Robert Groysman, MD

Robert Groysman, MD Physician with a focus on Long COVID, post-vaccine syndromes, ME/CFS, dysautonomia, POTS. Author of seven books on Long COVID. Early U.S.

clinical adopter of Epipharyngeal Abrasive Therapy (EAT). FB page not affiliated with practice.

04/27/2026

How COVID hijacks your mitochondria.

The virus is gone. The PCR is negative. But the damage it left behind in your energy-producing organelles is still running the show months later.

SARS-CoV-2 protein ORF10 binds to NIX, a receptor on the mitochondrial outer membrane. This hijacks the cell's own cleanup system, selectively destroying MAVS, the protein your mitochondria use to signal immune threats. With MAVS degraded, the immune alarm goes silent. The virus gains unchecked access to the organelle.

Inside, the viral proteins disrupt cristae structure. Cristae are the folded inner membranes where the electron transport chain operates. Think of them as the surface area manufacturing energy. When cristae collapse, the assembly line shortens. Fewer electrons move. Less ATP is produced.

In affected tissues, ATP production can drop substantially. Your muscles fatigue at rest. Your brain fogs without cognitive load. Your heart races to compensate for reduced cardiac efficiency.

The virus cleared. The structural damage remained. And your body has been running on a fraction of its energy capacity since.

This is not deconditioning. This is not depression. This is measurable cellular injury with a known viral mechanism and a predictable clinical presentation.

04/27/2026

Is it too late? The answer is no, but expectations must change.

04/27/2026

Twelve months of symptoms is not a mental health crisis. Twelve months of symptoms is twelve months of data your doctor ignored.

The pattern is there. The timing is there. The mechanism is there. What is missing is the willingness to test for it.

04/27/2026

EKG normal. Holter normal. Your cardiologist said your heart is fine.

But your heart rate hits 140 walking to the kitchen. You feel pounding in your chest every time you stand. You wear a smartwatch that shows heart rates your cardiologist would flag if they saw them, but your resting EKG was clean.

EKG measures resting rhythm. Holter captures 24 hours of rhythm variation. Neither measures what happens when you change position. Neither provokes the system to reveal its dysfunction.

Inappropriate sinus tachycardia and postural orthostatic tachycardia do not appear on a resting test. They appear on provocation. A tilt table test. A 10-minute standing test with continuous monitoring. A NASA lean test in an office with a wall and a heart rate monitor.

Your heart structure is normal. Your heart rhythm at rest is normal. The autonomic regulation controlling that rhythm under postural stress is not.

The test was measuring the wrong variable. The cardiac muscle is fine. The nervous system controlling it is dysregulated.

If your heart feels wrong but your cardiac tests are clean, ask what happens when you stand for ten minutes.

04/27/2026

The vagus nerve controls more than digestion. It controls five systems that appear unrelated on paper but trace to one trunk.

Heart rate variability. The vagus modulates beat-to-beat heart rate. When vagal tone drops, your heart loses flexibility. It races with minor exertion and recovers slowly. Your cardiologist sees tachycardia. The vagus sees lost regulation.

Immune tone. Vagal signaling suppresses inflammatory cytokines through the cholinergic anti-inflammatory pathway. When the vagus is injured, inflammation runs unchecked. Chronic low-grade immune activation without obvious infection. Labs show vague elevations. Nothing definitive. Everything slightly off.

Gut motility. The vagus controls the migrating motor complex, the wave pushing food through your GI tract between meals. When signaling weakens, food stalls. Bloating, constipation, SIBO. Your gastroenterologist treats the gut. The signal originates in the brainstem.

Anti-inflammatory signaling. The vagus tells your immune system when to stand down. Without that signal, mast cells stay activated, microglial cells stay primed, and your body remains in a state of low-grade defense.

Vocal cord function. Hoarseness, voice fatigue, the sensation of something in your throat. The recurrent laryngeal nerve is a branch of the vagus. When vagal function is impaired, your voice tells the story.

Five symptoms. Five specialists. One nerve.

04/26/2026

You never had irregular periods before COVID.

Twenty-eight days. Give or take one. Predictable enough that you packed accordingly for vacations. Predictable enough that you knew exactly when PMS hit.

After COVID, the cycle changed.

Periods arriving at 21 days. Then 35. Then 21 again. Flow that doubled for three months, then nearly disappeared. PMS symptoms that now start at ovulation and last two weeks instead of two days. Cramps that bring you to the floor when they never did before.

Your OB-GYN ran labs. FSH normal. LH normal. Estradiol in range. "It could be stress."

But you can name the date this started. You can trace the change to within a week of your infection. This is not psychological stress manifesting as cycle disruption. This is viral inflammation reaching the hypothalamic-pituitary-gonadal axis and altering the signaling that controls ovarian function.

The glands are capable. The instruction set changed.

Cycle mapping with timed hormone panels, drawn on specific cycle days, not random labs, can reveal the pattern your annual bloodwork keeps missing.

04/26/2026

Probiotics restore a healthy microbiome. In MCAS-driven gut dysbiosis, the wrong strain can trigger a systemic flare within hours.

You bought the highest-rated probiotic. Your friend recommended it. Your naturopath said gut health is everything. You took it for three days and your symptoms exploded. Bloating, flushing, brain fog, joint pain. All worse.

Certain probiotic strains are histamine-producing. Lactobacillus casei, Lactobacillus bulgaricus, and certain strains of Streptococcus thermophilus increase histamine load. In a stable gut, this is negligible. In a gut already overwhelmed by mast cell mediators and depleted DAO enzyme, the additional histamine pushes you past threshold.

The probiotic did not fail. It worked exactly as designed. It produced histamine. Your system could not clear it.

Histamine-neutral or histamine-degrading strains exist. Lactobacillus rhamnosus, Bifidobacterium infantis, Bifidobacterium longum. These do not add to the histamine burden.

The question is never "should I take a probiotic." The question is which strain, at what dose, given what your mast cells are already doing.

(Consult with your doctor before starting any new treatment.)

04/26/2026

You crashed.

Here is what to do in the next 72 hours.

Post-exertional malaise follows a pattern. The activity happened yesterday, or two days ago. Now your body is paying the debt. This protocol is not a cure. It is damage control that reduces the depth and duration of the crash.

Phase 1: First 24 hours.

Horizontal rest. Not couch rest. Horizontal. Legs level with heart. Minimize all sensory input. No screens if possible, no conversations requiring effort, no decisions. Salt and electrolytes, sipped slowly. The goal is not recovery. The goal is stopping the energy hemorrhage.

Phase 2: Hours 24-72.

Supine activity. You can talk. You can listen to something. You can eat sitting up briefly. No walking beyond the bathroom. No standing tasks. Your mitochondria are attempting to rebuild ATP stores that were catastrophically depleted. Every upright minute taxes them further.

The crash is not random punishment. It is a predictable biological event with a predictable recovery arc. Timing matters more than willpower.

(Consult with your doctor before starting any new treatment.)

04/26/2026

Endothelial repair is slow. But it is measurable.

Three markers that shift before exercise tolerance returns. Before the fatigue lifts. Before you notice you are getting better.

Nitric oxide availability. The endothelium produces nitric oxide to dilate blood vessels and regulate flow. When endothelial cells are damaged, production drops. As healing occurs, flow-mediated dilation improves on ultrasound testing. This is measurable before symptoms change.

Glycocalyx thickness. The endothelial glycocalyx is a gel layer coating the inside of your blood vessels. COVID degrades it. As it regenerates, microvascular perfusion improves. Sublingual capillary imaging can track this recovery in real time.

Microvascular density. Dark-field microscopy of the sublingual capillary bed shows how many small vessels are actively perfusing. In endothelial dysfunction, density drops. As repair progresses, capillary loops reappear. More loops means more tissue receiving oxygen.

These markers move weeks to months before you feel better. The biology heals before the experience of healing catches up.

Recovery from endothelial dysfunction is not faith. It is measurable biology on a timeline you can track.

04/26/2026

By the time you found a specialist trained in Long COVID, you had already paid for care your insurance would not cover.

Your plan covered the antidepressant. It covered the psychiatry referral. It covered the CBT sessions recommended when your labs came back normal.

It did not cover the tilt table testing. It did not cover the gastric emptying study, the autonomic function panel, or the mast cell mediator labs pointing to what was actually happening.

The gap is not about denial of care. Health insurance was built decades ago around a model where one symptom maps to one diagnosis with one standard panel of tests. Long COVID does not fit that model. Multiple mechanisms. Multiple organ systems. Tests sitting outside the standard workup because the standard workup predates the disease.

So the diagnostic testing pinpointing your mechanism often falls outside what a plan will reimburse. The specialist trained to interpret it often does too.

This is not a failure of individual doctors. It is a structural mismatch between what this disease requires and what the reimbursement system was built to support.

04/25/2026

The first hour out of bed can set the tone for the entire day. Four things that worsen morning crashes, and three that help.

What makes it worse:

Caffeine on an empty stomach. Coffee triggers a cortisol spike and vasoconstriction. On a system with already low blood volume and impaired autonomic regulation, the spike is followed by a crash hitting harder than the fatigue you started with.

Hot shower first thing. Heat dilates blood vessels. Blood pools in your legs. Your autonomic system cannot compensate, and your heart rate climbs trying to maintain perfusion to your brain. The lightheadedness after a morning shower is not low blood sugar.

Standing quickly. Orthostatic stress on depleted blood volume. Your baroreceptors need time to adjust. Going vertical fast triggers the compensatory surge that exhausts your sympathetic reserves before 8 AM.

Checking your phone immediately. Screen light and information processing demand cortisol and norepinephrine. On an already dysregulated HPA axis, the cognitive load in the first minutes of waking compounds the crash.

What helps:

Salt and water before your feet hit the floor. 16 oz with a quarter teaspoon of salt. Blood volume expands. Orthostatic tolerance improves.

Supine stretching for five minutes. Gentle limb movement while horizontal. Blood begins to circulate without gravitational stress.

Light protein within 30 minutes of waking. Amino acids stabilize blood glucose and support neurotransmitter production without the cortisol spike caffeine causes.

(Consult with your doctor before starting any new treatment.)

04/25/2026

You turned forty-five this year. Your mother is seventy-two.

She walks faster than you. She carries more groceries up the stairs. She climbs the steps you avoid. She keeps saying she does not understand what happened to you.

You do not understand either.

You used to hike. You used to carry both kids at once. You used to finish a full day of work and still cook dinner. Now the grocery trip is the day. Now showering requires a plan. Now you sit in the car for twenty minutes after arriving somewhere because the drive depleted you.

This is not aging.
This is not deconditioning.

This is cellular energy production running at half capacity. Your mitochondria are injured, and every cell in your body, muscle, brain, heart, gut, is rationing what little ATP they produce.

You are not weak. You are not lazy. You are running a body on an energy budget that no longer covers the basics.

Your mother does not understand because she cannot see what is broken. Neither can your doctor, unless they know where to look.

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6957 W Plano Pkwy, Suite 2100
Plano, TX
75093

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+12143907557

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