In this talk Dr. A addresses a common frustration among patients with chronic or complex illnesses: why treatments sometimes seem to make them feel worse instead of better. He contrasts acute conditions, where a single clear problem and solution lead to predictable recovery, with chronic cases that involve multiple overlapping pathologies (autoimmunity, infections, hormonal imbalances, toxicity). He explains that the body can establish a pathological "new normal"—a physiological set‑point that accepts ongoing inflammation, hormonal dysregulation, or infection as the status quo. When treatment attempts to shift this set‑point back toward health, the body perceives the change as a threat, leading to resistance, worsening symptoms, or “die‑off” reactions when large numbers of microbes are killed, triggering intense immune activity. Dr. A uses long COVID as a vivid example of a previously healthy person who now faces a new normal after a massive viral insult. He also notes that hormone replacement or other targeted therapies can feel odd until the body acclimates. The core practical advice includes: stay in regular contact with your healthcare provider, ask explicitly about expected side‑effects and red‑flag symptoms, be patient with the healing timeline, and communicate openly about any adverse reactions. He emphasizes that the body’s non‑verbal language (symptoms, treatment responses) is crucial information for clinicians, and that a two‑way dialogue can help adjust therapies promptly.
Chapters
Hey, it's Dr. A. I want to answer a very, very common question. Most of the things we talk about seem to be common questions, but this one comes up as very frustrating for people, and that is, why do I react to treatment in a direction I don't think I'm going to react? So normally we expect if we have a disease, we have a treatment, And we get better. That should be a very linear thing. And what I tell people is, if you've sprained your ankle, broken a bone, you got strep throat, something like that, probably that's how it's going to work out. Now, none of those are pleasant, but there's a clear problem, there's usually a pretty clear treatment, and then there's resolution over a certain amount of time. But one of the things that happens with people is, if it's not an acute problem like that, In a complex or a chronic case that's going on, you may actually get the opposite that happens because in something like a broken bone, there's, there's one large problem, there's one large solution, and it kind of lines up. In a complex case or a chronic case or something that's being complicated by other factors, You may have 10 of those things going on or 100 all at the same time. And so one of the things to consider is that these things would happen not so much in a very healthy person with a couple of exceptions, but in people that have underlying problems that might be totally well controlled. So let's say you have an autoimmune disease, or let's say that you have, you know, some other type of chronic condition. But it's pretty well controlled. You, you and your healthcare providers have got it lined up. That doesn't mean that your body doesn't have some weak places. Now everybody does, but if you have an underlying disease and it's controlled but it's still there, you may have some kind of holes in the bucket that you don't notice till you get something new thrown in on top. So When you have that going on, you want to be thoughtful about you may have a more complex trip to healing if you have an underlying chronic disease. The other thing is if you have an active chronic disease that's not totally well, maybe it's symptoms under control, but your body's still very inflamed, there's either maybe autoimmunity or chronic infectious problems or certain toxicity syndromes that do this, etc. The other one, if you're listening now in 2021 or anytime near, you've probably heard of COVID Well, there's the idea of long COVID or COVID long-haul patients who I am speaking with many, many of them and hearing stories and doing a lot around long COVID, and that's sort of a unique one where you have people who are completely healthy and had no known underlying problems, and they get hit, you know, like a cement truck, and they get COVID, and then in the post-COVID time, they keep all these symptoms that are just really, really perplexing and very difficult to deal with. So long COVID is a unique example of what normally would happen to somebody with a lot of underlying problems. Now, certainly, if you already had other problems, and then you get COVID, you're still more likely to take a while to resolve, et cetera, but I have seen and talked to and interacted with enough people now who were seemingly quite healthy before they started with COVID that they have a lot to do. So then you'd start to treat them, and then all of a sudden things don't work out the way that you think they should. That's not just for long COVID, this could be any other chronic illness. And one of the concepts that I think is most important to keep in mind so that you keep your sanity while you're going through this longer process of healing is that your body physiologically, when you are sick, whether it's a lot of stuff all at once, a really big input like a bad case of COVID a bunch of chronic issues, autoimmunity and infections mixed together, whatever it is, When it's a whole bunch of stuff, your body literally physiologically adjusts to what's called a new normal. And so your body believes that if your hormones are out of balance or your inflammatory chemistry is high and you're inflamed, your body starts to believe that's normal. Now, it didn't happen the first day, but with chronic illness, you get a lot of confusing signals. So the new normal is not a good normal, it's just a new normal. So then think about trying to take yourself from the new normal, which is sick, and your body does this as a matter of preservation. It's like, well, if these problems aren't going to go away, we're going to adjust the physiology around these problems because maybe they're just going to be here forever. It's gonna be part of us, right? So your body now, and again, this doesn't happen overnight, this takes some time, but your body now believes any change from abnormal, this new normal that's not good, is not going to be good for you. Your body really gets that confused. So then when you and your healthcare team go to right the ship and balance everything back up, it feels to your body like there is something very wrong happening. Okay. Analogy would be if you're totally healthy and then suddenly you get a change, you get an infection with fever and aches and all of this stuff, you know that that's not your normal, right? Well, it's all flipped upside down when you have a chronic illness where your normal is that you don't feel well in any number of ways, and so trying to push you back towards normal Feels odd to the body. So part of why you're reacting to treatment sometimes is that it's doing the right thing. It's just that your body neurologically, hormonally, musculoskeletally, sometimes all of the body systems resist moving away from illness in the beginning. Now, the body does like to go back to normal and like to a healing plane, but when it's been real sick, it's not a quick trip. So that's probably the biggest reason why that can happen. Now another thing that can happen is a direct effect. This happens a lot with people who may be given a medication that kills, say, microorganisms, whether they're bacteria or fungus or whatever, and either just because of the sheer magnitude of the organism that's dying, so you had lots of it in there, or you had maybe a lot of relatives of that organism that your doctor thinks they're killing and they're killing a bunch of other ones, and so the therapy causes microbes to die, which creates a lot of inflammatory and immune activity, which is good, but it doesn't feel good. Okay, now we'll do a whole thing about Die-off syndromes and all of that. In fact, I'm going to do a long podcast on all that, but that's the bottom line is your body is trying to eradicate something. The immune system gets active. Whenever your immune system gets active, you can get unpleasant symptoms, and you think, well, I'm taking the anti-infective drug to kill that stuff, shouldn't I feel better? Well, you will, and you should feel better, but not always right away. The other thing that I've seen happen is sometimes, you know, we, sometimes we doctors act, you know, like we know more than we really do, but, you know, we may be targeting one particular microorganism or a family, and the drug that we're using might kill 3 related families or 3 unrelated families, and we may not know from your signs and symptoms. bacterial type of a walking pneumonia, how many organisms are in there. So we might think that we're going in to kill a small, you know, family, and we kill a whole neighborhood. Well, that's good because the neighborhood was a bad neighborhood and it should be gone, but your body's going to react a lot more aggressively, okay. So that's one of the reasons why that can happen, sort of a direct effect. The other is this sort of new normal effect where your body just doesn't want to, you know, it doesn't like to ratchet back to normal. Same thing happens if your hormones have been imbalanced for a long time, or, you know, maybe you've had a low thyroid condition or whatever hormone. If it's been a long time, your body's used to that. It doesn't like it, but it's used to it. So you start to take hormone replacement or do some other therapy for it, it may feel very odd for a while until you get used to the new normal. Now, there's a lot of other things, but the real point I wanted to get to here, as I said, you know, when it gets to like die-off syndromes and other, you know, syndromes that go along with chronic illness treatment, I'm going to be doing a long-form podcast on that that we'll put up here on YouTube as well. But mostly I wanted to get to what are some top tips for dealing with this. Uh, I, I'm not reacting well to my treatment, and, you know, I want to get better, but I don't feel like I'm getting better. The first thing is to, you know, ask your healthcare provider, stay in contact with them. If you have a chronic illness or a lot of complex things going on, ask them, you know, what would be— what kind of odd reactions can I have? Can I get like die-off things from this, or do I need to take— you know, things to help out with my digestion, or whatever it is that they're working on treating. Talk to them. You know, one of the things that happens when you're a healthcare provider is you've said it so many times to other people, sometimes you assume that, you know, well, everyone would know that they should drink more water or they should do whatever. Ask us. We like that. We like to be reminded. The other thing that you want to ask, and normally your healthcare provider will tell you this up front, but If there's signs or symptoms that would mean that this therapy is too strong or, you know, too much for me or I'm having a reaction, you want to know what those are when you're taking it if you have never had the therapy before. And so they will generally say, or if it's a complex therapy, they may give you a handout that says, you know, these are common symptoms, but if you get these symptoms, call us right away. You know, for example, there are some therapies where, you your heart, you know, can have certain issues, heart can start racing or something, and we need to call right away, or if you start getting dizzy, or you start having other things, whereas they might say almost everybody who takes this has digestive issues and you can do these things about it, those are kind of normal and we just deal with them as they go along. So really, uh, stay connected with your healthcare provider and they will tell you which things are red flags that you need to call them about or get in and be seen right away. The other thing is, you know, to be patient with the process. And when you're sick, the last thing you want to do is be patient with anything. But if you've been sick for a while or you get hit with something very unusual like long COVID, or you have an underlying disease and then you get another one on top of it, it's a journey. It's not a 1, 2, 3 step destination that you're in. So as hard as that is to do, you do have to take a deep breath. But the other thing is just be open and honest with your healthcare provider. We know it's frustrating. We know it's frustrating for us. We'd like you to heal faster. It's frustrating for you. And just keep checking in because sometimes there are things that can be tuned up or changed around or whatever And that is a two-way street. I always tell, especially chronically ill patients, but everybody, your body has a language it speaks, and the language is a nonverbal language. It's usually signs, symptoms, and the way that you're reacting to treatment. Those things all mean something to your healthcare provider, so, but they don't know what's going on inside of you, so stay connected. And if things really are going off the rails, Reconnect and just see what's going on. All right, well, that's all our time for today. We'll be back with more later. Please like, share, subscribe, notifications, all those things that I barely know what, what they do. Please do those if you want to, and I'll see you later on the channel. Thank you.
