A 35 year old Vietnamese gentleman was well until September, 2008. At that time he developed burning sensations in his upper extremities. He developed a chronic sore throat. Muscle and joint pains started coming and going in a diffuse distribution. He developed fatigue with some brain fog, then intermittent night sweats. Additionally he has experienced dyspnea- shortness of breath at night and occasional palpitations. There has been progressive weakness affecting both arms and the left leg. The pains, especially around his shoulders and neck have been disabling at times.
He went to his primary care physician who ran a plethora of tests. Finally a Lyme test was done. It was positive. He was referred to ID.
He saw the Nurse Practitioner. She prescribed Doxycyline for 3 weeks. After two weeks he developed a rash on his face. The Doxy was stopped and he was given Amoxil for an additional 3 weeks. Even though symptoms persisted the NP would prescribe no further antibiotics.
He went to a neurologist who found nothing amiss.
I saw him today for the first time. I examined him.
He had obvious weakness of the left arm. His deep tendon reflexes were asymmetrical, increased in the left versus right upper extremity. An obvious decrease of sensation to pin prick in a stocking/glove pattern was present.
He has lived in this country for 25 years but his accent is a bit thick.
I wanted to get a clear history about his use of antibiotics. He told me the Amoxil had been prescribed at a dose of 500 mg 3X daily. I asked if he only took it for the three weeks? He was quiet for a moment as if he were trying to size me up. Quietly, sheepishly, he confided: He had been taking Amoxil from Vietnam- continuously.
Not trusting or believing in his health care providers, this patient like many others went underground to acquire antibiotics. These are the guerrilla warfare tactics of Lyme disease I allude to in the title of the post.
He recently visited the ID again. He showed me those labs. The ELISA was positive at 1.3. The IgM was positive with 23 and 41 bands. The IgG showed 23 and 66 bands. This of course is "CDC positive" and according to the CDC model indicates acute infection. The possibility of another bite, a new infection and co-infection was apparently not considered.
The Lyme disease is gone quipped the nurse practitioner. The patient was sent on his way.
He was worried that the self prescribed Amoxil had caused harm, that perhaps it had made his germs resistant.
I told him that this was unlikely. Rather, he had been under treated.
I thought: "Underground for antibiotics: A sad state of affairs."