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Thursday, May 14, 2009

Wellness, Illness and Lyme

Wellness and Illness exist on a continuum. We all have a balance sheet of sorts which relates to our status on this scale. On the wellness side we have: favorable genes and environment, happiness, laughter, low stress, good mental health and self esteem, fulfillment of career-relationships-family, positive nutrition, exercise, healthy sexuality, music, dance, intellectual curiosity, reading, writing, hobbies and other things which make us well rounded. A person on this side of the health continuum feels well and energetic, sleeps well and is devoid of pain. (I think you also need a surplus of money and time).

On the other side of the balance sheet we have pretty much the opposite of all these positives. You can go down the list. The negative side of the balance sheet also tends to include many chronic illness and negative factors; some are of our own making and others are just the result of bad luck. These include: unfavorable socioeconomic status, unfortunate genes and environmental factors, smoking, drinking, substance abuse, an abusive diet, migraine or headache disorders, heart disease, diabetes and other endocrine disorders, asthma and allergic disorders, gastrointestinal disorders, autoimmune disorders, pain syndromes, malignant disorders and much more. Those living of this side of the spectrum experience life quite differently. Every day may be a struggle fraught with an array of challenges and discomforts. These folks are in pain. They sleep poorly- have mental health issues, and experience subjective and objective signs of a lack of good health or illness.

There are always unexpected factors and influences, such as illness, accidents or personal tragedy, which can precipitously change one's status. An individual experiencing all the benefits associated with column A can quickly find themselves experiencing a predominant column B status.

Sometimes it appears humans are incredibly resilient while at other times it appears we are delicate and tenuous. Of course most of do not live in either of the extremes of the continuum described. We reside somewhere in the middle of two,(I hope). Those of us closer to the the health side (column A) may at times be be better equipped to handle a new negative challenge than those who resides predominantly in column B. But this is not always the case: Enter the unpredictable world of infectious diseases.

Someone ranking high on the health side, may have a better immune system and fend off a typical case of pneumonia with relative ease. Influenza may be another matter. It turns out that the H1N1 strain of flu, last seen 91 years ago, caused the highest mortality and morbidity in those who would appear to be the healthiest, namely 20 to 40 year olds. In fact it was their excellent health that likely led to the disastrous outcomes. Their perfectly tuned immune responses actually became their Achilles heel. Hyper-responsiveness of the immune system led to an outpouring of pro-inflammatory cytokines. These are the chemical mediators which direct the activity of our immune system. Readers of this BLOG should be familiar with cytokines; these are the molecules responsible for Herxheimer reactions so frequently experienced with Lyme therapy. The overactive responses, called a cytokine storm, could be thought of as a Herx reaction on steroids, and could overwhelm the infected host and lead to organ failure.

Other insults to our health are much less predictable; I am thinking of Lyme disease.

Today I saw a woman who cannot comprehend how Lyme disease could have made her so ill. After all, she has done everything to promote the best possible health. She is committed to exercise, yoga, a vegetarian balanced diet, healthy relations, laughter and all the other positives noted in the column associated with good health. In fact her professional life centers around teaching others these concepts. The germ still prevailed. She has neuroborreliosis associated with significant cognitive deficits. Her brain MRI and SPECT scans confirm this. Against her innate judgment she has accepted the reality of a long and intensive treatment course of antimicrobial therapy.

Health and illness can exist on a balance beam. Sometimes all it takes is one factor, like Lyme disease, to act as the hair that broke the camels back. The weight of that hair varies for each individual.


Unknown said...

Is it cytokines that are being checked when a C3, C4 test is ordered?

Also is a Lyme disease patient less likely to get Lyme associated diseases or conditions in the long run such as MS or other autoimmune diseases if they do accept long-term antimicrobial therapy or are they at a high level of risk no matter what? Does it matter how long a patient has been infected or how many times for the risk?

Thank you

Lyme report: Montgomery County, MD said...

C3a and C3b measure split products which result from the complement system. This an effector mechanism.
In other words these are molecules which are produced by activation of the immune system, both the innatate and acquired immune resonses. They have nothing to do with cytokines. Cytokines are mediators which coordinate activities of the immune responses once they are triggered. Cytokines have names like interferons, interleukins and tumor necrosis factor. Measurements of these molecules are not available through commercial labs such as Labcorp. "Lyme" labs like IgeneX do not performed this tests. They are available at speciality labs and mostly used at research institutions. There are no clinical studies or guidelines for the use of these measurements in the clincial management of infectious or autoimmune disease, although in the future this may change.

Patients who develop MS are those that are genetically inclined. No one can answer your question. One could postulate that if were known that a particular individual was predisposed to develop MS, then treatment of potential triggers, including infections, could in theory be helpful.

Unknown said...

A very special article of a woman who suffered from Lyme disease, published in MSN, shows precisely these variations between health and illness. Read it and cry with me!
There are also comments from people in similar situation... may God have compassion!
Thank you for your blog.

Jared said...

What form of exercise should Lyme patients do: aerobic, anaerobic, or both? I have read conflicting opinons everywhere! Dr. Burrascano says no aerobic exercise "until stamina improves," so does that mean we should do aerobic exercise if we do not have symptoms of lethargy?

Thanks in advance.