For ease in downloading and printing, this Master Lyme Symptom List is available in PDF format. Short Symptom List It is estimated that 30-50 percent of acute Lyme disease patients develop chronic Lyme (chronic borreliosis; neuroborreliosis). That is, despite antibiotic and other treatment, the Borrelia burgdorferi organism remains alive and well, periodically causing a worsening of symptoms or causing new symptoms to appear. Two-thirds of those bitten by an adult tick or tiny tick nymph never even know they've been bitten, and fewer than 50 percent of those finding ticks or nymphs feeding on them develop the "classic" bull's-eye rash that the CDC stipulates as one of its diagnostic criteria; many people with Lyme never exhibit any type of rash. There are over 300 known strains of Bb and at least six genotypes, increasing the difficulty in testing people for its presence. This is compounded by the fact that the majority of public health and commercial labs such as Quest Diagnostics, LabCorp, Unilab, etc., use a hierarchy of tests, established by the CDC and followed by the AMA. The first of test to be done, the ELISA, is known to miss the organism in the samples tested. Only when this less-than-accurate ELISA is positive is a second test, the Western blot, ordered. Since these labs use the Centers for Disease Control & Prevention's epidemiological criteria, which even the CDC says is not to be used for diagnostic purposes, thousands of people each year who get negative ELISA and Western Blots are told by their doctors that they do not have Lyme, when in fact they do. Many of those who go on to develop chronic Lyme do so because of not getting properly diagnosed right away, or not getting the appropriate treatment (too many doctors still prescribe too-short a period of antibiotics). Others keep testing negative for the disease because the tests used do not detect the strain they have, or the Bb is in one of its many presently undetectable morphs. Over the past several years, as independent labs such as IgeneX and MDL have developed more sensitive tests for Borrelia and other tickborne diseases, an increasing number of people who were originally diagnosed with CFS and FM are turning up positive for Borrelia and, frequently, one or more of the other tickborne diseases. Others who are seronegative for Bb (getting false negatives on tests) respond to appropriately aggressive antibiotic therapy, and may later show positive on the Western blot IgM (early or reactivated infection) and/or IgG (chronic or ongoing infection) tests, despite negative ELISAs and earlier Western blots. Note on the following symptoms: Many of these are symptoms common to other diseases. Getting a proper diagnosis for CFS, FM, and CMP is as much ruling out other diseases (including proper testing and assessment for Lyme and other tickborne diseases) as it is looking at the clues in dozens of tests and the actual physical exam. In the case of Lyme disease, however, even if you test negative, many Lyme-knowledgeable physicians and patients recommend starting on an appropriate antibiotic protocol for Lyme, testing again after being on the antibiotics for 6-8 months. For more on Lyme Disease, please see www.anapsid.org/lyme. For a truncated symptom list that may be more acceptable to physicians new to Lyme, see the listing included in Joseph Burrasano MD's Diagnostic Hints And Treatment Guidelines For Lyme And Other Tick Borne Illnesses. AUTONOMIC NERVOUS SYSTEM/ENDOCRINE/IMMUNE/HORMONE

Abnormal sensitivity to hot or cold

Allergies (nasal, other; new, increased or worsening)

Canker sores (frequent)

Chills and/or shakes when hungry (may occur instead of feeling hungry)

Cold hands and feet

Extreme fatigue after minimal exertion

Feeling hot or cold often

Flu-like symptoms, on-going or recurrent after initial gradual or acute onset; includes mild fever (99.5-101.5 F / 37.5-38.6 C), chills

Hair loss (alopecia)

Herpes simplex or shingles rash

Increased susceptibility to infections

Low-grade fevers

Low blood pressure (below 110/70)

Low body temperature (below 97.5)

Lymph nodes painful, swollen (in neck; under arms)

Night sweats (not related to menopause or fever)

Orthostatic Intolerance (neurally mediated hypotension)

Reactive hypoglycemia and insulin resistance

Thirst, increased

Temperature irregularities; often feeling hot or cold irrespective of actual ambient temperature and body temperature; low body temperature (below 97.6 F / 36.4 C)

Thyroid inflammation (acute thyroiditis; hypothyroidism; Hashimoto's thyroiditis) CARDIOPULMONARY/RESPIRATORY/CIRCULATORY

Cardiac abnormalities (mitral valve prolapse; myocarditis; tachycardia; palpitations; dysrhythmia)

Cough

Dyspnea (out of breath) or shortness of breath (air hunger) after minimal or no exertion

Heart attack

Heart palpitations

Heart pounds so hard it shakes body, bed

Pulse skips

Serious rhythm disturbances of heart

Sighing, frequent, not related to mental/emotional state

Stroke

Vasculitis CENTRAL NERVOUS SYSTEM/NEUROLOGIAL/NEUROPATHIC/OTOLOGIC

Abnormal CAT, MRI and/or SPECT scans

Alcohol intolerance

Aseptic meningitis

"Brainfog"; inability to think clearly

Difficulty moving tongue to speak

Diminished or absent reflexes

Fainting or blackouts; feeling like you might faint

Headaches (frequent, severe, recurring)

Hearing fluctuations (sounds fade then return)

Hearing changes, often from day to day (need to turn up, then down, volume of radio, TV)

Joint or arthritic pain not relieved by NSAIDs (ie, ibuprofen)

Libido (decreased)

Light-headedness, feeling spaced-out

Migraine headaches

Muscle twitching

Noise intolerance

Paralysis or severe weakness of limb

Parasthesias (numbness, tingling, crawling, itching sensations) in face, head, torso, extremities

Photosensitivity

Radiculitis

Seizures; seizure-like episodes

Sensory alterations (hyper- or hyposensitivity) - smell, taste, hearing (noise intolerance)

Severe muscle weakness

Syncope (fainting)

Tinnitus (ringing/noises in one or both ears)

Touch or weight of clothing on or against body causes discomfort or pain

Tremors, trembling COGNITIVE FUNCTION

Becoming lost in familiar locations when driving

Difficulty with simple calculations (e.g., balancing checkbook)

Difficulty expressing ideas in words

Difficulty moving your mouth to speak

Difficulty making decisions

Difficulty following directions while driving

Difficulty remembering names of objects

Difficulty remembering names of people

Difficulty recognizing faces

Difficulty following simple written instructions

Difficulty following complicated written instructions

Difficulty following simple oral (spoken) instructions

Difficulty following complicated oral (spoken) instructions

Difficulty integrating information (putting ideas together to form a complete picture or concept)

Difficulty putting tasks or things in proper sequence

Difficulty paying attention

Difficulty following a conversation when background noise is present

Difficulty making and/or retrieving memories (long/short-term memory deficits)

Difficulty understanding what you read

Easily distracted during a task

Feeling too disoriented to drive

Forgetting how to do routine things

Forgetting the use of common objects (such as, what to do with the shampoo when you are standing in the shower)

Forgetting how to get to familiar places

Impaired ability to concentrate

Losing your train of thought in the middle of a sentence

Losing track in the middle of a task (remembering what to do next)

Poor judgment

Switching left and right

Slowed and/or slurred speech

Stuttering; stammering

Transposition (reversal) of numbers, words and/or letters when you speak and/or speak

Word-finding difficulty

Using the wrong word DIGESTIVE/HEPATIC

Bloating; intestinal gas

Decreased appetite

Digestive chemicals (acid, enzymes) reduced or absent

Esophageal reflux; heartburn

Frequent constipation

Frequent diarrhea

Food cravings (especially carbohydrates, sweets)

Food/Substance intolerance

IBS

Liver function impaired; mild abnormalities

Increased appetite

Nausea

Spleen tender or enlarged

Stomach ache, cramps

Vomiting

Weight gain or loss EQUILIBRIUM/PERCEPTION

Bite your cheeks or tongue frequently

Bump into things frequently

Difficulty discriminating printed matter despite proper vision correction

Distances (difficulty judging when driving; when putting things down on surfaces)

Dizziness or vertigo

Dropping things frequently

Dysequilibrium (balance problems)

Impaired coordination

Loss of balance when standing with eyes closed

Perception (not quite seeing what you are looking at)

Some patterns (stripes, checks) cause dizziness

Spatial disorientation

Staggering gait (clumsy walking)

Words on printed page appear to jump off page or disappear when staring at them EYES/VISION

Acuity changes not related to prescription changes

Blind spots

Blurred vision

Conjunctivitis

Diminished visual acuity in absence of actual vision change

Drooping eyelid

Double vision

Eye pain

Flashes of light perceived peripherally

Optic neuritis or atrophy

Oscillopsia (image jiggles)

Prescription changes more frequently

Pressure sensation behind eyes

Red and/or tearing eyes

Retinal damage

Slowed accommodation (switching focus from far to near, near to far)

Spots or floaters not related to migraines

Swelling around eyes

Uveitis and/or iritis

Wandering or lazy eye HEAD/NECK/MOUTH

Bell's palsy (facial paralysis, one or both sides)

Bruxism (grinding/clenching teeth)

Canker sores

Dizziness when you turn your head or move

Dry chronic cough

Dry eyes, nose and mouth (sicca syndrome)

Pain in ears, palate, gums

Periodontal disease

Prickling pain along skin of jaw

Problems swallowing, chewing

Runny nose in absence of cold, allergies

Sinus infections

Sore spot on the top of your head

Temperomandibular Joint Syndrome (TMJ)

Unexplained toothaches

Xerostoma (dry mouth) MUSCULOSKELETAL

Arthritic pain that migrates from joint to joint

Carpal tunnel syndrome

Frozen shoulder

Intermittent joint swelling

Joint aches (arthralgia)

Joint pain, without redness or swelling

Loss of tone

"Lumpy, bumpy" long muscles

Morning stiffness

Muscle aches (myalgia)

Muscle pain, stiffness, weakness

Pyriform muscle syndrome

Reduced range of motion

Stiff neck

Writing causes pain in hand, arm shoulder PAIN SYMPTOMS

Abdominal pain

Chest pain

Generalized pain

Shooting or stabbing pains

Painful tender points (FMS: 11 out of 18 tender points) PSYCHOLOGICAL SYMPTOMS/MOOD/EMOTIONS

Abrupt/Unpredictable mood swings

Anxiety or fear for no obvious reason

Appetite increase/decrease

Decreased self-esteem

Depression or depressed mood

Feeling helpless and/or hopeless

Feeling worthless

Frequent crying for no reason

Helpless/Hopeless feelings

Inability to enjoy previously enjoyed activities

Irritability; over-reaction

New phobias/irrational fears

Panic attacks

Personality changes (labile, irritable, anxious, confused, forgetful)

Phobias (irrational fears)

Rage attacks; anger outbursts for little or no reason

Suicidal thoughts or suicide attempts SENSITIVITIES

Acute or abnormal reactions to medications

Alteration in taste, smell, and/or hearing

Chemicals (alcohol, medications; lower tolerance for)

Food sensitivities

Increased perception of and sensitivity to noise

Light sensitivity

Sensitivity to odors (able to detect and/or react in concentrations far lower than before and that healthy people cannot smell) SKIN / NAILS

Abnormal scarring

Acrodermatitis Chronica Atrophician

Blotchy or mottled skin

Bruise easily

Bruises may take longer to appear, and/or longer to fade

Bull's-eye (Erythema migrans) on light skin (resembles a bruise on dark skin)

Dermographia (minor scratch pressure on skin leaves vivid red welts)

Dry, itchy skin

Easily scar

Eczema or psoriasis

Fragile nails

Frequent skin irritations

Lymphadenosis benigna cutis

Nails that curve under or downward

Overgrowing connective tissue (ingrown hair, adhesions, thickened/split cuticles, cysts, fibroids)

Painful skin (abnormal/excessive pain when scratched or rubbed)

"Paper" skin (feels fragile, tissue-thin when rubbed)

Rashes on body, face

Vertical ridges or beads in nails SLEEP SYMPTOMS

Abnormal brain activity in stage 4 sleep

Altered sleep/wake patterns (alert/energetic late at night, sleepy during day

Difficulty falling asleep

Difficulty staying asleep (frequent and/or prolonged awakenings)

Hypersomnia (excessive sleeping)

Myclonus (restless leg syndrome; occasional jerking of entire body)

Nightmares (frequent, extremely vivid and/or disturbing)

Unrefreshing/Non-restorative sleep UROGENITAL / REPRODUCTIVE

Decreased libido

Discharge from breast or galactorrhea

Endometriosis

Frequent urination

Incontinence

Impotence

Infant: premature; low birth weight; low muscle tone; failure to thrive

Interstitial cystitis

Miscarriage or stillbirth

Painful intercourse

Painful urination or bladder

Pelvic and/or rectal pain

Prostate pain

Swollen testicles

Other symptoms worsen before start of menstruation

Worsening of PMS OTHER

Abnormal or other changes in sweating

Activity level reduced to less than 50% of pre-onset level

Burning sensation (internal and/or external)

Cancer

Changed voice

Changes in sweat odor/body odor

Delayed reaction to overactivity/exertion (onset 24-48 hours after exertion)

Electromagnetic (EM) sensitivity (electrical storms, full moon, affect function of electrical devices)

Fatigue, prolonged, disabling, made worse by exertion or stress

Fibrocystic breasts

"Galloping" cholesterol and triglycerides

Hair loss (not related to age, hormones, diet, medication)

Hands hurt excessively when put in cold water

Handwriting changes, altering signature and/or other writing

Hoarseness

Painful, weak grasp that gives way/lets go

Periods of concentrated thinking causes physical and mental exhaustion, increases pain

Sore throat

Swelling/Idiopathic edema (fluid retention syndrome)

Symptoms worsened by extremes of temperature (hot, cold), stress, and/or air travel

Symptoms change focus from time to time, like infection is moving through the body

Thickened mucus secretions (nose, bowel, vaginal)

Thickened "sleep" around eyes in mornings

Very attractive to biting flies and mosquitoes

Weight changes (usually gain) COMMON CO-INFECTIONS AND DISORDERS

Babesiosis

Cytomegalovirus (CMV)

Epstein-Barr virus (EBV)

Ehrlichiosis

Herpesvirus

HHV6

Iron deficiency

Mercury or other metal toxicity

Mycoplasma

Systemic mold and/or mold sensitivities Sources

Fibromyalgia & Chronic Myofascial Pain. Devin Starlanyl & Mary Ellen Copeland. 2001. New Harbinger Publications Inc. www.sover.net/~devstar Chronic Fatigue Syndrome, Fibromyalgia and Other Invisible Illnesses. 2001. Katrina Berne. Hunter House Publishing. www.livingwithillness.com The Interface of Chronic Lyme Disease, CFS and FM. Bonnie Gorman. In, The Update. Massachusetts CFIDS & FM Association. 18(3):1, 35-40. Fall 2002. www.masscfids.org Arthritis Foundation

www.arthritis.org American College of Rheumatology

www.rheumatology.org Fibromyalgia Network

www.fmnetnews.com Centers for Disease Control & Prevention:

CFS www.cdc.gov/ncidod/diseases/cfs

Lyme www.cdc.gov/ncidod/dvbid/lyme Jay Goldstein, MD.

(retired 2003) IgeneX, Inc.

www.igenex.com Medical Diagnostic Laboratories (MDL)

www.mdlab.com The Carousel Network

www.tcnsupport.org Melissa Kaplan

Chronic Neuroimmune Diseases www.anapsid.org/cnd

Lyme Disease www.anapsid.org/lyme