S3 E22: Dr. Omar Morales Talks About His Path to LymeMexico

A sudden storm of obsessions, tics, rage, and cognitive chaos can follow a simple infection—and families are left searching for answers. We sit down with Dr. Omar Morales, a hematology‑trained clinician innovating at the intersection of  infections and immune engineering, to unpack how blood-based therapies can change the trajectory of Lyme and PANDAS/PANS. 

Dr. Morales explains why he treats the biology rather than the label, then breaks down the roles of apheresis modalities. Red cell exchange rapidly dilutes Babesia lodged in red blood cells. Plasmapheresis removes inflammatory plasma, autoantibodies, and toxins that hammer the brain. Photopheresis, supercharged with photosensitizers, both weakens pathogens and reshapes immune signaling. From those sessions, his lab matures dendritic cells that “teach” T and B cells to target the right invaders—an  immune reboot especially useful for Bartonella and persistent viral loads.

We explore a practical sequence for severe PANS: “clean the house” with plasmapheresis, then add IVIG, and repeat as needed while targeting infections in parallel. Morales details how environmental disruptors—mold, heavy metals, chemicals, and STDs—can trigger relapse, why diet and microbiome rebuilding matter, and how barrier repair for the gut and blood–brain barrier reduces neuroinflammation. He shares neuroregenerative strategies, from peptides to neural‑derived exosomes, to help brains recover from years of inflammatory wear and tear.

What emerges is a playbook for complex, immune‑mediated neuropsychiatric illness that blends hematology, microbiology, and patient‑centered pragmatism. You’ll hear a remarkable case rescued by red cell exchange, the logic behind choosing each modality, and the call for tighter collaboration between clinicians and scientists to speed innovation. Subscribe, share with someone who needs this, and leave a review to help more families find these tools. 

Link reference in the interview:  https://youtu.be/oNI52TIFEGA?si=XLnAzSXWoPAuSKIG

Disclaimer: The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the views or positions of any entities they represent.

Credits: Music by Kingsley Durant from his "Convertible" album

To learn more about PANDAS and PANS and The Alex Manfull Fund, visit our website: TheAlexManfullFund.org

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Transcript

Mission, Tragedy, And The Stakes

Susan Manfull, PhD 0:07

Untangling Pandas and Pans is a podcast about two little-known medical disorders characterized by the sudden and dramatic onset of symptoms such as obsessions and compulsions, vocal or motor ticks, and restricted eating behaviors, and a whole host of other symptoms following a strep or other bacterial or viral infection. I have the privilege of interviewing some of the top researchers and clinicians in this rapidly growing area, known by various names such as immune-mediated neuropsychiatric disorders, infection-associated neuroimmune disorders, and autoimmune encephalitis, or simply pandas and pans. My name is Dr. Susan Manfall. I am a social psychologist, the executive director of the Alex Manfell Fund, and the mother of Alex Manfall, who died at 26 years old due to pandas. A disorder my husband and I knew next to nothing about. Certainly not that our daughter could die from it.

William Manfull 1:18

This is episode 22 of Untangling Pandas and Pans, recorded February 18th, 2026.

Meet Dr. Omar Morales

Treat The Patient, Not The Label

Susan Manfull, PhD 1:27

Welcome to Untangling Pandas and Pans, a monthly podcast in which we talk about infection-associated immune-mediated neuropsychiatric disorders. Today's guest is Dr. Omar Morales. You might call Dr. Morales a physician innovator. He is at the forefront of tick-borne disease treatment and research, and treating pandas and pans is now also part of his practice. He was born in San Diego and raised in Tijuana. He trained in Guadalajara, earning a secondary degree in transfusion medicine with a focus on immunological diseases. After relocating to Puerto Villarta, he founded Lyme Mexico Clinic in 2014, establishing one of Latin America's leading centers for complex Lyme and coinfection care. With a background in hematology and blood bank medicine, Dr. Morales developed a novel approach treating severe babesia by implementing red cell exchange therapy, successfully eradicating infection in a critically ill patient, and opening the door to advanced aphoresis-based protocols. His work now integrates red cell exchanges, photophoresis, dendritic cell therapy, and other immunomodulating strategies to address the multifaceted nature of Lyme disease. Dr. Morales serves on the board of directors of ILADS and chairs the International Lyme Latin American Group. He is medical subdirector of the Biomedical Center de Occidente, president and co-founder of the Biomedical Cancer Institute, and oversees the Puerto Vallarta Blood Bank. He's an active researcher and international contributor to peer-reviewed publications. He is particularly focused on the neurological complications of tick-borne illnesses and emerging neuroregenerative therapies. Driven by the belief that complex infections demand multidisciplinary, integrative solutions, Dr. Morales combines science with compassionate, patient-centered care, bringing innovation, collaboration, and hope to patients worldwide. Something you might not know is that on the weekend you may find Dr. Morales in a small shipyard working with his crew, tinkering or fixing things up. That's his hobby. Much like his work as a doctor, restoring health in his patients, in this case, he's restoring things, and it's a hobby he loves. All right, Dr. Morellis, I'm so glad that you are with me today. And we are going to start off right off the bat about talking about how did you become a physician that's devoted to treating patients with Lyme and pandas and pans.

Environmental Triggers And Relapse

SPEAKER_02 4:57

Good morning, Susan, and thank you for inviting me. Sometimes I argue with uh what is it that we do if uh if it's really treating a disease, because I often forget about the diagnosis. I I hate being married to a diagnosis. I treat a patient for the illness, and sometimes uh, you know, I I'm not uh afraid to say sometimes we don't have a complete diagnosis. To me, the goal, the end goal is to make a difference in their quality of life, make a difference in their health. So yeah, I do treat patients with Lyme disease. My office is called Lyme Mexico for a reason, but it's it's been interesting to me to fe to see people walk in my door that have nothing to do with Lyme disease whatsoever, but that they've, I think, uh found that maybe my curiosity is helpful um in helping them, even in in circumstances when they themselves or myself have not really achieved a definitive diagnosis. But um I pursued Lyme disease out of passion, personal interest, because at some point in my life I too had my share of uh medical hardship. And so that led me to be very laser focused on specifically Lyme. I learned through the years that Lyme is just an umbrella to cover all of these other inflammatory and chronic illnesses that are triggering parts of the immune system and affecting nerves and affecting neurons and a number of tissues and organs. Uh, we could just spend an hour making a list of all the things that it can damage. So I think that in itself, I think the name of the office now is outdated. And maybe maybe it should be something like Factories Associated Chronic Illness Uh Center or something like that. I don't know. The reality is that in order to be healthy, it's not just to lack illness, uh, you know, it's also to be in good shape. So a lot of my recommendations to my patients are um, you know, what are you doing on your own to stay fit, healthy, eat well, have a good microbiome, stay in a healthy environment, be uh not so close to STDs, for instance, which can throw you off. Uh, what are you doing to procure positive thoughts? So all of these things are on the patient. That's not me. That's just me saying, What are you doing for yourself? Because ultimately to be healthy is not just lacking illness. You also have to be in good shape. And so when someone is sick, they have to at all costs achieve improvement and some of them achieve remission. If you're fortunate enough to achieve remission, you're gonna be fearful all the time of relapse. And I've found that there are all of these environmental uh agents that can either uh make things worse for you if you get exposed to those environmental factors. If you don't, and your immune system is in good shape, that you then you never actually relapse. And that's usually what I'm what I'm focused on on patients when they're uh in that level, trying to keep them in remission. And so these environmental disruptors are anything from radiation that you can get from uh the environment, toxins in the environment, pollution, chemicals, insecticides, pesticides, glyphosate. We're talking about heavy metals. We're talking about, of course, mold, which is a huge disruptor because about 80% of buildings in the United States uh have mold. So the same construction goes in many uh places like Canada, Europe. Uh in Mexico, our construction is a bit different. We we use uh uh ribar and cement and concrete. So it's it's the mold does not have that much of a chance, but still grows, especially here in Puerto Vallarta, where it's pretty tropical. So STDs or sexual transmitted diseases is another disruptor because uh you don't really think about it, but you're sharing pathogens with everybody when you're walking through the street. When you go into a classroom with all of your classmates, and when you're in bed with someone else, then that proximity is down to zero meters or zero inches. And that it's a full infection transmission, and easy for you to relapse from anything that that other person is carrying, like all of these emergent pathogens that we don't even know about. You know, we hear all these people getting sick, sudden deaths, sudden illness, and no diagnosis. And I don't want to sound like a like a goody two shoes over here, but this is the best moment to be aligned with uh the best education possible in terms of staying with one partner, uh, maybe not drinking too much, maybe not doing drugs, because our health has never been uh this this bad as a uh species. We've never been this sick.

Susan Manfull, PhD 10:40

So your dad was very influential in your life and your career. Can you talk just a little bit about that, how that was the case? Because he I think he played a large role in um creating a path that you chose to follow that has led you here.

Blood Banks, UV Light, And Early Clues

SPEAKER_02 11:06

Yeah, yeah, of course. I mean, um, you know, all of us uh are pretty proud sons or daughters, uh and we will always cherish our parents. Uh I I guess when when you're talking about uh academic um goals and um and and you know reaching reaching for the stars, you you kind of think for uh you kind of put in your mind your father because you you usually the dad is at least uh uh in my experience, the more uh the the working part that of the house, uh and then the mother is more the loving part of the house. And although sometimes it's not that uh that way. But in my in my case, that was the way my dad he really came from nothing from a small town in Jalisco, um uh called La Experiencia, which is something that not many people know. And he was uh a son with six uh brothers, well, brothers and sisters, so they were it was seven of them. And my dad, he wanted to be able to do a lot, and he couldn't reach what he wanted in Guadalajara, which is the bigger city next to that town where he was uh born. And so he he decided that he would go as far as he could and pursue a specialty and pursue a career. He was already a doctor at that point, so he went to Tijuana. And in Tijuana, he worked with all of these different uh people that also were crossing the border. So he had a lot of friends from San Diego and um a lot of uh doctors, scientists. He was really good at what he did. Um, he was not just only a great hematologist, which is a uh blood specialist and all by all definition, he also had uh another specialty, and uh he will also had a master's and he was involved in science a lot. He was very well prepared, you know. That those kind of that kind of education I don't think is uh done anymore, where you're just on in school from morning to night and and then uh and then repeat, right? Um so he was huge in my um influence of uh what I was doing in general, not not just uh as a doctor. I actually was not supposed to be a doctor. He he kind of tricked me into becoming one. We uh I used to be very independent and I had my business uh at age like 20 something years old. It was a it was a construction and window business. So I I would install windows, which uh curiously enough, I would purchase from from the US and I would import them and sell them here for Americans that were living here, that they knew the product, which was double pane windows. And and I'm so proud of that. It we used to carry windows like Phillips, Jelwin, Millgard, Pela. So I'm very when I go into a house, um I look at their windows and oh, you have good tasting windows. I can tell these are these are great windows, which is it's it's funny, it it comes up sometimes. And and so I needed a larger truck because my truck had just left me stranded in a little town here close to Puerto Vallarta where I was working. One of those uh uh clients that I was putting their windows in when I was returning, huge storm, and so something happened to the little truck and it and it and it left me there. Uh and so I said to my dad, hey, if you can get me a pickup truck, I would really appreciate it because you know I don't I I'm doing well, but I'm not doing that well. And he goes, Well, if you can do the test to to see if you can get into a uh a profession in the university, just I just want to know. He's like, just give me, give me that gift, he said, and and I'll give you your truck. And I'm like, okay, I mean it sounds fair. Let me give it some thoughts. So I studied a little and I gave it obviously a good thought. And I'm like, okay, sure, we'll let's do this. And I didn't know what was going to happen. I presented the test, and it just so happens that I uh I got into the Universidad of Guadalajara, which is one of the most prestigious universities in in our country, in Mexico. At that point, my dad had already kind of paved the way for him to have all of these resources. He was running already the blood bank. He was the first man to start a blood bank in Tijuana. And by the time we left, because of security reasons, it was really we were my dad's office was in downtown Tijuana. If anybody has ever heard of Tijuana, uh, you know it's it's a rough neighborhood. And I grew up in that rough neighborhood. So some of that stuck with me, I guess. There is uh Avenida Revolución, which was just a block away from our blood bank, and you would see all of these donkeys painted like zebras, where usually Americans, especially military uh that were under break, would cross the border, get some drinks, and take some pictures there. So I grew up with all that. Uh, once Tijuana became really unsecure, my dad looked, you know, where where could you know the next Tijuana be? And he was so smart. He looked into Puerto Vallarta. And I don't know if this data is correct, but Puerto Vallar has become one of the best medical tourism spots in in our country. But without the things that are associated with Tijuana, which is insecurity and uh some Puerto Vallarta on on the contrary is really safe, really nice, a touristy town. It's just beautiful to visit. And so we we've been here since my dad started his blood bank, which was around the year 2000. And so he started blood bank. I was working for him there. Uh uh, and I was working with him, and I kept seeing uh these individuals, let's just say, people that would come in wanting to wanting to donate blood, and they would pass their all these questions that I as a doctor would have to ask them. And I would ask them and and and and they were okay, but they just didn't look right, you know, like they were shaking, or or they had brain fog, or they had some kind of problem with their movement or joints. And so we we started using uh because we had a blood bank and we had a lab. So we started using the lab and we looked at the uh these samples and there was just stuff in their blood. We we didn't know what it was, it was just little stuff, little particles, little things in the blood. I got to work with a great hematologist in San Diego at Scripps. He was the top hematologist at the time, and uh, and and so he he would put me on microscope and just what are what do you see? And and then he would tell me, you know, these are white blood cells, these are uh red cells, and then these are amorphous red cells. And so I learned a lot on the morphology. And by the time I was working with my dad many years later, well, where we were looking at the blood, I got to see so many of these differences that uh I was familiar with seeing in the US, and it was from patients mostly that were donating blood from the US, which was funny. Of course, we had the cruise ship come, people who would come down, and some of these people would donate blood, and some of these people were sick. And it was not until much later that I learned that the blood supply from a report done from the Red Cross in America showed that uh a huge number of uh units of blood annually were infected with Babesia. This is a statistic from 2014 or something like that. And we haven't done anything about that. This is happening every day in all of the blood banks, almost all around the world, but the larger numbers are happening in America, obviously. Since then, we started using a machine. It was it was a Ubilite machine to sterilize the blood units. And eventually we heard that a large pharmaceutical and equipment uh corporation started manufacturing their own. And my dad was the first to manufacture his, and he was doing it out of a box where you usually keep bread. He thought that that would be able to work for his needs, so he purchased one of those brand new, and I think it was, I don't know, back then, Price Club or something. And he told his engineers, put some UV light up there and leave an entrance for a little line so that the blood can go through and then leave an exit. And at least the blood that we're using is gonna be purified by the time it reaches the person who is being the one that's gonna use it the end user. So that was pretty uh smart of him. And I'm talking about this was like early 90s. Wow. Nobody was thinking about this.

Susan Manfull, PhD 20:10

What a an a fantastic environment to to grow up in. Uh it it certainly fueled your curiosity, creativity. It planted the seeds for your interest in blood. Your dad had a major blood bank there.

SPEAKER_02 20:28

Oh, he was the first hematologist, the first blood bank. He and uh another doctor who was an orthopedic surgeon, they started the medical university here. So I was part of the few initial generations of doctors.

Susan Manfull, PhD 20:44

So maybe we could talk a little bit about how you became an expert in Lyme. I know that you met a patient at, I think your dad's hematology office who had uhesiosis and anaplasmosis and maybe anemia too. Can you tell me about that patient a little bit and what role he played?

SPEAKER_02 21:16

Yeah. So this is a case of a of a young guy who his family was well positioned financially speaking, and they had all the resources at their disposal. But this young man had a lot of infection in his blood. Anaplasma, ricketzia, bartonella, papisia, uh, borrelia. And so the father of this young man was a tremendously smart individual, super smart guy, just a researcher by nature. He researched all of the documents available about all of these. Very atypical cases of blood infections. And when that happened, he noticed that a repetitive cycle of information surrounding red cell exchange was popping up again and again because he found research, old research and new research, that was just very interesting about how cases which had tried everything for treating Babesia, then after doing red cell exchange, they were able to be cured from their Babesia. And so he used someone in his corporation and started calling all of the hospitals in the US to the best specialist. And he knew people in the government, he knew people in uh at the highest levels in America, and they would put him in touch, and he even donated I don't know, millions of dollars to these institutions, these hospitals or these universities. And they would do everything they could. The best doctors would get there and say, yes, this is what is the best choice, but we can't do it. And so he would go, okay, so then what do I do? Well, don't say that I said this, but you can go to Mexico and you can ask someone there because they might be able to do it. But this is the best choice. Oh, if if your son had HIV, we would be able to do it. And why HIV? Well, because it would be an extra layer of complication that he's gonna die. So it's it's like an emergency intervention, so we can do it. Or if your son had no spleen, we could do it.

Susan Manfull, PhD 23:41

Okay, so but we can't do it for a vector-borne disease.

SPEAKER_02 23:47

We can do it for Babesia, uh, but if if he had no spleen. Or we get to do it for Babesia, but if he had also HIV.

Susan Manfull, PhD 23:55

Okay, I see.

SPEAKER_02 23:56

So he started calling just the people in Mexico, and he had a friend who owns uh a large uh chain of hospitals in Mexico, all across, and he goes, he talked to his friend and he said, Yeah, I'll put you in touch with all the directors of all the hospitals, and they'll tell you who's the best person to do this. And so he spoke to them, and someone said, Yeah, we have a hematologist here, and then the other said, Yeah, we have a hematologist here. And and so they said, Okay, so go to Morales. He he he might be a good option because he's he he's an outside of the box kind of guy.

Red Cell Exchange Explained

Susan Manfull, PhD 24:31

And so So well, before we go any further, what is red blood cell exchange?

SPEAKER_02 24:37

Right.

Susan Manfull, PhD 24:38

This is what he was looking for, right?

SPEAKER_02 24:42

What he wanted was to get rid of his son's blood and get someone else's blood entirely. That's it. The process it would normally be difficult if you didn't have a machine that is called a apheresis machine. What is apheresis? Apheresis means separation of cells, a means separate and pharesis cells. So apheresis, so you're separating red cells, or you're separating white blood cells, or you're separating platelets, or you're separating plasma, which are all the components in the blood. And so my father had these machines, and I have to say the older models, he had the very older models, which he brought from Tijuana, and they were excellent machines. He used those machines like for 20 years. They were excellent machines, they would never break. Nowadays, they don't let us use these machines anymore, but they're still great. I think they're even the best. Uh, I think they're better than the new ones, much better. Now we use the newer ones, and we still have some of the older ones, which sometimes we can we can use. So I guess where I'm going with this is that as doctors get constricted with what they can do in their medical office, medical practices around the world get constricted with what devices and components we can use, because there is a larger plan in place where someone decides which machines they can continue using and which machines they should take out of the market because they're not making enough money, even if they're great machines. So it's like pharmaceuticals, like we've seen with Aslocillin, where they took it off of the market and it's a great antibiotic. It almost cures Lyme in many cases. And um, other computers and stuff that they just take it out of the market. They don't care if it's making the right result, if it's if it's curing people. Medicine is not about curing people, medicine is about what makes the most money.

Susan Manfull, PhD 26:48

That sure feels like it sometimes. So you're talking about aphoresis machines. Maybe they didn't have that name just yet.

SPEAKER_02 26:58

Aphoresis, yeah. The apharesis machine can do plasmapheres, red blood cell pharesis, granulocidepharesis, platelet pharesis. And so at that point in time, they wanted us to do a red cell exchange, which is through the machine, separate the cells of the patient which were the most infected. And and then the machine does that. It separates the cells, and it separates the red cells and then discards them into the garbage, basically. And then you put healthy blood cells that are also selected uh from a donor, you but but the machine selects the cells, like it's it's not grabbing everything else, it's just getting the red cells. It doesn't have DNA, no platelets, no immune cells, no nothing, no plasma, just a red cell. And then you give that to the the sick patient. And and if you do that a few times, then by uh dilution, you get rid of the pathogen. Uh you get rid of it enough so that the immune system can actually do something about it. Because the problem with all these chronic conditions is not that the immune system is not there, the immune system is there, it's just not educated enough. And the little numbers of cells that are educated enough, uh, they're they're not enough in numbers. It's a depleted immune system. So if you reduce the infection rate enough and you give the patient some antimicrobials, and then you allow the immune system to take over, and now it's possible.

Susan Manfull, PhD 28:30

So this is what is referred to uh often as plasmapheresis today.

Plasmapheresis Versus Photopheresis

SPEAKER_02 28:38

So plasmapheresis is the process of eliminating the blood plasma. And blood plasma is like 70% of the liquid in the blood, but it's not the blood. The blood itself is a little red cell that has the shape kind of like a donut, but it's no hole in the middle. That's a red cell. And the plasma, it's all the liquid that is surrounding the red cell. And the liquid carries with it autoantibodies, which we need to get rid of in cases like, for instance, in pans that are corrupt autoantibodies. There is also inflammatory cytokines like in Lyme disease. So we get rid of those for Lyme. There is uh heavy metals in metabolic uh patients. This is useful to bring out the heavy metals, especially because they are not able to clear out all of these things on their own. And then toxins like glyphosate or radiation exposure or other things, even mold is in the bottom in the blood plasma. So when you do a plasmapharesis, you're not just getting rid of some of the waste products of your cells, but you're getting rid of also waste products that of stuff that you never should have consumed in the first place, that your body does not have a means to eliminate. So by doing this plasmapharesis or plasma exchange, you're getting rid of roughly three liters worth of stuff that you'll never going to, that you're not going to need. And it's gonna be replaced by proteins, amino acids, electrolytes, and um vitamins so that you don't feel depleted because obviously during that process, taking three liters worth of anything out, uh it uh it is uh gonna leave some of the cells starving for electrolytes, for instance, or for potassium or stuff like that. So we have to replace that immediately during the process.

Susan Manfull, PhD 30:46

Okay.

SPEAKER_02 30:47

That's plasmapharesis, that's not red cell exchange. This man received both, but I want to make the distinction that red cell exchange is specific for Babesia, even though a lot of Bartonella is on the red cell as well. But when you look at Babesia, it's a microscopic parasite that is embedded in the red cell. And what it does in the red cell, it expands if its lifespan. So instead of living 120 days, the red cell starts living maybe 20 days more, 50 days more, because the parasite is allowing it to stay in that shape so that it doesn't get destroyed, because then it means the parasite has to migrate to another cell, and that's inconvenient. So these parasites are very quick to repopulate. And 24 hours, 48 hours, you have from a 2% infection rate to a 5% infection rate. So it's a very quick disseminating blood-borne parasite. And so that's why the blood is like the only thing that you can do, because that's the only thing quick enough to drag it out and then replace it quickly so that it doesn't multiply as quickly. But during that process, you've seen, if you've ever noticed where Bartonella is, Bartonella is also a lot of the times in the red cells. So a lot of the Bartonella comes out as well. Or although it's not its main, it's not the main recommendation. For Babisia, it can be, but for Bartonella, it's like more of like a bonus.

Susan Manfull, PhD 32:15

So interesting. All right, I'm gonna back up just a minute. So we have this this man with a variety of vector-borne diseases who was looking for someone who could do this red cell exchange. And he found you uh and your father as well. Or were at this point, were you he found he found my father.

Dendritic Cells And Immune Re‑Education

When To Use These Therapies

SPEAKER_02 32:37

He found your father. I was nobody then then. I was working for my father, I was carrying my dad's briefcase. And so he found my father. They spoke to two to two guys, two hematolists, one in Monterey and another one in Puerto Rico. They speak over the phone. My dad was the last one they spoke to after they speak with him, and he goes, Yeah, we can change the red cell, then no problem. But we can also treat his blood with ubilite. And maybe we can also give him some high dose uh vitamin C as well, because it helps well with my cancer patients, he says. My dad never treated Lyme. Some people ask me, he he never treated Lyme, but he was just so smart, he could treat anything. Uh, and he could have treated it much, you know, much better even than myself, probably. But he was focused on cancer, that was was his passion all his life. And um, and and um the the the the the the family of this young man said, yeah, enough said. We'll fly the when can can you use can you get us tomorrow? And and my dad said, Yeah, sure. And they said, but we need a we need a like a good private room, we need the best hospital. We're gonna fly in in a private jet with the doctor and nurses and people. And and my dad goes, yeah, sure, we'll we'll kind of he goes, I'll pick you up from the airport and you know we'll we'll we'll go from there. And so he did, and they were treating they they started treatments, but nobody spoke Spanish. I'm sorry, no from from their group, only one person spoke Spanish. Uh, but from our group, nobody spoke English but my dad. And so, curiously enough, during that time, my dad and I were going through a little kind of a phase. So we we weren't really that friendly with each other during that time. And so this man said, You need to have an English-speaking doctor here, or we're gonna have to go, even though you know you're great and all, but we we can't communicate. How is this gonna work? Because my dad was so busy that he couldn't be there, like babysitting them. He was there 20 minutes, 30 minutes, and he had to go see other patients. And so he then had to call me and we kind of uh fixed our little issues, and he said, Listen, you know, if you can help me, please, and besides, I'm gonna pay you. He said the magic word, he said, please. And I was, you know, falling in love with him again quickly and said, I'll be there tomorrow. So I got in the hospital, met this uh case, and I studied it. Obviously, I studied it all this, but they brought a doctor with them, and their doctor was uh Lyme literate, and he was already a member of ILETS and a super smart physician. So he started teaching me all of these things while we were treating the patient, and I was contributing what all of the things I knew from aphoresis. So at one point, this young man who was having hemolytic anemia. So this means that his red blood swell, red cells were being destroyed, so his kidneys were shutting down because of this. As a result, he was gonna die. They got in a Monday, we started treatment on a Monday. It was like super crazy type of case. And he he couldn't speak, he was like in in bed, like sedated, like it was terrible. So, and uh once we were like halfway to the treatments, he well, slowly started feeling better, but he's he finished the the red cell exchange and we disconnected him from the arm, and he got up from the bed on his own. He walked towards his dad and he said, Dad, thank you for saving my life. And the dad was like, you know, so uh just appreciative of that, I guess, that moment for for his son recovering, this young man who had all of you know all of uh his future ahead of him and he was about to die. So eventually he got better. Uh eventually he got so much better, he invited me to snowboard with him, and I've been I've been I I've done this, I've no snowboarded with them a few times. At the moment, he's the I don't know how to say this, the the healthiest guy almost. He has other issues like related to other stuff, uh, that has nothing to do with Lyme. But as far as Lyme, he's amazing. He he has a job, he had redone his life, uh just living, you know, people that want to just live it out, that's what he's doing. He's living the life. And um, and when did when that treatment was done, his dad was the one who said, Would you like to continue learning on this? I was coming out of a situation, uh divorce at that time. So it was, you know, I had nothing. My my life was zero. And so that was the best moment to start a new beginning, and I accepted his offer. And so he he uh sponsored me to go to uh Washington in 2014 and start learning everything I could about Lyme and other infections. He uh introduced me to um Dr. Horowitz. Uh he signed my book, and uh and it was very cool. And and so it was this magical, magical world. It was like Disneyland for adults for doctors, and it was opening up all to me. And and I got to see a great conference there about uh with Dr. Jemsek and just all of these Bureau of Scout and all of these great doctors, and so I learned a lot from these guys. And then after that, he he said, Would you like to keep learning? And I said, Of course. So he sends me to Texas uh and I go there and I learn about ozone therapies, got me get my certification there, and and then he he says, Would you like to then keep learning? And I said, Yes, of course. So I went to Utah and I shadowed this man who's a doctor, great doctor, who's a real dear friend of mine, who explained to me the intricacies of you know what to expect clinically, and very, very, very fond of all of his teachings. And um and then he said, Okay, you're ready, you're just missing something. This man, the the dad of my patient, he he takes me to this uh this lab, and he everybody knows him, and he goes, Hey, um, do you have that thing I I asked for? And yeah, sure. So they bring out a microscope, and and he he pays the man cash. It was a used microscope, but it's a beautiful beautiful dark field microscope with a camera. And he's he gives it to me and he says, You think you can put it in your bag? And I'm like, Yeah, of course, yeah, I can, yeah, sure. So uh I put it in the bag and I'm like, How much do I owe you? He said, No, you you're gonna pay me one day. But right now, what I want you to do is when you go back home, I want you to go to Mexico and I want you to to start using all of the knowledge you have. And uh and he gets on the phone and he calls one of the best doctors of Lyme disease in the country, and he tells her, This is a doctor that I think you should meet. I'm gonna put him on the phone. And I speak to this doctor, and we talk for like 40 minutes, and and she goes, I I want to send you a patient tomorrow. And I'm like, Okay, yeah, sure. I'll I'll treat him and I'll and I'll it was a she, I'll treat her. And so, long story short, the patient comes, gets treated, gets super well. This is the patient who was super known, and and that patient tells another patient, and another patient, another patient, and then soon then we're just moving out of the office because we couldn't fit patients anymore.

Susan Manfull, PhD 40:20

So that was your watershed event. Yeah, that was your pivotal point. This man and his father who came down for the the red cell exchange. That's what got you uh started in your your interest in in Lyme. And now, of course, you're exceptionally well known for your work uh with patients with Lyme disease. That's really fascinating. So you mentioned a a couple of things that I'd like to ask you about. You mentioned, well, aphoresis, and you have mentioned plasmaphoresis. And I'm wondering, I know that you're gonna be repeating some of this, if you don't mind if we put it in this context. You mentioned aphoresis and plasmaphoresis. And as I understand it, aphoresis is uh as an umbrella term, correct?

SPEAKER_02 41:21

Which includes aphoresis is the umbrella term, yes.

Susan Manfull, PhD 41:24

Okay, for plasmapuresis, and what else falls under that umbrella?

“Clean The House” Then IVIG

SPEAKER_02 41:28

Yeah, so as the as a functioning blood bank, uh it that uh I I I now have to, so I I haven't mentioned this part, uh, but yeah, so because of life, my dad was taken from me about three years ago. He he suffered for from an illness, and so he had to he retired and I had to step up and and be in charge of his blood bank, and in addition to my own practice. So now I have to be in charge of the blood bank. And my my dad, I'm sure, um is looking down on us happy because his legacy continues, you know, his blood bank continues, and I think that's important. The blood bank itself needs apharesis because let's say you have a heart surgery, you need 15 times more platelets than normal. So the machine does that, it separates the platelets and you have them ready so that the surgeon can intervene and do the surgery, and you give him the platelets of 15. Instead of giving him platelets from 15 people, you give them a bag of one person with all these platelets, and that's that's the the effect that it can have on any other cell. So the same goes for red cells, platelets, white blood cells, blood plasma, and and then it has other modalities where you can also treat the blood because the blood is going in a loop in and out, it's a closed loop, it never really touches anything that is not uh like inside, it's it's like a closed loop. The blood can also be treated during that time. So if you've ever heard of EBU, this is like EBU with steroids. If the blood goes in and out and it can be treated with ozone, it could be treated with uvulite, it could be treated with a lot of these things. And my dad found many years ago, this is something I've I've presented in a few in a few conferences, that uvulite does not work by on its own. Most of these pathogens, especially viruses, can self repair themselves. So you use uvulite, you chop off an arm or a leg on them, but they they fix it. They re put it back. That's their innate mechanism of reconstruction. And Borelia does the same. But my dad found many years ago because he was working. With HIV patients. He actually was granted a medal by the Magic Johnson uh society group or something. This is in the 80s or something like that. And he was working with a drug that was used for cancer and Ubilite against HIV. And he won that award. And he won an honorary uh seat at the at the table of the hospital, which I think was scripts too. I don't remember that. He he was there with using that technology. So the the the he learned that it's not the same just using uvulite on the blood, that when you give the patient a photosensitizing agent, then the effects the uvulite has are irreversible. And that's the key thing, that's the key element. That's why the uvulite treatments that we do are so effective, because we first give the patient a photosensitizing agent. A lot of doctors are doing that now. And I I hope that a lot of it is because I've spoken very publicly about this. And I've I made a presentation once about all of the different photosensitizing agents.

Susan Manfull, PhD 45:15

Well, can you talk about that for just a minute? What are photosensitizing agents?

SPEAKER_02 45:22

These agents can be anything from even vitamins to soralens, which are a type of pharmaceutical, uh, even methylene blue and they're under the right circumstances. And but I don't want to say too much because I don't want people then doing stuff that they might not know what they're doing. But with that said, these substances go inside the cell and are then able to acquire the ultraviolet light C, a specific C of 492 nanometers that is needed to destroy these pathogens within the cell. So that's why the photosynthesizing agent is so important when doing ultraviolet light therapy. Without it, the effect is still useful. You can see it, you feel better, but it's not as as effective.

Susan Manfull, PhD 46:23

Okay.

SPEAKER_02 46:23

Maybe, maybe the efficacy is twice as more or three times as more.

Susan Manfull, PhD 46:29

Okay, and so then can you just walk me through when you use aphoresis or are you using plasmaphooresis when you use the photosizing agent?

Gut, Barrier Integrity, And Peptides

SPEAKER_02 46:39

Okay, great question. Um so uh, and I'm sorry to bring up my dad so much, but my dad he worked with dendritic cell therapy. He was a pioneer uh with the dendritic cell therapy. Um, there was a Dr. Engelman from Stanford, I don't know if he still exists, but he he used to work with um closely with research with that scientist or doctor, I'm not really sure what he was. And the dendritic cell is by definition the best antigen presenting cell of the immune system. Meaning wait, the the which cell is the best? Antigen presenting cell of the immune system. Okay, which means that it interacts with cells that destroy pathogens and tells them which pathogens to destroy. So it's the best cell of the immune system to re-educate someone's uh corrupt immune system. He used that technology for cancer so uh much that he had people lining up to get treatment to get treated by him with andritic cell therapy and photopheresis, which is how I got to learn how to do these apharesis practices on other things besides cancer. And with cancer, the photopheresis, which means the apharesis machine with UV light, photo means light, pharesis, you know, separation uh of cells and dynamic separation of cells. The photopheresis is so that we disrupt the immunological process that is happening and that we send the old cells to their programmed depth so that the new cells that are not corrupt anymore can start targeting cancer cells, for instance, or pathogens, for instance. That's that's how a photophoresis works. And then as that process is happening, the machine is able to separate a fine line of dendritic cells. Not only dendritic cells, you get other mononuclear cells too. But in the lab, we separate these dendritic cells, and then we add growth factors to them because they're immature. In cancer, topoisomeras 1 and topoisomeras 2 enzymes inhibit the dendritic cell maturity. In infection, outer surface protein B and outer surface protein C inhibit maturity, for instance, in Lyme disease of these dendritic cells. So there is a similar mechanism of immune suppression or immune corruption. When we get the dendritic cells from the patient, they're immature. So we add growth factors, we nurture them, we develop them into active adult dendritic cells. We expose those adult dendritic cells to the patient's infections because they're in their blood already. But they've been purified by the UV light. So they're not aggressive infection, they're just like the shadow of the infection or the proteins of the infection, which is enough for the dendritic cell to use to recognize the patterns of those infections. And these dendritic cells now matured, now educated, we inject them to the patient. And what that does, it causes a ripple effect because it goes and it says to the T cell, hey T cell, go find borelia. And it goes to cluster differentiation cells, hey, CD cells activate against borrelia. And then it goes to the B cell, and the B cell then produces antibodies, and you have immunoglobulins being produced properly, all of which are happening just because of the dendritic cells. And the dendritic cells tell other dendritic cells, hey, dendritic cell, I have this information, pass it along. And then the dendritic cell, when it finds actually a borrelia, it engulfs the borrelia and it produces lysosomes, which completely destroys the borrelia, and it call and it's a process called opsonization. Destroys the borrelia. So it's one of the best immune cells that we can manipulate safely without causing autoimmunity, because dendritic cells also have tolerance. They're called tolerant dendritic cells. They can cause T-regulating cells to get uh activated. So the T regulation can reduce cytokine expression. So it'll reduce interleukin 10, interleukin 2, all of these cytokines that are causing inflammation and inflammation in the brain. So it's a very interesting process on its own. And that's because of the photophoresis, which is a part of the uh apheresis process. Not to be confused with plasmapharesis, which is another part that cleans the blood plasma, not to be confused with red cell exchange, which is the red cell phareses that cleans the blood from Babesia. And also not to be confused with platelet pharesis, which is the phyreces that is used for patients in heart surgery to have more platelets in order for them to have a successful outcome during surgery.

Susan Manfull, PhD 52:29

Wow. All right, and this just to summarize here, that's called photophoresis.

SPEAKER_02 52:36

The right term for the procedure would be called extracorporeal photovoresis and dendritic cell therapy. Extracorporeal means a process that is occurring outside of the body. Okay, corporeal means body, so extracorporeal. It's like I think it's Latin. So extracorporeal uh means outside of the body, uh, photo means light or uvilete, pharesis, so dynamic separation. So it's it's the treatment of the blood outside of the body, treated with uvile, and during that process, the endritic cells come out from that process.

Susan Manfull, PhD 53:18

Okay. And this process is used to treat Babesia.

SPEAKER_02 53:24

This photophoresis process, you can treat many pathogens, many, not just babesia, but many pathogens, viruses, including so many pathogens.

Susan Manfull, PhD 53:35

Okay.

SPEAKER_02 53:36

And but it helps, it's a process that helps you gather the dendritic cells that you need to help the immune system. So it's it's like it's two different processes happening that both have different effects, but they're both happening for the same reason. Okay.

Susan Manfull, PhD 53:52

I think I've got that. That's fascinating. Now that process, well, what do you use that process for? What conditions?

Clinic Model And Patient Logistics

SPEAKER_02 54:00

So, because my dad was using it for the most part in in HIV patients, I focus on like persistent viruses. Because a virus is always gonna be there. But it's only gonna be there, even if you kill it, even you throw Baltrix and Balciclober and all of those things, it's still gonna be there because it's not about just the virus, it's about how the immune system is. If there's a poor immune system, you can destroy all the viruses. You only need one for it to replicate and cause infection again. So you need to get rid of the viruses and stimulate the immune system. That's why the procedure focuses on targeting infection and boosting the immune response simultaneously. So I use it for the most part for viruses. I use it a lot for Bartonella because Bartonella is a super resilient pathogen. So Bartonella is one of the best things that it I that we've seen that it responds to because you reduce the pathogen activity and at the same time you activate the immune cells to target Bartonella. The only side effect is that sometimes the die-off of Bartonella is so much that patients don't feel that great. But um, we in those cases when they're highly populated with Bartonella, we give them half a dose. So that manages it.

Susan Manfull, PhD 55:23

Okay. So the role of blood, blood cleansing plays a very important role in your practice now. I think I can see the the roots of of some of that. Can we segue to blood cleansing and how you've used that for Lyme disease?

SPEAKER_02 55:50

So blood cleansing would be the plasma for easy.

Susan Manfull, PhD 55:53

Okay.

SPEAKER_02 55:55

And and it's cleansing the blood in a sense, because blood is not just blood, you know. Blood is also plasma, blood is also platelets, blood is also white blood cells. Uh, and most of the components of the blood are plasma, and most of the residues, toxins, inflammatory cytokines, and autoimmunity are in the plasma. So plasmapheresis is a way of cleansing the blood, effectively getting rid of toxins, autoantibodies, infection, and inflammatory cytokines.

Susan Manfull, PhD 56:40

All right. And often, as I understand it, you use plasmapharesis with other procedures. For example, IVIG.

Extreme Cases And Creative Care

SPEAKER_02 56:53

Yes. So this is in the particular cases like PANS, which I see many of these cases by necessity, because I'm not a pediatrician. I serve at the committee of pediatrics at ILATS with Dr. Nancy O'Hara, Dr. Christine Sava, with some great neurologists and pediatricians, neuropediatricians. But I'm there because of necessity, because I'm the link to the treatment part, because of my background in transfusion medicine, which is my area of focus, always been that area. I work with anything related to blood, and that means apheresis as a definition, because it separates the blood. And I see many patients, adults and children. I treated patients as young as months old. Obviously, you can't do a plasmapheresis on a month-old patient or months-old patient. Some five-year-olds can get a plasmapheresis done very rarely, because it's only you have to understand that there are cases with pants, and then there are cases with pants. You know what I mean? Where there's no other choice. So in those cases, yeah, we will have to do things a certain way, even in very young individuals. I see a lot of patients with autism as well, which is curious because they have a lot of metabolic challenges, and a lot of these metabolic challenges come from inflammation, and a lot of these metabolic challenges also come from exposure to chemicals. So either they have Lyme as well or they have pants as well, which is super interesting because we see these kids that have autism and they get better. And it's like nothing can get an autism patient better, but this does. But I'm not saying it's with everybody. Um, all I'm saying is that some of these autistic cases have pants. And some of these cases, of course, respond great to the plasmapheces because you're taking a lot of the immunological burden that is attacking their brain, that is attacking the basal ganglia, and that is attacking their cerebral cortex. So, of course, they there will be a positive impact. And as we're cleaning up the house, you want to kind of think of that analogy. Imagine that you have a house. It's a beautiful house, but the inside is filled with furniture that is dirty, that is moldy, that is toxic. And you decide, okay, how am I gonna fix this? You go to the store, you go to the best store, I don't know, West Elm or whatever, and you buy all of these furniture, new furniture, and then you bring it home and you put it in, and then you mix the new furniture with the corrupt old toxic furniture. That is what you're doing when you're just getting IVIG without changing first the IGs that are already in the blood circulating. So plasmapharesis, look at it like the movers coming in, taking all of that dirty furniture out and cleaning the house. And now you come in from West Elm putting all of your new furniture in. That's how it works, and that's how it should work, and that's what Dr. Frankovich does at Stanford. And I spoke with her and I sent a few emails about some cases, and uh, she said the best way of doing this, the best way, but it's not the most convenient one, but is five plasmapheres and at least five plasmaphares and I VIG. And I found that there's even a little better way of doing this, but it's even more inconvenient and more expensive. But this is for the real hard, hard cases, which is plasmaphooresis, IVIG, and then you repeat that five times. So five times plasmapheresis, five times IVIG. Of course, every time you're doing plasmapheces, you're clearing the house again. So it's like this is it's gonna sound bonkers, but you clear the house, you bring in new furniture, and then the new furniture gets again toxic because not it's not just the furniture, there are other pieces of the environment that are toxic. So then you clear the house again. So the all the new furniture goes to the garbage five times, and that's crazy, but it helps when patients are so overloaded with inflammation. The inflammation is not just happening in the natural killing cells, it's not just happening in the antibodies and the AGs. The inflammation is happening in the B cells, in the T cells, in the cytokines, in the interleukins, tumor necrosis factor. So you have to account for that. And sometimes you have to do all of these uh cleanup processes before you are seeing results. And I would like to add that it's not just about the immune system. You have to get rid of the infection. If you don't get rid of the infection and you don't then fix the immune system, then the process itself re-returns and restarts. So it's absolutely imperative that you address all of the matters simultaneously.

Susan Manfull, PhD 1:02:26

And you spoke earlier in our conversation about environmental factors uh outside the body, like mold, for example, or uh, I don't know, cigarette smoking, for example. That's where this comes in as well, too, correct?

SPEAKER_02 1:02:45

Absolutely.

Susan Manfull, PhD 1:02:46

And what about diet?

How Morales Evaluates PANDAS And PANS

SPEAKER_02 1:02:47

Diet is more important in sick patients than it is in healthy patients. There are some patients who are having minimal issues in their microbiome. So I wouldn't be too concerned with diet, but there are cases that they have issues like a small intestine bacterial overgrowth, where whatever they eat that causes inflammation manifests into inflammation systemically. So in these cases, it's important that we look into rebuilding the gut microbiome, rebuilding that barrier. Um, maybe, you know, if we have to use peptides for that, bone broth, um, fecal matter transplant. I like to use camel milk and uh donkey milk, because that in itself helps the gut a little, but it also potentially may help build up on the blood brain barrier, because the blood brain barrier can also be uh affected. And the blood just this is a good uh way of thinking about it. The gut barrier, if it opens up, it becomes permeable. So the stuff that is in your gut crosses into your blood, and that stuff causes inflammation. Same thing with the blood-brain barrier. This barrier keeps the stuff from the blood not getting into the brain, because the stuff in the blood is a lot of it more inflammatory and a lot of it more aggressive and immunologically speaking, more unstable than the stuff in the brain, where it is very delicate machinery that is sometimes overreacting, but not all of the time. And when the infection is over-triggering your immune response, that blood brain barrier opens up, becomes permeable. And now how do you close it? And that's the the question for the for the ages. There is nobody that can tell you how to close the blood brain barrier, but you can help reduce the impact of the infection. Well, at least that is not going to inflict the blood brain barrier to keep opening. You can reduce the burden of the immune system, so you do the IVIG, and that helps so that the immune system is uh not being overreactive. And then if you have antibodies that can repopulate the area and help that blood brain barrier close, like camel milk or donkey milk, then that may also be useful. And uh, and I use all of the above and peptide therapy because peptides are helpful to re uh regenerate some of the tissues that have been damaged from inflammation. If you have an injury in your toe and you hit your toe every three days, that's gonna become a scar. So imagine what's happening in the brain, where the brain is being hit with inflammation every day, every day. So that tissue of structurally speaking changes, it is hardened. It is inflamed, it changes in its size. So all of these tissues in the brain need something to go back to their original shape as much as possible. And the only something that I know of is either nebulized exosomes, because exosomes that are delivered in a nebulized way, if the exosome is derived from neural origin, then that exosome can participate in the right hypocampus of the brain to create new neurons. It's the only mechanism that we know of as humans that can create new neurons by stimulation, the exosomes by neural from neural origin. And in addition to that, peptides like cerebral lysin and thamicin beta, which are known to help with the neurorrejuvenating process and neurorregenerating process. And I presented a case study, which you can find in our YouTube. If you go about two years ago, it's called the Pandas and Pans case study by Dr. Morales. And it's a case who had Lyme, who had strep, who had mold, and developed all of these crazy symptoms. And at the end, what helped her was an antiviral. So it shows you that you can think of all the answers, but sometimes if you're missing something and you get to what that is, you have a resolution of that case. And that case became a normal child. And it's a very good way of seeing, you know, that someone who goes through the whole treatment series, including IVIG, plasmapharesis, tonsilectomy, antibiotics, antivirals, and peptides. So it uh it's a good way of um understanding the concept of all of the areas that need to be fixed in order for someone to be as successful as possible.

Susan Manfull, PhD 1:07:58

Wow, it's incredibly um complex and it does require a doctor, as we've discussed, who's um curious and who has perseverance. They're going to continue to try and figure out what in the world is going on here and um, for lack of a better word, some creativity in terms of how do we treat this. So we're about at the end of our time here. With a pandas or pans patient who comes to see you, um, can you walk me through how you evaluate them and determine what course of action to take?

Bridging Science And Medicine

Closing And Resources

SPEAKER_02 1:08:46

Every case is different. So there has to be an individualized uh evaluation and individualized treatment approach. And it's a little bit of I I hear this a lot with other physicians, and it really is a little bit of a detective work. So I go from the most uh general to the most specific. Where are you from? How was your uh growing up when you were delivered? Were you a vaginal delivery, C-section? Were you achieving your milestones? Did you get all your vaccines? Was uh your your were you living with a brother, sister? Was that person sick in the classroom? Were people sick? When did the symptoms begin? What were the symptoms? Did the symptoms improve? With what did they improve? Did the symptoms worsen? Have you have you identified why they worsened? Was there exposure to chemicals, pesticides, mold, others, bacteria, pathogens? I start making a picture. I start making a picture in my mind of you know, it it's it's such a repetitive process that I gotten really good at uh understanding the possible culprits. But it's a it's a question, just question to question, question. You know, it's uh the Aristotle method, just question everything and you get the answer, and then you you you find the culprit, and then what is the best course of action for this? And as as complex as the answer is, as the complexity of the care in some cases, it's very simple. Some cases are able to answer those questions, those cases are not as bad, some cases cannot answer those questions. I have their families answering those questions, so I know that there's more to it. I have cases where they're autistic, Down syndrome, pans, panda, lime, mold, viral, and covet, all in the same one. So those cases have to be structured. And this the the case itself has to be dismembered so that you understand what is causing what, one by one, and so that you have a plan of action, effective plan of action, even if the plan of action means five different measures or ten different measures for each of these things, then that's what you do, and you create a timeline and you start treating it simultaneously. But keeping always number one, the first rule in medicine, which is do no harm. So we do it in any way possible where the patient's well-being comes first, and so that the risks are the least possible because there will always be risks in medicine and any medical setting. Just by getting an IV, you're signing a waiver for your life because someone could die from an IV always. Not I'm not saying just here with me, thank you, thank thank God nobody has died, but I'm talking about general practices all over the world and healthcare is uh a dangerous thing. But in some cases, it's worse having the illness. In most cases, it is. So you have to always be very careful, and and I think that that is uh that is say my focus with children always, because um children deserve all of our opportunities. Um I don't want to say more so than adults, but I do have a tendency to give children preference over adults um because uh they have all the opportunities that have been stolen from them. And so we have to do everything we can to return these opportunities to them as quickly as possible, and also because they're developing. If we don't do something quick, then their development can get affected. So treatment can be very um simple in the cases where it's needed to be simple and uh very complex in the cases where it's needed to be complex.

Susan Manfull, PhD 1:12:48

So, Dr. Morales, these are very complex cases that we are talking about, and they require a very complex treatment approach as well. So it's not surprising when patients go to your clinic that they're there for a long time. Now, to clarify, you are an outpatient clinic, but people come from far away. They certainly come from the United States, but also from Europe and Asia and I'm and they stay in apartments that are nearby and frequently go into the clinic, I believe, and with most of the people I've spoken with who have been to Lyme Mexico, that they're almost every day. Because they're there, so you can evaluate the effects of the treatment on a nearly daily basis and make adjustments where necessary. You work very closely, you and your staff work very closely with these patients.

SPEAKER_02 1:13:55

I understood this from day one that we had to be an outpatient clinic because we're dealing with pathogens. Hospitals are known to cause infection. You're more likely to die in the hospital from a pneumonia caused by uh an infection in the hospital than you are than by the for the procedure that you're there for in the first place. So as a result, every night we use uvilite to clean up the clinic because we are dealing with infections every day. So it's an outpatient clinic. We don't have patients staying. We have patients staying around the area. There's a a place where most patients stay, which is an apartment building, and it's a building complex where they stay comfortably and they walk to the clinic. So um some cases are so um difficult. Uh, you know, pans cases can be very disruptive in their behavior, self-injuring, injuring others, suicidal, wanting to j to run across and be uh ran over by a car or just run away. Some I've had patients steal passports so that they can run away. I've had patients trying to commit suicide, I have patients running away from the clinic, and um, and in all of these circumstances, we found a way to to handle it. There's no, there's no real, you know, we we're not a psychiatric facility. We I wish we were a psychiatric hospital where we could have all these cases. Some of these cases need to have uh restraints. And we what we do, we'll we do it the old-fashioned way. Put them in a room, and we, if we need to, we restrain them. We wrap them in a sheet like a burrito, and we wrap their arms with an IV, or we sedate them if we don't want the PTSD um or you know, any stress. And and there are some cases where like they don't want to step out of their house. For instance, I had this case that he would not step out of his home, and it just so happened that his home was an RB. And this is a man who was like 6'7, uh 200 and something pounds, big man. Uh he was 17 years old then, but he's uh bigger than any of us. Uh, he was a gentle giant as long as he was inside his RV or his home. If he were to come out, the light, the sun, he might be able to walk at night, like for something quick that during the day, impossible. And so the family, and you have to give it to the family, they drove down here all the way from I believe it was California. It was something like a three or four-day trip, something like that. Uh, the roads are super dangerous, and they drove in the RV and they took the chance because they believed in this and they believed that their son could get better. And they parked in front of my building. And what did I do? Well, I brought the staff and the machines into the RV and started treating him. That's it. I believe the only occasion where we couldn't treat him in there, I believe it was during apharesis. So we sedated him and we moved him in and we move him back into his home. Um, but we have that flexibility. We want to do everything we can for these kids while this disease exists. So if it's uh if it's having to do this, we will. And and when right now we're too tremendously busy, so it be it becomes a challenge, especially because the staff has to be properly trained. So we will um leave spaces open for these kids when necessary, if they're that radical. We'll have to maybe see less patients during that period of time. But if necessary, it will do whatever is necessary. I do remember that in that occasion that the police wanted us to move the army. And I said to him, Would you like to please come join the people that are here and meet them? And he goes in, he sees this kid and sees the situation, and he goes, You know what, man, just do your thing. We're not gonna bother you guys. And I'm like, Thank you. Yeah, and that's that's what we need empathy and flexibility. And I think we've had enough of that, and and and that's exactly what we do.

Susan Manfull, PhD 1:18:28

All right, Dr. Morales. I just have one other question for you that is uh a big question. So, Dr. Morales, you work with very complex cases, and you see a variety of presentations of pans and pandas. You are familiar with the research that's taking place as we try to understand what the etiology of these diseases are. How do we best diagnose them? How do we best treat them? Pandas, for example, as you know, was first identified in in night, well, the seminal paper came out in 1998 by Dr. Sue Suito and her team at uh NIMH. But we're still trying to answer those questions. How do you think we can best move forward?

SPEAKER_02 1:19:23

This is a quote from Max Blank, and I don't remember it properly, but it goes something like in order for a truth to become a reality for most of the population, the generation that is living it has to perish, and the new generation will confirm it. So I hate I hate it, but then it it it forces me to think more outside of my area, and that's what we need to do. Uh there, I'm not I'm a physician, but I'm not a scientist, and I have to think like a scientist because the scientists are not physicians, and they too have to think like medical physicians. There is a gap between scientists and doctors, or scientists and and nurses, and and there is there's a gap, but specifically, I think for the progress of coming up with new therapies, then it would have to be the doctors and scientists, or new diagnostics. So we have to be able to have that duality and become more close than apart as we are, because I have these conversations with scientists that are great scientists and sponsored by the best of the best, and they don't they don't have a clue of what I'm telling them when it comes to the patient's clinical process and problems. And I see the other doctors there, and in some cases I count myself in there, and I don't fully understand everything that the scientist is saying. And I see the doctors there completely clueless when when you come when you get to some very specific topic. So we have to start getting out of our comfort zone with this challenge so that we can uh eventually see a quicker solution and not have to wait for the next generation to solve it.

Susan Manfull, PhD 1:21:31

I agree completely. And not having to wait the 17 years from the bench to the bedside. So I hope you come to our symposium. It's in November, it's November 14th, and we believe in um dialogue saves lives. And if we talk to one another, as you say, I think that we will be able to move forward much faster. We've had people come who have not met one another before, and now they're conducting research together. It's really been a great experience, and um, it's fun too. That's yeah, you have to have you do, don't you? All right, thank you so much for for spending all this time with me. Thank you so much.

SPEAKER_02 1:22:22

Thank you, Susan, and uh I appreciated the the the interview was amazing.

Susan Manfull, PhD 1:22:26

Thank you, thank you very, very much.

William Manfull 1:22:28

This concludes episode 22 of Untangling Pandas and Pans. Thank you for listening. For more information about pandas and pans and the Alex Manful Fund, please visit the AlexManfulfund.org. The content in this podcast is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.