Читать книгу Sick - Porochista Khakpour - Страница 11

AUTHOR’S NOTE

It seems impossible to tell this story without getting the few certainties out of the way, the closest one can come to “facts.” The hardest part of living with Lyme disease for me has always been the lack of concrete “knowns” and how much they tend to morph and blur over the years, with the medical community and public perception and even within my own body. To pinpoint this disease, to define it, in and of itself is something of a labor already.

Still: Lyme disease is a clinical diagnosis, a disease that is transmitted by a tick bite. The disease is caused by a spiral-shaped bacteria (spirochete) called Borrelia burgdorferi. The Lyme spirochete can cause infection of multiple organs and produce a wide range of symptoms. Less than half of Lyme patients recall seeing a tick bite, and less than half also report seeing any rash. (They say the deer tick—which is usually the carrier of Lyme—can present as smaller than a speck of pepper.) The erythema migrans (EM) or “bull’s-eye” rash is considered the main sign of Lyme, but atypical forms of this rash are seen more frequently. Testing is quite flawed; the commonly used ELISA (enzyme-linked immunosorbent assay) screening test is unreliable, missing 35 percent of culture-proven Lyme disease. There are five subspecies of B. burgdorferi, over one hundred strains in the USA, and three hundred strains worldwide. Testing for babesia, anaplasma, ehrlichia, and bartonella (other tick-transmitted organisms) should always be performed as well, as coinfection with these organisms points to probable infection with Lyme and vice versa.

There are multiple stages and progressions of the disease. Stage 1 is called early localized Lyme disease, and it signifies a stage where the bacteria have not yet spread throughout the body; this form of Lyme can be cured with timely antibiotic use. Stage 2 is called early disseminated Lyme disease, and here the bacteria have begun to spread throughout the body. Stages 3 and 4 are often known as chronic and late-stage Lyme disease, and at this point the bacteria have spread throughout the body. Many patients with chronic Lyme disease require prolonged treatment, all while relapses may occur and retreatment may be required. There are no tests to prove that the organism is at any point eradicated or that the patient with chronic Lyme disease is “cured,” although one can test for inflammation and other markers. Each year, approximately thirty thousand cases of Lyme disease are reported to the CDC. Over the past sixty years, the number of new cases per decade has almost quadrupled; the number of outbreaks each year has more than tripled since 1980.

I have Lyme, with “bands” (lines on a test that represent antibodies to different components of the bacteria) that afford it CDC-level recognition (bands 23 and 41). My main coinfection has been ehrlichia. Several doctors believe I also have babesia and bartonella due to certain symptoms, although my tests don’t always come out positive for them.

Living with this disease has cost me more than $140,000 so far. Experts put the average cost of late-stage Lyme at somewhere around $20,000 to $200,000. The annual cost of Lyme disease in the United States is more than $1–$3 billion as of 2017.

It is unclear when I got the disease. Doctors have mostly pinpointed somewhere in the 2006 to 2009 range, but I’ve had doctors who think I’ve had it since childhood. Although the disease and its complications—including addictions—have defined my life, it is unlikely I will ever know when I contracted it, just as it is unlikely I will ever be rid of it entirely.