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Wednesday, June 17, 2020

Old drug, new drug: nimodipine

Mary, a 35 years old woman was extremely healthy – until she wasn’t.  The culprit was Lyme disease, an ancient, thin, spiraled bacterium called a spirochete – one that is insidious and opportunistic.  But Lyme disease is more often than not so much more.

Our ability to stave of infection frequently depends on a healthy immune system.

Many factors can adversely impact normal immune function.  Stress is a huge factor.

Lyme and Mary’s immune system had been locked in mortal combat with Lyme for some time. Life stressors mounted and a tipping point was reached. Lyme won the battle and spread throughout her body attacking many organ systems.

These were some of the stressors. Her father died of a sudden heart attack, a child was diagnosed with autism, her husband was emotionally abusive and this led to an ugly divorce.

Mary managed stress by gardening – more and more. Ironic.

The fatigue was overwhelming. It felt like she had been run over by a Mack truck. Mary was diagnosed with chronic fatigue syndrome/CFS, myalgia encephalitis or systemic exertional intolerance disorder – three names for the same thing. She simply could not function. Sleep was miserable, too much or too little. She struggled to get out of bed. She needed help with simple household chores. She rarely got dressed; she no longer put on makeup and she took few showers. Sadly, Mary blamed herself for her poor health. She lost all self-esteem.

Headaches diagnosed as migraine came out of the blue. Pounding, throbbing, ice pick, with temporary loss of vision nausea. The pain was unbearable.  Several doctors were of no help and she seriously considered suicide.  

Symptoms mounted. Doctors said it was psychosomatic. Family members believed the doctors. Mary was abandoned by both family and friends.

Mary had so many symptoms, symptoms which inexplicably came and went.

She frequently felt like she had the flu. She had night sweats, drenching at times.

Her whole body hurt at times. Sometimes the pain was localized to a particular joint or body part.

She experienced frightening cognitive impairments, poor memory, trouble thinking clearly, difficulty finding words. She frequently felt disoriented and depersonalized. She experienced depression, air hunger, sudden bouts of crying, intermittent joint swelling, weakness, numbness and tingling and trouble sitting up and standing.  

With changes in posture, from lying to sitting and then to standing symptoms her heart raced, brain fog increased, she became dizzy, felt she would black out and had to immediately sit down or lie down.

We know Mary has Lyme and Babesia. But she is not going to get better if we treat her only with antibiotics and anti-Babesia drugs.

Migraines:  There are a variety of new ways of treating migraines including those that antagonize calcitonin gene related peptide, a relatively new and sometimes successful therapy. Migraine therapy will be reviewed in detail in the future.

POTS:  With further questioning Mary had problems with her bowels, bladder, vision and temperature regulation.  POTS is a piece of the larger disease, dysautonomia or broken autonomic nervous system. A patient history, exam with measurement of vital signs in different positions can confirm the diagnosis. A tilt table test is unnecessary. There is a close connection between dysautonomia and CFS. Mary’s heart rate only increased by 20 points with standing not the requisite 30. Of course she was too dizzy to stand for long.

There are many effective therapies which usually work when prescribed properly. Described elsewhere.

Even when tests for POTS are negative, patients with chronic fatigue syndrome may benefit from POTS’ therapies including salt tablets and fludrocortisone.

Lyme patients, patients with chronic fatigue syndrome and patients with POTS all complain of brain fog. An old/new drug may be incredibly effective.

The calcium channel blocker nimodipine, which must be prescribed carefully dilates cerebral blood vessels and increases blood flow in the brain treating chronic encephalopathy. Patients with Lyme, POTS and CFS may all suffer with dysregulated blood flow to the brain.

Nimodipine may work well with other neurotropic drugs including Adderall and Namenda.

I have treated Mary for less than a year and she has done very well.

She is back at work, part time, telecommuting and even smiling at times.