I’ve been on a very steady health trajectory for the last six weeks or so after I kicked my lingering Covid symptoms from an infection I picked up at the beginning of the summer. Alas today I found myself with a significant pain flare.
I can barely focus on simple tasks like writing the pain is so forceful. Usually I have some warning with pain as it’s a symptom of an autoimmune inflammatory condition. If I over stress myself I’ll have consequences a few days later just like a regular person.
But today I went from working out to flat on my back in bed taking the highest doses of medication I’ve got. And I still at a 7 or 8 pain wise. I don’t quite know what to do about it expect as I’m not comfortable taking more medication.
I’m hoping it’s an anomaly and I’ll feel better tomorrow. I wish I could provide a better accounting of the sudden misery. But honestly the pain is so bad this is the best I can manage. Please no one worry as I don’t have the capacity to respond right now. I just can’t think clearly enough to write about anything but the pain so I’m stuck with chronicling it. And I’ve got a habit to maintain here where I write every day.
It’s always baffling to me when something that is supposed that is supposed to make you feel good makes me awful. And yet it’s a very consistent experience for me.
Every time I get bodywork done (massages, acupuncture, osteopathic spinal work, physical therapy) I feel like absolute shit for 24-48 hours afterwards.
I have an autoimmune condition called ankylosing spondylitis which is a fancy form of arthritis. It’s well controlled with medication and a healthy lifestyle but I am always looking for ways to increase my functionality as well as my capacity to tolerate stress.
This naturally leads me to want incorporate positive stress techniques like cold showers, saunas, and the thousands of other hacks to improve your capacity to tolerate stress.
I’ve tried supplements magnesium supplements to adaptogenic mushrooms and most major modalities of body work to even the whackiest of woo.
Yesterday I had an amazing osteopath work on my spine and yet today I feel about 10x worse than I did before I went in. The dip is just a misery of exhaustion, pain which leads to some anxiety from being tired and in uncomfortable.
I trust I’ll feel better after this dip and some progress as I recover from the good stress but at the moment I’m just miserable.
My assumption is that many things in life that make you feel better in the long term are uncomfortable. Delayed onset muscle soreness is a common issue for new weight lifters and pushes many out of their routines before they even get started.
It’s such an art finding the correct amount of stress to put your body under and I wish I had a more perfect intuition about how to do it. Until I do I’ll probably have to work through many types of dips.
I caught a case of Covid at the very end of May that took me down hard. I’d been struggling with “long” symptoms
So I tried an experiment. A pretty crazy one at that suggested by my osteopath and supervised by a doctor.
I am using going to use a 7mg slow release nicotine patch (of the type made for smoking cessation) for the next 3-5 days to see if it impacts my over-stayed their welcome Covid symptoms. I started my experiment at 9am Saturday July 6th
Day 1283 Nicotinic acetylcholine receptors (nAChRs)
The principle was pretty simple but not proven yet in clinical trials.
Nicotinic acetylcholine receptors (nAChRs) have been proposed as potential therapeutic targets for COVID-19. Research suggests that the SARS-CoV-2 spike protein may interact with nAChRs, potentially influencing the disease’s pathophysiology[1].
Please do go read the original post with lots of caveats as nicotine is an addictive substance and this is not something to try without consulting your doctor.
I was unable to do the full 7mg but cut the patches down to 3.5 to 5mg over the five days. The side effects included headaches for the first day or so and a persistent queasiness.
Within a day I was lifted out of my exhaustion (which you’d expect from something modestly stimulative even though it was a low slow release dose). By the end of the second day my persistent coughing lifted entirely. I’d been struggling with congestion and coughing after even modest exertion like a walk outside.
I was functional on the fourth and fifth day like I hadn’t been since I got Covid. You can see me go into the red on my first day (my HRV dropped significantly but my RHR was only up by a few BPM). I slowly felt better and saw better recoveries even while taking on a little bit more exertion. I pushed a little too hard and found myself back in the red on my last day.
My Whoop recovery and strain chart for the five days of experiment beginning on the 6th and ending on the 11th of July
I was really relieved to stop the patch by the end. The last day of treatment I had overextended myself so I was in the red and feeling it even as the nicotine pushed my system up. I wanted to rip it off and did eventually cave at the end of the day instead of doing it all night.
My symptoms seem to be at bay. I feel decent enough so days after wrapping even as I began menstruation this morning. I hate to report that it also improved my usually debilitating PMS which typically includes intense migraines.
I would do it again if I got Covid. I cannot imagine ever using a nicotine patch consistently. I didn’t not enjoy the extra push of energy except insofar as it got me out of the exhaustion of the illness. I feel like it would be too much if I were otherwise feeling healthy. I have no cravings or side effects after.
Honestly I’m still wrapping my head around how well this worked. A part of me is confused, indignant and angry that a substance I was taught to fear has therapeutic benefit. Updating your mental models around long held beliefs is an uncomfortable process. But it’s a heck of a lot better than long covid symptoms.
Nicotinic acetylcholine receptors (nAChRs) have been proposed as potential therapeutic targets for COVID-19. Research suggests that the SARS-CoV-2 spike protein may interact with nAChRs, potentially influencing the disease’s pathophysiology.
I am doing alright with it. I was wary of keeping the patch on all night long (I am very sensitive to stimulants such that I won’t drink caffeine past 10am) so I removed it at about 5pm. That may have been a mistake.
Yesterday my Whoop recorded physiological stress. I wasn’t coughing, I had more capacity for exertion, and I felt generally less exhausted.
But I didn’t come down easily for sleep. I ended up taking a number of anti-inflammatory medications as well as an Ambien. My heart rate was stable but I felt “up” which I don’t care for at night.
And I did not wake up to good news. My HRV absolutely tanked. There are lots of confounding variables here in that I got good restorative sleep (medicine induced surely) but some strain has clearly been too much. 40% down isn’t a rousing endorsement.
I am also noticing a lot of chatter around addiction and whether or not it’s responsible to discuss these things. The fear that the average person is in fact prone so addiction and will have adverse affects. Which I’m sure is true. I don’t think normal people should take unnecessary risks and it’s good to have the minimum viable dose be none at all.
It’s wise to remember that I am not at all living in average circumstances nor do I have average medical conditions so I am not necessarily who you should be looking to for health advice. You should do the basics like eat more protein, lift heavy things, sleep an adequate amount, be in the sun and move around, and manage your baseline health metrics first.
Never one to take things laying down, I started a crazy “n of 1” experiment today. My family doctor prioritizes keeping up on literature. We’d chat about anti-inflammatory research in reputable journals.
But I am on week seven of Covid symptoms simply not clearing. I’ve been coughing when under stress or exertion, my seasonal allergies exacerbated the issue, my reconditioning of my cardiovascular system wasn’t going great and I was exhausted.
At a visit with my osteopath who helps with my chronic autoimmune issues in my spine (I’ve been diagnosed with ankylosing spondylitis) I mentioned my ribs felt tender and constricted from Covid coughing.
She asked me if I was familiar with the research coming out about Nicotinic acetylcholine receptors and Covid-19 treatments. She’s casual like that.
In a joking “don’t try this at home” way my osteopath said she’d seen folks use nicotine patches for a week to shorten their Covid symptoms to some success.
Now for some caveats. In any type of crazy self treatment it’s important to consider your risks and consult a professional. Don’t do anything without your doctor’s input. Every medicinal treatment has risk and side effects.
I am using going to use a 7mg slow release nicotine patch (of the type made for smoking cessation) for the next 3-5 days to see if it impacts my over-stayed their welcome Covid symptoms. I started my experiment at 9am Saturday July 6th.
I am treating this as a “kitchen table” science experiment in which I am clearly an N of 1 from which you can only take anecdotal evidence. But maybe one data point becomes many and with the network effects of social media maybe we push forward other experiments.
Here is what I know so far thanks to searches from perplexity AI but I encountered some of the papers through mutuals on Twitter, some on forums, others I’d discussed with physicians, some were just raw dogging Google Scholar.
The AI synopsis I’m sharing isn’t meant to be conclusive just to give interested parties a starting place to see why I believe this is an experiment I’m comfortable running on myself.
Nicotinic acetylcholine receptors (nAChRs) have been proposed as potential therapeutic targets for COVID-19. Research suggests that the SARS-CoV-2 spike protein may interact with nAChRs, potentially influencing the disease’s pathophysiology[1].
Nicotine and other nAChR agonists could modulate inflammation and the immune response, offering therapeutic benefits[2][3].
Given that I’m working with inflammation as my primary issue which is not modulated even without Covid, I was obviously quite curious to learn about this cholinergic system and potential for up regulation. I’d seen discussions as early as 2020 about the curious fact that smokers had experienced some protection from Covid infections.
This all clicked in my head as being testable on my own without significant risk. Gwern had significantly reduced my concern about nicotine usage where previously as a child of the drug wars I’d put smoking nicotine in basically the same category of dangers as injecting heroin. It is not.
It seems it is possible we’ve got an explanation for why smokers didn’t catch covid at the rates you’d expect and they did better with the infections. We may even have things to learn from it to improve treatments.
Nicotine agonists could potentially be used to prevent inflammation in COVID-19 patients by modulating the immune response. Nicotine, a cholinergic agonist, has been shown to inhibit the release of pro-inflammatory cytokines, which could help mitigate the cytokine storm associated with severe COVID-19[1][2][3].
The cholinergic anti-inflammatory pathway, activated by nicotine, suppresses maladaptive inflammatory responses, suggesting that nicotine or similar agonists might offer therapeutic benefits in managing COVID-19-induced inflammation[3][4][5].
Nicotine and quercetin were some of the earliest predicted compounds to reduce the binding affinity of the spike protein to ACE2 — which in turn, we described the MOA of here: biorxiv.org/ TL;DR is that reducing the affinity may increase neutralizing immune response.
I do want to reinforce that I am aware nicotine is addictive. I’ve had to take drugs that form chemical dependencies in the past. I’ve used Prednisone in the less controlled phases of my spinal condition and tittering off that steroid is a nightmare. But it can be done. It is doable with a plan, careful monitoring, and supervision.
All evidence suggests this experiment isn’t long enough for me to develop a dependency let alone an addiction. I am thankfully free from any genetic predisposition to addiction in my family.
I plan to do a B3 Niacin flush at the end which is meant to help tittering. I will also be monitoring my heart rate as Nicotine has a tendency to raise your BPM so if I don’t like what I see I’ll lower dosage or stop usage.
With all that said, let’s see if it helps me out. I’ll post because it is in my nature.
The benefit of keeping trace of one’s biometrics that I at least have some visibility into the misery. Of course, the downside is that I have visibility into how much misery. An extremely both sides of the bus meme situation.
I have a lot of reconditioning in front of me. Or at least my health data suggests that. It’s very discouraging to have health apps say you’ve had a 90% decrease in activity.
This week I slowly began the work of going back to life. I attended a policy gathering. I’ve been working on deals. I suppose I was doing that while I had symptoms too. It’s been hard as I want this to be better but I lost a lot of ground and relatively quickly.
I’m now doing all the little things one does help get your body back on track. Simply changed and reminders are most effective if you have injuries or are chronically ill.
I have little routines where I get up and do body weight squats on the hour. I’ll make sure to walk 500 steps each time I get up. I’ll touch my toes and stretch.
All these things feel very hard at the moment and I get blaring warning signals from the trackers suggesting physiological strain when I do. The slog of not giving up is a permanent part of the human condition and I refuse to let entropy win. But I am discouraged by how much work it is to do the basics. You can’t ever escape that life is just chop wood and carry water
I am going on my third week of having Covid symptoms. I don’t know if it’s time to call it “Long Covid” but my autoimmune response to it feels like it’s being dragged out.
My family doctor (an absolute gem of a general practitioner with a concierge clinic if you are ever in need in Montana) helpfully reminded me of the basics of immune response.
The infection is cleared but my immune cells did not get this memo. I’m still coughing, I’ve got clear phlegm, and I am struggling with a high respiratory rate. I am exhausted.
Yesterday I went for a short 15-20 minute stroll to get sunshine and I found myself with a very heightened respiratory rate overnight.
Apparently even small stressors like pollen count or exertion are hard when your immune response is overactive. I’ve been living with an autoimmune condition for years so while rationally I know this, it helps to be reminded.
If one is inclined to a forced metaphor, the party is over and the guests have left but the host hasn’t figured out it’s time to turn off the stereo, lock up and pick up the trash.
Calming immune responses is a tricky business. Sometimes you succeed by waiting it out as your system slowly resets to a healthy baseline. Sometimes you use more interventionist approaches with either local or systemic steroids. I try to avoid this but sometimes the only approach is the brutal one.
It’s my hope that the party being over means I can simply manage the mop up but I hope my immune cells decide to chill and get back to baseline soon.
I woke up feeling reasonably good this morning. I thought perhaps my prayers have been answered. I have been managinga case of Covid for over a week so I really wanted to be turning the corner on recovery.
It’s hard fully rest with an infection and this case overlapped with a lot of big things for my portfolio companies. That excitement made it even harder to stay away from working. I was joyfully working all weekend for multiple deadlines.
I’ve not been the best behaved patient though I have stayed in bed. I thought I’d at least maintained the appropriate protocols for sleep, nutrition, supplements and medication.
What I really wanted was to go outside and enjoy the weather. June in Montana is heaven. Cool bright mornings turn into sunny dry days.
I thought that a short walk in this type of environment would be healthy. I walked the property and down our dirt road. I wasn’t out for more than twenty minutes.
Walking by our little pond fed by a creek.
It was too much. By early afternoon I was exhausted, feverish and coughing. I slept but it was the fitful half conscious sleep of the sick.
I am disappointed as I want this to be over. The pushback from supposedly health giving activity like strolling in the morning sun was immediate. It isn’t over and I’ve been punished for joyful nativity. But damn it’s a beautiful day to be alive.
I may give myself an out today to get very little written as despite me being a bit further into my “I’ve got Covid” saga I am in no way feeling better.
I do not want to have a long case of Covid or the much dreaded/debated Long Covid and I am trying to remain optimistic about the situation.
I do not feel optimistic about it as absolutely every aspect of my normal health troubles are 10x worse and I’ve got all your other fun symptoms like coughing.
I’m scared as it’s not getting better which brings up the anxiety that I’ll be back to where I was in 2019-2020 when stabilizing my health was more than a full time job.
I don’t mind having a part time job managing my health. Or as I prefer to think of it a side hustle as a biohacker. Except instead of making money I spend money.
I can’t think about most of this at the moment as I am officially on my Maximum Health Protocols which is a mix of expensive piss and biohacking basics with a hint of woo and a triple helping of pharmaceuticals.
I still feel like shit but my hope is that dedication will save me from long post viral complications. I’ve worked too hard on my health to let some stupid inflammatory Covid event get me off track.
Covid isn’t any more worrying than most triggers to my overclocked autoimmune system but the additional pain of the inflammation isn’t doing me any favors. Does anyone else remember cytokine storms? To quote South Park, I member
I dislike the brain fog and exhaustion as it feels like writing about illness has become boring. I’d rather be going on tangents and rants but I’m stuck linking to posts recommending vitamins and sleep. Probably a sign that I love my work that my irritation is this strong.
