A Personal Account of Lyme Recovery
Most people in early-stage Lyme disease respond to antibiotic treatment. Those with a tertiary (late-stage) infection often turn to long-term antibiotic combination therapy to relieve their symptoms. Over 12 years ago, Don Chinnici, who was diagnosed with late-stage Lyme, decided that he did not want to take antibiotics for the rest of his life. Combination therapy kept most of his symptoms at bay. Depression and fatigue disappeared, arthritic pain and sunlight sensitivity lessened, and memory and concentration improved. However, when he stopped the antibiotics, the symptoms returned. Concerned about the effect of long-term antibiotic use on his immune system, Chinnici decided to stop using them after two years of therapy and look for alternatives.

Chinnici concentrated on lifestyle changes such as reducing stress, improving his sleep habits, eating good food, avoiding sweets that contribute to Candida overgrowth, and exercising. As his symptoms returned, he tried various supplements. Chinnici found Pycnogenol taken with aloe vera especially helpful. Other useful supplements included a B-complex, a multi-vitamin, and 3000 mg of vitamin C. After a few months of decline, his health began to improve slowly but consistently. Chinnici also found the homeopathic Ledum helpful.

Chinnici's webpage (http://cassia.org) gives the history of his Lyme experience and lists the many supplements that he used. Nearly five years after stopping antibiotic therapy (December 1998), he reported doing exercise that included 20-mile bike rides and seven-mile roller blade runs. In his November 16, 2006 update, Chinnici is still antibiotic-free and in good health, despite a stressful job. The supplements that he found helpful may not benefit every Lyme patient. "Most Lyme people," Chinnici writes in the preface to the Treatments section, "have come to experience that what works for one, does not work for another, and vice-versa. Many people have different organ systems affected (eyes, heart, joints, central nervous system, etc.). And for that matter, entirely different illnesses (Lyme, babesia), not even to mention the entirely different strains within the same illness. For this reason, this is not, and could not be, a promise of what would work for you."

Nonetheless, I found his experience inspiring. In reading Lyme patients' accounts on the Web, I get the sense that desperation and determination propel many to try whatever therapy their financial circumstances allow. Antibiotics help, even "cure," some; but for others, the drugs are a stopgap, like a finger in a leaking dike. Chinnici knew that his symptoms would return when he quit taking antibiotics, but he was willing to try. He chose to support his body and immune system with lifestyle changes, and he was willing to experiment and give each change time to work (or not). His experience conveys the possibility of good health, even after years of symptoms. His website gives other Lyme travelers information for their own journeys.

Chinnici D. My Lyme history through diagnosis & treatment.
Available at: http://cassia.org/history.htm. Accessed December 29, 2006.

Homeopathy and Lyme
During his search for alternative treatments for chronic Lyme disease, Don Chinnici came upon information on the homeopathic Ledum, written by holistic veterinarian Stephen Tobin, DVM. Tobin reports that he has successfully used Ledum in a 1M potency to treat dogs, cats, and horses with Lyme disease. As in people, a course of antibiotics (e.g., amoxicillin or doxycycline) "works quite well in most cases of recent infection, but hardly at all in long-standing cases," according to Tobin. Dogs with Lyme have joint pain (evidenced by limping and, eventually, a reluctance to move), fever, and loss of appetite. Tobin gives these animals one pellet of Ledum 1M, three times a day for three days. Disease symptoms are gone by the end of the third day. The recovery in their pets has caused some people with Lyme to try Ledum themselves. Tobin says that he has shared this information with several naturopaths and homeopathic MDs. Many have found Ledum helpful.

After hearing about Tobin's work, Chinnici acquired Ledum 30C (a far less potent dose than 1M) from his local health food store. He reported that the homeopathic relieved two of his chronic Lyme symptoms – brain fog and low body temperature – within 15 minutes. Thinking that stronger is better, Chinnici acquired a 10M potency. He learned from experience that it is best to start with a low dose then gradually increase to stronger doses, rather than starting with the high-potency homeopathics available from a homeopathic pharmacy. Too high a dose does not help and can render lower doses ineffective for a few weeks. In addition, repeated use of high-potency homeopathics can cause problems. Michael Quinn of Hahnemann Labs warned Chinnici, who asked about listing the company on his website: "Please caution that taking [Ledum 1M] too often could exacerbate symptoms or even produce new symptoms. A 1M is a sharp tool and must be handled with respect and care. We generally require a practitioner's prescription in order to sell 200C, 1M, and 10M potencies. There is such a great need for help in Lyme disease that we will sell a 1M to the public with the caution that they should not repeat it after the first three days without consulting with a homeopathic practitioner."

Homeopathic remedies are most effective when they match a person's specific symptoms rather than a disease label. For this reason, consulting with a trained homeopath is helpful. Physician and homeopath Ronald D. Whitmont, MD, says that a repertory search lists seven homeopathic medicines for Lyme disease: Arsenicum album, Mercurius, Thuja, Carcinosin, Lac caninum, Ledum, and Syphilinum. He says, however, "Lyme disease must be considered in the context of the individual host who has proven to be susceptible. Illnesses manifest according to the patterns and cycles already in place in each particular individual." Any homeopathic medicine that matches a person's physical, mental, and emotional patterns (the simillimum) can effectively treat Lyme.

Chinnici, D. Ledum Homeopathic Treatment Discussion. Available at: http://cassia.org/ledum.htm. Accessed December 29, 2006.

Tobin S. Lyme disease and homeopathy. Available at: http://cassia.org/ledum.htm. Accessed December 29, 3006.

Whitmont, RD. Homeopathy and Lyme disease. Available at: www.homeopathicmd.com/articles_3.html. Accessed December 29, 2006.

Combination Antibiotic Treatment for Lyme
Medical literature shows that most cases of early Lyme disease that fit the current definition of Borrelia burgdorferi infection respond to a course of antibiotics (e.g., doxycycline). However, some people with the defining erythema migrans (bull's-eye rash) do not respond to accepted treatment. Others do not have the characteristic rash and the presence of B. burgdorferi is missed, allowing the infection to take hold. Co-infections with other tick-borne pathogens can also complicate diagnosis and treatment.

In addition to a skin rash (which may or may not have central clearing), Lyme patients can experience numerous symptoms including fatigue, low-grade fevers, night sweats, sore throat, swollen glands, stiff neck, myalgia, joint pain, chest pain and palpitations, sleep disturbance, headaches, poor concentration, memory loss, and mood swings. The similarity between these symptoms and the symptoms of chronic fatigue syndrome and fibromyalgia have caused the International Lyme and Associated Disease Society (ILADS) to suggest that some people with chronic fatigue or fibromyalgia may actually have a tick-borne illness. For patients with chronic Lyme, some medical doctors, such as those involved in ILADS, advocate the use of long-term combination antibiotic therapy, using two or more antibiotics. "The ideal approach would be to continue therapy for Lyme disease until the Lyme spirochete is eradicated," ILADS states.

But is a goal of eradication realistic? Bacteria develop resistance and change forms, as Jessica Snyder Sachs explained in her article "Are Antibiotics Killing Us?" for Discover (November 2005) [See "Shorts," Townsend Letter, April 2006]. Even if killing all the pathogens were possible, the therapy would destroy necessary, beneficial bacteria as well. Ronald D. Whitmont, MD, who practices general medicine and homeopathy, writes, "Antibiotics do not cure infections. This is a common misconception, even among physicians." Rather, antibiotics reduce the load of susceptible bacteria to a level that no longer overwhelms the host's immune system. The success of antibiotic therapy depends upon the patient's humoral and cellular immune defense. Whitmont views chronic Lyme disease as a "stalemate" between the spirochete "that has established a niche in a susceptible host" and the patient's immune system: "Neither the antibiotic nor the host's immune response is sufficient to break the cycle. The continued use of stronger and broader spectrum agents only weakens the immune system further and allows the infection to slip deeper toward organ systems less able to evoke a perceptible symptomatic inflammatory response." Whitmont cites Goodman and Gilman's The Pharmacological Basis of Therapeutics (1985) for evidence that pharmacological antimicrobial agents inhibit the immune system. Rather than relying on antibiotic therapy, Whitmont suggests focusing on therapies that stimulate and support the immune system.

The ILADS Working Group. The International Lyme and Associated Diseases Society evidence-based guidelines for the management of Lyme disease. Available at: www.ilads.org/files/ILADS_Guidelines.pdf. (326KB .pdf) Accessed December 29, 2006.

Whitmont, RD. Homeopathy and Lyme disease. Available at: www.homeopathicmd.com/articles_3.html. Accessed December 29, 2006.

Healing Chronic Illness with Traditional Native American Indian Medicine
In the 1990s, Lewis Mehl-Madrona, MD, PhD, took part in a study that integrated conventional medicine and many of the principles of Traditional Native American Indian Medicine. One hundred and sixteen people with worsening chronic health problems attended a seven-to-28-day intensive healing experience, facilitated by conventional and traditional healers. These people suffered from a variety of conditions that were not responding to conventional care including pregnancy-related complications, hypertension, infertility, cancer, chronic fatigue syndrome, non-malignant gynecological problems, depression and manic-depression, diabetes, and asthma. All participants were encouraged to spend at least seven days in the program. Some with less severe problems spent as little as three days. The average stay was 7.8 days.

All but two of the participants "reported major psychological breakthroughs" from the experience. Five years after the intensive, 50 of the 107 available for follow-up reported a "cure" from their condition; 41 reported "better"; nine had "no change"; five were "worse"; two had died. Mehl-Madrona compared this group to 1200 patients (100 for each disease), drawn from his database of emergency room patients. Those who attended the healing intensive had significantly higher rates of improvement, even though their conditions, initially, were worsening and less stable than those in the comparison group.

The healing intensive began with a period of physical rest and self-reflection that was designed to activate healing and change. During the first week, participants engaged in two to seven hours of "therapeutic attention" each day. The therapy included hypnosis and/or imagery, body therapy, projective techniques (including the use of Native American images, shields, or animal images), ceremony (respecting participants' religious beliefs), and discussion with healers. Art, produced on assignment, and journal writing also provided tools for self-reflection. The remaining time was spent "face-to-face with themselves."

Traditional healers believe that the many distractions of modern life "inactivate" the catalysts for change. Television, radios, books, newspapers, telephones, computers, and talking with others allow us to avoid self-contemplation. Consequently, we lose touch with our emotions, body rhythms, and messages, and natural ebb and flow of energy and stamina. We also forget how to relax and rest.

Mehl-Madrona reports that participants typically experienced restlessness and anxiety, alternating with sleep, during the first two or three days of this first week. This stage gives way to acceptance and yielding with relaxation on days three and four. Next comes a period of rapid insight (days four to five). Finally, participants tend to experience spiritual connection (days five to seven) and integration into life routine (days six to eight).

Therapies that had helped the process of self-discovery during the first week were continued in the second (if participants chose to stay), but more physical activity and tasks of service were added. Participants helped clean up and care for the property that hosted the intensive and nearby national forestland. During the third week, participants learned problem-solving techniques to prevent a relapse as they prepared to return to their homes. A fourth week, which none of the participants chose to attend, focused on Native American philosophy and skills such as desert survival and tracking.

"Physiological change often requires a break in usual daily rhythms," Mehl-Madrona writes. "While we are in an activated state of running our daily lives, necessary resources are not always available for the work of change, said our healers. The body needs rest and quiet to promote cellular repair….Often, the most important therapy we can give a client is to put them to bed."

Mehl-Madrona, L. Traditional [Native American] Indian medicine treatment of chronic illness: Development of an integrated program with conventional medicine and evaluation of effectiveness.
Available at: www.healing-arts.org/mehl-madrona/mmtraditionalpaper.htm. Accessed July 11, 2006.

"Lyme Wars"
Two conventional medical organizations are warring over the definition and treatment of Lyme disease. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), published in Clinical Infectious Disease (November 1, 2006), asserts that Lyme is difficult to catch and readily cured with 14-28 days of antibiotics. The bull's-eye rash and Centers for Disease Control (CDC)'s surveillance criteria using ELISA and Western blot tests should be used for diagnosis. IDSA also says, "'There is no convincing biological evidence for the existence of symptomatic chronic B. burgdorferi infection among patients after receipt of recommended treatment regimens for Lyme disease."

The International Lyme and Associated Disease Society (ILADS) criticizes IDSA for selection bias, stating that IDSA focused on studies whose subjects had a bull's-eye rash and ignored the neuropsychiatric symptoms of the disease when choosing supportive literature for its guidelines. In addition, ILADS says that FDA-approved laboratory test kits are only 36-70% sensitive in detecting Lyme disease. A 2005 Johns Hopkins study, published in the Journal of Clinical Microbiology, claims that the CDC two-tiered testing procedure misses 75% of positive Lyme cases. A 1999 report from the National Institutes of Health (NIH) says, "Until better tests are available, the diagnosis of Lyme disease must be based on characteristic clinical findings in which the results of laboratory tests play a supportive role."

IDSA's refusal to recognize the possibility of chronic Lyme disease and need for additional therapy is disturbing. Daniel Cameron, a New York internist and epidemiologist and ILADS board member, says, "The IDSA guidelines do not offer an answer for the thousands of individuals with Lyme disease left with a poor quality of life after their 21 to 30 days of treatment." ILADS asserts that chronic Lyme disease does exist and that "long-term antibiotic therapy can significantly improve the quality of life for [these] patients."

In an October 25, 2006 letter to the editor of Clinical Infectious Diseases, Raphael Stricker, MD, President of ILADS, asked for a retraction of the guidelines: "Clinical guidelines from societies as powerful as IDSA are generally accepted as accurate, fair, collegial, and transparent, and they rapidly become the standard of medical care in our country. It is wholly inappropriate and dangerous for guidelines to be formulated using exclusionary tactics, flagrant data selection, biased opinions, and sweepingly ‘strong' recommendations based on the weakest category III evidence….In our opinion, the Lyme guidelines article does not reflect accuracy, fairness, collegiality, or transparency and should be retracted." The letter was accompanied by an analysis of key points in the Lyme guidelines. Both are available at www.ilads.org/files/press_release_10_25_06.pdf.
(98KB .pdf)

International Lyme and Associated Disease Society. Subject: Retraction of "The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America." Available at: www.ilads.org/files/press_release_10_25_06.pdf. (98KB .pdf) Accessed December 29, 2006.

International Lyme and Associated Disease Society. Lyme wars: Lyme disease expert critical of new treatment guidelines. (November 27, 2006) Available at: www.ilads.org/publications_cameron_11_2006.pdf. (23KB .pdf) Accessed December 29, 2006.

Rife Frequency Devices and Lyme
Some people with Lyme disease are reporting that Rife frequency devices have helped them regain their health. Over 1800 Lyme sufferers share information about the use of these devices and other alternative therapies via the free online Yahoo! Health group (http://health.groups.yahoo.com/group/Lyme-and-rife/). Bryan Rosner, author of Lyme Disease & Rife Machines, credits Rife therapy for his transformation from "debilitated and bed-bound to a functioning member of society. No other therapies provided this improvement." Excerpts from Rosner's book and information about various frequency devices are available at www.lymebook.com.

The primary complaint from using Rife frequencies is the Herxheimer reactions, which can be quite strong – especially if too many frequencies are used for too long a period and/or too often. Also, a question about electromagnetic field (EMF) intolerance was raised at http://info.lymebook.com/profile2.html. Long-term effects of using frequency devices are unknown, although some of the people on these sites have been using the machines for as long as 15 years.

This movement is patient-driven, grassroots, and pretty much underground. The reluctance of doctors to get involved in this is understandable, given the FDA and AMA persecution of Royal Rife, the originator of these devices. Rife frequency devices are based on Royal Rife's work in the 1920s and '30s, using specific frequencies to destroy pathogens. Shawn Montgomery produced an excellent two-part video about Royal Rife and his work called The Rise and Fall of a Scientific Genius. The video is available from Zero Zero Two Productions (www.zerozerotwo.org).

Gupta C. Lyme disease & Rife machines. Available at: www.newmediaexplorer.org/chris/2005/03/31/lyme_disease_rife_machines.htm. Accessed January 13, 2007.

Lyme Disease Borrelia burgdorferi Forums. Available at: http://www.medconsumer.info/topics/lymeforums.htm. Accessed January 12, 2007.

Colloidal Silver
Colloidal silver, a product that some Lyme patients have found helpful, is a suspension of ultra-fine, electrically-charged (ionic) silver particles in water. This form of silver kills bacteria and other microorganisms, apparently by inhibiting enzymes common to microorganisms but not found in mammalian tissue cells. Colloidal silver was used to treat and prevent infection before pharmaceutical antibiotics became available. For years, the FDA said, "'All OTC [over-the-counter] products containing colloidal silver or silver salts are not recognized as safe and effective and are misbranded.'" Then, Curad began selling bandages with an anti-bacterial, silver coating. A 1999 article in Veterinary Surgery shows that silver is, indeed, an effective anti-bacterial agent. A.P. Adams and colleagues tested a silver chloride-coated nylon wound dressing and found that silver significantly reduced the numbers of several bacteria commonly found in horse wounds: Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Streptococcus equi subspecies zooepidemicus, and Staphylococcus aureus.

While insoluble salts, such as silver chloride, are bactericidal, they are also more likely to cause argyria when ingested. Argyria is the build-up of silver in organs and tissue. It is characterized by a silver or blue-grey coloring of the fingernails, skin, and hair. Most cases of silver toxicity stem from the ingestion or inhalation of silver salts. If made correctly, colloidal silver should not contain silver salts (or very, very little). On its own, silver has low toxicity to vertebrate animals, according to P.D. Warrington, PhD, writing for Canada's Environmental Protection Department of the Ministry of Environment, Lands and Parks. The liver removes over 90% of ingested silver, combined plasma proteins, and eliminates it in bile. Most of the silver is then excreted in feces.

Some case studies have implicated colloidal silver preparations in the development of argyria. In all colloidal silver cases that I found, regular consumption of large amounts of colloidal silver, especially products with high concentrations of silver, led to discoloration. One man had been drinking 16 ounces of 450 parts per million (ppm) colloidal silver, three times a day for ten months, when argyria developed, according to A. Wadhara and M. Fung. Colloidal silver promoters recommend using 5 ppm products. A woman reported a darkening of her fingernails (an early sign of argyria) after drinking eight ounces of colloidal silver each day for about four years. Stan Jones, a US Congressional candidate, also developed argyria by adding a high ppm colloidal silver that had been made with salt (so it also contained silver chloride) to his drinking water for several years.

Because colloidal silver products are not regulated and tend to be expensive, some people choose to make their own. Peter Lindeman, who developed two colloidal silver generators, emphasizes the importance of using high-quality, distilled water. Purified or filtered water contains minerals that will combine with silver to form the salts that increase the risk of argyria. Lindeman's article, "A Closer Look at Colloidal Silver," explains how to make a solution that contains three to five parts per million, an effective level that minimizes toxicity. Like other sources on colloidal silver consumption, Lindeman recommends a conservative dose of no more than two-to-four teaspoons a day. Several websites that promote colloidal silver recommend using the lowest effective dose and taking periodic breaks. Lyme patients who use colloidal silver report a Herxheimer effect (worsening of symptoms), which is a sign of antibacterial activity. Long-term users need to be aware that colloidal silver can kill off friendly gut bacteria; I found no evidence that silver discriminates between "good" bacteria and "bad" bacteria.

Adams AP; Santschi EM; Mellencamp MA. Antibacterial properties of a silver chloride-coated nylon wound dressing. (Abstract). Veterinary Surgery 28(4), 219-225. Available at:
www.blackwell-synergy.com/doi/abs/10.1053/jvet.1999.0219?journalCode=vsu. Accessed January 12, 2007.

Colloidal silver and its applications. Available at: www.health2us.com/csapps.htm. Accessed October 13, 2005.

The FDA and colloidal silver. Sharing Health from the Heart, Issue 5. Available at: www.sharinghealth.com. Accessed February 1, 2007.

Lindemann PA. A closer look at colloidal silver. Available at: www.elixa.com/silver/lindmn.htm. Accessed January 12, 2007.

The scoop on ionic/colloidal silver. Sharing Health from the Heart, Issue 2. Available at: www.sharinghealth.com. Accessed February 1, 2007.

Wadhara A, Fung M. Systemic argyria associated with ingestion of colloidal silver. Dermatology Online Journal. 11(1):12. Available at: http://dermatology.cdlib.org/111/case_reports/argyria/wadhera.html. Accessed January 28, 2007.

Warrington PD. Application of criteria for aquatic life. Ambient Water Quality Criteria for Silver. Water, Quality Branch, Environmental Protection Department, Ministry of Environment, Lands and Parks (British Columbia, Canada). Available at: www.env.gov.bc.ca/wat/wq/BCguidelines/silver/bcsilver-04.htm. Accessed January 12, 2007.

Jarisch-Herxheimer Reactions
Lyme patients often experience Jarisch-Herxheimer reactions (JHR) from antibiotic therapy and when using colloidal silver or Rife frequency devices. JHR, or "Herx," as some patients call it, is a worsening of condition that occurs shortly after the first adequate dose of an appropriate antimicrobial therapy. This reaction has been observed in many bacterial infections and in some protozoal infections. Classical symptoms include a sudden rise (within two hours) and gradual fall in body temperature, rigors (violent shivering), a transient rise then fall in blood pressure, and a fall in peripheral blood white cell count. Syphilis and louse-borne relapsing fever (both are caused by spirochetes) produce the most severe JHR, which can be life-threatening. About 80% of patients who receive penicillin for early syphilis experience JHR.

The cause of Herxheimer reactions has been long debated. Endotoxins released by dying pathogens have been blamed for the response, but G.E. Griffin says that endotoxemia was not detected in rabbit studies or in syphilitic patients experiencing JHR. Rather, he subscribes to the hypothesis that destruction of some pathogens trigger a cytokine cascade; the cytokines, themselves, cause JHR. Researchers have documented a huge release of cytokines (TNF-a, IL-6, and IL-8) during JHR. A 1991 study by D.G. Remick et al. (FASEB Journal 5, A1671) found that the peak of JHR symptoms in 17 patients with proven Borrelia recurrentis infection (louse-borne relapsing fever) "was strongly associated" with the peak in TNF plasma levels. Single pulsatile peaks of IL-6 and IL-8 occurred just after the TNF peak. The three patients in this study who did not experience JHR did not show increases in plasma cytokine levels.

Cytokines regulate antibody and T-cell immune interactions and amplify immune reactivity, according to Mosby's Medical Dictionary (Sixth Edition.). Tumor necrosis factor (TNF) increases inflammatory and immune responses and cytokine release. Interleukin-6 (IL-6) increases the inflammatory response and fever. It also boosts the normal formation and development of blood cells made in bone marrow. Interleukin-8 (IL-8) affects neutrophil and lymphocyte sensitivity to chemicals released by invading microorganisms, thereby influencing their phagocytic activity (i.e., the action of engulfing and destroying microorganisms and cellular debris).

Dr. Joseph Jemsek, who specializes in persistent Lyme disease, says that the Herxheimer response in Lyme patients usually is "an intensification of pre-existing symptoms, e.g., increased brain fog or muscle/joint pain, where these symptoms were reported prior to therapy." New symptoms can also arise. In his clinical experience, the severity of JHR generally correlates directly to the severity of a person's illness. Unlike the classical pattern found in syphilitic patients, JHR in Lyme disease usually occurs within three to five days after treatment begins but can take as long as two weeks to appear. Instead of waning within hours, Lyme patients may experience JHR for days or weeks, according to Jemsek. As therapy progresses, JHR severity tends to decrease. Jemsek says that some Lyme patients find the Herxheimer experience so intense and prolonged that they discontinue antibiotic treatment. Consequently, finding ways to manage JHR symptoms is a major concern.

Jemsek and colleagues use antioxidants, lots of fluids, and periodic washout to lessen the negative effects of JHR. Russell McMillan, DDS, DPH, reported to The Arthritis Trust of America that a hot bath that contains one cup salt, one cup soda, one cup epsom salts, and one cup aloe vera helped him deal with his Herxheimer reactions. He stayed in the bath, keeping the water hot, for one and a half hours while drinking about two quarts of warm water. "Evidently," he writes, "the perspiration and osmotic pressure removes the causative toxins."

Griffin GE. Cytokines involved in human septic shock – the model of the Jarisch-Herxheimer reaction. Journal of Antimicrobial Chemotherapy.1998; 41(A): 25-29. Available at: http://jac.oxfordjournals.org/cgi/reprint/41/suppl_1/25.pdf. (83KB .pdf) Accessed December 29, 2006.

Griffin GE. New insights into the pathophysiology of the Jarisch-Herxheimer reaction. Available at: http://jac.oxfordjournals.org/cgi/reprint/29/6/613. Accessed December 29. 2006.

Pybus PK. The Herxheimer reaction history. (Provided by The Arthritis Trust of America.) Available at: www.garynull.com/Documents?arthritis/Herxheimer_Effect.htm. Accessed January 22, 2007.
(April 2007: Link no longer active. Try http://www.gnhealth.com/Documents/Arthritis/Herxheimer_Effect.htm )

Jemsek J. The Herxheimer reaction. Available at: www.jemsekspecialty.com/lyme_detail.php?sid=10. Accessed January 29, 2007.

Morgellons Disease
In August 2006, the Centers for Disease Control and Prevention (CDC) announced its decision to investigate Morgellons disease (pronounced with a hard "g"). The CDC's multi-disciplinary task force consists of two pathologists, a toxicologist, an ethicist, a mental health expert, and specialists in infectious, parasitic, environmental, and chronic disease. Morgellons is characterized by skin lesions, a sensation of crawling and biting on and under the skin, sleep disorders, joint pain, fatigue, short-term memory loss, attention deficit, bi-polar or obsessive-compulsive disorders, and impaired thought processing (brain fog). The most puzzling symptom is the presence of fiber-like material that arises from skin lesions.

Testing the fibers has only increased the mystery. Physiologist Randy Wymore, who leads a Morgellons research team at Oklahoma State University Center for Health Sciences, says that tests have ruled out textile fibers, worms, insects, animal material, and human skin and hair. So far, he has been unable to identify the material. California infectious disease specialist Dr. Neelam Uppal has also seen the fibers and sent them to a lab for testing: "They can't identify it. They'll say ‘They're nothing.'" Wymore believes that the fibers are "apparent artifacts of something infectious" within the body. The Oklahoma State University website on Morgellons says that cases have been reported in Europe, South Africa, Japan, the Philippines, Indonesia, Australia, and all 50 states in the US. Most US cases have appeared in California, Texas, and Florida.

Dermatologists view Morgellons as delusional parasitosis and the open sores as the result of self-mutilation. Instead of anti-fungals and antibiotics, they recommend psychiatric drugs such as pimozide, risperidone, or aripiprazole. Caroline S. Koblenzer, MD, in her 2006 commentary for the Journal of the American Academy of Dermatology, blames the Morgellons Research Foundation website for fueling patients' delusions. Morgellons Research Foundation was founded by Mary Leitao in 2002 in an effort to increase awareness about the mysterious condition that afflicted her son. After reading letters to the journal, I can understand why some dermatologists might be skeptical of the patients who enter their offices with worries about Morgellons disease. Still, to deny the possibility of an unknown pathogen and immediately categorize all Morgellons patients as needing psychotropics reminds me of the early years of chronic fatigue syndrome and multiple chemical sensitivity. Doctors were quick to categorize those as psychiatric conditions, too.

Doctors make progress with mysterious disease. KTVU.com (May 23, 2006) Available at: www.ktvu.com/print/9264350/detail.html. Accessed November 20, 2006.

Gillette B. CDC to investigate mysteries of Morgellons disease. Dermatology Times. August 1, 2006. Available at: www.dermatologytimes.com. Accessed January 12, 2007.

Koblenzer CS. The challenge of Morgellons disease. J Am Acad Dermatol. 2006;55:920-2. Available at: www.physics.smu.edu/~pseudo/MorgellonsCommentary.pdf. (73KB .pdf) Accessed on January 12, 2007.

Morgellons. Available at: http://en.wikipedia.org/w/index.php?title=Morgellons. Accessed January 12, 2007.

Murase JE; Wu JJ; Koo J. Morgellons disease: A rapport-enhancing term for delusions of parasitosis (letter). J Am Acad Dermatol. 2006;55:913-14.

Oklahoma State University. Morgellons Disease. Available at: www.healthsciences.okstate.edu/morgellons/index.cfm. Accessed January 12, 2007.

Waddell AG; Burke WA. Morgellons disease? (Letter.) J Am Acad Dermatol. 2006;55:914-15.