The doctor of last resort

Excerpted from ( Posted: 12/23/2010 ) 

LEXINGTON — Dr. Cathryn Harbor was volunteering at her children’s camp outside Charlottesville last summer when she noticed a startling phenomenon: In the span of one week, 10 of her 100 campers came to her complaining of flulike symptoms.

Each reported being bitten by a tick, and four were spotted with suspicious rashes. All 10 cases were a ringer — at least in Harbor’s mind — for suspected Lyme disease.

With their parents’ permission, she treated the children immediately, and then she called the health department to ask: Should we shut the camp down?

Harbor, 50, runs a solo family practice in Lexington. An avid cyclist, she rides her bike to work, which is a cottage nestled amid Washington and Lee University’s fraternity houses.

Raised in a family of academics and activists — her minister dad was a Davidson College professor, both parents were Vietnam War protesters and civil rights advocates — she had dreamed of curing world hunger before she realized she hated agricultural economics and went to the University of North Carolina School of Medicine instead.

She hated medical school, too — but only because it seemed more about regurgitating facts than about complex, critical thinking.

“I don’t think the world works in multiple choice,” she says.

Her office opens onto a begonia-filled screened porch. During the warm months, her patients hear crickets chirping.

But the medical world beyond her doors is not so inviting.

In the past year, Harbor has become an outlier, a minority doctor who believes in the aggressive treatment of acute Lyme and its lingering effects, commonly referred to as chronic Lyme. It’s a position nearly as frustrating as trying to cure world hunger.

It’s so politically contentious that when she called the Virginia Department of Health to say she was swamped treating campers with acute Lyme, the response was: You can’t possibly have that many cases because the number of Lyme-carrying ticks in Western Virginia is insignificant and small.

Harbor wasn’t convinced, then or now. And she’s not standing by idly while researchers, scientists and Lyme advocates duke it out over the treatment of Lyme and the question of its latent effects.

Both sides agree on the existence of acute Lyme and its cause — a corkscrew-shaped spirochete, a bacteria that transmits Lyme when an infected deer tick feeds on a human. But this is where the camps part ways:

The medical establishment believes that acute Lyme is easily treated with a short course of antibiotics, with the exception of a very small number of patients who may get post-Lyme inflammatory illness or an immune system imbalance.

The outliers contend that chronic Lyme is a severe and potentially crippling disease, with a wide range of symptoms that set in when acute Lyme is not treated early or aggressively enough. They believe the spirochetes are virulent and hard to detect, corkscrewing deeply into joints and other collagen-rich tissues in the brain, eyes and heart.

They reason that the best regimen for late-stage Lyme includes longer courses of antibiotics, ranging from months to a year or more. But the establishment argues that long-term antibiotics are not only unproven, they’re potentially dangerous.

Meanwhile, sick people keep showing up at Harbor’s door, nearly 100 of them since February alone, some from North Carolina and Maryland. Most have already seen multiple doctors who have treated them for multiple illnesses. And yet their pains and complications persist.

For the complete article:

~ by Rob on December 23, 2010.

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