Recovery tools, part 4
Hormesis, or "gentle stressors"
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Three steps forward, one step back
See what I did there?
If first/second grade math is not accessible to you at the moment (no judgment; we know the brain will fog in odd ways sometimes), I’ll be clearer:
3 steps forward minus 1 step back still leaves me 2 steps forward
That is how my recovery is going. It is not perfect. It is not linear. Some days I am not patient.
Some days, I feel decent, yet my POTS is flaring a bit, or my neuropathy. Other days, the fatigue, POTS, neuropathy, and cognitive issues are all firing at once.
Yet overall, I am still moving forward.
Granted, those steps forward are a sloth crawl at times.
But I’m learning to nurture my achiever (his name is Saul) and not judge the speed of my forward progress. Sometimes, “forward” is not that X symptom improved or went away. Sometimes all it involves is a slight shift in mindset I’ve had after watching someone else’s recovery video, for example.
This entire healing venture is a marathon, not a sprint.
I was on the track & field team in middle school. My two best events? The 50-yard dash and the long jump. Get me there either QUICKLY or in ONE BIG MOVE.
I honestly thought I could sprint or somehow “achieve” my way quickly through this recovery (that pesky Saul…).
I have only recently realized that this mentality has become its own impediment to someday getting there. It also had me thinking that if I didn’t learn some new tools, then once I did “achieve” recovery, I’d go right back to living my life with Saul in the driver’s seat, which might work for a while, but would inevitably land me right back at ground zero once stress piled up or I caught the next virus.
No dice.
I’m taking my time and gaining new life skills in the process. And you can too.
Learn it, know it, live it 😁
So here we are at part four of my recovery series, which focuses on hormesis, or “gentle stressors” designed to tax and ultimately strengthen your body (and your resolve). More on that shortly.
For those who are new here or who may have missed them, I will link to parts one, two, and three of the recovery series below. Additionally, I created a tab at the top of my Substack page for all of these Recovery tools posts, so you can put your hands on them easily in the future.
Part one (particularly the intro) is important to read because it lays out all of the disclaimers and qualifiers that any person with Long COVID or ME/CFS should present before claiming to have anything resembling answers to these complex chronic illnesses. In fact, I do not claim to have the answers. I only share what has been helpful and why I think this has been the case for me so you can decide if it might make a difference for you too. Much of this is the result of me reading, watching, or listening to other people’s recovery journeys and culling tools from them, so I am merely paying this forward. To quote perhaps the most important part of the intro to part one:
If you’ve met one long hauler, you’ve met one long hauler.
Try what might speak to you, leave the rest. Maybe circle back. It’s your recovery journey and you have to do what feels right.
Hormesis
In the early stages of recovery, what was most helpful to me was 1) gaining the kind of knowledge that would help me believe that recovery is possible, including learning about things like the cell danger response, neuroscience, and neuroplasticity/brain retraining, and 2) calming my nervous system, which supports resolving my dysautonomia.
I first had to cognitively understand the science so that I could believe wholeheartedly that recovery was possible for me. I am not suggesting that this approach will work for everyone. But if you have had a lifelong tendency to intellectualize feelings and generally find information/knowledge comforting or safe, then my approach may work for you too (parts one and two of this series include programs and books that taught me much of the knowledge).
However, although gaining this knowledge was helpful, early efforts to retrain my fearful/defeatist thoughts were ineffective because my autonomic nervous system was far too amped up, still stuck in sympathetic or “fight-or-flight” mode, and extremely minor stressors (including noises, smells, and TV shows with any kind of tension/drama) were keeping me bathed in that fear.
I was not usually consciously aware of this fear, and if you had asked me point blank back then if I felt “afraid,” I might have said no. But you cannot simply tell your autonomic nervous system to get out of fight-or-flight; it’s called “autonomic” because it governs bodily functions that happen without your conscious thought. In other words, they happen automatically.
It was hard for me to adopt practices that regularly calmed my nervous system, because I was never wired had never been taught how to slow down, pay attention to my body’s signals, or get out of my head. I started small - 10-minute, guided mindfulness meditations on either the Calm or Insight Timer app, or using my Sensate device (discussed in part two). I gradually built up to longer meditations, added gentle yoga, listened to joyful music, spent more time with my cats - anything that brought my body and mind a sense of peace and safety.
It all worked. My system gradually became less sensitive to stimuli it considered stressful. About a month ago, I sat outside at an ice cream shop while a passing train blared its horn multiple times 300 feet from where I was sitting. Two years ago, this would have caused a rapid heartrate, anxiety, and a need to get as far away from the offending noise as possible. It would have led to a major crash. A year ago, this wouldn’t have happened simply because I became too afraid of stimulus like this and I would have not gone for the ice cream (by the train station) at all. But now? I embrace the joy of the outing and the train can pass by without my body feeling like there’s danger afoot.
To be clear, I am not ‘cured’ of this reactivity. Some days, my system’s sensitivities are heightened, and I have to put boundaries in place to feel safer (asking people to lower the noise their making, putting in my Loop earplugs in a restaurant, moving away from people when I smell their way-too-strong perfume or cologne, etc.). But eventually, my body started believing that a saber-toothed tiger was not in fact coming for me, and most days I can notice the stimuli without reacting to it.
I’m telling you all of this because it is only in this calmer state that the next parts of recovery - involving hormesis - have been possible.
For those new to the term (as I was about eight months ago), hormesis is defined on PubMed as “an adaptive response of cells and organisms to a moderate (usually intermittent) stress.”
Exercise is one example of hormesis; it puts a temporary stress on the body which in the long run makes the body stronger. You’ll see more examples below. Suffice to say that at some point, I realized that while merely resting or being very still was what my body may have needed in the early days of recovery, it was not going to keep serving me well if I wanted to progress further.
Indeed, some of the coaches in the ME/CFS and long COVID recovery spheres acknowledge the need to start applying hormesis practices once you are in a calmer state. Alex Howard refers to this practice as “bouncing the boundaries” and Miguel Bautista encourages gentle pushing with activity that may put you in an “adjustment period” (what others might call a dip, mini-flare, or a crash) so that we learn where the edges of such activity boundaries are. (Here’s a good short by Miguel Bautista on some of this). We are taught to not get discouraged or depressed by these symptom exacerbations, but to recognize that it is just information or data that tells us where we are and where we might want to head. In fact, calmly reassuring your scared brain that this information is merely something to notice and not to freak out about can help you start to come out of fight or flight.
It is critical to acknowledge that stressors are anything that can agitate your system, and can be both negative (work, relationship, financial, or family stress) and positive (a family or social outing, a stimulating concert or movie, reading a great book for too long, etc.). The good thing about gently testing the waters of what kind of stimuli your brain and body can handle is that you may find over time that the flares are not nearly as severe or long-lasting as they once were - a sign of your body adapting to the stressors in your life.
Here are some examples of hormesis and what they have looked like for me.
Red and near-infrared light therapy (discussed in part two; also, Red Therapy Co. is running a 4th of July sale: use code USA100 for $100 off any red-light unit. I have no stake in this company, FYI).
Intermittent fasting (discussed in one of my earlier posts).
Cold water therapy has been having a moment, and includes tub plunges, open water swimming, and showers. There are multiple benefits, and this article explains why it is an example of a hormetic stressor. This is not an easy one to dive right into (pun intended) and some will never feel it is for them. That’s okay; there are many other types of hormesis to choose and benefit from. I do cold water therapy by first taking a warm shower while I do all my cleaning/shaving, and then gradually turning the water colder and colder for the final rinse of my conditioner. I like having the cold water run over my scalp and brainstem because I feel like it helps with neuroinflammation. Over time, I have trained myself to tolerate some truly frigid water temps, which I can handle most days; other days, I can only tolerate cool water. I listen to my body and my mood on this. No matter what, when I emerge from the shower, I feel very good-to-amazing. Any tachycardia/POTS symptoms I had that day improve immediately and for a few hours my brain just works better. On occasion, I have resolved a headache this way too.
By the way, sauna is also considered an example of a hormetic stressor that promotes sweating, which helps the body clear toxins. I don’t have access to a sauna, though I did spend some time in one a few months back when I visited a friend who has one in her health center. Here is a good “short” on these types of hormesis:
Movement (that is slowly progressing into something more closely resembling light exercise): Some are extremely sensitive to anything resembling exercise, as indeed I was for the first 3.5 years of Long COVID. Chair yoga and going for walks would cause me to have bad crashes for days (otherwise known as post-exertional malaise or PEM). My recommendation is to think about exercise when you are in rough shape as just movement. When I spent more time on the couch than upright, this looked like gentle leg, groin, or back stretches. Gradually, I progressed to:
gentle yoga to start for a full year (discussed in part three), then as I got a bit stronger, I added:
Pilates-like floor exercises (bridges, leg lifts, ab holds), and stronger yet:
short walks at a leisurely pace, which became:
longer walks at a slightly faster pace, and also:
very light upright resistance work (body weight squats or wall sits, 1-3 pound bicep curls, etc. I learned from Raelan Agle that while lifting one-pound weights may seem too easy - even in our deconditioned states - it can be an invaluable way to simply send your brain the message that it is safe to lift weights again).
As I build on these activities, I don’t abandon the one before it. I keep everything in my arsenal and listen to what my body is craving or can handle on a specific day. Some days, I simply roll out the yoga mat and stretch my hips and back while I listen to folk music. Other days, I rock out to Prince while I do some squats, or I catch up on a podcast while walking.
Speaking of walking, I recently ordered this fairly inexpensive treadmill or “walking pad” from Amazon so that I can go for short, slow walks inside on days when it’s just too hot, cold, wet, etc. Here I am trying it out barefoot and at 1.4 mph the first night:
Another thing to keep in mind: initially, I was tracking my light exercise in a notebook so that I could keep an eye on my progress over time. But for me, that just brought Saul out of the woodwork, and I wound up pushing too far past my boundaries several times. I abandoned that practice and now I do the exercises as many times as they feel good to my body. Once they start not feeling good, I stop. It sounds so simple, but if you were an avid exerciser in the before times, it can be quite a foreign concept to not complete a certain set of reps before moving on to the next exercise.
Cognitive activity such as computer work, Zoom meetings, or driving can also cause crashes or PEM. This makes sense, since the brain is the most energy-intensive organ in the human body, requiring up to 20% of our calories daily. Many of us learned the hard way that although our bodies were laying down, if we were still scrolling on a laptop or phone, or reading a book, we would still get fatigued. I have more recently been able to be on a computer for an hour or occasionally an hour and a half, though I have had to get better at frequently checking in with my brain and body during cognitive work so that I am still pacing well. It is easy to go into zombie-mode when you’re on the computer and to all of a sudden realize you did probably 30 minutes more than you should have, so developing this periodic check-in has been helpful. Yesterday, for example, I set the timer on my phone in 25-minute increments so that I remembered to check in, go to the bathroom, hydrate. This has not always been easy for me but is getting easier.
I have also been able to drive increasingly longer distances before fatiguing, and also to drive at times with the radio on (something I could not do until only recently, and still needs to be songs I already know so I’m not distracted by cognitive novelty while trying to stay safe).
That wraps up this edition of recovery tools. Parts one through four have covered the big areas I wanted to address. Future recovery tools posts will share anything new I learn or come across, including tools others have found helpful.
Now stick around for…
🥳 The After-party 🥳
Announcements, links to articles and studies, recommendations and shout-outs, and miscellany joy and/or tomfoolery.
😂 Supplements madness with comedian Marc Maron:
🤧 This week, I heard about three people locally who have COVID right now, so yes: A summer wave of Covid-19 has arrived in the US.
🧠 COVID-19 Presenting as Encephalitis and Myopericarditis: A Report of a Rare Case.
🩼 Pandemic Patients webinar recording: COVID-19 and Disability Insurance.
♿ Speaking of disability benefits: Social Security to Simplify Disability Evaluation Process, Agency to Reduce Work History Period to Five Years.
😔 The situation in the U.S. in the wake of so many abortion bans is getting dire: Rate of Young Women Getting Sterilized Doubled After ‘Roe’ Was Overturned.
🏳️🌈 Health Status and Mental Health of Transgender and Gender-Diverse Adults.
🫏 This is pretty wild: A pet donkey disappeared in California five years ago. He’s been spotted living with a herd of wild elk. Live free, Diesel. Live free.
🤦🏽♂️ Buffoons of the week: the two candidates for the U.S. presidency, sparring like children about their respective golf games during their first debate of this election. I can’t bear to name them. We are so doomed.
🏆 Winner of the week: Congratulations to Wild Thang, who finally won the coveted World’s Ugliest Dog Contest after being passed over last year.
🐶 Sticking to dogs, click on the link to enjoy pics from the record-breaking three-legged dog picnic recently held in San Francisco.
🦃💩 And finally, it’s this week’s Cat Turkey Dump.
Walking and gardening have been great for me, but oh how dispairing it is to have an old symptom reappear after an absence of several months and I thought I was done with it.
Still at the beginning reading this but I just wanted to say, I can def identify with the 3 steps forward, one step back, non-linear, non-perfect, not always patient (insert positive, feeling high vibe and totally with it). Though for me this spring/summer it’s been 3 steps forward 2 steps back. The one thing I look for overall though is improvement year on year. I always get caught up somewhere in and amidst that year whether it’s an adjustment period, blip or whatever. What’s always amazed me is the baby steps and snails pace, when I look back from this way of being, this way of living, I can never believe how far I’ve come. And I often say, the wins are only there when you look for them! They def don’t align with societies perception of success and achievement - I got so comfortable with this a few years ago. Like you say, it can be witnessing someone else’s recovery. Edging forward to that being a possibility. It can be a shift in perception. A new practice. Learning to articulate something. It’s not always and most often not usually, any kind of massive reduction in symptoms or massively improved energy - though this does happen overtime. And usually after an adjustment period!