Lyme, IBS, CFS

August 22, 2005

Hi Everyone,

I have a complex new case which is challenging my beginner's mind in a

big way. I have only seen him twice thus far but I will relate as

much info as I can. Sorry this is kind of long...

General background: 25 y.o. male who started having health problems 10

years ago as a teen. His problems started with IBS-like symptoms of

abdominal pain and alternating constipation and diarrhea. These

problems continued for many years with no relief and have

proegressively gotten worse. At 19, he was diagnosed with chronic

fatigue syndrome. Last April (2004) he was diagnosed with Lyme

disaese (via Western blot) though he has no idea when he actually

contracted it - said it could have been at any point in his life. At

some point he got a Fibromyalgia diag too.

Specifics:

IBS - alternating constipation (up to 3 days with no BM) and pebble

stools and diarrhea a few times per week. Lower abdominal pain and

cramping which is better after moving his bowels. Also with

occasional HTburn, gassy, bloating, belching and indigestion. Abd pain

better with heat. He has tried many diets all to no avail - he

currently eats a whole grain diet with veggies and meat. No sugar, no

coffee. He has a dry mouth, thirst for warm drinks. Occasional

bitter taste in the mouth. His appetite fluctuates from zero to being

very hungry.

CFS - extreme fatigue every day. Sleep is very irregular - anywhere

from 1-15 hours perday, typically 8-15 hrs. over the course of the

day. Has vivid dreams, nightmares, easily awakened. His energy is

low (1-4/10) - sl. better in late afternoon for a few hours. This

issue has severely impacted his life (along with other issues).

Lyme - severe neck pain from GB 20 down traps. Entire back is painful

and sore. Extremely sensitive to palpation all over his body. Muscle

cramping, knee and elbow pain. He's very agitated, anxious, edgy, has

a busy mind. Has chronic low grade sore throat and several raging

sore throats/year. He has hypersensitivity of sight, hearing, touch,

smell. Constant PND and phlegm in the throat. He took one year of

oral antibx - which helped initially but now symptoms are getting

worse.

Other S/S -

postural lightheaded/dizzy few times/week, cold extremities, no

unusual sweating, SOB on exertion, occ. palps, urinary difficulty

(starting and completing urination) urinary frequency (10-15x/day)

with some pain, urgency and dribbling after urination, in general

feels worse w/the change of seasons, stress, hot weather, better

w/heat (sauna or bath), massage, rest, stretching. Sexual energy is

fine. Constant dry eyes, some blurry vision/floaters. Occ. hi-pitch

tinnitus. Some hair loss. Pitting acne. Hx of earaches. Poor

memory in the past few years.

Tongue - pale, scalloped, red dots in tip, thick yellow coat over the

back half of the tongue. Sublinguals are OK.

Pulse - tight, slow (today it was 45 bpm)

My thoughts are - some kind of latent cold/heat combo, Qi xu (Spleen,

Kidney), Blood xu, bi syndrome, some kind of shaoyang syndrome (lots

of alternating symps) and blood and qi stag and ????

I have given him one week of herbs (raw) which had minimal effects on

his main problems but some minor improvements. I gave him a combo of

Juan Bi Tang and Xiao Chai Hu Tang plus additions. After seeing him

again today my thoughts are that he is more deficient than I first

thought. But his neck pain is far from deficient. I realize (and

have talked with him about) that the course of treatment may be on the

longer side of things.

His priorities for tx are #1) neck,back pain #2) digestive

complaints #3) energy/fatigue.

That's all I can think of at the moment (I think it's quite enough!).

Any feedback is appreciated. Thanks in advance.

Adam Schreiber

August 25, 2005

Hi Adam,

This is a complicated case, indeed. I have fibromyalgia myself, and am treating

a few individuals with complicated, Western diagnoses that are different from

your patient, but the presentations and TCM diagnoses are quite similar. I'm in

my 3rd year of practice, and all of a sudden I am seeing lots of knotty

diseases, and I also feel like a beginner - but my own journey through

fibromyalgia and a lifetime of weird diseases has taught me alot, and I do quite

a bit of research on my patients' behalf. So I hope what I say here is of some

use to you.

Everyone I know with fibromyalgia has symptoms that are worse with cold, and

also with hot, humid weather. Seasonal changes and stress also worsen

fibromyalgia symptoms, so what you wrote may be not be due to the Lyme disease.

There are some doctors who believe that fibromyalgia and CFS are actually the

same disease, which manifest differently in folks with different constitutions,

some showing more fatigue and frequent sore throats, and others presenting more

with body pain. It is not uncommon to see patients with both presentations.

And IBS is a common diagnosis with fibromyalgia, as are anxiety and depression.

Many people with fibromyalgia or chronic fatigue have always been highly

sensitive all their lives. They fit the category of Highly Sensitive Persons,

and a book has been written about people who are extremely sensitive in this

way. It is called The Highly Sensitive Person, by Elaine Aron. This might

underlie your patient's hypersensitivity to sights, sounds, smells, etc. An

interestng read. I am one of these people, and I participated in research

studies the author did prior to the release of her book.

I have a patient with fibromyalgia and the most wrecked digestive system I've

ever seen or heard of (she cannot eat real food). Her liver is also horribly

stuck and she has a history of extreme childhood abuse. Her chief complaint is

chronic headaches, then depression, then her digestive system last. I think in

order to relieve her headaches in any lasting way, I'd need to untangle the

wood-earth disharmony, which seems to me would take a very long time. This is

not her priority, so it is hard to encourage her to buy into this treatment. So

I am also addressing her headaches simultaneously. I have another patient who

has fibro, who only wants to address weight loss - a worthy goal for her. She

claims she suffers from extreme hunger, but careful questioning reveals that she

isn't physically hungry; she eats for emotional satisfaction. She doesn't want

to acknowledge that she is extremely angry, and this is what drives her to eat

too much. And so addressing her anger is not

her priority.

My point is that I am learning that sometimes what our clients want to address

isn't necessarily what will heal them, and sometimes what they want is different

from what they need.

In your patient's case, I'd like to know about his psycho-emotional state. I

see lots of folks who have chronic neck and shoulder pain with IBS, and the

problem is often liver qi stagnation leading to liver yang rising. Is he

unusually stressed? Is he a type A personality, driving himself despite his

fatigue? Liver qi stagnation often causes the alternating constipation and

diarrhea of IBS. Does he have headaches arising from the neck and shoulder

pain? What is the nature of his pain?

I see unraveling his IBS symptoms as of primary importance. He may also have

concurrent leaky gut syndrome or candida, which he should be tested for. If you

can normalize his bowels, this will help the rapid loss of qi and improve the

fatigue. It will also be necessary to strengthen his spleen, and maybe also the

kidney, since I do see signs of kidney qi xu as well - frequent urination and

cold extremities.

The mixed symptoms of cold and heat in the stomach and spleen remind me of a Ban

Xia Xie Xin Tang presentation. Perhaps you cold explore whether this would be

appropriate as a base formula, with some liver soothing herbs.

Nice case presentation. Good luck and let us know how it goes and what you

learn.

Adam Schreiber <chinesemed wrote: