First of all, it should be clear, that my post yesterday, like many other posts, was prompted by a visit from a patient who had misconstrued published symptom lists. This patient clearly did not have Lyme disease.
The vast majority of patients who think they have chronic Lyme disease turn out to be correct in their assessments.
I would like to clarify yesterday's post. The TYPICAL patient I see complains of: fatigue, usually severe, pains which come and go of muscles, joints, tendons or ligaments, sensations of numbness and tingling and cognitive dysfunction. I believe that Dr. B's guidelines do a fabulous job covering the most common neuro-cognitive complaints typically seen in chronic Lyme patients. A history of tick bite and rash is important, but not as common as one might think. Established Lyme disease is a multi-system disease. Patients have a plethora of symptoms involving nearly every organ system. The take home point is that Lyme related symptoms occur within a cluster. Patients lacking the core symptoms described above are unlikely to be suffering with clinically significant Lyme disease, based on my clinical experience. The patient that prompted the post had: no fatigue, no cognitive dysfunction and no neurological dysfunction. He had knee pain after running, as well as various short lived symptoms which he found trolling the internet. Chronic Lyme patients are quite ill and have a multi-system illness. Admittedly, may chronic Lyme patients look quite healthy at first blush, but they are in fact quite ill- and this should not be trivialized. Although I think that over diagnosis of Lyme disease is rare, at least in my practice, the potential for this exists. It is clear that the IDSA believes that Lyme disease is grossly over diagnosed by LLMDS; sometimes I write with the specific intent of taking bullets out of their guns.
Neurological symptoms associated with Lyme disease are all over the map. They do include tremors, fasciculations, weakness, myoclonus, Parkinsonian features, MS features, ALS features, vertigo, dizziness, alterations in hearing- vision- sense of smell or taste, neurologically mediated stiffness, sleep disorders including sleep apnea, loss of balance, all manner of speech disturbances and psychiatric disorders as listed elsewhere, stiff neck of the meningitis variety, neurologically mediated changes in bowel and bladder function, pinched nerve syndromes, neurologically mediated pain syndromes of all sorts, trouble swallowing mediated by changes in the brain, stroke like symptoms, a wide variety of neuropathic symptoms not listed here, changes in heat and cold perception, HEADACHES, exacerbations of preexisting migraine or tension headache, ADD syndromes, personality changes, neuromuscular syndromes causing muscle atrophy and weakness--AND these are just a few of the symptoms that come to mind as I sit at my desk on my lunch break. My point is that any one symptoms can be taken out of context. There is a gestalt in diagnosing Lyme disease. Patients have multiple and varied symptoms which come together a whole.
Perhaps sometimes I write Blogs to encourage my readers to think- and to some extent, I am sharing my thoughts, as I think out loud. I hope that readers will understand my comment in this light.
Neck pain is extremely common in Lyme patients. AND it does suggest co-infection with Babesia. I have a general medical practice. One half the patients I see do not have Lyme disease. The vast majority of patients who complain of neck pain as their chief complaint do not have Lyme disease. Please understand this distinction.
If all horses are brown and you are brown it doesn't make you a horse.
This sound silly, but I think it was this sort of logic that brought the above described patients to my office for a consultation.