Lyme disease: Then and now

georgia · medicine forum Guru Joined: 06 May 2005 Posts: 505

http://www.chathamjournal.com/weekly/living/health/lyme-disease-60625.shtml

Lyme disease: Then and now
Posted Sunday, June 25, 2006

While leafing through a patient's medical record recently, preparing it
for
electronic scanning, I came across a barely legible note by a former
colleague dated July 13, 1975. The patient, then a 45-year-old high
school
gym teacher and scoutmaster, came to see the doctor after three days of
fever, chills, and night sweats. He had a 101-degree temperature and a
6-inch-wide rash on his back described in the chart as a "target" with
alternating red circles emanating outward from a dark red spot--a
then-uncommon type of rash called erythema migrans. Aspirin and bed
rest
were prescribed. Follow-up notes two weeks later read, "patient better,
afebrile (no fever); rash has faded."

This was about the same time that a group of determined mothers in the
small
Connecticut town of Old Lyme began demanding a medical explanation for
the
rashes, fevers, and inflamed joints that were afflicting their
children.
They managed to attract the attention of medical researchers, who
slowly
began to unravel the tangled thread that linked those rashes and joint
complaints to a previously unknown microscopic organism spread by the
ubiquitous deer ticks that inhabited the woods.

Thus was Lyme disease "born." It has now been reported in virtually
every
state and is endemic in a dozen states in the Northeast and upper
Midwest.

For almost as long as the disease has been around, it has been a source
of
controversy and confusion. Early diagnosis has been difficult,
especially
for the 20 to 30 percent of patients who don't develop the rash. A
vaccine
was developed, then removed from the market amid uncertainties about
its
safety and effectiveness. Doctors and patients have argued about the
appropriate type and duration of antibiotic treatment. But in the past
few
years researchers have learned much more about optimal treatment.

When and how to treat

Early treatment of Lyme disease is critical; the longer the time
between
infection and treatment, the more likely it is that the patient will
develop
so-called "late manifestations" of the disease, such as painful,
swollen
joints, heartbeat conduction problems, facial nerve palsies, or chronic
meningitis.

For that reason, anyone living in an endemic Lyme area who develops the
rash
should receive immediate antibiotic treatment--no blood test needed. A
2003
study reported in the Annals of Internal Medicine found that 10 days of
doxycycline works just as well as the standard 20-day course.

An even faster treatment is possible for those "lucky" enough to find
an
engorged deer tick on their body. A single large dose of doxycycline
within
72 hours of tick removal will prevent the development of Lyme disease
nearly
90 percent of the time. Again, this tactic should only be used in areas
with
a high incidence of Lyme.

If neither a tick nor a rash is discovered, diagnosis can be made only
when
a later manifestation appears. Treatment at that time doesn't always
have a
happy outcome. Symptoms usually, but not always, clear up with three or
four
weeks of intravenous antibiotics. Nonspecific symptoms, such as
cognitive
defects, memory loss, or fatigue, are the least likely to respond to
antibiotic treatment. Many self-help groups and Lyme disease clinics
advocate treating those symptoms with repeated courses of intravenous
antibiotics. Unfortunately, clinical studies have shown such treatments
don't help and may actually cause harm from antibiotic side effects.

Prevention preferred

Since treatment with antibiotics has no guarantee of success in all
cases,
prevention is the preferred way to avoid this disease.

... Wear protective clothing, such as long pants and sleeves, and tuck
pants into socks, especially when walking in low grass or past
low-growing
brush.

... After a walk or a hike, check yourself for ticks. If you find one,
grasp it with tweezers close to the skin and slowly but firmly pull it
off.

... Use a deet-based insect repellent on your exposed skin or permethrin
on your clothes. Picaridin, a mosquito repellent introduced in 2005,
has not
yet been thoroughly tested against ticks.

... To deny ticks a comfortable habitat in your yard, keep your grass
cut
short and place a strip of wood chips or gravel between your lawn and
surrounding shrubs and wooded areas.

And our gym teacher? Despite never having received antibiotics, he did
not
develop late complications and has remained in good health. A Lyme
disease
test five years ago was negative, which makes me wonder: Did he
actually
have Lyme disease at all--or did he just have the luck to escape it?

******************************************

This information is for educational use only, and is not a substitute
for
prompt professional medical advice.

The sooner you spot and remove a tick, the less likely you are to get
Lyme
disease. But if you do get infected, early treatment works best.
ConsumerReportsMedicalGuide.org and your doctor can guide you through
treatments for Lyme disease that work well.

Copyright 2006.

lipanz · medicine forum addict Joined: 19 Jun 2005 Posts: 62

And our gym teacher? Despite never having received antibiotics, he did
not
develop late complications and has remained in good health. A Lyme
disease
test five years ago was negative, which makes me wonder: Did he
actually
have Lyme disease at all--or did he just have the luck to escape it?

Perhaps the gym teacher was injected with a low amt. of bacteria or had
a super excellent immune system. Still one does not know it may pop up
way later - stress. death of a loved one, immune system down other
illness etc.

georgia wrote:

Google