I'm going to make believe I'm Dr. House for a minute, consulting with my team on a patient. You guys are the team.
The patient is a 22-year-old male with a generally healthy background except for some allergy and sinus problems. He is currently finishing up his B.S. in Business and also working part time in shipping and receiving in a local factory. Since he was 14 he has also been doing outside work to earn money - mowing, clearing brush etc. He lives in a small rural town heavily surrounded by woods.
Approximately 3 years ago he had an episode of pain in the knuckles of both hands and he blamed it on whatever work he had been doing. At the same time he had an odd rash under his arms and he blamed this on the fact that his brother sometimes borrowed his deoderant. Also at the same time he had a very noticable drooping left eyelid which his mother thought was probably sinus related. His aunt, a chronic Lyme patient, suggested he get checked out by a LLMD but you know kids -- denial!! At some point not much later he was put on first Doxycycline and then a sulfa antibiotic for an extended length of time - maybe close to a year - by his dermatologist, for a moderate acne problem. His aunt hoped that if he did have Lyme, this would take care of it.
For the last year 1/2 +/- he has been getting gradually more and more fatigued until he now says when he gets up in the morning he often feels just as tired as when he went to bed. He has intermittent fevers which last 3-5 days and which a local clinic told him were viruses. He has night sweats, aching and heaviness in his arms and legs, and occasional shortness of breath without exertion. He is sometimes light-headed. He can no longer do the same amount of activity he is used to. He was a runner in local road races and always came in the top 1/3 but he is now too tired to do much less strenuous things, never mind racing. He sometimes has heart palpitations when he is feeling especially weak.
As he is now uninsured, his grandparents convinced him to go to a regular doctor and offered to pay for the visit and for any tests. The doctor ordered bloodwork to check for anemia, thyroid, glucose, and vitamin panels. The doctor also ordered a Lyme ELISA with a "reflex" Western Blot, meaning that the lab will wait and see if the ELISA is positive and if so, go ahead and do the WB.
His aunt is not happy about the ELISA.
So, guys, what are YOUR "differential diagnoses?"
[ 05. October 2006, 10:52 AM: Message edited by: Laurie ]
Posted by minimonkey (Member # 8693) on :
My guess would be late lyme, and possible babesia (with the sweats, etc.) -- ELISA is almost useless, as we know. I'd want to test for all co-infections given his history of outdoor work, etc.
BTW -- I LOVE the show House. I actually have to walk with a cane at the moment due to my hip acting up so much, so I like to pretend I'm Dr. House, too!
So now, Dr. House, you are supposed to come on here and say some demeaning and sarcastic things to prove me wrong.... LOL.
Posted by SForsgren (Member # 7686) on :
Sounds like Lyme is possible. The drooping could have been an episode of Bell's Palsy also caused by Lyme.
A year of doxy alone won't resolve chronic Lyme in most cases. Not sure about the Sulfa drugs but generally don't see those being used for Lyme much.
Night sweats sounds like Babesia. Shortness of breath sounds like Babesia. Heart palpitations also common with Lyme.
I am not Dr. House, but I would be getting the tests done ASAP. ELISA is useless, WB from most labs is useless. If you are dealing with Lyme, you need a doctor that knows how to test and treat. The ELISA is the most useless test for Lyme known. Lyme doctors generally don't even order it.
Given what you have indicated, I would rule this out first. Then, I would check into mold-related issues. Maybe read the book "Mold Warriors" but Lyme sounds more likely.
Posted by LYMESCIENCE (Member # 9259) on :
Hey folks, Dr. Steere here to make sure you have a correct diagnosis. From her history, I'd ignore the blood testing, no arthritis is mentioned, and no further blood testing is required, give this patient anti depressants and diagnose Chronic Fatigue Syndrome, and tell him to stop being such a wimp.
Hope this helps, nothing is worse for the patient than an incorrect diagnosis.
Cheers:)
Posted by luke339 (Member # 8580) on :
Skip all the hubbub and get a western bot from Igenex. http://www.igenex.com/ Call them and order western blot testing materials (they are free). They come with directions so that the doctor can perform tha blood draw and send it fedex back to the lab. He will then get his results in 7-10 business days. This is the best way to find out what is going on.
Symptoms sound like Lyme, also needs to be tested for co-infections but one step at a time. Get western blot and if any bands show up that are lyme specific then that would be a good indicator other tests are needed.
Posted by trueblue (Member # 7348) on :
If I was one of your team, Dr House... I would order tests from a reputable lab for Lyme and Babesia.
Or alternately get him to an LLMD that can make a clinical diagnosis and do a challenge to see if starting Babs and/or Lyme treatment flares him.
In the meantime, maybe we should just pray he's one of the lucky one's and actually pulls a positive Elisa and a WB is run.
As myself, obviously having no medical training, I think a lot of his recent symptoms sound like the Babesia. They sound an awful lot like mine. I have Babesia that is yet untreated. *crosses fingers, knocks wood* Hopefully, it'll be taken care of soon.
Posted by kelmo (Member # 8797) on :
Speaking of Dr. House. He said something last night that was so appropriate for those who have been tested for Lyme and have been given a false negative.
When he asked the team to retest a man's bloodwork, he said, "You can go to the ocean and get a cup of sea water, but you aren't likely to get a fish in it. But, that doesn't mean there aren't fish in the ocean".
Posted by Laurie (Member # 159) on :
The bloodwork could pick up something else, of course, but even if so, doesn't mean he doesn't have Lyme, and his aunt (that's me, maybe you guessed) has convinced him to at least request a Western Blot at his follow-up visit, no matter what. It won't necessarily be from a LL lab, which certainly could cloud the issue, but you can bet that no matter what we will get him the Igenex test (just trying to think of a doc around here who will agree to do it...you can't just take the kit to a blood drawing place and ask, can you?)
Anyway, I heard Dr. House say that last night too. I loved it. My LL PA has said the same thing about my spinal tap, which was negative -- "just because you can't catch a fish, doesn't mean there are no fish in the ocean, does it?" In other words absence of proof is not proof of absence.
I can't think of some sarcastic thing to say to my team just yet.
Posted by Aniek (Member # 5374) on :
Not a diagnosis, just some advice.
Is there anyway to get him some health insurance ASAP? If he does have Lyme, better to get the insurance before it's known. It could be a lot harder to get insurance afterwards.
If he gets insurance through a job, he could have to wait up to a year to have pre-existing conditions covered.
That said, don't forget about the babesia. Night sweats, lightheadedness and shortness of breath.
Posted by Laurie (Member # 159) on :
Yes, he sure sounds co-infected with babesia (so am I).
He may be able to get short-term health insurance from the Alumni Assoc. of his university once he becomes an alumnus, and that should be the end of June as he still has one more 3-credit crash course to take to get his diploma.
At that time his work indicated to him they'd hire him 40 hours. When this happens (no promises it will) he will have to wait 3 months just to get insurance. I hadn't thought about the pre-existing condition condition. You're quite right. Dammit.
Posted by hurtingramma (Member # 7770) on :
You can get the kit from Igenex, but a doc has to sign off on it.
Posted by lymie tony z (Member # 5130) on :
Don't take it too too hard auntie....
No one listens initially...we're all just wacko's don't ya know.....zman
Posted by liz28 (Member # 4946) on :
You can order Nutricology artemisinin online and do a babesia challenge test. Remember, though, that there's all sorts of bugs out there to be worried about, not just babesia:)
If you do have some sort of babesia/malaria, welcome to one of the most hotly debated subjects on Lymenet. Definitely go beyond this forum and read as many malaria and travel medicine websites as you can. Not only will you get the scoop on the many medications which babesia patients borrow from the malaria community, but you will know more about the various tropical bugs which are moving into the U.S. thanks to the warming climate. My mother actually called to tell me how Dr. House had discovered plasmodium vivax (relapsing malaria) in one of his patients, the poor guy. You remember, the one where the journalist is about to get married...
I caught my babesia in a coastal tourist town surrounded by marshes, which draws visitors from all over the world during the summer, tons of mosquitos and other bugs, and rampant deer herds that wander through people's backyards. Unfortunately, it is no longer outlandish to think about these tropical bugs that once stayed put in exotic, far off locales.
Posted by Laurie (Member # 159) on :
We have lift-off.
Nephew went to get the results of all his bloodwork today. Fortunately, it all came back normal - all except for LYME DISEASE. And this was an ELISA, not even a WB (at least I think it must've been an ELISA, the test form said "Lyme AB With WB Reflex.")
Now you'd think things would finally be getting along, wouldn't you? Nope, this doctor is waiting for confirmation by WB - could take two weeks - and only THEN will he treat nephew, with 30 days of abx. Hey, I'm relieved enough to kiss the ground that he did test + for Lyme (though I am 100% sure he's co-infected with babesiosis), but I'm not happy with the way his doctor is proceeding, of course.
Hey beloved nephew - welcome to my world.
Auntie Laurie
Posted by Thereminator (Member # 8324) on :
Great news Laurie,thank the gods of chance! I saw that episode of House and when he said that,I was surprized. Thats EXACTLY how the PCR test was explained to me! Alan