Doctor I Have a Disease I Just Invented

The first few weeks of fellowship I saw a fair amount of Lyme disease which, being from Texas, was like a cool, exotic infection I'd only previously read about. Neat. The last few weeks of fellowship, however, I've been seeing a lot of chronic Lyme disease which, being a made up condition, has made me accordingly increasingly sad.

There are a lot of unfortunate, difficult to treat diseases that exist in the world: dementia, sciatica, fibromyalgia, the crazies; but for the most part there's little debate whether these are true disorders or not. Whether you believe the primary problem in management is organic or more pyschosocial isn't so important as in either case you can at the very least categorize it, label it, and provide a foundation upon which you can work with your patient. Fibromyalgia, the wackiest of them all, even has research proven therapies which can help, sort of, if anyone would ever cooperate with a physician's recommendations. Chronic lyme disease, on the other hand, is a disease that in all reality doesn't even exist. There is in fact no such thing as chronic Lyme. The patient may as well just tell me a woodland fairy placed a curse on them so I could at the very least reply with, "that's impossible. Woodland fairies don't know any curses. Only marsh fairies cast spells. Jeez." Instead I am left with either "get out of my office," or "interesting, tell me what's been going on."

The clinic appointments for these unfortunate souls inevitably becomes an endless list of various, mostly subjective complaints followed by a review of systems I wish I didn't have to go through. Everyone's abdomen will be tender. Everyone's joints sore. Everyone's blood work and imaging are completely normal. Sometimes they are at the very least a little creative with their complaints -- something I do appreciate -- but even if you can get a patient to admit that a particular symptom is getting better it is often quickly pointed out that it's only because it's about to get much, much worse. "Blue tongue you say? It doesn't look blue now." "Yes well it's not blue today." "So it's getting better?" "No! Why would you say such a thing?!" The worst part inevitably comes at the end when I must decide how I want to tell them they're full of it. Despite various approaches I have yet to find the reply that yields a grateful smile and gratitude for the visit. I am finding it is often enough easiest just to defer the conversation to my staff -- who I have to discuss the case with regardless -- who with his years of experience can tell patients there's nothing we can do for them in a very polite, scholarly, and time efficient manner.

If it weren't for the fact that most these people are otherwise good folks who are eagerly trying to figure out why they feel like crap literally all the time it would just be perversely funny. Because of their various personality disorders and tendency to believe whatever lunatic site they found on the internet over a trained specialist who can explain to them why chronic Lyme is nothing more than heavy metal induced insanity, however, I can often only extend so much sympathy. In the end the best solution may just be to give them what they typically want: an endless supply of medicine.  That's why I am actively working on a cure with the Willy Wonka Pharmaceutical Company. We hope to have a twelve month supply of prescription strength Sweet Tarts Lyme Zapper! ready to go by winter. Due to the unforeseen tastiness of the cherry and green apple formulations leading to production shortfalls, however, it'll initially only be available in grape. Thankfully that's the strongest flavor. Unfortunately it's also the most expensive. And the kind that gives them cancer; I read it on the internet.