Reflections on keeping pace through learning in action

I really enjoyed Sarah Cormode’s interview with Dr. Baranchuk. For me, one of the most relevant take home messages from listening to this podcast is that Dr. Baranchuk paid attention to the fact that another physician suspected Lyme disease, he realized that he needed to learn more about the disease, and he took action and dug into the research. 

As a result, he spared his young patient from unnecessary pacemaker surgery. 

Dr. Baranchuk’s first Lyme carditis patient came to him from another hospital with a temporary pacemaker inserted. There’s a critical difference between a temporary and permanent pacemaker. A temporary pacemaker is a temporary solution. It corrects a dangerously low (or sometimes high) heart rate. A wire is inserted through a vein, into the heart, and is attached to a small device that remains outside the body. The pacemaker will detect electrical activity in the patient’s heart and will send an impulse when needed to normalize the patient’s heart rate.

A permanent pacemaker is a much more serious intervention. It requires surgery and regular follow up visits that involve not only doctors and nurses, but also visits to the hospital or specialty clinic to check on how the pacemaker is functioning. For these reasons, along with the cost of the pacemaker itself, permanent pacemakers are much more expensive than temporary ones, and consume a lot more time and healthcare resources.

It’s also important to understand that Dr. Baranchuk’s Lyme carditis patients were most likely all in the early stages of Lyme disease. These early Lyme patients recovered after several weeks of antibiotics, and the pacemaker leads that were removed from two such patients tested negative for Borrelia, the bacteria associated with Lyme disease. Knowing that these patients were likely all presenting with early cases of Lyme disease, it is understandable and commendable that Dr. Baranchuk advocates for early treatment, often before blood test results are known. As he points out later in the podcast, other Lyme patients have been treated with multiple rounds of antibiotics yet still have Lyme bacteria in their body. 

Although Lyme rashes and Lyme carditis are tell-tale signs of Lyme disease, many other symptoms are more like clues and require an investigative approach. 

Cormode commends Dr. Baranchuk’s “learning in action” where a curious approach, along with information from patients, colleagues, research and self-directed learning can guide physicians in their practice. It reminds me of the Zen teaching in which the master is unable to teach his student because his cup is already full. I am grateful to all of those clinicians who still have room in their cups.

41. Looking at Lyme carditis with Dr. Adrian Baranchuk