Doctor Philpott Approved POLAR POWER MAGNETS "Negative Field" Magnetic Therapy Products. Dr Philpott is widely recognized as the worlds leading authoritiy on the use of biomagnets in magnetic therapy applications for pain relief, disease reversal and magnetic health enhancement. "I don't say that magnets healed you, you say that magnets healed you." William H. Philpott, M.D.
Forget everything you've ever read or heard about magnet therapy in the mainstream that didn't mention the importance of polarity! Polarity is the single most critical factor in the use and application of magnets to the body for healing! (biomagnetics) It is estimated that about 80% of all magnetic therapy products sold today are not proper polarity.
WHAT MAGNETIC THERAPY DOES
The biological response to a static positive magnetic field is acid-hypoxia. The biological response to the static negative magnetic fieldis alkaline-hyperoxia. Positive magnetic field therapy is limited to brief exposure to stimulate neuronal and catabolic glandular functions. Positive magnetic field therapy should be under medical supervision due to the danger of prolonged application, producing acid-hypoxia.
Negative magnetic field therapy has a wide application in such things as cell differentiation, healing, production of adenosine triphosphateby oxidative phosphorylation and processing of toxins by oxidoreductase enzymes and resolution of calcium and amino acid insoluble deposits. Negative magnetic field therapy is not harmful and can effectively be used both under medical supervision and self-help application. Some of the values of magnetic therapy are:
•Enhanced sleep with its health-promoting value by production of melatonin.
•Enhanced healing by production of growth hormone.
•Energy production by virtue of oxidoreductase enzyme production of adenosine triphosphate and catalytic remnant magnetism.
•Detoxification by activation of oxidoreductase enzymes processing free radicals, acids, peroxides, alcohols and aldehydes.
•Pain resolution by replacing acid-hypoxia with alkaline-hyperoxia.
•Reversal of acid-hypoxia degenerative diseases by replacement of acid-hypoxia with alkaline-hyperoxia.
•Antibiotic effect for all types of human invading micro-organisms.
•Cancer remission by virtue of blocking the acid-dependent enzyme function producing ATP by fermentation.
•Resolution of calcium and amino acid insoluble deposits by maintaining alkalinization.
•Neuronal calming providing control over emotional, mental and seizure disorders. “Magnetic therapy has been observed to have the highest predictable results of any therapy I have observed in 40 years of medical practice. ”William H. Philpott, M.D.
ABOUT WILLIAM H. PHILPOTT, M.D. William H. Philpott, M.D. has specialty training and practice in psychiatry, neurology, electroencephalography, nutrition, environmental medicine and toxicology.
JES Organics became a source for the superb American Made Polar Power magnet therapy products because these products were recommended to our founder by her doctor for Lyme Disease and the associated health issues and for her husband's osteoporosis.
Showing posts with label Lyme Disease. Show all posts
Showing posts with label Lyme Disease. Show all posts
Wednesday, October 26, 2011
Optimized Energy for Serious Mitochondrial Needs
ATP Fuel™ - NEW
Optimized Energy for Serious Mitochondrial Needs
ATP Fuel™ is designed to support the Krebs Cycle of cellular energy production. The Krebs Cycle takes place inside the mitochondria or “power plant” of the cell and it is the body’s primary energy producer.
ATP Fuel™ offers the top three energy nutrients and cofactors synergistically combined for maximum mitochondrial performance and energy production:
NT Factor Energy™
NADH
CoQ10
ATP Fuel™ starts with the base of our highly acclaimed NT Factor Energy™, and adds the two other well-researched energy producing nutrients, NADH and CoQ10 into one convenient and power-producing formula. Plus ATP Fuel™ is available in capsules.
NT Factor Energy™- to repair mitochondrial membranes NT Factor Energy™ was developed as a phospholipid delivery system to repair mitochondrial membranes that have been compromised due to acute and/or long-term health challenges.
Mitochondrial membranes contain their own DNA. If these membranes are damaged and not able to self-repair, they rely on healthy cells to donate their phospholipids. However, if there is a cascading impact of damaged cells splitting, the end result is a less than optimal energy level.
The product's efficacy is based on our proprietary method of extracting and stabilizing the phospholipids, and delivering them intact in the lower intestine for proper absorption. Phospholipids are very unstable and often oxidize in the manufacturing process or in the digestive tract before they can be presented for absorption in the lower intestine. After we stabilize the phospholipids, we wrap them in probiotics and prebiotics. Next, we add minerals and other nutrients to assist in the Krebs Energy Cycle and absorption. When the capsule reaches the lower intestine, the pre and probiotics are released first to promote a healthy flora. We follow this with the release of the NT Factor portion, whose matrix very closely matches that of the gastro intestinal mucosa. As these phospholipids are transported from cell to cell, they are absorbed into the outer and inner mitochondrial membranes --- allowing the mitochondria to provide its natural and healthy level of energy.
A healthy mitochondrial membrane:
allows more nutrients into the mitochondria to support the Krebs Cycle of energy production
is essential for the electron transport chain to efficiently produce healthy levels of ATP
promotes healthier (reduced) level of oxidative stress
NADH - to convert food into energy
NADH is the reduced (electron- energy rich) coenzyme form of vitamin B3 or B-Nicotinamide Adenine Dinucleotide. This "reducing" power (its ability to donate electrons) is what drives ATP production.
NADH is fundamental in the chemical process of converting the food we eat into cellular energy. Each unit of NADH creates three units of ATP (the body's energy fuel).
Studies conducted in Europe indicated that NADH promotes healthy energy levels and emotional balance.
NADH is notoriously unstable. As part of our proprietary formula, we stabilize our NADH with chlorophyll, followed by microencapsulation process to resist gastric acids.
Coenzyme Q10 - for ATP energy production
Coenzyme Q10 (CoQ10) is a compound found naturally in the energy-producing center of the cell known as the mitochondria. CoQ10 is involved in the making of ATP. ATP serves as the cell's major energy source and drives a number of biological processes including muscle contraction and the production of protein. CoQ10 also works as an antioxidant.
CoQ10 promotes healthy energy levels, enhances the immune system, and acts as an antioxidant. A growing body of research suggests that using coenzyme Q10 supplements alone or in combination with other drug therapies and nutritional supplements supports the body’s health in promoting a healthy heart, promoting healthy periodontal (gum) condition, and in supporting cognitive and nerve health.*
Mitochondria - what are they & why are they so important? Mitochondria are the primary energy producers in the body. The typical cell contains an average of 1,000 mitochondria. Given that there are 10 to the 13th power cells in a healthy adult, healthy and productive mitochondria are critical to maintain the body's energy and resilience.
Recent studies have shown the importance to maintaining healthy MTDNA, the DNA which resides inside the mitochondria. Unlike standard DNA which has histones and introns to protect it from free radical damage, the mitochondrial DNA does not have this protective mechanism so it is much more exposed and more susceptible to oxidative damage (ROS or reactive oxidative stress). And since mitochondrial cell division takes place approximately every five to six days and replicates the damage existing in the old cells, the damaged MTDNA spreads rapidly. This is what eventually depletes the patient's energy level and may lead to abnormal cellular formation.
Optimized Energy for Serious Mitochondrial Needs
ATP Fuel™ is designed to support the Krebs Cycle of cellular energy production. The Krebs Cycle takes place inside the mitochondria or “power plant” of the cell and it is the body’s primary energy producer.
ATP Fuel™ offers the top three energy nutrients and cofactors synergistically combined for maximum mitochondrial performance and energy production:
NT Factor Energy™
NADH
CoQ10
ATP Fuel™ starts with the base of our highly acclaimed NT Factor Energy™, and adds the two other well-researched energy producing nutrients, NADH and CoQ10 into one convenient and power-producing formula. Plus ATP Fuel™ is available in capsules.
NT Factor Energy™- to repair mitochondrial membranes NT Factor Energy™ was developed as a phospholipid delivery system to repair mitochondrial membranes that have been compromised due to acute and/or long-term health challenges.
Mitochondrial membranes contain their own DNA. If these membranes are damaged and not able to self-repair, they rely on healthy cells to donate their phospholipids. However, if there is a cascading impact of damaged cells splitting, the end result is a less than optimal energy level.
The product's efficacy is based on our proprietary method of extracting and stabilizing the phospholipids, and delivering them intact in the lower intestine for proper absorption. Phospholipids are very unstable and often oxidize in the manufacturing process or in the digestive tract before they can be presented for absorption in the lower intestine. After we stabilize the phospholipids, we wrap them in probiotics and prebiotics. Next, we add minerals and other nutrients to assist in the Krebs Energy Cycle and absorption. When the capsule reaches the lower intestine, the pre and probiotics are released first to promote a healthy flora. We follow this with the release of the NT Factor portion, whose matrix very closely matches that of the gastro intestinal mucosa. As these phospholipids are transported from cell to cell, they are absorbed into the outer and inner mitochondrial membranes --- allowing the mitochondria to provide its natural and healthy level of energy.
A healthy mitochondrial membrane:
allows more nutrients into the mitochondria to support the Krebs Cycle of energy production
is essential for the electron transport chain to efficiently produce healthy levels of ATP
promotes healthier (reduced) level of oxidative stress
NADH - to convert food into energy
NADH is the reduced (electron- energy rich) coenzyme form of vitamin B3 or B-Nicotinamide Adenine Dinucleotide. This "reducing" power (its ability to donate electrons) is what drives ATP production.
NADH is fundamental in the chemical process of converting the food we eat into cellular energy. Each unit of NADH creates three units of ATP (the body's energy fuel).
Studies conducted in Europe indicated that NADH promotes healthy energy levels and emotional balance.
NADH is notoriously unstable. As part of our proprietary formula, we stabilize our NADH with chlorophyll, followed by microencapsulation process to resist gastric acids.
Coenzyme Q10 - for ATP energy production
Coenzyme Q10 (CoQ10) is a compound found naturally in the energy-producing center of the cell known as the mitochondria. CoQ10 is involved in the making of ATP. ATP serves as the cell's major energy source and drives a number of biological processes including muscle contraction and the production of protein. CoQ10 also works as an antioxidant.
CoQ10 promotes healthy energy levels, enhances the immune system, and acts as an antioxidant. A growing body of research suggests that using coenzyme Q10 supplements alone or in combination with other drug therapies and nutritional supplements supports the body’s health in promoting a healthy heart, promoting healthy periodontal (gum) condition, and in supporting cognitive and nerve health.*
Mitochondria - what are they & why are they so important? Mitochondria are the primary energy producers in the body. The typical cell contains an average of 1,000 mitochondria. Given that there are 10 to the 13th power cells in a healthy adult, healthy and productive mitochondria are critical to maintain the body's energy and resilience.
Recent studies have shown the importance to maintaining healthy MTDNA, the DNA which resides inside the mitochondria. Unlike standard DNA which has histones and introns to protect it from free radical damage, the mitochondrial DNA does not have this protective mechanism so it is much more exposed and more susceptible to oxidative damage (ROS or reactive oxidative stress). And since mitochondrial cell division takes place approximately every five to six days and replicates the damage existing in the old cells, the damaged MTDNA spreads rapidly. This is what eventually depletes the patient's energy level and may lead to abnormal cellular formation.
Thursday, May 5, 2011
RibosCardio™ with CardioPerform™
Medical Food with Bioenergy Ribose, L-Carnitine, Acetyl L-Carnitine, Malic Acid and Magnesium GET ALL THE GREAT INGREDIENTS OF BIOENERGY CORVALENM PLUS MORE!
Special Dietary Usefulness as a Medical Food
Under a physician’s direction, RibosCardio™ may have special dietary usefulness for individuals suffering from energy-draining conditions, such as heart disease, Fibromyalgia, chronic fatigue syndrome, and Lyme disease. Published research has also shown D-Ribose effective in extending endurance exercise & increasing exercise tolerance, and muscle recovery from high intensity exercise.
RibosCardio™ has been designed to support serious energy needs of patients. The product has been formulated with CardioPerform™, a potent blend of L-carnitine (transports fuel into the heart to be burned as energy) and Acetyl L-carnitine (improves heart & brain health, protecting against oxidative damage), plus the patented form of D-Ribose, malic acid and magnesium gluconate to optimize energy production and synthesis.
Published research shows our patented form of D-ribose may be an effective adjunct in promoting cardiovascular, skeletal muscle, and neurological health. With heart patients, D-ribose has been found effective in restoring energy, improving ventilatory efficiency, oxygen uptake, stroke volume, diastolic function, physical performance, and quality of life. In neuromuscular disease, D-ribose helps to reduce pain, overcome fatigue, increase exercise tolerance, and help patients live more normal, active lives.
RibosCardio™'s magnesium gluconate and malic acid help your body use energy more efficiently. Your cells use magnesium in over 300 enzyme reactions, and it distributes energy evenly throughout the cell so it is available when and where it is needed. Malic Acid helps your mitochondria recycle the energy you have, maximizing cellular energy output.
D-Ribose Research Highlights
Cardiovascular Function: Scientific and clinical studies have repeatedly shown that our patented D-Ribose can restore energy and improve function in ischemic, hypoxic, and failing hearts. Oxygen deprivation causes hearts to use energy faster than it can be replaced through normal processes of tissue energy turnover. The result is a depletion of cellular energy reserves translating to a loss of heart function.
Mid-study results of an ongoing double blind, crossover trial with congestive heart failure patients were recently reported. Results showed conclusively that when patients were given ribose (15 grams per day for three weeks) they had improved diastolic heart function, increased physical function score and enhanced quality of life score. Echocardiographic studies of these patients showed that ribose administration enhanced relaxation of the left ventricle and improved the efficiency of filling from the left atrium. No such improvements were found during placebo administration (3).
RibosCardio™ increases cardiac energy to help fuel the heart. For patients, this can mean more energy and a higher quality of life.
Sports Nutrition:
In skeletal muscle, high-intensity exercise can lead to a loss of up to 26% of cellular adenosine triphosphate, or ATP. One consequence of this energy drain is an increase in free radicals in affected muscle. Free radicals attack cell and mitochondrial membranes and can destroy the genetic material that helps muscle tissues synthesize proteins.
RibosCardio™ helps in three ways:
First, if enough ribose is present in the cell or the circulating blood, energy compounds can be saved, or salvaged, before they wash out of the cell and are lost.
Second, ribose accelerates energy synthesis, so if energy compounds are lost, they can be quickly replaced.
Finally, by keeping the energy compounds in the cell, RibosCardio™ reduces free radical formation and preserves the energy the tissue needs to make proteins essential for maintaining muscle health and performance. This energy improvement has been shown to increased performance over time.
A study published in the journal, Current Therapeutic Research, showed that male recreational bodybuilders experienced a significant improvement in both muscular endurance (20% increase over the four weeks versus a 12% for the placebo group) and muscular endurance (3.2% increase over the four weeks versus a 1.7% for the placebo group) following 28 days of our patented D-Ribose supplementation(1).
Fibromyalgia & Chronic Fatigue Syndrome:
The muscle in patients with FMS and CFS is generally severely energy starved. This lack of energy leads to a number of physiological reactions within the muscle cell, ending in debilitating fatigue, muscle pain, soreness, and stiffness. By increasing the energy level in affected muscle, our patented D-Ribose helps patients overcome fatigue, and lessens the pain associated with their conditions.
Jar Size:
421 grams (15 oz) 28 day supply
Directions:
RibosCardio™ may be taken with other foods approved for your diet. Add one level scoop (two and 1/2 teaspoonfuls) to 4-8 ounces of your favorite juice, stir briskly and drink. As an alternative, sprinkle on cereal, fruit or applesauce.
Dosage:
Normal dosage is twice daily. Up to 4 doses per day may be taken as needed. If moderate to severe symptoms are present (as frequently seen in fibromyalgia and chronic fatigue syndrome) it is recommended that at least three doses per day be taken for the first two weeks before reducing dosage to twice per day. For best results, all doses should be taken no later than 3:00PM. Continued use is required to maintain the benefits of RibosCardio™.
Source:
Ribose is a fermentation process. The initial source is corn syrup. However, as the product is processed, all traces of corn are removed.
Cautions:
Insulin-dependent diabetics, pregnant women or patients with elevated uric acid levels should consult their physician before use.
Research Papers
1) Van Gammeren D, D Falk, J Antonio. The Effects of Four Weeks of Ribose Supplementation on Body Composition and Exercise Performance, Current Therapeutics Research 2002;63(8):486-495.
2) Jacob E. Teitelbaum, MD, CA Johnson, JA St.Cyr MD,PhD. Effective Treatment Of Chronic Fatigue Syndrome And Fibromyalgia With D-Ribose J Alt Comp Med, 2006;12(6):857-862.
3) White Paper: D-Ribose in Congestive Heart Failure and Ischemic Disease Bioenergy Life Sciences.
Medical Food with Bioenergy Ribose, L-Carnitine, Acetyl L-Carnitine, Malic Acid and Magnesium GET ALL THE GREAT INGREDIENTS OF BIOENERGY CORVALENM PLUS MORE!
Special Dietary Usefulness as a Medical Food
Under a physician’s direction, RibosCardio™ may have special dietary usefulness for individuals suffering from energy-draining conditions, such as heart disease, Fibromyalgia, chronic fatigue syndrome, and Lyme disease. Published research has also shown D-Ribose effective in extending endurance exercise & increasing exercise tolerance, and muscle recovery from high intensity exercise.
RibosCardio™ has been designed to support serious energy needs of patients. The product has been formulated with CardioPerform™, a potent blend of L-carnitine (transports fuel into the heart to be burned as energy) and Acetyl L-carnitine (improves heart & brain health, protecting against oxidative damage), plus the patented form of D-Ribose, malic acid and magnesium gluconate to optimize energy production and synthesis.
Published research shows our patented form of D-ribose may be an effective adjunct in promoting cardiovascular, skeletal muscle, and neurological health. With heart patients, D-ribose has been found effective in restoring energy, improving ventilatory efficiency, oxygen uptake, stroke volume, diastolic function, physical performance, and quality of life. In neuromuscular disease, D-ribose helps to reduce pain, overcome fatigue, increase exercise tolerance, and help patients live more normal, active lives.
RibosCardio™'s magnesium gluconate and malic acid help your body use energy more efficiently. Your cells use magnesium in over 300 enzyme reactions, and it distributes energy evenly throughout the cell so it is available when and where it is needed. Malic Acid helps your mitochondria recycle the energy you have, maximizing cellular energy output.
D-Ribose Research Highlights
Cardiovascular Function: Scientific and clinical studies have repeatedly shown that our patented D-Ribose can restore energy and improve function in ischemic, hypoxic, and failing hearts. Oxygen deprivation causes hearts to use energy faster than it can be replaced through normal processes of tissue energy turnover. The result is a depletion of cellular energy reserves translating to a loss of heart function.
Mid-study results of an ongoing double blind, crossover trial with congestive heart failure patients were recently reported. Results showed conclusively that when patients were given ribose (15 grams per day for three weeks) they had improved diastolic heart function, increased physical function score and enhanced quality of life score. Echocardiographic studies of these patients showed that ribose administration enhanced relaxation of the left ventricle and improved the efficiency of filling from the left atrium. No such improvements were found during placebo administration (3).
RibosCardio™ increases cardiac energy to help fuel the heart. For patients, this can mean more energy and a higher quality of life.
Sports Nutrition:
In skeletal muscle, high-intensity exercise can lead to a loss of up to 26% of cellular adenosine triphosphate, or ATP. One consequence of this energy drain is an increase in free radicals in affected muscle. Free radicals attack cell and mitochondrial membranes and can destroy the genetic material that helps muscle tissues synthesize proteins.
RibosCardio™ helps in three ways:
First, if enough ribose is present in the cell or the circulating blood, energy compounds can be saved, or salvaged, before they wash out of the cell and are lost.
Second, ribose accelerates energy synthesis, so if energy compounds are lost, they can be quickly replaced.
Finally, by keeping the energy compounds in the cell, RibosCardio™ reduces free radical formation and preserves the energy the tissue needs to make proteins essential for maintaining muscle health and performance. This energy improvement has been shown to increased performance over time.
A study published in the journal, Current Therapeutic Research, showed that male recreational bodybuilders experienced a significant improvement in both muscular endurance (20% increase over the four weeks versus a 12% for the placebo group) and muscular endurance (3.2% increase over the four weeks versus a 1.7% for the placebo group) following 28 days of our patented D-Ribose supplementation(1).
Fibromyalgia & Chronic Fatigue Syndrome:
The muscle in patients with FMS and CFS is generally severely energy starved. This lack of energy leads to a number of physiological reactions within the muscle cell, ending in debilitating fatigue, muscle pain, soreness, and stiffness. By increasing the energy level in affected muscle, our patented D-Ribose helps patients overcome fatigue, and lessens the pain associated with their conditions.
Jar Size:
421 grams (15 oz) 28 day supply
Directions:
RibosCardio™ may be taken with other foods approved for your diet. Add one level scoop (two and 1/2 teaspoonfuls) to 4-8 ounces of your favorite juice, stir briskly and drink. As an alternative, sprinkle on cereal, fruit or applesauce.
Dosage:
Normal dosage is twice daily. Up to 4 doses per day may be taken as needed. If moderate to severe symptoms are present (as frequently seen in fibromyalgia and chronic fatigue syndrome) it is recommended that at least three doses per day be taken for the first two weeks before reducing dosage to twice per day. For best results, all doses should be taken no later than 3:00PM. Continued use is required to maintain the benefits of RibosCardio™.
Source:
Ribose is a fermentation process. The initial source is corn syrup. However, as the product is processed, all traces of corn are removed.
Cautions:
Insulin-dependent diabetics, pregnant women or patients with elevated uric acid levels should consult their physician before use.
Research Papers
1) Van Gammeren D, D Falk, J Antonio. The Effects of Four Weeks of Ribose Supplementation on Body Composition and Exercise Performance, Current Therapeutics Research 2002;63(8):486-495.
2) Jacob E. Teitelbaum, MD, CA Johnson, JA St.Cyr MD,PhD. Effective Treatment Of Chronic Fatigue Syndrome And Fibromyalgia With D-Ribose J Alt Comp Med, 2006;12(6):857-862.
3) White Paper: D-Ribose in Congestive Heart Failure and Ischemic Disease Bioenergy Life Sciences.
Energy Multi-Plex - Adrenal Support Formula
Adrenal Support Formula with 14 researched nutrients
Our product developers were assigned the task of developing the most advanced adrenal support product based on published research. After a thorough review of the literature, they formulated Energy Multi-Plex™ --- the total energy formula. A favorite among doctors and patients, Energy Multi-Plex™ is a reasonably priced answer to many people's dreams of more energy.
“I have improved energy after supplementing with NT Factor Energy and Energy Multi-Plex. Especially notable are the increased maximal sudden power, endurance, and ability to recover during exercise and also for the next day events - for example in distance bicycling on hilly roads and weight lifting and aerobic exercising at the Y.
These two Researched Nutritionals products were added to a thorough treatment program for a longer-term fatigue illness from tick borne infection complex illness in the later, more recent stages of therapy. I think the products address some of what we know about mitochondrial damage in the longer-term fatigue- like syndromes and look forward to discussing this further with others interested in increased energy. I have no conflicts of interest in my dialogues regarding Researched Nutritionals products.” --- H. Smith MD
Each bottle provides a one month supply of the following complexes and health benefits:
Energymax™ Complex:
Targeted blend of D-ribose, panax ginseng which
• promotes healthy energy levels by raising the level of the body’s energy fuel, ATP
• supports healthy cognitive performance
MuscularEnergy™ Complex:
Combination of malic acid and rhodiola rosea which
• plays a key role in energy producing Kreb’s Cycle
• has an adaptogenic affect to support physical activity
Mitrochondria Energizer™ Complex:
Powerful duo of acetyl-L-carnitine and alpha lipoic acid which
• acts as a catalyst for ATP production in mitochondria
• improves mitochondrial function while promoting healthy cognitive function
Metabolism Plus™ Complex:
Natural, non-stimulation blend of pyruvic acid and 7-Keto DHEA which
• naturally increases, without artificial stimulation, resting metabolism
• multiple studies
show increased fat utilization (fat loss) as an energy source
• promotes fat loss through thermogenesis
HeartStrong™ Complex:
High potency Co Q10 and L-Taurine which
• is used by the body to transform food into adenosine triphosphate (ATP), the energy on which the body runs
• promotes healthy heart and gum tissue
• modulates the immune system
• promotes healthy heart beat and cell wall stability
Key Nutrient Blend:
pantothenic acid, vitamin B-12, magnesium and potassium which
• are essential nutrients involved in producing, transporting and releasing energy from fat
• promotes healthy neuromuscular function and muscle contractions
Suggested Use
As a dietary supplement, take three capsules per day (at one time or throughout the day) or as directed by your healthcare professional.
Our product developers were assigned the task of developing the most advanced adrenal support product based on published research. After a thorough review of the literature, they formulated Energy Multi-Plex™ --- the total energy formula. A favorite among doctors and patients, Energy Multi-Plex™ is a reasonably priced answer to many people's dreams of more energy.
“I have improved energy after supplementing with NT Factor Energy and Energy Multi-Plex. Especially notable are the increased maximal sudden power, endurance, and ability to recover during exercise and also for the next day events - for example in distance bicycling on hilly roads and weight lifting and aerobic exercising at the Y.
These two Researched Nutritionals products were added to a thorough treatment program for a longer-term fatigue illness from tick borne infection complex illness in the later, more recent stages of therapy. I think the products address some of what we know about mitochondrial damage in the longer-term fatigue- like syndromes and look forward to discussing this further with others interested in increased energy. I have no conflicts of interest in my dialogues regarding Researched Nutritionals products.” --- H. Smith MD
Each bottle provides a one month supply of the following complexes and health benefits:
Energymax™ Complex:
Targeted blend of D-ribose, panax ginseng which
• promotes healthy energy levels by raising the level of the body’s energy fuel, ATP
• supports healthy cognitive performance
MuscularEnergy™ Complex:
Combination of malic acid and rhodiola rosea which
• plays a key role in energy producing Kreb’s Cycle
• has an adaptogenic affect to support physical activity
Mitrochondria Energizer™ Complex:
Powerful duo of acetyl-L-carnitine and alpha lipoic acid which
• acts as a catalyst for ATP production in mitochondria
• improves mitochondrial function while promoting healthy cognitive function
Metabolism Plus™ Complex:
Natural, non-stimulation blend of pyruvic acid and 7-Keto DHEA which
• naturally increases, without artificial stimulation, resting metabolism
• multiple studies
show increased fat utilization (fat loss) as an energy source
• promotes fat loss through thermogenesis
HeartStrong™ Complex:
High potency Co Q10 and L-Taurine which
• is used by the body to transform food into adenosine triphosphate (ATP), the energy on which the body runs
• promotes healthy heart and gum tissue
• modulates the immune system
• promotes healthy heart beat and cell wall stability
Key Nutrient Blend:
pantothenic acid, vitamin B-12, magnesium and potassium which
• are essential nutrients involved in producing, transporting and releasing energy from fat
• promotes healthy neuromuscular function and muscle contractions
Suggested Use
As a dietary supplement, take three capsules per day (at one time or throughout the day) or as directed by your healthcare professional.
Tuesday, June 22, 2010
When a Complement is not a Compliment: The Role of C3a and C4a Complement Proteins in Chronic Lyme Disease
When a Complement is not a Compliment:
The Role of C3a and C4a Complement Proteins in Chronic Lyme Disease
by Ginger Savely, DNP
Readers of this publication are well aware of the controversies surrounding the diagnosis and treatment of Lyme disease. When the disease is missed in its early, easier-to-treat stage, it goes on to become a complex, multi-system disease that eludes diagnosis, mimics many other diseases, and requires aggressive, long-term treatment. Because the testing methods for Lyme and other tick-borne diseases are insensitive, many true cases of infection go undetected. Even when the diseases are detected, the unreliability of the testing makes it difficult to track treatment progress and test for cure.
Work by Drs Stricker and Winger identified CD57 positive natural killer cells as immune markers that tend to be low in chronic Lyme patients and increase with clinical improvement. An earlier article that I wrote for this publication explained how the measurement of CD57+NK cells in the blood has helped Lyme-literate health care providers in making the diagnosis of Lyme disease when tests are inconclusive. It has also provided a convenient marker to assist in following treatment progress and determining treatment end.
Although the CD57 marker has been a helpful tool, it has not been without its problems. We don't yet understand what confounding variables can skew the results. Some very sick patients start out with normal or above-normal CD57 levels. Other patients' levels stay low and never increase with treatment, despite the fact that they are symptom-free and otherwise seem completely cured. There may be large day to day variation in the CD57 level as I observed in a study looking at twice daily blood draws over 3 days for both Lyme patients and well patients. The level can increase or decrease as much as 50% within the same day. So the CD57 level can be a useful marker for some patients but it is not always reliable and consistent.
Enter C3a and C4a, the new kids on the block in the world of Lyme diagnosis and treatment. The "C" in C3a and C4a stands for complement. Complement proteins work with antibodies to destroy pathogens. They activate immunity through control of inflammation, phagocytosis (ingestion of pathogens by white blood cells) and cell death by lysis (breaking of the cell membrane). There are about 30 of these complement proteins that circulate in the bloodstream making up complement "cascades", so called because activation of one protein initiates activation of the next, etc.
Dr. Ritchie Shoemaker and his colleagues published a study in 2008 reporting elevated C3a and C4a levels in acute Lyme disease. Many patients who contract Lyme disease do not develop the diagnostic "bull's eye rash", and Lyme tests are frequently negative shortly following a tick bite when prompt diagnosis is crucial for effective treatment. Shoemaker et al. suggested that elevated C3a and C4a levels can serve as early markers in the diagnosis of acute Lyme disease.
Because CD57+ NK cell levels are not always reliable markers for chronic Lyme, there is an ongoing search for new biomarkers to aid in the diagnosis of chronic, disseminated Lyme disease and to follow treatment progress. Dr. Stricker and I recently published a study in the Scandinavian Journal of Immunology comparing C3a and C4a levels of chronic Lyme patients to those of healthy controls, AIDS patients and patients with systemic lupus. The C3a complement protein level was normal in the AIDS patients, the healthy patients and the chronic Lyme patients. So, although C3a was shown to be elevated in a cohort of early, acute Lyme disease patients, it appears to be normal in chronic Lyme patients.
In our study, only the systemic lupus patients had elevated levels of C3a. Other published studies have associated elevated C3a with autoimmunity as well. Therefore, the C3a may prove to be a useful marker in differentiating ongoing symptoms due to an autoimmune process versus an ongoing infectious process.
For purposes of our C3a/C4a study, Dr. Stricker divided the chronic Lyme patients into two groups: 1) those with primarily musculoskeletal symptoms (MSK) and 2) those with neurological symptoms severe enough to warrant treatment with intravenous antibiotics. Interestingly, C4a levels were significantly elevated in the MSK group, but only slightly (and not statistically significantly) elevated in the neurologic group. C4a levels were also elevated in the AIDS and systemic lupus groups, but not in the healthy controls. In Lyme patients with elevated C4a, the levels decreased in those who responded well to antibiotic treatment. Those patients who did not improve on antibiotics (more often than not, the severe neurological group) had no statistically significant reduction in their C4a levels.
Keep in mind that almost all chronic Lyme patients have some degree of neurological involvement. The neurological Lyme patients in the study who did not have elevated levels of C4a were those with severe cognitive dysfunction as evidenced by abnormal blood flow to areas of the brain noted on their SPECT brain scans. Examples of these patients are those who presented with symptoms mimicking Alzheimer's disease, multiple sclerosis, Parkinson's disease, or Autism Spectrum Disorder. Amyotrophic lateral sclerosis (ALS) patients do not have cognitive deficits and, in fact, Lyme patients with this type of severe neurological presentation did have elevated C4a levels.
The normal range for the C4a is zero to 2830. In my chronically ill Lyme patients I have seen C4a levels as high as about 26,000. However, most of my patients start with a pre-treatment level between 6000 and 12,000. In the two years that I have been using the C4a test to track treatment progress, reduction in C4a levels has consistently correlated with clinical improvement.
Patients often ask if there are other medical conditions that may lower or raise the C3a and/or C4a. Both of these complement products may be increased in normal pregnancy and in certain types of vasculitis (an inflammatory condition that destroys blood vessels). C4a levels are elevated in adult insulin dependent diabetes. Those who suspect that chronic fatigue syndrome (CFS) may actually be misdiagnosed Lyme disease may not be surprised to hear that C4a is also elevated in CFS patients. In fact the C4a is probably elevated in all sorts of infections, and therefore is not specific to Lyme.
If you would like your health care provider to order your C3a and C4a levels, it is extremely important that the tests be performed only at the National Jewish Medical and Research Center Laboratory in Denver. LabCorp has a contract with National Jewish and therefore your health care provider can order LabCorp tests # 840702 (C3a) and # 857334 (C4a). LabCorp uses two different send-out labs for the test and it is important to indicate that samples should be routed to National Jewish for most accurate results. Ask your health care provider to write on the requisition slip in large letters: "ACCESSIONING: C3a & C4a MUST BE ROUTED TO NATIONAL JEWISH". To find the LabCorp drawing station nearest you, go to www.labcorp.com and enter your city or zip code in the space provided in the lower left of the home page.
If your health care provider writes the ICD-9 (diagnostic) code of 279.3 (Immune dysregulation) on your LabCorp requisition slip, insurance will more than likely cover the C3a and C4a tests. However, if your insurance does not cover the tests, the prices are not prohibitive. Each of the tests cost $ 75.60 (valid as of 3-25-09).
Because most lab technicians are unfamiliar with the C3a and C4a tests, it is in your best interest to go to the LabCorp drawing station knowing exactly how your blood should be handled. This way you will be assured that your sample will arrive at the lab satisfactory for testing. The blood needs to be drawn into an EDTA tube ("lavender top") and immediately spun and separated. The plasma should be frozen right away and sent frozen to National Jewish.
The C4a is not as specific to chronic Lyme as the CD57+ level because it may be elevated in many types of infection, including other tick-borne diseases. However, in patients with known tick-borne infections, the C4a complement protein test can provide a useful way to determine initial degree of infection, to follow treatment progress and to aid in deciding upon treatment end. For more information about the C3a and C4a, please see the suggested readings below:
Shoemaker RC, Giclas PC, Crowder C, House D, Glovsky MM.Shoemaker, R. C., Giglas, P.C., Crowder, C., House, D. Glovsky, M.M. Complement split products C3a and C4a are early markers of acute lyme disease in tick bite patients in the United States. International Archives of Allergy and Immunology, 146(3), 255-261.
Stricker, R. B., Savely, V.R., Motanya, N.C. & Giglas, B.C. (2009). Complement split products C3a and C4a in chronic Lyme disease. Scandinavian Journal of Immunology, 69(1), 64-69.
The Role of C3a and C4a Complement Proteins in Chronic Lyme Disease
by Ginger Savely, DNP
Readers of this publication are well aware of the controversies surrounding the diagnosis and treatment of Lyme disease. When the disease is missed in its early, easier-to-treat stage, it goes on to become a complex, multi-system disease that eludes diagnosis, mimics many other diseases, and requires aggressive, long-term treatment. Because the testing methods for Lyme and other tick-borne diseases are insensitive, many true cases of infection go undetected. Even when the diseases are detected, the unreliability of the testing makes it difficult to track treatment progress and test for cure.
Work by Drs Stricker and Winger identified CD57 positive natural killer cells as immune markers that tend to be low in chronic Lyme patients and increase with clinical improvement. An earlier article that I wrote for this publication explained how the measurement of CD57+NK cells in the blood has helped Lyme-literate health care providers in making the diagnosis of Lyme disease when tests are inconclusive. It has also provided a convenient marker to assist in following treatment progress and determining treatment end.
Although the CD57 marker has been a helpful tool, it has not been without its problems. We don't yet understand what confounding variables can skew the results. Some very sick patients start out with normal or above-normal CD57 levels. Other patients' levels stay low and never increase with treatment, despite the fact that they are symptom-free and otherwise seem completely cured. There may be large day to day variation in the CD57 level as I observed in a study looking at twice daily blood draws over 3 days for both Lyme patients and well patients. The level can increase or decrease as much as 50% within the same day. So the CD57 level can be a useful marker for some patients but it is not always reliable and consistent.
Enter C3a and C4a, the new kids on the block in the world of Lyme diagnosis and treatment. The "C" in C3a and C4a stands for complement. Complement proteins work with antibodies to destroy pathogens. They activate immunity through control of inflammation, phagocytosis (ingestion of pathogens by white blood cells) and cell death by lysis (breaking of the cell membrane). There are about 30 of these complement proteins that circulate in the bloodstream making up complement "cascades", so called because activation of one protein initiates activation of the next, etc.
Dr. Ritchie Shoemaker and his colleagues published a study in 2008 reporting elevated C3a and C4a levels in acute Lyme disease. Many patients who contract Lyme disease do not develop the diagnostic "bull's eye rash", and Lyme tests are frequently negative shortly following a tick bite when prompt diagnosis is crucial for effective treatment. Shoemaker et al. suggested that elevated C3a and C4a levels can serve as early markers in the diagnosis of acute Lyme disease.
Because CD57+ NK cell levels are not always reliable markers for chronic Lyme, there is an ongoing search for new biomarkers to aid in the diagnosis of chronic, disseminated Lyme disease and to follow treatment progress. Dr. Stricker and I recently published a study in the Scandinavian Journal of Immunology comparing C3a and C4a levels of chronic Lyme patients to those of healthy controls, AIDS patients and patients with systemic lupus. The C3a complement protein level was normal in the AIDS patients, the healthy patients and the chronic Lyme patients. So, although C3a was shown to be elevated in a cohort of early, acute Lyme disease patients, it appears to be normal in chronic Lyme patients.
In our study, only the systemic lupus patients had elevated levels of C3a. Other published studies have associated elevated C3a with autoimmunity as well. Therefore, the C3a may prove to be a useful marker in differentiating ongoing symptoms due to an autoimmune process versus an ongoing infectious process.
For purposes of our C3a/C4a study, Dr. Stricker divided the chronic Lyme patients into two groups: 1) those with primarily musculoskeletal symptoms (MSK) and 2) those with neurological symptoms severe enough to warrant treatment with intravenous antibiotics. Interestingly, C4a levels were significantly elevated in the MSK group, but only slightly (and not statistically significantly) elevated in the neurologic group. C4a levels were also elevated in the AIDS and systemic lupus groups, but not in the healthy controls. In Lyme patients with elevated C4a, the levels decreased in those who responded well to antibiotic treatment. Those patients who did not improve on antibiotics (more often than not, the severe neurological group) had no statistically significant reduction in their C4a levels.
Keep in mind that almost all chronic Lyme patients have some degree of neurological involvement. The neurological Lyme patients in the study who did not have elevated levels of C4a were those with severe cognitive dysfunction as evidenced by abnormal blood flow to areas of the brain noted on their SPECT brain scans. Examples of these patients are those who presented with symptoms mimicking Alzheimer's disease, multiple sclerosis, Parkinson's disease, or Autism Spectrum Disorder. Amyotrophic lateral sclerosis (ALS) patients do not have cognitive deficits and, in fact, Lyme patients with this type of severe neurological presentation did have elevated C4a levels.
The normal range for the C4a is zero to 2830. In my chronically ill Lyme patients I have seen C4a levels as high as about 26,000. However, most of my patients start with a pre-treatment level between 6000 and 12,000. In the two years that I have been using the C4a test to track treatment progress, reduction in C4a levels has consistently correlated with clinical improvement.
Patients often ask if there are other medical conditions that may lower or raise the C3a and/or C4a. Both of these complement products may be increased in normal pregnancy and in certain types of vasculitis (an inflammatory condition that destroys blood vessels). C4a levels are elevated in adult insulin dependent diabetes. Those who suspect that chronic fatigue syndrome (CFS) may actually be misdiagnosed Lyme disease may not be surprised to hear that C4a is also elevated in CFS patients. In fact the C4a is probably elevated in all sorts of infections, and therefore is not specific to Lyme.
If you would like your health care provider to order your C3a and C4a levels, it is extremely important that the tests be performed only at the National Jewish Medical and Research Center Laboratory in Denver. LabCorp has a contract with National Jewish and therefore your health care provider can order LabCorp tests # 840702 (C3a) and # 857334 (C4a). LabCorp uses two different send-out labs for the test and it is important to indicate that samples should be routed to National Jewish for most accurate results. Ask your health care provider to write on the requisition slip in large letters: "ACCESSIONING: C3a & C4a MUST BE ROUTED TO NATIONAL JEWISH". To find the LabCorp drawing station nearest you, go to www.labcorp.com and enter your city or zip code in the space provided in the lower left of the home page.
If your health care provider writes the ICD-9 (diagnostic) code of 279.3 (Immune dysregulation) on your LabCorp requisition slip, insurance will more than likely cover the C3a and C4a tests. However, if your insurance does not cover the tests, the prices are not prohibitive. Each of the tests cost $ 75.60 (valid as of 3-25-09).
Because most lab technicians are unfamiliar with the C3a and C4a tests, it is in your best interest to go to the LabCorp drawing station knowing exactly how your blood should be handled. This way you will be assured that your sample will arrive at the lab satisfactory for testing. The blood needs to be drawn into an EDTA tube ("lavender top") and immediately spun and separated. The plasma should be frozen right away and sent frozen to National Jewish.
The C4a is not as specific to chronic Lyme as the CD57+ level because it may be elevated in many types of infection, including other tick-borne diseases. However, in patients with known tick-borne infections, the C4a complement protein test can provide a useful way to determine initial degree of infection, to follow treatment progress and to aid in deciding upon treatment end. For more information about the C3a and C4a, please see the suggested readings below:
Shoemaker RC, Giclas PC, Crowder C, House D, Glovsky MM.Shoemaker, R. C., Giglas, P.C., Crowder, C., House, D. Glovsky, M.M. Complement split products C3a and C4a are early markers of acute lyme disease in tick bite patients in the United States. International Archives of Allergy and Immunology, 146(3), 255-261.
Stricker, R. B., Savely, V.R., Motanya, N.C. & Giglas, B.C. (2009). Complement split products C3a and C4a in chronic Lyme disease. Scandinavian Journal of Immunology, 69(1), 64-69.
Friday, June 4, 2010
Soothe & Relaxx™ Soft Tissue & Stress Support
Soothe & Relaxx™ Soft Tissue & Stress Support
Has anybody tried this? My doctor put me on this for Lyme disease and it works great for me. It also works great for the fibromyalgia symptoms and anything to do with soft tissue pain, stress and relaxation. Thought I would share the information with you.
Product Description
Soft tissue, joint & muscle support with Relaxx™ Complex to calm the mind. (180 capsules)
Special Dietary Usefulness:
Under a physician’s direction, Soothe & Relaxx™ may have special dietary usefulness for individuals suffering from fibromyalgia and other chronic illnesses with soft tissue, joint and muscle pain.
Soothe & Relaxx™ was developed to meet the combination of needs that many chronically ill patients experience: pain and anxiety. The product addresses pain as a result of soft tissue or joint injury and the concomitant anxiety often associated with long-term health issues. The Relaxx™ Complex is designed to take the edge off versus being a sedating micro-formula. This is a favorite of patients who feel the benefit fairly quickly.
Each bottle provides a one month supply of the following complexes and health benefits:
Pro Joint Soothers™:
Proprietary blend of glucosamine sulfate, MSM, chrondroitin sulfate, hyaluronic acid which supports connective tissue, lubricates joints, promotes joint resilience, elasticity and overall strength.
ExInflame™ Complex:
Proprietary blend of White Willow Bark, Boswellin, Curcumin Extract, Holy Basil which promotes a healthy inflammation response.
Muscle & Leg Calmer™:
Proprietary blend of magnesium hydroxide and malic acid which calms muscle contractions and relaxes the body's muscles.
Relaxx™ Complex:
Proprietary blend of 5HTP, Valerian, Lemon Balm, Passion Flower, German Chamomile which relaxes & calms the mind, and promotes healthy sleep patterns.
Suggested Use:
As a dietary supplement, take two capsules three times per day or as directed by your health care professional.
Has anybody tried this? My doctor put me on this for Lyme disease and it works great for me. It also works great for the fibromyalgia symptoms and anything to do with soft tissue pain, stress and relaxation. Thought I would share the information with you.
Product Description
Soft tissue, joint & muscle support with Relaxx™ Complex to calm the mind. (180 capsules)
Special Dietary Usefulness:
Under a physician’s direction, Soothe & Relaxx™ may have special dietary usefulness for individuals suffering from fibromyalgia and other chronic illnesses with soft tissue, joint and muscle pain.
Soothe & Relaxx™ was developed to meet the combination of needs that many chronically ill patients experience: pain and anxiety. The product addresses pain as a result of soft tissue or joint injury and the concomitant anxiety often associated with long-term health issues. The Relaxx™ Complex is designed to take the edge off versus being a sedating micro-formula. This is a favorite of patients who feel the benefit fairly quickly.
Each bottle provides a one month supply of the following complexes and health benefits:
Pro Joint Soothers™:
Proprietary blend of glucosamine sulfate, MSM, chrondroitin sulfate, hyaluronic acid which supports connective tissue, lubricates joints, promotes joint resilience, elasticity and overall strength.
ExInflame™ Complex:
Proprietary blend of White Willow Bark, Boswellin, Curcumin Extract, Holy Basil which promotes a healthy inflammation response.
Muscle & Leg Calmer™:
Proprietary blend of magnesium hydroxide and malic acid which calms muscle contractions and relaxes the body's muscles.
Relaxx™ Complex:
Proprietary blend of 5HTP, Valerian, Lemon Balm, Passion Flower, German Chamomile which relaxes & calms the mind, and promotes healthy sleep patterns.
Suggested Use:
As a dietary supplement, take two capsules three times per day or as directed by your health care professional.
Thursday, June 3, 2010
Lyme Disease & Common Co-Infections
Lyme Disease & Common Co-Infections
Short Symptom List
Borrelia, Babesia, Bartonella, and Ehrlichia
The following symptoms were excerpted from Diagnostic Hints And Treatment
Guidelines For Lyme And Other Tick Borne Illnesses, by Joseph J. Burrascano Jr.,M.D. (Fourteenth Edition, November, 2002). Available online at www.ilads.org/burrascano_1102.html
Borrelia
(Borreliosis, neuroborreliosis; also known as Lyme Disease)
Spread primarily though the bite of infected ticks that live on a wide range of mammalian species; secondary human-to-human transmission through semen, breast milk, and possibly in utero.
**Bladder dysfunction
**Burning or stabbing sensations
**Cardiac impairment
**Change in bowel function
**Chest pain
**Confusion
**Depression
**Difficulty thinking
**Difficulty with concentration and reading
**Difficulty with speech, writing
**Difficulty finding words; name blocking
**Disorientation: getting lost, going to wrong places
**Disturbed sleep: too much, too little, fractionated, early awakening
**Ears/Hearing: buzzing, ringing, ear pain, sound sensitivity
**Exaggerated symptoms or worse hangover from alcohol
**Eyes/Vision: double, blurry, increased floaters, light sensitivity
**Facial paralysis (Bell's palsy)
**Fatigue, tiredness, poor stamina
**Forgetfulness
**Headache
**Heart block
**Heart murmur
**Heart palpitations
**Heart valve prolapse
**Increased motion sickness
**Irritability
**Irritable bladder
**Joint pain or swelling
**Lightheadedness
**Mood swings
**Muscle pain or cramps
**Neck creaks & cracks
**Neck stiffness, pain
**Numbness
**Pelvic pain
**Poor attention
**Poor balance
**Poor short-term memory
**Problem absorbing new information
**Pulse skips
**Rib soreness
**Sexual dysfunction or loss of libido
**Shooting pains
**Shortness of breath; cough
**Skin hypersensitivity
**Sore throat
**Stiffness of the joints or back
**Swollen glands
**Testicular pain
**Tingling
**Tremor
**Twitching of the face or other muscles
**Unavoidable need to sit or lay down
**Unexplained breast pain
**Unexplained fevers, sweats, chills or flushing
**Unexplained hair loss
**Unexplained menstrual irregularity'
**Unexplained milk production
**Unexplained weight loss or gain
**Upset Stomach or abdominal pain
**Vertigo
**Wooziness
Babesia Babesiosis)
Babesia is a protozoan spread by ticks, blood transfusion, and in utero. Despite there being 13 known forms to date, current testing only looks for two of them.
**Air hunger
**Cough
**Fatigue
**Fevers
**Headache
**Hemolysis
**Imbalance without true vertigo
**Mild encephalopathy
**Shaking chills
**Sweats
Bartonella (Bartonellosis, also known as cat scratch fever)
Spread by bites from infected ticks and in utero
**abnormal liver enzymes
**encephalopathy
**endocarditis
**flu-like malaise
**headache
**hemolysis with anemia
**hepatomegaly
**high fever
**immune deficiency
**jaundice
**lymphadenopathy
**myalgias
**myocarditis
**papular or angiomatous rash
**somnolence
**sore throat
**splenomegaly
**weakened immune response
Ehrlichia (Ehrlichiosis)
Bites from infected ticks
**elevated liver enzymes
**headaches
**myalgias
**ongoing fatigue
**persistent leukopenia
**thrombocytopenia
Printed from www.anapsid.org/lyme/symptoms/tbi-symptoms.html
More information on Lyme and other tickborne diseases:
www.calda.intranets.com
www.ilads.org
www.lymenet.org
Short Symptom List
Borrelia, Babesia, Bartonella, and Ehrlichia
The following symptoms were excerpted from Diagnostic Hints And Treatment
Guidelines For Lyme And Other Tick Borne Illnesses, by Joseph J. Burrascano Jr.,M.D. (Fourteenth Edition, November, 2002). Available online at www.ilads.org/burrascano_1102.html
Borrelia
(Borreliosis, neuroborreliosis; also known as Lyme Disease)
Spread primarily though the bite of infected ticks that live on a wide range of mammalian species; secondary human-to-human transmission through semen, breast milk, and possibly in utero.
**Bladder dysfunction
**Burning or stabbing sensations
**Cardiac impairment
**Change in bowel function
**Chest pain
**Confusion
**Depression
**Difficulty thinking
**Difficulty with concentration and reading
**Difficulty with speech, writing
**Difficulty finding words; name blocking
**Disorientation: getting lost, going to wrong places
**Disturbed sleep: too much, too little, fractionated, early awakening
**Ears/Hearing: buzzing, ringing, ear pain, sound sensitivity
**Exaggerated symptoms or worse hangover from alcohol
**Eyes/Vision: double, blurry, increased floaters, light sensitivity
**Facial paralysis (Bell's palsy)
**Fatigue, tiredness, poor stamina
**Forgetfulness
**Headache
**Heart block
**Heart murmur
**Heart palpitations
**Heart valve prolapse
**Increased motion sickness
**Irritability
**Irritable bladder
**Joint pain or swelling
**Lightheadedness
**Mood swings
**Muscle pain or cramps
**Neck creaks & cracks
**Neck stiffness, pain
**Numbness
**Pelvic pain
**Poor attention
**Poor balance
**Poor short-term memory
**Problem absorbing new information
**Pulse skips
**Rib soreness
**Sexual dysfunction or loss of libido
**Shooting pains
**Shortness of breath; cough
**Skin hypersensitivity
**Sore throat
**Stiffness of the joints or back
**Swollen glands
**Testicular pain
**Tingling
**Tremor
**Twitching of the face or other muscles
**Unavoidable need to sit or lay down
**Unexplained breast pain
**Unexplained fevers, sweats, chills or flushing
**Unexplained hair loss
**Unexplained menstrual irregularity'
**Unexplained milk production
**Unexplained weight loss or gain
**Upset Stomach or abdominal pain
**Vertigo
**Wooziness
Babesia Babesiosis)
Babesia is a protozoan spread by ticks, blood transfusion, and in utero. Despite there being 13 known forms to date, current testing only looks for two of them.
**Air hunger
**Cough
**Fatigue
**Fevers
**Headache
**Hemolysis
**Imbalance without true vertigo
**Mild encephalopathy
**Shaking chills
**Sweats
Bartonella (Bartonellosis, also known as cat scratch fever)
Spread by bites from infected ticks and in utero
**abnormal liver enzymes
**encephalopathy
**endocarditis
**flu-like malaise
**headache
**hemolysis with anemia
**hepatomegaly
**high fever
**immune deficiency
**jaundice
**lymphadenopathy
**myalgias
**myocarditis
**papular or angiomatous rash
**somnolence
**sore throat
**splenomegaly
**weakened immune response
Ehrlichia (Ehrlichiosis)
Bites from infected ticks
**elevated liver enzymes
**headaches
**myalgias
**ongoing fatigue
**persistent leukopenia
**thrombocytopenia
Printed from www.anapsid.org/lyme/symptoms/tbi-symptoms.html
More information on Lyme and other tickborne diseases:
www.calda.intranets.com
www.ilads.org
www.lymenet.org
Distinct pattern of cognitive impairment noted in study of Lyme patients
Distinct pattern of cognitive impairment noted in study of Lyme patients
by Marian Rissenberg, Ph.D. & Susan Chambers, M.D.
the Lyme Times, Vol. 20, January-March 1998, pp. 29 -32
1) Cognitive Characteristics of Chronic Lyme Encephalopathy
On the basis of both a formal neuropsychological study of 49 patients (APA 5/96) and on clinical observation and comprehensive neuropsychological examination of well over 100 patients, a distinct pattern of cognitive impairment occurring chronic Lyme disease can be described. These patients consistently demonstrate deficits in directed, sustained and divided attention, planning and organization of responses, temporal ordering, verbal fluency, abstract reasoning, speed of processing, and motor programming. The overall pattern of intellectual impairment is not unlike that seen with diffuse brain injury, and it most often results in some degree of work-related disability.
Although performance is impaired on measures of cognitive functions associated with specific brain regions -- receptive and expressive language, visuospatial problem solving and memory -- the quality of performance is not suggestive of focal lesions in these areas. Rather, deficits are secondary to impairment of higher level integrative functions, likely mediated by complex neuronal systems. Specifically, the receptive language deficit is secondary to impaired auditory tracking and slowing of mental processing. The expressive language deficit is secondary to impaired word retrieval and response planning, The visuospatial problem solving deficit is secondary to impairment of mental flexibility, conceptualization and the ability to compare and contrast necessary in decision making. Finally, deficits on test of memory function are most often secondary to impairment of the encoding or initial processing of information, which depends on attention, and the retrieval of stored information. The storage of new information, or memory per se, is rarely impaired.
This pattern suggests that cognitive dysfunction in chronic Lyme, while expressed variably across individual patients, results from a common factor -- the breakdown of diffusely represented processes involving both integration and activation, and impacting primarily on attention and reasoning. The fluctuation of impairment over short periods of time suggest that a physiologic rather than a structural mechanism is responsible.
2) Neuropsychological deficits in chronic Lyme disease (A study presented at the annual meeting of The American Psychiatric Association , May 1996)
The neuro-psychological characteristics of 49 patients with Lyme disease were examined. The study set out to answer three questions:
1) Do all patients with subjectively perceived cognitive dysfunction have measurable intellectual impairment on objective testing?
2) In those without measurable impairment, does depression account for the perception of cognitive dysfunction?
3) What is the nature of the cognitive impairment in Lyme disease when it does occur?
Subjects were patients seen consecutively between 1990 and 1994 in a private neuropsycological practice with complaints of cognitive dysfunction and a symptom complex consistent with Lyme disease. Diagnosis was based on former CDC criteria. Mean duration of illness, defined as the time from the onset of general symptoms to the neuro-psychological exam, was 4.7 years (range: 3.3 to 14 years). Mean age was 39.9 years (range: 21 to 58 years) from 18 to 60 years. Mean level of education was 15.3 years (range 12 to 20 years).
Subjects were interviewed and administered a comprehensive battery of tests, including the complete WAIS-R and WMS-R, and additional test of language, attention, reasoning, visuospatial processing and complex motor function. They also completed the Beck Depression Inventory and a symptom checklist. Tests were divided into seven groups based on the cognitive functions they are presumed to measure: Attention, Memory, Language, Visuospatial Processing, Reasoning, Verbal Fluency and Motor programming.
Subjects were grouped into three levels of impairment based on their neuropsychological performance: Intact (N=11; 22%), with no functions impaired, Moderate (N=31; 63%) with two functions impaired, and Severe (N=7; 14%) with three or more functions impaired. Subjects in the Severe group met diagnostic criteria for dementia. The correlation between depression and cognitive impairment was nonsignificant, but the trend was positive, rather that negative. Anxiety by self report was significantly greater in the impaired groups that the Intact group. Duration of illness was greater in the Severe group (nonsignificant).
Of the 38 subjects with cognitive impairment, deficits of attention were most common, occurring in 26 subjects (68%) Deficits of memory storage were least common, occurring in 8 subjects (21%), Motor, Verbal Fluency, Visuospatial, Language and Reasoning deficits occurred in 24, 26, 29, 36 and 36% of the subjects respectively.
3) Possible Pathophysiologic Mechanisms of Cognitive Impairment in Lyme Disease
Based on these findings and on patients' reports, two characteristics of Lyme Encephalopathy arise which provide insight as to possible neurophysiologic mechanisms:
One, the nonfocal nature of the cognitive functions affected, and
Two, the subtle fluctuations and reportedly abrupt and global shifts in cognitive function from one day to another in a given patient.
Four broad categories of possible neurophysiologic mechanisms might be compatible with this pattern:
1) Diffuse cerebral diffusion abnormalities -- Single photon emission computerized tomography (SPECT) scans of the brain in Lyme disease often display a diffuse pattern consistent with heterogeneous areas of hyperfusion and/or diminished neuronal metabolism. While vasodilators are often capable of reversing these abnormal patterns on SPECT scan, this reversal does not consistently correlate with a symptomatic improvement in cognitive function.
2) Alterations in cellular metabolism at the cortical level -- Evidence of alterations in neurotransmitter function is suggested by clinical evidence of cognitive improvement following treatment with selective serotonin reuptake inhibitors (SSRI's) which appears to be independent of their antidepressant effect. Systematic studies of the impact of SSRI's on cognitive function, as well as the role of other transmitters, are required.
3) Neuro transmitter abnormalities (imbalances of synthesis and/or receptor activity) -- Neurotoxic substances may well play a role in Lyme Encephalopathy. given the neurotropic nature to Treponema pallidim , and the close parallel between syphilis and Lyme disease, it is possible that Borrelia burgdorferi could produce intracellular or extracellular neurotoxins which we have yet to identify.
4) Neurotoxic substances produced endogenously or possibly exogenously -- Endogenous neurotoxins have been identified as by-products of the humoral immune response. Among these is quinolinic acid, a product of the interleukin cascade system, which accumulates as a result of the humoral response to acute infectious agents and functions as a neuronal excitotoxin. As there are many similarities between Lyme Encephalopathy and the nonspecific mental dysfunction of acute systemic infections, such as influenza, it is quite possible that continue stimulation of production of quinolinic acid and other cytokines plays a role in the pathophysiology of Lyme encephalopathy.
4) Clinical Impressions and Implications for Diagnosis and Treatment in Chronic Lyme Disease
This study demonstrates that for the majority of chronic Lyme patients with cognitive complaints, there is in fact a measurable and significant decline in intellectual acuity. The nature and severity of the cognitive impairment is such that it interferes with all aspects of normal functioning: employment, home, marriage, social interactions, and general emotional well-being. Rather than the cognitive complaints being secondary to anxiety or depression, as is sometimes suspected, depression and anxiety increase with, and are apparently secondary to, cognitive impairment and the emotional and practical impact of a loss of competence. Thus, while patients with chronic Lyme disease can present a confusing and "psychiatric" picture to the clinician, it is important that their concerns be properly investigated and addressed.
Patients with Lyme encephalopathy complain of problems with memory and concentration, word retrieval, confusion, problems with thinking, "mental fogginess", a decline in job performance, difficulty with calculations, directions, and judgment. Decreased initiative, manifest as difficulty getting started with or following through with projects is often noted. Mood disturbance is common with complaints of irritability, explosiveness or "a short fuse," sadness, hopelessness or guilt, increased anxiety or mood swings. Sleep disturbance is also common, and can present as initial, middle or terminal insomnia or some combination of these. Fatigue is universal. Headache is common, and of course joint and muscle pain. Increased sensitivity to light and noise, visual disturbance, and tingling in the extremities are also common.
On interview patients with Lyme encephalopathy tend to be vague and disorganized in the presentation of the history of their illness. This is despite their close attention to their symptoms and having recounted them many times before. Although in most cases memory of discreet events - tests, dates, diagnoses, responses to medications -- is intact, the patient is unable to recall them spontaneously or organize them in temporal order. They may be unclear as to their chief complaint. They may completely lose track of what they were saying, sometimes repeatedly, or of what the question was. They may get off on a tangent and have trouble re-orienting themselves. Frequent prompting and refocusing will be necessary. beginning the interview with an open-ended question like "Tell me what the problem is" will allow these qualities to become clear.
Often patients with chronic Lyme disease will seem overly focused on their illness, or overly concerned with convincing the clinician that they are ill. The clinician may be tempted to interpret this as evidence of a primary psychiatric disorder. It is important to understand that the frustration many of these patients experience is real, and results from the general attitude of doubt toward Lyme disease as a serious and chronic illness, the invisibility of their symptoms, the difficulty in getting a definitive diagnosis and getting approval for extended treatment from insurance carries. Many have been accused of hypochondriasis or malingering. As with head injury, the patient may "look fin" though they are having difficulty with very basic work, social and day to day functioning.
The cognitive deficits in chronic Lyme disease involve primarily attention and arousal mechanisms. Patients have difficulty keeping track of external and internal events, retrieval of information from memory and with planning and sequencing, as occurs in attention deficit disorder. However their experience is different from that of ADD, in that rather than having the experience that there are many thoughts competing for attention, the Lyme patient has difficulty bringing any thought into clear focus. They experience difficulty thinking. One patient described it as the universe ending six inches from his face. He can't process information that is not immediately apparent, immediately experienced. Another said that when he tries to think about something, or figure something out, all he can do is repeat the question -- he can't get to the meaning. This is like the idea of "surface" versus "deep" processing in cognitive psychology. Reading a passage for typing errors would be surface processing, while reading for meaning is deep processing. One patient, a physician, described it as a "mental intention tremor" -- the more she tries to focus on something the more out of focus it becomes.
The clinician should proceed with empathy and reason. Specific cognitive complaints in previously high functioning individuals are unusual and indicative of serious illness, either psychiatric or neurologic. Comprehensive neuropsychological evaluation will most often differentiate the two.
Where the neuropsychological exam is normal or there is a significant psychiatric component, a psychiatric evaluation is advised. Psychiatric symptomatology is not uncommon in Lyme and the presence of depression, anxiety, obsessive compulsive symptoms, flat affect and so on may cloud the issue of significant cognitive decline. Both the cognitive and psychiatric symptoms would be expected to improve with antibiotic treatment in Lyme encephalopathy. However sometimes concurrent treatment with psychotropic medication is necessary.
Unfortunately for some patients significant cognitive impairment persists even after years of antibiotic treatment. These patients may never be able to return to their premorbid level of employment, or be gainfully employed at all. Cognitive remediation can help them learn strategies for improving memory and concentration and relieving stress. Support and advice in regard to living with a chronic condition is equally important. Strategies include reducing work hours when possible, taking regular rest periods during the day, limiting the number of outings in a week, and using a calendar to stay organized and structure their time.
5) Cognitive impairment in Lyme disease: specific functions and the impact or deficits
1. Attention and mental tracking: includes directed and sustained attention: the ability to direct and maintain one's focus on a particular event or idea, whether in the environment or internally; and divided attention: the ability to simultaneously attend to two events, or dot two or more things at a time, or to retain awareness of one thing while doing another.
Impact: difficulty functioning effectively in many situations, remembering what one was doing before a distraction, keeping track of conversation, taking notes while someone is speaking, remembering that someone is on hold or what you were about to say.
2. Memory: Retaining new information.
Impact: secondary to impaired attention, slowing of processing and the retrieval of stored information, but not storage per se, a tendency to lose or forget things, miss appointments, repeat oneself.
3. Receptive language: understanding spoken or written language
Impact: secondary to impaired attention and speed of processing, difficulty participating in meetings or social conversation, difficulty with reading comprehension.
4. Expressive language: Using spoken or written language to express ideas
Impact: difficulty finding the right word, using the wrong word and not noticing, not being able to express oneself or communicate
5. Visuospatial Processing: Efficient scanning of the visual field, making sense of how things are related in space, visuospatial conceptualization and problem solving.
Impact: a tendency to get lost, difficulty with reading comprehension.
6. Abstract reasoning: The ability to generalize from the particular, to identify the common factor between related concepts, to compare and contrast two things or ideas, to see the "big picture", to identify the critical factor in a situation, to anticipate consequences and make inferences regarding cause and effect.
Impact: difficulty with decision making, planning, and problem solving.
7. Speed of mental and motor processing: the ability to think and respond quickly, critical to understanding speech which occurs at a fairly constant rate.
Impact: difficulty understanding or keeping up a conversation, functioning in a timely manner in day to day situations, meeting deadlines.
by Marian Rissenberg, Ph.D. & Susan Chambers, M.D.
the Lyme Times, Vol. 20, January-March 1998, pp. 29 -32
1) Cognitive Characteristics of Chronic Lyme Encephalopathy
On the basis of both a formal neuropsychological study of 49 patients (APA 5/96) and on clinical observation and comprehensive neuropsychological examination of well over 100 patients, a distinct pattern of cognitive impairment occurring chronic Lyme disease can be described. These patients consistently demonstrate deficits in directed, sustained and divided attention, planning and organization of responses, temporal ordering, verbal fluency, abstract reasoning, speed of processing, and motor programming. The overall pattern of intellectual impairment is not unlike that seen with diffuse brain injury, and it most often results in some degree of work-related disability.
Although performance is impaired on measures of cognitive functions associated with specific brain regions -- receptive and expressive language, visuospatial problem solving and memory -- the quality of performance is not suggestive of focal lesions in these areas. Rather, deficits are secondary to impairment of higher level integrative functions, likely mediated by complex neuronal systems. Specifically, the receptive language deficit is secondary to impaired auditory tracking and slowing of mental processing. The expressive language deficit is secondary to impaired word retrieval and response planning, The visuospatial problem solving deficit is secondary to impairment of mental flexibility, conceptualization and the ability to compare and contrast necessary in decision making. Finally, deficits on test of memory function are most often secondary to impairment of the encoding or initial processing of information, which depends on attention, and the retrieval of stored information. The storage of new information, or memory per se, is rarely impaired.
This pattern suggests that cognitive dysfunction in chronic Lyme, while expressed variably across individual patients, results from a common factor -- the breakdown of diffusely represented processes involving both integration and activation, and impacting primarily on attention and reasoning. The fluctuation of impairment over short periods of time suggest that a physiologic rather than a structural mechanism is responsible.
2) Neuropsychological deficits in chronic Lyme disease (A study presented at the annual meeting of The American Psychiatric Association , May 1996)
The neuro-psychological characteristics of 49 patients with Lyme disease were examined. The study set out to answer three questions:
1) Do all patients with subjectively perceived cognitive dysfunction have measurable intellectual impairment on objective testing?
2) In those without measurable impairment, does depression account for the perception of cognitive dysfunction?
3) What is the nature of the cognitive impairment in Lyme disease when it does occur?
Subjects were patients seen consecutively between 1990 and 1994 in a private neuropsycological practice with complaints of cognitive dysfunction and a symptom complex consistent with Lyme disease. Diagnosis was based on former CDC criteria. Mean duration of illness, defined as the time from the onset of general symptoms to the neuro-psychological exam, was 4.7 years (range: 3.3 to 14 years). Mean age was 39.9 years (range: 21 to 58 years) from 18 to 60 years. Mean level of education was 15.3 years (range 12 to 20 years).
Subjects were interviewed and administered a comprehensive battery of tests, including the complete WAIS-R and WMS-R, and additional test of language, attention, reasoning, visuospatial processing and complex motor function. They also completed the Beck Depression Inventory and a symptom checklist. Tests were divided into seven groups based on the cognitive functions they are presumed to measure: Attention, Memory, Language, Visuospatial Processing, Reasoning, Verbal Fluency and Motor programming.
Subjects were grouped into three levels of impairment based on their neuropsychological performance: Intact (N=11; 22%), with no functions impaired, Moderate (N=31; 63%) with two functions impaired, and Severe (N=7; 14%) with three or more functions impaired. Subjects in the Severe group met diagnostic criteria for dementia. The correlation between depression and cognitive impairment was nonsignificant, but the trend was positive, rather that negative. Anxiety by self report was significantly greater in the impaired groups that the Intact group. Duration of illness was greater in the Severe group (nonsignificant).
Of the 38 subjects with cognitive impairment, deficits of attention were most common, occurring in 26 subjects (68%) Deficits of memory storage were least common, occurring in 8 subjects (21%), Motor, Verbal Fluency, Visuospatial, Language and Reasoning deficits occurred in 24, 26, 29, 36 and 36% of the subjects respectively.
3) Possible Pathophysiologic Mechanisms of Cognitive Impairment in Lyme Disease
Based on these findings and on patients' reports, two characteristics of Lyme Encephalopathy arise which provide insight as to possible neurophysiologic mechanisms:
One, the nonfocal nature of the cognitive functions affected, and
Two, the subtle fluctuations and reportedly abrupt and global shifts in cognitive function from one day to another in a given patient.
Four broad categories of possible neurophysiologic mechanisms might be compatible with this pattern:
1) Diffuse cerebral diffusion abnormalities -- Single photon emission computerized tomography (SPECT) scans of the brain in Lyme disease often display a diffuse pattern consistent with heterogeneous areas of hyperfusion and/or diminished neuronal metabolism. While vasodilators are often capable of reversing these abnormal patterns on SPECT scan, this reversal does not consistently correlate with a symptomatic improvement in cognitive function.
2) Alterations in cellular metabolism at the cortical level -- Evidence of alterations in neurotransmitter function is suggested by clinical evidence of cognitive improvement following treatment with selective serotonin reuptake inhibitors (SSRI's) which appears to be independent of their antidepressant effect. Systematic studies of the impact of SSRI's on cognitive function, as well as the role of other transmitters, are required.
3) Neuro transmitter abnormalities (imbalances of synthesis and/or receptor activity) -- Neurotoxic substances may well play a role in Lyme Encephalopathy. given the neurotropic nature to Treponema pallidim , and the close parallel between syphilis and Lyme disease, it is possible that Borrelia burgdorferi could produce intracellular or extracellular neurotoxins which we have yet to identify.
4) Neurotoxic substances produced endogenously or possibly exogenously -- Endogenous neurotoxins have been identified as by-products of the humoral immune response. Among these is quinolinic acid, a product of the interleukin cascade system, which accumulates as a result of the humoral response to acute infectious agents and functions as a neuronal excitotoxin. As there are many similarities between Lyme Encephalopathy and the nonspecific mental dysfunction of acute systemic infections, such as influenza, it is quite possible that continue stimulation of production of quinolinic acid and other cytokines plays a role in the pathophysiology of Lyme encephalopathy.
4) Clinical Impressions and Implications for Diagnosis and Treatment in Chronic Lyme Disease
This study demonstrates that for the majority of chronic Lyme patients with cognitive complaints, there is in fact a measurable and significant decline in intellectual acuity. The nature and severity of the cognitive impairment is such that it interferes with all aspects of normal functioning: employment, home, marriage, social interactions, and general emotional well-being. Rather than the cognitive complaints being secondary to anxiety or depression, as is sometimes suspected, depression and anxiety increase with, and are apparently secondary to, cognitive impairment and the emotional and practical impact of a loss of competence. Thus, while patients with chronic Lyme disease can present a confusing and "psychiatric" picture to the clinician, it is important that their concerns be properly investigated and addressed.
Patients with Lyme encephalopathy complain of problems with memory and concentration, word retrieval, confusion, problems with thinking, "mental fogginess", a decline in job performance, difficulty with calculations, directions, and judgment. Decreased initiative, manifest as difficulty getting started with or following through with projects is often noted. Mood disturbance is common with complaints of irritability, explosiveness or "a short fuse," sadness, hopelessness or guilt, increased anxiety or mood swings. Sleep disturbance is also common, and can present as initial, middle or terminal insomnia or some combination of these. Fatigue is universal. Headache is common, and of course joint and muscle pain. Increased sensitivity to light and noise, visual disturbance, and tingling in the extremities are also common.
On interview patients with Lyme encephalopathy tend to be vague and disorganized in the presentation of the history of their illness. This is despite their close attention to their symptoms and having recounted them many times before. Although in most cases memory of discreet events - tests, dates, diagnoses, responses to medications -- is intact, the patient is unable to recall them spontaneously or organize them in temporal order. They may be unclear as to their chief complaint. They may completely lose track of what they were saying, sometimes repeatedly, or of what the question was. They may get off on a tangent and have trouble re-orienting themselves. Frequent prompting and refocusing will be necessary. beginning the interview with an open-ended question like "Tell me what the problem is" will allow these qualities to become clear.
Often patients with chronic Lyme disease will seem overly focused on their illness, or overly concerned with convincing the clinician that they are ill. The clinician may be tempted to interpret this as evidence of a primary psychiatric disorder. It is important to understand that the frustration many of these patients experience is real, and results from the general attitude of doubt toward Lyme disease as a serious and chronic illness, the invisibility of their symptoms, the difficulty in getting a definitive diagnosis and getting approval for extended treatment from insurance carries. Many have been accused of hypochondriasis or malingering. As with head injury, the patient may "look fin" though they are having difficulty with very basic work, social and day to day functioning.
The cognitive deficits in chronic Lyme disease involve primarily attention and arousal mechanisms. Patients have difficulty keeping track of external and internal events, retrieval of information from memory and with planning and sequencing, as occurs in attention deficit disorder. However their experience is different from that of ADD, in that rather than having the experience that there are many thoughts competing for attention, the Lyme patient has difficulty bringing any thought into clear focus. They experience difficulty thinking. One patient described it as the universe ending six inches from his face. He can't process information that is not immediately apparent, immediately experienced. Another said that when he tries to think about something, or figure something out, all he can do is repeat the question -- he can't get to the meaning. This is like the idea of "surface" versus "deep" processing in cognitive psychology. Reading a passage for typing errors would be surface processing, while reading for meaning is deep processing. One patient, a physician, described it as a "mental intention tremor" -- the more she tries to focus on something the more out of focus it becomes.
The clinician should proceed with empathy and reason. Specific cognitive complaints in previously high functioning individuals are unusual and indicative of serious illness, either psychiatric or neurologic. Comprehensive neuropsychological evaluation will most often differentiate the two.
Where the neuropsychological exam is normal or there is a significant psychiatric component, a psychiatric evaluation is advised. Psychiatric symptomatology is not uncommon in Lyme and the presence of depression, anxiety, obsessive compulsive symptoms, flat affect and so on may cloud the issue of significant cognitive decline. Both the cognitive and psychiatric symptoms would be expected to improve with antibiotic treatment in Lyme encephalopathy. However sometimes concurrent treatment with psychotropic medication is necessary.
Unfortunately for some patients significant cognitive impairment persists even after years of antibiotic treatment. These patients may never be able to return to their premorbid level of employment, or be gainfully employed at all. Cognitive remediation can help them learn strategies for improving memory and concentration and relieving stress. Support and advice in regard to living with a chronic condition is equally important. Strategies include reducing work hours when possible, taking regular rest periods during the day, limiting the number of outings in a week, and using a calendar to stay organized and structure their time.
5) Cognitive impairment in Lyme disease: specific functions and the impact or deficits
1. Attention and mental tracking: includes directed and sustained attention: the ability to direct and maintain one's focus on a particular event or idea, whether in the environment or internally; and divided attention: the ability to simultaneously attend to two events, or dot two or more things at a time, or to retain awareness of one thing while doing another.
Impact: difficulty functioning effectively in many situations, remembering what one was doing before a distraction, keeping track of conversation, taking notes while someone is speaking, remembering that someone is on hold or what you were about to say.
2. Memory: Retaining new information.
Impact: secondary to impaired attention, slowing of processing and the retrieval of stored information, but not storage per se, a tendency to lose or forget things, miss appointments, repeat oneself.
3. Receptive language: understanding spoken or written language
Impact: secondary to impaired attention and speed of processing, difficulty participating in meetings or social conversation, difficulty with reading comprehension.
4. Expressive language: Using spoken or written language to express ideas
Impact: difficulty finding the right word, using the wrong word and not noticing, not being able to express oneself or communicate
5. Visuospatial Processing: Efficient scanning of the visual field, making sense of how things are related in space, visuospatial conceptualization and problem solving.
Impact: a tendency to get lost, difficulty with reading comprehension.
6. Abstract reasoning: The ability to generalize from the particular, to identify the common factor between related concepts, to compare and contrast two things or ideas, to see the "big picture", to identify the critical factor in a situation, to anticipate consequences and make inferences regarding cause and effect.
Impact: difficulty with decision making, planning, and problem solving.
7. Speed of mental and motor processing: the ability to think and respond quickly, critical to understanding speech which occurs at a fairly constant rate.
Impact: difficulty understanding or keeping up a conversation, functioning in a timely manner in day to day situations, meeting deadlines.
Monday, May 24, 2010
Adrenal Support Formula
Adrenal Support Formula with 14 researched nutrients
Our product developers were assigned the task of developing the most advanced adrenal support product based on published research. After a thorough review of the literature, they formulated Energy Multi-Plex™ --- the total energy formula. A favorite among doctors and patients, Energy Multi-Plex™ is a reasonably priced answer to many people's dreams of more energy.
“I have improved energy after supplementing with NT Factor Energy and Energy Multi-Plex. Especially notable are the increased maximal sudden power, endurance, and ability to recover during exercise and also for the next day events - for example in distance bicycling on hilly roads and weight lifting and aerobic exercising at the Y. These two Researched Nutritionals products were added to a thorough treatment program for a longer-term fatigue illness from tick borne infection complex illness in the later, more recent stages of therapy. I think the products address some of what we know about mitochondrial damage in the longer-term fatigue- like syndromes and look forward to discussing this further with others interested in increased energy. I have no conflicts of interest in my dialogues regarding Researched Nutritionals products.” --- H. Smith MD
Each bottle provides a one month supply of the following complexes and health benefits:
Energymax™ Complex: Targeted blend of D-ribose, panax ginseng which
• promotes healthy energy levels by raising the level of the body’s energy fuel, ATP
• supports healthy cognitive performance
MuscularEnergy™ Complex: Combination of malic acid and rhodiola rosea which
• plays a key role in energy producing Kreb’s Cycle
• has an adaptogenic affect to support physical activity
Mitrochondria Energizer™ Complex: Powerful duo of acetyl-L-carnitine and alpha lipoic acid which
• acts as a catalyst for ATP production in mitochondria
• improves mitochondrial function while promoting healthy cognitive function
Metabolism Plus™ Complex: Natural, non-stimulation blend of pyruvic acid and 7-Keto DHEA which
• naturally increases, without artificial stimulation, resting metabolism
• multiple studies show increased fat utilization (fat loss) as an energy source
• promotes fat loss through thermogenesis
HeartStrong™ Complex: Hight potency Co Q10 and L-Taurine which
• is used by the body to transform food into adenosine triphosphate (ATP), the energy on which the body runs
• promotes healthy heart and gum tissue
• modulates the immune system
• promotes healthy heart beat and cell wall stability
Key Nutrient Blend: pantothenic acid, vitamin B-12, magnesium and potassium which
• are essential nutrients involved in producing, transporting and releasing energy from fat
• promotes healthy neuromuscular function and muscle contractions
Suggested Use
As a dietary supplement, take three capsules per day (at one time or throughout the day) or as directed by your healthcare professional.
Buy Researched Nutritionals
Our product developers were assigned the task of developing the most advanced adrenal support product based on published research. After a thorough review of the literature, they formulated Energy Multi-Plex™ --- the total energy formula. A favorite among doctors and patients, Energy Multi-Plex™ is a reasonably priced answer to many people's dreams of more energy.
“I have improved energy after supplementing with NT Factor Energy and Energy Multi-Plex. Especially notable are the increased maximal sudden power, endurance, and ability to recover during exercise and also for the next day events - for example in distance bicycling on hilly roads and weight lifting and aerobic exercising at the Y. These two Researched Nutritionals products were added to a thorough treatment program for a longer-term fatigue illness from tick borne infection complex illness in the later, more recent stages of therapy. I think the products address some of what we know about mitochondrial damage in the longer-term fatigue- like syndromes and look forward to discussing this further with others interested in increased energy. I have no conflicts of interest in my dialogues regarding Researched Nutritionals products.” --- H. Smith MD
Each bottle provides a one month supply of the following complexes and health benefits:
Energymax™ Complex: Targeted blend of D-ribose, panax ginseng which
• promotes healthy energy levels by raising the level of the body’s energy fuel, ATP
• supports healthy cognitive performance
MuscularEnergy™ Complex: Combination of malic acid and rhodiola rosea which
• plays a key role in energy producing Kreb’s Cycle
• has an adaptogenic affect to support physical activity
Mitrochondria Energizer™ Complex: Powerful duo of acetyl-L-carnitine and alpha lipoic acid which
• acts as a catalyst for ATP production in mitochondria
• improves mitochondrial function while promoting healthy cognitive function
Metabolism Plus™ Complex: Natural, non-stimulation blend of pyruvic acid and 7-Keto DHEA which
• naturally increases, without artificial stimulation, resting metabolism
• multiple studies show increased fat utilization (fat loss) as an energy source
• promotes fat loss through thermogenesis
HeartStrong™ Complex: Hight potency Co Q10 and L-Taurine which
• is used by the body to transform food into adenosine triphosphate (ATP), the energy on which the body runs
• promotes healthy heart and gum tissue
• modulates the immune system
• promotes healthy heart beat and cell wall stability
Key Nutrient Blend: pantothenic acid, vitamin B-12, magnesium and potassium which
• are essential nutrients involved in producing, transporting and releasing energy from fat
• promotes healthy neuromuscular function and muscle contractions
Suggested Use
As a dietary supplement, take three capsules per day (at one time or throughout the day) or as directed by your healthcare professional.
Buy Researched Nutritionals
Medical Food with Ribose, l-Carnitine, Acetyl l-Carnitine, Malic Acid & Magnesium
Medical Food with Ribose, l-Carnitine, Acetyl l-Carnitine, Malic Acid & Magnesium
RibosCardio™ has been designed to support serious energy needs of patients. The product has been formulated with CardioPerform™, a potent blend of L-carnitine (transports fuel into the heart to be burned as energy) and Acetyl L-carnitine (improves heart & brain health, protecting against oxidative damage), plus the patented form of D-Ribose, malic acid and magnesium gluconate to optimize energy production and synthesis.
Published research shows our patented form of D-ribose may be an effective adjunct in promoting cardiovascular, skeletal muscle, and neurological health. With heart patients, D-ribose has been found effective in restoring energy, improving ventilatory efficiency, oxygen uptake, stroke volume, diastolic function, physical performance, and quality of life. In neuromuscular disease, D-ribose helps to reduce pain, overcome fatigue, increase exercise tolerance, and help patients live more normal, active lives.
RibosCardio™'s magnesium gluconate and malic acid help your body use energy more efficiently. Your cells use magnesium in over 300 enzyme reactions, and it distributes energy evenly throughout the cell so it is available when and where it is needed. Malic Acid helps your mitochondria recycle the energy you have, maximizing cellular energy output.
D-Ribose Research Highlights
Cardiovascular Function: Scientific and clinical studies have repeatedly shown that our patented D-Ribose can restore energy and improve function in ischemic, hypoxic, and failing hearts. Oxygen deprivation causes hearts to use energy faster than it can be replaced through normal processes of tissue energy turnover. The result is a depletion of cellular energy reserves translating to a loss of heart function.
Mid-study results of an ongoing double blind, crossover trial with congestive heart failure patients were recently reported. Results showed conclusively that when patients were given ribose (15 grams per day for three weeks) they had improved diastolic heart function, increased physical function score and enhanced quality of life score. Echocardiographic studies of these patients showed that ribose administration enhanced relaxation of the left ventricle and improved the efficiency of filling from the left atrium. No such improvements were found during placebo administration (3).
RibosCardio™ increases cardiac energy to help fuel the heart. For patients, this can mean more energy and a higher quality of life.
Sports Nutrition: In skeletal muscle, high-intensity exercise can lead to a loss of up to 26% of cellular adenosine triphosphate, or ATP. One consequence of this energy drain is an increase in free radicals in affected muscle. Free radicals attack cell and mitochondrial membranes and can destroy the genetic material that helps muscle tissues synthesize proteins.
RibosCardio™ helps in three ways. First, if enough ribose is present in the cell or the circulating blood, energy compounds can be saved, or salvaged, before they wash out of the cell and are lost. Second, ribose accelerates energy synthesis, so if energy compounds are lost, they can be quickly replaced. Finally, by keeping the energy compounds in the cell, RibosCardio™ reduces free radical formation and preserves the energy the tissue needs to make proteins essential for maintaining muscle health and performance. This energy improvement has been shown to increased performance over time. A study published in the journal, Current Therapeutic Research, showed that male recreational bodybuilders experienced a significant improvement in both muscular endurance (20% increase over the four weeks versus a 12%for the placebo group) and muscular endurance (3.2% increase over the four weeks versus a 1.7% for the placebo group) following 28 days of our patented D-Ribose supplementation(1).
Fibromyalgia & Chronic Fatigue Syndrome: The muscle in patients with FMS and CFS is generally severely energy starved. This lack of energy leads to a number of physiological reactions within the muscle cell, ending in debilitating fatigue, muscle pain, soreness, and stiffness. By increasing the energy level in affected muscle, our patented D-Ribose helps patients overcome fatigue, and lessens the pain associated with their conditions.
RibosCardio™ has been designed to support serious energy needs of patients. The product has been formulated with CardioPerform™, a potent blend of L-carnitine (transports fuel into the heart to be burned as energy) and Acetyl L-carnitine (improves heart & brain health, protecting against oxidative damage), plus the patented form of D-Ribose, malic acid and magnesium gluconate to optimize energy production and synthesis.
Published research shows our patented form of D-ribose may be an effective adjunct in promoting cardiovascular, skeletal muscle, and neurological health. With heart patients, D-ribose has been found effective in restoring energy, improving ventilatory efficiency, oxygen uptake, stroke volume, diastolic function, physical performance, and quality of life. In neuromuscular disease, D-ribose helps to reduce pain, overcome fatigue, increase exercise tolerance, and help patients live more normal, active lives.
RibosCardio™'s magnesium gluconate and malic acid help your body use energy more efficiently. Your cells use magnesium in over 300 enzyme reactions, and it distributes energy evenly throughout the cell so it is available when and where it is needed. Malic Acid helps your mitochondria recycle the energy you have, maximizing cellular energy output.
D-Ribose Research Highlights
Cardiovascular Function: Scientific and clinical studies have repeatedly shown that our patented D-Ribose can restore energy and improve function in ischemic, hypoxic, and failing hearts. Oxygen deprivation causes hearts to use energy faster than it can be replaced through normal processes of tissue energy turnover. The result is a depletion of cellular energy reserves translating to a loss of heart function.
Mid-study results of an ongoing double blind, crossover trial with congestive heart failure patients were recently reported. Results showed conclusively that when patients were given ribose (15 grams per day for three weeks) they had improved diastolic heart function, increased physical function score and enhanced quality of life score. Echocardiographic studies of these patients showed that ribose administration enhanced relaxation of the left ventricle and improved the efficiency of filling from the left atrium. No such improvements were found during placebo administration (3).
RibosCardio™ increases cardiac energy to help fuel the heart. For patients, this can mean more energy and a higher quality of life.
Sports Nutrition: In skeletal muscle, high-intensity exercise can lead to a loss of up to 26% of cellular adenosine triphosphate, or ATP. One consequence of this energy drain is an increase in free radicals in affected muscle. Free radicals attack cell and mitochondrial membranes and can destroy the genetic material that helps muscle tissues synthesize proteins.
RibosCardio™ helps in three ways. First, if enough ribose is present in the cell or the circulating blood, energy compounds can be saved, or salvaged, before they wash out of the cell and are lost. Second, ribose accelerates energy synthesis, so if energy compounds are lost, they can be quickly replaced. Finally, by keeping the energy compounds in the cell, RibosCardio™ reduces free radical formation and preserves the energy the tissue needs to make proteins essential for maintaining muscle health and performance. This energy improvement has been shown to increased performance over time. A study published in the journal, Current Therapeutic Research, showed that male recreational bodybuilders experienced a significant improvement in both muscular endurance (20% increase over the four weeks versus a 12%for the placebo group) and muscular endurance (3.2% increase over the four weeks versus a 1.7% for the placebo group) following 28 days of our patented D-Ribose supplementation(1).
Fibromyalgia & Chronic Fatigue Syndrome: The muscle in patients with FMS and CFS is generally severely energy starved. This lack of energy leads to a number of physiological reactions within the muscle cell, ending in debilitating fatigue, muscle pain, soreness, and stiffness. By increasing the energy level in affected muscle, our patented D-Ribose helps patients overcome fatigue, and lessens the pain associated with their conditions.
Friday, November 9, 2007
Lyme Disease
The Treatment Guidelines for Lyme Disease are now published in the National Guideline Clearinghouse™. ILADS.org
MAJOR RECOMMENDATIONS
Highlights of Guidelines
Since there is currently no definitive test for Lyme disease, laboratory results should not be used to exclude an individual from treatment.
Lyme disease is a clinical diagnosis and tests should be used to support rather than supersede the physician’s judgment.
The early use of antibiotics can prevent persistent, recurrent, and refractory Lyme disease.
The duration of therapy should be guided by clinical response, rather than by an arbitrary (i.e., 30 day) treatment course.
The practice of stopping antibiotics to allow for delayed recovery is not recommended for persistent Lyme disease. In these cases, it is reasonable to continue treatment for several months after clinical and laboratory abnormalities have begun to resolve and symptoms have disappeared.
Diagnostic Concerns
The most important method for preventing chronic Lyme disease is recognition of the early manifestations of the disease.
Atypical Early Presentations
Early Lyme disease classically presents with a single erythema migrans (EM or "bull’s-eye") rash. The EM rash may be absent in over 50% of Lyme disease cases, however. Patients should be made aware of the significance of a range of rashes beyond the classic EM, including multiple, flat, raised, or blistering rashes. Central clearing was absent in over half of a series of EM rashes. Rashes can also mimic other common presentations including a spider bite, ringworm, or cellulitis.
Physicians should be aware that fewer than 50% of all Lyme disease patients recall a tick bite. Early Lyme disease should also be considered in an evaluation of "off-season" onset when flu-like symptoms, fever, and chills occur in the summer and fall. Early recognition of atypical early Lyme disease presentation is most likely to occur when the patient has been educated on this topic.
New Chronic Lyme Disease Presentations
A detailed history may be helpful for suggesting a diagnosis of chronic Lyme disease. Headache, stiff neck, sleep disturbance, and problems with memory and concentration are findings frequently associated with neurologic Lyme disease. Other clues to Lyme disease have been identified, although these have not been consistently present in each patient: numbness and tingling, muscle twitching, photosensitivity, hyperacusis, tinnitus, lightheadedness, and depression.
Most patients diagnosed with chronic Lyme disease have an indolent onset and variable course. Neurologic and rheumatologic symptoms are characteristic, and increased severity of symptoms on wakening is common. Neuropsychiatric symptoms alone are more often seen in chronic than acute Lyme disease. Although many studies have found that such clinical features are often not unique to Lyme disease, the striking association of musculoskeletal and neuropsychiatric symptoms, the variability of these symptoms, and their recurrent nature may support a diagnosis of the disease.
The Limitations of Physical Findings
A comprehensive physical examination should be performed, with special attention to neurologic, rheumatologic, and cardiac symptoms associated with Lyme disease.
Physical findings are nonspecific and often normal, but arthritis, meningitis, and Bell’s palsy may sometimes be noted. Available data suggest that objective evidence alone is inadequate to make treatment decisions, because a significant number of chronic Lyme disease cases may occur in symptomatic patients without objective features on examination or confirmatory laboratory testing.
Factors other than physical findings, such as a history of potential exposure, known tick bites, rashes, or symptoms consistent with the typical multisystem presentation of Lyme disease, must also be considered in determining whether an individual patient is a candidate for antibiotic therapy.
Sensitivity Limitations of Testing
Treatment decisions should not be based routinely or exclusively on laboratory findings. The two-tier diagnostic criteria, requiring both a positive enzyme-linked immunosorbent assay (ELISA) and western blot, lacks sensitivity and leaves a significant number of individuals with Lyme disease undiagnosed and untreated. These diagnostic criteria were intended to improve the specificity of tests to aid in identifying well-defined Lyme disease cases for research studies. Though arbitrarily chosen, these criteria have been used as rigid diagnostic benchmarks that have prevented individuals with Lyme disease from obtaining treatment. Diagnosis of Lyme disease by two-tier confirmation fails to detect up to 90% of cases and does not distinguish between acute, chronic, or resolved infection.
The Centers for Disease Control and Prevention (CDC) considers a western blot positive if at least 5 of 10 immunoglobulin G (IgG) bands or 2 of 3 immunoglobulin M (IgM) bands are positive. However, other definitions for western blot confirmation have been proposed to improve the test sensitivity. In fact, several studies showed that sensitivity and specificity for both the IgM and IgG western blot range from 92 to 96% when only two specific bands are positive.
Lumbar puncture has also been disappointing as a diagnostic test to rule out concomitant central nervous system infection. In Lyme disease, evaluation of cerebrospinal fluid is unreliable for a diagnosis of encephalopathy and neuropathy because of poor sensitivity. For example, pleocytosis was present in only one of 27 patients (sensitivity 3%) and with only seven cells. The antibody index was positive (>1) in only one of 27 patients (sensitivity 3%). An index is the ratio between Lyme ELISA antibodies in the spinal fluid and Lyme ELISA antibodies in the serum. The proposed index of 1.3 would be expected to have even worse sensitivity.
Several additional tests for Lyme disease have been evaluated. These include antigen capture, urine antigen, and polymerase chain reaction. Each has advantages and disadvantages in terms of convenience, cost, assay standardization, availability, and reliability. These tests remain an option to identify people at high risk for persistent, recurrent, and refractory Lyme disease but have not been standardized.
Seronegative Lyme Disease
A patient who has tested seronegative may have a clinical presentation consistent with Lyme disease, especially if there is no evidence to indicate another illness.
Although many individuals do not have confirmatory serologic tests, surveillance studies show that these patients may have a similar risk of developing persistent, recurrent, and refractory Lyme disease compared with the seropositive population.
Continued Importance of Differential Diagnosis
The differential diagnosis of Lyme disease requires consideration of both infectious and noninfectious etiologies. Among noninfectious causes are thyroid disease, degenerative arthritis, metabolic disorders (vitamin B12 deficiency, diabetes), heavy metal toxicity, vasculitis, and primary psychiatric disorders.
Infectious causes can mimic certain aspects of the typical multisystem illness seen in chronic Lyme disease. These include viral syndromes, such as parvovirus B19 or West Nile virus infection, and bacterial mimics, such as relapsing fever, syphilis, leptospirosis, and mycoplasma.
The clinical features of chronic Lyme disease can be indistinguishable from fibromyalgia and chronic fatigue syndrome. These illnesses must be closely scrutinized for the possibility of etiological Borrelia burgdorferi infection.
Clinical Judgment
Clinical judgment remains necessary in the diagnosis of late Lyme disease. A problem in some studies that relied on objective evidence was that treatment occurred too late, leaving the patient at risk for persistent and refractory Lyme disease.
As noted, time-honored beliefs in objective findings and two-tier serologic testing have not withstood close scrutiny. Lyme disease should be suspected in patients with newly acquired or chronic symptoms (headaches, memory and concentration problems, and joint pain). Management of patients diagnosed on the basis of clinical judgment needs to be tested further in prospective trials, and diagnostic reproducibility must be verified.
Testing for Coinfection
Polymicrobial infection is a new concern for individuals with Lyme disease, and coinfection is increasingly reported in critically ill individuals. Although B. burgdorferi remains the most common pathogen in tick-borne illnesses, coinfections including Ehrlichia and Babesia strains are increasingly noted in patients with Lyme disease, particularly in those with chronic illness. Bartonella is another organism that is carried by the same ticks that are infected with B. burgdorferi, and evidence suggests that it is a potential coinfecting agent in Lyme disease.
Recent animal and human studies suggest that Lyme disease may be more severe and resistant to therapy in coinfected patients. Thus, concurrent testing and treatment for coinfection is mandatory in Lyme disease patients.
Treatment Considerations
Since Lyme disease can become persistent, recurrent, and refractory even in the face of antibiotic therapy, evaluation and treatment must be prompt and aggressive.
Prompt Use of Antibiotics
Although no well designed studies have been carried out, the available data support the prompt use of antibiotics to prevent chronic Lyme disease. Antibiotic therapy may need to be initiated upon suspicion of the diagnosis, even without definitive proof. Neither the optimal antibiotic dose nor the duration of therapy has been standardized, but limited data suggest a benefit from increased dosages and longer treatment, comparable to the data on tuberculosis and leprosy which are caused by similarly slow-growing pathogens.
Choosing an Antibiotic
In acute Lyme disease, the choice of antibiotics should be tailored to the individual and take into account the severity of the disease as well as the patient’s age, ability to tolerate side effects, clinical features, allergy profile, comorbidities, prior exposure, epidemiologic setting, and cost.
Conversely, persistent and refractory Lyme disease treatment is more likely to include intravenous and/or intramuscular antibiotics. The choices depend in part on the patient’s response to antibiotic therapy and on the success of antibiotics in treating other Lyme disease patients.
Therapy usually starts with oral antibiotics, and some experts recommend high dosages. The choice of antibiotic therapy is guided by weighing the greater activity of intravenous antibiotics in the central nervous system against the lower cost and easy administration of oral antibiotics for B. burgdorferi.
Oral Antibiotic Options
For many Lyme disease patients, there is no clear advantage of parenteral therapy. Along with cost considerations and pressure to treat patients with Lyme disease with the least intervention, there is growing interest in the use of oral therapy.
First-line drug therapies for Lyme disease may include (in alphabetical order): oral amoxicillin, azithromycin, cefuroxime, clarithromycin, doxycycline, and tetracycline. These antibiotics have similar favorable results in comparative trials of early Lyme disease.
Intravenous Antibiotic Options
It is common practice to consider intravenous antibiotics upon failure of oral medications in patients with persistent, recurrent, or refractory Lyme disease, and as the first line of therapy for certain conditions, (i.e., encephalitis, meningitis, optic neuritis, joint effusions, and heart block).
Ideally, the intravenous antibiotic should be selected on the basis of in vitro sensitivity testing or clinical experience. Intravenous antibiotics are also justified by concern for penetration into the central nervous system.
Until recently, ceftriaxone, cefotaxime, and penicillin were the only intravenous antibiotics routinely studied for use in Lyme disease. Intravenous imipenem, azithromycin, and doxycycline have an adequate antispirochetal spectrum of activity and may represent suitable alternative therapies. However, the latter two drugs are often considered for intravenous use only if they are not tolerated orally.
Intramuscular Antibiotic Options
Intramuscular benzathine penicillin (1.2 to 2.4 million units per week) is sometimes effective in patients who do not respond to oral and intravenous antibiotics. If intramuscular benzathine penicillin is used, long-term therapy may be necessary due to the low serum concentration of this form of penicillin. Benzathine penicillin has mainly been used in patients who have had multiple relapses while receiving oral or intravenous antibiotic therapy or who are intolerant of oral or intravenous antibiotics.
Combination Antibiotic Treatment
Combination therapy with two or more antibiotics is now increasingly used for refractory Lyme disease and has also been given as initial therapy for some chronic presentations.
This approach is already used for another tick-borne illness, babesiosis. Oral amoxicillin, cefuroxime, or (more recently) cefdinir combined with a macrolide (azithromycin or clarithromycin) are examples of combination regimens that have proven successful in clinical practice, although controlled clinical trials are lacking in persistent, recurrent, and refractory Lyme disease.
Combination therapy in patients with Lyme disease raises the risk of adverse events. This risk must be weighed against the improved response to combination therapy in Lyme disease patients failing single agents.
Sequential Treatment
Clinicians increasingly use the sequence of an intravenous antibiotic followed by an oral or intramuscular antibiotic. In two recent case series that employed combination therapy and sequential therapy, most patients were successfully treated. A logical and attractive sequence would be to use intravenous therapy first (e.g., intravenous ceftriaxone), at least until disease progression is arrested and then follow with oral therapy for persistent and recurrent Lyme disease.
Dosage
Increasingly, clinicians recommend that certain drugs used for Lyme disease be given at higher daily doses: for example, 3,000–6,000 mg of amoxicillin, 300–400 mg doxycycline, and 500–600 mg of azithromycin. Some clinicians prescribe antibiotics using blood levels to guide higher doses. Close monitoring of complete blood counts and chemistries are also required with this approach.
With higher doses, there may be an increase in adverse events in general and gastrointestinal problems in particular. Acidophilus has reportedly reduced the incidence of Clostridium difficile colitis and non-C. difficile antibiotic-related diarrhea.
Serious adverse effects of antibiotics, however, were less common than previous estimates. In a recent clinical trial of chronic Lyme disease, the overall serious adverse event rate was 3% after three months of antibiotics, including 1 month of intravenous antibiotics. Clinicians who have experience with higher dose antibiotic therapy must balance the benefit of higher drug levels achieved with this therapy against the modest risk of gastrointestinal and other side effects.
Duration of Therapy
Because of the disappointing long-term outcome with shorter courses of antibiotics, the practice of stopping antibiotics to allow for a delayed recovery is no longer recommended for patients with persistent, recurrent, and refractory Lyme disease. Reports show failure rates of 30–62% within 3 years of short-course treatment using antibiotics thought to be effective for Lyme disease. Conversely for neurologic complications of Lyme disease, doubling the length of intravenous ceftriaxone treatment from 2 to 4 weeks improved the success rate from 66 to 80%.
The management of chronic Lyme disease must be individualized, since patients will vary according to severity of presentation and response to previous treatment.
Concurrent risk factors (i.e., coinfections, previous treatment failures, frequent relapses, neurologic involvement, or previous use of corticosteroids) or evidence of unusually severe Lyme disease should lead to the initiation of prolonged and/or intravenous antibiotic treatment. Physicians should always assess the patient’s response to treatment before deciding on appropriate duration of therapy (i.e., weeks versus months).
Empiric Treatment
The importance of establishing the diagnosis of Lyme disease is heightened in light of increasing concern about antibiotic overuse. After an appropriate history, physical examination, and laboratory testing are completed, empiric antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient’s acute illness, underlying disease, and the likelihood of B. burgdorferi infection. The International Lyme and Associated Diseases Society (ILADS) working group recommends that empiric treatment be considered routine for patients with a likely diagnosis of Lyme disease.
Persistent Lyme Disease
Persistent Lyme disease is more resistant to treatment and more likely to produce a relapse. Although persistent Lyme disease may resolve without additional therapy, many experts believe that this condition should be treated with repeated and prolonged antibiotics. Physicians should extend the duration of antibiotics to prevent or delay recurrent and refractory Lyme disease.
Recurrent Lyme Disease
Despite previous antibiotic treatment, Lyme disease has a propensity for relapse and requires careful follow-up for years. The data suggest that failure to eradicate the organism may be the reason for a recurrence of symptoms. Early and aggressive treatment with antibiotics is indicated for recurrent Lyme disease. The ultimate impact from retreating each episode of recurrent Lyme disease is currently unclear.
Refractory Lyme Disease
Refractory Lyme disease is a devastating condition that usually affects patients with persistent symptomatology and long-term disability. Prompt and aggressive institution of antibiotic therapy may be essential to prevent refractory disease. Increasing evidence shows that antibiotics have a beneficial effect on the course of refractory Lyme disease even in cases where the patient is intolerant of antibiotics or when a previous regimen has failed. Several months of therapy are often required to produce clear evidence of improvement. During this time, symptomatic treatment may be combined with antibiotic treatment.
Treatment Failure
When patients fail to respond or their conditions deteriorate after initiation of empiric therapy, a number of possibilities should be considered other than Jarisch-Herxheimer reaction. These include adverse events that limit treatment, allergic history to medication, inappropriate or inadequate dosing regimen, compliance problems, incorrect medication, immune sequelae, and sequestering of the organism (e.g., in the central nervous system). An alternative diagnosis or coinfection should also be considered.
Symptomatic Treatment
Although there may be a potential role for symptomatic treatment in chronic Lyme disease, this approach has little support due to the strong possibility of persistent infection. Owing to the potential hazard of immunosuppression and the poor outcome in one study, steroid therapy is not recommended. Surgical synovectomy is associated with significant morbidity and does not address neurologic presentations; it should be reserved for knee pain failing antibiotic treatment. Intra-articular steroid injection may be useful as a temporizing procedure in patients with persistent knee pain but this runs the risk of masking persistent infection.
Symptomatic therapy (particularly anti-inflammatory medications, tricyclic antidepressants, selective serotonin re-uptake inhibitors, and hydroxychloroquine) may be useful in concert with antibiotics and in individuals failing antibiotics.
Hyperbaric oxygen therapy (HBOT) is under study but is not recommended for routine therapeutic use. Other treatments, including cholestyramine (CSM), antifungal therapy, and antiviral agents require further study.
Since patients are becoming more interested in alternative therapies (e.g., traditional Chinese medicine, anti-oxidants, hyperthermia, bee venom, naturopathy and homeopathy), physicians should be prepared to address questions regarding these topics.
Fibromyalgia
The outcome of treating fibromyalgia secondary to Lyme disease with nonantibiotic regimens has been poor. The most encouraging clinical trial showed success in only one of 15 patients and only modest improvement in 6 of 15 individuals with fibromyalgia despite 2 years of treatment.
Antibiotic therapy has been much more effective than supportive therapy in symptomatic patients with fibromyalgia secondary to Lyme disease.
Fibromyalgia treatment alone without antibiotics raises the risk of conversion to refractory chronic Lyme disease and/or exacerbation of an undiagnosed persistent infection and is not recommended. Increasingly, clinicians do not feel comfortable treating fibromyalgia in Lyme disease without antibiotics.
Decision to Stop Antibiotics
Several studies of patients with Lyme disease have recommended that antibiotics be discontinued after 30 days of treatment. Complicating the decision to stop antibiotics is the fact that some patients present with disease recurrence after the resolution of their initial Lyme disease symptoms. This is consistent with incomplete antibiotic therapy. Although the optimal time to discontinue antibiotics is unknown, it appears to be dependent on the extent of symptomatology, the patient’s previous response to antibiotics, and the overall response to therapy (see below).
Rather than an arbitrary 30-day treatment course, the patient’s clinical response should guide duration of therapy. Patients must therefore be carefully evaluated for persistent infection before a decision is made to withhold therapy.
The decision to discontinue antibiotics should be made in consultation with the patient and should take into account such factors as the frequency and duration of persistent infection, frequency of recurrence, probability of refractory Lyme disease, gains with antibiotics, the importance to the patient of discontinuing antibiotics, and potential for careful follow-up.
The ideal approach would be to continue therapy for Lyme disease until the Lyme spirochete is eradicated. Unfortunately there is currently no test available to determine this point. Therefore, the clinician must rely on the factors outlined above to decide on the length of antibiotic therapy for chronic Lyme disease.
Alternative Antibiotics
There is compelling evidence that Lyme disease can result in serious and potentially refractory illness. Use of alternative antibiotics to treat early Lyme disease with erythema migrans is generally not indicated unless coinfection is suspected.
The ILADS Working Group believes that the risk of alternative antibiotics is acceptable in selected Lyme disease patients presenting with chronic Lyme disease. Alternative antibiotics include less commonly used oral antibiotics (cefixime, cefdinir, metronidazole) and intravenous antibiotics (imipenem, azithromycin). The role of alternative antibiotics in low-risk patients is less certain and there is less consensus among the guideline developers as to whether the potential benefits outweigh the risks.
Therapy for Coinfection
Therapy for polymicrobial infection in Lyme disease is a rapidly changing area of clinical practice. Uncomplicated Lyme disease may be managed without addressing coinfection by means of standard oral or parenteral antibiotic therapy. Some but not all experts recommend therapy for subclinical or chronic coinfection with Ehrlichia, Babesia, or Bartonella on the basis of their belief that responses are more prompt with this approach.
The dose, duration, and type of treatment for coinfections have not been defined. Published reports of coinfection are limited to a small number of patients treated in open-label, nonrandomized studies. Doxycycline has been indicated for Ehrlichia. A recently published randomized trial determined that treatment of severe Babesia microti with the combination of atovaquone and azithromycin was as effective as the use of standard oral therapy with clindamycin and quinine.
The decision to use alternative antibiotics should be based on the individual case, including a careful assessment of the patient’s risk factors and personal preferences. Patients managed in this way must be carefully selected and considered reliable for follow-up. Further controlled studies are needed to address the optimal antimicrobial agents for coinfections and the optimal duration of therapy.
Evidence-based guidelines for the management of Lyme disease. Expert Rev Anti Infect Ther 2004;2(1 Suppl):S1-13. [66 references]
MAJOR RECOMMENDATIONS
Highlights of Guidelines
Since there is currently no definitive test for Lyme disease, laboratory results should not be used to exclude an individual from treatment.
Lyme disease is a clinical diagnosis and tests should be used to support rather than supersede the physician’s judgment.
The early use of antibiotics can prevent persistent, recurrent, and refractory Lyme disease.
The duration of therapy should be guided by clinical response, rather than by an arbitrary (i.e., 30 day) treatment course.
The practice of stopping antibiotics to allow for delayed recovery is not recommended for persistent Lyme disease. In these cases, it is reasonable to continue treatment for several months after clinical and laboratory abnormalities have begun to resolve and symptoms have disappeared.
Diagnostic Concerns
The most important method for preventing chronic Lyme disease is recognition of the early manifestations of the disease.
Atypical Early Presentations
Early Lyme disease classically presents with a single erythema migrans (EM or "bull’s-eye") rash. The EM rash may be absent in over 50% of Lyme disease cases, however. Patients should be made aware of the significance of a range of rashes beyond the classic EM, including multiple, flat, raised, or blistering rashes. Central clearing was absent in over half of a series of EM rashes. Rashes can also mimic other common presentations including a spider bite, ringworm, or cellulitis.
Physicians should be aware that fewer than 50% of all Lyme disease patients recall a tick bite. Early Lyme disease should also be considered in an evaluation of "off-season" onset when flu-like symptoms, fever, and chills occur in the summer and fall. Early recognition of atypical early Lyme disease presentation is most likely to occur when the patient has been educated on this topic.
New Chronic Lyme Disease Presentations
A detailed history may be helpful for suggesting a diagnosis of chronic Lyme disease. Headache, stiff neck, sleep disturbance, and problems with memory and concentration are findings frequently associated with neurologic Lyme disease. Other clues to Lyme disease have been identified, although these have not been consistently present in each patient: numbness and tingling, muscle twitching, photosensitivity, hyperacusis, tinnitus, lightheadedness, and depression.
Most patients diagnosed with chronic Lyme disease have an indolent onset and variable course. Neurologic and rheumatologic symptoms are characteristic, and increased severity of symptoms on wakening is common. Neuropsychiatric symptoms alone are more often seen in chronic than acute Lyme disease. Although many studies have found that such clinical features are often not unique to Lyme disease, the striking association of musculoskeletal and neuropsychiatric symptoms, the variability of these symptoms, and their recurrent nature may support a diagnosis of the disease.
The Limitations of Physical Findings
A comprehensive physical examination should be performed, with special attention to neurologic, rheumatologic, and cardiac symptoms associated with Lyme disease.
Physical findings are nonspecific and often normal, but arthritis, meningitis, and Bell’s palsy may sometimes be noted. Available data suggest that objective evidence alone is inadequate to make treatment decisions, because a significant number of chronic Lyme disease cases may occur in symptomatic patients without objective features on examination or confirmatory laboratory testing.
Factors other than physical findings, such as a history of potential exposure, known tick bites, rashes, or symptoms consistent with the typical multisystem presentation of Lyme disease, must also be considered in determining whether an individual patient is a candidate for antibiotic therapy.
Sensitivity Limitations of Testing
Treatment decisions should not be based routinely or exclusively on laboratory findings. The two-tier diagnostic criteria, requiring both a positive enzyme-linked immunosorbent assay (ELISA) and western blot, lacks sensitivity and leaves a significant number of individuals with Lyme disease undiagnosed and untreated. These diagnostic criteria were intended to improve the specificity of tests to aid in identifying well-defined Lyme disease cases for research studies. Though arbitrarily chosen, these criteria have been used as rigid diagnostic benchmarks that have prevented individuals with Lyme disease from obtaining treatment. Diagnosis of Lyme disease by two-tier confirmation fails to detect up to 90% of cases and does not distinguish between acute, chronic, or resolved infection.
The Centers for Disease Control and Prevention (CDC) considers a western blot positive if at least 5 of 10 immunoglobulin G (IgG) bands or 2 of 3 immunoglobulin M (IgM) bands are positive. However, other definitions for western blot confirmation have been proposed to improve the test sensitivity. In fact, several studies showed that sensitivity and specificity for both the IgM and IgG western blot range from 92 to 96% when only two specific bands are positive.
Lumbar puncture has also been disappointing as a diagnostic test to rule out concomitant central nervous system infection. In Lyme disease, evaluation of cerebrospinal fluid is unreliable for a diagnosis of encephalopathy and neuropathy because of poor sensitivity. For example, pleocytosis was present in only one of 27 patients (sensitivity 3%) and with only seven cells. The antibody index was positive (>1) in only one of 27 patients (sensitivity 3%). An index is the ratio between Lyme ELISA antibodies in the spinal fluid and Lyme ELISA antibodies in the serum. The proposed index of 1.3 would be expected to have even worse sensitivity.
Several additional tests for Lyme disease have been evaluated. These include antigen capture, urine antigen, and polymerase chain reaction. Each has advantages and disadvantages in terms of convenience, cost, assay standardization, availability, and reliability. These tests remain an option to identify people at high risk for persistent, recurrent, and refractory Lyme disease but have not been standardized.
Seronegative Lyme Disease
A patient who has tested seronegative may have a clinical presentation consistent with Lyme disease, especially if there is no evidence to indicate another illness.
Although many individuals do not have confirmatory serologic tests, surveillance studies show that these patients may have a similar risk of developing persistent, recurrent, and refractory Lyme disease compared with the seropositive population.
Continued Importance of Differential Diagnosis
The differential diagnosis of Lyme disease requires consideration of both infectious and noninfectious etiologies. Among noninfectious causes are thyroid disease, degenerative arthritis, metabolic disorders (vitamin B12 deficiency, diabetes), heavy metal toxicity, vasculitis, and primary psychiatric disorders.
Infectious causes can mimic certain aspects of the typical multisystem illness seen in chronic Lyme disease. These include viral syndromes, such as parvovirus B19 or West Nile virus infection, and bacterial mimics, such as relapsing fever, syphilis, leptospirosis, and mycoplasma.
The clinical features of chronic Lyme disease can be indistinguishable from fibromyalgia and chronic fatigue syndrome. These illnesses must be closely scrutinized for the possibility of etiological Borrelia burgdorferi infection.
Clinical Judgment
Clinical judgment remains necessary in the diagnosis of late Lyme disease. A problem in some studies that relied on objective evidence was that treatment occurred too late, leaving the patient at risk for persistent and refractory Lyme disease.
As noted, time-honored beliefs in objective findings and two-tier serologic testing have not withstood close scrutiny. Lyme disease should be suspected in patients with newly acquired or chronic symptoms (headaches, memory and concentration problems, and joint pain). Management of patients diagnosed on the basis of clinical judgment needs to be tested further in prospective trials, and diagnostic reproducibility must be verified.
Testing for Coinfection
Polymicrobial infection is a new concern for individuals with Lyme disease, and coinfection is increasingly reported in critically ill individuals. Although B. burgdorferi remains the most common pathogen in tick-borne illnesses, coinfections including Ehrlichia and Babesia strains are increasingly noted in patients with Lyme disease, particularly in those with chronic illness. Bartonella is another organism that is carried by the same ticks that are infected with B. burgdorferi, and evidence suggests that it is a potential coinfecting agent in Lyme disease.
Recent animal and human studies suggest that Lyme disease may be more severe and resistant to therapy in coinfected patients. Thus, concurrent testing and treatment for coinfection is mandatory in Lyme disease patients.
Treatment Considerations
Since Lyme disease can become persistent, recurrent, and refractory even in the face of antibiotic therapy, evaluation and treatment must be prompt and aggressive.
Prompt Use of Antibiotics
Although no well designed studies have been carried out, the available data support the prompt use of antibiotics to prevent chronic Lyme disease. Antibiotic therapy may need to be initiated upon suspicion of the diagnosis, even without definitive proof. Neither the optimal antibiotic dose nor the duration of therapy has been standardized, but limited data suggest a benefit from increased dosages and longer treatment, comparable to the data on tuberculosis and leprosy which are caused by similarly slow-growing pathogens.
Choosing an Antibiotic
In acute Lyme disease, the choice of antibiotics should be tailored to the individual and take into account the severity of the disease as well as the patient’s age, ability to tolerate side effects, clinical features, allergy profile, comorbidities, prior exposure, epidemiologic setting, and cost.
Conversely, persistent and refractory Lyme disease treatment is more likely to include intravenous and/or intramuscular antibiotics. The choices depend in part on the patient’s response to antibiotic therapy and on the success of antibiotics in treating other Lyme disease patients.
Therapy usually starts with oral antibiotics, and some experts recommend high dosages. The choice of antibiotic therapy is guided by weighing the greater activity of intravenous antibiotics in the central nervous system against the lower cost and easy administration of oral antibiotics for B. burgdorferi.
Oral Antibiotic Options
For many Lyme disease patients, there is no clear advantage of parenteral therapy. Along with cost considerations and pressure to treat patients with Lyme disease with the least intervention, there is growing interest in the use of oral therapy.
First-line drug therapies for Lyme disease may include (in alphabetical order): oral amoxicillin, azithromycin, cefuroxime, clarithromycin, doxycycline, and tetracycline. These antibiotics have similar favorable results in comparative trials of early Lyme disease.
Intravenous Antibiotic Options
It is common practice to consider intravenous antibiotics upon failure of oral medications in patients with persistent, recurrent, or refractory Lyme disease, and as the first line of therapy for certain conditions, (i.e., encephalitis, meningitis, optic neuritis, joint effusions, and heart block).
Ideally, the intravenous antibiotic should be selected on the basis of in vitro sensitivity testing or clinical experience. Intravenous antibiotics are also justified by concern for penetration into the central nervous system.
Until recently, ceftriaxone, cefotaxime, and penicillin were the only intravenous antibiotics routinely studied for use in Lyme disease. Intravenous imipenem, azithromycin, and doxycycline have an adequate antispirochetal spectrum of activity and may represent suitable alternative therapies. However, the latter two drugs are often considered for intravenous use only if they are not tolerated orally.
Intramuscular Antibiotic Options
Intramuscular benzathine penicillin (1.2 to 2.4 million units per week) is sometimes effective in patients who do not respond to oral and intravenous antibiotics. If intramuscular benzathine penicillin is used, long-term therapy may be necessary due to the low serum concentration of this form of penicillin. Benzathine penicillin has mainly been used in patients who have had multiple relapses while receiving oral or intravenous antibiotic therapy or who are intolerant of oral or intravenous antibiotics.
Combination Antibiotic Treatment
Combination therapy with two or more antibiotics is now increasingly used for refractory Lyme disease and has also been given as initial therapy for some chronic presentations.
This approach is already used for another tick-borne illness, babesiosis. Oral amoxicillin, cefuroxime, or (more recently) cefdinir combined with a macrolide (azithromycin or clarithromycin) are examples of combination regimens that have proven successful in clinical practice, although controlled clinical trials are lacking in persistent, recurrent, and refractory Lyme disease.
Combination therapy in patients with Lyme disease raises the risk of adverse events. This risk must be weighed against the improved response to combination therapy in Lyme disease patients failing single agents.
Sequential Treatment
Clinicians increasingly use the sequence of an intravenous antibiotic followed by an oral or intramuscular antibiotic. In two recent case series that employed combination therapy and sequential therapy, most patients were successfully treated. A logical and attractive sequence would be to use intravenous therapy first (e.g., intravenous ceftriaxone), at least until disease progression is arrested and then follow with oral therapy for persistent and recurrent Lyme disease.
Dosage
Increasingly, clinicians recommend that certain drugs used for Lyme disease be given at higher daily doses: for example, 3,000–6,000 mg of amoxicillin, 300–400 mg doxycycline, and 500–600 mg of azithromycin. Some clinicians prescribe antibiotics using blood levels to guide higher doses. Close monitoring of complete blood counts and chemistries are also required with this approach.
With higher doses, there may be an increase in adverse events in general and gastrointestinal problems in particular. Acidophilus has reportedly reduced the incidence of Clostridium difficile colitis and non-C. difficile antibiotic-related diarrhea.
Serious adverse effects of antibiotics, however, were less common than previous estimates. In a recent clinical trial of chronic Lyme disease, the overall serious adverse event rate was 3% after three months of antibiotics, including 1 month of intravenous antibiotics. Clinicians who have experience with higher dose antibiotic therapy must balance the benefit of higher drug levels achieved with this therapy against the modest risk of gastrointestinal and other side effects.
Duration of Therapy
Because of the disappointing long-term outcome with shorter courses of antibiotics, the practice of stopping antibiotics to allow for a delayed recovery is no longer recommended for patients with persistent, recurrent, and refractory Lyme disease. Reports show failure rates of 30–62% within 3 years of short-course treatment using antibiotics thought to be effective for Lyme disease. Conversely for neurologic complications of Lyme disease, doubling the length of intravenous ceftriaxone treatment from 2 to 4 weeks improved the success rate from 66 to 80%.
The management of chronic Lyme disease must be individualized, since patients will vary according to severity of presentation and response to previous treatment.
Concurrent risk factors (i.e., coinfections, previous treatment failures, frequent relapses, neurologic involvement, or previous use of corticosteroids) or evidence of unusually severe Lyme disease should lead to the initiation of prolonged and/or intravenous antibiotic treatment. Physicians should always assess the patient’s response to treatment before deciding on appropriate duration of therapy (i.e., weeks versus months).
Empiric Treatment
The importance of establishing the diagnosis of Lyme disease is heightened in light of increasing concern about antibiotic overuse. After an appropriate history, physical examination, and laboratory testing are completed, empiric antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient’s acute illness, underlying disease, and the likelihood of B. burgdorferi infection. The International Lyme and Associated Diseases Society (ILADS) working group recommends that empiric treatment be considered routine for patients with a likely diagnosis of Lyme disease.
Persistent Lyme Disease
Persistent Lyme disease is more resistant to treatment and more likely to produce a relapse. Although persistent Lyme disease may resolve without additional therapy, many experts believe that this condition should be treated with repeated and prolonged antibiotics. Physicians should extend the duration of antibiotics to prevent or delay recurrent and refractory Lyme disease.
Recurrent Lyme Disease
Despite previous antibiotic treatment, Lyme disease has a propensity for relapse and requires careful follow-up for years. The data suggest that failure to eradicate the organism may be the reason for a recurrence of symptoms. Early and aggressive treatment with antibiotics is indicated for recurrent Lyme disease. The ultimate impact from retreating each episode of recurrent Lyme disease is currently unclear.
Refractory Lyme Disease
Refractory Lyme disease is a devastating condition that usually affects patients with persistent symptomatology and long-term disability. Prompt and aggressive institution of antibiotic therapy may be essential to prevent refractory disease. Increasing evidence shows that antibiotics have a beneficial effect on the course of refractory Lyme disease even in cases where the patient is intolerant of antibiotics or when a previous regimen has failed. Several months of therapy are often required to produce clear evidence of improvement. During this time, symptomatic treatment may be combined with antibiotic treatment.
Treatment Failure
When patients fail to respond or their conditions deteriorate after initiation of empiric therapy, a number of possibilities should be considered other than Jarisch-Herxheimer reaction. These include adverse events that limit treatment, allergic history to medication, inappropriate or inadequate dosing regimen, compliance problems, incorrect medication, immune sequelae, and sequestering of the organism (e.g., in the central nervous system). An alternative diagnosis or coinfection should also be considered.
Symptomatic Treatment
Although there may be a potential role for symptomatic treatment in chronic Lyme disease, this approach has little support due to the strong possibility of persistent infection. Owing to the potential hazard of immunosuppression and the poor outcome in one study, steroid therapy is not recommended. Surgical synovectomy is associated with significant morbidity and does not address neurologic presentations; it should be reserved for knee pain failing antibiotic treatment. Intra-articular steroid injection may be useful as a temporizing procedure in patients with persistent knee pain but this runs the risk of masking persistent infection.
Symptomatic therapy (particularly anti-inflammatory medications, tricyclic antidepressants, selective serotonin re-uptake inhibitors, and hydroxychloroquine) may be useful in concert with antibiotics and in individuals failing antibiotics.
Hyperbaric oxygen therapy (HBOT) is under study but is not recommended for routine therapeutic use. Other treatments, including cholestyramine (CSM), antifungal therapy, and antiviral agents require further study.
Since patients are becoming more interested in alternative therapies (e.g., traditional Chinese medicine, anti-oxidants, hyperthermia, bee venom, naturopathy and homeopathy), physicians should be prepared to address questions regarding these topics.
Fibromyalgia
The outcome of treating fibromyalgia secondary to Lyme disease with nonantibiotic regimens has been poor. The most encouraging clinical trial showed success in only one of 15 patients and only modest improvement in 6 of 15 individuals with fibromyalgia despite 2 years of treatment.
Antibiotic therapy has been much more effective than supportive therapy in symptomatic patients with fibromyalgia secondary to Lyme disease.
Fibromyalgia treatment alone without antibiotics raises the risk of conversion to refractory chronic Lyme disease and/or exacerbation of an undiagnosed persistent infection and is not recommended. Increasingly, clinicians do not feel comfortable treating fibromyalgia in Lyme disease without antibiotics.
Decision to Stop Antibiotics
Several studies of patients with Lyme disease have recommended that antibiotics be discontinued after 30 days of treatment. Complicating the decision to stop antibiotics is the fact that some patients present with disease recurrence after the resolution of their initial Lyme disease symptoms. This is consistent with incomplete antibiotic therapy. Although the optimal time to discontinue antibiotics is unknown, it appears to be dependent on the extent of symptomatology, the patient’s previous response to antibiotics, and the overall response to therapy (see below).
Rather than an arbitrary 30-day treatment course, the patient’s clinical response should guide duration of therapy. Patients must therefore be carefully evaluated for persistent infection before a decision is made to withhold therapy.
The decision to discontinue antibiotics should be made in consultation with the patient and should take into account such factors as the frequency and duration of persistent infection, frequency of recurrence, probability of refractory Lyme disease, gains with antibiotics, the importance to the patient of discontinuing antibiotics, and potential for careful follow-up.
The ideal approach would be to continue therapy for Lyme disease until the Lyme spirochete is eradicated. Unfortunately there is currently no test available to determine this point. Therefore, the clinician must rely on the factors outlined above to decide on the length of antibiotic therapy for chronic Lyme disease.
Alternative Antibiotics
There is compelling evidence that Lyme disease can result in serious and potentially refractory illness. Use of alternative antibiotics to treat early Lyme disease with erythema migrans is generally not indicated unless coinfection is suspected.
The ILADS Working Group believes that the risk of alternative antibiotics is acceptable in selected Lyme disease patients presenting with chronic Lyme disease. Alternative antibiotics include less commonly used oral antibiotics (cefixime, cefdinir, metronidazole) and intravenous antibiotics (imipenem, azithromycin). The role of alternative antibiotics in low-risk patients is less certain and there is less consensus among the guideline developers as to whether the potential benefits outweigh the risks.
Therapy for Coinfection
Therapy for polymicrobial infection in Lyme disease is a rapidly changing area of clinical practice. Uncomplicated Lyme disease may be managed without addressing coinfection by means of standard oral or parenteral antibiotic therapy. Some but not all experts recommend therapy for subclinical or chronic coinfection with Ehrlichia, Babesia, or Bartonella on the basis of their belief that responses are more prompt with this approach.
The dose, duration, and type of treatment for coinfections have not been defined. Published reports of coinfection are limited to a small number of patients treated in open-label, nonrandomized studies. Doxycycline has been indicated for Ehrlichia. A recently published randomized trial determined that treatment of severe Babesia microti with the combination of atovaquone and azithromycin was as effective as the use of standard oral therapy with clindamycin and quinine.
The decision to use alternative antibiotics should be based on the individual case, including a careful assessment of the patient’s risk factors and personal preferences. Patients managed in this way must be carefully selected and considered reliable for follow-up. Further controlled studies are needed to address the optimal antimicrobial agents for coinfections and the optimal duration of therapy.
Evidence-based guidelines for the management of Lyme disease. Expert Rev Anti Infect Ther 2004;2(1 Suppl):S1-13. [66 references]
Subscribe to:
Posts (Atom)