Retired Air Force Col. Nicole Malachowski recalls the terror of being in the cockpit of her F-15E Strike Eagle during a training mission and experiencing a wave of brain fog that left her temporarily unable to locate the radio switch — on a control panel she’d been using for 15 years — to answer a call from air traffic control.
It was one of more than five dozen symptoms, ranging from neurological issues to night sweats, that would emerge in 2012 and 2013, halting her flying career and nearly ending her life. It would take years, and appeals to medical providers outside the military, for Malachowski to receive a diagnosis. She had a tick-borne illness — five of them, actually, including Lyme disease. She’d finish her career, which had included making history as the first woman to fly with the U.S. Air Force Thunderbirds, essentially bedridden and with a medical retirement. Her retirement certificate, she said, was mailed to her home.
Malachowski believes the military didn’t give her the information she needed to prevent tick-borne illness, or the diagnoses and medical treatment she needed when she became ill. She’s now on a mission to change that for the military.
In May, recognized nationally as Lyme Disease Awareness Month, Malachowski’s advocacy helped lead to the first tick-borne illness prevention program to be deployed across the Air National Guard. A letter of appreciation from Col. Russell Kohl, air surgeon for the Missouri Air National Guard, states that more than 100,000 Guardsmen were briefed through the program, and more than 100 doctors and 1,000 medical technicians were involved.
“Statistically, it is anticipated that these efforts are likely to have prevented at least 30 cases annually of tick-borne illness in [Air National Guard] personnel let alone the immeasurable impacts to their families and friends who benefit from their knowledge and experience,” Kohl wrote in the letter. “These impacts positively impact our military readiness and national security as well as securing our social contract to support those who step forward and serve and defend our nation.”
Malachowski’s comment in a LinkedIn post sharing the letter was poignant: “I think I may have finally made a difference.”
For Malachowski, who reached the peak of her profession as a squadron commanding officer for the 333rd Fighter Squadron and went on to serve as the executive officer of the Joining Forces initiative under the Obama administration, her saga of chronic illness is full of glaring missed opportunities for diagnosis and proper treatment. Despite her medical retirement, she said, she still pays out of pocket for private health care, having lost faith in the military medical system.
Entrenched doubt about the prevalence of Lyme disease — famously illustrated in a quote from a National Institutes of Health provider who dismissed the concerns of “Lyme Loonies” — still affected medical care, Malachowski said. And the stakes, she added, were getting higher.
“What we’re finding is the incidence of tick-borne illness is increasing because the population of ticks is spreading because of climate change and and more and more people are getting sick,” she said. “And now it’s becoming an issue that they can no longer ignore.”
A military study of vector-borne diseases published last year did find that Lyme disease was the most common one tracked between 2010 and 2022, with 3,400 confirmed cases in that period, nearly all of them in North America. But the study also found that the number of confirmed and probable Lyme disease cases had decreased sharply in recent years, from a high of 471 in 2012 to 90 in 2022. That trend contrasts with the Centers for Disease Control, which recorded just over 30,000 cases in 2010 and nearly 90,000 in 2023. Notably, the CDC issued a new case definition for Lyme disease in 2022, reflecting a growing understanding of how the disease presented and how certain well-known symptoms, like the bull’s-eye rash, were not necessary for a diagnosis.
Malachowski did get a bull’s-eye rash on her hip when she was first bitten in 2012, but says the flight surgeon who examined her dismissed the possibility of Lyme disease because he didn’t believe there were any cases in North Carolina, where she was at the time. When Malachowski actually did find an engorged tick on her leg the following year, in a rare instance of a patient suffering two disease-causing tick bites, the doctor who examined her advised her to wait to see if a rash developed instead of testing for Lyme disease.

Malachowski has been told, she says, that the small number of recorded military cases means Lyme disease is not a serious concern.
“I scoff,” she said, “because we know the tests aren’t any good, and we know people get undiagnosed and misdiagnosed all the time. And we know we’re not testing for all tick-borne illnesses, we’re only testing for Lyme. And Lyme barely scratches the surface.”
By the time she got her full diagnosis in 2016, Malachowski and her husband had catalogued 63 symptoms, she said. At her lowest point, she was bedridden and housebound, required a home health aide and couldn’t even talk. Her treatment, supervised by specialists at Massachusetts General Hospital in Boston, required a PICC line, or central catheter, to deliver medications to large arteries near her heart. Even today, when Malachowski is best known as a sought-after motivational speaker and disease prevention advocate, she said she’s at 50-60% of what she used to be.
Malachowski’s fingerprints are on much of contemporary Lyme disease advocacy. In addition to the recent Guard campaign, she was able to help the Air Force rewrite regulations for dealing with ill service members as an ambassador and mentor for the service’s wounded warrior program. As a member of the Committee on the Evidence Base for Lyme Infection Associated Chronic Illnesses Treatment, she contributed to the National Academy of Science’s report on new treatments for Lyme, published in May.
She said she’s still connecting, though, with service members who are suffering from tick-borne illnesses and feel unseen. Among her current priorities is working with the Defense Health Agency to support awareness programming like that recently pushed out by the Guard, and to update outdated aspects of the tick-borne illness training provided to medical providers. DHA, she said, hasn’t responded to her inquiries.
In response to an inquiry from Military Times, DHA officials provided a statement and linked to a number of articles the agency had published about Lyme disease and coverage of “Bugapalooza,” an insect risk awareness event it had supported.
“The Defense Health Agency has promoted and continues to share a wealth of resources designed to educate and inform beneficiaries about bug-borne illnesses and how to prevent them,” the statement read.
For Malachowski, the issue continues to be personal.
“I still go through the grief cycle,” she said. “I lost my career, I lost my identity, and I lost my means for providing for my family, and I had to reinvent myself alone. And this is happening to young airmen, and that pisses me off.”
Read the full article here