 Hey, everybody. So glad to be here this afternoon with Dr. Dan Kindlir. And as we were just speaking before we got on, we both happened to be in the Denver, Boulder, Colorado area, and yet Dr. Kindlir, as you'll hear today, is a world-renowned expert in Lyme disease. And I'm going to do a few housekeeping things and then introduce him, and we'll dive right in. But I am so honored to have my colleague, we've known of each other and worked with mutual patients on quite a few cases for the last almost decade. But I have such great respect. And here he is in my own backyard and yet a world leader. He's been part of ILADS. And again, I will introduce him formally. But you're in for a treat today because this epidemic of Lyme disease is only getting more complex and more common. And we'll talk about some of the causes of why we're seeing more cases and those kinds of things today. But if you are just joining us now, this will be recorded. You can go back and watch it. You can also find this in all of my other interviews on my YouTube channel. And if you just search my name, Jill Carnahan, my YouTube channel will come up. And again, you can watch this, you can share it. If you want any other information about me, I have a blog and frequent content on my website, which is just my name, jillcarnahan.com. And our product page is drjilhealth.com. So those are places where you can find more information. And I will be sure and include in all of the spaces where this video plays. If you look below, you'll see links. We're gonna talk about two articles that Dr. Kindler recently published. And we're gonna talk about his book that just got released, Recovery from Lyme Disease. And I will include links to all of these things here and everywhere you see this video. So if you didn't catch it as we're talking, you will be able to see those links below. So I want to first introduce my guest, Dr. Dan Kindler, like I said, a colleague and just such great respect for him and his work because I think Dr. Kindler, this area, both mold, Lyme and all these complex chronic infections and illnesses, there's no more difficult area of medicine that we could have chosen. Let me introduce you and then I want to hear your story. So Dr. Kindler is a nationally recognized physician with an expertise in the fields of nutrition, allergy, environmental medicine, Lyme disease and the healing of mind, body, spirit as a unified whole. He co-founded a New England Center for Holistic Medicine in Newbury, Massachusetts and has taught extensively, including practitioner training courses at the Omega Institute, the National Institute of Behavioral Medicine in the International Lyme and Associated Diseases Society. He created and organized the Lyme Fundamentals course which is presently at the International Lyme and Associated Diseases Conference. He's the author of several review articles and these two new ones that we're gonna talk about today. His integrated medical practice in Denver, Colorado focuses on the diagnosis and treatment of tick-borne illness. And again, that doesn't do you justice. You are such an expert in this field. So welcome, Dr. Kindler. Thank you so much for joining me today. Thanks so much for having me, Jill. You're welcome. So where I always like to start is we all have a story. We all have a journey and it really, it kind of gives us a framework of where we practice and even the compassion and the mind, body pieces that we bring to our patients because we've all been in situations. I'd love to hear a little bit about your journey to becoming a world expert in Lyme disease. Okay, first of all, it's hard for me to imagine myself as a world expert, but I have developed a certain amount of expertise over the years. It's interesting, I have to say that that journey really started in my training in internal medicine. I had a very classic training in internal medicine and I felt that it gave me a foundation of which I understand the human body. But I never wanted to practice internal medicine. This is, I finished what? I finished my residency in 1979 and instead of opening up an internal medicine practice, I actually opened up what was then referred to as a holistic medical practice. One that you would know well, we didn't have the name integrative practice or functional practice. We were called holistic MDs and were generally considered quacks, quite frankly. I thought that I would see people who are just interested in treating things naturally, but in fact, again, like you, I ended up seeing people who fell through the cracks who just weren't getting help through mainstream docs. And so I was drawn to like, I wanna be the person who can really help this person who hasn't gotten help anywhere else. It's sort of satisfied my desire to help, but also I really enjoyed the detective work. And so that's what I was doing back then. There were not very many of us. I mean, we knew each other, those of us who were doing that kind of work. Not have journals. We did not have big conferences. We had small groups. And so that's the work I was doing. I was doing a lot of environmental medicine. And then in August of 1996, right in the middle of the summer in Massachusetts, I came down with a high fever, shaking chills, sweats, diffuse aching and fatigue. And so I was in bed for two or three days and then I was gone. And now I did live in an endemic area for Lyme, although it hadn't spread that much at that point. Like it was weird, but there were epicenters of Lyme at that point. And there was an epicenter about 10 miles as the crow flies in Ipswich, Massachusetts. There was an epicenter. And I actually had worked in emergency room there. Okay. So I had these three days of high fever and chills and sweats. It goes away, but recurs the next week. Another couple of days, it goes away, recurs then for the third time. And at that point I say, oh, I can't ignore this anymore. It's not just some sort of virus. I never saw a tick. I never saw a rash. So I go to see a colleague of mine. He does a physical exam and tells me I have an enlarged spleen. And he does some blood tests. It comes back positive for Lyme. Great. Okay. I have this simple bacterial infection. Simple, right? Right. And then, I figured I'll go on antibiotics for two to four weeks and it'll be fine, but I wasn't. I got worse. I developed severe insomnia. I went from being like a great Olympic sleeper to being up, you know, on most of the night, you know, I would take a hundred milligrams of Benadryl to try to make myself unconscious. It was really pretty terrible. And anxiety. I had been someone who, you know, most people would consider reasonably calm and collected. I was in a state of nine out of 10 and pending doom all the time. I just wanted to hide under the covers. Everything overwhelmed me. It was just abject terror, really. And so after a month on antibiotics, we tested again. It really was a slam dunk for Lyme and it was a strongly positive Western blood. At that point, I called a physician at the Tufts New England Medical Center, which is my alma mater, and I was considered a world expert. And back then, you could call another doctor and they'd call you back. I mean, it's not so easy now, right? But, you know, he was very gracious, called me back and very politely listened to my story. And then he said, well, you don't have Lyme disease. And I said, why not? And he said, because if you had Lyme disease, you'd be better by now. You've been on a month of antibiotics. Wow. And I said, but what about the tests? I mean, they were a slam dunk. He said, well, false positive, they were wrong. And I said, well, what do you think I have? He said, something else. And I was like, I mean, my head was spinning, right? So I call up a colleague of mine in upstate New York who I knew was treating Lyme disease and I really had not been. Yeah. And I described what had happened. And he said, Dan, welcome to the Lyme Wars. Yes. So that was my introduction to Lyme. And it got bad. You know, one thing, one comment on the expert is, although he was categorically wrong, I clearly had Lyme, he was right that I had something else, which you probably recognize from that story. There's no question I had Babesia. It was under the radar back then, but if any Lyme literate doc was taking my history now, they'd say, oh, you got Babesia, right? And then later, probably from another tick attachment, I got Bartonella. So my main symptoms were neuropsychiatric, but really bad neuropsychiatric. I mean, I was severely depressed. I was suicidal. The anxiety was over the top. I was having panic attacks. It was really hard to get through the day. But when I did finally recover, and it took years, when I did finally recover, I said, all I wanna do is treat people with Lyme disease. There are very few doctors who really have a handle on this. And hopefully I can help people not experience what I went through because it felt worse than death to me. And that's in fact what patients are like when they come to see us often, right? So it's really been a calling for me. What can I do for each patient who comes in? But also, I came to Lyme with this, what we'll now call an integrative medicine background, even though we didn't have that language for it, it was holistic, then it was complimentary medicine, alternative medicine, eventually it became integrative and functional medicine, but I came with that background. And back then, ILADS, which was a fledgling organization, was actually very straight physicians. But almost all of us, virtually all of us, the reason we were there is because either we or a family member had had this devastating illness. And we were tuned into it. But I was one of the very early docs who came in with this other background. And I was the first one to present at the conference on what else can we do from that integrative medicine direction to help these patients. So that's what I've been doing ever since. Wow, some salient things jump out at me. First of all, you didn't have the classic bull's-eye rash, which is a little, a lot of our colleagues still think that that's required. And what is it about 30% of patients who get Lyme get the rash and the other 70% don't? Is that about right statistically? It's really an open question. Some people say it's as low as 15%. Some studies suggest it's high as 70%. I would say in my experience, it's like probably more, I would say the rash itself might happen in 20% of my patients, but less than half of them actually have a bull's-eye rash. Most common rash is sort of an oblong salmon-colored homogeneous rash, but your point is very well taken. Doctors say, well, if you don't have arthritis, you don't have a rash, you don't have Lyme disease, which of course is totally false. And what we're talking about is there's a chronic inflammatory thing that happens with this and the acute infection, like I said, again, that febrile illness that you have may come and go and so conventional docs are kind of like with mold thinking it's just an allergy when it's just an immune inflammatory thing. It's much bigger than we were taught in medical school. So again, most people who are listening are very, very Lyme literate. They're aware of this. You're probably there suffering from this or know someone who is. However, if you're not, there is a dichotomy still between what is taught in medical schools and what Dr. Kindler and I are seeing in clinical practice and actually the reason why we're passionate about doing what we're doing, Dan, my story is like, I always said, I'm never going to do Lyme disease. Never say never, right? Because I was like, oh, it's so complex and I don't want to hurt the gut. But what I found is if I really am dedicated to be a healer, which both of us are and I want to help people, I cannot ignore this. And then like you, I was diagnosed with a perellia tick-borne relapsing fever, Bartonella, Babesia, and Ehrlichia. So same classic. And what we're seeing now is it's actually way more common to have the conglomeration of especially Bartonella, Babesia, and Lyme. Those are like the trifecta, right? You can talk a little bit about it. So it's confusing because Lyme has one, I always call them like footprints, right? And what I find too is clinically, I have to be really good because usually it's a clinical diagnosis that I prove with the best labs in those areas. So we can talk a little bit about that too. But it's often, you have to really be a stew because again, insomnia, anxiety, air hunger, disequilibrium might be more towards Babesia whereas, and so listening as a clinician, we can usually have a pretty good idea of what direction to go without even testing, although you and I both appreciate and use laboratory and scientific validation testing. Let's talk a little bit about, so your journey obviously opened this door. Gosh, it's like where to begin? Let's talk about when you first see a patient and how you would navigate. Do you ask questions about their clinical symptoms and kind of make a clinical observation first and then test or what's your order of operations for figuring out what you're dealing with? Okay, well, unfortunately, there's a bar to even get into my practice. Either they have to have a Lyme test or if it's a negative Lyme test, I'll talk to them on the phone to make sure their symptoms suggest that they might in fact have a tick-borne illness. So if they're in my office, there's already, it's usually an iron-clad diagnosis that at least they have Lyme disease and that's probably all I know about them when they first sit down. And then the initial intake takes about three hours for an adult patient. And I don't start with, why are you here or what's your chief complaint which is right how we were taught. I start with where did you grow up and tell me about your childhood? Yes, love it. So, first I wanna know, did they grow up in an endemic area? I wanna know what their family life was like. As you know, adverse childhood experience can have a significant impact on your immune system. And did they also, by the way, happen to get a lot of tick bites? And did they have chronic runny noses and recurrent ear infections that suggest they have food allergies? So I start there and then we just slowly work it up chronologically. And even though I asked patients to write all this down before they get to see me, we end up filling in all sorts of stuff as they remember as I take them up through one set of years at a time. And we watch how this illness evolves because it's rarely, I was fine until 32 years old and then I fell off the cliff. It's usually this stuttering and a gradually worsening situation where people become less and less dysfunctional, more and more symptomatic. And so that's what we're doing. We're sort of like documenting this odyssey of illness. And while we're doing it, okay, what doctors did you see? What did they do? What was your response? Like when you went on a moxicillin for your sinus infection, what did you notice? Did you have a herximer reaction? Did you feel better? What happened when they put you on steroids for poison ivy? So all of these are clues, as you know. And you're right, it's not just the medical tests. In fact, I don't use medical tests nearly as much as one might suspect. I do order depending on insurance coverage and it's always nice to get that backup or the objective findings, but particularly Babisi and Bartonella, which, as you said, are the most prominent, the most prominent of the co-infections. I'll usually diagnose them clinically before I ever get a lab test. And the lab tests aren't that good for those anyway, right? But then, as you know, since you're so well trained in integrative medicine, I'm looking for all the downstream issues associated with the chronic inflammation, auto-immunity, immune suppression. So we're looking, you know, as you said, we're looking at mold. You know, I used to think, so this goes back like 10 years ago, for sure. I used to think that, well, maybe mold's a problem in some people and if they're not getting better, I'll look at it. Now, day one, I'm looking. Right, I know you, it's how you can't know. And then way back when I had the mold and I started to understand that I was like, not everybody has mold, Jill, but then you feel and find almost everybody, I mean, especially our piecing population, the toxic burden is a big piece of it, isn't it? It sort of blows me away, especially since we live in a relatively dry climate, right? Excuse me. So it turns out that it's sometimes hard to find a house or an apartment without mold right here in Colorado, right? And that the person with Lyme in the family gets sick from it to people without Lyme in the family don't even notice that there's mold growing on their ceiling. So, yeah, that's a huge issue. So, we're asking all of these questions to see what the heck else is going on that might be impacting this person's health. And that's why I use, in my book, I use the term Lyme disease complex, not chronic Lyme or just Lyme disease. We're talking about people with chronic infection, but it's never just Lyme. You know, I've been seeing, it's been 20 years now that my practice has been limited to seeing people with Lyme and tick-borne infections. Other than some cases of acute Lyme disease, I never see anyone with chronic Lyme disease who only has Lyme. They all have co-infections. And this is more and more accepted in the literature. There was actually a study not that long ago, which did, they actually looked at CERA from 420 people who were CDC positive for Lyme. And they found that there was an 85% probability of a co-infection. Yes. And that's from looking at the CERA, you know, you and I both know, you're gonna find a lot more if you just look at the patient. Right, right, exactly. I'd love that you say that because it really is this conglomeration of, I would say functional medicine is real simple. It's a toxic load in infectious burden and the merging of those two. Now that of course oversimplifies it, but the idea that these two things play together. And I have seen cases where if you take away the environmental toxic burden and help their immune system, you don't necessarily have to be as aggressive in the treatment of the infections because their immune system does what it should do naturally. Now that's the exception because a lot of these people have dysfunctional immune systems. Let's talk just a little bit about because Babesia, Bartonella and Lyme are so common and then I wanna talk specifically about tick-borne relapsing fever, but those three in particular, because I think those are probably the three that we see the most, especially together. Can you give us just a little bit of a footprint on, we talked a little about Babesia, but let's just review, what would you see clinically for each of those? So that the patients listening, they're like, oh yeah, that's me, I may have Bartonella and they maybe go, you know, what would you say their picture is like for those? So if you're gonna put together a Venn diagram, okay? Yes. In the middle where they overlap so that all the infections can do this and probably when there's more than one infection, they do it even more so, but you're gonna see fatigue, headaches, joint pains, muscle aches, cognitive impairment and mood disorders. I think that's more likely than not, patients are gonna have those symptoms. Now, as you mentioned before, let's say someone wakes up with anxiety, shortness of breath and night sweats, slam dunk, they have Babesia, right? Now they might, all these other things might be worse, they might also have migraine headaches and neck pain. So that's how we diagnose Babesia clinically, but I have to point out, not everyone with Babesia has those symptoms, right? Okay, and then Bartonella is known, it's known as causing these neuropsychiatric problems. Now it's not the only one that causes neuropsychiatric problems, but it is the one that does it the worst. I mean, when we see not just anxiety, but panic attacks, when we see not just irritability, but rage attacks, we see bipolar, we see psychosis. That's, you know, we think, I bet Bartonella is an issue. There's certain symptoms that strongly suggest Bartonella, in addition to the neuropsychiatric symptoms, I would say peripheral neuropathy. So, you know, sharp pain, burning pain, electric-like pain, stabbing pain, as well as not a numbness and tingling. Again, not only Bartonella, but particularly Bartonella. Pain on the soles of your feet, particularly when you get up in the morning. Joe Buriscato described this to us like 12 years ago, or remember it well. And that's almost always Bartonella. Even as I say that, I have seen babesia do it. It's a neuropathy. It's a peripheral neuropathy. It's not only Bartonella, but it sure as hell suggests it. And then there's the Bartonella stria, these lines. That's what I was going to be starting to talk about, because it's a young person, no other risk factor, and they have huge stretch marks. Yeah, so people think that they are stretch marks. And this is interesting. I have another article that I'm going to submit for publication for review. It's on someone who presented a 16-year-old presented with anorexia nervosa. I mean, she clinically refused to eat, felt she had a weight problem. She was purging and had a distorted body image. She was in and out of eating disorder units, was getting all of her nutrition through a nasal gastric tube when I saw her, because she refused to eat, right? Among other things, she had these stria that she thought were stretch marks, or evidence of the fact that she was overweight, except they weren't stretch marks, right? They weren't, right? Also, in December of 2020, so just three months ago, Ed Breitschwerp in North Carolina, who's this world expert in Bartonella, he and colleagues, they had a paper in which they saw 29 people who tested positive, either serologically or PCR positive for Bartonella, 24 of them developed neuropsychiatric symptoms and these skin issues at the same time. Yeah. Okay, Bartonella, by the way, also causes a lot of eye symptoms, it causes a lot of gastrointestinal symptoms, and it does cause other kinds of rashes at all as well. One of the things I've seen stuff often is, and I wonder if, I was just thinking the other day, because I've seen a few patients with this, and I was associated with Bartonella, is that they feel this random sore throat flu coming on, just a little bit of something, and then it goes away. But is that pretty classical for Bartonella too, kind of that? It feels fluid, and then it goes right away, and it's usually sore throat and kind of a malaise. That's, thank you for reminding me. It is very common. Often people say, yeah, I have a sore throat almost every morning, and it gets a swollen glands, and sometimes it's not just cervical nodes, it might be axillary nodes, and inguinal nodes, but it never amounts to anything, right? But you're absolutely, you nailed it. That's usually Bartonella. And one other thing I remember from my youth, because I think my infections go back to probably eight, or 10, I grew up in the hiking in the woods of Wisconsin and Illinois, and of course, we pulled ticks off ourselves all the time, so no surprise, but the thing that was interesting as when I started menstruating and cycling, every month I would have this weak immune system, I'd get kind of sick around my cycle, and I've seen that with women now, and now I understand it's associated, I don't know if it's particularly Bartonella, it might be all of these trifecta, but I would see that in young women now, or older women, that the cycle was very related to how they felt with the illness and immune system. Yes, I see the same thing, you know, the Lyme bug Borrelia burgdorferi, that tends to cycle about once a month, and usually in females it's associated with the menstrual cycle. As I'm sure you know, once women start menstruating, their immune system is suppressed to some degree, and that's when the bugs flourish. Obesity tends to cycle every one to three weeks, one to two weeks maybe more often. You know, not always, and Bartonella, I don't see a consistency with Bartonella, to be honest, but those are clues, like you're describing of like, well, what's going on here, right? Yeah, and that's honestly, again, because we'll talk next about a little bit of the lab testing that's out there, nothing is great. There are continued new tests, PCR and fish and stuff that are better, but it's hard. Really, truly, you have to have a good clinical diagnostic skill, because I can't tell you number of times I hear the symptoms and like, I'm positive this person is Bartonella, and I may never have a positive test, but I have to have enough confidence to move forward because that's the only way they're gonna get better, right? Absolutely, I would say only a low percentage, at most 20%, but probably closer to 10% of the patients that I diagnosed with Bartonella have positive Bartonella serologies or PCR tests. Yeah, ton of research, I totally agree with you. So if you're out there as a patient and your doctor says, well, you're all negative, or you do a Western blood on lab core request, and it comes back negative, this is one strain of East Coast type of Lyme, and this leads us into tick-borne relapsing fever. This has been a massive aha for me because I am seeing so many people, first of all, out West here, Texas, it's actually more endemic with these soft-bodied ticks. So I think in our state, tick-borne relapsing fever and some of the other Rickettsial or Licky are actually more common than the classical Lyme, although we see them all. But what's your thoughts on, I feel like this is a hidden epidemic because most docs don't know how to test and right now I think the only one really testing well is hygienics. But what's your comments on testing, tick-borne relapsing fever, are you seeing it? Let's talk a little bit about that. Well, you know, I'm glad you brought this up. So relapsing fever used to have this standard clinical description in which people would feel fine and then once a week or so, they would have this program and run a high fever. I mean, sometimes high enough that they'd have a seizure and then they would quickly defravest all sorts of symptoms associated with that. And then they'd go another five, six days and feel fine. That's the classic relapsing fever. Well, it turns out that at least one and probably more than one of the species of bugs that causes relapsing fever, that's genetic, doesn't cause relapsing fever, but genetically is in the relapsing fever group, doesn't cause relapsing fever, it causes Lyme. And the most prominent one is Borrelium meumotii, which has only been recognized, I don't know, certainly within the last decade, not that long, initially in Russia and so on. So at any rate, what's important and I think you're bringing this up is that the standard tests for Lyme are gonna be negative, even though someone is presenting with Lyme, they don't get a rash, but as far as we can tell, they get everything else that Lyme does. And we treat it the same as Lyme. So I don't actually test for it if I know they have Lyme because we're gonna be treating it anyway. The treatment's the same for Borrelium meumotii as Borrelium burgdorferi, the Lyme pathogen. But if there's someone who has a Lyme-like illness and they test totally negative, then I'm gonna start looking for it. And by the way, I don't know if you get the New York Times Magazine, but a couple of months ago in they, Lisa Sanders, she's a Yale doctor who does these clinical, what is this, who done it kind of thing. And there was a case of Borrelium meumotii that was diagnosed by Brian Fallin, whom we know at Columbia, right? Yeah. Amazing. Well, I have to tell you, I told, when I interviewed Dr. Horowitz, I told the story, this is real personal, but it's very telling. So I had cancer at 25, Crohn's at 26, have overcome both, but the way my Crohn's presented, first of all, think you're gonna totally get this as a clinician. So first of all, I had cancer, immune compromise, and then three drug chemotherapy that totally trashed my immune system. Six months later, I presented with cyclical fevers. That's it. I had no gut symptoms. I had cyclical fevers and they were up to 102, 101. They weren't like 99. I worked, I was in my medical school 30 years. So I was working in the ER shifts and I was just like, I wouldn't even tell anybody because I knew I'd not be able to work and the standard, as you well know, for medical students is almost abusive. They just, you work, you don't go. So I would work through these shifts with fevers and I felt horrible, but I just went through. Six months later, I had an abscess and was diagnosed with Crohn's, but that was my only gut symptom. And I believe that that tick-borne relapsing fever, and there's some evidence now that not only Bartonella, which can cause granulomas, which looks like Crohn's, right? But that tick-borne relapsing fever, all these infections at that time in my life after the chemo started to pop up. And I probably really did have Crohn's. I have the genetics, but quit it of EZ-BEN, which will go to your article on autoimmunity in just a moment, because this is all gonna fit together. But I believe that that tick-borne relapsing fever, maybe the Bartonella were actually popping up and creating a symptom or a syndrome that looked like Crohn's like identical. And again, doesn't that make a lot of sense that that might have been at play? Oh, absolutely. You know, someone we don't hear from anymore, but a pediatric gastroenterologist by the name of Martin Fried is in New Jersey. And he presented the iLADS and he's written articles. So this is in the medical literature where he took kids with, both with nonspecific gastrointestinal complaints and some with Crohn's and ulcerative colitis and he would biopsy their intestines and he would find Lyne and he would find Bartonella. He's one of the first people actually to describe Bartonella stria. Yes, wow. Yeah, so I can tell you Bartonella, as you know, is associated with a wide range of autoimmune illnesses, including Crohn's, including colitis. And just a year ago, I had a paper published of Bartonella causing primary sclerosis and cholangitis. Yes. And this is so interesting. So what happened was I saw this kid when he was about 10 years old and he had a bunch of nonspecific symptoms, but it certainly looked like Lyne, but it felt like, and he tested positive, but it felt like Bartonella, he did not test positive to it. It's just no big deal, of course, right? He responded well to treating the Lyne, but every time I tried to give him something for the Bartonella, he would get a bellyache. Well, if we didn't give him something for Bartonella, he felt 100%. So he just stopped and we stopped treatment and he was happy. I always thought he had Bartonella. Well, three years later, I get a call from his mom. He's been diagnosed with primary sclerosis and colangitis. And just so the listeners understand, this is a very serious illness. It's actually associated with cirrhosis of the liver and early death and also a bunch of different cancers. Typically happens in adolescent males, most commonly. And it's inflammation of the biliary tract, both outside the liver and inside the liver and often associated with colitis. So what happened is he presented with bellyaches and some blood in his bowel movements. They scoped him and said, you have colitis and they did blood tests and then they saw, oh my God, this kid's got colangitis. They did the scans and they made that diagnosis. Okay, so the mother goes to this specialist in California and they're really having good luck with oral vancomycin. And she told me, and I looked it up, a bunch of case histories and small case series of how well vancomycin is working. And I said, well, why do they think vancomycin is helping these kids because it's not absorbed, it's not getting into the biliary tract. And she said, they have no idea. And I said, I know why. Exactly. It's hitting the Bartonella in the gut and there was an autoimmune reaction from the Bartonella causing the colangitis. So I call up Dr. Freed and I present the case to him and I said, here's what I think is happening. And he said, bingo. Bingo. So anyway, I wrote that article. It's got a lot of attention, but as you point out, the Bartonella, oh my God, it can do so many things of all the bugs. I actually think it's the worst one and the hardest to treat. I could not agree more. I could not agree more. And I think it's persistent. I don't think we really have a handle on exactly the very best. And we have some good treatments and you and I know have had some good successes. But the bane of my existence is this, the recurrent Bartonella. Now, interestingly, another thought on this is, so years ago, I read the research on New Zealand on mycobacterium avium species in correlation with Crohn's. And so I started, because I've had Crohn's, I draw a lot of inflammatory bowel patients. I love treating them. Where everybody else is like, I don't wanna see you on like Crohn's and colitis. I love treating. So I started testing all of these infections, including Lyme. And what I would find often as a co-infection is MAP, this mycobacterium avium. Well, guess what the treatment regimen for MAP is. It's chlorithromycin and rifampin or rifabutin. That treats Bartonella very well. And sometimes I'll add on a third drug that actually is not available in the US right now. But what I found is I was getting cures of Crohn's disease by using this regimen that I thought was for MAP. Well, about four or five years ago, like you, I was like, I think I'm treating Bartonella. Like, I don't know for sure because look, a lot of tests were negative, but that same regimen that would treat the MAP. And then I wondered all this research on MAP, were they just seeing this co-infection and saying, let's treat it. And obviously they got results just like I did, but I wonder if at the core, this is just my postulation. I have no science to back this, except my clinical experience. And I think that most of us were treating Bartonella. I suspect you're correct. I know about the atypical mycobacteria and that association. I really don't know how well it's documented. Yeah. I've not perused that literature. But I have a patient just like what you're describing. And she was put on a regimen just like you described. And, but what really made the biggest difference was Cipro. And when she went on Cipro, not only did her gut get better, but she was better all over. Yeah. I mean, you know, and to me it was like, yeah, this is Bartonella. This is really Bartonella. You guys want to treat mycobacteria, Avium, that's fine because they're the same. Totally agree. And I agree the evidence is not strong. I was always like, ah, am I really on the fringe? And you know what you and I have to do too is we have to be really good detectives. You mentioned this in the beginning and observe. And the ones of us that, I mean, we're really hopefully making inroads because we're doing stuff that isn't necessarily standard of care yet. And that's okay. I'm fine being there because I know that I'm using good science and my patients are getting better. But we have to be willing to push the envelope a little bit sometimes because otherwise nobody is treating or thinking outside the box to get new answers and solutions to these people. Well, you're being polite because I would say the standard of care sucks. Yeah. These people are not getting appropriate attention. I think one of the gifts we give them is just giving the time and validating their experience. They go to their family doc and they're in and out in five to 10 minutes to go to the gastroenterologists who looks up to them, looks down on them and doesn't look at them from a functional perspective, certainly doesn't know anything about tick-borne infections. In fact, it's only recently, it seems that the gastroenterologists are diagnosing SIBO. Yes. Excuse me. So yeah, I mean, we could spend a lot of time talking about how Western medicine has failed people with chronic illness. It's really sad. Well, so obviously the other thing I want to talk about is, I think you used kind of a balance, where you came from a holistic background and I did too. And I find that either purely medical, pharmaceutical approach doesn't usually work and a purely herbal approach doesn't usually work. Although there's exceptions to both. What's your thoughts? Because I feel like we have to have the most tools in our toolbox and really, really pull these all in because there is appropriate use of hydrocortisone. There's appropriate use for these other things. Thoughts on that and let's talk just a little bit about how we need these tools and what you use. Yeah, it's a big question. As you know, every patient's different. There's no cookbook that we can just say, okay, here's step one, two and three. If a patient's really fragile, I'm gonna be spending time on infrastructure before we even consider hitting the infections. And as you're suggesting, looking at adrenals and looking at other food sensitivities and gut issues and all the stuff that we do as integrative physicians to try to get people into balance, particularly with their hormones. And then in terms of anti-microbials, if they're not that, if they don't seem that fragile, I probably will start with pharmaceuticals. And I always start things one at a time and I always start things at half dose because I really don't wanna herks them, give them a herksime or a dial-free action, which are to some extent unavoidable and they can be helpful diagnostically, but they're not good for you. As you know, they're causing a lot of inflammation in the body, which is the problem. So we don't wanna cause undue herksime reactions. Okay, so I'm adding things one at a time and ideally what happens is I get people fairly well at that point and then I start adding botanical antimicrobial. So now we're hitting it from two different directions and I think that's ideal. If we can get both of those on board, I think we have more killing powder power and the botanicals, as you know, also support the immune system all the time we're doing whatever we need to to make sure the gut stays healthy. And then over time, people go into remission, I'll start peeling away the pharmaceuticals and just leave them on the botanical antimicrobials for a while. And then over time, some people say, I just wanna stay on this rest of my life and other people after a while they say, you know, I'm ready to stop and knock on wood, you know, I have patients in prolonged remissions, but as you pointed out, that's not gonna work. It's interesting to me, of course there are people who don't tolerate the pharmaceutical antibiotics. I have more people who don't tolerate the botanical, the herbal antibiotic. I totally agree with you. I feel like there's such a broad range of activity that sometimes it's too much for this too much noise and static, even though they're beautiful and whole as an herb, I totally agree with you. I think sometimes that just hitting and I was, that was for me a decade ago before I did this, that was my fears. I don't wanna hurt their gut, I don't wanna use the drugs. And then I realized the drugs actually really work and there's a place for them, a perfectly appropriate place. Yeah, yeah, and people will say, well, is it okay for me to take these drugs? Let's go and do my microbiome. And I'm like, you know, we can do a lot of things to help protect that, but I can tell you what's gonna happen if you don't take the drugs. Exactly. There's a benefit risk there that, you know, is really obvious. Totally agree. So a few last things, this is so fun, because it's so fun to talk on to some of you who understand so well and just really you are an expert, Dr. Kindler transmission. We have tons of questions. I always find these a little hard to answer because some of it we don't have a ton of science, but I wanna know your opinion on mosquitoes, spiders, bedbugs, which I have a story about. And then between couples, can it be sexually transmitted or in utero? Let's talk about those kind of transmission questions and some we may not have answers for, but for what you do, share with us, but that's your wisdom. Okay, so the most common form of transition is of course the deer tick or a long legged tick or a zootie stick, whatever you wanna call it, but they're these tiny ticks, which are hard to see. Okay, that's the most common. What's very well documented is that lime can be transmitted in utero to an unborn fetus, and that's not just lime, it's also babesia and bartonella. Okay, that can cause serious issues, often not noticeable in the newborn, but by the time these kids reach toddlerhood and so on, manifesting some really significant issues, often manifesting as a pans-like syndrome. Okay, so that's two ways people can get it. In terms of other biting insects, I don't think there's great documentation, but then we hear these anecdotal stories. I have a patient who swears that he got it, he got Lyme disease from a horse fly. Which caused some painful bites. And I have another one who swears it was from a mosquito bite. Who am I to say, no, it didn't. I mean, we do know that the Borrelia burgdorferi do inhabit other insects. We just don't know how well it transmits. So it's certainly not impossible that you can get it from these other biting insects. And I'm interested in hearing your story about bed bugs. And then can it be sexually transmitted? Of course, Lyme is a spirochete and guess what, syphilis is a spirochete. Syphilis can be sexually transmitted. Can Lyme be? And this is still a really great area. There's three animal studies, two of them suggested it could be. One of them found no transmission. There was a really well-known study where they actually tested vaginal swabs from females and semen from males who were actively infected and they found Lyme. Now, does that prove it can be transmitted sexually? No, they did find antibody strains. This is by antibody testing similar in spouses to suggest, well, you know, we think it was. And it may have been something I've seen and I know other doctors have described this as well, even though I don't know that it's been reported, is I do see spouses of patients. And this is usually the male who is asymptomatic. But if you test them, he's positive. And sometimes even more positive than his wife. Now, as you know, more positive doesn't mean he's sicker. It could mean he's got a better immune response. And so maybe it's like a vaccination. I don't know, maybe he's got a low-level exposure and through his mucosa. And now he's got antibodies to it, which of course, as you know, it doesn't mean he's protected if he gets a tick bite. But in general, those people have remained asymptomatic. And if they're asymptomatic, I don't treat them. I don't know what my endpoint would be if I treated them because the serologies don't tell us whether they're cured or not. So that's still a gray area. And there are people on both sides, oh, they're convinced. I'm not convinced, but I can't say for certain. Totally, I agree 100% on everything you said. It's kind of like, could it be possible? Yeah, do I have convincing evidence for sure? Do I have clinical experience to suggest maybe? Exactly, so the bed bugs, I had a patient who had a massive infestation of bed bugs in their beautiful town, it's a penthouse on Michigan Avenue. And so, this is no respecter of persons. And she got very, very ill with anxiety and salmia, what I thought was the BCI afterwards. And I went looking at her literature, I thought, could that be an association? These are the little racnoids. And we know that lice carry tick form lexine fever. So I was like, this seems like it could be. And I found that there is evidence in bed bugs of babesia being found in the bug, but there's no clinical evidence yet of transmission of humans. But I tested her fish positive off the charts for babesia. And I'm treating her and the bed bugs are gone, but I don't, this is again, just N of one clinical experience, but it was so timeline related to the bed bugs. And we know that they do carry it. I have a suspicion that might be the first case. So you should publish that. I'm curious. And if you want, I really enjoy writing up stuff for medical journals. Oh, I hate that. So I'll share the info and I would love to. I think that's a great case. And I think it should be presented at iLADS too, yeah. I would love, let's talk about that. Cause I would love, I really thought I'm like, I think this is, and I called a few of the experts around and everybody said the same thing. We don't have any evidence, but is it possible? And then when I looked, there's clear evidence they found the BCI organism in bed bugs and lice. So it is seemingly possible. Well, this is interesting. Well, the last few minutes here, we didn't get to talk a lot about your articles. I'm going to share those. One is on, could it be assisted line, be assisted with pan and pandas? We talked a little about Bartnill and in utero. So maybe touch on that. And then, and these are huge topics. So we'll just touch on them auto immunity. So let's talk about pan pandas and auto immunity. Okay. So back in 1994, Susan, sweet Owen colleagues described these neuropsychiatric symptoms in kids who had previously been healthy. They got a strep infection and they fell off the cliff with really significant mood and behavioral disorders, particularly OCD and anxiety. And they named this pandas pediatric autoimmune neuropsychiatric disease associated with streptococcal infections, pandas. Okay. Well, it turns out that many of these kids also had eating disorders. And then it turned out it wasn't only strep. In fact, you know, a bunch of different viruses, including the common cold and influenza and HIV. And then in addition, mycoplasma and bartonella have been documented as causing pans. Line by itself has not been documented by itself as causing pans. Okay. So what this is, they changed the name from pandas to pans because it's not just strep. So pan stands for pediatric acute onset neuropsychiatric syndrome. And now we have an umbrella for all of these syndromes that basically result in auto immunosephalitis. That is they have brain inflammation, brain on fire is poor kids. So, you know, I explained to my patients, I said, think about a strep throat and rheumatic fever. Antibodies to the strep attack the heart valves because there's some sort of structural similarity and the antibodies pick up on the heart valves and attack them. It's both an infection and it's an autoimmune reaction. We're talking about the same thing with pans, which is that it's an infection. And even as I say that, there are non-microbial causes of pans like mold, for example, right? But usually it's an infection. And then it's triggering these anti-neuronal antibodies and activating certain enzymes that cause all sorts of inflammation in the brain. And these poor kids particularly tend to have OCD and anxiety and depression. They become obstreperous. I mean, these kids going to rage attacks and try to destroy the house. I mean, really stories of where the father has to hold the kid down when they go into these places they're oppositional. They can develop ticks and career form movements which are sort of involuntary stuff. And so, okay, these poor kids and they usually end up being diagnosed as ADHD or bipolar and the eating disorders, of course. So that's what pans is. And I wrote this article. The article is entitled, does Lyme disease cause pans? And when I go through the data, Lyme disease is associated with all the same neuropsychiatric symptoms associated with pans. But when we look at all those neuropsychiatric symptoms with Lyme, it really doesn't pull out what's caused by co-infections. We don't know how much is caused by the Borrelia burgdorfery microbe and how much maybe Bartonello, which admittedly is hard to diagnose with blood tests. And usually they don't even try. So, but there is clearly this parallel in symptoms. And then Brian Fallon and Cunningham, they had a study about a year ago where they took people and found that those with a prior history of Lyme disease, some of whom were still symptomatic, tended. So a positive Cunningham panel means that they have these antineuronal antibodies, right? And these are adults, like the mean age was around 56. Okay, I won't go into any more. I cited a whole lot of different studies. There are probably a hundred citations, but basically we don't have the evidence yet to convict Borrelia burgdorferi as a cause of pans, even though it's clear that other tick-borne infections, mycoplasma, Bartonello absolutely can. But my whole proposition at the end of the article is we need to change the name. Pans, which is pediatric acute onset, doesn't apply to the greater range of people. Adults get pans and it's not acute onset. It's often a stuttering onset. My suggestion was we change the acronym to MANS, which is microbial induced autoimmune neuropsychiatric syndrome. So that's what that article was about. Brilliant, and I couldn't agree more because I see all kinds of adults and we're doing the Cunningham and we see the same pattern and it's not just a childhood illness. So this is brilliant. Dr. Kindler, this has been just so much enjoyment for me to talk and to talk to you, all your information and wisdom. I know that our listeners have enjoyed it and thank you so much for sharing your wisdom with us. It's my pleasure, I'd love to do it again.