Consultant General Physician, Dr Paul Glynne sharing what he has learned about treating Long Covid. 

done! thanks for the prompt.

Promethazine should only be taken for a short while to disrupt the insomnia - it’s not a great drug to take long term. Yes the insomnia changed dramatically after some time. I now use CBD oil, magnesium and also take HRT which helps. We are all on a bit of a journey of discovery!

@@suzyboltyogaforlongcovid Thank you for such a prompt reply!

Hi Louis. Phenergan (or the drug promethazine) is a very drowsy antihistamine. I can increase brain fog but it’s quite useful in cutting through terrible insomnia. General antihistamines are likely to help stabilise your gut mast cell issues but you will do well to watch Gez’s vidoes on MCAS and possibly cut out some high histamines food for a week or so and see if that helps too. Talk to your doctor about H1 and H2 blockers xx

One hour twenty is a long watch.

His clinical approach; He said that the main barriers to recovery he sees are 1. poor sleep 2. overexertion (both mental and physical) 3. stress (mental and physical) 4. hormonal issues e.g. perimenopause/ menopausal hormones 5. gut health. If these issues aren't addressed pharmacological interventions won't be successful Immune system, long covid and diagnosis Him and his colleagues are discovering reasons why different people react differently to various medical interventions 90 per cent of patients have an aberrant immune system (adaptive immune system), T cell abnormalities. Inflammatory responses have many facets that need to be treated together - long covid involves a long drawn out inflammatory response. Originally anti histamines used as treatment because patients were getting classic histamine symptoms e.g. hives, urticaria, food intolerance and GI symptoms. But some symptoms which weren't expected to improve with antihistamines were also improving (eg. brain fog). Antihistamines seem to not only block histamine, Dr Glynne thinks they also have an immuno-modulatory effect. Autonomic dysfunction causes anxiety and there are direct neuropsychiatric effects of covid infection. Severe infection can lead to a change in the way information is processed Viral persistence Many patients look like they are actively reacting to something in their system - this could be because they're reacting to the memory (this is a recognised immunological phenomenon of immune memory, or that the virus is still present, or other viruses are being reactivated. Reactivation could be caused by defect in immune surveillance and there is emerging literature on EBV reactivation. He is watching this area closely with interest. It raises the question of whether some patients would benefit from prolonged antiviral treatment. Vagus nerve Some patients report improvement with vagus nerve stimulation Autonomic dysfunction extremely common after C19 infection, likely at least partly caused by vagus nerve disruption. Some people think that there is inflammation of vagus nerve, which Dr Glynne finds an attractive theory. Vagus nerve issues could be caused by autoantibodies.

pt2! Autonomic dysfunction cont, AD is like having a thermostat that triggers at the wrong temperature. Dr Glynne says that physical practices e.g. relaxation, rather than medical, are the best way to overcome it. Neuropathy - why do we have weakened legs/ hands Neurosensory symptoms common in LC Some patients get especially nasty neuropathic pain - thought to be caused by small vessel inflammation (vasculitis/ small fibre neuropathy). Long covid has a similar manifestation to small fibre neuropathy. Interesting work going on about endothelial dysfunction e.g. microclot formation, that may be associated Post vaccine neuralgic pain also common - he saw 5 women present with it to him in a month. If you experience specific neuropathic symptoms it is best to see a neurologist who sees many postviral cases. He'll do a shorter Q&A with Suzy at some point to answer more questions.

@@emmapearce1769 Brilliant. thankyou so much. This is an excellent, clear, very helpful summary. I'm sure it will be useful to me and probably others :)

@@emmapearce1769 Thankyou!

I asked my doc for H2 and she said no....despite this info

I’ve been using Allegra 24 hour in high doses for 11 months with great results. It turned my symptoms down 85-90 percent, enough to live a normal life again. Had to experiment with dosage, 3-5 pills a day, but it works amazing. Going to ween off starting next month…. See what progress I’ve made.

It’s different for everyone. Some are still suffering from the 2020 first round infections where as others have fully recovered now.