I paused before going on. Lynn and John stared at the paper. “Now, I want to spend a few minutes telling you about options in treatment.”
“Are you sure?” Lynn asked. “Didn’t you say you were going to retest me for Lyme disease?”
“Yes. That’s right. Here it is.” In concentrating on the CCP antibody, I’d neglected to mention the repeat Lyme test. I flipped to the next page. “The Lyme ELISA test was negative.”
“But it says here …” Lynn, seemingly anticipating my answer, unfolded the papers and pointed to a paragraph she’d copied from an Internet site, “It says here that the Western blot is more sensitive. Lots of times doctors don’t get the Western blot when the initial test is negative. Why didn’t you get that test?”
“Because,” I gathered my thoughts before deciding to confront the question head on. “I believe that approach is wrong. Among physicians, only a vocal minority believe that a positive Western blot and a negative Lyme ELISA are diagnostic for Lyme disease. You have a positive CCP test, which is seen exclusively in rheumatoid arthritis. I’m sorry, but there’s no question in my mind that you have rheumatoid arthritis, not Lyme disease.”
“But I have so many of the symptoms of Lyme disease. I could have been bitten by a tick and not known it. More than 50% of patients don’t have the rash. Here.” She handed me a copy of a website article titled: The truth about Lyme disease: What your doctor won’t tell you.
I handed it back to her. “I know. I’ve seen the list. Most of these symptoms are shared by patients who have inflammatory arthritis, no matter what the cause. It’s a view that proponents of Lyme disease believe. I don’t.” Lynn P.’s eyes were welling up. I handed her a Kleenex. “I’m sorry.”
An Opening Appears
John’s voice drifted over my shoulder. “Lynn, you’ve already done two courses of doxycycline through Dr. Barnes. Isn’t that supposed to cure Lyme disease? You were in pain enough to stop breastfeeding, but that didn’t work. You’ve fasted, and that helped a bit until you needed to eat. Now you’re popping Advil and Aleve and the supplements, done the elimination diet, the copper bracelets, and nothing’s working. You’re getting worse. You can hardly hold Abe.”
Now, this was news. In fact, as I asked Lynn to lie on the table to examine her knees and ankles, I felt that the admission she’d been treated unsuccessfully for Lyme disease might be my opportunity to initiate traditional medical management for RA.
