Forums » Ask a doctor for free health information

Ankle Pain

    • 12 posts
    September 12, 2014 9:26:21 AM PDT

    DX Ankle Rt 3 View

    There are no fractures or subluxations of the right ankle. There are no abnormal masses or calcifications. There are no blastic or lytic lesions.

     

     ankle lying down

    I don't know what to think anymore about this. My foot has been like this for 8 months now. It is painful and pops a lot.


    This post was edited by Torvren at September 12, 2014 9:33:54 AM PDT
    • Moderator
    • 1957 posts
    September 12, 2014 10:24:09 AM PDT

    Greetings T,

     

    Thank you kindly for your question. 

    Legal disclaimer:  we do not have a doctor- relationship and we cannot give specific instructions of care to you, but we can give you our best effort to find high quality information that you can consider. If we are wrong, or you don't like what we say, feel free to leave a message and let us know how we can improve  quality of service.In addition, we encourage other people in the community to contribute their knowledge to the questions that are asked. 

    For example, if you have a rare disease, and had a rare surgery, please simply state "back surgery," and if needed we can explore that further.  If your neighbor or best friend reads this, will be they be able to identify you based on the information given? If yes, please remove the information or change it slightly. 

    BAD example:  I live in Boston, Dr. Patel at MGH hospital diagnosed me with a schwannoma tumor last month, then I traveled to Tokyo and taught english for a year.  

    Acceptable example: I live in the United States, I had a tumor & surgery, then I traveled abroad for work

     

    1. Please tellme a bit more, when did this start. Did you notice a sudden change in your foot? 

    How has it affected your life? Are you able to hop, jump, and skip if you tried? Would it be without pain?


    This post was edited by Brett Snodgrass at September 13, 2014 3:28:15 AM PDT
    • Moderator
    • 1957 posts
    September 12, 2014 10:30:33 AM PDT

    1b. Age: Please add or substract (2-5 years if adult for privacy)
    2. When did problem start?
    3. Have you had this before?
    4. Is it getting better or worse?
    5. Height?
    6. Weight?
    7. Heart Rate?
    8. Temperature?
    9. Medical conditions current?
    11. Your current medications?
    11. Your current supplements?
    12. Your surgeries?

     

    19. Medical conditions in family?

    20. When was your last doctor appointment?

    21. What did the doctor tell you about the current

    22. What medical conditions do you have?

    22b. What medical conditions did you have in the past.

     

    22. What Medications are you taking?

    23. What medications were you taking over the past few years?

     

    I look forward to hearing from you.

    Kind regards, 

    -BrettMD

    • 12 posts
    September 12, 2014 10:33:01 AM PDT

    It has been at least 8 months. I think it started when I had some kind of a bite below that bulge. It swelled up then and was very painful. It healed and now I have this bulge sticking up. There is a band of pain between the ankle bone and that 'bone'. I am not able to do anything with it without it hurting.

    • 12 posts
    September 12, 2014 10:48:54 AM PDT

    It has been at least 8 months. I think it started when I had some kind of a bite below that bulge. It swelled up then and was very painful. It healed and now I have this bulge sticking up. There is a band of pain between the ankle bone and that 'bone'. I am not able to do anything with it without it hurting.

     

    1b. 32 
    2. at least 8 months ago
    3. first time and the left ankle looks normal 
    4. I tripped a month ago and that made it worse
    5. 5'4 
    6. 200lbs 
    7. 90 
    8.  normal 
    9. muscles in my body sensitive to the touch, joints hurt a lot 
    11. none
    11. none
    12. just an upper GI that showed some chronic inflammation

     

    19. MS, Degenerative joint disorders

    20. last month

    21. No Lupus, No MS, Ankle Xray shows nothing

    22. muscles sensitive to the touch and a lot of joint pain

    22b. Lyme Disease Last year between April and June

     

    22. no meds

    23. 3 months of cipro ear drops(tick was in my ear for 10 days before this), 10 days of Doxycycline and Cipro, then 2 weeks of Zoloft that ended with a 3 day hospital stay with muscle spasms and locking, 

    • Moderator
    • 1957 posts
    September 12, 2014 11:15:17 AM PDT
    Did the doctor who ordered your foot x-ray set up (refer) an appointment with an orthopedic surgeon?

    Did this happen suddenly?
    Did you hear a pop when it occurred ?
    Please see the picture and let me know where the pain is.
    Do you have joint pain anywhere else?r
    Do you play any sports?



    Were
    Thank you kindly,
    -BrettMD
    This post was edited by Brett Snodgrass at September 12, 2014 11:15:45 AM PDT
    • Moderator
    • 1957 posts
    September 12, 2014 11:18:31 AM PDT
    Is this correct:

    90 says of ciproflixacin in the right ear
    10 days of docxycline + ciproflixacin, (both were by mouth..)
    • 12 posts
    September 12, 2014 11:35:48 AM PDT
    Brett Snodgrass said:
    Is this correct: 90 says of ciproflixacin in the right ear 10 days of docxycline + ciproflixacin, (both were by mouth..)

    It was in the left ear, this is what the doctors gave me after the tick was removed from my left ear after 10 days of it being in there, it took 3 doctors to find it, the inside of my left ear was lacerated in many places. They just kept giving me more antibiotic ear drops after the tick was removed. After 90 days of antibiotic ear drops the whole left side of my head was red and inflamed. Then I went to the ER and the doctor did no tests but looked in my ear, said it looked bad and gave me 10 days of Doxycycline and ciproflixacin oral antibiotics.

     

     

    My ankle was deformed with that bulge on the right for at least 6 months. My doctor did no tests but concluded it was probably a ganglion cyst. There may have been a pop when I tripped yes.  Nearly every joint in my body hurts at one time or another. The pain is about from H to I in your diagram. With the ankle being on the bottom side of I and the other 'bone' being on the top side of I. I am not a physically active person.

    I don't know how that spot on my foot got there. It has been there for about 6 to 8 weeks. It started out as a small 1/4  inch circle that didn't seem to want to heal. That is what it looks like now.


    This post was edited by Torvren at September 12, 2014 11:36:57 AM PDT
    • Moderator
    • 1957 posts
    September 12, 2014 3:22:27 PM PDT

    Dear T,

     

    If that is your real name, PLEASE* change it, as this is a public forum. I want to respect your privacy, I want to be in the good graces of the Federal Trade Commission, and I hope they soon begin to hold State Medical Boards accountable for repeated acts of fraud, incompetence, and harassment. I cannot promise that the Supreme Court will uphold the fourth circuits previous decisions, but I can hope. There is more on this in our politics and healthcare forum. For clarity, I am not a licensed physician, I am in the process of suing the medical board for my medical license. I do not know if I will ever be licensed. I reported physicians that routinely and negligently permitted poor patient care for months. This despicable conduct was not addressed despite my numerous intra-department written & verbal objections. I eventually reported the poor patient care to the National Accrediting Agency. Instead of investigating, they believed the false information provided to them by the University. However, had the medical board spent three hours to review the surgical pathology reports they would have proof that I was accurately reporting the routine risky, unsafe patient care. 

    ---

    If that is your real name, PLEASE* change it, as

    - Have you ever had an MRI of the foot?

    MRI of the foot radiopedia

    Do you think it is possible that you sustained a ligamentous injury to the foot? 

     

    Pain Questions: 

    P1. Location of pain. Can you point your finger to the spot of pain?___ 

    P2. Intermittent or Constant? 

    P2a.Intermittent?___ 

    P2b. Constant and Consistent in severity?______ 

    P2c. Constant and Variable in severity?_____ 

     

    P3INTENSITY OF PAIN 

    P3a. Intensity of pain at worst 0-10 (0 is nopain10 is the worst pain)?____ 

    P3b. Intensity of pain at its best without treatment?___ 

     

     
    P4. QUALITY: sharp, dull, other?=____ 
    P4. Onset: when did it start, eg. last week, 5 years ago?=___ 

    P5. Constant or intermittent 

    35. Duration: How long does it last=____ 
    36. Radiation: does the pain spread anywhere?  
    37. Has anything else been associated with the pain?  
    38. Alleviating: What has made the pain better? 

    39. Aggravating 
    39. What has made it worse? 

    40. How muchpainare you in after treatment with your current medications?=____ 

    41. How much pain are you in without treatment? =____ 


    This post was edited by Brett Snodgrass at September 13, 2014 3:29:22 AM PDT
    • 12 posts
    September 12, 2014 4:07:22 PM PDT

    I have not had an MRI done of the foot. A possible ligament injury is what I have been thinking. What else is there with the X-ray results I have gotten?


    Pain Questions: 

    P1. Location of pain. Can you point your finger to the spot of pain? 

    P2. Intermittent or Constant? Constant

    P2a.Intermittent?___ 

    P2b. Constant and Consistent in severity?______ 

    P2c. Constant and Variable in severity?Yes

     

    P3INTENSITY OF PAIN 

    P3aIntensity of pain at worst 0-10 (0 is nopain10 is the worst pain)?9 

    P3b. Intensity of pain at its best without treatment?5

     

     
    P4. QUALITY: sharp, dull, other?=dull, achy
    P4. Onset: when did it start, eg. last week, 5 years ago?=6 weeks

    P5. Constant or intermittent Constant

    35. Duration: How long does it last=always.
    36. Radiation: does the pain spread anywhere?  With more use the entire ankle joint hurts all around.
    37. Has anything else been associated with the pain?  Had to position the foot without it getting pins and needles.
    38. Alleviating: What has made the pain better? Not putting weight on it.

    39. Aggravating Wearing shoes.
    39. What has made it worse? Trying to walk.

    40. How muchpainare you in after treatment with your current medications?=No Meds 

    41. How much pain are you in without treatment? = constant not wanting to walk.

    • Moderator
    • 1957 posts
    September 12, 2014 7:56:53 PM PDT
    Thank you for the reply.
    Sorry I made an error on the two dates 4 weeks and six weeks.

    What started 8 months ago?
    The dot on your foot has

    Tre pain has been going on for six weeks.
    What is the problem that has been going on for 8 months?

    Have you ever had ankle surgery.

    I will crowd source this to people around the world. In that I hope to engage MD, DOs, MBBS, patients with similar conditions, podiatrists, and people with interest in pain; foot, nerve, bone & joint disorders.

    What happened 8 months ago that changed how you were doing? Have you ever been tested for diabetes?

    Who have you seen so far for this?
    1. What type of doctor -clinic did you go to for evaluation.
    2. You have had foot pain for 4 weeks
    3 Trauma to ankle 6 weeks ago.
    4. 8 months ago developed "mass," or "lump," distal to the distal aspect of the fibula.

    Please take a look at the photograph and let me know if it appears accurate. Did the x-ray make any comment about the soft tissue?

    What medical conditions run in your family or what conditions do your immediate family members have? (Please reply cautiously or not at all as this is public).

    Kind regards,
    -BrettMD
    This post was edited by Brett Snodgrass at September 12, 2014 8:02:33 PM PDT
    • Moderator
    • 1957 posts
    September 12, 2014 8:04:40 PM PDT
    Is this image, figure B, more accurate?
    • 12 posts
    September 12, 2014 8:27:43 PM PDT

    My wife thinks it has been 4 weeks of pain, I think it's been closer to 6.  Earlier I stated that

     

    "It has been at least 8 months. I think it started when I had some kind of a bite below that bulge. It swelled up then and was very painful. It healed and now I have this bulge sticking up. There is a band of pain between the ankle bone and that 'bone'. I am not able to do anything with it without it hurting."


    So 8 months ago I had some kind of puncture at the bottom part of that bulge. It was really painful then. My doctor though nothing of it. It healed to the point of minor discomfort with the bulge still being there, then I would say 6 weeks ago I tripped and ever since then It has really hurt to walk on.


    I have never had ankle surgery. It kinda forms a crease in the skin from the ankle to the top of the foot between my ankle bone and that Mass. The Xray said nothing about the soft tissue. 


    ANKLE 3 VIEWS RIGHT
    "FINDINGS: There are no fractures or subluxations of the right ankle.
    There are no abnormal masses or calcifications. There are no blastic or
    lytic lesions. IMPRESSION: Normal right ankle. "

     

    When my foot is in the position that they used for the Xray the lump is almost not visible. It is only when moved that it is seen protruding. Yet it is still uncomfortable no matter what position it is in.

     

    They tell me that if I had diabetes it would have showed up on any blood test they have given me and they have given me a lot. 

    My family has MS, Parkinsons, Diabetes, and some degenerative joint disorder I can't remember the name of.

    As far as the ankle goes my pimary care first said it was a ganglion cyst and told me not to worry about it. When it started to cause pain I got the Xray at a radiology lab and because that came back with nothing he's not worried about it. 

     

    I think that part under the ankle is a crease in the skin where it is getting pinched under the ankle bone when I move it.

    • Moderator
    • 1957 posts
    September 13, 2014 3:27:25 AM PDT
    Thank you very much for the reply.

    Here is an article in a few conditions. If it is causing you pain, you may want yo ask your primary care doctor for an MRI of the Foot and an ultrasound.

    I'm sorry to hear that this is so painful and yet it is keeping you from walking. I would encourage you to see another doctor within a few days at the latest and ask for imaging tests for the soft tissue of the foot.

    You have the option to go to the Emergency room it the pain becomes unbearable. You may want to do that anyways. Again I can't tell you what you should do, but I can tell you that the medical literature has shown that MRI and ultrasound have been of use in diagnosing pain.

    One of the things that probably would be good for us to discuss is why you are having pain elsewhere.

    I understand that you have pain in the foot, near the -subcutaneous mass; but do you have pain in other joints?

    If you acquired Lyme disease before, is it not possible that you have acquired it again?

    Have you ever been free of the symptoms of Lyme disease? How did they diagnose you?
    Were they certain that you have Lyme disease? Did they perform PCR? Do you know what blood tests they performed if any?

    Well, I will crowd source this forum, and review more literature for additional ideas. Hopefully we can help get you on the path to a better quality of life with less pain.

    Kind regards,
    -BrettMD
    • Moderator
    • 1957 posts
    September 13, 2014 4:11:28 AM PDT

    This is only one article, but there are many other resources for you to consider. 

    http://sharecare.com

    http://zocdoc.com

    http://www.healthtap.com

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259410/

     

    Please consider keeping me updated. I don't think that I have enough information to provide you with relevant medical literature that wold permit you to definitively diagnose yours. 

    Please, seek additional information and opinions. Sharecare would be a great place to start. Although doxycyline has been reported to effectively treat lyme disease at a duration of 10 days, it does not definitvely mean that it did. Laboratories can test for Lyme disease with antibodies and with molecular genetic tests. In addition, your doctor may consider other things such as a referreral and peripheral nerve testing. 

    Please consider keeping me updated, but also please search for health information elsewhere. Any physician who says, only stick with my company, we are teh best and we are always right is not a patient advocate. They are a self-advocate. 

     

    Kind regards and best wishes.

    -BrettMD

    • 12 posts
    September 13, 2014 6:18:38 AM PDT

    Since I acquired Lyme Disease April of last year I have never been without the symptoms of it.

    Before that I had never been sick enough to even visit a doctor.

    After 3 months with Lyme they did the Doxycycline and Cypro for 10 Days.

    Then performed a Western Blot test which came up negative just after I finished the antibiotics.

    That was the last testing I had for Lyme. Right after I finished those antibiotics they put me on Zoloft because the tick being in my ear for 10 days had made me a nervous wreck. I seemed every negative and extreme side effect of Zoloft. Every muscle in my body was randomly twitching. My left arm and leg locked in place and was extremely painful. I was having facial drooping with slurred speach like I was having a stroke. When the muscle spasms hit my EKG was thrown off as well. I was in the hospital for 3 days, they did a spinal tap, mri and catscan of the head, and concluded that no neurological disorder was present. After getting them to bring me the side effects list of Zoloft I point out the muscle related side effects. This was just after 2 weeks on the Zoloft. After 3 days in the hospital I finally got the doctor to agree to take me off Zoloft. He told me he would take me off of it just to prove me wrong. My muscle twitches stopped within 48 hours of stopping the Zoloft with the last one being an extremely painful one while I was watching television the night before they released me. Upon release I wasn't able to walk without assistance for a really long time after that. Since that time I have been to the hospital maybe a dozen times. Sometimes because I was around smokers and I stopped being able to breathe properly with what the doctors said was pleurisy. Other times my muscles have not been twitching like they did on zoloft but extremely painful. 

     

    Also in the last 8 months I became inable to hold cold things without protection. I can't feel something cold when I first touch it, but after a short time it sends pain down my arm enough to make tears run down my face.

     

    I've also been having digestive issues, in January they did an Upper GI. They took biopsys which showed chronic inflammation. They stretched my esophagus and then found that the food was not leaving my stomach and streatched my duodenum as well. In March I went to the ER again with extreme pain in the duodenum. I projectile vomitted in the ER room and then I don't remember anything until the next day. Testing revealed a really high white count and Lactic acid count. 

     

    My current and ongoing symptoms is:

    Muscles in every part of the body are sensitive to the touch. Especially in my chest arms and neck. 

    Inability to grab cold things without extreme pain. (my doctor says this is nothing)

    Every joint in my arms, hands, shoulders, neck and even my jaw cracks and grinds when I  move it.

    Getting around is a chore, especially with that ankle. I have an overall weekness throughout all of my muscles.

    Intermittent headaches as well.

    Inability to be around things like smokers without difficulty breathing and chest pains.


    This post was edited by Torvren at September 13, 2014 6:20:36 AM PDT
    • Moderator
    • 1957 posts
    September 13, 2014 8:51:49 AM PDT

    Dear T, 

     

    I think you should be further evaluated for autoimmune, infectious, and demyelinating diseases. Your conditiosn sounds very consistent with lyme disease. 


    Now the medical board reprimanded a doctor for treating the so-called "chronic lyme." 

    -(next post)

    ----------------------

    1. Please obtain your medical records as you will  likely need them as you visit future physicians. 

    2. Please consdier deleting the photo as someone may be able to identify you. 

    3. I have downloaded the photo to my personal comptuer and can delete it  if you like, but it iwll be availabe for my reference. 

    4. Please try to understand my concern.

    4a. I presume that you were diagnosed with Lyme disease by Western blot, but I do not know

    4b. I do not know whether  you could have had another immune condition that gave a false positive test result.

    5. I do not know what specifially the wester blot was testing for, or if it was the same test that was used to diagnose you with lyme disease.

    Is it true that you can get Lyme disease anywhere in the U.S.?

    No. Lyme disease is spread through the bite of a blacklegged tick (Ixodes scapularis or Ixodes pacificus) that is infected with Borrelia burgdorferi. In the United States, most infections occur in the following endemic areas:

    • Northeast and mid-Atlantic, from northeastern Virginia to Maine
    • North central states, mostly in Wisconsin and Minnesota
    • West Coast, particularly northern California

    Maps showing the distribution of human cases are based on where people live, which because of travel, is not necessarily where they became infected. Cases are sometimes diagnosed and reported from an area where Lyme disease is not expected, but they are almost always travel-related.

     

    I live in the southeastern U.S. and get a lot of lone star tick bites. I've heard that I can get “southern Lyme disease”. Is this true?

    The lone star tick is primarily found in the southeastern and eastern United States. Lone star ticks do not transmit Lyme disease. However, you are correct to be concerned about this very aggressive species. The lone star tick (Amblyomma americanum) can spread human ehrlichiosistularemia, andSouthern Tick-Associated Rash Illness (STARI).

    The rash of STARI is a red, expanding “bull' s eye” lesion that develops around the site of a lone star tick bite. The rash usually appears within 7 days of tick bite and expands to a diameter of 8 centimeters (3 inches) or more. The rash should not be confused with much smaller areas of redness and discomfort that can occur commonly at tick bite sites. Unlike Lyme disease, STARI has not been linked to arthritis, neurological problems, or chronic symptoms. Nevertheless, the similarity between the STARI bull’s eye rash and the Lyme disease bull’s eye rash has created much public confusion. The pathogen responsible for STARI has not been identified.

    In contrast, Lyme disease in North America is caused by a specific type of bacteria, Borrelia burgdorferi, which is transmitted by two species of blacklegged ticks, Ixodes scapularis and Ixodes pacificus. While blacklegged ticks exist in the southern U.S., their feeding habits in this region make them much less likely to maintain, sustain, and transmit Lyme disease.

     

    I have heard that the diagnostic tests that CDC recommends are not very accurate. Can I be treated based on my symptoms or do I need to use a different test?

    You may have heard that the blood test for Lyme disease is correctly positive only 65% of the time or less. This is misleading information. As with serologic tests for other infectious diseases, the accuracy of the test depends upon the stage of disease. During the first few weeks of infection, such as when a patient has an erythema migrans rash, the test is expected to be negative.

    Several weeks after infection, currently available ELISA, EIA and IFA tests and two-tier testing have very good sensitivity.

    It is possible for someone who was infected with Lyme disease to test negative because:

    1. Some people who receive antibiotics (e.g., doxycycline) early in disease (within the first few weeks after tick bite) may not develop antibodies or may only develop them at levels too low to be detected by the test.
    2. Antibodies against Lyme disease bacteria usually take a few weeks to develop, so tests performed before this time may be negative even if the person is infected. In this case, if the person is retested a few weeks later, they should have a positive test if they have Lyme disease. It is not until 4-6 weeks have passed that the test is likely to be positive. This does not mean that the test is bad, only that it needs to be used correctly.

     

    I am pregnant and just found out I have Lyme disease. What should I do?

    If you are pregnant and suspect you have contracted Lyme disease, contact your physician immediately. Untreated Lyme disease during pregnancy may lead to infection of the placenta and possible stillbirth.

    Thankfully, no serious effects on the fetus have been found in cases where the mother receives appropriate antibiotic treatment for her Lyme disease. In general, treatment for pregnant women with Lyme disease is similar to that of non-pregnant adults, although certain antibiotics, such as doxycycline, are not used because they can affect fetal development.

    Additionally, there are no reports of Lyme disease transmission from breast milk.

     

    If I have been diagnosed with Lyme disease, do I need to get tested for other tickborne diseases (coinfections)?

    Maybe. The blacklegged ticks that transmit Lyme disease can sometimes also transmit babesiosisand anaplasmosis. Fortunately, Lyme disease and anaplasmosis are treated with the same antibiotics, so if you are receiving treatment for Lyme disease, anaplasmosis will be treated at the same time (Wormser et al. 2006). Babesiosis is a parasitic disease that is treated with different medications. If your Lyme disease symptoms do not seem to be going away after taking antibiotics, see your health care provider.

    There is, however, a great deal of misinformation regarding tickborne coinfections on the internet. The possibility of having three or more tickborne infections or having pathogens such bartonella or mycoplasma (which have not been shown to be tickborne), is extremely unlikely.

    The chance of having multiple tickborne infections depends on your location. Several studies have looked at the prevalence of these different organisms in ticks, though methods and locations are very different. Studies have shown that the rate of coinfection in blacklegged ticks varies by region from 1 to 28%. The most common coinfection in ticks is Borrelia burgdorferi (Lyme disease) and Anaplasma phagocytophilum (anaplasmosis). The frequency of tickborne coinfections in Lyme disease patients from endemic areas ranges from 4 to 45% (Swanson et al. 2006). From 2 to 12% of patients with early Lyme disease may also have anaplasma infection, and 2 to 40% of patients with early Lyme disease may also have babesia infection, depending on the region (Wormser, 2006).

    References:

    Swanson, et al. Coinfections acquired from Ixodes ticks. Clin Microbiol Rev. 2006 Oct;19(4):708-27.

    Wormser, Gary. “Clinical practice. Early Lyme disease.” N Engl J Med. 2006 Jun 29;354(26):2794-801.

    Wormser et al. “The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: Clinical practice guidelines by the Infectious Diseases Society of America” Clinical Infectious Diseases 2006;43:1089-1134.

     

    I have been sick for a few years with joint and muscle pain, fatigue, and difficulty thinking. I was tested for Lyme disease using a Western Blot test. The “IgM” Western Blot test was positive but the “IgG” Western Blot test was negative. Is Lyme disease the cause of my symptoms?

    Probably not. First, you should only have an immunoblot (such as an FDA-approved Western Blot or striped blot) test done if your blood has already been tested and found reactive with an EIA or IFA.

    Second, the IgM Western Blot test result is only meaningful during the first 4 weeks of illness. If you have been infected for longer than 4-6 weeks and the IgG Western Blot is still negative, it is highly likely that the IgM result is incorrect (e.g., a false positive). This does not mean that you are not ill, but it does suggest that the cause of illness is something other than the Lyme disease bacterium. For more information, see the in-depth discussion regarding testing for Lyme disease.

    Top of Page

    Where can I get a test to make sure that I am cured?

    As with many infectious diseases, there is no test that can “prove” cure. Tests for Lyme disease detect antibodies produced by the human immune system to fight off the bacteria (Borrelia burgdorferi) that cause Lyme disease. These antibodies can persist long after the infection is gone. This means that if your blood tests positive, then it will likely continue to test positive for months or even years even though the bacteria are no longer present.

    A research tool called PCR can detect bacterial DNA in some patients. Unfortunately, this is also not helpful as a test of whether the antibiotics have killed all the bacteria. Studies have shown that DNA fragments from dead bacteria can be detected for many months after treatment. Studies have also shown that the remaining DNA fragments are not infectious. Positive PCR test results are analogous to a crime scene – – just because a robbery occurred and the robber left his DNA, it doesn' t mean that the robber is still in the house. Similarly, just because DNA fragments from an infection remain, it doesn' t mean the bacteria are alive or viable.

    Top of Page

    My serologic (blood) test for Lyme disease is still positive even though I finished 3 weeks of antibiotics. Does this mean I am still infected?

     

    No. The tests for Lyme disease detect antibodies made by the immune system to fight off the bacteria,Borrelia burgdorferi. Your immune system continues to make the antibodies for months or years after the infection is gone. This means that once your blood tests positive, it will continue to test positive for months to years even though the bacteria are no longer present. Unfortunately, in the case of bacterial infections, these antibodies don' t prevent someone from getting Lyme disease again if they are bitten by another infected tick.

    Top of Page

    I heard that if I get Lyme disease I will always have it. Is that true?

    No. Patients treated with antibiotics in the early stages of the infection usually recover rapidly and completely. Most patients who are treated in later stages of the disease also respond well to antibiotics, although some may have suffered long-term damage to the nervous system or joints. Approximately 10-20% of patients experience fatigue, muscle aches, sleep disturbance, or difficulty thinking even after completing a recommended course of antibiotic treatment. These symptoms cannot be cured by longer courses of antibiotics, but they generally improve on their own, over time.

    Top of Page

    Can you recommend a doctor who is familiar with diagnosing and treating Lyme disease?

    The American Lyme Disease Foundation (ALDF) keeps a national list of doctors who are familiar with the diagnosis and treatment of Lyme disease and other tickborne infections. You can access this list by:

    Please note that CDC cannot evaluate the professional qualifications and competence of individual doctors. The inclusion of a doctor on the ALDF list should not be seen as an endorsement by CDC. You could also choose to see a doctor in your area who specializes in infectious diseases. Often these doctors are affiliated with a university.

     

     

     

    • Moderator
    • 1957 posts
    September 13, 2014 9:32:33 AM PDT

    Dear T, I think you may want to 

    1. Obtain & keep your medical records

    2. Ask your primary care doctor to prove to you, that you had lyme disease, and then that you later were no longer infected.

    3. Look into other causes of your problems.

    4. Ask for an MRI or a referral to a foot surgeon for evaluation of your pain and the mass (the lump)

     

    Please consider keeping me updated and let me know if I may be of any help. 

    Kind regards,

    -BrettMD

     

    http://www.webmd.com/arthritis/lyme-disease-test?page=3

     

    -----

    Commentary about how medical regulation related to Lyme disease is negatively impacting patient care: 

    Howsome state  medical regulators is effectively degrading the quality of care and academic research 

    What I was stating is that the Medical Board (probably appropriately) reprimanded a doctor in my state for treating "Post-Lyme Disease Syndrome" as if she were treating "Chronic Lyme."

    If that was the plan, the patient should have been referred to a clinical trial. One does not simply start running clinical trials or testings experimental therapies without therapeutic rationale on patients. Perhaps what hte medical board did was good. However, it probably was not as good as they think. The CDC mentions that there can be very serious effects from treatment including death. Well, the patient who died in their report had an intravenous catheter that bcecame infections and sent the infections throughout the persons body. It should be clear that such therapy is diffferent than per-oral doxycycline. Now, if the doctor were to treat several pateints with the antibiotic, then yes, the risk of harm goes up Significantly. The Medical Board could have called the doctor and said, "we are concerned about your treatment of this patient for Chronic Lyme disease. Why have you not referred them to a clinical trial. What laboratory tests are you ordering to follow the alleged infectious burden."

    Yet the medical board rarely makes reasonble investiation into an event to find out the truth. They investigate merely to reprimand, and they assert that this improves patient safety. If only the darn doctors like Dr. Antoine Adem would stop providing excellent medical care they would win more of their frivolous litigations." 

    So, it is the harassing conduct of State Medical Boards, who often are unware of what the Standard of Care is, and do not stratify their need for investigation into that which is based on severity of harm, that probably intimidates some doctors to discuss controversial topics with their patients. Areas where medicine is unclear. 

     

    It would be incredibly foolish to say that "Lyme disease is the only bacteria that does not develop resistance to antibiotics." Yet, that is somewhat similar to what State Medical Boards are doing. Some people take doxycyline for years for acne. thus, the medical board's effort to revoke the license of one doctor for prescribing doxycycline for what was probably not active lyme infeciton was possibly overreach. Unlike the medical board, I change my opinion was evidence accrues. What I am trying to say is that I am frustrated with the manner in which medical regulation is done, and I have numerous examples of how, in many states, it negative impacts many people and causes more harm than good. In summary, you need to continue to seek medical care. A diagnosis of Lyme Disease may be reasonable to put on the differential diagnosis given the aformetioned. I won't use the term "chronic lyme." because the medical board actually read the Infectious Disease Gudeline  and they may equivocate "treatment failure." with the "Failure of 36 months+ of treatment." Next, it is also possible that you were re-infected with Lyme disease , or have another disease all together. It is frustrating for me to mention this because many are reprimanded for practicing what they assume to be "junk science." They assume this without justification,  referencing evidences and demonstrating multiple logical fallacies and conflating multiple types of information. For example, They may reference someone with no medical training who states " I have chronic lyme disease, even though I had 50 negative tests at 7 of the world's best laboratories,"  with someone who had  a "single negative test," and then demonstrates some signs/symptoms of Progression of Lyme Disease. Next, the former studies using PCR for the diagnosis of Lyme disease are incredibly outdated. Next, the symptoms that you reported from Zoloft seem plausible to be related to Lyme disease. Switching from Zoloft to another similar medication is often reasonable, especially when there is great concern for adverse effects. There are clinical trials that are ongoing evaluating patients for the presence of Chronic Lyme Disease. Simply because we do not know, and that it is usually unlikely does not mean impossible. 

     

    So as you may identify, I am slightly frustrated at the medical board as I am trying to provide you with relevant medical information. The thing is, they would not pickup the phone and say, "oh, I don't understand why you placed those coronary Dr. Adem, can you explain it to me?" Instead they toss the care to their attorney and say litigate. The attorney knows that the law permits the medical board to investigate aggresively, even when they are wrong, in order to "protect patients>' However, and likely due to a lack of active oversight, they dont merely make cautious decisions, they completely switch good and bad and they commit fraud against doctors. It is frustrating to try to do what is best for people, and provide good medical care (as Dr. Adem did), when meidcal boards reprimand the person for it. 

    ----

    Please, let me know what your plan is, as I think you should consider treatment failure of lyme disease. Doctors may say "it didn't happen in the study," and then they may go one to say, therefore, it never happens. I wish that medicine had regulators taht investigated patient harm, exhibited concern for patients and not "concern for reprimanding doctors," as I think it would improve the quality of care that you received, at least if you were in Missouri. 

    https://clinicaltrials.gov/ct2/results?term=lyme&recr=Open

     

     

     

     

    1

    Recruiting Study on Early Lyme Neuroborreliosis Condition: Nervous System Lyme Borreliosis Intervention: Drug: ceftriaxone 2 Unknown  Doxycycline and Ceftriaxone in Suspected Early Lyme Neuroborreliosis Condition: Suspected Early Lyme Neuroborreliosis Interventions: Drug: doxycycline;   Drug: ceftriaxone 3 Recruiting Searching for Persistence of Infection in Lyme Disease Conditions: Lyme Disease;   Borrelia Burgdorferi Interventions: Procedure: Skin Biopsy;   Device: Xenodiagnosis;   Procedure: Blood Drawing 4 Recruiting Evaluation of Lyme Disease: Clinical, Microbiological and Immunological Characteristics Conditions: Chronic Disease;   Healthy;   Lyme Arthritis;   Lyme Disease;   Multiple Sclerosis Intervention:   5 Recruiting Evaluation, Treatment, and Follow-up of Patients With Lyme Disease Condition: Lyme Disease Intervention:   6 Recruiting Borrelia Species in Cutaneous Lyme Borreliosis Condition: Lyme Borreliosis Intervention: Other: Cutaneous biopsy 7 Not yet recruiting Study of Lyme Neuroborreliosis Condition: Lyme Neuroborreliosis Interventions: Drug: Doxycycline;   Drug: Ceftriaxone 8 Recruiting Analysis of Lyme Disease Lesions Conditions: Erythema Migrans Lesions;   Erythema Migrans Intervention:   9 Recruiting Doxycycline in Therapy of Erythema Migrans Condition: Lyme Borreliosis Intervention: Drug: Doxycycline 10 Recruiting Antibiotic Treatment of Multiple Erythema Migrans Condition: Multiple Erythema Migrans Interventions: Drug: ceftriaxone;   Drug: doxycycline;   Other: erythema migrans patients treated with doxycycline 11 Recruiting Cytokines and Chemokines in Erythema Migrans Condition: Erythema Migrans Intervention: Drug: antibiotic treatment 12 Recruiting Culture Media for Borrelia Burgdorferi Sensu Lato Condition: Erythema Migrans Interventions: Other: MKP media;   Other: BSK-H media 13 Recruiting Laboratory Characteristics in Chronic Atrophic Acrodermatitis Condition: Chronic Atrophic Acrodermatitis Interventions: Drug: doxycycline orally, 100 mg, bid, 14 days;   Drug: doxycycline orally, 100 mg, bid, 28 days 14 Unknown  Human Anaplasmosis in Eastern France Conditions: Anaplasmosis;   Tick-borne Disease;   Ehrlichia Intervention: Procedure: Blood sampling 15 Unknown  A Placebo-controlled Efficacy Study of IV Ceftriaxone for Refractory Psychosis Conditions: Psychosis;   Schizophrenia;   Schizoaffective Disorder Interventions: Drug: ceftriaxone;   Drug: Normal Saline 16 Recruiting Antibiotic Treatment Trial for the PANDAS/PANS Phenotype Conditions: Pediatric Acute Onset Neuropsychiatric Syndrome (PANS);   Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections;   Obsessive Compulsive Disorder (OCD) Interventions: Drug: Azithromycin;   Drug: Placebo 17 Recruiting Injection Versus Splinting in Carpal Tunnel Syndrome Condition: Carpal Tunnel Syndrome (CTS) Interventions: Drug: Depo-Medrone;   Device: Wrist Splint
    • 12 posts
    September 13, 2014 7:19:31 PM PDT

    Going through my medical record now. It says they planned to test me for lyme  in 2 to 4 weeks following the one negative test they did, but never followed up with it.

    I also found that they ruptured my eardrum when removing the tick from my ear and was never told about it. The doctor used a thin blue tube with some kind of pincers on the end along with an otoscope in my ear to get it out. I was screaming the entire time.

     

    Also, does that pain when I touch cold things point to anything in particular?


    This post was edited by Torvren at September 13, 2014 8:54:50 PM PDT
    • Moderator
    • 1957 posts
    September 13, 2014 10:12:24 PM PDT

    Greetings T, 

     

    You could report the doctors that did not test you for lyme disease again, or did not order a follow-up appointment to the medical board. That will likely result in an investigation of the complaint, and may or may not effect the doctor, as sometimes these are system problems due to the choppy, discontinuous delivery of patient care. Now, patients and doctors shouldn't spend all day every day on the phone as that is obvious. However, when the quality of care is fragmented to souch a degree, that you were not retested for lyme disease, and they enver followed up with it. They may say that you did not answer the phone. ALternatively some places send certified mail to verify that if patients do not follow up on treatment recommendations there is documentation that it was secondary to the patient choosing not to follow the doctor's recommendations for care, and then the patient would have an incredibly difficult time trying to sue the doctors. Such a prevention is good. If good medical care and appropriate follow-up is reprimanded through the  legal system and through medical boards, it is harmful to patient care. There is nothing the physician can do to continue living a healthy life while providing excellent care. In fact, other than altruism, the incentive for excellent care diminshes. Thankfully most physicians do have altruism. 

    Or perhaps they demonstrate altruism. How one can distinguish between someone having altruism and demonstrating altruism  probably not possible to determine with reliability 

     

     

    1. You should call the hospital or clinic and ask for a follow-up test for lyme disease. If you don't have lyme Disease, you probably should have a peripheral blood smear, and an investigation for additional infectious organisms should be sought. 

     

    2. How is your hearing? You may  want to have an ear exam, and/or a hearing test.

     

    3. You may want to contact an attorney about this. You can contact the medical board, but they won't do anything to help you. they will reprimand the doctor whether or not the doctor did anything wrong (possibly imprecise to make a definitive statement at this point until I have more information, reviewed ENT literature on ticks, and what was the inciting event to your eardrum. Usually people are very careful 

    when working near the ear drum. 

      

    4. now the Missouri medical board reprimanded a doctor for treating  a patient with lyme disease. When medical boards take it upon themselves to selectively reprimand doctors for alleged moral character flaws or for mistreatment that did not result in harm, they really benefit no one. If they had given teh doctor a warning, and said, unless you explain your therapeutic rationale,  you risk being prosecuted in order to  lose your license as we are here to ensure patient safety. Instead, the medical did nothing of the sort, and reprimanded the doctor for what was bad care. Yet, the medical board members are hypocrites of the highest order. They committed fraud repeatedly against a good cardiologist and chose to use their position on the medical board to NOT reprimand themselves. They aren't thinking doctor, they are a rubber stamp that reprimands care, a threat to the practice of safe medicine and of improving healthcare. Yet, I admit in addition to their heinous crimes, they also do appropriately reprimand and revoke the licenses of some doctors who shouldn't simply lose their medical license, but they should be placed in prison.

     

    5. Most of the physicians, CEOs, and patients that I know do not like the medical board. Commiting fraud, reprimanding good care, selectively revoking licenses for suboptimal non-harmful care to a select group of patients in whom the literature is suboptimal.

    The conflating of Intravenous Antibiotic-induced catheter-associated death with oral antibiotics without side effect is a heinous act of the medical board. 

     

    6. Post-lyme syndrome is here. Further investigation may be warranted. The old PCRs are similar to comparing Aol online from 2001 to a google search today. What this may suggest, is that we should engage in more research on Lyme to figure why people who were infected continue to suffer. yes, we understanding that PCR identifies dead organisms. That's why we should use *Quantitative PCR*

    Such a test should monitor the diseases burden of Lyme disease, if any. 

     

    http://www.neurology.org/content/early/2007/05/23/01.wnl.0000265517.66976.28.full.pdf

     

    7. I do not know about hyperesthesia. 

    http://www.anapsid.org/lyme/symptoms/

    • Moderator
    • 1957 posts
    September 13, 2014 10:18:45 PM PDT

    one of the things that you may want to do is to ensure that you do not have raynauds or a peripheral vascular disease that is preventing blood from getting to your extremities. It would be reasonable to check your capillary refill time as a rough estimate. If normal => perfusion could be low. Yet if abnormal then there is a problem. So a positive result, or a prolonged capillary refill time greater than 3 seconds, is evidence of poor perfusion. 

    Please pardon our progress. Kind Regards, 

    BrettMD

     

    --


    This post was edited by Brett Snodgrass at September 13, 2014 10:24:34 PM PDT
    • 12 posts
    September 30, 2014 3:18:07 PM PDT

    I finally saw a doctor today. They are leaning towards Lupus now, and that the ankle damage is tied to it.

    I've documented things which point to Lupus including:

    Raynaud's, skin getting extremely hot when exposed to the sun for too long, aching joint pain, fatigue, chest pains, shortness of breath, 

    I've also had some lesions in my mouth, A rash across my chest.

    There is the remnants of a lesion near my left shoulder and 2 near that ankle with 1 in that picture.

    I've also had some stabbing pains in my kidneys at times.


    This post was edited by Torvren at September 30, 2014 5:12:41 PM PDT
    • Moderator
    • 1957 posts
    September 30, 2014 6:04:59 PM PDT
    Dear T,
    Thank you for the update.

    Here is some information about raynauds from the Mayo clinic.
    Diseases and Conditions
    Raynaud's disease
    SECTIONS
    Causes
    By Mayo Clinic Staff
    Doctors don't completely understand the cause of Raynaud's attacks, but blood vessels in the hands and feet appear to overreact to cold temperatures or stress:

    Cold temperatures. When your body is exposed to cold temperatures, your extremities lose heat. Your body slows down blood supply to your fingers and toes to preserve your body's core temperature. Your body specifically reduces blood flow by narrowing the small arteries under the skin of your extremities. In people with Raynaud's, this normal response is exaggerated.
    Stress. Stress causes a similar reaction to cold in the body, and likewise the body's response may be exaggerated in people with Raynaud's.
    Blood vessels in spasm

    With Raynaud's, arteries to your fingers and toes go into vasospasm. Vasospasm narrows your vessels dramatically and temporarily limits blood supply. Over time, these same small arteries may thicken slightly, further limiting blood flow. The result is that affected skin turns a pale and dusky color due to the lack of blood flow to the area. Once the spasms go away and blood returns to the area, the tissue may turn red before returning to the normal color.

    Cold temperatures are most likely to trigger an attack. Exposure to cold can be as simple as putting your hands under a faucet of running cold water, taking something out of the freezer or exposure to cold air. For some people, exposure to cold temperatures isn't necessary. Emotional stress alone can cause an episode of Raynaud's.

    Raynaud's may be partly an inherited disorder.

    Primary vs. secondary Raynaud's

    Raynaud's occurs in two main types:

    Primary Raynaud's. This is Raynaud's without an underlying disease or associated medical problem that could provoke vasospasm. Also called Raynaud's disease, it's the most common form of the disorder.
    Secondary Raynaud's. Also called Raynaud's phenomenon, this form is caused by an underlying problem. Although secondary Raynaud's is less common than the primary form, it tends to be a more serious disorder. Signs and symptoms of secondary Raynaud's usually first appear at later ages — around 40 — than they do for people with the primary form of Raynaud's.
    Causes of secondary Raynaud's include:

    Scleroderma. Raynaud's phenomenon occurs in the majority of people who have scleroderma — a rare disease that leads to hardening and scarring of the skin.
    Lupus. Raynaud's is also a common problem for people with lupus erythematosus — an autoimmune disease that can affect many parts of your body, including your skin, joints, organs and blood vessels.
    Rheumatoid arthritis. Raynaud's may be an initial sign of rheumatoid arthritis — an inflammatory condition causing pain and stiffness in the joints, often including the hands and feet.
    Sjogren's syndrome. Raynaud's phenomenon can also occur in people who have Sjogren's syndrome — an autoimmune disorder that may accompany scleroderma, lupus or rheumatoid arthritis.
    Diseases of the arteries. Raynaud's phenomenon can be associated with various diseases that affect arteries, such as atherosclerosis, which is the gradual buildup of plaques in blood vessels that feed the heart (coronary arteries), or Buerger's disease, a disorder in which the blood vessels of the hands and feet become inflamed. Primary pulmonary hypertension, a type of high blood pressure that affects the arteries of the lungs, can be linked to Raynaud's.
    Carpal tunnel syndrome. The carpal tunnel is a narrow passageway in your wrist that protects a major nerve to your hand. Carpal tunnel syndrome is a condition in which pressure is put on this nerve, producing numbness and pain in the affected hand. The affected hand may become more susceptible to cold temperatures and episodes of Raynaud's.
    Injury due to overuse. Raynaud's can also be caused by repetitive injuries that damage nerves serving blood vessels in the hands and feet. Some people who type or play the piano vigorously or for long periods of time may be susceptible to Raynaud's. Workers who operate vibrating tools can develop a type of Raynaud's phenomenon called vibration white finger.
    Smoking. Smoking constricts blood vessels and is a potential cause of Raynaud's.
    Injuries. Prior injuries to the hands or feet, such as wrist fracture, surgery or frostbite, can lead to Raynaud's phenomenon.
    Certain medications. Some drugs — including beta blockers, which are used to treat high blood pressure; migraine medications that contain ergotamine; medications containing estrogen; certain chemotherapy agents; and drugs that cause blood vessels to narrow, such as some over-the-counter (OTC) cold medications — have been linked to Raynaud's.
    Chemical exposure. People exposed to vinyl chloride, such as those who work in the plastics industry, may develop an illness similar to scleroderma. Raynaud's can be a part of that illness.
    Other causes. Raynaud's has also been linked to thyroid gland disorders..


    ....
    Did they do any test of your kidney function?
    Have you seen a rheumatologist or a dermatologist?

    What's that the current plan?


    • 12 posts
    September 30, 2014 6:22:18 PM PDT

    I have to wait 10 days before my primary care well see me next.

    They will not do any referals or orders for more tests unless I go in to see them in person.

    I do not know if this is standard procedure for all doctor's offices.

     

    Today was an emergency room visit after I was having an even harder time walking and lifting my extremities. I road an elevator and when the it started moving my legs collapsed and I fell against the wall of the eleveator. The person I was with told me they were taking me to the ER at that point.

     

    This prompted my primary care doctor to give me an appointment. The ER doctor told me that he thinks it is Lupus or another connective tissue disorder. He refered me to a rheumatologist that i have to wait to get a referal from my primary care to see. I am compiling all the symptoms I have had. My primary care said they were too random to be any kind of physical ailment. 

    • Moderator
    • 1957 posts
    September 30, 2014 8:35:33 PM PDT

    Are you having weakness in your extremities? 

    One of the things that could be concerning is a nerve disease or a demyelinating disease. 

    The App Sharecare will help you compile the symptoms. DrSocial is a social health network and so when we find a great product, even if its from a company that does something similar to doctor social, we let the users know. I would encourage you to use the app or website, and then let me know what it says. This will be useful because once you have that amount of information, there is much more to be explored about how the conditions relate to you.

     

    1. When you fell, did you get dizzy first? 

    2. When you fell did you lose consciousness

    3. Did you fall becuase you were feeling weak? 

    4. Please assess your extremities for muscle strength on a five-point scale. 

    http://www.neuroexam.com/neuroexam/content.php?p=29

    • 0/5: no contraction
    • 1/5: muscle flicker, but no movement
    • 2/5: movement possible, but not against gravity (test the joint in its horizontal plane)
    • 3/5: movement possible against gravity, but not against resistance by the examiner
    • 4/5: movement possible against some resistance by the examiner (sometimes this category is subdivided further into 4/5, 4/5, and 4+/5)
    • 5/5: normal strength
    Please see the website. Important to assess
    4(a) Bending your foot Up (dorsiflexion of the right foot) =  
    4(b) Bending your foot Up (dorsiflexion of the left foot) =  
    4(c) Bending your foot down (plantar flexion of the right foot) =
    4(d) Bending your foot down (plant flexion of the left foot) = 
    4(e) Elbow Flexion  (right arm, biceps) = 
    4(f)  Elbow Flexion (left arm, biceps)= 
    4(g) Elbow Extension (right arm, Triceps) = 
    4(h) Elbow Extension (left arm, triceps) = 
     
    Neurologists will do more thorough neurological examination, but if you are able to assess the above muscle groups, we may have more information. 
     
    5. ShareCare and then please consider sharing a few of the results that we could explore further. 
    6. What was your oxygen saturation when you were seen in the ER? 
     
    Kind regards, 
    -BrettMD