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Monday, June 10, 2013

Pregnancy and Lyme

Sitting at my desk today is a delightful 25 year old woman -- she is also 12 weeks pregnant. She lives in a rural wooded area. . Two and one half  years ago she developed an acute, multi-system disease.  She had myriad symptoms, to numerous to list: fatigue, swelling of lymph nodes, headaches, loss of balance, numbness and tingling, weakness with inability to walk associated with a severe loss of balance, painful and swollen joints, spontaneous lactation, depression, OCD, ADD like illness treated with Adderall, severe headaches.
Numerous doctors had been of no help. A friend referred her to me.

Her treatment has been aggressive:  she was on IV antibiotics for more than six months. At some point we treated her for adrenal fatigue and this made a tremendous difference.

 Now, 12 weeks pregnant.she has been hospitalized three times, not for Lyme disease but for hyperemesis gravida. Now resolved.

We had discussed the management of chronic Lyme disease vis-à-vis pregnancy. We had decided to use dual therapy Amoxil and Flagy which took for a short time and had to drop the Flagyl because of GI intolerance. Her gastrointestinal system is still very touchy. At this point we will use mono-therapy with amox.

Depression has been a serious issue: a year ago expressed suicidal ideation without plan or intent.  She still has a modicum of depression
She is on Zoloft. When she lowered the dose from 50mg to 25mg depression worsened: We are titrating the dose  We discussed the pros and cons -- of the medice, I think depression is worse for the fetus than potential risks associated with SSRI therapy. And post-partum depression is expected to be severe.

Did I mention -- today, all the Lyme symptoms are gone: including headache and  knee pain and swelling.

But we know this temporary.

During pregnancy the immune system is tamped down to protect the fetus from inflammation.  After the baby is borne the immune system is turned back on and a Lyme relapse may rage.

Then, we discussed breast feeding.  Lyme has been found in breast mild ---- but a new-born is immune suppressed,  a baby less than 8 weeks can die from herpes sepsis.

Not all babies acquire trans-placenta Lyme.  Cord blood can  be tested at a reference lab  like Clongen, 

Irrespective of the test result, I still recommend breast feeding.  Lyme is transmitted by a tick bite or perhaps an exchange of blood. The critical colostrum and  should not have contact with blood as its goes down the back of the throat; down a tube- the esophagus, and into the cauldron of acid in the stomach. Even when the baby spits up, the milk has already been in contact with stomach contents: and we will have antibiotics on board. Lyme is associated with autism:  lets get a head start with treatment.

I know that many in the Lyme community disagree with my approach; I can only make recommendations based on my understanding of the science and common sense.

From a wheelchair to asking for a note to go back to work today, I am delighted, and so is she.


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Anonymous said...

I have ALWAYS wondered if there were a correlation between Lyme and HG. My mom had lyme since she was a young girl in CT back in 1950 - and then was sick with her pregnancies. I believe I've had lyme all my life from her (I've tested positive from a generic lab - hard to do I'm told) and had HG during both my pregnancies.