(Lyme) Borreliose Anhang
[Frans Vermeulen]
Named after W. Burgdorfer, the physician who isolated the spirochete
from a deer tick in 1981.
Flexible, spiral-shaped, Gram-negative spirochete propelled by an
internal arrangement of flagella, bundled together, that runs the length of the
bacteria from tip to tip.
Microaerophilic, i.e. requires oxygen but less than is present in the
air.
Parasitic on many forms of animal life; found on mucous membranes.
Transmitted by tick bites.
The lipid components of Borrelia are unusual in that they include
cholesterol, a substance found in only one other bacterial genus, Mycoplasma.
Also one of the very few bacterial species having linear DNA [typical of
organisms with nucleated cells] instead of circular DNA.
B. burgdorferi is a slow growing [division time is estimated to be 12-24
hours], fastidious organism that requires a complex liquid medium and an optimal
temperature of 33-35° C for growth, due to which it is extremely difficult to
culture in vitro.
Glucose provides its major energy source and lactic acid is the
predominant metabolic end product.
Readily adapts to various hosts and "can enter the tissue that is
optimal for its survival, and it may evade the immune system and antibiotics by
hiding inside certain types of cells. ... It is for certain that its ability to
kill B-lymphocytes evolved as part of a defence mechanism to evade its own
destruction. The observation that it can use the B-cell's own membrane as
camouflage indicates that it may be able to go undetected by our immune system.
The way our immune system is supposed to work is that it recognizes foreign
invaders as being different from self, and attacks the infection. ... The most
intriguing fact about Borrelia spirochetes is their well documented ability to
change the shape of their surface antigens when they are attacked by the human
immune system. When this occurs, it takes several weeks for the immune system
to produce new antibodies. During this time the infection continues to divide
and hide." [Grier]
"Like other spirochetes, such as those that cause syphilis, the
Lyme spirochete can remain in the human body for years in a non-metabolic
state. It is essentially in suspended animation, and since it does not
metabolise in this state, antibiotics are not absorbed or effective. When the
conditions are right, those bacteria that survive can seed back into the blood
stream and initiate a relapse." [Grier]
NOTE: While it was first thought that B. burgdorferi was the only
species causing Lyme disease, it has since been determined that any number of
the different species in the genus Borrelia might be capable of this feat.
The different manifestations of LB do not show an even geographical
distribution. This is partly due to the uneven distribution of the different
genospecies of B. burgdorferi sensu lato, some of which seem to be associated
with particular symptoms. Only one of them, B. burgdorferi sensu stricto, has
been implicated as the cause of disease in North America, mainly causing
arthritis [60%], but in Europe three genospecies, B. afzelii, B. garinii and B.
burgdorferi sensu stricto, are known to be pathogenic. ... B. afzelii seems to be
associated with a degenerative skin condition, acrodermatitis chronica
atrophicans, and B. garinii with neurological symptoms. However, these
associations are not clear-cut and there is considerable overlap. B. garinii
seems to predominate in western Europe and B. afzelii becomes more prevalent in
northern, central and eastern regions, while there is some evidence that B.
burgdorferi s.s. has been introduced from the west.
[European Union Concerted Action
on Lyme Borreliosis, 1997-2003]
Borreliosis or Lyme disease occurs in the north temperate zone. It is
the most commonly reported tick-borne infection in Europe and North America. A
multi-system disorder, borreliosis can affect
a complex range of tissues including the skin, nervous and
musculoskeletal systems, and to a lesser extent the eyes, kidneys, and liver.
[Predilection for the latter three organ systems is more specific for
Leptospira.]
The term Lyme disease was first used following investigation into a
geographical cluster of juvenile rheumatoid arthritis in the town of Old Lyme,
Connecticut, USA, in the mid 1970s. Subsequent studies led to the isolation
from the deer tick, Ixodes scapularis [dammini] of a gram-negative spirochete,
which was named Borrelia burgdorferi. The disease has, however, been known in
Europe under a variety of names [including erythema migrans, acrodermatitis
chronica atrophicans, Bannwarth syndrome*] since the 1880s. In 1909, Afzelius
had associated a red rash [erythema migrans] with the tick, Ixodes ricinus.
In 1948, spirochetes were observed in erythema migrans [EM] biopsies and
in 1951 a Swedish clinician, Hollström, successfully treated EM infected
patients with penicillin. Also in 1951, it was suggested that EM, with
associated meningitis, was probably the result of an infection by a tick- or
other insect-borne bacterium. ... However, EM was considered a relatively
harmless condition with no connection made between the lesion and subsequent
symptoms caused by the same bacterium.
[European Union Concerted Action on Lyme Borreliosis, 1997-2003]
The clinical presentation of borreliosis can be divided according to its
progress. Borreliosis runs its course in three stages. The early stage presents
in up to 70% of cases with erythema migrans, an expanding red maculopapular rash
that can reach a large size in diameter and typically clears from the central
area ["bulls-eye rash"]. The rash can be circular, triangular, and
cover large portions of the body. Vague or pronounced flu-like symptoms and
sometimes glandular swelling accompany the rash.
During the second or disseminated stage, which may last for over a year,
the spirochete spreads gradually to other tissues via the bloodstream and
lymphatics. Manifestations of this stage may include erythematous patches
[usually smaller than the initial lesion], fatigue, headache, muscle and joint
pains, facial palsy or other cranial nerve lesions, and, rarely, carditis.
Progression to the third stage, late borreliosis, involves Lyme arthritis,
commonly restricted to the large joints, acrodermatis chronica atrophicans, and
neuroborreliosis.
Erythema migrans, the characteristic rash which may appear some days to
weeks following infection, is the most common manifestation, next comes
arthritis, then neuroborreliosis, while carditis is rare. Some studies report
higher disease incidence rates for males, although a recent Swedish study on
recurrence of erythema migrans showed the majority of cases to occur in
middle-aged women. In addition, acrodermatitis chronica atrophicans [indurated,
erythematous plaques, bluish-red, commencing on feet, hands, elbows, or knees,
and gradually progressing to epidermal atrophy with thin, shiny, papery
appearance of the involved sites] reportedly occurs mainly in elderly women,
whereas bilateral facial palsy is a frequent manifestation in children. The
number of cases of Lyme disease reported in the US
is about 17,000 per year, but the actual incidence is estimated to be
some 10x higher. According to a WHO report, the number of European cases
approaches 60,000 annually.
* Bannwarth syndrome or Garin-Bujadoux syndrome ["paralysie par les
tiques," tick-induced paralysis] is characterised by intense pain, mostly
in the lumbar and cervical regions, and radiating to the extremities,
accompanied by migrating sensory and motor disorders of the peripheral nerves,
including such symptoms as facial paralysis, abducens palsy, paraesthesias,
anorexia, fatigue, headache, diplopia, and erythema migrans.
THE IMITATOR'S NEW CLOTHES
Syphilis was known as the "great imitator" because its
multiple manifestations mimicked other known diseases. Lyme borreliosis,
likewise, has now entered the stage as "the new great imitator."
[P.H. Duray] "Initially thought to be a disorder beginning in the
skin and progressing to involve the joints, Lyme disease is now ranked as one
of the great mimickers of other diseases, in
a manner similar to that once ascribed to syphilis." Sir William
Osler remarked that "to know syphilis is to know all of medicine."
Homoeopathy knows the major syphilitic remedy, Mercurius, as the
"great masquerader." Judging by the close family connection between
both spirochetes, it does not come as a surprise that one of
very first cases of borreliosis, in 1922 in France, had a weakly
positive syphilis test and thus was treated with arsenicals, the then current
treatment for syphilis.
There are great differences in how borreliosis manifests in Europe
versus in the US. The major presentation of early neuroborreliosis in the USA
is facial palsy, whereas it is encephalomyelitis in Europe.
In Europe, the erythema migrans lesion is quite indolent and sometimes
hardly noticeable, while US patients have intense inflammatory cutaneous
reactions with early dissemination. Acrodermatitis chronica atrophicans is only
seen in Europe. Conversely, arthritis is uncommon in Europe, but extremely
common in the USA in untreated patients. Neuroborreliosis overall seems to
prevail in Europe.
These differences are attributed to the distribution of the various
Borrelia species.
There are a wide range of symptoms associated with Lyme borreliosis.
Symptoms vary greatly, one or more systems may be involved, and new
manifestations continue to be described. Like syphilis,
Lyme borreliosis may remain latent and asymptomatic for a long period of
time; progress for many years through successive stages; or fluctuate
dramatically and unpredictably.
Many Lyme patients were first diagnosed with other illnesses such as
arthritis, juvenile arthritis, rheumatoid arthritis, fibromyalgia, chronic
fatigue syndrome, multiple sclerosis, lupus, early ALS [amyotrophic lateral
sclerosis], early Alzheimer's disease, Crohn's disease, irritable bowel
syndrome and various other more nondescript illnesses.
So bewildering is the range of symptoms that a borreliosis patient
conceded that "while one misguided doctor writes in his book on Lyme that
the more widespread and peculiar the symptoms are, the
more likely the complaint is psychosomatic, I'd have to say that the
more widespread and peculiar the symptoms are, the more likely that the problem
is Lyme disease."
Diagnosis is controversial; some believe the disorder to be
"over-diagnosed," others think it is "under-diagnosed" and
again others speak of frequent "misdiagnosis." The virulence of the
spirochete is
equally poorly understood. Involvement of immunological host factors
have been proposed, whereas the remission of even psychiatric disorders after
antimicrobial treatment is deemed proof that it concerns merely a bacterial
infection.
Tracking the culprit, the new elusive spirochete, is riddled with
problems, considering that there are asymptomatic seropositive patients,
seronegative patients with intractable symptoms, patients with persisting
symptoms despite the standard two-to-four-week IV antibiotic treatment regimen,
seropositivity despite antibiotics, and so on. Patients may have one or all of
the stages, or the illness may not become symptomatic until stage 2 or 3. What
initially was held for "Lyme Hysteria" turns out to be linked with long-term,
chronic problems. Yet, there is, as one author put it, "chronic persistent
denial of chronic persistent infection in Lyme Disease."
TICK-STRICKEN
Borrelia is transmitted by ticks belonging to the genus Ixodes. The
two-year life cycle of the tick consists of four stages: egg, larva, nymph, and
adult. Between each stage the tick needs a blood meal in order to mature. It
usually becomes the host for the Borrelia spirochetes during its larval stage,
when it feeds on small animals such as rodents or birds. After its blood meal
the tick drops off the host to transform over a period of months into the next
instar. Because off-host ticks are vulnerable to desiccation, an environment
with high humidity is required to maintain a stable water balance. Temperate
deciduous woodland with patches of dense vegetation and little air movement
coupled with high humidity constitute ideal conditions. Here Ixodes will be
encountered, usually in the spring, the season that warrants sufficient
humidity. Animals or humans brushing through the vegetation may pick up ticks,
then commonly in their nymphal stage, involuntarily assisting in the completion
of their life-cycle. While gorging, ticks increase salivation and with the
saliva the spirochetes come along, which resided in the tick's digestive tract.
Ticks are slow feeders, so that spirochetal transmission usually happens after
the tick has been feeding for 24 hours.
Prompt removal of the attached tick is therefore believed to prevent infection.
Given time, the tick needs to strike only once. That such a relatively
short, though unwelcome visit has such devastating long-term effects seems
incredible. Although a history of exposure to a tick-endemic area is essential
to support the diagnosis of Lyme borreliosis, about one-third of patients do
not recall a rash or tick bite "because the nymphal stage of the tick is
so tiny and many rashes in body hair and indiscrete areas go undetected."
The dazzling array of borreliosis symptoms has prompted disbelief.
Explanations are offered that the tick with the transmission of spirochetes
inoculates other parasites as well, such as Ehrlichia canis [ehrlichiosis],
Coxiella [Rickettsia] burnetii [Q fever], other rickettsias, Staphylococcus
aureus, and Babesia species [babesiosis].
Rather than using the broad spectrum of symptoms as the main guideline,
a medical system that so strictly bases its treatment on diagnosis and
identification of causative agents is likely to fail.
Psychiatrist Robert Bransfield writes: "There has been a recent
trend to incorrectly view so called ‘objective' signs and symptoms as more
valid than those which are ‘subjective.' Often a machine or lab
test is perceived as giving validity to these ‘objective' signs. Many of
these ‘objective' tests are far less valid and are based on questionable
techniques, faulty assumptions, and flawed logic. On the other hand,
‘subjective' complaints are sometimes viewed with excessive suspicion. ... In
an effort to create predictability, reliance upon cookbook medicine has given
us a recipe for disaster."
And Thomas Grier: "Too often, I have seen the word cured used in
Lyme Disease Studies, only to find that the researchers have redefined the word
cure to mean seronegative. Seronegativity is not synonymous with cure. The
numerous culture positive cases in recent years should have negated that kind
of logic years ago, and yet, in 1997, researchers are still publishing studies
that use antibodies
and PCR as the end point for cure. It's time to ask the patients one
simple question: How are you feeling?"
SYPHILITIC MIASM
We cannot fail to see the close resemblance between Lyme borreliosis and
the syphilitic miasm with Syphilinum as its prototype. The correlations even go
beyond the symptomatology, encompassing such elements as controversy, denial,
stigmatisation, blame, and banishment. Hardly any other subject creates so much
alienation as the syphilitic miasm in all its disguises.
With the exception of a few symptoms, borreliosis appears to be a
spitting image of the syphilitic miasm in general and Syphilinum in particular,
as is evidenced by Boericke's and Clarke's summary of the latter:
Utter prostration and debility in the morning.
Fears the night, and the suffering from
exhaustion on awakening.
Shifting rheumatic pains.
Chronic eruptions and rheumatism.
Alcohol.
Loss of memory [names, dates, etc.]; remembers
everything previous to his illness [i.e. short-term memory deficit].
Hopeless; despair of recovery, does not think
will ever get better.
Cross, irritable, peevish.
Violent on being opposed.
Feels as if going insane or being paralysed.
The theme of insanity pervades the borreliosis picture. Pains are
described as maddening; patients are labelled as crazy by medical
practitioners; patients go out of their minds from falling on deaf ears. Descriptions
of the mental state induced by Borrelia depict the despair and darkness, the
taking away by force of hopes and dreams:
"In this darkness that surrounded me, there was no room left to
turn or to run. Only to survive. Days passed like an insect caught in tree sap.
Enveloping. A strangely warm, amber struggle in slow motion - a quiet
resignation to a world that was filled with nightmare images. Trapped in a mind
that knew it had gone insane."
"I thought I was slowly going crazy, never knowing what the next
day would bring."
"Some days I haven't a clue what I did two days ago or even that
morning. This continues to drive me crazy."
"After years of being told that I was crazy and then suddenly that
I had some type of auto-immune connective tissue disease ..."
"I was trying to make sense of it myself, I was grasping at straws
for an explanation of what was happening to me. ... I felt as if the self I
knew was dissolving."
"Sometimes one can't hope for better. One can only hope for
different. Death is definitely different."
"When I looked in the mirror I saw someone I didn't
recognise."
"In essence, I was dropping out of life."
[Citations extracted from the Personal Stories collected on the website
Lymealliance.org]
MATERIA MEDICA BORRELIA
Sources
Non-existent in homoeopathy to date, the extensive literature on Lyme
borreliosis provides a fine opportunity for the creation of a provisional
symptom picture.
The numbers behind the symptoms refer to the sources below from which
the symptoms were collated.
Mind:
General picture
"In one U.S. study of 27 patients with late neuroborreliosis, 33%
were depressed based on their scores on the Minnesota Multiphasic Personality
Inventory. 89% of these 27 patients also had evidence
of a mild encephalopathy, characterised by memory loss [81%], excessive
daytime sleepiness [30%], extreme irritability [26%], and word finding
difficulties [19%]. Controlled studies indicate significantly more depression
among patients with late Lyme borreliosis than among normal controls and other
chronically ill patients."
"A diagnostic tip in favour of Lyme disease as the cause of the
depression and irritability might be concomitant memory loss, word finding
problems, or a concomitant polyneuropathy."
Hypersensitivity.
Light
Photophobia [keynote]; must wear sunglasses or glacier glasses, even
indoors, even at night.
Feeling of faintness or dizziness form exposure to fluorescent lights,
making it difficult to go to supermarkets or other public places.
Panic attacks
triggered by light stimulation, esp. flickering bright lights.
Nausea from flickering
bright lights [fluorescent lights, TV or computer screens, strobe lights during
EEG testing or the headlights of cars moving in the opposite line of traffic].
Sound.
Ordinary conversation
perceived as deafening; wears head phones and puts pillows over his head to
block out the sound.
"To one woman
even the sound of another person's breathing seemed unbearably loud. In her
case, the sound sensitivity also included vertigo, nausea and nystagmus in
response to sounds. Any sudden sound, like the phone ringing, and certain
household sounds, like the running of tap water, could cause her to fall or
retch. This peculiar short-circuiting of the inner ear's auditory and
vestibular functions is known as the Tullio phenomenon. This phenomenon has
been deemed pathognomonic for syphilis but, as it appears, can occur in Lyme
disease as well, and thus provides one more example of the ‘new great imitator,'
Lyme disease, imitating the old ‘great imitator,' syphilis."
Smells.
Smells seem overly intense and noxious.
Taste.
Foods taste abnormally sour or bitter.
Or the reverse: loss of taste on left side of tongue.
Touch
Regional or generalised
hyperaesthesia of skin to touch or temperature.
Sensitivity to touch;
"the bed sheet resting lightly on my toe would make the toe ache, like a
toothache."
"Even the
thinness of a sheet was too painful for my legs."
Vibrations.
Abnormally heightened
vibration sense, eg, thinks car were vibrating with unusual violence.
Emotional lability / mood changes / irritability.
Accompanied by
headache and neck stiffness.
Sudden, intense
irritability from sensory stimulation [sound, touch, light] or occurring
unprovoked and inexplicably.
Sudden, unprecedented
fits of violence.
Uncontrollable
outbursts. "A woman, typically reserved and eager to please, became
uncontrollably irritable one day at work and found herself yelling at her boss
in a most uncharacteristic fashion."
Sudden bursting into
tears from trifles.
Fluctuations from
marked agitation to severe depression with suicidal threats.
Rapid
mood swings [from grandiosity to sudden tearfulness].
Violence; striking children and breaking furniture.
Homicidal ideation, urges, and behaviour occur in some of these
patients. Some adult patients describe struggling to not act on these urges.
When these patients act on a homicidal urge, more commonly it is a child
becoming assaultive to a sibling. Dissociative episodes sometimes occur with
these patients, occasionally accompanied by aggressive behaviour and loss of
memory.
Cognitive impairment - Lyme Fog
Short-term memory problems, word-finding difficulties, dyslexia,
problems with calculations or inability to concentrate.
Many Lyme patients state "I feel like I have become dyslexic."
Impairment of reading comprehension is an earlier sign with the later addition
of auditory comprehension difficulties. Acquired left/right confusion is seen
with some of these patients displaying what appears to be an acquired
Gerstmann's syndrome or some variant of this syndrome.* They have problems with
calculations and often complain of errors when trying to calculate their check
books. Fluency of speech is a very significant problem. When interviewing these
patients, this is a clearly evident symptom. Stuttering is seen in many of
these patients.
[Boy aet.] "I would mix up stories and get cranky. I tried to tell
Mom that my brain was ‘sticky', but she didn't know what I meant. It didn't
hurt, it just wouldn't work. I would climb up on the sink and put a wet
washcloth on my head. On those days, my behaviour was hyperactive and I would
stutter."
"The kicker, though, was the virtually unexplainable difficulty in
writing, typing, speaking, and thinking. I'd use the wrong letters, hit the
wrong keys, stutter, reverse things, and find myself unable to say the right
word. Everyone does this occasionally, but this was consistent and unrelenting.
I felt like something poisonous had taken over my brain."
On interview, patients with Lyme encephalopathy tend to be vague and
disorganized in the presentation of the history of their illness. This is
despite their close attention to their symptoms and having recounted them many
times before. Although in most cases memory of discreet events - tests, dates,
diagnoses, responses to medications -- is intact, the patient is unable to
recall them spontaneously or organize them in temporal order. They may be
unclear as to their chief complaint. They may completely lose track of what
they were saying, sometimes repeatedly, or of what the question was. They may
get off on a tangent and have trouble re-orienting themselves. Frequent
prompting and refocusing will be necessary. beginning the interview with an
open-ended question like "Tell me what the problem is" will allow
these qualities to become clear.
However their experience is different from that of ADD, in that rather
than having the experience that there are many thoughts competing for attention,
the Lyme patient has difficulty bringing any thought into clear focus. They
experience difficulty thinking. One patient described it as the universe ending
six inches from his face. He can't process information that is not immediately
apparent, immediately experienced. Another said that when he tries to think
about something, or figure something out, all he can do is repeat the question
- he can't get to the meaning. One patient, a physician, described it as a
"mental intention tremor" -- the more she tries to focus on something
the more out of focus it becomes.
Brain fog. Problems with facial recognition.
Spaced out, as if in a fog.
Difficulty
remembering details such as names or appointment times. Engaged in new
compensatory behaviour, such as daily list-making.
Compensatory compulsions are common in an effort to compensate for the
memory deficits.
These [Lyme disease] patients generally come to the office disorganised
[despite a supreme effort to be organized], unable to give a coherent history.
They will bring copious notes, which are invariably in the wrong order.
I used to have a quick mind and a good memory, now I was dependent on
notes plastered everywhere so I could remember things.
Mistakes in speaking and/or writing
"Patients with no prior history of dyslexia have found themselves
writing letters backwards, reversing numbers or routinely reversing the first
and second letters of a word."
Mistakes in time: says "tomorrow" instead of
"yesterday" and vice versa.
Spatial disorientation - sense of position ["spatial
dyslexia"]
Loses his way in well known streets.
Difficulty with spatial awareness of where front and back doors are in
one's own house.
Disturbed sense of position. "Repeatedly bumps into things on the
left side of her body, drops things from her left hand despite having no
weakness in that hand and
occasionally places objects several inches short of a table edge with
the result that they fall to the floor."
Disturbed sense of position, esp. in hands; grasps the air when reaching
for objects.
"Everything around me looked strange. The people sounded like
cackling geese. Everyone looked like they were in fast motion, like someone had
sped up the projector.
Every time I turned, I was dizzy and disoriented. I was sweating, and
completely lost."
"I was getting lost driving to places that I had been to hundreds
of times."
"I was getting lost in my own neighbourhood when I tried to
drive."
"I forgot where I was on my way home."
"Difficulty ‘recognizing' things when driving - familiar landmarks
lost their meaning; I stopped at green lights, made wrong turns or drove past
my destination, even
in
territory close to home."
Hallucinations
Musical hallucinations with a sudden onset and taking the form of
patriotic or operatic music.
"I was hallucinating both visually and auditory. I heard phones
ring when there were none. I saw shadows twist into menacing shapes. I heard
voices talking. At night, I saw
flashing lights fill my vision, and my ears were constantly buzzing with
static and ringing. I felt for the first time that I might be truly going
mad."
[Upon awakening in the night] "A skeleton hallucination in black
and white, looking at me, grinning a very toothy smile, head cocked, propped up
by one arm."
Intrusive thoughts/images
Intrusive obsessional thoughts with checking; horrific images of killing
others; excessive bathing.
Intrusive images which are more commonly of an aggressive nature but
sometimes can be of a sexual or other nature. Occasionally these images are of
a homicidal nature.
"My mind was a hopeless jumble of uncontrolled thoughts - images
and sounds that haunted me. It was as if several minds had been merged into
one, and there was no
way to sort the images."
Fears
Chronic morbid dread of vomiting [without actual emesis].
Panic attacks in sleep.
"I woke up several times in pain and experiencing panic
attacks."
* Gerstmann's syndrome: inability to perceive a stimulus applied to the
fingers, impairment of the ability to write, inability to do simple
mathematical problems, and confusion of laterality of body.
CHILDREN
The majority, over ninety percent, of the children that we have treated
complain of headache. The headache, in a few cases, has been very acute
accompanied by papilloedema [oedema of optic disk] but in the majority of cases
the headache comes on gradually, becomes quite persistent and does not respond
to over-the-counter analgesics. In addition to the headache, the children
complain of photophobia, dizziness, a stiff neck, backache, somnolence and,
those that are in school, have problems with memory and difficulty
concentrating. Some patients have developed progressive weakness. The parents
complain that pre-schoolers develop mood swings and become very irritable and
they see a personality change. Among the children that are school age and those
who are in adolescence, chest pain is a very frequent complaint. At least
seventy percent have complained of chest pain. About fifty percent have
complained of abdominal pain. More than half the children have arthralgia
usually involving the knee and sometimes the wrist. Other complaints include
palpitations, tingling, numbness, rashes that come and go, usually malar
[cheek] rashes, and sore throats that are excruciatingly painful.
It is easy to see how this long list can be very non-specific and many
of these children are thought to have functional problems.
GENERALS
Typical combination of features
Joint pain + major
cognitive dysfunction [esp. short-range memory] + major sleep disturbances +
terrible fatigue + sensory hyperacuity.
Alternating states
Perplexing fluctuation in
symptoms. Spry and energetic one day, drained and confused the next day. May be
brought on by exertion, stress, or exposure to sensory stimuli, or come without
apparent
cause. Cannot make plans
due to the unpredictable nature of the fluctuations.
Days of near normality
alternate with days of profound debility.
The symptoms shift in
kaleidoscope fashion from one hour to the next in the same patient and seldom
present identically in two different individuals.
"Days of hope and
black despair coupled together."
"I thought I was
slowly going crazy, never knowing what the next day would bring."
Suddenness
These patients can become
suddenly suicidal.
Sudden worsening of
symptoms.
Sudden inability to
remember how to transfer calls [in a woman who had been a telephone switchboard
operator for 20 years].
Worse by any sudden
sound.
Sudden intense
irritability.
Sudden soreness of sinuses
and throat, then disappearing, then sore again in a seemingly rhythmic way.
Sudden, complete inability
to swallow.
Awakened in the middle of
the night by severe arthritic pains over entire body. Pain sudden, dramatic,
and excruciating. Pain gone when waking the next morning.
Sudden changes in stool
consistency from normal to putty-like, to constipation [stools have to be
removed mechanically], etc.
Sudden arrhythmia.
Sudden falling to
the ground.
Sudden paralysis. "As I stood in front of the bathroom sink
brushing my teeth, I suddenly lost the use of my right arm and hand.
A
quivery, ticklish feeling travelled like lightning from the shoulder to the
fingertips; paralysed, the arm dropped down into the sink,
hit
the enamel hard and broke the skin."
Neurological
Left-sided hemiparesis when
waking up.
"The left side of my
face was paralysed with the numbness extending to the left side of my tongue
and down my throat. Also, my left side felt weaker and my left lung felt
somehow affected –
cold and heavy."
Intermittent paraesthesias.
Nerve pains severe,
burning, tearing, migrating, with characteristic exacerbations at night.
Clumsiness; "ataxia is
common in these patients who are often clumsy, which leads to frequent
accidents."
The close resemblance
between neuroborreliosis and certain neurological conditions has been explained
thus: "When the human brain becomes inflamed, cells called macrophages
respond by releasing
a neurotoxin called
quinolinic acid. This toxin is also elevated in Parkinson's Disease, MS, ALS,
and is responsible for the dementia that occurs in AIDS patients. What
quinolinic acid does is
stimulate neurons to
repeatedly depolarise. This eventually causes the neurons to demyelinate and
die. People with elevated quinolinic acid have short-term memory
problems."
Energy
"Too fatigued and sore
to even think about moving around."
"The best description
I can think of for the misery of acute Lyme disease is a combination of
debilitating mononucleosis and severe arthritis in the knees and elbows."
Debilitating fatigue &
periodic attacks of left-sided paralysis.
Sleep - Night aggravation
Excessive daytime sleepiness.
Falling asleep while talking with others.
Falling asleep at work.
Narcolepsy. "At first, I would fall asleep spontaneously and
unpredictably a few times a week, but over the next three months it climbed to
four hundred times a day. I would fall when this happened."
Can not sleep at night, can not wake up during the day.
Apnoea - a sudden ‘gasping' for air just before falling asleep.
Sleeping disorder. "He
[13-y. old boy] would thrash around at night disrupting his bedding, knocking
over lamps and rearranging things during the night. I never actually saw any of
these episodes but saw the result of them in the morning."
"When I did sleep, it was a tortured sleep where I would toss and
turn and tear at my covers. I despised warmth and craved cold. My bed in the
morning would look like a war zone."
"In the beginning, I was horrified to awaken knowing that I was
still alive and had not died in my sleep. What a great cop-out, I would think,
except the nightmares were actually worse than reality."
"Woke up angry in the night that I hadn't just died."
"I experienced night terrors, where friends that had died in the
last twenty years gathered around my bed nightly, smiling and waving for me to
come with them. ... I hated to go to sleep at night because of my dead friends
appearing."
Early morning insomnia with nightmares.
Sleeplessness due to pain in kidneys.
Sleeplessness from stabbing pain in feet.
Pains
Burning [pain] is quite specific [to neuroborreliosis]; the patient
describes a sensation that a blowtorch is burning the skin.
Feeling as if muscles and nervous system were on fire.
"The burning pain in my spine was so bad that I broke out in sweats
day and night."
Sharp shooting or stabbing pains.
Food & Drink
Anorexia.
"Eating disorders are common. Invariably these patients either gain
or lose weight. Sometimes massive weight gain is also seen."
Increased thirst.
Intolerance for alcohol. "Most patients state, ‘I don't drink any
more'."
Exaggerated symptoms or worse hangover from alcohol.
Temperature
Great chilliness.
Low body temperature [slightly below normal].
Profuse sweating.
Unexplained sweats. Night sweats. Sweating even in cool temperatures.
Weather
Symptoms worse in low pressure weather systems.
Miscellaneous
Lymphocytoma [small solitary bluish-red plaque or nodule], particularly
at ear lobes or nipples.
Delayed development, failure to thrive in infants.
LOCALS
Vertigo: Sensation of whirling motion of oneself or of
external objects.
Méničre's disease.
Vertigo with drop attacks of the Tumarkin type.*
Motion sickness.
Balance severely off; would fall when closing eyes.
Vertigo from even slightly turning head; "the world would swim if I
just moved my eyeballs."
Floor feels as it were rolling beneath the feet, or as if one were on an
elevator or a boat, going up and down in waves.
Head: Headache frontal or occipital; intermittent
[duration] and fluctuating [intensity].
Feeling of pressure behind eyes, pain < moving eyes.
Sore/tender areas on skull/scalp area.
Pressure migrating from vertex to occiput when turning head.
"When I would move my head, there was a disturbing gurgle as I
heard bubbles move around inside my head."
Eyes & Vision:
Conjunctivitis.
Intermittent diplopia and visual blurring.
Diplopia & vertigo and nystagmus.
Triplopia in right eye.
Sparks, spots, waves, floaters before eyes.
Sensation of a foreign body in eye[s] [keratitis].
Twitching.
Bloodshot eyes.
Vision reduced to a circle directly in front of eyes; peripheral vision
just a blurry swirling mess of lights and images.
"Seeing ‘trails' of objects, i.e. my own moving limbs or doorways I
walked through."
Hearing: Impaired hearing [bilateral] & fatigue,
headache, or arthritis.
Hearing loss & tinnitus.
Face: Bilateral facial nerve palsy.
Muscle twitches in face.
Pain in face, teeth, articulation of jaw, and masticatory muscle.
Swelling around eyes.
Facial redness.
"My chin hurt, and felt ‘ticklish' - as if something were blowing
on it."
Audible clicking of jaw when speaking or eating.
"Around my mouth, all around the lips and down into the chin, a
vibrating, biting, humming itch, as though there were a thousand bees swarming
over my lips and the majority of them were stinging."
Mouth: Numbness/tingling of face or tongue.
Weakness tongue.
Sore spots on tongue.
Speech; slow and laboured; slurred; poorly articulated.
Throat: Must drink in order to swallow food.
Urogenital: Irritable bladder; trouble starting/stopping;
frequent urination; voiding dysfunction.
Urinary retention followed by paralysis of lower limbs.
Numbness genitals.
Chest: Short stabbing pains in chest lasting only
seconds.
Dry, non-productive cough.
Awakening in middle of night with chest pains and pain and tingling down
my left arm.
“As of hot water were being poured into lungs”.
Back: Stiffness of nape of neck & headache,
pain in joints and/or muscles, or fatigue.
Weakness nape of neck.
Tired feeling between shoulder blades, “As if neck wouldn't support
weight of head”.
Jabbing pain in the back “As if being kicked in the kidneys”.
Limbs: Wandering joint/muscle pains [without
swelling]; lasting only hours or days in a given location.
Pain in joints only on motion.
Joints sensitive to pressure.
Localised joint pains/swelling involving mostly the knee[s], and to a
far lesser extent the ankles, shoulders, and elbows.
"I kept looking down at my upper arms to brush off the hair or
cobwebs on them, and realised there was nothing there."
“As if a band pulled tightly around [right] lower arm halfway between
wrist and elbow”.
Tendon problems - hands/fingers temporarily lock into unusual positions.
Carpal tunnel syndrome; & numbness of fingers < during sleep or
using hands.
Intention tremor hands.
Fingers on both hands fumble and cannot pick up small objects.
White spots on fingernails; ridges; brittle nails.
Deep, aching, burning pains in the hamstring muscles when sitting; sits
on the very edge of a seat; cannot bear touch or slightest pressure on
hamstrings.
Leg joints give out or wobbly, rubbery legs. Unable to walk.
“As if a tourniquet wrapped around right leg”.
Restless legs at night in bed, resulting in sleeplessness.
Throbbing pain in ankles and in long bones in calves and shins; "not
an ache, but a feeling that someone had scraped the skin away, thrown salt into
the raw tissue, then set it on fire."
Severe pain in balls of feet; painful to put any weight on feet.
Skin: Warm, wet or cold sensations on skin.
Regional or generalised hyperaesthesia of skin to touch or temperature.
Excessively itchy skin. Urticaria.
* During Tumarkin's episodes or Tumarkin's otholothic crisis patients
suddenly fall to the ground without prior warning and without losing
consciousness. Thought to be caused by a sudden change of the otolithic organs,
the condition is not uncommon in the later stages of Méničre's disease.
[Will Taylor]
An Anamnesis of Lyme Disease
Applying the process of determining the Genus Epidemicus to a Subacute
Miasm
early in the development of homeopathy, Hahnemann discovered the value
of taking the case of a population afflicted by an epidemic acute illness, as
if of one person - searching for a remedy nearly
specific to each particular occurrence of an epidemie. This process of
finding a genus epidemicus has proven invaluable in treating numerous epidemic
diseases over the 200+ year
history of homeopathic practice.
Nearly 30 years into Homeopathy's development, Hahnemann turned this
process of working with a population as if of one person to the issue of
chronic disease. By attending to a group anamnesis of his chronically-ill cases
not afflicted with the more obvious chronic diseases of Sycosis or Syphilis, he
was able to elucidate the nature of Psora, and declare a number of remedies as
potentially antipsoric by their similitude to this group anamnesis.
Chronic vs. Acute Miasms
The distinction between acute miasms (scarlet fever, smallpox,
influenza, whooping cough) and chronic miasms (syphilis, sycosis, psora,
tuberculosis) is in some respects rather straightforward.
True acute diseases, the acute miasms among them, either resolve
spontaneously on a scale of days to weeks, or result in the death of the host.
Chronic diseases engraft themselves into the economy
of the organism and engage the dynamis in their self-perpetuation;
although they may slip into temporary latency, they cannot be eradicated merely
by diet, optimization of lifestyle, or the best intentions of the vital force
of the organism.
Yet between these extremes of acute and chronic, lie a number of
disease-conditions that we might best describe as sub-acute or half-acute;
sharing something of the pace of chronic diseases, along with, at least in
part, the tendency of the chronic diseases to engage the organism in their own
self-perpetuation.
Half-Acute Miasms
In The Chronic Diseases, Hahnemann speaks of rabies as an example of a
half-acute miasm. I suspect that we can reasonably add malaria and perhaps
typhoid to this list. Reflecting on the nature of Lyme disease, I believe it
most reasonably belongs in this category - as an obstinate and excessively
tedious acute disease that, although not technically chronic in the manner of
psora, sycosis,
syphilis and tuberculosis, may play out over a lengthy period of time and
express in highly varied and changeable ways.
Lyme disease results from infection by the spirochete Borrelia
burgdorferi, although many clinical cases appear to involve multiple tic-born
pathogens in addition. The Borrelia pathogen is born by
tick vectors including Ixodes scapularis (the deer tick), Amblyomma
americanum (the Lone Star tick) and Ixodes pacificus. Over 17.000 cases of Lyme
disease were reported to the CDC in 2000. Considering a typical underreporting
bias, this suggests perhaps 170,000 new cases of Lyme disease annually in the
U.S.
The initial infection with Borrelia burgdorferi is characterized by a
local skin eruption that grows circumferentially with central clearing,
suggestively termed a target rash. Borrelia can be isolated
from this eruption, but is apparently disseminated systemically from the
moment of initial infection.
Secondary disease expression is highly individually variable, and Lyme
disease is known as a great imposter for its ability to mimic many disease
conditions. The most common presentations involve inflammation of the large
joints and peripheral nerves. Neurologic and Cardiac complications may follow.
The Group Amanesis
If we collect the common symptoms of Lyme disease from reports in the conventional
medical literature, we can begin to construct a group anamnesis of the disease,
in order to identify the most likely remedies for the disease genus.
The classical target-rash of Lyme disease is not described in our
homeopathic literature. The closest description we can find is:
SKIN - ERYSIPELAS
- which can reasonably be expected to include remedies capable of
covering the erysipelas-like Lyme target rash.
A common early post-rash symptom of Lyme disease is sore throat:
THROAT - PAIN - sore
The arthralgias of Lyme most commonly begin with rheumatic pain in the
neck, with associated headache:
BACK - PAIN - Cervical region
BACK - PAIN - Cervical region
- rheumatic
HEAD - PAIN - rheumatic
Lyme classically presents with a combination of inflammatory arthralgic
pains and inflammatory neuralgic complaints:
GENERALS - INFLAMMATION -
Joints; of
EXTREMITIES - PAIN - rheumatic
GENERALS - INFLAMMATION -
Nerves; of
GENERALS - PAIN - neuralgic
The Arthralgias focus in the shoulders, hips and knees, and may be of
acute +/o. chronic nature:
EXTREMITIES - INFLAMMATION -
Joints
EXTREMITIES - PAIN - Joints -
rheumatic
EXTREMITIES - PAIN - Shoulder
- rheumatic
EXTREMITIES - PAIN - Hip -
rheumatic
EXTREMITIES - PAIN - Knee -
rheumatic
EXTREMITIES - PAIN - rheumatic
- acute
EXTREMITIES - PAIN - rheumatic
- chronic
The Neuralgias most typically facial or sciatic:
FACE - PAIN - neuralgic
EXTREMITIES - PAIN - Lower
limbs - sciatica
There is a characterizing uniqueness in the concomitance of heart
symptoms with the arthralgias and neuralgias, with the potential for
inflammatory rheumatic myocarditis +/o. pericarditis:
EXTREMITIES - PAIN - Joints -
alternating with - Heart symptoms
CHEST - HEART; complaints of
the - rheumatism, after
CHEST - PAIN - Heart -
rheumatic
CHEST - INFLAMMATION - Heart
CHEST - INFLAMMATION - Heart -
Endocardium
CHEST - INFLAMMATION - Heart -
Pericardium
An important aspect of the "pace" of Lyme disease, is the
migratory nature of its arthralgias/neuralgias, and the rapid change and
alternation of symptoms:
GENERALS - PAIN - wandering
GENERALS - CHANGE - symptoms;
change of - rapid
We can take these common symptoms of Lyme disease, obtained from the
population affected and treated as if of one person; and repertorize this list,
to find:
Lyme Disease reportorization
Kalmia and Ledum lead the analysis and are closely botanically related,
both belonging to the botanical family Ericaceae.
Small Remedies
A small-remedies weighting brings up several
remedies poorly represented in our literature. Notably, Rhododendron
chrysanthum -another Ericaceaid- moves up to 4th position.
Lyme disease - small remedies
Analysis using the Vithoulkas Expert System in RADAR results in:
Lyme disease - Vithoulkas
The algorithms used in the Vithoulkas Expert System bring out Ledum as
the remedy bearing closest similitude to this group anamnesis. Kalmia and Rhododendron
make good showings in this analysis as well.
Leading the list of "very small remedies" Gaultheria
procumbens (wintergreen, teaberry) - a 4th member of the Ericacea
family.
The Botanical Family Ericaceae and Lyme Disease
We could restrict the repertorization of our anamnesis to the botanical
family Ericaceae:
Ericaceae analysis - RADAR
Anamnesis
to the botanical family Ericaceae:
The similitude to Lyme disease of the Ericaceae as a family suggests an
interesting comparative study of these remedies as a group. I'd like to begin
below with some fragments of a comparative study of this group in the context
of their similitude to Lyme disease, with the understanding that this is a
process that could be continued to considerably greater detail.
The Ericaceaids are represented in our Materia Medica by 13 remedies:
The
Ericaceaids are represented in our Materia Medica by 13 remedies:
Only 3 of these -Ledum, Rhododendron, and Kalmia- are reasonably
represented in our literature. Gaultheria procumbens has been only poorly
characterized, principally from its empiric use in the Eclectic and botanical medical
traditions, with a fragmentary proving in crude/toxic dose.
As a family of related remedies, these four Ericaceaids cover the common
or genus symptoms of Lyme disease well. This is not to suggest that other
remedies may not be useful in treating individual cases of Lyme disease - but
the analysis above suggests that this group of remedies describes a central
core of symptomatology essential to appreciating the common process of this
disease.
Rheumatic symptoms are central to all four. From Franz Vermeulen's
Concordant Materia Medica, the opening lines in the description of these
remedies read:
Ledum - "Affects esp. the
rheumatic diathesis, going through all the changes, from functional pain to
altered secretions and deposits of solid, earthy matter in the tissues …"
Rhododendron - "Rheumatic
and gouty symptoms well marked …"
Kalmia - "A rheumatic
remedy …"
Gaultheria -
"Inflammatory rheumatism, pleurodynia, sciatica, and other neuralgias,
come within the sphere of this remedy …"
.
Neuralgic
pains also are common to these Ericaceaid remedies. Using the Extended Search
capability of RADAR,
…below
is a search for the neuralgic (and specifically sciatic) pains of this group of
remedies:
Some
commonalities and distinctions are brought out in this analysis. All four of
these remedies may address sciatic neuralgias, but Ledum dominates in
this lower extremity locality,
while
Rhododendron, and especially Kalmia, dominate in neuralgias of
the upper body. Gaultheria is too poorly characterized to warrant a
proper comparative study, but shares the general neuralgic and sciatic
tendencies of the group.
Migratory,
shifting and travelling pains are characteristic of the group, applying to both
the rheumatologic and neurologic pains. In Ledum, the characteristic
direction of travel is distal to proximal; in Kalmia, proximal to
distal. Rhododendron's pains may shift about rapidly, and
characteristically descend.
A search similar to that above, can
be made for the "extending" symptoms of these remedies:
Fever in Lyme disease - extended
search
137 rubrics are found in this
search; 32 listing Ledum, 41 listing Rhododendron, and 78 listing Kalmia. A
repertorization of this list, restricted to the Family Ericaceae -similar to
the repertorization of Ericacea neuralgic pains, above- will allow a ready
comparison of the traveling/shifting/migrating pains of this family of remedies.
Ledum most characteristically
affects the small joints, especially in the feet. It may involve the knees and
shoulders, but characteristically begins in the lower limbs and ascends.
Kalmia's peripheral arthralgias more characteristically involve the shoulders
or hips, and descend from shoulder to elbow and hand, or from hip to knees and
feet. Rhododendron may involve large or small joints, with pains shifting about
and wandering from one joint to another, but has a predilection for the great
toe, wrist, shoulder, Achilles tendon, and the long bones of the forearms and
lower legs.
Modalities
Modalities of the rheumatic and
neuralgic pains also differ between these remedies. All are sensitive to
weather and temperature, but in rather differing ways. Ledum has a
characteristic aggravation from warmth of covers, air, or radiant heat sources,
and amelioration from cold and cold bathing. Rhododendron is well known for its
keynote symptoms of aggravation by approaching storm, and from windy and
cold/wet weather. Kalmia is worse cold, but also worse heat of sun and better
in cloudy weather.
Gaultheria's preference for locality
and extension, and its modalities, are not well defined in our literature;
however, clinical experience tends to suggest more suddenness in its pace,
appropriate to more acute inflammatory arthralgias and neuralgias. Ledum,
Rhododendron and Kalmia all appear in the rubric:
EXTREMITIES - PAIN - rheumatic - acute
While only Ledum and Rhododendron
appear in:
EXTREMITIES - PAIN - rheumatic - chronic
An analysis of the Fever rubrics
listing these remedies can also offer us a measure of the pace of their
pathogeneses, which we can apply as well by analogy to aspects of pathogenesis
other than fever. This can easily be done by asking RADAR to perform a
comparative extraction of the Fever, Chills and Perspiration sections of the
repertory for this group of remedies:
Fever search extraction
The rubrics addressing the pace or
succession of stages of fever can then be selected and transferred to a symptom
clipboard, for repertorization restricted to the family Ericaceae:
Fever stages
Whereas Ledum may have a slow and
long-continued pace (reflected in its presence in PERSPIRATION - LONG-LASTING),
these remedies as a group –incl. Ledum- are characterized by
periodic and alternating symptoms.
This actually is a rather interesting aspect of the general similitude of this
group of remedies to the characteristic pace, or development over time, of Lyme
disease.
These studies could productively be
extended to investigation of the neurologic and cardiac symptoms of the
Ericaceae, in the context of the importance of these pathologies in Lyme
disease.
The Missing Pieces
I am particularly fascinated by the
missing pieces of the Lyme disease - the Ericaceae connection. What might an
adequate proving of Gautheria procumbens bring out? Will the Ericacea unknown
to our art and science fill in the
obvious pathogenetic gaps between the known members of this family?
I will leave this article as an
incomplete work, with pieces to be filled in as we collectively contribute to a
homeopathic understanding of Lyme disease based on further explorations of its
anamnesis and our collective clinical experiences.