Ask a Lyme Doctor: Q&A with Dr. Tania Dempsey

Dr. Tania Dempsey is an expert in chronic disease, autoimmune disorders and mast cell activation syndrome. In this blog, she is answering Lyme related questions that GLA followers submitted via social media. 

Are you seeing cases where Covid has re-activated Lyme or ignited new auto-immune diseases or mast cell activation syndrome? -Kimberly H.

We are just at the beginning of really understanding how COVID interacts with our immune system. Since there are few studies that have been published that give us complete clarity on this, much of what I discuss is based on my experience with my patients. What seems clear to me is there is often some sort of vulnerability or predisposition in the patient, like an autoimmune potential, underlying dysfunctional mast cells, or a history of chronic infections, that leads to the complications that we are seeing post-COVID. I have not yet seen post-COVID patients who did not have some hint of an underlying issue prior to COVID. I have patients who have a history of Lyme disease that is well controlled for a number of years but after COVID they see a recurrence in the symptoms that pre-dated their Lyme treatment. Some of these patients have new symptoms and I postulate that it could be related to their underlying old infection that reactivated in a new location in their body or the new symptoms represent a worsening of their immune dysfunction. COVID seems to both stimulate and suppress the immune system, depending on the timing of the infection and on the susceptibility of the person. If the patient has a history of Lyme disease that is chronic/persistent, we know that their immune system continues to be affected. The vast majority of Chronic Lyme patients (in my practice) have underlying dysfunction of their mast cells, even if they have not been formally diagnosed with mast cell activation syndrome. Many of them had a predisposition before being infected with Lyme, which was worsened by the infection. Since infections of various kinds are known to trigger mast cells, chronic infection can cause chronic mast cell activation that then can be triggered further by a new infection, such as COVID. The relationship between mast cells and other immune cells has been well described and MCAS can be a driver of the development of autoimmunity.

How should I deal with post Lyme flare ups? -Debra C.

There are three main scenarios that I see as contributors for “post-Lyme flares”.

1. Mast Cell Activation Syndrome (MCAS) is a leading culprit for increased symptoms after Lyme treatment. Whether there is underlying primary MCAS or secondary MCAS triggered by the infection, mast cells often continue to be dysfunctional even after the infection is cleared. Mast Cell Targeted Therapy can be very helpful in stabilizing mast cells, minimizing mediator release and thereby minimizing inflammation.
2. Another important possibility to consider when patients have flares of symptoms after treatment for Lyme, is the presence of “co-infections.” Treating Lyme can make room for other infections to reactivate, like viruses (EBV, HHV-6, etc), Babesia, Bartonella, and many other microbes. It is important to look for other infections while treating Lyme, so as to not miss the need for other types of treatment. 
3. Persister Lyme is a major cause of  “Post-Lyme flares.” The bacteria that causes Lyme, Borrelia Burgdorferi, can exist in a slow-growing, persister form that is resistant to antibiotics and other anti-microbial treatment. Even aggressive treatment for Lyme disease can leave behind these persister organisms that can continue to wreak havoc on the body.  

What are the best current treatment for “stubborn” Bartonella? -Deb T.

Bartonella is probably one of the most difficult chronic infections that I’ve had to treat in my practice. It is necessary to use a multi-pronged approach in treatment of Bartonella. Some patients have other co-infections, which complicates the treatment as well. While I don’t think there is a “best” treatment for Bartonella yet, in my practice what I have found helpful is a combination of modalities, which could include SOT therapy (Supportive Oligonucleotide Technique), Ozone therapy, Herbal protocols and/or Antibiotics, and other therapies.

GLA is currently fundraising for The Bartonella Discovery Program, a research project bringing together some of the top researchers world-wide who are experts on Bartonellosis. These researchers will learn more about the bacteria and which treatments are most likely to cure patients.

How do you heal the nervous system after neurological Lyme and Bartonella ravage it? -Katie M.

Healing the nervous system after Lyme, Bartonella or other infections is a complicated process.  Reducing inflammation, not just by treating the infections, but also by targeting the immune cells that can continue to cause inflammation, is key. We have a considerable amount of evidence that mast cells in the central nervous system are in constant communication with other immune cells like astrocytes and microglial cells and together can be a major driver of neuroinflammation. There is no cure for neuroinflammation but there are a vast number of drugs and natural treatments that have been studied and some show promise in reducing the neuroinflammatory process. Some strategies include mast cell targeted therapy, treatment with natural compounds such as proresolving mediators (SPMs), PEA (palmitoylethinolamide), resveratrol, turmeric, and others, and various drugs like low-dose naltrexone, minocycline, NSAIDS, and steroids. Treatment needs to be individualized and other confounding medical conditions should be taken into account when choosing a protocol against neuroinflammation.

The above material is provided for information purposes only. The material (a) is not nor should be considered, or used as a substitute for, medical advice, diagnosis, or treatment, nor (b) does it necessarily represent endorsement by or an official position of Global Lyme Alliance, Inc. or any of its directors, officers, advisors or volunteers. Advice on the testing, treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.