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Chronic Lyme Tough to Diagnose, Tough to Treat

Posted Dec 09 2010 1:22pm

Over at the Chicago Tribune, there is this superb review of the Chronic Lyme disease issue.

Lyme disease is real. The bacterial infection, chiefly transmitted by deer ticks, can cause rashes, swollen joints and inflamed nerves, and usually is curable with a round of antibiotics.

But doctors around the country are telling patients with common medical problems such as back pain, poor concentration and fatigue that their ailments stem from a chronic form of Lyme disease that can evade standard treatment and wreak havoc for years. To fight what they believe is a persistent infection, the doctors often order months or years of intravenous antibiotics, which can cost tens of thousands of dollars.

Strong evidence isn’t on their side.  But in a golden age of dubious medicine, that doesn’t matter.

My advice:  read the full article, as I cannot recall a better summary in the lay press of this highly-contentious topic.

Oh, and for the record, in my experience there are few encounters more challenging in ID practice than addressing the diagnosis of “chronic Lyme.”

Many patients given the diagnosis are (legitimately) so desperate to find an explanation for their suffering — and to do something rather than nothing — that they latch onto this unproven diagnosis and are willing to receive potentially harmful therapy rather than continue to live in misery without taking action.

And when, as an ID doctor, you review all the history and data and find no evidence of Lyme, you make a person who feels sick feel even worse — because usually there is no alternative infectious explanation for their various complaints.

It’s an unbelievably difficult situation.  In many ways, chronic Lyme is even more difficult to treat than HIV — which was my original (jokey) title of this post, until someone told me it might be offensive.  But you get my point.

So shared experiences, other thoughts, potential strategies for managing “chronic Lyme” — from my ID colleagues, from other providers, from patients — would be much appreciated.

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