Re: IDSA Guidelines...can anyone tell me what this means?


pam3001@xxxxxxxxx wrote:

#3, every time I check back here, which is not very often, I notice
you stay confused over the meaning of the term clinical diagnosis as
used by IDSA in Lyme Guidelines.

I concede that what you say here is entirely possible.

The IDSA guidelines state exactly
what LDA suggests on this issue, to wit, that clinical diagnosis refers
ONLY to the rash.

Where? (Please)? I am aware, as I have pointed out in this discussion,
that they say that the only sign that is distinctive enough to "call
it" is the EM rash. So, a doctor needs to order serological testing to
confirm "excutaneous" symptoms.

But I the definition of "clinical diagnosis" as most practitioners use
it (to my experience, at least, admittedly limited)...is similar to
this:

"clinical diagnosis"

"a diagnosis made from a study of the signs and symptoms of a disease".


(Retrieved from
"http://www.biology-online.org/dictionary/Clinical_diagnosis)"

So what you are telling me is that the "boys" have developed their own
definition solely for the purposes of Lyme disease diagnosis? And we're
supposed to understand that? The average GP is supposed to understand
that?

Other than that the Guidelines advise that doctors
defer to the two-tier test method in confirming the Lyme diagnosis --of
course, along with a few late major manifestations that are objective
in nature and well-circumscribed, but these cannot meet the bar without
serology.

Yes, we know...but the question here is what does it MEAN to "confirm
the diagnosis"? Why would you need to do that? Can you provide
treatment if the diagnosis is only "presumed"...is there a difference
between a diagnosis and a "confirmed" diagnosis?

I would suggest to you that these are not inconsequential questions.

If you follow the LDA logic to its conclusion, then what they are
advocating to their professional brethern...is that treatment for Lyme
disease be administered IF and ONLY if the diagnosis is "confirmed" via
a positive western blot in accord with CDC standards.

Now, they KNOW the limitations of the blot...KNOW that this procedure
will undoubtedly ERR in "confirming" diagnoses...

....so...again, if you follow the logic...

....then what you are saying is that the IDSA is KNOWINGLY advocating
the witholding of a known beneficial treatment to patients that it
would most likely benefit?

That's what you are saying? Consider the implications of that. That
can't possibly be a correct interpretation. It would seem that there is
sunstantial evidence of just how many could be reasonably expected to
be unttreated under that scenario.

The ultimate issue here, from a patient perspective, is to treat or not
to treat.

IF you have a history of exposure, a history of symptoms consistent
with the known "constellation" of symptoms, and a NEGATIVE blot...then
the question is "can the physician then provide treatment"?

THAT is the critical issue here, I would suggest. Can you treat in the
absence of a "confirmed" diagnosis? Yes or No?

The LDA suggests that the effect of the IDSA guidelines is "no". And.
as I have poited out, previously...that is SERODIAGNOSIS...pure and
simple. Effectively, this means that in the case of an EM rash, a
clinical diagnosis is possible. In all other instances, the diagnosis
is via serology ALONE.

Again...what is the difference...between a "confirmed diagnosis" and a
"diagnosis"?

My impression has always been that once a diagnosis has been reached,
then appropriate treatment must be provided.

Within the context of Lyme disease, a "confirmed diagnosis"
necessitates the reporting of the case to the CDC for surveillance
purposes.

"I will probably not check on this group again for months..."

Okay. (Always good to chjeck in to see whose penis Kathleen is
insulting, though...you don't want to miss out on that).

and certainly will not stay to argue with you on what seems to me a
point of reading comprehension.

Well, goodness...I was just trying to understand here...asking
questions. Anything wrong with that? I even said to Rita that I was not
trying to be "argumentative".

I thought this was supposed to be a "discussion" board...we were here
to talk about these very sort of things...to help one another
understand.

If I am wrong...I am wrong...you may not have noticed where I said to
Rita that I suspect she is correct. Sometimes it is good to re-examine
issues, to re-evaluate concepts...just for the sake of doing that.
(perhaps discussing penis size is more important)?


However, if you don't get IDSA's
interpretation of the term 'clinical diagnosis' from your read, I
suggest you call IDSA or one of the guideline authors to have them
confirm this. Good luck and I hope you are able to work this out. I
suggest that checking with the source is a better way to learn what
they mean by the term than arguing with people in this forum.

Again, my goodness...what has gotten you so upset? I do NOT think I was
"arguing"...and I do NOT recall ever having encountered you before...I
don't think I have ever had any communication with you whatever.

Goodness, gracious. That almost seems hostile...have I given offense in
some way?

But...do you think it is wise to just say...I'm right...you're
not...and not provide any reasoning for that assertion?

You
simply are incorrect and your read of the material is missing the crux
of the meaning that is spelled out in detail in the body of the text.

That certainly seems to be YOUR interpretation.

Well, THAT certainly is helpful. (I'm right...and YOU are not)!


.

Relevant Pages

  • Re: New directive from Fearless Leader
    ... about treatment...as I am about diagnosis. ... I wish the IDSA document ... especially in late stage disease. ... why IDSA and CDC guidelines are extremely important. ...
    (sci.med.diseases.lyme)
  • Re: New directive from Fearless Leader
    ... up the patient's ass {those who don't scream probably have lyme ... as most IDSA members do...so that is a somewhat poor analogy} " ... about treatment...as I am about diagnosis. ... stage disease from this perspective, ...
    (sci.med.diseases.lyme)
  • Re: Steere/Yale MAJOR screw-up.
    ... surveillance guidelines or what? ... the way and for the record) are NOT for diagnosis and they say so. ... If PCPs use them for diagnosis it IS their responsibility. ... Well I think many types of doctors end up seeing Lyme patients. ...
    (sci.med.diseases.lyme)
  • Re: IDSA Guidelines...can anyone tell me what this means?
    ... But this is not brought out in the IDSA guidelines. ... It is omitted just like other evidence that they consider 'unconvincing'. ... diagnosis and treatment". ... The Infectious Diseases Society of America considers adherence to these ...
    (sci.med.diseases.lyme)
  • Attention: LymeNUTS! Heres an idea...
    ... ASK THE LDA WHERE THE LANGUAGE IS WITHIN THE GUIDELINES THAT IS SO DAMN ... "Clinical findings are sufficient for the diagnosis of erythema ... For all other clinical manifestations, ... Because what the insurance companies would be citing in that instance, ...
    (sci.med.diseases.lyme)
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