Symptoms & Treatment of Tick-borne Disease

Steven Harris, M.D.

I always thought that I was gonna be doing international medicine, jungle medicine, war medicine, and as I was having these dreams, my father, Nick Harris, was taking a chance on an immunology offshoot of borreliosis, Lyme disease, and he developed, helped develop one of the early Western blots, and as he was doing this, he started realizing how many patients maybe actually had this infection and started talking to patients. He actually, as a scientist, many people would call him talking about tests and then the conversations would turn into life stories, and he’s always been a very good listener, and so we would sit around the dinner table and talk about his day and this new burgeoning concept of Lyme disease in the late ’80s, and then as I went through medical school in the ’90s and started seeing the controversies developing about what is Lyme, how do you get it, how do you treat it, how do you diagnose it, how do you address this ever-growing population. 

I started working with my dad in his lab at IGeneX, is the name of the lab, and became quite a bit more interested in the science of it, and then started attending conferences and learned from Greg Bach, Joe Burrascano, John Drulle, Richard Horowitz and got to see these people who were in the trenches at a very early, and Charles Ray Jones, of course, at a very early juncture in this field and what they were going through and how much of a difference they were making in people’s lives and saw, as I had gone through medical school and saw how doctors could close in on themselves, and probably out of anxiety that they couldn’t fix everybody, many doctors would develop a reactive approach where they would act like they knew everything, and I was seeing behind the scenes that they didn’t know anything, really, especially about Lyme disease, and they were becoming more and more entrenched in their wrong belief system, and so then patients were being the end product or the victims of all of this internal doctor anxiety and reaction going on. 

So I became very interested and then I worked with, decided I wanted to stay in the United States after residency for a year or two just so I could get my feet wet, understand how things worked in a medical system that was supposed to be a well-functioning medical system, and then go off into Latin America and Southern Africa and such, and so I worked with an amazing doctor, Therese Yang in San Diego, in Santee, and she ran the only free and nonprofit Lyme clinic at the time in the country, and it was basically jungle medicine as itself down there. We often practiced with the lights off because there was no money to pay the bills for the power, and not only that, but the patients were the sickest patients that, we never learned about these patients, even in inner city in Washington, D.C. 

This was a whole new class of patients and the complexity and the pain and the fatigue and the brain dysfunction and it was just amazing, and so many of these people were tickborne disease patients and there was the belief at the time that there’s no Lyme in Southern California and we saw the stories where with the tick bite and the rash, and even a lot of ’em didn’t even have a rash, which was another part of the problem, and then the way that the disease progressed and the way that they were treated by other doctors and it became just absolutely fascinating how much medicine and how many different strands of medicine were involved in these patients, and so realized, and then I realized at the same time, because we had an amazing neurologic chiropractor who worked at the office and then we had a naturopathic doctor who worked at the office, that allopathic medicine by itself wasn’t gonna work sufficiently for these patients. 

The science wasn’t far enough, so learning from patients and learning from naturopathic doctors and neurologic chiropractors and Dr. Yang and all of these other doctors who came before me, you who came before me, by quite a bit, I saw a whole new field that we didn’t learn about in medical school and residency, and I did quite a bit of alternative medicine and complementary medicine through residency and had lived in Mexico for a while and worked with a Mayan worldview of health practitioners and such, and so I was already aware of herbal medicine and aware of other aspects of medicine and traditional Chinese medicine and such, but watching what it took to get some of these patients better was really where my journey started and where it’s continued. In 20 years, it hasn’t changed all that much. It’s the same journey, and so I feel quite fulfilled, but also very humbled because I wish I had a cookbook where I could go through the 62 steps to get everybody, help everybody get themselves better, but it’s reinventing the wheel every time, and it is amazing. It is extremely intellectually and spiritually rewarding, but it’s also, it’s a grind reinventing that wheel every time.

Eric D. Gordon, M.D.

Yep. Yeah, it warms my heart to hear your story just ’cause it helps. Yeah, it’s just my experience over and over again that there are some people who are lucky. They’ll go find the doctor who’s a specialist in this aspect of the inflammatory process and they’ll get better, but the patients who we tend to see are a mix of problems. It’s because, as you said, it’s like when you were watching down there, it’s all aspects of medicine are involved in tickborne disease, and in fact, just as a little segue here is that people are wondering this is mycotoxins and chronic illness. In my mind, mycotoxins generally don’t become a problem for most people until they’ve had an underlying chronic illness, and tickborne disease is at least, and maybe ’cause it’s self-selection, but in my experience, the most common chronic illness to bring people into the mycotoxin and mast cell and other kind of falling apart world. It’s immune dysregulation and that’s what these bugs do. They dysregulate our immune systems.

Steven Harris, M.D.

Yeah, and it’s interesting because on the other hand from that story, I did, and I would test people for, we would do Shoemaker panels and I don’t think mycotoxin testing directly was available.

Eric D. Gordon, M.D.

Not in those days, yeah.

Steven Harris, M.D.

But we did a lot of inflammatory testing. We did a lot of autoimmune markers. We did a lot of viral testing. We did parasite testing, which has its own problems, and so we would find a lot of things that were positive, of course, the various fungi and all that, but when we found Lyme and we found Babesia and then eventually Bartonella, the first probably two years, it was just trying to find a bigger and bigger hammer, and it was, that was the part when things really shifted, was that I could no longer hold on to the hammer because it was so big and I would smack that nail down and I would wait the 12 or 14 months and I’d say, “Oh, you’re Herxing. In 14 months, the Herx will end,” and sure, for some people it was great and it did, and then of course, we detoxed people. We did a lotta that, a lotta functional medicine with it, but it was, yeah, and you say it perfectly, that it’s a dance with the patients, and so learning how to do that dance with all of these chronic complex illness patients, and I think that there’s a time for many of these patients who have tickborne diseases where that hammer can work, but it doesn’t have to be the whole time, and many of ’em aren’t ready for a hammer at first. There has to be that damage.

Eric D. Gordon, M.D.

And just to let people know, when you’re saying hammer, we’re like, it means antibiotics and often IV antibiotics is our big hammer.

Steven Harris, M.D.

Yeah, yeah, metaphorical hammer.

Eric D. Gordon, M.D.

Yeah, metaphorical hammer, but that, at least I think, that’s what we’re referring to ’cause I know I call it walking into the front door. When somebody comes in and they’re sick, this straightforward thing here. Here’s the antibiotics and then they get better. That’s the nice story, but that’s usually not what we see anymore.

Steven Harris, M.D.

That’s not the story that I see, yeah. Gosh, I’ve done this, I don’t know, 13, 14,000 times and I’ve maybe had that story 100 times.

Eric D. Gordon, M.D.

Yeah, I know, but it’s a very powerful story, though. Makes you happy. It’s like being in the emergency room again and they come and they’re short of breath. They’re in heart failure. You give ’em the IV Lasix and they’re breathing comfortable. It’s like, wow, what a hero you are, and that’s what doctors live for, but the reality is a little messier than that or a lot messier.

Steven Harris, M.D.

Yeah, yeah, yeah. Oh, no, for sure, and then over the years, it’s interesting because you do see new theories come up and then you see new treatments come up and then you see, then when you’re looking, especially when you’re listening to all of the or so much of the media and the patients and other doctors, so many different theories and so many different etiological agents and so many different aspects of pathology and then treatments come up and then there’s a, you watch these bandwagons over time. You’ve seen this, where it’s like something like Mannatech becomes the most famous, best thing, and it’s great for everything, and then colestyramine and that’s like the end-all and be-all and this is what we do and if you just give colestyramine everything’s gonna be, and so we see this over time and a lotta these things have stuck, but we’re finding the way to put them in, and so that’s where it’s really important, is looking at the patient, the whole patient, and all of the pieces together and then trying to find, and with that onion and it’s a, we use that metaphor a lot, but the layers of the onion. 

It’s more than just the onion because there’s a lot of other pieces that go with it, not just pulling layers out, but it’s interesting to watch some of these things come and go and then come back. For example, like with respect to tickborne diseases and other chronic illnesses, the Marshall Protocol, when everybody was doing the Marshall Protocol for years and then that just totally fell out of favor and now there’s a real place sometimes for it. It works sometimes really well and it’s trying to find working with each patient, where they’re at and how to get them to the other side or how to help them get themselves to the other side I should say ’cause that’s the key piece, is that it is a relationship that you’re working together with.

Eric D. Gordon, M.D.

Yeah, so what I actually, an interesting, just to mine your brain a little bit, is there a particular flavor of, how do you say it? Are there a few key symptoms that push you one direction or the other for what you think needs to be treated first? And when you’re looking, a complex patient comes in, is there, my reference for this is so old that nobody gets it anymore. It’s the old Groucho Marx TV show where the duck would drop down, and if you said the magic word, you got $100, but you’d have to be like, everybody who knows what that reference is is almost dead, but is this the idea that in medicine, when you go in in the seven-minute office visit, if you say the magic word that my joint hurts, they’re gonna give you a nonsteroidal. End of conversation, but in our world, while you’re listening, what flavor of symptoms push you to making your decisions? I think that’s two things.

Steven Harris, M.D.

First of all, it’s a complicated question because-

Eric D. Gordon, M.D.

Of course.

Steven Harris, M.D.

Even four or five years ago, I would’ve answered it differently. Four or five years ago, I would’ve said, “Okay, if you have major,” after looking at yeast and after looking at mold and after looking at other GI issues, for example, if you have major GI issues and you have anxiety and you have brain fog and you have nerve pain, or brain fog and nerve pain, or pain in the bottom of your feet and costal margin pain, tenderness, or some striae on your back or in your groin, all right, we gotta look at Bartonella, and then I, it was a decision between, “Hey, do I do Bartonella or Babesia first? Do you have head pressure? Do you have very vivid nightmares? Do you have night sweats? 

Do you have air hunger, shortness of breath? Do you have major neurologic symptoms?” Then I’d say, “Okay, they got Babesia and Bartonella. Which one? How am I gonna do it first?” Yeah, and then there’s benefits for doing both, but it’s not like that anymore. It’s become more formalized and it’s become more subtle since then because of this thing that we didn’t really, I don’t know, maybe I wasn’t looking, but back 20 years ago, mast cell activation syndrome, it didn’t seem like it was such a big thing. We didn’t really know it. I didn’t know it and so there is-

Eric D. Gordon, M.D.

I think we used to call it Herxing.

Steven Harris, M.D.

I think we called it Herxing, and it was. Patients have, the symptoms are much more like, some of ’em are more subtle, but sometimes they become so pervasive that you just can’t proceed. You just can’t cut to the chase, even if you know that Babesia is the thing that’s causing them to feel that way or Bartonella’s causing them to feel that way. You have to work out, now I find, and it could have to do with glyphosates and it could have to do with that there’s more mold and that there’s more EMFs and 5G and so mold is now polarized and more pissed off than it used to be and the way it acts in our body. Who knows? And that there’s, for some reason, we can’t just hit, we can’t use that hammer against a nail anymore. We have to prepare. We have to make the conditions proper in order to go in and cut to the chase. When it’s time to cut to the chase, that’s my favorite time. It’s like, okay, smash and grab. Bam, bam, bam. I love that time where I can use my three IV antibiotics and have maybe someone on disulfiram at the same time and just go hell’s bells, but I don’t get to do that very much. I spend a lotta my time-

Eric D. Gordon, M.D.

No, I know what you mean because, yeah, you are now dealing with patients who you have to say, “May I?” because their systems are so sensitive. If you push hard, yeah, yeah. The good old days are gone.

Steven Harris, M.D.

And sometimes, and I think to my detriment, having had so many patients who come to me who’ve been sick for years and have been to so many different treatment approaches and different clinics and such and have, I don’t know, failed or partially failed or partially recovered and then relapsed, having these really storied, complicated, experienced, super knowledgeable patients who are really self-aware and sensitive and know what they want, a lot of ’em, and know how to get there sometimes if you listen to ’em. They can’t just go straight to the chase. You can’t cut to the chase anymore and the dance, it’s different. Each time, sure there’s, we look at all of the things. 

We look at the viruses, we look at the mold, we look at the hormones, we look at their ability to detox, and so to my detriment, sometimes there are patients still who come in and all they need is just some stupid treatment and they do walk through that door and they could be part of that 100, but I’m a little traumatized from so many traumatized patients that I sometimes am a little bit too delicate, so it’s like, especially when I try, when I go with homeopathics first or LDI or naturopathic and naturopathic combos and I wanna do that first and I say, “Let’s see how your body reacts, and then once we do that, then we’ll debulk with the pharmaceuticals.” Sometimes just debulking with the pharmaceuticals first, I used to do that most of the time and then I would just wait and see what happened, but now I’ve seen too many people, thankfully through other people’s stories, I haven’t gotten in that much trouble myself with that, but because I’ve heard it so many times, it’s the recurring theme.

Eric D. Gordon, M.D.

Let me just, this would be a great training video for doctors I realize ’cause you are describing what has to be thought about, but let me just reference this for our listeners a little bit more specifically is, just so they make sure that they’re getting it ’cause we’re talking a little bit in our code, is that what Dr. Harris is really seeing that I think we, that most of us have, is that antibiotic therapy can be so effective and so powerful, but in this day and age, by the time people come to those of us who are in the, I guess, the subspecialty range of treating Lyme is that if we go in with the antibiotics, too many people get significantly worse because their systems are toxic or too toxic. They’re too sensitive. 

They’ve got other, so many layers, as Steve was talking about, whether it’s mold, mycotoxins, mast cell, all these complicating issues that to go in there and just knock down a load of tickborne disease is too much, but every once in a while, that’s what’s needed to get the system to actually move and we don’t know who those people are anymore because we’ve seen so many people get sicker when we lead with the antibiotics, and that’s why I know for me too is that antibiotics are something that are used now second, third, fourth line, long until we try to make sure the system is cleaned up as best we can, and one other point that makes life even more frustrating is that sometimes the most sensitive of the mast cell people can actually tolerate drugs much better than they can tolerate anything else, which is really-

Steven Harris, M.D.

It’s amazing. You’re right. Especially to that end, what I find, and when I get patients who have been through things and the story, the two-hour stories about their mast cell experiences with everything is more times than not, if I use some IV azithromycin or some ceftriaxone and I go low dose and I work it up, they really tolerate it and it’s amazing.

Eric D. Gordon, M.D.

Yes. Hallelujah. I know most people don’t think that, but they don’t realize is that the, a lot of the subtler things are rocking their immune systems and it’s the immune system that’s the issue and the antibiotics actually are anti-inflammatory and as well as killing the bug.

Steven Harris, M.D.

Yeah, yeah, and everything just, and sometimes because they’re a chemical, your body doesn’t even try to work with it. It just takes a backseat and lets it do its thing almost.

Eric D. Gordon, M.D.

Yeah. It’s the complexity of this world, and I always, I know that as a patient, it’s sometimes hard to hear this because when you’ve been suffering and you’ve been walking into walls, so to speak, going to different practitioners and being given something and just getting sicker, it can be disheartening to hear that that is your fate a bit, but the important thing to remember is that you know you’re with the right practitioner when you walk into the wall and it hurts, they don’t keep insisting that you run into the wall. They listen and back off and then will readjust and realize-

Steven Harris, M.D.

Yeah, I think that’s really important, that there’s ways, there’s so many ways to get in there, and then it’s, I think that’s where that experience comes in with when you’ve seen it, like, okay, so sometimes it works. Sometimes a little touch of this will work. Sometimes it doesn’t and then you just have to know quickly when to back off and then when to take a different approach. Let’s just say with that mast cell person that we tried a little, 100 milligrams of IV azithromycin and just wasn’t, it wasn’t the right thing, just didn’t work, and then probably your options would be, do you try a different antibiotic? Mm, probably not because zith is probably one of the easiest ones to assimilate. 

You’re not doing any direct killing that way. You’re going inside the cells, plus it’s not working that well if someone’s really acidic. If you use something easy and you get a sense that the body just is shutting down, then you take a different approach, and so if I was on a time crunch and someone said, and I’ve had this and it’s horrible, they’re like, “I have three months, and if I’m not better in three months, that’s it. I’m not gonna keep on treating,” and so they give you a timeline, which is flipped notes, but so in that approach, then what I would do is say, “Okay, look and see what kind of inflammatory markers there are,” and then probably do something like what we were just talking about before I got on. 

Do something like apheresis or plasmapheresis. Chase it with IVIG to decrease some of that neuroinflammation. This is after testing, so you know what you’re doing and you know that you can be safe with it and hopefully get insurance coverage for at least the IVIG, if not the apheresis, and then you make the conditions right, so then the actual treatment that’s needed will then be able to be tolerated, and so sometimes you don’t need to go that hardcore. Sometimes you can just use something like amlexanox or DSIP or some of these other peptides, thymosin beta-4 or whatever or even hist dio, some of these little things you can use to decrease mast cells, cromolyn sodium, whatever. There’s a million things out there or you do the Patricia Kane protocol. You do membrane stabilization therapy first. There’s a million ways to get someone to the treatment. I don’t necessarily, I love the membrane stabilization therapy and I think there are some things that it actually is a treatment in itself for, but I often use it to get me somewhere. I use a lot of these things to get me somewhere. I don’t think that plasmapheresis is the end-all and be-all for almost anything, but it gets me somewhere.

Eric D. Gordon, M.D.

They’re band-aids, but they let us, yeah, they’re-

Steven Harris, M.D.

They’re Facilitators. Yeah, they’re facilitators. They’re excavators, so you can put whatever you wanna put into that hole.

Eric D. Gordon, M.D.

Yep, I love it. I love it. This is what, and I just want patients to understand that in the complex, if you’ve been going to several doctors and you’re still not getting well, it’s step back and just realize that you have to keep opening the possibilities. One of the depressing things, not depressing, but one of the frustrating things is when people come in to see me and they’re 100% sure they know what they have, and that’s fine because I always believe that that deep intuition is a guide and we have to honor and acknowledge it, but sometimes it’s that deep intuition that’s also been focused by the fact that they saw a list online that said, “These are Babesia symptoms,” and we’ve joked about that for years. One man’s Babesia’s list is another man’s Bartonella list. There’s flavors, but the body only has so many ways to make noise, and yeah, and there’s different flavors of headaches and different flavors of head pressure, but at the end of the day, you can get there by inflammation, your brain fog and your mood disorder.

Steven Harris, M.D.

It’s interesting, yeah, which brings me to another point that I’m really excited about as far as not a specific treatment. I talked to Dr. Patterson the other day who’s publishing that new paper.

Eric D. Gordon, M.D.

Yes.

Steven Harris, M.D.

And I don’t know, maybe-

Eric D. Gordon, M.D.

Oh, I’m sorry. I said yes too quick. This is the problem of talking to you, is that we can talk in code. Dr. Bruce Patterson, who’s written a lot about long-haul COVID and about the function of mono, of how a piece of the spike protein stays in our white blood cells, and I’ll let Steve go on from there.

Steven Harris, M.D.

Talking to him, and I don’t know if this is gonna be part of his paper that’s coming out. There’s a paper coming out in the “British Medical Journal” imminently and he was talking about, and sorry, let me just backtrack a little bit. One of the biggest debates between who has chronic Lyme as an infection and who’s sick with post-treatment Lyme disease syndrome, is it an active infection or is it the junk that’s left over that your body thinks is still going on so you’re just making the inflammation? That’s kind of the hallmark of the treatment debate. That’s where all-

Eric D. Gordon, M.D.

Yeah, the Infectious Disease Society versus the International Lyme and Associated Diseases.

Steven Harris, M.D.

That’s where the fighting’s happening.

Eric D. Gordon, M.D.

That’s it.

Steven Harris, M.D.

Right, and so there’s a lot of evidence that both things are probably happening, that the bacteria there, like for Borrelia, at least for Lyme, there’s not a ton of actual organisms. It’s not, and it’s similar to syphilis, but syphilis, there’s like, every single cell would be infected. In Borrelia, it’s gonna be one out of, I don’t know, a million, three million cells are gonna be infected actually, and so there’s so few cells that are infected with Borrelia that one, yes, one packs a punch, but that punch is the immune response and that there’s we know having done this, and we see this with tuberculosis and a lot of other things, the whole latency of, and then there has to be some sort of trigger. Was it steroids? Was it an accident? Was it something happened-

Eric D. Gordon, M.D.

I think what you mean, the latency is that you can have this bug in you and it can be kept in check by your immune system until a stress happens, and then in stress-

Steven Harris, M.D.

Yeah, and so the point being is that, yes, the people who are sick with chronic Lyme, the infection is definitely one of the paramount things, but that the inflammatory response is also really important, and so we look at, there’s a few different kinds of cells that we think about and one of the first models was that whole toll receptor, toll ligand, where you get a very nonspecific immune activation. Even if it was just one bug, the whole body is going, “Ah, ah, ah,” crazy, and it sends a cascade of reactions. That’s a little bit what a Herxheimer is like. A Herxheimer specifically is that where organisms, probably from quorum sensing, where organisms communicate with each other, that a few of ’em die, one colony die, they send signals to a bunch of other ones and the bunch of other ones then die and they release their chemicals and the body responds to the chemicals by making their own chemicals and-

Eric D. Gordon, M.D.

Which then causes the Herx.

Steven Harris, M.D.

That which make you .

Eric D. Gordon, M.D.

Or the sensation that we call Herx.

Steven Harris, M.D.

A lot of this is science and is still being worked out, but at the end of the day, there are bugs, but there’s also what the bugs, what happens with the immune response, even if they’re just seeing pieces of the bugs. Maybe not the live bugs all doing them, and so what Bruce Patterson is finding with his chronic Lyme patients is that he think he finds that monocytes have, will take membranes ’cause we know that Borrelia, sorry, I’ll go back, Borrelia are spirochetes that have a cell wall and a cell membrane and that many of them will lose those pieces of their organism, and to make a so-called cyst or Lister form, they go into these hard cysts that become a little bit more treatment resistant. 

Some people think they’re dormant. They’re probably not dormant, but that when they lose that, that cell membrane and possibly even cell wall is being taken up by the monocytes and there’s a whole immune response that’s happening, and it’s a very similar mechanism immunologically, he’s finding, to long-haulers’ COVID, and that that drug maraviroc plus the using a statin, pravastatin, may actually work for, probably not the infection piece, but for the major piece of the symptoms with some of these Lyme patients. Super preliminary and I don’t wanna put the cart before the horse, but just that concept is really exciting. I’m not gonna get on the bandwagon yet because I’ve seen these kinds of things happen too many times over 20 years, but for example, that’s a really exciting piece that if we could get, not have to do plasmapheresis and IVIG followed by antibiotics for everybody and we could use something like a maraviroc that would decrease those chemicals without screwing up the immune system like the arthritis drugs and steroids do, because you can sometimes accomplish this with steroids temporarily, but it’s instant gratification versus-

Eric D. Gordon, M.D.

Yeah, that one’s a devil’s bargain sometimes. Yeah, no, this is, and it’s funny, I think that the first time, even before Dr. Patterson at least talked to me about the thinking that there was a glycoprotein from Lyme, it was one of my patients. Like I’ve always said, I learn everything from my patients and from you. It’s like they’re out there thinking about this right off the bat. As soon as he came out with his monocyte concept for COVID, some of these people on some of the Lyme forums were already going, “Oh, okay. Let’s do this test.”

Steven Harris, M.D.

Oh, yeah. No, it’s amazing.

Eric D. Gordon, M.D.

Yeah, that’s why I say the patient population, the blessing that we have is that some very, very smart people get these chronic diseases, and I said that they are a constant source of inspiration to me and knowledge ’cause they’re just reading and you never know what they’re gonna bring to us, but so you were getting on, I’m sorry. I hope I didn’t derail you from where you were going.

Steven Harris, M.D.

No, no, the points just being is that there’s the, people talk about, “Can I get rid of this infection?” and it’s a hard concept, one, and I say, my typical line is that, “The tests aren’t good enough to prove a cure.” Maybe the T cells are better, they’re pretty good for that, but you don’t prove cure. You just can prove if someone’s negative. You don’t find bugs. You don’t find B-cell antibodies. You don’t find T cells that are stimulated and they have no symptoms for a very long time. Okay, does it mean there’s no organisms there or does it mean that their immune system has actually been able to create a stalemate that’s probably never gonna be a problem? We don’t know enough yet about that whole concept of cure, but what we do, except in kids probably. 

If you treat ’em really past the resolution of symptoms, usually, especially if their bodies are still growing, I still think that kids whose bodies are still growing can eradicate, but there are so many different ways to work on this. There’s the band-aids. There’s the where you can decrease symptoms, but you don’t wanna just decrease symptoms and have things waiting. You can’t just always do that. You do need to work on the infections and then get to the point where the immune system can take over. Like when we use antibiotics, we forget. Maybe they told us this once in medical school, but we forget, but it’s the major thing. Our immune system is still doing more than 90% of the heavy lifting. 

The antibiotics are just making that 10% so the body doesn’t have to do 100% of it. It’s still our body that’s doing it. If you can use those antibiotics to debulk enough, then the immune system, if it’s working, and a lotta times, and then probably what this conference is about and previous conferences that you’ve had is about is that, yeah, there’s a lot of immune dysfunction that we’re looking at when patients have such chronic illnesses, and don’t forget the parasites. We haven’t even talked about GI parasites and other parasites and helminths and all that.

Eric D. Gordon, M.D.

Yeah, which is good. I would love some thoughts on that ’cause that’s another one I call this, I don’t mean black box. The limitation has been on our ability to test for seeing. We grew up with the idea that if you didn’t see it on a test, it almost didn’t exist, and yet we’ve had to walk into this world where, really, so many of the things we’re treating, we’re still treating based on tests that are far from perfect. I always tell people a blood count can vary, but if it varies by more than three points, either you’re bleeding or there’s something wrong, but it can vary a little bit, but we’re doing tests that can really vary dramatically depending on the time that you do them and the lab that you do them in.

Steven Harris, M.D.

And the other thing is you can, there’s ways to interpret them that could be totally opposite, the opposite way that they are, like if someone has an IgM-positive antibody test. Does it mean that they have a new infection, which is what the textbooks say, or does it mean that they have a persistent infection, which is what we actually see? There’s a lotta science behind why, but it’s not all that. It’s older science and then there’s still a lot of unknowns, but why people don’t turn a lot of their IgM into IgG, and then when people see IgGs on their antibodies, the older antibodies, do we say that they’re immune to this infection? That’s what we’re doing with vaccines. 

The whole, you know, I’m speaking to the choir, but just for your listeners, that when you give a vaccine or you get an infection, the standard story is that your Ig, that you get exposure. You make it your first response, which is an IgM response. That IgM response will last maybe up to four months then goes away. As it’s going down, your IgG response, which are your memory cells, they’re smaller, they stick around and then they help you, your body confer resistance for the next time that your body has that exposure, and so that’s the story that you typically hear. That’s why we make vaccines and all that, for the most part, but there’s certain infections, like trypanosomiasis, Lyme disease, there’s some syphilis data about this, that there are, and a few other infections where that IgM, we even see this with Epstein-Barr reactivations and things like that, that you can have a recurrent IgM.

It’s not necessarily the same IgM molecules because they do get broken down, but these persistent infections, they’re really good at being chameleons and they look different to the body at different times, and so when they look different, they come out and the body says, “Oh, a new infection,” and so they make an IgM, and so there are different ways to interpret that. IgG, sometimes when I see someone that comes in, especially partners of patients or people who are healthy or healthy health workers that work outta labs, and they say, “Oh, I’m IgG positive. Oh my gosh. What do I do?” And I say, “You just had some exposure. You had some antigen probably that you were exposed to. You have no symptoms. You have nothing, no IgM. Your IgG is positive. You probably have just some immune awareness of it, but it doesn’t mean that you have an active infection,” so whereas another person would say, “I’m CTC positive. I must be really sick.” And they’re not related.

Eric D. Gordon, M.D.

And this is the great, great problem, is that the sickest people we see are IgM positive and IgG negative, and it’s very hard, but they go to their-

Steven Harris, M.D.

Yeah, and Joe Burrascano saw that early on. It was one of my biggest take-home messages back in the ’90s. He’s like, “They’re not gonna turn IgG until they start getting better. You might have to treat them with IV antibiotics for a year before they actually test positive,” and sure enough, I cannot tell you how many times I see that.

Eric D. Gordon, M.D.

Yeah, but if they go to an infectious disease specialist, the IgM is a false positive as far as they’re concerned.

Steven Harris, M.D.

Right, because they got bit by a tick or they had their likely exposure more than three months ago so it couldn’t be.

Eric D. Gordon, M.D.

Right, so yeah, and I’ve never figured out, and they really believe in the false positivity of those very strongly, but I say, clinically, we’ve all seen this too many, we’re not making it up. It’s what we see over and over and over again, but it’s very difficult for patients because especially if you’re in a family where people haven’t believed that you were that ill to begin with because your regular blood count was normal and you go and get your Lyme testing and you’re IgM positive, you’re still, nothing wrong with you. If you go to the infectious disease doc, it’s a real difficult situation.

Steven Harris, M.D.

No, it’s hard and that time is, I wouldn’t say it’s wasted because obviously every day is precious, but it’s a day of health that’s given up potentially by being told that. That’s one of the hardest parts, is that when you throw in when doctors, these people who are supposed to be helping you are telling you that you’re not sick and you know that you are and you know that you feel that you are and then you start hearing this more than once, 3, 5, 12 times, that actually ends up creating part of the illness piece that the hormones and the neurotransmitters that we make when we have that, call it rejection or insecurity and anxiety, that contributes to people being sicker, and so those are the people that you and I see. That has to be unraveled too. We’re not psychiatrists and the, but there is so much a piece of the cellular memory, is the way I look at it, that becomes part of this process.

Eric D. Gordon, M.D.

Oh, yeah. We talk about that lots of times through this series, is how important the, your central nervous system is really running the show and when it’s in a place where there’s inflammation in it and it’s perceiving danger, it’s gonna upregulate your immune reactivity, and so whatever thing we do that instead of your body going, “Oh, I’m dealing with this infection,” it goes, “Oh, I’m dying,” and so you really, you, A, feel sicker, but you get more depressed, you get more anxious and that doesn’t help the people who unfortunately are in families where if they’re more anxious, they’re just told to increase their antidepressant.

Steven Harris, M.D.

You just said, yeah, Dr. Naviaux’s whole worldview notwithstanding, the psychoneural immunology, which has been around for a really long time, if you feel bad, your immune system is gonna be bad.

Eric D. Gordon, M.D.

Yeah, it’s hardwired. It’s just how the system works and we really have to respect that and that’s where all the mind-body work is so helpful. We can turn down an outta control immune system, but some people can and I think that’s what we always have to differentiate, that some of us are gonna be great athletes and some of us aren’t. I always love the people who are marathoners, like my joke, push hard, don’t give up, and unfortunately, I’m the kinda guy who, yeah, you can push me, but left to my own devices, my first question is, when’s lunch? When are we gonna sit down and talk about this? Enough with the pushing, and it’s the same thing with people who can meditate. 

Some people can sit and meditate and it just comes to them just like perfect, and other people, they have a more restless mind. That’s not going to work, and we really have to be aware of the differences in people and not insist that just because my uncle meditated and he cured his Lyme, ah, might not work for you. Be nice. Know that different things are gonna help different people. I just hate to see that bully pulpit used, but getting back, just we touched on something I’d love to get a little bit, I got lost in testing, but in the idea of where do you see, I’m throwing something totally from left field, but where do you see the parasites in all this?

Steven Harris, M.D.

It’s interesting and especially when you throw in these nebulous rope worms, some of the theories about that, and the pictures and the way that it can just devastate people, not to mention Morgellons, which I look at as parasitic in nature and I use the antiparasitics for, and that’s really where I’ve learned the most, interestingly, is with the Morgellon patients because I think that we haven’t found a way to address that piece, whether it’s an offshoot of Lyme or relapsing fever Borrelia or with Bartonella. 

Whatever that happens to be, one thing is sure, is that the only thing that I have found that’s come close to addressing Morgellons is really high doses of lots of antiparasitics. In the course of treating those patients I’ve treated, I’ve used as many antiparasitics as that can be found in not just this country, and so I’ve become very familiar with how high of doses I can get, how to use it, which kind of strategies, pulsing, straight through, but what’s been really interesting doing that is that for many of the Lyme patients and the tickborne disease illness patients and the chronic complex illness patients maybe who aren’t actively infected with tickborne disease, that the antiparasitics really have their place and it’s been a place where I’ve had to become, I don’t know, like Socrates, if I could, where I know that I don’t know, but just knowing that I don’t know and knowing that the, there’s certain symptoms that really seem to respond to antiparasitics. There’s certain presentations that if, and I do the testing and I try a lotta the testing, and now it’s difficult. There’s a few people that do very specialized stuff. Dr. Cahill, who’s probably retired at this point.

Eric D. Gordon, M.D.

I think he’s still going a little bit, amazingly.

Steven Harris, M.D.

And so guy in New Mexico and Nigeria. Yeah, and there’s a bunch of people who are doing specialized things, but for all of the testing that I’ve done, I’d say maybe 10% something will come up, but I haven’t just treated the people who are positive. I have treated some people who aren’t positive for the parasite test and so there’s patterns. There’s subtle patterns, I think, that we’re looking for, and so I’ll use a lot of the antiparasitics, and a lotta times we’re talking about finding a way in, whether it’s the plasmapheresis and the getting, working on the mast cell . The antiparasitic treatment, like if I try my stuff that I do know, like obviously it makes more sense as a scientist, as someone who’s trying to keep their medical license to treat things that I do know and that I have evidence that I’m doing the right thing, but if I do some of those things and I’m finding that I’m hitting a wall or the patient’s hitting a wall, that sometimes going around and doing the antiparasite protocol, one, it can be much easier on the gut than the antibiotics, and you can really, and there is crossover. I don’t want to use the I-word in public, but the I, that drug has been-

Eric D. Gordon, M.D.

Oh, no. I think we can say is that ivermectin is one of those drugs that I, up until COVID, I didn’t understand why it worked so well. I was amazed over the years. We’ve been using it for, what? I dunno, probably almost 20 years we’ve been, I think it was Dietrich’s thing where his four parasite high-

Steven Harris, M.D.

I remember that protocol, yeah, with the, you use the praziquantel.

Eric D. Gordon, M.D.

Yeah, the albendazole or whatever.

Steven Harris, M.D.

Pyrantel, and interestingly enough, pyrantel, when J. Rajadas was doing his high-pass Bartonella studies, pyrantel actually came up as one of the best things for Bartonella. It doesn’t get absorbed very well. The albendazole, the thiabendazole, I know a lotta patients, especially with Morgellons, have used non-human versions of those drugs, but those are great. Even mebendazole sometimes will work, even when albendazole doesn’t, which is weird, but it does, especially in the high doses. Of course, Alinia, the nitazoxanide is my favorite drug. I use it probably more than anything else, and they are working on something that gets more systemically absorbed. The diethylcarbamazine is something that has been amazing for a lotta these patients we see. We can’t get it very easily, not everybody has microfilaria, but Willy Burgdorfer did say there was a microfilaria in most of these ticks that was super related to the Lyme patients, and so way back when, he talked about this microfilaria and so DEC works for lots of people.

Eric D. Gordon, M.D.

But, yeah. We have a whole talk in the last five minutes right there to expand on, but just I think that the take-home message is that not everybody needs these, all these treatments, but is that there are subsets of patients who the way in is the parasite is imbalancing their immune response because parasites are designed to live with us, most of them. Most of these bugs aren’t designed to kill us, the ones we treat, and the way they live with us is they alter our immune response and sometimes that’s fine. Sometimes it’s to our benefit. One of the stories is that it helps decrease autoimmune diseases if you get these parasites when you’re young enough, but when we get them when we’re older, they don’t definitely dance with us as well, and so treatment, and also the fact that the ticks carry a lotta different things. I mean that it’s not just Bartonella and Lyme and Babesia. There’s a family. God knows what that tick is carrying.

Steven Harris, M.D.

Yeah, and then just back to the parasites. It’s interesting, and back, and gonna bring it around since I know we’re outta time, but just to my original journey, I actually, my first case of mast cell activation syndrome that I saw was as a resident and it was an amazing case, and it turned out that she had Strongyloides, and it was really from that when I started looking, treating Strongyloides and watching how the mast cell responded and watching all of the symptoms, how they got better, that really got me so interested in some of these occult parasites as they, and I’ve seen the amount of depression, the amount of headaches, the amount of extreme anxiety and delusional, the disorders, so many parasite-related conditions.

Eric D. Gordon, M.D.

Yeah, but see, but the problem is is that if you happen to have something like Morgellons, you’re just gonna be told that you have delusional parasitosis. I always tell people, “Shut up. When you go to see the specialist, do not talk about the symptom more than once because if you keep going about it, you’re gonna get that diagnosis.” If you’re focused on your symptom, you’re in trouble. Welcome to the world of-

Steven Harris, M.D.

It’s interesting because it was one of the things that I did see it in in San Diego 20 years ago in Dr. Yang’s clinic, and the thing that crosses over with that is methamphetamine addiction because there’s, people will scratch the same way and the sores will look similar, so there’s, and you remember when-

Eric D. Gordon, M.D.

There’s truth in them there hills. No, that’s the problem, is that there are people whose psychological issues will manifest as physical diseases, but there are far more people who have physical diseases that manifest as with psychological symptoms and we just don’t understand the physical etiologies. It’s like psychiatrists are always talking about the functional symptoms as though these symptoms don’t have physiologic operating, they’re not caused by something, that they always look for the psyche as the cause and the psyche-

Steven Harris, M.D.

Just going back to Victorian times, the perfect thing was everyone had hysteria, we ended up calling conversion disorder. How many conversion disorder cases have we seen?

Eric D. Gordon, M.D.

Right. Exactly. I have seen several people were diagnosed with that, but when I spoke to them, they were normal people. They were sick and now I actually can help them. I remember in residency, I just was impressed by they just weren’t being listened to. That is the point, is it’s the problem with medicine, is that we would rather label than listen. It’s quicker. Anyway, I can’t believe we’ve covered so much all over the place. They said that we have a course here. One of these days, the good Dr. Harris, we have to, just because… I don’t know. Maybe I like you so much because I think we think alike, but it’s just that ’cause you have and we each have windows on different pieces of this. It’s just amazing, it really is, and there’s so much knowledge that’s not written down and that-

Steven Harris, M.D.

Look, it goes back just maybe last point when we talk about, and ILADS has the same issue, and medicine at large and the scientific evidence body is evidence-based medicine and how much anecdote do we need before it becomes part of the evidence base?

Eric D. Gordon, M.D.

Yeah, I know. There was a guy, I hate this line, but this guy, I think, this infectious disease guy from New York when he was talking about COVID, his big line was, “The plural of anecdote is not data,” but on the other hand, you can’t, where I disagree is that how many pieces of data do I need for an anti-gravity device? If it works once, we got something, and so that’s the thing, is that, and we have to honor that we’re treating, the thing about chronic illness, and I’ll end with my favorite line about chronic illness, is that it’s not about what you have, it’s about how your body is reacting to what you have. That’s a difference.

Steven Harris, M.D.

The total, it’s so important. It is so important because you get people with the exact, not the, but theoretically, thought experiment, the exact same conditions, they’re gonna totally behave and feel differently than each other.

Eric D. Gordon, M.D.

Yeah, and that’s where the evidence-based medicine falls apart because is when you start just measuring, what are you measuring it on? ‘Cause six people can have the same bug, but they might react to that bug totally, as we see these days with COVID. Just on any infection, everybody reacts differently.

Steven Harris, M.D.

Yeah, it’s interesting. We keep having these last points, but-

Eric D. Gordon, M.D.

Go on for an hour. It’s okay.

Steven Harris, M.D.

Is that I do think that things have changed a little bit. Back to what I was saying before, it has changed over the every seven, eight years what those symptom complexes, what are highlighted. Right now, one of the big things is we do see that triad of the fatigue and the mast cells and the dysautonomia, some of them with hypermobility, and it’s like that is a group that, and maybe we weren’t looking and it’s true that possibly we just, we’re blind to it, but it just seems like who I saw before is different than who I see now.

Eric D. Gordon, M.D.

I think they’re sicker, but I think partly, ’cause I remember, one of my patients who I accidentally somehow sent for Chiari surgery in 2002 or something like that, she’s, now we’re sending her for CCI because even though she, and I remember I would always be surprised by how hyper, I never put it together. I wasn’t that smart, but I would always, ’cause I used to do a lot of osteopath, I would see these really hypermobile hips in all these patients. I would be like, “Wow, these people are all yogis,” and I just didn’t add it up to the fact that there’s something about the increased connection between inflammation, excess inflammation and hypermobility, and it might just be being on the same gene.

Maybe there’s no causal factor there. They’re just hooked together, but still, I think it might have always been there, but we didn’t know enough to know that it was important because I think I saw it and I just didn’t, ’cause I remember Ritchie started to mention it. That’s where, going way off topic. We’re supposed to end, but just the thing is that’s why I always give kudos to the good Dr. Shoemaker, who sometimes can be Dr. Shoemaker, but still, he really noted early on that he was seeing these long-limbed people, that their arm length was more than their height. Again, something that goes along with hypermobility in a lotta people. He was noticing it. That’s where I have to give him a lotta credit. He was an incredibly astute clinician, really was. I have to say I think it’s-

Steven Harris, M.D.

Look, I’ve learned from all of you guys, and so I thank you. It’s standing on the shoulder of giants, I think.

Eric D. Gordon, M.D.

Yes. We all got lots of them to stand on, thank God. Anyway, really, Steve, it’s a pleasure to chat with you. I hope, I know we’ve, I’ve at least, you always open my eyes. Every time we talk, I think little bit wider and a little bit bigger, and so thank you so much and looking forward-

Steven Harris, M.D.

My pleasure.

Eric D. Gordon, M.D.

To doing this again.

Steven Harris, M.D.

Thanks.