Pediatric Lyme Practitioner Tara Fox, CPNP

Meet Tara Fox, CPNP

At the Jemsek Specialty Clinic, we’re fortunate to have some of the most caring, compassionate, and experienced caregivers in the field of Lyme disease today. In our Provider Profile, we spotlight team members so you get to know them more personally. In this newsletter, meet Tara Fox, our certified pediatric nurse practitioner. She joined the Jemsek Specialty Clinic in 2011, and continues her enthusiasm for the well being of our patients from infancy to young adulthood.

Q: Where did you grow up?

Tara: I grew up in Mississippi and outside of New Orleans, and finished my last two years of high school in Tennessee.

Q: Where did you go to college and what’s your educational background?

Tara: I graduated from Virginia Polytechnic Institute and State University (Virginia Tech) in Blacksburg, VA. I have a Bachelor of Science degree in Biology, with a minor in in microbiology. Then I went to Vanderbilt University in Nashville, where I earned my RN certification and master of science degree in nursing.

Q: Why did you decide to focus on medicine as a career?

Tara: I wanted to do something that could make a difference. I like the immediate gratification you get when you help somebody and you can see that right away.

Q: Do you come from a long line of caregivers in your family?

Tara: I’m the oldest of three; I have a brother and a sister. My family is mostly engineers, so we all like to understand how things work. Even though I’m on the biology side, there’s some continuity for me here!

Q: How did you connect with the Jemsek Specialty Clinic?

Tara: I was working in primary care and really struggling in that setting. In primary care, due to insurance reasons and financial constraints, you need to see a significant number of patients each day. That limited the time I could spend with each person. A family friend, who knew I was struggling, happens to work for ILADS, the International Lyme and Associate Diseases Society, and she introduced me to him in 2011. I’ve been at the clinic ever since.

Q: Did you know much about Lyme disease when you started, and did you want to focus on pediatrics?

Tara: I had no real understanding of the Lyme disease process. I only knew the tidbit they give you in school – treatment with 21 days of doxycycline. Dr. Jemsek clearly showed me it was a little more complicated than that! He took me under his wing, hiring me to work with our pediatric patients. Early on he sent me to study on-site, with another mentor – Dr. Charles Ray Jones, a Lyme-literate pediatrician in Connecticut. I continued to stay in touch with Dr. Jones, he is everything that a doctor should be. I have a lot of respect for him.

Q: How many providers and clinics specialize in pediatric Lyme disease?

Tara: There are not very many people doing it. It’s a very small niche.

Q: How young are your patients and how far do they travel to get to you?

Tara: My patients range in age from newborns to 25 year olds. I have patients from every state and I have patients in Europe, Asia, and Australia.

Q: Do your patients call you Miss Tara?

Tara: Everyone usually just calls me Tara. Particularly because I have such a large adolescent population, I want to make sure I build a good rapport with them and that they feel comfortable talking to me.

Q: What are the challenges in treating young patients, especially those who aren’t talking yet?

Tara: You have to have a good understanding of the developmental milestones, as defined by the Academy of Pediatrics. In newborns, there are certain things we look for. Is the baby meeting those milestones with age-appropriate motor skills and normal reflexes? Is there dystonia (muscle spasms) or long bouts of colic – unexplained and uncontrollable crying with sleep disruption? Are there situational stressors? Are symptoms hormone-induced? How much of what we’re seeing is outside the norm and can be associated with neuroborreliosis, the chronic (and most debilitating) form of Lyme disease.

When kids are able to talk for themselves, it’s really important to listen and get a complete history. Laboratory testing can give us so much, but a clinical picture is so important, too. We need to get a good chronological history and find out what kind of issues they’re having.

As for treatment, we have to be much more conservative in the kinds of medications, and their dosages, that we give infants, children and adolescents. They can only tolerate so much.

Q: What’s your advice to parents who may be wondering if their child has Lyme?

Tara: The primary things I look for are headaches, joint pains, fatigue and not meeting developmental milestones appropriately. If your child has some or all of these symptoms, and you can’t rule out any other cause, then I suggest that parents make an appointment. We greatly value their input and support. The parents of our patients are true advocates for their kids. Many times, the children we see have been dismissed in a lot of ways by the medical community.

Q: Is there a patient success story that stands out for you?

Tara: There are two actually. I’d been here four months when I met a 9-year-old boy with gut-wrenching abdominal pain. It was as if he was having appendicitis. He had no quality of life. He went from playing and enjoying soccer, with tons of friends, to being withdrawn and fatigued because the abdominal pain kept him up at night. We believed his symptoms were associated with Lyme, and that there was a possible neurological reason why he was having such bad abdominal pain. He likely has a propensity for amplified musculoskeletal pain exacerbated by this disease process. We put him on a low-dose medication that we use for neurogenic pain. What a turnaround! He was a completely different child! For me, it validated my decision to be in medicine. By listening, understanding and finding the right medication, we could make a huge impact in his quality of life.

Q: What’s the second patient success story?

Tara: This is a recent case: a 9-year-old girl with severe obsessive
compulsive disorder (OCD). She had severe paranoids regarding the weather. During the office visit, she asked at least 20 times about the weather. She kept checking outside. She was obviously very intelligent, well-spoken and articulate. She knew her behavior wasn’t rationale but she just couldn’t control it. And then, on top of that, she could only wear certain colors.

This is the kind of OCD perseverance (persistence) that we see with this disease. It was an abrupt onset. She was a perfectly healthy child who was functioning well, excelling academically, and suddenly, her demeanor changes completely. We put her on antibiotic therapy and she has improved greatly. She still has some minor paranoia but she can go to school, she’s doing well in school, and she can play sports. Ultimately it took a few weeks, but there was a complete change in her behavior. And she can wear all colors now!

Q: What makes the Jemsek Specialty Clinic, and the care you all deliver here, so special?

Tara: We do two things here that no other clinic I’ve encountered does. Firstly, we have more time with our patients. I really appreciate that, and It’s why I am committed to the Clinic. Because the visits are longer, I can get more accurate diagnostic information. We work to rule out different causes before we automatically jump to Lyme. We want to make sure that other factors or comorbidities (when you have two or more diseases at the same time) aren’t playing a role in the symptoms we see.

And two, we take a holistic approach to patient care. You may have Lyme, but if you aren’t sleeping well, we’re also going to treat that. As everything plays a role in immunologic function, and how fast a person can get better, we implement treatment protocols that really look at the whole person.

We also look for correlations to better understand the Lyme disease process. Could nutritional status or metabolic function, for example, play a role? We look for biomarkers that could be a telltale sign. Many of our patients have really low vitamin D, and why is that? There is obviously a correlation, but why?

Q:  I can tell that you love what you do! What’s the best part of your job?

Tara: The last visit! Obviously I’m sad that I’m not going to see them again, but I’m always so happy that these kids are in a better place and feeling so much better. And I’m so grateful to have been a part of that.

Q: What’s the toughest part of your job?

Tara: When you do everything you can and patients aren’t getting better as quickly as you would like. It does happen at times, and that’s the tough part about working in medicine.

Q: When you aren’t treating kids, how do you spend your free time?

Tara: I have a pretty active social life in DC because a lot of my friends from college live here, which is great. They’re a great social support for me. I also enjoy painting. I work in acrylics, and I do abstract or landscape scenes. My friends will see a painting that they like and ask me to recreate it for them.

I used to sew and I made baby quilts for a long time. I also play golf. I play some tennis, and I’ve played indoor soccer, too, but my very favorite thing to do is wakeboarding. I don’t get to do it a lot around DC. You ride a small surfboard that attaches to your feet, behind a boat that pulls you. It’s kind of like snowboarding, only it’s on water!