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» LymeNet Flash » Questions and Discussion » Medical Questions » Proper meaning of 'herx'

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Author Topic: Proper meaning of 'herx'
Areneli
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I have a feeling that you guys use this term not always correctly.

Herx is a reaction of the body to the massive death of microorganisms in your body from antibiotics. Firstly it was described for Treponema pallidium (syphilis) treated with penicillin. This reaction may vary in symptoms depending on the situation and is a result of presence in your blood huge amount of foreign protein from dead bugs as well as toxins released from their dead bodies.


In my opinion you cannot use 'herx' term for any deterioration of your symptoms.
So writing that you have been just sitting at home without any treatment for the last year and you have been herxing is very incorrect. In fact, you probably have a relapse or your symptoms got worse from electrolyte imbalance. Chance that this is true 'herxing' is zero.

[This message has been edited by Areneli (edited 20 January 2005).]


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TheCrimeOfLyme
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Are you directing this post at someone?

To my knowledge, I dont know anyone that has "sat around a year not taking medicine, and calling it a herx"

But if you do, maybe you should email them?


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treepatrol
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quote:
Originally posted by Areneli:
I have a feeling that you guys use this term not always correctly.

Herx is a reaction of the body to the massive death of microorganisms in your body from antibiotics. Firstly it was described for Treponema pallidium (syphilis) treated with penicillin. This reaction may vary in symptoms depending on the situation and is a result of presence in your blood huge amount of foreign protein from dead bugs as well as toxins released from their dead body.


In my opinion you cannot use 'herx' term for any deterioration of your symptoms.
So writing that you have been just sitting at home without any treatment for the last year and you have been herxing is very incorrect. In fact, you probably have a relapse or your symptoms got worse from electrolyte imbalance. Chance that this is true 'herxing' is zero.


Herx is death of any spirochetes when they die it is dead pieces that are toxins this occurrs usually only by abx's.

That said I know that before treatment when I would get high fevers every once in a while and fever is the bodies way to deal with infection you could possibaly call that a herx. Because of the death of so many spirochetes = toxins.

The more spirochetes the worse the herx on abx's and when they cycle every 28 to 34 days in me massive herxs would happen but I also herxed for long periods also heavy load of spirochetes but when it ie cysts opened every 30 days wow what a herx could hardy handle it like the worst flu ever.

Medical Dictionary
One entry found for Jarisch-Herxheimer reaction.

Main Entry: Jarisch-Herxheimer reaction
Pronunciation: y-rish-herks-h-mr-
Function: noun
: an increase in the symptoms of a spirochetal disease (as syphilis, Lyme disease, or relapsing fever) occurring in some persons when treatment with spirocheticidal drugs is started -- called also Herxheimer reaction
Jarisch, Adolf (1850-1902), Austrian dermatologist. Jarisch published his description of the Jarisch-Herxheimer reaction in 1895, seven years before Herxheimer published his own description.
Herxheimer, Karl (1861-1944), German dermatologist. Herxheimer published his description of the Jarisch-Herxheimer reaction in 1902. In that same year he also described acrodermatitis chronica atrophicans.


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Areneli
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The more correct description of periodic symptomatic reactions may be:
cyclic exacerbation of symptoms or
unidentified exacerbation of symptoms
flare
or something like that.
(there should be an acronym for them)

Herxing is ONLY for reaction that typically occurs a few days after ABX treatment or after ABX dose increase.

[This message has been edited by Areneli (edited 20 January 2005).]


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lymelady
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I herx no end on meds, which is without variance.

However, I have an every other day pattern: one day not so bad, next day terrible.

Started this pattern before meds were taken. Tests showed I have a "very good" immune system (shocker). Could the every other day pattern be my own immune system killing off keets?

On meds every other day pattern still there but less definite cuz good days are worse and bad days are worse.

Oh for an answer to that one, I would give almost anything!!
Lymelady


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daniella
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You REALLY need to know that.....People can herx for days, months, and possibly even years depending on how sick they are.

[This message has been edited by daniella (edited 22 January 2005).]


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hatsnscarfs
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I herx during the "cyclic exacerbation of symptoms". It was worse when I switched antibiotics but has also occured without switching.

Plain & simple when more Lyme becomes active each monthly Lyme Cycle, the antibiotics have a lot more to kill. When a lot of Lyme is killed more toxins are created causing a herx.

The herx symptoms are very different from my normal Lyme symptoms.

I learn a lot here on LymeNet from reading other peoples experiences & opinions. No need to be judgemental, I just take what I like and leave the rest. I don't pass myself off as an expert and certainly don't post replies to tell people they are wrong or to correct their grammar etc.

Proper, correct whatever. I ONLY am sharing my personal experience on this board. If someone else's experiences are different from mine that doesn't mean one of us is wrong or in need of correcting, particularly by a self appointed authority.

Get the Point?

h&s


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Areneli
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Daniella,
Talk to your doctor if you don't believe me.
I suspect that if he accepts your 'herxing for months' only because he has no time to explain you the difference but he understands that you mean flare or exacerbation.


I hope, that the next time you will show us smiley face instead of the ugly one.

Again, change of symptoms can be has caused by many things - often it is not herxing.

[This message has been edited by Areneli (edited 21 January 2005).]


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robi
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Areneli.....what is your agenda here?
You must understand that many you are addressing here have been at this a long, long time and have done a lot of research.

I have found that when I am "new" to a group it is best to "sit back", ask questions and reserve my judgement for a while until I am trusted by the group.

You may or may not have good info.....I am not passing judgement on yor info. Perhaps the presentation is a bit too direct for someone so new to this board.

Yo must remember, most if not all of us have been screwed my the medical community and it's standard lines about lyme......we know from personal experience that researched and published material on lyme is simply wrong in many instances.

So quoting mediacl references rearding herx and or lyme really is meaningless ...... personal experience goes a long way.

Also, I tend to believe my LLMD who helps me muddle through the mainstream medical bull**** which you seem to be relying on.

Do you have Lyme? Are you seeing an LLMD?

robi


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Areneli
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I see your clear attempt to patronize me. I have to warn you that it won't be easy.

Part of the problem why research in Lyme is so poorly invested is common disconnection of patients (and some doctors) from medical science. Lets better be as specific as we can in expressing our symptoms.


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cindy_leigh
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whatever Areneli's reason for posting this...

My LLMD says a herx is only from a die-off related to abx.

A flare up of sx he refers to as "blebbing", for instance when feeling worse, or worsening of sx, when not on abx.

i was calling all increase is sx a herx, and the LLMD corrected me.


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daniella
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ugh...

[This message has been edited by daniella (edited 22 January 2005).]


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robi
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I am not trying to patronize you. Nor am I looking to be challenged. Believe me, I have more than I can handle right now and don't need another project.

Guess, I was trying to suggest that there are folks here that know a lot and have been around a long time.

I am trying to get well....I have no other agenda here on lymenet.

Hope you get well too. I'm done with this as all I was attmpting to do was make a kind suggestion.

Peace and healing,
robi


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treepatrol
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quote:
Originally posted by cindy_leigh:
whatever Areneli's reason for posting this...



http://flash.lymenet.org/ubb/Forum1/HTML/030829.html


[This message has been edited by treepatrol (edited 21 January 2005).]


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fish
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I believe also that lyme patients often misuse the term herx.

When a person has a large germ load and starts an antibiotics does it kill every spirochete the first round? We know the answer is no or we wouldnt all be here.

So what is happening to all the other spirochetes in our bodies when we begin the attack? Some die and then we have the Herxheimer. Meanwhile, all the other bugs in the body are still going on having a field day. If we're sick enough, it's virtually impossible to know where the Herx ends and simply feeling sick from remaining lyme begins.

This is quoted from the widely accepted Denise Lang book called "Coping With Lyme Disease" 3rd ed. pg. 176. The last paragraph under the heading The Jarish-Herxheimer Reaction says

"Generally, the longer the time between the initial dose of medicine and the Herxheimer, the more disseminated the disease and the longer the treatment may be needeed. A Herxheimer reaction can last from two days to two weeks, so a doctor's support is critical."

I used to say to my LLMD that I was herxing for 2 months straight. He corrected me too. Whatever was still left in me, was causing the worsening of my symptoms, not the Herxheimer reaction, once several weeks goes by. He also said that we can herx at the 28-30 mark as well.

I have even see posters in the past say they "Herx" like ONE HOUR after popping a new pill for lyme! Read Dr. Burrascano's guidelines to see that this is not possible.

pg. 10:

"Because it takes 48 to 72 hours of therapy to initiate bacterial killing, the Herxheimer reaction is therefore delayed. This is unlike syphilis in which these reactions can occur within hours."

I believe that Lymenet is a very accurate, informative site on the whole. But this was a good point, bravely brought up, that I have noticed as inaccurate as well. Ream me out if you like, I'm only quoting reputable sources. There should be plenty of articles out there about the nature of the herx reaction.

Respectfully,

Leslie

editing for typo

[This message has been edited by fish (edited 21 January 2005).]


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treepatrol
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I can tell you this I had three strains of lyme and numerous coinfections I herxed every 28 to 34 days and it was a herx plus when I went off abxs and came back on again quickly like 2weeks, I herxed for 3months straight at verying degrees my body was so over loaded with infection it couldnt clear itself fast enough thus felt like ongoing herx as a result.
Iam convinced that when your so overloaded from so many types of dead decaying bacteria (not all bacteria) spirochetes and some others your system cant clean itself fast enough then as a result of the first true herx then another strain starts up at a different cycle bingo you have a ongoing herx reaction then say the third strain kicks in you have one long herx. Or call it a overload of your systems ability to remove these toxins.
I had this long enough to recognize herxs, symptoms, etc. Delt with symptoms since 1988 delt with herx's since 2000 and thats my opinion, Since Drs are never wrong I guess Iam haha

Think Continual Cascade with a cork stuffed in the bottle.

BORRELIA NEUROTOXIN (With thanks to Dr. Shoemaker)

Two groups have reported evidence that Borrelia, like several other bacteria, produce neurotoxins. These compounds reportedly can cause many of the symptoms of encephalopathy, cause an ongoing inflammatory reaction manifested as some of the virus-like symptoms common in late Lyme, and also potentially interfere with hormone action by blocking hormone receptors. At this time, there is no assay available to detect whether this compound is present, nor can the amount of toxin be quantified. Indirect measures are currently employed, such as measures of cytokine activation and hormone resistance. A visual contrast sensitivity test (VCS test) reportedly is quite useful in documenting CNS effects of the neurotoxin, and to follow effects of treatment. This test is available at some centers and on the internet.

It has been said that the longer one is ill with Lyme, the more neurotoxin is present in the body. It probably is stored in fatty tissues, and once present, persists for a very long time. This may be because of enterohepatic circulation, where the toxin is excreted via the bile into the intestinal tract, but then is reabsorbed from the intestinal tract back into the blood stream. This forms the basis for treatment.

Synthetic fiber agents, available by prescription for the treatment of high cholesterol, have the ability to bind some bacterial toxins. When take orally in generous amounts, the neurotoxin, present in the intestinal tract, binds to the resin, is trapped, and then excreted. Thus, over several weeks, the level of neurotoxin is depleted and clinical improvement can be seen. Current experience is that improvement is first seen in three weeks, and treatment continues for two to four months. Retreatment is always possible.

Mine also removed themselves through my sinuses like haveing a wicked cold.


Have a nice day


[This message has been edited by treepatrol (edited 21 January 2005).]


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GreanPea
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Ok.

I usually stay out of these arguments, but I've got to say, I'm thinkin' the ol' H word is, indeed, overused and abused. Unintentional, as it were, but true.

There have been several posts on here pleading with us lymies to not assume, every time we feel worse and worser and worserer, that it's a herx.

I don't have the time or energy to do a search, but the posts are out there, describing how some of our members have checked into things that were going wrong with their bodies that actually turned out to be something ELSE going wrong, and not just a temporary worsening of lyme symptoms due to spirochetal die-off.

Sometimes "new and improved" symptoms are actually something unrelated to lyme.

It's important to acknowledge this possiblity to yourself.

On one hand, you may just assume a virus is a herx. No harm done. It works it's way thru your body and your done with it. Sooner or later the herx/virus is over and you feel better.

But on the other hand, by assuming, when you start to feel worse in new and different ways, that you are just herxing again can be dangerous. You may be ignoring something serious and unrelated to lyme that needs medical attention from someone other than your LLMD.


Please don't flame me for this. I'm not judging anyone for anything they've said. Just giving some food for thought and MHO.

Hoping this helps someone,
Pea


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bpeck
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The accepted definition of the herxheimer reaction, is the body's systemic immune response to the Lipopolychaccarides (LPS) given off by dying gram neagtive bacteria.
The release of LPS can also be either exacerbated or dampened by certain antibiotics.


In my opinion, it is used incorrectly when used to describe localized reactions in specific parts of the body (when using abx).

IMO, there probably is an increase in inflammation in localized areas in response to abx (and the bacteria) that maybe needs a NEW definition or term. - But that's not a systemic response - so IMO should not be called a Herx. In my opinion, that's where the confusion (and areguments) arise.

Gram neagtive baceria can release LPS when they replicate and morph (and make us feel crappy)- but not in the quantities they do when they die en masse... and I don't consider that a true herx, by definition.

If you do some reading on Sepsis (which can serve as a model for Herx in some instances) there are quite a few papers which discuss abx when dampen LPS expressing when bacteria die. The only good papers on Herx are in reference to relapsing fever or syphilis
( both spirochetes).

Barb


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TheCrimeOfLyme
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There's been plenty of times I have used the word herx wrongfully. FOr me, I got so used to the dreaded herx, that any time I felt like pure crap, I just called it a herx.

But, there have been times when the meds just were not working, or I was too toxic, or I needed a different med, or hey- guess what.. I still had lyme, so I was feeling the ramifications of that beating me up.

In any case, I took a fine tip permanent marker, a white t-shirt and in big words wrote

MOVE on one side

and IM HERXING, DO IT YOURSELF on the other side.

Doesn't matter if I was virusing, fluing, strepping, herxing, yeasting, mood swinging. I just knew I felt like crap and didnt want bothered.

Always worked- the shirt. Go figure. I'm PMSing now.. gonna have to pull the sucker out.



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beachcomber
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Am chiming in only because I just had this discussion with my MD. When I first started treatment he expalined that I may experience a J. Herxheimer reaction in 3 - 4 weeks when I have a high load of dead spirochetes that my body needs to evacuate (not his exact words). He also said that at that time it is possible to test more positive because the antibodies are working double time because the chetes lives are cyclical - hence, bigger die-off when more active infection.

On week number 4 of my first round of Doxy I was retested and my antibody levels were much higher (more positive) than 4 weeks prior. I also was feeling like I might die from what I call a herx. We did the test so that he could show me (in layman's terms) what he was describing.

The same thing happens with Candida. Your body has to deal with the toxins and it hurts.

It makes sense that you will feel worse about every 4 weeks becasue that is the approximate cycle of the spitochetes. When they are "awake" and your abx are killing them, you will feel lousy as the body tries to deal with high load of crap floating around. (How's that for a technical explanation)?

Anyway, I started a dose of Zithromax 4 weeks ago. Last week I thought I was going to die (again). I called my MD and he re-explained the herxheimer reaction. And, he was quite pleased that this was happening, as he feels the abx is working.

The time in-between when I feel like something on the bottom of a shoe, is not technically a herxheimer reaction but, it is a bad feeling that is associated with both the Lyme itself and the dead debris that takes quite a while for the body to clean up. So, in a sense, if the abx is working full-time, it is not unreasonable to assume that I am having small herxheimer reactions to episodal die-offs.

Yes, the term may be overused. But, the bottom line is that most people on this board understand how sick someone feels when he/she says "I am herxing". It is loosely used to describe an exacerbation of symptoms or a die-off reaction.

I am a stickler for accuracy but, I don't care too much if the term is used "correctly" or not, as I think it is the only way some of us have to express a bad feeling. I also firmly believe that everyone has a different herx cycle, and it can't be discounted that someone might actually feel a prolonged herxheimer reaction.

My MD has me keep a daily journal. This helps both of us to know my cycle and we can pinpoint what is a herx and what is just feeling like crap from Lyme in general. It helps me to understand what the difference is and to know my body better.

I wouldn't get too twisted in knots over the use of the term herx. Basically, when someone says they are herxing, it means they feel like s.........t.

Bc


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GreanPea
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Just for the record, I don't have a problem with the misuse associated with using 'herx' to describe feeling awful... that's just symantics.

Yes, we all know what a lymie means when he or she says "I'm herxing".

Nevertheless, I posted here because, IMO, it is IMPORTANT that us lymies NOT ignore symptoms that can be unrelated to lyme, thereby putting ourselves at risk for becoming dangerously ill in some OTHER way.

Listen to your body, and don't assume that everything that makes you feel bad is lyme.

Like I said above, if you assume that, say, a virus, is a herx, no big deal. No harm done. BUT if you assume that something MORE SERIOUS is a herx, and try to 'ride it out', some MORE SERIOUS HARM may be done before you know it, or later down the road.

I really don't care if someone describes whatever ails them as a herx. Fine. To each his/her own.

The important thing is that people don't resign themselves to suffer through everything that goes wrong, thinking 'herx', because they may be ignoring something that needs to be attended to sooner than later.

Again, hoping this helps someone,
Pea


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beachcomber
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Well said, Pea.
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GreanPea
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Thanks, Beach. I just hope it helps.
Pea

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flygirl
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good topic
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Recipegirl05
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TREEPATROL has named him/her as a TROLL in the l0th reply down.

http://flash.lymenet.org/ubb/Forum1/HTML/030829.html


TROLLS are huge "time wasters: whose aim is to cause eventual KAOS on the board.


Don't feed the TROLLS.


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GreanPea
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Whether or not this person is who or what you say he/she is,

and whether or not we are at risk for CHaos...

..IMO, this is a worthy topic the reasons for which I state pretty clearly in my post.


Pea

quote:
Originally posted by GreanPea:
Just for the record, I don't have a problem with the misuse associated with using 'herx' to describe feeling awful... that's just symantics.

Yes, we all know what a lymie means when he or she says "I'm herxing".

Nevertheless, I posted here because, IMO, it is IMPORTANT that us lymies NOT ignore symptoms that can be unrelated to lyme, thereby putting ourselves at risk for becoming dangerously ill in some OTHER way.

Listen to your body, and don't assume that everything that makes you feel bad is lyme.

Like I said above, if you assume that, say, a virus, is a herx, no big deal. No harm done. BUT if you assume that something MORE SERIOUS is a herx, and try to 'ride it out', some MORE SERIOUS HARM may be done before you know it, or later down the road.

I really don't care if someone describes whatever ails them as a herx. Fine. To each his/her own.

The important thing is that people don't resign themselves to suffer through everything that goes wrong, thinking 'herx', because they may be ignoring something that needs to be attended to sooner than later.

Again, hoping this helps someone,
Pea



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duramater
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Like Pea, I personally have no attachment to how people here use the term "herx" (as I know what is intended by this description) although I think the original poster has a valid point.

Originally by J & H themselves and subsequently in the literature, the "herx response" is meant in a very specific and measurable way. The precise biochemical cascade that causes the J-H reaction has garnered a lot of data and is still being researched. Overall, the herx reaction in the literature seems to be different than the "herx reaction" used here colloquially to describe the flares that occur in peoples' symptoms during treatment.

Of course, this difference between how J&H meant the term and how it tends to be used oftentimes by us with Lyme is one of the things that "Camp A" points to when saying how hysterical we are. Evidently "Camp A" is not as forgiving on these terms as is Pea, myself, and others :-)

No doubt some of the reactions people have on the first day or two is a J-H reaction as it is measured and meant in the medical literature. Whether the continued/cyclical flares in symptoms we experience are due to the same biochemical reaction as that described in the literature is actually an open question.

Guess one of has best get better and get to doing some research, eh?


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lymiecanuck
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Hi

My new lyme doc just told me the other day that it is not a herx unless you have some kind of skin flare like rash itchiness etc.

I have had a bad week and BANG, two lyme rashes on my butt, couldn't beleive it. I am in my 8 week of treatment. The rashes were gone in 24 hours and the times I had this rash before they lasted 3 weeks. I didn't even KNOW they were lyme rashes!!!!
I have been getting them off and on for 13 years!!!!!

Oh, what you learn. Just for the record I feel I have had herxs without such obvious rashes but with itchy nose, scalp and rednesss and this too is what he was trying to relate to me.

Lymiecanuck


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Mo
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Anybody here who can definatively identify Herx vs. flare with ease please share it with the Lyme community!

We really could use that skill!

My very basic understanding is based on syphillis literature and experience..

True "herxing" by definition is an actual die off reaction (mainly toxins and garbage in the blood)..that comes from initiation, change, change in dose of abx.

That said, I know one can "Herx" from aggressive, effective alternative methods that actually kill bacteria as well.

That's why detox measures and open pathways are always important.

Certainly a form of Herxing could be seen as a "healing crisis" in alternative medicines or immunotherapy..

Body clearing bacteria, even a strong immune system can do this..like when we are fighting the flu. Even alternative immune system therapies can cause what therapists who work in it will sometimes call a Herheimer.
(though a Herxheimer reaction caused by our own body's immune response will never become dangerous to our systems, as a Herx from abx's can at times)

I think they also refer to Herheimer reactions during the MP.

Sure, the origional definition came from die off reactions in response to abx, but stretching that definition to encompass whenever bacteria may be dieing..doesn't seem entirely innacurate to me.

There are monthly cycles and flares to these bacerial colonies, during which time my best guess is we may be having both a Herx and a flare (active infection)..at the same time.

I think what's important for patients is to differentiate that slowly getting worse and worse is not likely a Herx, but could be inneffective treatment regimen or the existance of another infection, super-infection, co-infection, toxicity...on and on..

So the message most prudent IMO is that we remain carefully on the lookout, and listening to our bodies, and coming to know and understand what is die-off in our cases, what is toxicity, what is unidentified infection, ect.

Everyone is different ..but the general rule for us is following regimen change, if we feel very mush worse rather quickly, we are having some die off.

Herx's on abx in my house have varied in lenghth dramatically..my son had four months of doe off (straight) upon initiation of Rocephin for a very high load of borellia in his brain..

Has had shorter duration upon initiating various meds for co-infections..ect.

His monthly flares are short, around the full moon, and he does I think experience some die off then, so is a bit "herxy"..but also flaring.

My daughter (a toddler) would have hard hitting JH's whenever a new mwd was started.
They lasted a week or two..

I had a three month one once that was intense, and others that were one or two symptoms of pain or specific neuro-symptoms that would last weeks.

To me, when these things happen with a med change, it is mostly JH happening, and detox can help some.

When it happens in cycles while on the same regimen a while, I am unclear as to how much is die off and how much is flare, but my gues is both..

Then there's toxicity, yeats, parasites..on and on to consider..

Even in immunotheraputic alternative approaches (as I have used when my little one went off abx's last summer)..

We saw a period of fluey fatigue, agitation, some pain..

So as her immune system took over, she also "herxed" I guess..
The way you do when your body fights and clears infection.

I don'r see any point in argueing what it is supposed to mean according to science, ect..

More to the point that we keep exploring this maze and always watch ourselves closely and keep learning.

The people I see have gotten well are doing that, it's really the only way!

Mo


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