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.

Post-trip Struggle in Paris, Not Over Yet

The battery died on me again. I went out to Place de Bastille and Rue St-Antoine and the camera gave up after take a dozen shots. The battery is so small that I have to keep recharging it every night and I keep forgetting it.

I had to go out despite the post-exertional sickness in the afternoon. Yesterday was the first sunny day in Paris since we arrived and it felt like summer. People were sunbathing in Place des Vosges in shorts. I felt like walking on and on following the St-Antoine till it ends. But I knew better; I turned around when my fitbit pedometer hit about 5000. This morning I feel OK. and I don't think I'll crap out this afternoon either since I reined in on the distance.

And, yes, I did crap out in the afternoon of 10/13 as I thought I would. I felt worse yesterday afternoon, making it a post-exertional sickness, not post-exercise fatigue. So, it seems, the post-trip struggle in Paris is not over yet.

You can't really tell if the struggle is over until it is well over. I figured it is over if I could walk 2 days in a row. But the struggle means frequent post-exertional sicknesses. So, the end of the post-trip struggle should really be defined as when the normal post-exertional sickness frequency returns. And I wouldn't know that till at least one month has past from the end, since my normal pre-trip frequency is currently one a month. (In Paris, I had 2 so far).

Back to Paris. I keep thinking Paris has a lot in common with Seoul. You forget historic and architectural difference, and the street scenes looks much much the same. The bus ride to Place de Bastille was no exception. It looked just like alley ways in Sinchon or Sang-il dong with millions people coming and going in narrow streets with shops on both sides. Add to that the Norman demeanor,  it has more more commonality with Seoul than, say, Chicago. (I was going to say New York, but New York is so multicultural, it has a little bit of Seoul and Paris mixed in it).

Is the Post-trip Struggle in Paris Over?

This isn't the Paris I knew. When I was here some 25 years ago, there were only a few guards in front of the gate of Elysee Palace. I even took a picture with one of them.  Now there are a slew of them all around it, in military fatigue and armed with Uzis. The alley ways around it was block off and I had to track back to Marigny to get to Champs-Elysee Clemenceau station. The recent terror attacks must have had some effect.

Ave. Marigny

On the health front, the post-trip struggle in Paris seems to be be over. I went out for two days in a row and I'm OK today, though I'll probably crap out this afternoon.  We'll have to wait and find out.

Post-trip Struggle in Paris

The familiar pattern of one-day-up-next-day-down continues. I walked 7,000 steps going up and down three stations  on Metro 9 taking photos yesterday. St Ambrosia, Oberkampf and Republique, I think. That's nothing compared to 12,000 steps and 600 feet elevation that I took on Navajo trail in Brice Canyon. Or 16,000 steps on Misty trail in Yosemite. Yet, I stayed home all day with fatigue today. I'll have recovered from this post-trip struggle when I can go out 2 days in a row.

Big Crash, Finally

This was just about the worst post-exertional sickness I've had since  I started out on this trip in April. I still was under the influence of Benadryl, with some sluggishness and muscular resistance. We went out to Notre Dame and Latin Quarter and I ended up registering 12,000 steps. I've done more than that in this trip and didn't get sick. This time, I stayed in bed all day.

This makes me think that Benadryl has the opposite effect of Sudafed on CFS: it lowers the exercise tolerance. Now, it could well be just coincidence, and there are other factors like jet lag and colder weather here in Paris, or the walk pattern/pace was more taxing. You wouldn't know till you do controlled trial. I could try Benadryl again and experiment, but I don't think I ever will. It has bad effect the next day, period, even if it doesn't lower the exercise tolerance of CFS.

Even if Sudafed and Benadryl have effect on my exercise tolerance, it does not mean that they do on other patients. Even for me, I didn't notice the effect till recently. I've been taking Sudafed since 2009, but only noticed that it partially relieves the ache and fatigue; its effect on the exercise tolerance was not noticed. It could be that my tolerance has increased and became flexible that I'm starting to notice the effect, where as the threshold was a brick wall back then.

Paris, Day 3

I'm still struggling with the jet lag. I swallowed a Benadryl to help sleep and my CFS worsened yesterday. It was like good old days: weakness, ache and draining fatigue returned in full force and I had to frequently sit down while out, and lie down while in. Too bad it didn't help much with the jet lag itself. Jet lag will take a finite amount of time no matter what, just like the post-exertional sickness, and the sleeping pill only makes it easier to endure by letting you sleep during that period. It doesn't shorten the jet lag.

The trip itself I handled very well. We checked out of Union Hotel at 11:30, hung out in SF till 4 PM and then I fetched the car to load up our stuff. I then returned the car to the garage and we took BART to the airport. The red eye flight wasn't till 10:30, so we hung out some more in the airport. I spent most of 16 hours flight drifting in and out of sleep. I didn't get up at all except once to go to the bathroom. We arrived at our rental home at 10:30 and I slept fine to make up for the deficit. This was about the best handling of long flight ever, before or after CFS.