Warning: This post includes content related to sexual health and habits; make your own decision about whether you wish to continue reading.
- Low Energy and Low Motivation
- Low Sex Drive
- Tooth Sensitivity
- Hair Loss
- Occasional Shortness of Breath
- Distancing from Relationships
- Concluding Thoughts
- 2023-10-31 Update
In mid-December 2022, I got sick with COVID-19 for the second time (the first being at the end of June / early July 2022). Perhaps ironically, I contracted it at a fitness conference (RP Summit 2022), but it was in Las Vegas, so I shouldn't be terribly surprised. Like the first go-around, it was pretty mild, all things considered, and indeed, it was quite a bit more mild than even the first time. It wasn't any worse than a run-of-the-mill cold. COVID gave me an excuse to stay at home over Christmas and the New Year, which seemed like a delightful Christmas present from the universe, given my introversion. So I got over it, and I didn't think much more of it.
I felt fine, so at the beginning of 2023, I continued my bodybuilding massing phase (that I had started in October 2022), coinciding with the start of a new mesocycle. And this time, I decided to use the RP Diet app, since Dr Mike suggested that it might help me, given my previous difficulty breaking 205 lbs. Given that the app's prescribed macros are calibrated to various statistical averages, it ended up recommending much less protein than I was accustomed to consuming on a daily basis. (It recommended about 1 gram per pound of bodyweight, whereas I was accustomed to eating closer to 1.5 grams, and sometimes even 2 grams, per pound of bodyweight.) I followed it scrupulously, with 100% compliance for the first 12 weeks of 2023, since I wanted to see how well it worked. I wondered whether this lower-than-usual protein intake could be responsible for what I'd been experiencing, but after ramping my protein intake back up to consuming-it-to-satiety levels in May, I noticed no difference. So much for that hypothesis.
But only a few weeks into those first 12 weeks, I started feeling pretty awful in general. In many ways, it was mostly feeling overwhelmed, like I was drowning in all the tasks that I had on my plate...but taking a step back, I realized that everything I had to deal with was no more than what an ordinary person deals with in the course of ordinary life. It was just "adulting", which, in actuality, was no more than I was dealing with before. But now, it was oppressive, and I was suffering. I was perpetually tired and exhausted. No amount of sleep (and no matter how good the sleep was) left me feeling refreshed. I woke up tired every morning, feeling basically the same whether I got 5 hours or 10 hours of sleep. Every moment of my day seemed spoken for, with no opportunity to relax. While I hadn't really felt bored in quite a few years, it felt more intense now: I only vaguely remembered the feeling of boredom, like it was something unreal and impossible; I seemed to be perpetually running around, rushing from one task to the next, without a moment to rest...from the moment I dragged myself out of bed to the moment I finally hit my pillow at night. And after scrupulously handling all my "required" daily tasks every day (which took forever in this state), when I did crawl into bed, I would fall asleep almost instantly. (Quick side note: Every task took forever, too, because in my low-energy state, it was so easy to get distracted by some low-effort dopamine hit, like scrolling through reels on Facebook, "just for a minute", I would tell myself, which obviously turned into much more than that. And while I was motivated by trying to take a little rest, it ended up being nothing of the sort, since I was just compounding my stress and anxiety about all the things I needed to get done.)
People would ask me how I'm doing, and I would try to answer truthfully, without being overly dramatic. I would say that I'm "hanging in there", but stressed out and overwhelmed. "By what?", people would ask, and I would say "By everything and nothing in particular.".
I even thought to ask ChatGPT to speculate on what could explain my symptoms, and the number one explanation, several times, was Chronic Fatigue Syndrome (CFS), sometimes also called myalgic encephalomyelitis (ME) or ME/CFS. I didn't find that surprising, after a friend of mine posted on Facebook about having been dealing with that for a little while, and one of my favorite online content creators, Dianna Cowern (better known online as Physics Girl), came down with an extremely severe case of ME/CFS after a bout with COVID. To this day, she's still heartbreakingly in a largely incapacitated state. And so that led me to wonder whether I had a relatively milder case of the same thing, given how well the timing lines up with my December 2022 COVID infection. But even as a possible "diagnosis", it wasn't very satisfying, since my cursory research on Dr Google (and even asking further questions of Dr ChatGPT) didn't reveal anything especially helpful as far as treatments...probably because, as is so often the case, "syndrome" means "We don't know what the fuck is actually going on, but here's a constellation of symptoms that usually go together, so we'll give it a respectable-sounding name.".
So I'm writing this in past tense, but this has been going on consistently and continuously since it began. At the time of the first draft of this post, that's roughly 7.5 months. It's hard for me to even believe that it's been the better part of a year that I've had what I guess I should be calling "chronic anhedonia", but that disbelief is purely intellectual. Intellectually, I remember what it's like to be happy, but on an emotional level, I don't remember it beyond a vague echo that occasionally fills me with grief, sorrow, and longing for being back to my normal self.
What follows is a bit more detail about different dimensions of my experience over the last handful of months.
Low Energy and Low Motivation
I've already described a lot of the physical manifestation of all this, but more concretely, I have had very little energy for anything.
But this is more as a baseline, chronic, systemic state. Surprisingly, perhaps, I have been able to summon energy and power for individual activities. For instance, I might be tired and exhausted, but when I go to lift, I can muster up the power to actually move the iron. Then I dread doing the next set because I'm so tired. But when I finally manage to do it, I can again summon the ability to do it. Another example was on my recent summiting of Mt Yale in July 2023: I was tired and miserable, and every step was a slog. But occasionally, I could somehow find the ability to do a "power 10", such as when Max and I were passing another dog, and I needed to pick him up (all 65-ish lbs of him) and swiftly walk up some "stairs" past the dog.
On the psychological motivation side, I have had basically zero motivation to do anything, and I have no ambition to accomplish anything. Everything, and I mean almost everything, has been just white-knuckling it. I don't care about anything; I don't want to do anything...except maybe just stay in bed all day. Were it not for my obsession with consistency, rules, spreadsheets, and checklists, I think I would have really been utterly incapacitated, unable to accomplish anything. I'm also relying a lot on making external commitments and relying on deadlines (which of course come with procrastination up until the last minute), because I have nothing internal to draw on. (In a weird way, it's like in order to pursue my first-handed values, I need to rely on second-handed mechanisms--but hey, that's better than abandoning my values altogether, I think.) And there's a part of me that realizes (or at least fervently hopes) that this is all temporary, and I so desperately don't want to disappoint future Arthur. I already feel time and life slipping away, and I don't want in a few years to be upset that I wasted all this time on doing nothing and not making any progress on any of the values and goals I (claim to) have. (And, ironically, while my spreadsheets and checklists have motivated me to actually do the things I need to do, they have also rendered all of those things hateful duties, further sapping me of any joy in anything I do.)
Of course, when I'm just forcing myself to do things I don't want to do, it's also exceedingly difficult to focus on anything or get into a state of flow. And activation energy for everything seems like it's at least ten times what it had been before. I've been called disciplined before, but I've never thought of myself as that, mostly because I just create mechanisms to want to do things, where the thing I "should" do becomes irresistible. In some ways, my checklists and streaks are continuing to do that, but the amount of willpower I have to muster up to do anything is just so fuckin' taxing. Even when I have mechanisms to get me to do things, I have to exert so much effort to actually do the things. Sucking it up sucks.
I find myself wondering whether the chemical dimension of this is a problem with my production or use of dopamine and/or serotonin.
Closely related to my experience of low motivation, my general emotional experience has been one of numbness. As someone who typically has big feelings, feeling everything deeply and intensely, with high highs and low lows, it now often seems as though I don't feel much of anything at all. I don't experience passion or happiness, and I also don't experience any sadness. The only things I seem to feel much of are stress, anxiety, and irritation. I'm not sad-depressed; I'm numb-depressed. Frankly, based on others' description of their experiences, this is what I imagine being on SSRIs is like (and which is why I've been deathly afraid of them)...it's like I'm technically alive, but I'm not living. It feels like enduring life, rather than really experiencing it. There's no richness to any of my experiences; in some ways, it's like I'm sleepwalking or on autopilot, where everything is in greyscale. This is how I also imagine being a Vulcan would be like...I sort of intellectually remember having some values and caring about them, and my pursuit of them (such as it is) is joyless and cold (and sometimes hateful, because it lands with me as something I have to do, rather than something I want to). But I muster up the willpower to do it anyway. When I described this to a friend, she quipped that I'm the most high-functioning depressive she knows. I think that's basically right.
Most heartbreakingly, perhaps--and I'm embarrassed to admit this--I don't love doggo Max. I want to love him, and I like him fine, but he's not the companion I hoped he would be. Part of that is comparing him to Billy and my continued grief about losing him. But all this about Max is actually about me and my emotional state...so it's no surprise that it seems that Max doesn't really love me, either. I don't get the sense that he really cares about me, probably reflecting back to me my own energy around how he often seems more like a burden I'm irritated with than an enhancement to my life. But gods-damn it, I'm trying, and I'm trying to give him the best life I can, with all the care I can manage, hoping that I will soon get out of this funk.
On the bright side, I am still able to experience moments of pleasure and joy, as well as sadness and longing. In some ways, this parallels my ability to muster up bursts of physical energy, except it happens effortlessly. I can laugh at a joke, I can get giddy at the prospect of meeting the cast of Star Trek: The Next Generation, I can take in and appreciate the beauty of the mountains, I can cry at the nostalgia of watching Back to the Future. And occasionally, I even get a deeper sense that everything really is okay, such as how I felt visiting with Brit and Honor in June 2023.
So it's not as though my emotional mechanism has been completely destroyed, but it's severely disabled.
Low Sex Drive
My entire life, even as a relatively young kid, I've had an extremely high sex drive. And since puberty's testosterone kicked in, my baseline state has been near-perpetual horniness. It was usually jacking off like twice per day, even into my late 30s. (Thankfully, with respect to sexual activity with others, that was tempered by extreme pickiness, so I didn't end up being driven to risky behavior.) And my testosterone levels toward the end of 2021 were so high that my brother quipped that they were higher than bodybuilders' on steroids, while on steroids.
I don't know what my testosterone levels are today, but the chemical dimension of all this aside, 2023 has been a dramatic and tragic contrast to what's felt like my normal self: I've had close to no interest in sex whatsoever. Yes, occasionally, I would be horny, but even then, most of the time, it's because someone got me in the mood or I had to get myself in the mood...but naturally, spontaneously, organically? Close to never. There have been weeks and months at a time in 2023 that I hadn't jacked off at all.
And a hot guy can still turn my head, but it's like looking at a menu when you're just not even remotely hungry...the experience is intellectual, like, "Oh, yeah, that looks good for when I'm hungry again.", but there's no burning desire, urgency, or craving.
And Chase (the dude I'm dating pretty seriously), bless his heart, has been so patient and supportive and encouraging and understanding. This has been so difficult for him (especially because his sex drive is what mine used to be), and he has done such a great job of igniting that spark when none exists.
From a clinical perspective, I'll mention that, even though it's difficult for me to get "in the mood", once I'm in the mood, I don't experience any dysfunction.
(One thought I had to potentially explain my low sex drive is that I currently--and intentionally--weigh more than I ever have in my life, at about 220 lbs. And while it's true that being overweight can affect sex drive, I've still got an ab or two that I can see. Sure, I don't feel great about my body right now, however gratified I am that I managed to mass successfully. And that can lead me to feeling less sexy, which itself can affect my sex drive, considering how much my sexuality is wrapped up in my own vanity, but this all seems far too severe to be simply explained by that. I've had similarly bad ab definition in the past when bulking and haven't had such an intense drop in sex drive. All the same, at the time of this writing in mid-August, I'm a few weeks into a 12-week cut, during which I will lose roughly 20 lbs of fat and regain those ab veins I love so much. I expect that'll help somewhat, I but I doubt it's the whole story. So we'll see how it goes.)
Given that low sex drive is another common side-effect of many SSRIs, I've even joked that maybe someone is slipping me some pills without my knowledge. But maybe the explanation is that my COVID infection caused some kind of damage that has a similar effect.
Shifting gears back to symptoms without psychological aspects, something I noticed in the first few months of 2023 (and which has since ameliorated) was a propensity for painful superficial infections. Throughout my life, my body has been exceptionally (and I mean amazingly) great at fighting off infections so efficiently that it encouraged a totally cavalier attitude about bad habits, such as "investigating" my "dermatological phenomena" (popping, squeezing, picking, performing "surgery" on, etc) and biting and picking at my nails. Sure, my bad behavior often led to a bloody mess, but aside from a little temporary pain, everything would heal relatively quickly, and I would almost never get an infection. So, in early 2023, I continued to pick with what I thought was relative impunity. Well, some of my toenail picking--which was intensified by my generalized anxiety and disinterest in whatever else I was doing--ended up going very badly. After the stupid picking, my "wounds" would clot quickly, as usual, but then, in the coming days, my toes got infected and would be so tender and would throb so hard that I often struggled to fall and stay asleep. The infections were so severe that I ended up losing three toenails (which thankfully have since grown back to normal). I never ended up with anything especially severe in terms of my skin, but I definitely noticed how much longer it took dog and cat scratches to heal.
Before I landed on my Long COVID hypothesis, I wondered whether this was a consequence of my lower-than-usual protein intake, speculating that maybe my infection-fighting superpowers relied on my prior protein consumption levels.
I still don't know, since my infection-fighting powers seemed to return around the same time that I increased my protein intake again, but it could also have just been a temporary symptom while my body normalized again after my COVID infection. Plus, as I learned from House, it's never two things, so I'm lumping it together with everything else. (That's a bit of a joke because, of course, it's possible that the lower protein intake could itself have precipitated Long COVID by starving my body of the nutrients it was accustomed to as it was "cleaning up" after the primary COVID infection. I mean, I say "possible", but that's pure speculation.)
Meanwhile, my immune system's ability to fight off other kinds of infections (such as colds, flu, etc) seems to have been working perfectly well. Indeed, after COVID in December 2022, I haven't gotten sick even once. Sure, I've had stomach issues, headaches, being totally out of it and especially fatigued--incapacitated enough to take time off from lifting and work--but not the kind of "sick" that's meant when we talk about viral infections and the like. And keep in mind that I live with two kids who have had their fair share of sickly snotty noses in this time.
By about February 17, when I had my regular dental appointment (periodontal maintenance), my teeth had become very sensitive, and what was a normal cleaning was quite a bit more painful, especially on a particular tooth on the upper-right side. I noticed that the normal pressure that I would apply flossing was also quite painful there, and it was a very acute, sharp pain. The dentist told me that it was that the gum had detached a little bit from the tooth (despite impeccable hygienic habits with flossing, using my OraCare, my Water Pik, and brushing), and I wondered whether it was a sort of inflammatory response to COVID, because, again, the timing lined up perfectly with the December infection. By June 16, when I had my next appointment, it was a little bit better, but still quite painful.
And then there's the very sudden hair loss. I have always had really thick hair on my head, by which I mean high follicle density. (And it's something I've always been so grateful for.) I'm sure the general and acute stress of the last few years hasn't helped, but in early 2023, I noticed, suddenly, that my hair was thinning pretty significantly. And this wasn't like the proverbial boiling frog; I spend a lot of time looking at myself in the mirror, and I take daily gym progress photos from the front and back, so I'm very attuned to the rate of various changes. It seems like too much to be mere coincidence, like I turn 38.5 years old, and Bam!, the typical getting older symptom of hair loss hits me like a ton of bricks. It's not like I have a bald spot now (though that's where the thinning is most noticeable), but under the exactly wrong conditions, it sure can look like I do. I was horrified at a picture that Melissa happened to snap of me in late April 2023, helping to set up our chicken coop, where my head was pressed up against the top of the cage, and it parted my hair in such a way as to make it seem that I have a massive bald spot. (It was so bad that I declined to have it posted on Facebook...which, if you know me at all, is really saying something.)
And I wouldn't have even thought that this was related to COVID until, just recently, Chase sent me this gem from the Miami Herald: Lower sex drive and losing hair among long COVID symptoms, study says. Fuckin' terrific. I haven't investigated this beyond reading the article (so it's hard to know how much stock to put in it), but it's all piling up. And how weird that two of my symptoms that just suddenly came on in early 2023 now turn out to be linked to Long COVID... I don't know how much solace it provides to have such a superficial "explanation" for my symptoms, but I sure hope that if we can uncover a root cause, some of these problems will disappear.
Occasional Shortness of Breath
It seems to be the case that, more often than I remember from earlier in my life, I've been experiencing occasional shortness of breath. It mostly manifests as an inability to get a fully deep breath (most often when I'm trying to get to sleep at night), and other times, it reminds me of what it's like when you suddenly go to a high elevation and try to do some strenuous activity without first acclimating. (Except, you know, I've been living at 9000 feet for almost two years now.) But neither of these manifestations has been at all debilitating or limiting; I only mention them because impaired lung function is a known symptom of COVID and sometimes lasting effect. That said, I really can't be sure whether my thinking that this is happening more often than it usually has in my life is just a cognitive bias. All the same, I'm mentioning it here in the spirit of completeness.
Distancing from Relationships
Back to a more psychological dimension, which I've saved for last: I have really retreated from a lot of social contact. As I've generally become increasingly introverted, I've really leaned into my alone time. As I've continued to get more and more exhausted over the course of 2023, I have had precious few spoons that I've been willing to spend on socializing. So I have rarely reached out to friends even to talk, much less to hang out. I don't want to leave home. And it seems like a miracle when I'm able to.
Depending on our relationship, this may come as a surprise to you, since I don't necessarily manifest an exhausted, depressed, numb affect. But remember that, depending on the context, I can indeed experience genuine enjoyment and pleasure; I can get excited; I can have fun. So I'm not faking it, but then I'm even more drained afterward.
What I want to emphasize, though, is that I don't want you to take this personally. To use a tired cliché, it's not you; it's me. I'm doing my best here, but being social is difficult for me, and I just don't want it (because, you know, I don't really want anything at all right now). I welcome inquiries on how I'm doing, expressions of empathy, and even invitations to do something together, but my responses tend to be delayed, and I can't promise that I'll actually be up for anything in particular. And, to be frank, given how I'm feeling, I really just don't want to dump that on anybody and be a drag.
So, I guess, thank you for your patience and understanding.
I'm doing everything I can to get better...for some meaning of the word "can". I'm doing everything I'm able to motivate myself to do: I'm keeping up with my daily 20-minute meditations, I'm lifting weights (and even making progress), I'm eating well (including covering my bases with good supplements), I'm maintaining as much human connection as I can tolerate, I'm getting plentiful sunshine and time outside, I'm generally active, I'm spending time with my animals, I'm continuously reading and learning, I'm keeping up with my job, I'm making modest home improvements, and I'm even chipping away at my to-do list. It's all pretty joyless, but damn it, I'm trying. (I've been pretty bad about consistently good sleep hygiene, but at least I tend to get a decent number of hours asleep, limiting blue light before bed, sleeping in a dark, cool room, etc.)
But ironically, I'm really struggling to do some really obvious things, like, you know, see the doctor or get some bloodwork. Aside from the administrative overhead involved in that, such as dealing with medical billing (which I despise), I think I just don't have much confidence that anything can be done. Maybe it's stupid for me to think that, but that just captures my feeling about it: I'm too exhausted, overwhelmed, and resigned to deal with my exhaustion, overwhelm, and resignation. It's a vicious cycle. But on August 14, I finally scheduled an appointment with my doctor for August 25, which is part of what finally motivated me to write all this up, so that I could share it with her in advance and get as much diagnostic labwork done as possible.
Aside from the dietary change I mentioned earlier, I also considered other possible explanations for my condition. For instance, I wondered whether there could be some environmental cause (eg, mold) or even something like living at 9000 feet of elevation. While I suppose these could explain what's going on, I find them unlikely, chiefly because my symptoms came on so dramatically at the beginning of this year. Sure, it's possible that there was a gradual accumulation of subclinical and unnoticeable effects that finally passed some threshold and cascaded into a sudden manifestation of all these symptoms, but that seems doubtful to me. I would have expected either a more marked onset closer to moving into my home in 2021 or a more gradual onset over the last two years. It's just too much to be mere coincidence that this all happened so quickly and suddenly within a few months of my COVID infection. That's also why I don't think it's a resurgence of my 2021-2022 hyperthyroidism or subsequent hemochromatosis, both of which resolved before my July 2022 labwork.
A lingering thought for me is whether I made the right call in not getting vaccinated. It's a much larger discussion, but I had and have various risk factors that made getting vaccinated not as "obvious" as many thought it was for themselves, and moreover, I didn't find the epistemological rigor around the various COVID vaccines' testing (and available data) sufficiently compelling, especially in light of my risk factors. And while what's done is done, I'm a ruminator and can't help wondering What if...?. Could I have avoided Long COVID--if that's even what's going on here--had I been vaccinated and boosted? I suppose we'll never know. (I believe that Dianna Cowern, Physics Girl, was vaccinated, and her Long COVID ME/CFS is absolutely horrific.) I guess it's possible, but at the same time, given the increasing data coming to light that the vaccines aren't nearly as safe and effective as many had previously believed, I do feel somewhat vindicated in my decision. On the one hand, we have the speculation that this is Long COVID (which I don't know how to confirm, since it's not like it's a thing we can just directly test for), and we'd have to make a statistical guess about the effectiveness of having been vaccinated to have prevented Long COVID. On the other hand, there are the risks, general and individualized, of getting vaccinated. Even if we knew for certain that I could have avoided all this by having been vaccinated, but still had to risk some adverse reaction, it would be a very difficult decision for me. But, like I said, it's all moot. (Questions about all this are welcome; arguing, moralizing, and condescending are not.)
We'll see how this all goes. Wish me luck; I definitely need it.
My appointment with my doctor didn't happen on August 25. I attempted to secure a lab order in advance of the appointment so that we could discuss the results when we met (rather than having to have two appointments), but between mistakes on the order and pulling teeth with Cigna to get clarity on coverage (including which ICD-10 and CPT codes needed to be used to qualify as being part of my annual physical) and cost estimates, I didn't finally get my labs done until over a month later, on September 27. Then my results were delayed, and so my appointment with my doctor didn't happen until October 11.
Well, some good news from the labs, but nothing diagnostically relevant, other than ruling out a few things:
- thyroid hormone levels were normal (so not hyperthyroidism again)
- iron/ferritin levels were normal (so not hemochromatosis again)
- total testosterone levels were high (1018 ng/dL, an increase from 905 ng/dL in November 2011, which is above the 916 ng/dL top end of the reference range), but free testosterone was normal, suggesting that my body has ample access to testosterone as needed (why I'm not as jacked as bodybuilders who are "juicing" or insatiably horny all the time is beyond me...)
Since Long COVID and ME/CFS aren't presently the sort of thing that you can just test for (see my quip toward the beginning about the word "syndrome"), and we've ruled out some of my personal usual suspects, it's looking more like this really is Long COVID.
In advance of my appointment, Chase's dad suggested that I consider two treatments:
- a Nitric Oxide booster (to help with blood flow generally)
- a Nattokinase, Bromelain, and Curcumin protocol (to help break up the spike protein)
After some research (including help from Dr ChatGPT) and discussion with my doctor, it seems that the evidence isn't especially strong (in terms of scientific rigor) that these would have any ameliorative effect on my Long COVID symptoms, but there is some cause for optimism. In the worst-case scenario, these supplements are benign in the recommended dosages, and I've only wasted time and money on ineffective treatments.
Now, it's been over a month since starting the NO booster and a few weeks on the Nattokinase, Bromelain, and Curcumin protocol. It could very well be placebo (which I'll happily take!), the fact that I'm 13 weeks into my cut (and have lost nearly 30 lbs of fat), my greater discipline about going to bed early and waking up between 04:00 and 05:00 daily to get stuff done ahead of my workday, or general statistical noise, but my experience of life has improved noticeably, even if not tremendously. I'm still not happy, but I find myself with
- a little bit more motivation
- a little bit better ability to focus
- a little bit less stress
- a little bit more sex drive
- significantly less shortness of breath in general and better cardiovascular endurance on fast-paced uphill walks at 9000 feet of elevation
- faster-healing cuts and scrapes
I'm significantly more irritable, but I attribute that primarily to hanger, since I'm currently consuming about half my daily maintenance calories.