Lancaster County and other Pennsylvania doctors: It’s time to think Lyme [column] | Local Voices

Pain developed in my right ear for no apparent reason overnight on Tuesday, June 3. It became so intense that I couldn’t put the side of my face to the pillow.

Early Wednesday, I called my primary care practice and got an afternoon appointment. I was diagnosed with an outer ear canal infection, often called swimmer’s ear, and prescribed ear drops.

I went directly to the pharmacy and applied the drops. Since I don’t swim and have never had an ear infection, I was baffled as to how I got one. But I was optimistic it would clear up, as I’m fortunate to be healthy and active.

Instead, the pain intensified, and a red rash and swelling started spreading across my cheek and down my neck.

On Thursday, my primary care practice said to increase the ear drops and made pain management recommendations. Friday afternoon, the practice prescribed an oral antibiotic sometimes used for severe swimmer’s ear cases, and I started it immediately. Still the rash and swelling kept increasing, until that evening I had no choice but to go to the hospital emergency room.

The hospital doctors started IV broad-spectrum antibiotics. They told me they were also ordering a head CT scan and complete blood count out of concern the infection was spreading into bone and blood.

There and then I said I also wanted a Lyme blood test. This was on the advice of a good friend.

The complete blood count results showed no cause for concern, the doctors said. Based on the scan, they diagnosed a parotid gland infection from an unknown cause. I was kept at the hospital on IV antibiotics through early Sunday morning. I went home later that morning with prescriptions for two oral antibiotics and started them that day.

The Lyme test results didn’t come in until Sunday afternoon: positive for new Lyme infection. Treatment shifted to include a two-week course of the antibiotic doxycycline (which, along with amoxicillin, is a standard treatment for Lyme infection), starting Monday, June 9.

In treating Lyme infection, time is of the essence. If the infection progresses, Lyme can lead to ongoing or recurrent cardiac, joint or neurological complications.

I suspect I got the deer tick bite the week of May 26. A friend and I are outside often, walking trails and working in my yard. With my family visiting Memorial Day week, we were outdoors even more.

Test results to confirm Lyme came back positive in mid-June. The doxycycline was lengthened to a month.

Having to go to the ER and stay two nights was very costly and stressful, for me and my family. Having to ask medical experts standing at my hospital bed for a Lyme test took a courage that was hard to summon when I was in pain and exhausted and my mind was racing, worrying about what was happening.

In Pennsylvania, a patient shouldn’t have to be the one to think of Lyme testing.

Lyme disease is spread through the bite of a deer tick or black-legged tick. According to the state Department of Health, “Deer ticks are found in every county of Pennsylvania, even in green spaces in urban areas.”

In April, the department issued an advisory to health care providers statewide, citing an increase in emergency department visits from Lyme infections.

A news release issued in July by the commonwealth noted that “Pennsylvania typically ranks among the top 10 states in the country for Lyme disease cases per 100,000 residents.” Last year, the state Department of Health recorded 16,620 lab-confirmed cases of Lyme disease.

I believe my treatment would have been much better if the primary care practitioner had included Lyme infection among the possibilities when I presented in the exam room. She should’ve considered how common Lyme infections are in the spring and summer months and started with simple patient communication. Because timeliness is important in identifying and treating Lyme, the care provider could have:

— Asked if I’ve been swimming recently (I would’ve said no).

— Asked if I’m active outside (I would’ve said yes) and, if so, what kinds of activities I do.

— Asked if I have a dog or cat that goes outdoors (I would’ve said yes).

— Ordered a Lyme blood test immediately.

— Considered prescribing doxycycline or amoxicillin immediately.

— Made a referral to an infectious disease specialist.

Bigger picture: Simple communications could also be included in basic patient care to increase Lyme infection awareness — among doctors as well as patients. For example, new-patient forms typically ask what type of work we do. It would be easy to add a question asking what outdoor activities we do and how often.

Lyme education posters should be commonplace in the spring through fall, like the posters on covering your cough or washing your hands. For example, a poster might educate people to keep tick repellent next to their sunscreen for ready use.

I believe that, had Lyme been considered immediately, I wouldn’t have spent a nerve-wracking weekend in the hospital.

Like many Pennsylvanians, my family and I are active in our great outdoors. This isn’t going to change, nor should it!

There’s been a lot of public education recently on tick bite prevention and Lyme (two good sources: hopkinslyme.org and cdc.gov/lyme). My experience leaves me wondering if health care providers need more education.

Doctors, in spring and summer, when you walk into an exam room to an otherwise healthy and active patient in sudden pain or illness, it’s time to think Lyme.

Deb Klenotic is a communications professional who resides in northern York County. She enjoys doing yard work, volunteering on ecosystem restoration projects, and walking the trails in Pennsylvania’s beautiful parks and forests.

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