In recent years, Lyme disease has almost become another one of those fad medical conditions that tends to catch headlines (and audiences), similar to Vitamin D, supplemental testosterone, and gluten sensitivity. I’m not saying these things are not real … they are very real for some. But they are overly-used and abused in order to gain media attention (sorry again, Dr. Oz).
With Lyme disease being so over-hyped in the media, and with it being such a mysterious illness with common symptoms, it’s challenging to decipher fact from fiction. And that’s my goal for today’s episode—to explain what we do know about Lyme disease, and what may be over-sensationalization.
What Is Lyme Disease?
Lyme disease stems from the bite of a tick, of all things. And in the Unites States, it is associated with one blood-sucking species that transfers a bacteria called “Borrelia burgdorferi.”
After that nasty (and sometimes not noticeable) tick bite carrying the illness, there are three phases of the condition in adults:
1. Early Localized: In about 80% of patients with Lyme disease, a particular skin lesion typically develops at the site of the tick bite, referred to as “Erythema Migrans,” within a month after the bite. This one skin lesion itself often expands over the next few days or weeks, and appears as a “bulls-eye” (think “Target,” no pun intended). This stage may also include very non-specific viral-like symptoms (but without the upper respiratory or stomach symptoms), such as fevers, body aches, fatigue, headaches, lymph node enlargements, neck stiffness, etc. Not very unique or distinguishable without that rash, huh?
2. Early Disseminated: Within days to weeks after the infection, the rash tends to spread. And within weeks to months after, Lyme can spread to the nervous system, heart, or eyes and produce more specific Lyme symptoms:
- Nervous System: Numbness/tingling in the hands or feet, symptoms of meningitis, or abnormalities of the nerves on the face
- Heart: Inflammation or weakness of the heart muscles and palpitations caused by heart block on an EKG that resolves in days to weeks
- Eyes: Inflammation of the eyes or acute vision changes
3. Late: This later stage (typically months to a few years after the initial stages) often includes joint pain or arthritis in one or multiple larger joints, most commonly the knee. Also, if it attacks the nervous system, further neurologic symptoms can also develop, including subtle difficulty concentrating. These neurologic symptoms are often also non-specific and attributable to numerous other conditions as well. So, it can be challenging to pinpoint.
Some patients may “miss” or skip the early stages altogether and instead initially present in the late stages. That’s what makes this rare disease so tricky to diagnose. So, how do you diagnose Lyme disease?
Diagnosis of Lyme Disease
Testing for the antibodies for Lyme is recommended when suspecting the disease; this means testing for those proteins that the immune system produces in order to fight off the bug. These include IgGs, which are the antibodies that remain positive for prior infections (often termed “memory” antibodies, since the body remembers it long term via these proteins), and IgMs, which are only produced in an acute and current infection.
Unfortunately, false-positive testing has been reported for Lyme disease, and therefore the blood test alone is not enough to diagnose the disease. According to the Infectious Diseases Society of America, the guidelines also require the following three:
- Recent travel to an endemic area
- Risk factor for exposure to ticks, specifically
- And very specific symptoms of Lyme disease: to include symptoms due to meningitis, nerve pain, cranial nerve palsy, unusual swelling of the joints/arthritis, or symptoms due to inflammation of the heart
Here’s the KEY take-home point: non-specific symptoms (such as fatigue, body aches, headaches, etc), plus a Lyme disease positive antibody testing is NOT sufficient to fulfill a true diagnosis of Lyme disease. Lyme disease is NOT a “diagnosis of exclusion,” which means it “must” be Lyme since all other testing is normal.
Treatment of Lyme Disease
Lyme disease is treated with the following 3 first-line antibiotics, for anywhere between 10 to 21 days:
Another controversial phase after treatment termed “post-Lyme disease syndrome” is also reported to linger for up to 6 months to 1 year after treatment, with continued symptoms of fatigue, headaches, and joint pain.
The tricky part about this phase is that these non-specific symptoms can be attributable to numerous other medical conditions. It’s a very small percentage of patients thought to experience Lyme disease chronically after treatment, and is not due to active infection by no means. To give you an example, the more common stress, depression, anxiety, fibromyalgia, autoimmune-disorders, and illicit drug or alcohol abuse can also cause fatigue, body aches, and/or headaches. Sometimes, it can be quite a challenge to tease it all out and blame Lyme disease for everything little symptom.
My advice is to find a well-respected physician in your community that has extra knowledge and expertise in Lyme disease and your symptoms, in order to find an accurate diagnosis.
Well, thanks again for listening to this episode of the House Call Doctor. If you have any future topic suggestions, you can email me at [email protected]. Have a healthy week!
Please not that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health care provider. Please always seek a licensed physician in your area regarding all health related issues.
Lyme disease image courtesy of Shutterstock.