Dr. Ann Corson had nearly twenty years of experience as a primary care doctor when she was faced with one of her most complex and challenging medical cases. Her only child was literally dying from an unidentified illness without clear answers. It took three years for her to more fully understand the illness that was ravaging her son's body. It was at that time that Dr. Corson realized "how totally inadequate my 'ivory-tower' medical education had been regarding tick-borne diseases." As a result of her own son's personal struggles with Lyme disease, Dr. Corson has emerged as one of the most respected Lyme-literate medical doctors (LLMDs) in the field.

​After discovering the etiology of her son's mysterious illness, Dr. Corson feverishly read the scientific literature and studied with respected Lyme clinicians Dr. Joseph Burrascano, MD, and Dr. Charles Ray Jones, MD. She started her own practice devoted solely to the treatment of tick-borne diseases. Her mission has become to help "those mothers who otherwise would have to watch their children slowly decay without knowledgeable doctors."

Dr. Corson quickly recognized that the clinical challenges that chronic tick-borne disease patients present are incredibly complex and require a multidisciplinary, holistic approach. Over the years, it became apparent that allopathic medicine did not offer a complete solution. As a result, she has incorporated treatment strategies into her practice from many different healing disciplines. Helping patients attain the improvements they are striving for requires a willingness to think beyond the boundaries of that which is understood today. Consideration must be given to those things which will only be more widely accepted in the future.

In her presentation at the LIA Foundation "From Roadblocks to Recovery" event in June 2009, Dr. Corson shared her approach to the evaluation and management of pediatric tick-borne diseases (TBDs). "Ticks are cesspools of disease," she noted. Besides Borrelia burgdorferi, ticks harbor numerous other organisms that are pathogenic and result in considerable health challenges in humans. Some of these include other Borrelia species, Babesia microti, Babesia duncani, Ehrlichia chaffeensis, Anaplasma phagocytophilum, Bartonella henselae, Bartonella quintana, Mycoplasma fermentans and other Mycoplasma species, Rickettsia rickettsii, Coxiella burnetii, Francisella tularensis, viruses such as HHV-6, nematodes, and possibly many other organisms. These are just the ones that are known today; in reality, the list may be much longer.


Approach

In the evaluation of a patient with tick-borne disease (TBD), a full history is obtained including risk factors for TBDs, a complete medical history including the medical history of the mother, and a social and family history. A detailed physical exam is performed. Laboratory evaluation includes assays for TBDs, a full medical workup, and appropriate imaging studies. Once a patient has been evaluated, management of the illness may include diet, environmental changes such as mold remediation or reduction of exposures to electromagnetic fields (EMFs), use of the German Biological Model of Homotoxicology to modulate the immune system and support organ regulation and drainage, and various antimicrobial compounds including allopathic, homeopathic, or herbal options.

Patients may also be referred to other practitioners for osteopathic work, acupuncture, chiropractic neurology or other chiropractic interventions, various types of body work, and psychological counseling. Risk factors for TBDs include any known tick attachments, rashes, living in an endemic area, close proximity to reservoir animals such as deer or mice, travel to infested areas, family members or pets with known TBDs, and a mother's risk factors both before and during pregnancy. Maternal health at the time of conception and any complications of the pregnancy are important factors in evaluating a child with suspected tick-borne disease.


Evaluation

Birth history looks at factors such as term length, type of delivery (spontaneous vaginal delivery, C-Section, or forceps assisted birth), any delivery complications such as meconium staining of the amniotic fluid, Apgar score (a mechanism to assess the health of newborn children immediately after birth), and any congenital abnormalities. Next, the neonatal course (first 12 weeks of life) is evaluated by reviewing blood sugar control, body temperature control, hyperbilirubinemia (an elevated level of bilirubin which may present with jaundice), difficulties in sucking, and history of immunizations. Factors of interest when the child is an infant include whether the child was breast-fed or bottle-fed, colic issues, sleeping problems, frequent infections, trauma, and developmental milestones.

From toddler to school age, Dr. Corson looks at history of illnesses, trauma, problems with sleep, developmental delays, socialization, play behavior, gastrointestinal issues, food intolerances, environmental exposures, dental problems, and immunization history.

During elementary school, consideration is given to illnesses, trauma, sleep issues, social behavior in school, learning problems, orthodontic issues, neuropsychiatric symptoms or personality changes, medication reactions, and environmental exposures.

Tick bites or tick exposures are always considered and highly suggestive of possible tick-borne disease. Dr. Corson further evaluates past surgical history, traumas, especially head injuries, dietary history, family dynamics, psychological traumas, and family history. She considers such factors as living in a home that may have a wet basement or going to school in a building suspected of having had water intrusions as both of these could be suggestive of mold as a possible co-factor in the illness.  Electromagnetic field (EMFs) exposure is another factor which impacts the course of illness.

It is important to understand why the parents believe the child is sick and to fully understand the entire chronology of the illness. At times, it is the seemingly unimportant detail that helps to assemble the often complex puzzle pieces necessary to arrive at a diagnosis.


Symptoms

A long list of symptoms must be reviewed including generalized symptoms such as fevers, day or night sweats, cold or clammy hands or feet, and weight gain or weight loss. Central nervous system symptoms are evaluated by looking at developmental milestones both in gross and fine motor development, delays in language, processing speed, attention, working memory, dyslexia, cranial neuropathies, and ophthalmologic abnormalities. Headache frequency, duration, location, time of day and intensity are evaluated. Borrelia headaches are commonly suboccipital (between the skull and first vertebrae), whereas headaches resulting from Babesia tend to be frontal or behind the eyes. 

Balance is observed. Peripheral nervous system symptoms include numbness, tingling, itching, stinging, stabbing, burning, sharp stabbing shooting pains, bug crawling sensations, hypersensitivity to noise, light, odors, or touch, and painful radiculopathies (nerve problems at the root of a nerve which manifest in an extremity). Clues to these PNS symptoms may be an infant that does not want to be held, a child being unable to tolerate the feeling of clothing tags or certain fabrics, not wanting to have hair washed due to scalp sensitivity, or being overwhelmed in environments with high sensory input such as childhood parties.

A number of symptoms related to the head, eyes, ears, nose, and throat (HEENT) may be present. Scalp tenderness, lesions or pimples, or other sore spots are often observed. Ear pain, redness of the outer ears especially in the afternoon, tinnitus which may often be described as "crickets", and hearing abnormalities are not uncommon. Eyes may be red, itching, burning, tearing, have discharge, or have problems with tracking an object. Lazy eye is often observed as are eye alignment issues such as strabismus or sixth cranial nerve palsy, or drooping eyelids known as ptosis. Floaters may be present. Sensitivity to light, known as photophobia, may also present. Sinus congestion, runny nose, post nasal drip, or sneezing may be involved. If nasal symptoms are worse after eating, this may be a sign of food allergies. Mold exposure can lead to runny nose presentations. Patients may have fever blisters or canker sores in the mouth.

Other HEENT symptoms include tongue soreness, teeth sensitivity, problems with tooth enamel, cavities, changes in taste or smell, sore throats that may be chronic or intermittent, hoarseness, difficulties swallowing, and swollen or enlarged lymph nodes.

Neck symptoms may include soreness or stiffness, muscle spasms or "cricks", cracking or creaking, and restriction in range of motion. Lung symptoms of interest include shortness of breath, air hunger, intermittent sighing, and cough. Cough may be day or night, wet or dry, and may be cyclic. Often times, sighing or a dry cough are related to coinfection with Babesia. 

Cardiac symptoms may appear such as heart palpitations including skipping or racing feelings, and pain in the chest, chest wall, or ribs. Abdominal symptoms include problems with appetite, food cravings, nausea, acid reflux, heartburn, gas, belching, bloating, cramping, and abdominal pain. Stool color may be brown, tan, green, or black. Stool frequency may be impacted. Consistency of stool may be dry, moist, runny, or mushy. The child may strain and have hemorrhoids, rectal bleeding, or mucus in the stool. Stool odor is another often observed change. Dr. Corson says, "We talk about poop a lot in my office; it's just that important." 

Genitourinary symptoms manifest as delay in toilet training, bed wetting, loss of bladder control, painful urination, awakening at night to urinate, bladder pain, hesitancy, urgency, frequent urination, incomplete emptying of the bladder, and pelvic, genital, or testicular pain. Babesia may be a factor in bladder symptoms.

Skin manifestations may include neonatal acne, eczema, seborrhea, hemangioma birth marks, difficult to manage diaper rashes, skin rashes of all kinds, erythema migrans (EM) rashes, reddish changes in skin coloration at the back of the neck also known as a "stork bite".

Joints may be stiff, crick, crack, or pop. Pain is often intermittent, cyclical, and migratory. Migratory joint pain is a common characteristic of TBDs. On one day, the patient's left knee may hurt while the next day, it may be the right. Joint symptoms often worsen with exercise. Foot pain upon rising is a common sign of Bartonella. Morning stiffness suggests mold exposure.

Muscle manifestations may include lowered or increased tone, pain, spasms, cramping, morning foot pain on first steps, morning body stiffness, and twitching. 

Often times, children prefer sedentary activities or need to rest after school or play as they may not have the energy or stamina for something more active. Sleep is often challenged and patients experience difficulty falling asleep or staying asleep, frequent awakenings, nightmares, night terrors, sleep walking, and difficulty arising in the morning. Nightmares and night terrors are often present with Bartonella. 

Psychiatric cofounders may be irritability, moodswings, increased emotionality, tantrums, anger or rage attacks, frustration intolerance, physical aggressiveness, separation anxiety, new onset phobias, anxiety, panic attacks, depression with or without thoughts of suicide, obsessive-compulsive disorder (OCD), and personality changes. Panic attacks may be the result of Babesia while self-mutilating behaviors may be associated with Bartonella.

Neurological symptoms may present as tics, seizures, lowered or increased muscle tone, motor or sensory abnormalities, gross lack of muscle coordination, neuropathies, neuralgias, vertigo, and motion sickness.

It is difficult for many to imagine that one disease could present with so many widely varied symptoms, and yet it is not uncommon to see children with TBDs present with dozens of these symptoms.


Physical Examination

A physical examination is a key part of Dr. Corson's evaluation of a patient potentially challenged with TBDs. Vital signs are evaluated, though these are generally normal. Tongue size, color, coating, edges, and sublingual veins are evaluated. Red crescents in the pharynx are often observed. Tonsils, teeth, gums, ears and eyes are investigated. Halitosis may be present.

In the neck area, range of motion and head posture are observed. Thyroid and lymph nodes are examined. Lungs are evaluated for abnormal breathing sounds or excursion of the chest wall. Heart murmurs and rhythms are listened for. Peripheral pulses are felt. The abdomen is palpated for enlarged organs and areas of tenderness.

In evaluating the musculoskeletal system, soreness is evaluated along the neck and spine. Trigger points, shins, and thigh muscles are assessed. Muscle twitches or fasciculations may be present. The skin often holds many clues in TBDs.

Dr. Corson stresses that every part of the body must be evaluated and that parents are often surprised by what she finds on their children. Hands and feet are evaluated. These may be cold or warm, clammy, or sweaty. Scalp, finger and toenails, and the opening of the rectum are examined. Multiple hemangioma birthmarks may be observed in gestational cases of TBDs. Rashes of all kinds are often visible. These may include Erythema migrans (EM) rashes or Bartonella rashes which are often seen as striae presenting as either bands, stripes, or lines that look much like stretch marks.

Neurological evaluation consists of a review of cranial nerves and extraocular muscles looking for abnormal movements or tracking abnormalities. Motor strength and tone are evaluated as are balance and gait. Reflexes, speech, and language are assessed. Behavior, appropriateness, attentiveness, and interactions with parents and siblings are key factors in a psychological evaluation.

Dr. Corson looks for the possibility that mold may be a factor in the child's illness. Mold may be found in the home, school, or even the car. For some patients, mold exposure is a very significant component of the overall illness as mold mycotoxins produce a number of symptoms. Improvement is often observed through either remediating the moldy environment or removing the child from the environment entirely. 

An emerging theory in the puzzle of chronic illness is that biologically incompatible frequencies, or frequencies that are not supportive of human health, may have damaging effects. These electromagnetic fields (EMFs) come from numerous sources such as cordless phones, microwaves, wireless internet devices, and cellular phones. EMFs should be eliminated or reduced where possible. Televisions and computers should not be present in the bedroom. Video game use should be entirely eliminated.

Clearly, there are many physical clues which may support a diagnosis of tick-borne diseases in a patient. Nonetheless, doctors must open their eyes and look before they will find. Fortunately, for patients of Dr. Corson, the physical examination is thorough and often telling.


Laboratory Testing

A physical examination may yield clues which may lead Dr. Corson to further consideration of tick-borne diseases. In addition to a thorough physical examination, laboratory tests are used to evaluate additional indicators that may support a diagnosis. Dr. Corson first orders a full panel of tick-borne disease testing from IGeneX in Palo Alto, CA. This includes tests for Borrelia burgdorferi via Western Blot and PCR as well as testing for common coinfections such as Bartonella, Babesia, Ehrlichia, and Anaplasma.

A CD57 panel is ordered from LabCorp to evaluate a subset of natural killer cells which are known to be suppressed in chronic Lyme disease. Results of the CD57 often correlate clinically with the severity of the disease presentation.

Dr. Corson believes that Clongen and Fry Labs are useful as well. Medical Diagnostic Laboratories (MDL) is used to evaluate the patient for other related infections. Epstein-Barr Virus (EBV), Human Herpes Virus Type 6 (HHV-6), Cytomegalovirus (CMV) as well as HSV-1 and HSV-2 are types of herpes viruses which are often activated in patients with chronic Lyme disease due to the immuno-suppressive nature of the illness. Chlamydia pneumoniae and Mycoplasma species are evaluated. The presence of any of these infections is important when defining the treatment protocol for the patient.

Sulfates are tested using a urinary dipstick. Some patients will exhibit high levels of sulfates which may be the result of genetic influences, inadequacies of liver detoxification pathways, past sulfa-antibiotic use, or simply eating meat from animals that were fed sulfa-antibiotics to enhance their growth.

A Complete Blood Count (CBC) as well as a Comprehensive Metabolic Profile (CMP) are run to evaluate basic components of the immune system, functioning of organs such as the liver and kidneys, electrolyte and fluid balance. When BUN is high and iron is low, Dr. Corson suspects Babesia. When ALT is slightly elevated and WBC is low, she considers Ehrlichia. She has found that CBCs often show neutropenia, lymphopenia, or a reversal of the normal lymphocyte/neutrophil ratio. 

Human Leukocyte Antigen (HLA) testing is performed based on the work of Ritchie Shoemaker, MD. The HLA panel provides specific insights as to the patient's ability to remove biotoxins effectively from the body. About one-quarter of the general population will be found to have genetic types that would increase the likelihood of more severe illness if exposed to biotoxins produced from Lyme disease or molds. Somepatients are "multi-susceptible" types meaning that they are susceptible to both Lyme and mold biotoxins. In patients with chronic Lyme disease, the percentage of those evaluated who express genetic issues in this area is much higher than in the general population.

Dr. Corson runs tests to investigate the possibility of autoimmunity as a piece in the illness as the immune system often becomes dysregulated when a patient has chronic Lyme disease. She evaluates whether or not hypercoagulation is a factor. It is not uncommon for the blood to become thickened, which essentially serves to protect the organisms and makes treatment more difficult.

It has long been known that toxicity is a significant factor in chronic illness. Heavy metal toxicity is a common finding in many patients. A stool analysis is performed to look for pathogenic bacteria, parasites, yeast, and levels of beneficial probiotic bacteria as well as to evaluate whether or not the patient may have leaky gut syndrome.

Food allergy panels are performed as elimination of allergenic food items is often a key part of the approach to treatment. When the baby is born, PCR testing is ideally performed on the first urine, the cord blood, the placenta, and the foreskin to evaluate for the presence of infection with Borrelia burgdorferi. Thereafter, PCR testing is performed monthly on the urine.

In terms of imaging studies, a brain SPECT scan is often helpful. These can, however, be normal even in children that are significantly impaired. When the SPECT scan is abnormal, this is a very significant finding. The Amen Clinics look at both perfusion (blood flow) and metabolism at rest and with concentration in their SPECT scans. Often times, these laboratory tests provide important clues to Dr. Corson as to the potential causes of illness. However, testing for tick-borne disease is still in its infancy and better diagnostic tools are desperately needed. As a result, it is important to look beyond laboratory testing alone and to evaluate the patient in other ways.


Pathophysiology

Pathophysiology is the study of changes in function within the body that result from a disease process. In tick-borne diseases, the list of these changes is potentially a very long one. Multiple infections lead to multi-system organ damage. The nervous system is heavily impacted in tick-borne disease. Herpes viruses, Chlamydia, Mycoplasma, and many other infections heavily impact the course of the illness.  Borrelia is clearly the ring-leader in chronic Lyme disease. It opens the door to many other infections which are then able to invade the body and take up residence. 

Dysbiosis (microbial imbalance) of the gut is a common finding. The mucosal lining of the GI tract often harbors infection. It is a known site for the formation of biofilms. Leaky gut is commonly present in children with TBDs, as is intolerance to gluten. The GALT, or Gastrointestinal-Associated Lymphoid Tissue, is a key component of the body's immune system and it protects the body from invaders. In many patients, the GALT is often found to be dysregulated, thus impairing the proper functioning of the immune system throughout the body. According to Dr. Corson, cleaning up the gut is one of the first things that must be done before moving forward with treatment.

Liver detoxification abnormalities are almost always present. These may be in the methylation or sulfation pathways and are often genetically-influenced - such as in patients with an MTHFR defect or problems with other detoxification pathways.
Levels of homocysteine and methionine may be abnormal. Systemic inflammation is often observed. Lipid abnormalities may be present. Cytokine imbalances may be the result of a confused immune system attempting to respond to items that are foreign. These imbalances must be corrected in order to reduce inflammation. The immune system must then be upregulated to respond to specific targeted pathogens.

Blood vessels may be inflamed in what is known as vasculitis. The blood itself may become thickened due to the overproduction of fibrin. Bone marrow becomes dysfunctional and as a result, the patient may have low platelets (thrombocytopenia), low neutrophils (neutropenia), or low lymphocytes (lymphocytopenia). This further impacts the body's ability to mount an effective immune response to address chronic infections. Anemia may be present. 

Autoimmunity is unfortunately another common finding in chronic Lyme disease. As the immune system becomes dysregulated, autoimmune responses become more common. Autoimmunity may be in part the result of molecular mimicry, a process through which the infections are able to look like normal tissues in the body and cause the immune system to incorrectly recognize self vs. foreign invaders. 

Autoimmunity to the thyroid is very common in patients with TBDs. This can be evaluated by looking at thyroglobulin antibodies and TPO antibodies. Anticardiolipin antibodies are used to evaluate autoimmunity to the interior lining of the blood vessels while myelin basic protein antibodies give clues to autoimmunity to nerve tissue. Antigliadin antibodies suggest an immune response to gluten as a result of leaky gut syndrome or congenital abnormality. Antinuclear antibodies are evaluated using an ANA and a rheumatoid factor (RF) is often ordered. Both are indicators of autoimmune activity.

Changes are often present in the central nervous system. Oxidative stress levels may be elevated. Glutathione levels are often depressed. There may be changes in the metabolism of homocysteine and methionine. Important detoxification pathways such as methylation and sulfation are often impaired which leads to elevated levels of both ammonia and sulfates. Autonomic and peripheral nervous systems can be severely affected resulting in Neurally-Mediated Hypotension, Postural Orthostatic Tachycardia Syndrome (POTS), or even "Bell's Palsy" of the gut.

Biotoxins are often elevated resulting from both exposure to external sources of biotoxins as well as toxins that are created from the microbes that live within infected patients. In chronic Lyme disease, these water and fat soluble toxins may be the result of indoor mold exposures and infection with Borrelia, Babesia, and other toxin-producing microbes. Biotoxins increase the production of inflammatory cytokines which in turn upregulate systemic inflammation and lead to a worsening of symptoms.

Insulin resistance increases, lipid profiles deteriorate, and levels of VEGF and PAI-1 are altered. Leptin receptors are damaged which leads to weight gain. Key regulating hormones in the body such as MSH (melanocyte stimulating hormone) and VIP (vasoactive intestinal peptide) become deficient. All hormonal systems of the body are negatively and significantly impacted by the presence of biotoxins. Hormonal dysfunction is present in almost all chronic Lyme disease patients, even in children. Insulin and leptin resistance develop. Thyroid insufficiency is often present. 

There are deficiencies in sex hormones. The reninangiotensin system is impacted resulting in problems with blood pressure and fluid balance. Abnormalities in antidiuretic hormone (ADH) lead to retention of fluids. Adrenal glands are often stressed or entirely exhausted.

Heavy metal toxicity, such as that resulting from mercury, aluminum, or arsenic exposure, is almost always a factor in chronic illness. In children, this may be related to vaccinations where mercury and aluminum are used as preservatives. Many over-the-counter medications contain aluminum. Very few people recognize that factory-farmed chicken is high in arsenic. Children, especially the first born, can acquire heavy metal toxicity from their mothers in utero.

Dr. Corson has found that patients often have a history of past physical, emotional, or psychological trauma. These factors, though not pleasant, must be considered and dealt with in order to return the child to a state of wellness.


Management - Restoring Effective Function

The management of tick-borne disease is complex and requires the consideration of many factors. Just as Dr. Corson thoroughly evaluates each child through history, physical examination, and laboratory testing, she creates an equally thorough treatment program, which optimizes the outcome of each child she cares for. It is only through addressing the many factors involved in chronic tick-borne diseases that notable improvements are realized.

Diet is a key part of approaching chronic illness. Paleolithic dietary principles are often appropriate. Organic grass-fed meats, wild-caught fish, fruits, vegetables, and tree nuts are good options; whereas grains, legumes, cow dairy products, refined sugars, and processed oils are best avoided. In many cases, avoidance of gluten, cow dairy, sugar, and yeast are necessary. Individual dietary restrictions are introduced based on food allergy testing. It is important for the child to have a diet with the least possible risk of allergic reaction as the immune system is already overburdened and inappropriately responding.

The living environment must be carefully considered. This includes home, school or day care, car, and any other environments where the child spends time. Each of these must be evaluated for the presence of mold.

Biotoxin-binding substances such as Cholestyramine may be necessary in order to bind toxins which are a common source of symptoms throughout the body. Algae products and homeopathics are often helpful. Avoidance of environments with toxic exposures is a key to recovery.

Electromagnetic fields (EMFs) should be investigated and every possible approach to minimizing these biologically incompatible frequencies should be implemented. This may include removing TVs, computers, electrical toys, turning off circuit breakers in the child's bedroom at night, removing cordless phones and wireless devices from the home, and avoiding cellular phones.

Dr. Corson incorporates the concepts of German Biological Medicine and Homotoxicology in her practice. This involves an assessment of where the patient is within six phases of disease development. The earlier stages include: Excretion, Inflammation, and Deposition. With each further stage, the disease process becomes more deep seated in the body. As the illness progresses, it moves to the later stages which are Impregnation, Degeneration, and Neoplasm. Dr. Corson's goal is to identify the child's current stage and then to move them back towards the earlier stages of the Homotoxicology model using the principles of German Biological Medicine.

Restoration of patient vitality through rebuilding of vital heat and energy, or chi, is the first step.The health and function of the extracellular matrix is of crucial significance. The matrix provides structural support to cells and is critical in both bringing nutrients into cells as well as supporting the removal of toxins from the cells. It must be cleared of biofilm formations, toxicity, and infection. Many functions in the body are supported through communication that occurs throughout the tissues in the matrix. As these are often impaired, the matrix must be a focus of treatment.

Metabolic function of the Gastrointestinal-Associated Lymphoid Tissue (GALT) is evaluated and corrected. Many children have leaky gut syndrome whereby the bowel lining has increased permeability and allows larger than expected particles into the bloodstream, thus creating an undesired immune response.

Biofilms in the gut must be broken up while simultaneously removing infections and any dysbiotic microorganisms. The gastrointestinal tract must be repopulated with both prebiotics and probiotics in order to bring healthy balance to the bacteria found in the gut. The flow of material and the mechanical activity of the digestive system must also be optimized.

It is critical for the liver to function optimally in order to return a child to a state of wellness. There are often detoxification defects in methylation and sulfation pathways. These may be genetic in origin or acquired, but can be bypassed with appropriate therapies. Toxicity and infections both significantly affect the function of the liver. The flow of bile and function of the gallbladder must be improved in order to support an effective overall detoxification program. Dr. Corson finds that the liver will often improve dramatically once the toxic load from dysfunctional intestines is removed. Thus, any attempts to improve the function of the liver are often not successful until the toxic load of the gastrointestinal tract is addressed.

The Mucosal-Associated Lymphoid Tissue (MALT) is evaluated. This includes the sinuses and the lungs. Often, biofilms present in the sinuses create a haven for infections that further stress the patient's overall system. Allergic responses are often upregulated. Head, neck, and chest lymphatics may be congested.

The function of the bone marrow is considered given that the bone marrow is the source of red blood cells, white blood cells, and platelets.The more normal the immune cells produced by the bone marrow are the better the child's immune system can respond to the many infectious and toxins present. 

The central nervous system is a common source of symptoms for patients with Lyme disease. Dr. Corson works to lower oxidative stress which impacts the CNS. Levels of ammonia and sulfates are examined and appropriate interventions are put in place. Both the myelin sheath and cell membranes are in need of repair.

Various systems in the body have regulatory effects on others systems. Optimization of one system leads to beneficial effects on the other. For example, neuroimmunology is a field which looks at the interactions between the nervous system and the immune system. Neuroendocrinology considers the interactions between the nervous system and the endocrine, or hormonal, system. The neurovascular system considers how the nerves control the caliber of blood vessels. Often times, hypercoagulation, or thick blood, is a factor that must be addressed in order to effectively treat chronic infections.

In managing patients with tick-borne diseases, Dr. Corson generally uses a cycle of release, provoke, release, provoke, release. She comments that "The effective management of tick-borne disease is not unlike peeling an onion. There are many layers to the problem that must be addressed over the course of the treatment."

There are a number of different tools that Dr. Corson uses in the management of tick-borne diseases. She finds that since many things have gone wrong in the bodies of people dealing with these diseases, it takes many different approaches and therapies in order to return a patient to vitality. Spagyric homeopathic remedies and herbal medicines can be very helpful. She states that "Pekana® products are incredibly magical medicines." She uses spagyric products from Energetix as well. Nestmann has a number of useful homeopathic remedies. Medications that modulate or balance the immune system are often helpful. Syntrion® and San Pharma™ have created homeopathic preparations of metabolic products from common fungi and bacteria which regulate and modulate the immune system. Syntrion® offers cellular reprogramming medicines which are incredibly effective. Nosodes from Energetix and Deseret Biologicals can be beneficial tools. Researched Nutritionals® has a "wonderful range of transfer factors" that are helpful in dealing with the various infections commonly present in TBD patients. 

Nutritional supplementation is generally necessarily in order to provide the body with the building blocks needed to support optimal function. The nutritional supplementation aspect of the recovery program is interwoven with the homeopathic and immune-modulating medications in a synergistic manner.

A fresh organic diet with grass-fed meats and sprouted grains is recommended. In fact, "A good diet is always the first place to start," according to Dr. Corson. A multivitamin with trace minerals and magnesium serves as a foundational item.
Essential fatty acids are generally required. For children, DHA, phosphatidyl serine, glycer-phosphocholine (GPC), and phosphatidyl choline are most appropriate. For adolescents and adults, EPA or DHA are generally suggested. In support of appropriate methylation, activated coenzyme forms of B vitamins such as folinic acid, methyl-B12, P5P, and even BH4 are considered. Antioxidants of all kinds are often necessary. These include vitamin C, vitamin D, vitamin E, R-Lipoic Acid as well as specific cerebral antioxidants such as Cerebro PTC from MarcoPharma and Fibroboost® from Allergy Research Group®.

Specific consideration is given to mitochondrial energy production within cells and the use of specific nutrients to "resuscitate" energy producing capabilities. These include CoQ10, NAC, Acetyl-L-Carnitine, D-Ribose, R-Lipoic Acid, organic acid homochords (Lactiplus, Citiplus, and Formiplus from Pekana®), and Researched Nutritionals® NTFactor Energy™.

Dr. Corson uses a multitude of advanced nutritional creams available from Health Pro Labs which can be highly effective, especially in children. Several creams that she has found to be beneficial include molybdenum, ornithine, folinic acid with TMG or folinic acid with TMG and B12, B12, CoQ10, Vitamin D3, Vitamin C, taurine, melatonin, GABA, GABA with theanine, R-Lipoic Acid, niacin, glutathione, "Cognitive Therapy", "MS", "Autistique", magnesium citrate, and magnesium sulfate.

The importance of probiotics cannot be over stated as these are critical not only in fighting yeast infections but also in addressing pathogenic bacteria in the gut. KlaireLabs™ Ther-Biotic®, Researched Nutritionals® Prescript-Assist™, MarcoPharma's Ba-Co-Flor, and Theralac® are good options. Nutrients to repair the gastrointestinal tract include glutamine, Syntrion's® SyCol, Tyler's Permeability Factors™, deglycerinated licorice (DGL), and aloe.

Heavy metal binders include PectaSol®, chlorella, Energetix' Arctic Alginate, Modifilan®, BodyGuardSupreme™ from Supreme Nutrition Products, and Klaire Labs™ Interfase Plus®.

For removing vaccination stress, homeopathics from Energetix and Pekana® are helpful.


Management - Antimicrobial Therapies

Though Dr. Corson does not believe that allopathic medicine alone holds the keys to recovery from the complexities of tick-borne disease, she does believe that there is a place and a time for allopathic treatment options in a well-planned protocol. She follows the treatment guidelines set forth by the International Lyme and Associated Diseases Society (ILADS) in her practice.

For the treatment of Borrelia, a cell-wall antibiotic such as a penicillin or cephalosporin along with an intracellular antibiotic such as a macrolide or tetracycline is used. Plaquenil, Flagyl, or Tindamax may be added along with a cell-wall drug and intracellular drug in order to address the cyst form of the infection.

For Bartonella, doxycycline and a macrolide drug, doxycycline and Rifampin, Bactrim and Rifampin, or a quinolone drug may be used.

For Babesia, Mepron, macrolides, Plaquenil, Artemisinin, or Bactrim may be helpful. 

Macrolides or quinolones may be used for Mycoplasma; while macrolides or Rifampin may be used for Chlamydia.

In looking towards non-allopathic antimicrobial options, Dr. Corson utilizes many of the antimicrobial herbs from the "Cowden Support Program". These include NutraMedix®Cumanda™, Samento®, Quina™, Banderol, Mora, and Enula. She incorporates homeopathic and herbal antibiotics and antivirals from numerous companies that utilize traditional Native American, South American, European and Asian traditions to target infections such as CMV, Epstein-Barr Virus, HHV-6, HSV-1, HSV-2, Mycoplasma, Babesia, and Chlamydia. The key is that all of these tools are used in an integrative manner.

Beyond restoring function, using therapeutic tools, and implementing an appropriate antimicrobial strategy, there are a number of other therapies that Dr. Corson may suggest. Cranial osteopathy is invaluable whenever there is any history of trauma. Chiropractic neurology can assist in rehabilitating the brain and rewiring neural circuits. Chiropractic care and acupuncture can be useful interventions.

Lymphatic drainage via machines such as the Lymphstar Pro® or through lymphatic massage can support the removal of toxic wastes.

Physical exercise and rehabilitation are appropriate, but only to tolerance and only when the patient is able.


Treatment Caveats

Dr. Corson has observed a number of important caveats along the way. She believes that any child that becomes ill after a tick bite needs a full evaluation for the presence of coinfections. She further states that any child who becomes ill after a tick bite and was only treated with 3-4 weeks of oral antibiotics has most likely been inadequately treated. Often times, inadequate treatment makes future treatment more difficult.

Neurological or neuropsychiatric signs and symptoms are often the first and only signs of infection. They are also the most common indication of persistent infection after inadequate treatment.


Summary

It becomes clear rather quickly that the evaluation and management of tick-borne disease is a complex and evolving area of medicine. From a review of symptoms to a physical evaluation, and consideration of laboratory findings, to a restoration of function using various therapeutic tools including the incorporation of antimicrobial therapies, tick-borne disease management is far from straightforward.

Dr. Corson's son graduated from Franklin and Marshall College with honors in Philosophy last May and will be starting graduate school at St. Andrews University in Scotland in September. He is nearing the end of his seventh year of a successful multidisciplinary treatment for TBDs. It takes someone with a deep passion for healing to have an impact on children and their families. Fortunately for many, that "someone" has been found in Dr. Corson.

Disclaimer: This article is not intended to serve as individual medical advice. All statements made are general in nature and should be discussed with a licensed health-care practitioner.