Blog production declines – a red flag for me.
Someone recently asked me, “Is something up? Are you OK?” Apparently, they noticed that my blog production is down. I don’t know if many people noticed my drop in productivity over time, but I did, and I wrote this blog to get it off my chest, explain what’s going on, and make it clear that it may continue for a time.
My blog production thus far this year has been down by about 25% compared to last year, and was down by 20% in the last six months of 2024.
That’s a big red flag for me. Blog production has always been my highest priority. I will throw virtually everything else under the bus – emails, keeping up with finances, cleaning, organizing, taxes, etc. – to keep up with the blogs.
Resilience Tested
How many things have regressed on the energy end became blatantly clear during Health Rising’s end-of-year donation drive. Health Rising’s very long donation drives provide a nice year-end assessment of my resilience. They are intense, not just because Health Rising gets a majority of its funding from them, but because they’re such an exceptionally demanding time. Writing blogs, recording 500 or so donations, and sending out thank-you notes is a real workout.
Exhaustion set in much earlier during the donation drive this year.
Four years ago, I got through them fine. Three years ago, I was able (barely) to keep up and I vowed not to go through that again. Two years ago, I made it about halfway through the drive before I gave up on recording the donations, etc., and spent the week after it collating the donations and thanking everyone. A year ago, I bowed out earlier and spent about two weeks afterwards gathering up the donations and thanking everyone.
This year, I pooped out after about 10 days, and three months later, I still haven’t thanked everyone – which also means that I haven’t thanked almost anyone who donated after the drive ended on Jan 17th as well.
Even after cutting back so much on that, I’ve still done about 25% fewer blogs than usual. It’s time to face the music—I’m not the person I was a year ago.
A Slow Slide – and then a Faster One
My resilience has plummeted over the past nine months, but according to my Oura scores, I’ve been on a slow slide for about three years.
Early 2022—Heart Rate Variability Drop—In early 2022, I experienced a mysterious and dramatic drop in my heart rate variability scores. Over two months, my HRV scores dropped by 40% (@22-13), stayed there for two years, and then started to inch up. Interestingly, I don’t remember my symptoms getting worse. My Oura readiness scores also dipped for four months, rebounded, and then were back to normal.
I can think of three things that happened during that period: a shingles vaccine shot; a heavy concentration on fermented foods, that was accompanied by about a 10 lb weight loss.
Feb 2023 – Activity Goal Drop—About a year later, in Feb 2023, the activity goal Oura set for me each day started dropping. While I’d had my share of 250 and 350 active calorie burn days, as often as not, Oura gave me a nice, robust 500 active-calorie-burn activity goal, and every now and then I’d even bounce up to 600 or 650.
By Feb, 2023, though, Oura thought I was better off trying for 400. By August of next year, the 500s were essentially gone for good. By March of this year, I was, more often than not, not even making it to 400.
Sept 2025—Cardiovascular Age Drops—In May 2024, Oura started tracking something called “cardiovascular age,” which refers to pulse wave velocity (PWV) and arterial stiffness. I was happy to find that Oura thought my PWV indicated I was 2.5 years younger than I was, but then the drops came. A year and a half later, my cardiovascular age matched my real age, and by February, Oura thought I was 1.5 years older that I am.
2023 to Present – Sleep Scores Drop—If anything tells the tale of the last three years, it’s probably been my sleep. Three years ago, I averaged 6 hours and 15 minutes of sleep. It dropped 30 minutes in 2023 and 2024, and was down to 5 and 1/4 hours in 2025.
My sleep score—which had averaged a mediocre but bearable 70 in 2024—dropped until it bottomed out at a pretty miserable 61 in the first three months of 2025. I’m convinced that poor sleep has taken the greatest toll.
Doxepin, ramelteon, trazodone, gabapentin, eszopiclone, and Kava have been tried and failed. The only things that seem to help are CBD oil and high-THC gummies.
Flexion Points?
For most of my time with ME/CFS I’ve pretty much been the picture of resilience.
Of course, I’ve been looking back and trying to figure out what happened. I can see four factors that may have played a role. Most of them have overexertion in common, which is a bit surprising to me.
Overexertion has never been much of a problem for me with my “mild” ME/CFS. I’ve planted large gardens, worked at catering for several years in the 90s, and traveled cross-country several times. Sure, I often paid the price each time, but back to baseline I always went. I was a pretty darn resilient person with ME/CFS.
If I look back, though, there were four times when it appears I kept paying the price for quite a while.
Mid 1990s – The Survey—It was admittedly a stretch for me to do my Master’s thesis surveying native grasslands in the Santa Cruz Mountains in the mid-1990s. I was determined to do it, though, and pushed and pushed. At one point, I even felt like I had pushed through something and was able to hike more easily. In the end, I returned to my normal baseline, but towards the end of the project, I developed a roaring case of chemical sensitivities that continues today, albeit in reduced form. Was it caused by too much exertion? I don’t know.
The Plague—If any one thing started my recent decline, I would pick “the plague” (lol). My idea of dealing with the occasional cold was to get a little activity in. This time, that idea failed miserably, and I woke up the next day with a deep, aching feeling in my muscles that I had never experienced before.
It took months to get over that, but it popped again and again when I overexerted. It’s much rarer now, but it’s a no-nonsense sign that I must pull back when it comes.
Warning sign of slippage—Prior to the plague, I’d done a couple of cross-country trips. I knew they would be a challenge, but I didn’t fear for my health and looked at them more as an adventure and a chance to see the country than anything else. After “the plague”, though, that changed. I was very careful on the one long-distance trip I made in 2023 and decided not to do one in 2024.
The Big Slide: I Get Puppies, and My Activity Levels Skyrocket—In retrospect, things had been on a slow slide for several years, but I felt pretty much the same. I would have been hard-pressed to say that anything other than normal fluctuations were occurring.
Then came the puppies. Over about a year, I lost both River and Skye – and in May of last year, I got two puppies – Anni (Icelandic for River) and Cielo (Italian for Skye) :).
You might ask what I was thinking about getting two puppies at 64? (My partner asks me that frequently :)). Well, I wanted that bond that comes from growing up with puppies. Besides, it had worked well before (13 years before (lol)).
It wasn’t just puppies—it was these puppies. They were Catahoula hounds, a breed bred to hunt. While my last dogs (whom I thought were Catahoulas but clearly weren’t) stuck around camp, these guys roamed and roamed. Because I don’t like keeping them tied up when I’m camping, I spend a good bit of energy chasing them. When I wasn’t chasing them, I went on short hikes with them.
11,000 steps…What was I thinking?
Between the hikes and the chasing, my steps per day reached new heights. During one month in summer, I was shocked to see that I’d somehow averaged over 11,000 steps a day—a step count I’d never come close to approaching before. Over a four-month period last summer, I averaged about 10,000 steps a day—something else I’d never come close to doing since I got the Oura ring about five years ago.
Why didn’t I catch this and pull back? For one, I wasn’t having my usual post-exertional malaise symptoms (hot burning sensations in my muscles, lots of upper body pain, fatigue, irritability, difficulty concentrating, and every now and then a little dizziness. If I really overdid it, I’d get flue-like symptoms and immediately pull back.)
Instead, I was experiencing symptoms I’d never experienced in my 40+ years of ME/CFS, such as wooziness, dizziness, fatigue, disorientation, “floppy feet”, numbness and tingling in my ankles, plus lots of left side (neck, shoulder, and hip) pain. I attached none of it to my exertion.
I only began to realize what was going on when the activity score on my Oura tumbled despite all my activity, and my “Recovery Time” assessment slipped from “Optimal” to “Good” to “Fair” and then to the lowest level, “Pay Attention”. Alarmed at this new onset of symptoms, I became a patient of Dr. Ruhoy’s in Seattle.
Warning Sign – How much resilience I’d lost was vividly displayed when a tire shredded on the way to Flagstaff in the fall. Usually, changing a tire would be no problem, but this time, it was not. I staggered around, and I was quickly spent, and was lucky that a good Samaritan came by and helped out. The fact that I could not generate energy in a pinch really blew my mind. Even at my worst in the past, I’d been able to do that.
Stuck
Reducing my activity level helped, and the puppy problem has gotten better (dog trackers and more leash time have helped). While I am still doing too much activity, for various reasons, at times, I’ll be able to reduce it more coming up.
Unless I overdo it, my wooziness and disorientation are much, much less, and my left side pain is mostly gone. My sleep scores are still in the pits. My fatigue is still high, my resilience is reduced, and it takes me much longer to recover (elevated heart rate/symptoms) from stressful activities, and my activity goal continues to sink. Oura certainly doesn’t think I’m over this, and neither do I.
Warning Sign – Last month, the van got stuck in the desert, and I had to do some work to recover it. I got it out – and I was in better shape than during the Flagstaff fiasco – but again, my energy dissipated alarmingly fast. This is probably not surprising for many people with ME/CFS/FM, but for me, it was. In the past, I would have been in considerable pain, but would have been able to push through. This time, there was simply nothing left.
It’s a different world. Over the past 9 months, my symptoms have changed radically. The old me had to deal with much more pain – the new me just can’t function as well. I prefer the old me!
Worse Health – Less Worry (?)
Oddly, enough, in some ways I am less worried about my health than I have been in the past. I came across a letter I wrote to my sister in 2017 in which I spilled my guts and said I was worried about my ability to continue working. That was a revelation as 2017 seems kind of like a golden age right now (lol). The truth is that I was really concerned about my ability to keep going on, and I’ve always been worried that something was going to happen.
I’m actually less worried about that now because I have more confidence in my ability to take care of myself. One of the odd but revealing memories I have from 10 years or so ago is being too tired to brush my teeth at night. Given what a financial thorn in my side my teeth have been, I have to be really, really tired to get to the point where I don’t brush. At one time I got there frequently.
That doesn’t happen anymore. I’m never too tired to brush my teeth at night and always do so. It’s a little thing, but it’s revealing to me. It’s probably because I’m taking better care of myself.
So, while I’m dismayed that my productivity is down at precisely the time there is so much to write about, I’m not worried about collapsing.
New Health Efforts
Some things have turned around. My heart rate variability ticked up in 2024 and now averages 17, and my ‘cardiovascular age” has improved and now suggests I’m a year younger than my age.
I started and have been intermittently doing Dan Neuffer’s ANS REWIRE program. One of the things I agreed to was to take more breaks. While I’ve been doing the program fitfully, it is helping at times, and I believe it will help more over time. (I’m also hoping that at some point, my long-term meditation practice (@ 1 hour a day for the last 3 years) is going to finally kick in at some point and I’m going to have a nice stretch of restful meditations (lol)).
As I noted, I also started seeing Dr. Ruhoy. With her new fee increases, my time with her will be brief, but she will be able to advise me on the results of the 26 vials of blood and the MRI and MRV imaging results that were done (thank god for Medicare) – and I will pass them on to my other doctor. The vast majority of my blood tests fell in the normal range, but there were a couple of standouts, including a lactic acid level that was so low that it almost defied belief (lab error?).
So, to wrap up, my blog production will probably continue at a slower pace than usual.
Dear Cort,
First I wish you better times ahead. You deserve those.
Second, it sounds a lot like your body *chooses* to produce less adrenaline / epinephrine that used to try and push you trough your lows and keep you going.
Signs that seem to point to that:
* You are more fatigued but less worried now. Adrenaline produces plenty of emergency energy, pushing you out of crashes. Very frequent high adrenaline peaks however come with their own side effects, including increased vigilance / worrying. It could also have produced irritability you experienced in PEM before. By chance, would you not only worry less but have also a slower more relax thinking pattern now and “almost have to do effort to get angry” (compare to what it was before) too? That IMO could also be due to less peaks of adrenaline.
* You were too tired to brush your teeth before but no longer now, while you had much more energy then compared to now. That also points to you “living on adrenaline” back then. It pushes you through everything you consider most urgent to do, but leaves you very depleted a number of hours later when the adrenaline peak is consumed / depleted. So while you may have been able to replace tires during the day (on adrenaline), you couldn’t push yourself anymore to brush your teeth at night. Note: if you pushed your body on adrenaline during the day and would often be depleted from it during the night, your body would then have required more sleep due to more exertion during the day and be able to better do so due to lower then normal adrenaline (reverse hit towards reduced adrenaline production to let the body recover from the peak) at nights.
* Adrenaline peaks can lead to lactic acidocis. If your body *choose* “to cut you off this (possible) decades long living on adrenaline (for safety reasons for example)”, then you might be rather below average in it now. With it, lactic acid may well be consumed (by neurons, muscle cells, heart…) at a(n almost) higher pace then you produce it.
See paper with title “Effects of adrenaline on lactate, glucose, lipid and protein metabolism in the placebo controlled bilaterally perfused human leg” saying “Adrenaline directly increases lactate release and lipolysis and inhibits insulin-stimulated glucose uptake in the perfused human leg. Adrenaline has no direct effects on peripheral amino acid metabolism.”. As you are well aware of, glucose uptake is reduced in ME/CFS. Combined with even regular levels of adrenaline and more so on below normal levels that could likely lead to lower plasma lactic acid then seen in healthy people (for patients “unable” to “live on adrenaline”). IIRC there are papers on reduced lactic acid during rest in ME/CFS too.
While I do not think your brain retraining programs are at the cause of this, you may experience the switch from a “pro stimulant balance” to a “pro relaxation balance”. If I recall well you used to do well on things like caffeine. Just like adrenaline that is a stimulant. And with ME/CFS patients doing well on stimulants, brain relaxation and meditation often works poorly or even makes them more agitated. When you make the switch, IMO stimulants tend to more easily kick you into agitation and brain relaxation and meditation techniques tend to help more. Rather then seeing you following these programs as a cause of this switch, I would estimate that since your body “choose” to make the switch, these programs “finally” start to help you rather then work backwards.
Maybe follow the advice you write about yourself: listen to your body and pace yourself?
All the best to you,
dejurgen
DeJurgen! Good to hear from you :). Maybe it is less adrenaline or something like that. I vividly remember a doctor telling me 20 or so years ago, that when my immune system calms down as I get older I will feel better.
I have less of the “wiredness” and less of the “oomph” as well. Interesting. I would get jacked up at times while I was writing that I had to get up and walk around. My shoulders would rise up to my ears! Now I’m calmer – not calm – but calmer.
“It pushes you through everything you consider most urgent to do, but leaves you very depleted a number of hours later when the adrenaline peak is consumed / depleted” – this makes sense. I was definitely more active back then. I was younger too – but my twin brother is still very active. (Too bad I didn’t have an Oura ring).
I also had problems with spatial orientation while driving (vertigo going over bridge or merging (scary as heck), worsened chemical sensitivities.
Interestingly, back then I could get a nice boost from meditation – no more.
Thanks for the tip on the reduced lactic acid and how that might work. My lactic acid was so low (0.4; reg 4.8-25.7 normal) that it was either a mistake or I’ve found a test result that pops out. From what I’ve read by pyruvic acid should have been high – but it was low normal (0.3; 0.3-0.7).
While Labcorp found my overall acetylcarnitine profile normal there were some high or high normal results in there. It’ll be interesting to see what Dr. Ruhoy thinks.
I find caffeine very helpful – and I am very sensitive to it – it usually takes just a few sips to get me me going – but it does have its downsides. If I do it too much the deep aching muscles that I associate with “the plague” comes back When I’m really beat it doesn’t work.
I hope the meditation does kick in at some point. I’ve been kind of astonished that it hasn’t yet.
Thanks so much for your response. (I hope we see more of you! :))
Hey Cort
Honestly you write such a prolific number of blogs that when I first found healthrising I figured your blog entries were supported by a team or something like that. Even if each entry was a team effort I’d be impressed if such a team made half as many blogs as you make at present. Of all the sources I use for keeping up with the present state of ME/CFS none have anywhere near as much to say as you do about the specifics of new research and why it matters
–
Regarding your health
Don’t know how you survived on such poor sleep for so long, I’d be dying if I had only 6 hours sleep every single day. When I started having real trouble sleeping I started testing sleep med after sleep med with my ENT until we found some that really worked, a doctor at a sleep center probly would also be able to help anyone looking for sleep meds. I typically just use dayvigo to get enough sleep but after I read Dr. Jacob Teitelbaum and Dr. Sarah Myhill advised combining sleep meds I started to do so. If I’ve overexerted to the point of having real trouble sleeping I will combine meds, for instance, taking cbd+diphenhydramine+dayvigo all together. Melatonin, theanine, and gabapentin are other ones I often add when combining. I’ve never had any problems with any of the combinations I’ve used, even when combining frequently.
You have mentioned a less toxic version of cyclobenzaprine several times, I have it written down as Tomnya, don’t know if you ever tried cyclobenzaprine but it knocks me out for 8-16hrs depending on dose, I’d use it all the time but I feel slightly poisoned the day after, not that it’s that bad but my health won’t improve no matter how much I pace if cyclobenzaprine is in my system, though it’s still very useful to have in when I absolutely can’t sleep as cyclobenzaprine is so powerful, If it just wasn’t toxic it would be perfect for me. In any case I don’t know if it would make you sleepy as it is prescribed to me as a muscle relaxer for pain relief not a sleep aid, gabapentin is also rx’d for something other than sleep otherwise insurance wouldn’t pay for it at the same time as dayvigo as they clamped down on individual patients having multiple rx sleep aid from what I understand. They might not even allow multiple sleep aids for one person with or without insurance. By the by, have you been to a sleep center and had them run an in-lab sleep test on you?
You mentioned things got worse when you used fermented foods. I wonder if the fermented foods could have caused SIBO or perhaps large intestinal dysbiosis. The biggest uptick in health I’ve experienced in the last decade was from taking Alinia as an antimicrobial for my gut after being in a real bad state health wise for months after eating spoiled food repeatedly. Xifaxan, another gut focused antimicrobial taken a year or two later, did a lot for my health as well.
–
I’ve always had a knack for coming up with original ideas that improve the efficiency of things, here are some ideas that may be of use to you, though use your judgement as I don’t know in detail what you’re dealing with and I don’t have experience with writing blogs or handling donations
There have been many blog entries on healthrising written by others, perhaps one or multiple people among the community would be willing to step up and write blog entries consistently, maybe with your direction or with you picking the subject and providing data of interest.
Perhaps you could hire someone or get an AI to help do some of the work on blog entries, are there any parts of the blog that you think don’t need your expertise to complete
I haven’t looked into AI yet but I wouldn’t be surprised if there are good uses for it for writers. Perhaps you could find an AI you could feed the ideas and stuff you want in your blog and it could organize them into paragraphs without you having to worry about making the grammar match up or doing the spell checking or any of that kind of tedious stuff. I notice rewriting stuff to add new information is especially tedious, don’t know how much you deal with that but I could see AI dealing with that being a big boon. Dictating generally feels so much better than typing, an AI that one could talk to seems ideal. maybe there are other things blog writers are using AI for these days?
Perhaps you could do blogs half as often for a while, with a pinned notice at the top of the blog that you’re cutting back for a time for the sake of health. Maybe halfway between releasing each blog put a small notice above the most recent blog entry stating what the next blog is going to be on and when it’s likely to release, this to show that there is activity
–
As to the Thank You notes, I can’t speak for others but I would be fine without being thanked, maybe whenever you have a big donation drive you could say somewhere during the donation’s payment process or in the segment of the blog which alerts that there is a donation drive and asks for support something that conveys the following: in the past you personally sent out thank you messages to everyone but it was a major drain on energy, energy that you could use to write more blogs and maintain the health you need to continue the blog in the future, so going forward you will simply thank everyone who support healthrising here and now.
Perhaps after that, when the drive is over, send one standardized letter of appreciation to the entire community explaining the situation and thanking them all.
Maybe there are other people who run donation drives you could speak to in order to discuss the pros and cons of different ways of handling thanking the community for their support
I’d be interested to hear what other posters on here think of the above ideas on thank you letters for donations
In any case I hope you get your health figured out, I’d be real sad if your working on this blog that has given hope and help to so many ended up bringing you down
All the best to you Cort
The most important thing is to look after yourself Cort.
What you have done with Health Rising has been an outstanding resource for patients within these communities. Even with what you call a ‘lower productivity rate’, it is still – objectively – a high productivity rate, as anyone would say from looking at your recent output, were they to be coming across Health Rising for the first time.
I have found the buteyko method very helpful for sleep. You might like to try one of the free five day workshops lead by the ‘Learn Buteyko Online’ group (Christopher Drake). It’s a bit of a slog and takes time, so perhaps something to consider after you have finished with ANS Rewire. Buteyko really helps with blood perfusion and makes the circulation feel warmer. Also drinking ORS at night helps me sleep better.
On meditation, I recently learnt that the Buddhist nun Pema Chodron has ME/CFS. It’s interesting that someone who must be meditating for hours every day has still not recovered from the illness. I wonder what therefore is the best kind of neuroplastic exercise to fix the (undoubted) neutoplastic issues in ME/CFS.
Although I don’t always agree with you, and there’s no harm in that, I really admire you and your work Cort. This y is an amazing resource, and the research you consistently cover provides hope, even if the answers are still frustratingly slow.
Take care of yourself
‘Website’ not ‘y’!