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» LymeNet Flash » Questions and Discussion » Medical Questions » THE MOST SCARY LYME ATTACK EVER-never thought that it could be.

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Author Topic: THE MOST SCARY LYME ATTACK EVER-never thought that it could be.
NeuroEcclectic
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Fellow Patients,
I have been a Neuroborelliosis (Neuro-Lyme) patient since 2006. I am a young male who was nearly

diagnosed with MS whose first attack was Acute Transverse Myelitis (ATM). The proverbial internal voice

was certain that I did not have MS; Though for the entire year as I tried to find answers for my symptoms,

which all story told ended up being some 67 symptoms, I, through internet searching was certain that it had

to be Multiple Sclerosis. But when I found out that I had multiple lesions on my brain and cervical spine-a

bell went off in my mind that it was not the so-called etiology- ``MS.'' I was finally able to get my hands on

the radiological report after a general Connecticut doctor said, ``There are no if ands or buts-you have

MS!'' ``Could it be anything else I asked?'' My question was trite to him, ``NO!'' he said tersely. However,

the report stated ``suspicious for MS plaques, however, Lyme disease should be considered through clinical

correlation>''

Thanks to that I report I found my proper diagnosis by way of Dr. P in Connecticut.


I went through many horrid neurological attacks and thought that they were over until last Thursday. I had

a gradual onset of the following symptoms, very scary symptoms rather: I was lucky to have found Dr. M

for the following problems:

1. Diplopia
2. Dysmetria.
3. Lateral Gaze.
4. Convergence insufficiency.
5. R Auxiliary lymph-node pain.
6. Ataxia.
7. Fatigue.
8. Topical Numbness about the Lower Trunk and R Thigh.
9. R Leg stiffness.

...to name a few. I just want to say that I am afraid.

Jack.

Posts: 123 | From Seattle, WA | Registered: Oct 2008  |  IP: Logged | Report this post to a Moderator
Dekrator48
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Hi Jack,

I am sorry that you are going through such a scary time right now.

You have been through alot already, so you know that you can make it through this too.

As long as you have a great LLMD who will address your current problems thoroughly, you should have every hope of recovering from these symptoms.

What has your LLMD told you about your new symptoms and what is your current treatment for this?

Is he ordering an MRI to rule out any new problems?

Keep the faith. Many very ill people have made their way back to normalcy. I will pray for your recovery.

--------------------
The fibromyalgia I've had for 32 years was an undiagnosed Lyme symptom.

"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". -Jeremiah 29:11

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NeuroEcclectic
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Your prayers are HUGE and I love you for it. She is an ND and this is what she wants me to do:

PHARM:
Tobramycin 2 drops 4 times a day.

3 days doxy @ 200 MG.
after that - 400 MG doxy a day.

Biaxin 500 MG daily.

Wait 5-7 days then:

SMZ/TMP (Bactrim) RS 1 tabe 2x daily.

NATURAL:

Theralac 2 caps daily.
Saccro B 2 caps daily.
B12 20 drops 2x daily.
B Complex 4 drops 2x daily.
Trace Minerals 4 drops 2x daily.
Taurine 500 MG 23x daily.
Omega 3:6:9 tsp 2x daily.


Your thoughts please? She is my new doc and I barely know her...She claims that she went legally blind for 2 years.

Jack.

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Keebler
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-

Hundreds, if not thousands of neurolyme patients are first wrongly dx with MS. They get lyme treatment and often get better. You can do a search here of dozens of previous threads with "MS" in the headline.


Glad you found a LL ND (is she also a member of ILADS?) If she also does acupuncture, that will enhance your treatment tremendously.


It looks as if you are in excellent hands. This will not be an easy treatment (it never is), however, it appears that your doctor is very well educated about lyme.


I assume she has informed you that, for neuroborreliosis, treatment is always at least 30 weeks, or a year or more - with adjustments all along the way.


Taurine dose seems off. Is that 23 drops a day? 23 pills a day would be way too much unless homeopathic. But the coding seems off for the way homeopathics are usually done. Still, taurine is your primary liver support, from what I can see. It is excellent for neuro stuff, too.


Whatever you do, be sure to take your taurine. It will help make the Tobramycin tx easier for your ears. Never go over the amount she Rx for you of the Tobramycin. It is powerful and too much can damage ears. At just the right dose (and you are starting a very low dose which is good), and with the taurine in you plan, you should be fine staying with what she instructs.


Have you read Singleton's book and Burranscano's guidelines so that you understand the self-care stuff that you can do to make this easier?


Has your new LL ND suggested any reading materials or given you self-care instructions? An action plan (that includes both "active rest" and non-aerobic movement) can replace the fear.

And, daily activities that are totally NOT health related are important, too, even if that's just looking at travel magazines.


Best of luck.


-

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Keebler
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-

from BettyG who copied the entire article here, breaking it up for those who neuro lyme to be able to read more easily.


http://www.ilads.org/lyme_research/lyme_articles7.html


Controversies in Neuroborreliosis
**********************************

Audrey Stein Goldings, M.D.

Updated October, 2002


The objectives of this article are to cover issues related to Lyme disease that are not even-handedly addressed in the current literature. It will:


Present a practical approach for making the diagnosis of neuroborreliosis,

Explore the other side of the post-Lyme syndrome (i.e. the likelihood of chronic ongoing infection),

Discuss the relationship between MS and Lyme,

Critique the current regimens published for treating neuroborreliosis, and

Present my own approach which may differ from some leading authorities.


``Anyone who, in discussion, relies upon authority uses not his understanding but rather his memory.''
--Leonardo da Vinci, Notebooks (c. 1500)


It is hoped this data will provide the reader with a broader understanding of neuroborreliosis so that he or she may better use current and evolving knowledge for clinical decision making.


I. NEUROBORRELIOSIS: MAKING THE DIAGNOSIS


Because of difficulties in making the diagnosis of neuroborreliosis, the physician will need a familiarity with the most common forms of presentations, which will be emphasized.


The following points will help evaluate the patient for neuroborreliosis:


For most patients, systemic features of disease coexist with, or predate, neurologic manifestations.

Both central nervous and peripheral nervous system involvement is frequent with Lyme disease and typically occur together.


Laboratory data may or may not confirm the diagnosis, and other disease in the differential diagnosis must be evaluated thoroughly in cases where diagnostic ncertainty exists.


Although history of exposure to B. burgdorferi should be sought, for various reasons, patients may not remember a history of a tick bite, or the pathognomonic rash particularly if the disease is presenting years after the exposure.


Early on, personality changes, psychiatric symptoms, or cognitive manifestations may be the first, and occasionally the only, symptoms that the patient or family is aware of.


CLINICAL DESCRIPTIONS OF NEUROBORRELIOSIS
******************************************


CENTRAL NERVOUS SYSTEM INVOLVEMENT

Meningismus with normal CSF
Lymphocytic Meningitis
Meningoencephalomyelitis
Subacute Encephalopathy (SAE)
PERIPHERAL NERVOUS SYSTEM INVOLVEMENT


Cranial Neuropathy
Painful Radiculitis
Distal Neuropathy
Plexopathy
Myositis
Polymyalgia Rheumatica


CENTRAL NERVOUS SYSTEM


MENINGISMUS

Patients may present with headache and stiff neck without evidence of CSF inflammation.


Since early CNS seeding has been described, as well as culture positivity during latent disease without concurrent CNS inflammatory changes, these symptoms probably indicate active infection.


Stiff neck might alternatively be due to axonal degenerative changes of the cervical paraspinal musculature, but there should be other evidence of a more widespread neuropathy when this is the case.


LYMPHOCYTIC MENINGITIS

Lymphocytic Meningitis may appear to be indistinguishable from aseptic meningitis during early-disseminated disease (weeks to months after inoculation with B. burgdorferi).


Most patients will have headaches that will fluctuate in intensity. Associated features may include a cranial neuropathy in about one-third.


Low-grade encephalopathy is present in up to one-half, with mild memory concentration deficits, mood changes, and sleep disturbance.


MENINGOENCEPHALOMYELITIS

Rarely, focal parenchymal CNS lesions occur.

The MRI may show punctate white matter lesions best seen on T2-weighted images; larger lesions occur infrequently.


One brain biopsy showed increased numbers of microglia cells, rare spirochetes, and minimal inflammation. Transverse myelitis, movement disorders (extrapyramidal cerebellar, chorea and myoclonus), and hemiparesis can occur.


PSYCHIATRIC DISORDERS

Psychosis, mood swings (mild or bipolar), profound personality changes, depression, anorexia nervosa, obsessive-compulsive disorder, and panic attacks may occur. CSF may be normal.


SUBACUTE ENCEPHALOPATHY (SAE)

The most common chronic CNS manifestation is a SAE, characterized by memory problems and depression.

Many patients (or their families) will complain of their excessive daytime sleepiness and extreme irritability.

These patients generally come to the office disorganized (despite a supreme effort to be organized), unable to give a coherent history.


They will bring copious notes, which are invariably in the wrong order.

Most patients will complain of fatigue, and about one-half have headaches.

Coincident polyneuropathy is very common with spinal or radicular pain, or distal paresthesias.

Quantifiable deficits in memory, learning and retrieval, attention and concentration, perceptual-motor skills, and problem solving are common.

MMPI testing generally shows a stable psychological pattern without significant psychopathology, similar to other medically ill patients.


ADDITIONAL CNS TESTING:
**********************


NEGATIVE TEST RESULTS DO NOT RULE OUT THE DIAGNOSIS OF NEUROBORRELIOSIS


Confirmation by CSF CULTURE is seldom practical because the organism is very fastidious, present in small numbers, takes a long time to grow out, and may undergo changes to forms which cannot be cultured easily.


CSF ANTIBODY TITERS may be present but are inconsistent and therefore their absence does not rule out CNS infection. The MRI is seldom abnormal and the findings, when present, are not specific for Lyme.


CSF PCR (test for spirochetal DNA) is a useful tool, but at present, because the capture of DNA is inconsistent, a few questions still need to be addressed.


OLIGLOCLONAL BANDS AND IGG INDEX -- Looking for evidence of an intrathecal immune response may be helpful, but it is not specific.

As a rule, oligoclonal bands and an elevated IgG index are not present in North American Lyme disease and their presence should suggest other diseases.


THE PERIPHERAL NERVOUS SYSTEM

Cranial neuropathy, painful radiculitis, distal neuropathy, and plexopathy are seen and generally reflect different clinical presentations of mononeuritis multiplex (polyneuropathy).

Bell's Palsy occurs in almost 11% of all Lyme patients and is bilateral in up to 1/3.

Therefore, a bilateral Bell's Palsy is very suspicious for Lyme in an endemic area.


Painful radiculitis or cranial neuropathy can be seen with meningitis but also with normal CSF due to axonal neuropathy.

Myositis may occur with Lyme as well as polymyalgia rheumatica.


Symptoms of chronic involvement of the peripheral nervous system in a series of patients with chronic neurologic manifestations of Lyme disease developed a median of 16 months after the onset of infection, while CNS involvement began a median of 26 months after the onset of disease.


PERIPHERAL NERVOUS SYSTEM TESTING

Electrophysiological testing may show evidence of a mild peripheral neuropathy.

Axonal degeneration and perivascular inflammatory infiltrates are noted on pathological specimens.


CHRONIC NEUROBORRELIOSIS
**************************


THE MOST COMMON PRESENTATION IS SAE, POLYNEUROPATHY, AND ARTHRITIS


Most typically, patients present with SAE, most often combined with polyneuropathy.

Brief episodes of arthritis, primarily involving the knees, generally predate the symptoms and may persist after onset of neurological abnormalities.


The TRIAD OF SAE, POLYNEUROPATHY, AND ARTHRITIS IS HIGHLY SUSPICIOUS FOR NEUROBORRELIOSIS.


Since serologies may be contradictory or negative, the physician will have to settle for treating if clinical suspicion is strong enough and assess whether the patient has ``possible'' or ``probable'' neuroborreliosis.


Vigilant attempts to rule out other disorders should be undertaken.


Screening should be done for collagen vascular disease, other infections, cancer, metabolic or endocrinological disturbances, etc. when a definite diagnosis cannot be made.


II. CURRENT MEDICAL MYTHOLOGY
*********************************


``YOU HAVE FIBROMYALGIA. YOU MIGHT HAVE HAD LYME DISEASE IN THE FIRST PLACE, AND EVEN IF YOU DID, YOU WERE GIVEN ENOUGH ANTIBIOTICS. RETREATMENT WILL NOT HELP.''


PERSISTENT INFECTION VERSUS POST-LYME SYNDROME
********************************************


Many patients are sent home with antidepressants, muscle relaxers, but no antibiotics from doctors' offices because they have symptoms of fibromyalgia.


Pictures similar, or identical, to fibromyalgia may be part of the constellation of symptoms of Lyme; it may occur more rarely as an isolated symptom, or surface after what would otherwise be considered successful treatment.


Symptoms of fibromyalgia due to Lyme disease have not been cured with short-term oral or intravenous antibiotics, so some argue fibromyalgia is not due to active infection.


I would question whether those particular antibiotic regimens were adequate to eliminate the infection, rather than assume the patient has developed ``Post-Lyme Syndrome'' (some yet to be defined immunologically triggered disorder).


THE SCOPE OF THE PROBLEM

Bujak et al. evaluated patients a mean of almost five years after treatment.

15% of these patients had symptoms of fatigue and arthralgia.

Almost one-half met criteria for fibromyalgia or chronic fatigue syndrome.


Fibromyalgia is thought to be a variant of the chronic fatigue syndrome.

Of note, nearly all patients continued to complain of memory loss or concentration difficulties.

One quarter had objective evidence of cognitive impairment, and 15% manifested depression.


SYMPTOMS OF FIBROMYALGIA AND CHRONIC FATIGUE SYNDROME IN LYME DISEASE MAY BE ATTENUATED FORMS OR CHRONIC MANIFESTATIONS OF THE FLU-LIKE SYMPTOMS ASSOCIATED WITH EARLY DISSEMINATION


All physicians experienced with treating Lyme disease have had patients who present with a recurrence of flu-like symptoms, months to years after they have completed the usual antibiotic course of therapy, oral or intravenous, and re-exposure had not occurred.


These patients describe their flu-like symptoms as identical to their early-disseminated stage of Lyme disease.


The flu-like symptoms may reoccur following what appears to be a trivial stressor, such as an uncomplicated viral URI.

Patients may be able to ``contain'' their symptoms without specific antimicrobial therapy, but many will have to resume antibiotics.


These patients complain of having to go to bed due to excessive fatigue or hypersomnolence.

They cannot think straight, their muscles and joints ache, and they may have a low-grade fever.


Do these symptoms sound like a ``fibromyalgia-like syndrome'' or ``acute fatigue syndrome?''

Prior medical experience suggests reactivation of infection.

Despite what may appear to have been a previous ``cure,'' relapse of symptoms in this context would appear to be due to failure to eradicate the infection and with reactivation after a period of dormancy.


Reoccurrence of symptoms due to immunologically triggered disease, INDEPENDENT of persistent infection seems unlikely.


In reality, DISTINCTIONS BETWEEN FLU-LIKE SYNDROME, FIBROMYALGIA, AND CHRONIC FATIGUE BLUR.

It seems more logical to postulate that fibromyalgia and chronic fatigue syndrome, when seen with Lyme disease, may be attenuated forms of chronic manifestations of earlier flu-like symptoms associated with early dissemination.

[page 2]


III. THE ASSOCIATION BETWEEN MULTIPLE
SCLEROSIS AND LYME DISEASE:

THREE DIFFERENT SCENARIOS


1) LYME CAN LOOK LIKE MS BUT SYMPTOMS AND PATHOLOGY RESIDE OUTSIDE THE CENTRAL NERVOUS SYSTEM

Lyme may present as a MS-like illness, but on many occasions the pathology is not actually in the CNS.


Since chronic Lyme symptoms often are predominantly shifting, vague, behavioral-psychological, psychiatric, and, as mentioned, neurological, they are likely to conjure up the diagnosis of MS in patients and physician alike.


However, the existence of pathology outside the CNS should rule out the diagnosis of MS.

Some of the vague symptoms that can be mistaken for MS include those that are better attributed to peripheral nervous system damage, as part of the mononeuritis multiplex that may occur.


This might cause numbness, tingling, facial weakness, diplopia, etc.

The diagnosis of MS cannot be made in the absence of CNS symptoms and signs.

MRI and CSF findings would also help support the diagnosis of MS.

In addition, a significant CSF pleocytosis may occur with Lyme disease, which should not be present with MS.


2) OTHER LYME PATIENTS DO HAVE CNS LESIONS, BUT THESE ARE GENERALLY DISTINCTLY DIFFERENT, CLINICALLY, AND PATHOLOGICALLY FROM MS


Patients can have CNS lesions in the brain or spinal cord with Lyme disease.

The European literature includes many more cases than the American for encephalomyelitis, strokes, etc.

In those cases where there is focal involvement of the brain or spinal cord, it may be more difficult to distinguish neuroborreliosis from MS.

Again, a brisk CSF pleocytosis would help diagnose Lyme and the specific aforementioned test for CNS Lyme antibodies.

Simultaneous appearance of peripheral nervous system abnormalities or arthritis should suggest the diagnosis of Lyme.


3) ANOTHER GROUP OF PATIENTS HAS MULTIPLE SCLEROSIS AND LYME


There are some patients who have a clear-cut preexisting history of MS before the onset of Lyme disease.

The Lyme appears to accelerate their clinical course.

For others, it appears to be the initiating infection that triggers the MS.

These patients are most likely genetically predisposed to MS and the Lyme bacteria exerts its major effect by ``turning on'' immunologically directed CNS injury.


It is not uncommon to get a history of the onset of an exacerbation of MS related to infections, so Lyme exacerbating MS would be expected.


HLA Class II molecules determine the intensity of the immune response to pathogenic foreign or self-antigens.


With MS, the HLA-DR4 DQw8 haplotype has been associated with chronic progressive MS and the HLA-DR2 DQw6 haplotype has been associated with susceptibility to both chronic progressive and relapsing or remitting MS.


It is possible that in genetically predisposed patients of certain HLA types that infection by Lyme bacteria would cause a high production of cytokines that would mediate the demyelination and destruction of oligodendrocytes.


Most recently, researchers are studying positive outcomes when antibiotics that are most useful in treating Lyme disease are used to treat ``MS.''


IV. WHAT'S WRONG WITH ``CURRENT GUIDELINES FOR TREATMENT'' OF NEUROBORRELIOSIS?


First, read the fine print.


It is interesting to note that recommendations for treatment in the medical literature may carry provisos in small print that can easily be overlooked but are instrumental to understanding how important individualization of therapy is at the current time.


For instance, in the past and in small print, Dr. Alan Steere has written, ``treatment failures have occurred in all these regimens, and retreatment may be necessary; the duration of therapy is based on clinical response, and the appropriate duration of therapy with late neurological abnormalities may be longer than two weeks.''


A more recent article written by Rahn and Malawista states ``these guidelines are to be modified by new findings.


It should always be applied with close attention to the clinical course of individual patients.''


Dr. Katzel surveyed several Lyme Borreliosis conferences, including international ones. He finds a trend towards the use of antibiotics for longer periods than previously described and lack of standardization of care worldwide.


50% of physicians responding considered using antibiotics for time periods greater than one year in symptomatic seropositive patients, with almost as many extending therapy up to one and a half years when necessary.


THE CASE FOR PERSISTENT INFECTION

Studies have shown that Lyme bacteria can be an intracellular pathogen and may evade the normal host immune response.


The causative spirochete, B. burgdorferi, for instance, may persist within fibroblasts and survive at least 14 days of exposure to ceftriaxone.


In addition, B. burgdorferi has been cultured from CSF more than a half year after a standard regimen of IV antibiotics, according to Preac-Mursic.


Logigian and Steere looked at patients with chronic neuroborreliosis, evaluating them six months after two weeks of IV ceftriaxone.


Over one-half of the patients had already been treated with therapy that was thought appropriate for their stage of illness, yet the illness progressed.


The majority of patients studied had subacute encephalopathy and polyneuropathy.

Most had persistent fatigue, and almost one-half had headaches.


One-third of these patients had to stop working or had to go part-time, underscoring the disability that may be seen with Lyme disease on an individual and societal level.


After therapy, two-thirds of patients improved markedly, but seldom completely. Twenty-two percent improved but then relapsed, and fifteen percent had no change in their condition.


This study suggests that additional antibiotics greatly helped the majority with neuroborreliosis but they were insufficient to cause long lasting remission in those patients who subsequently relapsed.


Persistent residual or irreversible disease may explain the fifteen percent who had no change in their condition.


For those clinicians who have had extensive experience with chronic neuroborreliosis, more recent recommendations suggesting that a regime of only 20 to 28 days or even 6 weeks of intravenous antibiotics is sufficient for cure proved contrary to clinical experience.


That brief dosing does not appear to prevent relapse or improve long-term outcome dramatically in many cases.


Perhaps, as recent information has instructed, that is because the immune system does not begin to repair itself until the beginning of the fourth month of antibiotic treatment.


A trial of prolonged use of oral antibiotics seems more reasonable in many cases, given these circumstances.


Antibiotics used for chronic neuroborreliosis should be able to penetrate the blood-brain barrier, express activity against intracellular organisms, and assure good intraphagocytic penetration.


It is anticipated that the microbe during late disease has achieved maximal adaptation to its host environment. Also, because of the long generation time of the organism, lengthier therapy is warranted.


V. WE DON'T HAVE ALL THE ANSWERS BUT HERE'S WHAT IS RECOMMENDED


If a patient has meningitis or appears acutely ill, particularly with possible arrhythmia, admit him or her to the hospital for intravenous antibiotics and observation.


Generally, however, in patients with stable late disease, oral antibiotics can be tried first.


The majority of patients will have some improvement or gradual resolution of encephalopathic symptoms with a better energy level.


After a six-week trial of appropriate antibiotics, the patient is re-evaluated.


If there is no Herxheimer response or some clinical improvement during this interval, it is worrisome, and the physician needs to be concerned about:

1) misdiagnosis,
2) noncompliance,
and/or 3) permanent end organ damage.


These possibilities should be addressed with the patient before proceeding with intravenous antibiotics since they may not be maximally beneficial either


Over the long haul, whether intravenous antibiotics are used for two weeks or longer, with chronic refractory disease, ultimately other methods are necessary.


A lengthier use of oral antibiotics seems more logical than intravenous antibiotics for some patients.

Unfortunately, there are no current tests that adequately measure disease activity with neuroborreliosis in all patients.


We are sorely in need of a test similar to the CSF VDRL for syphilis that would give us a measure of disease activity.


Culture negativity or disappearance of a specific immune response in the serum or CSF has not been useful at this time to establish cure. CSF antibodies may persist for years after otherwise successful treatment.


Particularly in the CNS, judging response of therapy is problematic because pathological changes may incompletely or, at least, very slowly reverse.


Any clinical improvement would be expected to occur in a delayed fashion after therapy is given.


Likewise, one would expect neuropathy related to axonal degeneration to remit slowly and/or incompletely.


Formal neuropsychiatric testing is of value in documenting pathology and following the patient.


It also helps delineate what the patient can and cannot do.

It also can help to define the disease for the patient, family, insurer, and the employer.


The patient needs to be told that his or her symptoms should remit slowly and incompletely, when on antibiotic treatment.

This is particularly important when the symptoms have been chronic.


VI. IN SUMMARY
****************


The premise of this approach to diagnosing and treating neuroborreliosis needs to be reinforced.


There is no current laboratory test that makes or breaks the diagnosis of neuroborreliosis.


It is a clinical diagnosis substantiated by laboratory data when possible.

Fortunately, the majority of cases are fairly uniform in their lack of uniformity, and other diagnoses are easily ruled out.


In situations where the physician simply cannot achieve diagnostic certainty, he or she should notify the patient that the diagnosis is ``possible'' or ``probable'' neuroborreliosis.


This has been done previously with MS (i.e., possible, probable, and definite MS), another disease where laboratory testing does not make the diagnosis in and of itself.


There is no perfect current laboratory test to monitor success of therapy, and this is critically needed.


Until better testing is available, assessing progress, or lack thereof, will largely be determined with clinical acumen.


The infection is difficult to eradicate and may require long-term treatment.

The spirochete, particularly in later stages, becomes well adapted to survival within its host environment.


There are some patients that we may not be able to cure, but will be able to palliate with currently available antibiotics.


Although immunopathogenic factors may play a crucial role in disease presentation, the presence of chronic infection appears necessary to perpetuate the process and play a causative role in persistence of immunologically triggered symptoms.


There is no Diagnostic and Statistic Psychiatry Manual (DSM IV) category for ``antibiotic seeking behavior.''


It is common for physicians who are unable to explain patients' symptoms or effect their cure to ascribe a psychiatric cause to their malady.


This is easily done with Lyme since objective findings may be subtle or non-existent.

Because neuropsychiatric symptoms may pre-dominate, it is easy in some patients to attribute their symptoms to depression or secondary gain.


These patients do not in any other way seek other medication that would be associated with habituation or addiction (i.e., pain medicine).


Many patients suffer unfairly at the hands of physicians who refuse to make the diagnosis because blood tests are either contradictory or negative.


``Lyme bashing,'' for instance, referring to Lyme disease as ``yuppie flu,'' is demeaning.


The ``just say no'' attitude of certain physicians towards Lyme patients who request retreatment with antibiotics should not be condoned in the face of continuing experience with this potentially chronically disabling infectious disease.


Audrey Stein Goldings, MD is a private practice neurologist in Dallas.

She is member of ILADS and a founding member of the Board of Directors.


********************

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Great--so there's pretty much no way someone like me, who's had constant cognitive deterioration for almost 2 years, can ever get himself back in full. Pretty much what I had suspected.
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NeuroEcclectic
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Member # 17783

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I would like to share the following: I wrote

this letter 2 years ago:

Age 19 while on vacation in Pennsylvania I woke

up with bilateral topical foot numbness, malaise

and mild vertigo followed. This went of for a

week.

After this ended I remained generally symptom

free, but often very tired until the next

attack. I was 26, living in Nebraska under

arduous and taxing academic pressure. I woke up

on Feb 14 2005 with topical numbness from the

waist down after a few weeks of pain in my left

lymph nodes, stomach troubles, profuse sweating

and a feeling of sickness. The ``numbness''

remained for 2 or 3 weeks. Went away for a month

and then came back with additional symptoms

which included slight gait trouble, the feeling

of heaviness climbing stairs, felt like my legs

were a pair of psychotic chop sticks descending

stairs.


I was sent by a baffled GP to a neurologist in

Lincoln who did in the office tests and

clinically concluded (w/o MRI) that I had an

Acute Transverse Myelitis at the thoracic level

and a 20% chance of developing MS.


The GP tested for HIV and Syph because I am a

gay male. All neg.


The ``numbness'' went away after a few weeks and

after nearly two months most of the other

symptoms did as well.


And then, one morning, I woke with numbness in

both hands but it was pretty much gone within 2

days, but, paresthesias was left and still

remains there. My hands ``buzz'' when I wash my

hair, for the most part, this is all that

happens.


Shortly after this (a week) I developed ``Bells

Palsy'' of the gut (right) (common in Lyme).

Lasted for over 2 weeks.

Things cleared up for the most part for 4 months

until the day before I moved to Connecticut

(PLEASE NOTE THAT I WAS SICK BEFORE CT, CT WAS

JUST PROVIDENTIAL). I then got sick again, flu

like, icky, and started having bouts with a form

of vertigo. Some spinning but not much but

mostly a feeling of the floor moving and

dropping (like air pockets). Urinary hesitancy

also happened.

The GP there thought that is was

neuropsychological but sent me for an MRI of my

Brain. These were the results (Feb, 06):


BRAIN WITH & W/O CONTRAST


2/15/06


INDICATION:


Evaluate for MS. Parethesias, weakness, and

visual changes.


TECHNIQUE:


Multiplanar T1, T2 weighted and FLAIR sequences

were obtained prior to intravenous contrast.

After intravenous Omniscan, T1 images were

obtained.

FINDINGS:

There is no MRI evidence of midline

shift or mass effect. Multiple round to ovoid

foci of increased T2 weighted signal are noted

in the periventricular and deep white matter of

both cerebral hemispheres. Some foci within the

centrum semi-ovale are oriented perpendicular to

the plane of the corpus callosum and cingulate

gyrus, suspicious for MS plaques. More ill-

defined increased T2 weighted signal is noted in

the periventricular white matter. Faint nodular

areas of increased T2 weighted signal are noted

within the corpus callosum. A small, 3-4 mm

ovoid focus of increased T2 weighted signal is

seen within the posterior aspect of the left

middle cerebellar peduncle.


After IV contrast, at least five of the

presumed plaques appear to enhance, the largest

seen in the right frontal white matter,

measuring 8 mm in maximum AP dimension.


Normal signal void is demonstrated in

the major vasculature at the base of the brain.

Visualized paranasal sinuses appear clear.


IMPRESSION:

Multiple round to ovoid foci of increased T2

weighted signal in the periventricular and deep

white matter of both cerebral hemispheres, as

well as within the left middle cerebellar

peduncle and corpus callosum. Several lesions

appear to enhance after IV contrast. Findings

are non-specific, but are suspicious for MS

plaques. Other etiologies, such as Vasculitis or

Lyme disease, could produce similar findings.

Clinical correlation advised.


--


And so, my freakish GP freaks out, ``You have MS.

I am shocked. I am so sorry for doubting you.

You need to get to the MS clinic immediately!'' I

was naturally a wreck. My Dad had died 2 months

prior. But, I did not believe him. I looked into

Lyme on my own, found a Yale physician who knows

all about Lyme. He claims that Lyme and MS are

the same thing. He said, ``antibiotics only'', and

he sent me for the following C and T spine MRIs

which concluded his dx:


CERVICAL SPINE WITH & W/O GADOLINIUM

4/05/06

HISTORY:


Chronic posterior neck pain and stiffness w/

hand parethesias.


TECHNIQUE:


Multiplanar T1 and T2 weighted sequences were

obtained before and after intravenous gadolinium

administration.


FINDINGS:


The bone marrow signal appears well maintained.

There is reversal of normal cervical lordosis.

Disc space heights appear well maintained. Not

acute verterbral body compression fracture is

demonstrated. The carniocervical junction

appears unremarkable.

Saggital STIR sequence shows extensive

signal abnormality within the cervical spinal

cord, throughout the entire cervical spine. No

cord compression is demonstrated. The neural

canal regions appear ample in size.

Gladolinium-enhanced imaging shows no

abnormal enhancement.


IMPRESSION:


Extensive areas of hyperintense signal

abnormality within the cervical spinal cord,

most consistent with a demyelinating process. No

enhancement was demonstrated. Please see report

from MRI of the brain.


THORACIC SPINE with and W/O CONTRAST

4/19/06

INDICATION:


History of brain lesions and parsis.


TECHNIQUE:


Saggital T1, T2, and STIR; and axial T2

weighted/CBASS sequences were obtained. After

intravenous Omniscan, T1 sequences were obtained

in the saggital and axial planes.


FINDINGS:


Today's study is limited due to the patient's

body habitus.


There is normal alignment of thoracic vertebral

body segments. No evidence of fracture or marrow

signal abnormality. Multilevel endplate

osteophytic lipping is seen. Mild annular

bulging is seen at T6-T7. No disc herniation is

demonstrated at any level. Visualized paraspinal

soft tissues are unremarkable. Evaluation of

cord signal is limited, but no obvious

intramedullary lesions or abnormal enhancement

is demonstrated.

IMPRESSION:

Mild multilevel degenerative disc/endplate

changes with mild annular bulging of T6-7. No

evidence of disc herniation or cord compression.


Finale:

Now I am nearly 29. I moved home to


Seattle and found a doctor here who treats Lyme.

He concurs with the other Lyme doctor.


From May 06 until now I took massive amounts of

antibiotics. I am nearly asymptomatic now. All C-

spine lesions are gone, as well as the brainstem

and corpus-c lesions. This has been proven on 2

repeat MRI studies of these areas.

I also take 4.5 mg of Low Dose Naltrexone

nightly. What do you think? MS? Lyme? I was neg

on Eliza but very positive on WB. Or, is it

Benign MS?

Thanks,
Jack.

I kept notes:

SYMPTOMS


NOTE: Due to the complex nature of these

symptoms, it is possible that not every symptom

has been noted.


SYMPTOM HISTORY:


SYMPTOM: Internal Vibration.

NOTES: -recurring, common. exists w/in the

internal body, epicenter low back (cntr),

postural/aggravated.

DESCRIPTION: -non-painful, feels like a storm or

flurry is in my back (esp. low), has been felt

waist down, as high as the chest/arms, reg.

back. Have had sensation of internal echo when

singing or reading aloud. Aggravated by

posture/hard chairs (never soft), worse when

laying bed.


SYMPTOM: Parathesias.

NOTES: -recurring/common/aggravated.

DESCRIPTION: -internal hand buzzing/vibration

aggravated by using a towel or running hands

against certain fabrics, also from using an

electric object such as a vacuum cleaner. Began

Aug, 2005.


SYMPTOM: Numbness.

NOTES: -recurring/uncommon/existed/exists waist

down (not any longer), feet, hands, low trunk

(not anymore), stomach.

DESCRIPTION: -experience w/numbness variable, exp. sep:

Waist Down: -topical, aggravation

suspicious/unknown. (everything from waist down,

2 occurrences).


Feet: -light topical numbness occasional,

aggravated/postural: especially in bed when neck

is contorted w/pillow/wall or seated position

for duration. First occurrence 1999 in humid

weather (Scranton PA).


Hands: -occasional w/ paraesis, light topical,

aggravated w/ contact or rubbing on certain

fabrics, occ. postural (seated pos.)


Low Trunk: -stiff numbness/tightness, came when

sleeping suspicious


postural/aggravated due to contortion/neck.


Stomach: -r/side, stiff/tightness, poss.

Aggravation/postural due to contortion/neck,

suspicious.


SYMPTOM: Vertigo.

NOTES: -recurring/moderately common, suspected

vertigo, unclear do not know if it is coming

from ears/brain.

DESCRIPTION: -developed over 1 week w/light

dizziness, dev. no spinning/altitudinous changes

such as being on an airplane feeling light

drops/pockets. On and off, 2 mo. Prior light

dizzy spells over 15 yrs/esp. when descent has

occurred.


SYMPTOM: Burning/Heat patches.

NOTES: -recurring/mod. Common/burning in r/knee,

pinprick burn cntr spine/upper back, heat

L/thigh left side of thigh.

DESCRIPTION: -burning is not painful yet only a

sensation of such, burning pinprick sensation is

directly a little above mid back and right in

the center/postural (sitting), heat patches

knee/L thigh not painful.


SYMPTOM: Stabbing pain/Shooting pain.

NOTES: -recurring/common, temples L/R.

DESCRIPTION: -occasional shooting/stabbing pain

in temples.


SYMPTOM: Possible Lhermitte's Sign.

NOTES: -recurring/common, is most likely

LS/aggravated/postural.

DESCRIPTION: -almost always in/morning due to

neck contortion thus aggravated/postural.

Result: neck flexion fwd buzzing patches (qt

in.) thighs/arms, no shock down spine, no pain,

internal vibration/chest.


SYMPTOM: Possible Short Term Memory Loss.

NOTES: -recurring/common, mind is overwhelmed.

DESCRIPTION: -occasional mem/loss, such as not

remembering if I took a pill or if I prayed

before I meal.


SYMPTOM: Raised rash/lesion.

NOTES: -acute, appeared 4 yrs ago on

cntr/chest.

DESCRIPTION: -not measured/not large, dark

red/poss. Disappear/reoccur.


SYMPTOM: Headache.

NOTES: -recurring/common, over 15 yrs.

DESCRIPTION: -all over, med-severe, throbbing,

shooting pains. Prominent in forehead.


SYMPTOM: Pressure in Head/White Matter Lesions.

NOTES: -recurring pressure/common,

heaviness/lightness, 5 or more lesions.

DESCRIPTION: -heavy pressure, 5 or more non-

specific lesions on MRI; stated poss. MS, Lyme

Disease, Vasculitis.


SYMPTOM: Twitching/Fasciculation's.

NOTES: -recurring./common, as of summer 2005.

DESCRIPTION: -twitching/fasciculations all over,

especially knee joint R/ face/mouth region.


SYMPTOM: Tingling of nose, (tip of).

NOTES: -recurring/common.

DESCRIPTION: -annoying/itchy.


SYMPTOM: Stiff/Painful neck.

NOTES: -recurring/common.

DESCRIPTION: -neck flexion to R/decreased

ability, shooting pains from low neck into head,

throbbing. This is occasional, onset Dec. 2001

severe shooting sensations from low neck into

back of head. Seems to be aggravated/postural.


SYMPTOM: Jaw pain/stiffness.

NOTES: -recurring/common.

DESCRIPTION: -clenches up/seems

aggravated/occasional, painful, since late

1990's.


SYMPTOM: Sore throat/clearing throat a

lot,/phlegm/hoarseness/runny nose.

NOTES: -recurring/common.

DESCRIPTION: -from forever, many nasty sore

throats.


SYMPTOM: Decreased hearing in one or both

ears/plugged ears/buzzing in ears/pain in

ears/oversensitivity to sounds, ringing in one

or both ears, popping in ears.


NOTES: -recurring/common.


DESCRIPTION: -from forever, ringing/pain

increased 2005-2006.


SYMPTOM: Increased floating spots/pain in

eyes/oversensitivity to light/flashing lights.


NOTES: -recurring.

DESCRIPTION: -eye pain often coupled w/head

pressure or


headache(forehead), 1 or 1 occurrence of

flashing light from L/peripheral vision. Eyes

examined Jan 2006, optic nerves healthy.


SYMPTOM: Diarrhea.

NOTES: -recurring/common, as long as I can

remember.

DESCRIPTION: -if I were to have a bowel movement

3 times in one day it could be once w/reg. and

twice w/diarrhea or vice verse.


SYMPTOM: Constipation.

NOTES: -recurring/common, for a few years.

DESCRIPTION: -either cannot go for a day or so,

hard/painful to push out. Causes

itching/irritation, secretion, possible large

hemorrhoid.

SYMPTOM: Irritable bladder/trouble

starting/poss. Interstitial cystitis.


NOTES: -recurring/common, for a few years.

DESCRIPTION: -occasional pain w/urination.


SYMPTOM: Upset stomach/nausea/pain/ poss. GERD.


NOTES: -recurring/occasional.

DESCRIPTION: -upset stomach not uncommon since

childhood, nausea not uncommon, and pain not

uncommon, borderline GERD symptoms.


SYMPTOM: Bone pain/joint pain/ poss. carpal

tunnel syndrome.


NOTES: -recurring/common.

DESCRIPTION: -experience pain/soreness in

joints, occasional hand pain w/typing thus

aggravated.

SYMPTOM: Stiffness of joints/back/neck.


NOTES: -recurring/common.

DESCRIPTION: -worse in the morning, last 4 years

or so, worse 2006.


SYMPTOM: Muscle pain/spasms/cramps.

NOTES: -recurring/moderately common.

DESCRIPTION: -severe spasms/cramps in calves,

mostly L/began age 13, can occur in

back/postural, in lower stomach/postural. 2005,

from calve L shooting to low back L, all

correctable with straightening, unable to walk

during.

SYMPTOM: Chest pain.


NOTES: -recurring/occasional

DESCRIPTION: -generalized.

SYMPTOM: Night sweats/Day sweats/Unexplained

chills.


NOTES: -recurring/occasional

DESCRIPTION: -generalized.

SYMPTOM: Heart Palpitations.


NOTES: -recurring/occasional

DESCRIPTION: -started in high school/not

aggravated, have decreased but were really

irritating in high school/late teens/early

twenties.

SYMPTOM: Tremor.


NOTES: -

recurring/occasional/aggravated/postural.

DESCRIPTION: -only in L/arm, aggravated by

weight/pressure such as laying down side ways

and resting my hand under my head thus placing

weight.

SYMPTOM: Fatigue.

NOTES: -recurring/occasional

DESCRIPTION: -not common/aggravated by lack of

sleep.

SYMPTOM: Weakness.


NOTES: -recurring/occasional

DESCRIPTION: -worse in the morning, legs R/L,

arms R/L; seems to be aggravated postural such

as after sitting in certain positions,

descending hills, absence/lack of sleep.


SYMPTOM: Malaise.


NOTES: -recurring/common.

DESCRIPTION: -feeling of bodily discomfort (such

as before an illness), tiredness, confusion,

dead brained, depressed, non-specific illness,

feeling cold or hot. Has been worse in the past

4 yrs, but has been around poss. many yrs as it

is hard to recall.

SYMPTOM: Partial Paralysis (possible).


NOTES: -occurrence (1)

DESCRIPTION: -seemed to be coming from the

cervical spine, came in the morning


a non-painful take over of the control of my

left arm/hand/shoulder/upper back/wing,

duration 5 minutes. Accompanied by possible

Lhermitte's sign. Went to the hospital (fear of

stroke), clinical dx cervical radiculopathy,

treatment ibuprofen.

SYMPTOM: Dental Pain.


NOTES: -recurring/occasional.

DESCRIPTION: -mostly in gums/rear teeth R/L,

pain w/o reason.

SYMPTOM: Pain.


NOTES: -recurring/occasional.

DESCRIPTION: -ligaments/joints esp. R knee,

wrist joints, armpit lymph nodes, occasional

facial lymph nodes, neck B, elsewhere exists not

noted, exhaustible areas, main points noted.

SYMPTOM: Pressure in head.


NOTES: -recurring/commonl.

DESCRIPTION: -prev. noted, heavy pressure on all

parts, usually worse in temples/forehead.

SYMPTOM: Poor balance, dizziness, difficulty

walking.


NOTES: -recurring/occasional.

DESCRIPTION: -prev. noted: dizziness occasional

esp. w/descent, gait was a finding from Sposato

MD w/ATM, since then not noticed. Balance is

lightly off at times as has been for yrs, not

disruptive.

SYMPTOM: Increased motion sickness,

lightheadedness, wooziness.


NOTES: -recurring/occasional.

DESCRIPTION: -all prev. noted.

SYMPTOM: Depression, irritability, mood swings.


NOTES: -recurring/common.

DESCRIPTION: -all may be circumstantial or

related to life issues, dx. of PTSD.


SYMPTOM: Insomnia.

NOTES: -recurring/common.

DESCRIPTION: -depends on circumstances, have not

looked at it much.


SYMPTOM: Difficulty falling or staying asleep.

NOTES: -acute.

DESCRIPTION: -very difficult to fall asleep,

though poss. circumstantial due to poss.

internal tremor or anxiety.


SYMPTOM: ``Bubbling'' Sensation.

NOTES: -recurring, common.

DESCRIPTION: -exists primarily on the bottom of

the feet L/R, an internal pulsating sensation

that usually goes along with internal vibration

of leg. Usually only experienced when standing,

non-painful (annoying), began November 2005.


SYMPTOM: Jerking.

NOTES: -recurring/occasional.

DESCRIPTION: -sometimes I am jerked away while

sleeping and my body jerks or jolts. I usually

fall back asleep w/o incidence.


SYMPTOM: poss. Sleep Apnea.

NOTES: -suspected by Siegel, MD.

DESCRIPTION: -not been tested.


SYMPTOM: ``Atrophy''

NOTES: -prior recurring, prior common.

DESCRIPTION: -strange sensation after spending

time at home resting such as when I tried to use

body parts a large tingle, actually an

indescribable sensation but worth noting. Last

occurrence last year, onset later childhood. My

mother called this atrophy from lying around

sick.


SYMPTOM: Expressed Energy in Bed.

NOTES: -recurring, common.

DESCRIPTION: -while trying to full asleep an

overwhelming feeling of energy that makes me

want to run, or slap someone it is a very

strange symptom; does not make me mentally

violent yet aggravated from all of the unwanted

energy.




SYMPTOM: Anxiety.

NOTES: -recurring/occasional.

DESCRIPTION: -fear, sorrow, confusion, dismay

over past/present issues.


SYMPTOM: Testicular/pelvic pain.

NOTES: -recurring/occasional.

DESCRIPTION: -stabbing pains in pelvis, gripping

pains in testes especially during cough, this


way for yrs.

SYMPTOM: Increased affect from alcohol and

possible worse hangover.

NOTES: -any time I drink.

DESCRIPTION: -unusual intolerance for height/way

variable, hang overs are severely dizzy/vertigo.

[ 03-27-2009, 03:07 PM: Message edited by: NeuroEcclectic ]

Posts: 123 | From Seattle, WA | Registered: Oct 2008  |  IP: Logged | Report this post to a Moderator
Dekrator48
Frequent Contributor (5K+ posts)
Member # 18239

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Whew, that's alot of lyme and coinfection symptoms!!!!!!

At least you keep good records!!

--------------------
The fibromyalgia I've had for 32 years was an undiagnosed Lyme symptom.

"For I know the plans I have for you", declares the Lord, "plans to prosper you and not to harm you, plans to give you hope and a future". -Jeremiah 29:11

Posts: 6076 | From Pennsylvania, USA | Registered: Nov 2008  |  IP: Logged | Report this post to a Moderator
NeuroEcclectic
LymeNet Contributor
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Bartonella? What do you think?
Posts: 123 | From Seattle, WA | Registered: Oct 2008  |  IP: Logged | Report this post to a Moderator
polar blast
LymeNet Contributor
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you sound like you really do have lyme and co infections..you must have had this since childhood..please dont be scared..take your treatment and hold on thru the herx..things will get better..one of the cardinal things you mentioned was the nose tingling..that is lyme lyme lyme..we at this board will help you to not be scared..
Posts: 593 | From long island ny | Registered: Apr 2006  |  IP: Logged | Report this post to a Moderator
NeuroEcclectic
LymeNet Contributor
Member # 17783

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Hi Everyone-Vision got so bad I went away for several days of sleep.

I love you all. You will always be remembered by Me.

Vision is almost back to normal-balance isn't

budging however.

I double spaced my long list and history per

request of Betty G.

BTW. A question: Dr. M told me that a Herx with

Neuro Lyme is not common. I think that I am

totally herxing. Your thoughts?

Grateful for God-Grateful for You,
Jack.

Posts: 123 | From Seattle, WA | Registered: Oct 2008  |  IP: Logged | Report this post to a Moderator
TTLav
LymeNet Contributor
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KEEBLER- ALL OF THIS INFORMATION SEEMS WONDERFUL

BUT I WOULD NEED TO SPEND A TON OF TIME USING A

DICTIONARY TO LOOK UP WORDS I DON'T KNOW. IS

THERE ANY WAY TO PUT THIS IN LAYMENS TERMS

Posts: 109 | From Western Massachusetts | Registered: Aug 2011  |  IP: Logged | Report this post to a Moderator
   

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