Basic Q&A's about Lyme

Lyme Disease and associated diseases
A plain-language introduction to tick-borne diseases
THE BASICS
Fourth Edition June 2004
written by Douglas W. Fearn


Q. What is Lyme disease?
A. Lyme disease is a bacterial infection, most commonly contracted from a tick bite, that may initially cause a flu-like sickness. Untreated, or inadequately treated, it may cause long-term, persistent illness that often affects many systems of the body. Other tick-borne diseases are often contracted at the same time.

Q. How do you get it?
A. Lyme Disease (LD) is spread primarily through the bite of a deer tick. Some researchers believe that other ticks and some biting insects such as mosquitoes, fleas, biting flies, and lice may also transmit LD. Babies may be born infected if the mother is infected, or possibly acquire it through breast milk. A blood transfusion with Lyme-infected blood may transmit the disease to the recipient. Some specialist medical researchers believe that Lyme, or other tick-borne diseases, can be sexually transmitted, although there has never been any research to confirm or deny it.

Q. How do I know if I have Lyme disease?
A. This can be a problem because the symptoms of LD are very similar to those of many common infections, and mimic some of the symptoms of other diseases. One sign that is almost unmistakable is the development of a bull’s eye rash around the site of a tick bite. If you have this rash, you have Lyme disease. The bull’s eye rash varies considerably in different people, but it is typically centered on the tick bite and may range from a fraction of an inch to many inches in diameter. It may be colored anywhere from a mild red to a deep purple. It may appear in a few days or even several weeks after the bite. It may spread to other areas of the body, or there may be additional rashes far from the primary one. The classic rash has concentric areas of lighter and darker colors, but the rash is not always in a bull’s eye form. It is usually painless, but it may be warm to the touch and may itch. Typically it is flat, but some people have raised areas or bumps in the rash. Unfortunately, not everyone develops a rash, and many people fail to notice it if it is in a hard-to-see location, such as the scalp. Fewer than half the people who develop LD recall a rash or a tick bite.
Other symptoms may appear at the same time. These often mimic a cold or flu, with fever, headache, muscle and joint pains, tingling or numbness, and/or general fatigue. Early Lyme can produce a wide range of symptoms, or no symptoms at all, and is different in each person. The varied symptoms may change rapidly, sometimes within hours. The symptoms may disappear in a few days or a week (even without treatment), or may be so minor that the infected person barely notices them. Since flu season runs during the winter months, and most LD infections occur during the other seasons, any case of “flu” in warm weather should be considered suspect.
Even if these initial symptoms subside, the bacteria can remain in your body and may harm you later. In other cases, symptoms become increasingly severe, requiring prompt medical attention. In persistent Lyme disease, symptoms are most often severe fatigue, pains that seem to have no obvious cause, and neurological and/or psychiatric problems. The disease may involve multiple body systems and organs. Symptoms may be complicated by other tick-borne co-infections acquired from the same tick bite.
You should insist on no less than six weeks of antibiotic treatment if you have a tick bite with a bull’s eye rash. If your doctor refuses, it may be prudent to search for a a doctor who will support extended treatment.

Q. Is there a test for LD?
A. According to the CDC, there is no reliable test for Lyme disease at this time. Your doctor should base his or her diagnosis on your symptoms, medical history, and your exposure to ticks. Doctors should not rely solely on tests. There are several blood tests available, but all have problems. The blood test typically used by most family doctors, called an ELISA (or Lyme titer) test, means nothing if it is negative, and it rarely indicates infection if it is performed too early (2 to 6 weeks after the tick bite).
Patients with persistent LD seldom have a positive ELISA test, possibly because they have ceased to produce the antibodies the test looks for. Most experts believe that the ELISA test is only about 30-60% accurate. The ELISA test is not based on the specific Lyme bacteria strain that is most useful for accurate diagnosis. While a positive ELISA test is a reasonably reliable indication of infection, a negative test is useless.
There are other tests that may be more accurate.
The Western blot test for Lyme disease often shows infection when an ELISA test does not. Unfortunately, the U.S. Centers for Disease Control (CDC) have set arbitrary criteria for considering a Western blot test as positive for LD. These criteria were established for statistical analysis of the spread of the disease and were not intended to guide doctors in their diagnosis and treatment. The CDC surveillance criteria are very strict and miss many people with LD. Doctors who use only the CDC guidelines to decide whether or not to treat leave many infected people without proper antibiotic treatment.
Even if the test results are not positive by CDC standards, any positive Lyme-specific “bands” are useful indicators of infection.
Another test, PCR analysis, looks for the DNA of the Lyme bacteria in blood, urine, or tissue. Multiple tests are usually required before a sample is obtained that contains the bacteria. However, in recent years PCR testing has become extremely reliable when positive. Most doctors are unaware of this test.
Medical textbooks, the FDA, and the CDC emphasize that LD is a clinical diagnosis, which means that the doctor should examine the patient for typical LD signs, listen to the patient’s history and description of his or her symptoms and use this information to make a determination.
Blood tests are usually done at the same time, but should not be relied upon. If the doctor suspects LD, and sees little reason to believe the patient has some other disease, he or she should begin antibiotic treatment without delay.
Of course, doctors should also perform general blood and other tests to rule out other diseases or conditions.

Q. Are all testing labs the same?
A. No, they are not. Some labs have made special efforts to focus on tickborne
disease testing and they use procedures that make their tests
more reliable and sensitive to LD. Use the resources in the back of this
booklet to help you identify laboratories that utilize tests that are more
sensitive to tick-borne disease organisms, and urge your doctor to send
your blood sample to one of the specialist laboratories. Test kit request
forms may be available on the laboratory’s web site.

Q. I had a bull’s eye rash and other symptoms, but my
doctor said my blood tests showed I didn’t have LD, so it
must have been something else, right?
A. Almost certainly not! This scenario has caused many people to needlessly
suffer for months or years. Left untreated, LD can be a devastating
disease. There are few conditions that mimic the LD rash. Lyme-literate
doctors suggest starting immediate antibiotic treatment, regardless
of the results of any tests.
Often a person suffering from chronic, unsuspected Lyme disease will
be diagnosed as having something else, such as chronic fatigue syndrome,
fibromyalgia, lupus, multiple sclerosis, Parkinson’s disease,
Alzheimer’s disease, ALS, Crohn’s disease, carpal tunnel syndrome,
temporomandibular joint disorder (TMJ), and a wide variety of psychological
or psychiatric disorders. Doctors often mistake tick bites for spider
bites, but spider bites are actually uncommon. In areas where LD is
prevalent, it should be seriously considered before a doctor denies
antibiotic treatment.

Q. What happens if LD is not properly treated?
A. This varies tremendously among individuals. Some people may never
have a recurrence of symptoms, while others may become permanently
disabled from LD that is untreated or inadequately treated. Serious
symptoms can appear immediately or they could take months or years
to develop. The most common symptoms are unrelenting fatigue; joint
or muscle pain (particularly in the neck, knee, back, or foot); vision or
hearing abnormalities; numbness or tingling, particularly at the extremities;
facial paralysis; heart damage; psychological disturbances; and
stomach problems. (There is an extensive checklist of symptoms in the
back of this booklet. Consider bringing this list to your doctor if you suspect
you have LD.)
Untreated LD can result in neurological disorders, crippling arthritis,
blindness, deafness, psychiatric or psychological disorders, or death.
Ehrlichiosis, a common co-infection spread by ticks, has a 5% death rate
in untreated children.

Q. What is the proper treatment for Lyme disease?
A. Antibiotic treatment is the simple answer. But the detailed answer is
unknown. If they are treated immediately after a tick bite, many patients
seem to obtain elimination of all symptoms after a course of six weeks
of an oral antibiotic like doxycycline. However, it is not known if this
treatment permanently cures the disease. If you had a tick bite and a
rash, you should be treated with antibiotics as long as symptoms persist.
If there is any recurrence of symptoms after treatment, your doctor
should put you on another course of antibiotics.
A patient who seems to be symptom-free should be vigilant in watching
for any recurrence, and so should his or her doctor.
At the other end of the spectrum, some patients find no relief at all from
a short course of antibiotics, particularly if they have co-infections. Many
long-term LD patients given the standard oral antibiotic treatment seem
to do fine for years and then suddenly they experience the same or new
symptoms. Often a stressful life event such as a jarring accident, head
injury, surgery, divorce, or a death in the family can trigger reemergence
of symptoms mimicking a new infection. Some patients obtain relief
with another course of oral antibiotics, while others require long-term
treatment with oral, intravenous (IV), or injected antibiotics. Because of
the complexity of the Lyme bacteria’s life cycle, combinations of antibiotics
may be necessary.
In addition to medication, Lyme patients need to develop a good program
of exercise and nutrition. Patients on antibiotics need to take acidophilus,
which replaces the good bacteria (killed by the treatment) that
are necessary for the body’s digestive system to function properly. Many
patients also take supplements that help boost the immune system.
Consult with your physician on all non-prescription treatments.

Q. How does my doctor know when I am cured?
A. Many doctors who treat LD patients avoid using the term “cured”
because of the possibility of a relapse in the future. However, most Lymeliterate
doctors believe that treatment of persistent infection should continue
for at least two months after all symptoms have disappeared. Both
the patient and the doctor should be prepared to resume treatment if
symptoms recur.

Q. Isn’t there a vaccine for Lyme disease?
A. There was one, but the manufacturer has taken it off the market.
Evidence indicated that people with a certain gene might develop an
autoimmune arthritic disease from the vaccine. About 30% of the population
has this gene, and taking the vaccine could result in severe arthritis.
There is no known cure for this condition. Some doctors have seen
cases where “cured” or previously undiagnosed LD is reactivated in
patients who were vaccinated. There are currently lawsuits against the
vaccine manufacturer. The vaccine offered no protection against other
tick-borne disease co-infections that frequently accompany LD.
The vaccine was only about 80% effective and it is not known how long
the partial immunity lasts.
Perhaps a safe and effective vaccine will be developed in the future, but
for now, the only way to avoid contracting Lyme disease is to avoid ticks
and the other possible sources of infection.

Q. Once you have had Lyme disease, you’re immune,
right?
A. No. You can get Lyme over and over from new tick bites. Each new
tick bite can infect you with a new case of Lyme disease or other tickborne
diseases. Some Lyme doctors believe that each subsequent infection
makes symptoms more severe and treatment more difficult.

Q. Why haven’t I heard much Lyme disease until
recently?
A. Lyme disease and its variants have been known throughout the world
for at least 100 years (often by different names). There are hundreds of
identified strains of the bacteria that causes LD, dozens of them in the
U.S. There is even evidence that prehistoric people were infected with it.
Also, in the past, patients with LD may have been undiagnosed or misdiagnosed
before doctors became more knowledgeable.
However, it does seem that Lyme disease is much more prevalent now
than it was in the past. The “reservoir” for Lyme disease is the white-footed
mouse (and other small animals in some parts of the world). The
Lyme spirochetes live in the blood of the mouse and are passed to a tick
when it feeds on an infected mouse. The white-tailed deer is a major host
for the ticks that carry LD, and the deer ensure that the ticks and their
Lyme spirochetes have a comfortable place to live and breed. Many
areas of the U.S. have had a tremendous increase in the deer population
in recent years, so there may be many more ticks in the environment.
The loss of diversity in our wildlife means that ticks are more likely to
attach to the mice that harbor the Lyme bacteria. Birds are known to
transport ticks to new areas.

Q. Why don’t doctors know more about Lyme disease?
A. Some doctors are very up-to-date on the latest research on LD, but
many are not. Many doctors are taught that LD is rare and easily-cured
and they may think that it is not a serious disease. With thousands of diseases
and conditions to learn about, Lyme doesn’t seem to rank very
high with the majority of doctors, even though it is the most common
vector-borne infectious disease in the U.S. Nevertheless, it is a major
medical problem in the U.S., resulting in billions of dollars in expenses
and lost time from work. Nearly 24,000 new cases were reported to the
CDC in 2002, and it is estimated that at least ten times that many cases
are not reported.

Q. What can be done to address these issues of poor
tests and uninformed doctors?
A. Organizations such as the International Lyme and Associated
Diseases Society (ILADS, an organization of LD health professionals),
the Lyme Disease Association, the Lyme Disease Foundation, Lyme
Disease Association of Southeastern Pennsylvania, and many others
have programs that are aimed at educating the public and doctors on the
latest information about the disease. These organizations are working on
federal legislation that would fund research into prevention, more accurate
tests, and improved treatments for Lyme disease and co-infections.

Q. What are these “co-infections” and “associated
diseases?”A. The ticks that carry the Lyme bacteria also often carry microorganisms that cause other diseases. The most common “co-infections” are
ehrlichiosis, babesiosis, bartonella, and Rocky Mountain spotted fever.
Ehrlichiosis, bartonella, mycoplasma, and Rocky Mountain spotted fever
may be cured by some of the same antibiotics that are prescribed for
Lyme disease. But babesiosis is a different type of disease, caused by a
blood parasite and not a bacterium. Antibiotics alone are not effective
against babesiosis. It’s a sobering fact that new tick-borne diseases are
being discovered every year.
Few doctors are familiar with these diseases. They may fail to recognize
the symptoms or test for these diseases, so many people are suffering
from untreated infections. The lab tests for these co-infections have
many of the same problems as LD tests. Often, it is this combination of
diseases that makes the patient so mystifyingly ill and unresponsive to
treatment.

Q. What are the symptoms of ehrlichiosis?
A. Like Lyme disease, ehrlichiosis infections peak during May, June,
and July and the symptoms typically appear from a week to a month
after infection. The initial symptoms are flu-like and can include high
fever, chills, headache, fatigue, and general achiness. Fewer than half of
infected people report a rash. The rash is different from a Lyme disease
rash; it is usually smaller and may have raised areas. The rash is more
common in children than adults. As in Lyme, children may also suffer
from swelling of the hands and feet. Other symptoms may develop later,
including nausea, diarrhea or constipation, loss of appetite, cough, stiff
neck, confusion, and weight loss. Untreated, the disease can sometimes
be fatal in a few weeks, especially in children.

Q. How is ehrlichiosis diagnosed?
A. There are blood tests for ehrlichiosis, which vary in accuracy and reliability
depending on when the test is performed. It is difficult to obtain
an accurate test result during the first few weeks after infection.

Q. How is ehrlichiosis treated?
A. Ehrlichiosis is usually treated with doxycycline. Most cases respond
quickly when diagnosed and treated promptly. Like Lyme disease, you
can get ehrlichiosis over and over again from new tick bites.

Q. What are the symptoms of babesiosis?
A. People with babesiosis sometimes have no symptoms at all. However,
it can be life-threatening for someone with a suppressed immune system.
It is also more serious for people over age 50. Symptoms are often
the same as for Lyme disease (see list in the back of this booklet), but
there may also be a very high fever of up to 104°F, and anemia. Night
sweats, chills, severe headaches, fatigue, and sleep disturbances are
common. You can get babesiosis from a blood transfusion from an
infected donor.

Q. How is babesiosis diagnosed?
A. There are blood tests, but the test reliability declines after a few
weeks of infection. These tests suffer from the same lack of sensitivity
that plagues Lyme disease testing. PCR tests for babesiosis can be useful
if positive, but a negative result does not rule out the disease.
Examining the red blood cells under a microscope may reveal the para12
sites, but few diagnostic laboratories are skilled at the tedious job of
carefully observing the blood cells.

Q. What is the treatment for babesiosis?
A. It is important to remember that babesiosis is caused by a protozoan
parasite and not by a bacterium, so antibiotics alone will not cure this
disease. Many people appear to recover without treatment, but the disease
may flare-up later. Since babesiosis is closely related to malaria,
anti-malarial drugs are used to treat it. Usually a drug like Malarone or
Mepron is used along with an antibiotic such as azithromycin; the combination
increases the effectiveness of the treatment. The anti-malarial
drugs are very powerful and patients often have a limited tolerance of
the side-effects, so treatment may have to be interrupted several times.
As with most tick-borne diseases, you do not develop any immunity after
infection and you can get babesiosis over and over.

Q. What are the symptoms of bartonella?
A. Bartonella usually starts with a rash and swollen glands. Often it is a
mild disease and the symptoms subside on their own. But in some cases,
bartonella may cause on-going fatigue, mental symptoms, headaches,
swollen glands, arthritis, generalized aches and pains similar to the
other tick-borne diseases, seizures, neurological disorders, and even
dementia. Vision loss and eye infections may occur. Symptoms tend to
come and go.
Some areas have a very high rate of bartonella organisms in ticks, sometimes
much higher than the rate of Lyme bacteria.

Q. How is bartonella diagnosed?
A. There are blood tests, but as with other tick-borne diseases, the tests
are often inaccurate. Some doctors report success with a series of PCR
tests, but tick-borne bartonella has not been recognized long enough to
have other reliable diagnostic testing procedures. Few doctors are familiar
with tick-borne bartonella. The tick-borne disease is a variant of the
bacteria that causes “cat scratch disease,” which typically is far less serious.

Q. What is the treatment for bartonella?
A. Antibiotics are used to treat bartonella. As with the other tick-borne
diseases, treatment time can be lengthy. Since this disease has been recognized
only recently, doctors are still learning which drugs are best.
Some doctors report that Ciprofloxacin may be effective.

Q. What are the symptoms of Rocky Mountain spotted
fever?
A. Despite its name, Rocky Mountain spotted fever is far more prevalent
in the South and East than it is in the Rocky Mountains. Like Lyme disease,
it is caused by a bacterium. Untreated, it can sometimes be a fatal
disease. It is spread by dog ticks as well as the deer tick. After two to
fourteen days, most infected people suffer from a fever (sometimes
102°F or higher), headache, and achiness. Most people will develop a
rash which may begin around the wrists and ankles, but it sometimes
starts on the trunk. A classic symptom is a rash on the palms and soles
of the feet, but fewer than half of the patients will have that. Untreated,
half of the people infected with Rocky Mountain spotted fever will develop
permanent neurological problems.
If you handle a tick while removing it, be sure to wash your hands thoroughly
to minimize your risk of infection with RMSF. There are reports
of infection simply from contact with an infected tick.

Q. How is Rocky Mountain spotted fever diagnosed?
A. Like Lyme disease, RMSF is a clinical diagnosis, which means that it
is up to your doctor to evaluate your signs and symptoms to determine
if you have the disease. Early blood tests are not accurate.

Q. How is Rocky Mountain spotted fever treated?
A. Doxycycline is the recommended antibiotic for RMSF.

Q. Can children get Lyme disease and these other tickborne
diseases?
A. Yes, and because they spend more time outdoors and may not know
what areas to avoid, they are at greater risk than adults. Their symptoms
may be very different from an adult case of LD.
Children infected with LD often initially have a flu-like illness during the
summer months and may sleep for a day or more. They often complain
that light hurts their eyes. Few children develop the bull’s eye rash.
Stomach problems are common in children with LD.
With long-term LD, they tire easily and often do not want to participate
in physical activity. Most devastating are the cognitive problems LD may
bring. Infected children may suddenly develop learning disabilities
and/or behavior problems. Many researchers find that LD is the cause
of some instances of Attention Deficit Hyperactivity Disorder (ADHD).
Some children become physically impaired or even disabled. Teenagers
in particular may suddenly exhibit psychological problems. Many children
of all ages struggle in school.

Q. How are children treated for Lyme disease?
A. Antibiotics are used to treat LD in children, but the drugs used may
be different from those used to treat adults. Unfortunately, not many
doctors are experienced in diagnosing and treating LD in children.

Q. What about pregnant and nursing mothers?
A. A woman with Lyme or other tick-borne diseases can transmit the
infection to her baby before or after birth. The DNA of Lyme bacteria
can be found in breast milk and it may be possible for the baby to be
infected from nursing. Unfortunately, many antibiotics are unsafe for
pregnant or nursing mothers, so a doctor’s choice of treatment is limited.
Expectant mothers need to be extremely careful to avoid becoming
infected with tick-borne diseases. Early and aggressive antibiotic treatment
of the mother during pregnancy appears to be effective in preventing
infection of the newborn.

Q. How do I prevent Lyme disease?
A. The simple answer is to avoid being bitten by a tick. This isn’t a very
practical answer for many people who enjoy working and playing outdoors,
and some occupations expose workers to ticks every day. Many
Lyme sufferers were bitten in their own yard. But there are some things
you can do to reduce your risk.
Ticks are most plentiful in areas where woodlands transition into fields,
meadows, or yards. Ticks are often found in tall grass, gardens, or mulch
beds. Deer paths through the woods are often loaded with ticks. Leaf litter,
wood piles, and rock walls are also areas of high tick concentration.
Where mice are present, ticks are usually abundant.
When you are in such areas, you need to be particularly vigilant to prevent
a tick from attaching to your body. There are various insect repellents
such as permethrin spray, that may help. Insect repellents containing
DEET are also effective. (On children, for safety, avoid products that
contain more than 30% DEET.) Light-colored clothing makes it easier to
spot ticks. Wearing long pants, long-sleeved shirts, and a hat are helpful.
Tuck pant legs into socks to make it more difficult for ticks to crawl up
your legs. Walk in the center of trails. After any time spent outdoors,
check for ticks while you are out and as soon as you get back. Showering
is also helpful. Remember that some of the ticks are extremely small and
are almost impossible to see. Putting your clothing in a clothes dryer at
high heat will kill ticks in about an hour.
There are products that can be used outdoors to kill ticks. For example,
Damminix™ consists of cotton balls soaked in permethrin insecticide
inside cardboard tubes that you place around your property where you
expect field mice may live (wood piles, stone walls, etc.). The cotton will
be used by mice building their nests. The permethrin in the cotton kills
the ticks on the mice with minimal danger to people, pets, or wildlife.
Some communities are experimenting with deer feeders that apply
insecticide to the deer as they eat. Tick traps are also commercially
available. Some lawn care companies can spray your yard with a version
of permethrin.
Even if you rarely go outside, you can still be infected if your pets bring
ticks into the house. Veterinarians recommend a product like
Preventic™ collars, Frontline™, and Top Spot™ to minimize the risk.
(Use of chemicals is a personal decision and we do not make product
recommendations.)
Some researchers think that Lyme can be spread by other biting insects
like mosquitoes, horseflies, deerflies, fleas, and lice. Although human
infection has not yet been proven, these insects have been shown to
carry the Lyme bacteria.

Q. What should I do if I am bitten by a tick?
A. The tick should be removed promptly by pulling it slowly straight out
with fine-pointed tweezers or a special tick-removal tool inserted as close
to the skin as possible. Do not apply heat, alcohol, petroleum jelly, or
any other substance. (Aggravating the tick in this way may cause it to
regurgitate into your blood, increasing your chances for infection.) Do
not squeeze the tick with your fingers either, as this can force Lyme bacteria
into your body. You can use antiseptic on the site of the tick bite
after the tick is removed.
Some experts believe that you can be infected almost immediately after
the tick attaches to your skin, while others think it takes 24 hours or
more to be infected.

Q. What should I do after removing a tick?
A. Call your doctor. Some doctors will prescribe several weeks of an
antibiotic such as doxycycline as a preventive measure. If you develop
symptoms after a tick bite, see your doctor and be sure to get adequately
treated for LD and any co-infections you may have contracted.
You can save the tick in a plastic bag or small bottle and show it to your
doctor so he can see what bit you. Ticks can be tested for a price, but
treatment should not be delayed while waiting for results. A false-negative
result could affect your doctor’s decision to treat you.

Q. I think I have Lyme disease. How can I help my doctor
in the diagnosis and treatment?
A. First, keep careful track of your symptoms. Use the list in this booklet
to check them off and take the list to your doctor. It’s easy to forget
to mention something important during an office visit. Make a copy of
your list to leave with your doctor. Even if a symptom seems minor, you
need to tell the doctor. He needs all the information to make a diagnosis.
If your doctor seems skeptical of LD, you might want to bring some
printed literature that may help him or her. Make sure that what you
bring is from a credible source (such as a recognized medical journal),
and present it tactfully. The Resource section in the back of this booklet
will guide you to appropriate information.
Some doctors respond positively to patient input, but many do not. If
you are not satisfied with the way you are being treated by your doctor,
it may be time to find one better qualified to help you. Most patients with
persistent LD have been to several doctors before getting a proper diagnosis
and treatment.
Lyme Disease, perhaps more than most conditions, requires the active
participation of the patient if good health is to be regained. Your efforts
to educate yourself about LD will be well worth the time spent, and your
doctor may learn as well.

Q. How do I find a good doctor for Lyme Disease
diagnosis and treatment?
A. Ask at your local Lyme disease support group’s meeting, or ask a LD
patient who seems to be well-informed. Doctors who treat LD generally
prefer to maintain a low profile, since there is controversy surrounding
this disease. The Lyme Disease Association maintains a nationwide doctor
referral list, available at www.LymeDiseaseAssociation.org or call 1-
888-366-6611.

Q. Why is there so much controversy regarding Lyme
Disease?
A. That’s one question that seems not to have a logical answer. There is
a huge difference of opinion between some academic doctors and the
doctors who actually treat Lyme patients. Some influential academic
doctors have taken a position that LD is hard to catch and easily cured
with a few days or weeks of oral antibiotics. They have advocated this
position for a long time and they may be ignoring new research. The evidence
is overwhelming that LD is a serious and potentially debilitating
illness that can become a persistent, life-long disease. The cost of proper
early treatment is far less than the expense that most LD-sufferers
incur in their quest for relief.