The Groysman Podcast

Dysautonomia and Long COVID

Dysautonomia explained: what it is, how it connects to Long COVID, and the full range of symptoms and treatments.
Dr. Groysman provides a comprehensive overview of dysautonomia and its role in Long COVID. He explains the two branches of the autonomic nervous system, walks through the full symptom list from orthostatic intolerance to cognitive dysfunction, and covers the medical conditions and infections that cause autonomic damage. He compares the symptom overlap between dysautonomia, POTS, chronic fatigue syndrome, and Long COVID, explains how to test for POTS vs. orthostatic hypotension, and discusses treatment options including medications, lifestyle modifications, stellate ganglion block, and vagus nerve stimulation.
What You'll Learn:
What dysautonomia is: damage or inflammation to part or all of the autonomic nervous system
How the sympathetic and parasympathetic nervous systems control opposite bodily functions
The full symptom range: orthostatic intolerance, tachycardia, GI issues, temperature dysregulation, fatigue, sleep disorders, cognitive symptoms, urinary/sexual dysfunction, vision and hearing changes
Medical conditions that cause dysautonomia: diabetes, chronic alcoholism, amyloidosis, lupus, Parkinson's, Ehlers-Danlos syndrome, low vitamin D
Infections that damage the autonomic nervous system: HIV, herpes family viruses, Lyme, COVID-19
The striking symptom overlap between dysautonomia, POTS, CFS/ME, and Long COVID
How to test for POTS vs. orthostatic hypotension using tilt-table testing
Heart rate variability, deep breathing test, sweat tests, Valsalva maneuver, and QSART
Treatment options: hydration and salt, compression garments, beta blockers, ivabradine, midodrine, fludrocortisone, pyridostigmine, SGB, and vagus nerve stimulation
[00:00] Introduction: what is dysautonomia[00:30] Definition: dysfunction of the autonomic nervous system, primary vs. secondary causes[01:00] Forms of dysautonomia: POTS, vasovagal syncope, orthostatic hypotension[01:30] The two branches: sympathetic vs. parasympathetic nervous system[02:00] Parasympathetic functions: pupil constriction, salivation, digestion, bladder, heart rate[02:30] Sympathetic functions: pupil dilation, airway dilation, glucose release, adrenaline[03:15] Dysautonomia symptoms: orthostatic intolerance, tachycardia, hypotension[04:00] GI symptoms, temperature regulation, fatigue and exercise intolerance[04:45] Sleep disorders, cognitive and emotional symptoms, urinary and sexual dysfunction[05:15] Vision and hearing changes: photophobia, tinnitus[05:30] Conditions that cause dysautonomia: diabetes, alcoholism, amyloidosis, lupus, Parkinson's[06:15] EDS, low vitamin D, and infections: HIV, herpes viruses, Lyme, COVID-19[07:00] What is POTS: hallmark rapid heart rate, testing criteria[07:30] CFS/ME: persistent fatigue lasting 6+ months, post-exertional malaise[08:15] Symptom overlap across dysautonomia, POTS, CFS, and Long COVID[09:00] Testing: tilt-table test for orthostatic hypotension (systolic drop 20+ mmHg or diastolic drop 10+ mmHg within 3 min)[10:00] POTS criteria: 30+ bpm heart rate increase within 10 min of standing, no BP drop[10:45] Additional tests: HRV, deep breathing, sweat tests, Valsalva, QSART[11:30] No direct way to measure autonomic function: all tests are indirect[12:00] Treatment: address the underlying cause first[12:30] Hydration and salt intake (oral or IV), compression garments[13:00] Medications: beta blockers, calcium channel blockers, ivabradine[13:45] Midodrine, fludrocortisone, pyridostigmine[14:15] Dietary triggers, physical therapy, exercise[14:30] Stellate ganglion block and vagus nerve stimulation[15:00] Closing remarks
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The Complete Long COVID Handbook Series (7 volumes)Comprehensive guides covering 100+ symptoms, mechanisms, and evidence-based approaches across all six primary causal mechanisms.https://www.longcovidfamily.com/shop/
Join the Long COVID Family CommunityConnect with other Long COVID patients, access free resources, and stay updated on the latest research.https://www.longcovidfamily.com/
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Medical Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. The views expressed are Dr. Groysman's clinical opinions based on available evidence. Always consult with your healthcare provider before making changes to your treatment plan.

What Activates Long COVID?

What activates Long COVID?
Dr. Groysman breaks down the four major hypotheses and explains how autoimmunity, inflammation, and the autonomic nervous system interact.
Dr. Groysman walks through the current hypotheses for what causes Long COVID: autoimmune response, viral persistence, chronic inflammation, and microclots. He explains where dysautonomia fits into the picture and why the relationship between these mechanisms is not yet fully understood. The episode covers what autoimmunity actually is, how the inflammatory cascade works, and why targeting "inflammation" is more complicated than most patients realize.
What You'll Learn:
The four primary hypotheses for Long COVID: autoimmune response, persistent virus, chronic inflammation, and microclots
Where dysautonomia fits as a potential fifth hypothesis, and the unresolved question of which comes first
What autoimmunity really means: molecular mimicry, self-recognition failure, and autoantibody production
Common autoimmune conditions explained: Hashimoto's, Graves', Type 1 diabetes, MS, myasthenia gravis, celiac disease
How the inflammatory system works: cytokines direct production, chemokines direct location
Why "anti-inflammatory" treatments may only affect one part of a much larger cascade
The connection between clotting, inflammation, and sympathetic overdrive in Long COVID
[00:00] Introduction[00:30] The four hypotheses: autoimmune, viral persistence, chronic inflammation, microclots[01:00] Dysautonomia as a fifth hypothesis and the chicken-or-egg question[01:45] SGB, vagus nerve stimulation, and vagus nerve exercises as treatment approaches[02:15] Does COVID cause dysautonomia, or does dysautonomia increase Long COVID risk?[02:45] What autoimmunity is: molecular mimicry and loss of self-recognition[03:30] Examples of autoimmune conditions: allergies, Hashimoto's, Graves', Type 1 diabetes, MS[04:30] Myasthenia gravis, Sjogren's, psoriasis, rheumatoid arthritis, celiac, Crohn's, eczema[05:15] The immune system as an assembly line: how one failure cascades[05:45] What inflammation actually involves: mediators vs. cells[06:15] Cytokines, chemokines, interleukins, prostaglandins, leukotrienes, histamine, serotonin[07:00] Why "anti-inflammatory" may only target one part of a much larger system[07:30] Clotting and inflammation: thrombin's role, and why chronic inflammation becomes the problem[08:00] Dysautonomia, sympathetic overdrive, and inflammation all linked together[08:15] Closing remarks
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The Complete Long COVID Handbook Series (7 volumes)Comprehensive guides covering 100+ symptoms, mechanisms, and evidence-based approaches across all six primary causal mechanisms.https://www.longcovidfamily.com/shop/
Join the Long COVID Family CommunityConnect with other Long COVID patients, access free resources, and stay updated on the latest research.https://www.longcovidfamily.com/
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Medical Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. The views expressed are Dr. Groysman's clinical opinions based on available evidence. Always consult with your healthcare provider before making changes to your treatment plan.

Parosmia: Why It Happens, and What You Can Do About It

Parosmia after Long COVID: how the olfactory system works, why smell becomes distorted, and treatments that may address the root cause.
Dr. Groysman explains the biology behind parosmia, one of Long COVID's most isolating symptoms. He walks through how the olfactory system detects and interprets smell, covers the four main hypotheses for why smell becomes distorted after COVID, and explains why some patients experience temporary recovery during vacations only to relapse when they return home. He presents his clinical reasoning for dysautonomia as the underlying driver and discusses why stellate ganglion block and vagus nerve stimulation both support this mechanism.
What You'll Learn:
How the olfactory bulb, nerve endings, and brain work together to create the perception of smell
Why 75-90% of what we perceive as taste actually comes from smell
The four existing hypotheses for parosmia: inflammation, epithelium damage, nerve infection, and abnormal reconnection
Why some patients recover smell temporarily on vacation and lose it again at home
How dysautonomia explains parosmia better than the other hypotheses
Why stellate ganglion block produces results within 30-60 seconds, and what that timing tells us about the mechanism
How vagus nerve stimulation works as a slower but effective alternative (30-90 days)
Other treatments discussed: neti pot, nasal steroids, olfactory retraining, gabapentin/amitriptyline, nasal theophylline
[00:00] Introduction and medical disclaimer[00:45] The impact of parosmia: diet disruption and social isolation[01:15] How the olfactory system works: nerves, chemicals, and the brain[02:30] Why you cannot describe a smell without naming it[03:00] Taste vs. smell: 75-90% of taste perception comes from olfactory input[03:30] What parosmia is: abnormal smell, common triggers (coffee, eggs, garlic, chocolate)[04:15] Four hypotheses: inflammation, epithelium damage, nerve infection, abnormal reconnection[05:30] Delayed parosmia: why symptoms appear weeks or months after infection[06:30] Temporary recovery on vacation and why it reverses[07:30] The autonomic nervous system as the unstable variable[08:30] Why blood work will not reveal the cause[09:00] Dysautonomia as the proposed mechanism for parosmia[09:45] Why POTS and diabetic neuropathy do not cause parosmia: segmental autonomic function[10:30] Stellate ganglion block: why 30-60 second response rules out inflammation and rewiring theories[11:45] Vagus nerve stimulation: daily use, 30-90 day timeline, and why overuse reduces benefit[13:00] Other treatments: neti pot, nasal steroids, olfactory retraining, gabapentin/amitriptyline, bland diets, nasal theophylline[14:30] Closing remarks
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The Complete Long COVID Handbook Series (7 volumes)Comprehensive guides covering 100+ symptoms, mechanisms, and evidence-based approaches across all six primary causal mechanisms.https://www.longcovidfamily.com/shop/
Join the Long COVID Family CommunityConnect with other Long COVID patients, access free resources, and stay updated on the latest research.https://www.longcovidfamily.com/
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Medical Disclaimer: This podcast is for educational purposes only and does not constitute medical advice. The views expressed are Dr. Groysman's clinical opinions based on available evidence. Always consult with your healthcare provider before making changes to your treatment plan.

Long COVID Q&A - SGB, Epstein-Barr & Taste/Smell

Long COVID Q&A: stellate ganglion block, Epstein-Barr virus, and recovering taste and smell. Patient questions answered.
Dr. Groysman answers questions he receives frequently from Long COVID patients about stellate ganglion block (SGB), loss of taste and smell, and the role of Epstein-Barr virus. He explains why the nervous system gets stuck in overdrive during Long COVID, how SGB works to reset it, and why loss of smell and distorted smell often respond very differently to treatment.
Questions Answered:
Q1: How does stellate ganglion block work and where is it done?
Q2: What are the success rates for recovering taste and smell?
Q3: How does Epstein-Barr virus increase Long COVID risk?
Q4: How do you know if the block actually worked?
Q5: Can both sides be done the same day?
Q6: Why do smell and taste symptoms come and go or change over time?
Q7: How does vagus nerve stimulation help, and how should settings be adjusted?
Q8: What is heart rate variability and what does it tell you?
[00:00] Introduction and audio setup[03:00] Why Long COVID symptoms come and go[05:00] Stellate ganglion block: where and why specific levels are targeted[08:00] First questions: nervous system dysfunction, Epstein-Barr virus, and prior nerve injury[14:00] Loss of smell vs. distorted smell vs. reduced smell: how recovery unfolds[20:00] Which numbing medication is used and why it matters[25:00] Vagus nerve stimulation: how it works, results, and tips for better response[30:00] Success rates for smell, taste, anxiety, and sleep[36:00] Epstein-Barr virus: why it raises Long COVID risk[42:00] How Dr. Groysman confirms a successful block[47:00] Doing both sides the same day: the protocol and safety precautions[52:00] What to do when the block did not work[56:00] Heart rate variability as a window into nervous system function[59:00] Nasal spray options for reduced smell and closing remarks
 
The Complete Long COVID Handbook Series (7 volumes)Comprehensive guides covering 100+ symptoms, mechanisms, and evidence-based approaches across all six primary causal mechanisms.→ https://www.longcovidfamily.com/shop/
 
Join the Long COVID Family CommunityConnect with other Long COVID patients, access free resources, and stay updated on the latest research.→ https://www.longcovidfamily.com/
 
This podcast is for educational purposes only and does not constitute medical advice. Always consult with your healthcare provider before making changes to your treatment plan.

Long COVID brain fog explained: The biological mechanisms behind the symptoms

In this episode, Dr. Robert Groysman breaks down why brain fog in Long COVID is not psychological, it is a measurable biological problem with multiple distinct causes. He covers dysautonomia's effect on cerebral blood flow, mitochondrial dysfunction and why the brain is uniquely vulnerable to energy deficits, neuroinflammation from overactive microglia, endothelial dysfunction and microclots impairing oxygen delivery, hormone disruption across thyroid, adrenal, and sex hormone systems, sleep architecture loss, gut-brain axis dysregulation through the vagus nerve, and post-exertional cognitive crashes.
 
What You'll Learn:
Why the brain uses 20% of your body's total energy  and what happens when ATP production drops
How dysautonomia causes cerebral blood flow to fluctuate with posture, activity, and even eating
Why your MRI can look completely normal while neuroinflammation is still actively impairing cognition
How the gut communicates with the brain through the vagus nerve, and why gut dysbiosis worsens mental clarity
The post-exertional pattern: why cognitive crashes can appear hours after the triggering activity
Why identifying which specific mechanism is driving your brain fog is the key to addressing it
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The Complete Long COVID Handbook Series (7 volumes) - Comprehensive guides covering 100+ symptoms, mechanisms, and evidence-based approaches across all six primary causal mechanisms.→ https://www.longcovidfamily.com/shop/
 
Join the Long COVID Family Community - Connect with other Long COVID patients, access free resources, and stay updated on the latest research. → https://www.longcovidfamily.com/