Long-Term Assessment of Fatigue in LD

Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
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RitaA
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Joined: Thu 1 Jul 2010 8:33

Long-Term Assessment of Fatigue in LD

Post by RitaA » Fri 24 Oct 2014 9:44

http://www.sciencedirect.com/science/ar ... 4314008973
The American Journal of Medicine
Available online 15 October 2014

In Press, Accepted Manuscript — Note to users

Long-Term Assessment of Fatigue in Patients with Culture-Confirmed Lyme Disease

Gary P. Wormser, M.D, , Erica Weitzner, B.S, Donna McKenna, N.P, Robert B. Nadelman, M.D, Carol Scavarda, R.N, John Nowakowski, M.D

Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595

Received 22 August 2014, Revised 12 September 2014, Accepted 12 September 2014, Available online 15 October 2014

Abstract

Background

Fatigue is a common symptom with numerous causes. Severe fatigue is thought to be an important manifestation of post-treatment Lyme disease syndrome (PTLDS). The frequency with which severe fatigue occurs as a long-term sequela in prospectively followed Lyme disease patients, however, is unknown.

Methods

Patients with culture-confirmed Lyme disease who originally presented with erythema migrans have been evaluated annually in a prospective study to determine their long-term outcome. In 2011-2013, subjects were evaluated for fatigue using an 11 item fatigue severity scale (FSS-11) that has been used in studies of PTLDS. A FSS-11 score of >4.0 is indicative of severe fatigue.

Results

100 subjects were assessed, 52% of whom were male; the mean age was 64.9 years (range 42-86 years). The mean duration of follow-up was 15.4 years (range 11-20 years). Nine subjects had severe fatigue but none as a consequence of Lyme disease. Only 3 subjects were thought to possibly have persistent fatigue from Lyme disease. The FSS-11 value for these 3 individuals was under 4, averaging 2.27, and none had functional impairment.

Conclusions

Severe fatigue was found in 9 (9%) patients with culture-confirmed early Lyme disease at 11 to 20 years after presentation, but was due to causes other than Lyme disease. Fatigue of lesser severity was possibly attributable to Lyme disease, but was found in only 3% of 100 patients, and therefore is rarely a long-term complication of this infection.
I wonder if symptoms other than fatigue have also been evaluated in patients who were diagnosed with early Lyme disease. Are patients who were diagnosed with late Lyme disease also being followed over the long term?

phantasm
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Re: Long-Term Assessment of Fatigue in LD

Post by phantasm » Fri 24 Oct 2014 14:30

How is this science? They say that fatigue has numerous causes so why is this in any way a conclusion worth posting?

"and therefore is rarely a long-term complication of this infection."

Therefore, anytime anyone says "therefore" or "thus" it says to me they wish they were scientists instead of just being pompous.

This is meaningless because people with these infections go through several stages and react in different ways depending how they are treating, it sounds like some junk a chronic lyme disease denier would write.

RitaA
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Joined: Thu 1 Jul 2010 8:33

Re: Long-Term Assessment of Fatigue in LD

Post by RitaA » Fri 24 Oct 2014 15:10

phantasm wrote:How is this science?
It is posted under "Science" based on the description for that category on this forum as opposed to the content of the abstract.
Science

Scientific topics related to Lyme disease, like (peer-reviewed) scientific medical publications and articles supported by such publications.
Posting an article abstract and/or a full article doesn't necessarily mean that we personally endorse/agree with the content or conclusion(s) of the author(s). As in this case, they often serve as a catalyst for discussion among members.

Posts can be reclassified if and when admin thinks it's appropriate.

admin
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Re: Long-Term Assessment of Fatigue in LD

Post by admin » Fri 24 Oct 2014 15:23

I can confirm what RitaA says.

Margherita
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Re: Long-Term Assessment of Fatigue in LD

Post by Margherita » Fri 24 Oct 2014 18:29

Thanks for posting Rita.
I wonder if besides Borrelia, these patients have also been tested for other possible pathogens/viruses such as Epstein Barr, of which has been found that can be reactive and which perhaps cause long term fatigue.

duncan
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Re: Long-Term Assessment of Fatigue in LD

Post by duncan » Fri 24 Oct 2014 19:22

Ok, I'm not seeing if these culture-confirmed cases with EM had received treatment during their early Lyme. I am assuming they did, so aren't these findings almost meaningless? If they caught the disease early in its tracks, treated and cured it, then one would expect a majority of those followed to be asymptomatic, including fatigue values. The roughly 10% value would be in line with most generally accepted estimates of individuals who seem in some way refractory to treatment - and I'm not sure I trust their interpretation of the cause being something other than Lyme, anymore than I am of their decision to classify a host of serious symptoms as minor in their Guidelines.

If these cases did NOT receive treatment, then the individuals who allowed these patients to go untreated should no longer be allowed to practice medicine, imho.

I swear to me it seems these people like to generate meaningless press just to keep a presence out there.

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ChronicLyme19
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Re: Long-Term Assessment of Fatigue in LD

Post by ChronicLyme19 » Thu 30 Oct 2014 3:32

duncan wrote:I'm not sure I trust their interpretation of the cause being something other than Lyme, anymore than I am of their decision to classify a host of serious symptoms as minor in their Guidelines.
Agreed
Half of what you are taught is incorrect, but which half? What if there's another half missing?

velvetmagnetta
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Re: Long-Term Assessment of Fatigue in LD

Post by velvetmagnetta » Thu 30 Oct 2014 12:43

So, according to my favorite scientist, Dr. Wormser, I should be alright in about 15 years. Great. I've already been in bed for 5 years - only 10 more years to go until I am no more fatigued than the rest of the general population.

Exactly how fatigued is the rest of the general population that the severity can be compared with post-treatment Lyme fatigue??

This study has been going on for 15 or 20 years? Does that mean 20 years ago patients had the same question about the origin of their pain and fatigue after treatment for Lyme disease? I mean, doesn't that fact alone say to Wormser et al. that the post-treatment fatigue we have all been trying to tell the CDC and the IDSA about is exceedingly more than likely from a past (or present) Lyme infection?

Guys, what is going on here? For at least 20 years, people have been suffering from disabling pain and fatigue that they suspected was due to Lyme disease, and we're still asking the same question?

And what about the measly piddling 3 people with severe fatigue that the researchers are sure is due to Lyme? That's 3 people of 100 who cannot get better. If we extrapolate those odds to the number of new Lyme disease cases each year...hmmm...calculating...that leaves 9,000 of us with severe fatigue (and disabling pain) 15 years - YEARS - after treatment??? And this is acceptable to Dr. Wormser and friends?

Well. I find myself in agreement with Phantasm for once.

Phantasm wrote:
How is this science? They say that fatigue has numerous causes so why is this in any way a conclusion worth posting?

"and therefore is rarely a long-term complication of this infection."

Therefore, anytime anyone says "therefore" or "thus" it says to me they wish they were scientists instead of just being pompous.

This is meaningless because people with these infections go through several stages and react in different ways depending how they are treating, it sounds like some junk a chronic lyme disease denier would write.
Not that it should not be posted under "Science", but that it is barely science.

I would like to know "why" people are still ill after treatment more than I want to know "if" people are still ill after treatment. I think the "if" question has really just answered itself right here.

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