LIVE from ILADS: Tick Boot Camp welcomes back Dr. Cory Tichauer, ND, owner and lead physician of Bear Creek Naturopathic Clinic in Medford, Oregon, and a member of the ILADS Board of Directors.

After years of treating Lyme disease and other complex chronic illnesses, Dr. Tichauer has become increasingly interested in a particularly difficult group of patients:

The people who do many of the "right" things but still don’t fully recover.

Dr. Tichauer describes them as his "20%."

While he says the majority of his chronic Lyme patients can achieve substantial improvement through individualized combinations of conventional and integrative treatments, another group remains stuck despite working with knowledgeable practitioners and trying numerous therapies.

Why?

Dr. Tichauer believes some answers may lie at the intersection of persistent infection, immune dysfunction, chronic inflammation, mitochondrial dysfunction, and the cell danger response.

The conversation also explores his research into a 12-week high-dose IV vitamin C protocol for Lyme disease, including the improvements he reports in quality-of-life measurements, Horowitz MSIDS scores, CD57 levels, and other immune markers.

This interview was recorded live at the ILADS conference, so you may hear some of the energy and background activity of the event throughout the conversation.

Who Are the "20%" of Lyme Patients Who Remain Sick?

After more than 15 years focused on chronic Lyme disease, Dr. Tichauer says his attention has increasingly shifted toward patients who don’t respond as expected.

He describes a broad spectrum.

Some patients respond well to relatively straightforward treatment.

Others require additional therapies and considerably more detective work.

But then there is a group that may improve somewhat yet never regain the level of function they hoped for.

Those are the patients Dr. Tichauer can’t stop thinking about.

Some have already seen five, six, ten, or even twelve doctors — including experienced Lyme-literate clinicians — before reaching his practice.

Rather than assuming everyone before him got it wrong, he asks:

What are we missing?

Lyme Treatment Is Rarely One Thing

For the patients who do respond well, Dr. Tichauer describes drawing from a large therapeutic toolbox.

Depending on the individual, his approach may include:

• Oral antibiotics
• IV antibiotics
• Off-label medications
• Herbal medicine
• Biofilm strategies
• Immune support
• Peptides
• Mitochondrial support
• Nervous-system approaches
• Other integrative therapies

The challenge is that there are countless possible combinations.

That makes complex Lyme disease less like following one treatment recipe and more like finding the appropriate combination for the individual patient.

Dr. Tichauer says that approach has allowed him to help many patients substantially improve.

But it doesn’t explain everyone.

When Doing More Isn’t the Answer

One of the strongest messages in this episode is especially important for people who have spent years cycling through increasingly aggressive treatments:

More isn’t automatically better.

If a patient has already worked with knowledgeable doctors and repeatedly tried reasonable approaches without recovering, Dr. Tichauer says it would be arrogant to assume that simply doing the same thing harder will produce a different result.

That realization has pushed him toward studying the underlying biology of his most difficult cases.

Among the patterns capturing his attention are:

• Immune dysfunction
• Mitochondrial dysfunction
• MCAS
• Hypermobility
• Chronic inflammation
• Cellular dysfunction
• Persistent infection
• Cell danger response

Instead of simply asking what else can kill a pathogen, he is increasingly asking what prevents the patient’s system from returning to normal function.

Persistent Infection vs. Persistent Immune Dysfunction

Dr. Tichauer pushes back against treating persistent infection and post-infectious dysfunction as necessarily competing explanations.

They may coexist.

He discusses the possibility that some organisms may persist at levels below a threshold that produces direct tissue damage while the immune system remains activated.

In other words, eliminating every last organism may not always be the only meaningful goal.

The clinical objective may sometimes be achieving remission — reducing microbial activity while helping the immune system regain appropriate tolerance and regulation.

Tick Boot Camp has explored the science and debate surrounding persistence in many conversations. Learn more on our Lyme disease persistence resource page.

"Getting the Genie Back in the Bottle"

The interview develops a useful metaphor.

Rather than assuming the body must become completely sterile of every potentially problematic microorganism, Dr. Tichauer discusses restoring a healthy relationship between microbes and the immune system.

Our bodies already coexist with enormous numbers of microorganisms.

The immune system must constantly determine what requires attack, what can be tolerated, and where organisms can exist without creating disease.

Dr. Tichauer describes the goal as getting the genie back in the bottle.

The pathogen burden matters.

But so does the immune response to it.

Immune Tolerance & Chronic Inflammation

Dr. Tichauer is particularly interested in immune tolerance.

A healthy immune system needs enough activity to protect us from infection without remaining chronically activated when that response is no longer helpful.

He discusses several interventions he uses or studies in the context of immune regulation, including:

• Low-dose naltrexone
• Vitamin D
• Herbal medicine
• Peptides

Dr. Tichauer has lectured extensively on low-dose naltrexone and Lyme disease, including its potential role in modulating inflammatory pathways in chronic and post-treatment illness.

The broader goal isn’t simply stimulating or suppressing the immune system.

It is helping restore appropriate immune regulation.

Vitamin D Is More Complicated Than a Number on a Lab Report

The discussion of immune function leads into vitamin D.

Most patients are familiar with having 25-hydroxy vitamin D measured during routine bloodwork.

Dr. Tichauer explains that vitamin D metabolism is more complicated than that single measurement.

He discusses active and inactive forms of vitamin D and his interest in how infections may potentially interfere with vitamin D metabolism.

He has become particularly interested in calcitriol, the active hormonal form of vitamin D, and discusses its potential influence on macrophages, immune polarization, and inflammatory signaling.

These are advanced clinical concepts, and prescription calcitriol requires appropriate medical supervision because altering active vitamin D metabolism can carry significant risks.

The Cell Danger Response

Another concept connecting Dr. Tichauer’s difficult cases is the cell danger response.

In simplified terms, cells exposed to infection, toxins, oxidative stress, or other threats can shift their metabolism toward defense and survival.

That response is useful when danger is acute.

The problem may arise when the system fails to return to normal.

Dr. Tichauer describes patients whose cells appear to remain metabolically impaired, with reduced energy production and mitochondrial dysfunction.

For someone experiencing profound fatigue, cognitive dysfunction, exercise intolerance, and other persistent symptoms, this creates another possible piece of the puzzle beyond simply measuring whether an infection is present.

Mitochondria & the Patients Who Stay Sick

Mitochondria produce the energy required for cells to function.

Dr. Tichauer sees mitochondrial dysfunction as one potential common denominator among some of his hardest-to-treat patients.

This connects directly with the cellular-health conversations Tick Boot Camp had at ILADS with Dr. Melanie Stein and Dr. Vy Simeles.

The question becomes:

Even if microbial burden is reduced, can a patient fully recover if cellular energy production and immune regulation remain severely impaired?

For Dr. Tichauer, helping restore mitochondrial and cellular function may be an important part of moving some patients from illness toward remission.

Rethinking Antibiotic Treatment

Dr. Tichauer still uses antibiotics.

But his thinking about how to use them has evolved.

Rather than relying exclusively on prolonged courses, he discusses circumstances in which he may use IV antibiotics more intensively for a shorter period, followed by pulsing, herbal therapies, mitochondrial repair, or other individualized strategies.

He also mentions daptomycin in the context of approaches intended to address persister forms.

His objective is not simply more antimicrobial treatment.

It is finding a strategy that appropriately addresses infection while limiting unnecessary collateral effects and supporting the patient’s overall physiology.

High-Dose IV Vitamin C & Lyme Disease Research

One of the most significant parts of this interview involves Dr. Tichauer’s research into high-dose intravenous vitamin C in Lyme disease.

At ILADS, he discusses a research project examining a protocol involving high-dose IV vitamin C.

The study initially needed to establish safety and tolerability, but Dr. Tichauer says the research team was also able to collect exploratory clinical and laboratory measurements.

The protocol involved:

12 weeks of treatment, 24 infusions, and 75 grams of IV vitamin C per treatment.

The protocol also incorporated DMSO and calcium EDTA.

Dr. Tichauer explains the rationale for these additions in terms of tissue penetration and biofilm-related strategies.

Why Add DMSO & EDTA?

Dr. Tichauer discusses DMSO as a compound used in the protocol with the intention of increasing membrane permeability and potentially helping vitamin C reach tissues where Borrelia may be difficult to target.

He also describes adding calcium EDTA based partly on earlier laboratory research examining potential approaches to Borrelia biofilms.

The resulting protocol attempted to address several potential barriers simultaneously:

• Microbial burden
• Intracellular infection
• Tissue penetration
• Biofilms
• Oxidative mechanisms
• Cellular dysfunction

Importantly, the findings discussed in this episode should be viewed as early research, not evidence that this protocol is an established treatment or appropriate for every Lyme disease patient.

What Did the Study Find?

Dr. Tichauer describes the results as exciting.

First, he says the study demonstrated the required safety and tolerability endpoint, with reported adverse events generally limited to issues such as headache and nausea.

He then describes improvements in several exploratory outcomes.

According to Dr. Tichauer, over the 12-week study researchers observed approximately 20–30% improvements across measures involving:

• Sleep
• Pain
• Fatigue
• Pain interference
• Anxiety
• Depression

He reports that fatigue continued improving during the 12 weeks after treatment ended.

Dr. Tichauer also says participants’ Horowitz MSIDS questionnaire scores dropped by approximately 25 points during treatment and another 11 points during the post-treatment period.

These findings are intriguing, but they should be interpreted within the design and limitations of the study rather than assumed to establish efficacy for high-dose IV vitamin C in Lyme disease.

CD57 & Immune Markers

Dr. Tichauer also reports changes in laboratory markers.

He says CD57 lymphocyte measurements increased approximately 50% during the 12-week treatment period, followed by an additional increase during the post-treatment period.

He also discusses changes in interferon-gamma-related testing.

Perhaps most interesting to him was what happened after treatment stopped.

Participants weren’t continuing the study intervention during the follow-up period, yet some measures continued moving in a favorable direction.

Dr. Tichauer says some participants remained in remission at the time of this interview.

Again, these are results as described by Dr. Tichauer during the interview and should not be interpreted as proof that the protocol will produce the same outcome for other patients.

Could This Help Explain the "20%"?

The episode then comes full circle.

Why might this research matter for the difficult patients discussed at the beginning?

Dr. Tichauer believes the answer could involve simultaneously addressing infection and cellular dysfunction.

In his model, intracellular organisms may interfere with normal cellular function while also helping perpetuate a danger response.

If treatment can reduce that intracellular burden while other interventions support mitochondrial repair, autophagy, mitophagy, and immune regulation, perhaps some patients can move out of the chronic defensive state that has kept them sick.

That hypothesis is helping shape where he wants to take his research and clinical work next.

Senolytics, Autophagy & Emerging Therapies

Dr. Tichauer briefly introduces several additional areas he is investigating, including:

• Senolytic therapies
• Autophagy
• Mitophagy
• Rapamycin
• KPV
• MSH
• Fisetin
• Urolithin A
• Spermidine

Each could easily become its own interview.

In fact, Dr. Tichauer says he has accumulated considerable clinical data involving rapamycin, setting up an obvious topic for a future Tick Boot Camp long-form conversation.

Individualized Medicine Remains Essential

Despite discussing new therapies and promising research, Dr. Tichauer repeatedly returns to individualization.

There isn’t one Lyme protocol.

There isn’t one explanation for every persistent symptom.

And there isn’t one treatment that will move every person into remission.

That is especially true for the difficult cases that now fascinate him most.

The goal is to identify patterns without losing sight of the individual person.

Serving on the ILADS Board

The conversation closes on Dr. Tichauer’s service with the International Lyme and Associated Diseases Society.

He describes attending his first ILADS conference years ago as a naturopathic doctor entering a medical community that wasn’t always as integrated as it is today.

Now he serves on the organization’s Board of Directors.

ILADS currently identifies Dr. Tichauer as an integrative clinician with more than 20 years of practice focused on tick-borne diseases, neurodegenerative conditions, environmental medicine, and autoimmune illness.

For him, serving on the board represents an opportunity to give back, mentor newer clinicians, and help bridge conventional and integrative approaches to complex illness.

His message is collaboration:

The whole is greater than the sum of its parts.

About Dr. Cory Tichauer

Cory Tichauer, ND is the owner and lead physician at Bear Creek Naturopathic Clinic in Medford, Oregon.

His clinical work focuses on chronic complex illness at the intersection of Lyme disease and tick-borne infections, environmental illness, immune dysfunction, neurodegenerative conditions, MCAS, hypermobility/Ehlers-Danlos syndrome, and functional gastroenterology.

Dr. Tichauer has been involved with ILADS for more than a decade and currently serves on its Board of Directors.

He lectures on tick-borne illness, immune dysfunction, low-dose naltrexone, peptide therapies, environmental medicine, and other aspects of complex chronic disease.

Key Topics in This Episode

Chronic Lyme disease, persistent Lyme disease, Dr. Cory Tichauer, Lyme disease treatment, treatment-resistant Lyme disease, Lyme disease research, high-dose IV vitamin C, intravenous vitamin C, IV vitamin C Lyme disease, CD57, Horowitz MSIDS questionnaire, immune dysfunction, mitochondrial dysfunction, cell danger response, persistent infection, PTLDS, immune tolerance, chronic inflammation, low-dose naltrexone, LDN, vitamin D, calcitriol, Lyme disease biofilms, EDTA, DMSO, daptomycin, persister cells, peptides, senolytics, autophagy, mitophagy, rapamycin, KPV, urolithin A, spermidine, remission, ILADS, and integrative Lyme disease treatment.

About This LIVE from ILADS Interview

This short-form conversation was recorded in person at the 2025 International Lyme and Associated Diseases Society Annual Scientific Conference, From Terrain to Treatment: Advances in Vector-Borne Illness, held October 9–12, 2025, in San Antonio, Texas.

Because these interviews were recorded live at the conference, they have a different feel from Tick Boot Camp’s traditional long-form virtual and studio conversations — shorter, focused, and surrounded by the energy and background activity of ILADS.

Explore all Tick Boot Camp LIVE from ILADS interviews.

More from Tick Boot Camp

Learn more about the science and debate surrounding Lyme disease persistence.

Hear more conversations with Lyme disease doctors and healthcare professionals about testing, treatment, persistent illness, and recovery.

Explore the Tick Boot Camp Podcast for patient stories and conversations with doctors, researchers, advocates, and other voices working to improve understanding of Lyme disease and tick-borne illness.