Do you suspect that you, a family member, or friend has Lyme disease in its early stage? Finding and selecting the right physician to consult involves a number of factors and decisions that only you can make. Here are a few considerations that you should keep in mind.
If you live in — or visit– an area where there are deer ticks, and it’s the season when they are biting, there may be a risk of Lyme disease and other tick-borne diseases. The appearance of an expanding red rash wider than the size of a quarter in diameter and accompanied by other symptoms, such as fever, headache, fatigue and/or muscle and joint pains, may be early Lyme disease. If it is tick bite season and there is a fever without a rash, this could be Lyme disease, too, or also one of the other diseases carried by deer ticks. A tick need not have been found. Both situations call for prompt medical attention at a primary care practice, walk-in clinic, or urgent care center.
Lyme disease itself is usually not a medical emergency, However, some of the other tick-borne diseases are severe enough to merit hospitalization. In areas where Lyme disease is common, many primary care physicians, such as family practitioners, general internists, and pediatricians, are experienced in dealing with cases of early Lyme disease. A medical specialist, such as a physician who is board certified in the specialty of infectious diseases, is usually not necessary. In fact, the wait for an appointment to see a specialist may needlessly delay antibiotic treatment when that is called for. A good first step then might be to look for a local primary care physician or practice group with experience in diagnosing and treating Lyme disease.
If either the early stage was missed or not attended to, and the main symptoms are the new appearance of arthritis of a joint, such as the knee, or a disorder of the nervous system, this may be Lyme disease, especially when there was exposure to deer ticks a few weeks or months before. But another disorder may account for these symptoms, and this may call for a different treatment than Lyme disease. So, the steps for diagnosis may be more complicated. Many primary care physicians in regions with a high Lyme disease risk are also experienced in handling cases of Lyme disease that are further along in their course. But at this point a specialist, such as a rheumatologist for a joint problem, a neurologist for a nerve problem, or an infectious diseases expert may be consulted and also would likely be knowledgeable about Lyme disease in its later stages.
A more vexing and frustrating problem for the patient is when there are long-standing symptoms, which may be fluctuating in their severity and which are hard to ascribe to a single disease. Symptoms like persistent fatigue, generalized muscle or joint aches without actual joint swelling, and difficulty concentrating or a foggy brain sensation can be disabling but not indicative of one disease. There may several different causes for unexplained physical symptoms like these, some of which are infectious in origin but most of which are not. In such cases a primary care physician with a broad general perspective might be helpful in sorting things out and coming up with a plan for improved health.
In the course of seeking help for their troubling symptoms, a person may have received the diagnosis of “chronic Lyme disease” by a practitioner. The person may also have come to that diagnosis on her or his own after seeking answers on the web or through various Lyme disease advocacy groups in the United States and Canada. If either the prescribed therapy falls short of expectations or a second opinion about the diagnosis of “chronic Lyme disease” is desired, a board-certified specialist in Infectious Diseases (ID) is often consulted. ID specialists across the country–even in areas where Lyme disease is uncommon–often have experience in dealing with the question of whether a disorder is “chronic Lyme disease” or not. If there is another explanation, the physician with this training and experience is usually competent to explore with you other treatment options. Of course, if these more general symptoms, like fatigue, are accompanied by disorder of a particular body part or system, e.g., a joint problem or neurological disorder, then physicians in specialties like rheumatology and neurology, as the case may be, may be more appropriate.
The reference “Castle Connolly Best Doctors” provides an excellent way to find local physicians who are board certified in various specialties such as infectious diseases, rheumatology, neurology etc. Here, perhaps a good first choice would be to select “Infectious Diseases” as the specialty, and then give your zip code (or city), as well as your state.
When you contact the physician you have selected, you might ask him/her about their experience in diagnosing and treating Lyme disease and other tick-borne infections — and whether he/she generally follows the guidelines developed by the Infectious Diseases Society of America (IDSA) for the treatment of Lyme disease and other tick-borne infections. The IDSA guidelines are near universally accepted by experts on Lyme disease, and are in agreement with those of several other established medical societies, including the American Academy of Neurology, the European Federation of Neurological Societies, the European Union of Concerted Action on Lyme Borreliosis, the Canadian Public Health Network, and the German Society for Hygiene and Microbiology. They also are in agreement with recommendations made by expert panels from 10 European countries, i.e., The Czech Republic, Denmark, Finland, France, The Netherlands, Norway, Poland, Slovenia, Sweden, and Switzerland. None of these organizations or expert panels, as well as the Centers for Disease Control (CDC) or the National Institutes of Health (NIH), recommends periods of antibiotic therapy of more than a few weeks for Lyme disease infection, even if the early stage was missed.