A 37-year-old male presented to CFNC with a chief complaint of chest pain, weakness in his arms and legs, swollen lymph nodes over his entire body, tachycardia upon standing, tremors, fatigue after exertion and brain fog.
Symptoms started within days after his second Covid-19 vaccine. Patient was previously a CrossFit athlete and a professor. When he presented to our office he was unable to exercise or teach back-to -back classes.
His symptoms were daily and waxed and waned in both duration and intensity throughout the day. He was on a beta blocker, prescribed by his cardiologist, when he presented to our clinic. He was previously diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS) by his cardiologist and had a plan to get fibrinogen levels checked if the chest pain continued. He eventually had an ultrasound done and cardiology diagnosed him with pericarditis, and he was treated accordingly using medication.
Examination and diagnosis
Physical examination and diagnostic testing revealed:
- Orthostatic heart rate change from 78 – 107 bpm, not sustained while standing. Patient was on a beta blocker during testing
- Blood pressure was normal and within range bilaterally
- Oxygen levels were 99%
- Vertical eye movements showed: recruitment of head with saccades with slowed velocity and latency, saccadic pursuits, decreased gain in OPK downward.
- Horizontal eye movements showed: recruitment of head to the right with rightward saccades, decreased gain with right OPK
- Strength, sensory and MSR all intact and equal bilaterally
- Left trap reflex was elicited and generated a startle response
- Early fatigue in the left eye, right eye showed hippus
- Swollen cervical and sublingual lymph nodes were palpated
- Posterior center of pressure of 2.35”, reduced stability scores on perturbed surface with eyes closed and with head in extension.
- Vitamin D deficiency, High ALT, Hypercholesterolemia, functionally elevated homocysteine
The patient was initially treated two times per week for 60 minutes over 5 consecutive weeks (10 visits) with a re-examination following his last treatment. After re-examination the patient was recommended to follow up 1x per month for 3 consecutive months. He was given on-going rehabilitation exercises to complete at home as well as recommendations for increasing his physical activity and time at work.
Treatment consisted of vestibular rehabilitation and oculomotor exercises, neurosensorimotor integrator (memory saccades, trails B and hand-eye tasks), brainstem neuromodulation through RPSS to the face and tongue, Bemer therapy globally and red/NIR light therapy to the face and neck.
Patient was also put on supplementation to support vitamin D levels, antioxidants, anti-inflammatory and phase 1/phase 2 detox pathways of the liver.
** Patient reported that after his initial evaluation and before starting treatment he contracted Covid-19 and all symptoms worsened initially but he started returning back to where he was during his evaluation. He also reported the beta blocker was not helping as much at that time.
During the re-examination the patient reported he is no longer having the tingling in his legs when standing stilll. He is able to focus better, not having to re-read, and brain fog is generally improved. He is looking forward to getting back to workouts. He has still been doing the 25 minutes of walking.
His orthostatic heart rate changed from 71 to 91 bmp. His standing heart rate is better, but he is still tachycardic if he is doing a lot of talking and moving fast (like he does at work); otherwise, it is under control. Quick movements and a lot of talking still bothers him. He is no longer noticing swollen lymph nodes. Chest pain is being treated with medication from his cardiologist.
Re-examination objective findings:
- Fatigue in left pupil compared to right
- Mild hippus on the right
- Supine to standing: 71-91 bpm
- Convergence: no spasm
- OPK: minimal reflexive response at bedside
- PLR: intact and equal B
- Trap reflex: still present
- Vertical saccades: no head recruitment
- Horizontal Pursuits: head recruitment still present
- CAPS: center of pressure normalized to .77” posterior, all stability scores were in healthy range except head in extension which improved from moderately to mildly reduced
Patient was sent home with box breathing exercises, vestibular rehabilitation exercises and a general plan to continue to increase intensity and duration (not simultaneously) of exercise and lecturing, utilizing exercises to help reduce sympathetic output as needed.
One month after re-examination: Patient reported that he pushed himself too hard helping train a track student. He went home, hydrated and did his exercises, but his heart rate remained in the 80s for the day. He took it easy and the next morning he felt better and two days later felt completely back to normal.
Three months after re-examination: Patient reported that he has been doing great. He has been going on walks daily. He is getting back to doing push-ups. He is utilizing his exercises as needed. He is down to half the original dose of his beta blocker and he is feeling good. He has a month left on the medication for the pericarditis and then they will start to wean him off.
At this time the patient was cleared from care and instructed to reach out to us if he needed any further assistance or if any of his symptoms reemerged. We have not heard from this patient since May 2022.
Functional neurological care and functional medicine have been shown to be effective in the treatment of POTS and Long-Covid symptoms from the Covid-19 vaccine and Covid-19 infections. Every patient requires an individualized approach and targeted treatment to achieve optimal results.