Dear Long COVID Suffers: You Are Not Alone!

Dear Long Covid Suffers, While you may feel alone, please know that you have much in common with sufferers of Chronic Fatigue Syndrome (CFS/ME) which has been around for decades. Many of us attribute our CFS to a preceding viral infection, in my case, pneumonia.  You may find the description of CFS similar to your Long Covid symptoms. 

According to the Mayo Clinic Website (note the comments in bold are mine):

Chronic Fatigue Syndrome (CFS/ME) is a complicated disorder characterized by extreme fatigue that lasts for at least six months and that can’t be fully explained by an underlying medical condition. The fatigue worsens with physical or mental activity but doesn’t improve with rest.

Other characteristic symptoms include:

  • Sleep that isn’t refreshing–YES, DAILY!
  • Difficulties with memory, focus, and concentration–YAH!
  • Dizziness that worsens with moving from lying down or sitting to standing —YOU BETCHA!
  • Doctors without answers saying “maybe you’re a little depressed.”

The condition is typically abbreviated as CFS/ME. The most recent term proposed is systemic exertional intolerance disease (SEID). I will stick to CFS/ME.

The cause of CFS/ME is unknown, although there are many theories — ranging from viral infections to psychological stress. Some experts believe chronic fatigue syndrome might be triggered by a combination of factors. I suspect a severe case of viral pneumonia in Japan complicated by salmonella on Bali (travel isn’t all glamour ;))

No Tests to Confirm CFS/ME or Long Covid

You may need a variety of medical tests to rule out other health problems that have similar symptoms–and spend all your time, money, and sanity schlepping around from doc to doc, dept to dept. Treatment for CFS/ME focuses on improving symptoms. You will likely be encouraged to take an anti-depressant which feels like insult added to injury. You Long COVID patients have a similar conundrum as you may not have a positive COVID test result to “prove” your Long Haul Covid!

Strength in Numbers 

Suddenly, the news is rife with stories of people suffering from Long COVID who are experiencing many of the same CFS/ME symptoms I’ve struggled to manage for decades. It’s hard to watch: many of them are young, like I was, debilitated by fatigue in their prime on the cusp of great things: careers, marriages, starting a family. Many of these people will end up on disability, as holding down a full-time job may become impossible.

What is “Debilitating Fatigue”? 

The kind of fatigue that prevents you from hopping  a train to  see the finals at Wimbledon. It’s a kind of tired that leaves you stranded in the dairy aisle because you don’t know how you’re going to carry the milk all the way to the front of the store and back to your car. If you do push through it, you know it will mean a nap once you get home. It’s the kind of fatigue that seems so irrational to friends and family, they start to lose their grip right along with you. You’re forced to say “no” to so much that pretty soon the invitations stop coming altogether.

One-Two Million Americans suffer from CFS/ME

According to the article “The Tragedy of the Post-COVID Long Haulers'” (Health.Harvard.edu) that number could double in the next two years due to the COVID “Long Haulers” / “Long Haul COVID” sufferers. Trust me when I say, our healthcare system IS NOT ready for this. My heart breaks knowing so little has been accomplished on the CFS/ME front in the past decades and the frustrations the afflicted will face. 

Show Me the Progress! 

Many CFS/SE sufferers are women and that is the case for Long Covid as well. All the Infectious Disease and Internal Medicine docs I saw were men. What they had in common: terrible listeners.  Secondly, CFS/ME patients are lousy advocates. Why? They’re TOO TIRED!  It may take half a day to get ready for an appointment and another half day’s nap to recover. All that to hear the same BS and see the same lab-coat shoulder shrugs.

In one of my final appointments, the doc tried to write me a script for Prozac after 5 mins. My husband started cross-examining: “What’s the “end game”–is she on it forever? Why do you think she’s depressed?” To this day, we’re not sure if we stormed out or were thrown out of his office.  Worse yet, that doctor was on the Board of a CFS Association in Minnesota! What about the people who don’t have a partner to ask the tough questions during appointments?

Luckily, somewhere along the way, when I still had some energy, I had taken a few yoga classes. I found myself in a situation where my energy improved somewhat and I could commit to a weekly yoga class. It became clear to me that I got a hella lot more out of yoga classes than doctor appointments. Slowly, my health improved, albeit in fits and starts.

 “C” in CFS is for “Chronic” 

It never goes away; it’s a condition that has to be “managed.” I basically fired all my doctors and started managing it myself, primarily through yoga–but not just any yoga.

Stay in the Energy Envelope

One of the most frustrating symptoms for a former athlete is post-exercise malaise which is perhaps why experts are starting to refer to it as systemic exertional intolerance (SEID). Luckily my first teacher was a classically trained Yogi and Zen Buddhist in Singapore. She was in her 60’s and no-nonsense. She did a lot of seated meditation and it showed in her approach. She knew that the “exercises” were to be done as meditations, not gymnastical performances. She also paced the class as “relaxed exertion”; fast flow would have kept us too busy in our heads managing choreography. 

Slow the Flow Down

There was plenty of time to phase in and out of the pose, downshift if need be, and integrate between poses. No music or mirrors–she would have disdained such distractions. The point was to reside in your body, not let your mind drift, and most importantly, accept how it was for you that day. No comparisons to last week or last year. You were forced to confront the silence and to deal with the thoughts in your head, the sensations in your body.

In Search of Meditation in Motion

I finally came across a Kripalu teacher on Cape Cod. If you would’ve told me when I could barely shower that I’d enroll in a 1-month residential yoga training of all things yoga from 6 am to 10 pm, I wouldn’t have dared to dream. I became certified in 2001. Confession: there was a break in the afternoon, so I could catch a nap; otherwise, I don’t think I would have made it. Coffee was banned but they had really strong tea.

Lifestyle Change, Lessons Learned

I started teaching yoga full-time and never really went back to my “professional” pre-yoga life. Turns out, CFS/ME had taught me a lot. First and foremost, you have to have a strong purpose, a mission for your life that, against all odds, gets you out of bed in the morning. My first mission was “heal thyself.” Accepting that I’d maybe be lucky to reclaim 80% of my previous energy was a big part of that.

Share the Journey

I’m always trying out the latest “life hacks” to boost my energy and clarity; and, I’ve even invented a few on my own. I stay inside my “energy envelope” as much as possible. I relish sharing what I’ve learned with others, especially those with similar symptoms who might be dealing with anything from Lyme disease to fibromyalgia to Long Haul Covid to general stress and burnout.  I have a lot more patience and empathy for sick people and the difficulties of aging.

Pursue Passions that Energize

Travel has always been my jam. I crave the buzz of being out of my comfort zone–a buzz I used to enjoy as a lifestyle pre-CFS. Now, I get to share some of my favorite destinations with my students on yoga retreats which I plan.  Yes, I do get nervous contemplating how people are entrusting me with their vacations, some of the most important days of their year; but, it’s the good kind of nervous as those wee butterflies keep me energized.

I also treat myself to the occasional trip to Japan to re-immerse myself in the language and re-activate that part of my brain. You just don’t have time to be tired in Tokyo: 30 million people in an energetic vortex where the ancient and futuristic intersect. I throw myself into the mayhem, feed off the flow, and go-go-go. I do “pay” for it though when I return, but to me, it’s worth it. 

Conversely, I’ve learned to protect my energy and avoid things that drain me. I view energy as a finite quantity to be “spent” carefully. Bureaucracy, in-the-box thinking, and unnecessary paperwork are best avoided; so are social-climbers, one-uppers, and fixed mind-setters.  I have come to realize that “busy” and “important” are not the same things. I avoid conversations about errands and to-do lists. There seems to be a uniquely American pastime I term “competitive busyness.” Did you know Europe has a kind of “Slowness Society?” You can check it out in a book called In Praise of Slowness: Challenging the Cult of Speed, which we could also call “mindful living.”

My purpose now is to use the energy I can muster to make as much of a positive impact on the lives of my students as possible. With so many of us experiencing Long Haul COVID symptoms, I’m eager to help. Happiness for me requires a yoga mat, a library card, and yes, a passport. If you’d ever like to discuss books, travel, or yoga, I’m all ears and will stay awake for that. If you want to learn more about what has and has not worked for me in terms of CFS/ME, exchange information, I’m also happy to oblige. I hope to set up a Zoom practice for CFS/ME/Long Haul COVID soon, so do get in touch via the contact page if that applies to you.

Women Over 40 Need Yoga!

This post is brought to you by  our own Yoga HotDisher, Top Doc,  and now,  Minnesota Monthly CoverGirl,  Dr. Carrie Ann  Terrell, MD, University of Minnesota (UMN). Thanks Carrie for contributing to our blog!

DrT

The evidence for yoga improving various health problems is deep and varied.  I recommend the website nccam.nih.gov for an overview of the benefits of yoga as presented by the National Institutes of Health.  The evidence is solid as is my experience.

My most common patient scenario presents with a litany of concerns that reads something like this:

  • Fatigue, low energy, difficulty completing the umpteen tasks before her
  • Low libido
  • Inability to focus, memory loss, distractedness
  • Mood swings, irritability
  • Weight gain, digestive problems
  • Dissatisfaction with life

These women are 40-60 years old, often partnered with a significant other of varying participation in the relationship/housework/child rearing/care taking/cooking/shopping, have busy/successful/demanding careers, are the primary caretaker of the house/parent(s)/children/pets, and have unwieldy expectations for what they “should” be doing to take care of themselves.

These patients are essentially working every hour of their lives.  If and when they sleep it is erratic and interrupted and they wake without having rested. Or they “rest” while watching TV, iPading, gaming, texting, Facebooking. These activities are not restful, rejuvenating, nor replenishing. As if this isn’t enough they are also constantly talking to/bombarding themselves with negative or expectant commentary that translates as “not enough or not good enough.” In fact, the incessant loop of streaming thought these women live with is exhausting.

These women often come in seeking a magical hormonal cure.  They read that estrogen or bioidentical hormones or compounded hormones will resolve all of their issues; that their issues must be related to menopause or perimenopause. Now, I’m not underestimating menopause. Estrogen deficiency causes hot flashes.  Hot flashes can disrupt thought, the work day, the physical body. When hot flashes occur at night, sleeplessness results and irritability, mood swings, memory problems can follow suit. However, in many many cases, estrogen deficiency is not the problem. These women need a break, a time out, a mini-retreat, a respite.

Many women have found their solution. Some have found it in running, others in meditating. However, for many the potential solutions are untenable, unreachable, or add to the never-ending list of shoulds. Or, the options are so overwhelming women cannot begin to decide what to do or how to perform self care.

For me, this is where yoga comes in. When taught well, with attention to the philosophy and teachings, Yoga provides peace, quiet and a chance to observe ourselves.  Some know yoga to be an exercise; a physical activity leading to fitness, improved health, increased heart rate, etc etc. The secret is that asana practice (the poses are called asana) is solely meant to allow us to sit comfortably enough,quietly enough to see and feel clearly. Undoubtedly, the physical practice feels good. “Doing” yoga feels good, but, what feels even better is being able to look at my thoughts and see, ‘huh, those are my thoughts. I am not my thoughts.” Or, “look, this awful thing happened to me or someone said this awful thing to me and gee, I don’t have to be affected by that. I can still be me.” Or, “This pose sucks. I hate this pose. My muscles are shaking. This is dumb. I’m way too important for this pose. Why did I come? I have better things to do.” Which over time can become, “This pose sucks. I hate this pose. I’ve gotten through this pose before. I am stronger. My resilience is better.”

After 14 years of practicing yoga I can honestly say it makes me a better person. I build better relationships. I think more clearly. I know my limitations and know what I need to care for my self. I can separate myself from my wrongdoings, my suffering, my awards, my rewards, my family and my thoughts. With this ability I am able to set my work and personal goals in alignment with my deepest beliefs. I am able to achieve lifelong goals and hold positions of leadership with a sense of love and responsibility. I get to choose how I will react to incoming stimuli (if at all) and I can readily access a place of peace and serenity within myself.