Sometimes I spend more time giving general health and lifestyle advice than treating infectious diseases. I think this is a good thing – I enjoy doing it, but sometimes patients get quite upset when I tell then that they are unlikely to have an infection. This situation arises mostly in the clinic.
Often patients are sent for infectious disease evaluation when they feel unwell but a specific disease cannot be found as the cause. Many of these patients have very non-specific symptoms – pain in the muscles, pain in the joints without redness or swelling, tiredness, insomnia, memory and concentration problems, headache, back pain, sweats, anxiety, etc, etc.
What is often absent is weight loss, poor appetite (sometimes they say they are eating more) and symptoms related to specific organs such as coughing from lung disease, or bloody urine from urinary tract disease, for example.
Patients with these complaints are usually feeling unwell for months and even years. They often turn to “Dr Google” from time to time and come up with diagnoses such as “chronic Lyme disease,” chronic Epstein-Barr virus (EBV) infection, chronic cytomegalovirus (CMV) infection, to name a few.
I had one such patient some time ago, whose symptoms were present for over 5 years! She was middle aged and convinced that she had “chronic Lyme disease” even though her primary care provider did a test for Lyme disease and it came back negative (he probably shouldn’t have run the test but that’s another story). She had it in her head that 90% of people who have Lyme disease have a negative test result (this is false).
My first order of business in evaluating patients is to get detailed medical history. Next, I examine them for clues such as pale or jaundiced eyes, sores in the mouth or poor dental hygiene, swollen lymph nodes (glands in the neck, armpits and groin), enlarged organs, swollen or deformed joints, skin rashes, etc. Lastly I run some baseline blood tests to look for abnormal blood counts, kidney and liver problems, and the level of inflammation in the body.
The labs for the patient who thought she had chronic Lyme disease came back quite unremarkable. What was interesting about that patient was the fact that she was on several medications that act on the brain: a sedative (Ativan), not one, but two antidepressants (Seroquel and Paxil), a muscle relaxant which acts on receptors in the brain, an anti nausea medication which also acts on receptors in the brain, and an anti-itch mediation which didn’t act on the brain but had a sided effect of drowsiness.
In reviewing all the medications they had long lists of side effects. Can you imagine the effect of five different chemicals acting on different receptors of your brain (and probably receptors elsewhere in your body as well)? In combination, the effects of those drugs are additive and include exacerbation of drowsiness, slowing of reflexes, poor coordination, “brain fog,” dry mouth and skin, flushing, sluggish bowels (constipation and bloating), among many others.
You are not going to feel great if you are taking many drugs acting on receptors in the brain.
I challenge everyone…
If you are feeling chronically unwell, before you blame it on Lyme disease, or chronic EBV, or rocky mountain spotted fever, or some other obscure infection, take a look at the drugs you are taking every day. All of them. But pay particular attention to those for depression, anxiety, pain, or anything that could be having it’s effect through an action on the brain. Even more important, review how long you have been taking the medication(s) for.
Many of these brain acting medications start displaying quite severe (but sometimes non-specific) side effects after the patient has been on them for many years. The patient mentioned above had been on her medicines for over 10 years. When I mentioned the medicines as a possible cause for her symptoms, she quickly dismissed the suggestion, saying it could not be, because she had been on the medicine for so long and did fine on it (but in another breath she said she had been sick for over 5 years). She just could not wrap her mind around the possibility that her problem could be as simple as medication side effects.
Now some people are actually not on a long list of medications. In those cases, I like to ask about the diet. There are so many chemicals added to food nowadays and our bodies are just not meant to take in this adulterated food in such large quantities. It is not natural. The more refined and processed a food is, the more chemicals it contains. No doubt some people have significant reactions to some of these chemicals on the cellular level, and over time, all these reactions can build up and cause significant inflammation and stress in the body.
High fructose corn syrup and other forms of sugar are some of the most abused additives nowadays. The sugar addiction is currently at epidemic levels. I have had patients come to me who drink up to 12 sodas per day, every single day! How on earth can you feel well with that level of refined sugar consumption? It is impossible.
So back to your challenge…
If you are feeling unwell, first look at your list of medications that you take daily, and evaluate the foods that you eat. If the medications are prescribed, ask your doctor which of them you really need and which ones can be stopped. For antidepressants and other drugs that act on the brain, you cannot stop them abruptly otherwise there will be withdrawal symptoms. The doctor has to slowly taper them while monitoring you.
Regarding food intake, do you eat real food (fresh fruits, vegetables, legumes, fish, meat, etc), or do you eat fast food or packaged meals almost every day? If you eat packaged food with long lists of ingredients including some with names you cannot even pronounce, this is not real food. Try to eat food as close as possible to the natural form. When able, choose organic, non-GMO foods.
Though not present 100% of the time, signs that are more suggestive of infection include fever of more than 100.4 degrees Fahrenheit, shaking chills, poor appetite, and weight loss. Seek medical attention urgently if such symptoms persist.
Even if you do not feel unwell per se, I think everyone would achieve some benefit from reviewing and eliminating unnecessary medications, reducing, if not eliminating added sugar in the diet, and eating more wholesome foods.
Sometimes you do not realize that you are not feeling well, until you start to feel great.