Symptoms of Lyme Disease

 In Fatigue, Lyme disease

For years we referred to Syphilis as the great masquerader, a disease that could disguise itself in many forms. If this disease was not caught in the initial stages of a painless chancre or sore that appeared at the site of entry into the body, it could elude diagnosis from physicians as the infection moved deeper into the body. Now Lyme disease is the new masquerader.

Having many similarities, both Syphilis and Lyme disease are caused by a spiral-shaped, gram negative, highly mobile bacteria, called a spirochete. Syphilis is caused by Treponema pallidum and is believed to have been around since the mid 1400’s. Lyme disease came to the stage much later in 1975 in the small town of Lyme, Connecticut, when there were clusters of children diagnosed with Juvenile Rheumatoid Arthritis. In 1981, Willy Bergdorfer identified the causing agent of Lyme disease to be the spirochete, Borrelia burgdorferi. Since that time, many species of Borrelia have been identified, including Borrelia afzeii, Borrelia garinii, Borrelia hemsii, Borellia parkeri, Borrelia miyamotoi and Borrelia recurrentis. At this time we are unsure of the ability of all of these organisms to cause disease in humans or to what extent, but we are learning more each day and realizing these varied species likely attack different parts of the body. As the scope of this information is too broad for this article, I will focus on the many presentations of Lyme disease.

Both Syphilis and Lyme can initially present as skin manifestations such as a small painless sore or ulcer-like wound in Syphilis and the Erythema migranes rash of Lyme disease that is also not usually painful or itchy. This rash has a red center surrounded by a clear circle surrounded by a second red circle and is referred to as the bullseye rash since this is what it resembles. 

Often these initial presentations can be missed or do not manifest. The CDC estimates that the bullseye rash of Lyme disease is present in only 70-80 percent of patients who get the disease and can vary depending on geographical location and Borrelial species1. If not caught and treated early, these infections can move deeper into the body–into the organs, bones, joints, nerves and brain–and create chronic inflammation and damage.

Lyme Disease symptoms can vary and can be categorized by stages depending on timing from when it was acquired.

Stage 1: Early Localized Lyme Disease
This stage may begin hours or days (occasionally weeks) after a tick bite. During this phase the illness has not spread deeply into the tissues. Symptoms may include Erythema migrans (bullseye rash), flu-like symptoms, fever, chills, fatigue, headache, stiff neck, muscle soreness, joint pain, swollen nodes and a sore throat.

Stage 2: Early Disseminated Lyme Disease
This stage may occur several weeks or months after the tick bite when bacteria are beginning to spread throughout the body. In addition to flu-like symptoms, people also experience fevers, chills, headaches, fatigue, pain or numbness in the extremities, vision changes, heart problems, such as palpitations or chest pain, body rash or Bell’s palsy. 

Stage 3: Late Disseminated Lyme Disease2
If Lyme disease goes untreated, or if initial treatment was not administered long enough to fully eradicate the spirochete, the disease can develop into a chronic condition. This can occur weeks, months or years after the initial tick bite. Some people may feel well for a period of time, and then when the immune system becomes weakened, the Lyme can become more active. At this point the Lyme disease has spread throughout the body, and many patients develop signs of chronic arthritis as well as neurological symptoms. Some people develop migraines, vertigo, dizziness, tinnitus (ringing ears), aching neck, insomnia, palpitations, brain fog, concentration issues, numbness in parts of the body and severe fatigue.

Although most conventional physicians recognize acute Lyme disease symptoms, especially if a bullseye rash is present, they often miss chronic Lyme disease symptoms or may suspect it but rely on testing to make the diagnosis. Unfortunately, most conventional tests like the Western Blot and Elisa test specifically for Borrelia burgdorferi and are not highly sensitive in detecting illness. Advanced testing that not only looks for Borrelia burdorferi but also tests for other species of Lyme is needed. 

By the time I see patients with Lyme disease, they have had it for months or years, and have seen multiple physicians and yet still lack a root cause for their chronic, unrelenting illness. They are frustrated, tired and looking for answers. The symptoms that follow are the most common manifestations I see in my patients who have Lyme disease.

By and large, this is the most common complaint and is present to some degree in the majority of my patients with Lyme disease. Some patients have mild fatigue; some patients have fatigue so severe they cannot get out of bed in the morning. No matter how much they sleep, they do not feel energized and vital. Some are unable to maintain employment, and others are too fatigued to play with their children or exercise.

Joint Pain
Some people experience isolated joint pain–pain in only one joint–such as in an elbow or a shoulder. However, patients more commonly have migrating joint pain–pain that wanders from one joint to the next. One day they may feel pain in their hips, and the next day they suffer from pain in their elbows or shoulder. People often feel isolated pain in their chest or a part of their face. I have had multiple patients present with frozen shoulder or temporomandibular joint dysfunction (TMJ).

Bell’s Palsy
Bell’s palsy can be acute or chronic and results in paralysis or the inability to move one side of the face. Usually, Bell’s palsy is not an isolated symptom, but the finding warrants me to investigate for Lyme.

Interstitial Cystitis3
This chronic inflammation in the bladder leads to frequent symptoms of urinary tract infections (burning, urgency, and frequency), yet when the urine is cultured, it does not reveal pathogenic bacteria. As Lyme is not easily cultured in the urine of patients, it can be difficult to diagnose as the causative agent for the symptoms.

Neurological Complaints4
There are documented cases of dementia from Lyme disease that have infected the brain– neuroborreliosis.  Most of my patients have not developed dementia but do have some level of brain dysfunction including poor concentration, slow response time or difficulty remembering. They often feel like they are in a “fog.”  

Autoimmune Diseases5,6
Infections are one of the main triggers for developing autoimmunity. Many of my patients present with autoimmune conditions including joint conditions like ankylosing spondylitis, psoriatic arthritis and rheumatoid arthritis. Others have intestinal manifestations and develop Inflammatory Bowel Disease including Crohns and Ulcerative Colitis. Some patients have Hashimoto’s and an autoimmune thyroid condition that causes hypothyroidism (low thyroid) or have isolated positive antinuclear antibody tests (ANA) that signify the body is having an immunological response to the proteins inside the cells.

Insomnia can be one of the most difficult aspects of Lyme disease and can include the inability to fall asleep or stay asleep throughout the night. Neurotransmitter imbalances with serotonin and dopamine can contribute to insomnia. Dysregulation of the autonomic nervous system is also common. People are often stuck in “fight or flight” in which they constantly feel threatened, resulting in abnormal levels of cortisol, epinephrine and norepinephrine.

Tinnitus, or ringing in the ears, can be an annoying symptom and one that may be difficult to treat. It appears that Lyme can infect the nerves supplying the ear and auditory canal and possibly the inner ear creating inflammation that can contribute to the ringing as well as a fullness that sometimes accompanies tinnitus. Some patients also experience intermittent episodes of dizziness, or vertigo, a sensation that feels as though they or the room may be spinning.

Neck Pain and Pain Between the Shoulder Blades
The spirochetes of Lyme attack connective tissues like tendons and ligaments, but they can also cause deep inflammation in muscles as well as manifest in pain anywhere in the body. The most common places of pain in my patients are pain in the neck and between the shoulder blades. This pain can often be accompanied by stiffness and a popping sensation in the neck. Some people complain of isolated tendon inflammation (tendonitis) as well as pain on the soles of their feet.

Palpitations can be isolated or associated with Postural Orthostatic Tachycardia Syndrome (POTS), anxiety or panic. Lyme can attack the Vagus nerve and decrease its ability to function appropriately. This nerve is essentially the brakes on your nervous system, calming down your fight or flight response and slowing your breathing and heart rate when you feel like you are in danger.

As you can see, there are many different and varying symptoms that can present with Lyme disease. It is a disease that, when chronic, can disseminate into the entire body and can affect any organ system. Healing from the symptoms of Lyme disease is possible and can dramatically change a person’s life. If you think you may be suffering from Lyme disease, we can help. Call Vitality 615-891-7500 to schedule a consultation.



  1. Shor S, Green C, Szantyr B, et al. Chronic Lyme Disease: An Evidence-Based Definition by the ILADS Working Group. Antibiotics (Basel). 2019;8(4):269. Published 2019 Dec 16. doi:10.3390/antibiotics8040269
  5. Arvikar SL, Crowley JT, Sulka KB, Steere AC. Autoimmune Arthritides, Rheumatoid Arthritis, Psoriatic Arthritis, or Peripheral Spondyloarthritis Following Lyme Disease. Arthritis Rheumatol. 2017;69(1):194‐202. doi:10.1002/art.39866

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