Received: July 21, 2017; Published: August 01, 2017
Corresponding author: Douglas Trenkle, DO, Board Certified, American Board of Internal Medicine, American Board of Clinical Lipidology, USA
What is happening to medicine? Are the dictums of Standard of Care outweighing the needs of those who are to be served? I think so. Take, for instance, the screening recommendations for prostate cancer. The USPSTF concluded several years ago, 2012 I believe, that screening for men younger than 75 “offered no benefit” to that age group. Insufficient evidence was their language. And if someone is over 75, then they recommend totally against screening. I have read the background to these recommendations. There have been extensive studies, those with PSA, those without PSA who get DRE (digital rectal exams). It is remarkable, really, that this has been the position for over half a decade by the preventative task force. But it is a challenge when in your training the 70’s and 80’s, through medical school, internship and residency, palpating the prostate and later the blood analyses (there are multiple ones now) was an integral part of examining men.
Well there is another area that seems to me less clear, and that is the standards for tick bites in areas where Lyme disease is endemic. Currently the recommendations are no treatment at all if the tick is not engorged, and one day (maybe) if the tick IS engorged. Now granted, a tick bite does not confer the diagnosis of Lyme disease to the individual. But in endemic areas, where 60% of the ticks are infected with Borrelia burgderfori, it might be a consideration to treat someone preventatively. Not to mention that over 20% of those infected never recall a tick bite. Not to mention that doctors give prescriptions for doxycycline for years for individuals with cystic acne. So what is the thinking? I was bitten recently by a tick, saw it tightly attached under my right arm, and called my wife. We have a tick spoon remover, and used it. It felt like a phlebotomy. But the whole darn thing was removed, and I was pretty certain it was new, ie, within the last 10 or 12 hours. So I called the clinic for a week of doxycycline. “Can I get it?” “No,” was the answer initially from the nurse. “Let me talk to the doctor.” I get a call back a few hours later and was asked if the tick were engorged. “No” I replied. Well then, no treatment will be given….well, maybe one dose of 200 mg of doxycycline.
I responded by mentioning the above facts, and was ignored since giving a week of doxycycline for a tick bite is not the standard of care. Amazing, I thought. So, I called the pharmacy and prescribed the week of antibiotics for myself….and took it….along with three refills just in case.