I’ve done really well at starting to pull myself out of a pretty deep two-ish month long ME/CFS crash, not that I’m completely out of it by a long chalk but I want to be able to take pause to appreciate where I have got to considering how long and deep a crash can be (and the many months of overexertion that had lead up to this one, risking that it might take just as long to get out of). Also, a moment to ponder the matter of inching back into the world cautiously enough to not throw yourself back into the deep end again because, whilst the natural urge is to want to progress towards reclaiming a more “normal” routine full steam ahead now, this is actually NOT the time to do so and I will cover exactly why these experiments of reintroduction to life have to be as paced and cautious as the exertion activities themselves.

So this post is split into three parts, starting with my thoughts before a first venture out further than the immediate vicinity of the house, then some analysis of the after effects and what I have learned from it all.

As a quick recap of where I have been, a few weeks ago I struggled to be on my feet for 10 mins and a short walk outside the house would send me into the shakes for an hour or so afterwards from the effort and then around three days of exacerbated post exertional malaise (PEM) to follow. I was forced to mostly stay in and around the house for several weeks because venturing too far would wipe the floor with me and “walking” as an activity in its own right was out of the question.

However, two weeks ago I managed a short and exceedingly slow walk around my village, stopping to sit down on 5 benches along the route, getting home intact without exceeding my exertion limit more than very briefly 9around a minute or so) for a handful of times. When you have ME/CFS, you need to come to terms with the fact that you have an energy limit or “energy envelope” and you need to stay beneath or within that in order to avoid over-exerting yourself…because overexertion leads to (PEM). That, in turn, can then lead you to, or can keep you in, a crash or even, possibly, result in more condition severity (loss of functionality) with the possibility that you may struggle, or even fail, to ever recover from that again. So many of the people with severe ME/CFS, the kind where you can’t get out of bed or take care of yourself, look back at various phases of over-exertion as the factor that got them into such a severe state. So, without exaggeration, over-exertion is a very serious business in ME/CFS and I’ve recently begun using the Visible app for ME/CFS activity tracking so that I am able to keep tabs on where I am with regard to my energy limit, in real time, all day long which is proving to be utterly essential to achieving the level of pacing required to restabilise my health.

Your exertion limit is the point before your heart starts to go into an over-exertion zone, somewhat calculable by age (it can be worked out by the equation of deducting your age from 220 then calculating 60% of that total, a figure that, in my case, is 98.4 bpm, which almost exactly matches my observed over-exertion limit of 97bpm). The observed over-exertion limit is the point you can reach without triggering PEM and takes some close observation to establish. It can be pretty hard to stay under your exertion limit at the start of a crash (I was going over mine every time I got up to boil a kettle or use the bathroom at the beginning of this crash) so to manage to go for a walk without going over the limit much at all was a real breakthrough and testament to just how hard I had been working at pacing (see all my other posts on this topic). It still took about three days of diligent rest to recover from my first excursion, which I anticipated by planning very low-key days, but it felt so good to be out again that I was on a high for a few days and didn’t mind so much as I felt like I was getting somewhere.

Then, a week later, I managed to walk a bit further and with only two benches to sit on this time, only going over my limit once, really briefly, on an uphill slope (and then I stopped walking, immediately, as soon as my Visible alert went off, which dropped my rate down to a reasonable level again, before sitting down for a few minutes at the first opportunity before continuing). Again, it took a few days to bounce back from some moderate PEM but it was another positive sign.

So, at the risk of sounding a bit too smug (the kind of smugness that ME/CFS can very quickly wipe off your face!), I feel so proud of myself for getting to this point and not languishing in a horizontal stuck state for more than a relatively brief period, considering how much rolling PEM I had built up (see my recent post on this) so now not to blow it all by rushing back into doing too much or forgetting everything I’ve learned!

It’s not that I wasn’t all that severe at the start but that I did all the right things and here I am, the product of diligent pacing. I’m not recovered to my previous baseline by any means (not even close) but at least I have enjoyed an upward trajectory, which is very hard to do with ME/CFS and pacing, combined with activity tracking, is fully responsible for that.

I hear about just too many compromises made to pacing because a person needs to get back to work, back to family and other responsibilities or “just” because they don’t feel like they are pulling their weight or are worrying about what other people think about all their time-out (worrying about other people’s opinions is such a mental tripwire in ME/CFS because so few people understand it). I used to be that person…last time I was this severe, I had a large dog that had to be walked and no one else that was around to do it during the day, plus I was a full-time parent, had a fairly chaotic house to run, a self employed income I was trying to sustain…all these things got used as excuses to push through and set back my recovery repeatedly so that it took a very long time time to find any stability, with a lot of disheartening setbacks. Now that I’m so much older, and know much more about ME/CFS than I did, I don’t want to take any more risks as you never know whether a setback is going to turn into a new, much lower, state of functionality that can’t be shifted. Also, this time I don’t have any of those old excuses, this house is so easy to maintain that it can be done in bite sized 5 minute portions of housework, there’s no dog, no child just a husband who is always at home now and more than willing to help. So I do appreciate just how lucky I am compared to a lot of folk but, either way, you have to listen to your body and just stop or risk the consequences.

So its still galling having to watch people push through or go back to doing too much with ME/CFS because all the years of hard experience have taught me the terrible risks. An Admin on the Visible forum itself just posted a warning to all those people who routinely announce themselves as exceeding their energy envelope whilst using the app (when there is readily available advice how to avoid this), which instils a culture of ever worsening symptoms and frequently increased severity in ME/CFS as though it is the normal path, when it doesn’t have to be that way. What it does require is such almost militant following of the rules about not going over that exertion limit that you are prepared to draw heavy boundaries, come up with numerous creative get-arounds, self-advocate to the nth, ruthlessly delegate and, yes, do without all sorts of things you would really like to be doing if you had a free choice, in order to get yourself on a better footing!

What I just did, over the last few weeks, goes to highlight that if you can surrender to the pacing protocol fully and properly then you can start to get results, almost without having to think about it…it just kind-of happens…but then the next trick is to not take that subtle improvement as a cue to go crazy with doing more than you have now established is your upper limit but to continue with the watchfulness, the pacing, the resting, the rationing of exertions and allowing of many days off in between so that you don’t get set back, potentially even harder, again. Learning this is an art and one I am still trying to master!

I think the absence of too much stress, as an almost inevitable part of the pulling back and pacing process, is a big part of its effectiveness of diligently pacing (the considerable stress of worrying about the illness itself put to one side…). How many of us with ME/CFS report terrible stressful dreams if we do ever get a rare good night’s sleep (I see this particular discussion appearing all the time on the forums) and I think that’s a measure of how overstimulating just so many of us generally find life to be (perhaps many of us are highly sensitive people or empaths…) plus all the pseudo-life exposures we suffer every day, TV being such a big source of those (I carefully cherry pick what I am exposed to on that front yet am still prone to over-vivid dreams). One thing pacing organically does for you is that it pulls you out of the constant modern-day slipstream of “too much”. When you’re convalescing in bed or in a quiet room all of the time, you don’t get to soak up all the micro traumas of human life and that provides its own kind of nervous system reset. But if you don’t do that properly (or if you are lying there in constant terror about the future because of the impact of your health on your finances etc) life continues to fill you up to the brink with the horror show kind of thoughts that, even if you don’t deal with them at the surface, tend to resurface and recycle as the fodder of our more colourful dreams, leaving you feeling unrested and burned out in the morning. Yet its amazing how a long phase of appropriate rest and recovery can dial all that down and lead to a more benign interior landscape.

So it’s important…just so important…that when you go back into life you do it slowly and in titrated measures of sensory stimulation. Even those first walks around my village left me so overstimulated I couldn’t get to sleep for toffee on those nights; I just tossed and turned for, on average, two to three hours of insomnia each time, even though my “outing” had been much earlier in the day. So this is another factor to watch out for if you go back to doing too much too soon.

Likewise, if you start to engage with more people again you risk overdoing it in another way because those other people haven’t been leading your very quiet life and will likely bring their overstimulating worlds with them! Just the other day, I spoke to someone online who couldn’t understand why she had such severe PEM after “just” sitting down chatting with three old friends. As I pointed out to her, it would have been the combined effect of getting ready to go out, the car journey, sitting outside, the different food, keeping up with all those different threads of conversation, preparing to interject, keeping up with face expressions and body language, hearing news that is faster paced than anything you yourself have been exposed to lately, moving your arms about more than usual, sitting upright, laughing, talking, journey home and trying to wind down again. Expecting yourself to be up to speed with the plunge back into life from day one is a big mistake that can literally throw you straight back into very severe PEM.

Before the first outing – thoughts and considerations

So my mistake today (we are intending to take our first trip out by car to the local market town) would be to suddenly forget where I am, in my actual state of health right now, because of the distraction of being back in a familiar place doing ordinary things from “before” the crash. I still need to check in a lot more and pace everything I do. I still need to take pauses and opportunities to sit whenever opportunity presents. I still need to think about dividing-up exertions, not doing them continuously such as, for instance, going into several shops one after another. I still need to be aware that noisy places and crowds count as a very high exertion factor with similar time limits as doing something more physical. I still need to be aware that this is meant to be just a brief dip back into life, an experiment, not a full blown day out, however much I seem to be enjoying it at the time (remembering the masking effect of dopamine and endorphins, which can make it seem like you’re not as tired or in pain as you actually are). I need to remember that, whilst seeing friendly faces and having some chats is a morale boost when you’ve been stuck at home for weeks, these things can drain you very quickly. I also need to thinking ahead by booking a reliable spot for some lunch so that there is no waiting around and a guaranteed place to sit down and take a rest.

Another important factor to take into consideration is that being outside is not the same as being indoors and is super stimulating to a crashed-out nervous system. A big clue that I wasn’t doing well this year, long before the crash, is that I’ve hardly sat outside my house at all since I moved in and only ever in the evening, always in the shade and never for very long. Whenever we’ve been out somewhere, I’ve had to insist on being under cover when we eat or drink, even in the gentlest of sunlight and have often opted to be indoors. There was a handful of years that I was like this, when ME/CFS was very severe and then I seemed to get over it and tolerate more daylight again as things settled down. In fact, I spent a lot of time outdoors over the last 5 years, often setting up my desk or easel out there in the garden, but am now back to such outdoors daylight intolerance outside again, even though I prefer to be in a well-lit room. I’m alright when I walk, as long as I have a brimmed hat, but this degree of light sensitivity is definitely one of my symptoms of ME/CFS and one that is commonly recognised. So, as it stands, I intend to eat lunch indoors today, even though there is a lovely outside area where we are headed.

Finally, (one last hesitation) the truth of the matter is that I feel tired before I even go out today, not helped by a restless night; so should I still risk going or should I pull rank with myself? It’s difficult because the impact on morale, if I cancel (which is sometimes your best ally at this stage of recovery) would be to feel so disappointed and hopeless again. So I’m going to allow myself to go but I do need to keep things really low key, not stay too long then diligently rest all afternoon. I hope I’m doing the right thing!

After the outing – so, how did I cope, what did I learn?

Overall, the trip went very well and, astonishingly, I only hit the red over exertion warning in Visible twice, once when I went off to navigate a public loo and the other time right at the end just before we got to the car. I was able to sit down a fair bit and keep to the shadier side of the street. J carried everything and I had the right layers of clothes to keep warm but not too hot (at one point, he dashed off to get me another layer from the car). In the end, we opted to sit outside for lunch as we found a nice table tucked away in the shade and it was less stimulating than all the noise inside the cafe. I stuck to a familiar dish that has been tried and tested before. In total, we popped into four shops and wandered around the cathedral, which I usually find so soothing but I found it deeply draining today; the energies and the strong sense of history in there felt too big for me somehow and I wanted to leave fairly promptly. Its interesting how extra-sensitive I am when I’m like this. I clearly knew where I wanted to be and where I didn’t and there was no arguing with it today. It was nice to see some friendly faces but I was far less conversational than usual.

So, physically, I did notice I was terribly out of breath today. I assume this is part of the worsened orthostatic intolerance as I had terrible episodes of blood pooling to my feet when I stood still for even a moment (keeping steadily moving works out much better). At one point, I felt it all literally drop from my head to my shoes as I stood waiting to be served in a flower shop, as the assistant slowly wrapped my flowers, and I should have really stepped out and asked my husband to pay for them whilst I went off to find a bench but I struggled on through (this was right before my Visible alarm went off). That was at the very end of the trip and I was on my last legs walking to the car. Thankfully, it is only a very short car journey and I was zoned out for most of it whereas I had paid full attention all the way there. That was about three hours out of the house in total and it felt like a marathon!

There is no denying that being out for this long, albeit with a long break for lunch and sitting down a lot, was a huge triumph because, even right before my crash, I would often spike my Visible app from ten minutes of everyday overexertion such as changing clothes or standing at the sink getting washed. It seems my several weeks of resting and striving to keep under that limit has built some improved resiliency back into my system, which is what it’s all about.

I knew as soon as I got home that now absolutely had to rest and rest a lot. With just 5 or so points left in my pacing budget (my daily PacePoints) and it was only 3pm, plus the knowledge that those points would now go down at least twice if not three time as fast now I was so tired (this is how energy expenditure seems to accelerate once you reach that exhaustion point…), I had to build in some white zones (resting phases) for the next few hours and as a matter of urgency so I went straight to the sofa to lie down.

However, this is where I hit my first hurdle as my system was so amped-up from the overstimulation of spending a very different morning to usual that I found it impossible to ramp it down again. Though I made myself a comfortable nest to go to sleep and settled down as I usually would, my brain simply wouldn’t switch off and my whole body felt like it was still being active…a factor then proven by the Visible which showed me I had achieved absolutely no rest at all after several hours of closing my eyes or trying to be still. It took a total of around 4 hours for my nervous system to settle down again and for accompanying arrhythmia to cease. This is another typical factor of overexertion for me (I experience ectopic beats when I am overtired, typically late afternoon or in the evening, sometimes overnight) and this can be hugely distressing not to mention disruptive when you are trying to get some much needed rest!

The arrhythmia response to overexertion shows that the Visible app doesn’t warn for all the various repercussions of overexertion because, as far as it was concerned, I was doing fairly well and had avoided going over my exertion heart rate almost all of the time I was out, though the factor it did warn about was using energy too quickly (it had warned me a couple of times that I was using up PacePoints too fast for keeping under my daily budget). That Visible isn’t yet infallible is something to be aware of as you start to push your boundaries; you do still have to use what you know about your body and common sense. In essence, it provides useful data and its down to you to make good use of that. Sustaining an activity too long can be just as detrimental as going over the exertion limit and, besides, there are always cognitive and emotional sources of “overdoing it” that it simply can’t take into account. Its best, therefore, to aim to stay at something like 60% of your perceived energy capacity to allow a buffer zone for extra stresses…and to keep activities to no more than an hour or two from beginning to end to start with (not the three that I had just put myself though); memo to self!

Meanwhile, my Garmin tracker watch showed I had been in severe unrelenting stress all day, with long-sustained medium stress most of the time and a few brief highs plus it also counted some fairly modest movements during my day as “exercise” which means, as far as my body was concerned, these must have been as exerting to me as a jog or a workout to someone else (remember, its all relative). What I suspect “got me” wasn’t so much the level of exertion (measured by heart rate) but the length of time it was sustained for, indicated by the overall pace points it used up in one go (the PacePoints meter did, in fact, warn me I was ahead of target using up my daily quota of energy, as I just mentioned) plus all the other kinds of stimulation I already covered above, the impact of which can’t be measured. Worth noting is that I apparently used up 4 points out of my daily target of 14 (a staggering amount!) just getting ready to go out so the activity tends to begin long before you have even gone anywhere!

True to form, the remainder of my daily PacePoints budget was gobbled up in very quick time once I started to move around again. I suspect that, once the ANS becomes so fired up from the initial overexertion, it starts to use multiples of the usual amount of energy to carry out everyday things; probably because it is now in a state of sympathetic overload and very probably running on aerobic energy production methods too. A sign of this can be sudden stiffening of muscles (hypertonicity) indicating excess lactic acid, something I very frequently experience after very moderate exertion.

These factors, of course, are what then feed back into the state of PEM that is a delayed distress response by the body hours, or even days, after the exertion itself. Not being able to tell if you’re overdoing it at the time you are in the exertion phase loads every activity, however minor, with added risks because its as though you are operating blind with no gauge with which to monitor or measure the likely after effects. This risk is then multiplied many times over once you start to extend the degree and the range of exertions as you begin to explore “normal” activities again, to which you are now, effectively, deconditioned.

This means that, at the time of doing the thing, you really have to be spending far more time listening to THE most subtle clues of overdoing it, with the risk that this detracts from the enjoyment of doing whatever it is. In fact, you have to pretty much assume that you’re already doing too much, even without the obvious signs that you are, thus always egging things towards being on the smaller side, until you get the after effects right. This inevitably makes you feel like you’re always having to curtail things that you’re enjoying, though worth it if you then manage to get home unscathed.

It’s clearly still work in progress for me as I didn’t quite achieve it this time. A couple of days later and there’s no doubt that, as well daily arrhythmia being back on the scene and feeling dog tired every day since (really struggling to get up again, needing many more naps), I’m experiencing pretty strong PEM as I’m back to much reduced functionality at the moment, hopefully temporary but its impossible to ignore. I am certainly in a lot more pain with extremely hypertonic muscles, affecting everything from neck stiffness and therefore much nerve impingement to gut motility and bladder to having restless legs in bed. I guess my previously relaxed body is having to overcompensate for hypermobility and low blood volume again in a renewed effort to keep me upright against the odds. One of the symptoms to come on more strongly than I’ve even had all these weeks of being physically disabled is the cognitive fatigue or “brain fog” which is proving to be quite severe this week (its taken such a lot to write this post and I keep having to close down the lid of my laptop and succumb to the need to sleep after a few minutes of writing). This is flagging up to me one of the big dangers of upping the amount of mental stimulation too soon during an ME/CFS crash as I suspect that doing so could be a big factor in things taking a much more serious downturn if the brain is rushed or pushed!

It can be so galling and disheartening to feel like the brakes are being put on again but the point is learn and to keep working at getting it just right until you can manage a few extra things within your energy envelope or, if that is still proving far too much, to pull back again until more stability is achieved.

At this stage of my recovery, excursions like this will have to remain very much the rarity but it’s better than not having them at all. I do feel like I’ve learned far more about my limits these two months than ever before. Its also been fascinating to acknowledge just how many years I have been experiencing what I’ve just described and yet how, for years, I had no real handle on how much it was putting my ongoing stability at risk if I kept shrugging and pushing through…not until I had the Visible app to show me the moment to moment impact on my body.

One last point I want to make about the risks that come along with trying to reintroduce yourself back to life at the right pace for you: be prepared for a possible lack of understanding from other people in order to ensure that this doesn’t become another factor risking set-back. Let me explain what I mean by that.

For starters, you are probably used to people in general not taking your condition all that seriously if you have lived with ME/CFS for a while. They likely don’t ask after you, like they often check in with other people with other more accepted conditions, because they assume there is nothing much wrong with you, though how you can struggle to so much as leave the house without there being very much wrong is a mystery to me. But, because you are likely not deemed to be at great risk or in desperate struggle by people who totally misunderstand your condition, you can pretty much guarantee you will fall off people’s radar once you haven’t been out for a while…but then the converse can happen just as soon as you try to come back out of your shell, which can be equally detrimental because you are back in their attention.

Because you can bet that, as soon as they know you have been out again, even for a short experiment, they will likely assume you are “back to your old self” and both willing and able to join in, show up or take on the responsibilities of the outside world. This is very far from the case at the point you are just starting to experiment with going out for a short while so…my advice is…don’t ever broadcast the fact. The very last things you need are assumptions being made about how you obviously weren’t that bad since you are apparently fine now or how much better you are now since you have just been seen out and about, so simply don’t provide any fodder for that kind of speculation. The merest photograph on social media of you sat smiling doing something “normal” and they will be back onto making all those grossly unjust assumptions about what ME/CFS is or isn’t (especially given the curse of the invisible illness) so my advice is to keep a low profile and don’t make any big announcements while you are in this phase…you simply don’t need the added pressure on top of the efforts you are making to gather enough energy for doing a few more things at your own unique pace. You certainly don’t need anyone making demands of you at this stage!

Below, I just want to add some more information gathered about why PEM happens and the degree to which someone with ME/CFS is uniquely likely to crash after a single bout of exertion, without the same ability to rest and recover themselves back to normal again that is apparently possible with all other comparable fatigue-inducing conditions. Understanding this may encourage you to go easy on yourself and allow for the extra long recovery phases after any unusual exertion, even when you haven’t gone over your exertion limit, because the after effects are still going to be far stronger and longer than you probably expect them to be in your case (which is why, though keeping within your energy envelope is crucial, pacing is still THE most important thing).

For instance, this article discussing the unique exercise intolerance that is a big part of ME/CFS refers to numerous past studies “that indicate that people with heart failure, pulmonary hypertension, end-stage renal disease, cystic fibrosis, mild-moderate COPD, and stroke can all jump on a bike and exercise to exhaustion one day and then hop on the bike again the next day and generate the same amount of energy”. However  “not so” with two ME/CFS patients used in a similar study as “exercise one day whacked their ability to exercise the next day”. (This latter from a study involving six women which included “a sedentary but healthy person without fatigue, an active person without fatigue, a person with multiple sclerosis (MS), a person with HIV, and two people with ME/CFS, one more highly functioning than the other and yet the higher functioning individual came out even more poorly than the other ME/CFS one in the second day test).

“The exercise scores of the lower functioning patient suggested that any activity more intense than slow walking, standing while washing dishes, or playing a musical instrument” was likely to “trigger excessive activation of (her) impaired oxidative metabolic pathway”. The outcome was that while the MS and HIV patients and healthy controls adapted to the exercise, generally getting stronger during the second exercise test “the ME/CFS patients significantly declined in just about every parameter.” It also took far less to reach the anaerobic threshold on day two for those with ME/CFS compared to other participants who were able to meet the same level of exertion as the previous day.

“The MS patients’ physical and mental fatigue did rise 8 hours after exercise, but both were back to baseline within 24 hours.  At no point did the exercise bout increase their pain levels. The ME/CFS patients, on the other hand, immediately experienced increased levels of physical and mental fatigue and pain after exercise that were still present 8, 24 and even 48 hours later. Plus, exercise evoked different patterns of gene expression.”

All of the above taken from The Exercise Intolerance in ME/CFS – Is it Unique? – Health Rising

Another factor that feels entirely consistent with my experience is this: In the case of ME/CFS, the body just doesn’t seem to know how to ramp down after exertion! “There’s some evidence that the body has trouble turning itself off, thus possibly keeping the healing process from kicking in as quickly as it should and allowing the damage to spread. Perhaps a signal, or signals, that tell the body to come off its exertional state don’t get fully produced, or are not responded to, leaving the body in a kind of jacked up and ultimately exhausted state.” (See article Post-Exertional Malaise Busters for ME/CFS, FM and now Long COVID – Take II.)

Another matter that feels on topic is, are heart arrhythmias, which are extremely common in ME/CFS, something to worry about?

“Two heart-related things appear to be going wrong in chronic fatigue syndrome; one, the ‘stress nerve’ is firing more quickly than it should be, and two, the vagus nerve is firing less quickly. Put those two problems together and you have a heart that doesn’t get the rest it should. Clearly, if the heart is not resting, the body’s not resting either”. This from ME/CFS specialising cardiologist Dr Visser who believes this imbalance between the sympathetic nerve and the vagus nerve is likely causing the increased number of arrhythmias that he’s found in ME/CFS.

Other potential factors discussed in this context are possible higher catecholamines in the blood of people with ME/CFS (as suggested by studies), lower blood volume in ME/CFS patients, as documented in his own patients by Dr Visser, meaning the heart compensates by beating faster, and also possible immune activation (see this related article Exercise Triggers Major Immune System Letdown in ME/CFS).

All of the above, based upon the work of Dr Visser, is taken from the article Heart Palpitations, Heart Pounding and Heart Fluttering – Oh Lord!..A Cardiologist on Heart Racing and Arrhythmias in Chronic Fatigue Syndrome – Health Rising

The general consensus is that ectopic beats are harmless if the heart is otherwise healthy but the best advice is to always check these things out with a medical expert and not assume anything, to be on the safe side. They can also be extremely bothersome and I know, in my case, that they coorelate more or less directly with how much I have been overdoing things as, besides the latest onset since my trip out on Saturday, I was experiencing them a lot at the beginning of this crash before I started to rest up and pace and at other times I have had minor crashes earlier in the year. In a sense, I get to use them as a cue that its time for me to pull my exertions back in for the time being or to at least modify which part of the day I do them in (afternoons are unfailingly my most arrhythmia prone times and also the time of day when I most need to stop, lie down and take naps). It’s irksome to feel so constantly tugged back from what you really want to be doing but there is really no choice but to listen, as I am working so hard to do.

Disclaimer: This blog, it’s content and any material linked to it are presented for autobiographical, general interest and anecdotal purposes only. They are not a substitute for medical advice, diagnosis, treatment or prescribing. Opinions are my own based on personal experience. Please seek medical advice from a professional if you are experiencing any mental or physical symptoms that concern you.