Publish date: Dec 15, 2011
By: Fred Gebhart, Contributing Editor
Lyme disease may be the most rewarding compounding niche that most pharmacists have never considered or even heard of. That was the key message from Misty Appling, RPh, co-owner of Denton Prescription Shop, Denton, Texas. Patients with Lyme disease have a variety of needs for nutritional support and prescription drugs that can only be met by compounding. There are also ancillary services such as hormonal testing, information, and referral to Lyme-literate physicians, who can be difficult to find in many parts of the country.
Misty Appling“As with any new practice niche, the first step is research and self-education,” Appling told the annual meeting of the National Community Pharmacists Association.
“As with any new practice niche, the first step is research and self-education,” Appling told the annual meeting of the National Community Pharmacists Association.
“It is a terribly complex illness. But if you put in the time and the effort, it is definitely worth it. People with Lyme are terribly underserved.”
Appling has seen just how underserved Lyme patients can be — she has Lyme disease herself.
Appling isn’t sure when she was infected, but it was almost certainly some time before the birth of her 2 daughters, now 8 and 4. She had an occasional tick bite as a child, but she has spent almost no time camping, hiking, or in other outdoor activities as an adult.
An array of symptoms
Appling said her first pregnancy brought general myalgia, which she and her physician attributed to the pregnancy. Her second pregnancy brought Bell’s palsy and chronic insomnia.
A friend suggested that she had many of the classic symptoms of Lyme disease and suggested that she pay for polymerase chain reaction (PCR) testing. She tested positive. She found a physician who was willing to treat the disease, and 4 years later, she is still recovering.
Part of the problem, Appling explained, is that Lyme disease is a condition that is dramatically underreported.
The disease is often thought of as a tick-borne illness that is largely confined to the northeastern and western United States, but the Centers for Disease Control and Prevention (CDC) has recorded Lyme disease in all 50 states — including in Texas.
Clinicians report approximately 28,000 cases annually, although CDC estimates that the actual incidence is at least 10 times higher.
One reason for the higher estimate is the relative ease of transmission. Ticks were originally named as the key insect vector following an outbreak identified in Lyme, Conn., that gave the disease its name.
Ticks were long thought to be the sole vector, but more recent research has found that Lyme can be transmitted by mosquitoes, sand flies, gnats, and almost any other biting insect or arthropod.
Despite low reporting rates, it has emerged as the most widely reported vector-borne disease in the United States.
Another problem is that Lyme disease is easily misdiagnosed. It has been called the great imitator, Appling said.
Symptoms can mimic chronic fatigue syndrome, fibromyalgia, rheumatoid arthritis, lupus, multiple sclerosis, Parkinson’s, even autism.
“People with Lyme disease are highly individual in their presentation and their response to treatment,” Appling told Drug Topics. “As pharmacists, we can be very proactive in recognizing the signs and symptoms of Lyme.”
Simply obtaining an accurate diagnosis is problematic. While the characteristic erythema migrans, or bullseye rash, is clearly diagnostic, it does not always appear.
The Elisa and Western blot antibody tests most often used to diagnose Lyme disease have a 50% to 70% rate of false negative results, said Appling.
Patients can be symptomatic for months before Lyme antibody titers can be detected, she added. Furthermore, some patients with clinically confirmed Lyme disease have never tested positive for Lyme antibodies.
PCR testing for Lyme DNA is more effective, Appling said, but often it is not covered by insurance. A blood draw and PCR testing can cost between $500 and $1,000, she said, which is enough to discourage many patients.