Follow up visit. I have known this 50 year old male for a long time. He is a chronic depressive type. Divorced poorly. Working two jobs. Antidepressants help and he needs a refill. He mentions as a side bar he had red bumps on his leg 8 weeks ago, thought it was bug bites and went to a walk in clinic. Told - nothing to worry about. he suffers with anxiety and is disease phobic too. Just updating my files. Great. Thanks for the info. This was three visits ago.
No symptoms except the usual fatigue and depressed mood.
I order a few tests, perhaps the wrong test, including a tick borne disease panel. I have Lyme on my brain. Gotta stop that. Surprise(or not). Labcorp CDC positive for Lyme, ELISA and IgM WB. Babesia duncani titer 1:512 cinches the deal.
I carefully query: " Change in fatigue, Headaches, neck pain, change in vision, night sweats, any sweats, air hunger, joint pain, muscle pain, muscle pain, twitching muscles, Numbness and tingling, brain fog, cognitive issues, anything?"
He pauses to think: Maybe a few night sweats, over the last 6 months. Perhaps the heat was up too high, wearing heavy night clothes, not sure. Nothing else.
I treat him with antibiotics and Mepron for a month.
Now the current follow up visit.
Feels the same, except anxiety has increased; now he is worried about these new exotic sounding and frightening diseases.
It would be a lot easier if he was sick. Then I would know what to do.
There are the perils of a primary care practice - seeing patients on the front line. I suspect most patients infected with Lyme are asymptomatic. It is impossible to test this theory. I know many patients infected with Babesia are asymptomatic.
In a specialty Lyme referral practice you don't have to wrestle with these problems. I spent more time thinking about his case than I did the sick patients I saw that day.
Now I know a lot of readers are thinking: Treat him, treat him! Here's the problem. With Lyme you treat until symptoms are gone. What end point do you suggest I use?
I am still scratching my chin.