Tissue is the issue--revised version

NB: images in this post are thought to be in the public domain, but were not well labeled, so if you feel they have been posted without proper attribution, please email me or leave a comment. Thanks. Also, this is a revision of a post from yesterday which I've pulled secondary to ethical concerns. I've deleted the comments so we can start out fresh. --PalMD

I can't seem to get this whole "morgellons" thing out of my head (which gives me something in common with the sufferers). Lots of the "literature" on morgellons focuses on the "fibers" which supposedly infest these people. If you google it, you can get pictures galore of these fibers. The advocacy websites are also full of stories of "fiber analysis" from law enforcement. I'm not much for crime lab analyses when it comes to human pathology. Show me the tissue!

If morgellons were a disease as such, it would cause pathologic changes in the tissue affected. These should be visible on both a gross an microscopic level. Let me show you what I mean.

A young woman came to see me a few years back with a rash. She had rashes in the past---poison ivy, mosquito bites, chicken pox---but this one was different. It was all over her legs, many of the bumps were raised, and it was spreading quickly.

i-92435be37ebb69572454bcca95c3e048-eruption.jpg

I'm not a dermatologist, but a good internist knows the difference between a usual rash and an unusual rash---this was an unusual rash; the kind that often indicates underlying systemic disease. I of course did a thorough history and physical, and ordered laboratory studies, but what I really needed was a biopsy.

The pathologist prepared microscopic samples by slicing pieces of the specimen very thinly and applying certain stains.

__________________________________________________

Now, there are diseases and syndromes for which pictures do not speak as clearly. When someone has a typical case of low back pain, you can't slice up a piece of back and learn anything. But you can do imaging studies to look for significant pathology.

Lupus, a rather tricky disease, doesn't have one diagnostic study that says, "this is lupus", but when you put together a number of abnormal findings on a patient with lupus, you've got a diagnosis. Each finding in and of itself can be a bit "mushy", but the findings are objective, verifiable, and replicable.

I've received a lot of very earnest mail about morgellons. The people who think they have this are miserable. They are pretty convinced that this "morgellons" thing explains what's going on. But to successfully hang a name on a syndrome, you've got to do a lot better than having non-specific skin lesions, a wide range of seemingly-unrelated psychological symptoms, and some pictures of fibers. The literature on morgellons, such as it is, is full of pictures of rashes and fibers, but I've been searching in vain for pathology slides of biopsies (feel free to send web addresses or images if you have the real thing).

Look, folks, if you're going to try to "discover" a new disease, gather some data. Fiber analysis is meaningless when isolated from true pathologic data. When the only positive information is coming from a pharmacologist, physicians assistant, nurse practitioner, and patient advocate, we're not going to learn all that much. They just don't have the right tools. Dermatologists who have seen this "syndrome" have been unimpressed.

It is not reasonable to believe that every real physician is conspiring to ignore an emerging illness. We love new diseases...they're fascinating. When an astute observer noticed a rash of cases of Pneumocystic carinii pneumonia a few decades ago, epidemiologists and other professionals went on the hunt and discovered HIV/AIDS. When, a few years ago, people on the east coast began to fall ill with fevers and encephalitis during the summer, we found that West Nile virus had immigrated to the U.S. We're pretty good at this. It's not arrogance to demand evidence to back up extraordinary claims. When simple and elegant explanations for a set of data are available, there is not need to invoke a deus ex machina.

When a physician is confronted with an unusual skin finding, sometimes a glance is all you need. Shingles looks like shingles (although there are further tests that can confirm it). But if it looks unusual, we send a biopsy, as I did on the woman pictured above.

Skin is a pretty complicated organ, and when things go wrong, you can usually see something abnormal under the microscope. This slide is pretty typical of what was seen on my patient.

i-78f0dadbee42b08e6a088cf294103751-eruptionmicro.jpg

Now, instead of having a pathologist figure out that my patient had a leukocytoclastic vasculitis, I could have come up with an explanation on my own. Some reasonable guesses would have been infectious endocarditis, leukemia, idiopathic thrombocytopenic purpura. But I would not reach for "previously unknown parasitic disease set off by Lyme disease infested with fibers that cannot be identified by a crime lab in Oklahoma." I also would not consult a non-medical professional with odd ideas. When confronted with a mystery whose answer is elusive, it's better to grab an explanation that doesn't require us to overturn decades of basic medical knowledge.

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Sorry, forgot to turn comments back on. Good now...have at it.

You blasted reductionists always want to boil things down to tissues and cells and molecules and atoms instead of dealing with the WHOLE PERSON. How can you understand something like Morgellons if you never look up from the cells to see the fibers?

By D. C. Sessions (not verified) on 16 Oct 2008 #permalink

I have heard of many Morgellons patients who have had dermatological biopsies, including myself. I have never actually seen the slides for myself, but only read the pathologists' reports. Invariably, they rule out numerous OTHER diseases, but show only a non-specific inflamatory reaction with more, or less, surrounding tissue necrosis and large amounts of non-specific cellular debris. By the time it is stained and processed in an off-site lab, I have never heard of ANY fibers, or unusual cells or organelles being present.
This is one of the PRIMARY reasons that patients have been accused of delusional parasitosis and self-inflicted lesions.
I believe that we should perhaps consider that while this process may cause only non-specific inflammatory damage to the skin tissues involved; there may be related pathological agents that simply degenerate to "non-specific cellular debris" during our standard collection, processing, storage, transportation, or staining methods for most office collected punch biopsies. We may not be seeing the full picture, or correctly interpreting the results we are getting. MORE CAREFUL STUDIES need to be done and more complete, thorough analysis should be made.
However, why would I, as a patient, seek multiple (more costly) biopsies, when NO-ONE has suggested that they can offer me better treatment and care than I can get without these? If you tell me a lab that wants to run special studies on Morgellons' specimens for free, I can help you get doctors to submit samples prepared in what-ever manner that lab requests, within the week. Just let me know how and when you wish to fund this study.

By Beverly BD MD (not verified) on 16 Oct 2008 #permalink

Occam's Razor, while not a "law", is a pretty good thinking guide. For example,

Invariably, they rule out numerous OTHER diseases, but show only a non-specific inflamatory reaction with more, or less, surrounding tissue necrosis and large amounts of non-specific cellular debris. By the time it is stained and processed in an off-site lab, I have never heard of ANY fibers, or unusual cells or organelles being present.
This is one of the PRIMARY reasons that patients have been accused of delusional parasitosis and self-inflicted lesions.

The most parsimonious explanation of the pathology report is not "ur doing it rong" but that there are no pathologic "fibers" and that the patient's invocation of a strange new disease is incorrect.

Reductionism? What is wrong with asking for some plausibility? All things produced by a body have to come from cells.

New Age ideas may feel good, but if I have some strange things coming out of my skin, the first I'm going to want to know is what the pathologist sees on the biopsy.

By The Blind Watchmaker (not verified) on 16 Oct 2008 #permalink

If I look in my closet, and I see no evidence of the bogeyman, I must assume that there is no bogeyman in my closet. Or should I postulate an invisible bogeyman? Perhaps one that can turn into a shoe when the closet door opens?

By LanceR, JSG (not verified) on 17 Oct 2008 #permalink

First apologies for getting you into ethically gray areas. My feeling is that it was HIPAA compliant, but I understand the need for caution. Particularly since the chances of a discussion in this context leading to anything useful for the patient are extremely low.

We may not be seeing the full picture, or correctly interpreting the results we are getting. MORE CAREFUL STUDIES need to be done and more complete, thorough analysis should be made.

What factors, theoretical or emperical, lead you to suspect that something is being missed in the biopsy samples? What would you like to see done to better preserve the samples for analysis? What more careful studies would you like to see made in order to clarify the diagnosis in patients where the question of Morgellon's syndrome has arisen? Simply saying "something's not right here" may be true, but by itself it doesn't lead to a useful research pathway.

OMG...someone get the butterfly net.

The patient above had leukocytoclastic vasculitis, secondary to, in retrospect, an exposure that can cause this rash.

How many times to I have to dis-invite you?

You make the false assumption that a physician does not develop a proper differential diagnosis. I did have a good differential on the patient. I did not include certain conditions, for example motor vehicle accident or porphyria, both of which can cause skin changes but were entirely unlikely. The biopsy confirmed my suspicion.

But... everything that may LOOK like whatever my obsession is must BE whatever my obsession is!

Listen, twit. Just because you have a hardon about Lyme disease does not mean that every strange rash *is* Lyme disease. There are specific tests for Lyme disease, as there is a specific parasite that causes Lyme disease. No parasite, no Lyme disease.

Just because you disagree from looking at a picture does not make you right. Only Bill Frist can diagnose long distance! (kidding!)

By LanceR, JSG (not verified) on 17 Oct 2008 #permalink

I suspect that low NO in the skin may predispose a patient to get this. In that sense it may bear some resemblance to DoP which I think is also usually caused by low NO in the skin causing hypersensitivity of mast cells.

I found this interesting abstract, where a woman had similar recurring episodes coincident with menstruation and which remitted during pregnancy.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/33/6/586

The time of menstruation is a time of low NO, ovulation and pregnancy are times of high NO (except during preeclampsia and other sequelae of late pregnancy which are characterized by low NO).

Exposure to many different agents can cause low NO because most xenobiotics are metabolized by the cytochrome P450 enzymes which generate superoxide as a necessary part of their activity. The skin also contains xanthine oxidoreductase which can produce superoxide too when activated by xenobiotics or proteases.

Hi PalMD,

I can't work out how to post pics but you can see some morgellons fibres in skin at the links below. The third link includes text. In the context of 'tissue is the issue' I'd appreciate it if you could provide some comments.

http://www.morgellons-research.org/morgellons/pics/after-dsp1.jpg

http://www.morgellons-research.org/morgellons/pics/morgellons-fibers3.j…

http://www.clongen.com/morgellons_disease.php

By Doctor Duck (not verified) on 17 Oct 2008 #permalink

Thanks, DD, but those are simple photographs of skin. Pathology specimens are prepared, stained, etc.

There's an old saying in medicine.

"When you hear hoof-beats, think horses. Not Zebras."

Thus gives rise to the term "Zebra diagnosis". This is a variation of Occam's Razor.

PalMD likely had all of the Zebra's on the differential, but the Horses must always top the list.

Medical students spend a lot of time learning about the Zebra's. They start "hearing" them everywhere. It is not until about the second year of residency that they get pretty good at spotting the horses. When it does not really act like a horse, then the zebra-loving medical student in us awakens.

In the end, it's the tissue diagnosis that matters. All the rest is zebra hunter cognition.

By The Blind Watchmaker (not verified) on 17 Oct 2008 #permalink

"In the end, It's tissue diagnosis that matters."
I was always taught to never rely on a solitary test to make a diagnosis or treat a patient. If you have ever worked in a path lab (I did a rotation in one as a student.) you will understand why it is NEVER safe to trust completely in one single lab test, unless that test is confirming a well-considered clinical diagnosis.

I appreciate Dr. Niels' comments, and must agree that if you have a sick patient, what good is a meaningless descriptive diagnosis? You either need to rule out all the possible treatable etiologies of similar conditions, or determine how to care for the symptoms of the illness that your patient is exhibiting. Abandoning a sick individual to an "idiopathic," or descriptive diagnosis, is NOT offering medical care! One might as well diagnose someone with Morgellons. :-) (In our current state of medical neglect for such patients.)

I feel, however that discussing patient-centered, compassionate care here on this blog is a lot like trying to reason with a drunk or psychotic person. After reading the definitions of "denialism," I see that it is possible to define any opinion or perspective that is not completely standardized and pre-measured in its agreement to your own simple logic, as "denialistic," or just mis-guided.

Incidently, Lyme disease is NOT a Zebra, it is the largest vector-borne transmissible illness in our country and the cases keep growing every year. The consequences and sequelae for missing the diagnosis and delaying treatment are enormous.

To reply to earlier responses on my post; Blind Watchman--I have had some of MY fibers analyzed, and they were composed of simple poly-glycolic acids at that particular time. (The building blocks of hair & nails, etc.) Other people have had fibers collected and analyzed and they had more exotic components such as polyethylene. Now what good is my biopsy, if it tells me NOTHING about why my body continues to produce abnormal fibers and excrete them?
In response to PalMD, I would like to have studies done where multiple subjects gave multiple "fresh" specimen samples, collected at a research facility. Wet-preps could then be compared to preserved & stained specimens. More types of stains could be used to assess the amount and TYPE of "cellular debris, and whether this is actually the remains of what originally appeared as "fibers."
LanceR, I am living every day of my life with Bogeymen, and NOT simple clothes in my closet. If I wasn't sick, I wouldn't keep looking for a better answer. If my flesh would heal and remain intact when I do NOT scratch or touch it, I would feel healthier. If my doctors could explain what causes my symptoms and give me any effective treatment, I would not hesitate to use it. I have fully explored the possibility of OCD or DOP with my psychiatrist. He cannot offer me any help in this matter, despite numerous forms of medications tried faithfully over the past few years. I don't care what label I am given or what I am called, if only someone can find an easier method of controlling this problem, than the current mish-mash of home remedies that we are using!

By Beverly BD MD (not verified) on 17 Oct 2008 #permalink

From whence came the assumption that PalMD stopped at the diagnosis? I feel certain that he went on to treat the allergy that (probably) caused the problem, and the young lady went away happy.

If he had spent time and resources chasing zebras, the problem may have spread to her organs, causing a serious possibility of death or disfigurement before *real* medicine took over.

"they were composed of simple poly-glycolic acids" Polyglycolic acid is not "The building blocks of hair & nails, etc.". It is a polyester blend commonly used for absorbable sutures. If the fibers *were* keratin (the actual building blocks of hair and nails) the doctor would be an idiot to not realize that an adult grows hair.

Any competent doctor or pathologist would realize that there are fibers on everything. Every surface we touch, everything we eat, are covered in tiny fibers. They come from the clothes we wear, the fabrics we use in our homes, the insulation we use. Everyone has these fibers. When a patient decides that these fibers are abnormal, we know they are suffering from a form of delusional parasitosis.

There has never been a case of "morgellon's" that did not turn out to be clothing fibers or hair. Ever. Not once. You need to consult a *reputable* dermatologist to discover why you itch, and have these sores. Forget about some mystery zebra disease and find the horse that is causing the problem.

Good luck.

By LanceR, JSG (not verified) on 17 Oct 2008 #permalink

Beverly,

Of coarse you would not rely on one test. A good doctor would not order a biopsy without first having a examined the patient, developing a differential, and doing the basic blood tests. The tissue will either confirm your suspicion, falsify it, or be equivocal.

If the pathology fits with the clinical picture, then you have your working diagnosis. I am sure that you understand this if you are a practicing doctor. Sheeeesh!

Oh, and "Chronic Lyme Disease" should never be at the top of a differential for nonspecific symptoms. Sure, do a Lyme titer, but don't cling to this diagnosis when the titer is negative. "Seronegative Lyme" is the king of Zebras.

By The Blind Watchmaker (not verified) on 18 Oct 2008 #permalink

Nice. The entire site at www.morgellonshope.org is link spam. Click any link on the entire page, and it serves up ads. For which I assume the site's owners get paid.

For someone accusing doctors of only having profit in mind, this is pretty hypocritical.

Asking us to believe in mysterious fibers that only you and like-minded people can find is difficult at best. This sort of blog spamming is not helping. And the "rot in hell" tirade against doctors is called "poisoning the well". By accusing doctors of wanting to make "a killing", you are trying to taint anything they say afterwards as just another try to defend their profits.

We've asked several times: show us the evidence. If there is evidence, just bring it out. There is none, you know it, and yet you persist. Until you have evidence, we will continue to look for the horse, not the zebra.

By LanceR, JSG (not verified) on 18 Oct 2008 #permalink

OMG

By The Blind Watchmaker (not verified) on 18 Oct 2008 #permalink

Part of the problem with things like this is the enormous stigma our society places on mental illness. If you miss work or cancel dinner plans because of the flu, no one judges you or thinks less of you. If you do the same because you suffer from depression, though, there's a damn good chance you will be judged, and harshly. Depression is not just feeling sad, it is not a matter of being weak-willed, and it certainly is not a moral failing. If a doctor suggests that a patient has depression, she is not saying that the patient is a bad person or did something wrong. She is honestly trying to help that patient, because while no treatment is perfect, depression is something that we can generally treat and help people live with.

Although "delusional" is an insult in day-to-day speech, a doctor suggesting that a patient has delusions of parasitosis is not insulting her patient or calling him stupid. She is honestly trying to help him, because the signs and symptoms suggest that the patient's problem is psychiatric in nature. While such conditions are difficult to treat, therapies do exist, and offer the patient a better chance of recovery than does diagnosing them with a non-specific, poorly defined, and likely non-existent disease like Morgellons.

By Xerxes1729 (not verified) on 18 Oct 2008 #permalink

Semmelweis syndrome.

Doctors in denial...

Very, very sad indeed.

By triggrhapi (not verified) on 18 Oct 2008 #permalink

Another shot from our troubled competitor! He's attempting a variant on the Gallileo Gambit, combined with a "No, you're the denialist" twist! Do the judges agree??? NO! 0.1, 0.2, 0.2, and 0.00001 from the Russian judge! What an epic fail!

Stay tuned to the Trollympics as this patriotic prick gets his red, white, and blue ass handed to him!

By LanceR, JSG (not verified) on 19 Oct 2008 #permalink

Doctors call me secretly because they don't know what to do and don't want anyone to know they are seeing these people

"People support me in email" (or some variation thereof) dates back to usenet.

You know Dasher and Dancer, and Prancer and Vixen,
Comet and Cupid, and Donner and Blitzen,
But do you recall, the most famous denier of all?

LanceR the red-faced denier
Had a very shiny nose,
And if you ever saw it,
You could even say it grows.

Ah, the irony... I just have to laugh:
http://en.wikipedia.org/wiki/Units_of_textile_measurement#Denier

LanceR my confused friend... I am flattered to be considered a competitor as I lack the education and expertise that so many of you possess on this forum with regard to all things medical. I must tell you I am in an extraordinarily good mood today. Why you ask?... Well, I just did a complete system check and you know what I found?... No?... Well let me tell you then. Stop mumbling for a minute will you? One fiber... one measley little fiber and it didn't even come from my d*ck. It was in my right eye. Yes, they sometimes come out of your eye sockets... cool huh?

Anyhow, It seems I have found a very effective treatment for a condition you "experts" are still grappling with whether or not to admit may actually exist. This treatment has taken me from a fiber-ridden, black speckled, fluid oozing ogre to a clean, healthy skinned, vibrant, and dare I say quite humorous and happy individual.

I won't bore you with every detail and ingredient but in a nutshell: no sugar (i mean zero), no carbs, Budwig protocol + lots of spinach salad, yogurt (Budwig style), and all the fresh sashimi, tomatoes, avocados, almonds, apples you want. It is important to eat lots of raw sauerkraut made the real way (ingredients are cabbage, water and salt and must be fermented) and drink the juice as well. Same goes for pickles made the same way. They must be fermented as they are loaded with beneficial bacteria. (drink the juice). Canned tuna or smoked fish no problem.

Last but not least, join a healthlub and work out 2 or 3 times a week. Cardio (treadmill, stairs, etc...)for minimum 40 minutes and then steam room for as long as you can stand it. I usually alternate a few times between steam room and cold shower to "shock the system". I'm not kidding here I have seen amazing results. Lost 25 lbs. in the process and feel damned good thank you very much.

So you professionals go on about your business of non-treatment and let the people continue to suffer... heck, theyv'e suffered this long already and most will be dead soon and you won't have to worry about it then, will you?

Good night and good luck... fools.

By triggrhapi (not verified) on 19 Oct 2008 #permalink

Folks, I gotta say, that the content and tenor of the "morgie" commenters pretty much makes a better case than I ever could for linking morgellons with mental illness and muddled thinking.

Okay, for the last time, www.morgellonshope.org is an adspam website. Anything you click on brings up another list of advertisements for which the proprietors of the site get paid.

Taking advantage of the mentally ill for profit? You, Trisha Springstead, are a real piece of work. How much do you, personally collect from each deluded fool who comes searching for some answers? Do you laugh at them while you take their money? Do you sleep with their husbands, too?

Take your mercenary a** away from here.

I'm actually gonna dump the comments linking to that site.

Good plan. It's bad enough that some unethical types take advantage of the mentally ill by feeding their obsessions. We should definitely avoid helping them.

Just a quick, sane comment...

The only reason Trisha Springstead has the opportunity to prey on the desperate people visiting her site is because mainstream medicine put them there at her mercy.

There has been created an huge opportunity to exploit the treatment vacuum. It is obvious that people are selling "products" at these sites and are literally stoking the fire. Yes, many sufferers are quite crazy, and these opportunists have them thinking they are literally infested with parasites, nematodes, you name it. It is a tragedy matched only by the lack of availability of treatment from their regular doctor.

As for the content and tenor of some of my previous posts... our friend LanceR raised the bar of idiocy and I made the mistake of attempting to compete with the trollympic champ.

Seriously guys, I am fortunate to have my condition in check and able carry on somewhat normally. The next time a "morgie" comes along, don't attack them (LanceR), don't put them immediately on the defensive. You might learn something, but then... I tend to doubt that the truth is what you seek.

By triggrhapi (not verified) on 20 Oct 2008 #permalink

What cracks me up about you empathetic medicos is the way you casually refer to patients with a condition officialy (CDC) described as "an unexplained dermopathy", as a mental illness. Is that ethical, professional behaviour?

If you are well read on unexplained dermopathy you may have seen a Washington Post quote from an Associate Professor of Psychiatry from the Mayo Clinic. When discussing morgellons and DoP he was prudently non-commital and stated that over 50% of patients with a diagnosis of DoP, when subsequently seen at Mayo, were found to have a real cause to explain their symptoms and were not in fact delusional.

If you take that as a straw test it would indicate that over 50% of doctors get it wrong when it comes to DoP. Of the doctors blogging on here, what percentage are getting it wrong?

As for protecting the morgies from morgellonshope etc, I can only speak for myself. It's ok guys, dont bother, I have an unexplained dermopathy not a mental illness and so can still detect a hidden agenda when I see it. Self appointed protectors rattle my libertarian sentiments.

Quis custodiet ipsos custodes?
Juvenal

By doctor duck (not verified) on 22 Oct 2008 #permalink

Actually, if you read the Mayo study, it says that the *itch* had an actual cause. The delusional part is the fixated belief that it was caused by parasites or mysterious fibers. The actual point, and PalMD's above, was that if you can clear up the *actual* causes, often the DP goes away on its own.

Morgellon's is a hoax made up to sell product. There are no "fibers" coming from your body. There are no parasites in your skin. If there were, it would show up in the tissue scans. Hence this post. If there is something in the tissue, we will find it and treat it. In the case of Morgellon's hoax, there's no "there" there.

What is it with these types and their inability to read for comprehension?

By LanceR, JSG (not verified) on 22 Oct 2008 #permalink

Doctors, with reference to my posts. How come you dont address the points? PalMD. Pictures of skin, but not stained samples...therefore no comment? hahaha....what a cop out!!

LanceR, can you provide a link to the Mayo study, I have only ever come across a quote referring to it in the Washington Post? And to take up your point about that study...hello? u said; "if you can clear up the *actual* causes, often the DP goes away on its own". Isnt that what this discussion is largely about? The PalMD school is saying Morgellons doesnt have an actual cause cos it's a delusion and Mayo says if you clear up the actual cause there is no delusion... ffs is it any wonder people with morgellons are getting nowhere!!!

And LanceRboil, The products to treat morgellons are symptomatic of amoral and opportunistic capitalism rather than an engine room for Morgellons discussion.

I believe, as that same psychiatrist from mayo implied, the divide between morgellons patients and doctors is a communication issue. I think what the Mayo clinics study shows is that the skin is a very sensitive organ and when ailing can cause symptoms which can be very distressing. Such can be the level of distress caused, even by something as simple as rash, that patients can become desperate for relief. The challenge for doctors it would seem is to learn to recognise that distress, concern, frustration, despair and 'persistence of belief' may fit the DoP etiology but these 'symptoms' also and more probably, reflect a rational reaction of an ineffectivly diagnosed and treated patient. Mayo seems to be saying clear up the diagnostic problem and the pychological symptoms will go away.

The simple and obvious first step toward resolution for a morgellons patient is identification of the fibres. You guys, who presumably have no first hand experience of morgellons, insist there are no fibres, yet we say they are obvious and prolific. Somewhat of an absurd impasse wouldnt you say?

Given the amount of egotistical pleasure this topic provides for blogdocs, I'm not that surprised that there is little interest in putting this issue to bed once and for all. Surely the simplest way to do that would be to officially debunk the existence of these apparently ubiquitous fibres? It's not enough to rely on the petulant mantra of "there are no fibres...there are no parasites" when the web holds literally thousands of photographs of consistently similar fibres from disparate sources.

For me, the challenge to you guys is to explain, if tissue is indeed the issue, what are all these delusional people taking photos of that your path labs aren't seeing?

Patient: Doctor, you have to help me, every time i have a shower i burst into song, i cant help myself and i dont know whats wrong...!!!
Doctor: Ah yes, what you have is "tom jones syndrome".
Patient: Is that common?
Doctor: It's not unusual!

By Doctor Duck (not verified) on 23 Oct 2008 #permalink

if tissue is indeed the issue, what are all these delusional people taking photos of that your path labs aren't seeing?

Lint. Clothing fibers. In every single case.

If you could read for comprehension, DP usually runs along these lines:

1. sufferer feels unexplained itching
2. sufferer comes to believe he has "parasites" or "fibers" in his skin.
3. sufferer becomes obsessed with these "parasites" and "fibers".
4. often, unscrupulous people (I'm looking at *you*, Trisha Springstead, RN and Dr. Duck) feed these obsessions in order to milk these poor people for money.
5. When a *competent* doctor discovers the *actual* reason for the itching, the patient has to choose:
a. OH! It wasn't "parasites" or "fibers" in my skin! It was (eczema/dry skin/mosquito bites/allergy to laundry detergent/etc)! I feel better!
b. NO! It's not (eczema/dry skin/mosquito bites/allergy to laundry detergent/etc)! It's Morgellon's, I tell you! Doctor Duck said so! There's these pictures on the internets!

If there were a single shred of evidence *ANYWHERE* that these fibers were not environmental, it would be trumpeted from every newspaper and tabloid in the world. Why is this not front page news? Why don't you and your ilk publish this information? Could it be because you are a mercenary fraud? Hmm...

By LanceR, JSG (not verified) on 23 Oct 2008 #permalink

LanceR...if you think I am making money out of Morgellons all I can say is 'you're dreamin'! I abhor exploitation as well, the causes of that exploitation is what we disagree on. Because I vehemently disagree with your position does not by default, make me a shyster!

you said "...If there were a single shred of evidence *ANYWHERE* that these fibers were not environmental..." and "Lint. Clothing fibers. In every single case..."

I have yet to see anything published verifying lint, acrylic fibres etc. The references to these particular types of (amorphous) fibres as 'the' fibres, seem to be the author(s) assumptions and acceptance of vague termingology rather then specifically determined by any testing process.

Underlying much of the arguments you guys present is a theme that the burden of proof is on the patient. I believe this is inherintly unfair and reflects a defensive and insular attitude of your profession toward this condition. As every morgellons affected person will tell you, this condition is communicable. In light of that warning I believe that the official response is inadequate and ill conceived. In terms of doctors pontificating online about DoP/Morgellons theory, I find such attitudes offensive. When such anti-morgellons positions are challenged, the response is inevitably aggressive and arrogant. Further proof that cyberspace accurately reflects real life.

By Doctor Duck (not verified) on 24 Oct 2008 #permalink

a. OH! It wasn't "parasites" or "fibers" in my skin! It was (eczema/dry skin/mosquito bites/allergy to laundry detergent/etc)! I feel better!

I developed a rash/itch when the water softener stopped working.

Wow. Cut and paste insanity *AND* pictures that appear to be drywall! I'm amazed!

By LanceR, JSG (not verified) on 25 Oct 2008 #permalink

From the "thenmo" link above:

The predominant band was identified (from gel excision and in gel digest/nanoHPLC/MS at the University of Arizona Proteonomics Laboratory) as human serum albumin and cytoskeletal keratin II (67 kDa) with significant peptide fragment coverage over both protein sequences.

Dissecting all of that sciency talk is hard work, isn't it, Niels? Of course, if you do, you find out that the mysterious fiber IS HAIR! (dum dum DUUUUUM!)

How about the "...bioweaponized and genetically modified organisms including borrelia, Mycoplasma, HIV, West Nile..."? Why won't you answer the questions?

By LanceR, JSG (not verified) on 25 Oct 2008 #permalink

The idea that people resist the delusional parasitosis label because of the stigma of mental illness may have been true thirty years ago, but now people tell you at the drop of a hat of their depression, ocd, bipolar ADHD and asperger diagnoses. There is little shame about these problems.

The real block for patients against accepting a dianosis of dop is that if I accepted that I only imagine I see splinters in my skin and coming out of my skin, then how could I believe that my hand, or the computer screen or my glasses frames are what I see in front of me? how could I believe that anything in the world is real?

Doctors say that asking them to believe splinters are coming out of our skin is asking too much. Maybe it is, because I might not believe it if someone else told me. But asking patients to accept a diagnosis of dop is asking them to make an even bigger leap to believe that they are imagining these splinters. We might as well believe that our perception of the entire world is a delusion.

So, maybe we should wait on this study in Washington State and hope for some evidence that both doctors and patients can accept.

Umm, Crazy Person? I was quoting *YOU*!

How about the "...bioweaponized and genetically modified organisms including borrelia, Mycoplasma, HIV, West Nile..."? Why won't you answer the questions?

And just what do you believe my profession to be, anyway? You keep referring to my job. I don't believe I've ever mentioned my employment here. Or is this just another of your reality lapses?

I would like an answer about the "...bioweaponized and genetically modified organisms including borrelia, Mycoplasma, HIV, West Nile...".

By LanceR, JSG (not verified) on 28 Oct 2008 #permalink

Niels, please take a hint. The fact that I delete every one of your meaningless, paranoid rants should tell you that you are not welcome to comment here.

Wow. More cut and paste insanity. Will the joy never end?

By LanceR, JSG (not verified) on 29 Oct 2008 #permalink

Yoou sound like a good detective type MD interested enough to look for answers. I have an experiment for you. First you have to have a patient who thinks he has Morgellons who also has a active sore on his lower arm or foot. Then find a pan that will hold water and the foot or arm and put water (warm is more comfortable) and baking soda in the water to make a high ph solution Then immerse the arm or foot in the water and watch the wound. If nothing happens then you are probably right about it being nothing. If something happens it might cause you to wonder what is going on. Maybe? Epson salts might cause the same response.

I'd recommend a pathology text, say Robbins, Coltran, and Kumar. It will explain the correct techniques of tissue analysis.

Gee, I would be SO shocked if a pan of warm water with a high PH level would fizz when a normally dirty human limb was placed in it. Wow. Does it do the same when a hydrogen peroxide solution is placed on the sore?

Do tell.

By LanceR, JSG (not verified) on 07 Nov 2008 #permalink

Trish Springstead RN. is doing a very good thing and has no ill will in mind and saying she is trying to help people just to make money is wrong!!!!!!

By Julie A. Springstead (not verified) on 16 Mar 2009 #permalink

Look up sockpuppet. Ring any bells?

www.m*SPAM DELETED*hope.com is link spam. The whole point of the site is to generate ad pages. There is nothing else there. Anyone who links to it, or sends people to that site, is abusing vulnerable, mentally ill people for profit. That is pretty slimy in my book.

Does the shoe fit?

By LanceR, JSG (not verified) on 16 Mar 2009 #permalink

You can all knock it off right now by bashing me and Neils Meyer here. These people are sick and we need a cure. They have been exposed to horrid amounts of toulene and its by products.
They are heavy metaled and need 24 hour urines for heavy metals. And they need a detox for the heavy metals. Along
with our horrid misuse of GMOs in this world.
we now have over 45,000 people reporting this and 900 reporting to me alone.
So get over yourselves and your meanness, you do not know me and if I was in this for the money I would be rich now wouldn't I.
These people are like magnets and attract everything to them and they are horribly Endocrine Disrupted. I have mothers with children and families reporting to me.
So please do not go there and please be nice. I don't understand why people can't just get along. I am not about my Patent, I am about getting people better. So Back off.
Trisha

By Trisha Springs… (not verified) on 22 Mar 2009 #permalink

If you don't want to be "bashed", then I would suggest reading what this blog is about. You have no evidence of your claims, and the only link to any "evidence" you've provided turned out to be ad-spam. To this point you have shown yourself to be a typical woo-meister, profiting off the misery of desperate, delusional people.

There are effective treatments for what ails these people. Charlatans like this Neils Meyer and yourself feed their delusions and prevent them from getting the help they need. Perhaps you should think about that.

In short, *you* back off. Life is tough, wear a helmet.

By LanceR, JSG (not verified) on 22 Mar 2009 #permalink

I'm an old man who has seen denialism in many arenas. Things not fixable are not broken. Bad behaviour never happened. Things you can't identify are not seen. Often when a physician encounters and can't ignore invisible symptoms or visible skin lesions they are put into the physcosomatic box.

While most skin conditions, whether "horses" or "zebras" can be explained, some go unacknowledged (here is the denialism).

I have a unidentifed parasite that's lived in and off me for over 20 yrs. I don't give a damn whether anyone links it to Morgellons or to the crazies...I want it gone. To date the only attempted remedy has been an ointment (cortisone I think), which has had no effect.

It now resides in about 15 sites on the back of my neck. It appears to be a tiny fly. It lays eggs (presumably....because it can feel like an extremely painfull "bite") under the skin. Then a chain of white, football-shaped segments form that appear rope-like under a magnifier. Next they morph into a tiny sack shaped like those that hang over a hospital bed attached to feeding tubes. The sack is translucent pink...as if containing diluted blood. A stiff black tube is attached to one (top?) edge. Tho tiny, it is courser than a whisker. This begins to morph into an emerging fly (see prominent photo of baby's lips on Morgellon site. That is exactly what it is...and I see it as an emerging fly.) The fly, after emerging, leaves behind debris, which is the pieces of dried, skin-like sack...sometimes white, sometimes black, sometimes intermediate shades of reddish-brown. Continuous episodes of emersion go on for years from the same site (at least in my case) until it becomes dormant. Unfortunately, other sites startup...presumably from new bites. The fly is extremely tiny. It is all black, with black veined wings (strikingly beautiful), and a fuzzy head...otherwise non descript under my magnifier.