CME Archives

How education can bend the curve in the tick-borne disease epidemic

Kris Newby on May 11, 2023

There’s a dire shortage of health-care providers who are experienced in the diagnosis and treatment of tick- and other vector-borne diseases. This means many suffering patients must travel long distances and wait months for an initial appointment, leading to worse patient outcomes. [1]

There are immense insurance and logistical barriers that discourage providers from taking on patients with tick-borne diseases. Some of these were identified in a 2022 survey-study of 155 clinicians from 30 states who treat Lyme patients. They included complexity of care (79%), the cognitive impairment of patients (57%), and frequent patient calls between scheduled appointments (49%). [1]

This shortage of trained providers is getting worse as the incidence of vector-borne diseases rises. The Centers for Disease Control reports that:

Diseases spread by mosquitoes, ticks, & fleas tripled in the U.S., 2004-2016.
Since 2004, 9 new pathogens spread by mosquitoes & ticks have been discovered.
476,000 Americans are diagnosed with Lyme disease each year, in all 50 states.

Despite the alarming rise in these diseases, a 2023 study led by Cornell University, “Review of Continuing Medical Education in Tick-Borne Disease for Front-Line Providers,” found a “limited availability of continuing education for multiple life-threatening tick-borne diseases of increasing importance in the United States.” [2]

Invisible International is filling this educational gap by producing best-in-class Continuing Medical Education (CME) courses on vector-borne and environmental disease, available to anyone online for no cost. These courses cover prevention, diagnosis, and treatment of these disease.

What is CME?

Continuing Medical Education (CME) educational activities are classes, workshops, or conferences that increase the knowledge and skills of health-care providers, ensuring that they stay current on the latest medical research and best medical practices. Some states require that doctors, nurses, and other health professionals accrue a certain number of CME course credits each year to keep their medical licenses active.

What is unique about its CME offerings?

Invisible has one of the largest online CME collections of vector-borne diseases available. The courses are delivered by some of the most knowledgeable experts in their respective fields, featuring topics like persistent Lyme disease, the Bartonelloses, Lyme disease treatment, and neuropsychiatric symptoms of tick-borne diseases. Our courses incorporate the One Health concept, a recognition that the health of humans, pets, and the environment are all intertwined.

What is CME accreditation?

CME courses can be developed by medical societies, universities, companies, or nonprofits such as Invisible International. For these activities to be counted towards annual CME totals, they must be approved by independent accreditation organizations. This ensures that the educational activities are relevant, practice-based, effective, based on valid content, and independent of commercial influence.

Is Invisible’s CME accredited?

Invisible International’s Continuing Medical Education (CME) platform is accredited by two governing bodies:

The Accreditation Council for Continuing Medical Education (ACCME) sets course development guidelines to ensure accurate, balanced, scientifically justified clinical-practice recommendations, all free of commercial bias.
The American Academy of Family Physicians (AAFP) reviews individual courses to ensure that they:
- are relevant to family practice
- are evidence-based
- communicate the risks and benefits of clinical recommendations
- evaluate a learner’s grasp of the material.

Physicians taking AAFP-approved courses can receive reciprocal continuing education credits from the American Medical Association, (AMA), the American Osteopathic Association (AOA), the College of Family Physicians of Canada (CFPC), and other health professional organizations.

The Invisible Education Initiative, funded by the Montecalvo Foundation, provides free, accredited Continuing Medical Education (CME) courses that focus on vector-borne and environmental illness within a One Health framework. These courses are available to clinicians and the public. To donate to this initiative and to learn about Invisible International, please go here http://invisible.international/give.

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[1] Johnson LB, Maloney EL. Access to Care in Lyme Disease: Clinician Barriers to Providing Care. Healthcare. 2022; 10(10):1882. https://doi.org/10.3390/healthcare10101882

The authors of this study are Elizabeth L. Maloney, MD, a Minnesota family physician and Invisible’s education co-director; and Lorraine Johnson, JD, MBA, the Chief Executive Officer of LymeDisease.org and the principal investigator of its patient registry and research platform, MyLymeData.

[2] Malkowski AC, Smith RP, MacQueen D, Mader EM. Review of Continuing Medical Education in Tick-Borne Disease for Front-Line Providers. PRiMER. 2023;7:497812. Published 2023 Feb 2. doi:10.22454/PRiMER.2023.497812

Neuropsychiatric Lyme symptoms: A new masterclass

Kris Newby on March 11, 2023

Invisible International has just released an important medical education course on neuropsychiatric symptoms associated with Lyme disease, with treatment recommendations for specific manifestations. The course is taught by Shannon Delaney, MD, MA, an assistant professor in the Department of Psychiatry and neuropsychiatrist at Columbia University Irving Medical Center.

A key section of the course reviews the latest evidence on Lyme disease persistence after standard treatments, useful in overturning the long-held belief that Lyme disease is always easy to treat and cure.

“It’s staggering,” said Dr. Delaney. “Months to years after the initial infection of Borrelia burgdorferi, patients with Lyme disease may have chronic encephalopathy, polyneuropathy, or less commonly, leukoencephalitis,” she said.

Other topics covered in this masterclass include:

The definition of Post-Treatment Lyme Disease Syndrome (PTLDS), as defined by the medical community.
Case studies that illustrate the unreliability of testing for neurological Lyme disease.
Immune system biomarkers associated with neurological Lyme disease.
A description of how the Lyme bacteria creates disease in humans.

Dr. Delaney also reviews a cohort study that analyzed the clinical data of 12,616 Lyme disease patients over 22 years. The study, a collaboration of Columbia University and the Copenhagen Research Centre for Mental Health, is believed to be the first large, population-based study examining the relationship between Lyme disease and psychiatric outcomes. The results are a wakeup call for those who think of Lyme as a disease of mainly rashes and swollen joints; the study found that patients who received a hospital diagnosis of Lyme disease—inpatient, outpatient, or at the ER—had a 28 percent higher rate of mental disorders and were twice as likely to have attempted suicide post-infection, compared to individuals without the diagnosis.

This course reinforces the need for physicians to consider mental health symptoms when developing treatment plans for tick-borne disease patients.

Watch here: https://learn.invisible.international/courses/neuropsychiatric-symptoms-with-lyme-disease-tick-borne-illness/

Why is it so hard to find a Lyme doctor? Here are some reasons.

Kris Newby on March 11, 2023

In the first study of its kind, two Lyme disease experts gathered data on a question frequently asked by tick-borne disease patients: Why is it so hard to find a Lyme-treating physician? And how could there be such a doctor shortage, when there are 476,000 new annual Lyme cases per year reported from all 50 states?

Invisible’s new short course answers this question based on data from a survey-study of 155 clinicians from 30 states who treat Lyme patients. The study’s goal was to identify the problems that clinicians face when treating these patients, a first step to overcoming these obstacles. The study’s authors are Elizabeth L. Maloney, MD, a Minnesota family physician and Invisible’s education co-director; and Lorraine Johnson, JD, MBA, the Chief Executive Officer of LymeDisease.org and the principal investigator of its patient registry and research platform, MyLymeData.

The first point that the study authors make is that these patients aren’t easy. Seventy-nine percent of survey respondents said that their biggest challenge was the complexity of care required for tick-borne disease patients. Because Lyme and co-infection testing is unreliable or nonexistent, clinical exams typically take longer than is reimbursed by medical insurance. This means that clinicians lose money on these patients because the economic reimbursement model in the U.S. doesn’t work for complex and/or chronic conditions.

In many cases, Lyme patients have cognitive impairments caused by brain inflammation, making it hard for patients to communicate accurate medical histories and follow treatment protocols. About half of the providers said that their Lyme patients require more handholding and calls between regular appointments than with other diseases.

One of the most surprising findings was the stigma-burden faced by Lyme-treating physicians. Three-quarters said that they had suffered from professional stigma, including:

61% experienced a lack of collegial support
59% faced opposition from physician organizations
19% had been subject to medical board inquiries
11% had been excluded from insurance networks

“We can think of professional stigma, regulatory investigations, and failed economic models as forming a wall that not only separates patients from clinicians but produces significant disincentives for clinicians to provide care,” said Dr. Maloney. “This leads to a significant supply-and-demand mismatch, which is why patients have trouble finding a treating clinician.”

The Invisible Education Initiative, funded by the Montecalvo Foundation, is working to educate more health-care providers on the best protocols for getting Lyme patients better faster. We do this by providing free, accredited Continuing Medical Education (CME) courses that focus on vector-borne and environmental illness within a One Health framework. These courses are available to clinicians and the public. To donate to this initiative and to learn about Invisible International, please go here http://invisible.international/give.

Watch here: https://learn.invisible.international/courses/barriers-to-lyme-disease-treatment-what-the-data-is-showing/

New course on healthy dog ownership

Kris Newby on February 7, 2023

Invisible’s new continuing medical education course, “Zoonotic diseases and pet dogs,” discusses common diseases that can spread from dogs to humans, along with some simple prevention tips. It’s taught by Erin Lashnits, MS, DVM, PhD, DACVIM, a clinical assistant professor in small animal internal medicine at University of Wisconsin’s School of Veterinary Medicine. Her pedigree as a veterinarian and a dog lover includes an MS degree in biology from Stanford University, a DVM from Cornell University, and a PhD in comparative biomedical sciences from North Carolina State University.

It’s estimated nearly half of all U.S. households own one or more dogs (80 to 90 million total), and along with cohabitation comes additional disease risks. In this course, Dr. Lashnits covers diseases that can be transmitted from dogs, advice on how to safely import dogs from abroad, and preventative measures when introducing a new dog into a home.

Dr. Lashnits’ new dog checklist:

Make sure your dog is vaccinated, dewormed, and treated for fleas and ticks before taking it home.
Before letting a new dog roam free with other dogs, keep it separated for about a week, observing for any signs of disease.
Avoid feeding your dog raw food to prevent food-borne diseases.
Take your dog for routine veterinarian checkups.
Provide your dog with year-round flea, tick, and heartworm.
Review the CDC guidelines on importing dogs from abroad.

In Dr. Lashnits’ practice, she sees dog bites and flea- and tick-borne diseases as major disease risks. Fleas can carry Bartonella, plague, and rickettsia species. Ticks can transmit Lyme disease, Rocky Mountain spotted fever, several deadly viruses, and a host of other pathogens.

She also offers a warning about dog kisses: “Try to train your dog not to lick you on the mouth, and if it does, wash your hands and face,” said Dr. Lashnits.

Dr. Lashnits goes on to explain how dogs can serve as sentinels for human disease, citing the use of dogs for tracking the alarming spread of invasive Asian longhorned ticks across the middle Atlantic states.

Watch here: https://learn.invisible.international/courses/zoonotic-disease-and-pet-dogs/

The tick-borne disease epidemic in Ireland: A call for more research

Kris Newby on January 10, 2023

In our newly released medical education course, a Dublin-based infectious disease physician-researcher raises the alarm about the undercounting and under-treatment of tick-borne diseases in Ireland, as well as the risk that this poses to the country’s blood supply.

This course, “Call for international collaboration and data sharing from the clinical trenches,” is taught by Jack Lambert, MD, PhD, a Professor of Medicine and Infectious Diseases at Mater and Rotunda hospitals, and University College of Dublin School of Medicine in Dublin, Ireland. He is also the founder of the Lyme Resource Centre in Scotland and a member of Invisible’s Scientific Advisory Board.

In the course, Dr. Lambert cites studies that have found that:

The standard two-tiered antibody tests miss more than 50% of verifiable Lyme patients.
One-in-five serum samples from the Irish blood bank showed the presence of antibodies to the Lyme disease bacterium, Borrelia burgdorferi. [Source: Irish Surveillance Center data from high prevalence areas]
The overall rate of borrelial infection in ticks collected at six sites in Ireland was 5%, with a range from 2% to 12%, depending on the locations of tick collection. The most prevalent species detected were garinii (70%) followed by B. valaisiana (20%) and B. miyamotoi (10%). All of these Borrelia species cause human disease, and this is the first time that B. miyamotoihas been detected in Ireland.

“Most people don’t remember a tick, many don’t get the bullseye rash, and many are not offered a Lyme test. For those truly infected, the Lyme antibody test is insensitive. Until we have enhanced surveillance of clinical cases and improved sensitivity of the diagnostic testing, numbers of cases of Lyme disease and coinfections will be underreported,” said Dr. Lambert.

Dr. Lambert also highlights a major flaw in the Lyme disease tracking in Ireland: Reporting is only required for the most serious neurological manifestations of the disease, i.e., patients who have been admitted to a hospital and have had a lumbar puncture that shows specific abnormalities in the cerebral spinal fluid.

Other topics covered include the undercounting of Lyme cases in Canada and the United Kingdom, the geographic spread of Lyme in Europe, and the need to treat patients according to symptoms, not one-size-fits-all guidelines. He goes on to cite evidence that treating with longer courses of combinations of antibiotic yields better patient results.

This free, accredited Continuing Medical Education (CME) is brought to you by the Invisible Education Initiative, funded by the Montecalvo Foundation.

Watch here: https://learn.invisible.international/courses/call-for-international-data-sharing-from-the-clinical-trenches-in-ireland/

Free course on treatment strategies for long haul COVID and Lyme patients

Kris Newby on September 20, 2022

A Dublin-based infectious disease doctor who’s treated both long COVID and chronic Lyme patients shares new research and treatment strategies for managing patients with these complex conditions, in a new continuing medical education course sponsored by Invisible International and the Montecalvo Foundation.

The course instructor is Jack Lambert, MD, PhD, a Professor of Medicine and Infectious Diseases at Mater and Rotunda hospitals, and University College of Dublin School of Medicine in Dublin, Ireland, as well as the founder of the Lyme Resource Centre in Scotland.

Dr. Lambert is also the lead author on an early, COVID-19 patient study that analyzed 155 COVID-19 patients over a year, to identify predictors and probabilities of developing post-COVID-19 syndrome. This was one of the first studies to identify severe brain-related issues, including brain fog, head pressure, sleep disturbance, memory problems, exhaustion, personality changes, and a whole host of symptoms related to inflamed nerves.

“There are clear similarities between the clinical manifestations seen in Long COVID and Long Lyme,” said Dr. Lambert.

Among the more interesting findings of the study was the prevalence of the mental health conditions associated with Long COVID:

18.3% had moderate-to-severe signs of depression one year after infection
13% had moderate-to-severe signs of anxiety at one year
21% had findings consistent with Post-Traumatic Stress Disorder (PTSD)
72% had concerning alcohol use after a year

These issues are also common among chronic Lyme patients, and for both cohorts, his most passionate plea to front-line physicians is this: “When you conduct a series of tests and find nothing wrong, don’t start prescribing psychiatric medications, suggesting that patients are just anxious, or are having trouble coping, or are having family issues that are driving their symptoms. These patients are suffering from real, inflammation-driven conditions, and we need to start by addressing these first.”

Dr. Lambert’s most important advice to medical clinics treating Long COVID and Lyme is to establish a case management process to help these very ill patients coordinate specialist visits and treatment protocols.

“Both COVID and Lyme disease can affect multiple organ systems, so case management should simultaneously address persistent infection, a deranged and disrupted immune system, and neuro-inflammation,” he said.

He admits that setting up a case management process can be challenging, even in a country like Ireland, with its free, government-sponsored health plan: “Care is fragmented, and patients are sent by their general practitioners to specialist after specialist—gastroenterology, cardiology, rheumatology, and so on. We need to do a better job of connecting and coordinating these specialists.”

As for treatment protocols, he recommends that clinicians use standard therapeutics to suppress the cascade of inflammation triggered by long COVID and to aggressively test and treat for the reactivation viruses that commonly occurs during COVID infections. He also presents study results on the use of low dose Naltrexone for symptom reduction.

This free Continuing Medical Education (CME) is brought to you by the Invisible Education Initiative and the Montecalvo Foundation. Accreditation is in-process.

Take the course here: https://learn.invisible.international/courses/long-lyme-co-infections-and-long-covid/

Five simple ways to save someone from developing chronic Lyme disease

Kris Newby on July 7, 2022

Whoever saves a life, it is considered as if he saved an entire world.
—Mishnah Sanhedrin 4:5; Yerushalmi Talmud 4:9

Anyone who has lived through a serious case of Lyme disease has probably experienced true despair and hopelessness. In the eyes of the medical system, you are invisible. Your case probably wasn’t sent to the CDC’s broken disease reporting system. The record of your suffering may not be acknowledged in the electronic medical records, because there were no diagnostic codes for chronic Lyme or its complications until January 2022. And finally, the “official” sources for Lyme disease information still say that the disease is easy to diagnosis, treat, and cure—the ultimate insult to those who have personally experienced the opposite.

Invisible International’s team is dedicated to righting these wrongs, by delivering the best diagnostic and treatment evidence to the frontlines of medical care. As we learn how to break through the walls of ignorance, we humbly offer up some ideas on how individuals can save lives from the plague of chronic Lyme disease and other tick-borne diseases.

Make your case count

Enter your Lyme story into the MyLymeData patient registry and research platform. LymeDisease.org’s survey tool tracks patient progress over time. By analyzing large amounts of patient data, researchers can see patterns that help identify gaps in care and treatments that work best.

Share our education courses with physicians

Invisible currently offers 25+ accredited medical education courses on tick- and vector-borne diseases, free to all. The courses cover important topics, such as neurological manifestations of Lyme, new evidence for persistent Lyme, and best practices for treating patients. Watch our medical education courses here and share them with physicians.

Distribute prevention resources to your community

PA Lyme offers a set of tick-bite prevention resources that can be shared with local schools, churches, and camps. Its “Dare 2B Tick Aware” program includes free webinars, educational flyers, and info on tick protection and testing.

Forward our newsletter to friends and family

Invisible’s newsletter delivers a steady stream of information on emerging research, promising treatments, new educational courses, and ways you can help others who’ve been bitten seek prompt, effective treatment.

Donate to our physician education program

One of Invisible’s top priorities is to integrate the Montecalvo physician education platform into the medical school curriculums in the U.S. and abroad. All donations, big or small, will help us make sure that the next generation of physicians learn about the latest strategies for preventing serious tick-borne disease complications and how to get patients better faster.

To read more about Invisible’s medical education, research, and community empowerment programs, visit https://invisible.international

Tulane researcher asks, “Could chronic Lyme contribute to Alzheimer’s dementia?”

Kris Newby on April 13, 2022

In 2019, the late-great-science-writer Sharon Begley wrote an insightful article, “The maddening saga of how an Alzheimer’s ‘cabal’ thwarted progress toward a cure for decades.”

Begley’s reporting described how a powerful group of researchers became fixated on one theory of Alzheimer’s causation at the expense of all others. Their hypothesis: that Alzheimer’s cognitive decline was caused by neuron-killing, beta-amyloid protein clumps in the brain, and that if you dissolved the clumps, the disease process would stop.

As this theory hit a brick wall, Begley showed how the actions of the cabal harmed patients: “…for decades, believers in the dominant hypothesis suppressed research on alternative ideas: They influenced what studies got published in top journals, which scientists got funded, who got tenure, and who got speaking slots at reputation-buffing scientific conferences.”

Decades later, with no cure or effective drugs for Alzheimer’s dementia, some researchers are gathering evidence on a different causation theory — that dementia could be triggered by any number of chronic infectious diseases, and that amyloid plaques are a byproduct of an active infection, not the cause.

One of these researchers is Monica Embers, PhD, an associate professor of microbiology and immunology at the Tulane National Primate Research Center. She’s also the leading expert in identifying treatments that can eradicate Lyme bacteria infections in nonhuman primates, our closest mammalian relatives. In her new continuing medical education course, “Chronic Infection and the Etiology of Dementia,” she lays out the evidence that the Lyme bacteria could be one possible cause of dementia.

Her theory is this: When pathogens like the Lyme bacteria sneak past the blood-brain barrier, the immune system doesn’t allow protective killer cells from the entering the inflexible brain cavity, because resulting brain inflammation and swelling could lead to death. Instead, it encapsulates invading microbes with protein clumps, called beta-amyloid plaques or Lewy bodies, to stop the infection. As a person ages, the bodily processes that clean up this “brain gunk” slows, resulting in protein accumulation that impedes brain signaling and kills neurons.

In her 31-minute course, Dr. Embers describes the clinical symptoms of Alzheimer’s and Lewy body dementia, the impact on public health, genetic risks, and the list of infections associated with dementia-like symptoms.

The course also reviews a well-documented case study about a 54-year-old woman who was treated for the Lyme bacteria (Borrelia burgdorferi), developed dementia, then died 15 years after the initial infection. After death, B. burgdorferi was identified by PCR (DNA detection) in her brain and central nervous system (CNS) tissues, and by immunofluorescent staining of the bacteria in the spinal cord. (For more, read this peer-reviewed study.)

Dr. Embers and her study’s co-authors conclude, “These studies offer proof of the principle that persistent infection with the Lyme disease spirochete may have lingering consequences on the CNS. Published in postmortem brain autopsy images and extensive pathology tests are a compelling reason to pursue this line of scientific inquiry.”

You can watch this free CME here.

To help us launch our CME curriculum in hospitals and medical schools, donate here.

Invisible International’s Education Platform for Tick-borne Illness is funded by the Montecalvo Family Foundation. This platform currently offers 24 free, online Continuing Medical Education (CME) courses on the diagnostics, epidemiology, immunology, symptoms, and treatment of Lyme disease, Bartonellosis, and other vector-borne diseases.

Free online medical education course on early Lyme disease

Kris Newby on April 21, 2021

Three patient case studies guide physicians on how to diagnose and treat early Lyme disease. This online course summarizes the latest research on disease risk, symptoms, and treatment options.

Diagnosing early Lyme disease cases can be notoriously difficult. Initial symptoms mimic those of the flu or Covid-19 — fever, chills, headache, and aches. The recommended antibody testing isn’t reliable in the first month. And many of those infected by a tick never see the tick or the most helpful diagnostic sign — an expanding erythema migrans rash at the bite site.

In the meantime, it’s more important than ever for physicians to keep up with clinically relevant information that will enhance their Lyme disease diagnostic and case management skills. Lyme disease is the fastest vector-borne illness in the United States, with an estimated 476,000 new cases a year, according to the Centers for Disease Control. Approximately 10 to 20% of those treated with antibiotics go on to experience disabling long-haul symptoms, such as severe fatigue, joint/muscle pain, brain fog, and neurologic symptoms. Prompt diagnosis and treatment of early Lyme disease results in better outcomes.

“Case studies in early Lyme disease” is an online continuing medical education course that discusses disease risk in geographic regions, Lyme disease rashes, NIH-funded treatment trials, the basics on how Lyme bacteria evade the immune system, and the pros and cons of various patient treatment options. Participants’ diagnostic skills are tested with three real-life patient case studies. This course has been approved for 1.0 CME credit by the American Academy of Family Physicians.

Elizabeth L. Maloney, MD, the course’s author, is a Minnesota family physician focused on tick-borne disease education and policy. She is also the education director of Invisible International; the founder/president of the Partnership for Tick-borne Diseases Education; a former subcommittee member of the HHS Tick-borne Diseases Working group; and a peer reviewer for the Canadian Institutes of Health Research.

This project was funded by the Montecalvo Platform for Tick-Borne Illness Education, through Invisible International, a 501(c)(3) nonprofit foundation dedicated to reducing the suffering associated with invisible illnesses and social marginalization through innovation, education, and data-driven change projects. You can sign up to receive news and updates at https://invisible.international/newsletter

Image credit: Tricia Shears 2009, Lyme rash on a 5-yr-old

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