Dr. Maigaelle Moulene Long Covid
Resource

 

Symptoms & Treatment Options: 

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Long Covid does not have a cure, it is a chronic and debilitating illness that some people will have to live with. There is hope that some patients are recovering to a certain extent, or at least finding that their symptoms improve over time, and some have recovered completely, but those might have only had a mild version. Others, like me, who have other underlying conditions like Ehlers Danlos Syndrome and POTS, may never recover. I was infected with covid in 2022 and still have not 'recovered'; there are still days when I feel like I could lie in bed forever, but I have found ways to feel better and manage my symptoms. 

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Treatment of Long Covid is particularly difficult because not everyone has the symptoms and there is no 'protocol' that doctors can follow to treat their patients. ​

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Here, I have listed many of the most common symptoms in alphabetical order - out of over 200 - to focus on. I have had mostly all of those symptoms at some point or another, and have figured out how to manage most of them, to a certain extent. Some of the symptoms might have more than one cause so it is important to treat all the causes, not just one cause of that particular symptom. 

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Abdominal Pain (Leaky Gut)

Gut Inflammation (Abdominal Pain/Bloating/Reflux) 

1. L-Glutamine to treat leaky gut​ (19)

2. Symprove Probiotics (20)

3. Proton pump inhibitors for reflux (22)

4. Probiotics for pain/bloating (20)

5. Butyric Acid to heal the gut (21)

6. Slippery Elm for reflux (22)

7. Aloe Vera juice for reflux and LC treament (23)

8. Fennel Tea/Marshmallow root/chamomile (22)

9. Inulin post biotics (20)

10. Collagen 

11. Creatinine

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Allergies (MCAS) (7)

MAST CELL ACTIVATION SYNDROME Treatment:

Dr.  Monroy a MCAS specialist based in the US wrote an excellent protocol for MCAS Management: 295884.pdf

 

MCAS DIET:

- Exclude gluten/dairy/histamine food

- Avoid triggers (stress, mould, electricity, chemical triggers, hair colouring etc...)

- Good food: apples, brazil nuts, chamomile, high fiber diet, galangal, moringa, nettle tea, peaches, turmeric, Vitamin C and D. 

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- MCAS Step 1 Therapy:

Add one at a time every 4 days to test tolerance. 

1. H2 Blockers: Pepcid of Famotidine. Start 20mg twice and day and increase to 20mg three times a day. Or Nizatadine. 

2. H1 Blockers: Claritin 10mg or Zyrtec 10mg twice a day or Allegra 180mg one to two times a day. 

3. Quercetin: 500-1000 mg twice a day

4. Vitamin C slow release: 500mg once a day up to 750/1000mg a day

5. Vitamin D 1000-5000 units per day (depending on blood levels).

6. Low Dose Naltrexone: to reduce inflammatory proteins which can trigger MCAS. Start at 1mg and gradually increase up to 4.5mg

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If tolerating the above yet symptoms not controlled, to try substitutes for LDN/Quercetin: 

7. Cromolyn- start at 1 ampule per week, slowly increase to 2 ampules four times a day over a few weeks.

8. Ketotifen: 2mg (one - two capules) 1-2 times per day. 

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MCAS Step 2 Therapy

Low doses aspirin: start 81mg and increase to 650mg twice a day. 

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MCAS Step 3 Therapy

Immune Globulin Therapy: useful if co-morbid auto-immune POTS.

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Natural Therapies for MCAS:

1. Dynamic neural retraining system: http: www.retrainingthebrain.com

2. Vagus Nerve retraining

3. Gut health: Probiotics Lactobacillus Rhamonosus, Bifidobacter species. 

4. Gut health: Zinc, Carnosine, L-Glutamine with meals 2 times a day. 

5. DAO enzymes with meals. 

6. Alpha Lipoic Acid 600mg 

7. Omega 3 Fatty Acids

8. N-Acetyl-Cisteine

9. Mitochondrial Support: L Carnitine 2000mg twice a day and CoQ10 200mg twice a day. 

10. CBD Oil: ie. Hemp Meds, CBD Fx

11. THC: there are THC and CBD receptors on mast cells and can reduce inflammation. 

12. Adrenal Support: DHEA, Rhodiola, Ashwagandha helps sleep and may help decrease histamine 

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Anxiety (Due to POTS/Vagus Nerve/Serotonin Depletion)

1.Amitryptiline: If anxiety and peripheral neuropathy and insomnia.

2. Beta Blocker: treats anxiety and  tachycardia/POTS

2. SSRIs: Duloxetine 

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Brain Inflammation/Brain Fog (Mitochondrial Dysfunction/Brain Inflammation)

1. *NAC

2. Alpha Lipoic Acid

3. Inositol Choline

4. Duloxetine

5. B12

6. Phosphatidyl Choline

7. Omega 3

8. Gingko Biloba

9. Turmeric 

10. Vagus Nerve treatment 

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Burning Pain (Neuropathy)

1. Alpha Lipoic Acid

2. Inositol Choline

3. CBD

4. See General inflammation treatment

5. See Pain Treatment

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Chest Pain (Inflammation)

1. See General Inflammation Treatment

2. See Pain Treatment

3. If due to MCAS: Proton pump inhibitor (7)

4. If due to MCAS: Extra H2 Anti histamine (7)

5. If due to MCAS: Peppermint oil (7) 

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Clotting disorders (Circulatory system damage)

1. Aspirin or Gingko Biloba

2. L-Arginine

3. Beetroot powder

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Cognitive dysfunction: memory loss, brain fog, difficulty concentrating, decreased attention (Brain inflammation/low oxygen)

See Neuroinflammation treatment

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Energy depletion/Fatigue (Mitochondrial damage/Low oxygen)

See Fatigue Treatment

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Fatigue/Post Exertional Malaise (Mitochondrial damage/Low oxygen)

1. Treat MCAS: Anti-histamines

2. Treat Hormonal dysfunction in women

3. Treat General Inflammation 

4. Sleep treatment: Melatonin, Metoprolol if tachycardia during the night.

5. Treat Mitochondrial Dysfunction 

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PACING FOR LONG COVID AND POTS: 

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1. Pacing Protocol: Pamela Rose Fatigue Coaching

- Daily Pacing Schedule

- Task list

- Weekly Planner

2.  Gentle Exercise Protocol: Use BORG SCALE (WHO Support for Rehabilitation: self management after COVID 19 illness. 2nd edition) and the LONG COVID Rehabilitation Booklet: Information for patients. NHS. Produced in partnership with Leeds Teaching Hospitals and Leeds Community Healthcare Trust.

- Activity and Fatigue Diary  

3. If POTS: Instructions for POTS Exercise Program. Children's Hospital of Philadelphia

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- POTS Global Training Guidelines for Cardio

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Gastroparesis (Autonomic Nerve damage/Vagus Nerve damage)

1. See Abdominal inflammation treatment 

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Gut Problems:

See Abdominal inflammation treatment/pain/Leaky Gut

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Reflux/Heartburn (Autonomic Nervous System/leaky gut/Abdominal pain)

1. Proton Pump Inhibitors (Pantoprazole)

2. Famotidine

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Hair Loss

1. Hair loss from MCAS: Benadryl Shampoo or Nasal Cromolyn spray (7) 

2. Mix Basil oil and Jojoba oil for a spray (7). 

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Headaches

See Brain inflammation treatment 

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Hoarseness (Autonomic dysfunction)

1. Vagus Nerve Reset

2. Pacing 

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Infections (Lowered immunity from Immune Dysfunction)

1. Treat Infections

2. Prevention: D - Mannose for UTI, Caprylic Acid for thrush/candida

3. Immunity Support: Zinc, Vitamin C, Vitamin D, 

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Insomnia (Brain inflammation/MCAS/Vagus Nerve Dysfunction)

1. Magnesium Glycinate 500mg at night 

2. Melatonin 2-10mg

3. CBD oil drops - as many as needed

4. Ketotifen/Cetirizine

5. Calming oils: It Works Sleep Oils

6. Acupuncture

7. Teas: Chamomile/Ashwagandha/Hemp

8. Ashwagandha

9. L- Theanine

10. Phosphatidyl Serine 100mg 

11. Vagus Nerve Healing Meditation

12. Sleep Meditation

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Joint Pain (General Inflammation)

1. Omega 3

2. See Pain Treatment

3. See General Inflammation Treatment 

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Leaky Gut:

See Abdominal inflammation treatment

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Loss of smell/taste:

1. Treat Nerve inflammation

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MCAS:

See Mast Cell Activation Syndrome Protocol

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Muscle Pain:

1. Treat General inflammation

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Neuropathy/Neuropathic Pain (inflammation)​​

- Amitryptiline

- Duloxetine: for general inflammation, shortness of breath, fatigue, neuropathic pain due to increased serotonin.

- Gabapentin: Neuropathic Pain

- Pregabalin: Neuropathic Pain 

- THC/CBD: Pain 

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Pain (Inflammation): Can be caused by the individual organ's inflammation or lack of oxygen so treating inflammation and increasing oxygen to the organ should help with the pain. Simple pain killers can also be used. 

1. Paracetamol

2. CBD Balm - for neuropathy

3. Meditation

4. Lidocaine Patches - for neuropathy

5. CBD Oil 

6. THC

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Palpitations: POTS/Autonomic dysfunction

1. Beta Blockers

2. Relaxation techniques

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Post - Exertional Malaise: Mitochondrial dysfunction

1. See Fatigue Treatment

2. Pacing ​​​

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POTS

 

Shortness of Breath: Low oxygen levels/circulatory dysfunction​

1. Treat General Inflammation including SSRIs. ​​

 

Small Fibre Neuropathy:

See Nerve inflammation treatment

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Stomach Pain (See Abdominal Pain)

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Stress

1. Ashwagandha - Adrenal Support

2. Phosphatidyl Serine

3. Magnesium Glycinate

4. CBD oil - as many drops as needed

5. Chamomile tea

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Tachycardia: ANS/POTS

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Tinnitus: Nerve inflammation 

See neuroinflammation treatment​​