Today, we have Dr. Todd Maderis. He is the founder and medical director of Marin Natural Medicine Clinic in Marin County in Northern California. He specializes in the treatment of complex chronic illnesses caused by Lyme disease.
To learn more about the podcast go to https://www.lyme360.com
I put together a Free Detox for Lyme Checklist for you. Click here to get your copy:
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https://lyme360.com/lyme-disease-the-perfect-storm-with-dr-todd-maderis/
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Today, we have Dr. Todd Maderis. He is the founder and medical director of Marin Natural Medicine Clinic in Marin County in Northern California. He specializes in the treatment of complex chronic illnesses caused by Lyme disease.
To learn more about the podcast go to https://www.lyme360.com
I put together a Free Detox for Lyme Checklist for you. Click here to get your copy:
https://lyme360.com/podcast-checklist/
To learn more about our podcast guest, click here:
https://lyme360.com/lyme-disease-the-perfect-storm-with-dr-todd-maderis/
If you enjoy this podcast, please help support the podcast by purchasing some of my favorite products on the shop page. Lyme 360 receives a small percentage for the sale of each item. Thank You for your support, I really appreciate it!
https://lyme360.com/shop-products-for-lyme-disease/
Follow us on Instagram:
https://www.instagram.com/lyme.360/
Mimi MacLean:
Welcome to the Heal podcast, for all things related to Lyme disease and other chronic illnesses. I'm Mimi MacLean, mom of five, founder of Lyme360, and Lyme warrior. Tune in each week to hear from doctors, health practitioners, and experts, to hear about their treatments, struggles, and triumphs, to help you on your healing journey. I'm here to heal with you.
Mimi MacLean:
Hi, welcome back to the Heal podcast. This is Mimi, and today, we have Dr. Todd Maderis. He is the founder and medical director of Marin Natural Medicine Clinic in Marin County in Northern California. He specializes in treatment of complex chronic illnesses caused by Lyme disease. Thank you so much for coming on. I really appreciate it, and I'm excited to talk with you today. I love the fact that you are treating chronic Lyme, like the complex cases, and so persistent Lyme. That's right up my alley, and I think there's a lot of people that have been following and listening in that are in the same boat I am where they've been trying everything and hopping around from doctor to doctor, and we know we have Lyme, but it's like nothing's working. And we all have different, obviously, symptoms, but what is that, right? So I'm excited to talk to you today to try to peel back and figure out what that perfect storm is and if there's a way to actually ... what you're doing for your patients to help us. So thank you so much for coming on.
Dr. Todd Maderis:
Of course. Thank you for having me.
Mimi MacLean:
What originally got you into specializing in Lyme?
Dr. Todd Maderis:
Yeah, it was probably ... Like Lyme disease, it was a perfect storm where I remember seeing a patient ... I had sort of a general practice at the time of naturopathic practice, which is kind of what we refer to as functional medicine now, treating people with chronic fatigue and hormonal issues, thyroid issues, digestive issues. And I was seeing a new patient who, in his stack of labs, he had an IGeneX Lyme test that someone had ordered. And he had actually never reviewed the results with a practitioner because I think this was back when the IGeneX results were pretty difficult to interpret and read and people would look at him and scratch their head and they didn't really ... if this is positive or not.
Dr. Todd Maderis:
So anyhow, he showed me the result. He asked if it could be a contributor to his fatigue. And at the time, I was pretty Lyme-illiterate, and I actually gave that knee-jerk response you hear too often about IGeneX testing and being everyone's positive for IGeneX. And what I now realize is that's not the case. But I told him I didn't know and I was going to find out. And around the same time, a colleague of mine, someone I knew in the medical industry, had told me about a Lyme conference in San Diego. And she said, "You really should attend this. It's a bigger deal. We know very little about it right now, and more and more cases on the rise."
Dr. Todd Maderis:
So I ended up flying down to this conference, and it was great. We had guys like Joe Burrascano and Richard Horowitz, and some of the top Lyme experts in the world, or at least in the US at the time, in this small room. There was 30 of us, I think in attendance. So I attended the conference, and then actually, it hit close to home when we found a tick attached to my two-year-old daughter. So I have three kids, and my daughter's our middle child. We had been hiking with her. She was in a backpack. And we got home and we were actually changing her diaper and found the tick inside of her diaper, of all places.
Mimi MacLean:
Oh, no.
Dr. Todd Maderis:
So it was that perfect sort of confluence within months of all these things sort of coming together, and that was my intro to the work.
Mimi MacLean:
Now, did you put her on antibiotics right away, your daughter, when you found it on her?
Dr. Todd Maderis:
You know, we didn't, because at the time, it was still sort of foreign. We weren't sure how long the tick had been attached, there was a lot of unknowns. I consulted with some people, and we put her on antimicrobial herbs at the time. And interestingly, she ended up having another tick bite when she was six years old, so she's now had two tick bites where neither one of our sons have had tick bites. She tested very positive for Lyme and, I think, three co-infections.
Mimi MacLean:
Oh, she did?
Dr. Todd Maderis:
Yeah, yeah. At one point, she was really positive. And at this point, she's negative and is doing quite well. Yeah, she's doing really well.
Mimi MacLean:
And that was from the antimicrobials, and because she's young and kind of spry.
Dr. Todd Maderis:
Well, she's had a variety of treatments over the years, but primarily herbal. Yeah, she didn't do anything. And I think we caught it early enough.
Mimi MacLean:
If someone were to ask you right now, like, "Hey, I just got bit by a tick, and it was attached, and maybe it's been on for 24 hours and maybe it was less," would you recommend antibiotics?
Dr. Todd Maderis:
Yeah, the tick bite scenario's always interesting. The perfect scenario is when someone actually sees a tick, is sometimes people come in and they say, "I found this bump or this lesion. We had been hiking, but we're not sure if it was a tick." If you have the tick, of course, you can in that case have it tested. I have patients send it to UMass. They have a tick testing program called TickReport. And I have them do the full panel, test it for 23 different viruses, bacteria, parasites. And then that's helpful because they turn the results around in like three days. But to answer your question, I typically, if someone has found a tick, if they think it's been attached for any duration greater than a couple hours ... Because we know transmission can occur pretty quickly, right?
Mimi MacLean:
Mm-hmm (affirmative).
Dr. Todd Maderis:
There are some studies that show definitely less than a couple hours, transmission can occur. I always say the longer it's been attached, the rate of transmission goes up, but it's not zero at even 15 minutes, right? There's the possibility that transmission can occur. So I typically do prescribe antibiotics when someone has had a tick attached.
Mimi MacLean:
And it's a couple weeks, right? Some doctors only want to give you three days, and you're like, "No, no, no, no. That's not going to cut it."
Dr. Todd Maderis:
Yeah, I usually write a minimum of 28 days.
Mimi MacLean:
28 days, yeah. That's definitely been one of my biggest regrets, of not taking that, because I feel like common sense, right? If it broke the skin, the chances are if it broke the skin, it went into your blood stream. So the chances are, you probably have something. But you brought up another really good point, whereas that you were hiking in California, right?
Dr. Todd Maderis:
Yeah.
Mimi MacLean:
And so you live in California, so-
Dr. Todd Maderis:
Yeah.
Mimi MacLean:
And most doctors don't think of that, like, "Oh, Lyme, California."
Dr. Todd Maderis:
Of course.
Mimi MacLean:
They think Connecticut, East Coast. So you brought up a good point that I would love for you to talk about, is how even if you're on the West Costa or anywhere in the United States at this point, it should be something in your mind.
Dr. Todd Maderis:
Yeah, absolutely. I think that the general party line is that Lyme doesn't exist on the West Coast, and we still hear that from healthcare providers, even ... We're close to university hospitals in San Francisco and down in the peninsula. And they have patients, they'll see patients that mention a tick bite, and I think there's just a lack of awareness and understanding the research that's out there. We know that Lyme has been in California for ... Well, we know there were people studying ticks back in the early '70s. And Bob Lane at UC Berkeley has been studying ticks for his whole career in Northern California, and finding pathogens within these ticks. He's [inaudible 00:07:33] all the coinfections in ticks.
Dr. Todd Maderis:
And so Lyme has existed in California since, well, right around the same time they discovered it in Lyme, Connecticut. But again, the lack of awareness here doesn't lead physicians to think about treating. Or if they do, a patient might get a single dose of doxycycline, maybe a week if they're lucky. And then if symptoms persist, it's typically they're not thinking Lyme was the cause of their continued symptoms.
Mimi MacLean:
So I would assume that most patients who come to you who have persistent Lyme, obviously have been to other doctors before they get to you.
Dr. Todd Maderis:
Yeah. There's a couple different patient types. I see patients that maybe come here because they've been chronically ill for a number of years, they've seen multiple doctors. They may or may not have Lyme disease. I might see them because they might suspect they have Lyme or they have another diagnosis and they want to rule out Lyme. And then I have other people that know, they test positive for Lyme disease, or someone, maybe a practitioner orders a test, they are positive for Lyme, but that practitioner doesn't treat Lyme disease, so they come to me for my expertise. And then there's people that have been in the Lyme world for a number of years and they're just not getting better and I'm maybe their third or fourth Lyme-literate doctor that they've seen. So I see a whole variety of people.
Mimi MacLean:
Yeah. So when they do come to you, have you found that there's ... Well, obviously, you have a set protocol, what you go through. But do you find that the reason why the ones who are persistently not getting better is the same reason, or do they all have different reasons?
Dr. Todd Maderis:
Yeah. I mean, I think most people have a variety of reasons why they're not getting better, and it's not just that maybe the infection has persisted. It could be that they have other concomitant issues or exposures that are not part of the picture or haven't been picked up yet. I tend to think about other environmental exposures, things like mold, for example. Mold can be a big problem with Lyme disease. And I tend to believe that if mold is there and hasn't been diagnosed or treated, then it's very, very difficult to treat Lyme. So then the infections persist, and we maybe chalk it up as either it's a really difficult infection to treat or the antibiotics are not good enough. There's a lot of reasons that people will give. But it could be that there's other undiagnosed conditions or exposures that are suppressing the immune system or creating the same symptoms.
Dr. Todd Maderis:
I remember hearing Joe Brewer, who's an infectious disease doctor from Oklahoma. He spoke at an ILADS conference in 2013. And I remember looking at the line up of speakers over the weekend, and most talks are centered around Lyme disease, and Dr. Brewer was speaking about mold. And I thought, "Why is there a doctor here talking about mold at a Lyme conference?" Well, it turns out mold causes a lot of the same symptoms. So in those patients where their symptoms do persist, I think there's the possibility they haven't been fully or properly evaluated, they could have other issues. They might not have all been tested for all coinfections. That could be part of it as well. Treatments have been limited for Lyme disease. And in recent years, we have newer studies coming out looking at persister or stationary phase Lyme, and that's been really insightful to see the studies where they can do these drug screens or herbal medicine screens and determine what medications are most effective. That's really helpful. But the patients that have persistent symptoms, everyone's a little bit different, and you have to figure out exactly why they're not getting better. Is it they haven't been properly evaluated or fully tested for these other issues, or is it the treatments that they've failed? It's difficult, right? That's why there's so many people that suffer from these chronic tick-borne infections.
Mimi MacLean:
And what are typically your go-to treatments for people with persistent Lyme?
Dr. Todd Maderis:
Well, everyone is a little bit different. Sort of depending on what the findings are from our initial intake, I tend to run a lot of tests up front to not miss anything, because if you do, if you miss that one or even two positive tests, someone could spin their wheels for another six months to a year because something went undiagnosed. So what I tend to do is cast a broad net, see what comes back on all these tests, and then come up with a specific protocols to treat whatever the findings are. And I call it being specific and intentional about what we're doing. I mean, people come in with a shopping bag full of supplements, and-
Mimi MacLean:
Yeah, I know.
Dr. Todd Maderis:
... and they'll put them out on the desk and I'll ask them, "Well, why are you taking this one?"
Dr. Todd Maderis:
And they'd say, "Well, I don't really know." And it's something that's very nonspecific.
Dr. Todd Maderis:
And sometimes, when someone has fatigue, we just say, "Well, here, take ... These things can be helpful for fatigue." But ultimately, I feel like a lot of times people end up treating their symptoms, and it's sort of .... You're chasing symptoms, it's like a dog chasing his tail. So for my sanity and for the patient's sanity, I like to be specific and intentional about what we're treating: "Okay, this is what we've found on testing. These are the therapies or treatments we're going to use for this issue or this condition," and work through it systematically, and not ... I think a lot of times, it's sort of we go, "Well, that's not working. Let's throw that out the window and try this whole new protocol that I heard can work really well."
Mimi MacLean:
Yeah. Now, is there a pecking order that you do?
Dr. Todd Maderis:
Yeah.
Mimi MacLean:
Like, okay, say if they come back with mold or they come back with parasites or they come back with heavy metals or their gut, and then you get to Lyme? Or do you do them all at once, or do you wait? Is there an order?
Dr. Todd Maderis:
Yeah, it's a really good question, because ... And again, I think everyone's a little bit different, right? In a really sensitive patient, you can't go after everything at the same time, otherwise they'll crash, they'll go down and feel worse than they did before treatment. So for the sensitive patients ... Mast Cell Activation Syndrome's a great example. People that have untreated ... we call it MCAS ... If it's untreated or not well-treated, then they're going to react to almost everything that you put them on. It's like anything that sets off their immune system that much more is going to trigger this mast cell activation and they're going to be symptomatic, and it just ... [inaudible 00:14:15] become a vicious cycle.
Dr. Todd Maderis:
So for some people, we have to stabilize the mast cells. For other people that have digestive issues, we'll do proper testing for ruling out things like SIBO or doing a comprehensive stool test and address gut-related issues first because you probably know that 80% of your immune system is around your gut. And if this isn't working well, then your immune system is going to be hyper reactive and drive inflammation. If they have toxicities like heavy metals or mold, I tend to want to address that first because that can be a burden on the immune system, suppress the immune system. And again, you could initiate some treatments for tick-borne infections. But ultimately, it's important to get rid of the toxic burden or reduce it at least before maybe going after the infections. And in some people, if they have a strong enough constitution, you can maybe go after it all at the same time.
Mimi MacLean:
Now talk to me about the MCAS or the Mast Cell Activation Syndrome. Now that typically happens ... I think that's what's happening to me, because all of a sudden maybe a year ago or two years ago, I started getting massive hives randomly, like if it's cold, I'm walking through the freezer section at Costco, or it could just be the most random reasons why I get it. Then I started reading about it. Even though I keep doing the test and it keeps coming back negative, I keep getting massive hives for no reason, and I'm wondering why is it, I guess, the Lyme or chronic Lyme starts triggering this Mass Cell Syndrome, what I'm reading about?
Dr. Todd Maderis:
Yeah. You made a couple great points there, and I think it's all really common. Number one, let's talk about the causes of Mast Cell Activation Syndrome. There's a group of physicians here in the US, and definitely internationally as well, that really focus on Mast Cell Activation Syndrome. And I think sometimes it's thought of as the end all, be all: that's what they have, we're going to treat that condition, and it should resolve their symptoms. And for some people, that may be the case. There can be some congenital predisposition. But when patients also have these chronic infections or environmental exposures like mold, those tend to be a driving force behind the mast cell activation. So the mast cell is sort of ... it's a result of as opposed to the primary issue.
Dr. Todd Maderis:
And there are a lot of different triggers to it. Stress and the stress hormones are known to trigger mast cell activation. And that's been pretty well studied. There's a lot of great research on Mast Cell Activation Syndrome. Temperature changes, like you said. Heat sometimes does it. And there's a variety of things, from physical trauma. I wrote an article about mast cell activation. I try to list all the known triggers. And then you brought up a good point about testing. You said, "Every time I've tested, it comes back negative." And that's been a big, I think, limitation with getting a proper diagnosis, because the testing is very ... Well, the specimens, when blood is drawn, require special handling. They all need to be chilled or frozen, so I've actually created ... I have a handout I give patients to take to ... I use Quest primarily for these markers. And they give it to the phlebotomist and I highlight all the tubes that need to be drawn and how they need to be handled because if the temperature of the blood drops to room temperature, then it's going to render the test ... You're basically going to get a false negative. So I think a lot of physicians end up not testing because the testing's so insensitive or poor. However, it's, I think, really important to get an accurate test.
Dr. Todd Maderis:
Dr. Larry Afrin I've learned a lot from over the years. And he'll say, "Out of eight markers we run, if we get one positive marker, I think of it like a home run. And if I get two or more positive markers, then it's a grand slam." And then I put people on treatment that's specific to the mast cell, look of their response, and then ultimately I may retest them down the road if they're not responding to treatment. I want to know, is this improving the objective lab markers?
Mimi MacLean:
Can the treatment actually reverse the syndrome, like can you get rid of it? Or is that something you have forever?
Dr. Todd Maderis:
Again, I think if you can address the underlying cause to the mast cell activation, then people are going to have better success. And I know Lyme physicians that say the same thing. They'll say, "Well, if you treat the Lyme, the mast cell resolves, and you really have to focus." But in the interim, you have to also stabilize or treat the mast cell activation to help the patient be more comfortable, to ... can reduce symptoms. And again, there may be this propensity for the mast cells to degranulate. The tricky thing about mast cells are these ... Everyone knows about histamine because of allergies. But mast cells contain about a hundred chemical mediators.
Dr. Todd Maderis:
So every time a mast cell releases their contents, we say, those chemical mediators circulate throughout the body and they can cause symptoms from the head all the way down to the feet and everything in between, so brain fog, anxiety, depression, shortness of breath, bladder irritability. People get diagnoses with interstitial cystitis a lot, and it may be a histamine issue. Heartburn, nausea. There's a variety of symptoms. And subjectively, if someone says, "Oh, I get flushed all the time. I heat up and I can look in the mirror and I'm red, or I break out in hives, or just take a fingernail and scratch your inner arm." Wait a minute, and if you see a red streak there, that's a histamine reaction. It's call dermatographism. So there's a couple ways to tell. And again, I think a lot of times physicians go, "Well, you probably have it. Here, we'll put you on some quercetin." But for some of my patients, they need a little bit more than that.
Mimi MacLean:
Right. Now, can you talk about also I see that you use the low dose immunotherapy in your practice?
Dr. Todd Maderis:
Yeah. Low dose immunotherapy was sort of a spin off of low dose allergy therapy that's been used here in the United States for about probably 30 years at this point. And both therapies are basically very dilute antigens that we give patients, almost like an allergy shot you'd get from a traditional allergist, but in lower doses. And we can use these antigens, whether they're environmental or, in the case of low dose immunotherapy, these are microbes and pathogens that have been diluted and typically administered in a little shot under the skin, although they can be administered sublingually. And Ty Vincent pioneered the work of the low dose immunotherapy, so using these antigens, different viruses, bacteria, parasites, et cetera. And the goal is to ... Well, there's a belief that some chronic, persistent conditions are really just an immune response, sort of an inappropriate or persistent immune response to something that the immune system shouldn't be responding to.
Dr. Todd Maderis:
So the LDI and LDA are designed to help down-regulate that immune response. It's almost like a hyper-reactive immune response. And if you can sort of turn the noise down a little, then it can help resolve symptoms. With Lyme in particular, I have an antigen mix that has, I think, 74 species of Lyme, Babesia, Bartonella, Ehrlichia and plasma. And I find that it can be effective helping with mostly pain-related symptoms with Lyme disease. I haven't seen someone's energy improve, for example, from using LDI in a Lyme patient. But it can down-regulate the pain, potentially brain fog, anything that's more directly related to inflammation from the infections.
Mimi MacLean:
Right. And then I saw you also use ozone therapy.
Dr. Todd Maderis:
We do, yeah.
Mimi MacLean:
Do you tend to use that for most patients as well?
Dr. Todd Maderis:
I wouldn't say most, but for some patients where it's indicated, we'll use ozone therapy. We use the 10-pass ozone, so that's [crosstalk 00:22:46]
Mimi MacLean:
I love those. Yes.
Dr. Todd Maderis:
Yeah, it's a higher dose than traditional. It's called major [todis 00:22:54] hemotherapy. And ozone's been studied ... Primarily, the research comes out of Europe, but there's a lot of studies showing that ozone's effective at treating viruses and bacteria and down-regulating inflammation, so helping with cytokines. And then there's some evidence that it can support mitochondrial function, so helping with fatigue. So I will use it in my patients that maybe have worse symptoms and might be reacting to other medications. But ozone's a case, and people tend ... They can have a Herxheimer reaction from killing off the infections. But they're not going to develop an immune reaction to ozone like they might to, say, an antibiotic or an [inaudible 00:23:42]. So I've found ozone quite effective in a lot of my patients, and we've treated autoimmune conditions with it too, and people respond well.
Mimi MacLean:
Right. And can you get the same kind of benefit ... Obviously, it's not going to be as intense, but the same benefit by doing ozone either through rectally or through the ear?
Dr. Todd Maderis:
Yeah, it's a little easier to do rectal ozone or [inaudible 00:24:04] ozone. But unfortunately, with something like 10-pass ozone, we're ozonating 200 milliliters of blood each pass. And if we do 10 passes, that's quite a bit of ozone that comes into direct contact with the blood. Whereas rectal ozone, although you do have a great blood supply in the rectum, I don't think the effects are quite the same. The upside of doing something like rectal ozone is you can do it every day at home. You don't need great veins, you don't need to go to the doctor. We don't do it in patients more than once a week. So yeah, home devices can be helpful. Whether or not it eradicates chronic infections, I think it's to be determined.
Mimi MacLean:
Are there negative effects to the ozone, doing it rectally? Because I've heard people like, "Well, it's actually an antioxidant, which is not great, and especially if you're dealing with chronic illness." Is there a negative to that?
Dr. Todd Maderis:
Well, it's a prooxidant. It's an oxidative therapy, just like something like a high dose of vitamin C is. And the oxidative effect is what purportedly kills these infections. I would say it's a pretty benign therapy with very few side effects or downsides to using ozone. So most people tend to tolerate it pretty well.
Mimi MacLean:
Okay. Now, your patients, are most of them in person or do you do video or patients from across the country?
Dr. Todd Maderis:
Pre-COVID, we mostly saw people in person, although I've been doing video consults with patients for years that live out of the area or out of the state. Then since COVID hit, we didn't see patients in person for a couple months. And at this point, are patients are either in person, on the phone, or in video. But I treat patients from all across the country. So those patients tend not to ... They don't have to fly to California to see me.
Mimi MacLean:
That's good. And then you're able to help them even though they're not by you for the ozone therapy or the LDI.
Dr. Todd Maderis:
That's right. We sometimes mail LDIs. And of course, medications can be prescribed in their home state, tests can be performed, blood draws performed in their home state. We send test kits that we have here that need to be collected at their residence. But for the most part, we can navigate around ... They just can't do IV therapies, essentially.
Mimi MacLean:
You mentioned that you give antibiotics when someone is bit. Do you also prescribe antibiotics to patients through their journey? And I know that there's probably some that you do or don't, and I'd just love to know your take on that.
Dr. Todd Maderis:
Yeah-
Mimi MacLean:
I'm one of those people, I've done it all. I tell people, when they ask my opinion or whatever, I'm like, "I am not here to judge. I have done everything and anything to try to get better, and you can't know anybody's situation." So I'm just curious.
Dr. Todd Maderis:
Again, it's one of those individual case scenarios where some people can respond favorably to antibiotics orally. For years, I used oral antibiotics and we were prescribing at least two antibiotics if not some doctors were doing three, four, even five antibiotics at a time. I once saw a patient who saw a doc in New York that had him on nine antibiotics at one time, which-
Mimi MacLean:
That must have been a doctor I went to. I was on an IV and I had six to nine rotating.
Dr. Todd Maderis:
I couldn't. I was scratching my head. And ironically, he-
Mimi MacLean:
I did feel better, though. I did feel better before I got my sepsis. Actually, for the five months I was doing it or four months I was doing it, I did feel good. But I didn't make it to the end.
Dr. Todd Maderis:
You got sepsis while on six antibiotics?
Mimi MacLean:
Yeah, I had-
Dr. Todd Maderis:
A port.
Mimi MacLean:
... a port that was going directly into my heart and it got infected.
Dr. Todd Maderis:
So, I have used orals, and that was a big part of my practice. I've always used them in conjunction with other therapies. But if I had someone on oral antibiotics, I might also have them on an herbal formula for one of the coinfections. And again, it's almost like creating sort of the perfect treatment plan for that particular patient. But what I would notice or I began to notice over time was someone might feel better while they were on the antibiotic. And I noticed this with Bartonella a lot, using something like rifampin and clarithromycin, which is a common regimen for Bartonella. And they'd feel good on the two antibiotics. And then after a period of time, we'd say, "Okay, well, let's retest you, and why don't you take a break off the antibiotics while we're waiting for your results. And as soon as they'd stop, or within weeks of stopping the antibiotics, a lot of their symptoms would return.
Dr. Todd Maderis:
So what we now know from research is that a lot of these antibiotics work on the bacteria when they're in their growing phase, or what's called the log phase, but they're not very effective in the stationary phase. So that's been the coolest findings in the last couple years is when the researchers at Johns Hopkins, Dr. [Zhang 00:28:55] and his team have been looking at using different therapies to treat the stationary phase of Lyme disease and Babesia and Bartonella. So I think that's one of the shortcomings of the antibiotics is they're not that effective at the stationary and persister phase.
Dr. Todd Maderis:
I do use IV antibiotics in my practice. We tend to pulse the IV antibiotics, so it's not a daily administration. And that can help reduce some of the resistance to the medication. And I might do that in the beginning of treatment with someone, especially if they have a lot of neurological symptoms, and have seen really great things happen with patients. Some of, again, this newer research that's coming out of Johns Hopkins, using the essential oils for the stationary phase of Lyme and Babesia and Bartonella, that's really promising, and I've been using a lot more of those in my practice. I'm also really excited about methylene blue, which there's been a couple studies now in both Lyme and Bartonella treating the stationary phase of Bartonella with methylene blue, either alone or in conjunction with an oral antibiotic. And the research is evolving and we're learning more. And the medications aren't perfect. I mean, none of these antibiotics were ever developed to treat Lyme disease or the coinfections. We borrow them from other infections.
Mimi MacLean:
Do you prescribe disulfiram?
Dr. Todd Maderis:
We've used it a little with patients. My whole premise and the way I approach things is if we can identify everything that is causing someone's symptoms, contributing to their disease state, and address the collateral effects, then I find I don't have to use these higher risk therapies. And disulfiram's pretty benign. People tolerate it well. Dapsone has a lot more side effects and a little more difficult to manage with patients. And the goal is not to make the patient worse. But for some patients, they do respond really well and it doesn't ... I've also seen patients that were on disulfiram that now have symptoms that started on the disulfiram and they haven't resolved since stopping the disulfiram. So everyone's a little bit different, but it is a promising therapy, and that came from some of these drug screens that they've been able to do at Johns Hopkins to see what's most effective against the bacteria.
Mimi MacLean:
Now, if there is somebody who is listening right now and they either are waiting to get into a Lyme-literate doctor or don't have the financial means to do it, is there any advice that you could give them at home that they could do at home to help them feel better or get better?
Dr. Todd Maderis:
Yeah. I think, always in the interest of trying to treat the specific underlying cause or causes of someone's issue, you really have to know what you're dealing with, and that's tricky. That's where the expense comes in, is the testing. I mean, right? The Lyme panel I run on my patients at the very first visit is almost $1,600.
Mimi MacLean:
Is it the IGeneX?
Dr. Todd Maderis:
Yeah, that's primarily the lab I use. And there's a panel called TBD number four that I use with all my patients because I want to see the tick-borne relapsing fever group. That panel includes Bartonella Western Block, which I've found to be really helpful clinically because historically, Bartonella testing hasn't been very good, and patients would have all the classic symptoms of Bartonella and we'd test them and they'd come back negative. And now, the new Bartonella Western Blot's been really accurate. So you really have to start with that proper diagnosis to direct the treatments. There's some testing assistance programs out there for patients so if they can't afford testing, there are some resources out there. I'm sure if they searched around on the internet they can find them. And then with that information, that's how you would guide treatment.
Mimi MacLean:
So there's no typical ... I guess, say, [inaudible 00:33:15] they do know they have Lyme, is there any kind of ... Is it biocytin, or is there any kind of go-to herbals or something they can take that they can buy somewhere [crosstalk 00:33:27]
Dr. Todd Maderis:
Yeah. There's a lot of great herbs out there that are effective at treating Lyme. There's formulas that I tend to use, things like the Byron White Formulas and Beyond Balance formulas. There's the herbs that Stephen Buhner recommends in his books. And Johns Hopkins in one of their studies last year looked at Cryptolepsis and Japanese knotweed were really effective at treating Lyme. So those are things people can play with to see if they help. But I'm hesitant to make-
Mimi MacLean:
A general-
Dr. Todd Maderis:
I think [crosstalk 00:34:00] starts with an accurate diagnosis, and [crosstalk 00:34:02]
Mimi MacLean:
Until you figure out you definitely have that and you don't have mold and you don't have this and you don't have that, right?
Dr. Todd Maderis:
It could be [crosstalk 00:34:07]
Mimi MacLean:
I have a random question. Do you think Lyme is transmitted sexually?
Dr. Todd Maderis:
That's a ... Well-
Mimi MacLean:
It's a loaded question. I'm sorry. I'm just curious because it's like-
Dr. Todd Maderis:
... it's not. There was a study that came out I think in 2015. And initially, I think people were concerned about it. Both Lyme-treating physicians and patients were concerned that they were reinfecting their partners. And the argument is you can have a patient that has symptoms, tests positive for Lyme or the coinfections, and we run a test on the spouse just because we want to make sure they don't have it too, and they do test positive but they don't have any symptoms at all. And I know physicians that would treat that, and I think that can be a disservice. We're looking at [crosstalk 00:35:00] antibody tests here, and we have to remember that that's what we call an indirect test. So we're looking at the immune system to see if the immune system has seen the infection. So it's indirect. And because you've had an exposure doesn't necessarily mean it's an active infection. You could have formed antibodies, but it doesn't necessarily mean it's an active infection. Now that's not to say that it can't create problems down the road if someone is under increased stress or they have a surgery or something else, they get exposed to mold, and it triggers the onset. But I've also heard physicians say that the volume that you mind see of the Lyme spirochete in semen or vaginal secretions is not significant enough, and the route of transmission doesn't necessarily cause an infection, so-
Mimi MacLean:
Well, that's good.
Dr. Todd Maderis:
... I think it's a big unknown. The study was small. It was, I think, only maybe four couples that they used, six couples.
Mimi MacLean:
Well, because it's in the same family of like a syphilis, at least some of the coinfections are, right?
Dr. Todd Maderis:
Right, right. Yeah, and I think that's where the excitement came from, was [crosstalk 00:36:05]
Mimi MacLean:
Like if that's the case, then how is it not-
Dr. Todd Maderis:
Right.
Mimi MacLean:
... in that same kind of thing? And then do you look at the MTHFR, like the mutations at all, as far as treating people? Is that something that's of significance to you?
Dr. Todd Maderis:
MTHFR, I remember when everyone sort of first became aware of it and it was really exciting and we kind of thought that it was going to cure everybody if we figured out what their mutations were and their whole profile. And it turns out that it really can be helpful in how you maybe support someone. But ultimately, a lot of people have these genetic polymorphisms or mutations. And a lot of the study of what we call epigenetics has proven to be more of an interest, right? And epigenetics is sort of how the genes express themselves. So things like diet and lifestyle and stress management and proper sleep all influence the genetic expression, and that's a little bit more important. A lot of people have MTHFR mutations that don't have any symptoms at all. So I think ultimately it goes back to the lifestyle, and the epigenetic influence.
Mimi MacLean:
Right, right. So is there anything we haven't touched on at this point, because I feel like we've covered so much ground? Anything that we haven't touched on that you're like, "Okay, this is something that I cover in my practice that we should talk about"?
Dr. Todd Maderis:
Well, we covered a lot. Again, I think it's really important that people take a ... If they can, if they have the means to cast a broad net, get an accurate diagnosis or diagnoses because in the words of Richard Horowitz, it's like having 15 tacks in your foot, and if you identify one or two ... And I see people like that a lot. Their treatments have been focused on the Lyme, and they haven't looked at anything else. Well, if they have 14 other tacks in their foot, they're not going to get better. So you really have to do some really good testing up front, get a proper diagnosis, and then use therapies that are really effective at treating whatever's diagnosed. Of course, that's easier said than done, but I think if you're strategic about it, it's not just sort of off-the-cuff, willy-nilly, but if you're very strategic about how you go about treating ... We like to call it complex chronic illness, because it's rarely one thing. And if you follow that systematic approach, the next thing you know, you look back and you go, "Wow, we're six, eight months, or a year into treatment, and the patient's doing a whole lot better."
Dr. Todd Maderis:
And it doesn't happen overnight. I describe it to my patients, it's like we're trying to turn the Titanic sometimes, and it takes time, and they have to stay patient and do all their lifestyle things like good diet and everything else they have in their control, but ultimately ... We're in California. I think you and I both are. So we know there's great resources here, but there's a lot of people in the middle of the country that don't have great resources, and that's really difficult. So it starts with awareness. If people think they have Lyme disease, they should get properly tested. So they need to find a physician they can work with and get the proper testing done upfront, and then that really helps ... It's like the roadmap.
Mimi MacLean:
Right. And so you're a Lyme-literate doctor, but you're different than a Lyme-literate doctor, because I feel like most Lyme-literate doctors, the real intense ones, they're just very heavy antibiotics right off the bat, right? What is that Lyme doctor that's not just heavy [crosstalk 00:39:41]
Dr. Todd Maderis:
Not heavy antibiotic Lyme doctor.
Mimi MacLean:
Yeah. They'll use it when they have to [crosstalk 00:39:46] but they're also like the whole person. What is that called? If someone wants to research and find a doctor like you where they live, what are they looking for?
Dr. Todd Maderis:
Yeah, that's funny you put it that way, and I think that's shifting a lot, I really do. I see more and more physicians that are treating Lyme disease that are not just focused on the bug. And for a lot of people, a classic scenario is someone, maybe they grew up on the East Coast where they potentially had an exposure, but I see them out here in California and they've been out West for 20 years, but a couple years ago, something stressful and major happened, a car accident, a surgery, death, divorce, whatever, and all of a sudden they become symptomatic, and it's a myriad of symptoms, right? It's like a progression. And then someone runs a Lyme test and they think, "Aha, we figured it out. You have Lyme disease." Well, hold on a minute. If you were bit 20 years ago and it's surfacing now, what else has occurred?
Dr. Todd Maderis:
So there's a lot of immune dysfunction that happens with Lyme disease. Dr. Mozayeni, who's on the East Coast, he likes to say it's potentially we're dealing with more of a host response condition than an infection, meaning it's how the person's body is responding to that infection is really what's driving the symptoms. So it's this immune dysfunction that happens, and a lot of these therapies we discussed, whether it's LDI, or I use a lot of what's called low dose naltrexone in my practice. That's LDN. Things like turmeric and glutathione, all of those help to modulate the immune system. And then of course, you have to remove anything else that's contributing to that total burden. It's like a bucket; once your bucket's full ... And then someone will say, "Yeah, I do okay, but then I have a little bit of gluten. Or I get stressed out," and it's like their bucket spills over. Well, let's focus on reducing that bucket so they have more tolerance. [crosstalk 00:41:53] What's already in the bucket? And then people don't have to tiptoe around in their lives. People should be able to-
Mimi MacLean:
There's more leeway.
Dr. Todd Maderis:
... do most things and not react. [crosstalk 00:42:04] So that's a long way of answering your question about [inaudible 00:42:08]. Again, more and more physicians ... There's a group ... I'm a member of an organization called the International Society for Environmentally Acquired Illness; iseai.org, I believe is their website. And so it's a group of physicians, a lot of us treat mold and some of us also treat infections and some of us are also aware of other environmental factors like heavy metals and pesticides and herbicides and things we're exposed to in the environment. I think if you can overlap those three environmental exposures, you really cover a lot of bases.
Mimi MacLean:
Yeah, I never heard of that group. That's great. I mean, one of my doctors said it to me before, and I kind of like this analogy too. He's like, "Even if you've gotten rid of the Lyme, you have to think of Lyme as almost like the termites that went into a house. It kind of wreaked havoc on your body. So at this point now, it's like repairing the damage that Lyme did to your body, like how a termite did to a house, like how it ate all the wood. Now you got to have to figure out where that is and correct it." So I don't know if that's a correct analogy, but.
Dr. Todd Maderis:
It's a great analogy, and I would agree 100%. Sometimes I'll say, "You can remove the bug, but the immune response can resist," or the collateral damage that's occurred, whether it's oxidative damage or there's this concept of what's called cell danger response that Dr. Robert Naviaux coined. And cell danger response is when the cells sort of shut down when they sense stressors. And so that contributes to chronic fatigue and mitochondrial dysfunction. And again, you can remove that threat, you can remove the infection, but the cell danger response can persist, or the immune dysfunction can persist in people. And that's why it can be a disservice to say on antibiotics for ... I see people that have been on antibiotics for five, six, seven years, almost nonstop. And at that point, what are you really doing? You might keep the antigenic load low enough so it's maybe preventing symptoms from manifesting, but you're not getting rid of the infection by any means. So you really do have to repair the body after as well. It's not just about killing the bug. It's also about healing up and repairing tissue. And for some people, it's trauma. There's this whole concept of limbic system injury in people that have had past trauma. And for some people that have limbic injury, nothing helps them get better, and they probably won't get better until they do some sort of limbic retraining type of program that-
Mimi MacLean:
What do you recommend for that?
Dr. Todd Maderis:
There's a couple out there that commonly get used in our world. I think Annie Hopper's program, DNRS, a lot of patients have had good success with. And then Ashok Gupta has a program as well, the Gupta Program. And both of those can be quite effective. I have seen patients that have responded favorably to ketamine too. So there's a couple different routes to do it. I've also seen people have really strong adverse reactions to ketamine too. And maybe it wasn't administered properly. Ketamine has to be done properly.
Mimi MacLean:
Yeah. Well, this has been amazing. Thank you so much for your time. I really appreciate it. [crosstalk 00:45:48] I've learned so much. What's the website that anybody can come find you?
Dr. Todd Maderis:
My site where I write most of my articles is at drtoddmaderis.com, so it's drtoddmaderis.com. And then through that site, it links to my clinic's site, which is [crosstalk 00:46:08]
Mimi MacLean:
Perfect, okay.
Dr. Todd Maderis:
But all the articles I've written, whether it's about mast cell or mold, are on the drtoddmaderis.com, or just Google it.
Mimi MacLean:
Yeah, I love that, because you have great newsletters, and that's how I found you is through your newsletters that you were sending out.
Dr. Todd Maderis:
Yeah. Again, it's about awareness. And the more people that are aware, the bigger impact we're going to have. And then everything unfolds from there. So thank you for having [crosstalk 00:46:30]
Mimi MacLean:
Yeah, it's going to be interesting with this COVID too, to see how the ongoing symptoms ... It's in a kind of parallel.
Dr. Todd Maderis:
I just read something this morning, a paper was ... It's in pre-print right now, but it's going to be published. And they just discovered that COVID is triggering an autoantibody response. And maybe that's what we're seeing in the long-haulers. So COVID's been really ... I think it's opened up eyes for the medical and scientific community about chronic Lyme disease and how other infections can persist as well. So we've learned a lot, and cytokine storms and hypercoagulation and persistent post-infectious fatigue. So there could be a silver lining for the Lyme community.
Mimi MacLean:
Yeah, because there's a lot of similarities, so you [crosstalk 00:47:19]
Dr. Todd Maderis:
Very much so. Yep, that's right.
Mimi MacLean:
Yeah. Well, thank you so much, and enjoy the rest of your week.
Dr. Todd Maderis:
Yeah. Thank you for having me.
Mimi MacLean:
Thank you for tuning in today for Heal. And if you want to find out more influencer about Dr. Maderis, please go to his website or you can go to Lyme360 to see the show notes for today, and also any other articles that we have written about him and the other Lyme topics. Thanks again, and please subscribe and review this podcast so other people can find it. Thanks so much. See you next week.