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Volume: 2
Issue: 16
Date: 28-Sep-94


Table of Contents:

I.    LYMENET: National LymeNet Hits the Internet
II.   J CLIN INVEST: Early and specific antibody response to
      OspA in Lyme Disease
III.  LYMENET: LD Surveillance Goes High Tech
IV.   OP-ED: What a Doctor Should Be, By Karen Angotti
V.    How to Subscribe, Contribute, and Get Back Issues


Newsletter:

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*                  The National Lyme Disease Network                  *
*                         LymeNet Newsletter                          *
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IDX#                Volume 2 - Number 16 - 9/28/94
IDX#                            INDEX
IDX#
IDX#  I.    LYMENET: National LymeNet Hits the Internet
IDX#  II.   J CLIN INVEST: Early and specific antibody response to
IDX#        OspA in Lyme Disease
IDX#  III.  LYMENET: LD Surveillance Goes High Tech
IDX#  IV.   OP-ED: What a Doctor Should Be, By Karen Angotti
IDX#  V.    How to Subscribe, Contribute, and Get Back Issues
IDX#


QUOTE OF THE WEEK:

     "A doctor should be someone who loves what he is
      doing so much that he would do it if he were not
      paid or otherwise compensated.  For in this ongoing
      battle between life and death, God's most precious  
      creation, Man, must inevitably confront his soul."


    -- Author Karen Angotti (see Section IV)


I.    LYMENET: National LymeNet Hits the Internet
-------------------------------------------------
Source: LymeNet News
Byline: By Marc Gabriel <marc@lymenet.org>
Date: September 24, 1994


After a full year of fundraising, planning, construction and
debugging, the National LymeNet is finally directly connected
to the Internet.  In volume 1, issue 16 of the Newsletter, The
Lyme Disease Network of New Jersey, Inc., announced their
intentions to build a computer network designed to facilitate
information dissemination and communication between individuals
interested in LD.  One full volume of the Newsletter later, the
system is a reality.


The Network has been in operation since last April, but accessible
only via modem.  The opening of the LymeNet to the Internet
gives LymeNet users access to the wide resources of the Net,
while providing Internet users with valuable information on LD.


In upcoming issues of the Newsletter, we will announce new
LymeNet services available to Internet users, as well as
services available only to subscribers of the National LymeNet.
As of today, Internet users can access the LymeNet gopher
server by pointing their gopher clients to:  


                   gopher.lymenet.org

For information about subscriptions to the National LymeNet,
contact Bill Stolow, President of the Lyme Disease Network of
New Jersey at:  bill@lymenet.org .  The National LymeNet has
been made possible by the generous donations of both individuals
and organizations.  Corporate contributors include Sun Microsystems,
Novell, Hewlett Packard and Digital Express Group.  



=====*=====


II.  J CLIN INVEST: Early and specific antibody response to OspA in
    Lyme Disease
-------------------------------------------------------------------
AUTHORS: Schutzer SE, Coyle PK, Dunn JJ, Luft BJ, Brunner M
ORGANIZATION: Department of Medicine, University of Medicine and
             Dentistry of New Jersey-New Jersey Medical School
REFERENCE: J Clin Invest 1994 Jul;94(1):454-7
ABSTRACT:


Borrelia burgdorferi (Bb), the cause of Lyme disease, has appeared not
to evoke a detectable specific antibody response in humans until long
after infection.  This delayed response has been a biologic puzzle and
has hampered early diagnosis.  Antibody to the abundant organism-
specific outer surface proteins, such as the 31-kD OspA, has rarely
been detected less than 6 mo after infection.  Antibody to a less
organism-specific 41-kD flagellin protein, sharing common determinants
with other bacteria and thus limiting its diagnostic potential, may
appear after 4 to 6 wks.  To investigate our hypothesis that specific
antibody to OspA may actually be formed early but remain at low levels
or bound in  immune complexes, we analyzed serum samples from patients
with concurrent erythema migrans (EM).  This is the earliest sign of
Lyme disease and occurs in 60-70% of patients, generally 4-14 d after
infection.  We used less conventional but more sensitive methods:
biotin-avidin Western blots and immune complex dissociation

techniques.  Antibody specificity was confirmed with recombinant OspA.
Specific complexed antibody to whole Bb and recombinant OspA was
detected in 10 of 11 of the EM patients compared to 0 of 20 endemic
area controls.  IgM was the predominant isotype to OspA in these
EM patients.  Free IgM to OspA was found in half the EM cases.
IgM to OspA was also detected in 10 of 10 European patients with EM
who also had reactive T cells to recombinant OspA.  In conclusion a
specific antibody response to OspA occurs early in Lyme disease.
This is likely to have diagnostic implications.



=====*=====


III.  LYMENET: LD Surveillance Goes High Tech
---------------------------------------------
Sender: David Katsuki <Katsuki@BBN.COM>
Source: Aviation Week and Space Technology, Sept 12,1994:
Headline: Tracking Infectious Disease from Above.


Scientists are predicting high risk areas for the transmission of
debilitating Lyme disease using Landsat imagery combined with
computerized overlays of related canine infection data.  Results of a
joint NASA-New York Medical College survey of suburban areas in
Westchester County, N.Y., will help improve future infectious disease
surveillance and prevention techniques.  Lyme disease is transmitted
to humans via infected deer ticks and is one of the most rapidly
emerging insect-borne diseases in the U.S.  Using satellite sensors
saved the cost of sending survey teams throughout the 450 sq.-mi. area.



=====*=====


IV.   OP-ED: What a Doctor Should Be, By Karen Angotti
------------------------------------------------------
Sender: Karen Angotti


A doctor should be a hero in shining armor, the sheriff in the white
hat.  A brave, courageous defender against wanton diseases and virulent
pestilences that kill, maim, and destroy.  He should be someone who
doggedly pursues the enemy without a thought of retreat.  Relentless
and determined, he fights until the last breath is gasped and the last,
faint heart beat is pumped through the struggling body of someone he
may not even know.  For this is his mission, to fight death and pain,
to endeavor to soothe, heal and relieve.  It is a thankless task for
death and suffering are as much a certainty as anything in this world.
For as soon as one hideous disease demon is squashed with his seemingly
pitiful weaponry, another more dreadful and fierce replaces it; and the
battle begins anew.


A doctor should be someone who cares more for people that for money or
prestige.  A doctor who does not care is like an airborne blind pilot
who cannot see the runway or read his instruments.  All the knowledge
in the world will not land that plane without the eyes to see.  And
likewise all the knowledge in the world will not cure a patient that
a doctor blinded by indifference and apathy cannot see is truly ill.  
For a real doctor will listen to his patients with a heart of
concern.  He will listen to all his patients not just those who are
comley or form, polished, refined, and educated.  And adding that
working knowledge of the patient to his book knowledge and experience,
he will attempt to piece together a treatment that will work.  No
computer can compete with this ability.  For though computers can
spit out a diagnosis based on symptoms and then prescribe a standard
treatment, no computer has a heart that can see and hear the patient
with his own peculiarities and idiosyncrasies like a real doctor can.  

Compassion is at the heart of that indefinable "art of medicine."  
Without it, a doctor might as well be replaced by a timesaving,
efficient state-of-the-art computer whose memory has less capacity
for error that a frail, fallible human mind.


A doctor should be humble realizing that his craft is far from
perfected.  Medicine is a science that is constantly changing and
growing; and the modern "discoveries" of today may soon become the
obsolete "discarded failures" of tomorrow.  Only a doctor who is
humble enough to recognize the gaps in knowledge that exist can
begin to have the kind of open mind that considers intriguing, new
ideas and possibilities which may become the discoveries of tomorrow.  
He no longer looks for answers and the three little words, "I don't
know" cannot pass though the swelling lump of pride in this throat.  
Pride can construct an impassible roadblock on the path to the future.


A doctor should be someone who enters not a profession but a
ministry -- someone who is there to serve not to be served.  People
(even doctors) are not at their best when they are sick and scared.  
Who would not be irritated by listening to endless complaints all day
long year after year?  Only someone who realizes that the reason for
choosing this calling was to alleviate as many of those complaints as
possible.


And given the impossibility of curing all of these ailments, the
reward must not come totally from lessening of complaints or the
adulation of patients but from the knowledge of a service well
rendered.  The greatest satisfaction must come from knowing that you
have done your best, sometimes against seemingly impossible odds.  
Unraveling an intricate, diagnostic puzzle, using an innovative
technique, or maybe simply holding someone's hand and saying "I am
sorry."  These are the things that making being a doctor worthwhile.  
These are the intangible things that make the endless complaints,
petty annoyances, and invasions of time bearable.


A doctor should be someone who is honest and trustworthy.  Qualities
that we often ascribe as more necessary for bankers and accountants.  
But which has more intrinsic value -- mere money or an irreplaceable
life?  Trust is necessary between doctor and patient or a crucial
element that may mean the difference between life and death is
missing.  If a doctor is saying one thing to a patient and writing
another in the chart or gossiping about him with other doctors and
nurses, then a sacred, unspoken trust has been broken; and the breach
may impinge the entire relationship.


A doctor should be someone who is courageous and undaunted by the
challenges which he most surely will face.  There will always be some
in every profession who are dishonest and even evil, those who will
use their power for gain no matter how many or who it harms.  "All it
takes for evil to prevail is for good men to do nothing."  In
medicine, perhaps more than any other field, it is imperative that the
good men restrain the unsavory.  For if they do not, who else will
have the necessary knowledge or expertise to do so?


A doctor should be someone who is kind and discreet for ill-spoken
words can scar and main as surely as a knife.  And because these
hidden scars are undetectable by any test or examination, they almost
always cause a permanent affliction -- most notably a communication
rift between doctor and patient that cannot be bridged.


A doctor should be someone who loves what he is doing so much that he
would do it if he were not paid or otherwise compensated.  For in this
ongoing battle between life and death, God's most precious creation,
Man, must inevitably confront his soul.


--To my doctor, Edwin J. Masters, M.D., who showed me that a
doctor could be what he should be.


Karen Angotti is the author of "Lyme Disease: A Mother's
Perspective" (Anerak Books, 1993)



=====*=====


V.    HOW TO SUBSCRIBE, CONTRIBUTE AND GET BACK ISSUES
------------------------------------------------------


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LymeNet - The Internet Lyme Disease Information Source
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Editor-in-Chief: Marc C. Gabriel <a229@Lehigh.EDU>
           FAX: 908-789-0028
Contributing Editors: Carl Brenner <brenner@ldeo.Columbia.EDU>
                     John Setel O'Donnell <jod@Equator.COM>
                     Frank Demarest <76116.2065@CompuServe.COM>
Advisors: Carol-Jane Stolow, Director <carol@lymenet.org>
         William S. Stolow, President <bill@lymenet.org>

         The Lyme Disease Network of New Jersey (908-390-5027)
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