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Tuesday, February 12, 2013

Chronic fatigue syndrome, Lyme, Babesia, and Adrenal fatigue

I have been treating this patient for a few months. This 42 year old female came to see me for a Lyme evaluation.  Lyme didn't seem likely, but since her husband suffers with chronic Lyme disease she decided to check out this possibility. Her chief complaint was fatigue. She carried the diagnosis of chronic fatigue syndrome.

She feels she has been tired her entire life, at least since age 19. At age 20 she was diagnosed with depression. Various antidepressants were prescribed with minimal benefit. A sleep study(polysomnogram)  was negative. The MSLT, multiple sleep latency test was slight abnormal but did not meet the criteria for narcolepsy. She has been  treated with 600 mg of Nuvigil( a very high dose), without any benefit - this is unusual. Her symptoms had become significantly worse over the last year. She had episodes of profound fatigue and perhaps weakness of her legs. At  times it was  difficult for her to get out of bed in the morning. Other symptoms included: mild brain fog, rare knee pain and some numbness and tingling. She had a history of night sweats which stopped one year ago. She had persistent loose stools, short of diarrhea. She has been seeing a psychiatrist for years. Recently anxiety has become worse along with  panic attacks. She complained of the inability to accomplish tasks, difficulty handling stress, and indecisiveness.

Lab tests showed serological positivity to Babesia microti and Lyme. In addition, there was evidence of adrenal dysfunction. The ACTH level was very high, 98, while the cortisol level was 14, within the normal range.

In addition to chronic Lyme disease I felt she suffered with adrenal fatigue. The diagnosis is associated with dysfunction of the hypothalamic's-pituitary-adrenal axis. The ACTH level should not have been elevated in the face of a normal cortisol level.

Her treatment then included: typical antibiotics  -  plus Cortef. After only 6 weeks she claimed that "this  was the best she had felt in years!"  She states she now feels normal. Gone were fatigue and cognitive symptoms.She was incredulous, as were her psychiatrist and sleep specialist. Side effects of therapy included, nausea and constipation -  surprisingly, rather than diarrhea.

In patients who have been chronically ill for years or even decades, adrenal fatigue must be considered along with other potential causes. Patients with chronic fatigue syndrome should always have sleep studies including the MSLT  and be evaluated for gluten sensitivity, thyroid disease, and a variety of other disorders.


Tiggerkat said...

don't know what feed back you get, but your posts are appreciated!

jenifer deitterick
chronic lyme x 10+ years

jacquib said...

It states in the report "Patients with chronic fatigue syndrome should always have sleep studies including the MSLT and be evaluated for gluten sensitivity, thyroid disease, and a variety of other disorders."
I would like to know how to get these tests?

Nonnie said...

Glad to see you are writing again. Enjoy your discussions.

Unknown said...

I live in northern VA, and my doctor absolutely refuses to believe in chronic lyme, albeit the infectious disease doctor insists I have this. I have started Buhners Protocol, and actually for the first time in 3 years started feeling good again. But all of a sudden the brain fog, and fatigue have come back. Who can I see that believes in the patient's symptoms, and also in Chronic lyme here in VA? I also have had gluten intolerances, and have just had a sleep study completed. Any answers would be so appreciated. Thanks!

Naked Mole Rat said...

Leslie, I highly recommend Internal Medicine of Northern Virginia (, either Dr. Samuel Shor or Dr. Eboni Smith. The practice takes a holistic approach, prescribing antibiotics as well as supplements and a healthy diet for immune support. I wish you the best!

sherri said...

thank you for writing again. I check in weekly to see if there is something new. My daughter, sick with lyme since birth but only diagnosed at age 16 is no 18 and has responded so strongly to most treatments she has had to stop. She is under the care of a Chinese accupuncturist who was able to realize many food sensitivities. Among them gluten, dairy and milk.

Dizzy Green said...

Leslie I just started seeing Dr. Hart in Leesburg, VA. He is very much in line with all that is posted by Dr. LymeMD here (which I soak up like a sponge!). His office moved, so some info online is still old, but if you search and even call a prior number, they will get you to him. Um... much less expensive than... some of the 'experts' in our area too... Not sure if I'm allowed to say that... but I'll throw it out there :)

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