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
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 2 • 8 tweets • 1 min read
Hormone recovery in Long COVID is slow.
It is also measurable.
Three markers shift before you feel better.
2/8 Marker 1. The cortisol awakening response.
CAR is the morning cortisol spike, expected within 30 minutes of waking, signaling the HPA axis is releasing its morning surge.
In active HPA dysregulation, the spike is blunted or absent.
May 1 • 8 tweets • 2 min read
A true allergy releases IgE antibodies.
MCAS releases mast cell mediators without IgE.
Same trigger. Opposite immune pathway. Opposite treatment.
2/8 The food, the medication, the environmental exposure setting you off can produce identical-looking reactions through two completely different immune mechanisms.
From the outside, the symptoms overlap. Underneath, the biology is not the same.
May 1 • 9 tweets • 2 min read
Your mast cells have been in continuous activation for days.
Flushing. Brain fog. Joint pain. Skin reactivity. Every food feels like a trigger.
Here is a 48-hour histamine reset.
Not a diet. A reset.
2/9 Phase 1, hours 0 to 24.
Three rules, time-anchored.
Apr 30 • 8 tweets • 2 min read
Your pulmonologist said your lungs are fine.
But you cannot climb one flight of stairs without stopping.
The PFT was the wrong instrument for the question.
2/8 A PFT measures airway resistance and lung capacity at rest.
It tells you whether air is moving in and out of the lungs the way it should.
That is one question. Your symptoms are asking a different question entirely.
Apr 27 • 6 tweets • 1 min read
You crashed. Here is what to do in the next 72 hours. Post-exertional malaise is not random punishment. It is a predictable biological event with a predictable recovery arc, and how you handle the first three days decides how deep the hole goes.
2/6 Phase 1: First 24 hours. Horizontal rest. Not couch rest. Horizontal, legs level with the heart. Minimize sensory input. No screens if possible, no conversations requiring effort, no decisions. Salt and electrolytes, sipped slowly.
Apr 27 • 6 tweets • 1 min read
Endothelial repair is slow, but it is measurable. Three markers shift weeks to months before your exercise tolerance returns. The biology heals before you feel the healing, and there are tests that can track it while you still feel sick.
2/6 Nitric oxide availability. The endothelium produces nitric oxide to dilate vessels and regulate flow. In endothelial injury, production drops. Flow-mediated dilation on brachial ultrasound shows the trend as cells recover. Objective, noninvasive, repeatable.
Apr 26 • 6 tweets • 1 min read
The first hour out of bed sets the tone for the entire day in dysautonomia. Four things that worsen morning crashes, and three that help. If your worst hours land before 10 AM, the trigger is usually something you did in the first 30 minutes awake.
2/6 Caffeine on an empty stomach. Coffee triggers a cortisol spike and vasoconstriction. On already low blood volume and impaired autonomic regulation, the spike is followed by a crash hitting harder than the fatigue you woke up with.
Apr 20 • 6 tweets • 1 min read
Three MCAS tests your allergist is probably not ordering. And what each one tells you about your specific activation pattern.
2/6 Serum tryptase, timed to a flare. Tryptase is released when mast cells degranulate. A blood draw during a flare captures the spike. Many allergists order it once, at a random time, and call it normal. The timing is the test.
Apr 17 • 6 tweets • 1 min read
Exercise intolerance in Long COVID is not one problem. It can be three distinct patterns, each driven by different biology, each requiring different management.
2/6 Pattern one: oxygen delivery. Damaged capillaries cannot deliver oxygen to working muscles fast enough. Heart rate spikes disproportionately to effort. Lungs and heart test normal.
Apr 15 • 7 tweets • 1 min read
Three hormone markers your doctor probably is not checking in Long COVID. And what each one actually tells you.
2/7 Free T3. TSH tells you what your brain asks the thyroid to do. Free T3 tells you what your cells actually receive. Normal TSH with low Free T3 means conversion is stalling. Cost: $30-50.
Apr 14 • 6 tweets • 1 min read
Your doctor calls it "fatigue." But there are two completely different mechanisms producing that word, and the treatment for each one is different.
Thread:
2/6 Autonomic fatigue worsens upright. Improves lying flat. Can strike minutes after standing. Hydration and position change speed recovery. The nervous system cannot regulate blood flow when vertical.
Apr 13 • 7 tweets • 1 min read
The small blood vessels, not the large ones your cardiologist monitors, are the problem in Long COVID vascular disease. And every standard cardiac test is designed to miss them.
2/7 Standard cardiac evaluation focuses on coronary arteries, ejection fraction, valve function, rhythm. Echocardiogram, stress test, coronary calcium score.
These tools are built for macrovascular disease. In most Long COVID patients, they return normal results.
Apr 11 • 7 tweets • 1 min read
MCAS is not one condition. It is a spectrum with four distinct activation patterns, each triggered differently, each requiring a different management approach.
Most patients are told "take antihistamines." That manages output. It does not address the pattern.
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2/7 Pattern 1: Environmental activation.
Mold, chemical fragrances, cleaning products, temperature shifts. Your mast cells react to stimuli most people tolerate without noticing. Systematic elimination identifies the triggers. Guessing does not.
Apr 8 • 7 tweets • 1 min read
Gabapentin quiets nerve signal transmission. Long COVID neuropathic pain is not a signal transmission problem.
It is a nerve damage problem, and the distinction changes the entire diagnosis.
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2/7 Gabapentin reduces calcium channel activity in nerve cells, dampening the signals that carry pain.
For conditions where nerves are overactive but structurally intact, this makes sense.
