My Name is MRDAD and

Discussion in 'Lyme Disease Archives' started by mrdad, Feb 24, 2008.

  1. mrdad

    mrdad New Member

    ---I have Lyme. Sounds like one of those group meetings does
    it not? Anyway kids, if you saw my Post on Krista's inquiry
    you already know that. Victoria suggested that I post the
    results here on the Lyme Board and to solicit your input.
    So here goes:
    IGG IGM
    18kDa - 18kDa-
    22kDa- 22kDa-
    **23-25kDa- **23-25kDa IND
    28kDa+ 28kDa-


    30kDa- 30kDa+
    **31kDa+ **31kDa-
    **34kDa IND **34kDa-
    **39kDa IND **39kDa IND
    **41kDa+++ **41kDa++
    45kDa+ 45kDa-
    58kDa++ 58kDa-
    66kDa+ 66kDa-
    73kDa- 73kDa-
    **83-93kDa- **83-93kDa+

    Anyway, that's how they read, your input is welcome and
    appreciated!

    Thanks my Friends!
    MRDAD
    [This Message was Edited on 02/24/2008]
  2. victoria

    victoria New Member

    In a nutshell, most LLMDs would definitely consider you a very probable positive at the very least, based on the results above (as you did get positives on some important bands) and your continuing problems despite being treated for hemochromatosis... altho I don't think you qualify for being reported to the CDC unfortunately (IF I'm seeing clearly thru my brain fog...)

    You're already on doxy, aren't you? Are you getting a herx yet? That is something that is a constant response to treatment and indicates if you've got the right abx... unfortunately, different strains respond to different abx.

    How long is your doctor proposing treating you, and is s/he a LLMD? You should do some reading up on it all if s/he's not as usually there's a coinfection like bartonella or babesia... also flagyl needs to be used at some point to break up the cyst forms. There is a lot of good info here, as well as at
    ilads.org,
    canlyme, and
    http://flash.lymenet.org (also message boards there).

    There is a really good page on how to interpret the WB and the problems with the test and CDC's requirements for tracking, I've included some excerpts below, from

    http://www.lymenet.de/labtests/brenner.htm
    --------

    1. IgM is produced fairly EARLY in the course of an infection, while
    2. IgG response comes LATER.

    Some patients might already have an IgM response at the time of the EM rash; IgG response, according to the traditional model, tends to start several weeks after infection and peak months or even years later. In some patients, the IgM response can remain elevated; in others it might decline, regardless of whether or not treatment is successful.

    Similarly, IgG response can remain strong or decline with time, again regardless of treatment. Most WB results report separate IgM and IgG band patterns and the criteria for a positive result are different for the two immunoglobulins.

    Finally, in setting up a nationwide standard for a positive WB, one makes several assumptions --

    1. that all strains of Bb will provoke similar immune responses in all patients,
    2. that all patients will mount a measurable immune response when exposed to Bb, and
    3. that the IgG immune response will persist in an infected patient.

    Unfortunately, none of these is always true. Therefore, a judicious interpretation of Western blot results in a clinical setting should take into account both

    1. the vagaries of the human immune response and
    2. the possibility that strain variations in Bb might produce unusual banding patterns.

    The CDC criteria for a positive WB are as follows:

    * For IgM, 2 of the following three bands: OspC (22-25), 39 and 41.
    * For IgG, 5 of the following ten bands: 18, OspC (22-25), 28, 30, 39, 41, 45, 58, 66 and 93.

    How were these recommendations arrived at? The IgG criteria were taken pretty much unchanged from a 1993 paper by Dressler, Whalen, Reinhardt and Steere [2]. In this study, the authors performed immunoblots on several dozen patients with well characterized Lyme disease and a strong antibody response and looked at the resulting blot patterns. By doing some fairly involved statistical analysis, they could determine which bands showed up most often and which best distinguished LD patients from control subjects who did not have LD.

    They found that by requiring 5 of the 10 bands listed, they could make the results the most specific, in their view, without sacrificing too much sensitivity. ("Sensitivity" means the ability of the test to detect patients who have the disease, "specificity" means the ability of the test to exclude those who don't. Usually, an increase in one of these measures means a decrease in the other.)

    The IgM criteria were determined in much the same fashion (by different authors in different papers). Fewer bands are required here because the immune response is less mature at this point. Several studies have shown that

    1. the first band to show up on a Lyme disease patient's IgM blot is usually the one at 41 kDa,
    2. followed by the OspC band and/or the one at 39.

    The OspC and 39 kDa band are highly specific for Bb, while the 41 kDa band isn't. That's why the 41 by itself isn't considered adequate.

    Here's the rub, though: the CDC doesn't want the IgM criteria being used for any patient that has been sick for more than about six weeks. The thinking here is that by this time an IgG response should have kicked in and the IgM criteria, because they require fewer bands, are not appropriate for patients with later disease.

    A number of criticisms have been offered of the CDC criteria since their adoption in 1994.

    1. The first is centered on the CDC's failure to make any qualitative distinction among the various bands that can show up on a patient's Western blot.
    A number of Lyme disease researchers feel that different bands on a WB have different relative importance -- that "all bands are not created equal."

    For example,

    * many patients with Lyme disease will show reactive bands at, say, 60 and/or 66 kDa. However, these correspond to common proteins in many bacteria, not just Borrelia burgdorferi, and so are of limited diagnostic usefulness, especially in the absence of other, more species-specific bands.

    The band at 41 kDa corresponds to Bb's flagella (the whip like organelles used for locomotion -- Bb has several) is one of the earliest to show up on the Western blots of Lyme disease patients. But for some reason it is also the most commonly appearing band in control subjects. This may be due to the fact that many people are exposed to spirochetes at some time in their lives and so their sera might cross react with this protein.

    * On the other hand, certain other bands are considered highly specific for Bb -- the aforementioned
    o 31 kDa band, for example, or
    o 34 (OspB) or
    o 39 or OspC (anywhere between 22 and 25).

    Also thought to be species-specific are
    o The 83 and
    o 94 kDa bands.

    Many Lyme disease scientists believe that any patient whose IgG Western blot exhibits bands at, say, ANY 3 (or even 2) of these locations almost certainly has Lyme disease, regardless of whether or not any other bands are present. They feel that these bands on a Lyme Western blot are simply more meaningful than other, less specific ones and that a rational interpretation of a WB result should take this into account. Unfortunately, this does not often happen, and will happen even less with the new CDC criteria.

    2. A second criticism of the CDC Western blot criteria is that they fail to include the 31 and 34 kDa bands.

    This does indeed seem like an odd decision, since antibodies with these molecular weights correspond to the OspA and OspB proteins of B. burgdorferi, which are considered to be among the most species-specific proteins of the organism.

    Q: So why didn't Dressler et al. include them?
    A: These bands tend to appear late if at all in Lyme disease patients, and did not show up with great frequency in the patients that the Dressler et al. group studied (though they did show up sometimes). As a result, they weren't deemed to have much diagnostic value and didn't find their way onto the CDC hot list.

    However,
    * while the absence of either of these bands from a patient's immunoblot result does not rule out Lyme disease,
    * their presence is hardly meaningless.

    Thus, many Lyme disease experts believe it is a serious mistake to exclude these two antibody proteins from the list of significant bands. The CDC's decision to do so seems particularly strange in light of the fact that it is the OspA component of Bb that is being used as the stimulating antigen in the ongoing experimental Lyme disease vaccine trials. As one immunologist remarked shortly after the 1994 CDC conference, "If OspA is so unimportant, then why the heck are we vaccinating people with it?"

    3. Finally, it is important to keep in mind that no matter how carefully the Western blot test is carried out and interpreted, its usefulness, like that of all tests that measure B. burgdorferi antibodies, is ultimately contingent on the reliability of the human immune response as an indicator of exposure to B. burgdorferi. There are several scenarios in which the lack of a detectable antibody response may FALSELY suggest a lack of B. burgdorferi infection.

    A. First, it is well established that early subcurative treatment of Lyme disease can abrogate the human immune response to B. burgdorferi [3]. Although this is not thought to be a common phenomenon, a recent comparative trial for the treatment of erythema migrans found that a majority of patients who failed early treatment and suffered clinical relapse were seronegative at the time of relapse [4]. Even treatment for disseminated Lyme disease, in which the patient's IgG immune response was previously well-established, can render a patient seronegative after treatment despite post-treatment culture-positivity for B. burgdorferi [5, 6].

    B. In addition, patients with Lyme disease may not test positive for exposure to B. burgdorferi because their antibodies to the organism are bound up in immune complexes [7]. Once steps are taken to dissociate these immune complexes, free antibody can be detected; however, this is not routinely done when performing serologic tests for Lyme disease.

    C. Finally, an indeterminate number of patients with late Lyme disease are simply seronegative for unknown reasons [8]. The actual percentage of such cases as a proportion of all Lyme disease cases is impossible to estimate, since most studies of late Lyme disease enroll only seropositive patients, which tends to reinforce the circular and erroneous notion that virtually all patients with late Lyme disease are seropositive.

    D. It should also be noted that a positive Western blot is not necessarily an indication of active Lyme disease. A patient's immune response to B. burgdorferi can remain intact long after curative treatment for a Lyme infection; THEREFORE, THE RESULTS OF A WESTERN BLOT ASSAY WHOULD ALWAYS BE INTERPRETED IN THE CONTEXT of the TOTAL CLINICAL PICTURE.

    (caps mine)
    ------------

    LOL hope you don't get overwhelmed by all the info... print it off maybe to read later? I really hope this works for you!

    all the best,
    Victoria

  3. victoria

    victoria New Member


    Die Lyme DIE club!

  4. mrdad

    mrdad New Member

    You have provided much valuable insight and information. I'm
    really just starting to learn more in depth insight into the
    "disease". Your contributions and experience will prove to
    be very helpful.

    My Nurse Pract. actually spoke with the Tech at Igenex who
    evidently did the work. She has me on a 28 day Protocol
    Of Doxycycline. I've just finished the first week. No problems as of yet.(?) I have an appt. with Her, apres' the Protocol,
    and will request an intervention with a Specialist at UCSF
    Hospital. Have an email into my Hematologist too. We shall
    see. Thanks again. I'll be reading alot!

    MRDAD

    P.S. You mean like "Out Damn Spot"[This Message was Edited on 02/25/2008]
    [This Message was Edited on 02/25/2008]
  5. highcotton

    highcotton New Member

    just like out damn spot!

    treat and treat until it no longer omes back to plague you

    it's our mantra: Die Lyme Die!

    repeat until cured.