Digressions&Impressions

Two Years (of Long) Covid; (covid diaries)

Last time, I reported I caught covid in the first week of December. (For my official "covid diaries" see here; here; here; here; here; here; here;  here;  here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here;  here; here; here; here; here; here; and here.) It took about sixteen days before I was negative again. Most of my symptoms were flu-like without any fever.  I had a stuffy nose for another week or so, and it was accompanied by nose bleeding. The good news was that most of the very scary symptoms I had the first time around did not reappear.

However, for about four days I had a terrible skin rash and itch that reminded me of an episode that started after an insect bite in the Berkshires. That took seven years to resolve without any clear explanation. So, the recurrence of something very similar was very frightening. Luckily the itch went away.

Unfortunately, my convalescence took place on a deserted, but bug infested tropical island [don’t cry for me] and so I have had a few disturbed night’s sleep since because I am clearly rather sensitive to bug bites right now. While I was recovering, looking at tropical sunrises and sunsets and reading, my immediate family was cursed with bad luck. My better half caught a virus and was out with horrible flu-like symptoms for almost ten days. At first, I was convinced it was corona, but she kept testing negatively. And just as she recovered our son had a food poisoning. So, we only had a ‘real’ holiday for the last five days or so.

Tonight, I fly back to Europe. And my amazing research leave ends. (I am so grateful to everyone that made this possible.) So, it’s a useful time to take stock. First, by November I was pretty much in a place that my ‘long covid’ was under control with careful planning and relatively modest use of anti-inflammatories. I was able to be in more complex social environments again, walk and talk, and do non-trivial cognitive multi-tasking of the sort that ‘we’ (I should say ‘neuro-non-divergent’) take for granted especially in work environments and public spaces. I was thrilled to celebrate this, as you may recall with some more strenuous hiking and conference attendance.

When I got covid again last month, I was, of course, very anxious about what symptoms would re-appear and which new ones would develop. The good news was that I immediately noticed that I did not re-develop brain fog or dizziness of any kind. I had to stop reading books, but that was not especially disconcerting because I don’t read philosophy books while I have the flu. In other respects, I was very independent, albeit a touch forgetful. (I left some stuff behind during my move from Tucson. Bad news mom!)

It was a very disappointing end to my amazing research leave. And, emotionally tough because my family had basically let me 'opt out' for a few months with the implicit hope that I would return much better than I was. But a month later, I am confident that I can get to where I was in November. Now the only symptom I have is that I get (head) fatigued in social environments a bit quicker than during the late Fall. But I am not noise sensitive. I even listened to music again on holiday.

So, with planning and anti-inflammatories, I expect to have a normal quality of life. I start teaching my huge (500+ enrolled students) intro lecture course in Amsterdam early February. And that should give a very good reality check of where I stand in my recovery/living with long covid journey.

Meanwhile, I ended the year with an acceptance of a co-authored paper in Ethics/Epistemology of AI. (A new AOS!) That was very gratifying because my two co-authors (the wonderful Federica Russo and Jean Wagemans) basically waited for my recovery to complete the project. I also learned that the contracts between Dutch universities and for-profit publishers to arrange open-access publication, ration the number of annual papers the journals can publish. Luckily, the clock starts at zero at the start of the new year. (But the ration was filled some time in November at the journal that accepted our paper!) Also, I submitted two papers that are spin-offs of my quixotic Foucault project. One of them was desk-rejected quickly but with sensible editorial comments.

And so, on that entirely academic, humdrum note, I mark the two-year point of my first covid diagnosis and celebrate the start of the year with optimism. When I return home, there are a pile of referee requests (grants, tenure, papers) waiting to be completed. For some reason the ordinariness of that sentence pleases me.

Covid, again (Covid Diaries)

I tested positive for covid, again, last week. So, it's time for another entry in my Covid Diaries. (For my official "covid diaries" see here; here;  here; here; here;  here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here;  here; here;  here; here; here; here; here; here; here; here; here; here; and here). I attended a conference on December 2-3, and so when I felt crappy on Sunday, I assumed I had done too much socializing during the workshop (despite skipping a few meals). The headache and fatigue were bad, but not worse than any other post-cognitive-multitasking event. On Tuesday morning, I was concerned enough to do a self-test (which came back negative). So, initially I decided I had picked up a flu-bug. I ended up pulling out of all my social activities last week. (There were a lot of them because I was supposed to leave Tucson on Friday.)

While my headache disappeared after two days, a general malaise  -- fatigue, brain fog, and an annoying cough-- remained. On Wednesday night I slept especially badly; a weird skin itch had kept me up. Thanks to a mosquito in a quiet valley of the Berkshires near the Appelachian trail, I am not wholly familiar with skin rash. At the time -- it's now fifteen years ago or so -- I tried to treat it with OTC  steroid cream  to which I had an awful allergic reaction. Somewhat unfortunately, I turned out to be allergic to everything that was prescribed to me in that period. Eventually my skin allergies were diagnosed, and despite meds, I learned to live with itch (while being an irritable, unpleasant human being to others sometimes). After seven miserable years, the itch disappeared one day to the next after an ENT clinician added some meds to deal with  a chronic sinusitis half a decade ago or so. 

Because I was leaving town on Friday and visiting friends with an elderly mum, I decided to do another covid test. This time I was positive (something confirmed with numerous other tests since). Because I figured I might have to deal with travel insurance and airplanes and some documentation would be helpful, I went to a physician, who told me that the skin rash is a not uncommon side-effect of covid-19. But that otherwise I was in decent shape (no fever, all vitals fine, etc.), and that I could travel later this week again. (We checked the CDC travel guides together.) She said, that I should expect to test positive for quite a period ahead.

Luckily my hosts at the University of Arizona managed to let me stay in my rental for a few extra days. And except for the hyper-sensitive skin and itch -- which keeps me up at night -- most of my current symptoms feel like a mild flu, with brain fog. Last week, I was unable to read books or papers. In fact, I spent most of my time watching short scenes from Friends on my phone. Eventually I binge-watched the second half of Andor (which I loved), and cought up on some Jason Statham movies. (One of them, Mechanic: Resurrection, criminally underuses Michelle Yeoh--I can't believe they did not do a fight scene with her.)

The last few days, I did get exposed, anew, to some of the peculiarities of US health care system. When I scheduled a PCR test at a local Wallgreens, I almost got denied the test because I showed up on foot. (It was a drive through test!) The pharmacy is about 20 minute walk from me. Initially, the attendant declined to give it to me because I was not in a car. When I asked if I could get it inside, that raised even more heckles. Eventually, after a really sad look by me, she relented and let me take the test on foot in the drive through area. After I was done I asked her what happens to peoople without a car. And she said they come with friends or in an uber.

I am fully insured and figured it made sense to register with a GP or a family practice. Last week, I went to the list of approved practices and ended up calling half a dozen. None of them could schedule an intake before the end of the year. One called me back to deny me entry to the practice because their first appointment would be in the middle of January, and by then the insurance records showed I would be without coverage. (True enough I was planning to be back in Europe.) I called the insurance company for advice, and they suggested that if I got really sick I should just go to ER. The next day, while I was checking for covid testing places, I found a medical clinic specialized in covid. Much to my amazement, I could be seen on the week-end and it was all covered by my insurance. Anyway, at the moment the plan is that unless I suddenly deteriorate, I go on family holiday later this week and recuperate on the beach. (Could be worse.) 

I have to admit that while I often took precaution against renewed infection, I did secretly think of myself invulnerable after my first illness and the subsequent four shots of vaccination. Anyway, fingers crossed that I recover before the start of classes in February.

 

 

 

Covid Diaries: A Mixed Bag with some joy, and the mediocre

I have been on leave at the University of Arizona for nearly a full month now. It's time for another entry in my Covid Diaries. (For my official "covid diaries" see here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here;  here; here; here; here, here; here; here, here; here; here; here; here; here; here; and here). My situation is a mixed bag. I have a lot of great news, but also non-trivial new challenges. 

First, I love the weather in Tucson in November. My hosts have given me perfect working conditions with a nice office, and a lovely apartment a convenient fifty-minute walk through town. The free trolley connects my apartment with the university, but I prefer being outdoors and getting some activity walking to compus while taking pictures of local murals and the sky. I pinch myself that being paid to join a research group while on leave is possible in my academic life; although it's also a long time, too long away from my family. It's my son's thirteenth birthday tomorrow, and the occasion is bittersweet.

Anyway, let me start with the promising new. I am much better able to engage in socially complex activities: meet people for lunch in restaurants, hang out in cafes, attend lectures, give public lectures, and most amazingly of all: hike and talk simultaneously. Dave Schmidtz took me up Tumamoc Hill on Thanksgiving morning. And I felt so alive overlooking the city and the desert in the wind on top.

In addition, I often don't need any naproxen (my anti-inflammatory) to complete these activities. So, my quality of social and intellectual life has improved greatly while I have been able to cut back significantly on using anti-inflammatories. It's really enthralling not to be hypersensitive in environments with different kinds of voices or background noise. While I am still not planning to participate in large conferences, I am taking on commitments to give papers in workshops and department colloquia. I really did not expect this to be possible during the Summer when I felt I was stagnating.

Second, and unfortunately, my symptoms have shifted again. (As regular readers know this happens about every three to four months or so.) I develop mysterious headaches in the middle of the night without much rhyme and reason as far as discernable triggering conditions. (Having said that, going to bed on the late side or too much screentime before bedtime are reliable triggers of night-time headaches.) In addition, even on quiet days, I need many more breaks while writing on my laptop and even while reading books.

I have started to work in blocks of two hours, and it is not uncommon that I only have the cognitive energy/focus for one or two such blocks during a day. Because I don't have other obligations, I still get a lot of work done. But I have shifted my attention from my book project -- which feels too big right now -- to developing some paper projects. In fact, for the first time in a half a decade, I have three papers under review at journals. 

My leave ends next week, and I'll spend a few days in Boulder with my best friends before I re-unite with my family for our annual holiday break on a near deserted island in the Bahamas. (Yes, don't cry for me Argentina!) Taking unpaid leave from my job in Amsterdam is the smartest thing I have ever done for myself (other than giving up my job Stateside to give my relationship with my better half an opportunity). But I could not do it without the sacrifice of my immediate family. Luckily, I am clearly much better than I was before, and I have grounds for confidence that 2023 will keep improving. I have three weeks of quiet before, in January, I start preparing for my giant lecture course (which starts in February).

Covid Diaries: Transitions

After a week of family holiday in California with my immediate family, I am about to fly out to Tucson for a six week research stay at the University of Arizona. It seems like a good moment for a new entry in my covid diaries. It's time for another entry in my Covid Diaries. (For my official "covid diaries," see here; here; here; here; here; here; here;  here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here, here; here; here, here; here; here; here; here; here; and here.) I am writing these entries roughly a month apart for some time now. I seem to have turned an important corner since August. While I qualify this below (and will also mention some frustrating features about new symptoms), it’s fair to state that I am clearly much better than I have been at any time since I first got sick.

 

Before I get to that, my mom caught covid back in Amsterdam after managing to avoid it for so long. She is fully vaccinated, but at her age it’s still a bit terrifying. She was suffering greatly during the first few days; and while I was a bit relieved after talking to her yesterday it still sounds very challenging. So spare a few thoughts, prayers, and well wishes for her. Stateside Paxlovid seems to be almost a routine part of covid care (I can’t count the number of people who told me they had been prescribed it even with very modest symptoms), but typically (and somewhat frustratingly to me) not so in Holland.

 

After a few very quiet and deeply intellectually satisfying weeks at Duke with very structured and a low-key schedule (special shout out to Sunday Dim Sum at Geoff Sayre-McCord and Happy), I allowed myself to step outside of my comfort zone on a number of occasions. To summarize the take-away: the good news is that with judicious use of anti-inflammatories I can survive, even thrive, in social environments including pretty challenging ones. It’s not that I don’t encounter my limits (especially in larger, socially demanding environments), but the fall-out tends to be fairly limited with less cognitive and physical fatigue and almost no headaches, and with recovery periods that tend to be much smoother (better sleep). More on this below.

 

When I studied in Boston and Chicago, I would frequently meet my dad in New York city (where he had studied). Once, about twenty five years ago, when he was around sixty, as we were walking near his (and his father-in-law’s) old stomping grounds in the garment district, he complained that New York was so loud. It was the first time I felt he was aging. I often think of that moment because I increasingly believe, as I have noted before during these diaries, that a lot of symptoms we commonly associate with aging are really the aftermath of a viral infection. (I would love to study this hypothesis with a historical epidemiologist.)

 

This past week with our son, I wondered if he saw me as old now. Again, while most of my symptoms have vastly improved (I am really happy), it turns out that physical exercise has become much more difficult. I have a very strange fatigue when I try to exercise or run—it’s as if the brain signals don’t really reach the muscles, and that I have slept very badly. (Oddly I don’t notice the problem in my lungs.) This was not the case previously (after my initial five months of bedridden-ness had ended last year).

 

Early in the week we went to a NBA game (the Clippers vs Suns) at the Staples Center. And I was amazed that the experience felt like living in a boom-box. The beat and sound (organized by the Clippers/stadium) was unrelenting. (It was nothing like how I remembered the old Boston Garden or Chicago’s United Center.) Because he Clippers were completely outplayed and outclassed by the Suns, the crowd was rather lackluster during the game, and so it could have been worse for me. But much to my surprise, I survived the ordeal and even enjoyed it (especially watching his reactions).

Interestingly enough, I found the NBA game less challenging than a visit to Boston a week earlier, where I attended a retirement reception of my teachers Dan Dennett and George Smith. Ahead of it they had both written me expressing the idea that the other would really appreciate it if I attended. The reception was low key, but the back-ground murmur and the multiple demands on my attention clearly exhausted me—I had to cancel my dinner plans and rest. (It didn’t help that the hotel I had been staying in was next to a construction site and the generators were clearly audible in my room—I ended up measuring >65 decibels!) In light of this, and my experiences at the Chapel Hill philosophy colloquium (I had to call it quits after two talks), I have decided to pull out of larger conferences (the Eastern APA) and to skipp my cousin’s wedding.

 

One other new symptom is that at various times, and completely unaccountably (so without rhyme or reason), I will wake up with a splitting headache in the middle of the night a few times in a row during the night and a few nights in a row. Because I take melatonin – which is a godsend -- and have a good meditation routine I usually manage to fall back asleep fairly quickly, but sometimes I have to take anti-inflammatories to ease it along.

As an aside: it’s well-known that naproxen is not very good for one’s stomach. But it’s been surprisingly difficult to find papers or data with exact figures for the risks and thresh-holds given my age and other underlying issues. No physician nor pharmacological experts have been able to point me to any informative evidence. So, it’s made me curious what the underlying evidence is that has made it to the textbooks in all countries, especially because I do need to take the anti-inflammatories a few times a week.

 

Anyway, be that as it may, let me wrap up. Because my social life is so much better I am also much more upbeat. Also,I really enjoyed being with my wife and son. I was much less noise sensitive and generally able to partake in daily banter and activities without it being cognitively painful. As I have noted in these diaries, the way my long covid symptoms manifested made it especially difficult for me to be social with others and for others to be around me. So, saying a temporary goodbye to them knowing that I am now much better at family life again felt very difficult. Okay, so on that wistful note I’ll end this post. I am in a better place and grateful for it.

Covid Diaries: a much fuller glass despite some tricky issues.

It's time for another entry in my Covid Diaries. (For my official "covid diaries," see here; here; here;  here; here; here; here;  here; here;  here; here;  here; here; here; here;  here; here; here; here; here; here; here; here; here; here; here; here; here, here; here; here, here; here; here; here; here; and here.) If you don't want to read the whole post, here is my executive summary: the glass is much fuller than two months ago, while some tricky issues remain.

About a month ago, I wrote that "I can report some modest, good news. Without any evident explanation, I suddenly improved greatly from the start of August onward." Since then I traveled to Durham for a six week visiting stint at Duke University. (I am exactly at the half-way point now.) Packing, travel, and getting oriented in a new place is pretty stressful. Luckily the trip was uneventful, and Kirun Sankaran (a very talented local postdoc) helpfully picked me up at the airport, and  organized a stop at a supermarket before dropping me off at my new abode. 

Despite the lovely and very organized welcome at the Center for the History of Political Economy, the first week in Durham was pretty challenging due to my jetlag and the really oppressive humidity and heat (as well as some maintenance issues in my rental). I adore warm weather, but dislike having to hide in airconditioned spaces. By the end of the first week I was, in fact, under the weather, and worried that I had overestimated my recovery. I canceled my social schedule, and spend a few days in bed and on the sofa of my rental. By Tuesday I was feeling much better, and able to comment on a fascinating workshop paper by Jennifer Jhun in the Duke philosophy department. Shortly thereafter the humidity disappeared and until Hurricane Ian we've had just lovely, even inspiring. weather. 

As the hurricane arrived on campus -- classes got canceled -- I workshopped a chapter of my Foucault/liberal art of government book in progress in the HOPE Center, and then enjoyed a festive reception and a joyous dinner (in the otherwise deserted campus center). Ian was a serious storm, but not frightening in my location. While I was in bed relatively early, no amount of meditation helped my excited brain relax. I went over the day countless times, and had to pinch myself I had been in a professional academic environment focused on my work. I had a restless sleep, and the next day I just chilled--with the storm raging there were no other options anyway. The dreaded headache did not materialize, but I felt very fatigued.

So, looking back at my first three weeks here: I have had some intense and very good conversations, socialized a few times (a Dim Sum, a BBQ dinner, some lunches and coffee, etc.), and even engaged in non trivial academic work. All of  that is very encouraging. The anti-inflammatory meds I use are excellent  in preventing and treating headaches and other long covid related symptoms. And I have become more willing to experiment with social interactions without taking meds altogether. And while I still struggle in environments with other social stimuli, it's much improved from where I was.

Having said that, I have woken up with random (but sadly familiar) headaches in the middle of the night a few times, and I do bump into my limitations at odd moments. I am currently struggling greatly in my morning work outs, and I need to take more regular breaks while writing/researching.

I have my own cubicle in the library (sadly without windows), and access to the open stacks. It's bewildering that I have more shelve-space for books in the cubicle at a place I am visiting than at my shared office at my home university. I was completely blown away when, during my first day at the HOPE center, the economics department's tech support came by to set me up with local printing (etc.). (I was happy I had brought extra Harrods ginger biscuits from London so I could express my gratitude spontaneously.) 

As an aside, in fact, while I have spent a good chunk of the first few years of my academic life employed at rather wealthy, private US universities (and have visited countless times since), the contrast between life at Duke with my current work conditions at a massive Dutch state university hit me hard. While I may publish in similar outlets as the locals, what one may call the 'phenomenological-geography of our daily academic lives' (e.g., class size, office space, technical support, length of academic year, etc.) is incomprehensibly different. For example, in order to visit here I had to take unpaid leave (and cash in overtime hours) because it will be a while before I am eligible for the very new sabbatical arrangement my department finally instituted. Odds are I will never be eligible for it. (Don't ask, but it's basically a money/funding issue.)

Anyway, I spent mornings writing, and if I socialize at all this starts after lunch. I mostly read secondary literature in the afternoon. I miss my family intensely, but I very much appreciate the lack of responsibilities to others and the general quiet of my life. This week, I have set aside to get on top of some professional obligations to others (letters of recommendation, reviews, revise and resubmits with other authors). All and all, I feel pretty blessed. (And I welcome suggestions for more opportunities to be on paid leave!)

Okay, I should wrap up. Technically speaking I am not on disability anymore since the first of September. But I am obviously relieved I don't have to teach full time this Fall, especially because of the many small cognitive (weird memory issues and odd moments of head fatigue) and physical issues I still encounter. And while I teach a huge lecture course in the spring, It's under seven weeks. So, the real test of my cognitive stamina will occur only a year from now (at the start of next academic year). I am tentatively scheduling academic commitments (talks, workshops) along the way. Because I love undergraduate teaching, I am more optimistic than I have been in close to two years that it's not unreasonable to expect I will be able to return to things I adore about my profession on a regular basis. I am even hopeful I will be able to socialize with friends and family more normally again. So, there, the glass is filling up with the nectar of life; I said it.

Covid Diaries: Good Enough Professing

It's time for another entry in my Covid Diaries. (For my official "covid diaries," see here; here; here;  here;here; here; here; here; here; here; here; here; here; here; here;  here; here; here; here; here; here; here; here; here; here; here; here;  here, here; here; here, here; here; here; here; and here). Finally, I can report some modest, good news. Without any evident explanation, I suddenly improved greatly from the start of August onward. I found swimming enjoyable again, my writing picked up, and I had the impression I was becoming less noise sensitive. I went to the opera at Glyndebourne with my better half. (That's annual tradition for us, but she went without me earlier in the year.) It's a long drive in both directions, but we decided to try it because intermission is a leisurely picnic. I adored it, and except for a few minutes while the orchestra was tuning and the audience buzzing with anticipation at the start of the second act, which triggered my noise sensitivity, it was marvelous. (Well, I loved the music and the performances, but the production was awful.) More recently, I attended a department (management) meeting for ninety minutes, and have even ventured out to enjoy lunch and coffee in outdoor terraces. So, I am participating in life more fully again!

Long covid is a roller-coaster -- 'coaster corona' -- with changing symptoms and often false starts and sudden setbacks. But this past month feels qualitatively different. I started using anti-inflammatories (basically extra strength Aleve) a few months ago, and I finally have figured out when to use them and what the so-called minimally effective dosage is in order to prevent the weird head fatigue and headaches. In the Spring I was averaging about six headache days per months and now it's really zero. (I do sometimes get headaches in the middle of the night, but with meditation and melatonin I tend to sleep those off.) And as the first paragraph indicates, I have grown bolder trying to manage meetings or conversations without meds and being alert to the onset of symptoms. 

The other big news is that since yesterday I am formally off Dutch disability (and so '100% healthy' again)! [I wondered if I should put a sly reference to that info into yesterday's digression!] My occupational physician and I were working towards this decision for about a half year now. Incrementally reducing my 'disability percentage.' The decision became much easier once I had a Fall research leave Stateside lined up (thank you family, Duke, Arizona, and department!), and the sudden improvement this past month. It also helps that my spring teaching is relatively light: only one massive lecture course I have taught before. (I basically cased in a year and half of "over-hours.'') So, the real 'work test' will only occur Fall 2023, a year from now, when I have to start teaching a full load again, including discussion heavy seminars (which was so difficult last Fall).

I am by no means recovered to where I was in all kinds of un-expected ways, but I do sincerely expect that I can actually do most of the activities expected from me in my position. After ''good enough parenting" this should be "good enough professing" (GEP)! Hopefully by this time next year I have continued to improve, and so I can be confident about being a solid GEP.

Earlier in the month, Shelley Tremain published an interview with me (big reveal!) at Biopolitical Philosophy here. I mention it because, due to space constraints, we had to cut a paragraph that, after the fact, I thought rather important. During the interview I explain how much my chronic illness prevents me from participating in professional activities and triggers a withdrawal from the world. But I added a qualification. Here's the paragraph we cut:

I don’t mean to suggest my life is primarily an adjustment to limitations by narrowing the range of activity. While that’s undoubtedly true – I have had to give up on lots of activities, especially social ones. But it’s also opened up new ones. I had to give up cycling around Amsterdam (because I am native born that’s really a second nature there). I started to walk to work or to the supermarket. And on foot one moves so more slowly that one really has time to take in the astonishing beauty, even sublimity of the place. Because my agenda was much less cluttered, I would also work with time to enjoy my surroundings. I started to take pictures of my walks on my mobile phone; and I found that these, in turn, connected me with all kinds of people; amateur photographers, folks that share my aesthetic, old friends, etc.  And it's been such a thrill that amidst non-trivial solitude I felt a sense of community. 

That seems like a good place to end this post.

Covid Diaries: Attention Deficits

I interrupt my usual Summer blogging break with a new entry in my Covid Diaries. (For my official "covid diaries," see here; here; here; here; here; here; here; here; here; here; here; here;  here; here; here;  here; here; here; here; here; here; here; here; here; here; here; here;  here, here; here; here, here; here; here; and here). And, as is depressingly familiar, the situation is a mixed bag.

First, the interesting news is that earlier this week I saw a clinical neuro-psychologist through a referral from the NHS long covid clinic. Curiously enough, when my Dutch GP and Dutch occupational physician tried to refer me to one a year ago (!), my Dutch neurologist and the wider group of the occupational physician blocked it! It's against protocol in the Netherlands, where long covid is treated by occupational therapists (unless there are serious lung or heart symptoms). So after the covid induced migraine was diagnosed by my UK neurologist, my Dutch neurologist admitted it had never occurred to him as a possible diagnosis. This was a bit bitter for me because during my first visit with him I had an intolerable headache which he somehow kept discounting. (Mind you I am a male academic with lots of cultural capital in the Netherlands.)

As an aside, I am not entirely convinced I have a real migraine because, as I have noted before, my symptoms are very well managed by anti-inflammatories (basically extra strength Aleve--this is not available over the counter in the UK), and in my view the triptans are less effective against them. I return to this below.

The clinical neuro-psychologist is a young lad, who called me 'Professor' when he looked for me in the corridor outside of his office. (I was not used to that in this context so it took me a while to realize he was calling me.) I later learned he is also getting a PhD in cognitive science with a specialization on frontal lobe functioning. (I hope I have not outed him.) He had a two-volume copy of William James The Principles of Psychology on his shelves which immediately endeared him to me.  Anyway, after the 110 minutes (!) of testing, he could reassure me there is nothing wrong with my frontal lobe or any of my cognitive functioning. However, I do have rather striking attention issues; so, once the information comes in I process it okay, but certain kinds of information (white middle aged male faces, long digits of numbers, and domestic images) are often screened out. Whereas words and geometric objects go in just fine--so I should still manage okay with the Principia!

On the whole the results are not surprising (although I found my inability to manipulate medium length strings of digits really disconcerting) because they chime in with the reasons why I was interested in this referral in the first place. As an aside, I did wonder if I would do better with women's faces. But then I remembered a disconcerting conversation with one of my lecture course students this past Spring, where after polite small talk in the hall way where she studied next to my office (in which I asked her name, who her favorite theorist we discuss is, etc.), I suddenly had the good sense to ask, 'we have had this conversation before, right?' And she said, it's the fourth time.

The really good news lurking here is that the patterns he found are very dissimilar to what they find in early stages of Alzheimer, dementia or stroke. (On the way home I did wonder what I would do with my life if there were signs of the first two.) Anyway, he didn't know what kind of label to put onto me (I think he is leaving that to the neurologist), except to say that I have a weird kind of attention deficit now (but nothing like ADHD he emphasized). Not unlike the neurologist, he emphasized that they seem my symptoms a lot in in the NHS long haul clinic. In addition, he was pleased to note that once in my cognitive functioning is okay, "superb" even. He and I both regretted there is no pre-Covid baseline to compare me with. 

Second, earlier in the month we had a long family holiday on Paros. There I learned that I am still incredibly hyper-sensitive to sound and that social interactions (which exhaust me) have to be planned very carefully. It seems nearly every restaurant plays some background music, and even the kite-surf shack (where my family spent a lot of time without me) on the beach, which does not have running water or a kitchen, does have music playing. I was reminded of my graduate school dog park friend, Matthew Crawford's second book, The World Beyond Your Head: On Becoming an Individual in an Age of Distraction. In it he points out that in modern life we're surrounded by music and images that try to attract us or distract us, and that the airport lounges of the very wealthy are very quiet. (But I bet these, too, have a soft background music that barely register unless you are me.) Our public or communal spaces are not allowed to be still.

That's to say, the first week of holiday was a bit of a struggle to find the right balance for the three of us. Somewhat annoyingly, whereas during most of my long covid swimming has been a source of enduring pleasure, on holiday I noticed that I found it exhausting (which had also been true ahead of our trip). The really annoying thing of long covid is that my symptoms keep switching slowly after every three or four months or so (more below). Anyway, I do swim most mornings just to stay active. Even played some pick-up basketball with my son in the (rather warm) Greek evenings, which felt like a precious moment I would not have expected a year ago, but still wasn't wholly pleasant (because my head felt so strange).

Luckily, extra strength Aleve (500mg naproxen) is available and cheap over the counter in Greece, so I stacked up on it.:) And the really good news is that most of my symptoms (weird head fatigue, headaches) are very well managed with anti-inflammatories. I haven't had a real headache day in months. Sometimes I am very aware my body and even my head registers I was socially too active, but because of the Aleve I don't have any pain. So, on the whole I am much better than, say, six months ago because I really suffer less.

The bad news is that I have clearly stagnated; I continue to be hypersensitive to sound if there is more than one source in the area and all my social activities, including with my family, have to be carefully planned. This puts considerable hardship on my family, even on days where I think things are going okay. I have also noticed since I returned from holiday that when I spent hours on end in the library, my head starts to feel fatigued; this has never happened to me before not even during long covid (much to the bewilderment of my occupational therapists who all assume that anything work related must be stressful and exhausting). So, I take more breaks now. (The British Library is actually well designed for that.)

As a total aside, this year I submitted two co-authored papers that originated in my pre-covid days but where completion had to be postponed due to my illness. The first got rejected with decent reports (ref 1 fair; ref 2 a bit silly) and the second a major revise & resubmit, and while neither is tremendous news, it did make me feel almost like a normal academic again. This week I also completed a long draft of my review of Neil Levy's Bad Beliefs (which you should read his book that is, well also my review!:)). 

I should close, but one pet-peeve. There is increasing evidence that weight loss helps manage long covid symptoms. And so lots of folk send me press releases on this and nudge me to 'consider losing weight.' Now, ever since I probably had a mini stroke/TIA a decade ago, I pay attention to my weight. And it is very clear  that because of long covid I have gained weight; not just because I probably exercise less and eat more from stress/emotional need, but also because when I do 'diet' (basically a low carb diet), I don't lose weight as quickly as I used to. It's pretty annoying to be told 'consider doing X' while you are 'doing X.' (Beccy Lucas has a hilarious sketch on that if you are into that kind of thing.) 

Anyway, while I dislike the social norm that we must exude optimism, I do feel very blessed that I have a forthcoming Fall (unpaid) research leave. I feel grateful my family found a way to make it work for them, and lucky that the folks at Duke and Arizona are willing to host me (with some funding). Recently I bought my ticket and found housing, and it's suddenly starting to feel very real. Anyway, with that I return to my customary Summer blogging break. 

On adequately filled places (Covid Diaries & Seneca)

After nearly a month, it's time for another long covid update. (For my official "covid diaries," see here; here; here; here; here; here; here; here; here; here; here; here; here; here; here;  here; here; here; here; here; here; here; here; here; here; here; here; here, here;  here;  here, here; here; and here). And, as usual, the situation is a mixed bag.

First, the good news. Thanks to non-steroidal anti-inflammatories (basically extra strength Aleve for those Stateside) I have managed to eliminate debilitating headaches. By 'debilitating' I mean: being in bed all day, and being incapable of reading or watching streaming online content. So, the amount of suffering has been reduced dramatically! In addition, if I take the meds before I socialize -- say a lunch in a quiet place -- I am capable of enjoying it without nuisance. So, I have some hope that I can reduce my relative social isolation. My body does notice I have socialized (I have a strange kind of fatigue then), so it's not without consequence, but it's better than it was. 

Unfortunately, some of life's simple pleasures remain out of reach due to my inability to engage in quite modest cognitive multitasking: even gentle walking while talking with others wipes me out cognitively. (I can do serious walking alone.) I am unable to enjoy music in the background while we're talking or even playing silently. I can't cycle in the city, I can't play basketball with my son, etc.

For example, recently, I had a lunch with a college friend in a quiet London club. The background music and noise of other lunch-guests were quite modest. I enjoyed it. (Hurrah!) I did have a vague sense that my capacity to eavesdrop on other conversations was much diminished. Once I walked out of the club into the air, I noticed how exhausted I was; and despite the lack of headache, and more meds, I was unable to concentrate again that day. It would not be wrong to call it 'brain fog', but the fatigue in my body is even worse: I walk slower then, and think slower. As I have mentioned before, I suspect a lot of symptoms commonly associated with aging are really the effects of post-viral syndromes. 

In Seneca's Letter 56, he notes that "words seem to be more distracting" to him "than noises; for words demand attention, but noises merely fill the ears and beat upon them." Seneca mentions that shouting is not as distracting as singing and an intermittent noise more troublesome [molestior] than a steady one, and I would agree. In fact, hearing other people talk or even just hum while I am engaged in some activity of my own drives me batty. (Well not as badly as a few months ago, but still.) I have mentioned, I think, that this makes family life with a teenager challenging. He hums when he is happy.

While Seneca repeatedly suggests in this letter and others that finding inner mental tranquility is fundamentally healing, he also recognizes that rousing ourselves to keeping busy with good works is healing, too [ad rerum actus excitandi ac tractatione bonarum artium occupandi sumus], and, if I read him alright, necessary for the non-sage (that is all of us). A Christian may well think this is a call to charity, but I read it somewhat self-servingly as keeping true to my vocation (as scholar and teacher). I don't want to claim Seneca invents the protestant work ethic, but I do think he is an important voice in its development.

In fact, Seneca notes that when he is in forced retirement (due to illness or political failure--the letter contains a rare admission or at least allusion to it) ambition is often revived [interdum recrudescit ambitio]. I recognize the truth of this because much to my own surprise, in my forced leave of absence, my disabilities have re-directed even expanded my vocational ambitions as a scholar (even if I have come to accept that some projects have to be let go), and (while more challenging) teacher.

Even though I had to withdraw from quite a few projects and also have given up on a number of papers, in some respects being a scholar has become easier because I have so many fewer social interactions and don't travel to conferences. I probably read more than I have ever. 

One unexpected effect -- I have mentioned it before -- of these covid diaries is that other scholars reveal their own enduring challenges with disability to me. I recognize that in my environment I have missed a lot of quiet suffering and almost heroic persistence. It's humbling to recognize what a bad observer of my umwelt I have been and, more importantly, to recognize that so many folk have achieved so much with chronic pain and cognitive instabilities. 

This experience makes me interpret Seneca's suggestion that a hidden disease is worse than one in the open (which is on the road to being cured) in a social way. Norms that internalize suffering, 'being Stoic' as they say, hidden from the world are, while convenient to the powerful, a social evil. In a famous passage, Adam Smith notes that people tend to refuse acknowledgment of poverty and disease and thereby make it worse. (Smith thinks our gaze and recognition naturally falls on the rich, famous, and beautiful/healthy.) Sometimes I wonder if I hear about other people's suffering now because other people sense greater receptivity on my part, or if they think it's only fair that after having read about my trials I ought to welcome learning of theirs, or if I have actually become more willing to discern other people's struggles. Despite my vocation as a teacher, I tend to be skeptical of narratives of growth. 

And after hinting at the need for regular cognitive-therapy -- good and solid thoughts [cogitationes bonas, solidas] -- as the road to wisdom, Seneca grudgingly admits that sometimes the best self-care is to seek out a quiet spot. I laugh, and admit that the reading room of the British Library is indeed my best friend. In fact, I now have my spot in the reading room that the other regulars leave alone -- and the librarians at circulation have started to recognize --; I love quietly reciting, in the spirit of cognitive-therapy, Newton's (early) definition of place being a part of space that a thing fills adequately just before I sit down at 'my' desk. 

This past month a co-authored paper was rejected by referees. And I had hoped to circulate the first seven chapters of my Foucault/liberal art of government book [I am soliciting catchy titles!], which covers his material on the physiocrats and the ordoliberals, to trusted friends. But the manuscript is still too much a mess, and so its circulation has been pushed back into the Summer. No professional life without ordinary professional disappointments, I tell myself. 

This is also my last digression of the academic year. On Saturday, we go on family holiday, and I don't expect resuming D&I until August. Thank you, my dear reader, for your continued interest in my (near) daily mumblings. 

Covid Diaries: A Half Full Glass and despite Minor irritants, maybe filling

It's been about a month since my last covid update. (For my official "covid diaries," see here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here;  here; here, here; here; here, here; and here). And, as seems common in the most recent updates, the situation is mixed. But let me start with the non-trivial bits of good news.

First, if I take anti-inflammatory medicine before I have a social interaction (like a lunch or tea) I am capable of engaging in much longer social interactions than I was able to do during the past nine months. I am also capable of doing so in much more complex social environments. I have even been able to do so twice in a day (with a few hours apart). By this I mean that the usual symptoms of head fatigue and subsequent headache don't follow. So that's a big win, and at times I have felt euphoric about it. 

Interestingly enough, after some such activities later in the day I do register physically that I have had some such interactions. My body will feel unusually fatigued, and I need to take time to chill. (I am not allowed to nap because I need to keep day/night rhythm very distinct.) Some day, when I am fully recovered, I would like to team up with a (historical) epidemiologist and geriatric specialists because I am increasingly convinced that a lot of symptoms that in the past usually were treated as 'aging' really were the longue durée effects of (post-)viral infections.

Anyway, on the medical side, I am experimenting with the dosage of the anti-inflammatory meds. As they say in jargon: I am looking to find the minimally efficacious dosage. The month before I lost about six full days to random headaches. This past month, clearly 50% less. That's a lot of less suffering.

As an aside, it's fascinating that while the physicians can all tell you that there are increased risks associated with the use of my particular meds, nobody can tell you what the order of magnitude of the risk might be for a generic patient or for somebody that shares in some of my demographic or medical characteristics. So, while a lot of physicians practice a kind of pseudo medical autonomy -- telling me things like, 'it's your decision' or 'you need to weigh the trade-offs'  --, de facto there is a lot of ignorance being buck-passed onto a patient who is not being given even the minimal coarse-grained information to make autonomous decisions. (And regular readers know, I am no Bayesian--I am not asking for exact statistics, just very broad orders of magnitude.)

Be that as it may, I am quietly hoping that the anti-inflammatory meds also treat some underlying condition such that I can keep hoping for continued improvement over the medium term. The really interesting question for me is this: my symptoms have shifted around every few (two to three) months. And what I am wondering is whether that cycle can be broken. Stay tuned.:)

One thing I have learned about chronic disease or newly acquired disability: other ailments that in a different context would be barely noticed can be greatly destabilizing in the context of disability/chronic disease; think of things like a cold, modest hearing loss, swimmer's ear, blisters, etc. When you are learning to adjust to chronic disease such incredibly modest ailments sap energy. (Again see my comment above about aging as instances of post-viral symptoms.)

Second (back to the good news), next academic year, I'll have the kind of work-load I probably should have had this past year. I am only teaching my giant lecture course Winter 2023. To make this possible a lot of people showed me incredible amount of good-will: my immediate family, which is signing off on three months of research leave stateside (with two weeks of holiday for visits); the folks at Duke University's Center for the History of political Economy and the philosophy department; the folks at University of Arizona's Center for the Philosophy of Freedom. These allowed me to take  three months unpaid research leave this Fall. In addition, my department signed off on this. That, too, showed, good-will, but it did involve some negotiations.

Let me explain, one of the very strange features of the University of Amsterdam is that it works with a system of registered hours (for research, teaching, and some admin). Undoubtedly it was introduced for a mixture of fairness considerations (everyone pulling their fair share) and administrative control over the budget. But in practice, the 'hours' registered are by no means equal (and also model-based). And the obvious effect of the system is to turn academics into a bean-counter of sorts and, for some, also a chance to game the system. (I'll get to the really strange part in a second.)

Now, in practice these plan hours are bit like frequent flyer miles. You know what their official value is, but if you have been around for a while you also recognize you can never really cash them for their (ahh) labor value. This is especially so when there is a dire need for budget cuts; these hours are then easy prey. (That's how I 'lost' one batch of over-hours a few years ago.)

Anyway, despite my partial sick-leave, during the past few years, I actually accumulated more over-hours than I had when I started my partial sick-leave! So, to facilitate my leave and considerable teaching reduction I agreed to donate my (ca 900!) hours and start the next academic year back at level zero. I rationalized the deal to myself as a business class upgrade on a transatlantic/pacific flight.:) In addition, because of my medical leave I have been rather costly to the department and a lot of my rank-specific chores have been parceled out to others. While an apparent bad deal on paper, I felt this was very win-win, and also a chance for me to show my gratitude.

So, my underlying outlook is actually quite positive right now. Next year, I feel my work-load should allow me space to recover and do what I love work-wise (research, write, and lecture). It also allows me space to experiment, when I feel sufficiently recovered, with activities I have not dared to try yet (giving professional lectures, attending seminars, etc.) And while I will miss my family and my undergrad electives/seminars, it's good not to have to stress about their effect on my health. On the other hand, as I have hinted above, I am dealing with a bunch of minor ailments that prevent me from having unconditional optimism right now. The glass is half full, possibly filling.

 

 

 

Covid Diaries: Covid Induced Migraine

It's time for another Covid Diaries update. (For my official "covid diaries," see here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here; here;  here; here, here; here; and here, and here).

 

It's been about a month since my last covid update. Unfortunately, the news is that it's been challenging. The last update coincided with the end of teaching and my return to London. And I figured that I would take ten days off, get back into a swimming routine, and then start working on some small projects before I would return to major research.

 

As you may recall I also saw the NHS long covid clinic neurologist, who diagnosed me with covid induced migraine. I have to admit that I was a bit surprised by her diagnosis because I thought my headaches were only triggered by social interactions beyond thirty minutes and i didn't have any other major characteristics of migraine. (In fact, the interactions first induce a weird fatigue and not always a headache.) On the other hand, she was optimistic I would continue to improve because on the whole I keep improving slowly.

 

But as it happened, my family left for a US trip and I was alone for a week without any social interactions at all (except very small talk at the swimming pool, supermarkt, and British Library). In their absence, I lost two days to debilitating headaches while they were away. Looking back over the month I have clocked six days of headaches--and my current best guess is that bad sleep and social interactions are possible triggers. I do find that days when I swim well and am well rested it's less likely to happen.

 

What's annoying about this is that in some respects the pattern of long covid has been that every two to three months the major symptoms shift. And this time is no different. Luckily on the non headache days I can swim, and do my reading and writing. But my social life is very limited, although my spouse has said I am in much better general mood than last year (which she takes as evidence that I am suffering much less). I still can't enjoy terraces, and even joint hiking. (There is a weird issue that walking and talking/coordinating with another while walking totally floors me--same with biking. It's as if cognitive load is too much.)

 

Unfortunately, the migraine meds I received have contraindications with pre-existing conditions/meds, so it's been a bit challenging to find the palliatives when the headaches hit. I know lots of people who manage migraines with varying degrees of success, so in a strange way I feel less alone with my condition. (It has made me wonder about the medical pathway from post-viral infection to migraine.)

 

Anyway, thanks to Federica Russo and Jean Wagemans, we finished one paper, and thanks to Nick Cowen we finished another. (Both under review.) And I wrote a book review. And then a week ago I did start my Foucault project, and while I lost one day through headaches, I have a nice writing rhythm and folks are even recognizing me again in the British Library. And I am really excited about the project--which started as a kind of therapy last year, but now feels like it might become a very neat book. I am lucky I have a work related passion that can be done in relative solitude for long chunks of time.

 

Before I left Amsterdam my occupational physician thought it was a good idea if I can figure out a research leave this Fall. So now I am in touch with various places which might sponsor a visit (you know who you are and I am very grateful for your help), so that I can take an unpaid leave. Hopefully I can sort something out that ticks various boxes and not be away from home too long.

 

That is it, I feel very grateful I have such supportive family, and the kind of job that is relatively secure and also so flexible now that teaching is done. I am still hoping that in six months i can attend workshops again and enjoy going out on dates with my better half, but I also thought that six months ago. So now I am mostly taking one day at a time.