Re: More Herxheimer information.

[Guest guest]

Hi Dabs,

I have never heard of anyone dying from a herxheimer reaction, that is

not to say it cannot happen though, but with good medical care it is

doubtful to me. And usually a herx can last one day to three days in my

personal experience, but all of us are different. Here is another article I

had on herxing:

Hugs,

Marta,

Southern NJ

Lyme Disease What is a Herxheimer Reaction? By Donna Herrell Founder, Lyme

Disease Information Resource pending 501©(3) status Overview: The

herxheimer reaction, nicknamed " herx " or otherwise referred to as Jarisch-

Herxheimer (J-H) is a phenomena originally observed in the treatment of

Syphilis, but later found in other illness. In general terms, it is

described as a temporary increase of symptoms when anti-syphilitic drugs

(antibiotics) are administered. What is known or speculated about Lyme

disease herxheimers are based heavily on the reactions seen in Syphilis.

This is due to the fact both diseases are caused by a bacteria known as a

spirochete, the former being Treponema pallidum, the latter Borrelia

burgdoferi (B.. However the herxheimer reactions in Lyme disease are not

identical to those seen in Syphilis, especially in terms of timing,

frequency and duration as noted below. In Lyme disease it is thought that

the cause of herxheimers are the result of endotoxin release, that is

toxin(s) within the spirochete that are released as the B.b are killed or

broken down. This may be a result of the toxin(s) itself or the body’s

immune response to such. Symptoms: As mentioned, the general description

is a temporary increase in symptoms, but also included is the development

of new ones. More specifically the most common events include: increased

joint or muscle pain, headaches, chills, fever (usually low grade), drop in

blood pressure, hives and rash. A multitude of other symptoms have been

described. Worth noting is that hives and rash are sometimes mistaken for

an allergic reaction. It is up to one’s physician to determine this, but

with close observation and the use of medications such as Benadryl often

prevents stopping antibiotics prematurely. In more severe cases of J-H a

reduction of the dosage or temporarily cessation of the treatment is an

alternative. Timing, Frequency and Duration: This is individualistic and

Herxheimer can occur within days to weeks after the onset of antibiotic

therapy. In some patients they occur only once or twice (if at all) and with

others continue throughout the course of treatment, usually lessening in

severity. They can occur and are more often described in cycles (example:

every 4 weeks) and have been reported to last from days to weeks. It can

be very beneficial to document these exacerbations. Some physicians use this

as a guideline for treatment. Further it may help differentiate herxheimers

from the normal symptoms or progression of Lyme disease. Treatment:

Herxheimer reactions can be very difficult on patients and affect compliance

with therapy so supportive measures should be sought or utilized to lessen

discomfort if needed. The use of aspirin, NSAIDs (non steroidal anti

inflammatory drugs), pain medication, muscle relaxers, hot baths or others

remedies can be appropriate. Of note, some have found Benadryl helpful even

in the absence of rash or hives. The good news is that the herxheimer is

thought to indicate that the antibiotics are indeed working and that

following each worsening may bring about more improvement. However the lack

of herxheimer reaction should not cause anxiety if symptoms are improving.

Other considerations: Something often overlooked but can present with

similar symptoms as a herxheimer is Candida (yeast) infection. Treatment

with acidophilus and if needed prescription medications such as Nystatin or

Diflucan can be utilized. Sources of Information: 1) Lyme Disease 1991 -

Patient/Physician Perspectives from the U.S. and Canada The

Jarisch-Herxheimer Reaction H. Katzel M.D. 2) Managing Lyme Disease

(1996) ph J Burrascano M.D. 3) Principles and Practice of Infectious

Diseases 4th Ed. Mandell, and 4) Seronegative chronic

relapsing neuroborreliosis. Lawrence C, Lipton RB, Lowy FD, Coyle PK Eur

Neurol 1995;35(2):113-117

____________________________________________________________________________

__ This document is for informational purpose only. This article may be

copied for personal use. For republication in any format Copyright 1997

http://www.x-l.net/Lyme/HERX.html

Copyright © 1995-1998 Lyme Disease Information Resource

Herxheimer reactions:

Posted to sci.med.diseases.lyme newsgroup by JWissmile 6/16/98

In the Book, Everything You Need to Know About Lyme Disease by

Vanderhoof- Forschner on page 53. She talks about what happens if the

eighth cranial nerve is affected by Lyme, " ..Equilibrium disturbances such

as dizziness, vomiting, or reeling are also associated with nerve

dysfunction " . With a Herxheimer Reaction symptoms get worse before they

get better. I know more than two people that experienced vomiting while

on IV antibiotics as part of a Herxheimer. They are now better.

This is from the 5/93 update to Lyme disease 1991- it is taken from Dr.

Burrascano's 5th edition of Lyme Disease Treatment Guidelines:.... " In

virtually all patients, when antibiotics are begun, symptoms flare in a

Jarisch Herxheimer-like fashion. This will usually occur within the first

five days and usually lasts from several days to two weeks. A late

ocurring or prolonged Herxheimer often predicts that more aggressive or

prolonged treatment will be needed. Be sure to have the patients expect

increased symptoms initially and stick to the treatment. Don't mistake a

Herxheimer-like reaction as either a treatment failure or an allergic

reaction.

" When IV antibiotics are given for more than three weeks, it is common for

a very SEVERE flare of symptoms to accur at the fourth week, similar to a

serum sickness reaction. This can be associated with leukopenia and/or

elevations in liver enzymes. You must follow these patients closely, and

decrease the dose temporarily or interrupt treatment for one to three days,

then resume carefully with s lower dose initially. This reaction only

seems to occur in those with longstanding, highly symptomatic disease. It

is IMPORTANT to expect this reaction, and quickly cut the dose, for if

you are able to continue therapy and get the patients through this rough

time, and continue IV meds through to the sixth week, then they

dramatically improve. Those whose treatment is stopped and not restarted

at this point usually need retreatment in the future due to ongoing or

recurrent symptoms. "

For what it is worth, I have seen this happen exactly as described

more than twice. The people that worked through the reaction got better,

the people that didn't relapsed. Benadryl, taken about 1/2 hour before the

administration of the antibiotic helped two friends very much. Both had

much less vomiting and nausea when the benadryl was added.

These are some quotes about the Herxheimer from another very informed

doctor.. I am not going to mention the doctor's name due to " dumb non-LLD

syndrome " . This doctor is one of the most knowledgeable but also, I

suspect, one of the most persecuted. (Probably because they don't want the

doctor to educate others.)What is a Herxheimer reaction?

Answer: The term was originally used to describe a reaction that occurred

6-10 hours after the initial treatment for syphilis. It consisted of

transient fever and a brief exacerbation of visible lesions. It is thought

that this is caused by either an allergic response to antigens or foreign

substances released by the organism when it is killed or that these

substances may have endotoxic properties. Much the same situation occurs

during the treatment of Lyme disease. Patients encounter a variety of

symptoms which may include fever, chills, rash and increased

symptomatology. Usually this reaction is seen with IV therapy but it can

(does-my words) occur during oral antibiotic therapy as well. The point at

which it happens during therapy varies from one antibiotic to another but

generally it does not occur prior to day 10. However, it is important that

you ask your doctor about this so that you will know what to expect.

Q. How can a Lyme patient be certain that he/she is experiencing a Herx

reaction and not an allergic reaction?

A: This is very difficult. Herx reactions are very common during

treatment of Lyme disease. It usually consists of fever, chills, sweats,

joint and muscle pain (me again-sounds like a fibromyalgia attack! I

couldn't resist.) and exacerbation of symptoms. It occurs in

approximately 50% of patients in varying degrees of severity. However,

this symptom complex is very similar to a type of allergic reaction that is

antiboby dependent, called serum sickness.

Originally serum sickness occured when large amounts of antiserum

prepared in horses or rabbits were injected into patients to protect them

from various diseases particularly during the period from 1900-1940. But

this reaction is also encountered with penicillin and other drugs.

Typically it occurs 3 days to 3 weeks after injection and the patient

experiences fever, enlarged lymph nodes and spleen, and painful joints.

Since a large amount of antigen or foreign substance is injected, there is

still a considerable amount of antigen available once antibody production

begins. This excess of free antigen is able to bind to newly formed

antibodies and form Ag-Ab complexes. In turn these complexes bind a

substance found in the blood called complement and attract

polymorphonuclear leukocytes (white blood cells). Lysosomal (digestive)

enzymes are released which cause tissue damage with destructive

inflammation of small blood vessels (vasculitis). Free complement in the

blood is depressed at the height of the reaction. This can be detected by

a blood test. Once the complexes are destroyed, free antibodies appear and

symptoms abate. But if the offending substance continues to be

administered, the vasculitis will result in chronic inflammmation.

Since the Herxheimer reaction seen in Lyme disease also involves a

reaction to a foreign substance (either one released by the organism once

it is killed or an endotoxin), it is important to carefully monitor the

patient once the reaction begins. Also, since the reaction is fueled by

excess antigen it can be controlled by decreasing the amount of antibiotic

that is used. This in turn decreases the amount of antigen or toxin. If

it is determined that this is not a detrimental situation it is important

not to stop therapy. It can be altered as described above but not stopped.

Once the patient has safely passed through this period he or she often

experiences a lessening of symptoms since reaction is often elicited in

response to spirochetal demise.

Re: [ ] Welcome to lyme-aidonelist

>From: Dabret22@...

>

>Dear Marta,

> I am overwhelmed by the warmpth and support I have rec. since joining

>lyme-aid.....I had forgotten about herx. and now realize I am not

>dieing...but I really thought I might.. did a wlll update and

>everything...Husband is great, but doesn't really get itHow long does a

herx.

>last??? HAS anybody died from lyme or herx??

>

> Dabs conn

[Guest guest]

Hi Marta,

I'm feeling much better today, and no longer think I might die. Honestly,

tho, I was so sick I just couldn't imagine my body being able to sustain much

more. Now I feel kind of stupid b/cause I was having a bad HERX AND SHOULD

HAVE REALIZED IT.

Thanks everyone for info and support.

Dabs

conn

[Guest guest]

Dabs,

I have gone through this up and down of Lyme disease for almost three

years now, I haven't been able to work since 10/96. Believe me, sometimes I

think this is it....here I go, but I always recover, and feel pretty foolish

afterward. Even worse, sometimes I think I am getting better, and get my

hopes up and start making plans etc., and then the tick bite site on my

scalp starts to swell up to the size of half an egg, I get sick all over

again.....it's like a damned roller coaster ride....

Hugs,

Marta NJ

>From: Dabret22@...

>

>Hi Marta,

> I'm feeling much better today, and no longer think I might die. Honestly,

>tho, I was so sick I just couldn't imagine my body being able to sustain

much

>more. Now I feel kind of stupid b/cause I was having a bad HERX AND SHOULD

>HAVE REALIZED IT.

>Thanks everyone for info and support.

> Dabs

> conn

>

>---------------------------

[Guest guest]

I found an article on serum sickness which Dr. Burrascano says your

symptoms can be similar to it. I will post it as soon as I receive it. [i

have to email to myself off the internet because I have separate email and

browser programs.]

Kiana (CA)

mailto:bornfree@...

O happy day

Rocephin

Came my way

To fight this Lyme

It is about tyme!!!

[Guest guest]

That was a great article on herx. Thanks very much. I am going through it now

and it is torcherous.

Holly

J & M McCoy wrote:

> From: " J & M McCoy " <mlmccoy@...>

>

> Hi Dabs,

> I have never heard of anyone dying from a herxheimer reaction, that is

> not to say it cannot happen though, but with good medical care it is

> doubtful to me. And usually a herx can last one day to three days in my

> personal experience, but all of us are different. Here is another article I

> had on herxing:

>

> Hugs,

> Marta,

> Southern NJ

>

> Lyme Disease What is a Herxheimer Reaction? By Donna Herrell Founder, Lyme

> Disease Information Resource pending 501©(3) status Overview: The

> herxheimer reaction, nicknamed " herx " or otherwise referred to as Jarisch-

> Herxheimer (J-H) is a phenomena originally observed in the treatment of

> Syphilis, but later found in other illness. In general terms, it is

> described as a temporary increase of symptoms when anti-syphilitic drugs

> (antibiotics) are administered. What is known or speculated about Lyme

> disease herxheimers are based heavily on the reactions seen in Syphilis.

> This is due to the fact both diseases are caused by a bacteria known as a

> spirochete, the former being Treponema pallidum, the latter Borrelia

> burgdoferi (B.. However the herxheimer reactions in Lyme disease are not

> identical to those seen in Syphilis, especially in terms of timing,

> frequency and duration as noted below. In Lyme disease it is thought that

> the cause of herxheimers are the result of endotoxin release, that is

> toxin(s) within the spirochete that are released as the B.b are killed or

> broken down. This may be a result of the toxin(s) itself or the body’s

> immune response to such. Symptoms: As mentioned, the general description

> is a temporary increase in symptoms, but also included is the development

> of new ones. More specifically the most common events include: increased

> joint or muscle pain, headaches, chills, fever (usually low grade), drop in

> blood pressure, hives and rash. A multitude of other symptoms have been

> described. Worth noting is that hives and rash are sometimes mistaken for

> an allergic reaction. It is up to one’s physician to determine this, but

> with close observation and the use of medications such as Benadryl often

> prevents stopping antibiotics prematurely. In more severe cases of J-H a

> reduction of the dosage or temporarily cessation of the treatment is an

> alternative. Timing, Frequency and Duration: This is individualistic and

> Herxheimer can occur within days to weeks after the onset of antibiotic

> therapy. In some patients they occur only once or twice (if at all) and with

> others continue throughout the course of treatment, usually lessening in

> severity. They can occur and are more often described in cycles (example:

> every 4 weeks) and have been reported to last from days to weeks. It can

> be very beneficial to document these exacerbations. Some physicians use this

> as a guideline for treatment. Further it may help differentiate herxheimers

> from the normal symptoms or progression of Lyme disease. Treatment:

> Herxheimer reactions can be very difficult on patients and affect compliance

> with therapy so supportive measures should be sought or utilized to lessen

> discomfort if needed. The use of aspirin, NSAIDs (non steroidal anti

> inflammatory drugs), pain medication, muscle relaxers, hot baths or others

> remedies can be appropriate. Of note, some have found Benadryl helpful even

> in the absence of rash or hives. The good news is that the herxheimer is

> thought to indicate that the antibiotics are indeed working and that

> following each worsening may bring about more improvement. However the lack

> of herxheimer reaction should not cause anxiety if symptoms are improving.

> Other considerations: Something often overlooked but can present with

> similar symptoms as a herxheimer is Candida (yeast) infection. Treatment

> with acidophilus and if needed prescription medications such as Nystatin or

> Diflucan can be utilized. Sources of Information: 1) Lyme Disease 1991 -

> Patient/Physician Perspectives from the U.S. and Canada The

> Jarisch-Herxheimer Reaction H. Katzel M.D. 2) Managing Lyme Disease

> (1996) ph J Burrascano M.D. 3) Principles and Practice of Infectious

> Diseases 4th Ed. Mandell, and 4) Seronegative chronic

> relapsing neuroborreliosis. Lawrence C, Lipton RB, Lowy FD, Coyle PK Eur

> Neurol 1995;35(2):113-117

> ____________________________________________________________________________

> __ This document is for informational purpose only. This article may be

> copied for personal use. For republication in any format Copyright 1997

> http://www.x-l.net/Lyme/HERX.html

>

> Copyright © 1995-1998 Lyme Disease Information Resource

>

> Herxheimer reactions:

> Posted to sci.med.diseases.lyme newsgroup by JWissmile 6/16/98

> In the Book, Everything You Need to Know About Lyme Disease by

> Vanderhoof- Forschner on page 53. She talks about what happens if the

> eighth cranial nerve is affected by Lyme, " ..Equilibrium disturbances such

> as dizziness, vomiting, or reeling are also associated with nerve

> dysfunction " . With a Herxheimer Reaction symptoms get worse before they

> get better. I know more than two people that experienced vomiting while

> on IV antibiotics as part of a Herxheimer. They are now better.

> This is from the 5/93 update to Lyme disease 1991- it is taken from Dr.

> Burrascano's 5th edition of Lyme Disease Treatment Guidelines:.... " In

> virtually all patients, when antibiotics are begun, symptoms flare in a

> Jarisch Herxheimer-like fashion. This will usually occur within the first

> five days and usually lasts from several days to two weeks. A late

> ocurring or prolonged Herxheimer often predicts that more aggressive or

> prolonged treatment will be needed. Be sure to have the patients expect

> increased symptoms initially and stick to the treatment. Don't mistake a

> Herxheimer-like reaction as either a treatment failure or an allergic

> reaction.

> " When IV antibiotics are given for more than three weeks, it is common for

> a very SEVERE flare of symptoms to accur at the fourth week, similar to a

> serum sickness reaction. This can be associated with leukopenia and/or

> elevations in liver enzymes. You must follow these patients closely, and

> decrease the dose temporarily or interrupt treatment for one to three days,

> then resume carefully with s lower dose initially. This reaction only

> seems to occur in those with longstanding, highly symptomatic disease. It

> is IMPORTANT to expect this reaction, and quickly cut the dose, for if

> you are able to continue therapy and get the patients through this rough

> time, and continue IV meds through to the sixth week, then they

> dramatically improve. Those whose treatment is stopped and not restarted

> at this point usually need retreatment in the future due to ongoing or

> recurrent symptoms. "

> For what it is worth, I have seen this happen exactly as described

> more than twice. The people that worked through the reaction got better,

> the people that didn't relapsed. Benadryl, taken about 1/2 hour before the

> administration of the antibiotic helped two friends very much. Both had

> much less vomiting and nausea when the benadryl was added.

> These are some quotes about the Herxheimer from another very informed

> doctor.. I am not going to mention the doctor's name due to " dumb non-LLD

> syndrome " . This doctor is one of the most knowledgeable but also, I

> suspect, one of the most persecuted. (Probably because they don't want the

> doctor to educate others.)What is a Herxheimer reaction?

> Answer: The term was originally used to describe a reaction that occurred

> 6-10 hours after the initial treatment for syphilis. It consisted of

> transient fever and a brief exacerbation of visible lesions. It is thought

> that this is caused by either an allergic response to antigens or foreign

> substances released by the organism when it is killed or that these

> substances may have endotoxic properties. Much the same situation occurs

> during the treatment of Lyme disease. Patients encounter a variety of

> symptoms which may include fever, chills, rash and increased

> symptomatology. Usually this reaction is seen with IV therapy but it can

> (does-my words) occur during oral antibiotic therapy as well. The point at

> which it happens during therapy varies from one antibiotic to another but

> generally it does not occur prior to day 10. However, it is important that

> you ask your doctor about this so that you will know what to expect.

> Q. How can a Lyme patient be certain that he/she is experiencing a Herx

> reaction and not an allergic reaction?

> A: This is very difficult. Herx reactions are very common during

> treatment of Lyme disease. It usually consists of fever, chills, sweats,

> joint and muscle pain (me again-sounds like a fibromyalgia attack! I

> couldn't resist.) and exacerbation of symptoms. It occurs in

> approximately 50% of patients in varying degrees of severity. However,

> this symptom complex is very similar to a type of allergic reaction that is

> antiboby dependent, called serum sickness.

> Originally serum sickness occured when large amounts of antiserum

> prepared in horses or rabbits were injected into patients to protect them

> from various diseases particularly during the period from 1900-1940. But

> this reaction is also encountered with penicillin and other drugs.

> Typically it occurs 3 days to 3 weeks after injection and the patient

> experiences fever, enlarged lymph nodes and spleen, and painful joints.

> Since a large amount of antigen or foreign substance is injected, there is

> still a considerable amount of antigen available once antibody production

> begins. This excess of free antigen is able to bind to newly formed

> antibodies and form Ag-Ab complexes. In turn these complexes bind a

> substance found in the blood called complement and attract

> polymorphonuclear leukocytes (white blood cells). Lysosomal (digestive)

> enzymes are released which cause tissue damage with destructive

> inflammation of small blood vessels (vasculitis). Free complement in the

> blood is depressed at the height of the reaction. This can be detected by

> a blood test. Once the complexes are destroyed, free antibodies appear and

> symptoms abate. But if the offending substance continues to be

> administered, the vasculitis will result in chronic inflammmation.

> Since the Herxheimer reaction seen in Lyme disease also involves a

> reaction to a foreign substance (either one released by the organism once

> it is killed or an endotoxin), it is important to carefully monitor the

> patient once the reaction begins. Also, since the reaction is fueled by

> excess antigen it can be controlled by decreasing the amount of antibiotic

> that is used. This in turn decreases the amount of antigen or toxin. If

> it is determined that this is not a detrimental situation it is important

> not to stop therapy. It can be altered as described above but not stopped.

> Once the patient has safely passed through this period he or she often

> experiences a lessening of symptoms since reaction is often elicited in

> response to spirochetal demise.

> Re: [Lyme-aid] Welcome to lyme-aidonelist

>

> >From: Dabret22@...

> >

> >Dear Marta,

> > I am overwhelmed by the warmpth and support I have rec. since joining

> >lyme-aid.....I had forgotten about herx. and now realize I am not

> >dieing...but I really thought I might.. did a wlll update and

> >everything...Husband is great, but doesn't really get itHow long does a

> herx.

> >last??? HAS anybody died from lyme or herx??

> >

> > Dabs conn

>

> ---------------------------