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Thread: Doxycycline

  1. #41

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    Quote Originally Posted by tdoczi View Post
    theyre out in the woods carrying the drugs with them to use at their own discretion.
    And this can be quite empowering for them.

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    Quote Originally Posted by trailmercury View Post
    And this can be quite empowering for them.
    thats a fascinating line of thinking re: medical care that i will not pursue further at this time.

    with all due respect, you wouldn't be my doctor.

  3. #43

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    no harm done, I was certainly not recruiting you.

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    Quote Originally Posted by Offshore View Post
    Instead of taking the "I'm the expert here, so do as I say", we had an intelligent conversation re: the pros and cons, and I came to a decision with his input. That's my decision to make and may not be right for everyone, but a blanket refusal to even talk about it in light of decades of peer-reviewed medical literature showing a benefit really is a disservice to a patient.
    The last conversation I had with my Doctor regarding a tick bite included a discussion on the probability a Mount Desert Island tick (Acadia National Park) could be a vector (my info on that was superior to his), Bayes’ Theorem (I though myself about his equal but probably not given the context), the strategy suggested by Trail Mercury (virtually identical) and first hand experience dealing with this (hands down he had more).y

    I think of him as a good doctor, but who could possible know? No red flags on the Internet, and I am alive and healthy. If I have a heart attack I will blame him, of course.

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    The tick/Lyme/other vector subject is so medically complex that it really doesn't lend itself to quick comments on WB; however, the idea that several have now suggested about having a conversation with a trusted medical professional who shares the decision making with you makes the most sense. Then you are informed and you make your own decision about what to do with an embedded tick, etc. If you get a red 'bullseye' rash after/while hiking an East Coast trail, see someone promptly.

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    Quote Originally Posted by chef4 View Post
    The tick/Lyme/other vector subject is so medically complex that it really doesn't lend itself to quick comments on WB; however, the idea that several have now suggested about having a conversation with a trusted medical professional who shares the decision making with you makes the most sense.
    I understand what you are saying, but a hiker needs to have a decision tree in place BEFORE going to see his trusted medical professional, and BEFORE hitting the Trail.

    There are a number of good resources on line to help, and of course these can be followed up with a meaningful dialog with your doctor when you have your annual physical.

    There is one school of thought that the time of tick attachement is important when considering a prophylactic (short) course of antibiotics— both with regard to the minimum time a tick needs to have been embedded to be of concern, and also the time beyond which a prophylactic course is not going to help anyway. Opinions on this differ.

    The CDC speaks to this on-line, but their direction is less than crystal clear. Other resourses are out there to help — and of course a tick-litterate physician can be an important one.

    When you are out hiking, the logistics of seeing a doctor quickly are not easy — much easier to just say “screw it” and hope for the best. If that is what one wants to do, fine. But far easier to think of things while reading WhiteBlaze than when out on the Trail.

    I would think it wise to establish a means of contact with your doctor (email?), and discuss his willingness to help long-distance if you should discover a rash (it’s not always a bulls eye). Older folks like me know their Doctors and are probably not reluctant to ask about such things, but I expect many people might be. You ar their patient first, but also a customer.

    If your Doctor prescribes a couple pills to take — under certain conditions — you might be able to take them at a time when they might have the greatest potential to be effective. Of course they could never be effective if you don’t have them.

    There are plenty of details on all this — worthy of discussion I think.

    My real message is stating what is probably obvious, but may not be:

    A thru hiker should know exactly what to do if he gets a tick bite under various scenarios of time and place before taking his first step on the AT, and also make sure he has the ability to excersize that plan to the extent he thinks it important to do so.

    Far better to have a plan worked out ahead of time, than to listen to a person like me at a shelter for help and direction.

  7. #47

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    Quote Originally Posted by rickb View Post
    I understand what you are saying, but a hiker needs to have a decision tree in place BEFORE going to see his trusted medical professional, and BEFORE hitting the Trail.










    A thru hiker should know exactly what to do if he gets a tick bite under various scenarios of time and place before taking his first step on the AT, and also make sure he has the ability to excersize that plan to the extent he thinks it important to do so.

    Far better to have a plan worked out ahead of time, than to listen to a person like me at a shelter for help and direction.

    Agreed wholeheartedly.

    If one of my regular patients or somebody new came in and said they were going on a long hike in a place where Tick disease is prevalent, a fairly long discussion would be had about tick bite prevention and tick borne illnesses. I would likely offer them a script for a 200mg doxycycline dose (or alternative) to be used out in the field later if certain criteria were met (attachment time, tick species etc.). I would let them share in the decision. I would want to get the impression from the dialogue that they reasonably understood when/if to use it (most likely the case for 95% or more adult humans, 100% of Whiteblaze members of course!!!).


    Some folks incur preventable serious long term/permanent effects from Lyme disease. (Don't confuse this with "Chronic-Lyme", which is still highly debated and not an accepted diagnostic entity by the Infectious Disease Society of America and other highly esteemed peer-reviewed academic societies).



    Post-Drift:
    I thought about the other thread "AT in 100 years"...
    In my fantasy, I see a pharmacy at Amicalola, stocked with doxycycline, Vitamin I, immodium, probiotics etc with providers there available to discuss with hikers if they should take them along on the hike, and when to use them.... again a shared decision.

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    Anyone who regularly hikes the east coast and particularly for distances like thru hikers should have a plan in place for tick bites (among other potential medical issues); few healthcare providers would welcome a phone call and/or cellphone image with a long distance request from a thru hiker whom they haven't seen in years. Most university hospitals have travel clinics staffed with infectious disease experts you can see to develop a plan, although depending on insurance these may be too costly for hikers, so I acknowledge the impracticality of this option (although it might be worth it if you also cover infectious diarrhea and skin infections). Among family docs/internists there is a full range of expertise on practical advice for tick bites and complications, from experts likely to offer your approach to novices, so hikers could be taking their chances when they see a healthcare provider. It would be good to have a list somewhere of docs who have a special interest in hiking medicine, perhaps there is one linked to the wilderness medicine society. Of course the majority of hikers do just fine with no advanced planning for this, you just never know who is going to have a problem.

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    Quote Originally Posted by chef4 View Post
    Anyone who regularly hikes the east coast and particularly for distances like thru hikers should have a plan in place for tick bites (among other potential medical issues); few healthcare providers would welcome a phone call and/or cellphone image with a long distance request from a thru hiker whom they haven't seen in years. Most university hospitals have travel clinics staffed with infectious disease experts you can see to develop a plan, although depending on insurance these may be too costly for hikers, so I acknowledge the impracticality of this option (although it might be worth it if you also cover infectious diarrhea and skin infections). Among family docs/internists there is a full range of expertise on practical advice for tick bites and complications, from experts likely to offer your approach to novices, so hikers could be taking their chances when they see a healthcare provider. It would be good to have a list somewhere of docs who have a special interest in hiking medicine, perhaps there is one linked to the wilderness medicine society. Of course the majority of hikers do just fine with no advanced planning for this, you just never know who is going to have a problem.

    Not so complicated.

    Part A

    Just research the short window of time when a single pill of Doxy has the potential to PREVENT serious health issues. There is a bit of disagreement on particulars, so read up.

    Discuss with a tick literate physician.

    Ponder how you would source and administer a single pill (if that is indicated) while you out in the woods. Rember the clock will be ticking (no pun intended).

    Discuss that with your physician.

    Thank your doctor for his advise,and for the single pill script he very well might have written.

    Part B

    Research, research and research, then discuss with your Doctor how to recognize actual Lyme Disease (or the possibility of it) at the earliest possible stage, and what to do if you find yourself in that position — including the potential impact of postponing treatment — because on the Trail it will never be convenient.

    Ask you doctor for his advise on what to if you find yourself in a situation where it will take a few days (minimum) before you can present yourself to a Doc in a Box, or (last resort) an ER.

    Thank him for considering your special situation as an AT Hiker.


    Relax and handle things as the come.

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    Some of the studies suggest that 3-4 days of doxy within 24 hours of the bite is just as effective as 30 days

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    Here are a couple of things that everyone should know:
    1. Most Lyme disease comes from the tiny tick nymphs, about the size of a poppy seed, who transmit the disease in spring and until midsummer, they're easily missed on self exam. The larger ticks can transmit it, but they are easier to find, and they are more active later. They typically have to be on you for more than a day before the disease can be transmitted.
    2. If you decide to take doxycycline try to limit sun exposure, as it can sensitize you to sunburn (similar to essential oils, see related posting)

  12. #52

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    Just because it has not come up yet, do not take old Doxycycline! While many Rx meds are ok to take past their expiration date, doxy becomes liver toxic...... so that Rx you had filled years ago that you may be carrying ‘just in case’ needs to be replaced.
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    Quote Originally Posted by Sailing_Faith View Post
    Just because it has not come up yet, do not take old Doxycycline! While many Rx meds are ok to take past their expiration date, doxy becomes liver toxic...... so that Rx you had filled years ago that you may be carrying ‘just in case’ needs to be replaced.
    Settled science?

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    It's based on some old case reports of what happened to 3 people who took out of date tetracycline (precursor of doxycycline). The army tested doxycycline (since it's used for anthrax exposure) and found that it didn't deteriorate that way for a substantial time, and in fact sent 'expired' doxycycline out after testing it. Doxy is also expensive now (used to be dirt cheap, then a drug company pumped up the price) unless your insurance covers it. However, it's probably not a great idea to take it too long after the expire date, if you can afford a new supply, as no one is testing your batch.

  15. #55

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    Quote Originally Posted by chef4 View Post
    It's based on some old case reports of what happened to 3 people who took out of date tetracycline (precursor of doxycycline). The army tested doxycycline (since it's used for anthrax exposure) and found that it didn't deteriorate that way for a substantial time, and in fact sent 'expired' doxycycline out after testing it. Doxy is also expensive now (used to be dirt cheap, then a drug company pumped up the price) unless your insurance covers it. However, it's probably not a great idea to take it too long after the expire date, if you can afford a new supply, as no one is testing your batch.
    Doxy is really not that expensive even if you have no prescription drug coverage. I get a prescription for 2-100 mg capsules from my doctor each year for my pack FA kit and it runs about $2.00. (Putting it through my insurance would actually make it higher due to the generic co-payment required.) Looking at prices for the normal course of 100 mg twice per day for 21 days (42 capsules), its running about $42 (Costco) - $95 (Walmart) and as low as $22 with a free coupon from goodrx.com.

    Completely agree that given the long-term consequences of untreated or incompletely treated Lyme, its not worth using expired drugs of unknown efficacy - especially since doxy is so cheap.

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    Doxycycline if the antibiotic of choice for Lyme and a bunch of other stuff. Other than sun sensitivity it doesn't have terrible side effects. I carry it. I would hesitate to use it if I got a suspicious tick bite or Lyme symptoms.

  17. #57

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    Quote Originally Posted by swjohnsey View Post
    Doxycycline if the antibiotic of choice for Lyme and a bunch of other stuff. Other than sun sensitivity it doesn't have terrible side effects. I carry it. I would hesitate to use it if I got a suspicious tick bite or Lyme symptoms.
    Use the 200 mg prophylactic dose if you have gotten a suspicious tick bite, as it's been shown to prevent up to about 90% of expected Lyme infections. If you develop or already have symptoms of Lyme, then you need the full course of treatment. The 200 mg single dose doesn't apply to treating an infection, only preventing one.

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    Quote Originally Posted by Offshore View Post
    Use the 200 mg prophylactic dose if you have gotten a suspicious tick bite, as it's been shown to prevent up to about 90% of expected Lyme infections. If you develop or already have symptoms of Lyme, then you need the full course of treatment. The 200 mg single dose doesn't apply to treating an infection, only preventing one.
    Or do 90% of tick bites not transmit Lyme? Could you provide a credible source for your statistic?

  19. #59

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    Quote Originally Posted by OCDave View Post
    Or do 90% of tick bites not transmit Lyme? Could you provide a credible source for your statistic?
    Note my use of the word "expected" in my post. As far as sources, start with https://www.nejm.org/doi/full/10.105...00107123450201 but there are many more articles on Pubmed. To be completely accurate, the reduction was not 90%, it was 87.5% - but still close enough to qualify as "about 90%".

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    Quote Originally Posted by Offshore View Post
    Note my use of the word "expected" in my post. As far as sources, start with https://www.nejm.org/doi/full/10.105...00107123450201 but there are many more articles on Pubmed. To be completely accurate, the reduction was not 90%, it was 87.5% - but still close enough to qualify as "about 90%".

    Thanks for the source.

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