Safety and risks: the full picture
Honest information about monitoring, side effects, rare risks, and contraindications. Trust through transparency.
Read more →Reviewed by Julian Douwes M.D., Chief Medical Officer, Klinik St. Georg
Whole-body hyperthermia is a significant medical procedure. It is not appropriate for every Lyme disease patient. Understanding the eligibility criteria before you begin the process saves time, avoids disappointment, and ensures that treatment decisions are guided by your safety above all else.
Core requirement: Confirmed or clinically suspected Lyme disease with persistent symptoms, adequate cardiovascular health, and ability to tolerate general anesthesia.
Main exclusions: Severe cardiac conditions, active uncontrolled seizure disorders, pregnancy, severe organ failure, and other conditions that make the procedure medically unsafe.
How it is assessed: Eligibility is evaluated in two stages—an initial case review before you travel, and a comprehensive diagnostic workup after you arrive at the hospital.
Gray areas exist: Many patients fall between clear eligibility and clear exclusion. These cases require individual clinical judgment, which is why the case review process exists.
The following criteria describe the profile of patients for whom hyperthermia-based treatment is most commonly appropriate. Meeting these criteria does not guarantee eligibility—final determination requires clinical evaluation—but they provide a useful starting framework for self-assessment.
These lists are not exhaustive. They represent the most common criteria that our medical team evaluates. Some conditions not listed here may also affect eligibility, and some listed conditions may be manageable in specific clinical contexts.
If you see a condition on the exclusion list that applies to you, it does not necessarily mean treatment is impossible. It means that condition requires careful evaluation and honest discussion with the medical team. Here is a more detailed explanation of the most common exclusion criteria and why they matter.
Whole-body hyperthermia places significant demands on the cardiovascular system. Sustained core temperature elevation causes increased heart rate, vasodilation, and shifts in blood volume distribution. In a healthy cardiovascular system, these changes are well-tolerated. In a compromised heart, they can precipitate dangerous arrhythmias, ischemia, or hemodynamic instability.
Patients with a history of cardiac conditions undergo careful cardiac evaluation during the diagnostic workup. Some conditions (mild, well-controlled hypertension, certain stable arrhythmias, remote history of cardiac events with full recovery) can be managed with appropriate precautions. Others (recent myocardial infarction, unstable angina, severe heart failure, significant structural heart disease) are firm exclusions because the risk is not justifiable.
Elevated core body temperature lowers the seizure threshold. In patients with known seizure disorders, the risk of seizure during hyperthermia is elevated. Patients with well-controlled seizure disorders on stable medication may be considered on a case-by-case basis, with input from a neurologist. Patients with active, uncontrolled seizures are excluded.
Sustained core temperature elevation to 41.6–41.8°C poses documented risks to fetal development. This is a firm exclusion with no exceptions. Breastfeeding patients are also excluded because of the anesthesia medications used during the procedure and the potential for medication transfer through breast milk.
The liver and kidneys play critical roles in metabolizing medications, clearing bacterial debris, and maintaining fluid and electrolyte balance during and after hyperthermia. Severe impairment of either organ system increases the risk of complications. Mild to moderate impairment may be manageable with appropriate precautions and modified protocols.
The hyperthermia session requires deep sedation lasting 6–8 hours. Any condition that makes prolonged general anesthesia unsafe—including severe respiratory disease, significant obesity affecting airway management, or known adverse reactions to anesthetic agents—may affect eligibility. The pre-treatment anesthesiology consultation specifically evaluates these factors.
Medicine rarely operates in absolutes. Many patients do not fall neatly into "clearly eligible" or "clearly excluded" categories. They fall somewhere in between—and this is where clinical judgment, experience, and honest conversation become essential.
The following situations are frequently encountered and require individual assessment:
Many patients with blood pressure well-controlled on medication can proceed with appropriate monitoring. Uncontrolled or severe hypertension is a different situation.
Patients who have been seizure-free for years on stable medication may be considered. Requires neurological review and additional monitoring during the session.
Obesity can affect temperature regulation and airway management. The anesthesiology consultation determines whether the procedure can be performed safely.
Certain implants may interact with the infrared heating system. Each case is evaluated individually based on the type, location, and composition of the implant.
Many Lyme patients have concurrent autoimmune diagnoses. These are generally not exclusions, though active autoimmune flares may warrant delaying treatment.
Age alone is not a contraindication. Overall health, cardiovascular fitness, and functional status matter more than chronological age. Careful evaluation is required.
If your situation involves any of these gray areas—or any medical condition not addressed here—the appropriate step is to share your full medical history with our team. We will evaluate your case honestly and tell you whether treatment is a realistic option, whether additional evaluation is needed, or whether we recommend against it.
Eligibility assessment happens in two distinct stages. This two-stage process is designed to give you clarity before you make travel commitments, and to provide thorough safety confirmation after you arrive.
Before you travel, you submit your medical history, current medications, relevant test results, and a description of your symptoms and treatment history. A physician on the medical team reviews this information and provides an initial assessment of whether you are likely to be a suitable candidate. This review is conducted without cost or obligation. If there are clear reasons why treatment would not be appropriate or safe, you are informed at this stage—before you spend money on flights or accommodation.
For patients whose case review suggests they may be candidates, a video consultation with a treating physician is the next step. This allows for a more detailed discussion of your medical history, your symptoms, your expectations, and any questions or concerns. It also allows the physician to ask clarifying questions and to begin forming a treatment approach. The consultation is direct, personal, and honest. If there are concerns about eligibility, they are discussed openly.
After you arrive at the hospital, the comprehensive diagnostic workup serves as the final eligibility confirmation. Advanced blood work, cardiac evaluation, organ function testing, and an anesthesiology consultation provide the clinical data needed to confirm that the hyperthermia session can proceed safely. In rare cases, the diagnostic workup reveals information that was not apparent from the remote review—a previously undetected cardiac issue, an unexpected lab finding, or another concern. If this happens, the treatment plan is modified or, in some cases, the hyperthermia session is deferred.
Before the hyperthermia session is scheduled, the treating physician, the anesthesiologist, and the hyperthermia team review your case together. All team members must agree that the session can proceed safely. This team-based decision process ensures that no single perspective is missed and that your safety is evaluated from multiple clinical angles.
If the medical team determines that whole-body hyperthermia is not safe for you, that does not mean treatment at St. George Hospital is impossible. The hospital offers a range of treatment modalities beyond hyperthermia, and a modified treatment program may still provide significant benefit.
Alternative or modified approaches may include:
In cases where the medical team recommends against treatment altogether—because the risk is genuinely too high or the likely benefit too uncertain—that recommendation is given honestly and with explanation. We would rather turn away a patient we cannot safely help than treat someone who should not be treated.
A confirmed positive test is helpful but not always required. Many patients with chronic Lyme disease test negative on standard assays (ELISA, Western blot) despite clear clinical presentation. If your symptom history, tick exposure history, and clinical picture are consistent with Lyme disease, you may still be considered for treatment even without definitive positive serology. The diagnostic workup at the hospital includes advanced testing that often identifies infection when standard tests have been negative.
There is no fixed age cutoff. The relevant question is not how old you are, but how healthy you are. Patients in their 70s with good cardiovascular health have been treated safely. Patients in their 40s with significant cardiac disease have been excluded. Functional health status matters more than age.
Pediatric eligibility is evaluated on a case-by-case basis with heightened caution. Very young children are generally not candidates. Adolescents may be considered depending on their clinical situation, physical maturity, and ability to cooperate with the treatment process. Parental consent and extensive discussion are required.
Complex, multi-system illness is common among chronic Lyme patients. Conditions such as mast cell activation syndrome, mold-related illness, chronic inflammatory response syndrome, and chemical sensitivities do not automatically exclude you from treatment. However, they add complexity to the treatment plan and may affect how your body responds to hyperthermia. The medical team evaluates the full picture of your health, not just your Lyme disease.
If you are unsure whether you are eligible, the right first step is to share your story. The case review process exists precisely for situations where eligibility is not clear-cut. It costs nothing, commits you to nothing, and gives you a physician's honest assessment of whether treatment is a realistic option for you.
Tell us about your medical history, your symptoms, and what you have been through. A real physician reads every case within 2 business days and responds honestly about whether treatment is right for you.
Request a case reviewNo cost. No obligation. No sales pressure.
A case review takes the guesswork out of eligibility. Share your medical history and our team will give you an honest answer within 2 business days.
Honest information about monitoring, side effects, rare risks, and contraindications. Trust through transparency.
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