Personal Blogs

It's been over 12 weeks now since I developed Covid-19 and although I recovered from the infection in just over 2 weeks I still have the post-viral complication of presumed postural orthostatic tachycardia syndrome (POTS). I've blogged already about some of my symptoms (as a lecturer in health I'm somewhat fascinated by how the body behaves!) but today I thought I'd focus on something I've only recently noticed - the affect of posture.

I noticed several weeks ago that I occasionally got mild air hunger (large intake of breath) when sitting at my computer, and that this apparently was common in POTS. It's a very odd symptom, given the condition, as the tachycardia occurs to improve oxygenation when standing. Clearly both responses are to improve oxygenation but they are very different.

But last week when I took a break from work/study, I found myself sitting at the kitchen table hunched over my iPad and getting increasingly lightheaded and gasping for breath. It was quite distressing as it felt like my breathing was deteriorating, when until then I had only noticed it getting better. I then realised that it improved with better posture, which would explain why I had it then but not sat on the sofa with the iPad in my hand. Interesting that it's positional, I thought, and carried on with life.

Then on Tuesday I did my yoga class. Until recently my post-covid fitness levels haven't allowed me to do a whole session without tachycardia but I'm now walking several miles a day and feel much fitter. I was pleased to do a whole class of mainly standing poses and have no tachycardia. But wait, I have postural tachycardia and can get a fast pulse just from lifting my arms up -why was it okay to do standing yoga? I suspected that the strict yoga posture was the answer and reflected on my walking tachycardia. I had noticed recently that my tachycardia when out for a walk is better when I'm thinking about it but my pulse starts galloping when my mind wanders, only that day it had suddenly leapt from 104 to 135 for no apparent reason. Was it because my posture dropped?

I tried it out today and worked really hard on my posture when walking; chest out, shoulders back and down. And my pulse stayed below 110 (normal walking pulse) throughout my 2 mile walk. Now, this might be because I walk slower when concentrating on posture but I've ordered a simple back brace and will explore this further. It might be a breakthrough at managing my pulse rate.

My tachycardia is postural, my resting pulse is around 65 and it goes up to 90 when I stand up - when I first noticed it was up to 128 just walking around the house. It is exacerbated by exercise (walking upstairs can raise it to 110, going for a walk to 125, once 150), raising my arms (carrying laundry downstairs or sitting to chop vegetables raises it to 125, even brushing my teeth raises it), heat (gardening on a warm day made it 140), and eating (rise to 90 when seated). Alcohol sometimes exacerbates it, caffeine doesn’t and might well improve it.

The paramedic on my second trip to casualty did a seated and standing pulse and BP and suggested Postural Orthostatic Tachycardia Syndome. I have since researched this (I am an ex-nurse) and it fits my symptoms and circumstances, especially as a post-viral autonomic response. I have instigated suggested lifestyle changes including increased fluid intake, slow transition on rising, wearing light compression running leggings, gentle yoga and taking a daily morning walk with regular rests and water. 

I think water intake has had an enormous effect. Taking water 20 minutes before getting up in the morning has resulted in a normal pulse on rising. I can now, most days, walk around the house without tachycardia as long as I keep my fluid intake up. My morning walk pulse is gradually improving too. Arm raising is still an issue but I am aiming to increase my upper body strength with seated and supine yoga.

I have to avoid fatigue, though. If I push myself too far I can get fatigue for the next few hours or even the next day. The best solution for the tachycardia is to sit on the floor cross legged, that results in an immediate drop in pulse. If I am outside I stand with legs crossed.

Obviously I am in a better state than many people recovering from covid as I was not hospitalised and did not spend my symptomatic two weeks on bed rest so my body is not very deconditioned. I am well enough to do my usual online teaching job and carry out activities of daily living despite my tachycardia. But I thought I would share my experience of dealing with post-covid tachycardia in the hope that it might be useful for other people.

(Hopefully once I’ve beaten the tachycardia I can find a solution to my strange lung pressure issue! I can’t bear high air pressure and get air hunger, especially at rest. I’m hoping increased exercise will lead to greater lung expansion)

This morning I stood up and did not have tachycardia. I even managed to walk to the bathroom with a normal pulse. Admittedly it did increase when I brushed my teeth (and more so when I got dressed). But this is quite a development. Let me explain.

On the 17th March 2020, a couple of days before lockdown, my 15 year old developed a cough. Just a mild occasional one, not a hacking cough, but the warning signs were there and we went into isolation. He never developed more than this mild cough, though it went on for at least 6 weeks. Several of his friends also had it and apparently a parent of a fellow pupil had a positive covid diagnosis.

The next day I had a cough and sore throat so called in sick. I had mild fatigue but never developed a fever. I felt better after a few days and told my manager I would be back after a week and I duly returned to work. Later that evening I developed shortness of breath and chest tightness. This later developed into a central chest pressure where it felt I might stop breathing, exacerbated by exercise. But on day 16 I felt better. On day 17 I even phoned a student and a work colleague, with just mild shortness of breath.

On day 18 it all changed. I was overcome with extreme fatigue and shortness of breath on exertion. Over the next few days I developed anxiety and panic attacks. Then the fog lifted and I realised that what I really had was tachycardia. I had tachycardia when standing up and moving around and it seemed to be getting worse. It appeared to be autonomic, as I also developed a severe aversion to food which was clearly not gastric; I had to do breathing exercises in order to eat. Eventually I could stand it no more and went to casualty.

After a thorough check up all they could find was sinus tachycardia with a mild rise in blood pressure. The doctor suggested maybe a mild myocarditis which would improve on bed rest. As one of my bloods was slightly raised I was started on anti-coagulants and would have a lung scan to check for a clot on Monday.

The next day I felt awful, presumable due to the anti-coagulants. I spent the day in bed (where, incidentally, my pulse stayed in the 60s) but got up in the evening. I had a massive surge in pulse with chest pain and resultant panic attack and ended up in casualty again. Here an x-ray was taken and the doctor reassured me that he did not think there was anything wrong with my heart or lungs (I think he thought I was just an anxious patient, a common problem for tachycardia patients but I am also bipolar which colours perceptions). 

The lung scan was normal and the doctor in the acute admissions clinic sympathetic and interested. I’m on a waiting list for a 24 hour ECG and echocardiogram.

The paramedic earlier had told me he thought I had Postural Orthostatic Tachycardia Syndrome (POTS) and I looked it up; it fitted everything I was experiencing. The tachycardia on standing and moving around, exacerbated by lifting my arms (chopping vegetables gives me a pulse of 125!), the shortness of breath and chest pain, even the panic attacks. Over the next few weeks I recognised other symptoms such as tachycardia after eating, heat intolerance (my record tachycardia was 140 on the VE bank holiday due to gardening in the sun) and air hunger when sitting and concentrating. It is now 8 1/2 weeks since I developed my assumed covid symptoms yet I’m still recovering from the experience. The prognosis for POTS due to a post-viral Dysautonomia is generally good and I instigated rehabilitative techniques early, an advantage of being an ex-nurse who uses cognitive behavioural therapy daily to manage mental health. But I’ll discuss that in another thread.

Annie

I openly discuss my bipolar disorder so it sometimes comes up in tutorials when we are discussing health theory or disability. Recently I was discussing the concept of 'curing' in a K219 tutorial and one of the examples being discussed was mental health so I gave my personal opinion. I enjoy the positive reactions I get from students when I discuss my mental health, students are very encouraging on the need to reduce stigma and often come out with their own experiences. Someone mentioned how mental illness can creep up on you and I acknowledged this, pointing out I often don't realise I'm manic until well into an episode, partly because it is enjoyable, and the need to have a confidant who is able to recognise and discuss it with you. A student then said 'What about the lows?' and I realised that I very seldom discuss the lows.

I don't have lows very often, my bipolar mainly features hypomania and I seldom have deep lows since the first ones I experienced when I was first diagnosed 20 years ago. Manic depressives are often diagnosed during a depressive episode, mania can be enjoyable but depression isn't. McKeon (1995) suggests that the first depressive episode is often triggered by emotional stress switching on a genetic mechanism. Mine was triggered by my father becoming seriously ill and almost dying. 

I discussed my mental illness at a church meeting this week and my husband said that he could detect my mood swings and we then worked together on strategies to manage them. Later I challenged him on this; he actually identifies my manic periods but not my depressive ones. Mania is a very public thing, it is outward in its appearance, but depression is quite private and inward. I can't always tell I'm depressed myself until well into a period, it creeps up on you as noted earlier but it is also difficult to tell what normal is if your moods are usually abnormal. 

I've had marking over the last few weeks and I've been prevaricating over it. Now, finding displacement activities to avoid marking is quite normal, I'm sure, for most ALs. But it was when I was crying at the thought of it that I realised that I was depressed not just avoiding work. Recognising it meant I could develop strategies to manage it. Firstly, giving myself very small goals, perhaps 2 papers to do,  to make it manageable. I often find if I set myself to mark 2 papers I actually mark 4 as starting is often the hardest thing and once I'm into an activity it provides a welcome distraction from my emotions. I also prepare myself mentally, physically and spiritually. I make sure I go for two walks a day and get some fresh air and exercise. I eat healthily and take vitamins. I meditate and say a prayer before working (non-religious people might consider an activity such as writing down some positive things to be thankful for and some short term, achievable goals). I take regular breaks and have a cup of tea.

So, why I am I writing this? Well, in my experience, students with mental health challenges often face similar struggles when writing an assignment; it becomes a big wall that seems impossible to get over. As ALs we need to recognise these hurdles are real issues and work with our students to overcome them. Acknowledgement and empathy is the first priority alongside open channels of communication so that students can voice their fears and anxieties; this does much to reduce the burden. Work with students to come up with achievable goals over a period of time, perhaps just listing key points at first, then developing a plan for an essay, then tackling a paragraph a day so it does not become overwhelming. Plan ahead to the next assignment so that they are prepared in advance. Encourage them to look after their physical health too, to take regular breaks and get some rest. Most of all, let them know that you value them and you are on their side, even if their decision is to take a break from their studies. 

Most importantly, listen to their voice so you can empower and support them to achieve their potential in whatever way they can.

Well, I've just finished the marking marathon of November so thought it might be a good time to reflect on how I am getting on with my increased workload.

October is a month of welcoming and signposting, phoning students and getting to grips with module structures; a busy but enjoyable time as you meet new people and learn new things. November is a different beast - virtually every module has an assignment due in November which needs marking.  Marking is by far the most labour-intensive parts of an associate lecturer's role and also one of the most important. Not only is it part of a student's continuous assessment, it is also one of the main ways ALs use to communicate with students and advise them of their progress. So it is important to do it properly, hence the time consuming nature.  In my case I had 4 lots of assignments over a 3 week period from the end of October. I'm now on a week's break from marking before more 3 lots of assignments submitted over 2 weeks. It's a bit hectic!

Of course, by break I don't mean a rest; I have 3 tutorials to plan and deliver in the next 2 weeks as well as as the usual emails, forums, admin and telephone calls as well as staying up to date with the 3 new modules I'm teaching. But it does mean the pressure is off and I can relax and take stock. Being a great believer in the connection between physical and mental health I'm also using this week to detox and take some mental health walks.

So, on reflection, how has the last month gone? Well, I got all the assignments back on time. The first ones were returned very early due to my increased hours allowing for more efficient timetabling. My last lot only just got back in time but that's how they fitted in the bigger picture so that's okay. I paced myself well; I decided in the end not to fill whole days with marking but break my days up which will have implications how I manage this period next year when I hope to be studying a PhD alongside my teaching. 

Most importantly, my bipolar disorder seems to be under control with no adverse effects from the increased hours. I am neither more manic nor more depressed than usual, despite being tired by the end of the last marking period. The last lot of marking was a slog and I had to give myself several pep talks but it worked. I am approaching my work this week with a positive mental attitude and am also keen to get back to work on my research proposal tomorrow. So all in all a win.

Annie

I recently decided to increase my work hours. It was something I had wanted to do for a while and this year finally presented an opportunity for me to apply for several appropriate modules. I had a firm idea of the number of hours I wanted to do and was lucky enough to get offered modules that met this requirement; in fact, I had to turn two modules down.

So why did I want to increase my hours? Well, the most straightforward answer was that I had time on my hands. My children are now teenagers so I need to be around less for them and I wasn’t studying last year so I was bored. I needed something more challenging to do with my life, which brings me on to my main reason for taking on more work; I wanted a career again. I now had the time and opportunity to make a serious career in academia, I was applying for a Doctorate and the time was right to make a big step forward.

I also hoped that increasing my workload would provide more structure to my life. Only working a few hours a week can create a feeling of being disconnected but by increasing my hours I could formalise my days. This isn’t just important for getting my own work done and managing my own haphazard mental processes but also also ensures my new workload is recognised at home. Like many work-at-home parents, most of my work is hidden. My family need to know that I have work to do, that I can’t just drop everything to pop to the shops for them. So, by having firm perimeters my status at home changes. If I want to successfully build my career my work must be visible at home as well as among colleagues.

To do this I have given myself 3 full working days plus the necessary flexibility for the odd evening or weekend tutorial to make up my hours. I also have a day set aside for study; this year it is used for background reading and small projects, next year it will be part of my PhD timetable. I’m only 2 weeks into it but I can see how it will be effective in organising my time and I feel purposeful. What I hadn’t anticipated is the difficulty switching off in between work days, I have a constant urge to check my work email and forums. As someone prone to hypo-mania this probably isn’t surprising but I’m hoping this will settle down as I get used to the pattern and as my students settle into their modules – routine is the key. But yesterday (my day off, otherwise known as the day I do the housework) I managed to switch off completely. I will keep monitoring how I am keeping to my timetable as the academic year progresses and the workload varies from week to week.

Annie

Like many people with bipolar disorder, I have a problem with anxiety. Stress is a major trigger for bipolar disorder and my main method of controlling my stress, and consequent anxiety, is to meticulously plan my life. I don’t like surprises and I try to limit my exposure to them. Friends know not to turn up randomly on my doorstep and I plan my work diary efficiently with achievable goals. And this all has a positive effect on my working life as it means I am able to meet deadlines and have the time and space to manage any extra issues that crop up; phoning worried students, covering for colleagues, etc. I live a very organised life.

But it does mean sudden, unplanned changes to my routine make me anxious. Perhaps in some ways the method I use to combat anxiety can also cause it and today is a fine example.

We’ve been planning to get a new drive for several months but pinning builders down has been difficult. But suddenly we had an offer to do it today so we snapped it up.

Today I had planned to spend the whole day working (I work part time). I would spend the morning doing admin, sending weekly emails to my students, planning a tutorial, updating forums. This afternoon I would do marking. This was all in my diary. But my day has been unsettled and I cannot get my head around my work. The builders aren’t that noisy, I’ve heard far worse. But they seem to insist on the occasional social interaction which involves discussion which I don’t necessarily know the answers to (and numerous requests for tea). They also keep telling me things which they say my husband agreed but I am not so sure. To make matters worse, they cut through the internet cable first thing (I am currently borrowing the neighbour’s wifi, with their permission) so I have no landline and no way of phoning my husband, who has since reassured me via email that he will try to work from home this afternoon. But I need to feel settled to work properly and at present I am on edge. I know there’s no point in marking this afternoon.

My usual daily routine involves an afternoon walk and that would do my mind the world of good but I don’t want to go outside and speak to the builders. I suppose I could sneak out the back but what if they need me for something while I’m gone? More anxieties raise their ugly head.

The marking will get done this evening when the builders are gone, the world is quieter and all is well again. But I do know the next time we have builders that I’m going to plan to spend the day at a museum or gallery instead.

Annie