Conditions
Lyme disease and chronic infection
Few areas of medicine are as polarised as this one. Patients are often caught between being told they definitely have chronic Lyme and being told the whole idea is nonsense. Neither position is much use when you are unwell.
Where I stand
Acute Lyme disease is well characterised and treated with antibiotics. Where it becomes contested is persistent symptoms after treatment, and whether ongoing infection explains them.
My honest position: a proportion of people clearly remain unwell after treated Lyme disease, and their symptoms are real. The mechanism is genuinely uncertain and may differ between people, involving persistent infection, immune dysregulation, or damage from the original illness. I do not think anyone yet knows reliably which applies to whom.
What I try to avoid is the two failure modes this field produces: dismissing people whose symptoms are real, and attributing everything to an infection without adequate evidence while other explanations go uninvestigated.
How I assess it
Exposure history, the shape of the original illness, what treatment was given, and how symptoms evolved. Serology where appropriate, interpreted with its known limitations rather than as a definitive answer in either direction.
Equally important is looking properly for the other things that produce this symptom picture, because thyroid disease, anaemia, sleep disorder, autoimmune conditions and biotoxin illness all can, and all are more treatable when found.
Biotoxin illness and CIRS
Chronic inflammatory response syndrome, most often linked to water-damaged buildings and mould exposure, overlaps considerably with this picture. Where the history points that way, exposure assessment is part of the work.
It is a contested diagnosis too, and I apply the same standard: investigate seriously, interpret carefully, and be clear about what is established and what is inference.
What I will not do
I will not prescribe prolonged, escalating antibiotic regimens on the basis of contested testing. The evidence does not support it and the harms are real.
If you are looking for a practitioner who will confirm chronic Lyme and treat aggressively on that basis, I am not that doctor, and it is fairer to say so before you book.
Common questions
My NHS test was negative but a private lab was positive. Which is right?
Possibly neither, on its own. Lyme serology has real limitations, and some private laboratories use methods that are not validated to the same standard. I interpret both alongside the clinical picture rather than treating either as decisive.
Can you treat me if I have been ill for years?
I can assess you properly and treat what is treatable. I cannot promise resolution, and long-standing illness of this kind usually improves gradually if it improves at all.
Related
Discuss your case with Dr Greenland
A short discovery call is the usual starting point. It costs nothing, and it is the fastest way to find out whether this approach fits your situation.