How do you know when to back off?

Yeah pretty much when i have a hard time breathing and pain becomes too much i take a break sometimes i will push harder when i'm on a good roll/rythm and sometimes i will back off a bit earlier because fed up, to be fair i still feel unsatisfied either way, when i push too hard the physical and mental takes a toll and i tell myself that it was stupid to push this hard and when i back off early it's frustrating to think about the stagnation and potential lack/slow progress, still havent found ease of mind in that regards, maybe it just sort itself out at some point when the bacteria has less grip on the mind and body or maybe it's something about seeing the positive side of it as in the bravery of pushing harder and the wisdom of backing off earlier or maybe a little bit of both or maybe something else entirely, but really i dont think it matters that much compared to doing the right thing, taking the treatment when you can and taking brakes when you have to, but everyone is different so maybe to someone else having that ease of mind is much more important or maybe i'm not aware of how valuable it is.

Back off from antimicrobial treatment, you mean?

I remember from earlier posts that you are a particularly sensitive person when it comes to treatment (if I'm remembering correctly!). For sensitive patients, "low and slow" is the name of the game. Not only is it more comfortable, but it's also the best way to proceed because pushing through herxes can be damaging and destablilizing for folks with hyper-reactive systems. I definitely learned this the hard way. Your LLMD will not be able to tell you what you can and can't tolerate, so you have to be the judge of how far from your baseline is safe and tolerable. Everyone tells them that herxing is hard and unpleasant, so they're just going to tell you to keep pushing, because most patients can.

If you have not read the book Toxic by Neil Nathan yet, then I would strongly recommend it. His whole practice is devoted to treating patients who are especially sensitive - the patents that other LLMDs called "too sensitive" and gave up on. This book provided me with a roadmap for quelling my body's hyper-reactivity so that I could get better.

If you don't get your body's hyper-reactivity under control (mast cells, dysautonomia, etc.) then you will not be able to tolerate antimicrobial treatment for any significant length of time. Treatment has to happen in the right order, and most LLMDs don't have enough experience with protocols for especially reactive folks. (They all say that they do, because people who are chronically ill with tick-borne disease are more sensitive than folks who are in average health, but it's not the same as what some of us experience.) A "low dose" of most meds would send me to the ER with severe intractable tachycardia, gastroparesis, frightening mast cell reactions (MCAS can lead to anaphylaxis), and other medical emergencies that you can't just push through, and shouldn't try to push through.

I'm sorry to hear that you are struggling. Don't be afraid to back off or try something else.

I ordered the book too. I am definitely in the super sensitive category and it's insanely frustrating. 15+ years 5 relapses and still haven't figured it out long term.