The following is an excerpt written by Dr. B. Robert Mozayeni from our book Lyme Savvy: Treatment Insights for Lyme Patients and Practitioners.
Traditional Tick Bite Treatment
Diagnosis for Lyme Disease is not simple and neither is treatment.
Let’s move out three months from the original tick bite and classic ECM rash. Now we have a patient who is ill and the antibody tests are still not clearly positive. In the meanwhile, that person has already had the standard two weeks of doxycycline because a practitioner wanted to allay the patient’s concerns even though the Western blot done in the beginning was negative.
Let’s assume the Western blot has slightly changed, but not in any way that convinces anyone. In other words, they might have one new IgG band or maybe the total antibody, or the EIA, is now slightly positive or weakly positive.
Now we have this symptom complex and it is not clear. In other words, there is no other explanation and we cannot prove it is from the original event.
At this point, doctors who believe that only a two-week protocol is necessary to start calling this post-Lyme syndrome. They may not call it that until it is a few more months out. They might give the person up to 30 days of doxycycline. They might even add another antibiotic if that didn’t work. But to those who believe antibiotics are uniformly 100% effective against Borrelia there is no other explanation other than calling the problems the patients is experiencing post-Lyme syndrome.
Other physicians are apt to believe it is common sense that this patient still has Lyme Disease because the patient originally had the tick bite with the diagnostic ECM rash. At this point, because there is no other explanation, we need to simply intensify or extend the treatment for chronic Borreliosis.
The point to make about this debate is it can exist only in the absence of good information. You can have this argument over what it is and what it isn’t because you really don’t have any way to disprove or prove either theory. So people argue over whose evidence is bigger and better.
If a practitioner is also consulting Infectious Disease specialists you feel like you are starting to go out on a limb and potentially risk professional sanctions if this patient has an adverse reaction to the medications. If you are a patient, you are terrified that your doctor is worried more about his professional sanctions than about giving you the proper treatment.
If, as the practitioner, you always try to do the best you can for the patient, then your good intentions carry the day. But you may still be persecuted even if the patient gets better; sad, but true.
From the patient’s point of view, additional and more intense treatment is the way to go. If you subject this to a rigorous evidence-based medicine (EBM) analysis, according to Canadian medical doctor and pioneer David L. Sackett, you must acknowledge patient preference is a very important determinant of the evidence database, because the perception of benefit and harm is the patient’s. Rarely do medical policy makers consider patient preference in evidence-based medicine guidelines.
When you are gauging the value of a treatment, there are two measures. One is called the number needed to harm (NNH). In other words how many patients do you have to treat before you harm someone? The other one is the number needed to treat (NNT) to see benefit. The NNT is how many do you have to treat in order to help someone? The numbers are out of 100. For example, out of 100 people you would treat with a longer course of antibiotic, what fraction will have a significant adverse reaction and how do you compare that to the number who will have a significant positive reaction?
The number of patients needed to treat and the number needed to harm are the way we measure the efficacy and risk of any treatment. But the perception of what constitutes benefit and harm belongs to the patient with guidance and information from the physician. This point is extremely critical and central to evidence-based medicine, but it is completely lost on the medical professionals who would rather weigh in with a top-down dogmatic and paternalistic view of how things should be done. In a free society this should not be.
We are now at the point of dealing with this patient who either has post-Lyme syndrome or chronic Lyme Disease depending on whether or not you choose to look at it from the patient’s or the doctor’s point of view.
This is because the patient will prefer, usually, to take a chance to have full recovery over a death or disability sentence.