Lyme Treatment Update

Lyme Treatment Update

One of the areas in which patients are wronged is chronic Lyme.

There are two forms of chronic Lyme. One are those who have persisting symptoms after receiving standard therapy after a valid Lyme diagnosis. Persisting symptoms can occur after a variety of infections, from EBV to Q fever to Borellia. I suspect these patients have a pathologic dysregulation of their response to infections, leading to prolonged, and often debilitating, symptoms.

The other is form is diagnosed by ND's and other pseudo-medical providers using unverified and unreliable tests. Often, especially here in the NW, the patients have no risks for the disease and are subjected to prolonged courses of antibiotics and other treatments.

Do these prolonged courses of antibiotics have any effect? Not that I can tell. The few patients I see (for other reasons) do not appear to have improvement from their antibiotics. It would be interesting to audit the patients of a "Lyme literate" provider and see if the patients have any improvement.

The medical literature has not found benefit from prolonged antibiotics for Lyme. This pattern has been repeated in Randomized Trial of Longer-Term Therapy for Symptoms Attributed to Lyme Disease.

This was a European study, where there are different strains of Borrelia and the disease has a somewhat different tempo than the US version.

After a standard course of ceftriaxone, 86 patients received doxycycline, 96 clarithromycin–hydroxychloroquine, and 98 had placebo group.

And?

No difference in symptom improvement over the 12 weeks of the treatment. There were two interesting aspects of the study.

One is that there was significant improvement in the placebo group.  Patients often experience improvment just from interacting with their providers. It is part of why pseudo-medicines never, ever, die.  The other is only a third had objective finding of Lyme; as the accompanying editorial notes

nearly two thirds of their study population had nonspecific symptoms that were attributed to Lyme disease solely on the basis of positive IgM or IgG (or both) immunoblot assays for B. burgdorferi. Such laboratory findings do not necessarily imply causation and could represent either false positive results or remote infection, since antibody titers can remain elevated for decades.

Most may not have had Lyme, much less an infection, at all.  Not a surprise that antibiotics had no effect given no organism to kill. There was no benefit, only side effects from the antibiotics

The editorial, entitled Time for a Different Approach to Lyme Disease and Long-Term Symptoms, does mention, in a politic manner,

the more nebulous chronic Lyme disease that is often not associated with customary, objective measures of Borrelia burgdorferi infection.

In the West coast, and Europe, the problem is not Lyme, it is pseudo-Lyme diagnosed by pseudo-doctors and the ill patients who waste time, money and hope on useless therapies because, as is noted,

we do not know what is truly helpful.

in treating those with the symptoms falsely attributed to Lyme.

This is not a group of providers who will alter their approach based on data. You cannot alter an opinion with data if that opinion was not derived from data.  I suspect that the "Lyme literate" providers will not apply this, and similar studies, to their practice.  Literate here is the first definition, "able to read and write", and not "having or showing knowledge about a particular subject."

Points of Interest 04/06/2016
Points of Interest 04/05/2016

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