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Re: Blue Cross Blue Shield Empire

Re: Blue Cross Blue Shield Empire

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Posted by Lynn Shepler, MD, JD on February 06, 2000 at 15:06:31:

In Reply to: Blue Cross Blue Shield Empire posted by Phyllis on January 21, 2000 at 11:00:01:

: i've been denied coverage for iv therapy. (had a positive elisa and negative western blot) have been continuing to appeal- any suggestions?

Dear Phyllis,

Yes --- here's a suggestion. My own view about Lyme disease testing is that testing should be pursued through laboratories that run very sensitive western blots. There are two labs in the country that seem to fall into this category ---- Igenex in Palo Alto, CA and a lab at SUNY Stony Brook. I am most familiar with testing through Igenex.

I would invest in having repeat IgG and IgM western blots done through Igenex following an antibiotic challenge test and also have some Lyme urine antigen tests run. You can order the mailing kit from Igenex (1-800-832-3200) and have the specimens collected at your local hospital or physician's office.

There are a variety of antibiotic challenge tests that are in use. This can increase the yield on these tests and boost the level of Borrelia-specific antibody that can be seen on standard diagnostic tests. I like to use tetracycline 500 mg tid for 10 days (assuming someone is not pregnant or a child) and then repeat the IgG and IgM western blots through Igenex 4-5 days after the antibiotics are stopped. It is also important to note if someone experiences a Jarisch-Herxheimer reaction while taking the antibiotics -- this is also an important clinical clue to the diagnosis of Lyme disease.

Other physicians like to use injections of Rocephin and then collect urine for the LUAT at intervals following the injection. The LUAT can be helpful becuause it is arguably direct evidence for the presence of the bacteria.

If you have all the symptoms of Lyme disease but simply don't have a positive western blot ---- I wouldn't stop here. It is well known in Europe, for example, that individuals with chronic syphilis may not demonstrate positive antibody to the organism until after antibiotics. So, doctors give a patient a shot of penicillin and then retest for antibody. It's the same principle with Lyme disease but the phenomenon is not well known.

If you have further questions, please send me a backchannel. Good luck!

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