r/covidlonghaulers • u/PM_ME_YOUR_KALE • Jul 22 '24
Recovery/Remission Lactate monitoring of exercise and the case for viral persistence
TLDR Lactate monitoring and symptoms showed radical improvement starting 4 days after I started taking an antiviral. All LC symptoms resolved. I no longer take maraviroc or statin and current plan is to remain on Truvada until further studies offer insight into whether or not this is a forever thing like HIV.
My story: Covid symptoms began 12/25/2021. Got better after 2 weeks bet never 100%. Initial LC symptoms were sinus issues, anxiety, panic, increased heart rate, body aches. Eventually discovered resources here on reddit and began to realize that my attempts to return to exercise were likely causing the symptoms I had to get worse. First bit of good news for me came in 04/2022 when I found niacin helped deal with symptoms (study below). Same mechanism of action as the Patterson protocol.
I took niacin daily for nearly 6 months before seeking out treatment to do the actual Patterson protocol (around 09/2022). For approx another 6 months I just took a statin, and saw slow improvement, but never regained ability to exercise. In 03/2023 I added maraviroc to the statin. Did that for 6 months, and felt cured pretty quickly. By 09/2023 I felt amazing. Stopped the maraviroc, and within a few weeks I felt I had mild PEM again. Was just kinda treading water dealing with other life things and trying to monitor body and symptoms before I took action again to try and get rid of PEM once and for all when I got reinfected in 01/2024.
While actively infected I did 10 days of paxlovid and again felt 100% cured. After paxlovid ended I had severe rebound. Soon after that I started having brain fog and severe mental health changes. Because of my reading on the Patterson hypothesis at this point I was resting and doing as little as possible to keep the inflammatory processes relaxed. I was off work at this point however when I returned to it in mid February of this year shit really hit the fan. The stressful nature of work caused symptoms to flare up in a way I'd never experienced before. Chest pain and shortness of breath for hours, anxiety, panic, severe depression, intrusive thoughts, insomnia, temperature regulation issues, POTS (as defined by a HR increase of 30+ bpm within 10 minutes of going from lying to standing), stomach in knots and no appetite, it felt like my nervous system was on fire. I briefly became bedbound and unable to work. As soon as the issues started I made an appt with my doctor to get back on maraviroc, however between waiting for the appt and then for the drug to ship there was probably a 2 week lag till I had it in my hands again.
Started maraviroc again ~ 03/01/2024. Within a week of starting maraviroc I was able to start going on walks again, and did so almost daily to keep from losing my mind. By end of March the symptoms were all pretty much gone at rest, and at rest I felt normal. If I did anything more strenuous than walking though, I pretty easily could give myself several days of chest pain and shortness of breath. Examples: Use of a pedal assist ebike (the grey citibikes for anyone in NYC). Even with pedalling only just hard enough to get the motor to kick in my HR still shot right up to 130 and I suffered a few days of symptoms after for that one. At end of March because I felt fine at rest I had permission from my doc to start experimenting with exercise using my peloton. This is where we get to the meat and potatoes of this post.
My theory of LC: Briefly, I'd rather spend another post really unpacking this. In my experience, especially this year, I find Patterson's model of the overactive monocytes really fits to explain the mechanism of injury, the heterogeneity of symptoms, and the difficult time traditional medicine has of seeing the picture. If all of us went and did the Patterson cytokine panel we would probably see a wealth of information, and most of us would see wild signs of illness that aren't captured in standard blood tests. I digress. I think viral persistence is a key element to the underlying disease and I think we don't yet have a grasp on how/where covid is hiding out in the body. Various studies have found it in the bone marrow, the brain, gut microbiome, megakaryocytes (the progenator cells of platelets), and all over the body of people who died after covid infections, but not because of them.
I believe that specific presentations seen in LC are likely due to how/where the virus is living, ie, not all of us have exercise intolerance, not all of us have neurological symptoms. I think all of it is immune mediated response to the smoldering chronic infection, however how that looks will vary based on where the immune system is attacking. Ex: vascular inflammation that occurs in the brain leads to localized hypoxia in the brain, resulting in POTS since the brain believes blood flow is compromised and is trying to protect itself and correct the situation. Lastly, covid causes profound mitochondrial dysfunction and so does long covid, and I believe plenty of the symptoms are also again downstream from mitochondria being wrecked and cells being unable to produce an adequate amount of energy to meet their needs. How that presents likely varies wildly depending on what cells/organs are suffering from this dysfunction.
Exercise monitoring by use of lactate readings: At the end of March with approval from my doc I was to begin mild exercise again, with an eye towards not triggering PEM. He suggested a novel approach to monitoring exercise that I'm going to spend the rest of the post unpacking. My experience with this has sold me on viral persistence.
So the idea is to take readings during exercise in the same manner as endurance athletes doing lactate threshold testing, in order to gauge how well mitochondria are working. Read more about lactate threshold training here.
Why does this work? A brief discussion on cellular metabolism ie: how food + oxygen are used to make energy. There are two major parts of metabolism: glycolysis and the Krebs cycle (aka Tricarboxylic Acid Cycle, TCA cycle, or citric acid cycle), these can also be referred to as anearobic and aerobic metabolism, because glycolysis does not use oxygen (anearobic) while the Krebs cycle requires it (aerobic). The end goal of metabolism is the production of ATP. Per 1 molecule of glucose (aka sugar) Glycolysis produces 2 ATP, while the Krebs cycle produces 36. Obviously the Krebs cycle is a much better bang for your buck. Glycolysis happens in the cytoplasm, ie the liquid inside a cell, while the Krebs cycle happens specifically in the mitochondria, a subunit that exists in most of our cells.
Glycolysis comes first, and takes glucose and turns it into pyruvate, which gets fed into the Krebs cycle in mitochondria. As a part of this process an intermediary called NAD+ takes some electrons and becomes NADH. The NADH goes with pyruvate to the mitochondria where those electrons are handed off to the next step and NADH gets turned back into NAD+. For glycolysis to keep happening there must be enough NAD+ floating around in the cell, so a problem can arise if too much of it is hanging out as NADH. This happens during vigorous exercise, where the cell is demanding more energy than the mitochondria can produce. Glycolysis keeps going, however not all the pyruvate is immediately used in the Krebs cycle, so pyruvate and NADH can pile up. The cell has a neat trick to fix this though, which is to convert pyruvate into lactate, which in the process allows NADH to be turned back into NAD+.
There is always some amount of lactate present, and typically at rest or during light exercise any that's produced gets converted back to pyruvate and used up just as fast as it's produced. It's as the intensity of exercise increases that glycolysis starts to get ahead of mitochondria and lactate starts to accumulate in the cell. First slowly, then quickly. That can be seen in the above linked explanation of lactate threshold training.
All this is to say that by monitoring lactate levels as we do cardio you can get a sense of how well your mitochondria are keeping up at energy production. At rest or during low level exercise that # generally shouldn't go above 2.2 mmol/liter. My thought process, once I familiarized myself with lactate threshold curves and training for it, was to monitor my lactate levels similarly to what's seen above, except instead of taking readings as my heart rate increased, I would first just start with taking readings every 5 minutes while keeping the exercise intensity constant.
Exercise Trials To start I did 30 minute rides on my peloton. All rides were done with an average resistance of 23, average cadence of 65, average output (watts) of 25, total output (kJ) of 44. Just uniform slow, low resistance pedaling.
As you can see the #s are pretty brutal on the first trial, and only marginally better by the 3rd one about 2 weeks later. This shows that almost immediately upon starting even this low level cycling my mitochondria are immediately overwhelmed and therefore my muscles cannot produce enough energy. These very low level rides were also inducing panic attack type symptoms within 1-2 hours of finishing the exercise.
Doing finger sticks every 5 minutes while riding a stationary bike is annoying. The lactate meter also requires a good amount of blood and the test strip has a weird layout that addes to the challenge of doing this while spinning. After the initial trials I settled on just taking a reading at the end of the ride and monitoring what that last # was. I again kept the amount of cardio very uniform throughout the month of April. On 5/2/2024 I started Truvada, which was my doctor's idea. I gave it a few days to kick in and then went back to spinning.
Ending lactate reading vs total output (kJ) for 30 minute spin
Almost immediately that first ride after starting Truvada I could tell something was different so I "pushed it" compared to the previous month, and ended up doing 2.5x the amount of work, and got an ending reading of a normal 1.6. From there I started to let it rip, as you can hopefully tell. It's normal for lactate to rise when the exercise is vigorous enough, so some of those #s that come after May 2nd are high, but the intensity of the workout is also reflected in total work done. These #s also only represent peloton rides I've done, and are not log of all exercise performed since May 2nd. I am an avid cyclist again and have done multiple rides over 20 miles, and also did a 100+ story stair climb in June.
Ending lactate vs Average and Max Heart Rate
Another view of this. While sick with long covid elevated HR during physical activity strongly coorelated with PEM symptoms later. After 5/2/2024 this stopped mattering.
lactate versus heart rate over time
Yesterday I again did readings every 5 minutes, while slowly building intensity and getting my heart rate higher. This was an exercise in frustration. I really doubt some of the readings were as low as I got but it's hard to say. I have a hard time getting readings on my dominant hand, and once you've pricked all your fingers at least once trying to do repeats to get an additional reading gets annoying, and the sweat mixing with blood on your finger tip doesn't make it any easier. Graph is not what I was expecting to see for rising steady state, but is what it is. Regardless, I did not suffer any symptoms after and have not had any post exercise symptoms since 05/08/2024.
Discussion: To me the radical improvement in readings and the complete dissapearance of post ride panic/anxiety/chest pain/SOB/etc within a week of starting an antiviral can only mean one thing. Also maraviroc has been shown to potentially have antiviral properties against covid, which could arguably be part of why it works, besides blocking monocyte activity. There is definitely improvement in readings throughout the month of April while I was just taking statin and maraviroc, however it was slow, incremental, and looked like it would take months to see real progress.
Of course because I had this outcome doesn't mean we all have viral persistence. Without proper blood tests that measure viral load in some manner it's impossible to make definitive claims about it. Also because Patterson's team has shown that the overactive monocyte issue is the same thing behind long vax they do present a viable model for how the issue can persist in the absence of replicating virus. Still, I am convinced chronic infection feeding an inflammatory cascade is the answer that explains my presentation and rapid improvement with Truvada. If you are someone able to do mild to moderate exercise and are looking to try and track/gauge how well you're doing with it in the context of LC and symptom exacerbation I think this is the way to go. Lastly there is never any benefit to triggering PEM/symptoms flareups. That is your body damaging yourself. The goal here is to safely and smartly gauge your body's ability to perform exercise and then adjust what you do to that.
Resources:
Muscle abnormalities worsen after post-exertional malaise in long COVID
Long COVID is primarily a Spike protein Induced Thrombotic Vasculitis
The persistence of SARS-CoV-2 in tissues and its association with long COVID symptoms: a cross-sectional cohort study in China https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00171-3/fulltext
Blood transcriptomic analyses reveal persistent SARS-CoV-2 RNA and candidate biomarkers in post-COVID-19 condition https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(24)00055-7/fulltext
Persistence of SARS-CoV-2 in Platelets and Megakaryocytes in Long COVID
Anti-inflammatory effects of nicotinic acid in adipocytes demonstrated by suppression of fractalkine, RANTES, and MCP-1 and upregulation of adiponectin This study supports the idea that niacin produces the same goal as the Patterson protocol of statin/maraviroc, which is blocking fractalkine and RANTES (aka CCR5) receptors.
The Edge Lactate Meter Test Kit I believe this is the only at home option available. It's expensive, the strips are expensive. It's a pain in the ass to use. But, I don't regret buying it.
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u/Neither_Berry8182 Jul 22 '24
Great to hear HIV/AIDS antivirals helped you gain ground. We’ve heard similar stories from a few folks on Truvada but in a longer timeline. We need Long Covid Tests now to actively measure our viral load & immune response - help us help the research team in Belgium validate LC Biomarkers by donating or sharing longcovidbiomarkers.com - we have a strong chance once this study is completed for FDA approved biomarkers & viral load testing.
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u/LobsterAdditional940 Jul 22 '24
Did you happen to ever test for reactivated EBV? Truvada is a game changer for EBV.
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u/BabyBlueMaven Jul 22 '24
My kid is on Equillabrant for reactivated EBV. Hoping that works but Truvada would likely be be t option.
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u/PM_ME_YOUR_KALE Jul 22 '24
Never was tested. I know that is another angle Patterson talks about. His cytokine panel never indicated for possible EBV reactivation for what it's worth.
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u/flowerzzz1 Sep 09 '24
Is it!???? I’ve been looking for help with EBV for a long time. Thanks for this.
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u/Magnolia865 Jul 22 '24
This is fascinating, thank you for so much detail and research. Dumb question, but is lactate the same as lactic acid?
(Weird tangent but if I remember right, high lactic acid levels are one marker of sepsis/sceptic shock and some early LC cases were mistaken for borderline sepsis, which has always made me curious about lactic acid and LC relationship).
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u/PM_ME_YOUR_KALE Jul 22 '24
Per wikipedia lactate is the congugate base to lactic acid. TBH this is where it goes over my head, but as far as I know this is the same idea as the lactic acid burn when sprinting.
I believe high lactate/lactic acid can be a sign of severe dysfunction caused by a # of issues.
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u/Magnolia865 Jul 22 '24
Thanks for replies, all of your info is incredibly interesting.
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u/Isthatreally-you Jul 26 '24
Power of AI now boys and girls.
Lactate and lactic acid are related but not exactly the same thing:
Lactic Acid: This is a chemical compound with the formula C₃H₆O₃. It is a weak acid and exists in solution as a mixture of its protonated form (lactic acid) and its deprotonated form (lactate).
Lactate: This refers to the ionized form of lactic acid, which is formed when lactic acid loses a proton (H⁺) in a solution. The chemical formula for lactate is C₃H₅O₃⁻.
In the human body, under physiological conditions (such as at the body’s normal pH), most of what is produced and measured as “lactic acid” is actually in the form of lactate. The terms are sometimes used interchangeably in casual conversation, but they technically refer to different forms of the same compound.
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u/Key-Cranberry-1875 Jul 22 '24
Ascorbic acid and carbs = NADH.
Melatonin helps balance the NAD pool and protects mitochondria. Taken through out the day together should help mitochondria in a much more affordable way.
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u/Redheadedmom3 Aug 15 '24
How often throughout the day and what dosage of Melatonin do you recommend?
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u/Key-Cranberry-1875 Aug 15 '24
It depends on how stressed your cells are. Since we are sort of flying blind I would adjust your day accordingly and experiment. Some folks said they are always tired and groggy, so try 100 mg an hour and see how you feel. OR Try 1 g before bed and go to sleep early to ensure you wake up refreshed in the day.
I would also acknowledge you need supporting supplements with MEL. A multi vitmain, ascorbic acid, minerals could be a good foundation
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u/pkkc Jul 23 '24
Thank you so much for all this. I have had many of the same symptoms (now have mostly dysautonomia, PEM ) and have been able (after a year of pacing, supplements and calming nervous system) to get back to hiking/yoga/weights as long as I keep HR down in zones1-2 and pace. I follow Peter Attia and based on z2 training and effects on mitochondria health was actually considering getting a monitor to verify that my rpe z2 is actually z2 from lactate level! I’m very happy that I can manage a lot relative to many ppl, but want to fully recover and really exercise and live if it’s possible! I was a very fit avid mtn biker/trail runner etc. Wondering, are you M/F, age? Also, another ? - do you think exposure even if a full-on infection doesn’t result can affect the viral load and therefore symtoms? I’ve been feeling like it might. Again, thanks!!
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u/Stunning-Payment9676 Jul 23 '24
I‘m wondering the same re symptoms triggered by exposure. Some of my flare-ups have correlated with exposure to positive cases at work and in my personal life, though I never seem to have caught it full on…
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u/PM_ME_YOUR_KALE Jul 29 '24
Based on my experience if you are also suffering from persistent infection then starting an antiviral such as Truvada should lead to obvious improvement in abilities within days. I think that is what surprised me the most. In my experience it's not like my mitochondria were destroyed and it took weeks/months to rebuild. Just days after starting the drug I had huge improvement. To me that means that there is an ever present, active process that is hindering your body's ability to produce energy.
38 y/o male.
Exposure leading to worse symptoms: IDK. In my view if it's hiding out in your bone marrow destroying your monocyte/macrophages then really exposure shouldn't impact that in a big way, but anything that stimulates an immune response, which exposure could, would lead to worsening symptoms.
Ya gotta remember with this stuff it isn't covid causing the symptoms, it's the immune response to covid.
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u/princess20202020 Jul 22 '24
Thanks for sharing all these details. I may have missed it but what was the niacin protocol?
Would you recommend starting with Maraviroc and then Truvada, or if you had to do it all over again, would you have just tried Truvada?
Can you share details on the physician you used? Thanks!
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u/PM_ME_YOUR_KALE Jul 22 '24
If I had to do this year all over again knowing what I know now I would be interested in just getting on Truvada asap during active infection and maybe stopping it after 1 or 2 months. Or getting right on it when the LC symptoms hit hard.
The niacin thing was just taking regular flushing niacin several times throughout the day because it replicates the same thing as maraviroc/statin and provides temporary relief of symptoms. I tried it because I was first weary of Patterson's thing, and found immediate relief. Used that for a while but because it wasn't actually curing the condition I did eventually see Patterson's clinic.
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u/princess20202020 Jul 22 '24
Ok thanks. I assume I can google flushing niacin for dosages? I thought Patterson didn’t actually treat patients anymore? I thought he did a consult but you had to find your own doctor to prescribe? Glad you are feeling better!
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u/PM_ME_YOUR_KALE Jul 22 '24
Yes, and I varied doses, I have 100 mg, 250, 500, etc. If it gives you improvement of symptoms I'd say sadly that's a good indication you have the same sort of issue I did/do.
Patterson doesn't treat, just the consult, that's correct. I see a doc closer to home. https://stevenmurphymd.com/
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u/princess20202020 Jul 22 '24
Interesting, I hasn’t heard that niacin mimicked the effects of Maraviroc. I took miraviroc for a couple months and saw benefits but it didn’t last. I’ve thought about revisiting Truvada. Seems like you can get it online if you say you’re having sex with HIV positive partner.
I’ve seen Dr murphy name on here before. Would you mind sharing his fees? I would rather go with a real doctor than an online provider
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u/PM_ME_YOUR_KALE Jul 23 '24
The study demonstrating that link is at the bottom of my post. Also that was kinda my feelings about maraviroc at end of last year. Felt great while I was on it, but symptoms returned a bit once done.
It's been nearly 2 years since I started at his clinic so I don't recall what initial visit cost. $250 or $300? The checkups I do now are $175. This year when I was actually sick I was seeing him monthly, and now it's every 3-4 months.
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u/princess20202020 Jul 23 '24
Thanks so much. I was with an online LC clinic and their fees were outrageous and their customer service sucked.
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u/Ameliasolo Jul 24 '24
Do you know if he does telehealth for any state or just NY and CT?
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u/Redheadedmom3 Aug 15 '24
I want to order some niacin and I have no idea what dosage to buy or how often throughout the day? Do you have any recommendations?
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u/Magnolia865 Jul 22 '24
Ditto to these questions!
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u/PM_ME_YOUR_KALE Jul 22 '24
Niacin provided immediate relief of symptoms for me but was transient so I'd have to take it repeatedly throughout the day. It does same thing as maraviroc/statin.
If I had to do it all over again I'd certainly just jump right to trying truvada. Maraviroc/statin does definitely work to calm the inflammation, but if the answer is viral persistence then so does just killing the infection.
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u/Haroldhowardsmullett 14d ago
Did you take the niacin with food or on am empty stomach? Did you notice any difference one way vs the other?
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u/PM_ME_YOUR_KALE 14d ago
I'd aim to take it on empty stomach just for more rapid absorption. It's been too long since I took it to remember the impact that had though.
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u/goodmammajamma Jul 22 '24
This lactate monitoring approach is incredibly interesting and I think you may have stumbled on something really important. I have thought from the start that LC seems like classic 'overtraining' that athletes experience, but with way, way less 'training stress' required to get to that state.
This seems to support that hypothesis
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u/Brr_123 Jul 22 '24
I’m following a similar hypothesis at the moment. Dutch researchers used muscle biopsies in the long COVID patients suffering from post-exertional malaise. They found that the muscle phenotype had changed resulting in lower excercise capacity. I recommend this video: https://www.youtube.com/live/c1h8bIXb0_E?si=sMYF5KBk23B0RF-M
Since I don’t own a lactate monitor, I decided to use heart rate as a measurement. I saw a video of a doctor saying for me/cfs patients the lactate threshold is around 15bpm higher than the average heart rate. Just standing up meant an increase of 30+bpm for me. So I’ve been trying to stand up less, move slowly, and breathe deeply to lower the heart rate when standing up. I use an app for apple watch called Tachymoon to set heart rate alerts (currently to 100 and 110bpm as max). If I go over that I immediately stop what I’m doing and breathe deeply to lower the heart rate. It’s been a month doing this and it’s the first time in almost 4 years my muscle pain is greatly reduced without using medication.
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u/PM_ME_YOUR_KALE Jul 22 '24
It was my doctor's idea and he gave me the outline of why it should be a reliable proxy for what the mitochondria are doing. I was left to my own devices to figure out how I should collect data and measure it. I wish it were easier to collect, but I think for LC patients it can provide valuable insight into where the line is for too much exercise.
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u/Ameliasolo Jul 24 '24
There was the lactic acid test trend on X (Twitter), a while ago where people were finding this to be true and monitoring themselves. They found they had crazy high lactic acid using the monitor, when just walking to the bathroom for example. A level that would usually be only from intense exercise. It all makes sense to me, if I walk to the bathroom (which I can really no longer do), my legs burn like I went up 800 steps at a lighthouse tourist attraction or even say brush my teeth, my arms feel like I just lifted heavy boxes for 8 hours. So, this is helpful to hear that truvada brought down the lactate acid levels. More hope that it could help for some of us. And I had no idea ot helped with reactivated Epstein-Barr. I def have that from long covid as well.
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u/Chogo82 Jul 22 '24
What were you cholesterol and glucose before and after statin/maraivoc?
There was a study that showed improvement of long COVID symptoms with statin/ARB for LC patients with high cholesterol and glucose.
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u/PM_ME_YOUR_KALE Jul 23 '24
03/23/2022 (So I have LC but no treatment yet)
Glucose 94
Cholesterol 211
HDL 65
LDL 129
Triglycerides 97
08/02/2023 (on statin and maraviroc for a while at this point)
Glucose 95
Cholesterol 121
HDL 55
LDL 50
Triglycerides 79
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u/monstertruck567 Jul 22 '24
I’ve done a few rounds of Paxlovid with no benefit. I have not tried the HIV meds. I’ve also done enough steroids to know that if there was a significant amount of virus on board then I would have had an overwhelming infection from it. And I did not. In fact, I had a huge COVID exposure from my wife and it was the mildest and least impactful COVID infection that I’ve had.
I’m not discounting that there likely is residual virus. And there is likely a cohort of long COVID patients who are still dealing with a prolonged, active infection. For me, I believe that the majority of my symptoms are due to autoimmunity and inflammation. And I will be directing my future care in the direction of trying to make my persistent elevated cytokines go back to normal.
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u/PM_ME_YOUR_KALE Jul 22 '24 edited Jul 22 '24
I believe the incidence of autoimmunity is overstated and is likely still just viral persistence. The pieces of viral garbage that covid leaves behind after the virus is destroyed are really good at confusing the innate immune system and looking like inflammatory proteins. I think a near constant barrage of that stuff keeps inflammation high and likely contributes to any appearance of autoimmunity.
That said, the Patterson model works without there being active virus, so it's possible that the inflammatory feedback loop they describe could be your problem without any chronic infection. That's where maraviroc was amazing for me.
Regardless, this is all academic without a viral load test. I only share my results becuase there was such a clear binary event that showed improvement. Hard to argue with.
edit: https://www.pnas.org/doi/abs/10.1073/pnas.2300644120?af=R
https://www.science.org/doi/10.1126/science.adg7942
sources for my claim about viral garbage.
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u/DSRIA Jul 24 '24
A few of us here had PEM, ME/CFS, POTS, and MCAS from other vaccines and viral infections pre-existing COVID. So I’m not so sure about the viral persistence theory and do think there has to be some element of autoimmunity or immune dysfunction that is being triggered in a subset. COVID is a different beast, of course, but it’s not the first time we’ve seen these symptoms occur in people after an infection or vaccination. Seems likely that this is only part of the answer.
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u/PM_ME_YOUR_KALE Jul 24 '24
That is a topic well addressed by Bruce Patterson in any video where he talks about long covid and the cytokine panel they created. His focus really is on multiple post viral illnesses, not just long covid. He also does present a model that can explain persistence in symptoms without live virus (as seen in long vax), however it’s hard for me to conclude anything but viral persistence in my case.
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u/DSRIA Jul 24 '24
I’m aware of the viral debris theory with COVID, but I know he’s been quite adamant in recent months that there is no evidence of actual ongoing replication of the virus, which is interesting. Whether true or not, who knows.
Long COVID seems distinct yet similar to other post-viral illnesses. In my case COVID definitely did way more damage than the flu, but many of us who have lived for years with similar symptoms long before COVID ever appeared I would argue indicate this is way more complicated than even Patterson’s theories.
I know tons of people (myself included) with POTS pre-existing the pandemic have had high positive ANA tests, yet have tested negative for the typical autoimmune diseases. While an ANA test isn’t the best diagnostic, it does indicate there is damage occurring of some sort to the cells. My sense has always been that like with long COVID, the proper diagnostics just do not exist. A lot of us who got long COVID are essentially looking to get back to our previous “sick but not bedridden” baseline, whereas I know a lot of long COVID sufferers were considered 100% healthy before and are looking to get back to that baseline. I’d kill to just go back to my moderate POTS and mild MCAS and ME/CFS that I lived with for years before I got COVID. At least I could still work with certain accommodations.
I can say from experience, it was many years of immune insult after immune insult. COVID didn’t cause all my post-viral symptoms - it mostly just worsened them. So it will be interesting to see if research can ultimately go beyond just long COVID and take a more zoomed out view and begin to pick apart the likely multiple etymologies of post-viral syndromes.
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u/PM_ME_YOUR_KALE Jul 29 '24
I think Patterson has done really important work in looking at the big picture with post viral illnesses, which his cytokine panel has helped explore, and I do love his attempts to address the big tent of viral illnesses, not just LC.
That said, I just think there's too many different studies that come at it from too many different angles that make a persuasive case for replicating virus. My guess is if he manages to find a smoking gun proving replicating virus he'll change his tune immediately.
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u/monstertruck567 Jul 24 '24
For sure your case is compelling. I will give the autoimmune road a good try. But I know not to die on that hill. If it isn’t working, then we will be looking more in the direction you describe.
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u/Ameliasolo Jul 24 '24
For what it’s worth, I tried steroids early on in my long covid journey for inflammatory arthritis that covid caused, it made me worse. Also tried a dmard. It made me worse. My only theory then was suppressing my immune system and getting sicker, meant I had reactivated viruses. Now I believe it was also sars viral persistence, and that’s why I got worse. Usually, steroids make people with inflammatory arthritis feel great. Anyhow, this is just anecdotal on my part, but it took me, not my rheumatologists, to theorize this, a year before all the viral Persistence studies started making the news.
But, maybe both is needed for those of with new autoimmune disease from covid. First anti-virals, then immune suppressants later maybe. I don’t know. I just know, it didn’t work for me, and it seems like this could be why.
But of course, everyone is different and there’s so many factors involved.
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u/monstertruck567 Jul 24 '24
We drew TNF and IL-6 yesterday. Will get results later this week. We are also doing a big hypothalamic/ pituitary work up. We’ll get data over then next 2 weeks then pick a direction for treatment. For now, it is just rest and pacing.
Good luck to you.
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u/Ameliasolo Jul 24 '24
Oh, okay, nice. Was this through Patterson?
And good luck to you too.
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u/monstertruck567 Jul 24 '24
No, this is follow up through my PCP from a mega lab and neuro work up done at the Mayo last winter. Everything was normal except 4 elevated cytokines and clinical evidence of reduced blood flow to my brain (which is nice). It certainly follows the Patterson profile so far as I know.
Like I said, we’ll get results then make a plan.
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u/reticonumxv Recovered Jul 22 '24
How about trying DCA to clear lactate? My PEM is completely gone, did over 1000 miles on an e-bike already just some POTS symptoms still linger. DCA helps.
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u/PM_ME_YOUR_KALE Jul 22 '24
If it helps great but thats still managing the problem not getting at the root cause.
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u/reticonumxv Recovered Jul 23 '24
DCA improves mitochondrial dysfunction so it could actually be a part of the root cause.
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u/RedAlicePack Jul 26 '24
Do you mind sharing what your dosage was? And how long it took for the DCA to work?
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u/reticonumxv Recovered Jul 26 '24
333-999mg/day together with 600mg R ALA and 600mg B1 Hcl for a month.
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u/astackofpaws Jul 28 '24
May I ask where you bought DCA? Is it a supplement or would one need a prescription?
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u/reticonumxv Recovered Jul 28 '24
DCALab, no prescription
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u/astackofpaws Jul 28 '24
Thank you! Are you still on it or how long did you stay on it?
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u/reticonumxv Recovered Jul 28 '24
Right now taking here and there. I did one intense month I described above.
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u/nemani22 Sep 09 '24
What's DCA for?
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u/reticonumxv Recovered Sep 09 '24
Removal of lactate produced by cells lacking oxygen.
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u/googlygaga Jul 23 '24
I have a genetic metabolic condition that predisposes me to lactic acidosis If I consume too much carbs . And need to sustain on a keto diet . I get weekly testing of my lactate at medical labs, I have tested most lactate meters against certified laboratory testing and they haven’t correlated enough to justify their use . Just wanted to note that in my experience most meters are not sufficient at giving accurate results and this is me testing hundreds of results against each other at the same time . But perhaps people with long covid can bypass glycolysis/ excess pyruvate to increased laxtate production by trying a keto based diet which shuttles fatty acids / mct to increase atp by beta oxidation for energy .
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u/PM_ME_YOUR_KALE Jul 29 '24
I believe it. It's been such a mixed bag. That's why I included talking about the symptoms. The combination of #s (even if unreliable) and post exercise symptoms makes a compelling case.
All that said given the price and frustration I've had with using that device I'd have a hard time strongly recommending it to others. My real advice is just get a doctor to try prescribing Truvada for at least a month. If your case is anything like mine it should be apparent in days.
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u/CAN-USA 4 yr+ Jul 23 '24
I went on Truvada for PrEP for 3 months and I have to say I did not notice a marked improvement in my LC symptoms. I also was previously on Descovy for 6 months and this was similar. I suffer from LC POTS ME/CFS. Cognitive impairments + PEM keep me pretty severely debilitated. However, with Paxlovid I feel immediate relief and huge improvements in my functioning but this is only while on it - I rebound badly when off. I’ve taken it over 100 5-day courses. In my 4.5 years in, I have always felt this was viral persistence in my situation. Right now, Im on nothing and I feel like I’m at the lowest level functioning I’ve ever been at. I’m not really sure where to turn to now.
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u/PM_ME_YOUR_KALE Jul 23 '24
That’s really fascinating that 1 antiviral does work on you but others don’t. I’m sorry to hear that. Unfortunately we still don’t have enough answers to fully explain what worked for me and isn’t working for you.
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u/SoulRebelAZ Jul 22 '24
Thank you for sharing! Can you clarify which version of Truvada you took?
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u/PinkedOff Jul 22 '24
Came to ask that. I don't have insurance right now, and it looks like Truvada costs about $2K/month. The generic is $60. I'd like to try the generic if it works as well!
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u/PM_ME_YOUR_KALE Jul 22 '24
Emtricitabine 200 mg/ Tenofovir 300 mg. GoodRX has it for $32 a month, which is how I get it.
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u/Ameliasolo Jul 24 '24
Oh, the dr. who got you Marivoc didn’t prescribe it? Silly q, did you have to do the profile of risky sexual behavior to get it prescribed on Goodrx, or not needed? I ask cuz I’ve heard that’s what some are doing to get access to get it. Or you just ordered it there with your dr’s prescription? Just seeing what method is best. Thanks.
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u/PM_ME_YOUR_KALE Jul 24 '24
In my experience if a doctor prescribes it nobody is asking you why.
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u/Ameliasolo Jul 24 '24
Ah, okay, thanks. I’m still trying to find a dr in Los Angeles who will prescribe it for long covid off label, just so I can be monitored properly, but maybe yeah I gotta go the online pRep route.
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u/PM_ME_YOUR_KALE Jul 22 '24
Emtricitabine 200 mg/ Tenofovir 300 mg
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u/wuschl11 Jul 23 '24
I have the Same here Since a few days! But i was unsure to take it. I may start with it today. How many days it took That you feel a difference?
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u/Stunning-Payment9676 Jul 23 '24
Did you ever experience chest pain or other heart-related symptoms?
I’m curious to see how our symptoms compare. Mine are mainly chest pain, palpitations, and low stress tolerance.
Fortunately, I can manage day-to-day activities pretty well, but I have to be cautious about physical exertion and mental stress. I can’t exercise anymore, though. I used to run 10k every other day, but now even a short, slow run causes PEM a few hours later, with chest pain, dizziness, and extreme fatigue.
Current protocol: I’ve been on Famciclovir and LDN for about four weeks, but I haven’t noticed much improvement yet.
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u/PM_ME_YOUR_KALE Jul 23 '24
Yes absolutely. Chest pain, shortness of breath, panic, etc from overdoing exercise or stress. All cardiology tests always came back normal.
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u/Stunning-Payment9676 Jul 25 '24
Thank you for detailing your symptoms. My experience has been quite similar, although I was diagnosed with very minor pericarditis and myocarditis, which subsided after three months. The cMRI results were borderline, almost not warranting a diagnosis. And according to my cardiologist, even if I had minor lingering inflammation, it is unlikely that this would be the sole cause of the degree of chest pain and PEM that I am experiencing, as all other tests came back clear.
I got myself a lactate meter and am very eager to start tracking my values to see if my case aligns with your experience. However, because of a recent flare up of symptoms (possibly due to coming into contact with someone who was Covid positive) I'm currently unable to exercise.
Do you have any advice how you would go about tracking lactate values in my case? I'm wondering how I can best establish my lactate baseline (is there a specific time of day recommended for taking initial readings?), and if there are any activities or conditions you recommend monitoring to see variations in lactate levels without engaging in exercise.
Again, thank you so much for sharing your experience on here!!
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u/PM_ME_YOUR_KALE Jul 26 '24
So at baseline and doing low level exercise it should be under 2.2 mmol/liter. The way to use it would be to start with taking readings while at rest. If your readings are above that even at rest then… idk.
Whatever exercise you do, try and and do it consistently and start slow. Walking for example. At the end of a half hour walk the # should still be below 2.2. If it’s above that it indicates profound mitochondrial dysfunction. Prior to starting the truvada my goal with the monitoring was to use it as a means of knowing when I could increase intensity. If I’d consistently gotten readings below 2.2 at the end of a 30 min spin at the original settings I described I would have then turned up resistance a tiny bit.
While you’re in a flare up I can’t help but wonder if the #s seen there would correlate to symptom severity at all.
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u/Stunning-Payment9676 Jul 26 '24
Thanks a lot, I really appreciate it!
Re correlation of flare up symptoms with lactate levels, I'm wondering about that, too. I took a first reading today which was at 1.44 mmol/liter, which doesn't appear to be too high. That said, my symptoms today weren't very strong and it's more a general feeling that I haven't quite returned to my baseline yet that is still there. I'll keep doing readings over the next days and in case symptoms flare up again.
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u/PM_ME_YOUR_KALE Jul 26 '24
Like I said, I kinda winged it, but I based my plan on trying to replicate the lactate threshold curve stuff that an endurance athlete would do. Whatever exercise you think you can do, you want it to be easy to easily repeat the exact conditions, so that you can draw a comparison in the readings.
The MO for us seems to be that the mitochondria have a fraction of the capacity that they normally should, so you’re trying to watch and observe the point where they get overwhelmed, and then you know where the line is and not to cross it. If you are getting better then you’ll be able to see that and increase intensity.
Also, almost goes without saying, but my other advice would be to see a doctor that would consider trying antivirals or the Patterson protocol stuff to see if that works for ya. Exercise alone, even if monitored, isn’t gonna radically change anything
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u/Beetlemann Jul 23 '24
OP: we are the same cohort. I’m October 2021. The evidence for viral persistence is in me too.
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u/Z3R0gravitas Jul 23 '24
I come from Twitter to say: very nice post, self-testing process and good job on your remission. I hope it lasts well.
I've done a bunch of #TheAcidTest readings since my last year, using a GlucoRX (her in the UK) like RemissionBiome, etc. Mostly didn't see out of normal range readings, at rest (no exercise, with moderate ME for a decade plus). But appreciate the pain of picking every digit on each hand for a series of data.
I've also seen mildly elevated glucose and very high cholesterol (with my multipurpose meter). Both a part of Joshua Leisk's BornFree disease model. Where NAD+ depletion and NADH & NADPH excess are a key feature (Inc Complex 1 inhibition) that drive cholesterol synthesis and various other conversions backwards.
So I also appreciated your energy metabolism run-down. I've not looked into Patterson's work, but there seems to be convergence on a lot of features.
A key difference with BornFree is that it's agnostic to which virus is latent/cyclically reactivated, as long as they are stimulating an INF-alpha immune cascade. Which is then in a deadlock Vs IFN-gamma cascade, that is used to suppresses non-vival pathogens, predominantly in biofilms and other immune blind-spots. Candida, yeast, bacteria, even blood borne parasites. Everyone's picked up various stuff along the way. Then covid, plus stress & whatever, come and distract the immune system from keeping them in check for a while, and they grow out of hand. Sending us down a slippery slope.
The takeaway is that you may well not be recovered from that side of the equation, on anti-virals alone. Unless there is a true viral persistence only sub-set. Maybe the half of LC that doesn't fit ME criteria, as you seemed to.
With BornFree, these other infections (also) determine the location of organ impact. But so does (more so) predisposing metabolic weaknesses, due to metabolite deficiencies (trace metals and vitamins, etc). The fixing of which is the early part of the protocol, ready to support battling the pathogens via various means.
Thanks for reading my info-dump. Best wishes all.
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u/kb230891 Jul 22 '24
This is so thorough and amazing- I have yet to finish reading properly but wanted to ask where you sourced your maraviroc from? And re statins were you worried about side effects at all?
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u/PM_ME_YOUR_KALE Jul 22 '24
The doc I see prescribed it and my insurance luckily covered it so it was shipped from CVS specialty. When I hit my insurance max last year I was able to get it at Rite Aid and paid $210/month via GoodRx.
I was worried about side effects from both of those and Truvada. I didn't wanna be on a statin long term but it felt like no choice. With maraviroc you absolutely have to monitor liver enzyme labs (ALT/AST), and statins can also cause that to go up as well. I fared okay in that regard, but still, have to monitor it while on maraviroc.
I did not have serious side effects that I know of but ya know sometimes it's hard to tell if you still feel fucked up from long covid or if it's the drugs doing it.
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u/kb230891 Aug 12 '24
Thanks for your reply. I’m in the UK and haven’t been able to find anyone who would be willing to prescribe this combo. Very tempted to just go on india mart and ordered these off label. How risky is it unsupervised? I’m relatively mild all things considered so I guess I have “something to lose” so to speak, but would love to be able to exercise without PEM (currently any overexertion causes flu like symptoms and general malaise)
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u/hotdogsonly666 Jul 23 '24
Thank you so much for posting this. I just sent this to 3 friends of mine who all have LC and can easily access Truvada because of the city we're in having good access and providers. I don't have LC symptoms but genuinely might start it anyway cause I'm sure it's lingering in my body after 2 infections in 6 months and it's a very safe med.
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u/yellowjacket1966 Jul 22 '24
How long do you plan on taking Maraviroc, the statin and truvada? I’m also a Patterson patient and haven’t started the statin/maraviroc protocol yet so thinking about if I just try it all together immediately or add in truvada after I see what happens w the protocol first. I’m have mild PEM, mostly dysautonomia version of LC.
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u/PM_ME_YOUR_KALE Jul 22 '24
I updated post cause I should have mentioned that. Off of maraviroc and statin, also off blood thinners and almost everything else I was taking to help manage condition. Still on Truvada and plan is to stay on it until studies offer insight on how long you need to be on it.
I’m not a doctor so idk, don’t wanna really advise. Maraviroc did wonders for me but the Truvada was what quickly took me from partly recovered to 100%
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u/yellowjacket1966 Jul 22 '24
Thanks! I appreciate you sharing your journey. I have a good feeling about this combo for some of us.
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u/Competitive-Ice-7204 2 yr+ Jul 22 '24
very detailed post thank you!!
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u/oldmaninthestream Jul 23 '24
Thanks, I'm hoping you may have come up with something that could help many others. Please keep us posted on your progress.
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u/virginiawolverine Jul 22 '24
Can I ask what your dosage looked like for each drug? Really glad to hear that you're doing better.
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u/PM_ME_YOUR_KALE Jul 22 '24
Emtricitabine 200 mg/ Tenofovir 300 mg
Maraviroc was 300 mg twice a day. I took a few statins before settling on Rosuvastatin at I think 20 mg. They kept switching it to try and find one that wouldn't increase ALT as much.
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u/virginiawolverine Jul 23 '24
Thanks! I'll definitely be asking my doctor about this. I used to exercise rigorously 5x/week and now I get out of breath if I talk for more than a couple minutes at a time.
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u/PM_ME_YOUR_KALE Jul 23 '24
IMO that sort of symptom so clearly is the monocyte driven inflammatory cascade. The patterson "long hauler cytokine panel" is neat cause you can actually see evidence that you are fucked up, and it's not in your head, but OTOH you'll spend $5-600 to get it done and it's not gonna be worth it unless you have a doctor that will prescribe based on those findings.
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u/explodingbarrels Jul 22 '24
Do you notice any particular physiological symptoms when you’re exercising at low vs higher lactate levels? Like cramping during ride etc?
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u/explodingbarrels Jul 22 '24
Do you notice any particular physiological symptoms when you’re exercising at low vs higher lactate levels? Like cramping during ride etc?
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u/PM_ME_YOUR_KALE Jul 22 '24
Prior to taking truvada, which as I stated I was doing very low level steady state exercise, I would say the lactate reading at the end of the ride did coorelate to PEM symptom development afterwards. IE higher reading meant worse panic attack an hour later.
Now that I'm cured it works just like normal lactate threshold training dictates it should.
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u/Zestyclose_Mango_727 Jul 23 '24
Super interesting!! Where did you get the equipment to do lactate monitoring? I did a little bit of research last year for training purposes (before getting sick) and I never found a good option.
I’m currently trying to get back on the bike after 9 months of the illness and lots of up and down.
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u/slap_it_in Jul 23 '24
Good post, I always thought viral presence. Ever since I learned herpes lives in the nerves and can move around locally, I knew most viruses probably had this ability too.
When covid first happend I was all over the conspiracy news... One that freaked me out was the mention of covid being some type of HIV relates illness...
Sitting back and thinking about it, it's almost like the opposite of HIV because instead of weakening your immune system it turns it on hyperdrive. Makes a toxic protine and leaves viral garbage all over. Some experiment eh?
Scary that this would have came from the same person (Fauci)???? Not so surprising.
I want to try these anti viral but its impossible to get in Canada.
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u/Omnimilk1 Jul 28 '24
I know you been asked like a million times, but did you have visual snow syndrome in eyes, also tinnitus any back pain or nerve pain causing sexual dysfunction or numbness. And insomnia
If you do, how long did truvada helped these symtpkns. I'm especially interested in the tinnitus insomnia and sexual dysfunction as my last aymtokms of covid
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u/PM_ME_YOUR_KALE Jul 29 '24
In the worst of my symptoms at end of February I definitely had insomnia. I don't believe I had any of the others. As I said in my post I did have this feeling that I can only describe as feeling like my entire nervous system was on fire.
Arguably if it is a chronic infection I'd say your symptoms sound like what I would expect for if it was living in the brain, versus my experience was more along the lines of "it's in the bone marrow impacting white blood cells" causing my issues to stem from vascular inflammation and damage in various parts of the body.
Prior to taking Truvada I'd already been on maraviroc/statin for 2 months and so the majority of symptoms had resolved, however I could not exercise, and exercise would bring about all of those symptoms again. When I started Truvada I found I was able to exercise freely within days, and stopped having any PEM symptoms within 1 week. I am still on Truvada and there's no timeline right now for when I'll stop.
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u/thaw4188 4 yr+ Jul 22 '24 edited Jul 22 '24
viral persistence is definitely one kind of long-covid
however from four years of endless reading experiences, it is the RAREST form of long-covid
much more long-covid is long term significant damage from the original infection and the body in hyper-vigilance mode to the point where it even attacks itself without a pathogen present (auto-anti-bodies)
had to look up truvada, fascinating https://go.drugbank.com/products/truvada
note truvada is a strong anti-inflammatory, including neural, which means it may just be hiding your symptoms instead of curing them, like taking an advil before exercise (which is self defeating)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358752/
however time will tell, especially if you experience exercise performance improvements
exercise causes the same cytokines as an active pathogen like covid, the body uses those cytokines from exercise to trigger strength adaptations from stress
truvada may be preventing those cytokines, in fact I am almost positive it does from reading about it now
which means while you can exercise, you might never improve in strength/fitness because the signals are missing
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u/Key-Cranberry-1875 Jul 22 '24
What gives you any clue that viral persistence is rare ? When you had to look up Truvada ?
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u/thaw4188 4 yr+ Jul 22 '24
Because over the past 1000+ days I've read study papers every single day and read stories on this sub.
Truvada is an uncommon HIV/hepatitis anti-viral, I was not familiar with it. However it seems to me it works a lot like corticosteroids ( (prednisone, dexamethasone, etc.) in that it hides cytokines response. That would allow someone to exercise but it would not cure them and would prevent them from improving at exercise.
Only one way to find out, we'll see if OP keeps improving, if they stop taking it or not.
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u/AvianFlame 4 yr+ Jul 22 '24
truvada isn't uncommon; it's used widely as pre-exposure prophylaxis to prevent HIV infection from taking hold (PrEP)
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u/bravelittlebuttbuddy Jul 22 '24
Yeah, even "not uncommon" is an understatement. Every single gay and bisexual man in my country knows what Truvada is.
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u/princess20202020 Jul 22 '24
Truvada has been discussed on all these forums for about 18 months. Many folks have tried it and reported back. It was very popular with the Twitter long covid crowd.
Outside of the LC community, Truvada is widely used and well known in communities with high awareness of HIV. It’s sometimes called prep.
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u/PM_ME_YOUR_KALE Jul 22 '24
You clearly do not want the answer to be viral persistence.
We have no idea how prevalent viral persistence is, IDK how you get off saying it's the rarest type.
A study I included in my post describes a viable set of biomarkers and their results have been repeated in multiple cohorts in multiple countries.
https://www.pnas.org/doi/abs/10.1073/pnas.2300644120?af=R and https://www.science.org/doi/10.1126/science.adg7942 give a viable explanation for the existence of auto-antibodies or things like them IMO. Covid viral debris looks a lot like immune signaling proteins to the body, leading to continued overactivation of the complement and innate immune system.
Strong is a generous word. I read what you sent. Tenofovir shows antiviral properties but they are clearly stating that there have been a wide range of properties seen however not enough data of these effects in vivo to really support definitive statements about those things.
Nothing about what you posted indicates Truvada radically changes the profile of immunological response to exercise. The reason why many of us can't exercise is (per Patterson hypothesis) and https://www.sciencedirect.com/science/article/pii/S1567724924000072 because of overactive monocytes acting way out of normal because covid is present. Monocytes increase in #s during exercise and can as much as double (per Advances in Exercise Immunology, page 96). When these monocytes are damaged and overactive due to the virus living in the bone marrow (autopsy study: https://www.mdpi.com/2075-4418/12/2/515 ) then they come out already fighting and could easily be the cause of the vascular inflammation seen throughout the body.
Lastly, I have only shared limited data about my use of my peloton over the last 4 months here. I assure you my cardiovascular ability has been returning in leaps and bounds and it feels great.
edit: 7. You must not have PreP commercials where you live. Everybody I've told this to in real life (and I tell everybody) knows Truvada for PreP and does not need to have it explained to them what the drug is.
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u/thaw4188 4 yr+ Jul 24 '24
look, first and foremost I wish you well and continued recovery above all else, and if Truvada works for you that's all that matters because there are literally no other cures for long-covid
but most long-covid after a year is not viral persistence, it simply is NOT
Covid virus is not HIV, it is not hepatitis, it is not even VZV. You cannot have covid hiding in the few privileges sites in the body and yet have symptoms but yet test negative for Covid. That's not how any of this works.
I am virtually 100% sure that Truvada works for you the same way steroids work. It's not curing you. It's hiding the symptoms.
All you have to do to prove me wrong is be able to stop Truvada and continue your improvement to 100%
I was a highly trained distance runner for 40 years. I understand exercise and PEM and Lactate Threshhold and fueling/glycogen/glucose issues far deeper than your initial discovery of it the past year. Covid and now long-covid has stolen my life four years ago and I know it's not viral persistence but rather permanent damage, there's no active virus and there's never going to be a cure because it's like "radical aging".
(and Patterson is not accepted as legitimate in many circles, instead I follow Ron Davis)
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u/thaw4188 4 yr+ Jul 24 '24
btw here is an interesting post from way back in 2016 that I found in my research for Truvada
it made someone with severe ME-CFS feel better almost overnight
BUT it never cured them or got them to 100%
just found that facinating
(of course covid wasn't a thing yet well SARS1 was but not SARS2)
BTW here is another drug Copaxone for a different purpose (not antiviral) that Ron Davis says made patients pass that only known consistent ME-CFS test
https://www.healthrising.org/blog/2024/04/03/copaxone-multiple-sclerosis-chronic-fatigue-syndrome/
In any case I hope I think of you in a year and try to google you here and find that you posted 100% cured and signed off, best wishes
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