Robert Groysman, MD, 6957 W Plano Pkwy, suite 2100, Plano, TX (2026)

01/19/2026

You started treatment three weeks ago. You're frustrated it's not working yet.

Standard medicine teaches us to expect quick fixes. Antibiotics clear infections in days. Pain medications work in hours. So when Long COVID treatment takes months, it feels like failure.

It's not failure. It's biology.

Your body doesn't heal on prescription timelines.

Dysautonomia treatment: Weeks to months before you notice changes. Your autonomic nervous system spent months or years in dysfunction. Recalibration takes time, and timelines vary by individual.

Mitochondrial repair: Months for cellular recovery. Your mitochondria are rebuilding energy production at the cellular level. The good news: mitochondrial dysfunction is often reversible with proper support.

Gut microbiome restoration: Three to six months minimum to rebuild. Your beneficial bacteria were decimated. Repopulating takes consistent effort.

MCAS stabilization: Four to eight weeks with consistent mast cell stabilizers. Your mast cells need time to stop overreacting to triggers.

Hormonal rebalancing: Two to four months for optimization. Endocrine systems are slow to shift.

Endothelial repair: Three to six months for stable gains. The endothelium can heal quickly with the right support, but vascular healing takes patience.

Three weeks isn't enough time to judge whether treatment is working.

Slow recovery doesn't mean failed recovery. It means your body is doing the hard work of repair.

Give your biology the time it needs.

01/19/2026

"Getting better" sounds abstract when you're struggling just to shower.

So let me make it concrete.

Recovery isn't a feeling. It's measurable change over time.

Here's what "better" looks like in patients I've treated:

PEM crashes: From three times per week to once per month. Same body. Fewer crashes. That's recovery.

Upright time: From two hours maximum to six hours daily. You're not standing all day. But you're standing twice as long. That's recovery.

Brain fog: From unable to read a paragraph to working part-time. Your mind isn't razor sharp. But it works when you need it. That's recovery.

Sleep: From two to three hours of broken sleep to five to six hours of restorative rest. You're not sleeping perfectly. But you're sleeping better. That's recovery.

Social capacity: From total isolation to dinner with friends once a week. You're not your old social self. But you're connecting again. That's recovery.

The improvements don't look dramatic on any single day. But across weeks and months, they compound.

Track your symptoms. Write them down. Compare today to three months ago.

Small improvements are still improvements. Celebrate them. Build on them.

Recovery is happening even when it doesn't feel like enough.

01/19/2026

You're waiting to feel "normal" again. 100% back to your old self. That's the goal, right?

I see this belief in almost every patient who walks through my door. And I understand why.

You remember who you were before. The energy. The clarity. The life that didn't require spreadsheets to track symptoms. You want that person back.

So you've set a standard: full recovery or failure.

But this thinking keeps you stuck.

When I began treating Long COVID patients over five years ago, I noticed a pattern. Patients who aimed for "100% or nothing" often stayed at 30%. Patients who celebrated 50%, then 60%, then 70%, kept improving.

Recovery in Long COVID is not a switch. It's a direction.

What if you got to 70%? That's more than double where many patients start. At 70% you might work part-time, attend family events with rest breaks, have conversations without losing words.

Is that your old life? No. Is that a life worth building? Absolutely.

Some symptoms may never fully resolve. That doesn't mean quality of life can't dramatically improve.

You're not waiting for a cure. You're moving toward better. That's recovery.

01/19/2026

Your doctor says you're "just anxious about medications."

Your family thinks you're being dramatic. They saw you take medications before without problems, so they don't understand why everything bothers you now.

You start to doubt yourself. Maybe it is in your head.

It's not.

Medication sensitivity in Long COVID is documented biology. Not psychological. Measurable physiological changes.

Long COVID research has documented:
- Mast cell activation creating hyperreactivity to medications
- Mitochondrial dysfunction slowing drug metabolism
- Blood-brain barrier changes
- Autonomic dysfunction affecting drug distribution
- Histamine overload reducing tolerance thresholds

These changes are measurable and reproducible.

The problem is most doctors don't know this yet. Medical school pharmacology assumes healthy metabolism. Standard drug dosing protocols don't account for Long COVID's effects on drug processing.

So when you react badly to normal doses, they conclude it must be anxiety.

They're wrong.

Your experiences are valid. Your reactions are real biology, not fear.

You need providers who understand altered drug processing in Long COVID. Who start low and go slow. Who time medications carefully. Who address the underlying mechanisms making you hyperreactive.

Starting low and going slow isn't weakness or being "difficult." It's medically appropriate for your current biology.

You're not making this up. Your medication sensitivity is real.

Don't change any medications without medical supervision. But do seek providers who understand this is biology, not psychology.

Your body changed. Your medication responses changed. That's documented science.

You deserve care that recognizes this reality.

01/19/2026

You can handle one trigger. Maybe two.

But add a medication and you crash completely.

This is the histamine bucket concept, and it explains why your medication responses are so unpredictable.

Imagine a bucket that represents your body's capacity to handle histamine and inflammatory mediators.

Every trigger adds to the bucket:
- Stress adds histamine
- Certain foods release histamine
- Heat increases histamine
- Hormonal fluctuations raise histamine
- Physical exertion triggers histamine
- Medications can trigger histamine release

In healthy people, the bucket is mostly empty. You can add several triggers before overflowing into symptoms.

In Long COVID, your bucket is already near full.

Chronic inflammation keeps your baseline histamine load high. Mast cell dysfunction continuously releases mediators. Autonomic dysfunction prevents normal histamine breakdown.

You're constantly near overflow.

So one medication, on one day, tips you over the edge. Bucket overflows. You get reaction cascades that feel completely out of proportion to the trigger.

This explains patterns you recognize:

Why you tolerate a medication some days but not others. Your baseline varies based on stress, sleep, food, hormones.

Why timing matters. Morning doses may work better when your baseline is lower.

Why adding multiple new things at once is challenging. Each addition brings you closer to overflow.

Why medication reactions seem random. They're not random. Your baseline load keeps changing.

Inconsistent reactions don't mean you're making this up. Your baseline histamine load varies.

This is real biology. And it explains why "start low, go slow" and careful timing matter so much.

01/18/2026

Medications that never made you drowsy, anxious, or "weird" now affect your brain intensely.

Even non-psychiatric drugs make you feel altered, spacey, disconnected.

You mention this to your doctor. They look at you like you're making it up.

You're not.

Your blood-brain barrier can become more permeable.

The blood-brain barrier (BBB) is a protective layer that keeps most substances in your bloodstream from entering your brain. It's selective, letting oxygen and nutrients through while blocking toxins and many medications.

Long COVID can cause neuroinflammation. This inflammation may increase BBB permeability.

Medications may cross into your brain that normally wouldn't.

This explains experiences you might recognize:

Why antihistamines knock you out when they never did before. Sedating effects that used to be mild now feel overwhelming because more of the drug reaches your brain.

Why you feel mentally "off" on medications that aren't supposed to affect cognition. They're crossing your BBB and affecting neural function.

Why brain fog compounds when you take medications. Your baseline cognitive impairment plus medication effects in the brain creates severe mental slowdown.

Why stimulating medications feel too intense. When more crosses the BBB, normal doses create overstimulation.

Your brain's protective barrier is compromised. You're not "overly sensitive." Your neurological shielding changed.

Long COVID research has documented changes in BBB function. Your experience is real biology.

Don't change medications without medical supervision. But do find providers who understand why your brain reacts differently now.

01/18/2026

Same medication. Same dose you took for years.

Suddenly side effects, no benefits, or extreme reactions.

Your doctor is confused. "You tolerated this fine before."

Your liver's drug processing system changed.

Your liver uses specific enzymes to break down medications. These enzymes require cellular energy to function properly.

Long COVID causes mitochondrial dysfunction in liver cells. Less energy production means slower, less efficient drug metabolism.

Medications that used to clear your system in 4 hours now linger for 8 or 12 hours. They accumulate when they shouldn't.

This explains several patterns you might recognize:

Why medications feel stronger than they should. Because they're staying in your system longer at higher concentrations.

Why drug interactions happen that never did before. Your liver can't process multiple medications simultaneously when it's energy-depleted.

Why genetic variants suddenly matter. If you're a slow metabolizer genetically, Long COVID made it slower.

Why the timing of medications matters more now. Your liver has limited processing capacity. Stacking medications overwhelms it.

Standard pharmacology assumes healthy liver metabolism. Your doctor prescribed based on that assumption.

But your metabolism isn't standard anymore.

This doesn't mean medications don't work. It means dosing, timing, and selection need adjustment based on your current biology.

Your body's drug processing system changed. Same drug does not equal same result anymore.

Work with providers who understand how Long COVID affects drug processing.

01/18/2026

You react to foods. Medications. Supplements. Fragrances. Temperature changes.

Everything triggers you now.

Your family thinks you're being dramatic. Your doctor suggests therapy.

You're not imagining this. Your mast cells are dysfunctional.

Mast cells are immune cells that release histamine and over 200 inflammatory mediators when activated. In healthy people, they release these chemicals only when there's a real threat.

In Long COVID, mast cells get stuck in an activated state.

Once activated, the threshold for reaction drops dramatically. Things that shouldn't trigger a response now cause full inflammatory cascades.

This creates a compounding problem:

One trigger causes mast cell degranulation. The released mediators create inflammation. Inflammation makes mast cells more sensitive. Now smaller triggers cause bigger reactions.

This is why you react to medications that "shouldn't" cause reactions. It's not allergies in the traditional sense. It's inappropriate mast cell activation.

Your reactions are real. They're measurable biological processes. Not anxiety. Not being dramatic.

This is Mast Cell Activation Syndrome (MCAS), one of the six mechanisms driving Long COVID symptoms.

When providers understand this, they approach medications completely differently. Lower doses. Careful timing. Addressing the underlying mast cell dysfunction.

Your reactivity isn't weakness. It's dysfunctional immune signaling.

And it's treatable.

01/18/2026

You used to take Tylenol, Benadryl, antibiotics without issues.

Now even half a pill makes you feel terrible.

Your doctor says it's anxiety. Your family thinks you're being dramatic. You start to doubt yourself.

This is real biology.

Long COVID changed how your body processes medications:

Your mast cells became hyperreactive. Now they release histamine and inflammatory mediators in response to medications that never triggered reactions before.

Your autonomic nervous system dysfunction affects blood flow and distribution. Medications don't move through your system the way they used to.

Your mitochondria are impaired. Your liver cells can't detox medications at normal speed. What used to clear in hours now lingers for days.

Your blood-brain barrier can become more permeable. Medications may cross into your brain that normally wouldn't. Sedating effects feel much stronger.

Your histamine bucket is already near full from chronic inflammation. One medication tips you into overflow and cascade reactions.

This is why "start low, go slow" isn't weakness. It's smart medicine.

Your medication sensitivity is real. Your biology changed. Work with providers who understand this.

01/18/2026

You started treatment two weeks ago. You're not better yet. You're wondering if it's working or if you should quit and try something else.

This is where most patients make critical mistakes. They abandon treatments prematurely because they don't understand mechanism-specific recovery timelines.

Different systems heal at different rates. Expecting immediate improvement from interventions targeting slow-healing mechanisms leads to frustration and treatment-hopping which prevents real recovery.

Here's the general principle:

Faster-responding mechanisms: Mast cell stabilization with antihistamines often shows benefit relatively quickly—many patients notice improvement within days to weeks. If you're not seeing any change after an adequate trial, either the approach needs adjustment or MCAS may not be your primary mechanism.

Medium-timeline mechanisms: Autonomic nervous system stabilization takes longer. Medications like fludrocortisone, midodrine, or beta blockers for POTS may show initial effects within weeks, but full autonomic recalibration requires consistent treatment over an extended period. Don't quit prematurely.

Slower-responding mechanisms: Mitochondrial recovery, nervous system regulation, and endothelial healing require the longest timelines. Mitochondrial support with CoQ10, NAD+ precursors, and B vitamins requires extended use before cellular energy production improves meaningfully. Mitochondria don't regenerate overnight. Nervous system recalibration and small fiber neuropathy recovery are measured in months, not weeks. Blood vessel healing and microbiome restoration also happen gradually.

The key insight: different systems heal at different rates. Quitting a treatment that targets a slow-healing mechanism after only a few weeks means abandoning it before it had time to work.

The biggest mistake I see patients make is starting an appropriate treatment for a confirmed mechanism and quitting at 2-3 weeks because they're "not seeing results."

You're measuring progress on the wrong timeline. Different mechanisms heal at different speeds. Patience isn't optional. It's required.

Track objective metrics weekly. Look for trends over 4-8 weeks, not day-to-day fluctuations. If the trajectory is slowly improving, stay the course. If there's zero change after an adequate trial period for that specific mechanism, then consider adjustment.

Healing takes time. Treatment timelines aren't arbitrary. They're based on biological recovery rates for different systems.

Don't abandon treatments that are working just because they're not working fast enough.

01/18/2026

You've tried ten different treatments. None worked. You're ready to give up.

Low-dose naltrexone, antihistamines, supplements, pacing, medications for POTS, dietary changes, rest, graded activity. You did everything people said would help. You're still sick. Maybe even worse.

So you conclude, nothing works. I'm beyond help. This is permanent.

But treatment failure isn't random. There are specific, identifiable reasons why treatments don't work. Understanding why helps you adjust strategy rather than abandoning hope.

Reason one: Wrong mechanism targeted. If your primary dysfunction is mitochondrial and you're taking antihistamines for presumed MCAS you don't actually have, the treatment can't work. It's not addressing what's broken. You need accurate mechanism identification before treatment selection. Many patients pursue treatments based on online suggestions without confirming they have the mechanism that treatment addresses.

Reason two: Inadequate dosing or wrong formulation. Low-dose naltrexone dosing varies significantly between patients and requires individualized titration with your physician. Different forms of magnesium have different absorption and effects. Compression garments need adequate pressure—typically 20-30 mmHg is recommended for POTS. The right intervention at the wrong dose or formulation still fails.

Reason three: Single intervention for multi-mechanism illness. If you have dysautonomia, mitochondrial dysfunction, and MCAS simultaneously, treating only one mechanism provides partial improvement at best. You may need layered interventions addressing multiple dysfunctions concurrently. One supplement won't fix three broken systems.

Reason four: Ongoing triggers perpetuating dysfunction. If you're treating MCAS but continuing to eat high-histamine foods, sleep four hours per night, and push through crashes, you're working against your treatment. Environmental triggers, inadequate rest, and continued overexertion can override therapeutic interventions.

Treatment failure isn't proof that nothing works. It's feedback that your current approach needs adjustment.

Get accurate mechanism identification. Optimize dosing and formulation. Allow adequate trial periods. Address multiple mechanisms if needed. Remove perpetuating triggers.

You haven't failed. Your strategy needs refinement. That's different.

01/17/2026

"Should I try LDN? What about antihistamines? Mestinon? CoQ10? Magnesium? Ivermectin? Methylated B vitamins?"

You see others talking about treatments. Some report dramatic improvement. Others say it did nothing. You don't know what to try or how to decide.

Here's a clinical reasoning framework worth discussing with your physician when evaluating whether a specific intervention might be worth exploring:

First: Does the intervention target your specific mechanisms? Low-dose naltrexone is thought to modulate immune function and may help reduce chronic inflammation. If your primary issue is POTS without significant inflammatory symptoms, your physician might suggest other options first. If inflammatory symptoms are present, it could be worth discussing (always consult with your physician before starting any new treatment).

The principle: matching potential interventions to identified mechanisms tends to be more productive than experimenting randomly because someone online improved.

Second: What's the safety profile? Some options, like antihistamines, are generally well-tolerated and might be reasonable to discuss as early considerations for suspected MCAS. Others, like anticoagulation, carry more significant risks and typically require careful evaluation and monitoring.

The principle: discussing lower-risk options first, then considering higher-risk interventions if needed, is a common approach.

Third: What's a reasonable trial period? Different interventions may require different timeframes to assess. Antihistamines for MCAS often show improvement relatively quickly. Mitochondrial support with CoQ10 typically requires longer trials. Autonomic medications may take several weeks to show full effect.

The principle: understanding expected timeframes helps you and your physician evaluate whether something might be working.

Fourth: Can you isolate the effect? If multiple things change at once, it becomes difficult to know what's helping. Many physicians recommend introducing one change at a time when possible, and tracking symptoms objectively with measurable data like heart rate, steps per day, or cognitive function tests.

Fifth: What does the evidence say? Some interventions have preliminary research support; others are more anecdotal. Discussing the available evidence with your physician can help inform collaborative decisions.

Not every intervention works for every patient. But having these conversations with your healthcare provider helps you make informed decisions rather than trying everything desperately.

Does it match your mechanism? Is it safe enough to try? How long until you'd expect results? Can you track the effect? What does the evidence suggest?

These are the types of questions worth discussing with your physician before exploring any new intervention.

Robert Groysman, MD

01/19/2026

01/19/2026

01/19/2026

01/19/2026

01/19/2026

01/18/2026

01/18/2026

01/18/2026

01/18/2026

01/18/2026

01/18/2026

01/17/2026

Address

Telephone

Website

Alerts

Shortcuts

Featured

Share

Category