Analysis of interview transcript:
The analysis of interview transcript related to the experience of two patients with Lyme disease gave rise to the following theme:
Poor diagnosis of Lyme disease and inappropriate referral to services:
One of the reasons for complication in patient with Lyme disease is that the disease is not diagnosed at an early stage. Many times the early test may be negative or in certain cases, physicians fail to interpret that the symptoms as indication of tick borne infection (Rebman et al., 2017). Hence, patients are given an alternative diagnosis which increases the risk of complication for patient. This was a common issue which was also found in two interview transcript of patient with Lyme disease. Both the patient went to the neurologist to treat symptoms of tingling and headache. However, the neurologist of patient 9 ignored the symptom by stating that ‘You are perfectly healthy you are going to live a long healthy life, pretty much’. However, her symptoms kept getting worse and later he was also diagnosed with symptom of Fibromyaglia as evident from the patient narration that ‘So he says that that’s a symptom of Fibromyalgia, or can be a symptom of Fibromyalgia ………. It wasn’t a quick wasn’t a bang, bang bang, it was over years it began getting worse. Began getting worse’. For patient 5, neurologist suggested that he had migraine and he was given medication for migraine. In both patient, it was found that both physician assured the patient that there was nothing wrong, however worst symptoms appeared with time. This indicates that inappropriate diagnosis increases morbidity of disease for patient.The same fact is also understood from the study by Lantos, (2015) which reported that many of the referred patient with infection related to Lyme disease had alternative psychiatric diagnoses and delay in diagnosing the infection deteriorate health of patient.
Worsening and diverse range of signs and symptoms:
Patient with Lyme disease posses early symptom of rashes, fevers, headache, bodyache initially and when the infection is left untreated, patients start developing new symptoms like that of neurological problem, joint pain and erythema migrans (Sanchez, 2015). Such diverse and deteriorating symptoms of infection were also evident in the two interview transcript. For patient 9, tingling sensation in the left foot and lower back was the early signs of infection, however after the delay in treatment, his symptoms got worst. This is evident from the narration ‘Symptoms progressed, kept progressing’. The patient also developed symptoms of fever, dizziness and increase in tingling sensation in other areas too. This is eminent from the word of patient that ‘I was having flashes of light in front of my eyes, tingling up and down my back, tingling in my skull, tingling in my left back, upper back, um tingling in my buttocks’. Later neurological and visual symptoms and joint pain also became an issue for the patient. Compared to patient 9, the main issues for patient 5 was decrease in stamina, migraine headaches and excruciating pain during the early stage of infection. At the later stage, the patient also witnesses sign of neurological complication evident by the narration that ‘I was having a really strange sensation in my head and in my arm’. This implies that different patient suffers from diverse range of excruciating symptoms, however the common link is that symptom deteriorate when treatment is delayed.
The review of evidence also suggests that people infected with Lyme disease experience symptoms in the joints, skin, muscles and nervous system (Halperin, 2017). It is also regarded as a severe form of infection compared to other chronic condition it has a significant impact on the health-related quality of life of patient (HRQoL). It showed that even if patient received antibiotic treatment, persisting symptoms last more than six months. Hence, people with the infection have to cope up with more bad mental and health days. The two interview transcript also revealed the impact on quality of life by narration related to progressing symptoms of the disease (Johnson et al., 2014). This finding of interview transcripts clearly shows the need for early diagnosis and implementation of innovative treatment approach to reduce the burden of illness.
Unawareness and misconception about Lyme disease:
Lyme is an infectious disease caused by the bacteria Borrelia burgdorferi and the transmission of bacteria to humans occurs because of the bite of an infected tick (Nelson et al., 2016). However, lack of awareness about tick as the source of infection has claimed lives of many people. This was evident from the interview transcript of two patients too. This is evident from the word of one of the patient who said ‘So, I didn’t even know it was a tick when I pulled it out of my ear. It was stuck’. The patient reported that she did not knew it was a tick and she developed no classics symptoms too. The symptoms were detected much later in life. However, the contrasting finding of the second interview transcript is that the patient did not reported any incidences of being bitten by a tick The symptom of headache and pain in the eye was seen in patient after an auto-accident. However, it might be possible that there might be other source of infection. Despite such contrasting view point, the theme of unawareness about infection was also observed from the narration of patient 5. The patient gave idea about ignorance of neurologist as evident from her words ‘And then they told me there was nothing wrong with me’.
The above analysis of interview transcript gives the indication that misconceptions related to lyme disease is the reason for poor outcome in patient and increase in challenges for patient management. Nervous system related complication is observed in 10-15 of patient with Lyme disease, however presence of non-specific symptoms like headache, cognitive problem, fatigue and other issues increases challenges in treatment for patient. Such kind of symptom is also found in patient without Lyme disease (Halperin, 2015). Hence, treatment of complex symptoms becomes challenges and increases substantial risk for patient. This indicates the need for having a clearer diagnosis process and increasing public awareness about Lyme disease.
Halperin, J. (2017). A critical appraisal of the mild axonal peripheral neuropathy of late neurologic Lyme disease. Diagnostic microbiology and infectious disease, 88(1), 107.
Halperin, J. J. (2015). Chronic Lyme disease: misconceptions and challenges for patient management. Infection and drug resistance, 8, 119.
Johnson, L., Wilcox, S., Mankoff, J., & Stricker, R. B. (2014). Severity of chronic Lyme disease compared to other chronic conditions: a quality of life survey. PeerJ, 2, e322.
Lantos, P. M. (2015). Chronic lyme disease. Infectious Disease Clinics, 29(2), 325-340.
Nelson, C. A., Starr, J. A., Kugeler, K. J., & Mead, P. S. (2016). Lyme disease in hispanics, United States, 2000–2013. Emerging infectious diseases, 22(3), 522.
Rebman, A. W., Bechtold, K. T., Yang, T., Mihm, E. A., Soloski, M. J., Novak, C., & Aucott, J. N. (2017). The clinical, symptom, and quality of life characterization of a well-defined group of patients with post-treatment Lyme disease syndrome. Frontiers in medicine, 4, 224.
Sanchez, J. L. (2015). Clinical manifestations and treatment of Lyme disease. Clinics in laboratory medicine, 35(4), 765-778.