What To Do If You Get COVID, including Paxlovid (Especially for ME/CFS or Long-COVID)

The greatest danger of COVID--for everyone--is that it can cause lingering, long-term or permanent effects. Research (and much experience over the past four years) has shown that COVID often causes damage to the heart and/or lungs, blood clots that can lead to serious, even fatal, issues, and a cluster of severely debilitating symptoms now known as long-COVID (or PASC, post-acute sequelae of COVID). Long COVID symptoms/characteristics can include a long list of serious issues like flu-like symptoms, fatigue, cognitive dysfunction, muscle weakness, shortness of breath, microclots in the blood, neurological symptoms, GI symptoms, and much, much more, often leaving those affected bed-ridden or housebound and unable to continue with their normal functioning. In many cases, long-COVID develops into ME/CFS, an immune disorder triggered by a wide range of different infections (though COVID is turning out to be a particularly strong trigger).

 

Risks of Developing Long-COVID (or of Worsening if you have ME/CFS or Long-COVID)

Studies show that each reinfection with COVID increases the risk of developing long-COVID or other serious complications like organ damage.

For those--like me!--who already have ME/CFS (or long-COVID), a COVID infection or re-infection increases the possibility of worsening the existing condition, temporarily or permanently.

Two of the best ways to reduce this risk--for both those who are healthy and those who already have ME/CFS or long-COVID--are:

Get COVID Vaccines:

Keep up to date with the latest COVID vaccines, if you are able to tolerate them (lots of studies support this; research shows that vaccines decrease your chance of developing long-COVID by 30-50%).

NOTE: Some people with ME/CFS--including me!--are not able to get the vaccines. For me, they make me worse for at least six months and I hardly make any antibodies to COVID anyway (not even when I get infected). But if you tolerate them, it is highly recommended that you stay up to date with each new one that covers current variants. The study about vaccines linked above notes that the mRNA ones provide a bit more protection than the adenovirus ones, though either would help. If you're healthy, they will reduce your chances of developing any lingering, long-term conditions after COVID.

 Take Paxlovid:

If you do get COVID, immediately start taking Paxlovid (or, if you can't tolerate it, another COVID antiviral or other treatment).

The FDA reports that Paxlovid reduces the incidence of hospitalization and death in unvaccinated adults by 86% and also has protective effects for those who are vaccinated.

The research on long-COVID so far isn't clear (and of course, isn't focused on those who already have ME/CFS or long-COVID). This large NIH study on the effects of Paxlovid in preventing long-COVID is very confusing. Their conclusions don't match the details they describe. Right in the abstract, they state that Paxlovid during an acute COVID infection did not reduce the chance of developing long-COVID, but then they say that data showed it did reduce the incidence of cognitive and fatigue symptoms post-COVID ... which, of course, is much of what long-COVID and ME/CFS is! In addition, ME/CFS has a long history of responding well to treatment (with antivirals or other medications) of underlying or triggering infections.

What about rebound? I have heard of doctors telling patients (that are high-risk but are typically overlooked, like those of us with ME/CFS) that they don't recommend Paxlovid for them because it can cause rebound. This is not accurate. FDA studies show that rebound is a characteristic of COVID and occurs both in those who take Paxlovid and those who don't. Some studies show a slightly higher risk of rebound in those who take Paxlovid, but rebound just means a few extra days of acute illness and/or testing positive. After reading the research, I decided it was worth it for Paxlovid's protective benefits.

Other Treatment Options:

I know one person who had an allergic reaction to Paxlovid. If you are unable to tolerate it, there are other treatment options (link to CDC).  Molnupiravir is another COVID antiviral. It is slightly less effective at preventing long-COVID symptoms than Paxlovid but is a good option if you can't take Paxlovid. Both of those are oral pills. Remdesivir is a COVID antiviral administered as an IV infusion that is another option.

You can also take (or increase your dose of) herbal antivirals, like olive leaf extract, monolaurin, and l-lysine. I take herbal antivirals every day, but I increased them when I got COVID, as explained below.

  

My Experiences

Back in early July, I got COVID for the second time. As someone with ME/CFS (an immune disorder), COVID is very dangerous for me, and the first time I got it, in January 2022, it took me five months to return to my "normal" chronic illness baseline. At that time, Paxlovid had just become available but was in short supply, and I was unable to get it. I was extremely sick (i.e. couch-ridden) for about a month, then gradually improved over the following four months, with the help of some treatments. You can read about that in my Relapses and Recoveries post from 2022 (note that while a short course of steroids helped that time, it made things worse at other times and should only be used with great caution and under the supervision of a doctor).

My Experiences with Paxlovid:

So, when I got COVID this July, I immediately messaged my primary care physician (who first diagnosed my ME/CFS 21 years ago and understands it well) to ask for Paxlovid. Unfortunately, she was out for surgery herself, so it took multiple messages and phone calls to her office to finally get Paxlovid, but it was certainly worth the effort for the reasons I explained above. 

I had only one side effect from Paxlovid: a metallic taste in my mouth for the five days I was on it. While this was unpleasant, it was tolerable and went away as soon as I finished my course of the medication. I did have a very small rebound: after beginning to feel better for a couple of days, I had about 24 hours where I felt worse again. Again, that was tolerable.

While I still got extremely sick, my illness trajectory seemed better with the Paxlovid than when I had COVID in 2022. I was bed-ridden/couchbound for about 2 1/2 weeks and then began to slowly improve, even able to begin taking (very short, very slow) walks again in the 3rd week. Since then, I have steadily improved. 

Now, exactly three months after I got COVID, I am almost back to my normal baseline. I track how I feel each day on a scale of 1 to 5 (1 being great and 5 being bed-ridden/couchbound). The first 6 months of the year were the best I've been in years - see my Mid-Year Update, posted the day that I got COVID, hours before my symptoms began! My average of how I felt was 2.2 (with a couple of months coming in at 2.1), which is outstanding for me. You can see what COVID did and my gradual return (I got COVID on July 10):

• Jan - June - avg. 2.2 with 0 crash days (!)
• July - avg. 3.5 and crashed (4 or 5) 55% of the time
• August - avg. 2.6 and crashed 10% of the time
• September - 2.3 (actually 2.27!) and crashed 3% of the time (just one crash day all month)

So, you can see that I am almost back to my own "normal" baseline.

 

What Else Did I Do?

I went back to my notes and blog posts from the early days of COVID and vaccine prep, based on advice from experts to support my immune system.  I made the following changes to my supplements:

For the first month:

• Doubled liposomal vitamin C dose to 2g (2000 mg) a day
• Doubled vitamin D3 dose to 10000 IU/day
• Doubled Zinc Glycinate dose to 40 mg/day 

For the first two months, I increased or added these herbal antivirals:

• Doubled my usual dose of olive leaf extract, from 750 mg twice a day to 1500 mg twice a day
• Added l-lysine, 500 mg twice a day
• Added monolaurin, 600 mg twice a day

Finally, just a few weeks ago, I began taking digestive enzymes, as recommended by my ME/CFS doctor, but that requires a whole separate blog post to explain! It's a new approach that is helping those with ME/CFS and long-COVID and is not related to recovering from COVID specifically; the timing was just coincidental. After trying it for another few weeks, I will report back!

So, that's the research I found and my own experiences.

What have your experiences with COVID been?

Have you taken Paxlovid?

Have any other treatments helped you to recover from COVID?

Let me know in the comments below.

You can also connect with me on Facebook and Twitter and Instagram.

 

 

Note: This post contains affiliate links. Purchases from these links provide a small commission to me (pennies per purchase), to help offset the time I spend writing for this blog, at no extra cost to you.

Fall Camping Vacation Vlog - Nature Videos

Whew, it's been a whirlwind couple of weeks, filled with catch-up medical appointments and family obligations, but before that, my husband and I enjoyed a wonderfully relaxing 9 days of camping in beautiful New York State. We visited two different state parks that we'd never been to before, visited our nephew at college, and found two great bookstores! In this video, you can come along with us on the trip, with lots of videos of soothing, peaceful outdoors (what I love so much about camping), so be sure to turn the volume up to listen to the birds, the breezes, and other sounds of nature.

You can watch the trip vlog on YouTube or here:

I hope you enjoy that little respite as much as I did! I'm ready to go again--could really use the relaxed downtime.

How do YOU enjoy nature?

Let me know in the comments below.

You can also connect with me on Facebook and Twitter and Instagram.

Two New Orthostatic Intolerance (OI) Resources to Help Patients & Doctors

Dr. Peter Rowe, MD, of Johns Hopkins is a renowned specialist in pediatric ME/CFS and Orthostatic Intolerance (OI) aka dysautonomia and is recognized as one of the most knowledgeable experts in the world. He directs a growing clinic at Johns Hopkins Hospital in Maryland: Chronic Fatigue Syndrome (CFS) program at Johns Hopkins Children's Center. This has expanded quite a bit from the days when it was just him, and he answered his own phone!

New Book

Dr. Rowe's General Information Brochure on Orthostatic Intolerance and Its Treatment has long been a go-to resource for patients around the globe - I've linked to it many, many times here in this blog!

That valuable information has now been expanded and updated into a book: 

Living Well with Orthostatic Intolerance: A Guide to Diagnosis and Treatment by Dr. Peter Rowe

It is available from:

Johns Hopkins University Press, and

on Amazon

(all book proceeds help to support the clinic.)

New Webinar

Dr. Rowe has been conducting medical education webinars, to help train medical professionals in caring for children, teens, and young adults with ME/CFS. The series is called, Evidence-Based Pediatric ME/CFS Medical Education Webinar series. The first two webinars are available online (links to YouTube):

1 - Evidence-Based Pediatric ME/CFS

2 - Pediatric Orthostatic Intolerance: A Focus on Management

These webinars are SO important. What the ME/CFS patient community needs more than anything is for doctors to become better informed and educated. Even once ME/CFS becomes a standard part of the curriculum in medical schools (and we're a long way from that now), there are millions of medical professionals already in the field who don't understand or even recognize ME/CFS.

So, feel free to watch these videos yourself, but also, PLEASE, share these webinars with your doctors and other medical professionals.

A huge thank you to Dr. Rowe who has devoted his life to our patient community and has helped so many young people in his many decades of working in this often-ignored field. 

Note: This post contains affiliate links. Purchases from these links provide a small commission to me (pennies per purchase), to help offset the time I spend writing for this blog, at no extra cost to you.

Relaxing & Peaceful Nature Videos

Oh, my gosh--I can't believe I haven't written a new post here in three weeks! I did send a newsletter out, so that's a win. Sorry about the gap in posts. Life's been very hectic, and my energy and stamina are still really low after getting COVID in early July. I am struggling to keep up with everything (and not doing very well at that). I have some new treatments to try after a phone appointment with my doctor this week to review recent labs, so I'll fill you in a couple of weeks on what they are and if they're helping.

In the past month, we traveled to see our son for his 30th birthday (highlight: he's working full-time and says he feels the best he's ever felt in his 20 years with ME/CFS!), attended a graduation party, took a 4-day camping trip, and just last weekend, attended a wedding about five hours from here. The wedding weekend was wonderful, filled with our closest friends, but exhausting, as you can imagine! This week was two doctor's appointments, a book group meeting, and a Zoom meeting with our local support group. We are currently packing for another, longer camping trip, and I can barely keep my eyes open!

So, I thought I would just quickly share the vlog I made from that last camping trip--it was a very relaxing few days, and the vlog includes photos and videos of nature--lakes, waterfalls, birds, and more. It's all very serene and peaceful. Remember, as I explained in my book (and here on the blog), even just looking at pictures of nature is beneficial to your physical and mental health, so enjoy!

You can watch the video on YouTube or below:

I'm really wiped out today, but once we leave on this trip, I'm looking forward to some complete downtime, with nothing to do but lie in my lounge chair and read or stare into a campfire and be surrounded by nature.

I hope you enjoy the vicarious camping trip in the video!

How do YOU enjoy nature?

Let me know in the comments below.

You can also connect with me on Facebook and Twitter and Instagram.

Summary of Long-COVID Statistics and Recent Research

I recently read an excellent article on long-COVID from PBS News that I wanted to share with you. My time and energy are very limited this week, as we were away last weekend and are leaving again Sunday (but this time for a few days of relaxing camping), AND we have unexpected house guests this weekend! But I wanted to at least share this article with you.

You can read the article here: Scientists Are Piecing Together the Puzzle of Long-COVID. Here's What to Know. It is relatively brief and written in clear language for regular readers (not doctors or scientists). A few interesting points:

• Percent of those infected with COVID who get long-COVID (i.e. lingering symptoms or effects) has gone down since 2020, in part due to vaccines and in part due to different variants of the virus.
• Unvaccinated people are at twice the risk of developing long-COVID as those who've been vaccinated.
• Post-exertional malaise (PEM) is on their list of symptoms, but the article doesn't mention the cross-over with ME/CFS.
• Many who develop long-COVID had only a mild infection at first.

Overall, the article emphasizes the disabling severity of long-COVID and the danger of developing it. I think this is a good one to share with friends and family (especially those who think COVID is no big deal and they don't need to keep getting vaccines!).

Hope you find the article informative and helpful.

New 15-min Documentary on ME/CFS & Other Patient Stories

Image & logo from Solve ME - www.humansofchronicillness.org

My energy is still lower than usual since my COVID infection five weeks ago, so writing longer posts is on the back burner for now. But I saw an excellent mini documentary this week that I wanted to share with you.

This short film, just 15 minutes long, tells the story of Elizabeth, a young woman with severe ME/CFS who was at one point bedridden and completely non-functional. She's been able to improve enough to sit up with her family once in a while and even speak on this film, but she is still severely limited. This mini biopic does a great job of showing how disabling and debilitating ME/CFS is.

You can watch the short movie here (sorry this one can not be embedded into my blog).

It was created by an ME/CFS charitable organization called #NotJustFatigue. You can read a bit more about them here. At the bottom of both pages are links for more information or to connect. There are more patient stories - told through a photo and short quote, starting here.

The movie and the other patient stories are very powerful and well worth sharing.

The fabulous research and advocacy organization Solve ME also has a website for patient stories, Humans of Chronic Illness, and you can add your own to their site. It's their image and logo I included above.

What is YOUR story?

Let me know in the comments below.

You can also connect with me on Facebook and Twitter and Instagram.

Movie Monday: Killers of the Flower Moon

Since I got COVID in July, we've been tackling some of the longer Oscar-nominated movies we missed last year. Last weekend, we watched Killers of the Flower Moon, which was nominated for 10 Oscars, including Best Picture. I had read the nonfiction book (my review at the link) back in 2018, and my husband hasn't read it, so we came from different perspectives. We both agreed it was a gripping, fascinating film.

Like many Native American tribes, the Osage were pushed onto a reservation on what the U.S. government thought was useless, barren land in northeastern Oklahoma. But at the turn of the 20th century, the Osage discovered that their useless land was on top of massive oil deposits. Almost overnight, the Osage became the wealthiest people in the world, but their wealth attracted greedy criminals of all kinds. The Osage built nice homes, drove beautiful cars, and lived comfortable lives, while whites poured into their town and took control of the bank and their lives. They did everything they could to control and manipulate the Osage people, including marrying Native women and murdering Native peoples to take control of their wealth. The U.S. government set up a system where every Osage citizen needed a white "guardian" to supposedly protect their interests, but the system was used to keep the Osage from their own assets and steal them.

The movie (and the book) focuses on a young Native woman named Mollie, played by Lily Gladstone, who lives in a large home with her mother and sisters. William Hale, played by Robert De Niro, is a white man who has put himself in the role of wealthy benefactor to the Osage, learning their language and participating in their traditions. He's accepted by them, and he treats Mollie and her sisters fondly, often referring to his deep friendship with their father. Hale's nephew, Ernest Burkhart, played by Leonardo DiCaprio, comes home from WWI, and his uncle welcomes him as a part of the family. He encourages him to marry one of the Native women. Ernest is driving a cab when he meets Mollie, and there is an instant attraction between the two. They eventually marry. It's clear that Hale thinks Ernest is following his advice, though Ernest and Mollie do truly seem to love each other. Osage people begin to die from suspicious deaths and clear, outright murder. Mollie's sister Millie, who's also married to a white man, dies of a mysterious "wasting illness," her sister Anna is found cruelly murdered outside of town, and many other (over 20) Native deaths follow. Mollie herself, who suffers from diabetes, begins to sicken and rapidly worsen. The newly-formed Bureau of Investigation (which will become the FBI), comes to look into the Osage murders, led by Tom White (played by Jesse Plemons).

Martin Scorsese directs this stunning film, with the setting and time period perfectly recreated. The A-list actors, as well as the supporting actors, are all outstanding, and many believe Lily Gladstone should have won the Oscar for Best Actress. She is excellent in this emotional yet understated role. With murder at the heart of the story, there is plenty of suspense, but the audience knows who's behind each death, so it's more of the "will they get caught?" than "whodunit" type. The true story is absolutely horrifying and hard to believe (truth is stranger than fiction!). When it was over, I explained to my husband that the book gave more time to the FBI's investigation, and the importance of this case in cementing its role as a federal crime unit. But we laughed about me wanting more detail because as is, the movie is 3 1/2 hours long! It took us two nights to finish it, but it was well worth the time spent. The entire production was excellent, with great attention to historical detail. It's a long movie, but we were both fully engrossed the entire time.

Killers of the Flower Moon is currently available on Apple TV or to buy on several other services, including Amazon ($19.99).

Chronic Illness Vlog: COVID and ME/CFS - Small Improvements, Small Joys

It's now been three weeks since my COVID infection struck, on top of ME/CFS, and I am still struggling. Many of the viral symptoms have improved (though I still have a lot of mucus), but I am still severely lacking in energy and stamina. I am now able to sit up for short periods of time most days, so that's an improvement. But, I am mostly still living life from my "couch nest," lying down a lot, and sleeping more than usual.

My writing energy is still very limited, but I did put together a vlog last week, so I thought I'd share that with you. It's hard to see any changes day-to-day because these last three weeks have all felt pretty much the same (I'm sure many of you can relate!), but when I look back at these video clips covering 8 days, I can definitely see some small improvements, which is encouraging. I also shared some moments of joy and even fun with my husband and son. You can watch the video on YouTube or I'll include it below:

 

I did get some good news yesterday. I checked with my ME/CFS specialist in NYC to ask if she or her colleagues (she's part of the ME/CFS Clinician Coalition) knew of anything to help someone with ME/CFS with recovery from COVID (when I got it in 2022, it took me six months to recover back to baseline). I didn't expect much, so I was surprised and thrilled when she replied immediately to say that, yes, there were some treatments they have been using for patients that get COVID that have been helpful! Yay! 

She called in a prescription for me to a compounding pharmacy for oxytocin nasal spray, and I ordered a powdered combination of two amino acids, l-ornithine and l-aspartate, from Amazon. I won't received either one until the end of next week, but once I start them, I will let you know if they help. And I need to investigate and research both a bit further, but here is one paper on oxytocin and COVID (from June 2020!). No clinical trials yet on the two amino acids, but Open Medicine Foundation researchers released a preprint just a month ago of their data analysis showing that these two amino acids might help ME/CFS and long-COVID. Cutting edge science! Reason for hope.

P.S. I was trying to work on my monthly newsletter for my e-mail list today, but I just didn't have the energy. I'll try to get it out next week.

 

Have you had COVID? How long did it take for you to return to your usual baseline?

Let me know in the comments below.

You can also connect with me on Facebook and Twitter and Instagram.

I'm Still Here! COVID on Top of ME/CFS

Ironically, just three days after my last post, 2024 Mid-Year Update: Yeast, Diet, NO Crashes, COVID hit me with full force. For the last 13 days, I've been badly crashed, living life horizontally, though I am slowly improving now. Here's a brief recap to bring you up to date:

How Did I Get It?

Good question! I don't go out a lot, I avoid crowds when I can, and I always wear a mask in public. When I started feeling sick on July 13, my husband had been away for a week. Our son lives with us, but he's not around much! He and I did have breakfast together Saturday, but my symptoms began that evening, so I didn't get exposed through him. With my husband away, I did see a few friends during the week and ran a few errands (wearing my mask). A friend came here Tuesday (specifically to reduce my risk), and I met two friends at a restaurant for dinner Thursday evening. I rarely eat in restaurants because obviously, you have to remove your mask to eat, but we were at a table in a far corner without anyone else nearby, and we went early, while it was still pretty empty. Still, I could have been exposed from our waitress. None of those three friends had any symptoms or got sick. Typical incubation period for COVID is anywhere from 3-8 days, so who knows?

Course of the Illness So Far

It started with a severe sore throat Saturday evening. While sore throats were a typical part of immune activation for me in the early years of ME/CFS, I don't usually get them anymore. The severe sore throat, plus swollen glands, continued for about a week and has gradually cleared up. I was pretty sure right from Sunday that I had COVID because of the severity of the sore throat, I hadn't done anything to overdo (and as I explained in that last post, hadn't crashed from over-exertion in 7 months in spite of being very active), and I just don't catch other viruses (the immune dysfunction typical of ME/CFS makes our immune systems over-react to viruses and allergens). I haven't had a cold in decades. I also read that this very severe sore throat (it hurt even to swallow water) is very common in the recent COVID variant that's on the rise right now.

Besides the sore throat and swollen glands, I felt feverish, though as is typical for me, didn't have much of a measurable fever. My "normal" temperature runs about 97.5 F, and the highest it went (that I measured) was about 100. And of course, I was just completely crashed - absolutely exhausted, zero energy, no stamina, couldn't even sit up for more than a few minutes. I also developed some mild sinus and chest congestion and mild cough. Those symptoms are slowly improving.

I tested negative for COVID on Sunday and Monday before finally testing positive on Tuesday. Did you get that? No positive test until Day 3 of symptoms. Last time my son had it, it was Day 5 before he finally tested positive. It is SO important to keep testing if you or someone near you is sick and has the symptoms of COVID and to isolate from the first symptoms.

Paxlovid

Just on heavy suspicion of COVID, I messaged my primary care doctor Monday morning to ask for Paxlovid, the antiviral combination that works most effectively against COVID. She's known me for 21 years and was the first to accurately diagnose ME/CFS in me, so she gets it. Unfortunately, she is out of the office for a month with a medical situation of her own! Yikes - bad timing! It took me 2 days (even after the positive test) of messages and phone calls with various office staff, trying to explain ME/CFS and how dangerous COVID is for us, before the Nurse Practitioner covering for my doctor finally called in the Paxlovid prescription. I started it on Tuesday. It's a 5-day course of 3 pills taken twice a day, so I finished it Saturday. The only side effect I experienced was a nasty taste in my mouth.

The reason I was so adamant that I start Paxlovid was because COVID is such a strong trigger for ME/CFS, to start it or to worsen it if you already have it. The research so far isn't clear (and of course, isn't focused on those with ME/CFS). This large NIH study on the effects of Paxlovid in preventing long-COVID is very confusing. Their conclusions don't match the details they describe. Right in the abstract, they state that Paxlovid during an acute COVID infection did not reduce the chance of developing long-COVID, but then they say that data showed it did reduce the incidence of cognitive and fatigue symptoms post-COVID (which, of course, is much of what long-COVID and ME/CFS is). 

The first time I had COVID, Paxlovid was not yet widely available, and it took me 6 months to fully recover back to my normal baseline. By taking Paxlovid this time, I am hoping to both reduce the severity of the initial infection and reduce (greatly, I hope) my recovery time. So far, so good. I didn't get the severe chest congestion and cough this time (and I am highly susceptible to bacterial bronchitis, which I want to avoid). Last time, I was severely ill for the first month, and this time, I'm starting to see improvements in the second week. I'm hoping that continues.

What Else Did I Do?

I already take piles of medications and supplements every day, including everything usually recommended to help fight COVID or other viruses. To give myself an extra boost, I increased my dose of nutrients that support the immune system and the herbal antivirals I take every day, and I added in a couple of extra herbal antivirals:

• Doubled vitamin D3 from 5000 IU to 10000 IU daily (5000 IU twice a day)
• Doubled liposomal vitamin C from 1000 mg (1 g) to 2000 mg (2 g) daily (1000 mg twice a day)
• Doubled Zinc Glycinate from 20 mg to 40 mg daily (20 mg twice a day)

Herbal Antivirals:

• Increased olive leaf extract from 750 mg (with 20% oleuropein, the active ingredient) twice a day (1 pill twice a day) to 2250 mg (3 pills) twice a day
• Added L-lysine 1000 mg (2 pills) twice a day
• Added monolaurin 600 mg twice a day
• Adding (next week) inosine 250-500 mg (1/2 pill to 1 pill) a day on weekdays - inosine is an immune modulator that will help to normalize my immune system, and it also has antiviral properties. Dosing is complicated, and I go on and off of it periodically to keep it effective. Details on what it is, how to use it, dosing, and a link to a caplet that can be split in half all at this link.
  

 

Current Status

As of Day 13, I am seeing tiny improvements every day. By Day 11, I tested negative. The sore throat is pretty much gone and most of the hoarseness. Congestion and cough are improving. My energy and stamina are very slowly getting better. I celebrated my 59th birthday Tuesday with my husband and son and was able to sit at the table for dinner (I've been living on the couch!). The past two days, I have begun to walk outside again - very slowly and carefully. Yesterday, I managed two very slow strolls around the cul-de-sac in front of our house. As I often say of everything related to ME/CFS ... baby steps!

We're supposed to be leaving on a two-week vacation this weekend to Michigan's Upper Peninsula. I've been so looking forward to this trip! But, I can see that I'm not up to it. I'll cancel all the campground reservations tomorrow.

When I last had COVID in 2022, I was in much worse shape at this point, almost two weeks in. But I also see from my journal that I was pushing myself to do way too much, even while feeling awful! This time, I have been very, very careful to listen to my body, stay horizontal, and rest as much as I needed. I did not attempt to accomplish anything until the past couple of days. I guess I am trainable!

 

How are you doing?

Have you had COVID? How did it affect you?

Let me know in the comments below.

You can also connect with me on Facebook and Twitter and Instagram.

 

Note: This post contains affiliate links. Purchases from these links provide a small commission to me (pennies per purchase), to help offset the time I spend writing for this blog, at no extra cost to you.

2024 Mid-Year Update: Yeast, Diet, No Crashes!

 

While I often mention how I'm doing at the start of blog posts on other topics and in my chronic illness vlogs, I thought it was time for a more comprehensive update. Besides, we just passed the halfway point for the year (!!), so the timing is right. The last time I focused on my own health here on the blog was My 2023 Year in Review back in February, so I'm due for an update!

NOTE: My updates below refer to ratings of how I feel. For details on how I simply track how I feel on a calendar, check out my post, My Progress in 2020 and Goals for 2021 and scroll down to My Health in 2020 and below that, the section called "How Do I Know This?" Or you can watch my short video, Chronic Illness: Tracking How I Feel, Symptoms, and Treatments. I use a 1 to 5 rating, where 1 is good and 5 is mostly bedridden. At the end of each month, I tally up the average of how I felt and also the % of time I spent crashed (a 4 or 5 on my scale). I also rate my exertion each day on a 1 to 5 scale.

 

How I Felt the First 6 Months of This Year

Simply put ... great! It felt like a miracle after my very difficult last three months of 2023, but I've been greatly improved since the start of the year (that's not coincidence--see below for what's making a difference). Most amazing of all: 

I have not had a single crash day in 2024 so far!

For comparison, last November I spent 50% of my time severely crashed, mostly couchbound, and unable to do much of anything. My very few worse days in 2024 have been rated 3--feeling a bit run-down but still able to function. And those were few and far between and always related to yeast overgrowth (see below). 

Even more incredible is that I have been very active so far this year--able to take walks most days, get back into a strengthening routine, go on long (for me - over an hour) hikes with my husband, and even go shopping. I danced at a wedding last month! And with all of that activity, I have not even once worsened from exertion intolerance. It's truly stunning to me.

My rating (1 to 5, with 5 being worst) for the past 6 months has been a steady 2.2. I haven't been that good since 2017. Last year, my average was 2.5 and 2.9 in 2022. 

It's all been good news, and it's been such a joy to be living my life again, able to get together with friends, enjoy my family, and get caught up with work and home.

So, that leaves the big question ... WHY?

Enjoying a 90-minute hike two weeks ago!

Factor #1: Normalizing Thyroid Function

I spent all last year working with my primary care doctor to find the best treatments for my hypothyroidism, after we realized that my thyroid labs were about as low as they could get. It required a lot of trial and error--and patience and persistence--to get new labs every two months, adjust the treatments, and wait to see the effects. But it was well worth the effort. By fall of 2023, my numbers were finally in the normal range for both T3 and T4, I had settled into a stable dose of two medications, and my energy had improved. I then added iodine, which is essential to thyroid function, which helped me to further improve. 

Most surprisingly (to me) was that I lost about 20 pounds last year just due to treating thyroid dysfunction. I made no other changes to diet or exercise (I was actually less active for other reasons explained below)--the weight just slid off me, bringing me back to my pre-illness (22 years ago) weight. What's interesting to me is that I had gained that extra weight gradually, a few pounds a year, even though I was eating a restricted, healthy diet and exercising as much as I was able. That tells me that my thyroid had been dysfunctional for many years, and we missed it due to not testing the right things.

I summed up all the lessons I learned in my post, Diagnosing and Treating Thyroid Dysfunction in ME/CFS and Long-COVID because thyroid dysfunction is extremely common in our diseases, due to endocrine dysfunction. 

 

Factor #2: Yeast Overgrowth and Diet Changes

As I said, by last fall, my thyroid function was almost normal and I had more energy ... but I was still badly crashed and very sick. The reason why was a mystery to me, and I tried everything that had helped in the past to no avail. For the last three months of the year, I had constant flu-like aches, a sign of immune activation and an indication that my ME/CFS was badly flared up. I had more energy, but I felt awful, and if I did anything at all, I got even worse.

Finally, in mid-December, I saw my functional medicine specialist and told her what was going on. I explained that yeast overgrowth was a chronic problem for me (and many others with ME/CFS, due to our immune dysfunction) but that I was already treating it. She asked me to pull my mask down and stick out my tongue and told me I still had visible thrush in my mouth. I was stunned because I take piles of probiotics every day, prescription antifungals daily, and thought I was eating a strict diet. She questioned me a bit about all of that and said that since nothing else was working, I'd need to get extremely strict with my diet--no carbs at all--in order to starve the yeast.

I was desperate, so I did as she said. She recommended a carnivore diet, which is just as it sounds: meat, fish, eggs (a little high-fat dairy is also OK but I'm dairy-intolerant). Within 10 days of changing my diet, those relentless flu-like aches finally disappeared (just in time for Christmas).

I stuck mostly with carnivore, with just a few bites of cruciferous veggies or avocado each day--what I called 97% carnivore. After three months of that, I transitioned to a more keto diet and have kept that up. For me, that means more veggies but still no grains, no sugars at all, and no starchy vegetables. I explain more about my experience with the carnivore diet in this video. Next week, I hope to post a new video, with brief explanations of the diets that are typically best for those with immune disorders like ME/CFS (paleo, keto, carnivore).

Unfortunately, the yeast overgrowth is still very persistent. I am still taking my maximum dose of prescription antifungals, a whole range of probiotics focused on my own gut testing results with the aim of controlling yeast, and herbals antifungals. And I still have to stick to a very strict diet. I was tired Sunday and Monday this week and realized it was again due to yeast overgrowth. I had "cheated" a bit: two cups of popcorn Saturday evening, a quarter-cup of blueberries Sunday. That's all it takes for the yeast to come back and thrive in me. It is barely kept under control with this diet ... but if I stick to it, it is. That's difficult for me, but I realize it is something I can control, and I'm grateful for that.

Since yeast overgrowth (aka candida) is extremely common in ME/CFS and long-COVID and often overlooked, I wrote a blog post about Treating Yeast Overgrowth/Candida that includes lots of different treatments to try (just updated this year).

That's how my year is going so far!

How are you doing this year?

Have you tried treating thyroid dysfunction or yeast overgrowth? 

Have any other treatments helped you?

Let me know in the comments below.

You can also connect with me on Facebook and Twitter and Instagram.

Movie Monday: A Quiet Place: Day One

On the 4th of July, with temperatures in the high 90's here, we escaped to a movie theater to see the third movie in John Krasinski's Quiet Place series, an origin story called A Quiet Place: Day One. First, let's get some misconceptions out of the way. I don't like horror movies. Although these movies are about an invasion of gruesome aliens that hunt by sound, like its predecessors, this movie is a quiet (very quiet!) character study, with plenty of emotional depth, insights about humanity, and heart. And, yes, there are some gross and very dangerous aliens, too. Check out my earlier reviews of A Quiet Place and A Quiet Place Part II (I just reread them both and rewatched their trailers, and I would definitely watch the movies again!). Although John Krasinski helped to write this third movie, he and Emily Blunt and their film family do not appear in it, and he doesn't direct it. It's a new take on the setting and premise of the series.

The movie opens in a quiet nursing home environment, during a group therapy session. Sam, played by Lupita Nyong'o, is younger than many of the other residents and somewhat flip and disdainful of the group session. We soon find out that this is hospice care and Sam and the other residents are dying. While Sam seems brash and uncaring at times, she has a cat named Frodo that she clearly loves and is attached to, and it's obvious that her coolness is merely a shield to protect her. Reuben, played by Alex Wolff, is a nurse at the facility who leads the group session and convinces Sam to come with the group on an outing to see a show in the city by agreeing to her plea for real New York pizza afterward. She figures this will be her last trip to the city. Their bus takes them to the city, but the show has barely started when the alien invasion hits. Everyone runs into the street to see the fireballs fall from the sky and the gruesome aliens emerge. It soon becomes clear that the aliens hunt by sound, and people quickly learn to be quiet in order to avoid them. Announcements tell people to head south to South Street Seaport to board boats, but Sam has her own private mission and moves against the flow of people, heading north and clinging tightly to Frodo. She meets a British man named Eric, played by Joseph Quinn, who is also alone in the city, on a business trip, with no family or friends nearby. The two of them (plus Frodo) struggle to stay safe from the aliens, as Sam single-mindedly pursues her mission.

Michael Sarnoski helped to write and directd the movie and said in an interview that John Krasinski gave him almost total freedom to come up with a unique take on this apocalyptic world. What he came up with is brilliant because Sam has a very unique perspective during this disaster: she knows she is already dying (soon). And the focus here is squarely on the characters, especially Sam and Eric, as they are bonded by their terrifying experiences and confide in each other, as people tend to do in this kind of intense situation. The actors are all excellent, but Lupita Nyong'o's performance is especially good. It is a thriller, yes, with plenty of fast-paced scenes, but it also has a laser-focus on these two people, with plenty of emotional depth and heart. I cried at the end. For scaredy cats like me, while technically alien invasion movies are usually classified as horror, this doesn't feel like a typical horror movie, and my husband and I both noticed that there is no gore and the violence mostly happens off-screen (though those aliens are pretty disgusting up close). It's a unique movie experience, like the first two movies were, though with its own new twist on the theme. We both enjoyed it very much.

A Quiet Place: Day One is currently in theaters, which is the ideal way to see all three movies, if you can. It can also be purchased on YouTube for $25 or pre-ordered on Amazon for the same price. The first two movies are available on Amazon, Paramount+ and other services.

Note: This post contains affiliate links. Purchases from these links provide a small commission to me (pennies per purchase), to help offset the time I spend writing for this blog, at no extra cost to you.

Roadmap to Effective Treatments for ME/CFS and Long-COVID

The problem with a blog is that older posts kind of get buried, and my blog is now over 18 years old! So, I wanted to write a new post that directs you to all of my main treatment posts, since that is the topic that people with ME/CFS and long-COVID are often most interested in. For a more detailed explanation of each of the topics below, check out the Effective Treatments tab at the top of the page. That is also a guideline of all the treatments we have found effective, but I thought it would be helpful to write a current post to bring it to more people's attention.

(NOTE: Everything mentioned in this post is based on research and the practices of the top doctors treating ME/CFS and Long-COVID patients, as well as our own experiences.  You can direct your doctors to the U.S. ME/CFS Clinician Coalition for extensive resources on how to diagnose and treat.)

There is a misconception that there are no effective treatments for ME/CFS, but that is not true--it's just difficult to find a doctor who is knowledgeable about all of them. As with most aspects of this complex immune disorder, patients (or their caregivers) often have to be their own advocates and suggest treatments to their doctors. This post on Finding a Doctor for ME/CFS includes lists of ME/CFS experts all over the world, second-tier doctors who know how to treat some aspects of ME/CFS, and tips on finding a local primary care doctor to help you.

Below, I will just provide a brief outline on the aspects of the disease where treatments can help (based on our experiences) with links to the blog posts with detailed information, including how that aspect affects the disease, why treating it can help, and options for treatment. Each of those posts also includes links to research and more information. Check out the Effective Treatments tab at the top of the page for a more detailed outline.

Here are the treatments that have helped my sons and I to greatly improve our ability to function, our stamina, our exertion tolerance, and ultimately, our quality of life. We now live active, semi-normal lives. My son is now even working full-time!

These are not necessarily in order (though going down the list works). ME/CFS specialists often focus on treating those symptoms or aspects of the illness which are causing the most problems first. Remember: everyone is different!

Roadmap to Effective Treatments:

Correct Sleep Dysfunction. Fixing sleep helps everything! These treatments help to correct the problem at its root cause, not just knock you out with sedatives. Most of the treatments are cheap and readily available and any doctor should be familiar with them.

Treat Orthostatic Intolerance (OI). OI is an integral part of ME/CFS and long-COVID and treating it can often bring dramatic improvements. There are a wide variety of treatments available, many of them familiar to any primary care doctor. This post provides an overview of diagnosing & treating OI, with lots of links to more information.

Treat Methylation. Methylation is almost always dysfunctional in people with ME/CFS and long-COVID and directly affects GI function, energy production, detoxing, and mitochondrial function. This blog post explains what methylation is, with information on how to treat it with simple supplements. If you are one of those who can't tolerate even small doses of medications or supplements, start here. Vitamin B12 is an important part of improving methylation; this post explains the types and formats that are most effective.

Treat Immune System Dysfunction. Since ME/CFS is, at its heart, an immune disorder (as more and more research has proven) and immune system dysfunction is behind many of our symptoms, it makes sense to try to normalize the immune system. Both immune suppressants and immune stimulants can make us worse, so we need immune modulators. Some to try, plus other treatments:

• Low-Dose Naltrexone (LDN)
• Inosine or Imunovir
• Increase Glutathione 
• Treat MCAS (Mast Cell Activation Syndrome) 

Diagnose and Treat Underlying Infections. For many people, this aspect of treatment might need to come first, not last, especially if you have tried some of the above treatments and nothing seems to help you. Because our immune systems are dysfunctional and various infections are usually the triggers that start ME/CFS, almost all of us have some infections present that prevent us from improving.

• Reactivated Viruses. Our immune dysfunction allows old viruses to reactivate, especially herpes-family viruses. In these cases, treating with anti-virals often helps. If you know what infection triggered your ME/CFS to start, like mono/glandular fever, then treating that is often very effective. Dr. Martin Lerner, now deceased, led the way on research into Treating ME/CFS with Anti-Virals.
• COVID. If you have long-COVID or COVID worsened your ME/CFS, then treatment with Paxlovid could help, according to anecdotal reports. Studies are on-going.
• Lyme Disease and Other Tick Infections. Tick infections often go hand-in-hand with ME/CFS (and, indeed, Lyme disease is one of the dozen or so infections identified as a trigger for ME/CFS). This post explains why everyone with ME/CFS or FM should be evaluated for tick infections and includes a link for finding a Lyme expert near you. This is especially important for anyone with join pain and/or nervous system symptoms. The urgency is that tick infections can cause permanent neurological damage if left untreated. If you've had a negative test for Lyme, that doesn't really mean anything--the post explains why.
• Yeast Overgrowth. This is incredibly common in ME/CFS and long-COVID due to our specific kind of immune dysfunction. While not technically an infection, the immune system reacts as if it was. Wide range of treatments (newly updated in 2024) at the link.
• Infection-Triggered Crashes/Relapses. Exposure to even a simple cold can often trigger a severe crash or relapse in ME/CFS or long-COVID, due to our immune dysfunction. This post covers ways to improve the immune system to prevent those crashes and ways to treat when they occur.
  

Diagnose and Treat Endocrine Dysfunction. ME/CFS causes severe endocrine dysfunction--that's the part of the body that controls hormones, and hormones control everything. Messed-up hormones are behind sleep dysfunction (which can be corrected) and are one factor behind Orthostatic Intolerance, too. Both sex hormones and cortisol are covered in that endocrine dysfunction post link.There a more detailed post on Diagnosing and Treating Thyroid Dysfunction, as it's a complicated topic.

Diagnose and Treat Gastrointestinal (Gut) Issues. 70-80% of immune cells in the body live in the GI tract, so it's critical to address GI issues. Plus many people with ME/CFS and long-COVID develop GI problems. This blog post outlines the testing, diagnosis, and treatment of my son's GI problems, which resulted in huge improvements in his overall condition, finally allowing him to work full-time! 

 

There's no miracle cure or single treatment for ME/CFS and long-COVID, but these are the treatments that have most helped us.

What treatments have most helped YOU?

Please leave a comment below.

You can also connect with me on Facebook and Twitter and now on Instagram, too!

Movie Monday: Hit Man

In our hotel in Virginia this weekend (we were there for a wedding the next day), we only had access to Netflix and aren't currently watching any TV shows on it, so we chose a new movie I'd heard about: Hit Man. This fun, twisty thriller/rom-com turned out to be very entertaining!

Glen Powell stars as Gary Johnson, a classic mild-mannered professor who lives alone with his two cats, Id and Ego. He teaches philosophy at the University of New Orleans. As a hobby, he has a talent for electronics, so he works part-time for the NOPD, helping them with electronic surveillance. Undercover cop Jasper, played by Austin Amelio, pretends to be a hit man, someone tries to hire him, the police get him on audio (and often, video) with Gary's help, and they arrest the person. One day, Jasper gets suspended from the force just before one of these fake hit man appointments is to occur, and Detective Claudette, played by Retta, asks Gary to come out of the surveillance van and instead take Jasper's place and pretend to be the killer-for-hire. It turns out that quiet, introverted Gary does a great job in the role, and he becomes the new fake hit man for future sting operations. Gary, teaching philosophy to uninterested undergrads in his day job, gets really into making up a different persona to fit each new prospective "client," based on what he thinks they'll expect. He uses wigs, facial hair, different clothes, and even fake teeth, and fully inhabits the character he's pretending to be. His arrest rate speaks for itself. Then, a beautiful woman named Madison, played by Adria Arjona, tries to hire him to kill her husband. It's clear he's been controlling and abusive and Madison is scared, so Gary goes off-script. Instead of letting her clearly state that she wants to pay him to kill her husband (thus ensuring a conviction), Gary talks her out of it and convinces her to run away from him instead. His team is not happy with the outcome. When he met Madison, Gary was pretending to be Ron, an ultra-cool, handsome guy. They meet up again and are very attracted to each other. Though Gary knows it's wrong, he really likes Madison, and they begin seeing each other. Besides, he kind of likes being Ron. How can this relationship end well, when it's based on a lie? And how long can Gary keep his colleagues from finding out?

Crazy as it sounds, this movie is based on a real-life man named Gary Johnson who helped Houston police convict many people of hiring a contract killer over more than a decade. Of course, writer and director Richard Linklater (of Boyhood and the Before trilogy) gave the underlying story the Hollywood treatment here, with a lot of laughs, a hot romance, and some unexpected twists that didn't happen in real life. It's an intriguing premise for a movie, and Glen Powell is outstanding in the leading role, somehow easily transforming from nerdy teacher to slick criminal with dozens of different personas. This movie is filled with humor, from Gary's many disguises to his wide range of clients (including a teen boy who wants to pay him in video games--really happened!) to the sting operations. It's also very sexy, with Gary fully coming into his own as Ron, with Madison's help. But there is also plenty of suspense and lots of surprising twists, especially after Gary and Madison get involved and are in danger of being found out. It was highly entertaining, and we thoroughly enjoyed it. Lots of fun!

Hit Man is a Netflix original movie and is currently available there.

TV Tuesday: Dark Matter

I absolutely love when a book I enjoyed is adapted into a TV show or movie, so I was incredibly excited to hear that Dark Matter by Blake Crouch (my review at the link) was going to air on Apple TV. This is one of my all-time favorite books, a twisty sci fi thriller, and so far, the TV adaptation, Dark Matter, is living up to its source material.

Jason Desson, played by Joel Edgerton, is happily married to Daniela, played by Jennifer Connelly, and they both adore their teen son, Charlie, played by Oakes Fegley. They live in Chicago, and Jason works as a physics professor at a small, local college. Daniela had dreams of being a professional artist, but she now works to help support their family. In the first episode, Daniela encourages Jason to go to a party at a local bar, honoring his best friend, Ryan (played by Jimmi Simpson), who just won a prestigious science award. From their conversation at the party, it's clear that Jason is just as talented but chose the path he did to support his family more reliably. Ryan asks Jason to join him in a new venture, but it would require moving to California, and Jason turns him down. Walking home, Jason is brooding over the path not taken when he is suddenly grabbed on the street and kidnapped. He's taken to a deserted warehouse by his masked captor and injected with something. The next thing he knows, he's waking up in a place he doesn't recognize, surrounded by people he doesn't know but that know him. They say he's been gone for over a year, and they're glad to see him. Jason finds out that this place has the technology to travel to parallel universes, a concept he understands because he himself did the initial research years ago, before he got married. He realizes that he is somehow in one of those parallel worlds, and he is desperate to get back to his wife and son ... but how?

As with the book, this TV show is based on a mind-blowing concept, that there are infinite worlds and that with every choice made or change in events, another variation splinters off. This isn't fantasy but science fiction, based on quantum mechanics (don't worry--it's all beyond my understanding, too!). Crouch put this fascinating concept to good use in this twisty, gripping, and thought-provoking thriller. My husband and I both loved this fabulous novel, and the TV show hews very closely to the book (much to our delight), probably due to the author being the one who created the show and did much of its writing to adapt it. Blake Crouch is adept at that, having written other TV shows, including Wayward Pines and Good Behavior (also based on his own novels). So, the writing is sharp and engaging. The actors all do a great job here, each portraying the same character in many different worlds, each one the same person but slightly different. And that plot! It's unique, suspenseful, and full of surprises. The cinematography is also outstanding for the small screen, as Jason visits Chicago in world after world (some of them apocalyptic). It's just an all-around outstanding TV show. Apple TV really seems to excel at science fiction shows (like their adaptation of Silo by Hugh Howey, coming back soon for season 2, and For All Mankind, an alternative history of the space program). We are loving this one and look forward to a new episode every week!

Dark Matter is currently airing on Apple TV. We've seen six of the nine episodes and will be watching #7 tonight. I can't wait!

I practically squealed in delight watching this trailer again:

Potential New Treatment for ME/CFS & Long-COVID Shows Promising Results

One of the top ME/CFS specialists, Dr. Kaufman of the Center for Complex Diseases in California, published a paper with a colleague in 2022 about a supplement that has shown stunning results in his ME/CFS and long-COVID patients. The supplement is oxaloacetate, and in an informal "proof of concept" study (i.e. not a placebo-controlled study), his team gave the supplement at various doses to patients with ME/CFS and long-COVID over six weeks and assessed changes in fatigue scores, using a standard scoring guideline. Results showed significant improvement in both groups of patients (22-28% in ME/CFS patients and 47% in long-COVID patients). They clearly saw that higher doses were more effective. You can read the details of their preliminary study here.

They then began a more formal clinical trial, placebo-controlled and over a longer period of time, for ME/CFS patients. That trial is in progress, but Dr. Kaufman reported on stunning interim results at an ME/CFS symposium last November. You can watch his short (14-min) video on YouTube or below:

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He explains that he is mainly a clinician (treating patients), so he keeps the science fairly simple here, and it's an interesting talk. Watch for the results he presents, about halfway through. The trial has so far shown amazing results, not only in reduced fatigue levels but also in patients being able to spend more time upright (sitting or standing), rather than horizontal ... which is, of course, huge.

They are currently recruiting long-COVID patients for a similar trial through the Bateman-Horne Center. You can sign up here.

Other researchers are studying it in ALS and cancer patients, as well.

Of course, I immediately searched to find out if this supplement is available now. It is, but at the doses used in the study (1000 mg twice a day), it is very expensive, about $500 for a month. This is the exact supplement being used in the trials, with the higher dose, and available directly through the manufacturer.

Oxaloacetate is already available commercially through Amazon (and other suppliers, I'm sure), sold as a supplement for anti-aging and PMS support (interesting), but these are a much lower dose, just 250 mg per pill (so you'd have to take 8 pills a day to hit the amount used in the trials). I saw two main brands there, benaGene (looks like the same manufacturer as what was used in the trial) and Jubiliance, each with 30 pills for about $50. But since you'd have to take 8 pills a day to get the most effective dose, a bottle of 30 would only last just under 4 days, and you'd need 8 bottles to last a full month, which would cost $400. And I can't tell from the labels whether these contain the exact same molecule as was used in the trial (which specifies AEO anhydrous enol-oxaloacetate). So, I wouldn't recommend going it on your own just yet (unless you can afford the $500/month for the exact one used in the trial). I plan to wait for these latest study results to be published and hope that maybe the price will come down.

This study presents one of the most promising treatments for ME/CFS and long-COVID we've seen so far! And, while the cost is currently out of reach for many patients, it is currently available, which is pretty amazing. Keep your eye on this one! I'll report any additional news I hear about it.

Note: This post contains affiliate links. Purchases from these links provide a small commission to me (pennies per purchase), to help offset the time I spend writing for this blog, at no extra cost to you.