What a Headache...

Health Complications on the Tree of Woe

My productivity has dropped off at the Tree of Woe, and I thought I should write a bit to explain why. It’s certainly not for lack of things to write about - never has so much woe been available to contemplate! What’s been missing has been my own ability to contemplate the woe in a clear-headed way.

Here’s the executive summary: An acute illness last year triggered a chronic condition that has left me discombobulated for months. I’ve finally gotten a diagnosis and now I can get surgery to address the problem. I should get better after the surgery. The end.

If you want MrBallen’s Strange Dark & Mysterious Medical Mysteries version… read on.

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Last October my wife and I caught COVID. We had somehow evaded the dreaded Wuhan-made bioweapon since 2020, presumably due to our clean lifestyle, diet of raw horse-paste, and minimal social interactions with fellow Homo sapiens. Sadly, it didn’t avail us in the end.

Given Amy’s myriad health problems, it was no surprise that COVID hit her hard. But it hit me hard too, and that was a surprise. Normally I power through and keep going. Not this time. COVID left me with constant brain fog and fatigue. It felt like I had the flu, but it lasted for weeks instead of days.

Still, life goes on. I followed the various post-COVID protocols to aid recovery. I increased my coffee intake to compensate for the mental malaise. I went outside and played with the dog. I started to get better.

A few months later, things worsened. While attending the Republican State Convention, I picked up another nasty viral infection. A week later, I woke up to bizarre ocular auras. Shimmering shapes were everywhere in the periphery of my vision. Lights were brighter, as if imbued with an astral effervescence from some higher plane. Shadows were darker, seemingly pitch black. It was like seeing the spirit world.

Now I’ve had migraine auras before, but they had been faint and short. This aura was far worse and it didn’t recede, not after 20 minutes, not after an hour, not after two hours. My wife decided to take me to the ER in case it was a stroke or ischemic attack. It wasn’t that, thank God, and I was discharged. But it was clearly something.

Whatever “it” was, the auras continued for weeks, lasting sometimes just an hour or two, but sometimes ten hours per day. When the auras were active, I couldn’t even look at a computer monitor without being nauseous. When they weren’t, I was playing constant catch-up. It was intolerable.

So I followed up with neurology, ophthalmology, and (from there) neuro-ophthalmology. I pursued test after very expensive test. I discovered that Obamacare does, in fact, suck. The wheels of specialty medicine move slowly, so each appointment took weeks to secure. In the meantime, the auras slowly diminished in frequency and intensity. But as they faded, the brain fog, fatigue, and pain came back, worse than before. Mornings have become uniquely miserable. I’m barely functional until late afternoon or evening. Far too many months have passed in which I accomplished far too little. I went from writing million-word RPG books with laser-focus to struggling to get through my email.

Finally, last week, the results of an MRI with Contrast revealed what was going on. I have allergic fungal sinusitis (AFS) in my sphenoid sinus. It’s serious enough that my neuro-ophthalmologist referred me to an ENT for surgery to remove “fungal detritus.”

What is AFS, you ask? I certainly had never heard of it. It sounded rather innocuous when I saw it on the test result. Here’s a summary, as best as I understand it.

The Stages of Fungal Sinusitis According to My Discord Community (Thanks, Guys)

Every breath we take carries fungal spores into our sinuses. The sinuses are lined with cilia, the microscopic hairs that beat in waves, moving mucus down the nose. Normally, mucus traps the spores and the cilia sweeps it all out. Macrophages and neutrophils destroy any spores that linger.

In AFS, the immune system overreacts. It mounts a Th2 allergic response, sending IgE antibodies, mast cells, a “cytokine cascade” of eosinophils that create a sticky allergic mucin. The mucin blocks the drainage openings, closing off the sinuses; the cilia can’t clear it. The fungal spores and mucin stay trapped, and become mineralized. The trapped fungus keeps driving more allergic reactions, increasing the pressure. Left untreated the pressure can eat away at the bone.

That pressure and inflammation are what’s causing the deep headache, fatigue, and cognitive slowdown. The same inflammatory mess that fills and blocks the sinuses also leaks signals into the bloodstream, which creates the constant flu-like malaise. Lying flat lets the secretions pool and pressure rise; hence the brutal morning misery. The AFS also explains the visual oddities. The sphenoid sinus sits millimeters from the optic nerves and the visual parts of the brain. Swelling and pressure there triggers “aura-like” light phenomena even without classic migraine.

I’ve been allergic to mold my whole life, so why did I develop AFS now? Because of COVID, most likely… COVID infects and kills ciliated cells in the nasal and sinus lining, causing impaired clearance. It also tends to shift the immune system towards Th2 dominance in people with allergies (like me), which amplifies the IgE and eosinophil activity. The combination of increased eosinophils and reduced drainage created the conditions necessary for my sinuses to seal up with fungal cement.

Now that the fungus has mineralized in the sinus, the only way to treat the condition is to cut it out. I’ll be seeing an ENT on Wednesday and aim to schedule surgery sooner rather than later.

That’s about the gist of it. I’m hopeful I’ll return to form after I have sinus surgery. Until then, the frequency at which I update will continue to be less than it was. If you’ve been interested in writing a guest post for the Tree of Woe, it’s a good time to reach out as the posting schedule has some openings.