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House Calls, April 26, 2012

Practicing family physicians from the UNC Department of Family Medicine have teamed up with The Carrboro Citizen to bring you a weekly feature responding to your questions about health and medicine. Send your questions or comments to yourhealth@unc.edu

This week we respond to questions about bee stings and Lyme disease.

Dear HOUSE Calls, I recently got stung on my arm. My whole arm swelled up and I could barely bend it. Should I carry an EpiPen?

The good news is this type of severe local reaction does not put you at greater risk of a systemic or anaphylactic reaction. You are likely to have severe local reactions when stung by a bee. The EpiPen is for anaphylaxis, which occurs after an exposure like a bee-sting. The person will rapidly develop difficulty breathing, and his or her throat will swell. The EpiPen can reverse such symptoms temporarily and give the person time to get to an emergency room. With a severe local reaction, our best advice is to avoid bees. Failing that, ice and antihistamines (like Benadryl) are the best treatments for severe local reactions. If you do have any breathing problems, get to the emergency room right away.

Dear HOUSE Calls, I recently had Lyme disease. My doctor treated me with 100mg of doxycycline twice daily for 21 days, which is the current CDC recommendation. I have since read that many Lyme researchers recommend 200mg twice daily. My symptoms came back, and my doctor wants to treat me again with 100mg twice daily. Since it did not work the first time, I think he should prescribe the higher dose. What do you recommend?

The most important thing we recommend is that you talk with your doctor and develop a diagnosis and treatment plan together with which you are comfortable. We prescribe 100mg twice daily for 10-21 days. Longer courses have similar rates of cure. The 200mg dose is sometimes used for the first dose or for prevention after tick bites in states where Lyme is common (like Connecticut). If you have read other research comparing treatment courses of 100mg to 200mg, share it with your doctor. There is little downside to the higher dose, so even if your doctor does not recommend it, he might be willing to prescribe it. We wonder if you and your doctor have the right diagnosis. This might be based on exposure, travel history, symptoms and blood tests. However, there are many misdiagnoses of tick-born disease. Further, there is something called “post-Lyme disease syndrome,” which can have similar symptoms and will not respond to doxycycline and includes fatigue and joint or muscle pain. This occurs in 10-20 percent of people with Lyme disease and can linger for six months or more.

House Calls is a weekly column by Dr. Adam Goldstein, Dr. Cristy Page and Dr. Adam Zolotor on behalf of Your Health and the UNC Department of Family Medicine.

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