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An interview with Dr. Steven Meress, Forum Health
By Nate Sleger
Just a little over four months ago, my wife Amanda, myself and our dog Jack moved from the city where we lived in Wisconsin into the woods. We moved about 45 minutes away into the first kind of country, rural living for Amanda and for me. And we're loving it so far.
But one thing that we noticed right away since we moved in the spring was the presence of ticks. Now, it may be that when we were in the city, they were there, we just didn't notice them. But after we got into our new place, it didn't take long for us to start getting a little freaked out.
The people around us were talking about ticks. And it didn't take long before I found one on my leg. And he was enjoying what I learned is referred to as a “blood meal.” So super gross!
Anyway, these experiences got me wondering about what the truth about ticks really is. And it got me questioning the things that we hear about tick-borne disease and Lyme disease in particular.
So I went on a search to find the foremost tick-borne disease expert in our neck of the woods.
One of my friends steered me in the direction of Dr. Steven Meress, a functional medicine doctor who specializes in tick-borne diseases, including Lyme. He was kind enough to grant me an interview and help us all to learn more about tick-borne diseases, what we can do to prevent them, and what he does to help his patients to deal with the symptoms of the diseases that come from tick exposure.
Here's the thing, we’re here on this site because we want to be healthier versions of ourselves. We talk about that all the time. Many of us are doing that by paying attention to working out, to eating better, to working on our sleep, etc.
But the reality is we could be doing all of that and then we could be careless or just in the wrong place at the wrong time and get exposed to some really, really serious diseases even as we're out enjoying nature, which of course is a part of a healthy lifestyle.
I hope this interview allows you to enjoy the outdoors a little more. Perhaps having a better understanding of the signs and symptoms of Lyme and other tick-borne diseases will also give you some clues on what to do if they show up in your life in the future.
Here’s my interview with Dr. Steven Meress from Forum Health, in Fond du Lac, WI.
Me: Where does Lyme disease come from? How does someone really contract it?
Dr. Meress:
I really don't even like the word Lyme disease because we call it tick-borne disease. A single tick can give you multiple infections. The chance of you getting only one infection, really burgdorferi, from a single tick bite is pretty unusual. The majority of infections are going to be multifactorial. You know, bacteria, viruses, protozoan, can all be part of a single tick bite. Okay, so Lyme disease is a single entity of a single bacteria. We call it more tick-borne disease because it's more of an umbrella term versus a singular term.
Me:
Okay, I know you're not a tick expert, or maybe you are, but when you say “tick-borne,” is there a certain type of tick? Because now we hear so often that it's just the smaller Deer Tick that you have to worry about. Is that really the case?
Dr. Meress:
I mean, the Exosite Scapularis, the Black-Legged Deer Tick, is obviously the vector that we're talking about. And that critter really has a unique lifestyle because it goes through three distinct blood meals from its larval phase to its nymph phase to the adult phase. It's looking for a blood meal every time.
These ticks can live year round. They're obviously most active from mid-summer or mid-spring to late fall, but even in the wintertime they may come out on a nice warm day and they can get cross country skiers or hunters that are outside enjoying the sunny day. They can drop down from trees or branches.
The adults or the nymphs have a back set of legs that hold onto the trees or the grass or whatever, and the front legs are reaching out to grab the host. The larvae does not have the back legs, so they only have three sets of legs, whereas the other two forms have four sets of legs. That's kind of unique because the larger ticks are the ones that are more commonly found causing the infections. That's because they can grab on in the back and reach forward in the front.
I'm not a tick expert, but I do know about ticks, yes.
Me:
I'm new to the area, I live in the woods… and the neighbors are like, “If you get one of the big ones on you, you don't have to worry. But if it's a little one, you do.” Is that true?
Dr. Meress:
To an extent. We're talking about Lyme disease specifically. That is true, but remember that we're looking at other infections from other bacteria, including things like Bartonella or Leakia Anaplasma, Rocky Mountain Spotted Fever, Scrub Typhus, Rickettsia—all these infections primarily come from ticks. So we call this vector-borne infection. And Lyme disease specifically is the largest vector-borne infection in the world.
NBC News came out about two months ago and said 14% of the world's population has had Lyme disease. Think about that for a second. First of all, there's roughly 300,000 cases of Lyme disease being reported to the CDC every year and that's markedly underreported.
When I find a patient with seropositive laboratory diagnosis of Lyme disease, I have to report it to the county that they live in. Well, most of the time the county may or may not forward that information to the CDC. So I feel there's a lot of underreporting. But when the research is showing 14% of the world's population has had Lyme disease, which is primarily found in Europe and in the United States, that's saying an awful lot. So in my population, in my practice, the majority of patients I see have tick-borne disease, including Lyme disease and co-infections present.
Me:
Okay, so I'm going to just sit on that for a second. So if I heard you right, most of the people that come to you have some type of tick-borne disease, or Lyme specifically.
Dr. Meress:
If they are from Wisconsin or the Midwest, the chance of them never having a tick exposure in their lifetime is pretty remote. We're talking about an organism that could be the size of a pencil tip. So when I do the evaluations and what I do is I always tell patients I'm going to look at their immune system first, because the serologic tests, the laboratory tests, are dependent upon a healthy immune system.
So let's say you've been sick for a period of time and your immune system has been beat up and it's been weakened, and then we do this laboratory test that comes back negative. It doesn't really give you a lot of information. But if you do immune evaluation and see that they have a weakened immune system, then you can look at those blood tests to try to make a diagnosis of tick-borne disease and kind of bring that in line.
There are certain parts of the immune system that are exquisitely sensitive to tick-borne infection. If that cell line is down, that's a flag that they may have something going on. And a lot of physicians rely on blood tests to make a diagnosis. But even the Center for Disease Control says, ‘Do not do that.’
Lyme disease, and really, tick-borne disease is a clinical diagnosis. So I use the analogy. If it looks like a duck, quacks like a duck and walks like a duck, it's probably a duck. So if they've been outside and they're a hunter and a fisherman, they've had tick exposures, they've got all the symptoms of tick-borne disease, but they test negative. Are we going to say, you don't have Lyme disease? Or we're going to say, you have a negative test and it sounds clinically like you have this infection? And that's where the problem is.
A lot of Lyme disease treatment is making the initial diagnosis. Because most of my patients come to me with chronic disease. They've had this for a period of time, on average, seven
physicians, 20 months to make a diagnosis of Lyme disease. That's ridiculous. It should be the first physician that sees them takes a clinical history, makes a diagnosis, and then the CDC says, you can do tests to help confirm, but not make the diagnosis.
And what's happening is a lot of physicians wait for that blood test to come back to make the diagnosis. If it's negative, they say, well, you don't have Lyme disease. If it's positive, they say, well, you do have Lyme disease.
In medicine, that's not usually what we do. If you come in and you have a cough and you're congested, we listen to your lungs. We can say you have pneumonia. We don't need an X-ray to show that you have pneumonia.
So I think what's happened with this specific infection is people have really gotten to focusing on the lab test instead of focusing on the complaints and the history.
Me:
Got it. So I'm curious to know about the symptoms that you see. I'm sure there's a spectrum from maybe the least bothersome symptom up to some of the worst types of symptoms that you see…
Dr. Meress:
Well, initially, Lyme disease can be a very simple infection. It can be very flu-like. So you've got achiness, fatigue, headaches. A lot of patients complain of cognitive issues. Their brains just aren't working well. About 30% of the patients will report a ring rash, and that's obviously what people are always looking for. But statistics and research shows only about 30% of patients really see a target lesion—that Ring rash, and we call Erythema Migrans. If you obviously see that and you have those symptoms that's pathognomonic for Lyme—nothing else can do that but Lyme disease.
But when 70% of the patients really don't see that rash, and now they have these symptoms that are flu-like, and initially that's all you get. They may just blow it off as, well, I got a virus. Or they may think they have COVID now and they may get a COVID test, and the COVID test is negative, and off they go. And initially, that's maybe all you get for symptoms. But then after that, if it continues without treatment, you're going to be getting other organs involved. And Lyme really affects five organ systems: the skin, the heart, the nervous system, the joints, and the bladder. And it could be really any parts of those in any combination that we tend to see. So it could be somebody that comes in saying, my brain’s just not working, and I've developed this joint pain that's kind of unique. And the joint pain is unique because it's migratory. So maybe in your elbow one day, and then it's in your right knee the next day, and then it's in your shoulder the next day. Again, if you get that, chances are you've got Lyme disease or some form of tick-borne disease. So if you have this fever and this achiness and this cognitive issue and fatigue, and now you develop joint pain, chances are you're dealing with Lyme disease or some form of tick-borne disease, vector-borne disease.
Me:
Okay, so most of the tick-borne disease diseases, they kind of present the same in terms of symptoms?
Dr. Meress:
Well, in my practice, again, I get chronic patients, so I don't get the patients that come in with tick bites and a ring grash. They tend to go to their primary care or they go into walk- ins or whatever.
Every once in a while, I see some acute, but most of my patients are chronic. So by the definition, acute means four months or so after a tick bite or tick exposure.
Remember, it doesn't have to be a bite. If you see ticks on your animal, if you see ticks crawling on you, if you have ticks on clothing, that's a tick exposure. It's the ones that we don't see that we're concerned about, the ones in your hair or in your back that you may never see or feel. You're not going to feel these, but if you see ticks on you or on your animal or on your clothes, there's a good chance they could be on you. So if you develop symptoms after an exposure, you go camping somewhere and everybody's got ticks, but you don't get a tick bite that you know of, but then you get these symptoms, you probably had a tick bite that you just didn't find.
So you've got to be a little bit cognizant of what's going on. We do have some recommendations of if you do go camping or hunting or whatever. You can buy clothing that's impregnated with Permethrin from Gander Mountain or Cabela's, for example, or you can spray it on yourself. You can even send in your clothes to companies that will impregnate it for you, and they'll go through 70 washes.
We do have some things you can put on your skin. They're more of a Cedarwood essential oil type. Products that are safe to take. Essential oils are very good. I actually have a few companies that we utilize for this, but Cedarcide Tick Shield, for example, includes cedar wood.
For animals, I recommend Seresto dog collars or cat collars to keep ticks off, because if the ticks are on the animal, they're going to carry those ticks into the house, and all those ticks can get on you. So trying to keep the ticks from coming into the house by eliminating it from the animals or eliminating it from you is what we're trying to do.
Prevention is obviously a big part of this.
Me:
I'm curious about your perspective—is it possible to prevent tick-borne disease from affecting you by just taking really good care of yourself all the time? Or is it like no matter who you are, if you get Lyme disease or another tick-borne disease, it's going to eventually show itself in some of these symptoms?
Dr. Meress:
I've been in medicine for a very long time, over 40 years, and I never would see farmers in my practice. Farmers never came in. For a farmer to come into a medical doctor, their arm’s going to have to be hanging off, or [otherwise] they just don't want to come in.
But I've been in this practice now for 25 years next February. My late wife, Julie, and I started this practice up 25 years ago. I never saw farmers and I was thinking, well, obviously farmers are outside, they're getting ticks, they're getting tick bites. I have to believe they're having tick infections.
But I think what happens is the immune system does adapt to these infections. And some immune systems are very healthy and people just live with their symptoms. And some patients’ immune system’s are very weak and they become very symptomatic.
So the bottom line, and I always tell patients, where the tire meets the road is your immune system. That's really one of the parts of when I talk about the six pillars of wellness with my patient.
The first pillar is we're going to look for infectious diseases and what it does to your immune system. So looking at B cells and T cells and natural killer cells. Looking at autoimmune markers are all part of the workup because if the immune system is compromised, it's going to take a while to get better.
So we want to work on making sure the immune system is healthy and active and attacking everything that's not you. You don't want it attacking you (autoimmune), you don't want a weakened immune system or other things can come forward, COVID on down.
So I have to believe that there are people out there like farmers who get constant exposures to these things, almost like getting vaccinated, if you will. They're getting inoculated with infection, but their immune system is active enough and ready enough to fight this off, where they either don't have symptoms or their symptoms they don't care about enough to bring them into the doctor.
It's going to affect everybody, but it's going to be dependent upon how symptomatic you are by looking at your immune system. Healthy immune system—probably not a lot. But weakened immune system— probably more things coming up.
Me:
And I suppose if there's some life event now that weakens your immune system, that now makes you more susceptible to experiencing the symptoms of having that infection. Is that true?
Dr. Meress:
You hit the nail on the head. And we're seeing that with COVID. So with patients to get COVID, and they were patients I've seen before for tick-borne infection, they get over their COVID.
But all these tick complaints—they're saying, “I feel like I got Lyme disease or Bartonella back again.”
And we are seeing reactivation of certain infections after COVID. We're seeing chronic Epstein Barr virus reactivation. And in my practice I'm seeing tick-borne disease reactivation after COVID.
So what does COVID do? It's going to weaken the immune system and these other infections can come forward. So one of our key therapies when I'm treating COVID or chronic COVID. We want to make sure the immune system is healthy, active and reacting to infection and not attacking self. We don't want to see any autoimmunity, so we use prescription medication. We use supplemental therapies. We use injections. We use a variety of things IV therapies—anything we can do to help the immune system is what we're after.
Me:
Okay, great. I'd like to just wrap up with this kind of general question for you: From your perspective, what would you say is the easiest first step for someone to take who's ready to take their health more seriously? What would you recommend?
Dr. Meress:
This is easy. Truly, in my practice, I tell every single patient the three most important words in my practice, and they have to memorize these. They have to remember them. The three most important words. The gut, the gut, the gut. Where your immune system is made. It's where you're going to eliminate your waste. It's where you're going to utilize your nutrients. And if I can do anything for anybody, it's to always talk about gut health, which is really three things: a good probiotic, a good digestive enzyme, and a good fish oil. If you do that and nothing else, you're going to do better, you just are. Because you're going to help your immune system get healthy, and you're going to eliminate some of these toxins.
Now, obviously, there's other things we do, but I always come back to the gut. We heal through nutrition and we heal through sleep. And if either one is compromised, we don't heal. So the gut is where our nutrition is going to occur. It's where we're going to utilize these nutrients and eliminate the toxins that we have to get rid of. So we want to make sure our liver is working well and our gut is working well. And if you would start with three simple things: a good probiotic, a good digestive enzyme, and a good fish oil, you're off to the races. You really are. And that's one of my first pillars that I talk about with my patients.
Me:
Okay, nice. What's the best way for people to connect with you, Dr. Meress?
Dr. Meress:
We are at Forum Health Fond du Lac. Some people knew us as Fox Valley Wellness Center for the last 24 years. That's what we were known as. But we are now part of Forum Health, which is a functional medicine group of clinics that have been put together for the last three to four years.
Forum Health Fond du Lac is where we're at, and we're here to see patients. The majority of our patients are obviously [dealing with symptoms that are] tick-borne, but we also deal with cancer, women's health, hormonal balancing. We do pretty much everything because we are functional medicine, which is holistic. We look at the whole patient and we try to figure out what's going on with them.
To hear my thoughts on this interview and my big takeaways for myself and my clients, check out the full audio of my interview with Dr. Meress. Here’s the link to listen now.
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