Madeleine Boyson is currently on a second hiatus from pursuing a degree in history in an effort to better treat her Lyme disease. Her time away from school has led her to seek out a healthcare community on social media. After noting the positive health benefits of social media in a TEDx talk, Madeleine joined Peer Health as a Patient Advocate, to help improve Peer Health for patients like herself and to create a better-connected healthcare system.

Have you ever woken up feeling like you’ve been beaten by a screaming Dwayne “The Rock” Johnson? Now that I’m a pro with herxes, I’ve decided The Rock is my best analogy for this experience. Dealing with a chronic illness means that I’m no stranger to pain and discomfort and, in one week I can experience random symptom flares, unexplained “better” days, and changes in my treatment plan. But those changes in treatment often result in an unpleasant experience called a Jarisch-Herxheimer reaction or “herx.”

So, what is a herx? Essentially, a herx is when toxins are released by bacterial die-off during treatment at a faster rate than the body can comfortably handle. I’ve always thought of it in a battle analogy: As a war is waged, a city must deal efficiently with the casualties. These casualties may take a toll on the city, exacerbating pre-existing problems. Similarly, my body must manage the death of good and bad bacteria and, if my body can’t deal with this efficiently, my pre-existing symptoms are exacerbated. For me, symptoms of a herx include (but are not limited to) increased muscle and joint pain, brain fog, fever, chills, headaches, and flu-like symptoms. See where The Rock comes in?

The National Institute of Health has a more technical definition. In relation to syphilis patients, the NIH has described it as: “The [Jarisch-Herxheimer] reaction is generally attributed to the release of endotoxins or spirochaetal breakdown substances… These substances are thought to produce systemic manifestations, such as fever, chills, and malaise, as well as exacerbation of syphilitic lesions.”¹ Herxing can occur in almost any patient undergoing treatment for bacterial infections including Lyme disease and other tick-borne illnesses, Tuberculosis, Rheumatic Fever, Whipple’s Disease, and Typhoid. I have even heard chronic illness patients without bacterial infections describe herx-like experiences.

Herxes can last from a few hours to a few weeks, and noting variation in duration and severity is a good measuring tool for treatment progression. My doctor describes it in a binary: “Good Herxes” are reactions that last relatively few days and may involve any difficulty of symptoms, but that leaves the patient feeling improved. These indicate that treatment is going well and that the correct methods or dosage are being used. Conversely, “Bad Herxes” are reactions that make the patient feel worse long after the herx is technically over. These indicate that the methods or dosage being used are too extreme or wrong for the body, and that treatment should be altered.

There are also a few recommended ways to find relief in a herx. First, it is best to accept that herxing is inevitable.Then, determine the best detox methods for you. Staying hydrated and encouraging your kidneys and renal system to flush out toxins should be at the top of your list. For me, it’s taking a hot 20- to 40-minute bath with Epsom salt and baking soda. This may initially increase your symptoms and fatigue, but it will generally leave you feeling refreshed. The salt is dehydrating, so drink lots of water! To help boost your lymphatic system, you might also want to use a dry skin brush before getting in your bath. With a natural bristle body brush, you should use small and light strokes and brush upwards from your feet towards your heart. Taking supplements can also help, but you should consult your doctor beforehand. Taking activated charcoal capsules or AlkaSeltzer Gold in a glass with water and lemon juice may be recommended.

Lastly, I know that herxing will end. I make it a priority to communicate with my doctor. If a herx is lasting longer than I thought it might, she and I will discuss ways to reduce my antibiotic dosage or otherwise alter my treatment plan for relief. Herxing won’t kill you, but it’s definitely supposed to make you stronger. Make sure your practitioner is working with that in mind.

Do you have any pointers for herxing patients? Have you experienced a particularly good or bad herx and think someone would benefit from hearing about it? Add your comments so others can learn from you. Peer Health is designed with peer support in mind and, I’d love to collaborate with others who experience herxing by tracking our reactions on the app. Maybe together we can gather some useful information for ourselves AND our doctors. Email me at madeleine@peerhealth.me or connect with me on Instagram: @mad_claire_bee. Maybe Dwayne “The Rock” Johnson can make us collectively stronger!

^{1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1053806/pdf/brjvendis00160-0002.pdf}