I.M.120 Helping you to BE YOUR BEST SELF

They're disgusting little creatures. The mere thought of one crawling up your leg, and latching onto you while feasting on your blood for a meal is enough to send you running to the psychiatrist, let alone the doctor. As if the violation of your personal space by a blood swapping arachnid is not enough, they have the potential to deposit the spirochete that causes Lyme disease, A potentially life altering long-term infection.

ACT FAST

If you can save the tick and bring it to your doctor, it can be analyzed to determine if it carries the spirochete that causes Lyme Disease. If the tick is not infected, it cannot infect you, and no further action is required. What if you don't have the tick, or if you see evidence of a bite but you are not sure what bit you?

WAIT AND WATCH

Waiting for signs of infection such as a classic bull's-eye rash, fever or other signs of illness is the standard medical advice in this situation. That approach has been questioned by many Lyme literate providers since it can put an individual at risk for late stage disease. In some cases, Lyme Disease can remain dormant, bypassing the typical early symptoms, and emerge months or years later with devastating consequences.

SHOOT FIRST, ASK QUESTIONS LATER

There is evidence that early introduction of antibiotics, prior to three days from the tick bite, can reduce the incidence of subsequent infection. Either a single dose, one day approach or a more extended seven day approach is often used.

Whether or not you choose to be treated with antibiotics initially, blood testing can offer significant benefit. A two-stage test with one performed immediately, and the second one perform four weeks later can provide diagnostic information of value. If the first test is negative for Lyme, it could be that your immune system just hasn't responded yet to the introduction of the spirochete. If the second test turn positive, it is evidence that the spirochete has been injected into you. This situation presents an opportunity for early treatment.

If the first test is positive, it could be a coincidence and represent exposure from the prior infection, or it could be an early reaction to the current bite. The second test can help clear up the uncertainty.
If the Lyme titer level remains the same, it is probable that you were not exposed by the recent tick bite and that the positive titer represents a more remote exposure. On the other hand, if the second test shows a significant increase in the titer it most likely represents a recent exposure and antibiotics should be considered.

SHOULD I GET TESTED ON A REGULAR BASIS?

The conventional medical answer is that no testing should be performed unless there are concerns for an ongoing infection with the Lyme Disease spirochete. On this issue, I have to disagree with the standard dogma. If you live in an endemic area, such as New England or anywhere in the northeast, it is reasonable to get tested on an annual basis. If the test converts from negative to positive, I would recommend that you consider prophylactic treatment with a 21 day course of oral antibiotics. Lyme disease can be sneaky and create symptoms years after exposure. As I have mentioned, those symptoms can sometimes bypass the traditional early stage presentation of a rash and fever, and go straight to neurological findings such as severe pain, fatigue, even impaired mental function up to dementia. In the face of such sneaky and serious consequences, a proactive approach seems reasonable.

Whatever you decide to do, and open exchange of information with your physician is warranted. This area of medicine is fast-moving and full of uncertainty. It is important to take into account your personal medical history as well as your philosophical approach to healthcare when deciding what path to follow. Ultimately, you will live with the decisions that you make. No matter the outcome, you'll feel best if your thoughts and concerns have been thoroughly listened to and respected. The best of health care providers will engage you in this topic, and not use an impersonal guideline as a substitute for critical thinking.

To your best health,
Dr. Stephen Petteruti