49  Page 2                                              Robert S. Grimshaw, Jr. M.D.  Newsletter    January 1999

Yes, I’d like the Lyme vaccine.  Here is my check for $130 for the day 1 and day 30 doses: Name___________________________________ Telephone______________________________ LYMErix vaccine for preventing Lyme disease is now available!  The vaccine is approved for people 15-70 years old.  It does not prevent all cases of Lyme, and it does not prevent the other two diseases carried by the deer tick, Ehrlichiosis (common in our area) and Babesiosis (not seen here yet).  But it does provide significant protection against Lyme: 50% after the first two shots (one month apart) and 78% after all 3 shots (one year).  Side effects have been few (soreness, swelling and rare flu-like symptoms, muscle and joint pain).  Your cost will be $65 per dose, with 3 doses needed: day 1, roughly day 30 and day 365.  Spring is the time to immunize! Due to the anticipated demand, we’ll need a check  beforehand; if you want the shots, send us a $130 check for the 1st 2 doses, and we’ll buy them for you.  Insurance coverage is unlikely.  I  intend to get the vaccine myself.

Hypertension is Not Treated Hard Enough: says Boston University’s Dr. Dan Berlowitz and colleagues.  Their study in The New England Journal of Medicine, looked at 800 hypertensive patients at 5 VA hospitals.  40% had BPs higher than 160/90 despite more than 6 visits a year.  Increases in therapy occurred in only 6.7% of visits. All of us -- doctors and patients -- have to be more aggressive in attacking blood pressure to prevent stroke, heart attack and congestion, and kidney failure.

Mavik for Diabetic Nerves
An “Early Report” in The Lancet from Dr. Rayaz Malik and colleagues at the Manchester Royal Infirmary in England looked at 41 diabetic patients. Those treated with trandolapril (Mavik) showed improvement in diabetic nerve damage.  Mavik is in the class of drugs called angiotensin converting enzyme (ACE) inhibitors; it is not yet known if the other drugs in the class (Accupril, Altace, Capoten, Monopril, Prinivil, Vasotec, Zestril, etc.) might do the same.  ACE inhibitors are known to help prevent and improve diabetic eye and kidney disease.
A Viral Cause of Multiple Sclerosis?  A report from Dr. Konstance Knox and colleagues at the University of Wisconsin and the Institute for Viral Pathogenesis caused a big stir at the 123rd annual meeting of the American Neurolog-ical Association in Montreal.  Their studies and those of Dr. Joseph Brewer at St. Luke’s Hospital in Kansas City (presented at the annual Infectious Diseases Society meeting in Denver) showed early evidence that human herpes-virus-6 (HHV-6) reactivation may set the stage for the nerve destruction disease.  Dr. Knox’ group found cells infected with HHV-6 in the central nervous system of 8 of 11 MS patients.  Dr. Brewer’s group found HHV-6 in blood cells in 8 of 13 with relapsing remitting MS.  Dr. Brewer said there’s hope that antiviral agents such as ganciclovir (Cytovene) might alter the course of the disease.  HHV-6 is known to cause illnesses such as the skin disease roseola, and is acquired by most people by age 3.  Some skepticism about HHV-6 is in order, according to Dr. Gary Birn-baum, Professor of Neurology at the University of Minnesota.  “We told our patients that the data as presented did not establish a cause-and-effect relationship.”
“Brain Attack!”: Up to 6 Hours for Clot Buster
according to researchers involved in the European Cooperative Acute Stroke Study II.  The clot buster, t-PA (Activase) can be used later after the onset of stroke, they say. Currently less than 1% of stroke patients get t-PA in the US, because most arrive beyond the current 3 hr guideline.  T-PA treatment has been shown to decrease disability (though not survival).  So, if you or a loved one are having new weakness in one body area, such as an arm, leg or speech, get to the hospital immediately.


Homocysteine & Diabetes by now most of you know that homocysteine - which is produced by the metabolism of protein - is likely involved in heart, brain and other artery diseases. Now comes a report in Diabetes Care that homocysteine rises early in diabetic kidney disease.  Elevations are treated with B-vitamins: folic acid, B-6 and B-12.