ASK THE DOCTOR: With Dr. Keith Sadel, MD – Lyme Disease
ASK THE DOCTOR: With Dr. Keith Sadel, MD
Lyme Disease
A 40-year-old healthy male who has been my patient for over 10 years presented to the office for an urgent visit with complaints of rash. When I interviewed the patient, he had been away to Lake Erie with the family about 5 days earlier. He developed a rash on his back that did not itch or hurt but was nervous and went to the emergency room when he came back into the area. In the emergency room he was evaluated and treated by a nurse practitioner and was treated with a Medrol dose pack and sent home. The rash was getting larger, so he came into see me for another opinion. Upon further questioning he developed shaking chills in the car on the way home form Erie. He had only been there with the family for about 3 days. He does mow his own lawn weekly.
When I examined the patient, he had three large roundish rashes on his back with a clear margin and clear center. The size was about 6-7 cm. He told me the rash had tripled in size since starting the steroids given to him by the emergency room. His exam was otherwise negative.
I had told him that is suspected Lyme disease and I checked blood work to confirm my diagnosis and I prescribed him antibiotic treatment appropriate for this diagnosis. I also told him to stop the steroids.
2 days later the labs came back, and they confirmed the diagnosis of Lyme disease. The patient had early Lyme disease and will most likely make an uneventful recovery with completion of the antibiotic (Doxycycline for 21 days) I gave him.
Lyme disease in the United States is caused by a bacteria called Borrelia Burgdorferi and is transmitted by an infected tick of the genus Ixodes that bites a person. The primary infection can cause flu like symptoms and about 50% of people can develop the classic “bulls eye rash” or erythema migraines rash. If untreated Lyme disease can progress to disease in the joints, nerves, and heart. Lyme disease is very common in this area, and I frequently diagnose and treat it.
Lessons to be learned from this patient: 1. Don’t go the ER for a rash that does not cause you symptoms. It is not an emergency. The patient would have been better of seeing me instead. The nurse practitioner misdiagnosed the rash and prescribed the wrong treatment that could have made the infection worse. 2. If you are going to be outside in wooded areas or doing lawn work, protect yourself against ticks. Use tick repellants like DEET spray (found in Off spray) prior to going in the yard. Wear long sleeve shirts and long pants while doing the yard work. Always check yourself for ticks after being in the woods or the yard. You can place the exposed clothes in a dryer after washing in hot water to kill ticks. 3. If you are concerned about Lyme disease always seek help from your doctor.
Thankfully my patient had an uneventful recovery. His rash went away after a few days of treatment and he suffered no consequences of acute Lyme disease.
Dr. Keith Sadel is a board-certified Internist with over 23 years of experience. His focus is on preventative medicine and, more recently, has focused on personalized membership medicine. His goal is to merge modern medicine with age-old holistic practices. In addition to Preservation Health, Keith and his wife own and operate Lma Mineral Float, a holistic clinic on the first floor of his medical office. Lma offers float therapy in magnesium-rich water, sauna, and CBD remedies, all ailments to reduce stress, pain, and inflammation and to increase relaxation.
As Seen in The Doylestown Cardinal