Preventing Long Covid with a Concussion Recovery Protocol?
Preventing Long Covid with a Concussion Recovery Protocol?
Connecting the Therapeutic Dots
This post is a continuation of my previous posts, Covid Day 0, Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, Day 7, Day 8, Days 9 - 14, and Days 15 - 22.
It’s “28 Days Later” and I seem to have turned the corner in a comprehensive way after taking severe damage from the anti-viral drug, which I detailed in previous posts.
I am following a concussion recovery protocol.
If this post were just about me, I would likely not end the title with a question mark. I think I’ve answered that question for myself. But since other people might be thinking about whether this would apply to themselves, it definitely is an open question.
And it’s a question other people are investigating. It seems that people working in concussion recovery are beginning to connect the pathogenic and therapeutic dots between the two conditions.
This week I’ve discovered several interesting items that I’ll link to here. More about that in a minute. First, a bit more about where I am now, some 28 days after the initial infection.
I’m able to exercise with a fairly high level of vigour, pushing myself (in the concussion recovery world, this is known as Graded Exercise Therapy).
I am able to do mental work all day and night without mental fatigue.
I have regained two of the things that I consider to be hallmarks of mental health. A sense of humour and a sense of orchestrating my day from a slight remove (as if I am the director of a film that is my day).
At night, I don’t feel utterly wiped out from mental and physical exertion.
And sorry for TMI, but after weeks of gut dysregulation, I am back to having normal BMs again, which likely means that my gut biome has recovered.
I’ll go into what I’m doing currently for my protocol, but first a bit more about what’s emerging out there.
Covid and Concussion: Connecting the Pathogenic and Therapeutic Dots
A concussion is not a diagnosis. It is the mechanism of injury. From that injury, pathobiological responses emerge.
Can we say the same for Long Covid? My personal take is, yes and no. If Covid has actually been neutralised and sequestered and is no longer actively damaging you, then yes, Covid was the mechanism of injury, and “Long Covid” isn’t necessarily a diagnosis (in the same way TBI isn’t a diagnosis).
A concussion can lead to a variety of pathologies because a variety of brain structures may or may not have been injured and our ability to determine the exact nature of the injury is still fairly crude.
With TBI recovery, we often have to start with the symptoms and work backwards from there toward the solution. For example, if one is dizzy, vestibular and vision therapy are likely going to be helpful. We do this not knowing exactly where the neurological injury is. It’s a bit like treating a broken arm without knowing where the fracture is.
It appears that some of the same approaches are being taken for people with Long Covid, in part because medicine is still pretty rubbish at treating neurological injuries and the pathobiologies that result from them.
It seems that some of the people who help patients recover (or prevent) Long Covid are taking note of lessons learned in the concussion recovery space, and vice versa.
I recently stumbled upon this article.
COVID-19 and Traumatic Brain Injury (TBI); What We Can Learn From the Viral Pandemic to Better Understand the Biology of TBI, Improve Diagnostics and Develop Evidence-Based Treatments
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8720751/
I’m going to include a couple of quotes from that piece here with some relevant thoughts.
Traumatic brain injury (TBI) has been referred to as the “silent epidemic” but given its substantial and recurring impact on global health, it should be renamed to the “silent pandemic”. While the world understandably focuses on the COVID-19 pandemic, other diseases have not disappeared. TBI affects ~3 million people, kills ~50,000, and permanently disables ~80,000 people in the US alone EVERY year.
The person who wrote this is a tad resentful about how we’ve opened the firehouse of cash and resources for Covid treatments whilst TBI has historically received comparatively little. Those who suffer from Long Covid are more likely to be seen as blameless. There’s always been a sense that TBI isn’t real and if it is you probably deserved it, or you’re simply too weak to take a blow to the head, which is something men, in particular, are supposed to be able to do.
Since there is no drug for treating an “infection” per se, there is and will be no drug for “treating TBI”.
We can treat the pathobiological responses that develop downstream from TBI or Covid.
As in the case of infectious diseases where the pathogens as well as their pathomechanisms are identified, in addition to the type of primary injury, we must be able to identify the pathobiological process triggered by the initial injury.
As Han Solo said in Star Wars, “Well, that’s the trick isn’t it? And it’s going to cost you something extra.”
In the video from Stanford that began this series of posts about Covid, they talk about reversible brain inflammation, and that sounds straightforward, but amazingly we still know very little about the THERAPEUTIC WINDOWS for such interventions, with Covid or with TBI. To wit:
Clinical studies have shown that treatment with antivirals (e.g., Remdesivir) is only effective during the early phase (7-10 days) of infection while anti-inflammatory treatments (e.g., dexamethasone or anti-IL-6 monoclonals) do more harm than good during this phase. Conversely, anti-inflammatory treatment can significantly reduce unfavorable outcome and death at the later phase of the disease. Inflammation is a key adaptive response to any kind of noxious stimuli in all multicellular organisms. Neuroinflammation has been extensively studied since the 1990s but all experimentally successful anti-inflammatory treatments have failed in clinical TBI trials. This can be plausibly explained by the lack of key information regarding the temporal pattern of the inflammatory process, and its specific components that cannot be determined by using markers of damage. We know that there is a neuroinflammatory response to TBI but the temporal pattern of its different phases, reparative vs. injurious, and their cellular and humoral components are currently not well known. It is likely that the many experimentally successful pharmacological treatments, including anti-inflammatories, missed their therapeutic windows in clinical trials… We know that time is a critical dimension of most disease processes, including TBI, so we must identify not only the pathobiological responses after TBI but also their temporal patterns; both are essential for developing specific treatments and applying them within their therapeutic window to successfully mitigate the consequences of TBI.
I’d like to note here that this bit reveals something of a bias toward seeking and finding a pharmacological solution, a pill we can take at the right time. And while I would love that to be possible, what can we do in the meantime? For those of us suffering from a neurological injury, this isn’t an intellectual curiosity.
I’ve written several posts about the treatments and protocols that I’ve found helpful and most if not all of them are aimed at mitigating or eliminating pathological processes like the forms of brain inflammation that are damaging.
When I suffered a concussion in 2008, my doctor told me to simply wait and do nothing and the symptoms would resolve on their own within weeks or months or at most a year.
Over the course of that year, I steadily declined as the pathobiological responses took hold. I was in far worse shape a year after my injury than I was a week after it.
I’m guessing Long Covid may have a similar contour.
In my case, no actions were taken to counteract the development of pathobiological responses. After a TBI, this total lack of treatment happens all the time.
If you’ve ever dipped into stories about Victorian-Era medicine, you’ve likely shaken your head at how many preventable amputations and other grievous losses people had to suffer back then due to a lack of collective knowledge, tools and technologies. That’s kind of where we’re at with neurological injuries today. Millions of people suffer needlessly in a way that future generations will shake their heads at.
COVID-19 mainly involves the respiratory system but like most diseases, it is multi-systemic, it can affect all systems from gastrointestinal to the CNS. Clinical and especially experimental TBI studies have almost exclusively focused on the brain, largely ignoring the rest of the body. This is based on the traditional view of the blood brain barrier (BBB) as a “brick wall” with binary function: closed or open. There is already ample evidence about the complexities of BBB function, from regulating transendothelial transport to real “opening”. Endothelial stress and microvascular injury are emerging as important, maybe even dominant, (endo)phenotypes across the TBI spectrum.
Even though doctors specialise in different systems and structures of the body (and begin to see any possible solution through that lens), the whole is always greater than the sum of the parts.
The brain includes a vascular system and a lymphatic system. The brain is completely dependent on the gut. Damage to the brain may cause pathobiological responses in totally “unrelated” areas of the body, even in our bones.
Okay, now moving on to a resource that is a little more actionable.
The excellent resource Concussion Alliance has put together a page about Long Covid. Personally, I look to Concussion Alliance for clues and ideas, but not necessarily for conclusions. They generally take a very conservative and cautious tack.
That said, props to them for including acupuncture in the list of effective treatments for both Covid and TBI.
Long Covid
https://www.concussionalliance.org/long-covid
Compare the content on that page, including the treatment options, to the content of the following page.
Guidelines for Concussion Recovery
https://www.concussionalliance.org/guidelines-for-recovery
What protocol am I following now?
What am I doing to possibly prevent the development of Long Covid?
A mix of what I typically do every day with a few extra points of emphasis and a few extra supplements that I don’t normally take.
Now, before I list these things out, I’m guessing some of you reading this must think I have acres of time to devote to this, and “that must be nice” for me and there’s no way you could follow a protocol like this.
And some of you almost certainly believe that I’m overthinking all this, that the brain and body are self-healing, and I should just chill because the stress of all this is probably making things worse.
Let me address each of those points.
On a daily basis, I don’t do any more or less than a typical high-performance individual does to sustain or optimise their health or wellbeing. Like them, I am simply prioritising it. Listen to some Tim Ferriss interviews. He always asks people about their daily routine and most people have a fairly involved one.
It isn’t extra shit you have to do. It’s the exact opposite. It allows you to do extra shit. It makes it possible to sustain performance at a high level.
It takes the same amount of time to take a capsule of L-Tyrosine as it does to take a Flintstone vitamin. Literally seconds. It just sounds more involved.
I don’t have any more hours in my day than anyone else. I have a business. I have clients. I write these posts. I have family obligations. And I have gotten very good at interweaving what I do with the rhythm of my day. And I will often do things simultaneously to shorten the total timeframe needed.
Finally, yes, the brain and body can be self-healing. They can also be self-disease-causing. If you think I should be doing less, I can only assume that less is working out for you right now. Isn’t it great that you can take your brain and body for granted? I remember those days. Good times.
And now, here’s what I’m doing right now, 28 days after the Covid infection. As I stated at the top, I’m feeling good generally.
My current daily routine includes:
A cup of coffee with 500mg of L-Tyrosine (from Thorne; L-Tyrosine isn’t something I’ve taken daily, but I added it as part of my Covid recovery, it takes 10 seconds to take one capsule)
Three rounds of standard Wim Hof breathing in the morning, preferably done outside (takes about 10 minutes, gets me outside immediately, does double duty in getting natural light into my eyes, which sets my circadian rhythm and improves sleep)
A hot then cold shower (takes maybe 3 minutes longer than a regular shower)
A large electrolyte beverage (made with LMNT electrolyte powder, which takes 30 seconds to make)
A session with the Vielight Neuro device (typically done when I sit at my desk to do my initial bout of morning work; sometimes done in tandem with my Wim Hof breathing on mornings when that happens later; takes 60 seconds to put on and take off).
A walk over varying terrain with optional exercises (including an “agility ladder” exercise — I favour exercises that challenge my sense of balance / vestibular system; takes 20 minutes, and usually happens mid-morning after I have done my first bout of work in my office).
A mid-day dose (one full scoop) of SynaQuell+ (this is not something I normally take on a daily basis; I accidentally took a double dose two days in a row after my misadventure with the antiviral drug, and that double dose may have proven pivotal in bouncing back quickly, but I can’t know for sure; it takes 60 seconds to make).
An afternoon greens beverage (includes a scoop of powdered greens, such as Athletic Greens or Green Vibrance; it takes 60 seconds to make).
An optional mid-day dose of L-Tyrosine (this isn’t something I’ve taken daily, but I added it as part of my post-Covid protocol as a kind of anti-depressant)
An afternoon round of exercise (takes 10 or 20 minutes, cardio or core or vestibular exercises)
A session with the Vielight X-Plus, every other day (takes 60 seconds to put on and take off and I do the 20-minute session whilst attending to other things, as it’s entirely portable).
An evening walk or exercise (takes 10 to 20 minutes, often done with family)
Bedtime supplements of Magnesium Bisglycinate, L-Theanine, and Inositol (takes 90 seconds)
On a daily basis, the items that take the most time are the exercise blocks, which everyone is supposed to be doing anyway, at least 3 hours a week if not more. So if this list feels like a lot to you, it may be because you’re not exercising or training on a regular basis.
In general, I need to take breaks from working at my desk at my computer. It isn’t healthy to just sit for hours. Even the Apple Watch warns people if they sit for too long. So what I typically do is use those breaks to do things like the items in the list above.
If I were to wake up, have a coffee, shower, work all day, eat an average American diet, drink a beer, and go to sleep, I would deteriorate rapidly—and maybe the rapidity of that decline is really a blessing-in-disguise because the slow decline seems to fool a lot of people.
I would be remiss if I didn’t mention that in the past week (since my previous post) I have also received four acupuncture treatments focusing on my brain, gut, kidneys and vestibular system, and I found those to be very helpful. I have also received one adjustment to my atlas, which was much needed.
As ever, my intention in presenting you with my recovery and health protocols is to give you more information and another point of reference.
Am I still in danger of developing pathobiological responses to the Covid infection? I don’t know. I’m going to proceed as if I am in danger of that, and I am going to proceed as if 28 days ago I suffered a concussion. So far, it seems to be working for me, and I’m grateful for that. Hey, this TBI experience is really paying off, right?
Brainwave is an informational resource for people whose symptoms haven’t resolved after a concussion or mTBI. I aim to present this information in a clear and concise way, spelling out what’s backed by science and what remains unknown. Nothing here is meant as a substitute for professional medical advice, diagnosis, or treatment. I am not a physician or a healthcare practitioner of any kind; I’ve had a lot of sports-related concussions and had to learn this stuff the hard way. If you found this information helpful or know someone who might benefit from it, please share and subscribe to Brainwave.