Episode 110 Long COVID & Dysautonomia: Cutting-Edge Treatments & Vagal Nerve Stimulation

Time stamps and show notes

0:00 - Intro: Long COVID, Dysautonomia, and the Autonomic Nervous System

1:07 - Introducing Dr. Robert Groysman and His Journey

3:24 - Dr. Groysman's Medical Background and Interest in Long COVID

5:03 - Stellate Ganglion Blocks for PTSD and Connection to Long COVID

7:20 - How Dysautonomia Drives Long COVID Inflammation

9:19 - The Four Primary Causes of Long COVID11:18 - Inflammatory Mediators and Brain Fog

12:25 - Defining Dysautonomia and the Role of the Vagus Nerve

14:28 - The Vagus Nerve and Its Anti-Inflammatory Pathway

16:43 - Vagal Nerve Stimulation as a Treatment for Inflammation

17:55 - Transcutaneous Vagal Nerve Stimulation (tVNS) Devices

19:16 - Accessing the Vagus Nerve Through the Ear

21:55 - How VNS Works in the Brainstem

23:40 - Vagal Nerve Dysfunction in Long COVID

24:29 - Anesthesiology Background and VNS Therapy

26:30 - Research Supporting Vagal Nerve Stimulation

27:25 - Ear vs. Cervical Vagus Nerve Stimulation

29:30 - Choosing the TENS 7000 for tVNS

31:28 - Real-World Patient Response to tVNS

32:45 - Measuring Dysautonomia: Heart Rate Variability and Resting Heart Rate

34:15 - Orthostatic Readings and POTS

35:38 - Pre-Selecting Patients for Vagal Nerve Stimulation

36:50 - VNS as part of an Integrative Treatment Program

38:35 - Dr. Groysman's Four-Pillar Approach to Long COVID

41:10 - Long COVID Centers and Lack of Root Cause Treatments

42:48 - Introducing the EAT Procedure (Epipharyngeal Abrasive Therapy)

45:18 - How the EAT Procedure Cleans Inflamed Nasal Tissue

47:00 - Diagnosing the Need for the EAT Procedure

47:55 - EAT Procedure Success Stories: Voice Changes

49:10 - The Connection Between Vocal Cord Problems and the Vagus Nerve

50:15 - LPR (Laryngopharyngeal Reflux) and Potential Connection to Vagus Nerve

51:19 - Dr. Groysman's Practice, Telehealth and Treatment Approach

53:03 - Unique Combination of EAT and Stellate Ganglion Blocks

53:37 - Final Thoughts on Vagal Nerve Stimulation & Education

55:01 - Outro and Podcast Info

Show notes

**I. Introduction**

*   **Speaker:** Dr. Adam Rine
    *   Highlights the fascinating aspect of Long COVID and post-viral illnesses: the trigger of dysautonomia by viral infections.
    *   Introduces Dr. Robert Groysman, a specialist in treating dysautonomia using electrical stem techniques.
    *   Mentions the topics covered: stellate ganglion blocks, Long COVID approaches, vagal nerve stimulation.
   
**II.  Dr. Robert Groysman's Background**

*   **Speaker:** Dr. Robert Groysman
    *   Shares his background as a first-generation Ukrainian who always wanted to be a doctor.
    *   Explains his training in anesthesiology and pain management at Robert Wood Johnson Medical School (Rutgers).
    *   Discusses how treating PTSD with stellate ganglion blocks led him to discover the connection with Long COVID symptoms.
       
**III. Stellate Ganglion Blocks & PTSD**

*   **Speaker:** Dr. Robert Groysman
    *   Explains that PTSD is not just a mental condition but a physical one involving the amygdala.
    *   The amygdala in PTSD is overwhelmed and releases signals, driving the sympathetic nervous system.
    *   Stellate ganglion blocks temporarily disconnect the brainstem relay center, allowing processing of emotional memories without the associated feelings.
    *   Procedure can reduce sympathetic overdrive, improve sleep, and reduce anxiety with 80-85% success.
    *   Dominance in the stellate ganglion is a factor, and both sides may need blocking.
      
**IV. Dysautonomia & Long COVID**

*   **Speaker:** Dr. Robert Groysman

    *   Dysautonomia is a key factor that keeps Long COVID going.
    *   Fight-or-flight mode triggers the immune system, releasing inflammatory mediators and activating white blood cells, driving inflammation.
    *   Four primary causes of Long COVID:
        *   Dysautonomia
        *   Mitochondrial dysfunction
        *   Gut dysbiosis
        *   Mast Cell Activation (Excess Histamine).
    *   These causes are interlinked but have separate mechanisms.
  * **Speaker:** Dr. Adam Rindy
     * Notes that chronic brain fog, malaise, and fatigue point back to the elevation of cyto kines.

**V. Definition of Dysautonomia**

*   **Speaker:** Dr. Robert Groysman
    *   Dysautonomia is a disruption of the autonomic nervous system that operates behind the scenes (e.g., heartbeat, tears).
    *   The parasympathetic branch (rest, digest, heal) includes the vagus nerve.
    *   The sympathetic branch is the fight-or-flight response.
    *   The vagus nerve is important in Long COVID: thickened and dysfunctional in imaging.
    
**VI. The Vagus Nerve & Inflammation**

*   **Speaker:** Dr. Robert Groysman
    *   The vagus nerve's main anti-inflammatory pathway is the cholinergic anti-inflammatory pathway.
    *   Uses the alpha7 nicotinic acetylcholine receptor on immune cells, reducing inflammation.
    *   Also reduces nuclear factor kappa beta (NF-κB), a transcription factor for inflammatory markers.
    *   A secondary pathway is the splenic sympathetic anti-inflammatory pathway, an indirect method.
   * **Speaker:** Dr. Adam Rinde
     * Notes that many autoimmune treatments aim to reduce Tnf alpha and IL1 beta
     *  Highlights the benefit of the vagus nerve in inflammation regulation.

**VII. Vagal Nerve Stimulation (VNS)**

*  **Speaker:** Dr. Adam Rindy
    * Notes they discovered Dr. Groysman youtube channel when looking for proper use of tVNS
*   **Speaker:** Dr. Robert Groysman
    *   He researched this area before Long COVID.
    *   The ear (especially the tragus and cymba conchae) is an accessible point for VNS.
    *   The ear has a high density of aeren fibers (sensory fibers that listen to the body).
    *   Stimulation mainly affects the brainstem (nucleus tractus solitarius or NTS).
    *   NTS picks up inflammatory markers (cytokines), and with an underfunctioning system it cannot regulate.
    
**VIII. VNS Research & Mechanisms**

*   **Speaker:** Dr. Robert Groysman

    *   He studied VNS from refractory epilepsy, inflammatory bowel disease, and rheumatoid arthritis treatments.
    *   Vagal nerve stimulator implants vs. ear stimulation:
        *   Implants activate all efferent and afferent fibers, affecting multiple organs and causing potential side effects like bradycardia, gut issues, and shortness of breath.
        *   Transcutaneous VNS (ear stimulation) has negligible side effects.
        *   Cervical stimulation at the neck is brief due to habituation.
   
**IX. TENS 7000 Device**

*   **Speaker:** Dr. Robert Groysman
    *   The TENS 7000 unit is chosen for accessibility and affordability.
    *   It can alter frequency, pulse width, and intensity, which is key for nerve stimulation.
    *   Produces a monophasic square wave; there is no clear benefit of other waveforms.
    *   Must be used with caution as a muscle stimulator and is not FDA cleared for nerve stimulation.

 * **Speaker:** Dr. Adam Rinde
     * Notes Dr. Gryan's Youtube channel provides education on setup and use.

**X. Patient Response to tVNS**

*   **Speaker:** Dr. Robert Groysman

    *   More than 70% of patients report benefits if they have dysautonomia.
 * **Speaker:** Dr. Adam Rinde
     * Notes that some patients have amazing responses and others don't feel it.

**XI. Measuring Dysautonomia**

*  **Speaker:** Dr. Robert Groysman
    * Two ways to quantify Dysautonomia:
        * Resting heart rate
        * HRV (heart rate variability).
    *   Ideal resting heart rate: low 60s.

   * **Speaker:** Dr. Adam Rinde
    *   Uses HRV as a marker of dysautonomia.
    * Uses orthostatic readings of blood pressure and heart rate

**XII. Integrating VNS Into Treatment**

*   **Speaker:** Dr. Robert Groysman
    *   VNS is part of an integrative approach, even for those without dysautonomia, as it aids in healing.
    *   A slow, deliberate treatment plan requires a commitment of 90+ days.
    *   He combines VNS with stellate ganglion blocks and EAT procedures.
    *   Focuses on 4 causes: dysautonomia, mitochondrial dysfunction, gut dysbiosis, excess histamine.
    *   Treatments are focused on the root cause not just symptom chasing.
    *   Critiques long covid centers which often do not offer treatment plans beyond cognitive therapy, PT, and/or excessive lab work with no action.
   *  Notes that POTS is not the entire picture of dysautonomia.

**XIII. The EAT Procedure**

*   **Speaker:** Dr. Robert Groysman
    *   EAT (Epipharyngeal Abrasive Therapy) is a Japanese procedure he discovered.
    *   Reduces cytokines by cleaning the area between the nasopharynx and oropharynx using an endoscope.
    *   Removes trapped mucus with potential pathogens, reducing local inflammation.
    *   Activates the vagus nerve in a unique way not accessible through the ear or neck.
    *   Helps with tinnitus, Eustachian tube dysfunction, and pressure headaches, not addressed by other procedures.

**XIV. Diagnosing & Success Stories with EAT**

*   **Speaker:** Dr. Robert Groysman
    *   Uses a questionnaire to determine if EAT is appropriate.
    *   Notes there is usually visible inflammation under the mucous.
    *   Shares the story of a young singer whose voice improved after the EAT procedure.
    *   Highlights the vagus nerve's control over vocal cords through the recurrent and superior laryngeal nerves.
    *   Discusses LPR (Laryngopharyngeal Reflux), another condition with a connection to Vagal nerve imbalance
  
**XV. Practice Details & Takeaways**
    *   **Speaker:** Dr. Robert Groysman
    *  Offers telehealth services.
        *   Contact information via covidinstitute.org
    *  Practice focuses on evidence-based, root-cause-oriented treatments.
    *   Tests are specific to identifying involved causes.
    *   Treatments are specific to the causes.
    *   He is the only one outside of Japan and maybe the world, to offer the EAT procedure with stellate ganglion blocks.

**XVI. Outro**
*   **Speaker:** Dr. Adam Rinde
    * Thanks Dr. Groysman
   

**Keywords:**
Long COVID, dysautonomia, vagal nerve stimulation, TENS 7000, stellate ganglion block, EAT procedure, epipharyngeal abrasive therapy, autonomic nervous system, inflammation, immune system, mitochondrial dysfunction, gut dysbiosis, mast cell activation, histamine, brain fog, chronic fatigue, PTSD, ear stimulation, brainstem, cytokines, heart rate variability, orthostatic hypotension, POTS, leaky gut, microbiome, root cause, transcutaneous vagal nerve stimulation, tinnitus, Eustachian tube dysfunction, LPR

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