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The mask debate. Masks protect us and others. Not all are made the same. Surgical type masks, the blue ones with elastic ear straps, have been used for years in surgery to protect the patient from bacteria spread from the surgery personnel to the patient on the table in the surgery suite. They are used also by medical personnel in rooms with immunocompromised individuals to protect the patient.

Medical personnel also wear surgical type masks to protect themselves from infected patients.

With COVID, the goal is not to spread the virus if you have it and also to protect yourself from the spread by others. The tighter the mask fits to the face the less likely spreading occurs and also that you will be protected by breathing filtered air thru the mask and not from around it.

The N95 mask is designed so it fits to the face better and with a bigger pocket for the nose but may be harder to breathe through. Homemade masks and face coverings are definitely better than nothing to protect you and others. Using some sort of face covering is important to reduce spread so choosing the one that you can tolerate and will use is so important. Try the different types for fit and tolerance.

I’m seeing face shields being worn without masks. Shields were designed to protect health care workers from the direct contact of body fluids to the eyes and face. They are meant to be worn with a mask.

Wearing the shield without a face covering only prevents direct contact of particles from a cough or sneeze by others around you. You are unprotected with your next breath, as you breathe in the expelled respiratory particles from around the shield that are still suspended in the air. When you cough or sneeze you spread the expelled particles to the shield and the particles are directed down and out into the air, clothing and surfaces below the shield.

Overall, not much protection either from you spreading particles or receiving particles. Wearing one does remind the wearer of COVID-19 and the need to distance.

Keeping a strong immune system. Supporting your immune system is important. Zinc suppresses viruses from multiplying as well as the amino acid Lysine. Vitamin D is also reported to be a protective nutrient. In my practice many patients are severely Vitamin D deficient when I first see them and measure their blood level. Proper guidance by a health professional is helpful in determining what level of supplementation is right for you.

Which are the best tests? Testing can be confusing. The nasal swab, PCR for COVID-19, looks for the virus being present by detecting its specific genetic material. This tells us the virus is present in the nasal cavity and is capable of being spread to other people. True illness occurs when that person has symptoms such as fever, chills, cough, aching and fatigue.

Antibody testing looks for your immune response to the virus. IgM antibodies may be present within a few days of exposure, showing an acute exposure situation. IgG antibodies form after days to weeks after the virus contacts your body and show prior exposure or infection and may indicate some immunity to the virus has developed. IgA antibodies indicated a mucus membrane immune defense response to the virus and generally is seen early on like IgM.

Antigen testing looks for specific proteins on the surface of the virus indicating virus is present. Just like IgM positive you may or may not have symptoms when positive. Results that are obtained quickly are the most helpful in the symptomatic patient.

How testing and treatment all ties together. In medical treatment of a disease early detection and treatment is useful in decreasing the severity of the medical problem. In my experience the same is true with COVID-19. Testing to confirm infection with results obtained within one to two days is important in symptomatic patients to begin early treatment. The longer the time the virus has to multiply before treatment the greater the infective load the ill individual’s immune system has to overcome.

Early treatment in infections generally provides a better outcome. The recent study from Henry, hydroxychloroquine, cut the death by 50 percent. Seeking medical help early when symptoms occur is important in improving the individual’s outcome and recovery.

Dr. Alfred Johnson, D.O. is a physician practicing in Richardson, specializing in internal medicine, environmental medicine and chronic disease. For more information, visit johnsonmedicalassociates.com or call 972-479-0400.

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Getting a diagnosis. It can be hard to get a proper diagnosis because not all doctors are familiar with Lyme disease. Finding a doctor that frequently treats Lyme, such as myself, improves your chances of knowing what is really going on in your body. That physician can recommend the best available testing methods and interpret the results correctly because they know what other types of information can be helpful thanks to their experience in evaluating and treating the disease among their patients. This should be done as quickly as possible because the lab results for long-term Lyme disease is not as accurate. The body may stop producing antibodies after a while.

The two-step test. The Center for Disease Control recommends a two-step test which much both turn out positive before Lyme disease can be confirmed. If a person has a negative result in either of these tests, then Lyme can be ruled out and other causes may be explored. The first test is called ELISA which is an acronym for enzyme-linked immunosorbent assay. The next step is the Western Blot Test. These are just two ways to check for antibodies that can confirm the presence of the B. burgdorferi bacteria in the blood. If only one of these is performed, then the risk of having a false positive is high.

Why direct testing is not advisable. You might wonder why the tests are looking for antibodies instead of the bacteria itself. Other diseases, including COVID-19, can be found through direct testing using the PCR test or polymerase chain reaction. The answer is that direct tests are difficult for Lyme because the bacteria can hide to protect itself from antibiotics. If the test is conducted while they are in hiding, then false negatives are likely. It’s fortunate that the bacteria has no control over the production of antibodies. These are easier to search for in infected persons.

The ELISA Test and Western Blot Test. This is the standard testing protocol. This is good for short-term diagnosis using antibodies as targets. The body produces antibodies to fight infection. Different pathogens like viruses and bacteria result in different antibodies. Their presence indicates that the person’s immune system is fighting the B. burgdorferi bacteria. A negative result is deemed to be conclusive that Lyme disease is out of the question. No further tests are necessary. If positive, then confirmatory test is required. The Western Blot Test is an immunoblot test that also looks for antibodies.

Why false positives occur. There are many reasons why false positive results come out of these tests. Usually, the culprit is the presence of another infection. If your body is currently fighting mold infection, then you might get a positive test even if you don’t have Lyme disease. Physicians should explore other possible causes to prevent wrong diagnoses by asking about possible mold exposure and other issues that are commonly associated with false positives. Mold infections are particularly problematic since the symptoms are like what you would find with Lyme.

There are even cases wherein the patient has no symptoms at all and yet the tests turn out positive. There are two possible explanations. The first is that the bacteria is present in the body but the immune system is so strong that it is not affecting the person. The second is that it is a false positive in which another type of infection is causing the problem. New tests may be needed to pinpoint the exact issue. After all, symptoms might emerge later and make life harder for the individual. Early intervention will lead to better outcomes.

Mold infection can be assessed using a culture of suspected areas. DNA probes and standard growth techniques are utilized. The toxicity in the body can be analyzed using urine, blood, hair, or saliva samples. Longer exposure in a problematic environment increases the chances of inhaling the spores. Known symptoms include fatigue, headaches, joint pain and chronic cough. Consulting a physician familiar with mold illness, Lyme, and the conflicts between them can help you ensure proper diagnosis and treatment. With my years of experience with the matter, my staff and I have been able to help many find their way to better health despite these difficulties.

Dr. Alfred Johnson, D.O. is a physician practicing in Richardson, specializing in internal medicine, environmental medicine and chronic disease. For more information, visit johnsonmedicalassociates.com.

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Evaluating the underlying causes. This is a complicated situation for the physician and the patient and requires time and patience for both the patient and the physician to work through the process of evaluating for underlying causes or triggers. Triggers can be allergies to mold, food, dust mites or animal dander. It also may be due to viruses such at Epstein Barr (Mononucleosis), West Nile Virus or Lyme Disease. Exposure to toxic chemicals in the workplace or at home such as solvents or pesticides affects cell function, thus fatigue. Excessive dampness in a home or building can produce mold growth that in many cases produce mycotoxins, a neurotoxic substance, that affects the nervous system including adverse effects on brain function.

Be mindful of when and where you experience your symptoms. A chronological history is important in understanding the time and place of onset of symptoms including work and living conditions. Frequently, I hear that the illness began shortly after the patient moved from out of state, moved to a new residence or started a new job.

When this is the situation indoor air quality issues are a strong consideration such as mold or chemical exposure. Dampness in a dwelling creates an environment for mold growth that causes allergic conditions such as asthma, cough, eye irritation, nasal congestion and yes – fatigue. If that mold is one that produces mycotoxins such as aspergillus, penicillium or stackyboytris, which are neurotoxins, that affect not only the brain but also the cell mitochondria ATP production (the energy producers) resulting in fatigue.

Food sensitivity and fatigue. If fatigue starts after a meal, then food sensitivity needs to be considered. Foods include what you drink, seasonings and all types of ingredients that one ingests. Recently, I saw a lady that was falling asleep when driving home from work. In taking a history of her problem I asked what was different in what she was eating for lunch. She thought for a moment and then said she had added tea. Skin testing showed a sensitivity to tea. She stopped and the problem resolved.

Many food problems can be defined by doing a Four Day Rotation Diet. This involves eating two to three individual foods per meal and not repeating any of those foods until four days have elapsed. Keep a diary on how you feel after eating. Reactions may occur quickly or be delayed hours, some to the next morning. Pay attention to how you feel on awakening and the quality of sleep you had. Repeat for at least three times for 12 days in total. If you find a reactive food omit the next time around.

Viral infections that can cause fatigue. Some viral infections just make you feel bad and not diagnosed unless the correct tests are run. IgG antibody tests show past exposure or infection. IgM antibodies present in high amounts generally means acute infection. PCR (DNA detection) means the virus is present. Possible offenders could be EBV, West Nile, or Lyme if one has been bitten by a tick. Appropriate testing can be run by a physician.

COVID is the current virus concern. If you have symptoms get tested. Nasal swabs pick up the DNA of the virus. Blood antibody tests evaluate for acute infection, IgM positive, and past exposure is expressed by IgG positive test results. Early treatment as in any infection should lessen the adverse effects of the infection. The recent Henry Ford study is proof of that response.

Stay healthy, pay attention to safeguards and hopefully this will help you understand some of the underlying triggers of fatigue.

Dr. Alfred Johnson, D.O. is a physician practicing in Richardson, specializing in internal medicine, environmental medicine and chronic disease. For more information, visit johnsonmedicalassociates.com.

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Previously, we have broached the topics of mold exposure and housing situations that produce sickness. The same symptoms discussed were fatigue, fever, headaches, joint and muscle pain, nausea, visual disturbances, rashes, shortness of breath, “brain fog,” cognitive dysfunction, numbness and tingling of skin.

These can be caused by other underlying factors and it is especially frustrating when all the standard laboratory tests are negative and physicians have instated trials of therapy with little or no health improvement. People many times resort the self- treatment with vitamins, minerals and herbs with varying results but no resolution.

Labels attached to these individuals may include Chronic fatigue, Chronic Fatigue Syndrome, Fibromyalgia, Chronic Mononucleosis (EBV), Chronic Lyme Disease, different chronic virus or bacterial infections (CMV, etc.), leaky gut, parasitic infection or Mast Cell Activation syndrome. A diagnostic label gives some people comfort but little help in resolving the problem.

This situation presents a challenge to both patient and physician as determining the specific cause becomes even more important so that a cause directed treatment approach can be instated.

How is this done? A timeline history of health problems along with living and/or work situation needs to be recorded to determine time and place of symptom onset. This allows us to determine changes in environment that occurred area of country, different allergens in new area or amount in current residence/work, different lawn, pesticides, or cleaning products (always read labels for content), emissions from close by factories, natural environmental factors and disease vectors in the area like carriers such as tics, mosquitoes and fleas, contact with others with like symptoms, Mononucleosis or other transmittable diseases, potential exposure at work due to chemicals, mold, or poor air quality and travel in a time close to the onset of symptoms.

By creating a timeline of health and illness, a better idea of the time and place of onset can be determined and then discussed with your physician. The environmental and industrial changes surrounding the onset of your illness may need to be researched thru the EPA, Toxic Waste sites and also be discussion the physician.

If your physician is unwilling or does not have the time or interest then it is important to find one that is focused on doing specific diagnostic testing to find the underlying cause, generally one with internal medicine and environmental training.

Specific tests for acute infection are generally PCR (genetic) based showing presence of the organism in blood or secretions. An example of this is the COVID 19 nasal swab, a PCR test. Upon exposure, the body also reacts by producing antibodies to the individual insults. The immediate response is an IgM (immunoglobulin M) response.

Days to weeks later an immunoglobulin G (IgG) response occurs if the individual is not immune deficient. In those individuals they have low IgG and may produce a lower or no response. IgM positive means acute infection. IgG elevated levels mean past exposure or serial elevation may mean reactivation in the case of EBV. Interpreting the IgG tests must be done with caution as a virus or mold IgG antibody may cross react in the test tube causing a false positive in other IgG tests. Just because your IgG level is positive does not mean you have that specific infection now.

An example is in the EBV antibody panel test (acute and chronic Mononucleosis). The IgG portion may be falsely elevated by mold or virus exposure creating confusion of reactivation.

Another confusing test is the Lyme Western Blot Test were IgG antibodies measure the presence of specific proteins. These proteins are found in many organisms, just not Lyme. The CDC has a specific criterion for the number of bands present for the test to be considered a positive IgG test (past exposure) or IgM test (acute exposure). If this criterion is not met, then one is considered negative for Lyme. Treatment failures probably mean that there is another underlying condition.

Hidden causes include toxic substances such as heavy metals, pesticides, carbon monoxide, hydrogen sulfide and volatile organic chemical compounds which include mycotoxins from mold. Toxins affect the body in such an adverse way, at the cellular level including the mitochondria (the energy engines of the body), that until the toxic problem is resolved the body has a difficult time recovering (person symptom free).

Mycotoxins are measured by a urine test thru Realtime Labs, Carrollton in requested by you or your physician.

Once the cause is defined then a treatment plan can be designed for your individual need.

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Now that we are all stuck inside due to the COVID-19 pandemic, how are you feeling physically? Do you find that you are more fatigued, having nasal congestion, difficulty concentrating, allergies feeling worse than normal, an unsteady mental state, bowel changes or unusual shortness of breath?

Certainly, we are all experiencing the anxiety of the unknown, concern for those sick and worry for our extended families during this time. It is especially overwhelming with children, family members and pets under our feet 24/7. However, your health can also be affected by odors and other living contaminants that may inhabit your living space, such as a natural gas leak, dust mites and mold.

I have never experienced a time where we were basically confined to our homes for an extended period. We need to ensure that staying inside is not going to harm us as a potentially toxic environment.

Do you feel better when taking a walk and getting out of your home? If yes, this is a first clue that there may be something in your home that is adversely affecting you. Not everyone may experience the same symptoms or feel anything at all, because individuals have different tolerances and immune symptoms, even in the same family. Everyone’s genetics are different, except in identical twins. The most allergic or sensitive person in a home generally notices the problem first. The canary?

Is there something in your home harming you? Some things to think about that could potentially harm you while you are staying inside in quarantine:

Natural gas leaks. These have that putrid odor of mercaptans-sulfur that is mixed in the natural gas to help detect leaks.

Dust mites. These microscopic insects live off your skin flakes and are generally most concentrated in the bedroom in sheets, pillows and pillowcases.

Mold. Different types of molds hide in the damp areas of your home. They have to have dampness to grow and produce that musty damp smell along with odorless toxins called mycotoxins that affect an individual’s nervous system. Mold can also affect the brain and the extended peripheral nerves to the extremities, intestinal tract and lungs, resulting in the multisystem effects a person may experience upon exposure.

Mold is most likely one of the biggest issues you may encounter, because a lot of people may have it in their home and not realize it. The National Institute of Health published a book titled Damp Indoor Environments, which describes in detail the adverse health effects of mold and mycotoxins. Excessive exposure may cause or exacerbate allergies, cause a mold infection in the sinuses or lungs, or the mycotoxins are inhaled and absorbed and distributed by the blood throughout the body causing neurological symptoms.

Molds grow in damp and dark spaces and are commonly seen as a result of roof leaks, broken pipes, standing water under the house, overflowing bathtubs or toilets, faulty shower pans or shower tile and leaks under the sink.

All these issues contribute to the dampness and potential mold growth frequently resulting in adverse health effects. Many times, the mold isn’t visible as it is in the wall cavities due to water seeping down from a roof leak, or wicking up the wall from the floor.

To determine if your home is having these issues, a Texas state certified Indoor Air Quality inspector is the best person to use to confirm if there is a problem, as they can measure dampness, are trained to visually inspect and do mold spore counts and mycotoxin counts, as well as volatile organic compound analysis of the air inside your wall cavities or other parts of the home.

In my 40 years working as a physician, I have seen all manner of environmental factors that affect patient’s health, oftentimes without their knowledge. Sometimes, the last place we suspect — our homes — may be the culprit when it comes to unexplainable symptoms. However, there is hope. When we ask the right questions and explore all factors that can affect a patient’s health, including their environment, I have seen time and time again that people’s quality of life changed for the better with a specific diagnosis and appropriate treatment.

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