Raj Patel, MD

1. Raj Patel, MD Education: MS-Rutgers University MD – Robert Wood Johnson Medical School Residency-Family Medicine Post Graduate studies in Autism Spectrum Disorders & Lyme Disease Research: Ampligen-CFIDS (Hemispherx Pharmaceutical) Clinical: 18+ years clinical experience Active member of Defeat Autism Now (DAN) Active member of International Lyme and Associated Diseases Society (ILADS) Active member of California Lyme Disease Association (CALDA) Raj Patel, MD Medical Options for Wellness 5050 El Camino Real, #110 Los Altos, CA 94022 650-964-6700 www.DrRajPatel.net Raj Patel, MD

2. Lyme Disease Overview Fastest growing vector borne infection CDC estimated 24,000 cases in 2002 with the CDC itself admitting reported cases represent less than 10% of all cases. Tick bites frequently transmit multiple infections: Borrelia Ehrlichia/Anaplasma Babesia and other piroplasms Bartonella like organisms Raj Patel, M.D.

3. Reported Cases of Lyme Disease, United States, 1995-2009 National Surveillance case definition revised in 2008 to include probable cases; details at http://www.cdc.gov/ncphi/disss/nndss/casedef/lyme_disease_2008.htm Raj Patel, M.D.

4. Vector Life Cycle www.cdc.gov/ncidod/dvbid/lyme/ld_transmission.htm Raj Patel, M.D.

5. Raj Patel, M.D.

6. Lyme Disease Lyme Disease Symptoms Symptom presentation typically mixed depending on mix of infections present Classic Symptoms Associated with Borrelia Starts gradually with flu-like symptoms Multi system involvement when disseminated Migratory arthralgias that evolve into arthritis Occipital headaches with neck stiffness Fatigue Four week cycle of symptom flare-ups EM rash (bulls-eye) Raj Patel, M.D.

7. Lyme Disease Classic Symptoms Associated with Babesia Rapid onset of symptoms (cyclic high fevers, severe headaches, & sweats esp. at night) Air hunger Dull global headaches Prominent fatigue with exercise intolerance Symptoms cycle every 4-7 days Hypercoagulable states Raj Patel, M.D.

8. Lyme Disease Classic Symptoms Associated with Bartonella like organisms CNS symptoms prominent (anxiety, agitation, insommnia, seizures, outbursts and anti-social behavior) Lymphadenopathy Soles tender esp. in morning Striae (hyperpigmented stretch marks) Elevated VEGF (vascular endothelial growth factor) useful marker to follow response to treatment. Raj Patel, M.D.

9. Ticks: Year round threat with Spring and Summer being prime time Carried by deer as well as other animals to your yard Mice become carriers when infected ticks feed on them. Subsequently, when non-infected ticks feed they become infected Found in cool moist areas, around shrubs and woody areas, tall grass, and around the edge of yards Ticks prefer moist skin folds: Back of neck Inside part of elbows and knees Hairlines In and around ears Protecting Yourself Raj Patel, M.D.

10. Minimize Exposure: Yard Prevention Yard prevention very important Keep lawn mowed, cut down brushy areas, & clear away leaves Trim trees to ensure adequate sunshine Creating a 3 ft. wide wood chip or gravel border and stone wall can reduce ticks by 50% Hiking Precautions Walk in middle of trails Wear light colored clothing Wear gloves, hat, long sleeves Use Deet type repellent on exposed skin Use Permethrin tick repellent on clothing Check yourself thoroughly afterwards After possible exposure take clothing and place in dryer at high heat for 15 minutes to kill ticks left behind Protecting Yourself Raj Patel, M.D.

11. Keep your pets protected: Particularly susceptible, frequently bringing deer ticks into your house Use Frontline or K9 Advantix monthly for cats and dog Use Damminix tubes to reduce deer ticks by more than 90% (tubes filled with cottton treated with Permethrin) Protecting Yourself Raj Patel, M.D.

12. What To Do If You Get A Tick Bite • See a doctor immediately. The sooner treatment is started the better the results. • Go to www.lymediseaseassociation.org for a list of lyme literate MDs (LLMD). Otherwise, take a copy of the ILADS treatment guidelines with you for your doctor http://www.ilads.org/files/ILADS_Guidelines.pdf • Save the tick. Laboratories can test the tick for the presence of lyme and associated coinfections. • If a rash develops take photographs. It may help your doctor in the diagnosis. • Laboratories vary in terms of the depth of lyme testing provided. Dr. Patel prefers to use the following: • Igenex www.Igenex.com • 1-800-832-3200 • Stony Brook Laboratory www.path.sunysb.edu/labsvs/tickpics/TICKpic.htm • 1-631-444-3824 • Clongen Laboratories www.Clongen.com • 1-301-916-0173 Raj Patel, M.D.

13. Testing and Treatment After Tick Bite • Testing • PCR (blood and Serum) for Lyme, Ehrlichia, Bartonella, Babesia, Mycoplasma • FISH for Babesia and Bartonella • Western-Blot not useful. Take 2-6 weeks to turn positive • Treatment: IDSA: Rx within 72 hours with Doxycycline 200 mg (4mg/kg) one time dose if age >8 years. No treatment recommended for < 8 years unless symptoms warrant it. ILADS: No specific Rx. Use clinical judgement based on geographical location, type of tick, if engorged, and method of removal. Burrascano Guidelines: Treat 28 days regardless of age. Note: Make sure to treat for coinfections if the tick tests positive. Raj Patel, M.D.

14. Lyme Western Blot Testing Raj Patel, M.D. Grier, T. Laboratory Tests. Lyme Times. Summer 2004:21-25

15. ILADS (International Lyme and Associated Diseases Society) www.ilads.org Turn The Corner www.turnthecorner.org CALDA (California Lyme Disease Association) www.lymedisease.org “Coping with Lyme Disease, A Practical Guide to Dealing with Diagnosis and Treatment” by Denise Lang and Kenneth Liegner, MD “Prevention Tips” LymeTimes. Summer 2004, p.5-8. Other Useful Websites/Articles www.tickencounter.org www.ilads.org/lyme_disease/B_guidelines_12_17_08.pdf www.healthypets.com/ticks.html www.igenx.com www.drrajpatel.net/pages/lyme.php www.drrajpatel.net/pages/lyme/lyme-support-group.php Useful Resources Raj Patel, M.D.