Over 100 years ago, the great physician Sir William Osler said, "He who knows syphilis knows medicine." His point was that syphilis can affect so many parts of the body in so many different ways that its manifestations are a veritable encyclopedia of medicine. In the 1980's the same was said of AIDS.
Lyme disease is also a bit of a shape shifter, as I've been reminded this summer.
Lyme is most prevalent in New England, along with the mid-Atlantic and northern midwest, so it's not surprising that I'd see lots of Lyme, though this summer it seems that I'm seeing the infection more frequently and in more varied forms.
I've seen the classic bullseye rash (erythema migrans):
The multiple skin lesions of early disseminated Lyme:
Lyme affecting the nervous system, as Bell's palsy:
And Lyme affecting electrical conduction in the heart:
I'm also seeing something less visible than these effects, but often no less painful: conflict and confusion.
The manifestations of Lyme pictured above are well recognized--and usually easily treated. Much more controversial is "chronic Lyme disease," not recognized by the CDC and many other medical organizations. The CDC does recognize Post-Treatment Lyme Disease Syndrome (PTLDS), but this is not the same entity as chronic Lyme, which many people believe causes a variety of symptoms for years (even if they test negative for Lyme) and for which some physicians may prescribe antibiotics for months or years.
In the New Yorker, Michael Specter wrote this article exploring the Lyme controversy.
I had a personal view of the passion with which many believe in chronic Lyme after I wrote a column about medical intuition. I wrote about a patient I felt sure had Lyme disease (he did, in fact), just by seeing his name and the vague notation "doesn't feel well" on my schedule, and tried to analyze what that feeling meant.
After the column appeared, I received several emails from people who thought, happily, that I was advocating diagnosis and treatment of Lyme completely by intuition--a position they felt supported the concept of chronic Lyme.
I also received emails from physicians and others who felt, unhappily, I was in favor of abandoning science for emotion.
Just before the column was published, I contacted a colleague who specializes in infectious diseases. I wrote that I had a couple of "simple questions" to ask her, to make sure I had my facts right.
"There's nothing simple about Lyme," she responded.
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