该 “我们是30万” 活动是由莱姆社会的新的基层活动，以提高认识为更有效的治疗从莱姆病所有的人.
根据CDC, 有 300,000 individuals who are affected annually by Lyme disease. How to treat patients who are misdiagnosed or diagnosed late has created decades of debate between doctors, 患者和科学家试图确定为什么许多患者仍是标准的抗生素治疗这种疾病后，病重长. 而更多的研究继续显示，莱姆细菌遗体 “一贯” 他们所看到的合并感染在多达治疗和世界各地的索赔更多的医生后， 90% 他们的病人, the IDSA’s guidelines for treatment of patients have not been revised. This can lead to insurance claim issues for patient treatments. 为此原因, 莱姆病通常被称为富人的疾病, 因为那些没有钱是买不起适当的治疗.
格伦·米勒, 莱姆援助圣罗莎, 开始于一个支持小组 2009 并解释, “I have talked to hundreds of patients and their families. Insurance is a problem for every single one of them. This includes private insurance, 大众保险, VA和印度的卫生机构。” 是保险公司和医生在全国范围知道相关的诊断和莱姆患者重返健康正在进行的新的研究和复杂的问题? Are they aware of existing treatments that appear to be helping some patients?
今天，在第 14 的 “蜱,” I have invited two leading Lyme disease doctors to comment on some of these major issues. Fresh off his recent appearance on the Katie Couric show, 这是我高兴地欢迎医生和作家博士. 理查德·霍洛维茨 (为什么我不能得到更好的? 解决莱姆和慢性疾病的奥秘, 圣. 马丁的新闻).
另外, 我问医生. Daniel Cameron to weigh in. Dan just began a reprise of his presidency of the International Lyme and Associated Diseases Society (ILADS). He has testified as an expert on Lyme disease for legislation in Connecticut, 马萨诸塞州, 和宾夕法尼亚州, 并已收录为国家媒体莱姆专家, 包括NBC的Today Show和ABC的早安美国.
理查德, 哪些呢术语 “慢性莱姆病” 对你意味着什么?
患者与经典治疗莱姆病后，慢性症状有多方面的原因，他们的病情. 我把这种综合征莱姆-MSIDS. MSIDS代表多全身感染疾病综合征, 并表示在莱姆病人造成持续性症状16潜在重叠的医疗问题.
在MSIDS地图上的第一点是感染. 蜱现在包含多个细菌, 可同时与被发送的病毒和寄生虫感染 莱姆病螺旋体, 莱姆病的药剂. 感染患者莱姆病和相关的共同感染是多病情加重和耐标准疗法.
例莱姆-MSIDS也有相关的免疫功能低下的证据, 炎, 环境毒素和重金属负担, 排毒问题, 营养缺乏, 荷尔蒙异常, 睡眠障碍, 线粒体功能障碍, 食物过敏和敏感问题, 功能失调和不平衡的自主神经系统 (主体的，用于控制心脏速率的部分, 血压和消化系统). 所有这些因素都可以保持患者病患.
有一个在医学上普遍持有的信念, 所谓巴斯德的假设, 有 “原因之一，一个疾病。” 这并不适用于治疗慢性莱姆症状. 期限 “慢性莱姆病” 需要被重新定义为莱姆 - MSIDS更准确地反映责任症状持续多潜在病因.
和, many Lyme patients I have interviewed have problems with insurance claims. Can you please comment?
在治疗莱姆病最有经验的医生不与领先的健康计划参与, which makes it difficult for patients. The doctors with the most experience cannot manage the complexity of care needed to properly treat Lyme disease patients. The cost of the first visit can be expensive and is not covered within the plan. Patients with out of network benefits typically apply the cost to their deductible. 当地实验室涵盖了医疗保健计划，但如果需要一个专业的实验室就可以花费 $1,000 这可能不被覆盖. 处方的常用药物, 例如, 强力霉素, 阿莫西林, Ceftin, and Biaxin often are covered by a prescription plan. The price without insurance coverage can range from $40 to several hundred dollars per month. The cost for the co-infection drugs to treat Babesia, 例如, 的范围可以从 $40 对灭滴灵近 $2,000 每月Mepron, 这可能不被覆盖. 一些保险公司否认覆盖面，静脉注射抗生素, 援引IDSA指南. Ⅳ的成本, 如果不属于保险公司, 可能是昂贵的，并把一个巨大的负担对个体和他们的家庭.
理查德, 为什么会这样难有的患者得到更好的?
蜱传合并感染的患者保持病起到了很大的作用, 和测试莱姆病和共感染是不可靠. 这些感染是使用标准的验血常规错过, 由于测试是不够敏感拾起这些生物体的存在，可以从免疫系统隐藏.
患者也保持长期病患者，因为很多这样的蜱传播的感染，尽管仍然存在 “看似充足” 抗菌疗法, leading to immune dysfunction and inflammation. These infections cause the release of inflammatory molecules called cytokines, which are responsible for many of the symptoms we see with Lyme disease, including fatigue, joint and muscle pain, memory and concentration problems, and mood disorders. Unless we simultaneously treat the three “I’s”: 感染, immune dysfunction and inflammation, patients will not get better.
最后，, most physicians are unaware of the concept of MSIDS, and that there are multifactorial causes for the patient’s illness. It is as if a patient came to the doctor with sixteen nails in their foot complaining of foot pain. Unless you pull out all of the nails, the patient is not going to feel better.
理查德, Lyme disease has been known to mimic so many disease processes including CFS, 纤维肌痛, Autoimmune conditions, Psychiatric conditions including Dementia, 等. What advice can you share with doctors trying to diagnose a disease like Lyme? What should doctors be looking for?
Lyme disease is a multi-systemic illness, so taking a proper history is essential in making the clinical diagnosis. 例如, patients with Lyme disease often have a cluster of classic presenting symptoms, which include fatigue, joint and muscle pain, neuropathic pain (tingling, numbness and burning), 睡眠障碍, as well as memory and concentration problems. Although these same symptoms can overlap other diseases, there are certain classic symptoms that point towards Lyme. Lyme disease symptoms tend to come and go with good and bad days. The joint and muscle pain as well as the neuropathic pain tend to migrate around the body. These symptoms may improve with antibiotic therapy, or worsen with antibiotics (a Jarish-Herxheimer reaction), and women often report an increase in symptoms right before, during, or after their menstrual cycle.
If physicians were to routinely give out a screening questionnaire of Lyme symptoms and review it during the patients visit, this would alert them to the presence of a multi-systemic illness. They should then send off a tick borne panel with a Lyme Western Blot. If Borrelia specific proteins such as the 23, 31, 34, 39 and/or 83-93kda bands return positive and other diseases have been ruled out, then Lyme disease is likely.
理查德, you have treated over 12,000 Lyme patients and made extraordinary progress. Can you share with us briefly some of your key strategies when treating a patient with this disease?
Patients with Lyme disease can be extremely complex, so it is important to have them fill out a Lyme questionnaire at each visit to track their symptoms and progress. Do they have day sweats, night sweats and chills? If Babesiosis and associated parasitic infections are not properly diagnosed and treated, patients will not get better. 同样, co-infections like Bartonella and Mycoplasma can cause resistant symptoms. Combining and rotating antibiotics to address the different forms of Lyme disease, as well as simultaneously treating associated co-infections will often have a positive clinical effect.
It is also essential to review the Lyme-MSIDS map and see if there are any associated medical conditions interfering with the patient’s clinical progress. This requires that all appropriate diagnostic tests be performed. Prioritizing and addressing the sixteen points on the MSIDS map will ensure that those suffering from Lyme disease have the best chance of recovering their health.
和, what is currently being done and what more needs to be done to improve awareness for clinicians and treatment for patients?
ILADS continues to encourage further dialogue between doctors with different views on Lyme disease. We also offer training programs through our members for physicians to help them understand the complexities of diagnosing and treating Lyme disease.
然而, we need to begin to do more clinical trials to better understand how we treat people who remain seriously ill after contracting Lyme disease. 另外, we need to continue to understand the range of infections that may be passed along in a tick bite such as Babesia, 无形体病和埃立克体病. Insurance companies must recognize the risk of chronicity and the severe manifestations of Lyme disease in the lives of the patients they insure.
有关医生的更多信息. Richard Horowitz’s book, 为什么我不能得到更好的? 解决莱姆和慢性疾病的奥秘 (St Martin’s Press): http://www.amazon.com/Why-Cant-Get-Better-Solving/dp/1250019400
Photos are courtesy of United Lyme Action.
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