Newsletter #15 Why Can’t I Get Better?







I have a confession to make. I have perused (translation: skimmed)

Dr. Richard Horowitz’s book, Why Can’t I Get Better?  several times and my sense of it was that he had written the best overview of Lyme disease and how to treat it. I have recommended the book to dozens of my patients.

So finally, I have gotten around to reading this book (with the title of this newsletter) cover-to-cover, and I would like to discuss it in this issue in more detail, as I am impressed and delighted that this book is, indeed, a must-read for both patients and physicians who are wrestling with Lyme disease. Actually, this book is about much more than Lyme disease: Dr. Horowitz clearly explains our current understanding of chronic illness from his many years of work with patients with Lyme disease and coinfections. (This discussion involves just this first book by Dr. Horowitz, published in 2013—his second volume, which came out in 2017 will be noted below).

Most of us began working with Lyme disease as if were merely another (but nastier) infectious microbe. Over time, it became apparent that in order to treat it properly, we had to understand not only how to kill this bacteria, but also to manage the profound toxicity that it created when it was being killed, and to understand and treat the many other body systems that were affected by the persistent inflammation that these infections engendered.

Dr. Horowitz, who has been at the forefront of working with patients with Lyme disease, has done a masterful job of putting all of this information together in this exceptional book. To emphasize the complexity and nature of this process, he has renamed this as MSIDS: Multiple Systemic Infectious Disease Syndrome, and describes this as “a road map for identifying the multiple components” of MSIDS. When patients present to him, he utilizes this road map to analyze the many factors that contribute to creating their chronic illness and then sifts through this information to create a working treatment program.

Let’s review his sixteen-point diagnostic map, by looking at the overlapping factors that contribute to chronic illness:

  1. Lyme disease and co-infections
  2. Immune dysfunction
  3. Inflammation
  4. Environmental toxins
  5. Functional medicine abnormalities with nutritional deficiencies
  6. Mitochondrial dysfunction
  7. Endocrine abnormalities
  8. Neurodegenerative disorders
  9. Neuropsychiatric disorders
  10. Sleep disorders
  11. Autonomic nervous system dysfunction and POTS
  12. Allergies
  13. Gastrointestinal disorders
  14. Liver disorders
  15. Pain disorders/addiction
  16. Lack of exercise/deconditioning

Each of these subjects receives its own chapter in this book so that Dr. Horowitz can go over each in more detail. Although Lyme disease is the underlying cause for, or major contributor to, a great deal of chronic inflammatory illness, Dr. Horowitz has expanded his understanding of this amazingly complicated illness to encompass a much wider scope. As I have alluded to in many of these newsletters, and my books, unless a medical practitioner can take into account all of these dysfunctional systems to address them properly (allowing for individual variations: we are quite different in terms of our genetics, chemistry and exposures), many patients will not be able to heal completely.

He presents case after case in which simply treating Lyme disease or co-infections was not sufficient for recovery to occur. For some, he needed to look at hormonal imbalances; for others, heavy metal toxicity; for others, emotional and spiritual issues needed to be addressed; for others, looking for sleep apnea, or a dysfunctional liver and/or gall bladder; for others environmental toxins (e.g. mold)….and so on.

This book constitutes a wonderful overview of this complicated field and an excellent starting point for patients and physicians to look at their illnesses in a much more comprehensive way. If I have anything to add, it would be that although mold toxicity is mentioned throughout the book as a contributing factor, my own bias is that it is so important that it should be an integral part of the evaluation for most patients.

For those who have been ill for a long time, and whose physicians have not explored these areas, on page 33 of the book, Why Can’t I Get Better”, readers will find the Horowitz Lyme-MSIDS Questionnaire which can provide a quick assessment of the possibility of a tick-borne illness and give the impetus to dig deeper if the probability of this is high.

An added bonus for physicians is the inclusion of Appendix A, which provides treatment protocols for MSIDS. Of course, this is only the beginning. This has rapidly become a medical field of specialization unto itself: the evaluation and treatment of complex medical illness. I would strongly encourage all health care providers who have realized that there are millions of individuals who are suffering, undiagnosed and untreated, to avail themselves of the opportunity to study with the various medical organizations that are devoted to teaching these principles:  ISEAI, ILADS, TFIM, and AAEM being among the leaders of this effort.

The newest version of this book is “How Can I Get Better? An Action Plan For Treating Resistant Lyme and Chronic Disease.” It contains information that is more up-to-date and has a new chapter on persisters, discussing the use of dapsone and pyrazinamide. The Appendix has been expanded to include more information on medications and supplements/herbals which will be of great help to health care providers.