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.

[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/co...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/co...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.