In the world of Lyme disease there is a little thing called the Herxheimer reaction. It is something that is extremely prevalent and affects a countless number of people, yet is still largely counted as a mystery by many patients and doctors alike. So, what even is the Herxheimer reaction? And why is it such a pain in my ass?
But first, some history: In the late 1800’s/early 1900’s there were two Dermatologists/bacterial researchers. One, an Austrian-Adolph Jarisch-and the other, a German-Karl Herxheimer. While studying the affects of Syphilis on patients during treatment, the two first observed that many patients got much worse before they got better. They noted that it appeared in both the early and later stages of treatment and believed that the reaction was caused by toxins being released from the dying spirochetes (Syphilis is a spirochetal cousin of Lyme disease). And thus the term Jarisch-Herxheimer Reaction, or JH (aka herxing), was born.
JH generally occurs in patients when the Lyme spirochetes are being killed off. When spirochetes die, their bodies fragment into pieces and in reaction to this the immune system produces what is called a cytokin. These cytokins create inflammatory symptoms in the body which is what creates a temporary worsening of symptoms in patients.This is the major reason why patients who suffer from Lyme tend to get worse before they get better during treatment. Though interestingly enough, it has been reported that only 15% of patients experience this reaction.
The general worsening of a patient’s underlying symptomatology can last anywhere from a day to several months. The symptoms related to this event can range from the mild to the severe and at times even debilitating side of fatigue, headaches, fevers, joint and muscle pain, etc. Patients whose Lyme has progressed to the tissue of their central nervous system can often experience a whole slew of neurological and emotional side effects as well. To be clear, herxing does not happen to all patients and it cannot be a bar to which you judge whether or not your treatment is working. If you start a new treatment and you do not herx, you’re lucky.
It is a mystery as to what symptoms a patient will experience, and it varies from patient to patient as to how long their JH will last. So on the whole, it just sucks.
Many LLMD’s (Lyme literate medical doctor’s) who are aware of JH often like to treat those affected in pulses. For example, if a patient is taking oral antibiotics they will take them for 3 days, then not take them for 4 days and repeat that for however long the doctor thinks is necessary. For some people this can help with the herxing, and give the antibiotics a chance to kill as many spirochetes as possible.
Spirochetes can take on four different forms. First those corkscrew buggers can encyst-that means that the spirochetes become immune to all forms of treatment a doctor can throw at it. Furthermore, a spirochete can survive in the cyst form for years and cause no symptoms to the patient. Secondly, spirochetes can burrow into cell walls wreaking all kinds of havoc which can lead to intracellular infection. Many people are often misdiagnosed with psychiatric and autoimmune disorders. This stage proves to be very difficult to diagnose and treat. Third, it has been shown now that spirochetes can band together and create a biofilm. Imagine a sticky, ooze of a basketball net coming together and forming a solid layer of goop. And that is what spirochetes do when they are feeling spiteful and want to protect themselves from antibiotics. To be fair, it’s just what they are meant to do-can we really be mad at them?
And last, but most certainly not least, the spirochete themselves in all of their corkscrew, drilling glory. The spirochete has an incredible ability to be extremely mobile, and due to it’s unique corkscrew shape it can drill right into dense areas of tissue and bone where it hides from the penetration of antibiotics. In the end, spirochetes prove incredibly difficult to kill. Since herxing is a reaction to dead spirochetes, it actually turns out to be a pretty good sign.
One more thing I want to mention, along these same lines, is POTS. Some of you may have heard of it, but it goes hand in hand with chronic Lyme and the Jarisch-Herxheimer reactions. POTS (Postural Orthostatic Tachycardia Syndrome) is a type of autonomic nervous system dysfunction. What this means is a patient experiences chronically low blood pressure (one reason why you may get really dizzy when you stand up), causing the heart to overcompensate by beating faster-resulting in palpitations (tachycardia). Due to the poor cerebral blood flow that is going on in the body, fatigue, dizziness, poor concentration problems and, more seriously, nearly or actually passing out are common symptoms. POTS could be an additional reason why so many Lyme patients have lingering, chronic symptoms. Be careful, though-POTS can often be misdiagnosed as an anxiety or panic disorder. In order to definitively diagnose POTS, a head-up tilt-table (HUT) test would need to be done.
I embellish with my own personal knowledge and humor, but almost all of this information I got from two amazing books:
-“Why Can’t I Get Better” by Richard L. Horowitz, MD
-“Healing Lyme” by Stephen Harrod Buhner
Read them, learn from them, use them.
Next week, I’d like to get back to talking about antibiotics and alternative treatments and protocols.