The more I've learned (I have been research a lot in the past couple of months and had no idea how much there was to learn) the more I'm understanding why MDs think the 21-days is "curative".
I won't belabor the point too much and there are MANY nuances and other contributing factors, but here are some cliff notes to help explain the suggestions for longer treatment. It's good to understand the basic issue with the prescribed treatment, particularly if you choose not to seek a specialist but also suspect you might need more treatment once you're nearing the end of your prescript
ion:
- The IDSA guidelines, which are likely guiding your MD, cap the treatment at 200mg/day and 21 days max because the studies the guidelines are based on suggest this is effective.
- Unfortunately, for MANY lymees, the studies used a specific type of lyme manifestation to prove this prophylactic approach.
- Lyme manifests itself in many, many different ways, but early on the researchers studying it (who are rheumatologists and scientists--not MDs who have broad experience treating lyme patients) studied and learned Lyme from this very narrow perspective. When they studied the very early lyme patients they found one common denominator in most patients - the EM rash.
- So when they did subsequent studies, they used the EM rash as a qualifier for the study subjects and determined the early lyme manifestations based on the other symptoms these EM-producing lymees also developed.
- Therefore, the definition of Lyme was originally very narrowly defined as having only these objective symptoms (not because that is what is found out in the real world in people who have lyme, but because this narrow definition helped these scientists study Lyme more easily, made it easier to select study subjects AND helped streamline how effective the treatments were - the fewer symptoms to "resolve" with treatment, the more effective it is).
- This is where the "21 days and you're done" comes from
- However, many people don't produce this rash and instead produce many many other subjective symptoms. The orthodox view of lyme ignores these other symptoms, what they indicate as far as how the lyme infection has manifested into the body, and what is therefore required to effectively treat the infection.
- The early studies also didn't follow up with people who relapsed, which can happen if the initial treatment isn't effective.
- And this is why this 21 days is often not effective for many people.
Unfortunately, most MDs religiously follow the guidelines because they don't specialist in lyme and have no clue of the origin of the guidelines, have no idea if they are effective, have no idea what the options are, don't treat enough lyme patients to understand how it manifests and what treatments do and don't work.
Also, based on history within the lyme wars, MANY lyme specialists have been--and still are being investigated for over-diagnosing and over-treating. Your MD confidently diagnosed due to your rash (because that is THE symptom that the guidelines are based on). Many MDs don't feel confident in prescribing more than the guidelines for fear they may be targeted.
Many, many studies have been done to prove that 21-days is ineffective; the main reasons stem from the discovery that the lyme microbe can be a persistent pathogen:
- Before injecting its load of pathogens into your unsuspecting body, the tick that bit you injects an immune inhibiting substance, allowing the spirochete to gain a strong foothold. The spirochete itself secretes enzymes that help it to replicate and infect your body.
- The Lyme microbe can sometimes evade something it senses attacking it - like your immune system and/or antibiotics and can leave the blood system and instead, burrow into scar tissue, other tissues, CNS where it is unreachable by the abx. Or it can change into other forms (cyst, L-form, biofilm) that can't be reached easily by doxy, either.
- Each of these forms needs a different antibiotic or treatment - none of this is addressed in the guidelines
ETA: I removed my comment about
replication rate, as there is a lot of controversy over this so will wait to comment on this until I find better sources...
Hope that is helpful! ;)
-p
Post Edited (Pirouette) : 7/31/2016 5:42:49 PM (GMT-6)