Archive for the ‘Lyme’ Category

Chronic: The Hidden Cause of the Autoimmune Pandemic & How To Get Healthy Again

https://www.lymedisease.org/excerpt-chronic-phillips-parish/

TOUCHED BY LYME: Read excerpt of “Chronic,” long-awaited book by Phillips and Parish

By Dorothy Kupcha Leland

CDC Lyme Count is Still Too Low

https://www.lymedisease.org/cdc-lyme-disease-cases-undercount/

How Much Does the CDC Undercount Lyme Cases?  It Depends on Where You Live

By Lorraine Johnson, JD, MBA

2/2/2021

The Centers for Diseases Control and Prevention recently compared its annual surveillance Lyme numbers [those that meet the agency’s narrowly defined case definition] to the number of Lyme cases tallied in a major insurance claims data base from 2010 to 2018. Their study concludes that the CDC is still undercounting cases1.

But, if you dig deep into the numbers, you see that the undercounting is much more severe in some areas—namely in southern and western states. This has huge implications for Lyme patients in those regions, making it much harder for them to get properly diagnosed and treated.

Here are my four main take-aways from the study:

  • Undercounting is the rule: The CDC increased its estimate of annual cases of Lyme disease from 300,000 to 476,000, based on insurance claims made. That’s a 58% increase in estimated cases.
  • Not all states are equal: In states the CDC considers low incidence, only 1 in 50 cases is counted, while in high incidence states 1 in 7 is counted.
  • State-based gender bias: In states the CDC considers low incidence, 63% of cases are female.
  • The revised estimate does not affect surveillance cases reported by the CDC, which reporters and physicians rely on. This leaves the public unaware and harms patients by giving their physicians a false sense of complacency that Lyme disease is not a big problem.
CDC undercounting of Lyme disease is more severe in some areas — namely in southern and western states

Misdiagnosis of Lyme disease by geography is a big problem

It’s important that the CDC is acknowledging an extraordinary amount of undercounting and it is also important that they are looking at other big data sources (here insurance claims) to see how far off the mark they are. However, the degree to which the CDC surveillance system undercounts cases is not equally distributed geographically. States that are considered low incidence states are disproportionately undercounted.

Here’s a table comparing the amount of underreporting reflected in the reduced number of surveillance cases compared to insurance claims in the CDC study in high-incidence, neighboring states, and low-incidence states:

How much does the CDC undercount Lyme disease?
Table - CDC undercount of Lyme disease in high-incidence, neighboring states, and low-incidence state

What we see is that the undercount is not equal among the three categories: high-incidence states are undercounted by a factor of 7, neighboring states by a factor of 10, and low-incidence states by a factor of 50. Undercounting cases by a factor of 50 means that for every single case identified, the CDC throws out another 49 cases. Thus, the CDC geographic case restriction impairs accurate counting of cases.

How much does the CDC undercount Lyme cases? It depends on where you live.

Moreover, the percentage of increase in cases reported by the CDC compared to insurance claims data shows the same anomalies among the different categories of states.

Table - Differences Between the CDC and Insurance Database Regarding Lyme Disease Growth Rate Percentages

The CDC surveillance counts place a heavy emphasis on “high incidence” states—which are primarily confined to the East Coast and Midwest as the map below illustrates.

CDC Lyme Disease Incidence Map

Unfortunately, saying that a state is either high or low incidence oversimplifies the complex geographic distribution which is driven by whether the local ecosystem will support and sustain the tick population that carries Lyme disease. In California, for example, there are areas as highly endemic as the east coast. The CDC totally ignores such variation within a single state. This emphasis on high incidence states is not only inaccurate, it also leads to misdiagnosis in other states where clinicians are led to believe the risk is not present. The feedback loop is further distorted because the CDC case report form includes endemicity as a requirement for counting cases, which in turn reflects awareness of risk, physician diagnosis, and counting of future cases. This misleading feedback loop will artificially suppress case counts in areas outside the Northeast and Midwest in perpetuity until it is abandoned.

For years, the Lyme community’s complaints about misdiagnosis by geography have fallen on deaf ears. Although the study increased the number of cases by 58% with the new 476,000 estimate, it also demonstrates how much cases in low incidence states are under-counted compared to high incidence states when different data sources are compared.

So for example, while surveillance data shows 93.2% of cases in high-incidence states, insurance data shows only 80.5%. That’s a 12% difference and it matters. It means that the CDC is undercounting cases in states that it does not characterize as high-incidence. We know this is likely true because another insurance data base study showed many states the CDC considers to be low incidence states to be in the top five states in insurance claims.

As reported in the Wall Street Journal: “North Carolina reported 32 Lyme cases to the CDC in 2016 but in the same year made 88,539 health-care claims for a Lyme diagnosis. California reported 90 cases to the CDC but had 46,820 claims. Texas reported 31 cases to the CDC but had 31,129 claims. All three are considered low incidence states 2”.

We also see this in the differences between MyLymeData geographical distribution of cases compared to the CDC below. The states in blue have a higher number of people enrolled in MyLymeData than are included in total CDC Lyme disease case reports. (In green states, the CDC has more cases.) The differences reflected on the map suggest a broad pattern of underreporting by the CDC of Lyme disease in the South and the West.

Differences between MyLymeData geographical distribution of cases compared to the CDC

If the CDC is going to look at real word data, it should be willing to consider that its preconceived notions of geographical distribution are incorrect and “listen to the data.”

A similar variation in seasonality occurred. A higher proportion from high-incidence states (59%) occurred during the summer compared with diagnoses from neighboring (53%) and low-incidence states (42%). This may reflect the warmer weather in the west and southwest and an extended tick season.

Do more males have Lyme disease than females? It depends.

Distributions by sex also differed across high-incidence, neighboring, and low-incidence states. Male patients accounted for a greater proportion of diagnoses in high-incidence states (50.8%) than in neighboring (41.9%) and low-incidence (36.6%) states. Biodiversity of strains and ticks across different ecosystems may affect males and females differently. But the fact that 63% of cases in low incidence states are female underscores the fact that gender-based assumptions may not accurately reflect the real world data. We do not know.

The CDC’s increased Lyme disease case estimate is important, but not enough.

The increase should be viewed as part of an effort by the CDC to find other ways of tracking Lyme cases because the current surveillance system is essentially broken. The current surveillance system imposes too great a burden on healthcare providers and on the local departments of health. As a result, cases are simply not reported. Streamlining this process by using either automated laboratory results or insurance claims from sources that already exist would dramatically reduce these burdens and hopefully more accurately reflect cases that occur in the real world.

Significantly, the new CDC study concludes that the MarketScan insurance claims data they used “provided a stable source of data for . . . diagnosis. . .that could serve as a resource efficient adjunct to surveillance.”.

The CDC’s increased estimate based on it’s comparison of real world insurance claims data to surveillance data is important. Even this increase widely misses the mark though. MyLymeData tells us that 50% of patient report that their clinician does not accept insurance. Those patients may not be included in the insurance data base.

 
50% of patient report that their clinician does not accept insurance

I am also bothered by the fact that when the geographic real-world data differs from the surveillance data, the CDC assumes that the real world data is wrong—that it’s due to miscoding or misdiagnosis. Why not consider the possibility that the CDC’s surveillance data could be incorrect? That independent data sources may provide us with a look at a larger reality and geographic and gender-based difference that require a deeper examination?

Even with the increased CDC estimate in Lyme disease cases, patients in the south and west will continue to be harmed by delayed and missed diagnosis because of the weight the CDC places on geography in the surveillance case reporting.

Click to tweet

We know that the surveillance data is skewed because it has inherent biases for cases that present with a rash and for cases that are geographically on the East coast or Midwest. Both of these factors play a large role in meeting the requirements of the surveillance case definition. Even with the increased estimate in cases, patients in the south and west will continue to be harmed by delayed and missed diagnosis because of the weight the CDC places on geography in the surveillance case reporting.

It’s good news that the CDC has increased its estimate of the annual number of cases after seeing that they are well below insurance claims cases. It would be better if they overhauled their surveillance case definition so that reporters don’t use these drastically under counted cases in their news articles and physicians are given the tools to promptly diagnose patients.

If you are a patient who is not enrolled in MyLymeData,  please enroll today. If you are a researcher who wants to collaborate with us, please contact me directly.

The MyLymeData Viz Blog is written by Lorraine Johnson, JD, MBA, who is the Chief Executive Officer of LymeDisease.org. You can contact her at lbjohnson@lymedisease.org. On Twitter, follow her @lymepolicywonk.  If you have not signed up for our patient-centered big data project, MyLymeData, please register now.

MyLymeData Lyme Disease Research
About MyLymeData Lyme Disease Research

MyLymeData is one of the largest patient-driven registries in the nation, with over 13,500 patients enrolled. It was created by patients, is run by patients and will address the issues that Lyme disease patients care about. MyLymeData Viz provides the community with results from MyLymeData. If you are enrolled in MyLymeData, we thank you for providing the data that will accelerate the pace of research in Lyme disease. If you are not enrolled, please enroll today.

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**Comment**
 
Great points.  The CDC has been assuming incorrectly for a very long time.  

Live Webinar: Lyme Disease & Heart Health

https://rawlsmd.com/webinars/lyme-heart-health/

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Lyme Disease + Heart Health with Dr. Bill Rawls

The fatigue, pain, and brain fog that often accompany chronic Lyme are bad enough. But when the disease starts affecting your heart and triggering symptoms like chest pain, palpitations, dizziness, and shortness of breath, it can be especially debilitating and worrisome.

LIVE WEBINAR on Wednesday, 2/10, at 8 pm EST

What causes Lyme to manifest in the heart (aka Lyme carditis) in some people, and how can you overcome the symptoms and ensure your heart is healthy?

Join a live webinar with Dr. Bill Rawls, author of the best-selling book Unlocking Lyme, who knows firsthand what it’s like to live with chronic Lyme disease and cardiac symptoms. He’ll demystify Lyme carditis and share critical therapies to restore your heart health and get much-needed symptom relief.

PLUS: Don’t miss an exclusive gift for webinar attendees, and have your questions ready for a LIVE Q&A on Lyme disease and your heart with Dr. Rawls.

In this webinar, Dr. Rawls will discuss:

  • Why cardiac symptoms such as chest pain, irregular heartbeats, and shortness of breath occur in Lyme disease patients
  • What common Lyme coinfections and your gut microbiome have to do with it
  • Why the connection between heart symptoms and Lyme often goes unrecognized by healthcare practitioners
  • The best conventional and natural therapies for relieving symptoms and supporting heart health 
  • Numerous insights during the live Q&A with Dr. Rawls

RESERVE MY SEAT »

Lyme Announcement at the SuperBowl

https://globallymealliance.org/news/gla-public-service-announcement-airing-on-the-radio-during-the-super-bowl/?

Get ready for the Super Bowl!

Listen below to GLA’s new Public Service Announcement (PSA) which will air for 30 seconds during the super bowl coverage this Sunday on Westwood One/SiriusXM!

If you are looking to hear the PSA live, game-day coverage will begin at 2:00 PM ET. The Super Bowl game broadcast will begin at 5:00 PM ET, hosted by Jim Gray, with kick-off expected at approximately 6:30 PM ET.

Millions of listeners around the globe will tune in to Westwood One’s Super Bowl LV coverage across more than 600 radio stations nationwide! Fans can also hear the broadcast on SiriusXM and through NFL Game Pass, which is available on NFL.com and the NFL App. You can also follow Westwood One Sports on Twitter, @westwood1sports. Click here to find a station near you.

The broadcast can also be heard worldwide via the American Forces Radio Network, which provides programming to America’s military. The network serves over one million men and women in uniform, Department of Defense personnel, American Embassies and Consulates in over 175 countries and territories, as well as on more than 200 U.S. Navy, U.S. Coast Guard, and Military Sealift Command ships at sea!

This Global Lyme Alliance (GLA) PSA kicks off our 2021 radio campaign which is aimed at raising awareness for GLA and our mission to serve the Lyme Community! In addition to the Super Bowl spot, GLA will also debut several radio public service announcements (PSA’s) during the Yankees/Mets broadcasts throughout the season.

Yankees and Mets Opening Day is April 1.

Stay tuned to the Yankee/Mets Radio Network Affiliate Stations or stream the games on WFAN.com, RADIO.com, and any devices or smart speakers that play WFAN and listen for GLA.

In addition to the radio piece, we’ll have a full digital element to the overall campaign that will deliver 3.7 million impressions via streaming audio and companion ad banners online.

GLA is very excited to bring more awareness about the dangers of Lyme disease to millions through this campaign & can’t wait to see the impact that it has as we continue to advance our mission to conquer Lyme & other tick-borne diseases.

Dreaming of the Past- and the Future

https://globallymealliance.org/dreaming-of-the-past-and-the-future/

By Jennifer Crystal

People who haven’t had late-stage Lyme disease sometimes ask what the worst symptom I experienced was.

Without hesitation, it was insomnia. The Lyme bacteria had burrowed so deeply into my nervous system that my brain was on overdrive; despite bone-crushing fatigue, I could not shut my brain off to sleep. At one point, I was awake for three weeks straight. Worse, when I did sleep, I had hallucinogenic nightmares that were more exhausting than my waking hours.

Most of my dreams were non-sensical, and I had so many of them in a night, in such vivid detail, that it was hard to recall them all. But certain ones stick with me to this day. There are the good ones, the ones with meaning, like the recurring dream I described in “Missing the Summer of Life”.

And then there are the awful ones. I’m not talking about the worst of the nightmares, in which I was shot, burned, or raped. Those were traumatic in their own right. But more awful to me were the realistic dreams, those that played out the fatigue I felt in real life, in the context of things I could no longer do. Sometimes I would dream about lying in the middle of my former college campus, too tired to talk to friends walking by. Sometimes I’d be at the bottom of a ski hill, too tired to open my eyes or sit up, as healthy skiers whooshed past. I felt fatigue in my sleep as deeply as I felt it when I was awake. Not only were nights not restorative, but I woke feeling sad and anxious, longing for my old abilities and wondering if life would just pass me.

But as treatment for Lyme disease and the co-infections babesiosis and ehrlichiosis began to work, inflammation in my brain decreased. My waking energy improved, and my dreams shifted. Many nights I still had the awful nightmares, but peppered among them were better dreams about feelings I’d once experienced, but had long forgotten in my years of convalescence. Instead of lying at the bottom of a ski hill, I zoomed down it, without air hunger or a headache. My legs, which had felt so achy and weighted for so long, were light and strong in these dreams. I skied for hours, never tiring. The rush I used to feel from skiing in real life came back to me in these dreams, and I woke smiling.

Other nights my dreams reminded me of the euphoria of being in love, or of the giddiness of being tipsy. I didn’t only feel healthy in these dreams; I also got to experience the emotions that come with joy and fun. I wasn’t yet able to ski, or date, or go to a party in real life, but my dreams made those activities feel within reach. Instead of longing for what I’d lost, I started feeling hopeful about what I might someday be able to do.

I was once again dreaming of living, and those dreams worked as a nice metaphor for the possibilities that opened up to me as I got healthier and healthier. Eventually, I was able to ski, albeit slowly. I started socializing more. I laughed.

My journey to wellness wasn’t linear, and neither was the trajectory of my dreams. When I had physical setbacks, my dreams often mirrored them. Or, sometimes they’d forewarn them. For example, I might dream about driving a car too fast and not being able to hit the brakes. These dreams told me that I was pushing my body a little too hard; if I didn’t slow down, I might crash. As I wrote in this post, sometimes rest was the most important message of my dreams.

Dreaming of the past can be difficult, but it’s a way for us to mourn what we’ve lost. Dreaming of the future gives us hope, and lets us grasp feelings we can’t yet access in real life. Joy, fun, happiness, silliness—they’re hard to come by when you’re sick, but with proper treatment, rest, and time, they can shift from dream to reality.


jennifer crystal_2

Opinions expressed by contributors are their own.

Jennifer Crystal is a writer and educator in Boston. Her memoir about her medical journey is on submission. Contact her at lymewarriorjennifercrystal@gmail.com.