“Faith is taking the first step even when you don’t see the whole staircase.” — Martin Luther King Jr.

A few weeks ago, I wrote on the topic of a chronic, post-COVID syndrome, a dysautonomia affecting the autonomic nervous system. This has a potential to linger in millions of patients who are younger, women, with mild or moderate COVID infections.

Symptoms are as varied as COVID infections themselves affecting heart, brain, gastrointestinal and immune systems. Headaches, diarrhea, shortness of breath, chest pain, mood disorders, brain fog and profound fatigue with minimal exertion can characterize this condition.

One of my favorite science writers, Ed Yong, wrote a revealing article about this in Atlantic magazine on Aug. 19.

Post-COVID patients, named “long-haulers” since the effects of their infections have lasted for months, express frustration that many doctors don’t know about this condition and don’t believe their stories. Similarly, their employers sometimes consider them as lazy, unreliable or faking their real disabilities.

In Yong’s article, he compares post-COVID to another condition patients and doctors have struggled with over the years. This is the chronic fatigue syndrome/fibromyalgia/myalgic encephalomyelitis syndrome that has long been thought to be an aftermath of another viral illness, mononucleosis.

Like post-COVID syndrome, fatigue syndrome/fibromyalgia/myalgic encephalomyelitis syndrome has been suspect as there are no specific diagnostic tests that are reliable markers of it. In post-COVID patients, even the antibody tests showing a recovered case may be negative, casting doubt that they even ever had the disease. This can happen despite positive COVID infection test results earlier. Such false negative tests throw us further into confusion about this new syndrome.

Integrative and holistic medicine approaches may help based on core medical principles:

1. Believe and listen to the patient when she reports her symptoms (most patients are women).

2. Recognize that the condition has multiple presentations and symptoms.

3. Treat each person as a unique case accepting that the long-haul approach may involve much trial and error.

A patient I see had what in retrospect was a typical case of COVID-19 in October: three weeks of severe respiratory symptoms, fever, fatigue and diarrhea. Now, 10 months later, she suffers with new ongoing severe headaches, brain fog and intermittent diarrhea. A simple anti-inflammatory diet and acupuncture have largely relieved her symptoms.

Some potential treatments we have learned from management of fatigue syndrome/fibromyalgia/myalgic encephalomyelitis syndrome that may be transferrable to post-COVID patients are:

1. Energy support for severe fatigue: CoQ10, ashwaganda, ginseng, DHEA, high potency B vitamins, carnitine and hormones.

2. Immune support: Vitamins C, D, zinc, mushroom extract, probiotics, sleep and stress management.

3. Inflammation: anti-inflammatory diet, Zyflamend, fish oil, turmeric and ginger.

4. Pain management, mood and brain issues: cognitive behavioral therapy, mindfulness, meditation, graded mental and physical rehabilitation exercises, acupuncture, yoga, tai chi, SAMe, ginkgo, cannabinoids, magnesium and medications.

This can be a complex best guided and individualized in partnership with a trusted health professional or post-COVID clinic. You may be in for the long-haul, so stay patient, focused and hopeful. Certainly, research is needed.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.

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(1) comment

Kim Etheridge

Could you please elaborate on the time frame mentioned here. You cite a patient of yours who had typical symptoms of COVID-19 in early October. The first Chinese case of COVID-19 is traced to November 17, 2019. Has this patient tested positive for the COVID-19 antibodies?

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