Cody Willard, the affable charismatic FOX News Business "Happy Hour" anchor, is a financial genius. So it came as no surprise to me when Cody pointed out, in the midst of a dramatic recovery from a bout of acute Neuro-Lyme Disease, that he'd been doing a lot of reading about the topic, particularly about the enormous costs in treating a disease that is both over- and underdiagnosed.
Willard is one of the "lucky" ones. His right-sided facial droop (Bell's Palsy) was preceeded a few weeks earlier by a hike in the woods with his dog, who had come out covered with ticks. And Willard himself, though he found no ticks on his body, developed a bright red oval rash on his leg, profound fatigue, and when he came to see me (referred by Frank Raphael and Maurice Tunick of Sirius Satellite Radio) he had a drooping mouth and difficulty closing his right eye. Lyme disease was clearly a plausible explanation for Willard's problem.
Unfortunately, not all physicians respond the same way to this constellation of symptoms. Calling this Bell's Palsy and ignoring the probability of Lyme or treating it quickly with oral antibiotics without performing a spinal tap is part of the undertreating and underdiagnosing of Lyme disease that Willard was referring too. Chronic Lyme can develop from a delay in diagnosis or inadequate use of antibiotics. In Willard's case, a spinal tap revealed over a hundred white blood cells, an elevated protein, and a low glucose level, all characteristic of an acute infection. He was started on intravenous ceftriaxone right away, and by the time his Lyme titre came back overwhelmingly positive a few days later, he was already well on the road to recovery.
Watch him on "Happy Hour" this week, and you won't even be able to detect a problem.
But not all cases of Lyme are this clearcut. The bright red rash with a lighter center (erythema migrans) occur in only two thirds of cases, and the rash can also be missed or misconstrued as due to an another insect or skin condition. Serological laboratory testing for Lyme disease is far from 100% accurate, and it is often negative in the early stages of the disease. The characteristic symptoms of headache, fatigue, and subsequent joint aches, are not specific for Lyme and are often mistaken for other problems. As Willard realized, the longer you wait for a diagnosis the more expensive both medically and financially. Chronic Lyme disease, which can include severe arthritis, heart problems, and marked cognitive difficulties, is very difficult to eradicate and expensive to treat. And fear of chronic Lyme in people who don't really have it also creates a great health care expense.
Lyme disease, caused by the bacteria Borrelia burgdorferi, is spread to humans by the bite of infected blacklegged ticks (the most common culprit, a deer tick, generally has a tiny white spot on its back). The tick has to be in the skin for over 24 hours to cause infection, and the vast majority of ticks do not carry Lyme. Still, Lyme is on the increase, with almost 20,000 cases in 2006, a national average of 8.2 cases per 100,000. Lyme is especially prevalent in 10 states.
Marc Siegel MD is an internist and associate professor of medicine at the NYU School of Medicine. He is a Fox News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of False Alarm: the Truth About the Epidemic of Fear (Wiley 2005) and Bird Flu: Everything You Need to Know About the Next Pandemic (Wiley 2006). Read more at www.doctorsiegel.com