I am concerned about lists of symptoms listed by ILADS and others associated with chronic Lyme disease. My sense is that these lists are misleading. Lyme doctors are already practicing outside the box of mainstream medicine. I fear that all inclusive lists of possible symptoms diminish the credibility of practitioners of this new paradigm. It provides an opening for critics who will say: those doctors think everyone has Lyme disease. If we look at the symptom list, it includes a huge percentage of patients who are treated in a primary care office, most of whom do not have Lyme disease. The Lyme symptoms listed with the ILADS guidelines include: fatigue, low grade fevers, night sweats, sore throat, swollen glands, stiff neck, migrating joint pains, stiffness, arthritis, muscle pain, chest pain and palpitations, abdominal pain, nausea, diarrhea, sleep disturbance, poor concentration and memory loss, irritability and mood swings, depression, back pain, blurred vision and eye pain, jaw pain, testicular and pelvic pain, tinnitus (ringing in the ears), vertigo, cranial nerve disturbance, headache, hotheadedness and dizziness. There are many causes for most of these symptoms. When doctors evaluate a patient they first ask for a chief complaint. If a patient has a sore throat and swollen glands one first thinks about viral pharyngitis or Strep infection. Doctors in training frequently hear the expression: When you hear hoof beats in Central Park (New York) you think of horses not zebras. When a physician suggest an unusual diagnosis based upon a common complaint he is said to be looking for zebras. I do not deny that these symptoms and many others may be seen in chronic Lyme patients, but such a list is misleading. Chronic Lyme is a multi-system disorder that presents in a predictable way with a clear cut pattern. Of course there are exceptions to every rule, but zebras should only be considered when other diagnoses have been excluded. As has been said regard to science: When all the likely explanations have been excluded that that which remains, no matter how unlikely must be the explanation. Chronic Lyme patients have: fatigue, cognitive changes, numbness and tingling and muscle, joint, tendon or ligament pain. This constellation of symptoms is reliable in my experience. Patients with a chief complaint of a primary Lyme syptom such as joint pain or numbness and tingling should have Lyme diseased moved up on the list of possible diagnoses.Many other symptoms may exist, but they should be in addition to the basic symptom complex. If the only complaint is depression or back pain for example, both listed by ILADS as Lyme symptoms, Lyme disease should not be considered except as a zebra.
ILADS states that these symptoms may present without objective markers. Based on my experience this is not true. I believe that an expanded list of objective markers shows some abnormalities virtually in 100% of cases. In fact, a complete absence of objective markers would lead me to doubt the diagnosis of Lyme disease.