d in the martial arts. On Intake, we asked standard history and family history questions. We found Jim to be a very verbal and engaging young man, obviously bright, and a deep thinker. We saw agitation, restlessness, and anxiety, as well as the paranoia reported by his parents. Toward the end of our initial interview, we asked about his hobbies. With great enthusiasm, Jim told us about his volunteer work at an environmental center here in Dutchess County, and of his hopes for a career involving environmental studies. Jim was a real puzzle to us. We were faced with a set of symptoms and functional problems that made no sense, even in examining his history. Realizing that there had been a dramatic onset of symptoms at a particular point in time
, and that Jim had spent so much time out of doors in what we now see as the Lyme capital of the universe, we referred him to his family doctor for a Lyme assessment. His pediatrician took a titer, which came back "negative", (any of you parents have that experience?) indicating to this doctor
that Lyme was not a factor! That
road appearing closed, we continued to see Jim, as well as his parents, and watched a steady decline in Jim's functioning. He could not go to school, and was placed on home teaching. His parents and we were completely baffled.
As Jim's symptoms got worse, we thought he might have to go into a psychiatric hospital. In a last
quest for a possible medical answer, we suggested that his parents take him for a consultation to a pediatrician who we knew to be Lyme-knowledgable. On the day that consulting doctor saw Jim, he called to tell us that he had made a CLINICAL DIAGNOSIS of Lyme disease, a diagnosis based on Jim's clinical symptoms, NOT on a blood test. The doctor prescribed Ceftin, a drug that crosses the blood brain barrier, attacking spirochetes that were in the brain. Within three days
, Jim's paranoia disappeared. He admitted to having had hallucinations, and they too were gone. He was now sleeping 14 or more hours a day, and for the first time, had joint pain, as part of a Jarisch Herxheimer reaction to the antibiotics, a reaction in which the symptoms temporarily get worse. Thus began Jim's long struggle with what turned out to be chronic Lyme disease. Jim went from being a teenager who could not attend school, could not participate at all in the educational process, was failing all tests, to a good student at one of the best colleges in the New York State system. He went from being a very sick kid, who was on homebound instruction for a year and a half, to a college graduate. He was helped by a supportive family, a Lyme-literate doctor, who treated him effectively, a school administrator who accepted the fact that he was, indeed, ill, and a school system that provided accommodations, to help him succeed.
Most of you know that Lyme disease is a multi-system illness. Someone with Lyme can have joint pains, heart problems, stomach problems, any kind of physical manifestation. I'd like to focus this evening on the neurological and neuropsychiatric problems, the ones that have the greatest effect on learning, and the ones that lead to the greatest misunderstandings between parents and school professionals. Most common with children and adolescents who have chronic Lyme are intense headaches that can last for days, cognitive, attentional and mood problems, profound fatigue, and difficulty sleeping. Many kids have problems with vision, or visual and auditory overstimulation. Some have a sensitivity to flourescent lighting. Some of these symptoms may be very subtle, so it is difficult for the teachers to realize that they are dealing with a sick child, rather than a child who is daydreaming, or simply trying to avoid his school work. Once a child has been diagnosed, and is undergoing treatment, there are problems produced by the treatment itself. High doses of antibiotics and other medications the child may be taking can produce gastointestinal problems. The child may be uncomfortable, and complaining a lot, particularly of stomach aches. Since young children s