The following is reprinted with permission from Dr. James Schaller’s newest research. I also recommend Dr. Schaller’s Bartonella 2-book set.

JAMES SCHALLER, MD, MAR

The Bartonella Checklist

Increasing Suspicion of This Emerging Stealth Infection

1.      Insomnia [If profound fatigue this might not apply].

2.      Current anxiety that was not present at age ten.

3.      Current anxiety or depression not present at twenty years old.

4.      Knee-jerk emotional responses worse than past decades and worsening.

5.      Unusual discomfort on the soles of your feet

6.      A temperature under 98.3. A temperature under 99.0 if Lyme disease or Babesia is present

7.      Puffy tissue on insole or any part of ankles

8.      Depression

9.      Depression that is not fully controlled. [Improvement of mood is not successful in depression treatment].

10.  Gingivitis or bleeding during flossing

11.  Anxiety is poorly controlled with average dosing

12.  Depression is poorly controlled by reasonable medication trials

13.  Sleep medicines work poorly at routine dosing

14.  Rage worse with time

15.  Irritability worse with time

16.  IL-6 is very low

17.  IL-1B is very low

18.  TNF-a is in lower 10% of normal range

19.  Any skin markings or growths greater than most people

20.  Blood vessels or color on skin greater than most people

21.  Impatience > in personality when compared to ten years ago. [in a child, any can be any irritability]

22.  Cursing or hostile speech that is worse over time.

23.  One or more medical problems with unclear cause(s) and “idiopathic.”

24.  Red papules of any size.

25.  Skin tags including ones removed by dermatologist or shaved off.

26.  Unusual blood vessels of any kind including inside organs such as   bladder or intestinal walls

27.  Any skin finding in excess of 95% of most humans

28.  Skin findings showing increased blood vessels of any size

29.  Skin findings showing increased tissue formation that is increased over the flatness of surface skin.

30.  Skin showing blood vessels that are too large or too many forthe location of the blood vessels, e.g., surface thigh and calf skin with very thick surface blood vessels. Or legs, upper arms or shoulders have explosions of many fine blood vessels.

31.  Increased addictions that are more resistant to recovery than average.

32.  Increased impulsivity in contrast to past years or past decades.

33.  Burning skin sensations [this may have many causes].

34.  Itching without a clear cause and which is hard to control and remove

35.  Skin erosion without a clear cause such as a fire or chemical burn.

36.  Minor cuts or scratches which heal slowly.

37.  After a surgery, you heal very slowly.

38.  You have two tick or flea infections with two positive tick or flea borne viruses, bacteria or protozoa. [Bartonella has >30 published species in public genetic databases and has more vectors than possibly any infection in the world. Therefore, the presence of other infections such as tick borne viruses, bacteria or protozoa, should raise suspicion.

39.  Exposure to cats and dogs in excess of very incidental rare contact.

40.  The patient’s mother is suspicious for Bartonella based on newer direct and indirect testing.

41.  A sibling, father, spouse of child with any tick or flea-borne infection who shared a residence or vacation with proximity to brush.

42.  Exposure to outdoor environments with brush, wild grasses, wild streams, golf courses or woods.

43.  Outdoor expose in locations such as brush, wild grasses, wild streams or woods which happened without the use of DEET orwithout very high off- gassing essential oils on exposed skin areas.

44.  The outdoor exposures such as brush, wild grasses, wild streams or woods which occurred without permethrin on shoes, socks and all clothing. 

45.  Clear exposure to lice, fleas or ticks. [Bartonella is carried by a huge number of carriers, but for now, the % that carry Bartonella is not known. Further, the capacity to detect all new species in the vectors or in humans infected, does not exist or is not routinely available in direct testing of all human infectious Bartonella organisms in both large or specialty labs].   

46.  Stretch marks in eccentric locations, e.g., arms, upper side under armpit, around armpit or on the back.   

47.  Stretch marks filled with red, pink, purple or dark blue color.

Certainty claims or criticism about Bartonella positions without reading at least parts of 1,000 articles is confusing. How this is this possible with new Bartonella findings and understandings each month? There are also new species genetically sequences to show uniqueness almost every month in public databases. In this spirit, this scale is meant to merely increase suspicion of Bartonella, which is a super stealth infection that takes perhaps fifty days to grow out on some bacteria growth plates, and floats in the blood as it lowers fevers. It also clearly suppresses some key immune system fighting chemicals. Cure claims are made without the use of indirect testing markedly documented in superior journals, but which are not used by immensely busy clinicians working full-time.

Dr. Schaller is the author of 29 books and 27 top journal articles.  His publications address issues in at least twelve fields of medicine. He has the most recent textbooks on Bartonella, which was only recently discovered.  He has published on Bartonella under the supervision of the former editor of the Journal of the American Medical Association (JAMA), and his entries on multiple tick and flea borne infections, including Bartonella [along with Babesia and Lyme disease] were published in a respected infection textbook endorsed by the NIH Director of Infectious Disease. He has approximately six texts on tick and flea-borne infections based on his markedly unique full-time reading and study practice, which is not limited to either finite traditional or integrative progressive medicine. Since he has a medical license he has been able to sort through many truth claims by ordering lab testing. He does not follow truth claims without indirect testing laboratory proof. He has read full-time on these emerging problems for many years.

COPYRIGHTED 2011   JAMES SCHALLER, MD version 9.

This form cannot be altered if it is printed or posted in any mannerwithout written permission. Posting in a critical evaluation is forbidden. Printing to assist in diagnostic reflections is encouraged, as long as no line is redacted or altered including these final paragraphs.  

Dear Dr. Shippen – Let me be of assistance.  I was on every combination of Lyme appropriate Antibiotics for over TEN YEARS.  I had a catheter in my chest getting another series of Antibiotics for over FOUR YEARS.  The saga of Lyme disease we all know is clearly an area of contentiousness.  However, what I know with certitude is the treatment for most of these heretofore seemingly imponderable chronic conditions in light of emerging breakthroughs in genomics and molecular biology are outdated clinical approaches.

The only thing “dangerous” to me was staying on the dead end Lyme treatment options I was on.  Thank God I was open and willing to try and LEARN a far superior approach.  Thank God for the internet that has completely change the paradigm.  Will more physicians get out of their orthodoxy and catch up to us patients?  

PBS/NJN News shot a story about Lyme and the current testing and treatment right in my home.  I was on the Front Page of Sunday “The Star Ledger” (the largest paper in the state), in addition to other major media appearances.  I know the issue and every treatment option VERY WELL I assure you.  Nothing I tried moved my clinical condition and serology even close to the what the MP so dramatically did!

My results are NOT anecdotal.  There are websites (MarshallProtocol.com; CureMyTh1.com, and others) with powerful positive (in many cases miraculous) testimony from patients from all over the world.  I ask respectfully that you and others please begin to listen – REALLY LISTEN and learn from highly informed patients.

From: Eugene ShippenSent: Monday, June 20, 2011 9:38 PM
To: Harold Smith
Subject: Re: mmi The latest on the Marshall Protocol. Latest what?

To all in this discussion, I would add the following observations, not withstanding that some members have had some positive experiences with the MP, either under treatment or through significant experience in prescribing it, such as Greg Baney, who I respect in his efforts and search for answers. What those of us that question the elements of the MP object to is the combined elements of the MP without adequate scientific support.

Some facts about the Marshall Protocol (MP):

1.     The MP has never been passed by a human experimental committee usually required before human trials are undertaken for new treatments (I have requested this information from several devotees and from Marshall himself and received no confirmation to date), nor has it undergone any controlled studies where various aspects of the protocol could be evaluated. Some patients may have benefitted, but for what reasons in the treatment – antibiotics? ARB effects? Vitamin D restriction? In any case, the treatment may take YEARS to see benefits and may require long periods of adverse (Herxheimer/immune dysregulation) reactions. Many patients cannot get through this initial phase or may never get through it. There is NO data on success/failure rates of those started on this unproven protocol. I have no doubt that some patients have been benefitted from treatment with the MP. My question would be how would they have done with antibiotics alone and would they have done better with additional vitamin D?

2.     The MP has several aspects that have potential benefits and potential side effects: 

a.     Antibiotics used in low doses cyclically or chronically (possibly beneficial as has been demonstrated by Brown and others – possibly negative effects of dysbiosis and antibiotic resistance. The use of various antibiotics such as tetracyclines and plaquenil have been used effectively for year to induce remission in various autoimmune diseases for many years. Is this the major benefit from individuals treated with the MP? I have used this treatment for years with beneficial results that occur much more quickly than those reported by Marshall’s devotees. I have concluded that this aspect is the basis for the major benefits seen in most patients. Many post-lyme patients have seen clear benefits from cyclic, diverse antibiotics in various different “protocols.”

b.     ARB with some documented anti-inflammatory effects (PPARgamma) – off label, untested at levels recommended – possibly may reduce inflammatory symptoms through several mechanisms, but potential adverse side effects at the recommended doses (as have been reported by some patients). Other ARBs, promoted by Richie Shoemaker, M. D. have better anti-inflammatory effects.

c.      ARBs have not been demonstrated to have specific “activating” or “blocking” effects on VDR. An early publication, Marshall calls it a VDR blocker; another, Marshall calls it a VDR activator. There is NO specific evidence that it has specific VDR activities despite theoretical “modeling” published by Marshall showing potential ARB linkage to VDR structure with NO data on effects.

d.     Restriction of all sources of vitamin D including sunlight exposure to the point of inducing overt well established severe deficiency of circulating levels of 25(OH)D3 – there are NO benefits ever demonstrated from this practice and clear adverse effects from sustained deficiency by all vitamin D experts published to date. There is no one other than Marshall’s group that have espoused this unproven theory. There are reports of exacerbation of symptoms in cases of Sarcoidosis with increases in vitamin D when increased 1,25D3 AND hypercalcemia are present. Interestingly, I know of NO patients that have been reported in published data of MP patients that demonstrate hypercalcemia, the hallmark of vitamin D toxicity. Many chronic infections have been shown to inhibit VDR activities that might reduce antimicrobial peptides (AMPs) that help the body fight off various infections. But vitamin D supplementation has been shown to increase AMP production, so why reduce it? Sunlight therapy has been reported for centuries to have specific healing benefits in patients with various chronic diseases, including TB, psoriasis, arthritis and autoimmune diseases and this treatment is available in the Dead Sea in Israel at the present time. This part of the MP doesn’t make common sense and my be detrimental as all studies of vitamin D deficiency have demonstrated. I have reviewed the bibliographies of many of the articles by Marshall and some of his devotees. The only source of published studies that would “support” the MP are articles written by devotees or Marshall himself in a circular bibliography fashion.

e.     The discussion of various “steroid” endocrine receptor interactions with vitamin D as a “steroid” is endocrine nonsense. Most hormones have the ability to activate or interact with similar receptors, but the actual hormones have the most effective activities with their specific receptors. To suggest that vitamin D may in some way interfere with other “steroid” receptors is an unproven theory in search of data to support the theory. Most hormones require adequate other supportive hormones for best effects. Correcting demonstrated deficiencies of various hormones, in my experience, has beneficial effects in treatment of all patients (with the possible exception of hormone dependent cancers) and I know Dr. Blaney, who prescribes the MP supports endocrine evaluation and treatment.

 Until the MP is subjected to controlled studies, it remains an unproven, (potentially dangerous?) approach to treatment of chronic diseases. Antibiotics may benefit some individuals with various chronic diseases, but the other aspects of the MP require validation before it should be promoted/supported on mmi.

Eugene Shippen, M. D. Private Practice, Shillington, PA

On Jun 20, 2011, at 2:58 PM, Harold Smith wrote:

Veny Musum and Dr. Bransfield.There are not any assumptionns but simply analytical summary of what the referenced web site details: anecdotal means one case, self reported means there is not an independent evaluator, chronic over years is evidence in the web site, and many treatments are utilized is evidenced in the web site and remitting relapsing is stated in parenthesis as my own experience of what the predominant number of chronic illness patients face.  Having read extensively about hormones and vitamin D, studied and practiced very practical medicine for over 45 years, having read extensively about the Marshall Protocol, attended Dr. Marshall presentations in which the presentation built extensively and quite illuminating on the work of others in chronic stealth infections while terminating when the audience awaited details of the evidence supporting the MP theories, and the even more in depth critical reviews of its flaws, published about Vitamin D, treated extensively Vitamin D deficient chronic illness patients, etc. , I appreciate your offer to educate me. Please do so with studies outside the cited authors of the Marshall Protocol.  From my point of view, go to CALDA web site and read the recent published LymeTimes article by Eugene Shippen MD and Harold Smith MD on Vitamin D in the 2010 publications. If you cannot access the article, I will regular mail you a copy. Although we are the authors, the references are to a multitude of other scientifically based physicians- not ourselves. I cannot find any studies on inducing vitamin D deficiency disease levels or hormone supplementation interfering with nuclear receptors in the immune system that support the confidence expressed in the “latest on the Marshall Protocol” beyond these authors. Scientific questions were presented to the MP and never answered. . There are components of the “latest” that are dangerous to patients- especiallly when an illness renders them desperate and more willing to gamble.. But I look forward to your contribution. When using MMI please include the details submitted in signature to enter MMI membership. I have included Dr. Shippen who may want to comment because I find the “latest” to have statements about hormone supplementation and hormone vitamin D that are generalizations and advice contradictedin the site’s referenced explanations about hormone supplementing This is very old ground for us and he may or may not find reasons to continue what has been a non dialogue before. Harold Smith MD private medical  practice Bloomsburg PA Dr. Smith – You are making a whole series of assumptions about both myself, the MP and the hard science it is grounded in. Are you interested in gaining a more complete understanding? Sent from my Verizon Wireless BlackBerry   Thank you for the  autobio info regarding Veny Musum MMI member. The link below is an anecdotal self-reporting story of recovery from a complex life altering chronic illness utilizing a complex treatment program over many years. Consequently it is likely there are both factors that made little difference, had significant impact, or were somewhat detrimental. Given that it requires months, even years to slowly steadily recover in a relapsing and remitting pattern ( my interpretation of the likely pattern), and many can be delayed, caution must be used in interpreting treatment as the one that did it all. Likewise, the concepts must make reasonable sense and be grounded in established open scientific discussion. Otherwise some conclusions may be dangerous to others. Harold Smith MD private practice Bloomsburg PA  — On Mon, 6/20/11, Paula Carnes    http://www.publichealthalert.org/Articles/miscellaneous/Veny.htm   I am not a supporter of the Marshall Protocol, nor am I a believer that D levels of 5 are normal or healthy.   Paula Carnes Biotech Investment Research Las Vegas, NV     On Jun 20, 2011, at 5:25 AM, Harold Smith wrote: Hello Dr. Bransfield. Perhaps I have missed a recent thread on the Marshall Protocol?  Anyone interested can find this link simply by googling their interest. For clarification purposes for myself and perhaps other MMI members, is the MMI notification of the link an endorsement that there is significant science as in MMI goals or simply a point of informaton. If one reads this site very serious questions arise: “many MP patients have kept their 25-D below 5 ng/ml for many years without any adverse effect”.  “Because hormonal supplementation can interfere with the activity of many nuclear receptors, hormonal supplementation is contraindicated”. There are some waivers to these strong recs-  It could be treated if HRT is “marked deficiency on a blood tests”. What are the deficient levels on blood tests that should or should not be treated and at what level do they match clinical symptomatology and physical exam findings?  What about a patient in the lower 40% with symptoms?  Here is the explanation: “Therefore, hormone supplementation treatment may compromise innate immune functions in a dose dependent fashion. Research is needed to validate this theory”.That last MP statment is the most or perhaps only significan statement.  There is no reasonable scientific methodology establishing not only Vit D levels of 5 ng/ml as without adverse effect or that hormone therapy is contraindicated- but also if one checks out the references there is an extremely low level of scientific methodology to nearly all the medical advice given with such confidence as this site.  What is the membership info provided by Veny Musum?  Thank you- Harold Smith MD private medical  practice Bloomsburg PA — On Sat, 6/18/11, Robert Hi, Below is a page explaining the Marshall protocol: Thanks to Veny Musum for providing the link. http://mpkb.org/home/mp       Robert C Bransfield, MD, DLFAPA 225 Highway 35 Red Bank, NJ 07701 Phone: 732-741-3263 Fax: 732-741-5308 Email:  Website: www.MentalHealthandIllness.com