You have exceptionally bad brain fog one day and then a fever and chills the next. On another day your back aches something fierce, and an extra dose of elusive fatigue threads its way through all of these.
Half a dozen therapies, and life's other stressors play a tug-of-war with your symptom picture besides.
So how in the wicked world of Lyme are you supposed to know whether your heightened symptoms indicate a symptom flare, relapse, or a Jarisch-herxheimer reaction?
Good question. I'm still trying to figure that one out myself. You'd think a year and a half of going through the treatment-die-off-relapse rigamarole would have taught me a thing or two. But my body feels so random that at times I haven't a clue whether I'm moving backwards, forwards, or from left to right.
Herxing can produce an exacerbation of all Lyme symptoms, from fatigue, to brain fog, to gut pain, to whatever normally ails you. But life's stressors can do the same. A slip in the diet, the full moon, or a fight with your spouse, and look out, suddently it's 'Honey-I -Blew-Up-The -Symptom!'
It's good to pay attention to when stressors happen, so that you can discern flares from herxes, although sometimes, the effects of these aren't readily apparent. For instance, I can eat a piece of bread and the Monster mood that the gluten produces won't rear its ugly head until the next day.
But if my symptom-aggrandizement happens after a treatment, then I know I'm in herx territory, and not in the midst of a flare. But discerning this can be a challenge, too, since some folks herx immediately following a treatment, while for others, it doesn't happen for days.
And then there are a few who just don't seem to herx at all.
Perhaps the bigger question should be, How do you know if you are moving forwards? How do you know if a treatment is working if you aren't sure whether your increased symptoms are due to a herx, flare, or worse even, a relapse?
In navigating this question, I've come to a few conclusions. We Lymies are all unique, so your experiences may have led you to believe differently, but perhaps the following will shed for you some sunlight (or moonlight!) upon the herx-flare-relapse dance.
1) Okay, so the bad news first. If you seldom herx but don't seem to be improving (not even a teeny-weeny bit) over a period of many months, what you are doing is probably not working.
If you have tried several different therapies with little to no improvement, consider that Lyme may not even be a primary player in your overall symptom picture.
2) If you seldom herx but yet improve over a period of many months (I'm talking at least six here), what you are doing is working. You've just got superb chemistry and detox plumbing which allows your body to skirt the symptomatic effects of neuro and bio-toxins.
2) If your body goes bezerk after a treatment, keep treating (but back down a little on the medicine if it's really making you into a wacko). Keep going as long as you herx, no matter how many months it takes and even if you don't have major improvements for a long time. (But watch for some small ones! You should have these, at least, if you've been going at it for a good year). If the wackiness feels continuous, then slow down or back off for awhile on your treatments, or you may find yourself on a perpetual Jarisch-merry-go-round with no getting off to discern progress.
3)If you have no idea which end is up and your herxes might as well be symptom flares, but you DO feel worse from time to time, pay attention to whether the good ol' days in between are getting any better. Forget the bad days getting worse, it isn't as reliable an indicator of improvement and progress as whether your good days are getting any better. I just had one of my worst herxes ever, after 16 months of slugging away at Borrelia. Before this Herx Thing came at me, however, I had been experiencing greater energy than I was a year ago.
4)If the bad days just keep on getting worse, and the good days are starting to become few and far between, much more so than before you started treating for Lyme, consider that the bugs might not be impressed with your treatment arsenal, or that new critters, perhaps previously dormant, have cropped up to take the place of the old.
If this is happening and has been happening over many months (not just over one or two, as herxes can last a long time) then consider that you may be (gulp) partially relapsing, or that other infections are waking up to party in your body. Or perhaps you've just been aiming at the wrong ones the whole time.
But don't despair; that means it may be simply time to change treatment protocol, work on life's stressors, or find out what new thing has cropped up and treat it appropriately.
Finally, it's important to note that any of the above scenarios, and subsequently, the course of healing, can be skewed and/or altered if a person has congested detoxification pathways.
Taking measures to ensure that the liver, kidneys and other organs are in top working order by performing detox protocol, will enable treatments to work more effectively. Where there is congestion in the body, toxins cannot be released and you will feel like a perpetual garbage dump, no matter how many anti-Borrelia tactics you employ.