Lyme Disease
Tick-borne.
Underdiagnosed.
Treatable.
Lyme disease is one of the most misunderstood and misdiagnosed illnesses of our time. The standard tests miss half of all cases, leaving millions of patients untreated, dismissed, and suffering with a chronic infection that is — with the right approach — profoundly treatable.
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The silent epidemic
they told you wasn't real.
Lyme disease is the fastest-growing vector-borne illness in the United States. The CDC estimates 476,000 new cases annually — yet fewer than 50,000 are officially reported each year. The true burden is far higher: research published in Emerging Infectious Diseases and PLOS ONE suggests that up to 10–15% of the US population may have been exposed to Borrelia burgdorferi, the spirochete that causes Lyme disease.
The disconnect between reported and actual cases is driven by a deeply flawed testing paradigm. The standard two-tier testing protocol — ELISA followed by Western blot — was designed for surveillance, not clinical diagnosis. It misses between 40% and 60% of culture-confirmed cases in peer-reviewed studies. Patients with active, disseminated infection are routinely told they are "negative" and discharged without treatment.
Lyme is not confined to the classic Northeast corridor. Cases have been documented in all 50 states, and the range of infected Ixodes ticks continues to expand due to climate change, reforestation, and shifting wildlife patterns. Northern California, the Pacific Northwest, the Upper Midwest, and even parts of the Southwest carry significant risk.
At Sierra Integrative Medical Center, we have treated Lyme patients for over three decades. We have seen the devastation of missed diagnoses — patients who spent years being treated for multiple sclerosis, ALS, fibromyalgia, psychiatric disorders, and chronic fatigue syndrome when the true cause was a treatable tick-borne infection. We know what recovery looks like, and we know that the standard approach fails the vast majority of patients who need help.
A perfect storm
of diagnostic failure.
Lyme disease has been called "the great imitator" because its symptoms overlap with dozens of other conditions. When paired with inadequate testing, clinical dismissal, and the politicized debate around chronic Lyme, patients face a system that is structurally designed to miss them.
The CDC-recommended ELISA + Western blot protocol was adopted for epidemiological surveillance, not individual diagnosis. Sensitivity in early disease is as low as 30–40%. The CDC itself acknowledges these limitations, yet the testing paradigm has not been meaningfully updated in decades. Negative ELISA results are rarely reflexed to Western blot, leaving countless patients untreated in the critical window.
The classic "bullseye" erythema migrans rash is absent or unnoticed in 20–30% of confirmed Lyme cases. Many patients never recall a tick bite — nymphal ticks are the size of a poppy seed and their bites are painless. Without a rash, many clinicians never consider Lyme at all, even when all other signs point to it.
Lyme can present as virtually any neurological, rheumatological, or psychiatric condition. Patients are diagnosed with multiple sclerosis, fibromyalgia, chronic fatigue syndrome, rheumatoid arthritis, depression, anxiety, or early dementia — and the Borrelia infection progressing silently in the background is never investigated. Standard labs are often "normal," reinforcing the misdiagnosis.
Lyme is rarely
alone.
A single tick can carry multiple pathogens simultaneously. At Sierra, we estimate that more than 60% of our Lyme patients have at least one co-infection. These pathogens interact synergistically, amplify symptoms, complicate treatment, and are routinely missed by standard testing panels. Treating Lyme without addressing co-infections is one of the most common reasons for treatment failure.
A malaria-like protozoan parasite that infects red blood cells. Babesia causes severe fatigue, drenching night sweats, air hunger, high fevers, hemolytic anemia, and brain fog. It is one of the most common Lyme co-infections and is notoriously difficult to detect on standard blood smears — specialty PCR and FISH testing at IGeneX or similar labs are essential. Babesia requires dedicated antimalarial treatment (Mepron, Coartem, or artemisinin-based protocols) that is completely different from Lyme treatment.
A stealth vascular pathogen often called "the great pretender." Bartonella infects endothelial cells and can produce symptoms ranging from burning nerve pain in the feet (small fiber neuropathy) to visual disturbances, severe anxiety and panic attacks, gastrointestinal inflammation, and swollen lymph nodes. It is frequently misdiagnosed as anxiety disorder, IBS, or autoimmune vasculitis. Treatment requires prolonged courses of rifampin, azithromycin, or fluoroquinolones — often combined — and relapses are common if therapy is too brief.
Intracellular bacteria that infect white blood cells and cause a flu-like systemic illness with high fevers, severe headache, muscle aches, and cytopenias (low platelets, low white count). Human granulocytic anaplasmosis (HGA) and human monocytic ehrlichiosis (HME) can be life-threatening if missed. Unlike Lyme, they often present acutely with abrupt fever and chills. Doxycycline is the treatment of choice and is highly effective when started early, but concurrent Lyme and ehrlichiosis requires careful sequencing of multiple antimicrobials.
When the infection
becomes chronic.
The most contentious diagnosis in modern medicine — and the one we see most often. Chronic Lyme disease (also called post-treatment Lyme disease syndrome or persistent Lyme) occurs when Borrelia burgdorferi survives initial antibiotic therapy, either through biofilm formation, intracellular sequestration, or immune evasion. The result is a persistent, treatment-resistant infection that can affect virtually every system in the body.
Borrelia forms sophisticated biofilm communities — dense, multi-layered aggregates of spirochetes encased in a protective matrix — that render standard antibiotics ineffective. These biofilms act as physical barriers, concentrating within joint spaces, neural tissue, and the extracellular matrix, where they release persistent antigens that keep the immune system in a state of chronic activation.
Borrelia can invade and survive inside human cells — including fibroblasts, endothelial cells, macrophages, and neuronal cells — where most antibiotics cannot reach therapeutic concentrations. This intracellular niche allows the spirochete to evade both the immune system and standard short-course antibiotic therapy, re-emerging weeks or months after treatment is stopped.
Chronic Lyme infection induces profound immune dysregulation — including cytokine imbalances, impaired NK cell function, autoantibody production, and disruption of regulatory T-cell populations. This explains why Lyme patients often develop new autoimmune conditions, severe environmental sensitivities, and poor response to conventional therapy. Restoring immune competence is a critical component of successful treatment.
Seeing what
standard labs miss.
Dr. Bruce Fong has been diagnosing and treating Lyme disease since the early 1990s — long before the current wave of awareness. Over three decades of clinical practice, Sierra has developed a diagnostic approach that integrates advanced laboratory testing with meticulous clinical assessment.
We reject the notion that a negative ELISA equals no Lyme. In our experience, clinical presentation — tick exposure history, multi-system symptom pattern, and response to therapeutic challenge — is often more reliable than serology alone. When we suspect Lyme, we investigate until we find the evidence, using every tool available.
Specialty laboratories we utilize: IGeneX ImmunoBlot (most sensitive Lyme Western blot available), Galaxy Diagnostics for Bartonella enrichment culture/PCR, Vibrant America tick-borne disease panel (comprehensive serology + PCR), and RealTime Laboratories for detection of Borrelia antigen and immune complexes. When CNS involvement is suspected, Lyme CSF testing and advanced neuroimaging are pursued.
Our diagnostic evaluation also includes co-infection profiling (Babesia FISH/PCR, Ehrlichia/Anaplasma PCR, Bartonella culture and serology), immune system function panels (NK cell activity, CD57 count), and assessment of environmental and metabolic factors that influence treatment outcome — mold exposure, heavy metal burden, methylation status, and adrenal/thyroid function.
A multi-systems approach
to a multi-system disease.
Treating chronic Lyme requires more than a single antibiotic course. Our protocols address the infection directly while simultaneously supporting the immune system, reducing inflammation, clearing toxins, and repairing the damage caused by the spirochete. Every plan is personalized to the patient's specific infection profile, co-infections, symptom burden, and treatment history.
Three decades of
Lyme expertise.
Not all integrative practices are equipped to manage complex Lyme disease. Sierra's three-decade track record, deep experience with antibiotic and non-antibiotic protocols, and willingness to take on patients who have been turned away by every other provider set us apart.
Dr. Bruce Fong has treated Lyme disease since the early 1990s — before ILADS guidelines, before the Lyme literature explosion, before most doctors knew what Lyme was. We have treated thousands of Lyme patients from across the country and around the world, including the most complex, treatment-resistant cases.
We partner directly with IGeneX, Galaxy Diagnostics, and Vibrant America to run the most sensitive tick-borne disease panels available. No fighting with insurance to order the right test — we use the tools that find the infection, not the tools that miss it.
Multiple failed courses of antibiotics. Relapse after every treatment. Severe Herxheimer reactions. Neuropsychiatric Lyme that no one believes is Lyme. Autoimmune overlap. Co-infection cascades. If your case is complicated, you are exactly the kind of patient we are experienced in treating.
We see Lyme patients from around the country and internationally via telehealth. The initial consultation and ongoing follow-ups can be conducted remotely, with treatment protocols coordinated with your local physician when appropriate. We have treated patients in 30+ states.
Real patients,
real recovery.
"I spent seven years being told I had chronic fatigue syndrome, fibromyalgia, and depression. Seven years of psychiatric medications that made me feel worse. I could barely walk up a flight of stairs, my feet burned constantly, and I couldn't think clearly enough to hold a conversation. A friend who had been treated at Sierra told me to get tested properly. Dr. Fong ran the IGeneX panel — I was positive for Borrelia and Bartonella. Within three months of targeted treatment, the burning in my feet was gone. Six months later, I had my cognitive function back. I tell everyone I know: if you have mysterious symptoms, get tested for Lyme — the right way."
"I was diagnosed with seronegative rheumatoid arthritis at 34. Two rheumatologists put me on hydroxychloroquine and then methotrexate. The side effects were brutal, and my joints kept getting worse. Sierra found a Borrelia infection that had been missed for years — what everyone was calling RA was actually Lyme arthritis with co-existing Babesia. The immune modulation protocol, IV antibiotics, and gut-healing program changed everything. I'm off all pharmaceuticals and my inflammatory markers are normal. I never thought that would be possible."
"I was seeing a neurologist for what they thought was early-onset multiple sclerosis. I had numbness down my left side, facial droop, memory lapses so bad I got lost driving home from work, and migraine-like headaches every day. The MRI showed white matter lesions consistent with MS. But a spinal tap and standard MS workup were inconclusive. Someone finally thought to test for Lyme. I came to Sierra from out of state after a friend's recommendation. Dr. Fong found active neuroborreliosis. After eight months of IV antibiotics and immune support, my MRI lesions decreased, the numbness resolved, and my cognitive function returned. I avoided an MS diagnosis I didn't actually have."
You don't have
to keep searching.
New patients are typically seen within 2–4 weeks. Initial consultations are $550; labs and treatments are quoted separately. Remote consultations with Dr. Fong are available for out-of-state and international patients — we have treated Lyme patients from over 30 states.