Treatments for Lyme, Co-Infections, Biofilms and Candida with Dr. Casey Kelley

by Mike Mutzel



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About Casey Kelley, MD

Dr. Kelley graduated from The Ohio State University College of Medicine and completed her residency in Family Medicine at St. Joseph Hospital in Chicago. She now holds memberships in the Institute of Functional Medicine and the American Holistic Medical Association and is a dual Board Certified Physician in Family Medicine and Integrative Holsitic Medicine. She practices at WholeHealth Chicago.

Contact Dr. Kelley

Show Notes


03:37 Dr. Kelley’s Integrative Medicine Journey: Dr. Kelley went to traditional medical school, but was dissatisfied with making diagnoses, prescribing drugs, and then prescribing drugs for the side effects. She wanted to focus causes. She educated herself and became an integrative physician.

05:22 Why Lyme Disease? Her favorite patients were the ones who had seen lots of doctors, had somewhat normal test results, but were still sick. She did not give up. She began to investigate Lyme disease much more deeply than the cursory introduction during medical school.

06:53 Common Signs of Lyme: It is rare cases that have a rash and were out hiking the week before. Most of us do not know if we have been bitten by a tick. Only 50% or fewer of us get a rash from the bite. It doesn’t hurt and it doesn’t itch. You may get a flu or cold-like illness that goes away. It can manifest itself years later as chronic illnesses like joint pain, joint swelling, heart arrhythmia, heart block, acute mood changes, brain fog, concentration issues, or short-term memory issues.  Lyme manifests differently in each person.

08:47 Immune System Avoidance: It is a smart bug. There are 3 different forms of the bug that live in different parts of the cells and live in different kinds of cells. It morphs and adapts to each cell that it is in. The protect themselves. They can form cysts around themselves to hide from our immune system. They create biofilms, mucous-like substances to protect themselves from our immune system. They actively suppress the immune system. When you treat Lyme with antibiotics, it can utilize these and other strategies to avoid destruction.

10:13 Lyme Co-Infections: Lyme is lonely. It always brings its friends to the party. We often have one or two other bugs. Viruses can hitch hike as well. These bugs have their own sets of symptoms. They are similar to Lyme in that they cause a multitude of different symptoms. They can also hide for years.

11:19 Testing Flags: Patients with autoimmunity are big Red Flags. Also, people with illnesses that cannot be diagnosed. Cyclical symptoms may also be an indicator. Most of us do not know much about Lyme.

13:16 Testing for Lyme: The best test in the US is the Western Blot.  It looks at the immune system’s response to different proteins on the bug. Conventional labs only look at one strain, leaving out 5 different markers for the bug. Lyme specific labs are more effective, like IGeneX.  Clinicians need to know how to read the test and look at it objectively. The CDC has strict positive results standards. ILADS (International Lyme Associated Diseases Society) has different positive results standards.

14:33 Negative Labs: If you are really sick and your immune system is badly suppressed, your lab results may be negative. If these happens, Dr. Kelley will look at other immune system markers to see what the main system is doing. The CD57, the natural killer cell, will be suppressed in chronic Lyme disease. She also looks at a compliment level of C3a and C4a. In chronic Lyme, we typically see a high C4a and a low to normal C3a. If Dr. Kelley suspects Lyme, but the Western Blot is negative and the immune markers say that there is an issue, she may treat empirically. Once treatment starts and the immune system begins to rebuild, the Western Blot will be positive.

16:20 Improving Immune System Function: Herbs are antimicrobial and immune supportive. Cat’s claw supports CD57 and is anti-Lyme. Sometimes she prescribes antibiotics along with the herbs. Dr. Kelley works closely with an herbalist to make custom tinctures for her patients. Probiotics are one of the most important supplements, especially if you are on antibiotics. Most people with Lyme need probiotics and good yeast in high doses. Most people will need a good multivitamin, fish oil and vitamin D. Dr. Kelley uses interphase or nattokinase to break biofilm. Herbs and supplementation need to be tailored to the patient.

19:37 Biofilm Issues: Assume that everyone has a biofilm. If you are not getting the response you want from treatment with herbs or antibiotics, breaking into biofilm lets medicines get to the bugs.

20:32 Treatment of Acute Lyme: There is no protocol because everyone is different and unique. Doxycycline is the recommended antibiotic. Dr. Kelley recommends taking it for at least a month. Then transition to herbs for another month or more.

21:33 Treatment of Chronic Lyme: There is different treatment and different duration of treatment for everyone. Generally, you need at least 2 different antibiotics because there are different forms of the bugs.  Patients are on these antibiotics for a months, with a 3 month minimum. How long and how often you take the antibiotic depends upon how long you have been sick and how sick you are. To break up the cysts, Dr. Kelley recommends Tinidazole, a cousin to flatly/metronidazole. Most patients end up on nystatin, an antifungal. Yeast can be an issue when you are on antibiotics.

24:29 Yeast: Candida overgrowth can be caused by consuming too much sugar, having too much stress, or too many antibiotics, even from long ago. Symptoms can be gassy gut, bloating, especially after consuming sugar or carbs, skin rashes, jock itch, ring worm, toenail fungus, athlete’s foot or flaky scalp/dandruff. Also included is brain fog, concentration issues, and focus problems. Candida toxins can create issues in the brain. Check for candida prior to Lyme treatment. Lyme treatment kills the bacteria that keep candida in check. Saccharomyces boulardii is a beneficial yeast used for treatment.

27:30 Liver Support: Detox is important in Lyme treatment. As the bugs are being killed, the toxin load in your system increases.  Medicines also tax the liver. Liver testing should be done every month or so. Milk thistle and dandelion provide liver support. Saunas, hot baths with Epsom salts and other ways to detox are valuable.

28:46 Adrenal Support: Any kind of stress can affect the adrenals. They secrete 50 different hormones. They are meant to be on and off. When you have a chronic infection and/or have high stress, your adrenals are always on and can blow a fuse and exacerbate symptoms. Medications can be used, but Dr. Kelley prefers herbs. Adrenal cortex is ground adrenal gland to give your gland the building blocks it needs. Ashwaganda, eleuthero, and ginseng can be helpful. Phosphatidylserine can help calm adrenals at night. It also supports methylation and detox.

31:35 Maintenance Program: After taking antibiotics, patients take herbs. Symptoms can return if treatment is cut off too soon. Lastly, patients take standard supplements that address their issues. At the slightest indication of symptoms, go back on the herbs until you feel better.

33:08 Dr. Kelley’s Lifestyle Tip: Have fun and laugh. Let things out. This helps you manage stress and releases endorphins.


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Mike Mutzel: Dr. Casey Kelley, thank you so much for being on High Intensity Health Radio. Before we dive into Lyme and all your specialties, you’re treating here at WholeHealth Chicago, which is a wonderful integrative medical clinic, multidisciplinary. Let’s talk about your background. You come from a traditional medical path. What drove you into integrative medicine?

Dr. Casey Kelley: Well, I went to nutritional medical school at Ohio State and had some problems with it; I didn’t love it. The issue was we’re taught to diagnose people and then give them medicine, and when they got side effects from that, you give more medicine. And no one was asking why; no one was saying, “Why does have Joe have diabetes?” Maybe we should treat that, maybe we should look at his diet and see what he’s eating, maybe this is causing it. So I started to look at outside the box and see what else is out there. And then, I decided to go on family medicine because it seemed like the most general, like more holistic place to go in the Western realm. But even in that, I kept looking further and further and asking why. It wasn’t just good enough for me to give somebody insulin; I wanted to know why. So I started going to conferences and reading about it, and getting more and more involved, and joining organizations that are like-minded and becoming more active in those. So I just continued to do that along the way and knew that was my path. I always kind of figured that out along the way that Western medicine—that wasn’t my perfect niche. I need to do the integrative side of it.

Mike Mutzel: Sure, I hear that story a lot, where people—they’re going to medical school and they know this is not what they want to do and they just pursue it afterwards, or they have some sort of personal story where they have their illness and they become kind of just enchanted with nutritional medicine because it didn’t help resolve their underlying issues, or that a family member that got sick. That’s the pattern that I see. So you’re one where you knew initially that you didn’t want to go down that route. So you graduated from your family medical residency, you landed here at WholeHealth Chicago, and then went deep intro treating Lyme disease and complex chronic illness. So talk about what spur this interest in Lyme disease.

Dr. Casey Kelley: Sure. I ended up a little bit at WholeHealth Chicago serendipitously, and found quite great home here; it has a really unique practice. And I really started to love the patients that came in who had in 500 things wrong with them, they’ve been to 500 doctors and everything was normal, but they still didn’t feel well. And the other doctors just said, “Learn to live with the pain. Go see a psych.” They didn’t know what to do; they shrugged and kind of gave up. And those are my favorite—“Good, let’s dive into this. There is something there; let’s find out why—what’s going on.” Through that, too, started to kind of hear about Lyme in a lot of different conferences—“Hmm, I need to look into this more,” because you don’t learn about Lyme disease in medical school. I mean, I think I remember—you get a tick bite, you get a rash, you get two weeks of antibiotics, and you’re done—and that was it. There was no other education about it, except for that; it’s controversial so be careful. But you start to see all these patients, and I don’t give up easily. So I just keep digging and trying to find out why, so you start to pick up on these things when you go to conferences, you talk to other doctors, and you see one patient with it, then you look again and you see more and you keep seeing more people with it. You want to know how to treat it, you want to know how to deal with it, and you want to help people get better. That’s kind of how I ended up here.

Mike Mutzel: So let’s dive into common signs and symptoms and then let’s go through a workup. So like you mentioned that patient that had seen all these different doctors and they still don’t feel well. What do those people present to you with and where do we go from there?

Dr. Casey Kelley: I wish I had an easy answer for you, but I don’t. There are the acute cases—the random ones that you’ll see that have a rash, they’re—“We’re out hiking the week before,” and you’re—“Yes, perfect. We’ll put you on medicine; we’re going to treat this.” That one’s pretty easy, but that’s pretty rare. In most people, if they get a tick bite, they don’t even know that they got it because they’re so tiny. They don’t get a rash. Only about half or less of people actually get a rash from it. It doesn’t hurt; it doesn’t itch. So if it’s in your hair, you might not even notice that you have the rash. And then, maybe you get a little kind of flu like cold illness. You might think much out, but you think it’s just a little virus and it goes away, and so you don’t think so much about it. So it can kind of manifest itself years later with all this kind of chronic illnesses.

Typically, people will come in with pain—joint pain, joint swelling. It also really likes the heart so some people have arrhythmias or heart block, and it also really likes the brain so people will come in with acute mood changes, brain fog, concentration issues, and memory/short-term memory issues. But it can manifest itself. It’s a great imitator so it can manifest itself very differently in a lot of different people; no one is the same. But anybody that comes in with rheumatoid arthritis, multiple sclerosis, fibromyalgia, chronic fatigue, tachycardia, or these people that really don’t have a diagnosis but they just don’t feel well for a long time—you’ll dig into their history, find these things out; it’s always worth looking to see if that’s the cause of it because again, it’s that “why.” If we can’t figure out the “why,” I don’t need to give all these crazy meds for it; I can treat the “why” and get you better.

Mike Mutzel: Sure, so let’s dive into why these people with Lyme disease have so many different symptoms, like you talked about Lyme loves the brain; it loves the heart; we know it goes into the joint tissues. Let’s talk about the spirochete nature, and how is it able to like evade the immune system and get into all these different tissues

Dr. Casey Kelley: It’s a smart little bug.

Mike Mutzel: Yeah.

Dr. Casey Kelley: It’s a smart little bug. I think it’s one of the smartest that we know about there. It’s ability to adapt is insane; that’s so smart. And it has several different forms, first of all. There’s about three to five forms of the bug, and that lives in different parts of the cells and lives in different kinds of cells, and it morphs and adapts to each cell that it’s in. So Lyme bacteria that are in your joints are going to be a little different than the ones that are in your brain because those are different environments; they’re going to adapt to that environment. They protect themselves, they form cysts around themselves, they can hide out in the cell and kind of have the immune system ignore it, and they could hang out there for a long time until things are calm down, and then they can come back out. They create biofilms which are these mucousy sticky like substances to protect themselves from the immune system. But they also actively suppress the immune system, so if your immune system is trying to fight it—it knows it’s there and wants to get rid of it, but the immune system weakens the force so the immune system itself can’t fight it off. It’s a smart bug.

Mike Mutzel: Wow.

Dr. Casey Kelley: It’s a smart bug.

Mike Mutzel: So that’s called, I think, “antigenic shifting”—is that one of the ways?

Dr. Casey Kelley: Yup.

Mike Mutzel: And there’s a term, I can't remember exactly, but the bacteria can kind of shed its membrane and go inside the cell, invade itself.

Dr. Casey Kelley: Yup.

Mike Mutzel: So when you start to treat it with the antibiotics, then they can kind of move around and undergo these different personalities.

Dr. Casey Kelley: Yup.

Mike Mutzel: which makes it really complex. And then, to make an insult to injury, we have the Lyme coinfections, so you can have Borrelia burgdorferi, but have Bartonella, Babesia. So let’s talk about then the coinfections now, I suppose.

Dr. Casey Kelley: Yeah, coinfections—you know, I always tell people, “Lyme is lonely. It always brings its friends to the party.” So usually, someone has at least one, if not two, bugs hanging out. In this area in the Midwest, we typically have Anaplasma and Ehrlichia, Bartonella, Babesia. Those are the most common coinfections. But mycoplasma pneumoniae is another one that I see a lot. You can have lots of different viruses that come along. Chlamydia pneumoniae—it can also interact with candida; it’s not necessary that candida comes with it, but because of everything that’s going on, someone can have a candida overgrowth issue because of all of this. And all of these bugs cause different symptoms in it of themselves, but they’re similar to Lyme and they’re similar in the fact that they cause a multitude of different symptoms, and they can all just kind of smolder under the radar for years and cause these issues. The labs are great for it. So as the diagnostician, you have to kind of really look into that history and ask the questions and see what the symptoms are, and then try to fit it with the bugs that may be there.

Mike Mutzel: Interesting. So any symptoms—we talked about migrating some pains, there are logic disorders, heart issues—but any symptoms that really throw off that red flag, you’re like, “Alright, we need to dig deeper.”

Dr. Casey Kelley: Anything that kind of triggers, you need to test for it—some of the big autoimmune illnesses. If someone comes in with rheumatoid arthritis, multiple sclerosis, fibromyalgia—I’m just going to test them across the board because it’s so common. This cause these symptoms so commonly; it’s worth, at least, trying to rule that out, like, “Okay, that’s off the table.” But again, it’s these kind of people that come in with these chronic issues that no one can figure out, and it’s been going on for years. They can be cyclical in nature, so every month or so, the symptoms get worse; or without no rhyme or reason, they get better or worse. You have to start to think about that as an issue—these chronic infections underlying irritating the system causing the symptoms. They go undiagnosed; they find it in the radar and docs don’t look for it.

Mike Mutzel: Interesting. So do most of these people innately know that they have something really complex going on like Lyme? Do they come and ask you to be tested for it? Or they just think like, “Man, I’m a mess from maybe genetics or chemicals or whatever.”

Dr. Casey Kelley: Yeah, when I bring up Lyme, people get confused; they don’t know much about it. I think it’s still not really widely publicly known what it means to have Lyme and what Lyme, and how do you get it, and this kind of things. So I think they know that there’s something wrong; and even though doctors over years have been telling them, “You’re fine, you’re fine, nothing’s wrong with you. Your labs are normal,” they know that something’s wrong; they know something’s off. They just can't put their finger on it.

Mike Mutzel: So let’s talk about working the patient up. There are a few different labs. Which one do you recommend and how do you go about that?

Dr. Casey Kelley: The best Lyme test that we have here in the States right now, I think, is the Western Blot. The Western Blot is looking at the immune system’s response to different proteins on the bug—but you have to use the right lab. These regular conventional labs only look at the one strain and they leave out about five different markers for the bug, for a lots of political and vaccine issues and other things. I would still do that sometimes because of money issues, and sometimes that’s all it takes because if they’re enough positive on that, then it’s a positive. But the better labs are the Lyme-specific labs, like IGeneX, that do two strains, and then they look at all of the strains for the bug, but that’s out-of-pocket. There’s a little bit of money issues there, but that’s the best test that we have right now in the States. But you have to look at it, you have to know how to read it, you have to kind of look at it objectively in the whole picture because the CDC has very strict positive results for that; ILADS (International Lyme and Associated Disease Society) has different positive results for that. So generally speaking, I’ll start with one of those. If I could do the IGeneX one, then that’s where I prefer to start because that’s the better lab.

Mike Mutzel: Yeah.

Dr. Casey Kelley: That’s going to give us a better idea. The problem with these labs, though, is if you’re really sick and your immune system’s really suppressed, these labs may be negative even though you’re one of the sicker patients. So it’s part of the joys of figuring out Lyme disease.

Mike Mutzel: Wow. So since you just mentioned that, let’s dive into that. So I have MS, RA antibodies, ANA, something like that, depression, fatigue. My Lyme test comes back from IGeneX; the bands are all negative. Where do we go?

Dr. Casey Kelley: Where do we go? Well, there’s a couple of other tests that I’ll check, too, to look at the immune system markers, just to kind of see what the immune system’s doing because that can sometimes help, too. One of them is called the “CD57.” That’s a natural killer cell; it’s kind of a white blood cell. And generally, in chronic Lyme issues, it’s going to be suppressed; it’s going to be really low. And there’s another lab. It’s actually a comparison between two. These are complement levels—C3-A and C4-A. And generally, in chronic Lyme, you’re going to see a high C4-A and a low or normal C3-A. High C4, low C3. And so, if I’m suspicious of Lyme and their Western Blot’s negative but their immune markers are saying there’s something going on, then we might try and treat them. I’ll have the conversation with the patient, “Look, I think this maybe what’s going on. Nothing you’ve tried so far has helped. Do you want to try this route and see if we can get you better this way? We don’t have to do antibiotics, we can do some herbs, we can try some other treatments, then you can repeat that test later.” Usually, if they’re negative because their immune system’s so run down, once you start treating them and things start to replenish and rebuild, then you can retest it; it actually comes back positive.

Mike Mutzel: That’s really neat. I’ve heard of CD57, but didn’t know that you can test complement for Lyme.

Dr. Casey Kelley: Yeah.

Mike Mutzel: That’s really great. I think people are going to love that tip right there. So let’s talk about some of the herbs and botanicals. So we come back—we just talked about the patient that is not positive for Western Blot, but you know their immune system is suppressed. What are you doing there? You mentioned just like generally herbs and botanicals, but how are you getting their immune system to kind of wake up or get responses so that we’re trying to see these antigens from Lyme.

Dr. Casey Kelley: Well, we use herbs in combination with antibiotics a lot. But sometimes I’ll use them just by themselves especially in a really, really sick patient—really, really sick that I’m not sure if their body can handle the antibiotics, because the antibiotics are kind of like a cannibal; they’re pretty strong.

Mike Mutzel: Yeah.

Dr. Casey Kelley: Sometimes starting with herbs can be nice because herbs are antimicrobial, but they’re also really immune-supportive. So for example, like cat’s claw, actually supports CD57. So if they have a low CD57, the cat’s claw can help build that up; it’s also anti-Lyme. So you can certainly herbs in that sense, too, just to kind of, “Let’s try and kill the bugs and increase your immune system at the same time. See if we can get a response from that.” And I’m lucky enough to work here at WholeHealth Chicago an herbalist, Seanna Tully. So I get to learn a lot from her and talk to her, and there are different protocols, and different herbalists out there have a lot of different protocols out there in combination—different herbs that you can use. Drops, pills, the works.

Mike Mutzel: Nice. So what I hear you saying is you’re actually making your own custom tinctures for these people to not only build their immune system, but to help create antimicrobial herbs that will kill the bacteria.

Dr. Casey Kelley: Yeah, we can do that.

Mike Mutzel: Wow. So we have herbs—what about vitamins, minerals, dietary supplements—selenium, zinc, things like that?

Dr. Casey Kelley: Yeah, the basic stuff. In general, I think the most important thing supplement-wise when you’re in line was the probiotics, especially if they’re on antibiotics because you’ve got to protect the good. You know this. You’ve got to protect the microbiome; you’ve got to protect the good guys. So while you’re giving them herbs to kill the bacteria and giving them antibiotics to kills bacteria, or one or the other. You’re also going to kill the good bacteria, too. So you have to be really mindful of that. We have to first do no harm. So I think that’s the very most important thing that you do in really high doses. And some people also need good yeast and not just the good bacteria, so you have to kind of give both of those. And then, that’s the most important thing—hands down.

You also need to look at each patient individually and see what their needs are. Most people are going to need a good multivitamin, some fish oil, vitamin D, immune supporter one way or another, maybe some biofilm breaker uppers like Interface or nattokinase (things like that). There are a lot of different ways you can do, but you have to kind of tailor it to the patient. The problem with it is you end up giving them so many different supplements all at once; it’s hard to kind of tailored in because you’re trying so hard to protect their system while you’re kind of trying to kill the bugs. So you’re trying to kind of keep it limited and keep it to the ones that are most important, and then you add things on, like if there’s a lot of fatigue or dizziness maybe, we add elithro or adrenal cortex or things that are specific for the patient, but the basics-basics—probiotics. That’s the most important thing.

Mike Mutzel: So you hit on something that’s unique, and you talked about the biofilm busters. What are some signs and symptoms or clinical observations that might lead you to think if someone has some biofilms that are affecting treatment?

Dr. Casey Kelley: I think, in general, most people have a biofilm. We just kind of have to assume. Yes, the Lyme is smart; yes, the Lyme wants to protect itself; yes, you probably have a biofilm. But in some ways, if you think about it; if you’re not quite getting the response that you want from either herbs or antibiotics—what am I missing here? Using something that can break into that biofilm lets those medicines get to the bugs better so you have a better response. So it’s definitely something to look at if they’re not getting better, but I think just generally speaking, assume everybody has one and go on and treat it.

Mike Mutzel: Right. Awesome. Now you mentioned cannibals, talking about the antibiotics, which is a great visualization, gives people an idea. I know the CDC recommends if you do get a tick bite, I think it’s doxycycline, for three weeks or something, which you probably don’t think is enough. So let’s talk about acute treatment with antibiotics, and then let’s get into those patients where they’ve been flying under the radar and they’ve been sick for years. What’s your protocol?

Dr. Casey Kelley: So there’s no protocol. There’s no protocol because everyone is so different and unique, which makes it so challenging, but also makes it fun. So you kind of have ideas in your head that you kind of think of, but everyone’s so different; you have to really be flexible and able to adapt to everybody. But when you have an acute issue, if you’re not allergic, doxycycline is the recommended one, especially in this area because Anaplasma and Ehrlichia are so common with ticks, too, and those are treated very easily with the doxycycline. I would say the very least a month of antibiotics with an acute bite. Once they have a rash or response, you can check their Lyme Western Blot; if that’s positive, then you definitely want to give them at least a month. And then, I’ll probably transition herbs for another month or so, and just keep an eye on them and watch them, and make sure their symptoms are not evolving in any way, and then you’re probably okay, but they definitely need to be watched. If they’re not getting better, then you want to keep them on the antibiotics for longer; switch to a different one, or kind of reestablish, like what else may be happening. But if you’re lucky enough to catch it right away, chances are you can treat it with in the first month or so.

Dr. Casey Kelley: Chronic Lyme is a very different issue, and that requires a different duration of treatment for everybody. A different kind of treatment for everybody—that’s that; there’s no protocol. Generally speaking, you need at least two antibiotics if you’re going to give them antibiotics. And I do think that most people need antibiotics for at least a few months. Even if you start on herbs, you’re going to eventually probably going to need antibiotics at some point. It varies, but I would say the least I would probably put anybody will probably be three months.

Mike Mutzel: Oh, wow.

Dr. Casey Kelley: And that would be a very quick easy “I’m better” after three months, and then I’ll switch them to herbs and kind of transition them on. Most people need be on for a lot longer, but it varies. It depends on how long he’s been sick and how sick you are. So if you’ve had it for 15 years, chances are you’re going to be on it for a while—“So be used to it, we’re going to stick this out, kind of be on it for a while.” But you need to use at least two antibiotics because there are different forms of the bugs, and no one antibiotic treats all the forms of the bugs. So you have to use at least two, if not three different antibiotics.

Mike Mutzel: Wow.

Dr. Casey Kelley: And there are several ways to doing it. There are some medicines that we pulse so you take it just a couple of days a week. There are some medicines you take just Monday, Wednesday, Friday. Some doctors will do three weeks on, one week off; three weeks on, one week off. There is no right or wrong; it really is going to depend on the patient. Basic ones to start with—doxycycline—that’s a really common one. And tinidazole is another one that I use; that’s the cyst breast buster.

Mike Mutzel: Oh, I see.

Dr. Casey Kelley: That was the one that goes in and breaks up the cysts. But there’s also cefuroxime, clarithromycin; that combination works really well—plus tinidazole. Almost everybody ends up on a nystatin, too—just an antifungal. I mentioned that a little bit earlier that yeast can be an issue, especially when you’re on antibiotics. So you have to kind of watch that, make sure they’re getting their yeast under control.

Mike Mutzel: Right.

Dr. Casey Kelley: But there’s a good handful of medicine. Depends on what coinfection do you think may be there, too, then you kind of add things on or shift things around. If they’re not responding well enough, then you can change them to something else.

Mike Mutzel: Now I know why you like probiotics—makes a lot of sense now with all these different medications. So I’ve heard a lot about tinidazole. Do you want to talk about that?

Dr. Casey Kelley: Sure. Tinidazole is a medicine; it’s a cousin to Flagyl. A lot of people have heard of Flagyl (metronidazole) used for a lot, like traveler’s diarrhea, gastroenteritis, and that kind of stuff. So same kind of medicine, but what this does is get in, breaks up the cyst. So the cyst is that protective wall that these bugs can burrow and hide themselves in. That’s the medicine that will get in there and break that up. That’s usually the medicine where people feel the worst when they’re on it. So that’s one of the reasons why I only do it for a couple of days a week to try to give them a little bit of a relief. But that goes in there and breaks up the cysts, so it releases a lot more bugs in to the system.

Dr. Casey Kelley: That’s when you can use doxycycline or clarithromycin, cefuroxime, something else to kind of sweep the streets afterwards.

Mike Mutzel: Nice. So let’s talk about yeast. So we’re taking a lot of these antibiotics, maybe we’re creating a little bit of dysbiosis, we throw in the probiotic and you mentioned probiotic yeast (saccharomyces boulardii)—so let’s talk about saccharomyces boulardii, and then what are some other signs and symptoms because people may have yeast. I mean, sometimes I get a periodic rash that like appear, and I’m like, “Do I have candida?” And not to like throw this on one thing, but I think candida is not really as well-published or understood, at least in medical literature. If you type in symbiosis and SIBO and non-alcoholic fatty liver, you can find all these studies; you type in candida albicans, there’s not a whole lot there. So let’s talk about your experience with that, signs and symptoms, and what you do, and can I get rid of it?

Dr. Casey Kelley: Yeah, candida, in Western medicine thought, you’re not going to get it. I mean, there are a couple of things. One, when they get a yeast infection, and they get a day or two of Diflucan in the other way; or two, if they have something like HIV that really compromises their immune system and they can get really, really sick with the yeast infection. Yeast candida overgrowth is a different thing altogether, and that’s kind of in this integrative functional medicine world, you learn a lot of these things, and lots of different things can bring on a candida overgrowth—too much sugar, too much stress, too many antibiotics in your life even it was back in high school you took tetracycline for acne; that can kind of lead to the issue down the road, too. You’re going to have a gassy gut, a lot of bloating, uncomfortableness, maybe worse when they eat sugars or carbs.

They can have skin rashes, and they can be anywhere; they can be itchy, cannot be itchy, can be just a skin rash somewhere—jock itch, ringworm, toenail fungus, athlete’s foot, flaky scalp, dandruff (That can also be a candida issue.). But they also are going to have brain fog, concentration issues, focus problems; it’s all because candida toxins can create issues in the brain. So that’s one of the things that really have to watch for when you’re treating Lyme. One, you want to see—“Do they have this before I treat them for Lyme? Do I need to deal with this now?” Or if you’re giving antibiotics, you’re killing the bacteria, which usually keep the yeast in check. So all of a sudden, the candida don’t have these bacteria walk lording over them anymore and so then they can grow. So that’s when these symptoms can kind of come along.

That’s why most people on antibiotics long term end up on nystatin, as well, to keep that balance, and that’s why the good bacteria are important, and also the good yeast—probiotics and the saccharomyces boulardii. We really need to make sure that the good guys are winning in this fight, so you have to really load them up and be careful, and just watch for it and treat it when it comes along.

Mike Mutzel: Wow, very well said right there. As you’re talking, I was thinking about if we need to clear a lot of the stuff so then we need to look at the liver. So we know the liver’s so important in detox and stuff, so what do you do for the liver, I guess? Do we look at liver function test, liver enzymes, we track those? What are your favorite herbs and botanicals and nutrients that keep the liver firing so we can clear all this bad junk?

Dr. Casey Kelley: Yeah, the detox is really important in Lyme treatment. And as you’re killing the bugs, you’re increasing all the toxin load in your system. So you have to really work on clearing it out. You also have to note, too, that these medicines get filtered and changed in the liver, so there’s an extra strain in the liver when you’re giving people these medicines. You do have to check it on a pretty regular basis every month to make sure everything’s okay, and then rosily the liver’s doing well. If things are changing or shifting, then you need to stop the medicines, reestablish, and see what else is going on. But just detoxing in general is really important. If they are having liver issues, you can always give them milk thistle, dandelion—this kind of things to help with the liver itself. But there are other detoxes to choose—saunas, hot baths with Epsom salt. There are different ways to go about doing it, but that’s one of the very important things in the process, is to pay attention to the detox, pay attention to the body’s ability to clear things out. And if they’re struggling—if they seem like they’re struggling, they get worse on the medicine, they just don’t clear up, they don’t get better­—that could be a toxin overload. So giving them much more detox support can help those symptoms as well.

Mike Mutzel: Awesome. Another area that you focus on is the adrenals that you’ve lectured for the American Holistic Medical Association on this topic. So let’s talk about your favorites—whether it’s lifestyle tips or herbs, botanicals, nutrients to help support the adrenal function.

Dr. Casey Kelley: Yeah, the adrenals are so important. I call them the “governors” of your endocrine system. If they’re not working properly, no one’s working properly. Any kind of stress can affect those adrenals. They’re your stress center. These little wallet-sized guys that sit on your kidney, they secrete 50 different hormones that are really important, but their main job is stress, and they’re meant to be on and off: “A lion’s chasing you. Lion’s gone.”

But when you have a chronic infection, when you have high stress, and you’re an anxious person and you got all these going on, those adrenals just are on and are always on, and they can kind of blow off fuse, and that can just exacerbate all these symptoms of fatigue, brain fog, irritability, you’re running on fuse; you have nothing left to give. So it can be a very, very key point especially in treating Lyme disease or other chronic infections. You have to really pay attention. It’s like there system’s so depleted that they’re just really running out of fuse—and Chinese doctors will say they have no chi. You know, “What’s going on?” So you can use medications if it’s really bad; you can use Cortef, which is hydrocortisone, in physiological doses if you need to. But I prefer herbs; I’m trying to kind of give those adrenals the supplements and things that they need to run better on their own.

So you can use adrenal cortex which is just what its sound is like, it’s on the adrenal gland to give the gland the building blocks to do what it does. But there are lots of herbs; ashwagandha is a great one, elithro is another really good one, ginseng. There are different ways to approach it; some people really need that support in the morning, and other people, their adrenals don’t let go at nights. They really need to let go at night, so they need phosphatidylserine or other things that help calm them down at night, too. So these adrenals, it’s a balancing act for sure. But I think if you give them the support and you give them the ability walk, they bounce back.

Mike Mutzel: Now you mentioned phosphatidylserine, and I personally use that, but didn’t really notice anything. Are you seeing good results clinically with that?

Dr. Casey Kelley: Yeah, and you don’t have to be on it for very long. And usually, I only use it at night. There are people that use it during the day, too. But I’m usually trying to kind of burying down that night time cortisol to help people sleep. Usually within a month or two, they’ll see some changes, then you can stop; you don’t have to stay on it for very long. It’s one of those short-acting ones. You don’t have to stay on it for years and years.

Mike Mutzel: Right.

Dr. Casey Kelley: But you can always go back to it as well.

Mike Mutzel: Sure.

Dr. Casey Kelley: It also supports methylation so there’s bonus in that. It can help with detoxing things, so that’s a good one.

Mike Mutzel: So that’s a really good overview of the adrenals and different things. Now let’s talk about some maintenance for people that—you’ve put them on the antibiotics—the doxycycline, tinidazole—and it’s either autoimmunity is resolved, the energy is back, mental clarity is there. What’s your maintenance program look like?

Dr. Casey Kelley: Well typically, I’ll ride off the antibiotics and then I’ll put you on herbs, and then I would just continue. I want to push it further because if you stop it too soon, the symptoms can come back, so I’m going to push it a little further and then maybe even once or two because when they feel better, so they don’t want to keep taking things, but I'm—“No, no, no, one more month. We’re going to keep going a little bit.” So you use different herbs to kind of continue the process for a month to three months to kind of make sure everything is down. Watch their symptoms, make sure they’re not coming back, make sure they’re still getting better, and then you can really bring them down to just kind of a typical standard supplements depending on what are their issues that they may have.

Multivitamin, fish oil, vitamin D, probiotics, some just good basic stuff—and then you watch them, and they learn to watch themselves, and they can always go back to those herbal protocols if they need to if they start even if there’s just like an inkling, “I don’t know. I’m getting more tired.” Go back on the herbs for a little bit, feel better, go back off of them. You start to know yourself well enough, then you can preemptively do that so that you don’t give back down to a place for you so depleted that you don’t need the antibiotics again. So a lot of it, too, just the patient getting to know themselves and what their body’s telling them and listening to it, and doing something about it, and not just ignoring it.

Mike Mutzel: Really great information there, Dr. Kelley. Now one thing that we ask every guest in the show is if you can just pick one last tip, this can be related to Lyme or not—let’s say exercising five days a week, getting eight hours of sleep, meditating—what’s one tip that you wish all the patients that you saw really embraced and incorporated in their life?

Dr. Casey Kelley: Have fun. Laugh. We do not deal with stress well in this culture, and nobody is taught how to deal with stress at a young age, and one of the best ways is to laugh and let things out, and that’s on a daily basis. If you can have fun and smile and enjoy your life and let some that out, you’re going to feel better. You’re going to get endorphins; you’re going to feel good. It’s an easy way to try. It’s too hard for people to meditate for an hour a day; that’s too much. But given the laugh, they can buy into that; you can start with that; that’s a good place to start.

Mike Mutzel: I like it. Good idea. Yeah, we do take like too seriously sometimes, right? Awesome. So based upon what we talked about, you’re a Lyme expert. I’m really impressed with all the different testing—C4-A, C3-A, CD57. I’m sure a lot of our listeners would like to reach out to you. What’s the best way for our listeners to reach out to you and network with you?

Dr. Casey Kelley: Well, you can start by going to our website— You can email the front desk, they’ll get a hold of me through that way, and you can give us a call as well. Set something up if you want to make an appointment or just make a phone consult; that works, too.

Mike Mutzel: Right. And you have your personal Facebook page for business.

Dr. Casey Kelley: I do. Yes, Casey Kelley MD as a Facebook page.

Mike Mutzel: Awesome

Mike Mutzel: Thanks so much for being here.

Dr. Casey Kelley: Yeah, no problem, thanks for having me.



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