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Welcome to my blog

Hello. I am iciclehunter and this is my diary. My job title is "osteopath", and my work is hunting for clues, detective work, problem-solving. These things involve reason and science, but are not limited by them. They also involve the eye of experience, and "hunches". Thus, some would regard my activities as those of a quack, a title I assume here with irony. I am writing this blog because I like writing. I am quite opinionated, and perhaps I suffer from a repressed need for expression. I have no particular prior "agenda"; if I have any bees in my bonnet, no doubt they will make themselves apparent by their buzzing. All names and identifying details of any people featuring in these anecdotes have been changed. Thank you for reading.

Thursday, 18 August 2016

Spiritual reflection II

There is an oft repeated mantra among my fellow practitioners of alternative medicine, that holism acknowledges/addresses the unity of the body, mind and spirit. While I consider myself to be a spiritual person in my way, I have problems with this. Firstly, my way is not everybody's way, and my conception of spirituality is not necessarily that of yours or another person's. But the above proposition falsely and perhaps a little presumptuously assumes a shared belief.

The belief it assumes is the existence of some immaterial or energetic aspect of the human being other than anything that can be encompassed by the words "mind" or "body". This is purely belief, because the existence of such a "spirit" is not a universally accepted fact. The spiritually inclined but open-minded have also to consider at least the possibility that an entity called the spirit does not, in fact, exist. A patient might well ask, "In my book, there is no "spirit", does this mean I cannot be treated holistically?" At this point the practitioner, to care for that patient, would have no choice but to act as if. As if, "The spirit is there, you are just unaware of it". If that patient got wind of this, it would be just about as annoying to them as being talked at about the real "truth" by a pair of Jehovah's Witnesses. (They always travel in twos). Even if there were a shared belief, between those interacting, in something called "spirit", there is no guarantee that the thing believed in would have the same description, meaning or connotations. It is clear that different people who believe in a spirit may give very different definitions or descriptions of it.

Secondly, I would ask what special skills the people who repeat the mind-body-spirit mantra, over and above those who don't, have in ministering to the spiritual side. I would hazard a guess: in most cases, none. No doubt they would argue that treating the patient as a whole person (whatever that means to the individual practitioner) is enough. Body, mind and spirit being facets of the one whole, any improvement in any one of these facets will automatically bring about improvement in the others. Mens sana in corpore sano, stated Juvenal. Being a wise man, he left out the spirit, so great is the complexity and controversy of the argument. But let us ignore that omission. There is that school of thought that our body, mind and spirit find health or ill health as a whole. That is, for example, one cannot be unhealthy in body and be strong in mind and spirit. I am not of that opinion. History is full of examples of extraordinary people who despite the ravages of illness or age, have shown a strength of character and a determination of spirit that has transcended physical weakness. Nevertheless, these people are exceptional, characterised by their extraordinariness. Their psychological and/or spiritual characteristics are so strong that they can overcome severe physical limitations.

On the other hand, while physical health may not be an absolute requisite for inner strength, it cannot be doubted that for most people, lack of the former may detract from the latter. Good health and feelings of well-being and energy can only enhance our ability to feel effective and confident within ourselves, to think clearly and to persist determinedly in adversity. So that is why attention to healthy living, such as diet, fluid intake, sleep, rest and exercise help to lay down the physical context in which inner strength can develop, as well as the physical energy to carry through our will. Let us never have to reflect that the will is strong but the body weak!

But where does the spirit fit into this general consideration. A while ago I had a discussion with some colleagues about this. Most of them stuck to the point of view that spirit, mind and body find health in parallel. My own point of view was that if "spirit" has any kind of special meaning of its own, it must transcend the limitations of body and mind, limitations such as disease, for example. I do not know if such a spirit exists, so I have to find a lower level explanation that will allow for it but not depend upon it.

Myself, so far as medicine and holism are concerned, I regard the spirit in a much more down-to-earth way. For myself, I would define the spiritual dimension of healing as all things that "lift the spirit" in the colloquial sense. By that I do not mean good cheer or temporary enthusiasms. I mean feelings of deep and enduring enthusiasm, energy, joy and love of life. The word "enthusiasm" comes from the Greek en ("in") and theos ("God"), which produced enthousiasmos ("divine inspiration"). Let us say, for simplicity, that enthusiasm is a particular state of love. Different people may find this in a cathedral or in a cave, at Lourdes or Mecca or Benares, in the wild wood or by a wild sea, up a mountain or in the desert, in poetry, prayer or dance, in deep attention to the performance of one's craft or in full song, in group worship or in quiet meditation. In this sense, I urge everybody to seek to enrich the spirit.

Tiredness and the right dose of enjoyment

I have a burner for essential oils in the corner of my waiting room. I usually use lemon balm essence, which gives off a lovely fresh, energising aroma. While I was lighting the burner's tea candle this morning the fan happened to be directing air towards it, and I noticed how the air flow made lighting the candle difficult. It was not strong enough to put the flame out, but neither was the flame strong enough to take easily in the flow of the air. I reflected on a question a lady asked me just the other day. The lady is chronically fatigued, although I am not using that term as a diagnostic label. However, she confided that she loves to dance, and on those occasions when she goes out, has a glass of wine and a good time, the next day she feels full of energy. The question was, should she do this, or is she putting her health at risk. My answer was yes, absolutely, to do things she loves doing, but that it must be dosed. If you are in such a situation, you need to learn, by graded steps and through trial and error, what dosing is positive (amount and frequency) and what dosing is a toxic. Just as a flame needs oxygen, and blowing on embers will brighten them, a too forceful wind will blow a flame out and scatter the embers.

Saturday, 13 August 2016

Osteopathy - general plan that is tolerant of our ignorance

One of my patients needed written clarification of the things we discussed at our first meeting. She writes:

Could please tell me what your working hypothesis is of what is happening in my body to cause my symptoms? Also, what is your approach is for treating this?

In my reply, as premises to the comments specific to her case, I made the following points:
  1. We don't know everything (nor even a small part) about the way the body works, so we need an approach which is tolerant of our ignorance.
  2. In osteopathy, the working hypothesis is not as important as the general plan. The general plan says: "Be faithful to osteopathic principles and treat the patterns you find." The beauty of this is that it allows you to do useful work even if your working hypothesis may actually be wrong.
  3. Especially in chronic cases, chasing a single, clear "cause" is a wild goose chase. It is much more realistic and useful to think in terms of a network of multiple, reciprocal influences, each of which contributes to the maintenance of the whole (dysfunctional) system.
  4. The more you focus on detail, the less you appreciate the basic general patterns.
  5. As an osteopath I approach all problems in the same way (see number 2 above). The most important principle for the osteopath is to reduce at least one kind of stress and strain from the body (the mechanical kind), so that the whole organism, unloaded a little, frees up some resources for healing.


Thursday, 11 August 2016

Snakes, migration, and ecological change

Josephine hurt her arm bashing a snake with a stick. She tells me she and her husband have seen snakes several times in the garden of their house in the campo, of two different kinds. There were once no snakes on this island, but they have become increasingly populous in the past ten years, probably introduced in the trees and plants that are imported for people's land and gardens.

The The Montpellier Snake (Malpolon monspessulanus): 
a mildly venemous snake now present here

The official and popular line is that this is a bad thing. The introduction of new, alien species will change the ecology. These snakes will eat all the lizards. The Wall Lizard, for example, which used to be unique to these parts, but in its turn has now migrated and become naturalised in parts of the mainland. Then, who knows what will happen?

A Wall Lizard - Threatened by snakes? 

People are afraid of these new inhabitants of our island, thinking them to be dangerous. In fact, only one of the three species of snakes known to exist on Ibiza carries any venom, and then only mild and of a small quantity. But I think the reason why Josefa bashed the snake on the head with a stick has more to do with an ancient, atavistic fear buried deep in the collective psyche of humanity. When Adam and Eve (and the snake) were cast out of the Garden of Eden, God dealt with the evil serpent thus:

“Because you have done this, 
“Cursed are you above all livestock 
    and all wild animals! 
You will crawl on your belly 
    and you will eat dust 
    all the days of your life. 
And I will put enmity 
    between you and the woman, 
    and between your offspring and hers; 
he will crush your head, 
    and you will strike his heel.” (Genesis) 

So Josephine attempted to crush the serpents head.

But is the introduction of new species to an environment necessarily a bad thing? It is certainly true that a single species can have far reaching and dramatic consequences for an ecosystem. The video on this web page will probably amaze you at to what extent the reintroduction of wolves to the Yellowstone National Park changed the environment.

Nevertheless, nature has a way of adjusting to change. Species will always invade new territories, and compete with the existing species. The fittest will survive and in doing so, change the environment. That is the way it always has been and always will be.

What may happen as a result of human activities is that we aid the transportation of plants and animals from one part of the planet to another, so the process happens faster. But quite apart from this aspect of our activities, humans are changing their own ecology more than any snake could be responsible for. We spend a great deal of time and effort clumsily attempting to undo the inconveniences we have ignorantly inflicted upon ourselves.

Then, good and bad are human constructs, they have no meaning outside a human perspective. Places we call "tropical paradises" are, for the creatures that naturally inhabit them, both abundantly generous and cruelly perilous environments. John Steinbeck (in The Log from the Sea of Cortez) described the region of Magdalen Bay in Baja California thus:

"The abundance of life here gives one an exuberance, a feeling of fullness and richness.... The sea here swarms with life, and probably the ocean bed is equally rich.... There was food everywhere. Everything ate everything else with a furious exuberance."

In nature, everything eats everything else. For this reason people who profess to "love animals" tend to find nature disturbing: it confounds our human notions of "good" and "bad".

Beyond what we think about it or do to it, nature can look after itself, it will always adjust, but not necessarily congenially to our desires or ideals.

On vitality

Certain natural health practitioners, including osteopaths and nature cure practitioners, used to talk about vitality, and some of them still do, me for instance. A fashionable term nowadays is "energy", one I avoid unless in a strict physical sense; I have serious doubts that many people in the alternative medicine world use this word with any depth of understanding. Both terms, when used in alternative medicine or "New Age" contexts have (of course) been trashed by sceptical critics. Nevertheless, I stand by the word vitality because for me it describes something real and palpable, albeit not something easily pinned down.

Vitality I would define as a tendency to health and well-being. It is, let us say, the living manifestation of your potential for life. I do not see it as a distinct "life force", but as a composite quality. To the osteopath it is evident as a certain quality of the tissues. Some parts of the body may feel more vital than others. But the most vital organisms are those in which all parts emanate vitality. If I were asked to describe that palpable quality, from my own osteopathic perspective, I would say that it feels like a lively yet contained springiness that is both fluid and consistent. Too much yielding or too much resistance, bogginess, roughness or a lack of consistency, and the tissues feel less vital. This is a composite quality because it is produced and influenced by the interplay of many biological and psychological phenomena. The fact that it is a composite and that it cannot directly be measured does not make it any less "real". But what is "real" and what is not is another story for another day.

Wednesday, 10 August 2016

Crunch time - I've a good mind to drop this technique

I had a new patient last week who was in considerable pain in the right medial scapular region. As a small component of his treatment, he received from me a technique called a High Velocity Low Amplitude Thrust, or HVLAT for short. This is a kind of short, sharp push or pull which often makes clicking or crunching sounds from the joints. My patient really liked it. His pain improved somewhat but he had to come again a week later for further treatment. He came asking for another crunch. It was as though, for him, the other twenty-nine minutes and fifty seconds of treatment were completely forgotten.

Some patients do love a good crunch. Males mostly, especially of the alpha variety, but also some alpha females. A lot of people even associate crunching with osteopathy. But this is what osteopathy's founder A.T. Still said about the joint sounds that occur during certain kinds of techniques:

One asks, “How must we pull a bone to replace it”? I reply, pull it to its proper place and leave it there. One man advises you to pull all bones you attempt to set until they “pop.” That “popping” is no criterion to go by. Bones do not always “pop” when they go back to their proper places nor does it mean they are properly adjusted when they do “pop”. If you pull your finger you will hear a sudden noise. The sudden and forceable separation of the ends of the bones that form the joint causes a vacuum and the air entering from about the joint to fill the vacuum causes the explosive noise. That is all there is to the “popping” which is fraught with such significance to the patient who considers the attempts at adjustment have proven effectual. The osteopath should not encourage this idea in his patient as showing something accomplished.

I agree with Still on this, and I would go further. Are these techniques, the ones that often make the joints go "pop" (technically), useful in any way? In my experience and considered opinion their utility is very limited. Sometimes, when a patient is in acute pain, they can bring rapid relief. But so can other, gentler, less spectacular techniques. Clearly the gentler the technique, the less risk there is to the patient. I won't go into the whys and wherefores of why, in certain acute cases I would, up to now, prefer an HVLAT to a gentler technique. But I can say, that I am considering dropping them altogether.

Why?
  1. In most cases, other techniques are just as effective even in acute pain. That is, if we ignore the favourable attitude to the crunch in certain patients, which may boost the placebo part of their effectiveness. But I am beginning to feel the drawbacks of that attitude are weightier than the benefits (see below).
  2. They confer absolutely no advantage at all over other techniques when acute pain is not an issue, for example, in lower grade but longer term pain.
  3. If you use the technique just once on patients with the frame of mind that the crunch is "good", they want it every time. If you don't do it, they consider the treatment inferior. If you feed this, you feed psychological dependency and you may be led into using an inappropriate technical approach. This is an obstacle to good case management.
  4. The crunch reinforces the idea, an idea some people are very resistant to letting go of, that osteopathy is about putting bones "back in place". It is true, I think, that this is what our founder A.T. Still held that he was doing, even though he thought the "pop" an irrelevance. But I disagree profoundly with the notion conjured up by descriptions of that kind. People aren't made of lego.

Sunday, 7 August 2016

A bout with an alien entity

The experience

You are lying in bed, as well as well can be, no worries in your head, just falling off to sleep, when an unseen force approaches you with an invisible thick needle and sticks it deep into the right side of the tip of your right large toe. The pain is excruciating but only lasts for two seconds. You shout and jump up and grab your toe to have a look but there is nothing unusual about it. You search the bed for a spider or bug or something that might have bitten you, but you find nothing. You go back to bed and don't think much more about it, not realising that this is just the start. Not quite the start. You later realise that that mild, dull pain that has cyclically been appearing and disappearing at the right side of the same toe for the past week, about which you had thought little, was almost certainly the forerunner. I have been having a bout with an alien energy configuration, and this is how it started. 

But not how it ended. I was violently stabbed in the same place of the same toe roughly every 6 hours over the next three days. Sometimes it felt like a needle prick, other times like a horrible electric shock, always spontaneous, sudden, and never preceded by any warning signs. This kind of sudden, severe, unpredictable pain is psychological torture. The anxiety of expecting the pain to suddenly attack prevents you from sleeping. During the day while you are concentrating on other things it is easier. But still, sometimes it makes you cry out and jump or hop about. It is extraordinary to me that on one of those early occasions, before I knew the nature of the entity that was attacking me, the pain gave me the distinct impression of a small corkscrew suddenly turned in my flesh.

After those first three days the toe stabbing attenuated and became less frequent, finally disappearing altogether. As the toe stabbing reduced in intensity and frequency, I started feeling other sensations. There were pins and needles in various parts of my body. At first it was so subtle I thought I might be imagining it, but then it increased in intensity so there was no doubt. The irregularity and intermittence of this symptom was striking. It would appear at separate times in a foot, a leg, a hand, an arm, a part of my abdomen or thorax, eventually also my face and head. I also had weird sensations of things crawling on my skin. All these symptoms could affect any part of my body, but only rarely all at once. In general I can say that they affected my right lower limb most of all, followed by my left upper limb, and unmistakably worse at night. One night I lay in bed, worrying, pins and needles raging here and there, and realised that if I focussed my mind on any part of my body, I could conjure up the sensation of swarms of tiny ants biting me on that part. 

There were waves or pulses of dullish but somehow "bitter" pain. I hadn't realised pain can have qualities only describable by adjectives of flavour. These affected my feet, my fingers, my legs, my arms. When you are lying in bed at night these pins and needles, these pulses of dull, bitter pain bring you a sense of apprehension, a sense that something is brewing, even a sense of impending doom.

For a while I was also affected by mild, but clear nerve pain in my left arm and hand: a constant aching, cramp-like pain, together with pins and needles. For the clinicians out there I will say that it was predominantly in the C6 dermatomal/myotomal distribution, but not exclusively. 

Then all that went away and I had a few days of peace, before the stabbing pains in my right large toe came back. The excruciating pricks were always on the same side of the tip of the same toe, with occasional lesser stabs elsewhere. Notably, this "elsewhere" frequently included exactly the same spot on the other large toe. Thereafter, there was a repeating alternation between toe stabbing, body wide pins and needles with pulses of dull "bitter" pain, and relatively symptom free periods of up to a week or 10 days. So far, this has gone on over several cycles in a period of about 3 months. 

I travelled to the UK for a few days to see my parents. The entity went away. I came back home. The entity returned. I went to Italy for 2 weeks to see my children. The same thing. Is this entity in some way locked into my home location?

The last serious toe stabs happened on a Sunday two weeks ago. I hadn't experienced them for a while and was becoming confident they had disappeared altogether. Then one morning standing at the wash basin in my bathroom, it attacked suddenly and with intensity, just like the very first time. It repeated itself throughout the day and night with gradually increasing frequency, until it was happening every 5 or 10 minutes, but thankfully also with gradually decreasing intensity. On Monday morning it disappeared again. I hoped for good.

Then a week ago I went deaf in my left ear. The alien energy configuration has decided my interest in learning music must be curtailed. It happened suddenly one afternoon, when I thought that the noise of my mobile air conditioning unit at work should not be sounding in my ear, in view of the fact that it was turned off at the time. By the evening I realised that I was actually deaf, as I could not hear the telephone dial tone in my left ear. Or the automatic answering device's female voice. Or my clicked fingers if I stopped up the other ear. Or people talking to me from that side, at least not very well. I could hear, with that ear, certain kinds of sounds, but distorted and with much reduced acuity; sounds such as water running from a tap, cutlery clinked together, or the high pitched chirruping of small birds. The air conditioner in my ear changed to the padda padda padda of a helicopter, then the helicopter left and a screaming cicada took up residence. I lost my sense of direction about where sounds were coming from. Noisy environments made making sense out of sounds impossible. 

The last day and night the body-wide pins and needles and the waves of dull, bitter pain have returned, with occasional sharp but moderate stabs, but not in my right big toe. Last night the entity stuck a needle into the middle of my back, which made me jump awake and shout.

This is the current state of my bout with this alien energy configuration.

The entity

It is a strange parasytic life form which looks a bit like a wiggly worm or the business end of monstrous cork screw, that is when it is viewed through a powerful microscope. It is 15-20 micrometres long, which means that if you magnified it 570 times it would look about a centrimetre long. It is a spirochaete bacteria called Borrelia burgdorferi, borne by ticks, and apparently I have millions of them multiplying inside me. Mine almost certainly come from a tick I picked up on my left lower eyelid, just on the sensitive part where the eyelashes grow, after a walk in the forest in Malaysia. Here are some pictures of Borrelia from Google:



Borrelia is the infective agent that causes Lyme disease, a disease known as the great imitator, such is the variety of symptoms it may produce and its consequent ability to confound doctors by presenting as other diseases. I do not wish here to write specifically about Lyme disease - see the link above, or this one or this one, for some excellent information if you are interested - but about my particular experience of it, and what I have learned from it.

The experts

After 3 days of toe stabbing I saw my doctor, who was bewildered. She sent me out of the room for half an hour while she telephoned colleagues, an internal medicine specialist and a neurologist. Then she called me back in and told me her colleagues had said it was bizarre, but concurred that I should be referred to neurology for assessment. 

There are, where I live, three modalities for specialist referral: ordinary, preferential, and urgent. I was "preferential". I got my neurologist's appointment a month later. By this time I had been back to "my" doctor and found she was no longer "my" doctor, having migrated. My new doctor is young and enthusiastic. He's interested. I like him. I do not want a doctor who knows the general medical texbook from page 1 to page 1536. I want a doctor who is a detective and a bulldog. This man seems to have this frame of mind.

My new doctor asks me a question: "Have you had any kind of infection recently?" This brings to mind an idea I had entertained and then discarded. "No", I say, "But I was bitten by a tick." Doctor looks at his computer for 10 minutes and starts nodding his head. "It could be", he says, "There is something called neuroborreliosis". He is talking about the effects Borrelia sometimes has on the nervous system. I had discarded Lyme disease as an unlikely scenario early on because I had never experienced the typical rash or symptoms of fever and general joint and muscle aches. Then to be honest, I had simply forgotten about it. Doctor wants to prescribe antibiotics but wants the neurologist's opinion first.

I saw the neurologist 6 days later. He was a useless individual, commanding the exalted position (and salary) of head of neurology at the local hospital. "No", he pronounced immediately, "It cannot be Lyme disease, because Lyme causes paralysis, it doesn't cause the kinds of symptoms you have." (It can cause facial paralysis). This was clearly the one snippet of partial information he remembered from medical school, and as such was his total view of Lyme disease. He didn't take a history or examine me, or suggest any alternative hypotheses or arrange any tests, or anything else except (hearing that I was anxious, when going to bed, about experiencing sudden toe stabs) offer me a packet of diazepam, a drug used for anxiety. He didn't want to see me again, at least he didn't say he did. Instead he asked me if Malaysia was a worthwhile option for his next holiday destination. This man would be better employed tilling the fields. And they call us quacks.

Doctor prescribed an antibiotic anyway, doxycycline, telling me his retired father had advised him that he would have had no hesitation. I felt the effect immediately, the symptoms quickly attenuating to the point where I would have said I was almost cured. I returned to doctor with the good news a week or so after finishing my course of antibiotics. I asked for a second course "just to make sure" and he concurred. During the second course my symptoms came storming back. An overdue blood test confirmed the presence of the alien entity in my blood.

At present I am halfway through a 12 day course of another antibiotic, azithromycin. We'll see.

The mind

I write this as a health professional who has not hitherto suffered a great deal himself from physical symptoms. I have learned first hand some things that I thought I knew. Learning first hand rather than second hand, I have taken ownership of this knowledge. The themes that have developed are anxiety, frustration and irrationality.

I have learned first hand that unexplained symptoms cause anxiety in the person directly concerned and in their loved ones who are in daily contact with them.

I have learned first hand that sudden, unpredictable, intermittent pain is a kind of psychological torture. It is the lack of control, and the waiting for the inevitable but unpredictable unpleasantness that accentuates the distress.

I have learned first hand that you would like people, especially your health professionals, to understand the intensity and quality of your pain, but that there seems to be a wall of understanding which separates you from them, or your subjective experience from any faithful description of it. You would like your health professionals at least to do their best to understand, or even pretend to do so, by engaging in the simple act of listening well.

I have learned first hand that unexplained pain makes you irrational, or should I say, even more irrational. One looks for explanations, and not finding a credible rational one, one considers the irrational to be more credible. Among the less reasonable things I thought or did were:
  • Think that the line of tiny black ants running across the headboard of the bed were exerting some sort of psychic ant-bite influence upon my energy body.
  • Think somebody who hates me must be sticking pins into a Voodoo doll of me at random moments.
  • Believe that a recent meal of tuna carpaccio might have tipped my mercury levels over the edge. (Mercury toxicity can cause sensory symptoms).
  • Wear a flip-flop on my right foot every night, in the belief that the pressure of the bit between my toes inhibited the pain. For the same reason I even put an elastic band around my toe at night, just tight enough so I could feel the pressure, but not so tight as to cut off the blood supply. It transpired that it didn't make any difference. The relief I had at first attributed to this was coincidental with the natural waxing and waning of the symptoms.
I have learned first hand that you can develop psychological techniques to endure pain (will power, distraction, concentration, meditation, slow abdominal breathing). Just as focussing the mind on pain heightens it, focussing the mind elsewhere dulls it and even reduces the probability that it will occur.

I would also like to mention the peculiar phenomenon of intuition. Our minds, I think, can sometimes use perceptions in extraordinarily intuitive ways, resulting in a certain "direct knowledge" of phenomena which would otherwise remain obscure. I am thinking of the corkscrew sensation in my toe and the shape of this organism. Of course it is absurd to think that my sensation was an adequate picture of what was actually happening physically. There was no specific little worm there burying itself into the flesh of my toe. I don't know exactly how it works but I think it is probable that the sensory symptoms produced by this infection are caused by their influence on the peripheral nervous system more proximally (nearer the spine) than the site of the sensation itself. Nevertheless, that perception was extraordinary.

Lessons

It is my philosophy in life to try to take lessons from just about everything, negative as well as positive experiences, and this is no exception. Other than the things I have previously mentioned (see "The mind" above), here are some other things I think I've learned.
  1. Causes, triggers and influential factors can be extremely difficult to pin down. What seems to be the case for a while often comes up against contradictory evidence down the line.
  2. Everybody you know has well-meaning but largely ill-informed advice.
  3. The expert often is not as expert as he or she would have you believe, or as expert as you would expect.
  4. Disease cases are not always textbook cases.
  5. Doctors like to put things in boxes. It is quite common medical knowledge that a frequent symptom of Lyme disease is joint pains, technically "arthralgia". I do not have joint pain, but my doctors keep wanting to classify my pain as "arthralgia" in the little boxes on their computers. I find this curious.
  6. There is a lot of information and advice about Lyme disease on the Internet, and among this there is quite a large amount of claptrap and pseudoscience.  
  7. Many Lyme disease patients feel misunderstood by their doctors and by the medical establishment. Science is one thing, experience is another, and frequently the former provides inadequate explanations and solutions for the latter.
  8. Lyme disease, like a number of other complex health conditions, attracts alternative health gurus like bees to a honey pot. It is its very difficulty and complexity that makes it easy for alternative medical practitioners to sell hope where conventional medicine comes up short of patients' expectations. Not all the alternative ideas and approaches are claptrap, but I am fairly sure that quite a number of them are. I intend to go into this a little more deeply in another post.
To be continued.