The first most essential tool for the medical detective is therefore compassion and proper motivation.
Most Lyme patients have a long history of chronic complex illnesses and bring a stack of medical records and a long list of complaints. By meticulously reviewing their records and using the Horowitz questionnaire we can ensure a proper history.
The Horowitz questionnaire also provides the opportunity to formulate the most probable differential diagnosis while interviewing the patient. Taking a history from these patients usually takes an hour.
It usually takes between two and three hours with each new patient to complete a social history, family history, and environmental exposure history and to review their symptoms,conduct a complete physical exam, and assessment, and devise a treatment plan.
This model is quite comprehensive in its scope, and it has the potential to lead to diagnosis and treatment in the shortest period of time while costing the health-care system the least amount of precious resources.
One of the essential problems with the current medical model is that doctors are taught in medical school that there is generally only one a areetiology for each illness. One implication of this model is that if a doctor can’t find a single answer to your host of problems, then they assert that the problem must be in your head, since the sophisticated laboratory tests and imaging studies in modern day clinics and hospitals surely are reliable and comprehensive.
The majority of Lyme patients generally do not have one sole cause for their symptoms. They often have an overlapping set of medical problems.
Horowitz identified sixteen likely categories of illnesses that can occur simultaneously with Lyme disease ‘Lyme-MSIDS’, or exacerbate the symptoms of other diseases that occur without Lyme disease (non-Lyme-MSIDS).
The difficulty in establishing a diagnosis is that Lyme disease can cause symptoms that are seen with each of these sixteen separate medical conditions. Lyme disease like its cousin syphilis, can mimic many illnesses commonly seen in modern day medical practice and exacerbate previous medical problems. For example, if you were always prone to headaches, you may begin to have migraines.
Laboratory Testing to diagnose Lyme disease:
According to the CDC surveillance case definition, late manifestations require laboratory confirmation. This may involve obtaining a positive culture for Borrelia burgdorferi from, blood, skin, a joint or cerebral spinal fluid, or by identifying antibodies to the bacterium in the CSF: the most common method, however, known as the two tier testing algorithm, uses a specific sequence of blood tests. The first is the ELISA, the second is a Western blot.
These are indirect tests of infection because instead of identifying the organism itself, they look for antibodies to Borrelia burgdorferi that were made by the immune system.
ELISA tests measure the total amount of anti Borrelia Bergdorferi antibodies present, while Western blots identify individual antibodies and look for specific proteins patterns that are unique to Borrelia. If enough of Borrelia proteins are present the test is considered to be positive.The CDC points out that there are problems with testing, and that a patient with lime disease may not be diagnose using these criteria. The presently used two tiered testing missed 81% of the lyme cases, especially when the patient did not have a Bullseye rash.One of the most comprehensive reviews of the standard lyme tests comes from a 2005 Study at John’s Hopkins University confirming the poor sensitivity of the ELISA.Another study published in 2007 in the British medical Journal by Ray Stricker MD found that the overall sensitivity of the combined Eliza Western blot was only 56%.
Polymerase Chain Reaction (PCR), a DNA test, is an important diagnostic tool for patients who have negative blood tests, at Many require multiple samples over time, using specimens from different body compartments(Such as serum, aspirated joint fluid, synovial tissue, urine, cord blood, placenta, and/or spinal fluid), and it must be performed at a reliable laboratory. The PCR has an overall sensitivity of around 30% when any individual specimens, with a specificity of over 99% (It is highly specific for the disease, with a few false positive results). New tests increased the sensitivity to 62% in early lyme disease. Horowitz says that he may need to send off several sets of PCRs on blood or urine before getting back a positive result.
Other tick borne diseases such as the Babesia and Bartonella can be transmitted with the same tick bite the transmits lyme disease. These diseases complicated clinical presentation often making the symptoms of lyme disease much worse.
Identifying multiple systemic infectious disease syndrome:
Horowitz created the differential diagnostic system as a roadmap for identifying multiple components of MSIDS. Health care providers finally have a single tool that organises the list of seemingly unrelated symptoms that a chronically your patient brings to the doctor.
Chronic inflammation lies at the heart of most chronic illnesses, and addressing the underlying causes of inflammation, using the MSIDS Map, has the potential to decrease inflammation and improve health.
The initial inflammation may have developed as a direct effect of lime disease and associated coinfections, or it could be a response to an over stimulated immune system, environmental toxins, food allergies, or an associated sleep disorder.
The MSIDS model offers an intelligent and sensible path to help diminish the cost and the burden of disease for Lyme and associated co-infections. By not driving lyme patients to search relentlessly and fruitlessly, year after year, for other diseases that might be responsible for symptoms, it provides the methodology for processing diagnosis and treatment options that can save millions of dollars annually.
MSIDS: overlapping factors contributing to chronic illness
1. Lyme disease and co- infections
2. Immune dysfunction
4. environmental toxins
5. functional medicine abnormalities with nutritional deficiencies
6. mitochondrial dysfunction
7. endocrine abnormalities
8. neurodegenerative disorders
9. neuropsychiatric disorders
10. sleep disorders
11. autonomic nervous system dysfunction and pots
13. gastrointestinal disorders
14. liver dysfunction
15. pain disorders/ addiction
16. lack of exercise/ deconditioning
Horowitz on page 68 of his text describes the appropriate laboratory testing for medical conditions associated with his 16 point MSIDS Map. This approach allows us to combine different intracellular medications simultaneously to maximise the effect and reduce possible side-effects.
Perhaps the patient has not gotten well because he/ she suffers from adrenal fatigue with a low cortisol levels. This condition is quite commonly soon in patients with MSIDS. These patients may need adrenal supplements and/or hydrocortisone. Often we will see clinical improvements once a patient’s adrenal function is normalised.
Poor sleep can be the reason the patients fatigue and memory and concentration problems processed. Or perhaps they have nutritional deficiencies in magnesium, iodine or zinc, which are needed for proper hormone production, detoxification and immune function.
Other possibilities include mitochondrial dysfunction from oxidative stress which has not been corrected, or perhaps they have a parasite that has not yet been discovered and are decondition from a lack of exercise, which could account for their ongoing fatigue.