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Basics/Controversy on Lyme Disease

Posted Jun 01 2011 12:00am

Recently, a good friend of my family (someone who I consider to be an uncle figure in my life) has been diagnosed with Lyme disease. However, prior to his diagnosis, for what seemed like endless months, he endured neurological testing, MRIs, CT scans, blood tests, and extensive examinations. He had vague neurological symptoms of weakness, difficulty walking, slowed mental processes, and inability to work. With nothing to work with, even the best doctors at Yale New Haven (in Connecticut) were reaching dead ends with differential diagnoses. (Ironically enough, because of the fact that Lyme disease was originally discovered in Lyme, CT, and further tests were performed at Yale Research Center to further study the condition and etiology/pathogenesis)

His condition was highly unusual for his constitutional state, for he was an active construction worker, always on the move, and always working on some machine, car, or house in his spare time. We knew that once he began describing his neurological symptoms and inability to walk to the bathroom, that this was more than just weakness. An otherwise healthy 40 year old man should not be complaining of these symptoms. However, even though Lyme disease has its highest prevalence in the Northeast, and some incidences in the Mid-West, it was not entirely clearcut.

Lyme disease is caused by the bite of a tick (Ixodes) infected with Borrelia burgdorferi, a spirochete. Increasing numbers of cases are reported from patients hiking, walking through tall grass, wearing dark colored clothing, not checking for ticks after being outdoors. Please take precautionary measures against this life altering disease. Stay informed.

For the CORRECT way to remove a tick

Signs and Symptoms of Lyme Disease > Chills
> Fever
> Lethargy
> Muscle Problems
> Classic “bulls eye” rash – may occur in up to 60% of patients, which occurs 1-30 days after being bitten; often called erythema migrans, because of the exapanding nature of this rash

Later on in the pathology, you might experience > Neurological problems such as weakness or mental deterioration (loss of concentration, inability to think clearly, unable to recall memory)
> Vast itching
> Unusual behavior
> Stiff neck (similar to seen in meningitis, therefore this is a good rule out condition)
> Joint pain
> Intermittent blindness
> Irregular heart beats or other cardiomyopathies
> Autoimmune conditions (since the antibodies made by the immune system against the spirochete have similar antigenicity to some proteins in the body, resulting in the body attacking itself)

Laboratory (Antibody) Tests To be Performed > ELISA for Lyme disease
> Western blot to confirm

Treatments > Vaccination against Lyme Disease
> Doxycycline or amoxicillin (antibiotics) for early disease

Controversy Within most medical circles, there is a controversy whether or not Chronic Lyme Disease exists, as well as whether or not long-term use of intravenous drug usage as a treatment protocol is an ethical approach to Lyme Disease. The Infection Disease Society of America (IDSA) is constantly debating over this topic, setting the treatment guidelines for the entire medical community. Because the IDSA has reigned that treating with long-term use of antibiotics for Lyme disease is dangerous and at risk to the patient, many doctors, particularly in the Northeast, are unwilling to treat patients with Lyme, for fear of malpractice and harm to their patient.

To me, it is an interesting debate of whether or not Lyme disease would even be questioned as a chronic condition. It is clearly evident, through many patients, including my “uncle”, that Lyme disease is a chronic condition. Who knows when someone was bit 5, 10, or 15 years ago by an infected mosquito and is now having neurological complications. Yes, there can be an acute exacerbation of symptoms up to a month in about 60% of people, but what about the other 40% that do not have the characteristic bulls eye rash or any other problems associated? Are we to diagnose them with some type of mental disorder or other neurological disorder, such as myasthenia gravis or multiple sclerosis, later on in life? I, for one, would suggest taking a thorough history, physical exam, and intake of presenting signs and symptoms when seeing a patient that has vague symptoms of this sort. Or, referring out to a specialist is also another option.

The politics of the issue is obviously lengthy and involved, which will not be further explored at this time. If you would like to share an experience of Lyme disease, treatment, or the politics behind this issue, please comment below, I’d love to read about it.

References:

http://emedicine.medscape.com/article/330178-overview

http://neuro.psychiatryonline.org/cgi/content/full/20/1/iv

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002296/

http://www.drydenfamilymedicine.com/lyme_disease_alert.gif

http://www.lawestvector.org/LymeDisease.htm

http://www.nhpr.org/node/29157

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