Is this dysautonomia? Or long COVID?

1. Medical History

• I had a mild cold for 5-7 days (I don't know if it was COVID).
• One week after recovering, I had surgery for an anal fistula. I was under anesthesia for about two hours. Afterward, I could walk normally again. It wasn't a major operation.
• After the operation, I took painkillers for two weeks.
• I had a wound healing disorder; the wound healed poorly.
• For months, I had changed my diet: no meat, no cheese, no milk, and no animal products. I ate mostly vegetarian food. I rarely ate meat. I only had two meals a day because I practiced intermittent fasting. ...

1. The First Symptoms

• After 2-3 months, I experienced the first symptoms that I hadn't had before.
• It started with restless sleep; I tossed and turned a lot and couldn't get a good, uninterrupted night's sleep.
• Occasionally, I noticed a significant drop in energy after eating. It wasn't classic postprandial fatigue, but rather a complete energy crash. I wasn't tired enough to fall asleep, as if I'd been completely drained. At the same time, I sometimes had a cold forehead. This lasted for 2-3 hours after eating. Both the energy crash and the cold forehead came in waves, always after eating, after my first meal around 1-2 pm. By evening, everything had returned to normal.

...

• I had trouble finding words a few times; I really noticed it when I was talking to my colleagues.
• I sometimes have to go to the bathroom 3-4 times a night. Only at night while sleeping.

1. Break for 3-4 months (no symptoms)

• This lack of energy after eating was gone.
• Only the restless sleep and the increased need to urinate at night remained.
• I sometimes had mood swings.

1. The Crash

• August 20, 2024, changed my entire life: suddenly I experienced another energy crash. 50% of my energy disappeared, as if a switch in my energy metabolism had flipped. A few days prior, I had slept poorly, resulting in brain fog, which is why I noticed it as a slight warning sign.
• It happened to be the same day I first took a certain medication for tendonitis in my wrist caused by all the typing. I was actually preparing for an exam.
• I thought to myself, "Oh God, not those energy crashes again like I had a few months ago." I experienced these extreme energy dips, especially after eating and then going for a walk. My energy levels fluctuated wildly, sometimes rising and sometimes falling. Occasionally, I would get a sudden burst of energy. So, it was very erratic.
• This condition didn't go away and became chronic. My persistent low energy level worried me so much that I woke up in the morning and realized I still had it. As a result, I developed severe depression within four weeks.

Then we started experiencing those severe energy crashes after meals again. They came on top of everything else, even though my energy level was already down by 50%.

I also had extreme noise sensitivity. I only went out with headphones; the car noise was much too loud for me. That went away after 4-6 weeks.

5. Exam Stress

I was preparing for an exam during this entire period. I studied for months on end. It was very monotonous.

• All the writing gave me tendonitis, which put a lot of mental strain on me because I didn't know if I'd be able to pass the exam. That was an additional stress factor.
• Then I took ibuprofen for two weeks, followed by 10 days of cortisone. Then I took a different medication for my tendonitis for one day. After two hours, I experienced this abrupt drop in energy, which then became chronic.

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6. Cause

- Either it was COVID

- Or it was the surgery + the medication

- Or it was a combination


7. My blood test results

- I've had a vitamin B2 deficiency all along due to my diet (intermittent fasting)

- I have low arginine, high nitrosative stress, and elevated TH1 and TH2 levels (IFN, Gamma, and IL-4)

- Autoantibodies against the beta-2 adrenergic receptor (GPCR autoantibodies) were found in my blood

- I have low blood pressure between 100 and 110.


- Otherwise, I had no abnormalities in my blood work.



8. My suspicion

- Long COVID (without PEM)

- Dysautonomia (without POTS)

- Endothelial dysfunction (my forehead felt cold after eating, or after blow-drying my hair, or when I came home after a walk and sat down, I also had a cold forehead and hot flashes). The low arginine level also supports this. So I have a problem with vascular regulation. This also fits with the impaired wound healing.



- No CFS, since I don't have PEM. I was physically intact, could take long walks, and wasn't limited in my daily life in this respect. So I could still do things if I wanted to.



What really got to me was the very low energy level, the energy crashes, brain fog, and especially this severe depression. There were days when I just cried. It was the worst time of my entire life.

After three to four months, it very, very slowly improved. Now it's been 1.5 years. The symptoms are still there, but in a milder form.

Do you have any idea what I might be experiencing? To this day, I don't know exactly what it could be.

Ultimately, it's a low energy level and vascular regulation problems. But I've also run 10 km. It's not exhaustion or muscle weakness in the classic sense, but rather a low energy expenditure, as if my body is in starvation mode.