The following will help you be prepared for whatever occurs. If he knows you're educated and know what to expect, he'll be less inclined to blow you off and it will be less effective if he tries. Information is power.
IDSA GUIDELINES
Here is the "MD's continuing education" short version of the IDSA's Lyme Practice Guidelines:
/wwwnc.cdc.gov/eid/article/22/7/pdfs/15-1694.pdfHere is the full version:
cid.oxfordjournals.org/content/43/9/1089.fullAccording to the strictest dx and tx guidelines, the IDSA Lyme Practice Guidelines,
if you have an EM rash, no further testing is required and an MD can diagnose you w/ LD and start abx prophylaxis.
"Thus, a bite from an I. scapularis tick may lead to the
development of Lyme disease, human granulocytic
anaplasmosis (HGA, formerly known as human granulocytic
ehrlichiosis), or babesiosis as a single infection or, less
frequently, as a coinfection.
Clinical findings are sufficient
for the diagnosis of erythema migrans, but clinical findings
alone are not sufficient for diagnosis of extracutaneous
manifestations of Lyme disease or for diagnosis of HGA or
babesiosis. Diagnostic testing performed in laboratories
with excellent quality-control procedures is required for
confirmation of extracutaneous Lyme disease, HGA, and
babesiosis." ---IDSA Guidelines • CID 2006:43 (1 November) • 1089
What this means: If you show up to an MD's office with a very obvious and classic bullseye rash, he/she can diagnose lyme infection. But joint problems or any other symptoms don't qualify and testing is then required.
HOWEVER...
You then need to qualify for treatment to prevent the lyme infection from turning into lyme disease, which is a single 200mg dose of doxy. PRESTO, you're cured.
"For prevention of Lyme disease after a recognized tick bite,
routine use of antimicrobial prophylaxis or serologic testing is
not recommended (E-III). A single dose of doxycycline may
be offered to adult patients (200 mg dose) and to children
greater than or equal to 8 years of age (4 mg/kg up to a
maximum dose of 200 mg) (BI) when all of the following
circumstances exist:
(a) the attached tick can be reliably identified as an adult or
nymphal I. scapulars tick that is estimated to have been
attached for greater than or equal to 36 h on the basis of the
degree of engorgement of the tick with blood or of certainty
about
the time of exposure to the tick;
(b) prophylaxis can be started within 72 h of the time that the
tick was removed;
(c) ecologic information indicates that the
local rate of infection of these ticks with B. burgdorferi is
greater than or equal to 20% (with the exception of the west coast I. pacificus ticks, because "...rates of infection with Bb in these ticks is low" but if your LOCAL area has a rate of infection greater than or equal to 20%" then you might qualify for one dose of doxy, as long as you meet all other requirements; and
(d) doxycycline treatment is not contraindicated.
The time limit of 72 h is suggested because of the absence
of data on the efficacy of chemoprophylaxis for tick bites
following tick removal after longer time intervals. Infection
of greater than or equal to 20% of ticks with B. burgdorferi
generally occurs in parts of New England, in parts of the
mid-Atlantic States, and in parts of Minnesota and
Wisconsin, but not in most other
locations in the
United States. Whether use of antibiotic prophylaxis after
a tick bite will reduce the incidence of HGA or babesiosis
is unknown." --- IDSA Guidelines • CID 2006:43 (1 November) • 1090
What this means is:
MDs might refuse to give you even one dose of doxy unless you meet all four conditions listed above (read: how you present his case to the MD could determine his response so keep that in mind as you give the background...):
a) You need to be able to describe that yes, you identified the right tick (you may need to help the MD know what these look like) and yes, the tick was attached for at least 36 hours (based on when you were outside and when you took a shower and felt it on your shoulder, etc.) and
b) yes, you're showing up in the MDs office within the 36-72 hr window (I hope you can get into the MD's office without an appt...) and
c) yes, you live in an endemic area - although you may have to prove this to the MD if he/she isn't familiar with current statistics of the area in which they are practicing in (this is pretty common) and
d) no, you're not pregnant or nursing, a child under 8, you're not on any other meds or have an allergy to doxy.
If you do have contraindication with doxy, you won't get any substitutes because something like amoxicillin might require more than one dose, and even if it does develop into "lyme disease" you'll be fine due to the, "...the excellent efficacy of antibiotic treatment of Lyme disease if infection were to develop, and the extremely low risk that a person with a recognized bite will develop a serious complication of Lyme disease (D-III)."
MDs are discouraged from treating you with additional courses of abx or from doing any testing--of you OR the ticks. The Guidelines don't explain this but my guess is these restrictions help distinguish between Bb infections and manifestation of lyme disease... for surveillance purposes. However, the CDC has been pretty clear about
not using the CDC's surveillance case definition criteria for diagnosis or treatment purposes. The IDSA ignores this and the CDC ignores that the IDSA ignores this. I'd like to see them defend this in a court of law.
MDs are then encouraged to monitor the patient for 30 days and watch for EM rash and/or viral symptoms. The patient is encouraged to seek immediate medical attention if either of these symptoms develop "1 month after removing an attached tick". ---IDSA Guidelines • CID 2006:43 (1 November) • 1091
-p
Post Edited (Pirouette) : 5/17/2017 1:43:03 PM (GMT-6)