There may be a lot of controversy and nuisances in Lyme medicine. But here is the story of a new patient I saw today. Several months ago, a patient was bitten by a tick. This was followed by a classic bulls eye rash (which he only learned after he looked it up on the Internet). He ignored it. It went away. He had few symptoms except a little joint pain which he attributed to weight lifting. After some time, he developed acute Bell's Palsy. He went to a major University teaching hospital in search of some help. Because he also had a little numbness in the arm and shoulder of the affected side, he was evaluated by the stroke team. (Did I tell you he is his early twenties.) They did some blood work which got lost in the "system." The did a spinal tap and two CAT scans. They then treated him with steroids (predisone) and Valtrex, a medicine for Herpes and Shingles. No antibiotics were given. A month later he went back to the neurology unit to have his scheduled brain MRI, which was done. The neurologist involved came running out excitedly: "We know what it is!" Apparently the lost lab work was found. He had 5/10 IgG Lyme WB bands, meeting the CDC national surveillance criteria for a positive Lyme test. The previously puzzled team of neurologists and experts now proclaimed: "You have Lyme disease!" They gave him two weeks of Doxycycline and sent him out the door.
Comments: The guy had a tick bite, a classic EM rash and the docs at the ivory tower University hospital didn't ask about it. It must be because they are programmed with the mantra, repeat after me: There is no Lyme disease: There is no Lyme disease:... After all, that's what the prestigious New England Journal and the American Neurology Association have said.
Even without that history of tick bite and EM rash: The majority of cases of Bell's Palsy in a Lyme endemic area are due to Lyme disease. Every mainstream text and resource will tell you that. Herpes viruses are an unlikely cause. There is no role for steroids. They spent how many thousands of dollars on a spinal tap, two CAT scans, one MRI and overpriced consultant fees before they even bothered to look at his Lyme lab report.
Two weeks of Doxy? Bell's palsy indicates we are dealing with stage 2 Lyme according to the IDSA. Even stage 1 is treated with 3 to 6 weeks of antibiotics. Gary Wormser himself would recommend that this patient recieve at least 6 weeks of antibiotic therapy.
I couldn't make this stuff up.