What do you do when you’re sick, your Lyme disease test comes back negative, and your doctor tells you everything is fine—even though you know something is wrong?
For many people living with Lyme disease, tick-borne infections, and complex chronic illness, the search for answers can involve years of unexplained symptoms, multiple specialists, frustrating medical appointments, and feeling dismissed by the healthcare system.
But what if improving the patient-doctor relationship could become one of the most important steps toward finding answers?
In this LIVE from ILADS episode of the Tick Boot Camp Podcast, co-host Rich Johannesen sits down with Dr. Kirsten P. FitzGerald, DNP, FNP-BC, a board-certified family nurse practitioner and functional medicine provider based in Ridgefield, Connecticut, to discuss Lyme disease awareness, missed diagnoses, patient advocacy, and the importance of building collaborative relationships between patients and healthcare professionals.
Recorded at the 2025 International Lyme and Associated Diseases Society (ILADS) Conference in San Antonio, Texas, this conversation explores how Dr. FitzGerald transitioned from conventional primary care into functional and integrative medicine after recognizing that some patients with persistent symptoms were not finding the answers or support they needed.
Dr. FitzGerald shares her experiences working with patients affected by Lyme disease, long COVID, mast cell-related concerns, and pediatric neuroinflammatory conditions, including PANS and PANDAS.
Together, Rich and Dr. FitzGerald develop a practical framework for helping patients prepare for medical appointments, communicate more effectively, participate in treatment decisions, and work with their providers toward better health outcomes.
Their central message: Patients deserve to be heard, and meaningful progress often begins when patients and clinicians work together as partners.
Meet Dr. Kirsten P. FitzGerald, DNP, FNP-BC
Dr. Kirsten P. FitzGerald is a Doctor of Nursing Practice and board-certified Family Nurse Practitioner with more than 25 years of healthcare experience.
She is the founder of FitzGerald Health and Wellness, an integrative and functional medicine practice in Ridgefield, Connecticut.
She also collaborates with the team at New Frontiers Functional Medicine & Nutrition, led by Dr. Kara Fitzgerald in Sandy Hook, Connecticut, and works alongside pediatric naturopathic physician Dr. Lindsey Wells, ND, in Trumbull, Connecticut.
Her clinical interests include:
- Lyme disease and tick-borne infections
- Persistent and complex chronic symptoms
- Long COVID and post-infectious illness
- Functional and integrative medicine
- Mast cell activation syndrome (MCAS)
- PANS and PANDAS
- Metabolic health and lifestyle medicine
- Patient education and collaborative care
Dr. FitzGerald grew up on a trout farm in Connecticut and has spent much of her life around animals, including horses, chickens, cats, and dogs.
Despite living in a region historically associated with Lyme disease, she explains that her understanding of the complexity of tick-borne illness changed significantly after attending a professional presentation.
That experience ultimately helped redirect her medical career.
Learn more about Dr. Kirsten FitzGerald and her clinical background.
From Conventional Primary Care to Functional Medicine
Dr. FitzGerald describes a pivotal moment at an advanced practice registered nurse (APRN) conference in Connecticut.
A presentation by fellow clinician Pam Cipriano challenged her understanding of Lyme disease and prompted her to reconsider patients she had previously encountered.
She began thinking about people whose Lyme disease test results had been negative despite symptoms and exposure histories that continued to raise clinical questions.
Dr. FitzGerald explains that conventional primary care often relies on established diagnostic pathways, laboratory testing, and specialist referrals.
These tools are essential, but she became increasingly concerned about patients whose symptoms remained unexplained after multiple evaluations.
During the COVID-19 pandemic, she encountered additional patients struggling with persistent symptoms, including long COVID.
One experience was particularly influential.
A patient who was also a nurse became emotional during an appointment and asked Dr. FitzGerald to stop sending her to additional specialists.
The patient wanted someone to take responsibility for understanding her overall health picture rather than continuing a cycle of referrals without satisfactory answers.
For Dr. FitzGerald, that conversation reinforced the need to expand her knowledge and explore different approaches to complex chronic illness.
She eventually transitioned toward functional and integrative medicine, including working with Dr. Kara Fitzgerald’s New Frontiers team.
The conversation illustrates why continuity of care, clinical curiosity, and thoughtful follow-up matter when patients experience symptoms that do not fit neatly into one diagnosis.
Why Lyme Disease Can Be Difficult to Recognize
Dr. FitzGerald expresses frustration that Lyme disease and other tick-borne illnesses are not always considered during evaluations of patients with unexplained symptoms—even in Connecticut.
She describes how patients may visit several specialists for seemingly unrelated problems without anyone initially recognizing a possible connection.
Symptoms discussed include:
- Persistent fatigue
- Brain fog and cognitive difficulties
- Headaches and migraines
- Tremors and neurological complaints
- Joint and muscle pain
- Changes in mood or irritability
- Symptoms initially attributed to aging or menopause
- Other unexplained changes in physical functioning
Dr. FitzGerald explains that patients may see orthopedic specialists for pain, neurological specialists for tremors, and other providers for fatigue or cognitive concerns.
Each specialist may focus on a particular symptom or organ system.
Her concern is that clinicians can sometimes miss the broader pattern.
Could several seemingly unrelated symptoms have a common explanation?
Lyme disease and other tick-borne infections are among the conditions that may warrant consideration when a patient’s history and clinical findings support that possibility.
However, these symptoms are not specific to Lyme disease. Many other medical conditions can produce similar complaints, and appropriate evaluation should consider alternative explanations.
Dr. FitzGerald’s message is not simply to test everyone for Lyme disease, but to remain attentive to exposure history, symptom patterns, and unresolved clinical questions.
For more information about the strengths and limitations of available tests, explore Tick Boot Camp’s Lyme Disease Testing Resource.
When Lyme Disease Tests Are Negative but Symptoms Continue
One of the challenges discussed in the episode is the interpretation of Lyme disease testing.
Dr. FitzGerald recalls patients whose initial tests were negative even though she remained concerned about the possibility of tick-borne illness.
Rich and Dr. FitzGerald discuss the frustration patients can experience when a negative test result ends the conversation despite ongoing symptoms.
Lyme disease testing has important limitations, particularly early in infection, when antibodies may not yet be detectable.
At the same time, persistent symptoms and negative testing do not automatically establish an undiagnosed Lyme infection.
The appropriate next step depends on the patient’s symptoms, exposure history, examination, timing of testing, and other potential diagnoses.
This episode encourages patients to ask informed questions about test results rather than assuming that one result always tells the complete story.
Why Dr. FitzGerald Attends ILADS Conferences
Dr. FitzGerald explains that attending the ILADS conference helps her expand her understanding of tick-borne illnesses and connect with healthcare professionals who encounter complex cases.
She values opportunities to learn from other clinicians, explore research, and discuss diagnostic challenges.
She also hopes to bring information back to her colleagues in conventional medical settings.
Throughout the interview, Dr. FitzGerald emphasizes that changing medical practice requires education, open dialogue, and a willingness to consider new evidence.
She believes that increasing awareness among primary care providers, nurse practitioners, pediatricians, and other healthcare professionals can help patients receive more informed evaluations.
The conference also provides an opportunity to connect with clinicians who share her interest in patient-centered care.
The Patient-Doctor Relationship: A Partnership, Not a One-Way Conversation
The conversation takes an important turn when Rich asks Dr. FitzGerald a question that patients do not always hear:
What can patients do to help their doctors provide better care?
Rather than focusing exclusively on the shortcomings of the healthcare system, Rich suggests that patients may benefit from approaching medical appointments as active participants.
Dr. FitzGerald agrees.
She explains that patients can contribute valuable information that may not be immediately apparent from laboratory results or a brief office visit.
Together, they discuss how a collaborative relationship allows both the patient and clinician to make better use of their time, knowledge, and resources.
This does not mean patients are responsible for diagnostic errors, inadequate access to care, or dismissive treatment.
Instead, the conversation offers practical ways for patients to strengthen communication and advocate for themselves within the healthcare system.
Step 1: Prepare Thoroughly Before Your Medical Appointment
Dr. FitzGerald explains that her initial consultations typically last at least two hours and sometimes extend to three hours.
Before those appointments, she asks patients to complete detailed medical history and intake forms.
She acknowledges that this paperwork can feel overwhelming, particularly for patients already struggling with fatigue, brain fog, or other symptoms.
However, she explains that comprehensive intake information helps her begin understanding the patient’s health history before they meet.
The forms may reveal important details about previous illnesses, symptoms, medications, treatments, and medical events.
They also allow her to identify questions she wants to explore during the appointment.
Rich shares his own experience completing extensive intake paperwork before seeing a Lyme-focused physician.
Initially, he found the process frustrating.
But as he worked through the forms, he began recalling medical events and health concerns he had not previously considered relevant.
The experience changed how he approached his medical care.
Instead of arriving at an appointment expecting the doctor to gather all the information and provide an immediate solution, he began seeing himself as an active partner.
Dr. FitzGerald encourages patients to approach medical history forms thoughtfully.
Practical Ways to Prepare
Before an appointment, consider organizing:
- A timeline of symptoms and when they began
- Previous diagnoses and medical evaluations
- Important laboratory results and imaging reports
- Current medications and supplements
- Previous treatments and responses
- Relevant travel, tick exposure, and environmental history
- Changes in physical, cognitive, or emotional functioning
- Questions and concerns you want to discuss
A trusted family member or caregiver may be able to help patients who have difficulty organizing information because of illness.
The goal is not to create a perfect medical record. It is to help your healthcare provider understand your experience as accurately as possible.
Step 2: Share Your Complete Story Without Embarrassment
Dr. FitzGerald offers one of the episode’s most important messages:
“Don’t hold back. Put it all on the table.”
She encourages patients to discuss their symptoms openly, even when those symptoms feel embarrassing, confusing, or difficult to explain.
She wants to know how patients feel physically and emotionally, what has changed over time, and what they have experienced during previous medical evaluations.
Dr. FitzGerald acknowledges that many patients arrive at her office after disappointing encounters with other healthcare professionals.
Some are exhausted.
Others are frustrated or fearful.
Some become emotional while describing years of illness.
She explains that these reactions are welcome in her office and that she keeps tissues available for patients who need them.
Patients should not feel pressured to minimize symptoms, hide concerns, or present themselves as doing better than they actually are.
Honest communication helps clinicians understand both the medical and personal impact of illness.
For people who have repeatedly felt dismissed, finding a healthcare professional who listens can be an important part of rebuilding trust.
Step 3: Participate in Developing Your Treatment Plan
Rich and Dr. FitzGerald agree that patients should be involved in decisions about their healthcare.
A treatment plan should not simply be a collection of instructions handed to someone at the end of an appointment.
Instead, patients should understand what is being recommended, why it is being recommended, and what outcomes they should monitor.
Important questions may include:
- What diagnoses are we considering?
- What is the purpose of this test or treatment?
- What benefits and risks should I understand?
- What alternatives are available?
- How will we measure progress?
- What should I do if symptoms change?
- When should I follow up?
Dr. FitzGerald emphasizes that patients need to understand their responsibilities and feel comfortable participating in decisions.
Rich describes this as a partnership in which both sides contribute.
The clinician brings medical training, diagnostic reasoning, and professional judgment.
The patient brings personal experience, symptom history, preferences, and feedback about how treatment affects daily life.
Working together can help create a plan that is both medically appropriate and realistic for the individual.
Step 4: Follow Through—and Speak Up When Something Isn’t Working
Dr. FitzGerald explains that medical appointments are only one part of the care process.
Patients spend most of their time outside the clinic, where they must manage medications, follow recommendations, and monitor changes in their health.
She discusses the importance of following agreed-upon treatment plans, including lifestyle recommendations when appropriate.
However, she also stresses that patients should not continue suffering silently when a treatment is not helping.
If symptoms worsen, side effects develop, or a plan becomes difficult to follow, patients should contact their healthcare provider.
Rich and Dr. FitzGerald emphasize that follow-up communication is an essential part of the partnership.
Patients should share both improvements and setbacks.
Dr. FitzGerald recalls how meaningful it can be when someone contacts her simply to say they are feeling better.
These updates provide feedback about the patient’s experience and help clinicians understand how their recommendations are working.
Progress should be evaluated through ongoing communication—not assumptions.
Why Lyme Patients May Need Additional Support
Rich asks whether people with Lyme disease should approach medical appointments differently from other patients.
Dr. FitzGerald explains that many people seeking care for suspected tick-borne illness have already experienced years of frustration.
Some have been told their symptoms are caused by stress, aging, menopause, or other conditions.
Others have visited multiple specialists without finding a clear explanation.
These experiences can make patients hesitant to trust another healthcare professional or share their complete history.
Dr. FitzGerald encourages patients to describe their symptoms comprehensively rather than presenting each concern as an isolated problem.
She believes that understanding the full pattern can help clinicians determine whether Lyme disease, another tick-borne illness, or a different condition warrants investigation.
For patients who have struggled to find answers, she emphasizes the importance of working with someone willing to listen, explain their reasoning, and consider appropriate next steps.
Lyme Disease, Brain Fog, and Neuropsychiatric Symptoms
Another important discussion involves the neurological and psychological dimensions of Lyme disease and complex chronic illness.
Rich introduces Tick Boot Camp’s patient-informed description of Lyme disease as:
A polymicrobial, multisystemic, chronic infectious or post-infectious disease.
Dr. FitzGerald responds positively but suggests that neurological and neuropsychiatric symptoms deserve greater emphasis.
She discusses concerns involving cognition, mood, and neurological functioning.
Rich acknowledges the importance of these symptoms and explains how Tick Boot Camp’s understanding has evolved through interviews with patients and healthcare professionals.
The conversation raises broader questions about how clinicians distinguish active infection, post-infectious symptoms, other tick-borne diseases, and unrelated medical conditions.
Neurological manifestations of Lyme disease are recognized, and some patients experience persistent symptoms after recommended treatment. However, the mechanisms and appropriate management of persistent symptoms remain areas of ongoing research and clinical discussion.
Tick Boot Camp’s proposed description is an advocacy framework discussed during the interview, not an established consensus medical definition.
For another perspective on neurological symptoms and cognitive recovery, explore Dr. Jacqueline Becker’s work on brain fog and cognitive rehabilitation.
PANS, PANDAS, and Pediatric Complex Chronic Illness
Dr. FitzGerald also discusses collaborating with Dr. Lindsey Wells, ND, in Trumbull, Connecticut.
Their work includes supporting families navigating PANS and PANDAS.
These conditions involve sudden-onset or significant neuropsychiatric symptoms in children and can present complex diagnostic and treatment challenges.
The interview does not explore pediatric testing or treatment protocols in detail, but Dr. FitzGerald’s collaboration reflects her interest in the relationship between physical illness and neuropsychiatric symptoms.
For a more detailed discussion, listen to Tick Boot Camp’s interview with Dr. Lindsey Wells on Lyme disease, autism, PANS/PANDAS, and folate receptor alpha autoantibodies.
Long COVID, MCAS, and Overlapping Symptoms
Dr. FitzGerald describes how her interest in complex chronic illness expanded during the COVID-19 pandemic.
She encountered patients experiencing persistent symptoms after infection and became increasingly interested in understanding why some individuals were not recovering as expected.
She also identifies mast cell-related conditions among her clinical interests.
Lyme disease, long COVID, and other chronic conditions may share symptoms such as fatigue, cognitive difficulties, sleep disturbances, and reduced physical functioning.
These similarities can complicate diagnosis.
The presence of overlapping symptoms does not mean the conditions share the same cause or require the same treatment.
The discussion reinforces the importance of individualized evaluation and careful consideration of alternative diagnoses.
For a related conversation, listen to Dr. Tania Dempsey on MCAS, chronic Lyme disease, inflammation, and precision medicine.
Why Tick Prevention Must Become Part of Everyday Life
Toward the end of the interview, Rich shares stories about growing up on Long Island in a family that practiced routine tick checks.
He recalls how his mother required the children to check for ticks before entering the main living areas of their home.
Although some of the tick removal methods used decades ago were based on outdated advice, the family’s commitment to regular tick checks became a lifelong habit.
Rich explains that he continues checking for ticks regularly and has passed these habits along to his family.
Dr. FitzGerald relates to this experience because she grew up in Connecticut around animals and outdoor environments where ticks are common.
They discuss how families can make tick prevention part of everyday routines.
Important prevention practices include:
- Checking yourself, children, and pets for ticks after outdoor exposure
- Using appropriate EPA-registered tick repellents
- Wearing protective clothing in tick habitats
- Using veterinarian-recommended tick prevention products for pets
- Removing attached ticks promptly with fine-tipped tweezers
- Seeking medical advice when a tick bite presents a meaningful risk or symptoms develop
Do not use petroleum jelly, heat, matches, or burning to remove attached ticks. These methods are not recommended.
Rich’s experience also illustrates why tick identification matters: different tick species are associated with different health risks.
Testing a removed tick may identify organisms in that tick, but it cannot determine whether a person has become infected and should not replace clinical evaluation.
For step-by-step prevention and post-bite guidance, visit the Tick Boot Camp Tick Bite Blueprint.
How One Tick Bite Helped Inspire Tick Boot Camp
Rich shares a personal story about discovering an engorged tick and seeking medical care.
At the time, he had already been involved in helping a friend navigate serious challenges related to chronic Lyme disease.
His friend’s experience had motivated him to learn more about tick-borne illness.
When Rich later found a tick attached to his own body, he became concerned about the possibility of infection.
He describes difficulty obtaining a timely appointment and frustration with the medical advice he received.
The tick was eventually identified as a lone star tick.
Rich also recounts sending the tick for laboratory analysis and receiving a report identifying an infectious organism.
His experience reinforced how important it is for patients and clinicians to understand tick species, potential infections, testing limitations, and appropriate post-bite care.
The story also helped motivate the creation of Tick Boot Camp as a platform dedicated to Lyme disease awareness, education, and patient advocacy.
Lone star ticks are associated with several health concerns, including ehrlichiosis and alpha-gal syndrome, but are not established vectors of the bacterium responsible for classic Lyme disease.
Additionally, finding a pathogen in a tick does not establish transmission to the person bitten.
Changing the Conversation About Lyme Disease
Throughout the interview, Dr. FitzGerald expresses appreciation for Tick Boot Camp’s efforts to educate patients and healthcare professionals.
She believes greater awareness can help people recognize potential tick exposures, ask better questions, and seek appropriate medical evaluation.
Rich emphasizes that Tick Boot Camp was built around patient experiences and a desire to improve the way people navigate complex chronic illness.
Their conversation moves beyond identifying problems in healthcare and toward practical solutions.
How can patients prepare more effectively?
How can clinicians listen more carefully?
How can both sides communicate with greater honesty and respect?
And how can education help prevent future tick-borne infections?
For Dr. FitzGerald, these questions are central to improving patient care.
Key Takeaways From Dr. Kirsten FitzGerald
- Negative Lyme disease testing does not always end the diagnostic discussion. Test timing, exposure history, symptoms, and alternative diagnoses all matter.
- Patients deserve to be heard. Persistent symptoms should be taken seriously, even when the cause is not immediately clear.
- Prepare before medical appointments. A detailed medical history can help clinicians identify patterns and make informed testing decisions.
- Be open about your symptoms. Patients should feel comfortable discussing physical, cognitive, and emotional concerns.
- Build a collaborative relationship. Patients and healthcare providers can work together to understand treatment options and establish realistic goals.
- Understand your care plan. Ask questions about recommendations, potential risks, and how progress will be assessed.
- Communicate changes. Report improvements, worsening symptoms, side effects, and treatment difficulties rather than waiting silently for the next appointment.
- Look at the complete clinical picture. Symptoms affecting different parts of the body may require coordinated evaluation.
- Consider neurological and cognitive symptoms. Brain fog, headaches, and other neurological complaints deserve appropriate medical assessment.
- Healthcare professionals benefit from continued education. Dr. FitzGerald values conferences and collaboration as opportunities to strengthen clinical knowledge.
- Tick prevention is a lifelong skill. Regular tick checks and evidence-based prevention strategies can reduce exposure risks.
- Hope and advocacy can coexist. Patients can seek answers, advocate for better care, and work toward improved health without carrying responsibility for failures of the medical system.
Resources Mentioned in This Episode
Guest and Professional Resources
- FitzGerald Health and Wellness – Dr. Kirsten FitzGerald’s Practice
- Meet Dr. Kirsten FitzGerald
- Dr. Kirsten FitzGerald at New Frontiers
- New Frontiers Functional Medicine & Nutrition
- International Lyme and Associated Diseases Society (ILADS)
Related Tick Boot Camp Episodes and Educational Resources
- Dr. Lindsey Wells on Lyme Disease, Autism, PANS/PANDAS, and FRAA
- Dr. Tania Dempsey on MCAS, Chronic Lyme Disease, and Precision Medicine
- Lyme Disease Testing and Diagnostic Challenges
- Tick Bite Blueprint: Tick Prevention and What to Do After a Bite
- Tick Boot Camp Doctors Podcast Collection
- Tick Boot Camp Podcast
About This LIVE from ILADS Episode
This episode was recorded at the 2025 ILADS Conference in San Antonio, Texas, where Tick Boot Camp co-host Rich Johannesen interviewed Dr. Kirsten P. FitzGerald, DNP, FNP-BC, a Connecticut-based family nurse practitioner specializing in functional and integrative medicine.
Their conversation explores Lyme disease awareness, diagnostic challenges, patient dismissal, long COVID, neurological symptoms, PANS/PANDAS, the patient-provider relationship, medical appointment preparation, shared decision-making, and tick prevention.
The episode also features Rich’s personal experiences navigating medical care after a tick bite and his reflections on how patient advocacy helped inspire Tick Boot Camp.
If you’ve ever left a doctor’s appointment feeling unheard, confused, or unsure what to do next, this conversation offers practical ideas for becoming a more informed, confident participant in your healthcare.
You deserve a healthcare relationship built on listening, respect, and collaboration. And you are not alone in your search for answers.
