Chronic Illness, Misdiagnosis & the Truth About Tick-Borne Disease with Dr. Susan Marra

Podcast Introduction and Guest Welcome 0:00

Welcome to the Doctors Making a Difference podcast where we help physicians to be empowered with the tools they need to be successful in medicine, in finance, and in life. Join us as we highlight doctors and other professionals around the world who are making a difference. Today I'm pleased to welcome Dr. Susan Mara. Dr. Mara is a naturopathic doctor who has done extensive work in Lyme disease and she has more information on this for us as physicians and I'm really excited to hear about it. And it sounds like she's done a lot of work and I'm pleased to welcome you.

So Dr. Mara, would you mind introducing yourself to our audience and telling them a little bit about your journey? Sure. So my name is Dr. Susan Merrill, and I've been practicing for 27 years. I have a bachelor's and a master's in psychology, but not the Freudian psychology, more like psychobiology, the way that the mind and the body interact. I had thought that I was perhaps interested in going into neuroscience. And so my first real job was working under Tom Insel at the NIMH in Bethesda, Maryland.

This was way back in the 80s. So then when I got there, I I thought, I'm not sure that the lab is the best place for somebody like me, because I'm a little bit of an introvert,

Dr. Mara's Background and Path to Naturopathic Medicine 1:29

but I'm too bubbly for the lab bench. I was a pain in the neck to the people. They just wanted to do their work. Well, you found where you belong. That's great. And then I happened to come out to Seattle to visit my sister Lauren. She told me of this naturopathic school, Bastyr, which at the time was the premier natural medicine school really in the world. And I went to look at it and I loved it. I thought, this is, this is, this is who I am. And so I applied and I got in and I did the four years and I got out and I joined a practice in West Fort, Connecticut.

and I started seeing all these patients and they had strange symptoms. They had migratory joint pain, migraine headaches lasting for seven days, severe, severe PMS, gut dysbiosis, all kinds of things. They weren't isolated. So in a single patient, you saw disturbances in more than one organ system. And I thought to myself, something is wrong here. I know something is wrong. I also tend to be very intuitive. So for me, if something doesn't feel right, it's not right, I just have to figure it out, right?

So I called doctors all over the area and I asked them, you know, are you seeing this? What are you seeing? I finally found a doctor, Dr. Bernie Raxlin, who happened to be a pioneer in the field of clinical diagnosis of Lyme disease. And he said to me, he said, you're right. He said, these patients have chronic infection. They have Lyme disease and co-infections. And I thought, you know, from school, we only had maybe three sentences about Lyme disease, about vector-borne illnesses. It wasn't emphasized at all.

And that was in the mid-90s, so like 30 years ago. And I thought to myself, well, yikes, you know, I don't really know anything about Lyme disease. And I started testing all my patients. And I would say nine out of 10 patients came back positive for Lyme. Now remember, Westport, Connecticut is about 40 miles south of Lyme, Connecticut. And Lyme, Connecticut is where it really sort of blossomed. So I said, oh, All right. Well, I got to get trained. So I joined ILADS, the International Lyme and Associated Diseases Organization, which is not the IDSA.

The IDSA is the Infectious Disease Society of America, which is the more traditional way of looking at infections. And I work in the more holistic, I guess you'd call it alternative. I don't call it alternative, but it's clearly not mainstream. And then I arranged to work with Dr. Richard Horowitz in Hyde Park, New York, because I got a preceptorship through Turn the Corner Foundation to sponsor me. And then I also did work for six years with Charles Ray Jones in New Haven, and he was the world leading pediatric Lyme specialist.

Discovering Lyme Disease in Practice 4:47

And so I got to learn, I basically did a residency essentially with both of them. Now, obviously, you know, A residency in a hospital is different, but I mean, being immersed, absolutely immersed in a topic for six years, you come out the other end knowing something. Absolutely. Right. So then where did your path take you after that? Well, unfortunately, I lived in Westport, Connecticut, which is highly Lyme endemic. There's probably a member of every household in Connecticut that has Lyme disease.

And I had a beautiful yellow lab and she would jump up on my bed. And I'm pretty sure that a tick got on her. And then it jumped onto me and that's how I got Lyme because I already knew about Lyme. I was already practicing Lyme. I knew to be careful, you know, but it's so prevalent there that you just can't stay away from it. In 2000, I got Lyme disease and also Bartonella, which is a co-infection, and I got very, very sick. I lost the vision in my right eye for six months and I had to go on IV antibiotics and oral high dose prednisone because the pressure in my eye was so high, they were afraid it was going to burst.

They did these therapies and then I came off the prednisone. I went on to oral antibiotics and I got much, much better. My vision returned. It's not as good as my left eye, but it's fine with glasses. I would say that it is not cured in me. I am in remission. And what I mean by that is if I have a really big stress, like a move or a death of a parent or a death of a sibling or anything like that, I will relapse and symptoms will slowly creep back in. But I know what they are, so I know right away, okay, we've got to get this under control.

This is very typical of tick-borne illness. And it's most likely because in a stressful situation, and I mean like high stress, like losing your job, moving. The body becomes acidic. It's largely in an acidic state. And those organisms flourish in acid and sugar. They love sugar. Bartonella loves sugar and spear keats. Raleigh burgdorferi, they like fats. That's one of the reasons why there is neuro-lime and neuro-Bart is because they cross the blood-brain barrier and get into the brain and cause encephalopathy and cause a myriad of different cognitive issues like poor memory, brain fog, inability to make decisions, impaired executive function, emotional ability, things like that.

Well, you can speak the language of patients, you can speak the language of caregivers and doctors, like you had studied it, then unfortunately contracted it yourself. Obviously, you've stayed engaged if you've done this for 27 years, so I'm just curious about what you've seen evolve over that period of time as far as recognition and diagnosis and treatment modalities. So the recognition of tick-borne illness is far greater than it was 27 years ago. In fact, just this past Sunday on 60 Minutes, there was an excerpt on some research that's being done on Nantucket Island, which is on the East Coast, just off of Cape Cod.

And they're doing research looking at genetically modifying the white-footed mouse. because that is a very large vector on the island of Nantucket and the research hasn't started yet, but that's the plan. Well, that's a very big deal.

Personal Lyme Infection and Chronic Relapse 8:49

Very, very big deal. So Martha's Vineyard and Nantucket are two of the most endemic places in the world for Lyme disease and tick-borne co-infections. Well, like you say, we've gone from barely recognizing two words, three lines about it in your training to your job, you know, became lots about it. And now we're talking about genetic modification of the vectors. Have you seen any other advancements in the world of, like I said, diagnosis or treatment in line? I have, yes. Yes, why the tests have become much more sensitive.

The laboratory that I choose to use is called Eigenics. It's in Palo Alto, California. And they specialize in tick-borne illness. That's all they do. That's all they've ever done for 35 years. And the tests have become more and more sensitive as the instruments have become more precise. And so you can do a myriad of different tests. You can look at antibodies. You can look at PCR, polymerase chain reaction, which actually identifies the DNA of the offending organism. Or you can do a FISH test, fluorescent in situ hybridization, where you actually visualize the blood cells.

And if there is Babesia in there, if there's Bartonella in there, if there's Spirochetes in there, then you can see that. That's good to hear. A lot of times we rely on older style tests, which it's nice that we have had all these different generations of tests. But if it was exclusively antibodies, it's challenging because you have IgM, you have IgG, and sometimes that doesn't reflect the chronicity of the disease or you don't know how recent it was. You're correct. isolate it from a PCR sample and say, hey, we have genetic material from these microorganisms that is still present somewhere in this person's body, that certainly lends some specificity to your diagnosis.

So let me just say, you're right with the exception of this. There has been an argument that PCR is perhaps not the best test because you cannot tell if the organism is living or not. Oh, that's a good point. If the organism is dead, then you're going to pick up the DNA, right? it's dead. It's not pathogenic to your body. Although then the other side says, oh, no, no, no, no, no. Even the remnants of the bacteria have peptidoglycans on them that are sort of toxic to the body. So there's a a lot of need for research.

And I'm actually on the board of two organizations. One is called Global Lyme Alliance, and they're sort of the premier nonprofit organization. And what they do is they raise money to then grant certain scientists research money to look at certain questions. And then the other board that I'm on is the board for Dr. Horowitz's nonprofit foundation. And I've been on these boards for like five or six years now. And we meet quarterly and talk about research and what do we think needs to be done. So it's, I think, a really good thing to help continue to move the ball forward.

Oh, absolutely. So I'm a primary care doctor. So educate me a little bit. What would you recommend ordering if I have someone who comes in with a multitude of symptoms and says, hey, I think I may have been exposed to Lyme disease. I visited Connecticut. You know, we've kind of got the traditional teaching of what we've done with, you know, antibody-based diagnosis, but I'm curious, what would you recommend if you say, what's the initial workup for somebody who comes in and says, do I have this or not?

Okay, so first of all, 27 years ago, when you would test a patient, more than 50% of them would only have Lyme.

Advances in Testing and Specialty Labs 12:40

Now, I only have one patient in my practice who just has Lyme. Everybody has a multitude of co-infections, and they can range from Bartonella, Babesia, Ehrlichia, Anaplasma, Q fever, Tularema, Tularemia, Rocky Mountain spotted fever, Powassan virus, Heartland virus, Bourbon virus. I mean, tick-borne relapsing fever. I mean, there's like 16 or 17 that think vector-borne illnesses that we know are a problem. And so depending on the myriad of symptoms that a patient has, you would choose the correct test to look at that.

For example, If somebody came to you and they had night sweats, they had air hunger, and they had a pressure headache that felt like their head was in a vice, those are all signs of a Babesia infection. I use the Babesia antibody test and the Babesia fish test. Okay. I use both of them and you know, you just sign up for an account with iGenics and their phone number is 800-832-3200. Sign up. They'll send you test kits and then. You can take a look at all the different tests that you can order. You can order per pathogen or you can order bundles.

And I typically order bundles just because of who I am. I'm pretty heavily sought after for what I do because I've been doing it for so long. So most of the people that come to me are really infected and really sick. Like you said, most of your patients have this and you found co-infections with these precise tests. So how, another question kind of related to the practical part of it is patients come in and a lot of times they have limited insurance or things like that and they don't have the ability to pay for expensive tests.

How often are these tests covered by insurance? It depends on. the insurance company. There are some insurance companies that pay really well. Medicare will pay for igenex, but some also will not. So it really depends on the person's type of insurance that they have. What happens is they'll give you a super bill They'll give you a super bill for what you paid for in the test, and then you can submit that to insurance and see if your insurance company will pay for it. Sometimes it does, sometimes it doesn't.

Ideally, patients with health savings accounts, could they use those funds to help cover uncovered tests in this regard? Is that used as like a credit card? You can. I mean, health savings accounts come if you have a high deductible insurance plan. And with that, you can put money aside that is earmarked for payment of medical bills. And I've come across some patients who will say, look, I've got this health savings account and it does help me cover various things that are kind of considered medical, but are not covered by May insurance.

And if you don't know the specific answer to that, it's okay. I was just curious because a lot of times when I start ordering, yeah, when I order PCR tests and things like that, if they're not covered, my patients always come back and complain like, this was a $900 test. And so I was curious, you know, if you come across that much. No, it's a huge problem. It's a huge problem. And unfortunately, you know, it's not accessible for everybody because of the cost. But I'm not in charge of that. If you run a person's blood through LabCorp or Quest, the likelihood of that test, which is an antibody test, being positive is very low.

Because those labs, they don't specialize in the identification of tick-borne illness or pathogens. They're a general lab, right? And so, Hygenics has really perfected the precision which with, they can identify tick-borne illness. And there are other companies as too. Armin Labs is a really good lab. T-Labs in Gaithersburg, Maryland, those are probably the two other ones that might be useful to doctors, but the tests are expensive. I mean, to run a comprehensive panel for tick-borne illness through eugenics, it's $1,970. Yeah.

Ordering Tests, Insurance, and Access Barriers 17:28

And that's on par with what I've discovered on most PCR, you know, when you're getting down to that level and they're expensive. So that's why I was asking because again, most of the people who listen to this are physicians and they're saying, okay, I want to order this test because they have somebody with these crazy symptoms, you know, this constellation of symptoms that makes me think of a vector borne illness. But then that becomes kind of a rate limiting step. behoves you to either check insurance or have the patient check insurance or possibly like this health savings account deal for patients who have high deductible insurance plans.

That's interesting to see that and I bet that's kind of developed over the last 27 years. So, you know, I have never taken insurance and there's a reason for that. I didn't want to get into the controversy of whether or not what I was seeing was chronic Lyme because it's highly controversial, highly. And I didn't want to get into that. That's not why I went into medicine. I have no desire whatsoever to be convincing anybody of anything, right? I want to do the right tests. I want to help the patient.

And that's what I focus on. I am a very clinical doctor. I guess the best word to say, I am controversial, but I'm not in your face like about stuff. I'm sort of a back of the room kind of a kind of a doctor. Yeah, you're not going to be abrasive with somebody. You're trying to help patients. That's really what we're all committed to do is help patients. But no, a lot of medical doctors, I've been called every name in the book, charlatan, fake, all kinds of things, because they don't understand what I do.

And so they get a little bit irritated when they don't understand. And my response to that is, well, guess what? I don't understand cancer, but I don't call these people bad names, right? Just because someone is looking at something a different way doesn't mean they're wrong. That's been my experience and I've been very grateful that I've been a little bit rebellious, silently though, not making a big ruffle, but just trusting my gut and just being like, something just doesn't feel right here. It's not right.

I know it's not right. I would say 99 percent of the time, I'm right. Well, you've been doing it for a long time. Now, remember, that's the only patient that I attract. I'm not a general practitioner. So people will Google their lists of symptoms, right? And then recently they've been putting it into chat, GPT, and perplexity, and somehow they're coming up with my name. So now they're, it's like the quickest route to me now is my website. And my website is www.gpt.com. drsousanmera.com. And there's a plethora of information on that website, which I've been working on for 27 years.

So it's got all kinds of stuff, videos, it's got financial assistance information. There are some organizations like the Limelight Foundation that will grant money to pay for children's testing. So there are some, they're on my website. There's lots of blogs and articles, things like that to help patients familiarize theirself in a watered down fashion, right? So that they can understand it. Cause you have to meet the patient where they are or they're not gonna get it. Right. Another question on this is, again, your career spans multiple decades.

What have you observed about the treatment changes? Certainly we've had different antibiotics and different things that have been developed during that time. Have you seen any more specificity toward treatment of vector borne illnesses develop over the past three decades? Yes. There's been a couple of, obviously, the antibiotics, doxycycline, minocycline, amoxicillin, zithromax, biaxin, clindamycin, rifampin. Yes, all of that. But there's been in the last, I would say 10 to 15 years, there was a drug called disulfiram, which is actually used in addiction.

It's been shown to be very effective in some patients to kill the spherike. The problem is that disulfiram has a lot of side effects, one of which is pretty severe neuropathy.

Treatment Options: Antibiotics, Antiparasitics, and Herbs 22:08

And these people already have neuropathy, so why are you gonna do that? But some people do well on it. Another drug that I use a lot in my practice is methylene blue, which is actually a dye. And I do get it from a compounding pharmacy, and it is rather expensive. But that drug, for whatever reason, is very, very good at crossing the blood-brain barrier and getting to the crevasses, I call, of where these organisms live, especially Bartonella, but also lawn. So Lyme and Bardenella are very much affected by the presence of methylene blue.

The downside of methylene blue is it will stain your toilet bowl bright blue, bright blue, and it's difficult to get off. So that's another issue. And then another drug called Dapsone, And Dapsone is a drug I'm pretty sure was used originally in leprosy. And my mentor, Dr. Richard Horowitz, is the person that identified its use in tick-borne illness. And it's wonderful at really treating Lyme and Bardenol and Babesia. especially Lyme and Bartonella. However, I don't like to use that drug. People develop methemoglobinemia very easily.

They have folate deficiencies. It's just, it's really risky. So I don't like to use that drug unless I absolutely have to. There's another drug called tefenequin, or ericota, which is an antiparasitic, and it's very strong, and it works against babesia. Babesia is an intracellular red blood cell parasite, and it looks like a Maltese cross in the red blood cell. And, you know, things like meprone, malarone, coardum, Plaquenil, albenza, the anti-parasitic drugs can be very useful against babesia. However, babesia is becoming more and more resistant to medication because more and more people are getting it.

And it's an epidemic in New York. New York, Martha's Vineyard, and Nantucket, I think, have the highest incidence of babesia second to Slovenia in the world. In the world. I mean, it's very bad there. And anyways, this drug, tefenequine, which has been on the market for a long time, but it has a new application now. And this one, you also usually have to get from a compounding pharmacy and you start with a dose of a hundred milligrams twice a day for three days. And then you do a hundred milligrams once a week.

So it's a really strong drug. You have to measure the G6PD before that, same with methylene blue, make sure the glucose 6-phosphate dehydrogenous pathway is normal. If it's not, you cannot use those drugs. You will have a problem. So there's goods and bads about all these drugs. But if you look in medicine, that's true about every drug. That's true about cancer drugs. That's true about the statin drugs. It's true about antibiotics. It's true about every drug has goods and bads. I'm just trying to sort of give you the playing field.

And you talk about the side effects with your patients and say, look, here's what we know can happen. And then you help them make a decision about what they want to do. Some people don't want to go on antibiotics at all. They want to just do herbs. And that's where being a naturopathic physician is really in my favor, is because we're well-trained in that. And there are lots of herbs like teasel, Japanese knotweed, andrographis, oregano, thyme, wormwood, walnut that are very effective at killing these organisms.

The difference is that it takes much longer to treat a patient with multiple tick-borne illness or complex chronic illness with herbs than it does with the antibiotics. Well, I always tell patients little solutions for little problems and big solutions for big problems. And I think that's a lot because a lot of patients, you know, buy all sorts of stuff, you know, sometimes under the advice of someone with training and other times just what they've Googled and purchased. And, you know, and most of the time, if it's harmless and I say, well, if it's a little solution for a little problem, go for it.

If you're trying to treat stage three hypertension with something that is ineffective, I'm not going to recommend that because you're going to toast your kidneys. But we just kind of have to match the treatment to the disease. And it sounds like you do that with your patients. Oh, I do very, very personalized medicine, very. I used to actually look at the genome. And then what I found was that, let's say, for example, the patient had the histida gene or the HNMT histamine N-methyltransferase gene.

but they didn't have allergies, they didn't have an MCAS response. And I said, what's going on here? And I realized that what it is is that in that particular patient, the antigen is not activating or not turning on the histamine genes. So that's why I was talking to you earlier about how tick-borne illness is very much an epigenomic disease.

Personalized and Epigenomic Approaches to Care 27:48

And epigenomic meaning that the actual pathogenic organisms very much affect the genetic expression and the phenotypic expression of a patient. And that's why there's a plethora of symptomatology for complex chronic illness and multiple tick-borne illness. You can have GI Lyme. You can have NeuroLyme. You can have CardiacLyme. You can have MusculoskeletalLyme. You could have issues with your jaw and dental issues. It really is a very individual thing. And so You really have to tailor your treatment to that particular patient because as you know, certain drugs treat certain things, right?

So doxy and minnow are really good at their anti-inflammatory. You know, they'll calm down the Lyme arthritis a little bit. Plaquenil will help with the autoimmune component. So it's, you know, it's just like any other wing of medicine. You have to know what you're doing. I've thought this often, Dr. Mera, as I've encountered patients, our interaction with our environment, and that includes microorganisms in our environment, influences a lot of things, including, I think, the expression of genes, how our bodies respond to stuff, and then also what your immune system happens to be up to.

Fighting off these microorganisms certainly has a big effect on the body in general and your ability to respond to other diseases. We see people who gain, unfortunately, an infection in the setting of some other chronic heart disease or kidney or liver disease. And then it really disturbs their ability to fight that. And I think that is true across the spectrum. So our interaction with microorganisms is something our immune system often shields us from, but it is certainly something we encounter almost every day.

And there's more interactions with microorganisms, I think, than we even recognize. I 100% agree with you. Yeah, thank you. One question for you is, we're still at the level where we're trying to understand things at the molecular level of how these organisms are interacting at a cellular level, at a DNA level, at a mitochondria level. In what? What way are they acting at that microscopic level of our bodies? And I guess the question is, going forward, where do you see research going with this? Are there any things on the horizon outside of the genetically modified vector mice?

I was wondering if there's any other research that you're aware of that's ongoing to try to change this. Dr. Horowitz is trying to work on a double-blind clinical trial on Dapsone. So we're trying to get that organized. There's a couple of universities that are interested, and there is a drug that Kim Lewis, I believe he's at Northwestern University, he found a drug, it's called hygromycin. And the reason that it's wonderful is that it doesn't disrupt the gut microbiome. and it only targets Lyme, only Lyme.

So they're doing research on that as well. It's called Hygromycin A. Well, it is exciting to see some changes. And like you said, your career has spanned enough time. You've observed things changing a lot from the diagnostic side and even the treatment side. And then going forward, hopefully, as we understand things more at that DNA or molecular level, you'll be able to develop more things because A traditional

Research, Chronic Infection, and Future Directions 31:28

antibiotic treatment for an acute infection is the model we're taught, but you're observing that a lot of people have so many effects, whether it be from the acute infection or the prolonged exposure and your immune system's interaction with that disease, it can create a chronic disease state, which is really interesting. It's not unlike strep or TB or syphilis or leprosy. or HIV, they can all become chronic. For the most part, all of them are chronic. I think now HIV can be healed. I'm not 100% sure about that, but I think that there's a triple cocktail that is very effective and can either put HIV into great remission or it cures the patient.

That's not my area of expertise. So take it with a grain of salt. But I think it's something like that. Well, even like we were talking before we hit record, my observation is that there's so much research being done. And the example I shared with you is hepatitis C. The screening, the recommendations for hepatitis C screening weren't really in place because our treatments were kind of ineffective, tons of side effects, really didn't work that well. And so it was hard to recommend that. And then a few years back, the treatment was developed that really, really worked on hepatitis C, almost 100% cure rate.

And then they said, hey, let's screen everybody for hepatitis C because we can remove it for an individual that has it. And you hope for that day to come with these tick-borne illnesses, if we say we can identify it. And not only can we identify, but we have effective treatments so that we don't ostracize people or make them feel like they are left out that there's no answer, but rather we say we think we know what's actually going on here and help you find a way that treats your disease. Well, let me tell you the two areas that I'm most concerned about.

One is these organisms, they actually live deep in the tissue, but they come out into your blood. And if you are a blood donor, they do not screen for Bartonella or Babesia or even Lyme. They only screen for HIV and syphilis, I think. I'm not positive about that, but I know the tick-borne illnesses they do not screen for. So if you receive a transfusion from somebody who had those infections and they lied dormant and nobody knew, then you're gonna get infected. And I've seen that many times, many times.

The other place that I'm concerned is that Lyme and the other offenders, the other vector borne infections, they cross the placenta. So gestational Lyme, gestational Bartonella, gestational Babesia is a real thing. And so the baby is sort of bathed in this infectious soup for nine months. And then when it's born, it can have a myriad of issues, anything from colic to autism to heart defects, a myriad of things that are not well known, right? They're not well known. So you really have to look for it.

Thank you for sharing. Obviously you have a lot of passion, a lot of drive and a lot of knowledge on this. I want to, as we kind of wrap up here, I want to think about what are some things you would like, if you could pick two or three things you would want physicians to know about this who are not Lyme experts, what are the two or three things that you would say, takeaways that you would want them to know from this conversation to change how they interact as they recognize and treat folks with, you know, with potential disease or ones who've already been confirmed with disease?

So, the first thing I would say is when you have a new patient come to you and they have a laundry list of symptoms, the first thing you should be thinking is some sort of vector borne illness, and they probably have had it for a while. Either that or they got a huge pathogen load at the time of the bite. So, that would be the first thing. When you see multiple organ systems that are dysfunctional or sick or diseased, you should immediately start thinking infection, tick-borne illness. Then of course, the questions I ask, have you ever been bit by a tick?

Key Takeaways for Physicians and Closing Remarks 35:48

Did you do a lot of camping and hiking? Because some of the ticks are nymphs and they're the size of a pinhead, you can't see them. You got to look at their lifestyle. Did they have an animal? Did they hike and camp a lot? What was their life like? What was their risk of exposure? So that would be the second thing is assessing risk of exposure. And then I think the third thing would be to make sure that you test for co-infections. And to use a specific lab, you don't have to use Hygenics, that just happens to be the one that I'm using, but you can use Armand Labs or T-Labs are really also really good labs.

So that would be my suggestion is to go to a specialty laboratory for those tests. Now the downside of that is, is that you have to pay upfront and then you can submit the super bill to insurance and They will usually pay some amount, but it depends really on your insurance carrier. Excellent. Thank you for sharing that. I appreciate your information and your perspective. And again, I can tell this is something you're very driven and passionate about. And you've been able to help, I'm sure, hundreds or probably thousands of people over those 27 years.

9,000 now. Goodness gracious. Well, thank you for the work you're doing. 9,000. And one more time, will you tell us the name of the website so folks who may want to follow your work and follow along? My website is www.drsusanmera.com and you can go on there and you can read about me. If you're interested in like, how does she know this? Well, it'll tell you. And then there's a lot of articles, there's a lot of blogs, there's videos, there's financial assistance information, there's Books that you can read.

I tried to be as comprehensive on my website as possible because there's not a lot of resources for tick-borne illness patients. My website, it's 27 years old. I just keep adding stuff, adding stuff, adding stuff, and also modifying it as things change. Cause you know, medicine is always evolving. Absolutely. Thank you for taking the time to record a podcast. I'm sure this will be tremendously beneficial to those who listen to it. And I wish you the best in what you're doing, and I look forward to following your work.

So thank you so much, Dr. Mara. All righty. Thank you, Peter. Thanks for tuning in to the Doctors Making a Difference podcast. And thank you for what you do to help your patients and your community. Your work truly helps so many people. We produce this content to help you have the tools you need to stay in medicine and to highlight the amazing work being done by physicians around the world. Please note that while I am a physician and many of the guests on this program are also physicians or other professionals, the discussions on this podcast do not represent my employer or any professional organizations to which I belong.

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