In this 10‑minute YouTube presentation, Dr. Aaron Hartman highlights Lyme disease as a major blind spot in modern medicine. He begins by noting that acute Lyme cases outnumber new breast‑cancer diagnoses in the United States, yet the condition receives little public or clinical attention. The talk contrasts the infectious disease community’s split stance—IDSA dismisses chronic Lyme while ILADS affirms its existence—and explains why the spirochete Borrelia burgdorferi behaves like a “great imitator,” adopting multiple forms (cystic, intracellular, extracellular) that allow it to evade immunity and mimic a wide array of disorders such as chronic fatigue, fibromyalgia, brain fog, dementia, neuropathy, and dysautonomia. Dr. Hartman shares several patient anecdotes (e.g., a veterinarian with drop‑foot that resolved with doxycycline, a hypermobile Ehlers‑Danlos patient with stress‑triggered flares, a Parkinson’s‑diagnosed patient whose Lyme serology later turned positive) to illustrate the diagnostic challenges. He critiques the standard two‑step serology (ELISA screening followed by Western blot), citing CDC data that 50 % of true cases have a negative initial screen, and points out that antibody‑based tests fail when immune pathways are compromised. Consequently, he advocates for advanced, often uninsured, laboratory testing. The presentation also covers common co‑infections (Babesia, Bartonella) that add hormonal disturbances, POTS, and pain syndromes, and stresses the need for a high index of suspicion because the tick bite may be unnoticed, the rash absent, and the infection can remain dormant for years before reactivating under immune stress. Finally, Dr. Hartman discusses systemic barriers—lack of physician training, insurance coverage gaps, and global spread of diverse Borrelia strains—that keep chronic Lyme under‑diagnosed, and invites viewers to submit questions for future short podcasts.
Chapters
So I've been asked to talk about something that is happening more and more often that you are hearing about in the media, more often you're hearing about in social media, more in groups. And it's Lyme disease or tick borne illnesses. So I want to talk about this briefly because it's a big blind spot in our healthcare system. It's a big blind spot in doctors and how we look at healthcare. And it's super common and it shows up not the way you think. So first, let's talk about Lyme infections from a national standpoint. According to the cdc, there are more cases of acute Lyme every year in the country than there are cases of new breast cancer. What that means is acute Lyme a new case. New case, not old case, not chronic Lyme disease, not recurrent, but just acute, is more common, is occurring at a higher rate than breast cancer. So you think something that's that common would be commonly talked about. And the answer is no. Our head care system is set up to look at acute infections. Acute Lyme, acute, rocky, mounted, you know, acute, whatever. But the chronic, insidious, chronic infections that you see with reactivation Epstein Barr virus or chronic mono or CMV or people who get recurrent C diff or whatever the chronic infection is, we're using Lyme as the example because this is a big, big deal. We're not set up for those chronic infections because they're more complex, they're more complicated, and they're harder to track. And so what's happened with the infectious disease society of America? They have taken a stance against managing chronic Lyme disease that ilads, the International Lyme and associated Disease society has taken that, hey, chronic Lyme is a thing. Recurrent Lyme. So what do I even mean by this? And what are these illnesses? You have to realize that Lyme disease is a spirochete Borrel burgdorferi. And if you think about spirochetes, the great imitator back in the 1700s was syphilis. It could look like anything. You'd have the little chancoid, little lesion, it goes away, you get heart issues. 20 years later you get, you go psychotic, you become crazy. From neurosyphilis, really common in Europe, but it was a mystery on this. It could look like almost anything. In many ways, Lyme disease is like that. You wonder why. Well, Lyme is a spirochete, just like syphilis. And one of the things that's interesting about spirochetes is they can take different Forms, they can have an acellular form, a cystic form, a four form where they basically kind of hide from your immune system and aren't active or they're active or they change the form from inside cells versus outside. So it's really kind of interesting how the infection of Borrelia lyme, Borrelia burgdorferi works. And that's one of the reasons why it looks like so many different things. It can look like chronic fatigue or fibromyalgia. It can look like brain fog. It's really interesting. There's one study looking at people who died from Alzheimer's disease and 80% of the Alzheimer's patients had spirochetes in the brain biopsies. So then all of a sudden you have to wonder is chronic, are chronic spirochetal Lyme type infections players in patients with dementia? I've had patients come to me, actually several veterinarians that I see. One of them actually came in and had a neuropathy. I actually came with a drop foot, had an MRI from orthopedic surgeon and it looked like she needs surgery for her back. She came and saw me and because of her story, I wasn't 100% sure because you can get Bell's palsy and other facial paralysis from Lyme. So I checked it and she actually had rabid Lyme disease and her drop foot went away with doxycycline for two, three months. So that's the problem with chronic Lyme or recurrent Lyme. It's going to look like single nerve thing. It can look more diffuse like dementia, it can look like chronic fatigue and fibro, which appears unrelated. And because chronic Lyme diseases typically the majority have other things with them, like Babesia, like Bartonella. You can also have weird hormonal like things, hot flashes, cold flashes, you have brain fog. With Bartonella you tend to see more pots, more dysautonomia, more pain, pain, nerve pain syndrome. So all of a sudden now chronic lime and the company keeps can be a mystery illness that can be sometimes hard to nail down. And what makes this even more difficult, what makes this more difficult than fact? It can be a great imitator. What makes it more difficult that it's a blind spot in our current healthcare system with the big, you know, Infectious Disease Society of America doesn't acknowledge this, is that our current testing is poor. Currently the standard of care is to do a Lyme antibody test for the antibodies for Lyme before you do a western blot or some more advanced test. According to the CDC, 50% of people that are later found to have Lyme disease have a negative initial screening test, which means the test is useless, but it's still the standard of care. And then you go to the western blot testing, which some of you may be more familiar with. Western blot. With hiv, you do an antibody test. If it's positive, the first test, the second test to make sure it's really positive is a western blot. That's typically how we make the diagnosis. But the issue is there can be a lot of cross reactivity and because of the immune, because of the western blot requires an intact immune system, requires your body to recognize Lyme, to have your T cells, to have antigen presenting cells eat up, eat it up, then present it to B cells to then make antibodies. If there's any dysfunction in that, that handoff that has multiple steps, multiple layers, all of a sudden antibody testing will be negative. And that's one of the big flaws, one of the big blind spots and how we currently are diagnosing it with, with our current labs. And so you need better advanced lab testing, which unfortunately is not covered by insurance. So you can see how this, this chronic line becomes a big blind spot being recognized. Lab testing. So what, what else do you need to think about issues with Lyme and chronic Lyme? Well, one of the concepts to think about is that like many other infections, whether it's Epstein Barr or HSV for cold herpes, cold sores, or chickenpox, varicella, zoster, the borrelia, these, some of these tick borne illnesses, the actual parasites I call them, that they can actually become dormant, then pop their head back up and go back down and pop their head back up. So what can happen is you can have a tick bite. And again, you know something, I think 60 old numbers, this, this is a number I read about five years ago. Something like 60% of people will have a, the bullseye rash, the typical erythema, migraines, which means 40% of the rash. And most people, half of people never remember tick bite. So, so if you don't catch that, all of a sudden it kind of goes in your system and it can lay dormant for years and years and years and years and just kind of smolder. You might not have any idea that you've got this thing smoldering there and so it pops up when your immune system gets suppressed. I had one patient who actually happened to be a hypermobile Ehlers Danlos patient. She was in a very stressful relationship and Every time her and her, her spouse would have massive, massive blow ups which happened every, every year or two, she, she would have these massive flares of alarm disease. And you come in seeing the round bullseye rashes. And the strange thing is this would happen. I've seen other patients present with their first case of Lyme disease in the middle of winter. I had one patient, actually Parkinson's patient, who initially her whole story started with mold causing her neurological issues. And then one day she got shingles because her immune system was suppressed. And it was obviously shingles, developed a tremor, got the diagnosis of Parkinson's. So that's kind of weird. You got, you know, mold issues and then infection and then Parkinson's. Come to find out, I've been checking lime tires on her forever and she didn't go out a lot. So she wasn't camping or anything like that. In the middle of one winter, all of a sudden the Lyme tower became positive and it'd been there for years. And that's what makes diagnosing Lyme super tricky. You have to have a pretty high, what's called an index of suspicion. What that means is the person sounds like they have Lyme, smells like it's Lyme, and you have to always keep on looking for it. And sometimes you do empirical, you have to do empirical treatments. The reason I want to talk about this is it's becoming discussion of Lyme and the complexities of it. We've been talking about a lot on our blogs, our social media, YouTube channel, et cetera. But I wanted to talk about again because it's coming back to public consciousness through different social media, well known people popping up with Lyme, how that happened. I wanted people to understand the context of. It's actually really, really easy to miss this if you're not trained in it, if you're not looking for it. And the reality is, is I was not trained in this in medical school in central Virginia. I did not learn about it in my residency program in central Virginia. And so I want to talk about the next, next little short thing. One of the, one of the sticking factors. Why is this so hard? Find good physicians to take care of Lyme disease. And part of it's the system itself. So hopefully this information is helpful. I want to keep on doing these, a couple, few more of these little small 10 minute snippets on the podcast about something that's popping up more common and something you need to keep on your. Especially if you've ever. Well, the reality is it's kind of sort of everywhere, even having massive amounts of increased incidents of Lyme actually in China and Russia as well. So this is kind of not just here in the United States, it's throughout Europe as well. And they have different strains over there which make even more difficult. So. But I digress. Anyway, keep on talking about this. Let me know if this interests you. If you have questions, put them in the wherever you're watching this below, ask us on social media because we love answering patients questions. Otherwise, take care. We'll talk to you soon.
