Lyme Disease: Expert Answers to Complex Questions Health Radio October 16, 2007 Jorge Benach Ph.D. Introduction

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1 Lyme Disease: Expert Answers to Complex Questions Health Radio October 16, 2007 Jorge Benach Ph.D. Please remember the opinions expressed on Patient Power are not necessarily the views of Health Radio, our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. Please have this discussion you re your own doctor, that s how you ll get care that s most appropriate for you. Introduction Hello once again. Thank you for joining us. I'm Andrew Schorr. This is Patient Power live on Health Radio Network. This is what we do, connect you with leading experts, help you understand important health concerns. So we're going to talk about that in a second but I have to tell you folks I'm a big baseball fan, and I also believe in the underdog. If you've been watching now in mid October the baseball play offs, and my Seattle Mariners are certainly not in it. I'm so excited for the people of Colorado and the Colorado Rockies. What is it? They've won 21 of 22 games, sweeps as they go to the post season. Good luck to them. I have friends in Boston, and we'll see what happens to them between them and Cleveland but congratulations to the Colorado Rockies. It's really fun to see that night. That's what I love about sports, that sort of anything can happen. Well, what we devote ourselves to every day to though, beyond catching up on sports, is of course your health concerns, and we invite your calls today. I live in Seattle and one of the conditions we have not had to think about much is Lyme disease that you can get from deer ticks, and we're going to learn a lot more about it. But if I were back home where I grew up in New York state, I'd have to think about it a lot. Whether I was out in the back yard or whether I went for a hike in the woods it would be something very real, certainly in the summer and in the early fall. Would I get some kind of bite and could that be life changing even with the effects of the illness. So what we decided to do on Patient Power since we have a huge library of discussion on medical topics is, hey, we haven't done anything on Lyme disease so Tamara, our producer is so astute, she said, Okay, who is one of the recognized world experts? Let's go see if he can do a program with us. Here he is, Dr. Jorge Benach, and he is director at the Center For Infectious Diseases at the Stoney Brook University Medical Center at the State University of New York on Long Island, and he is also chairman of the department of molecular genetics and microbiology. 1

2 And back in the 80s, I guess it was, Dr. Benach, you made the, I'm told, the landmark discovery of the organism that causes Lyme disease. Thank you so much for being with us, sir. Thank you. Very happy to be here as well. And, yes, that is correct. In the early 80s I and a group of other individuals were working on other organisms that are carried by ticks, and it became apparent that one particular organism, which we call a spirochete, and the name tells you that it is a spiral bacteria, was the culprit for the cases of Lyme disease that we were seeing in our environment. Since then it has become a lot easier to work with this organism once we had it identified and we were able to culture it in the laboratory. What is Lyme Disease? Okay. Well, we're going to talk a lot more about the science and also how it's affected people. Now, let's see if I get this right. What is Lyme disease? Lyme disease is an infectious disease caused by bacteria that are spread by, as Dr. Benach was just saying, tiny infected ticks, typically deer ticks, right, Dr. Benach? That's correct. Lyme disease is what we call an inflammatory infection. There is the bacteria or the spirochetes that actually cause the infection. However, it is the host response, it is what we do in order to fight the spirochete that sometimes actually is what causes the disease. It's the inflammation that is our response to the organism that gives us the manifestations of the disease itself. Now, I know it's not a fatal condition, but for many people it becomes chronic and for many people it becomes debilitating. I was looking on the website of the Lyme Disease Foundation, one of the organizations that deals with this, and they have the faces of Lyme disease. And I'm reading right now, just reading the story of a police officer from Fairfield County, Connecticut, and he went from doctor to doctor for a while. Why is it hard for this to be recognized, either have tests that are positive for it always? Why is it difficult to pin down, because many people go through sort of vague symptoms, headache, fatigue, etc., besides the joint pain. And of course it could be a lot of other things but why is it hard to diagnose Lyme disease? There is one major feature about Lyme disease that makes it difficult, and that is that very often the different manifestations of the disease are not in close sequence. And some of them are relapsing, some of them are remitting. For example the arthritis of Lyme disease can begin months to years after there was an initial skin lesion. So very 2

3 often it's very difficult to put together a skin lesion that may have happened two or three years earlier with a manifestation of inflammation of for example the knee joints. So though this maybe an associated event, sometimes it's very difficult to put together. And I think this is the hallmark of this infections with spirochetes is the fact that it takes them a very long time to play out their natural history. That's one reason that they are difficult to diagnose. Signs of Lyme Disease Okay. Now, let me see if I get this right. So typically somebody gets bitten by a deer tick, they may not even be aware of it, and they get this kind of bulls eye-looking bite on their skin. They may notice it, they may not, but that's the first indication? Yes. The first indication is what's called the cutaneous face of the disease, and it is exactly the way you mention it. It's usually bulls eye skin lesion, and I stress the word "usually." There are many different morphologies to the lesion, which by the way is called an erythema mygrans. Erythema means red in Latin, and mygrans mean that is it grows. So it is a lesion that actually enlarges for a period of time. And this is the first of the lesions that one can see in Lyme disease. Some patients either do not notice or didn't have a lesion in the skin. My personal bias is that they probably didn't notice it simply because of the place on the body that it may be occurring, for example in the scalp or in the back where you cannot really see it. And for those people then the situation becomes a little more difficult because they never had a point of origin. You can never go back and remember that you had that lesion. Right. Now, I'm just reading. I know some people's immune systems react differently so I know there are signs that can go along with it. You can have flu-like symptoms, itching, hives, redness of the cheeks under the eyes, swollen eyelids, fever, headache, stiff neck, aching muscles and joints, fatigue, sore throat. Oh, my, it sounds terrible. And I know these symptoms can go away sometimes, but the person remains affected, and without medical treatment it can come back again. It can show up back. You're right. It can come back. It may not necessarily come back in the same form that you had it before. 3

4 Dr. Benach, we're going to take a break because I want to hear a lot more of your answer. We're discussing Lyme disease with a world expert, the man who with his group ask discovered the organism. We're going to learn a lot more about it, see if it's at work in your family, or how you can treat it or maybe keep it from happening to you. Stay with us. Progression of Lyme Disease Welcome back live on Health Radio Network. Andrew Schorr here with Patient Power. Please take a look at my website too, patientpower.info. I meet some incredible people. On Sunday I did a program with a 16-year-old girl who when she was 13 ended up being diagnosed what looked like a bug bite but hers turned out to be really the worst, and that would be malignant melanoma, a scary cancer that starts in the skin and spreads, and it started to spread for her. But she's had a variety of treatments, and she's doing well, Katie Bunker. I wrote a blog about her on my website on patientpower.info. But the replay is there, and I think you'll get a lot of inspiration from Katie. So take a look and all our replays on healthradio.net. But let's go back to today's discussion, which is with a world expert in Lyme disease. I don't think about Lyme disease a lot in the Seattle area, but I was walking the dog this morning and talked to a friend of mine, Linda, who moved from Boston. She said she went back there this summer and was talking to some of her friends. There were three children with Lyme disease, and you know, got it in the back yard or on a hike or wherever, in the park, quite worrisome. So with us is Dr. Jorge Benach, who is director for the Center For Infectious Diseases at Stoney Brook University Medical Center out on Long Island in New York. Dr. Benach, we were talking about the progression of Lyme disease. So we were talking about how these symptoms, and I gave this whole long list and I know it varies by person, can go away, but then they can come back. So help us understand the progression of Lyme disease. There is literally two stages to Lyme disease. There is the cutaneous form, which is the initial lesion, which I mentioned, called erythema mygrans. And that can go away by itself sometimes even without antibiotic treatment. But that is for the organisms are constrained within the skin. They haven't migrated anywhere. When the organisms break out of the skin and seek other organ systems, such as for example the joints or other parts, distant parts of the skin or the nervous system or even the heart, then this is what we call the disseminated stage of Lyme disease. 4

5 And these stages don't always occur immediately following the skin lesion. Sometimes they are separated by a period of time. So the patient may have, say, for example an inflamed knee, very often may not remember the fact that there may have been a skin lesion several months or even maybe a couple of years before. So it is this jumpiness about the manifestations of the disease that makes it very often very difficult to diagnose. And the manifestations don't always follow a very rigid pattern. Some patients can develop neurologic manifestations. Some other patients can develop arthritis. Some other patients can develop carditis, and these are the most prominent of the secondary or disseminated stage of Lyme disease. Treatments Now, let's go back and talk about if you were aware that you had a deer tick bite. What treatments are available that can get rid of the organism? Well, there's been a lot of work that has been done in the treatments, and there is actually a periodical update on what are the more critical antibiotics and their use in managing this disease. But the disease is responsive to antibiotics. You can do oral antibiotics and you also can do intravenous antibiotics, depending on where you are in the disease. The earlier you treat the disease the easier and the better because you can break the cycle and impede the fact that there may be other manifestations down the road. Can the antibiotic, though, kill it if you catch it early so you can be done with it? In general the antibiotics do kill the organisms, and you can achieve what's called a microbiological cure. In cases of some patients that may have had Lyme disease for a very long time where let's take for example the arthritis manifestation where the joints have been harmed by the presence of the organisms over a long period of time, even though you may achieve a biological cure your manifestations may not go way because the damage that occurred to the organ is not going to be reversed by the fact that the organisms are not there. But the good news is that once the organisms are not there it won't get worse. So there are some patients that will continue to experience pain simply because the infection was lodged in there for so long. Right. Dr. Benach, one of the things though I see just from reading stories of people is because the symptoms can be variable and, as we said, the initial tick bite may not have even been realized and happened a long time before, it must be difficult, you go to the 5

6 doctor or the clinic the nurse practitioner, physician's assistant, whoever you see, and it's not diagnosed. It could be so many other things. Is there a particular blood test or one way to say for sure you have Lyme disease? Let me give you a little bit of information to put it all in perspective. If you have a sore throat and it's red and you have white pustules in your throat, you can take a swab and culture and you could end up growing streptococcus bacteria, and then you would know that you have a strep throat. And that's called direct cultivation. This is actually isolating and culturing the cause, the organism, the bacteria that causes the illness. In Lyme disease we do not do that because the organisms don't grow quickly. These organisms are what we call fastidious, and they take a long time to grow. And for that reason what we look for instead of looking or growing the organisms we look for the antibodies, in other words the response, our response to the organism. And this immediately tells you that you don't get a very quick diagnosis because antibodies take up to maybe a week or more to develop. So we cannot diagnose Lyme disease unless antibodies have been formed, which means that we can only diagnose Lyme disease a few days into the illness. And because we're measuring indirect phenomena here, we're measuring antibodies, we can never actually be sure that this is the case. So if we take a patient with an acute skin lesion the patient may turn out to be negative at that stage. If the patient continues to be ill with some of the manifestations of Lyme disease then the antibodies will grow, will be detected, and then you can make a real clear laboratory diagnosis. All right. Let me see if I understand this from a practical point of view just in the time we have before our commercial messages. So you can get a blood test as your doctor's. Even if it comes back negative, if you have symptoms that persist it might be worth repeating the blood test. Yes, absolutely. Absolutely. And the doctor can look at your skin lesion and say, well, this is an erythema mygrans strictly on clinical terms. I mean the doctor ought to be able to do that because this has been very well described. These lesions are very well described. There's pictures all over medical literature, so it wouldn't be very difficult for a doctor to say this is an erythema mygrans, and I'm going to treat this patient, even without having the serology. Right. We're going to take another break, learn a lot more about Lyme disease. I think it's important for us. Certainly there are people living with it. How you get an accurate diagnosis, what treatments are, how you can prevent it, for sure, and where research is 6

7 headed. We're visiting with Dr. Jorge Benach, who is a world expert from Stoney Brook University Medical Center out on Long Island in New York. We'll be back with more Patient Power and your questions as we continue on Health Radio Network right after these messages. Benefits of Early Treatment Welcome back to the show, Patient Power, discussing Lyme disease today. And today again I said I have this bias, maybe I'm not as familiar with it even though I'm a New Yorker and lived there a long time lived in the east for many years, I've been out in the west for a long time, in Seattle now, but our producers are all over. I was just talking to Blake, who comes to us from North Carolina, and she was saying how in North Carolina it's a big deal, Lyme disease. So if it touches somebody you know then you think about it a lot more. And as we visit with Dr. Jorge Benach from Stoney Brook University Medical Center, and he was part of the team that discovered the organism, the bad guy that was causing all this problem that you get from deer tick bites, we're learning about it. So what we were discussing a minute ago, Dr. Benach, was how you can have a blood test, and you're looking to the antibodies to see is your body reacting to this organism. So we talked about antibiotics in trying to then kill the organism. However, as you mentioned earlier if you had the illness for a while then maybe it had already caused some effects to your joints or other places in your body. But is the good news that if you get early treatment you maybe can just be done with it? Is that the hope? Yeah. Let me preface by saying you can never say never. I could be that categorical about these things, but, yes, the fact is that if you treat this disease early you can simply block the development of some of the later stage manifestations. The message that I would like to leave is that by and large Lyme disease is treatable with antibiotics, and even though there is a group of people who do not often respond to the antibiotic treatment as well as we would like and I wouldn't want to even put a percentage, but I would say the bulk of the patients that get treated do very well. So there's a great deal of hope when it comes to this. Another point that I wanted to make about this jumpiness and shiftiness about the disease that Lyme disease is caused, as I mentioned, by a spirochete, and this is a spirochete of the genus Borrelia. There is another disease that is also caused by another spirochete, in this case it's called Treponema, Treponema pallidum, which is the organism that causes syphilis. And because they are very close in certainly morphology and even slightly genetically, syphilis also is a disease that shifts and jumps in stages such as Lyme disease does. And one of course is a sexually transmitted disease, syphilis, the other one is tick-borne disease, but if you look at them in certain parallels you will see there are certain similarities, and that's because they are carried by organisms that are related. 7

8 Transmission of Lyme Disease Now, I know syphilis is typically treated with antibiotics, big doses of antibiotics. So it's similar in that regard. Well, let me ask you, though, so syphilis can be transmitted from person to person. Can Lyme disease be transmitted from person to person? No. Lyme disease is transmitted by the tick. And research has shown that residence in the tick, or how we call being in the vector, within the vector, is actually very critical for this organism to be infectious because this organism changes its outer coat depending on whether it's on a tick or whether it's on a person. So person to person would be an extremely unlikely if not outright impossible situation for the organism that causes Lyme. Whereas of course in syphilis it is the way in which it is transmitted is person to person. So they're very, very different in this sense. So one other question. So an animal could get Lyme disease like your dog or something like that, right? Right. If you got bitten by a dog with Lyme disease would you contract it yourself? I would most certainly think not. No. I would think not. Listener Questions Here's another question we got while we were just talking about transmission. This is one we got on from Samuel in Rutland, Vermont. He wrote in, "Is it possible for Lyme disease to be contracted from eating the meat from a deer that has been infected with Lyme disease?" No. The answer to that is no. The organisms, the spirochetes would not survive passage through the very acid stomach, and you would not be able to get Lyme disease that way. 8

9 Lyme disease you can get in only two ways. One is by the natural way, which is by the bite of an infected tick. Or if you're in a laboratory such as yours and you stab yourself with a needle full of spirochetes, that will work also. But it's got to enter always into the skin. Okay. And again here's a question from Audrey in Altoona, Pennsylvania, and she wrote, "What treatments and complications would an expectant mother have with Lyme disease?" And I'm just going to broaden that. So she might also worry, could she transmit it to the fetus. And I think the answer on that one is no, right? Yeah. Very early on and simply guided by the biology of syphilis where transmission, transplacental transmission can occur there was a very, very vivid debate and research on the possibility of transmission to the child, and the general consensus right now is that it just does not happen. And of course Audrey is pregnant and so she wants to have her Lyme disease treated. So are there antibiotics that she could be taking while she's pregnant to control or kill the Lyme disease, not hurt the baby? There are but that is certain between I would say her obstetrician and her. And I think that's one area that I think she needs to pretty much rely on the obstetrician for that because that's an obstetric issue. But there are antibiotics that she can use. Right, that can be used during pregnancy. Here's a question from Gail who's in upstate New York, and she said, "The doctor says my 78-year-old mother has Lyme disease and she needs to take antibiotics for that. She doesn't believe in antibiotics. She believes more in alternatives like homeopathy and acupuncture. Are there alternative remedies for treating Lyme disease?" So for you as a researcher have you seen anything like that work, sir? No. If I was her mother I would take the antibiotic. 9

10 Okay, enough said on that. I know a lot of people, they hate medicines, first of all, homeopathy-- No, understandably. But in this particular case you're talking about killing an organism, and you need these molecules, these medicines to do it. I think you would be taking a chance if you didn't, particularly if you know you have it. Sure. Here's a question from Bruce in Buffalo, a lot of East Coast questions certainly. "Over the past few years I've been battling extreme fatigue, not relieved by diet or exercise. Three years ago I found a tick burrowed into my right hip, tried to get it out and found out that I only got the body of it out. What are my chances of having Lyme disease?" And if I heard you earlier there is a chance because it could have been delayed reaction, right? Yeah. If he didn't see or notice the skin lesion at the time, the three years ago before when he had the tick and he has these manifestations that cannot be ascribed to anything else, I would most certainly bring that up to your family doctor, the family physician, certainly an internist that would take it from there and would do the appropriate tests and evaluate the case. On the face of it, fatigue alone is not part of what you would consider very strong indication that you have Lyme disease. Right. Fatigue could be a hundred things. With other things you can. But by itself no. Right. Fatigue could be a million different things, even sleep apnea. It could be a million different things and that's why you need to talk to your doctor. Absolutely. 10

11 However, if there are some of the other symptoms we've talked about then possibly a blood test looking for the antibody might be helpful. Is that right? In a case that would have been going on for over three years I would most certainly have the blood test done, and if it's positive I would certainly include Lyme disease, and if it wasn't then I think I would probably continue to look for some other reason for his fatigue. Okay. Here's a question from Judy in Pennsylvania. She writes, "I have found very small ticks," and she thinks they're deer ticks, "imbedded on various areas of my body, and I've removed them but can't get rid of the inflammation where the tick's head was imbedded. I believe I may have Lyme disease. I've also heard of a new preventive medication for Lyme disease. Do you have any information on this new medication?" So is there anything you can use to prevent it? No. The consensus, the medical consensus, what's been written in journals after different studies is that it is not useful to treat tick bites preventively. For one thing not all ticks carry this organism, and you would be basically utilizing an antibiotic for no apparent reason and with all the problems that you might have down the road in terms of resistance and so forth. If this person is telling you or me that she's getting a lot of these ticks, I would say those ticks are probably not deer ticks. They're probably larva or another tick that is very common in her area and in fact all in the Northeast called the lone star tick. As the name would imply you would think this would belong in Texas, and they do have it in Texas, but the larvae of these ticks tend to attack en masse, and this is probably what she's seeing. Because a deer tick would not be likely to be this, you know, there would be so many bites, certainly not simultaneously. And they do not transmit Lyme disease. So if that is the connection she shouldn't make that connection there's Lyme disease. But what she can do is if she can get them and pull them out and send them to, every state has cooperative extension, agricultural extension, they would identify them for her. And I think this is something that she would do just for her peace of mind. 11

12 Lyme Disease Around the Country Right. Now, help me understand. We have certain regions of the country where this is very prevalent and others where it's not. So where are we with Lyme disease and the spread of Lyme disease around the country? Well, there are areas that have been endemic for Lyme disease, and they've been traditional since the early 80s when we first started looking. And those areas are the northeast and they are in the midwest and there are areas and--well, I don't know as far north as Seattle but certainly in northern California and areas that have a lot of moisture. The tick that carries this organism requires moisture. We've got moisture here, believe me. I know you do. In fact my friend Blake here, though, she's from North Carolina, so in the Piedmont, North Carolina green area in the mountains there, they worry about it there too. So is it mostly forested areas? Forested areas and what you need is a habitat for the tick, the mice and the deer, and this trio of animals is required in order to maintain a very forceful cycle of Lyme disease. And whenever you have these conditions you're likely to have this type of Lyme disease. There are other Borrelias or the spirochetes that have been associated with this disease or other forms of Borrelias, just like relapsing fever, and they can tolerate dryer climates, but by and large this is a high forested disease. It needs to be in the temporal forest. Okay. Not going to be in the desert part of our country. No, not likely. Not in Phoenix. Okay. Skylar from Rochester, New York writes, "My husband suffers from chronic Lyme disease. He frequently has a low body temperature, sometimes as low as Are there other medical conditions we should be aware of which cause a low body temperature that are known to pair with Lyme disease? 12

13 Conditions that can cause low body temperature, yes, that would be associated with Lyme disease, I actually can't say that I can think of any. Even making a quick survey I don't think I can think of any. Dr. Benach, what about, though, we talked about complications of Lyme disease as it advances, so I want to get to that. You said it can even affect your heart over time. Is that right? That is true. There is a manifestation of Lyme disease which is actually the rarest of the three that I mentioned. The most common would be the joints, then neurologic manifestations can be frequent. The carditis of Lyme disease is an inflammation of the apex of the heart. It's not very common, but as you can imagine it's a little frightening because anything that really affects the heart in that manner can give you a jolt. Sure. No kidding. But it is a reversible condition also with antibiotics. So the good news is that it's reversible. The bad news is that it could initially scare you. Prevention If you're just joining us we're visiting with a world expert on Lyme disease, and that's Dr. Jorge Benach, who is director of the Center For Infectious Diseases at Stoney Brook University Medical Center in New York. So here's a question we just got in from Ginger in Maine. And she writes directly to you, sir, "Hi, Dr. Benach. It's funny my son and I were reading a textbook with your name in it just the other day." She writes, "Is there a current vaccine that could be given at birth to prevent Lyme disease? We just moved to a very wooded area and I'm concerned about my unborn child possibly contracting this illness after she's born. What research if any is being done on a vaccine?" There are no vaccines at the moment. As far as research, there is research on vaccines, but right now there's none. And I think it will be a while before there's another one. There was one that was taken off the market for a variety of reasons. But right now I think a lot of the research that gets done in certainly Lyme disease and bacteriology as 13

14 well always have an eye on the possibility of vaccines even if there is no specific vaccinology being done at this stage, and I'm not even sure that that would be true. But right now there's none. What can we do to prevent it? I mean can the agriculture departments be spraying for this, or how do we avoid it? Well, the spraying issue, as you might imagine, is controversial because in order to spray for ticks you have to spray pesticides that are going to have effects on other nontargeted organisms. And you're going to have a very strong backlash of very pro-environmental people that are not going to be happy with the broadcast of pesticides in the environments. So on balance there are ways that you can avoid ticks and, not completely, but there are ways. And first you need to learn where they are, and if you are going to go out in the wooded areas and in areas where you know there's going to be ticks you can do a lot of things by the way you dress that can minimize that kind of contact. And you also need to know at what time of the year that they're most active, and that actually would you believe is not that frequent. They're active, the nymphs, the middle creatures that give you the most Lyme disease in the summer, are active in the months of May and June. And then the females, which are the later stage, are active in October, around this time now. But the rest of the year it's not so bad. So you may lower your expectations at other times of the year, whereas if you go out in May and June and then again in October then you want to take most precautions. Okay. So this would be covering up, right? And what about any insect repellant? The repellants are very useful. Ticks don't like repellants. And ticks are mostly going to make contact with a person in the lower extremities. So if you spray your pants, and hopefully you've tucked your pants so the socks are over the bottom of the pants so the ticks don't have a free access to your skin, and this is all treated with repellant, I think you'll do fine. I don't think you should come back with a lot of ticks. But also in heavily infested areas, people know this where there are a lot of ticks, you just got to check your kids almost on a daily basis at those times. You've got to check the scalp, you've got to check their back, you've got to check skin folds where the ticks can go unnoticed, and the minute you see them, pull them out. 14

15 Okay. So here I am, Seattle guy, so I'm not that familiar with these deer ticks. What does it look like exactly? If you have very, very good vision, the immature form of the tick, which is probably the most largely responsible for the disease, is smaller than a pin head and dark. The female of the species, which is the one that you would expect to find in the fall, has like a little black shield close to the mouth parts or to the front of the tick and sort of a brick red abdomen, which would be the bottom part or the posterior part. So it's a little bit distinctive and much easier to see the female than the immature form. The immature form, unless you have it directly in front of you, it's very easy to miss. And this is why very often when doctors ask their patients, Have you been bitten by a tick, very more often than not the answer is no. They don't know. Yeah, I think we have to hand out magnifying glasses. Exactly. Exactly. It's very easy to pick the female. But the immature form, it's not. But if you're really looking it looks like a black speck. Dr. Benach, so my final question to you is for people who are suffering with this or worried about it or living in areas where it's now infested, are you hopeful that research will maybe give us some better ways to deal with this? Oh, I think so. We're constantly trying to find out more about this very enigmatic organism. Why doesn't it like to grow in the laboratory? I think that we're trying to learn about the immune response to the disease. We're trying to learn how it can last so long in the body, how does it sometimes evade the immune system. All of these things I think will be cracked. I'm not sure whether it will be next year or the next, but certainly in time I think our effort against Lyme disease is going to pay off very, very handsomely. Well, we cheer you on, sir. You've been devoting your life to it with your whole Center For Infectious Diseases, your microbiology department at Stoney Brook University Medical Center at the State University of New York. Dr. Jorge Benach, thank you so much for being with us and helping us better understand Lyme disease. We really appreciate your time. Thank you, Andrew. My pleasure. 15

16 Well, this is what we do on Patient Power, folks, every day. Please direct people to the replay. We'll have it posted both on healthradio.net and on my website, patientpower.info, and it will be helpful for people to discuss it and listen as we did learn from a world expert. Tomorrow we're going to have a replay program as we discuss Alzheimer's disease. There's so much more to learn about it as that affects more and more families as we get older. And then also later in the week we're going to talk about cystic fibrosis again with Dr. Columbo at the University of Nebraska helping leading the way, helping people live longer and live better with cystic fibrosis. Thank you so much for joining us. Remember knowledge can be the best medicine of all. Hope your team wins if they're still in the playoffs. Andrew Schorr from Seattle signing off. Have a great day. Please remember the opinions expressed on Patient Power are not necessarily the views of Health Radio, our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. Please have this discussion you re your own doctor, that s how you ll get care that s most appropriate for you. 16