Lyme disease is often thought of as a tick bite and a bullseye rash, followed by a course of antibiotics. The reality is much more complicated.
First, Lyme disease is a tick-borne illness, the primary bacterial pathogen being the spirochete, Borrelia burgdorferi. But because it is transmitted by ticks, there are often other pathogens present within the tick that can be very problematic.
These co-infections can be bacterial, parasitic, or viral, which makes Lyme disease much more difficult to diagnose and treat than many of us wish to admit.
Why We Often Miss Lyme Disease
One of the challenges with Lyme disease is that the tick itself is very small. Often, when it bites someone, it is in its nymph stage, about the size of a poppy seed or the tip of a ballpoint pen. It also releases an anesthetic in its saliva, so people typically don’t feel the bite.
Even if one does notice it, the reaction may look like a small red spot. Sometimes people develop a bullseye rash, but that’s actually less common than many people think, and it is often mistaken for something else.
In many cases, the most common symptom is no symptom at all, at least initially. Lyme bacteria grow very slowly, so symptoms can take time to appear.
Many people believe Lyme disease is hard to get, easy to diagnose, and easy to treat. In reality, all three of theese are misconceptions.
When symptoms do show up, they may be triggered by B. burgdorferi itself, or by one of the co-infections that came along with it. Anaplasma or Ehrlichia can cause acute illness within days or weeks of a bite, with symptoms including high fever, severe fatigue, and cognitive difficulties. Some people may experience flu-like symptoms, joint pain, or muscle aches.
Why Symptoms Persist
Clinically, we often treat Lyme like a fast-growing bacterial infection that would typically respond quickly to a short course of antibiotics. But Lyme bacteria don’t behave that way. They grow very slowly, sometimes taking days or even weeks to reproduce. Antibiotics work best on actively reproducing bacteria, so short treatment durations may fall short of fully eradicating the infection.
Another issue is that if someone has co-infections, but we only target B. Burgdorferi, those other pathogens may be left to continue proliferating and causing symptoms.
This is why it is so important that we test properly and do a thorough evaluation of symptoms. We need to identify all of the contributing infections and take into account the entire clinical picture, rather than focusing on a single pathogen or a narrow set of symptoms.
The Great Imitator
Lyme disease has often been called “the great imitator” because it can mimic many different conditions. It can impact so many systems, and it can present in such a wide variety of ways that it is frequently mistaken for other conditions.
Testing for Lyme is largely based on the body’s immune response, not direct detection of the pathogenic organism. The problem is, the tell-tale immune response may not appear until weeks after the infection occurs, which means testing can be negative even though pathogens are actually present.
Joint pain is common in people with Lyme, but one of the things that makes Lyme different is that the pain is often migratory. It moves from one joint to another rather than remaining in a single location. Migratory joint pain can strongly suggest Lyme disease clinically, though it is essential to look beyond the joints.
Lyme can affect multiple systems throughout the body. People may experience cognitive problems, including memory loss that seems unusual for their age. Others may have pelvic pain or abdominal pain due to nerve involvement. Some develop heart-related symptoms such as irregular heart rhythms or fainting spells, which can become serious.
Muscle pain, cramping, fatigue, headaches, sleep disturbances, and neurological symptoms are also common.
Look at the Whole Person
Our approach begins with time, and a thorough history.
For new patients, we spend approximately an hour and a half understanding their full background because history remains the most important part of diagnosis. Testing is supportive, but it doesn’t replace a detailed clinical picture.
We look at risk factors such as outdoor exposure, occupation, pet ownership, and the environment in which a person lives.
From there, we evaluate for other possible conditions using a broad diagnostic approach and a thorough assessment of the biological terrain. This may include laboratory testing, imaging, and other evaluations to identify factors that may be contributing to illness.
The biggest difference in our practice is the time we dedicate to patients. It allows us to build a relationship and gain a deeper understanding of what’s really going on.
Nutrition and Lifestyle Matter
Nutrition plays a significant role in recovery from Lyme disease. Diet can have a major influence on inflammation, which drives a lot of the symptoms across various organ systems. Therefore, a thorough review of dietary patterns is a vital part of our assessment, and our patients routinely work with a dietitian as part of their total care plan.
While dietary recommendations need to be individually tailored, there are a few near-universal guidelines. Processed foods, preservatives, refined carbohydrates, and excess sugar can negatively affect the gut microbiome, promote inflammation, and worsen. So we strongly encourage patients to reduce processed foods, sugars, and refined carbohydrates.
Mental health support is equally important. Chronic illness takes a psychological toll. Counseling and emotional support can be key components of recovery and overall well-being.
Hyperbaric Oxygen for Lyme
Hyperbaric oxygen therapy (HBOT) has become an important component in our overall approach to treating Lyme disease.
HBOT provides oxygen under pressure, thereby increasing oxygen levels in blood and allowing oxygen to reach tissues that may otherwise have limited blood flow. This is essential for tissue repair and healing.
In Lyme disease, hyperbaric oxygen may also function as an antimicrobial treatment because Borrelia as well as some of the other common co-infections do not thrive in highly oxygenated environments.
B. burgdorferi protects itself by creating a biofilm to hide from the immune system. It can nestle into tissues, create inflammation, evade blood flow, and in some cases remain dormant for years. Often, antibiotic therapies fall short of providing complete symptomatic relief because blood flow is insufficient to deliver adequate quantities of the drug to eradicate the well-protected bacteria.
In Lyme disease, hyperbaric oxygen may also function as an antimicrobial treatment because Borrelia as well as some of the other common co-infections do not thrive in highly oxygenated environments.
With HBOT, the plasma becomes saturated with oxygen at levels that are not otherwise possible under ordinary life circumstances. This results in a significant elevation of tissue oxygenation, bypassing the need for oxygen delivery solely through hemoglobin carried by red blood cells.
The bacteria may be able to hide from immune cells carried through the bloodstream, but they cannot hide from oxygen.
Increased oxygen levels can also enhance white blood cell activity and improve the bactericidal action of those cells. HBOT can also promote angiogenesis, creating new blood vessels that improve blood flow to affected tissues. The improved circulation may enhance the effectiveness of antibiotics and other therapies by improving tissue penetration.
We’ve also seen HBOT have beneficial impact on many of the symptoms that patients struggle with every day. These may include reductions in neuroinflammation, improvements in short-term memory, decreased chronic fatigue, fewer headaches, improvements in depression, better sleep, less inflammatory joint pain, less muscle discomfort, and improved energy levels.
When used as part of a comprehensive Lyme treatment plan, HBOT makes a significant difference, accelerating recovery and improving overall outcomes.
Common Misconceptions
Many people believe Lyme disease is hard to get, easy to diagnose, and easy to treat.
In reality, all three of these beliefs are misconceptions. Lyme is actually quite easy to get, especially in endemic areas. It is much harder to diagnose than many people realize, and it is much more difficult to treat than we wish it was.
Testing for Lyme is largely based on the body’s immune response, not direct detection of the pathogenic organism. The problem is, the tell-tale immune response may not appear until weeks after the infection occurs, which means testing can be negative even though the pathogens are actually present.
Another misconception is that a single dose of antibiotics is sufficient treatment. Because Lyme bacteria grow slowly, short or minimal treatment courses may not always be effective.
There is also a misconception that Lyme disease exists in isolation. In truth, co-infections are common and need to be identified and addressed for patients to fully recover.
Finally, persistent symptoms after treatment are sometimes labeled simply as “post-treatment Lyme disease.” But often, those residual symptoms reflect an incomplete treatment or an incomplete understanding of the full scope of the illness.
If initial testing is negative, but symptoms suggestive of Lyme persist, then repeat testing may be appropriate because timing can affect accuracy. Testing too early or too late can both lead to false-negative results.
Most importantly, treatment decisions should be based on clinical judgment, not solely on laboratory results.
If someone has a high likelihood of exposure, and the pattern of symptoms is consistent with Lyme disease, you should consider treating for Lyme. Antibiotics, when used appropriately and accompanied by probiotics and supportive care, are generally safe and can be very effective.
The key is in recognizing that Lyme is often far more complex than other, simple, single infection diseases. Successful treatment requires looking at the whole patient, not just the test results.
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Ronald Stram, MD, is founder and medical director of the Stram Center for Integrative Medicine, in Delmar, NY. The Center is a collaboration of healing arts practitioners dedicated to serving the well-being of their patients, families, and community by integrating the best of all therapeutic modalities in a safe, effective, and respectful manner, with the intent to nurture natural healing and promote balance and well-being. Dr. Stram earned his MD from the Icahn School of Medicine at Mount Sinai in New York City, and is board-certified in Emergency Medicine. His journey into integrative medicine began with completion of the University of Arizona’s Integrative Medicine Fellowship in 2003. He also completed a preceptorship with the International Lyme and Associated Diseases Society (ILADS).
