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Thursday, December 18, 2008

Easy one

A 64 year old woman visited me two months ago. She is a mushroom picker and has had multiple tick bites. A classic EM rash in 2005 was treated with 3 weeks of Doxycycline.
She complained of generalized pains, joint pains- especially knees and elbows, numbness and tingling, leg cramps, night time chills and sweats which awakened her, weakness, fatigue and short term memory loss. Lab results from IgeneX revealed the following results.
Lyme Western Blot: IgM 34 band and 66 band. IgG 31 band and 41 band. Babesia duncani IgG titer 1:40- considered a borderline positive. She was treated with Biaxin and Plaquenil for one month. A month later she was dramatically improved. The fatigue, pain, tingling, cramping and memory were mostly improved. She reported a minor short lived Herx.

She was placed on: Biaxin and Plaquenil plus- Malarone 2x per day, Artemesisn (which she never took) and Flagyl 250 mg 2x per day.

Four weeks later, yesterday, she was seen again. The fatigue, sweating and chills, joint pain, tingling, cramping, memory loss, and blurred vision (which was mentioned now for the first time) were 100% better. This robust appearing woman was in full remission after two months of therapy. She told me she was "wowed" by the results. I suspect I was much more "wowed than she was!
Incidentally the chills and sweats- attributed to Babesia went away after one week of Malarone.

I decided to continue the same protocol for another two months and then see her back in the office. I am learning: Don't change horses in mid-stream when you are winning the race.
There are many temptations to change the regimen for this reason or that. It takes some discipline to shut my over-active brain off. Thankfully, I closed my pen and put it away. By the way, I told her to skip the Artemesin.


cehansen said...

Are all your patients this easy? :) I have yet to meet anyone whose case was so short-lived. Malarone for a week? Sign me up!

Diane said...

why did you test for B duncani and not B microti?

Lyme report: Montgomery County, MD said...

I always check both. Labcorp will not do B. duncani for me so I send it to IgeneX.

Michele said...

Isn't B duncani becoming more prevalent on the east coast now? And doesn't it cause stronger symptoms?