Do you have to feel worse before you get better from Lyme disease? And could pushing through severe Herxheimer reactions actually make recovery more difficult?

In this LIVE from ILADS interview, Tick Boot Camp co-host Rich reunites with Dr. Casey Kelley, MD, a functional medicine physician, Lyme disease survivor, and founder of Case Integrative Health in the Chicago area, for an important conversation about Jarisch-Herxheimer reactions, Lyme disease treatment, inflammation, neuroplasticity, and the physical and emotional rehabilitation involved in chronic illness recovery.

Recorded at the 2025 International Lyme and Associated Diseases Society (ILADS) Conference in San Antonio, Texas, the discussion explores one of the most debated questions in the Lyme disease community: Is a Herxheimer reaction a necessary sign that treatment is working, or can excessive inflammation interfere with healing?

Dr. Kelley draws on her experience as both a physician and former Lyme disease patient to explain what a Herxheimer reaction is, why symptoms may temporarily worsen during treatment, and why she believes aggressive treatment should not come at the expense of a patient’s ability to function.

Rich also introduces Tick Boot Camp’s PARM healing framework: Prehabilitation, Assist, Rehabilitate, and Maintenance, which reflects patterns observed through hundreds of patient interviews.

Together, they explore why recovery is rarely linear, why patients need individualized treatment plans, and how nervous system regulation and neuroplasticity may play a role in rehabilitation.

The conversation also celebrates an encouraging milestone: Dr. Kelley is expanding Case Integrative Health to improve patient access to care.

Meet Dr. Casey Kelley, MD

Dr. Casey Kelley, MD, is a functional medicine physician and founder of Case Integrative Health, a Chicago-area practice focused on complex chronic illnesses.

Her clinical interests include Lyme disease and associated infections, immune dysfunction, inflammation, and integrative approaches to patient care.

Dr. Kelley also brings personal experience to her work.

As a former Lyme disease patient, she understands what it feels like to experience debilitating symptoms while appearing outwardly healthy.

During the interview, she recalls living with postural orthostatic tachycardia syndrome (POTS), which made standing and everyday activities difficult.

Her recovery journey helped shape her approach to individualized treatment and rehabilitation.

Dr. Kelley has appeared on Tick Boot Camp multiple times, sharing her experiences and insights into chronic illness recovery.

Case Integrative Health Is Expanding

Rich begins by congratulating Dr. Kelley on the growth of her medical practice.

At the time of the interview, Case Integrative Health had two locations, with plans to open a third.

Dr. Kelley explains that the expansion is primarily about improving access to care.

Her practice offers intravenous therapies, which may require patients to attend appointments regularly.

In the Chicago area, traffic and travel distances can make frequent visits challenging, especially for people experiencing significant fatigue or other chronic symptoms.

She hopes additional locations will reduce some of those barriers.

The conversation highlights an important issue for people with chronic illness: treatment access involves more than finding a healthcare provider. Transportation, physical limitations, appointment frequency, and financial resources can all affect a patient’s ability to receive care.

What Is a Jarisch-Herxheimer Reaction?

One of the main topics of the interview is the Jarisch-Herxheimer reaction, commonly called a Herx.

Dr. Kelley explains that the reaction was originally described in patients receiving treatment for syphilis, another infection caused by spirochete bacteria.

A Jarisch-Herxheimer reaction is an acute inflammatory response that can occur after antimicrobial treatment for certain bacterial infections.

In Lyme disease, it may involve a temporary worsening of symptoms after antibiotics are started.

Dr. Kelley describes patients experiencing:

• Increased fatigue
• Worsening pain
• Flu-like symptoms
• Generalized discomfort
• A feeling resembling a severe hangover
• Temporary worsening of existing symptoms

She explains that these reactions can vary considerably between individuals.

Some people experience relatively mild discomfort, while others report more significant symptoms.

Importantly, not every symptom flare during treatment is a Jarisch-Herxheimer reaction. Medication side effects, allergic reactions, disease progression, and other medical complications can also cause worsening symptoms.

Is Herxing a Good Sign That Lyme Treatment Is Working?

Rich asks Dr. Kelley about a common belief in the Lyme disease community: that experiencing a strong Herxheimer reaction means treatment is successfully eliminating an infection.

Some patients believe they need to push through increasingly severe symptoms to make progress.

Dr. Kelley challenges that assumption.

She explains that although inflammatory reactions can occur during treatment, more intense symptoms do not necessarily mean better outcomes.

In her clinical approach, the goal is not to make patients as uncomfortable as possible.

Instead, she tries to balance treatment with the patient’s ability to tolerate it.

A severe Herxheimer reaction is not required for successful Lyme disease treatment, and the intensity of a reaction is not a reliable measure of treatment effectiveness.

Dr. Kelley emphasizes that treatment should be individualized and that patients should communicate significant symptom changes to their healthcare professionals.

Can You Recover From Lyme Disease Without Herxing?

Dr. Kelley describes patients who improve without experiencing noticeable Herxheimer reactions.

She acknowledges that some people become concerned when treatment does not cause an obvious symptom flare.

They may wonder whether their medication is working or whether they need a more aggressive approach.

Dr. Kelley explains that she has seen patients make progress without experiencing significant treatment-related worsening.

Her message is encouraging for patients who fear they must endure severe discomfort to recover.

Not experiencing a Herxheimer reaction does not mean treatment is failing.

Likewise, experiencing a reaction does not establish that a treatment is effective.

Treatment response should be evaluated through appropriate clinical assessment rather than symptom worsening alone.

How Much Herxing Is Too Much?

Rich asks Dr. Kelley where she draws the line between manageable treatment-related discomfort and symptoms that warrant changing the treatment plan.

Dr. Kelley explains that she becomes concerned when patients experience severe functional limitations.

Examples include being unable to get out of bed, care for children, complete essential activities, or think clearly.

She believes prolonged, debilitating symptom flares should prompt reassessment rather than automatic encouragement to push harder.

In the interview, Dr. Kelley discusses supportive approaches used in her practice, including measures intended to address discomfort and inflammation.

However, supplements, detoxification products, and other supportive therapies should not be assumed to prevent or treat a true Jarisch-Herxheimer reaction.

Severe, persistent, or unexpected symptoms during treatment require medical evaluation. Patients should not independently stop, increase, or reduce prescribed medications without appropriate clinical guidance.

Why More Aggressive Treatment Is Not Always Better

Dr. Kelley explains that patients differ significantly in their tolerance of medications and other interventions.

Some patients can tolerate complex treatment regimens.

Others experience substantial symptoms or adverse effects from relatively small changes.

She emphasizes that treatment decisions should account for the individual patient’s medical history, symptoms, functional status, and response.

Rich asks whether reducing treatment intensity might slow the process of addressing an infection.

Dr. Kelley suggests that treatment intensity and overall recovery are not always the same thing.

Her concern is that excessive symptom burden may create additional challenges that patients must overcome during rehabilitation.

The broader takeaway is that successful care requires balancing effectiveness, safety, and tolerability.

Patients should not interpret worsening symptoms as a reason to continue an intervention without reassessment.

Why Dr. Kelley’s Personal Lyme Disease Experience Matters

Rich asks whether physicians who have personally experienced Lyme disease bring a different perspective to patient care.

Dr. Kelley believes lived experience can deepen a clinician’s empathy and understanding.

She recalls struggling to sit upright, think clearly, and complete ordinary activities while appearing healthy to others.

Those experiences helped her understand how difficult invisible illnesses can be.

However, she also emphasizes that physicians do not need to have experienced a particular disease to treat it effectively.

She believes the most important qualities include clinical knowledge, compassion, careful observation, and the ability to tailor care to each patient.

Her perspective highlights the value of combining medical expertise with genuine understanding of the patient’s experience.

Why Lyme Disease Recovery Is Not Linear

Rich and Dr. Kelley discuss how recovery from prolonged illness often involves periods of progress followed by setbacks.

Some patients improve steadily.

Others experience fluctuating symptoms, changing functional abilities, or periods when additional medical evaluation is needed.

Dr. Kelley explains that these experiences can be especially frustrating when patients expect recovery to follow a predictable timeline.

She encourages recognizing progress even when it occurs gradually.

The discussion also emphasizes that patients may need different forms of support at different stages of their journey.

Medical treatment, physical rehabilitation, psychological support, and ongoing prevention can all have roles depending on the individual’s circumstances.

Introducing Tick Boot Camp’s PARM Healing Framework

Rich introduces a framework developed from patterns observed through Tick Boot Camp’s extensive patient interviews.

The framework is called PARM, representing four interconnected stages of recovery.

P — Prehabilitation

Prehabilitation involves preparing and supporting the patient before or alongside more intensive treatment.

Depending on the person’s medical needs, this may include addressing nutritional concerns, sleep disturbances, physical limitations, or other health conditions.

The goal is to improve readiness and tolerance for appropriate medical care.

A — Assist

Rich uses the term Assist to emphasize supporting the body’s response to illness rather than viewing treatment exclusively as a battle against microbes.

For infections requiring antimicrobial therapy, appropriate medications remain essential.

Other supportive interventions may help address symptoms or coexisting health concerns.

R — Rehabilitate

Rehabilitation involves addressing functional limitations that may remain during or after treatment.

This can include physical conditioning when medically appropriate, occupational rehabilitation, and support for cognitive or emotional challenges.

For some patients, rehabilitation may require a gradual, individualized approach.

M — Maintenance

Maintenance focuses on sustaining improvements, managing ongoing health needs, and reducing preventable risks.

For Lyme disease, this includes continued tick bite prevention and prompt evaluation of possible reinfection.

Rich emphasizes that the framework is not necessarily linear.

Patients may need to revisit different aspects of care as their circumstances change.

PARM is Tick Boot Camp’s observational framework, not a clinically validated Lyme disease treatment protocol.

Celebrating Recovery: Dr. Kelley’s Disco Balls

Dr. Kelley shares a tradition from her medical practice.

Her team refers to patients who have made meaningful progress in rehabilitation as disco balls.

The name reflects their desire to celebrate recovery milestones.

Dr. Kelley explains that working with complex chronic illness can be emotionally demanding for patients and healthcare professionals alike.

Recognizing meaningful improvements helps reinforce hope and acknowledges the work patients have invested in their recovery.

For someone who has spent years struggling with basic activities, being able to walk, exercise, work, or participate in family life can represent an extraordinary achievement.

Dr. Kelley believes these milestones deserve celebration.

Recovering From POTS: Learning to Trust the Body Again

Dr. Kelley shares a personal example from her experience with POTS.

At one point, standing was frightening because she feared fainting and injuring herself.

Even after her physical condition improved, she needed time to regain confidence in activities that had previously felt unsafe.

She describes gradually becoming more comfortable standing, walking, and eventually returning to exercise.

Her experience illustrates how recovery from a prolonged medical condition can involve both physical and emotional adjustment.

The fear of symptoms returning may persist even after substantial improvement.

For patients with POTS or other conditions involving exercise intolerance, rehabilitation must be adapted to their medical status and should not involve pushing through unsafe symptoms.

Fear of Relapse After Lyme Disease

Rich discusses another challenge that can arise after significant recovery: the fear of becoming seriously ill again.

He shares Tick Boot Camp co-founder Matt Sabatello’s experience of progressing from long-distance running to being bedbound during his Lyme disease journey.

After a prolonged period of illness, Matt gradually regained significant physical function and returned to running.

Rich celebrates that progress while acknowledging that the fear of relapse can remain.

The discussion highlights an important reality for people recovering from chronic illness.

Regaining physical abilities does not automatically eliminate the emotional impact of having lost them.

Dr. Kelley recognizes that rebuilding confidence may take time.

Supportive rehabilitation can help patients gradually resume activities when medically appropriate.

Neuroplasticity and Brain Retraining During Rehabilitation

Rich asks Dr. Kelley about the role of neuroplasticity in recovery.

Neuroplasticity refers to the nervous system’s ability to adapt and change through experience, learning, and repeated activity.

Dr. Kelley discusses how prolonged pain, illness, and stressful experiences may influence patterns of attention, fear, and symptom perception.

She believes some patients may benefit from learning to respond differently to certain sensations and situations.

Rich and Dr. Kelley emphasize that these experiences do not mean symptoms are imaginary.

Pain and other symptoms are real, even when nervous system processes influence how they are experienced.

Research supports certain psychologically informed approaches for managing chronic pain and related functional difficulties.

However, brain retraining is not an established cure for Lyme disease, persistent infection, POTS, or all symptoms following treatment.

Its potential role should be evaluated alongside appropriate medical assessment and individualized care.

For related conversations, explore Tick Boot Camp’s interview with Ben Ahrens about neuroplasticity.

Why Medical Validation Matters When Discussing Brain Retraining

Dr. Kelley acknowledges that conversations about the brain and nervous system can be difficult for people who have experienced medical dismissal.

Many patients have previously been told that their symptoms are psychological or that nothing is physically wrong.

As a result, suggestions involving brain retraining may feel invalidating.

Dr. Kelley makes an important distinction.

She recognizes that patients can experience genuine physiological illness while also benefiting from strategies that address pain processing, fear, stress responses, or functional limitations.

These approaches are not mutually exclusive.

A patient can need medical treatment for a physical condition and also benefit from supportive rehabilitation.

The key is ensuring that brain-based interventions are not used to dismiss symptoms or discourage further medical investigation when appropriate.

Finding Purpose After Chronic Illness

Rich and Dr. Kelley also discuss how difficult health experiences can change a person’s perspective on life.

For some patients, recovery creates opportunities to reconsider priorities, relationships, and personal goals.

Rich reflects on how the Lyme disease journey has influenced Tick Boot Camp’s advocacy mission.

Dr. Kelley’s experience similarly shaped her decision to help others navigating complex illnesses.

They acknowledge that finding meaning can be an important part of some people’s recovery stories.

However, patients should not feel obligated to discover a greater purpose in their suffering.

Everyone deserves compassionate care regardless of how they interpret their illness.

How to Learn More About Dr. Casey Kelley

Dr. Kelley is the founder of Case Integrative Health, serving patients in the Chicago area.

Her practice focuses on functional and integrative approaches to complex chronic illness.

During the interview, she discusses the practice’s expansion and its efforts to improve access to services for patients who may struggle with frequent travel.

Visit Case Integrative Health for information about the medical team, available services, locations, and appointments.

Key Takeaways

• A Herxheimer reaction is an inflammatory response associated with treatment of certain infections. It can cause temporary worsening of symptoms.
• Herxing is not required for recovery. Patients can improve without experiencing a noticeable Jarisch-Herxheimer reaction.
• More severe symptoms do not prove treatment is more effective. Significant or prolonged worsening should prompt medical reassessment.
• Treatment must be individualized. Patients differ in medical history, medication tolerance, symptoms, and rehabilitation needs.
• Dr. Kelley’s lived experience informs her care. Her history with Lyme disease and POTS gives her personal insight into invisible illness.
• Recovery may involve several overlapping stages. Tick Boot Camp’s PARM framework describes prehabilitation, assistance, rehabilitation, and maintenance.
• Physical rehabilitation can be important. Regaining strength, mobility, and confidence may take time.
• The fear of relapse can persist after improvement. Emotional recovery may require support alongside physical rehabilitation.
• Neuroplasticity may contribute to symptom management. Evidence varies by condition, and brain retraining should not replace medical treatment.
• Progress deserves celebration. Dr. Kelley’s disco ball tradition recognizes meaningful patient recovery milestones.
• Hope and realistic expectations can coexist. Improvement is possible, but recovery pathways differ and no treatment guarantees a particular outcome.

About This LIVE from ILADS Interview

Recorded at the 2025 International Lyme and Associated Diseases Society Conference in San Antonio, Texas, this conversation features Dr. Casey Kelley, MD, founder of Case Integrative Health and a returning Tick Boot Camp guest.

Rich and Dr. Kelley discuss Jarisch-Herxheimer reactions, the risks of overly aggressive treatment, individualized Lyme disease care, rehabilitation, neuroplasticity, and the importance of celebrating recovery milestones.

The interview also introduces Tick Boot Camp’s PARM framework and explores why healing from prolonged illness may involve much more than addressing an infection alone.

Discover additional physician interviews and conference conversations through Tick Boot Camp’s LIVE from ILADS podcast series.