Robert Groysman, MD

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.

08/17/2026

Which of your symptoms flare on the same days?

Not which ones you have. Which ones move together.

For a lot of people the pattern looks like this...

The temperature swings pick a day, and the food reactions pick the same one. The word you wanted hides on exactly the afternoon the television gets too loud. When a bad day arrives, it arrives everywhere at once, and when things ease, they ease everywhere together.

Separate problems do not usually keep a shared calendar.

Some systems in your body do not live in one organ. The autonomic nervous system runs from your pupils to your gut. Blood vessels and the lining inside them touch nearly every tissue you have. Injure a system like that and symptoms surface wherever it reaches. Skin, stomach, ears, memory. Different places, one system underneath.

This is what the shared calendar is telling you. Symptoms flaring together point at what they share, and in long COVID the systems capable of producing that pattern are a short, known list.

The pattern you noticed is real, and it is usable. One disturbance surfaces wherever its system runs, and sometimes two act together. Either way the source can be found, and the answer changes what helps.

08/16/2026

If you followed the recovery plan exactly as written, added a little more each week the way the printout said to, and finished the month sicker than you started it, the failure was not yours.

The advice - For years the standard prescription for post-viral exhaustion was graded exercise. Start small. Add a little on a schedule. Let the body re-adapt. It sounded sensible, and for deconditioning, the decline from inactivity itself, it works.

The reports - For those whose crash arrives a day or two after effort, scheduled increases did not rebuild them. They flattened them. Not soreness. Days lost. And the reports were often read as a dosing problem. Go slower, try again. The plan stayed.

The reversal - In 2021, the UK's national guideline body withdrew graded exercise therapy as a treatment for ME/CFS, after weighing the trial evidence alongside years of patient reports describing harm.

The distinction - Deconditioning is real, and gradually increasing activity is still the right treatment for it. The failure was treating one condition with the other one's plan, without checking which one it was treating. Some effort builds you; some costs you days. They are different biologies, and a program unable to tell them apart was not written for what you have.

If a plan keeps making you worse, that is information about the plan, not about your character. It belongs in the conversation before the next increase does.

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

08/16/2026

Doctors have a version of this conversation patients never hear.

Hallway consults. Referral calls. The quick message to a colleague about a difficult case. Five years ago, when long COVID came up in those places, the question underneath was usually the same one. Is this real?

I have not heard that question in a long time.

The questions now are practical. What did you check first. What helped. What did not. Who has seen this pattern before.

No single trial flipped that switch. No conference did it either.

Patients did it. The ones arriving with three years of notes in order. The ones with trigger logs so consistent the pattern was undeniable. The ones who came back, visit after visit, and declined to accept a shrug as a diagnosis.

Enough of you did that, in enough exam rooms, and the private conversation moved.

You were never in the room for it. You are the reason it sounds different now.

08/15/2026

Resveratrol is a reasonable thing to reach for after reading about how blood vessels work. It sits in the group of plant compounds with real anti-inflammatory activity, and it may help repair the vessel lining.

The trouble is the distance between what it does and what people expect it to do.

It addresses oxidative stress on the endothelium, or blood vessel lining. Long COVID patients show elevated oxidative stress markers, so lowering that load is a genuine target rather than a marketing one.

It does not work alone. Antioxidants operate as a system that recycles itself, which is why resveratrol appears alongside vitamin C, NAC and quercetin rather than by itself. Taken as a single bottle and judged after three weeks, it will look like nothing happened.

There is also an absorption problem the label never mentions. Resveratrol is poorly absorbed and cleared quickly, so the quantity reaching your vessels bears little relationship to the number on the front.

If you are thinking about Resveratrol do your homework. It has mild blood-thinning activity of its own. If you are already taking something for clotting, this is a combination to raise with your care provider.

If circulation symptoms are the main complaint, the more useful move is working out what is driving the oxidative load before deciding what to buy for it.

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

08/15/2026

What do you say to the person who saw you at the barbecue and has decided you are fine now?

Most people say nothing, because the honest answer takes longer than the moment allows. Here is a version short enough to send.

Start with the part they have right. You did look fine. That part is true. They are not lying about what they saw, and arguing with what somebody saw with their own eyes is how this conversation is usually lost in the first thirty seconds.

Then the part that was not in the room. You did not have two spare hours. You spent hours you did not have available.

For a lot of people the cost arrives a day or two later, long enough that almost nobody watching connects the two events. If the crash landed at the barbecue, you would never have to explain any of this. It lands on Monday, with no witnesses, and Saturday is the part everyone remembers.

The good hours do not mean you are better. They usually mean the cost has not landed yet.

Then ask for one thing, and keep it small. Do not ask them to believe you. Ask them to watch the two days after rather than the two hours during. This is something a person can actually do.

Send this to the one person whose opinion of you costs you something. Not the group chat. One person.

You are exhausted in a way your activity cannot explain. Your weight and temperature shift for no reason. Your sleep is ...
08/15/2026

You are exhausted in a way your activity cannot explain. Your weight and temperature shift for no reason. Your sleep is brittle, your mood swings, your drive is gone. And your hormone panels come back "normal."

This is hormone and metabolic dysfunction. COVID can disrupt the endocrine system, from thyroid to adrenal to s*x hormones, and standard panels often miss it. Being told you are "normal" while you feel exhausted, anxious, and inflamed is not the end of the story. These are real chemical imbalances changing how your brain and body function.

Volume 7 of The Complete Long COVID Handbook explains why "normal" panels miss it, including thyroid testing beyond TSH (thyroid stimulating hormone).

This is education, not medical advice; work with your own provider on next steps.

08/15/2026

Forty years. That is how long one person on this page has been ill.

Last month, under a post about the trip you circle on the calendar and quietly give up on, they wrote out their entire travel kit in a comment. Every item, with notes on most of them. Not for themselves. For whoever needed it.

Somebody else, nineteen years in, asked why this page almost never covers pain. A fair question, politely put, after nineteen years.

There is a version of this where the people who got sick first resent the ones who arrived in 2020. It would be a fair emotion to feel. Decades of being waved off, and then the same illness gets a name, a research budget and everyone's attention the moment it happens to enough people at once.

The comment section says otherwise.

It looks like somebody decades into this answering a beginner's question for the hundredth time, on a Wednesday afternoon, on a day they had probably already run out.

They keep doing it for people who turned up late to something they carried alone.

If that is you, this morning's post is for you, and there is nothing else in it.

08/14/2026

An EKG tells you whether your heartbeat is normal. It does not tell you whether the system controlling it still works.

Only one of those gets asked at a standard appointment.

The finding - Heart rate variability. Not your heart rate, the small differences in the gap between one beat and the next. A healthy autonomic system produces plenty of that variation, because two branches, one speeding you up and one settling you down, are adjusting it constantly. Consistently low variation usually means the accelerating branch is dominating and the calming branch is barely registering. In Long COVID, that imbalance often persists long after the infection.

Why standard testing misses it - The EKG your doctor read lasted about ten seconds and was scored for rhythm and electrical abnormality. Variability needs a longer recording and a different analysis, and ten seconds does not supply either. The result is correct. It was answering a different question from the one you had.

What it does not tell you - Whether you are ill, or how ill. Sleep, alcohol, a cold, stress and where you are in your cycle all move it. One night's reading is noise. A trend across several weeks can point at something.

Where yours may already be - Most sleep trackers and smart watches record HRV without being asked. Plenty of people have months of it they have never looked at the data.

Take your HRV trend to your next appointment, not last night's number, and ask whether formal autonomic testing is worth doing. Proper versions of this test exist, and they measure more than a wrist can.

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

08/14/2026

If whatever set you off was gone within twenty minutes and you were still flattened three days later, the gap is not evidence you overreacted.

Histamine is only the opening line.

A firing mast cell releases a whole set of chemicals at once. Histamine. Tryptase, which loosens tissue so immune cells can move through it. Heparin, a natural blood thinner. Cytokines and prostaglandins, the inflammation drivers. Leukotrienes, which tighten the airways and produce mucus. Different chemicals, different jobs, and no reason to finish at the same time.

An antihistamine addresses one item on that list.

Which is why it can be useful and genuinely insufficient at once, and why people get labeled non-responders when their reactions are driven mostly by the ones nothing is blocking.

Inflammation is a process, not an event. The exposure ends. The chemistry carries on.

The aftermath is also not local. Mast cells are stationed in your gut, your skin, your airways and your blood vessels, so one activation is felt in several places, and each runs its own clock.

The specialized mast cell labs are only elevated during a flare, and not always then. Blood drawn on a quiet Tuesday can miss it entirely. If testing is on the table, when it is drawn matters as much as what is drawn.

One exception. None of this describes a throat closing or breathing you have to fight for. That is emergency care today, whatever else is going on.

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

08/14/2026

One comment on this page has stayed with me.

Somebody asked whether anyone else's symptoms move around from week to week. Before I got to it, the thread had answered. One person described the pattern better than I would have, and a second corrected them, gently, and was right to.

I typed something and deleted it.

This happens most weeks now. I open the comments to answer a question and find it answered, usually by somebody who has lived with this condition, and in words I would not have reached for.

I have not worked out when to step in. If I answer everything, the thread becomes a queue for me and the person who actually had the answer stops offering it. If I stay out, somebody occasionally gets told something I would correct.

The useful voice is not always mine.

Some of the clearest descriptions of this illness I have read sit under posts on this page, written by people who spent years being told they were not reliable witnesses to their own bodies.

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