Lyme on a Dime

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Reprinted from http://lymemd.blogspot.com/ with the kind permission of Dr. Daniel Jaller. To read the original article click here.

Treating Lyme disease can be expensive, incredibly so.

I hear all the time about patients suffering with the disease who don’t seek help because they can’t afford it.

Patients sometimes treat themselves with dubious advice from “the internet.”

Doctors sometimes distance themselves from patient costs.

We can do better than that.

You can get good care for your Lyme disease and keep the farm as well.

Rule one: Be your own advocate

Rule two: Know what you are getting into: is the practice allopathic, integrative, functional, naturopathic etc.

My practice is allopathic which is a little confusing. Allopathic doctors follow Western Medicine. My beliefs and practices run counter to mainstream medical practice which follows a sort or orthodoxy. In that sense I am an alternative practitioner. In the sense that I primarily rely on Western Medicine tools I am an allopath.

I base my diagnosis and treatment on evidence and science.

Make sure you know what you are committing yourself too so you don’t prematurely spend your entire Lyme budget.

Supplements

Supplements can cost a fortune. Do you really need them?

I am not inherently opposed to supplements or nutraceuticals but think their use should be well conceived and limited. I don’t sell supplements because I see it as a conflict of interest. Whenever I research a supplement I become half convinced than that it is a life saver that I must take. The other half says: wait a minute. It is important to distinguish between hype and science. (I do take several supplements daily) I assume the reader has a limited healthcare budget. Beware of the supplement trap. Vitamins, herbs and various nutritional supplements can quickly drain limited resources. A poor investment of Lyme dollars.

Labs

Do not order your own tests.

Labs can cost an unnecessary fortune.

I my early days patients were diagnosed using this on formula describing sources of data used to make a diagnosis: patient history 85%, physical exam 10% and lab 5%. Today there is an overreliance on technology. The new formula reverses the numbers, diagnosis 85% lab. When it comes to diagnosing Lyme and tickborne disease the old paradigm (history 85%) should be applied; one of our problems is that the new paradigm (85% lab) is leading to misdiagnosis.

Patients should have a comprehensive general examination by a qualified physician. Most patients have seen many. Physicians frequently order expensive and experimental tests. Many such tests will not be covered by commercial insurance. As a rule, if results of a test will not change treatment, don’t have it done. Some excellent labs participate with insurance plans and have reasonable fee schedules. Testing for Lyme and coinfections is a necessity.

The Lyme Western Blot, a standard test, should be done at a specialty lab because there is a lot of room for human error with this complex test. And — because the standard test is inadequate. I like MDL; they do an excellent job with a good test for a reasonable price and a lower rate charged to patients without insurance. Many automated tests can be adequately performed at commercial laboratories. I order only antibody tests, not DNA/PCR tests. The latter are costly and miss most cases. I limit initial testing.

Here is what I typically order: MDL: Lyme Western Blot, Anaplasma and Bartonella henselae antibody panels. LabCorp or Quest: Babesia microti, Babesia duncani called WA1, Ehrlichia, Rickettsia antibody panels. If Babesia is suspected an in-office Giemsa stain may be ordered.

Don’t waste limited Lyme dollars on dubious and/or unhelpful lab work. A little homework might save a lot of money.

Treatment

In most cases generic options exist.

Coupons from sources such as GoodRx.com can save tons of money. Lyme and coinfections are treated with antimicrobial “cocktails.” There are many alternative options.

For example, Babesia treatment with Mepron is notoriously expensive. Much cheaper, alternative options which include herbs e.g. (artemisinin derived from artemisia, worm wood) exist.

There are many ways to treat Lyme and associated infections. There is no clear right way. There is a best way: the way you can afford.

Even IV antibiotics can be inexpensive.

Generic Rocephin, the most commonly used IV antibiotic is surprisingly inexpensive through generic sources.

I have discussed primarily saving money on supplements and testing. The biggest budget buster is treatment. I will not discuss treatment specifics here. This is where I save my patients the most money.


Paradigm Medicine Daniel A Jaller, MD Focus on Lyme disease and related illnesses. He is accepting new patients by appointment: 301 528 7111 He does not participate with any insurance plans. To read his blog, see: http://lymemd.blogspot.com/.

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