I just got a simple question in my email: do I treat Lyme Disease? I wish there was a simple answer.
Lyme is one of those political diseases. You know, like Gulf War Syndrome, Multiple Chemical Sensitivity, etc. It shouldn’t be, because we have a clear cause and some decent treatments. But it has become more and more polarized rather than reaching medical consensus.
The process of treating Lyme has fallen into two camps: ILADS vs. the CDC.
At this point, they even have their own labs, with the CDC labs
requiring five genetic markers and IGENX requiring one for a positive test.
I have desperately waited for there to be a middle ground, but the two
groups (M.D.s on both sides) have become more entrenched in their
views rather than less.
On the ILADS side, (which includes most N.D.s), statistically 92% of
patients are diagnosed with Lyme by the lab. The CDC diagnoses around 6%. (see another blog post on this lab result) So as a practitioner, I’m left with patients who either clearly have Lyme or absolutely do not, depending on the lab. Very rarely, I’ve had patients who are clearly positive with the CDC markers, so I have both camps’ blessing to treat.
Now, treatment becomes an issue because ILADS tends to think that
antibiotics are necessary for the rest of your life (I’m paraphrasing,
but that’s the gist). They also throw in anti-parasitics, anti-fungals, the works. According to the CDC, a short course of Doxycycline will do the trick. If someone has continued symptoms according to the CDC, they have a mental illness that gets called Chronic Lyme Syndrome.
The problem I have with treating all the complexities of Lyme is that
I have colleagues who only treat Lyme, and they don’t have many cures.
People get better, but they tend to get better doing the same things I
would use for chronic fatigue, low thyroid, chronic stress, etc. In
other words, once you start treating the whole person, the Lyme
symptoms get better.
So I do treat Lyme, but not in a way that would make either the ILADS
or the CDC groups happy. If a patient has not started on Doxycycline
(I always start at 100mg and build up, because it can make people very
sick from the medication). I would start on that immediately. If she’s
miraculously better within four to five days, then Lyme (or
Bartonella, or the other cofactors, they all respond to Doxy) is her
primary problem. If she’s not better, then she’s looking at a fairly
long road, and should consider how much time and energy she wants to
dedicate to chasing Lyme before looking at whether it is Lyme (which
is hard to do, depending on who you believe).
So do I treat Lyme? Yes, I suppose I do. I just wish it was clearer how and when I should treat it.