Assessing Your Home For Root Causes of Chronic Fatigue & Inflammation

If you have been experiencing chronic health problems that seem to be unexplained it’s possible you stumbled upon my blog in an effort to find solutions.If you are a current patient in my Tampa holistic medicine practice, I may have asked you to read this blog to help better understand some next steps in your treatment plan. In this post I am going to share with you the importance of checking your home to be sure you are breathing clean air. I will also share resources so that you may start to improve your health immediately. 

Some tells. If you play poker you probably heard of a “tell”. This is a signal made by another player that essentially foreshadows her hand. Over twenty years of practice I have picked up on some tells that often suggest there is an indoor environmental issue at home. A few appear obvious, while for some symptoms the connection may be harder to comprehend, and you’ll see from a review of the list below: 

• Wake up with allergic type responses- sinus congestion, runny nose, red eyes, sneezing, coughing 
• Wake up fatigued even after a good night’s sleep (also seen with adrenal issues — read Adrenal Fatigue Treatment Options for Tampa Residents for more about this) 
• Interrupted sleep pattern with no reason (i.e. the dog isn’t barking and the kids are not waking you) 
• When you leave for vacation, work, or even just for the day, symptoms are worse when you return home. In other words, you generally don’t feel well when your home. (or at work if it’s a workplace exposure). One of my patients recently told me that he spoke to a friend about how he became ill in a water damaged home, he was sharing his story, when his friend told him his wife at 40 years old had become so ill, she was using a walker and was getting ready for a wheel chair. The friend decided to have the wife stay in a hotel for the week to see if removing her from the environment would help. Well, not only did it help but in a few short days at the hotel, she was walking without a walker. They later found a water intrusion in the home that was creating mold.
• Different parts of the house set you off. You feel different in your bedroom than you do in your living room. One example here is a patient that I had who was hanging out all the time in the family room. She felt worse in that room than her own bedroom. Later we found a source of hidden mold in that room! 
• Your downward health spiral started when moving homes or at a certain job.
• The most common signs of bad air in the home are fatigue, loss of concentration, and BRAIN FOG! The brain is sensitive to the indoor environment. 
• Please understand that a water damaged building causes the immune system to become out of whack. Now that may not sound very scientific but that is what ultimately happens. The immune system will drive inflammation in the brain and the brain inflammation will start to shut down or dysregulate digestion, hormones, glandular function, metabolism, and urinary function. This is why so many symptoms can be sourced back to the air you breathe.

While these symptoms can be present for other reasons, we should be careful not to ignore the condition of the air we breathe while we move around the house and during sleep. Especially, when you find yourself stuck without good cause for the above symptoms. In my patients who have chronic digestion problems, fatigue, brain fog, poor sleep, and a host of autoimmune conditions, I have found that if we ignore the patient’s indoor environment, be it a source of mold, dust, water damage, or toxic chemicals, the patient will have minimal responses to treatment and some will not get better at all.

I have also observed patients and commonly physicians, deny, minimize, or flat out refuse to accept that the home or work indoor environment is at least in part causing or exacerbating their health problems. Just as often it’s the landlord or spouse who refuses to accept the facts.

Ok, at this point you have decided to check the home for air quality and exposure. What are some of the best ways to proceed? You have two options. 

1. DIY – Do it yourself. Start to visually inspect your home and collect samples. 
2. Hire a professional IEP- Indoor Environmental Professional  who will inspect your home and collect samples. 
3. Start some type of remediation of the indoor environment. 

As I break down the options here, let’s start with the understanding that according to Michael D. Schrantz, an Indoor Environmental Professional,  a “perfect method” for visually inspecting, testing and cleaning the home does not exist. There is no absolute, or 100% standard that can be applied. People respond differently to indoor environments in the same way they do to viewing a movie. One person can rave about the movie and the other can criticize it all day. One person can be sick in a given environment, while the other feels perfectly fine. 

Therefore, when we begin to assess or apply cleaning strategies to the home in question we should agree to move forward with an open mind. The solution is found when the patient finally feels like themselves again. 

DIY: 

Let’s talk about doing your own home inspection. You can start a few ways. I would suggest that first you start by thinking about your home. 

• Have there ever been leaks that were repaired? How long did it take before the repair was made? Were the wet building materials removed from the home? 
• Did you ever have flooding in any part of the home? When and how was it repaired? 
• Have you ever had your HVAC vents cleaned? When? What about the AC coils? Do you regularly clear the lines and check for fluid backup? Do you regularly service the HVAC and check at least visually for signs of moisture or mold? 
• Do windows condensate in your home? 
• Are there signs of visible mold on a ceiling, base board, under a sink, in a bathroom? 
• Musty smells anywhere in the home? Bathroom, carpet, closet? 
• Do you have a crawl space or attic? Has anyone checked it recently for humidity issues or visible growth? Is there condensate on any HVAC returns? 
• Is the home generally dusty? How often do you dust, ceiling fans and all? 
• Are you backed up to a lake or pond? Is there mold growth on the outside of the home that can be tracked inside? 
• Start to make a list of any of the above. This is not meant to be comprehensive, but a place to start. There can be hidden sources of mold in a wall cavity.. Here we are first concerning ourselves with the low hanging fruit. 

The above checklist can be done by a professional or at least started on your own. Obviously, a professional will come in and know exactly what to look for and will start to measure things like humidity, dust samples, air samples and more. 

Let’s suppose you want to start by collecting a sample in your home. 

Samples you can collect on your own include: 

• ERMI
• Petri Dish Samples 

ERMI -The Environmental Relative Moldiness index (ERMI) was developed by the U.S. Environmental Protection Agency, Office of Research and Development (ORD) as a research tool to investigate mold contamination in homes. The company I generally recommend (I do not receive compensation) is https://www.envirobiomics.com/product/ermi/. I often suggest test number one on their menu. Pricing is determined by how quickly you want the test completed.  You have an option to select the time frame. I recommend selecting the swiffer cloth and not the vacuum sample. 

The ERMI test was later adopted by physicians who wanted to know the general status of a person’s indoor air quality. The benefit of this particular test is that it measures DNA fragments of mold. This is critical because here we are not checking for mold spores as would be done in an air sample test. ERMI checks for mold fragments. These fragments are known to have a variety of allergenic or immune stimulating properties. One spore breaks down into 300-500 fragments. Think about a dandelion in its seedling stage. You can pick up one dandelion, blow on it and there are hundreds of seeds that are dispersed.

If you sample the air in your home, it may show some mold species present if there are large amounts or obvious water damage exists. However, it is quite common to test the air and not find enough spores to be considered a problem in the eyes of the inspector or based on industry standards. 

Air samples while at times helpful can pose a problem for the patient who does not feel well and is now told based on a single air sample that “all is clear”. Consider that air has a unique flow and different parts of one room can have clean air while another air pocket has excessive spores. To obtain a more valid air sample, it would be best to collect over a period of a few days or weeks and in different parts of the room. This is not practical. 

ERMI is a test that has been used by physicians over the last 15-20 years to validate if the patient will respond to treatment. It has been studied in peer review literature and documented to predict that given a certain score the patient can start to heal. Is it perfect? No. 

I have found that sometimes there are false negatives. The patient has the test and it’s normal but they still have a problem that needs to be found in the home and when an inspector shows up the problem is found. However, more consistently when I suggest a patient order the test, it comes back as showing over exposure to certain mold fragments that are known to incite the immune system and cause the symptoms listed earlier in this blog. 

The ERMI test is easy to do yourself. You will be provided with a swiffer cloth from the lab upon ordering a kit. You simply collect samples from a variety of surfaces in your home. You can collect what is called a composite sample taking dust from different areas of the home, providing a general idea of what is lurking in the dust. Or you can go direct to an area where you suspect a concern, i.e, in the air handler or vents. Now, we always expect to find some mold fragments, as no home is “mold free”. However, we are looking for certain types that relate to water damage and also certain quantities. Dust itself can cause symptoms, so just performing the test sometimes sheds light on the air quality and the number of particulates that may be present in the air. Now you have a benchmark so that if the vents need to be cleaned or a room needs to be remediated, you can check it post remediation and we can know that you should start healing based on the published data.

Let’s be sure not to mistake ERMI with what a home inspector would generally use as an acceptable test to determine causation. ERMI is a tool that you and I can use to start making some determinations about your treatment and understand how important your environment is in your specific case. An environmental professional can also choose to use this test to answer questions about remediation and further discover the root cause of the problem in the home. If you are going to litigate, I would suggest you have pictures of any water damage, air samples, swabs, and complete documentation by a professional inspector.

Petri Dish Samples  

Another relatively inexpensive way to get started is to use Petri Dishes to assess for mold spores. This is quite different than the ERMI and in my opinion less preferential as it does not provide information of spore equivalents or particles using DNA. Those are the 300-500 fragments discussed earlier. What it can do effectively is check for 50 different genera of mold. The plates can be placed in different parts of the home that are suspect or in areas where you spend a good deal of time. I would suggest doing sampling a few areas. 

The company I suggest is ImmunoLytics.

A Word About Remediation

There is a great deal discuss with respect to remediation and I would prefer to leave this to the indoor environmental professionals. However, as with all professions there are going to be differences in the quality and understanding of the professionals selected to assist you. I am going to provide some insight from what I have learned in both seminars on environmental acquired illness and from my time in practice observing patient responses to treatment. 

First let me remind you that there is no “perfect solution”. There are however some great guidelines. 

1. Find the source of the problem. As with your own health, finding the root cause will always trump masking symptoms. One example I hear too commonly is “I bleached the mold and now it’s gone”. It’s not! Killing mold spores can serve to split them up into fragments actually aggravating the patient. Besides, what’s the source? Some companies will come in and spray antimicrobial chemicals that are said to be safe. For some this may actually work, while others become sicker as the contents of the microbes you are killing are released into the air. Let’s proceed with caution. 
2. If you have not cleaned your AC unit or vents, please do so. There are instances where dust has built up in the vents, causing health problems and allowing for mold growth. We should also emphasize that there is more than mold in a water damaged building. There are dozens of potential “inflammagens” (things that inflame your body and cause illness) These can be from bacteria that produce endotoxins or volatile organic chemicals from construction materials, viruses, and many other microorganisms. Cleaning can go a long way. I often speak to patients (no judgement here) that were not aware of how to maintain the HVAC system and have lived in a property that has never had the vents cleaned. Sometimes that’s all that is needed. Often, especially here in Tampa there is going to be mold in your AC that builds up due to condensation or a backflow. The coils of the AC need to be cleaned and the lines cleared. This should be checked at least yearly and better yet every six months. For the sickest patients, more may be required than a simple cleaning. I should also point out that when the dust is “shaken up” during cleaning this could elicit more symptoms for some. The AC specialist should take precautions when cleaning the vents by running a HEPPA air scrubber, sealing the duct work during cleaning and possibly venting the air to the outside. These techniques are not ordinarily performed. For some it will matter. I am working locally here in Tampa with a group of professionals who are helping my patients to complete these tasks and are willing to take the precautions. Other remediators or HVAC professionals may skip steps due to ignorance, expense or convenience. Make sure you hire someone you feel is trustworthy and understands that you are not feeling well.
3.  Clearly, if visible mold is present and there are wet materials they need to be removed. Proper containment is needed  Once that happens, depending on the severity of the findings in the home and the patient’s illness, we need to start to consider how mold in one part of the home may have dispersed through the air, rendering spores and fragments throughout the home or building. In this case, the home may require air scrubbing and what is called small particle remediation. Porous furniture and drapes may need to be replaced or properly cleaned where possible. Again, here there are no “perfect” solutions and each case is unique. Now, the main caution here is to ensure containment during remediation. It defies logic, but I often hear a patient say they were worse after remediation because of the poor containment techniques employed. You should not be in the home during remediation! Yes, a patient who was renting an apartment was allowed to be in the home during remediation and became violently ill as a result.
4. Lastly, I would start by filtering your air regardless of what might be happening in the house. This does not replace the advice listed above. It’s just a way to hopefully breath some better air. Buy a stand alone air filter. I like HEPPA. I also like Air Oasis, Molekule, and many more. The key is to put the free standing unit where you are sleeping to filter the air your breath while sleeping.

Taking Back Your Health

Taking the time to assess your home in the early stages of treatment can save you lots of grief in the long run. Many patients seek treatment after visiting both conventional and holistic medicine providers only to find out the source of their problems was lurking in their AC system or other areas of the home. Precious time, money and quality of life has been depleted. It’s not worth it. It is imperative that you get those people in your life who will be making decisions with you regarding repairs, testing, and treatment on board. Their support will make or break your healing in many ways. I always encourage my patients to come into the office with their spouse or partner so that everyone is able to understand the seriousness and consequences of the environmental and health problems and make educated decisions along the way. 

Once the health problems have kicked in it sets off a chronic inflammatory response that now requires treatment. Many symptoms may improve after remediation or moving. However, just as many people continue to suffer with ongoing fatigue, brain fog, pain, mood swings, anxiety, and don’t feel the same as they did before exposure. They are often misdiagnosed with other conditions or start having autoimmune issues. It’s way better to find out the home is a problem, minor or major, correct it, receive treatment and move on. Now, I realize patients reading this blog may find that they have been exposed to a water damaged property for many years, not knowing it was the problem. Or possibly working in a water damaged building for years before coming to the understanding of what has triggered many of their symptoms, concerns and quality of life. I want you to know that given the right testing, treatments, and attention to your environment, results in your health will follow. 

If you want to learn more about the diagnostic process and treatment for people suffering environmentally acquired illness due to a water damaged building please read Chronic Fatigue Syndrome – Healing Your Frustrations. 

If you believe you are experiencing symptoms that may be related to an environmental issue and you would like to have a one hour consultation to review your health history, current symptoms, and set a plan of action, schedule an appointment today for your in-office or phone consultation. 

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