Lyme and Psychiatric Illness: Jane Marke, MD at Central Mass Lyme Foundation Conference

In September of this year, Dr. Marke, who has made a subspecialty of treating patients with tick-borne disease, gave a lecture before the Central Massachusetts Lyme Foundation’s Annual Conference. She was on a panel with other esteemed physicians treating Lyme Disease: Dr. Kenneth Liegner, Dr. Daniel Cameron, and Dr. Elena Frid, as well as Dr. Neil Spector.
Her lecture addressed the psychiatric aspects of tick-borne disease, and was geared for a general audience of patients, advocates, and health care providers.

Click here to see the lecture

Natural Bug Sprays

What’s the story with natural bug sprays? Especially, essential oils? In fact, what are essential oils?

Essential oils are the distillation of the ingredients from plants that give them their smell, such as citrus or rose.

There are many recommendations online about essential oil bug sprays. This DIY (Do It Yourself) bug spray is a simple recipe:

1. 4 oz. witch hazel (or half witch hazel and half alcohol, distilled water, or apple cider vinegar)
2. 40 – 75 drops essential oil.

Which essential oils to use? All the following work to repel bugs:

1. Mosquitos – citronella, lemon eucalyptus, peppermint, lemon, eucalyptus, catnip, basil, clove, thyme, lemongrass, geranium, lavender
2. Fleas – cedarwood, citronella, eucalyptus, tea tree oil, lemongrass, lavender, orange, pine,
3. Ticks – rose geranium, juniper, rosewood, thyme, grapefruit, oregano, Cedarwood Texas

This recipe is essentially calling for 1.6% – 3.0% essential oils. Keep that in mind. Stay with me here.

My questions after reading so many recipes, and listening to what my patients were already doing were these: Do these oils work? Are the proportions correct? I’d love to recommend a repellent made of essential oils, but I want to know first, is the recipe a recipe for success?

So, this is how I went about researching the topic.

First, I began with the CDC

The CDC has a page addressing natural repellents, and explains that natural repellents must be registered with the FDA, but not approved. That means they’ve been evaluated for safety, but not efficacy. They go on to list compounds for which there are studies of effectiveness and which they appear to be encouraging.

1. 2-undecanone
2. Mixed Essential Oils (rosemary, lemongrass, cedar, peppermint, thyme, and geraniol)
3. Nootkatone

Unfortunately, the literature the CDC references on the above products does not really address the issue of human use. So much for that. An additional problem is that CDC is in business with tick-repellent companies, and has granted a license for production of a Nootkatone spray. It’s not come to market, perhaps because of expense, but the fact that CDC gave a license to a company to produce the spray brings the issue of conflict of interests to their assessments.

Next, I did a search of the scientific literature on PubMed, the U.S. National Library of Medicine.

I read studies showing that the following agents are effective against ticks:

  • Oregano essential oil
  • clove
  • thyme
  • vetiver
  • sandalwood
  • cinnamon
  • cedarwood
  • peppermint oil
  • tree tea oil

None of the studies I read address the kinds of strength of the agent that are encouraged in the DIY preparations, which are pretty consistently 40 drops/4 oz., or 1.6%; nor do they address how long the agents work on people, in the kinds of preparations humans use on skin.

Lastly, I turned to Consumer Reports which studied several natural bug repellents as well as the chemical repellents.

  • Chemical products containing Picaridin 10-30%, or Deet 30%, were effective against both kinds of mosquitoes tested, as well as ticks and lasted 7 – 8 hours. But these are the commercial, chemical agents many of us want to avoid, as I do, though if you’re on a long hike and can’t reapply, they’re useful.
  • Natural products are effective, also, but for much briefer periods of time. If you are not going to reapply them often, they will be useless.
  • The effective natural products are all stronger, more concentrated, than the DIY recipes.

Natural Agents Rated by Consumer Reports:

1. Repel: Eucalalyptus
Effectiveness: Mosquitoes and ticks: 7-8 hours

(30% essential oil)
2. Burts Bees: Castor oil, Rosemary oil, lemongrass, cedar, peppermint oil, Citronella, clove oil, geranium oil

(20% essential oil)
Effectiveness Aedes, and Culex Mosquitoes and Deer ticks: 3 – 3.5 hours.
3. HOMS Bite Blocker: Zanthoxylum armatum

(7.5% essential oil)
Effectiveness against mosquitoes and ticks: 3 – 3 ½ hours.
4. California Baby: citronella, lemongrass, cedar

(6% essential oil)
Effectiveness against mosquitoes: ONLY ½ hour.

Effectiveness against Deer Ticks: 7 hours

5. EcoSmart: geraniol, rosemary, cinnamon, lemongrass

2.5% essential oil)
Effectiveness against mosquitoes: ½ hour

Effectiveness against Deer Ticks: 1.5 hour

The 40-drop/4oz DIY preparation is much weaker than the effective commercial essential oil products, and resemble Ecosmart the most. This means they might will probably only last against mosquitoes around ½ hour, and against ticks – only about 1 ½ hours. So, we need something stronger.


This requires an entirely separate blogpost. Much is written on essential oil use at various ages. But a strong caveat is to avoid Eucalyptus and Rosemary in children under age 10.

It is not advised to use essential oils on babies less than 3 months of age because their skin is not mature yet and therefore more permeable and sensitive to essential oils. Unlike adults, newborns are also not as capable of dealing with adverse reactions to essential oils.

For more details, on what to use with children, try reading Essential Oil Safety – By Robert Tisserand and Rodney Young.


1. I can’t recommend the commonly used DIY recipes, when I see that the more effective commercial preparations are much stronger. If you buy a commercial brand, buy one that has a minimum of 3 hours of effectiveness and reapply every 2 hours. Repel lasts as long as the chemical DEET.

2. If you want to avoid DEET, and like the DIY model: Make a more concentrated mix than the more commonly recommended.

a. For a 7.5% solution: 180 drops/4oz.

b. For a 10% solution: 240 drops in a 4-oz. spray bottle. Dr. Mercola makes a spray from citronella, lemongrass, and peppermint, and he has chosen 10% essential oil.

I am not recommending the above brands over any others. These are the brands Consumer Reports studied, from which I could get useful human data. If you find brands with comparable strengths, their effectiveness is likely going to be comparable.

What did I do? I bought 6 bottles online, made up a concentrated bug-spray, and am giving bottles away as gifts! I keep a smaller spray bottle in my purse or backpack, and spray when I’m about to enter grassy areas.

Here’s a supply list for doing that.



IDSA Lyme guidelines removed from NGC; ILADS guidelines still there!

Great News!

We all know there has always been great controversy around the diagnosis and treatment of Lyme Disease.  This controversy was between the IDSA-Infectious Disease Society of America– and the general community of health care clinicians out in the field, seeing tens of thousands of patients.  ILADS was formed by these clinicians to further the dissemination of information and research on Lyme Disease as it affects the patients we see across the country.

The National Guidelines Clearinghouse–a federal database that provides treatment information to health care professionals and insurance companies–for a long time contained only the IDSA Lyme guidelines.  But ILADS wrote guidelines, and the National Guidelines Clearinghouse posted them in 2014, so the government was posting two conflicting sets of guidelines.


This means that the only Lyme disease guidelines listed on the NGC are those that ILADS submitted in 2014, and which were accepted for publication. This is terrific for the Lyme community.

So what is this all about? How did this happen and what does it mean for you?

In 2006, shortly after the IDSA published its most recent guidelines on the treatment of Lyme disease, an antitrust investigation was filed by then-Connecticut Attorney General Richard Blumenthal. (Blumenthal is now a U.S. senator.)

The IDSA settled the antitrust investigation by agreeing to review its guidelines in a public hearing—which provided essentially equal time for the IDSA and patients, clinicians, and scientists who held opposing views.

The hearing panel released its finding in 2010. But the panel was made up essentially of the same people who wrote the original guidelines, so no wonder they found it acceptable. IDSA advised the NGC that the IDSA had reviewed its guidelines and that no change was necessary. (Actually, the panel recommended 25 changes)

The NGC decided IDSA could post its guidelines until 2015 without further review and update.

However, in 2014, the NGC revised its rules for writing guidelines to conform to some of the standards adopted by the Institute of Medicine in 2011 for creating trustworthy guidelines. These standards included using a rigorous evidence review system.

ILADS guidelines took the new standards very seriously, and carefully conformed to the high evidentiary standards of the IOM. Although the IDSA guidelines did not conform, because they were filed before the NGC adopted the IOM standards, they were given a “free pass” on compliance.

But not anymore.  They’ve been removed, without comment, but presumably for not meeting the scientific standards of the Institute of Medicine.

The IDSA guidelines are currently undergoing revision. The IDSA’s guideline revision process was publicly posted for comment in May 2015. The new process which did not have a patient on its review panel, as required by the Institute of Medicine was met with an outpouring of protest from the Lyme Community.  We don’t know what their final conclusions will be, but for now, IDSA guidelines are gone.

What does that mean for you? It means that in the controversy over what kind of treatment should be given to people who are ill with Lyme and associated diseases, we are free to use antibiotics as we believe indicated by the clinical picture, and not to arbitrarily stop because IDSA insists Lyme is hard to catch and easy to treat!  Chronic and late-stage Lyme are recognized, and the need for IV antibiotics for some people who are very sick is recognized.


If you get bit, test the tick!

August 12, 2015

This month, the Centers for Disease Control published a new study ( revealing tick populations continue to spread in various parts of the country.  But whether you visit those places or not, ticks can come to you, carried either by wild animals (deer and mice) or domestic (dogs and cats).  Within my family, among my friends and in my practice, I have been dealing more and more with the consequences of tick bites. And one thing is clear; being prepared to respond to a known tick bite makes a huge difference in treatment and outcomes

It is very important to send the tick for testing. While treatment decisions should not be based solely upon the results, the information can only help.  While labs claim that tests are 100% accurate, what they are saying is that if they find the organism’s DNA, it is definitely present. But we don’t know exactly how good they are at finding the DNA.  Some think they are 60-70% accurate; some think more so.   We just don’t have that data.  Compared to waiting to get ill, and dealing with tests with a 40-50% accuracy, I think it can only help to test the tick.


 Make a Tick Kit; Keep it Handy


 Here is what your DIY Tick Kit should contain:

  • An envelope addressed and stamped to the lab of your choice
  • A completed requisition form for the lab you choose
  • A small zip-lock baggy
  • A small piece of paper towel to be moistened
  • A fine-nosed tweezers (only a fine-nose tweezers can be counted on for the smallest ticks.)


Correctly Remove the Tick

Learn the correct method for removing a tick. Squeezing the tick can send more potential infections into your system. And you must get the head out.  The International Lyme and Associated Diseases Society (ILADS) has an instructional video on its site.  (


Get the Tick Tested

At the moment, testing for tick infections in humans is less accurate than testing the tick. Some labs state testing ticks for the presence of infective agents is 98% accurate. So, if you see the tick, get the tick. There are a number of labs to choose from.  I’ve made a list of several well-respected labs, their prices and what they test for, as of today.   Decide in advance which lab you want to use, so you don’t have to spend time researching after being bitten.


Choosing a Lab:  What do they look for?  All Labs are Not Equal!


  • All the labs test for Lyme, (borrelia). But only some test for Borrelia miyamotoi, which is increasingly found in US ticks and causes a Lyme illness marked by fevers.
    • Labs which test for Borrelia miyamotoi: Igenex, UMass, and UConn.
  • Bartonella is another common co-infection, and is very hard to detect in humans, because it hides out deep in tissues.
    • Labs which look for Bartonella: Igenex and Pharmasan Tic-Kit.


The Cost/Benefit of These Labs?

  •  If cost is not an issue, Igenex is the most thorough lab. In fact, considering how costly it is to get ill, Igenex is a good choice for the economically minded also, even with a significant up-front charge.
  •  If cost is an issue, the Tic-Kit is a very good buy. For $50 or so, you can get your tick tested for 4 organisms.   However, you lose the chance of finding Bartonella, which is quite common, makes us very ill with neurological symptoms, and is hard to diagnose in humans.




Find your handy DIY Tick Kit containing your fine-nosed tweezers! Correctly remove the tick. Put the tick in the baggy with a slightly moist small piece of paper towel.  If you must delay mailing it, refrigerate the baggy.  Send even the most mushed up or tiny ticks to the lab of your choice.

If you use your DIY Tick Kit, you have done your best to protect yourself after the bite, and before consulting your physician.

What Next?

You’ve been bitten by a tick, and the earlier treatment is begun the better.  Here at LymeCareNow, we will do our best to see you within 24 hours of your tick bite to provide prophylactic antibiotics, and assist with sending your tick to the appropriate lab.

Call for an appointment:  (212)  228-2332.


ScreenHunter_31 Aug. 23 16.24

Tick Season Is Here – Choose The Right Repellent!

Well, tick season is well upon us; the calls are coming in already.  Nymphs emerged early, and with them, all the tick-borne diseases.

Some news:  There’s a new concern about ticks developing tolerance to Permethrin, but still, it’s the best prevention we have.  Treat all clothes which you will wear in grasses with Permethrin.  I highly suggest using the military wash, and drying outdoors, if possible.  This will last many washings.

DEET is not as effective as icaridin/picaridin and even citiridiol.  It’s greasy, and smelly, and people don’t like using it, so compounds which contain these ingredients are more palatable, as well as more effective. citriodiol is also known as lemon eucalyptus and icaridin/picardin is also known as saltidin

If you choose DEET, choose the longest lasting brand, not the strongest. A higher percentage of DEET won’t help you if it wears off.

And don’t forget, shower as soon as you come in, and do a tick check!


Lyme activism event

I participated in my first Lyme activism event on September 19, 2014! The protest was for more complete reporting on the Lyme pandemic and was staged in front of the NY Times building as a symbolic statement. I was interviewed by the NY Times reporter on Infectious Diseases, Donald G. McNeil Jr. at the protest. Not sure how much impact we had but it felt good to be creating awareness with passer-bys.

Coverage by the website can be found at this link –