Tuesday, May 8, 2018

Trip Analysis

I finally got around to charting my activities during the trip. Here it is the trip route and the 7 day rolling sum of the number of steps taken.

The bad days, with the condition level 4 or less, are overlaid on the activity chart as the red vertical lines:

Here are some observations:

  1. There is no red line in late March and April. This is when I was on the move.  
  2. Thick lines appear in early May when we stopped in Virginia. 
  3. The lines disappear again till we settled in NYC in June.
  4. Then the lines get denser as we approach July. This is the post-trip struggle in NYC.
  5. Lines disappear in August as we got back on the road. 
  6. Thick lines in the middle of September when we stopped for  a week in Mesquite.
  7. Once we got back home, the lines became regular as before.
  8. Similar pattern appears while we traveled to Paris in Oct and Nov. It was less conclusive though, because it was only for a month.
  9. Ignore thick lines in Dec and Jan. This is when I was having flu.

These observations agrees with what I observed before:
  • The novelty of taveling elevates the crash threshold
  • When the novelty fades, so does the elevation effect
  • When the elevation effect dissipates, post-trip struggle sets in.
  • The post-trip struggle ends quickly when traveling resumes.

Saturday, February 3, 2018

Heat Wave

It's now 7PM and still warm. I had to take my outer shirt off. It was even warmer this afternoon. I went to Naked Lounge this afternoon and lounged in 72F weather. A lot of people were out on this sunny Saturday afternoon. The air was so pleasant, it took me an hour to get off my butt and come back. (I'm looking forward to the summer in Sacto -- it'll be hot and I'd like to find out how it affects my CFS).

It appears my post-flu struggle is over. I looked at my activity log and it seems to have ended on 2/28, about 2 weeks after the flu was over. It is the same amount of time it took to get over the struggle after the flu shot in 2016. Coincidence? Maybe. Or maybe low grade inflammation persisted for 2 weeks after the flu was over. Or maybe I'm forcing myself to find a pattern. I was looking for the end of one-day-up-one-day-down pattern. And it ended on 1/28 when I went several days without a down day. After a down day on  2/1, I took 7500 steps and then 5500 today. So the struggling pattern is definitely ended.

As for the post-trip struggle, my theory now is that the trip triggers inflammation that takes 3 weeks to fully dissipate. Healthy people either don't feel it or recover when the inflammation goes down. CFS patients, on the other hand, continue to feel the the full 3 weeks while the low grade inflammation persists. This also gibes with the depression as an inflammation disorder. (Post-vacation blues are commonly understood as depression). How credible a theory is that? Well, I'm now boldly predicting that they'll find the inflammation marker in people who suffer from post-vacation blues. And, if the test is sensitive enough, it will reveal that the low grade inflammation persists for 3 weeks. And my theory is likely to be true if that prediction comes true.

One could ask: why don't people feel the inflammation effect while travelling? My answer is that their tolerance to inflammation goes up while they are aroused. For CFS patients, that also means the crash threshold goes up, or perhaps even removed. I'd like to test that out the next time I travel. I'll finish 2+ mile hiking over 600+ feet elevation and see what happens. That ought to be enough even for people without CFS but extremely out of shape. And that is more than the Navajo Loop that I did not finish last September because I didn't want to get sick while travelling. If I make it at a decent pace, I could claim that the crash threshold is entirely removed while travelling. I'll have to continue to travel 4 more days afterward though, and taper down. If I quit travelling right after the hike, the inflammation will be high enough to trigger the crash or worse.

Finally, I'm making a slow progress in analyzing my trip data. I got tripped up on last year's February data when my Fitbit went kaput. It took me 2 weeks to replace it, so there is a hole in the tracking data. I spent a couple of days to figure out the best way to deal with it and settled with filling it with NA. That done, I'll resume the data analysis tomorrow.

Monday, January 22, 2018

Out of Jail, Out of Penalty Box

It's been a while. The post-trip struggle was over in December as expected, about a month after we settled in Sacramento. Shortly after, we went to SF and I registered 10,000 step on Christmas day.  That's when I caught the flu. Then another one in January and I missed my nephew's wedding. It was a nasty one and I got back on my feet only a few days ago. Then I went out for a walk, got caught in the rain and walked fast back home. And I paid for it with 3 days of post-exertional sickness. So only now I'm finally out of jail (of the post-trip struggle) and out of penalty box (of post-exertional sickness), book-ending the two flus in between. Long story short, my plan for post-trip observation went out the door, lock stock and barrel.

I'm now in the familiar one-day-up-one-day-down territory as if I'm back in a post-trip struggle. I'll get out of it in a few weeks and then we'll see if there has been any steady state improvement from the pre-trip condition. I'm hoping for at least the half way between the pre-trip valley and peri-trip peak.  (I'll call it the post-trip plateau). That means about 43,000 steps per week.

Meanwhile, I'll finally get to analyze my trip activity data for the past 9 months this week. I'm anxious to see what they will turn up, though I pretty much know already what it will look like: the elevation during the trip followed by 3-4 weeks of post-trip depression when settled in, sprinkled with several post-exertional sickness during the post-trip struggle. But it'll be good to confirm with the concrete data and see if it reveals anything new. What I still don't know and am really interested in finding out is weather the post-trip plateau is real and there is a lasting improvement after the post-trip struggle is over. I haven't been able to observe that so far, thanks to the double flu. But I will in the next few weeks. Stay tuned.

Tuesday, November 21, 2017

Settling In

In SF, I've never turned on the heater. The first night in Sacramento, I borrowed a space heater from the landlord and had it run all night long. Its a little colder in winter and the old building with hardly an insulation didn't help. I don't see staying here too long, though we chose it knowingly because of the midtown location. I don't need the location, but wife who doesn't drive does.

And all that moving didn't help my health. This second story walkup has a narrow and steep stairs in the back and carrying a few stuff on the first day was enough to throw me into a post-exertional sickness for 4 days. It's always the quads -- a few squat used to be enough to trigger the sickness so I stopped it long time ago. Apparently it hasn't improved. And the triceps still ache when quads over-work.

Why is it that the triceps ache when quads over-work and vice-versa? It's as if they are somehow connected. With what, I'm  not sure. One possibility is the inflammation. Though the muscular inflammation is supposed to be local, the inflammation the day after may not. The cleaning up of cellular debris has to be global since the debris are circulating in the blood stream. That global inflammation could trigger the ache in the triceps. And why triceps and quads? They may have gotten sensitized by the years of judo, perhaps by sprouting more inflammation receptors. Anyway, these are all speculations. All I know for now is that use of quads triggers the sickness and quads and triceps are highly sensitive.

Coming back to the walkup, having to go up and down stairs everyday will reduce my margin of error. Managing CFS can only be done statistically -- there are so many unknowns and measurements are imprecise -- and not having enough margin of error will make the post-exertional sickness more frequent if I don't reduce stress elsewhere. I'll have to pace more carefully and keep it below 90 steps per minute all the time. Distance probably won't get effected -- it's always the sustained speed/intensity that  triggers the post-exertional sickness.

Monday, November 13, 2017

Back at Home

The air feels just different here. It's fresher and crisper. That's what I feel every time I come back to the Bay Area. And the blue sky too. Paris was swell, but the air wasn't much better than Korea that constantly suffer from smog blown over from China.

Anyway, I slept 9 hours, then was fed and pooped. Now I feel like a million in bucks, the day after the ordeal of 18 hour flight.  And my pace was up to 98 per second this morning on my way to retrieve the car from the garage. No jet leg for now, it seems. Will I be suffering from the post-trip struggle again? I already paid the price in Paris and this leg of the trip from Paris to SF lasted only one day really. So, I'm thinking I shouldn't get another one. We'll see.

Saturday, October 28, 2017

Rethinking Post-Exercise Fatigue vs Post-Exertional Sickness

I've been classifying the fatigue lasting less than 48 hours as post-exercise fatigue rather than post-exertional sickness. I reasoned that a day of fatigue after a heavy activity is normal even for a healthy person. It is a happy fatigue flush with endorphin. But the fatigue on 10/3 was not a happy fatigue even though it lasted only a day; it was a sick, wallowing fatigue. That made me wonder if the duration was the correct criteria for the distinction, or if the distinction is meaningful at all.

Frequent post-exertional sickness means  that you are over-reaching. And knowing that is imperative in managing CFS. So the duration and frequency of post-exertional sickness must be measured and recorded. But the normal post-exercise fatigue should not be included in it because, well, it is normal. More importantly, post-exercise fatigue is not disabling; my mind actually works better when I'm having post-exercise fatigue. So the distinction between post-exertional sickness and post-exercise fatigue is still meaningful and useful.

The problem is, again, there are one-day fatigues that are not happy post-exercise fatigues: the one-day-up-next-day-down pattern during a post-trip struggle is not post-exercise fatigues even though they last one day. So the duration-base classification can end up with false negatives (for post-exertional sickness) and under-register the struggle. I could remedy the problem by adding the happy/sick feeling as a criteria, but that is yet another subjectivity that I don't need.

Since post-exercise fatigue usually last one day and post-exertional sickness usually multiple days, the current classification by the duration is probably still useful enough. I'll stick to it for now till I find a better way to cull out the post-exercise fatigue from the post-exertional sickness. For post-trip struggles, enough multi-day post-exertional sickness also occur, so ignoring one day sickness may not be a big problem.

Post-trip Struggle in Paris, Over

We went to Louvre yesterday evening, after doing the Rodin Museum the day before. And today I'm still up and writing this blog after registering 10,000 steps, two days in a row. I only have a happy post-exercise fatigue for now, though I may crash in the evening when the 24 hour probation of post-exertional sickness is up.

This week has been fairly trouble-free even though my activity is up -- I already registered 48,000 steps and I still have one more day to go. As such, I'm declaring the post-trip struggle in Paris over. That makes it the struggle of 3 weeks, about same as the one in NYC or maybe a little shorter.

By now, there is no doubt that the elevation effect of traveling and ensuing post-trip struggles are real. I know that not only from the repeated observation, but because I predicted the effect before this trip started and the trip proved it correct. That makes it more than anecdotal. What I still don't know is whether the exercise tolerance threshold after the post-trip struggle is higher than the pre-trip one. For now, the trips doesn't seem to have lowered the tolerance, as I have feared before I started out on this experiment. So, I can at least continue with this "travel treatment" and see if I can eventually cure myself.