October 25, 2007
Re: John Doe
To Whom It May Concern:
Mr. John Doe is a 55-year-old male who presented to Lyme Resource Medical P.C. on October 2, 2007, with symptoms including severe headaches, burning sensations in the feet, back, arms and hands, and drenching sweats. Onset of symptoms took place 21/2 years ago. Prior to his visit Mr. Doe had been diagnosed with ALS in June 2006, and had been seen and treated by specialists at the University of California at San Francisco, Johns Hopkins Medical Center, the Mayo Clinic, and the University of Pennsylvania Pain Center, which referred him to our practice. Mr. Doe was also acquainted with two other Lyme Resource Medical patients from Pennsylvania. Currently Mr. Doe is being treated with IV IG therapy and has had two of three infusions.
Mr. Doe has a long history of exposure to tick-borne disease in endemic areas including Martha’s Vineyard and southern Pennsylvania. During summers on Martha’s Vineyard he cut down trees in heavily wooded areas. In Pennsylvania he “romped through the woods” with his Lyme-infected dog. His father was diagnosed with Lyme disease.
Given this history of exposure and increasingly painful, untreated sensory symptoms known to be inconsistent with ALS, there exists the probability that Mr. Doe may be suffering from an atypical presentation of chronic relapsing Borreliosis (Lyme disease) and possible co-infection with other tick-borne diseases (Babesiosis is highly endemic on the Cape). Blood was drawn for laboratory testing at specialty laboratories including Fry Laboratories, Igenex, and Medical Diagnostic Laboratories. Oral medications including Azithromycin 250 mg bid and Mepron 750mg/5mL bid were prescribed for him.
Our 90-minute interview with the patient revealed evidence of a persistent, unusually debilitating, atypical neurosensory pain syndrome, as well as autonomic nervous system pathology (excessive sweats, vasomotor dysautonomies). At this visit his pain level had reached an intolerable level of discomfort. Mr. Doe’s symptoms now interrupt both daily activities (he works full-time as a litigator) and sleep.
Although several descriptive diagnoses of uncertain etiology have been proffered—i.e. large motor peripheral neuropathy, demyelinating polyneuropathy – the precise etiology of Mr.Doe’s symptoms remains unknown. A select subset of clinical patients have presented with similar symptoms of chronic relapsing Neuroborreliosis, and have benefited from extended intravenous antibiotic therapy. In addition, recent evidence has shown that IV ceftriaxone may in fact be useful in maintaining neurological function and slowing the progression of degenerative activity in ALS patients.
Therefore, we recommend the following protocol for Mr. Doe:
- – Insertion of a PICC line
- -IV Rocephin 2 g daily for 4 months
- -Weekly dressing change
- -Weekly blood draw—CBC with differential, CMP
Should you have further questions, please feel free to contact our office.
Bernard D. Raxlen, MD Carolyn B. Welcome, PA-C