Second Installment: Collateral Conditions
When Lyme disease exists for an extended period of time the immune system is compromised. This sets the stage for the possibility that other conditions will develop. Dr. Burascanno and others have observed the following abnormalities may coexist:
• Vitamin B 12 levels may be compromised and if serious deficiencies are found aggressive treatment is indicated, especially with neurological involvement. This is what Wikipedia has to say about the function of B12: “Vitamin B-12 is a water soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood. It is one of the eight B vitamins. It is normally involved in the metabolism of every cell of the body, especially affecting DNA synthesis and regulation, but also fatty acid synthesis and energy production.” So you can see that energy levels may be effected with low vitamin B12 levels, and the functioning of the brain and nervous system enhanced with supplementation if indeed there is a deficiency. This is a very complex subject and referral to an endocrinologist may be indicated.
• Magnesium deficiency is commonly found in chronic Lyme patients, and Dr. Burascanno reports that cases can be quite severe. Hyperflexia, muscle twitching, heart (myocardial) irritability, poor stamina and recurrent tight muscle spasms are clues to this deficiency. Sound familiar? Oral preparations are acceptable for maintenance, but if there is a severe deficiency parenteral dosing (dosing by injection or infusion) may be needed until neuromuscular irritability has cleared.
• Pituitary and other endocrine abnormalities are more common than thought. A full battery of tests is often needed, especially with the low energy levels associated with Lyme. The thyroid indicators of free T3 and free T4 levels as well as TSH, and nuclear scanning/testing for auto antibodies may be necessary to ferret out dysfunction.
• Inflammatory cascade is a phrase that has such panache, doesn’t it? It is an elegant way of reflecting the painful condition that usually accompanies most stages of Lyme disease. When this is activated a process occurs in the cells that blocks hormone receptors. Insulin resistance can result! Clinical hypothyroidism (or sub-clinical hypothyroidism) can result from this receptor blockade and hypothyroidism can exist in spite of normal serum hormone levels!! This may account for weight gain in 80% of Lyme patients. Low AM body temperatures are common in this condition. If hypothyroidism is found, it is recommended that both T3 and T4 levels are treated until levels are normalized.
• Neurally mediated hypotension (NMH) is not uncommon. What is this, you might ask? This is low blood pressure caused by disease in the neural pathways of the autonomic nervous system. Symptoms include: heart palpitations, lightheadedness, shakiness after exertion and prolonged standing, heat intolerance, dizziness, fainting or near fainting, and the unavoidable need to sit or lie down. Sound familiar? (Hypoglycemia should be ruled out.) A cardiologist can test for this by a tilt table test and something called the Isuprel challenge. Treatment may include increasing sodium and fluid intake and possibly something called Florinef plus potassium. Treating the underlying cause, Lyme disease, is critical to correct the autonomic dysfunction in the long run.
• Abnormal brain function; Spect scans can help to identify a pattern of abnormal blood flow and chemical reactions in the brain associated with Lyme disease/s. A knowledgeable radiologist may be able to distinguish between a psychiatric based illness as opposed to Lyme encephalopathy. There are certain characteristics that show up in Lyme patients called hypoperfusion or what is called cerebral insufficiency. These tests are not used for diagnostic purposes, but can be helpful in understanding the functioning of the brain, and lay the groundwork for treatment.
Treatments may include vasodilators, acetazolamide, serotonin agonists and even Ginkgo Biloba (pharmaceutical quality) – although more tests on this herb need to be completed. These treatments, as always, should be prescribed by a knowledgeable treating physician.
Now, this has been quite technical, but interesting, don’t you think?