Breathing difficulties have made the last two weeks hell. The one symptom of dermatomyositis that has largely been dormant for over a year has returned—weak pectoral and diaphragm muscles. My breaths are once again shallow. Working out is a chore. I wake up in the middle of night feeling like my body is not getting enough air, like I’m panicking, like a demon is sitting on my chest.

Has stress inflamed my condition? Have my medications stopped working? Have I simply taken them too irregularly and messed up my progress?

Two business trips, a late-night birthday bash, and attending to doctor appointments have meant irregular schedules and interrupted circadian rhythms. I compensate for sleepiness with caffeine. Too much caffeine keeps me awake, creating a vicious sleep cycle. I struggle to motivate myself to workout. Both exacerbate my symptoms.

Just doing a mild abdominal workout took all my strength tonight. Typing out this note has zapped what little energy I have left.