Direct Anterior Approach for Total Hip Replacement

Lyme Disease

Lyme disease is a bacterial infection transmitted to humans through the bite of an infected tick. It is caused by the bacteria Borrelia burgdorferi and Borrelia mayonii.

What is Lyme Disease?

Lyme-Borreliosis as a disease was first recognised in the mid 70’s when it became prevalent in the town of Old Lyme in Connecticut, USA. Lyme is an infectious disease. A bacteria, the spirochaete Borrelia burgdorferi, first described in 1982 by US/Swiss micro-biologist Willy Burgdorfer, is transmitted by ticks in most cases. In some instances, mosquitos or horseflies are responsible.

Quite a few species have been identified so far, with the most common types in America the B. burgdorferi sensu stricto, in Europe the B. b. sensu stricto, B. b. afzelii, B. b. garinii, B. bavariensis. In Australia, according to the Australian Chronic Infectious Disease Society Limited, B. afzeli, B. garinii, B. valaisiana and b. bavariensis can be found.

Following a bite of an infected tick, the saliva and thus the Borrelia burgdorferi goes into the skin and/or the blood. The organisms are very agile and begin to spread both locally and systemically.

Signs of Infection

Usually, several days elapse before the first signs of infection, i.e., erythema migrans (EM), other less typical rashes or flu-like symptoms occur. Due to its agility and phenotypic changes the Borrelia can easily penetrate the cells and survive inside long term. When it goes intracellular, the bacteria becomes resistant to antibiotics because most antibiotics do not go intracellular. It builds biofilms and produces biotoxins. The toxins destroy tissues especially nerves & glands.

Chronic Lyme Disease is the most common form of borrelia infection. 30-50 percent of untreated or conventionally treated patients develop a multisymptom and multisystem disorder.

Whole Body Hyperthermia and Lyme Disease

In 1998, St. George Hospital saw two cancer patients who at the same time suffered from severe symptoms of Lyme disease. They were treated with Whole Body Hyperthermia as part of our integrative cancer treatment concept. As expected, both patients showed good improvements concerning their cancer symptoms. But to everyone’s surprise, the symptoms of Lyme disease completely disappeared as well!

Dr. Friedrich R. Douwes immediately went into intense research about chronic Lyme disease. Pretty soon he realized the immense suffering of these patients: the year-long conditions, with loss of life quality and the little that mainstream medicine has to offer besides antibiotics and symptomatic treatment. This led him to a treatment protocol for chronic Lyme disease based on Whole Body Hyperthermia.

Chronic Lyme Disease

Weeks or even months after the tick bite, a great variety of symptoms may occur. Multiple rashes after infection are typical of systemic dissemination to their target tissues and cells. Neck stiffness is rather common for the chronic state of Lyme. Some of the chronic symptoms can in fact be disabling.

Symptoms can Develop Years After Infection

While in general three stages of Lyme are mentioned, we at St. George Hospital differentiate by symptoms and treatment options. Thus we distinguish between an acute and a chronic stage.

Acute Lyme Disease

The main symptom of the acute phase is the erythema migrans. Days or weeks after the tick bite an erythema forms around the puncture site, which first spreads and later pales centrally, leaving a circular erythema. This occurs in fewer than 50% of the patients.

General symptoms that occur may be flu-like:

fever
myalgia
sore throat
headaches
lymph node swelling
neck aches
fatigue

Rhinitis, sinusitis and cough are not usually present, distinguishing this “flu” from other influenza-like illnesses.

Different countries have different borrelia species and different species may cause different symptoms. For instance, Lyme disease is principally a neurological disease in Australia, whereas in North America single or pauci migratory arthritis with gross swelling predominates.

Chronic Lyme Disease

For instance meningoradiculitis Bannwarth is distinguished by burning radicular pain with or without paralysis. In children, one more often sees meningitis type courses. Cardiac involvement is specified by an atrioventricular blockade grade I-III. The Lymphadenosis cutis benigna Bäfverstedt (borrelia-lymphocytome) is a tumor like manifestation mostly occurring at the earlobe, breast nipple, or scrotum. Arthralgias primarily involve the large joints (e.g. knees, elbows, hips, shoulders), although smaller joints (e.g. wrists, hands, fingers, toes) may also be involved.In the late chronic stage, sometimes referred to as stage III, lyme arthritis and acrodermatitis chronica atrophicans Herxheimer (ACA) are typical manifestations.

They may develop even years after the infection. ACA leads to an atrophy of the skin.The symptoms of chronic Lyme are caused by biotoxins & co-fact.

Symptomatology

For simplification we add a list of the symptoms that may occur with chronic Lyme disease.

Pains

can be severe, jumping from joint to joint
can be in the teeth or in the temporal-mandibular joints
can be in the ribs and chest
can be abdominal, testicular or pelvic
paresthesias such as burning, numbness, tingling and itching are frequent; there may be crawling sensations, vibrations, or electric shock-like sensations
there rarely is an actual palsy of the affected areas, making this much more of a neurosensory, rather than a motor disease

Neurologic

headaches,
dysequilibrium
cognitive dysfunction, brain fog
short-term memory loss
tremor
encephalitis or encephalopathy
aseptic meningitis and facial nerve (Bell’s) palsy tend to occur within the first few months following the tick bite, but may also occur as part of a reactivation

Psychiatric

anxiety
depression
panic

Other

fevers
sweats
visual dysfunction (described primarily as blurriness, but can include optic neuritis or uveitis, keratitis, episcleritis)
tinnitus, hyperacusis (noise sensitivity), hearing loss
Shortness of breath, palpitations and/or tachycardia
diarrhea or irritable bowel
urinary frequency or urgency

Co-factors associated with chronic Lymes Disease

Infections transmitted with a tick bite (Babesia, Bartonella, Brucella, Chlamydia, Ehrlichia, Mycoplasma, Rickettsiae, Theileria. etc.)
Herpes viruses
Fungus, Candida
Hormonal dysbalance
Toxicity (metals, mold, neuro and biotoxins)
Allergies
Immune system dysfunction
Endocrinal problems (thyroid, Hashimoto, adrenals, etc.)
Mitochondrial dysfunction
cardiac diseases (myocarditis, cadiomyopathy)
Inflammatory reactions, Arthritis
Autonomic nervous system dysfunction
Gastrointestinal problems (colitis, leaky gut, etc.)
Liver and kidney dysfunction
Psychological dysfunction

In our patients we quite often find impaired: Hypophysis-adrenal axis, adrenal fatigue, disturbed sexual function, no periods (menopause-like symptoms in young women), estrogen dominance, hypogonadism, etc. Typical periods of worsening symptoms alternate with phases of improvement. This occurs cyclically every few weeks. Some patients are more symptomatic than others. Occasionally a macular or haemorrhagic rash may appear. Generally, these rashes are only slightly irritating or pruritic. This may indicate co-infection.

As symptoms can be diametrically opposite and Lyme disease mimics various other diseases, it becomes clear why diagnosing it is such a difficult task. Therefore, much too often Lyme patients end up in the psychiatric corner.ors.

Acute Stage

At the time of the first rash, it is advisable to treat immediately with antibiotics and not to wait for laboratory results, because an early therapy increases the healing chances markedly. Several antibiotics are effective in the acute stage if given for two weeks. Nevertheless, patients still developing subsequent symptoms of arthralgias, fatigue, or paresthesias should be treated longer with antibiotics. Tetracycline, doxycycline, or amoxycillin should then be used for one month.

Chronic Stage

If symptoms persist for more than six months, antibiotics don`t work anymore and even prolonged treatments are useless. Why? Borrelia at this time are intracellular or in areas where the concentration of antibiotics is questionable (tendon insertions, ligaments, brain etc.). The borrelia may have built a biofilm, so they cannot be reached by the antibiotics.

Treatment for Chronic Lyme Disease

Treatment Protocol

Clinical Work-Up

Initial and final lab controls (CBC, electrolytes, coagulation parameters)
ECG, lung function test
Dark field blood analysis or similar diagnostics dependent on each patient’s individual situation
VCS

Systemic Whole Body Hyperthermia

The ancient world already knew the healing power of an elevated body temperature achieved by fever. This is the effect we use here.

Borrelia burgdorferi is very thermolabil. The low tolerance of spirochetes for high temperatures is well known and explains the absence of B.b. in the tropics, where infected ticks may be exposed to high temperatures detrimental to spirochete survival. Thus, the borrelia can be completely destroyed at 41,6 °C (106,9 °F).

In vitro cultivation of B. burgdorferi demonstrates that the spirochete replicates most quickly at 37°C (98,6 °F). If the temperature is increased to 39°C (102,2 °F) the growth of B.b. is significantly impeded. At 41°C (105,8 °F) all spirochetes in the culture are being killed after 24h, whereas at 41,6°C all spirochetes are being killed after 2h.

In our Whole Body Hyperthermia Unit (Heckelbed), the temperature rise is achieved slowly in the entire system, including the brain. We raise the temperature to 41,6 – 41,8 degrees C (106,9 – 107,2 °F) and then maintain it for two to three hours. This treatment takes place under analgosedation, no general anaesthesia is being used.The patients are monitored as in Intensive Care, one Intensive Care nurse for each unit and one physician for 5 units. With some 15.000 treatments carried out during the past 20 years we never had any major complications.

Contra-indications for Hyperthermia

pronounced bone marrow depression
pronounced cardiac/pulmonary insufficiency >2
thrombosis, anti coagulants
inadequate cerebral circulation
severe lymphedema
kidney insufficiency
acute infections, body temperature above 38,5°C

Side Effects of Hyperthermia

During the warming-up phase, due to an extention of the vessels, the blood pressure may drop. This can easily be met with a substitution of liquids.
Under the therapy, all known forms of cardiovascular and sedation related side effects may occur, such as arrythmia, aspiration, respiratory depression, lung edema, etc. These effects can be reduced to a minimum by a conscientiously preparation.
Cerebral seizures rarely occur, but can be treated with intravenous Diazepam.
Burns are rare and thermo-related pressure lesions occur only in about 3% of the patients when positioned correctly.
After the hyperthermia, the body temperature often rises by itself. This fever is a result of an immunologic response. We also see Herxheimer reactions, which can be treated adequately.

Adjuvant Therapy Program

Infusions with high dose Vitamin C, chelation, selenium, procaine, antibiotics (not obligatory)
Ozone Therapy (intravenous and/or rectally)
Laser Therapy (intravenous)
Pulsing Magnetic Field Treatment in combination with Singulet Oxygen Therapy
Special massage with andulation
Blue light

Detoxification Program

Detox footbath
Colon cleansing
Daily oral medications and supplements

Infusions/detoxification program is established by the physicians according to the individual situation of the patient. It is necessary to cope with the Post Lyme Syndrome caused by the toxins created by the borrelia. That means repair of the damaged nerves or endocrinic organs with special treatment, including cell therapy.

Partner Treatment

Lyme can be sexually transmitted. Many people have Lyme without ever having had a tick bite. Therefore, we offer a Lyme Partner Treatment which includes 2 nights as inpatient, 1st day preparation (EKG, lung function, basic laboratory, detox with colon therapy), 2nd day the whole body hyperthermia + intravenous therapy, 3rd day observation.

Pre-Travel Steps:

Identification of Treatment Need: Your GP or consultant will diagnose the need for Lyme disease treatment, such as surgery, based on your medical condition and symptoms.
Contact Healthcare Abroad: Initiate contact with Healthcare Abroad to begin the process of arranging your Lyme disease surgery in an EU country under the Cross-Border Directive. We specialize in facilitating timely access to medical care, bypassing waiting lists.
Liaison with GP and Diagnostic Tests: Our team will collaborate with your GP to organize a referral letter and any necessary diagnostic tests, ensuring a comprehensive assessment of your condition. Test results will be promptly provided to the chosen hospital.
Selection of Hospital and Surgeon: Utilizing our extensive network of hospitals and surgeons, we will match you with a facility and specialist that meet your specific requirements and preferences.
Financial Assistance: If needed, we can assist you in organizing finances through Irish credit unions to cover the costs associated with your Lyme disease surgery abroad, allowing you to access treatment without delay.
Arrangement of Surgery Dates: We will liaise with the chosen hospital to secure suitable surgery dates, prioritising your needs and ensuring timely intervention. Your medical files will be transmitted securely for review by the surgical team.
Confirmation of Travel Dates: Once your healthcare plan is finalised, including surgery dates and logistics, we will confirm your travel arrangements with the hospital team, ensuring seamless coordination for your journey abroad.
Travel Preparation: With all arrangements in place, you are now ready to travel. Upon arrival at the hospital, you will have an outpatient appointment with your consultant the day before your scheduled surgery, providing an opportunity for final pre-operative assessments.
Post-Discharge Paperwork: Following your discharge from the hospital, our team will handle all necessary paperwork, including submission to the Health Service Executive (HSE) for reimbursement. We ensure timely processing to facilitate your refund efficiently.
Update of Medical Records: Your GP will receive a detailed report from the hospital abroad regarding the Lyme disease treatment you received. This information is essential for updating your local medical records and ensuring continuity of care upon your return to Ireland.

Download Travel Information

Some important information for patients travelling for Lyme disease.

Patient Information

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Healthcare Abroad

Our service is free to our patients.

The EU Cross Border Directive scheme is a refund scheme. You pay the hospital or clinic for your treatment and we submit a refund application to the HSE afterwards. We prepare the application form and all the supporting documentation required for you to claim your refund.

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