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This week we answer questions about bee stings and Lyme disease:

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Dear HOUSE Calls,

I recently got stung on my arm.  My whole arm swelled up and I could barely bend it.  Should I carry an epi-pen?

That sounds scary, but great thinking regarding an epi-pen.

So the good news is that this type of severe local reaction does not put you at greater risk of a systemic or anaphylactic reaction. What happened to your arm is actually pretty common. Most people are likely to have severe local reactions when stung by a bee.

On the other hand, the epi-pen is used to respond to a very severe reaction known as anaphylaxis. This occurs in a smaller percentage of people after they are exposures to an allergen such as bees. The person will rapidly develop difficulty breathing and throat selling. The epi-pen can reverse such symptoms temporarily and give the person time to get to an emergency room. For you, with a severe local reaction, our best advice is to avoid bees. Failing that, ice and antihistamines (like Benadryl) are the best treatments for severe local reactions. If you do have any breathing problems, get to the emergency room right away.

Dear HOUSE Calls,    

I recently had Lyme disease.  My doctor treated me with doxycycline 100 mg twice daily for 21 days, which is the current CDC recommendation.  I have since read that many Lyme researchers recommend 200mg twice daily.  My symptoms came back and my doctor wants to treat me again with 100 mg twice daily.  Since it did not work the first time, I think he should prescribe the higher dose.  What do you recommend?

That is a tough question. The most important thing we recommend is that you talk with your doctor and together develop a diagnosis and treatment plan with which you are comfortable.

We usually prescribe 100 mg twice daily for 10-21 days. Longer courses have similar rates of cure. The 200 mg dose is sometimes used for the 1st dose, or for prevention after tick bites in states where Lyme is even more common than it is in North Carolina (like Connecticut).

If you have other research comparing treatment courses of 100mg to 200mg, share it with your doctor. There is little down side to the higher dose, so even if your doctor does not recommend it, he might be willing to prescribe it.

We wonder if you and your doctor have the right diagnosis. This might be based on exposure, travel history, symptoms, and blood tests. Further, there is something called post-Lyme disease syndrome” which can have similar symptoms and will not respond to doxycycline and includes fatigue and joint or muscle pain. This occurs in 10-20% of people with Lyme disease and can linger for six months or more.

We hope you feel better soon.

HOUSE Calls is a weekly column by Dr. Cristy Page, Dr. Adam Zolotor, and Dr. Adam Goldstein on behalf of YOUR HEALTH™ and the UNC Department of Family Medicine.

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