My Seasonal Worsening in Fall & Winter Came Early
I haven't posted here in a while because the seasonal relapse or worsening of my ME/CFS (myalgic encephalomyelitis / chronic fatigue syndrome) that hits me every fall/winter came early this year, knocking me down in mid-September. This happens to me every fall: sudden onset of immune symptoms, like flu-like aches, severe fatigue, and sore throat, indicating that my immune system is stuck in an overactive state. This seasonal downturn is very common in those with ME/CFS and long-COVID, and I wrote a blog post, The October Slide: ME/CFS and Infectious Triggers, about it. That post describes this annual phenomenon for many of us, along with one possible explanation: that more exposure to infections at this time of year can trigger this kind of immune activation. It also summarizes many treatments that have worked well for us in the past, including treatments to improve immune function and treatments to help if you are exposed to or actually catch an infection.
However, for the past five years, none of that has been enough to prevent this seasonal worsening in me that lasts longer each year. In 2023, this relapse began in November, last year in mid-October, and this year, in mid-September. And once it starts, nothing seems to help, and it usually lasts until January. So, every year recently, I am couchbound through fall (my favorite season!) and through the holiday season, which makes our travels and family events pure torture for me. Last Thanksgiving, I needed 2 naps just to manage to get through the afternoon and evening, and I felt awful the whole time, wracked with severe flu-like aches. As I said to my husband recently, if anyone "normal" and healthy woke up feeling this way, they wouldn't get out of bed!
So, it's become very frustrating and depressing, especially when the flu-like feelings began so early this year, just before our 10-day trip to New York State to visit family and enjoy some fall camping. Every year at this time, I try a short round (5-7 days) or two of steroids (prednisone) to try to calm down the immune activation but it often doesn't help much. I would probably need a much longer round of steroids to really settle my immune system down, but they have side effects, including worsening my chronic yeast overgrowth (another common feature of ME/CFS and long-COVID, thanks to our immune dysfunction) ... and yeast overgrowth also causes flu-like aches! So, I tried 7 days of steroids a couple of weeks ago, and I felt better the first couple of days but then got much worse again, as I reduced the dose.
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| I spent much of vacation lying in my lounge chair, but the view was great! |
A New Treatment to Try ... and New Hope!
I e-mailed my ME/CFS specialist a couple of questions and let her know I was relapsed again, with immune activation, and she suggested we talk on the phone. Much to my surprise--since we have this same conversation every year at this time!-- she offered me an entirely new treatment that could potentially get right to the heart of the disease--the immune dysfunction--that I hadn't even heard of yet.
She is part of the ME/CFS Clinician Coalition, a cooperative group of all the top ME/CFS doctors in the U.S. They work closely together, watching (and participating in) the latest research, trying things with their patients, and sharing information. She said there was some evidence that the new GLP-1 agonist weight loss drugs helped to normalize immune function in patients with autoimmune disease (while ME/CFS is not technically classified as an autoimmune disease, it is a disease with immune dysfunction at its heart). ME/CFS doctors in the coalition have been trying microdosing (using tiny doses) of these medications and are seeing some remarkable results ... though, of course, it doesn't work for everyone. Here's an excellent article summarizing the experience with ME/CFS, long-COVID & fibro patients so far, and here is a video of a recent discussion by some of these doctors about this new treatment.
So, I'm trying it! I'm very excited to have a new treatment possibility to try, especially something that gets right to the heart of ME/CFS. If I could normalize immune function, then everything else would improve.
It's expensive, though. Even with the microdosing, these are new medications, being used off-label (other than their approved purpose), so insurance won't cover it. The first delivery cost about $350, and that should last me about 6 weeks. However, if it really works, then I could potentially stop taking some of the expensive supplements I take and possibly reduce my dose of certain medications (like thyroid medications and anti-fungals). I talked it over with my husband, and we thought it was worth a try to maybe prevent spending half of every year lying on my couch, unable to do anything.
The one she prescribed for me is tirzepatide, sold under the brand names Zepbound (for weight loss) and Mounjaro (for diabetes), though they're the exact same drug. This is the one that ME doctors have been focusing on, because it has additional actions, besides targeting GLP-1. She sent my prescription in, and I purchased it directly from the pharmaceutical company (Eli Lilly). It comes in small vials, and I do the injections myself (I am used to that with my B12 injections). I think a normal dose for weight loss is 2.5-5 mg, and my doses are 0.5 mg, three times a week. At these lower doses, doctors have found that the side effects are lessened (and I'm actually hoping not to lose any weight, as I lost over 20 pounds a couple of years ago when I got effective treatment for my thyroid dysfunction).
Effects So Far
As of today, I've had 5 doses. The first two were at half dose, just 0.25 mg, just because I was worried about side effects. This week's three doses were the full microdose, 0.5 mg.
Last Wednesday, when I took the first dose, I felt about the same and was very achy (those flu-like immune system aches). But, the next day, I had no aches for the first time in over a month and my energy was great; it was the best I'd felt in months! By Friday, I had mild aches again, but I managed to run some errands and go to Trader Joe's, all long overdue. I was achy Saturday but felt pretty good on Sunday and managed to help my husband with some cleaning.
This week, I've had mild to moderate aches every day. I was crashed Wednesday and Thursday, but I had a lot of stress and exertion the night before (a flat tire on my way home from a medical appointment!) and then yesterday, we had heavy rain all day, which affects my illness.
As that article explains, some people with ME/CFS who tried this treatment felt better immediately, others felt better after 3-5 weeks, and for some, it didn't help at all. So, we'll see!
I'll write more about this treatment, including my response to it, when I have more information to share. If you want to hear more about my fall-winter relapse, immune activation, and how I learned of this new treatment, check out my recent Chronic Illness Vlog on YouTube or below:
