This was posted on the LymeAid group on Yahoo. If it's not OK to post it here, let me know. This is also 3 years old, so he may have changed the protocol since then."Attached is the Shoemaker Protocol for Lyme:
Lyme Antibiotic, Actos & Cholestyramine Treatment
Dr. Ritchie C. Shoemaker, 05-FEB-02
When Lyme or tick-borne disease is indicated in Dr. Shoemaker's
opinion, the following protocol is used. First, rule out other
biotoxin exposures, such as indoor air or outdoor fungal mycotoxins,
Ciguatoxins (seafood), Brevetoxins (marine red tides), Pfiesteria
toxins (estuaries), cyanobacteria toxins (fresh water), or Brown
Recluse or another poisonous spider bite, by taking a thorough
neurotoxic history. Symptoms from these toxic exposures can look like
Lyme but won't get better with antibiotics. Second, verify as well
as possible that the patient has had a tick bite or a good potential
for such. Question the patient about ticks and rashes, and obtain
laboratory tests for exposure to Borrelia, Ehrlichia, Babesia or
other potentially co-infecting organisms if possible, remembering
that those tests may have a high false-negative rate.
Doxycycline, 100 mg, 2 x day for 3 weeks [If allergic, Amoxicillin,
250 mg, 3 x day, 3 weeks; or Cefuroxime axetil (Ceftin), 250 mg, 2 x
day, 3 weeks]. Note : the doses used here are quite different than
what you may read elsewhere.
Then, Actos (pioglitazone; if not available take Avandia, 4 mg x
2/day) to upregulate peroxisome proliferator activated receptor gamma
(PPARg) which in turn downregulates production of pro-inflammatory
cytokines, such as tumor necrosis factor alpha (TNFa), taken once
daily with or without food for 5 days prior to beginning
cholestyramine (CSM). See Actos instructions in treatment protocol
available on website: 1) Protocol for Prevention of Intensification
Reaction (Herxheimer-like reaction) by Actos in Chronic Lyme Patients
Beginning Cholestyramine; 2) Actos information sheet (soon available
on website).
Begin cholestyramine (CSM) on day 6 of Actos, and continue CSM for 3
weeks; continue Actos for 4 more days (total of 10 days Actos). See
CSM instructions in treatment protocol available on website: 1) What
to expect from cholestyramine; 2) Information on cholestyramine; 3)
cholestyramine protocol.
Physician evaluation after 3 weeks of CSM, Note: most patients are
seen frequently during the first several weeks of Actos/CSM protocol;
this MD review is the minimum. Don't skip getting a VCS test done!
It is your "compass" to find your way home.
If vision and symptom are improving as Lyme patients normally will,
continue CSM alone until symptoms abate or reach a plateau.
If no improvement or worse, consider alternative diagnoses or
complications of Lyme beyond neurotoxins alone. Discontinue CSM, and:
A. Get deep nasal (body, not vestibule) culture for Coagulase
Negative Staphylococcus (CNS), and blood tests for Leptin and alpha-
Melanocyte-Stimulating Hormone (MSH); the culture must be grown for
at least 5 days; don't let the lab say "normal flora" as CNS is still
regarded as "benign" by most infectious disease physicians. Make
sure the lab runs the Leptin and MSH assays properly - special blood
drawing tubes are necessary and aren't a "routine" test for most labs.
B. While waiting for Part A test results, consider:
- i.v. ceftriaxone (Rocephin), 2 gm, 1 x day (PICC line catheter), 28
days.
If i.v. Rocephin not available:
- Biaxin (clarithromycin), 500 mg, 2 x day, 4 weeks; or Roxithromycin
(foreign use) or other macrolide antibiotic.
After completing antibiotic regime, CSM per protocol for 3 weeks.
When test results are available, if culture for CNS (produces delta
toxin) is positive, leptin is high and MSH is low, begin:
- Rifampin, 2-300 tablets mg with food in morning, 4 weeks (it turns
saliva, tears and other secretions red - is not blood!), plus;
- sulfamethoxazole-trimethoprim (Bactrim DS - make sure you are not
allergic to sulfur), 1 tablet, 2 x day, 4 weeks, plus;
- Muciprocin (Bactroban cream), apply to swab at one end of Q-tip,
coat front and deep nostril thoroughly, repeat with other swab or
other end of Q-tip in the other nostril, 3 x day, 4 weeks.
- Take Actos per protocol if an intensification reaction occurs, and
it often will, making some patients think that their problem is still
Lyme. (We think that the cytokines made in response to the
neurotoxins of Lyme or the antibiotics used to treat Lyme may alter
the normal defenses of the mucus membranes of the nose, permitting a
slow-growing, opportunistic organism, resistant to nearly all
commonly used antibiotic, like CNS, possibly growing with an unusual
fungus, to take over a "niche" in the nose.)
[Treatment for CNS is evolving; we are conducting studies. You may
wish to sign up on the website for a phone consultation with Dr.
Shoemaker, particularly if you have the MSH problem (not uncommon)
which indicates a hypothalamic abnormality.]
After completing antibiotic regime, CSM per protocol for 3 weeks.
If still ill, and symptoms include sweats, shortness of breath and
cough, and unexplained hematuria, without red cells in urine, get
polymerase chain reaction (PCR) test for Babesia (tick-borne
protozoan). If positive, begin:
- Atovaquone (Mepron), 750 mg (1 teaspoon), with food, 2 x day, 6
weeks (2 bottles); continue CSM.
After completing antibiotic regime, CSM per protocol for 3 weeks."