Ticks, Lyme & What Your Doctor Might Be Missing
The Root of Wellness® Newsletter
Georganne Backman Garfinkel, FMCHC, NBC-HWC
Functional Medicine Certified Health Coach, National Board Certified-Health & Wellness Coach
Ticks, Lyme & What Your Doctor Might Be Missing
Most people put away their tick worries at the end of summer, but in many parts of the country, particularly the Northeast, mid-Atlantic, and upper Midwest, ticks remain active well into fall and can even be active during winter whenever temperatures rise above freezing.1
Symptoms can begin days to weeks after a bite, and some appear months later. If you develop a new rash, fever, facial weakness, palpitations, joint swelling, or unexplained fatigue after possible tick exposure, talk with a clinician.1
Lyme Disease and Other Tick-Borne Illnesses
You may never see the tick. People with Lyme disease are often unaware of the bite, and even the rash can go unnoticed, especially since nymphs can be as small as a poppy seed. Up to 80% of infected people develop an erythema migrans (EM) rash, but it is not always the classic bull's-eye. It may be uniformly red, oval, or otherwise atypical and can be mistaken for another skin reaction.1
Lyme testing has a window period. The CDC recommends a two-step antibody testing process. Testing can be falsely negative during the first few weeks, before the body has produced enough detectable antibodies. A characteristic EM rash with likely exposure can therefore be diagnosed and treated clinically without waiting for a positive blood test. Testing generally becomes more reliable after 4–6 weeks. If symptoms persist, ask your medical practitioner whether repeat testing or evaluation for another tick-borne illness is appropriate.1
Different tick species in our region can transmit other infections, including babesiosis, anaplasmosis, ehrlichiosis, Borrelia miyamotoi disease, Powassan virus disease, and tularemia. Bartonella is also sometimes discussed as a tick co-infection.1,2
There Are Two Different Approaches to Lyme
One reason Lyme disease can be so confusing is that there are real differences within the medical community about how much weight to give laboratory testing and how Lyme should be treated when symptoms persist.
The CDC approach relies primarily on the standard two-tier antibody testing process when laboratory confirmation is needed, while recognizing that early testing can miss infection and that a typical EM rash can be diagnosed clinically.1
ILADS, the International Lyme and Associated Diseases Society, takes a broader clinical approach, one that is very much in keeping with the whole-person perspective of functional and integrative medicine. ILADS looks at the full picture rather than relying on a single test result. This includes possible tick exposure, symptoms, physical findings, the course of the illness, and laboratory results. It cautions that current blood tests can miss cases and that a negative test should not automatically rule out Lyme when the clinical picture strongly suggests it.2
The approaches also differ on treatment. ILADS generally recommends longer initial treatment for early Lyme than CDC guidelines and allows for a more individualized approach when symptoms persist or recur. This remains an area of active medical debate.3
For someone with persistent or unexplained symptoms, particularly after possible tick exposure, it may be worth discussing both approaches with a knowledgeable medical practitioner.
In early August, Suffolk County health officials confirmed a fourth tularemia case on Long Island, NY in 2026. Tularemia, or "rabbit fever," can be spread by infected ticks or deer flies and may cause sudden fever, a skin ulcer, and swollen lymph nodes.4
Why Diagnosis Can Be Difficult
Lyme can affect the skin, joints, nervous system, and heart. When the nervous system is involved, symptoms may include pain, numbness, facial weakness, headaches, cognitive changes, and sometimes neuropsychiatric symptoms. Depression and anxiety have been reported, and more serious psychiatric symptoms have occasionally been described in neurologic Lyme disease. Because fatigue, pain, brain fog, mood changes, and other symptoms overlap with many conditions, this does not mean every case of fibromyalgia, autoimmune disease, anxiety, depression, or Long COVID is undiagnosed Lyme. If symptoms remain unexplained, particularly when neurological or unusual psychiatric symptoms occur after possible tick exposure, ask your medical practitioner to consider Lyme and other tick-borne illnesses among the possible causes.5
Learn More and Find Support
Dr. Horowitz is a board-certified internist, one of the founding members and a former president-elect of ILADS, and the developer of the MSIDS (Multiple Systemic Infectious Disease Syndrome) framework.6
His new book, Ending Chronic Illness: A Revolutionary New Program to Reverse Inflammation and Heal Persistent Disease, will be released in October and applies his MSIDS framework to a broad range of chronic illnesses.7
In this recent episode, Dr. Hyman talks with Dr. Horowitz about infection, immune dysfunction, inflammation, and chronic illness. I highly recommend it.8
Listen: Undiagnosed Infections Are Silently Causing Chronic Disease (Episode 1164)
Navigating Lyme and other tick-borne illnesses can be overwhelming. These organizations offer patient education, support groups, peer connection, and resources for finding knowledgeable practitioners:
Three Things to Try
1. Do a Tick Check, and Know What to Look For
When possible, avoid high grass, brushy areas, and leaf litter, and walk in the center of trails. If you'll be in those environments, wear long sleeves and pants, use an EPA-registered repellent, and consider clothing, boots, and gear treated with 0.5% permethrin; never apply permethrin directly to skin. After time outdoors, check your entire body, especially behind the knees, between the legs, under the arms, around the waist, and in and around the hair and ears, and shower within two hours.1
If you find an attached tick, remove it promptly as per the CDC: What to Do After a Tick Bite. Seek medical advice if concerning symptoms develop.
2. Make a Golden Latte
Turmeric contains curcumin, a compound widely studied for anti-inflammatory effects. Black pepper contains piperine, which can help increase curcumin bioavailability.9
Ingredients: 1 cup unsweetened almond, oat, or coconut milk; 1 teaspoon ground turmeric; ½ teaspoon ground ginger; ¼ teaspoon cinnamon; a pinch of black pepper; 1 teaspoon raw honey or maple syrup, or stevia to taste; optional: 1 shot espresso or strong brewed coffee, regular or decaf.
Whisk the spices with a splash of milk until smooth. Add the sweetener, remaining milk, and coffee if desired. Warm gently, or serve over ice. Finish with cinnamon.
3. Take a Relaxing Epsom Salt Bath
A very warm Epsom salt bath can be a simple relaxation ritual, may help ease temporary muscle soreness, and can encourage gentle sweating. Sweat is one of the body's natural routes of elimination and can help excrete small amounts of certain heavy metals and environmental compounds.10 Sauna is a more extensively studied form of deliberate heat exposure, but Rhonda Patrick, PhD, notes that very warm baths can produce some similar physiological effects, including increasing core body temperature and heat-shock proteins. For people without access to a sauna, a very warm bath can be an easy way to incorporate heat exposure while also relaxing and unwinding.
Add 1 to 2 cups to a comfortably very warm bath and soak for 15 to 20 minutes. Check with your clinician first if you have kidney or significant heart disease, open wounds, or another serious medical condition.
Supporting Normal Immune Function
Sleep, good nutrition, regular movement, and stress management support healthy immune function and may help the body respond to infection and recover more effectively. They are not substitutes for tick-bite prevention, appropriate testing, or medical treatment when a tick-borne illness is suspected.
Low vitamin D is extremely common and is linked to immune function. Studies suggest that up to about 70% of American adults have levels below 30 ng/mL. Rhonda Patrick, PhD, and other vitamin D researchers recommend aiming for a blood level of 40–60 ng/mL. Have your vitamin D level tested and discuss supplementation with your practitioner.11
Spending time in nature is one of the simplest ways to support both mental and physical health, reduce stress, and support healthy immune function. The goal of these precautions is not to make us afraid of the outdoors, but to help us enjoy it more safely and with greater awareness.
References
1. cdc.gov/ticks/about/where-ticks-live, cdc.gov/lyme/causes, cdc.gov/lyme/signs-symptoms, cdc.gov/lyme/diagnosis-testing, cdc.gov/lyme/prevention
2. ilads.org (Lyme brochure), ilads.org/statement-on-guidelines
3. cdc.gov/lyme/erythema-migrans-rash, ilads.org/treatment-guidelines
4. suffolkcountyny.gov, cdc.gov/tularemia
5. pubmed.ncbi.nlm.nih.gov/40641539
6. msidsfoundation.org/about
7. Ending Chronic Illness — Simon & Schuster
8. drhyman.com/podcast-ep1164
9. pubmed.ncbi.nlm.nih.gov/36720711
10. foundmyfitness.com/topics/sauna
11. foundmyfitness.com/micronutrients-exercise
Until Next Time
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Please note: This newsletter is for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment. Seek prompt medical care for concerning symptoms after a tick bite or possible tick exposure. Do not change medications or supplements except under the guidance of your medical practitioner.
Be well,
Georganne
The Root of Wellness®
575 Lexington Ave., 14th Floor, New York, NY 10022
therootofwellness.com | info@therootofwellness.com
