Roanoke Response 2005: Standard of care for Lyme is under dispute
- From: "CaliforniaLyme" <CaliforniaLyme@xxxxxx>
- Date: 27 Oct 2005 08:34:42 -0700
http://www.roanoke.com/editorials/commentary%5Cwb/38011
Thursday, October 27, 2005
Standard of care for Lyme is under dispute
Leila Zackrison, M.D.
Zackrison is a doctor in Alexandria.
Jen McCaffery's article on my hearing before the Virginia Board of
Medicine was accurate but incomplete ("Shining a light on Lyme
disease," Oct. 11).
As McCaffery stated, the charges of improper patient care stemmed from
a very acrimonious debate within the medical community over how to
treat patients suffering from Lyme disease.
At issue is the standard of care followed by most physicians (Centers
for Disease Control guidelines), which is based on eradicating the Lyme
spirochete during the disease's acute phase, and consists of less than
a four-week course of antibiotics. This standard is successful if the
diagnosis is made almost immediately after infection and if the patient
is otherwise strong and healthy.
Prior to medical school, I earned a master's degree in biochemistry,
and learned how to apply its research techniques to the knowledge
provided by medical training and subsequent clinical observation.
Thus, I, and a minority of like-minded colleagues, have observed that
if the infection occurs in patients already suffering from other
diseases, the acute phase of Lyme (and other tick-borne diseases) can
be masked by other symptoms or misdiagnosed and treated as something
else, often under the label of fibromyalgia, chronic fatigue syndrome
or similar diagnoses which share the same symptoms as Lyme.
The spirochetes, which never read the CDC guidelines anyway, remain in
the patient's body, entering a longer-lasting or chronic phase.
Their life-cycle is longer than four weeks, and they prefer to hide in
places that have low blood flow and thus are difficult to reach even
with "adequate" antibiotics. It stands to reason that four-week
antibiotic treatment is incapable of eradicating a six-week or longer
life-cycle bacterium. Most internists in Northern Virginia and
nationwide refuse to accept the fact Lyme exists in a chronic phase.
The damage caused by the complaint against me was extensive: many weeks
of intense preparation for the hearing, a significant amount of lost
income, declining physician-originated referrals (though
patient-originated referrals are very robust), lawyer's fees, not
seeing many patients who needed my type of specialized care and, worst
of all, the unnecessary fear and anxiety my patients experienced over
the possibility of losing the best doctor that they have ever seen.
As demonstrated in the hearing, none of the three patients were harmed.
In fact, one is still under my care.
Even the Board of Medicine's expert witness concluded his comments by
stating that the basis of this complaint should best be dealt with by
debate and research within the medical community, not by a disciplinary
hearing.
I was exonerated because it was clear during the hearing that I know
what I am doing, I am a capable diagnostician and I have a higher rate
of success with immuno-compromised patients -- especially with Lyme
patients -- than do those physicians who insist on using the standard
of care for non-standard infections and patients with complex
presentations who do not fit any standard but their own.
.
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