Ep. 228 - A Lyme Expert Discusses Why So Many Cases Get Missed
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Dr. Dean Mitchell sits down with Dr. Kenneth Liegner, an internist and critical care physician who has treated thousands of chronic Lyme patients since the early days of the disease's recognition. Dr. Liegner trained in anatomic pathology, internal medicine, and surgical critical care before opening a general practice in Westchester County, where he found himself in the middle of one of the most contested debates in modern medicine.
The conversation traces how Dr. Liegner came to understand that Lyme disease could follow a relapsing, persistent course, and why that conclusion put him at odds with mainstream infectious disease guidelines. He discusses the IDSA's 2000 and 2006 guidelines, the role of insurance industry interests in shaping treatment coverage, and what it meant professionally to keep treating patients during an era he describes as dangerous for practitioners. He also shares a 1991 case in which spirochetes were cultured from a patient's spinal fluid after prior intravenous antibiotic treatment, later published in the science press.
Dr. Mitchell and Dr. Liegner cover the complexity of tick-borne coinfections including Babesiosis, Ehrlichiosis, Anaplasmosis, and Bartonella; the limitations of standard serological testing and the Dearborn criteria; and the challenge of biofilm as a barrier to antibiotic effectiveness. Dr. Liegner also explains his current approach to prophylactic treatment following a tick attachment, including his use of minocycline and Malarone, and his reasoning for that protocol given what he has seen over decades of practice.
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