Chronic Disease Group discussion
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Why Can't I Get Better? Solving the Mystery of Lyme and Chronic Disease
Dr. Horowitz's Wisdom
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Chapter 4: Discussion and Summary
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Mod
I know! I was taking notes throughout the chapter on things to ask my doctor. My doctor is good, but I don't think he's as good as Dr. H. Thank you so much for this excellent and comprehensive outline. I tested positive for IgG antibodies for mycoplasma, and I'm beginning to wonder how it contributes to the whole picture. In two weeks, I have my next appointment, and I will get back my latest babesia and bartonella results (previously negative). My friend says that when one infection goes down another "pops up." For example, when she was first infected she did not have many bartonella symptoms. Now she has the bartonella rash that looks like red stretch marks.
Mod
I know – I don't have any of those symptoms either! Do you remember being bitten? I don't.
Mod
Oh God, me too. I don't remember THE bite, but I have vacationed in all sorts of endemic areas and I live in an endemic state (NY), although I am in the city, not where Dr. H is. I never was the outdoorsy type, but I used to pet people's dogs all the time. I'm guessing a nymph tick got me. I started to feel awful in 2009 and was diagnosed with fibromyalgia and ME, despite having had a positive Lyme IgM. I think I mentioned this already, but I have a lot of brain fog, so I'm not sure.
Mod
Very sad that 11 doctors and two years is not considered that bad! So true, though. I went five years and who-knows-how-many doctors ... my all-time favorite misdiagnosis was "an autoimmune disease that maybe only you have." My second favorite was acromegaly, which is very rare. It is adult-onset gigantism. I'm not a giant--I just had a messed-up growth hormone marker on several tests. It was called "Insulin Growth Factor One." It turned out I didn't have the pituitary tumor that causes acromegaly. I had to get a brain MRI to find that out.I'm waiting for the part in the book where he says, "Lyme can cause an elevated Insulin Growth Factor One." :-) I won't be surprised.
We do cost the healthcare system a lot of money, but the healthcare system needs to remove its blinders. Antibiotics are a lot cheaper than brain MRIs.
And eww--hundreds of ticks! Oh man! Vets and vet techs probably deal with this a lot.
Mod
I know, totally eww! I think it's really interesting to see Vets and the Lyme community come together recently. If your pet has been exposed to ticks, so have you.
Exactly! I know someone who has Lyme and doesn't bother to check her dog for ticks. She somehow thinks they're going to stay on the dog.
Chapter 4 Discussion Questions:
1. Dr. Horowitz suggests that when it comes to Lyme, there is usually another underlying problem, and that single antibiotic therapies are often insufficient for these patients. Do you feel your drug regimen is covering all of your co-infections?
2. Did any of the bacterial infections that Dr. Horowitz outlined in this chapter fit your symptoms that you haven't explored before?
Chapter 4 Summary:
• Lyme may take center stage, but there are a host of additional bacterial, parasitic, viral and fungal infections that can be playing a role. Dr. Horowitz spends this chapter going over the common tick-borne bacterial infections reviewing symptoms and treatment options.
• Dr. Horowitz’s combination antibiotic regimens for treating intercellular bacterial infections in MSIDS can be found on page 133.
o Ehrlichia or Anaplasma
Very common and comes in multiple forms (HSE, HME, HGA, HEE, & HWME).
Symptoms include: high fever and flulike symptoms.
A diagnosis can be made through blood work such as; antibody titers, CBC and liver functions.
Treatment with a tetracycline is recommended. Rifampin may be used in young patients. It is very important to diagnosis and start treatment. Like Babesia and Rocky Mountain Fever, this can be fatal in patients who are immunocompromised.
Can be cured if caught early and patients properly treated do not appear to have the same chronic clinical issues like we see with other co-infections
o Bartonella or Cat Scratch disease
Relatively easy to diagnosis and treat. It is one of the more common co-infections. Different types of Bartonella can be transmitted by hard bodied ticks, lice, sand flies or a cat scratch.
Symptoms usually present with a rash (small red raised bumps on the skin). In chronic patients symptoms advance to neurological issues. Unusual symptoms range from the appearance of stretch marks, pain in the soles of the feet.
Can be transmitted from a mother to fetus.
Diagnosis needs to be made by a combination of Bartonella titer, PCR testing and clinical findings
Treatment needs to be a combination intracellular therapy approach. “Two drugs are better than one.”
o Mycoplasma
Blood tests are unreliable so Dr. H recommends IFA and serial PCRs to check for different species. Patients with atypical autoimmune disorder should be tested.
Symptoms overlap with other diseases making it hard to diagnosis. Fatigue, joint and muscle pain, cognitive difficulties and headaches are the top symptoms.
Mycoplasmas are intercellular infections that can persist despite long-term therapy. This can explain Lyme patients who continue to have symptoms post treatment.
o Chlamydia
Is an intracellular infection that is not transmitted by hard bodied Ticks, but isn’t always sexually transmitted.
Detoxing for heavy metals is an important part of treatment for Chlamydia as it can be contributing to the severe arthritis seen in patients.
Treatment is done through intracellular drugs.
o Rickettsial Infections
Rocky Mountain spotted fever is a Rickettsial infection. Like Mycoplasma and Chlamydia, this bacteria also lives inside cells but can also survive outside the host and remain extremely infectious. It can be transmitted by several species of hard bodied ticks.
Treatment of a tetracycline should be started immediately if suspected as this can be fatal in patients who are immunocompromised.
Symptoms are very nonspecific ranging from fever, nausea, vomiting, severe headaches, and muscle pains. Classic red spotted petechial rash can present in 50-80% of patients.
CBC results are similar to what we see with Ehrlichiosis; low white blood count, low platelets and elevated liver function.
Q Fever is another Rickettsial infection and presents with a “myriad of diverse symptoms.” Patients with unresolved Lyme symptoms should be checked. Usually transmitted by domestic animals
Q Fever is diagnosed through a blood antibody test called phase I and phase II titers.
Treatment for Q Fever is “several years of doxycycline and rifampin with Plaquenil.
o Tick-Borne Relapsing Fever: Borrelia Hermsii and Borrelia Miyamotoi
Transmitted by fast-feeding, soft-bodied ticks.
Patients have a high relapsing fever every couple of days along with a variety of skin rashes. Diagnosis can be done through a Wright-Giemsa stain, with paired acute and convalescent antibody titers by EIA and IFA.
Patients can recover with or without the use of antibiotics. This suggests either a large spreadof the illness or false positive titers. Patients with symptoms of a meningitis or encephalitis should also use IV Rocephin.
o Tick Paralysis
A potentially lethal tick-borne infection that causes nonspecific viral like illness followed by a neurotoxic phase with acute ataxia.
Can be confused with Guillain-Barre syndrome.
Proper and prompt tick removal is key to prevent respiratory complications. Full neurological recovery can take place within one to two days.
o STARI (Southern Tick-Associated Rash Illness)
There is no reliable blood test for STARI.
Has a similar presentation of Lyme disease, even with the bull’s-eye-rash we see from Lyme caused by the Borrelia burgdorferi spirochete. Long term research is lacking and the cause is still unknown.
Patients should be treated like they would if they had contracted Lyme disease.
o Tularemia
Typically contracted by exposure or consumption of infected rabbits, the bite of a deerfly, or inhaling aerosolized bacteria. It is very rare.
Caused by another intracellular bacteria, Franciseel tularensis.
Presents with nonspecific symptoms.
Treatment is still a dilemma because IV gentamicin and IV streptomycin have significant side effects.
o Brucellosis
Another rare intracellular bacterial infection that also presents with nonspecific symptoms. Over 90% of patients will experience drenching night sweats and fevers. It is common to experience weight loss.
Can be transmitted by ticks or exposure/consumption of infected animal tissue.
Treatment is similar to Tularemia.