Re: Today's New Dr. Visit ended as I thought it would

[Guest guest]

Dear Meg,

I hope my last reply helped you. If not please contact me via email I would

very much so like to help any way I can. I have a wonderful new email

address been meaning to find a way to switch all my email to it but for some

reason when I try to change my email in oneslist it says I can't do it cause

it already exists, don't know how that is so but anyone want to email me at

my main email addy it is cyntha@...

I understand every body's advice for me to see an LLMD. Believe me I want to

so very badly. Does anyone know the phone number at Igenex. I think it is

a good idea for me to call them. Thanks who ever suggested that I can't

remember who. Matter of fact I read many of the informations that people

list here but I can't think or comprehend what I read. It is so

frustrating. Especially since I have my own webpage lol...and can't

remember how I did it at times.... it is http://members.xoom.com/Myesha I

wish finding an LLMD was that easy for me...insurance won 't cover out of

state and I have no money to do anything about it. I feel like I am

inbetween a stone and can't move or budge. I plan on fighting though and

chiseling my way through that stone but it isn't going to be an easy battle.

I am looking into seeing if Pocatello Regional Medical Center..it probably

isn't a university hospital but I am curious. I hope maybe some miracle

will happen. I believe in the power of prayer. I hope we pour our hearts

out to him for all of us. I think unified we can do all things. I hope my

faith if you notice on my webpage doesn't detour you from being my friend.

I find that many people are so against our church and our faith, even claim

we aren't christian, but I can assure you I see myself as Christian, since I

believe and worship our Savior. Okay getting to deep. But to let you guys

know how much I see you as family and trust that this won't matter to you,

*I have lost so many friends this way please don't let it be here*

LOL...plus whenever anyone hears what faith I am they automatically see me

as someone trying to convert them, I assure you I am not trying to do no

such thing. I thank you all for being my friends. You have been there

through my laughter, my tears, frustration, hopelessness, pain, and ultamite

sorrows. You have helped me through grey clouds and helped me to see that

rainbows still appear after the storms.

For you my friends

my heartfelt wish

is that you feel the love

that you have given through my bliss.

My sorrows so transparent

my soul so vulnerable

through the roughness of my oceans current

and the pain you made bearable.

I think of you everyday

when awake and asleep

you have become my sun ray

and made my life complete.

I can wake tomorrow morn

and know you will be there

to help me through my sorrows

that I need never fear

By Flying Dove

I am not indian but was honoured with a name that an indian friend of mine

gave me.....Flying Dove...

Thankyou my friends

Cyntha Landon Idaho

>From: hughes@... (Meg )

>Reply-lyme-aidonelist

>lyme-aidonelist

>Subject: Re: [Lyme-aid] Today's New Dr. Visit ended as I thought it would

>Date: Thu, 2 Sep 1999 19:02:21 -0700 (PDT)

>

>From: hughes@... (Meg )

>

>Dear Cyntha, I am so very sorry. I know exactly how you are feeling. You

>have to just hang in there. Keep fighting, keep talking, try to keep

>smiling. You mentioned seizures. Could you tell me something about these?

>My daughter Annie is having seizure like activity and her EEG comes out

>fine. She has not had the EEG while in the middle of one of these

>attacks.

>I don't know if that makes a difference or not. She says they make her want

>to kill her self in order to make them stop. Doc sees no reason to see her

>for this. ER doc was totally blown away, said it was definately

>neuorological. I hate most docs and the insurance Co. for sure!!!! I am

>very curious as to how your " seizures " manifest themselfs. Meg No. CA

>

> >

>

>

>---------------------------

[Guest guest]

cynthia,

u need to find a lyme literate doctor or u will continue to go thru this

agravation i know i have been there.....get the complete symptom list

.......off of one of the websites.....fill it out truthfully....and go from

there since most llmd in my area are not taking pts....many people are

finding docs who are willing to learn about lyme and helping to eductate them

by getting things off of the net....articles from web sites(jama ect) dr b's

protocol.....i email with my llmd all the time and when i see something new i

forward it to him as i have more time to do this stuff ( since i am no

longer working ) then he has.....he loves it...since i was away i was not

emailing him......he wrote me today to see if everything was ok......he is a

special doc whos family suffers from lyme.....so he has a personal stake in

this disease....hate to say it but keep trying till u find one willing to

learn...they are out there......i know dr. b will consult with docs who want

knowledge as will other llmd......just a suggestion ....

hang in there we all know what u are going thru......went to a rheum at the

wets hosp he was the only one who could prescribe my pain pills.......he do's

not believe in chronic lyme......quoted sigal to me.....when i told him i had

seen sigal and that sigal had told me i am chronic ......he was

shocked......i am now attempting to school him in lyme disease.......thank

god for web sites......

this to shall pass......hang in better days are coming but when we are going

thru this it seems like they take so long to get here

Reid

[Guest guest]

Dear Cyntha, I am so very sorry. I know exactly how you are feeling. You

have to just hang in there. Keep fighting, keep talking, try to keep

smiling. You mentioned seizures. Could you tell me something about these?

My daughter Annie is having seizure like activity and her EEG comes out

fine. She has not had the EEG while in the middle of one of these attacks.

I don't know if that makes a difference or not. She says they make her want

to kill her self in order to make them stop. Doc sees no reason to see her

for this. ER doc was totally blown away, said it was definately

neuorological. I hate most docs and the insurance Co. for sure!!!! I am

very curious as to how your " seizures " manifest themselfs. Meg No. CA

>

[Guest guest]

Hi Cyntha,

I can't remember all your posts, is there a LLMD anywhere near you at all to

get antibiotic. I will keep you in my prayers. Maybe you could flood the

rheumy with information, I will send you things if you need them

Hugs to you

connie, MI

[Guest guest]

Connie,

You are so kind thankyou. I have looked here in Idaho for an LLMD. There

may be one yet but just haven't found her/him. There is one in Wyoming that

I am hoping I can find a way to go see. but man that big M word MOney, which

I don't have lots of and insurance won't cover me elsewhere unless i had a

referrel from my primary doc, fat chance. Anyway am hoping for a miracle on

this end. Hoping the Lord is going to open gates for me soon. I have been

teasing my husband and have been saying we need to move to a place that has

more LLMD's. Boy I have thought seriously about that sometimes. I do love

Idaho though this is where I grew up. Never been far from it except when I

live in Salt Lake City, Utah for almost a year getting treatment with my

twin pregnancy and later for my twins Celeste who has had many surgeries and

revisions for her shunts. What a world. But Idaho I love. Sigh. Well I

hope all is going well with all my friends.

Cyntha Landon Idaho

>From: Cslyme@...

>Reply-lyme-aidonelist

>lyme-aidonelist

>Subject: Re: [Lyme-aid] Today's New Dr. Visit ended as I thought it would

>Date: Fri, 3 Sep 1999 07:06:44 EDT

>

>From: Cslyme@...

>

>Hi Cyntha,

>I can't remember all your posts, is there a LLMD anywhere near you at all

>to

>get antibiotic. I will keep you in my prayers. Maybe you could flood the

>rheumy with information, I will send you things if you need them

>Hugs to you

>connie, MI

>

>---------------------------

[Guest guest]

Okay everybody a lesson today from Mrs. Landon. Just got to give you guys a

hard time. Family always do right. My name is CYNTHA no i please.

Pronounced *sin th uh* Thankyou so much. Hee....boy I am glad you guys are

such good sports. I thank all who have gotten it right and have written a

Big A on you report cards...lol

Cyntha Landon Idaho

>From: DJinMECH@...

>Reply-lyme-aidonelist

>lyme-aidonelist

>Subject: Re: [ ] Today's New Dr. Visit ended as I thought it would

>Date: Fri, 3 Sep 1999 22:15:41 EDT

>

>From: DJinMECH@...

>

>In a message dated 9/2/1999 8:57:38 PM Eastern Daylight Time,

>cyncfs25@... writes:

>

><< From: " Cyntha Landon " <cyncfs25@...>

>

> Well I saw the new doc today. Rhuemotologist. He says. I am sure you

>have

> Fibromyalgia. He made me do so many bend overs and asked me a million

> questions. I told him about the rash and so forth. No good, he says it

>has

> to be Fibromyalgia. Now what

>Dear , I am sorry to hear that, I go to a new dr next Fri and I am

>worried that I to will suffer the same fate.

>Is there anyone on this list that lives in Va?? and knows a LLMD, if so,

>please e-mail or IM me.

>Thanks Deb-va

>

>---------------------------

[Guest guest]

In a message dated 9/2/1999 8:57:38 PM Eastern Daylight Time,

cyncfs25@... writes:

<< From: " Cyntha Landon " <cyncfs25@...>

Well I saw the new doc today. Rhuemotologist. He says. I am sure you have

Fibromyalgia. He made me do so many bend overs and asked me a million

questions. I told him about the rash and so forth. No good, he says it has

to be Fibromyalgia. Now what

Dear , I am sorry to hear that, I go to a new dr next Fri and I am

worried that I to will suffer the same fate.

Is there anyone on this list that lives in Va?? and knows a LLMD, if so,

please e-mail or IM me.

Thanks Deb-va

[Guest guest]

<!doctype html public " -//w3c//dtd html 4.0 transitional//en " >

<html>

Hi ,

<p>If you think you have a sleeping problem let me know. I have had the

sleep lab twice and the sleep apnea operation and a sinus operation. I

have really been around that block.

<p>Wes

<br> & nbsp;

<br> & nbsp;

<p>Cyntha Landon wrote:

<blockquote TYPE=CITE>From: " Cyntha Landon " & lt;cyncfs25@...>

<p>Well I saw the new doc today. Rhuemotologist. & nbsp; He says. & nbsp; I

am sure you have

<br>Fibromyalgia. & nbsp; He made me do so many bend overs and asked me a

million

<br>questions. & nbsp; I told him about the rash and so forth. & nbsp; No good,

he says it has

<br>to be Fibromyalgia. & nbsp; Now what? & nbsp; sigh. & nbsp; I predicted that

would be the

<br>diagnosis. So now I have the Chronic Fatigue Syndrome and Fibromyaglia

<br>diagnosis. & nbsp; He wants to do an x ray of my knees, since I have

been having a

<br>lot of problems with my hips and knees and lower back. & nbsp; I feel

like I am

<br>dieing after all his poking and proding. & nbsp; Excuse the spelling. & nbsp;

I guess just

<br>more battling to come. & nbsp; But I am so tired of fighting it. & nbsp;

If it wasn't for

<br>the fact that maybe my kids could have contracted it from me. & nbsp;

Sigh I

<br>wouldn't be fighting as hard. & nbsp; I am not suicidal or anything but

days like

<br>this I just want to give in at times. & nbsp; But that little voice just

never

<br>gives up does it. & nbsp; The fight for survival. & nbsp; I was there for

an hour and a

<br>half. & nbsp; I think lol...the longest doctor visit I have had. & nbsp;

I could use some

<br>good encouraging. & nbsp; I need it to keep fighting. & nbsp; I hate insurance

I hate

<br>doctors. & nbsp; Sigh. & nbsp; Thanks for all your friendship. & nbsp; I

think this group has

<br>been a life saver.

<p>Cyntha Landon Idaho

<p>PS the only thing that has him puzzled is the seizures. & nbsp; Is it

Sleep Apnea?

<br>sigh. & nbsp; He thinks so too as well as do all the other doctors who

have seen me

<br>since the seizures. & nbsp; I guess we will see. They have questioned

wether that

<br>is what it is but all they have done thus far is a home overnighter

test

<br>with an oximeter. & nbsp; Negative as all my tests seem to be.

<p>>From: Shasus@...

<br>>Reply-lyme-aidonelist

<br>>lyme-aidonelist

<br>>Subject: Re: [ ] Rash, Bell's Palsy, and Back Pain Followin

<br>>Date: Tue, 31 Aug 1999 02:32:58 EDT

<br>>

<br>>From: Shasus@...

<br>>

<br>>In a message dated 99-08-31 02:19:31 EDT, you write:

<br>>

<br>> & lt; & lt; Final Diagnosis

<br>> & nbsp; Lyme disease

<br>>

<br>> & nbsp; Discussion

<br>> & nbsp; Lyme disease has gained the distinction of being the most common

<br>>tick-borne

<br>>disease in the United States, with over 70,000 cases reported between

1982

<br>>and 1994 in North America. The disease has also been reported in Europe,

<br>>including Scandinavia, as well as Russia, China, Japan, and Australia.

The

<br>>etiologic agent of disease in North America is B burgdorferi, initially

<br>>isolated from the deer tick Ixodes scapularis in 1982 and from infected

<br>>humans in 1983.[1] B garinii and B afzeli have been implicated as

the

<br>>responsible genospecies for Lyme disease in Europe.[2]

<br>> & nbsp; History

<br>>

<br>> & nbsp; In 1909, Afzelius recorded a rash associated with what we now

call Lyme

<br>>disease, erythema migrans (EM), and hypothesized that disease was

<br>>transmitted

<br>>to the human host via a tick bite. The responsible vector was identified

<br>>and

<br>>named Ixodes ricinis in 1921 by Lipshitz. Lenhoff reported finding

<br>>spirochete

<br>>structures in EM skin biopsies in 1948, and soon thereafter, the efficacy

<br>>of

<br>>penicillin for treatment was documented in Europe. In the United States

the

<br>>first report of EM was in 1970 by Scrimenti, a Wisconsin dermatologist.

In

<br>>1976 Mast and Burrows noted a cluster of EM lesions in Old Lyme,

<br>>Connecticut,

<br>>among patients thought to have juvenile rheumatoid arthritis. This

was

<br>>apparently Lyme arthritis. Dr. Willy Burgdorfer identified a new Borrelia

<br>>species as the etiologic agent of Lyme arthritis, and the spirochete

was

<br>>named after him.[3]

<br>>

<br>> & nbsp; Etiologic Agent

<br>>

<br>> & nbsp; B burgdorferi is a loosely coiled, motile spirochete that is

visible by

<br>>phase contrast or light microscopy. The organism is microaerophilic

and

<br>>grows

<br>>well in Barbour-Stoener- media at 33 & deg;C (91.4 & deg;F). It has

a prolonged

<br>>doubling time of 8-24 hours. Its structure consists of a protoplasmic

helix

<br>>first surrounded by a cell membrane and 7-11 flagella which are then

<br>>covered

<br>>by an outer membrane.[1] Antigens present on Borrelia that are important

to

<br>>immunity, lab detection, and vaccination include outer surface proteins

<br>>(Osp)

<br>>A, B, and C, as well as flagellar antigen and heat shock protein.

The

<br>>flagellar antigen is similar to that of treponemes and other Borrelia.

The

<br>>heat shock protein cross-reacts with similar antigens elaborated by

a

<br>>variety

<br>>of bacteria. Plasmids code for these pathogenic proteins.[1,3]

<br>>

<br>> & nbsp; Transmission

<br>>

<br>> & nbsp; The organism responsible for transmission is the Ixodes tick,

also the

<br>>vector for Ehrlichia chaffeensis and Babesia microti.[4] Ixodes resides

<br>>close

<br>>to bodies of water since it requires 85% relative surface humidity

for

<br>>survival. The salivary gland and gut of the tick are reservoirs for

the

<br>>spirochete, and the tick must feed on its host longer than 24 hours

for

<br>>transmission to occur.[3] This observation is important in recommendations

<br>>for prevention.

<br>>

<br>> & nbsp; There are three stages of the tick's life cycle: nymph, larva,

and adult.

<br>>The nymph begins feeding in early summer and prefers the white-footed

mouse

<br>>or other small rodents, which represent the primary reservoirs for

B

<br>>burgdorferi. The larvae feed in late summer, and the adult feeds in

the

<br>>fall.

<br>>The preferred host for adult ticks is the white-tailed deer. The larvae

and

<br>>nymphs are so small and the bite so painless that they are easily

missed by

<br>>unsuspecting humans. Wild animals do not contract Lyme disease, but

dogs,

<br>>horses, and cattle do.[3,4]

<br>>

<br>> & nbsp; Different species of Ixodes are prevalent in different areas

of the

<br>>country,

<br>>and the percentage of ticks infected also varies from region to region.

<br>>From

<br>>land to Mass-achusetts and Wisconsin to Minnesota, 15% to 70%

of ticks

<br>>are infected, while in the western United States only 2% to 5% harbor

<br>>organisms. Amblyomma americanum is a tick species currently being

<br>>considered

<br>>as a vector in eastern Texas and Arkansas.[3]

<br>>

<br>> & nbsp; Clinical Presentation

<br>>

<br>> & nbsp; The onset is typically from May 1 to November 30, with most

cases

<br>>reported

<br>>in June and July, a manifestation of the feeding patterns for tick

<br>>vectors.[1] The tick bite itself often goes unnoticed, but 50% to

75% of

<br>>patients will present with EM, the classic rash of Lyme disease. It

occurs

<br>>at

<br>>the site of the bite and is an expanding erythematous, raised rash

with

<br>>central clearing. Lyme disease can disseminate early, so the rash

may be

<br>>accompanied by constitutional symptoms such as headache, fatigue,

myalgias,

<br>>and/or fever. Occasionally multiple EM lesions appear, indicating

<br>>dissemination. Flu-like symptoms may be the only manifestation.[5]

<br>>

<br>> & nbsp; Disseminated acute and subacute disease can involve multiple

organ

<br>>systems.[3] Fever and myalgias are common. Arthritis characteristically

<br>>affects large joints, and symptoms are episodic. Fifteen percent of

<br>>patients

<br>>have neurologic abnormalities such as meningitis, encephalitis, peripheral

<br>>neuropathies, or cranial nerve palsies, with cranial nerve VII affected

<br>>most

<br>>frequently. Garin Bujadoux Bannworth syndrome has been described in

<br>>patients

<br>>with Lyme disease and consists of severe headaches, hyperesthesias,

and CSF

<br>>lymphocytosis (~100 WBCs).[2] Cardiac involvement such as myocarditis,

<br>>pericarditis, and atrioventricular block is seen in 8% of patients.

The

<br>>most

<br>>serious is third-degree heart block, which may require temporary pacing

but

<br>>usually resolves spontaneously in less than a week. Borrelia lymphocytoma

<br>>can

<br>>be encountered at this stage. It is usually a solitary, bluish-red

nodule

<br>>and

<br>>histologically has dense lymphocytic infiltrates within the dermis

or

<br>>subcutaneous tissue. Conjunctivitis, pneumonitis, and mild hepatitis

have

<br>>also been reported.

<br>>

<br>> & nbsp; Inflammation is said to be the predominant feature of chronic

Lyme

<br>>disease,

<br>>manifesting as arthritis, meningoencephalitis, and peripheral neuropathy.

<br>>In

<br>>Europe, acrodermatitis chronica atrophicans was reported 10 years

<br>>post-infection in elderly women; this rash presents as a blue papule

of

<br>>doughy consistency on the trunk of a distal extremity that spares

the face,

<br>>palms, and soles. Eventually it becomes atrophic or sclerotic.

<br>>

<br>> & nbsp; Laboratory Findings

<br>>

<br>> & nbsp; Nonspecific laboratory abnormalities may include an elevated

ESR,

<br>>elevated

<br>>serum IgM, and increased liver enzymes. Mild anemia occurs, and WBCs

can be

<br>>increased with a left shift.[1] Identification of B burgdorferi is

the gold

<br>>standard for diagnosis, but unfortunately it is not easily isolated

from

<br>>specimens other than biopsies of EM lesions. Sixty percent to 80%

of 2mm

<br>>punch biopsy specimens from the leading edge of EM will identify Borrelia

<br>>on

<br>>appropriate culture medium. Saline needle lavage will yield organisms

in

<br>>approximately 30% of EM aspirates.[5]

<br>>

<br>> & nbsp; Established serology consists of the tests summarized in Table

I.

<br>>Currently,

<br>>ELISA is the preferred screening assay for Lyme disease. Because of

the

<br>>confusion and controversy associated with testing, guidelines have

recently

<br>>been published.[6] Many experts emphasize that laboratory tests are

not

<br>>cost-effective if a patient has nonspecific complaints such as myalgias,

<br>>arthralgias, or palpitations. Under these circumstances, the probability

of

<br>>a

<br>>false positive is higher than the probability of a true positive,

even in

<br>>high-risk areas for disease. Serologic assays also are not cost-effective

<br>>in

<br>>patients with classic symptoms. For such patients, treatment should

be

<br>>initiated based on the clinical diagnosis, particularly when EM is

<br>>documented.

<br>>

<br>> & nbsp; If a patient has a mixed presentation or a moderate possibility

of Lyme

<br>>disease, it is appropriate to perform an ELISA screen. If the ELISA

is

<br>>indeterminate or positive, the test should be confirmed with Western

blot

<br>>and

<br>>treatment initiated only if it is positive.[5,7,8] However, these

guideline

<br>>recommendations have exceptions, and each situation must be individualized.

<br>>

<br>> & nbsp; Neuroborreliosis is characteriz-ed by a CSF lymphocytosis with

increased

<br>>protein and normal glucose.[4,9] An enzyme immunoassay Lyme determination

<br>>that demonstrates CSF to serum ratio of antibodies greater than one

is

<br>>highly

<br>>suggestive of intrathecal antibody production and therefore supportive

of

<br>>this diagnosis.[1,2]

<br>>

<br>> & nbsp; Polymerase chain reaction (PCR) has successfully detected Borrelia

DNA in

<br>>blood,[10] urine, skin, synovial fluid, and CSF.[2,11] However, there

has

<br>>also been a high incidence of negative PCR determinations in confirmed

<br>>neuroborreliosis, so its value in clinical practice is still being

<br>>assessed.[2,12] Urinary antigen tests are also being developed.[4]

<br>>

<br>> & nbsp; Treatment

<br>>

<br>> & nbsp; High in vitro activity and good tissue penetration make ceftriaxone

and

<br>>doxycycline the drugs of choice.[13] Doxycycline should not be used

<br>>routinely

<br>>in children younger than 8 years of age or pregnant women when there

is a

<br>>safer alternative. Amoxicillin is usually substituted for these

<br>>populations.

<br>>However, some strains of Borrelia have high-level resistance to penicillin

<br>>and are also resistant to rifampin, ciprofloxacin, and aminoglycosides

in

<br>>vitro.[1] Cefuroxime and erythromycin have also been used successfully

but

<br>>are generally less effective.[9] It should be noted that early treatment

<br>>may

<br>>interfere with progression of the normal antibody response, thereby

making

<br>>it

<br>>difficult to subsequently document disease.[8]

<br>>

<br>> & nbsp; Intravenous therapy is indicated for neurologic disease (except

isolated

<br>>facial palsy) and heart block; for these cases antibiotics should

be

<br>>administered for a minimum of 3-4 weeks.[14] Jarisch-Herxheimer-like

<br>>reactions occur in 15% of patients with disseminated disease, typically

<br>>within 24 hours of initiation of treatment.[12]

<br>>

<br>> & nbsp; Prophylactic treatment for a tick bite is not generally

<br>>recommended,[4,11]

<br>>although a 10-day course of amoxicillin or doxycycline taken after

tick

<br>>bites

<br>>has been shown to prevent disease in endemic regions.[1]

<br>>

<br>> & nbsp; Most patients' symptoms resolve after one course of treatment,

although

<br>>it

<br>>may take several weeks before improvement is seen.[15] If symptoms

do not

<br>>resolve, the physician should consider another diagnosis rather than

<br>>treating

<br>>repeatedly or with prolonged courses.[6]

<br>>

<br>> & nbsp; Prevention

<br>>

<br>> & nbsp; The best methods of prevention include insecticides such as

DEET and

<br>>permethrin application to clothing. Wearing long-sleeved shirts and

<br>>longpants

<br>>and checking for ticks is also important. If a tick is found, it is

<br>>imperative to remove it by slow gentle traction with tweezers.[9]

<br>>Environmental measures to control tick and rodent populations are

difficult

<br>>to implement but are currently being pursued in highly endemic

<br>>regions.[1,9]

<br>>

<br>> & nbsp; Vaccination

<br>>

<br>> & nbsp; Lyme disease vaccine has recently been licensed by the Food

and Drug

<br>>Administration for use in high-risk individuals 15 years of age and

<br>>older.[16,17] The efficacy of the vaccine is 68% in the first year

after

<br>>vaccination and 92% in the second year. There is an approximately

4%

<br>>incidence of adverse effects, usually mild, self-limited local and

systemic

<br>>reactions, but only during the 7 days after vaccination. Long-term

<br>>effectiveness still needs to be determined.

<br>>

<br>>

<br>> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Drugs Mentioned

in This Article

<br>> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Amoxicillin

Amoxil, Trimox, Wymox

<br>> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Ceftriaxone

Rocephin

<br>> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Cefuroxime

Kefurox, Zinacef, generic

<br>> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Ciprofloxacin

Cipro

<br>> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Doxycycline

Doryx, Doxy, Monodox,Vibramycin, generic

<br>> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Erythromycin

Generic

<br>> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Levothyroxine

Synthroid

<br>> & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Rifampin Rifadin,

Rimactane

<br>>

<br>> & nbsp; Dr. Baumgarten is an infectious disease fellow, Ochsner Foundation

<br>>Hospital,

<br>>New Orleans, La. Dr. is Assistant Professor, Department of Medicine,

<br>>Section of Infectious Diseases, LSU School of Medicine, New Orleans,

La.

<br>>Dr.

<br>>Pankey is staff physician, Department of Medicine, Ochsner Foundation

<br>>Hospital. Associate Editors: ph R. Dalovisio, MD, Ochsner Foundation

<br>>Hospital; Newton E. Hyslop, MD, Tulane University School of Medicine;

<br>>H. , MD, LSU School of Medicine; VanDyke, MD, Tulane

<br>>University

<br>>Combined LSU/Tulane Pediatric Disease Program. This series is edited

by Dr.

<br>>Steele, Professor and Vice Chairman, Division Head Infectious Diseases,

LSU

<br>>School of Medicine.

<br>>

<br>>

<br>> & nbsp; References

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<br>> & nbsp; & nbsp; & nbsp; 5.. American College of Physicians: Guidelines

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<br>> & nbsp; & nbsp; & nbsp; 6.. Reid MC, Schoen RT, J, et al: The consequences

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invasions in early

<br>>Lyme

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<br>> & nbsp; & nbsp; & nbsp; 13.. Dattwyler RJ, Luft BJ, Kunkel MJ, et al:

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N Engl J

<br>>Med 337:289-294, 1997.

<br>> & nbsp; & nbsp; & nbsp; 14.. Gilbert DN, Moellering RC Jr, Sande MA: The

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<br>> & nbsp; & nbsp; & nbsp; 15.. Donta ST: Tetracycline therapy for chronic

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<br>> & nbsp; & nbsp; & nbsp; 16.. Sigal LH, Zahradnik JM, Lavin P, et al: A

vaccine consisting of

<br>>recombinant Borrelia burgdorferi outer-surface protein A to prevent

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<br>> & nbsp; & nbsp; & nbsp; 17.. Steere AC, Sikand VK, Meurice F, et al: Vaccination

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<br>> & nbsp; & nbsp; >>

<br>>

<br>>---------------------------