This is topic UPDATED 5/9 (More pics) PLEASE HELP....bit by a tick [pictures inside] in forum Medical Questions at LymeNet Flash.


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Posted by yankees237 (Member # 25791) on :
 
I added a handful of pics that i have been taking thru out the week, they are pretty much in order, with the last pics being the most recent.

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i was bit by a tick recently...caught it no later then 30 hours of being on me...i removed it and rubbed isopropyl alcohol on the areas...i went to the doctor and within 48 hours of the bites i have been taking 200mg per day of doxycycline....i have been feeling ok but some of my lymph nodes near the areas of the bites are tender....should i be worried that those bites/rashes are definitley lyme???

[ 05-09-2010, 03:06 PM: Message edited by: yankees237 ]
 
Posted by sutherngrl (Member # 16270) on :
 
Yes there is need for concern.

You should go to "seeking a doctor" section and find a lyme literate medical doctor(LLMD).

That looks like a bullseye rash to me and a regular doctor does not know how or how long to properly treat for LD. If you get the proper treatment early you will likely get well quickly.

If you postpone proper treatment, you can end up very ill and it can take years of treatment to get well.

Lyme Disease is nothing to fool around with.
 
Posted by yankees237 (Member # 25791) on :
 
by the way the size of the tick i caught digging into me was about the size of the tip of a pencil...he was dark, looked black. he wasn't fully inside of me, but kind of hard to pull off me thats how i figured it was a tick - not a spider... and the bites are very itchy by the way
 
Posted by LymeXtu (Member # 24590) on :
 
I 2nd sutherngrl's opinion.

Don't take a chance on this!!
 
Posted by yankees237 (Member # 25791) on :
 
so the immediate doxycycline for 21 days is not enough? my doctor made it seem like that would take care of it "IF" it was even lyme....i actually insisted on the doxycycline because i just recovered from mono and i didnt wanna take any chances
 
Posted by DeniseNM (Member # 11182) on :
 
Third! If I had known when I got bitten, and caught it early, I might be better and not so neurologically compromised.

Please see an LLMD.
 
Posted by Keebler (Member # 12673) on :
 
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Yankees,

I am so sorry to be the one to say this but it sure looks like the classic EM (bulls eye) rash. You need a doctor who will treat this much more aggressively. The amount of doxy you are on is not enough and treatment should last for at least 30 weeks.

How long is your current doctor planning to treat this? (Probably just a few weeks, at best, and with one drug - not enough. At least 400 mg. doxy is best, too.)

Don't be worried. That will do no good. However, although lyme is a very serious illness, early treatment can mean you have an excellent chance at avoiding devastating downhill effects.

I hope you can find a good ILADS-educated LLMD very soon. You will also need to be assessed for other Tick-Borne infections.

Good luck. And you are so luck to be treating this early and that you have proof. You will not need a lyme test since you got the rash (just tests for other TBD - tick-borne disease).

Take care, now. No steroids, no alcohol - at all. Also avoid aerobic exercise as it can strain the heart with infections. If you are sexually active, it may be best to put that on hold until you talk with a LLMD as, even on abx, in early stages, this may be much more transmissible to a partner.

All this is very important and will be explained below. Read. Read. Read - and REST. Take absolutely excellent care of yourself. It's very important at this stage. Good luck.

==================

www.ilads.org

ILADS

===================

www.IGENEX.com

IGENEX - testing

=====================

http://www.lymenet.org/SupportGroups

Find your area support groups to find doctors, etc:

=======================

http://www.lymepa.org/html/dr__j__burrascano_september_20_0.html

Burrascano's Powerpoint SLIDE presentation 9-20-08

------------

http://www.ilads.org/lyme_disease/B_guidelines_12_17_08.pdf

Advanced Topics in Lyme Disease (Diagnostic Hints and Treatment Guidelines for Lyme and Other Tick Borne Illnesses

Dr. Burrascano's Treatment Guidelines (2008) - 37 pages

------------
As important as any supplements, sections regarding self-care:

Go to page 27 for SUPPORTIVE THERAPY & the CERTAIN ABSOLUTE RULES

and also pages 31-32 for advice on a safe, non-aerobic exercise plan and physical rehabilitation.

----------------------
This is included in Burrascano's Guidelines, but you may want to be able to refer to it separately, too:

http://www.lymepa.org/Nutritional_Supplements.pdf

** Nutritional Supplements in Disseminated Lyme Disease **

J.J. Burrascano, Jr., MD (2008) - Four pages

===========================

http://www.lymeinducedautism.com/images/Lymewhat_is_it_part_3,_LIA.pdf

LYME DISEASE Considerations in Diagnosis and Management

June 26, 2008 Lyme-autism Connection Conference

125 pages - Powerpoint presentation

------------


Chapter 1 from the book "Insights Into Lyme Disease Treatment"

http://www.lymebook.com/steven-harris

--------------

http://www.amazon.com/Insights-Into-Lyme-Disease-Treatment/dp/0982513801/ref=sr_1_1?ie=UTF8&s=books&qid=1272566632&sr=1-1

Insights Into Lyme Disease Treatment: 13 Lyme-Literate Health Care Practitioners Share Their Healing Strategies

Connie Strasheim (Author), Maureen Mcshane M.D. (Foreword), Thirteen Lyme-Literate Doctors (Contributor)

==================

http://www.klinghardtneurobiology.com/LymeProtocolOct09.pdf

A Treatment Guide: Lyme and other Chronic Infections

by Dietrich Klinghardt, MD, PhD

October 2009 - 87 pages

-----------

http://www.klinghardtneurobiology.com/popups/PC1.html

Online Radio Interview with Dr. Klinghardt

====================


Important information about treatments options and support measures, supplements and self-care:

http://tinyurl.com/6lq3pb (through Amazon)

THE LYME DISEASE SOLUTION (2008)

- by Kenneth B. Singleton , MD; James A. Duke. Ph.D. (Foreword)

You can read more about it here and see customer reviews.

Web site: www.lymedoctor.com

=========================

RIFE

http://www.lymebook.com/lyme-disease-rife-machines-bryan-rosner

Book: Lyme Disease and Rife Machines by Bryan Rosner

=======================

http://tinyurl.com/5vnsjg

Book: Healing Lyme: Natural Healing And Prevention of Lyme Borreliosis And Its Coinfections - by Stephen Harrod Buhner

website: http://planetthrive.com/2009/08/buhner-healing-lyme-program/

-----
http://flash.lymenet.org/ubb/ultimatebb.php/topic/1/86857

Topic: Buhner Healing Lyme Q & A links

================

http://tinyurl.com/5drx94

Lyme Disease and Modern Chinese Medicine - by Dr. QingCai Zhang, MD & Yale Zhang

web site: try www.sinomedresearch.org and use "clinic" and then "clinic" for the passwords or call Hepapro through www.hepapro.com

====================

Post here:

http://flash.lymenet.org/scripts/ultimatebb.cgi/forum/2?

SEEKING A DOCTOR

================

http://www.lymediseaseassociation.org/

Lyme Disease Association - See PHOTOS in the green menu, lower left
-
 
Posted by Keebler (Member # 12673) on :
 
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A warm (not hot) bath in Epson Salts will help your lymph nodes move stuff out and you should feel better. About 20 minutes. Don't get too exhausted or stay too warm for too long.


PROBIOTICS - I so hope your doctor told you to take Probiotics so as to offset possible candida (systemic yeast) infection. Taking this early on is vital. Avoid sugar, artificial sweeteners and processed foods, too.

Enjoy good vegetables, whole grains and lean proteins. Dark berries and tart apples. Nuts are good, too. More above in all those links about nutrition. It's your best friend right now.
-
 
Posted by yankees237 (Member # 25791) on :
 
Yes thank you i have been taking a probiotic, recommended by my doctor... thank all of you for your input... i cant believe this is happening to me
 
Posted by Keebler (Member # 12673) on :
 
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Yes, it's a shock, I'm sure. But you are so lucky to have proof. Very few ever get the classic rash and then it can take years, or decades before finding a doctor.

Hearing that your doctor knows about probiotics, s/he may have started you slow on doxy. FInd out your doctor's intentions and if s/he is ILADS-educated. You may have lucked out. Just be very sure. If your doctor follows the IDSA guidelines, that will NOT be adequate, at all.

You are about to find out that this is a very hot potato, politically speaking. For more detail, Google the main sites for these:

Book: Cure Unknown (Pam Weintraub or Weintaub)

Documentary: Under our Skin - Open Eye Pictures

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Posted by Keebler (Member # 12673) on :
 
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Sorry for so many notes. You need to also retake a few photos and get your face in at least one, with the rash. You also need a magazine or newspaper that shows current date.

And, a clean coin or ruler to determine size may help.

I suggest this so that it can be documented that this is, in fact, your rash, on this date, and not a file photo. Always keep one set for your own file.

Your doctor will need another set in case s/he needs to justify treating you. Your LLMD would need one set just for the record and in case they'd need to ever defend their treatment.
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Posted by blinkie (Member # 14470) on :
 
Also, you should treat babesia and bartonella just for safe measure. IMO. You need to get to an LLMD who can do this for you.
 
Posted by yankees237 (Member # 25791) on :
 
is it possible that early treatment from a LLMD will completely heal me? or is this something that i will have to deal with forever no matter how early it was detected?
 
Posted by Keebler (Member # 12673) on :
 
-
In addition to the usual coinfections from ticks (such as babesia, bartonella, ehrlichia, RMSF, etc.), there are some other chronic stealth infections that an excellent LLMD should know about:

http://flash.lymenet.org/scripts/ultimatebb.cgi?ubb=get_topic;f=1;t=069911#000000

TIMACA #6911 posted 03 August, 2008

I would encourage EVERY person who has received a lyme diagnosis to get the following tests.

- at link.

==================

http://flash.lymenet.org/scripts/ultimatebb.cgi?ubb=get_topic;f=1;t=020605

MAKING THE MOST OF YOUR LLMD VISIT

From Melanie Reber

==================

With much thanks to Marnie for these enlightening threads:

http://flash.lymenet.org/ubb/ultimatebb.php/topic/1/80718#000001

Topic: How did they CURE lyme in Romania

========================

FAR Infrared Sauna has been very helpful for many (low heat but great penetration for releasing and sweating out toxins). High heat saunas are not suggested and can put lyme patients at risk.

=========================

www.townsendletter.com/FebMar2006/lyme0206.htm

From the Townsend Letter for Doctors & Patients, February/March 2006

BIOCHEMISTRY OF LYME DISEASE: BORRELIA BURGDORFERI SPIROCHETE / CYST

by Prof. Robert W. Bradford and Henry W. Allen
-
 
Posted by Keebler (Member # 12673) on :
 
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Yankees,

Probably, with early treatment, you may be fine. You will have to watch this for at least a year. However, you could be feeling better in a couple months (even while still on treatment).

A lot depends on what other infections might be going on. It is absolutely essential to be evaluated for the full range.

Other factors, too, such as the health of your liver and kidneys, determines the outcome.

And, quite often, many who get proper and early treatment do very well.

Good luck. Rest well tonight, knowing that knowledge is power and that rest is healing. Ommmmm.
-
 
Posted by yankees237 (Member # 25791) on :
 
thanks keebler, im definitley not taking any risks...i am going to go to a LLMD asap
 
Posted by yankees237 (Member # 25791) on :
 
i still dont understand how i could get lyme if the tick was on me for less then 30 hours...
 
Posted by Hoosiers51 (Member # 15759) on :
 
It is possible! The whole 48 hours thing is BS.

Anyways, yes, early treatment can prevent chronic Lyme. It doesn't always prevent chronic Lyme, but since you caught it early, you stand a good chance of recovering fully I'd say.

I'm assuming you are male? I ask because females should be fully recovered before having babies, or else go on antibiotics for pregnancy.
 
Posted by littlebit27 (Member # 24477) on :
 
I agree with everyone else go see an LLMD ASAP, don't wait! Don't believe all the BS you read about why it can't be Lyme and how Lyme doesn't exist in this place or in that place or in this form. It does exist in so many places and in so many forms.

I didn't even have a rash nor do I remember a tick biting me. You have all the proof you need to see an LLMD, don't wait until you have all these crazy symptoms, it is so much harder to treat.

Any LLMD is going to treat you just based on that rash so see what you can find and schedule an appointment asap. Good luck to you.
 
Posted by Pinelady (Member # 18524) on :
 
Good point on the Pics Keebler.

I think Mono is possibly one of the worst coinfections you can have.

You need to have your blood monitored closely by a LLMD who knows how to watch for viral takeovers.

Till you can get there- I would try to do some coconut oil to keep it in check.

Maybe a pinch to start.
 
Posted by 17hens (Member # 23747) on :
 
The 48 hours thing is definitely BS.

My friend had a tick on her less than 10 minutes and had lyme for 3 years before diagnosis. She now remembers brushing the tick off and getting a large red rash days later.

My neighbor was gardening and had a tick on her for less than 20 minutes and got a definite bull's eye within 2 days. She was treated immediately (by her doctor husband).

And yet another friend pulled a tan dog tick off her 5 year old and he got a bull's eye w/in a few days. So the whole "deer tick" thing is BS too.
 
Posted by yankees237 (Member # 25791) on :
 
i made a post in the seeking a doctor section but i haven't gotten any replies. so if anybody can me here i'd appreciate it. i live in central new jersey...i heard there's a doc in howell?
 
Posted by yankees237 (Member # 25791) on :
 
and yes hoosier i am a male , 24 yrs old
 
Posted by yankees237 (Member # 25791) on :
 
by the way, what is considered getting treatment early? within the first week? month? year?

i feel fine so far, other then the itchy rash and my lymph nodes being tender i feel normal
 
Posted by treepatrol (Member # 4117) on :
 
Treat NOW! Classic bullseye rash you have lyme.
Start doxy and find llmd.
 
Posted by mojo (Member # 9309) on :
 
The rash tells the story - Bullseye rash = Lyme.
 
Posted by merrygirl (Member # 12041) on :
 
yes not a doctor but A EM rash is DIAGNOSTIC of lyme disease no lab testing needed and would come back negative anyway because your body takes at least 6 weeks to make antibodies.

Sorry to say you have Lyme. I am hopeful that you can get rid of it though! Try to get your doxy dose to 300 a day. That is better than 200. Stay on abx for at least 4-6 weeks an dtill symptom free for 2 months!!!

that is your best chance of beating this now!

best of luck.
 
Posted by Keebler (Member # 12673) on :
 
-
Q: what does it mean to get treatment early?

Within hours of a bite is best. In the first few weeks, that can still be better than a couple of months but spirochetes can move to any part of the body within hours of transmission.

Sometimes, if one is lucky, spirochetes may stay in a particular place but stress will make them zoom all over. Once lyme becomes disseminated the nervous system is usually infected and long-term treatment is required, for sure.

====================

* This explains WHY you need an ILADS LLMD or ILADS LL ND (naturopathic doctor) to guide your treatment protocol. NOW.

www.clinicaladvisor.com/Controversy-continues-to-fuel-the-Lyme-War/article/117160/

CONTROVERSY CONTINUES TO FUEL THE "LYME WAR" - 2007

" . . .To treat Lyme disease for a comparable number of life cycles, treatment would need to last 30 weeks. . . ."


". . . If all cases were detected and treated in the early stages of Lyme disease, the debate over the diagnosis and treatment of late-stage disease would not be an issue, and devastating rheumatologic, neurologic, and cardiac complications could be avoided. . . ."

. . . .

- Full article at link above.

==================

Coinfections are not discussed in that article but, as stated above, it is imperative that a LL doctor assess you for the full range. Good luck.
-
 
Posted by jasek (Member # 12395) on :
 
Yankees, Try not to be afraid, this is very overwhelming at first and hard to digest.

Every bit of advice you have gotten from here is important, and once you get a good llmd he will help you sort thru it.

Never stop asking questions, everyone here are very invested,DON'T listen to anyone who does NOT have it. They know nothing. Good Luck.
 
Posted by blinkie (Member # 14470) on :
 
You don't even need a classic bullseye rash. My rash looked more liek this picture (I don't see much of a clearing, or ring). Mine was just a round, red, rash around the bite.


Yes, you can get completely well if you treat quickly and aggressively. Don't be afraid to be aggressive. I think I have seen "early" referred to as within the first week. But, I also think there is a little wiggle room there. I think within the first few weeks and you can still have a much better outcome then some of us.

I had lyme over ten years, then a second bite with many coinfections. Been in treatment 2.5 years and am at 90% functioning.
 
Posted by Haley (Member # 22008) on :
 
Yankee,

Thank God you are well informed and have come to the right place. You have a good chance of getting well if you follow all of the advice here, including treating co-infections.

I had a huge Bulls eye rash. I flicked the tick off of me and had it in my possesion. I didn't know anything about Lyme. I thought I had been bitten by a deadly spider.

I got violently ill a couple of weeks later. I completely forgot about the bite. 1 1/2 years later a doctor mentioned Lyme. I am now treating it but living with this disease is like living in hell.

You are very fortunate to catch it early. You will be fine.
 
Posted by yankees237 (Member # 25791) on :
 
yes strangely i do feel fortunate about this situation since i caught it so early. so for that i am thankful.

thanks to all of you. im in the process of trying to get a LLMD's info so i can make an appointment.

another question:

does it make it worse that i actually have 3 bites? as compared to just having 1 bite? all 3 bites gave me the rash by the way
 
Posted by Keebler (Member # 12673) on :
 
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Ohhh. Three bites. Well, if it was the same tick, it might not be as bad. If from three different ticks, that could triple your chances of the total infection mix.

Be sure your LLMD knows you had three bites. Did you get the license numbers of the tick(s)? Did you see more than one get-a-way car?
-

[ 05-07-2010, 04:27 PM: Message edited by: Keebler ]
 
Posted by yankees237 (Member # 25791) on :
 
not sure if it was the same tick. the two leg bites there was no sign of a tick...but i did find a tiny tick crawling on my clothes the same day....

the third bite is near my armpit, that tick i actually removed. bigger then the other tick but still gave me the rash
 
Posted by IckyTicky (Member # 21466) on :
 
That is what my rash on my hip looked like when I got bit in 2003. I thought it was a normal tick bite reaction or possibly got infected. Now I'm seriously ill. I'd definately suspect Lyme.. and co-infections just about always go along with it.
 
Posted by Dekrator48 (Member # 18239) on :
 
Make sure you take pictures of all your rashes/bites and show that they are on different body parts.

Also get pics with your face and rash in the same pic and a dated newspaper.

You want to have very good documentation of your bites and rashes.


Glad you came here for information and that you plan to find a LLMD asap!
 
Posted by merrygirl (Member # 12041) on :
 
take a pic of all rashes!! ASAP.

You can get the EM rashes in other places and only have one bite. But it is possible you were bitten 3 times. Not good. Try to get that 300mg doxy!
 
Posted by yankees237 (Member # 25791) on :
 
thanks dekrator. i have already taken several pictures and ill probably take some more just in case.

so far ive realized that the whole ''if the tick wasnt on you for at least 72 hours you can't get lymes'' is a myth but am wondering if the ''if you get treatment early you'll be fine'' is a myth as well?

seems like all the experts are making this stuff up because im positive that tick wasnt on me for more then 24-30 hours and i got a rash the next day
 
Posted by yankees237 (Member # 25791) on :
 
by the way i got the # for a LLMD and i will be calling to make an appt tomorrow. Should i be expecting them to say sure we'll squeeze you in in about 6 weeks or will i be able to get a near appt?
 
Posted by onbam (Member # 23758) on :
 
First thing's first--call your doctor, tell him you lost your doxycycline bottle and get another. It doesn't act on the spirochete (yes, like syphilis) unless you're taking 400 mg/day. This needs to continue for 3 months past the point at which all your symptoms disappear. Other antibiotics that your PCP won't provide which you'll probably need to take a long with it inclde a macrolide (like biaxin) and tinidazole, for the exospore that it forms under adverse conditions. Google "burrascano lyme" and read the guidelines. Furthermore, this needs to started very soon as, lyme not gotten rid off right off the bat becomes incurable.

Also, a negative test means absolutely nothing.
The reason your PCP doesn't know all this is that there is a coverup being directed by some very powerful people of the truth of tick-borne disease. I know this all sounds outlandish, but google "lyme is a biowarfare issue."

Also, be aware of the modes of human-human transmission. these include through all reproductive fluids, blood, through tears, urine (it may be wise to saran rap your toilet before flushing until you are well, as it shows here that borrelia, at least in the lab, can be spread via aerosol. http://www.phac-aspc.gc.ca/msds-ftss/msds21e-eng.php)

Re transmission: according to Stephen Barthold, a researcher I spoke to, the infectious dose, at least when it's injected into a host, is one germ. Furthermore, it has a .1 micron "granular form" (most analogous to a fungal spore in that many a produced as reproductive units) that is small enough, according to data in HIV studies, to cross reproductive prophylaxis.

here's more on human-human
http://www.canlyme.com/sex.html
www.ilads.org/files/harvey.pdf
http://www.youtube.com/watch?v=WozrCFW0mRM

check out
lymecryme.com
underourskin.com

i will send you the info of my doctors.
one, in wisconsin, may be able to see you soon.
 
Posted by yankees237 (Member # 25791) on :
 
By the way , what is the normal duration of the erthema migran rash? my rashes are all fading/mostly gone after about 3 days and are no longer itchy like they were at first.....
 
Posted by WildCondor (Member # 434) on :
 
quote:
Originally posted by yankees237:
i still dont understand how i could get lyme if the tick was on me for less then 30 hours...

Because the 24 hour rule is a myth. When a tick bites you it injects the contents of its saliva into your body, and can infect you immediately.
Make sure you are on the right dose of Doxycycline, it should be 300-400 mg/day of Doxy not 200 mg.
 
Posted by hshbmom (Member # 9478) on :
 
Yankees, the tick that bit you didn't read the book. He should have politely waited longer before infecting you.
 
Posted by Haley (Member # 22008) on :
 
''if you get treatment early you'll be fine'' is a myth as well?

I don't think it is a myth. They have discovered that there can be co-infections, doxy may not be enough to cover other infections.

Someone may get bitten and be treated with Doxy and then they begin to feel sick again. If the tick transmitted Babesia then the Doxy would not be enough.

That's why this stuff is so darn complicated.
 
Posted by Keebler (Member # 12673) on :
 
-
Early treatment is usually best but, even with immediate treatment according to ILADS guidelines, there have been cases to go on to full blown chronic lyme.

That is discussed in this book:
----------------------

http://tinyurl.com/5crsjv

Cure Unknown: Inside the Lyme Epidemic (2008) - by Pamela Weintraub

This details what an entire family went through. Having this knowledge of their journey will help others to get better, faster treatment.

http://www.cureunknown.com
-
 
Posted by onbam (Member # 23758) on :
 
The IDSA recommended 200 mg/day is bacteriostatic, not cidal. This means that the people who are cured on it were probably infected with strains only capable of causing a rash (that these exist is asserted in Pam Weintraub's book Cure Unknown.) It may be better than nothing, but even this is debatable; some doctor's state that in individuals infected with pathogenic strains it simply curtails the immune response and allows the disease to become more severe.

I developed encephalitis at 10 days after my bite ON 200 mg/day.

This is why I think there's more to it than just the poisoners covering their @$$3@. They could just as easily recommend the bacteriocidal dose, 400mg, without raising any eyebrows. In fact, if we accept that the coverup is the end itself, it follows that they would want to, in order to reduce the magnitude of what they could possibly be exposed as causing. The only explanation for recommending an known ineffective dose that they want people to develop chronic Lyme. Why, we can only speculate, but motive isn't necessary to prove a crime.

[ 05-09-2010, 12:33 PM: Message edited by: onbam ]
 
Posted by yankees237 (Member # 25791) on :
 
updated
 
Posted by Keebler (Member # 12673) on :
 
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We don't need to see your face (as lovely as I'm sure it is) but be sure you have a view of your face in some photos for future doctors.

A long shot should do - and then close-ups of the actual rashes for detail -- or use of a mirror can help establish that this is your body and your rashes, not file photos or funny photo shop tricks to obtain antibiotics.

(Yeah, chronic lyme patients who've been denied treatment have been accused of having antibiotic-seeking behavior. Proof helps. Even a year or more from now, you may really need these photos to get treatment.)

Your wife may also need a set of these photos for her own use if she's been exposed or infected (as many spouses do acquire lyme from their partners).
-

[ 05-09-2010, 03:51 PM: Message edited by: Keebler ]
 
Posted by Rumigirl (Member # 15091) on :
 
NJ is VERY endemic! I got another tick bite there last Memorial Day---and had a bad relapse while on Doxy, because I got another case of Babesia. Plus, I got Bell's Palsy!! (And I got 2 blasted ticks on me in 24 hrs).

So this is why you need an LLMD ASAP. It's great that you came here and got all this good advice. Be proactive with your treatment. And ask to be fit in for an appt ASAP. If they don't have any opening, stress your acute situation. ANd ask to be put on a cancellation list. Plus, you could call several LLMD's to see when you could get in.
 


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