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As a science writer, I’ve spent years covering the rise of allergic conditions. Why couldn’t I figure out my own?
Credit...Illustration by James Zucco
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By Moises Velasquez-Manoff
My year of torment began with a brutal headache. The pain came on gradually over several weeks, as if some part of my brain were being slowly squeezed in a vise. Darkness lapped at the edge of my vision. Over-the-counter painkillers didn’t help. Occasionally, a dementia-like loss of vocabulary struck, often when I was talking to people over the phone. I found myself unable to recall easy things like “Washington, D.C.” or “George Clooney.” I’d end up staring at my computer without any inkling of what I’d sat down to do.
I suspected something was wrong with my sinuses because I had sinus infections in the past, and this headache was accompanied by a waterfall of mucus running down the back of my throat: postnasal drip, in medical parlance. I figured it wasn’t Covid, which a test eventually confirmed.
When I went to the only ear, nose and throat doctor who could fit me into her schedule, she gently inserted a long, flexible rubber scope into my nose to examine my sinuses. As I sneezed and gagged, she pushed the scope farther, to peer down my throat. I might have reflux, she said — acid splashing up from my stomach into my esophagus. She could see “damage” in my pharynx. She seemed unconcerned, though. Some people have terrible reflux but don’t feel a thing, she said; others have a little reflux, and it causes intense discomfort. I must belong to the former group, if my throat looked like this and I wasn’t feeling pain there now. She prescribed a course of antibiotics to clear out whatever nasty microbes might have established themselves in my sinuses, the presumed source of my pain.
Unfortunately, something was starting to disturb my insides. It began as a faint sensation of heat under my sternum and over several weeks grew stronger, until it felt as if some part of me had caught fire. The sensation reached an apogee one night following a meal of greasy quesadillas with hot peppers. After that, I changed my diet, abandoned coffee and avoided heavy foods, all said to aggravate reflux. But whatever was happening to me only got worse. Warmth began to rise in my throat soon after every meal, no matter how light or bland the food. To avoid the feeling of lava bubbling up within me, I ate as little as possible. I started to lose weight.
I didn’t know it at the time, but I was embarking on a journey into territory I knew well. My ailment, it would turn out, was of a piece with a much larger development in affluent countries over the past 150 years or so. As improved sanitation, vaccines, antibiotics and other innovations beat back infectious diseases, some chronic diseases have been on the rise, including disorders in which the very immune system meant to protect us turns on us instead. A leading explanation for such self-sabotage involves the changes we have wrought on our microbiomes, the communities of microbes living in and on our bodies. As a science writer, I’d covered this phenomenon extensively. But despite having written a book about some of the diseases involved and the reasons for their increasing prevalence, I hadn’t ever considered how they could lead to the kind of unremitting pain that was making my life so miserable now at 47.
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