The post entitled "Routine Physical," is the essence of my quandary. I have been clearly instructed from legal quarters: DON'T DO LYME- JUST DO REGULAR FAMILY MEDICINE. How do I do that? To paraphrase Plato: Once you have seen the light it is impossible to return to the cave. The old me, the pre-Lyme me, would have thought: "Of course he has brain fog, he abuses alcohol and marijuana, what does he expect." "Depression- sure- common, connected to substance abuse." Aches and pains- It is just a somatic manifestation of his depression and other issues." He would have been treated with Prozac and Motrin; and sent for extensive substance abuse counseling and rehab, for which he would have likely been non compliant. He would likely have never returned to my office and been "lost to follow up." This is the world I am told I must to go back to. For God's sake, this patient had 12 of 13 standard bands positive on a Lyme Western Blot WHICH I OTHERWISE WOULD NOT HAVE ORDERED. NOW HIS ENTIRE LIFE HAS BEEN TURNED AROUND BECAUSE HE HAS BEEN TREATED FOR THIS NON EXISTENT LYME DISEASE!
The Lyme community is busy spitting hairs while the system prepares to throw yet another LLMD under the train- AND then how many more?. Folks if this is important, and of course it is, PLEASE unite over the big issues. News Flash: A single payer system utilizing "Evidence Based Medicine" will be a disaster for the Lyme community if the ILASDS guidelines are not put into the mainstream. This will only happen through political change.
I started this blog for personal reasons. It was a therapeutic way of venting my frustrations. I began writing about odds and ends, patient stories and my understanding of the science as it has evolved. Perhaps the Blog took on a life I had not considered. Often I say things that challenge the status quo and force people to think. That is the point. We are all learning. It is a work in progress.
The debated about CAM must come to an end- at least here. That is another battle for another day which should be fought somewhere else. Yesterday, a patient with neuro- degenerative disease asked me if IV glutathione would be of help. I told him I didn't know but that perhaps he should explore this avenue. I certainly had nothing to offer from my bag of tricks.
I personally am not CAM. I was trained as an allopathic physician and that is the model within which I practice. Unfortunately or not, depending upon your point of view, a mainstream acceptance of chronic Lyme can only come from an allopathic perspective. In terms of the pecking order of "the system," CAM physicians are at the lowest rung on the totem pole.
I DO NOT DISPARAGE CAM PRACTITIONERS. They frequently are very valuable. I think it would be an insult to well trained CAM doctors if a physician like myself were to casually enter into the fray. These physicians, many of whom are quite accomplished, have spent many years honing their trade. Patients should make informed choices and discover what works for them.
Medicine sometimes seem like a religion. Perhaps in many ways it is. To the extent it is possible, Lyme medicine must be fact driven if we are to win this war. The discussion should not be: "So you don't believe in Bartonella." Rather the discussion should be" "The Bartonella hypothesis is interesting, what evidence do we have to support it?"
Having given this a great deal of thought, if I were to be told by a governing body of physicians, as may happen in the near future, that I have to follow the IDSA guidelines, then I could no longer in good faith be able to practice the medicine that I love. I couldn't live with myself if I were compelled to throw this young man described in the vignette above "under the train." I already have enough trouble sleeping some nights.