Lyme Disease / Lower Body

Bigger Stronger Leaner Injuries and Rehab
1

my goal this summer was to get back into shape, and stronger so i can try out for my school track team and pole vault this year (gonna graduate in the spring). however i hurt my knee a bit ago.

in about mid june my left knee, calf, and ankle were swollen and i couldnt walk for a week, and would wake up in pain from my knees at times. i didnt have insurance until mid july and didnt see doctor till the end of the month when most of the swelling went down and i was walking again. i got some blood work and i had lyme disease, put me on antibiotics, and told me to cancel my ortho appt that i scheduled and just worry about getting rid of the lyme disease first. now from what ive read joint pain is common with lyme disease, and even swelling in my knee, (just didnt know it would affect my whole left leg).

heres the problem, i still have the rest of the month on antibiotics. My left knee is still a bit swollen, maybe some fluid or something, but it feels pretty good otherwise and im sick of not doing any lower body work. this is prob a stupid question but i was wondering if anyone here had lyme disease and wat their thoughts of exercising the body part that was hurting was. i forgot to ask about exercise and dont know if i should wait till after i see him next month or not.

also i tried just doing squats with the bar last week, and my legs were definitely feeling it. the problem was when i was doing them, my right side (the good side) felt more strained then the left side (injured side). i think im unconsciously overcompensating and wasnt sure if i should just keep on doing complex movements, or if i should i just do unilateral stuff on just my left leg or something till it catches up with my right?

so i guess my two questions are, should i try and stay off my knee until hopefully the antibiotics work and im good? and if i should lift, what types of exercises should i do to try and rehab and get back into things.

3

Hi, I just wanted to weigh in on this thread since it concerns an area I know a bit about. First, as a former track athlete, let me say that everyone knows that pole vaulters have the biggest balls around. People thought that the 1500m was tough but I’d much rather do that than pole vault.

I’m concerned about the care you may be getting regarding your Lyme diagnosis. I understand that your young and that you were uninsured for a period of time, but Lyme has far reaching consequences if not treated properly.

Because of your swollen joints, your Lyme is categorized as early disseminated, assuming you have no neurological symptoms (facial twitches or paralysis, unexplained weakness in the limbs, etc).

Currently, there are two standards of care for Lyme. The first (IDSA) would call for a month of antibiotics (typically Doxy). The second (International Lyme and Associated Diseases Society) would call for oral therapy until there is no clinical proof of disease for 4 - 8 weeks, which would mean your being treated for 4 - 6 months typically.

I don’t know if you have any experience advocating for yourself in a medical setting, and I know it can be hard to sit across from a doctor and question his advice, but this is the time to do it. The consequences of untreated Lyme are too serious, otherwise.

When two standards of care exist, the treatment decision belongs to the patient. I would encourage you to spend 2-3 hours educating yourself, and then when you see your doctor again, getting the treatment that you and your doctor think will be most efficacious.

EDIT: DO NOT GET STEROID INJECTIONS TO REDUCE THE SWELLING IN THE KNEE Sorry for the all caps and bold, but this is extremely important. Steroids (cortisone, Prednisone) are immunosuppresive and are absolutely contraindicated in Lyme.

Good luck and feel free to post here or PM me if you have any questions.

For further reading:

Advanced Topics in Lyme Disease, 16th Ed., October 2008 Burrascano, J.J

<---------- Not a Dr.

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[quote]Dr. Pangloss wrote:

Currently, there are two standards of care for Lyme. The first (IDSA) would call for a month of antibiotics (typically Doxy). The second (International Lyme and Associated Diseases Society) would call for oral therapy until there is no clinical proof of disease for 4 - 8 weeks, which would mean your being treated for 4 - 6 months typically.
[/quote]

did u mean i should be doing one or the other or both?. currently im taking doxycycline hyclate and have about 10 days left till im done that (for a total of 30 days). should i be taking the oral therapy afterwards for another 4-6 months?

and also im pretty confused about the rehab part of the article:
“Despite antibiotic treatments, patients will NOT return to normal unless they exercise, so therefore an aggressive rehab program is absolutely necessary. It is a fact that a properly executed exercise program can actually go beyond the antibiotics in helping to clear the symptoms and to maintain a remission.
Although the scientific basis for the benefits of exercises is not known, there are several reasonable theories. It is known that Bb will die if exposed to all but the tiniest oxygen concentrations. If an aggressive exercise program can increase tissue perfusion and oxygen levels, then this may play a role in what is being seen. Also, during aggressive exercise, the core body temperature can rise above 102 degrees; it is known that B. burgdorferi is very heat sensitive. Perhaps it is the added tissue oxygenation, or higher body temperature, or the combination that weakens the Lyme Borrelia, and allows the antibiotics and our defenses to be more effective. Regular exercise-related movements can help mobilize lymph and enhance circulation. In addition, there is now evidence that a carefully structured exercise program may benefit T-cell function: this function will depress for 12 to 24+ hours after exercise, but then rebound. This T-cell depression is more pronounced after aerobics which is why aerobics are not allowed. The goal is to exercise intermittently, with exercise days separated by days of total rest, including an effort to have plenty of quality sleep. The trick is to time the exercise days to take advantage of these rebounds. For an example, begin with an exercise day followed by 3 to 5 rest days; as stamina improves, then fewer rest days will be needed in between workouts. However, because T-cell functions do fall for at least one day after aggressive exercises, be sure to never exercise two days in a row. Finally, an in intermittent exercise program, properly executed, may help to reset the HPA axis more towards normal. On the following page is an exercise prescription that details these recommendations.”

this confuses me because i thought that aerobic exercise promoted blood flow throughout the body and so there would be tissue oxygenation?
do you think that warming up on a bike for a couple mins and doing 5 mins of intervals is ok bc im not doing it that long or should i just stop and do more warm up sets or something instead?

7

[quote]fong520 wrote:
did u mean i should be doing one or the other or both?. currently im taking doxycycline hyclate and have about 10 days left till im done that (for a total of 30 days). should i be taking the oral therapy afterwards for another 4-6 months?
[/quote]

Lyme spirchetes go through long periods of dormancy where antibiotics can not affect them. It’s believed that antibiotics can only kill Lyme during the growth phase, which occurs for some short period of time every 4 weeks or so. Therefore, treatment needs to last longer than just 4 weeks and your symptoms need to be watched 4 weeks after treatment starts.

Here’s why: patients undergo something called the Jarisch-Herxheinmer effect, or herxing for short. Essentially, the bacteria contain a neurotoxin that is released as they die off. The body is slowly overwhelmed in it’s ability to filter out the neurotoxin and a new bout of symptoms occur that may include flu like symptoms as well as a rash and itchiness. Although it sounds awful, it’s actually a good thing. It means that the antibiotics are working. The first bout of herxing may take place 48-72 hours after treatment starts, and then apporximately every 4 weeks thereafter. Once you stop herxing, you continue to take antibiotics until another 4 weeks elapses. No herxing means that no living bacteria are present.

Continued use of Doxy is the oral therapy referred to above. Additionally, it’s been shown that higher serum levels of Doxy results in more killed bacteria than stable serum levels, therefore 200mg qd (once a day) is better than 100mg bid (twice a day), provided your stomach can handle it. Doxy is caustic so take it with plenty of water, you don’t want it getting stuck in your esophagus. Pick up some acidophilus to keep your intestinal flora intact. Doxy is a relatively benign antibiotic otherwise, and is well tolerated. It’s also well researched for prolonged use and it’s given to teens commonly for months at a time to battle acne.

A little bit of my story: I found a tick on me and the tell tale bulls eye rash 3 days later. I went to my doc the next day and got a 2 week course of Doxy. A little more reading and I realized how serious the consequences of untreated Lyme (or failed treatment) could be, so I went to the University of Chicago Library, parked my ass in a chair for a couple weeks and read everything I could. Most striking was the divergence in courses of treatment between the Infectious Diseases Society of America and the International Lyme and Associated Diseases Society. The treatment recommended by the IDSA was inadequate IMHO, given the risks of long term infection, so I brought the ILADS treatment guidelines to my doc and told him this his how I wanted to be treated. After 6 weeks, I believe that the living organisms were eradicated.

Best of luck, let me know if you have any other questions.

Thanks to BBB for answering the second part of the OPs question.

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Continuing the discussion from Lyme Disease / Lower Body:

Dr Pangloss –

I have been dealing with neurological symptoms for awhile, and things like swollen knees and tests (without arthritis) - received 3 weeks doxy about 3 years ago. Was bitten as a teenager, now 28 y.o.

do you have any recommendations on how to pursue new course of treatment? I’m impressed with your approach, I was uneducated and was not inclined to question my doctors orders at that time.

I’ve read up on ILADS standard of treatment, but there are limited options that allow for use of insurance. Any advise you can provide would be appreciated.