DR Show: “Diagnosing & Treating Lyme Disease”

The Diane Rehm Show | “Diagnosing & Treating Lyme Disease” | February 29, 2012

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dramatis personae

Diane Rehm
your host

Dr Paul Auwaerter
associate professor of medicine, Johns Hopkins University School of Medicine
and clinical director, division of infectious diseases.
Johns Hopkins Hospital

Dr. Samuel Shor
internist, private practice and associate clinical professor at George Washington University.

Dr. Brian Fallon
professor of clinical psychiatry.
director, Lyme and Tick-Borne Diseases Research Center. and
director, Center for the Study of Neuroinflammatory Disorders & Biobehavioral Medicine
Columbia University

Stephen Barthold
professor,department of pathology, microbiology and immunology
Center of Comparative Medicine at the School of Veterinary Medicine, University of California, Davis

Program Highlights

Questions as to whether chronic Lyme disease exists, how to test for it, and how to treat it are dividing doctors and confounding patients. Diane’s guests discuss why diagnosing and treating the disease remains so challenging and controversial.

Best Treatment Practices

Doses of specific antibiotics are recommended for both early-stage Lyme disease and for patients who may be experiencing some neurological problems or arthritis, like knee swelling, Dr. Auwaerter said. But as for the question about whether or not it’s possible to have so-called “chronic” Lyme disease, Auwaerter said that carefully performed studies have shown no evidence that bacteria seems to persist in people with ongoing complaints after being treated for Lyme disease.

A Different View On Chronic Lyme Disease

Dr. Shor believes that there’s “no scientific basis” for concluding that 30 days of treatment in all patients with Lyme disease is going to be adequate to cure the disease. Dr. Barthold has found in his veterinary practice and research that the bacteria that causes Lyme disease is very good at persisting in an animal’s body for that animal’s entire lifespan. It’s possible, Dr. Barthold said, that this could be the same pattern for the disease in humans.

What Happens With “Chronic” Lyme Disease?

“The infection is persistent, the disease is not,” Dr. Barthold said. “And what’s curious about Lyme disease is in the early phase of the infection you have arthritis and inflammation of the heart and other manifestations in animals as you see in humans. And then the immune response, particularly antibody, comes in and clears a large number of the bacteria from tissues leaving behind persisting organisms that are sequestered away in connective tissue,” he said.

Difficulties In Diagnosis And Treatment

Dr. Fallon said that it’s certainly possible for some patients to have Lyme disease but to not test positive for it. Dr. Shor agrees that the available testing is “insensitive.” “And we have managed care which pushes physicians to see very complex patients in short periods of time and insurance companies that are loathe to pay any more than they have to,” Dr. Shor said.

Dr Fallon adds that single-dose doxy is not supported by science. That the studies used to support the thesis do not demonstrate the efficacy of single-dose doxy.

You can read the full transcript here.

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