When I suggested that treating the bacteria might not be enough to explain why some Lyme patients remained sick, a well-known Lyme physician told me I was "full of shit."

What stayed with me wasn't the insult. It was the difference in how we understood the illness. His approach centered on identifying the infection, eliminating the organism, and expecting the patient to recover. I understood that reasoning. After all, most people with Lyme disease do recover following appropriate antibiotic treatment. But I was seeing patients whose experiences didn't fit that explanation.

Depending on how prolonged symptoms are defined, approximately 10 to 20 percent of patients continue to experience problems after treatment. Some remain ill for years. I kept coming back to a question that seemed more important than our disagreement: What distinguishes those patients from the majority who recover?

In my practice, patients with similar diagnoses often responded very differently. Some improved steadily, others relapsed, and some became increasingly unable to tolerate treatment. I couldn't explain those differences by looking at the infection alone.

An infection enters a body with its own biological history. Genetics, previous illnesses, environmental exposures, and metabolic health influence how that body responds. The infection itself can then alter immune signaling, nervous system regulation, and energy metabolism. Some of those changes may persist after treatment, potentially contributing to symptoms even when ongoing infection cannot be demonstrated.

This doesn't mean persistent infection or coinfections should be dismissed. They remain important possibilities to investigate. But neither should we assume that every continuing symptom must be caused by bacteria that escaped treatment.

That was the distinction I had been trying to make. We needed to understand not only what the organism was doing, but also what had happened to the person carrying it.

That thinking eventually became the foundation of Precision Lyme Management, an approach that considers the infection, the individual's biological vulnerabilities, the adaptations that develop during illness, and how those factors change over time.

I don't know whether that physician ever reconsidered our disagreement. But the encounter helped clarify something that has guided my work ever since.

The patients who don't recover as expected may have the most to teach us about what our understanding of Lyme disease is still missing.



-Thomas A. Sult, MD

*Learn more about Precision Lyme Management HERE.