Aside from the SGB, many of the maneuvers that help improve your vagus nerve tone also calm down your sympathetic response.

The easiest way is to use a TENS unit with adjustable frequency and pulse width.  TENS 7000 is inexpensive and easy to use.  You will also need 2 ear clips or 1 ear clip and 1 pad.  The pad can be placed on the shoulder or back of the neck.  The clip should be placed on the tragus of the ear.  If the ear clip is not staying, it can be placed on the cocha or the concha cymba.  The other clip can be placed anywhere comfortable on the ear.

Part of the reason is that your body is on constant alert thanks to the fight or flight constant state. 

Initially this happens because of direct damage from the covid-19 virus to the supporting cells of the nerves of your nose and tongue, however this tends to heal within a few weeks after recovering from the virus. The smell and taste problems may spontaneously resolve after a few weeks, or they may turn into a lasting effect. The abnormality is fueled by stress and illnesses because both increase sympathetic drive.

No.  It is not dangerous and it is temporary when associated with an SGB.  We need to see this to verify that you actually received a good SGB and a sympathetic nervous system block.  You are not having a stroke or anything like that. 

Your body is meant to have the PNS in the driver seat most of the time. PNS allows your body to heal and take care of maintenance. SNS is like a wrecking ball to our inside, or better yet, a bull in a China shop (although, I can’t think of any time I would want that).  It’s great for short term when needed but not 24/7. You are being exposed to epinephrine (adrenaline) and cortisol all day long.  You will not only be on edge and have anxiety, but you will also have a difficult time shutting down to go to sleep.

The vagus nerve is part of our parasympathetic (PNS). It modulates the immune system and inflammation. When it’s not working like it should, we see autoimmune conditions sprout up. We see chronic inflammation of nerves, muscles, and joints.

Most are monoclonal antibodies and bind an a specific interleukin or receptor.   These work for rheumatoid arthritis, asthma, eosinophilic diseases, eczema, psoriasis, ankylosing spondylitis, Crohn’s disease

Antibodies of one type created to treat many different conditions.  These bind to a receptor, binding protein, or another antibody.

It helps to maintain your heart rate and breathing rate even if it’s not in control.  It controls your blood pressure.  Its main purpose is to protect you from harm and stress, the so-called fight or flight.  Best examples are if you almost got run over by a car or being chased by angry bees or dog, perhaps even during and after a heated argument.  Its function is to create the best possible conditions to either fight or run.  These could include dilating your pupils to allow light to enter the eye, increasing your heart rate and force of heart pumping, dilatating your airways to allow for harder and faster breathing, and supplying more blood flow to muscles of your arms and legs.  What does the SNS sacrifice to do all of this?  It shunts blood away from your digestive tract so that you won’t be digesting anything.  You won’t secrete anything: tears or saliva.  You will sweat though. 

When the sympathetic nervous system (SNS) is kicked into overdrive, it’s out of balance with the parasympathetic and vagus nerve tone. This is most likely due to the initial cytokine storm that can occur during the acute COVID-19 infection.  At the same time the vagus nerve of the parasympathetic (PNS) is thickened and suppressed.

The parasympathetic (PNS) is responsible for body maintenance and building new tissue, healing, controlling inflammation, and your immune system. This is your fun and relax system.  Keep the heart rate slow, reduce how fast you take breaths.  Digest all that food you ate.  The vagus nerve leaves your brain and travels throughout the body following the carotid artery and then the aorta.  It helps regulate most of digestive organs including the gallbladder.  It also controls the pacemaker of the heart or the sinoatrial node.  It even helps to decrease blood glucose by getting it turned into glycogen and stored in your liver. 

It is a cognitive impairment.  It is a state of confusion, inability to focus, or inability to think straight.  It can also include memory loss and inability to recall words.

Understanding Dysautonomia and Its Link to Long COVID

Dysautonomia is a complex and often misunderstood disorder that affects the autonomic nervous system (ANS), which regulates vital involuntary functions such as heart rate, blood pressure, digestion, and temperature control. 

For many, this condition disrupts daily life, causing a wide array of symptoms that can range from inconvenient to debilitating. Dysautonomia has gained attention recently due to its prevalence among patients with Long COVID, highlighting the importance of awareness, diagnosis, and treatment.

The Autonomic Nervous System

The autonomic nervous system is responsible for maintaining essential bodily functions without conscious effort. It comprises two main branches:

1. Sympathetic Nervous System (SNS): Often referred to as the “fight or flight” system, the SNS prepares the body to respond to stress by increasing heart rate, dilating airways, and raising blood pressure.
   
2. Parasympathetic Nervous System (PNS): Known as the “rest and digest” system, the PNS promotes relaxation and recovery by slowing the heart rate, aiding digestion, and supporting restorative functions.

When the balance between these two systems is disrupted, it can result in dysautonomia, causing a cascade of symptoms that impact various organ systems.

What Is Dysautonomia?

Dysautonomia refers to a dysfunction of the autonomic nervous system, leading to imbalances in the SNS and PNS. This condition can develop as a primary disorder or as a secondary complication of other medical conditions, such as diabetes, autoimmune diseases, or viral infections like SARS-CoV-2.

Common Symptoms of Dysautonomia:

• Tachycardia or bradycardia (abnormally fast or slow heart rate)
• Orthostatic intolerance, including Postural Orthostatic Tachycardia Syndrome (POTS)
• Blood pressure fluctuations
• Gastrointestinal disturbances (nausea, constipation, diarrhea)
• Temperature regulation issues (excessive sweating or chills)
• Fatigue and exercise intolerance
• Dizziness, light-headedness, or fainting

Some forms of dysautonomia may present with an overactive SNS, creating a persistent “fight or flight” state, while others involve vagus nerve dysfunction, compromising PNS functions.

Dysautonomia and Long COVID

The emergence of Long COVID has brought dysautonomia into the spotlight, as many COVID-19 survivors report persistent symptoms consistent with autonomic dysfunction. Among the most common forms of dysautonomia in Long COVID is Postural Orthostatic Tachycardia Syndrome (POTS), which can cause dizziness, fatigue, and rapid heart rate after minimal exertion.

Mechanisms Linking Dysautonomia and Long COVID:

• Immune Dysregulation: The immune response to SARS-CoV-2 can result in cytokine release and chronic inflammation, potentially damaging autonomic pathways.
• Direct Viral Impact: SARS-CoV-2 may infect neurons or glial cells, disrupting autonomic regulation.
• Vascular and Endothelial Dysfunction: COVID-19-associated microvascular damage can impair blood flow and autonomic stability, contributing to orthostatic intolerance.
• Serotonin Deficiency: The majority of the body’s serotonin is produced in the gut and is essential for autonomic regulation. Serotonin deficiencies, coupled with vagus nerve dysfunction, may exacerbate symptoms such as gastrointestinal distress and POTS.

These mechanisms underline the complexity of dysautonomia in Long COVID patients and the need for tailored treatment strategies.

Diagnosing Dysautonomia

Accurate diagnosis of dysautonomia requires a thorough medical history, symptom evaluation, and specialized tests. Key diagnostic tools include:

• Tilt Table Test: Measures heart rate and blood pressure responses to changes in posture.
  
• Autonomic Reflex Screening: Evaluates nerve responses to stimuli.
  
• Heart Rate Variability Testing: Assesses autonomic control of heart function.

Given the complexity of dysautonomia, consulting specialists who understand autonomic disorders is crucial for an accurate diagnosis and effective treatment plan.

Treatment and Management Strategies

Managing dysautonomia often requires a multidisciplinary approach tailored to the individual’s symptoms and underlying causes. Key strategies include:

Lifestyle Modifications:

• Increasing fluid and salt intake to support blood pressure.
• Implementing small, frequent meals to manage gastrointestinal symptoms.
• Gradually increasing physical activity to improve exercise tolerance.

Medications:

• Beta blockers for heart rate control.
• Fludrocortisone or midodrine to stabilize blood pressure.
• Medications to manage gastrointestinal symptoms or migraines.

Therapies:

• Physical therapy for improving mobility and reducing orthostatic symptoms.
• Breathing exercises and vagus nerve stimulation for parasympathetic activation.

Our Clinic’s Unique Approach: At Covid Institute, we specialize in treating dysautonomia with a holistic approach combining cutting-edge diagnostics, personalized treatment plans, and ongoing support. 

Learn more about our innovative treatment methods here.

Living with Dysautonomia

Living with dysautonomia can be challenging, but practical strategies and support can make a significant difference. Patients are encouraged to:

• Monitor and track symptoms to identify triggers.
• Build a routine that balances activity with rest.
• Engage with support groups and online communities for emotional and practical advice.

Our team is dedicated to empowering patients to regain control of their health and improve their quality of life.

Conclusion

Dysautonomia is a complex condition that affects the lives of millions worldwide, with its prevalence in Long COVID underscoring the importance of awareness, research, and effective treatment. By understanding its mechanisms, symptoms, and management strategies, patients and healthcare providers can work together to achieve better outcomes.

If you’re experiencing symptoms of dysautonomia or suspect you may be affected, our experts are here to help.

Take the first step toward comprehensive care and relief.

This syndrome is temporary and results from the decreased output of the sympathetic nervous system to your brain, face, head, neck, arms, and chest.  It causes a slight droopiness of the eye, redness in the white of the eye, a smaller pupil compared to the unblocked side, a stuffy nose on one side, and flushing of the eye, face, neck, ear, shoulder or arm.  The skin in these areas increases in temperature around 1 degree Celsius and appears flushed or red.  It is not necessary to see all of these, but I prefer to see at least 3 different signs to indicate that we did a good and solid sympathetic block.

This is the timing in milliseconds or 1/1000^th of a second between heart beats.  A higher number suggests a good functioning autonomic nervous system and parasympathetic nervous system

It is an intravenous delivered pooled antibodies that are pooled from 1000’s of patients.  These are mainly used to treat antibody immunodeficiencies (low amounts of antibodies of IgG, IgM, and IgA).  These can also help with autoimmune conditions ,  neuropathies associated with long covid, and MCAS.

These are mutually exclusive.  Orthostatic hypotension (OH) is a more severe form of POTS and involves drops in blood pressure in addition to the tachycardia (high heart rate) that occurs with POTS.

More information on Postural Orthostatic Tachycardia syndrome (POTS) .

This part of our nervous system handles all of the automatic functions that we don’t even think about such as digestion of food, stimulating the acid to be released in your stomach, regulating the diameter of your lung airways, breathing rate, heart rate, pupil size, sweating, and much more.  It also directly and indirectly helps maintain body temperature, regulate your immune system, and control inflammation.  It has 2 components: the parasympathetic nervous system (PNS) and the sympathetic nervous system (SNS).  They work like a see-saw with each on either end.  Both are active at all times, but what actually happens depends on which one is in the driver’s seat or in control.

The Some providers talk about the SGB as a reset.  What exactly is reset?  It is a nerve block.  During the duration of the block, the sympathetic nervous system is off on one side.  During this time, the parasympathetic tone is elevated and there are regional blood flow changes in your brain, head, neck, and chest.  The combination of these things persist after the block wears off.

What causes Parosmia and anosmia in long covid?

Anosmia is a complete loss of smell while parosmia is abnormal smell. Because the COVID virus and Long COVID is still relatively new, we are not completely clear yet on how or why the COVID virus causes the loss of smell or abnormal smell/taste. Unlike similar colds, this change or loss of smell doesn’t occur because of nasal congestion or stuffy nose. Recent findings suggest that this occurs because of a dysregulation of the autonomic nervous system (ANS), persistent damage in the nasal epithelium, vascular dysfunction, and neuroinflammation of the olfactory nerves from direct viral damage. Olfactory epithelium are full of ACE2 receptors making them prime targets for the covid virus.

Often, anosmia that occurred during the acute phase of the covid infection will turn into parosmia later on.

What has worked for anosmia and parosmia?

Stellate ganglion block has been the most successful so far for smell and taste restoration both for parosmia/dysgeusia and anosmia/ageusia. 

Also, while there are no current studies published on this, I have personally found that EAT has helped some of my patients regain smell using several procedures of EAT.  Other treatments that have worked have been:

• external ear vagus nerve stimulation
• nicotine patch (limited evidence)
• Other possible treatments include:
  • oxytocin nasal spray
  • nasal theophylline spray
  • nasal insulin/NPH spray
  • Vasoactive Intestinal Peptide nasal spray – there are no current studies available, however there have been some anecdotal accounts of it helping.

None of these are effective for every single person suffering from smell and taste disturbances.

In general, smell training has not been effective in restoring smell and taste.  There has been some limited success from stem cell injections into the olfactory cleft area, but the studies were not specific on the amount of recovery.

What about Hyposmia?

Hyposmia is a muted sense of smell. Everything smells normally just very muted. This form of smell abnormality is more resistant to treatment if it occurs from long covid.

 Some smooth muscles that we can’t control voluntarily are controlled by both the parasympathetic and sympathetic nervous system.  Others only have one or the other.  The droopy upper eyelid or ptosis is caused because we stop the functioning of one of such smooth muscle in your upper lid.  The pupil size becomes small under predominantly parasympathetic control when we take away the sympathetic nervous system influence.  Similarly, the nostril on the side of the blood becomes engorged and swells without the sympathetic nervous system influence.