Too many patients with persistent Lyme disease are told, “You’re fine,” when they clearly aren’t. Their fatigue, brain fog, joint pain, and autonomic issues are dismissed or misattributed—and the longer that goes on, the more trust in the system erodes.

But what if we approached persistent Lyme the way we approach other chronic illnesses? With structure. With curiosity. With a focus on treatable traits.

In my practice, I’ve found that identifying these traits—those small, modifiable contributors to illness—can make a significant difference.
And primary care physicians are in the perfect position to start that process.

What Makes Persistent Lyme Disease So Complex?

Persistent Lyme disease isn’t just about the bacteria.

It’s about how that infection interacts with the patient’s immune system, nervous system, and day-to-day reality.

Common treatable traits in persistent Lyme disease include:

1. 1. Undiagnosed co-infections like Babesia or Bartonella

   2. Dysautonomia or POTS

   3. Medication intolerance or non-adherence

   4. Herxheimer reactions without support

   5. MCAS or food sensitivities

   6. Trauma, anxiety, or depression

   7. Sleep dysfunction

   8. Physical deconditioning

The symptoms may be vague. But the suffering is not.

When we recognize these traits early, we reduce the risk of long-term disability.

Start With the Basics: Medication Adherence and Tolerance

For patients with persistent Lyme disease, treatment plans are often complex—multiple antibiotics, antimicrobials, or supplements.
But that doesn’t mean the medications are being taken consistently—or correctly.

Side effects, cost, timing confusion, or Herx reactions often disrupt treatment. Primary care physicians can move the needle simply by asking:

“How are you tolerating this?”
“Are you seeing any benefit—or setbacks?”

A five-minute medication review can save months of stalled progress.

Don’t Miss the Invisible: Dysautonomia and Fatigue

Orthostatic intolerance, heart palpitations, and exercise crashes are common in persistent Lyme disease. Yet they’re frequently overlooked—especially in younger or athletic patients.

Consider screening for POTS or dysautonomia in patients reporting:

1. 1. Dizziness when standing

   2. Heart rate spikes

   3. Fatigue after mild exertion

   4. Brain fog or blurry vision

Hydration, salt intake, compression garments, and pacing strategies can significantly improve quality of life.

Mental Health Support Is a Medical Need

Persistent Lyme disease takes an emotional toll—especially when symptoms are invalidated. Anxiety, trauma, and depression often follow years of misdiagnosis and dismissal.

That doesn’t make the illness psychosomatic. It means the emotional experience is part of the disease burden—and needs treatment, too.

Ask open-ended questions:

“How has this affected you emotionally?”
“Would you feel comfortable talking to someone about it?”

Validation opens the door to recovery.

Co-Infections and Missed Diagnoses: Trust Your Clinical Instinct

Doxycycline alone isn’t enough if Babesia is driving symptoms. Neither is ignoring Bartonella when neurological or psychiatric signs persist.

Persistent Lyme disease often involves co-infections that require different medications—like atovaquone for Babesia or rifampin for Bartonella.

If your patient is still sick after 30 days of treatment, don’t stop there.
Use your clinical judgment—even when tests are negative.

MCAS, Food Sensitivities, and the Gut Connection

Patients with persistent Lyme often struggle with gut symptoms, food triggers, or histamine intolerance.
These can complicate treatment tolerance and nutrition, especially when diets become severely restricted.

Consider asking about:

1. 1. Reactions to leftovers, alcohol, fermented foods

   2. Symptoms tied to dairy, gluten, or sugar intake

   3. Appetite loss, bloating, or early satiety

Working with a dietitian can help patients stabilize their diet and restore resilience.

Persistent Lyme Disease Requires Clinical Curiosity

Primary care physicians don’t have to solve every aspect of persistent Lyme disease.
But you can move the needle by:

1. 1. Identifying treatable traits

   2. Validating symptoms

   3. Coordinating care

   4. Referring when needed

You may be the first provider who says:

“I believe you.”
“Let’s figure out what’s driving this.”

That alone can be transformative.

Final Thoughts on Treatable Traits in Persistent Lyme Disease

Persistent Lyme disease is real. It’s complex. And it’s manageable—when we treat more than just the infection.

By recognizing and addressing treatable traits, primary care providers can play a powerful role in recovery.

It’s not about curing everything at once. It’s about identifying what can be helped—today—and acting on it.

Ruling Out Other Conditions Matters in a Lyme Disease Evaluation

As a Lyme disease expert, I’ve seen how symptoms like fatigue, brain fog, and pain can overlap with other conditions. That’s why I encourage patients to work closely with their primary care doctor—and, if needed, with specialists—as part of their Lyme disease evaluation. A broad, thoughtful evaluation helps ensure nothing important is missed and allows for a more focused, effective treatment plan.

Related articles:

1. 1. Signs and Symptoms of Untreated Lyme Disease

   2. Lyme disease treatment options

   3. Why I Treated Him for Lyme—Even When His Test Was Negative

This blog is for educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Please consult your healthcare provider for guidance specific to your situation.