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Lyme Disease Specialist Cleveland Clinic

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Treating Late Stage Lyme Disease

Robert Perhala, MD | Cleveland Clinic Rheumatologic & Immunologic Disease

Most cases of Lyme disease involve a rash and flu-like symptoms that resolve within 1 month of antibiotic treatment. However, some people go on to develop late-stage Lyme disease, which includes Lyme arthritis and neurologic Lyme disease.

Slightly more than half of people infected with B. burgdorferi develop Lyme arthritis. About 10 to 20 % of people develop neurologic Lyme disease. A very small percentage may develop acrodermatitis chronica atrophicans, a serious type of skin inflammation. These conditions are treated for up to 28 days with antibiotic therapy.

If arthritis symptoms persist for several months, a second 2 to 4 week course of antibiotics may be recommended. Oral antibiotics are used for Lyme arthritis and acrodermatitis chronica atrophicans.

In rare cases, people with arthritis may need intravenous antibiotics. A 2 to 4 week course of intravenous ceftriaxone is used for treating severe cases of neurological Lyme disease. For milder cases, 2 to 4 weeks of oral doxycycline is an effective option.

What Is A Lyme

A LLMD is a physician whose experience with Lyme disease patients makes them familiar with the vast range of symptoms, co-infections, and complications associated with the disease at various stages. Because of this knowledge and expertise, many patients also find LLMDs more open-minded and understanding of their experiences, especially if theyre having a hard time getting an accurate diagnosis from another physician.

But how do you know if you need to see a LLMD? Below are some common reasons, any or all of which may apply to you.

Same Day And Affordable Western Blot Lyme Disease Test Locations Nationwide

Known as “The Great Imitator,” Lyme disease can mimic the symptoms of Fibromyalgia, Chronic Fatigue Syndrome, MS, ALS, Parkinson’s and Alzheimer’s. The Lyme Disease Western Blot test is typically used as a confirmatory test for people who have positive results from previous Lyme Disease testing. An initial screening can be achieved with a Lyme Disease Antibodies Test or Lyme Disease PCR Test which confirm the presence of the bacteria responsible for this disease. The CDC recommends that a positive result for either of these tests be followed up with a Western Blot Test for confirmation. In the event of a positive or indeterminate result of a Lyme Disease Antibodies test, a confirmatory Western Blot test will be automatically run at no additional charge.

Recommended Reading: Lyme Disease Specialist Long Island New York

Treating Lyme Disease: A Functional And Integrative Medicine Approach

On Wednesday, March 8, Dr. Sunjya Schweig and his wife, Lia Gaertner, together gave a deeply affecting and informative presentation sharing their personal and professional experiences with Lyme disease. The talk was part of the ongoing Distinguished Speaker Series. What follows is a synopsis of some of the highlights.

Lia Gaertner sharing her story with a full room at the speaker series event in Berkeley, CA.

Lia Gaertner, a member of the Bay Area Lyme Foundation Science Committee, and Dr. Schweig, who is on the foundations Advisory Board, bring a wealth of professional expertise and knowledge to the table. But their story starts on a personal note, for it was just one month after Dr. Schweig started working in private practice that Lia after 10 years of battling serious illness, unexplained symptoms, and debilitating physical and mental challenges was finally diagnosed with Lyme disease. Together, the couple took what they describe wryly as a rapid descent together down a rabbit hole a deep dive into Lyme, trying to learn as much as possible for their survival.

Infection Protection: Our Prevention Services


In addition to treatment, MetroHealth’s infectious disease experts help prevent the spread of infections to individuals and the community. This includes:

  • Vaccines and advice for people traveling to countries where infectious diseases are common. Should you come home with an illness, we can help you too. Our Travel Medicine Clinic offers these services.
  • Screening and treatment of latent tuberculosis infections, which helps prevent tuberculosis disease. These services are offered in our Tuberculosis Clinic.
  • Medication to help prevent HIV in people who are HIV-negative but at high risk for infection. The medicine is administered through our HIV/AIDS Clinic.

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Serologic Tests Are The Gold Standard

Prompt diagnosis is important, as early Lyme disease is easily treatable without any future sequelae.

Tests for Lyme disease can be divided into direct methods, which detect the spirochete itself by culture or by polymerase chain reaction , and indirect methods, which detect antibodies . Direct tests lack sensitivity for Lyme disease hence, serologic tests remain the gold standard. Currently recommended is a standard 2-tier testing strategy using an enzyme-linked immunosorbent assay followed by Western blot for confirmation.

Diagnostic testing methods in Lyme disease

What Should I Do If I Am Bitten By A Tick

If you experience a tick bite, the best way to remove it is by taking the following steps:

  • Tug gently but firmly with blunt tweezers near the “head” of the tick at the level of your skin until it releases its hold on the skin.
  • Avoid crushing the tick’s body or handling the tick with bare fingers as you could exposure yourself to the bacteria in the tick.
  • Wash the bite area thoroughly with soap and water.
  • DO NOT use kerosene, petroleum jelly , or hot cigarette butts to remove the tick.
  • DO NOT squeeze the tick’s body with your fingers or tweezers.

Recommended Reading: Can Late Stage Lyme Disease Be Cured

Appropriate Laboratory Testing In Lyme Disease

How to Obtain AMA PRA Category 1 Credit and ABIM MOC points

  • Review information on this page.
  • Read the journal article.
  • Return to this page to advance to claim CME or MOC.
  • Login to your myCME account.
  • If claiming MOC, choose the ‘CME & MOC’ option and complete the posttest.
  • Complete the registration / evaluation form.
  • Print your personalized CME / MOC certificate.
  • Release Date: November 1, 2019Expiration Date: October 31, 2020

    Estimated Time of Completion: 1 hour


    Testing for Lyme disease is challenging and, if done incorrectly, can lead to unnecessary treatment.

    Learning Objective

    Readers will diagnose or rule out Lyme disease using a logical process based on clinical clues and diagnostic tests.

    Target Audience

    Directed to practitioners in infectious diseases, immunology, rheumatology, neurology, and dermatology.


    The Cleveland Clinic Foundation Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

    The Cleveland Clinic Foundation Center for Continuing Education designates this journal-based CME activity for a maximum of 1.0AMA PRA Category 1 Credit. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Participants claiming CME credit from this activity may submit the credit hours to the American Osteopathic Association for Category 2 credit.

    Activity Director and Authors

    Lyme Disease Comes To Cleveland Recent Updates Now That Lyme Is Here

    Francisco Marco Canosa, MD | Cleveland Clinic Infectious Disease

    Last year we posted a review of ticks and Lyme disease, making the point that global warming appears to have led to an explosion of tick populations here in NE Ohio, but that our privileged position of being relatively free of Lyme disease was holding.

    Unfortunately, 2018 brings further bad news with regard to Lyme disease. People can now get Lyme disease very easily right here in Cleveland and our surrounding suburbs.

    So, here is a brief update on Lyme disease and how we got here.

    Why was Cleveland spared, why do we have it now?

    Lyme disease is named for where the infection was first discovered in the US, Old Lyme, Connecticut. It is an infection with a bacteria that can only be caught by the bite of a deer tick, typically a baby or nymph tick.

    So, you can only get the infection of Lyme disease if there are the right ticks in your area of the world, and if those ticks are loaded with the Lyme disease germ.

    As the name of the disease suggests, the germ of Lyme disease, called Borrelia burgdorferi, was all over the regions near Old Lyme, Connecticut including much of New England and the mid to Northern Atlantic seaboard. And when first described, turned out to be all over the Upper Midwest in Wisconsin and Minnesota. That left Cleveland in between and almost free of Lyme. Our ticks simply did not have Borrelia burgdorferi in them. No Borrelia burgdorferi, no Lyme disease.

    So, what is Lyme disease?

    Catching Lyme disease

    Early Lyme disease- days after the tick bite

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    Are Llmds Infectious Disease Specialists

    No. While it is possible for a LLMD to be an infectious disease specialist, LLMDs can come from any field or background. Many LLMDs are general practitioners or family doctors, while others may specialize in a specific type of medicine, such as naturopathic medicine.

    For more information on finding a LLMD, read IGeneXs blog How to Find Doctors Who Can Help with Your Tick-Borne Disease.

    Tick Bites: Lyme Disease Symptoms

    Lyme disease, also referred to as infection, is a bacterial illness transmitted to humans when ticks bite them. The deer ticks carry a bacterium that is called Borrelia burgdorferi, harbor it and spread to anyone they are feeding on.

    People who have the greatest possibility of obtaining Lyme disease are those that live in grassy and wooden areas. These are the places where ticks carrying this disease, live. For people who reside in such areas and have a great risk of having Lyme disease, it is important to take some precautionary measures.

    In case the person who was bitten is sensitive to the saliva of the tick, redness may start appearing just at the time of the bite. However, this would be different from the usual rash which is known as erythema migrans as these would disappear within a few weeks and will not enlarge and become redder.

    Other symptoms include fever accompanied by chills, ache in the body, fatigue, and severe headaches. Other people may experience less common symptoms, such as heart problems and an irregular heartbeat, hepatitis and severe fatigue.

    4.Muscle pains

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    What Diseases Can Ticks Spread

    While there are several diseases that ticks can spread, Dr. Bazzoli outlines these particular tick-borne diseases to be aware of, plus their symptoms.

    Text Of Cleveland Clinic About Lyme Disease

    Lyme Disease Specialist Maryland

    Title of Presentation Arial 50pt Bold

    Lyme Disease 2015 March 9, 2015Daniel M. Sullivan MD FACPMedicine Institute

    1What is it?Lyme Disease is a tick borne illnessThe tick transmits a bacteria into our skinBorrelia Burgdorferei in the United StatesBlacklegged ticks are the source

    2Ticks need 36 hours of attachment to transmit diseaseThe ticks are often in the nymph stage2 mm in sizeBlacklegged Ticks SymptomsFeverHeadacheFatigueRashErythema MigransRash is called Erythema MigransLooks like a red bulls eye with a white center UntreatedSpreads to JointsHeartNervous SystemDiagnosis is Based on SymptomsRed expanding rashFatigue, Chills, FeverHeadache, Muscle, and Joint AchesSwollen Lymph Nodes

    Lab TestingShould be done if exposed to blacklegged ticks and have symptomsTreatmentIf diagnosed with symptoms & lab testing..

    Most cases resolve with a few weeks of antibioticsPreventionInsect repellentRemove the tick promptlyReducing Tick Habitat

    Prevention×195.jpgWhere is the Highest RiskNortheast and Mid-AtlanticWisconsin and MinnesotaNorthern CaliforniaReported Lyme disease cases in the United States from 1990-2013

    Reported cases of Lyme disease in the United Stated, 1991-2012

    Confirmed Lyme disease cases by age and sex in the United States, 2001-2010

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    Treating Early Stage Lyme Disease

    The early stages of Lyme disease usually include the bull’s-eye rash and flu-like symptoms of chills and fever, fatigue, muscle pain, and headache. In rare cases, people develop an abnormal heartbeat .

    All of these conditions are treated with 14 to 28 days with antibiotics. The exact number of days depends on the drug used and the person’s response to it. Antibiotics for treating Lyme disease generally include:

    • Doxycycline. This antibiotic is effective against both Lyme disease and human granulocytic anaplasmosis . It is the standard antibiotic for anyone over 8 years old, except for pregnant women. It is a form of tetracycline and can discolor teeth and inhibit bone growth. It can also cause birth defects if used during pregnancy.
    • Amoxicillin. This type of penicillin is the first and probably the best antibiotic for pregnant women. Unfortunately, many people are allergic to penicillin and strains of bacteria are emerging that are resistant to it.
    • Cefuroxime . This cephalosporin antibiotic is an alternative treatment for young children and some adults.
    • Intravenous ceftriaxone or cefotaxime. Intravenous infusions of one of these cephalosporin antibiotics may be warranted if there are signs of infection in the central nervous system or heart.

    Other types of antibiotics, such as macrolides like azithromycin and clarithromycin, are not recommended for first-line therapy.

    Living With Lyme Disease

    Once antibiotics resolve the infection, you can support your recovery from Lyme disease as you would with any kind of arthritis or nerve injury. It is recommended that you:

    • Eata healthy diet and limit your sugar intake.
    • Getplenty of rest.
    • Exerciseat least three times a week for at least 30 minutes each day.
    • Reducestress.
    • Useanti-inflammatory medication when necessary.

    The damageLyme disease causes to your nerves or muscles would heal over a course ofmonths, Dr. Sullivan says. Identifying the infection and treating itappropriately so that the infection is cleared is the first step. And then thebody can start to heal.

    Also Check: Can You Have Lyme Disease Without A Rash

    The Different Types Of Doctors Who Can Test For Lyme Disease

    Home » Tick Talk » The Different Types of Doctors Who Can Test for Lyme Disease

    Lyme disease is a tick-borne infectious disease caused by a group of spiral-shaped bacteria we now refer to as Lyme borreliae. This includes, but is not limited to, Borrelia burgdorferi. It is treatable with antibiotics, but in order to have the best chance at full recovery, its crucial to get your disease diagnosed and treated as soon as possible. That means finding the right doctor.

    But what kind of doctor tests for Lyme disease? You may be wondering if you need to see a specific kind of physician to get the right test and treatment. The answer can depend on your particular situation.

    What To Know About Seeing A Doctor And Getting Tested

    Ahmed Elghawy, DO | Cleveland Clinic Rheumatologic & Immunologic Disease

    Whatever kind of doctor you see, they will consider your medical history, your symptoms, and your Lyme disease test results when making a diagnosis. They should perform what is known as a differential diagnosis in order to rule out common misdiagnoses, such as Rheumatoid Arthritis, Chronic Fatigue Syndrome, ALS, MS, etc.

    Many doctors rely on the two-tier system recommended by the Centers for Disease Control and Prevention, which consists of the following two blood tests:

    • EIA
    • Western blot test

    However, research shows that these tests are severely limited in accuracy and sensitivity. A LLMD may be able to help you get tested with newer and more accurate testing technology.

    Lyme disease recovery starts with finding a doctor who has sufficient experience with Lyme as well as access to the right diagnostic testing. To learn more about what tests are available for Lyme disease today, including IGeneXs ImmunoBlot test, check out the blog The Best Test for Lyme Disease.

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    How To Prevent Ticks

    The Cleveland Clinic outlines the following things you can do to keep your family safe during tick season:

    • Ticks like to hide in high grass, so keep the lawn mowed and hedges trimmed.
    • When going into the woods, cover up exposed skin with clothing. Insect repellant containing DEET can also be used to help protect exposed skin.
    • After being in heavily wooded areas — do a tick check. Its important to look behind knees, under arms and on the scalp.

    How Is Anaplasmosis Treatedand How Can You Prevent It

    Luckily, the number of people who die as a result of an anaplasmosis infection is low. According to the CDC, less than 1% of individuals who have anaplasmosis die as a result of it in the United States. But, again, it’s important to receive treatment early to prevent serious illness or death.

    As with other infections, your doctor might suggest antibiotics once they confirm an anaplasmosis infection. “Usually, we treat it with antibiotics. Doxycycline is a common one,” Dr. Parikh says. Doxycycline is commonly used to treat bacterial infections, including those spread by not only ticks but also mites, infected animals, lice, and contaminated water and food, per MedlinePlus, a resource from the US National Library of Medicine . Patients who take doxycycline usually feel better in no time, Dr. Taege says: “People respond rather quickly. Within 48 hours feeling better, temperature’s going away.”

    While the drug would likely be prescribed for those in the early stages of anaplasmosis, more serious treatments might be required for those who delay seeing a doctor. You could end up hospitalized in the ICU if you allow the infection to progress, causing those late stage symptoms, such as organ failure, Dr. Parikh warns.

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    Also Check: How To Treat Dogs For Lyme Disease

    Why Are Ticks So Dangerous

    Ticks are small arachnids . They can be hard to spot because theyre small and favor making their home in grassy, overgrown and wooded areas. Theyre also known to spread potentially dangerous diseases, like Lyme disease, via their bites.

    That they can be so small and so hard to spot is part of the danger.

    It typically takes more than 24 hours for a tick to infect a human, says Dr. Bazzoli. If a tick falls into your hair or makes its way to a spot thats hard for you to see even on your own body, like your armpit or groin, they could attach themselves and be there long enough to infect you.

    How Is Anaplasmosis Diagnosed

    Reduce Your Risk of Lyme Disease  NewsMD: What

    Fortunately, there’s a definitive way for doctors to know whether they’re dealing with anaplasmosis or not. “It is diagnosed by a blood test,” Dr. Parikh says, explaining that, after doctors have evaluated all the signs and symptoms, blood tests are used to make 100% sure the patient is suffering from anaplasmosis and not a similar infection.

    If you notice a tick on you after a day spent in your garden or on a hike, you might be tempted to keep it in a plastic bag and show it to your doctor if you start experiencing symptoms of infection. While this won’t necessarily hurt, Dr. Parikh says, it might not end up doing you any good, since infectious disease specialists might not know what they’re looking at when you present them with a tick. “It can be helpful, but I don’t know enough about how the ticks look. I would still order the bloodwork ,” she explains.

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