Please talk about treatment fatigue in general, in particular, what are your options if your body cannot tolerate antibiotics, maybe the liver function is limited?
By “treatment fatigue” I assume you mean that a specific patient cannot tolerate ongoing standard doses of antibiotics. I would like to address a broader view of this problem, since what it is really addressing is how capable the individual is of mobilizing their immune system (with the aid of antibiotics) to kill the infecting organisms (Lyme, Bartonella, Babesia, Ehrlichia, Mycoplasma, etc.), and then how capable it is to remove those dead organisms and toxins from the body. This requires the coordinated workings of the organs of detoxification: the liver, intestines, lymphatic system, kidneys, skin, lungs, and spleen, along with the immune system, to do this properly.
By its very nature, Lyme disease weakens the immune system, often profoundly, and compromises the ability of these organs to do their jobs properly. The longer the individual has been wrestling with Lyme disease, the weaker these systems get. Part of our job, as Lyme-literate specialists, is to attempt to evaluate all of these components, to create a treatment plan. While we have some tests that can help us in doing so, most of these tests are somewhat limited, and we often have to observe how our patients respond to our treatments to get a better picture.
When we treat Lyme, we often start with an antibiotic and herbal/detoxification approach, but some of our most compromised patients cannot tolerate this at first. This means that before we start antibiotics (either medications or herbal) we may have to first build up our patients’ bodies. Patients who have been ill for a long time usually have weakened adrenal, thyroid, and sex hormone systems, as well as depleted neurotransmitters. Many have heavy metal toxicity and/or mold toxicity, or multiple chemical sensitivities, or allergies, or difficulty with methylation chemistry as well. We may have to start with those systems and build them up before even thinking about detoxification or using antibiotics. Liver function is only one aspect that we must consider. Often we find that gentler approaches, such as homeopathic remedies, can help us get started.
Each patient is different. Each requires that we delve into their unique chemistry to try to find an approach that they can tolerate before we proceed with antibiotics.