The Lyme Conundrum: Acute Lyme, Chronic Lyme or None of the Above?

Lyme disease is a challenging infectious disease to treat that, if not treated completely, could lead to a chronic condition. The challenge is made more difficult by the co-occurrence of several other troublesome bacteria with the Lyme bacteria. A full evaluation and treatment addresses the signs and symptoms of all of these bacteria.

The infections that occur with the Lyme bacteria (Borrellia burgdorfii) are Babesia and Erlichia (now called Anaplasma). Another bacteria, Bartonella, can occasionally co-occur.

The Lyme bacteria is insidious because it exists in at least three forms in our bodies: the free flowing bacteria in the bloodstream, the bacterial form that hides inside cells and evades identification and basic antibiotic therapy, and the encysted form which also evades diagnosis and treatment. For this reason a Lyme test, either the titer test or the Western Blot test, may be negative even though the bacterium is present in the body. In other words, a negative test cannot definitely tell you that you do not have Lyme. It can only say that at this time, in this sample, the Lyme organism has not been identified. Some people need many Lyme tests before the bacterium is finally identified.

When a Lyme infection is recent, a bull’s-eye rash often occurs. This will require immediate treatment for Lyme in all of its forms. Treatment for the co-infections may be necessary at this time as well. However the rash can show up in as few as 30 percent of the cases of Lyme. Most people never know they have been bitten. If the tick is removed within 6 hours in a way that does not force the tick’s content through the mouthpart into your body, then the likelihood of Lyme transmission is quite low. Be sure to do regular tick checks – even if just walking across the yard – especially if you have pets.

When a person has unusual or unexplained fatigue, muscle aches, joint aches, weird electric-like feelings, brain fog, unusual troubles with sleeping, or mood instability, a Lyme test is often required. At the Center for Integrative Medicine, under these circumstances, we run a very detailed test that must be sent out. In addition to checking for the basic Lyme titer and Western Blot test, this test also looks for the DNA of the Lyme organism. The testing may be expanded to look for the co-infections as well.

Treatment for acute Lyme begins as soon as a person has been bitten by a tick and changes according to the results of tick testing. If the tick tests negative, treatment is stopped. If the tick tests positive, treatment continues for up to three weeks. At the Center we give people an initial course of antibiotics if they have been bitten by a deer tick but do not have the tick to submit for testing.

If a person has been identified with Lyme disease at a time remote from the potential exposure, treatment for Lyme and co-infections are begun and last at least two months. This treatment may include several antibiotics to address all forms of Lyme disease as well as supplements and medications that support the liver and the intestines. Other antibiotics may be added to cover the likely co-infections as well. Control of yeast overgrowth in the gut is an important component of the treatment. This treatment protocol is based on the work of Richard Horowitz, MD. Our goal is to manage the Lyme so that the body’s immune system can keep it in check. There is no evidence that chronic Lyme disease can be eradicated from a person. Ongoing management and maintenance with the fewest courses of antibiotics is the goal of therapy.

In addition, the treating physician must discern between the effects of Lyme and co-infections and the consequences of long-term antibiotic therapy. Unfortunately some of the same symptoms of Lyme disease may be caused by the consequences of long-term antibiotic therapy. In addition, for therapy to be successful, the person’s liver and detoxification system, gut and digestive system, and anti-inflammatory systems must all be in good working order. Stress can also get in the way of therapy and may need to be addressed