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The great Lyme controversy.

According to the prestigious U.S. Centers for Disease Control and Prevention (CDC), Lyme disease is a very rare disease. Try to tell that to the thousands of patients in New Jersey's Monmouth and Ocean counties who are still sick after being treated specifically for Lyme disease!

So convinced are the residents of these New Jersey communities that Lyme is rampant among them that an estimated 20 percent of Ocean County's population no longer engage in some of the common outdoor activities of summer, such as gardening and picnicking, for fear of exposing themselves to ticks. Lawns have been replaced with concrete, decks circle some homes like moats around a castle, and one doctor has even built a four-foot concrete wall around his backyard--all to repel the invaders. One in four residents of Ocean County have had a blood test for Lyme within the past five years--and at one hospital alone, the Jersey Shore Medical Center, more than 1,300 patients have been given long-term intravenous antibiotic therapy for the disease.

The accepted treatment for Lyme disease is a course of oral antibiotics if the patient shows signs typical of Lyme (a "bull's-eye" rash, for example--a patch of clear skin surrounded by a circular red rash) or a positive blood test. Many doctors, however, prescribe antibiotics for anyone bitten by a tick, even before any symptoms appear. For patients whose symptoms recur after a three-week course of oral antibiotics, intravenous therapy through a surgically implanted chest tube is increasingly common. Such treatment may involve as many as three infusions of antibiotics each day, for a year or more.

The battle rages on. On one side are doctors and patients who believe Lyme can be a chronic infectious disease requiring lifelong monitoring and antibiotics. Their convictions have led to a major new industry in many places--home IV treatment companies, some of whom have been known to pay "referral fees" to doctors sending patients to them. Most doctors prescribe extended IV treatment because they honestly believe it is the right thing to do.

On the other side are the CDC and researchers from Harvard, Yale, and other major university medical centers who believe that most Lyme patients are misdiagnosed. Unless they have a positive blood test, the typical rash, or joint and neurological abnormalities characteristic of Lyme, these experts say, the disease is not Lyme. Among known Lyme patients, they contend, only rarely does the Lyme spirochete (the bacterium that causes the disease) survive a course of oral antibiotics--and intravenous antibiotic therapy is thus rarely indicated--if at all.

Even the CDC, however, agrees that Americans in the 12 states in which nearly all deer ticks (the carriers of the spirochete) are found are at higher risk of acquiring Lyme disease--Rhode Island, Massachusetts, Connecticut, New York, New Jersey, Pennsylvania, Delaware, Maryland, Michigan, Minnesota, Wisconsin, and northern California. With summer at hand, therefore, observe the following precautions if you will be vacationing in any of these states:

1. Check with the local health department to know in which parks, woods, or wilderness areas ticks are known to occur.

2. Be particularly careful in late spring and summer, when ticks are no bigger than a pinhead. It is then the arachnids are just beginning their second (and last) year of life.

3. Spray insect repellent with Deet on clothes and skin and keep as completely covered as possible--with light-colored clothing to enable easier detection of ticks.

4. Carefully inspect the entire body for ticks after you come back indoors.

5. The experts believe a tick must attach itself for at least six hours before passing on the bacteria--so remove them as soon as possible. Use tweezers to grasp the tick as close to the skin as possible and pull it slowly out, taking care not to crush it--and forget those ancient remedies your grandmother may have given you, such as covering the tick with Vaseline or applying heat to the tick with a cigarette or match. These particular methods simply do not work.

6. If bitten, look for such signs or symptoms (which can occur days or weeks later) as the bull's-eye rash, fatigue, chills, headache, and muscle and joint pains. If they occur, see your physician.
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Copyright 1995 Gale, Cengage Learning. All rights reserved.

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Title Annotation:is it or isn't it?
Author:Brown, Edwin W.
Publication:Medical Update
Date:Jul 1, 1995
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