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What a question that has become. The evolution of the schools of thought regarding Lyme disease and the related co-infections, their diagnosis and treatment, is quite a story, one that continues to evolve. The result is a continuing evolution that is enough to turn your head around many times as one dives into the related literature, arguments and web sites. It can be extremely frustrating for patients navigating through this world while trying to figure out what path is best for them. For clinicians and health care providers trying to help, it can also be a confusing mess that many choose to avoid. One way to avoid it is to adhere religiously to one school of thought and follow that standard of care. For some this means only recognizing acute Lyme disease (and related co-infections) and treating with an appropriate medication over a 2 to 4 week period and leaving it at that. Patients who still have symptoms after that may find their doctor reluctant to prescribe more medication and risk professional ridicule if they treat beyond the standards or care currently accepted, whether they feel the subsequent symptoms related by the patient are Lyme related or not.
To begin to learn more about this battle of paradigms there are a number of places to begin your journey. For the more conservative and accepted mainstream approach, material from the Centers For Disease Control and Prevention (CDC) is a good start, http://www.cdc.gov/ncidod/dvbid/lyme/, and the organization representing the more conservative school is The Infectious Disease Society of America (IDSA). The more “open minded” school of thought representing those who recognize the possibility of chronic Lyme disease, that may be more common that we thought and hard to diagnose, is the International Lyme and Associated Diseases Society (ILADS). The website, Lyme Disease Support Group of Oklahoma has this to share about the “ILADS vs. IDSA Lyme War Controversy”:
Below is the current debate being waged between the opposing sides:
The political battle over Lyme disease features two polarized medical camps: the dominant camp adheres to the philosophy that the disease is ‘hard to catch and easy to cure’, and that chronic infection with Borrelia burgdorferi, the spirochetal agent of Lyme disease, is extremely rare or nonexistent. The opposing camp views Lyme disease as an underreported and growing menace that often fails to respond to standard antibiotic therapy, resulting in a chronic debilitating infection that requires prolonged antibiotic treatment. This difference of opinion has resulted in frequent denial of treatment for patients with chronic Lyme disease and prosecution of healthcare providers who treat these patients, and over the past decade the ‘Lyme Wars’ have become progressively more acrimonious.
...What sustains this controversy? It is important to recognize that the science of Lyme disease suffers from two major problems. First, there is no test currently available that proves the eradication of B. burgdorferi from the human body. Conversely, there is growing evidence for long-term persistence of the Lyme disease spirochete in animal models and humans, despite supposedly adequate treatment for the disease with 2 to 4 weeks of antibiotics.
Authors: Raphael B Stricker, Andrew Lautin and Joseph J Burrascano
Published: Expert Rev. Anti Infect. Ther., April 2005, Vol.3, No.2, Pgs 155-165
Source: www.future-drugs.com or
www.future-drugs.com/doi/abs/10.1586/14787210.3.2.155
To review a comparison document between the two opposing organizations' guidelines:
http://www.ilads.org/guidelines_compare.html
As a chiropractor and board certified nutritionist I am not an expert on Lyme disease and I don’t treat Lyme disease and its co-infections. I have offered complementary and supportive care while patients are also receiving appropriate medical care, related to the school of thought they choose. In this scenario we are part of an integrative model that uses a functional approach, which recognizes that each person has their own individual immune systems and health history with genetic individuality that requires tailored approaches and support. In this view one need not adhere to any particular school of thought and take lessons from all schools and apply them into a functional medical model that treats the whole person in regards to their own specific needs. This path does not fit well into linear algorithms and cookbook treatment protocols based on a specific diagnosis. In this world, disease A doesn’t always get treatment A.
The Functional Medicine Institute (www.functionalmedicine.org) describes proper patient care and today’s challenges of evaluating chronic disease and the individual in the following manner:
· Biochemical individuality describes the importance of individual variations in metabolic function that derive from genetic and environmental differences among individuals.
· Patient-centered medicine emphasizes "patient care" rather than "disease care," following Sir William Osler’s admonition that "It is more important to know what patient has the disease than to know what disease the patient has."
· Dynamic balance of internal and external factors.
· Web-like interconnections of physiological factors – an abundance of research now supports the view that the human body functions as an orchestrated network of interconnected systems, rather than individual systems functioning autonomously and without effect on each other. For example, we now know that immunological dysfunctions can promote cardiovascular disease, that dietary imbalances can cause hormonal disturbances, and that environmental exposures can precipitate neurologic syndromes such as Parkinson’s disease.
· Health as a positive vitality – not merely the absence of disease.
· Promotion of organ reserve as the means to enhance health span.
Ultimately as you treat the whole person and their specific imbalances, the functioning of the immune system is improved and better able to meet the challenges to health as they present themselves. In this scenario appropriate lifestyle changes that include stress management, diet, addressing biochemical imbalances, improved gut health and elimination along with appropriate medical intervention is more likely to support optimal outcomes. In this sense instead of applying “one size fits all” medicine we begin the journey by sizing up patients for their specific needs and designing individualized treatment programs. To quote Sir William Osler’s admonition again, "It is more important to know what patient has the disease than to know what disease the patient has."
The intention of this article was to lay the groundwork and background to understand the bigger picture before diving into any specific discussions. Stay tuned for more practical information on Lyme disease in the near future.
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