Tuesday, February 3, 2009

To not treat Lyme disease means....

A 28 year old female came into my office 18 months ago. She complained of acute left hip pain for 3 days and was unable to walk. My previous training told me that it was something called "toxic synovitis," an acute joint inflammation or a hip joint, possibly do to a virus or a rheumatological disorder. She was in severe pain, I prescribed a Medrol dose pack and Vicodin. Her initial labs showed a sed rate of 32 a CRP of 160- which is off the charts, a Lyme C6 peptide index of 0.3, vitamin D reversal, a Lyme WB 41 band on the 13 band test. She took antibiotics for 2 months for presumptive Lyme disease and got better. She stopped the antibiotics and relapsed 4 months later. This time her hip and knee hurt. She had mild neurological signs of peripheral neuropathy.

"Standard" labs were negative for Lyme. Her sed rate was 47 and her CRP 30.
After one week of resuming antibiotics she was better. Her course was complicated by a yeast infection. Her antibiotics were adjusted. After 4 months, a more careful history elicited- some tingling in the hands, some fatigue and some subtle cognitive issues.

At 7 months her CRP was normal at 1.2 and she felt entirely normal; all the symptoms had resolved. New labs showed that her vitamin D dihydroxy 1,25 had climbed to 98. The vitamin D hydroxy 25 was 12. I was a little nervous about the vitamin D and prescribed 2 months of Benicar. The levels quickly corrected 28 and 20 respectively.

After 3 negative Labcorp WB for Lyme, the last two showing no bands, a Lyme WB was sent to IgeneX. This time she was CDC positive and IgeneX positive by IgM criteria. She had positive bands 23,31,34,41 and 58.

We both felt confident that the diagnosis of Lyme disease had been correct all along.
She has been maintained on low doses of maintenance antibiotics and is symptom free.

To not treat Lyme disease means: To not consider Lyme in the differential diagnosis, to omit neurological examinations of my patients, to not order the labs I am familiar with- stop practicing medicine as I know it- just go through the motions to make a living, and still smile? Not worth it. If that what it comes down to I will leave medicine and find something else to do.

More importantly: God knows what would have happened to the patient?

4 comments:

Aaron said...

i have igenex western blot test i think have 41 ban. been ill 4 years with EBV, HH6, mycoplasma, candida, etc. i am thinking about doing antigen floridalabs lyme test. what is your email?

Starlings Preschool said...

This is nuts. What would have happened to the patient if YOU WEREN'T THERE?!
I'm so glad that you are out there and wouldn't blame you if you don't want to practice cookbook medicine....or be a "doc in the box" as one of my friends says!

lyme4achange said...

I'll tell you what could have happened to the patient.

She could have been me. I can tell you that being me isn't always fun.

When I had that hip pain in 1989 where I couldn't walk, two years after having the flu-like symptoms, I didn't get pain pills or blood work or even an advil and I was told it was stress when nothing showed on an xray. I was 19, and no one thought this was odd...

It did eventually get better on its own, and hit on and off for a few years. The shoulder hit on and off for a few years.
When it happens to the shoulder...you can walk, you just cannot breathe.


now much of my joint damage is permanent...since i went 20 years without a diagnosis.

EyeBob said...

LymeMD,

What's your feeling about elevated Sed Rates in patients? I have searched and seem to be coming up with conflicting answers. How common is an elevated Sed Rate in Lyme or Lyme-like illnesses?

bt