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I am both a high tech RN of 30 years' experience and a sufferer of Lyme disease x23 years. Please do not accept any of the information in this text on Lyme, as it is grossly out of date. Lyme is endemic in many, many states due to migratory flight patterns. The bulls eye rash is found in only 20-30% of cases and frequently does not itch. If it is on the back or an area not frequently observed by the patient, they may not observe the rash if it does exist. Transmission of the spirochete has been found to occur sometimes as quickly as a few hours. If the disease is not aggressively treated within the first two weeks, you are probably going to be dealing with chronic disease. The remarks about cardiac block are accurate. Arthritis is a major problem, as are neurological problems. Lyme manifests in many different ways, and one should never underestimate the spirochete. It is capable of hiding from the immune system in many ways. Currently we have no tests with >60% accuracy, largely due to its ability to hide from the immune system and its ability to suppress the immune system. Negative blood tests tell you nothing of significance. Penny Duff, RN (retired) 

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