While I am a fully licensed physician in Kansas, this communication does not constitute personal medical advice or establish a physician-patient relationship. See your own physician to discuss your particular diagnosis and treatment
CHRONIC FATIGUE SYNDROME/LONG COVID
I see patients with this diagnosis or collection of symptoms often. This is a debilitating condition that causes loss of employment, relationships, and quality of life. Patients that have these symptoms often are told that it is “all in your head,” even by medical professionals at times. I have included my thoughts about this condition below.
Root causes: Chronic viral infection, toxic overload, limbic trauma, hormonal imbalance, mitochondrial dysfunction
Diagnostic criteria: History: Impairment in function with profound fatigue, post-exertional malaise, orthostatic intolerance, unrefreshing sleep, cognitive impairment, recurrent infectious symptoms.
Suggested preliminary lab work-up to identify a potential cause of chronic fatigue: CBC, CMP, thyroid, vitamin B12, C-reactive protein, sed rate, ferritin, vitamin D, urine, cortisol level, rheumatoid factor, ANA.
Differential diagnosis: Adrenal insufficiency, thyroid disease, diabetes, rheumatologic disorders, vitamin B12 deficiency, multiple sclerosis, Parkinson's disease, myasthenia gravis, traumatic brain injury, seizures, Chiari malformation, psychiatric disorders, sleep apnea, narcolepsy, periodic limb movement disorder, Lyme's disease, hepatitis, tuberculosis, Giardia, Q fever, coccidiodomycosis, syphilis, Epstein-Barr virus infection, Parvovirus B19 infection, small intestinal bacterial overgrowth, inflammatory bowel disease, celiac disease, food intolerance, anemia, iron overload, heavy metal toxicity, mold infection, substance abuse disorder, cancer, obesity, and COPD.
Treatment: Pacing with activity, physical therapy, occupational therapy, compression hose, salt loading, fluid loading, fludrocortisone, alpha-adrenergic agonists, meditation, antidepressants, Topamax, modafinil, IV immunoglobulin, noise canceling headphones, sunglasses, sleep hygiene, dietary trials. Interconnection between "leaky gut" and leaky brain. Increased histamine release causes brain fog. The small intestine has an extremely large amount of immune system cells.
Antiviral medications have limited effects.
For patients that have significant post-exertional malaise consider supplementation with resveratrol, coenzyme Q10, and lipoic acid. If this helps, suspect mitochondrial dysfunction. If not improved with this trial, consider heavy metal toxicity or mold infection as a rare but possible cause. If using urine mycotoxin testing, this should clear within 4 months of treatment.
Other considerations: Quercetin and resveratrol for mast cell down-regulation. Probiotics for intestinal immune function regulation. Oregano for antimicrobial effect. Limbic retraining to improve neuroplasticity due to maladapted stress response with chronic illness.
I hope this information helps you and your loved ones!
Jason Williams, D.O.