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Sunday, August 5, 2018

I don't understand. This story left me confused.

A young Londoner came down with a illness that left his doctors stumped. And according to The London Free Press, this "experience is all too typical in a country in which Lyme disease has grown to epic proportions, a crisis that neither doctors nor public health officials have adequately addressed..."

One problem: The young boy did not have Lyme disease. A Maryland specialist discovered the boy had Bartonella, commonly called Cat Scratch Disease. According to the CDC (Centers for Disease Control and Prevention in the States) people get CSD from the scratches of domestic cats, particularly kittens. The disease occurring most frequently in children under 15. The boy in the story was 12 when he came down with his illness.

Which bring us to my second problem: The CDC and many other official sources claim ticks may carry some species of Bartonella bacteria, but "there is currently no convincing evidence that ticks can transmit Bartonella infection to humans."

The young man had an illness that went undiagnosed. Why? The story does not give us enough information to understand why this terrible thing happened.

I sense a bias against the Canadian healthcare system in this story. If it was simply the shoddy Canadian system at fault, why did the boy have to travel to Maryland, a nine hundred kilometre trip. If the American system is so great, why didn't the boy simply cross the border and immediately get help? There are a lot of American doctors closer to London, Ontario, than the specialist in Maryland.

I can feel for this young man. I had a somewhat similar experience. I had a V-tach event while vacationing in California. After running up a bill approaching $30,000, the American heart specialists found nothing to explain what had happened. I was released from the hospital to drive to Vancouver and on home to London, Ontario.

Although one should wait six months before getting behind the wheel after such a cardiac event, I drove some fifty six hundred kilometres immediately after having my heart reset by two paddles pressed tightly to my chest to deliver a jolt of 200 joules. Unlike my Canadian doctors, the American ones failed to discuss driving after being released from the hospital.

When it came to finding a cause for my V-tack event, my London doctors didn't fare much better than their American counterparts but the Canadians persevered, discovered I had a relatively rare form of heart disease and installed a pacemaker/ICD in my chest. I'm now on my second pacemaker/ICD. Thanks to the Canadian system, I have a life. (And thanks to my granddaughters, I have a good life.)

Should the American doctors with all their sophisticated testing equipment have been so easily stumped by my heart disease. I don't know. But what I do know is that I owe my life to my Canadian doctors.
To keep the above post short I did not examine the newspaper's criticism of the Canada's supposedly out-of-date approach to testing for Lyme disease, but, if interested, read the following.

The story informs readers that in Ontario "doctors won't use a test well-established in the United States and Europe, a Western Blot test, unless patients first test positive using a method known to miss many cases, an Elisa (sic) test."

This would be very damning if it were true. But, it isn't. The CDC (Centers for Disease Control and Prevention) in the States recommends performing an ELISA, or similar EIA test, first and a Western Blot test second. If the first test is negative, no further testing of the specimen is recommended. The American CDC approach and the Canadian one are in agreement. (The respected Mayo Clinic also agrees with the Canadians and the CDC.)

Furthermore, the two steps should be done as designed. The CDC does not recommend skipping the first test and just doing the Western blot. The CDC warns, "Doing so will increase the frequency of false positive results and may lead to misdiagnosis and improper treatment."

Since writing this, I've encountered some criticism. I've decided to post some info from the Mayo Clinic in the States.

Lab tests to identify antibodies to the bacteria can help confirm the diagnosis. These tests are most reliable a few weeks after an infection, after your body has had time to develop antibodies. They include:
  • Enzyme-linked immunosorbent assay (ELISA) test. The test used most often to detect Lyme disease, ELISA detects antibodies to B. burgdorferi. But because it can sometimes provide false-positive results, it's not used as the sole basis for diagnosis. This test might not be positive during the early stage of Lyme disease, but the rash is distinctive enough to make the diagnosis without further testing in people who live in areas infested with ticks that transmit Lyme disease.
  • Western blot test. If the ELISA test is positive, this test is usually done to confirm the diagnosis. In this two-step approach, the Western blot detects antibodies to several proteins of B. burgdorferi.
The above has a reference date of May 16, 2018. The above is not stale-dated information.