Lyme disease Frequently Asked Questions
For Lyme Disease Awareness month, our office manager, Evan Wallace sat down with Dr. Stram to ask popular questions about Lyme disease. Please watch the full video interview or read the transcription of that interview here:
Question: What exactly is Lyme disease and why is it so often misunderstood?
Answer- Dr. Stram: First, Lyme disease is a tick-borne illness- a vector borne illness caused by a microbe- typically a bacterial parasite. However, its actually more complex than that. Because its transmitted by ticks, there can also be other infections present within the tick that cause disease (co-infections). These can range from other bacteria to parasites, to viruses, which makes Lyme disease more complicated than people often realize.
Q: What are some early warning signs of Lyme that people commonly overlook?
Dr. Stram: The tick itself is very small—often in its nymph stage, about the size of a poppy seed or the tip of a ballpoint pen. It also releases an anesthetic in its saliva, so you typically don’t feel the bite. Even if you do notice it, the reaction might just look like a small red spot. Sometimes people develop a bullseye rash, but that’s actually less common than many think and is often mistaken for something else.
In many cases, the most common symptom is no symptom at all, at least initially. Lyme bacteria grow very slowly, so symptoms can take time to appear. When symptoms do show up, they may be linked to co-infections like Anaplasmosis or Ehrlichia, which can cause acute illness—high fever, severe fatigue, and cognitive difficulties—within days or weeks of the bite. Others may experience flu-like symptoms, joint pain, or muscle aches. But again, many people don’t realize they have it at all.
Q: Why do some patients continue to have symptoms even after standard treatment from their primary care provider?
Dr. Stram: Lyme is often treated like a fast-growing bacterial infection, which typically responds quickly to short courses of antibiotics. But Lyme bacteria grow very slowly—sometimes taking days or even weeks to reproduce. Antibiotics work best on actively reproducing bacteria, so short treatment durations may not fully address the infection.
Additionally, if someone has co-infections and only Lyme is treated, those other infections may continue causing symptoms. That’s why proper testing and a thorough evaluation of symptoms are so important, so all contributing infections can be identified and treated appropriately.
Q: Can tick-borne illnesses affect more than just the joints and cause broader systemic issues?
Dr. Stram: Absolutely. Lyme disease is often called “the great imitator” because it can mimic many different conditions. While joint pain is common, it’s often migratory—moving from one joint to another—which is a key distinguishing feature.
Beyond that, Lyme can affect multiple systems. People may experience cognitive issues like memory loss, which can be unusual in younger or middle-aged individuals. Others may have pelvic or abdominal pain due to nerve involvement, or even heart-related symptoms like irregular heart rate or fainting spells, which can be serious. Muscle pain, cramping, and fatigue are also common. Because it can impact so many systems, Lyme disease can present in a wide variety of ways.
Q: What is your approach to treating Lyme disease, and how does it differ from conventional methods?
Dr. Stram: Our approach starts with time and a thorough history. For new patients, we spend about an hour and a half understanding their full background, because history is still the most important part of diagnosis. Testing is supportive, but it doesn’t replace a detailed clinical picture.
We assess risk factors like outdoor exposure, occupation, pet ownership, and living environment. Symptoms like migratory joint pain can strongly suggest Lyme disease clinically. From there, we also evaluate for other possible conditions using a broad diagnostic approach—what we call assessing the biological terrain. This may include lab work, imaging, and other evaluations to rule out or identify contributing factors. The biggest difference in our practice is the time we dedicate to patients, allowing us to build a relationship and gain a deeper understanding of their health.
Q: How important is nutrition and lifestyle support during Lyme treatment?
Dr. Stram: It’s very important. Diet can significantly influence inflammation, and many aspects of the standard American diet—like preservatives and processed foods—can negatively impact the gut microbiome and promote inflammation. We encourage reducing processed foods, sugars, and refined carbohydrates, as sugar can feed bacteria and worsen symptoms. Nutrition is part of our assessment, and patients work with a dietitian as part of their care. We also incorporate mental health support. Chronic illness can take a psychological toll, so counseling is an important part of recovery and overall well-being.
Q: What role does hyperbaric oxygen therapy play in treatment and recovery?
Dr. Stram: Hyperbaric oxygen therapy increases oxygen levels in the body under pressure, allowing oxygen to reach tissues that may otherwise have limited blood flow. This supports healing, as oxygen is essential for tissue recovery.
In Lyme disease, it can also act as an antimicrobial treatment, since Lyme bacteria and some co-infections don’t thrive in high-oxygen environments. Additionally, it enhances the effectiveness of other treatments by improving circulation and tissue penetration. We’ve seen it make a significant difference in patient outcomes, often accelerating recovery.
Q: What is one misconception about Lyme disease you wish more people understood?
Dr. Stram: A major misconception is that Lyme disease is hard to get, easy to diagnose, and easy to treat—all of which are false. It’s actually quite easy to get, especially in endemic areas, but difficult to diagnose because testing is outdated and based on the body’s immune response, which may not appear until weeks later.
Another misconception is that a single dose of antibiotics is sufficient treatment. Lyme bacteria grow slowly, so short or minimal treatment is often ineffective. There’s also the misconception that Lyme disease exists in isolation, when in reality, co-infections are common and must be addressed. Finally, some believe that persistent symptoms after treatment are simply “post-treatment Lyme disease.” In many cases, it may actually reflect incomplete treatment or an incomplete understanding of the full scope of the illness
Q: If someone suspects they may have Lyme disease, what should they do next?
Dr.Stram: People should advocate for themselves. If a test is negative but symptoms persist, request repeat testing, since timing can affect accuracy. Testing too early or too late can both lead to false negatives. Most importantly, treatment decisions should be based on clinical judgment, not just test results. If someone has a high likelihood of exposure and consistent symptoms, treatment should be considered. Antibiotics, when used appropriately and with probiotics, are generally safe and can be very effective.
