Starting in the early 1990s, after we moved from a city apartment to
a wooded property in Westchester County, New York, our family
began to get sick. At first the illness was subtle: The vague headaches,
joint pains, and bone-weariness seemed par for the course in our busy
suburban lives. But as years passed, the symptoms intensified and multiplied,
burgeoning into gross signs of disease.
My knees became so swollen that I descended the steps of my house
while sitting. Swallowing my food, I choked. My arms and legs
buzzed—gently at first, but then so palpably I felt like I was wired to a
power grid. A relentless migraine became so intense I spent hours each
day in a darkened room, in bed.
My husband, Mark, an avid tennis player with great coordination,
began stumbling and bumping into walls. Formerly affable, he began exploding
at offenses as slight as someone spilling water on the floor. He
was an award-winning journalist with a love of literature and a vocabulary
so vast he was our stand-in for the dictionary. But slowly he began
struggling with memory and groping for words. Finally, ground to a
halt, he left his job as editor in chief of the newsletter, Bottom Line
Health one day after realizing that he’d spent hours trying to read a single,
simple paragraph.
Our youngest son, David, began to sleep—first so long that he could
not do his homework or see his friends; eventually, so much (fifteen or
more hours a day) that he could not get to class. Violating the strict attendance
policy at his prep school, he was asked to leave.
Hardest hit was Jason, our oldest, who suffered fatigue and shooting
pains starting at age nine, the summer we took up residence in our fairytale
house in the woods. The doctors called these “growing pains” normal,
but by age sixteen Jason was essentially disabled. He couldn’t
think, walk, or tolerate sound and light. His joints ached all day long.
On medical leave from high school, he spent his days in the tub in our
darkened main-floor bathroom, drifting in and out of consciousness
while hot water and steam eased his pain. As his condition worsened, as
all sorts of lab tests came back negative, a raft of specialists at New York
City’s top teaching hospitals suggested diagnoses from migraine aura
(the dizzying buzz of a migraine) to fifth disease (a swelling of the joints
caused by infection with parvovirus). Each diagnosis elicited a treatment,
but none of them worked.
“What about Lyme disease?” I asked.
“There are too many symptoms here and he’s way too sick for Lyme
disease,” responded the pediatrician, who declined to even test for it.
But by 2000, with answers still eluding us, the pediatrician drew
fourteen vials of blood, testing for hormone imbalance, mineral deficiency,
anemia, and a host of infections, including Lyme. A week later
he contacted us, baffled. Just one test, a Western blot for antibodies
against Lyme disease, had come back not just positive, but off-the-charts
reactive. Jason was quickly reported to the Centers for Disease Control
and Prevention (CDC) as an unequivocal case of Lyme disease. When the
head of infectious disease at Northern Westchester Hospital put his imprimatur
on the diagnosis, we had an explanation for Jason’s illness and
an inkling as to what might be wrong with the rest of us, at last.
Our nightmare had just begun. As with the quest for diagnosis, almost
everything about Lyme disease turned out to be controversial.From the length and type of treatment to the definition of the disease to
the kind of practitioner we should seek to the microbe causing the infection
(or whether it was an infection at all), Lyme was a hotbed of contention.
It was the divisiveness surrounding the disease that had caused
our pediatrician and the specialists we’d consulted to hold back diagnosis
as Jason and the rest of us became increasingly ill.
For patients with early-stage Lyme disease the illness tended to be mild,
and a month of antibiotic treatment usually offered a cure. But for those
who slipped through the cracks of early diagnosis, for people like us, infection
could smolder and progress, causing a disabling, degenerative
disease that confounded doctors and thrust patients into the netherworld
of unexplained, untreatable ills.
Despite the effectiveness of early treatment, withholding therapy had
become increasingly common as a battle royal over Lyme’s essence
spilled from medical centers and clinics into the communities where
people got sick. The same doctors who routinely doused acne and ear infections
with years of antibiotic often would not prescribe even ten days
of such treatment for Lyme unless proof of infection was absolute.
Meanwhile, the few doctors willing to treat the sickest patients with
longer-term or higher-dose antibiotics could be called up for trial by
medical boards, putting their practices and licenses at risk.
The war over Lyme had raged for twenty-five years when it swept us
up in its madness. On one side of the fight were university scientists who
first studied Lyme disease, initially writing it up in medical journals as an
infection of the joints. The disease they described was caused by the
spirochete Borrelia burgdorferi and transmitted to people by the bite of
a deer tick. It was hard to catch and easy to cure no matter how advanced
the case when first diagnosed. Late disease was rare, these academics said,
because Lyme was recognized easily through a bull’s-eye rash and a
simple, accurate blood test. Rarely was their version of the disease seen
outside the Northeast, parts of California, and a swath of the Midwest.
To the horror of these scientists, the circumscribed disease of their studies
had been hijacked by “quack suburban doctors” who saw Lyme everywhere,
from Florida to Texas to Michigan, invoking so many signs and
symptoms that they included every complaint under the sun. These heretical
doctors, the scientists charged, were dispensing antibiotics like water,
all the while raking in money from patients too deluded to realize they
didn’t have Lyme disease at all. The patients had other things, the scientists
said: sometimes mental disorders, but also chronic fatigue syndrome and
fibromyalgia, illnesses with no known cause or cure.
On the other side of the fight, far from the ivory tower, the rebel doctors
and their desperately sick patients insisted that Lyme and a soup of
coinfections caused a spectrum of illness dramatically different from the
one the scientists described. Knees didn’t always swell and the rash
(rarely a bull’s-eye) often wasn’t seen. Instead the patients were mostly
exhausted, in chronic pain, and dazed and confused. The mental condition
they called “Lyme fog” robbed them of short-term memory,
stunted their speech, and crippled their concentration. Brain infection
could inflict a host of frank psychiatric problems from bipolar disorder
and depression to panic and obsessive-compulsive disorder (OCD), they
said, and Lyme could trigger autism or be confused with amyotrophic
lateral sclerosis, known as Lou Gehrig’s disease, or ALS. Because their
illness differed profoundly from the disease described in textbooks, because
it often eluded blood tests, the patients went undiagnosed and untreated
for years. As they struggled for answers, once-treatable
infections became chronic, inexorably disseminating, and causing disabling
conditions that could never be cured. If treatment was to work at
all, the heretic Lyme doctors said, it required high-dose antibiotics, often
in combination or delivered intravenously, sometimes for months or
years.
The patients, for their part, tried to comprehend why the academics
dismissed their cases as false. The scientists were promoting an impossibly
narrow version of Lyme disease to protect their early work and secure a
windfall from Lyme-specific patents, some patients believed. A flow chart
entitled “The Wall of Money” began circulating around support groups,
connecting some of the researchers with U.S. patents and federal or industry
grants. Other patients complained that university physicians consulted
for managed care, making hundreds of dollars an hour dismissing Lyme
diagnoses and advising rejection of their claims. The academics advanced
their agendas, the patients charged, by reporting the doctors who treated
them to disciplinary boards.
Whatever the motive for such reports, the resulting investigations had
an effect. As medical tribunals swept through the Lymelands, primary care
physicians became ever more cautious about treating or even diagnosing
Lyme disease for fear of becoming targets themselves. Stepping into the
breach, a few doctors—Ed Masters of Missouri, Charles Ray Jones of
Connecticut, Ken Liegner and Joe Burrascano of New York—went to the
mattresses for the patients, but with the Lyme war so brutal, thousands of
cases were missed.
Lyme or not Lyme? Diagnoses could get mixed up. Dueling brain tumor
stories make the point. A young woman from Australia went hiking
in California. From that trip on her health declined. She eventually experienced
such pain, disorientation, and inflammation that doctors
thought she might die. She returned to the U.S. for treatment, and neurologists
in Manhattan diagnosed a brain tumor. They actually operated,
but when they opened her up, there was no tumor. It turned out the
young woman had Lyme disease. She was treated with antibiotics and
cured. A young man from New Jersey was diagnosed with Lyme disease
and treated with antibiotics for months without impact. Finally he was
sent to a local medical center, and further testing was done. Doctors
discovered a brain tumor and operated to remove it. The boy from Jersey,
like the girl from Australia, got well.
The more I investigated, the fuzzier the whole thing seemed. Doctors
and labs report more than 23,000 cases falling within the CDC’s circumscribed
definition for Lyme disease each year—a number the CDC
estimates is 10 percent of the total such cases in the United States. At more
than 200,000 new cases a year, Lyme had become one of the fastest spreading
infectious diseases in the United States. But how many bona
fide Lyme disease patients fell outside that umbrella? Thousands? Hundreds
of thousands? More? With so many patients failing to see a rash
and the blood tests so equivocal, it was impossible to say.
The line blurred still more because other ticks and infections contributed
to the epidemic called “Lyme.” Babesia, a malarialike disease
of fevers, headaches, sweats, and profound exhaustion, was almost as
prevalent as Lyme disease itself in many areas. Patients sick for years despite
aggressive treatment for Lyme disease “miraculously” recovered
once babesia was treated. Ehrlichiosis and anaplasmosis, found in a quarter
of Lyme ticks in Connecticut, New York, and many other places, including
the South, could cause a draining, painful illness marked by fevers,
headaches, confusion, and occasionally a rash. Many an “incurable”
Lyme patient had been found to have this second, lurking infection; such
patients were treated with doxycycline and generally got well. Added to
the triad of Lyme-babesiosis-ehrlichiosis/anaplasmosis are other suspect pathogens
inhabiting the same ticks: among them, forms of the the rod-shaped bacterium
bartonella and Mycoplasma fermentans, both sometimes invoked
as a cause of neuropsychiatric symptoms and chronic fatigue.
Finally, a series of newly discovered spirochetes inhabiting a diversity
of ticks have been shown to cause a “Lyme-like” disease, including the
classic Lyme rash, in regions overlapping with and extending way beyond
traditional Lyme zones. The upshot: an illness that was a ringer for
Lyme disease—except that sufferers didn’t test positive because they
weren’t infected by the same spirochete as the one causing Lyme disease.
With so many cases of true Lyme disease falling short of the CDC definition,
and with emerging infections, real and potential, at the periphery
of the hostile debate, chaos reigned.
In all the Sturm und Drang, anyone who fell ill could get caught in
the mania. Sure, there were those diagnosed with Lyme disease who did
not have it. But the more contentious the fight became, the more doctors
were targeted for diagnosing outside the CDC definition or treating
beyond official guidelines, the more the balance shifted the other way.
All you had to do was live in our neighborhoods and meet our families,
our children, to grasp how many had waited months and years for diagnoses
that should have been rendered swiftly, missing the window of
opportunity for early treatment and cure. Adding insult to injury, so
many of those who were missed, like our son Jason, had textbook-perfect
cases of classic Lyme disease in proven Lyme zones. They, too,
were denied. First thousands, then hundreds of thousands, perhaps a
million or more fell victim to the war over Lyme disease, getting so sick
they were incurable, as the fight raged on.
I was a patient and a mother, but also a science journalist when my
family was swept up in the Lyme war. The winds of that war carried us
far from normal reality to a twilight zone of double-talk, an inside-out
world with layers of obfuscation, where disease was dismissed as delusion
and nothing was as it seemed. How had an affliction so cruel and
insidious gripped the underbelly of the suburbs? How had so many patients
of relative sophistication wound up victimized by a fight between
doctors, ridiculed and marginalized as illness destroyed their lives? What
was the truth about Lyme disease? Would I discover the answers in
Lyme’s past or from present-day scientists toiling at the workbench, far
from the maelstrom of the fight?
Because I was sick myself, my job as a journalist was complex. Some of
the experts I interviewed would have deemed me suspect had they known
my status, so I strived to draw the line between my life and my job. I attempted
to do that which was almost impossible in Lyme: to lead a double
life and inhabit two worlds. In the first I was one of the chronic patients,
in the midst of a suspect illness. In the second I was a science journalist,
discussing, with equanimity, the notion that patients like me were false.
“You cannot argue on the basis of anecdote and individual case history
and speculation,” Leonard Sigal, the New Jersey rheumatologist
and Robert Wood Johnson Medical Center professor, insisted when I
asked him about our ilk. “This way lies madness. Where is the evidence?”
On the beat I looked for evidence, but within myself I felt what Sigal
doubted taking hold. Without antibiotics I was sick but with them I was
getting well.
As I fought Lyme in my life and struggled to restore my family’s
health, the questions and contradictions haunted me. For the mother
and patient, Lyme was an albatross, but for the science journalist, it was
the story of a lifetime. I couldn’t walk away from it, not when it devastated
my family, not when it inhabited my woods.