LNN

Ok DUT - you are going to have to educate me please. Take pity on a poor art major...Can you give me a methylation for dummies explanation? I mean, I think I get the very very basic idea. But can you give me a tutorial? I think this is good stuff and might be really important - I just don't know what it means!

I have the same thoughts Nancy does. In my own bias, I'm not sure that 50 yrs from now, anyone will think there's such a thing as "regular" OCD. That said, "regular" OCD isn't known to respond to IVIG the way your DD did. It doesn't go "whammo" to myco p. But that's my bias. I would venture a guess, given the doctors you've seen, that long term abx or combo abx (two at the same time) isn't something you've tried for a length of time. If you haven't, you may want to consider that as a trial - maybe a few months? You can also ask your doctor about some blood tests that show certain things about the immune system. CD57 is a measurement of natural killer cells. It's used in lyme to see if the body's ability to mount an attack is being suppressed. C3d is a measurement of a general activation of immune complexes. A chronic infection might cause the immune complexes to stay elevated (my daughters rose consistently for a year before she was treated and have drastically declined after 10 mos of combo abx). C3a and C4a are immune complexes that suggest immune complexes activated against lyme or mold (and probably other things). So there are some immune systems you can check on - where "regular" OCD people theoretically would have normal results. My impression is that not every Pandas doc is willing to go down this path. It's just something to look into. In the meantime, I second the thought that helping your daughter and family cope is also important and think ERP is a tool that will serve her well for her whole life. (Tho she may have a really hard time until the medical piece is under control - if it's an infection-triggered OCD). I also think an SSRI isn't the worst thing in the world. As Nancy said, it's not a life long decision. You can always start very low and always chose to taper off if it doesn't give relief. That said, I too have always tried supplements first. Inositol helped my son during a bad period. We tried NAC for my daughter (started at 600 mg then moved to 1200) but after a week of full dose, she was far more emotional and angry, so we tapered off. I hear good things about in in the OCD world. But my daughter has lyme and NAC is apparently a good biofilm dissolver (lyme can live in biofilms). NAC dissolve mucus, so if there are organisms living in a mucus castle where the immune system can't see it, NAC can expose the buggers and set off a PANS episode as the infection loses its camouflage. So I only throw that out not to say don't do it, but to be aware. If you did try NAC and saw a negative reaction, that might tell you something (strep and viruses can live in biofilms too). As I said, lots of good press about NAC for OCD, so I'm not trying to discourage you. Getting your child relief is priority number one. But I would still encourage you to consider medical treatments given her response in the past. As Nancy said, that medical piece can make a night and day difference in the effectiveness of the ERP and SSRI/supplement tools. Best of luck!

MaggiesMoon will have to explain the link her doc saw between histadelia and Pandas. But methylation I crudely understand it is just how well your body's chemistry lab is working. It's a discussion around how well or how poorly your body uses available enzymes, minerals and such to conduct its daily chemical transactions. It's basically a look at how well a particular body system is running. It's impact on overall health runs far and wide yet I don't believe it's specific to one ailment. I've seen it discussed on pyroluria, autism and mercury detox forums. My general takeaway is that is your have a poorly functioning methylation system, you're going to struggle with health and ridding your body of toxins and antigens - whether that be allergens, fungus, bacteria or pollutants. What I really like about DUT's link is that is discusses how an under or over-methylating system can respond to one group of supplements vs. another. As we've added B6, zinc and other things recently, my son has improved. It seems to be addressing an underlying need of his body, regardless of what infection or toxin he may be fighting. I'm starting to appreciate that this is a "core" of good health structure that may be life long, beyond disease labels. Very interesting.

Bees, My DS did two month-long steroid bursts with great improvement, while he likely had lyme as an underlying infection. Those were when he was in serious exacerbations and he remained on abx so if there was immune suppression, perhaps the abx helped support him despite the prednisone. I don't know. One other time, when he was not in an exacerbation but a second Pandas doc dx'd him visually with a sinus infection, we were instructed to do a third taper and switch abx. After only a few days, I saw a decline in his overall situation. Since he had not been in a bad place prior to this, I discontinued the taper (we were only a few days into it), returned to the abx that had been doing a decent job and he rebounded - not to baseline but to where he'd been before the taper. In general, I believe steroids are not recommended for those with lyme or other chronic infection because the idea of immune suppression would be contra-indicated. However, this line of reasoning probably does not take into consideration that impact inflammation has on our flavor of kids. I personally feel the risks have to be weighed against the benefits. The entire family suffers when a child is in a neuropsych flair. If lyme is a potential issue and the issues can be managed in another way, I'd suggest alternatives. But if you can't get a child to school or he's raging or is in some way non-functional, if your other kids or your marriage are bearing the brunt, steroids may be worth the possible gain you give the bugs. DCMom has found tremendous relief with steroids, NMom had a horrible experience. I think any parent has to weigh the pros and cons in their own situation and just be aware of the risks so they can make an informed decision. Prednisone is one of the last tools I'd use for my son at this point in our journey, but I also haven't tossed the bottle that's in the fridge for an emergency. PMom and I disagree on the relevance of your labs, especially if you're seeing better results on an abx combo, but that is for you to decide.

I didn't even realize it could be mixed or that you'd drink it. We always used the capsules. I looked but couldn't find anything regarding temperatures. Sorry.

DUT - thank you for this link! It is still over my head and I'm going to have to re-read several times. But what's really interesting is that some of the supplements listed - zinc, B6, choline, taurine - are the things involved in pyroluria treatment (aka KPU) and have helped my son immensely. I also see Pfiefer mentioned on a pyroluria forum and this helps me connect dots. Like the article says, it's a chicken/egg thing, but certainly raises some good stuff to look into. I really like the author's tome, too. Sort of "not sure what it all means but maybe it will be helpful" instead of absolute truths. Good find!

I know I'm going to regret this post. But here goes... In watching the passionate debate unfold this weekend around the "lyme issue", I've found it hard to not think about it even when away from the computer. While I see both sides, I end up feeling like everyone is losing. When people finally run out of things to say, the forum will go weirdly quiet. People whose kids might straddle more than strep will hesitate to ask a question and people with a foot in more than one world will hesitate to use the "L" word, even when it might be constructive. So I guess I feel the need to suggest a truce and propose some ideas: 1. All members should remember that this is the Pandas forum and the members here have decided to explore Pandas as a possible explanation for their kids' issues and possible treatments. Anyone from a different world should speak with the appreciation that we are guests in a "foreign country" and act accordingly. Last winter, lyme was attacked on the lyme forum and it was met with equally upset parents. So this applies to all forums, not just Pandas. 2. In the recognition of PANS, I would personally like to see Pandas parents suggest, or tolerate the suggestion, that a child's issues may be infection-triggered but not necessarily be strep triggered, especially if there are outlier symptoms, non-rising titers, negative culture, etc. This has happened in the past and I hope it continues. 3. I think nearly everyone would agree that "testing" for Pandas, lyme and a myriad of other neuro diseases s**ks. But if we could point people to links that discuss the merits or flaws of a test, or a treatment, or a diagnosis, rather than attack a lab or doctor, it might keep conversations more productive. The lyme forum has a list of articles pinned that can help a parent interpret lyme bands. Maybe it's best to just refer parents to those links and let a parent decide what to make of lab results. The other day, I wanted to suggest a certain thing that we found helpful in our journey, but because it came from the lyme world, I felt like I had to apologize in advance. Like "sorry - please don't think I'm suggesting lyme, but we found this worked well...." And I found it sad that I would have to apologize for what I was about to say. I try to keep what happens in lymeland in lymeland. But there are topics I wish I could share more with my old Pandas family - things that apply to general disease, therapies, supplements - but I don't always feel like I should post, because the whole topic has become toxic. So without trying to re-fuel the fire, I just wanted to post to try to mend fences and find common ground. Worried Dad posted about my belief that if your child doesn't respond to the things that usually help for one disease, there may be more to the puzzle, more worth exploring beyond what's covered by a particular disease. I do hope this remains a place where it's ok to express that idea. Because I still have a lot to learn from other parents struggling with schools and attention deficits and sock seams. Even if my kids have the "L" word and who knows what else. What's the best way to do this?

Ok, I can see that disruptive is not ok. But I still think taking this personally is totally ridiculous. Seems this is about her feeling she is being disrespected or that her authority is being challenged - as if dealing with your own son's insecurities weren't enough! Now you have to make her feel good about herself? The harder she pushes, the bigger the problem will get. Kids will turn into class clowns or juvenile delinquents rather than be caught being embarrassed because they can't do something their peers can. Ask her how a dyslexic should be taught, or someone with cerebral palsy. She is not getting through to him and she is failing. So she is angry at herself but would rather blame your son. My son (also 4th grade) fakes it. He stares off and says he can't think of an idea. He works slowly so he doesn't have time to finish a project. He basically stalls so it looks unfinished rather than untalented. But he does so without drawing too much attention to himself, so no one makes an issue of it. One thing a teacher might try to do is put a disruptive boy at a table with well behaved girls. This works for my son when he gets too chatty in class. But it would be the worst thing to do in an art class, because girls will be making pretty pictures of flowers, further making your son feel inept (sorry to be sexist). It would be like rubbing his nose in it, and he'd be tempted to be more disruptive as a way to distract people from noticing his deficits. So ask the principal to take note of seating and social dynamics on Monday. My guess is you're absolutely right and your son's reactions are totally normal in the context of anxiety. The goal should be to defuse that anxiety. Otherwise, nothing else is going to help. Wish I had more concrete suggestions. Let me know how it goes on Monday.

I know nothing about MSM. So stop reading now if you think I know what I'm talking about. But I've seen it mentioned several times in my chelation readings. I have no idea if this is valid - it comes from a guy who's written a lot about lyme and also followed Cutler's chelation protocol - but you can find others who totally disagree - so I pass it along but you need to decide for yourself: The first problem that can render chelators nonproductive and dangerous is that the chelator used does not bond strongly enough with mercury to remove it. Instead, the mercury is merely dislodged from its resting places in the body and sent into circulation, where it quickly bonds to tissues elsewhere. This is called mercury redistribution. It can have seriously damaging effects and can dramatically increase symptoms of toxicity. Body tissues themselves have a high affinity for mercury. If the chelating agent used creates only a weak bond, the mercury will be dropped by the chelator and grab onto other body tissues on the way out of the body. An ideal mercury protocol minimizes redistribution. Substances that are not proven to be appropriate chelators (even though they are quite popular) include cilantro, chlorella, and MSM, to name a few. These substances are not ideal mercury removal agents. Nor are many of the “mercury detoxification” herbal preparations sold in health food stores and by various healthcare practitioners. In some cases, these substances and products can be very dangerous and often do more harm than good. Such substances and products typically create a strong enough bond to move mercury around in the body and cause mercury redistribution, but not a strong enough bond to actually usher mercury out of the body. Taken from this link: http://www.chroniclymedisease.com/mercury-and-lyme-disease He actually does a good job outlining my big question - if you have lyme and mercury, don't you need a chelator on board the entire time you're getting the lyme/biofolms to release their mercury? If you only chelate every other weekend, isn't the released mercury just going to redistribute in the meantime - the very thing they say daily chelation does (and say it's dangerous)? Way confusing and contradictory. Just when the author gets to the crux of my dilemma, he says further discussion is outside the scope of his book. ??? That's exactly what I need the scope of the book to be about! Anyway, not weighing in on MSM. I have no experience with it. But wanted to pass along this point of view FWIW.

Ok, what am I missing? This is ART. Not a critical thinking class, or math or composition - skills that are needed by everyone. It's making clay pots and painting pictures. Isn't this supposed to be a place where creativity and self-expression, marching to your own drum, breaking boundaries - are encouraged? Why is a perceived failure to be "creative" being made into such a big deal? Some kids just aren't artistic - for whatever reason. I have a minor in art, my DD is very artistic. My husband and DS9 can't make a respectable stick figure. (regardless of any illness). Why is the Art teacher having a tizzy fit? Why is she angry? This hardly seems a rational reaction to a kid who can't draw. Shouldn't your son's self esteem and ability to handle the rest of the day trump a teacher's desire to make sure her class is treated as "important"? Maybe if you can figure out what emotional need is driving this teacher, you and the principal can find a way to meet that need without having to punish your son for his "shortcoming" that will surely ruin his life if not corrected by this teacher. (ok, I am obviously not the voice of reason that you need).

I can totally appreciate your frustration. It's a big obstacle to get an ex on board, because there's so much baggage beyond a medical crisis that's on the table. I didn't mean to make you feel you had to defend your position on lyme or bartonella. You've been here as long as I have and you're an active researcher. I was only imagining the horror of the suicidal thoughts and wanted to toss out a combo abx idea, not push another label. Like it or not, our kids are lab rats. If doctors and science don't know what's wrong, but we know something's wrong, what are we supposed to do? Not try because we don't know what to call it? Rely on a drug to mask symptoms temporarily without also trying to kill a "little bit" of a bacteria? So I respectfully disagree with your ex, but then, that's why you're venting here. I hope you catch a break soon.

Denise, I'm so sorry you've had to go through this. What a nightmare! Please don't take this as any sort of suggestion about lyme - you're a smart woman and you know enough about how to pursue if you were so inclined. That's not why I'm posting. I was just struck that the abx that worked for you are ones that are often used for bartonella - and that made me wonder if you or your docs might consider a lyme-like treatment of combo abx this time around. Rifampin has a half life of 4 hrs, Clindamycin half life of 2-3 hrs. You could dose each in between each other kind of like you can dose motrin then tylenol every 3-4 hrs...(not sure how to fit probiotics in but sacc. boulardis might work for you even with abx). And/or a longer course of treatment? I understand the liver concerns, but you can use milk thistle or other liver detox support to help. The RF risks would seem at least as high on the other side of the scale. Again, not trying to push any sort of label. Only trying to help brainstorm. I can't imagine the fear of having to face your nightmare another time. Your family is in my thoughts. Laura

Same here. They seem to last awhile. Epsom salts seem to both make more and dry them out. I try to use a loofah (exfoliation) but the kids get annoyed and say it hurts. The other thing that seems to help - tho it's hard to say there's a direct connection - is a lymphatic massage. Jodie had mentioned it awhile back and I found a place nearby that teaches patients how to do the massages themselves - chemo and diabetes patients who struggle with endema. The kids love it and it does help swelling go down when DS has struggled with colds and/or an increase in CORE/zinc. Insurance covered it (I think) - (2) 30 min visits. The pimples are almost gone. But again, can't say it's due to the massage. Could also be just time taking care of it, or the bentonite clay we started using, or the phase of the moon, the tilt of the earth, who the heck knows. But the massage is worth looking into as an overall way to boost the immune system. Takes about 15 min to do a neck massage. Makes the kids feel pampered.

Ummm. Susan? You are crazy. That's why you're here. re: tums - I'd ask your pharmacist. I read somewhere 2 hrs. But pick your battles. The girl has to be able to eat. Tried to see if pepcid has the same issue but it wasn't clear. But it lasts longer, so maybe could be given earlier in the day and still be effective. Maybe ask the pharmacist what your best option is re: product and timing.

I was wondering how DD was doing. We've held at 2 and things stabilized. Then added some other minerals (magnesium, taurine - away from abx) - can't tell if they've done much or if time alone has helped things settle. One thing that struck me is that you're using TUMS. Tums has magnesium, which can interfere with the absorption of some abx. Be careful of the timing. In bad times, we've also found it more helpful to dose regularly with an NSAID rather than as needed. It keeps things from ramping up. I try not to do it for more than a week steady, then I usually taper if I can. But while in the middle, motrin every 6 or 1/2 aleve every 8.

Milk Thistle is well studied. You can find research on PubMed. Here's a good overview: http://books.google.com/books?id=J4TFtQeHkQAC&pg=PA174&dq=lyme+milk+thistle&hl=en&ei=-amWTuD5OIS2tgel09WIBA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CEsQ6AEwAA#v=onepage&q=lyme%20milk%20thistle&f=false For charcoal info: http://www.alsearsmd.com/activated-charcoal-the-detoxifier-found-in-every-emergency-room/ Charcoal can be found in any pharmacy or health food store. Clay is similar to charcoal. Some moms feel it works better. You can find it easily in health food stores as a liquid. For capsules, try: http://www.uniquehealing.com/unique-healing-store/unique-healing-body-bentonite-capsules/ Regarding the dark circles under the eyes, lots of parents have discussed them. Could be histamine, could be general illness, could be sinus. It's also one of the symptoms of pyroluria (a zinc/B6 issue). I think a mineral/vitamin workup is a good start (pyroluria can't be detected this way - it's a urine test from a specialty lab). But bear in mind that some minerals, like magnesium, act primarily within the cell. A blood test measures the level outside of the cell. So the extracellular level could be fine but you could need a supplement to amount available intracellularly. It's one of those tests where a deficiency is telling. But a normal result could be normal or could be meaningless. Fun, right?

Momcap - looks like a great find! Wish I could tell pricing without having a sales rep contact me S - sorry - I don't know the answer. We used A-Bart for a short time - gave it at dinner along with abx, which of course was away from abx. You may be able to call Byron White and ask - they may be the more definitive source than the LLMD (and maybe easier to reach!).

Emerson, I'm glad you've seen improvements! But the weight - holy cow!! Have you been checked for parasites? Have you checked your mineral and vitamin levels to make sure you're not also getting severely malnourished? Sounds like 3 meals isn't nearly enough right now. Have you checked the herbs you're on to make sure there aren't any side effects? Has your adrenal system, pituitary, hormone levels been checked? I'm not driving at anything specific - just trying to think of the systems that could be coming into play. Have you discussed with Dr R any medication holidays - maybe going off some things to see if you get improvement? Are you forcing yourself to eat - like you're not hungry? Or is your appetite normal?

Mycoplasma can release toxins when they're killed. Those toxins can cause a worsening of symptoms. It's called a herxheimer response. Scarlet fever is a rash caused by toxins released from dying strep bacteria - in a sense, a mild herx response. So the worsening you're seeing may be a herx rather than a failure of the abx. As others suggest, rate each day and watch the trend. My son's worst episodes took 8-10 weeks to resolve (but he has more than Pandas going on). One thing you can do to lessen a herx response is to help the body get rid of those toxins. The faster the body can detox, the faster it can feel better (assuming that this is a herx and the abx are doing their job). For the liver, you can look into milk thistle (do not use if allergic to ragweed and do your own research - this is not a universal supplement for everyone). To help the gut get rid of toxins, you can use activated charcoal (5-10 pills) or bentonite clay (sold as a liquid - take 1-2 tsp to start or in capsules - take 5-10). Charcoal and clay should be taken at bedtime (to sit in the gut overnight), at least 2-3 hrs away from any other meds (or the meds will get soaked up). My son becomes more regular on clay, my daughter gets a little constipated. So she takes a few capsules of pysillium husk to clean the pipes. You're looking for 1-3 BMs a day to get those toxins out. Water, or water with lemon, is always a great way to help flush the kidneys. Some kids like epsom salt baths (maybe 1 cup in warm tub). Sometimes you'll see small bumbs/pimples emerge on the backs of the arms and legs after a few baths, as toxins work their way out through the skin. Exercise/sweat can help too. I know it's hard to watch your child struggle. But I personally would give the abx more time - myco is not a quick fix. Some have treated for 8-12 months. It would be far worse to stop too soon and then have the bacteria be resistant to those abx later on. Sometimes rotating the abx combo helps. But doing some detox may help your son feel better while his body does battle. Since it sounds like he's also prone to infections, you may want to consider running some mineral/vitamin blood work. Zinc, D, B6, magnesium - all play a role in the immune system. Supplementing, with some blood work to show what may be needed, might help.

Ditto here - one really sick kid with obvious needs for help in so many areas, one kid who's generally bright and independent but has these things that make you wonder...and there's this small matter of money.... Turns out my bright/healthier one also has medical issues driving those things that make you wonder. It's taken a long time to unravel because her symptoms are so vague. But we have enough blood work to tell us there's something there. My advice would be to run some tests that are covered by insurance and can be ordered by the pediatrician if he/she is on board or at least willing to humor you: standard WB (unless you fear that a negative would shut the door with your pedi - but it would tell you if some bands showed up) C3a/C4a complements - will indicate an immune response to lyme or mold C3d - won't tell you any specific illness, but will tell you if the immune system is activated (we watched DD climb from 25->53->93 which is when we started with the LLMD and after 8 months on combo abx it's down to 23 - so it tells us something is helping) maybe some others. Is he having attention problems? those could be OCD or ADD. Our school psychologist will go into the class and observe, marking down DS's attention rate compared to peers. It quantifies an ADD behavior. He's now allowed to chew gum in class when the teacher sees that he's struggling with attention. He also chews gum at homework time and journal writing time. It helps. because of my bias in all this, I tend to think missing problems like this isn't "normal" and I'd consider it a clue. Maybe not something to rush to an LLMD about but enough to see if you can get the pedi to run a few labs as a starting point.

Funny - I was just working on a chart, reading labels of all their supplements, and read your response while taking a break. I'm just going to have to piece together a supplement plan as best I can. Can't really account for what they may get in their diets. The school has been helpful in the past. I just need to list whatever they'd have to take on a form and get the doctor to sign it. But they have to go to the nurse's office to take each pill. They cannot just pop pills at the lunch table (which I understand). So that makes DS feel singled out and "sick", and we already battle a "sick kid" self-perception. So I hate to make him do that. He did it for a month last year to take probiotics and he hated it. Back then, the nurse gave me weird looks about probiotics (she had never heard of them!), so I really don't want to have to go there again if I can avoid it. The school is generally supportive but the nurses tend to be judgmental. They are trained to think daily abx is harmful to the herd. Plus DS is missing a lot of school so far, and coming home early several times due to not feeling well. I explained KPU as a zinc deficiency and how his immune system is waking up and I got a semi-understanding but wary look from the nurse. I'd rather not get her involved with our business. For now, picking them up at dismissal with "Hi Honey, how was your day? Are you buckled in? Good - Take these pills." is working. We have an LLMD appt in a few days (for which I have to pull him out of school). I'm putting together a chart and we'll go from there.

Well, we may be looking at a lot of mid-night wakings if we head toward chelating, but for now, trying to avoid it. They get up at 6:30, so I do have the ability to shove a pill in them about 30 min before breakfast. The taurine between meals is from the label (NOW Foods 500mg). I know Cutler mentions the with/without food issue sometimes. His book should arrive tomorrow - I have mixed feelings about reading it. The CORE label doesn't say anything about the meals issue but I think I read that zinc should also be away from food - the pyroluria group suggested a half hour before a meal. What really kills me is the clay, because it removes the bedtime meds slot and school - oh how much easier it is in the summer when you can dose at lunch or 2pm. Driving myself nuts right now. I know I'll get it figured out, but already have a growing cabinet of half-used supplements. Trying to not pee away money by giving stuff at the wrong time.

I'm starting to add some minerals/vitamins into our schedule and need to be mindful of timing. For instance, I want to add magnesium but it needs to be taken away from antibiotics. Taurine is best on an empty stomach. CORE is supposedly best away from food but you also want to take it several times a day rather than all at once....With school taking away a large chunk of time and clay at night, my window for scheduling is narrow. Does anyone know of a site or resource that tells you when to take particular supplements? (with/without food, with/without a complimentary mineral). Also looking for ratios - e.g. zinc:copper should be 10:1, calcium:magnesium 2:1 - 4:1 etc... Any help greatly appreciated.

Deb, I had to do the biopsy thing in our early Pandas days. It was a sleepless, gut-wrenching time. For me, the results were benign and followups show no issues so far. But nothing anyone says can ease your mind. I hope you can put this behind you and get back to feeling healthy. Please know you will be in my thoughts. Laura

As Kara described, when the borellia/lyme spirochete (the name of the shape of the bacteria) is intra-cellular, it's sometimes called the "L Form" and when it's extracellular, it's called a spirochete. When a spirochete comes under attack by an antibiotic, it can curl up and go into a dormant form, forming a harder outside shell called a cyst form. The cyst form is resistant to a large number of antibiotics and only a few are known to be able to penetrate (flagyl and tinidazole). So if someone has been on antibiotics for awhile, it's very possible that some of the lyme spirochetes have gone into the cyst form, waiting to re-emerge when the antibiotic threat is over. Further complicating things, spirochetes, like many bacteria, can form colonies, called biofilms. It's thought that biofilms are built with several important minerals found in the body (magnesium, calcium, zinc) and some heavy metals (lead, mercury). Research is still just emerging. Plaque on your teeth is a biofilm. As it matures, it can become hard and resistant to abx. Periodically, the colony life cycle matures and some spirochete emerge from the biofilm to reproduce and go off an start new colonies. So if you've had an untreated, chronic infection, you can have 3 forms of the borellia bacteria living in you - the spirochete (extra-cellular) vulnerable to one class of abx, the L-Form (intra-cellular) requiring a different class of abx, and a cyst form - requiring a third class of abx. And as Kara mentioned, your tick may have also brought bartonella, babesia (a red blood cell infection), erhlichiosis, mycoplasma and all sorts of goodies along too. Some unlucky people also end up having to deal with biofilms, which first have to be broken down (NAC, chelators and some natural supplements do this) to get at the bugs inside. And inside, you may find not only borellia, but other bacteria and viruses as well as mercury and/or lead. So as the stuff in the biofilm gets killed off (requiring abx) you also need to be able to handle the toxins that get released and possibly the metals that get released. I know some of this sounds overwhelming, too nuts to be true. Not everyone who gets lyme gets chronically sick. Some people have the immune systems to handle it quickly, or if caught early enough, with just the help of a few antibiotics for a few months. Just like most people get strep and it's no big deal. But for those not blessed with healthy immune systems, it becomes a long, strategic war. Ok, a much longer answer than you really wanted. From the outside, it looks like it's just a bunch of nuts chasing their tails. But it can get complicated and I just wanted to toss out a few of the complications so you might understand why we get as nuts as we do. The longer things go untreated or partially treated, the worse it can get.