Diagnosing Lyme Disease

 In Understanding Lyme

It’s a simple enough question – do I have Lyme disease?  Yet navigating this question is about as counterintuitive as the fact that cells divide in order to multiply. When faced with this scenario, many of us feel unsure where to turn for answers.  I hope this article helps you choose the right course of action for yourself and loved ones.

Bites, Bullseyes & Other Rashes

Not all infectious tick bites manifest in the same way.  If you have a known tick bite (you saw the tick) and it is particularly red, itchy, swollen, causing localized lymph gland swelling, or otherwise looks and feels “angry,” assume it to be infected and treat it as a known acute infection.  

We recommend keeping clove essential oil on hand so that if a tick is found, (no matter how long you think it’s been there), you can apply clove oil directly to the bite twice per day until all signs of inflammation at the bite have resolved completely.  This penetrating, highly antimicrobial oil is absorbed into the epidermis and can extinguish microbes from the bite site before they have a chance to move further into the body.  This is a most potent tool for preventing infection.

It’s estimated that 30% of the time an infected tick bite will generate the classic bullseye rash.  When you see this hallmark sign, have no doubt that you have Lyme disease.  Take a picture!  The rash typically lasts a day or two and changes shape over time, so that by the time you make it to the medical center, it may appear different (and debatable) to the doctor or nurse.  Showing a picture can help make the case for prescription antibiotics should you want them.

Not all bullseye rashes look the same. Through my decades of clinical practice, I’ve seen small ones (on the scalp), large ones (across the abdomen), disseminated rashes (multiple blotchy bullseye rashes all over the body), and atypical rashes look more like a blood blister, a poison ivy rash, a necrotic spider bite, or a traumatic bruise.  The lesson here is that Lyme-borreliosis and coinfections often produce inflammation and damage to the skin and these are key signs, even if they don’t fit the classic description of a bullseye rash.

If It Looks Like Lyme and Feels Like Lyme, It’s Probably Lyme 

Besides changes in the skin, other common Lyme symptoms include fatigue, joint and or muscle aches, an overall heightened  level of inflammation that leads to pain and stiffness, headaches, feeling hungover in the morning (sans alcohol), neurological tingling or burning sensations, or an exacerbation of a pre-existing inflammatory condition.  

The manifestations can vary widely, so while none of these symptoms are conclusive, it is worth investigating by either obtaining lab work, or talking to a health professional who is knowledgeable about Lyme disease.  Unfortunately, many health professionals still have a limited perception of how Lyme disease can present, so if your doctor poo-poos the notion, seek a second or third opinion.   

The ELISA and the Western Blot

The ELISA and the Western blot are the two types of blood tests that can be ordered from common labs such as Lab Corp or Health Quest.  The ELISA is (according to official standards of care) the first test that is recommended for doctors to prescribe, but it has been shown to miss cases of Lyme-borreliosis about 50% of the time.  Therefore it is best to skip this step of the testing process entirely, and simply ask for the Western blot test straightaway.  

The Western blot is thought to be accurate about 65% of the time.  This means that it is still possible to have Lyme-borreliosis, and yet test negative.  There are several reasons for this, including but not limited to:

  1.  Testing too soon: In an acute case of Lyme, an individual must wait a minimum of 1 month following the initial infection (the bite) before there are sufficient antibodies circulating in the blood to generate a positive result. 
  1. Limits of antibody testing: Lyme-borreliosis is considered a “stealth pathogen;” this means that it has multiple methods of deceiving and hiding from the immune system.  The Western Blot is not a direct test for the presence of the Lyme bacteria, it is a test of immune system response to an antigen, in this case the outer surface protein of the Borreliosis spirochete.  It follows that if the immune system is not detecting it (because it’s hiding in biofilm or tissues where the immune system’s scouts are not circulating), the test result will be falsely negative.  When the immune system is very weak and/or the Lyme infection is deeply embedded, the WB may appear negative or only weakly positive.
  1. Limits of test positivity criteria: There may be evidence of 1 or more “exclusive” bands – signifying that Lyme-borreliosis is the only organism that could cause that band to read positive – but without 5 or more, the test is negative according to the CDC’s standard of positivity.  This leads to many people being told by their doctor or nurse that the “test is negative,” yet the results show clear evidence for positivity.  For this reason, I always recommend obtaining a copy and looking for ANY sign of positive response.  Then you can consider the true data along with signs and symptoms.

Other Helpful Lab Markers

The CD 57 count is a marker of immune system strength.  It represents the quantity of natural killer cells that are circulating as a first line of defense against bacterial and viral invasion.  When this is low, it is a sign of a weakened immune system.  Low numbers are associated with chronic Lyme infection.  

A Lyme-literate health practitioner may have other lab recommendations that will be useful to rule Lyme-borreliosis and other possible infections and diseases in or out, depending on your particular case.  

Don’t Overlook Coinfections

Keep in mind that tick bites – and bug bites in general – commonly carry numerous types of infections, not just Lyme-borreliosis. Experiencing intense or chronic symptoms is one sign that one has been infected with multiple disease-causing organisms, since coinfections are doubly burdensome on the system.  

Fatigue, brain fog, heart palpitations, anxiety, and neurological symptoms are just some of the manifestations that may be more extreme when Lyme-borreliosis is coupled with one or more coinfections. Coinfections that are worth testing for include Babesia species, Bartonella species, Rocky Mountain Spotted Fever, and Ehrlichia / Anaplasmosis.  

Other infections that cause Lyme-like presentations and may be useful to rule in or out include Epstein-Barr virus (and other Herpes family viruses), Covid, candida yeast overgrowth, Toxoplasmosis gondii, parasites, mycotoxin illness, and Mycoplasma pneumonia. 

When To Use Specialty Labs?

Specialty labs such as Igenex or Vibrant Wellness have tick-borne disease panels that are more sensitive than the tests that are performed by the conventional labs such as Quest and Labcorp.   They also include testing for coinfections, which often gets overlooked initially.  On the downside, these tests must be paid for “out of pocket,” and insurance reimbursement is spotty.  However, when more information and clarity is needed in order to commit to a path of treatment, spending the money on a speciality lab test may be worth it.

A Good Rule of Thumb

If you are facing the need to make choices about what labs are worth paying for, and which may not be worth it given limited financial resources – especially when the cost of treatment is also at hand – then some discernment may be wise.  

Ask yourself, and your practitioner, how will knowing the result of this lab influence the course of treatment?  Some lab tests are critical to commit to a particular path, while other labs may not be so critical because either the signs and symptoms are clear, or the result of the lab will not influence the course of treatment you’re already choosing.

In some cases, it makes sense to trust the configuration of symptoms, leave the labs aside for the moment, and see how the body responds.  When the treatment is on target, the body will respond either with a Herx die-off response or straightforward improvement in symptoms.

Next Steps Towards Receiving Diagnostic Clarity

If you feel overwhelmed or unclear about how to proceed, reach out to us for support.  Our affordable and holistically-minded expert consultations include a review of any current lab work, recommendations for additional labs if warranted, and feedback about your current presentation.  You will also receive a natural medicine-based treatment plan and answers to all of the questions you may have so that you feel clear about your next steps.

We are offering a $50 savings when you book your initial consultation with Daniel Weinberg, LAc. during the month of August, 2022.  We look forward to supporting you!


  1. Brenner, Carl.  Understanding the Western Blot.  https://www.lymedisease.org/assets/Understanding-Western-Blot-Lyme-disease-test.pdf 
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  1. Reed KD. Laboratory testing for Lyme disease: possibilities and practicalities. J Clin Microbiol. 2002 Feb;40(2):319-24. doi: 10.1128/JCM.40.2.319-324.2002. PMID: 11825936; PMCID: PMC153420.
  1. Stricker R, Johnson L. Lyme disease: the promise of Big Data, companion diagnostics and precision medicine. Infect Drug Resist. 2016;9:215-219.  https://doi.org/10.2147/IDR.S114770 
  1. https://vtlyme.org/2019/03/24/misinformation-lyme-disease-vt-2019/

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