Thursday, December 15, 2011

Primay care: Lyme endemic

Follow up visit. I have known this 50 year old male for a long time. He is a chronic depressive type. Divorced poorly. Working two jobs. Antidepressants help and he needs a refill. He mentions as a side bar he had red bumps on his leg 8 weeks ago, thought it was bug bites and went to a walk in clinic. Told - nothing to worry about. he suffers with anxiety and is disease phobic too. Just updating my files. Great. Thanks for the info. This was three visits ago.

No symptoms except the usual fatigue and depressed mood.

I order a few tests, perhaps the wrong test, including a tick borne disease panel. I have Lyme on my brain. Gotta stop that. Surprise(or not). Labcorp CDC positive for Lyme, ELISA and IgM WB. Babesia duncani titer 1:512 cinches the deal.

I carefully query: " Change in fatigue, Headaches, neck pain, change in vision, night sweats, any sweats, air hunger, joint pain, muscle pain, muscle pain, twitching muscles, Numbness and tingling, brain fog, cognitive issues, anything?"

He pauses to think: Maybe a few night sweats, over the last 6 months. Perhaps the heat was up too high, wearing heavy night clothes, not sure. Nothing else.

I treat him with antibiotics and Mepron for a month.

Now the current follow up visit.

Feels the same, except anxiety has increased; now he is worried about these new exotic sounding and frightening diseases.

It would be a lot easier if he was sick. Then I would know what to do.

There are the perils of a primary care practice - seeing patients on the front line. I suspect most patients infected with Lyme are asymptomatic. It is impossible to test this theory. I know many patients infected with Babesia are asymptomatic.

In a specialty Lyme referral practice you don't have to wrestle with these problems. I spent more time thinking about his case than I did the sick patients I saw that day.

Now I know a lot of readers are thinking: Treat him, treat him! Here's the problem. With Lyme you treat until symptoms are gone. What end point do you suggest I use?

I am still scratching my chin.





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8 comments:

Renee K said...

You are scratching your chin but at least you are thinking about it. NO guarantee of "cure" with treatment, is it worth treating someone who is asymptomatic and make things worse? Up to the patient to decide?

glytzhkof said...

You get used to feeling "the usual terrible" you feel. Any change, and you notice. You measure your well being compared to a baseline that has sunk very low.

I was very worn down by Borrelia and the metabolism disorder it triggered (Graves Disease / Hyperthyroidism - molecular mimicry? http://www.ncbi.nlm.nih.gov/pubmed/15671776). I have been treated several times with different medications, sometimes experiencing increased tension and anxiety.

At this point I am on a higher threshold of wellbeing, and I can honestly say I wish someone would have risked a harder treatment sooner. What worked best for me was Plaquenil and Clarithromycin in two long 8-week periods with a month or two in between. I then supplemented with a few weeks of Flagyl afterwards. Pretty much a carpet bombing with antibiotics. It's effect has been dramatically much better than anything else.

Rashes on my legs that appeared simultaneously with the first Borrelia symptoms have started to clear up now - two years after I finished the last antibiotics cure. They were diagnosed as Schambergs disease and were bright red at first, then fading to a brownish "rust" color. Red blood cells leaking iron into the skin or something. Couldn't tell, you will know. I am now on metabolism stabilizing drugs with Anti-TPO levels still high but dropping. I eat well and sleep a lot. My body is doing the rest of the cleanup itself - or so I hope.

Lyme is still there. Hidden inside cells just waiting for a chance. Just a few days with little sleep, and I notice a significant decline in my mental state and sometimes I do see some bleeding into my skin.

T9im said...

Hi Doc:

Is one month is enough. My daugher became worse for 2+ months on the Mepron & Zith for Babesia (she never tested positive but had the symptoms).

We were never sure if it the meds were working and she was becoming worse until fevers finally started to abate just after 2.5 months.

Crazy diseases and of course everyone is different. I agree long term med treatment is difficult at best and if the patient doesn't buy in then dosages are missed and probiotics are not taken.

AlphaCarbon said...

Hey Doc,

Your posts are informative, and I have learned a bunch from you in the past month since finding this site.

I'm located in NoVA, and am interested in potentially scheduling an appointment for chronic lyme (about 5 years since tick bite/EM rash). I couldn't locate your contact info within this site; please email me at bigdogsal14(at)hotmail.com.

Thanks in advance,
Mike

zofiaf said...

I'm 58 years old woman, living in Florida. About 8 months ago I was bitten by the spider. Since then I started to feel really bad and week, lost weight, have a problem with blood circulation in my hands and feet, my eyes are tired all the time .
After a long time of searching for the reason of such a condition during the blood tests the bacteria called bartonella was found in my blood.
According to the laboratory there are many (21 or greater organisms per total fields observed) of Hemobartonella or Hemoplasma.
Also there was a detected biofilm community-like structures.
I'm not able to find any doctor to establish the treatment for me. is it possible to have the appointment with you? Please contact me at zofiaf(at)hotmail.com

zofiaf said...

I'm 58 years old woman, living in Florida. About 8 months ago I was bitten by the spider. Since then I started to feel really bad and week, lost weight, have a problem with blood circulation in my hands and feet, my eyes are tired all the time .
After a long time of searching for the reason of such a condition during the blood tests the bacteria called bartonella was found in my blood.
According to the laboratory there are many (21 or greater organisms per total fields observed) of Hemobartonella or Hemoplasma.
Also there was a detected biofilm community-like structures.
I'm not able to find any doctor to establish the treatment for me. is it possible to have the appointment with you? Please contact me at zofiaf(at)hotmail.com

John M said...

I am currently under treatment for chronic neuroborreliosis. My treatment regimen was recently changed for coverage of babasia. Mepron and Artemisinin every other day for two weeks then a week off. I was wondering if evidence of hemolysis would be helpful in evaluating effectiveness of treatment for babesiosis.

I have been told that current evidence is suggesting that I will always have borrelia in my body. It is just a matter of my immune system gaining the upper hand. Could it be the same for babesia?

worriedmom said...

Did you give him Welchol to bind toxic products in gut?

Is he drinking enough filtered water?

Thank you for being here!