Lyme Disease Signs, Symptoms, Testing + Treatment: Part 2

In part 1 of this 3-part blog series, I discussed potential Lyme disease transmission, infections as well as common misconceptions about Lyme disease.

This post will highlight common signs and symptoms as well as current testing and treatment protocols. It is not meant to self-diagnose or treat Lyme disease symptoms.  It is important to seek professional healthcare advice from a provider

Acute Lyme Disease: Signs + Symptoms

Lyme disease is a challenging illness. Some people never experience symptoms with an acute tick/infectious insect or arachnoid bite. However, if symptoms occur, these are often the most prevalent indicators:

  • Fever
  • Chills
  • Fatigue
  • Body aches
  • Headache
  • Swollen lymph nodes
  • Joint pain
  • Bullseye rash (aka erythema migrans) 
  • Neck stiffness
  • Bell’s Palsy (facial paralysis or weakness on one side of face)

Chronic or Post-Treatment Lyme Disease Symptom (PTLDS): Signs + Symptoms

People that experience chronic or “late state” Lyme disease can experience all of the same acute signs and symptoms listed above in addition to others:

  • Neuropathic symptoms – nerve pain, numbness, hot/cold sensations, tingling, burning in feet, poor balance, headaches
  • Memory impairment – forgetful, confused, difficulty finding words, brain fog
  • Respiratory + cardiovascular symptoms – air hunger, heart palpitations, chest pain, shortness of breath, unexplained pericarditis
  • Unprovoked pain which may interfere with sleep
  • Lightheadedness, fainting
  • Gastrointestinal symptoms
  • Psychiatric symptoms- depression, anxiety, mood changes
  • Ringing in the ears
  • Loss of muscle tone and muscle cramps
  • Chronic, debilitating fatigue

Testing Options

Lyme disease is a difficult disease to diagnose without adequate testing. Many of the symptoms associate with Lyme can easily be confused with (or characterized as) fatigue or seasonal illnesses.

Testing options are somewhat limited, especially with traditional standardized testing. Western Medicine has a 2-part approach for diagnosing Lyme disease. First, the patient must have regular blood draw with an ELISA test, to see if any antibodies are present for Lyme.

If these results are positive, then a second test is administered, called the western blot. The western blot results have to show specific bands to confirm a positive Lyme test. 

One drawback of the 2-part testing approach is the timeframe for a test to show positive Lyme disease.  The first test (ELISA) is designed to show if your body has produced any antibodies in response to infection.  The acute antibody levels (IgM) usually appear within two to four weeks and the long-term antibodies (IgG) appear around four and six weeks with a peak at eight weeks. 

Unfortunately, the timing of ELISA testing can have an impact on whether a person is accurately diagnosed with Lyme disease.

If you were to get bit by a tick and start having symptoms a few days later and go to your provider, it’s highly likely that your test will come back negative until the 2-4-week mark. By that time, you should already have a treatment started. 

To Treat or Not to Treat

The challenge with Lyme disease in western medicine is that Lyme disease symptoms can be confused for other illnesses which can cause delay in treatment, undertreating or even non-treatment. 

Misdiagnosing Lyme disease or delayed treatment can have costly implications for patient’s quality of life in the future. 

The Center for Disease Control and Prevention (CDC) recognizes a traditional western approach to this disease whereas the International Lyme and Associated Diseases Society (ILADS) was formed to provide a robust approach to treating Lyme disease specifically.  ILADS is a nonprofit, international, multidisciplinary medical society dedicated to the appropriate diagnosis and treatment of Lyme disease and its associated illnesses.

Treatment Options:

Conventional Treatments

There are different treatment options for Lyme disease depending on many factors. In the recent past, the CDC recommended a single antibiotic dose for positive Lyme tests, but have since updated their protocol to prescribe a 10-21 day treatment plan with antibiotics specific to the age of person, allergies, etc.

Alternatively, ILADS has a specific way they use antibiotics for preventing and treating of a tick bite and Lyme disease infection. 

 Recommendations from ILADS:

Instead of a standardized antibiotic approach, treatment decisions hinge on a variety of factors like the duration of the illness, the types of symptoms and signs the person has, and whether they were previously treated for this specific infection in the past.

  • ILADS recommends that prophylactic treatment be discussed with anyone who has had a blacklegged tick bite whether or not they are immediately symptomatic. This is to prevent the onset of infection with a proactive approach.
  • When the decision is made to use an antibiotic prophylactically, ILADS recommends 20 days of doxycycline (for persons ages 8 years and older – without allergies).
  • ILADS recommends that most patients with erythema migrans (bullseye rash) receive an initial 4-6 weeks course of antibiotic therapy. Follow up treatment decisions are based on whether the signs and symptoms remain or relapse.
  • ILADS recommends that patients with persistent (chronic) signs and symptoms of Lyme disease receive individualized care that tailors an antibiotic approach to their specific treatment plan. The duration of treatment, and the choice of antibiotic or antibiotic combinations, are clinical decisions made with several factors in mind. Long-term antibiotic therapy is not without risks and should only proceed under close supervision.

Homeopathy Treatments:

Homeopathic remedies are best used at first sight of puncture wound, bite or sting. Ledum palustre is one of the go-to homeopathic remedies for tick bites. Ledum is used as a first-aid modality to prevent infection, and for all puncture wounds including insect stings and animal bites. Recommendations are to take Ledum palustre 30C or 200C as soon as a bite or sting is noticed. Dosing is typically 2 pills each, dissolved under the tongue, three times a day for 3 days. Dosing 30 minutes away from food or drink, both before and after each dose. This can be used without prescription, until further treatment or testing is rendered by your provider. It’s always important to see a provider when there is a tick bite involved. *Please talk to your provider before starting any natural therapies.

Herbal Treatments:

There are a handful of herbs that are antiviral + antibacterial in nature that can help at an acute onset of a tick/insect bite. Dosing depends on age and weight so I will just list the specific helpful herbs here. Remember, these are suggestions that can be used at initial finding of a tick bite, until you can get into your provider for further testing. 

  • Andrographis is an amazing antiviral, antibacterial, and antiparasitic. Numerous clinical trials have demonstrated its ability to reduce the length and severity of common viral illness.
  • Cat’s Claw has long been used traditionally to treat microbial illnesses. It offers antiviral, antiparasitic, anti-inflammatory and antioxidant properties.
  • Sarsaparilla offers anti-inflammatory, antioxidant, and antibacterial properties against gram-negative bacteria. Sarsaparilla can also decrease flu-like symptoms. 
  • Berberine is the active component of many different medicinal herbs. It offers antiparasitic and antifungal properties. It is known to decrease blood sugar, so people with hypoglycemia (low blood sugar) need to be mindful of this. 
  • Allisure AC-23 Garlic is a potent and patented, broad-spectrum antibacterial. 

In conclusion, I prefer to have homeopathic remedies and herbs in my ‘medicine cupboard’ to be proactive against any acute summer bites.  Ticks do not just bite when healthcare professionals are in the office.  

As a clinician and patient myself, I understand the limitations of the current Lyme disease testing and diagnostic approach. If a patient had an appointment with me 2 weeks after a bite, and their initial ELISA testing was negative, I would most likely retest them at 4 weeks in addition to running a western blot. If my patients come to me before the 2-week mark and they are having symptoms and had a recent tick bite, I would consider treating them prophylactically until we know, either from testing or resolution of symptoms, that they have recovered.

If you happen to be bitten by a tick, it’s always helpful to save the tick and send it to a place like Igenex laboratory in California for specific tick testing. The results of sending the tick to be tested will tell us what infections the tick was harboring and whether a longer duration of antibiotic treatment is required.

As always, please seek out a provider that will help you get to the root cause of your illnesses. If you are one of the many that experience multiple symptoms in the “Chronic Lyme disease” list, further investigation should be sought.  

In Health,
Stephanie Grutz, ARNP, FNP-C