Updated Guidelines on Diagnosis, Treatment of Lyme Disease
ALEXANDRIA, VA -- October 2, 2006 -- In response to growing concern and confusion about Lyme disease, the Infectious Diseases Society of America (IDSA) has updated its Clinical Practice Guidelines on the disease, in order to provide guidance to physicians and patients based on the latest scientific evidence. The guidelines were originally published in 2000.
The most significant changes in the updated version include:
-- The addition of information on human granulocytic anaplasmosis (HGA) and babesiosis, two diseases transmitted by the same tick that transmits Lyme disease; -- Recommendations of a single dose of an antibiotic for certain high-risk patients who have been bitten by a tick but do not have symptoms of Lyme disease; -- Expanded discussion and definition of so-called "chronic" or post-Lyme syndromes.
The Guidelines, developed by an expert panel according to widely accepted criteria for evidence-based medicine, contain updated information on the epidemiology, clinical features and diagnosis of Lyme disease, according to Gary P. Wormser, MD, Chief, Division of Infectious Diseases and Vice Chairman of the Department of Medicine, New York Medical College.
Dr.Wormser is lead author of IDSA's 2006 Lyme disease guidelines and chair of the expert panel that developed the guidelines.
"We worked to make the guidelines as comprehensive as possible based on a thorough review of all credible scientific literature," said Dr. Wormser.
The guidelines are now available on the IDSA Web site and will be published in the Nov. 1 edition of the journal, Clinical Infectious Diseases.
Lyme disease is caused by an infection with the bacteria Borrelia burgdorferi. This infection is principally transmitted by the black-legged deer tick (Ixodes scapularis) that typically feeds on small mammals, birds and deer but may also feed on cats, dogs and humans.
Although the disease has been reported in nearly all states, the majority of cases are concentrated in the Mid-Atlantic and northeast states. Other regions in the United States with significant numbers of cases include Wisconsin, Minnesota and northern California.
"Most people who are infected with Lyme disease have a circular, red rash surrounding the site of a tick bite, that may be accompanied by muscle and joint aches and less commonly, facial paralysis," said Lyme disease expert Paul Auwaerter, MD, MBA, who was a reviewer of the IDSA guidelines.
Dr.Auwaerter is the Clinical Director of the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, and managing editor of the Johns Hopkins Antibiotic Guide.
"The symptoms are sometimes alarming, but with proper diagnosis and antibiotic treatment almost all will go away within a few weeks."
HGA and Babesiosis
Although Lyme disease is the most common tick-borne infection in North America and Europe, the updated guidelines now contain information on two other tick-related diseases, HGA and babesiosis. HGA is a tick-associated disease caused by a species of bacteria called Anaplasma phagocytophilum.
The most common symptoms are headache, fever, chills, muscle pain and fatigue. Babesiosis is a parasitic infection which affects the red blood cells, resembling malaria; it is also transmitted through the bite of a deer tick. In the United States, the disease usually does not cause symptoms in healthy individuals and is most likely to affect those who are elderly or have compromised immune systems.
Treatment for Lyme Disease
Although routine preventive antibiotic administration is not recommended for individuals with tick bites and no symptoms of disease, one substantive change in IDSA's treatment recommendations is that some selected, high-risk tick bites may be treated with a single dose of the antibiotic doxycycline for people who are eligible for the drug, according to Dr. Wormser.
Eligibility criteria for preventive Lyme disease treatment with doxycycline include:
-- the attached tick can be reliably identified as an Ixodes scapularis tick that is estimated to have been attached for 36 hours or longer; -- preventive treatment can be started within 72 hours of the time the tick was removed; -- ecologic information indicates that the local rate of infection of these ticks with B. burgdorferi bacteria is 20% or greater.
Whether use of antibiotic prevention after a tick bite will reduce the incidence of HGA or babesiosis is not known, Dr. Wormser said.
In general, doxycycline is not recommended in pregnant women and in children under the age of eight, he said.
Most patients who develop Lyme disease are cured with a single course of 10-28 days of antibiotics, depending on the stage of their illness. Occasionally a second course of treatment is necessary.
More prolonged antibiotic therapy is not recommended and may be dangerous, according to Dr. Wormser.
"Nearly all people -- more than 95% -- who do get sick with Lyme disease and are treated with the recommended course of antibiotics get better and go on with their lives," he said.
"Chronic" or Post -Lyme Disease Syndromes
A small number of patients report a variety of non-specific symptoms such as generalized pain, joint pain or fatigue following an episode of Lyme disease that has been appropriately treated with antibiotics.
The updated IDSA guidelines contain greater detail in the discussion of post-Lyme disease syndromes, and conclude that objective evidence of prior B. burgdorferi infection must be part of any acceptable definition of these syndromes.
As in the past, the guidelines do not recommend ongoing antibiotic therapy for those with chronic symptoms who have completed the recommended initial course of treatment for Lyme disease.
"After a thorough review of the literature, the panel concluded there is no convincing biologic evidence for symptomatic, chronic Borrelia burgdorferi infection after completion of the recommended treatment for Lyme disease," the guidelines state.
Furthermore, long-term antibiotic therapy may be dangerous and it also can lead to complications for the patient such as blood stream catheter infection (for those on intravenous antibiotics) and Clostridium difficile colitis (a potentially severe infection of the bowel).
Long-term antibiotic therapy may also foster the development of drug-resistant superbugs that are difficult to treat, Dr. Auwaerter added.
"IDSA and its expert panel do not doubt that patients with symptoms that persist for weeks, months or longer are suffering, but many report non-specific symptoms that also are associated with a number of other medical conditions," Dr. Wormser said.
"People who continue to have symptoms that persist after appropriate antibiotic treatment for Lyme disease should talk to their physicians about whether the diagnosis was accurate or if they may have a different or new illness to be certain they get the proper medical care."
The IDSA updated practice guidelines and more information about Lyme disease -- including a fact sheet for the public and practice guidelines for physicians -- can be found on the IDSA Web site at www.idsociety.org.
Vermont_Lymie
Frequent Contributor (1K+ posts)
Member # 9780
posted
These new guidelines are a tragic capitulation to the priorities of the insurance industry - keeping costs down no matter how many lives are damaged by inadequate treatment.
We are going to have to continue to fight like hell in order to get the proper treatment for lyme to those of us who need it.
Fortunately, we have tons of peer-reviewed literature on our side. And each other in this remarkable community - I have learned so much of value from other lymenet members, thank you for all you do!
Yes, as trails pointed out:
How is it that so much literature documenting on-going infections is disregarded by the IDSA authors here - is it laziness, or deliberate neglect?
Posts: 2557 | From home | Registered: Aug 2006
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posted
Take note that Dr. F's retreatment is cited in these guidelines - citation #332. They fail to mention the improvement in cognitive function after the 10 weeks of therapy, but say that no sustained improvement 14 weeks after treatment. How's that for presenting a slanted view? Also mention for some there was a sustained physical improvement. But then trivialize this finding by pointing out there were some adverse events.
Perhaps Trails is right on about the timing of this just prior to Dr. F's study being published.
"Never doubt that a small group of thoughtful, concerned citizens can change the world. Indeed, it is the only thing that ever has." - Margaret Mead Posts: 63 | From USA | Registered: Jul 2006
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Foggy
Frequent Contributor (1K+ posts)
Member # 1584
posted
Amazing how they don't address the scenario where a patient has ruled out all other possible condition causing this so-called "post Lyme" syndrome. Too easy to label it CFS or Fibro, write an SSRI Rx, & give the patient walking papers to a shrink.
They denigrate lt abx yet also have no effficacious treatment modality for PLS or "antibiotic-refractory arthritis." Posts: 2451 | From Lyme Central | Registered: Aug 2001
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posted
I was told just TODAY by rheumetologist that "they now know there is no such thing as chronic lyme, they USED to think there was such a thing...but not anymore" So he proceeded to take 12 vials of blood to try and "figure out" what is wrong with me. I say....good luck.
-------------------- Corinne Posts: 529 | From Raleigh, NC | Registered: Jun 2006
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posted
in piccs of two of these authors, they look like w.c. fields leaning against a philedelphia lamp post, after a bad night.
is it any wonder then, that, too many of these published statements read like they came from the fortune teller, after she squeezed the goat's testicles?
Posts: 2708 | Registered: Feb 2005
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bettyg
Unregistered
posted
Thanks Ann for posting this disgusting, trashy guidelines. I see the link shows the cost at $15.00 per copy!
Cave, I'm puzzled; on the liars end .... do these addresses match up with ALL who wrote this trashy guidelines? Please help my neuro lyme brain...
I broke up addresses to try to comprehend what you are saying, but thanks Cave!
quote:Originally posted by cave76: Here they are!!!
Gary P. Wormser,1 Raymond J. Dattwyler,2 Eugene D. Shapiro,5,6 John J. Halperin,3,4 Allen C. Steere,9 Mark S. Klempner,10 Peter J. Krause,8 Johan S. Bakken,11 Franc Strle,13 Gerold Stanek,14 Linda Bockenstedt,7 Durland Fish,6 J. Stephen Dumler,12 and Robert B. Nadelman1
And their lairs: ******************??
Divisions of 1Infectious Diseases and
2Allergy, Immunology, and Rheumatology, Department of Medicine, New York Medical College, Valhalla, and
3New York University School of Medicine, New York, New York;
4Atlantic Neuroscience Institute, Summit, New Jersey; Departments of
5Pediatrics and
6Epidemiology and Public Health and
7Section of Rheumatology, Department of Medicine, Yale University School of Medicine, New Haven, and
8Department of Pediatrics, University of Connecticut School of Medicine and Connecticut Children's Medical Center, Hartford;
9Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, harvard Medical School, and
10Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts;
11Section of Infectious Diseases, St. Luke's Hospital, Duluth, Minnesota;
12Division of Medical Microbiology, Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland;
13Department of Infectious Diseases, University Medical Center, Ljubljana, Slovenia; and
Evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis were prepared by an expert panel of the Infectious Diseases Society of America.
These updated guidelines replace the previous treatment guidelines published in 2000 (Clin Infect Dis 2000; 31[Suppl 1]:1-14).
The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them.
For each of these Ixodes tickborne infections, information is provided about prevention, epidemiology, clinical manifestations, diagnosis, and treatment.
Tables list the doses and durations of antimicrobial therapy recommended for treatment and prevention of Lyme disease and provide a partial list of therapies to be avoided.
A definition of post-Lyme disease syndrome is proposed.
posted
Here is the breakdown on board certification in infectious diseases for the authors of this IDSA guideline:
5 of these are board cert in ID
7 of these are not board cert in ID
2 of these are Europeans, status of ID training unknown
In the previous edition, 5 of 12 were board certified in ID
In this edition, 5 of 14 are board certified in ID. So the proportion is worse, unless the Europeans have specialized training equivalent.
Furthermore, the authors include no psychiatrists even though lyme has significant psychiatric symptoms.
And the authors include an entomologist with no medical degree at all.
And none of these authors has any experience in treating chronic lyme disease because they do not recognize it to be an infectious disease.
(This information was checked on the website of the organization that certifies medical specialists.)
Posts: 8430 | From Not available | Registered: Oct 2000
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Sooooooo.. the LDSC Guidelines have FINALLY hit the top of the trash can!
YIPPEE!!!!
Looks like the Little Devils will now get to bask in their 2 minutes of fame... after scribbling out 60 pages of Swiss Cheese (so many holes in it).. and 30 pages of self-promoting references!
HA!
L ittle D evils S wiss C heese Guidelines
LDSC
Actually it only took me reading about 10 pages before I had to stop because I was laughing so hard.
WHO in their right mind is going to believe any of that hooey?
I thought... at the least... they would give us a challenge of some sort... but these LDSC guidelines are just sooooooo ignorant and soooooooo unrealistic.. I do believe they have finally found the final nail to hammer into their own coffins.
The BIG question now is...
What happened to the 6 patients who hung around long enough to be used in their studies?
What? What? Oh.....
Someone told me they were telepathicaly shipped back to Mars once the LDSC guidelines were completed!
Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
By the way..
ma.. you made me laugh.
lou said.. "And none of these authors has any experience in treating chronic lyme disease because they do not recognize it to be an infectious disease."
Foggy
Frequent Contributor (1K+ posts)
Member # 1584
posted
I can't wait until one of these guys or a loved one has Chronic Lyme and they feel the pain, devastation, despair & financial burden we've all suffered.
Will they still consider it to be an illness "other than Lyme?"
Posts: 2451 | From Lyme Central | Registered: Aug 2001
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posted
We already know what they would do if a friend or relative got it. There have been several cases in which that happened and of course they didn't follow the guidelines. We are not dealing here with honest people.
And remember when the TN governor got what was probably lyme disease. He was treated aggressively at the early stage without any positive test or a positive ID for anything. This happens to VIPs, but not to the rest of us. He was the third governor to get it, and all were treated at an early stage and cured. No wonder they think lyme is not serious longterm chronic disease.
Posts: 8430 | From Not available | Registered: Oct 2000
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
The Little Devils Swiss Cheese (LDSC) guidelines say..
"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."
HA!
Sooooooooooooooo... if you see a Lyme rash.. you CAN diagnose it as a LYME RASH. BUT..
You can't diagnose the person with the Lyme rash with having Lyme.. even when they have the LYME RASH!
Ahhhhhhhhhhhhhhhhh!!!!!!!!
This actually sounds like something a total "control freak" would try to pass off to the unsuspecting. Ya think?
That is like saying if you are sitting in a tub filled with water... and you are wet and soapy .. you can say you are in a tub and wet.. but you CAN"T say you are taking a bath!
sometimesdilly
Frequent Contributor (1K+ posts)
Member # 9982
posted
TinCup-
i read that quote about clinical findings a bunch of times. It sounds to me like what is being said is that you have to "see it" before lyme can be believed.
So yes, it is OK to use clinical judgement to diagnose lyme if you see that irrefutable EM, but it is NOT OK to use clinical findings to diagnose lyme or any other TBD absent an EM (or, as stated elsewhere, "objective" labs, etc.s).
Seems like a straight forward assault on how LLMDs treat, not to mention on lyme patients, since what we say about our own health is not to be given any credence at all.
Cretins all.
Dilly
Posts: 2507 | From lost in the maze | Registered: Aug 2006
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treepatrol
Honored Contributor (10K+ posts)
Member # 4117
posted
Gary P. Wormser, MD, Chief, Division of Infectious Diseases and Vice Chairman of the Department of Medicine, New York Medical College.
Whoopty doopty look at me iam special look look iam special.
What a freakin piece of work.
-------------------- Do unto others as you would have them do unto you. Remember Iam not a Doctor Just someone struggling like you with Tick Borne Diseases.
posted
Compare i.d.s.a. guidelines and I.L.A.D.S. guidelines.
1. http://www.ilads.org See: I.L.A.D.S. guidelines, position papers, and evidence-based medical facts at variance with those of the authors of idsa-guidelines .
2. http://www.lymeinfo.net/lymefiles.html see scientific, and evidence-based medical facts at variance with those made by the authors of the idsa guidelines.
Some of the sordid history of several authors of the idsa guidelines: See some of their piccs, and links to their behavior,here: http://www.actionlyme.org/SPINDOCTORS.htm
1. J Infect Dis. 1992 Aug;166(2):440-4. Related Articles, Links
Fibroblasts protect the Lyme disease spirochete, Borrelia burgdorferi, from ceftriaxone in vitro. Georgilis K, Peacocke M, Klempner MS.
Department of Medicine, New England Medical Center, Boston, Massachusetts.
The Lyme disease spirochete, Borrelia burgdorferi, can be recovered long after initial infection, even from antibiotic-treated patients, indicating that it resists eradication by host defense mechanisms and antibiotics. Since B. burgdorferi first infects skin, the possible protective effect of skin fibroblasts from an antibiotic commonly used to treat Lyme disease, ceftriaxone, was examined. Human foreskin fibroblasts protected B. burgdorferi from the lethal action of a 2-day exposure to ceftriaxone at 1 microgram/mL, 10-20 x MBC. In the absence of fibroblasts, organisms did not survive. Spirochetes were not protected from ceftriaxone by glutaraldehyde-fixed fibroblasts or fibroblast lysate, suggesting that a living cell was required. The ability of the organism to survive in the presence of fibroblasts was not related to its infectivity. Fibroblasts protected B. burgdorferi for at least 14 days of exposure to ceftriaxone. Mouse keratinocytes, HEp-2 cells, and Vero cells but not Caco-2 cells showed the same protective effect. Thus, several eukaryotic cell types provide the Lyme disease spirochete with a protective environment contributing to its long-term survival. PMID: 1634816 above abstract found here on pub med: http://tinyurl.com/e9r5k
kelmo
Frequent Contributor (1K+ posts)
Member # 8797
posted
On the first link, there is a place that says "contact us". So, I wrote them a nice letter telling them that they are going to create a society of non-productive, disabled Americans. Shame on them. They are hypocritical to their oath of "do no harm". They are harming by denying.
Wormser----what a fitting name for a spineless invertibrate that lacks a heart.
Posts: 2903 | From AZ | Registered: Feb 2006
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NP40
Frequent Contributor (1K+ posts)
Member # 6711
posted
Here's my "Letter to the Editor" in response to Wormser. Hope they print it.
Rebuttal of New Lyme Disease Guidelines
I read with incredulity your article titled ``New Guidelines for Lyme disease.'' The IDSA's outdated, scientifically unverifiable, short course antibiotic guidelines have doomed hundreds of thousands nationwide to a lifetime of chronic pain and misery from lyme disease and other tick-borne co-infections.
The IDSA completely ignores the hundreds of thousands who've gotten their lives back with long-term antibiotics.
The National Guideline Clearinghouse {US Dept. of HHS} completely contradicts the IDSA's absurd standards and states ``The duration of therapy should be guided by clinical response, rather than by an arbitrary [i.e., 30 day] treatment course''.
Another favored tactic of the IDSA is the insistence that long-term antibiotics are dangerous.
Of course, the IDSA has no qualms about giving children antibiotics for years for simple cases of acne yet, long term antibiotic therapy for a severe debilitating illness like lyme disease is beyond the pale.
The FDA website and their studies on the effects of long term antibiotic treatment renders the following quotes: ``.......fatalities are very rare [on the order of one in several million''.......or............
''These antibiotics have an extensive history of use, and the lack of any serious adverse events as reported in these studies support their reputation as safe drugs. Reassurance can be derived from the fact that no increase in serious adverse events has been reported in the literature despite broad usage.''
Hmm.....makes one wonder whether the IDSA is more concerned with patients or insurance company bottom lines ?
Sincerely,
Posts: 1632 | From Northern Wisconsin | Registered: Jan 2005
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Ann-OH
Frequent Contributor (5K+ posts)
Member # 2020
posted
Bravo! NP40 I hope they do publish it. I hope lots more people will reply.
I hope they will publish letters before the weekend.
posted
Now we know why she was cured. Of course, even IDs change course when faced with a VIP. Just look at the way the TN governor's case was handled. They took it seriously, treated it aggressively, even without any positive tests.
Posts: 8430 | From Not available | Registered: Oct 2000
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Ann-OH
Frequent Contributor (5K+ posts)
Member # 2020
posted
Good for you, Kelmo. I think we should go to the IDSA site and say the same.
At the bottom of the page athttp://tinyurl.com/fedhk you can rate the article.
I hit "Strongly disagree" And that it would greatly influence doctors' treatment.
At the side there are lots of ads related to Lyme disease, including the Fatigue and Fibro centers. If you hit that, you can read their very good article, which contradicts the IDSA guidelines very nicely. They say "real doctors to treat you".
lymewreck36
Frequent Contributor (1K+ posts)
Member # 4395
posted
My oldest daughter, a brilliant young lady, is planning to attend med school. I suggested some schools in the northeast.
We are filling jars with ticks as we speak.
Problem solved.
Mary
Posts: 1032 | From North Carolina | Registered: Aug 2003
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kam
Honored Contributor (10K+ posts)
Member # 3410
posted
LOL Mary.
I take it these are infected ticks?
And you are going for on hands training?
I have not read the posts above you so I am guessing here.
Posts: 15927 | From Became too sick to work or do household chores in 2001. | Registered: Dec 2002
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posted
Have sent the following letter to the editor of Newsday:
Your recent article, ``New guidelines for Lyme disease'', should be read with a great deal of caution. Since Long Island is a highly endemic area for Lyme disease, it is particularly important that residents are aware that the medical community is divided in its approach to Lyme disease.
Unfortunately, your article presented some statements as though they are well established fact. For instance, the article states that ``long-term antibiotic therapy - a treatment regimen sometimes prescribed - has not proven effective, and may be dangerous.''
In fact, the first scientifically sound study to test this approach has only recently been completed. Preliminary results of this $4.7 million study funded by the National Institute for Health and conducted at Columbia University are very promising.
The IDSA guidelines inappropriately downplay study results in a poor attempt to mask positive study findings. The fact that both physical and cognitive improvements were achieved by study participants receiving long term therapy suggests that such treatment is on the right track.
It is well established that bacterial infections not completely eradicated by antibiotics are likely to return. The fact that participants began to relapse following cessation of treatment leads to the reasonable conclusion that the treatment was insufficient and more treatment is needed.
Using the word ``dangerous'' to describe the adverse outcomes is clearly meant to scare people. Adverse outcomes are part of virtually every medical treatment and by omitting from the guidelines the specifics concerning these adverse outcomes, Dr. Wormser and his colleagues are removing the risk/benefit decision from the patient, where it rightly belongs.
It is the responsibility of the medical profession to educate patients about the risks of any treatment. When a person is faced with any debilitating disease, they are faced with difficult decisions and deserve to make them with all of the available information.
Your readers should be aware that the evidence-based guidelines published by the International Lyme and Associated Diseases Society offer a different perspective than that presented in the IDSA guidelines.
Readers who are dissatisfied with the lack of consensus regarding Lyme disease may want to express their support for the ``Lyme and Tick-Borne Disease Prevention, Education, and Research Act of 2005'' which provides for ``expansion of Federal efforts concerning the prevention, education, treatment, and research activities related to Lyme and other tick-borne diseases by writing their elected federal representatives and/or signing the online petition supporting its passage at: www.petitiononline.com/lyme.
"Never doubt that a small group of thoughtful, concerned citizens can change the world. Indeed, it is the only thing that ever has." - Margaret Mead Posts: 63 | From USA | Registered: Jul 2006
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quote:Originally posted by imanurse: Poor Wormser.....
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96227 | From Texas | Registered: Feb 2001
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david1097
Frequent Contributor (1K+ posts)
Member # 3662
posted
Don't get too upset. You have to read what the damn thing says CAREFULLY. From the press release all it appears that they have done is leave more loop holes becuase of their careful wording.
For example "no proof of ongoing SYMTOMATIC infection". That does not mean there is no proff of ongoing infection... So what happens with ongoing infection???? Lets see.... maybe relapse for one...?
Another one.... "Nearly all people -- more than 95% -- who do get sick with Lyme disease and are treated with the recommended course of antibiotics get better and go on with their lives," he said.....
95% is almost all???? I will have to see if my next airplane flight has a 95% chance of NOT crashing.... Very re-assuring..
What about the other 5%...
And... "People who continue to have symptoms that persist after appropriate antibiotic treatment for Lyme disease should talk to their physicians about whether the diagnosis was accurate or if they may have a different or new illness to be certain they get the proper medical care."
NEW ILLNESS....perhaps soon to be called called Wormser diease....now if it responds to antibiotics like things like TB or leporosy.... Then what do you do.....
Basically the way I read the press release.... Try the treatment, if it doesn't work, try it again. If it doesn't work then, you are on your own with the NEW ILLNESS . Good luck and get lost.
It basically looks like a commitee generated document that was reviewed by a team of lawyers and then edited by a human rights group for politcal correctness.....and then edited again to save paper.
lets see... I think I will write into the nuclear regulatory commision (NRC) and ask for the acceptable worst case accident scenario probability to be raised to 5% from the current 1 in 1000 million. I will tell them that some esteemed Dr's came up with this number as they feel is virtually he same as 0% so why go to the extra effort or money to hande the last 5%.
There is a real good reason for the NRC to change this... think how much money that can be saved at the nuke plants not having to have all those big expensive building and safety systems.....
Posts: 1184 | From north america | Registered: Feb 2003
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-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96227 | From Texas | Registered: Feb 2001
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dontlikeliver
Frequent Contributor (1K+ posts)
Member # 4749
posted
David, that was excellent!
Posts: 2824 | From The Back of Beyond | Registered: Oct 2003
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Truthfinder
Frequent Contributor (1K+ posts)
Member # 8512
posted
Did I understand this correctly - that now the ID ducks are warning against a "clincal diagnosis" of Lyme AT ALL if there is no EM rash?
Maybe I just misunderstood.
Tracy
-------------------- Tracy .... Prayers for the Lyme Community - every day at 6 p.m. Pacific Time and 9 p.m. Eastern Time � just take a few moments to say a prayer wherever you are�. Posts: 2966 | From Colorado | Registered: Dec 2005
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sometimesdilly
Frequent Contributor (1K+ posts)
Member # 9982
posted
Lynne-
wow- what a well-written letter, and I love that you connected ISDA guidelines isues to federal legislation!
maybe you should consider sending it to other relevant places as well..
Dilly
Posts: 2507 | From lost in the maze | Registered: Aug 2006
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posted
The article on the new guidelines was printed in a Martha's Vineyard newspaper (online) with the following comments from a "researcher" from Tufts: "In particular he cited references to post-Lyme syndrome which he said suggest that folks really should wonder if their persisting signs and symptoms are really more unusual than what many people experience every once in a while or more frequently as we age." AND THIS "Folks should then move on and entertain other diagnoses, including, in my opinion, change their diet, do more exercise, drink more red wine, watch more Three Stooges, go fishing, think positively. (I can hear it now, 'easy for you to say, you've never been infected.')" This is why lyme is so hard to deal with......
Posts: 15 | From Rhode Island | Registered: Oct 2006
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bettyg
Unregistered
posted
quote:Originally posted by tennisplayercc:
The article on the new guidelines was printed in a Martha's Vineyard newspaper (online) with the following comments from a "researcher" from Tufts:
"In particular he cited references to post-Lyme syndrome which he said suggest that folks really should wonder if their persisting signs and symptoms are really more unusual than what many people experience every once in a while or more frequently as we age."
AND THIS "Folks should then move on and entertain other diagnoses, including, in my opinion,
change their diet, do more exercise, drink more red wine, watch more Three Stooges, go fishing, think positively.
(I can hear it now, 'easy for you to say, you've never been infected.')"
This is why lyme is so hard to deal with..
Welcome tennis to the board; I notice you are an atorney; what is your specialty please?
Do you also have chronic lyme disease and for how long?
I'm sending you by PM, private message, my 18 pages of newbie links/advise. Bettyg
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posted
The words are different, but the strategy is eerily the same.
Whenever the "system" has an ulterior motive NOT IN THE PUBLICS BEST INTEREST, they initiate a persistent and repetitive onslaught of propaganda from XYZ government agency and it's public sector sycophants, which is specifically designed to demean and further isolate whatever group is on the verge of seeing behind the "wizards curtain".
Courts do it all the time.
When someone questions the "system" the courts are designed to protect, the courts follow a method of
1. Ignoring the plain language of the law,
2. Disallowing any discussion or argument about the technicalities of the "law" in question in open court, and
3. Call plaintiffs argument "frivolous" or other such vacuous insult, and then keep repeating that methodology over and over again until it gets cited as precedent by other courts, and repeated by the media.
Here are some questions I'd like to ask as a rebuttal (in no particular order):
1. Before the infectious agent which causes Lyme was identified, the people who were infected with it were diagnosed with what?
Were those Doctors wrong in there dignoses?
Based on what evidence do you now know you are right enough to take a chance with peoples lives?
2. What is the mechanism which causes the so-called, often cited "resistance" in infectious bacteria?
A course of antibiotics which is too short, or one which is too long??
3."Furthermore, long-term antibiotic therapy may be dangerous and it also can lead to complications for the patient, such as:
. blood stream catheter infection (for those on intravenous antibiotics)
. and Clostridium difficile colitis (a potentially severe infection of the bowel). "
Since one of the two listed dangerous side effects of so-called "long term" antibiotic treatment is Clostridium difficile colitis, what is the rate of incidence of this infection in people on long term antibiotics?
What is the incidence of this infection with people NOT on long term antibiotics?
What is the rate of infection due to hospital visits?
What is the normal treatment for this infection?
How dangerous is the treatment relative to the dangers of un or under-treated lyme/lyme like infections or other tick borne diseases?
4. What data is being used to support the guidance that long term antibiotic usage, particularly for patients reporting subsequent relief of symptoms, is more dangerous then the possibility or reality of infection with an agent which causes symptoms similiar to Syphilis, MS, RA, Alzheimers, ALS and the like?
5. "...one substantive change in IDSA's treatment recommendations is that some selected, high-risk tick bites may be treated with a single dose of the antibiotic doxycycline but only under certain conditions.
Those conditions include a reliable identification that the bite came from a deer tick that has been attached for 36 hours or longer."
When was the guidance changed from 24 to 36 hours?
Will you bet your credentials on the diagnosis that I am absolutely NOT infected if the tick was attached for 35 hours 50 minutes?
How about 34 hours?
What repeatable scientific evidence are you using to suggest that biological systems and infectious agents accurately utilise man-made timetables?
6. "..and if preventive treatment can be started within 72 hours of the time the tick was removed."
So a "single dose" is effective at 72 hours or before?
What dosage is recommended at 72 hours and 5 minutes?
7. "IDSA states that most patients who develop Lyme disease are cured with a single course of 10 to 28 days of antibiotics, depending on the stage of their illness."
What test and/or test results are being utilised to make this assertion?
How do you confirm that infected patients are in fact "cured", or that people who test negative are not actually infected?
Isn't it true that the CDC emphatically states that diagnosis of Lyme disease cannot be either confirmed or denied based on the inaccuracy of the current tests?
8. "Occasionally a second course of treatment is necessary. More prolonged antibiotic therapy is not recommended and may be dangerous, according to Dr. Wormser."
Isn't that a non-sequitor based on the rest of your stance?
Why would a second course be necessary?
Was the intitial dose too low?
Was the course not long enough?
How much more dangerous is a 60 day course versus 30?
If a second course became necessary, what would preclude the necessity of a third course, or a fourth, etc.?
9."This is as authoritative a statement as they come from an evidence-based medicine approach."
A patient presenting with symptoms IS THE FOUNDATION OF EVIDENCE BASED MEDICINE. Without that, you usually don't need a doctor. No?
Please remeber that Doctors are not Scientists!
In many cases even they don't understand the vaunted "peer reviewed" scientific literature they quote!
And like so many other diciplines, Doctors and Scientists are merely humans with their own individual agendas.
Science is NOT real life.
And scientists change their assessments all the time....afterall until just recently Pluto was a planet, and in the '70's scientist adamantly warned that civilisation was on the verge of extinction due to GLOBAL COOLING!
"Never doubt that a small group of thoughtful, concerned citizens can change the world. Indeed, it is the only thing that ever has." - Margaret Mead Posts: 63 | From USA | Registered: Jul 2006
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