Dr. Gary Kaplan was recently interviewed on The Health Fix podcast, hosted by Dr. Jannine Krause, aka “Dr. J”.
Episode #397: How chronic illnesses provoke the body to attack you vs. the bug
The effects of bacteria, viruses, parasites, molds, and other infections can linger in the body long after the infection. These molecules of invaders can trigger your body to attack itself. This is a common phenomenon that has been going on for a long time but has been gaining publicity with long-haul symptoms since the pandemic. Turns out viruses aren’t the only bugs causing long-haul syndromes. In this episode of The Health Fix, Dr. J interviews Dr. Kaplan on how to identify if your chronic symptoms are related to lingering effects of previous infections.
You can access the podcast via any podcast streaming website/app (Apple Podcast link below).
What You’ll Learn:
Why chronic fatigue is a sign of brain inflammation
20-50% of people do not make enzymes to neutralize mold toxins
How pieces of the bugs that you get infections from cause inflammation in your body
Why mold, Lyme, strep, viral infections, and parasites could be keeping you sick
How mental health issues can be related to chronic infections, especially in kids
Tests commonly used to sleuth out chronic infections
The connection between sleep apnea and chronic illness
How to test yourself for the autoimmune condition POTS by taking your blood pressure
There are over 20 million Americans suffering from a group of chronic disabling disorders who are diagnosed without a clear elucidation of pathophysiologic mechanisms. Fibromyalgia, Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS), Neuropsychiatric illnesses, Posttreatment Lyme Syndrome, Pediatric Acute on Neuropsychiatric Syndrome (PANDAS/PANS).
Adding to this massive disease burden the CDC now estimates that of the 40% of Americans who were infected with COVID-19 1 in 5 continue to suffer with what is now referred to as Post-acute sequelae of COVID (PASC). Research has demonstrated that common to all of these conditions is dysregulation of the immune system resulting from an infectious insult. Dramatic advances have occurred in our understanding of all of these conditions as a result of COVID. We are entering an incredibly exciting period in medicine where these diseases are beginning to coalesce around an understanding of shared pathophysiology. We are entering a period of true hope for those millions who are suffering where we will finally be able to provide comprehensive solutions for their illness.
This conference will bring together some of the leading researchers and clinicians from around the world to discuss the advances in our understanding of these conditions and breakthroughs in diagnostic and treatment options.
The peripheral nervous system includes the nerves that lead from the brain and spinal cord throughout the body. There are several different types of peripheral nerves including motor nerves, which carry messages that make our muscles work; sensory nerves, which carry sensations from our skin, muscles, and organs including touch, temperature, vibration, and pain; and nerves that control autonomic function (involuntary) such as heart rate, breathing, blood pressure, and digestion. Peripheral neuropathy is a term used to describe damage to these peripheral nerves.
Symptoms of peripheral neuropathy depend on what types of peripheral nerves have been damaged but typically can include numbness, tingling, pain, and weakness, as well as digestive difficulties and bladder dysfunction. The peripheral nerves most commonly damaged are those that deal with sensation, therefore the most common symptom of people suffering from peripheral neuropathy is pain, which can unfortunately be quite severe.
Damage to the peripheral nerves can be caused by many conditions, including:
Autoimmune diseases such as Celiac disease, pernicious anemia
Alcohol abuse
Side effects from medications (chemotherapy, for example)
Metabolic disorders such as diabetes, hypothyroidism, and nutritional /vitamin deficiencies
Trauma
Hereditary disorders such as Charcot-Marie-Tooth (CMT) disease.
Treating Peripheral Neuropathy
Treatment is first and foremost aimed at addressing the underlying cause and finding the appropriate solution to resolve and/or manage it. Unfortunately, in approximately 30% of the cases, an underlying cause cannot be identified, and this is called idiopathic peripheral neuropathy.
The next goal of treatment is to alleviate pain and preserve function. In our Center, we typically start with acupuncture and herbal supplements that stimulate the body’s natural healing process. Both of these therapies have been very effective for a large number of our patients over the years. Physical therapy can also be helpful. Topical medications such as lidocaine patches or creams that we have compounded specially for our patients are our next line of therapy.
Next, we consider the use of antidepressant medications such as amitriptyline or nortriptyline, or anticonvulsant medications such as gabapentin or Lyrica, as both types of medications can be helpful in moderating pain by altering neurotransmission in the peripheral nervous system. All of these medications have potential side effects, and unfortunately, none of the therapies are 100% effective.
For those who are diabetic, management of blood sugar is crucial to control the progression of the neuropathy. There are several supplements such as magnesium and chromium picolinate that might be helpful as people who have diabetes are typically low in both. Also, there is a significantly higher risk of celiac disease and thyroid disease in people who have Type-1 diabetes. If you have not already been evaluated for these diseases, you need to be tested. A simple blood test can be done for both conditions.
Peripheral neuropathy can also put you at higher risk of injury from a fall and other types of accidents. Ask a family member or friend to help you organize your home in a way that minimizes clutter and keeps walking areas open.
Peripheral neuropathy can improve with time if the underlying condition is addressed, but unfortunately in some cases, the damage may become permanent. If you’re suffering from nerve pain don’t delay talking to your provider about your symptoms. A healthy lifestyle combined with a holistic treatment approach can improve the physical and emotional effects of peripheral neuropathy and help you re-engage in life.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
This article was originally published in May 2015. It was reviewed and updated in September 2023.
The number of patients diagnosed with chronic pain conditions continues to rise in the United States, topping 51 million in 2021. 1
Chronic pain is defined as pain that lasts for more than 3 months, a time frame that under normal circumstances should accommodate the body’s normal healing process. But when the body doesn’t respond how we expect it to, lives can quickly be interrupted, and for many, it can be life-shattering.
Chronic pain is treatable and there are many effective options available, so why are millions of people being left behind?
One of the biggest challenges in diagnosing and managing chronic pain is the fact that providers have to rely almost exclusively on the individual’s description of their pain and the disability it causes. Pain is subjective – there is no biomarker, blood test, or imaging study that can objectively detect the presence and severity of pain.
However, research that looks at the way our brains and nervous systems initiate and sustain severe chronic pain continues to point to the same conclusion – that chronic pain, in and of itself, is not the problem to be treated. Instead, chronic pain should be seen as a symptom of an underlying medical problem, and it is to this underlying problem that treatment must be targeted.
Specifically, chronic pain is a symptom of inflammation in the brain, or what I call “a brain on fire”. This inflammation is triggered by the body’s own immune system, which is designed to respond to any kind of assault. For example, physical injury, infections (such as Lyme disease or COVID-19), exposure to environmental toxins, concussions, celiac disease, loss of oxygen to the brain caused by sleep apnea, and even long-term emotional trauma, can set off an inflammatory response in the brain and central nervous system. Identifying the source(s) of inflammation is critical to breaking the cycle of chronic pain; and frequently, the sources are multiple, compounding, and cumulative.
To accurately diagnose and treat the causes of neuroinflammation that manifest as chronic pain, providers must:
Take a comprehensive medical history of each individual.
Work to correctly identify and treat the underlying root cause(s) of chronic pain.
Educate people about their relationship with chronic pain. Like all relationships, how this is managed can make life substantially better or worse.
Pain Management Programs
Intensive pain management programs can be an extremely important tool in helping patients manage their pain and live a better life. They typically involve a treatment schedule that spans several weeks, during which time attendees are typically seen by a team of healthcare providers with a variety of specialties. Although programs vary somewhat from one to another, each is likely to include:
Initial consultation with a provider who has pain management experience.
Specialized lab tests.
Nutritional intervention, including anti-inflammatory elimination diets and consultations with nutrition experts.
Behavioral health techniques, such as meditation and relaxation therapies.
Movement therapies, such as yoga (especially restorative yoga and yogic philosophy training), and physical therapy, including core strengthening and biomechanics.
The goal of this type of intense programming with an emphasis on education is to help individuals think differently about their pain while providing them with new tools to manage their pain and re-engage in their lives. Additionally, if the programs are designed to approach pain as a symptom of an underlying medical condition and the treatment aims to resolve the root cause of the pain, there is a very good possibility that the pain will go away.
The Bottom Line
Chronic pain is not a disease but a symptom.
The way we treat pain now has, for the most part, been a costly, abysmal failure. Opioids are the most pressing issue but there are also serious concerns about the number of unsuccessful and unnecessary procedures (surgeries in particular) and the proliferation of the use of dorsal column stimulators (implanted electronic devices placed near the spinal cord to treat chronic pain), and the overutilization of spinal blocks (injections of anesthetic into the spine). The research evidence for these approaches for the treatment of chronic pain ranges from fair to poor. 2,3,4,5
Behavioral health programs have some of the strongest data and the greatest success in treating chronic pain conditions. And, more importantly, when these programs are not successful, they don’t make the situation worse (unlike surgery and other invasive procedures).
What Needs to Happen
Individuals suffering from chronic pain must, in every single case, be offered a comprehensive workup with an individualized treatment approach.
We need to continue with research into the causes of inflammation in the brain, while also working on developing a treatment for brain inflammation that leads to chronic pain. We also need to develop testing that will provide us with an objective indicator of the chronic pain/underlying disease and its response to treatment.
In the interim, we should focus on improving the lives of our patients by using targeted therapies that address the biology of the pain, rather than its symptoms; anything short of this is like putting a Band-Aid on a bullet hole.
Our Long-COVID Recovery Program provides comprehensive care to patients who still have COVID-19 symptoms more than six weeks after recovering from the initial infection. If you are experiencing symptoms beyond six weeks of being diagnosed, please give us a call at 703-532-6302.
LISTEN NOW: Dr. Gary Kaplan on infections and chronic illness
/in Long Covid, Wellness/by Kaplan CenterDr. Gary Kaplan was recently interviewed on The Health Fix podcast, hosted by Dr. Jannine Krause, aka “Dr. J”.
Episode #397: How chronic illnesses provoke the body to attack you vs. the bug
The effects of bacteria, viruses, parasites, molds, and other infections can linger in the body long after the infection. These molecules of invaders can trigger your body to attack itself. This is a common phenomenon that has been going on for a long time but has been gaining publicity with long-haul symptoms since the pandemic. Turns out viruses aren’t the only bugs causing long-haul syndromes. In this episode of The Health Fix, Dr. J interviews Dr. Kaplan on how to identify if your chronic symptoms are related to lingering effects of previous infections.
You can access the podcast via any podcast streaming website/app (Apple Podcast link below).
What You’ll Learn:
There are over 20 million Americans suffering from a group of chronic disabling disorders who are diagnosed without a clear elucidation of pathophysiologic mechanisms. Fibromyalgia, Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome (ME/CFS), Neuropsychiatric illnesses, Posttreatment Lyme Syndrome, Pediatric Acute on Neuropsychiatric Syndrome (PANDAS/PANS).
Adding to this massive disease burden the CDC now estimates that of the 40% of Americans who were infected with COVID-19 1 in 5 continue to suffer with what is now referred to as Post-acute sequelae of COVID (PASC). Research has demonstrated that common to all of these conditions is dysregulation of the immune system resulting from an infectious insult. Dramatic advances have occurred in our understanding of all of these conditions as a result of COVID. We are entering an incredibly exciting period in medicine where these diseases are beginning to coalesce around an understanding of shared pathophysiology. We are entering a period of true hope for those millions who are suffering where we will finally be able to provide comprehensive solutions for their illness.
This conference will bring together some of the leading researchers and clinicians from around the world to discuss the advances in our understanding of these conditions and breakthroughs in diagnostic and treatment options.
For more info and to register, visit https://medstar.cloud-cme.com/course/courseoverview?P=0&EID=20362
Treating Peripheral Neuropathy
/in Treatments/by Gary Kaplan, DOThe peripheral nervous system includes the nerves that lead from the brain and spinal cord throughout the body. There are several different types of peripheral nerves including motor nerves, which carry messages that make our muscles work; sensory nerves, which carry sensations from our skin, muscles, and organs including touch, temperature, vibration, and pain; and nerves that control autonomic function (involuntary) such as heart rate, breathing, blood pressure, and digestion. Peripheral neuropathy is a term used to describe damage to these peripheral nerves.
Symptoms of peripheral neuropathy depend on what types of peripheral nerves have been damaged but typically can include numbness, tingling, pain, and weakness, as well as digestive difficulties and bladder dysfunction. The peripheral nerves most commonly damaged are those that deal with sensation, therefore the most common symptom of people suffering from peripheral neuropathy is pain, which can unfortunately be quite severe.
Damage to the peripheral nerves can be caused by many conditions, including:
Treating Peripheral Neuropathy
Treatment is first and foremost aimed at addressing the underlying cause and finding the appropriate solution to resolve and/or manage it. Unfortunately, in approximately 30% of the cases, an underlying cause cannot be identified, and this is called idiopathic peripheral neuropathy.
The next goal of treatment is to alleviate pain and preserve function. In our Center, we typically start with acupuncture and herbal supplements that stimulate the body’s natural healing process. Both of these therapies have been very effective for a large number of our patients over the years. Physical therapy can also be helpful. Topical medications such as lidocaine patches or creams that we have compounded specially for our patients are our next line of therapy.
Next, we consider the use of antidepressant medications such as amitriptyline or nortriptyline, or anticonvulsant medications such as gabapentin or Lyrica, as both types of medications can be helpful in moderating pain by altering neurotransmission in the peripheral nervous system. All of these medications have potential side effects, and unfortunately, none of the therapies are 100% effective.
For those who are diabetic, management of blood sugar is crucial to control the progression of the neuropathy. There are several supplements such as magnesium and chromium picolinate that might be helpful as people who have diabetes are typically low in both. Also, there is a significantly higher risk of celiac disease and thyroid disease in people who have Type-1 diabetes. If you have not already been evaluated for these diseases, you need to be tested. A simple blood test can be done for both conditions.
Peripheral neuropathy can also put you at higher risk of injury from a fall and other types of accidents. Ask a family member or friend to help you organize your home in a way that minimizes clutter and keeps walking areas open.
Peripheral neuropathy can improve with time if the underlying condition is addressed, but unfortunately in some cases, the damage may become permanent. If you’re suffering from nerve pain don’t delay talking to your provider about your symptoms. A healthy lifestyle combined with a holistic treatment approach can improve the physical and emotional effects of peripheral neuropathy and help you re-engage in life.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
This article was originally published in May 2015. It was reviewed and updated in September 2023.
Treating Chronic Pain
/in Long Covid, Treatments/by Gary Kaplan, DOThe number of patients diagnosed with chronic pain conditions continues to rise in the United States, topping 51 million in 2021. 1
Chronic pain is defined as pain that lasts for more than 3 months, a time frame that under normal circumstances should accommodate the body’s normal healing process. But when the body doesn’t respond how we expect it to, lives can quickly be interrupted, and for many, it can be life-shattering.
Chronic pain is treatable and there are many effective options available, so why are millions of people being left behind?
One of the biggest challenges in diagnosing and managing chronic pain is the fact that providers have to rely almost exclusively on the individual’s description of their pain and the disability it causes. Pain is subjective – there is no biomarker, blood test, or imaging study that can objectively detect the presence and severity of pain.
However, research that looks at the way our brains and nervous systems initiate and sustain severe chronic pain continues to point to the same conclusion – that chronic pain, in and of itself, is not the problem to be treated. Instead, chronic pain should be seen as a symptom of an underlying medical problem, and it is to this underlying problem that treatment must be targeted.
Specifically, chronic pain is a symptom of inflammation in the brain, or what I call “a brain on fire”. This inflammation is triggered by the body’s own immune system, which is designed to respond to any kind of assault. For example, physical injury, infections (such as Lyme disease or COVID-19), exposure to environmental toxins, concussions, celiac disease, loss of oxygen to the brain caused by sleep apnea, and even long-term emotional trauma, can set off an inflammatory response in the brain and central nervous system. Identifying the source(s) of inflammation is critical to breaking the cycle of chronic pain; and frequently, the sources are multiple, compounding, and cumulative.
To accurately diagnose and treat the causes of neuroinflammation that manifest as chronic pain, providers must:
Pain Management Programs
Intensive pain management programs can be an extremely important tool in helping patients manage their pain and live a better life. They typically involve a treatment schedule that spans several weeks, during which time attendees are typically seen by a team of healthcare providers with a variety of specialties. Although programs vary somewhat from one to another, each is likely to include:
The goal of this type of intense programming with an emphasis on education is to help individuals think differently about their pain while providing them with new tools to manage their pain and re-engage in their lives. Additionally, if the programs are designed to approach pain as a symptom of an underlying medical condition and the treatment aims to resolve the root cause of the pain, there is a very good possibility that the pain will go away.
The Bottom Line
What Needs to Happen
Individuals suffering from chronic pain must, in every single case, be offered a comprehensive workup with an individualized treatment approach.
We need to continue with research into the causes of inflammation in the brain, while also working on developing a treatment for brain inflammation that leads to chronic pain. We also need to develop testing that will provide us with an objective indicator of the chronic pain/underlying disease and its response to treatment.
In the interim, we should focus on improving the lives of our patients by using targeted therapies that address the biology of the pain, rather than its symptoms; anything short of this is like putting a Band-Aid on a bullet hole.
–Dr. Gary Kaplan
Sources:
1. Rikard SM, Strahan AE, Schmit KM, Guy GP Jr.. Chronic Pain Among Adults — United States, 2019–2021. MMWR Morb Mortal Wkly Rep 2023;72:379–385. DOI: http://dx.doi.org/10.15585/mmwr.mm7215a1.
2. PMID: 24308846
3. PMID: 25840040
4. PMID: 26824399
5. PMCID: PMC3777049
Long-COVID Recovery Program
Our Long-COVID Recovery Program provides comprehensive care to patients who still have COVID-19 symptoms more than six weeks after recovering from the initial infection. If you are experiencing symptoms beyond six weeks of being diagnosed, please give us a call at 703-532-6302.
We are here for you, and we want to help.
Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2
This article was originally published in September 2016. It was reviewed and updated in September 2023.