Raj Patel, MD

Raj Patel, MDRaj Patel, MD

Raj Patel, MDRaj Patel, MD

Education:MS-Rutgers UniversityMD – Robert Wood Johnson Medical SchoolResidency-Family MedicinePost Graduate studies in Autism Spectrum Disorders & Lyme Disease

Research:Ampligen-CFIDS (Hemispherx Pharmaceutical)

Clinical:18+ years clinical experienceActive member of Defeat Autism Now (DAN)Active member of International Lyme and Associated Diseases Society (ILADS)Active member of California Lyme Disease Association (CALDA)

Raj Patel, MDMedical Options for Wellness5050 El Camino Real, #110Los Altos, CA 94022

650-964-6700www.DrRajPatel.net

Raj Patel, M.D.

Lyme Disease

Overview Fastest growing vector borne infection

CDC estimated 24,000 cases in 2002 with the CDC itself admitting reported cases represent less than 10% of all cases.

Tick bites frequently transmit multiple infections:

BorreliaEhrlichia/AnaplasmaBabesia and other piroplasmsBartonella like organisms

Raj Patel, M.D.

Reported Cases of Lyme Disease, United States, 1995-2009

National Surveillance case definition revised in 2008 to include probable cases;details at http://www.cdc.gov/ncphi/disss/nndss/casedef/lyme_disease_2008.htm 

Raj Patel, M.D.

Vector Life Cycle

www.cdc.gov/ncidod/dvbid/lyme/ld_transmission.htm

Raj Patel, M.D.

Raj Patel, M.D.

Lyme Disease

Lyme Disease Symptoms

Symptom presentation typically mixed depending on mix of infections present

Classic Symptoms Associated with Borrelia Starts gradually with flu-like symptoms

Multi system involvement when disseminatedMigratory arthralgias that evolve into arthritisOccipital headaches with neck stiffnessFatigueFour week cycle of symptom flare-upsEM rash (bulls-eye)

Raj Patel, M.D.

Lyme Disease

Classic Symptoms Associated with Babesia Rapid onset of symptoms (cyclic high fevers, severe headaches, & sweats

esp. at night)Air hungerDull global headachesProminent fatigue with exercise intoleranceSymptoms cycle every 4-7 daysHypercoagulable states

Raj Patel, M.D.

Lyme Disease

Classic Symptoms Associated with Bartonella like organisms CNS symptoms prominent (anxiety, agitation, insommnia, seizures, outbursts

and anti-social behavior)LymphadenopathySoles tender esp. in morningStriae (hyperpigmented stretch marks)Elevated VEGF (vascular endothelial growth factor) useful marker to follow

response to treatment.

Raj Patel, M.D.

Protecting YourselfProtecting Yourself

Ticks:

Year round threat with Spring and Summer being prime timeCarried by deer as well as other animals to your yardMice become carriers when infected ticks feed on them.

Subsequently, when non-infected ticks feed they become infected

Found in cool moist areas, around shrubs and woody areas, tall grass, and around the edge of yards

Ticks prefer moist skin folds:Back of neckInside part of elbows and kneesHairlinesIn and around ears

Raj Patel, M.D.

Protecting YourselfProtecting Yourself

Minimize Exposure:

Yard PreventionYard prevention very importantKeep lawn mowed, cut down brushy areas, & clear away leavesTrim trees to ensure adequate sunshine Creating a 3 ft. wide wood chip or gravel border and stone wall

can reduce ticks by 50%

Hiking PrecautionsWalk in middle of trails Wear light colored clothingWear gloves, hat, long sleevesUse Deet type repellent on exposed skinUse Permethrin tick repellent on clothingCheck yourself thoroughly afterwardsAfter possible exposure take clothing and

place in dryer at high heat for 15 minutes to kill ticks left behind

Raj Patel, M.D.

Protecting YourselfProtecting Yourself

Keep your pets protected:

Particularly susceptible, frequently bringing deer ticks into your house

Use Frontline or K9 Advantix monthly for cats and dogUse Damminix tubes to reduce deer ticks by more than 90%

(tubes filled with cottton treated with Permethrin)

Raj Patel, M.D.

What To Do If You Get A Tick Bite

1. See a doctor immediately. The sooner treatment is started the better the results.2. Go to www.lymediseaseassociation.org for a list of lyme literate MDs (LLMD).

Otherwise, take a copy of the ILADS treatment guidelines with you for your doctor http://www.ilads.org/files/ILADS_Guidelines.pdf

3. Save the tick. Laboratories can test the tick for the presence of lyme and associated coinfections.

4. If a rash develops take photographs. It may help your doctor in the diagnosis.5. Laboratories vary in terms of the depth of lyme testing provided. Dr. Patel

prefers to use the following:

Igenex www.Igenex.com1-800-832-3200

Stony Brook Laboratory www.path.sunysb.edu/labsvs/tickpics/TICKpic.htm 1-631-444-3824

Clongen Laboratories www.Clongen.com 1-301-916-0173

Raj Patel, M.D.

Testing and Treatment After Tick Bite

Testing

PCR (blood and Serum) for Lyme, Ehrlichia, Bartonella, Babesia, MycoplasmaFISH for Babesia and Bartonella Western-Blot not useful. Take 2-6 weeks to turn positive

Treatment:

IDSA: Rx within 72 hours with Doxycycline 200 mg (4mg/kg) one time dose if age >8 years. No treatment recommended for < 8 years unless

symptoms warrant it.ILADS: No specific Rx. Use clinical judgement based on geographical

location, type of tick, if engorged, and method of removal.Burrascano Guidelines: Treat 28 days regardless of age. Note: Make sure to treat for coinfections if the tick tests positive.

Raj Patel, M.D.

Lyme Western Blot Testing

Grier, T. Laboratory Tests. Lyme Times. Summer 2004:21-25

Raj Patel, M.D.

Useful ResourcesUseful Resources

ILADS (International Lyme and Associated Diseases Society)

www.ilads.orgTurn The Corner

www.turnthecorner.orgCALDA (California Lyme Disease Association)

www.lymedisease.org“Coping with Lyme Disease, A Practical Guide to Dealing with Diagnosis

and Treatment” by Denise Lang and Kenneth Liegner, MD“Prevention Tips” LymeTimes. Summer 2004, p.5-8.

Other Useful Websites/Articleswww.tickencounter.orgwww.ilads.org/lyme_disease/B_guidelines_12_17_08.pdfwww.healthypets.com/ticks.htmlwww.igenx.comwww.drrajpatel.net/pages/lyme.phpwww.drrajpatel.net/pages/lyme/lyme-support-group.php