Finished? And How to Prevent Relapse

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The End of a Lyme disease treatment image from Marty Ross MD

At The End of A Lyme Treatment

"This article was originally written while I practiced in Seattle, Washington, at The Healing Arts Partnership. Since then I have updated it a number of times to keep the treatment options current." Marty Ross MD

It was a good week here at The Healing Arts Partnership. One of my patients with chronic Lyme disease graduated from treatment while another group of patients seen this week are nearing that point. While I enjoy many aspects of my practice, seeing patients complete treatment and celebrating that with them is what I enjoy most. So what does it mean to finish treatment?

For patient confidentiality I cannot identify the graduating patient by name, but I can by how he occurs to me. He is Mr. Canadian Sweet Spirit Big Heart (MCSSBH). MCSSBH came to my practice a couple of years before. Because of his illness, he had to stop his job as a carpenter and was no longer able to participate actively in his family life. In our recent visit he noted very good energy and that his life was once more under his command. He spoke of fully working as a carpenter and participating actively and lovingly in his family life. We talked about what it means to be finished with treatment. We then created together his plan of action to maintain his health in order to live his life fully. As we said goodbye, MCSSBH blessed me and thanked me for the return of his life. I thanked him for his kind and touching words and sent him on his way ... and I blessed him back.

Lyme Lives On Even After Treatment

The conversation I had with MCSSBH is similar in medical content to those I have with others in his situation. The concern I have in finishing treatment is to prevent relapse. So there it is .... the reality I do not like to share, and what my patients do not like to hear. For most with Lyme of a year or more at the beginning of treatment, treatment does not get rid of every germ. Relapses are actually quite common for those with chronic Lyme disease. It might be fair to say that for those who have had the illness more than a year before beginning treatment at the end their dis-ease is in remission. This is not the case for those with acute Lyme treated within a month of infection. Treatment for the majority of this group truly seems to eradicate the germ. For those treated within 1 month to a year after the infection, it is a mixed bag based on my experience. Some do not relapse while others do.

Preparing to Stop Active Treatment

As I prepare patients for remission I am focusing on preventing relapse. One reason patients may relapse is that Lyme germs convert to prescriptive antibiotic resistant forms. These resistant forms are germ cysts and biofilm communities. Biofilms are layers of slime that cover germs hiding them from the immune system and preventing antibiotics from getting in. So in the months leading up to the end of treatment I work to treat the Lyme borellia cysts with anti-microbials like metronidazole, tinidazole, fluconazole, or grape fruit seed extract. I also work to remove biofilms with an enzyme derived from earthworms called Lumbrokinase. Another option to the anti-microbials and Lumbrokinase is to use cat's claw and otoba bark extract or Biocidin in the final months. These treat all three forms of the germ and eliminate biofilms.

The Lyme Done Test

I wish there was a done test in Lyme, but there is not. For more about this see Is There a Lyme Done Test? No. When I first started treating this illness, many of my colleagues promoted an idea that a person would not relapse at the end of treatment if two conditions were met. First, a person had to be symptom free for 2 months. Second, the CD-57 test had to be in a normal range of at least 150 or higher. So the CD-57 looked like it could be the done test.

The CD-57 is a type of white blood cell that is often low in those with immune suppression caused by Lyme disease. If it is normal at the end of treatment it indicates that there is not immune suppression. What I learned through my own observations over the years is that even with normal CD-57 counts and having no symptoms at the end of treatment, many will eventually relapse years down the road. In fact the level of the CD-57 test does not predict how quickly a person will relapse.

Active Treatment is Done

I now consider treatment "finished" in two separate situations. A person's treatment is complete when

  • they are symptom free of Lyme disease for two months, or
  • if they are at a plateau for 4 or more months and no changes in his or her treatment protocol moves the treatment forward. (To see changes in the treatment protocol I consider Read the chapter Can't Get Better? Do This.)

I no longer test the CD-57 because I do not think it accurately predicts anything.

Marty Ross MD On Six Steps to Prevent Lyme Relapse

This video was recorded during Conversations with Marty Ross MD on 3/28/19.

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Relapse Prevention Steps

When a person's treatment is "finished" I suggest one of three different courses. The foundation of all three choices is to support the immune system vigorously. More on this later. The three choices are:

  • wait and see if relapse occurs while supporting the immune system,
  • use preventive herbal anit-microbials, and
  • use preventive prescriptive anti-microbials.

In the wait and see approach I advise a quick return visit if any Lyme disease symptoms return. My experience for those that choose this option is that if Lyme disease does become active, a course of antibiotics or herbal anti-microbials quickly turns things around. People usually do not go back into the "hole" of the disease, but rather have a return to health within weeks to a few months.

In the preventive anti-microbial approaches, I use herbs or prescriptive anti-microbials in a more limited way than while under full treatment to police the body and to keep the remaining Lyme germs under control. In using anti-microbials this way, I treat Lyme disease as I would other chronic infectious conditions like HIV disease where people do quite well as long as they take anti-virus drugs to keep the germ-load down. I might use the following pulsed regimensfor 4 days on and 3 days off of each week:

  • cat's claw and otoba bark extract at 15 drops 2 times a day or even 1 time a day,
  • doxycyline 100mg 1 time a day or
  • clarithromycin 250mg up to 500mg 1 time a day.
  • Biocidin LSF 1 pump 3 times a day.

Pulsing is one way to prevent the development of persister cells. Persister cells are forms of spirochetes and cysts that go into hibernation when they are continually exposed to antibiotics. Research at Northeastern University in Boston suggest pulsing antibiotics can eliminate persisters. Read more in How to Pulse Antibiotics in Lyme. For more information about these herbal and prescriptions antibiotics see A Lyme Disease Antibiotic GuideBiocidin: A Potent Antimicrobial and Biofilm Breaker, and Otoba Bark Extract and Cat's Claw Tinctures.

Support The Immune System to Prevent Relapse

Although the to-do or not-to-do anti-microbials discussion is important, what is most important at the end of treatment is to support the immune system. So I recommend whether a person uses anti-microbials or not:

  • regular sleep of seven or more hours a night.
  • regular exercise as long as it does not make a person worse.
  • continuing emotional detoxification.
  • whole and organic foods to limit toxins that can suppress the immune system.
  • a good multi-vitamin that provides all of the essential nutrients the immune system requires, and
  • immune system support with
    • a mulit-immune mushroom formula 1 pill 3 times a day like The Immune Builder 5 Mushroom Formula by JHS Naturals, or 
    • a general multi-immune transfer factor mix like Transfer Factor Multi-immune as 1 pill 2 times a day, or
    • targeted transfer factors against Lyme germs like Transfer Factor L-Plus 1 pill 2 times a day. Read Transfer Factors: Turn On The Army for more information. 

Who Decides?

You may wonder how I decide which of the three approaches I recommend to each patient. How do I decide? I don't. I have a patient decide based on the above information and what feels right. I strongly believe in the power of intuition. In having a patient choose what feels right to them, I am tapping into the deep knowing "intuition" that we all innately have. In my practice, I observe that people do best when I give them the choice to tap into their own sense of what is right, their own intuitive sense.

So back to my patient, MCSSBH. We discussed his options. He was not certain if he would choose a wait and see approach or to use an herbal anti-microbial preventive approach. I was not disturbed by this, because I knew he would figure out what is best for him based on his innate intelligence.


The ideas and recommendations on this website and in this article are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.

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About The Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State (License: MD00033296) where he has treated thousands of Lyme disease patients in his Seattle practice.

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS), The Institute for Functional Medicine, and The American Academy of Anti-Aging Medicine (A4M).

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