Author Topic: Exercise-induced POIS-like symptoms  (Read 6933 times)

Quantum

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Exercise-induced POIS-like symptoms
« on: October 23, 2016, 11:01:23 AM »
There seems that for some POIS sufferers, there are exercise-induced POIS-like symptoms like fatigue, brain fog, or else, that will occur after sport and exercise, independently of any sex activity.  Such post-exercised symptoms are less severe and are of shorter duration than a POIS attack, but they nevertheless are a hindrance for normal daily activities.


I am one of those who have shared that problem.  Exercise is beneficial for me in general, but I really have to dose it well.  I must not exercise or do sport for more than 1h30 or 2hours max at a time, must have at least a day without exercise between any other exercise or ejaculation.  I can not do more than 2 times of exercise a week, I have tried to go to 3 times a week, and it is simply too much for me.   

The main symptom I have after sport is fatigue, and I take an abnormally long time to recover ( 24h to 36 hours).  It is less than a POIS attack, and all the symptoms do not manifest, but the day after sport, I am out of shape and not ok.  It is normal for anybody to have some fatigue after sport, and even more at over 50 y/o like myself, but my level of fatigue is clearly more than what is "normal". And this exercise-induced fatigue is additive, just like POIS symptoms.  it adds up if I do sport again, like two days in a row, and it also adds up to any ejaculation within 24 hours before or after sport.   

If I have sport, and have sex the day after, within 24 hours, I may have some symptoms, like 30% POIS, even if I take my pre-pack.  I have share in my method/pre-pack thread that this summer, when I was in pretty good shape, I had sport, than one ejaculation ( with my pre-pack before) the same night, and it was ok.  But I had sport again the day after, even if i felt some fatigue, and pouf.... had about 40% POIS after, the worst POIS attack in more than a year ( since I am using my current pre-pack) and I wouldn't want to see what kind of monster POIS I would have had in these circumstances if I had not taken my pre-pack...!

I sure now take a simpler version of my pre-pack before sport, and it helps, but not to the point that I can have 3 times of sport a week.  It is just more comfortable at work the day after.  I mostly take omega-3, curcumin, quercetin, other antioxidants like astaxanthin or rosemary or vitamin C or else, and sometime ibuprofen.  I am still in the process of finding what works best.

Recently, romies have shared he has the same exercise-induced phenomena, having brain fog and fatigue after exercise.  He also shared his pre-pack for sport, and has very good results with it ( see at http://poiscenter.com/forums/index.php?topic=2090.msg19834#msg19834 ).

If you have also POIS-like symptoms after exercise, please share your experience in this thread.

If you do not have any symptoms after sport, do share also. 

 
« Last Edit: October 23, 2016, 11:04:26 AM by Quantum »
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demografx

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Re: Exercise-induced POIS-like symptoms
« Reply #1 on: October 23, 2016, 01:17:04 PM »
In recent years, with major surgeries, my excercise activity has been low (E.g., walking at moderate pace). But when I was more active, I suffered terribly from excercise-induced POIS-like symptoms unrelated to sex.

I'm very happy to see this topic open up. This is as freakish as POIS is to me. Similarly, alcohol and jet lag can also induce my POIS like symptoms.
« Last Edit: October 24, 2016, 06:56:10 PM by demografx »
Usually have major POIS-reduction, treatment consisting of daily (365 days/year) testosterone patches.

TRT must be checked out carefully with your doctor due to fertility, cardiac and other risks associated with it.

40+ years of severe 4-days-POIS, married, raised a family, started/ran a business.

MirkoThiel0

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Re: Exercise-induced POIS-like symptoms
« Reply #2 on: October 23, 2016, 03:52:29 PM »
this is really interesting for me, some years ago (i was around 15 years old) i had no idea about pois and did go to doctor neurologist
and told him "every time i make sports i feel dizzy and have problems with thinking well" after some test`s he could not help me
and gave me a transfer to an Hospital, i was there around 1 week and they did not found anything i got a lot of test`s one of them was even an painfully
Liquorpunktion/Lumbar puncture and
Magnetic resonance imaging.
at that time i already did think about an connection between orgasm and that symptoms aswell, but never took it serious enough to talk about it with an doctor (i was very shy with thing like that) after that the docotor told me it could go away after puberty today im 19 y old...
if you want i can look for the medical records.

POISse

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Re: Exercise-induced POIS-like symptoms
« Reply #3 on: October 24, 2016, 12:53:05 AM »
I recently identify the link between some symptoms and exercise. These symptoms are mostly brain fog, fatigue, depression, feeling detached and insomnia. These symptoms do not appear all the time (1/3), and when they don?t, sport help me a lot. Excersizing after 0 increase probability of symptoms but it can be during abstinence period also. Sometimes, I needed more than 48 hours to recover from exercising and I can?t sleep properly for days but it isn?t a big surprise since the vagus nerve is responsible for regulating the heart beat.

I made some research and found out about CFS / fibromyalgia which are accroding to me really close to pois. Why do I believe that ?
-   A lot of symptoms are similar with POIS
-   They are also convinced that the vagus nerve is involved
-   What cure CFS also cure me : specific diet, no sport, acetylcholinesterase inhibitor, protein intake

Now from my experience with sports-related symptoms, the best way to prevent the apparition of symptoms for me is to take a protein shaker 20 min before doing sport. In fact high dose of protein help me not only with sport but in general. For the ones who are eating eggs every day, I guess it is the same effect, but shakers are more concentrated in protein and easier to take when needed. However I tried different brands and not all kinds seems to work.
Acetylcholinesterase inhibitor (mytelase) also work for me after sport (with brain fog and insomnia) but I prefer protein shaker since it works very good and it?s more natural.

Quantum

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Re: Exercise-induced POIS-like symptoms
« Reply #4 on: October 24, 2016, 06:41:03 PM »

Now from my experience with sports-related symptoms, the best way to prevent the apparition of symptoms for me is to take a protein shaker 20 min before doing sport. In fact high dose of protein help me not only with sport but in general. For the ones who are eating eggs every day, I guess it is the same effect, but shakers are more concentrated in protein and easier to take when needed. However I tried different brands and not all kinds seems to work.
Acetylcholinesterase inhibitor (mytelase) also work for me after sport (with brain fog and insomnia) but I prefer protein shaker since it works very good and it?s more natural.

Very interesting, POISse.

Did you notice any difference in the protein formulas that work better?   Were they whey protein based ?   Did they have more tryptophan, or more tyrosine, or more BCAA ( proline, leucine, isoleucine) ?
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POISse

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Re: Exercise-induced POIS-like symptoms
« Reply #5 on: October 26, 2016, 05:32:42 AM »
Unfortunately I don?t have the formulas of the previous proteins I use to buy so I cannot make comparison. But what I know for sure is that pure whey protein is not the one which had been working the best for me so far (no matter the brand). I am currently buying syntha-6 from bsn, which contain a mix of different proteins and indeed Quantum, lot of BCAA and other essential and non essential amino-acids (I don't know for sure about tryptophan, or tyrosine).

Also, there is lecithin in it and interrestingly, lecithin is what I take coupled why anticholinesterase inhibitor to get rid of my pois symptoms. However, lecithin alone don't do anything for me, so it must be the protein. In fact even eating chicken can also be helpful but to a lesser extent.

The effects of taking protein are for me : better mood, more energy, more mental capabilities. Plus it enables me to do sport without fearing symptoms.
« Last Edit: October 26, 2016, 08:50:10 AM by POISse »

Quantum

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Re: Exercise-induced POIS-like symptoms
« Reply #6 on: October 26, 2016, 06:39:45 AM »
Thanks for the information, POISse !
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Mr Raba

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Re: Exercise-induced POIS-like symptoms
« Reply #7 on: October 28, 2016, 07:34:34 PM »
You are describing the hallmark symptoms of CFS.   Not  only the symptoms but how they happen. For example cumulative effect, 24 to 36 hours to recover, brain fog, etc.

This is not at all surprising to me. I have both POIS and CFS. Simultaneous onset. Same moment.

I also believe that most people with POIS have exercise induced flare ups to differing degrees.

The good news is that much is now known about CFS. With amazing discoveries in the last year and few months.
What improves CFS also does POIS. My 23 year experience has shown me that.

Read Healthrising.org for great new research and what helps.

My suggestion is to try immunocal as explained in my previous posts.

I am certain that what will cure CFS will also cure POIS.  The cure is IHO less than three years away to be implemented in US.

Already being used in Norway. See Fluga et al research in site above.
Pasted below:
Cort
Cort
Founder of Health Rising and Phoenix Rising
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(This blog is based on a post on Phoenix Rising describing Dr. Mella’s Oct. 10th talk in Arendal, Norway and a typically tortured Google translation of part of that talk.)​

Another Hypometabolic Signature Found

Naviaux’s paper has clearly sparked a lot of interest. Certainly, antecedents hovered in the background; metabolism has actually been a niche topic in ME/CFS for years. Lemle proposed that a hydrogen sulfide induced state of hibernation or hypometabolism caused the low energy problems in chronic fatigue syndrome in 2011. The Aussies have been doing metabolomics research for quite some time. Their 2014 review paper argued it could be helpful in ME/CFS.

Metabolomics is not a niche topic anymore. The Japanese, who have also done metabolomics research, recently released a metabolomics ME/CFS study (to be covered soon).

bigstock-Low-battery-Silhouette-of-man-87297569.gif Last month Hanson reported finding evidence of a hypometabolic state in ME/CFS, and now Fluge and Mella have apparently found it as well. The metabolites they've found suggest to them that low energy production is a central feature of this disease.

Problems producing energy appear to be fundamental and extend to the immune cells - something Ron Davis has proposed. Fluge and Mella reportedly found reduced levels of phosphate – the P in ATP – in immune cells in ME/CFS. That suggests the reduced killing ability of NK and T-cells could be caused by poor energy production. That makes sense given that some immune cells need to power up to kill pathogens.

Fluge and Mella also have evidence suggesting that metabolic problems may be loading ME/CFS patients with lactic acid – a by-product of anaerobic energy production. (If aerobic energy production is impaired or insufficient, the less-efficient, dirtier and lactic-acid producing anaerobic energy production process kicks in.)

These Norwegian researchers believe ME/CFS patients have two problems with lactic acid; they're producing too much of it, and are having trouble getting rid of it. Mella noted that he produces lactic acid but he can get rid of it quickly - people with ME/CFS cannot. Lactic acid remains a puzzling subject - some researchers find it increased and others do not. That variability may reflect a subset issue.

Rituximab Update

If my calculations are correct, the trial is a bit over halfway done, and we should expect it to end sometime in the summer of next year. At that point, Fluge and Mella will crack the code, and by late 2017 (optimistically) or the first half of 2018, we should know the results.

We've seen some promising Phase III trials go bust recently. Because the larger Phase III trials include more types of patients, they often have less positive results, and Mella warned that this was possible in Rituximab as well. If the results don't apply to ME/CFS overall, then the goal will be to find out which patients it’s effective in and target them. Mella noted that different mechanisms can produce the same symptoms in autoimmune diseases, and he expects this is true in ME/CFS.

According to the translation, Mella stated that they can be "reasonably sure" that a subset of the patients responded. Whether enough people respond to make the trial statistically significant is another matter. Rituximab could be effective in some patients, but not in enough to result in a significant overall response.

(Dr. Patrick in Canada believes he may have found a biomarker that will help identify which patients respond to Rituximab. Dr. Peterson is reportedly testing that biomarker in his patients. )

Mella also cautioned that even if the Norwegian trial is successful, each country will have to put on its own trial. (As it is now, Rituximab would be available off-label to doctors willing to prescribe it, but the drug is very expensive.) The U.S. – the most difficult place to get drug approval – will need its own trial.

According to clinicaltrials.gov. the NIH, one of the biggest clinical trial producers in the world, is currently recruiting for no less than 49 Rituximab trials, mostly in cancer but also in lupus and other autoimmune disorders.

How the NIH, after the IOM and P2P reports, and its statements that ME/CFS constitutes a serious, unmet need, could find a way not to fund a Rituximab trial in the face of a successful Norwegian trial is unclear, but if any group can find a way, surely the NIH can. If the NIH waits for the results of Fluge/Mella’s trial before proceeding, we might be looking at a U.S. Rituximab trial beginning in 2019 with the results in 2020 or 2021.....

It’s remarkable to continue to see the NIH with its 30 plus billion budget continue to sit on its hands while a small country like Norway produces a large Rituximab trial.

Another Drug Possibility…..Cyclophosphamide

Chemotherapy may end up being very good to chronic fatigue syndrome. Fluge and Mella have been giving twenty-five people who didn’t respond to Rituximab or who relapsed after getting it, a shot at another chemotherapeutic drug called cyclophosphamide. Cyclophosphamide is used to treat cancer, autoimmune diseases, and amyloidosis.

A quite toxic drug, Wikipedia reports that it's side effects usually limit it to the beginning phases of treatment in autoimmune diseases. It’s typically used only when first-line treatments such as Rituximab don't work. Like Rituximab it’s an immune suppressant.

Cyclophosphamide_iv.jpg

Not all immune suppressants are the same; etanercept (Enbrel) didn’t work for Mella and Fluge. Cyclophosphamide findings have, interestingly, excited some hospitals…

Fluge and Mella are using cyclophosphamide in the lower doses associated with autoimmune disease treatment. They reported that while some people get worse at first, it does appear to work in some ME/CFS patients. Like in autoimmune diseases, the positive effects show up months after taking the drug. Approval for a second trial with severely ill ME/CFS patients has been received.

“Toxic Blood?” (or Another Good Reason Not to Donate Blood)

The idea that something in ME/CFS patient's blood may be turning off the mitochondria or natural killer cells or what have you is not a new one. Although no new studies have come out, reports indicate that the natural killer cell problems in ME/CFS apparently disappear when NK cells from ME/CFS patients are put into a healthy person's blood. Conversely, healthy NK cells poop out when put into ME/CFS patient's blood. Fluge and Mella are finding that healthy muscle cells act strangely when cultured with ME/CFS patient's blood.

Fluge and Mella are also finding that the blood vessels of ME/CFS patients are producing too little nitric oxide. Nitric oxide is a gas produced in the walls of the blood vessels which allows them to enlarge and increase blood flow. If you produce too little nitric oxide, your blood vessels will be so constricted that getting enough blood to the muscles during exercise or other blood requiring activities will be impossible.

Nitroglycerin tests indicate that ME/CFS patient's ability to produce nitric oxide is still present, suggesting presumably that either the signal to produce NO is not being sent or is being ignored, or that the cells that produce NO are being shut down in some way.

(Fluge and Mella filed a patent in 2014 to use a nitric oxide donor in conjunction with Rituximab in ME/CFS. Their understanding of the role that blood flows play may date back to this patient. After checking into a hospital for chest pains, she found that a nitric oxide donor (Imdur) improved her symptoms in much the same way as Rituximab had - except that the results were immediate. They got moderate results in six patients and suggested that using supplements with relatively high doses of L-Arginine 5 g twice daily combined with L-Citrulline 200 mg twice daily might suffice as well.)
See Fluge/Mella Take out Patent on Nitric Oxide Treatment for ME/CFS
Finding some factor in the blood that turns things off could be very helpful. It could a) directly point to a cause, and b) to clear treatment options that block the factor or stop it from being produced.

Fluge and Mella's Journey

Fluge and Mella’s range has become so large, that it’s totally inappropriate at this point to think of them as Rituximab researchers; they're after the source of ME/CFS itself. They're looking at the immune system, blood flows, exercise metabolism, and genetics and have developed a model which incorporates all of it.

Fluge_Mella..jpg They've experimented with at least three different drugs. They'll be presenting the data from the Rituximab trial in an open source format so that it's available to other researchers. A 150-person Biobank that is storing blood taken before and after ME/CFS patients receive Rituximab could reap diviidends. We’re lucky to be the focus of two such creative and persistent researchers.

Other researchers – most of whom I would guess were not interested in ME/CFS prior to their work - have clearly been excited by it. Their international partners draw from the Charite University Hospital in Berlin, UCL London, Arizona State University and Institute of Immunology Rikshospitalet and Biomedisn UiB.

Fluge and Mella are going to make their first trip, so far as I can tell, to the U.S. for the IACFS/ME conference where Dr. Fluge's plenary address will focus on how the Rituximab trials have helped him and Mella understand the cause of ME/CFS. At the Patient Day we'll get a trifecta; Fluge, Mella and Dr. Peterson on "Rituximab and Emerging Treatments". It's a rich time for them and for us.
Last edited by a moderator: Oct 17, 2016




 Link below: scroll all way up after cliking.

http://www.healthrising.org/forums/threads/mella-finds-hypometabolic-state-in-chronic-fatigue-syndrome-plus-rituximab-and-new-drug-for-me-cfs.5004/#post-25386

« Last Edit: October 28, 2016, 08:38:02 PM by Mr Raba »
Simultaneous onset of CFS and POIS since Feb 1993. 
Married since 1989.

Helped by Immunocal (I explained how to take in previous posts).  Significant relief day one and day two.  It affects neurotransmitters!

Quantum

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Re: Exercise-induced POIS-like symptoms
« Reply #8 on: October 28, 2016, 10:11:51 PM »
Mr Raba,

I do not share your enthusiasm about chemotherapy for POIS treatment.  Rituxan and Cytoxan are very dangerous medications, maybe warranted in life threatening conditions, but not for POIS, in my opinion.

And, even if you consider these clinical trials as a sign of hope, not many will have the $200 000 a year for these treatments anyway, even if they would accept the high risks. ( insurance companies will not pay for the treatment of a condition like POIS, that is not in medicine textbooks and has no objective way yet neither to be diagnosed).

Let's hope that research will come up with safer and cheaper treatments for CFS.  In this case, it will  possible to contemplate trying it for the treatment of POIS.


For now, I would like to hear from other members about their reaction to exercise.  If you do not have any symptoms after sports or exercise, I would like to hear from you too.  If you have symptoms, please do share.   I am not sure that every POIS sufferer have symptoms after exercise.
« Last Edit: October 29, 2016, 06:36:16 AM by Quantum »
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Mr Raba

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Re: Exercise-induced POIS-like symptoms
« Reply #9 on: October 29, 2016, 02:17:07 PM »
If you were to follow the rituximab research papers more closely, you would find that the treatment fot CFS is NOT like that one for cancer. Researching just the drug on the net without knowing HOW it is being used in CFS will give a incorrect alarming picture.

The dosing is very different and the risks as well. Only one administration is sufficient for most. As opposed to higher dose weekly dosages.

The study involved a large number of people. No one was hurt in any way. It is an off label use.

The point is that resetting the immune system with an agent has cured people.

Also the trials were done by top experts in the field that did not put subjects to great risks. Again they used far different  dosaging than that used for cancer.

If I were to chose between the professional judgment of the world renowned Fluge and Mella and  whatever comes from quick google search. I go with informed expert knowledge.

Yes. I would probably wait until a cheaper drug is used to do the job. And I would not do it wity just any doctor.
Simultaneous onset of CFS and POIS since Feb 1993. 
Married since 1989.

Helped by Immunocal (I explained how to take in previous posts).  Significant relief day one and day two.  It affects neurotransmitters!

Quantum

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Re: Exercise-induced POIS-like symptoms
« Reply #10 on: October 30, 2016, 08:37:47 PM »
If you were to follow the rituximab research papers more closely, you would find that the treatment fot CFS is NOT like that one for cancer. Researching just the drug on the net without knowing HOW it is being used in CFS will give a incorrect alarming picture.

The dosing is very different and the risks as well. Only one administration is sufficient for most. As opposed to higher dose weekly dosages.

The study involved a large number of people. No one was hurt in any way. It is an off label use.

The point is that resetting the immune system with an agent has cured people.

Also the trials were done by top experts in the field that did not put subjects to great risks. Again they used far different  dosaging than that used for cancer.

If I were to chose between the professional judgment of the world renowned Fluge and Mella and  whatever comes from quick google search. I go with informed expert knowledge.

Yes. I would probably wait until a cheaper drug is used to do the job. And I would not do it wity just any doctor.

Mr Raba,

First, to be honest, I do not like the tone of your introduction, and of your message as a whole. I suggest you should maybe lower or postpone your expectations about rituximab, and stay kind and supportive in what you write here on this forum.

You may also read the following article written by an evidence-based doctor:  https://www.sciencebasedmedicine.org/rituximab-for-chronic-fatigue-syndrome-jumping-the-g/ , and see why it is too early to conclude anything on rituximab for CFS treatment.

Also, the dose used in CFS, are, in fact, higher, at 500mg/m2, than in most cancer indications ( at 375mg/m2, usually).  It is only that the infusion are less frequent in CFS protocols, so cumulative, annual dose, yes, may be lower, depending on the protocols, but acute doses are high, so risks for severe reactions is totally there. There is no mention neither of single-dose protocols for CFS.  The first 3 cases of 2009, the 2011 study of 29 patients, and the study that was supposed to begin in 2015 ( RituxME, 152 patients), are all using a few loading infusions, and infusions each 3 months or so thereafter ( for RituxMe,  first two infusions two weeks apart (500 mg/m2, max 1000 mg, or placebo) followed by maintenance infusions 500 mg fixed dose (or placebo), at 3, 6, 9 and 12 months - see http://simmaronresearch.com/2015/01/chronic-fatigue-syndrome-rituximab-fluge-mella/ )


So, no, my goal is not to give an incorrect, alarming picture, but you have to be clear about rituximab, it does not reset anything, it destroy B-cells, which are part of the immune system.  Anyway, I am not here to give any professional advice to anyone, and I decline any professional responsibilities for anything I write on this forum  (see my signature at the end of my posts),   so if you "were to chose between the professional judgment of the world renowned Fluge and Mella and  whatever comes from quick google search. I go with informed expert knowledge", that is ok with me, but please, accept that my opinion may differ from yours. 

I think you should wait, at least, for the results of the ongoing 2015-2017 RituxME study.  It may conclude that rituximab may have higher benefits than potential risks for a particular sub-group of CFS patients, but maybe not all CFS patients, and that is what the preliminary results tend to show.   The goal will then be to be able to screen and identify which patients would benefit from it.


I am done for now about CFS, and about rituximab in CFS treatment.  POIS is already a very complex issue in itself.  I will wait for any consistent results before investing anymore interest in this. And even then, this will in no way warrant any usefullness in POIS until more is known about POIS pathophysiology.



Again, I would like this thread to be back to the topic it was supposed to, that is, do all or many POIS sufferers have, or not, mild POIS-like symptoms, after exercise.

I hope to hear from other members on this !


« Last Edit: October 30, 2016, 08:40:22 PM by Quantum »
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demografx

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Re: Exercise-induced POIS-like symptoms
« Reply #11 on: October 30, 2016, 11:13:02 PM »
Thanks, Quantum, I also think it's really preferable to stick to the exercise-induced POIS-like symptoms on this thread -- it's a great topic!
Usually have major POIS-reduction, treatment consisting of daily (365 days/year) testosterone patches.

TRT must be checked out carefully with your doctor due to fertility, cardiac and other risks associated with it.

40+ years of severe 4-days-POIS, married, raised a family, started/ran a business.

joelawerence

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Re: Exercise-induced POIS-like symptoms
« Reply #12 on: October 31, 2016, 06:32:29 AM »
For me aerobic exercise helps reduce POIS symptoms severity and duration. The difficulty though is getting my tired body to do exercise. My POIS was at it's lowest when I used to do sports regularly. I have been diagnosed with very low testosterone and I believe that exercising raises it and hence reduces my POIS symptoms and duration. I am surprised though that demografx has mentioned exercise increased his POIS.
30 years old, POIS for around 9 years with increasing severity.
Major symptoms - Severe fatigue, back pain, unrefreshed even after 9+ hours sleep, pain behind eyes, very dry face, bald head with inflamed scalp, digestion issues and constipation. Very low testosterone and high glucose in blood tests.

Quantum

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Re: Exercise-induced POIS-like symptoms
« Reply #13 on: October 31, 2016, 08:06:29 AM »
Thanks for your input, joelawerance, it is very interesting.  That would show that not every POIS sufferers have exercise intolerance.


When you were doing sports regularly, and when not during a POIS attack, do you consider having a normal recovery time after sports, or longer than your friends ?

Were you able to do sports 3 to 4 times a week, or were you limited to 2 times like myself, even when out of POIS ?

Thanks!
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demografx

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Re: Exercise-induced POIS-like symptoms
« Reply #14 on: October 31, 2016, 11:20:08 AM »
I am surprised though that demografx has mentioned exercise increased his POIS.

Thanks, joelawerence. Actually, the symptoms-after-exercise were a little different from POIS symptoms. And they stood on their own, apart from POIS/sex. And the symptoms didn't last for DAYS, like POIS.

My exercise-induced symptoms, terrible as they were, only lasted about 5-6 hours, not for days as they did with POIS.


« Last Edit: October 31, 2016, 11:25:53 AM by demografx »
Usually have major POIS-reduction, treatment consisting of daily (365 days/year) testosterone patches.

TRT must be checked out carefully with your doctor due to fertility, cardiac and other risks associated with it.

40+ years of severe 4-days-POIS, married, raised a family, started/ran a business.