Nicole Malachowski made her name as the first woman to fly for the Air Force Thunderbirds, the service’s elite flying demonstration team who perform at airshows around the country. She also flew over 180 hours in combat, instructed F-15 pilots, and served as a military aide to former First Lady Michelle Obama
All of that came to a screeching halt in 2013 when her body was overrun, almost overnight, by chronic pain, leaving her fighting for her career and her life.
She had been hit by a tick-borne illness, though she didn’t know it yet. She went from being an elite fighter pilot to losing her ability to read and write, experiencing hallucinations and balance issues and eventually being unable to get out of bed. She was medically discharged from the Air Force in December 2017 as 100% unfit for duty due to chronic systemic tick-borne illness.
“I should be wearing my nation’s uniform, maybe still flying as an old general. I should be leading airmen. The millions of dollars invested in me as a fighter pilot, millions wasted because of a lack of education awareness on tick-borne illness,” Malachowski said. “You don’t just lateral in a 20-year fighter pilot from JP Morgan Chase. You have to grow a 20-year fighter pilot.”
The Centers for Disease Control estimates that nearly 476,000 people are treated for Lyme disease each year. Between 2019 and 2022, the CDC received reports of more than 46,000 tick-borne illness cases from state and local health departments.
“The public health burden of tickborne disease is considerably underreported,” because of surveillance and current diagnostics, National Institutes of Health scientists said in a 2018 report. While the CDC receives reports of nearly 30,000 Lyme cases disease annually, “the true incidence is 10 times that number.”
The Department of Defense maintains a MilTICK database of information submitted by military families. In 2024, the DoD tested 3,000 ticks and 167 were positive for one or more human pathogens. The most common reports are lone star ticks which are found in the Southeastern U.S. where many bases are located, according to the Defense Health Agency.
This week the DHA highlighted new research co-authored by one of the military’s leading tick scientists on the rise of ticks carrying babesiosis — a tick-borne disease typically causing flu-like symptoms but that can be fatal compared to others. It has been more commonly found in the Northeast and Midwest, but scientists are seeing it expand to mid-Atlantic states because of climate change.
Service member uniforms are treated with pesticides and the Department of Defense provides free tick identification and testing services at its clinics. Local units can request specific training materials provided by the Defense Health Agency.
But Malachowski believes it’s not enough.
“Not a month has gone by over the last six years, at least, that I am not helping another airman, soldier, sailor, Marine or military spouse with this issue. I am the go-to person for tick-borne illness. Why am I the go-to person?” she said. “What cohort of the American public is exposed to more global vectors than our service members and military families? And why then is the Department of Defense and Veterans Affairs not leaders in this space?”
‘Lightning struck twice’
Malachowski was first bitten in July 2012 while stationed at Seymour Johnson Air Force Base, North Carolina. She had flu-like symptoms and a rash on her hip. She went to doctors on base.
“I distinctly remember them saying, ‘We don’t have Lyme disease in North Carolina.’ That was the instant that I would become chronically ill for the rest of my life,” she said.
Her health deteriorated in the following months — she felt pins and needles, became clumsy, couldn’t find the right words and had a panic attack in a grocery store.
A doctor interpreted her first Lyme disease test as negative. She got a brain scan and was told she may be developing multiple sclerosis. She went to her next assignment at the Naval War College in Rhode Island.
“Lightning struck twice” Malachowski said, when she pulled an engorged tick off of her right thigh. Malachowski believes that tick ironically saved her life because it gave her the evidence she needed.
To get permission to see doctors at one of the only tick-borne illness-focused clinics in Boston, she sat outside the former Air Force surgeon general’s office until he authorized it.
She was diagnosed with five tick-borne pathogens. The infection spread to her brain stem, threatening her sensory and motor functions, and her life. She was given three months of antibiotics directly to the central veins near her heart.
‘The more information I would bring them, the more they would fight me‘
Malachowski has lingering symptoms but she’s substantially better since the treatment. She’s now on a mission to fight the stigmas that tick-borne illness patients face for appearing seemingly healthy while dealing with chronic symptoms and being dismissed as “Lyme loonies.” There are more than a dozen tick-borne illnesses but the most common diagnosis comes from ticks carrying Lyme disease, hence the name.
She co-authored a May report from the National Academies of Sciences, Engineering, and Medicine on Lyme infection-associated chronic illness. While patients experience similar symptoms to long COVID and chronic fatigue syndrome, “there are currently no validated interventions to treat Lyme IACI,” according to the report.
“There’s this idea that you all have been cured because you all have been treated. We’re not even talking about the people that are undiagnosed and misdiagnosed, or people diagnosed in the later stages of disease,” she said. “This is where the stigma comes in.”
Malchowski received multiple diagnoses during years of suffering. At one point, a military rheumatologist told her: “You have been a high-performing woman in a male-dominated career field for a long time. Maybe this is your body’s way of saying it’s time to retire.”
Anders Karlsen, a medically retired C-17 pilot, had a similar story when he felt like doctors switched between uncertainty of his condition and gaslighting him to believe a diagnosis he knew was wrong. Karlsen still isn’t sure when the infection occurred, but in 2016 he found a bullseye rash, a classic early sign of Lyme disease, while stationed at Travis Air Force Base, California.
In 2019, he had dizzy spells, heart issues, and nerve problems. He stopped flying. He didn’t know what was wrong but one thing was certain: “I don’t wanna become a statistic,” he said. He was sent to behavioral health and was almost diagnosed as a hypochondriac.
“The more information I would bring them, the more they would fight me. It was very strange,” Karlsen said. “I’m a major at this point in the Air Force. I was in a highly classified secret drone unit before this so I’ve done a lot of high-level stuff and I’ve proven myself, high-level clearances and Air Force Academy grad — nothing in my record that would support this.”
Karlsen enlisted the help of Malachowski. Her behind-the-scenes work with military officials and referrals to private doctors changed the trajectory of his health. He got a Lyme disease diagnosis — but not before he spent more than $100,000 out of pocket seeking answers.
“I’ve essentially received almost no real tangible help from the U.S. government to this date, other than what was kind of forced by the secretary of the Air Force and through the help of Nicole,” he said. “They basically were willing to give me referrals, but I mean, I’m literally at a point where I’m wondering if I’m gonna wake up in the morning because my heart wasn’t firing right.”
After Malachowski was discharged, she fought to get Department of Veterans Affairs disability coverage, sending letters to prove her private doctor’s credibility and explain the latest science of chronic Lyme disease. Because Lyme is considered mostly treatable — despite up to 20% of patients remaining chronically ill — there was no relevant VA disability code. Malachowski said her rating had to include “a laundry list of horrific and chronic suffering symptoms,” a lesson she uses to help other veterans going through similar headaches.
“I tried to make things better so that people don’t have to go through what I went through,” she said. “It was unnecessary. It was painful.”
As a former colonel who dreamt of rising through the ranks and potentially wearing stars on her shoulders, she wants to improve training and awareness for troops. In May, she got the Air National Guard to do tick-borne illness training with 100,000 airmen, including over 100 physicians and 1,000 medical technicians. The training materials were also given to the Army National Guard’s medical service.
“We have military service members being medically retired for something that is highly preventable. That is a loss of skills and experience. That is a loss of taxpayers’ dollars,” she said. “This is indeed a military readiness issue, and therefore a national security issue.”
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