Wednesday, August 15, 2018

Lyme and the rule of 3s.


I had this conversation today. 
“Are Babesia symptoms better?”
“Which are those?”
“You have had Lyme for 10 years. Let me try to make it simple.”
Here is -- I hope -- an easy way to remember Babesia symptoms and others.

Rule of 3s.

3 pathogens.
Each pathogen has 3 prototypic, characteristic symptoms.
A patient yesterday what to know if she was different because she has Rocky Mountain Spotted Fever. 
First off, she does not have and never did have Rocky Mountain Spotted Fever.  The positive test shows cross reactivity to other related species of Rickettsia.  
As a rule, it doesn’t matter what else you tested positive for, outside of the big 3.  They get better. Almost always. 
The big 3 pathogens may not get better.  They are tenacious and hang on despite best efforts. 
Lyme is variably pathogenic.  The other two are opportunistic conspirators.  They hit you when Lyme has knocked you down and jump into the fray. 
We start with an alliteration. 
Borrelia (Lyme), Babesia and Bartonella. 
These are stereotypic symptoms. You may have a few or none of the above. But here it goes:
Lyme:  Fatigue.  Pain (tends to come and go) and brain fog (cognitive dysfunction).
Babesia:  Night sweats (at times fevers).  Air hunger.  Depression, especially random tearfulness. 
Bartonella: Pain, not joint (shin, heel, neck, headache), craziness (irritability, anger, rage, psychosis and others) and rashes.
After I presented my rules of 3s, the patient said:  Yes. Nigh sweats and air hunger are improving.  Mood is better.  Babesia symptoms. 
You might want to know why these pathogens are different from all others. Why won’t they just leave?
Narrative of persistence. 
We explain persistence of pathogenic microbes with a science based, biologically plausible explanation. 
Lyme:  Context is always important.  A few points.  Doctors have argued about the existence of chronic or persistent Lyme symptoms for decades.  First: no such thing.  Then: Post-Lyme syndrome, autoimmune residua. Now: Post treatment Lyme disease syndrome.  The new term is a concession to science. Science informs it has thus far been impossible to eliminate Lyme from mice, dogs and monkeys. Further, some studies prove persistence in humans after treatment. Lastly, Lyme is about impossible to eliminate in a test tube. The experts who propose no chronic Lyme have been wrong on the first two account are sure that got it right this time.  Even if organisms persist, additional treatment hurts patients and doesn’t help them.  Patients have chronic persisting infection.  Long-term antibiotics make symptoms go away, frequently only temporarily. The other side has been wrong 2/2 times. Shall we go for 3?
Babesia:  If I failed to mention it. I did. Lyme is pantropic, meaning it goes everywhere, infects virtually every tissue and organ.  Babesia is organ specific – blood system.  It’s minions exclusively inhabit red blood cells.  Clinically we know it doesn’t go away because it keeps coming back.  We side it hides or sequesters in small blood vessels (capillaries), the spleen and bone marrow.  The mechanism is not fully understood. In general, the immune system functions poorly within cells. 
Bartonella: Lives in cells lining blood vessels.  Hides inside cells or sequestered in the intracellular milieu. This is a safe harbor against the immune system.  Clinically the thing is difficult to kill. 
We have effective treatments for the all the above. Some new things are working. If you would like to learn more call our office for a consultation.

2 comments:

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lymie said...

I am wondering why anorexia can be associated with babesia. Don't understand the mechanism. It happened to me and to a number of other people. Once the babesia was eradicated, the weight was regained.