The most useful diagnostic reference: the “Bible” of Lyme medical literature.
The When To Suspect Lyme Disease essay:
This essay, written by John D. Bleiweiss, M.D., in April, 1994 is very long, but also very comprehensive and helpful. Any doctor checking for Lyme disease would do well to read this essay first; any potential patient should read this carefully in order to know how to discuss symptoms with his/her physician and should leave a copy for the doctor’s reference. (Do not be concerned—it may be read only by the office staff but they are the ones who often guide their physicians to much needed resources.)
As presented by LIFELYME,
When to Suspect Lyme
TTraditionally, the public has been advised to suspect Lyme (LD) if a round or oval, expanding, red rash develops 3-32 days after a deer tick bite associated with or followed by a flu-like illness. This limited description will apply to only some cases. About 50% of patients do not recall one or more of tick bite, rash or flu-like illness. The rashes associated with LD can assume a variety of morphologies including vesicular, urticarial, eczematoid or atrophic (Acrodermatitis Chronicum Atrophicans). For many patients, neurologic, cardiac, arthritic, cognitive and/or psychological complications predominate. While deer ticks and LD have a well known affiliation, other potential vectors can carry the spirochete that causes LD (Borrelia burgdorferi; Bb). These include, the lone star tick, fleas, the biting flies (e.g. green-headed fly) (and mosquitoes?). A case of suspected transmission via blood transfusion has been reported by Dr. Burrascano.
Many express morbid fears of occult illness, impending death and can be generally pessimistic or maudlin. Some develop intricate paranoid theories regarding imagined conspiracies against them. Lyme patients often evince a tendency for being overly sentimental. Hyperbolic thought finds expression in obstinacy, self-righteousness, being contentious, speaking in categoricals, and inappropriate and atypical vulgarity. Internalized anxiety results in the perception of being hurried even without a deadline or the inability to remain calm when there is no reason for not feeling calm. Panic attacks are the extreme of this anxious state and should arouse a suspicion of LD. I suspect that in addition to CNS infection of the limbic system, these phenomenon could also be the result of elevated adrenaline levels, Mg++ deficiency or hypoglycemia. A rare LD patient will admit to agoraphobia or claustrophobia.
An expanding cohort of patients in my practice appear to have long-standing LD that dates to their "growth spurt" years and their past medical history contains the previous development of Osgood-Schlatter's Syndrome (water on the knee) in their teens. A relationship to LD can't be excluded.