We are a premier long COVID and long covid vaccine injury treatment clinic in Plano Texas. Stellate ganglion block (SGB). EAT Procedure. Robert Groysman, MD
Jul 21 • 6 tweets • 1 min read
You feel a crash coming on. The heaviness, the fog rolling in, the floor dropping out of your energy. What you do in the first hour can change how much the next few days cost you. A triage thread.
2/6 The first hour is triage, not recovery. You are not going to fix the crash today. The goal is smaller and more important: stop feeding it, and give your body quiet before the hole gets deeper.
Jul 1 • 7 tweets • 1 min read
Most Long COVID patients can tell you the exact hour their energy gives out. For a lot of them it is around 2 PM.
It is not laziness. It is happening at the level of the cell.
2/7 The energy comes from the mitochondria, the part of each cell that turns food and oxygen into fuel.
After COVID they can run inefficiently. They burn fuel but turn less of it into usable energy.
Jun 29 • 6 tweets • 1 min read
An allergy reacts to one thing. MCAS reacts to almost everything.
They look the same on the surface, which is why a clean allergy panel sends so many patients home with no answer.
2/6 The two look identical from the outside.
Flushing, hives, a swollen throat, a stomach in revolt. So when the allergy panel comes back clean, the reactions get waved off as stress or imagination.
Jun 28 • 7 tweets • 1 min read
Low-dose naltrexone, or LDN, is one of the most asked-about drugs in Long COVID circles right now.
The honest answer: it helps some people a great deal and does very little for others. The reason is worth understanding first.
2/7 At full dose, naltrexone blocks opioid receptors.
At a tiny fraction of that dose, it seems to do something different.
Jun 21 • 7 tweets • 1 min read
In Long COVID, cortisol does not disappear. The rhythm reverses.
That distinction is why a "normal" blood test misses it entirely.
2/7 In a healthy system, cortisol peaks sharply in the first hour after waking.
This is the signal telling your body it is morning: mobilize glucose, raise blood pressure, focus attention. The steepest slope of the day.
Jun 20 • 5 tweets • 1 min read
Why does the same antihistamine that helped last spring barely work now?
In Long COVID mast cell activation, what is being released can shift over time. The drug you chose for the first problem may not cover the second one.
2/5 Phase 1: Histamine-dominant.
Flushing, hives, itching, sneezing. An H1 antihistamine works here because histamine is the lead driver. This is the window where most people get diagnosed, if they get diagnosed at all.
Jun 18 • 7 tweets • 1 min read
If you can pass a cardiac workup, a clear chest scan, and a standard blood panel, and still lose your breath crossing a parking lot, the problem is almost never in the organs those tests check.
2/7 In the patients we evaluate with low exercise tolerance, the same pattern shows up far more often than chance.
Large arteries fine. Oxygen saturation reads normal on the finger. And yet oxygen is not reaching the tissue needing it.
Jun 17 • 7 tweets • 1 min read
The twenty minutes after you overdo it decide how long the flare lasts.
Spend them wrong and a single afternoon becomes three days in bed.
2/7 An energy-debt is being called in faster than your cells can repay it.
When you push past what your mitochondria can sustain, the system keeps spending until you make it stop.
Jun 14 • 7 tweets • 1 min read
The antihistamine did nothing, so they told you it wasn't MCAS.
The opposite may be true. The mediator driving your flare may never have been histamine.
2/7 Mast cells carry hundreds of chemical mediators. Histamine is only one of them.
When a mast cell fires, it trips every sensor at once. Histamine is the one everyone names. The others get missed.
Jun 13 • 7 tweets • 1 min read
You step into a room you know is 68 degrees and your skin reads 85.
That is autonomic thermoregulation misfiring, not you being dramatic about temperature.
2/7 Your body runs temperature through one thermostat and two response systems.
The thermostat is the hypothalamus, reading core temperature and signaling the body to heat or cool.
Jun 13 • 7 tweets • 1 min read
You take an antihistamine for MCAS and half your symptoms do not move.
The drug is not wrong. It is covering less than half the receptor map.
2/7 Cetirizine, loratadine, diphenhydramine are H1 antihistamines.
Histamine actually binds four receptor types. In MCAS, H1 and H2 carry most of the load.
Jun 12 • 7 tweets • 1 min read
Inulin. Chicory root. FOS.
The three ingredients hiding under the word prebiotic on your label. In a dysbiotic gut, they often feed the exact overgrowth you are trying to clear.
2/7 Fiber still belongs in the picture. The problem is selection, not category.
Most gut-health advice assumes a balanced microbiome that simply needs feeding. After COVID, many guts are not balanced.
Jun 8 • 7 tweets • 1 min read
Your blood vessels are not passive tubes. The lining of every vessel is active tissue that decides, moment to moment, when to relax and widen.
In Long COVID, that control is thought to falter.
2/7 The signal they use is nitric oxide.
When you stand, move, or your tissues need more oxygen, endothelial cells release it, the smooth muscle in the vessel wall loosens, and the vessel opens to match demand.
Jun 8 • 7 tweets • 1 min read
Three hormone panels came back normal. You still feel the flatness, the cold, the mornings that will not start.
Hormone recovery in Long COVID often shows up only if the labs are read in sequence.
2/7 The hormonal changes are not a separate endocrine disease.
They sit downstream of the same mechanisms: autonomic dysregulation, the mitochondrial energy deficit, the inflammatory state. As those settle, hormone curves often begin to follow.
Jun 7 • 7 tweets • 1 min read
The first hour of a MCAS flare decides whether it escalates or stays contained.
This is a cascade, not a single event. The first trigger fires a group of mast cells. The mediators they release then activate the neighbors.
2/7 Histamine rises. Prostaglandins follow. Leukotrienes add to the load.
The cascade amplifies for 60 to 90 minutes after the first trigger fires. The first hour is the window before it peaks.
Jun 4 • 8 tweets • 1 min read
You are taking magnesium. It may be the wrong form for your symptoms.
The form determines bioavailability, tissue destination, and clinical effect. Magnesium oxide is what most drugstores stock. It's also the least useful form for Long COVID symptoms.
2/8 Magnesium oxide has poor bioavailability.
Most of it reaches the colon, draws water in, and produces a laxative effect.
If you're taking oxide for sleep, fatigue, or brain fog, it isn't delivering meaningful amounts to the tissues where those symptoms originate.
May 17 • 7 tweets • 2 min read
Temperature dysregulation after COVID is not one problem.
You feel cold when others are comfortable. You flush after climbing stairs. You overheat in a warm restaurant and cannot recover for hours.
Each pattern has a different mechanism underneath.
2/7 Three subtypes show up most often in Long COVID.
Each one has its own trigger pattern. Each one points to a different test and a different treatment.
The first step is naming which one fits your symptoms.
May 13 • 4 tweets • 1 min read
Your gut microbiome is not permanently broken.
It is one of the most regenerative systems in your body. The gut lining turns over every three to five days. Bacteria can recolonize over weeks.
The reason your gut still feels wrecked is not damage. It is conditions.
2/7 In Long COVID, dysbiosis follows a sequence.
Bacterial diversity drops in the first weeks. Protective species shrink. Opportunistic species expand. Gut wall permeability increases. Bile acid metabolism is disrupted. Short-chain fatty acid production falls.
May 7 • 7 tweets • 2 min read
Your MCAS flare started 20 minutes ago.
Here is the next 60 minutes, broken into four windows.
Save this before the next flare hits.
2/7 Minute 0-5: Distance from the trigger.
Leave the restaurant, the room, the space you walked into ten minutes ago and now feel worse standing in.
Whatever you ate, touched, smelled, or stood near opened the cascade.
Distance is the first move.
May 6 • 7 tweets • 1 min read
Magnesium calms the nervous system.
In MCAS, the wrong form triggers a histamine cascade.
The form matters more than the mineral when your mast cells are reactive.
2/7 Magnesium citrate uses citric acid as its carrier molecule.
Citric acid can be a trigger for some MCAS patients.
You take the supplement expecting calm. Within an hour, you flush, your gut cramps, your brain fogs.
May 6 • 7 tweets • 1 min read
The first 90 minutes out of bed determine your entire day for Long COVID dysautonomia.
Four steps before you stand.
2/7 Minute 0-5: Drink before sitting up.
16 oz of salted water or an electrolyte packet.
Your blood volume is lowest after overnight fluid loss.
Salt expands plasma volume before gravity pulls blood downward.
