1. Raj Patel, M.D. Handling Herxheimer’s Reactions in Lyme Disease Handling Herxheimer’s Reactions in Lyme Disease Lymelighters Forum Raj Patel, MD 650-964-6700 www.DrRajPatel.net

2. Raj Patel, M.D. Overview Overview A.History B.Definition C.Symptoms D.Clinical Implications E.Management F.Goal

3. Raj Patel, M.D. Handling Herxheimer’s Reactions in Lyme Disease 1. History  Adolf Jarisch and Karl Herxheimer at the turn of the century  Seen in syphilis patients treated with mercury  Commonly seen in spirochetal infections

4. Raj Patel, M.D. Handling Herxheimer’s Reactions in Lyme Disease 2. Definition  Inflammatory immune response to endotoxins, cell wall antigens, and other cellular constituents  Elevations in cytokines, TNF, IL6, & IL8  Toxin release exceeds clearance

5. Raj Patel, M.D. Handling Herxheimer’s Reactions in Lyme Disease 3. Clinical Implications  Clinical indicator of treatment efficacy and presence of spirochete  Antibiotics vary in the intensity of herx they elicit

6. Raj Patel, M.D. Handling Herxheimer’s Reactions in Lyme Disease 4. Symptoms  Headaches  Fevers  Myalgias  Arthralgias  Fatigue  Rashes  Nausea/vomiting/diarrhea  Behavioral changes  Others

7. Raj Patel, M.D. Handling Herxheimer’s Reactions in Lyme Disease 5. Management  Mild: Water, Exercise/Lymph drainage, Homeopathic drainage remedies (oral)  Moderate: Charcoal, Clay, Cholestyramine, Dry skin brushing, Epsom salt/Baking soda baths, Ionic foot baths  Severe: Enemas/Colonics, Homeopathic drainage remedies (injectable), Glutathione, NSAIDS

8. Raj Patel, M.D. Handling Herxheimer’s Reactions in Lyme Disease 6. Goal Effectively control the severity and length of Herxheimer’s reactions during the early stages of treating chronic infections