Specific fatigue after specific exertion

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If I use a specific muscle repeatedly, it fails to contract before the actual muscle tissue fails. Overusing my leg muscles caused chronic damage to motor neurons in the CNS that move them.

If I listen to music, it causes typical autonomic responses with goosebumps, but eventually, they completely disappear, and I expect to feel them, but the feeling in my body simply doesn't happen. The reflexes take days or possibly weeks to fully recover. Sexual stimulation similarly fails.

Being in an anxiety-provoking situation made me feel less anxious the next day. There were many times that I'd do something brave without a second thought, only to leave a memory that haunts me until this day. During a particularly bad time in my life, I suddenly became outgoing and took lots of risks.

My lifestyle was inconsistent. I'd never be able to do exactly the same thing. I abandoned hope of reaching any goals a long time ago. I fail to get better at something through repeatedly trying it. Actually, more often than not, I get slightly worse. If there was a hard challenge in a game I couldn't beat the first few times, that was it. I simply couldn't move on.

What made me realize just how specific my fatigue is, is central apnea after lots of bag breathing. I'd automatically breathe less later, and inhale suddenly and involuntarily, like a snort in sleep apnea, whenever I felt a desire to yawn.

Since there's low blood flow to the brain in ME/CFS in an upright position, it causes less blood flow to both the brain as a whole, and specific neurons. Since I seem to have a greatly neurological form of ME/CFS, what some would consider to be ME, this effect is especially noticeable in me.

When cells of any kind receive less blood flow, they end up starved of nutrients faster, and this insufficiency ends up causing more damage to them than otherwise, temporary or permanent. Providing cells with more blood flow and nutrients makes them tire less easily, and also lets them heal faster. It's also possible that there's toxins, a deficiency, or a defect in processing, but if that were the case, more than just my CNS would be impacted.

I believe that maximizing blood flow to the head with bag breathing, thiamine, and thyroid (slowly increasing) to increase carbon dioxide, using salt, baking soda, and fluid to increase blood volume, and lying supine, minimizing being in an upright position, and wearing compression stockings to mechanically increase brain blood flow are capable of curing ME over time, given that the original cause of it is absent or overpowered by the treatment methods.

It's also worth mentioning that the leg function damage didn't show up on an MRI. It was completely normal, despite having slowly worsening ME for over a decade.

I believe the tilt test is by far the best way to diagnose ME/CFS. A standalone tilt test will capture roughly half of people with symptoms severe enough for a diagnosis, those with POTS and dOH. ~4/5 of the patients with a normal standalone tilt test will have an abnormal tilt test if combined with a transcranial Doppler. I'm looking into if any hospitals are able to do this, but most likely not.

https://pubmed.ncbi.nlm.nih.gov/32140630/

An abnormal tilt test is far more effective for proving disability than tests such as blood tests and MRIs because it's easy to prove how it would impact one's ability to work.

On the bright side, even if the Doppler tilt wouldn't be possible at this time, orthostatic intolerance without POTS or dOH tends to have a less severe effect on cerebral blood flow, and has a higher chance of recovery.

To minimize specific fatigue of important functions in one who is susceptible to it, a behavioral method is to vary one's actions and rest during or after performing them, to prevent the nerves from receiving enough damage that it's difficult to recover from them.

For example, if one has to both think or plan and prepare physically, then a wise course of action is to switch back and forth, rather than try to cram either of them. In a normal person, cramming may be simpler and easier, but in a person with specific fatigue, cramming is likely to be reckless.

More or less the same rules apply to fatigue of muscle cells as neurons. Muscles accumulate microtears with exercise and heal stronger, and neurons act the same way, which is why in normal people, "practice makes perfect". Damaging a muscle often is more effective for building it than damaging it more thoroughly and increasing blood flow and nutrition aids the healing process. Insufficient blood flow causes cells to be less energetic, fatigue easily, and be susceptible to permanent damage.
 

Wishful

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Yes, a lot of PWME might have OI or POTS, but that doesn't make the tilt test a good way to diagnose ME. If the patient has other symptoms suggestive of ME, then having OI or POTS would be good additional evidence. I expect there are plenty of people with OI or POTS that don't have ME.