Yes, I am serious. These days, from what we’re learning about Lyme disease (more about its specific terminology later), anything is possible.
If you regard yourself as healthy and were asked, “Overall, how do you feel?” and you answered “Just fine, thanks,” then Lyme in any form is very unlikely and testing you would be a waste of your time and money.
In other words, we don’t test populations of healthy people for Lyme, even if they live deep in the Wisconsin woods where Lyme is prevalent.
But for others of you who have for months or years been troubled by one or more symptoms (Lyme has many symptoms) that have gone otherwise undiagnosed OR if you were diagnosed as having something, but haven’t responded to conventional treatment, you really should get tested, especially if you grew up in or spent time in a Lyme-rich area (New England, Michigan, Wisconsin, northern Illinois).
With any luck, your testing will be done in the office of a doctor who knows something about Lyme disease, so that with your test results and her expertise you can at least take Lyme disease off the table.
Let’s take one of Lyme’s symptoms, fatigue, as an example. Feeling tired all the time is an underlying symptom of literally dozens of conditions, from emotional depression and underactive thyroid to heart disease, neurological disorders, early cancers, and anemia. Here’s the wiki list if you’re interested.
When you go to a doctor complaining of fatigue, your medical history, physical exam, and lab tests will trim the list of potential causes significantly. Let’s say your doc finds you have an underactive thyroid gland. Good news! It’s a clear-cut condition with a straightforward answer. You’re prescribed thyroid replacement and, lo, you feel better almost immediately. Oh, if all patient care were so simple.
But what if you felt only 10% better after treatment? Then it’s back to the drawing board, with more tests and more doctor visits. And if your doctor doesn’t test you for Lyme then Lyme as a cause of your fatigue has not been ruled out.
And that’s only the first part
Understand that so-called chronic Lyme disease is really two quite separate conditions.
–One is called post-treatment Lyme disease syndrome (PTLDS).
–The other is called disseminated Lyme disease, which in turn is subdivided into Stage 1 (early) and Stage 2 (advanced).
Both types of Lyme disease are labeled “protean” after the Greek god Proteus, the original shape-shifter in myths, able to appear in multiple manifestations.
A protean disease has a great diversity of presenting symptoms. Fortunately, most medical or surgical problems are not protean. Strep throat presents with sore throat and fever, mononucleosis with swollen glands and fatigue. Not protean.
Lyme? Oy veh!
Lyme disease is protean extraordinaire. Here are two of the most popular Lyme questionnaires, pretty much respected by Lyme-literate physicians. Click through and have a look at the symptoms, from rib pain to irritable bladder and everything in between.
If that’s not challenging enough, here’s a list of still more symptoms linked to Lyme disease.
Cough, shortness of breath
Unexplained fevers, chills, sweats
Cystitis (bladder inflammation)
Chest plain/heart palpitations
Double/blurry vision, pain or floaters
Photophobia (abnormal aversion to bright light)
Rash at bite site or other areas
Swelling around the eyes
Unexplained weight loss/gain
Buzzing, ringing or ear pain
Nausea or vomiting
Diarrhea or constipation
Eyelid/facial twitching or Bell’s Palsy
Joint pain and swelling
Irritable bladder or bladder dysfunction
Neck creaks, cracks or stiffness
Joint or back stiffness
Muscle pain or cramps
TMJ (jaw pain)
Tingling or numbness
Difficulty concentrating or reading
Loss of libido
Grim stories and a suggestion
What’s emerged from this bouillabaisse of symptoms are grim stories of patients who experienced years and years of misdiagnosis and incorrect treatment. Ally Hilfiger spent most of her teenage life in and out of psych hospitals until someone diagnosed Lyme.
Kris Kristofferson (who is performing November 15 at the Chicago Theater) had been diagnosed with Alzheimer’s until a doctor tested him for Lyme. Kelly Osbourne’s symptoms, including pain, seizures, and psychiatric disturbances, lasted for years.
Please pause, right now, and consider the question I posed earlier. Namely, if you have any chronic symptom or symptoms that have been undiagnosed or you’re not responding to treatment for your symptoms—and especially if you’ve lived in or visited a Lyme-rich area–ask your doctor to test you for Lyme.
Here’s the question to put to your physician: “Could you test me for Lyme using the Western Blot technique?”
You will hear one of three responses:
–“No. I read there’s no such thing as chronic Lyme. Stay off the internet.” If you hear this, find another doctor.
–“OK, but we’ll start with the ELISA test first and then go to Western Blot.” Politely refuse, pointing out that ELISA misses 50% of Lyme cases.
–“Sure. Go on over to the lab now.”
Let’s talk about that snippy “no such thing” answer. There are different stages of Lyme disease.
First, there’s acute Lyme disease (also called early localized Lyme or Stage 1 Lyme), which is a flu-like illness occurring within days of a tick bite. Nobody argues about this. It’s easy to treat with three weeks of an antibiotic like doxycycline.
Second, what’s commonly called chronic Lyme disease probably should be dropped (though it never will be) and replaced by two separate and distinct entities.
—PTLDS The first exists in someone who had a definite diagnosis of Lyme and received adequate treatment but never felt well again OR this person felt well for a while and then months later had a recurrence of symptoms that he or she attributed to Lyme. This condition is called post-treatment Lyme disease syndrome (PTLDS). Symptoms are real, but there’s little evidence of infection and clinical studies have shown that antibiotic treatment is no better than placebo. In fact, some research is showing that PTLDS is an autoimmune disorder triggered by the initial Lyme infection.
—Disseminated Lyme disease The second condition is completely separate. It occurs in someone who has been infected with the Lyme bacteria for anywhere from months to years but never knew it OR they knew they once had Lyme but likely received inadequate treatment. All they know for certain is they’re chronically ill with a variety of symptoms and have been told repeatedly “we can’t find anything wrong with you.” The term for this condition is disseminated Lyme disease, with new symptoms occurring months to years after the original tick bite. This illness does respond to antibiotics.
Interestingly, even though PTLDS is allegedly not an infection, most doctors experienced with Lyme disease (called Lyme-literate doctors) will give their patients a course of antibiotics as a better-safe-than-sorry precautionary measure.
Here’s a Lyme disease summary from Medline, the federal government’s information website.
Since some of the most serious symptoms of advanced disseminated Lyme include the following, you can see how Kris Kristofferson got misdiagnosed with Alzheimer’s and Ally Hilfiger was tagged with a psychiatric diagnosis.
–Abnormal muscle movement
–Numbness and tingling
–Thinking (cognitive) problems
Some cases of Parkinson’s disease, autism, and schizophrenia and have turned out to be disseminated Lyme, as have chronic heart rhythm disturbances, fibromyalgia, chronic fatigue syndrome, hypothyroidism, rheumatoid arthritis, multiple sclerosis, and virtually every autoimmune disease.
When these conditions turn out to be disseminated Lyme, just about all of them will respond to antibiotic therapy.
Are you getting the picture? The so-called Lyme Wars are completely unnecessary. Confusion over terminology has prevented people suffering deeply with chronic illnesses from being correctly diagnosed and appropriately treated.
Any doctor who tells a patient “there’s no such thing as chronic Lyme disease” is simply unfamiliar with the accepted terminology and is possibly endangering his patient’s life by withholding lifesaving treatment.
Next week: where to get tested and how to interpret your results.
David Edelberg, MD