Dr. Todd Maderis is the Founder and Medical Director of Marin Natural Medicine Clinic. He specializes in the treatment of complex chronic diseases such as Lyme disease and its co-infections, chronic viral infections, chronic fatigue and pain syndromes, immune dysfunction, environmental medicine and mold toxicity. He finds most chronically ill people need to be assessed in all of these areas to have a successful outcome. Dr. Maderis’ approach is to find the root cause of a patient’s symptoms, so treatment can be properly directed. To reach an accurate diagnosis, he uses current and progressive testing methods, as well as clinical findings. Treatment modalities include vitamin and mineral supplementation, herbal medicine, German homeopathic remedies, pharmaceutical medication, Low-dose allergy (LDA) and Low-dose immunotherapy (LDI), and IV nutrient therapy. Having trained with ozone expert Robert Rowen, MD, Dr. Maderis regularly uses IV “ten-pass” ozone therapy in his practice. “It is an honor to hear patient’s stories, then help them find and address the underlying causes of their illness or symptoms. The most rewarding part of my job is helping patients improve their quality of life.” Dr. Maderis is a member of the International Lyme and Associated Disease Society (ILADS), California Naturopathic Doctors Association (CNDA), and the Naturopathic Academy of Environmental Medicine (NAEM). He regularly attends medical conferences on the most recent advances in the diagnosis and treatment of chronic illnesses.
I’m Todd Maderis, and I’m a naturopathic doctor. I attended a naturopathic medical school in Portland, Oregon, called National College of Natural Medicine, which is a four-year medical doctorate program. People often want to know what the difference is between allopathic and naturopathic medical training. And the first two years look very similar. We all study the same clinical sciences, but the therapies tend to differ. I think one of the most important tenets of naturopathic medicine is the goal is to find and treat the cause of the issue, which is a little different than how we approach conventional medicine. Everyone knows that Lyme is typically transmitted via tick, that it would commonly manifest this bull’s-eye rash that patients would then develop fever, sweats, fatigue, arthralgias, headaches. And then a course of doxycycline would cure that patient, and that can be the case for acute Lyme. However, a certain percentage of patients go on to develop these persistent symptoms, and the conventional medical system has coined that post-treatment Lyme syndrome. When a patient comes in, I will take an integrative approach to diagnosing and treating them. In the workup, I’m not just looking for tick-borne illness. I may also be ruling out something like mold exposure or environmental toxicant issues, like heavy metal issues. And when I address these other concomitant issues, I find that patients get better quicker. This has allowed me over time to reduce the amount of antibiotics I’ve used in my practice. With the infection, it can affect any system in the body.
So most of the time patients have seen multiple doctors by the time they may find me, and so they’ve ruled out other conditions, maybe things like MS. Or they get mislabeled with something like fibromyalgia or a chronic fatigue syndrome, which is another common diagnosis, although neither one of those would suggest any underlying cause to the diagnosis. It’s really just a description of symptoms. Lyme disease complex or tick-borne illness is really a clinical diagnosis. It always has been. Testing has definitely gotten better. It’s still very challenging to test patients for these chronic infections for various reasons, so the standard medical approach for diagnosing Lyme disease is to run what’s called the two-tier test. It starts with an ELISA test, and if that’s positive it reflexes to a Western blot. Well, the ELISA is very insensitive, so if a patient tests positive with the ELISA, they never get to run the Western blot. The Western blot is really the gold standard. The patient might get tested for Lyme and it may be, indeed, negative, but they could have been infected with another bacteria that never gets tested for.
Co-infections are infections that can exist with the Lyme bacteria. These are often transmitted in the same tick bite. Ticks can contain multiple bacteria. The best analogy I’ve heard is Dr. Joe Burrascano has said if you took a-a needle and you stuck into a rabbit and a mouse and a possum and then a deer, and then you stuck yourself with that needle, do you think you’re going to have one bacteria? No, you’re probably going to have multiple bacteria. Some of the co-infections, like bartonella, for example, we know that mites can transmit, that fleas can also transmit bartonella, and cat scratches and what people know as cat scratch fever is really an infection with bartonella. So I really believe that bartonella could potentially be a bigger issue than we see with Lyme. There’s more modes of transmission. Bartonella is more difficult to test positive for, and oftentimes it doesn’t get looked at. One of the nuances of testing is that the bacteria don’t hang out in the bloodstream. The bacteria tend to burrow into tissues such as muscles, ligaments, tendons. It lives inside of cells and will also form structures around itself, such as a cystic form of the bacteria or what’s called a biofilm, which is hundreds of thousands of bacteria living in the structure. So with the testing, we’re looking at someone’s immune system to see if their immune system has seen the bacteria. But if the bacteria is either dormant or it’s in a tissue or it’s in one of these protective structures, then the immune system doesn’t see the bacteria and it doesn’t balance an immune response. Thus, a test would be negative, and that’s where we defer to the clinical diagnosis.
And then the third step would be, well, let’s initiate treatment and see how the patient responds to therapy. I think all too often, physicians will stop at, “Well, yeah, you did get a positive result, but you know, it’s probably a false positive.” Let’s take that extra step. Let’s treat and see how the patient responds, and, you know, my experience and-and maybe it’s the population of people that come and see me, but you know, they’ll ultimately respond to treatment. Patients will come in and having been on antibiotics for two, three, five years and something is likely missed, because patients don’t need to stay on antibiotics for that duration of time. And at some point, I may switch gears and use something like an herbal approach. I also use other therapies in my practice, like ozone therapy. We do what’s called a multi-pass ozone treatment, and we know ozone’s antimicrobial and so it’s not just killing off Lyme, but probably killing off other bacteria and viruses and parasites, as well. So it actually reduces inflammation and at the same time strengthens immune response.
A common approach that I will take is either to have someone on antibiotics in conjunction with ozone, or if we’re using an herbal therapy in conjunction with ozone, I find that either one of those approaches can be very effective. What’s nice about herbs is they can be very potent and cause side effects, but a lot of times the formulas include herbs that help to minimize these adverse reactions. So they’re put together in sort of a synergistic way to minimize side effects and I’ll sometimes use those in conjunction with antibiotics if a patient’s dealing with a couple, uh, infections, which is why it’s so important to rule out all co-infections in the beginning. So during treatment when we are killing off bacteria, the bacteria are going to breakdown, release proteins and create an immune response, and this is sometimes referred to as a Herxheimer reaction, where a patient’s symptoms will flare up. And so our ability to eliminate or detoxify during that process is really important, and some of us are genetically better than others at eliminating. You can think of it like a bathroom sink. If you have the water on full-blast and the drain is working well, then someone’s going to not have as many symptoms because they’re eliminating. However, if that drain were to be plugged, once that sink fills up, water starts to overflow and creates more symptoms. What I like to do with my patients is support their immune system to minimize this inflammatory response.
So I will use herbs like turmeric or compounds like glutathione that help their body keep the inflammation at a minimum so they don’t suffer from the inflammatory effects. Lifestyle choices are really important in the healing process with tick-borne infections. Patients have control over their diet on a daily basis, and a lot of times when they have found their way to my office they’ve already discovered that eating a healthier diet has improved some of their symptoms. So they’ve discovered things like gluten or dairy creates more inflammation in their body. And I think those are two of the most important foods to avoid in the healing process. Sugar should also be avoided if someone is on antibiotics, because that predisposes them to yeast infections and yeast overgrowth. And as far as exercise is concerned, patients have a difficult time maintaining any sort of exercise because of their symptoms. And so minimal exercise, such as walking or yoga, stretching, things like that can be helpful. It doesn’t need to be anything extreme, and in fact, too much cardiovascular exercise can be counter-productive because it can suppress the immune response for a period of time afterwards.
A lot of times patients have sought out other modalities that will help with their treatment process, and so some of my patients may be receiving acupuncture or massage. Patients can feel worse before they begin to feel better as we start treating these infections. This tends to be from a breakdown of the bacteria, releasing, uh, byproducts that create an inflammatory response. And for some people it’s worse than others. It can be short-lived. I don’t think people have to be in this state of inflammation to get better. It’s a process. These patients typically didn’t get ill overnight. That’s a common question that I get. “How long is this going to take?” I tend to think that the longer someone’s been infected and the more co-infections that they might have, the longer it’s going to take to gain full recovery. Someone that’s been sick for s-six months and they’ve tested positive for one or two bacteria, they have a pretty good prognosis. Patients ask the question, “Is Lyme disease or tick-borne illness curable?” And I tend to think that these infections can go into remission, and for some people it’s a real blessing. Their lifestyle has had to change because of this illness. With tick-borne illness, fatigue is almost ubiquitous, and there could be a couple different reasons why someone’s energy is low.
First, we know that infections can affect the endocrine glands, such as the thyroid and the adrenals, so their fatigue may stem from hormonal-related issues. The infections can affect mitochondrial dysfunction, and that’s our little energy powerhouses in every cell that create energy in the body. Sometimes patients are anemic from infections like Babesia because it will destroy red blood cells. So with a comprehensive assessment, we can determine what’s the contributing factor or factors to someone’s fatigue. Some patients’ level of fatigue is so extreme that they’re spending 12 to 14 hours a day in bed and they can’t hold down a job. It’s a different type of fatigue. There rarely is a spike in energy, and patients have to pace themselves throughout the day regarding what they can accomplish. Going to the store may be the only errand that they’re able to run, and they have to literally plan their day around how much energy they’re going to exert to accomplish their tasks. So pain is one of the most common complaints that patients with tick-borne illness have.
I’ve once heard a physician say that Lyme may be more of a host response disease than an infectious disease, meaning it’s this immune response that drives a lot of the symptoms. When someone has the flu virus, the aches and the pains, the fever, the chills, the fatigue that they experience isn’t from the flu virus itself. It’s from the immune response trying to kill that virus. Migratory pain is a hallmark sign of tick-borne illness. If someone injured their knee playing soccer as a kid and their right knee always hurts, it’s clear that that’s more of an osteoarthritis issue. But when pain moves around from joint to joint, we tend to think of infectious arthritis first. Anti-inflammatories can really help, but also immune modulation is where it’s at. I use a therapy called low-dose immunotherapy that helps to down-regulate that persistent immune response that’s driving a lot of these symptoms.
What patients refer to as brain fog is what we call maybe cognitive impairment, and it’s often driven by what we refer to as encephalitis, so it’s inflammation of the brain. So the approach to treating that is ultimately to treat the underlying cause, if it is driven by an infection, and also helping to reduce the inflammation in the patient can help improve brain fog, as well. I see a population of patients that come in that have been labeled with things like attention deficit disorder or hyperactivity disorder, and they are on medications like Adderall, where they actually feel better on these stimulants and they’re able to focus. What always raises an eyebrow with me is if the patient also complains of fatigue and headaches and joint aches and pains, then you can’t just think of this as a cognitive issue and really need to look at the patient holistically.
Insomnia falls into that vicious cycle with fatigue where patients are tired throughout the day. Come nighttime they can’t fall asleep, or they do fall asleep and then they wake at night. This can be caused by a couple of different factors. We have what’s called the hypothalamus pituitary adrenal access, and the adrenals are what produce cortisol in the body, and then all of a sudden they have more cortisol at night and they’re more alert, more awake when they should be going to sleep. Sometimes it’s using herbal formulas that help to modulate or reduce cortisol at nighttime. Other times they may need a sleep medication to help them fall asleep, but ultimately as they navigate their healing process, they begin sleeping more. Their energy improves during the day, and rarely do these things go away overnight. It’s not like flipping a switch, but as the patient improves, we start to see these symptoms diminish more and more.
Anxiety and depression are really common with tick-borne illness, and there could be multiple reasons why. First, when someone doesn’t feel well, whether it’s pain or fatigue, their mood follows, as well. They could also have just true depression that needs to be addressed, whether it’s with prescription medication or some sort of natural support. A lot of times I tend to think it can be secondary to the tick-borne illness, and so again, as we treat the underlying cause, we’ll see their mental health improve, as well. One of the co-infections is known for causing anxiety, and that’s bartonella. So when I see a symptom picture with all the classic bartonella symptoms, including anxiety, I may go after that infection first, which in turn will hopefully help that patient’s anxiety. So they may need support along the way, but as we address that underlying cause, I find the mood disorders sort of melt away.
Patients need to realize that when they go down the road of treating these chronic infections, they need to be committed to the process, and there’s a certain level of trust that needs to come with their physician, and they also need to take ownership of everything that they’re doing, as well. I’ve had people that come to me and they’ll say, “Well, I just want the antibiotics and, you know, we’ll just test down the road and we’ll see how I do.” And I find that those patients rarely get better, because there’s a lot more involved in treating this disease complex, and the more vested the patient is in that process, I find the-the greater the outcome. With complex chronic illness like tick-borne illness, oftentimes it’s multifactorial, and unfortunately conventional medicine is not set up to address the complexity of this. No one is putting it all together, and ultimately there could be a common thread. W-at least we see that with these chronic infections.
In my experience, we need to address all the issues along the way. It’s a multifactorial approach that ultimately will help patients get better, but it’s a process and patients need to be patient. And the more engaged in the process, I find the better the outcome they have. And so patients have really had to become their own advocates. Patients do get better, and are successful at going back and leading a normal life again. So where I see Lyme and tick-borne illness going in the future is going to be driven by awareness. Antibiotics that we’re using are antibiotics that have been around for 20, 30, 40 years, so we need better testing methods and better treatment options, and that’s going to come from the awareness which, in turn, should drive funding and research, and hopefully that will allow fewer and fewer patients to suffer. Although most of the patients I see have been suffering for many years and have had many diagnoses, ultimately if we’re able to find that correct diagnosis, I truly find they’re able to get their lives back, and that’s the most rewarding part of my job is to help people get their lives back.