TLC Sessions - Living with Long Covid

Dr Nancy Klimas, Director of the Institute for Neuro-Immune Medicine, Nova Southeastern University, is an immunologist internationally renowned for her work in multi-symptom illnesses.  In this week’s episode she explains her work, from HIV through ME/CFS and Gulf War Syndrome, that has led to her having insight and an amazing team to channel efforts into Long Covid research and treatment.  In an insightful overview she describes her work in understanding the mechanisms (viral persistence, viral reactivation), impacts of (MCAS, cell dysfunction, T-cell dysregulation) and potential alleviation of the disease.  She has been involved in studies looking at clinical therapeutics such as LDN and has seen remarkable results with the use of MABs which she is hoping to replicate in a larger clinical trial in the coming weeks.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Dr Rob Wüst, Assistant Professor in the Faculty of Movement and Behaviour Sciences, is an expert cardiac and skeletal muscle metabolism and mitochondrial function.  He and the team at Vrije Universiteit, Amsterdam, published the “PEM study” in Nature Communications, which investigated the muscular changes in Long Covid patients who experience post-exertional malaise (PEM), or “the worsening of fatigue- and pain-related symptoms after acute mental or physical exercise”. In this week’s episode Wüst talks us through the key findings of their study, including the muscular changes, mitochondrial dysfunction and microclots that were present in the Long Covid patients compared to their control group.  He discusses the effects of bedrest on the human body and how exercise is usually beneficial for overall health, but highlights what was revealed through blood tests and muscle biopsies in their study – that Long Covid patients have limited exercise capacity with lower mitochondrial function and our rehabilitation needs to be handled with this unique understanding.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Dr Thomas Chelimsky, Professor of Neurology and Director of VCU’s autonomic laboratory, is a specialist in autonomic dysfunction and a vocal advocate for considering the mind and body as one cohesive system.  He, along with his team at the VCU clinic, take a unique brain-body approach to treating Long Covid patients, with success.In this week’s episode he discusses the autonomic issues faced by Long Covid patients including migraine, which he believes is prevalent in c. 50% of patients, and POTS which he discusses ‘almost never shows up alone’, linking  it with the migraine, fibromyalgia and IBS (irritable bowel syndrome).  He explains the roles of the periaqueductal gray region of the brain and the vagus nerve, alongside the implications of trauma (both physical and mental) on the autonomic system, and the role that it plays in Long Covid. Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Dr Andrew Klein, an anaesthetist at the Royal Papworth Hospital Cambridge, runs the Cambridge Iron Clinic where he treats people with Iron and B12 deficiencies.  Since the start of Covid he has seen an increase in people with these deficiencies, many of whom have been diagnosed with Long Covid.In this episode Dr Klein talks us through the overlapping symptom sets that render people debilitated with all three conditions.  He describes the various ways in which are body is not able to uptake and store sufficient B12 and iron, the consequences of this, and the way in which they can be simply treated.  And we discuss the data ranges used by the NHS to determine conditions and allocate treatment and once again draw the conclusion that correct care should only be determined by listening to the patient.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Physiatrist Benjamin Abramoff, M.D. is the Director and Co-founder of the Post Covid Assessment and Recovery Clinic at the University of Pennsylvania, Philadelphia. An Assistant Professor in Physical Medicine and Rehabilition, Abramoff used his expertise to co-author the study, published in Cell, that found that serotonin depletion is prevalent in Long Covid patients.  In this week’s episode, Abramoff talks us through the findings of their study, the hypothesis of what drives the depletion, the impacts that this has on the body, and preliminary ideas of what might help, both symptomatically and to address the root cause of the disease that seems to be viral persistance.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Tim Henrich is a Professor of Medicine and expert in infectious diseases, focused on chronic viral infections at the University of California, San Francisco. He is another member of the titan Long Covid research team who have tracked patients since the beginning of the pandemic (LIINC study) and are making roads into understanding the mechanism of the disease and potentials for treating it.In this week’s episode he talks us through some of the exciting work that he is doing, alongside our previous guests Steven Deeks & Michael Peluso.  Using a combination of longitudinal studies, biopsies and high resolution PET / CT imaging, the team have established changes to t cells throughout the bodies of Long Covid patients, and found evidence of viral persistence.  They are currently conducting multiple clinical trials including monoclonal antibodies to act on viral reservoirs, and the anti-viral Ensitrelvir which has undergone several trials in active SARS-COV2 previously, and believe that they are getting to grips with the pathophysiology of the disease.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

A supplement to Episode 68 - Consultant Neurologist Steven Allder of Re:Cognition Health explains what tinnitus is and why we are experiencing it in Long Covid.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

A supplement to Episode 68 - Consultant Neurologist Steven Allder of Re:Cognition Health discusses the way that injury to the brain causes anxiety and depression in Traumatic Brain Injury and could explain some of the mental health impact of Long Covid.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Consultant Neurologist Steven Allder of Re:Cognition Health has applied his wealth of experience investigating Traumatic Brain Injury (TBI) and Functional Neurological Disorder (FND) to understanding the impact of Long Covid on the brain. In this week’s conversation we discuss inflammation of the brain of Long Covid patients which is visible using PET imaging;  Allder believes this inflammation could be driving the neurological symptoms, and beyond, in a similar way to the impact of a blow to the head observing numerous similarities to TBI; we discuss polyvagal nerve theory; and Allder explains the way in which it takes more than just cold, hard evidence to persuade the scientific community.And following up on our previous episode, Dr Allder is working with Prof. Andrew Shaw at Attomarker, believing that Long Covid may be driven by viral persistence and that establishing a patient’s antibody gap, using the Attomarker testing, could enable us to remove viral residue with tailored antibody treatment.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Professor Andrew Shaw, University of Exeter, believes that he has devised a diagnostic test for Long Covid.  His company, Attomarker, have developed a test which can reveal a gap in a patient’s antibody spectrum – their response to acute SARS-COV2 from a finger prick of blood. This gap, he says, has lead to a viral residue that causes the chronic symptoms of Long Covid.  Their hypothesis is that the gap can then be filled, either with monoclonal antibodies, or with an appropriate vaccine, to rid the patient of the disease.In this week’s episode we explore the theories of antibody response to the strains of Covid, the effects of the vaccine, the results that the Attomarker test and treatment which is being offered by Re:Cognition Health have so far yielded. Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Imperial College Professor of Immunology, Danny Altmann  recently published “The immunology of long COVID”, a fantastically comprehensive overview in Nature Reviews Immunology.  In this week’s episode Altmann, to whom we first spoke in the summer of 2021, talks us through some of the highlights of the work he's reviewed - serotonin depletion, gut biopsy findings, anti-virals, monoclonal antibodies and T cell depletion, along with his impression of a wide range of issues facing Long Covid sufferers, doctors and researchers – the state of patient care, vaccines, and the lack of funding for large scale studies and trials.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Dr. Amy Proal is the President and Research Director of PolyBio Research Foundation, a non-profit organisation that brings together some of the brightest scientific minds to research how infection-associated chronic conditions are studied, diagnosed and treated.  Their work into Long Covid is bringing together some of the leaders in the field to accelerate studies and clinical trials to further develop understanding and treatment strategies for the condition.  In this week’s episode we talk to Dr. Proal about the current most prominent mechanistic theory of viral persistence in tissues, PolyBio’s research into anti-viral therapeutics, and SARS-COV2 strategies that could help us to prevent Long Covid, rather than having to constantly clear up the increasing residue for years to come.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Michael Peluso M.D., an HIV and infectious disease specialist at UCSF, has been studying Long Covid patients since April 2020 (LIINC Study).  This, along with his history of working with HIV and other viruses, has given him the knowledge and methods to make some break-throughs into Long Covid pathogenesis, effects and, potentially, treatments.  He, along with his team, has established that Long Covid causes T-cell and immune dysregulation and he has used multimodal molecular imaging to reveal that viral RNA reservoirs are persistent in Long Covid patients.  With the aim of clearing this viral debris, Peluso is now leading a clinical trial using a monoclonal antibody infusion.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Eric Topol must be one of the leading voices in Long Covid advocacy.  Cardiologist, scientist, author, editor-in-chief of Medscape, and founder of the Scripps Research Translational Institute, Topol has written about Long Covid in publications from The Lancet and Nature, to The Washington Post.  As a clinician a large proportion of his patients are now Long Covid sufferers and he spends a huge amount of his time pushing for advancements in Long Covid treatment and prevention.  In this week’s episode Dr. Topol guides us through his frustrations surrounding the lack of urgency with which the world is treating this condition, the use of Metformin as a preventative therapy, his understandings of the mechanisms of Long Covid, and how we could make significant advancements by embracing digital data collection and technology. The Long Covid review which he authored with PLRC and Julia More Vogel, published in March this year, is now the third most downloaded medical paper of 2023.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Harlan Krumholtz, cardiologist and Professor of Medicine at Yale University, is attempting to move the needle when it comes to patient-centric care in Long Covid and beyond.  Working closely with immunologist Akiko Iwasaki, Krumholz not only looks at the heart when it comes to his research into Long Covid. Together this Long Covid power couple are trying to design studies and trials considering the patient first and foremost. In this week’s episode we discuss his latest studies: the LISTEN study, a 15-day trial into Paxlovid for treating Long Covid, and his paper, currently in preprint, looking into internal tremors and vibrations in Long Covid. With a broad understanding of the disease and its effects on patients, his knowledge of the illness goes far beyond the heart, whilst, once again, displaying this humility and humanity we are seeing amongst some of the most prominent medical professionals who are carrying the torch for Long Covid patients. Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Credited as being the founder of functional medicine, Dr Leo Galland has spent the past 40 years trying to create a patient-centred version of healthcare. Using pharmaceuticals, supplements, lifestyle and complimentary therapies he has drawn on his vast knowledge of patients and holistic healing, to create a comprehensive protocol for Long Covid patients.  Designed to remove any active virus, rebuild our natural stores and repair the misfiring of our cells, Dr Galland’s method has been effective in helping people to recover from disease. In this episode we discuss his wide ranging knowledge, including diving into ACE2 which he believes drives the disease, discussing the complexities of Mast Cell Activation Syndrome, and getting his impartial opinion on some of the supplements or treatment strategies we’ve previously featured.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Researcher Vicky van der Togt and virologist Dr Jeremy Rossman have spent the past 2.5 years trying to help Long Covid patients and research via their organisation Research-Aid Networks.   Their latest paper, published in Frontiers, hypothesises that it is an acid-base disruption that drives the symptomatology of Long Covid.  In this week's episode we discuss the impacts of dysregulated pH, how you can rebalance it and the results that they have observed.  Further research in this field has the potential to help with both Long Covid and a wide range of other diseases.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Dr Wes Ely, a pulmonary and critical care doctor, has built a remarkable resource for Long Covid sufferers within the Critical Illness, Brain Dysfunction and Survivorship Center at Vanderbilt University Medical Center in Nashville, Tennessee, of which he is co-director.  A professor, using his knowledge of his clinical knowledge and his extensive research into debilitating brain disease, he has developed care strategies and support for large numbers of Long Covid patients and helped many more with his writing on social and in the mainstream media, trying to raise awareness, understanding and compassion for sufferers.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Molecular Virologist, Bhupesh Prusty, promised to reveal more when we last spoke, four weeks ago.  Here he presents what he believes to be a biomarker for Long Covid, explaining the mechanism, its similarity to ME/CFS, what his research and findings have proven, and how we might take this research forward to develop further understanding and treatment strategies.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

Lavanya Visvabharathy, a T cell immunologist at Northwestern University, Chicago, has led extensive studies into Long Covid, but we learned that some of those studies, despite their merit and rigour, were proving hard to publish in top tier medical journals.  In this week's episode we lift the lid on the process of scientific publishing, talking through the challenges that Visvabharathy has faced trying to publish Long Covid research, the peer review process and the political landscape of the scientific research world.  Her latest paper, despite almost a two year delay, is published this week in Frontiers in Immunology.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions