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Volume: 2
Issue: 06
Date: 21-Apr-94


Table of Contents:

I.    STAR TRIBUNE: U of MN Scientists Show Persistence with PCR
II.   ANN INTERN MED: The persistence of spirochetal nucleic
      acids in active Lyme arthritis
III.  Q&A: Exposure risks of Lyme disease (Q)
IV.   Q&A: Exposure risks of Lyme disease (A)
V.    Q&A: Lyme-Associated Gastric Reflux and Cardiac
      Arrhythmias (Q)
VI.   Q&A: Alternative Treatments? (A)
VII.  How to Subscribe, Contribute, and Get Back Issues


Newsletter:

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*                  The National Lyme Disease Network                  *
*                         LymeNet Newsletter                          *
***********************************************************************


IDX#                Volume 2 - Number 06 - 4/21/94
IDX#                            INDEX
IDX#
IDX#  I.    STAR TRIBUNE: U of MN Scientists Show Persistence with PCR
IDX#  II.   ANN INTERN MED: The persistence of spirochetal nucleic
IDX#        acids in active Lyme arthritis
IDX#  III.  Q&A: Exposure risks of Lyme disease (Q)
IDX#  IV.   Q&A: Exposure risks of Lyme disease (A)
IDX#  V.    Q&A: Lyme-Associated Gastric Reflux and Cardiac
IDX#        Arrhythmias (Q)
IDX#  VI.   Q&A: Alternative Treatments? (A)
IDX#  VII.  How to Subscribe, Contribute, and Get Back Issues
IDX#


QUOTE OF THE WEEK:

     "Any important scientific innovation rarely makes its way
      by gradually winning over and converting its opponents;
      it rarely happens that Saul becomes Paul.  What does
      happen is that its opponents gradually die out and the
      growing generation is familiarized with the idea from
      the beginning."


   -- Pioneering physicist Max Planck, 1936.


I.    STAR TRIBUNE: U of MN Scientists Show Persistence with PCR
----------------------------------------------------------------
DATE: March 15, 1994
SECTION: News; Pg. 4B
HEADLINE: 'U' uses DNA to find hidden Lyme disease; Technique expands
         ability to make correct diagnosis
BYLINE: Gordon Slovut; Staff Writer


University of Minnesota scientists reported Monday that they have used
a DNA expanding technique to diagnose Lyme disease in people who might
otherwise be thought to be suffering from some other inflammatory
disease or from a central nervous system disorder.


They also diagnosed it in patients who have gone through a three-month
course of antibiotics that under most conditions would be considered
sufficient to wipe out all traces of the tick-borne infection.


The test relies on extracting genetic material from the synovial or
lubricating fluid inside a patient's knee with pliers-like DNA probes,
then replicating the genetic material billions of times so that
laboratory personnel can see if it is from Lyme bacteria.


Earlier this year, researchers from the Mayo Clinic in Rochester,
Minn., and Tufts University in Boston reported that they had used the
same test - polymerase chain reaction (PCR), developed by a California
scientist - to sort out Lyme disease bacteria DNA from tissue that had
been frozen and stored years ago.


Dr. Jesse Goodman, an infectious- disease specialist at the university
who collaborated on the research with John Bradley and Russell C.
Johnson, said the university's PCR study can help doctors better target
treatment in some patients.


Unlike the Mayo-Tufts study, the test material all came directly from
patients, he said.  Material stored for years in research freezers is
subject to possible contamination, he said.


The university study demonstrated conclusively that in some cases where
bacterial culture tests are negative for Lyme bacteria, the germs may
be still be present - as many as 10,000 organisms per teaspoonful of
synovial fluid, he said.


He said that flare-ups of Lyme disease symptoms years later - such as a
badly swollen, painful knee - often were thought to be an autoimmune
reaction, the body attacking itself, when the cultures for the germ
were negative.


He said the missed diagnoses do no immediate harm when the flare-ups
are treated with aspirin or Motrin, which may actually ease the
symptoms.


But in difficult-to-treat flare-ups, the prescription of powerful
drugs such as prednisone to dampen the immune system could make matters
worse, because the body might actually be trying to fight off an
infection, he said.  Bradley, a laboratory technician, examined
synovial fluid from seven patients from Minnesota and Wisconsin with
suspected Lyme arthritis.  Results of the traditional culture tests for
the bacteria - in which efforts are made to get the bacteria to grow in
a laboratory dish - were negative.


However, with the PCR test, Bradley found evidence of the Lyme
bacteria's DNA in six of the seven patients.  He also examined synovial
fluid from similar, healthy people with PCR.  He found no traces of
Lyme germs in the fluid from people without symptoms.  Bradley did not
know in advance whether the fluid came from people with suspected Lyme
infections or people who had shown no symptoms.


Among the patients was a 20-year-old man who had developed facial
palsy, fatigue, knee pain and swelling.  He had received antibiotic
therapy for three months, only to turn up positive for the bacteria in
the PCR test.  Another was a 28-year-old man who for a year had been
suffering from worsening episodes of arthritis of the knee.


[...]


=====*=====


II.   ANN INTERN MED: The persistence of spirochetal nucleic acids in
                     active Lyme arthritis
---------------------------------------------------------------------
AUTHORS: Bradley JF, Johnson RC, Goodman JL
REFERENCE: Ann Intern Med 1994 Mar 15;120(6):487-9
ORGANIZATION: Section of Infectious Diseases, University of Minnesota
             School of Medicine, Minneapolis 55455.
ABSTRACT:


Six of seven patients with Lyme arthritis were positive by PCR.
In contrast, all 18 synovial fluid samples from patients with other
disorders, including rheumatoid arthritis, spondyloarthropathy, gout,
pseudogout, hemarthrosis, degenerative joint disease, lupus,
papillary synovitis, and trauma, were negative by PCR (P < 0.001,
Lyme arthritis compared with controls, Fisher exact test).
All 38 laboratory controls were negative by PCR. The assay
reproducibly detected 20 or fewer B. burgdorferi cells directly or
when added to extracted synovial fluid that was previously negative
by PCR.  Polymerase chain reaction was done four times with identical
results, including analyses with both outer surface protein A primer
sets.



=====*=====


III.  Q&A: Exposure risks of Lyme disease (Q)
---------------------------------------------
Sender: Howard Moss <hmoss@hpnmmfg.sad.hp.com>


The letter from Steve Tobin [vol#2 #05] really touched a nerve for me.
Living in Northern California is exposing my family and I to Lyme
disease or at least, that's what I've heard.  I don't see people
performing "tick inspections" or exercising true caution (staying away
from all tall grassy areas, etc), so I'm not sure if I'm feeling
paranoid or properly cautious.  Even if I were to institute
inspections, what am I looking for?  My impression has been that the
deer tick is VERY small and almost invisible to the naked eye.
Besides waiting anxiously for the answers to Steve's questions, I'd
like to know what would constitute and effective inspection for deer
ticks.  I, too, feel like "staying home" and I think that I need to
clear this up now. Thanks for being here as a resource.



=====*=====


IV.   Q&A: Exposure risks of Lyme disease (A)
---------------------------------------------
Sender: Carol Stolow, Director, The Lyme Disease Network of New Jersey
[In response to Steve Tobin's question, vol#2 #05]


Lyme Disease is one of the greatest health threats to the American
public according to the CDC.  Presently, it has been known to cause
debilitating, chronic problems in many of those afflicted with the
disease.  However, it is still not clear whether the problem is the
result of a persistent, resistant bacteria, improper or delayed
treatment or a combination of both.  Until there are better tools to
measure success of treatment, such as an accurate test, this question
can not be properly addressed.


In the meantime, those of us at the Network do not encourage people to
hide out in their homes waiting for the crisis to pass.  We urge
everyone to use common sense.  Life is short.  If you love hiking
and camping then it is foolish to deny yourself the pleasure of these
activities.  Here are some hints for making these activities a safer
experience:


1. Spray all clothing to be worn during trip with Premethryn products
  (Permanone and Duranon).  These are the only known tick killers.
  Consumer Reports (July, 1993) demonstrated DEET is ineffective in
  protecting individuals from ticks.  Premethryn will remain on
  clothing until agitated in a washing machine.  Clothes are safe
  once they are dry.  This product should not be put on skin.  It will
  break down within 20 minutes proving useless.  Since ticks are
  antigravitational, it is safe to assume it will pass some clothing
  even if shorts are worn on its way to the top of an individuals head
  unless it gets interrupted.


2. If a tick gets interrupted on its journey upward, it will stop and
  feed at that point.  That is why a thorough tick check is very
  important.  The frequency of the check should reflect the area.  The
  least amount of ticks will be found on a well manicured lawn.  The
  most likely place is the woods.  A tick check should be done in pairs
  when possible as follows:
  (Bear in mind, the nymph is quite small and may not be easily visible)


   * All bending parts (behind knee, groin area, under arms)
   * Under points of pressure (waistbands on underwear and clothing,
     bra straps)
   * Gentle sweep of all skin areas using eyes then fingertips
     (an embedded tick feels like a tiny scab)
   * Gentle sweep of hair, neck, in and behind ears, and bellybutton.


3. Shower as soon as possible after exposure to a high risk area.  Any
  wandering tick should wash off during a vigorous shower.


4. If a tick is found, remove carefully with fine tweezers grabbing as
  close to the skin as possible.  The recommendation from several
  studies and Lyme specialists is that prophylactic treatment should
  be given for 4-6 weeks to ensure that Lyme does not become a
  problem.


5. Parents of your scouts should be made aware of the situation.
  Alternative or rotating of activities should be considered for
  those who do not feel comfortable with the risks.  Parents should
  be made aware of the symptoms and should be encouraged to act
  quickly should they appear.  Early Lyme may or may not have a rash.
  There are many different rashes associated with Lyme so any skin
  eruption should become suspect until proven otherwise.  Other
  symptoms that may appear initially are general malaise, muscle and
  joint pain and low grade fever.  Unfortunately, symptoms vary with
  each person.  Many improve for a while and then become ill again
  months or years later.  The sooner Lyme is treated (for a minimum
  of 4-6 weeks) the less likely the patient is to have further
  problems.  The longer the delay in receiving treatment the greater
  the risk of a more difficult infection.


6. Until Lyme is fully understood and brought under control, awareness
  is your best defense.



=====*=====


V.    Q&A: Lyme-Associated Gastric Reflux and Cardiac Arrhythmias (Q)
---------------------------------------------------------------------
Sender: Phyllis Tyzenhouse <PTYZEN@gems.vcu.edu>


Can anyone provide information on the prevalence, pathophysiology,
duration, and treatment for Lyme-associated gastric reflux?  This has
persisted for over 1-1/2 years.  Onset was about five days after the
tick bite and beginning of erythema migrans, accompanied by cardiac
arrhythmias.


Can the gastritis produce cardiac arrhythmia?

I have been unable to find a discussion of this in the literature and
a Medline search was unfruitful.  Any and all help will be appreciated.



=====*=====


VI.   Q&A: Alternative Treatments? (A)
--------------------------------------
Sender: Rolf K. Taylor <ac219@cleveland.freenet.edu>
[In response to Carol Gardner's question vol#2 #04]


[Editor's Note: Patients should consult with their physician before
beginning any regimen of dietary supplements.]


First of all, you don't mention if you were taking any "ProBiotics"
or "good bacteria" supplements.  While there are very published
studies, some MDs and many alternative practitioners highly recommend
these supplements to keep up your levels of friendly bacteria and
leave you less vulnerable to infections by nasty bacteria and yeasts.
See the Feb 1994 Lyme Disease Update for a fairly thorough article
about this.  Two of the Dr's I have seen have recommended them for me.


My advice is that you find and Lactobacillus "Acidophilus" supplement
of at least 1 billion organisms per dose and take 2 in the AM and one
at noon time and one at bed.  Preferably take them after any
antibiotics, but if that is difficult take them with the antibiotics.
I have seen suggested that they be taken with milk, if possible.
I have seen reports which suggest taking one strain at a time
(they'll be listed on the label) but I personally feel a combination
is best since it increases the chance of having one ideally suited to
your intestinal conditions.  For this reason I buy them from a variety
of different sources.  Be sure to check potency.


Regarding more traditional supplements:

Dr. Burrascano recommends the following (from an article by him in
issue #10 of the Lyme Times (Spring 1993).


 * Essential Fatty acids.  Use at least 2 sources.  Fish Body Oils
   (1 to 4 capsules per day).  One or more of the following sources;
   Evening Primrose oil, Black current seed oil, borage oil, and
   fungal oils.  I take 3 fish oil, 2 black current and 1 primrose
   per day.


 * Co Enzyme Q10.  200-300 mg. day in 2 or three doses.  This stuff
   is expensive.  You want to find the pure stuff which is a yellow
   powder.  Look for 30 mg capsules or greater for the best value.
   My current Dr. recommends taking them on an empty stomach and I
   am currently taking 60 mg each AM.


 * Vitamin C.  Needed for proper functioning of the Co Q10.  He
   recommends 500 mg with each dose of Co Q10.  My Dr. recommends
   up to 10,000 mg per day (work up to this slowly or diarrhea may
   be a problem) spaced out over 3 does a day.


 * Iron - Timed release.  50 mg with each dose of Co Q10.  Iron is
   also needed for the Co Q10 to be used.


 * Vitamin B Complex-One balanced 50 mg B complex per day.

My Dr. also recommends the following supplements:

 * Vitamin E (Natural) 400 International Units 2 times per day

 * Selenium 50 mg per day.

 * Beta Carotene (natural) 15 mg 2 times per day.

Note that the E, C, Carotene are all anti oxidants and are believed by
many to reduce your risk of cancer as well as bolster your immune
system.


I can't say that these supplements have done much for me.  I definitely
believe that the Acidophilus and probiotics make VERY good sense
as a preventative measure to prevent what has happened to you.  I'd
warn you that IN MY HUMBLE OPINION you cannot rely on these to
"cure" you of Lyme Disease.  Of course Lyme is sometimes cured /
put into remission without any treatment at all, but I'd be very wary.
I would strongly urge you to continue (intermittent if necessary)
antibiotic treatment until BOTH you and your Dr. are quite convinced
that you've licked the Lyme.  IMHO the risk of eventual sequelae is
greatly underestimated in LD


By the way, eating yogurt, cheese, and other cultured products has
been recommend to me by a chiropractor friend.  Avoid the blue cheeses
though.  Good Luck.




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