Autonomic Dysfunction from Long COVID – A Discussion with Dr

all this Dr mobeen say yes from welcome to one more show and with me we have our own Dr Keith Berkowitz welcome Dr Keith Burke thank you so much for having me absolutely it’s always a delight to have you and um cool beans as you can see I have my coffee here because Keith is going to be talking and I’m gonna be sipping my coffee at night though which will make the rest of my night very interesting as well so Keith once again welcome uh the discussion that I want to start with is a very common two very common problems for which I think that either the progress is very slow or we do not yet know how to manage them well very well so you are practicing I think these two are very interesting to ask you one of them is tinnitus after covet or vaccine and the other one is the autonomic dysfunction or an appearance of the autonomic dysfunction where the patient has tachycardias and palpitations and then they have postural hypertension or dizziness even fainting so let’s start with the second part first let’s start from the Baseline first how about covet covet not the long covet do you see much patience of covert nowadays actually this week we’ve had a nice little search of and the trouble now is we’re not sure what it is whether it’s covid RSV influenza I’ve had other viruses rhinovirus enterovirus so we’re actually seeing a huge surge in viral illness absolutely and as the cold weather swings in this surge would continue to increase and interestingly tell me if I’m wrong but with the covert morphing more towards upper respiratory type infection more towards human coronavirus type infection still very dangerous compared to other human human coronaviruses it will become more and more difficult to see to differentiate it from other viruses commonly the you know going to a place for PCR deaths and they’re finding that actually the testing is pretty negative a lot of the time so I have people that are testing negative for four days then the fifth day they’re testing positive so it’s very different than what we’ve seen in the past and you know as I’ve talked to in the past with you I treat more on symptoms than opposed to you know a positive test and I think now with these other viruses and we’re not really sure are they also cross-reacting on the testing so is the testing good enough to really properly distinguish between the different viruses we’re seeing understood so uh before once again going to the long covet the basic topic for today uh with this acute covet has your management approach changed or has any part of your management become more challenging now and so you’re looking for other possibilities and what these may be so what’s interesting I mean the nice part and you’ve probably said this is the audience it’s much more modeled right we’re seeing a much more mild illness than we’ve seen before what really is a major issue though is that what we’re seeing is people are testing positive for much much longer period of time I remember in early stages when we thought of you know the alpha strain or the beta or Delta gamma people would be positive for five six seven days maybe now I’m really seeing people positive up to 14 days and what’s interesting is they’re not symptomatic necessarily after five or six days but they’re still testing positive in our challenges and you know I think not everyone’s sure how long has someone actually contagious are they still contagious when they’re testing positive or is that just a remnant of you know the virus has been there before so can I make a comment on this one for how long they would be positive thinking about human coronaviruses that are about 86 percent of our population has them in our throat and that means we’ll be positive for them if sarskov 2 eventually becomes more human coronaviruses like then wouldn’t this always be positive in majority of our population going forward I would say yes and the question is what are we testing positive for right if we’ve always been exposed to coronaviruses right and I wonder if previous exposure also to covet and now re-exposure is that really creating that humanized type of virus that’s kind of I guess the term endemic into our you know population correct correct and for the audience for the cool beans here this doesn’t mean that the coronavirus has become totally harm harmless the starscope too it is still very dangerous it can still cause issues so uh but as it continues to become more human friendly or humanized it will become more endemic in our population so uh patients are positive multiple viruses are present how is severity so it’s what’s really interesting severity is in a different part I know we had talked previously back when Omicron was first around about how it was more upper you know as opposed to early on where it was more pulmonary complications now we’re seeing I’m seeing a lot of coronavirus followed by acute sinusitis so people are actually now developing oftentimes a secondary bacterial infection so they have a lot of sinus pressure sinus headache even after already recovering from that first stage of covid and so that’s what’s different that’s very different than what we saw early on in Omicron and obviously you know years before that so so these probably are secondary infections because the immune system is busy somewhere else so it is not as optimally running after having to fight with the other viruses and so now bacterial infections are taking hold so do you uh antibiotics do you use them you wait for them what is your approach I see many doctors are kind of a little hesitant with the antibiotics what do you do so I mean we look at antibiotics obviously you know I’ll again the histamines we had talked about before definitely antihistamines have a big role in this aspect especially with all the sinus pressure the inflammation that’s going on I kind of are using in a lot of cases antibiotics early both from the anti-inflammatory effect again which sinusitis even though it could be viral will have a benefit and also in some cases I’m seeing you know secondary bacterial but I suspect that secondary bacterial sinusitis got it and for the covet itself is there any change for example there are possibilities of using let’s say ivermectins or vitamin Ds and vitamin C and so though all of those my apologies uh do you have any other regime that you use so again I I still like the the you know the basics we use for room support vitamin D vitamin C zinc quercetin I find definitely continue that I in some cases I’ll use Ivermectin what’s interesting though and and this goes back to the point we were talking before about positivity I’ll often use Ivermectin in the past we would see the viral lobe really decrease pretty immediately now I’m not seeing that I’m seeing the symptoms decrease but the viral load or if we think it’s that’s what’s correlated with a positive test still happen for up to 10 to 12 Days even if they’ve already completed their course of ivermectin in five days they still can be positive for five or six even though they’re not symptomatic so they’re not symptomatic they are so interesting Sovereign may not be helping as much with the newer variants but luckily the variants themselves are becoming milder so there is a balancing act that is going on okay so if we now move from covet let me ask you about the respiratory synthesial virus are you seeing that in adults as well immunocompromised or comorbidity address with how are you seeing that so it’s so strange again a lot of cases I don’t see in the office so I’m not you know we’re not having specific testing for it so I’m I’m what’s interesting is I’m not sure which is which I was actually speaking to one of my friends today she’s a pediatrician she had 40 cases yesterday she said she had more cases yesterday and said more kids to the emergency room this week than she has throughout covert interesting so there’s an interesting question from yikes she’s saying what is being tested for now when they look for covert what is the test so what tests are you use doing and what is the use of the test nowadays so typically now we’ve really moved into a home testing stage where most people are actually being diagnosed at home so they’re using the rapid home test in general I think that’s the majority obviously in the hospitals you know in other acute care settings or using PCR tests but I would say the majority of the diagnosis now is based on a home test I see overwhelmingly where and again people are not and in my practice they’ll call before so you know we probably won’t see them when they come in with code but they’ll call me say I have a cold and I got congestion I have all these other things you know could this be coveted and the first thing I hear I tested myself negative four times and I’m negative I go it’s covered then I get a call back the next day I tested positive so what’s really interesting is that the I think the testing and maybe this is the change in the virus is is really not as accurate as we saw before or it could take several days to have a positive test interesting okay so now we’re gonna move towards the long covet and within the long covert these two more very prevalent and difficult to treat situations so let’s start with the tinnitus first have you found a solution for tinnitus I I would all the symptoms and all the complications has to be the hardest one of all you know and again the challenge is depending on where they get it from so again the longer someone’s had it I think the more difficult it is to repair definitely the vaccine injured as opposed to Long covet that’s also more challenging and so a couple mechanisms that I’ve thought of that I’ve tried looking at things like vascular is it a vascular problem is it an inflammatory problem you know is it even a simple thing in some cases it could be nasal congestion or histamine related problem those tend to be the most easily resolved the ones that may be even inflammatory or you know possibly vascular are much more challenging I am still looking I hope you have a better solution because I think we’re not having as good a success with that symptom as opposed to a lot of other things we’re treating yeah so I don’t have much success as well those who develop tinnitus after covered or after vaccine and they the tinnitus does not go away within three four days they just keep having it even on a cyclical basis and I’ll give you my own example so my tinnitus I used to have it from childhood if I had it when I could not even articulate what it is I used to ask people that hey do you hear that sound in your ears and they would say word sound and I’d be surprised they don’t hear this sound so I had it forever so I don’t really care for it but for last two three days once again I heard it to be a little louder and I have no other exposure so it just keeps coming and going in Cycles since my covert infection and it used to become better with Aspirin but now it doesn’t respond to anything right so what’s interesting so the question is are these you know cells you know permanently damaged I mean I think that’s what you know and I don’t think we have a good way of really determining that and I guess that level of damage is really probably what’s going to determine how well someone improves you know versus someone who doesn’t improve but again this is I think the hardest symptom to treat a ball so he was in mute so nicoline says antihistamine diet helps Okay so uh Mary says it’s fair by neti pot so Mary is that for tinnitus or just in general M Gregory says tinnitus may be lack of certain vitamins or minerals which I am kind of overdosed on vitamins and minerals so that is the reason so pre-covet right before covet a lot of people use things like bioflavonoids so that was one group of supplements that really seemed to have make a difference and this is pre-co another what’s interesting another hypothesis I learned years ago could it be also be related to low blood sugar so there was a theory that low blood sugar really kind of triggered some of those symptoms because if you think of the symptoms of tinnitus people get them most commonly when it’s quiet when they’re aggressed when there’s not a lot of things going on and when they’re active the symptoms tend to be a lot less so there was a thought that I’ve tried both you know and it’s it’s it’s still the mechanism may be different this time but it’s still very hard to treat and it is gosh it is I I know some other patients as well whose tinnitus just keeps hanging on um eike says what does the at-home test test for what is the test looking for I think we responded to that most of these are for sarskov too correct correct yes okay so now the big one the long covered or after covert infection or vaccine issues with the postal hypertension and palpitations so if I can just give a quick overview of the physiology and then I would like to hear your your management approach so you bring in the practice experience and let me bring in the mechanism so what happens is imagine I get covered infection and after that infection I have or 20 bodies those antibodies are against The receptors muscarinic and and you know adrenergic receptors so that means receptors for epinephrine or epinephrine and acetylcholine the result of that is that now when if I am sitting right now if I stand up what will happen is my body will immediately release epinephrine norepinephrine and acetylcholine to kind of increase my heart rate a little bit because when I stand up my my blood will flow downwards that would cause a baroreceptors to pick up that the blood volume or blood somehow pressure is reduced that would cause the release of epinephrines like substances which will cause tachycardia brief tachycardia then vasoconstriction would occur blood pressure would become normalized and I’ll be fine I would not even know that my body did that but in the in the in these patients what happens is that when they stand up the epinephrine release is overwhelmingly more than less so when there is a lot of epinephrine released that causes severe tachycardia plus palpitations is defined as the awareness of the heartbeat so they would feel the palpitations and now as the tachycardia occurs and the palpitations are force of contraction increases that causes blood pressure to go up more than needed which causes a reflex you know parasympathetic system or vagal triggering which then causes vasodilatation and blood pressure goes down and blood volume starts pooling in the lower legs which then causes fainting and even sorry spinning dizziness nausea and even fainting so that is a basic mechanism it could be with hypovolemia as well this could be because of these hormonal imbalances question for you first let’s start from the management do you see such patients how do you manage them so actually and one of the presentations is where we call when I do what I call orthostatic measurements right where I’ll measure blood pressure pulse sitting stay uh lot supine lying sitting and standing and what we’ll see typically in a young person the pulse will go up by more than 25 from supine up till standing or an older person their blood pressure could either go up or go down we’ll drop I have a second presentation I’ve seen where and it’s a little different interesting with mild exertion people will have a very large increase in the heart rate that they may feel okay when they’re resting but a little bit exertion they have this overwhelming heart rate response I remember one of my first cases this young man I walked around the whole way and it’s already went to 145 just by walking around yeah it is very common and I just wanted to quickly respond to Alexander yes Alexander the mechanism that I mentioned I am talking in context of the long covet as well okay so back to you okay so the question and what I’ve always was taught we you know throughout my my career is my thought is always to increase volume first right so one thing assume again if if either heart rate or blood pressure is changing is if we can actually increase volume and the best way is to you know normal saline intravenously can we actually relax the heart so right so that will heart rate come down will blood pressure stabilize and and a lot of people does the other thing we’ll add with that is oftentimes magnesium with that which also helps also manage the heart rate and also you know bring down blood pressure as well what’s interesting though and I was saying before is typically I never saw where the blood pressure went up and that I also see as well that’s really new you know in Long covered where typically we look for a drop in blood pressure but it actually could be either either formatted either way and that actually once again if there is an autoimmune outcome because of the molecular mimicry and The receptors for epinephrine or epinephrine are stimulated by the antibodies and then you add more epinephrine when somebody stands up then there can be a shooting of the blood pressure and if the parasympathetic system cannot counter it enough then they would just have a higher blood pressure which is which is interesting to me because I was always taught if someone is high blood pressure the last thing you want to give them is intravenous sailing right because you’ll send the blood pressure up but interesting enough it actually has the opposite effect it actually brings the blood pressure back down and I think the first couple of times I did that I made my nurse a very very anxious of course I mean if somebody has higher blood pressure you add more volume and so please for not for non-medicals this is not a prescription and for my for the doctors and nurses or providers please be careful be very very sure that this may be the mechanism if that is not the mechanism don’t do it because that would just make and one of the things we can actually you know with lab work we can actually confirm it I’ll do a urine oftentimes and we’ll see a very high specific gravity or we’ll see you know in the blood work a high you know CO2 level in the blood so we’ll look at other other markers to kind of confirm that diagnosis as much like that and you’re going to confirm the diagnosis of hypovolemia correct correct yeah if there is hypovolemia then then volume correction is important regardless of how the heart rate or the blood pressure may be looking like normally we say in medicine that hypovolemia cannot correct it above the normal but here we also have the mimicry going on and antibodies coming in which are also causing the epinephrine or acetylcholine receptors to be to be stimulated and then comes the epinephrine when I stand up and so this just becomes compounded so very interesting a question here from India and just says what kind of magnesium so intravenously we’ll use magnesium chloride is is common what we use so I actually want to bring up another point with the reason why you want to correct hypovolemia first what I’ve learned is the other treatments don’t work in a very stressed state which hypovolemia is the body really can’t take on other roles so you know trying to make it use other resources is very complicated and I learned you know with treatment that if I didn’t correct the hypolumia first and try to do other treatments or mechanisms they weren’t successful and it makes sense so if somebody has hypovolemia not only they’re going to have cardiovascular or hemodynamics instability issues they have less blood flow and less blood volume going to the tissues that means nutritional Supply is less that means lactic acid is going to start accumulating that means the local acidosis is going to occur the tissues are going to start saying hey we are getting damaged here they are going to start producing their own inflammatory markers so there is the whole body is going to go in a very strange State of Affairs and so it is important to look at the volume and fix that and then the rest of the body would start coming back towards normalcy so I want to bring another mechanism in so there’s another and I want to hear what your thought is so the other group that I see benefit from this is I do see a group of people that develop blood sugar instability where they get blood sugar volatility where either the glucose is high or the glucose is low and especially in the low glucose insulin is inappropriately high so this is a mismatch and they also tend to get that same kind of you know norepinephrine adrenaline response from that that group also seems to benefit as well because I think by giving the normal sailing we’re able to stabilize the glucose level much faster and this could also be again without knowing the mechanism I’m just now going to be thinking in terms of the mechanisms and that is it is possible that if a person is hypovolemic and they have an autoimmune disorder going on with the epinephrine hormone or epinephrine receptor antibodies and if these antibodies are keeping the system in that stressed out state that will mean the body would generally be insulin resistant and the other possibility you and I were talking about maybe there is something going on with the pancreas maybe there’s inflammation over there and pancreas isn’t functioning correctly and also again one of the other things I don’t know I see Labyrinth which is really unusual is the liver dysfunction where we’ll see actually high iron levels below ferritin so I wonder if that and you know I’m trying to find any literature about that I don’t know if you’ve ever seen I’ve never heard of that combination prior to covet me neither and the point is is that iron kind of it’s not really iron overload because ferritin which is the measure of iron storage is normal but is that actually affecting the way the liver deals with glucose yeah so do you see the ferritin to be normal above normal below normal well in a lot of cases below normal we know that the ferritin-like substances are reduced during the infections or stressful situations because the body is trying to keep the iron away from the pathogens so maybe the body has never actually come out of that inflammatory state of conserving the ferritin and leaving the iron in the macrophages in the bone and other places so we you do the volume correction you give them magnesium as well what else so most often do B12 as well so I’ll do B12 together with that to help I think it calm some of the the nerve or sympathetic overdrive people have that goes along with that and that does help a lot and do you mind if I before we get there the group that I find most at risk we started talking about that so the group I find most at risk for that is people with actually genetic predisposition people that have the gene called MTHFR which affects I can never pronounce it so I’m not going to try it which affects the body’s ability to take folic acid or folate and convert it into a usable form which is methylfolate and there thereby impacts their neurotransmitter production that group seems to also get more of these kind of pots or or blood pressure heart rate variability issues is that the methyl tetrahydrofolate yes thank you I think productives right yes reductas are for reductase so methyl tetrahedrofolate reductase so that means it is working with the folates and that means so you are mentioning this is the enzyme that would help make dopamines and serotonins and other right and so I’m going to make it even more complicated so also I think a lot of these patient cells have digestive issues so I think that is even impacting their ability to make neurotransmitters so I think what’s really interesting is that the system really isn’t responding well because it’s unable to compensate for this overly stressed thing interesting so how do you manage them so we’re gonna get all of your recipes right here and we’re gonna sell them so first again fluid and and the you know what I I you know where I took this from if you go back when people come in sick right to the hospital with flu or other symptoms what’s the first thing they get they get intravenous fluids so to me it was like okay let’s try that first because it’s you know the body’s probably stressed you know from from being to have an infection or low covered or a vaccine injury what I’ll often do afterwards which I find that does help but I don’t do it up until the the patient’s volume you know repleted is I’ll intravenous vitamin C definitely has an effect and where the effect is I think it does really help endothelial function very interesting so of course the possibility of this this symptom set which is the tachycardia palpitations blood pressure irregularities fainting dizziness they can be hypovolemic issues there can be blood vascular endothelial issues there could be hormonal issues there could be all of them together okay so a couple of questions from here one question is from so Martin says that what are your thoughts on hairy milis’s in MetroPCS saying that they’re not to be you so Martin even if I say that yeah sure let’s not use them these have been used for two and a half years so interesting discussion but let’s I wanna stick to the so we have Keith here he’s practicing every day he’s managing patients I want to get maximum out of him so this this session becomes variable this one part of the long covered with the autonomic like dysfunction I don’t want to call it autonomic dysfunction I do not think it is an autonomic dysfunction disease I think it is a set of circumstances or pathologies that then give the appearance of an autonomic dysfunction and I want to make sure we can get the solutions from Keith let’s see one more question uh Alternatives constant gut pain head pressure brain fog all cause and symptoms since one week after my second Pfizer over one year suffering have you seen this in others so do you see in context of Pfizer or just in general with vaccines yes so so so you actually there we may be a couple different mechanisms right we can talk about we’ll skip over the tinnitus because we kind of talked about but the gut gut pain is really interesting so I really one of my colleagues uh Sabine Azan has done some studies we actually see that the both covid and probably the vaccine probably does have a major negative impact on the gut microbiome and and what what they’re seeing in practice is one of the main phylum we known as bifidobacterium seems to be really damaged by this and I think that’s where we’re seeing a lot of the digestive stuff come from and and actually what’s interesting in all my long covet of vaccine injury I will give them something to help repair the gut every single patient I think that’s so critical and you know we mentioned before even when you look at things like um parts or the you know orthostatic changes neurotransmitters which are really the regulatory process behind that are made in our digestive tract so a non-functioning digestive tract really plays a big issue then you know we talked about the brain fog and other things it brings up my favorite issue I know mobim loves us which is histamines [Laughter] so I love talking about histamines and someone talked about antihistamine diet so histamines may be part of that mechanism behind it so histamines are you know we know we have allergies we have a histamine response that sort of but they’re also markers of inflammation in addition they’re also involved with the way our muscles function the way energy is provided and that also may be part of the reason for the for the brain brain fog is so interesting I think the problem is there’s so many different mechanisms is it autoimmune is it vascular is it post-inflammatory is it post viral is it histamine it’s and I think it’s very challenging to determine which of those because all five of those can definitely contribute to the brain fog so then how do you manage that so my questions are going to be how do you manage that this video I’m greedy to make it the best video for long covet so what we want to do is you got to start somewhere and I think I’ve always liked the supportive method you know easy things you can do first again we’ve talked about fluid right correct and hypovolemia that’s an easy one right and I think people with that will benefit from that right away I think we learn about giving gut support I use a lot of I like soil based probiotics I also like using what we call bovine immunoglobulins which unlike colostrum to help with some of the digestive issues I like using an antihistamine diet I use that a lot actually I measure histamines because that is also really also and we started talking about a little bit blood sugar stabilization if you can and and really the key in doing those things first is the key is to get the body out of the stress statement if we can at least get the body of out of stress State I think we have more chance of correcting the problem I think oftentimes where our mistake is made is we try and fix something when the body’s still in a stress State and it it’s it says back to us hey I can’t do one more thing so I think that’s always the foundation of the start is to correct those which I call low hanging fruit first and then work on other things after that totally makes sense so if you are ready I have some questions here as well from the cool beans cool beans are the best they think that is unique about the cool beans is that they know mechanisms we have spent two three years now talking about mechanism so the questions are always awesome so let’s start let’s start from here I’m going to start from the latest and go backwards as much as I can so mom27 says have you used seen patients recover from Parts dysautonomia while with saline infusions good question and the question is I let me let me put the word recover and I’ll use that a little differently I think it’s a great first step I think by itself it’s and this is the challenge I think in Long covet is it’s not one individual treatment that’s gonna correct everything but I think it’s a great first start and probably the most important thing to do and with sailing I’ll use B12 and magnesium to have support for that but it definitely in in people that are hypovolemic which is a large part of the pots population they feel a lot better after that and they can get to the point where they can functionally you know on a day-to-day basis walk around without a racing heart rate or palpitations or shortness of breath definitely a big First Step but I’m always resident in saying that one thing solves all the problems and the low code we’ve definitely learned that it’s a multi-factorial approach to solve this got it got it so thank you very much for that then there are so many questions so I’m gonna I’m trying to uh I hope they don’t ask me the mechanisms okay to let go is the video and audio sync is off mobile so yes my video and audio is always out of sync the reason for that is this mic plugs into the go XLR which then plugs into the Blackmagic which then goes to the camera then from there it comes in here so it is always out of sync my apologies it’s just you usually miss it because I’m sharing the screen so you don’t know I’m on a side out of sync but apology I was going to take that question I could answer that one yes thank you so Nipa says what precautions should young people take to avoid set especially from cardiac arrest so so interesting you say that so one thing I do measure and I may not be the only mechanism I do measure things like the dimer right which is one mechanism behind that I think also even if you look at things like hypovolemia could actually play a role as well right because it’s more stress than cardiac function I think if someone is symptomatic with either chest pain shortness of breath especially with mild exertion I think it’s worthwhile to do an echocardiogram to see to make sure the heart is functioning properly and what’s interesting in well being correct me if I’m wrong on this that’s also helpful for hypovolemia diagnosis if the ejection fraction is very high that’s also very confirmatory that the patient isn’t a hypovolemic State and that when they start and exert themselves they’re going to put so much more stress on the body and that can create issues absolutely so if I was somewhere in the administration I would have said that at this time a whole nation gets a baseline of cardiovascular cardiovascular workup neurological workup hormone workup kidney liver git functional workup and Baseline it because to me it seems like there are so many people who are suffering and we do not know where exactly the pathology is but there is pathology so very good question NEPA thank you um M Gregory says I mean if I can answer one more thing about that so one actual thing is d-dimens we talk about I do see in a large number of patients an elevated D-dimer and then D you want to explain you’re better explaining what that is than I am so you are always explaining better I just like to dive deeper into the mechanisms so dive d-dimers are when there are clots formed or micro thrombi formed within the blood vessel so imagine my fingers are like fibrin clots and we they are kind of mushed together and when we break them and open the clots then those tiny pieces that are formed for snipping and breaking these are called d-timers so d-dimers are actually an indicator of breaking clots but breaking clot is an indicator of making clots and if we are always making some clots and breaking them all the time but if that becomes too much then that means we are in thrombotic state there is a study from Canada that recently came out that study shows that antinuclear antibodies d-dimers CRP interferon gamma together are a good indicator of long covered for fatigue neuromuscular problems and cough and they say that over time in one year the Ana levels reduce to half so meaning there is some level of gradual Improvement as well do you see your patients continue to improve over time or do they stay stable or no I definitely so what’s interesting I don’t see a lot of elevated CRPS interesting enough I do and the more severe I had a case recently and he came to me a year after the vaccine his CRP was 125. and it was it had remained like that for a year so this was an interesting case and even when he got symptomatically better the CRP did not improve interesting enough so it wasn’t correlated he was able to do more functional stuff and really feel a lot better so that’s case anas I don’t see his Elevate as much but I do see elevated a lot are thyroid peroxidase levels which is one of the immune markers that look at thyroid that I see where and what’s interesting about it I see ordering firing markets in the setting of normal thyroid function so it’s not a thyroid dysfunctional aspect but instead an autoimmune process that’s going on and that definitely does get better over time interesting so M Gregory says question can occupressure ease you out of stress state I think anything that helps you you relax in that form absolutely would be helpful your medicine I’m not an expert at pressure so I don’t want to go too deeply in it but yes I think anything that has a positive effect would be good absolutely uh Daniel says is Dr Keith using lumbrokinase NATO kinase or pine bark extract for managing vascular issues oh great question I used a lot of you a little more kindness I really like it a lot and again the reason I use that more than the others is really the low risk of bleeding episodes from that in the and again with elevated that’s one of the treatments we’ll use and and also I’ll also try it if someone has brain fog or tinnitus that didn’t respond to other treatments we’ll use that as well I will use nanokinase as well and I also sometimes use seropeptics as well this is an excellent question Gina says does intermittent fasting help tinnitus I want to give my experience first I had been doing intermittent fasting and I actually did feel that my tinnitus had reduced for a couple of weeks a dist in intermittent fasting because my wife was making some really good foods and I started eating them and my my tinnitus is back this is just an anecdote but that is what happened to me how about I I would say yes so one of I talked earlier about one of the mechanisms the two mechanisms that really are affected by intermittent fasting one is cortisol regulation so of course we now know from studies that intermittent fasting one of the benefits is it actually lowers cortisol so people have much lower cortisol and one of the issues I see around low covid is this dysregulation of cortisol and in some individuals which is really interesting is almost like there’s circadian rhythm flips where they’ll have often low cortisol in the morning and a higher cortisol at night so that definitely gets better and my favorite topic which is also blood glucose regulation also gets better and insulin sensitivity or or insulin resistance becomes better also with intermittent fasting so I have a question intermittent fasting so I always matured and I want to hear your thought on this is then you want to finish eating earlier at night more importantly than fasting through the morning so I always tell people and I want to see what your thoughts are I’ll have them finished in early to me that’s much more important than missing breakfast and eating later in the morning real quick so my intermittent fasting after I watched the work or read the work from Dr Professor Anna carvio if I’m pronouncing her last name correctly she had said that the 16 hour window should include the sleep as well so what I had been doing is I take breakfast in the morning at whatever time I wake up five or six in the morning nowadays five so I take breakfast at that time and then I take my lunch dinner kind of a little late for example instead of 12 maybe one or two but that’s it and then that allows the 16 hour window to go into the sleep time because the micro autophagy starts at 14th hour of fasting and we need the micro autophagy to be active for brains you know cleaning as well if you will and that has to occur during sleep so you are actually correct people like I hear a lot of people says okay I stopping the EPM and I don’t eat till 11AM that’s really not what the goal is the goal is to allow for repair and repair really happens during sleep the sleep it especially for the brain tissue so that means if you have let’s say 14 hours of fast and that starts from you had the dinner at eight o’clock it at night and you said you know what I’m gonna just continue and have my breakfast later 88 to 8 let’s say you started at eight at night 12 hours and then two more hours ten that at 10 o’clock is when autophagy is going to start with the brain but if you’re awake at that time brain is going to turn off the switch to do autophagy it’s going to say I’m working right now I’m not going to do it so you’re gonna miss the boat to do the autophagy so yes early dinner or late lunch and then stop till the breakfast and breakfast can be at the correct time and I use enough so I also look for my digestive perspective my I really believe people should complete really to digestive process before they go to sleep so the body doesn’t have to use resources towards digestion and I think I it’s interesting people know if they eat late and then go to sleep oftentimes they’ll wake up in the morning bloated because that digestive process was not completed got it thank you very much all right so some more questions danger zone says what is the cause and treatment of joint tendon and muscle pain so a couple things one thing uh definitely one thought process is mitochondrial damage where it’s affecting the production of ATP we definitely see that more and more common um I think the transient what we call autoimmune thyroid can have an effect as well um and even any any post-inflammatory process too is going to put stress on the muscles and Joints as well so give me one second I want to open a study if I can quickly get it which would strengthen the point that you just made so let me bring this study here and I’ll talk while you’re doing that so what it is is one of the things I’m we’re learning more and more and kind of we didn’t focus in the beginning is the importance of really correcting mitochondrial function and really supporting that then during the process yeah so check this study out this is a study uh what is the date in this one some date here but I think it is 2022 study in this study what they say is they had some patients go through exercise and these patients had the muscle and joint pains and what they found out was that the mitochondria were not functioning correctly and the marker for that was number one the fat oxidation problems of fatty um metabolism for fats Incorrect and lactic acid buildup these both pointed towards the mitochondrial damage or mitochondrial dysfunction which in turn means muscle have less energy which also means there is lactic acid produced and acidosis is occurring which will mean when you move your muscles you’re going to start having pain so one possibility for the pain is the the mitochondrial dysfunction within the muscle leading to the pain the other possibility is that excuse me when there are autoimmune antibodies those antibodies that are against for example let’s say neuromuscular Junctions what happens is when there is a nerve that is connecting into neuromuscular Junction and you disrupt that nerve it is possible that the nerve is now losing its connection and is not that’s an apps is not working correctly that means the muscle fiber is not going to work very or the group of fibers are not going to contract very well so your brain is saying contract this biceps and the biceps is saying I cannot employ all of the fibers so the remaining fibers that are still working they are pulling the load for the work and they would start aching this is another possibility the third possibility is that when the neuromuscular Junctions become damaged then the neuronal external sprouting occurs sprouting means that the nearby healthy neurons would try to say you know what I’m going to make an extra branch that would cover this neuro this neuromuscular synapse and if they make too many branches then the neuron body has to send all those branches the food to eat and ATP and the nutrients and take away things from them and the body may not be able to take care of that that would mean body will undergo stress and the neuron can die which can make the pains permanent so there are so many mechanisms that are possible with vaccine or with long covet and what about I guess the other one is is vascular right if Microsoft right so microclotting can also especially if people absolutely I mean and I call the end joints end muscles absolutely hands in the feet absolutely so uh here is a question Megatron says nmn for raising entity levels to help with mitochondrial Health lower neuroinflammation and blood flow thoughts on NAD levels in relation to all of this so I just had a case today we discussed this actually so and we would discuss this right before then definitely NAD I do use as part of it I also use coenside Q10 and that other and look at other what we call mitochondrial cofactors definitely plays a role the question about NAD and this is always my question in the study and maybe mobe can answer is that a problem or if someone in the study note someone who’s hypovolemic starting to give a lot of any and I that’s where I would be careful I’ll agree with you so that means once again if we go back to your approach first correct the volume and then start looking at other things okay so here is a question um there are so many questions Keith answers the addresses are the B cells or tumor necrosis Factor Alpha implicated a lot of my military co-workers are now diagnosed with rare autoimmune disease too since incurring covet and kylosing Spondylitis and Amos architosis ra and so on do they hear my speech at the conference so it brings up my and Moby knows this is my favorite medication so the answer is yes and I think that’s part of the again you’re talking about two different things immune complex related and also post-inflammatory you know being tuned in across Factor being a cytokine definitely big play is a major role and I think that we’re seeing in the I would say the I would say the sicker patients are developing autoimmune disease definitely and that’s where the role of things like low-dose Naltrexone plays such a major role and it’s so unique and I you know well beans talk about us for how it actually is able to really address multiple cytokines that are out there and help really quote that very strong inflammatory response but I am seeing a lot of new autoimmune disease actually I have three new cases this week where patients have been to all these doctors they looked at for example thyroid function they were normal and all three of these cases actually have elevated thyroid antibodies but in the setting of normal thyroid function so when the regular blood work was done it was never picked up because they weren’t looking at the autoimmune beyond the function itself and and to add to this one the continuous presence of inflammation ends up causing more autoimmune diseases and I’ll explain why so it is possible that the basic injury to the body starts with some other disease for example let’s say sarskov 2. but then as there is auto antibodies or other temporary antibodies that are produced that are causing sustained inflammation then what happens is let me share my screen so imagine this and I’m sorry for the black background I make them transparent so that I can put them in whatever document I want so if you see here this is a broken cell and this broken cell imagine this got broken because of some inflammation when it was broken the cell’s guts or the contents of the cell and the nucleus Spilled Out now most of these content are kind of new thing for our immune system our immune our immune system my apologies my our immune system is generally able to identify ourself and ignore it but those things that are packaged within the cell can appear new to our immune system on on top of that this little monster that I’ve made over here the reactive oxygen species so imagine this is a vulture so the cell broke down the guts are spilling out and this little vulture the reactive oxygen species present in the vicinity and it continues to damage and denature even these dead cells so what happens is when immune cells come here imagine there’s an immune cell here looking at this broken cell and pondering if it is self or not and this little monster is deshaping and denaturing these proteins our immune cell would think well this may be foreign material these may be antigens and the anti-nuclear antibodies and other kind of antibodies would start coming into place and now we have created autoimmune disease so it is actually possible that chronic inflammation for some other reason can translate into becoming autoimmune diseases or give rise to autoimmune diseases with which the patient may be stuck for for years do you also think I mean now we’re seeing a lot more research like for example Epstein-Barr virus and it’s linked to autoimmune disease could actually covid-19 also have that similar effect on the body that we’re seeing with Epstein-Barr virus absolutely absolutely I think it’s even worse Epstein-Barr virus we know what it does and we know how long then the relapse occurs and here is what happens with the relapse covered is just so strange it’s very it’s it is very diverse in its impact okay so let’s have one more question and I noticed 654 I know you’re on the East Coast it’s almost 10 o’clock I am by 10 o’clock sleeping not not today with the coffee so a couple of more questions okay we’re good okay excellent thank you thank you for this did you have your coffee I’m good yes telepathic effects Zizi Berman says doctors are you seeing an improvement in patients with MCAS histamine issue as well as as well over time thank you for your time and expertise yes and and so what’s interesting about ncas and histamine again we use a multiple approach prior to covet we actually used to use modos Naltrexone antihistamines with that but also I find that when we give good gut support and also a low histamine diet people are getting better at that and that and I’m seeing more and more now cases of MCAS and histamine now that I did earlier in the pandemic but yes they do get better with that and before I put this question up I want to say this that yes it is very difficult to find doctors who are doing their research or who are trying to figure out long coveted vaccine injury these are a thing and how to manage them so here is the question Andrea says how can I see Dr Keith seriously is he ritual so first my disclaimer I have no commercial interest with Keith I have no commissions I have nothing but it will actually be good if you have time and you can help manage some more patients so how can people find you and are you virtual so so I have a website for that’s my website I am located in New York and currently I am seeing patients in New York and in Florida soon to be We’ll add New Jersey as well and maybe California we’re not sure yet but as of that point that’s where I’m able to see people excellent thank you very much and one more question before we probably take off danger zone says is navy blue in color of the day so mine do you know what’s so interesting we did not coordinate on this we did not although I did ask prior to the show where I can get swimming like that good wait you know what’s interesting about that well beans in California which is typically a warmest state he’s wearing a sweater and I’m in New York which is now starting to go through cold spell wearing a shirt we in California are comfortably spoiled my brother makes fun of me I so I have lived in Massachusetts for 13 years and I used to be in you know leg deep snow and cleaning my cars and and moving about and my brother has been in Ontario Canada and he makes sense he makes fun of me that you start wearing sweaters because you actually don’t have an an opportunity to wear them you just wear them for fashion so one more question golden time says is Fibromyalgia linked without immune disease so so it’s interesting so what’s interesting about fibromyalgia a lot of term I don’t like that actually because it’s it’s a very you know kind of ambiguous term but there is a lot more research thinking that it may be a viral disease related to Epstein-Barr virus and we actually said before Epstein-Barr virus now there’s more studies there’s a recent study done earlier this year where Epstein-Barr virus they thought is one of the mechanisms behind developing multiple sclerosis I do think that there is uh a link that epstein-barrison probably also coveted 19 that as we said before can link to automate disease absolutely excellent so two minutes to the hour let’s see if there is anything there are so many questions still um okay excellent all right so let’s start with the so after the fibromyalgia actually that question has been there a little more okay so actually we saw this one as well I have a question for you the therapy the saline and then magnesium and the vitamin C usually how many times a week and who pays for it does insurance cover number one and number two how many times so so again so I’ll separate it out I don’t always lower vitamin C and the reason why what’s interesting about vitamin C is one of the main side effects is actually the lower blood glucose level and so if someone’s very hypovolemic you don’t want to do that right off the bat because it can make them worse so with about the normal saline it depends on the patient normally I look I’ll do it once a week for about three times and see how they do and how they feel and and it’s an easy test to do we can do blood pressure pulse lying down sitting standing I’ll walk them down the hallway if that starts to get better then I’ll go on to oftentimes the vitamin C and again I’ll also do that in sections of three I mean again depending on insurance can reimburse some of that depending on your insurance plan the nice thing about normal sailing it’s not that expensive to do which is nice that an IV vitamin C may be a little bit more expensive but again in people that can’t do intravenous I’ll do things which one interesting thing I’ll do it and it’s somewhat effective not as effective it’ll have them add something like Himalayan salt or something to the water a couple times a day and see if that can also help increase some of their volume as well it’s what’s interesting about that early on I had several cases where and and Mobility you’ve seen that where I’ve had my diabetics who’ve been so well controlled prior to covet their glucoses just go out of crazy go up and one of the treatments that I found that worked is actually when I hydrated them and actually I had Himalayan salt that actually helped more than any of the medications and bringing down their blood glucose levels because they actually probably developed also from the glucose going up hire some hypovolemia as well very interesting thank you very much uh Texas mag says so uneven muscle fiber effort and sprouting this is a lot review time no don’t say permanent Okay so in some cases permanent and here is how when the neuronal sprouting occurs so imagine this was a neuron with one Exon and that axon was finishing on this some tissue neuromuscular Junction or neuroendocrine or whatever and then this synapse became stressed out and because of that this brush this axon is not working correctly so this neuron imagine I’m the neuron neuron decides you know what I’m going to sprout I’m going to make more branches or my neighboring healthy neuron decides to sprout so so far it’s okay when once they cover that little synapse they’re okay but if this continues for example in chronic inflammation as may be occurring with task of 2 or vaccine injury or other issues then the neurons would continue to sprout as there is continuous resistance at the neuromuscular Junctions or then the muscle is not working because of the mitochondrial dysfunction vascular problems other antibody and T sorry autoimmune problems so now when the too many branches have formed the headquarters the neuron body is still responsible to nourish them all and the energy stress or nutrient stress on the cell body is a stress as well this is like if a parent set of parents they have 100 children and they have to feed them all that is a stress on them so when the neuron body cannot feed them all because of two numerous branches the neuron decides to commit suicide and die by apoptosis so that will then end up in a permanent problem with the muscle control and that can cause permanent pain because less nerve fibers more muscle fibers and there is a async do you think that happens more so again the more purple the issue is so the further away from the heart the more problematic that becomes correct this especially occurs when there is a autoimmune issue with the neuromuscular Junctions or the autoimmune issue with the receptor you know there are antibodies Against The receptors which happens with the long covet that there can be antibodies against the acetylcholine receptors or not adrenergic receptors which causes epinephrine and acetylcholine not to work correctly which then causes this whole cycle and if it continues this this is also why it is not interesting for the patients to do rigorous exercises because the more load they put in the muscle the more muscle would say I need you know you know neuronal activity and the more sprouting would occur this is why it is important to just keep the exercise light keep yourself fit in shape and slowly continue to grow the exercise uh management or exercise routine all right so one last question promise a queen says why does methylene blue seems to be helping reverse my lower blood pressure increases increase Exercise capacity very good question we have an answer I’m gonna have you give that one because you would talk about that yes so I actually just recorded a lecture for fscc for it uh methylene blue is such a beautiful system but in general what it does is low dose methylene blue 0.5 to 4 milligram per kilogram body weight low dose not high dose in high dose it is actually reverse so that is it becomes toxic low-dose methylene blue has a special propensity towards neuronal tissues so it likes to go to the neuronal tissues so when it is given orally or systemically it can go to the neuronal tissue number one number two low-dose methylene blue helps restore mitochondrial function do you know how it does that so in the mitochondria the complex four the electron transport chain the complex four needs Electro complex one two three and four they all work with the electrons but the electron donors are fadh fadh2 and nadh right when there is a mitochondrial dysfunction the complexes electron transport chain stops working and the production of electrons for the chain reduces methylene blue comes in and says oh well the the machine is not working for the electrons I will give electrons I don’t have to run the whole machine this is like if your kitchen is not working and you say you know what I cannot cook food today my kitchen my stove is not working my sink is not working my coffee machine is not working and some Angel comes in and says forget about all of that I’ve already cooked food for you and here it is you don’t need to run your kitchen so methylene blue becomes the electron donor once the electron donation occurs to the complex four the second thing it does is so hold on to this thought that the methylene blue gives the electron the second thing it does is it consumes the oxygen present in the mitochondrial environment it converts that into water so what happens is the result is number one electron transport chain can start working again and number two as oxygen consumption increases because methane blue help create water from that more oxygen is needed another thing that happens is that nitric oxide production complex 4 is responsible for increasing the nitric oxide levels so when oxygen levels go down because methylene blue use them nitric oxide levels go up when nitric oxide levels go up that causes vasodilatation and all of a sudden there is flow of blood coming in and the blood comes in and it brings in nutrients and it brings in more oxygen and then mitochondrial functions start becoming better and the lactic acid and the carbon dioxides and other bad things are washed out and all of a sudden neuronal tissue feels happy and finally what methylene blue does is it reduces the chances of apoptosis or it improves the survival of the neurons so not only neurons become healthy they survive as well and the neuronal tissue starts becoming better that is methylene blue and I’m not sure we have another compound that really works that way right that we know of nope and if you wanted to watch this lecture I just did it for flccc there is a YouTube channel called long story short with Dr Bean on which fsccc puts all of these lectures interestingly these get 200 views or 500 views and I feel that for long covert patients and vaccine injured patients that is a gold mine it’s just that not many people know about it and these lectures that I’m speaking go over there and I can I make a comment about one Covenant vaccinager for a second please I think people have to realize that I think that’s their frustration that it’s such a varied mechanism that you have to keep on digging deeper and deeper and looking at different possibilities and and and I know people often get frustrated because of that but they I always tell people you just if you haven’t found the answer you haven’t looked enough and you have to keep on looking in the answer it may not fix everything but people do get better and increase functionality the other thing we talked about but we’re finding that it may take a longer time than we thought for repair and resolution to happen absolutely so with this what a beautiful discussion and I think it is actually such a sad thing that the long videos are watched less but these videos are so full of beautiful content that doctors can actually run their clinics based on these discussions and serve a lot of patients so thank you very much for being here cool beans thank you very much for being here as well and watching and listening and learning please don’t use this as a prescription but instead talk with your doctors and your providers and see what can be done thank you Keith for your time well thank you for having me perfect cool beans thank you very much if you would like to support this work there are links in the description that you can use to support I would see you tomorrow bye Keith good night thank you

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top