“There are many potential explanations for why somebody has ongoing complaints after what should have been adequate antibiotic therapy. First of all, it’s possible that the patient didn’t take the antibiotics. You give them 2 weeks of doxycycline and they got 5 days [but now it’s] sitting in the medicine cabinet because they feel so much better. Why bother, right? [The thought is] so they’ll have the antibiotics for next time that they get bitten by a tick. This is not the way that we practice medicine. And so, it’s possible that they didn’t take the antibiotic. It’s also possible that the antibiotic was not absorbed. There are some people for whom the diarrhea and abdominal pain from doxycycline are so great—and the same thing is true sometimes of amoxicillin—that they just flush it right through their system and it never really gets absorbed. There are other people for whom it’s not diarrhea, it’s just that they don’t absorb it; it’s possible. There are people who had more advanced disease than you identified at the time you saw them. Let’s say that you see somebody with erythema migrans—the rash of Lyme disease—you give them oral antibiotics because it turns out that they already had meningitis; it was subclinical, you didn’t see it, you didn’t appreciate it. They come in 3 weeks later for a follow-up and they say, ‘My neck is so stiff and I’m feeling so weak.’ We can do a spinal tap if there are cells; you can also find antibodies against the organism, but if you find a lot of inflammatory cells, this is meningitis. This requires intravenous (IV) therapy, not oral therapy. And so, I didn’t give the appropriate therapy the first time through, not because of my incompetence, but because it was subclinical. Assuming that you have given appropriate antibiotics and they were absorbed, some people will have persistence of organisms—presumably. That’s very ill-defined, as of now. But it is possible that there is a persistence of organisms. All of the organisms that have ever been identified, all the Borrelia burgdorferi, are sensitive to the antibiotics that we use; it’s not as though there’s a resistant strain out there. But it’s possible that it was in a cell someplace and the cell broke open and now, you’ve got the organism multiplying again. And so, in some sort of a privileged site, it’s possible—unproven, but possible. The second potential explanation is debris, dead organisms lying there in a joint, as an example, and it’s a focus of ongoing inflammation because your macrophages are trying desperately to get rid of this residual stuff and it’s very indigestible. And so, there’s ongoing inflammation; that’s ongoing symptoms, despite. It’s possible that you might have debris elsewhere in the body and have inflammation and inflammation is causing your symptoms—global inflammation, systemic inflammation. It’s possible that what’s going on in the patient is immune in mechanism, that somehow the infection has caused an immune response, not necessarily autoimmune, but an immune response, an ongoing inflammation, and so, it just can’t be tamped down. It could be autoimmune; I must tell you that Alan Steere looked at autoimmunity due to B. burgdorferi outer-surface protein (OspA), or centered on OspA. I think that has been demonstrated to not be of any clinical relevance. My laboratory, when I was at Robert Wood Johnson, looked at neurologic disease. We found cross-reactivity between a Borrelia burgdorferi antigen and a human antigen. The possibility of autoimmunity was raised. We demonstrated it in the laboratory; I don’t know that we have ever seen that be of clinical relevance, but it’s possible. There’s no evidence to suggest that it happens, but it’s possible. Ongoing immunity, autoimmunity, maybe. The final explanation is that the patient once had Lyme disease but something else is going on now. As I said before, Alan Steere has shown that there are people who have chronic inflammatory diseases that have nothing to do with Lyme disease, that follow Lyme disease. Life does not come to a screeching halt medically when you eradicate Borrelia burgdorferi; other things can happen. Are they causative? Is it that the B. burgdorferi caused rheumatoid arthritis? There’s no reason to believe that’s the case, but it happened. And so, it’s very important that you not assume. Remember the old expression, ‘When you assume, you make an ass out of you and me?’ It’s very important that you not assume that something that happens after Lyme disease, is, therefore, due to the preceding Lyme disease. You have to have an open mind about this. What you need to do is approach the patient, with the Lyme disease in the background, but look for other potential explanations. Does this lady have Lupus? Does this lady have rheumatoid arthritis? Does this lady have amyotrophic lateral sclerosis? And then, there’s always the very real question: Was the initial diagnosis of Lyme disease correct? Very frequently, in a referral practice, you’ll see somebody come in with a diagnosis of Lyme disease that I can’t substantiate; I don’t know how that diagnosis was made. When I start digging through the records, there’s [nothing there to indicate it]. And so, it’s very important that you be sure that there’s really a Lyme disease diagnosis that is supportable in the first place. But even if there was, look for other things to make sure that you don’t miss something. Because the diagnosis of chronic Lyme disease is almost a diagnosis of exclusion, and a diagnosis of exclusion is a very difficult thing to do because it means that you’ve excluded everything else? Not the easiest of practicing medicine.”
What Is "Lyme Anxiety?" “Lyme anxiety: the anxiety related to Lyme disease, usually related to the diagnosis of chronic Lyme disease. So, somebody walks into the office with erythema migrans, who’s done a little bit of research, and says, ‘That. That’s Lyme disease, isn’t it?’ And I say, ‘Yep. We’re going to give you some antibiotics and you’re going to get better.’ And the overwhelming majority of people in that setting do get better. It’s the person who walks in with vague complaints, no physical findings, nothing that I can say, ‘That’s what it is.’ It’s a vague constellation of complaints. Those people, somebody has told that that it’s Lyme disease; it might have been at the grocery checkout; they might have been looking at something on the internet; they might have been going to a physician who claims that it’s chronic Lyme disease. And then they would wind up coming to me at the referral center that I used to run at Robert Wood Johnson. And they’re scared out of their minds because they think ‘I’ve had this disease for who knows how long. Look what it’s doing to me. I’m not going to be around to watch my children grow up.’ People’s anxiety runs wild. Should you be concerned if you have Lyme disease? Sure. Is there reason to be afraid of it? A little bit, sure. But to approach hysteria is in nobody’s best interest and it’s really unnecessary. And it’s really one of the really toxic consequences of this ongoing debate about chronic Lyme disease.”
If you listen to the news, Americans care more than ever about what we put in our bodies. Fats, additives, cholesterol, too much sugar, and on and on have become big media and legislative issues. We are paying a lot of attention to what is eaten
On the other hand, we don’t spend much time thinking about the water we drink. Make no mistake about it, we are way ahead of previous generations and past civilizations in the safety of our water. History is full of whole armies, societies and populations that have been decimated or even ended by drinking water contaminants and diseases. We are a far cry from that state of affairs, but not completely safe.
If you think about it, the amazing and at the same time disgusting fact is that the water in your spigot may contain water treated by an upstream sewage plant, and yet we drink it.
America has one of the safest water systems in the world. On the other hand, we have seen serious brain damage and other health problems can occur in places like Flint Michigan. The scary part is that the damage to many lead poisoned children is now a health and developmental problem that will live with them and those around them all of their lives.
The rest of the story in Flint Michigan is that even if the water quality is corrected, the pipes themselves are now chemically damaged and will continue to leech lead into the drinking and cooking water of the residents. Digging up and replacing the underground main service line pipes, hot water tanks and damaged pipes in homes has been estimated to have a cost of between 20 and 200 million dollars in that city of 100,000 residents. Many of those residents can simply not afford to do the needed work in their individual homes. Cost of replacing the damaged underground municipal system is claimed to be 1.5 billion dollars.
If the water of Flint was properly treated, the poisoning and permanent physical damage to the people drinking the water would have never occurred. The big question to ask as you stare at your own glass of water from your tap should be: Is my water safe?
The EPA requires that each municipal water treatment system provide an annual “Consumer Confidence Report” (abbreviated CCR) and make that report available to the consumers of the water. It only took minutes for me to look up the report for the local water authority that supplies our home. The good news is that the water was pretty good……in this case. The bad news is that I had never checked that information on the water we drink before today. All of us need to take a look at the report for our homes. Click for download of full PDF article http://goo.gl/BM9Skv
Click for download of full PDF article http://goo.gl/BM9Skv
You are traveling to a warm area or looking ahead to mosquito season where you live.
In order to protect from birth defects, we must take every possible precaution to interrupt the process of mosquitoes infecting people with the Zika virus.