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Still Have Symptoms After Treatment for Babesia

Question: With a history of dysnomia related to babesia, although the babesia may be gone, I still have Neurally Mediated Hypotension, high BP (blood pressure), POTS (postural orthostatic tachycardia), temperature problems, sleep off and on, it often takes until 5 AM to fall asleep, 8 years post-function adrenal collapse.  Please explain the physiological dynamics of what is going wrong with the autonomic nervous system and the hypo-pituitary adrenal system.

Answer from GMA Staff:

We have written about factors predisposing to infection, the “total load” and the cycle of maladaptive responses that can follow Lyme and tick-borne diseases.  In fact, these problems also are common among chronic fatigue (syndrome or not) patients, people suffering from long-term stress and others who are chronically-ill.

Our writer comments that after the infection has been treated, his (let’s assume) adrenal, autonomic, and other symptoms persist.  There are several possibilities we should acknowledge: First, the infection may still be active, just “underground.”  Please, though, do not assume that freedom from all symptoms is the only sign of cure!  Secondly, the patient’s infection, and the many stresses it caused in his life, may well have weakened his “constitution” and produced these symptoms in the spiral of consequences I earlier addressed.  Thirdly, these same problems could have been latent in the patient before the infection – could have been the reason the infection became rooted and caused him trouble in the first place.  That “8 years post-adrenal collapse” is tantalizing; we don’t know if that was before or after his infection had started.

Neurally Mediated Hypotension (NMH) is an interesting diagnosis.  First described at Johns Hopkins, it has been widely accepted.  Researchers have shown patients’ blood pressure drops excessively when they are passively tipped from lying down to an upright position (called the “tilt-table test”).  But is the problem really “autonomic?”

In fact, all the symptoms of NMH are identical to those of adrenal insufficiency.  What’s more, successful treatments of NMH specifically cover for adrenal problems.  Indeed, a synthetic adrenal steroid (Florinef or fludrocortisone) is the first-line treatment used – in addition to a high-salt diet, which also compensates for low adrenal function.  Researchers say their patients’ adrenals are normal, but never specify on what test(s) they base this assertion.

Remember, conventional Endocrinologists don’t believe there is any such thing as “adrenal fatigue” or in this case, “functional adrenal collapse.”  However, experience indicates the condition indeed exists and this is supported by Drs. Jonathan Wright, James Wilson and many other practitioners.  Before believing the “NMH” patient has anything other than adrenal fatigue, we’d like to see his 24-hour adrenal steroid profile performed with GC-Mass Spect.

Do his temperature problems support the hypothesis that his autonomic nervous system is weak?  It would be far more successful to ask instead whether this patient is capable of activating his thyroid pre-hormone T4.  You know why?  Not only is such an issue, called “Non-Thyroidal Illness,” quite well defined and rather common, we can easily test it.  We have but to draw blood for total T3 and total Reverse-T3 and calculate their ratio (put ‘em in the same units, OK?).  Oh, sure – we ought to test the whole panel of thyroid hormones if that’s not been done already.  Most docs, though, test only a standard panel, which omits both tT3 and RT3.

Here’s what happens: Our body adapts to stress by slowing down the metabolism – the rate at which we produce and use up energy.  This is a defense designed to keep us alive longer when we are hurt, as by infections (like Lyme and Babesia).  This is partly mediated by the hypothalamic-pituitary axis, as our questioner points out.  Another aspect of the stress response occurs in the cells of our body.  They “choose” to not activate the pre-hormone T4 into the active form, T3.  Instead, our cells make T4 into RT3, which is known to further block T3 production and can have anti-thyroid effects.  It could be  expected that Lyme and tick-borne disease (TBD) victims will have a persistently low ratio of T3 to RT3.  If so, they are “stuck” in a maladaptive response resulting in “functional” hypothyroidism (NTI).  Fortunately, this can be corrected with biologically simple treatment.

We agree that basal body temperature is not exclusively a test of thyroid function.  No, low body temps show a lower metabolic rate and many factors put-in on that.  While the thyroid gland is (as Dr. DeGroot famously wrote) the “thermostat” of the metabolism, the adrenals are the furnace.  Low adrenals will result in low body temperature as well.  Your levels of steroid sex hormones influence your body temperature, too (remember birth control using a thermometer?).  Of course, illness and nutritional deficiencies can also lower the metabolism and cause low body temps.

The complex condition of Lyme disease may aggravate other latent health problems.  For example, 40% of Americans carry the genetic program for insulin resistance (IR).  Lyme and TBD patients often have to stop their exercise routine, which makes trouble for those with IR.  An elegantly simple Swedish research project showed reduced activity significantly worsens insulin sensitivity – after only 3 weeks, they needed twice the insulin to keep their blood sugar the same as it had been when they were exercising.  Insulin resistance can cause lots of the same symptoms we associate with TBD.

There now; with these few issues we might be able to explain all of the symptoms bothering the writer of this question.  If this were not the case, we’d have to act like clinicians: Listen to our patient, ask questions, examine him, use the laboratory skillfully, and assess our data.  Discuss options with the patient and fix what we’ve found.  Then, we need to re-assess and find out what else needs to be fixed!  It is an on-going project.  When patiently pursued – and both the patient and the practitioner are included here – good results usually crown the effort.