National Lyme Report - Help for Lyme Disease sufferers?

Help for Lyme Disease sufferers?

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Opinion/Editorial: FAMILY DOCTOR: Some help for Lyme disease sufferers

FAMILY DOCTOR: Some help for Lyme disease sufferers
Canton Repository (subscription), OH
Monday, August 7, 2006
PETER GOTT, M.D.

Q: As the founder of the NY Penn Lyme Disease Support Group from Millerton, Pa./ Corning, N.Y., I was given six copies of your article “Lyme disease a growing problem in the Midwest” and asked if I could respond. It was good that you printed the story and thanked the author for contributing to your ongoing medical education.

Lyme and other tick-borne diseases are not only a growing problem in the Midwest, but in all of the United States. Unfortunately, there is no “simple test” that can be relied upon, unless you are using something that the Lyme Disease Association (LDA) or the International Lyme and Associated Diseases Society (ILADS) know nothing about.

Many of your readers take your word as gospel, and if they truly believe in this “simple test,” they will most likely die of a dreadful, debilitating (physically and mentally) ailment of unknown cause or misdiagnosed disease.

A: Thank you for writing. Unfortunately, I don’t agree with your generalizations about the Lyme disease blood tests. Here is how I respond to the disease in my New England community, where Lyme and ehrlichiosis (a related tick-born disease) are epidemic.

If a patient does not remember having had a tick bite but has symptoms of Lyme infection (rash, sore muscles, painful joints), I give a one-month course of doxycycline therapy. Likewise, I treat if the patient had a tick bite and then developed symptoms.

If, on the other hand, following a tick bite, the patient has no symptoms, I monitor the situation for three to four weeks, after administering two doxycycline tablets, then obtain blood tests, because it takes at least three weeks for the immune system to manufacture anti-Lyme proteins that can be measured in the blood.

If the blood tests are negative, no treatment. However, in the presence if a positive test, therapy is appropriate. I routinely order a Western blot analysis, plus an ehrlichiosis blood test. If the blood has been screened using what is called an ELISA test and the test is negative, the more detailed Western blot is not performed.

On the other hand, if the ELISA is positive, the Western blot is the next step and will indicate that no Lyme infection is present, that acute disease is, in fact, present or that the patient has actually had Lyme disease in the past. At this point, further (or new) therapy should be carried out.

Although I am certain that the majority of my readers will ignore this important topic, I am printing my response to you in hopes that at least some Lyme sufferers will learn something and be able to educate their physicians with respect to diagnostic testing and therapy. Lyme disease, which until recently was unusual in the Midwest, has now grown to be a serious ailment that must be addressed. I hope that I can contribute to its extinction.

You are correct that Lyme and ehrlichiosis blood tests are not 100 percent accurate in diagnosis. But, in conjunction with clinical judgment, they can be quite useful. For example, people who have received Lyme vaccine (which has been withdrawn from the market) may become Elisa positive but have negative Western blot.

In summary, here are some observations.

A tick bite can be harmless. Yet, in areas where Lyme disease is prevalent, the victim should be suspicious if the tick fed for more than 24 hours.
Gardeners, hikers and other people at risk should conduct tick checks after possible exposure, usually the afternoon or evening after being outdoors.
Although the classic “bullseye” rash is diagnostic for Lyme (and should be treated), about 30 percent of patients do not experience this symptom. In such instances, a history of off-season flu symptoms, with or without a recognized tick bite, makes therapy an appropriate option.
Lyme (and ehrlichiosis) blood tests are not helpful diagnostic tools until at least three weeks after the tick exposure. Therefore, doctors should not order them unless the patients have been ill for at least three weeks.
If the tests show continuing signs of ongoing infection, patients should probably be given a second month of doxycycline treatment.
Animals (cats and dogs) that are allowed outside can carry infected ticks back to their families.
Seek medical attention for any symptoms suggesting Lyme disease.

Write to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, NY 10016.

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Help for Lyme Disease sufferers?