It’s Not a Mystery Illness - The Hidden System Patterns Behind Fatigue Brain Fog and Chronic Symptoms with Dr. Christian Jenski | Stress | E122

We actually found a frozen cave guy in Switzerland area who was running away from some people. He had like a head injury, had some additional mushrooms on him. So you know, they do these little finds like try to figure out the culture. Yeah. The blood DNA testing on him. And he had Borrelia in his blood. So we don't know if he had Lyme disease per se. But we know the Lyme spirochete has been around for 7,000 years. Yeah. But yet it's causing havoc. Welcome back once again to another episode of May for health. Myself and Dr. Jinsky, partner in crime as always. The typical things you know. This information is for educational purposes only. You cannot diagnose or treat anything. Of course. Discuss anything you learn here with your primary care provider. On that note, today we're going to talk about an interesting topic that has been around for thousands upon thousands of years in ancient historical books and yet is still bewildering and bemusing to the most scientific of all people. I use the word mystery illnesses to encompass a bunch of things. The paradigm typically is your mold patients, water damage, building, mast cell activation syndrome, your autoimmune patients, your MCAST mast cell activation syndrome patients. There are four or five major one of these. But the concept of mystery illness is actually, is old. For example, in the Old Testament there are actually parts of that where in the ancient Israeli Jewish law where you actually have to cut out part of your building if there's mold in it. This is, you know, 1500 B.C. if you have a mold, you cut it out, comes back, you literally destroy the building. Inf tuberculosis, you know, syphilis, the great imitators, certain diseases people would get from exposure, like lead. In ancient Rome, for example, they actually stored wine in lead containers. And we think some of the insanity of ancient Rome may actually have been people going crazy because of lead exposure. Yeah, different. Miners improve in the silver mines, people would get so much mercury in their systems, then when they died, there'd actually be pools of mercury where their bodies would decay. So environmental toxin exposure, work related exposures, infections. So all of a sudden this idea, this new idea of mystery illnesses actually is a. I wrote down. It's an old concept with new science. So these are the topics we're going to talk about over the next couple episodes. Those are my introductory remarks. I don't know if you have any other introductory marks about.

That was great.

Oh, thanks. But the idea is like, and this is something we deal with on a daily basis, like so maybe the question to you is Dr. Jinsky have you ever seen a mystery illness before? You know, these kind of things? And why do people come to us with these things? Other providers, other physicians, other specialists overlooking under recognizing, like, why do you think they work the way to us?

Yeah, I think it's because we don't really see them as mysteries. Like to me, the term mystery illness is a little bit of a misnomer. It's common in our practice. It's mysterious elsewhere. And it's because there may be not, there's not a definitive way to diagnose it, or there is a constellation of symptoms that overlaps with another constellation. And so when there's not clear black and white clarity, it's often befuddling to conventional medicine. They need that black, white, gray they don't do well with. You need a disease label. So we can give you a prescriptive band aid. If you have to do a therapeutic or diagnostic trial of intervention, if you have to look at a constellation of symptoms combined with some screening tools, combined with this lab and maybe this lab, and then have a conversation with the patient, that's not really where conventional medicine shines, but it is kind of where we, we do. So I think as these individuals have kind of essentially weaned themselves out of conventional medicine, they found their way to us because they haven't met the specialist that's able to diagnose or determine what their, the cause of their problem is. And then they land on our doorstep and it's like, you know, you hear a couple of buzzwords in an interview and it's like, oh yeah, you have mast cell activation. At least that's what I clinically think is going on. Let me get some labs and even then the labs and we'll talk about this. They might not give you any insight, but you then do a trial of intervention and that gives you the insight, like, there has to be a degree of intellectual medical curiosity. There has to be clinical acumen, There has to be the willing, the willingness to do something that is safe, not harmful, something you'd be willing to do yourself, but not necessarily the standard of care, not necessarily FDA approved. Like the whole goal is do something. Don't say, I don't know, don't say I have no options for you. Just try to figure it out. So I think that's really why they wind up on our doorstep, is because they're just kind of gaslit until they, until they eventually find us.

I like everything you said, but also to take that a little deeper as well, is that, you know, we Are the specialty between the specialties. Yeah. And so that's when people have been asking me recently, what do you do? That's kind of my new thing, I'm saying because it's the reality. It's like you see your cardiologist for your heart, you see your GI doctor for your gut, See your rheumatologist for your autoimmune issue, but who talks about the gut issue being related to the rheumatoid and the heart stuff. Who talks about the autoimmune disease in your arteries called cardiovascular disease. Right. And so if someone has a. What is. I almost say a one trick pony, but as a, you know, I just had a massive heart attack. I just had my appendix removed.

It's specialized.

We're so specialized.

It goes even deeper because now they're subspecialized, and so we're the. Never. I've not heard you say it. I like it. So we're interstitium, right? Like, we're the glue. We are the connective tissue that holds the body together and holds these different organ systems that have been compartmentalized together.

And the connective tissue, it's the unappreciated, unrecognized song hero that gets no. The rock nature field. I get no respect here yet. The thing that holds everything else together.

Right.

That's the first thing I want to say off of what. Bouncing off what you said. The second thing is that, you know, there's this thing called vomit syndrome that I learned about at a trauma course probably in 2003, 2004. It was actually a surgery trauma course, Virginia Beach. And vomit syndrome is we're victims of modern imaging techniques. And the concept was, is we become so specialized, and this was over 20 years ago. Keep that in mind.

Yeah.

We become so enamored with technology that clinicians are no longer clinicians. Yeah, we're no longer diagnosticians. We're technologists. I think you have this issue. Let me get a ct. I think you have that issue. Let me get an autoimmune panel. And we've lost the art of medicine. We've lost the art of diagnosis. And literally these diseases, the interstitium, the space between the specialties, specializes in that, Requires that. Yeah, requires that. And that's something. It's a lost start. You know, we talked about William, you know, William Osler. We learned about him medical school. He was the guy, you know, back in the day when they didn't have therapies, people got really good at diagnosing things. Weren't A whole lot of treatments, but they. They literally had to listen to a patient. They could feel the pulse, listen to their heart, and tell them which valves are off. Right. No one does that anymore. But they got really good at making diagnoses, and we've almost done the exact opposite. We're really good at ordering testing now, but we've lost that clinical acumen. And literally these things sit in that space.

Yeah, that's what you need for this. And not that there's not testing for it, but the testing isn't always helpful. And if it is, great. But if it's not, then what? Doesn't mean they don't necessarily. They don't have it. You have to use your clinical acumen. You have to use the art of medicine. And that goes along with treatment plans, too. I mean, you know this. Every single patient you see is different. That's the whole point of what we do. But plan A may not be the plan that they're responsive to or tolerant of. A lot of these patients also have chemical sensitivities and react to stuff. And so you have to play that card too, where it's not just, okay, your presentation is mysterious. Your, the ability to work this up is a little bit muddied. And the first plan I put in place, you can't tolerate, then what? If you don't have the ability to pivot, if you don't have the ability to be flexible and, let's say, artistic in your practice of medicine, you're not going to get that patient better.

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And what other concept I kind of lost my train of thought after that. Okay, yes, the multi system, multi symptom

illness, complex biological illness and you know,

roughly they're 80% similar. You know, chronic Lyme, chronic tick borne illnesses, reactivation of Epstein Barr mold related illness, post concussive syndrome, chronic inflammatory response syndrome. You know now people are more aware of these because of long Covid but the long Covid like symptomatology is something in this world. We've been working chronic fatigue and fibro for decades. And so to your point, you do need to have that toolkit of your clinical expertise. We both have been doing this for 20 plus years. You know as well as the ability to order fancy testing but also requires longevity in a relationship with the patient. Like you know, I telepath my wife, we were married about for about 15 years before I realized one of her big triggers was grad school. We've had this conversation before. We all went to. Literally all of us went to the same anatomy class. She had a massive formaldehyde exposure first year in grad school that caused horrible anxiety. Almost dropped outta school multiple times. Ended up starting getting better as the year along she thought she was just coping better with school. It was just. No, she was getting a distance from lab and funny talking with you about that. You had this weird kind of feeling about anatomy lab where you.

Same.

Yeah, you just like.

I stopped going. I just learned from the textbooks. And then I would show up during practical exams. I would lean heavily on my classmates. They were aware of it. I wasn't aware of what was going on, but I let them know how I feel. Probably thought that I was a bonehead, but the reality was that I was getting sick. And so I would show up, I would push through, I would feel unwell. Thankfully I passed and didn't have to repeat the course. But it was the formaldehyde for sure.

Yeah. And so on that note, this is common, it's everywhere. And let's actually start with one of the most ancient. The most ancient of the mystery illnesses. Chronic infections. Yeah, now I like to talk about Lyme because you know, when was the first. I assume, you know, maybe we have similar knowledge bases but the first actual diagnosis. Like when did we first in the history. When was the first individual with Lyme ever?

I have no idea. Okay, that's ancient Egypt.

I don't know.

Okay, I'm sorry, I'm gonna guess I'm gonna just throw a hail Mary.

Well, there was, okay 5000 BC we actually found a frozen cave guy in Switzerland area who was running Away from some people. He had like a head injury, had some additional mushrooms on him. So, you know, they do these little finds, like, try to figure out the culture. Yeah. Did blood DNA testing on him, and he had borrelia in his blood. So we don't know if he had Lyme disease per se, but we know the Lyme spirochete has been around for 7,000 years, but yet it's causing havoc. Same thing for syphilis, same thing for tuberculosis. Epstein Barr has been around forever. So let's talk a little bit about one everybody's talking about now, I feel like, which is Lyme.

Yeah.

You know, how common is it? Do we see it? What are. Give us a little brief overview of Lyme.

Yeah. So common. More common than I think people want to admit and often overlooked unless it presents very classically. I mean, we live in a Lyme endemic state, so we see it more often. But it's spreading. It's not confined to Connecticut. It is up and down the east coast and it's moving out west, Midwest. I mean, it's just kind of everywhere. And as the climate has changed, this has become more and more of a problem. We're seeing new species, we're seeing more cases, we're seeing atypical cases. The incidence of the classic, you know, bullseye rash. And yes, I know I got bitten by a tick and it was a deer tick, and it was this time of year and it was on my body for this period of time. Like that is incredibly rare, Having worked in the emergency department, but also in urgent care, like, it was very rare that someone came in with a presentation like that. And so in this situation, you know, I take a history on a patient and like, of course they'd been bitten by a tick. Of course they pull ticks off of themselves or their pets or whatever the case may be. So I think it's incredibly common. But we also see a lot of the co infections too, and I'm sure we'll touch on this. But Bartonella, babesia, and some of these others that we're seeing. So I think Lyme is very common. I see it often. The problem is that its presentation isn't always obvious and the timing is really, really hard to pin down. So you have to have a high degree of suspicion. If someone presents with a history of a tick bite, is having fatigue, muscle aches, joint pain, obviously a rash, maybe a low grade intermittent fever, headaches, you know, those are kind of the classic presentations. That's for early, you know, then if it gets Disseminated, or you start to get secondary or tertiary Lyme, they start to have cardiac or neurologic manifestations. It's a problem, so you got to pick up on it sooner than later. It tends to hide. Lab testing is not easy. CDC has strict criteria. I get equivocal results all the time. You just have to make an educated decision with that patient. What's best for them in that clinical presentation to determine what the next best steps are. Are you going to use antibiotics and for how long? Are you going to use botanicals and for how long do you need biofilm disruptors? Do you need to test for co infections? Do you need to expand out to specialty testing? I mean, it just gets deep. And there are these certified providers that are, you know, Lyme literate MDs or ILAD certified that are out there fighting the good fight, but even they are not convinced exactly what it should look like when someone presents. So. But they're more amenable to keeping their eyes open for it versus just, oh, you didn't meet C2C criteria, therefore you can't have Lyme. Like, it's. To me, that's clearly not appropriate.

And I want you to clarify that statement because that's a good point. You said you're in the ER for 10, 15 years, in urgent care for three to five years, four years. Okay, so the question for you at the front lines, how often do you see Lyme? And the answer is you see it all the time in the ER in there.

I wouldn't see it at all in the er. Okay, yeah. In urgent care, people come in all the time saying, I got be my tick. And. But then you don't know. And then how do you get lab testing? How do you follow up on that? How do you do that appropriately?

Yeah, my. It was interesting because when I did my training at VCU and mcv, we did same place, and I went in the military for four years, traveled around the world, went to Germany, et cetera. The first case of lab I saw was a patient when I came back here, did the test on them and was positive. I wasn't quite sure what to do with it because I'd never seen it before. So I called the local infectious disease doctor and was told they don't take consults for it, and it's not in central Virginia. And So that was 2007, where I had to like, okay, I have to figure this out my own. And so according to the cdc, there are more cases of acute Lyme by their criteria, which who Knows what the numbers really are. Right.

Yeah.

More cases than there are new diagnoses of breast cancer every year. So it's really, really common.

Yeah.

And, you know, I have a couple patients that are veterinarians, and one of them was I was talking with, and they're like, oh, yeah, 25 of all dogs that come into our clinic test positive for Lyme. We don't treat them all because they don't have symptoms. But I started thinking, you know, dogs have owners. Yeah. And most of the dogs that take him to the vet are usually indoor dogs.

Yeah.

They go outside, pick up some ticks, probably drop them off from the house. That's where my son's got. Yeah, he got Lyme about two years ago, and fortunately, we called it early. I knew what to look for. Got him on antibiotics two weeks later, it was fine. But it was from the dog hopping his bed.

Yeah.

Then. So my question is, how many people with pets have the borrelia?

Yeah, for sure. Let me clarify the ER comment even further. You never test for Lyme in the er. It's not an ER test. When someone comes in, let's say, with body aches or a headache, like you're ruling out sepsis or you're working up a migraine, no one's thinking Lyme. They might, if they're sick enough, get admitted for some reason, and then the hospitalist or infectious disease gets tapped, and then they might work them up in urgent care. People would show up and, hey, I got a tick bite and I have a rash. I want to make sure I don't have Lyme. And then you have to kind of figure it out. But even then, it was just like, what do you do? That person may not have a primary care. That's why they're in the urgent care. What's the timing? If I get blood now, is it too early? Is it going to be a false negative? And so there's just so many layers to it. You have to have that clinical suspicion. But it is incredibly common.

And on a side note, one of my friends and colleagues, Cynthia Thurlow, I've talked about her before. She was, for a long time a nurse practitioner, John Hopkins, and the cardiologist, urine cardiology. And they got patients come with heart blocks.

Yeah.

And they routinely checking them for Lyme and finding them with Lyme disease.

And that's awesome that they were doing that.

But this is like they already have a heart block. Yeah. This is at a specialty center in John Hopkins.

Yeah.

Does that happen here in Richmond, which we're like two and a half hours south from there. No. And so the point being is this is ridiculously common. Some people recognize it. Most don't know. And the other caveat I want to add to that is I've had, at this stage, been working with patients for years, and I've been patients. I've checked for Lyme every year because it's here. And over the last couple of years, there's been patients I've been working with who are negative, negative, negative, negative. And all of a sudden, one day in the middle of wintertime, positive, flip positive. You have to ask yourself, it's. The ground's frozen. Yeah. There's frost on the windows, and you're Lyme. Flip positive. It's been there. Yeah. It's not new. And so now some of the question is, how many people have it? Like Epstein Barr, like herpes, like chickenpox, it's reactivated, and it gets reactivated, and all of a sudden, like, is the goal cure, is the goal dormancy. So these are all things, I think, that play to the mysteriness of Lyme. And this applies to every infection. It's not just Lyme. It's Babesia, Bartonell.

Like you said, Ehrlichiosis.

Ehrlichiosis. Also viruses, reactivation of Epstein Barr, herpes. You know, I remember I've been in the hospital and seen patients coming in with altered mental status from herpes encephalitis. You know, there's an association with Epstein Barr and a whole host of autoimmune diseases, including Hashimoto's and multiple sclerosis.

So all of a sudden, cancer, Burkitt's lymphoma.

A hundred percent. Yeah. So the point is that infections are a mystery kind of thing, especially the

ones that hide, like Lyme's pleomorphic. That changes shape. Right. Lyme can go from spirochete to cyst and back. It hides in all kinds of tissue. It is highly mobile. It's not a stupid bug. That's why it's been around for 7,000 years. Like, plus. Yeah, yeah, plus. Like, it. It knows what it needs to do to survive. It's gritty like that. And it's hard because, like you said, you get negative, negative, negative, then positive. And the question is, was it. Is it new or has it been there? And then what are you going to do about it? And it's kind of. That bit of information reminds me a little bit of, like, when we talk about that incendiary moment in a patient's story where, like, I Felt fine until some event happened that unleash other things that were already there to begin with. These dormant infections or these. This toxic burden that overflows the well, so to speak. Like, this is incredibly common.

Yeah. And to your point, does you. It's not the acute. I got a tick bite. I got mono with a big swollen tonsils. I've got strep.

Oh, that stuff's easy.

Yeah. It's usually something insidious that then triggers something. And it could be the. You know, one of my patients graduated from uva, was going to medical school, hiking the Appalachian trail, got a tick bite, got Lyme, Kahashi motors. Come to find out, the setup for all that stuff was mold.

Yeah.

Set him up. Yeah. The tick bite triggered it. He went to the doctor for thyroid, worked his way around. But it's like, again, multi system, multi symptom. And, you know, that's our. That's our specialty.

That's. That's really common. I mean, that. Andrew Heyman talks about that all the time. Like when he opened up his practice in Northern Virginia and he had this, like, subset of the sickest of the sick, and he was like, I don't know what's wrong with these patients. Wait, I live in Virginia now. He came from, I think, Michigan. I live in Virginia now. Let me start checking Lyme. And all his patients tested positive for Lyme or were close enough where he is, like, maybe I should treat this. And he did. And then a subset of those patients got better, but then a subset of the sickest of the sick didn't, and they were all mold patients. And then he went back and realized that all of them were mole patients. And it was the mole that had triggered the Lyme that had been dormant along. Some had new infections, but it was like, you just see it like dominoes. And if you can kind of take a step back and look at it, you can kind of see this lineage of events happening over time. That's the whole point of taking a good history. And then you start to kind of peel the onion, so to speak, and get to these layers, and patients can get better.

Yeah. So actually, next episode, we'll talk about sirs.

Yeah.

Yeah. Because that's the big mold one.

Yeah.

So again, back to multi system, multi symptoms. Let's go back. We'll take a system. So let's talk about the nervous system. What are symptoms? We see these apply to all of these. And this is where we're not going to go into nuances of the clinical evaluation. But if you have any of these symptoms? Think any one of these five that we'll be talking about over the next several episodes. So neurological system, anxiety, brain fog, panic attacks, you can see sleep disturbances, you can see dysregulation and regulation. So temperature, dysregulation issues, blood pressure, pulse, dysregulation issues, a whole host of things in the nervous system that can be associated with this and others.

I would even add fatigue to nervous system.

Yeah, sorry, that's. Fatigue is like, the big one, people.

Yeah, but people don't really equate fatigue to nervous system. Right. To your brain, it's like fatigue. Oh, it's my thyroid, or I'm stressed or I'm not sleeping or my sex hormones are off. It's. It's a neurologic symptom for me, 100%.

Yeah. Yeah. So why don't you take a system and give us some symptoms?

So, cardiovascular. So you see hypertension or hypotension. So high or low blood pressure, dysautonomia all the way to pots. Postural orthostatic tachycardic syndrome. So high heart rate, low heart rate, heart blocks, dysrhythmia. So you know, someone whose heart is too slow or skipping beats or having extra beats or popping into a rhythm that isn't your normal sinus rhythm. Vasomotor symptoms, flushing of the skin, those are, to me, dizziness, especially if it's related to positional changes in hypertension. I think that would be the cardiovascular stuff.

Yeah. When you think, you know, when we did our training through a form, they talk about cardiopulmonary, neurovascular. It's like one of the systems you look at when you think heart. It's also the nervous stuff associated with the heart and also the vascular stuff. So all of a sudden, you know, Raynaud's, Cold hands, cold feet, blanching your skin, looking at someone's legs, they have that mottled appearance. So many different symptoms that say there's a dysregulation in blood flow, which means circulation volume and nervous system as well. Yeah. Because that's the systems.

Yeah. They go hand in hand. Every blood vessel travels in a neurovascular bundle. Right. Artery, vein, nerve wrapped in a sheath.

Yeah. With immune cells there as well, which is where mast cell comes into play. We'll talk about that later. Gut symptoms. What kind of gut symptoms do people get with all of these? Not just Lyme.

I mean, diarrhea, constipation, like, all of them. Diarrhea, constipation bloating, gas, heartburn, pain, you name it.

I mean, like organ pain. Sometimes people get kidney pain.

Yeah.

Liver pain. They'll say, it's my kidney, it's my liver.

Yeah.

Gallbladder, you can actually have. My mother in law actually lost her gallbladder in Northern Virginia after my sister in law's getting married. Lots of stress, went to the hospital, she had a gallbladder, removed it, she got this crazy rash. They thought she was reacting to the antibiotics. Come to find out, she had a ricklea.

No way.

And so she lost her gallbladder, got in the hospital, got the rash, then they thought it was the antibiotic and actually was. Now we know it's auriclia. Yeah. And so sometimes you have these representations of a gallbladder or an appendix and it's literally the immune system inflamed. Yeah. And that was one of those interesting kind of like.

Yeah.

And the physician who saw her in the hospital actually ended up being a Lyme specialist up in Northern Virginia. So it's. She was fortunate.

That is fortunate. Organ inflammation. It's a good point. So hepatomegaly, splenomegaly, big liver, big spleen. It's classic for mono associated with Epstein Barr. So you can see organs get enlarged, you can see the GI tract kind of suffer. Yeah. And then secondarily, if the GI tract is getting a hit, then you get mast cells unleashed, and now you have all the mast cell stuff that follows suit and it just becomes again like the domino phenomenon.

I love that point you mentioned about the lymph nodes. Because how often will we see someone who had a CAT scan or CT and they said swollen lymph nodes in the neck. Yeah. In the chest. And they go to the pulmonologist to rule out cancer or whatever. Doctor. And they come to us. Everybody's done their testing, and my lymph nodes are still swollen. I still have pain in my groin. Yeah. My spleen. I can still kind of. It's a little big, like you said. And it's like, okay, the immune system's

active for a reason. For a reason that. Yeah. Maybe badness has been ruled out in the way of cancer. Great. But what's the cause? Literally, I have a patient that just saw Jodi for this. She's got some random lymph nodes that are swelling. And Jodi ran a viral panel on her very astutely, and her EBV is off the chart. And that is her only symptomatology. And so we're treating it. And I can't wait to see her lymph nodes go away. Like, that's the whole point. Like, this is what needs to be on people's radar if they're trying to practice whole person medicine. You have to think about these things. They're not mysterious. They're well documented. They've been around forever.

Gotcha. So we've talked about Lyme on the podcast a lot in the back. So the point of this series is just mystery illnesses. If people have additional questions. Want to learn more about this? We have tons of blogs on it. We've done lots of interviews on it in the past as well. But again, the idea is mystery illnesses. What's being missed? And I think the next one we'll talk about in the next episode is chronic inflammatory response, which includes. But it's not limited to mold.

Mold, yeah.

Take care, be well. We'll talk to you soon.

See you soon.

If you've lost trust in your body or in the system that was supposed to heal you, don't give up. Dr. Aaron Hartman's book Uncurable will help you rediscover what's truly possible. Visit UncurableBook.com to get your copy and start your healing journey today.