Worst Birthday Present Ever

I was so looking forward to my birthday this year. I’d cleared almost an entire week of obligations and planned to give myself the gift of six whole days working in the woods and garden. I’ve been building a new stone wall, cutting and splitting a black cherry tree that came down in a storm, and tending to my vegetable gardens.

Around noon on the day before my birthday, I started to feel awful. Headache, body aches, cold chills, the infectious works. I rescheduled my few remaining work appointments and went to bed.

Delirium

I don’t remember much of the next two days, but on the third day I felt a teeny bit better and thought I might even be able to eat something and keep it down. I texted Tim (my husband, who was on call for the infectious diseases service at our local hospital) the good news, and that’s when things took a turn.

Thud

I’m not sure precisely what happened before that last text, but somehow I ended up on the bathroom floor in a puddle of sweat with three dogs and a cat standing guard nearby, sniffing, and watching. Tim called right away and apparently I made very little sense on the phone, so he rushed to find coverage for the ID service and drove home.

Differential Diagnosis

My lovely health care provider ordered blood tests and Tim’s early money was on anaplasmosis, a tick-borne bacterial infection. I spend so much time crawling around in the woods and get tick bites all the time, so when my Lyme antigen tests came back positive we were not surprised. Remember: a positive test for Lyme antigens does not necessarily mean active Lyme. EIther way, I decided to go ahead with the treatment protocol for Lyme disease (doxycycline) and cross my fingers.

Caveat

Now, we Laheys don’t take antibiotics without clinical proof that a specific antibiotic is warranted. The more humans take antibiotics (and give them to our pets and livestock) when we don’t need them, the more likely we are to create all kinds of drug-resistant strains of diseases we won’t be able to treat. Besides, antibiotics are not harmless. They can cause all kinds of side effects, and mess with your body’s microbial balance. Tim and I have written about this for The Atlantic, actually.

The Death Spiral

Lyme disease is caused by a bacterium called Borrelia burgdorferi, a spirochete. It is shaped, as the name suggests, like a spiral or corkscrew, and is spread from small mammals and birds (where it does not cause disease) to humans (where it does) via blacklegged ticks. The tick acquires the spirochete from the small mammals and birds it feeds on, the spirochete hangs out in the tick’s stomach, the tick jumps on a human host, bites, then settles in to feed on that human’s blood. As the tick fills up with blood, it regurgitates blood back in to the human host, and that tick barf carries the spirochetes from the stomach of the tick into to the bloodstream of the human.

Once the spirochetes get into the human body, our miraculous immune systems send up an alarm (“Spiraly invaders! Attack! Attack! Shred those twisty bastards!”) and that’s when all hell breaks loose symptomatically. Sometimes a rash appears (a bulls-eye is classic, but there are other kinds, too) along with headache, fever, muscle aches, and fatigue. I never had a rash, but I sure did have everything else.

Enter Drs. Jarisch and Herxheimer

In the hours after my first dose of doxycycline, Tim was on high alert (read: a heightened state of scientific titillation) for signs of Jarisch-Herxheimer reaction, a short-term recapitulation of Lyme symptoms that can happen in some patients when they start treatment.

Around 8:00 PM, I noticed a red spot on my knee. Then there were two, then four, popping up as fast as I could count them, all over my body. Pretty soon after that, my headache returned, then the chills, and finally muscle soreness. While it was uncomfortable, it was also fascinating. How often do you get to watch your body go to immunological battle in real time?

I also realized this is the first time I’ve been sick with something I could not spread. Unless I bit you. And barfed. Maybe.

Here’s a breakdown of how Jarisch-Herxheimer reactions work: my body knew it had been invaded by an army of corkscrew-shaped invaders. it had seen the twirly bastards and learned how to recognize, find and rip them to shreds. However, once the ripped-up shreds started circulating around in my body, my immune system was re-activated because it did not recognize those shreds as something it had seen and fought before. As far as my immune system was concerned, I had a new invader and it mounted an immunological response. As it began to battle against the shreds, the same physical manifestations of the original battle against Borrelia burgdorferi began to appear once again.

That’s so cool, right??? It’s not only cool, it’s proof positive that Lyme is what caused my illness and that the doxycycline is working.

Tim and I geeked out and took some pictures of my spots for posterity. His colleagues made the requisite syphilis jokes (another well-known spirochete) and I rolled my eyes and went back to sleep for two days.

Moral of the Story

The human body is a miraculous thing and while this experiment in immunology has been a gas, I’m happy to report I’m nearly back to my old self. I will be heading out into the woods today to work on that cherry tree armed with a full dose of tick repellent and sporting the latest in tick-resistant fashion: long sleeves and pants tucked into socks and work boots.

Stay safe out there friends, and don’t forget to do your tick checks! Here’s a handy guide from the U.S. Forest Service to help you out.

P.S.

I’ve turned comments off because I am not particularly interested in getting into any medical or Lyme-related debates. I’m just reporting back from the front lines of my own very cool, geek-a-licious immunological experience.