LYME DIAGNOSIS
If you have a confirmed diagnosis via laboratory testing the following is academic
information and you may want to skip to co-infection diagnosis or go straight to
treatment protocol and
supplements.
You may be in an undiagnosed limbo, sick but stuck in the cracks of “we
don’t know what you have”. Or worse, being misdiagnosed and therefore possibly
mistreated. Having suspected that you may have Lyme disease this is unlikely the
first site you have looked at and therefore going into a lengthy discussion about the
myriad of potential symptoms associated with Lyme would be redundant.
It is useful to look at a few opinions as to the non-laboratory diagnosis and I suggest
the links to diagnosis.
LAB DIAGNOSIS:
1. Western blot;
This is a good initial test as it is relatively inexpensive and readily available.
Unfortunately it is only useful if you actually do have Lyme and it is positive. Understand
that ‘positive’ is a relative term and the CDC has a very narrow criteria for diagnosis.
Many labs will only report a test positive if the CDC criteria are met.
Igenex, a Lyme specialty lab, uses a much broader
interpretation of the “positive” bands to determine if a test is positive for Lyme.
The problem with the western blot is that this test relies on the patient, you, having a
strong enough immune system to mount a reaction to borrelia. People with multiple
preexisting conditions and or co-infections may not have enough immunoglobulins to be
detected by the western blot.
2. Elisa;
This test is similar to the western blot in that it is an effort to detect antibodies to
Borrelia b. from a fluid, i.e. blood, sample. Again, false negatives.
3. PCR, borrelia
This test can be performed on any bodily fluid or tissue (commonly, blood, spinal fluid or
urine are use). The objective is to detect ‘fragments’ of the Borrelia b. organism,
the finding of which results in a conclusive diagnosis. This test too can have false
negatives simply because the sample being tested may not contain Borrelia fragments.
Running a PCR on a urine sample after 5-7 days of an appropriate antibiotic will improve
the chances of detecting Borrelia fragments in a person with Lyme disease. PCR
testing on a tick that one has been bitten by is strongly recommended as a
positive test will aid one in choosing to begin therapy early.
4. CD57;
Through a mechanism not fully understood Borrelia b. infections in humans may result in a
lowered CD57 (a specific human lymphocyte) count. The CD57 test (done via a method called
flow cytometry) can reliably report the number of these lymphocytes per a given volume of
blood and in ratio to other lymphocytes. Some clinical evidence exists that shows a
relationship to a low CD57 number and chronic Lyme disease. Having a CD57 count of less
than 60 is considered to be abnormal.
Most full service labs can run this test or at
least send the sample out for testing. LabCorp
is a large national lab that runs this test and you should easily be able to get your
local lab to send your sample to them.
These are not the only lab tests used to determine a diagnosis of Lyme disease. Look on the
Igenex web site for a more complete list.
CLINICAL DIAGNOSIS
The last case of Lyme I diagnosed was in a young women who presented with a nondescript rash
on her lower leg of a month duration. She also reported that she had been
unusually emotional lately. After examining her rash I asked her if she had also been
experiencing headaches or any nerve symptoms. She said she was having frequent
headaches which were new and that she had been feeling “weird pains” in her forearms.
My next question was, “Do you remember having a tick bite?” She said yes, five years
ago in France. Her western blot test is both IgM and IgG positive.
I would have looked for other causes of her unusual combination of symptoms while
encouraging her to begin treating a suspected case of Lyme disease had her test come back
negative.
The point is, the diagnosis is as much subjective as anything else and often it is all
one has to go on. If you have multiple, unusual or new, symptoms in 3 or more
seemingly unrelated systems of the body, Lyme disease must be suspected.
Having stated this, the index of suspicion increases if;
2. you were healthy before the new symptoms presented
3. your symptoms began with a flu-like state and fatigue
4. your “new” symptoms include some combination of the following:
headaches with a stiff neck
numbness or tingling in the extremities
heart palpitations with or without shortness of breath
confusion, disorientation or forgetfulness
BOTTOM LINE
I cannot stress enough the importance of pursuing the diagnosis if you
are suspicious of having Lyme disease. This requires having
relationship with a physician that is at least willing to entertain the
possibility of Lyme. Also, if you are suspicious and have not been
helped by trying treatments designed to treat other possibly incorrect
diagnoses,
DON’T WAIT UNTIL YOU ARE WORSE!!
Understand that you do not need to begin aggressive antibiotic
treatments to begin treating. It is important to at least begin by
protecting the systems of your body in which you are experiencing
symptoms, presumably your nervous system and or heart as well as
your immune system. It is also possible to begin a Borrelia
killing regimen without antibiotics (
treatment)
(
supplements).