Lyme disease may call for prolonged antibiotics
DEAR DRS. DONOHUE AND ROACH: My daughter has been diagnosed with Lyme disease. She has been put on antibiotics for four months. What can you tell us about this disease? -- L.R.
ANSWER: Lyme disease is an infection caused by the bacteria Borelia burgdorferi, which is spread by the bite of the deer tick. This tick is quite small and easily overlooked. As a consequence, many people do not realize they have a tick bite.
The tick needs to stay attached for 24 hours in order to pass Lyme disease, so a careful inspection after possible exposure is helpful. Although Lyme disease has been reported in many places, it's common in the Northeast United States, from Virginia to Maine, and most common in New York, Connecticut (it is named after the town of New Lyme, Ct.), Wisconsin, Minnesota and northern California.
Blood tests usually are not necessary to diagnose Lyme disease. Its diagnosis is made primarily on a characteristic rash, which looks like a bulls-eye, although this rash is not always present. In the early stages, people with Lyme disease may have fever, muscle aches or other flulike symptoms. Lyme disease is best treated as soon as diagnosed.
Treatment for Lyme disease in its early stages is with oral antibiotics. If Lyme disease is not recognized until later stages, which happens especially if there is no distinguishing rash, then complications relating to the nervous system can occur, such as facial paralysis and numbness.
A later-stage Lyme disease diagnosis can be confirmed with blood tests. Treatment of late Lyme disease usually is done also with oral meds, but occasionally with IV medications, usually for four to six weeks. I always get suspicious when I see people treated with antibiotics for longer periods of time. Symptoms of late-stage Lyme disease may persist despite treatments that are effective in killing all the bacteria in the body, and several trials have shown that prolonging antibiotic treatment beyond the recommended four to six weeks does not provide any benefit.
DEAR DRS. DONOHUE AND ROACH: Our 20-year-old daughter has become less active, gained weight, is tired during the day and doesn't sleep at night. She was treated with an antidepressant, but her gynecologist, who saw her for irregular periods, has diagnosed her with polycystic ovarian syndrome. Her cousin also has PCOS. Is it serious? Is it genetic? Will our daughter be able to have children? -- L.C.
ANSWER: Polycystic ovarian syndrome, also called PCOS, is a condition of imbalanced female sex hormones.
Most patients have irregular periods, and many have excessive hair. A condition closely related to PCOS is abnormal blood sugar or diabetes, which should be looked for in everyone with PCOS. Although some women with PCOS have ovarian cysts, having cysts on the ovary isn't a major part of the condition. There is a family predisposition. The diagnosis is made with a combination of a careful history, physical exam and blood testing.
Women with PCOS often have a harder time getting pregnant; however, it's still possible. PCOS is generally treated with a team approach, with an obstetrician/gynecologist and an endocrinologist. Depression is indeed more common in women with PCOS, so an antidepressant sounds like good treatment for your daughter. Weight loss can be very helpful in improving PCOS.
READERS: The booklet on stroke explains this condition that is deservedly feared by all. Readers can obtain a copy by writing: Dr. Donohue -- No. 902, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
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