Introduction

Nicole Bell is the CEO of Galaxy Diagnostics and author of the memoir What Lurks in the Woods. She came to this work the hard way — through her husband's devastating experience with misdiagnosed tick-borne illness that was initially labeled early-onset Alzheimer's. In this episode, Nicole joins me to talk about why standard Lyme testing misses so many people, what co-infections like Bartonella and Babesia actually do to the body, and how Galaxy Diagnostics is using a fundamentally different approach to finally catch what older tests can't.

Episode Highlights

Nicole's Husband's Story — and Why It Matters

Nicole's husband began showing mood shifts — irritability, rage, anxiety, and depression — followed by cognitive decline. He tested negative for Lyme, was diagnosed with late-stage early-onset Alzheimer's, and only 15 months later was found to have Lyme disease plus two co-infections: Bartonella and Babesia.

• His symptoms started with behavioral and mood changes that seemed more like a relationship problem than a medical one
• He was a highly logical engineer who began forgetting basic things like the security code to his own home
• His initial Lyme test came back negative — a result that, as Nicole later learned, is far too common
• He was placed in memory care in 2019 and passed away in 2022; Nicole has since donated his brain to research, which has found evidence of Babesia
• His case is a stark example of what happens when the root cause is missed and treatment is delayed

Lyme Myths Worth Busting

There are several widely held beliefs about Lyme disease that continue to lead to missed diagnoses. Nicole addresses the most common ones directly.

• Lyme is present in all 50 states — not just hot spots — and you don't have to go into the woods to be exposed (Nicole found a tick on her suitcase in a hotel parking lot in DC)
• Only about 14% of Lyme patients get the classic bullseye rash; another 60% get a rash that gets misdiagnosed, and roughly 30% get no rash at all
• Completing a standard round of antibiotics does not guarantee the infection is gone — about 14% of patients go on to develop long-term chronic symptoms
• Symptoms can appear months to years after exposure, making it hard to connect them to a tick bite
• Ticks should be tested when found — not just for Lyme, but for co-infections too, since ticks are, as Nicole puts it, "nature's dirty needle"

Why Standard Testing Falls Short

The most commonly used Lyme tests are based on 30-year-old technology and rely on antibody detection — which has real limitations when the pathogen actively suppresses the immune system.

• Borrelia (the bacteria behind Lyme) is a stealth pathogen that hides in tissues, evades the immune system, and circulates in low quantities in the blood
• Antibody testing requires that your immune system mount a detectable response — which doesn't always happen, especially in chronic cases
• Even a positive antibody test doesn't tell you whether the infection is active or past, making it difficult to guide treatment decisions
• Nicole's husband had suppressed IgG titers, which is why he continued to test negative even while the infection was causing serious neurological damage
• Early treatment is critical — Johns Hopkins research has shown that a 30-day delay in treatment can more than double the likelihood of developing ongoing chronic symptoms

Variable Symptom Presentation — Especially Neuropsychiatric Signs

One of the reasons tick-borne illness goes unrecognized for so long is that it can present very differently depending on which tissues the pathogen infects.

• Brain infection leads to cognitive decline, forgetfulness, mood changes, anxiety, and even rage
• Joint infection presents as joint pain or rheumatoid arthritis-like symptoms; heart infection can cause carditis and inflammation
• Bartonella in particular has been linked to psychiatric presentations including OCD, anxiety, PANS/PANDAS, psychosis, and schizophrenia
• A published case study describes a boy who developed sudden-onset psychosis after his family adopted a kitten; he was later found to have Bartonella and recovered with appropriate antibiotic treatment
• A Columbia University study found that 43% of patients diagnosed with psychosis tested PCR-positive for Bartonella — statistically significant compared to controls
• Sudden onset of neurological or psychiatric symptoms — especially in someone without a genetic predisposition — should prompt consideration of tick-borne illness

Co-Infections: Bartonella and Babesia

Lyme rarely travels alone. Nicole breaks down why Bartonella and Babesia are just as important to identify and treat — and why they're so often missed.

• Bartonella is often spread by fleas rather than ticks, and cats are a natural reservoir; exposure can happen through a scratch, a lick on an open wound, or a flea infestation
• Babesia is a parasite, not a bacteria — antibiotics won't touch it; treatment typically requires anti-malarial drugs
• Both are low-abundance stealth pathogens, meaning standard tests frequently miss them
• Babesia has been linked to chronic fatigue syndrome and ME/CFS in emerging research from NC State
• Nicole believes undertreated Babesia may have been a major factor in her husband's failure to recover — and his donated brain has since shown evidence of a Babesia species previously thought to only infect deer
• Knowing which pathogens you're dealing with is essential; as Nicole says, "if you don't know what you're fighting, it's difficult to win"

How Galaxy Diagnostics Tests Differently

Galaxy's approach is built around direct detection rather than antibody testing, using methods that are matched to the actual biology of these pathogens.

• For Lyme (Borrelia), Galaxy uses urine-based antigen detection: Borrelia sheds surface proteins as part of its life cycle, those antigens filter through the kidneys and concentrate in the bladder, and can be detected in urine
• Urine is also more practical than blood draws, especially for children
• For Bartonella and Babesia, Galaxy uses a blood-based panel with enrichment techniques to increase the concentration of pathogen DNA before testing
• Standard PCR is like finding a needle in a haystack; digital PCR splits that haystack into 26,000 separate piles and interrogates each one — dramatically improving sensitivity
• There are actually two groups of Borrelia: Lyme Borrelia (which hides in tissue) and Relapsing Fever Borrelia (which is blood-borne); Galaxy's panel accounts for both
• Galaxy's technology is backed by approximately 450 peer-reviewed publications and academic collaborations with Johns Hopkins, Virginia Tech, Northwestern, UNC, and Columbia

How to Access Testing and What to Do Next

If you're having trouble getting your doctor to order more advanced testing, Nicole walks through the practical options available to patients and providers.

• Galaxy's website has resources for both patients and providers, including materials you can bring to a doctor's appointment to make the case for ordering the test
• Providers can sign up directly on the site; many doctors will order tests on a patient's request even if they aren't specialists
• If your current provider won't order the test, Nicole's advice is to find one who will — there are practitioners in traditional medicine who are open to it
• Galaxy is active on Instagram, Facebook, and LinkedIn with updates on new research and webinars
• Nicole's memoir, What Lurks in the Woods, is available on Amazon and is especially useful for helping people around a sick person understand what they're going through

Notable Quotes from this Episode

Ticks are nature's dirty needle. They carry a lot of stuff, and some of those things are gonna be covered by doxycycline, but some of them are not.
Nicole Bell

If you don't know what you're fighting, it's difficult to win. Understanding what you're up against and what's causing those symptoms is really critical.
Nicole Bell

You can't find what's not there. And "not there" doesn't mean "not in you" — it means "not in the tube."
Nicole Bell

Those symptoms are your body trying to tell you something. You might not be the medical expert, but you are an expert in you and what feels right.
Nicole Bell