A 28 year old female came into my office 18 months ago. She complained of acute left hip pain for 3 days and was unable to walk. My previous training told me that it was something called "toxic synovitis," an acute joint inflammation or a hip joint, possibly do to a virus or a rheumatological disorder. She was in severe pain, I prescribed a Medrol dose pack and Vicodin. Her initial labs showed a sed rate of 32 a CRP of 160- which is off the charts, a Lyme C6 peptide index of 0.3, vitamin D reversal, a Lyme WB 41 band on the 13 band test. She took antibiotics for 2 months for presumptive Lyme disease and got better. She stopped the antibiotics and relapsed 4 months later. This time her hip and knee hurt. She had mild neurological signs of peripheral neuropathy.
"Standard" labs were negative for Lyme. Her sed rate was 47 and her CRP 30.
After one week of resuming antibiotics she was better. Her course was complicated by a yeast infection. Her antibiotics were adjusted. After 4 months, a more careful history elicited- some tingling in the hands, some fatigue and some subtle cognitive issues.
At 7 months her CRP was normal at 1.2 and she felt entirely normal; all the symptoms had resolved. New labs showed that her vitamin D dihydroxy 1,25 had climbed to 98. The vitamin D hydroxy 25 was 12. I was a little nervous about the vitamin D and prescribed 2 months of Benicar. The levels quickly corrected 28 and 20 respectively.
After 3 negative Labcorp WB for Lyme, the last two showing no bands, a Lyme WB was sent to IgeneX. This time she was CDC positive and IgeneX positive by IgM criteria. She had positive bands 23,31,34,41 and 58.
We both felt confident that the diagnosis of Lyme disease had been correct all along.
She has been maintained on low doses of maintenance antibiotics and is symptom free.
To not treat Lyme disease means: To not consider Lyme in the differential diagnosis, to omit neurological examinations of my patients, to not order the labs I am familiar with- stop practicing medicine as I know it- just go through the motions to make a living, and still smile? Not worth it. If that what it comes down to I will leave medicine and find something else to do.
More importantly: God knows what would have happened to the patient?