Coming from a California, I agree! Obviously, for me this is not a common occurrence. But in Lyme endemic areas, I understand that 25% of Bell's in kids and adults is Lyme related. Many providers I know in those areas empirically treat for Lyme in the setting of Bells, esp bilateral. Doxy for 14-21 days is the treatment for Lyme associated Bells in both adults AND kids. Remember this is one of the later signs of Lyme, so they may have EM or hx of but not necessarily, and they might not remember. Arthritis or pain in the tendons, muscles, joints, and bones, along with headaches and shooting nerve pains might support a diagnosis of late Lyme. Testing is a 2-step process starting with an immunoassay. Thank you for reminding me that not every locale sees more murine typhus than Lyme!!
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Byron F. - September 28, 2022 3:59 AM
it would be nice to have a discussion of how to diagnose lyme disease as the eitiology of VII nerve palsy.
ilene c. - September 28, 2022 1:45 PM
Coming from a California, I agree! Obviously, for me this is not a common occurrence. But in Lyme endemic areas, I understand that 25% of Bell's in kids and adults is Lyme related. Many providers I know in those areas empirically treat for Lyme in the setting of Bells, esp bilateral. Doxy for 14-21 days is the treatment for Lyme associated Bells in both adults AND kids. Remember this is one of the later signs of Lyme, so they may have EM or hx of but not necessarily, and they might not remember. Arthritis or pain in the tendons, muscles, joints, and bones, along with headaches and shooting nerve pains might support a diagnosis of late Lyme. Testing is a 2-step process starting with an immunoassay. Thank you for reminding me that not every locale sees more murine typhus than Lyme!!