Five Questions With: Dr. Timothy Flanigan

DR. TIMOTHY FLANIGAN heads the Lifespan Lyme Disease Center at Newport Hospital. He reports that more people are reporting Lyme disease as the general awareness of it, as well as other tick-borne diseases, has increased in recent years. / COURTESY LIFESPAN
DR. TIMOTHY FLANIGAN heads the Lifespan Lyme Disease Center at Newport Hospital. He reports that more people are reporting Lyme disease as the general awareness of it, as well as other tick-borne diseases, has increased in recent years. / COURTESY LIFESPAN

With the prevalence of tick-borne diseases, particularly Lyme disease, in the Northeast over the past 20 years, Lifespan has created The Lifespan Lyme Disease Center at Newport Hospital. The multidisciplinary center unites academic and clinical infectious diseases experts for the treatment of Lyme disease and other tick-borne illnesses. Dr. Timothy Flanigan, an infection disease specialist, is medical director of the clinic.

PBN: Is the number of cases of Lyme disease holding steady in our region? What are you seeing at the clinic so far, and what has the hospital been seeing in recent years?
FLANIGAN:
The number of cases of Lyme disease reported to the Department of Health has continued to increase over the last three years. Reported cases in Rhode Island alone rose fourfold over the past six years, and the rise in other tick-borne illnesses, such as babesiosis, ehrlichiosis and anaplasmosis, is almost as steep. This is not surprising because the general awareness of Lyme disease both within the general community and by medical care providers continues to increase.

PBN: About what percent of people with Lyme disease present a bull’s-eye rash at the time of infection?
FLANIGAN:
The majority of Lyme disease patients develop an erythematous circular rash, often called a bull’s-eye rash, at the time of infection. Often this rash is red all over, but does not have the bull’s-eye appearance that people imagine. For that reason, the rash can be missed. Sometimes the rash is itchy or slightly painful or somewhat bothersome. It is likely to occur in places where ticks tend to embed, including around the waist and belt, under the arms, in the groin, or at the base of the neck. Many patients with Lyme disease do not recall getting a tick bite. Sometimes at the time of diagnosis, patients will recall having had an odd-looking rash.

PBN: Talk a little bit about the difficulty of diagnosing Lyme disease.
FLANIGAN:
Lyme disease can be a significant challenge to diagnose as the blood tests used to evaluate antibodies are not particularly effective and patient symptoms are nonspecific, making it hard to pinpoint their origin. Typically we utilize both a Lyme Disease Antibody Index along with a Western blot as diagnostic tools to identify Lyme disease antibodies. Other tests are being developed.

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PBN: What percent of your patients so far are suffering from post-treatment Lyme Disease Syndrome, also known as chronic Lyme disease?
FLANIGAN:
Many infectious diseases such as Lyme disease cause chronic arthritis and inflammatory conditions, and these occur even after the causative agent is eliminated through appropriate antibiotic therapy. It is hard to know how often this occurs. If Lyme disease is not diagnosed, or is under treated even with appropriate antibiotics such as doxycycline, patients appear to be more likely to develop these chronic inflammatory syndromes even after receiving appropriate antibiotic therapy. There is a lot we still do not know about this syndrome. The good news is that it does appear to respond over time to treatment that focuses primarily on symptom relief, physical therapy to improve function, improved nutrition, and a wellness approach that can strengthen the overall body.

PBN: Why are so many types of practice represented in your Lyme Disease Center treatment team?
FLANIGAN:
Because patients can develop chronic inflammatory syndromes from Lyme disease, the Lifespan Lyme Disease Center offers evaluation by an infectious diseases specialist, as well as referral for complementary therapies such as behavioral and physical therapy, psychological support, and nutrition guidance for those who need it. This is a wellness model, so we collaborate with specialists in neurology, rheumatology and other fields to provide integrated, seamless care for patients with acute tick-borne illnesses, especially those who continue to struggle with syndromes after the initial infection has been treated.

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