Female: …because if it is negative, it is reliable enough.
Male: It is 400% to 500% more expensive.
Female: It is definitely and more sophisticated and you have to send the blood to a good place where they can run this test. So it is not worth it if you are negative. If you are positive, it is important that you know.
Male: And then somebody then tests—it has to be a certain number of the, how many do you need>?
Female: This Western blot—it has two parts. It has what is called immunoglobulin IGG and in immunoglobulin IGM. They are two different antibodies that they look in the Western blot and there are many, many different markers that come this way or different bands that they look in the immunoglobulin.
Male: How many that would possibly say we have got this problem?
Female: So for IGG, it has to be at least five or more, and for the IGM, it has to be at least two or more. If it is less than that it is not really reliable to be a positive test.
Male: So we treat that person successfully, do we have to do any follow up tests?
Female: If a patient has a good response to the medication and the patient is not having any more symptoms or problems, there is no need for follow up in the blood test. We are not expecting for the Lyme test to become negative short term. This is not happening. You will still be positive for a long time.
Male: How long is a long time?
Female: A long time could be sometimes months or years.
Male: If the next season came along, and you are already positive the year before, can you trust these tests the next season?
Female: Well, normally, the amount of markers or the amount of bands that were positive before, they will become eventually negative over time.
Male: IGM?
Female: Exactly, and you can with a future infection become positive again for the same bands or maybe positive for new ones, so you will have the opportunity to distinguish between new infection or old infection.
Male: Well, some patients would say—just give me antibiotics, but we realize using a lot of the antibiotics, long periods of time, there are problems with it, sometimes, you get some bacteria that is sleeping in your digestive system and it wakes up and it over grows and then we want to take a thing called C-diff, so we are trying to be a little selective, and also we are running out of the antibiotics. If we use them too much, they may not be--
Female: We have to be cautious and we have to be careful. I will say if a kid has some minimal differences in between one test or another or maybe a kid who had Lyme in the past who is having again arthritis, it can be maybe a little bit more cautious in a kid like this compared with somebody who was never exposed to Lyme. It is challenging sometimes to make the decision, but I agree with you, we have to be cautious with antibiotics.
Male: A very bad case of Lyme disease, do we use this injection called Rocephin ever?
Female: Yes.
Male: That is the—should it not be used for a mild case?
Female: No. Actually, the indication for Rocephin, the indication for IV antibiotics is when a kid is not responding to the regular treatment. You give a kid one month of amoxicillin for example. You give a kid one month of any other oral antibiotics and the kid is not resolving the problem. The kid is still having arthritis, or worse scenario, you can have some central nervous system disease with Lyme, so if a kid does not respond to the oral medication, you need to go ahead and offer a more aggressive treatment and IV antibiotics.
Male: It looks like simplistic, it is a great imitator of a lot of diseases.
Female: Well it is actually, the two bacteria have the same things between them, so for central nervous disease, I would probably be more inclined to use IV antibiotics because we are dealing with something more important and we definitely need to be cautious with this.
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