This is a friendly reminder that a staggering 67% of individuals with Long COVID develop a form of dysautonomia(1). This translates to 38 million Americans who have likely developed dysfunction of the autonomic nervous system (dysautonomia) following a SARS-CoV-2 infection. However, the actual number of patients formally diagnosed with dysautonomia is likely much lower, as many physicians fail to recognize the clinical presentations. The symptoms associated with dysautonomia in those with long COVID include: - Orthostatic hypotension (drop in blood pressure when standing) - Sensory disturbances or paresthesias (tingling or numbness) - Heartbeat irregularities (e.g., tachycardia or palpitations) - Gastrointestinal issues (e.g., bowel dysfunction) - Brain fog or cognitive disturbances - Dizziness or light-headedness - Shortness of breath (dyspnea) - Bladder dysfunction - Sleep disturbances - Chest pain - Fatigue Also, if you are reading a scientific publication about Long COVID and the researchers do not describe POTS or dysautonomia, it's because they were not screening for it. Help us raise awareness that millions with Long COVID may be experiencing disruptions in the function of their autonomic nervous systems. Literature Cited: 1. Larsen, N., Stiles, L., et al. Front. Neurol. 2022; 13: 1012668. buff.ly/tx9T5XD

A subset of individuals with depression (1), sleep disorders (2), bipolar disorder (3), or mood disorders (1) have all been found to have elevated pro-inflammatory cytokines in their blood. The study below is yet another example of why immunopsychiatry is an area of active research. Literature Cited: 1. Felger JC. Curr Neuropharmacol. 2018. PMID: 29173175 2. Zielinski MR, Gibbons AJ. Front Cell Infect Microbiol. 2022. PMID: 35392608 3. Dolsen MR, Soehner AM, Harvey AG. Psychosom Med. Jan 2018. PMID: 28914726

Thank you again for allowing us to host you in our webinar series and for inspiring this week's Substack article. We admire the academic and clinical contributions you are making in the dysautonomia world! For those who haven't yet watched Dr. Blitshteyn's @dysclinic recent webinar, it's outstanding. youtube.com/watch?v=gi03hmor…

Key brainstem regions help control heart rate, blood pressure, breathing, and the body’s inflammatory “brake” through the vagus nerve. In this article, we examine neuroimaging and post-mortem findings in COVID-19, a recent neuroimmune hypothesis for POTS, the medulla’s role as an inflammatory thermostat, and how connective tissue laxity or mast cell activation may amplify vulnerability in a subset of patients. Read more here: buff.ly/Lx71wkY

After having her daughter at age 27, Sebrina Smith-Henry was constantly thirsty, with dry mouth and skin, body aches, and chronic fatigue. It took about 7 years of symptoms before she received a diagnosis. Sebrina was in and out of a military hospital while her husband was in service, but she explained, “I had never had a doctor put all the pieces together before then… and you never saw the same doctor twice there.” It wasn’t until a chance encounter with a nurse that things began to change. Her daughter, then 7, was participating in a clinical study at Duke University Children’s Hospital. The study required long hours at the hospital, and a nurse allowed her to sleep in a guest room. After waking up 8 hours later, the nurse checked her vitals and said, “You need to tell your doctor about all these things that are happening to you." A new doctor outside the military network examined her skin, eyes, and scalp. He ran tests and told her, “I think we found the answer.” She was diagnosed with: - Rheumatoid arthritis - Sjögren’s - Lupus Managing her autoimmune diseases has her feeling better at age 59 than she did at 46. Common signs include joint pain, rashes, extreme fatigue, dryness, anemia, and more. If your symptoms linger without answers from your doctor, maybe it’s time to find another doctor. Always keep advocating for yourself. Read more: msn.com/en-us/news/other/she…

Validated survey instruments provide a reliable way to measure symptoms and overall quality of life. But one of the biggest misconceptions about health tracking is that a single score can tell you specifically what's wrong. It doesn't. Instead, measuring scores over time can help catch setbacks and improvements to help you to adjust care. In this way, your trend reports help answer questions like: • Am I improving over time? • Have my symptoms been getting worse? • What does "normal" look like for me? • When did things begin to change? A single score is a snapshot. A series of scores over time tells a story. That's why unhide® doesn't just show your latest survey result; it helps you see your health over time. Your reports aren't designed to diagnose a condition. They're designed to help you recognize patterns that may otherwise be difficult to see. Explore: unhidenow.org/validated-heal…

ME/CFS, Long COVID, PTSD, rheumatoid arthritis, and multiple sclerosis have one thing in common. Prof Dmitry Pshezhetskiy explains, "patients frequently report remarkably similar symptoms," such as: - brain fog - disturbed sleep - poor concentration - overwhelming fatigue - autonomic dysfunction - dramatic reduction in everyday functioning Researchers at the University of East Anglia and Oxford BioDynamics investigated the causes of many shared symptoms. Here is what they found. Using 3D genome analysis rather than linear DNA sequences, the team discovered little overlap in individual genes. "But when we analyzed how those genes interact in complex biological networks, a completely different picture emerged. Suddenly, the diseases appeared deeply connected," noted lead researcher Prof Dmitry Pshezhetskiy. The shared systems involve: - stress responses - immune signaling - mitochondrial energy production Different triggers, from viral infection to trauma, may converge on these circuits to drive the overlapping symptoms. "What we discovered is something approaching a biological unifying theory of fatigue," Pshezhetskiy said. Read more: buff.ly/aUYyxOW

Progress in treating depression has largely stalled over the last 30 years. Could this be because the field has largely ignored a key biological driver present in a substantial subset of patients: chronic low-grade inflammation? Multiple meta-analyses of randomized trials show that anti-inflammatory agents (as add-ons or in patients with elevated inflammatory markers) can reduce depressive symptoms, with moderate effect sizes (1,2,3). This is especially relevant for treatment-resistant depression, where standard antidepressants often fall short in 1/3 of treated patients. At the Brain Inflammation Collaborative, we recognize the strong link between chronic inflammatory conditions and psychiatric disorders such as major depressive disorder, and we actively incorporate this relationship into our research. Learn more at buff.ly/X9I08WE Literature Cited: 1. Köhler O, et al. (2014). JAMA Psychiatry. PMID: 25322082 2. Bai S, et al. (2020). Journal of Neurology, Neurosurgery & Psychiatry. PMID: 31658959 3. Kappelmann N, et al. (2018). Molecular Psychiatry. PMID: 27752078

Vitamin D was classified as a vitamin by historical accident. It’s actually a steroid hormone that crosses cell membranes and directly controls gene expression. In chronic inflammatory and post-infectious conditions, the real issue can be resistance: the active hormone simply isn’t signaling efficiently. Learn: • What drives resistance • How to actually test for it • Why vitamin D acts more like a hormone • Practical ways to improve your body’s response Read more: buff.ly/VIjX1UN

POTS, hypermobile EDS, and MCAS often occur together, and the connection is stronger than many realize. A 2021 study found a markedly higher rate of Mast Cell Activation Syndrome in patients who already have both Postural Tachycardia Syndrome and hypermobile Ehlers-Danlos Syndrome. If you live with one of these conditions, it’s worth discussing the others with a knowledgeable clinician. Better awareness can lead to more complete care.