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  • From: Chris Reid <chriscreid AT yahoo.com>
  • To: market-farming AT lists.ibiblio.org
  • Subject: Re: [Market-farming] lymes disease
  • Date: Tue, 2 Feb 2010 12:04:37 -0800 (PST)

Richard Robinson wrote: " Ticks attached less than 24 hours, and that have not become engorged, are highly unlikely to pass along Lyme disease. If you discover the tick after that, but within 72 hours of attachment, you can probably prevent disease with a single 200 mg dose of doxycycline."

http://content.nejm.org/cgi/content/short/345/2/79
 
I reply:
I don't know how widely the point of view I received is held, but let me share my experience in seeking the "single dose of doxy."
 
Yes, that single dosage protocol is repeated in many places, but I'm not sure who agrees with it and who does not at this point.  This NEJM article linked is from 2001. We are now 9 years more experienced with Lyme.
 
This spring, after getting weird symptoms and an increasingly red, streaky  and itchy bite site, I started reading in earnest about Lyme, since the bite site looked to me like it was moving on toward a target shape.  After reading in several places about quickly taking a single dose of doxy,  I frantically called my doc  on a Friday night to see about getting a single dose of doxy in time, before the weekend. The doctor I spoke to,  a sub for my regular doctor and on call by phone, refused to give it to me, and I understood her to say that it was not considered an appropriate treatment for Lyme at this point.  (Yes, I know, IDSA and the CDC and many local government sites do  identify this protocol -- all I can say is, it makes it worth carefully asking a lyme experienced doc whether it is sufficient.).  She did prescribe a longer treatment period, though. 
 
Because doxy can bring on chronic skin photosensitivity and I work outdoors all the time, I knowingly opted for a different antibiotic that will not go after all of the tickborne diseases a bite can carry (it would not have treated ehrlichiosis).
 
I asked a Lyme literate friend (who is a chronic sufferer) about her refusal on the single dose of doxy and he said that it was his understanding from lyme literate doctors he knows that they considered the followup period too short on studies they had seen.  I assume this "too short" means, when compared to how long after a bite they were seeing the disease show up.  Without delving into the right or wrong of it, suffice it to say that I discovered that there is more than one opinion on whether this is adequate treatment.
 
The IDSA treatment protocol (which I think includes the one shot doxy treatment idea) has been challenged by the State of CT's Attorney General and a settlement reached in which it was agreed that doctors and experts with no "horse in the race" would at arms length examine the IDSA treatment protocol and examine the soundness of the scientific research basis of  it.    I'm not sure where they are in empaneling the group to look into this.
 
I have to say, one of the reasons I was frantic to take a drug and eliminate the chance of getting lyme is the fear of having a disease that was a political football.  Anything I can to do avoid that nightmare, I will do.
 
CT has also passed unanimously a bill  in the General Assembly making it legal for CT doctors to use a different protocol involving long-term use of antibiotics without fear of censure (At least one Lyme literate doctor here was censured and forced out of practice a few years ago -- and he treated kids.) I believe it has become law, but am not 100% on this because at first the governor was not signing the bill.
 
Another note about getting ticks tested:  Free tick testing in my state has a downside or two -- results take two weeks and they only test engorged ticks. Really the purpose of the lab seems more to be to gather statistics about prevalence and to make broad generalizations.  This is a different purpose than finding out if  a specific and symptomatic patient may have lyme from a rather unusual method of transmission.
 
Again talking to my lyme literate friends, they said that HOW one removes the tick is highly important, and that while less common, Lyme can spread via an unengorged tick.  If you do things like squeeze the tick while trying to remove it (I used my fingers to just rip it off and did probably squeeze it), the tick may regurgitate into the bite and spread the spirochete that way.  Lesson learned - YES tweezers next time and NO tick body squeezing, or any of the other stuff I don't want to mention here becauase somebody might wrongly remember it as the right thing to do.
 
 If I were bitten again and was quickly and strongly symptomatic and the tick seemed not to be engorged,  I would not bother sending it to the state and would perhaps try to find a private lab and pay for having the tick tested.  (As it was, I just wrote them a letter and asked for my tick back.  They thought I was nuts, but they sent it back, explaining how I could not possibly be sick because the tick was not engorged.). 
 
I relate the tick testing/engorgement story, by the way, to demonstrate that having reliable guidance through this disease is critical.  If new information is emerging and other information is less relied upon, a doctor who sees lots and lots of lyme is more likely to know this.
 
I did not end up testing the tick so cannot verify that I had Lyme.  All I know is that the memory issues and rash/bite site problems within days began to resolve and I have had no further symptoms to date, almost 9 months later.
 
Chris Reid
Stamford, CT




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