W/M w/ PMH signif for: allergies, asthma,
salmonellosis (hospitalized, on Vancomycin), gluten
sensitivity with a history of chronic diarrhea X yrs (better
now); black mold exposure (↑ fatigue), sleep apnea
(mouth guard helps): Complains of low grade fever (37.5),
day & nt sweats, 10 lb wt loss, severe fatigue, swollen
glands, low libido (low T found), tachycardia, migratory
joint pain, muscle pain & twitching, headaches,
neuropathy, memory prob’s

◼ 3 MVA’s secondary to poor concentration

◼ Finally diagnosed with Lyme, clinical Babesia, Bartonella,
and POTS/dysautonomia in 2014 (7 yr)

Sick for 15 Years w/MVA’s

◼ Positive Lyme, Bartonella (B. Henselae IgG Ab 1:64), HHV6
IgG 1:160, Parvovirus B19 (high, 4.5)

◼ High plasma histamine level (leaky gut, food all’s)

◼ Phase 3 Adrenal dysfunction: low cortisol, low DHEA, low
testosterone, low Vit D, mold Gliotoxin found (Real Time
Labs), ↑ gram – on CDSA

◼ Had already done IV Clinda, IV Doxy, IV Rocephin, oral
mino, Mepron, Tindamax, Zithromax, Rifampin and
Omnicef and remained ill, functioning at 40%

◼ Placed on Dapsone 25 mg BID, Zyrtec & Zantac BID,
Leucovorin 15 mg BID, Clinda, Mepron, Zithro

◼ 1 month later: Best in 15 years. Up to 60% normal with ↓
fatigue, pain, fevers/sweats, & headaches

Case 8: Resistant Fatigue/ Neuropathy

◼ 32 y.o. W/F presents with 12 year history of resistant
fatigue and neuropathy. Can’t wear clothing on skin
(especially blouses) secondary to severe pain
(hyperesthesia). On Morphine Sulfate > 100 mg/day +
gabapentin without pain relief. PCP, Neurology unable to
determine etiology pain

◼ PMH: No known tick bites, illnesses. Had surgery for
thoracic outlet syndrome without relief of pain

◼ Associated symptoms: mild night sweats

◼ Medical work-up: + Lyme Western blot, + Babesia microti
titers, + Mycoplasma, low zinc, phase II adrenal
dysfunction, low immunoglobulin levels

Case 8: Resistant Fatigue/ Neuropathy

◼ Treatment: placed on IVIG for resistant pain/neuropathy,
adrenal support (Adrenal essence, Adrenal complex),
rotations of antibiotics and anti malarial drugs (Bicillin, IV
Rocephin, oral rifampin, tetracycline HCL, macrolides,
quinolones, Malarone, Artemesia..) with minimal help

◼ Dapsone added to tetracyclines with IV Rifampin: 1st time
neuropathy and fatigue improves, but still symptomatic
requiring morphine. Stays on this protocol for
approximately 1 year with slow improvement

◼ Testing rechecked: + Bartonella FISH! (negative titers,
VEGF)

Case 8: Resistant Fatigue/ Neuropathy

◼ Treatment: placed on a triple IC persister protocol:
Pyrazinamide, Zithromax, Bactrim. At the end of the 2nd
month, notices improvement. Is able to decrease
morphine dosing to 2/3rd (appx 70 mg/day)

◼ Gentamycin added for 10 day course (by body weight,
checking peak and trough levels) by 3rd month

◼ Month 5: energy is better and is able to get off morphine
for the first time in 10 years! Finishing up 6 month PZA…

◼ Take home message: Occult intracellular infections such
as Bartonella may be driving an inflammatory response,
esp. in cases of resistant neuropathy. Multiple IC
combinations with “persister” drugs can help (4-5 +?)

Case 9: MSIDS ‘Gal’ w 16/16
Abnormalities, Relapsing off AB’s

◼ 60 yo W/F w/ PMH significant for: Lyme (+ IgM W Blot),
+ PCR Borrelia burgdorferi in the blood despite years of
antibiotic and herbal rotations on and off

◼ Also: Babesia, Bartonella, Mycoplasma fermentans PCR
+, Adrenal dysfunction (phase II), hypothyroidism,
hypoglycemia/metabolic syndrome, menopause with
low estrogen, prog, food allergies with leaky gut,
inflammation with MCAD (+histamine, tryptase,
chromogranin A), detoxification problems (ION test),
PTSD (Family trauma), sleep apnea, and mitochondrial
dysfunction. Apart from that, she was fine.

Case 9: MSIDS ‘Gal’ w 16/16
Abnormalities, Relapsing off AB’s

◼ Labs: + ANA, elevated CRP, elevated HbA1c (5.7),
hyperlipidemia, low free T3 with high normal TSH,
phase 2 adrenal dysfunction on DHEA/cortisol test,
Babesia microti titer 1:160, Bartonella henselae titer
1:64 +, Mycoplasma fermentans PCR + , Alcat food
panel with > 30 food allergies, elevated histamine,
elevated chromogranin A, elevated tryptase (MCAS),
urine heavy metals + for Pb, As, Hg, Cd, mold exposure
(black mold found under bedroom/bathroom) with +
stachyboctris titer, low serum glutathione, RBC
magnesium, iodine, zinc

Case 9: MSIDS ‘Gal’ w 16/16
Abnormalities, Relapsing off AB’s

◼ Treatments over the years: every abnormality on the
MSIDS map was treated, and usually each time she felt
somewhat better. Percentage of normal kept ↑

◼ Rotated through multiple cell wall/cystic/IC regimens
(Ceftin, Plaquenil, Zithromax) or double IC regimens
(Mino+Zithro, Mino+Cipro, Mino+rifampin). Each time
felt better on a new regimen, relapsed within weeks off

◼ Herbal regimens would occasionally help to stay in
longer remissions (Zhang, TCM: Coptis/circP/HH) or
Samento/Banderol/Parsley/Burbur

Case 9: MSIDS ‘Gal’ w 16/16
Abnormalities, Relapsing off AB’s

◼ Finally tried dapsone combination therapy: doxycycline,
rifampin, dapsone + Plaquenil/GSE/Nystatin: got help
with ↑ doses of dapsone, after getting through
Herxheimer reactions lasting days (Good Herxes)

◼ Detox support helped Herxes: + response to Alka Seltzer
Gold and 2 g liposomal glutathione, increased salt and
fluids, liver support (NAC, ALA, GSH, broccoli extracts:
[DIM, sulforaphane glucosinolate], methylation support
[methylprotect, Xymogen], with drainage remedies

◼ FIR saunas + coffee enemas occ. helpful. Husbands
expresso wasn’t enough.

Case 9: MSIDS ‘Gal’ w 16/16
Abnormalities, Relapsing off AB’s

◼ Felt good after 6 months of DDS CT, with 50 mg of
dapsone. Stopped treatment.

◼ Bb PCR + → restarted treatment with higher dose
dapsone combination therapy (100 mg/d). Felt good
after 6 months. Stopped treatment.

◼ Relapsed several months later. Did double dose
dapsone therapy (100 mg BID) with same doses of doxy,
rifampin, and biofilm agents (Stevia, Biocidin, oregano
oil). Worked up dose of DDS over 3 weeks (25, 50, 100
mg) and then did 4 weeks of 200 mg/d of dapsone

Case 9: MSIDS ‘Gal’ w 16/16
Abnormalities, Relapsing off AB’s

◼ Anemia: Hemoglobin dropped from 12.9 to 8.9 over 5
weeks. Slow decline didn’t cause symptoms except
some DOE walking outside on hills. Remained on
Leucovorin 25 mg two in am, one in pm (75 mg), with L-
methylfolate 15 mg BID (30 mg)

◼ Methemoglobin levels held at 3.9% with NAC, ALA and
1000 mg liposomal glutathione BID.

◼ After a several day Herx at 200 mg/d of DDS, the
patient felt fine (and even well) for the rest of the
month

Case 9: MSIDS ‘Gal’ w 16/16
Abnormalities, Relapsing off AB’s

◼ Anemia: resolved over 4-6 weeks off DDS, keeping high
dose folic acid on board X 1 month (Leucovorin 25 mg
BID + L-methylfolate 15 mg/d or BID). Repeat Hb 13.6

◼ No kidney or liver abnormalities. GI was fine, remaining
on Ultraflora DF, Theralac & saccharomyces b. BID

◼ Has stayed in remission now for almost 2 years, on no
herbs to treat TBD’s. Remains on immune, G.I., hormonal
and detox support. Exercises at least 30 min/day

◼ POTS has required ongoing low doses of Florinef and
Midodrine. Annie Hoppers limbic retraining is the next
step

Summary

◼ Chronic Lyme disease is better defined as Lyme-
MSIDS; patients often have multiple overlapping
etiologies responsible for resistant symptoms

◼ Use the screening questionnaire & 16 point MSIDS
map to review all possible differential diagnoses
responsible for ongoing symptoms

◼ Treating all forms of Bb, associated co-infections &
all abnormalities on the MSIDS map often results
in clinical improvement in complex cases
unresponsive to standard therapies.

◼ Horowitz, R.I.; Freeman, P.R. Precision Medicine: The Role of the MSIDS Model in Defining,
Diagnosing, and Treating Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome and Other
Chronic Illness: Part 2. Healthcare 2018, 6, 129.

Crucial Steps on the MSIDS Map in
Healing the Difficult to Treat Patient

◼ Evaluate and treat MCS and detoxification problems
◼ Evaluate and treat GI abnormalities
◼ Evaluate and treat chronic persistent infections and toxins,

which may be driving MCAD and vagal nerve dysfunction
w/POTS/dysautonomia. Use limbic + vagal retraining, esp.
when PTSD/chronic illness is present (reset the system)
◼ Evaluate and treat immune dysfunction (under/overactive)
◼ Evaluate and treat sleep disorder(s)
◼ Evaluate and treat genetic abnormalities and mitochondrial
dysfunction w/abnormal Cell Danger Response

Caveman MSIDS

Parting Wise Words of Health