Health Report - September 13, 2022

Seven months ago, on February 14th, as I was leaving the home of a friend, I had the thought that I hadn't been sick for a long time but felt that I was about to get sick. When I arrived home I went to bed. Through the next week I cancelled all my appointments and spent much of every day sleeping. I had chills and sweats but no fever. Two rapid COVID tests and one PCR test were negative. After a week of staying home I resumed my appointments, traveling to them by subway or foot rather than on bike. The following week I started riding to my appointments, which I have continued to do.

For the last seven months I have experienced muscle weakness, stiffness, and achiness. The discomfort has been in my shoulders, elbows, wrists, hands, fingers, hips, and knees. I've consulted with my primary doctor several times since the trouble started. Blood work has shown that I have chronic inflammation, which can account for the trouble I've been experiencing. At my doctor's suggestion I've been taking several supplements to help reduce the inflammation. The blood work has ruled out Lyme disease, lupus, osteoarthritis, chronic-fatigue syndrome, Epstein-Barr, and probably other diseases that I don't recall.

I’ve been to a hematologist and a rheumatologist, the latter of whom told me "You have a thing, it has a name, and there's a treatment". The name is "polymyalgia rheumatica", Greek for “many painful muscles inflamed”. The rheumatologist said nobody knows the cause of polymyalgia rheumatica, and that the treatment is a long course of steroids starting at 12 mg per day and eventually tapering off. I think that Greek names describing symptoms and lab results (for example, “polymyalgia rheumatica”) let doctors act like they know something that the patient doesn't already know. Listen to what Richard Feynman had to say about knowing the names of things.

My primary doctor suggested an alternative course of steroids in which I would start on the smallest dose and gradually titrate up to the smallest effective dose to suppress the inflammation (and then gradually taper off). Before seeing the rheumatologist I had already been on a six-day tapering-off course of steroids at my primary doctor's suggestion. It was amazingly effective from the first day but completely ineffective after the sixth. Furthermore during the six days I experienced stinky flatulence, profuse sweating throughout the night, and irritability. I found my primary doctor's suggestion interesting but I did not want to take any more steroids without at least first exploring other options.

I found an article by Katie Mark entitled "Athletes and Inflammation - when is it too much?" that explains how endurance athletes can develop leaky gut which could lead to inflammation and then muscle trouble. A test for leaky gut came back negative. The cause of the inflammation remains a mystery.

Rebecca Dietzel, one of the authors of the BE CALM protocol about which I have previously written, asked whether I had considered acupuncture. I told her that I hadn't and that I considered acupuncture to be hocus-pocus. She told me that it could be effective for inflammation so I had four sessions with Cynthia Hewett during the first two weeks of July. My ability to lift my arms overhead was significantly improved after the first session. I've had one session each week starting in August and plan to continue the weekly sessions.

I’m now doing better than I was a month ago. All the items listed below were problematic for many months but no longer are.

Putting on shoes while seated
Putting on pants while standing
Rolling over in bed
Getting arms out from under the sheets in bed
Going between standing and lying on the floor
Standing up after sitting awhile
Swinging my leg over my bike
Grip strength
Walking speed

My 38-year experience with the Feldenkrais Method, both as a student and as a practitioner, has been helpful with all the movement challenges I've recently faced. For example, I habitually put my right leg in my pants before my left, but I discovered that, because of the increased limitation of bending of my left knee, it was easier to put my left leg in my pants before my right. I no longer need to do that.

My movement is generally improved, and I’m becoming more and more energetic riding my bike. I’ve been riding at least 5 miles six days every week (2.5 miles to and from a client). My longest rides were 20 miles, during which I needed to rest because of the pain in my hands, wrists, and shoulders. Before the trouble started I would not have needed such a rest. A month ago I felt like I was in Limbo (or was it Hell?), from which I would never leave, but now I feel more like I'm in Purgatory, with an eventual end.

I still feel a general stiffness, and because of the limitations in my shoulders I am not able to reach my left arm all the way over my head and the reaching of my right arm over my head is somewhat compromised. Because my wrists do not bend 90 degrees I am unable to do even a single pushup. I suspect the condition of my shoulders also contributes to that inability. I can stand on my hands and knees but because of the stiffness in my knees I am unable to sit on my heels. Fortunately when riding I do not feel any limitation from the stiffness around my knees and hips.

In late July, two days after having a fever, I tested positive for COVID. Fortunately my symptoms were mild. I wonder whether I am experiencing any lingering effects of COVID.

In early October I have an appointment with another rheumatologist, Dr. Weijia Yuan. Based on her website and video, I'm optimistic that she'll be helpful.

I didn't take a multi-day bike trip last December because my wife and I took a two-week trip in the midwest by car. I didn't take a multi-day bike trip in January because there were not three consecutive days warm enough. I haven't taken a multi-day trip from February through today because of my recent trouble. So it's been nine months since my last multi-day trip (November of last year). I'm starting to think that I might soon be ready to take another such trip. Before doing so I will see how I feel on some 30-mile or 40-mile trips. I'm so looking forward to taking the three-day trip I planned in January of this year! You can find the routes here: Hudson, NY

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