tag:blogger.com,1999:blog-56948941538992814852024-03-14T04:28:57.055-07:00LymeMDLyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.comBlogger516125tag:blogger.com,1999:blog-5694894153899281485.post-83982871713465480142021-07-16T11:37:00.003-07:002021-07-16T11:37:59.381-07:00Methylene Blue and Lyme<p> </p><p class="MsoNormal">Is there a magic bullet and is it methylene blue?<span style="mso-spacerun: yes;"> </span>Methylene has been shown to have activity against
malaria/Babesia, Bartonella and Lyme.<span style="mso-spacerun: yes;"> </span>It
has activity against persister forms of Bartonella and Lyme (borrelia) as well
as biofilms. <span style="mso-spacerun: yes;"> </span>It is active against coronavirus
(Covid).<span style="mso-spacerun: yes;"> </span>It has neuroprotective effects,
inhibits tau proteins in the brain and therefore may help fight Alzheimer’s
disease and other neurodegenerative brain disorders. It has been used with
photodynamic therapy to treat cancer, including lung and breast malignancies.
The drug is also known to strong psychoactive properties and has been shown to
benefit patients with psychiatric illness, including bipolar disorders. <o:p></o:p></p>
<p class="MsoNormal">It has serotonergic effects and cannot be taken by patients
on antidepressants. <o:p></o:p></p>
<p class="MsoNormal">The drug was developed in the late 1800s.<span style="mso-spacerun: yes;"> </span>No patents, no money, and no research--may be a problem.<span style="mso-spacerun: yes;"> </span>It is not commercially available (orally),
but capsules are prepared by some compounding pharmacies. <o:p></o:p></p>
<p class="MsoNormal">The most common use in the past century has been the
treatment of methemoglobinemia, a relatively rare condition in which oxygen
carrying hemoglobin is converted to a non-active form, generally a genetic disorder
trigged by an outside agent.<o:p></o:p></p>
<p class="MsoNormal">It sounds like the MacGyver of drugs – or Swiss army knife
of drugs.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Lyme patients are not infrequently desperate, suffering
despite much standard and experimental therapy, looking for the next thing. <o:p></o:p></p>
<p class="MsoNormal">The question is: Is methylene blue (MB) safe and effective for
chronic Lyme patients? Is it finally the Holy Grail?<o:p></o:p></p>
<p class="MsoNormal">First off, MB has been shown to be safe and effective in
humans (malaria).<span style="mso-spacerun: yes;"> </span>It was the first
synthetic anti-malaria drug, preceding commercial penicillin by about 50
years.<span style="mso-spacerun: yes;"> </span>Recent studies employ high doses
of the drug administered over 3 days. Malaria has become more resistant to a
wide array of therapies and MB has been resurrected and dusted off as if it is
something new. <span style="mso-spacerun: yes;"> </span>Short term use does not provide
cover for long-term usage, the hallmark of Lyme and associated diseases
therapy.<span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">Effectiveness for Lyme patients is inferred from in vitro
(test tube) studies (Lyme, Bartonella, Babesia).</p><p class="MsoNormal">Methylene blue has broad spectrum antimicrobial activity against protozoans, bacteria and virus. Generally I prefer narrow spectrum drugs. A scorched earth drug may be problematic. I don't think we know anything about its effect on the microbiome, especially with prolonged use. </p><p class="MsoNormal">MB is undergoing clinical in
vivo trials for the treatment of Covid. This adds a log to the evidential fire
of drug safety.<span style="mso-spacerun: yes;"> </span>The Covid trials employ
low doses, MB 100 mg twice daily but for only 5 days. Malaria trials have used
higher doses but only for 3 days--10 mg/kg for 2 days followed by of 5 mg/kg
for one day.<span style="mso-spacerun: yes;"> </span>For example, a typical 70
kg man receives 700 mg for 2 days followed by 350 mg on the third day. <o:p></o:p></p>
<p class="MsoNormal">It should be clear that long-term clinical use for non-studied
infections is entirely experimental. But at this point there are numerous anecdotal
reports which praise MBs efficacy and appear to support safety when used this
way. <span style="mso-spacerun: yes;"> </span><o:p></o:p></p>
<p class="MsoNormal">I spoke at length with a patient today who is a big fan. He
has tried various doses and found 200-400 mg per day to be an effective dose.
He has found it works well only as part of cocktail therapy. <span style="mso-spacerun: yes;"> </span>One therapy, Zithromax, Rifampin and MB worked
well for Bartonella. <span style="mso-spacerun: yes;"> </span>For Babesia it has
been effective when combined with artemisinin (or Coartem) and primaquine (or tafenoquine).
<o:p></o:p></p>
<p class="MsoNormal">MB is now part of the Lyme disease armamentarium. It has been in common use,
in some corners for more than 2 years. Treatments must always be individualized. <o:p></o:p></p>
<p class="MsoNormal">If the drug is used, I recommend starting with a low dose
like 50 mg twice daily and gradually increasing as tolerated. <o:p></o:p></p><p class="MsoNormal">All drugs have numerous side effects and drug interactions. Please do not purchase MB on the internet and treat yourself. The consequences could be disastrous. Don't have a fool for a doctor and a fool for a patient. </p>
<p class="MsoNormal">Methylene blue plays an increasingly important role in the management
of tickborne disease and may ultimately have other important clinical
applications. </p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com4tag:blogger.com,1999:blog-5694894153899281485.post-26117757552488794202020-06-17T16:16:00.001-07:002020-06-17T16:18:17.847-07:00Old drug, new drug: nimodipine<br />
Mary, a 35 years old woman was extremely healthy – until she
wasn’t.<span style="mso-spacerun: yes;"> </span>The culprit was Lyme disease, an
ancient, thin, spiraled bacterium called a spirochete – one that is insidious
and opportunistic.<span style="mso-spacerun: yes;"> </span>But Lyme disease is
more often than not so much more.<br />
<br />
Our ability to stave of infection frequently depends on a
healthy immune system.<br />
<br />
Many factors can adversely impact normal immune function. <span style="mso-spacerun: yes;"> </span>Stress is a huge factor. <br />
<br />
Lyme and Mary’s immune system had been locked in mortal
combat with Lyme for some time. Life stressors mounted and a tipping point was
reached. Lyme won the battle and spread throughout her body attacking many
organ systems.<br />
<br />
These were some of the stressors. Her father died of a sudden heart attack, a child was
diagnosed with autism, her husband was emotionally abusive and this led to an
ugly divorce.<br />
<br />
Mary managed stress by gardening – more and more. Ironic.<br />
<br />
The fatigue was overwhelming. It felt like she had been run
over by a Mack truck. Mary was diagnosed with chronic fatigue syndrome/CFS, myalgia
encephalitis or systemic exertional intolerance disorder – three names for the
same thing. She simply could not function. Sleep was miserable, too much or too
little. She struggled to get out of bed. She needed help with simple household
chores. She rarely got dressed; she no longer put on makeup and she took few
showers. Sadly, Mary blamed herself for her poor health. She lost all self-esteem.<br />
<br />
Headaches diagnosed as migraine came out of the blue.
Pounding, throbbing, ice pick, with temporary loss of vision nausea. The pain
was unbearable. <span style="mso-spacerun: yes;"> </span>Several doctors were of
no help and she seriously considered suicide. <span style="mso-spacerun: yes;"> </span><br />
<span style="mso-spacerun: yes;"><br /></span>
<br />
Symptoms mounted. Doctors said it was psychosomatic. Family
members believed the doctors. Mary was abandoned by both family and friends.<br />
<br />
Mary had so many symptoms, symptoms which inexplicably came
and went.<br />
<br />
She frequently felt like she had the flu. She had night
sweats, drenching at times. <br />
<br />
Her whole body hurt at times. Sometimes the pain was
localized to a particular joint or body part. <br />
<br />
She experienced frightening cognitive impairments, poor memory,
trouble thinking clearly, difficulty finding words. She frequently felt disoriented and depersonalized. She experienced depression, air hunger, sudden bouts of crying, intermittent
joint swelling, weakness, numbness and tingling and trouble sitting up and
standing.<span style="mso-spacerun: yes;"> </span><br />
<span style="mso-spacerun: yes;"><br /></span>
<br />
With changes in posture, from lying to sitting and then to
standing symptoms her heart raced, brain fog increased, she became dizzy, felt
she would black out and had to immediately sit down or lie down.<br />
<br />
We know Mary has Lyme and Babesia. But she is not going to
get better if we treat her only with antibiotics and anti-Babesia drugs.<br />
<br />
Migraines:<span style="mso-spacerun: yes;"> </span>There are
a variety of new ways of treating migraines including those that antagonize
calcitonin gene related peptide, a relatively new and sometimes successful
therapy. Migraine therapy will be reviewed in detail in the future.<br />
<br />
POTS:<span style="mso-spacerun: yes;"> </span>With further
questioning Mary had problems with her bowels, bladder, vision and temperature
regulation. <span style="mso-spacerun: yes;"> </span>POTS is a piece of the
larger disease, dysautonomia or broken autonomic nervous system. A patient history,
exam with measurement of vital signs in different positions can confirm the
diagnosis. A tilt table test is unnecessary. There is a close connection between
dysautonomia and CFS. Mary’s heart rate only increased by 20 points with
standing not the requisite 30. Of course she was too dizzy to stand for long.<br />
<br />
There are many effective therapies which usually work when
prescribed properly. Described elsewhere.<br />
<br />
Even when tests for POTS are negative, patients with chronic
fatigue syndrome may benefit from POTS’ therapies including salt tablets and fludrocortisone.<br />
<br />
Lyme patients, patients with chronic fatigue syndrome and
patients with POTS all complain of brain fog. An old/new drug may be incredibly
effective.<br />
<br />
The <b>calcium channel blocker nimodipine,</b> which must be
prescribed carefully dilates cerebral blood vessels and increases blood flow in
the brain treating chronic encephalopathy. Patients with Lyme, POTS and CFS may
all suffer with dysregulated blood flow to the brain.<br />
<br />
Nimodipine may work well with other neurotropic drugs including
Adderall and Namenda.<br />
<br />
I have treated Mary for less than a year and she has done
very well.<br />
<br />
She is back at work, part time, telecommuting and even
smiling at times. <br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com16tag:blogger.com,1999:blog-5694894153899281485.post-12815638522604892882020-05-08T12:57:00.003-07:002020-05-08T12:59:44.927-07:00Summer flu, Lyme or Covid?Lyme patients, those suffering with chronic illness must be
considered immune suppressed and at higher risk for serious Covid related
illness.<br />
<br />
There are dangers at the edge of the woods and dangers from
neighbors and family.<span style="mso-spacerun: yes;"> </span>The world is
surreal.<span style="mso-spacerun: yes;"> </span>But it is the real world, the
one we have to live in.<br />
<br />
The Covid nightmare, is in some ways like 911, a watershed
event that will forever change our prior naivety regarding person to person
transmission of deadly germs.<br />
<br />
I am optimistic that meds given early in the course of
illness will prove effective. Current candidates include<br />
<br />
The summer flu. It has long been acute stage Lyme misdiagnosed
by the doc-in-a-box. Now we have another bigger worry.<br />
<br />
The presentation of the two illnesses can in some cases be
identical: <span style="mso-spacerun: yes;"> </span>fever, malaise and
achiness.<span style="mso-spacerun: yes;"> </span><br />
<br />
Testing should be done, although deficient for both.<br />
<br />
Do not get the Covid antibody test. 100 non-vetted
companies, tests.<span style="mso-spacerun: yes;"> </span>Get the nasal swab
sent for PCR which directly identifies the RNA virus. There are still false
negatives and you may want to repeat the test.<br />
<br />
Lyme testing. Many of us are operating remotely doing
telemedicine. That obviates the ability to send specimens to more reliable Lyme
labs:<span style="mso-spacerun: yes;"> </span>Stony Brook, MDL, IgeneX etc. We
have to manage with LabCorp or Quest. <span style="mso-spacerun: yes;"> </span>Get the Western Blot test, not the reflex to
WB.<span style="mso-spacerun: yes;"> </span>Also get C6 peptide.<span style="mso-spacerun: yes;"> </span>Coinfection testing must include Babesia
duncani, WA1, IFA IGG.<br />
<br />
Do not worry too much
about poor Lyme blood tests. <span style="mso-spacerun: yes;"> </span>Patient history
is the most reliable test. <br />
<br />
If there is any doubt treat both. <span style="mso-spacerun: yes;"> </span>Doxycycline and (ivermectin which many Lyme
patient feels has been effective) is a good starting place. If you are worried
about sun induced toxic skin reaction, I recommend you stay in the shade and
tough it out for at least 3 weeks. This is the only drug that has widespread
effectiveness against many coinfections.<span style="mso-spacerun: yes;">
</span>Amoxicillin, Ceftin and Minocycline are not adequate substitutes.<br />
<br />
<br />
Search my blog for more about ivermectin.<br />
<br />
<br />
Despite what you may have heard or red otherwise, Covid
cases and deaths are very underreported.<span style="mso-spacerun: yes;">
</span>Same as Lyme. <span style="mso-spacerun: yes;"> </span>With Lyme some
elected officials have helped promote the cause.<span style="mso-spacerun: yes;"> </span>With Coivd, unfortunately, it is the other way
around.<br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">. </span><br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com9tag:blogger.com,1999:blog-5694894153899281485.post-49097739446851341932020-04-29T16:00:00.002-07:002020-05-01T09:35:33.740-07:00Telemedicine vist
<br />
Telemedicine visit<br />
<br />
Your doctor does not want to see you in his/her office. At
least your doctor should not want to see you in his/her office. Not now. <br />
<br />
We are in the middle of a pandemic – goes without saying. Covid-19
stands for coronavirus disease 2019. Its novel because it is new and something
the human immune system has not previously encountered. <span style="mso-spacerun: yes;"> </span>We have experience with other deadly
coronavirus infections. SARS had a mortality rate of around 15% and MERS was
scary deadly with a mortality rate in the smallpox range, 30+ percent. Covid-19
is less deadly but much more contagious. The true numbers of those infected and
the mortality rate are to date unknown.<br />
<br />
Covid-19 is the dreaded pandemic, more than an epidemic. <br />
<br />
An epidemic occurs with rapid dissemination of an infectious
illness through a susceptible population. It may be worldwide as occurs yearly
with influenza.<br />
<br />
A pandemic is worldwide dissemination of a new deadly
infectious disease. This is the stuff of sci-fi movies. <br />
<br />
A friend’s parents live in a Maryland Assisted Living facility
and tested positive for Covid. <span style="mso-spacerun: yes;"> </span>Both presented
with diarrhea and without fever or cough. Unusual presentations may not be
unusual. <br />
<br />
A typical physician’s medical examination room is an 8X10 or
somewhat larger rectangle with relatively poor circulation. It is a perfect
incubation chamber for coronavirus. Infectious particles may persist in air –
droplets and aerosols and on incompletely sterilized surfaces. I am more
concerned about transmission to patients from asymptomatic medical staff.<br />
<br />
Covid is present in at least two thirds of our state’s
nursing homes. Family members are barred. The virus is invariably introduced by
unwitting staff members. <br />
<br />
When possible, and it mostly is, stay at home and stay safe.
<br />
<br />
Telemedicine in Maryland is defined as a medical encounter
with the use of an audiovisual aid such as a computer using a HIPPA approved
platform. Telephone calls are excluded from the definition of telemedicine. <br />
<br />
State licensure rules regulate the use of this technology
for out of state patients. Most states have loosened the rules. But changes in
regulations vary tremendously from state to state. <br />
<br />
Telemedicine is more personal than phone medicine and feels
more like a normal doctor-patient visit. I can get a sense of the patient’s
general overall health based on his/her appearance. Objective data is missing
but patients can help fill in some of the blanks. <span style="mso-spacerun: yes;"> </span>Patients have easy access to home BP devices, oximeters,
scales and thermometers. I can look at a throat, rash or swelling. I can see
where pain is without having to guess. I can get a general sense of breathing
based on observation. And many patients can get an EKG with a wristwatch or
other portable device and show me the tracing on the screen. Prescriptions are
electronic. <br />
<br />
If a patient needs more advanced care, at an ER for example,
the platform is extremely helpful vs a phone call.<span style="mso-spacerun: yes;"> </span><br />
<br />
Please use the doxy.me or another similar platform. It’s
easy to use and does not require an app. And I can hear much better as well. <br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike><br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com34tag:blogger.com,1999:blog-5694894153899281485.post-34173064840330922882020-03-04T17:29:00.001-08:002020-03-04T17:29:29.726-08:00Mold toxins in perspective, a science based approach<br />
Mycotoxins – the noxious chemical defense of these ancient
and troublesome microorganisms. <span style="mso-spacerun: yes;"> </span>Recently
a <span style="mso-spacerun: yes;"> </span>patient showed me a urine test.
Mycotoxins were present in high concentrations. The patient was prescribed cholestyramine
and the next test was almost clear. He said “his mold level” had improved. He
fundamentally misunderstands the problem.<br />
<br />
First, we want to know if he is right about his “mold
level.” Are there a significant number of pathogenic mold organisms living in
our body actively secretin caustic toxins? <span style="mso-spacerun: yes;"> </span>Mold is not generally found in our bodies, at
least at high or clinically significant levels.<br />
<br />
Sure, we are all a waking zoo of microorganisms: bacteria,
yeast viruses, perhaps some protozoa but no mold. Although yeasts and mold are
cousins and frequently killed by the same drugs they act very differently.<br />
<br />
I ask again: why are the toxins found in our urine at measurable
concentrations. <br />
<br />
Most readers likely believe that the primary source is largely
aerosolized spores emanating from hiding places – wet basements and the like.<br />
<br />
In actuality the biggest source of mold/mold toxin is food. <span style="mso-spacerun: yes;"> </span>Many foods we eat all the time may have high
levels of mold. We have all found moldy bread in the fridge at one time or
another (I certainly have). Before the putrid green and blue areas appear mold
long present. Just not in numbers easily observable to the naked eye. Our
berries are covered in mold before the white exudate appears. Mold is present
in many foods: cereals, grains, corn, fruit, peanuts and peanut butter, eggs,
milk, meat, coffee beans, coffee – especially from our Keurig with its inaccessible
wet, warm environs, a perfect culture media, etc.<br />
<br />
The more serious, life threatening mold infections, for
example aspergillosis of the lung or brain generally occur in those seriously
immunosuppressed. <span style="mso-spacerun: yes;"> </span>Ordinarily,
aspergillus is a common food mold, a good source of aflatoxin and ochratoxins. Another
common food mold, penicillin is a good source of ochratoxin. There are many
other food molds and food toxins.<br />
<br />
Black mold, Stachybotry lives in our homes. It eats
cellulose, things like ceiling tiles, tiles and fiberboards. Its spores are aerosolized,
along with very noxious trichothecene toxins.<br />
<br />
Many mold toxins are xenobiotics recycled from liver
produced bile to the intestines and back again endlessly (or perhaps 20 times).
Enterohepatic recirculation may be beneficial in some circumstances. In this
scenario the liver is assaulted by the same destructive toxins over and over
again. <br />
<br />
I have written about this system in a few posts. The bottom
line is that this process explains why bile acid sequestrants (BAS) like
cholestyramine and Wellchol work. Activated charcoal also works because at high
concentrations it performs like a BAS. In fact, like the BASs, activated
charcoal (24 gm daily) lowered cholesterol by 25%. These drugs grab bile acids
and biliary toxins causing excretion through the colon – and the liver makes
new bile acids, primarily from cholesterol.<br />
<br />
The drugs lower the overall level of toxins in the blood
and therefore spare the liver and kidneys by a second mechanism.<br />
<span style="mso-spacerun: yes;"><br /></span>
<span style="mso-spacerun: yes;"> </span>But we have not fixed or addressed the
underlying problem.<br />
<br />
Dietary sources of mold and mold toxins are
significant.<span style="mso-spacerun: yes;"> </span>We may need to seriously
change our diets.<br />
<br />
We may need to remediate our homes, especially wet basement
areas if black mold spores are in the air.<br />
<br />
But these molds do not really or should not really take up
residence in our bodies.<span style="mso-spacerun: yes;"> </span>They are not
part of our normal microbiota.<span style="mso-spacerun: yes;"> </span>But this
in not always the case, especially with deep, chronic infection and immunosuppression.<br />
<br />
<span style="mso-spacerun: yes;"> </span>Where is the mold then hiding?<span style="mso-spacerun: yes;"> </span>Sinuses, lungs and skin are possibilities. Specific antimicrobial therapy is indicated, either intranasally or with systemic agents. The mold may be eliminated, or numbers significantly reduced. Retreatment may be par for the course.<br />
<br />
A lot is made about epigenetics, especially MTHFR variants
Genetic variations may interfere with “methylation.” DNA methylation is part of
a switching -- turning genes on and off, with far reaching consequences. This is a
real phenomenon. Complex and poorly understood.<br />
<br />
Eliminating exposure to toxins is the most important part of
therapy. You cannot get better if the fundamental problems is ignored. <span style="mso-spacerun: yes;"> </span>BASs and vitamins for MTHFR can be given
simultaneously- icing on the cake -- not the cake. MTHFR for another day.Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com9tag:blogger.com,1999:blog-5694894153899281485.post-33086820093613606442020-02-24T16:31:00.000-08:002020-02-28T10:58:08.447-08:00Detoxing and science and doctors <span style="line-height: 107%;">I talked to a patient today who is mad. Mad at doctors who are unprofessional, disrespectful and who disparage other doctors. This is what I recommend. Calmly call out the doctor's misbehavior. Be the grownup. Rise above the petulant, entitled child who never grew up. This describes many doctors. My patient wants to be proactive, respond to ill=treatment form doctors. Something about ratings in Apps. No comment.</span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">If you are
like me you sometimes grab an orange from the basket, hold it under the faucet
for a few seconds, peel and eat it. Perhaps
you grab a waxed apple and do the same. You should scrub the fruit with a
natural detergent. Your produce is likely grown in an invisible stew of things
like the widely used pesticide 1,3 dichlorpropene banned in the European Union,
Roundup, Organophosphates, Arsenic related and others to
name a few. Big agra-business makes the
oranges and apples shine – with more chemicals. The FDA assures us the levels of toxins and carcinogens are safe. Organic
produce has less of the same but is exposed to the same contaminated water table and soil, our toxic biosphere. The FDA tells us the levels of these entirely
safe. The Mayo Clinic suggests natural
products used by organics farmers are not proven safer than unpronounceable
chemicals known to quickly kill white mice. Who told them that?</span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;"><span style="-webkit-text-stroke-width: 0px; background-color: white; color: black; display: inline !important; float: none; font-family: Times New Roman; font-size: 16px; font-style: normal; font-variant: normal; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">Weeds,</span><span style="-webkit-text-stroke-width: 0px; color: black; font-family: Times New Roman; font-size: 16px; font-style: normal; font-variant: normal; letter-spacing: normal; line-height: 107%; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"> like unwanted bacteria are becoming increasingly resistant to the usual pesticides calling for more drastic measures. Nice. </span></span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">This is not
my usual topic and I know little about the subject and have much to learn. But I hear a lot about detoxing. This what it might mean to me. </span><br />
<br />
<span style="line-height: 107%;">Enter the
word Xenobiotic.</span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">You already
know about probiotics and antibiotics. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Xenobiotics
are foreign, non-biological substances which may be toxic to tissues including
liver and kidneys. Very bad toxic substances we ingest daily. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Likely the doctor has never heard the word. Give them scientific source material. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Xenobiotics
can be difficult to eliminate and cycle endlessly through enterohepatic re-circulation.
</span><br />
<span style="line-height: 107%;">This is
where activated charcoal comes in. It waits
in the intestines for the toxin laden bile, grabs the xenobiotics and eliminates
them through the colon. Charcoal and cholestyramine eliminate mold toxins
(mycotoxins) the same way. They may also eliminate your expensive medicines. Follow directions. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Frequently
sage allopathic doctors, especially infectious disease experts, jump down the
gullets of Lyme patients who say they are “detoxing.” The word detoxing is foreign to mainstream medicine and practitioners. It raises the antennae of doctors who are quick to denounce such talk as voodo pseudoscience. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Lyme bacteria do not have
toxins they will opine. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">It’s true Lyme bacteria lack the endotoxins of pathogenic gram-negative
bacteria. That’s not at issue. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">I always try
to teach patients how to talk to doctors. The answer is, “Of course not. The
chronically ill patients may have difficulty with toxic xenobiotics (look up
the word doctor). General inflammation challenges the ability of the overworked liver and kidneys to remove the toxic chems. And doctor, if you are content with paraquat
and roundup in your diet it doesn’t apply to you.” (Less snarky -- unless the doctor is a narcisistic, arrogant piece of excement).</span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">The doctor may come away realizing there is something here to learn. Nah. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">In general, don't mention detoxing. Its not worth it. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Charcoal
helps with Herxeimer reactions because it binds cytokines. This can be further
explained if the doctor if she/he is still standing in the exam room. This
straightforward, unassailable science. </span><span style="line-height: 107%;"><br /></span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">A lot of doctors don't like science. Ironically they are quick to lable those with whom they disagree anti-science. Old news. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Don't be angry with doctors. Set realistic expectations. Unless they attack me. Then go for the jugular. JK.</span><br />
<span style="line-height: 107%;"><br /></span>
Organic foods are better. GMOs are not the problem. They are the bright, shiny object which distracts. A discussion for another day.Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com6tag:blogger.com,1999:blog-5694894153899281485.post-52990622779942690162020-02-21T16:20:00.004-08:002020-02-28T11:10:34.327-08:00DSF, dose, activated charcoal managing the Herxheimer reaction
My patient
is feeling optimistic. The best she has felt in years. Disulfiram/Antabuse, AKA DSF is the game
changer. She takes a tiny amount. I prescribed 10 mg compounded capsules, a very
low dose. She started with one capsule every 4 days and has increased the dose
to 2 caps, 20 mg daily. She reacts to this small dose, significantly.<br />
<br />
She feels OK
the first day of disulfiram pulse. The second day she is assaulted with a
variety of symptoms: fatigue, brain fog, muscle/joint pain, shooting pains,
muscle twitching, head pressure, etc. She feels increasingly better over the next
4 days and the cycle repeats.<br />
She is happy.
No longer depressed. Really happy.<br />
<br />
She tells me
she manages the second day Herxheimer reaction with doses of activated
charcoal.<br />
I’m
naturally skeptical. Everything has to
make sense. Scientifically and logically.<br />
<br />
Herxheimer
reactions are modulated by the immune system, something like a cytokine storm.
This is all very complicated so let’s not get lost in the weeds. These
cytokines are a complex set of proteins which regulate activity of the immune
system (traffic the immune system). When Lyme is killed cytokines and the
immune system are kicked into high gear. This leads to inflammation, too much
inflammation, a bad thing. We need to reduce cytokine activity and/or cytokines
themselves.<br />
<br />
It’s
exciting to learn that activated charcoal is incredibly effective at binding cytokines.
When blood is filtered through activated charcoal cytokines are removed.<br />
<br />
How does
that help us? Blood has to be removed from your body and filtered. Not
likely. Activated charcoal is the “universal
antidote” and good for reducing bloating and gas. It stays in the gut. It does not get into the blood where cytokines live.<br />
<br />
Ah ha. Like
cholestyramine, it interferes with the natural recycling of bile (from the
liver) to the intestines and back to the liver. OK. And..<br />
<br />
<b>
A published
study looked at oral charcoal in mice loaded with malaria and treated with an
intravenous antimalarial drug. Charcoal
reduced brain swelling and reduced key cytokines. Gut only charcoal did all
this. </b><br />
<b></b><br />
Cytokines may
be cycled through enterohepatic pathway and processed through the
intestines. Charcoal may be there
waiting to gobble them up. (Conjecture on my part).<br />
I finally
have an idea why Wellchol/cholestyramine lowers C-reactive protein. CRP is
cytokine driven.<br />
<br />
Normal
functioning of the enterohepatic pathway impacts the concentration of medicines,
toxins and other substances present in serum. I discussed this in another post.
Messing with the enterohepatic re-circulation of bile can do good and bad
things. This is a very complex and vital part of our physiology.<br />
<br />
The best
treatment for Herxheimer reactions may be antioxidants (oxidative stress) and
activated charcoal.<br />
<br />
I do listen
to my patients and believe what they say. I worry that many desperate patients
are taken advantage of by various scams. I worry about overpromoted nostrums, a
mass placebo effect. Think-- The Emperor’s
New Clothes. <br />
<div>
<b></b><b></b><br /></div>
My patient
today snickered at my skepticism. I am
humbled. She was right and I was wrong.<br />
<br />
I still want
people to stop think Herxheimer reactions are caused by toxins and
cholestyramine/Wellchol and charcoal remove toxins. Speaking of toxins specific to the Herxheimer reaction. This does not make scientific
sense. (I am not saying other toxins are not removed, I am speaking of the mechanism of the Herxheimer response).<br />
<br />
Yes, the
best starting dose (and ending up dose) of disulfiram is variable. Starting low is a good idea. 10 mg seems to be a good starting place, for sensitive patients. Options include 25 mg, 62.5 mg and others generally are well tolerated. Gradually increasing the dose likely mitigates damage caused by an overly eager immune system.<br />
<br />
Take home points: DSF, start low. Herxheimer reactions -- antioxidants and charcoal.<br />
Also, if you had a bad reaction with a higher dose of DSF you may do well with a small starting dose.<br />
<div>
<br /></div>
Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com10tag:blogger.com,1999:blog-5694894153899281485.post-57906899991066937242020-02-13T16:26:00.000-08:002020-02-13T16:26:27.164-08:00CFS, SEID, (a little POTS?)If you treat Lyme you see boatloads of patients with chronic fatigue syndrome and many with POTS. CFS, myalgia and encephalitis has been renamed SEID, systemic exertional intolerance disorder. Many patients with SEID have orthostatic intolerance. When they stand up for any period of time they feel the need to sit down or lie down. Is there a connection we are missing?<br />
<br />
POTS, postural orthostatic tachycardia syndrome is a manifestation of dysautonomia, a broken autonomic nervous system. This important part of the nervous system does many things. With POTS with focus on a cardiac manifestation.<br />
<br />
A lot of disorders are diagnosed based on cutoffs. The numbers are somewhat arbitrary. For example, POTS is diagnosed when supine pulse goes up 30 points with standing. Perhaps a lying down heart rate goes from 60 to 90 when a patient stands, and stays there and may increase. <br />
<br />
A patient may need to stand for 15-20 minutes before the change occurs. Some patients are tortured with a tilt table test (not originally designed to diagnosed POTS).<br />
<br />
Today I saw a 54 year old male I have been following for a number of years. His main problem has been crippling fatigue. Maybe he has Lyme, not clear. Antibiotics were a little helpful (or placebo effect). With high viral titers, EBV and HHV6 the antiviral Valcyte helped, for a while. Maybe. Always looking for the next thing he asked me to prescribe rituximab (kills EBV?). NO WAY. He is always looking for a new cure. He tends to overdo exercise when he feels better and relapses.. <b>Treatment for mast cell activation disorder has been somewhat helpful. </b><br />
<b></b><br />
Today he is feeling the best he has felt in 10 years -- normal. How did we get there?<br />
<br />
When he changed position lying to standing his pulse only increased about 12 points. No POTS by standard criteria.<br />
<br />
I wondered what would happen if I treated him for POTS.<br />
<br />
I didn't make many changes. He has high blood pressure. I changed his BP med, an ARB, Cozaar, a standard go to BP med to Coreg. Coreg is an alpha/beta blocker and has been shown to help POTS. <b>Normal B blockers should not be used. </b> I started him on salt (only started one gm NaCl) and he added more to food. ( crazy in a patient with HTN, right?)<br />
<br />
The change in pulse corrected. His blood pressure did not go up. Only a small subset of blood pressure patients are salt sensitive, especially blacks and the elderly. <br />
<br />
Will it work for others? I don't know. I don't know if it will continue to work for him.<br />
<br />
The experience of one patient may be a fluke and mean nothing.<br />
<br />
Both POTS and CFS are poorly understood. They share certain features.<br />
<br />
<b>Mast cell activation syndrome may overlap as well in many cases.</b> The diagnosis is usually clinical.<br />
<b></b><b></b><br />
This therapy must be done slowly with careful patient monitoring.<br />
<br />
A little dysautonomia, a little POTS, a spectrum, continuum? Maybe. Medicine is frequently gray. Black and white cut off points should be looked at critically.<br />
<br />
A thought.<br />
<br />Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com9tag:blogger.com,1999:blog-5694894153899281485.post-77836895911780850072020-02-04T18:18:00.000-08:002020-02-04T18:18:00.450-08:00Lyme update 2020: Key points<span style="font-size: x-small;"></span><br />
<span style="font-size: medium;"></span><span style="font-size: x-small;"></span>
<br />
<div style="margin-bottom: .0001pt; margin: 0in;">
<b><span style="color: black; font-size: 18.0pt;">Eradication</span></b><br />
<br />
We go back to the three legged monster I described so many years ago. The tickborne monster has legs of Lyme, Babesia and Bartonella.<br />
<span style="color: black;"></span></div>
<br />
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<span style="color: black;">For the first time Lyme has been
eradicated in an animal model (murine/mice). Dr. Zang of Hopkins was
successful with a daptomycin based 3 drug cocktail: daptomycin, ceftriaxone and
doxycycline. These 3 FDA approved drugs are well known and well used. Short of human studies, considered repurposing of vetted drugs may be considered. </span><br />
<br /></div>
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<span style="color: black;">IV therapy is preferred and/or the
standard of care in specific cases: sometimes indications are gray. The
risks of IV therapy include infection and venous access line and possible
sepsis, thrombosis/blood clots and pulmonary embolism. The use of
intravenous antibiotic does not decrease the likelihood of C. difficile
infection. The mainstay of intravenous antibiotic therapy has been Rocephin for
many years. Other antibiotics frequently employed include Flagyl,
azithromycin and doxycycline. Treatment incorporating daptomycin is new
and has been well tolerated. The drug itself is actually quite old.
It has been reserved for serious, resistant infections in many institutions and
infectious disease experts have cautioned against first line therapy or other
inappropriate use.</span></div>
<br />
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<span style="color: black;">The primary indications for
intravenous therapy include: Acute/subacute neurological disease ranging from
encephalitis, meningitis to peripheral neuropathies including Bell’s palsy and
others; acute inflammatory arthritis nonresponsive to oral therapy; Lyme
carditis. Patients with chronic Lyme encephalitis, /neuroborreliosis with
cognitive problems are frequent candidates. Patients who fail aggressive
oral therapy, suffering with a multisystem disorder and poor quality of life
are candidates. The choices available for oral therapy are evolving.
As a general rule, IV antibiotics and oral antibiotics should be started and
added one ag a time. The anticipated duration of therapy is always completely
unknown. Every case is different.</span></div>
<br />
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<b><span style="color: black;">Antabuse</span></b><span style="color: black;"></span></div>
<br />
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<span style="color: black;">Antabuse/disulfiram may be a game
changer. In Vitro studies (Stanford University) demonstrated efficacy against
Lyme spirochetes, round forms and biofilm forms. Antabuse has been used for
more than a century as an antiparasitic, a commercial agent used for rubber
manufacturing and for treating alcoholism. Antabuse inhibits degradation
of acetaldehyde, a toxic intermediary of alcohol metabolism. Alcohol with
disulfiram is a miserable experience one will never forget. There are
better ways to treat alcohol abuse. Antabuse has new life as a Lyme
killer. Antabuse has been effective against resistant forms of bacteria,
including Staphylococcus (including biofilms) in-vitro. It seems to have a
narrow spectrum against gram positive bacteria and should be easier on the
gut. </span></div>
<br />
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<span style="color: black;">Side effects and tolerability
described in older literature regarding aplicability for alcoholism does not to
apply to our experience with Lyme patients. For example, rare neuropathy
described in alcoholics is not rare for Lyme patients. Herxheimer reactions are
common and frequently severe; lower doses of the drug is required. </span></div>
<br />
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<span style="color: black;">One option is to cut a 250 mg tabs
into quarters enabling initial treatment with 62.5 mg. Compounding allows for
more flexibility. Disulfiram can be compounded to any dose you like, for
example, 10 mg or 25 mg. A target dose of 250 mg is frequently effective. Some
patients claim that the 500 mg dose is more effective. I still combine
disulfiram with traditional antibiotics for an optimal response. </span></div>
<br />
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<span style="color: black;">In my experience disulfiram does
not eradicate Babesia. In many cases Lyme and Babesia are mysteriously linked.
When Lyme clears and remits Babesia too may recede into remission. This may
give the appearance the drug kills Babesia. </span></div>
<br />
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<b><span style="color: black;">Babesia</span></b><span style="color: black;"></span></div>
<br />
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<span style="color: black;">The malaria like red blood cell
parasite is very problematic. B. duncani and other unidentified organisms
are very troublesome. Full eradication should be the goal. Recurrences can be very difficult since the parasite often returns resistant to an arsenal of anti-Babesia drugs. Most “virgin” Babesia cases respond to Mepron. It is
important to start with 10 cc or 2 tsp twice daily with fat. The 5 cc dose frequently recommend is inadequate. Mepron must be used with Zithromax. Zithromax has the unique ability to concentrate
inside cells at an incredibly high level. </span><span style="color: black;">Other drugs like
Biaxin, doxycycline, Bactrim and clindamycin are not effective. <span style="-webkit-text-stroke-width: 0px; background-color: white; color: black; display: inline !important; float: none; font-family: Times New Roman; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"> I recommend more than one anti-Babesia drug even when Mepron appears effective. Bellwether<span style="background-color: transparent;"> symptoms: </span></span></span><span style="color: black;"> night sweats, air hunger, random tearfulness are important but Babesia may cause many other symptoms as well. Coartem is my next favorite agent. It includes a much more bioavailable and effective artemisinin derived component, artemether. </span><br />
<br /></div>
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<span style="color: black;">My third preferred agent is tafenoquine (well tolerated excluding G6PD
deficiency). It comes in 2 forms. Krintafel comes in 150 mg tabs and is
used as a single dose for Malaria, repeated at intervals, e.g. weekly and Arakoda, approved for malaria prevention. The 100 mg tab is approved for daily use for malaria prevention. </span></div>
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<br /></div>
<span style="color: black;">How long is Babesia treated? We say until symptoms are gone. I have
seen many cases of hoped for cure relapsee. I currently treat for 4 months beyond the point of complete remission if possible. . </span><br />
<br />
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<b><span style="color: black;">Bartonella</span></b><span style="color: black;"></span></div>
<br />
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<span style="color: black;">This small bacteria lives in the
cells that cover the inside of blood vessels. The bacteria may occupy red
blood cells after infection until they "Uber" into blood vessel lining cells (endothelial cells). Bartonella persistern forms have been observed.
Complex antibiotic cocktails with multiple bacteriostatic antibiotic, including
tetracyclines, macrolides, rifamycins and sulfa drugs do not eliminate the
bacteria. Bactericidal drugs, including gentamicin and daptomycin have proved
effective. (only by injection, IV or IM). Quinolones should be avoided for
safety reasons. </span></div>
<br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike><br />
<span style="font-size: x-small;"></span><b></b><i></i><u></u><sub></sub><sup></sup><strike></strike><br />
<span style="font-size: x-small;"></span><br />
<br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com30tag:blogger.com,1999:blog-5694894153899281485.post-25791352174381730592020-01-27T13:09:00.001-08:002020-01-27T13:10:17.824-08:00Chronic nocardiosis, Morgellons?<br />
<span style="line-height: 107%;">My lab is certified
by CLIA and the College of American Pathologists for blood parasitology.<span style="mso-spacerun: yes;"> </span>I examine blood for bloodborne parasites:
Plasmodium (malaria), Babesia, Trypanosomes – flagellates, microfilaria. Today
I became aware of a bacterium which may appear in the blood but is not
bloodborne. Nocardia. I have a patient with this infection. I have been
treating her for a long time. <span style="mso-spacerun: yes;"> </span>We think Nocardia
infection it is chronic along with tickborne pathogens. The bacterium is found
in soil and water and is ubiquitous, there are numerous species, some not yet
speciated/characterized. We (the patient and me) have thought she suffers with
chronic nocardiosis. <span style="mso-spacerun: yes;"> </span>She has a clear,
documented history of Nocardia: positive pulmonary infiltrate and positive
blood culture. This is a slow growing organism. Texts say this rarely seen
organism cultures slowly, 3-5 days. Her culture was positive only after 28
days. Nocardia infections is thought to primarily occur in patients with impaired
immunity. She lacked clear evidence of immune dysfunction. The bacteria forms
lesions in the skin, lungs and brain. Generally, IV antibiotics are recommended
initially followed by oral therapy. Standard sources say skin infection is
always curable, lung infection is usually curable and brain infection is curable
half the time. Texts don’t address chronic nocardiosis, but I haven’t done a
literature search. </span><br />
<span style="font-size: xx-small;"></span><br />
<span style="line-height: 107%;">This
bacterium takes on an unusual appearance. <span style="mso-spacerun: yes;"> </span>We are accustomed to rods, cocci and spirochetes.<span style="mso-spacerun: yes;"> </span>Microscopically these appear as fungal-like
filamentous structures. <span style="mso-spacerun: yes;"> </span>The filaments
vary in length.<span style="mso-spacerun: yes;"> </span>Over the years I seen
similar things I thought they were contaminants or artifacts and most likely
were (not using the same stain).<span style="mso-spacerun: yes;"> </span>Perhaps
I missed something.<span style="mso-spacerun: yes;"> </span>Of course, this was
not on my radar.<span style="mso-spacerun: yes;"> </span>Images are startling. Images
of clumped filamentous structures, looking not like bacteria at all but rather the
dense threads seen with Morgellons appear. The images, if correct (I have not
validated them) can be found on google images. I know for a fact that some images
on google images are incorrect. </span><br />
<span style="font-size: xx-small;"></span><br />
<span style="line-height: 107%;">Then there
are patient images of skin lesions of the cutaneous form of the disease. Some look
horrible. <span style="mso-spacerun: yes;"> </span>Some clearly resemble lesions
seen with Morgellons. </span><br />
<span style="font-size: xx-small;"></span><br />
<span style="line-height: 107%;">The chest X rays
and brain MRIs are distinct from those seen with tickborne disease. </span><br />
<span style="font-size: xx-small;"></span><br />
<span style="line-height: 107%;">Again, this
organism is found on skin and in the lungs and brains. In severe cases it may also
appear in blood, gram stains. I don’t know if it also appears in Giemsa stains
I perform. </span><br />
<span style="font-size: xx-small;"></span><br />
<span style="line-height: 107%;">I wonder if
some cases of Morgellons are misdiagnosed nocardiosis. I wonder if Lyme immunosuppression
plays a role in the pathogenesis of the disease. <span style="mso-spacerun: yes;"> </span>Antibiotics recommended are some of the same
ones used for Lyme but not exactly the same ones. The initial early treatment
recommended is IV Bactrim. </span><br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com4tag:blogger.com,1999:blog-5694894153899281485.post-64563244097522471002020-01-13T16:22:00.003-08:002020-01-13T16:22:44.591-08:00Lyme and biliary disease<br />
<span style="line-height: 107%;">Most readers
have some familiarity with the liver and gallbladder. The biliary (bile duct) system includes the
gallbladder and a collection of ducts coming from the liver which join to enter
the first part of the small intestines, the duodenum, the first part of the
small intestines (bowel) just below the stomach. </span><br />
<span style="line-height: 107%;"><br /></span>
<br />
<span style="line-height: 107%;">The liver is
best known as our body’s detoxification organ (along with kidneys). The liver “metabolizes,” alters
and excretes medicines and other substances. </span><br />
<span style="line-height: 107%;"><br /></span>
<br />
<span style="line-height: 107%;">The liver makes
bile, a yellow viscous fluid stored in the gallbladder, located directed under
the liver. The gallbladder contracts with meals. Bile made of bile acids, from cholesterol,
aid in the digestion of fat (an emulsifier) but has many other functions. </span><br />
<span style="line-height: 107%;"><br /></span>
<br />
<span style="line-height: 107%;">The liver
detoxifies medications and toxins through a system of enzymes with names like
cytokine P450. Toxins and medications may end up in bile. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Adsorption
of medications may be dependent on something called the enterohepatic
recirculation of bile.</span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Most bile is
recycled from the gut which is considered 95% efficient. A particular bile acid
molecule may be used 20 times before it is replaced. This is not necessarily a
bad thing. The process of repeated cycling may enhance the function of therapeutic drugs
and delay their excretion. For liver toxins this works the other way. Proper functioning of the enterohepatic
system depends in part on a healthy gut flora and specific bacterial enzymes. Higher doses of antibiotics may be required
because disruption of normal flora and necessary enzymes caused by the antibiotic(s). </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">The use of
bile acid sequestrants to remove unknown toxins like cholestyramine is not
supported by scientific evidence. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Some
antibiotics promote the production of biliary cholesterol sludge and gall
stones, primarily Rocephin, the popular intravenous drug used to treat Lyme
disease. Cholecystitis (gall bladder attacks) with or without the presence of gall stones is a common occurrence. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Lyme anecdotally can attack the biliary
system. Cases of positive Lyme PCR/DNA from gallbladder tissues are known to me but there are no published reports to date. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Published
reports have established Lyme liver disease in the form of granulomatous hepatitis. </span><br />
<span style="line-height: 107%;">Tests like
sonogram, HIDA/CCK scan and others may be used diagnostically for problems with
gallbladder and bile ducts. Negative
test results do not rule out gallbladder/biliary disease. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">I am
treating a patient with primary biliary cholangitis (PBC). Generally, the disorder is
considered autoimmune, “idiopathic,” which of course means the patient is
pathological and the doctor is an idiot. Some European literature (this patient
is European) connects Lyme with this enigmatic illness. The patient has a clear
history of Lyme. No such connection is made in the U.S. PBC is now a treatable disease. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Bile via an
array of ducts ultimately empties into the common bile duct. Bile the empties
into the duodenum into a structure called the Ampulla of Vater. The flow of
bile is regulated by a muscle called the sphincter of Oddi. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">After cholecystectomy,
(surgical removal of the gallbladder), prior gallbladder pain may seem to recur.
The bile ducts may become dilated. When a medical workup excludes a left-over stone
stuck in bile duct, liver disease, pancreatic disease and other rare diseases,
the diagnosis may be post-cholecystectomy syndrome or sphincter of Oddi dysfunction.</span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">These
syndromes are more common in Lyme patients, many of whom suffer with
gallbladder disease and biliary tract disease and have had their gallbladders
removed. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">The diagnosis
is commonly missed or not taken seriously. The disorder can be disabling. Effective
medical therapy, in my recent experience, is available but overlooked. </span><br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com10tag:blogger.com,1999:blog-5694894153899281485.post-75174757884302785312019-12-02T17:35:00.000-08:002019-12-02T17:35:13.526-08:00PANDAS: diagnosed 15 years after the fact
<br />
<span style="line-height: 107%;">A young
adult is struggling with PANDAS/PANS and much more. He is
33 years old, I diagnosed him at age 29. I treated him briefly. We arranged a
single dose of IVIG. The plan was long term therapy. He was directed to another
physician who treated him with a single dose of IV rituximab. He got better –
for a while but quickly regressed. </span><br />
<span style="line-height: 107%;"><br /></span>
<br />
<span style="line-height: 107%;">He had a
normal childhood – until he didn’t, excelling academically and in sports. But
that changed overnight. One day normal the next the beginning of a nightmare
that has never ended. Mom and dad wanted to know what happened to their son. He
had become a different person, for no good reason, out of the blue. He became
withdrawn, irritable and rageful. He developed tics, anxiety and OCD. Mom took
him to his pediatrician who referred him to a psychiatrist. </span><br />
<span style="line-height: 107%;"><br /></span>
<br />
<span style="line-height: 107%;">He was dosed
with psychotropic meds which never made a difference. He refused to go to
school.</span><br />
<br />
<span style="line-height: 107%;">Finding no alternative, his parents sent him
off to boarding school for 2 years. He returned sullen, paranoid and angry. He dropped out of school and worked odd jobs, never
for more a few months. He wandered around, from on place to the next, from one
relationship to the next. </span><br />
<span style="line-height: 107%;"><br /></span>
<br />
<span style="line-height: 107%;">There were numerous
suicide attempts and hospitalizations. He was given every psychiatric diagnosis
in the book, schizoaffective to borderline personality to bipolar. He was
prescribed every psychotropic: atypical antipsychotics, SSRIs, SNRIs, mood
stabilizers, anticonvulsants and lithium. The diagnoses were wrong, and the medications
never worked. </span><br />
<span style="line-height: 107%;"><br /></span>
<br />
<span style="line-height: 107%;">He lives on
the other side of the country and I have not seen him in years. I care for a
family member who referred him to me because he suffers with Lyme disease and
thought the patient might have the same. </span><br />
<span style="line-height: 107%;"><br /></span>
<br />
<span style="line-height: 107%;">Our patient
is a little better than he was the day I met him, but he is not a functional
human being. </span><br />
<br />
<span style="line-height: 107%;">He is uncontrollably
enraged constantly mourning the life he has lost. He is so angry at his
parents. Unfairly he blames them for the delayed diagnosis of PANDAS (15
years), and there is so much other water under the bridge.</span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">He in fact has Strep
related PANDAS and also tickborne disease picked up later which stoked the
fire. </span><br />
<span style="line-height: 107%;"><br /></span>
<br />
<span style="line-height: 107%;">The medical
literature offers nothing in this case and other like it stating PANDAS is a pediatric
illness. An NIH paper admits some young adults may be afflicted but it stops
there. </span><br />
<br />
<span style="line-height: 107%;">Unfortunately,
I suspect there are a lot of patients who have a similar story. PANS was not
diagnosed in childhood. In adulthood they are diagnosed. What is there to do
about it. And I do have other similar patients in my practice. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Do doctors imagine that undiagnosed pediatric PANDAS cures itself in adulthood? The problem is doctors who write papers are academics and don't see a lot of patients. They only see cohorts of carefully culled patients who meet study criteria. And they usually don't see those patients for long term follow up.</span><br />
<span style="line-height: 107%;"><br /></span>
<br />
<span style="line-height: 107%;">Patients are
frequently diagnosed with Strep, Lyme, Bartonella and others. </span><br />
<br />
<span style="line-height: 107%;">Treatment,
the right treatment can be prohibitively expensive. Tonsillectomy is
recommended and may help. Antibiotics
are part of the treatment. There may be
psychiatric Herxheimer reactions. Steroids are “the poor man’s IVIG.” A
therapeutic response to steroids is predictive of a positive response to IVIG. IVIG is dosed high, 1.5-2 gm/kg every 3 weeks
may be effective. Rituximab is a third line treatment. Some patients are
managed with a combination of IVIG, Rituximab, steroids and antibiotics.
Whatever works. </span><br />
<span style="line-height: 107%;"><br /></span>
<br />
<span style="line-height: 107%;">These
patients need a lot of supportive services and therapies. </span><br />
<span style="line-height: 107%;"><br /></span>
<br />
<span style="line-height: 107%;">All of this
new, largely opinion driven, because there is little research or science. The waters
are uncharted because PANDAS wasn’t recognized until the late 1990s and
tickborne PANS much later. There may be countless young adults suffering in
much the same way. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="line-height: 107%;">Naturally I think my approach is the most logical and effective given what we currently know. </span><br />
<br />
<br />
<span style="line-height: 107%;">Treatment:
tonsillectomy, antibiotics, steroids, IVIG, rituximab. Rituximab is not a
substitute for IVIG, it is third tier therapy. </span><br />
<span style="line-height: 107%;"><br /></span>
<span style="font-family: "Calibri",sans-serif; line-height: 107%;">Intensive therapy and psychotropic meds are
going to be part of the picture. Psych drugs are not bad. It fact, they are incredibly helpful. It must be understood
these meds are adjunctive, supportive and do not target the underlying cause of the illness. </span>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com7tag:blogger.com,1999:blog-5694894153899281485.post-1534622141289785962019-11-18T15:07:00.002-08:002019-11-18T15:08:40.145-08:00Disulfiram resistant strains of Lyme!No. I don't know if there are disulfiram resistant strains of Lyme. However, the emergence of such strains seems inevitable but may be preventable.<br />
<br />
How does disulfiram kill bacteria? <span style="mso-spacerun: yes;"> </span>Biochemistry.<span style="mso-spacerun: yes;">
</span>Disulfides or thiols bind to critical metabolites in the bacteria. Medical
literature claims it has a narrow spectrum of action killing specific gram-positive
organisms, like Staph aureus and several others. The construction of the cell wall
of susceptible bacteria determines the entre of the drug. <span style="mso-spacerun: yes;"> </span>Spirochetes like Borrelia burgdorferi, are neither
gram positive nor negative. The out surface of the spirochete is comprised of
double membrane, one that is lipophilic (loves fat). The disulfiram molecule is
also lipophilic (loves fat). This shared biochemistry dooms the Lyme
spirochetes. <span style="mso-spacerun: yes;"> </span>The disulfiram molecule carrying
its poisonous chemicals is a trojan horse and quickly puts the spirochetes out
of commission. <br />
<br />
A narrow spectrum may be a good thing. This is the ideal
scenario. The drug kills the target and only a few bystanders (collateral
damage). Most antibiotics essentially nuke, or carpet bomb our bodies, carrying
around their 2-8 pounds of normal flora – bacteria, indiscriminately killing
huge numbers of good guys.<br />
<br />
Disulfiram represents an entirely new class of antibiotic
with a novel way of killing bacteria. <br />
<br />
Traditional antibiotics work by inhibiting cell wall
synthesis, inhibiting protein synthesis by disrupting ribosomes, interfering
with DNA or RNA function – and that’s about it.<br />
<br />
We don’t know if antibiotic resistance will emerge against disulfiram.
The best predictor of what might happen is history.<br />
<br />
There currently exist bacteria resistant to antibiotics from each of the known classes.<br />
<br />
It may be wise to listen to Alexander Fleming, the Nobel laureate
who discovered Penicillin. Over the course of his career he watched susceptible
strains of Staphylococcus become resistant to the the wonder drug, penicillin,
in a few short years.<br />
<br />
He cautioned that one must make sure the antibiotic is
necessary, then make sure the dose is high enough and the drug is given long
enough to prevent the emergence of resistant strains of bacteria.<br />
<br />
Popular pulsing and prescription of low, subtherapeutic
doses of antibiotics/disulfiram are practices which needed to be avoided lest
we kill the goose who lays the golden eggs<br />
<br />
The emergence of resistance is nearly universal.<span style="mso-spacerun: yes;"> </span>It has happened with every bad infectious disease
you can think of, ranging from malaria and tuberculosis to HIV. It is the rule,
not the exception.<br />
<br />
The Lyme buggers are very, very smart. Expect no less.<br />
<br />
ID doctors and the IDSA frequently talk about stewardship of
antibiotics. I think they are frequently wrong about the details, but the
concept is sound.<br />
<br />
The thousands of patients suddenly taking disulfiram are a Facebook
ragtag army with no sense of the history of antibiotics and germs and the
decades long battles, lost and won.<br />
<br />
My suggestion is simple but probably hard to implement.<br />
<br />
Hit Lyme hard and long (disulfiram, and as I think about, a cocktail of other antibiotics makes a lot of sense). Treat for months after the
disappearance of symptoms.<br />
<br />
Using disulfiram as monotherapy, the only drug, may accelerate the evolution of disulfiram resistant Lyme strains.<br />
<br />
<br />
In the words of the immortal Bob Marley “you have to kill it
before it grows.”<br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com8tag:blogger.com,1999:blog-5694894153899281485.post-78086996824626161902019-11-15T16:07:00.000-08:002019-11-15T16:13:24.686-08:00Disulfiram, disulfiram and Monurol? <span style="font-size: medium;"></span><br />
<span style="font-size: 16.0pt; line-height: 107%;"><span style="font-size: small;">Perhaps, when the history of Lyme disease is told at some future date, it will be divided
into the pre-and post-worlds of disulfiram.<span style="mso-spacerun: yes;">
</span>Maybe since Antabuse is not classified as an antibiotic, the IDSA will back off,
who knows.<span style="mso-spacerun: yes;"> </span></span></span><span style="font-size: 16.0pt; line-height: 107%;"><span style="mso-spacerun: yes;"><br /></span></span><br />
<br />
<span style="line-height: 107%;">The drug
seems to be amazingly effective for so many patients. Still, it’s not for
everyone. <span style="mso-spacerun: yes;"> </span>Some patients tolerate
relatively high doses of the drug out of the gate; for the most part, is better
start low and gradually increase the dose as many patients do not tolerate high
doses. <span style="mso-spacerun: yes;"> </span>The effective dose is unknown. <span style="mso-spacerun: yes;"> </span>250 mg may be effective for <span style="mso-spacerun: yes;"> </span>many patients (not 500 mg).</span><span style="font-size: 16.0pt; line-height: 107%;"><br /></span><br />
<br />
<span style="line-height: 107%;">Patients
have had a hard time finding the drug, scouring pharmacies across the continent.
<span style="mso-spacerun: yes;"> </span>A patient I saw today did incredibly
well after 6 weeks of therapy.<span style="mso-spacerun: yes;"> </span>Then, she
could not find any more drug and symptoms returned with a vengeance.<span style="mso-spacerun: yes;"> </span>She is now well stocked from an overseas
pharmacy. With nearly 30 years of
disease, the majority of her life, she suffers with POTS, EDS and MCAS – and chronic
pain. <span style="mso-spacerun: yes;"> </span>Antabuse is not going to fix
everything.<span style="mso-spacerun: yes;"> </span>I continue to enjoy
excellent success managing pain without opioids. </span><span style="font-size: 16.0pt; line-height: 107%;"><br /></span><br />
<br />
<span style="line-height: 107%;">Antabuse for
most patients may not be a quick fix.<span style="mso-spacerun: yes;">
</span>But it’s effectiveness is undeniable and it is quickly changing the game.</span><span style="font-size: 16.0pt; line-height: 107%;"><br /></span><br />
<br />
<span style="line-height: 107%;">Elevated
liver function tests are common. <span style="mso-spacerun: yes;"> </span>Frequently
the drug can be stopped for several days until labs normalize and tolerated at
a lower dose without budging liver numbers. Liver function tests in excess of 3
times the upper limit of normal (120ish) should be of immediate concern. </span><span style="font-size: 16.0pt; line-height: 107%;"><span style="font-size: x-small;"><span style="mso-spacerun: yes;"> </span></span></span><br />
<span style="line-height: 107%;">Another
novel therapy been very effective for 1 of my patients.<span style="mso-spacerun: yes;"> </span>Fosfomycin, Monurol is a 3 g powder is
typically used for urinary tract infections.<span style="mso-spacerun: yes;">
</span>It also works very well against Lyme persister.<span style="mso-spacerun: yes;"> </span>With a typical UTI the dose is a single 3 gm
packet. The drug has a prolonged duration of effects, about 48 hours, despite a
short half-life: it continues to work because of its PAE (post antibiotic effect).
A current patient is responding beautifully to twice weekly dosing along with
doxycycline and Zithromax – Zithromax combined with Mepron for Babesiosis. </span><span style="font-size: 16.0pt; line-height: 107%;"><br /></span><br />
<br />
<span style="line-height: 107%;">There are
more great and effective options than ever before, including IV daptomycin. </span><span style="font-size: 16.0pt; line-height: 107%;"><br /></span><br />
<br />
<span style="line-height: 107%;">I am accepting
new patients with Lyme (and coinfections) and a host of other conditions: PANS,
POTS, CVID, CIDP, EDS, MCAS, CFS, FMS, neuropathic and central pain syndromes,
headaches and chronic, mysterious difficult to diagnose ailments. </span><span style="font-size: 16.0pt; line-height: 107%;"><br /></span><br />
<br />
<span style="line-height: 107%;">I offer
blood Giemsa staining screening for active Babesia infection:<span style="mso-spacerun: yes;"> </span>Lab CLIA approved and certified by College of
American Pathologists. </span><br />
<br />
<span style="line-height: 107%;">Blogging about
Lyme and related topics since 2008. </span><br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com4tag:blogger.com,1999:blog-5694894153899281485.post-25612067038741594182019-10-29T15:33:00.002-07:002019-10-29T15:33:47.001-07:00Disulfirm/AntabuseIts true: Antabuse/disulfiram is the most exciting new therapy for Lyme since daptomycin.<br />
<br />
We are getting a lot more experience with disulfiram/Antabuse.<span style="mso-spacerun: yes;"> </span>In some cases, it seems to be very effective.
<span style="mso-spacerun: yes;"> </span>I don’t think it is clear which microbes
it is active against. It is an old drug repurposed as an antibiotic.<span style="mso-spacerun: yes;"> </span>Its antimicrobial spectrum may remain unknown
for the foreseeable future (there is no money researching it).<span style="mso-spacerun: yes;"> </span>One thing worse than dreaded MRSA is VRSA –
vancomycin resistant Staph aureus.<span style="mso-spacerun: yes;"> </span>In
vitro it was shown that the addition of disulfiram to vancomycin conferred the
ability to kill this dreaded superbug. This should be catching some eyes, even
outside the Lyme world. <br />
<br />
Disulfiram clearly has potent antibiotic effects. It also
has side effects. Twenty five percent of users have some rise in liver function tests –markers of liver inflammation. The rise is usually modest, and therapy
can continue if AST/ALT numbers don’t exceed 2-3 twice the normal limit, with
close monitoring. Three times makes me nervous. My comfort zone limits closer to 2. Waiting for numbers to
normalize and restarting with a lower dose may work. Severe liver disease may
occur 1-2% of the time, not a trivial number. <br />
<br />
ONLY YOUR DOCTOR CAN MAKE CLINICAL DECISIONS REGARDING
ANTABUSE AND LIVER TEST. <span style="mso-spacerun: yes;"> </span>THIS IS WRITTEN
FOR GENERAL INFORMATIONAL PURPOSES ONLY; FULMINANT LIVER DISEASE CAN BE FATAL. <br />
<br />
You should never treat yourself. The man who has himself as his
doctor has a fool for a patient. <br />
<br />
Side effects may include, dizziness, brain fog, fatigue, GI
intolerance and others – in my patients. Many patients have had to discontinue
because of side effects. Monotherapy may be fine. It runs counter to my experience,
so I tend to prescribe it with doxycycline.<br />
<br />
A word for the wise. We don't really know how safe the drug is. Sometimes problems only become known when an occasional drug becomes one in common use. We have seen it over and over, for example, fenfluramine off fen-fen fame caused unexpected heart and lung disease and Vioxx the great new anti-inflammatory caused heart disease. Drug companies who have studied drugs extensively and had FDA approval call this "post-marketing" side effects.<br />
<br />
Yes, Antabuse is an old drug used by hundreds of recovering alcoholics. When this old drug, largely disregarded from decades, it is suddenly used by thousands of lyme sufferers it many ways acquires characteristics of a new drug. In this case one that has not been tested. Quality control of generics is increasingly becoming an issue, e.g. Zantac.<br />
<br />
I am prescribing the drug, just not throwing caution to the wind.<br />
<br />
There is the issue of dose.<span style="mso-spacerun: yes;">
</span>For alcoholics the loading dose is 500 mg and maintenance dose is
125-250 mg. This suggests that lower doses have efficacy. <br />
<br />
There is some confusion about Lyme Herxheimer
reactions.<span style="mso-spacerun: yes;"> </span>From experience, Lyme,
Babesia and Bartonella have separate and distinct Herxheimer responses. <span style="mso-spacerun: yes;"> </span>Herxheimer reactions occur when mass killing
of chronic, entrenched infection leads to an over-reaching immune response, a
cytokine storm. The average, non-Lyme doctor,
is unaware of the phenomenon treating mostly acute infections. These same doctors no doubt encounter a fair number
of Herxheimer reactions which are misdiagnosed, e.g. drug allergy. Some
patients have an “allergy” to every antibiotic. No, they don’t. Other patients say,
“every time I take an antibiotic it hits me hard.”<br />
<br />
Babesia and Bartonella Herxheimer reactions are very vexing,
chronic and sometimes difficult to manage. They are qualitatively different
from Lyme Herx reactions. <br />
<br />
Lyme “Herxes” tend to be easier and follow a specific pattern.<span style="mso-spacerun: yes;"> </span>An antibiotic is introduced, with days severe
symptoms ensue, like fatigue (inability to get out of bed fatigue) low grade
fevers, brain fog, achiness etc. After a period of days, weeks, usually no more
than 3 weeks, symptoms begin to improve and go away and the patient improves. The Herxheimer reaction (Lyme only) should not return in cycles. Such cycles, apparent recurring Herxes, may be the result of normal ups and downs of
the disease or due to killing something else other than Lyme. If we add one or
more drugs, which gain access to a previously off-limits group of bacteria
(round forms, biofilms etc.) a Herx may return, maybe even a more difficult Herx. <br />
<br />
Dr. Zhang has dichotomized Lyme bacteria for us: active
forms (free spirochetes) and stationary/persister forms (round bodies, biofilms).<br />
<br />
After a reasonable amount of treatment with antibiotics
targeting both populations, e.g. doxycycline, rifampin and Flagyl we would like
to think there are few Lyme bacteria left. We are incorrect.<br />
<br />
Add in disulfiram and an intense Herxheimer reaction may
ensue (in some cases, not all). <span style="mso-spacerun: yes;"> </span>Patient
tolerance to varying doses of the drug is all over the map.<span style="mso-spacerun: yes;"> </span>Some handle 500 mg out of the gate, others
struggle with 125 every other day. <br />
<br />
It makes sense to start with a low dose and gradually
increase over time.<span style="mso-spacerun: yes;"> </span>I am more aggressive
apparently than many others.<span style="mso-spacerun: yes;"> </span>Most
patients can increase from 250 mg daily ramped to 500 mg over a week or two. For
sensitive patients much lower doses and more gradual ramping is required. <br />
<br />
I have seen patients on the border of needing IV
antibiotics get better with Disulfiram. <br />
<br />
It doesn’t always work.<span style="mso-spacerun: yes;"> There is still no one drug that works for every patient. </span>And symptoms still relapse quickly with discontinuation after a few
months.<span style="mso-spacerun: yes;"> </span>Some patients are still going to need IV antibiotics, (Rocephin, daptomycin, doxycycline) if possible. <br />
<br />
In my experience disulfiram doesn't appear to kill Babesia. My experience. Babesia is an opportunistic infection riding on Lyme’s coat
tail.<span style="mso-spacerun: yes;"> </span>Lyme has inherent immune suppressing
properties. If Lyme is largely gone, Babesia symptoms may abate as well. In a normal host the body's immune system can eradicate Babesia, or reduce it to a mild parasite causing no symptoms. Just a thought.<br />
<br />
So far, we only know that Antabuse kills Lyme spirochetes
and Staphylococcus. Hopefully research will be funded so we can learn more about the drug. We really don't know what it does or doesn't kill.<br />
<br />
Bottom line: Go for it! Monitor labs, watch for side effects (no
alcohol including herbal tinctures): disulfiram –is not an overnight miracle cure
-- but it is quickly rising to the top of the list of go-to Lyme drugs. <span style="mso-spacerun: yes;"> </span><br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com5tag:blogger.com,1999:blog-5694894153899281485.post-80393539213892497442019-10-14T16:47:00.001-07:002019-10-14T16:47:24.852-07:00Unecessary suffering and beating a dead horseMy new 40 year old patient is besides herself. She has struggled with a tickborne illness for 5 years. She has managed to keep her job, but barely. She cries uncontrollably. She is very irritable and angry. She complains of anxiety and panic attacks. Mostly, she is depressed. She admits to night sweats. She denies air hunger. Ongoing symptoms include exhaustion, chills, poor sleep, tinnitus, painful lymph nodes, abdominal pain and nausea, GERD, irregular menses, joint pain, headache, dizziness and vertigo and feeling off balance, dysesthesias and crawling sensations, panic attacks, suicidal ideation (no plan or intent), brain fog, trouble with with focus and concentration and thinking clearly. She has had a lot of unexplained abdominal pain over the years.<br />
<br />
She has seen 2 "Lyme" doctors off and on over the last 5 years. She has also seen many "regular" doctors. The first Lyme doctor diagnosed Bartonella and treated her extensively with minocycline, azithromycin and rifampin.She didn't get better. A second Lyme doctor confirmed the diagnosis of Bartonella. Laboratory tests were negative but the physician was certain on clinical grounds the diagnosis was correct. After all, what else causes severe GI symptoms and abdominal pain? Anxiety and irritability are typical symptoms, almost diagnostic - she heard somewhere.<br />
<br />
The "regular" doctors diagnosed depression, fibromyalgia, chronic fatigue syndrome and hypochondriasis.<br />
<br />
One Lyme doctor treated her with ivermectin for one year. She states she thinks she had a Herxheimer reaction but does not know why this drug was prescribed. The treatment did not help.<br />
<br />
The same doctor prescribed Biaxin and rifampin. The dose of rifampin was increased to 1200 mg daily. After 9 months of this therapy she has gotten worse. The doctor told her she has not been treated long enough. She decided she has waited long enough. She thinks she had Herxheimer reactions but never got better.<br />
<br />
She has never been treated for Babesia or even Lyme. A course of doxycycline with other Lyme drugs was never prescribed -- or anti-Babesia therapy.<br />
<br />
A LymeWestern Blot was equivocal by MDL standards, IgG only.<br />
Serologial tests demonstrated a low positier titer for Rickettsia species.<br />
All other serological tests, inclusive of Bartonella and Babesia were negative.<br />
CRP was elevateed at 10.<br />
<br />
I am able to offer another test in my CLIA certified blood parasitology lab.<br />
<br />
Her an image taken from her Giemsa smear:<br />
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVqtp7Aq2WUw65FekhavrwEQ7p8swxsQ7EmvFOz6tN2WHnBWoKSpWsy4Rdq2iUrzdLnx_Yu8e4siylwwU0dy-JFx6I39RelZ6dlYH94FpKJNyu1KyzNI8d-JrWzoDpQr__x3VZQQMINTw/s1600/Shonea+Miller+091019.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1200" data-original-width="1600" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVqtp7Aq2WUw65FekhavrwEQ7p8swxsQ7EmvFOz6tN2WHnBWoKSpWsy4Rdq2iUrzdLnx_Yu8e4siylwwU0dy-JFx6I39RelZ6dlYH94FpKJNyu1KyzNI8d-JrWzoDpQr__x3VZQQMINTw/s640/Shonea+Miller+091019.jpg" width="640" /></a></div>
<br />
<br />
If a patient doesn't respond to a therapy the clinician is obligated to go back to the blackboard and take another look.<br />
<br />
The slide shows marked infection with the malaria-like red blood cell parasite: Babesia. Few things are black and white in Lyme's orbit. This is an exception.<br />
<br />
This CDC endorsed standard malaria/Babesia smear is a gold standard. Many tests circulating in the Lyme-osphere are questionable. <br />
<br />
Even without this piece of dramatic evidence, the patient should have been treated for Lyme, e.g. Doxycycline/Ceftin (Tindamax, Flagyl, disulfiram and others) and also treated for Babesia.<br />
<br />
This poor long-suffering patient went 5 years, with night sweats and profuse tearfulness (depression) and Babesia was never considered or treated.<br />
<br />
Hundreds of things can cause abdominal pain other than Bartonella, etc, etc. The symptoms of Lyme and common coinfections overlap. No one symptom should be attributed to a particular tickborne pathogen.<br />
<br />
Babesia treatment includes Zithromax and high doses of Mepron plus Coartem plus Krintafel. It is important to completely knock out Babesia when first encountered. Otherwise, the parasites relapse and return mean and drug resistant. *Please don't use Malarone because Mepron, the yellow paint is hard to stomach. Two malarone twice daily provides a daily Atovaquone dose of 1000 mg. Two tsp of Mepron twice daily provides 3000 mgs of atovaquone, three times the dose. This dose falls within FDA approved, manufacturer guidelines. This high initial dose must be used to avoid drug resistance and years of misery. If its virgin Babesia you have one change to hit it hard and fast. Don't miss.<br />
<br />
I am optimistic. We will get her better and sooner rather than later.<br />
<br />Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com5tag:blogger.com,1999:blog-5694894153899281485.post-33439335730389402572019-09-03T14:56:00.003-07:002019-09-03T14:57:49.679-07:00Lyme germ warfare? <br />
Complex subjects, like the provenance of Lyme, are oversimplified into a soundbite and the truth is lost in the noise. The Washington Post does us a disservice.<br />
<br />
<b>Sam Telford, in the Washington Post told us that
Lyme is not an escaped military bioweapon.</b> The headline is an implicit smirk at the alternative Lyme community said to be steeped in unfounded conspiracy theories. Ant-science. Fits right into the IDSA narrative. <br />
<br />
Dr. Telford is a smart guy, a professor of Biowarfare at Tufts University, who has researched the topic for decades. Largely, he is telling the truth. Largely.<br />
<br />
Let's listen to his truth. It speaks volumes.<br />
<br />
Lyme is an old disease, even ancient. <span style="mso-spacerun: yes;"> </span>Lyme was found in the 5300-year-old ice man
dug up from the permafrost in the Alps – previously published in National
Geographic. Lyme infected ticks were found from 1945
and 1896 in the northeast US. Facts.<br />
<br />
Ticks (Lyme carrying ticks) were studied during the cold war as a means of transmitting germ warfare. Fact.<br />
<br />
Deadly agents, including Tularemia and Q fever – transmitted
by the same Ixodes ticks were studied (and continue to be an area of research -- other source).<br />
<br />
The double helix of DNA was discovered in 1953. Scientists during the cold war (1950s - 1980ish) lacked technology to modify germs and make them more deadly. Now it can be done.<br />
<br />
Germ warfare research was done at Fort Dietrich and Plum Island. Modern Biocontainment procedures were unknown. (Animals and Ixodes ticks were allowed to roam free on the Island, with the belief they could not leave the island -- other sources). It was unknown that seabirds could ferry ticks to the mainland.<br />
<br />
Lyme and the coming
epidemic was something military researches could not have imagined. The Lyme Bacteria was not discovered until 1981.<br />
<br />
The Lyme epidemic cannot be entirely sourced to Plum Island since the epidemic broke out in the Midwest and West Coast at around the same time as Lyme Connecticut. <b>The author does not say that Plum Island didn't contribute to the epidemic. </b><br />
<br />
Willie Burgdorfer participated in tickborne biowarfare research for the US Department of Defense.<br />
<br />
Dr. Telford says a few dumb and obviously incorrect things: Willie was just joking with the interviewer about his role in germ warfare research. <span style="background-color: white; color: black; display: inline; float: none; font-family: "times new roman"; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;"> Plum Island was repurposed for agriculture
research in 1954 -- during the height of the cold war. (not a cover story).</span><br />
And -- the US stopped
bioweapon research in 1969 because Nixon said so.<span style="mso-spacerun: yes;"> </span><br />
<br />
These are the clearly established facts.<br />
<span style="mso-spacerun: yes;"><b></b><br /></span>
<span style="mso-spacerun: yes;"><b>In summary: Our government was involved in germ warfare research for years. Some of the research involved ticks and tickborne disease (Q fever, Tularemia). Willie Burgdorfer, whose names is attached to the Lyme agent, B. burgdorferi worked for the government and some of this research was with the same ticks that transmit Lyme disease. Biocontainment procedures were unknown and government scientist did not know the ticks and the unknown pathogen (Lyme) could easily jump across the Long Island Sound to Lyme Connecticut. </b></span><br />
<b></b><br />
<b>It is easy to conjecture the Government unwittingly helped spread the epidemic of Lyme disease to New England as an unexpected consequence of secret germ warfare research. And, it is widely known the Government has a habit of not admitting wrong doing and covering its tracks. </b><br />
<b></b><br />
<b>When we say Lyme was not an escaped bioweapon the statement is both true and false. There was no conspiracy to infect Americans with a horrible disease. But is seems likely that an unexpected consequence of tickborne disease bioweapon research on Plum Island was the spread of some Lyme infected ticks to the mainland. </b><br />
<br />
The law of unintended consequences applies and there is much we will never know.<br />
<br />
Congress can investigate and it will be a waste of time.Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com8tag:blogger.com,1999:blog-5694894153899281485.post-82850836581402087722019-07-18T15:06:00.002-07:002019-07-18T15:06:47.712-07:00Novel drugs for Lyme<br />
The dry spell is over. We have some promising new therapies.<br />
<br />
Investigators have been used a method to screen large numbers
of drugs which might treat Lyme. Dr. Lewis has apparently found that <b>disulfiram,
Antabuse,</b> used to treat alcoholics and makes them vomit if they drink
alcohol seems to kill Lyme. Apparently, he has discussed his findings at
lectures. Practicing doctors don’t get the low down until findings are
published in a journal. A recent case report of 3 patients showed efficacy of the drug. <span style="-webkit-text-stroke-width: 0px; background-color: white; color: black; display: inline !important; float: none; font-family: Times New Roman; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: left; text-decoration: none; text-indent: 0px; text-transform: none; white-space: normal; word-spacing: 0px;">Antabuse is something I have used throughout a 37-year
career in medicine. It is generally safe, but liver tests need to be monitored. Repurposing the drug empirically seems quite reasonable. Dr. Fallon, Columbia University, is doing a clinical study. </span><br />
<br />
The fact that Antabuse is not an antibiotic is exciting.<br />
<br />
The combination of Rocephin, doxycycline and <b>daptomycin </b>may
be effective in humans. A clinical question is how long do the drugs need to be
given?<span style="mso-spacerun: yes;"> </span>Will we see durable benefits in
30 days, 60 days etc.? <span style="mso-spacerun: yes;"> </span>Can an intensive
IV therapy circumvent months, even years of other complex and perhaps less
effective therapies? Let’s find out.<br />
<br />
Controlled clinical trials are important. Placebos are incredibly effective. Personal interactions influence outcomes as do other confounding variables. Studying a complex disease like Lyme is challenging; coinfections are not accounted for and a million other variables are not and perhaps cannot be taken into account.. Study results must be interpreted with care, nuance and ample discussion. The limitations of the study must be addressed. And I hope investigators will not be strong armed by politically motivated institutions to parse words when stating conclusions. These few words have been misinterpreted, willfully with far reaching ramifications. The IDSA drew incorrect and absurd conclusions from Fallon's last Lyme study. And here we go with another set of IDSA recommendations.<br />
<br />
Tafenoquine in the form of<b> Krintafel</b> is being used
for treatment resistant Babesia. Looks good so far. <br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com4tag:blogger.com,1999:blog-5694894153899281485.post-24260413398833000282019-06-28T15:27:00.002-07:002019-06-28T15:27:26.593-07:00Bartonella persisters and daptomycin: two for the price of one?<br />
<span style="font-size: 14.0pt; line-height: 107%;">While Lyme
persistence I denied for political reasons the persistence of other human zoonotic
pathogens is recognized.<span style="mso-spacerun: yes;"> </span></span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">I have seen two
cases of brucellosis recently and Brucella is recognized as a persistent
bacterium, perhaps impossible to eradicate, at least with currently used and/or
recommended therapy. </span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">B. abortus
is one of several well-known human pathogens of the genus, the one which may be
acquired via tick bites. </span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">Brucellosis
can be acquired by consumption of uncooked meat and raw milk. I don’t
understand the fad of drinking unpasteurized milk, a potentially deadly fad. </span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">Brucellosis may
cause numerous untoward clinical syndromes many of which similar to those seen
with chronic Lyme. </span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">Bartonella,
especially B. henselae is a well known tickborne pathogen also known to exhibit
persistence. The bacteria, a fastidious (difficult to culture) gram negative
rod is an obligate (facultative) intracellular gram-negative bacteria
associated with well described clinical syndromes, discussed elsewhere. Spotty
medical literature supports the notion that Bartonella infection is clinically persistent.
</span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">Biologically,
Bartonella are the only bacteria which may reside in red blood cells. The only
other RBC pathogens are malaria and babesia species. Specific biological
features, a protected niche and the discovery of stationary forms provide an
ample narrative of fact and biological plausibility for persistence. </span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">The primary
home for these bacteria is not RBCs but the endothelial cells that line blood
vessels. This is why bartonellosis causes well known vasculitis syndromes. </span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">Zhang, a
prolific publisher, should now be a star at JHH published about Bartonella
persisters in <b><i>antibiotics </i></b>April. Again, daptomycin is the star. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>Daptomycin
has the best activity against stationary (persister) forms. Only aminoglycosides,
e.g gentamycin are competitive. <span style="mso-spacerun: yes;"> </span>In my
experience, gentamycin may eradicate clinical infection, but not consistently. Complex
multidrug regimens are frequently recommended for Bartonellosis, perhaps this
is unnecessary. </span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">This study added to others vis-à-vis Lyme raises
the clinical (preclinical) question. Should patients with chronic illness caused
by Lyme and Bartonella be treated with combination IV therapy, Rocephin,
Doxycycline and Daptomycin earlier rather than later in the course of
treatment?</span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">From an
Evidenced Based Medicine approach this is anathema, <span style="mso-spacerun: yes;"> </span>such therapies can only be recommended after
randomized clinical trials, peer reviewed and published.</span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">Such studies
are perhaps decades away.<span style="mso-spacerun: yes;"> </span>Currently the
political divide make diagnosis of Lyme nearly impossible, let alone
coinfections. </span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">The
preclinical approach allows for empiric use of the therapy without waiting for
IDSA approval, which may or may not ever come. </span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">This concept
of applying preclinical data (translational medicine) is well developed and
well used in the field of oncology. Of course, cancer is considered a serious
disease (and Lyme isn’t?).</span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">Those of us
in the alternative universe of Lyme disease are accustomed to very long-term
antibiotics, including IV ones. <span style="mso-spacerun: yes;"> </span>In this world,
the use of these 3 IV drugs sounds reasonable. In the other world we are no
strangers to cocktail therapy and IV therapy. <span style="mso-spacerun: yes;"> </span>In the IDSA/CDC world of doxy for 3 weeks even
discussion of this idea is heresy or treasonous, if such things apply in
medicine (apparently, they do). </span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">Treating
chronic Lyme through the other world approach is very complicated, lengthy and
expensive. This sort of preclinical information should be considered in lengthy,
informed consent discussions with patients. <span style="mso-spacerun: yes;"> </span></span><br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com4tag:blogger.com,1999:blog-5694894153899281485.post-69749577305638641972019-06-24T15:22:00.000-07:002019-06-24T15:22:02.063-07:00Lyme arthritis, peptidoglycans and political correctness<br />
<br />
<br />
Medical science and other branches of science are biased and
political.<span style="mso-spacerun: yes;"> </span>A researcher, an
investigator(s) has to walk on eggshells when their findings bump up against
beliefs of mainstream beliefs espoused by the experts. They have to fall in
line with political correctness if they hope to see their research published,
and if they want to keep their jobs as academic researchers. . <span style="mso-spacerun: yes;"> </span><br />
<br />
The research findings published in the PNAS, Proceedings of
the National Academy of Science this month entitled <b><i>Borrelia burgdorferi
peptidoglycan is a persistent antigen in patients with Lyme arthritis</i></b> appears
to be excellent science.<br />
<br />
The research moves the ball forward in our understanding of
chronic inflammation associated with Lyme disease. Political correctness and
conformity with mainstream thinking corrupts the paper from the start seriously
damaging the credibility of the authors. <span style="mso-spacerun: yes;"> </span>Immediately the terms postinfectious Lyme
arthritis and posttreatment Lyme disease are used and they poison the broth.<br />
<br />
The preponderance of scientific evidence, overwhelming and
mounting evidence supports the understanding that Lyme bacteria persist in the
face of the standard antibiotic therapies discussed. <br />
<br />
The finding that peptidoglycan (PPG), the crosslinking
molecules which comprise cell walls in gram-negative and gram-positive bacteria
are a major determinant of persistent Lyme arthritis is new information that
moves the ball forward.<br />
<br />
Borrelia spirochetes have a double outer membrane and lack PG
cell walls. However, PG molecules are present internally, inside the outer
membrane (cell envelope) providing support to the spirochetes. <br />
<br />
The fragments of PG are call muropeptides.<br />
<br />
We learn Bb, Lyme processes a unique PG structure. And we
learn these fragments are highly immunogenic – incite an excessive immune
response or cytokine response likely responsible for clinical manifestations of
Lyme arthritis.<br />
<br />
Perhaps the peptide fragments do cause an autoimmune
response. Although the theory is discussed at length this is not what the
research shows. Lyme related joint inflammation is directly caused by unique Lyme PGs. <span style="mso-spacerun: yes;"> </span><br />
<span style="mso-spacerun: yes;"><br /></span>
<br />
A variety of experiments, controlled experiments using a
variety of bacteria with different PGs, a variety of clinical diagnoses, mice,
humans, joint fluid and serum support the findings. The findings are based on a
great deal of animal and human research.<br />
<br />
Antibodies were developed against Lyme specific PGs. These
antibodies could be the basis for a <b>new, more accurate diagnostic test</b>.<br />
<br />
From recent research we know that Lyme biofilms and
planktonic round forms cause more inflammation than spirochete forms. We know
these are the most antibiotic tolerant forms or resistant forms.<br />
<br />
The article at length discusses issues related to diminished
bacterial recycling of PGs compared with gram negative bacteria.<br />
<br />
Two theories are proffered as to how Lyme PG persists after “curative
therapy” with a short course of doxycycline or Rocephin. The authors suggest
that these mechanisms account for the persistence of symptoms lasting weeks or
months.<br />
<br />
But Lyme arthritis lasts for years. Biofilm forms are impervious
to standard antibiotic therapies. <br />
<br />
Somehow the authors suggest that immune suppressive therapy
should be considered rather than additional antibiotics.<br />
<br />
We have heard catchy phrases like “persistence of evidence
or evidence of persistence." The issue has prevsiously be settled.<br />
<br />
Good science can easily self-destruct with the unforced errors
all for the sake of political correctness. <br />
<br />
To bad.<br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com5tag:blogger.com,1999:blog-5694894153899281485.post-70425380537503182432019-06-06T14:39:00.000-07:002019-06-06T14:39:02.270-07:00Lyme, Alzheimer's, Enbrel -- new potential treatmentI have learned that most people want a simple sound bite answer or conclusion. The edges of medicine always operate in the grey and nuanced.<br />
<br />
It has long been dogma in Lyme circles that immune suppressing drugs, e.g. Enbrel are very dangerous and should not be used. The same is true with prednisone.<br />
<br />
I have patients who get the occasional injection by their rheumatologist; joint pain gets better and they are no worse for the wear.<br />
<br />
The drug is used for psoriasis amongst other many other conditions. The drug has serious side effects: its use should not be taken lightly.<br />
<br />
A study suppressed by Pfizer, brought to light be the Washington Post, was based on insurance company data considering outcomes of hundreds of thousands of patients and found those taking Enbrel had a <b>64% decrease in the incidence of Alzheimer's disease. </b><br />
<b><br /></b>
Enbrel impairs the function of TNF alpha, a master cytokine responsible for trafficking immune cells.<br />
<br />
Pfizer did not make the disclosure because: a generic version will be available. A shiny new, me-too drug promoted heavily by pharm reps costing obscene amounts of money will take its place. Doctors will be given shiny data, along with lunch, proving equivalency? with the old drug.<br />
<br />
The myth that generics are poor (dangerous) and lack quality control may be resurrected.<br />
<br />
Watch out for first year generic prices: cute trick. For the first year a single company is given a monopoly and only required to reduce the price by 20%. "See, the generic is almost as cheap as the brand," the rep will inform a doctor. This is a bad pro big-pharma rule passed by Congress decades ago I'm sure) by the way. Cheap is a relative term.<br />
<br />
The pharmaceutical giant, Pizer has excuses, reasons why it withheld the data, for example, they claimed the data is wrong because of biological plausibility: the molecule is too large to cross the blood brain barrier.<br />
<br />
Really? I care if the molecule gets into the brain; maybe it's an advantage. The brain has its own immune system which needs to be tweaked lightly. Ask anyone who has had a brain Herxheimer reaction knows. The Cytokine storm which may make you crazy results from peripheral cytokine reactions/overproduction primarily. And there is no data the molecule cannot get into the brain. Cytokines get in the brain.<br />
<br />
Alzheimer's is in part motivated by inflammation. Other major factors are: production of amyloid beta protein (AB) (plaques and tangles), genetic factors and multiple external factors.<br />
<br />
It is thought that AB protein is a naturally occurring antibiotic which responds to inflammation. Discussed elsewhere. Lyme resides in the brain along with many bacteria, viruses, protozoans. It is true that spirochetes have been reported to aid in the transportation of AB into the brain. Infection (or colonization) may be omnipresent and therefore not the whole story -- or the most critical piece.<br />
<br />
The vast majority of my patients present with cognitive complaints. Many or most Lyme patients, at one time or another fit the criteria for a disorder call MCI, minimal cognitive impairment. The mainstream medical community considers this a pre-Alzheimer's condition, often.<br />
<br />
What's a Lyme patient to do?<br />
<br />
First off, if symptoms completely resolve with usual therapy do nothing.<br />
<br />
If you are a patient who has had very aggressive therapy, e.g. months of IV antibiotics and cognitive symptoms persist, look up MCI and consider the following:<br />
<br />
Get an AB PET. The tests measures metabolic activity in the brain and the presence of early AB protein deposition. IF the test is positive you are at very high risk for developing Alzheimer's.<br />
<br />
Prednisone and Enbrel have largely been dangerous seen as because patients are misdiagnosed and not also treated for Lyme. Enbrel is likely tolerably safe, in many cases, considering benefit to risk ratio.<br />
<br />
A lot of money has been spent searching for an Alzheimer's cure. To no avail. Nothing very promising in the literature.<br />
<br />
I for one am very angry with Pfizer. I suppose it is typical behavior in the industry. We still need big pharma. Don't throw out the baby with bathwater. Hold them accountable. But, do not conclude big pharma is corrupt therefore all drugs developed through the system are fruit of a poisoned tree and are therefore inherently untrustworthy and dangerous -- in addition to being immorally overpriced.<br />
<br />
It's a bad syllogism. Drug companies are a very necessary evil.<br />
<br />
Getting back to Enbrel Is this a silver bullet?. More comment, biostatistics and analysis are required as well as prospective RCT medical studies. Since the drug will be generic soon big pharma will not finance the research. Fortunately, Alzheimer's, a burgeoning epidemic as our population ages, is well funded through private sources.<br />
<br />
Ideal prospective studies, which will likely be done make observations moving forward starting with a baseline current population. The process is slow.<br />
<br />
Retrospective, population studies, primarily manipulation of data already there will not take long. These studies are never as good as prospective studies but perhaps good enough.<br />
<br />
If you want my bottom line: don't run out and get Enbrel-- YET.<br />
<br />
I am not endorsing the use of the drug for any medical condition, including Alzheimer's,<br />
This site is for informational purposes only. Medical care can only be delivered by a certified medical practioner who properly evaluates your particular issues.<b> Please don't diagnose or treat yourself. </b><br />
<br />
<br />
<br />
<br />
<br />Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com6tag:blogger.com,1999:blog-5694894153899281485.post-35328923837422220932019-05-20T10:11:00.000-07:002019-05-21T13:05:53.505-07:00Posttreatment Lyme disease case<br />
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 16.0pt;"><span style="color: black; font-size: 14.0pt;">A 52-year-old female was seen in my office several months
ago. She has a history of tick bite and bull’s-eye rash treated
with recommend "standard" doxycycline for 3 weeks and she felt well
-- until she didn't. Symptoms appeared gradually. Eighteen months
later18 months later she complained of: incapacitating fatigue, poor sleep,
diffuse pain, weakness, numbness and tingling, headaches, cognitive impairments–trouble
remembering words, impaired focus and attention and memory loss, to the point
of disability. She was hanging onto her job by a thread.</span></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 16.0pt;"><br /></span></div>
<span style="color: black; font-size: 16.0pt;">
</span>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 16.0pt;"><span style="color: black; font-size: 14.0pt;">She also experienced severe night sweats but had chalked it
up to menopause. The sweats however, were new and drenching,
occurred several days weekly and were qualitatively different from
previous night sweats -- primarily hot flashes. </span></span></div>
<span style="color: black; font-size: 16.0pt;">
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">With further question she stated she had been experiencing gasping
mid-sentence and thought she had developed a tic. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Lab testing was positive for Lyme (CDC, IgM and IgG) and
Anaplasma.</span></div>
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Lyme was initially treated with a triple regimen, doxycycline,
rifampin and Tindamax. Also covers Anaplasma. </span></div>
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Within 4 months she reported getting her life back and regaining a
high level of function. Babesia symptoms, well described above (night sweats, air hinger) persisted.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">The treatment was changed. Rifampin was discontinued.
Doxycycline, Zithromax and Mepron were prescribed. </span></div>
<div style="-webkit-text-stroke-width: 0px; margin-bottom: .0001pt; margin: 0in; orphans: 2; word-spacing: 0px;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Notes: Typical posttreatment Lyme disease, relatively
early presentation (in my practice). The role of coinfection has been ignored in clinical
studies. Lyme as sole infection, absent coinfection is rare. Coinfections
may be difficult to diagnose because of poor diagnostic testing.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Human trials have used only doxycycline and Rocephin. In mice,
triple IV therapy: daptomycin, doxycycline and Rocephin (ceftriaxone) was shown
to eradicate Lyme spirochetes. </span><br />
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Medical literature suggests that about 20% of early patients
treated by CDC standards will have chronic symptoms.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Many reasons have been suggested, Including:</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Tick inoculates human host with antibiotic resistant biofilms.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Coinfections.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Strain specific virulence factors.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Host specific immune responses. </span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Host already infected but asymptomatic.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br />
<span style="color: black; font-size: 14.0pt;">Standard therapy ineffective -- high failure rate unacceptable,
leads to chronic illness and/or serious sequalae.</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<br />
<span style="color: black; font-size: 14.0pt;">Clinical approaches may include: </span><br />
<span style="color: black; font-size: 14.0pt;"><br /></span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">More aggressive cocktail therapy early</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Careful monitoring of patient for persistent symptoms and symptoms
suggesting coinfection and early treatment</span></div>
<div style="margin-bottom: .0001pt; margin: 0in;">
<span style="color: black; font-size: 14.0pt;">Not telling patients: don't worry, symptoms will clear.</span></div>
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike></span></div>
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com9tag:blogger.com,1999:blog-5694894153899281485.post-82360435136158499032019-05-07T15:51:00.002-07:002019-05-07T16:01:04.144-07:00PANDAS/PANS and Lyme, clinical notes<br />
<span style="font-size: 14.0pt; line-height: 107%;">PANDAS and
Lyme.</span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">Based on my
beliefs and clinical experience.</span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">Mainstream
medicine currently does not recognize PANS, the notion that other infectious
organisms can induce the same disorder or exacerbate the disorder. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;">PANDAS
stands for: Pediatric autoimmune syndrome associated with streptococcal
infection. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">PANS stand
for Pediatric autoimmune neuropsychiatric syndrome.</span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">I would
suggest the proper acronym is ANS.<span style="mso-spacerun: yes;"> </span>The
disease is not limited to children and occurs in adults.<span style="mso-spacerun: yes;"> </span></span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><span style="mso-spacerun: yes;"><br /></span></span>
<span style="font-size: 14.0pt; line-height: 107%;">Mainstream
view: Strep only.<span style="mso-spacerun: yes;"> </span>Autoimmune, not
related to persistent infection.</span><br />
<span style="font-size: 14.0pt; line-height: 107%;">Alternate
view: <span style="mso-spacerun: yes;"> </span>Multiple microbes may be involved
including tickborne pathogens: Lyme and Bartonella. Maybe others. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">When
confronted with something new it is only natural that doctors compare the
disorder to other similar ones, well described and put place the new illness
into a similar, pre-made boxe.. <span style="mso-spacerun: yes;"> </span>Streptococcus is well known to be associated
with a variety of syndromes which may be averted with early treatment. The
syndromes in question are autoimmune and <b style="mso-bidi-font-weight: normal;">post-infection</b>
– as <span style="mso-spacerun: yes;"> </span>every medical student knows and
include rheumatic fever and glomerulonephritis. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">Rheumatic
fever (RF) can weaken heart valves, cause arthritis and lead to a movement
disorder. RF is rarely seen these days. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">PANDAS was
put in the box of RF. Lyme, not even considered, would likely be put in the
same box if so discovered. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">Most
practitioners see PANDAS, PANS as a subset of autoimmune encephalitis. Therefore,
the RF analogy is incorrect. <span style="mso-spacerun: yes;"> </span>PANDAS/PANS
is something else. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;">Novel autoantibodies
have been discovered, i.e. Moleculera Cunningham panel. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;">PANDAS/PANS (PP)
responds to IVIG. IVIG <span style="mso-spacerun: yes;"> </span>has not benefited
acute RF in clinical trials. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">Immune
modulation with drugs for autoimmune encephalitis including rituximab has
helped some patients with PP (with other therapies). </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">PP is
associated with sudden neuropsychiatric symptoms which appear overnight. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;">Typical
symptoms include: <span style="mso-spacerun: yes;"> </span>change in
behavior/personality, OCD, tics, Tourette’s, anxiety, ODD and others. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">The
disorders are not limited to children. There exists a population of adults,
long treated with psychiatric drugs, ineffectively, who have persistent PP symptoms
which may respond to PP therapy to be described. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">Primary
therapies include: IVIG and antibiotics. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">In patients
with chronic Strep pharyngitis/tonsillitis tonsillectomy may be of benefit. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;">The duration
of antibiotic therapy and of IVIG is best left open. Every patient is
different. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">If Step is
the only concern drugs like amoxicillin or Zithromax may be adequate. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;">IVIG. Two
issues to discuss. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">One theory
is that treatment need be given only once every 6 months the other is it must be
given every 3-4 weeks.</span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">Dose:
Getting approved for IVIG is difficult. Getting IVIG approved for the optimal
dose is more difficult. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">There are 2
general sets of illness and 2 dosing sets. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">Neurological
disorders are treated with high dose IVIG (1.5- 2 gm/kg) and immune deficit
disorders low dose IVIG (0.4-1 gm/ kg)</span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">PP patients
are usually only approved for low dose therapy. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">(I am not
saying the patients who truly have an immune deficit will not benefit from low
dose therapy, rather I am say PP patients will receive an inadequate dose). </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">There is a
theory that low dose IVIG can actually make PP worse. I think this may apply
when the therapy is given subcutaneously once weekly, not IV. Patients should receive
IV therapy. The starting dose is generally around 0.6 gm/kg and the dose may be
titrated upward based on clinical effectiveness. Published data with other
forms of autoimmune encephalitis suggest doses as low as 0.4 gm/kg have been
helpful.</span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">Patients
with Lyme, more often than not, also are infected with Bartonella and
Babesiosis. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">Therapy should
start with doxycycline because it covers a wide array of other coinfections and
possible contributors, such as Mycoplasma. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;">Bartonella
therapy is generally inclusive of Rifampin/rifamycins and possibly Dapsone. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">I think
Dapsone may not be a great Lyme drug but rather have great activity against
Bartonella. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">As discussed
elsewhere, antimicrobial choices may need to be shifted to cover the complete
array of coinfections, including Babesia. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">Antimicrobial
therapy, in the presence of tickborne pathogens may need to be low and slow
because of the risk psychiatric Herxheimer reactions and worsening of
autoimmune neuropsychiatric symptoms.</span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">If Step is
primary a higher dose needs to be used. Something like Keflex might be a
consideration since it kills only Strep and no tickborne pathogen that I am
aware of. This is the idea that targeted therapy may reduce psychiatric
Herxheimer effects.</span><br />
<br />
<span style="font-size: 14.0pt; line-height: 107%;">I reiterate:
I think medicine is a weak science. <span style="mso-spacerun: yes;"> </span>In
PubMed there are hundreds of thousands of references to hypertension and yet
recommended therapies seem to change every year or two. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">Medical
studies, by necessity are internally valid. Yes, there are biases from the
get-go. Aside from that: inclusion criteria are narrow (symptoms and lab tests),
therapies are limited, e.g. one antibiotic and endpoints are narrow – e.g. one symptom
is evaluated, such as improvement in cognition. To date, study groups have not
used consensus methods (each group have evaluated the symptom with a different
set of tools). </span><br />
<span style="font-size: 14.0pt; line-height: 107%;">Studies
frequently lack external validity or real-world application.<span style="mso-spacerun: yes;"> </span>Minimal results are expanded, generalized -- to
fill an ethos of preexistent belief about the inherent nature of the disease
and its appropriate treatment. </span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<span style="font-size: 14.0pt; line-height: 107%;">Evidence
Based Medicine as a construct only looks at clinical studies, frequently deficient,
and excludes basic science research and “biological plausibility.”</span><br />
<span style="font-size: 14.0pt; line-height: 107%;">PP remains “controversial”
and contested much as does Lyme writ large. What else would you expect?</span><br />
<span style="font-size: 14.0pt; line-height: 107%;"><br /></span>
<br />
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 107%;">Not to be used to diagnosed or treat
any patient or particular illness. My clinical impression are presented strictly
for general informational purposes. </span></b><br />
<br />
<br />
<br />
<br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com8tag:blogger.com,1999:blog-5694894153899281485.post-88681856582271325502019-04-26T18:36:00.002-07:002019-04-29T13:14:19.187-07:00Zhang's mice. And, where have all he patients gone? The cure!<br />
Lyme cured! Or is it. Dr. Zhang and (Jie Feng) are heroes in
the Lyme story and their work will be of great import in the history of
medicine.<br />
<br />
Dr. Zhang and colleagues have been very busy building the
case for chronic Lyme disease or persistent Lyme disease. Their publication
March 28, 2018 support previous in-vitro (test tube) studies in a mouse, called
a “murine model.” He has previously demonstrated that Borrelia burgdorferi
strains, bacteria responsible for Lyme disease subdivide into different
morphological forms. The means the same bacteria, with the same DNA, can alter
their appearance and function dramatically. We associate a thin spiral,
elongated form with Lyme, a spirochete. But the long thin forms of Lyme can
change shape and appear round. Alternatively, the spirochetes can aggregate in
a community protected by strong mucopolysaccharide substance, a microcolony or biofilm.<br />
<br />
Three forms:<span style="mso-spacerun: yes;">
</span>spirochetes, round forms and microcolonies (biofilm colonies). <br />
<br />
The bacteria can be free floating in the blood referred to
as planktonic forms. The term contrasts bacteria safely guarded in the biofilm
(microcolony) form. I have always thought of planktonic bacteria as free
swimmers. They are demonstrated to be primarily round form and non-motile in the studies.<br />
<br />
Test tube finding (in-vitro) support the mouse
study.<br />
<br />
<div style="line-height: normal;">
The different forms, morphologies
Lyme takes on are best killed by different antibiotics. Only a specific
combination of three antibiotics eradicates Lyme spirochetes in mice infected
with microcolonies. </div>
<br />
<div style="line-height: normal;">
Posttreatment Lyme or
persistent/recurrent symptoms may occur in 20% of patients treated by standard
protocols, generally with doxycycline. (This is from the CDC). A study from 2015
indicates that 36-63% of patients may have persistent symptoms. </div>
<br />
<div style="line-height: normal;">
The term PTLDS, posttreatment
Lyme disease syndrome is popular but not helpful.<span style="mso-spacerun: yes;"> </span>I believe its use is primarily political, used in deference to the powers that be. </div>
<br />
<div style="line-height: normal;">
PTLDS ostensibly describes a
group of patients with early diagnosis and treatment who nonetheless develop
chronic symptoms.</div>
<br />
<div style="line-height: normal;">
The authors brilliantly point out
that there exists a large population that never receive early diagnosis or
treatment which he refers to as type 2 patients. <span style="mso-spacerun: yes;"> </span>In my experience most patients are type 2. </div>
<br />
<div style="line-height: normal;">
Experimentally, spirochetes were
divided into the three forms through laboratory procedures. </div>
<br />
<div style="line-height: normal;">
Mice were inoculated with either
spirochete or persister forms. </div>
<br />
<div style="line-height: normal;">
Pathologists examined tissues for
inflammation. The <span style="mso-spacerun: yes;"> </span>greatest was observed in mice infected with persister forms, especially biofilm forms. </div>
<br />
<div style="line-height: normal;">
Mice infected only with
spirochetes could be cured with doxycycline and other antibiotics.</div>
<br />
<div style="line-height: normal;">
Mice infected with stationary forms were
only cured with the specific combinations of: Daptomycin, Ceftriaxone and doxycycline.
Negative cultures were obtained from <span style="mso-spacerun: yes;"> </span>ear
biopsy and bladder tissues. </div>
<br />
<div style="line-height: normal;">
The authors suggest that
different forms of Lyme are delivered through the tick bite. Biofilm colonies
may be introduced in tick saliva and then seed other tissues. </div>
<br />
<div style="line-height: normal;">
This is contrary to what I know
about the bacteria. Lyme bacteria are highly motile, extracellular
and possess ligands which facilitate adhesion to the matrix between cells. The
bacteria are polytropic or pantropic and quickly infect many tissues and organs.
There is no known mechanism by which biofilms can directly seed other tissues. The
standard model is that organisms within a biofilm communicate by molecular
signaling, quorum sensing-- and that individual, planktonic spirochetes are
released under the right conditions to seed new tissues and create new biofilm
colonies. <span style="mso-spacerun: yes;"> </span>The spirochetes may be
protected by special compartments in the body, for example they readily cross the
blood brain barrier and live in the brain, an immune privileged area. Biofilms
have been demonstrated in the brain. I think only individual spirochetes with
their lipophilic outer membrane can get through the blood brain barrier. </div>
<br />
<div style="line-height: normal;">
There is ample evidence that
spirochete rapidly convert to round forms when attacked by antibiotics. In-vitro
colonies of spirochetes morph into other forms, persister forms, the 5%
doxycycline does not kill. </div>
<br />
<div style="line-height: normal;">
If biofilm colonies are truly
injected into skin by ticks at the outset, standard therapy, doxycycline and others is doomed to fail. <span style="mso-spacerun: yes;"> </span>Very plausible. Frightening. </div>
<br />
<div style="line-height: normal;">
The currently recommended therapy
for early, stage 1 Lyme disease is a failure. It might be argued that other
regimens should not be experimented with. These new therapies have no scientific basis. But
there is compelling scientific evidence that standard therapy is a failure. <span style="mso-spacerun: yes;"> </span></div>
<br />
<div style="line-height: normal;">
Oral therapies with combinations
that showed some promise invitro might have a better chance, for example,
doxycycline, rifampin and artemisinin. </div>
<br />
<div style="line-height: normal;">
The curative therapy described is
problematic. Ceftriaxone and doxycycline are standard, generic fare but not
daptomycin. Daptomycin is a relatively new, powerful antibiotic currently held in
reserve for multi-resistant bacteria such as MRSA. <span style="mso-spacerun: yes;"> </span>It’s non-generic cost of $400.00 per dose/day--
not covered by insurance may be prohibitive. A thirty-day course costs $12,000. <b>Generic available, $150.00 per dose. Cost lowered to about $4000.00 monthly.</b></div>
<b></b><br />
<div style="line-height: normal;">
Experimental treatment based on
scientific plausibility and clinical experience for late stage Lyme has helped many, many patients.</div>
<br />
<div style="line-height: normal;">
The paradigm that Lyme disease
present with: an observed tick bite, a bull’s eye rash, Bell’s palsy, a swollen
knee, meningitis, heart block and other well described acute manifestation
is wrong.</div>
<br />
<div style="line-height: normal;">
Ticks go unseen, rashes are the
exception not the rule and most patients present with -- fatigue, pain,
neurological symptoms and cognitive dysfunction – the bones of Lyme disease.
The meat is filled with symptoms referable to nearly every organ system. Most
patients go misdiagnosed for months, years or decades. This is the tragedy of
the Lyme epidemic. </div>
<br />
<div style="line-height: normal;">
Patients are belittled, diagnosed
with chronic fatigue syndrome, fibromyalgia, depression and/or the aches of
pains of daily living. </div>
<br />
<div style="line-height: normal;">
Doctors who take chronic Lyme
seriously are ridiculed by peers and medical licenses are censured. </div>
<br />
<div style="line-height: normal;">
There is math problem</div>
<br />
<div style="line-height: normal;">
Of 300,00 type 1 Lyme cases
yearly in the U.S. 60,000 become chronically ill. <span style="mso-spacerun: yes;"> </span>The number is at least doubled when you add in
type 2 cases. </div>
<br />
<div style="line-height: normal;">
This means there must be hundreds
of thousands of patients, more likely not millions of patients suffering with chronic
Lyme disease.</div>
<br />
<div style="line-height: normal;">
Despite this patient are nearly
universally told it’s not Lyme, can’t be Lyme, no known disease acts like that,
etc.</div>
<br />
<div style="line-height: normal;">
This leaves a simple question:
Where are all the missing patients?<br />
<br />
Einstein warned scientist lack imagination. Everything doctors do today with be laughable to future counterparts. Phages which kill only specific bacteria or other technologies will surely make antibiotics obsolete in the not too distant future.<br />
<br /></div>
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com2tag:blogger.com,1999:blog-5694894153899281485.post-28472904017760933122019-04-23T13:14:00.000-07:002019-04-23T13:14:40.100-07:00Antibiotics and Germs <br />
Its still complicated but I am trying to explain some basic concepts for the lay person.<br />
<br />
Antibiotics only kill germs called bacteria.<span style="mso-spacerun: yes;"> </span>Germ is not a medical term but a colloquial
substitute for pathogen, a microorganism of one sort or another that causes
human illness.<br />
<br />
Disease causing germs are representatives of various
families in the animal kingdom of microbes, including:<span style="mso-spacerun: yes;"> </span>bacteria, viruses, fungi, yeast, protozoans and
worms .<br />
<br />
With few exceptions, antibiotics kill only bacteria so that is
what we will discuss.<br />
<br />
Bacteria are one cells prokaryotic microbes, so named
because they lack an organized nucleus. <br />
<br />
Please keep in mind that the vast, vast majority of bacteria
are friendly or harmless, including the 2-6 pounds of normal “flora” we carry
around, necessary for immune functions and detoxification.<br />
<br />
Bacteria present as a menagerie of forms and shapes: comma,
spiral (spirochete), cocci (round), rod (elongated), chains, grape-like
groupings, filamentous etc.<br />
<br />
THE SHAPE OF A <span style="mso-spacerun: yes;"> </span>BACTERIA DOES NOT DETERMINE WHETHER IT IS A
PATHOGEN, A GERM.<span style="mso-spacerun: yes;"> </span>ONE SPIROCHETE MAY BE
NORMAL FLORA, <b>HARMLESS,</b> AND ANOTHER MAY BE <b>LYME</b>.<br />
<br />
Families of antibiotics may contain similar members. Members
of the same family may perform different.<br />
<br />
In general, specific antibiotics target bacterial germs which
possess certain characteristics. <br />
<br />
For example, an antibiotic may target bacteria with cell walls constructed somewhat differently -- gram negative or
gram positive. Antibiotics may target gram positive bacteria, gram negative or others such as intracellular bacteria etc.<br />
<br />
Intracellular bacteria may only survive in host cells: some have no cell wall e.g. mycoplasma.<br />
<br />
Bacteria (think Lyme) may lack a cell wall but rather have a
double outer membrane.<br />
<br />
Antibiotic classes include penicillins and cephalosporins which are considered cousins because both share a <span style="mso-spacerun: yes;"> </span>ring structure (beta lactam). The drugs are
divided into generations. First generation, second and third.<br />
<br />
<span style="mso-spacerun: yes;">With progressive generation more types of bacteria are killed (broad spectrum versus narrow spectrum. </span><span style="mso-spacerun: yes;"> </span><br />
<span style="mso-spacerun: yes;"><br /></span>
<br />
Antibiotic classes include tetracycline, macrolide, sulfa, rifamycin,
quinolone, antiparasitic, e.g. (Flagyl (nitroimidazole) etc.<br />
<br />
We use principals of pharmacology to decide which antibiotic(s)
to use for a particular infection.<span style="mso-spacerun: yes;">
</span>Deciding factors may include the severity and location of the infection.<br />
<br />
We consider MIC, minimal inhibitory concentration and MBC,
minimal bactericidal concentration.<span style="mso-spacerun: yes;"> </span>This
means the amount of antibiotic to inhibit growth or to kill the bacteria.<br />
<br />
We must consider the risk of side effects and complications,
like C. diff colitis.<br />
<br />
We have to make sure the antibiotic can get to the source of
trouble, for example the brain, with ability to transverse the special BBB)
blood brain barrier.<br />
<br />
There are a lot of very complex factors that influence antibiotic
decision making.<br />
<br />
Treating chronic Lyme disease is a vary complex
process.<span style="mso-spacerun: yes;"> </span>As <span style="mso-spacerun: yes;"> </span>with a patient I saw this afternoon, Lyme triggered a cascade of problems, including: dysautonomia (POTS), MCAS, mast
cell activation syndrome.<span style="mso-spacerun: yes;"> </span><br />
<span style="mso-spacerun: yes;"><br /></span>
<span style="mso-spacerun: yes;">She also suffers with a very stubborn case of babesiosis.</span><br />
<span style="mso-spacerun: yes;"><br /></span>
<br />
There are a lot of balls in the air to juggle.<br />
<br />
<span style="mso-spacerun: yes;"> </span>A recent live Facebook event was
successful.<br />
I hope we will soon cut through some of the confusion.<br />
<br />
<b>I will be scheduling another live Facebook presentation:
Treating Lyme with Q&A in the near future. My Facebook coordinator Brittany
Goff will be setting this up. </b><br />
<b></b><i></i><u></u><sub></sub><sup></sup><strike></strike><b></b>Lyme report: Montgomery County, MDhttp://www.blogger.com/profile/11035327980787631502noreply@blogger.com0