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Lyme Disease (transcript)
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ANNOUNCER:

 

MAJOR FUNDING

FOR "SECOND OPINION"

IS PROVIDED BY THE BlueCross

AND BlueShield ASSOCIATION,

AN ASSOCIATION OF INDEPENDENT, LOCALLY OPERATED,

AND COMMUNITY-BASED BLUE CROSS AND BLUE SHIELD COMPANIES.

FOR MORE THAN 80 YEARS,

BLUE CROSS AND BLUE SHIELD COMPANIES

HAVE OFFERED HEALTH CARE COVERAGE IN EVERY ZIP CODE

ACROSS THE COUNTRY

AND SUPPORTED PROGRAMS

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THE HEALTH AND WELLNESS

OF INDIVIDUAL MEMBERS

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THE BlueCross AND BlueShield ASSOCIATION'S MISSION IS

TO MAKE AFFORDABLE HEALTH CARE AVAILABLE TO ALL AMERICANS.

NEWS ABOUT OUR INNOVATIONS IS ONLINE AT BCBS.COM

AND ON TWITTER

@BCBSAssociation.

 

 

 

"SECOND OPINION" IS PRODUCED

IN ASSOCIATION WITH

THE UNIVERSITY OF ROCHESTER MEDICAL CENTER,

ROCHESTER, NEW YORK.

 

 

SALGO:

 

WELCOME TO "SECOND OPINION,"

WHERE YOU GET TO SEE, FIRSTHAND,

HOW SOME OF THE COUNTRY'S

LEADING HEALTH CARE

PROFESSIONALS TACKLE HEALTH

ISSUES THAT ARE IMPORTANT

TO YOU.

I'M YOUR HOST, DR. PETER SALGO,

AND TODAY I'M HAPPY TO WELCOME

DR. ALLEN STEERE FROM

MASSACHUSETTS GENERAL HOSPITAL.

OUR "SECOND OPINION" PRIMARY

CARE PHYSICIAN,

DR. LOU PAPA.

DR. CAROLYN BRITTON FROM

COLUMBIA UNIVERSITY.

DR. MARK SHELLY FROM THE

UNIVERSITY OF ROCHESTER

MEDICAL CENTER.

AND TREVOR SHORB, WHO IS HERE TO

SHARE HIS PERSONAL STORY.

BY THE WAY, THAT'S A STORY THAT

OUR PANELISTS, ALONG WITH YOU

AT HOME, WILL BE HEARING FOR

THE FIRST TIME RIGHT NOW.

SO LET'S GET RIGHT TO WORK.

THANK YOU FOR JOINING US.

SO, TREVOR, YOU'RE

A LACROSSE PLAYER.

I'VE HEARD ABOUT PEOPLE

LIKE YOU.

YOU GET HURT ALL THE TIME.

 

 

SHORB:

 

TOO MUCH.

 

 

SALGO:

 

YOU LIVE OUTSIDE OF BOSTON,

AND IN JUNE OF 2009, YOU WERE

STILL IN HIGH SCHOOL AND YOU

BEGAN EXPERIENCING SOME PROBLEMS

IN YOUR RIGHT ELBOW.

TELL ME ABOUT THAT.

 

 

SHORB:

 

IT WAS PRETTY FUNCTIONAL.

I COULD DO MOST THINGS, BUT I

COULDN'T EXTEND MY ELBOW

COMPLETELY.

AND SO I WENT TO MY DOCTOR.

 

 

SALGO:

 

AND WHAT DID YOUR

DOCTOR SAY?

 

 

SHORB:

 

HE WASN'T REALLY SURE WHAT IT

WAS, BUT I GOT A CORTISONE SHOT

THAT FIXED IT.

I WAS ALL SET.

SALGO:

 

YOU WERE ALL SET

EXCEPT WHAT?

WHAT HAPPENED?

 

 

SHORB:

 

IT CAME BACK

IN THE OTHER ELBOW,

A COUPLE MONTHS LATER.

 

 

SALGO:

 

DID YOU GET X-RAYS OR

ANYTHING ELSE?

 

 

SHORB:

 

I GOT X-RAYS.

DIDN'T REALLY SHOW ANYTHING.

KIND OF WENT AWAY.

 

 

SALGO:

 

WHAT ELSE DID YOU HAVE?

DID YOU HAVE ANY OTHER SYMPTOMS

OTHER THAN YOU COULDN'T EXTEND

YOUR ARM?

DID ANYTHING SWELL UP?

DID YOU HAVE ANY FEVERS?

 

 

SHORB:

 

MY LEFT KNEE WAS A LITTLE

SWOLLEN, BUT I COULD STILL PLAY

LACROSSE AND RUN AND EVERYTHING.

I WASN'T IN PAIN.

 

 

SALGO:

 

YOU WERE IN PAIN?

 

SHORB:

 

I WAS NOT IN PAIN.

 

 

SALGO:

 

YOU HAD A SWOLLEN KNEE AND

YOU WERE STILL OUT THERE PLAYING

LACROSSE.

 

 

SALGO:

 

HE'S SITTING HERE.

DO YOU HAVE ANY QUESTIONS

FOR HIM?

 

 

PAPA:

 

WHEN THESE SYMPTOMS CAME ON,

DID YOU NOTICE, WAS THERE ANY

SWELLING IN THE JOINT AT ALL, OR

IT JUST FELT LIKE YOU COULDN'T

STRAIGHTEN IT OUT?

 

 

SHORB:

 

NOT IN MY ELBOW, I DIDN'T

NOTICE ANY SWELLING.

 

 

PAPA:

 

WAS THERE ANY OTHER JOINT

INVOLVEMENT AT ALL?

DID YOU HAVE ANY SWELLING IN

THE JOINTS IN YOUR FINGERS

OR IN YOUR TOES?

 

 

SHORB:

 

NO.

 

 

PAPA:

 

THERE WAS NO UNUSUAL RASHES

OR LUMPS AND BUMPS ANYWHERE?

 

 

SHORB:

 

NO.

 

 

SALGO:

 

SO, THIS IS KIND OF

A MYSTERIOUS MOMENT OVER HERE.

HE'S GOT THESE JOINT PAINS AND

SOMETIMES SWELLING AND IT COMES

AND IT GOES AND IT'S TAKEN

OVER A YEAR.

WHAT'S YOUR DIFFERENTIAL HERE?

"DIFFERENTIAL" MEANING, WHAT'S

THE LIST OF THINGS THAT YOU

THINK MIGHT BE WRONG WITH

TREVOR?

 

SHELLY:

 

I JUST WONDER WHETHER

SOMEBODY AT SOME POINT SAID,

"LAY OFF THE EXERCISE FOR A BIT

AND SEE IF IT GETS BETTER

WITH TIME"?

 

 

SHORB:

 

IT WAS DURING THE PLAYOFFS.

IT WASN'T REALLY AN OPTION.

 

 

SALGO:

 

SEE? I DIDN'T KNOW

THIS BUT I KNEW THE ANSWER.

 

 

BRITTON:

 

AND SOMEBODY WHO REALLY IS

INTO COMPETITIVE SPORTS OR

ANYTHING WHERE THEY ARE HIGH

REPETITIVE PLAYERS, IT'S VERY

HARD FOR THEM TO GIVE IT UP.

BUT THE ONE THING I'D WANT TO

KNOW IS WHETHER OR NOT THERE'S

ANY FAMILY HISTORY OF ARTHRITIS.

HAD HE EVER HAD ANY ILLNESS IN

THE PAST THAT HAD COME AND GONE?

IS THIS REALLY THE START POINT

OR IS THIS A RENEWAL POINT?

SO, THINKING OF DIFFERENTIAL

DIAGNOSIS, YOU'RE TRYING FIRST

TO CATEGORIZE IT, IS IT

SOMETHING GENETIC, WHEN YOU DEAL

WITH A YOUNG PERSON?

IS IT SOMETHING INFECTIOUS?

IS IT SOMETHING INFLAMMATORY?

 

 

STEERE:

 

I THINK, IN A VERY ATHLETIC

YOUNG MAN, THE FIRST THING THAT

ONE WONDERS ABOUT,

IS THIS TRAUMATIC?

BUT CAN YOU TELL US

ABOUT THAT MORE?

I MEAN, IT SOUNDS LIKE IT DIDN'T

REALLY MAKE SENSE TO YOU THAT

THERE HAD BEEN TRAUMA TO THIS

ELBOW AND THEN TO THIS ELBOW

OR THIS KNEE.

COULD YOU TALK ABOUT IT MORE?

 

 

SHORB:

 

YEAH. NO, I DIDN'T KNOW WHERE

IT CAME FROM -- THERE WASN'T

A SPECIFIC INSTANCE IN WHICH

IT HAPPENED.

 

 

STEERE:

 

IT JUST APPEARED.

 

 

SHORB:

 

AND WHEN I NOTICED MY KNEE

WAS SWELLING, I DIDN'T THINK TO

CONNECT IT TO THE ELBOWS.

THAT WAS SOMETHING THAT CAME AND

HAD GONE.

 

 

SALGO:

 

BUT THAT BEING SAID,

YOU GET BANGED ALL THE TIME.

SO YOU CERTAINLY COULD HAVE BEEN

BANGED IN ONE ELBOW, ANOTHER

ELBOW AND THE KNEE, AND YOU

MIGHT NOT EVEN HAVE

REMEMBERED IT.

PART OF THE GAME, RIGHT?

 

 

SHORB:

 

YEAH. I USUALLY HAVE BRUISES

TO REMEMBER THOSE ONES.

 

 

SALGO:

 

WHAT ARE YOU FEELING

LIKE AT THIS POINT?

 

 

SHORB:

 

I STARTED GETTING REALLY

FATIGUED.

I WOULD SLEEP A GOOD PORTION

OF THE DAY.

AND I GOT A PRETTY BAD FEVER

WHICH KEPT ME IN BED FOR

TWO DAYS.

 

SALGO:

 

HOW HIGH WAS THE FEVER?

 

 

SHORB:

 

102 DEGREES.

 

 

SALGO:

 

102 IN A GROWNUP.

 

 PAPA:

 

THAT'S PRETTY HIGH.

 

 

PAPA:

 

SO AT THIS POINT, YOUR DOCTOR

LOOKED AT YOU, THOUGHT A LOT

ABOUT WHAT WAS WRONG, AND WHAT

DID HE SAY WAS WRONG WITH YOU?

 

 

SHORB:

 

HE WAS GOING TO SEND ME TO

GET MORE TESTS, BUT HE SAID,

"WHY DON'T WE TEST YOU

FOR LYME DISEASE?"

 

 

SALGO:

 

LYME DISEASE.

ALL RIGHT.

WHAT IS LYME DISEASE?

ANYBODY WANT TO GIVE ME

A DEFINITION?

PAPA:

 

LYME DISEASE IS AN INFECTION

THAT'S BROUGHT ON BY A TICK.

AND IT CAUSES AN INFECTION.

IN THE BEGINNING, IT CAN BE JUST

AN INFECTION IN THE SKIN, BUT IT

CAN EVENTUALLY GET DISSEMINATED

OR SPREAD TO OTHER ORGANS.

 

 

SALGO:

 

WHAT ABOUT THIS TICK?

WHAT DO WE KNOW ABOUT THE TICK

THAT GIVES YOU LYME DISEASE?

 

 

SHELLY:

 

WELL, THERE'S ONE OR TWO

SPECIFIC TYPES OF TICKS WHICH,

WHEN THEY BITE, WILL END UP

SPILLING A LITTLE BIT OF

BORRELIA BURGDORFERI,

THE LYME --

 

 

SALGO:

 

YOU WANT TO SAY THAT

THREE TIMES FAST?

BORRELIA BURGDORFERI?

 

 

SHELLY

 

BURGDORFERI.

SPILLING THAT INTO

THE TISSUES.

 

 

SALGO:

 

THAT'S A BACTERIUM.

 

 

SHELLY:

 

YES, A BACTERIUM, OR A TYPE

OF BACTERIUM WE CALL

A SPIROCHETE.

IT'S A LITTLE CURLICUE

THAT GETS IN THERE AND

MULTIPLIES.

AT THE AREA OF THE BITE, IT THEN

CAN CAUSE A SPECIFIC TYPE

OF RASH.

LATER ON, IT CAUSES A NUMBER OF

THE OTHER SYMPTOMS THAT ARE

ASSOCIATED WITH LYME.

 

 

SALGO:

 

BEFORE WE GO ANY FURTHER,

LET'S HAVE A LOOK AT THAT LITTLE

SUCKER.

 

 

STEERE:

 

WELL, THAT'S THE

ADULT FEMALE STAGE.

THERE ARE THREE STAGES

IN THE TICK'S LIFE CYCLE, AND IT

TAKES A BLOOD MEAL AT EACH

STAGE, THEN MOLTS

TO THE NEXT STAGE.

IT IS THE NYMPHAL STAGE THAT IS

PRIMARILY THE INFECTED ONE THAT

TRANSMITS THE DISEASE.

 

 

SALGO:

 

SO HOW DO TICKS GET FROM

THE DEER

TO OUR FRIEND HERE?

 

 

STEERE:

 

IT'S THE ADULT STAGE OF

THE TICK THAT FEEDS ON DEER,

THE ONE WHOSE PICTURE YOU

SHOWED, BUT THE IMMATURE STAGES

FEED PRIMARILY ON SMALL RODENTS.

AND WE SAY THEY "QUEST,"

PRIMARILY IN THE SUMMER MONTHS.

USUALLY LOW TO THE GROUND.

AND THEY'RE LOOKING FOR A MOUSE.

BUT IF YOU COME ALONG,

IT MAY ATTACH TO YOU.

THE SUMMER BEFORE YOU HAD

THE ARTHRITIS FIRST IN AN ELBOW,

WHAT WERE YOU DOING?

AND DO YOU REMEMBER BEING SICK

AT ALL?

 

 

SHORB:

 

I WAS WORKING A LANDSCAPING

JOB IN THE WOODS IN LINCOLN,

WHICH WAS DOING A LOT OF WALKING

AROUND IN THE WOODS.

I DON'T REMEMBER GETTING SICK.

 

 

SALGO:

 

BY THE WAY, THE MINUTE YOU

SAID "LANDSCAPING" AND "WOODS,"

EVERYBODY ON THIS PANEL LIT UP.

THAT'S A CLASSIC STORY,

ISN'T IT?

 

 

BRITTON:

 

IT'S A CLASSIC

STORY, AND I WAS GOING TO MAKE

THE COMMENT, IT'S NOT WHO YOU

ARE BUT WHAT YOU DO.

 

 

SALGO:

 

SO THIS

IS THE LITTLE GUY.

 

 

STEERE:

 

LITTLE GUY.

 

 

SALGO:

 

AND YOU CAN'T SEE HIM, AND

HE'S HANGING IN THERE FOR DEAR

LIFE, DRINKING YOUR BLOOD.

BANG, YOU GET A BITE,

BANG, YOU GET SICK?

OR DOES IT TAKE TIME?

 

 

SHELLY:

 

IT TAKES A CERTAIN AMOUNT OF

TIME FOR THE BACTERIA TO BE

TRANSMITTED ACROSS, SO AT FIRST

THEY'RE TAKING IN THE BLOOD

MEAL, BUT LATER ON THERE MAY BE

A LITTLE BIT OF FLOW IN

THE OPPOSITE DIRECTION.

 

 

STEERE:

 

THE TICK ATTACHES.

IT TAKES ROUGHLY 24 HOURS FOR IT

TO START FEEDING BLOOD.

IT THEN IMBIBES BLOOD.

THAT OCCURS FOR MAYBE THREE,

FOUR OR FIVE DAYS.

THE TICK THEN FALLS OFF.

 

 

SALGO:

 

SO, SUPPOSING IT IS

A TICK THAT CAN GIVE YOU LYME.

SUPPOSING IT HAS THESE

SPIROCHETES.

SUPPOSING IT'S BEEN ON FOR 24 TO

36 HOURS.

AND SUPPOSING THEN YOU GET

INFECTED.

CLASSICALLY, WHAT DOES THAT

INFECTION LOOK LIKE?

 

 

STEERE:

 

THE CLASSIC THING TO HAPPEN

WOULD BE, AFTER AN INCUBATION

PERIOD THAT'S USUALLY 3 TO 32

DAYS, BUT MOST COMMONLY ABOUT 7

TO 10 DAYS,

A REDNESS FORMS AROUND THE AREA

OF THE BITE AND IT BEGINS TO

EXPAND SLOWLY.

AND AS IT EXPANDS, IT MAY HAVE

THEN A REDDER OUTER BORDER WITH

SOME PARTIAL CENTRAL CLEARING.

 

 

SALGO:

 

THE -- SHALL WE SAY IT

ALL TOGETHER? --

BULL'S-EYE RASH.

FUNNY ABOUT, BUT WE MIGHT

HAVE A PICTURE OF.

THERE IT IS,

THE BULL'S-EYE RASH.

 

 

SHELLY:

 

YOU MENTIONED THE INCUBATION

PERIOD, AND FREQUENTLY THERE

WILL BE A LITTLE BIT OF

AN ALLERGIC REACTION AROUND

THE BITE, WHICH WILL SHOW UP

THE NEXT DAY.

THAT CAN'T BE LYME DISEASE.

YOU WOULDN'T HAVE MULTIPLICATION

QUICKLY ENOUGH TO SHOW UP

LIKE THAT.

AND YOU CAN BASICALLY DISCARD

THAT CONCERN ABOUT THE RASH THAT

SHOWS UP RIGHT AWAY.

THE OTHER THING IS THAT PEOPLE

SOMETIMES THINK OF THIS

THE SIZE OF A MOSQUITO BITE, BUT

FOR MOST OF THESE, WE'LL GET UP

TO AT LEAST 2 OR 3 INCHES AND

USUALLY 3 OR 4 OR 5.

AND SOMETIMES REALLY HUGE

AT THAT SITE.

SO IF IT'S NOT A BIG ENOUGH ONE

AND IT'S NOT EXPANDING AND IF IT

CAME ON TOO SOON,

THERE'S NOTHING TO WORRY ABOUT

WITH THAT BITE.

 

 

SALGO:

 

DID YOU EVER HAVE

THE BULL'S-EYE?

 

 

SHORB:

 

NEVER FOUND IT.

 

 

SALGO:

 

THERE WE GO, FOLKS,

BACK TO SQUARE ONE.

SO, NO TICK.

NO BULL'S-EYE RASH.

NOW WHAT DO YOU DO?

HOW DO YOU MAKE THE DIAGNOSIS?

 

 

STEERE:

 

IT'S DEPENDENT ON THE FACT

THAT THEY WOULD DEVELOP OTHER

MANIFESTATIONS OF THE DISEASE

THAT WOULD BE TYPICAL

OF WHAT ONE SEES IN LYME

DISEASE.

NOW, NOT NECESSARILY SPECIFIC

FOR LYME DISEASE.

 

 

BRITTON:

 

WELL, COULD WE GET

BACK TO TREVOR'S CASE?

 

 

SALGO:

 

YES.

 

 

BRITTON:

 

HE HAD THREE DOMINANT THINGS

THAT HE EXPLAINED TO US.

ONE, WE KNOW HE HAS VERY

SIGNIFICANT EPIDEMIOLOGIC RISK,

BOTH FROM WHAT HE ENJOYS DOING

AND WHEN HE'S WORKING.

AND THEN HE HAD NO KNOWN TICK

BITE, BUT HE HAD A POLYARTICULAR

ARTHRALGIA.

 

 

SALGO:

 

POLYARTICULAR ARTHRALGIA.

 

 

BRITTON: WHICH MEANS MULTIPLE

JOINTS INVOLVED WITH PAIN.

WELL, THE KNEE THAT WAS SWOLLEN

BUT NOT PAINFUL, BUT BOTH ELBOWS

WERE PAINFUL AT INDEPENDENT

TIMES.

HE HAD A FATIGUE AND HE HAD

FEVER.

SO I'D SAY IF YOU LOOK AT

THE FIRST THINGS YOU COMMONLY

SEE PEOPLE FOR, IT MAY BE

A NEUROLOGIC PRESENTATION,

WHICH IS ALSO COMMON.

PARTICULARLY BELL'S PALSY.

SO, BELL'S PALSY IS --

 

 

SALGO:

 

BELL'S PALSY,

DROOPY EYELID.

 

 

BRITTON:

THE DROOPY FACE, RIGHT.

IT IS REALLY THE NERVE TO THE

FACE BECOMES PARALYZED OUTSIDE

OF THE BRAIN.

THAT MAY BE A FIRST

MANIFESTATION OF LYME DISEASE.

OR THIS FEVER, FATIGUE, AND

ARTHRALGIA.

 

 

SHELLY:

 

BUT AT THE POINT THAT YOU'RE

DEALING WITH A FEVER AND

AN ARTHRITIS, MOST DOCTORS

WOULD, AT THAT POINT, BE PUTTING

ON A BLOOD TEST.

 

 

SALGO:

 

THE BLOOD TEST DOESN'T TEST

FOR THE BACTERIA.

YOU'RE LOOKING FOR ANTIBODIES,

WHICH IS YOU'RE LOOKING FOR

THE BODY'S RESPONSE TO

THE BACTERIA.

 

 

SHELLY:

 

RIGHT.

SO, THAT BLOOD TEST GOES OFF.

IF IT COMES BACK POSITIVE,

DO YOU HAVE LYME?

 

 

SHELLY;

 

NO. THE BLOOD TEST COULD BE

POSITIVE BECAUSE YOU HAD ANOTHER

EXPOSURE AND HAD FOUGHT OFF

THE DISEASE IN THE PAST,

NEVER HAD LYME DISEASE, AND IT

WAS POSITIVE.

BUT THE CURRENT IS CAUSED

BY SOMETHING ELSE.

 

 

SALGO:

 

IF A BLOOD TEST IS NEGATIVE,

DOES IT MEAN YOU DON'T HAVE

LYME?

 

 

STEERE:

 

IT WOULD MEAN IT

IN THIS CASE.

LET'S EMPHASIZE ANOTHER POINT.

ARTHRITIS IS THE MOST COMMON

LATE MANIFESTATION OF THE

DISEASE, BUT IT MAY BE

A PRESENTING MANIFESTATION.

USUALLY, THE PERSON HAS BEEN

INFECTED FOR MONTHS, THOUGH,

BY THE TIME ARTHRITIS DEVELOPS.

SO AS SOON AS YOU KNOW WHAT

YOUR EXPOSURE HISTORY WAS

IN SUMMER, FOLLOWED BY ONE

ELBOW, THEN ANOTHER ELBOW, THEN

A VERY SWOLLEN KNEE,

THERE'S VIRTUALLY NOTHING ELSE

THAT REALLY LOOKS THAT WAY

OTHER THAN LYME ARTHRITIS.

 

 

SALGO:

 

I WANT TO NAIL THE BLOOD TEST

JUST BEFORE WE STOP FOR A BREAK.

YOU CAN HAVE A POSITIVE BLOOD

TEST AND NOT HAVE LYME.

IT TAKES TIME FOR THAT TEST TO

TURN POSITIVE.

SO IF YOU TEST TOO EARLY, YOU

CAN HAVE A NEGATIVE TEST AND

STILL HAVE LYME.

 

 

STEERE:

 

BUT THAT'S WITHIN THE FIRST

SEVERAL WEEKS, THAT'S ALL.

 

 

SALGO:

 

BUT, IN POINT OF FACT, THIS

IS NOT A GREAT TEST.

 

 

STEERE:

 

WELL, I DISAGREE.

 

 

PAPA:

 

THE IMPORTANT THING ABOUT

TESTS -- AND THIS IS

A MISCONCEPTION IN MOST PEOPLE'S

MINDS -- IS THEY ARE TOOLS.

AND THE USE OF A TOOL DEPENDS ON

HOW YOU'RE GOING TO USE IT.

AND I THINK EVERY TEST, EVEN

SOME OF THE BEST TESTS, CAN

STILL BE FAULTY, SO IT REALLY

DEPENDS ON THE CLINICAL PICTURE.

 

 

STEERE:

 

 AND THEY CAN BE

MISINTERPRETED.

 

 

PAPA:

 

ABSOLUTELY.

 

 

SALGO:

 

LET ME PAUSE FOR

A SECOND AND SORT OF SUM UP.

WE'VE COVERED A LOT OF GROUND

OVER HERE.

LYME DISEASE IS AN INFECTIOUS

DISEASE CAUSED BY A MICROSCOPIC

BACTERIA CARRIED BY TICKS.

TYPICAL SYMPTOMS INCLUDE FEVER,

HEADACHE, FATIGUE, A

CHARACTERISTIC BULL'S-EYE RASH.

BUT THESE SYMPTOMS ARE NOT

ALWAYS EVIDENT, OR YOU COULD

OVERLOOK THEM.

LABORATORY TESTING CAN BE

AN IMPORTANT TOOL IN THE

DIAGNOSIS BUT IT'S NOT THE ONLY

METHOD AND IT DOESN'T REPLACE

TAKING A GOOD LOOK AT

THE PATIENT AND USING YOUR

BRAIN.

FAIR ENOUGH?

 

 

BRITTON:

 

FAIR ENOUGH.

ALL RIGHT, WE'RE TALKING

WITH TREVOR.

HOW ARE YOU, TREVOR?

 

 

SHORB:

 

GREAT.

 

 

SALGO:

 

THERE'S BEEN A LOT OF

MEDICINE FLYING AROUND

OVER HERE.

YOUR DOCTOR TESTED YOU FOR LYME.

YOUR TEST WAS POSITIVE,

I UNDERSTAND.

SO, WHAT THEN DID YOU DO NEXT?

 

 

SHORB:

 

I WENT ON A ROUND OF

ANTIBIOTICS OF AMOXICILLIN,

I BELIEVE, AND THAT DIDN'T WORK

AFTER ONE MONTH, AND THEN I WENT

ON ANOTHER ROUND OF ANTIBIOTICS

OF DOXYCYCLINE.

 

 

SALGO:

 

OKAY. SO THERE ARE

DIFFERENT STAGES OF LYME

DISEASE, RIGHT?

AND THE ANTIBIOTICS AND WHAT YOU

DO FOR THEM DIFFER FROM STAGE TO

STAGE.

DID IT SOUND AS IF HE GOT

THE RIGHT TREATMENT EARLY ON?

 

 

STEERE:

 

WHAT YOU RECEIVED WOULD BE

THE STANDARD TREATMENT

FOR ARTHRITIS,

LYME ARTHRITIS.

AND IN ROUGHLY 50% OF PATIENTS,

A ONE-MONTH COURSE OF EITHER

ORAL AMOXICILLIN OR ORAL

DOXYCYCLINE WOULD BE CURATIVE

AND THE ARTHRITIS WOULD GO AWAY.

BUT THAT MEANS THERE'S ANOTHER

50% OF PEOPLE IN WHOM THAT'S

NOT THE CASE.

COULD WE EMPHASIZE AGAIN,

THOUGH, THAT THIS IS A LATE

MANIFESTATION OF LYME DISEASE,

THE MOST COMMON LATE

MANIFESTATION, BUT USUALLY AT

THAT POINT, THE DISEASE IS

FAIRLY LOCALIZED.

I MEAN, IT WAS REALLY,

AT THIS POINT, ONE KNEE.

 

 

SALGO:

 

THE WHOLE STORY ABOUT LYME

IS THAT IT COMES IN PHASES.

 

 

STEERE:

 

IT DOES.

 

 

SALGO:

 

YOU GET BITTEN,

YOU GET THE ACUTE PHASE.

AND THEN THINGS HAPPEN

OVER TIME, RIGHT?

 

 

STEERE:

 

AND THE ACUTE PHASE MAY BE

ASYMPTOMATIC, WHICH WAS

APPARENTLY THE CASE WITH YOU.

 

 

SALGO:

 

WHAT HAPPENS IF YOU DON'T

TREAT IT?

 

 

BRITTON:

 

WELL, WHAT CAN HAPPEN IS

THE PERSON MAY GO ON TO DEVELOP

OTHER MANIFESTATIONS, BUT IN

SOME CASES, THEY MAY ENTER

A QUIESCENT PERIOD.

I'VE SEEN PATIENTS WHERE IT'S

TAKEN TWO OR THREE YEARS,

WITH AN EPISODE THIS YEAR, SOME

OTHER EPISODE THE NEXT YEAR,

A THIRD EPISODE THE THIRD YEAR,

BEFORE ONE GETS TO THE DIAGNOSIS

OF LYME.

SO IT MAY SETTLE IN WHERE YOU

DEVELOP CHRONIC, RECURRENT

ARTHRITIC SYMPTOMS OR YOU MAY

HAVE FATIGUE THAT BECOMES

DISABLING.

 

SALGO:

 

WHAT HAPPENS TO

THE NERVES IN THE BRAIN?

 

 

BRITTON:

 

WHAT HAPPENS TO THE NERVES IN

THE BRAIN IS, PEOPLE CAN DEVELOP

A COUPLE OF CLINICAL

PRESENTATIONS -- ONE IS AN ACUTE

MENINGITIS, WHICH YOU WON'T

MISS, BECAUSE THEY'LL COME IN

WITH HEADACHE, FEVER,

AND STIFF NECK.

SO, THAT YOU WILL KNOW, IS

YOU'RE GOING TO DO A SPINAL TAP,

YOU'RE GOING TO FIND IT.

THE OTHER THING IS, THEY MAY

COME IN WITH A MORE SUBACUTE,

PROGRESSIVE ENCEPHALOPATHY.

AND I TELL YOU, TWO POPULATIONS

TO BE AWARE OF ARE THE VERY

YOUNG AND THE VERY OLD.

SO A SUBACUTE CHANGE IN MENTAL

STATUS OR A MORE CHRONIC

COGNITIVE CHANGE, AND THEN

THE ACUTE MENINGITIS CHANGE.

 

 

SALGO:

 

SO, TREVOR,

YOU GOT TREATED.

YOU GOT TWO DIFFERENT

ANTIBIOTICS, A MONTH OF EACH.

YOU MUST HAVE BEEN FEELING

GREAT?

OR NOT?

 

 

SHORB:

 

I MEAN, MY KNEE WAS STILL

SWOLLEN.

I WAS WORKING 50 HOURS A WEEK.

I WAS FUNCTIONING BUT MY KNEE

WAS STILL SWOLLEN, WHICH WAS

A SIGN THAT NOT EVERYTHING

WAS FIXED.

 

 

SALGO:

 

ALL RIGHT, SO NOT.

TWO COURSES OF ANTIBIOTICS.

TREVOR'S STILL FEELING SICK.

WHY?

 

 

SHELLY:

 

AT THIS POINT, THERE'S

PROBABLY NOT ANY OR THERE ARE

VERY FEW SPIROCHETES AROUND AND

WHAT REALLY IS HAPPENING IS THAT

THE ANTIBODIES THAT WERE

DIRECTED AGAINST THE SPIROCHETE

HAVE MANAGED TO START ATTACKING

THE REGULAR TISSUES, THE BODY'S

RESPONSE TO LYME DISEASE, WHICH

IS WHAT THE MAJOR DRIVER OF

THE INFLAMMATION WAS.

IT WASN'T FULL OF SPIROCHETES,

IT WAS FULL OF INFLAMMATION THAT

WAS A RESPONSE TO THE

SPIROCHETES.

THAT INFLAMMATION ISN'T KILLED

BY THE ANTIBIOTICS.

 

 

SALGO:

 

EVEN IF THE ANTIBIOTICS,

THE BUG JUICE, KILLS THE BUGS,

AT THAT POINT -- BY THAT POINT,

IN SOME PEOPLE -- THE BODY'S

BEEN SO SENSITIZED TO

THE BACTERIA THAT IT SETS UP

ANOTHER PROBLEM ENTIRELY.

NOW, WE'RE GOING TO GET BACK TO

THAT, BUT YOU WENT TO COLLEGE

RIGHT AROUND THAT TIME, AND YOU

WERE STILL FEELING SICK, RIGHT?

YOUR KNEE WAS STILL SWOLLEN.

WHAT DID THEY DO?

 

 

SHORB:

 

WELL, THE DAY BEFORE I WENT

OFF TO COLBY COLLEGE, THEY PUT

AN INTRAVENOUS ANTIBIOTIC INTO

MY ARM, SO I HAD A NICE I.V.

RIGHT HERE.

EVERYONE I MET, I SAID "HI,

NICE TO MEET YOU."

 

 

SALGO:

"THIS IS MY I.V."

 

 

SHORB:

 

I WAS "LYME DISEASE KID,"

AND I'D INJECT MYSELF TWICE

A DAY WITH ANTIBIOTICS AND IT

INCREASED MY FATIGUE A LOT

AND MADE ME FEEL EVEN WORSE.

 

 

SALGO:

 

COULD YOU PLAY LACROSSE,

BY THE WAY?

 

 

SHORB:

 

NO, I COULD NOT.

IT WAS A GREAT CONVERSATION

STARTER, THOUGH.

 

 

SALGO:

 

AND WAS YOUR KNEE GETTING

BETTER ON THIS -- WHAT'S CALLED

A PICC LINE, BY THE WAY.

 

 

SHORB:

 

NO, IT WAS STILL SWOLLEN.

 

 

SALGO:

 

SO ALL THIS -- YOU'VE GOT

THE PICC LINE, YOU'RE GIVING

YOURSELF TWO SHOTS A DAY OF

ANTIBIOTICS, AND YOU'RE STILL

NOT GETTING BETTER.

ALL RIGHT, SO, WAS HE GETTING

THE RIGHT TREATMENT?

WHY IS HE NOT GETTING BETTER?

 

 

STEERE:

 

WE FOLLOW AN ALGORITHM FOR

THE TREATMENT OF LYME ARTHRITIS,

AND IT STARTS WITH ORAL

ANTIBIOTIC THERAPY BECAUSE IT

WORKS IN 50% OF PATIENTS AND

IT'S CERTAINLY THE SAFEST,

THE LEAST EXPENSIVE.

NOW, EARLY INFECTION SEEMS TO

ALMOST ALWAYS BE ABLE TO BE

TREATED SUCCESSFULLY WITH ORAL

ANTIBIOTIC THERAPY, BUT WITH

NEUROLOGIC INVOLVEMENT OR WITH

ARTHRITIS, THERE ARE PEOPLE IN

WHOM IT REQUIRES INTRAVENOUS

ANTIBIOTIC THERAPY FOR

SUCCESSFUL TREATMENT OF

THE INFECTION.

AND GENERALLY, AFTER FOUR WEEKS

OF INTRAVENOUS ANTIBIOTIC

THERAPY, IT HAS NOT BEEN

POSSIBLE TO SHOW EVIDENCE OF

A LIVE SPIROCHETE.

SO, AT THAT POINT, WE DO THINK

THAT THERE ARE PEOPLE IN WHOM

AN AUTOIMMUNE RESPONSE --

IT'S NOW DIRECTED AGAINST SELF

TISSUES.

 

 

PAPA:

 

BUT IT'S IMPORTANT FOR

PATIENTS TO KNOW, AT THAT POINT.

THERE'S ALWAYS A CONCERN IN

THEIR MIND THAT THERE'S JUST

THIS RAMPANT SPIROCHETE THAT'S

CONTINUING TO RAVAGE THEIR

BODIES, AND THAT'S A MAJOR

CONCERN OF THEIRS.

AND IT'S DIFFICULT FOR THEM TO

UNDERSTAND SOMETIMES THAT THIS

IS A CONSEQUENCE OF HAVING

THE DISEASE THAT MAY BE

PERMANENT.

 

 

STEERE:

 

AND WE'RE REALLY TALKING

ABOUT ARTHRITIS, TOO.

WE'RE TALKING ABOUT WHAT'S

HAPPENING IN A JOINT.

SO WE THINK OF IT AS

INFECTION-INDUCED BUT

SITE-SPECIFIC.

IT'S NOT HAPPENING ALL OVER

THE BODY, IT'S HAPPENING

IN ONE JOINT.

 

 

SALGO:

 

SO, YOU'VE HAD TWO ROUNDS OF

ORAL ANTIBIOTICS, THEN YOU HAD

THIS LINE AND YOU HAD AT LEAST

ONE ROUND OF I.V. ANTIBIOTICS,

YOU'RE STILL HAVING SYMPTOMS.

WHAT DID THEY SUGGEST YOU DO

AT THAT POINT?

 

 

SHORB:

 

THEY SUGGESTED ANOTHER FIVE

WEEKS OF THE INTRAVENOUS

ANTIBIOTICS.

 

 

SALGO:

 

IS THAT WHAT YOU DID?

 

 

SHORB:

 

AT THAT POINT, MY MOM TOOK

CONTROL AND FOUND ANOTHER

SPECIALIST WHO REALIZED THAT WAS

NOT THE CORRECT THING TO DO.

 

 

SALGO:

 

CAN WE PAUSE FOR A MINUTE

AND SAY, "THANKS, MOM."

MOMS OF AMERICA GET IT.

 

 

PAPA:

 

THAT MOM CERTAINLY DID.

 

 

SALGO:

 

AND WHAT HAPPENED

NEXT?

 

 

SHORB:

 

WE REALIZED THAT I.V.

ANTIBIOTICS WERE NOT THE ANSWER,

THAT I HAD TO GET SURGERY.

 

 

SALGO:

 

SO YOU WENT FOR SURGERY.

 

 

SHORB:

 

ON THE KNEE.

 

 

SALGO:

 

NOW, THIS STARTED OUT WITH

AN ITTY-BITTY, TEENY-WEENY

TICK BITE.

WENT ON TO A BACTERIUM.

WENT ON TO FEVERS, NO RASH.

WENT ON TO A SWOLLEN KNEE, AND

NOW YOU'RE IN

THE OPERATING ROOM.

HOW DOES AN OPERATION FIX

AN INFECTIOUS DISEASE THAT

STARTED THIS WHOLE THING?

 

 

STEERE:

 

IT'S A SPECIFIC TISSUE.

IT'S THE SYNOVIAL LINING TISSUE

OF THE JOINT THAT BECOMES

INFLAMED.

WHEN THE PROCESS IS QUITE

LOCALIZED IN ONE KNEE, THERE IS

THE OPTION OF GOING IN

SURGICALLY AND TRYING TO JUST

REMOVE AS MUCH OF THAT INFLAMED

TISSUE AS IT'S POSSIBLE TO

REMOVE.

 

 

SALGO:

 

BUT LET ME ASK --

I'M SURE OUR VIEWERS ARE ASKING

THE SAME QUESTION.

HE'S GOT ONE KNEE THAT'S

INFLAMED AND IT'S INFLAMED

BECAUSE THERE'S SOME ANTIBODY IN

HIS BODY THAT'S ATTACKING

HIS KNEE.

AND HE'S BEEN SENSITIZED BY

THIS INFECTION.

YOU GO AND TAKE THAT TISSUE OUT,

HE'S GOT A LOT MORE TISSUE.

WHAT'S TO PREVENT THIS THING

FROM CHEWING UP ANOTHER KNEE?

 

 

STEERE:

 

BECAUSE YOU'RE NO LONGER

INFECTED.

HE HAS BEEN TREATED WITH

ANTIBIOTICS.

THE SPIROCHETE IS PRESUMABLY

NO LONGER PRESENT.

BUT THERE IS A SITE-SPECIFIC

AUTOIMMUNE RESPONSE.

AND THAT'S THE REASON IT'S

POSSIBLE TO GO IN AND SIMPLY

REMOVE THAT TISSUE.

 

 

SALGO:

 

OKAY, SO THE RISK OF IT

AFFECTING THE OTHER KNEE

IS LOW, MINIMAL?

 

 

STEERE:

 

IT'S LOW, BUT --

 

 

BRITTON:

 

IT'S NOT NOTHING,

THOUGH.

 

 

STEERE:

 

WELL, BECAUSE

NOTHING IN --

MEDICINE IS HUMBLING.

 

 

BRITTON:

 

IT IS, I AGREE.

 

 

STEERE:

 

WE DON'T HAVE 100%

ABILITY TO PREDICT ANYTHING

IN MEDICINE.

 

 

SALGO:

 

WE DON'T?

OH, MY GOSH, I GOTTA GO TO

ANOTHER CAREER.

 

 

STEERE:

 

THAT WOULD BE

A GOOD IDEA.

 

 

SALGO:

 

THANK YOU SO MUCH FOR THAT

VOTE OF CONFIDENCE.

 

 

BRITTON:

 

I THINK YOU'RE GOOD AT THIS.

I THINK THAT THERE ARE A NUMBER

OF TROUBLING AREAS WHERE WE

REALLY DON'T HAVE GOOD

INFORMATION AND WHERE WE, AS

CLINICIANS AND AS RESEARCHERS,

HAVE TO BE MORE THOUGHTFUL ABOUT

WHAT MECHANISM MIGHT BE

INVOLVED.

FOR INSTANCE, YOU MENTIONED

A THING OF RESIDUAL INFECTION

AND HOW LONG DO YOU TREAT.

THERE CLEARLY ARE PEOPLE WHERE

YOU NEED TO TREAT LONGER THAN

INSIDE THE PARAMETERS.

MOST PEOPLE -- ALL OF OUR DATA

ON EVIDENCE IS BASED

TO THE AVERAGE, AND THAT AVERAGE

HAS A RANGE.

SO SOMETIMES WE SAY, EVERYBODY'S

GOING TO BE CURED IN A MONTH.

THERE ARE SOME PEOPLE WHO NEED SIX WEEKS.

 

 

SALGO:

 

SO THE TRICK IS NOT TO GET

BITTEN IN THE FIRST PLACE,

RIGHT?

SO HOW DO YOU DO THAT?

 

 

PAPA:

 

IT'S LIKE ANYTHING -- WHEN

YOU GO OUT INTO THE WOODED

AREAS, YOU NEED TO MAKE SURE

THERE'S NOT EXPOSED SKIN.

THERE ARE TICK REPELLENTS

THAT YOU CAN USE.

MAKE SURE, IF YOU'RE GOING TO BE

IN HEAVILY WOODED AREAS, YOU

PROTECT YOURSELF, OR NOT TO BE

IN THOSE AREAS IF YOU DON'T NEED

TO BE, ESPECIALLY IF YOU'RE

IN AN ENDEMIC AREA.

AND, MOST IMPORTANTLY, A VERY

CAREFUL SKIN EXAMINATION AFTER

YOU COME OUT OF A WOODED AREA.

 

 

SHELLY:

 

WE CAN SUCCESSFULLY KEEP

TICKS FROM ATTACHING USING DEET.

THAT IS AN EFFECTIVE WAY

TO DO IT.

THERE'S A LOT OF

MISUNDERSTANDING ABOUT DEET.

YOU REALLY ONLY NEED 10% OR 15%

TO DO THE JOB

OF DOING REPELLENTS.

SO YOU CAN GO WITH A LOWER

AMOUNT RATHER THAN THE 100% THAT

EVAPORATES TOO QUICKLY.

GET SOME THAT YOU CAN APPLY ONCE

THAT WILL LAST MOST OF THE DAY.

SO, SOME OF THESE SUSTAINED

RELEASE PREPARATIONS.

I WOULD TREAT MY CLOTHING

WITH A PERMETHRIN.

A SPRAY-ON THAT YOU DO IN

A WELL-VENTILATED AREA.

THAT THIS IS AN INSECTICIDE

ON YOUR CLOTHING AND THAT IS

ALSO GOING TO MAKE THE NUMBER OF

TICKS THAT SURVIVE

AROUND YOU LESS.

 

 

SALGO:

 

IF YOU DO GET ANTIBODIES --

WHICH IS WHAT WE TEST FOR

WITH THIS BLOOD TEST -- DOES

THAT MEAN IF YOU'RE INFECTED

ONCE, YOU CAN'T GET IT AGAIN?

 

 

STEERE:

 

IT DEPENDS.

 

 

SALGO:

 

OH, I KNEW YOU WERE GOING

TO SAY THAT.

 

 

STEERE:

 

WITH LATE DISEASE AND A HIGH

ANTIBODY RESPONSE, ONCE TREATED,

IT DOES DECLINE, BUT IT STAYS

POSITIVE, AT A LOW LEVEL, FOR

MANY YEARS AGAINST A RANGE OF

SPIROCHETAL PROTEINS.

AND THAT RESPONSE DOES SEEM TO

BE PROTECTIVE AGAINST

REINFECTION.

NOW, ON THE OTHER HAND, IF YOU

HAD EARLY DISEASE, AND THAT TYPE

OF RESPONSE HAS NOT DEVELOPED,

THAT PERSON CAN GET

LYME DISEASE AGAIN.

 

 

SALGO:

 

IF YOU KILL THE BUG

BEFORE YOUR BODY CAN RAMP IT UP

AND MAKE THIS ANTIBODY, THEN

YOU'RE AT RISK AGAIN.

WE'RE GOING TO PAUSE FOR

A MOMENT AGAIN,

SUM UP WHERE WE ARE, BEFORE WE

LAUNCH INTO THIS ONCE MORE.

MOST CASES OF LYME DISEASE CAN

BE EFFECTIVELY TREATED WITH

ANTIBIOTICS.

LATE DIAGNOSIS CAN LEAD TO OTHER

COMPLICATIONS SUCH AS ARTHRITIS,

AUTOIMMUNE RESPONSES.

AND WHILE THERE ARE EFFECTIVE

TREATMENTS, IT'S IMPORTANT TO

TAKE PRECAUTIONS TO PREVENT

LYME DISEASE, WHICH IS

THE BEST WAY TO DO THIS.

USE INSECT REPELLANT, EXAMINE

YOURSELF, REMOVE TICKS PROMPTLY.

REDUCING THE TICK HABITAT.

I SUPPOSE WE COULD TRY TO REDUCE

THE AREAS WHERE TICKS MIGHT LIVE

AND WHERE WE'RE COHABITING

WITH THEM.

THAT MIGHT BE A GOOD IDEA.

HOW ARE YOU DOING, TREVOR?

 

 

SHORB:

 

GREAT.

 

 

SALGO:

 

HAS ALL THIS CHANGED THE WAY

YOU LOOK ON LIFE?

 

 

SHORB:

 

DEFINITELY.

 

 

SALGO:

 

HOW SO?

 

 

SHORB:

 

CHECK FOR TICKS, NUMBER ONE.

THINGS I LOVE THE MOST --

LACROSSE AND EXERCISE

AND SOME OF THE THINGS

I DIDN'T HAVE --

I FOUND THE THINGS THAT WILL

ALWAYS BE THERE -- FAMILY,

FRIENDS AND JUST A GOOD

ATTITUDE.

 

 

SALGO:

 

WHAT DID YOU DO

TO YOUR LEG?

 

 

SHORB:

 

WELL, AFTER MY FIRST SURGERY

FOR THE LYME, WHICH SHAVED

THE TISSUE, THEY SAW THAT MY ACL

WAS PARTIALLY TORN.

I SOON AFTER TORE IT AND

A YEAR AND A HALF LATER, ONE

FULL LACROSSE SEASON AFTER I

REHABBED, THE OTHER DAY,

TORE IT AGAIN.

 

 

 

PAPA:

 

OOH!

 

 

SALGO:

 

I WANT TO THANK ALL OF

YOU FOR BEING HERE,

ESPECIALLY YOU.

UNFORTUNATELY, WE'RE OUT

OF TIME.

I HOPE YOU CONTINUE

THE CONVERSATION ON OUR

WEB SITE.

THERE YOU'RE GOING TO FIND THE

ENTIRE VIDEO OF THIS SHOW, AS

WELL AS THE TRANSCRIPT AND LINKS

TO RESOURCES.

THE ADDRESS OF THE WEB SITE IS

SecondOpinion-tv.org.

THANKS FOR WATCHING.

AGAIN, THANK ALL OF YOU --

ESPECIALLY YOU, TREVOR --

FOR BEING HERE.

I'M DR. PETER SALGO, AND I'LL

SEE YOU NEXT TIME

FOR ANOTHER "SECOND OPINION."

 

 

 

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