Robert Groysman, MD

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

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

10/21/2026

When your bloodwork comes back normal, does that settle the question of microclots?

Most regular blood tests, like D-dimer or a complete blood count (or CBC), do not detect microclots. Volume 6 of The Complete Long COVID Handbook makes that point, and it also describes a test that can see them.

People often ask what is the test. It is called live fluorescence microscopy.

Scientists take a small drop of blood and stain it with a fluorescent dye. The dye sticks to fibrin, the sticky protein in clots. Then they examine it under a special microscope with blue or ultraviolet light, and the clots glow like tangled webs.

The method lets scientists see microclots directly, in real time, in a living sample. They can watch how the blood is behaving, not just guess from chemical markers. Dr. Resia Pretorius and her team in South Africa were the first to use this method in long COVID research.

This test is not widely available outside research labs yet. It is used mostly in research studies, experimental diagnostics and some advanced or private labs exploring long COVID. In rare cases, specialized clinics may offer it as part of an investigational approach. It is not yet a standard medical test, but it may become one.

10/21/2026

7:40am. Stood at the counter making coffee, kitchen warm. Dizzy within a minute, heart racing, brain fog. Had to lie down. Eased off after 10 min or so. Again, like most mornings.

That is the kind of line the one-week log in my free dysautonomia guide has you write.

You pick the one symptom that keeps coming back. For one week, every time it shows up, you write a line like that one. There is nothing to score, and you do not set it off on purpose to see what happens. You just live your week.

After a week, you may be able to say what sets it off and how fast it comes on. That part does not go on the chart, so bring the log to your next appointment.

The guide is free and does not diagnose you. It comes by email, with a short series of emails after it. The link is in the first comment.

10/20/2026

If methylene blue has come up as a way to address mitochondrial dysfunction, it might sound harmless.

Volume 3 of The Complete Long COVID Handbook, discusses how scientists are discovering it may help improve the flow of electrons inside mitochondria, the parts of your cells that make energy.

It also reveals that without proper medical supervision, it can sometimes cause a serious reaction called serotonin syndrome, or too much of the brain chemical serotonin. Combining it with other drugs or supplements affecting serotonin increases the risk. Those can include some antidepressants, some pain relievers, and even some over-the-counter cough medicines.

If there is any chance of glucose-6-phosphate dehydrogenase (or G6PD) deficiency, a genetic disorder making red blood cells more vulnerable, it is best to get a simple blood test before starting the medication.

Methylene blue can also potentially block an enzyme the body uses to break down tyramine, a substance in many aged or fermented foods. That can lead to a sudden spike in blood pressure.

Used correctly, methylene blue has the potential to be a useful treatment. It can also cause unwanted reactions.

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

10/20/2026

Three kinds of breathlessness in long COVID.

When it comes on with standing, heat, a shower or a big meal, the driver may be dysautonomia, or autonomic dysfunction.

On standing, blood can pool in the legs, so less blood, and with it less oxygen, reaches the brain and muscles. The thing to notice may be how your breathing feels standing versus sitting.

If a tight chest or a cough follows a trigger such as w**e or b**r, fermented foods, perfume or cold air, sensitive airways may be part of it.

Mild bronchospasm, or the airways tightening, can add to it. Which trigger came first is often the thing to notice.

After a small effort, you can be far more out of breath than the effort explains. That can point to the circulation as well as the lungs, since small vessel dysfunction, a problem in the smallest blood vessels, can make oxygen delivery less efficient. Here the thing to notice is how breathless you get, from 0 to 10, next to how small the effort was.

Two of these, or all three, can run together, since one symptom can have several drivers.

Knowing which of the three are yours can point to what to notice first.

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

10/20/2026

If your racing heart, your dizziness in the shower and your temperature swings keep getting called anxiety, I have a free guide for you.

Dysautonomia means your autonomic nervous system, the part that runs your heart rate, blood pressure, digestion and temperature on its own, is not regulating them well. It is an umbrella, not one diagnosis, and even a long list of symptoms does not prove you have it.

The guide covers four patterns under that umbrella, one for standing up, one for feeling wired, one for digestion, and one for temperature and sweat. Then it gives you a one-week log to fill in on paper and bring to your next appointment.

The framework behind it was published in Frontiers in Medicine in 2026. It is a hypothesis, meant to be tested.

It is free and comes by email, with a short series of emails after it. It does not diagnose you. The link is in the first comment.

10/19/2026

It starts between 2 and 4 a.m. You wake with a racing heart, followed by hours of disrupted sleep. A nighttime racing heart has two possible readings, the autonomic nervous system stuck on high alert, or a problem with the heart's own rhythm.

In dysautonomia, or autonomic dysfunction, the heart rate can run a bit high, and normal beats can be easier to feel.

A racing heart can also start with the heart itself, as an arrhythmia, or a problem with the heart's rhythm.

To tell the two apart, ask your doctor about an electrocardiogram (or ECG), or a heart monitor you wear at home. Both record the heart's rhythm.

Take your findings to your next appointment.

Also, if you experience loud snoring, or waking up choking or gasping, ask about a sleep study.

(A racing heart with fainting or with new breathlessness at rest, or sudden, new or severe chest pain or pressure, is a reason to call 911 or your local emergency number now. Consult with your doctor before starting any new treatment.)

10/19/2026

If you have surgery planned, some of the medicines used for it can trigger mast cells.

Mast cell activation syndrome, or MCAS, is among the six root mechanisms behind long COVID. Some medicines can trigger mast cells directly or block the breakdown of histamine.

Several of the medications (which you can find in Volume 5 of The Complete Long COVID Handbook) are used around a scan or a surgery. Contrast dye for imaging is one, and anesthetics are another. Opioids are also on the list, as are NSAIDs such as ibuprofen and naproxen.

For someone with mast cell activation, a reaction around a procedure can be the result of the medications themselves.

Before a planned scan or surgery, make sure you mention any mast cell reactions to your doctor or care team, and ask questions about medicine given beforehand.

Stopping a prescribed medicine, or delaying a needed scan or procedure, is a decision for your practitioner.

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

10/19/2026

You were referred to a specialist more than a year ago.

Do not put the rest of your care on hold until you get in.

Many long COVID patients have three providers. A primary care doctor, a specialist, and someone who helps coordinate their care.

Keep seeing your primary care doctor. If you can, find a long COVID doctor.

If not, start with Volume 1 of my Complete Long COVID Handbook.

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

10/18/2026

Should you consume more salt?

Even if you reach for Himalayan salt to help with postural orthostatic tachycardia syndrome (or POTS), any table salt will do.

The salt does not have to be sea salt or Himalayan salt.

When managing POTS, fluid and salt sit side by side among the lifestyle changes. Where a doctor agrees and blood pressure allows, the aim of a modest salt increase is more blood volume.

POTS is a common form of dysautonomia, or autonomic dysfunction, and can have two components. One of those components is hypovolemic, or low blood volume. Which is why people reach for salt.

However, more salt does not suit everyone, and for those with high blood pressure, heart failure or kidney disease salt can be unsafe. If you're thinking about increasing your salt intake, make sure you speak with your doctor and make sure they understand the full picture of your symptoms.

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

10/17/2026

For some people, feeling better comes first and the labs follow; for others, the labs improve first and feeling better comes later.

With endothelial dysfunction, or vascular dysfunction, one of the six root mechanisms of long COVID, not all labs move in sync with symptoms. When a doctor is tracking labs, a result can lag behind how someone feels, or the result can be ahead of it.

For many people, symptoms change before lab values. Microclots can be one reason. When the microclot burden is partly reduced, blood flow to the organs can improve, and how someone feels may change.

The reverse can happen too, with lab values improving before symptoms do. Whichever side moves first, the change can be real.

A lab test captures specific markers in your blood at one moment in time. Progress often shows up as trendlines and not snapshots. Because symptoms and lab values can move at different times, a series of results taken together can say more than any single test result.

Reading the direction across several results is a job for the doctor tracking them.

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

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75093

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