artur737 Plan strategiczny organizacji w Vermont 21.04.07, 22:03 Podaje, bo moze Stowarzyszenie cos z tego wyciagnie dla siebie. The Vermont Lyme Information Resource reorganized and renamed itself recently--we are now the Vermont Lyme Network. We have been increasingly active in outreach and education activities, with a lot of good media coverage over the five years we've been in existance. With the IDSA guidelines last year, we began making plans to approach the legislature this session. Several new members on our steering committee have really run with this, and a few weeks ago approached some legislators to feel out the possibility for a resolution simply recognizing the issues around Lyme and asking them to support the federal bill. To all our surprise, we had such a positive response from our legislators that it almost ran away from us! We had to move fast to catch up, and make sure we didn't get in each other's way too much in the process. The last 3 weeks have been amazing. With the resolution making the rounds of the house for co-sponsors, we got lucky and got a slot to sponsor a legislative breakfast and "awareness day" last Tuesday, April 10th at the State House.("Awareness days are what lobby days are called in Vermont.) We had several respresentatives and senators helping us through the process and advocating for us. In ten days, we made arrangments, organized people, pulled together literature (thanks to LDA, ILADS, and the SE Pa Lyme group), chipped in to pay for the coffee and made or begged breakfast breads, donuts, bagels, coffeecakes. It was an incredible success. We had legislators thanking us for doing what we doing and for bringing it to the legislature. My legislator arranged for me to talk to our governor in his offices, to explain the key issues and the impact they were having on people's lives. I couched it in terms of breaking through paradigms (we all have them- they are ways we structure what we know about the world, but can make it hard to adjust to new information that seems to contradict what we are used to) Odpowiedz Link
artur737 Maj miesiacem boreliozy 01.05.07, 16:54 www.emediawire.com/releases/2007/5/emw523166.htm Streszczenie: Fakt czy fikcja? FAKT: Przez mniej niz 3 dni kretek boreliozy przenika z miejsca ugryzienia przez kleszcza do stawow i od osrodkowego ukladu nerwowego FAKT: Poczatkowo mikrskopijna ilosci bakterii Bb jest w stanie calkowicie zasiedlic organizm czlowieka. FAKT: Wiadomo, ze Bb przenosi sie z saren i myszy. Ale pelna lista zwierzat przenoszacych te chorobe zawiera takze: elki, wedrowne ptaki, kroliki, konie, psy. Dzikie zwierzeta moga przenosic kleszcze na znaczne odleglosci. Domowe zreszta tez podrozuja np na pokazy. Dlatego, jezeli nawet ktos mieszka w rejonie w ktorym kleszcze nie wystepuja endemicznie to zagrozenie zawsze istnieje. FAKT: Jakkolwiek kleszcze stanowia glowny wektor zarazenia to obecnosc Bb zostala takze potwierdzona we krwi konskich much, pchel, roztoczach itp. Sa pacjenci, ktorzy nigdy nie zostali ugryzieni przez kleszcza, ale przypominaja sobie inne ugryzienia przez owady, po ktorych pojawily sie objawy poczatkowe choroby. FAKT: Kleszcze przecietnie sa zarazone 13 roznymi patogenami (wirusy, bakterie, mykoplazmy). Jezeli lekarz leczy tylko borelioze to pozostale patogeny nie beda leczone. Te inne to m.in. Babesia, Bartonella, Erlichia, H. pylori, Mycoplasma, Tularemia, HIV, HPV, Q Fever, Rocky Mountain Spotted Fever. Pacjenci z Morgellon's czesto tez maja borelioze i poprawiaja sie znaczaco po antybiotykach. FAKT: Standardowo badania na borelioze sa dwustopniowe zaczynajac od Elisy. Na kazdych 100 pacjentow z borelioza az 51-67 z wczesna choroba slyszy od lekarza, ze nie ma boreliozy. 21 pacjentow z choroba pozna takze slyszy od lekarza, ze nie ma boreliozy na podstawie testu ELISA, ktory to test nie jest dostatecznie czuly i nie pozwala na prawidlowa diagnostyke. Odpowiedz Link
artur737 Re: Maj miesiacem boreliozy 01.05.07, 16:55 FAKT: Obecny Western blot uzywany przez wiele laboratorium powstal w oparciu o probke pacjentow majacych borelioze przez 5 miesiecy lub mniej a nie pacjentow chorujacych dluzej. Takze nie wykrywa STARI zwanej inaczej Master’s disease (dot USA) i jest badaniem zautomatyzowanym. W rezultacie 33 ze 100 chorych na borelioze uslyszy od lekarza blednie, ze nie maja boreliozy w oparciu o Western blota. Ci pacjenci najczesciej otrzymaja mylnie jedna z nastepujacych diagnoz: Multiple Sclerosis, Fibromyalgia, Przewlekle Zmeczenia, Lupus, Miastenia Gravis, Paraliz Bell'a, ALS (Stwardnienie Zanikowe Boczne), urojenia, Schizofrenia, Choroba Dwubiegunowa, otepienie lub choroba Azlheimera. A to dlatego, ze Borrelia burgdorferi moze udawac kazda z wymienionych chorob. FAKT: Borelioza jest jak syfilis – wystepuje w kazdym narzadzie i w kazdym plynie tkankowym. Moze przeniknac od matki do plodu. Wrodzona borelioza w 75% charakteryzuje sie neuropsychiatrycznymi objawami, w tym autyzmem, ADHD, zaburzeniami ukladu czucia. Tak jak w kile, ludzie z Bb moga miec tylko znikome objawy lub wcale nie maja objawow przez lata zanim pojawi sie rozsiana pozna borelioza. W czasie bezobjawowym moga oni nieswiadomie rozsiewac chorobe poprzez kontakty seksualne lub matka-plod. FAKT: Borrelia burgdorferi ma wiele form: kretek, cysta, bleb, moze wystepowac wewnatrz i zewnatrz komorkowo, moze miec sciane komorkowa lub nie miec, moze laczyc swoje DNA z DNA czlowieka, moze efektywnie ukrywac sie przed ukladem immunologicznym. Potrzeba efektywnej kombinacji antybiotykow by efektywnie wyleczyc wszystkie formy. International Lyme and Associated Diseases Lyme Literate Medical Doctors (ILADS LLMDs) jest organizacja doswiadczona w zastosowaniu dzialajacych protokolow leczenia. FAKT: Borrelia burgdorferi wedruje do stawow, blon maziowych, tkanki serca, narzadow rozrodczych oraz do mozgu, rdzenia przedluzonego, wlokien nerwowych przez co negatywnie wplywa na na osrodkowy i obwodowy uklad nerwowy. W skrocie, kazdy organ ciala moze zostac uszkodzony. FIKCJA: Borelioza nie wystepuje na terenie (wpisac dowolne miejsce na Ziemi). FIKCJA: Borelioza jest nadmiernie diagnozowana i nadmiernie leczona. FIKCJA: Chorzy z borelioza nie sa naprawde chorzy tylko poszukuja uwagi ze strony lekarza. FIKCJA: Borelioze mozna wyleczyc 10 dniami doksycyliny. FIKCJA: Chronicznej boreliozy nie mozna wyleczyc antybiotykami. FIKCJA: Wskazowki leczenia przedstawione przez The Infectious Diseases Society of America (IDSA) sa wystarczajace do wyleczenia boreliozy. FIKCJA: Borelioza nie powoduje smierci. Odpowiedz Link
artur737 Re: Maj miesiacem boreliozy 01.05.07, 16:56 Oryginal May Marks Lyme Disease Awareness Month: Is Lyme Disease The Next Tsunami Fact or Fiction? Download this press release as an Adobe PDF document. May 2007 is Lyme Disease Awareness Month. Christine N. Cibula, M.S. of Living With Lyme, A Division of Strategic Living, Inc. sheds light on the lesser known facts and widely accepted fiction surrounding Lyme disease that perpetuates the improper diagnosis, testing, and treatment of Lyme Disease patients Nationwide and Worldwide. You decide whether Lyme disease as the next tsunami is fact or fiction. San Diego, CA (PRWEB) May 1, 2007 Odpowiedz Link
artur737 Re: Maj miesiacem boreliozy 01.05.07, 16:56 May Marks Lyme Disease Awareness Month: Is Lyme Disease The Next Tsunami Fact or Fiction? Download this press release as an Adobe PDF document. May 2007 is Lyme Disease Awareness Month. Christine N. Cibula, M.S. of Living With Lyme, A Division of Strategic Living, Inc. sheds light on the lesser known facts and widely accepted fiction surrounding Lyme disease that perpetuates the improper diagnosis, testing, and treatment of Lyme Disease patients Nationwide and Worldwide. You decide whether Lyme disease as the next tsunami is fact or fiction. San Diego, CA (PRWEB) May 1, 2007 Odpowiedz Link
artur737 Re: Maj miesiacem boreliozy 01.05.07, 16:57 FICTION: Lyme disease does not exist in (City, State). FICTION: Lyme disease is being over diagnosed and over treated. FICTION: Lyme disease patients are attention seeking excuse makers. FICTION: Lyme disease is cured by a 10-day dose of Doxicycline. FICTION: Persistent Chronic Lyme cannot be treated with antibiotic therapy. FICTION: The Infectious Diseases Society of America (IDSA) Treatment Guidelines are sufficient and curative. FICTION: Lyme disease can't kill you. Is Lyme disease the next tsunami fact or fiction? You be the judge. Living with Lyme will be providing more free educational information about Lyme disease awareness throughout May 2007. To learn more about how to safeguard and protect your family visit www.livingwithlyme.com/lyme_awareness_may_2007.html. Living With Lyme will be providing patient education on symptoms and differential diagnosis, the one laboratory in the country that has highly sensitive and specific testing, and how to find an ILADS LLMD to oversee your ongoing treatment and care. About Living With Lyme: Christine N. Cibula, M.S. founded Living With Lyme (www.LivingWithLyme.com and www.LivingWithLymeBlog.com) in 1999 after being diagnosed wtih Lyme disease and realizing she had been suffereing with Lyme for 11 years prior to being accurately diagnosed. Her symptoms resolved after year of high dose antibiotic therapy. As she read the research she discovered that the basic information most people know about Lyme disease is just the tip of the iceberg. In response she created Living With Lyme to get Lyme patients up to speed quickly with everything they need to know and nothing they don't. To sign up for her Free Living With Lyme Ezine and enjoy a Free Teleseminar Lyme Educational Series in May 2007, visit www.LivingWithLyme.com/lyme_awareness_may_2007.html and sign up today! ### Trackback URL: www.prweb.com/pingpr.php/Q3Jhcy1Mb3ZlLUhvcnItUHJvZi1NYWduLVplcm8= Odpowiedz Link
artur737 Maj miesiacem boreliozy 03.05.07, 08:36 www.ucsf.edu/synapse/content/50307/lyme.html May is Lyme Disease Awareness Month By Komal Bawa Staff Writer May 2nd, 2007 It seems as though nearly everything nowadays has an awareness month, but Lyme disease is a particularly important health concern that does not seem to be well acknowledged. May is designated Lyme Disease Awareness Month because spring is the time of year that ticks lay their eggs and nymphs become active. However, this is not to say that ticks are not biting all year long. The “Lymies” or those infected with Lyme Disease, are very strong advocates in drawing attention to what they describe as “a plague,” with the hopes that even one less person may suffer from the debilitating disease. To give a little background — Lyme disease (LD) was first found in Lyme, CT about 1970, but the vector of disease was not established until 1975 when an outbreak of juvenile arthritis was followed by a rash among these residents. It is thought to be carried by many common insects but its transmission has been predominantly linked to deer ticks. The infected ticks transmit the bacterium Borrelia burgdorferi via their bite which then resides in various tissues in humans and animals. Common symptoms associated are an expanding rash (Erythema Migrans) resembling a bull's-eye, flu-like symptoms, fibromyalgia, severe fatigue and various CNS symptoms i.e. brain fog. However, LD has symptoms that mimic about 320 other diseases, which is why it very often goes undiagnosed. The alarming concern surrounding LD is not new; rather it has been a concern for quite some time. Testing methods such as ELISA produce false negatives 50 percent of the time and physicians who are unaware may misdiagnose or more commonly miss it altogether. To date the most efficient test is done by Palo Alto based IGeneX using western blots to see which antibodies a patient may be making. A breakthrough test newly introduced by Central Florida Research Lab is the antigen test to detect the bacterium. The problem with this disease, like many others now, is that there is no cure. There is only symptomatic relief. On the West Coast the prevalence of LD is still relatively low, but it is spreading. To bring it into perspective an elderly woman was bit on Hippie Hill, the hillside that overlooks the children's playground in Golden Gate Park and is in such poor health that she is unable to walk. Another case was seen in Glen Park when a woman was trimming hedges in her backyard. These local reports show that this is no longer a disease that is just being spread throughout endemic areas, rather it is being reported just about everywhere. The low incidence of reported cases is multidimensional. UC Berkeley entomologist, Robert Lane, made note that only about 18-30 percent of people actually see the tick that bites them. Very often the nymph spreads the disease and it is the size of a poppy seed, and thus not seen. Therefore, if the tick is unseen and the symptoms mimic other diseases, the diagnosis of LD is far down the list if the telltale symptoms are absent. Essentially all that can be done in a disease like this is prevention. Most of the following recommendations are for outdoor activities such as hiking, camping, etc. but can generally be applied. First off, be aware of your surroundings. Don't walk through tall grass; rather, stay on the trail. Often times the ticks are sitting at the edge of grass blades just waiting. Wear proper attire (boots, socks, hats, long sleeves, pants). Also, apply an insect repellent (with DEET or permethrin) on skin and especially at junction on clothing. If you are bitten, remove the tick with tweezers and make sure that the head is out. Then save the tick (it can be sent off to a lab and analyzed for LD). To be cautious, an antibiotic course may be done soon after the bite to decrease the risk of contracting the disease if the bacteria are present. It is also very important that if you have contracted LD to be seen by a “Lyme literate physician” as they will best be able to work through the disease with you. Lastly, it is important to not only protect yourself, but your animals as well. Yes, your dogs and cats can also get LD via the same mode of transmission as we do. Keep up with giving your pets their Frontline and Advantix. There was a case that was recently reported about a dog contracting LD around 46th and Taraval. Unfortunately this disease has made its way out to our neck of the woods and all we can do is be aware and cautious. Available resources: www.Lymenet.org/discussion/medicalquestions www.Lymediseaseassociation.org www.igenex.com (800-832-3200) www.Centralfloridaresearchlab.com Odpowiedz Link
artur737 Re: "Sezon na Kleszcza" cz druga 03.05.07, 23:36 Thursday May 3, 2007 VIEWPOINTS Lyme disease can limit your life Copyright 2005 Deer ticks can be Lyme disease carriers. May is Lyme Disease Awareness Month. Most people are unaware that Lyme is often a complex infection of several kinds of bacteria, viruses and parasites that work synergistically with the Lyme spirochete, Borrelia burgdorferi, to make a person chronically ill. The severity of the illness depends on the combination of co-infections, the germload and the health of the individual at the time of infection. Current testing is inadequate, and often patients must go from doctor to doctor before being diagnosed and must pay out of pocket for most services. Many doctors will not even acknowledge the existence of chronic Lyme. We are at moderate risk for Lyme here right now, but it is endemic just a few counties away. Learn how to protect yourself and your loved ones from tick exposure to best avoid this painful illness that can severely debilitate and limit your life. Odpowiedz Link
artur737 Lyme Disease Symposium raises concerns 11.05.07, 05:27 Lyme Disease Symposium raises concerns By Nancy Robinson New Canaan News - Review Article Last Updated:05/10/2007 www.newcanaannews-review.com/ci_5864472 Connecticut remains ground zero for Lyme disease, and it is a rare household that has not been touched by some aspect of this multi-faceted illness. A distinguished panel of speakers, sponsored by the Democratic Town Committee, addressed an audience Tuesday night at Town Hall. The speakers included Attorney General Richard Blumenthal, State Rep. William Tong (D-147), Dr. Leo J. Shea III, clinical assistant professor at Rusk Institute, and Dr. Steven Philips, a world-renowned expert on Lyme disease. Phillips has studied Lyme disease for 15 years. He is past-president of the International Lyme and Associated Diseases Society (ILADS) which is dedicated to educating physicians about accurate diagnosis and appropriate treatment of Lyme and its associated diseases. There is much misinformation surrounding this disease. For example, according to Phillips, only 40 to 50 percent of patients will develop the well-known bulls-eye rash. And while some people will respond to a treatment of antibiotics and will not suffer any reoccurrence, many others will not be so fortunate. There are several hundred strains of Lyme, Phillips said, which is why people react differently to the treatment. To make the situation even more difficult, there is no blood test that will prove the presence of Lyme. Typically the disease presents itself as a multi-system illness that can affect the nerves, brain, heart, muscle and joints with a variety of symptoms. Symptoms can disappear then reappear because the illness is caused by a bacteria and single-cell organism that is slow-growing. Contrary to what many people believe, statistics have shown that there is no advantage to oral versus intravenous treatment with antibiotics. "There is no definitive therapy for Lyme disease, though antibiotics have proven helpful," Phillips said. Shea, now serving as chairman of the National Research Fund for Tick-Borne Diseases (NRFTD), told the audience that Lyme disease first received recognition 30 years ago, though it had been around for decades before that. Lyme disease can result when a tick invades the body, causing an illness which often results in lingering effects from co-morbid infections. Shea began his presentation by referring anecdotally to a situation that is common to many New Canaan residents. "Some people react very well to a treatment of antibiotics, while others who receive the same treatment have lingering symptoms over many years," Shea said. "Good, unbiased research is needed," he explained. Currently there is little or no funding from the federal government centered on research studies to help scientists understand this complex disease. The NRFTD's mission is to support scientific research and understanding of the complicated infections caused by ticks. Shea also reported that all of the fund's six pilot projects underway will appear in peer-review journals, which is critical in acquiring more funding for additional research. This factor is critical for two reasons. Viable, peer-reviewed projects that adhere to the highest standards of quality have a greater likelihood of receiving long-term funding by the National Institutes of Health or the National Science Foundation. In practical terms for sufferers of Lyme disease, these study results are examined by insurance companies, who have been criticized often for denying coverage to people receiving treatment for Lyme disease. Also concerned about insurance coverage was Attorney General Richard Blumenthal, who reported that there was a systemic denial of coverage by insurance companies. Blumenthal said he believed people who were entitled to insurance coverage were being denied improperly. He has been on the forefront for several years in defending the rights of patients requiring treatment, including long-course and intravenous antibiotics. "It is a legal mandate and a principle that qualified doctors and patients should decide on treatment, not insurance bureaucrats or public officials," he said. Recently Blumenthal ordered civil investigation of the Infectious Disease Society of America's (IDSA) development of treatment guidelines for Lyme, which appeared to be overly negative and opposed to long-term antibiotic treatment. Blumenthal discovered that in some cases panel members were consultants to firms that might possibly influence them to favor one treatment over another. He also has been instrumental in requiring the reporting of pharmaceutical company payments to physicians. Another area of concern is the need for ongoing regulation of the Department of Public Health, which is no longer required to report cases of Lyme disease in Connecticut, which can limit the help received from the federal government. State Rep. William Tong is working closely with Attorney General Blumenthal on two legislative proposals. Having contracted Lyme disease himself, Tong was one of the fortunate ones who responded to treatment and has not suffered a relapse. "This is a scary, chronic condition that deserves attention and it has not received that attention here in Connecticut," said Tong. In 2002, more than 4,600 cases of Lyme were reported and that is estimated to be only 10 percent of the active cases. In 2003 the DPW stopped mandatory reporting of cases and in 2005 only 1,500 cases were reported, even though Connecticut is No. 1 in the county in the rate of Lyme infection. "You would think from those numbers that the problem has been solved, which we all know is not the case," Tong said. Tong recently introduced a proposal in the state House that included reinstatement of mandatory lab reports of Lyme disease and another proposal that establishes a Connecticut Lyme Disease Task Force. "We need a strategic plan for the diagnosis and treatment of Lyme because we are affected more than any other state," Tong said. Odpowiedz Link
artur737 Re: Lyme Disease Symposium raises concerns 11.05.07, 05:27 The NRFTD's mission is to support scientific research and understanding of the complicated infections caused by ticks. Shea also reported that all of the fund's six pilot projects underway will appear in peer-review journals, which is critical in acquiring more funding for additional research. This factor is critical for two reasons. Viable, peer-reviewed projects that adhere to the highest standards of quality have a greater likelihood of receiving long-term funding by the National Institutes of Health or the National Science Foundation. In practical terms for sufferers of Lyme disease, these study results are examined by insurance companies, who have been criticized often for denying coverage to people receiving treatment for Lyme disease. Also concerned about insurance coverage was Attorney General Richard Blumenthal, who reported that there was a systemic denial of coverage by insurance companies. Blumenthal said he believed people who were entitled to insurance coverage were being denied improperly. He has been on the forefront for several years in defending the rights of patients requiring treatment, including long-course and intravenous antibiotics. "It is a legal mandate and a principle that qualified doctors and patients should decide on treatment, not insurance bureaucrats or public officials," he said. Recently Blumenthal ordered civil investigation of the Infectious Disease Society of America's (IDSA) development of treatment guidelines for Lyme, which appeared to be overly negative and opposed to long-term antibiotic treatment. Blumenthal discovered that in some cases panel members were consultants to firms that might possibly influence them to favor one treatment over another. He also has been instrumental in requiring the reporting of pharmaceutical company payments to physicians. Another area of concern is the need for ongoing regulation of the Department of Public Health, which is no longer required to report cases of Lyme disease in Connecticut, which can limit the help received from the federal government. State Rep. William Tong is working closely with Attorney General Blumenthal on two legislative proposals. Having contracted Lyme disease himself, Tong was one of the fortunate ones who responded to treatment and has not suffered a relapse. "This is a scary, chronic condition that deserves attention and it has not received that attention here in Connecticut," said Tong. In 2002, more than 4,600 cases of Lyme were reported and that is estimated to be only 10 percent of the active cases. In 2003 the DPW stopped mandatory reporting of cases and in 2005 only 1,500 cases were reported, even though Connecticut is No. 1 in the county in the rate of Lyme infection. "You would think from those numbers that the problem has been solved, which we all know is not the case," Tong said. Tong recently introduced a proposal in the state House that included reinstatement of mandatory lab reports of Lyme disease and another proposal that establishes a Connecticut Lyme Disease Task Force. "We need a strategic plan for the diagnosis and treatment of Lyme because we are affected more than any other state," Tong said. Odpowiedz Link
artur737 Lyme disease tests and guidelines inadequate 11.05.07, 08:24 Wazny artykul adresowany do kanadyjskich lekarzy a wyprodukowany przez Canadian Lyme Foundation. Wydrukowal go Medical Post czyli taki odpowiednik Polskiego Informatora Polfy - cos co dostaje i czyta kazdy lekarz. INSIDERS: Lyme disease tests and guidelines inadequate April 24, 2007 | Jim Wilson CDC testing protocol opposed for being inconsistent, producing false negatives Lyme disease, a bacterial infection caused by the spirochete Borrelia burgdorferi, mimics many diseases. It has been misdiagnosed as other diseases or disorders in a number of cases (multiple sclerosis, several forms of arthritis including juvenile arthritis, heart disorders not limited to heart block, other neurological disorders, psychiatric disorders, chronic fatigue syndrome, fibromyalgia, Alzheimer?s disease, Crohn?s disease and other conditions). Late-stage Lyme disease can resemble any of these other illnesses. Acute Lyme disease is in some cases more flu-like, with headaches, muscle aches, fever, stiff neck, etc. Some people do not get this initial flu-like acute phase. Lyme disease is much more prevalent in Canada than our tests indicate. Not diagnosing and treating Lyme disease early can result in a serious decline in health and quality of life similar to untreated syphilis T. pallidum, another spriochaetal disease. B. burgdorferi has more than 1,500 gene sequences, 132 functioning genes (syphilis has only 22), 21 plasmids (three times more than any other known bacteria) and has the ability to evade the immune system. It is a formidable bacterium and has been shown in peer-reviewed research to remain as an active persistent infection after several weeks of antibiotic therapy. The classic bull?s-eye rash (erythema migrans) by itself is diagnostic but occurs or is seen in fewer than 50% of cases. Making things more difficult, research has proven that laboratory serology is less than adequate for diagnosis. More important, serology cannot satisfactorily rule out Lyme disease in either the early or late stages. Odpowiedz Link
artur737 Re: Lyme disease tests and guidelines inadequate 11.05.07, 08:25 Canadian labs follow the 1994 U.S. Association of State and Territorial Public Health Laboratory Directors (ASTPHLD) two-tier testing protocol of a screening test such as Enzyme-Linked Immunosorbant Serum Assay (ELISA), and only if that test is positive is a confirmatory positive Western Blot. We, along with scientists from around the world, oppose the CDC testing protocol. The protocol was heavily influenced by industry. The problem is that in large, blinded multiple-laboratory studies findings indicated the labs using this ASTPHLD protocol could only identify Lyme disease via ELISA 45% to 55% of the time and could not identify the same sample consistently in the same lab. Further problems are that the criteria looked at in the Western Blot as put forward by ASTPHLD exclude some of the most Lyme-specific bands on the blot, making this test a poor one as well. To exemplify this point of poor testing, at a 1995 rheumatology conference in Texas, Dr. Paul Fawcett (PhD) presented an analysis of the new Lyme disease criteria. All of 66 children who had a history of tick bite, bull?s-eye rash and symptoms of Lyme disease tested positive using the pre-1994 criteria. Using the new criteria, only 20 tested positive (a 69% false negative rate while the old criteria had 0% false negative). In October 2006, the Infectious Disease Society of America (IDSA) released their updated Lyme disease clinical practice guidelines. Other medical groups had asked to participate in the creation of the guidelines but were refused. The guidelines rely heavily on the two-tier testing protocol following the ASTPHLD criteria and ignore the global database of research. Some of the authors of these guidelines also sat on the committee in 1994 that set the ASTPHLD criteria. The insurance industry has quickly adopted these IDSA guidelines and quote them verbatim as they deny claims for treatment. Richard Blumenthal, the Attorney General of Connecticut, announced recently he is investigating the IDSA with respect to the publishing of these guidelines under anti-trust laws, and is bringing the insurance industry into his investigation. The IDSA guidelines and the ASTPHLD criteria have no place in Canadian health care. Diagnosing and treating Lyme and co-infections can be complex and cannot be properly addressed here. For that information and information on testing labs visit our Web site at www.canlyme.org/. Jim Wilson is president of the Canadian Lyme Disease Foundation. Odpowiedz Link
gucina69 Re: Lyme disease tests and guidelines inadequate 11.05.07, 08:55 a jak jest "kleszcz" po angielsku Odpowiedz Link
franiolek1 Re: Lyme disease tests and guidelines inadequate 11.05.07, 09:40 kleszcz = tick Odpowiedz Link
biol6 Re: "Sezon na Kleszcza" cz druga 11.05.07, 10:06 Pewne stereotypy dotyczące kleszczy nie zawsze są zgodne z prawdą. Szczyt aktywności kleszczy przypada na maj-czerwiec (wcześniej jeśli robi się cieplej w kwietniu) oraz wrzesień, co nie oznacza, że nie występuja w pozostałych miesiącach. Najczęściej lokalizują się do 1 m wysokości na krzakach, trawie, ale spotykane są również na drzewach przenoszone przez ptaki, wzdłuż ścieżek zwierząt. W Polsce kleszcz pospolity jest gatunkiem leśnym, coraz cześciej spotykanym w parkach miejskich, placach zabaw, działkach i ogródkach. Skuteczne na kleszcze są repelenty (Autan) ale też dobrze jest wybrać się na spacer do lasu w jasnych ubranich (lepiej widać klescze), długich spodniach, długi rękaw, okrycia głowy. Miejsce po ugryzieniu dokładnie obserwować, w razie jakichkolwiek pzrzedłużających się objawów najlepiej uda się do lekarz/lekarzy z prośbą o przepisanie antybiotyku. A jeśli chodzi o Borrelia-występuje u wielu gat ptaków i ssaków (wolnożyjące i domowe np. psy)lokując się głównie w krwi, tkace usznej, mięśniu sercowym, mazi stawowej, pęcherzu moczowym, płynie mózgowo-rdzeniowym itp. Pzdr Odpowiedz Link
biol6 Re: "Sezon na Kleszcza" cz druga 11.05.07, 10:18 Kleszcz Ixodes ricinus po opadnięciu na żywiciela nie "wgryza" się od razu. Najpierw szuka odpowiedniego miejsca-gdzie trudno go usunąć (zwierzęta), blisko naczyć krwionośnych zlokalizowanych pod skórą. Żywiciela lokalizuje za pomocą tzw. organu Hallera na stopach I pary odnóży - reaguje głównie na ciepło. W ślinie kleszczy zawartych jest mnóstwo związków odpowiedzialnych min. za "miejscowe" znieczulenie (dlatego często nie czuć momentu ugryzienia) czy też zapobiegających krzepnięciu. A wraz ze śliną przekazuje patogeny, które wcześniej wniknęły do jego ślinianek. Kleszcz I. ricinus pije krew kilka dni (2- 11 w zależności od stadium rozwojowego) po czym odpada do środowiska aby ulec lnieniu do następnego stadium rozwojowego. U samic warunkiem złożenia jaj (nawet do 2 tys za jedym razem) jest napicie się krwi. Samce się nie odżywiają i giną zaraz po kopulacji. Ciekawostka- niektóre gat z Ameryki Północnej mogą żć bez jedzenia (okresv diapauzy) nawet 7 lat! Pzdr Odpowiedz Link
franiolek1 Re: "Sezon na Kleszcza" cz druga 11.05.07, 10:25 Dzieki wielki za wszystkie informacje o kleszczach. My znamy te bestie z bezposredniego kontaktu, nie mamy danych naukowych Jednak zdanie o obserwacji miejsca ugryzienia i pojsciu do lekarza z prosba o antybiotyk, niektorych moze rozbawic. Poczytaj nasze historie, i nasze pielgrzymki do lekarzy roznych specjalizacji z prosbami o ratunek - szybko zorientujesz sie, ze lepiej nie miec niczego do obserwowania.... Jestes biologiem? Interesujesz sie kleszczami? Jeszcze raz dziekuje za udzial na forum Odpowiedz Link
biol6 Re: "Sezon na Kleszcza" cz druga 11.05.07, 10:31 Niestety masz rację. Szczęka mi opada (wielokrotnie!!!) gdy czytam o kompetencji lekarzy - szczególnie tych od chorób zakaźnych. Co do prośby o antybiotyki u lekarzy - nie chciałam nikogo urazić. Takie rozwiązanie dotychczas skutkowało zaraz po ugryzieniu - ale może to kwestia znajomego lekarza. Pzdr i życzę więcej szczęścia w kontaktach ze służbą zdrowia. Pzdr Odpowiedz Link
artur737 Kleszczowka? 12.05.07, 17:09 Podatek od boreliozy Okreg Alameda w USA zamierza wprowadzic dodatkowy podatek „na walke z chorobami odkleszczowymi” a glownie z kleszczami. Wstepne rozeznania sugeruja, ze 60% spoleczenstwa ten podatek chetnie zaakceptuje. Answers to questions on tax rise to fight pests Don't toss the mail ballot arriving this month from Alameda County. Failure to open, mark and return it before July 10 could result in taxation minus your representation. Here's some information from the county's Vector Control Service District about the election by mail to raise the vector control property tax. Q. What is a vector? A. A vector is any animal capable of transmitting agents of disease, or human discomfort or injury, such as mosquitos, flies, mites, ticks and small mammals. For example, the district monitors and controls Norway rats, which inhabit sewer lines. Q. What is the proposed measure? A. The county's Vector Control Service District's mission is to prevent human disease, injury and discomfort by controlling insects, rats and other rodents and emerging diseases. The current tax has not been increased in 10 years. Costs have increased, and the district is operating at a deficit. If approved, the increased rates would provide more money for disease surveillance and vector control, including testing for vector-borne diseases, such as plague and Lyme disease. Q. What are the rate increases? A. Single-family residential properties on 1 acre or less would be assessed another $4.08 a year. Current rates are $7.20 a year in Oakland, and $5.92 annually in other cities and unincorporated areas. Other residential properties will be assessed based on the numbers of units and sizes. Commercial, industrial and agricultural properties will have additional rates based on their parcel sizes and property type. Q. How much money comes in now, and how much would be raised? A. Each year, the current tax raises $2.6 million. The new assessment, which would appear on property tax bills, would raise about $1.5 million annually. Q. Where can I get more information? A. Call (510) 567-6800 or visit www.acvsd.org. Odpowiedz Link
artur737 Kwestowanie a zarazem podnoszenie swiadomosci 13.05.07, 05:01 LymeBlog News Lexington, KY USA By Marina Andrews How One Local Minnesota Lyme Disease Support Group Raised Money and Increased Awareness of the Effects of Lyme Disease on People Worldwide. "When names poured in ... the circle of Lyme disease heartache left tears on my computer keyboard." "People wrote of whole families infected ..., of job loss, lost family connections and friends, of financial devastation, and misdiagnoses." Last fall one tiny Lyme disease-suffering person, Jill Kuschel, told the Minnesota Lyme Action Group, "I want to have a 5K race and walk to raise money for Lyme disease. I know nothing about holding a 5K but I can call this lady who heads one every year. What do you think?" On Saturday, May 5th, only seven months later, Jill watched hundreds of walkers and runners fill the 3.2 mile course in Forest Lake, Minnesota, proving her little idea was worth all the effort that went into the Minnesota Lyme Action Group's first "Walk--for someone who can't/Run for Research". Jill shouldered much of the organizing work for the Lyme-Walk fundraiser to benefit the Minnesota Insect-Borne Disease Education Council even though five other women volunteered to be on the event's planning committee. Like Jill, four of the five other planners suffer from Lyme disease. At times, the Lyme-caused limitations of committee members made planning the Lyme-Walk feel like a walk in the dark. Not one of the Jill's five volunteers had ever organized a fundraiser. I was one of those volunteers but I was completely in the dark on how to raise money. "Tap the people you know in the area for donations," the committee told me. Okay. I could do that. If I had to embarrass myself with my unpolished donation-seeking performance, I'd at least know the people I'd be standing in front of, blushing and stammering. First stop, my insurance man. He wrote out a check on the spot! Next stop, the gal who used to cut my hair twenty years ago, she owned her own salon now, which looked prosperous. She remembered me and offered a duffel bag full of hair care products. Another success! What about the veterinarian who'd cared for my animals for more than twenty years? He wrote out a check too. Feeling pretty good about myself and my fund-raising capabilities, I wondered what more I could do. With the phrase "walk for someone who can't" stuck in my head I thought of friends like Tory in Madison, Wisconsin whose chronic Lyme disease keeps her in a wheelchair she may never leave. Was there a way to show the world, or at least people in Forest Lake, Minnesota, that thousands of people like Tory endure profound crippling effects of Lyme disease? For many home-bound Lyme disease sufferers their connection to the world runs through the wires of their computers. Could I worm into the homes of these people through Internet connections to interest them in the Forest Lake event? Because Lyme disease sucks away brain cells and financial resources I needed something easy and free to involve Lyme-suffering cyberspace friends. Odpowiedz Link
artur737 Re: Kwestowanie a zarazem podnoszenie swiadomosci 13.05.07, 05:01 In a Lyme Net (www.lymenet.org) message I asked for "paper participants." I asked people affected by Lyme disease--"[who] can't walk to the mailbox let alone come to Minnesota to walk or run in an event"--to send in their names. I promised each name sent to me would be written in a Lyme-green paper circle along with the county and state of each paper participant. Name circles would be physically carried on the Forest Lake trail by people walking and running in the event. Names trickled in. My posting directions were poor, another step in the dark. I re-considered my original message. My thoughts of the Lyme-Walk's paper participants centered on people visibly crippled by Lyme disease but I realized the illness cripples in other ways. I enlarged the circle of Lyme by writing a reply to my own posting: "You don't have to be in a wheelchair or walk with a cane. Maybe you can't drive a car any more, or you can't return to the job you had before Lyme, or you were sick in bed with Lyme but you're better now. You count too!" Names filled my email. I wrote back to every sender. Later, in response to the email plea for more names sent by a friend who strayed from my original message, people sent in names of family members who didn't have Lyme disease but were affected by the sickness of one family member. They let me know they would be walking or running in Minnesota for their loved one if they could. Another consideration. The circle of Lyme disease expanded outward. Lyme disease support group leaders began collecting names for me. I fell behind in my email responses and struggled to write every name in a new paper circle. When names poured in from thirty-two states, Canadian provinces, and England, the circle of Lyme disease heartache left tears on my computer keyboard. People wrote of whole families infected with Borrelia burdorferi--the Lyme-disease carrying bacteria, of job loss, lost family connections and friends, of financial devastation, and misdiagnoses. One Wisconsin woman, Mary Jean, had been misdiagnosed with Multiple Sclerosis for twenty-five years before she learned she has late-stage Lyme disease. I took her name for myself. Her husband also has Lyme disease. I took his name too. As I pinned and stapled paper participants to t-shirts, jackets, and the numbers runners and walkers were wearing during Saturday's event, I explained, "For many people with Lyme disease, knowing you are carrying them with you along this trail is the biggest and happiest thing that might happen to them in months." My words scored bull's-eyes. People grew serious and thoughtful. They didn't know what to say as they took on the names but somehow the message of the paper circles spread throughout the crowd. A stampede of people rushed forward asking for names to carry. Later, as I walked the trail myself, I saw runners and walkers looking at the circles of paper, acknowledging at least for a moment the pain of a person suffering from Lyme disease. When the walkers and runners were gone and it was time tear down tents and pack away tables and chairs, Jill's husband held out a bouquet to me: "Thank you for doing that with the names. It made this more than what was here; it was a spiritual event." To view more MN Lyme-Walk photos visit www.minnesotalymeactiongroup.com Odpowiedz Link
artur737 Why is a protest in Westchester NY important? 14.05.07, 10:15 Lyme Rights IDSA Protest www.rally11-30-06.lymerights.org/html/controvery_highlights.html Media Talking Points Why is a protest in Westchester NY important to your readers? Doctors all over the country rely on treatment guidelines to instruct them in patient care. The doctors who write them are considered the “experts” on an illness and it is their conclusions that will determine how an illness is diagnosed and treated. These “experts” are often invited to hospitals as teachers to hold seminars for other medical professionals. Other physicians do not know about the experts’ biases, and they certainly don’t mention other treatment guidelines that contradict their own. The experts’ guidelines are picked up without scrutiny by the CDC, insurance companies and local hospitals. They simply become the “truth.” Three of the 14 authors of these guidelines are based at Westchester Medical Center/NY Medical College, including lead author Dr. Gary Wormser. What are the most problematic changes we see in these new IDSA guidelines? Dr. Raphael Stricker, president of the International Lyme & Associated Diseases Society (ILADS) (the medical society with conflicting viewpoints) prepared an excellent analysis of the flaws in these new guidelines. It is in our press kit and also available on the lymenews.org and the ILADS.org websites. ILADS has asked for a retraction of the new guidelines. One of the main concerns with the guidelines is the attempt to oversimplify Lyme disease as a “hard to catch, easy to treat infection” where testing or a bull’s eye rash can always be relied upon for diagnostic purposes. According to ILADS, the complexity of co-infections, unreliable testing, and frequent absence of as bull’s eye rash are serious reasons why this approach will leave many Lyme patients undiagnosed and thus untreated. How many people actually have a bull’s eye rash? Only 35 – 68% of Lyme patients present with a bull’s eye ‘EM’ rash, but up to 40% develop neurologic involvement. The IDSA guidelines will cause physicians to miss many cases of Lyme, resulting in missed diagnoses and a future epidemic of late stage chronic Lyme. The guidelines ignore the Lyme-related psychiatric literature. How accurate is the testing? The IDSA guidelines-recommended tests are 36 – 70% sensitive. (95% sensitivity is the goal). Missing so many cases results in a high percentage of non-rash patients becoming chronically ill. Doesn’t Lyme just affect people in the Northeast? Lyme is now in 49 states. There are numerous documented cases of indigenous Lyme disease in the South, Midwest, and far West. We have Lyme patients attending the protest from as far away as Texas, California and Florida. Won’t doctors they just go ahead and diagnose Lyme disease if they see the symptoms? For years, the CDC has advised doctors to make a clinical diagnosis and to use testing in a supportive role, but these IDSA guidelines put additional pressure on doctors NOT to diagnose without either a positive test or bull’s eye rash. But if they do make a diagnosis, what changes? Insurance companies have the ammunition they need to deny patients reimbursement for Lyme disease medications. Medical boards nationwide have guidelines from the “experts” to use in investigating and prosecuting treating physicians. Odpowiedz Link
artur737 Re: Why is a protest in Westchester NY important? 14.05.07, 10:15 Why does IDSA say there’s no such thing as “Chronic Lyme” although people continue to be sick? IDSA guidelines tell doctors that 14-28 days of antibiotics will cure Lyme and antibiotics do not help patients with “chronic symptoms” after that initial treatment regimen for Lyme is over. The IDSA doctors admit patients do experience symptoms following treatment but minimize their importance as simply the “aches and pains of daily living.” Treating symptoms is recommended but treating the disease is notÑüthey will not admit there is an ongoing infection or need for continuing antibiotics. The ILADS doctors believe the clinical and research evidence shows long-term antibiotics can significantly improve the quality of life for these patients. The potential harm in letting a persistent Lyme infection go untreated far outweighs the potential side effects of long-term antibiotic care. Why are Lyme patients so angry over these guidelines? We see these guidelines as a giant step backward for Lyme patients. We need the science to catch up with our reality. Doctors should be working together for an accurate test and cures rather than ignoring the full body of science and attempting to simplify a very complex disease. We are also very concerned that only those patients with the financial resources to pay for their own medications will find relief from this disease. Quality of care will be compromised because the neediest patients will be denied care based on these IDSA “one size fits all” guidelines. We are also concerned that there will be a decrease in the number of treating physicians. How many cases of Lyme disease are there in the United States? According to the CDC, only 10% of Lyme disease cases meeting the CDC criteria are reported each year, thus approximately 240,000 new cases of Lyme meeting the CDC criteria occur each year in the US, and it is now a problem worldwide. Children are at the highest risk of acquiring Lyme disease, and there have been studies showing significant IQ drops in students with Lyme- reversed after treatment. If Lyme is easy to diagnose and treat, why: * 1. Has federal legislation with significant congressional support been introduced for $100 million? * 2. Is Lyme disease listed as a bio terrorism agent and why is money being spent on research? * 3. Have over 200 Lyme organizations been created throughout the US? * 4. Is the US Army putting large sums of money into treated uniforms, a field testing device for ticks, and GIS . . technology to protect its soldiers? * 5. Why do insurance companies ask if you have chronic Lyme when you apply for a policy? * 6. Why have 18,000 people already signed an LDA petition in a few weeks time opposing the guidelines on humanitarian grounds? (see www.LymeDiseaseAssociation.org) * 7. Why has the patient community been able to raise millions of private dollars for a chronic Lyme disease research center to be opened in 2007 and housed at Columbia University? (see www.LymeDiseaseAssociation.org) * 8. Why has the national patient group, LDA, been able to meet with CDC Director and top CDC officials in DC? * Why does the IDSA : * 1. Feel compelled to list tests and treatments, both conventional and alternative, that they do not support? * 2. Feel so compelled to remove clinical discretionÑü diagnosis by EM & blood test only, when research has demonstrated these tests can be wrong up to 50% of the time? * 3. Seem to have designed these new guidelines for easy insurance company denial of testing/treatment? * 4. Allow 14 doctors with minimal or no chronic Lyme (post treatment failure) experience to have so much power and what checks and balances exist to protect against personal agendas? Odpowiedz Link
nataszkam Re: Why is a protest in Westchester NY important? 14.05.07, 16:16 Artur, wielkie dzięki za podanie tegona forum- te pytania są naprawdę bombowe- i juz wiem, jak i gdzie je wykorzystam Odpowiedz Link
artur737 Epidemiology of European Lyme Borreliosis 13.06.07, 22:07 Epidemiology of European Lyme Borreliosis March 2007 meduni09.edis.at/eucalb/cms/index.php?option=com_content&task=view&id=29&Itemid=99Introduction Lyme borreliosis (LB) has been reported throughout Europe where it is the most common tick-borne infection, as it is in the USA. Despite increasing awareness of the disease and increasing attention in the media there are few published data suggesting an increase in LB prevalence throughout Europe, but recent studies (2002) suggest that incidence in several countries (e.g. Sweden, The Netherlands) has increased markedly over the last 10 years. Media reports have coloured European public perceptions of LB by suggesting that the infection is difficult to diagnose and treat and has a high morbidity, but this applies only to a tiny minority of cases. Some of these misconceptions are due to misdiagnosis (mainly overdiagnosis) which may occur because clinical presentations of LB are not unique to that condition. Diagnosis is primarily clinical and takes into account the risk of tick bite. Supporting evidence is provided by laboratory investigation, usually antibody tests . LB clinical presentations range from asymptomatic infection to significant illness, usually affecting the skin, nervous and musculoskeletal systems and rarely the heart. Very few deaths associated with LB have been reported in the medical literature. Erythema migrans (EM), the characteristic rash which may appear some days to weeks following infection, is the most common manifestation (approx. 60-80% of cases), neuroborreliosis occurs in approximately 20% of case , arthritis in approximately 10% and carditis is rare. The most feared complication of LB, chronic neuroborreliosis, is very rare in Europe. The different manifestations of LB do not show an even geographical distribution. This is partly due to the uneven distribution of the different genospecies of B. burgdorferi sensu lato, some of which seem to be associated with particular symptoms. Only one of them, B. burgdorferi sensu stricto, has been implicated as the cause of disease in North America, mainly causing arthritis (60%), but in Europe three genospecies, B. afzelii, B. garinii and B. burgdorferi sensu stricto, are known to be pathogenic. Others such as B. valaisiana and B. lusitaniae are of unknown pathogenicity at present, though both have been detected in human cases, as has the newly described species B. spielmanii. B. afzelii seems to be associated with a degenerative skin condition, acrodermatitis chronica atrophicans, and B. garinii with neurological symptoms. However, these associations are not clear-cut and there is considerable overlap. B. garinii seems to predominate in western Europe and B. afzelii becomes more prevalent in northern, central and eastern regions, while there is some evidence that B. burgdorferi s.s. has been introduced from the west. The seasonal occurrence of early LB cases is linked closely to that of the vector tick, Ixodes ricinus (see tick activity graphs on this page). Thus the seasonality of EM is determined primarily by the activity pattern of nymphal and adult ticks and is further influenced by the propensity of people to engage in outdoor pursuits in early summer (see seasonal manifestation graphs on this page). The seasonality of slightly later manifestations such as neuroborreliosis is less related to tick activity and that of late stage LB (Lyme arthritis and ACA) is independent of tick activity patterns. European LB incidence Very few countries have made LB a compulsorily notifiable disease, so that case rates only give an approximate estimation of LB incidence in Europe. In most countries reporting is mainly conducted through diagnostic laboratories reporting available details of patients with positive tests. There are several drawbacks involved in using such systems for the estimation of European LB incidence, including under-reporting of EM, varying patterns of test referrals, varying serodiagnostic criteria and seropositivity linked to past exposure. Prospective clinically based studies yield the most accurate information on incidence. However, these are more costly in time and resources than indirect methods, which may represent the only means to carry out surveys in some areas. Indirect methods may include the measurement of the abundance of Ixodes ricinus ticks, the prevalence of B. burgdorferi-infected ticks and seroprevalence studies. All of these indirect measures have weaknesses as indicators of Lyme borreliosis, but at present human seroprevalence studies probably represent the best method to obtain epidemiological data throughout Europe. Taking the limitations of seroprevalence methods into account, it is clear that LB shows a gradient of increasing incidence from west to east with the highest incidences in central-eastern Europe (Table 1), A gradient of decreasing incidence from south to north in Scandinavia and north to south in Italy, Spain and Greece has also been noted. Risk groups Seroprevalence and disease incidence rates are increased in certain occupational groups, e.g. forestry workers, in some recreational groups such as orienteers and in tourists to high-endemic areas. However, identification of high risk groups is not always straight-forward and confounding factors are evidently present. For example, Swedish orienteers have been shown to have similar seroprevalences to the general population despite the relatively high prevalence of the disease in that country, and in Ireland, park rangers who are frequently exposed to ticks in areas where the disease is present, have been found to be seronegative. Gender appears to influence seroprevalence and disease incidence rates and most studies report higher rates for males. This is presumed to be due to higher occupational risk and outdoor recreational activity. However, it is interesting to note that in a recent Swedish study on recurrence of erythema migrans (4% of all cases) the majority were recorded in middle-aged women. The nature of disease manifestations are also influenced by age. Radiculopathy, a relatively common complication in adults, is rarely seen in children, while facial palsy is the most common paediatric neurological manifestation of LB. Acrodermatitis chronica atrophicans, the chronic skin manifestation, mainly occurs in elderly women and while a specific age-related reactivity is not evident in LB arthritis, most cases occur in adults. Some reports suggest that LB incidence is generally higher in children, because of their greater tendency to make close contact with tick habitat. Odpowiedz Link
artur737 Re: Epidemiology of European Lyme Borreliosis 13.06.07, 22:08 LB awareness The most effective preventive measures against LB currently depend on awareness. Workers in high-risk occupations and long-term residents of endemic areas are likely to recognise ticks and may have some LB awareness, whereas many other people, especially city dwellers and visitors from non- and low endemic regions, often have little or no knowledge of ticks and inaccurate perceptions of the disease. These people may acquire infection during brief exposure in high endemic areas and the condition may not be recognised by them or their doctors, so that a proportion of them could go on to develop disseminated or chronic disease, which may remain undiagnosed. To combat this, awareness of LB in the general population should be increased throughout Europe, even in areas of low endemicity. Co-infection and co-transmission Ixodes ricinus, the tick vector of B. burgdorferi s.l., transmits other zoonotic organisms (Table 2), some of which may interact with B. burgdorferi s.l. and thus affect LB diagnosis and epidemiology. In co-infections patients may present with a confusing mixture of manifestations, for example there are reports of tick-borne encephalitis (TBE) cases accompanied by thrombocytopenia, leukopenia and elevated transaminases, which are classical features of ehrlichial and babesial infections. Sometimes manifestations caused by different pathogens may overlap sufficiently for one of the infections to be overlooked, resulting in failure to provide appropriate treatment, as in the case of TBE and early neuroborreliosis. Serodiagnostic confusion may also arise where cross reactions occur, for example occasional false positive LB serology in ehrlichiosis. Some of the zoonotic pathogens transmitted by I. ricinus are known to be immunosuppressive, for example ehrlichias and babesias, and they may affect the severity and duration of infection of co-transmitted pathogens. For example more extracutaneous signs may occur in LB patients co-infected with human granulocytic ehrlichiosis. It is possible that some of the diagnostic difficulties and treatment problems encountered in LB may be due to co-infections with other pathogens. Conclusions In conclusion it is evident that the prevalence of Lyme borreliosis varies considerably in different European countries with an overall increasing prevalence from west to east. Although much data were obtained when awareness was low and the available clinical case definitions and serological methods were not optimal, recent studies suggest that the overall trends reported here are genuine. Information on the distribution of genospecies of B. burgdorferi (Saint Girons et al., 1998, Zent. bl. Bakteriol., 287, 190-195), on the prevalence of infected ticks and on the nature of habitats in LB foci (Gray et al., 1998, Zent. bl. Bakteriol., 287, 211-228) show differences within Europe which seem to be relevant to LB prevalence and possibly to the different manifestations encountered. It is also apparent that a high level of awareness of the complex nature of this disease is desirable for its recognition, treatment and prevention. Table 1. Estimated Lyme borreliosis annual incidence in selected European countries (based on Report of WHO workshop on Lyme Borreliosis Diagnosis and Surveillance, Warsaw, Poland, 20-22 June, 1995, WHO/CDS/VPH/95. (1996) 141-1.) Country___Incidence per 100000 Annual # cases UK*_____________0.3_______200 Ireland_________0.6_______30 France__________16.07_____200 Germany*________25.0______20,000 Switzerland*____30.4______2,000 Czech Republic*_39.0______3,500 Bulgaria________55.0______3,500 Sweden (south)__69.0______7,120 Slovenia________120.0_____2,000 Austria_________130.0_____14,000 * No published figures available All these data should be regarded with caution in view of recent improvements in case definitions and serodiagnosis Table 2. Zoonotic organisms potentially co-transmitted with Borrelia burgdorferi s.l. by Ixodes ricinus. Organism________________Disease Babesia divergens_______babesiosis Babesia microti_________babesiosis Coxiella burnetii_______Q fever Anaplasma spp___________ehrlichiosis Francisella tularensis__tularaemia Rickettsia helvetica____perimyocarditis, sarcoidosis? TBE virus_______________tick-borne encephalitis Odpowiedz Link
artur737 Rzad zmiata problemy pod dywan 21.06.07, 20:01 W Kanadzie pierwsza reakcja na problem w sluzbie zdrowia i lecznictwie jest zawsze ukrywanie informacji tak dlugo jak sie da. Artykul sam w sobie nie jest o boreliozie ale przytacza liczne przypadki, kiedy tak wlasnie rzad kanadyjski postapil z powazna szkoda dla pacjentow. www.theglobeandmail.com/servlet/story/RTGAM.20070621.wxlpicard21/BNStory/specialScienceandHealth/home Secrets and lives ANDRE PICARD From Thursday's Globe and Mail E-mail Andre Picard | Read Bio | Latest Columns June 21, 2007 at 9:14 AM EDT Last month, it was revealed that hundreds of breast cancer patients in the Eastern Health region of Newfoundland had erroneous test results and, as a result, many of them had inappropriate or inadequate treatment. The revelation provoked outrage and much media coverage, and rightfully so. These women were betrayed by a health system that did not have checks and balances in place, and treated dismissively by officials. The Government of Newfoundland and Labrador has called a public inquiry, which will be headed by Madam Justice Margaret Cameron, and should shed light on what went wrong in this case. But the government, and Health Minister Ross Wiseman in particular, has taken umbrage at the suggestion that it failed to act with sufficient speed and openness. The botched tests may date back as far as 1997, yet the failings (human, mechanical, systemic - we don't know) only came to light in 2005. The tests were sent to another laboratory to be redone and individual patients were notified of the results. Ads were placed in newspapers to request women who had had the hormone receptor tests to come forward, which prompted a couple of small media stories. Last December, Eastern Health held a media briefing where partial results of the retesting were released. But only when the victims sued and court documents were filed did the full extent of the fiasco begin to emerge. Then, after some hemming and hawing, the inquiry was finally called. Mr. Wiseman says he and his government have been "nothing but forthcoming and transparent in dealing with this issue." He says the "focus has always been on patient disclosure and ensuring that problems with testing are corrected." Those words are no doubt sincere; the sentiments are noble. But we've heard this kind of thing from politicians before. The implication is that when things go horribly wrong in the health system, it is sufficient to utter a few perfunctory, soothing words and call a retrospective inquiry. But is that really what transparency is? In a democracy, transparency implies openness, communication and accountability. In this instance, and so many others where there have been large-scale failures in the health system (because the debacle in Newfoundland is certainly not unique), there have been only a modicum of openness, minimal communication and virtually zero calling to account of those who failed. In every one of these all-too-familiar disasters - tainted blood, breast implants, improperly sterilized equipment and so on - the situation persisted because the public was kept in the dark about routine matters, because they were denied basic information. Transparency requires everyday participation in the health system by the public and the media. Yet patients play a marginal role in the administration and oversight of our health care institutions. Transparency requires an unbending devotion to rigorous quality control and a fundamental commitment to the release of data. But our health departments remain hell-bent on secrecy and notoriously uncritical (if not willfully blind) of their own shortcomings. Recent reports from both federal and provincial privacy commissioners make this point eloquently. Ann Cavoukian, Ontario's Information and Privacy Commissioner, pointed to a troubling reality, that government routinely hides information from the public. "Surely the time for secrecy and withholding information should have come to an end by now," she said. Robert Marleau, the federal Information Commissioner, gave Health Canada an F in his most recent report card because it persistently drags its feet on public requests for access to information. This is particularly troubling for an institution responsible for public safety. Bureaucrats behave like this because they are following the orders and example of their political masters. In Canada, the political class remains remarkably condescending when it comes to the release of health-related information. It has an annoying tendency to blame everything on a bogeyman named "the previous government" and to dismiss systematic failures as unrelated "isolated incidents." Worse yet, our political leaders like to trot out the well-worn canard that details have to be withheld so as to "not alarm the public." What is alarming is that our politicians and policy-makers have not yet grasped that secrecy, not information, is what is harmful. Over and over again, half-truths and inaction have proved deadly. Those who are ultimately responsible for our health systems do not seem to fully comprehend that real transparency requires not only openness, but foresight and leadership. It is not sufficient to stage retrospective inquiries that will echo with plaintive what ifs. To ensure patient safety and quality health care, we need to actively seek out problems and nip them in the bud. We need a health care culture where transparency is not merely a word, but a way of life. Odpowiedz Link
artur737 Boston Globe article 25.06.07, 17:44 The Boston Globe Diagnosis: Controversy More than two decades since the threat of Lyme disease was recognized, doctors and patients are still warring over how to identify and treat it By Stephen Smith | June 25, 2007 A hike,a bite,a rash: Lyme disease. When a tick digs into a bare patch of skin and a telltale rash sprouts within a month, there’s scant doubt about the diagnosis — or the treatment, for that matter. From a doctor’s perspective, those are the easy cases. Prescribe a few weeks’ worth of antibiotics and the germs transmitted by deer ticks typically retreat. But what about the patient who shows up desperate for relief after being engulfed with headaches, joint pain, and malaise for years? Is it Lyme disease? And if the doctor thinks it is, what then? In some cases, desperate patients confront an equally desperate prescription: an order to take antibiotics for many months, even though there’s little scientific evidence that prolonged treatment does more good than harm. A quarter of a century since Lyme disease first loosed a bolt of fear across southern New England, the insect-borne illness still engenders controversy among doctors, patients, and governmental regulators. And polarized positions have only hardened in recent months as luminaries in infectious-disease and neurology research released new guidelines on diagnosing and treating the disease. Usually, discussions regarding expert recommendations are confined to the pages of arcane medical journals. But it is a sure sign of the passions excited by Lyme disease that Connecticut’s attorney general is investigating whether guidelines issued in November by the Infectious Diseases Society of America trampled antitrust laws. ‘‘Our interest was prompted by a number of complaints from healthcare professionals as well as patients,’’ Connecticut Attorney General Richard Blumenthal said in an interview. ‘‘The unresolved issues related to treatment combined with the prevalence and pernicious effects of Lyme give rise to a lot of public controversy.’’ It is a controversy that has grown as rapidly as the number of Lyme disease cases. Earlier this month, federal disease trackers reported that the nation's annual tally of infections more than doubled from 1991 to 2005. In Massachusetts, the migration of Lyme disease has proved even more striking: In 2005, there were almost 10 times as many confirmed cases as in 1991. A resurgence of deer, a favorite host for ticks, and the continued encroachment of homes into their habitat has fueled the increase, specialists said. A Lyme infection is usually heralded by the appearance of a circular rash, fever, fatigue, headache, and aching muscles and joints. If recognized early, a two- to four-week regimen of antibiotics is prescribed and symptoms typically vanish. That is the treatment recommended in the guidelines issued last fall by the Infectious Diseases Society and in May by the American Academy of Neurology . "The cure rate with antibiotics is very, very high," said Dr. John J. Halperin , a New Jersey neurologist who helped author the neurology group's recommendations. But the two medical associations are emphatic that antibiotics should not be used for longer than a month. And it is on that point that sharp divisions emerge between the traditional medical academies and other doctors who remain deeply suspicious of those mainstream recommendations. It is a debate that embodies not only differences on how to treat Lyme disease but even how to define it. Dr. Raphael Stricker said he has watched patient after patient stream into his San Francisco office stricken with virtually the same symptoms: pain that leaps from one joint to another, muscle aches, depression, memory loss. Often, they are patients who never had the distinctive rash, or who had early symptoms but ignored them, or who were previously treated for the disease but continue to suffer complications. Frequently, Stricker said, their complaints have gone unheeded by other physicians for months or years. "If you listen to the patients and don't immediately say they're crazy, you hear that same pattern over and over again," said Stricker, president of the International Lyme and Associated Diseases Society , a medical association. "They've usually been to 10 to 20 doctors who can't diagnose them, and that's almost becoming a symptom of Lyme disease, unfortunately." The recently released guidelines, he said, neglect such patients and reflect the work of "an old boys' network." "It doesn't serve patient interest, it doesn't serve physician interest, it doesn't serve anybody's interest except the insurance industry because they can deny care based on these very restrictive guidelines," Stricker said. Stricker and a New York doctor, Brian A. Fallon , contended in interivews that the Lyme bacterium may be able to persist, lurking in patients despite treatment. But Halperin disputed the notion that the germs can find a hiding place and then strike again. "It's a fascinating hypothesis," he said, "but there's no data to support it." The dispute exists in part because blood tests used to diagnose Lyme disease show only whether a patient has ever been exposed to the bacterium, not whether the germs are still present. To render a diagnosis of chronic Lyme infection, Stricker said he matches a constellation of neurological and joint symptoms with a history of tick bites or visits to regions infested with ticks that carry the dangerous bacterium. Patients with long-term infections may need long-term doses of antibiotics, said Stricker, who concedes there isn't extensive scientific evidence supporting such care. It is that lack of proof, the authors of the treatment guidelines said, that led them to recommend against prescribing antibiotics for more than a month to treat Lyme. Dr. Eugene Shapiro , who sat on the panels that drafted both sets of recommendations, said that specialists reviewed a wide spectrum of evidence, including material cited by Stricker's confederation. They relied on gold-standard research, Shapiro said, not on anecdotal reports. Similarly, the Infectious Diseases Society said in a statement responding to the Connecticut attorney general's investigation that its guidelines hew to "widely accepted criteria" for making recommendations on how to treat diseases. "If somebody said, 'I rode a motorcycle up the side of the building, I felt great, why don't you try it?' you're not going to do it, right?" said Shapiro, of Yale University. "If there was evidence that the benefit of long-term use of antibiotics substantially exceeded the risk, I'd jump right on the bandwagon and recommend them myself." And the risk is not trivial, specialists said. Some Lyme disease drugs are given intravenously, raising the possibility of infections. Then there's the specter of resistance: If antibiotics are used too much, bacteria can evolve ways of outsmarting the drugs. "Unfortunately, Lyme disease has become an answer for a lot of people, and you can't blame them for wanting to have an answer and particularly one where there's hope of treatment and therapy and a cure," said Dr. Paul Mead , a medical epidemiologist at the US Centers for Disease Control and Prevention . "But I fear sometimes people fall into a trap of accepting Lyme disease as this broad diagnosis that could explain any symptom." Diane Blanchard said she can still recall the day in 1987 when a tick attached itself to the nape of her neck while she gardened on New York's Long Island. She never had the signature rash of Lyme disease, but a doctor diagnosed her with the condition in 1988, prescribing a three-week course of antibiotics. Her symptoms, though, persisted for a decade, until she was told s Odpowiedz Link
artur737 Re: Boston Globe article 25.06.07, 17:46 she had a lingering form of the disease. Nine years of on and off treatment with antibiotics ensued. "None of us want to take antibiotics, but if it is the only remedy that is offered at this moment that gives us relief, that allows us to function, then we're stuck," said Blanchard, co-president of the advocacy group Time for Lyme. "We wish we could find a cure. Until we do, we must remain open-minded. "This controversy with two sides taking different positions is not helping either side or any patient." Stephen Smith can be reached at stsmith@globe.com. © Copyright 2007 Globe Newspaper Company. www.boston.com/news/globe/health_science/articles/2007/06/25/diagnosis_controversy/?page=full Odpowiedz Link
artur737 Tiny Tick, Big Problem 09.07.07, 20:34 Kolejny artykul z USA opisujacy problemy ludzi, ktorzy zlapali zakazonego kleszcza i kontrowersji wsrod lekarzy na temat diagnozy i leczenia. Nie tlumacze, bo w zasadzie nie ma nowych istotnych informacji. Ktos moze byc zainteresowany forma podania informacji. Tiny Tick, Big Problem The incidence of Lyme disease is increasing, parents are panicked about potentially dangerous consequences Odpowiedz Link
artur737 Re: Tiny Tick, Big Problem 09.07.07, 20:35 Difficult Diagnosis If you live in a town where others have gotten Lyme disease, you're probably already a little paranoid about ticks. There are actually hundreds of types of ticks, but Lyme is only transmitted by two species of black-legged ticks that are known as deer ticks because deer often carry them from place to place. However, these ticks also hitch a ride on mice and other small animals, and that's where they pick up the bacterium, called Borrelia burgdorferi, which causes Lyme disease. Fortunately, Lyme disease doesn't spread from person to person, but a child can catch it more than once. Young deer ticks, known as nymphs, cause most of the infections, partly because they're so small and hard to spot. A nymph is about the size of a poppy seed, and an adult is the size of a sesame seed. Hungry ticks often wait on blades of grass and try to grab on to an animal or a person who brushes up against them. A bite is painless, but a tick can cling to your child's skin Odpowiedz Link
artur737 Re: Tiny Tick, Big Problem 09.07.07, 20:35 Unfortunately, anywhere from 10 to 65 percent of people with Lyme disease don't recall getting the telltale EM rash, says Brian Fallon, MD, director of the new Lyme Disease Research Center at Columbia University. It's hard to nail down an exact number because some people who get a rash never notice it Odpowiedz Link
artur737 Re: Tiny Tick, Big Problem 09.07.07, 20:36 Contentious Cures With the incidence of Lyme disease increasing and parents panicking about potentially dangerous consequences, the medical community is intensifying its efforts to understand this perplexing illness. However, Lyme has also become incredibly controversial Odpowiedz Link
artur737 Re: Tiny Tick, Big Problem 09.07.07, 20:37 Emily Lantz, now 10, is one of them. Although she never had a rash and doesn't remember a tick bite, her mother, Lori, says that she's been sick since she was 5. Her symptoms have included double vision, mood swings, and severe fatigue and confusion. "Everything else was ruled out, but her Lyme disease test was definitely positive," says Lantz, of Trappe, Maryland. Emily has been receiving daily IV antibiotics for more than a year, to the tune of about $50 a day. "When we tried stopping the treatments, her symptoms came right back in three days," says Lantz. Since insurance companies often won't pay for extended antibiotics Odpowiedz Link
artur737 Re: Tiny Tick, Big Problem 09.07.07, 20:39 Clear away fallen leaves in your yard, where ticks thrive, and mow the grass frequently. If you have a swing set or play structure, move it to a sunny area away from trees and shrubs. Keep your pets out of the woods, if possible, and talk to your vet about tick repellents. Although there are Lyme vaccines for dogs, being vaccinated won't keep dogs from bringing ticks indoors. Choose an insect repellent with DEET, and check the label to be sure the product is formulated to repel ticks. High concentrations seem to work best against ticks, but the American Academy of Pediatrics advises against using a formula with more than 30 percent DEET on children. Avoid dressing kids in open-toed shoes or sandals. Traditionally, experts have also suggested wearing light-colored clothing so it's easier to spot ticks, but one study found that ticks are more attracted to light colors, so the jury's out on that advice. Use products containing permethrin, such as Permanone, only on clothes, not skin. Let the spray dry completely before putting the treated clothing on your child. One application stays effective through several washings. Remove ticks from your child's clothes outside. Any ticks that you might have missed will be killed by washing clothes and drying them in a hot dryer. Finally, check your child carefully in the bath or shower, and remove any ticks immediately. (Don't bother saving a tick; few doctors are able to identify different types, and experts say that sending the bug to a specialist isn't worthwhile.) To make head checks easier, use a hair dryer on cool to blow the hair away from the scalp so you can see the skin. Says Dr. Johnson, "It's a drag to look for ticks, but I encourage people who live in an area where Lyme disease is common to do it at least once a day." Ticks on the Move "There's no doubt that we're going to see an increase in Lyme disease every year," says Harvard epidemiologist Dr. John Brownstein. Why? Growing populations of deer play a role, but it's possible that birds are also distributing ticks over a wider territory. Building new homes in forested areas also puts residents at risk. Global warming could even be causing ticks to spread to different parts of the country because they're sensitive to temperature. Top 10 Lyme Disease States 1.Connecticut 2.Rhode Island 3.Delaware 4.Pennsylvania 5.New Jersey 6.New York 7.Massachusetts 8.Wisconsin 9.New Hampshire 10.Maryland Odpowiedz Link
artur737 Re: "Sezon na Kleszcza" cz druga 10.07.07, 17:17 Lyme Disease Grips Vineyard; Experts Say Research Needed By MIKE SECCOMBE Dr Bela Matyas i Dr Sam Donta zgadzaja sie tylko co do dwoch rzeczy: 1. Za malo pieniedzy wydaje sie na badania boreliozy 2. Leczenie boreliozy to bardziej sztuka niz nauka medyczna Dr. Matyas jest dyrektorem wydzialu epidemiologii i nalezy do ortodoksyjnego nurtu medycyny ktora zaprzecza istnieniu przewleklej boreliozy - bo wg niego nie zostala ona udowodniona. Dr Donta z kolei ma praktyke, ktora nie zajmuje sie niczym innym jak chroniczna borelioza. Wg niego przynajmniej 20% ludzi zakazonych borelioza przechodzi w stan przewleklej infekcji. Dr. Matyas twierdzi, ze objawy kliniczne tych chorych sa bez sensu i w oparciu o nie lekarz nic nie jest w stanie stwierdzic. Nadto, ze takich chorych jest bardzo malo. Dr. Donta uwaza, ze diagnoza kliniczna jest bardzo latwa i trzeba tylko zlej woli by nie widziec typowego obrazu boreliozy: zmeczenia, bolu miesni i stawow, problemow z pamiecia i koncentracja, dretwien oraz mrowien. Wg niego jest to jedna z najlatwiejszych chorob do diagnostyki klinicznej. (Zgadzam sie z tym w zupelnosci) Artykul ponadto mowi, ze najbardziej opanowane przez borelioze jest obecnie Martha's Vineyard i jest tam rocznie 577 nowych przypadkow na 100000 mieszkancow i ze liczba zachorowan ciagle rosnie. Dr. Michael Jacobs twierdzi, ze jak ktos byl w Martha's Vineyard i zachorowal to w pierwszym rzedzie nalezy rozwazyc borelioza. Zapobiec chorobie mozna tylko poprzez regularne i dokladne sprawdzanie ciala na obecnosc kleszczy. Pomaga ubranie wysycone permethrinem i dodatkowo odstraszacz z DEET nalozony na odkryte czesci ciala. Zaleca on, ze po kazdym ukaszeniu kleszcza w tym rejonie nalezy jak najszybciej przyjac 200 mg doksycykliny na wszelki wypadek. Tylko jeden raz. Swoim ugryzionym pacjentom przepisuje na ogol kilka takich dawek aby mieli lek na przyszle ugryzienia. Wg niego to naprawde dobre podejscie i wydaje sie, ze nikt kto tak zrobi pozniej nie zakaza sie. Ci co rozwineli rumien dostaja od niego leczenie na 3-4 tygodnie. Pani Enos mowi, ze jest sporo ludzi, ktorzy maja borelioze w testach a nigdy nie mieli objawow choroby. Nikt nie wie o co tu chodzi. Czy choroba naprawde zniknela, czy po prostu czai sie by wybuchnac kiedys jak bedzie ku temu lepsza okazja. Dr. Jacobs twierdzi, ze potencjalnie groza tym osobom objawy reumatyczne, sercowe i neurologiczne. Do tego dochodzi ta najtrudniejsza kategoria pacjentow: ci ktorzy ciagle maja objawy po 4 tygodniach antybiotyku. Istota problemu jest to, ze obecnie nie ma sposobu by klarownie zdecydowac czy zywe kretki sa u nich obecne czy nie i lekarze po prostu zgaduja. Dr Donta: "Jest to bardzo niefortunne, ze wielu ludzi medycyny od razu oswiadcza, ze chroniczna borelioza nie istnieje. Bo az 20% lub wiecej ludzi wpada w te kategorie po zakazeniu. To prawda, ze obecnie nie ma wiarygodnego testu na obecnosc bakterii, ale jak zlozyc wszystko do kupy to to wyglada na nawracajace infekcje bardziej niz cokolwiek innego. Obecnie w medycynie panuje szkodliwy mit, ze nic nie moze przetrwac kilku tygodni antybiotyku. Cos przezywa takie leczenie. Istnieje multum dowodow, ze antybiotyki podawane dlugoterminowo dzialaja w chronicznej boreliozie a tylko nie ma dowodow w formie prob klinicznych. Bakteria nie wystepuje we krwi. Przebywa wewnatrztkanowo, glownie w ukladzie nerwowym. Gdzie dokladnie? „Nikt jakos tego nie kwapi sie badac i naprawde dziwi mnie skad ta niechec.” Dr. Donta opracowal swoje wielomiesieczne sposoby leczenia tych zaawansowanych przypadkow i to dziala- twierdzi, ale ciagle trzeba je jeszcze udowodnic. Dr Matyas niby nie jest wrogi ale mocno sceptyczny. Dr. Matyas „To tylko reakcja ukladu immunologicznego sie tak przeciaga” Sterydy wtedy by pomagaly. Ale jezeli podac sterydy komus z przewlekla infekcja to wynik takiego leczenia bedzie nieciekawy. Nieznane sa powody dlaczego rzad USA jest tak niechetny w wyjasnieniu tej sprawy. Originally published in The Vineyard Gazette edition of Tuesday, July 10, 2007 Odpowiedz Link
artur737 Lyme Disease Grips Vineyard 10.07.07, 17:19 Lyme Disease Grips Vineyard; Experts Say Research Needed By MIKE SECCOMBE Drs. Bela Matyas and Sam Donta agree on at least two points when it comes to dealing with Lyme disease. One, there is not nearly enough money spent on research. Two, the medical response to the disease as a result is as much art as science. But they are poles apart on so much else. Dr. Matyas, medical director of epidemiology for the state Department of Public Health, adheres to the medical orthodoxy when it comes to chronic Lyme, that is, a continuing active infection for a prolonged period even after treatment. "That's never been proven to actually occur," he said. Dr. Donta, who practices in Boston and Falmouth and has a long track record of treating people who have - or believe they have - chronic Lyme, thinks it possible that as many as 20 per cent of people who have been treated for the tick-borne disease may have ongoing symptoms consistent with continuing infections. Dr. Matyas says that even if a small minority of Lyme cases do become chronic, they are almost impossible to diagnose on the basis of the general symptoms they present. Dr. Donta, in contrast, sees a relatively easily diagnosed suite of symptoms: fatigue, muscle and joint aches, impairment of memory and concentration, numbness, tingling. "It's remarkable, I think, how easy it is to make a diagnosis," he said. And so here we are at the height of another tick season in the Lyme disease capital of the world, and the same old argument persists. Thirty years after the disease was first identified, it has become the most common vector-borne disease in the United States and it occurs at a higher rate on this Island than anywhere else. And there is still so much about it that is unknown. But before that debate, first go to what is known and what everybody should know, if they want to stay healthy in tick country. First, its incidence. In 2005, Martha's Vineyard passed Nantucket as the place with the nation's highest infection rate - 577.2 cases per 100,000 population. The figures for 2006 have not yet been collated, but there is no reason to assume they will be significantly different. And as for this year, well, Sam Telford 3rd, associate professor of infectious diseases at the Tufts University School of Veterinary Medicine and the preeminent tick researcher, said deer ticks - the species which spreads the disease to humans - appear to be more numerous than usual this spring, due to the cool, wet weather. That, however, was some weeks ago, before the recent long spell of dry, warm weather. Deer ticks are prone to death by dessication. Odpowiedz Link
artur737 Re: Lyme Disease Grips Vineyard 10.07.07, 17:19 "The extent to which we have cool wet weather into July will influence how many nymphs, and even some adult deer ticks, will be around into July. They normally disappear by the end of July, but with the right weather may persist into August," Dr. Telford said. Donna Enos, the infection control nurse who collates the statistics at Martha's Vineyard Hospital, said it was way too early to say whether this was shaping up as a bad summer. Most cases appear in July, both because of the number of nymph ticks (which are pinhead-sized and therefore hard to spot) and because so many people are out and about in tick habitat. "But we're starting to see lots of cases coming in. Lots of people with bulls eye rashes," she said. The rash is the surest sign of a Lyme infection. It appears in about 60 or 70 per cent of cases, usually as a red ring which slowly expands outwards from the site of the tick bite. But it is not always circular, and often it is not there at all. The other symptoms of early Lyme are flu-like fevers, chills, sweats, joint, muscle and headaches. People can be tested for the presence of antibodies in their blood, but usually doctors will prescribe antibiotics on suspicion. "We have to go by symptoms this time of the year more than at any other. If you've got a febrile summer illness it raises red flags straight away," Ms. Enos said. There is good reason to treat the disease on speculation, particularly in the case of summer visitors who may go home to places where doctors are less familiar with Lyme. Said Vineyard Haven internist Dr. Michael Jacobs: "You've got to realize it could take up to a month for symptoms to develop and it can certainly take a month for antibodies to develop. "If people become ill after they leave the Vineyard, they should certainly still be thinking Lyme disease." He continued: "The most important thing to stress is that Lyme is a preventable disease if people do a careful inspection for ticks, especially under the hairline, under the arms, groin, behind the knees, all the crevices and cracks so to speak. "If hiking in a heavily-infested area, they can wear permethrin on their clothing and put DEET insect repellent on their arms and legs as well. "Lastly, there is now a way to prevent Lyme. If you treat yourself early, within 72 hours of being bitten, you simply take two doxycycline tablets all at once, you can prevent it. People should be aware of that, and not just pull the tick off and hope that something doesn't happen." Dr. Jacobs prescribes a short-term dose of doxycycline for everyone who comes in with a tick bite, and usually gives them extra doses for subsequent bites. Odpowiedz Link
artur737 Re: Lyme Disease Grips Vineyard 10.07.07, 17:20 "I am very liberal with it," he said. And that is a real advance; people treated in this way never become symptomatic. That is the good news. The not-so-good news is that those who already have the rash or other symptoms like joint aches, must still undergo the usual treatment with a course of antibiotics, often for three or four weeks. The bad news is that for those who are not treated early, the correct treatment remains a matter of medical contention. Said Mrs. Enos: "We get people that will get tested and find out they had Lyme Disease and never had a symptom in their life." And that is problematic. Have the immune systems of such people beaten the bacterium without the aid of drugs? Or could the disease be lingering inside them dormant, but not dead? "I don't think there is any data on what happens with untreated Lyme Disease," said Dr. Jacobs. "But there is the prospect of arthritis, heart problems and neurological problems." He treats it all as he would early Lyme, with a three to four-week course of antibiotics, but concedes: "They definitely carry some risk of an ongoing infection. Even if they're feeling well." Which comes to the most difficult category of patient of the lot: those who continue to experience symptoms of illness, even after treatment. The essence of the medical problem is this: there is currently no way of determining if the germ lives on in these people. Doctors have only the subjective experiences of the patient to rely on. Said Dr. Donta: "Unfortunately, some medical people interpret this as ‘This is not real. We don't believe in chronic Lyme.' About 20 per cent, perhaps more had sequela [lingering symptoms] after treatment. Now, it is true I cannot prove the bacteria are present, but when you put all the information together, the type of symptoms people are having, it fits very nicely with relapsing infections." He continued: "My concern is that progress is being obstructed by the view that there couldn't possibly be persisting infection and that antibiotics can't work. "That's not correct. We have compelling evidence that certain antibiotics do work, but we haven't had controlled clinical trials to prove it. The germ itself does not appear to stay in the circulation. It probably goes into a tissue, probably nervous system tissue. The question is where? No real attempts have been made to find it. It is dumbfounding to me the lack of inquiry here." Dr. Donta has developed his own treatment regime using different antibiotics, administered over a period of months. "I think I've made a fair amount of progress," he said. "But it needs to be proven." Dr. Matyas is not hostile, but remains skeptical. "The big complication [with alleged chronic Lyme] is the symptoms themselves," he said. "There is no disease that impacts the body heavily that doesn't cause depression, impression, insomnia, mood change and fatigue. If a person shows up with just those, the doctor is faced with literally thousands of possible explanations. "There are probably some people who truly have those symptoms due to Lyme disease. The problem is finding them against the thousands of other potential causes." And even if they are due to Lyme, they are not necessarily due to active Lyme. Even if a patient is treated promptly on showing symptoms, after effects could linger several months, and if not treated promptly, for several years. "There are lots of theories about this," Dr. Matyas said. "One is that it is just a lingering effect. Another is an autoimmune reaction, that by being infected you've somehow stimulated your immune system to react against you. Another is that it's an active infection." He added: "It's important to distinguish, because antibiotic treatment is appropriate for one of the explanations, but is exactly the worst thing you could do for another. If you believe it's autoimmune you probably want to treat it with steroids and not expose you to the risks of the antibiotic. If you believe however, that it's active illness, the last thing you want to give is steroids, because steroids give the germ an advantage by suppressing your immune system." He concurred that the problem would benefit greatly from research dollars that have not been forthcoming: "There is no question this is a very important public health issue. It affects a lot of people and it causes a lot of disability. For whatever reason at the federal level it hasn't really made it onto the agenda. It should." And on that point at least, all are in agreement. Originally published in The Vineyard Gazette edition of Tuesday, July 10, 2007 Odpowiedz Link
artur737 Tiny Tick, Big Problem 22.07.07, 06:33 From Parents.com tinyurl.com/2wru9m Tiny Tick, Big Problem By Sharlene K. Johnson July 2007 The incidence of Lyme disease is increasing, parents are panicked about potentially dangerous consequences Odpowiedz Link
artur737 Re: Tiny Tick, Big Problem 22.07.07, 06:33 Difficult Diagnosis If you live in a town where others have gotten Lyme disease, you're probably already a little paranoid about ticks. There are actually hundreds of types of ticks, but Lyme is only transmitted by two species of black-legged ticks that are known as deer ticks because deer often carry them from place to place. However, these ticks also hitch a ride on mice and other small animals, and that's where they pick up the bacterium, called Borrelia burgdorferi, which causes Lyme disease. Fortunately, Lyme disease doesn't spread from person to person, but a child can catch it more than once. Young deer ticks, known as nymphs, cause most of the infections, partly because they're so small and hard to spot. A nymph is about the size of a poppy seed, and an adult is the size of a sesame seed. Hungry ticks often wait on blades of grass and try to grab on to an animal or a person who brushes up against them. A bite is painless, but a tick can cling to your child's skin Odpowiedz Link
artur737 Re: Tiny Tick, Big Problem 22.07.07, 06:34 Lyme disease is also a difficult diagnosis because blood tests alone aren't very reliable; they frequently have false-positive or false-negative results. The tests can only detect antibodies that your child has made (recently or in the past) in reaction to the bacteria, not the actual bacteria. Since the body doesn't produce measurable levels of antibodies until two to four weeks after a tick bite, tests will be negative if they're done too soon. On the other hand, if your child has an "off-the-charts" test result, that doesn't necessarily mean he has a very bad case of Lyme, says Dr. Fallon. "High antibody levels could just show that he has a strong immune system that's fighting off a present infection or has fought one in the past." Contentious Cures With the incidence of Lyme disease increasing and parents panicking about potentially dangerous consequences, the medical community is intensifying its efforts to understand this perplexing illness. However, Lyme has also become incredibly controversial Odpowiedz Link
artur737 Re: Tiny Tick, Big Problem 22.07.07, 06:36 While mainstream doctors acknowledge that a small percentage of people have symptoms that remain after treatment, they prefer to call the problems "post-Lyme syndrome," based on the belief that the symptoms are caused by something other than an ongoing bacterial infection, such as lingering inflammation. They believe that continued antibiotics don't necessarily help, and may even be harmful for kids Odpowiedz Link
franiolek1 Newsweek 31.07.07, 09:51 www.msnbc.msn.com/id/20010701/site/newsweek/ The Great Lyme Debate Patients ache as doctors disagree about whether there is a chronic form of the tick-borne malady. By Mary Carmichael Newsweek Aug. 6, 2007 issue - There's a debate raging over Lyme disease, although you'd never know it unless you've been paying close attention—because on the surface it sounds like the dullest argument imaginable. Last year, the Infectious Diseases Society of America issued new guidelines saying physicians should treat Lyme with antibiotics for no longer than 30 days. Some docs think that's wrong. It's a seemingly straightforward difference of opinion. So why has the debate dissolved into animosity, with one side suggesting that its opponents have no credibility and the other slinging deeply personal insults on the Web? And why has it now spilled out of medical journals and into the office of a state attorney general? Clearly, something other than ticks is bugging a lot of doctors. Story continues below ↓advertisement Lyme disease—the most common insect-borne ailment in America, with roughly 20,000 cases diagnosed each year and more undetected—is transmitted mostly by a well-known pest, the deer tick. But the real culprit is something even nastier, a bacterium called Borrelia burgdorferi that lives in the tick's gut. When Borrelia infiltrates the human body, it can cause a suite of distinctive symptoms, most notably a flulike feeling and a red rash like a bull's-eye. Sometimes, though, it causes no symptoms at all, and that's more dangerous, because the early signs are the only warnings doctors have. If Lyme is left undiagnosed and untreated, its consequences can be serious, including arthritis, meningitis, heart problems and inflammation of the brain. "The real secret," says Dr. Michael Zimring, director of the Center for Wilderness and Travel Medicine at Mercy Medical Center in Baltimore, "is to be able to recognize the disease early enough." Zimring would know. Several years ago his wife felt fluish and came down with an oval-shaped rash. Zimring wasn't sure what she had, but "knowing our backyard is loaded with ticks was enough," he says. He started his wife right away on one of the classic, effective antibiotics used to treat Lyme. When her medical tests came back, they proved him right. "I treated her for three weeks," he says, "and that was it. No problem." Unfortunately, not all Lyme patients recover so easily. And that's what's at the heart of the debate—some docs think patients who are treated inadequately can develop a chronic form of the disease, while others deny that it's possible. Dr. Rafael Stricker, president of the International Lyme and Associated Diseases Society, believes in "chronic Lyme disease," and he says that in his clinical experience about 70 percent of patients with it get better if they're treated long term with the same drugs used to treat early infection. But the doctors who made the new IDSA guidelines on treatment say there's no such thing as chronic Lyme, because in most patients who complain of it, Borrelia isn't detectable in the body. Dr. Gary Wormser, who chaired the IDSA panel, prefers the term "post-Lyme syndrome." Treating that syndrome with high-dose antibiotics for months —as some physicians did before the new guidelines—can only hurt patients, he says. It can give them gallstones and infections and lead to antibiotic resistance while not curing anything. "The majority of patients treated for 'chronic Lyme' do not have post-Lyme," he says, "and in fact never, ever had Lyme disease at all." This does not sit well with thousands of patients who believe they do have chronic Lyme and badly want antibiotic treatment for it. "The IDSA is basically saying to them, 'We're right, you're wrong, we don't want to listen to you, just take some antidepressants and go away'," says Stricker. The IDSA is a highly respected group of doctors. But it's facing formidable opposition, not just from Stricker's group (and angry patients who've taken to Internet message boards) but also from the attorney general's office in Connecticut, the state with the country's highest incidence of Lyme disease. A.G. Richard Blumenthal has launched an investigation of the IDSA panel, looking into whether it ignored any research that would support long-term antibiotic treatment (the guidelines cite more than 400 studies). "Our question basically is whether the guidelines were formulated through a process that was proper, without self- interest or conflicts of interest," Blumenthal says, noting that some of the panel members have financial interests in treatments and vaccines. Blumenthal also worries that the new guidelines might be used by insurance companies looking to avoid paying for Lyme drugs. The investigation is at "an important juncture," he says. Meanwhile, Wormser is baffled. "How could the interests of the patient be served by treating with unnecessary and potentially dangerous therapies?" he says. "The guidelines represent the best that medical science has to offer." The question, then, is whether that's good enough. © 2007 Newsweek, Inc. Odpowiedz Link
artur737 Dlaczego Bush ukrywal chorobe (artykul z UK) 13.08.07, 21:27 Bush and Lyme disease: what's the secret? Dean Baker and Helene Jorgensen August 13, 2007 4:10 PM tinyurl.com/2kwu6c The White House reported last week that President Bush was treated for Lyme disease last summer after he discovered the bull's eye rash associated with the disease on his leg. According to the spokesperson, Bush's doctors determined that he had fully recovered from the disease in his annual physical earlier this summer. However, the spokesperson refused to disclose the treatment that Bush had received, citing doctor-patient privilege. While Bush has the right to keep details of his medical treatments private, this is certainly a sharp contrast with how the White House dealt with Bush's recent surgery. The public got the play-by-play on the operation in which several polyps were removed from the presidential colon. By comparison, the course of treatment for Lyme would appear to be G-rated. Some background on the controversies surrounding Lyme disease could explain this peculiar turn to secrecy. The standard course of treatment recommended by the medical establishment is two weeks of antibiotics. This is supposed to be sufficient to kill the bacteria and cure the patient. However, there are tens of thousands of people in the United States who developed Lyme and did not fully recover after receiving this treatment. Instead they experienced increasingly severe symptoms, which include joint and nerve pain, headaches, cognitive problems, and fatigue. In some cases the symptoms are debilitating, preventing the patient from working or carrying on a normal life. International Lyme and Associated Diseases Society (ILADS), a group of doctors specialising in tick-borne diseases, recommends treating people with chronic Lyme with extended courses of antibiotics. ILADS recommends treatment until the symptoms go away, as is done with syphilis and some other diseases. This can take years and be fairly expensive. Insurers often refuse to pay for the extended course of treatment advocated by ILADS, forcing chronic Lyme patients to pay for treatment themselves. This is an especially severe hardship for people with chronic Lyme, since many cannot work. Getting turned down by the insurer often means financial ruin. Lately the battle with insurers has heated up as the Infectious Diseases Society of America and the American Academy of Neurology, the main bodies of the medical establishment that deal with Lyme patients, both issued new guidelines strongly endorsing the two-week treatment path. This will provide powerful ammunition for insurers who don't want to pay the bills of people with chronic Lyme disease. This is why Bush's course of treatment for Lyme is a matter of public interest. If his doctors thought it was appropriate that the president get treated for a period of time that is longer than the standard two-week course, and if this fact became public knowledge, it might call the two-week standard into question. Lyme sufferers and their doctors would be able to point out that the president's doctors (presumably not quacks) thought that a longer course of treatment was beneficial. This could help to prompt more serious research on treating chronic Lyme and make it more difficult for insurers to cut off treatment for chronic Lyme victims. Given the controversy around the disease it is difficult to see why Bush would not disclose his treatment, unless he was in fact treated for more than the standard two weeks. After all, what would be the issue if his spokesperson told the press that Bush got two weeks of antibiotic treatment? If our suspicions are true, this is yet another disgusting episode of this administration's hypocrisy. He personally has benefited from a course of treatment that through his silence he would deny to tens of thousands of others. Thank you, Mr President. Odpowiedz Link
artur737 Scientists Seek Better Tests for Lyme 14.08.07, 03:47 Monday, Aug. 13, 2007 Scientists Seek Better Tests for Lyme By AP/LAURAN NEERGAARD www.time.com/time/health/article/0,8599,1652559,00.html (WASHINGTON)—President Bush's recently revealed treatment for Lyme disease makes him part of an unfortunate trend: The tick-borne infection is on the rise, with cases more than doubling in the past 15 years. The good news is that most patients, like Bush, take antibiotics for a few weeks and are cured, especially if they were diagnosed early. But people who aren't treated promptly can develop painful arthritis, meningitis and other serious illnesses. If they don't experience, or notice, Lyme's hallmark round, red rash, they can struggle to be diagnosed, as other early symptoms are flu-like and vague. And a small fraction of patients report pain and fatigue that linger for months or years after treatment. Do they still have Lyme, or something else? No one knows, although desperate patients often try repeated antibiotics despite little evidence that the drugs do more good than harm. The central problem: No test can tell when someone has active Lyme disease — when Lyme-causing bacteria are alive in the body. Today's tests instead spot infection-fighting antibodies, which can take weeks to form but then linger long after Lyme is gone. A push is on for better Lyme tests, with parallel hunts getting started by the National Institutes of Health and, separately, by patient advocacy groups angry that modern medicine hasn't found an answer. "The time is right to take a closer look," says Dr. Dennis M. Dixon, chief of bacteria research at the NIH's National Institute for Allergy and Infectious Diseases, which plans to gather leading scientists later this year to determine the best approaches. "We would not rule out any avenue." "We have a lot of new tools" to explore, adds Dr. Brian Fallon, who directs Columbia University's new Lyme and Tick-borne Diseases Research Center, funded by the advocacy groups Time for Lyme and the Lyme Disease Association. "Science is going to bridge the gap." Among the research: —A newer antibody test seems to indicate when antibiotics are working in early Lyme stages, offering the possibility of tracking treatment response. —Hunting markers of active infection, including bits of Lyme-related protein in the blood or spinal fluid. —Fallon is using brain imaging to try to distinguish when Lyme penetrates the nervous system. About 20,000 new cases of Lyme disease are reported to the government every year, says a June analysis from the Centers for Disease Control and Prevention. The CDC acknowledges that's a fraction of the true toll, as many cases go unreported. Experts say it may be five times higher. Still, the figure is more than double the count in 1991, when official tracking began, and CDC says it's not due just to better awareness of Lyme. The rise is expected to continue as suburbia expands into the woodland home of black-legged tick species, commonly called deer ticks, that carry Lyme-causing "Borrelia burgdorferi" bacteria in the Northeast, mid-Atlantic, north-central states and Pacific Coast. The only human vaccine was pulled off the market in 2002 for lack of consumer interest. It was partly protective; better, next-generation vaccines are years away. Don't live in a high-Lyme area? Different tick species carry different threats, such as Rocky Mountain spotted fever. Most recently discovered is STARI, or Southern tick-associated rash illness — a rash very similar to Lyme's but not yet linked to other symptoms. It's caused by a still unknown organism carried by the lone star tick. But Lyme is the most common tick-borne infection, and overshadowing the treatment success for most patients is debate over what patient groups call "chronic Lyme" and mainstream medicine, striving for neutrality, calls "post-Lyme syndrome." The two camps became even more polarized as two major medical associations released guidelines in the past year that found no good evidence that long-term antibiotics help lingering symptoms — but warned they can cause serious side effects and spur formation of drug-resistant super-germs. "If there were evidence that prolonged therapy was beneficial ... I'd be the first person to jump on the bandwagon," says Dr. Eugene Shapiro, a Yale University pediatrics professor and co-author of the guidelines from the Infectious Diseases Society of America and American Academy of Neurology. That's not to say some people aren't sick, the guidelines stress, just that it's not clear why. Among other possibilities, Lyme may over-activate some people's immune systems so that antibodies attack their own joints. "I think many have been told they have Lyme when in fact they have something else," says Dr. Paul Auwaerter, an infectious disease specialist at Johns Hopkins University. "I can sense, palpably, their frustration." Furious patient groups say the guidelines prompted some insurers to quit paying for some patients' only relief — and that the recommendation instead should have been there's not enough data to know what works. Diane Blanchard, co-president of Time for Lyme, points insurers to still other guidelines, from the International Lyme and Associated Diseases Society, doctors aligned with the patient groups who back more antibiotics. "The last thing many of us want to do is ingest an antibiotic," says Blanchard. "We are basically sitting on our hands watching this disease expand its ill effect ... and doing very little except for taking sides, and essentially that's not helping anyone." Odpowiedz Link
artur737 Niebezpieczenstwo dla Busha jeszcze nie minelo 14.08.07, 20:43 Oswiadczenie prasowe CLDA. Na razie media tego nie podlapaly. Lyme Group Warns Bush May Not Be Out of Woods The California Lyme Disease Association warns that President Bush may not be cured of Lyme disease. Although he finished one course of treatment, symptoms can return months or years later. Ukiah, CA (PRWEB) August 14, 2007 Odpowiedz Link
artur737 Putting disease in the Lyme light 22.08.07, 22:43 Putting disease in the Lyme light By SARAH LARSON phillyBurbs.com tinyurl.com/22alpq A local state senator hopes new attention to Lyme disease might help get one of his bills passed. Sen. Stewart Greenleaf has introduced the Lyme Disease Education Prevention and Treatment Act each legislative session for more than 10 years, he said this week. Committee leadership has never called it up for a vote. “I don't know why they haven't moved it. It's not like it's a big ticket item,” said the senator, who represents eastern Montgomery County and part of Bucks. “I think we just have to educate them to the importance of this.” This session, which starts in September, might be the time to do it. President Bush's revelation that he contracted and was treated for Lyme disease last year has given the ailment new prominence. So, too, has the finding that Pennsylvania has a high rate of the disease, especially here in the Southeast. Bucks and Montgomery counties have some of the highest rates of Lyme disease in the state. Bucks is sixth, with 84 cases per 100,000 people reported from 2002 to 2004; Montgomery County is 11th, with about 60 cases per 100,000 people. Greenleaf's bill, currently in the health and welfare committee, was introduced so long ago, one of its provisions — requiring that every case of Lyme disease be reported to local or state health authorities — already takes place. Its two other provisions, though — an educational program for the public and one for health care providers — still are badly needed, the senator said. “We need a coordinated effort among the various state agencies to get the information out about how to protect yourself and the types of treatments,” Greenleaf said. “Not everyone's familiar with the disease, even after all these years.” Odpowiedz Link
artur737 Re: Putting disease in the Lyme light 22.08.07, 22:48 The bill calls for the state Health Department, the Game Commission and the Department of Conservation and Natural Resources to work together to create an educational program that reaches beyond hunters and outdoorsmen to reach all residents and health care workers, Greenleaf said. click here Nationally, about 20,000 new cases of Lyme are reported each year, more than double the number reported in 1991, when official tracking first began. National health officials say it's not due to increased awareness of the disease. The increase is expected to continue as suburbia expands into the woodland home of black-legged tick species, commonly called deer ticks, that carry Lyme-causing bacteria in the Northeast, mid-Atlantic, north-central states and Pacific Coast. As the disease continues to spread, education remains an important part of the fight against it, Greenleaf said. No test now can determine when Lyme-causing bacteria are alive in the body. Today's tests spot infection-fighting antibodies, which can take weeks to develop and linger long after active Lyme is gone. Though the tick bite often leads to a characteristic, bulls-eye rash, many people either never develop the rash or don't recognize it. And the disease's symptoms, which include fever, headache and fatigue, are vague and resemble other common ailments. Antibiotics can treat the disease in early stages, but people who aren't treated promptly can develop painful arthritis, meningitis and other serious illnesses. A small number of patients report pain and fatigue that linger for months or years after treatment. Greenleaf says he was moved to write the bill because he knows people who have had Lyme. Educating people on how to protect themselves from the disease and health care workers on how to spot it would help, he said. Though his bill doesn't specify funding for the new program, he said the amount likely “wouldn't be substantial” and would pay off in the end. “Whatever money is spent on educating people,” he said, “would offset the cost of medical treatment and the consequences of non-treatment.” Sarah Larson can be reached at (215) 345-3187 or slarson@phillyBurbs.com. August 22, 2007 Odpowiedz Link
artur737 State Joins Dispute Over Lyme 24.08.07, 23:53 Ten artykul pokazuje gorzki smak boreliozowej wojny. Wszystkie chwyty dozwolone jak widac. Chamstwo i prostactwo kroluje. Taka powtorka z nieslawnego artykulu z Forbsa. Ale z przyjemnoscia mozna zauwazyc, ze z agresywnych wypowiedzi Fisha (IDSA) wyziera strach. courant.com/news/local/hc-durlandfish.artaug24,0,5354694.story Courant.com State Joins Dispute Over Lyme Scientists Battle Over Treatment By MICHAEL REGAN Courant Staff Writer August 24, 2007 NEW HAVEN Click here to find out more! Durland Fish, Ph.D., professor of epidemiology, leading authority on disease-carrying insects, is sitting in his paper-strewn office at the Yale School of Public Health. He is ticking down a list of physicians who disagree with him on the matter of chronic Lyme disease. "This guy ..." Fish begins. "He cheated. He fabricated an article in the New England Journal of Medicine. He provided false results. The paper had to be retracted. He was banned from [National Institutes of Health] funding for a period of time. The guy used to be the director of some penile enlargement clinic out on the West Coast. I mean, this guy ... There's some problems with him." He proceeds down the list, name by name: "Totally bogus." "He killed one of his patients." "They tried to shut him down." Words like "crackpot," "wacko," "buffoon" and "fraud" pepper his discourse. A little later, he stops to ponder a question. "I don't know," he says after a moment's thought. "I don't know why they hate me so much." "Hate" may be too strong a word, but many in the chronic Lyme community return Fish's evident antipathy. With varying degrees of vehemence, he is accused of being part of - even a leader of - what they view as a conspiracy to deny chronic Lyme sufferers the care they need for reasons of pride and profit. It is a resurgence of a long and heated dispute over the nature and treatment of Lyme disease. On one side are mainstream physicians and researchers, including Fish, who believe Lyme is a relatively straightforward infection that can be treated in almost all cases with no more than four weeks of antibiotics, although some effects of the infection, such as fatigue or joint pain, can persist. On the other is a small but extremely vociferous group of doctors and patients who say it is much more serious and requires much longer treatment - years of intravenous antibiotics in some cases. Now Fish is fighting a subpoena from state Attorney General Richard Blumenthal, who says Fish and 13 other experts may have improperly excluded scientific evidence of chronic Lyme when they issued guidelines last year for treating the disease. How did a guy with no formal training in medicine find himself in the middle of what is perhaps the most virulent medical debate going on right now? One might say that it started with his being a bad restaurant inspector. Fantastic Mosquitoes The United States was in the process of doubling its force in Vietnam, to about 400,000 troops, when Fish graduated from Albright College in Redding, Pa., in 1966. He had a degree in biology and wanted to do graduate work on mammals. But with the draft looming, he opted instead for an occupational deferment. "I went to work for the state health department, totally bored out of my mind inspecting restaurants. A terrible job, and I wasn't very good at it," Fish said. He hated imposing regulations on eateries just scraping by in the poor county where he was assigned. "I'm not a very good cop. ... I used to coach them on how to get by - how to cheat." "I was on my way out," Fish said, when he was transferred to the regional office in Redding and given a job nobody wanted: tromping around the woods and swamps checking the stations set up to monitor mosquitoes and disease-bearing animals - in scientific parlance, vectors. He loved it. "I thought, `You're going to pay me to do that?'" said Fish, who had grown up surrounded by woods in rural Berwick, Pa. "That got me interested in mosquitoes. I didn't know anything about mosquitoes - I thought they were fantastic." Fish went back to school in 1970, but not to study mammals. He earned a master's degree in entomology from the University of Massachusetts and a doctorate from the University of Florida, and did postdoctoral work at the University of Notre Dame. He then set out to look for a job doing research on mosquitoes. It was a struggle. "It wasn't a fundable area. Nobody cared," he said. "You couldn't get any grants on it. Nobody cared about the ecology of vectors." So in 1980, Fish went to work teaching general biology, ecology and medical entomology at Fordham University. Its campus was in the Bronx, N.Y., but Fish got to live at the university's research station in Westchester County. It was there he discovered the insect that came to dominate his professional life: the deer tick. "I was doing some field work on mosquitoes there and these little brown ticks started showing up. Nobody knew anything about these ticks," he said. "I'd never seen them before. They weren't there in '80, maybe we just started seeing them in '81, a rare one. By '82 they were pretty easy to find." The tiny deer tick had already infested southeastern Connecticut by the time Fish started finding them in New York, and had already been associated with what was beginning to be called Lyme disease. But no one was sure just how the disease was transmitted from tick to human. In 1982, however, a researcher found that long, spiral-shaped bacteria called spirochetes were responsible for the disease. Fish got the news in a phone call. "So I gathered up a bunch of these ticks and went down to Fordham and I was looking through a microscope," he said. "I saw these tiny little threads, about the limit of visibility under a microscope." The discovery altered Fish's professional course. "I said, `Geez, every other tick has these spirochetes in them'" Fish said. "Nobody knows anything about these ticks, there are a hell of a lot of them here, and half of them are infected. This is going to be a big, big problem." "So I just dropped all the mosquito stuff and started working on ticks," Fish said. "It was a totally wide-open field. Anything you did was new." Two Camps And, as it turned out, controversial. Within a few years of the discovery that bacteria were responsible for Lyme disease - which meant it could be treated with antibiotics - two camps developed: One saw Lyme as a simple, easily detectable and easily cured infection; the other believed it was an insidious, long-term disease capable of invading the brain and other organs and hiding its traces. What the latter group lacked in mainstream scientific support it soon made up for in organizational clout. In 1992, for instance, when several presentations on chronic Lyme were rejected by the program committee for an international conference on the disease, angry advocates contacted members of Congress and the conference's sponsors to complain. The presentations were allowed back in. Odpowiedz Link
artur737 Re: State Joins Dispute Over Lyme 24.08.07, 23:56 Organizers denied that they were caving in to pressure. Accepting the presentations "was the human and nice thing to do," one told a reporter for the journal Science. But Fish, a member of the committee that had rejected the papers, thought otherwise, and said so with characteristic bluntness. "I'm damned annoyed," he told Science. "These lay pressure groups are interfering with research." Even then the passions stirred by the issue were evident: Although the Science article quoted several researchers critical of the about-face, only Fish would allow his name to be used. The debate was fueled last year when a group of 14 experts, including Fish, published Lyme treatment guidelines under the auspices of the Infectious Disease Society of America. Those guidelines called for the use of antibiotics for no more than four weeks, disputed the existence of chronic Lyme and rejected treatments favored by the chronic Lyme community, including long-term antibiotic use. That brought Blumenthal into the fray. Shortly after the guidelines were published, Blumenthal - long associated with Lyme patient advocate groups - began an antitrust investigation to determine whether the panel ignored scientific evidence that conflicted with its guidelines. That investigation is still going on, Blumenthal said last week. His office has subpoenaed documents from IDSA and from members of the panel, he said; so far, the society has complied, but the members have not. Blumenthal would not discuss details of the investigation. "I can tell you," he said, "that the information we've received so far has created very significant concerns about the process and about potential conflicts of interest." Dr. Henry Masur, president of IDSA, disputed the notion that any society member could benefit from the guidelines. "In fact, it would be better financially for IDSA members if our guidelines recommended the broadest possible diagnostic criteria (which would mean more patients, more people needing antibiotic treatment, more research dollars, etc.) and the longest possible course of treatment (which would mean more doctor visits, and more drugs and diagnostic tests being sold)," he said in a statement. But Blumenthal's investigation heartened chronic Lyme believers, who have long claimed that the mainstream consensus is driven by conflicts of interest. "There's a group represented by the IDSA that has staked out this position that Lyme disease is hard to catch and easy to cure, and they don't want to admit they're wrong," said Raphael Stricker, a San Francisco physician, the former penis enhancement doctor and current president of the International Lyme and Associated Diseases Society. He and other chronic Lyme advocates say IDSA members stand to benefit financially from their position. Some, they say, have relationships with insurance companies that don't want to pay for extended courses of antibiotics or other long-term Lyme treatments. Others have interests in drugs or vaccines. Fish, Stricker contends, is in the latter group. "He's really into supporting the party line and developing vaccines that can make him a lot of money," Stricker said. "He has a lot of patent interest." Fish scoffs at such allegations. Yale had an interest in a vaccine that has been taken off the market, he said, but none of the Yale researchers who helped develop the guidelines stands to gain from them. Besides, he says, it's the doctors treating chronic Lyme cases for months and years who have a financial interest in their position. "If anyone has ... conflicts it's this group. I mean, they're making millions on this scam," he said. "This cast of characters here has some gall to challenge the Infectious Disease Society of America." Stricker said pharmaceutical companies may make a lot of money on long-term Lyme therapy, but physicians don't. To Fish's remark on his previous work in penis enhancement, he said, "I wish I was still doing that. I could make a lot more money doing that than doing what I'm doing now." Both his previous employment and a 20-year-old determination by the National Institutes of Health that he had falsified a paper - a finding he disputes - are "irrelevant" to his Lyme work, Stricker said. And he's dismissive of Fish's background as well. "He and others in the IDSA camp make these kinds of statements: that this is all motivated by greed, that there's no chronic Lyme disease, that there's no reason to treat these people who are sick with these symptoms," Stricker said. "That isn't what patients want to hear. And they don't want to hear it from an entomologist." But Gary Wormser, a physician and researcher at New York Medical College, says telling patients what they want to hear isn't necessarily good for them. The long-term antibiotic treatment advocated by many doctors who diagnose chronic Lyme disease can be harmful or even fatal, he said, but patients are convinced that it's the only way to cure their ailments. "Many feel abandoned by conventional medicine and are desperately seeking help from somewhere. They are especially vulnerable to those who profess to have the answer, even if they do not," Wormser said. "We are very, very concerned about these patients." Wormser, who headed the IDSA panel that drew up the 2006 guidelines, said they were based on repeated studies that showed that a brief course of antibiotics is effective in preventing or treating Lyme disease. Most people treated for "chronic Lyme" never had the disease at all, he said, and among those who did, no sign of the infection remained after standard antibiotic treatment. As for Fish, he said his role on the IDSA panel and in the Lyme controversy generally relates only to his expertise about ticks, not to medical matters. "I'm not an M.D. I don't have the training to be making recommendations on therapy or even to some extent diagnosis," he said. "But I understand science, and what's good science and what's bad science." "This is a matter of good science vs. junk science." Contact Michael Regan at mregan@courant.com. Copyright © 2007, The Hartford Courant Odpowiedz Link
artur737 Beware of ticks that carry 'fatal' disease 25.08.07, 00:22 Z prasy brytyjskiej - ostrzezenie przed kleszczami i roznoszana przez nie potencjalnie smiertelna borelioza. Autor pisze, ze choroba moze spowodowac slepote i paraliz a jedna zakazona osoba na 30 umiera. tinyurl.com/36qbua Beware of ticks that carry 'fatal' disease By Daily Telegraph Reporter Last Updated: 3:11am BST 24/08/2007 Ticks that can carry a potentially fatal disease have "exploded" in number because of the wet summer, experts said yesterday. One bite can pass on Lyme disease, which can cause blindness or paralysis, and can kill in one in 30 cases. Tick experts have warned visitors to wooded areas such as the New Forest, the Lake District and the North York Moors to be careful. Kirsty Wade, from the campaign group Tick Alert, said: "The wet weather is definitely a factor but climate change is playing a big part." The number of reported cases has risen from 292 in 2003 to 683 last year. Two cases have been confirmed in the Peak District this year. Derek Jordan, from the environmental health department at New Forest district council, said: "If people take precautions such as covering up their legs they can still have a great day out." Dr Christine Jackson, the public health director at Hampshire Primary Care Trust, said: "Examine yourself and your children for ticks every three hours and at the end of the day, paying attention to folds of skin. "Any ticks should be removed by grasping them as close to the skin as possible using fine tweezers or fingernails, taking care not to squeeze them." Odpowiedz Link
artur737 Ticked off, pol's taking action 28.08.07, 19:18 tinyurl.com/2yedsk Ticked off, pol's taking action by Denis Hamill August 28th 2007 Queens chick fixed tick glitch for hicks in sticks. Still, I didn't go to "the country" on my summer vacation. I stayed right here in Queens. I won't go anywhere near where the deer and the antibiotics roam. Because where there is Bambi, there is a little monster called a Lyme tick. According to Assemblywoman Nettie Mayersohn (D-Flushing) - who co-authored a 2005 State Assembly bill that demanded HMOs and the State Office of Professional Medical Conduct stop harassing doctors who treat Lyme disease as a chronic illness - New York State has the highest number of Lyme disease cases in the nation. So if I have to spend the rest of my life dodging killer traffic on Queens Blvd. as opposed to frolicking in the deer-dotted meadows of "the country," I will consider myself one lucky city slicker. See, I have a niece who has chronic Lyme disease. Cara was bitten by a dirty little deer tick in Rhinebeck, N.Y., when she was 7. She's 26 now and the last two decades of her life have been a living hell of pain and suffering, mega doses of antibiotics, wars with bloodless HMOs, alternative medicine treatments, lethargy, scary weight fluctuations from drug bloating and loss of appetite, and an almost spiritual quest for lasting relief. "It took us six years to get Cara diagnosed," says Betsy Jacaruso, Cara's mother, a well-known Hudson Valley painter who also is a chronic Lyme sufferer. "Some doctors don't even believe in chronic Lyme disease because it doesn't always show up positive in a blood test because when Lyme mutates, it can change structure into cyst forms and hide deep in the immune cells. But simple stress can make it flare." As a child, Cara's chronic Lyme disease often forced her to leave school mid-term. This incurable disease also has affected her adult working life, as some days she is simply unable to get out of bed because the infection caused by the spiral-shaped bacteria called spirochetes causes severe headaches, fatigue, pain, insomnia, nausea, general malaise. Chronic Lyme disease can leave some people completely disabled. And, of course, instead of trying to help these victims through a life of despair, the HMOs, those towering institutions dedicated to bottomless greed, have spent millions on lobbyists and lawyers who pressured the New York State Office of Professional Medical Conduct to harass doctors who treat Lyme disease as a chronic illness. Odpowiedz Link
artur737 Re: Ticked off, pol's taking action 28.08.07, 19:18 "I represent Flushing, where we don't have a huge Lyme problem," says Mayersohn, a member of the Assembly health committee. "But I had an intern who went off to graduate school and the work world; then I received a very disturbing letter from her saying she'd developed chronic Lyme disease." Mayersohn says the disease had attacked the young woman's central nervous system, her ability to think clearly and her memory. "She had deteriorated from a beautiful, bright young woman with her whole life in front of her to a point where she could not function," says Mayersohn. "She also told me about the whole debate about Lyme disease and how it was affecting her ability to find a doctor to treat the disease." So this city slicker state rep took her Queens street smarts and looked into the upstate Lyme situation and found that the Office of Professional Medical Conduct was targeting those doctors who treated chronic Lyme victims with prolonged antibiotic treatments. "One 27-year-old woman, named Lia, was so afflicted that she was wheelchair-bound," says Mayersohn. "They wanted to put her into a nursing home. But once she received long-term antibiotic treatments, she was able to get out of the wheelchair. Today she rides a bicycle because, obviously, prolonged antibiotic treatments work. But the insurance companies didn't want to pay the costs so they brought pressure on the OPMC and one doctor actually lost his license." So the outraged gentlewoman from Queens co-authored her legislation which passed the state Assembly and the state Senate. Gov. Pataki, dedicated to protect and serve the insurance companies, vetoed it. "But he did have the state Department of Health send out a June 15, 2005, memo demanding that the harassment of Lyme doctors cease," says Mayersohn. "It did. Still, that one doctor never got his license back." Mayersohn says if the harassment of Lyme doctors begins anew, she'd consider drafting new legislation for Spitzer's consideration. Amazing that it takes a legislator from Queens to spearhead change to a raging upstate health problem. "But it's no different than my legislation on AIDS and stroke victims," says Mayersohn. "I'm not a doctor but I have common sense. If a woman suffering from chronic Lyme disease can go from a wheelchair to a bicycle on prolonged antibiotic treatment, it must mean it works." But it still won't get me to leave Queens for tick country. dhamill@nydailynews.com Odpowiedz Link
artur737 Oswiadczenie prasowe od Turn the Corner Foundation 29.08.07, 01:15 tinyurl.com/ypcmd5 Moja uwaga: Ta organizacja zaczyna robic dobrze to co LDA powinno bylo robic od dawna. Niestety LDA to skupisko starszych osob, z ktorych niewiele ma wyzsze wyksztalcenie i nie radza sobie z takimi rzeczami jak kontakty z mediami lub edukacja. Sa swietni, jezeli chodzi o zbiorki funduszy, ale krepuja sie prasy i telewizji. Te pustke w dzialalnosci oswiatowej LDA zaczyna wlasnie pelnic Turn the Corner i zycze im wszystkiego najlepszego. Ponizej artykul, ktory jest nawiazaniem do dziesiejszego programu na kanale ABC, ktory lecial na cala Ameryke. Turn the corner zrobilo dobra robote, ale nie dopilnowali by IDSA im nie pomieszala szykow na antenie. Na koniec programu dr z IDSA wszystkich 'pocieszyl', ze borelioza, to nie problem, tylko trzeba uwazac na kleszcze i wyjac przed uplywem 24 godz, antybiotyki przez 2-4 tygodnie kazdego wylecza i inne tego typu banialuki. Nadto ABC dla rozszerzenia wiedzy 'zyczliwie' umiescial na swojej stronie materialy IDSA na temat boreliozy. Turn the Corner Foundation Board Member, Brooke Landau, to Discuss Lyme Disease Awareness on Good Morning America Aug 27, 2007 2:11 PM (1 day ago) NEW YORK, Aug 27 - Turn the Corner Foundation (TTC) Board of Directors member, Brooke Landau, will appear on Good Morning America on Tuesday, August 28, 2007 to discuss the importance of Lyme disease awareness and the need to find a cure. Brooke is the Traffic Anchor for ABC affiliated 10 News/KGTV in San Diego. As a Board member of TTC, Brooke is dedicated to the Foundation's mission to support research, education, awareness and innovative treatments for Lyme disease and other tick-borne diseases. Each year, TTC hosts its annual fundraising gala, Unmask A Cure, at Guastavino's in New York City to raise funds to support its mission. This year's gala will be on Thursday, November 1, 2007 from 6:00 PM to 10:00 PM and will feature a musical performance by Daryl Hall. Brooke was first diagnosed with Lyme disease in 1995 and has spent twelve years fighting for her life. Physicians once told her that she may not live due to compromised brain functioning as a result of Lyme disease. Fortunately, Brooke was treated by physicians in an experimental study five years ago that saved her life and is now living at a level close to where she was before she contracted Lyme disease. Lyme-literate physicians eventually brought Brooke back to full capacity, just in this past year alone. Lyme disease is incredibly difficult to diagnose and treat. Many physicians are not trained to deal with this epidemic and thousands of people are misdiagnosed annually. Lyme disease is the number one tick-borne illness in the US and has been diagnosed on every continent. The CDC reports there are 24,000 new cases of Lyme disease in the US annually, but the CDC says that figure could be underreported by tenfold due to physicians who are not trained to identify symptoms of Lyme disease. TTC has been influential in Lyme disease research and education since its inception, providing grants to organizations nationally. Columbia University, International Lyme and Associated Diseases Society, Lyme Disease Association, Genesis Laboratories and Lyme Induced Autism Foundation are examples of some of the organizations who have benefited from TTC's funding this year. In addition, TTC has created education and Lyme-literacy training programs that are nationally recognized such as The Physicians Training Program and the Lyme Educational Awareness Development Series. To learn more about TTC please visit www.turnthecorner.org. SOURCE Turn the Corner Foundation Odpowiedz Link
artur737 Re: Oswiadczenie prasowe od Turn the Corner Found 29.08.07, 01:18 Podobalo mi sie tez, ze oswiadczenie prasowe zostalo wypuszczone na dzien przed programem w TV. Czuc juz fachowa reke, a z czasem sie moze jeszcze polepszyc. Odpowiedz Link
artur737 Climate change ticks ever closer 01.09.07, 16:14 Climate change ticks ever closer TheStar.com - tinyurl.com/2koykb On the Leslie St. spit, signs of global warming are being picked right from the feathers of migratory birds. And the ticks now spreading north carry with them the spectre of Lyme disease September 01, 2007 Hannah Hoag Special to the Star At the foot of Leslie St., a spit of land fans out into Lake Ontario. Over the years, the man-made peninsula, built with rubble from Toronto construction sites, has grown into an urban wilderness, home to butterflies, birds, rabbits and the occasional coyote. The cottonwoods, birches, grasslands and bugs make the park popular with migratory birds that stop in to refuel on their flights – many coming from as far away as South America. But lurking among the feathers of these international travellers are blood-sucking stowaway ticks that can carry Lyme disease. Every morning before dawn during the spring and fall bird migration, Dan Derbyshire, co-ordinator of the Bird Research Station in Tommy Thompson Park, organizes a small group of volunteers who track the birds winging through the region. The station is part of the Canadian Migration Monitoring Network, a string of sites across southern Canada and the northern United States that monitor the population trends of northern breeding birds. From March to June, in 2005 and 2006, Derbyshire and his team of volunteer birders plucked ticks from the heads of the migrating birds. Then they mailed the ticks to scientists who are trying to gain a better understanding of how birds and climate change might increase the spread of Lyme disease through Canada. "The number of cases of Lyme disease have been fairly low in Canada, until recently," says Nicholas Ogden, an expert in tick-borne diseases at the Université de Montréal in Quebec and a researcher at the Public Health Agency of Canada. Since the 1970s, parts of the United States have suffered an epidemic of Lyme disease, mostly within the northeastern, mid-Atlantic, and north-central states. In the United States, approximately 20,000 new cases are reported each year. The disease – which causes fever, headaches and can spread to the heart and nervous system if untreated – is rarely reported in Canada, but ranks among the top bug-borne diseases in the United States. Ten years ago, eastern Canada had only two known populations of Ixodes scapularis, commonly known as the eastern blacklegged tick. Today, there are 13 or 14, says Ogden. "It's not that those two have spread out, but that there are new ones bobbling up," he says. They tend to settle in migratory bird landfalls, resource-rich chunks of land near large bodies of water. Point Pelee National Park is one of the better-known migratory bird landfalls in southern Ontario. Each year millions of migratory birds funnel through this small spit of land that juts into Lake Erie. But the Leslie St. Spit, the Toronto Islands and the Toronto lakeshore are also popular resting spots for migrants. Like Point Pelee, the region lies within the crossroads of two major migration flyways. It provides weary-winged travellers a chance to rest during their migration over the Great Lakes and stock up on energy for the next leg of their travels. "Toronto has always been on the migration highways," says Derbyshire. "There are lots of green spaces where the birds can drop in and rest, and the creation of the spit has really added to that." Ogden says the migratory birds may be bringing ticks into Canada after passing through the northeastern and north-central states, where they're abundant. The birds may also be carrying ticks from established Canadian populations farther north. Other researchers have previously found blacklegged ticks on migratory birds. "We just wanted to know if it was rare or a common thing," says Ogden. Although Ogden won't reveal details of the study until they have been published in a scientific journal, he says all the stations from western Ontario to Nova Scotia captured migratory birds with ticks on them. "We think migratory birds are quite efficient at spreading the tick around," he says. But once the ticks are here, will they survive? Canada's cooler climate once offered protection from the diseases of warmer regions. But as climate change brings milder winters, scientists worry that the ticks – formerly limited by the cold – may move farther north. "Insects are cold-blooded – air temperature determines body temperature," says Jonathan Patz, Director of the Center for Sustainability and the Global Environment at the University of Wisconsin in Madison. The warmer air temperature can make it easier for the insect to survive the Canadian winter. It can also speed up the rate at which it develops. According to the Ministry of Natural Resources, should greenhouse gas emissions remain high, average summer temperatures in southern Ontario are expected to be 4 to 5 degrees Celsius warmer and average winter temperatures about 6 degrees Celsius warmer before the end of the century. "All the biological processes that are going on require a certain amount of heat," says Ogden. "If it is very cold, those processes are very slow or will stop altogether." "When people say why should we worry about a half-degree of warming, it means everything to a mosquito carrying dengue or West Nile virus. It means do you have infectious mosquitoes after 10 days or three weeks?" says Patz. Odpowiedz Link