CBC (Complete Blood Count) and Chemistry Panel
TSH
Free T3
Free T4 (these three might be combined in some kind of "thyroid panel")
optional: testosterone while we're poking around in the endocrine system, can *rarely* be the cause of fatigue
These rule out anemia and hypothyroidism which are two common causes of fatigue. If you ever been told by a significant other that you stop breathing for periods of time while sleeping, or wake gasping for air, or are significantly overweight, or have any other sleep apnea risk factors you might want to get a sleep study performed.
From Igenex, you should have tests #188 and #189 performed, the IgM and IgG Western Blot.
WESTERN BLOTS
The Lyme Western Blot tests involve a highly complex visual determination of protein bands, based on their molecular weights and intensities. For both tests, IGeneX uses multiple negative controls to serve as baselines for comparison to positive responses. The IGeneX report form provides an interpretation along with the results in detail for the physician. Two Western Blot tests are available: IgG and IgM.
IgG WESTERN BLOT
The IgG Western Blot is an immunoassay and qualitative test in which antibodies are visualized. The IgG antibody is typically present a few months following initial infection. It is a qualitative test and is generally more sensitive and specific than the ELISA. This test must be used if the Lyme IgG/IgM antibody serology or Lyme IgG/IgA/IgM IFA is equivocal or positive. The somewhat specific Lyme antibodies of importance are against the following molecular weights of the B. burgdorferi antigens: 23-25 kDa (Osp C); 31 kDa (Osp A); 34 kDa (Osp B); 39 kDa; 41 kDa (common of flagella-bearing organisms); and 83-93 kDa. The term “kDa” refers to kilodalton for molecular weight designations. The term “Osp” refers to Outer Surface Protein of the bacteria.
There are currently multiple criteria that support a positive blot. “Positive” means consistent with the presence of antibody against B. burgdorferi. The CDC/ASTPHLD criteria are very conservative and require 5 of 10 bands for a positive result; equivocal or borderline results are not recognized. Unfortunately, not all Lyme patients have similar immune systems: only approximately 70% of those with Lyme disease generate a strong enough antibody response to appear on a western blot. IGeneX criteria of 2 starred bands is >96% specific for exposure to B. burgdorferi.
IGeneX has several years of clinical data that support more liberal reporting criteria.10 In addition, current studies show that the CDC/ASTPHLD criteria miss some patients with culture-proven erythema migrans (EM).5,11 Both the IGeneX and the CDC/ASTPHLD criteria are included on the IGeneX report form sent to the physician. 3,5,8,9 The CDC/ASTPHLD criteria for positive results are 5 of the following 10 antigenic bands: 18 kDa, 23-25 kDa (Osp C); 28 kDa, 30 kDa, 39 kDa; 41 kDa, 45 kDa, 58 Kda, 66 KDa, and/or 83-93 kDa. IGeneX criteria for positive result is 2 of the following 6 bands: 23-25kDa, 31 kDa (Osp A), the 34 kDa (Osp B), 39 kDa, 41kDa and/or the 83-93 kDa. 31kDa and 34kDa antigens are included to the criteria due to their importance in the recurrent and/or persistent disease period. IGeneX criteria of is 96% specific for exposure to B. burgdorferi.
A positive IgG result with clinical history may be indicative of Lyme disease. Patients with other spirochetal disease and/or who test positive for rheumatoid factor or Epstein Barr virus may have cross-reacting antibodies. A positive response in this, as in any antibody assay, indicates sensitization, not necessarily active disease. 12
Figure 4. Significant antibodies detected by Western Blot (Lane 1 has kDa marker proteins)
Test # 189
Description Lyme IgG Western Blot
Specimen 0.5 ml Serum
Collection & Shipping
Collect in Red top tube, separate serum and send at room temperature.
OR Collect in SST tube, spin and send at room temperature.
CPT CODE: 86617
IgM WESTERN BLOT
The IgM Western Blot is a very sensitive indicator of exposure to B. burgdorferi. It may be positive as early as 1 week after a tick bite. This test will usually remain positive for six to eight weeks after initial exposure. Re-exposure will also cause this test to be positive for a brief period of time. For the testing to be complete, it is preferable that the IgM blot be run along with the IgG blot.
The antibody specificities of importance for the IgM blot are the same as those for the IgG blot. The CDC/ASTPHLD criteria for positive results are 2 of the following 3 antigenic bands: 23-25 kDa (Osp C); 39 kDa; and/or 41 kDa.8,9 IGeneX adds the 31 kDa (Osp A), the 34 kDa (Osp B),10,12 (with the argument that these two antigens were used for the vaccines and therefore, antibodies to these antigens are of importance) and/or the 83-93 kDa to the criteria due to their importance in the recurrent and/or persistent disease period. IGeneX criteria of 2 bands is 96% specific for exposure to B. burgdorferi. Sera from patients with some acute viral infections can give false positive results. Therefore, an IgM viral panel may useful to rule out false positives IgM Western blot results due to viral infection. Note: The IgM Western blot is often positive in patients with persistent infection.6 Sometimes it is the only marker detected.
A positive IgM result with clinical history may be indicative of early Lyme disease or persistent infection in otherwise serologically negative individuals. Recently reported data support our observation that some Lyme patients may have only restricted IgM response to B. burgdorferi.
Test # 188
Description Lyme IgM Western Blot
Specimen 0.5 ml Serum
Collection & Shipping
Collect in Red top tube, separate serum and send at room temperature.
OR Collect in SST tube, spin and send at room temperature.
CPT CODE: 86617
If all of this comes up negative I would start chasing viral possibilities, of which there are several.
If you come up with absolutely nothing after exhausting all of those possibilities and everything that any of your more imaginative doctors come up with (heavy metals, mold, other similarly rare and unlikely options), I would try one empiric trial of minocycline and another with valtrex or valcyte while having CBC and chemistry, liver, kidney, and pancreatic function monitored by a physician (monthly blood test). This kind of self-doctoring would be an absolute last resort and I don't recommend it -- I'm just telling you what I would do.
Good luck!
P.S. do you have any issues with digestion, gut health, etc? I notice you are taking multiple probiotics already and average people do not typically have much interest in probiotics until gut problems strike. It is potentially relevant.
I am also making a basic assumption that you eat a healthy diet rich in fruits and vegetables, and low or zero processed foods, junk food, refined grains, no excessive sugar consumption, no excessive caffeine or other stimulant abuse, get adequate exercise and sleep, etc etc. If any of this is untrue you can put the testing on hold and straighten yourself out first.
Edited by FunkOdyssey, 07 November 2008 - 09:22 PM.
