Mimi MacLean :
Welcome to the Lyme360 podcast for all things related to Lyme disease and other chronic illnesses. I'm Mimi MacLean, mom of 5, founder of Lyme360 and a fellow Lyme Warrior. Tune in each week to hear from doctors, health practitioners, and experts. To learn about their treatments, struggles and triumph. To help you on your healing journey. I'm here to heal with you. Before we get started with the podcast, I wanted to talk to you about what is in your personal care products and cosmetics? What you put on your skin, which is your largest organ, is just as important as what you consume, your body immediately absorbs what is on the skin, but did you know that there is limited regulation in the personal care industry? And the last law that was passed was 1938. So the chemicals and ingredients in your products have not been tested for human safety.

Mimi MacLean :
So for those of you struggling with your health, it is super important to use clean products. Eight years ago, I started using beauty counter for my cosmetics and personal care products. They are the leaders in clean, safer products that work. Beauty counter has done the research and taken the guesswork out of what is safe. Go to lyme360.com/beautycounter to learn more, reach out to me at mimi@lyme360.com if you want to learn more or find out what my favorite products are.

Mimi MacLean :
Welcome back to Lyme360. This is your host Mimi MacLean. And today we are talking about pain management with Dr. Deepti Agarwal and she's the director of integrative and interventional pain and management at case integrative in Chicago. Her specialty is helping in pain management through traditional and alternative treatments. She is a licensed anesthesiologist and she decided after her experience with her grandfather's type I diabetes to pursue a more integrative and functional medicine approach in addition to the Western medicine that she had studied.

Mimi MacLean :
To get my detox for Lyme checklist, go to lyme360.com/detoxchecklist. Dr. Agarwal, thank you so much for coming on. You are a pain management expert on the traditional and also alternative practice, which is great because I think a 100% of us who have chronic Lyme are in constant pain. And if there's some way to get past that pain, I've learned a lot about pain management through this past seven years, just because it's kept me up at night and it makes you almost want to take your life, because the pain is so unreal. So I'm so glad that we could talk about this and dissect it and figure out what people can do. So thank you so much for coming on.

Dr. Deepti Agarwal :
Thank you for having me.

Mimi MacLean :
So I'll just put the ball back in your court as far as how we should take this in the direction of pain. I've done everything from narcotics to alternative. I've even done ketamine, I've done CBD, I've done it all just to get past the pain that Lyme has caused, especially because it's like migraine, right? I've had just an email today, someone's like, I can't take the pain anymore. And they tell me it's all in my head and that's the problem. I think we've gotten to a point where like maybe it's in your head, maybe it's not, maybe it's managing it the symptoms. I think there's also the whole like PTSD thing that is going on that, even if you don't have Lyme anymore, your body still thinks it has Lyme and it's just interacting with that. So I'll just let you take it away and just let's go talk about what anybody who's dealing with pain with Lyme, what should they be doing?

Dr. Deepti Agarwal :
Well, that is a big question and also very complicated I think. With Lyme disease, there can be lot of gray areas of pain management and especially when a traditional physician is looking at it, it's not as simple as coming in and saying, oh, I have joint pain, right? Because patients with Lyme are also dealing with this co-infectious state, which is causing a lot of inflammatory conditions in the body. And those are not always so identifiable and treatable. So I think it's really important to have a broader understanding of pain in the context of Lyme disease.

Mimi MacLean :
It's definitely true. Let's start off with just even simple things. What would you recommend as far as like, is it going to see someone like you? You're like unusual. I don't think there's many pain doctors out there. What would you start with? What should they be doing? The inflammation is a good starting point too.

Dr. Deepti Agarwal :
So I think, it's hard to isolate a condition without seeing them because it's multifactorial, right? Pain is multifactorial. It depends on people's lifestyles, their conditions, what other past medical history they have. And so someone like me with my background you're right, is absolutely unique. I'm a traditionally trained anesthesiologist and pain management physician who's been practicing for a while. So I really do understand from a very traditional viewpoint how to treat pain, but I've also witnessed a lot of morbidity and increasing morbidity over the years, which has really fueled this quest to understand the root cause of illness and take a more integrative approach to pain because we don't always have all those answers in a traditional model.

Dr. Deepti Agarwal :
And so I like to look at people's pain issues from both vantage points and see how we can use the best of both worlds, our traditional allopathic model and maybe another whole health system and integrate it for the individual. So it really depends on that individual what they're willing to do, what they're interested in. Some people may not have an interest in energy healing, right? So we have to tailor treatment based on the patient.

Mimi MacLean :
That's a good point. Like the energy healing. So let's go from one end of the spectrum to the other. So you have your narcotics that can use, if you're in pain. For example, I'm not somebody who even used Tylenol before I got Lyme, but I remember being in so much pain. For some reason, it migrated from my shoulder and it went to my ear and my ear pain was so unreal. I could not sleep for seven days. I almost was hallucinating because I was so exhausted. I remember going to urgent care and just saying, I've such ear pain. He's like, but there's nothing in there. I'm like, I know you're not going to see anything.

Mimi MacLean :
There's no infection. I can tell you what it is. It's my Lyme. It's migrated. Please just give me something. And he gave me some narcotic. I don't even know what it was at this point to sleep through the night. And I woke up and I had a full night sleep and my pain was gone. Could we just go through the different options available? Because I think there's a lot of people listening here who didn't even think of energy healing to help their pain or it could be something more, where you're just talking about more of a prescribed drug. So maybe we could just not knowing what the client is, but what their options are.

Dr. Deepti Agarwal :
Sure. So often with patients that have a history of Lyme, they have pain anywhere from their joints, their nerves, their muscles. They may even have an underlying condition prior to getting the Lyme like a herniated disc or something else. They may also be misdiagnosed based on their Lyme disease with the fibromyalgia or myofascial pain or something else. And a lot of Lyme will present as an autoimmune condition, even after treatment, which can be very complicated to treat because there's this underlying inflammatory response in the body. And like you said, it presents in odd ways in your ear. And so we have our traditional way to look at things and we have medications. Oftentimes anti-inflammatories are probably the first line of defense. We have medications that can help like a muscle relaxant. And then we also have medications like narcotics and some of these medications A people are not able to tolerate, B they have side effects.

Dr. Deepti Agarwal :
So it just depends on how patients respond to those. Then we have other options in terms of interventions. And that really depends on exactly where the patient's pain is and if it's amenable to an intervention for instance, we can do joint injections and the beauty of being in an integrative practice case is we can do things aside from steroids. Steroids can cause a reduced immune response for some of the patients with Lyme. And so that's not a great thing to use. We also have to be careful with continued use of steroids, especially with people whose joints are already more in a compromised situation. So we can use different things like Prolozone therapy, which is helpful because we...

Mimi MacLean :
I love that, I've that done in the joint.

Dr. Deepti Agarwal :
Did you have done steroids?

Mimi MacLean :
[inaudible 00:08:54] I couldn't even walk so like that. And afterwards, I feel better. Give me more. And he's like, Nope, we can't, sorry, you've reached your one time limit. And then I've also done like where I injected into the joint, the Prolozone.

Dr. Deepti Agarwal :
And it's a wonderful option aside from having to get multiple steroid injections because a lot of patients will require multiple steroid injections over multiple years. And so this is a great way to mix it up. And then there's also a lot of new regenerative techniques like PRP, stem cell therapies even a newer technique that we're using in joints to really help regenerate tissue and cartilage without using steroids.

Mimi MacLean :
So you do that at your practice?

Dr. Deepti Agarwal :
We do.

Mimi MacLean :
Yeah. I've heard great things about that. I haven't done that, but I've heard some really good things about it.

Dr. Deepti Agarwal :
And then you mentioned a few things too, that can also be helpful in terms of ketamine infusions and that we reserve for patients that really have tried so many different things or even patients that may have an underlying depression or depressive moods, we can kill two birds with one stone using it for pain control and to help with people suffering from depression. There's also things like Lidocaine infusions, which is similar to doing a ketamine infusion with not necessarily all the benefits that you would have for depression. So we do have a lot of options. And then aside from pharmaceuticals, there's also a whole world of botanicals and nutraceuticals that can be used.

Mimi MacLean :
I feel like it's now becoming so much more prevalent, like the CBD that really helps my pain a lot, taking like CBD tinctures or gummies at night before I went to bed, that seemed to really cause. The inflammation go down and my pain just subside.

Dr. Deepti Agarwal :
Absolutely. And there's different forms of even the nerve lines or plant-based medicine that patients can use if they don't want to always be using a pharmaceutical drug.

Mimi MacLean :
That's great. And then do you, like I was saying, I was referring to this person this morning and I'd love for you to talk a little bit. I think about even food, I feel like there is a huge part of it. And that's what I said to her. I figured out a lot of my joint pain, it's really paying attention to what I'm eating because a lot of it might just be my body's natural response to whatever I'm eating, especially if it's processed. I find my stuff like the more I grab, those energy bars or protein bars, which is in a package and you think you're eating something so healthy because it's like macro this or organic that, but then I found that was causing my joint pain.

Dr. Deepti Agarwal :
Absolutely. And Mimi, that's a really important point and I'm glad you brought it up. So in the integrative medicine world, we love talking about culinary medicine and how to optimize your body through food and food is medicine. It's a very important medicine that I think we often overlook, but it can also be poisoned, right? So it's knowing what to eat and how to optimize that. And I think it's also one of the hardest and most challenging things to do because food is not just a means of living for a lot of people, it's also a source of pleasure, right? And so I think there's a fine balance and figuring out how to optimize your diet and that's going to be different for everyone, but absolutely in terms of really creating an anti-inflammatory state in your body, you really want to avoid processed foods and sugar. And like I said, that is easier said than done, but whole foods, whole grains, no sugar, that is probably one of the best things that people can do for their diet.

Mimi MacLean :
And speaking for somebody like I even went to school [inaudible 00:12:40] for holistic health counseling. So I knew the importance of food even before I got sick. And it's funny because being sick, the last thing when you don't feel well, it's like being hungover, you look to food as like your comfort, right? So even when you don't feel well, you're like, okay, well I'm just going to have this bagel or this piece of pizza or something, even that just because you feel sorry for yourself because you're in so much pain and you don't feel well and you're missing out on life anyway, because you're sitting at home.

Mimi MacLean :
But then it took me almost two years to really be okay, if I really want to get better, I need to really, really 100% abide by this and cut out everything until I feel better. And that I think is what ultimately got me back to feeling almost [inaudible 00:13:26] minus, almost back to normal where I'm like, okay, you really have to do that, you keep compromising with yourself, I'm just going to have this one piece of the cake, and then you just realize it's not worth it, because you're in so much pain.

Dr. Deepti Agarwal :
I'm so glad you brought that up especially from personal experience because I really do think, like I said, it's one of the hardest things to do. It's so much easier to swallow a pill. But at the end of the day, getting your metabolic health under control is going to have far reaching impact, it's almost like this return of investment that you'll see a few years from now, if you can really change your diet and really be in tune with what you're putting into your body.

Mimi MacLean :
But it's funny because it's like you talk to yourself, when you get up in the morning, you're like, should I go for a lunch or not? It's almost like when you're talking to yourself and you're looking, you're hungry and you're looking at that bar and that's like an easy solution. You're like really can that thing really cause that much pain and damage in my body? Can it really, right? You're kind of like how can that one piece of fruit or food or whatever, the one thing I don't know, what kind of diet you subscribe to, you tell your clients, but one other thing that people, if they haven't listened to is the blood type diet. Because one of my doctors like, are you eating for your blood type? I was like, I don't even know what my blood type is. So I did the research and literally everything I was eating was causing inflammation for my blood type. And it was healthy stuff like avocados, coconut oil, but my blood type can't have those things. So it was funny how like things I thought were healthy were actually causing my inflammation.

Dr. Deepti Agarwal :
I'm pretty agnostic when it comes to diets. I don't think this diet or that diet, I think it's important to understand what foods are good for you and then what works for you. And I think everyone were on this precipice of understanding nutrigenomics, nutrigenetics, it's a whole another field that we actually don't know whole lot about. So that would be very personalized nutritional approach, which we don't quite know yet. So we have to take the knowledge that we do have and work with that. Also people's got microbiomes are totally different and they've been exposed to totally different things and they're changing on a daily basis. So they respond to food very differently. Behavioral modification is also the hardest thing like you were talking about with the bar. And one thing I found that can be really helpful for people, and this is probably an emerging concept and those who subscribe to it are really into it.

Dr. Deepti Agarwal :
And I think it's a harder concept for some people, but that's wearing a continuous glucose monitor and historically people do that when they're diabetic. But actually in terms of understanding what food does to your body, for yourself at any given moment, if you have that sensor on, you can actually test your blood sugar and see how you're responding to food. So you may respond to something totally differently than I'm responding to it. Even though we both know that, our sugar may go up based on a carb heavy meal or eating a bagel, the extent to which it responds is different depending on outward metabolic flexibility. So I think some of those things are also important hacks that people can use in their daily life.

Mimi MacLean :
[inaudible 00:16:32] ask for you more one of those one time and I was watching it. I'm like, oh, that's cool. So do you have to have a doctor's note for that? Or how does that work?

Dr. Deepti Agarwal :
You do historically, although there's a lot more marketing around this device and I believe there's some companies that are coming up where you can get it just as a consumer without a doctor's note, but it's something that you can get through your insurance, but because of lot of insurances are not covering it for someone that's not diabetic, which is, these are part of the problems with our healthcare system because we don't think in a preventative approach, but there are companies that are coming and I think this is going to become a very important wearable here in the next year or so.

Mimi MacLean :
Do they hurt or are they easy to apply?

Dr. Deepti Agarwal :
Very easy to apply, almost zero pain. You'll feel a little poke as it's going in and that's it.

Mimi MacLean :
I've always wanted to do that. Maybe this will be inspired. I always like to try things I haven't tried. So you've mentioned about energy healing. I'd love for you to talk a little bit about what you advise your clients to do as far as the emotional part and the spiritual part that they can do from home.

Dr. Deepti Agarwal :
So that, like I said is not for everyone, but for people that are interested, Reiki is a great energy healing option. And especially in a patient that's had Lyme disease and has diffuse joint pain. That's not something that we can necessarily go in and inject Prolozone in. And that becomes more of a diffuse inflammatory state and also just related to a lot of different inflammatory factors. So we need something that may be a little bit more ethereal sometimes. And so doing Reiki is non-invasive and can sometimes help people just clear out their energy and sometimes this type of pain also gets propagated or it's more intense for people who are carrying a lot of stress in their life or who do have some past emotional trauma. So energy healing is great for people like that.

Mimi MacLean :
One of my past doctors explained it to me, Lyme is almost like having termites because the termites is the Lyme, until you kill the termites. Once the Lyme's gone, they leave massive damage in a house to your body. So at that point it's going back through and healing it if it's either through metabolically or also now like emotionally and getting your body used to subsiding on the trauma. So even I'm not a huge yoga person, I'm not a huge meditating person, but I learned that I had to start seeing life through a different lens, and not letting go of things and not holding onto anger, not yelling as much with my five kids and just be like, it's funny. We were just talking the other day with my kids and my husband because he's more of a yeller and I used to be the yeller and now my son was like, mom, doesn't yell anymore.

Mimi MacLean :
She just gets up and walks out and [inaudible 00:19:27] she snaps and back. So I'm like, because I don't want to yell. So I just I'm like, I'm out of the situation until I can calm down and then I can come back and talk like a normal person, but I'm not going to engage. You know? And so I think that's super important for pain management and people who are dealing with a chronic illness because like you said, if your body is so heightened with stress and that's emotional, but there's other things that you can do, like if it's meditating or is there any other advice you could give towards that?

Dr. Deepti Agarwal :
Yeah, absolutely. So stress is also another cause of inflammation in the body and having this internal infection also reeks stress on your body. It's like this insidious stress that your body's constantly in this fight or flight mode. And so we want to figure out how to rewire our brain and not just with medicine because medicine's only going to do it at the time that you have the medicine in your body. We really want to figure out how to rewire on a chronic level, our stress levels, and that can be done through meditation and yoga, great, great practices. And I think, this isn't just for the Lyme patient. This is for anyone in life. The idea of resiliency is an anti-inflammatory for your body.

Dr. Deepti Agarwal :
And this is also something that's hard for certain people to understand. But once you start engaging in a mind body practice, there are very small micro changes that occur at a cellular level that we haven't even completely been able to elucidate. And those micro changes like you are mentioning even just the ability to take a step back and not yell or not get involved in a situation and walk away. That's actually a behavioral change that maybe you don't know it or not, but it could be related to your mind body practice. So I always tell people that they just need to give it a try over some time, even if it's a five to 10 minute practice and they may start to notice really subtle changes within themselves.

Mimi MacLean :
Yeah. Even breathing, right? Like if even a simple act of breathing in five, letting out three and just being cognizant of your breath?

Dr. Deepti Agarwal :
Breathing is probably one of the easiest, least expensive and most important things that anyone can engage in. And there are multiple types of breathing practices and people can go down a rabbit hole, but breathing and breath work has literally cured disease too. And it's a great way to detoxify the body naturally.

Mimi MacLean :
Which brings me to another thing is like, it's amazing how all of a sudden you could have knee pain and you watch a funny TV show and your pain goes away, right? It's just diverting your attention of your mind. So it's all the same thing. It's like teaching your mind to put it somewhere else.

Dr. Deepti Agarwal :
And what laughter is like, it's a natural feel good, right? You're not stressed when you're laughing and engaged and something's funny. And so these are all things that I think we sometimes forget, because we're so wrapped up in our day to day lives. And especially in the Western world, we are in a constant fight or flight mode, whether we realize it or not, it's very endemic to our culture. So just going back to the basics is really helpful for help.

Mimi MacLean :
And what I'd love to end on is a little bit of hope. Because again this morning, I was going back and forth with a listener and she was like, thank you so much because my traditional doctor told me I'm going to have to live with this pain for the rest of my life. And having talked to you, you're giving me hope. And I do feel pain is such a huge part of Lyme that's why people give up going ahead and living because they don't ever see that they're going to be out of pain and it just gets unbearable. It's excruciating. I was at a point where I was having four Advil every four hours, for weeks on end because I was in so much pain. And so I guess I'd love for them to hear it from an actual doctor that there is hope and they can get through it and it's not pain that they're going to have to live with the rest of their life.

Dr. Deepti Agarwal :
Absolutely. And that's part of this quest that made me pivot from a very traditional career and do something that's very different for an anesthesiologist and a pain management physician. But in a traditional setting, we cannot do or talk about some of the things that we can talk about in an integrative setting. And for me, I just knew that I wasn't truly able to help patients in chronic pain in just a traditional model. And that's what really drew me to a place like case. And I feel like I even have hope as a physician in how I can help people because there's so many more things in my toolbox. And there's also a way to add a creative art to the science of medicine. And I think that's really needed for patients who are suffering from what I like to call more enigmatic medical issues, where we don't really have all the answers.

Mimi MacLean :
And there's going to be a lot more of us now going through the pandemic and people who are now injured from it long term, how long haulers or whatever.

Dr. Deepti Agarwal :
And if people didn't understand what brain fog meant before or neuro inflammation, I think the pandemic has really brought to light some of these issues and really brought to light how bad stress can be for our body and how much rewiring a lot of us require in our brain.

Mimi MacLean :
No, it's so true. So is there anything we haven't covered that you would like to discuss?

Dr. Deepti Agarwal :
I think we covered a lot of interesting things. I'd say that the most important thing that people can do at home is really engage in a healthy lifestyle, optimize your lifestyle as much as possible through food, through sleep. That's one thing that we didn't touch on sleep is so important. And I know that is probably one of the most difficult things to do while you're in pain and finding some movement or exercise routine in your daily life is also very important to help decrease brain fog and just keep your body healthy.

Mimi MacLean :
So true. And that's hard to do when you don't like, you're like, oh, my hip hurts, my knee hurts. I can't walk. But I think even my husband who has Lyme, he goes, all my joint pain went away when I started lifting weights. I don't know why that is, but he is like, you need start lifting weights because your joint pain will go away. It's like the more you do, it's helps, I don't know, clean out the joints.

Dr. Deepti Agarwal :
Two things. Muscle is truly an anti-inflammatory organ and it's actually very important to keep building muscle, especially the more birthdays we have because we lose muscle mass every single year. And then actually exercise releases important neurotransmitters, but brain derived neurotrophic factor is one important transmitter that gets released that actually helps clear neuro inflammation. So whether we're thinking about it or not, movement is very important to our health and is another form of medicine.

Mimi MacLean :
Do you do tell, if someone's listening and they want to work with you and they don't live in Chicago area, do you work through zoom or tele? What do they call it telemedicine now?

Dr. Deepti Agarwal :
We absolutely do in terms of, if someone needed a true physical exam for something that's more difficult to do, but if someone wanted to discuss more lifestyle approaches or botanicals in order to help manage pain, we can absolutely do that via telehealth. And we do that quite a bit in the office.

Mimi MacLean :
That's great. Well thank you so much, Dr. Agarwal. I really appreciate your time and you are located at case integrative, it's in Chicago, correct? I believe.

Dr. Deepti Agarwal :
In Chicago.

Mimi MacLean :
Perfect. Well thank you so much. I really, really appreciate it.

Dr. Deepti Agarwal :
Absolutely. Thank you for having me on.

Mimi MacLean :
Each week, I will bring you different voices from the wellness community so that they can share how they help their clients heal. You will come away with tips and strategies to help you get your life back. Thank you so much for coming on and I'm so happy you are here. Subscribe now and tune in next speak. If you want to learn how I detox and you want to check out my detox for Lyme checklist, go to lyme360.com/detoxchecklist. You can also join our community at Lyme360 warriors on Facebook and let's heal together. Thank you.