Being bitten by a tick can affect you in many ways: Your skin might crawl; you might get a case of the heebie-jeebies; or you might not be able to relax until you’ve had a scalding shower. Joking aside, though, tick bites can seriously affect your long-term health if you become infected with Lyme disease.

Here, Dr. Adam Breiner shares six scary-but-important facts everyone should know about this often-misunderstood illness:

1. Lyme disease doesn’t always cause a bull’s-eye rash.

Most people associate Lyme disease with a bull’s-eye rash at the site of the bite; however, this “trademark” rash does not appear in at least 30 percent of patients. That being the case, it’s not surprising that many patients erroneously attribute other Lyme symptoms like fever, chills, fatigue, swollen glands, and muscle pains to an off-season flu or cold.

2. It’s also difficult to diagnose. The most common Lyme screening test (ELISA) has a notoriously high false negative rate, missing up to 35 percent of culture-proven cases.

“There are a number of specialized laboratories that focus on detecting tick-borne pathogens, though they, too, may miss cases,” reports Dr. Breiner.

3. Over the long term, untreated Lyme disease can cause a variety of surprising — and confusing — symptoms. When left untreated, Lyme disease — also known as the Great Imitator — can become a disorder that settles in one or more of the body’s systems (e.g., nervous, musculoskeletal, and/or cardiac) where it can cause chronic pain and facial paralysis.

Some people may suffer only from psychological symptoms including brain fog, severe anxiety, obsessive-compulsive symptoms, depression, and even violent rage.

4. Lyme disease might be the culprit responsible for many unsolved medical mysteries.

Unfortunately, the longer a patient has Lyme, the more difficult it is to diagnose using standard testing — and care providers may not connect confusing symptoms with a long-ago tick bite (assuming the patient is even aware of being bitten!).

“If you’re sick and the symptoms do not add up, or are unresponsive to the normal treatments, seriously consider Lyme as a possible culprit,” advises Dr. Breiner.

5. Antibiotics are usually the first — though not always the best — course of action.

Normally, a 30-day course of antibiotics is prescribed for individuals who are diagnosed with Lyme disease. But many find their symptoms return a few weeks, months, or even years later. Dr. Breiner explains that the Borrelia bacteria (which causes Lyme disease) likes to “hide out” in tissues where oxygen and therefore blood flow are reduced, such as connective tissues.

“Borrelia has also been found to create biofilms, which are like a walled-in city,” he says. “Bacteria can live here in safety until antibiotics are no longer in the body’s system. Then the Borrelia bacteria will reemerge, causing symptoms of Lyme disease to appear once again.”

6. Environmental toxins can help Lyme disease stick around.

“It’s important to supplement antibiotics with natural therapies that promote whole-body balance,” comments Dr. Breiner. “When the body is overwhelmed with toxins, chemicals, viruses, and bacteria (which is a common state of affairs in the modern world), the organs of detoxification like the liver and lymphatic system become stressed and overtaxed. This makes it much less likely that they’ll be able to fight off Lyme disease and its symptoms.”