- A young adult presents to the office
with body aches, fatigue, and joint pain.
What happened next may surprise you.
Let's get started.
Before I walk in to see the patient,
I actually do a chart review
to see if the patient has been seen before,
what the vitals are,
what information has been shared with my medical assistant.
And I find out that the patient
has actually seen several other doctors
over the last few weeks for the same issue,
and hasn't gotten a satisfactory answer,
meaning a diagnosis or treatment to solve the issue.
In looking through the notes,
I saw that the patient was initially diagnosed
with arthritis,
that they attributed to the patient being overweight.
His BMI, I think, put them into the category
of morbid obesity.
While that can cause osteoarthritis,
he seemed to be a little bit too young
for that to start happening.
I walk in to see the patient,
I introduced myself.
One of the first questions is
what has been the diagnosis thus far?
What have all the doctors told you?
You went to see a doctor first
who diagnosed a patient with arthritis
related to his weight.
The treatment for that was
some over-the-counter medications,
which I thought was a rather incomplete treatment,
even if that was the correct diagnosis.
Then patient said when they went home
and tried the over-the-counter options,
the pain did not get better at all.
In fact, it got worse and then a rash appeared.
So the patient over the weekend
went to an urgent care facility
where they gave the patient a cream.
When I investigated what the cream was,
it happens to be a topical steroid
and the rashes did go away with the cream.
However, over the period of about 10 days,
the pain in the joints, in the muscles,
specifically, the knees, the elbows
started to return for the patient.
So he came back to that same doctor and said,
"Hey, why am I not getting better with the treatment,
what's going on?"
And the doctor made some other evaluations
and ended up sending the patient for x-rays
to see if there was anything going on
from the imaging side of things.
And again, reiterated to the patient that the suspicion was,
all the symptoms were coming from
the fact that the patient was overweight.
Clearly that wasn't the issue.
If you look at the course of illness for this patient,
the fact that it was getting worse,
there's not only joint pain,
but there's also body aches.
There's also fatigue setting in,
rashes starting to happen.
These are multiple systems being involved
and that tells me something systemic is going on.
I decided to ask the patient,
if he sent a message to any of his friends of the rashes,
typically we do that, right?
We're like, "Oh my God, what is this?"
And we take a picture with our iPhones.
And to my luck, he did,
he took a picture of the rash early on when it started.
And it looked like an erythematous,
meaning very red rash of the skin.
He only had a picture of one of them,
but he said, all of them looked quite similar.
Now this is unique
because the fact that it's not happening again
in one area
tells me that it's not an isolated
or localized reaction to something.
If I have a reaction right where my watch is
that tells me something is going on in this area,
either there's a contact dermatitis
where I'm allergic to one of the components of the watch,
maybe a fungal infection from trapping of the moisture.
So the localized nature of the rash would tell me something.
But when we have a rash,
that's happening all across the body,
that means something's happening internally.
Whether it's in the blood, in the lymphatic system,
I need to think further.
So I started putting pieces together and I said,
"Wait, you have fatigue, joint pain, body aches, a rash.
Does this patient have Lyme disease?
So I asked the patient,
does he spend a lot of times outdoors, hiking, gardening?
And he said, "No, absolutely not.
I'm kind of a home body.
I like to stay home.
I don't really go outside much."
And I'm like,
"Do you have a dog?"
And he's like, "Yeah, I love my dog.
I sleep with my dog."
I'm like, "Has your dog ever had a tick?"
I see his eyes opened wide.
And he says, "Yes, my dog,
I actually pulled a tick off of him
not that long ago."
The way that we get exposed to ticks
is not only through being outdoors and in tall grass,
but through carriers or vectors.
Like, Bear can literally run into a big forest and area,
get a bunch of ticks on his fur.
And him being brown, me not see it,
climbs into my bed,
leaves one of the ticks next to me.
And they could easily start feeding and cause an infection.
Every other provider he seen thus far
wrote them off as just an allergy, needing some medications,
it's all due to his weight.
Weight is a problem for a lot of my patients.
A lot of my patients do suffer with their quality of life
because they fall into the category of morbid obesity.
But it's also not right to blame everything that's going on
without doing a proper history and physical.
Like, that gets lost right then and there.
So at this point we make a decision
that I think what's going on
is that the patient had an erythema migrans rash.
But what's unique is
erythema migrans sometimes appears with multiple lesions
throughout the body.
And sometimes they're all completely red,
and they don't all look like the prototypical bullseye rash
that we study in our textbooks.
But then I started having to think
the patient actually has early disseminated Lyme disease.
Why?
Because he's starting to have joint pain,
migratory arthritis,
body aches,
which is myalgias,
basically pain in the muscles
that means the inflammation is spreading.
And unless we catch these and act appropriately,
it could lead to further Lyme, late Lyme,
which is very problematic
because then it could spread to your heart
causing things like arrhythmias,
AV blocks,
neurologic complications.
We had to act quickly.
We drew blood then in there
to do two tests,
one the ELISA test
to make the initial diagnosis of Lyme disease,
and then a Western blot
to do the confirmation test for it.
And then right away prescribed a course of Doxycycline,
which is an antibiotic that we like to use
for the treatment of Lyme.
Patient follows up two weeks later,
what do we find out?
A, his Lyme tests, both positive,
b, he feels a hundred times better.
Zero fatigue,
zero joint pain, zero muscle aches.
He's completely cured.
Had he progress to late stage Lyme disease,
and had neurologic or cardiac complications?
He may have needed a hospital stay for IV antibiotics.
He could have lost his life
as a result of a cardiac arrhythmia.
If you happen to be a patient
and you feel your provider is overly focused on your weight,
and you feel like you're not getting good care
because of that,
you have two options:
Option one,
be direct point out to your provider
that you feel like there's an overemphasis on your weight.
And while you know it is an important factor in your health,
it's not the sole determinant of your health.
And you'd like to have a further discussion on that.
If they're not receptive,
move to option two,
or if you don't even wanna have that conversation,
that's your choice to move to option two,
which is seek a second opinion.
That is your right as a patient,
and insurance cannot deny you for seeking a second opinion
because medicine is as much art as it is a science.
The relationship between a provider and a patient
has to be strong
in order for a proper health outcomes to occur.
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I wanna stress this super strongly.
Be careful with certain health providers
who make the diagnosis of a condition,
which is not really a correct condition
of chronic Lyme disease.
They say that you need to do all sorts of treatments
like chelation therapies,
extremely long courses of antibiotics
that have no real evidence for them.
And they blame a lot of my patient's symptoms
on this chronic Lyme disease,
when in reality,
that's not what's going on.
If someone's pushing on you,
expensive lengthy complex treatments,
seek a second opinion
either with another primary care doctor
or even an infectious disease specialist,
because there's a lot,
a lot of fraud and malpractice that happens in this area.
And I've seen my patients truly suffer.
That's just one of my patients' stories,
but click here to check out my bizarre life
as an attending doctor as always stay happy and healthy.
Click here to check that out.
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