CDC Criteria Confusing in Real Clinical setting

Remember we are talking about LYME (Borrelia Burgdorferi) ONLY!  Not other tick borne disease such as Babesia, Myomoto or the 32 known species of Borrelia.

The CDC recommends that the Lyme Western Blot be performed only when there is a positive or equivocal Lyme ELISA.

Yet 30% of patients with a CDC positive Lyme Western Blot have negative ELISA test.

Conclusion:  The standard ‘Lyme screen’ or ELISA test is a poor screening test.

From CDC:

It was recommended that an IgM immunoblot be considered positive if two of the following three bands are present: 24 kDa (OspC) * , 39 kDa (BmpA), and 41 kDa (Fla) (1). It was further recommended that an that IgG immunoblot be considered positive if five of the following 10 bands are present: 18 kDa, 21 kDa (OspC) *, 28 kDa, 30 kDa, 39 kDa (BmpA), 41 kDa (Fla), 45 kDa, 58 kDa (not GroEL), 66 kDa, and 93 kDa (2).

 

There are nine known (LYME) Borrelia burgdorferi species specific Western blot antibodies (bands): 18, 23, 31, 34, 37, 39, 83, 93

 

Only one of these genus specific bands is needed to confirm evidence of exposure to Borrelia burgdorferi spirochete, and confirm clinical diagnosis of Lyme disease..

Yet CDC IgM criteria includes only 3 burgdorferi species specific antibodies 18, 39 and 93.
The CDC includes non-specific cross reacting antibodies.  This can lead to false positives.  If Borrelia genus specific antibodies are considered, there would be no false positive.

This Make No Sense!

 

 WHAT TO DO??

Culturing Bb is now available in blood- but it is expensive, requires large volume of blood, cultures need to grow and patient must be off antibiotics x 3 weeks.

Sensitivity 94% !!!

 http://www.biomedicalreports.org/index.php?journal=bbr&page=article&op=view&path[]=98

A simple method for the detection of live Borrelia spirochaetes in human blood using classical microscopy techniques

Ivar Mysterud, Morten Motzfeldt Laane

Abstract

We have developed a simple method for the detection of live spirochaete stages in blood of patients where chronic borreliosis is suspected. Classic techniques involving phase-contrast and fluorescence microscopy are used. The method is also quite sensitive for detecting other bacteria, protists, fungi and other organisms present in blood samples. It is also useful for monitoring the effects of various antibiotics during treatment. We also present a simple hypothesis for explaining the confusion generated through the interpretation of possible stages of Borrelia seen in human blood. We hypothesize that these various stages in the blood stream are derived from secondarily infected tissues and biofilms in the body with low oxygen concentrations. Motile stages transform rapidly into cysts or sometimes penetrate other blood cells including red blood cells (RBCs). The latter are ideal hiding places for less motile stages that take advantage of the host’s RBCs blebbing-system. Less motile, morphologically different stages may be passively ejected in the blood plasma from the blebbing RBCs, more or less coated with the host’s membrane proteins which prevents detection by immunological methods.

 

More articles:

From University of Oslo:   http://www.apollon.uio.no/english/articles/2013/2_borrelia.html

This is an excellent article:  Lyme Disease:  the next Decade:     http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108755/

Trusting Rain in Culture Unplugged Festival

The Culture Unplugged online festival theme “Green Unplugged” showcases films that “witness the regeneration of the environment”—and invites you to- “contemplate upon the integral spiritual values that form our relationship with Mother Earth and our fellow species”.

Trusting Rain was accepted into this online festival.

Trusting Rain has played in Festivals across the United States, where it won an award

Winner of Best Documentary Short at the Blue Ridge Film and Music Festival in 2012

In Bermuda at the Bermuda International Film Festival where it came in 3rd place..and Filmmaker magazine called it Visually Entrancing!

Also in Bermuda for Bermuda’s Environmental Sustainability Taskforce (BEST)

Trusting Rain has also screened in Trinidad and Tobago and Voices from the Waters, India.

Work vs Work

 

 

 

 

I would like to spend my days filming and editing…

 

So why am I working as a Nurse Practitioner?  So many reasons, all valid, for now.

I have decided to take the commute across the water, rather than over the highway.

Roger, and Love

–>

The boy arrived with a present not long after they met.  “Don’t feed him too much” he warned her.

I looked at the two of them, glowing with the happiness of fresh, unblemished
love.  I looked at the fish, so small and fragile.  “It is a Beta fish,” she said.  “His name is Roger.”

I had seen the male Beta before, once in a small round bowl of water sitting next to the bank teller as I cashed my check.  I remember the color, a bright blue with streaming fins.   “He has to live alone” she said, “If you put another fish in there he will kill it”.    The next time I went to the bank the fish was gone.  I did not ask what happened.

I would watch them together, so in love.  It seemed as though they had they a chance.  I pushed away my cynical thoughts.  After all, what if I was wrong, and love could last?  He helped her put small glass stones in the bowl for the fish.  “Roger has not grown” he said, “Are you feeding him?”

I looked at Roger, he did not look like a Beta to me, but then I had never seen a baby Beta.  Roger was tiny, and his tail was silvery and small.
He reminded me of the guppy’s I had as a child.  “It says he will be full grown in 6 months” she said, “then he will have the color.”

He would bring her small gifts, and profess his love for her on Facebook.  He helped her clean Rogers bowl.  He bought a plastic plant for Roger, and put it in the bowl.   I remembered a Beta fish in a large bowl on the receptionist’s desk at my doctor’s office.  It was magenta and magnificent, she had a living plant in the water, and the Beta swam through it.

6 months had passed, and Roger was still the same.  “Maybe he is not what you thought.” I said.  Maybe, she replied.   Then one day she said; “I am glad you are home, I am not doing well.”  The boy had left her, suddenly.  “He said we were not right for each other.”  She was so sad, and it hurt to watch.  “He said he was surprised I didn’t see it coming.”  I wondered how someone could love so strong, and then suddenly stop.  “I cannot make him love me if he doesn’t.”  She replied.

I felt a loss, for the hope of young love.  I wished, as I have before, that love would last.  Maybe he was not who he seemed, I thought.  Like Roger, the Beta fish who was really a guppy.  I wondered if Roger should have another guppy to keep him company.
I looked in the bowl.  “Where is Roger, I asked?”  She replied; “He is dead.  I think he has been dead for a long time.”

Bermuda South Shore

Safely in harbor

Is the king’s ship. In the deep nook where once

Thou called’st me up at midnight to fetch dew

From the still-vexed Bermoothes, there she’s hid.

(Tempest, Act 1, Scene 2)

The Art of Medicine

–>

There was a time when medicine was an art.  The relationship with a patient was one of trust developed over time.  The Physician and Nurse practiced the art of medicine using tools of observation, a relationship with the patient, and subsequently developed a diagnosis based on evidence from a variety of sources.

Today the push toward “evidence based medicine” has degraded this practice of the art of medicine.
Physicians and Nurse Practitioners have become “providers” who are pushed by HMO’s and fear of lawsuits.
Medicine has become a job, not an art.

The arrogance of  ‘experts’ becomes the only “evidence” with limited studies.  This is not a diagnosis.  Evidence should not be limited studies taken out of context.  Evidence should be a combination of the patient’s symptoms, the physicians experience and the
published studies.  In the end the diagnosis is a healing art.

Lyme disease is an example of the failure of “evidence based medicine”.

The following is an abstract from a recent article in the Research Journal of Infectious Diseases:

Lyme disease remains a controversial illness. The controversy is based on a profound disagreement over the existence of
persistent infection with the Lyme spirochete, Borrelia burgdorferi, and the ability of this persistent infection to cause
chronic symptoms in patients who are untreated or undertreated for the initial spirochetal disease.

In this article, we summarize evidence from animal models, human studies and in vitro experiments that support persistent spirochetal
infection as the cause of chronic Lyme disease. Specifically, the role of cysts and biofilms in this process is outlined, and the need for better treatment options for patients with chronic Lyme disease is defined.

Raphael B. Stricker^1* and Lorraine Johnson^{1 2013}

(sorry link no longer available- below is another article)

Lyme Disease:  The next Decade

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108755/

Bermuda

The most beautiful island 600 miles off the US East coast.  The sky changes minute to minute, with the jet stream.  Water is collected on the roofs, each home responsible for their own supply.  There are no rivers or streams on the island of limestone.

Colorful little guy…

Driveway to the house…

The Princess

Documentary Film

While I finish up two projects, I am constantly mulling over ideas for the next one.

The Shona sculptures piece requires color correction, and a bit more editing for the Crisson and Hind Gallery on Front street in Bermuda.

The experimental piece is in the works, and will play before the dance begins.  Another portrait is in the planning stage, an extraordinary woman in Bermuda.  Finally an in-depth look at the Medical denial that exists is percolating as an idea.