Tough case I have been treated forever. Every symptom in the book. She went to a "famous" LLMD and now she is getting better! He diagnosed Bartonella (clinically): She has already been treated for this in spades. This time she is getting better. RX: Minocin, Zithromax and Rifampin. Is there something special about this combo? It involves two separate protein synthesis inhibitors and an RNA inhibitor. I had used the same stuff and more, not all at the same time. Now she is also using the gluten free diet I recommended (He agreed). What's working?
Does Lyme cause gluten sensitivity or does it just make an underlying gluten issue more problematic? I don't know. The patients don't have celiac disease. But- the tTG IgA level is greater than zero. The antigliadin antibody is greater than zero. The stool antigliadin antibody level is elevated as tested by Enterolab in TX.
The diet frequently makes a surprising difference. It is a difficult diet; it must be strictly adhered to; improvement won't occur for at least 8 weeks.
But I really want to talk about B12 and especially folic acid. The levels can be quite low, especially in sicker patients. The patients do not have pernicious anemia or any obvious GI dysfunction. What are the causes of folate deficiency? Medical texts claim: poor diet, alcoholism, GI maladsorption, drugs like sulfonamides and INH which compete with folate metabolites and "chronic illness." None of these apply. Besides, folic acid levels can remain very low in the face of massive supplementation. Hemolysis is also listed. This is what makes sense to me. Red blood cells may be infected with bacteria like Ehlichia and Bartonella. This in turn leads to an increased turn over of RBCs. Nutrients required in the manufacture of red cells such as B12 and folic acid become "lost?" in the process. The process occurs rather slowly. Overt hemolysis is not observed. If significant hemolysis were to occur then urine dip would show blood (myoglobin) with no RBCs. The serum LDH level, related to lysed RBCs would be elevated. The patient would be anemic. Haptoglobin levels would be increased. The reticulocyte count would be elevated.
I don't see these things (I also don't test for them).
Lots of RBCs with bacteria can be seen on blood smears. Something must be happening to infected RBCs. Babesia should do the same. But Babesia are hard to find on a blood smear. There doesn't seem to be enough organisms to cause the same effect. Perhaps the organisms are infecting progenitor cells in the bone marrow where such effects occur unseen. The idea of bacteria like Borrelia competing for use of these nutrients doesn't make sense. vitamins are trace nutrients needed to complete enzymatic functions. B12 and folate are used for red blood cell synthesis and nervous tissues. Spriochetes and other bacteria do not have these needs. Why would they compete for these nutrients? Lyme- Tick Borne Disease patients frequently have a mix of hematological abnormalities that have not been explained or cataloged: Unexplained anemias, low white cell counts, low neutrophil counts, increased lymphocyte counts, low platelet counts and other abnormalities which seem to vary from patient to patient. If I were to write a book about tick borne disease a whole chapter could be dedicated to hematological abnormalities- if I ever figure them out.
I am rambling a bit, but these is about pieces of the puzzle- see title.
Perhaps things like Bartonella do cause mild flu like symptoms and chills (min-hemolysis?) No. why would cells rupture with synchrony. It should be a slow trickling process. Wait. The same should be true about Babesia. Why then do patients experience drenching sweats and shaking chills. It really isn't like malaria where large numbers of blood parasites can be observed in red cells causing obvious hemolysis. Perhaps it is toxin medicated with a central hypothalamic effect.I have more questions than answers.
I am convinced that B12 and folic acid are key puzzle pieces. Where do they fit?
And where does Bartonella fit and what are the best treatments? Finally, do these two pieces of the puzzle dovetail?