Here's The Deal With Chronic Lyme Disease

Photo: Cultura/REX USA.
If you're feeling a disturbance in the reality-TV force, this might be it: Real Housewives of Beverly Hills star Yolanda Foster returned to her blog recently to write, "I have lost the ability to read, write, or even watch TV, because I can't process information or any stimulation for that matter." She says she has been struggling with a chronic form of Lyme disease since 2012, People reported this week. However, it turns out that "chronic" label is actually pretty controversial.
What is Lyme disease?
It's a tick-borne infectious bacterial disease, and it certainly isn't pleasant. The first symptoms of Lyme disease include a red, gradually expanding rash. For about 70-80% of people, this rash forms a characteristic bullseye pattern. Other symptoms include loss of muscle tone (Bell's palsy), joint pain, muscle stiffness, severe headaches, and dizziness. Although these symptoms may go away on their own after a few weeks, the disease could still cause arthritis (with severe joint swelling) months or even years down the line if left untreated.
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How do you get Lyme disease?
The predominant cause of Lyme disease, the spirochete bacteria Borrelia burgdorferi, is transmitted by the bites of already-infected ticks. Often, these ticks are lurking in wooded areas, but they usually have to be attached to you for at least 36 hours to transmit the bacteria, so it's important to be diligent about checking for ticks and getting those things off you after spending time outdoors.  
How many people get it?
The Centers for Disease Control and Prevention receive an estimated 30,000 case reports of Lyme disease per year, but due to missing data, it's difficult to get a firm number. Although it can be transmitted elsewhere, most Lyme disease activity is concentrated in the Midwest and Northeast — over 90% of cases come from just 14 states.
How is Lyme disease treated?
With a 2-4 week dose of antibiotics. When it's caught in the early stages, most people recover quickly and completely from Lyme disease. 
What makes Lyme disease chronic?
A minority of patients — one or two out of 10 — may develop long-lasting symptoms in what's called post-treatment Lyme disease syndrome (PTLDS) and is also sometimes referred to as "chronic Lyme disease." But, the exact definition of chronic Lyme disease is a little murky because it often includes expected later-stage symptoms of the disease as well as a long list of nonspecific symptoms (fatigue, pain, and issues with memory and concentration). Generally, these patients have had symptoms for at least six months despite antibiotic treatment.
Why is chronic Lyme disease controversial?
This is where it gets tricky. The evidence for a "chronic" diagnosis is pretty scarce, and the evidence that does exist is contradictory and convoluted. In the past, studies have used the term "chronic Lyme disease" to refer to different illnesses, even diagnosing patients with no history of B. burgdorferi infection with the chronic version of the disease. In one often-cited study, researchers were able to find traces of B. burgdorferi  in patients' systems even after they had received long-term antibiotic treatment, but other researchers were unable to reproduce these findings. Some investigators have also suggested diagnosing chronic Lyme without those markers, which is certainly not an idea supported by any substantial science. Due to the ongoing confusion, experts aren't too hot on the concept
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Is there any treatment for chronic Lyme disease?
Not really, since we're not totally sure what chronic Lyme disease actually is. What we do know is that staying on antibiotics for longer than the usual length of time either doesn't help or only helps with certain symptoms, such as fatigue. It won't help with any cognitive effects of the disease. In fact, there's plenty of evidence to suggest that continuing antibiotics for that long could do more harm than good. However, Yolanda's Instagram suggests she's undeterred on the hunt for an actual cure.
So, what's up with Yolanda?
It's unclear. No one is saying Yolanda's illness isn't real — okay, some people are — but figuring out alternative explanations in this or any suspected case of chronic Lyme disease could be difficult, due to the conflicting literature and opinions. Regardless, we wouldn't recommend diagnosing yourself or anyone else via the Internet. We'll leave that to the pros — and the lemons.
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