The Groysman Podcast

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 --- 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, acc

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 --- 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/ --- 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.

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 --- 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/