Why the Best Long COVID Treatments Weren’t Designed For Long COVID

Welcome back. Once again, we are going on third, round 3, third episode of our talking about the paradigm of Long COVID. And we're now, we're going to talk about just a lot of therapeutics. Many of these people have heard of, some they haven't heard of. These are all, not all, many of them are repurposed medications. Some are repurposed herbal things. Many of them work for many different things. They don't just do one thing, they do multiple things. And so a lot of times it has, we have to like layer things and use things that make the most sense for the individual. But this is just to give people an idea of what some things are out there that we've had really good success with. We're going to start with like one-offs, like things we've done like that we did this one thing, oh my gosh, that works so well. And then go to some of the more esoteric things. I don't know if you have any introductory remarks.

No, I think it's basically, you know, we talked about the issues with the government kind of essentially saying we're done and how patients are kind of left in the shu— lost in the shuffle. And then we, we last time we discussed the pathophysiology or at least proposed mechanisms. So I think now it's time to give some people actionable options. And so we'll run a list and we'll talk about what these things are, what they do, what our personal experience is. And then our advice would be to speak to, do your own research and then speak to your providers about it and see what might be indicated for your specific case. If this is something that you think is going on and Worst case scenario is they say no, but at least you tried and then you can maybe move on to the next person. But you shouldn't just sit thinking that you don't have any options and that you just, you know, are destined to a life of suffering. That's not okay. So, I think for me, probably the biggest game changer is most likely lotus naltrexone. I mean, like, that's probably why it's at the top of the list.

Number one.

Number one. So lotus naltrexone is an opiate antagonist. And it was, it was studied back in the day for the opiate epidemic that was going on as a way to intervene in a non-opiate-based mechanism of action, meaning help people control their pain without becoming addicted to pain medicine. And in studying it and seeing the benefits of it, they realized that there was this kind of paradoxical effect that wasn't expected where you saw this kind of upregulation of opiate receptors and upregulation of your own endorphin production, so your own natural pain medicine, and then this concurrent concomitant anti-inflammatory neuro— anti-neuroinflammatory immune modulatory effect that was just kind of like, wait, what, what just happened? And it's just snowballed and now it's just being used almost ubiquitously. I mean, I use it in chronic fatigue, fibromyalgia, other chronic pain syndromes, long COVID, SIRS and biotoxin illness, all of my autoimmune cases. Um, I have some people with mood disorders that I use it for. It helps suppress your appetite. And I have some people that have issues with addiction that it can help. I mean, it's just one of these things where it's just almost become like a panacea and it's because it's this kind of subtle underpinning of regulating the system in a more balanced way. And it's not always a hammer over the head. It's not always this kind of night and day, oh, I'm on it now. All of a sudden everything's all better. A lot of times it's, how do I know it's working? And my answer's always, let's stop and see. And 2 weeks later, like clockwork, hey, can I get back on my LDN? Yeah, you can. You know, my sleep's off, my energy's off, my pain's back. I guess it was working. But I do have these cases where it's been like, oh my God, I'm back. I'm better. It's all normal again. I feel great. Can I be on this forever? So it's one of these things where I think for me, that's by far been the biggest hitter. What about you?

Well, um, what's, what's the most you do use with low-dose naltrexone? Your highest dose of—

I do up to 4.5 milligrams. I know you do some higher dosing than that. I know sometimes you do some BID dosing. I'm pretty standard. I go 1.5 milligrams nightly for about a week, and then you go to 3 milligrams for a week, and then you go to 4.5 milligrams. If they're on it chronically, and chronically depends on the individual, let's just say greater than 12 months. I have them then stop, start dropping a few days where just to kind of keep the receptors sharp and prevent tachyphylaxis. So the, the, the first 3 of the last 3 days of the month, they might stop it and then you just get right back on it. Some patients don't get up to 4.5. They don't tolerate it. They feel better at 3. Some feel better at 2. I have some that feel better at 0.5. I don't really go much higher than 4.5, although I've had a few patients do that on their own unbeknownst to me and then just be like, hey, oh, by the way, I've been taking 9mg and I feel amazing. I don't see any any recourse clinically. I don't see anything in their objective data that says it's hurting them, so I let them stay there. But that's not really where I'd go right off the bat. What about you?

Well, you know, there are some practitioners that are doing like microdosing of like 0.5 pills and 0.5 to 1 to 1.5 to 2.

Yeah, I've done some of that too.

And that's some of our super sensitive patients.

Yeah.

Yep. I've had a few patients who couldn't tolerate by mouth and did topical cream.

Awesome.

That worked awesome for them.

I use that for skin, for rosacea. It works really great for that rosacea and, um, sometimes eczema and psoriasis.

Also works great if someone's had, uh, cosmetic surgery to to decrease scarring.

Yeah.

So breast, breast surgery, you put it on the spot, it works great.

I used it on a keyhole in a patient and it helped.

Yeah. Yep. But the FDA has proved naltrexone for weight loss and the doses for that are 8 to 16 milligrams twice a day. So some of my patients who, you know, want weight loss stuff and have some other things going on who've had some benefit, I will, in some select patients, do a trial. Let's try 4.5 twice a day. Let's try 9 once a day. Let's try 9 twice a day. And I basically will bump them up and if they feel better, we'll stick there. That's cool.

I like that.

I probably had 30 or 40% of people. Now, this is me self-selecting based on my clinical expertise and a bunch of other stuff. Yeah. So I'm not just willy-nilly doing it, but I've had some patients who respond nicely to like, and sometimes it's 9 milligrams and sometimes it's 9 milligrams in the morning, right? But I've had a subset, it tends to be my POTS, dysautonomia, my chronic fatigued hypermobile patients. Who that little extra works better for.

Yeah, great.

But it's like a therapeutic trial and, and it's pretty safe. What's the downside? And the FDA has approved the dosing.

Yeah. So I don't see many side effects, if at all. I mean, like if anything, and this is reported in the literature and I've seen this clinically, um, vivid dreams, you know, like sleep disruption and vivid dreams. It's typically transient. If it persists, we go down on the dose, it goes away. Um, I had a one patient with a little bit of dizziness. It was dose dependent. One patient with some appetite suppression. I think that's the point. That's what you were just talking about. Yeah. And one patient who had somnolence. And so they felt like it made them too tired. And so we went down on the dose and it got better. Like, none of them had to stop because of these mild side effects, and I had no one have a bad outcome from it.

Yeah, I've got one person who taking it in the morning gives them energy all day long.

Yeah.

And now people who take it at night, it helps them sleep like a baby.

And the coolest thing, my favorite thing is like I get somebody who's got an autoimmune disease and they're being told that there's nothing we can do other than manage your symptoms. Or they're put on a DMARD, some, some immune modulator or something like that. And, um, I, I work on their gut. I get 'em gluten-free, maybe dairy-free also. I put 'em on LDN and I just watch the anti-TPO antibodies and the rheumatoid factor and anti-CCP. And like, I just watch them going down. It's like my favorite thing. Oh, you're heading towards remission. It's like, it's just pretty profound what it does. All right. So what else on this list? Um, big hitters?

GLP-1s. Yeah. Particularly tirzepatide, particularly microdosing.

Yeah. I've used that. I use those a lot. I haven't used them in long COVID a lot. So, give me some of your long COVID experience with GLP-1s.

Well, okay. So, someone who's had long COVID who's reactive to stuff, like I can't do that. I'm reacting to everything. Like I rash up. My wife is a great example who like gets exposed to stuff. She'll get hives, get tingling in her mouth sometimes. 100% gone with microdose of GLP-1. Um, um, your dysautonomic patients who, who have their nervous system hyperreactive and you're like, this sounds mast cell-ish and they're having dermal response, they're having some dermal things, rashing, and they're super reactive to their environment. That's like the subset that I've found the GLP-1s to work really well with. And how I know they have an inflammatory component is because when I start their microdosing, which is for me, I usually, um, do like 1/5, so it's like 0.5 milligrams, not 2.5 milligrams.

Yeah.

They lose 5 to 10 pounds.

Yeah.

And all of a sudden, that's not the weight loss, that's the anti-inflammatory.

Yeah.

And it's, I've had several of my really super reactive people lose like 10 pounds, 5 to 10 pounds on a microdose. And you're like, okay, that's pretty cool.

Yeah.

And then they're, you know, it's really funny when I first started using these drugs, you know, 20 years ago, it was like all my diabetics and I was giving them super crazy high doses of stuff with, Bieda, then Victoza, and now I'm doing like 80% of what I do now is microdosing.

Yeah.

You know, or when you, where you start off for semaglutide, 0.1, 0.2? Oh, for semaglutide, semaglutide? Well, the, the like FDA starting dose is 0.25.

0.25. So I usually start at like 0.1.

I, I start, I usually do a fifth of that. So instead of the 0.25, I just calculate that dose then just 0.05. Yeah.

Yeah. Even lower.

Yeah. And, and again, you know, I'm almost, now I'm mostly using tirzepatide. I've had less side effects with it.

Yeah.

Same. It's a little stronger. Yeah.

It's a twofer. It's two peptides.

Yeah. And then we got retatrutide, which is in the pipeline. Yeah. And I've only had one or two people use it with really bad outcomes actually. So I'm just waiting to see what happens with that one.

Tirzepatide is probably my go-to.

It is mine as well.

Yeah. Yeah. It works well.

But there'll be ones. Do you have another, like, one you've used with people who are like, oh my gosh, this is like, I wanna start with all like the, the, like you've done one thing and people feel amazing. 'Cause we don't have time to go through everything, but.

Yeah. I, I would say all the mast cell stuff and like, that's not a one thing. Well, that's a stack.

So let's, let's, 'cause that is a stack. So Chromalin.

Yeah.

I've, I've had literally had a particular patient who had POTS and dysautonomia and horrible pain. And, and the oral Cromwellin made it all go away.

Yeah. And it was just like, that's profound. Cromwellin for me, it's like that. And that's, that it's, it's the rare case where you get that. More often than not with Cromwellin, it's like a, eh, I don't notice a difference. But if you get that one magic case where it's like, no, no one's tried that yet and you give it to 'em and everything gets better, that's, that's pretty profound. And I've had a few of those. Um, ketotifen has kind of been that for me.

Yep.

Yep. Because they're like, I try the over-the-counter antihistamines, but I don't like that they have other stuff in them. And then I take 'em for a time and they wear off, and then I take something else and then that works and then that wears off. Um, and I don't wanna suppress my stomach acid with Pepcid because I know that that's bad for my microbiome and my digestion and et cetera, et cetera. I'm like, well, what about ketotifen? And ketotifen, you can get it compounded and it's a combination mast cell stabilizer and antihistamine. So, it's up and downstream. The only main issue is that it's, it's centrally acting, so it can be a little sedating. So I have, I go low and slow with the dose, maybe 0.5, 1 milligram, something like that. And I have them start at night. And if they take it at night and they sleep fine through the night and they're not somnolent the next morning, they're not dragging. And they do fine throughout the day. We just do it at night, but you could also do BID dosing and you could do higher dosing than that, but it's, it's profound. I take it. My wife is on it, my daughter's on it, and it's been a game changer for all 3 of us and our allergies and our mast cell issues. And, um, so I think ketotifen is a really, really profound one that's impacted a lot of my long COVID patients that also had a, uh, a concomitant mast cell presentation picture. Um, what else?

Oh, cyclobenzaprine. Um, I, yeah, cyclobenzaprine now at the 2.8 milligram sublingual dose. Is FDA approved to treat fibromyalgia. Hmm. Interesting.

Interesting.

Yeah. And so cyclobenzaprine, it comes as a 5 and 10 milligram pill and I'll usually take the 5 and break it in half. Yeah. Unfortunately the, the 2.5, 2.8 sublingual is not, it's expensive and insurance doesn't like paying for it.

Yeah.

But it's interesting cuz people think about it as a muscle relaxer, but also as a muscle stabilizer. It also has some cholinergic effects. And it can be really helpful if people are having sleep disturbances. You, you just, if you want to stick it on your tongue, it's nasty, or just swallow it. I've had some, some people do really well with that. Clonidine and guaifenesin, particularly if the person's having a lot of POTS, dysautonomia patient symptoms, particularly waking up in the middle of the night, your heart is racing, symptoms that sound like adrenaline surges in the middle of the night, right? You go, you go horizontal. And all of a sudden, for some reason, epinephrine goes crazy. The clonidine and/or graphesin, I'll play with that depending on which the person, it can be super helpful. If their long COVID is having like the POTS kind of type symptoms, some people just can work really, really, really well. And, um, and if someone's having some pain issues with their long COVID and, um, sleep disturbances. And like this anxiety, like issue, we've tried a lot of things, low, low doses of benzos, you know, which I was trained to avoid. I've had some people do really well with, and I know it's a mast cell issue and literally you're taking your small Xanax or Lorazepam and you quarter it and you take it and you're like, oh my gosh, I feel so good. Like that. I know this is a mast cell thing.

I'm wondering if Have you ever tried L-theanine in those patients? I'm, I'm wondering if L-theanine, which, which is a basic amino acid that I use, it's an adaptogen. Um, it's basically an anxiolytic, doesn't have addictive potential. I would put it in the water if I could. It acts like a low-dose benzo because it works on GABA receptors and it works on actually dopamine receptors as well. I'm wondering if in some of those cases where you're, you're maybe going to reach for that really ultra low-dose benzo that you try some, some L-theanine and see that that is, um, not my first, second, or third weird thing.

It's, but it's a thing that can be really like, oh, kind of like amazing.

Yeah.

If you're coming with sleep disturbances, there's actually a product called 200mg of Zen, which is theanine plus 5-HT and a little bit of GABA. And that I've had, I typically use that in my patients who have like the mind racing, like you're, it's like you're, you know, kind of stuff. They can be really great for that.

Yeah. It's the magnolia and hinoki oil is really great for that too. So yeah, those extracts are great for kind of calming that mind.

That's relora.

Mm-hmm. Mm-hmm.

So, um, other, something else you've used that literally before and after people are like, that worked so well.

Depending on the case, but, and this isn't for all these, all these cases, but in certain situations it's a game changer. Um, antivirals in particular, antiherpetic virals like the, uh, valacyclovir of the world. If I have someone who is really screaming reactivation, EBV reactivation, high CMV titers, high HHV-6. Um, I may start with like lysine. I may sprinkle in some olive leaf extract or monolaurin and go the natural route. And eventually they're like, I'm not really feeling any different. I'm like, all right, well, let's kitchen sink it. We do a course of Valtrex and I don't mean like 7 days. I mean like 30 days or 2 months. And they come back and they're like, my brain fog's gone and my energy's back. I know that that was an intervention that made a difference. And I track the numbers and you can see these titers get better. You still gotta globally work on the system and get the, the T-cell polarization that led to the unleashing of these latent viruses back balanced. But, um, it can really hold space for you in some of these situations. Um, you just gotta be mindful of some of the side effects that go along with chronic use.

What, what dose are you using for the valserine?

Typically a gram once or twice a day.

Of course.

Yeah. Yeah.

Yeah. Some of those people when they come back, I'll do like a gram 3 times a day.

Yeah.

And you have like one, two, three.

Hit 'em hard and then deescalate.

Yeah.

Yeah. Do the same. Yeah.

So, um, Anything else? We have a list of a lot of things, but things that you have used in your clinic that you— people have been like, wow, I did this one thing and I felt like— I don't want to say that that was the one thing. Yeah, but I want to give people a list of things that we've done that have been like literally pretty cool.

Yeah, those are the big ones. Um, I think like from a, from a supplement standpoint with some of the respiratory issues, um, in particular, I, I air hunger, um, I've had the workup, my D-dimer is like marginal. If someone did some, did a PECT or DVT studies and they're negative, and I've seen a pulmonologist and my pulmonary function tests are normal and the cardiologist signed off, why can't I breathe? You know, at that point in time, especially if their fibrinogen is, is elevated, I give 'em some nattokinase, I give 'em some NAC, the combination of those, maybe bromelain, maybe quercetin, and all of a sudden their breathing is better. I think that's pretty profound. And those are all supplements. I mean, natto literally comes from fermented soybeans and, and ultimately NAC to me is like something that everybody should just be taking on a daily basis. Just does everything good for the body. This is newer in our practice and you alluded to this. I think we should dive a little bit deeper, but, but some of the phospholipid work, I mean, why don't you touch in on some of that, some of the, the IDPC. I mean, you've had patients that I think that one patient that couldn't breathe, couldn't breathe, seeing everybody and all of a sudden you do a couple IVPC infusions and she's breathing better, like that, that probably was not a coincidence.

Yeah. So, you know, what's the one ring that rules them all, right?

Yeah.

Everybody wants the one, the one party trick that does everything right. And stepping back, it's like we say mitochondria, we say gut, we say vitamin D, whatever. And really, you know, the cell membrane, the cell wall, like everything we, like everything is stuck in a phospholipid bilayer.

Yeah. Cell and mitochondrial membranes, right?

100%. Yeah. A lot of the things we do for, you know, making more bile, you know, omega-3s, omega-6s, phospholipids, butyrate, TUDCA, ursodial. They were using ursodial early on in China to treat long COVID. What is ursodial? It's a prescription version of TUDCA, torsodeoxycholic acid. It's ursodial.

Yeah. It's the secondary bile acid.

TUDCA, not TUDCA, right?

Yeah.

And strangely enough, they're using it and using it now in liver patients with primary biliary cirrhosis, post-transplant patients to bring the liver enzyme levels down. There's now research on it with our NASH. I'm sorry, NASH, long recess. Yeah, MAFLD, metabolic, oh my gosh. You know, metabolic associated fatty liver disease, right? To help bring down liver enzymes. I've actually had patients using the combination of Tucker and/or Ursodiol with butyrate and PC have mid to high range, their FF scores on their— there's a special ultrasound you can get that shows the stretchiness. Yeah. Elastography. Yeah. Yeah. Have that normalize over a year. You know, one of my patients actually went up to the NIH and she was trying to get a study up there and she failed because her numbers actually started getting better because she was working with me. So they didn't let her get in the study.

Yeah. Awesome.

Yeah, I know. So, and even GLP-1s in those patients. I reversed fatty liver in 2 patients with it, with trisheptide. Yeah. And so, we're kind of coming back to cell membrane stuff. And so, you know, how many of your patients do you start on oral phospholipids and the brain fog gets better?

Yeah.

It happens, you know. So, in lipid medicine, you know, we say phosphatidylcholine, sure, check. We'll mention we give liposurfactants to balance omega-3s, omega-6s. And the doses are a tablespoon to 2 tablespoons once to twice a day. So, these are elevated doses. Yeah. And people, you know, it's an oil change, oil change, and you can't do it with like a capsule or 2 capsules. You gotta get the, you need the scoops.

You gotta commit. If you're gonna do it orally, it's, it's a commitment. And then IV is a commitment too, financially and logistically. But that's, that's the bang for buck. I mean, that's where you're gonna see the most headway. And again, you know, as he was mentioning, all of our cell membranes, that's where all the action's at, right? It's where, it's where the cell itself is regulating. It's where the cell is communicating. It's where the cell is defending. It's where the cell is doing all the things that are necessary for it to be a cell. Function. The mitochondrial membrane's on the inside of the cell, but serves the same purpose, maybe even more important. And it's a lipid bilayer, so it's two layers and it's supposed to be that way and it's supposed to be very fluid and they're supposed to be able to kind of move across and around each other. And over time, as they get dysfunctional and toxic, these lipid rafts that he had mentioned previously form, um, and, and cause that lipid membrane to be less fluid. And now it's stuck and now it doesn't work as well. And now the cell doesn't work as well. And now the mitochondria don't work as well and you don't work as well. And so it's like in your car over time, the oil gets rancid and turbid and you have to go to the mechanic and get your oil changed. This is you getting an oil change. So it's cholesterol in the cell membrane, it's omega-3s in the cell membrane, it's omega-6s, and it's these phospholipids, which are the unsung hero that no one talks about. And so you get your 3s, you get your 6s, they have to be quality 6s, and there has to be balance and there has to be a proper ratio. And cholesterol that's been demonized and suppressed by statin use. You know, all these things that are going wrong already. Again, phospholipids. It's PC, which is phosphatidylcholine, and then it's phosphatidyl inositol, phosphatidylethanolamine. It's multiple phospholipids. And as you're putting them back into the system, you're changing out the bad fats, you're putting in the good ones. These, these lipid rafts or very long chain fatty acids get burned out by the TCA and the butyrate. You're detoxing, you're getting it out and things just work better. People just feel better. You can use it for renal vascular disease. You can use it for central nervous system issues. I do it in my SIRS patients. I'm doing it in a cardiac patient. I'm doing it in a renal patient. I'm doing it in a Parkinson's patient. And these are things that I think are potentially game changers. And if you do the oral route, it's a commitment, but it should be, should be done in just about every SIRS patient, in my opinion. It should be part of the Shoemaker protocol as far as I'm concerned.

Well, it's a part of Dr. Haman.

It's part of the Haman protocol.

Yes, it is.

Yeah.

So we've been doing it for a while. Yeah. But one of the things of interesting, if you do IV phosphatidylcholine, the IV form actually is a slight blood thinner. So people, if they have any, I've noticed more my older people, like 70-ish, they'll be like, I'm thinking better, I have more energy, I'm sleeping better. 'Cause you're getting an immediate blood thinning effect. Yeah.

Fusing better.

Yeah. Fusing better. And then when you're doing IV, that's the way you actually get, when people have endothelial dysfunction and they start getting thickening of their, their the, the cell, the vascular wall, the tunica media. I'm trying not to use simple words here. Yeah. That you actually start pulling that out. It's like, it's like soap pulling this stuff out.

Yeah.

And oh, by the way, oh, by the way, it's stabilizing cell membranes and walls. So the mast cell stuff gets a little better.

Yeah.

Oh, by the way, these lipid raft things are becoming unlipid rafted. And which part of that is how infections will bypass your immune system and jump from cell to cell to cell. Which is why some people will get chronic Lyme and Epstein-Barr and we can't get 'em away 'cause their cell membranes are so wrecked.

Yeah.

Now if you're rehabilitating those cell membranes, now maybe your antivirals will work. Maybe now you won't need them because the immune system can work more appropriately. So they can be really helpful. Yeah. And oh, by the way, some of the stuff with the, you know, you talk about viral particles and vaccine particles and, you know, toxins, you know, what is the soap for that stuff to get it out? IVPC.

Yeah.

So all of a sudden, like if this person has issues not getting better, now IVPC's tricky. There's only like one, maybe two places in the world you can source it from. You gotta do it a certain way. You gotta, you know, wrap the bag in aluminum foil. You cannot put it in normal saline, which I've had patients go other places and do that, which I'm like, oh my gosh, that's how you like clot people off.

Yeah. It's gotta be a slow infusion.

It's gotta be slow.

It's gotta be monitored.

It's gotta be D5. So it's something that's—

And stack it with other things.

Yeah. Usually B12, glutathione.

The Kevoran.

Yeah. And if you're getting really fancy, you might even use a little phenylbutyrate, serine phenylbutyrate in the front end of everything. But the point is like this can be super helpful. And I've, you know, my daughter Anna did just about 30 of them. And for her, it, you know, she, you know, people know my story. I won't go in detail with that, but a lot of issues with her, but she improved fine motor function. Now she's actually, when she draws, she actually, she colors within all the lines now. And she, as of 2 months ago, she was able to see stars. She was like, hey dad, I'm seeing stars. I'm like, what do you—

Hit your head?

Did we do it?

No.

She's like, have you never seen this before? She's like, no, I just, I can see them now.

Looking up at the sky.

Yeah.

Oh, that's awesome.

I'm like, and she's just sitting there going like, that is so cool.

That's profound.

But the point is that it's a really cool thing. Requires work with a practitioner.

Yeah. Yeah.

But it can be for a sick patient who's like stuck and nothing else is working. Can be super helpful.

Yeah. I think that's a big bang for buck, but that is clearly an investment. We do do that here, by the way, which is kind of cool.

Yeah. So other things in the list that for a long time we didn't mention, you know, on that style of list are ivermectin. That's something that we've had some pretty profound responses clinically to that is, that's, I guess it's still verboten.

I guess it's still, it's kind of, it's still, I don't even know if people still get their This, some insurance, their feathers ruffled.

Some insurances don't pay for it.

Some do. Yeah. I just compound it.

Yeah.

It's, I wind up compounding it because if I do get it covered by their insurance, they're only going to get an antiparasitic dose for 3 days and be done, or for 1 day and be done. So if you're treating it for long COVID, it's different. And most patients are just like, yeah, I'll pay out of pocket. I don't care.

There's a lot you can probably get from Canada for a little cheaper.

Yeah. And the other thing, peptides, you know, like again, like again, this is taboo, but no, um, prior to the FDA outlawing certain peptides, which they're now revisiting and hopefully going to release back into the wild, as of April 15th, they released the list that they're considering and they will go slow. It will probably only be 1 or 2 peptides per year. But that being said, and we're not claiming that any of these things cure anything or do anything other than what we've seen anecdotally, but like thymosin alpha-1 and TB4, these thymic peptides that are phenomenal for immune balancing and cell repair. Um, MOTC for mitochondrial boosting. Um, some of the, um, growth hormone analogs that can help. I mean, like there's just things that you can use, um, that are pretty beneficial and weren't available and are going to hopefully be available again. Um, things for sleep like DSIP or for pineal gland resetting with epitalon, or, you know, there's just antivirals and you've missed one very important one. SS37, which is it?

Which one? That's BPC-157. Oh, BPC. I know, it's like, it's so obvious.

It's just so obvious. But it's just everywhere now.

Like you can get it on the supplement sites, like orally it's fantastic.

I'm like, the injectable one is still outlawed. Um, you can even do nasal for, for brain support. BPC's phenomenal. Yeah. Like that one to me, like isn't verboten, like that's just kind of ubiquitous now and everyone's already on it.

So, yeah. And then some of the things that, we, people will see out there.

Yeah.

Rapamycin. Yeah. IVIG.

Yeah.

Maraviroc. I'm not gonna talk a lot about that. That's an HIV antiviral.

Yeah. I've not used that.

I've used a few cases. It was not, it was not amazing. Truvada, which is a, is a, another HIV antiviral. Again, these are things that people will see out there, but I just, you know, in my clinical practice, they've not been like amazing. The modafinil, it's interesting 'cause I've used that for years in my narcolepsy patients, in my shift sleep-wake disorder patients. And it's being used basically for fatigue. I haven't used it a lot with my long-term patients 'cause I've been able to get help with the fatigue with other things. But it's one of those, it's, but it's difficult. So the modafinil is an easy way to treat people's fatigue and daytime somnolence that a lot of specialists are using. But I feel like we have other options, but something people see out there. IVIG, it's listed. I have had, it's near impossible to get insurance to pay for that. It's like, I'm not sure what to say else besides it's near impossible to get insurance to pay for, and it's $10,000 to $15,000 a month. So. Unless you're independently wealthy, it's, it's not going to be, um, the only patients that I've ever had get it covered were ITP patients whose platelets plummeted.

And, um, and then I know it's used in the PANDAS world sometimes when they fail outpatient therapies, but yeah, it's, it's hard to get done. Um, what about Paxlovid? Are you, did you use that at all? I mean, maybe in the acute setting, did you use it for long COVID at all? Like an extended course? Have you seen any good results with that?

Paxlovid, I've seen people acutely respond well to it. The problem is it's only 5 days and how many people have all their viral stuff gone in 5 days?

Yeah, they don't.

So they flare at day 6 or 7 and you have to do another pack and then the insurance doesn't pay for it. Yeah. I just tend to go to ivermectin. Um, it's, it's not really available to do for long COVID because of insurance coverage. Um, and we have so many other options that work well that don't have— the Paxlovid is an older HIV drug that got repurposed. It's really funny how pharmaceutical companies can repurpose drugs, but you know, we can't, we can't, or we get, we get yelled at for it when it's common practice with them, but it has a significant amount of toxicity. So it's something I wouldn't be comfortable giving to people for months. Yeah. But you know, ivermectin's had over 3 billion doses used worldwide.

Yeah. It's dirt cheap. Dirt cheap.

It's safe. It's safe. We have Deca-Dex.

Worst case scenario, they get better and you diagnose parasites that you didn't know they had.

Well, you, okay. I had one patient. I know, I know this case.

I'm trying to provoke this story.

Okay. So one of my patients who I've worked with for years, she's awesome. She's super smart and researches a lot of her own stuff. But she got COVID and it was acute COVID and she was having respiratory issues. I'm like, okay, yeah, I'm gonna use ivermectin because I'm the cool, you know, integrative guy.

Cutting edge.

Cutting edge guy. Gave it to her and she started coughing up worms.

Worms. Yeah.

They started coming out of her nose and her shortness of breath got horrible. Horrible. And then this little, you probably remember this from medical school, Loeffler's syndrome. It's this thing where you have parasitic infection in your lung and you give people anti-parasitic. If you don't stop it, they die because it's almost like, um, the whole syphilis back in the day. You give them penicillin, they kill too much, they Herx, and you could literally kill someone, um, because there's a massive systemic inflammatory thing. Um, you know, things you learn about medical school you've never seen in real life. Yeah. And so I'm seeing this and I'm like, all right, thank God I remembered that weird factoid in my head. And I'm like, stop it. And she stopped and we started doing like a day, every other day, every— and so it took about 3 months before she stopped shedding.

Yeah.

But it was—

it just got better. And no one would've diagnosed that.

It was so, it was super cool, but super like, wow, this stuff still happens. Yeah. Yeah. Well, also learned from her. That in, um, Virginia, parasites are endemic in southwestern Virginia, just like they are in sub-Saharan Africa. So we act like parasites aren't here.

Yeah, but they are.

And this is common knowledge in the animal science world, the animal husbandry world, in the environmental, environmental medicine world. Oh yeah, you know, Appalachia, southwestern Virginia, parasites. And then you talk to vets and they're like, oh, if you have an animal, if you, you'll love this one. You have, you have pets, don't you? Oh, okay. We have pets. If you have a dog, if you have a dog, cat in your house, you are being exposed to parasites. And you're like, well, how many of our patients have dogs or cats in their house? Yeah, most of them. Yeah. I'm like, oh man. So all of a sudden, and it's really interesting. We're going to have this, I won't say a name now, but a practitioner on our podcast, hopefully later on who specializes in parasite stuff. The practice is up in New England. So it's coming soon for you all listening right now, but And her practice, what she's found out with her, her long COVID, Lyme, mold patients that get stuck in her population up there, that a majority of them have undiagnosed parasitic infections. And when she addresses them, all of a sudden now their immune system responds differently and start getting better.

Yeah.

So sometimes in some patients, depending on where they live and what they do, and I'll do these little trials of like albendazole, ivermectin, mebendazole, praziquantel, and sometimes you'll see some pretty responses. And that's more like layer 7 and 8, not layer 1, 2, and 3.

Yeah, but it makes sense because if you have a, if you have a parasitic infection, you're driving a Th2-mediated response, which is potentiating polarization of your immune system at the expense of Th1, yin and yang. Now you get reactivation of EBV. Now you get reactivation of another virus. Maybe you are activating a Th17 response, which when dysregulated leads to autoimmunity. So it's all about what's causing that shift. Is this person polarized and what can we do about it to get it right? Um, and sometimes you pick this stuff up, like I do a lot of stool testing. I don't see a lot of parasites, but sometimes I see a subtle eosinophilia and it's just getting worse and worse and worse. And it's like, okay, maybe we need to do parasite. Maybe we need parasite cleanse.

Are you doing that one? I'm doing this one test right now. I don't want to say it on here because we have actually a lot, a lot of followers and I don't want to overwhelm them., but that they, it's out west where they actually, the guy looks through it by hand. Like all of those have come back positive for parasites on my patients. Oh, like everybody's come back positive. That's, I did it on myself. Every patient I've sent it, they, they all come back positive. Interesting. It's literally, and what I didn't realize is, um, when we send our stuff off, they put it in formalin, right? Which will dissolve chitin. What's chitin? It's the, it's what's in shrimp shells. Yeah. It's also in the, the shells of many parasites. And then before they put it on the slides, they blend in the blender to even out so you can put it on a slide. I don't see any parasites. There's nothing there. Like, you just dissolved chitin with the formaldehyde stuff and you blended it. I'm like, and so he, he literally, um, just takes slides by hand, does it out by hand and does like a bunch of slides and looks at them. So he doesn't do any of that stuff. And they've all come back positive. Mine came back I was still, I shouldn't say it out loud, should I? But yeah, I've treated myself. I'm okay now. But yeah, but the point is like, it's like, yeah, so it's parasites are more common.

That's interesting.

Yeah.

Yeah. Let's talk about that more off air.

Yeah. Off air. Yeah. It's sometimes we have to, people ask me questions and I have to be careful cuz you know, we get a lot of listeners have a lot of, you know, and it's just, you know, we try to take care of our patients and you don't wanna say something and all of a sudden your, your mold inspector is booked out a year.

Yeah.

Because you know, everybody, called them up to kind of things.

Yeah. Protect our resources.

It's, you know, our goal, you know, we wanna educate people with our primary thing that drives us is we, we take care of people. We wanna help people that are hurting.

Yeah.

And you want, and you know, and we got our primary focus is the people that we take care of that we see daily, you know?

Yeah.

Um, having said that, um, and never quit and never close up shop. Never quit. Yeah. I mean, you know, well, how many days was our practice closed during COVID None. Zero. Zero.

Yeah.

We're open every day. We're in the office every day.

I remember when we both got COVID, we came in and we gave each other IV vitamin C for 2 days in a row and it was back to work, man. Yeah.

It's, it's, you know, I think I'd go back to work. I was off for like 2 weeks. Cause I got, I got, I was, I got pretty bad.

Oh, that's right. I shook it off in 48 hours.

You're tough, Miles. Like it got me bad. So other things, you know, you know, low doses of mepresol, which is an antipsychotic, other antivirals, you know, beta blockers for a lot of the POTS symptoms.

Yeah.

Propranolol. There's a whole list, you know, I don't want to go through a whole list of things, but the point is that hopefully this— we gave our personal clinical list of our top guns. There's probably 40, 50 more things that people could try one-offs. But the point is is to give people resources, to give them information, to give them hope. Yeah. And other things they can do. Ooh, hyperbaric. We forgot HBOT. I mean, that can be really, really— if you have decreased blood flow to your brain, your heart, particularly on the front end, that can be super helpful for individuals as well. We didn't mention HBOT, so.

Yeah.

Cool. Forgot that one.

So hyperbaric's great. I think it's one of these modalities that kind of gets lost in the shuffle. But, um, that definitely needs to be in the deck.

Yeah. Didn't actually, I actually didn't even write that one down. So good thing we're sitting here thinking, but yeah. Any parting thoughts for our listeners about this topic?

I just think the key is to realize that a lot of this stuff is complex and it will continue to be, and then there'll be the new next complex thing. Just know that as integrative and functional medicine practitioners, inherently we're curious. Inherently, we want to learn. Inherently, we want to drive and move forward with the care and concern, um, to help patients that are, that are suffering, to help patients that are stuck in this complex web and, and feel like there's not somebody out there that can care for them. And so the goal is for us to see one patient at a time and practice the medicine that we practice. But also provide this information so that if you can't come see us or a practitioner in your area, that's like us, then at least you have some starting point. You know, there's, there's just no worse feeling than feeling stuck or hopeless in my opinion. Like to me, like I'm borderline claustrophobic and feeling boxed in is not a good feeling. And, and feeling, I get it. I get what it might feel like. I remember what it felt like before I discovered functional medicine and I felt boxed in. It's almost like feeling claustrophobic every day, even though you're not in a tight space. So I just want people to, to keep that in mind and learn what they can and be an advocate and do their own research. And, but then find help, find somebody who can guide you. Right. And do the things that are necessary. You gotta do the work. It's not going to be easy. Like health is not easy to get or maintain. If you're willing to do the work, you can.

Yeah. I mean, I tell people never give up. Your body was made to self-heal and self-repair. If you can just find what's blocking that process and give your body what's lacking, it'll do what it's made to do. Yeah. When you're 12, it's going to do a lot better when you're 70.

Yeah.

But the hope is, you know, people, there are answers out there. People should never, ever, ever accept status quo and never give up. And if you're, you don't have access, you live in the middle of who knows where. You know, one of the reasons we do these podcasts, one of the reasons we have over 400 blogs on the website. One of the reasons why we have a book reading list of over 80 books on the website that I've had to like cruise over about 500 books to narrow down to is to give people like literally, here's your buffet. You know, if you're a self-driven, self-motivated person, we basically have every outlet there people could potentially use because we want to see people get better. And it's driven primarily by You know, first we start, we both started as practitioners and then for me, my, I adopted my daughter and then my wife got sick and then it, my family changed my direction. For you, you got sick. Yeah. And you got better and you're like, crud, I've got family and you fixed your family and now you're like, yeah, we, we, that's our primary driver is that, and that's what keeps us going, you know? Yeah.

Is, um, no going back, man.

Can't go back, man. It's like Dora, it's like with, um, um, Alice in Wonderland. Once you see the world's You go from black and white to color.

Yeah.

You just can't go back. No, you can't go back.

I always talk about Oz, like, you know, Oz pulled me behind the curtain. This is how it really works.

Yeah.

Sure.

In your life.

Yeah. I'm not going back. And, and I'm, I'm, I think that this is one of these things that you and I both realized we were meant to do, and I just want more people to have access to it. So that's why we do these things.

Yeah. And we have a lot of practitioners who listen to our podcast. And actually reach out to us and say, hey, if you're looking for someone to come join you, send me a, send me an email. So we, it's really interesting how impactful this has been for patients and practitioners and just educating people that, and that's what we want to do. That's, we want to change that.

So, yeah. Awesome. I'm excited to, I'm excited to see what people write about what they want to hear, you know, about what they want us to talk about next.

I'm excited to see Well, actually we, um, one of the things that I'm gonna be talking about, um, on the, the dual-tenant things we're gonna fire is actually, um, traumatic brain injuries. Someone actually reached out saying, hey, could, can I mention it here and there? We talked about it, but never actually done anything dedicated. 'Cause that's a, that's a small snippet that I feel like I've gotten pretty good at.

Yeah.

Awesome. That how often do people get concussions?

Yeah.

All the time. Yeah. You played soccer.

Yeah.

How many times did you get concussions?

Yeah. A lot. Diagnosed?

Well, zero. Well, there's a reason why.

Anecdotally, many.

Well, there's a reason why they said kids couldn't head the ball anymore if they're less than 12.

Yeah.

Because all these kids are getting microconcussions.

Yeah, my son is 10 and he just made travel. They still can't head the ball.

Yeah. But I thought it was 12 in Virginia or something like that.

Yeah, he can't head until he's 12.

Yeah. Now some people complain that they can't compete against Europeans and South Americans because they're heading away.

No, we do headers at home. He just doesn't do it at practice. I got European roots, man. He's got a hard Polish head. We don't have to worry about it.

Like his carpet, his skull's extra thick.

Yeah, we have extra thick skulls.

But that's one of the things that we're hopefully I'll be doing here when I get spare time, you know. But if people would please let us know if there's things you'd like us to talk about in longer form.

Or just tell us your story. Like, I just, yeah, just want to hear what you all think and what you guys are going through and what you want us to talk about. We're happy to do so.

Yeah. Cool. Excellent. Well, y'all take care and we'll talk to you soon.

Talk to you soon.