Why Lyme DiseaseTreatment is Sometimes Refused
Sometimes The Reason is Simply Lack of Understanding
Aug 11, 2008
Lyme disease presents challenges to physicians when early diagnosis is missed and treatment is delayed, and in some cases even when treatment is punctual and normally sufficient. Using immunosuppressants to prevent themselves from being repulsed, ticks depress our immune systems at precisely the time the spirochetes are injected.
The spirochetes rapidly alter their surface proteins before and after infection occurs. They move into our cells to avoid being attacked by our immune systems, and into the nervous system where the blood brain barrier protects them from many antibiotics.
After infecting blood cells and destroying them, the spirochetes may wrap themselves in the blood cell membranes and become hidden from other immune cells and antibiotics.
When faced with attack, Borrelia spirochetes can slough off their cell walls and change into spheroid bodies (L-forms) and inactive cystic forms – both of which present different antigens to our immune systems and require aggressive treatment using different suites of antibiotics and medicines (strategic-living.blogs.com/livingwithlyme/files/BurrascanoLymeGuideSept2005.pdf) than the IDSA protocol to be eradicated.
But these changes in spirochetes do not clarify why treatment is ended while symptoms are raging.
The Physician Factor
Physicians can not be well versed in every condition that their patients might present. Physicians from areas where Lyme disease is infrequent will be faced with a patient who presents the classic Lyme disease symptoms of a tick and a rash. The doctor then has to check for standard protocol (developed by the Infectious Diseases Society of America) and provides minimal treatment as directed by IDSA. If the patient is lucky, this cures the disease. If the patient is not lucky, he or she develops chronic Lyme disease.
Patients are often misdiagnosed when they present unusual symptoms or do not show a rash or remember a tick. After incorrect tratment because of misdiagnosis, the patient enters chronic Lyme disease, the symptoms often resemble those of other diseases and further treatment is also incorrect. Some of these patients have required extremely aggressive treatment and many can not be cured.
The Insurance Factor
During their search for relief, many chronic Lyme disease patients meet impatient doctors that are glad to be rid of them. HMOs and insurance companies often provide only the treatments described in the IDSA guidelines.
Patients with refractive cases of Lyme disease often have to go outside their health plans to find doctors sympathetic to their declaration that they have not been cured. As many Lyme literate doctors (LLMDs) are harrassed by the establishment (IDSA and HMOs), fewer physicians are willing to expose themselves to their wrath and more are refusing to provide aggressive treatment.
How Treatment Protocols are Determined
Most people obtain medical coverage through HMOs often parented by insurance companies and overseen by boards or trustees that may not be medical professionals. The board members generate treatment protocols based on guidelines generated by government agencies such as the Centers for Disease Control (CDC), IDSA, National Institute of Health (NIH), National Institute of Allergies and Infectious Diseases (NIAID), and others. Researchers provide the results on which these agencies base their suggestions for guidelines.
Using the same research base, IDSA and the International Lyme and Associated Diseases Society (ILADS) have issued contradictory guidelines for Lyme disease treatment:
- The IDSA guidelines are based on the concept that Lyme disease is a rare disease, Borrelia does not change form or develop resistance to antibiotics, and only minimal treatment with a restricted group of antibiotics is needed. These guidelines also do not provide for treatments of chronic Lyme disease.
- Guidelines proposed by ILADS are based on the concept that Lyme disease is a widespread epidemic, Borrelia changes into both spheroid and cystic forms which cause chronic Lyme disease, and suggest a wide range of antibiotics and other pharmaceuticals to treat chronic Lyme disease.
Many physicians and health providing agencies use the guidelines of IDSA and ignore or are unaware of those of ILADS. Thus, physicians often refuse to provide or are unaware of extended treatments for refractive cases. Many health agencies use the IDSA guidelines as their rationale to refuse treatments for refractive cases of Lyme disease that require tests, medications, and procedures not supported by the guidelines. Other doctors, who accept the ILADS guidelines but work within HMOs or with insurance companies, cannot prescribe out of protocol treatments unless the patient exhibits documented severe and unusual symptoms. Some of these physicians have been reprimanded and had their licenses suspended or removed when they do so (http://centuryinter.net/tjs11/bug/l12.htm). Thus, treatment often ends with: “That is all we can do for you.”
The basis for restrictions on treatment is complex.
Disclaimer
The information in this article is believed to be accurate and is presented for the sole purpose of informing community members of information pertaining to Lyme Borreliosis. Any and all liability for the content or any omissions, inaccuracies, errors, or misstatements in such information is expressly disclaimed. Because the symptoms of Lyme disease may vary from person to person, if Lyme Disease is suspected, consult a qualified, Lyme disease literate doctor to discuss your symptoms and for medical advice. The author and Suite101.com are not liable for any direct or indirect damages or any damages whatsoever resulting from loss of function, use, data, or profits arising from or in connection with the application of information presented in this article.
