Understanding the Underlying Causes of Widespread Pain and Fatigue
Fibromyalgia (FM) is a modern diagnostic term used to describe a constellation of symptoms—most notably, widespread muscular pain and heightened sensitivity at specific tender points throughout the body. While pain may begin in a localized area such as the neck or shoulders, over time it typically spreads and becomes more generalized.
🧠 Common Symptoms
FM pain is often described as:
Burning, radiating, gnawing, sore, stiff, or aching
Fluctuating based on weather, activity, sleep, and stress
Accompanied by fatigue, often severe, affecting daily function
Many patients describe feeling “flu-like”, even in the absence of an actual infection. Up to 90% of FM patients report profound fatigue, decreased stamina, and unrefreshing sleep.
😴 The Sleep Connection
Sleep studies have shown that many individuals with FM experience abnormal sleep architecture, especially disturbances in deep (restorative) sleep. This may help explain why patients wake feeling exhausted despite a full night’s rest.
🧩 Cognitive & Mood Symptoms
FM often overlaps with Chronic Fatigue Syndrome (CFS). Common overlapping symptoms include:
Poor memory
Brain fog
Difficulty concentrating
Mood swings
Confusion
These cognitive and emotional symptoms contribute to the overwhelming nature of FM and its impact on quality of life.
Exploring Root Causes
At its core, FM appears to be part of a broader infection-like or environmental illness syndrome. Triggers may include:
Undetected bacterial or viral infections
Environmental toxicants
Chronic stress and immune dysfunction
In many cases, genetics play a role, influencing how a person responds to a given pathogen or environmental exposure. This helps explain the high variability of symptoms from person to person.
Why Identification Matters
Effective treatment starts with identifying underlying causes. Proper testing can help reveal:
Hidden infections (bacterial, viral, fungal, or parasitic)
Immune system imbalances
Nutritional or mitochondrial deficiencies
Environmental or toxic burdens
Once the root cause(s) are identified, a targeted treatment plan using nutrition, herbal medicine, lifestyle changes, and in some cases, antimicrobial therapies can support the healing process and improve function.
Topical pain relievers can be a helpful part of managing discomfort caused by inflammation, especially when systemic treatments aren’t tolerated or additional support is needed. Dr. Marra often recommends the following trusted products for localized relief:
🌼 Arnica Montana 6X (Homeopathic)
A natural remedy known for its anti-inflammatory and analgesic properties. Often used to relieve:
Bruising
Muscle soreness
Joint pain
💨 Bengay Pain Relieving Cream
Recommended especially for MCAS (Mast Cell Activation Syndrome) due to its menthol and methyl salicylate content. It may help:
Reduce localized inflammation
Relieve muscle and joint stiffness
Improve circulation in the affected area
🐍 Cobroxin
A homeopathic formula derived from cobra venom peptides, known to support:
Moderate to severe chronic pain
Neuropathic discomfort
Anti-inflammatory activity without narcotics
❄️ Uncle Herb’s Icy Pot Medicated Salve
A natural salve that combines cooling herbs and essential oils. Ideal for:
Low Core Body Temperature (less than 97.0 degrees F)
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Many patients who suffer from chronic Lyme Disease and coinfections or chronic complex illness, also suffer from a low core body temperature (less than 97.0 degrees F). Sometimes this cold body temperature is due to hypothyroidism, which is relatively easy to diagnose with blood tests and a thermometer, an easily treated with some combination of T3 and T4 sustained release capsules.
However, sometimes a low core body temperature is due to the build up of toxins in the blood that causes the blood to become thick and viscous and unable to flow through arterial vessels and capillary beds. The lack of proper blood flow results in lowered oxygen concentrations to tissues, and therefore the body begins to become “cold”, and rigor mortis sets in, similar to what is seen in death. The absence of oxygenated tissues means the body will be cold.
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Frequent and proper daily detoxification in Epsom salt baths coupled with 30 minutes of full body movement (i.e., walking, dance, yoga, pilates, biking, trampoline, etc…), to exercise the muscle fibers and mobilize cellular waste and toxins in EXTREMELY important. Infra red saunas, hot baths, etc… are also important to elevate the core body temperature. This is why nearly all chronically ill patients feel better in warmer climates. If the core body temperature is too low, blood cannot properly flow to tissues, especially to the periphery, and the vital force of the patient is compromised. This is why patients with a low body temperature appear sluggish, fatigued, weak, and depressed.
A yeast infection (Candidiasis) is a fungal infection often caused by Candida albicans. Various reasons that fungal infections occur include: excess sugar and carbohydrates in the diet, alcoholism, mold exposure, allergic constitution, improper replenishing of intestinal flora with probiotics (i.e.,Lactobacillus, Saccromyces) long term use of antibiotics, corticosteroid use, and autoimmune illness. Symptoms associated with a yeast infection are: gas, bloating, cramps, diarrhea alternating with constipation, abdominal pain, brain fog and cognitive difficulties, fatigue, strange rashes all over the body, circular vague rashes on the abdomen under the bra area, anal itching, red raised “beefy” and itchy rashes, odorous vaginal discharge, a thick white coating on the tongue (otherwise known as “thrush”), and toenail fungal infections. Yeast overgrowth is particularly relevant to children diagnosed with “Autism” where Lyme Disease has also been documented.
Yeast infections are frequently observed in conjunction with Lyme Disease as the result of improper antibiotic and probiotic use. Fungal infections complicate the symptom picture of chronic illness related to tick borne infections because there is significant symptom overlap and additional pathogen burden on the immune system.
However, yeast (fungal) infections can be avoided with proper nutrition and natural therapeutic supplementation. Pharmaceutical intervention may be required (antifungal medications) at times to prevent a full blown yeast infection but dietary modification is the MOST important factor to avoid chronic yeast infections.
Most patients with chronic illness who have been repeatedly misdiagnosed, and virtually unheard, wind up with some form of PTSD and adrenal exhaustion. The fight to be heard, find a competent practitioner, receive proper and attentive care, is no small feat in this fast paced world, and is much more difficult for the severely ill. Sadly, this component of Lyme Disease is not very well recognized. This is really similar to the PTSD a soldier experiences once he/she is home from a war. The emotional, physical, psychological, and spiritual toll on the body is very significant. Although the war might be over, there are substantial lingering effects of the struggles that occurred during healing.
I encourage my patients to seek counseling from someone who understands the debilitating effects of chronic illness. Reiki, massage, acupuncture, energy healing, spa visits, and EMDR may be very helpful to patients who are unable to shake off the trauma that they endured during their struggle with Lyme Disease.
Many patients also choose to do a yoga retreat in Hawaii, Bali, etc…to regain their balance in life during and/or after treatment. Island trip (ie., Hawaii, Caribbean), also help patients regain a sense of nature and joy which was lost during their battle with chronic illness.
Please consult with Dr. Marra on ideas that may help minimize the effects of PTSD from chronic disease related to tick-borne illness. Having had the disease herself, she understands on a personal level the battles you face during treatment and after treatment.
Understanding MCAS (Mast Cell Activation Syndrome): A Comprehensive Guide
In this article, I’ll explain what MCAS (Mast Cell Activation Syndrome) is, how it presents itself, common triggers, how it’s diagnosed, and what steps you can take to manage it. Understanding this complex condition is the first step toward finding relief.
As someone who has worked with countless patients struggling with unexplained symptoms, I know how confusing and overwhelming it can be to find answers. One condition that often goes undiagnosed is MCAS (Mast Cell Activation Syndrome). If you’re experiencing symptoms that seem to affect multiple systems in your body—ranging from skin reactions to gastrointestinal distress—MCAS might be the piece of the puzzle you’ve been searching for.
To learn more about my approach to diagnosing and treating MCAS, or to schedule a consultation, visit my website. Together, we can take the next step toward addressing your health concerns.
Caption: Medical Minutes with Dr Marra; Episode 57: Amlexanox and MCAS
What is MCAS (Mast Cell Activation Syndrome)?
MCAS is a disorder where your mast cells, which are part of your immune system, release too many chemicals (like histamine, cytokines, and other inflammatory molecules) in response to things that normally wouldn’t cause a reaction. Mast cells are critical for fighting infections and healing injuries. However, when they become overactive—as they do in MCAS—they release these chemicals inappropriately, causing inflammation and a wide variety of symptoms throughout the body.
How Do Mast Cells Affect the Body?
Mast cells are often described as the “guardians” of our immune system. They help protect us from harmful pathogens and are involved in allergic responses. In people without MCAS, mast cells are activated only when necessary. However, in those with MCAS, these cells are triggered even when there’s no infection or allergic response, resulting in unnecessary inflammation and a cascade of symptoms.
Symptoms of MCAS (Mast Cell Activation Syndrome)
The symptoms of MCAS can vary greatly from person to person, which makes it difficult to diagnose. You may experience symptoms in one or more systems of your body. The most common signs I see in my practice include:
Skin Reactions: Itching, hives, and skin flushing are some of the most frequent symptoms. When mast cells release histamine, these types of skin reactions can occur.
Gastrointestinal Distress: Symptoms like nausea, diarrhea, bloating, or abdominal pain are common, as mast cells in the gut become activated, leading to digestive upset.
Respiratory Symptoms: Many patients experience asthma-like symptoms—such as wheezing, shortness of breath, or tightness in the chest—as mast cells in the respiratory tract react.
Cardiovascular Symptoms: Symptoms like dizziness, rapid heart rate, and low blood pressure can arise when mast cells trigger inflammatory chemicals in the cardiovascular system.
Neurological Symptoms: Brain fog, headaches, and mood changes such as anxiety or depression are also associated with MCAS, likely because of mast cell activity in the nervous system.
Common Triggers of MCAS (Mast Cell Activation Syndrome)
One of the most important aspects of managing MCAS is identifying and avoiding its triggers. I always encourage my patients to track their symptoms and note potential triggers. Some of the most common culprits include:
Environmental Triggers: Certain environmental factors, such as changes in temperature, exposure to mold, and even strong fragrances, can set off symptoms. I’ve seen many patients react to exposure to things like cleaning products or cigarette smoke.
Dietary Triggers: For many with MCAS, specific foods like fermented foods, alcohol, or high-histamine foods (such as aged cheese, processed meats, and vinegar) can aggravate symptoms. Keeping a food diary can help pinpoint these. Read more about how to maintain an anti-inflammatory diet.
Stress: Both emotional and physical stress can exacerbate symptoms. Stress management is crucial for those living with MCAS, and I always emphasize practices like deep breathing, yoga, or meditation to help reduce flare-ups.
Medications: Some medications can worsen MCAS symptoms, particularly preservatives or other compounds that may activate mast cells.
Diagnosing MCAS (Mast Cell Activation Syndrome)
MCAS can be challenging to diagnose because its symptoms overlap with so many other conditions. There’s no single test that can diagnose MCAS definitively, but the process typically includes:
Blood Tests: These can measure levels of mast cell mediators like tryptase, histamine, and other markers that indicate excessive mast cell activation.
Urine Tests: A 24-hour urine collection can measure histamine metabolites and other inflammatory substances.
Symptom Tracking: I always encourage patients to keep detailed records of their symptoms, triggers, and any changes in their health, as this is a key part of diagnosis.
How You Can Treat MCAS (Mast Cell Activation Syndrome)
There is currently no cure for MCAS, but with the right treatment plan, you can manage symptoms and improve your quality of life. Treatment typically involves a combination of medications, lifestyle changes, and trigger management. Here are some of the most effective strategies:
Antihistamines: Histamine is one of the primary chemicals released by mast cells. Antihistamines can help control symptoms like itching, hives, and swelling.
Mast Cell Stabilizers: These medications work to prevent mast cells from releasing their inflammatory chemicals in the first place, helping to reduce flare-ups.
Avoiding Triggers: By identifying what sets off your symptoms and taking steps to avoid those triggers—whether it’s a certain food, chemical, or environmental factor—you can significantly reduce the frequency and severity of symptoms.
Stress Management: Since stress is a significant trigger for many people with MCAS, I encourage all my patients to incorporate regular stress-relief practices into their routine, whether through mindfulness, yoga, or other relaxation techniques.
Supportive Therapies: In addition to traditional treatments, I’ve found that many patients benefit from integrative approaches like acupuncture, functional medicine, or dietary changes. These can support your immune system and help reduce inflammation.
Treating MCAS can be very tricky, requiring the use of several mast cell stabilizing medications and natural supplements. These can include any combination of the following and should be monitored by a physician:
Pharmaceutical Medications Natural Treatments
Zyrtec Hist DAO
Allegra Histaquel
Famotidine Histamine Balancer
Benedryl MC Balancer
Loratidine D-Hist
Ketotifen Bromelain
Zafirlukast Cannabinoids
Cromalyn Sodium Quercitin
Ranitidine Green Tea
Aspirin Saloxicin
Hydroxyurea Curcumin
NSAIDS Vitamin C
LDN (low dose naltrexone) Luteolin
Benzodiazepines Resveratrol
Zolair Honokiol
Hydroxyzine Rutin
Doxipen Genistein
Periactin Isatis
Tagamet Red Light therapy
DMSO cream for itching and hives Hyperbaric Oxygen
IVIG regulates the immune system
Living with MCAS (Mast Cell Activation Syndrome)
While living with MCAS may feel daunting, I want you to know that you are not alone, and relief is possible. Here are a few practical tips to help you manage your condition:
Follow a Low-Histamine Diet: One of the most effective ways to control MCAS symptoms is to avoid foods that are high in histamine, such as aged cheeses, fermented foods, and alcohol. Learn more about how to follow a low-histamine diet now.
Incorporate Stress Management Techniques: Given the role stress plays in MCAS, I highly recommend finding ways to reduce stress, whether through daily relaxation exercises or other mindfulness practices.
Build a Support Network: Living with a chronic condition like MCAS can be isolating. It’s important to build a strong support system of friends, family, or online communities who understand what you’re going through.
Educate Yourself and Others: The more you understand your condition, the more empowered you’ll feel in managing it. Educating those around you—your family, friends, and even healthcare providers—can help ensure you receive the support you need.
Partnering with Dr. Susan Marra for MCAS Treatment
If you suspect that MCAS may be the underlying cause of your symptoms, I understand how frustrating it can be to navigate the complexities of this condition. The good news is that with an early diagnosis and personalized treatment plan, significant relief is possible. I’ve seen firsthand how effective a tailored approach to managing MCAS can be, helping my patients reduce symptoms, identify triggers, and restore balance in their lives.
If you’re ready to take the next step toward managing your MCAS symptoms and improving your quality of life, I encourage you to contact us. Together, we can explore your unique health history, develop a comprehensive treatment plan, and work toward healing. Please don’t hesitate to contact us or call 206-299-2676. I’m here to support you on your journey to feeling better and living well.
Disclaimer The information, including but not limited to, text, graphics, images and other material contained in these videos is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician before undertaking a new healthcare regimen, and never disregard professional medical advice or delay in seeking it because of something you have seen, read, or heard in these videos.
Most patients with neurological Lyme Disease and coinfections (i.e., MS, ALS, Parkinson’s Disease, Autism), have elevated levels of ammonia toxicity in the brain which is neurotoxic. This is due to the fact that the spirochete, Borrelia burgdorferi, produces urease enzymes, and ammonia accumulation results. Sometimes ammonia levels will be elevated in the blood, and many times they are also normal. This is because the ammonia concentration is localized in specific tissues (brain), where the concentration is not high enough to be detected in the blood. But that doesn’t mean that ammonia is not causing destruction. It is VERY neurotoxic and needs to be removed with herbal supplements and diet adjustments.
A diet rich in arginine (an amino acid), is linked to increased ammonia levels, and therefore should be avoided. Arginine is found in nuts, seeds, chicken, salmon, shrimp, dairy, oats, soybeans, and coconut. Removing these foods from the diet will help minimize the ammonia load on the body. Cellular and tissue detox strategies are necessary to remove excess ammonia from the body.
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If you would like to discuss ammonia toxicity further with Dr. Marra,
Chronic fatigue syndrome (CFS) is a late 20th century buzz word used to convey a constellation of symptoms that patients’ experience, but it is a NOT formal diagnosis. Extreme exhaustion, poor stamina coupled with difficulty concentrating and poor memory render patients nearly completely disabled. Additionally, CFS may be accompanied by flu-like symptoms, joint and muscle aches, unrefreshing sleep, tender lymph nodes, sore throat and headache. This constellation of symptoms is similar to that which would be seen in many viral or bacterial infections such as walking pneumonia, strep throat, Borreliosis/ Lyme disease or even AIDS. Another distinct set of symptoms associated with CFS includes: post-exertional malaise, a worsening of symptoms following physical or mental exertion that occurs within 24-48 hours of the exertion, and requiring an extended recovery period. Neuroimmune and endocrine abnormalities are also frequently observed in CFS, and patients may require hormonal support including: thyroid, pregnenolone, DHEA, estrogen and/or progesterone and testosterone. Patients are generally unable to appropriately respond to stress and may require low doses of cortisol or the natural equivalent as well. Sleep disorders are also common in this patient population and may require natural sleep aids like melatonin or prescription sleep medication
The argument can be made that CFS is simply a set of symptoms particular to a patient that arises as the result of exposure to a specific pathogen(s). Proper identification of the infection causing the symptoms is the way in which patients can hope to find relief from this debilitating condition. We believe that proper diagnosis requires extensive blood and possibly stool testing. Additionally, when the infection is identified, extensive immune system support is necessary to help patient’s fight the infection(s), and also promotes inherent self-healing tendencies. Healing the immune system is JUST as important as identifying the pathogen then for recovery to occur. Also, various detoxification regimens may be required to cleanse the extracellular matrix of toxins and cellular debris. A holistic approach to pathogen identification as well as treatment seems to be the most efficacious way to return patients to a functional life and optimal health.
Additionally, elevated proinflammatory cytokines cause disruption in the production of several neurotransmitter systems that are required for basic brain function. Certain neurotransmitters that are characteristically low in Borreliosis/Lyme disease patients contribute significantly to excessive fatigue and mood disorders. Talk to your doctor about urine/saliva neurotrasmitter testing and genetic testing through 23andme.com and geneticgenie.org.
One explanation for chronic fatigue involves mitochondrial metabolic dysfunction. Mitochondria are organelles within the cell that are responsible for generating ATP. ATP is the “power” molecule providing energy to cells, tissues and organs. Mitochondrial damage may result from cellular hy
POTS (postural orthostatic tachycardia syndrome) is a serious complication of chronic tick-borne diseases, and often renders patients bedridden for many months. POTS is generally found in more women than men suggesting a hormonal component to the etiology as well. Typical symptoms of POTS include:
Fatigue
Headache
Tremors
Syncope (fainting)
Dizziness
Poor ability to concentrate
Exercise Intolerance
Lightheaded
Heat intolerant
Shortness of breath
Cold Extremities
Low blood volume
Drop in blood pressure on standing
Elevated plasma norepinephrine
Mast Cell Activation Syndrome
These symptoms indicate dysregulation of the autonomic nervous system between the brain and the heart. Somehow and not yet fully understood, the heart and brain get out of synchronization causing the above symptoms. Chronic infection, toxin accumulation, inflamogens, etc…are likely the cause of this constellation of symptoms, and correcting the underlying adrenal issues is important. You can certainly heal from POTS symptoms, however, it may take some time to heal the autonomic nervous system. Please consult with Dr. Marra if you are concerned about this.
Dyslipidemia is abnormal lipid metabolism. Patients who have had or have Lyme Disease often have significant abnormalities in their lipid metabolism. This results from chronic inflammation and prolonged activation of the proinflammatory cytokines such as IL-1, IL-6, and tumor necrosis factor-alpha (TNF alpha). Elevated cholesterol, triglycerides, VLDL, and LDL are commonly seen, while HDL (the good cholesterol) is decreased. Dr. Jones and I believe that these elevations in cholesterol are not only related to diet and genetic predisposition but may be a compensatory response of the body in an attempt to repair cell membranes (that are composed of lipids) that have been damaged by infection. The piercing of the cell membrane by organisms such as Borrelia, Bartonella, and Mycoplasma on their way to the intracellular compartment where they prefer to reside, can render changes in lipid metabolism and increase lipid peroxidation. Lipid peroxidation is a biochemical reaction resulting from damaged lipid-containing cells that increases the concentration of free radicals in the body and contributes to a state of overall oxidative stress. Oxidative stress affects not only cells but the vascular endothelium which can lead to increased stroke and myocardial infarction. The presence of biofilm created by spirochetes and other organisms also contributes to plaque formation in the arteries, which affects blood flow to peripheral tissues and the overall health of the cardiovascular system.
Optimizing lipid metabolism may require diet and lifestyle modifications as well as nutritional intervention. Dr. Marra’s extensive knowledge and experience in Lyme Disease and Functional Medicine will help you to regain optimal health in a reasonable amount of time.
For more detailed information about the glycemic index of foods (how much sugar they contain), please visit www.Mendosa.com and go to the food tab. You can search through the various options. This website is a phenomenal resource for everyone who wants to change their diet and needs help understanding what foods they can and can’t eat to improve their metabolic condition.
Frequently we see autoimmune diseases associated with Lyme Disease and coinfections such as Multiple Sclerosis, Lupus, Hashimoto’s Thyroiditis, Scleroderma, Graves Disease, Celiac Disease, etc. Essentially any tissue in the body can fall prey to autoimmune disease if the autoimmunity is driven by infection.
When pathogenic infections invade tissues, the bacteria produce LPS (lipopolysaccharides) which are found on their outer cell membrane and promote inflammation. These molecules are produced and fool the host’s immune system into thinking that there is a foreign invader. The body naturally mounts an immune response, but the response is against its own tissue, yielding autoimmune disease.
In 18 years of practice, most of my patients’ autoimmune conditions are completely eradicated with proper long-term antibiotic use as well as targeted nutraceuticals. If you decrease the infection in the tissue, the concentration of LPS decreases, inflammation decreases, and tissues can return to their healthy state. If the infection is allowed to persist, autoimmune disease simply gets worse.
It is my belief that most if not all autoimmune diseases are infection-driven. The challenge becomes to identify the exact pathogen and then treat it accordingly.
Scleroderma and Bartonella… Is there a connection?
Dr. Marra has been treating patients with tick borne illness since 1999 in both Westport Connecticut and Seattle Washington. She has had two patients with severe Raynaud’s Syndrome, a Scleroderma diagnosis, and a positive Bartonella henselae serology test, one from each coast.
Dr. Marra does not think that this is a coincidence as Bartonella is known to reside in the vascular system along the inside of the vessel endothelium. She strongly suspects that Raynaud’s Syndrome and Scleroderma could have an infectious etiology that has been overlooked by the medical community because Bartonella is just now considered an emerging zoonotic infection. There is sparse scientific literature on Bartonella infection implications, and she would like to see more research done in this area.
To date, there is no literature indicating an infectious etiology for either Raynaud’s Syndrome or for Scleroderma. There is also very few treatment options offered to patients with these diagnoses. Typically they are left to suffer with these diseases, and Scleroderma can be extremely painful.
Dr. Marra suggests to any patients that have Raynaud’s Syndrome or Scleroderma to be tested for Bartonella henselae through Igenex laboratory. It’s important that the test be done accurately so that tests document the presence of an infection. If an infection is present, prompt use of antimicrobial herbs or antibiotics is extremely important. It is also beneficial that herbs or antibiotics are taken just prior to a very hot shower so that the medicine can reach the peripheral tissue.
In both patients who were found to have a Bartonella infection, subsequent antibiotic therapy was initiated with substantial symptom relief. Better blood flow occurred and the pain and swelling in the fingers receded. Of course this is simply anecdotal evidence, but in the face of having no scientific articles to turn to, this may be a valuable clinical observation for patients with either Raynaud’s Syndrome or Scleroderma.
Alzheimer’s disease is a neurodegenerative disease that may have genetic (APOE4) and environmental influences on its manifestation in 60-70% of cases. The loss of cognitive function generally starts slowly and progressively gets worse with time and age. The disease is characterized by the development of amyloid plaques in the brain, neurofibrillary tangles, and neuronal degradation in the brain. It affects about 6% of people over 65 years of age and is expected to increase substantially by 2030. Dr. Alan MacDonald, a pathologist found that 7 out of 10 brains examined post autopsy were positive for Borrelia, the bacteria that causes Lyme disease. His findings have not been well accepted by mainstream medicine, and he continues to try and publish his data and change the thinking on the disease etiology. Here are a few videos where Dr. MacDonald explains his research, as well as some articles of research on the disease:
There is no definitive test for Alzheimer’s disease other than a western blot test for Borrelia, and there is currently no treatment, except for antibiotics, which are highly controversial for this disease.
I hope in the next decade, there will be a greater awareness of the role infections play in the development of this neurodegenerative disease.
