Biohacking

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

by Mike Mutzel

221 comments

 

Click here to listen on your mobile device in iTunes

 

Watch

 

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

www.wholehealthchicago.com

www.facebook.com/wholehealthchicago

wwww.twitter.com/wholehealthchi

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.

 

Related Podcasts

#11 Richard Horowitz, MD: Lyme disease expert reveals top treatment and prevention strategies

#31: Treating Lyme Disease and Co-Infections with Daniel Newman, MD

 

Transcription

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—www.wholehealthchicago.com. 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.

 

221 Comments

Join the conversation

  1. I’ve been exploring for a little bit for any high quality articles or
    blog posts on this kind of space . Exploring in Yahoo I
    finally stumbled upon this website. Studying this information So i am satisfied to express that I have a very just right
    uncanny feeling I discovered exactly what I needed.
    I so much undoubtedly will make certain to do not omit this
    site and provides it a look regularly.

  2. Thank you for some other magnificent article. Where else could anybody get that kind of information in such a perfect method of
    writing? I have a presentation subsequent week, and I’m at the search for such info.

  3. To help increase flip ultrahd’s results-oriented half-life, Trenbolone is not at
    all sold in an unrefined variety, it is preferably utilized as trenbolone acetate ,enanthate or Hexahydrobenzylcarbonate.
    you create decide to purchase oxandrolone pills beforehand and win can our appeared original medicated no person and expert be majority of normal
    steroid visitors detect this danger totally troublesome, and employ auxiliary drug treatments like Clomid®/Nolvadex® or HCG during
    a steroid never-ending loop with the intention to attempt and retain testicular process and volume during
    treatment plan. Athletes very often ignore this side
    effect, really during bulking methods any time the overload water supply in the
    muscle mass, bones and conjunctive tissue cells will help perk up the
    customer over-all sturdiness.

  4. Hello Web Admin, I noticed that your On-Page SEO is is missing a few factors, for one you do not use all three H tags in your post, also I notice that you are not using bold or italics properly in your SEO optimization. On-Page SEO means more now than ever since the new Google update: Panda. No longer are backlinks and simply pinging or sending out a RSS feed the key to getting Google PageRank or Alexa Rankings, You now NEED On-Page SEO. So what is good On-Page SEO?First your keyword must appear in the title.Then it must appear in the URL.You have to optimize your keyword and make sure that it has a nice keyword density of 3-5% in your article with relevant LSI (Latent Semantic Indexing). Then you should spread all H1,H2,H3 tags in your article.Your Keyword should appear in your first paragraph and in the last sentence of the page. You should have relevant usage of Bold and italics of your keyword.There should be one internal link to a page on your blog and you should have one image with an alt tag that has your keyword….wait there’s even more Now what if i told you there was a simple WordPress plugin that does all the On-Page SEO, and automatically for you? That’s right AUTOMATICALLY, just watch this 4minute video for more information at. Seo Plugin

  5. Hi there would you mind letting me know which hosting company you’re working with?
    I’ve loaded your blog in 3 different internet browsers and I must say
    this blog loads a lot faster then most. Can you recommend
    a good web hosting provider at a honest price? Thanks, I appreciate
    it!

  6. Interesting blog! Is your theme custom made or did you
    download it from somewhere? A design like yours with a few simple adjustements would really make my blog shine.
    Please let me know where you got your theme.
    Thank you

  7. You actually make it seem really easy along with your presentation however I in finding
    this topic to be really one thing which I think I might by no means understand.
    It seems too complex and extremely broad for me. I’m looking forward for your next submit, I
    will attempt to get the hang of it!

  8. Thanks for your personal marvelous posting! I seriously enjoyed reading it,
    you could be a great author. I will make certain to bookmark your
    blog and will come back someday. I want to encourage you to ultimately continue your great job, have a nice evening!

  9. Yesterday, while I was at work, my cousin stole my iphone and tested
    to see if it can survive a 30 foot drop, just so she
    can be a youtube sensation. My apple ipad is now broken and she has 83 views.
    I know this is completely off topic but I had to share it with someone!

  10. Yesterday, while I was at work, my sister stole my iphone and tested
    to see if it can survive a forty foot drop, just
    so she can be a youtube sensation. My iPad is now destroyed and she has 83
    views. I know this is completely off topic but I had
    to share it with someone!

  11. We are a group of volunteers and starting a new scheme in our community.
    Your site provided us with valuable information to work on. You have done a formidable job
    and our whole community will be thankful to you.

  12. Have you ever considered creating an ebook or guest authoring
    on other sites? I have a blog based upon on the same ideas you discuss
    and would love to have you share some stories/information. I know my audience would value your work.

    If you are even remotely interested, feel free to shoot me an e mail.

  13. With havin so much content and articles do you ever run into
    any problems of plagorism or copyright infringement?
    My blog has a lot of completely unique content I’ve either authored myself or outsourced but it appears a lot of it is popping it up all over the web
    without my permission. Do you know any solutions to help reduce content from being
    ripped off? I’d certainly appreciate it.

  14. Hi, I do believe this is an excellent web site.
    I stumbledupon it 😉 I may return once again since I saved as a
    favorite it. Money and freedom is the greatest way to change, may
    you be rich and continue to guide other people.

  15. We’re a group of volunteers and opening a new scheme in our
    community. Your web site provided us with valuable info to work on. You have done a formidable job and
    our whole community will be grateful to you.

  16. As a result of the 4K time period was already well known, tech companies cover their bases by utilizing the moniker 4K/extremely HD or 4K/UHD to
    check with the 3840 x 2160 format.

  17. I drop a leave a response when I especially enjoy a article
    on a site or I have something to valuable to contribute to the discussion. Usually
    it’s caused by the sincerness communicated in the post I read.
    And after this post Treatments for Lyme, Co-Infections, Biofilms and Candida w/ Dr.

    Casey Kelley. I was excited enough to post a comment
    🙂 I do have a few questions for you if it’s allright.
    Could it be just me or does it look like like a few
    of the remarks look like they are coming from brain dead people?
    😛 And, if you are writing at other online
    sites, I’d like to keep up with everything fresh you have to post.
    Could you list the complete urls of your shared pages
    like your twitter feed, Facebook page or linkedin profile?

  18. Hi there! Someone in my Facebook group shared
    this site with us so I came to check it out.

    I’m definitely loving the information. I’m book-marking and will
    be tweeting this to my followers! Wonderful blog and wonderful design and style.

  19. Please let me know if you’re looking for a author for your weblog.

    You have some really good articles and I think I would be
    a good asset. If you ever want to take some of the load off, I’d really like to write some content
    for your blog in exchange for a link back to mine.
    Please blast me an e-mail if interested. Thanks!

  20. Spot on with this write-up, I truly think this amazing site needs
    a great deal more attention. I’ll probably be returning to read more,
    thanks for the info!

  21. Thank you a bunch for sharing this with all people
    you really realize what you’re talking approximately!
    Bookmarked. Please also seek advice from my web site =).
    We will have a hyperlink exchange agreement among us

  22. Hey there! I’m at work surfing around your blog from my new iphone 4!
    Just wanted to say I love reading through your blog and look forward to all your posts!
    Carry on the superb work!

  23. Thanks for one’s marvelous posting! I certainly enjoyed reading it, you can be a great author.I will
    be sure to bookmark your blog and will come
    back later on. I want to encourage you to definitely continue your great
    work, have a nice holiday weekend!

  24. Thank you, I’ve just been searching for info about this subject for a while
    and yours is the greatest I have came upon so far. However,
    what in regards to the conclusion? Are you certain concerning the source?

  25. I do not even understand how I ended up here,
    but I assumed this submit was great. I don’t
    know who you might be but definitely you’re going to a famous blogger in the event you are not already.

    Cheers!

  26. Great blog! Is your theme custom made or did you download it from somewhere?
    A design like yours with a few simple tweeks would really make my blog
    jump out. Please let me know where you got your
    theme. Bless you

  27. A fascinating discussion is definitely worth comment.

    I believe that you ought to publish more on this subject matter, it
    may not be a taboo matter but typically people don’t discuss such
    topics. To the next! All the best!!

  28. What i do not realize is in reality how you are no longer actually much more well-liked than you might
    be now. You are so intelligent. You know thus significantly when it comes to this
    topic, produced me individually consider it from
    a lot of numerous angles. Its like men and women aren’t fascinated except it’s something to do with Girl gaga!
    Your individual stuffs excellent. At all times deal with
    it up!

  29. Howdy, I think your web site may be having internet browser compatibility issues.
    When I look at your website in Safari, it looks fine however, when opening in Internet Explorer, it has some overlapping issues.
    I merely wanted to provide you with a quick heads up!
    Apart from that, excellent website!

  30. Undeniably believe that which you said. Your favourite justification seemed to be at the net the simplest thing to understand of.
    I say to you, I definitely get irked at the same time as other folks
    think about issues that they plainly don’t recognise about.
    You controlled to hit the nail upon the highest as smartly as outlined out the whole thing with no need side effect
    , other folks can take a signal. Will likely be again to get more.
    Thanks

  31. Hi, I do think this is a great web site.
    I stumbledupon it 😉 I may revisit yet again since i have saved as a favorite
    it. Money and freedom is the greatest way to change, may you
    be rich and continue to help others.

  32. I almost never leave a response, however after browsing a few
    of the responses on this page Treatments for Lyme,
    Co-Infections, Biofilms and Candida w/ Dr.
    Casey Kelley. I do have a few questions for you if you do not mind.
    Could it be simply me or does it look as if like some of these comments look like they are left by brain dead visitors?
    😛 And, if you are writing at additional social sites, I’d like to keep up with you.
    Would you post a list of all of your social community sites
    like your linkedin profile, Facebook page or twitter feed?

  33. Write more, thats all I have to say. Literally, it seems as
    though you relied on the video to make your point. You
    clearly know what youre talking about, why throw away your intelligence on just posting videos to
    your blog when you could be giving us something enlightening to read?

  34. Thanks for another informative website. Where else may I get that kind of information written in such an ideal way?
    I’ve a project that I’m just now running on, and I’ve been on the glance
    out for such information.

  35. I do not know if it’s just me or if everyone else experiencing issues with your site.
    It appears as though some of the written text in your content are running off the screen. Can someone else please comment and let me know if this is happening to them too?
    This could be a issue with my web browser because I’ve had this happen previously.
    Thanks

  36. Its like you read my mind! You appear to know a lot about this, like you
    wrote the book in it or something. I think that you can do with a few
    pics to drive the message home a little bit,
    but other than that, this is wonderful blog.
    A fantastic read. I’ll definitely be back.

  37. I have been surfing online more than 3 hours as of late, but I never found any attention-grabbing article like yours.
    It is pretty worth enough for me. In my view, if all web owners and bloggers made
    just right content as you did, the internet can be much more useful than ever before.

  38. It’s the best time to make some plans for the future and it’s time to be happy.
    I’ve read this post and if I could I desire to suggest you few interesting things or advice.
    Perhaps you could write next articles referring to this article.
    I want to read more things about it!

  39. I don’t write a lot of responses, but I browsed some remarks on this page Treatments for Lyme, Co-Infections, Biofilms and Candida w/ Dr.

    Casey Kelley. I actually do have 2 questions for you if you do not mind.
    Is it simply me or does it give the impression like a
    few of these remarks look like they are written by brain dead folks?
    😛 And, if you are posting at additional sites, I’d like to follow anything fresh you have to post.
    Would you list of the complete urls of all
    your social networking sites like your Facebook page,
    twitter feed, or linkedin profile?

  40. I just like the valuable information you provide on your articles.
    I will bookmark your weblog and take a look at again right here frequently.
    I am quite certain I will be informed many new
    stuff proper right here! Best of luck for the next!

  41. Just want to say your article is as amazing. The clarity in your post is simply nice and i could assume you are an expert on this
    subject. Fine with your permission allow me to grab your RSS feed
    to keep updated with forthcoming post. Thanks a million and please continue the rewarding work.

  42. Woah! I’m really loving the template/theme
    of this site. It’s simple, yet effective. A lot of times it’s tough
    to get that “perfect balance” between usability and visual appeal.

    I must say you have done a fantastic job with this.

    Additionally, the blog loads very quick for me on Chrome.

    Exceptional Blog!

  43. Its like you read my mind! You seem to know so much about this, like you wrote the book in it or something.
    I think that you could do with a few pics to
    drive the message home a little bit, but other than that, this is magnificent
    blog. An excellent read. I’ll definitely be
    back.

  44. Excellent pieces. Keep writing such kind of info on your site.
    Im really impressed by your site.
    Hello there, You have done an incredible job. I’ll definitely digg it and personally recommend to my
    friends. I am sure they will be benefited from
    this website.

  45. Hey there! Quick question that’s entirely off topic. Do you know how to make
    your site mobile friendly? My site looks weird when browsing from my iphone.
    I’m trying to find a template or plugin that might be able to resolve this issue.
    If you have any suggestions, please share. Thank you!

  46. Definitely believe that that you said. Your favorite reason appeared to
    be on the net the easiest factor to remember of.
    I say to you, I definitely get irked even as other folks consider worries that they just do not understand about.
    You managed to hit the nail upon the highest and also defined out the entire thing without having side-effects , people could take a signal.
    Will probably be again to get more. Thank
    you

  47. Definitely imagine that that you said. Your favorite reason appeared to be at the web the easiest factor to be mindful of.

    I say to you, I definitely get irked while other folks think about concerns that they just do not know about.
    You controlled to hit the nail upon the highest as neatly as outlined out the entire
    thing with no need side effect , folks could take a signal.
    Will probably be again to get more. Thanks

  48. Hey this is somewhat of off topic but I was wondering if blogs
    use WYSIWYG editors or if you have to manually code with HTML.
    I’m starting a blog soon but have no coding expertise so I wanted
    to get guidance from someone with experience. Any help would be greatly appreciated!

  49. whoah this blog is great i really like reading your articles.
    Keep up the good work! You recognize, many people are
    hunting around for this info, you could help them greatly.

  50. I really like your blog.. very nice colors & theme.
    Did you make this website yourself or did you
    hire someone to do it for you? Plz answer back as I’m looking to design my own blog and would like to know where u got this from.
    thanks a lot

  51. Ten days after James Farrell primary Internet foray,
    he was the proud owner of four handsome, crisp,
    well stitched white shirts, accuracy tailored to his proportions.
    The brand speaks not only to the young but to the young at heart.
    Work with a piece of pressboard to make a great collar for your back of the dress.
    Lehengas as a part of the modern bride’s wedding trousseau
    has emerged to be more stylish and fashionable.
    Continued gender non-conformity can sometimes lead to gender dysphoria which is more
    serious. s the gradation of color that is the most important thing to consider.

    The white cuff contrasts with the shirt and then you can contrast the cuff by choosing a cufflink that is the color of the stripe or plaid.

  52. Hello there, I found your web site by means of Google even as
    looking for a related matter, your website came up, it appears to
    be like great. I’ve bookmarked it in my google bookmarks.

    Hi there, just changed into alert to your weblog via Google, and located
    that it’s truly informative. I am gonna be careful for brussels.
    I’ll be grateful in the event you continue this in future.
    A lot of folks might be benefited from your writing.
    Cheers!

  53. My spouse and I absolutely love your blog and find
    a lot of your post’s to be precisely what I’m looking for.

    can you offer guest writers to write content to suit your
    needs? I wouldn’t mind creating a post or elaborating
    on some of the subjects you write about here. Again, awesome blog!

  54. I’m truly enjoying the design and layout of your site. It’s a very easy on the eyes which makes
    it much more pleasant for me to come here and visit more often. Did you
    hire out a developer to create your theme? Excellent work!

  55. Do you have a spam issue on this website; I also am a blogger, and I was
    wanting to know your situation; many of us have created some
    nice procedures and we are looking to swap methods with other folks, be sure to shoot me an email if interested.

  56. What i don’t understood is if truth be told how you’re no
    longer really a lot more well-preferred than you might be now.
    You’re so intelligent. You already know thus significantly on the
    subject of this matter, made me individually believe it from so many numerous angles.

    Its like men and women don’t seem to be fascinated unless
    it is one thing to accomplish with Girl gaga!
    Your own stuffs outstanding. All the time take care of it up!

  57. I do agree with all of the ideas you have introduced
    in your post. They are very convincing and will certainly work.
    Nonetheless, the posts are very short for novices. May just you please prolong them
    a little from subsequent time? Thanks for the post.

  58. We are a group of volunteers and starting a new scheme in our
    community. Your website offered us with valuable information to
    work on. You’ve done an impressive job and our entire community will be thankful to
    you.

  59. With havin so much content do you ever run into any problems
    of plagorism or copyright infringement? My blog has a lot of
    exclusive content I’ve either written myself or outsourced but
    it seems a lot of it is popping it up all over the web without my authorization.
    Do you know any methods to help reduce content from being stolen?
    I’d really appreciate it.

  60. I blog frequently and I truly appreciate your
    content. This article has really peaked my interest. I’m going
    to take a note of your blog and keep checking for
    new details about once a week. I subscribed to your RSS feed as well.

  61. Hello there! This is my first visit to your blog! We are a collecxtion of volunteers
    and starting a new initiative in a community in the same
    niche. Your blog provided uus valuable information tto work on.
    You have done a outstanding job!

  62. Many young people are suffering from poor eating habits,
    these days. These can develop muscle strength as well
    as hand-eye coordination. Vicky is a shy and small kid who wants to impress his father who is a
    strong Viking chief.

  63. Hello! This is my first comment here so I just wanted to
    give a quick shout out and say I really enjoy reading your
    posts. Can you suggest any other blogs/websites/forums that cover the same subjects?
    Thanks a ton!

  64. This isn t legal advice if you are much more natural and spontaneous.
    It legal profession is not, making it a problem for you.

    There are some injuries that could be concluded personal use.
    In this way they try to have proper knowledge about the disadvantages of marriage, and to President Karzai.

  65. – Diego Armando Maradona – He won the world cup in 1986 and became most popular for his two
    goals against England in the quarter finals.
    Livefootballol: Free Live Football Streaming and Highlights watch free live football streaming, live football from EPL, Serie A,
    Bundesliga, La Liga on. Grier was announced to be suspended for the season as of Monday due to testing
    positive for performance-enhancing drugs.

  66. Definitely believe that which you said. Your favorite justification seemed to be on the web the easiest thing to be aware of.

    I say to you, I definitely get annoyed while people think
    about worries that they plainly do not know about.
    You managed to hit the nail upon the top and also defined out the whole thing without having side effect , people could take a signal.
    Will likely be back to get more. Thanks

  67. Importance oof getrting a ell written, profesional loking
    resume: Companirs don’t intyerview evesry applicant foor that job.
    In oder too have a powerfdul proposal, assembliung your projec
    narrativve musst include detailrd annd easy-to-read facts.

    Butt thhe evidence iss clpear that most inn thee inncome wirh thee ttop MLM mney iss noww online, wrioting articlees andd markeing oof agtraction practice.

  68. An impressive share! I’ve just forwarded this onto a friend who was doing
    a little research on this. And he in fact ordered me
    breakfast due to the fact that I discovered it for him…
    lol. So allow me to reword this…. Thank YOU for the meal!!
    But yeah, thanx for spending some time to discuss this issue here
    on your internet site.

  69. hello!,I really like your writing very so much!
    percentage we be in contact more approximately your article on AOL?
    I need a specialist on this house to unravel my problem.

    Maybe that is you! Taking a look forward to see you.

  70. – Diego Armando Maradona – He won the world cup
    in 1986 and became most popular for his two goals against England in the quarter finals.
    Manchester United v Newcastle United: match preview. Football matches when seen live on watch live TV online seem fantastic.

  71. Woah! I’m really enjoying the template/theme
    of this blog. It’s simple, yet effective. A lot of times it’s tough to get that “perfect balance” between superb usability and visual appearance.

    I must say you’ve done a superb job with this. Also, the blog
    loads super fast for me on Chrome. Superb Blog!

  72. Right here is the right webpage for everyone who hopes to find out about this topic.
    You understand a whole lot its almost hard to argue with you (not that I personally will
    need to…HaHa). You definitely put a fresh spin on a topic that’s been discussed
    for decades. Great stuff, just excellent!

Leave a Reply