Treatment Approach for Patients with Potential Lyme Anxiety

Leonard Sigal, MD, clinical professor and former chief of the Division of Rheumatology at Robert Wood Johnson UMDNJ Medical School, explains his approach for treating patients who may have “Lyme anxiety.”

Interview Transcript (modified slightly for readability):

“First, listen. Shut up and listen. That’s what I always told medical students and residents. Shut up and listen. Usually the patient will tell you what’s going on if you just be quiet. And so, if somebody is really scared, the first thing is to listen carefully, attentively. Don’t be dismissive. Ask appropriate questions. If something seems like there’s a loose end, pursue it. Because the more of those loose ends that you pursue, maybe you’ll come up with a diagnosis. It’s not going to be something obvious because the patient has already seen 3 doctors. Listen. Be compassionate. Do the follow-up questions and do the appropriate physical examinations. You do physical examination starting from the hair roots all the way down to the toenails; you look at everything.

Judicious use of laboratory testing? Sometimes. Clearly, the least important of the 3. History is most important. Physical examination, quite important. Laboratory—eh. And then you do something that is really at a premium and not very often done. Think. Think with an open mind and an open heart. And then, maybe you’ll come up with a diagnosis or maybe you’ll come up with a differential diagnosis that allows you to root through things. Ultimately, if there’s no disease process that you can identify as an infectious disease, as an autoimmune disease, as an inflammatory disease, then it’s not that the patient’s crazy; it’s not that it’s in her head; it’s that there is an ongoing and endless tape of anxiety playing in that person’s brain.

Now, what we have to do is deal with it. Understand the root of it. Try to get rid of it. It’s not to say that they’re crazy; it’s not to say that it’s all in their head; it’s to say that the confluence of everything that has happened has resulted in an ongoing problem that has no physical cause that I can identify. Of course, the patient can go off and look for another doctor, but at that point, that’s my approach.”