Updated: Jun 28, 2020
Live long enough and you will discover that things are often not what they seem. This is especially true of complex systems, which means that the human body is just brimming with confounding stories of something being masked, altered or amplified by something else. Follow me on a journey uncovering a strange pair of bedfellows.
This story begins with an omission, or two, I should say. There are two very specific, four-letter words I never heard in medical school or during my four-year residency and post-doctoral training.
These two words affect thousands of people every year, oftentimes leaving those who are suffering without proper diagnosis and treatment.
Those two words are mold and Lyme. The two may be more connected than we think. As it happens, symptoms of mold exposure have a very similar presentation as Lyme Disease. Let’s explore the similarities.
Mold is the first four-letter word I never heard in medical school or residency. Although each person responds differently to environmental exposures, here in the southeast and in many other regions, the culprit of many chronic conditions, and sometimes the trigger of other dormant infections (like Lyme disease), may be exposure to a water-damaged building. Why? It harbors mold. Half of the time mold is invisible and behind walls. Sometimes there is a musty smell that should raise the suspicion of mold spores and their chemical VOCs (volatile organic compounds). They are the source of the smell. The more dangerous toxins they secrete are called mycotoxins.
Indoor mold can be responsible for year-round (as opposed to seasonal or allergic) sinusitis, rashes, profound fatigue. It can also cause new onset illness such as autoimmune disease, brain fog, worsening anxiety or depression, severe psychiatric disease, hormone disruption, muscle and joint pain, digestive problems, allergies, a diagnosis of mast cell activation and more.
Many traditional providers are unaware of mold-induced illness. They only test for allergy to molds and treat the many possible symptoms without addressing the root cause.
Depending on dose, we may or may not mount a massive response immediately. An acute response or illness is generally obvious and more easily identified, like a cold or infection.
This is an opportunity to clarify the meaning of a word often used in medicine: chronic. It simply means over an extended time. Different disciplines have varying definitions, but it means at least 3 months, sometimes chronic means at least 1 year.
As a chronic exposure, mold can be insidious. It can start as a health injury that is tolerated and dealt with by our immune system but it may progress to something that undermines our immune system and can even cause it to behave in strange ways that are often described as autoimmune disease, when a "confused" immune system begins to harm its body instead of that body's invaders. That is also why it can be misdiagnosed, go untreated or improperly treated.
Many of my patients who have seen multiple physicians in different specialties before coming to Gesundheit Carolina tell me that they were told “You are fine. All the tests are normal.”
I hear stories of getting prescriptions for antidepressants or referral to psychiatrists. Needless to say, these people are often discouraged and angry that they are not being treated as credible.
During my medical training, I was taught that taking a complete patient history meant including environmental exposures that many healthcare providers today do not think about, nearby industries, factories and power plants, for instance. Coal-fired plants can pollute the air with mercury and leave mountains of ash also contaminated with mercury. Mercury exposure can also come from the old misnamed “silver amalgam” fillings. We were also taught to consider sources of pesticides, high voltage power lines, and other things, but exposure to mold was not on that list. I learned it later on, seeing new onset illness when volunteers returned from New Orleans after Hurricane Katrina in 2005
Ever since those goodhearted volunteers returned from helping clean up after Hurricane Katrina in Louisiana, many became ill.
The illnesses were diagnosed and symptoms were treated traditionally, but very few providers investigated the cause of these new symptoms in previously healthy people. Among the different presentations of this exposure were new onset fatigue, autoimmune disease and unexplained immune system dysregulation, neurological, psychiatric, gastrointestinal and year round allergic disease, among many other syndromes.
By omitting a thorough examination of the patients' exposure histories, an important clue was overlooked. The thing most of those who had fallen ill had in common was exposure to indoor mold caused by water damage.
The awareness of illness triggered by mold has improved a little bit thanks to the foresight and vision of experienced providers and several organizations. Environmental hazard awareness in general is on the rise due to adverse health effects of toxic exposures. The University of Arizona Center for Integrative Medicine, The Institute for Functional Medicine, The International College of Integrative Medicine, The International Society for Environmentally Acquired Illness and The American Academy of Environmental Medicine, among others, have made huge strides in promoting awareness among health providers of environment factors. This is much needed progress as the tragic flooding in the southeast these past few years has led to a massive increase in these illnesses.
A recent hurricane, Dorian, that devastated the Bahamas also passed by South Carolina, where I live. My house sustained some roof damage that allowed water to enter the house. Suddenly, I was faced with first-hand mold concerns myself! Fortunately, my experience sent me into action immediately and I marshaled a team to repair the damage quickly so no mold was able to grow. The process involved get rid of soaked building materials immediately, sealing off the room and putting the water-damaged area under negative pressure.
See photos: 1) water stain on ceiling, 2) creating negative pressure in the room to vent any spores or toxins outside and not into the rest of the house, and 3) sealing the room so as not to cross-contaminate other parts of the house. After the room was sealed, the environmental mold lab samples were taken with tape and sent to the lab. Luckily, the tests came back negative and the repair was finished. My quick action, the experience, swiftness and skill of the contractors spared me much more expensive remediation costs.
If you have a known water intrusion (leaky pipe, overflowing sink, HVAC condensation, dishwasher or refrigerator leak, mold in the water dispenser on the refrigerator door, water stains on the ceiling or ceiling tile, any flooding), please immediately protect yourself and your loved ones because mold can grow on building materials, especially gypsum board (commonly called sheetrock) within 24 hours. Any remediation starts with removing drenched materials as quickly as possible, drying the area and finding a qualified contractor to help if needed. Use personal protective gear such as a P100 mask, which should be available at most building supply stores. During the CoVID-19 season you may need to find other options like respirators for painters. Either use a disposable hazmat suit (also available at most building supply stores) or change and wash your clothes immediately after working in the damaged area. Inhaling mold spores and mold toxins can be very harmful to susceptible people and contaminated clothes have the potential to shed onto upholstered furniture like sofas and mattresses.
If the water intrusion was more than a week ago and nothing has been done, please regard the situation as a potentially major health hazard. If you can see it or smell it, it is there, yet half of indoor mold is not visible and may be behind a wall.
The number one rule of environmental medicine is to get away from the exposure or get the exposure away from you.
Escaping exposure is often enough to lessen symptoms and illness. but if they persist, find a ‘mold literate’ physician through one of the organizations mentioned in this article, use this contact us link or spend a little time at our main Gesundheit Carolina website to help you regain your good health after an exposure to mold.
Now for the second four-letter word, Lyme. I am not going to discuss acute Lyme because most physicians know to prescribe doxycycline immediately after a tick bite. I recommend at least 4 weeks of antibiotic treatment. Since Lyme testing is expensive and the validity of testing varies widely, the best action is to preserve the tick and send it to a local Lyme lab to have it tested for diseases. These labs may be be found by an internet search. A tick can transmit more than 300 known infectious agents and by sending the tick in for testing, you will quickly know which common pathogens that particular tick was carrying.
Having treated many chronic Lyme/tick-borne disease (henceforth referred to as TBD in this post) patients, I know that if I were bitten by a tick, my preferred treatment would be doxycycline for 6 weeks. Even as a board-certified integrative medicine specialist, fully aware that this approach would disrupt the very important gut bacteria, I would not wait for labs. Treating Lyme should be the priority. If the tests come back negative, the only downside is that one took antibiotics for a few days. A compromised microbiome can be handled during treatment and restored after the treatment is complete using probiotics and prebiotics.
It turns out there is a big surprise lurking in my records of treating patients with chronic TBD.
After my experience with patients who had become ill on their return from Katrina, and the subsequent move to South Carolina in 2014, I started testing all my patients, including those with chronic TBD or any with chronic symptoms, for exposure to mold found in water-damaged buildings. Every single one had been exposed to a water-damaged structure!
Just like mold can affect multiple body systems, so too can TBD: new onset illness such as autoimmune disease, brain fog, headaches, worsening anxiety or depression, severe psychiatric disease, hormone disruption, muscle and joint pain, digestive problems, allergies, a diagnosis of mast cell activation and more. There are a few signs that point directly to certain TBDs such as the striae (stripes) of Bartonella, foot pain, migrating joint pain and with the Lone Star tick, a new intolerance to red meat (called alpha-gal syndrome). The muscle and joint pain triggered by mold typically stays in the same places.
Clearly, this is complicated and intertwined, not the sort of thing you want to diagnose yourself with a few Google searches!
After taking a careful timeline analysis the big surprise was that with the possible exception of alpha-gal syndrome, all of my chronic TBD patients in this part of the world also tested positive for mold exposure. Sometimes they didn’t remember a simple water leak or musty carpet, but over time and taking a meticulous history, we were able to piece together a forgotten toilet leak or workplace that smelled musty or had water stains on ceiling acoustic tile. All of my patients are now tested for exposures to the two most common molds found in water-damaged buildings in this part of the world. I use LabCorp antibodies and two other labs (depending on insurance) to determine if there was a past exposure or if there is an ongoing hazard.
Just like Lyme can hijack your immune system to survive in the body, so, too, can mold affect the body’s ability to keep other infections in check.
Once the indoor sources of mold are identified, and the patient is removed from the immune-weakening mycotoxins and other VOCs mold emits, many “chronic Lyme patients” get better. In some cases homes were remediated, others (university dorm rooms and work environments are often an issue) changed locations. Since mycotoxins can contaminate upholstered fabrics and clothes, car seats, etc, these need to be considered as well. We have successfully used prescription antifungals along with detoxification therapy and immune system supportive supplements to help the body recover.
By using my novel approach of treating mold exposure and tick borne disease syndromes as entangled and interdependent, very few TBD patients actually needed to endure treatment for TBD!
The best defense is an appropriately tuned immune system.
Having played in the woods as a child and as an avid hiker, I test positive for Bartonella and Babesia. But I'm not sick, because my immune system is doing what it is supposed to - controlling infections.
So, are the four-letter words, mold and Lyme, related? Given the last 15 years’ experience, I am highly suspicious there is a relationship. In the approximately 25% of people who are genetically susceptible to mold, and who have chronic TBD, asking about water intrusions and testing for antibodies are my first approach. If still needed, my treatment for TBD is personalized because many patients with TBD have already had multiple treatments. My preference is botanical medicine (Cowden protocol, Stephen Buhner, et al.).
The next level is often a mixture of the above with some of Dr. Richard Horowitz’s combinations for treatment of intracellular infections. I was delighted to attend Dr. Richard Horowitz’s first master seminar at his office in Hyde Park, New York last year. He emphasizes how each person’s care is custom tailer. He also uses combinations of plant-based protocols along with multiple antibiotics and biofilm busters. He is the author of two books describing his innovative approaches to TBD:
Why Can’t I Get Better: Solving the Mystery of Lyme and Chronic Disease and
How Can I Get Better?: an Action plan for treating Resistant Lyme & Chronic Disease
In summary, our approach at Gesundheit Carolina is to remove the exposures, strengthen your immune system and monitor progress, keeping in mind that you are the expert in you, and therefore the boss. I am your consultant.
My working philosophy is that my relationship with patients is a collaborative partnership.
Of course, there are other factors that can affect one’s immune system, like pesticides, other chemicals, and stress. But that’s another post at another time.
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