SNT Gatchaman
Senior Member
- Messages
- 302
- Location
- New Zealand
We're currently talking about whether ME/CFS is a blood disorder.
On the back of the new long COVID micro-clot finding and noting changes over time in myself, I'd like to raise a separate discussion. I'm (very) slowly improving and am probably at the milder end of moderate currently (long may this continue). My observations and thinking are in this context, probably relevant only to the milder and/or more recent patient group.
It's been noted that POTS patients are often worse in the morning and then improve over the day, even describing being at their best just before bed-time. I experience this. This could relate simply to overnight dehydration and autonomic changes of course. POTS and ME patients also have "unrefreshing sleep" as a hallmark feature.
I've also noted a paradoxical pattern that if I have a bad night's sleep, I feel much better during the day and my POTS symptoms are less.
This made me consider the possibility that reduced cardiac output and the immobility of sleep might be having a negative effect. This would seem to take effect without the 24-48 hour delay typically seen in post-exertional malaise.
So, could "under-exertional malaise" be due to effects on RBC flow in the micro-circulation that occur e.g. overnight, in the context of lower cardiac output. Post-exertional malaise might take effect due to shear forces further damaging abnormal RBCs transiting an impaired micro-circulation, in the context of higher cardiac output.
This could lead to a diurnal variation in micro-circulation performance. Constant swings in the tissue and blood metabolic environment that result in cellular adaptations.
Potential mechanisms to consider for this model would be a relative "settling" of the micro-clots that puts them in more contact with the capillary endothelium and promotes the action of their internal inflammogens. A dynamically impaired micro-circulation could reduce venous-side volumes outside of the usual vascular homeostatic compensations.
We don't know if micro-clots are a COVID-related phenomenon only, but the symptoms overlap (including hallmark PEM) seems very important to me. Offers the intriguing possibility that there might be an optimal amount of activity to reduce symptoms, or potentially even help clear the micro-clots.
On the back of the new long COVID micro-clot finding and noting changes over time in myself, I'd like to raise a separate discussion. I'm (very) slowly improving and am probably at the milder end of moderate currently (long may this continue). My observations and thinking are in this context, probably relevant only to the milder and/or more recent patient group.
It's been noted that POTS patients are often worse in the morning and then improve over the day, even describing being at their best just before bed-time. I experience this. This could relate simply to overnight dehydration and autonomic changes of course. POTS and ME patients also have "unrefreshing sleep" as a hallmark feature.
I've also noted a paradoxical pattern that if I have a bad night's sleep, I feel much better during the day and my POTS symptoms are less.
This made me consider the possibility that reduced cardiac output and the immobility of sleep might be having a negative effect. This would seem to take effect without the 24-48 hour delay typically seen in post-exertional malaise.
So, could "under-exertional malaise" be due to effects on RBC flow in the micro-circulation that occur e.g. overnight, in the context of lower cardiac output. Post-exertional malaise might take effect due to shear forces further damaging abnormal RBCs transiting an impaired micro-circulation, in the context of higher cardiac output.
This could lead to a diurnal variation in micro-circulation performance. Constant swings in the tissue and blood metabolic environment that result in cellular adaptations.
Potential mechanisms to consider for this model would be a relative "settling" of the micro-clots that puts them in more contact with the capillary endothelium and promotes the action of their internal inflammogens. A dynamically impaired micro-circulation could reduce venous-side volumes outside of the usual vascular homeostatic compensations.
We don't know if micro-clots are a COVID-related phenomenon only, but the symptoms overlap (including hallmark PEM) seems very important to me. Offers the intriguing possibility that there might be an optimal amount of activity to reduce symptoms, or potentially even help clear the micro-clots.