Suom. huom. Aknen hoitoon annetaan kuitenkin usein 1 - 2 vuoden pituisia antibioottihoitoja.
http://www.washingtonpost.com/wp-dyn/co ... 03164.html
Ticked off, 'Lymies' challenge experts
A bite from a deer tick can cause Lyme disease.
By Maura Lerner
Tuesday, April 20, 2010
Four years ago, after being bitten by a deer tick, Michelle Backes got treated immediately for Lyme disease. She thought she was safe until three months later, when her body started going numb. Then the onetime teacher from Minnesota, turned to a highly controversial therapy: more than a year's worth of antibiotics.
It is, say medical experts, a reckless, unproven and potentially dangerous approach.
But today, Backes, 39, is fit enough to run marathons and is helping lead a grass-roots effort to change the way doctors treat patients like her. "We have to be little renegades," she said.
Lyme disease activists across the country -- who call themselves "Lymies" -- are speaking out in courtrooms, state legislatures and even a recent documentary, "Under Our Skin," to argue that the experts are wrong.
They may have a growing audience, with increases in some states of reported Lyme cases: In Minnesota, for instance, about 1,000 cases were reported in 2008, a fourfold increase since 1998. And last month, activists from the Minnesota Lyme Action Support Group pressured the state Board of Medicine to forgo, for now, the ability to discipline doctors for using the unproven treatment.
Johan S. Bakken, an infectious-disease specialist at St. Luke's Hospital in Duluth who helped write national guidelines for how to treat Lyme disease, calls it "a sad statement when politicians begin to practice medicine without a license."
The problem, he and others say, is that many patients blame a wide constellation of painful and disabling symptoms -- from panic attacks to impotence to memory loss -- on what they call "chronic Lyme disease," without any evidence they were ever infected. There's also concern that overuse of antibiotics can weaken their effectiveness and backfire on patients.
"We understand that people are suffering, and we don't deny that, but you need to apply the right remedy for the right condition," said Bakken. "Now this has all been carried into the political arena. The basic message becomes, 'Don't confuse us with the facts.'"
Backes has no doubt she was exposed to Lyme disease. She found the tick on her left thigh a day after a run in a state park in May 2006 and noticed the telltale circular red rash on her skin. Her doctor put her on standard treatment -- 10 days of antibiotics -- and sent her home.
Untreated, Lyme disease can cause arthritis, heart damage and other complications. But Backes felt fine. "I'd thought I was done with Lyme," she said. Three months later, though, when she was competing in a triathlon, she noticed that her lip was numb. By the end of the race, after swimming, biking and running, "my whole right leg was numb," she said.
A specialist said she might have multiple sclerosis, especially after a brain scan found the distinctive MS lesions. But when an acquaintance suggested it might be lingering effects of Lyme, it made "a lot of sense," she said.
Backes said she couldn't find anyone in Minnesota willing to give the treatment she'd heard about: long-term antibiotics. So she went to Missouri, where a doctor told her she had a "99 percent chance" of recovery. She took antibiotics daily for the next 14 months. She said her "crushing fatigue," dizziness and other symptoms slowly got better until "I was symptom-free."
To Bakken, that treatment makes no sense. But four years ago, he discovered how explosive the debate could be when he helped write the 2006 national Lyme treatment guidelines for the Infectious Diseases Society of America. The guidelines said that antibiotics should be given for 10 to 28 days and that the claims of any benefit from longer-term treatment are unproven.
That fall, Connecticut's attorney general launched an antitrust investigation of the group, saying the guidelines were flawed and were being used by insurers to deny patients care. He later accused members of conflicts of interest in drafting the guidelines. The group denied the allegations, but as part of a 2008 settlement it agreed to sponsor an independent review of the guidelines, expected later this month.
While no studies prove that long-term antibiotics work, onetime family physician and adviser to the Minnesota Lyme Action Support Group Elizabeth Maloney believes it's still an open question and, therefore, "the question becomes: 'What do we do for the people in whom standard therapy did not work?' "
But Gary Kravitz, an infectious-disease specialist in St. Paul, says many of these patients probably don't have Lyme disease at all; it's become a catchall for a "laundry list of symptoms. . . . [They] start treating these people with antibiotics under some blind faith that this causes [their] symptoms."
Maloney agrees that could be a danger. "I really do caution people to not see Lyme everywhere, because that's not helpful."
Backes, though, doesn't need any more evidence. "It made the difference for me," she said.
-- Minneapolis Star Tribune