A 52 year old female came to my office for the first visit one year ago. She had a history of a purplish blotch on her leg which she acquired while horse back riding 5 years ago. She subsequently developed a severe painful neuropathy associated with crippling pain and weakness of her limbs. An evaluation at John's Hopkins was negative. A rheumatologist later diagnosed fibromyalgia. At the time of our first visit she had been on social security disability for several years, mostly for pain. In 2006 a diagnoses of Lyme disease had been made and she received 6 weeks of Rocephin. Any benefits were apparently short lived. Her chief complaint related to our first visit was neurocognitive impairments. She complained of memory loss, anxiety, depression, panic attacks and episodes of frank confusion. She had a normal MRI and SPECT scan. Over the subsequent year she has been on several regiments of oral antibiotics. The treatment has been interrupted at times due to compliance issues. Because of her neurocognitive symptoms I have recommended further courses of IV Rocephin and she has been reluctant. During this period of time she has been followed by pain management specialists and mental health professionals. I am delighted to have in my procession a detailed consultation from a psychiatrist, a consultant who specializes in psychopharmacology. The note reviews her complex history. It outlines the history of all her medications- a long list, and includes the antibiotics she has taken over a period of months including: Omnicef with Benemid, Tindamax, and Minocin.
The consulting psychiatrist notes that CNS Lyme has been inadequately treated. (The history documents more than 9 months of oral antibiotics). He states that the CNS Lyme should be definitively and exhaustively treated. In his experience with a previous patient, improvement only occurred with 3 months of intravenous antibiotic therapy.
I thought the consult was brilliant.
Sometimes it is nice not to be alone.
I have to go home and listen to the Diane Rehm show which aired today.