Increasing Evidence Points To Inflammation As Source Of Nervous System Manifestations Of Lyme Disease
- Elsevier Health Sciences
- About 15 percent of patients with Lyme disease develop peripheral and central nervous system involvement, often accompanied by debilitating and painful symptoms. New research indicates that inflammation plays a causal role in the array of neurologic changes associated with Lyme disease. The investigators also showed that the anti-inflammatory drug dexamethasone prevents many of these reactions.
About 15% of patients with Lyme disease develop peripheral and central nervous system involvement, often accompanied by debilitating and painful symptoms. New research indicates that inflammation plays a causal role in the array of neurologic changes associated with Lyme disease, according to a study published in The American Journal of Pathology. The investigators at the Tulane National Primate Research Center and Louisiana State University Health Sciences Center also showed that the anti-inflammatory drug dexamethasone prevents many of these reactions.
“These results suggest that inflammation has a causal role in the pathogenesis of acute Lyme neuroborreliosis,” explained Mario T. Philipp, PhD, Professor of Microbiology and Immunology and chair of the Division of Bacteriology and Parasitology at Tulane National Primate Research Center .
What Causes Lyme Disease
Lyme disease is caused by bacteria. Infected ticks spread the bacteria by biting people or animals.
Two types of ticks carry the Lyme disease bacteria in Canada. They are:
- Deer ticks. They spread the disease in the eastern and south-central areas of Canada.
- Western black-legged ticks. They spread the disease along the Pacific coast, mostly in southern British Columbia.
Remove ticks as soon as you notice them. Infected ticks usually dont spread Lyme disease until they have been attached for at least 36 hours.
Is It Really Lyme Disease
An April 2022 study in The American journal of medicine comes to us from the University of Iowa Hospitals and Clinics and the Johns Hopkins University School of Medicine with the suggestion that while prior studies have demonstrated that Lyme disease is frequently over-diagnosed. . . few studies describe which conditions are misdiagnosed as Lyme disease.
In this study of 1261 referred patients, 1061 had no findings of active Lyme disease, with 690 receiving other diagnoses resulting in 405 having newly diagnosed medical conditions, 134 attributed to pre-existing medical issues, and 151 with both new and pre-existing conditions.
- Leading diagnoses were anxiety/depression 222 ,
- Osteoarthritis 62 , and
- sleep disorder/apnea 48 .
- Examples of less frequent but non-syndromic diseases newly diagnosed included multiple sclerosis, malignancy, Parkinsons disease, sarcoidosis, amyotrophic lateral sclerosis.
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The Problem Of Being Successfully Treated For Lyme Disease And The Continuation Of Symptoms
This is a frustration we often see in our cervical spine instability patients. They have been declared recovered, yet symptoms persist.
In December 2017 research paper, lead by Alison W Rebman at Johns Hopkins University School of Medicine published in the journal Frontiers in Medicine these observations:
Although a physical exam and clinical laboratory tests showed few objective abnormalities, standardized symptom questionnaires revealed that patients with post-treatment Lyme Disease symptoms are highly and clinically significantly symptomatic, with poor health-related quality of life.
Post-treatment Lyme Disease symptoms patients exhibited levels of fatigue, musculoskeletal pain, sleep disturbance, and depression which were both clinically relevant and statistically significantly higher than controls.
As the prevalence of post-treatment Lyme Disease symptoms continues to rise, there will be an increased need for physician education to more effectively identify and manage post-treatment Lyme Disease symptoms as part of integrated patient care.
A second paper published in 2021 , and again lead by Alison W. Rebman at Johns Hopkins University School of Medicine made many observations into the symptoms of Lyme Disease. Some of these findings included neck pain of unknown origin. Here are some brief learning points from this paper.
Is Your Back Pain Caused By Lyme Disease
Back pain can have a number of different causes. One potential cause that you may not immediately think about is Lyme disease. Lyme disease tends to be especially prevalent during the summer months when the weather is warm and people are more likely to be outside in nature. To learn more about how Lyme disease can cause back pain, we must first understand what Lyme disease is, how it spreads, and how it affects the body.
Lyme disease is a bacterial infection that is spread by infected ticks. It is most commonly spread by the blacklegged tick, which is commonly referred to as deer ticks. These ticks are found throughout the eastern United States and infect an estimated 329,000 individuals annually. Within that number, around 15% of people with Lyme disease can experience back pain.
Lyme disease affects the body in a few different ways. One of the first distinguishing signs of Lyme disease is a circular rash that forms on the skin surrounding the tick bite. Additionally, Lyme disease can also cause fatigue, fever, and pain in the muscles and joints. It can also cause a phenomenon known as Lyme arthritis.
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What Increases Your Risk
The main risk factor for Lyme disease is exposure to ticks that are infected with Lyme disease bacteria. In areas where Lyme disease is widespread, such as the eastern and south-central areas of Canada, southern British Columbia, and northeastern United States, several factors may increase your risk, including:
- Spending time outdoors during the warm months of the year when ticks are most active. This is usually between May and November, with peak activity in June and July.
- Having indoor/outdoor pets. They can bring infected ticks into the house. Although dogs and cats can become infected with the Lyme disease bacteria, they cannot pass the illness to humans. But the infected ticks can drop off the animal and then bite and infect a person.
- Having a stone fence or a bird feeder near your house. Stone fences often become homes for mice, and mice may feed on spilled seed from a bird feeder. Where there are mice, there are ticks.
Remove ticks right away, as soon as you notice them. Your risk for getting Lyme disease increases the longer a tick is attached to your body. Ticks generally cannot transmit Lyme disease until they are attached for at least 36 hours.
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Diagnosing Lyme Disease In Dogs
You will need to provide a thorough history of your dog’s health to give your veterinarian clues as to which organs are being affected.
Clinical diagnosis of Lyme disease is usually confirmed with a positive blood test for Lyme along with the clinical signs associated with Lyme disease.
Its important to note that tests can take 4-6 weeks to show up as positive after exposure, which is why veterinarians will use a combination of diagnostics to diagnose your dog:
- Blood chemistry tests
- X-rays and tests specific to diagnosing Lyme disease
- Fluid from the affected joints may also be drawn for analysis
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Imaging In Lyme Neuroborreliosis
There is limited knowledge of structural and functional changes in LNB with quantitative MRI techniques. Three studies have reported structural changes, and no difference between the patients and controls was found . However, these studies included a limited number of subjects and controls , so they probably lacked power to show subtle changes. Functional studies have been conducted with PET and with SPECT . These studies reported regional hypoactivity and hypoperfusion, but were hampered by heterogeneous study populations with non-specific symptoms and included individuals with uncertain diagnoses. Larger, prospectively conducted case-control studies are needed to learn more about imaging abnormalities in LNB.
What You Need To Know About Borrelia
Borrelia is an ancient microbe dating back 15-20 million years, and possibly even longer. Its an extremely adaptable microbe that can infect most anything with blood today, it commonly infects mammals, birds, and even some reptiles.
Infection is imperative for borrelias survival. To complete its life cycle, it must infect a new host via a tick-bite, reproduce within that host , and then reboard a new tick when the host is bitten again.
That last step reboarding a new tick is crucial. If the host is never bitten by another tick, the microbe reaches a dead end. It cant spread to new hosts. Here are some either key facts you should know about borrelia:
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Kidney Damage Caused By Lyme Disease
More serious complications, although uncommon, include:
- Damage to the kidneys
- Rarely, heart or nervous system disease 1,2
Lyme disease sometimes leads to glomerulonephritisthe inflammation and accompanying dysfunction of the kidney’s glomeruli .
Eventually, kidney failure may set in as the dog begins to exhibit signs such as vomiting, diarrhea, lack of appetite, weight loss, increased urination and thirst, and abnormal fluid buildups that can appear as swollen limbs.
Chronic Pain Due To Lyme Disease
In late 1975, a group of Yale scientists traveled to Lyme, Connecticut to investigate what they thought was an outbreak of rheumatoid arthritis . The most common symptom among the 51 patients was recurrent attacks of knee swelling. Others remembered a round rash before the onset of other symptoms . We now know these patients were suffering from Lyme disease, named for the town in which it was discovered. Today, Lyme disease is the most common vector-borne illness in the United States in 2019, a total of 34,945 confirmed and probable cases of Lyme disease were reported to the CDC . In large part due to advocacy efforts by people with Lyme disease, chronic pain due to the condition is gaining awareness from the medical community.
The exact cause of PTLDS is not known, leading to debate surrounding appropriate treatment . Some practitioners suggest continued antibiotic therapy, but evidence shows that it does not improve chances of recovery and might even cause complications . A range of medications can be used to reduce pain and discomfort, such as prescription or OTC pain relievers, NSAIDs and intra-articular steroids for joint swelling some research even suggests TNF inhibitors . Other sufferers find relief through yoga, homeopathy, and Reiki . Fortunately, an increasing number of doctors are receptive to the existence of PTLDS, which means that treatment and management approaches will continue to improve.
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Lyme Disease Vs Rheumatoid Arthritis
Lyme disease can sometimes be confused for other conditions, and its not uncommon for patients presenting with Lyme disease-related joint pain to be misdiagnosed with . Both Lyme and RA cause joint pain and can be debilitating when left untreated, but there are differences.
Lyme arthritis tends to manifest in larger joints , on one side of the body. Lyme joint pain tends to come and go.
Rheumatoid arthritis occurs more often in the hands, feet, fingers, and toes, and shows up on both sides of the body. RA joint pain and stiffness occurs every day, and is usually chronic.
Lyme disease usually goes away when treated, and most patients make a full recovery.
can manage symptoms and show the progression of the disease, but there is no cure.
Lyme pain can often migrate throughout the body, and patients may have pain in their knee one week, and in their wrists the following week, says Chicago-based integrative medicine specialist Casey Kelley, MD. With rheumatoid arthritis, the pain often stays where it begins and does not migrate.
Getting Lyme puts you at greater risk for later developing RA and other types of inflammatory arthritis. One study found that nearly one-third of participants who had Lyme-arthritis later developed an inflammatory arthritis.
When Symptoms Boil Up
You can think of it as a pot of water on the stove that starts out over a low simmer. As the simmer increases, minor discomforts start showing up general body aches and joint stiffness bloating, gas, and digestive issues lack of energy and simply not feeling well. Often, these kinds of changes become accepted as part of aging or life in general.
Its not until the pot is fully boiling over that things become noticeably uncomfortable. Sometimes its a specific event that causes the pot to bubble over severe emotional stress, an accident or trauma, an acute viral illness, or even a tick bite. But most often, its a perfect storm of cellular stress factors accumulating over time until a tipping point is reached.
At that point, the immune system can no longer keep a lid on things, and life becomes miserable. I refer to this as Chronic Immune Dysfunction.
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Preventing Lyme Disease In Dogs
If possible, keep your dog away from tick-infested environments where Lyme disease is common.
Check your dogs coat and skin daily to make sure you find any ticks hiding on your pet, and remove ticks by hand.
The most effective way to prevent Lyme disease and protect pets from other tick-borne diseases is to use flea and tick prevention.
Your veterinarian can prescribe a variety of prescription flea and tick options, including collars, topical solutions, and tablets and chews that kill and repel ticks. These products should be used under a veterinarian’s supervision and according to the label’s directions.
If you live in an area where ticks are abundant, Lyme vaccines are available. However, not all dogs are a good candidate for the vaccine. Talk to your veterinarian to see if the Lyme vaccination is right for your dog.
1. Lyme Disease. Companion Animal Parasite Council. https://capcvet.org/guidelines/lyme-disease/.
2. Littman MP, Gerber B, Goldstein RE, Anna M, Michael L, George RL. ACVIM consensus update on Lyme borreliosis in dogs and cats. J Vet Intern Med. 2018 :887-903. doi:10.1111/jvim.15085
Borrelia The Misunderstood Microbe
Retrospectively, I may have harbored Borrelia burgdorferi for years before I actually developed symptoms. Im an outdoor person tick bites have always been a common affair.
Its not uncommon for people to harbor borrelia and not know it stealth is this microbes middle name.
Lyme disease is mostly transmitted by nymphal ticks, which are about the size of a pin. They bite, transmit the microbe, and then drop off most people arent even aware of being bitten. Because symptoms of the initial infection are so mild , its not uncommon for people to be completely unaware of being infected.
And borrelia isnt the only microbe to worry about. Ticks carry many microbes that have similar characteristics to borrelia. What they all have in common is stealthy characteristics that make them hard to find and even harder to get rid of.
If immune system function is robust, a person can harbor these types of microbes indefinitely, keeping them in check without ever having symptoms. When illness does occur, its typically chronic and debilitating, but not life-threatening. Additionally, the degree of chronic illness is highly variable. Some people are severely debilitated, while others are only marginally miserable.
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Case Study: Treating Cervical Spine Instability Treats And Alleviates Symptoms Attributed To Lyme Disease
In the video below, Ross Hauser, MD discusses a case history of a patient with cervical spine instability who also had a diagnosis of Lyme Disease. This particular patient had significant positive treatment results. This may not be typical for everyone. This is one case study. If you would like to discuss your symptoms, send us an email.
Summary transcript and learning points of this video:
At 2:30 of the video, Dr. Hauser demonstrates one case of cervical spine instability and neck pain treatments that alleviated symptoms related to the patients diagnosis of Lyme Disease.
If you have Lyme Disease or have been on a chronic Lyme Disease treatment program or maintenance program and these treatments have not helped you as much as you would have hoped, one possible solution may be found in the treatment of cervical spine instability.
The patient in this video is having a Digital Motion X-ray examination. This allows the doctor and patient to visually see in real-time and real movement, problems of cervical spine and neck instability that may be leading to symptoms attributed to Lyme Disease.
What Is Spine Degeneration
Spine degeneration in dogs can be described in several ways. The effect of the degeneration on your pet will depend on the type of deterioration, and the prognosis after treatment. The recognition of the need for a veterinarian visit for treatment can be the result of a progressive condition, or may present in an acute manner. It should be noted that some degenerative conditions in dogs may not be easily recognised. Therefore, if you see your pet showing signs of pain or discomfort, contact the veterinarian without delay.
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Treating Dog Lyme Disease
If the diagnosis is Lyme disease, your dog will be treated as an outpatient unless their condition is unstable . Doxycycline is the most common antibiotic that is prescribed for Lyme disease, but other antibiotics are also effective.
Treatment usually takes at least 4 weeks, and longer courses may be necessary in some cases. Your veterinarian may also prescribe an anti-inflammatory if your dog is especially uncomfortable.
Unfortunately, antibiotic treatment does not always completely eliminate the infection from Borrelia burgdorferi bacteria. Symptoms may resolve but then return at a later date, and the development of kidney disease in the future is always a concern.
Administering the antibiotics properly to your dog reduces the likelihood of chronic consequences.
Improvement in sudden inflammation of the joints caused by Borrelia should be seen after 3-5 days of antibiotic treatment. If there is no improvement within 3-5 days, your veterinarian will want to reevaluate your dog.