Wednesday, October 1, 2008
I have a stack of interesting cases which I plan to write blogs about sitting on my desk. Since I am at home, I will mention the story of one patient I saw last week. This patient had "lupus" or systemic lupus erythematosis for more than a decade. She had the classic butterfly rash. She had arthritis, fatigue and frequent episodes of pleurisy. Her rheumatologist had treated her with corticosteroids and Plaquenil. Her symptoms were poorly controlled. About 18 months ago I told her about the Lyme hypothesis. She agreed to be tested. Her results were equivocal. We decided to try antibiotic. Results: No rash, no fatigue, no arthritis and no pleurisy. She ran out of Plaquenil and the symptoms did not recur. This had not happened in a decade. I asked her if she felt comfortable with the new paradigm. Her answer: A resounding yes. We are continuing antibiotics which work better than standard fare. She avoids her Harvard trained rheumatologist now. She is tired of hearing that her experiences are impossible and that her physician does not know what he is doing. It's all a placebo effect. Placebos don't work for an extended period. Find another explanation if you think mine is incorrect. More complex case summaries will follow.