Thursday, September 17, 2009

The Light at the End of the Herx

Around the turn of the previous century two dermatologists, an Austrian named Adolph Jarisch, and a German named Karl Herxheimer both observed an increase in symptoms of syphilis patients who were treated with mercury.  The death of the syphilis bacteria as a result of the mercury treatment caused a flood of endotoxins to be released, more than the body could filter out quick enough. It is now known that the presence of these toxins causes an increase in inflammatory cytokines including tumor necrosis factor alpha, interleukin-6, and interleukin-8.  It's not the toxins that make you feel sick, but your body's reaction to the increase in these inflammatory cytokines.

This increase in symptoms was dubbed the Jarisch-Herxheimer reaction.  It is known as a 'herx' for short.  This reaction has been observed in patients who are being treated for any spirochetal infection, the most common of which are Treponema pallidum, Leptospira, and Borrelia burgdorferi.  These bacteria are the causative agents of syphilis, leptospirosis, and Lyme disease respectively.

The herx reaction is a major source of concern and discussion among Lyme sufferers and practitioners.  People who are already suffering from Lyme disease are suffering from symptoms of the infection.  When they are treated with herbs and drugs that kill the spirochetes, their symptoms multiply. 

This was exactly what Lynette experienced at the end of January.  She told her story to her ob-gyn and he agreed that Lyme was a possibility.  He sympathetically prescribed Lynette a course of doxycycline. As soon as she started the doxycycline, all of her symptoms were exacerbated.  Lynette's numbness and tingling immediately transformed to neuropathy and paralysis.

A Lyme literate physician knows to incorporate detoxification tactics along with antimicrobial therapies.  Once you kill the spirochetes, you also have to eliminate the waste from the body as efficiently as possible.  Both Dr. Fishman and Dr. Jemsek have provided and continue to provide Lynette with tactics to assist with detoxification.

Lynette has had a much better week with the tigecycline.  Last week it was nausea, vomiting, and sleeping for 14 hours.  A classic herx.  This week she has felt much better, been quite active and required much less of the anti-nausea medicine.  She has had to curtail her schedule this week, not because of the way she felt, but because she had too many things she wanted to do.

Lynette gets basic blood work done about a week after she starts any new medicine.  I work from home on most Mondays and since she had just finished up her first week of tigecycline, she was due.  So we headed out to get her lab work.  On Tuesday she went to Anna's volleyball game, which happened to be an away game even though it was closer to home than Anna's school.  On Wednesday Lynette had an appointment with an occupational therapist to try and get some help rehabbing her hand.  She also did her Wednesday night church activities with her group of 1st grade girls.  Today she went to bible study at a local church with our friend Lisa.

Tomorrow is the last drug day for this cycle.  We are going back to Fort Mill on Tuesday.  This will be the first visit since June that Lynette has not had to try out a new IV drug.  Most likely they will be giving us 2 more weeks of tigecycling and meropenem, the latter being the very first IV drug that Lynette was prescribed. 

This means that if all goes according to schedule, Lynette is 3 weeks away from completing her IV therapy. Lynette continues to improve because of the treatment that she has been prescribed and the discipline that she has in following it. Is that a light I see?

No comments:

Post a Comment