Long COVID and the Brain

Most people who get COVID, especially if they are vaccinated, will recover without residual symptoms. But for some people, COVID infection can result in long-term health issues. So-called “long COVID” sufferers can experience many symptoms including crushing fatigue, dizziness upon standing up or standing too long, exercise intolerance, anxiety, headaches, heart palpitations, shortness of breath, brain fog, and more. Similar post-viral syndromes can result from other viruses too, and a very similar phenomenon can happen after concussions. The common thread is that when the brain suffers a blow, either literally or via the inflammation associated with a virus, the nervous system that runs almost every process in the body can be knocked off its axis. Across Canada, researchers and physicians are scrambling to try to understand how to help this new wave of people afflicted with a condition that is untestable and for which there are no simple drug solutions. Patients often feel frustrated and isolated. A greater understanding of what’s going on can help us target solutions for symptoms and speed the healing of the brain and nervous system. 

A patient I’ll call Emily had previously been in good health, so when she contracted COVID as an unvaccinated person ten months ago, she thought she would recover well. She did get over the acute symptoms of cough and congestion but was left with a mysterious assortment of symptoms that derailed her life. She has profound fatigue, dizziness when she stands up or stands for more than ten minutes in one place, and daily headaches; in addition, her mental processing and memory are impaired. When she tries to exercise, she crashes and is exhausted for two days. She has nausea and IBS. Her fingers go white when she gets cold, and her skin can be blotchy. Her periods are irregular for the first time. Anxiety seems to hit randomly, day or night, and depression is creeping in. 

Emily’s symptoms indicate that the nerves in her brain have been damaged. The brain governs the autonomic nervous system, which runs all the automatic processes in the body such as blood pressure, heart rate, circulation, balance, energy production, hormones, adrenalin release, sleep cycles, digestion, and more. When this critical system isn’t working right, we refer to this disorder as dysautonomia.  As a naturopathic physician, I treat people with complex, chronic conditions every day, so I have seen similar symptoms before triggered by both viruses and concussions. 

There are strategies to manage symptoms, such as wearing compression stockings to prevent blood from pooling in the legs while standing. Since the nervous system is intimately involved in digestive processes, such as motility of the intestines and secretion of digestive juices, in people with dysautonomia, we often see irritable bowel syndrome symptoms such as bloating, gas, diarrhea, or constipation. Without proper motility, food ferments in the small intestine, causing an overgrowth of bacteria where it shouldn’t be. Small intestine bacterial overgrowth (SIBO) can cause bloating, constipation or loose stools, as well as brain fog. There are excellent ways to test and treat SIBO through a naturopathic physician trained in this area. 

Brain healing requires a more comprehensive approach because the brain is highly sensitive to what is happening in the rest of the body. Emily started naturopathic medical protocols for dysautonomia include addressing the gut-brain connection through avoiding inflammatory foods, enhancing nutrition, and balancing the microbiome. She took natural medicines to target the mechanisms needed to heal the brain, including enhancing energy production (mitochondrial health), reducing inflammation and oxidative stress, promoting nerve healing, and helping the brain filter toxins. After three months she is feeling much better. Programs can also include hormone balance, stress-reduction training, physical therapy, and visual therapy can all also help address dysautonomia. 

Like most viruses, most people who get COVID make a full recovery. But for those whose lives have been turned upside down after this infection, it’s important for them to understand that there are strategies that can help.

Finding Calm within the Storm

Life is full of twist and turns, good days and bad days, change and uncertainty. These are the things we cannot change. What we can change is how we deal with all the ups and downs of life. We can face our fears and work through them as best we can. We can call upon our highest thinking, and bring forth our deepest strength.  We can have hope that out of struggles, new and better ways of being will be discovered. As a naturopathic physician, I have studied psychology, various therapeutic modalities, attitudinal healing, a number of spiritual practices, and watched how thousands of my patients have risen to the challenges in their lives. From this experience, I offer you a seven step system for facing the difficult emotions of life. May it help you to navigate this storm to find a place of greater calm.

Step One: Pause and observe your mind and body. Just noticing your thoughts, feelings and body sensations in a curious way is the first step. Gently observe with non-judgemental inquiry. Just stopping, stepping back, and noticing that this train of thoughts and feeling is causing you stress allows you to separate from the process a little bit so you can look at it and question it. 

Step Two: Breathe. Bringing your mind’s focus to your breath helps to calm both the body and mind.  It’s amazing how just a few deep breaths can begin to shift fear, anger, anxiety and more. You may wish to try breathing in through the nose and out through the mouth, or even add a small sigh on the outbreath. Imagine the stress flowing out as your exhale. Feel your shoulders drop and feel your weight settle into your pelvis, legs and feet to help “ground” you. Apps like Insight Timer and Calm provide guided relaxation and breathing exercises to follow.

Step Three: Name the feeling. Often we get overwhelmed and just feel “stressed” in general. Here I invite you to be curious about what you are feeling in particular.  Is it grief, anxiety about the future, anger at someone, powerlessness, or fear of rejection? Try and mine down to what’s really going on and put a label to that particular pattern of body sensations, thoughts and feelings. Just naming and acknowledging the feeling is a step towards acceptance. And in the naming, we are again stepping back from the feeling to a place where we can work with it. 

Step Four: Self Compassion. Here is where we give ourselves the kindness and understanding that we often seek from outside ourselves. Dr. Kirsten Neff describes Self-Compassion Practice well in her TED talk, website and online guided exercises. You might say to yourself, “yes, of course you are feeling nervous about your health; how human is that? It’s so understandable.” Or you might say “how hard it is to feel such uncertainty about the future or adapt to so much change….” By leaning into the feelings instead of rejecting them, we are in a place to practice being with our feelings instead of wanting to escape, blame others, or act out in reflexive ways. 

When we are stressed and running on adrenalin, the survival part of the brain is activated and the frontal cortex, where more creative problem solving can be accessed, is shut down. We tend to react in patterns we developed as children: fight, flight, freeze or fawn.  The first four steps of this system are designed to calm the nervous system, balance the brain, and prepare us to move from reactivity to more helpful, resourceful ways of being.

Step Five: Question the thoughts that drive the feelings. Consider the possibility that behind every feeling is a thought. By identifying the thought, we can start to question it, and reframe it from a more adult, realistic, and resourceful mindset. Cognitive Behavioural Therapy (CBT) is the world’s most researched and successful therapy technique and it is a set of tools for dealing with life stresses in a better way. The website anxietycanada.com is an excellent way to learn about CBT and how it can help you deal better with day to day life. I love the list of questions under the section “Challenging Negative Thinking”, such as “Is this a hassle or a horror?”, “Am I confusing a possibility with a certainty?”, “Have I confused a thought with a fact?” and more.

Step Six: Affirm your strength.  A lot of anxiety is really a fear that you don’t have what it takes to deal with adversity: rejection, pain, death, humiliation, grief, change, etc. I invite you to think of examples of when you have been strong in the face of adversity before, and think of what you drew on in yourself. Or think of others who have found strength in times of trouble: people you know, your ancestors, people around the world. By affirming your strength you can let go of trying to plan for every possible bad thing and how you would deal with it. You can simply trust that you will have the inner strength to face each challenge as it comes. You can focus more on the moment with self-talk like “Right here, right now, I am okay and I can deal with this moment”, “I am wise and strong”, “I am the source of the love and security I seek”. 

Step Seven: Let go and trust. It is often said that stress is the difference between expectations and reality. The outside world will always be full of challenges and changes. I humbly invite you to be open to the possibility that just maybe some meaning will come from these experience. Great growth rarely happens without great struggle.

These seven steps can be done in one minute or in a two-hour journaling session. They can be done alone or with a trusted person. You can reach out to me for a consultation visit or to another counsellor. The more each of us can commit to staying grounded emotionally the more we can help uplift others. May you find your calm within the storm.

Dr. Deidre Macdonald is a naturopathic physician with a B.A. in psychology, who is offering in-person and telemedicine appointments. Extended health insurance applies, and discounts are available for those in need.