Incorrect Treatment For Lyme Disease

lyme disease
Delays in proper treatment, inhibition of our immune systems by tick and bacterial defenses, and development of resistance of Borrelia to common antibiotics allow the bacteria to escape eradication. Caught early enough, most cases are cured with a short series of oral antibiotics. There is even talk about a single dose of long-release doxycycline being sufficient if given early enough. Yet many people are being misdiagnosed, given insufficient treatments (Burrascano 2005), and not cured even after prolonged antibiotic administration.

The Physician Factor

Physicians who follow the guidelines of the Infectious Diseases Society of America (IDSA) feel that the regime of antibiotics proscribed by IDSA is sufficient to eliminate Lyme disease. Thus, these doctors prescribe 14 days of doxycycline when they assume the patient has had the disease for less than a month, and 28 days when they feel there is neurological involvement.

When the patient symptoms are not relieved by this antibiotic regime, the doctor, following IDSA's guidelines, states the disease is cured, but now the patient is demonstrating “post Lyme disease syndrome”, and there is nothing further that can or will be done. The International Lyme and Associated Diseases Society (ILADS) produced different guidelines. ILADS physicians understand that the disease has entered a “chronic Lyme disease” state, and more intense measures must be taken to eradicate the disease.

How Borrelia Escape the Immune System During Chronic Lyme Disease
Borrelia penetrate into the cells of various tissues where they become isolated from both antibodies and killer T-cells (phagocytes) that would eat them. The blood brain barrier prevents many antibiotics from entering the tissues of the brain and spinal cord. When Borrelia penetrate that barrier, they are isolated from most antibiotics and wreak mayhem inside our nervous system, causing major alterations in nerve function – breaking the synaptic network and even destroying nerve cells.

The bacteria also burrow into and kill T-lymphocytes, the very cells designed to trap and kill them. As they destroy lymphocytes, Borrelia can hide inside a stolen portion of the lymphocyte's membrane and move through the bloodstream and tissue fluids looking to the immune system like a lymphocyte. The bacteria leave the lymphocyte membrane for only a short time before they enter a new cell.

How Borrelia Escape Antibiotics

  • Once inside the host, the bacteria reproduce about once every two weeks. (E. coli can reproduce once every twenty minutes.) Since most antibiotics prevent the bacteria from reproducing, ILADS feels a two week antibiotic treatment is ineffective as the bacteria may not reproduce during the period of treatment.
  • Each spirochete releases hundreds of membrane covered blebs, from their outer surface, and it appears these blebs are in part responsible for causing the symptoms of LD. Some antibiotics destroy these blebs, although the bacteria escape the antibiotic. In this case, the antibiotic reduces the severity of the illness because, although the blebs are rapidly destroyed by the antibiotic, bacteria continue to make blebs, so a few blebs remain active during treatment. The patient feels “better” but is not cured. Once the antibiotic is stopped, the blebs increase to pre-antibiotic levels and the disease comes back in full force – often producing new and more serious symptoms.
  • Borrelia has the ability to change from a spirochete into two other cell forms and enter body cells (Alan B. MacDonald, MD, power point presentation entitled: “Borrelia and Alzheimer's Disease”, presented to the ILADS national meeting Oct 30, 2007).
  • The first is an inactive cystic form that is able to produce new spirochetes at a later time. MacDonald feels this form is responsible for resurging Lyme disease after periods of remission.
  • The second is an L-form or spheroid without a cell wall. This form is often found inside T-cells and neurons and appears to be responsible for damaging these tissues. Each of the three forms of Borrelia requires different antibiotics or medications to destroy (Burrascano 2005). If these different medications are not provided at the proper times, the disease may return. IDSA does not agree the cyclic and L-forms develop in humans – even though Dr. McDonald has been demonstrating this for years. Thus, IDSA does not provide for treating any form but the spirochetal one.
  • Bacteria can acquire genes for antibiotic resistance from resistant strains of other species. If a few Borrelia become resistant to an antibiotic, the sensitive forms are destroyed by it - effecting a temporary “cure.” When the resistant ones reproduce and form a resistant population, LD returns but now must be treated with a different antibiotic.

Patients May Need Several Medications

The key to treatment of LD is to have the treatment started as soon as you suspect you have the disease - before the bacterium transform, mutate, or obtains antibiotic resistance. Once the bacteria are altered, a single antibiotic can not treat all of its forms, but there are many antibiotics available. If a particular antibiotic fails, another one might be effective.

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Kidney Stones

kidney stones
Stones in the kidney or urinary tract (nephrolithiasis or urolithiasis, both synonymous) often present as a medical emergency. Those afflicted seek help because of excruciating pain and other complications. Though not common, there are various ways for these stones to form. The options for treatment, however, are generally the same.

Formation of Stones

Calcium stones, mainly calcium oxalate, are the most common type of renal calculus. They can form when one doesn't drink enough water, allowing calcium that would dissolve to instead precipitate and crystallize. They also form in association with conditions raising the blood calcium level, including hyperparathyroidism, cancer, vitamin D overdose, and sarcoidosis. Other factors involve oxalate and citrate. Too much dietary oxalate or conditions increasing intestinal absorption of oxalate can promote stone formation. Citrate plays a role when there is too little of it, because it normally binds calcium and prevents crystallization into stones.

Uric acid stones can form with excessive ingestion of purines, primarily from meats. In addition, urine that is more acidic allows uric acid to crystallize more easily. Other types of stones include struvite stones formed through urinary tract infections by urea-splitting bacteria (e.g., Proteus mirabilis), cysteine stones from a rare genetic condition resulting in high levels of blood cysteine, and drug-induced calculi from certain medications that can crystallize within the urinary tract (e.g., the anti-HIV drug indinavir).

Symptoms and Signs

A calculus within the urinary tract triggers intense pain. One may feel it in the flank if the stone resides in the kidney itself. If the stone advances down the ureter, pain is felt in the abdomen or groin depending on the stone's location. Trauma can cause bleeding seen in the urine itself (hematuria). If the stone reaches the urinary bladder and causes outflow obstruction, one may have pain in the lower abdomen and frequent urges to urinate. On occasion, the stone is a large irregularly shaped stone that fills the space within the kidney (staghorn calculus). As a result, one may have signs of infection, like fever and low blood pressure, rather than pain.

The prime imaging study to diagnose nephrolithiasis is a CT scan of the abdomen and pelvis. Abdominal x-rays can detect calcium stones since they light up well, but not the other types of stones. Ultrasound of the kidneys can demonstrate urine backing up in the urinary tract (hydronephrosis), but it's not always seen, particularly when the stone is small and nonobstructing. Other tests for nephrolithiasis include urinalysis to detect blood, complete blood count to look for signs of infection, and serum chemistries to detect abnormalities in kidney function and electrolyte levels that may suggest a particular cause for the stone.

Treatments

The first step is to relieve any urinary obstruction. If the obstruction is in the bladder, a Foley catheter is inserted through the urethra to drain the urine. If obstruction involves the ureter and urine is backed up all the way to the kidneys, a nephrostomy tube is inserted directly through the skin and into the kidney to drain the urine.

As for the stone itself, treatment depends on its size. If it's small, like less than 5 mm, the patient may be given medications to help relax smooth muscle in the ureter and aid in passage of the stone (e.g., Hytrin, Flomax). For stones that are larger and are unable to pass, options include breaking the stone with shock waves (extracorporeal shock-wave lithotripsy or ESWL), inserting a tube through the urethra and all the way to the stone in the ureter in order to extract it with tools (ureteroscopy), and surgically opening the kidney (nephrolithotomy). The urgency of these urological procedures depends on the severity of symptoms. For the most part, they can be done at a urology follow-up appointment after hospitalization.

Once that is taken care of, analysis of the stone is done to determine its composition. From there, the underlying conditions that led to the stone are addressed.

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Understanding Seasonal Affective Disorder

seasonal affective disorder

According to the Mayo Clinic online, seasonal affective disorder (SAD) is a cyclic, seasonal condition with signs and symptoms that reoccur around the same time each year. Usually, symptoms appear during late fall and progress on through the winter, only abating with the onset of longer and sunnier days.

Though, conversely, some people have developed the opposite pattern and become depressed with the onset of spring or summer, only feeling relief when that season wanes. But, in either case, SAD symptoms generally start out mild and progress in severity throughout the length of the season.

Seasonal Affective Disorder Facts and Causes

According to Mental Health America, formerly known as the National Mental Health Association (NMHA), SAD mimics many signs of depression, though it is actually a mood disorder that is related to the body's inability to adapt itself to varying amounts of sunlight.
The NMHA further offers the following facts about this serious and often misunderstood disorder.
  • A million people suffer from SAD every winter between September and April.
  • The “Winter Blues" may be a milder form of SAD and affect twice as many people.
  • Three out of four SAD sufferers are women.
  • The main onset of SAD occurs between the ages of 18 and 30.
  • SAD occurs in both the northern and southern hemispheres, though, oddly, it is rarely seen in those living within 30 degrees latitude of the equator.
  • The severity of the disorder depends on both a person’s vulnerability to light variance and his or her geographical location.

Evidently, just as sunlight affects the seasonal activities of animals (reproductive cycles and hibernation), it may too influence human behavior in similarly cyclical ways. As seasons change, there is a marked shift in the human “internal biological clock,” or circadian rhythm, due in part to patterns directly linked to varying levels of sunlight. The effect is an internal clock that is in step with the seasons but out of step with year-round daily schedules.

Also, SAD sufferers seem to more easily produce increased levels of melatonin, a sleep-related hormone that is naturally secreted by the brain. It seems that sufferers excrete heaps of the hormone during extended periods of darkness, so, when the days become shorter and darker, they begin to crave carbohydrates, require greater amounts of sleep, become irritable, and develop a severe disinclination to boogie.

Correctly Diagnosing and Identifying SAD

Of course, despite its pervasive grip on so many Americans, Seasonal Affective Disorder is notoriously difficult to diagnose and treat effectively due to its elusive and broad-ranging symptoms and almost entirely subjective level of suffering across those effected. Nevertheless, if the majority of the following symptoms listed below (from the Mayo Clinic on-line) are experienced, SAD may be the cause.
  • Depression
  • Hopelessness
  • Anxiety
  • Loss of energy
  • Social withdrawal
  • Oversleeping
  • Loss of interest in activities you once enjoyed
  • Appetite changes, especially a craving for foods high in carbohydrates
  • Weight gain
  • Difficulty concentrating and processing information

Notably, it is important to talk with your doctor regarding any concerns about mood instability or depression.
Particularly interesting are the symptoms of social withdrawal, appetite changes, and difficulty concentrating and processing information, as these symptoms do not necessarily point to long-term and pervasive suffering. The other interesting notation here is that there is currently no cure for SAD. Medication, light therapy, and weekly exercise regiment are only treatments for the disease.

Light Therapy and Medications for SAD Sufferers

Light therapy currently is the main treatment, and research is continuing to determine the most effective way to use it. There are two types of light therapy: bright light treatment, which makes use of a "light box" for a certain amount of time (usually in the morning), and dawn simulation, which takes place during the sleeping hours, utilizing a low-intensity light timed to go on in the early morning and get brighter with the waking hours.

It may take anywhere from three days to two weeks before a patient experiences positive effects from light therapy. However, discontinuing the routine will likely cause a relapse back into depression, as the goal of the light box is to reset the biological clock to a time of full sun, thereby triggering the brain to function at its highest levels of production.

Other treatments include the use of antidepressants, which may take as many as 6 to 8 weeks to become fully effective. Medication can be used with light therapy, but, as always, it is important to talk with a doctor before taking any medications.

Perhaps SAD is a little misunderstood, but it is very treatable if given proper time, attention, and understanding.

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