Wednesday, February 11, 2015

Bummer of a birthmark, Hal. Or is it Lyme Disease?

Woke up last Saturday morning very early to take my daughter and her family to the airport, then came home and went back to bed. We usually sleep in on Saturday mornings.

Gary Larson cartoon:
When we finally awoke, about 10 or 11 a.m., I got up and Darlene said, "What's that on your back? Bummer of a birthmark, Hal!"

I immediately recognized the reference to the old Gary Larson cartoon. (At left.) She handed me her hand mirror, and looking in the bathroom mirror, what I saw on my back was a perfect "Bulls' Eye" target. (See photo below.)

"What is that?" she repeated.

"I have no idea. I must have leaned up against something," I replied, straining to think what might have caused such an unusual pattern.

"Well, if it's still there tomorrow," she said, "you're going to see the doctor."

bullseye rashSunday came, and it was still there, about the same. So we started searching the internet. "Bullseye rash" turned up some interesting information, mostly related to Tick bites and the diseases they can cause. The bulls-eye rash can be caused by many things, but the best-known (and probably most-feared) is Lyme Disease, which debilitates its victims with neurological symptoms: headache, fuzzy thinking, bad dreams, muscle and joint pain, fatigue, arthritic attacks and sometimes spinal meningitis and heart problems. The bacteria in infected ticks comes from mice or rats they have bitten. Lovely. Despite all this nasty history, though, it's rarely fatal.

I thought back. I had been hiking on Wednesday (briefly on the Deception Pass State Park trail, then a longer hike on the Galbraith Trail in Bellingham), and the time for appearance of the symptomatic rash is said to be 3 to 30 days. My wife took a closer look at the bulls' eye ... there was no embedded tick, thankfully, but there was a puncture mark in the center of it. (Which you can make out by zooming in on the photo.) Something bit me.

The only other insect that can cause a "bulls-eye rash," according to internet sources, is a spider, but those bites are typically painful. I would never have known the rash was there, had my wife not seen it.

I had no other symptoms, except for mild fatigue and muscle aches, and these could have been caused by my week-long vacation and the fact I had to go back to work on Monday.

So, instead of going back to work first thing Monday morning, I saw my doctor. He was immediately very interested, took photos, and disappeared to do research on his computer. He then returned with another doctor, who also wanted a look. And he had a list of possible causes on a print-out sheet.

"You're weird," was his diagnosis.

"I'm paying you all this money to tell me something I already know?" I retorted.

"Well," he backtracked, "statistically speaking, it's unlikely it's Lyme Disease." Most cases occur on the East Coast, although there are a handful (about two dozen, according to the State Health Department) in Washington each year. "I think the greatest likelihood is some sort of fungal infection, so I'm going to prescribe an antifungal cream for that. But because Lyme Disease is a possibility, I'll also prescribe an antibiotics course to make sure we can knock that down if that's what you have." The best chance victims of Lyme Disease have, I've read, is if they are treated early with simple antibiotics.

So, I started a two-week tetracycline course. The antibiotic is common, but hard to come by now when so many people are sick with infections. But 24 hours and about four pharmacies later, I had my antibiotic.

The antifungal lotion, Mentax, was another matter. My pharmacy didn't have it and couldn't get it for a few days. I ended up going to Wal-Mart's pharmacy (a nightmare in and of itself), and they got a tube after 24 hours, then informed me my insurance wouldn't cover it. That one little tube cost $112. Too rich for my blood.

I called the doctor back to explore alternatives. The first thing he asked was, "How's the rash? Any worse?" Darlene looked at my back. "No," she said, "it actually appears to be fading on its own."

"Good." He said. "Don't worry about the cream, then. It must not be a fungus. I consulted a few other doctors, and they all agreed with me that the antibiotic course is the wisest. And we'll see what the blood tests say."

I'm not sure exactly what this means. I may or may not have been infected with the bacteria that causes Lyme Disease, I guess. He also told me the early blood work would be relatively unhelpful, unless it came back positive, since I probably wouldn't have antibodies against Lyme Disease in my blood this early, anyway. (And it did come back negative, finally.)

So I went back and did more reading on the disease. The CDC actually has an extensive write-up about it on their website. They say there are more than 30,000 cases reported in the U.S. each year, but they believe in reality, as a result of their research, that nearly 10 times this many actual cases go unreported. In fact, I read elsewhere that because of its neurologic symptoms, Lyme Disease is often confused with ALS.

I thought back about how fortunate it was that Darlene saw the rash. I never would have. (Yet another great reason to marry a nurse!)

So, all this is probably not very helpful to anyone reading this, hoping for more definitive information about Lyme Disease. (I guess the bottom line is, if in doubt, do the antibiotic!) But, like many other things in life, an "interesting" incident like this often creates more questions than it does answers.

(By the way, the "target" on my back has now almost fully faded. So, if anyone was thinking of taking a potshot at me, don't bother. But continuing prayers would be appreciated!)

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