To Your Health With Dr. Jim Morrow: Episode 9, Lyme Disease

Episode 9, Lyme Disease

What causes Lyme Disease? What about chronic Lyme Disease? What is it about some treatments of chronic Lyme Disease that should be concerning?  On this episode of “To Your Heath,” Dr. Jim Morrow addresses these questions and more. Dr. Morrow also talks about why he maintains ownership of his practice and what that means for his patients.

Dr. Morrow’s Show Notes on Lyme Disease

• Today, I am going to talk about Lyme Disease, and before I am finished, I suspect that some of you will be shaking your heads and changing the dial, metaphorically at least.
• Lyme disease, caused by the bacterium Borrelia burgdorferi, is the most common tick-borne illness in the United States.
  • Transmission occurs primarily through the bite of an infected deer tick.
  • Lyme disease cases are concentrated in the Northeast and upper Midwest, with 14 states accounting for over 96% of cases reported to CDC.
  • Georgia has had cases of documented Lyme disease but the numbers are very low.
  • Identification of an erythema migrans rash following a tick bite is the ONLY clinical manifestation sufficient to make the diagnosis of Lyme disease in the absence of laboratory confirmation.
  • The Centers for Disease Control and Prevention recommends a two-tier approach using an enzyme-linked immunosorbent assay initially, followed by the more specific Western blot to confirm the diagnosis when the assay samples are positive or equivocal.
    • This is a tremendous point of conflict among patients. The test reports a series of positive or negative “bands” that correspond to possible infection.
      • In order for the test to be POSITIVE, you MUST have FIVE or more positive bands. This is due to cross-reaction or false positive results on any one band.
      • Very often, when we get these results back, 1-3 bands are positive. I have seen too many times when the patient, or even on occasion, the clinician, made the diagnosis of Lyme disease based on this.
• This is just wrong and is completely unfair to the patient. And it can make the patient vulnerable to the mountain of information available that would make them believe that they could someday have what has been labeled as “chronic Lyme disease”
• The treatment of Lyme disease is determined mainly by the clinical manifestations of the disease.
• Doxycycline is often the preferred agent for oral treatment because of its activity against other tick-borne illnesses.
• Preventive measures include
  • avoiding areas with high tick burdens,
  • wearing protective clothing,
  • using tick repellants (e.g., DEET),
  • performing frequent body checks and
  • bathing following outdoor activities, and
  • instituting environmental landscape modifications (e.g., grass mowing, deer exclusion fencing) to reduce the tick burden.
• Although there is controversy regarding treatment of post–Lyme disease syndrome and chronic Lyme disease, there is no biologic or clinical trial evidence indicating that prolonged antibiotic therapy is of benefit.
• Symptoms of early Lyme disease usually begin one to two weeks after a tick bite (range of three to 30 days)
• There are three well-recognized clinical stages of Lyme disease, and clinical manifestations are different at each stage.
• As many as 80 percent of patients develop the characteristic erythema migrans rash, which may be confused with other similar conditions.
• Erythema migrans is classically reported as a single lesion
  • most commonly appears as a uniform red oval rash with average size of about 7-8 inches. It can be as small as a couple of inches.
• Approximately 19 percent of Lyme rashes are a “bull’s-eye” rash. So, if you are basing the diagnosis only on a bulls eye rash, you could easily miss this.
• Multiple similar rashes may occur in up to 10 to 20 percent of patients.
• Associated symptoms are similar to a nonspecific viral illness and often include fatigue, malaise, fever, chills, myalgia, and headache.
• Following this initial stage, the bacteria disseminate systemically via the lymphatic system or blood.
• With untreated disease, the most common sites of extra-cutaneous involvement are the joints, nervous system, and cardiovascular system.

Stages of Lyme Disease

• Early localized
  • Erythema migrans – (typical rash)
  • Virus-like illness (e.g., fatigue, malaise, fever, chills, myalgia, headache)
• Early disseminated:
  • Cardiac (e.g., atrioventricular block)
  • Dermatologic (e.g., multiple erythema migrans lesions)
  • Musculoskeletal (e.g., arthralgia, myalgia)
  • Neurologic (e.g., lymphocytic meningitis, facial nerve palsy, encephalitis)
• Late
  • Arthritis (can be one or multiple joints)
  • Neurologic symptoms (e.g., encephalomyelitis, peripheral neuropathy)
• These are associated with a positive test for Lyme disease

Chronic Lyme Disease

• Symptoms attributed to Chronic Lyme Disease are chronic pain, fatigue, neurocognitive, and behavioral symptoms
  • Clinicians who subscribe to the idea that chronic Lyme is a real entity will misread, either intentionally or through ignorance, the lab tests for Lyme disease.
  • Too often, they will explain to the patient that the only treatment for their symptoms is long-term antibiotic treatment with or without some other very involved, complex and almost always wasteful treatment THAT ONLY THEY CAN PROVIDE.
  • Perhaps the most recognized and contentious facet of this debate is whether it is effective, appropriate, or even acceptable to treat patients with protracted antibiotic courses based on a clinical diagnosis of CLD.
  • Patients and their families spend an unbelievable amount of money every year on these treatments. Thousands and thousands of dollars are wasted and just handed over to unscrupulous physicians who prey on the hardship of others.
• The dialogue over CLD provokes strong feelings, and has been more acrimonious than any other aspect of Lyme disease.
  • Many patients who have been diagnosed with CLD have experienced great personal suffering; this is true regardless of whether Lyme infection is responsible for their experience.
  • On top of this, many patients with a CLD diagnosis share the idea that the medical community has failed to effectively explain or treat their illnesses.
    • In support of this patient base is a community of physicians and alternative treatment providers as well as a politically active advocacy community.
    • This community promotes legislation that has attempted to shield CLD specialists from medical board discipline and medicolegal liability for unorthodox practices, to mandate insurance coverage of extended parenteral antibiotics, and most visibly to challenge legally a Lyme disease practice guideline.
    • The advocacy community commonly argues that Lyme disease is grossly underdiagnosed and is responsible for an enormous breadth of illness; they also argue that the general scientific and public health establishments ignore or even cover up evidence to this effect.
    • A large body of information about CLD has emerged on the Internet and other media, mostly in the forms of patient testimonials and promotional materials by CLD providers.
    • This volume of information can be confusing and difficult to navigate.
  • The concept of CLD has for the most part been rejected. Clinical practice guidelines discourage the diagnosis of CLD and recommend against treating patients with prolonged or repeated antibiotic courses.
    • National and state public health bodies agree with this rejection of CLD.
    • Within the medical community, only a small minority of physicians have accepted this diagnosis: 2.1%
  • Many patients referred for Lyme disease are ultimately found to have a rheumatologic or neurologic diagnosis.
    • Rheumatologic diagnoses commonly misdiagnosed as Lyme disease include osteoarthritis, rheumatoid arthritis, degenerative diseases of the spine.
    • Some patients are found to have neurologic diseases, including multiple sclerosis, demyelinating diseases, amyotrophic lateral sclerosis, neuropathies, and dementia.
    • Some CLD advocates have argued that these various conditions are simply manifestations of Lyme disease, but these hypotheses are unable to be proven.
    • There is no evidence that these conditions are related to Lyme infection at any time.
  • Bottom line on chronic Lyme disease is that there is just no science behind it. No study has ever shown a definitive link between these vague symptoms and Lyme disease.
    • The only information even found with the infamous Google search is found on non-medical sites. Websites of any scientific value (those reporting actual scientific studies) reveal NO DATA supporting chronic Lyme disease.
    • The symptoms of chronic Lyme can sometime be explained by other REAL disease processes, but more often than not, these symptoms are just the symptoms of life. They can happen to anyone and do happen to a huge percentage of people in the everyday living of life.

(Information included in these notes comes, in part, from the American Academy of Family Physicians website at www.aafp.org.)

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

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