As we are now in our third year of COVID or post-COVID conditions, we are seeing a range of new, returning, or continuing problems that people experience after first being infected with the virus.
Most will get better within a few weeks after being infected, but some will have symptoms or new symptoms appearing after four weeks, and these are considered long haulers.
People who experience post-COVID conditions can have a multitude of ailments, the most common are the following:
- Heart palpitations
- Stomach pain
- Muscle or joint pain
The most common neurological symptoms and what I treat the most in the office and will focus on in the article are:
- Brain fog (difficulty concentrating or thinking)
- Loss or change of smell (anosmia-loss of smell, Dysosmia-altered smell)
- Loss or change of taste(Aguesia-loss of taste, Dysgeusia-altered taste)
- Sleep problems
- Depression and/or Anxiety
- Pins and needles feeling
As time goes on and more people are being infected with new variants, we are seeing more long-haul symptoms presenting in the health care setting.
I will focus on the most common we treat, which are loss of taste and smell, brain fog, and fatigue.
Patients will often complain of loss or altered taste and smell and brain fog/fatigue, leading to depression and anxiety. Some will have a very diminished smell and taste. Some have an altered smell and taste, often tasting metal with things like coffee or chocolate. Things that generally smell good can have no smell or a foul odor. General fatigue, a rebound of a previous diagnosis like Epstein-Barr Syndrome (EBV), or chronic fatigue, are common. Some may have phantom smells that come and go.
Research is continuing. Some new and older theories have either changed or emerged, leading to possible answers as to why the loss or altered smell/taste, brain fog, and fatigue are happening. Some ideas on why the metal dysgeusia is present are perhaps due to molecular changes in the kidney dysfunction, which leads to the build-up of waste materials in the blood, which may trigger dysgeusia. Taste alterations can also be caused by Vitamin D, B12 (metallic taste) deficiencies, and zinc.
Some new research has come out and offered different reasons for the loss of smell and taste.
Originally, it was thought that congestion led to a loss of olfactory receptors, which was the reason for alterations. With the current research, we are now seeing that the lining of the nose (epithelium) is showing massive destruction of support cells that send a signal to the brain. We are also seeing brain inflammation by the virus affecting the olfactory and taste centers of the brain. There seems to be an overactivation of inflammatory processes in regions of the brain and perhaps damage to the circulation of blood and lymph in the brain. The virus does not seem to have to get into the brain itself, but inflammation can get to the brain and cause many ailments.
The virus can affect the Orbital Frontal Cortex of the brain, which can alter the sense of taste and smell. In March of 2022, a study came out in JAMA titled “Even Mild COVID-19 May Change the Brain”. This study of 800 participants compared the brain scans (MRIs) before infection and several months after infection.
The findings: greater tissue damage in areas connected to the primary olfactory cortex, a greater decrease in whole brain volume and increase of cerebrospinal fluid, greater decline in the ability to perform complex tasks, which on the scan was associated with atrophy in an area of the cerebellum associated with cognition. Research also alludes to the possibility of inflammation/damage or loss of gray matter in the orbital frontal cortex, which can alter processing areas that integrate the olfactory and gustatory (taste centers). Information also shows a decrease in blood flow and abnormal EEG readings in certain areas of the brain. It seems like we now have enough evidence to show that in some cases of long-haul COVID patients, there is brain damage that may be hampering the neural areas and that information is not being received or interpreted due to this damage and/or inflammation of the areas.
So, what can we do?
In summary, I will list some of the treatments we have been having success.
First, we have an intake/history questionnaire addressing many of the above-mentioned conditions. From a western medicine approach, recommendations have been to add Vit C, Vit D, Zinc, and Vitamin B12 to supplement your diet. Research also calls for “smell training,” which I recommend to patients. I like to use essential oils for training the four distinctive scents we need to work on. Citrus: lemon or orange. Mint: peppermint or eucalyptus. Floral: lavender or rose. Spice: cinnamon or clove. You can use the bottle itself, hold it up to each nostril or put some on a piece of cotton and sniff for 10-20 seconds in each nostril. This will aim to help recovery based on what is known as neuroplasticity, the brain’s ability to reorganize itself to compensate for a change or injury.
From an Eastern approach to acupuncture, I use some specific acupuncture points with Electro-Acupuncture Medicine (EAM) or NeuroPuncture (specific electricity frequencies attached to the acupuncture needles). As well, as a few herb combinations that will help with the peripheral systems that can address the chronic fatigue post viral, anxiety/depression, and loss of taste and smell. Another herb seems to help with the brain functions that invigorates the blood and helps with lymph systems in the brain, more for longer durations of illness.
There are some preliminary case reports of using photobiomodulation (low-level laser or what is also known as cold laser) the use of visible red light in the range of 632-670 nm to infra-red laser 790- 850nm to help restore loss of smell and taste. The theories are increased blood flow, decreased scar tissue, restored lymph channels, and cellular repair. More research needs to be done in this promising field.
Mind-body practices such as meditation help for various issues and reasons, mostly by calming and becoming present and aware while enhancing the ability to concentrate. Studies have also shown that adding movement meditations like Qi Gong and breath work can help with stress reduction, emotional regulation, strengthening respiratory muscles, decreasing inflammation, and enhancing the immune system. As time goes on, we will undoubtedly get more information, studies, and research that will hopefully allow us to add more treatments to our arsenal to address some of the long-haul consequences of COVID-19.
*Research references available upon request