### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
For the past year I have been having a bunch of odd symptoms. I feel unsteady at times, I get a tremor in my left hand sometimes, I have an irregular heartbeat, I get ringing in the ears, my back is sore, my eyesight is blurrier sometimes moreso than others, I was diagnosed with acid reflux, I don t sleep well and was diagnosed with sleep apnea, I have ringing in my ears that comes and goes. I previously had a cardiac ablation and have had several ekgs that all came back normal. I was diagnosed with Lyme s Disease 20 years ago and treated, but I work outside near woods and wonder if I either got it again or if it never was totally cured. I am young and pretty healthy, and I need some ideas as to what this could be. I also have been to see a neurologist and had a brain mri that came back clean. Could it be Lyme s even though my last blood test came back negative? I know the blood test is not all that accurate. Should I ask for a Western Blot test to be taken?

### output:

Hello! Welcome on Chat Doctor! I passed carefully through your question and would explain that Lyme disease can mimic all this clinical scenario. A thyroid dysfunction can not be excluded either. Coming to this point, I would recommend repeat the blood lab tests for Lyme disease and perform a Western Blot test too. From the other hand, it is necessary also performing further tests to investigate for other possible causes: - a chest X-ray study-complete blood count, PCR, ESR for inflammation- a cardiac ultrasound- an ambulatory 24-48 hours ECG monitoring in order to examine your heart rhythm trends for a prolonged time and exclude possible cardiac arrhythmia- thyroid hormone levels for possible dysfunction. You should discuss with your doctor on the above issues. Kind regards, 