Question:
Last year, I had bypass surgery. Physically, I recovered very
quickly. Several months after the surgery, I slipped into a clinical
depression. I have a host of symptoms which are largely unresponsive
to anti depressants, and I noticed that my symptoms are generally
germane to neuropsychiatric lyme disease.
I have spent an active life outdoors, in areas which are now known to
be lyme hotspots. I have had many and multiple tick bites since the
early 70s.
Q. Would blood work up prior to bypass surgery reveal lyme disease?
Answer:
Testing for Lyme disease and other tick borne diseases is not routinely done.
It is even difficult to get tested if you go to a non LLMD (Lyme Literate) when
you have symptoms of Lyme disease.
So find yourself a good LLMD and go from there unless you have a Lyme disease
doctor who would test you.
I have been a cardiologist for more than 20 years and find that the
practice of cardiology may have become routine. The massive burden of
ischaemic heart disease sometimes obscures the clinical and
epidemiological traps that lay in our paths once in a while. The
47-year-old consultant of our neonatology department experienced vague
chest sensations accompanied by cough. Palpating his pulse he noticed
extrasystoles. During a transatlantic flight 1 month later, after a short
moment of discomfort in the right shoulder he experienced some
lightheadedness and blurred vision when he went to the lavatory. He
returned immediately to his seat where he collapsed and had a seizure,
which was were noticed by a fellow passenger. Shortly thereafter, all the
symptoms ceased and he fully recovered. He left the plane independently
and was admitted to our department. His ECG was normal, except for
first-degree atrioventricular block. He was observed on our cardiology
ward, where no significant bradyarrhythmias were seen. A 24 h Holter
recording did not show any abnormalities, except for persistent
first-degree atrioventricular block. Left heart catheterisation and
coronary angiography were normal. Invasive electrophysiology testing
revealed a prolonged sinus node recovery time, an atrioventricular node
refractory period of over 400 msec (normal less than 300 msec) and the
occurrence of Wenckebach block at a paced heart rate of 110 beats per
minute. A DDD pacemaker was inserted and the patient did not experience
recurrent syncope.
The patient consulted the medical literature on the causes of
atrioventricular conduction disturbances and had his serum tested for
antibodies to Borrelia burgdorferi in the blood samples taken at hospital
admission. They showed a strong IgM antibody response. Clearly, his
symptoms and conduction disturbances were due to Lyme's disease. He was
treated with doxycycline and the atrioventricular block disappeared on
follow-up ECGs. He had received his pacemaker for atrioventricular block
due to Lyme's disease. It is not the first time that patients themselves
made their correct diagnosis. Even physician patients do so, but for me
this is the first time that in a group of over 20 physicians during a
morning report session, where the ECG's of this 47 year old man with
atrioventricular block were shown, nobody suggested a possible diagnosis
of Lyme's disease. As their chief I fully took the responsibility. I
talked to my colleague and explained that at a later age his pacemaker may
be of value. Clinical errors influence the evolution of careers of many
physicians. A diagnosis missed by a group of doctors will be of use for
the whole group. On the other hand, discussing cases in large groups of
doctors does not guarantee a correct diagnosis of a common disease leading
to a common conduction disturbance treated inappropriately with a common
device.
