In early June of 2018 elite middle-distance runner Robby Andrews was on fire. Was, unquestionably, at the top of his running game. The then-27-year-old had just run one of his fastest races ever: 3:36 in the 1500 meters at the Oslo Diamond League Meet in Norway, beating out 18-year-old phenom Jakob Ingebrigtsen. Which is why, for Andrews—winner of the 800-meter national outdoor title in high school, holder of a national indoor record in the 800 meters as well as the 1000 meters—what happened two weeks later was such a shock.
June 21. The USATF Championships in Des Moines, Iowa. Andrews felt confident going into the 1500 meters, but mid-race he completely ran out of steam. He placed a disappointing fifth in his heat, not even qualifying for the finals. “I don’t know what happened,” a confused Andrews told reporters after the race.
A few days later he came down with flu-like symptoms. For the next month he battled nasty upper respiratory and sinus infections and 102-degree fevers. Training “just sucked,” says the Olympian. “My paces were nearly 40 seconds slower than they’d been just a few weeks before.” Andrews went to his doctor, who ran tests for everything from Lupus to Lyme, but they all came back negative. “I was told, ‘There is literally nothing wrong with you,’” recalls Andrews. But there had to be, he knew. This could not possibly be all in his head.
Still, he had a contract with Adidas to fulfill, so Andrews traveled to Europe, where he clocked disappointing times: 3:44 in the 1500 meters at the Lignano Meeting International in Italy; 1:52 in the 800 meters in Flanders Cup Kortrijk in Belgium. For the remainder of the summer, Andrews felt constantly wiped out. Normally he would be up at 7:30 to train; now, he couldn’t pry himself out of bed until 10. The few days a week he forced himself to run, he’d get so dizzy and breathless he’d have to quit after 20 minutes. Every afternoon, he napped for up to four hours.
He kept thinking how closely his symptoms resembled those of people he knew who’d had Lyme, including his older sister Kristin (also a runner who is a 2020 Olympic hopeful) and his former roommate, Donn Cabral (a 2012 and 2016 Olympian in the 3,000-meter steeplechase), so Andrews asked to have his Lyme test re-run in September. It came back positive. The doctor wanted to prescribe antibiotics—the standard treatment for Lyme—immediately, but Andrews was worried about the side effects. Instead, he decided to take the advice of a holistic doctor who had helped his sister during her bout with Lyme in 2016.
Once a week Andrews swallowed eight drops, an hour apart—a concentration of herbs such as ashwagandha, rhodiola, turmeric, licorice root, and cordycep mushrooms—that the holistic doctor said would help strengthen his immune system. He soaked his feet in a proprietary blend of herbs that he was told would draw toxins out of his body. He spent more than $1,000 on treatment. He didn’t care if anyone thought he was nuts. He just wanted to feel better.
And he did, for a few months. “My energy went way up. I could run three miles without having to stop,” says Andrews. Then, in February, it all fell apart—an almost overnight, dramatic decline in his physical and emotional health. Fatigue weighed down his body. Headaches crackled through his brain. He was sweating so much at night that he had to change the sheets. And perhaps the worst? “Really depressive thoughts. It was a dark couple of months,” Andrews says. “If it wasn’t for my girlfriend and family, I would have gone days without talking to anyone or leaving the house.” He raced at the U.S. Championships at the end of February on Staten Island, in the 1000 meters. “I felt bad from the first step. Something was wrong.” He clocked in at 2:26—dead last.
Disillusioned with the holistic protocol, Andrews finally accepted a prescription for antibiotics in March. His doctor told him to take them until his symptoms were relieved for a full month. Andrews’s concerns about side effects were valid; the antibiotic gave him severe fatigue and headaches, brain fog and GI issues.
Desperate to make the 2019 world championship team, he ran the 800 meters at the Adrian Martinez Classic in April, only to come in last, again. In June he set his sights on the Princeton Qualifier. “I missed my college roommate’s wedding for it, that is how important this race was for me,” he says. Midway through the 1500-meter race, he dropped out, wheezing and depleted.
Andrews felt like he was out of options. And although he didn’t know it at the time, he had entered the Lyme Wars, a fiercely contested fight about why some Lyme patients develop chronic, relapsing symptoms even after treatment—and what to do about them.
A stealth pathogen. That’s what some researchers call the corkscrew-shaped bacteria—Borrelia burgdorferi—that causes Lyme disease, now one of the fastest growing infectious diseases in America. More than 300,000 new cases are diagnosed every year, according to estimates from the Centers for Disease Control and Prevention (CDC).
Black-legged ticks pick up Borrelia from the birds and small mammals they feed on, then they pass the bacteria into our blood when they feed on us, usually from May to September—prime months for logging miles on wooded trails and grassy park paths.
Removing a tick quickly lowers your risk for infection—it takes an estimated 36 to 48 hours for the arthropod to transmit Borrelia. But once the bacteria enters your body, it is a master of evasion. The Borrelia can spread from the skin to other tissues, which can make it more challenging to treat. Your immune system takes days to a few weeks to recognize any infection, including Lyme. That’s why the standard Lyme test—which checks for antibodies (not the bacteria itself)—can more easily give a false negative test early on, like Andrews’s did.
When your body finally detects Borrelia’s presence, it launches an immune response to fight it, which is what can bring on flu-like symptoms such as sluggishness, fatigue, muscle aches, and joint pain. Runners—especially those who spend hours outside during the summer training for fall marathons—can attribute symptoms to overtraining.
The majority of Lyme cases are easy to treat and cure with a 10- to 28-day course of antibiotics, says Paul Auwaerter, M.D., the president of the Infectious Diseases Society of America (IDSA). Ying Zhang, MD, Ph.D., a leading expert on the Lyme bacteria and a professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health, disagrees. “Lyme can be a really terrible disease and a very complex one. Different patients have different responses, and the disease can manifest in different ways,” says Zhang, who believes Lyme can indeed develop into a chronic form that resists the current antibiotic treatment.
Indeed, for around 20 percent of Lyme patients, a dose of antibiotics isn’t the end of the story. Not by a long shot. They continue to suffer from a variety of symptoms that can last for months, even years: fatigue, headaches, muscle and joint pain, difficulty concentrating, and sleep disruptions. The frequently used medical term for these persistent problems is Post-Treatment Lyme Disease Syndrome (PTLDS). “PTLDS means that we know that a patient has had Lyme, has gotten a course of antibiotics, and doesn’t feel like they’ve bounced back,” says Auwaerter.
PTLDS is often referred to as “chronic” Lyme, a term Auwaerter disparages as a catchphrase for otherwise unexplained fatigue, pain, and neurologic symptoms in people who don’t meet the diagnostic criteria for Lyme—usually obtained by medical history, a positive blood test, and physical exam. But diagnosing Lyme can be tricky. In the first three weeks after infection, the test detects Lyme only 29 to 40 percent of the time and some 30 percent of all Lyme patients, like Andrews, don’t get the telltale bullseye rash.
What really keeps the controversy alive is this: There isn’t yet a sensitive and reliable test that can determine if ongoing symptoms after Lyme treatment are due to an ongoing active infection, says Brian Fallon, MD, director of the Lyme and Tick-Borne Diseases Research Center at Columbia University. Without one, some medical organizations, like the International Lyme and Associated Diseases Society (ILADS), believe chronic symptoms may be due to the persistence of the Lyme bacteria. They suggest that for some patients, the potential risks of treating with antibiotics for longer periods of time outweighs the consequences of an untreated persistent infection. Giving credence to this argument are several recent studies that found Lyme bacteria remained in animals even after they were treated with antibiotics. And in March, Zhang and his colleagues found that a slow-growing form of “persister” Lyme bacteria not only resisted standard single antibiotic treatment, but also caused more severe arthritis-like symptoms in mice. They found that a cocktail of three antibiotics—daptomycin, doxycycline, and ceftriaxone—completely killed the bacteria, and they are now planning clinical trials to see if the result is the same in humans.
On the other hand, groups including the IDSA maintain that symptoms that linger after antibiotic therapy are not due to an ongoing active infection of the Lyme bacteria and therefore should not be treated with additional rounds of antibiotics because they’re unlikely to help. “Six clinical trials have shown that long-term antibiotics—beyond the recommended 28 day—are not effective,” says Auwaerter. Plus, long-term use of antibiotics can lead to serious side effects, such as blood clots and, even, in rare cases, death.
If chronic symptoms are not caused by an active infection, then what? “It could be due to an autoimmune reaction, where a prior infection has triggered an immune reaction that is now acting independently, or it could be that the prior infection changed the brain activation patterns,” Fallon says. “There’s some evidence to support both of these processes.”
While researchers debate, patients are left sick, with lots of questions, and no good answers. “It’s devastating for people’s lives and some are willing to try anything to get better,” Fallon says. After his dismal race in Princeton, Andrews was one of them.
This June, after battling symptoms for nearly a year, Andrews visited Mark Sivieri, M.D., a board-certified family practice doctor in Maryland who is also board certified in integrative medicine (which pairs traditional medicine with complementary therapies). Andrews’s cousin had been seeing him for her own ongoing Lyme symptoms. There was an instant connection: Sivieri had also been a professional runner; he and Andrews even shared a coach at one point. During the three-and-a-half-hour appointment, Sivieri studied Andrews’s previous blood tests. He noticed that, in addition to Lyme, Andrews had tested positive for two other tick-borne infections (Andrews says the doctor who had ordered the test never mentioned them).
Ticks carry and transmit loads of other bacteria, parasites, and viruses beyond Borrelia burgdorferi. A single tick can make a person sick with several diseases at the same time, including Anaplasmosis (a bacterial infection that causes fever, aches, chills, and muscle aches), Babesiosis (a parasitic infection that attacks red blood cells), and Powassan virus (which can cause an infection in the brain and can even be deadly). And not all doctors check for these when they are focused on Lyme; those who do test for them may believe the antibiotics prescribed for Lyme will be enough to wipe out the co-infections. The estimates for co-infection rates with Lyme disease can widely range anywhere from about two to 40 percent. And not only are some, such as Powassan, more dangerous than Lyme, but simultaneous infection, some research suggests, may make Lyme harder to treat or recognize, and might affect how the immune system responds to Burgdorferi.
Sivieri put Andrews on a 60-day course of the two antibiotics he’d previously been taking to kill the bacteria for Lyme; he also prescribed a medication to wipe out the co-infections. “He said the night sweats and the shortness of breath, that’s what the Babesia parasite does, it eats your red blood cells and prevents the oxygen from moving around your body.” That’s obviously a big concern for runners. “I couldn’t breathe well when running, right from the start,” says Andrews. “And I’m a trained athlete.”
Sivieri’s tests showed that Andrews was also sensitive to gluten and dairy; he recommended avoiding them to help take pressure off his immune system. “My stereotypical Italian grandma was aghast when I told her no more pasta and chicken parmesan,” Andrews says. “That was a big transition for me. But if that’s what’s was going to get me better, I didn’t care at all.”
Sivieri then turned to natural remedies to help strengthen Andrews’s immune system, putting him on adaptogenic herbs—said to help with all types of stress—such as curcumin which can reduce the inflammatory response caused by Lyme.
Using alternative medicine to nuke hard-to-kill bugs might sound like folklore, but science is starting to back the theory: Zhang recently found that, in laboratory dish tests, 10 oils—including from garlic cloves, myrrh trees, thyme leaves, allspice berries, and cumin seeds—showed strong killing activity against the non-growing and slow-growing “persister” forms of the Lyme bacteria, even better than standard antibiotics. “We need to do proper clinical trials, to see how to use them more effectively without being toxic but [in the future, I believe that] the more effective treatment is going to come from a combined approach of antibiotics with essential oils or natural products.”
The combination of traditional and alternative medicine helped Andrews. The past year has been brutal, but he finally feels like his old self again. “I wake up in the morning and I have energy all day,” he says. “I’m not sweating at night, [there are] no headaches. The depressive thoughts are gone. I’m training at full capacity.” He plans to run the indoor season in 2020, still in hopes of achieving the Olympic qualifying time.
He stopped taking antibiotics in mid-August, now it’s complementary treatments—including vitamin C for his adrenals and immune system and curcumin for inflammation. He still avoids gluten and dairy and is content to continue the regimen for the near future. The supplements could be pointless, but he’s not going to chance it. “It seriously feels like I have my life back,” he says. “This is me. I’m back to me.”
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