LIVE from ILADS: Tick Boot Camp welcomes back Dr. Cory Tichauer, ND, owner and lead physician of Bear Creek Naturopathic Clinic in Medford, Oregon, and a member of the ILADS Board of Directors.

After years of treating Lyme disease and other complex chronic illnesses, Dr. Tichauer has become increasingly interested in a particularly difficult group of patients:

The people who do many of the "right" things but still don't fully recover.

Dr. Tichauer describes them as his "20%."

While he says the majority of his chronic Lyme patients can achieve substantial improvement through individualized combinations of conventional and integrative treatments, another group remains stuck despite working with knowledgeable practitioners and trying numerous therapies.

Why?

Dr. Tichauer believes some answers may lie at the intersection of persistent infection, immune dysfunction, chronic inflammation, mitochondrial dysfunction, and the cell danger response.

The conversation also explores his research into a 12-week high-dose IV vitamin C protocol for Lyme disease, including the improvements he reports in quality-of-life measurements, Horowitz MSIDS scores, CD57 levels, and other immune markers.

This interview was recorded live at the ILADS conference, so you may hear some of the energy and background activity of the event throughout the conversation.

Who Are the "20%" of Lyme Patients Who Remain Sick?

After more than 15 years focused on chronic Lyme disease, Dr. Tichauer says his attention has increasingly shifted toward patients who don't respond as expected.

He describes a broad spectrum.

Some patients respond well to relatively straightforward treatment.

Others require additional therapies and considerably more detective work.

But then there is a group that may improve somewhat yet never regain the level of function they hoped for.

Those are the patients Dr. Tichauer can't stop thinking about.

Some have already seen five, six, ten, or even twelve doctors — including experienced Lyme-literate clinicians — before reaching his practice.

Rather than assuming everyone before him got it wrong, he asks:

What are we missing?

Lyme Treatment Is Rarely One Thing

For the patients who do respond well, Dr. Tichauer describes drawing from a large therapeutic toolbox.

Depending on the individual, his approach may include:

• Oral antibiotics
• IV antibiotics
• Off-label medications
• Herbal medicine
• Biofilm strategies
• Immune support
• Peptides
• Mitochondrial support
• Nervous-system approaches
• Other integrative therapies

The challenge is that there are countless possible combinations.

That makes complex Lyme disease less like following one treatment recipe and more like finding the appropriate combination for the individual patient.

Dr. Tichauer says that approach has allowed him to help many patients substantially improve.

But it doesn't explain everyone.

When Doing More Isn't the Answer

One of the strongest messages in this episode is especially important for people who have spent years cycling through increasingly aggressive treatments:

More isn't automatically better.

If a patient has already worked with knowledgeable doctors and repeatedly tried reasonable approaches without recovering, Dr. Tichauer says it would be arrogant to assume that simply doing the same thing harder will produce a different result.

That realization has pushed him toward studying the underlying biology of his most difficult cases.

Among the patterns capturing his attention are:

• Immune dysfunction
• Mitochondrial dysfunction
• MCAS
• Hypermobility
• Chronic inflammation
• Cellular dysfunction
• Persistent infection
• Cell danger response

Instead of simply asking what else can kill a pathogen, he is increasingly asking what prevents the patient's system from returning to normal function.

Persistent Infection vs. Persistent Immune Dysfunction

Dr. Tichauer pushes back against treating persistent infection and post-infectious dysfunction as necessarily competing explanations.

They may coexist.

He discusses the possibility that some organisms may persist at levels below a threshold that produces direct tissue damage while the immune system remains activated.

In other words, eliminating every last organism may not always be the only meaningful goal.

The clinical objective may sometimes be achieving remission — reducing microbial activity while helping the immune system regain appropriate tolerance and regulation.

Tick Boot Camp has explored the science and debate surrounding persistence in many conversations. Learn more on our Lyme disease persistence resource page.

"Getting the Genie Back in the Bottle"

The interview develops a useful metaphor.

Rather than assuming the body must become completely sterile of every potentially problematic microorganism, Dr. Tichauer discusses restoring a healthy relationship between microbes and the immune system.

Our bodies already coexist with enormous numbers of microorganisms.

The immune system must constantly determine what requires attack, what can be tolerated, and where organisms can exist without creating disease.

Dr. Tichauer describes the goal as getting the genie back in the bottle.

The pathogen burden matters.

But so does the immune response to it.

Immune Tolerance & Chronic Inflammation

Dr. Tichauer is particularly interested in immune tolerance.

A healthy immune system needs enough activity to protect us from infection without remaining chronically activated when that response is no longer helpful.

He discusses several interventions he uses or studies in the context of immune regulation, including:

• Low-dose naltrexone
• Vitamin D
• Herbal medicine
• Peptides

Dr. Tichauer has lectured extensively on low-dose naltrexone and Lyme disease, including its potential role in modulating inflammatory pathways in chronic and post-treatment illness.

The broader goal isn't simply stimulating or suppressing the immune system.

It is helping restore appropriate immune regulation.

Vitamin D Is More Complicated Than a Number on a Lab Report

The discussion of immune function leads into vitamin D.

Most patients are familiar with having 25-hydroxy vitamin D measured during routine bloodwork.

Dr. Tichauer explains that vitamin D metabolism is more complicated than that single measurement.

He discusses active and inactive forms of vitamin D and his interest in how infections may potentially interfere with vitamin D metabolism.

He has become particularly interested in calcitriol, the active hormonal form of vitamin D, and discusses its potential influence on macrophages, immune polarization, and inflammatory signaling.

These are advanced clinical concepts, and prescription calcitriol requires appropriate medical supervision because altering active vitamin D metabolism can carry significant risks.

The Cell Danger Response

Another concept connecting Dr. Tichauer's difficult cases is the cell danger response.

In simplified terms, cells exposed to infection, toxins, oxidative stress, or other threats can shift their metabolism toward defense and survival.

That response is useful when danger is acute.

The problem may arise when the system fails to return to normal.

Dr. Tichauer describes patients whose cells appear to remain metabolically impaired, with reduced energy production and mitochondrial dysfunction.

For someone experiencing profound fatigue, cognitive dysfunction, exercise intolerance, and other persistent symptoms, this creates another possible piece of the puzzle beyond simply measuring whether an infection is present.

Mitochondria & the Patients Who Stay Sick

Mitochondria produce the energy required for cells to function.

Dr. Tichauer sees mitochondrial dysfunction as one potential common denominator among some of his hardest-to-treat patients.

This connects directly with the cellular-health conversations Tick Boot Camp had at ILADS with Dr. Melanie Stein and Dr. Vy Simeles.

The question becomes:

Even if microbial burden is reduced, can a patient fully recover if cellular energy production and immune regulation remain severely impaired?

For Dr. Tichauer, helping restore mitochondrial and cellular function may be an important part of moving some patients from illness toward remission.

Rethinking Antibiotic Treatment

Dr. Tichauer still uses antibiotics.

But his thinking about how to use them has evolved.

Rather than relying exclusively on prolonged courses, he discusses circumstances in which he may use IV antibiotics more intensively for a shorter period, followed by pulsing, herbal therapies, mitochondrial repair, or other individualized strategies.

He also mentions daptomycin in the context of approaches intended to address persister forms.

His objective is not simply more antimicrobial treatment.

It is finding a strategy that appropriately addresses infection while limiting unnecessary collateral effects and supporting the patient's overall physiology.

High-Dose IV Vitamin C & Lyme Disease Research

One of the most significant parts of this interview involves Dr. Tichauer's research into high-dose intravenous vitamin C in Lyme disease.

At ILADS, he discusses a research project examining a protocol involving high-dose IV vitamin C.

The study initially needed to establish safety and tolerability, but Dr. Tichauer says the research team was also able to collect exploratory clinical and laboratory measurements.

The protocol involved:

12 weeks of treatment, 24 infusions, and 75 grams of IV vitamin C per treatment.

The protocol also incorporated DMSO and calcium EDTA.

Dr. Tichauer explains the rationale for these additions in terms of tissue penetration and biofilm-related strategies.

Why Add DMSO & EDTA?

Dr. Tichauer discusses DMSO as a compound used in the protocol with the intention of increasing membrane permeability and potentially helping vitamin C reach tissues where Borrelia may be difficult to target.

He also describes adding calcium EDTA based partly on earlier laboratory research examining potential approaches to Borrelia biofilms.

The resulting protocol attempted to address several potential barriers simultaneously:

• Microbial burden
• Intracellular infection
• Tissue penetration
• Biofilms
• Oxidative mechanisms
• Cellular dysfunction

Importantly, the findings discussed in this episode should be viewed as early research, not evidence that this protocol is an established treatment or appropriate for every Lyme disease patient.

What Did the Study Find?

Dr. Tichauer describes the results as exciting.

First, he says the study demonstrated the required safety and tolerability endpoint, with reported adverse events generally limited to issues such as headache and nausea.

He then describes improvements in several exploratory outcomes.

According to Dr. Tichauer, over the 12-week study researchers observed approximately 20–30% improvements across measures involving:

• Sleep
• Pain
• Fatigue
• Pain interference
• Anxiety
• Depression

He reports that fatigue continued improving during the 12 weeks after treatment ended.

Dr. Tichauer also says participants' Horowitz MSIDS questionnaire scores dropped by approximately 25 points during treatment and another 11 points during the post-treatment period.

These findings are intriguing, but they should be interpreted within the design and limitations of the study rather than assumed to establish efficacy for high-dose IV vitamin C in Lyme disease.

CD57 & Immune Markers

Dr. Tichauer also reports changes in laboratory markers.

He says CD57 lymphocyte measurements increased approximately 50% during the 12-week treatment period, followed by an additional increase during the post-treatment period.

He also discusses changes in interferon-gamma-related testing.

Perhaps most interesting to him was what happened after treatment stopped.

Participants weren't continuing the study intervention during the follow-up period, yet some measures continued moving in a favorable direction.

Dr. Tichauer says some participants remained in remission at the time of this interview.

Again, these are results as described by Dr. Tichauer during the interview and should not be interpreted as proof that the protocol will produce the same outcome for other patients.

Could This Help Explain the "20%"?

The episode then comes full circle.

Why might this research matter for the difficult patients discussed at the beginning?

Dr. Tichauer believes the answer could involve simultaneously addressing infection and cellular dysfunction.

In his model, intracellular organisms may interfere with normal cellular function while also helping perpetuate a danger response.

If treatment can reduce that intracellular burden while other interventions support mitochondrial repair, autophagy, mitophagy, and immune regulation, perhaps some patients can move out of the chronic defensive state that has kept them sick.

That hypothesis is helping shape where he wants to take his research and clinical work next.

Senolytics, Autophagy & Emerging Therapies

Dr. Tichauer briefly introduces several additional areas he is investigating, including:

• Senolytic therapies
• Autophagy
• Mitophagy
• Rapamycin
• KPV
• MSH
• Fisetin
• Urolithin A
• Spermidine

Each could easily become its own interview.

In fact, Dr. Tichauer says he has accumulated considerable clinical data involving rapamycin, setting up an obvious topic for a future Tick Boot Camp long-form conversation.

Individualized Medicine Remains Essential

Despite discussing new therapies and promising research, Dr. Tichauer repeatedly returns to individualization.

There isn't one Lyme protocol.

There isn't one explanation for every persistent symptom.

And there isn't one treatment that will move every person into remission.

That is especially true for the difficult cases that now fascinate him most.

The goal is to identify patterns without losing sight of the individual person.

Serving on the ILADS Board

The conversation closes on Dr. Tichauer's service with the International Lyme and Associated Diseases Society.

He describes attending his first ILADS conference years ago as a naturopathic doctor entering a medical community that wasn't always as integrated as it is today.

Now he serves on the organization's Board of Directors.

ILADS currently identifies Dr. Tichauer as an integrative clinician with more than 20 years of practice focused on tick-borne diseases, neurodegenerative conditions, environmental medicine, and autoimmune illness.

For him, serving on the board represents an opportunity to give back, mentor newer clinicians, and help bridge conventional and integrative approaches to complex illness.

His message is collaboration:

The whole is greater than the sum of its parts.

About Dr. Cory Tichauer

Cory Tichauer, ND is the owner and lead physician at Bear Creek Naturopathic Clinic in Medford, Oregon.

His clinical work focuses on chronic complex illness at the intersection of Lyme disease and tick-borne infections, environmental illness, immune dysfunction, neurodegenerative conditions, MCAS, hypermobility/Ehlers-Danlos syndrome, and functional gastroenterology.

Dr. Tichauer has been involved with ILADS for more than a decade and currently serves on its Board of Directors.

He lectures on tick-borne illness, immune dysfunction, low-dose naltrexone, peptide therapies, environmental medicine, and other aspects of complex chronic disease.

Key Topics in This Episode

Chronic Lyme disease, persistent Lyme disease, Dr. Cory Tichauer, Lyme disease treatment, treatment-resistant Lyme disease, Lyme disease research, high-dose IV vitamin C, intravenous vitamin C, IV vitamin C Lyme disease, CD57, Horowitz MSIDS questionnaire, immune dysfunction, mitochondrial dysfunction, cell danger response, persistent infection, PTLDS, immune tolerance, chronic inflammation, low-dose naltrexone, LDN, vitamin D, calcitriol, Lyme disease biofilms, EDTA, DMSO, daptomycin, persister cells, peptides, senolytics, autophagy, mitophagy, rapamycin, KPV, urolithin A, spermidine, remission, ILADS, and integrative Lyme disease treatment.

About This LIVE from ILADS Interview

This short-form conversation was recorded in person at the 2025 International Lyme and Associated Diseases Society Annual Scientific Conference, From Terrain to Treatment: Advances in Vector-Borne Illness, held October 9–12, 2025, in San Antonio, Texas.

Because these interviews were recorded live at the conference, they have a different feel from Tick Boot Camp's traditional long-form virtual and studio conversations — shorter, focused, and surrounded by the energy and background activity of ILADS.

Explore all Tick Boot Camp LIVE from ILADS interviews.

More from Tick Boot Camp

Learn more about the science and debate surrounding Lyme disease persistence.

Hear more conversations with Lyme disease doctors and healthcare professionals about testing, treatment, persistent illness, and recovery.

Explore the Tick Boot Camp Podcast for patient stories and conversations with doctors, researchers, advocates, and other voices working to improve understanding of Lyme disease and tick-borne illness.

LIVE from ILADS: Tick Boot Camp sits down with Dr. Vy Simeles, ND, LAc of Restorative Health Clinic to explore one of the most difficult situations in chronic Lyme disease care:

What do you do when a patient becomes so sensitive that nearly everything intended to help seems to make them feel worse?

Dr. Simeles works with complex chronic illness patients, including people experiencing Lyme disease, mold illness, MCAS, nervous-system dysregulation, mitochondrial dysfunction, and significant environmental or treatment sensitivities.

In this short-form conference interview, she explains why her practice has been increasingly focused on cell membrane therapy and lipid replacement therapy as a foundational strategy for highly sensitive patients. The conversation explores phospholipids, omega-3s, plasmalogens, mitochondria, ATP production, the cell danger response, neuroinflammation, diet, SOT, and the relationship between cellular health and a patient's ability to tolerate treatment.

This interview was recorded live at the ILADS conference, so you may hear some of the energy and background activity of the event throughout the conversation.

When Lyme Patients React to Everything

Dr. Simeles describes a particularly challenging group of patients arriving at her practice.

They are very sick, highly sensitive, and may react negatively to interventions that would ordinarily be considered relatively gentle.

She describes patients experiencing symptoms including:

• Severe brain fog
• Numbness and tingling
• Short-term memory problems
• Anxiety
• Depression
• Irritability
• Aggression
• Neuropsychiatric symptoms
• Extreme sensitivity to supplements
• Difficulty tolerating treatment

Some even report feeling worse after taking supplements typically used for calming support, including L-theanine or holy basil.

When that happens, Dr. Simeles asks a different question:

Why is the body interpreting so many inputs as threats?

Cell Danger Response, MCAS & Nervous-System Dysregulation

There may not be one answer.

Dr. Simeles emphasizes that these are complex chronic illness patients, so multiple factors may be interacting.

She discusses possible contributors including:

• Mold and other toxic exposures
• Oxidative stress
• Mast cell activation
• Nervous-system dysregulation
• Chronic infections
• Cellular dysfunction
• What is often described as the cell danger response

Within this framework, a chronically stressed body can become increasingly defensive and reactive.

Interventions that should ordinarily be tolerated may suddenly produce unexpected responses.

Even nervous-system programs such as DNRS, Gupta, or Primal Trust may initially feel overwhelming to someone who is severely ill, cognitively impaired, or highly reactive.

That doesn't necessarily mean those tools will never be useful.

It may mean the patient first needs a more tolerable entry point.

For more on this aspect of recovery, listen to Tick Boot Camp's conversation about Primal Trust with Cathleen King.

Looking at the Cell Membrane

Dr. Simeles and Dr. Melanie Stein traveled to Atlanta for additional training in lipid replacement therapy and cell membrane therapy, building on approaches they were already using at Restorative Health Clinic.

That training helped deepen their focus on a foundational question:

Can the patient's cells properly receive, process, and communicate information?

Cell membranes aren't simply walls surrounding cells.

They are dynamic structures involved in signaling, transport, immune function, energy production, and communication.

Dr. Simeles' clinical model asks whether damage or changes to these membranes could be contributing to some patients remaining stuck despite extensive antimicrobial and supportive treatment.

The Cell Membrane as the Foundation

The previous Tick Boot Camp conversation with Dr. Stein used a simple metaphor:

Imagine the cell is a castle and the membrane surrounding it is the moat.

The moat helps regulate what gets in and out while supporting the communication necessary to recognize and respond to threats.

Dr. Simeles expands on that concept.

If the cellular environment is dysfunctional, the problem may extend beyond the presence of an infection.

The immune system itself is made of cells.

Mitochondria contain membranes.

Proteins involved in energy production and cellular communication are embedded in or associated with membranes.

From Dr. Simeles' perspective, improving membrane health may therefore help create a better foundation for the body's other systems to function.

Why Treating the Infection May Not Be Enough

Dr. Simeles makes an important distinction:

Antimicrobial therapy and cellular repair are doing different jobs.

Her practice still uses antimicrobial therapies when clinically appropriate.

But she describes seeing patients whose testing improves after infection-directed treatment while symptoms such as fatigue and brain fog remain.

In her clinical experience, integrating cell membrane support earlier — rather than waiting until antimicrobial treatment is finished — may help some patients better tolerate treatment while simultaneously addressing aspects of their lingering symptoms.

The philosophy is not necessarily:

Antimicrobials or cellular repair.

It can be:

Antimicrobials plus rebuilding the patient's underlying physiology when appropriate.

Phospholipids & Cellular Communication

A central concept throughout this conversation is phospholipids.

Phospholipids are major structural components of cellular membranes.

Dr. Simeles explains that oxidative stress associated with chronic infections, toxins, inflammation, and other physiological stressors may affect membrane lipids.

Within her model, restoring appropriate lipids can help support membrane structure and the cellular processes that depend upon it.

This becomes particularly important when discussing the immune system and mitochondria because their functions also depend on healthy cellular structures.

DHA, Omega-3s & the Brain

Dr. Simeles discusses omega-3 fatty acids, particularly DHA, in the context of neurological and neuropsychiatric symptoms.

She distinguishes DHA from EPA, noting that both are common components of fish oil but have different physiological roles.

Because DHA is an important structural lipid in the brain and nervous system, Dr. Simeles describes using DHA-focused omega-3 strategies with some of her highly sensitive neurological patients.

She also discusses carefully titrating treatment for people who react easily, including beginning with very small amounts and increasing based on tolerance.

Importantly, she cautions that high-dose fish oil can affect blood clotting and may increase bleeding risk in some people.

This is one reason high-dose supplementation should be individualized and discussed with an appropriately qualified healthcare professional rather than copied directly from another patient's protocol.

Plasmalogens & Neurological Health

Another major topic is plasmalogens, specialized lipids found in cellular membranes and present in significant concentrations within nervous-system tissues.

Dr. Simeles discusses using a specialized omega-9 plasmalogen product with some patients experiencing difficult neurological or neuropsychiatric symptoms.

Her interest is rooted in the role membrane lipids play in neural structure and cellular communication.

The product discussed in the interview, ProdromeGlia, is marketed as an omega-9 plasmalogen precursor intended to support glial cell membranes, myelin structure, and normal cellular membrane composition.

Dr. Simeles describes this as one tool within a broader cell membrane strategy — not as a standalone Lyme disease treatment.

Mitochondria: The Powerhouse Still Matters

Most people remember one thing from biology class:

The mitochondria are the powerhouse of the cell.

Dr. Simeles explains what that actually means.

Mitochondria produce ATP, the energy currency cells need to perform their functions.

When mitochondrial function becomes impaired, the consequences can potentially be felt throughout high-energy systems of the body.

Dr. Simeles connects mitochondrial dysfunction with symptoms she frequently sees in complex chronic illness, including:

• Fatigue
• Brain fog
• Memory difficulties
• Muscle weakness
• Neurological symptoms
• Reduced stamina

The brain is particularly energy-demanding, which helps explain why mitochondrial health is often part of conversations about neurological and cognitive symptoms.

Why Membranes Matter to Mitochondria

The cellular-health discussion gets even more interesting when Dr. Simeles connects cell membranes with mitochondria.

Mitochondria have their own specialized membranes, and their structure is essential to the biochemical processes involved in producing ATP.

Within Dr. Simeles' framework, membrane dysfunction can therefore influence mitochondrial function.

This creates a possible chain:

Cellular stress → membrane dysfunction → impaired mitochondrial function → reduced energy production → symptoms such as fatigue and brain fog.

That simplified model helps patients understand why her practice is interested in repairing cellular structures rather than exclusively targeting microbes.

Are Low-Fat Diets a Problem?

The conversation then moves from supplements and therapies to something much more fundamental:

Food.

Dr. Simeles doesn't recommend a single rigid diet for every patient.

She does, however, push back against diets that unnecessarily eliminate healthy fats.

Some fatty acids are considered essential because the body cannot adequately produce them on its own.

Omega-3 fatty acids are one example.

She therefore emphasizes obtaining adequate healthy fats through food while recognizing that individual dietary needs and tolerances vary.

Foods discussed in the conversation include:

• Fish and omega-3 sources
• Eggs
• Egg yolks as a source of phosphatidylcholine
• Plant-based fat sources
• Red meat in moderation

The larger takeaway isn't that every Lyme patient should follow a ketogenic or high-fat diet.

It's that healthy fats play important biological roles and shouldn't automatically be treated as the enemy.

The Goal Is to Graduate Patients from Care

One revealing moment in the interview has little to do with biochemistry.

Dr. Simeles explains that she is always trying to graduate patients from care.

The objective isn't indefinite treatment.

It is helping someone rebuild enough health and resilience that they can return to living their life.

That philosophy fits naturally with Tick Boot Camp's emphasis on recovery:

The treatment is not the destination. Life is.

SOT for Lyme & Associated Infections

Dr. Simeles also discusses Supportive Oligonucleotide Therapy (SOT), another treatment being used at Restorative Health Clinic.

She is notably measured about the results.

Some patients, she says, have experienced dramatic improvements.

Others have experienced more modest results, remain uncertain, or haven't responded.

That variability mirrors what Tick Boot Camp has heard across patient interviews.

There are people who describe SOT as transformational and others who report spending substantial money without receiving the outcome they hoped for.

Dr. Simeles emphasizes that there is no single protocol that will work for every person.

For more Tick Boot Camp conversations involving SOT, explore Dr. Hank Sloan's interviews and resources.

Can Cellular Health Improve Treatment Tolerance?

An especially interesting question raised in this episode is whether improving cellular health might make other treatments easier to tolerate.

Dr. Simeles believes it can for some of her patients.

Rather than repeatedly adding more aggressive interventions to someone who is already highly reactive, the practice is increasingly interested in strengthening the patient's foundation first or simultaneously.

The objective is to help the patient become resilient enough to tolerate whatever appropriate treatment comes next.

This closely parallels Tick Boot Camp's concept of prehabilitation:

Prepare the person for the treatment rather than simply assuming the person is ready for it.

Healing Is Individual

The SOT discussion leads to one of the most important messages in the entire interview:

There is no universal Lyme treatment protocol.

Patients are biologically different.

Their infections differ.

Their immune systems differ.

Their toxic exposures differ.

Their nervous systems differ.

Their nutritional status, genetics, microbiomes, environments, histories, and tolerances differ.

A therapy that dramatically helps one person may do very little for another.

For people who have spent years comparing themselves with someone else's recovery story, that message can be validating.

Someone else's success or failure with a particular treatment does not automatically predict yours.

The Language We Use With Ourselves

Near the end of the conversation, Dr. Simeles introduces another area she wants to explore more deeply: Neuro-Linguistic Programming, or NLP.

Her interest isn't about replacing medical treatment with positive thinking.

Instead, she recognizes that people living with years of chronic illness can develop deeply ingrained patterns around fear, identity, safety, and expectations.

She wants to develop additional tools to help patients reframe how they speak to and about themselves during recovery.

Tick Boot Camp connects that idea with a recurring principle:

Who we believe we can become can influence what we're willing and able to do next.

Belief alone isn't a Lyme disease treatment.

But hope, self-talk, nervous-system regulation, and the belief that improvement is possible can matter deeply during a long recovery journey.

About Dr. Vy Simeles

Dr. Vy Simeles, ND, LAc is a naturopathic physician and licensed acupuncturist at Restorative Health Clinic in Oregon.

Her work focuses on complex chronic illness, including Lyme disease, mold illness, MCAS, dysautonomia, and other multifactorial conditions. Her clinical approach integrates naturopathic medicine, Chinese medicine, nutrition, detoxification, somatic therapies, and Cell Membrane Therapy.

Dr. Simeles and Dr. Melanie Stein have also taught together on lipid replacement therapy and restoring membranes, mitochondria, and autonomic stability in chronic inflammation.

Key Topics in This Episode

Lyme disease, chronic Lyme disease, Dr. Vy Simeles, cell membrane therapy, lipid replacement therapy, treatment sensitivity, multiple chemical sensitivity, neuroinflammation, brain fog, anxiety, depression, neuropsychiatric Lyme disease, nervous-system dysregulation, cell danger response, MCAS, mast cell activation, phospholipids, phosphatidylcholine, DHA, EPA, omega-3 fatty acids, plasmalogens, ProdromeGlia, mitochondrial dysfunction, ATP, chronic fatigue, Lyme disease nutrition, healthy fats, SOT, Supportive Oligonucleotide Therapy, nervous-system regulation, NLP, integrative medicine, naturopathic medicine, and Lyme disease recovery.

About This LIVE from ILADS Interview

This short-form conversation was recorded in person at the 2025 International Lyme and Associated Diseases Society Annual Scientific Conference, From Terrain to Treatment: Advances in Vector-Borne Illness, held October 9–12, 2025, in San Antonio, Texas.

Because these interviews were recorded live at the conference, they have a different feel from Tick Boot Camp's traditional long-form virtual and studio conversations — shorter, focused, and surrounded by the energy and activity of ILADS.

This conversation is a natural companion to Tick Boot Camp's LIVE from ILADS interview with Dr. Melanie Stein, which explores the same emerging cellular-health model from a complementary perspective.

Explore all Tick Boot Camp LIVE from ILADS interviews.

More from Tick Boot Camp

Hear more conversations with Lyme disease doctors and healthcare professionals about complex chronic illness, treatment, nervous-system regulation, and recovery.

For more on nervous-system regulation, listen to Cathleen King's conversation about Primal Trust.

For more discussions involving SOT, visit Dr. Hank Sloan's Tick Boot Camp page.

Explore the Tick Boot Camp Podcast for patient stories and conversations with doctors, researchers, advocates, and other members of the Lyme disease and tick-borne illness community.

When Julia Bruzzese became seriously ill and lost the ability to walk, her brother James was beginning his medical education. Rather than allowing his family’s experience to drive him away from medicine, it gave him a new purpose: to become the kind of doctor his sister and other complex Lyme disease patients desperately needed.

In this deeply personal Tick Boot Camp Podcast episode, special guest co-host Nicole O'Donnell, co-hosts Rich Johannesen and Matt Sabatello welcome Dr. James Bruzzese, MD, founder of Bruzzese Medical. They are joined by returning guest and Lyme advocate Nicole O’Donnell, who brings her perspective as a patient, mother, and member of a family affected by tick-borne illness.

Julia’s story reached people around the world in 2015, when Pope Francis approached and blessed her on the tarmac at JFK Airport. She later appeared in the Lyme disease documentary The Quiet Epidemic. Behind the public moments was a close-knit family navigating medical uncertainty, debilitating illness, insurance barriers, and the painful experience of watching Julia’s symptoms be misunderstood.

James was present through it all. He attended appointments, accompanied Julia to hospitals, studied medical research, and advocated for her care. Those experiences shaped how he now listens to patients, evaluates complex symptom patterns, and approaches Lyme and tick-borne disease.

When Lyme Disease Becomes Personal

Dr. Bruzzese explains that he had already entered an accelerated medical program before Julia became critically ill. At the time, he was still questioning whether medicine was truly his calling.

Watching his sister become paralyzed, lose her independence, and struggle to obtain answers removed that uncertainty. He describes how helplessness and anger became motivation to study Lyme disease, challenge incomplete assumptions, and advocate for patients whose experiences were being dismissed.

The conversation also explores the effects of chronic illness on the entire family. While one person carries the physical burden of disease, parents and siblings may become caregivers, researchers, advocates, and witnesses to tremendous suffering.

Why Doctors May Miss Lyme Disease

Dr. Bruzzese offers an inside look at how Lyme disease is addressed during conventional medical training. He recalls receiving approximately two hours of Lyme education and being taught to consider other explanations before Lyme disease when evaluating symptoms such as a swollen joint.

He argues that medical education relies heavily on pattern recognition. That can help physicians work efficiently, but it becomes dangerous when doctors were never taught to recognize the shifting, multisystem patterns that can accompany Lyme and other tick-borne infections.

The result may be a patient whose fatigue, pain, neurological symptoms, dysautonomia, cognitive difficulties, or migrating symptoms are divided among specialists without anyone examining the complete clinical picture.

Medical Gaslighting, Bias, and the Patient Experience

Nicole O’Donnell shares what it felt like to remain sick while doctors and family members questioned whether Lyme disease explained her symptoms. The group considers whether clinicians deliberately gaslight patients or whether inadequate education, institutional pressure, limited appointment time, and rigid diagnostic frameworks produce an experience that feels like gaslighting.

Dr. Bruzzese discusses how patients, particularly women with complex combinations of pain, fatigue, dysautonomia, neurological symptoms, or autoimmune diagnoses, can become labeled as difficult before their complete histories are investigated.

Whatever the intent, the consequences are real. Patients may feel disbelieved, families may begin questioning them, and necessary evaluation or treatment may be delayed.

Building a Different Model of Lyme Care

Dr. Bruzzese describes his vision for Bruzzese Medical, a virtual practice focused on Lyme disease, tick-borne infections, and complex chronic presentations.

His goal is to provide individualized, patient-centered care that considers:

• Lyme disease and common tick-borne co-infections
• Multisystem and neurological symptoms
• Mold exposure and heavy-metal toxicity
• Immune, inflammatory, hormonal, and nutritional contributors
• Medication and supplement interactions
• Chronic and neuropathic pain
• Dysautonomia and peripheral neuropathy
• Quality of life during longer-term treatment

Rather than applying the same protocol to every person, Dr. Bruzzese emphasizes listening to the patient’s full story, studying how symptoms developed over time, and adjusting care according to individual response.

He also discusses the value of coordinated treatment planning. His family once had to determine how to organize and separate the more than 80 pills Julia was taking each day. He believes patients experiencing brain fog, exhaustion, and neurological symptoms should not be left to navigate complicated medication and supplement schedules by themselves.

Treating Pain While Addressing the Underlying Illness

Pain management is an especially important part of Dr. Bruzzese’s vision. His anesthesia training and work as a pain medicine fellow give him a perspective that is not always incorporated into Lyme disease care.

He explains that addressing an underlying infection and improving a patient’s immediate quality of life do not have to be competing priorities. Some people need relief from neuropathic pain, anxiety, sleep disruption, or other disabling symptoms while their medical team continues investigating and treating deeper contributors.

The discussion includes neuromodulation, chronic pain signaling, neuropathy, and why every intervention must be selected for the individual rather than offered as universal advice.

Expanding the Next Generation of Lyme-Literate Providers

Dr. Bruzzese does not want his work to stop with the patients he can personally see. Bruzzese Medical uses a team-based model with nurse practitioners, allowing additional clinicians to learn how to care for people with Lyme and tick-borne illnesses while expanding appointment availability.

His clinical perspective was influenced by extensive exposure to Lyme patients and training with physicians including Dr. Richard Horowitz and Dr. Somer DelSignore.

His message to patients is simple but powerful: whether someone has experienced a recent tick bite or has remained sick after visiting numerous doctors, their story deserves to be heard and investigated.

Key Topics Discussed

• How Julia Bruzzese’s illness affected James and his entire family
• Julia’s meeting and blessing from Pope Francis
• Her appearance in The Quiet Epidemic
• Why James pursued medicine and Lyme disease care
• Gaps in medical-school education about tick-borne disease
• The limitations of diagnosis through pattern recognition
• Why complex patients may feel dismissed or gaslit
• The effects of insurance and institutional pressures on care
• Clinical evaluation when testing does not provide a complete answer
• Lyme disease co-infections and environmental contributors
• Individualized treatment instead of blanket protocols
• Medication and supplement coordination
• Neuropathic pain and neuromodulation
• The role of anesthesia and pain medicine in chronic illness care
• Bruzzese Medical’s team-based virtual practice
• Training more healthcare professionals to serve the Lyme community
• Why patients need validation, communication, and continued hope

Work With Dr. James Bruzzese

Bruzzese Medical currently offers virtual appointments when appropriate and permitted by state regulations. The practice is private-pay and does not accept insurance for appointments.

Patients can learn more, request an appointment, and access the practice’s booking portal through the Bruzzese Medical website.

Additional Resources

• Find Lyme-literate doctors featured by Tick Boot Camp
• Learn about Lyme disease testing
• Explore the Tick Boot Camp Podcast
• Watch The Quiet Epidemic

LIVE from ILADS: Tick Boot Camp welcomes back Dr. Melanie Stein, ND for an update on her approach to chronic Lyme disease and complex illness — and the release of her book, Breaking Through Chronic Illness: The Science of Cellular Repair and the Path to Lasting Recovery.

Why do some people continue struggling after months or even years of Lyme disease treatment?

Dr. Stein believes part of the answer may be found at the cellular level. In this short-form conference conversation, she explains her clinical model of repairing cell membranes, supporting mitochondrial function, reducing inflammation, calming an overactive nervous and immune system, and rebuilding the foundations of health so the body may be better prepared for treatment and recovery.

Rather than waiting until the end of Lyme treatment to focus on repair, Dr. Stein makes a different argument:

Repair may need to begin at the beginning.

This interview was recorded live at the ILADS conference, so you may hear some of the energy and background activity of the event throughout the conversation.

Why Can Lyme Recovery Stall?

Dr. Stein begins with a familiar problem in the Lyme community.

A patient is diagnosed with an infection. Treatment begins. Yet months or years later, that person may still experience fatigue, brain fog, neurological symptoms, immune dysfunction, or other persistent problems.

Dr. Stein's clinical model asks whether focusing primarily on killing or reducing pathogens overlooks another important part of recovery:

What condition is the body in while we're treating the infection?

She discusses oxidative stress, mitochondrial dysfunction, impaired cellular communication, inflammation, and damage to cell membranes as factors she believes can help keep chronically ill patients stuck.

Her book, Breaking Through Chronic Illness, expands on this idea by focusing on cellular repair as part of the recovery process.

Treat the Body, Not Just the Bug

This conversation connects directly with a recurring Tick Boot Camp observation.

People who recover from complex Lyme disease often appear to need more than an antimicrobial strategy.

Tick Boot Camp discusses its PARM framework:

• Prehabilitation
• Assist
• Repair
• Maintenance

Dr. Stein agrees with the importance of repair but proposes an important modification:

Don't wait until the repair phase to start repairing.

She argues that improving the body's cellular environment earlier may help prepare patients for subsequent interventions and make treatment more tolerable or effective.

It's a shift from asking only, "How do we kill the pathogen?"

Instead, the question becomes:

"How do we help the body become healthier while we're addressing the pathogen?"

What Happens to Cells During Chronic Illness?

Dr. Stein describes cell membranes as essential structures that help regulate what enters and leaves a cell and facilitate communication between cells.

She discusses phosphatidylcholine and other lipids as important components of those membranes.

Within her model, oxidative stress associated with infection can damage these fats and disrupt membrane function, cellular communication, mitochondrial function, and immune signaling.

The science can become complicated quickly, so the conversation develops a much simpler metaphor.

The Castle & Moat Metaphor

Imagine the cell is a castle.

Surrounding that castle is a moat — the cell membrane.

The moat helps determine what enters and leaves while also participating in the castle's communication and defenses.

Dr. Stein explains that when the membrane becomes damaged, the system may no longer operate normally.

The drawbridge doesn't work properly.

Communication systems can become impaired.

Defenses may become less effective.

The goal of cellular repair, in her framework, is to restore that protective environment so cellular communication and function can improve.

It's an intentionally simple analogy for a complicated biological concept, but it helps explain why Dr. Stein places so much emphasis on cell membrane health.

Phosphatidylcholine & Cell Membrane Support

One intervention discussed in the episode is phosphatidylcholine.

Dr. Stein describes phosphatidylcholine as an important fatty component of cell membranes and discusses replenishing healthy lipids as part of her approach to cellular repair.

She also discusses butyrate, a short-chain fatty acid naturally produced by gut bacteria, within her broader cellular-health protocols.

These therapies aren't presented here as universal Lyme disease treatments.

They are components of Dr. Stein's clinical approach to patients with complex chronic illness and should be considered with an appropriately trained healthcare professional based on an individual's medical needs.

ILADS has also featured Dr. Stein teaching on lipid replacement therapy and cellular restoration in tick-borne disease. (pathlms.com)

Calm the Body Before Pushing Treatment

Before getting into advanced cellular therapies, however, Dr. Stein emphasizes something more fundamental:

Help the body feel safe again.

Many chronically ill patients describe feeling stuck in a state of hypervigilance or fight-or-flight.

Dr. Stein discusses several tools she uses clinically to address that state, including:

• Nervous-system regulation
• Limbic-system retraining
• Mast-cell support
• Anti-inflammatory strategies
• Sleep
• Breathing exercises
• Gentle foundational interventions

She references programs including DNRS, Gupta, and Primal Trust while acknowledging an important reality: some severely ill patients may initially be too symptomatic or overwhelmed to participate in an intensive brain-retraining program.

The approach therefore needs to meet the patient where they are.

For more Tick Boot Camp conversations on nervous-system regulation, explore Primal Trust with Cathleen King.

Sleep & Digestion Come First

For all the sophisticated science discussed in the interview, Dr. Stein's first priorities for a new patient are surprisingly basic.

Sleep and bowel function.

She emphasizes sleep because the body needs restorative time to regulate, integrate, and recover.

If someone isn't sleeping adequately, she argues that adding increasingly complicated interventions may accomplish little because the body isn't operating in an environment conducive to healing.

Dr. Stein also discusses evaluating patients for sleep disorders rather than assuming insomnia is simply another unavoidable symptom of Lyme disease.

That can include investigating:

• Sleep apnea
• REM sleep disorders
• Circadian disruption
• Cortisol dysregulation
• Poor sleep hygiene

She notes that sleep apnea isn't limited to people who fit the stereotype of an older or overweight patient and says she refers patients for sleep studies when appropriate.

Practical Strategies for Better Sleep

Dr. Stein discusses several approaches she may use or recommend depending on the patient, including:

• Consistent sleep routines
• Reducing television and screens before bed
• Creating a dark sleeping environment
• Sleep masks
• Breathing exercises
• Meditation
• Gradually shifting a delayed sleep schedule
• Evaluating possible sleep disorders

She also discusses L-theanine, GABA, magnesium, and low-dose melatonin within her clinical practice.

The larger message is more important than any individual intervention:

Don't overlook the foundations while pursuing advanced Lyme treatment.

Nutrition as Cellular Medicine

Food provides the raw materials cells need to function.

Dr. Stein emphasizes nutrient-dense foods and healthy fats as part of her cellular-repair philosophy.

She personally favors a lower-carbohydrate, ketogenic-style approach for many patients — not necessarily with the goal of maintaining nutritional ketosis, but as a way of emphasizing healthy fats alongside organic vegetables and nutrient-dense foods.

Diet, however, should be individualized.

The important principle in this conversation is that sophisticated therapies cannot replace the basic nutrients required for normal biochemical processes.

As Dr. Stein explains later in the episode, everyday choices influence biochemistry.

Movement Doesn't Have to Mean Exercise

For someone severely ill with Lyme disease, the word exercise can be intimidating — and in some situations inappropriate.

Dr. Stein instead talks about movement at the level a patient's body can currently tolerate.

That could mean something as simple as moving the legs while lying in bed.

Her goal is to gradually support circulation, oxygenation, mitochondrial activity, and energy production without demanding more from the body than it can currently handle.

Recovery doesn't have to begin with a workout.

It can begin with the smallest movement the body safely permits.

Mitochondria & Energy Production

Mitochondria produce ATP, the energy cells use to perform their functions.

Dr. Stein connects mitochondrial dysfunction with common chronic illness complaints such as fatigue, poor stamina, cognitive dysfunction, and difficulty recovering from stress.

But mitochondrial support can't exist in isolation.

If a patient remains chronically stressed, poorly nourished, sleep-deprived, or otherwise physiologically dysregulated, Dr. Stein argues that even sophisticated mitochondrial interventions may have difficulty producing durable improvement.

That brings the conversation back to the foundations:

Sleep. Nutrition. Movement. Nervous-system regulation. Cellular support.

The advanced protocols are built on top of those fundamentals — not instead of them.

Cellular Repair Before, During & After Lyme Treatment

One of the biggest takeaways from this interview is that healing doesn't necessarily have to follow a rigid sequence.

The traditional mental model might look like:

Kill the infection → repair the damage → rehabilitate the patient.

Dr. Stein proposes something more integrated.

Support the patient before antimicrobial treatment.

Continue supporting cellular health during treatment.

Repair throughout the process.

Then continue rebuilding and maintaining health afterward.

In Tick Boot Camp language, prehabilitation, assistance, repair, rehabilitation, and maintenance can overlap rather than existing as completely separate boxes.

Breaking Through Chronic Illness

Dr. Stein's book, Breaking Through Chronic Illness: The Science of Cellular Repair and the Path to Lasting Recovery, expands on the concepts introduced in this interview.

She wrote the book for both patients and practitioners.

Her goal is to translate complicated cellular science into language people living with chronic illness can understand while also encouraging clinicians to think beyond antimicrobial treatment alone.

The book explores her cellular-repair framework and the idea that persistent illness can involve dysfunction in cell membranes, mitochondria, energy production, detoxification, immune regulation, and cellular communication.

Learn more about Breaking Through Chronic Illness and Dr. Stein's cellular-healing approach.

About Dr. Melanie Stein

Dr. Melanie Stein, ND is a licensed naturopathic physician and founder of Restorative Health Clinic in Portland, Oregon.

Her clinical work focuses on complex chronic illnesses including Lyme disease and other tick-borne infections, mold-related illness, MCAS, POTS, chronic fatigue, environmental illness, and cellular dysfunction.

Dr. Stein's interest in complex chronic illness is also personal. She has publicly described developing Lyme disease and Bartonella and experiencing severe neurological illness, including paralysis, before ultimately receiving answers. That experience helped shape her focus on patients with difficult-to-diagnose and persistent illnesses.

ILADS identifies Dr. Stein as a clinician specializing in vector-borne illness and complex chronic conditions who integrates environmental medicine, chronic infection management, and individualized therapies. (ilads.org)

Key Topics in This Episode

Chronic Lyme disease, Lyme disease recovery, Dr. Melanie Stein, cellular repair, cell membrane therapy, mitochondrial dysfunction, mitochondrial health, phosphatidylcholine, butyrate, oxidative stress, chronic inflammation, chronic fatigue, brain fog, cellular communication, nervous-system regulation, limbic-system retraining, DNRS, Gupta Program, Primal Trust, MCAS, mast cell activation, sleep, sleep apnea, Lyme disease nutrition, movement, ATP production, prehabilitation, chronic illness recovery, integrative medicine, naturopathic medicine, and Breaking Through Chronic Illness.

About This LIVE from ILADS Interview

This short-form conversation was recorded in person at the 2025 International Lyme and Associated Diseases Society Annual Scientific Conference, From Terrain to Treatment: Advances in Vector-Borne Illness, held October 9–12, 2025, in San Antonio, Texas.

Dr. Stein was among the clinicians featured by ILADS at the conference, where her work focused on vector-borne illness, complex chronic disease, and cellular health.

Because these interviews were recorded live at the conference, they have a different feel from Tick Boot Camp's traditional long-form virtual and studio conversations — shorter, focused, and surrounded by the energy and activity of ILADS.

Explore all Tick Boot Camp LIVE from ILADS interviews.

More from Tick Boot Camp

Explore more conversations with Lyme disease doctors and healthcare professionals about testing, treatment, cellular health, nervous-system regulation, and recovery.

For more on helping the nervous system move out of chronic fight-or-flight patterns, listen to Cathleen King discuss Primal Trust.

Explore the Tick Boot Camp Podcast for patient stories and interviews with doctors, researchers, advocates, and other voices working to improve understanding of Lyme disease and tick-borne illness.

LIVE from ILADS: Tick Boot Camp sits down with Dr. Somer DelSignore, DNP, BC-PNP, founder of Hudson Valley Integrative Health in Beacon, New York, for a wide-ranging conversation about pediatric Lyme disease, congenital tick-borne infections, autism spectrum symptoms, PANS/PANDAS, autoimmune encephalopathy, developmental delays, behavioral changes, and the importance of investigating potential biological contributors to neuroimmune dysfunction.

Dr. DelSignore practices integrative pediatrics with a focus on children experiencing complex chronic illness and neuroimmune symptoms. Rather than stopping at a behavioral or developmental diagnosis, she describes a root-cause approach that asks a deeper question:

What biological processes could be contributing to this child's symptoms?

The conversation explores some challenging and evolving areas of medicine, including possible relationships among infections, inflammation, immune dysfunction, neurological development, and behavioral symptoms. Dr. DelSignore shares observations from her clinical practice and argues for more comprehensive biomedical evaluation of children with complex or atypical presentations.

This interview was recorded live at the ILADS conference, so you may hear some of the energy and background activity of the event throughout the conversation.

Looking Beyond a Pediatric Diagnosis

Dr. DelSignore describes treating children who don't always fit neatly into one diagnostic category.

Some arrive with:

• Autism spectrum diagnoses or symptoms
• Developmental delays
• Behavioral changes
• Cognitive difficulties
• Motor delays
• Speech and language delays
• PANS/PANDAS
• Autoimmune or neuroimmune symptoms
• Suspected congenital Lyme disease
• Other tick-borne infections

A pattern she says sometimes catches parents' attention is an unexpected improvement when a child receives treatment for an unrelated infection.

Parents may report that their child temporarily gains language, motor, behavioral, or other skills while taking an antibiotic, only to regress after treatment ends.

For Dr. DelSignore, observations like these are clues that warrant further investigation rather than immediate conclusions.

Root-Cause Medicine for Children

Dr. DelSignore describes her work as a form of detective work.

A diagnosis describes what clinicians are observing, but she wants to investigate why those symptoms are occurring.

When a child presents with neurological, developmental, behavioral, or immune dysfunction, she evaluates possible contributors and works backward from the symptoms.

That may involve extensive history-taking, laboratory evaluation, the child's medical history, environmental factors, immune function, infections, inflammation, genetics, and sometimes the parents' medical histories.

Once potential contributors are identified, her goal is not only to address them but also to support the immune and neurological systems as the child progresses.

Learn more about Dr. Somer DelSignore and Hudson Valley Integrative Health.

Congenital Lyme & Tick-Borne Infections

One of the most important subjects in this conversation is congenital or maternal-fetal transmission of tick-borne infections.

Dr. DelSignore discusses evaluating both children and their parents when the child's presentation suggests that infection or immune dysfunction could have begun during pregnancy or early development.

She specifically discusses Borrelia, Bartonella, and Babesia — the pathogens Tick Boot Camp often refers to as the Three B's — in the context of her clinical work.

Dr. DelSignore also discusses another possibility: even when direct transmission isn't established in an individual case, maternal infection and inflammation during pregnancy could potentially influence fetal immune or neurological development.

These are complex and evolving areas of research, and determining what occurred in an individual child requires careful clinical evaluation rather than assuming that every developmental or neuroimmune condition has an infectious cause.

Why Family History Matters

With very young patients, Dr. DelSignore says the parents' history can become especially important.

She asks mothers questions such as:

• Were you exposed to ticks?
• Did you experience unexplained symptoms before or during pregnancy?
• Did you have unusual illnesses earlier in life?
• Did you struggle with immune dysfunction?
• Do you have autoimmune conditions?
• Were there infections or inflammatory problems during pregnancy?

For an infant who cannot describe symptoms, family history may provide clues that aren't available from the child alone.

Dr. DelSignore combines that history with clinical presentation and diagnostic testing when deciding what warrants further investigation.

What Might Lyme Disease Look Like in a Young Child?

Young children present a unique diagnostic challenge.

They cannot necessarily explain that they are exhausted, experiencing pain, having temperature changes, or feeling neurologically different.

Dr. DelSignore describes seeing infants with findings such as hypotonia — unusually low muscle tone — along with feeding and sleeping difficulties that extend beyond what would ordinarily be expected.

As children grow, additional clues may emerge.

Clinicians and parents can begin evaluating whether a child is:

• Sitting appropriately
• Crawling
• Developing speech
• Gaining words
• Building sentences
• Developing motor skills
• Interacting socially
• Meeting expected developmental milestones

Dr. DelSignore emphasizes that none of these signs by themselves diagnose Lyme disease or another tick-borne infection.

Instead, they may be reasons to investigate further when considered alongside medical history, exposures, physical findings, and other symptoms.

Behavioral Symptoms in Toddlers & Children

In toddlers and older children with tick-borne illness, Dr. DelSignore says the presentation can become heavily neurological or behavioral.

She discusses symptoms including:

• Irritability
• Impulsivity
• Poor sleep
• Delayed speech
• Social difficulties
• Auditory sensitivity
• Visual sensitivity
• Anxiety
• Depression
• OCD-like behaviors
• Rage
• Fatigue
• Sweating
• Temperature dysregulation

The difficulty is obvious: many of these symptoms overlap with other pediatric neurological, developmental, psychiatric, and medical conditions.

A nonverbal child also may not be able to report fatigue, pain, headaches, sensory changes, or other physical symptoms.

That overlap is one reason Dr. DelSignore argues against trying to identify tick-borne illness from behavior alone.

Autism, Lyme Disease & an Important Distinction

A substantial portion of this conversation explores autism and possible biological contributors to autism-spectrum presentations.

This requires an important distinction.

Autism is not synonymous with Lyme disease, and an autism diagnosis by itself does not establish the presence of a tick-borne infection.

Dr. DelSignore's position is that some children diagnosed with autism or presenting with autism-like symptoms may also have infections, inflammation, autoimmune processes, or other biomedical issues that deserve investigation.

She describes autism as a syndrome diagnosed from patterns of behavior and development rather than through a single definitive laboratory test. From her root-cause perspective, she therefore asks what potentially modifiable biological factors might coexist with or contribute to an individual child's presentation.

This distinction is especially important because the scientific questions surrounding infection, immune activation, neurodevelopment, and autism remain complex and actively studied.

Can Treating an Infection Change Developmental Symptoms?

Dr. DelSignore shares clinical experiences in which she says children experienced substantial developmental and behavioral improvement after underlying infections and immune dysfunction were addressed.

She discusses one case involving a nonverbal child with significant autism-spectrum symptoms whom she says tested positive for Borrelia, Bartonella, and Babesia in the context of suspected maternal transmission.

Following treatment, she reports that the child progressed dramatically and was functioning much more typically by school age.

This is a clinical case described by Dr. DelSignore, not evidence that tick-borne infections explain autism broadly or that antimicrobial treatment is an established autism treatment.

What it illustrates is the central argument she makes throughout this episode:

When a child's presentation is unusual or complex, clinicians should remain curious about potentially treatable medical contributors.

The Neuroimmune Connection

Dr. DelSignore encourages clinicians to think about some pediatric presentations through a neuroimmune lens.

The nervous system and immune system don't operate independently.

Infection can trigger immune activity and inflammation, and immune dysfunction can have neurological consequences.

Dr. DelSignore discusses evaluating children for both infections and evidence of autoimmune activity when clinically appropriate.

Rather than attempting to draw a clean line between a behavioral diagnosis and an infectious diagnosis, she looks at the entire clinical picture and asks what combination of processes could be affecting that individual child.

PANS/PANDAS & Autoimmune Encephalopathy

This same framework is relevant to Dr. DelSignore's work with PANS, PANDAS, and autoimmune encephalopathy.

Children with these conditions can experience dramatic neuropsychiatric or behavioral changes associated with immune activation.

Dr. DelSignore's clinical focus includes identifying possible infectious and inflammatory triggers and then addressing both the trigger and the downstream immune or neurological dysfunction.

Her work therefore overlaps infectious disease, immunology, neurology, psychiatry, and developmental pediatrics rather than remaining confined to a single specialty.

ILADS identifies Dr. DelSignore's areas of focus as neuroimmunology, autism spectrum disorder, PANS/PANDAS, and chronic/congenital Lyme disease.

Why Comprehensive Evaluation Matters

One of Dr. DelSignore's strongest messages is that children with complex developmental or behavioral presentations deserve a thorough medical evaluation.

She says older children often reach her practice after seeing numerous providers while their symptoms have been characterized primarily as behavioral or psychiatric.

By the time they arrive, some families have spent years searching for explanations.

Dr. DelSignore advocates looking more broadly at potential contributors, including infection, immune dysfunction, inflammation, environmental exposures, genetics, nutrition, and other biological factors when clinically indicated.

The goal isn't to assume every child has Lyme disease.

It's to ask enough questions before deciding that nothing else is contributing to the child's symptoms.

Psychiatric Symptoms Can Have Medical Contributors

The conversation also examines the relationship between physical health and psychiatric symptoms.

Dr. DelSignore describes situations in which she believes infection-driven immune activation and neuroinflammation may contribute to anxiety, depression, irritability, OCD-like behaviors, rage, and other neuropsychiatric symptoms.

She argues for investigating potential biological contributors rather than automatically treating every behavioral presentation as an isolated psychiatric problem.

At the same time, the conversation acknowledges that psychiatric medications can be appropriate and important for some patients.

The larger message is individualized care: evaluate the whole child and determine what combination of supports that particular patient needs.

No Single Cause of Autism

Near the end of the interview, the conversation turns to claims about acetaminophen/Tylenol use during pregnancy and autism.

Dr. DelSignore rejects the idea that there is a simple, single explanation for autism.

She describes autism as potentially involving many interacting factors and argues that research findings about individual exposures need to be interpreted in context rather than reduced to a headline claiming one substance "causes autism."

Her broader point aligns with the philosophy she describes throughout the interview:

There is no simple answer for a complex biological system.

Instead, she looks for what she describes as a "stacking" of contributing factors that may differ substantially from one child to another.

Can Women with Lyme Disease Have Children?

The interview closes on a question that creates tremendous fear for many young women diagnosed with Lyme disease:

Can I safely have a child?

Tick Boot Camp raises the importance of helping women understand congenital Lyme disease, pregnancy, treatment before conception, care during pregnancy, and what parents and clinicians should consider after birth.

Dr. DelSignore agrees that these questions deserve much deeper discussion.

The existence of congenital transmission concerns should not be interpreted as meaning that someone with Lyme disease cannot have a healthy pregnancy or healthy child.

Instead, it reinforces the value of working with knowledgeable healthcare professionals to develop an individualized plan before and during pregnancy.

For a deeper Tick Boot Camp conversation with Dr. DelSignore, listen to Pediatric Lyme, Autism Regression, PANS/PANDAS & Root-Cause Healing.

About Dr. Somer DelSignore

Dr. Somer DelSignore, DNP, BC-PNP is a board-certified pediatric provider and founder of Hudson Valley Integrative Health in Beacon, New York.

Her clinical work focuses on complex chronic illness in children, including neuroimmunology, PANS/PANDAS, autoimmune encephalopathy, autism-spectrum presentations, Lyme disease, and congenital tick-borne illness.

She completed graduate and doctoral education at the University of Pennsylvania and SUNY Upstate Medical University and has pursued advanced mentorship and training in integrative medicine, Lyme disease, PANS, and autism. She developed the R.E.S.E.T. Protocol, a root-cause framework for addressing immune dysfunction.

Dr. DelSignore is also a member of the ILADS Pediatric Committee.

Key Topics in This Episode

Pediatric Lyme disease, congenital Lyme disease, Dr. Somer DelSignore, autism and Lyme disease, autism spectrum disorder, PANS, PANDAS, autoimmune encephalopathy, neuroimmune dysfunction, neuroinflammation, Borrelia, Bartonella, Babesia, Three B's, developmental delays, speech delay, hypotonia, behavioral symptoms, pediatric tick-borne disease, maternal-fetal transmission, congenital tick-borne infections, root-cause medicine, integrative pediatrics, biomedical evaluation, immune dysfunction, psychiatric symptoms, pregnancy and Lyme disease, and pediatric Lyme testing.

About This LIVE from ILADS Interview

This conversation was recorded in person at the 2025 International Lyme and Associated Diseases Society Annual Scientific Conference, From Terrain to Treatment: Advances in Vector-Borne Illness, held October 9–12, 2025, in San Antonio, Texas.

Because these interviews were recorded live at the conference, they have a different feel from Tick Boot Camp's traditional long-form virtual and studio conversations — shorter, focused, and surrounded by the activity of one of the world's major gatherings of Lyme and tick-borne disease clinicians, researchers, advocates, and innovators.

Dr. DelSignore was also a speaker at the conference, where ILADS highlighted her work in integrative pediatrics and personalized treatment for children.

Explore all Tick Boot Camp LIVE from ILADS interviews.

More from Tick Boot Camp

Watch or listen to Tick Boot Camp's long-form interview with Dr. Somer DelSignore for a deeper exploration of pediatric Lyme disease, congenital infection, autism regression, PANS/PANDAS, and root-cause healing.

Hear more conversations with Lyme disease doctors and healthcare professionals, or explore the Tick Boot Camp Podcast for hundreds of patient stories and interviews with doctors, researchers, advocates, and other voices throughout the Lyme disease community.

LIVE from ILADS: Tick Boot Camp sits down with Mindy Tobin Daigle, MSN, APRN-BC, a nurse practitioner whose approach to Lyme disease and complex chronic illness was profoundly shaped by her own experience as a patient.

Before treating people with Lyme disease, Mindy lived it. After years of misdiagnosis, she was diagnosed with Lyme disease in 2010 following earlier tick exposures. Her illness became multisystemic and severe, affecting her heart, brain, joints, gastrointestinal system, bladder, skin, muscles, and more. At her sickest, she describes being bed-bound, wheelchair-bound, experiencing seizures and aphasia, and dependent on others for basic care.

That experience gave her a mission: become the healthcare provider she needed when she was sick and searching for answers.

This conversation goes far beyond Lyme disease treatment. Mindy and Tick Boot Camp explore medical gaslighting, listening to patients, compassion versus empathy, realistic expectations for chronic illness recovery, the importance of self-compassion, finding your physical and emotional "edges," and why progress is often measured in inches rather than feet.

This interview was recorded live at the ILADS conference, so you may hear some of the energy and background activity of the event throughout the conversation.

A Nurse Practitioner Who Became the Patient

Mindy was already a trained medical professional when she became seriously ill.

Her first reported tick bite occurred in South Africa in 1997, followed by additional exposures while she was working as a nurse in Minnesota and Wisconsin.

Despite her medical training and access to healthcare, Lyme disease wasn't initially identified as the explanation for her growing collection of symptoms.

Mindy describes repeatedly mentioning her history of tick bites only to have the possibility dismissed.

Eventually, during a severe pain crisis, physician Dr. Ted Gillespie spent significant time listening to her history and asked a simple question:

What about Lyme disease?

Testing through Labcorp produced a positive Western blot, but Mindy says that even with that result, she continued encountering resistance to the diagnosis.

Eventually, she found her way to Dr. Patricia Salvato in Houston and began treatment.

Becoming the Practitioner She Needed

Mindy made herself a promise during her illness:

If she recovered, she would become the practitioner she had needed when she was lost and sick.

That commitment eventually brought her to ILADS.

At her first ILADS conference in 2013, Mindy heard the late Dr. Christine Green speak. The following week, she cold-called Dr. Green's office in San Francisco and asked if she could shadow her.

That decision turned into a professional relationship lasting more than a decade.

Mindy says her personal development as a Lyme patient became inseparable from her professional development as a clinician.

From Sympathy to Empathy to Compassion

One of the most powerful themes in this conversation is the evolution from sympathy to empathy to compassion.

Mindy describes having sympathy as a young nurse and developing greater empathy with experience.

After becoming seriously ill herself, she says she developed something deeper: compassion.

Her definition of compassion centers on being willing to sit with another person's pain without judgment, interference, or adding to their suffering.

For a Lyme patient who has spent years being dismissed, questioned, rushed, or told symptoms are unexplained, simply encountering a practitioner who genuinely listens can be meaningful.

What Compassionate Lyme Care Looks Like

Compassion isn't simply being nice to patients.

For Mindy, it changes how she practices.

When a patient arrives overwhelmed, crying, angry, frustrated, struggling with technology, or simply exhausted from managing chronic illness, her first goal isn't to rush through a checklist.

She meets the patient where they are.

She tells patients:

We're not in a rush.

The goal is to take the time needed to understand the person in front of her and determine what needs attention.

That approach can be particularly important for patients with complex chronic illnesses who may arrive at an appointment carrying years of symptoms, medical records, failed treatments, fear, and frustration.

Medical Gaslighting & the Importance of Listening

Mindy also discusses the medical dismissal she experienced during her own illness and what patients often describe as medical gaslighting.

The conversation explores why healthcare professionals may dismiss patient experiences even when a patient presents with a complicated history or evidence that warrants further investigation.

Mindy emphasizes something deceptively simple:

Remain curious.

A practitioner doesn't have to immediately know every answer.

But when something doesn't make sense, curiosity can keep the diagnostic process moving instead of shutting the patient down.

For Mindy, listening and believing that a patient is genuinely experiencing what they describe are foundational to the therapeutic relationship.

The Last Five Minutes

Mindy has developed a practice she calls The Last 5 Minutes: 8 Concepts and Contemplations in Healing.

After spending most of an appointment discussing symptoms, medical decision-making, treatment, and care planning, she reserves the final minutes for something different:

Healing.

It's a moment to put the metaphorical pencils down and talk heart-to-heart about what the patient is experiencing beyond laboratory results and treatment protocols.

Her eight concepts and contemplations include:

1. Keyhole Sunset
2. Progress is made in inches, not feet
3. Awareness, Acceptance, Compassion
4. Pain is Information
5. This is your Hero's Journey
6. Healing is possible, with or without a cure
7. Find a micron of joy and build on it
8. Do what you need to do, rest when you need to rest, force nothing

Mindy's original essay on the eight concepts offers a deeper exploration of the philosophy she discusses during this interview.

Progress Is Made in Inches, Not Feet

People with chronic Lyme disease are understandably in a hurry.

They want their health back.

They want their careers, relationships, independence, energy, and lives back.

But recovery doesn't always move at the speed a patient wants.

Mindy prepares patients for the possibility of a long process in which progress isn't perfectly linear.

There can be improvements followed by setbacks.

Instead of interpreting every setback as failure, she encourages patients to recognize that regression can sometimes occur within a larger pattern of progression.

Mindy expands on this philosophy in Progress Comes in Inches, Not Feet.

Self-Compassion During Lyme Recovery

Chronic illness can create a destructive cycle of self-blame.

Patients may think:

Why aren't I better yet?

Did I do something wrong?

Why can't my body handle this?

Why can't I do what I used to do?

Mindy explains that even an excellent medical treatment plan doesn't automatically resolve the patient's relationship with themselves.

Healing may also require learning to stop being at war with your own body.

That doesn't mean giving up on improvement.

It means learning how to pursue improvement without constantly punishing yourself for where you are today.

Her writing on self-compassion and healing explores this balance between accepting present limitations and continuing to move forward.

Finding Your Edges

One of Mindy's most useful metaphors is finding your edges.

After extensive treatment, she reached a point where she could no longer tolerate additional treatment in the same way.

She learned to recognize the boundaries of what her body could currently handle.

Rather than treating those boundaries as permanent walls, she describes living as well as possible within her edges — and periodically testing whether those edges can expand.

If you can stand and wash dishes for five minutes, perhaps eventually you try seven.

Small improvements matter.

Progress in inches can eventually create meaningful change.

Sometimes Progress Means Rest

Pushing isn't always the answer.

Sometimes the next productive step is doing less.

Mindy distinguishes genuine restorative rest from simply lying down while remaining mentally stimulated by television, phones, scrolling, or other distractions.

The challenge is learning when to push an edge and when the body genuinely needs recovery.

That requires awareness, patience, and wisdom.

For a practitioner, it also means understanding that two patients with similar diagnoses may need very different guidance at a particular moment.

A Biopsychosocial Approach to Lyme Disease

Mindy describes her clinical approach as biopsychosocial.

That means considering the patient's:

• Biology
• Psychology
• Social environment
• Physical limitations
• Emotional health
• Relationships
• Stressors
• Daily circumstances

Complex chronic illness doesn't occur in isolation from the rest of a person's life.

Treatment may target infections and physical dysfunction, but healing can also involve how someone relates to their illness, themselves, and the world around them.

Mindy's own experience as both patient and practitioner gives her a particularly personal perspective on those intersections.

Can Having Lyme Disease Make Someone a Different Practitioner?

The conversation explores a provocative question:

Does personally experiencing Lyme disease change someone's ability to care for Lyme patients?

Mindy says her own illness gave her an understanding she didn't have beforehand.

She can recognize nuances between different kinds of fatigue, pain, and physical limitations because she has experienced them.

At the same time, she points to her longtime mentor Dr. Christine Green as an example of an accomplished Lyme clinician who did not personally have Lyme disease.

The distinction isn't that someone must have Lyme disease to become an excellent practitioner.

Rather, lived experience can provide another form of knowledge — one that can complement medical education and clinical expertise.

Working with Ravel Health

At the time of this interview, Mindy had recently begun working with Ravel Health, a virtual care platform focused on complex chronic illness.

She explains that the model gives her greater flexibility to structure her schedule around both her patients' needs and her own ongoing health limitations.

That matters because Mindy continues to manage symptoms herself.

The flexibility allows her to dedicate significant attention to a patient while also building recovery time between demanding appointments.

For Mindy, finding a sustainable way to practice is another extension of the same compassion she encourages patients to develop for themselves.

The Human Capacity to Overcome

The interview ends with hope.

Despite everything Mindy has personally experienced — and everything she sees among people living with complex chronic illness — what repeatedly impresses her is the human capacity to overcome adversity.

She watches patients face enormous physical and emotional challenges, adapt, continue forward, and sometimes emerge with a different understanding of themselves and their lives.

That doesn't minimize how difficult Lyme disease can be.

It recognizes that even within an extraordinarily difficult journey, healing, growth, purpose, and progress remain possible.

About Mindy Tobin Daigle, MSN, APRN-BC

Mindy Tobin Daigle, MSN, APRN-BC is an adult health nurse practitioner with decades of nursing and clinical experience. She has worked extensively with people navigating Lyme disease, vector-borne illness, chronic fatigue, chronic pain, and other complex chronic conditions.

For more than a decade, she collaborated with Lyme disease specialist Dr. Christine Green at Green Oaks Medical Center. Her professional work has been profoundly influenced by her own experience as a Lyme disease patient.

Read Mindy's The Last 5 Minutes: 8 Concepts and Contemplations in Healing and her related writings about progress in chronic Lyme disease and self-compassion during healing.

Key Topics in This Episode

Lyme disease, chronic Lyme disease, Mindy Daigle, Lyme disease nurse practitioner, Lyme disease recovery, medical gaslighting, patient validation, compassion in healthcare, empathy, self-compassion, chronic illness recovery, Lyme disease misdiagnosis, Lyme disease treatment, healing from chronic illness, progress in inches, finding your edges, biopsychosocial medicine, patient-centered care, chronic fatigue, chronic pain, Lyme disease advocacy, Ravel Health, Christine Green, and ILADS.

About This LIVE from ILADS Interview

This short-form conversation was recorded in person at the 2025 International Lyme and Associated Diseases Society Annual Scientific Conference, From Terrain to Treatment: Advances in Vector-Borne Illness, held October 9–12, 2025, in San Antonio, Texas.

Because these interviews were recorded live at the conference, they have a different feel from Tick Boot Camp's traditional long-form virtual and studio conversations — shorter, focused, and surrounded by the activity of one of the world's major gatherings of Lyme and tick-borne disease clinicians, researchers, advocates, and innovators.

Explore all Tick Boot Camp LIVE from ILADS interviews.

More from Tick Boot Camp

Hear more conversations with Lyme disease doctors and healthcare professionals about diagnosis, treatment, recovery, and complex tick-borne illness.

Explore the Tick Boot Camp Podcast for patient stories and conversations with doctors, researchers, advocates, and other members of the Lyme disease community — all designed to educate, validate, build community, and reinforce that healing is possible.

LIVE from ILADS: Tick Boot Camp reconnects with Nicole Bell, CEO of Galaxy Diagnostics, for a focused conversation about one of the biggest challenges in Lyme disease and tick-borne illness: getting an accurate diagnosis.

Bell breaks down the differences between antibody testing, antigen testing, and PCR-based direct detection while explaining why stealth pathogens such as Borrelia, Bartonella, and Babesia can be so difficult to find. She also introduces Galaxy's BBB Direct Detect digital PCR testing, discusses emerging findings involving Babesia species, and explains why a negative antibody test doesn't always tell the entire story.

For Bell, the mission is deeply personal. Her husband, Russ, initially tested negative for Lyme disease and was later diagnosed with Alzheimer's disease before his family ultimately discovered tick-borne infections were part of his complex illness. That experience helped redirect Bell's engineering and medical technology background toward improving diagnostics for other patients searching for answers.

This interview was recorded live at the ILADS conference, so you may hear some of the energy and background activity of the event throughout the conversation.

Why Can Lyme Disease Testing Be So Difficult?

Bell begins by explaining one of the fundamental problems with diagnosing Lyme disease and other tick-borne infections: many of the pathogens clinicians are searching for can be difficult to detect.

Some occur at low levels in the bloodstream. Others may migrate into tissues or circulate intermittently.

Historically, much of tick-borne disease testing has therefore relied on indirect detection — looking for the patient's immune response rather than directly detecting the organism.

Antibody testing can provide useful information, but Bell explains why interpretation can become complicated.

A patient's antibody response can vary depending on factors including:

• Timing of infection
• Individual immune response
• Immune suppression or dysregulation
• Previous exposure
• Previous treatment
• Medications that suppress immune activity
• Cross-reactivity
• Whether an infection is current or historical

This is why Bell views antibody testing as one tool rather than the entire diagnostic toolbox.

Antibody Testing: Detecting the Immune Response

Antibody testing is an indirect testing method.

Instead of looking for Borrelia itself, for example, the test looks for evidence that the patient's immune system has responded to it.

Bell discusses IgM and IgG antibodies and why timing matters.

IgM antibodies are generally associated with an earlier immune response, while IgG responses can take longer to develop. In Lyme disease, that delay creates a particular challenge because early diagnosis and treatment can be especially important.

Some infected patients may mount a strong measurable antibody response, while others may produce a weaker or delayed response.

Bell points to research showing how dramatically immune responses can differ even under controlled experimental conditions.

This creates an important distinction:

A test of the immune response is not necessarily the same thing as a test for the pathogen itself.

When Antibodies Don't Tell the Whole Story

Bell uses her husband's experience to illustrate the stakes.

Russ had likely been ill for years before his most significant symptoms emerged. By then, Bell says his immune system was dysregulated and his overall antibody levels were low.

His Lyme testing was negative, and his worsening cognitive symptoms ultimately led to an Alzheimer's diagnosis.

There is also another side to antibody testing.

A person may have antibodies because of a previous infection even when the original infection is no longer active. That can make it difficult to determine whether persistent symptoms are associated with an ongoing infection, an undiagnosed coinfection, immune dysregulation, or another process.

Bell's point is not that antibody testing has no value. It is that complex tick-borne illness may require more than one diagnostic tool.

Antigen Testing: Looking for Evidence of the Pathogen

The conversation then moves from indirect testing to direct detection.

One method is antigen testing.

Rather than measuring the immune system's response, an antigen test searches for a component associated with the pathogen itself.

Bell discusses Galaxy's work with a urine-based Lyme disease antigen approach designed to capture and concentrate a protein shed by Borrelia.

Why urine?

Bell explains that Lyme-causing Borrelia may not remain abundantly present in the bloodstream. A pathogen-derived protein, however, may be filtered through the kidneys and become detectable in urine.

Galaxy continues to work on direct-detection approaches to Lyme disease testing as it pursues broader clinical adoption and regulatory pathways.

PCR Testing: Searching for Pathogen DNA

Another form of direct detection is PCR testing.

PCR looks for genetic material from the pathogen rather than relying on the patient's antibody response.

Galaxy uses PCR-based approaches for pathogens including:

• Borrelia
• Bartonella
• Babesia

But direct detection presents its own challenge.

These organisms may occur at extremely low levels in a sample.

A patient can be infected while very little pathogen DNA happens to be circulating in the particular blood sample collected that day.

That is where digital PCR, or dPCR, becomes especially interesting.

The Three B's: Borrelia, Bartonella & Babesia

Bell introduces Galaxy's approach to what Tick Boot Camp often calls the Three B's:

Borrelia. Bartonella. Babesia.

As patient and clinician awareness of tick-borne illness has evolved, these three pathogens have become increasingly important to the conversation around complex cases.

Galaxy's BBB Direct Detect digital PCR testing is designed to directly detect DNA from Borrelia, Bartonella, and Babesia.

Unlike an antibody test asking whether the immune system has responded to a pathogen, direct PCR testing asks a different question:

Can we find genetic evidence of the organism itself?

How Digital PCR Searches for Low-Abundance Pathogens

Bell gives a simple analogy for understanding digital PCR.

Imagine searching for a needle in a haystack.

Traditional PCR is trying to identify a tiny amount of pathogen DNA — the needle — among an enormous amount of human genetic material — the haystack.

Digital PCR effectively divides that haystack into thousands of much smaller piles and examines them individually.

That partitioning can make it easier to detect extremely small amounts of genetic material.

Galaxy also uses a culture-enrichment step for Bartonella. The blood sample is placed in an environment designed to encourage Bartonella growth before PCR analysis, increasing the amount of target material available for detection.

Learn more about Galaxy Diagnostics' direct-detection technology and its approaches to Borrelia, Bartonella, and Babesia testing.

Why Are We Seeing So Many Coinfections?

Tick Boot Camp and Bell also discuss an observation that has become increasingly common in patient interviews: many people with complex chronic tick-borne illness aren't reporting only Lyme disease.

Instead, patients frequently describe combinations involving the Three B's and other infections.

Why?

Bell says several factors may contribute.

Diagnostic technology has improved. Clinicians have become more aware of coinfections. Ecological research indicates ticks can carry multiple pathogens.

But Bell raises another important possibility: patients carrying multiple pathogens may also be among those who become the sickest and therefore are disproportionately represented within chronic illness communities.

That distinction matters.

Observing many coinfections among severely ill patients doesn't necessarily mean every tick-borne disease patient has the same microbial picture.

Bartonella, the Immune System & the Tipping Point

Bell discusses Bartonella as an example of the complexity surrounding infection and illness.

Exposure may be more common than many people realize, and Bartonella has multiple potential vectors and reservoirs.

Bell describes a hypothesis in which some people may harbor an infection while their immune system keeps it under control.

Then another infection, environmental exposure, significant stressor, or other immune-disrupting event may alter that balance.

A person who had previously remained relatively healthy may cross what Bell describes as a tipping point and begin experiencing significant illness.

This raises questions researchers are still working to answer.

Were multiple infections transmitted simultaneously?

Did they occur through separate exposures?

Was one infection already present before another destabilized the immune system?

Bell emphasizes that the answer may differ from patient to patient.

Emerging Questions About Babesia

Some of the most intriguing discussion in this interview involves Babesia.

Bell explains that research associated with the North Carolina State University team has identified Babesia species in complex patients beyond the organisms traditionally emphasized in U.S. human babesiosis.

She specifically discusses findings involving Babesia odocoilei and Babesia divergens-like organisms and contrasts those findings with expectations surrounding Babesia microti and Babesia duncani.

Bell also discusses the possibility of low-level parasitemia — infections involving pathogen levels that may be much lower than the classic severe presentation clinicians associate with babesiosis.

These emerging observations raise important research questions about Babesia species, their prevalence, their role in human disease, and whether existing diagnostic assumptions capture the full picture.

Bell is careful in the interview to distinguish between what Galaxy's current assay detects and what researchers may suspect based on sequencing and related scientific work.

Nicole Bell's Personal Mission

Bell's work in tick-borne disease diagnostics grew out of an experience no family wants to have.

Her husband, Russ, developed neurological and psychiatric symptoms, including cognitive problems, anxiety and hallucinations. Despite Bell specifically requesting Lyme disease testing early in his illness, his initial test was negative and his diagnostic journey eventually led to an Alzheimer's disease diagnosis.

Bell later documented her family's experience in her memoir, What Lurks in the Woods.

Today, she brings her engineering background and personal experience together in an effort to improve the diagnostic tools available to clinicians and patients.

From MIT & Duke to Galaxy Diagnostics

Nicole Bell is CEO of Galaxy Diagnostics and an engineer with extensive experience in medical devices and diagnostics.

She earned bachelor's and master's degrees in Materials Science and Engineering from MIT and a master's degree in Biomedical Engineering from Duke University. Before joining Galaxy, she worked in technology and medical-device development, including leadership roles involving diagnostic platforms and FDA submissions.

Bell became CEO of Galaxy Diagnostics in 2024, bringing together her professional background in engineering and diagnostics with the lessons learned through her husband's illness.

The State of Lyme Disease Research

Bell is also the primary author of The State of Lyme Disease Research in the United States for the Center for Lyme Action.

The paper examines gaps in Lyme disease research and outlines recommendations involving fundamental science, diagnostics, prevention, treatment, and research infrastructure.

In this interview, Bell references one particularly important issue explored in that work: delays in Lyme disease diagnosis and treatment are associated with a greater risk of patients experiencing persistent symptoms.

Better testing isn't simply about producing a more sophisticated laboratory report.

It's about helping clinicians get patients appropriate answers earlier.

Key Topics in This Episode

Lyme disease testing, Lyme diagnostics, Nicole Bell, Galaxy Diagnostics, Borrelia testing, Bartonella testing, Babesia testing, Three B's, BBB Direct Detect, digital PCR, dPCR, PCR testing, antibody testing, antigen testing, direct detection, indirect testing, stealth pathogens, Lyme disease antibodies, coinfections, polymicrobial tick-borne disease, low-abundance infections, Bartonella culture enrichment, Babesia microti, Babesia duncani, Babesia odocoilei, Babesia divergens, chronic Lyme disease, diagnostic delays, and tick-borne disease research.

About This LIVE from ILADS Interview

This short-form conversation was recorded in person at the 2025 International Lyme and Associated Diseases Society Annual Scientific Conference, From Terrain to Treatment: Advances in Vector-Borne Illness, held October 9–12, 2025, in San Antonio, Texas.

Because these interviews were recorded live at the conference, they have a different feel from Tick Boot Camp's traditional long-form virtual and studio conversations — shorter, focused, and surrounded by the activity of one of the world's major gatherings of Lyme and tick-borne disease clinicians, researchers, advocates, and innovators.

Explore all Tick Boot Camp LIVE from ILADS interviews.

More from Tick Boot Camp

Hear more conversations with Lyme disease doctors and healthcare professionals about testing, diagnosis, treatment, and complex tick-borne illness.

Explore the Tick Boot Camp Podcast for interviews with patients, doctors, researchers, advocates, and innovators working to improve understanding of Lyme disease and help people move toward recovery.

LIVE from ILADS: Tick Boot Camp reconnects with Dr. Alexis Chesney, MS, ND, LAc for a focused conversation about babesiosis, Lyme disease, coinfections, diagnostic challenges, herbal medicine, recovery, rehabilitation, and what it means to treat the whole person rather than a single infection.

Dr. Chesney is a naturopathic physician and acupuncturist specializing in Lyme disease and other tick-borne illnesses. In this short-form conference interview, she explains why Babesia deserves more attention, how the clinical picture of tick-borne disease has become increasingly complex, and why successful treatment often requires much more than simply targeting microbes.

This interview was recorded live at the ILADS conference, so you may hear some of the energy and background activity of the event throughout the conversation.

Why Babesia Deserves More Attention

One of the main focuses of this conversation is babesiosis, a tick-borne infection caused by Babesia parasites.

Dr. Chesney explains that Babesia differs fundamentally from Lyme disease because the organism infects red blood cells. That difference affects both how the disease presents and how practitioners approach diagnosis and treatment.

Symptoms discussed in the interview include:

• Night sweats
• Air hunger
• Heart palpitations
• Fatigue
• Symptoms related to red blood cell involvement
• Persistent symptoms that remain after other infections have been addressed

Dr. Chesney emphasizes that a patient may improve from treatment directed at Borrelia while continuing to experience symptoms that point toward Babesia or another coinfection.

A Naturopathic Approach to Babesiosis

Dr. Chesney recently published The Diagnosis and Treatment of Babesiosis: A Naturopathic Approach to an Emerging Tick-Borne Disease.

Her article examines babesiosis from an integrative perspective, including epidemiology, clinical presentation, testing, pharmaceutical treatment, botanical medicine, and supportive naturopathic care.

In the interview, she discusses combining conventional and natural approaches rather than viewing them as mutually exclusive.

She describes using pharmaceutical therapies such as atovaquone and azithromycin when appropriate, followed by or combined with botanical strategies intended to address Babesia and support the patient's overall physiology.

Herbal Medicine & Supporting the Body

Dr. Chesney's approach goes beyond simply trying to eliminate an organism.

She discusses botanical medicine that may help address Babesia while also supporting the red blood cells and other systems affected by infection.

Her broader point is that treatment should consider both sides of the equation:

How do we reduce the microbial burden, and how do we help the body function better while we do it?

That whole-person approach is a central theme of naturopathic and integrative medicine.

Dr. Chesney's published work discusses botanical options including Japanese knotweed, cryptolepis, Artemisia annua, Chinese skullcap, Bidens pilosa, and Sida acuta, along with supportive strategies intended to address detoxification, immune function, and tissue protection.

Lyme Disease Is Increasingly a Polymicrobial Picture

Tick Boot Camp and Dr. Chesney also discuss how the clinical picture of Lyme disease has changed.

Increasingly, patients are not presenting with only Borrelia.

Instead, clinicians may encounter combinations involving:

• Lyme disease
• Babesiosis
• Bartonellosis
• Anaplasmosis
• Other tick-borne infections
• Reactivated or latent viruses
• Long COVID
• Immune dysfunction
• Overlapping chronic conditions

Dr. Chesney explains that these overlapping illnesses can produce similar symptoms, making careful clinical investigation especially important.

This is one reason experienced practitioners matter.

Testing can be useful, but the clinical picture remains an essential part of diagnosis and treatment planning.

Babesia Testing & the Clinical Picture

The conversation also explores the limitations of testing.

Dr. Chesney discusses using different diagnostic tools depending on the situation, including PCR, antibody testing, and Babesia FISH testing.

She emphasizes that laboratory results must be interpreted alongside symptoms, history, exposure, and the patient's response to treatment.

For example, a patient who continues to experience night sweats, air hunger, or palpitations after other aspects of treatment may warrant further evaluation for Babesia even when earlier testing has been inconclusive.

The message is not that patients should diagnose themselves.

It is the opposite: complex tick-borne illness often requires an experienced clinician who understands both the strengths and limitations of available diagnostics.

Why Patients Shouldn't Have to Become Their Own Doctors

One important part of the interview addresses a common experience in the Lyme community: patients often become extremely educated because they have struggled to find appropriate care.

That education can be empowering, but Dr. Chesney and Tick Boot Camp emphasize that patients should not be forced to manage complex infectious disease on their own.

Lyme disease and associated infections can involve multiple pathogens, immune dysfunction, overlapping symptoms, changing clinical presentations, and imperfect diagnostic tools.

Finding an experienced practitioner who understands these complexities can make a tremendous difference.

Dr. Chesney describes spending substantial time gathering patient history and looking for patterns rather than simply treating laboratory values.

A Whole-Person Recovery Framework

The conversation then moves beyond diagnosis and antimicrobial treatment into the broader recovery process.

Tick Boot Camp shares its PARM framework:

• Prehabilitation
• Assist
• Rehabilitation
• Maintenance

Dr. Chesney discusses how this framework aligns with what she sees clinically.

Not every patient is physically ready to begin aggressive antimicrobial therapy immediately.

Some patients may first need support involving:

• Nutrition
• Sleep
• Movement
• Stress reduction
• Immune support
• Detoxification pathways
• Liver support
• Lymphatic support
• Kidney support

For people who have been chronically ill for years, strengthening the body before more intensive treatment can be an important part of the process.

Rehabilitation After Chronic Lyme Disease

Getting through antimicrobial treatment does not necessarily mean recovery is finished.

Dr. Chesney discusses the importance of rehabilitation and reconditioning, especially for patients who have spent months or years significantly limited by illness.

Physical therapy can become an important tool for patients who have lost strength, endurance, mobility, or confidence in their bodies.

The conversation highlights a reality that many recovering patients discover:

There can be a period between treating illness and fully returning to life.

That phase deserves attention too.

Maintenance, Prevention & Avoiding Reinfection

Recovery also includes learning how to protect the progress that has been made.

Dr. Chesney has made tick-bite prevention a major focus of her work after repeatedly seeing patients recover from Lyme disease only to experience another tick bite and a new infection.

Her book, Preventing Lyme & Other Tick-Borne Diseases, is designed as a practical field guide covering tick identification, tick-bite prevention, landscape strategies, what to do after a bite, and information about common tick-borne diseases.

The goal is not to create fear around the outdoors.

It is to help people enjoy life while understanding how to reduce risk.

Lifestyle, Resilience & Long-Term Health

The final portion of the conversation expands even further.

Dr. Chesney and Tick Boot Camp discuss how recovery from chronic illness can become an opportunity to reevaluate the foundations of health.

That may include:

• Better nutrition
• Consistent sleep
• Exercise and movement
• Stress management
• Reducing unnecessary exposures
• Rebuilding strength
• Supporting emotional health
• Supporting spiritual health
• Developing sustainable habits

For many people, recovering from Lyme disease is not simply about returning to exactly who they were before becoming sick.

It can become a process of learning the body more deeply and building a healthier life moving forward.

About Dr. Alexis Chesney

Dr. Alexis Chesney, MS, ND, LAc is a naturopathic physician, acupuncturist, author, and educator specializing in Lyme disease and other tick-borne illnesses.

She trained with Dr. Richard Horowitz and has spent years treating patients with Lyme disease, babesiosis, Bartonella, and other complex vector-borne conditions.

Dr. Chesney has also served in leadership roles with the International Lyme and Associated Diseases Society, including work with its Naturopathic Medicine Committee and physician training programs.

She is the author of Preventing Lyme & Other Tick-Borne Diseases, a practical guide to tick identification, prevention, tick bites, and tick-borne illness.

Read Dr. Chesney's article The Diagnosis and Treatment of Babesiosis: A Naturopathic Approach to an Emerging Tick-Borne Disease for a deeper look at the subject discussed in this episode.

Key Topics in This Episode

Lyme disease, babesiosis, Babesia, Bartonella, tick-borne disease, coinfections, Dr. Alexis Chesney, naturopathic medicine, herbal medicine, Babesia treatment, Babesia testing, Babesia FISH, atovaquone, azithromycin, botanical medicine, immune support, detoxification, chronic Lyme disease, polymicrobial infection, tick prevention, Lyme disease prevention, physical rehabilitation, whole-person medicine, integrative medicine, functional medicine, Lyme recovery, and tick-bite prevention.

About This LIVE from ILADS Interview

This short-form conversation was recorded in person at the 2025 International Lyme and Associated Diseases Society Annual Scientific Conference, From Terrain to Treatment: Advances in Vector-Borne Illness, held October 9–12, 2025, in San Antonio, Texas.

Because these interviews were recorded live at the conference, they have a different feel from Tick Boot Camp's traditional long-form virtual and studio conversations — shorter, focused, and surrounded by the activity of one of the world's major gatherings of Lyme and tick-borne disease clinicians and researchers.

Explore all Tick Boot Camp LIVE from ILADS interviews.

More from Tick Boot Camp

Hear more conversations with Lyme disease doctors and healthcare professionals about testing, treatment, recovery, and complex tick-borne illness.

Explore the Tick Boot Camp Podcast for interviews with patients, doctors, researchers, advocates, and others working to improve understanding of Lyme disease and help people move toward recovery.

LIVE from ILADS: Tick Boot Camp sits down with David W. Kazarian, RPh, pharmacist and founder of Infuserve America, for a focused conversation recorded in person at the ILADS Annual Scientific Conference.

In this short-form conference interview, Kazarian explores how compounding pharmacy can give practitioners additional options for Lyme disease and tick-borne illness patients dealing with medication sensitivities, reactions to fillers and excipients, alpha-gal syndrome, absorption challenges, and other complexities. With decades of experience working with the Lyme community, he explains why changing the formulation of a medication — not just the active ingredient — can sometimes become an important part of individualized care.

This interview was recorded live on the conference floor, so you may hear some of the energy and background activity of ILADS throughout the conversation.

What Is Compounding Pharmacy?

Kazarian describes compounding as both a science and an art.

Commercial medications generally come with predetermined doses, capsules, fillers, dyes, and delivery methods. Compounding gives a pharmacist, working with a prescribing practitioner, the ability to customize certain aspects of a medication for an individual patient's needs.

Depending on the prescription and patient, that can include changes to:

• Medication strength or dosage
• Fillers and excipients
• Capsule materials
• Carrier oils
• Route of administration
• Release characteristics
• Topical or oral formulations
• Sterile or non-sterile preparations

For people navigating complex Lyme disease and other tick-borne illnesses, those details may become particularly important when medication sensitivities develop or change over time.

Excipients, Fillers & Medication Sensitivities

One of the most important topics in this conversation is excipients — ingredients in a medication other than its primary active pharmaceutical ingredient.

Kazarian discusses patients who may have difficulty tolerating ingredients such as dyes, magnesium stearate, titanium dioxide, gelatin capsules, certain carrier oils, animal-derived ingredients, and other fillers.

For a highly sensitive patient, the question may therefore extend beyond "Can I tolerate this medication?" to "Can I tolerate this particular formulation of the medication?"

A compounding pharmacist may be able to work with the prescribing practitioner to explore alternative formulations when appropriate.

Alpha-Gal Syndrome & Animal-Derived Ingredients

The conversation also explores alpha-gal syndrome, a tick-associated allergy that can make mammalian-derived ingredients problematic for some patients.

Kazarian uses capsules as one example. Traditional gelatin capsules may contain animal-derived materials, while alternative formulations can use vegetable-based capsules.

He also discusses carrier oils and other excipients, including MCT, almond, and olive oils, illustrating how even the inactive components of a medication may need to be considered for an individual patient.

For people experiencing unexplained new sensitivities, the discussion provides an important takeaway: the active medication isn't necessarily the only ingredient worth investigating.

Why Can Medication Tolerance Change?

Many people living with Lyme disease and other complex chronic illnesses report becoming sensitive to foods, supplements, medications, or other substances they previously tolerated.

Kazarian discusses immune dysfunction as one possible piece of this complicated picture and explains why changing medication tolerance deserves investigation.

This is especially relevant for Lyme patients who experience symptoms that change, migrate, or seem disconnected from one another.

Rather than automatically dismissing a new reaction because a medication was previously tolerated, the episode explores why practitioners may need to look more closely at both the patient's changing health and the medication's ingredients.

Lyme Disease, Coinfections & Complex Illness

Kazarian prefers looking broadly at tick-borne illness rather than focusing exclusively on Borrelia.

The conversation discusses the polymicrobial nature of tick-borne disease, including coinfections and the potential involvement of immune and inflammatory processes.

That complexity leads to one of the central themes of the interview:

There isn't necessarily one recipe for every patient.

Patients can present differently, tolerate treatments differently, and require different approaches as their health changes.

Carrier Oils, Microemulsions & Medication Absorption

Kazarian also explains the role of carrier oils and what he describes as microemulsions.

Depending on the medication and formulation, these techniques may be used to influence delivery, absorption, or gastrointestinal tolerance.

He describes the concept simply as surrounding a drug with fat and explains why understanding the chemistry of both the active medication and its delivery system can be an important part of pharmaceutical compounding.

Thyroid Medication as an Example of Precision Medicine

Kazarian uses thyroid medication to demonstrate how individualized investigation and compounding can work together.

The discussion touches on TSH, T3 and T4, free T3 and free T4, reverse T3, iodine, ferritin, medication ingredients, animal-derived ingredients, bioidentical formulations, and sustained-release compounding.

The thyroid discussion serves as a larger example of the questions that can arise with a complex patient: Is the medication itself the problem? Could an inactive ingredient be contributing? Is the formulation appropriate? Is something else in the patient's clinical picture being overlooked?

These are questions for the patient's healthcare team to investigate rather than assuming there is a one-size-fits-all answer.

Precision Medicine & the Pharmacist's Role

A major theme throughout the interview is precision medicine.

Kazarian describes the compounding pharmacist as another resource for the treating practitioner when conventional medication options create challenges.

Depending on the individual situation, a pharmacist and prescribing clinician may consider a different formulation, excipient, dosage form, route of administration, release method, or active ingredient when clinically appropriate.

Kazarian is also clear about something important: the pharmacist does not replace the patient's practitioner.

Instead, the pharmacist can become another member of the team, helping the practitioner explore additional options when they encounter a medication-related obstacle.

Sterile & Non-Sterile Compounding

Infuserve America provides both sterile and non-sterile compounding.

Non-sterile compounding can include customized capsules, tablets, topical preparations, and other formulations. Sterile compounding includes preparations requiring specialized sterile environments and procedures, including certain injectable and intravenous medications.

With Infuserve America's background in home infusion, Kazarian also discusses prescribed IV therapies, PICC lines and ports, intravenous medications, nutritional IV preparations, Myers' cocktails, and high-dose vitamin C.

Giving Practitioners More Tools

Perhaps the most important message from Kazarian is that compounding isn't about replacing the doctor or allowing patients to prescribe for themselves.

It's about giving practitioners more tools.

Kazarian describes receiving calls from practitioners who have reached a difficult point with a patient and want to know what other options may be available.

Could an excipient be changed? Could another route of administration work? Could the medication be prepared differently?

Those conversations between practitioners and pharmacists can create possibilities that aren't available with an off-the-shelf medication.

Patients interested in exploring compounding with their healthcare provider can learn more about working with Infuserve America.

About David W. Kazarian, RPh

David W. Kazarian, RPh is a registered pharmacist and founder of Infuserve America with decades of experience in pharmacy, home infusion, sterile and non-sterile compounding, and working with the Lyme disease community.

His approach emphasizes collaboration between the pharmacist, practitioner, and patient to identify individualized solutions when conventional medication formulations present challenges.

Key Topics in This Episode

Lyme disease, tick-borne illness, compounding pharmacy, David Kazarian, Infuserve America, medication sensitivities, medication intolerance, excipients, fillers, alpha-gal syndrome, precision medicine, personalized medicine, immune dysfunction, carrier oils, microemulsions, thyroid medication, medication absorption, sterile compounding, home infusion, IV therapy, and practitioner-pharmacist collaboration.

About This LIVE from ILADS Interview

This short-form interview was recorded in person at the 2025 International Lyme and Associated Diseases Society (ILADS) Annual Scientific Conference, From Terrain to Treatment: Advances in Vector-Borne Illness, held October 9–12, 2025, in San Antonio, Texas.

Tick Boot Camp was onsite interviewing doctors, researchers, healthcare professionals, advocates, and innovators working across Lyme disease and vector-borne illness.

Explore all Tick Boot Camp LIVE from ILADS interviews to hear more conversations from the conference.

More from Tick Boot Camp

Hear more conversations with Lyme disease doctors and healthcare professionals about testing, treatment, complex chronic illness, and emerging approaches to tick-borne disease.

Explore the Tick Boot Camp Podcast for interviews with patients, doctors, researchers, advocates, and other members of the Lyme disease and tick-borne illness community.

What happens when a conventionally trained physician watches someone he loves struggle with years of unexplained, multisystem illness—and eventually discovers that Lyme disease and Bartonella may have been part of the picture all along?

In this episode of the Tick Boot Camp Podcast, hosts Matt Sabatello and Rich Johannesen sit down with Raphael “Tito” Balbino, MD, a physician trained in Family Medicine and Geriatrics who now leads Mandarin Wellness Center, a functional and integrative medicine practice in Jacksonville, Florida.

Dr. Balbino’s path into Lyme disease and complex chronic illness was not planned.

Born and raised in Rio de Janeiro, Brazil, Dr. Balbino moved to the United States as a teenager. His fascination with anatomy eventually led him to study human biology at UC San Diego, attend medical school at the University of Illinois Chicago, and complete postgraduate training in Family Medicine and Geriatric Medicine in North Carolina.

But while his medical career was developing, something much more personal was happening at home.

When His Wife’s Illness Changed Everything

Throughout medical school and residency, Dr. Balbino watched his wife experience a changing collection of symptoms including headaches, brain fog, sleep problems, gastrointestinal issues, anxiety, fatigue, and gallbladder attacks.

The symptoms appeared across different systems and at different times. Yet despite interacting with the conventional medical system, no one seemed able to step back and identify a unifying explanation.

Dr. Balbino describes watching his wife being treated as a collection of individual problems rather than as one interconnected patient.

Eventually, she began doing her own research and exploring nutrition, gut health, anti-inflammatory strategies, and functional medicine. Dr. Balbino credits that work—particularly addressing the gut and inflammation—with helping her become substantially more functional.

Years later, Dr. Shirley Hartman helped them investigate another possibility. Testing reportedly identified evidence consistent with multiple Borrelia strains as well as Bartonella, providing a new framework through which they could reconsider decades of seemingly disconnected symptoms.

That experience would ultimately transform not only his wife’s health journey, but Dr. Balbino’s approach to medicine.

Why Lyme Disease Can Be So Difficult to Recognize

Dr. Balbino reflects on how little emphasis tick-borne disease received during his conventional medical education.

He remembers learning the classic associations—tick exposure, characteristic rashes, acute presentations—but says there was little emphasis on the epidemiology or the complicated, multisystem presentations he would later encounter in practice.

During residency, he treated a patient with an acute presentation of Rocky Mountain spotted fever, including a characteristic rash and treatment with doxycycline. Looking back, he contrasts cases like that with patients whose symptoms develop gradually, migrate, fluctuate, or involve multiple systems.

Today, Lyme-related referrals are the largest referral source at Mandarin Wellness Center, where Dr. Balbino sees patients ranging from those who have no idea why they are chronically ill to experienced Lyme patients searching for additional options.

For more conversations with physicians working in Lyme and tick-borne disease, explore the Tick Boot Camp Doctors Podcast Directory.

Lyme Disease Beyond the Northeastern United States

The conversation also explores an important misconception: that Lyme disease is primarily a Northeastern U.S. problem.

Dr. Balbino discusses his Brazilian background, his wife’s childhood exposure to rural environments in Brazil, and how learning about Lyme cases in Brazil expanded his understanding of the global nature of tick-borne illness.

He specifically references a previous Tick Boot Camp interview about Lyme disease in Brazil that helped change his perspective.

Gut Health, Inflammation, and the Nervous System

One of the most personal portions of the interview involves Dr. Balbino’s description of his wife’s experience with years of intrusive anxiety and worrisome thoughts.

He explains that counseling and other approaches did not seem to resolve those symptoms, but that significant improvement followed her work on gut health and an anti-inflammatory diet.

The conversation expands into the complex relationship between:

• gut health
• inflammation
• immune regulation
• autoimmunity
• mast cell activation
• the nervous system
• chronic stress
• neurological symptoms

More recently, Dr. Balbino says his wife has also made additional progress through nervous system training and regulation.

For listeners interested in this area, Tick Boot Camp has also explored nervous system regulation and neuroplasticity with Cathleen King of Primal Trust and Lindsay Mitchell of Vital-Side.

Building an Individualized Lyme Disease Treatment Strategy

Dr. Balbino emphasizes that patients arrive at his practice at very different stages and therefore may require very different approaches.

For acute presentations, he discusses situations where antibiotics can play an important role. For chronic and complex patients, his approach may also incorporate herbal protocols, detoxification support, organ support, nutrition, vitamins, minerals, and other functional medicine strategies.

Rather than presenting one treatment as appropriate for everyone, the discussion highlights the need to understand the individual patient, their history, their tolerance for treatment, and the factors that may be keeping them stuck.

SOT / Q-REstrain for Lyme and Tick-Borne Infections

The conversation takes a deeper dive into Supportive Oligonucleotide Therapy (SOT), which Dr. Balbino discusses under the newer name Q-REstrain.

He explains why his practice became interested in the therapy, including exposure through ILADS education and conversations with patients and families who reported significant improvements.

Matt and Rich ask Dr. Balbino to explain the therapy, how it differs from antibiotics and herbal approaches, and where he believes it may fit within a broader treatment strategy.

Listeners interested in another physician’s perspective can also hear Tick Boot Camp’s discussion of SOT with Dr. Hank Sloan.

Frequency Specific Microcurrent (FSM)

Another major portion of the episode explores Frequency Specific Microcurrent (FSM).

Dr. Balbino explains the concept of pairing specific frequencies with targeted tissues or physiological processes. He discusses using customized programs intended to address issues such as inflammation, pain, joints, ligaments, adhesions, and other patient-specific concerns.

He contrasts FSM with technologies such as TENS units and Rife-type devices and describes how patients may use programmed frequency combinations over a set period of time.

Dr. Balbino also shares patient experiences from his practice, including a nurse with longstanding pain and arthritis who incorporated FSM into her care.

TruDOSE Platelet IV Therapy and Regenerative Medicine

The conversation also explores TruDOSE Platelet IV Therapy, a regenerative therapy Dr. Balbino has incorporated into his practice.

Dr. Balbino explains that the treatment uses a patient’s own blood, which is processed to concentrate platelets before the platelets are administered intravenously. He discusses platelets not simply in the context of blood clotting, but as carriers of growth factors and signaling molecules involved in inflammation, repair, and healing.

One aspect that particularly interests Dr. Balbino is the attempt to standardize the platelet dose. Rather than simply preparing platelet-rich plasma without knowing the exact concentration being delivered, he describes the TruDOSE process as measuring platelet levels before and after processing to provide a more individualized dose.

Dr. Balbino shares several memorable patient experiences that have shaped his interest in regenerative medicine, including patients dealing with traumatic brain injury, neurological dysfunction, chronic pain, PTSD-like symptoms, and vision problems.

One case involved a patient with longstanding neurological injuries who reported unexpected changes after treatment, including improvements in areas that had not been the original focus of therapy. Another patient with a history of traumatic brain injury and significant visual impairment reported improvements in vision following treatment.

These individual patient experiences have challenged some of Dr. Balbino’s previous assumptions about what may be possible for people dealing with longstanding dysfunction.

For a physician who originally trained in geriatrics—where much of medicine can involve managing decline—seeing patients report improvements in functions they believed were permanently lost has helped reshape the way he thinks about aging, chronic illness, repair, and healing.

From Conventional Geriatrics to Complex Chronic Illness

Dr. Balbino’s professional transformation is one of the central themes of this episode.

His wife’s health journey first opened his mind to approaches outside his conventional training. Later, his relationship with Dr. Shirley Hartman exposed him more deeply to Lyme disease, functional medicine, and complex chronic illness.

Dr. Hartman had practiced for decades before preparing for retirement, and Dr. Balbino eventually stepped into the practice she had built.

Following her passing, he describes initially feeling the enormous weight of continuing the work of a physician whose patients would tell him that she had “saved” their lives.

Over time, that pressure evolved into something different: a commitment to continue serving the community and carrying forward what he learned from her.

A Physician’s Mission to Serve

Near the end of the interview, Dr. Balbino explains how working with chronically ill patients has fundamentally changed his relationship with medicine.

Patients with Lyme disease and complex chronic illness often arrive after years of suffering, failed treatments, unanswered questions, and feeling unheard.

That experience has created what Dr. Balbino describes as almost a family environment within his practice—a community connected by a shared understanding of suffering.

His philosophy today is simple: his job is to serve the person sitting in front of him.

And if he is not the right person to help them, he wants to help connect them with someone who may be.

For patients who have spent years searching for answers, that willingness to listen, remain curious, and continue looking for options can itself be powerful.

Topics Discussed

• Dr. Raphael “Tito” Balbino’s journey from Brazil to the United States
• Medical school and training in Family Medicine and Geriatrics
• His transition from conventional medicine to functional and integrative care
• His wife’s decades-long chronic illness journey
• Lyme disease and Bartonella
• Migrating and multisystem symptoms
• Why Lyme disease can be missed in conventional medical settings
• Lyme disease and tick exposure in Brazil
• Gut health and the immune system
• Anti-inflammatory nutrition
• Intrusive thoughts, anxiety, and inflammation
• Nervous system regulation
• Mast cell activation and immune dysregulation
• Antibiotics versus herbal Lyme protocols
• Detoxification and organ support
• Supportive Oligonucleotide Therapy (SOT)
• Q-REstrain
• Frequency Specific Microcurrent (FSM)
• Chronic pain and inflammation
• TruDOSE Platelet IV Therapy
• Platelets, growth factors, and regenerative medicine
• Systemic inflammation and tissue repair
• Traumatic brain injury and neurological symptoms
• Vision changes discussed in patient experiences
• Dr. Shirley Hartman’s influence and legacy
• Physician burnout and caring for complex patients
• Faith, service, purpose, and healing
• Why individualized care matters in chronic Lyme disease