Dr. Aaron Hartman, a Virginia primary care physician, explains why doctors miss Lyme disease: specialists dismiss it as nonexistent in their region, CDC guidelines recommend only two weeks of antibiotics, and standard Western blot tests fail in immunosuppressed patients. About 25% of dogs in Chesterfield County test positive. Advanced tests like PCR and nanotrap urine analysis catch cases standard labs miss.
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Have you ever had a specialist tell you something doesn't exist that you know exists? That happened to me back in 2007, 2008 when I came back to Virginia. I've been in the military for four years and a patient came in the office, had some weird symptoms. I did a Lyme test on them and they had western blot positive Lyme disease. At that point time, I had no personal experience in treating Lyme disease. I'm not an infectious disease doctor. And so I did the natural thing. I reached out to my local infectious disease specialist. I was in the hospital at that point in time, still working in the hospital, and so said, hey, would you mind taking care of this Lyme patient for me? And they, it was really interesting what they said to me. They said, one, there is no Lyme disease in central Virginia and two, we don't take consults for it. And it was one of the striking things, like one of my early on my career aha moments like, wow, you don't take consults for something that doesn't exist. But this patient is literally sitting right in front of me in my office with multiple complaints and issues and the test is positive. And I realized that just to kind of take on this journey on my own. But that's part of the issue with Lyme disease, chronic Lyme, even acute Lyme, because this patient had more acute than chronic Lyme. Is that the infectious disease doctors usually focus on acute illness, acute infections, usually antibiotic resistant stuff, usually people with Mac, which is a weird lung infection or bronchiectasis, this weird infections in the lungs or flushing bacteria or whatever. But if you have chronic manu or recurrent Epstein Barr virus or you know, a tick bone illness like Babesia Bartonella or Lyme borrelia, don't expect an infectious disease doctor to be excited to see you because these patients are complicated and, and the system's kind of set up for them not to be looked at because they're not quote unquote acute, acutely ill, even though they have kind of chronic illness and chronic issues for years. And so what that requires is the practicing physicians, which is what I am currently still and where I was starting my career out back then, it's up to us to kind of deep dive and figure out what's going on. So with this patient, what I did is I took a deep dive and used uptodate, which is our big evidence based portfolio thing we have that have access to. I did some research on it and you know, 10 years later that led to Me studying through I lads and then all of a sudden, you know, think we're 18 years into it. I've kind of become, I like the word use word expert because that implies that I know everything. But I've become very facial in managing chronic Lyme patients. And we actually have a, have some people in our practice that they actually specialize that in as well. But the point is that it's hard to diagnose something when the specialist in the system itself chooses to ignore it because of whatever reason. And that's one of the reasons why it's hard when people get Lyme to get good treatment. So for example, the current standard of care says if you get Lyme disease, two weeks of antibiotics is all you need to treat it. Yet in iads, they say for acute Lyme, need three months of antibiotics for prevention. Get a tick bite and you pull the tick off with it and pull the tick off six or seven hours later. The current thinking is, oh, well, it's only been six or seven hours, it's less than 24, don't worry about it. If it's more than 24 hours, you take, you know, doxycycline 200 or 400 milligrams once. But according to the research, according to Ilads, you can actually get a line from a tick bite within several hours and you need an antibiotic for 10 to 14 days. Not just, you know, a one time thing. So you can see all of a sudden how the under recognization, under recognition, recognizing under treating tick bites in Lyme can lead to tons and tons of people having this kind of infection. So if you think you might have it, the first thing to do is, you know, we have some, you know, the Horwitz system questionnaire, which we actually interviewed Dr. Horowitz about this in the last year. It's available on his website, on our website as well. You can take that questionnaire if you have a high symptom score. It's actually his, his score has been validated in clinical trials, which means if you have a score above a certain number, you have a high likelihood of having Lyme disease. So I recommend people doing that. But if you have multiple systems, multiple symptoms, you just don't feel right, chronic fatigue, fibro, brain fog, and you've ever lived in any place that has ticks, which you know, becomes like the coasts, whether it's west coast, northeast, northeast, sorry, northwest, which is where the most population in the United States is. If you ever travel there and camp there, then that's probably the majority of Americans, there's a. There's a. You have a chance you might have been exposed to this. Now, to put things in perspective, in Chesterfield county, where my practice is, and Outside of Richmond, Virginia, 25% of dogs test positive for Lyme disease. And so you have to think about, you know, the owners who take dogs to get looked at usually are indoor dogs, right? Not farm animals, farm dogs, things like that. If 25% of them have Lyme disease, the question is, have you ever had a tick on your body and wondered where did it come from? Your dog can bring in the house, your cat can bring the house. So all of a sudden now, do 25% of people in Chesterfield, in this area where I live, have a. Are they exposed to animals or ticks that have Lyme? The answer is, yeah, they are. So all of a sudden just realizing this is kind of ubiquitous, which is a fancy word of saying, it's kind of sort of everywhere and looking for it. And when someone comes in, the symptoms, then ordering the right test. Now, it depends on your index of suspicion. I usually go right straight to a western blot test. This is where it gets. This is where it gets kind of tricky because according to the cdc, you have to have five bands of igm, which I know this is a little complicated, or two, three of IGM to be positive. The problem with that is, what if the immune system is suppressed? Chronic Lyme disease? Actually, one of the things you can do is you can see your IGM go down. It's an immunoglobulin. It's part of your immune system go down, and you can see a white cell count go down. So all of a sudden, if your immune system is not responding appropriately, that testing is not going to be as accurate. And so you might need to go to a more advanced test. The other thing is, like, the way the test actually works, it look that fluorescence, which is how bright the bands shine up when they dye them and shine a special light on them. If it doesn't shine bright enough, it's not said to be positive. And the typical labs, LabCorp and Quest, don't say, like, is it mildly bright? Is it barely bright? Is it indeterminate, or is it positive? 1, 2, 3. There are places like Igenics who actually do that and tell you that can be helpful in the diagnosis, but that not having that additional information all of a sudden makes the test testing, the standard testing, less accurate and the specialty testing more accurate. But if your immune system's not working, then there's other things you can do like pcr, you can do fish testing that there are different kinds of ways of looking at either bits and pieces of there's even a nanotrap test which looks for the PCR looks for bits and pieces of the Lyme in your urine. There's different ways of looking for this in your system. But the reality is just relying on a standard test, I mean having it being negative is not how you're going to catch chronically ill people who have immune suppression, immune symptom issues. So if you think you might have Lyme disease first I'd recommend reading some of the information we have on our website taking the Horowitz System Questionnaire, which is the the validated symptom questionnaire. And if you score high on that, getting with a practitioner who's open to learning with you or a Lyme leader practitioner who's who's familiar with the more accurate testing. But the reality this thing's kind of sort of everywhere. It's more common than breast cancer and it's overlooked commonly and it's a big blind spot our current healthcare system. And if you're having chronic health issues, autoimmune problems, chronic fatigue, long Covid, even mold issues, it's interesting how many of my patients with mold related illness, they get reactivation of Epstein Barr, reactivation of lime from the mold. So these things tend to go together. So looking for all these can be really super important. Hope this information is helpful. If it is, you have other questions you'd like to ask as other topics you'd like us to dive into, please let us know below. Otherwise, take care and we'll talk to you soon.
