Date: Wed, 10 Aug 2016 16:49:27 -0400
From: “John R Dykers”
Subject: Lyme disease
Tom’s post is spot on, and this is the reason I have recommended early treatment with doxycycline for tick bites. 1. prevent tick bit by wearing light color clothes so you can see the ticks, long sleeves and pants tucked in socks and check frequently and as soon as you come in from any possible exposure. Hope you have a friend to check where you can’t see. If not at least bathe vigorously 2. tick crawling on you, flick away and don’t worry. 3. find a tick attached when you are checking and just came in from exposure, spray with ethyl chloride if you have it, or if not, still remove tick, with magnification if you have it, with pointed tweezers as close to skin as possible and steady gentle pull. Try not to squeeze the body of the tick. 4. If you find tick in the morning after exposure, remove and flip a coin. 5. If tick embedded in flesh at bite site, swollen or red or your access to tick bite limited, get prompt professional help to remove and start on doxycycline.
DEAR DOCTOR, please do not wait for rash or systemic symptoms or positive tests unless there are definite contraindications to treatment with doxy or old tetracycline or alternative antibiotics. I know you can’t make “a diagnosis” at this stage, but the patient with the target rash of Lyme or palmar rash of Rocky Mt Spotted Fever or systemic signs or symptoms of Ehrlichosis is a failure of vigilance. This is one circumstance where “overtreatment” is more appropriate than failure to treat. Erradication and prevention of illness is too easy and the “sick” patient is too sick. I have been burned by Football Coach Jim Tatum dying of RMSF at UNC Hospital because the diagnosis was not definite. Purist would not treat and by the time diagnostic palmar rash appeared he was in organ failure and died. $2-3 of tetracycline and he would not have needed to be even in the hospital.
John R. Dykers, Jr. MD retired.
big dog ticks are really not a problem, but otherwise species identity of tick as carrier or not is too unreliable with current knowledge base. I have been farming here since 1964 and this is how I would treat myself.
Tue, 9 Aug 2016 13:54:32 -0400
From: Tom Glendinning <>
Subject: Lyme Disease
The question, Dr Dykers, is whether or not the doctors are Lyme literate enough to offer proper diagnosis and treatment in the proper timeframe.
When reported and treated incidence is 26-29 in 2015, the experience is not broad enough to build a decent database. Besides, its symptoms do not present in a consistent, predictable manner.
The Enzyme Immuno Assay, EIA, and Enzyme Immunoflourescent Assay tests are sometimes inconclusive and time dependent for point of infection. The doubling of testing with the Western Blot is also time of infection dependent.
This diagnostic problem decreases predictable diagnostic accuracy. It’s hard to nail down.
In Pittsboro area, 10 cases (not entire total, just those known by author) the incidence is not epidemic, but still significant in that diagnosis is difficult and unfamiliar to most MD’s.
If the tick bite is missed or ignored and sickness does occur, still start doxycycline or other antibiotic regimen chosen while waiting on test results. The diagnosis is difficult for the most knowledgeable doctor with a high index of suspicion for tick borne illnesses.
Information sources: CDC, VA Medical Center, MD’s, Lyme patients
Tom Glendinning