Get blood tested after deer tick bite

Dear Dr. Gott: I’m 81 and was bitten by a deer tick in 1990. I was placed on doxycycline and my doctor hasn’t given me anything for it since. I think I’m suffering from late Lyme disease. Is there any effective treatment for this condition?

Dear Reader: First of all, you should realize that not all deer ticks carry Lyme disease: Estimates range from 30 to 50 percent, depending on locale. Even if you had early Lyme disease, with a rash and flu-like symptoms, the doxycycline should have cured it.

If this weren’t the case, the infection could have progressed to cause arthritis, forgetfulness, exhaustion and other symptoms related to Lyme disease for which you should receive a protracted course of intravenous antibiotics.

Because the blood test for Lyme disease may not turn positive for up to a month after the disease has started, it probably wouldn’t have helped diagnose the disease in the acute phase. (Moreover, the blood test is far from 100 percent accurate.) Nonetheless, it is useful in diagnosing late Lyme disease.

You should bring your symptoms (if you have any) to your doctor’s attention. He may order a Lyme disease blood test, in conjunction with other tests (for arthritis and anemia, for instance) that can identify a separate or coexisting disorder.

Dear Dr. Gott: My doctor told me I have Gilbert’s syndrome but not to worry about it. Research at my local library has been unfruitful.

Dear Reader: Worn-out red blood cells are normally destroyed by the body, and their constituents (such as iron) are recycled for use in manufacturing new cells.

One byproduct of this ongoing process, which is essential for good health, is a yellow pigment called bilirubin. This harmless compound is absorbed by the liver, modified and excreted in the bile.

When the liver is unable to metabolize bilirubin (because of disease such as hepatitis, infection or blockage from gallstones), the pigment builds up in the bloodstream and eventually accumulates in the skin and other tissues, causing a condition called jaundice.

Thus, when people exhibit elevated bilirubin levels, doctors presume that the problem reflects either accelerated red-blood-cell destruction (as is seen in certain types of anemia) or liver disorders. These afflictions are serious unless treated.

Gilbert’s syndrome is a relatively common exception to this rule. Probably caused by genetic factors, it is marked by a slight increase in the blood bilirubin (without jaundice). The syndrome is not associated with any disease, produces no symptoms and is ordinarily discovered by accident during routine blood testing. It requires no treatment and does not affect health. The problem with Gilbert’s syndrome is that it may be initially mistaken for chronic hepatitis. However, the diagnosis can easily be clarified by blood and other tests, showing an absence of anemia or any liver disease. If you have Gilbert’s syndrome, you can relax; it’s simply a biological variation.