How a tick bitten hiker got Doxycycline from a conservative doctor.

[refreeman]

A section hiker that I regularly hike the AT with had a very innovative and desperate way of dealing with his Connecticut doctor that would not prescribe Doxycycline for his tick bite. The hiker, or Joe (not his real name for his protection) had several dog and deer ticks on him during our NJ/NY to MA/VT in June. One deer tick on his chest left a small welt after it was removed. I removed the ticks being careful not to squeeze the tick but just pull from the front of the tick with a v shaped tool. By the way, I didn’t get a single tick on me, most likely because I was wearing permethrin impregnated clothes. We finished the CT and MA sections and went home.

Joe went to his doctor and told him he had multiple tick bites. The doctor said, well let’s just wait and see if you get sick. Joe asked the doctor for a precautionary course of Doxycycline because he didn’t want to get sick. The doctor condescendingly said medicine is for sick people and we have no evidence you are sick. The doctor then suggested a Lyme disease blood test. Joe told the doctor that he knew the Lyme blood test was not completely reliable. The doctor asked if Joe had the tick, so the tick could be tested. They both agreed that the tick Lyme test was much more reliable and also faster, but Joe didn’t save any of the ticks for testing. The doctor grew tired of Joe’s questioning and requests. The doctor said, “I know waiting is difficult but that is the best thing to do at this time.” To placate Joe the doc said if you display any symptoms I’ll take you as an emergency patient that day. :-?

Joe went home unhappy and worried. His insurance didn’t let him choose his doctor. He said he did feel a little achy and tired, but we did just do a section hike. After 3 days Joe had an idea. Joe realized that all he needed was a bull’s-eye bruise and he would get the Doxycycline. So Joe took a large socket and wrench from his tool box and beat his leg on the inside fleshy part near his crotch. In about 12 hours Joe had a smaller sized but nice looking bull’s-eye bruise. ;)

Joe showed the doc the bruise and told him it wasn’t there last night and that he doesn’t want it to get any bigger. The doc surprised Joe and quickly prescribed Doxycycline. Joe has finished his course of Doxycycline and has no signs of Lyme at this time. Joe is still waiting for his Lyme disease blood test results. :sun

[Old Grouse]

Joe might also have done what my neighbor's sister did. She lives in NH and faced the same conservative medical response. So she got in her car and drove down here to CT and went to the nearest walk-in clinic. Got her Doxicycline at once, plus had dinner with her brother. Heck, he'd probably give Joe dinner too.

[Odd Thomas]

Why are doctors like this with lyme? I get a scratchy throat and the first thing any doctor I've ever had does is prescribe antib's just in case it's strep.

[burger]

Just because you are bitten by a tick does not mean that you will get Lyme disease, even if the tick stays attached for more than 24 hours. During my hike through the mid-Atlantic and NE, I pulled a bunch of ticks off myself, most of which were attached. I didn't get Lyme disease. I know of a few hikers who did get Lyme, but the vast majority did not.

Taking antibiotics when you don't even have a symptom of Lyme disease (or anything else) is a big mistake. A lot of antiobitics have unpleasant side effects, and by taking them unnecessarily, you're contributing to the alarming rise in drug-resistant bacteria.

I'd suggest you tell your friend "Joe" to learn a bit more about Lyme disease and not worry so much. Stress suppresses the immune system, so Joe is probably doing more damage to his body by worrying about the slight possibility that he has the disease than he would by mellowing out and waiting to see if any symptoms arise.

[Appalachian Tater]

No decent physician would prescribe antibiotics for psychological reasons or a scratchy throat nor would a decent physician mistake a fresh bruise for erythema migrans. Nor is there any insurance that I have ever heard of that doesn't allow a choice of physicians.

Make no mistake, the incident related by the OP is nothing more than insurance fraud.

[taildragger]

Good that the doc didn't give him the anti-b's right off the bat, thats the wrong thing to do all together.

[ChinMusic]

Antibiotics are routinely given for prophylactic reasons. In fact they are required in many cases.

Given the relatively high incidence of Lyme among the subject group in question, I would not think a course of doxy to be out of the question, and consistent with such use in other areas.

FTR: This in not my field.

[Lyle]

I applaud the original Doctor. I see so many patients on vast numbers of meds just to placate their demands that "something is wrong with me". This over-use of antibiotics does have serious consequences for all of us.

If you find a good doctor, who will give you an honest assessment and recommend a conservative treatment as a first step when that is all that is warranted, I would stick with them.

Please do not follow this persons deceptive tactics to "get what you want" out of the medical profession.

[taildragger]

Antibiotics are routinely given for prophylactic reasons. In fact they are required in many cases.

Given the relatively high incidence of Lyme among the subject group in question, I would not think a course of doxy to be out of the question, and consistent with such use in other areas.

FTR: This in not my field.

Do you know if they do this with pathogens that are not easily communicable within our population?

My thought is that if the risk of spread is negligible, then skip the antibiotics for the moment until symptoms show.

[Odd Thomas]

Good that the doc didn't give him the anti-b's right off the bat, thats the wrong thing to do all together.

It's not that bad. You'll hear people attribute this to the increase in antibiotic resistant bacteria, but that's not anywhere near the main factor. Antibiotic resistant bacteria appear when people don't take the entire prescription, leaving the most resistant bacteria behind, and alive.

[ChinMusic]

Do you know if they do this with pathogens that are not easily communicable within our population?

My thought is that if the risk of spread is negligible, then skip the antibiotics for the moment until symptoms show.
I find the communicable aspect irrelevant in this case and not what I was referring to.

There are many reasons to take antibiotics prophylactically. It is done in my field routinely. "Risk of spread" in not a part of the equation. Risk to individual IS. I am well aware of the overuse of antibiotics and am aware of their legitimate needs as well. I have a piece paper on my wall saying so.......;)

Lyme is NOT a part of my field, so I am speaking as a lay person. I do NOT find it unreasonable to be treated prophyactically when the risk of Lyme is great. Someone would have to explain the risk/reward aspects of treatment/non-treatment, as that is what it boils down to.

[FFTorched]

Burger makes a good point about peoples over use of antibiotics, hence why amoxicillin does nothing for him because as a young child he had chronic ear infections.

I am torn on the issue of precautionary drugs for many things. I know for us if you come in presenting signs of Gonorrhea you are leaving with shot of rocefrin and seven day course of an oral antibiotic. For tick bites I would prefer the precautionary course of doxycycline to be safe. If a doctor is routinely seeing a patient for hypochondria then yes don't give them anything but some aspirin and send them on their way in my opinion.

[A-Train]

Guy sounds like a hypochondriac.

Takes one to know one. :)

[Odd Thomas]

Overprescription of antibiotics is indeed a major cause of resistance. Most hospital pharmacies fill prescriptions for certain IV antibiotics only when certain criteria are met proving the necessity.

That used to be the thinking, however we are starting to learn more about how bacteria acquire resistance, and our old ways of thinking don't explain why penicillin, which has been found in nature for millions of years doing direct battle with bacteria in the fight between fungus and bacteria over food sources, hadn't already developed resistance to penicillin even before we started using it.

[take-a-knee]

Guy sounds like a hypochondriac.

Takes one to know one. :)

If you are refering to me, I'm hardly a hypo, I'm 5'8"/165# and normotensive with mile run time of a little over 7:00min. I have little use for doctors or drugs.

[Appalachian Tater]

That used to be the thinking, however we are starting to learn more about how bacteria acquire resistance, and our old ways of thinking don't explain why penicillin, which has been found in nature for millions of years doing direct battle with bacteria in the fight between fungus and bacteria over food sources, hadn't already developed resistance to penicillin even before we started using it.No, it's still the current thinking.


Why are bacteria becoming resistant to antibiotics?
Antibiotic use promotes development of antibiotic-resistant bacteria. Every time a person takes antibiotics, sensitive bacteria are killed, but resistant germs may be left to grow and multiply. Repeated and improper uses of antibiotics are primary causes of the increase in drug-resistant bacteria.
While antibiotics should be used to treat bacterial infections, they are not effective against viral infections like the common cold, most sore throats, and the flu. Widespread use of antibiotics promotes the spread of antibiotic resistance. Smart use of antibiotics is the key to controlling the spread of resistance.http://www.cdc.gov/drugresistance/community/anitbiotic-resistance.htm

[ed bell]

If you are refering to me, I'm hardly a hypo, I'm 5'8"/165# and normotensive with mile run time of a little over 7:00min. I have little use for doctors or drugs.He's refering to the subject of the OP.

[taildragger]

It's not that bad. You'll hear people attribute this to the increase in antibiotic resistant bacteria, but that's not anywhere near the main factor. Antibiotic resistant bacteria appear when people don't take the entire prescription, leaving the most resistant bacteria behind, and alive.

True, I work under the assumption that most people that I have met who want antibiotics for anything don't always take them all (just personal experience).

Personally, I don't take antibiotics unless there is a damn good reason to (i.e. symptoms are starting to show, high likelihood of having or getting infection etc...)

[Odd Thomas]

No, it's still the current thinking.

http://www.cdc.gov/drugresistance/community/anitbiotic-resistance.htm

It's our current policy (because we don't know what else to do) but this is not what current thinking is.

Bacteria have ways of passing on their genes we haven't always known about, such as through plasmids, where bacteria can pass resistance via small circles of DNA from one type of bacterium to another (we're not talking about offspring here or even related bacteria). For years we've been using antibiotics in a way where we try not to kill off so many benign bacteria when we can help it, but now scientists are finding that even benign bacteria, exposed to years of antibiotic use where they've been left alive on purpose, can pass on resistance to harmful bacteria.

In the near future, we may be receiving antibiotics with the intention of killing off our benign bacteria as well, to prevent this passing on of resistance through benign bacteria plasmids.

[Appalachian Tater]

It's our current policy (because we don't know what else to do) but this is not what current thinking is.

Bacteria have ways of passing on their genes we haven't always known about, such as through plasmids, where bacteria can pass resistance via small circles of DNA from one type of bacterium to another (we're not talking about offspring here or even related bacteria). For years we've been using antibiotics in a way where we try not to kill off so many benign bacteria when we can help it, but now scientists are finding that even benign bacteria, exposed to years of antibiotic use where they've been left alive on purpose, can pass on resistance to harmful bacteria.

In the near future, we may be receiving antibiotics with the intention of killing off our benign bacteria as well, to prevent this passing on of resistance through benign bacteria plasmids.If you kill off all your benign bacteria, you'll die.

[Odd Thomas]

True, I work under the assumption that most people that I have met who want antibiotics for anything don't always take them all (just personal experience).

Third world countries have a problem with this too. And prisons, where people are given long term treatment for TB, but quit treatment when they are released.

[Odd Thomas]

If you kill off all your benign bacteria, you'll die.

Dem's the berries

[Odd Thomas]

Dem's the berries

Seriously though, current policy is that the appendix is a functionless organ. Current thinking is that the appendix is a benign bacteria culture that's purpose is to restart the colonization of our intestines with the bacteria we need in the event of a dieoff.

That's not so important these days, when we come into contact with other people where we can get this bacteria again easily, but back in the motherland when we were wandering around in seclusion, it was important enough to evolve an organ with this purpose. The appendix may come in handy again.

[take-a-knee]

If you kill off all your benign bacteria, you'll die.

Not so, it is a moot point anyway because you'll wind up with a superinfection but (like C. difficile) that isn't a fact that you have to have bacteria in your alimentary canal.

[mkmangold]

Antibiotics are routinely given for prophylactic reasons. In fact they are required in many cases.

Given the relatively high incidence of Lyme among the subject group in question, I would not think a course of doxy to be out of the question, and consistent with such use in other areas.

FTR: This in not my field.

As with most of medicine, a decision to treat is based on an individual's circumstances. Here in Wisconsin, Lyme Disease is highly prevalent so the recommendation is for prophylaxis if it is an identified deer tick. That's why we keep epidemiologists around: to let us know what to expect.
As a comparison, if I am in a clinic that does not have rapid strep tests (or if the patient cannot afford one), I will take into consideration the prevalence of strep in the community AT THAT TIME, the exposure to others with confirmed cases of strep pharyngitis, patient history (including a history of heart valve disease or cardiac surgery), and clinical findings. If I suspect strep I will treat PRESUMPTIVELY which is not the same as prophylaxis. In fact, I may not even get a strep test even if available if I think my suspicions are high enough for or against antibiotic use. And then explain to the patient why.

[Lyle]

I will take into consideration the prevalence of strep in the community AT THAT TIME, the exposure to others with confirmed cases of strep pharyngitis, patient history (including a history of heart valve disease or cardiac surgery), and clinical findings. If I suspect strep I will treat PRESUMPTIVELY which is not the same as prophylaxis. In fact, I may not even get a strep test even if available if I think my suspicions are high enough for or against antibiotic use. And then explain to the patient why.


Two points:

1) In the quoted hypothetical above, there were clinical findings on exam. The case in the OP had absolutely NO clinical findings. Would some of you treat a person for strep if he just presented with a history of exposure, and the prevalence of the disease in others, but had no sore or inflamed throat? Seems to me that would be a comparable situation at the OP.

2) Are some of you defending the OP's tactic that involved the patient's use of deception and, in essence, lieing to the physician in order to get the treatment that they feel they should get? It sounds like some of you are

[Survivor Dave]

PLEASE! Let's keep on topic. No need to use profanity. It's an antibiotic for goodness sakes.

Carry on.

[orangebug]

There are reasons to give Doxycycline prophylactically for exposure to ticks in Lyme disease endemic areas.
http://content.nejm.org/cgi/content/abstract/345/2/79

This is an article from the New England Journal of Medicine about single dose doxycycline given within 72 hours of exposure for prophylaxis in a very inexpensive and efficient manner.

The other discussion about overuse of antibiotics are off topic for this specific condition.

BTW, Lyme isn't my field, but this is well known literature that most primary care docs should know about without spending excessive $ on inefficient Lyme testing in an acutely exposed person.

[Appalachian Tater]

2) Are some of you defending the OP's tactic that involved the patient's use of deception and, in essence, lieing to the physician in order to get the treatment that they feel they should get? It sounds like some of you areAddicts lie to physicians to get drugs all the time.

[Appalachian Tater]

There are reasons to give Doxycycline prophylactically for exposure to ticks in Lyme disease endemic areas.
http://content.nejm.org/cgi/content/abstract/345/2/79

This is an article from the New England Journal of Medicine about single dose doxycycline given within 72 hours of exposure for prophylaxis in a very inexpensive and efficient manner.

The other discussion about overuse of antibiotics are off topic for this specific condition.

BTW, Lyme isn't my field, but this is well known literature that most primary care docs should know about without spending excessive $ on inefficient Lyme testing in an acutely exposed person.People have quoted that old article before. Routine prophylaxis for tick-borne disease is NOT recommended. It is only recommended under very specific circumstances. There are old threads here on WhiteBlaze where this is discussed, with plenty of links and references to reliable sources. Popping a pill every time you have a tick on you is NOT recommended and it is not good physician practice to support patients in doing so, either. This is a re-hash.

[orangebug]

200 mg Doxycycline = $1.50 + whatever the pharmacy charges for shaking your hand.

Lyme test is far more expensive. (I think in the range of $150 last time I checked)

2 single issue E&M visits to the doc adds to the expense.

Adverse events from doxycycline are time limited GI reactions (Nausea and vomiting). Adverse events from Lyme and treatment of acute Lyme disease are much more significant.

YYMV, but I am not aware that the age of a classic study reduces validity.

[_terrapin_]

I had the opposite problem last summer. I carried with me a single dose of doxycycline, as prescribed by my doc when I told him what I was up to and where I was headed.

While on the trail, I was alone most nights so I wasn't able to check myself completely for ticks. One evening I discovered a tiny dark spot... something just under the skin, possibly a part of an insect, but it didn't look like a tick. I dug most of it out with a needle. I had to decide whether to pop the pill or not, and decided against it.

(What's the shelf-life of doxycycline, anyway?)

[orangebug]

Check the expiration date on the prescription bottle. There have been studies that suggest most medications are reasonable to use for up to 10 years, but this is not something that any physician or pharmacist is likely to advise due to product liability concerns.

[ChinMusic]

200 mg Doxycycline = $1.50 + whatever the pharmacy charges for shaking your hand.

Lyme test is far more expensive. (I think in the range of $150 last time I checked)

2 single issue E&M visits to the doc adds to the expense.

Adverse events from doxycycline are time limited GI reactions (Nausea and vomiting). Adverse events from Lyme and treatment of acute Lyme disease are much more significant.

YYMV, but I am not aware that the age of a classic study reduces validity.

Excellent summary.

When prescribing any medication the practitioner must weigh the pros and cons. In the case presented in this thread there has been nothing posted to dissuade the prescribing of doxy.

The risk of NOT prescribing seems to clearly outweigh prescribing (risk of Lyme vs untoward affect of doxy).

Again, NOT my field, but I deal with such decisions every day.

[ChinMusic]

2) Are some of you defending the OP's tactic that involved the patient's use of deception and, in essence, lieing to the physician in order to get the treatment that they feel they should get? It sounds like some of you are
I would NOT defend the deception. Deception is a dangerous ploy from all angles.

When I first started private practice I was an EASY mark for deception (wanting meds). I was not prepared for the public to lie to me. I learned.

If I had an MD tell me the following (in bold).....


Joe asked the doctor for a precautionary course of Doxycycline because he didn’t want to get sick. The doctor condescendingly said medicine is for sick people and we have no evidence you are sick.

..... I would find another MD, as the logic, if reported accurately, is not valid.

[dmax]

People are going to be mad at me for changing the subject alittle. I've learned so much on WB, I just can't help myself.
I've got a quick question in laymen terms please?
What is a pro biotic?

[Appalachian Tater]

People are going to be mad at me for changing the subject alittle. I've learned so much on WB, I just can't help myself.
I've got a quick question in laymen terms please?
What is a pro biotic?Probiotics are foods containing helpful micro-organisms. Yoghurt is probably the most commonly available probiotic and eating it is sometimes recommended to patients taking antibiotics, which kill bacteria in the gut.

[dmax]

Thanks.

[Appalachian Tater]

(What's the shelf-life of doxycycline, anyway?)Perhaps up to seven years under OPTIMAL storage conditions. Labeling is for two years. http://209.85.173.104/search?q=cache:P-0KErfUzCMJ:www.usamma.army.mil/documents/SLEPInfoPaper-Mar2005.pdf+shelf+life+doxycycline&hl=en&ct=clnk&cd=3&gl=us

Factors such as temperature, humidity, and ultraviolet radiation are important to shelf-life of various drugs. Doxycycline should be stored at room temperature.

Expired doxycycline can damage your kidneys.

[take-a-knee]

Perhaps up to seven years under OPTIMAL storage conditions. Labeling is for two years. http://209.85.173.104/search?q=cache:P-0KErfUzCMJ:www.usamma.army.mil/documents/SLEPInfoPaper-Mar2005.pdf+shelf+life+doxycycline&hl=en&ct=clnk&cd=3&gl=us

Factors such as temperature, humidity, and ultraviolet radiation are important to shelf-life of various drugs. Doxycycline should be stored at room temperature.

Expired doxycycline can damage your kidneys.

Yes, along with anything else in the tetracycline family (anything that ends in
"cycline").

[stick man]

had lyme in 1999 and treated went to new doc in 2006 for bite had to beg for test witch just delayed treatment the longer you wait the worse it is it can kill you give a shot the shot will not

[Appalachian Tater]

had lyme in 1999 and treated went to new doc in 2006 for bite had to beg for test witch just delayed treatment the longer you wait the worse it is it can kill you give a shot the shot will notLyme is not normally treated with an injection. The test is not crucial to diagnosis or the decision to treat. A negative test would not mean you are free of disease while a positive one would not mean that you have it.

[jesse]

ain't to smart to try and outsmart your doctor.

[Odd Thomas]

ain't to smart to try and outsmart your doctor.

No it's not, not very fair either, considering we hold them legally liable for decisions they make based on what we tell them.

[musicwoman]

I don't understand the purpose of the original post. Was it too condone the use of preventative antibiotics? Was it to show that if you manipulate your physical symptoms, you can easily obtain a prescription for something your MD was not willing to prescribe otherwise?

Also, how does it compare to my case, where I received a dog bite and was prescribed antibiotics as a precaution. How would that be different than someone seeking antibiotics for a tick bite, also as a precaution?

I see no difference, although since I am not an MD I am certainly not qualified to make that determination.

Someone please educate me.

[modiyooch]

Every doctor that I go to tries to put me on meds. I think they are bainwashed. I even got a postcard from the health insurance company suggesting that my son should be taking a certain drug daily. His condition has been controlled for 15 years.

BTW: I did get sick from antibiotics and steroids. It did wipe out the good bacteria and it took me a long time to recover. That's the main reason I won't currently take meds, perscription or over the counter. They all have side effects.

[orangebug]

...Also, how does it compare to my case, where I received a dog bite and was prescribed antibiotics as a precaution. How would that be different than someone seeking antibiotics for a tick bite, also as a precaution? Well, there is a difference.

A dog bite is likely to result in infection due to the puncture wounds and bacteria from the dog's mouth. Cats are worse, but humans are even worse.

The trouble with the tick bite has nothing to do with bacteria from the tick's mouth, but a spirochete from other blood meals the tick has ingested. The mammalian bites are very likely to cause infection. The tick bite is far less likely, leading to controversy whether treatment is worthwhile on relative risks and cost effectiveness concerns. Even without the Doxycycline, Lyme infection is a very infrequent occurence.

But if you are bitten by a dog, cat or person, expect to be placed on a broad spectrum antibiotic.

[ChinMusic]

Even without the Doxycycline, Lyme infection is a very infrequent occurence.
From reading the anecdotal reports on this board I would characterize Lyme as a frequent occurrence for thru hikers.

[orangebug]

From reading the anecdotal reports on this board I would characterize Lyme as a frequent occurrence for thru hikers.That is the problem with anedotal reports. You hear of problems, not the absence of them.

The suggestion of 25% Lyme in a cohort of hikers would not fail to get attention from public health, as Lyme is a reportable disease in every state. Even in the study I cited above, the untreated group only had 3.2% erythema migrans - which is reported to occur in less than half of those with actual infection.

If you read the list for anecdotal reports, one might suspect there are dead and dying animals in every water source, brimming with Giardia cysts waiting to infect the unwary wayfarer. Every trail town should be an infirmary for those with uncontrollable diarrhea and tick borne diseases.

Humans, like hikers, are pretty hardy critters who seem to avoid major illnesses until aging, malnutrition, hypernutrition and other lifestyle related conditions lead to problems. The biggest burden in hiking is carrying fear of one sort or another.

[ChinMusic]

The biggest burden in hiking is carrying fear of one sort or another.
I choose to wear my "burden" only if it is treated with permethrin first. ;)

[Greentick18d]

We used doxy prophylactically every week when deployed to 3rd world rat holes. It was "malaria mondays" and "doxy on tuesday" to prevent Leptospirosis or "rat-piss fever." Another spirochete. No biggie. No one got sick, either from Lepto or doxy (tho some consider it a sun-tan adjunct).

If a pt gave me a relevent history and had pulled off a tick I would explain risks and benefits and let them input their opinion. The longer Lyme goes untreated the worse it gets. If someone came in without a reasonable history but with a ream of garbage printed off of the internet "my symptoms match these 14 disease processes" it is time to send them to their primary care to sort through it. Doxy is dirt-cheap. If you live in the deep south the Publix chain of grocery stores will give it to you for free with an rx.

Finally an ounce of prevention is worth a pound of cure: DEET and permethrin all the way....

[rickb]

From reading the anecdotal reports on this board I would characterize Lyme as a frequent occurrence for thru hikers.

In Connecticut about one person (residents, mostly) in 1000 contracted a case a Lyme that was reported to the CDC last year. http://www.ct.gov/dph/lib/dph/LD2007CT.pdf

In many places near the AT the rate was higher. In Cornwall one person in 100 contracted a case of Lyme last year that was reported to the CDC. In fact, the entire northwestern corner of CT looks to be a particularly bad area if you go by the official reports.

I can't speak with any authority on whether or not thru hikers would attract more infected ticks in their short trip through that state than a Connecticut resident would in a whole year, but my gut tells me they would by a large measure. Hiking makes you a tick magnet. Lyme is also pretty bad in other states like NY and NJ.

[Undershaft]

southeastern MA is once of the worst places in the country for Lyme carrying ticks. I got two deer ticks on me, in the same spot but seperate incidents, in six days. I was walking along the Cape Cod Canal. The Doc put me on a two week course of Doxy without batting an eye. He looked at the ticks (I saved them) but didn't bother testing. I'm quite happy to be on antibiotics. It's exactly what I wanted the Doc to do. My uncle has advanced Lyme and it sucks. I probably don't have Lyme but I'm glad I'm taking something just in case I do.

[The Cheat]

Excellent summary.

When prescribing any medication the practitioner must weigh the pros and cons. In the case presented in this thread there has been nothing posted to dissuade the prescribing of doxy.

The risk of NOT prescribing seems to clearly outweigh prescribing (risk of Lyme vs untoward affect of doxy).

Again, NOT my field, but I deal with such decisions every day.

Is it true that if you take any antibiotics while you have Lyme you will then show negative on the Lyme test? If so, this would be a good reason not to prescribe before knowing for sure the person has Lyme.

[orangebug]

Is it true that if you take any antibiotics while you have Lyme you will then show negative on the Lyme test? If so, this would be a good reason not to prescribe before knowing for sure the person has Lyme.There is nothing to suggest that antibiotics would interfere with developing immune response to Lyme disease if already infected. Of course, prophylactic antibiotics would prevent Lyme antibodies by preventing infection.

The tests for Lyme antibodies are famously non-specific and unreliable for diagnosis or ruling out the diagnosis of Lyme disease.

[Farr Away]

... The appendix may come in handy again.
I hope not; I've been without mine for much longer than I had it.

[take-a-knee]

We used doxy prophylactically every week when deployed to 3rd world rat holes. It was "malaria mondays" and "doxy on tuesday" to prevent Leptospirosis or "rat-piss fever." Another spirochete. No biggie. No one got sick, either from Lepto or doxy (tho some consider it a sun-tan adjunct).

If a pt gave me a relevent history and had pulled off a tick I would explain risks and benefits and let them input their opinion. The longer Lyme goes untreated the worse it gets. If someone came in without a reasonable history but with a ream of garbage printed off of the internet "my symptoms match these 14 disease processes" it is time to send them to their primary care to sort through it. Doxy is dirt-cheap. If you live in the deep south the Publix chain of grocery stores will give it to you for free with an rx.

Finally an ounce of prevention is worth a pound of cure: DEET and permethrin all the way....

A voice of reason and experience. Listen to this man.

[Sleeps_With_Skunks]

Just because you are bitten by a tick does not mean that you will get Lyme disease, even if the tick stays attached for more than 24 hours.

I have nerve dead spots on my back from a car accident so I never even feel when I get bitten.

The worst thing a tick has given me was a nice case of ringworm!! By the time I got itchy it ran from my ears down my back to the tick bite near my waist. Now I zap tick bites with a mix of cortisone and monistat when I find I have been bitten and hope nothing else develops. :)

Permethrine is the best preventative other than not going into tick infected areas.

SWS

[Sleeps_With_Skunks]

As a person sensitized to most antibiotics due to mold allergies and over-prescibing as a kid with a lot of sinus and ear infections. If you take an antibiotic too much your body will adapt and the effectiveness of the antibiotic will decrease. As of now I can only take cipro or sulfa. Anything else gets me a trip to the ER and a ventilator.

So I urge many of you that are antibiotic users...always ask yourself is it worth it to take the antibiotic NOW or can I wait and see if my body will handle it?

As a result of my allergies I have found some simple things to help me without taking an antibiotc...tee tree oil, ecalyptus, and lavender oil make a very strong anti-fungal/antiobiotic. I found soap that contains all 3 oils and it gets rid of poison ivy and makes a nice wash for open wounds. My favorite stuff for infections from cuts, bites, and wounds (like ticks) is black salve or ichthamol ointment. Stinks to high heaven....but it works.

SWS