Treating Lyme disease - different approaches
By RAECHEL KELLEY
Bulletin Contributing Writer
Friday, July 8, 2011
It started out as a bruise on his hip.
Back in 2003, when the mark first appeared, Rush Hawkins of Shelburne didn't think much of it - even as the bruise spread to his spine.
It wasn't until he became extremely disoriented while driving in Northampton that he finally became concerned.
"I got lost in a town I had known my whole life," explained Hawkins of the incident. "It was really scary."
It turned out Hawkins, now age 27, was suffering from late disseminated Lyme disease. Hawkins later treatment from West County Physicians in Shelburne Falls, where he tested positive for Lyme and was prescribed doxycycline for approximately three months.
"My doctor told me [the disease] could reactivate," said Hawkins, "but luckily I haven't had any symptoms since."
Unfortunately, others have not been so lucky. Many have experienced reoccurring symptoms for months and even years after receiving treatment for Lyme disease.
In the 36 years since Lyme disease was first identified, two camps on how to treat it have developed.
One approach embraced by the International Lyme and Associated Diseases Society (ILADS), considers Lyme disease to be a chronic condition that demands aggressive treatment.
The other method is encouraged by the Infectious Disease Society of America (IDSA) and supported by the Center for Disease Control and Prevention (CDC). This group does not attribute these lingering symptoms to Lyme disease, but to another mysterious syndrome.
Lyme disease is currently the most commonly reported insect-transmitted illness in the United States, according to the CDC.
In Massachusetts Lyme disease is a growing concern. With over 4,000 cases in 2009, the CDC reported that Massachusetts has the fourth-highest rate in the country.
Hampshire and Franklin counties have the sixth- and seventh-highest percentage of Lyme infection among the state's 14 counties, as stated by the Massachusetts Department of Public Health. "Attack rates in these counties resemble those of some of the most highly infected areas in the country," said Dr. William Swiggard, an infectious disease specialist at Cooley Dickinson Hospital in Northampton.
Swiggard said the disease is under-reported, so there is a possibility that there may be more cases.
People and animals can contract Lyme from female deer ticks carrying the bacteria Borrelia burgdorferi. Swiggard said ticks typically transmit this bacterium to their host during the immature, or nymph, stage. At this stage, the tick is about the size of a poppy or sesame seed, making it hard to identify or detect.
While the tick is attached to the skin, it injects an anesthetic numbing agent into the feeding site, which only adds to the difficulty of detection. Swiggard said that once a tick has attached, it takes 24 hours for it to pass on the B. burgdorferi to its host.
Other medical practitioners, such as Dr. Emily Maiella, founder of Valley Naturopathic Family Medicine in Montague, say that the bacteria can be transmitted to an individual in as little four hours.
In order to properly diagnose the disease, some professionals use a series of two lab tests, the ELISA and the Western Blot, in addition to considering the signs, symptoms and environmental factors. Swiggard said while these tests are the standard diagnostic tools, it can take several weeks to produce a positive result after being infected because the antibodies need time to elevate in the body.
Maiella says Lyme disease is extremely difficult to diagnose and most tests are not very accurate.
The CDC describes the symptoms for the disease in three phases categorized by the time of contraction. People in the early localized stage, which is one to three days after being bitten, may experience fatigue, headaches, swollen lymph nodes, and muscle and joint pain. During this stage, approximately 70 percent of people suffering from the disease will develop a painless rash called an erythema migrains or "bull's eye" rash, though Swiggard added that the rash does not always resemble that shape.
In the second stage, known as the early disseminated stage, some may experience facial paralysis, swelling in the knees and/or heart palpitations. These symptoms can arise anywhere from a couple of days to weeks after the disease is contracted.
A person could experience symptoms from the late disseminated stage if the disease is left untreated for months or years. Serious prolonged symptoms may develop in this third stage, such as severe arthritis in the large joints, numbness or tingling in the hands and feet, and even short-term memory loss, similar to Hawkins' case. Swiggard explained that most cases, if caught early, are treated successfully with a 21-day cycle of oral antibiotics, like doxycycline, but treatments can vary based on the severity of the case and how long the individual has been infected. In extreme cases doctors may prescribe four to six weeks of intravenous antibiotics like Ceftriaxone.
But even after these treatments, some patients still experience debilitating symptoms that may be mistaken for multiple sclerosis, Parkinson's disease, fibromyalgia and chronic fatigue syndrome.
Reoccuring symptoms Swiggard said that most conventional treatments are successful. However, the CDC acknowledges that 10 percent of people who are treated for Lyme disease experience reoccurring symptoms that can include fatigue, muscle and joint pain and cognitive defects.
The cause of these symptoms is still under debate.
"... There is no evidence that these symptoms are due to ongoing infection with B. burgdorferi," the CDC announced on its website. "This condition is commonly referred to as Post-treatment Lyme Disease Syndrome (PTLDS)." Swiggard explained that in such cases, he will typically suggest regular light exercise, or he may refer the patient to a rheumatologist. He acknowledged there are other less-common approaches available, though many of these methods are not recommended by the CDC.
Maiella considers these extreme reoccurring symptoms to be chronic Lyme disease, and her treatment involves antibiotics combined with herbal remedies and diet control. Maiella also stresses the importance of strengthening and cleansing the body in order to fully heal from damaging effects of the disease.
George Bennett, one of Maiella's patients, didn't receive treatment until he experienced what he described as "muscle failure."
"When you can't lift your legs up, it's pretty alarming," Bennett said.
After receiving a year of treatment from Maiella and other practitioners, Bennett's symptoms finally subsided. His regimen consisted of eight months of doxycycline, Polygonum cuspidatum (Japanese knotweed) and other herbs.
Bennett said that it was a combined effort of antibiotics and herbal remedies that led to his recovery. While the debate over Lyme disease continues, doctors and specialists agree the best way to battle this disease is through prevention.
This includes people checking themselves, their children, pets and gear for ticks after coming indoors.
For information about Lyme disease visit the Infectious Disease Society of America, http://idsociety.org/lymedisease.htm;
The Centers for Disease Control and Prevention, http://www.cdc.gov/lyme/;
and International Lyme and Associated Diseases, http://www.ilads.org