Lyme Disease and Other Tick-borne Illnesses: A Conundrum[ed note: Doc Gumshoe is our favorite medical writer, and he usually pops in to explore a topic or answer questions readers have posed a couple times a month — he’s not a medical doctor and, as always, his opinions are his own.]
Let’s start this off with a hypothetical case, or rather, three hypothetical cases: three sisters – Maxine, Patty, and LaVerne – go for a lovely walk in the woods on a fine summer day. These young women are not dedicated hikers. They do not wear long pants tucked into their socks, they do not wear boots, they do not spray themselves with insect repellent. On the contrary, they wear nifty short shorts, sleeveless blouses, and cute open-toed sandals. They look like jazz babes, and they have a terrific time.
Maxine’s Story
About a week later, Maxine starts to feel a bit strange. She’s unusually tired. She has chills and a headache. She’s surprised to find that she’s running a temperature – about 102°, in fact. She thinks she’s picked up some kind of a virus, and she figures that she’ll likely develop some other symptoms pretty soon.
After a couple of days, she feels worse – genuinely lousy – but no other symptoms have appeared. Her sisters urge her to get herself to the doctor, and she does so.
Her doctor looks her over, and in the course of the physical examination, he notices several round reddish rashes on her upper legs and lower back. They are over an inch wide and show no signs of a bite. There are small reddish areas in centers of the rashes, surrounded by a lighter area, and then darker slightly raised red ring at the edges, making the rashes look like bull’s eyes.
The doctor tells Maxine that she almost certainly has Lyme disease. She was bitten by a tick when she went for that nice walk in the woods, and the tick – Ixodes scapularis, also called a deer tick or a black-legged tick – infected her with a micro-organism, a spirochete called Borrelia burgdorferi. He explains that spirochetes are nasty little creatures, hard to eradicate, because they tend to travel far from the site where they enter the body and hide deep in the tissues where the antibiotics that are used to kill them don’t easily penetrate. A particularly dangerous spirochete is Treponema pallidum, the pathogen that causes syphilis, which – if not properly treated early on – can penetrate the tissues and cause dementia, cardiac damage, and liver damage many, many years after the initial infection. The Lyme pathogen is thought by some to have the same potential. That’s why early, aggressive treatment is crucial. A four week treatment with any of several oral antibiotics eliminates the Lyme pathogen most of the time.
The doctor does not do any further testing. Maxine’s symptoms and her bull’s-eye rashes are enough to diagnose Lyme disease, and, in any case, the blood tests for Lyme depend on the formation to antibodies to the pathogen, and antibodies wouldn’t yet have formed. There’s no reason to delay treatment pending confirmation by a blood test, and every reason to start treatment right away, to kill those evil little pathogens before they further conceal themselves.
Maxine’s bull’s-eye rashes – known as erythema migrans – are not the sites of the tick bite, by the way. The tick probably landed on Maxine’s leg as she brushed against a bush on her walk. Then it wandered over her body until it found a nice spot to dig in, which might have taken a full day or even longer. Then the tick buried itself in Maxine’s tender flesh, feasted on her blood, and dropped off when it had had enough. Maxine would likely have felt nothing when the tick bit her – tick bites don’t sting or itch. As her doctor explained, if Maxine had felt the tick bite, she would have likely brushed the tick away, and the tick would have gotten no free lunch. Ticks are not quick, like mosquitoes, which can get their blood meal in a few seconds before you swat them.
Maxine’s doctor prescribes a 28-day course of a common antibiotic, probably doxycycline (although a number of other oral antibiotics work just as well – he checks first to see whether Maxine has demonstrated any allergies or sensitivity to doxycycline). And he firmly tells her that she must complete the full 28-day course, even if she feels perfectly fine after a week or so.
However, about a week later, Maxine develops another very distressing symptom. She feels numb on the left side of her face, and she has trouble fully closing her mouth on that side. In fact, she dribbles her food, and she’s afraid she’s had some kind of stroke.
She runs back to her doctor in a state of considerable concern. But her doctor reassures her: she has a touch of a temporary neurologic condition called Bell’s palsy. The emphasis here is on “temporary.” It will certainly pass in a few days, and she will be totally back to normal. Episodes of Bell’s palsy are quite common with Lyme disease, and Maxine should not worry.
Indeed, in a few days, the numbness in her face is gone, the bull’s eye rashes have disappeared, and Maxine is feeling like her old self again. The next time she’s invited to go for a walk in the woods, she will cover up and use insect repellant, resuming her more glamorous outfit when she’s on the boardwalk at Coney.
Patty’s Story
About a year later, Patty develops troubling pains in her knees. She racks her brain to try to remember anything she has done that would account for these pains, which seem to be a combination of soreness and stiffness. The pains are in both knees, and they seem to originate in the joint itself and to spread to the sides of the knees. They aren’t sharp pains, and they don’t really prevent her from doing anything she needs to do. But they slow her down, and, more than anything else, they are puzzling and disturbing. After all, she says to herself, I’ve just turned 40, and there’s no reason for me to be developing arthritis or anything like that.
So Patty goes to the doctor, and the doctor examines her and orders blood tests. The doctor explains that it’s possible, although unlikely, that Patty really is developing rheumatoid arthritis – women as young as their mid-30s sometimes develop rheumatoid arthritis – and it’s important to make sure Patty does not have this disease, because if she does, she needs to be treated quickly and aggressively to make sure the disease does not progress. There are also other possibilities that might need to be considered, including fibromyalgia, but the top priority is to rule out rheumatoid arthritis.
But at the same time, the doctor, remembering that Patty’s sister Maxine had Lyme disease the year before, decides to do a blood test for Lyme disease.
The rheumatoid arthritis tests all come back negative. But the test for Lyme antibodies – the enzyme-linked immunosorbent assay, or ELISA – came back positive. ELISA is a type of test, and ELISA tests can be used for a very wide variety of conditions, or even just for the presence of a large number of proteins. The advantage of ELISA tests is that they are relatively quick and inexpensive. However, they are far from definitive. There can be false positives, meaning that they appear to identify an antibody when in fact that specific antibody is not present, but the test reagents have responded to a different antibody. And there can be false negatives, meaning that the reagents have failed to respond to an antibody that may be present, but perhaps at insufficient levels.
However, a positive ELISA for Lyme disease at least requires further investigation, so Patty’s doctor orders the next level of test, a Western blot test. This is a more complex and more expensive test, and it evaluates several immunoglobulin types, typically about 10 immunoglobulin M (IgM) bands and 3 immunoglobulin G (IgG) bands. According to the Centers for Disease Control, a Western blot test for Lyme disease is considered positive if either 5 of the 10 IgG bands or 2 of the 3 IgM bands are positive. Western blot bands are distinguished by the size of proteins that migrate through a series of gels, as measured in kiloDaltons (a kiloDalton is 1000 Daltons, one Dalton being equivalent to the weight of one nuclear particle). Some particular Western blot bands are thought to be specific to Lyme disease, while others are not considered to be specific.
In any case, the point of this perhaps unnecessarily technical blather is to make it clear that the positive identification of Lyme disease is not simple. For most infectious diseases, identifying the pathogen is relatively straightforward. A tissue or blood sample is cultured, and colonies of the pathogen grow out in the culture and are usually fairly easily identified microscopically, frequently with the aid of stains. But Borrelia burgdorferi doesn’t grow in cultures, or at least not quickly enough to diagnose and treat the patient, so clinicians and the lab folks are stuck with trying to identify the antibodies that the wicked little pathogens elicit as they go around making mischief. And identification of Lyme antibodies is not always absolutely accurate; the best the lab is able to do is track correlations. For example, proteins in the 39 kiloDalton band are found in the serum of patients with established Lyme disease frequently enough so that proteins of this size are thought to be specific indicators of Lyme. The sensitivity and specificity of Western blot ranges is in the low to mid 90%s, which is good, but not perfect.
No surprise, Patty’s Western blot test comes back positive, and her doctor now has to recommend a course of treatment. Available options include oral, intramuscular, and intravenous antibiotics. The doctor and Patty talk it over, and the decision is to try a course of oral treatment first and see if it leads to improvement. There are a number of antibiotic candidates, with no single candidate having an edge over the others. Patty sticks with her antibiotic regimen for the recommended 28 days, and gradually begins to feel better.
LaVerne’s Story
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And, about a year after Patty’s experience, LaVerne develops problems of her own. Only these problems are a good deal more complicated and troubling. Yes, she has pains in her joints. But she’s having other problems as well – headaches, problems with her memory, difficulty concentrating. She feels truly lousy and in a bad mood. And she’s definitely worried.
Her doctor, knowing about Maxine’s and Patty’s Lyme disease episodes, immediately suspects Lyme, even though, like Patty, LaVerne had none of the typical Lyme symptoms after that historic walk in the woods. But the doctor knows that many patients overlook the initial symptoms. The erythema migrans doesn’t always take on the bulls-eye appearance, and the other symptoms, even if the appeared at all, might have been so mild that LaVerne shrugged them off. So, of course, the doctor orders the standard Lyme disease tests, the ELISA and the Western blot.
But they both come back negative. Or rather, the ELISA comes back negative, and the Western blot doesn’t meet the Centers for Disease Control standards for diagnosis of Lyme disease. Only one of the bands was positive, and it was not considered specific for Lyme.
LaVerne’s doctor still thinks that Lyme disease is a possibility; however, other possible sources of LaVerne’s symptoms need to be investigated and either confirmed or ruled out. So the doctor recommends to LaVerne that she consult with two other physicians – a neurologist and a rheumatologist.
The appointment with the rheumatologist comes up first. After reviewing LaVerne’s symptoms and her medical history, the rheumatologist orders blood tests to rule out rheumatoid arthritis, because RA, although unlikely, could be a real threat to LaVerne’s long-term health. LaVerne has tenderness and stiffness in several joints, and also at several points in her body which are not joints. While joint pain is characteristic of RA, the other pains that LaVerne is experiencing are not typical RA symptoms, so the rheumatologist thinks it’s not likely that LaVerne will turn out to have RA. But LaVerne should not take the risk of ignoring the possibility, since untreated RA can lead to permanent joint damage in as little as a few months. Fortunately for LaVerne, the RA blood tests – erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), and antinuclear antibody (ANA) all come back negative.
This leaves the rheumatologist to explore the possibility that LaVerne is suffering from fibromyalgia. This condition is genuinely difficult to diagnose precisely, and treatment is by no means straightforward. The causes are uncertain, and there are some who question whether fibromyalgia is a bona fide disease entity and not just a cluster of unrelated symptoms. A theory about the cause of this condition or syndrome that has many adherents is that fibromyalgia is brought about by low levels of serotonin. This is supported by the observation that women typically have lower levels of serotonin than men, and also that women, by a large ratio, are more susceptible to fibromyalgia than men. This has led to the use of drugs that boost serotonin levels, such as antidepressants of the selective serotonin reuptake inhibitor (SSRI) class – e.g., Prozac – and, indeed, these drugs do relieve some of the fibromyalgia symptoms in many cases.
LaVerne demonstrated some of the typical fibromyalgia symptoms, and the rheumatologist, in consultation with LaVerne’s main physician, suggests that LaVerne at least try a course of an SSRI. LaVerne agrees to give it a shot.
After about a month on the SSRI, LaVerne’s general mood, not surprisingly, improves. But the tender and painful areas in her body have not improved, and she is taking large doses of over-the-counter pain medications – non-steroidal anti-inflammatory drugs, or NSAIDs – just to get through the day. Her doctor does not think that long-term chronic NSAID use is a good option for LaVerne, and urges her to keep her appointment with the neurologist.
The neurologist, as the rheumatologist had done, examines LaVerne and reviews her medical history. Once again, the question of Lyme disease comes up. In spite of negative ELISA and Western blot results, the neurologist thinks that Lyme is a possibility. The other leading possibilities have been, if not entirely eliminated, reduced to “highly unlikely” status, and there’s no evidence of trauma or repetitive stress that could lead to LaVerne’s symptoms.
The neurologist recommends one more test – a spinal tap. The sample is sent for analysis to two different academic laboratories, and one of them reports identification of antibodies to the Lyme pathogen.
At this point, the treatment decision is fairly straightforward. LaVerne should be treated with intravenous infusions of an antibiotic that has optimal penetration, such as a cephalosporin. After consulting both with LaVerne’s primary care physician and an infectious disease specialist, a four-week course of ceftriaxone is recommended, and LaVerne should be closely monitored for signs of relapse.
… but what if LaVerne’s Lyme tests had all been negative?
Maxine’s and Patty’s cases were relatively simple. Maxine had the usual definitive Lyme symptoms, and Patty’s tests came back positive. LaVerne’s doctors, in the face of symptoms that weren’t easily explainable, went to the next step and had her spinal fluid tested, and Lyme antibodies were detected. But what would have been a reasonable course if the spinal fluid tests had also been negative?
I’m not prepared to pronounce whether it’s a reasonable course or not, but there’s a contingent of clinicians out there that strongly hold the view that seronegative Lyme disease is a reality, and requires treatment. What is meant by “seronegative” is that no test, whether ELISA, Western blot, or spinal fluid analysis, reports the presence of Borrelia burgdorferi antibodies. An organization called the International Lyme Diseases and Associated Diseases Society (ILADS) issued guidelines in 2004 calling for antibiotic treatment of patients with a long list of symptoms associated with Lyme disease, regardless of whether their sera test positive for Lyme antibodies. Here is the list of symptoms, taken directly from their published guidelines:
Lyme Disease Symptoms:
- Fatigue
- Low grade fevers, “hot flashes” or chills
- Night sweats
- Sore throat
- Swollen glands
- Stiff neck
- Migrating arthralgias, stiffness and frank arthritis
- Myalgia
- Chest pain and palpitations
- Abdominal pain, nausea
- Diarrhea
- Sleep disturbance
- Poor concentration and memory loss
- Irritability and mood swings
- Depression
- Back pain
- Blurred vision and eye pain
- Jaw pain
- Testicular/pelvic pain
- Tinnitus
- Vertigo
- Cranial nerve disturbance (facial numbness, pain, tingling, palsy or optic neuritis)
- Headaches
- Lightheadedness
- Dizziness
The ILADS are suspicious of laboratory testing for Lyme disease. Here’s what they say about it:
Treatment decisions should not be based routinely or exclusively on laboratory findings. The two-tier diagnostic criteria, requiring both a positive enzyme-linked immunosorbent assay (ELISA) and western blot, lacks sensitivity and leaves a significant number of individuals with Lyme disease undiagnosed and untreated. These diagnostic criteria were intended to improve the specificity of tests to aid in identifying well-defined Lyme disease cases for research studies. Though arbitrarily chosen, these criteria have been used as rigid diagnostic benchmarks that have prevented individuals with Lyme disease from obtaining treatment. Diagnosis of Lyme disease by two-tier confirmation fails to detect up to 90% of cases and does not distinguish between acute, chronic, or resolved infection.
The Centers for Disease Control and Prevention (CDC) considers a western blot positive if at least 5 of 10 immunoglobulin G (IgG) bands or 2 of 3 immunoglobulin M (IgM) bands are positive. However, other definitions for western blot confirmation have been proposed to improve the test sensitivity. In fact, several studies showed that sensitivity and specificity for both the IgM and IgG western blot range from 92 to 96% when only two specific bands are positive.
And here’s what they would say about LaVerne if all her tests had come back negative:
Seronegative Lyme Disease
A patient who has tested seronegative may have a clinical presentation consistent with Lyme disease, especially if there is no evidence to indicate another illness.
Although many individuals do not have confirmatory serologic tests, surveillance studies show that these patients may have a similar risk of developing persistent, recurrent, and refractory Lyme disease compared with the seropositive population.
In other words, LaVerne’s likelihood of having Lyme disease is the same whether her lab tests were positive or negative? My warning antennae go up sharply!
What this come down to is a “diagnosis of exclusion.” If LaVerne does not have RA, and probably does not have fibromyalgia, and none of her doctors can come up with a clear diagnosis that explains her symptoms, then it’s Lyme disease by a process of elimination – especially when you look at that list of symptoms, many of which are quite commonplace.
What’s wrong with this? In my opinion, there are two problems. The first is a logical failing: it’s tempting to try to come up with a single diagnosis to explain a disparate array of symptoms. A few years ago I was having, at the same time, a persistently stiff neck and also upper GI pains. The stiff neck disappeared when I got a prescription for eyeglasses that let me look at my computer screen without tilting my head down to look over the top, and the upper GI pains were due to reflux. But they could both have been Lyme disease symptoms – and I did have Lyme disease, complete with bull’s eye rash, about 12 years ago!
The second, and a good deal more serious, is that a decision to treat so-called “seronegative Lyme disease” would likely lead to lengthy antibiotic treatment courses that might not be necessary and could produce definitely negative consequences. Such treatment would probably kill all or most of the beneficial micro-organisms in the GI tract, and lead to really troublesome opportunistic infections such as Clostridium difficile, which is nasty and difficult to deal with. And it could very well produce resistant strains of some of the bacteria that normally colonize our bodies, causing serious soft tissue and upper respiratory infections.
The ILADS are in outspoken disagreement with the Infectious Disease Society of America (IDSA), which is the professional organization to which most infectious disease specialists adhere. The IDSA, and the infectious disease community as a whole, casts doubt on the notion of seronegative Lyme disease; their view is that if the Lyme pathogen is present it would be bound to leave some traces. And the ILADS are also in disagreement with the Centers for Disease Control. It’s worth pointing out that neither the President of ILADS, Dr Daniel John Cameron, nor the members of the working group that prepared the Lyme disease guidelines, are board certified in infectious diseases. Moreover, their guidelines, which were initially listed by the National Guidelines Clearinghouse (NGC), are no longer listed.
All of this said, it’s certainly possible that some people have seronegative Lyme disease. There’s no doubt that the pathogen is exceedingly elusive, and the antibody tests are far from perfect. Nevertheless, I don’t think that it’s remotely reasonable to conclude that there’s anything like an even chance that a person with someof the symptoms on that long list, whose Lyme tests are all negative, actually has Lyme disease. My guess is that an experienced and wise physician would go slowly in a situation of that kind, perhaps suggesting topical analgesics for pain. It might be nerve-wracking for the patient, but I doubt whether such a physician would initiate aggressive antibiotic treatment without some indication as to what pathogen was the culprit.
However, the wise and experienced physician would do well to consider other possibilities, such as …
other possible tickborne illnesses
In LaVerne’s case, the positive spinal fluid test made further investigation unnecessary. One could say that she was lucky. Other patients may not be so lucky. The same species of deer ticks, Ixodes scapulari, that carry the Lyme pathogen, may also carry at the same time other pathogens.
The more common of these other pathogens is babesia, a parasite or piroplasm that infects erythrocytes (red blood cells). The initial symptoms are fairly similar to those of Lyme disease. The bulls-eye rashes don’t appear, but then, in many Lyme patients these don’t show up until well after the other symptoms appear. A potentially useful difference between babesiosis and Lyme is that, whereas in Lyme disease, patients tend to get over the first wave of symptoms as the little spirochetes migrate to other parts of the body, in babesiosis, patients tend to feel worse as the infection progresses. That’s because the parasite is actually destroying their erythrocytes. Erythrocytes are the cells that latch on to oxygen in the lungs and convey it to all the cells in the body, so as the babesia parasite destroys blood cells, the body is deprived of oxygen even though the lungs themselves are working just fine. The condition is called hemolytic anemia, and in some people it can be life-threatening. Treatment for babesiosis is usually double therapy – an anti-parasitic drug called atovaquone plus an antibiotic of the macrolide family, such as erythromycin.
Erlichiosis/anaplasmosis
These are similar tick-borne illnesses caused by different, but related, bacterial pathogens. Both attack types of white blood cells – monocytes or granulocytes – and the result can be severe damage to several organ systems. These illnesses are uncommon, so far – the emphasis is on so far! Erlichiosis is somewhat more common in the middle-Atlantic states and the south, whereas anaplasmosis is more common in the Northeast. The number of reported cases of these two illnesses is relatively small, but there is evidence that many more persons have been infected without developing symptoms. Treatment usually consists of relatively short courses of doxycycline.
The risk from these diseases is somewhat aggravated by their relative rarity. A health-care worker who has not had experience with them might tend to stop the diagnostic process once the more usual suspects had been eliminated. Difficult diagnoses can lead to delays in treatment, or to misdirected treatment. If the patient should happen to be infected with the babesia parasite, but the physician is convinced that Lyme is the default option, the initial treatment is apt to fail, and the patient may be put at considerable risk. The situation may call for patience on the part of the physician – and fortitude on the part of the patient!
A Lyme disease vaccine?
Currently, no Lyme disease vaccine is available – for humans, at least! (There’s one available for dogs, and it works prettty well.) A vaccine was developed by SmithKline-Beecham (now GlaxoSmithKline – GSK), but was taken off the market in 2002 because of lawsuits claiming that the vaccine caused Lyme disease. The vaccine was administered as a series of three injections, and it had a reported efficacy rate of 78%. There never was any evidence that the vaccine caused Lyme. Objections to it were based on the way it was licensed, which was interpreted as resulting in the vaccination of lots of people who would be highly unlikely ever to be exposed to the tick. This might have been a bit of overreach on the part of the developer, who obviously wanted to have the vaccine used as widely as possible.
In the light of that fiasco, pharma is treading lightly. Other vaccines are in clinical trials. We’ll have to wait and see how effective they turn out to be, and how they fare in an environment which has become (in some quarters at least) highly suspicious of vaccines. I’ll have more to say about vaccines in a future piece, but an effective Lyme vaccine would be a Good Thing.
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I look forward to seeing your comments and criticism of this, and will try to address them. I note a comment that I should not use the “Doc Gumshoe” nom de plume, since I am not a doctor and don’t pretend to be. But calling myself “Medical Writer Gumshoe” is a bit awkward, don’t you think? I hope you don’t mind if I stick with Doc Gumshoe. I think of myself as a guy to whom folks put the question, “What’s up, Doc?” My answers will be based on curiosity, skepticism, and, as always, applying myself.
— Michael Jorrin, (aka Doc Gumshoe)
Earnest: I can’t believe you read all the comments and still don’t ” understand”. Regards.
Thank you Leo. Travis. Do not second guess yourself. Keep articles or posts like this coming on any subject. Not “One”, (or close), reader or Subscriber to the Gumshoe can ever say that it was a bad investment. When awareness reaches a point that all realize the scope of Lyme, and it’s impact, action will be finally and hopefully taken quickly. Given the number of Lives effected, Gumshoe readers will be able to say that they became aware due to these posts, well ahead of others. All will be served, from the Humanatarian aspect, to, yes, the investment aspect, as a secondary consideration , for Companys have a tremendous market from Testing to Treatment. There will be a “Win, Win”, for all. From those who want their Life back from a devistating disease, to those that want to profit from Companys that tap this market of Millions and growing.. Gumshoe readers will have the distinction of being ahead of the curve and profit. And if
possible, Millions will get their Life back. From personal experience, that will be the greatest and largest return on investment I will ever see or know. Knowing that “Each Day well lived is “Priceless”…
Leo, Having worked with and treated sick, ill and terminal patients over the last 30 years believe me, I “understand “, more than you can imagine.Thank you for the nearly pointless comment. Did you actually read my comment or “understand” it? If that is all you got …well then silence is golden
Sorry ET, I did not mean to be combative. I wrote that in a hurry. You make some excellent points. I just thought you lacked some empathy for the guys that are lost in the woods. I agree that way too many people get their doctor to prescribe the latest thing on TV. Advertising pharmaceuticals is a whole other subject and a red flag for me. There are still many old farts like me that still look for logical cause and effect (science) rather than a pill (art). Unfortunately the search for the cause stops if there is a pill available to match the symptoms. Thanks for your comments. Regards.
You are right Leo too much medicine is about taking a pill. PT/OT and other therapies are more expensive, life style changes are difficult and pills are usually cheap and fast by comparison. Insurance companies like that .I also agree that capitalist corporations are more interested in treatments than cures. Think of how much they make on Diabetes!
ET, just know I do not want Pity of sympathy. I am only 60 with my Life ahead of me very unknown, and I went to one of New England’s finer Medical Schools at the time. Foolishly, I perused a Life in my own 3 State Business, with some of that decision of youth for Social/Personal reasons. I am 60. The “Good Days “are here? I have watched the progression of Medicine from a caring, compassionate Life, to one of numbers, control, and in some cases corruption. A Family MD who was your Friend day’s are gone. The Corp. rules, and above. A life means little. The Elderly abused, and unless you have an advocate so you are not BS’ed by the Narcissists that seem to abound, you are at the will of God, for you will need Him or Her if so inclined. That Oath to be taken has been forgotten. Cure’s are swept under the rug, after all, Jobs are more important than Life. Look up the brief and quiet hello and goodbye Anti-CD 57 or 47 got some Months back in relation to Cancer. Death is a part of Life, but so many do not need to suffer needlessly for profit. But I did get 15 years of late, to see what medicine has become. I would not care to participate in it’s present structure. I see what it has done to the “Great People” still in Medicine. It rips their Soul away one Day at a time to see what it has become., and be basically powerless to do anything. They burn out or quit. Or, other just go for the $$$ and screw the rest. This has gone from a one Disease discussion to the root cause that it is out of control. I collect no disability, and pay my own way. I give to help those that have nothing, although it is a pittance. Medscape and PubMed is only seconds away for any specialty these day’s. So is the ticket to the Caribbean. H’mm,, which do I chose? I and most others I know would take a few hours or days without pain. It is 2013, and Lyme is a Basement Disease treated like Leprosy. Prohibition all over again, but you can buy a Bottle. Who prescribes the proper Drugs? The few LLMD’s in secret, and they have become about impossible to find. The CDC just said that there may be 300,00 cases a Year. A NIST speaker this June spoke and said those numbers were 4 to 10 time light. That’s quite a few People now isn’t it. But West Nile or Bird Flu will blow your TV apart. Why ET?? I guess that is why I care not to watch it. Many have much to learn, and Compassion and Humility better come back soon, or our Nation and World are Screwed. Thanks and I am now done on this topic. Good Night all. Lake
Good morning Lake,
Well I must say that I agree with you on most everything you’re saying, as I been in medicine far too many years myself. I myself have hit the burn out point and am hoping to retire before it kills me .Be that as it may, you may want to read the comments I made, to Sandra above.
May the force be with you…………….
E.T.
ET:) I don’t know how what I wrote came across as not agreeing with you. As for my “stump speech”, I guess my years of research in the political arena has tainted my writing skills:) I am all for SOCIALISM, however, in the framework of that structure, the difficulty lies in the choice of leader(s). Having the power to lead is a slippery slope. Hence the adage: ” Power tends to corrupt and absolute power corrupts absolutely,” Lord Acton.
I am guessing I am a bit more optimistic than you are about fixing the system. I used Diane Feinstein as an example of the corruption in Congress, not that she is the only one. GOP, Dems AND some Independents are just as guilty. Yes, she was a Mayor…but as I stated, she has never held a job in the private sector. So, how did she make millions as a public representative of The People?
I suspect you assume I honor the GOP philosophy. Nope…I sure don’t and even more so with the inclusion of the Tea Party. I am a registered Independent. There are very few politicians I trust to look out for us…The People. However, the two points I offered to fix the medical issues, I feel, would certainly go a long way to a fix. Federally funded campaigns would certainly go a long way to fixing other problems as well. A step further would be to end the lobbying in the halls of Congress. A lot of work needs to still be done and a lot is happening on the grassroots level. Be hopeful…the people are waking up and they are doing something about it!
Sandra,
Greetings from Seattle. Good luck with reforming the capitalist system we live in but alas I am not on board that boat anymore. For me, nothing short of a Third American Revolution will do. The first was the War of Independence, the second was the Civil War and the Third will be the War for Socialism. If you just happen to want to understand where I am coming from theoretically then just Google “Workers Vanguard” or send me an address and I will mail you one.
Have a Happy Rainbow filled day,
ET
ET:) Thank you for your greetings! I agree a third revolution is in order but, perhaps, not the kind you may be referring to. In spite of the negative corporate news media we are hypnotized with on a daily basis, there are some very positive (spiritual) changes taking place that the “corporate” news media chooses not to broadcast. Their goal is to instill fear into the American public. Through the fear they maintain control. Fortunately, there are a lot more of us that choose not to fear but to do something about what is happening. That is where the grassroots organizations come in. They “fight” in various ways championing our environment, human and animal rights, food freedoms, etc. All these things are under attack by capitalism. But our “wars” are all going on without the bloodshed. A much more difficult war to win because there are no loaded guns to shoot the enemies that choose to keep us afraid in their efforts and their goals to enslave us financially, physically, emotionally and spiritually. Winning without bloodshed takes longer but, as I said, the people are waking up but not taking up the weapons that shed blood, they are taking up the weapons of voice and stand-in-your-face peaceful demonstrations. What many Americans don’t know (thanks to the blacking out efforts of our corporate controlled news media) is that these demonstrations are taking place world-wide because the evilness that is taking place here is taking place all over the world, all in the planned precision of a global take-over.
I looked up your organization before writing this comment and I intend to read more about it. I am not an aficionado of Karl Marx so will not speculate on the motivations of your organization. ( I sense you have a good heart and want only good for the people.) We all know how Communism turned out for Eastern Europe, with people literally starving to death with their co-operative socialistic economic structure. It didn’t work very well. Painting Socialism with a broad brush has its dangers. There has to be a balance somewhere where all have the opportunity to prosper within a system that inherently harms no one.
Maybe after all these years, I still have rose colored glasses on but my heart tells me to keep them on even knowing just how evil our current system is with their inhumane goals challenging us every day. BUT…we will win! Because if we don’t…humans will become extinct and then…nobody wins…
Sandra thank you for your comments. I do not want a violent revolution any more than you. Also let me make clear that I think people who perpetuate violent acts in a non revolutionary era are fools who just strengthen the repressive powers of the state. That said, even if we elected a socialist party to power in this country do you really believe the capitalist ruling class would peacefully turn over power? It has never happened in history that way. Every significant revolution has involved war. The War for Independence, the Civil war , The Russian Revolution, The French revolution and on and on. Name ONE important revolution that did not involve war? As for what you call “communism” in eastern Europe it was in fact a deformed workers state based on Stalinism. If you wish to pursue that subject I would suggest reading Leon Trotsky’s , The Revolution Betrayed. So have a nice week end.
ET
Sandra and ET: My oh my, but those ticks have generated an interesting discussion. You both seem to realize that power corrupts. Why do you want to centralize it? Rulers answering to no one. That is what we have now. Capitalism made this country grow and prosper. Don’t eliminate it. Regulate it. Teddy Roosevelt had the right idea. Regards.
Leo:) Yes, good convo tends to migrate in various directions, often with no one being able to figure out how it ended up where it did. However, the medical profession has become another political tool of Capitalism being wielded like a sword over our heads making it easier to deplete our pockets.
I agree with you, Leo, there is a place for Capitalism but regulation is a must. However, since you brought up Teddy Roosevelt, he should not be considered a saintly God of Capitalism and how it should be conducted. All you need to know is the history of the Panama Canal and you will see he was just as thieving as most Capitalists. He most certainly should not be emulated.
I think a good rule of thumb to pay attention to is: If any leader comes from a banking family…wear garlic around your neck in the hope for some kind of protection.
Thanks for jumping into the convo. I truly enjoy the education I get from those who are capable of thinking, whether I agree or not:)
Leo:) By the way, our rulers DO answer to someone. They answer to the Corporations…not The People. That’s why The People are so frustrated with what is going on in Washington. We vote for leaders to represent us…but they don’t. Here, again, is another very good reason Federal funding of campaigns would end the conflict of interest of politicians elected to represent us but doing the corporate dance to appease their source of funding. This is the problem Obama has. He was heavily financed by Goldman Sacs so now he has to dance to their tune, whose goals are in direction opposition to what The People want and need. The banks own him and he knows it.
ET:) I am totally enjoying this convo we are having:)
No, our repressive government would never give up their power without a bloody fight. I think this is evident when our city police forces pepper spray peaceful protestors and then arrest them. Seems to me they hope a protestor will give them any excuse to shoot them. Certainly with the Stop and Frisk law in NYC, how anyone could call our country a Democratic society? Seems more like Fascism to me.
it is evident, at least to me, the Elite are arming for the revolution you mention (I, too, believe there will be one). The Elite are squeezing every drop of financial blood they can from the people. They know the push-back is coming and want to be ready. There are already local police forces that have armored tanks, missile launchers, etc. All tools of war, not the tools of police forces in a Democratic society.
I suspect you and I see things very similarly. Not a bad thing:)
Enjoy your weekend as well:) Sandra
Sandra,,
We do not live in a fascist state…yet , if we use traditional definitions or measures. We are not Nazi Germany or even Mussolini’s Italy of 1930. We are more accurately a police strong state on the road to a corporatist police state.
You seem to want to agree with me BUT your previous statements are clear that you are a reformist , and idealist who thinks you can reform the state from within. Clearly I do not believe that. I believe the state structure must be smashed and replaced by a “dictatorship of the working class” as opposed to the “dictatorship of the capitalist class”, as we have now. The two are not compatible. Maybe you view yourself as a socialist but if you do, you are a socialist of the Second International stripe. I am a socialist of the Third International stripe ie, Bolshevik.
Have a nice weekend.
socialist greetings
ET
ET: I see nothing wrong with you carving out your path to a more socialist society, via your Marxist philosophy, and me taking the reformist non-violent route to achieve that same goal. Our goals are the same, however, I do feel the best way is the non-violent route. It may take a little longer than your way, but then, I am so against killing people whose crime is mostly ignorance. The 1% are not the ones on the front line. They have a number of levels in front of them for them to hide behind giving them the freedom to walk around unmolested by the public for their horrendous actions against them. They walk around in plain site, with many of them being honored having buildings, airports, etc. named after them. The ones that will be murdered in your revolution are their ignorant minions. Many of those minions have been compartmentalized so they really have no idea the evil roles they are playing. However, unless your revolution actually knows who the sociopathic 1% are…that could change the conversation:) No matter the route…our end goals are the same:)
Sandra,
I get it, you’re a pacifist wanna be. Let me repeat my original question.Show me one major revolution that did not involve war ? I get your concern for the innocent victims of war.However is not the working class and poor who are organizing worldwide repression, murder, and suffering.It is not the working class of this country which has driven down wages for decades.it is not the working class in this country, which has created the greatest wealth disparity between the rich and the poor since 1917.it is in fact, the bourgeoisie capitalist class that perpetuates this system.
You seem to think in typical idealist/liberal fashion, that the problem is the leaders and that the system can be reformed.The problem is not just “bad” leaders. The problem is the capitalist economic system. This economic system has long outlived its progressive era of 200 years ago.It is now a repressive structure that burdens our society.
I believe it was Rosa Luxemburg who said,” the choice is between socialism and barbarism”. That is becoming more true every day. Time to take off the rose-colored glasses .
have a good day.
ET
OH BOY!!!!
Leo:) HANG ON TO YOUR HAT!!!!
I agree with ET but there’s a lot more to be read, digested, et al.
Peter Kropotkin, Mikhail Bakunin, Howard Zinn, Chomsky, etc.
And, yes, unfortunately humans kill one another. We have been somewhat conscious for around 15,000 years and still are killing one another. We are a defective species wherein mental evolution does not dominate instinct.
/* Phil */
Philip,
Well, since we are making reading lists : lets add Marx-Engels-Lenin-Trotsky- Luxemburg – Liebknecht- and James Cannon.
Red Greetings,
ET
Phil:) Yes, we are a defective species. Sociopaths abound with many of them in ruling positions. Killing another human being is something I will never understand, except in a self-defense situation and still not sure I could actually kill someone…wound them, yes, but kill?
Earnest,
Of course these should be added lol. Were you near by — we live near New Paltz, NY — I would invite you over for a drink-discussion but you are probably near to teaching hospital. I came across Hans Mommsen this evening when looking up other things in Wikipedia who apparently is an excellent German historian. btw if you wish to pursue this somewhere else, culann@earthlink.net reaches me.
best,
/* Phil */
ET:) I am not a pacifist wannabe…at least, perhaps, not by the definition I understand that to be. I consider myself to be a Progressive (is this the new word for a Liberal?). Without having to write a novel in here to make myself understood, our politics, or probably any political system cannot be summed up into a few words. Political systems are like a spider’s web branching off in many directions, purposely so the creators of that system can hide.
Our Central Banking system is at the heart of our corruption. It was set up to do just that…corrupt so the Banksters could fleece us all and they have had a merry ol day since the Federal Reserve was set up in 1913, in secrecy, with only Banksters involved in the planning. We previously had a Central Banking system in place in the early 1800’s but, I believe it was Andrew Jackson that kicked out that first system. In fact, he just about badgered our Congress to put an end to them. Unfortunately, it was Pres. Woodrow Wilson who ushered them back in realizing too late how disastrous it was going to be for our country. Now, after 100 years of the successful financial takeover of our country, we are sitting exactly where our banking system wanted us…on the doorstep of ruin. However, not just us. Via the World Bank and the IMF, the Banksters have intentionally destroyed the economies of other countries as well. Their intent? Global take-over. The Earth’s natural resources are dwindling and there are currently over 7 Billion people inhabiting the Earth. Far too many people. Our natural resources cannot possibly sustain that number for much longer. The Elite know this and are actively, and have been actively, pursuing various means to eliminate most of us…billions of us because they feel they are the only ones deserving of those limited natural resources. They want enough of us alive to serve them in the manner in which they have become accustomed. We are the new slave race…those of us that will be allowed to continue living…if you want to call that living. The man put in charge of orchestrating the various means of population elimination was Henry Kissinger (Mr. Nobel Peace Prize winner himself…laughable). Bill Gates is carrying on that project today with his Bill and Melinda Gates Foundation of supplying vaccines to third world countries. Vaccines tainted with Thimerasal (mercury) and aluminum. The very same ingredients with one more included called, Cadmium, that is being dumped on us via high-flying aircraft all over the country. I am sure the areas where the Elite live don’t see these aircraft and the crisscrossing of their skies looking like contrails but in fact are chemtrails. Our air is being poisoned, our water is being poisoned, we eat GMO foods, our Earth is being poisoned we are vaccinated with untested vaccines, the Federal Agencies are storm-trooping organic farmers to prevent us from having access to healthy foods. The Elite are not concerned about destroying America because they are rapidly stealing the lands in Africa, displacing hundreds of tribal villages that have grazed their herds for centuries on that land. They have built greenhouses two or three football fields long to grow their own organic foods, flowers, etc. on that land. George H. W. Bush has purchased over 100,000 acres in Patagonia just for the water rights and put the purchase of that land in his granddaughter, Jenna Bush’s, name. What and why does he need all that clean pure water for? Clean pure water we will no longer have here in the US.
I can go on and on with what I know is going on not only in my own country but what is going on in other counties that really tells the whole story about how the Elite plan to get rid of a few billion of us all because they feel the Earth’s resources can no longer support all of us, as well as there are now too many of us for them to control. Only they are worthy to inherit the Earth…
So, you see, ET, I am in agreement with you as to what is going on. I do a LOT of research. I do feel there will be a revolution and probably a bloody one at that. I believe the Elite know this, hence the bombardment of all the attempts at gun control. They will have all the big guns AND TANKS and we will have none, except for a few good steak knives to defend ourselves. Just because I know the revolution will probably be a bloody one, doesn’t mean that is what I want to see. Since I don’t even own a gun, I can tell you it is a safe bet I won’t be doing any shooting.
I will let you in on a recurring dream (should say nightmare) that I have had since I was a kid that scared the hell out of me. In the dream, I was in my home with my family. There was a war going on just outside my door. I opened the door to look out to see what was happening. What I saw frightened me through and through. There were dead bloody bodies all over the place with rats crawling all over them…the air was even red with blood. I slammed the door shut so as not to see that spectacle any longer, when a voice out of nowhere said, “As long as you stay inside your house, you and your family will be safe”. I can’t count how many times I had that same dream over the years. But I can say that with what I see going on world-wide, it seems to be coming to fruition. Something I had hoped to never live to see…I pray that I won’t.
There is a saying by who I can’t remember.” History is filled with conspiracies but history is not a conspiracy itself”. Progressive ? Fine.. Also part Libertarian and a bit of Tea Party stuff but no class analysis. Wanna read? OK Try Mark and Engels for starters. You need a deeper class analysis.
ET:) I am a bit confused with your post. Did you say I am a bit Libertarian and a bit Tea Party? If so, you couldn’t be more wrong. Don’t know how what I posted gave you that impression.
I understand you are a Marxist in philosophy and that is certainly your right to entertain that line of thought. I have never studied that philosophy so can’t comment on how I feel about it or think about it.
Hope you are enjoying your Sunday:)
Good AM Sandra,
Only in the sense that the Tea Party folks and Libertarian folks tend to see everything as a conspiracy. The Libertarians are more theoretical and consistent – they love Ann Rand…and that potty mouth FOX Ann Coulter for that matter. The Tea Party is based on poor white populism. So don’t take the analogy toooooo far.
As for Marxism, well IF you are actually interested in exploring that ,then the two recommendations I have are to: 1 read original sources—as other people often distort what they said and all of Marx’s & Engels works are on line nowadays. #2 If you want to see what real hard core modern Marxism- Leninism-Trotskyism is like as it is applied to daily class struggle then send me an address and I will mail you a copy of Workers Vanguard gratis . The real reason to read and study these folks ie; (M-L-T) is ,it gives you a deeper understanding and clarity about what is going on in this world. It takes analysis from Liberal ethical moralizing to a Marxist historical materialism analysis .
Ex, Animo (L)
ET,
ET:) OK, I have a major disagreement with you here. The Ayn Rand followers are not the Libertarians. Her followers are the Tea Party. Yes, the voting base for the Tea Party are the very misinformed poor aging while populist, however, the financial backing and creators of the Tea Party, itself, are the 1%, such as the Koch Brothers and extreme Right Wing organizations, i.e., The Heritage Foundation (founded by George H. W. Bush), Freedom Works, American Crossroads, American Legislative Exchange Council (of which Jeb Bush was an officer and may still be), etc.
I appreciate your offer to send me your publication, however, personal information I do not share online. That being said, I believe I have a very realistic view and understanding of what is going on in this world. Not wanting to own a gun and hoping NOT to see a blood-bath revolution does not equate to being ignorant as to what is going on. As I stated previously, I do a LOT of political research, a LOT of research into environmental issues, etc. I, also, have an uncanny ability to connect the dots (which I have discovered is a talent that many people lack) as to what is happening and the possibilities of what may happen down the road. I don’t feel I need to immerse myself into Marxist philosophy, as you are implying. That is not to say I won’t look further into it.
Once again, thank you for your offer, however, I must decline.
It is snowing, our first for the season:)
Sandra,
Well I have yet to meet a Libertarian who does not worship Ann Rand and they consistently recommend Atlas Shrugged, so connecting that dot should be easy. She was of course a lover of fascists at one time. As for reading Marx and others I have mentioned….well please do…….knowledge is power and if you perceive them as your enemy …then all the more to read them…………
Enjoy ,
ET
Starting with the original subject, I am thankful to Doc Gumshoe for relating the research on Lyme disease, and to the many comments regarding this disease. I am in sympathy with those suffering from the disease , but also with the doctors who are facing an overwhelming volume of new findings on all conditions, and I believe the system controlling what doctors learn, what they can say or do, is the big culprit.
I think we are on our own, and preparing for less and less from our system.
Thanks to tomt for returning us to the original subject. I read with interest the exchanges between ET and Sandra, and I have to warn Sandra that reading Karl Marx poses dangers – not of being corrupted by Evil Marxism, but of being put to sleep by the most tedious writer imaginable. I recommend instead Fernand Braudel’s excellent, entertaining, and perceptive three volume history of much the same subject, Civilization & Capitalism: 15th – 18th Century. As for Lyme, we’ve identifed the pathogen, we know how to eliminate it once we’ve spotted it, scientists are working on vaccines, and better diagnostic tests may be in the offing. In the meantime I recommend careful showering and inspection every time you go tromping about in the woods. Best to all, MJ (aka Doc Gumshoe)
Michael:) Thanks for the heads-up on the threat and dangers of boring reading:) While I really should get more sleep, being put to sleep by a book is not my idea of a fruitful day. I will take your advice and check out that author.
Thank you for that info:)
As for any aliment, such as Lyme, the full responsibility of treatment really falls on the sufferer Good to get advice from a doctor you trust, but it has been my practice to do the research and then, if it conflicts with what doctor says, I go with my gut. It has worked for me. I have found on many occasions, even when a doctor has gotten angry with me, when I chose to make my own decisions, the end result was I was correct in my choice. To this day, I am healthy as a horse.
My suggestion to guard against Lyme is to soak in a bath of water. By being completely immersed in the water, it drowns the tick (please do keep your face above water but do have your entire hair area in the water) and it releases safely. While a shower is good, I believe the bath method to be even better.
Thanks, again, Michael:)
I’m no scientist, but I don’t think soaking can be relied on to kill a tick or make it release from your body, from what I’ve read (in looking into it for our dogs and kids, who attract the little buggers in quantity) they require very little oxygen and don’t immediately drown so unless you’re soaking for hours there’s no guarantee they’re going to die or release their bite just because they’re underwater. Might work, but do check too.
Travis:) I can only tell you my experience with the bathing method. I live in a semi-rural area where Lyme disease is prevalent. He came in from outside quite dirty. Since he was wearing shorts, I spotted a very tiny bug or something on his leg. Instead of pulling it off, I ran him a hot bath and had him get in and had him soak for a good 15 minutes, telling him to keep his leg submerged in the water. I sat there with him keeping an eye on that bug. I watched it finally lift off his leg. I scooped it up in my hand to have a close look at it. I could definitely see its legs. Since we often have literally herds of deer that visit my yard, I had to assume it was a deer tick.
I know a few children and some adults, in my area, that have issues with Lyme disease. I can only assume because I was diligent with getting my son into a hot tub of water after having been outside, that he has never been infected. I believe it is a better solution than showering, where you are not “immersed” at all.
Good luck:)
Rather than go through all that, simply remove the tick with a trusty tick remover in seconds. Using methods such as petroleum jelly, burnt matches, cigarettes, dish liquid, etc. will only irritate the tick and cause it to regurgitate the bacteria into your bloodstream prior to backing out.
So, the best method is to gently and easily remove the little bugger.