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Wednesday, February 18, 2009

Routine physical

A 22 year old man, a new patient, scheduled an appointment for a physical, a general check up. This was supposed to be a health maintenance exam. I asked a series of questions and kept uncovering positive responses. He had suffered with fatigue, depression and anxiety for several years. He also complained of memory loss which he attributed to marijuana use. I further elicited complaints of joint pain and night sweats. Then it was uncovered that he in fact had a history of tick bite and rash 6 years previous to our encounter which had been treated with Doxycyline.(He didn't complete the course). He admittedly abused alcohol and tobacco, in addition to marijuana. There was a positive family history of anxiety and depression.
His physical exam showed multiple neurological abnormalities, including a positive Babinsky sign in addition to the usual changes in sensation.
His labs were impressive. All 10 IgG Lyme WB bands were present. Two IgM bands, 23 and 41 were present.

After only 2 weeks of therapy with Minocin and Biaxin his improvement has been astounding. The joint pain is better- almost gone. His energy is better, the fatigue almost gone. His memory has improved and the sweats are gone. His depression and anxiety are also markedly improved. He has stopped drinking and cut down his use of marijuana to a minimum. He continues to smoke cigarettes.

Perhaps, he has responded so quickly because of his youth. There is another possibility. Perhaps his dramatic IgG response is a marker for an improved immune response.

One thing is clear. The presence of IgG antibodies does not mean that he is clear of Lyme, as has been suggested by some. The diagnosis rests of an assessment of symptoms and signs.

Furthermore, the same would be said in the event that IgM bands were completely absent as well.

1 comment:

Michele said...

When I was teaching in Arizona I had a student who failed my class. He failed every test and did not attend often. The next semester he came back and made all A's and made an A in the class. I took him aside and asked "Hey, I know it was not my teaching that made you get those A's this semester so tell me, what gives" He looked me in the eye and said "I quit doing drugs" Sometimes there is another reason