Understanding Lyme Disease

Tick image via shutterstock

According to the CDC, almost 4,000 people were diagnosed with Lyme disease in Massachusetts alone last year; more than any other state. And Lyme disease is not simple to diagnose — it is often accompanied by other co-infections and chronic disease symptoms which make treatments almost impossible. After almost thirty years of studying the effects and complications of Lyme disease, Dr. Richard Horowitz lays out in his new book, Why Can’t I Get Better? Solving The Mystery of Lyme and Chronic Disease, his new 16 point differential diagnostic map for recognizing and successfully treating the often misdiagnosed disease.

Dr. Horowitz is has a degree in internal medicine, which means that he has studied all medical subspecialties. “Its kind of like being a family doctor but I’m trained in all of the specialties; cardiology, gastroenterology, infectious diseases, everything,” he says.

Lyme disease generally presents with a bulls-eye rash, according to the CDC’s diagnosis, and is caused by tick bites. Horowitz, who founded the Hudson Valley Healing Arts Center where he treats patients affected by tick-borne diseases, says in his book that the transmitting ticks are central to the diagnosis problem of Lyme disease. “Over the past 30 or 40 years, humans have moved more and more into wooded areas, so we’re more exposed to ticks,” he says. “And every tick lays 2,000 to 3,000 eggs.” With the increased exposure to ticks, comes increased exposure to infections carried by ticks, including, but not limited to, Lyme disease.

“Some of my patients are not just ill from Lyme disease but also from other infections they got from the ticks,” Horowitz says. “Over 50 percent of them have Babesia, which is like malaria. After a while, I started to notice that more and more patients had cat scratch fever as well, or Rocky Mountain Spotted Fever in addition to Lyme disease.” These co-infections that present alongside Lyme disease need to be diagnosed and addressed simultaneously in order to make a patient feel better permanently, he says.

Lyme disease, also known as “the great imitator,” can also go unnoticed by other doctors because it presents with symptoms that are characteristic of other chronic diseases. “Lyme disease will imitate most chronic diseases,” Horowitz says, “like chronic fatigue syndrome, fibromyalgia, and autoimmune diseases. People generally come to me after seeing 10 to 20 doctors, still searching for answers.”

Where other doctors try to find a single disease to cover each individual symptom, Horowitz looks at the whole picture as a Lyme disease puzzle. “That’s the problem with medicine these days,” he says. “Doctors tend to look for one cause for one disease. And that may have worked in the 1800s, but now it’s like a patient complaining about 16 nails in the bottom of their foot and the doctor only pulling out one. The patient will inevitable come back with continued pain.”

Horowitz, as an internist, thinks of himself as a “medical detective” when it comes to diagnosing Lyme disease. In the first chapter of his book, he outlines an interaction between himself and fictional patient Mrs. Q whose symptoms he explores in detail one by one. Ultimately, after a hefty 15 pages of questions and simple medical explanations, Horowitz comes to the conclusion that Mrs. Q is suffering from Lyme disease, babesiosis, POTS with autonomic nervous system dysfunction, reactive hypoglycemia, with metabolic syndrome, and possible adrenal dysfunction, a Lyme-induced costochondritis and fibromyalgia, and a possible B12 deficiency. And this is a “typical conversation” with a Lyme disease patient.

Returning to his nails in the foot analogy, Horowtiz says, “You have to look for all of these 16 reasons at once. Some patients are just given one antibiotic when they need several. You need to get the patient to sleep, help with their memory problems and fatigue, understand the biology of their specific form of Lyme disease and address co-infections. And this all needs to be done simultaneously.”

While Lyme disease is Horowitz’s focus, his 16 point differential diagnostic map—including markers like immune dysfunction, allergies, and sleep disorders to name a few—can also be applied to other chronic diseases. “We’ve seen a major rise in the numbers for Alzheimer’s, and autism, and many other chronic diseases” he says. “The 16 point map can be applied to all of these and I hope to get funding in the future to do proper studies about this.”