FREE: The Lyme Times For Lyme Awareness Month in May
In honor of Lyme Disease Awareness Month, the COVID-19 Issue is open access – freely available to all. The hope is you will enjoy and share these issues with your family and friends. Without you, Lyme Disease Organization would not be where they are today, and they’re so thankful for all of your support. (Click on link for access)
LYME CARDITIS SYMPTOMS MAY GO UNDIAGNOSED IN MEXICO
Lyme carditis symptoms can be a serious complication of Lyme disease. While the condition is well-recognized in the United States, officials in Mexico are reluctant to acknowledge Lyme disease in their country. In a letter entitled “Advanced AV-block: Is it time to consider Lyme carditis as a differential diagnosis in Mexico?” physicians describe the challenges of proving that a patient has Lyme carditis. [1]
The authors highlight the case of a 23-year-old woman who presented to their hospital “with a chief complaint of dyspnea and chest pain and was found to have a third degree AV-block on the electrocardiogram (ECG).”
A temporary pacemaker was implanted. And after an exhaustive work-up for other causes, the woman was eventually tested for Lyme disease. While Lyme carditis symptoms can be difficult to recognized, test results were positive by the Centers for Disease Control and Prevention (CDC) two-tier Western blot criteria.
Unfortunately, despite a three-week course of intravenous ceftriaxone, the woman required a permanent pacemaker. “At 3-month follow-up, she was still dependent on pacing,” writes Carrizales-Sepulveda and colleagues.
They argue that the woman lived in an endemic region and had visited the hospital with complaints consistent with Lyme carditis symptoms four weeks earlier. The authors cite the CDC, pointing out that “a region can be considered as endemic for [Lyme disease] if: at least two confirmed cases have been previously acquired or in which established populations of a known tick vector are infected with B. burgdorferi.”
However, the medical community in Mexico has been reluctant to acknowledge Lyme disease as a possible cause of the woman’s heart block. Officials argue “there is no convincing evidence that Borrelia burgdorferi is present in Mexico.”READ MORE: Which treatment guidelines should you follow for Lyme carditis?
Despite such resistance, Carrizales-Sepulveda and colleagues report “a seroprevalence of 6.2% for the Northeast region of Mexico and 3.4% for Mexico City, using a two-tier approach with enzyme-linked immunosorbent assay (ELISA) and western blot (WB) as recommended.”
Unfortunately, these results were dismissed as false positives, the authors write.
Furthermore, their Lyme carditis diagnosis was questioned with officials suggesting “the advanced AV-block that our patient presented had another cause that was not thoroughly investigated,” Carrizales-Sepulveda explains.
The authors recommend that Lyme carditis be considered as a possible diagnosis for patients living in Mexico.
“We agree that in our country other causes should be ruled-out first, however, there is no reason to leave out [Lyme carditis] as a diagnosis,” they write.
“[Lyme disease] in our country might be under looked, underdiagnosed, and underreported.”
Carrizales-Sepulveda EF, Jimenez-Castillo RA, Vera-Pineda R. Advanced AV-block: Is it time to consider Lyme carditis as a differential diagnosis in Mexico? J Electrocardiol. 2020.
Author John Nathaniel Aucott, Director of the Johns Hopkins Lyme Disease Research Center, Associate Professor of Medicine, Johns Hopkins University
Disclosure statement
John Nathaniel Aucott receives funding from the Steven and Alexandra Cohen Foundation.He is affiliated with the Bay Area Lyme Foundation as a member of their Scientific Advisory Board.
Her symptoms started quickly: neck pain, extreme fatigue and intermittent fever and chills. The woman had been healthy until then, and since she enjoyed gardening and landscaping at her rural Maryland home, she wondered if a tick bite might have given her Lyme disease although she had not noticed the telltale bull’s-eye skin lesion.
Her doctor told her it was likely just a virus. The next day, she felt worse and went to the emergency room, where she was diagnosed with mononucleosis.
The woman, a nurse in her 40s, returned to the emergency room a few weeks later with breathing trouble and low blood pressure. Doctors tested her for Lyme disease and found it had spread to her heart, a rare manifestation of Lyme disease that can be fatal.
Antibiotics resolved her heart and respiratory symptoms, but the fatigue, as well as joint pain and trouble concentrating, continued. Doctors told her it was just the recovery process, but the symptoms were debilitating and didn’t go away. It wasn’t until several months later, when she got a second opinion, that she was diagnosed with post-treatment Lyme disease, a known complication of Lyme disease.
“I felt dismissed and abandoned,” she later told me. “No one stopped to listen to my story and advocate for me.”
Her experience gives insight into a highly controversial medical term: chronic Lyme disease.
Because there are no definitive tests or treatments for this condition, patients who have symptoms can be dismissed by the medical establishment. Many are denied medications such as antibiotics they believe can control the chronic infections they suspect they have.
I am the former chair of the tick-borne diseases working groupat the U.S. Department of Health and Human Services and a medical researcher who has studied chronic Lyme disease for 20 years. It has become obvious to me that the problem is deeper and more complex than the polarized debate over the controversy would make one believe.
My colleagues and I have closely followed the health of Lyme disease patients as they recover, and what we have discovered runs counter to the mainstream teaching about Lyme disease. Doctors still often don’t know how to accurately diagnose patients with Lyme disease, and patients don’t always get better, even when they are diagnosed and treated. Physicians lack the diagnostic tools for early diagnosis or for documenting cure of the disease.
Studying this subgroup of post-treatment Lyme disease patients who are treated for Lyme disease but don’t get better is a clue on my way to find to understand chronic Lyme disease. While it may not provide definitive answers yet, we hope it will add to the body of knowledge about this perplexing set of conditions that are likely diverse in origin.
Yes, I Can Function With Chronic Illness. No, You Can’t Judge My Pain Off That.
A woman with chronic illness and pain describes the decades of struggle and fighting it took for her to be functional, and why we can’t judge someone’s pain off their ability to function or not. themighty.com
The chronic Lyme controversy
Lyme disease, first identified in the United States in the 1970s, has grown into a health epidemic as the ticks that transmit it to humans expand their range. The Centers for Disease Control and Prevention now estimates that about 300,000 people in the U.S. become newly infected every year now. The symptoms can be debilitating, including neurological symptoms, extreme fatigue and muscle and joint pain.
When symptoms linger long after a diagnosed patient receives the standard antibiotic treatment, like the nurse in Maryland experienced, the patient may have a condition called post-treatment Lyme disease syndrome, a subset of chronic Lyme disease. Many experts in the field estimate about 10% to 20% of patients diagnosed with Lyme disease get this syndrome.
The controversy around chronic Lyme disease emerged when patient advocacy groups and some doctors began to use the term to describe patients who had nonspecific symptoms such as fatigue and pain, and testing did not always show that they had been exposed to Lyme disease.
At the heart of the controversy is the question: Can a person have a chronic bacterial infection that may not show up on tests?
These patients are frustrated with a medical establishment whose focus is on evidence-based treatment in a field where evidence is often lacking. Without a diagnosis by the establishment, these sick patients are often dismissed and can’t get treated, leading to a sometimes toxic environment as they fight for treatment.
Symptoms without evidence
My training in infectious diseases didn’t prepare me for the patients I started seeing after moving to a Lyme-endemic region in 1996. Patients that I had treated for well-documented Lyme disease were experiencing chronic joint pain, neurological symptoms and extreme fatigue, yet most lacked “objective measurable manifestations” of Lyme disease, like abnormalities in blood tests or radiologic imaging evidence of tissue damage.
It was, and still is, uncomfortable telling patients that we don’t know exactly what is going on or how to best treat their illness. My chronic Lyme patients were sicker and had less hope than the AIDS patients I worked with, but the underlying mechanism of illness remained elusive.
Part of the challenge is the lack of definitive tests for chronic Lyme disease. After treatment with antibiotics, the bacteria that causes Lyme disease – Borrelia burgdorferi – is rarely detected, yet symptoms often continue.
There are several theories about why symptoms might continue for months if not years. Some of the bacteria might be able to evade the immune system, bacterial residue might remain that trigger ongoing inflammation or a severe initial infection, delayed treatment or coinfections from the tick bite, such as babesiosis, might lead to an uncontrolled and ongoing overreaction by the patient’s immune system.
Without laboratory findings, however, most doctors are uncomfortable with diagnosis and treatment of chronic Lyme disease.
This may be because Lyme disease symptoms can be mistaken for those of other illnesses, such as chronic fatigue, fibromyalgia and depression. Doctors also recognize the public health risks of antibiotic overuse and the potential risk to patients from long-term antibiotic treatments.
A group of doctors has championed the care of patients with chronic Lyme disease and developed guidelines for their care. Some of their practices have been criticized, especially long-term intravenous antibiotics which have the potential for serious side effects. Yet it is not uncommon for patient anecdotes and experience to report that long-term antibiotic therapy and other complementary care interventions have helped despite the lack of FDA approval or randomized trials to support their use.
Diagnosing the syndrome
Our research has shown that post-treatment Lyme disease syndrome can be meticulously identified in patients with previously treated Lyme disease by a constellation of quality-of-life symptoms, including fatigue, sleep disturbance, musculoskeletal pain and cognitive problems, and by the severity of those symptoms.
However, the holy grail for diagnosing post-treatment Lyme disease syndrome – and sorting out chronic Lyme – would be a blood biomarker to identify the biology of the disease in patients. Molecular markers are rapidly being discovered that provide insights into the mechanisms of disease that show the potential interplay of both microbial and host inflammatory responses that may cause ongoing symptoms in previouslytreated Lyme disease patients.
Once molecular markers are established, this will set the stage for new treatment trials.
The true extent of this insidious epidemic is still unknown, but it is clear, based on my experience and work, that it no longer accurate to simply argue that chronic Lyme disease doesn’t exist.
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**Comment**
One of the fairest pieces I’ve read in a long time.
My only correction:
Researchers keep saying it’s only 10-20% that go on to have persistent symptoms. This percentage is based upon those who are diagnosed and treated early. There’s a much larger group (nearly everyone I work with) that is diagnosed and treated late. According to Microbiologist Holly Ahern, this larger group constitutes 40-60% of patients. For an accurate percentage, you need to add both groups together to get a full picture of who remains with symptoms. According to Ahern, up to 60% of ALL patients go onto have persistent, sometimes life-long symptoms:https://madisonarealymesupportgroup.com/2019/02/25/medical-stalemate-what-causes-continuing-symptoms-after-lyme-treatment/
The reason this distinction needs to be made is 1) patients will be taken more seriously when authorities know many people are affected by this. 2) it is much more likely research monies will be directed toward an issue involving more people 3) it’s important to be accurate in science.
I would like to highlight a few thoughts in the article that hit a cord with me:
My colleagues and I have closely followed the health of Lyme disease patients as they recover, and what we have discovered runs counter to the mainstream teaching about Lyme disease.
My chronic Lyme patients were sicker and had less hope than the AIDS patients I worked with.
The true extent of this insidious epidemic is still unknown, but it is clear, based on my experience and work, that it no longer accurate to simply argue that chronic Lyme disease doesn’t exist.
When I was little, my grandmother used to sing the Dinah Washington song, “What a difference a day makes, twenty-four little hours…” Later, memories of her singing those lyrics carried me through some of my toughest days of tick-borne illness. They remind me even today that I just need to get through the next hour, the next minute, because things could be better tomorrow.
Sometimes they were better. A Herxheimer reaction might settle, a solid night’s sleep might lower my emotional temperature, or my actual fever might go down. And sometimes, the tomorrows weren’t much better. When I first started intravenous antibiotics, I felt horrible for six weeks before noticing any improvement. Often the next day was worse than the last. I learned that while I could coach myself to survive each minute or second, I had to wait longer to really live again and even longer to thrive, which was my desire. For that type of progress, it was better to chart my improvement over months, if not years. Check here for an overview of some of my long-term recovery strategies.
Birthdays are always a nice time to reflect on the year passed, and this has been especially true since I’ve been sick with chronic Lyme, two tick-borne co-infections—babesia, ehrlichia—and Epstein-Barr virus. A lot can happen in a year, both good and bad. We never know what joys or sorrows await us. Lyme patients don’t know how they’ll respond to treatment or how long it will take them to feel better. For many, though, they can see real progress—with dips and valleys—over a year or more.
I was thinking back to my 29th birthday recently, when I was in the midst of a relapse. Sick and exhausted, I wondered if I could endure further treatment. I struggled with my self-esteem. Frankly, there didn’t seem to be much to celebrate.
But flash forward a year to my 30th birthday party. I worea pretty pink dress. I was surrounded by friends and family. I was smiling, my cheeks glowing, with much to celebrate: a return to remission, to independent living and the resumption of freelance work. However, improvement over that year was by no means linear. I had many bad days, sometimes weeks. But when I considered the headway I made between my 29th and 30th birthdays, all I could think was, “What a difference a year makes.”
When I blew out the candles that year, I wished for continued health, for my life to keep blossoming—and it did. A couple years later, I moved to Boston and started graduate school. In the decade since, I’ve written two books and forged a teaching career. I have gotten back on my skis. I have also wrestled brief flare-ups of my illnesses, grieved the death of loved ones and mourned the loss of love. Those have been my low points, but when I see how many gains I’ve made over the last decade—and how much my stamina has improved—I want to pinch myself. I can hardly believe it.
As I blew out my candles last year, I never could have imagined the world would be in the midst of a global pandemic by my next birthday. But I also couldn’t have imagined all of the good things that have happened to me this year, including landing a literary agent, surviving COVID-19 despite my underlying health conditions. And thus, I hold onto hope—for me, for you, for the Lyme community, for our world.
When I blow out my birthday candles this week I’ll wish for a healthier year for all of us. I hope that by this time next year, I’ll be able to celebrate that wish coming true.
Opinions expressed by contributors are their own.
Jennifer Crystal is a writer and educator in Boston. Her memoir about her medical journey is forthcoming. Contact her at lymewarriorjennifercrystal@gmail.com.
Well, that made my day! I love to see patients improve. If you are having a rough day, month, or year – hang tight. It will get better in time.
