Tuesday 27 October 2015

BARTONELLA- DOCTORS TREATING NOW- POLICY MAKERS FORGETTING THEY NEED TO DO THE RESEARCH




Published on Oct 14, 2015
Dr. Mozayeni talks about Bartonella as one of the major co-infections of Lyme disease. It's more prevalent than Lyme, as there are many more ways to contract the disease (eg. flees, cats). In a study, that Dr. Breitschwerdt and himself published in The Journal of Emerging Diseases, about 60% of Lyme patients tested positive for Bartonella.
Dr. Mozayeni also talks about the importance of looking at Biofilm when treating Lyme, Bartonella etc as biofilm can harbor many of these microbes and be the cause of many symptoms.


Dr Mozayeni -

Bartonella spp. bacteremia and rheumatic symptoms in patients from Lyme disease-endemic region.


Transcript from above video presentation:-

Dr Robert Mozayeni was treating patients with Lyme Disease in a Lyme endemic area  and developed a partnership with veterinarian Prof Ed Breitschewerdt.

A partnership of One Health with MD's working with Veterinarians.

Dr Mozayeni started sending blood samples to Prof Ed Breitschwerdt to be tested for Bartonella, over 20% were positive - more than any other in any patient group, including high risk veterinarians.

Dr Mozayeni subsequently published a paper (see above link.) up to 62% of patients had significant proof of laboratory testing for Bartonella - some had failed Lyme testing  - some had psychiatric symptoms.

I see Bartonella more prevalent than Lyme and while Lyme is a big problem, Borrelia meaning  Lyme = Borreliosis. I think that the Bartonella is a much bigger Public Health problem over all, because there are more ways to get Bartonella than even Borrelia, including other insects- fleas and cats.

There are germs in the environment, the insects carry the germs just like all other animals, farm animals and rodents. The more you are exposed to these things the more likely you pick up these infections and so it's great to be in nature, but you being in nature also means being with the microbes and so the risks are there and they are poly microbial. So we have to start thinking about these single germs. We need to think each germ we know about is representative of a broader group of germs and we need to start looking at a Microbiome - look at all the germ genes. So as of this year you may get whole gene sequencing for about $1000 and it used to be millions of dollars 10 years ago.
( Short discussion on possible further developments)

We realise when we talk about Lyme disease it is a much bigger set of microbes and the public refers to all of that as Lyme Disease, but that confuses definitions and creates controversy, because the medical definitions are very narrow, the public definition is a social networking definition - so even patients when told they have Bartonella will still call it, when they tell their friends they have Lyme Disease.

Now for example Norvect is named after Vectors. ILADS is Lyme & Associated Diseases. So these groups started very narrow with Borrelia so now they are broadening their view and I think that in general the medical community is seeing this too. For example we know now that it is scientifically established that Atherosclerosis is due to chronic infections in the vascular system. Some of it will turn out to be Bartonella some of it will turn out to be other germs. Some of it is from Bio films that have been produced from protozoa and then the Bio film gets contaminated by microbes and the body can't clear it because the biofilms are a physical barrier to the immune system. So we are now realising and appreciating the role of biofilms. If you search Pub med 25000 on biofilms since 1975. But if you search Biofilm and Lyme there have been 8 publications in just the last couple of years. So there is a massive awareness of biofilm problems but clinically no one really looks at it.

We have started a biofilm lab in January 2014 and we have now measured 400, 500 specimens and I can tell you the biofilms are a big problem and they are directly responsible for many symptoms and they harbor microbes. So all of the talks we have about all of these specific germs are still incomplete because you have Biofilms in the picture of biofilms an example of biofilms is the layer that thrombus - lines the blood vessel which then causes inflammation which can lead to atherosclerosis. So even Atherosclerosis has now been recognised as a chronic infection.

In many chronic illness we are realising they have an underlying infectious cause, you know maybe MS maybe RA so there are are areas where people have always wondered but now we are going back with better tools and searching again. 

People have misunderstood  and confused symptoms with diagnosis so when you call something Fibromyalgia it's just a set of symptoms it is not a diagnosis. If you call something Chronic Fatigue it's only a set of symptoms it is not a diagnosis. In fact there are few things in medicine  where the name of the disease  is actually a diagnosis and by that I mean a diagnosis, as actually identifying a root cause. So no matter what you call it you have to realise that everything we do with medicine is a classification system. To try to understand things we classify it and we may classify, but all the classifications may have to be considered temporary until we find  a root cause.

So when you are a sick patient and you get a label of say Fibromyalgia you have to ask yourself what causes Fibromyalgia and there's research that looks at describing Fibromyalgia better, and there's research that may seek to test and find  an underlying cause of Fibromyalgia. So when you get to a root cause you have a chance of being able to reverse. 

So most physicians will label it and do whatever the guidelines say for that set of symptoms which is a classification not a diagnosis of a root cause and then they've done what they feel was medically prudent and they've satisfied the lawyers and the policy makers and they can go home and sleep that night. But some of us we can't do that unless we fix the problem we don't sleep well at night, we have a patient who is ill and we haven't found the cause. And some of us we try to do that we have to look hard and this is where you end up doing things that are not in the guidelines, because you are exploring new possibilities and if you are trained as a medical scientist you are just naturally curious and once you have learned that medically they can't take it out of you. This is where sometimes the regulatory agencies and the policy makers have problems with practitioners because they are trying to limit what they do to try to regulate, control and reduce costs. So they are practicing statistics on individual patients, that is what they want done, but if you are an individual physician trying to solve a problem for a patient you have to take a personalised approach and you can't apply epidemiology and statistics to the patients - to every patient.

The policy makers have to think in broad terms but practitioners are trying to treat individual patients. So there is this constant tension between the broad approach versus solving an individual case at a time and we were trained to trust our own evaluation more than anything else - more than lab data - but the auditors and the policy makers just want to audit you with lab data, because that's the easiest thing for them to do.

So in a way the doctors in the front line are responsible for taking care of the patient. But the policy makers are forgetting that they are responsible for doing the research that help those doctors take care of the patients. So in my opinion they may be, some of them are forgetting their  real mission. But they do it because they think they are doing the right thing, are trying to protect the public and keep the cost down and limit the use of anything that is not fully validated. But for it to be fully validated a paper could take 17-21 years and if you are a sick patient their paradox is it's too bad you didn't live at the right time.

Thanks to Norvect for allowing access to the full presentation along with many others at this link  http://norvect.no/the-norvect-movies-2015/  


Friday 23 October 2015

IGNORANCE OF PUBLIC HEALTH DANGERS- LYME DISEASE

Tick abundances in South London parks and the potential risk for Lyme borreliosis to the general public 
  • C. NELSON, 
  • S. BANKS, 
  • C. L. JEFFRIES,
  • T. WALKER and
  • J. G. LOGAN 
  • Abstract

    Tick abundances and prevalences of infection with Borrelia burgdorferi sensu lato, the causative agent of Lyme disease, were investigated in four South London parks. A total of 360 transects were sampled using three methods of collection (blanket, leggings and flags) simultaneously. No ticks were found on Wimbledon Common or at Hampton Court, but 1118 Ixodes ricinus (Ixodida: Ixodidae) ticks were collected at Richmond and Bushy Parks. At Richmond Park, lower canopy humidity [odds ratio (OR) 0.94; P = 0.005], increased mat depth (OR 1.15; P < 0.001) and increased soil moisture (OR 1.40; P = 0.001) predicted the presence of I. ricinus, and increased sward height [incidence rate ratio (IRR) 1.01; P = 0.006] and decreased ground temperature (IRR 0.90; P = 0.009) predicted increased abundance. At Bushy Park, thicker mat depth predicted tick presence (OR 1.17; P = 0.006) and increasing temperature correlated with tick absence (OR 0.57; P = 0.023). A total of 279 ticks were screened for the presence of B. burgdorferi using quantitative polymerase chain reaction. Point prevalences of 0% for larvae (n = 78), 2.14% for nymphs (n = 174) and 0% for adult ticks (n = 7) related to an acarological risk of 0.22 infected ticks per 40 m transect in Richmond Park. The abundance of ticks and the acarological risk, particularly at Richmond Park, highlight the need for appropriate communication of the associated risk to the general public frequenting these recreational areas.
    Interesting research on ticks in London Parks by researchers from the London school of Hygiene & Tropical medicine.
    James Logan has discussed his research in the media recently to help raise awareness of ticks and possible tick borne infections - Lyme Disease.
     Science daily - 'Dr James Logan, Senior Lecturer in Medical Entomology at the London School of Hygiene & Tropical Medicine, senior author of the study said: "The overall risk of Lyme disease in London parks is very low, but precautions should be taken. Check yourself and your pets after frequenting parkland areas, and remove any ticks as quickly as possible using a tick removal tool. To minimise the risk stick to footpaths and wear an insect repellent."
    Hopefully more such important work will be done and more awareness raised of Lyme Disease.
    In 1994 

    Evidence for Lyme disease in urban park workers: a potential new health hazard for city inhabitants.Rees DH1Axford JS.

    Abstract

    In the UK, cases of Lyme disease have only been reported from rural areas. Recently, however, Ixodes ticks infected with Borrelia burgdorferi have been found in London parks. To determine whether this constituted a health hazard, we questioned 44 workers from Richmond and Bushey parks to assess their exposure to tick bites and whether they had a clinical history of Lyme disease. Their serum was subsequently investigated for antibodies to two different preparations of Borrelia burgdorferi (whole cell sonicate and flagellin) and the specificity of these antibodies determined by immunoblotting. Comparison was made to zoo keepers (n = 27) from a wildlife park outside London. Tick bites were reported in 23% of park workers and of these, three described symptoms compatible with Lyme disease. Raised antibody levels were found in 10 (24%) of the park workers compared with one (4%) of the zoo keepers using ELISA with whole cell sonicate as antigen (P = 0.02) and 6 (14%) of park workers and none of the zoo keepers using purified flagellin as antigen (P < 0.05). Analysis of the immunoblots revealed more bands were detected in park workers (mean 1.8, range 0-6) than in the zoo keeper controls (mean 0.8, range 0-4); P < 0.001 and 14 (32%) of the park workers had reactivity with three or more protein bands, whilst only one of the zoo keepers showed this level of antigen binding (P < 0.005). These data suggest previous infection with B. burgdorferi in London park workers which has important health implications for these individuals, other park workers and possibly park visitors.

    20 years later and still no signage in the London parks.

    Anecdotal comments from patients infected in the London Parks show that there is still little doctor awareness too in that area. 

    Concerns that knowledge of tick borne disease in the UK will frighten people away from visiting the great outdoors seems to have been the policy of HPA but this is assumption and research does not support that concern. 

    So for 20 years the public are left ignorant and doctors are ill informed and ill equipped to help diagnose and treat Lyme Disease. 

    The human health burden rises year on year rarely seeming to magically resolve without treatment leaving a miserable existence for those infected and left untreated and a burden on our Health care costs benefit costs and economy. 

    Yesterday a meeting at the House of Lords on Lyme Disease asked the Health minister to respond to concerns - lack of awareness, public signage in the London Parks and lack of doctor awareness were just some of the many concerns.
    http://www.parliament.uk/business/publications/hansard/lords/todays-lords-debates/read/grandcommittee/674/

    Friday 16 October 2015

    LYME DISEASE- "THE INFECTIOUS DISEASE EQUIVALENT OF CANCER"

    Cancer Researcher Who Nearly Died of Lyme Discusses the Similarities Between the Two Diseases

    Neil Spector, MD, author of Gone in a Heartbeat: A Physician's Search for True Healing will speak at the International Lyme and Associated Diseases Society (ILADS) annual conference.

    FT. LAUDERDALE, FL., October 15, 2015-- Neil Spector, MD knows cancer. As a leading researcher, he led the development of two targeted cancer therapies which were FDA approved.  He is currently the Sandra Coates Chair in Breast Cancer Research at Duke University.  But in 2009, Dr. Spector faced his own mortality when a physician informed him he would die without a heart transplant. Dr. Spector's heart had been destroyed by an undiagnosed case of Lyme disease.

    Dr. Spector will discuss his experiences as an oncologist and Lyme disease survivor on Friday, October 16, 2015 at the ILADS conference being held at the Marriott Harbor Beach Resort in Fr. Lauderdale, Florida. His presentation is titled: How Lessons from Personalized Cancer Care Can Inform Management of Lyme Disease.

    Dr. Spector calls Lyme disease “the infectious disease equivalent of cancer.”  Cancer is not one specific disease and neither is Lyme, says Spector. “We talk about Lyme Disease as if it is ONE disease caused by one uniform strain of Borrelia when we know there are at least 16 pathogenic strains of the bacteria that cause disease in the United States.”

    Spector notes both cancer cells and Borrelia burdoferi (the spirochete which causes Lyme disease) are equipped with mechanisms to resist therapeutic interventions.  Both pathogens have a “sweet tooth,” says Spector, since each relies on glucose as a source of energy.  Yet, while cancer specialists design personalized treatment plans for cancer patients, Lyme disease treatments are generally still one-size-fits-all.

    “We have all witnessed via the media the struggles of Yolanda Foster and Avril Lavigne,” says Spector. They publically put a face on the private suffering of many Lyme patients, and this suffering is a direct result of a lack of understanding about Lyme and its co-infections,” he says.

    In a talk before the International Lyme and Associated Diseases Society (ILADS), Spector called for more “out-of-the-box thinking” on how to diagnose and treat Lyme disease and its co-infections.

    “I am not taking sides in this debate,” says Spector. “As a patient and physician-scientist involved in cancer research and drug development, I have a unique perspective on the way Lyme disease is currently diagnosed and treated, and the gaps in our understanding of the disease beg for more research funding.”



    To clarify the slide  the "green" personalized approach to treatment is where the treatment of Lyme Disease NEEDS to be but currently IS NOT. Instead, Lyme Disease is treated empirically (red), which is less scientifically based. 

    More research and research dollars are desperately needed to change this current state!!"

    Tuesday 6 October 2015

    LYME DISEASE PERSISTER DRUGS - DR YING ZHANG




    Interview with Prof. Ying Zhang at the NorVect Conference 2015

    Published on Sep 29, 2015
    Prof Ying Zhang from John Hopkins Bloomberg School of Public Health explains why Lyme disease is so difficult to treat. Having worked with Tuberculosis (TB) for many years, he sees the similarities and differences between these to bacteria. With Tuberculosis it is known that you have to treat with certain drug combinations that kill the growing form and the non-growing form (persisters) and if you treat shorter than 6 months, the patient will get a relapse.

    The bacterium that causes Lyme disease is much more advanced than the TB bacterium, and the main reason is that it also takes a persisting form. These persister forms of the Borrelia bacteria cannot be cultured.

    The two views – ILADS and IDSA are two different ways of seeing the same disease. Prof. Zhang thinks they are both right. When it comes to acute Lyme disease, IDSA is right. Then you only need shorter courses of treatment. When the disease turns chronic, longer courses of treatment with the right drug combinations are needed (ILADS view).

    The full presentation from Dr Zhang is available on the Norvect website from their 2015 conference http://norvect.no/about-norvect/    

    From Norvect website -
    Talk: Borrelia Persister Drugs: Implications for Improved Treatment
    http://norvect.no/conference/conference-2015/speakers/

    Dr Zhang also presented at a recent conference in Cambridge UK, organised by Lyme Disease Action presentations will be available on their website shortly

    It was a wonderful opportunity to hear Dr Zhang present and also to have opportunity to discuss his work.

    Dr Zhang told me that he studied at Birmingham University and later in London (I think he said UCL) - somewhat ironic for me in view of our Health Authorities head in the sands denial of chronic Lyme Disease, that this leading researcher in this field of why and how Borrelia persists, was trained at two of our Universities.

    I have posted previously about Dr Zhang's work