could lyme do this?

[mike-g]

  Back in 1990 when I was 21 y/o, I was diagnosed with Lyme disease.  At that time, my acute symptoms were severe fatigue, swollen lymph nodes, dark circles under my eyes, severe headache, aches and pains in every joint in my body, low grade fever (I think) and other strange symptoms.  I actually felt like I was dying.  Anyway, they put me on antibiotics (orally), I think it was Augmentin, and within days I felt 100% better and within 4 weeks I was back to normal.  Since that time however, strange symptoms have been reoccurring that makes me wonder whether LYME is a chronic condition, as some experts have suggested.  The symptoms include fatigue, muscle aches, nausea, jaw pain, ear pain, abdominal pain, knee pain and others.  The two most dominant symptoms that have been with me now for about 1-1 1/2 years are the fatigue giddiness and the nausea.  I have been tested extensively gastroenterologically (CT scan of abdomen, ultrasound of gallbladder, upper and lower bowel series, egd of stomach, gallbladder x-rays, etc.) and somewhat neurologically (MRI of head, neurological exam) and all are negative.  My gastro diagnosed me with depression and IBS.  Also, I did go for another LYME test (western blot?) and was negative.  My feelings are that since I've had these symptoms for so long and I'm not dead yet, they must be benign but annoying and I'll learn to live with them.  On the other hand, I wonder if there's something going on inside of me that I need to pursue further.  Please advise as to what tests you think might be needed to give me a better piece of mind, or do you think I am depressed and have IBS.  I am somewhat of a melancholic person.  Can depression cause fatigue, giddiness and nausea?  Thanks and have a great Turkey Day.  Go Lions!!

[CCF Neuro MD MJD]

Lyme Disease is a difficult problem - As a disease it causes some clear syndromes (e.g. rash, heart involvement) and some definite neurologic symptoms (e.g. involvement of the cranial nerves (for example, facial weakness) and inflammatory disease of the spinal roots).  The problem lies in the reporting of later cognitive and behavior effects of Lyme disease.  Although there is some good evidence for this, Lyme disease got picked up as an in vogue diagnoses and overdiagnosed in many patients with fatigue or difficulty concentrating.  This is compounded by the existence of a certain degree of false positive tests for Lyme depending on the lab. Some even advocate that you can have a normal exam and normal laboratory studies/MRI's and still have Neuro-Lyme.  You can see where the difficulty arises.  I am of the opinion that while Lyme might cause some of these behavioral changes, you need some clear evidence of cerebral Lyme involvement (MRI, Spinal Tap, Spinal Fluid Lyme Antibodies) to verify, otherwise you are saying that everyone who is fatigued could have Lyme of the brain.  I'm not sure how your initial diagnosis of Lyme was made - but given your past history, I think a neurologicx evaluation is appropriate. It seems like your exam, Lyme Western blot and MRI is normal.  Perhaps for completeness a Spinal tap would be helpful at evaluating nonspecific inflammation in the brain.  After that, it is probably quite unlikely that the problems you are feeling are Lyme-related.  Certainly fatigue and "giddiness" could have many etiologies and yes certainly there are types of mood disorders like depression that could be additive. Continue your neurologic evaluation; if you feel depressed, perhaps a psychiatric evaluation would help you too.  Hope this was of help and good luck.