Seattle

Kalaloch Beach

Climbing up Astoria Column was a big mistake. It's no more than 150 feet tall, nothing compared to 4 miles and 600 feet elevation hike I now am able to. But it was straight up  on spiral staircase. And it is always the sustained intensity that keels me over.  The next day I was  marooned all over again. The charging station at Kalaloch Lodge was about 300 m  away and I couldn't walk back to it after lunch. I had to send my wife to get the car despite she doesn't have a driver's license.

By the time we got to Sol Duc in the afternoon, however, I mostly recovered. In the past, such mistakes  would've costed me several days at the minimum. Now it's mostly one or two day affair. That's how far I progressed. Add the fact that I'm more exercise tolerant while I'm traveling, PEM is cut down to half a day.

Our 4500 mile trip to and from Canadian Rockies thus started.

It was  a smooth sailing till then. We left on Monday for CA coast and got to Eureka for the total of about 400 miles and millions of stops along the way for sightseeing and hiking.  More of the same the next day to Lincoln City, OR.

Somewhere North of Jenner, CA

Trinidad, CA

Cascade Head, OR

The original plan was to spend 2 nights in Lincoln city, so that I could get a full day of rest after hiking Cascade Head. Right after Cascade Head however, we went on to Aberdeen. And a smart decision that was. The Olympic Loop was just too big and it would've been impossible to make it one day from Lincoln City to Port Angeles. Starting the day from Aberdeen instead of Lincoln City allowed us to spend several hours in Sol Duc, hiking the trail to Sol Duc water fall and then dipping in the hot spring. And I tell you, alternating between hot spring and cold pool does wonders for your fatigue and ache after a long day.

Madison Fall in Elhwa Valley

View from Huricane Ridge

Entering Seattle over water via Bainbrige ferry rather than through land was yet another smart decision. For $18, we got to see the spectacular skyline from the water. And save at least one hour of travel time.

Seattle from Bainbridge Ferry

Gas Work Park in Fremont

Now here we are, perched at the Extended Stay in Bothell for 3 days. We stayed at Extended Stay millions of times during our cross-country trip in 2017, it's like coming home. And this is my opportunity to get some well deserved rest after 1,500 miles and charge up before the next leg to Banff.

I was here 12 years ago for the Whistler trip. We flew in and then rented cars to drive up North. We only had one day in Seattle. The dinner at the top of Space Needle was the highlight. (The rotating restaurant was no  longer, so we didn't go up this time.) Then we stopped there again on the way back for the New Years firework. I delegated the Seattle portion of the plan to someone else, so I don't remember the rest too well other than we hung out in the sculputure park and West Seattle.

The best way to explore a city is to divide it into neighborhoods and submerge yourself in them, one at a time. 3 days gave us enough time to do just that and we covered Fremont, Queen Anne, and Capitol Hill as well as Pioneer Square. Now I can say I have a better understanding of the city.

Despite the setback from climbing Astoria Column, I finished the week with 80,000 steps, the most ever. And, yes, the trip ended the PEM struggle after 5 mile hike prematurely by one week. In fact, it was over two days before the trip when I got busy with planning and packing.  Take a look:

Back in 2015

Yep, the 5 mile hike was a big mistake. 4500 steps yesterday, and I'm wallowing in that familiar feverless feverishness today. The gravity, about ten times as strong as it was yesterday, have me pinned down on the couch. I lay on my side -- pressing down on my iliotibial band relieves the thigh ache -- cross my ankles and have my legs stretched. Same thing with my wrists and triceps.

Yesterday was a brief respite: I did 6500 steps on Monday and paid price for 2 days. And now I'm right back in the pit. I am in about the same shape as I was in 2015 before the sudden improvement in June 2016.

5 Mile Hike And Aftermath

The Sentinel Dome - Taft Point hike in Yosemite was encouraging. I had the usual up and down for 3 days and then was right back up on my feet. No lasting PEM; I continued to register more than 40,000 steps a week. So I figured I should make the hiking a weekly event.

As usual, I got over-ambitious. I went for 5 mile hike last Saturday on Southfork American River Trail. It was the best rated trail near Sacramento on the website. Except that it wasn't. There were some distant views of the river soon after the ascent, but the trail was lined mostly with poison oak and dried up bushes the rest of the way. It was drab. But then, anything would be a drab after Sentinel/Taft.  I started at 11 and finished near 5PM, so it took me almost 6 hours for the effort.

I thought I was going to get away with it when I came out of 3 day recuperation period. But no, not this time. My exercise ability is now so shrunk, I struggle with 5000 steps a day. This week I barely registered 30,000 steps total.  An exertion would keel me over for 30 minutes, and then I'd get paralyzed for two hours, 5 hours after. The post-exercise inflammation wave is now highly pronounced and the constant need to lie down returned.

I'll have to lay low and abide my time for 2 more weeks. Except that I'm going on a 3 week trip through Western US/Canada to Banff National Park next week. It'll be 4,500 mile trip, a mini version of the cross-country trip we did in 2017. I think I'll manage alright. The novelty effect will kick in and I'll be road-worthy once I start out. If not, well, I can always turn around and come back. Just like I was prepared to do when we left for the cross-country trip.

Sentinel Dome and Taft Point

This one was worth 4 miles, and 20,000 steps total for the day. It's the most I've ever done since 2008 and it handily beat 16,000 steps I did in NYC in 2017.

I wasn't ambitious enough to the 5.5 mile loop. I was going to go as far as Roosevelt Point and back, then I realized I could do both Sentinel and Taft for the same distance. All I had to do was come back to the trail head and then head in the other direction. If I didn't feel up to it after Sentinel Dome, I could call it quit and my car would be right there too. I didn't quit. I probably could've done the loop the way I felt at the end of it.



I planned to take a 10 minute rest every 1000 steps. Going up to Sentinel Dome, I did. Then it became 10 minutes every half a mile from Sentinel Dome to Taft Point. Same thing on the way back up from Taft Point. It was getting past 6 PM and I only took only one break for the last 1 mile.

Strange thing's been happening this summer. Whenever I overdo, I have difficulty sleeping. It's similar to the sudden wakefulness that happened back in 2016, except that it is now happening after heavy exercises. It happened about 4 times and it was the same this time: I only slept 6 hours and I was ready to get up this morning. And there was no fatigue of sickness variety; only the exercise fatigue, and some dizziness, that you'd expect if you were healthy. It's as if I am recovered.

Except that I'm not. In between these exercise induced wakefulness, I fall back to the CFS state struggling with 6000 steps and then sleeping like a baby. I could play Jesus and try to walk on the water by keep over-exercising before I fall into the CFS state and wallow. I tried that, and it didn't work. My brain may be awake, but I was constantly in the exercise-recovery mode that I wasn't functioning, neither physically nor mentally. I was more like a zombie. Then, my ability tailed off after 2 long walks in 3 days, making me further useless. So I limited the over-exercise to a day or two a week.

Tomorrow I will poop out and get back to sleepy state, I'm sure. I'll rest one more day, get some work done -- I'm still working on deriving the fatigue measure from Fitbit intraday data so that I can wrap up my project -- and then go for 2 mile walk on Wednesday.

Why CFS Is Not Psychogenic

CFS was once thought of as a psychogenic disorder. The evidence that it is biological disorder is mounting and nobody is calling that anymore these days. But I thought of it when I read the NYT article on the invisible attack on US diplomats in Cuba and China. It raised a possibility that what the US diplomats experienced was a mass hysteria. The similarity to the Incline Village outbreak and subsequent labeling of CFS as middle aged women's hysteria is rather striking: they are both highly clustered, had no known cause, and they could not be replicated. No wonder people not versed with CFS thought that it was a conditioned response to initial infection or chronic stress.

And here is why CFS is not psychogenic even without any biological evidence to such. Most patients, including myself, come into CFS without knowing what Post-Exertional Malaise is. People suspect that they have CFS when they are constantly tired. But the real CFS patients struggle for months with worsening of symptoms after exertion. Then, after searching for answers for another months,  they are either diagnosed or find out themselves that it is CFS. They initially suffer from PEM without knowing what it is.

But a trained response in hysteria requires knowing and learning. The noise from the upstairs neighbor, for instance, can immediately trigger violent outburst to someone who had to put up with the annoyance for some time. It seems automatic as if you don't have control, when in reality you can retrain yourself and detach the response from the stimuli. CBT is a useful tool for that.

PEM in CFS is not immediate; it is delayed like a clockwork by 24 hours, just as buboes break out 24 hours after contacting plague. (Funny that I tell CFS people to avoid exertion like a plague). And it happens the same even when you don't know anything about it, just as buboes break out whether you know anything about plague or not. Since psychosomatic response requires the learning, PEM can't be psychosomatic. By extention, CFS can't be.

Learning about your PEM, BTW, takes long time and hard work. Many times I expected PEM but it did not happen. Even more times I wasn't expecting and then hit by the bus when 24 hours rolled in. You have to take a meticulous log of what you do every day and then eventually learn to predict  which activities trigger PEM. Even now after 11 years, I can't reliable predict. I only know that faster speed and/or fewer breaks cause PEM in general.

Cat Test for CFS Severity

It was meant to be a 3 week sentence, but I managed to extend it into 5 weeks. 2 weeks into it, I went on another biking, for 3 miles this time. It was a trip normally well tolerated, but not while in a 3 week PEM. It reset the clock and 3 weeks penalty restarted all over again.

As if the PEM sentence wasn't enough, the homeless cat we've been taking care of has developed a terrible flea problem. It was getting warm and fleas must be hatching en masse. I had to buy Frontline Plus, a vacuum cleaner and a flea comb to combat the infestation.

The cat moves around. I have to get up, chase it down and then sit again to comb it. I was effectively doing several reps of squat. My legs turned into jello after a few days of that and I still had to vacuum the house twice a day.  By last night I was getting so desperate that while lying in bed I contemplated locking the cat out.

Then, right on cue, I got better today. It's been 3 weeks since the 3 mile biking and I must be out of the jail. Life seems brighter all of sudden.

So, you could use the cat as a test for the severity of your CFS sickness. If you can take care of your cat's flea problem in a small 1 br home with hardwood floor, then you likely have a mild/moderate case. If you can't, you have a severe or moderate case. I'm right on the border. When I'm having PEM, I'm back in severe/moderate condition. When I'm out of it, I'm a mildly sick, functioning patient.

Officially speaking, of course, you are a mild patient if you can hold a job, but have to spend all your evenings and weekends recuperating. And a severe case if you are constantly home/bed-bound. Moderate is anything in between.

Getting Fit Is Dangerous to CFS

No, I didn't get to make to the skiing #3. The mountains had plenty of snow -- snow pack was 150% of the normal when the storms were done -- but the resorts jacked up the price after the storms so I gave up on skiing for the rest of the season. But I did go on a bike ride. The weather finally broke on the last day of March and temperature went up to 75F. I took advantage of it and went for the next segment of the river trail.

The trail undulated more as it approached Folsom and I had to pedal harder than usual a few times. Yet, by the time I remembered to take break, I was already 3.5 miles along. I ended up doing 7.5 mile ride with only one break. It was meant to be 6 miles to Folsom Outlet Mall, but I missed the turn and went way past on Willow Creek trail.  The way back after a long rest in the mall was pretty much the same: I took only one break when I got near Nimbus fish hatchery. In all, I did 15 miles only with 3 breaks when it should've been 12 miles with 5 breaks.

The outcome was predictable. I wallowed in the "worsening of CFS", aka PEM, for almost 3 weeks. Taking 5000 steps in a day was a struggle and then I had to lay off the next day, when as I was able to take 6000 steps several days in a row just prior to the biking. The CFS limit is still alive and well.

It must've been the skiing. I was cramping all over after I was done, and doing it that twice in a month must've put me back in a shape, enough that I could pedal on without remembering to take the break when I was supposed to.

And that is the danger of getting fit. You get fatigued quickly enough after a half a mile walk or 1-2 mile biking, that you don't forget to stop and rest when you are out of shape. If you are in shape, on the other hand, it's easy to forget and go on past your limit. It's better to be out of shape or depressed when you are a CFS patient, as that will help you and prevent you from over-doing

Strangely enough, I did not pay the same huge price after the skiing #1. It was the hardest exercise to date and I was cramping and aching all  over when I was done. But I was back on my feet after my condition bounced up and down for a few days. I think that was because skiing forces you take frequent breaks: you have to sit on the lift for 5-10 minutes to get back up the slope after skiing down for one or two minutes. As hard as the skiing was, the forced break must've prevented me from crossing my CFS limit. Biking slow on flat terrain is a much milder exercise in comparison, but I did it without enough break. So I ended up crossing my limit and pay the price.

The "ordeal" bike trip did not cause 3 weeks of struggle either.  It was also the hardest exercise to date at the time, but I took millions of breaks on that trip.

Graphically, the safe vs dangerous exercise zone for CFS patients looks like this:

You can either do high intensity exercise for a very short period of time or do a very low intensity exercise for a longer time. Skiing down a short bunny slope is the former and slow walking or biking on flat terrain is the latter. Either one should incorporate enough rest before repeating. When you get fit, you end up doing safe exercise at a higher intensity or for a longer duration, ending up in the danger zone. When you are atrophied or depressed, you do the reverse and get back in the safe zone.

So, if you have a moderate/mild CFS, it may be safer to stay out of shape. If you get fit, you must become extra vigilant and disciplined to force yourself to take frequent breaks. It's no different to the situation that serverely ill patients are in. For them, no activity is safe at any speed and therefore they have to be disciplined to pace themselves.