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Welcome to my blog

Hello. I am iciclehunter and this is my diary. My job title is "osteopath", and my work is hunting for clues, detective work, problem-solving. These things involve reason and science, but are not limited by them. They also involve the eye of experience, and "hunches". Thus, some would regard my activities as those of a quack, a title I assume here with irony. I am writing this blog because I like writing. I am quite opinionated, and perhaps I suffer from a repressed need for expression. I have no particular prior "agenda"; if I have any bees in my bonnet, no doubt they will make themselves apparent by their buzzing. All names and identifying details of any people featuring in these anecdotes have been changed. Thank you for reading.

Monday, 6 February 2017

Politics = biology + metaphysics

Roll over Karl Marx, roll over Gordon Gekko. Icicle Hunter's all-encompassing political theory is that it is all "just" a matter of biology and metaphysics. Biology because since the dawning of life on Earth the phenomenon of the fittest coming out on top has been essential for any species to survive and flourish. In the early days there was no complex social behaviour, individualism was the thing, so qualities like selfishness, strength, aggression, speed and specific capabilities were advantages. I am entitled to take as much as I can, because I have worked for it - this is the right wing view. Metaphysics, and specifically spiritual metaphysics, because it gave us the moral notions of what is "right" and "wrong". From which we derive that fairness, compassion and sharing are "right", and selfishness and unfairness are "wrong". This is the socialist view, meanwhile morality having changed its spots to "ethics" in secular societies. But more recently in biological evolution, societies have developed in various species, and with them, behaviour such as cooperation and altruism. One must assume that this confers an evolutionary advantage, or "fitness", to the species. Remember, fitness is king. If one is metaphysically minded, one might postulate a "purpose" or "direction" in this biological evolution, towards more spiritually "evolved" beings. Biology then meets metaphysics. If that is so the human race must only be at a midway stage - if that - and there will continue to be, for a long time to come, political tensions played out between these two contrary (but complementary?) archetypal attitudes.

What is the difference between osteopathy and chiropractic?

This is one of the most asked osteopathy-related questions, and one of the most difficult to answer. I get asked it every time I go to a lunch or dinner party, and I have yet to give an inspired or satisfactory answer. I am here recording what will be my best effort to date, so that at future askings I don't have to try, but can just hand over a small scrap of paper with this web address on it. Then if people are really interested in the subject matter more than social chit-chat, they can go and have a look. The skeptics could have a field day with this one.

Well, it is a little like asking what the difference is between whiskey and brandy. They look similar, they both have their adherents, and they are both used by their consumers to the same ends. Different history, different ingredients, different flavour. And to connoisseurs, a great deal of variation within each itself: two whiskeys can be as different as chalk and cheese, as can two brandies. That is also the way with osteopathy and chiropractic.

Now, I have to say here that there is always a heated debate going on in osteopathic circles as to what osteopathy actually is or should be. But I am not going to stand up here and declaim for you about that. I am just going to suggest what meaningful generalisations can be made in distinguishing between these two professions as they are actually practised today in Europe, and as I see it.

But first, why two different names for two apparently (in the eyes of the layman) very similar professional disciplines? Both professions began in America in the mid-19th century, deriving from an idea that was generating interest at the time, namely that body mechanics influence health. But the founders of these two professions had different ideas about the details of this interaction and exactly how manual treatment could/should be used to intervene. So two different schools of thought developed, which were given two different names.

So, what differences can we find today? I would say the following are the main ones. Remember they are generalisations. You may go to an individual practitioner and find that none of them apply. But if you went to ten practitioners of each variety (not recommended!), I think you would find them to be generally true. This is as I see it, no more, no less.

  • Osteopaths are less likely to require x-rays than chiropractors. That is because most of what osteopaths do is not based on the kinds of information that can be derived from an x-ray. On the other hand, many chiropractors often manipulate based on how they interpret the x-ray.
  • Osteopaths are more likely to spend more time working on muscles and other soft tissues, as well as the joints. Chiropractors tend to concentrate more on the joints.
  • Osteopathic treatment is more likely to be gentler. 
  • Chiropractors are more likely to use a kind of technique involving a short sharp thrust and the production of a cracking noise from your joints.
  • Osteopaths are more likely to give you more time.
  • Osteopaths are more likely to look at your whole body and the relationships within it. Chiropractors are more likely to focus on the specific parts they see as being at fault, especially in the spine.
  • Chiropractors are more likely to require you to have longer courses of treatment (number of treatments).
  • Chiropractors are better at marketing than osteopaths.

Tuesday, 24 January 2017

Tides of fortune

Have you noticed how there are times when a person can do no wrong, when everything they touch turns to gold, and other times when they can do no right, when everything for them turns to dust? You can observe this very easily, for example, with football managers. Or choose any example that pleases you better. Probably it is just such an observation that led people to believe in magic or other determining influences (the evil eye, the stars), and Shakespeare to write about the "tide in the affairs of men".

It is odd to think it might be all down to chance. If you throw a dice, you will get a random series of numbers between 1 and 6, right? Not all sixes or all ones, right? Probably that would be the case, most times (and it is a question of probability!) But if you threw that dice a thousand times, you would probably find times when you got a whole series of 4s, 5s and 6s, and other times when you got 1s, 2s and 3s. Good times and bad times.

Nevertheless, I do not believe life fortunes are just a question of chance. I am not so sure about magic or astrology. But I do believe there is a rather more sophisticated system at work, an intricate interplay between our own beliefs, attitudes and behaviour, those of others around us, and chance events, all influencing our fortunes. This interplay is capable of prolonging good or bad fortune, and turning one into the other.

Friday, 16 December 2016

Stress: Survive and Thrive

I have written a book which, if you are stressed, you must read. It is fairly well established that excessive negative stress is an important contributory factor to a great deal of ill health, including killer diseases. Therefore it makes sense for anybody who is interested in self preservation (most of us) and who is or has been under significant stress to do something to protect themselves. I was under a lot of stress for a number of years and I decided to do something about it. I was motivated to do so not only by my personal stress, but also because I witnessed the effects of stress on the health of my patients. I went back to school and I studied stress and stress management, and having studied it, put what I had learned into practice. It worked, and it worked so well that I wrote a small pamphlet about it for my patients, but the pamphlet gradually grew and grew until it became a book. The book is called "Stress: Survive and Thrive" and its content guides you to doing just that. As I say on the back cover, I want the reader to take charge of his or her life in order to manage it effectively, thrive, live a happy, fulfilled life, and as a natural consequence contribute to other people's happy, fulfilled lives, too. Based largely (but not only) on Cognitive Behavioural theory and methods (that is, changing your thoughts and behaviours), it is amply illustrated with instances and observations from my own life. In conclusion, this is a comprehensive and easy to understand guide to stress, how to eliminate the tension and worry it brings, and in doing so free yourself to survive and thrive. If you buy one book on managing stress, make sure it's this one.

Find out more.

View or download your free taster, including the contents list, preface, introduction, and first chapter.

Buy on Amazon.com (or go to Amazon for your country and search for Stress: Survive and Thrive).


Wednesday, 7 December 2016

Unrealistic expectations

A lot of distress in life is caused by our expectations. Of a right to an easy and constantly happy life. Of universal love and light. But look at the world. A bed of roses with sharp thorns. Everything that springs to life in this world is gifted with half a chance. Not even half. And there's no free lunch. Living is tough so toughness, resilience and resourcefulness win through. Just. That is the rule. Bonding, sharing, love, cooperation, compassion improve the resilience of the group in social animals like us. But easy philosophies of "love and light" don't acknowledge the overarching rule. Peace of mind is loving the whole of life, even this, and being ready to make peace with one's fate.


Sign at the edge of the jungle, Belum Forest Reserve, Perak, Malaysia.

Friday, 11 November 2016

Ordinary people in a quantum universe

I don't "do" politics so let's just get around that by calling this social commentary. And to be fair, this is one big turn of events.

Marty McFly, back to the future after meddling in the 50s, finds things at home the same yet weirdly different*. Quantum theorists propose multiple universes all going on at once, separated only by veils of probability. President-elect Donald Trump sits in the White House with President Obama having had an "excellent discussion". Had Marty driven the DeLorean back to to 1965, he might have heard Dylan singing, "Something is happening here but you don't know what it is, do you, Mr Jones?"

Do you, Mr Jones? No man, no way you don't, is what they say. That is, of course, if you are a member of what they - those people who like to sort the world into black and white boxes  -  call the "liberal elite", out of touch with "ordinary people".

As if "ordinary" were some kind of badge of honour. As if all things "elite" were shameful. As if one cannot be "ordinary" and "elite" at the same time. As if we were not all elite performers at being own individual selves. As if extra-ordinary people must somehow be held in contempt.

Whatever, it is obvious, now, that the received wisdom of "the establishment" severely underestimated the breadth and depth of discontent of the dispossessed and disregarded. Or at any rate those who have been feeling that way. Of course it is easy to understand that if one feels, rightly or wrongly, that things cannot get any worse, then one is ready to choose any hope of change over the maintenance of what is seen as a static status quo.

Without, of course, taking some things into account:
  1. Actually, yes it could get worse. Tariffs on Chinese imports? No more cheap stuff for the poor. More jobs for Americans? What about, only if Americans will accept the low wages Trump will expect them to? Sum this up and the overall benefits to the "ordinary people" from modestly increased numbers of people in work, if achieved, might well be insufficient to offset, in "ordinary" people's minds, the disadvantage of prohibitively expensive clothes and household goods. That is not an unlikely scenario.
  2. That an alleged fraud (e.g. Trump "University") and tax dodger, a known liar, an unpleasant oaf of a man who insults and harasses women, mocks the disabled, and insults Mexicans and muslims, a loudmouth trigger-happy cowboy who shoots from the hip, might not actually be the most trustworthy of people.
  3. That a man born a millionnaire, neither a self-made man nor a blue-collar worker, has ever been able to put himself in the shoes of the "ordinary" unemployed steel worker from the Rust Belt, might be a little bit doubtful. That it is all an act and a lie might not be improbable.
  4. That a property tycoon might not be expected to possess the knowledge and skill sets necessary to govern the most powerful nation on the planet.
They say be careful what you wish for. Is a choice in blatant disregard for these obvious concerns a careful choice? Is it a quality choice? But then, in an election, it is quantity that counts. That is how it should be, it is not pretty but (according to Churchill) it is the best system we know. And the numbers voted for "change". Any change at all, please, just give us a change! There speak some desperate people.

We'll just have to wait and see how it all turns out. Doc (liberal, elitist Doc!) didn't believe Marty that Ronald Reagan ("The actor?!?") was to become President. Arguably that didn't turn out too badly, and he was certainly popular. And happily, Donald rhymes with Ronald. Maybe, if we listen hard, we can hear a twisted, anti-matter version of Dylan singing still, to his Mr Jones, in this strange new version of the universe we now inhabit. See you in the future (God willing).


* See the 1985 film, Back to the Future.


Post-script, 12/11/2016

I read that people have been protesting violently on the streets of America at Trump's election victory. I have great regard for many Americans - their ingenuity, intelligence, talent, guts and drive - but, Dear America, at the moment I am under the fleeting and I am sure false impression that you are a nation of raving lunatics. I think the election of Trump was an act of folly, but now I see the other lot have nothing to envy anybody in the matter of lunacy. It was an election won democratically. Your fellow Americans chose quite convincingly the person they wanted as President. And you, Americans, go and riot on the streets? What, exactly, is your problem? What, exactly, do you expect from your protestations? In fact, WTF?

Thursday, 6 October 2016

Lyme disease: the great divide

I crave cool air; it's like a thirst. Late summer and early autumn have been particularly warm and humid. Luckily the cool sea is only 50 yards away. My tolerance of the heat, and especially this muggy warmth, has plummeted, a fact which I might attribute to The Alien Entity, but like so many other things, one cannot be sure. It is now five months since I became symptomatic, and three months since my first progress report: sufficient time for me to have gathered together a number of further impressions and reflections which I think are worth committing to writing. In my first post on this subject I concentrated on my subjective experience. In this one I would like to talk more about perceptions, beliefs and knowledge. Prior to getting into that  difficult subject though, I will briefly update the reader on what has happened with regard to my symptoms since I last posted.

Second progress report


Firstly, I regained the lost hearing in my left ear after 10 days, a relief as I had read that Lyme-related "sudden sensorineural hearing loss" (SNHL), sometimes resolves and sometimes never does. Then I went through a period of mental fog in which attempts at concentration were futile. Time slowed down and I perceived and thought in slow motion. My other symptoms lessened in frequency, intensity, and duration, but persisted.

Doctor would not give me any more antibiotics. He said I had had enough (two courses of doxycycline of about 2 weeks each, and one 12 day course of azythromycin). I understand his point of view: a free and easy supply of antibiotics means a world full of antibiotic resistant pathogenic micro-organisms. He averred that the normal course was that my symptoms would gradually diminish and finally disappear in time. But that, of course, was something he had read on his official medical intranet, rather than something he had learned from experience. I asked him about my blood tests. The first, done after the second course of antibiotics, was positive. The second, after the end of my antibiotic treatment, was also positive.

I asked: Does this mean The Alien Entity is still in my body? No, it just means that its presence has stimulated antibody production. So what was the point of the post-treatment test? (Here some professional back-peddling couched in waffle padding). So, how can we be sure that the antibiotic treatment has been effective? We can't be absolutely sure, but I really wouldn't worry, so long as your symptoms are diminishing.

I decided not to press the matter further: Doctor had obviously come to the far reaches of his pertinent knowledge. He then did a useful thing: he booked me an appointment with Internal Medicine to oversee my case.

At Internal Medicine I was seen by a pleasant young lady who was quite thorough within the common boundaries of day-to-day, run-of-the-mill medical knowledge and practice, but because of those boundaries, similarly limited. She did explain the tests a little more thoroughly. These are antibody assays which test for one or both of two different kinds of antibodies: IgG and IgM. Once infected, IgG will appear and remain in the blood. IgM on the other hand, will rise rapidly on initial infection and remain only as long as an active infection is present. That is, once the micro-organism is eliminated, it will subside and no longer appear at significant levels. I vaguely remembered this information from my own immunology classes way back in the day. So, I asked...

  • What did these two antibodies say in my case? Prior to treatment both IgG and IgM were positive.
  • What about after treatment? Only IgG was tested.
  • Wasn't that a bit pointless, given that it tells us nothing about an active infection? Yes.
  • So shall we test for IgM now? There's not much point. If it's positive, it might be a false positive, and if it's negative it might be a false negative.
  • So, if I understand you correctly, you will rely entirely on the evolution of my symptoms...? That is correct.

Uhm... you don't need to be a doctor to realise that this confusion doesn't show the actual practice of medicine in its best or its most rational light. And yet my impression is that doctors themselves (or, so as not to unfairly generalise, many of them) do not notice that, or bother to give it more than a passing thought. What if my symptoms, those which characterised my infection or related to it, persist after antibiotic treatment is concluded, and, just for the sake of argument, my IgM test result were negative? This appears to happen to many people. And this is precisely where, I read and hear, a lot of doctors begin to lose interest.

What is my current condition? I have irregular, mild bouts of the old, familiar toe stabbing, usually the same old right big toe, but occasionally other toes or other parts of my feet. A common site for mild pin-prick sensations are the corners of the nail beds of my fingers, mostly the index or middle fingers of either hand. Odd or what? I have occasional, brief waves of very mild pain through my feet. Overall my impression is that these are diminishing in frequency. Yet it seems that every time I have said to someone that my symptoms are leaving me, they hit me again in defiance the very next day. Is that a physical effect or a psychological one? Who can tell?

There are things I have found to make my symptoms reappear or worsen: getting hot, engaging in strenuous activity, over-exerting myself mentally, dehydration, too much alcohol, too much coffee. And things that make me feel generally better: sleep, sleep, sleep... light exercise, cool weather, drinking water.

I have had to come to terms with not doing things I love, in order to conserve my energy. Principally that means reducing my long, rugged cliff, coast and hill walks. I always have a symptomatic day afterwards. But I will not stop them completely, because they lift my mood. It is ironical that I got Lyme precisely because I love rough and forest walking.

The remaining symptom that troubles me most is a constant, pervasive tiredness, and a somewhat depressed mood. I want my energy back. I feel diminished as a person without it, and that affects my mood. I want my old self back. I hear this is a common refrain from Lyme-affected people.

Knowledge and the great divide


From my doctors I have learned an intriguing fact: that, concerning Lyme disease, there exists a vast gulf between the basic official knowledge in the possession of most doctors, generalists and specialists alike, and the experiences, needs, knowledge and beliefs of their patients.

This, to an extent, is inevitable, and we shouldn't blame doctors for this. The field of medicine is itself so mind-bogglingly vast that no doctor can be expected to know more than the basics about all the diseases they are supposed to keep in their mental inventories. The problem comes when the doctor irrationally believes that what he or she knows is all that really needs knowing, or when, even acknowledging that it is not, he or she is reluctant to find out more. Which, I believe, happens quite a lot.

So, I have learned that there is a body of basic common official knowledge about Lyme disease, and another body of somewhat more in-depth and sophisticated unofficial knowledge. Now there is an intriguing idea! "Official knowledge" contrasted with "unofficial knowledge".

The first kind is in the possession of the Common or Garden GP, and even the Common or Garden Mr Consultant. It consists in the few notes they learned at medical school. This is what it says, in a nutshell:

  • Lyme disease is caused by a spirochaete bacteria called Borrelia burgdoferi, borne by ticks.
  • It begins days to weeks after a tick bite with a characteristic bulls-eye rash spreading around the bite, high temperature, malaise and joint pains.
  • Then other symptoms can develop and become chronic if the disease is left untreated.
  • It is easily treatable with a short course of antibiotics.
  • That's about it.

The second kind, the unofficial knowledge is a little more difficult to define or encapsulate. It is the knowledge owned by the person who also owns chronic Lyme-related symptoms. It consists of perceptions, experience, interpretations of that experience, and beliefs based on reading, interactions with other affected people, and personal reflection. It has many facets. Here are a few, just by way of example, that are ignored, elude or denied by common official knowledge:

  • The range of symptoms that can be "caused by" Lyme disease is almost as wide and varied as the range of unpleasant human experience.
  • Many people are affected by constant or recurrent symptoms long after normal antibiotic protocols are completed.
  • Effective antibiotic treatment may require courses much longer than the conventionally recommended ones, and repeated treatment.
  • Many people are affected by these symptoms after tick bites but in the absence of positive antibody tests.
  • Many people experience aggravations of their symptoms in response to various triggers or stimuli, pharmacological, dietary, behavioural or environmental. (Chronic Lyme patients call this kind of phenomenon a "Herx", a term their doctors do not know that refers to a process they do not know of: the Jarisch-Herxheimer reaction.)
  • Borrelia burgdoferi can hide in the body, undetectable to the normal blood tests, either by living inside the blood cells for a part of their life cycle, or by forming little cysts around themselves within the person's tissues.
  • The toxins released by dying spirochaetes can be taken up and stored in fat cells, and can be released later under certain conditions, causing a bout of symptoms.
  • Several other tick-borne infectious microorganisms may be picked up at the same time as Borrelia burgdoferi. They too, can cause unpleasant symptoms and serious illness, but are unknown to or ignored by most doctors. They are not usually tested for.

I wish to state that the fact that I have enumerated these points of both official and unofficial knowledge does not necessarily mean I endorse their veracity. For the moment, I am still too ignorant to differentiate between the true and the false. I strongly suspect that neither of these two kinds of knowledge is the whole truth and nothing but the truth. Both require unbiased critical examination. I intend to engage in some of this in another post, not this one. My objective here has been simply to illustrate the divide great that exists between, on the one hand, the effective sum of medical knowledge as it is applied by the vast majority of practitioners, and on the other, the conceptual corpus of their patients. To be honest, as far as debating concepts is concerned, the average medic is out of his or her league here, compared with the average chronic patient.

What's in a name?


What do we understand by the terms "Lyme disease", "disease" even,  and "chronic"?

I ask this because some doctors (of those who, to give credit where credit is due, have at least got as far as having thought about it) deny the existence of chronic Lyme disease, whereas many patients with chronic Lyme-related symptoms vehemently affirm its reality. So it seems to me that as stumbling blocks to mutual comprehension, the concepts, definitions and semantics may be worthy of consideration.

To the medical scientist (and consequently to those doctors of mindsets more rigidly shackled to the principles of modern science) physical "disease" means, for all intents and purposes, "symptoms which can be related to detectable abnormalities in the tissues, physiological fluids or physiological processes of the affected person". Or increasingly nowadays (and controversially), just "the presence of detectable deviations from the statistical norm in the tissues, physiological fluids or physiological processes of a person" even in the absence of any symptoms. ("High" total and LDL cholesterol in an otherwise healthy person is a case in point). What is not covered by either of these definitions is the presence of symptoms without detectable abnormalities - precisely the predicament of many of those who believe they are affected by chronic Lyme disease.

To the medical scientist (and the more rigidly shackled doctors) "Lyme disease" means, for all intents and purposes, "active infection by B. burdoferi". This working definition seems to me to be of little practical value at present. On the one hand, conventional testing practices for B. burgdoferi are currently very imperfect and of limited value. On the other, co-infection by other tick-borne parasites, which are rarely tested for, seems to be common. Until or unless this situation is improved, perhaps it would be better to retire the term "Lyme disease" in favour of a term such as "tick-borne infection". But then, what of chronic symptoms arising from a primary infection?

A "chronic" disease is a persistent or recurrent disease. Many people who believe they have chronic Lyme disease also believe that their persistent symptoms must be attributable to the persistence of the initial infection. Many doctors deny this. I must confess, I can think of several alternative explanations. I have read writings by affected people that the belief in a persistent infection, validated by a positive test result, is felt to be somehow necessary for their mental well-being. That is, if we can prove the existence of an active infection by finding a test that will demonstrate it (never mind the possibility of false positives), then our symptoms are justified. I have the greatest sympathy with those affected by the emotional impact of distressing, unexplained symptoms. But nobody should feel they need to provide concrete justification for very real experiences - and all experiences are "real" -from any kind of moral or ethical standpoint. From a practical one yes, if, and only if, it will lead to appropriate treatment. But we should be wary of our own biases. My position has always been that it is more beneficial in the long term to look in the eye and come to terms with uncomfortable truths than to slumber under comforting untruths. What is needed here is open-mindedness all round. Yes, chronic infection is a possibility. Yes, there are other equally likely explanations for persistent symptoms. We do not yet know enough.

At what point is the disease not the disease? If, (capital IF) chronic symptoms, related to an initial infection, can no longer be explained by the continued presence of those parasites in the body (we will say, just for the sake of argument, that the antibiotics worked and the alien entities are vanquished), what then is the explanation for their persistence? And crucially, in that case, if the infection is no more, is it to be considered the same "disease" as before, or is it a different "disease", one that sometimes develops out of the first one? In a shorter phrase, do we still call it "Lyme" or do we not? And there, I believe lies the dissonance between patients and doctors.

Patients want to say: "I have chronic Lyme disease."
Doctors say: "But you have no active infection now, so it is not Lyme disease any more." If he or she is more aware, he will say, "You have Post-treatment Lyme Disease Syndrome". The doctor, believing this, has no choice but to treat the patient symptomatically. This difference in concept and terminology is the cause of a lot of resentment and entrenched positions. But entrenched positions are exactly what are not needed if we want to get to the bottom of all this. It is an unnecessary argument. We do not yet know enough.

Lymies


I have spent a little time in the support forums, and have developed positive feelings about them, but with reservations. On the one hand they provide valuable social and emotional support. There's a lot of nice tending and befriending. They can also are useful sources of information, so long as one does not take every piece of advice as gospel. On the other hand, I am a little apprehensive about a certain tendency I suspect exists in us to attach excessively to the sense of group belonging, and to our identity as a Lyme sufferer. A fellow Lymie. The danger is that we begin to identify with our disease. We label ourselves. Once we are labelled we are trapped. We possess and converse in a lexicon of esoteric jargon incomprehensible to the outside world. There is an assumption that we are in it for the long term, which can be a powerful conditioning agent to the newly diagnosed. All this shared social and cultural structure, the edifice we build around our condition, by subtle psychological mechanisms can help to bind us into a state of chronicity. But I want to say, "I wish you well with all my heart, but hey, I'm outa here!"

I do not wish this to be taken personally by anybody involved in online support groups, as indeed I am myself. It is a personal observation, not a criticism. Just a thing of which I wish to be to be a little wary, while benefiting from the practical help and encouraging words, and contributing too, in my way. Dependency, once acquired, is a difficult thing to shake off.

We Lymies tend to attribute all our ailments and discomforts to our special disease. In my case, apart from the primary presenting symptoms which took me to the doctor in the first place, I could cite: general tiredness, depressed mood, heat intolerance, disturbed sleep patterns, and a new difficulty in controlling my blood pressure (my hypertension preceded my Lyme by years, but was until recently under reasonable pharmacological and lifestyle control). Goodness knows there are a great many people with far more chronic, extensive and unpleasant lists than me. Yet the kind of relationship that many of the reported chronic symptoms have with any initial B. borrelia infection is unclear, and remains for the time being a matter of assumptions, conjecture, beliefs.

Lyme disease is rapidly increasing in incidence and prevalence. Climate change has been suggested as one cause of this. Another is increased awareness. Suddenly everybody knows somebody with Lyme disease. A lady friend of mine was out to lunch in London with three girl friends, all of whom told her they had Lyme disease. I have little doubt that many of those who claim the disease do so with solid justification. But it is becoming fashionable, too! Others, with only the flimsiest foundation, will clutch at the straw Lyme offers, as the latest in-vogue disease, to explain any persistent, undiagnosed symptoms. The upside of this raised profile will hopefully be more funds, more research, more knowledge, wider understanding, better diagnostics, improved treatment.

Questions


I have made a list of a number of questions which, in another post, I would like to critically appraise:
  1. First and foremost, I would like to come to an educated guess as to the likely processes behind chronicity. The assumption by many affected by chronic Lyme-related symptoms is that these are due to continued infection. This may or may not be true, or may be true in some cases but not others. I would like greater clarity on this.
  2. The assumption by many affected by chronic Lyme-related symptoms that any sudden acute aggravation is due to the Jarisch-Herxheimer reaction has, I think, a shaky foundation. Sometimes it is likely to be the correct explanation, other times there are other, equally or more likely explanations. I would like to understand better what is going on.
  3. There is clearly a problem with testing for B. burgdoferi. Conventional methods come up short. Valid and reliable alternative methods may not be widely available. Other alternative methods may not be any more reliable than conventional methods, or may lack any objective validity at all. I would like to understand more about this.
  4. B. burgdoferi has been accused of devious methods which enable it to survive attack and avoid detection whilst in the body (e.g. entry into blood cells, encysting). I would like to know whether these mechanisms have been reliably demonstrated, or whether they are simply a part of the folk mythology surrounding a mysterious disease.
If any readers can help me with these questions, I would be grateful. Thank you for reading.

To be continued.