Community Corner
South County Hospital Lyme Disease Clinic
Dang! You took all the right preventive measures but a deer tick still bit you. What can you do to avoid long term debilitating complications? Dr. Silverblatt says it could be as simple as downing two tablets. And he's not talking aspirin.
“I didn’t feel like sitting on my porch spitting out watermelon seeds,” said Dr. Fredric J. Silverblatt, Emeritus Professor of Medicine at Brown University, of his motivation to help launch South County Hospital’s Lyme Disease Clinic in June 2009.
Since then, the Clinic has served more than 250 patients, most from Washington County, Rhode Island, but some from other states, including Texas, according to Lee Ann Quinn, R.N., B.S., C.I.C., who is Director of Infection Prevention & Control at the Hospital.
The Clinic treats adult patients exclusively - and by physician referral only. Quinn explained that pediatric specialists are available at the Pediatric Lyme Disease Clinic at Hasbro Children’s Hospital in Providence, Rhode Island, to treat young patients from 1 to 18 years of age who have suspected Lyme Disease.
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It’s Complicated
Proper diagnosis and appropriate treatment are key to curing Lyme Disease and other tick-borne illnesses in their early stages. (For background information on ticks and see )
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“Most people get over Lyme Disease with no sequelae,” explained Dr. Silverblatt, who is an infectious diseases expert and a Fellow with the Infectious Diseases Society of America (IDSA). For most adult patients with Lyme Disease, the recommended treatment is a two-week regimen of twice-daily doxycyline, an inexpensive antibiotic, albeit one with side effects that preclude long-term use.
In a minority of patients, the illness can become disseminated leading to debilitating and even potentially life-threatening complications. Studies are ongoing at the National Institutes of Health to learn more about Lyme Disease.
The term 'chronic Lyme' is controversial, an unfortunate consequence of attempts to explain complications of the disease that persist - even in patients who display no objective evidence of continuing infection or indeed of ever having had Lyme Disease in the first place.
The term 'post-Lyme syndrome' seems now to be the more generally accepted term, encompassing as it does all the manifestations of a disease that can wreak long-lasting havoc on the human body. Some physicians and scientists suspect that certain aspects of post-Lyme syndrome might be the result of an overactive immune system.
Semantic issues aside, post-Lyme complications can be serious, said South County Hospital's Lee Ann Quinn. Among the complications: chronic joint inflammation or Lyme arthritis, particularly in the knee; neurological symptoms, including facial palsy and neuropathy, as well as cognitive defects such as impaired memory; and, less commonly, heart rhythm irregularities.
"People Want to Feel Better"...Dr. Silverblatt
In the videos accompanying this article, Quinn explains how the South County Hospital Lyme Disease Clinic can help you or loved ones who are suffering from post-Lyme complications like those just described.
Through careful analysis of your health history and followup blood tests, Dr. Silverblatt (or Dr. Jeffery Bandola, the co-director of the Lyme Disease Clinic) determines if, indeed, the Lyme infection is still present or if, as is more likely the case in the Clinic's experience, you are experiencing post-Lyme complications.
"We review all the information, including lab work from referring doctors, and do a complete physical," explained Dr. Silverblatt. "If the patient doesn't have Lyme, we try to figure out what they do have.
"I have patients who have been on antibiotics for years but do not have Lyme Disease," he added. He described one patient who stopped taking doxycycline after six months, only to have a very high fever return. But it wasn't Lyme Disease rearing its ugly head.
"The patient actually had gall stones. We took out his gall bladder," said Dr. Silverblatt, explaining that doxycycline has anti-inflammatory benefits as well as antibiotic ones.
IDSA recommends against long-term antibiotic therapy for Lyme Disease, citing not just the lack of benefit but the potential for harm. Antibiotics are not without side-effects, Dr. Silverblatt reiterated.
Health Regained After Years Lost
Thomas was one such patient who literally spent years taking medications for 'chronic Lyme' when, in fact, he was experiencing post-Lyme neurological complications.
“I live in Cumberland, RI, and was working on a golf course in Lincoln, RI,” explained Thomas, of his encounter with Lyme Disease. “I never saw a tick. I just remember feeling very tired,” he continued.
At his personal physician’s urging, Thomas went to a reputed Lyme specialist. “After two years of getting nowhere, my father Googled ‘Lyme specialist in RI’ and we came across Dr. Silverblatt’s information. We figured it was time for a second 'Lyme specialist' opinion,” Thomas said with wry humor.
“In just two meetings with Dr. Silverblatt,” Thomas said, “he listened to exactly how I felt, ran more blood work, and came up with a game plan.”
Dr. Silverblatt concluded that the young man’s symptoms were not due to active Lyme Disease, but rather to complications resulting from having had Lyme Disease two years earlier. Dr. Silverblatt referred Thomas to the appropriate specialist.
Thomas, now under the care of a neurologist, explained, “I still have those days where things seem a little foggy but then again who doesn’t? It really was a long and drawn out process to get back to where I feel normal and functional,” he added.
Michael, a part-time Narragansett resident, experienced a similar situation. He came to Dr. Silverblatt after a delay in treatment in Massachusetts. In Michael’s case, Lyme Disease led to a Baker’s cyst in the knee. “At first I just had a slight fever and general malaise.
“Dr. Silverblatt helped me to understand the progression of the condition and what the different blood tests mean,” said Michael. “You really feel as if he’s listening - because he really is!," Michael emphasized.
“My dog comes in with lots of ticks and I treat them all as though they carry disease,” Michael added. (Read to learn more about tick diseases and your pets.)
What to Do If a Tick Bites You
According to Dr. Thomas N. Mather of the University of Rhode Island (URI) Tick Encounter Resource Center, up to half of the people infected with Lyme Disease don’t remember the tick bite. For those patients, quick recognition of symptoms - the characteristic ‘bull’s-eye’ rash, headache, stiff neck, fever, achy joints, severe fatigue - should prompt you to seek timely treatment.
Don't dismiss the symptoms as 'summer flu.' According to the CDC (Centers for Disease Control and Prevention), reported cases of Lyme Disease are highest from May through the summer months and concentrated geographically in our area.
Quinn said that most physicians today realize the need to run a complete tick panel of blood tests to determine possible coinfection with babesiosis or anaplasmosis. Deer ticks carry a number of infectious agents, not just the bacterium that causes Lyme Disease.
If you are fortunate enough to find the tick that bit you, there is no longer any need to wait for symptoms to occur before seeking treatment. URI's Dr. Thomas N. Mather has calculated that
Dr. Silverblatt said that anyone who is bitten by a deer tick can now seek preventive treatment in accordance with IDSA guidelines found here. Save the tick so that it can be identified by your doctor. TERC shows you how to remove a tick safely. You can save the tick in a small plastic bottle or sealed plastic bag.
The next step will be to head to a doctor and request a one-time dose of doxycycline consisting of two 100 mg tablets. “Take them both at the same time. You won’t get Lyme Disease,” Dr. Silverblatt said reassuringly. At the Wakefield CVS, the two-tablet prescription costs you no more than $11.99 out of pocket.
South County Hospital’s Lee Ann Quinn said that Thundermist Health Center of South County in Wakefield, RI, has treated cases of acute Lyme Disease very well. Both Thundermist Health Center of South County and the South County Hospital Lyme Disease Clinic have a sliding-scale fee program for patients without health insurance.
Run, Doc, Run
No stranger to tick diseases either on the professional or personal level, Dr. Silverblatt, who is an avid gardener, said, “I’ve had Lyme at least two times and was coinfected with babesiosis. Last fall, I had anaplasmosis. I was out in the yard five minutes,” he said - almost incredulous at how adept ticks are at finding
“I hit the trifecta,” he laughed, with characteristic good humor, referring to the fact that he has now won battles with all three diseases commonly spread by deer ticks.
For Dr. Silverblatt, as for most people who receive prompt treatment for tick diseases, the news is optimistic. “I went from not being able to tell time (last fall because of anaplasmosis) to doing a triathlon six months later,” remarked Dr. Silverblatt.
More recently, Dr. Silverblatt ran the Boston Marathon.
The South County Hospital Lyme Disease Clinic, headed by Dr. Fredric J. Silveblatt and Dr. Jeffery Bandola, is open Fridays only, from 9:00 a.m. to Noon and 1:00 p.m. to 3:00 p.m. Appointments are made by physician referral only. If you do not have a primary care physician, South County Hospital can help you find one.
Click here to learn more about the South County Hospital Lyme Disease Clinic.
URI Tick Encounter Resource Center staff will be at the East Farm Spring Festival today (Saturday, May 7, 2011, from 10:00 a.m. to 2:00 p.m.), URI East Farm, Route 108, Kingston, RI. If you visit the TERC booth during the first hour, bring a pair of your gardening/golf/dog-walking shoes and they will be treated with permethrin free. Permethrin treatment kills ticks and lasts about a month.
