Mar 172007

3/20/2007 Edit: Decided that there was no value in listing the doctor’s name so edited the post to just using a pronoun for the name

Extremely disappointed!!! I did not expect him, or any doctor in Texas, to be an expert in Lyme, since it is a rare disease here. What I do expect is that as a doctor you either do your homework on a given disease (Lyme), or you refer me to someone who is familiar with the disease. I can even accept that you would have to follow-up with me after consulting with some reference materials and other specialists. Possibly, he may be an acceptable doctor with diseases he is familiar with; just not with diseases he doesn’t. What I really object to is his radical unpreparedness and blissful ignorance for my case. Overall, I was left with the impression (based on a general attitude) that he is not enthusiastic about his work, and thus does little reading of journals, etc. to stay at the forefront of his specialty (I would think that my case could add a little spice to an otherwise same old routine). Some tidbits from Friday’s visit:

  1. 30 minutes late for the appointment (trying to ignore his previous indiscretion, and then again.) He was late because he was reviewing my chart (I was the only appointment today), and he arrived minutes after I did. I would expect an infectious disease doctor to review his upcoming schedule so he can prepare for any diseases that he might not be that familiar with, and so he doesn’t look like an idiot when talking about the disease. He obviously did not want to proceed down that route, and would prefer to look like an idiot. He has had my lab work and back pictures (Bartonella Rash) for two days, and my suspected diagnosis (Lyme) for a month. Let’s wait until the appointment to quickly read over the chart, and any old textbooks I have laying around.
  2. In his first few sentences he made it clear that he had no idea about the C6 Peptide test, and the test’s significance. He said there are lots of “Mom and Pop labs” that do some weird tests. Of course this is not a weird test, and has been suggested as being the new “Gold Standard” for Lyme (although with criticism). Eriksgirl tries to explain the test with little success. He said he needs to call the labs director so that he can figure out what the test revels (like maybe it’s a positive test for Lyme disease!). Of course this should have been something he did before visiting with me, see #1.
  3. The CD-57 test was also mentioned, and he said that has nothing to do with Lyme. Eriksgirl did not go into a description of why this level is important in assessing efficacy of treatment. Again see #1.
  4. After discussing my symptoms, and that I am self-admitted in a light period at the moment, he thought there was basically no reason to think that I have Lyme and to question the diagnosis of Multiple Sclerosis. This was even after reading aloud the referral letter from my neurologist saying that there was “compelling” evidence for a potential Lyme infection, but an infectious disease specialist would have to make that determination. How we could see the exact same text two different ways is a mystery to me. He went on to say that a neurologist should be able to diagnose lyme disease based on the neurological symptoms (I guess so much for Lyme being the great imitator).
  5. He went on to ask what I wanted to achieve by being treated for Lyme (e.g. take high dose antibiotics). Apparently the wrong answer was to not have Lyme. He said that treatment of Lyme is a clinical one (and to some degree I do agree, but with the CD-57 it is less so; secondarily I would think you would rely on diminishing Herxheimer reactions), and without anything to treat there are no objectives. No clinical objectives = no reason to treat with antibiotics. He thought it was better to treat the Multiple Sclerosis rather than worrying about Lyme.
  6. He went on to offer a 3 week treatment of IV antibiotics to set my mind at ease. Eriksgirl noted later that apparently I am a hypochondriac, and he will treat my neurosis with 3 weeks of antibiotics to make it all better. I declined. (3 weeks of antibiotics would be insufficient for chronic Lyme anyways, which furthers my assessment that he doesn’t have a clue about treating Lyme). Secondly, who “hands out” high-dose anything if you don’t think the patient needs it?
  7. Eriksgirl mentioned that we will be going to see a Lyme specialist in PA for a second opinion (can he be considered a first opinion?). He noted that he thought it was a “waste of money.” I understand his hubris because he is an such an expert in Lyme, knows what all the tests mean, and the proper treatment methodology for chronic Lyme so there is no need for a second opinion from a Lyme specialist (especially no need to see the doctor who recommended the lab and all the tests that got run by that lab).
  8. I also noted that I was referred because of the recurrent rash that occasionally appears when when I am having problems (but definitely not always). He said that Lyme does not have a rash that appears with exacerbations; of course that was after I told him that it was (most likely) a Bartonella rash. He dismissed the rash as being Bartonella; noting that Bartonella does not have a rash (or so he seemed to indicate), and if I had Bartonella that I would have gotten over it by now. He also noted the Bartonella is not a tick borne disease; but instead is the disease of cat scratch fever. In the end he never suggested any cause for the rash simply leaving it that it was not a Lyme induced rash.
  9. He also noted that Lyme would not cause abnormal MRI’s (e.g. lesions). The insinuation was that abnormal MRI’s would be one more indication that I have Multiple Sclerosis, and not Lyme. This was despite the fact that my neurologist referred me to him for this assessment (and the neuro personally mentioned that if I have Lyme I could be cured; meaning I was misdiagnosed).
  10. He also noted that the treatment would be with Penicillin. That sounds like a fine choice, but from what I understand I will need to be treated with two antibiotics because an antibiotic that has good tissue penetration does not typically have good blood-brain barrier penetration and vice-versa (The International Lyme and Associated Diseases Society, p.6, Section 10); something I would expect and ID doctor to know. Then there will probably be yet a 3rd antibiotic to treat the Bartonella.

Endnote: Going in, I did not have high expectations that he would be able to help with the Lyme because of the rarity of the disease in Texas. It was a long shot, and it was worth a try. I was simply put off by his gross ignorance, apparent lack of interest in my case, and unwillingness to learn more about the disease. Overall this experience was for the best because I have been working on a list of questions to ask the doctor (which I did not have for the original meeting, so bizarrely it worked out for the best that he canceled) so I will be better prepared for future visits.

  9 Responses to “Infectious Disease Visit”

  1. Penicillin=placebo, I think–or he should be reported to the board for his medical specialty (since antibiotic-resistance has to be one of the major problems for infection disease specialists). I’d be tempted to ask him for a written report of his findings along with the prescription, and then forward it to them.

    Did your neuro suggest this doctor? or is he the only infectious disease specialist in your part of Texas? I’m sure you’re going to let your neuro–and your GP–know how it went, right? So they’ll send their business to someone else, if possible.

    • Call your county htlaeh department and ask who does tick testing in your area. Depending on where you live, it might also be a state agency that does it.Good sources of info about Lyme dl]Call your county htlaeh department and ask who does tick testing in your area. Depending on where you live, it might also be a state agency that does it.Good sources of info about Lyme disease:]

      • Sorry, but I am going to have to diagree. Anyone can test for Lyme, but Lyme is usually a clinical diagnosis. If you just want the standard Lyme test done your family practice doctor can do that. It has been a long time, but if you are getting labwork done get it done right.

  2. Yes, the neuro did suggest the infectious disease doctor, but I think it was based on his residency with him and not based on anything recent.

    I’m not going to report him, and not just because nothing would be done. It is just sad that this is becoming the state of care in the US. I guess so much for leading the world, but if childbirth is any indication of the whole system then it all sucks.

  3. I have found that Doctors hate it when we patients are well informed. It is as if an iron wall goes up around them and we are not in their environment anymore. You will find a good doctor eventually. They are out there.

  4. One day, these totally fallible doctors will be replaced by computers and disease specific chips (disposable chips! ta boot)

    I wish you well in your quest.

    I am starting to really loose faith in the medical community. There are more idiots in the profession than there are professionals.

  5. Anonymous,
    Interesting idea, and reminds me of a T-Shirt:
    Go away or I will replace you with a very small shell script

  6. Mouse,
    I agree, though I haven’t seen too much of that. What they seem to really like to do is give partial information which will guide down one particular path.

    In the end it is my body, and I am ultimately responsible for its care (and the one who suffers if it does not go well). Dr.’s are simply a highly paid consultant. I continue to be shocked when I run into people who are appalled that I would question a doctor’s advice.

  7. Erick, that was a funny T-shirt. Are you a programmer too? 🙂

    Seriously though, I ran across this AI site of 20 questions. here is the link.

    It’s almost spooky! (and fun to play with.. give it a go). Though being a programmer, I think ‘puters are very well suited to the task of successive approximation and narrowing down choices from a database of choices.

    Imagine if something like this were applied to medical conditions!

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