Immunocompromise After Covid in a Physical Therapy Student – LIVE Client Case Study (Part 1)

Dr. Jessica Drummond (00:00:03) – Hi and welcome to the Integrative Women’s Health Podcast. I’m your host, Doctor Jessica Drummond, and I am so thrilled to have you here as we dive into today’s episode. As always, innovating and integrating in the world of women’s health. And just as a reminder, the content in this podcast episode is no substitute for medical advice, diagnosis, or treatment from your medical or licensed health care team. While myself and many of my guests are licensed healthcare professionals, we are not your licensed healthcare professionals, so you want to get advice on your unique circumstances. Diagnostic recommendations treatment recommendations from your home medical team. Enjoy the episode. Let’s innovate and integrate together. Hi there and welcome back to the Integrative Women’s Health Podcast. I’m Doctor Jessica Drummond, your host. And today we’re going to deep dive into a case study using the IUI seven step system to help navigate through a chronic long Covid case that may look different than you expect. I think you’re going to see a lot of surprises in here. Also, if as a professional, you want to learn more about how to address long Covid in your clinic, know that we teach this in deep depth.

Dr. Jessica Drummond (00:01:36) – In our Functional Nutrition Certificate program, you can learn all the nitty gritty, and I update that about every six months because the research is coming fast and furious on long Covid. And you’re going to really appreciate this case study from a 22 year old physical therapy student who got Covid during her first orientation week in physical therapy school, and has now been dealing with it for 18 months. And you’ll see the ups and downs and some of the vulnerabilities of what may set her up to be more at risk for long Covid than some of her other classmates, some of the gaslighting she experienced in the medical system. I mean, you will be shocked. So let’s dive into this story and learn more about how to take a systematic approach to addressing long Covid from the root cause. Welcome back everyone. Hi there. I’m Doctor Jessica Drummond, host of the Integrative Women’s Health podcast. And today we have a very special case study for you. As you may know, I was speaking at the American Physical Therapy Association’s combined sections meeting earlier this month in Boston, and I was speaking about the integration or the intersection between Covid long Covid hormones and menstruation in women.

Dr. Jessica Drummond (00:03:16) – And Terry, who is a brilliant physical therapy student, reached out to me about her own struggles post-Covid hasn’t officially, from what I understand, been diagnosed with long Covid. But we want to talk about some of the things that can happen to the immune resilience after a Covid infection and what we can do about that, most importantly So welcome, Terry. Go ahead and introduce yourself. And I would love to hear a bit more about how your healing journey has gone so far, how your health has been in general, and then how it has been in the last year or so.

Terry Brown (00:03:56) – Thank you so much for having me. Like you mentioned, I am a second year of physical therapy student at Duke within their physical therapy program. So prior to. It’s kind of funny how my timelines work, because my first month here in August of 2022 for my first month of grad school was when I got Covid. I had made it through those two years of the pandemic without having it. And so I had Covid for the first time August of 2022.

Terry Brown (00:04:22) – I’d had three of my Moderna doses leading up to that. I had been working, you know, around a lot of people until I came here, and I just had been able to avoid the infection, which I thought was super lucky. But as soon as I got here, week one of classes, I got pretty sick with Covid. Like you mentioned before my undergrad. I can recall missing so few days of school just from being sick, and I typically just the way my parents raised me. You know, unless I’m throwing up or running a fever, I’m going to go to school. And so that’s kind of how I lived, and I don’t recall missing many days of school. I can remember my sickness as an undergrad, pretty much mainly sinus infections and then typical dorm viruses. But this past year and a half has been like pretty insane in terms of sickness. I’ve missed like about 35 to 40 days of classes, which the program at my level. It’s been pretty challenging to keep up and to not fall behind just because of how quickly this program moves each day.

Terry Brown (00:05:14) – So my first diagnosis, I guess the or first tested positive of Covid was August 2022. I was out for the five days that required for my school. I recall my fever getting a little over 100, but that was my main symptom for those days and at this time I’m very physically active for a few months. When I first got to school, when I was adjusting, I was in the gym as frequently, but I do work out about five days a week, and I try and eat healthy and I avoid all the bad foods and drinks they tell you about trying to get my body the energy and sleep I need to do well in a program like this, but after that. So that was August. I recall feeling this unwell lot that after I was sick with Covid, but nothing was positive. When I came back in January of 2023, back to school after winter break, I got really sick again. My fever was like 103 for multiple days straight, but they couldn’t figure out what it was.

Terry Brown (00:06:07) – They were just like, just stress. Maybe a viral infection. They sent me on my way. Then in April of 2023. So just a few months after that viral infection, I had mono and that was the sickest I think I’ve ever been. I was almost admitted to the hospital twice, just because of how high my resting heart rate was. I couldn’t like, get below 130 beats per minute and I was super dehydrated for a couple of days to get out of my bed to go to the bathroom, I would get up to like 140 beats per minute, which my resting is closer to low 70s so that was pretty significant. I felt like I had just finished running. Each day I would just get out of bed and go up the stairs. So that was mono in April. Then in August I got Covid again. So just a few months later, this time pretty similar. My fever was a little bit higher than that go round than the first go round of Covid. Then in November, I got pneumonia and I was out for a week and I was on breathing treatments and they gave me an inhaler and I got multiple chest x rays just because of how sick I was at that point.

Terry Brown (00:07:10) – And I’m still doing follow up chest X-rays just to make sure nothing else is settled. Then in November and then January, I got flu a just a few months ago, and then a few weeks after that, I had what they called a rebound infection of the flu, where my fever was just back spike to about 104 for a few days. Really sick. Very just overall malaise feeling just feeling really unwell. So those are my bulk of my things. I have been tested. They know for sure I have it. I was treated. There were a lot of moments in between that year where I just didn’t have my energy that I usually did. I’d go to the gym and I couldn’t perform what I could the week before, and there was no really thinking of my menstrual cycle to explain that.

Dr. Jessica Drummond (00:07:50) – Is your cycle been pretty regular in the last year? How’s that been going?

Terry Brown (00:07:54) – I am on birth control and I haven’t. I was 13 for like a heavier period that I’ve experienced, so it changed a little bit in terms of how many days it would last, but it hasn’t really changed drastically.

Terry Brown (00:08:06) – I had a few months after the Covid infection, most recently where it was a much like more severe period where cramps were worse, GI distress was worse, and my bleeding was heavier. So those are my made period changes. But like I said, I am on birth control, so I know there’s some control through that.

Dr. Jessica Drummond (00:08:23) – Right. So you’re on like, oral contraceptive. So every month you’re taking them with the breakthrough bleeding, that kind of thing. Okay. Perfect. And then did you go home for Christmas? Did you have any time off around Christmas?

Terry Brown (00:08:37) – Yes, we have two weeks off for Christmas with our program, so I went home for that time.

Dr. Jessica Drummond (00:08:42) – What were you doing then? Did you feel pretty well rested? That sort of thing.

Terry Brown (00:08:46) – So I had pneumonia late November. I was still kind of recovering for that whole month after, because that happened right before Thanksgiving. The pneumonia, I lied really low Thanksgiving week, and then I came back and immediately started finals. So a lot of days of not getting much sleep and studying late in the library.

Terry Brown (00:09:04) – So I kind of recall being pretty low energy that winter break. And then I stayed pretty cautious. I didn’t see many people just because I didn’t know what my body was going through. And by the time I got pneumonia this past November, I was a year into being just sick constantly, and so I was just having to rethink exposure because I had never had to be as vigilant about it as I had in that past year.

Dr. Jessica Drummond (00:09:28) – Yeah. And I think that’s something that’s very important to point out, that it’s really challenging in the state that we’re in right now. And, you know, spring of 2024, where it were four years into this, if you will, and most people if they’re not directly affected, although more and more people are at some level being directly affected, even if it’s in this way that you’re describing, like just kind of chronically getting sick, not officially being diagnosed with long Covid or diagnosed with a chronic autoimmune disease or anything like that, just sort of wondering like how to live.

Dr. Jessica Drummond (00:10:08) – And I think that’s an important thing for us to circle back to, maybe in a bit that now we’re having to start on an individual level, try to gauge risk, because there aren’t those more societal, you know, risk mitigation strategies like air quality or masking or things like that. And unfortunately, you know, while the vaccine is a really valuable tool to prevent death, and even now in younger people who are vaccinated and boosted, they have a six times lower death rate. But the death rate from Covid and younger people is quite low. It’s like 0.1 to 0.5 of 100,000 cases in older people. I think the cutoff is 65 and above. It’s about 12 to 13 per 100,000 for those who are unvaccinated, and six per 100,000 who are vaccinated and boosted. So there is a protection level from either being vaccinated or at some level, within a certain amount of time, actually having and recovering from a Covid infection. There is some natural immunity, if you will, as well, but it’s not really a sustained situation.

Dr. Jessica Drummond (00:11:19) – It’s not like, you know, you get a vaccine and ten years later you’re still protected. So we’re all having to navigate this challenge of personal levels of risk versus societal mitigations. And so we’ll come back to that. So one of the things that I think it’s important for all of us to understand that Covid does is it can deregulate your immune system. In what exact way? I think we’re going to learn. The research on this is not very clear yet. But you know, we do know that in some people they are later diagnosed with new autoimmune diseases. In other people they are diagnosed with essentially chronic forms of Covid. There is a study that shows that once you’ve had a Covid infection, not in everyone, but in this group of people that were having continued variable symptoms. And some of those included chronic viruses and other viruses like you’ve experienced. Covid can live in the system in the same way that Epstein-Barr or mono lives in the system. Had you ever had mono before?

Terry Brown (00:12:29) – I had not know.

Dr. Jessica Drummond (00:12:30) – Yeah. So something like 95% of people eventually get the Epstein-Barr virus or a mono. Only 5% or so express a more long term chronic expression of Epstein-Barr. But it’s one of those viruses that essentially goes dormant in the body in Covid. We’ve seen Covid reservoirs in the research up to just under a year, which was about as long as they did the study. And those reservoirs were in the brain, in the ovaries and the cardiovascular system. Like you name the organ, they found Covid, you know, in the penis, like it’s everywhere. And so Epstein-Barr is at some level the same way, and that it can kind of go into hiding and then later resurface or have a more chronic fatigue type presentation longer than just the acute two weeks or so of the virus. So I think we’re going to start seeing different phenotypes, if you will, of long Covid. There are some people who just have a kind of low grade active infection for months and months and months. They might even continue to test positive.

Dr. Jessica Drummond (00:13:40) – They might have a low grade fever. The good news is your body seems to be able to recover each time reasonably well. And, you know, being in your early 20s, that’s a nice protectant at a lot of levels. Although it’s not always the case that even young people just fully recover. So I certainly understand if they’re in your 20s and you’re dealing with long Covid, like I believe you, I get that. But in your case, Terry, I think that the fact that you’re able to recover in between is a good sign that there is some immune resilience there, but we have a little work to do. And Covid might have just been sort of the straw in the sense that your immune system may have been stressed by who knows what. Like did you have to move when you started graduate school?

Terry Brown (00:14:30) – I did, but I just am from South Carolina, so pretty quick move up to Durham.

Dr. Jessica Drummond (00:14:34) – Okay, so a small move, a new program. Did you come directly from undergrad?

Terry Brown (00:14:39) – I did not I took a gap year and I worked at my previous undergrad.

Dr. Jessica Drummond (00:14:43) – All right. Great. So these changes are some degree of stress. Is it an extreme stress? No, but it could be. You know, the sometimes we look at like is there a combination of factors that may have hit the perfect storm for this Covid infection? One of the things I’m seeing in my practice around long Covid is that so one thing we know, for example, it’s interesting that you were on hormonal birth control that can be protective against Covid infection. Being on either hormonal birth control or estrogen replacement therapy is somewhat protective, and we have some interesting data from transgender studies of people who are transitioning from female to male. We’re at a four times higher risk of even getting Covid than those transitioning male to female. So there’s some protectiveness around estrogen, but it is possible, and I have seen this a couple of times in my practice that maybe you were on the week of the breakthrough bleed when you got Covid. Do you have any memory? Do you know?

Terry Brown (00:15:45) – Well, you know, it actually might have been my sugar pill week because day one of classes, I think it was half the week would have been sugar pill.

Dr. Jessica Drummond (00:15:51) – Okay, that’s really interesting. So I’ve seen this a couple times. That’s more anecdotal than evidence based, but I think it is kind of interesting that if someone maybe had Covid three times and were perfectly fine, but their fourth infection, they happen to get in a low estrogen week, whether they were cycling or now they were in perimenopause. That happened to me. I was in my early 40s when I had my initial Covid infection. There’s a bit of vulnerability around that that I don’t think has been fully restored as much as it could be in the research. The other thing that has been found in the research is that every person with long Covid has low cortisol at the time of their Covid infection, so that’s a sign of either acute or long term chronic stress. I think many of us who are sort of high achieving, if you’re at Duke physical therapy school, I’m sure that you’re a person who, you know, has been maybe active, athletic, good grades. Tell me about your history of that.

Dr. Jessica Drummond (00:16:49) – Like you tend to be a good student, right?

Terry Brown (00:16:52) – Yes. Sometimes I have imposter syndrome. When I think about the fact that I’m at Duke School of Medicine, but in my undergrad I was more often or not in the library until 10 p.m. 11 p.m. less social than some of my peers and some of those moments, but really focused on achieving this next step, which was graduate school and I danced growing up. But other than that, I didn’t do any other sports into undergrad. But I just mean physically active, just walks and runs and going to the gym. But I have had very debilitating at times anxiety. I was in fourth grade and I’ve been treated various places in my life for that. At one point in high school, my anxiety kind of manifested into heart palpitations that would cause me to pass out. And so and then like fourth grade, it manifested as I would just every after we learned about storms one year and fourth, the one section and fourth grade. And we had to watch this video about like tornadoes and storm systems.

Terry Brown (00:17:44) – And then for about three months after every morning, I would throw up or almost throw up when I got to school because I was just, like, so scared of the storm and the impending doom. And that was my earliest memory of anxiety. So definitely cortisol levels have always been something that I’ve had that relationship with.

Dr. Jessica Drummond (00:18:01) – Yeah, yeah. So, you know, another possible picture as we kind of look at some of the potential Achilles heels or like slight vulnerabilities that someone might have that would set them up during any given Covid infection to be in a more challenged immune post recovery situation. Low cortisol, which if you have chronic anxiety that can relate to the hypothalamic pituitary axis. And over time, especially since this has been since you were in fourth grade, you know, your cortisol could be suppressed, it could have happened. It could have been more suppressed by simply the stress of the Covid infection. So I think what I’m seeing clinically is that the Covid infection is often like a big fire that can reveal some deeper vulnerabilities that really weren’t present, like you were a healthy kid, you were an active kid, you eat well.

Dr. Jessica Drummond (00:18:55) – You studied. You weren’t a huge partier. You know, there’s a lot of things you were doing, right. You were doing your best to rest and recover. You took a gap year. So this is a very strong virus on its own, even for people that are very healthy. And there are some aspects of being very healthy, which actually also set you up for this more long term presentation. And that is having more Ace receptors in your heart and lungs and cardiovascular system. These two, yes, Ace2 receptors, which is one of the receptors by which Covid enters it, also can potentially enter via the acetylcholine receptor, which is interesting around, again, like the ability to regulate your autonomic nervous system and kind of settle your system. And it’s really interesting that one of your anxiety symptoms was heart palpitations and passing out. I’ve seen this often that another expression of long-covid is a combination of hypermobility, dysautonomia, and mast cell activation, which is kind of another immune dysregulation which causes rashes and allergic type presentation.

Dr. Jessica Drummond (00:20:07) – So you said you were a dancer, which is very common. Any history of specifically that you’re aware of around chronic rashes, allergies, excessive flexibility, things like that?

Terry Brown (00:20:19) – I did actually, I meant to mention that my eczema has been the worst it’s ever been. So it’s like December or winter of 2022, and I’ve had eczema issues that I have not had since I was young in this past year and a half, and then also add over the summer, I rushed to get some poison ivy in a strawberry patch, and it took me like two months for my body to finally get rid of the rash. And I use so many treatments and it spread, and it was a very severe reaction to that. And just my overall allergies have just increased. So that’s something I’ve been dealing with for as hypermobility. I do have a sibling who is underneath the Ehlers-Danlos umbrella. Diagnoses. They originally diagnosed her with Marfan as a child, but they’ve been kind of second guessing that diagnosis and doing some more genetic testing.

Terry Brown (00:21:07) – But I do have some ligaments laxity in my hands that I’ve noticed in my finger joints, and I just am generally hypermobile in some areas my spine, especially during my musculoskeletal diagnosis class this past summer, they would use me as the example for a hypermobile patient that you might need to work a little differently on, compared to a more stiff patient.

Dr. Jessica Drummond (00:21:28) – Yeah, be careful of those little joints. Yeah.

Terry Brown (00:21:31) – Right, right. Totally. Since I’ve been in physical therapy school, I’ve been much more focused on strength training because I’ve seen that longitude of, oh, they were really hypermobile as a kid, super flexible. That was their like party trick. And now they have joint laxity and subluxation as they age because they didn’t strengthen those joints. So that’s kind of been a focus of my strength training. But long winded answer to, yes, I do have some of those things, and I have a family history of that Ehlers-Danlos Marfan syndrome umbrella.

Dr. Jessica Drummond (00:22:00) – Yeah, that’s really valuable. I’ve seen that many, many times among people in our clinic who are vulnerable to the more long Covid expression.

Dr. Jessica Drummond (00:22:07) – So now that we kind of know the backstory story and some of the red flags of vulnerability that you experienced, how do we move forward? So in our practice, we use essentially this seven step systematic approach to help people really just recover each system. Because Covid and these other viruses and bacterial infections that you’ve had continued to kind of knock down the immune resilience And the immune system doesn’t just function separately and independently of the other systems. We have to work with all of the systems together. So step one is really helping with nervous system regulation. So there’s three states of the autonomic nervous system sympathetic upregulation, which is that kind of active tachycardic anxiety free state, which is dorsal vagus nerve activation of the parasympathetic nervous system. So that’s like someone who just kind of finds themselves, like stuck, can’t move forward, can’t take a lot of action, like just stuck in doomscrolling, you know, the brain just feels stuck or ventral vagus nerve activation of the parasympathetic nervous system, which we know of as rest and digest calm aliveness.

Dr. Jessica Drummond (00:23:28) – When the autonomic nervous system is in that state, we can live this sort of calm, and that’s the state that the body can then do its healing work in. So being in the midst of physical therapy graduate school, this is a challenging thing to do. But would you just on a day to day basis, how often are you in each of those three states?

Terry Brown (00:23:53) – So I’m in a little bit of a curriculum change right now. I think if you’d asked me that question a few months ago when I was kind of in like the most the semester, they warn you about almost constantly, like the sympathetic response I would do school. When I woke up in class, a class was ran from 8 to 5, and I would typically do homework and studying until 11 at night. And then I would go to bed and wake up around like 630. So I feel like every waking hour with school or stressed or trying to figure out how I’m going to fit in my life outside of school. But right now I’m in the bridge period to clinical rotations, so my class schedule is decreased.

Terry Brown (00:24:28) – I’m able to find moments where I can pick up my hobbies again, and I’ve been trying to be mindful about finding moments where I force myself to put away the phone, try and get into that calm state. But I live in a sympathetic situation a lot. A lot of just like constantly having like, unclench my jaw, slow my heartbeat, do some like diaphragmatic breathing to slow everything down. I’m pretty conscious of that throughout the day, especially at night. I do that a lot. I count down from 100 with diaphragmatic breathing to fall asleep at night typically. So who I am, I live in that sympathetic state, that kind of high anxiety, high always on state. But I am better compared to a few months ago at getting into some rest and digest states, chilling out a little bit of.

Dr. Jessica Drummond (00:25:14) – Yeah, that’s really, really good. That number one, you have some awareness of it. And number two, that you already have some tools. Breathwork is one of my favorites because it’s readily accessible.

Dr. Jessica Drummond (00:25:25) – Everyone can do it. I strongly recommend one of the things we use in our practice is a watch or a ring, to help monitor your heart rate variability. Do you have anything like that? I do.

Terry Brown (00:25:37) – Yes, I wear Apple Watch every.

Dr. Jessica Drummond (00:25:38) – Day. Okay, great. So monitoring that and maybe even just like setting a little timer every couple hours and doing a bit of breath work. Just noticing when you’re in that sympathetic upregulation and practicing learning to live in calm, liveness or ventral vagal activation will be a really valuable skill for you as you navigate a clinical career. Because, as we mentioned earlier, there’s some levels of mitigation like being in a hospital, having access to PPE, that sort of thing. But living in that ventral vagus state will help give your immune system more resilience, because when you’re living in a sympathetic state, your nervous system is actually activating your immune system to be kind of in that chronically inflamed, high alert state and relatively higher blood sugar. Because the immune system preparedness of fight or flight is evolutionarily about an active immune system.

Dr. Jessica Drummond (00:26:44) – In case you encounter a bug or whatever, or you get injured, you know, literally running from a tiger. But that’s not adaptive long term because it does shift people into a more chronic, inflammatory, a slightly dysregulated metabolic situation, and one of the newest papers that’s come out around long Covid and metabolic health is that taking metformin with an active Covid infection can reduce long Covid risk by 40%. So that’s a useful tool potentially to talk to your physician or your medical team about, but also if in case you ever get Covid again, which I mean, I think most of us will probably at some point, you know, but also on a regular basis, using your nervous system as a tool to rest your immune system. Does that make sense? It does. So I would start with that. And then our next step is we think about your particular goals. So health is a continuum right. One end of the continuum is death, but the other end, optimally healthy, is a highly variable and subjective state.

Dr. Jessica Drummond (00:27:55) – So I would love to hear from you. What is your definition like? If you could wake up in six months from now and feel resiliently healthy, what would that look like to you?

Terry Brown (00:28:04) – I think this morning or early today, I was in the gym and I was like so weak compared to what I typically could do. But I start my period tomorrow. So I guess within the laws of my menstrual cycle and all that, it governs my body. I think being healthy would be able to each day accomplish the physical activity exercise I set up for myself so that I can strengthen myself and become strong within my subjective definitions of strong. I think it would look like being able to enjoy public spaces and high groups that having a kind of underlying fear of if I’m going to be sick in three days, because I do currently have that. In grad school, my main income has been babysitting on the weekends, and I absolutely adore kids and I adore babysitting. But same thing. They cough and I’m like, oh my gosh, am I going to miss a week of school now because my body can’t fight off what it used to fight off.

Terry Brown (00:28:55) – So I think feeling healthy, strong, able to do my exercises, but also just being able to go a few months without getting knocked down in bed for a week. Sick because most of my gaps have been like, I’ll get really sick, I’ll be recovering, I’ll make it like a month and a half. And then the same thing, you know, start cycling over again. So I think that for me, health would be waking up able to go about my day with high energy levels, not need a nap throughout the day, not rely on heavy amounts of caffeine, and then have confidence in my immune system to protect me against the daily amount of germs that I come into a counter with.

Dr. Jessica Drummond (00:29:29) – Yeah, yeah, that’s a beautiful vision. And I think there’s a lot we can do to get there. All right. So that’s the vision. We’re going to hold on to you, that you feel a sense of resilience, that you’re also more physically resilient and strong and able to tolerate exercise.

Dr. Jessica Drummond (00:29:43) – One of the things that I noticed with my long Covid experience was I didn’t ever really feel hypermobile, but I was always very strong. I was a gymnast as a kid, and I’ve lifted weights like my whole life, and then suddenly I couldn’t really exercise for several years. Then the hypermobility, you know, vulnerability was expressed. And I think you’re seeing that same thing, too, like you were a dancer. You always exercise. Now you see the real value of strength training. And I think that’s key for some people with long Covid they cannot strength train, at least not yet. But since you can and we’re going to work on your mitochondria a little bit more to give you even more capacity for that. And what I might suggest is that we integrate more recovery. So you think of yourself a little bit more as like a professional athlete. I watched a wonderful documentary on a number of NFL quarterbacks recently that was really inspiring, and they get in kind of a car crash every weekend for, you know, think of the hits they take for whatever long the NFL season is.

Dr. Jessica Drummond (00:30:44) – Then one of their trainers was talking about how, like day one post game is really about mobility, which is balance. And you know, this well, being a physical therapy student balance, mobilization of the fascia and the joints and the tissues around the muscles, and not so much heavy strength training, just mobilization, gentle stretching and mobility. And then the next day is about agility. So you’re going to be lifting weights but lighter weights with more challenging positions. So let’s say you get knocked off kilter. You know you’re lifting multiple functional movements, not just one isolated strength training exercise. And then you could use the rest of your week to. And so that could look like day one is maybe a Pilates session or something similar to that or a mobility session. Day two is more functional movement. Day three might be lower quarter. Day four might be a complete rest and recovery, which could utilize some of the restorative tools like cold immersion or red light bio modulation therapy to help give the mitochondria and a boost and the inflammation suppressed.

Dr. Jessica Drummond (00:32:07) – So those are some tools that I find really valuable for those that struggle with exercise at all, because it’s like you can’t get oxygen to your muscles. It doesn’t sound like that’s really your situation. Would you agree? So some people post-Covid feel like they can’t really get oxygen to their muscles for them. And for this like deep fatigue, I do really like a longer term recovery period, probably for a couple months before starting any progressive exercise with hyperbaric oxygen and red light therapy to support getting oxygen to the tissues and to support the mitochondria. But for your case, I don’t think that’s necessary. I think the tools would be more about anti inflammation and slow pacing of what you really dividing up your exercise bouts. So there’s like a recovery day almost in between every exercise day. It could be mobility but not heavy, lifting more than 3 to 4 times per week. But doing that, I think as much as you can tolerate will be good to help. Getting that stability back and walking in nature is like your best friend.

Dr. Jessica Drummond (00:33:15) – Swimming would be fine too, but lots and lots of outdoor walking. Duck has a beautiful series of trails, right?

Terry Brown (00:33:23) – Absolutely, yes. The gardens are perfect right now, so.

Dr. Jessica Drummond (00:33:27) – Yeah. Oh, yeah. And it’s spring. I mean, perfect. Absolutely. I used to work at Duke Hospital a long, long time ago.

Terry Brown (00:33:33) – Yeah. You take your breaks in the gardens, I’m sure.

Dr. Jessica Drummond (00:33:36) – Yeah, yeah. My husband used to be off every Friday, and he would, like, love that because he would just come over there and run.

Terry Brown (00:33:42) – Absolutely. Yeah. It’s a good area, the community as a whole for getting outdoors. I do try and make that a now that it’s getting warm, at least during the winter. I can’t say that I focused on that absolutely.

Dr. Jessica Drummond (00:33:53) – Well. So those outdoors, so I like to call it mindful cardio, will also help with shifting you back into that rest and digest calm aliveness state. So walking rather than high intensity cardio because we do have research on athletes that heavy training does suppress the immune system.

Dr. Jessica Drummond (00:34:12) – So for you, there’s going to be this nice balance between maybe 3 to 4 days of strength training, mobility and recovery, and gentle flexibility of the muscles more than the joints and lots of outdoor walking to your tolerance, but really limiting things like running and spin class and stuff like that, until we recover your immune system to have more resilience.

Terry Brown (00:34:38) – So how would I know that I’m recovered?

Dr. Jessica Drummond (00:34:40) – Well, one step would be don’t get an infection every day, you know, let’s go like six months without an infection. And then we’ll consider a little bit of heavier exercise.

Terry Brown (00:34:51) – Have some more faith in my immune system. Okay. I’ve been like, kind of following five on two off for my week of exercise. And I try and do I separate my systems in terms of upper body, lower body core and then cardio. But I definitely could put some more gaps in there, I think.

Dr. Jessica Drummond (00:35:07) – Yeah, I think a focus on recovery will be good because we’re looking at optimizing your musculoskeletal and cardiovascular fitness because also your cardiovascular system.

Dr. Jessica Drummond (00:35:16) – We need to talk about in a minute. But we don’t want to push it too hard because right now your general immune system is suppressed. And we really need to improve it because it’s not just Covid. You’re also dealing with, you know, pneumonia, history and bacterial infections, viral infections with the flu, Epstein-Barr. So it’s just generally suppressed. We need to take care of that. And then so in step two we’ve defined your goals. Step three and even further refined is like, let’s go six months without any kind of illness. It’s like a kind of an action step, something we can. No, I.

Terry Brown (00:35:50) – Would love to just have allergies for these next six months. That’d be like my only complaint for the doctor was allergies. That would be like my gold standard, right?

Dr. Jessica Drummond (00:35:57) – Allergies or less. Let’s try to get rid of the allergies too. We’re going to talk about that. And then have you done any kind of testing so we know your story. Have you done any lab testing that was significant.

Terry Brown (00:36:10) – Yes, ma’am. So after the viral infection in January of 2023, they did a CBC that was kind of nothing really came up on it. My white blood cells were elevated and a few things were kind of off, but nothing significant. However, February when I went back in after because I had the flu in January, and then I had this spike a few weeks later when my fever went back up high after I was complete with the Tamiflu, and I was like, please, I was like, just do a full lab workup. And that was conclusive for high white blood cell count. But they said it wasn’t enough to be extremely concerned, and it just matched the picture that I just been sick. I mean, I’m sure I’ll speak to this, but every single doctor that I’ve been like, this is not my normal. Something’s wrong with people. You’re stressed. And so my new annoying thing is people love to tell me, you see, to go eat some oranges or something. Like, you seem to get your vitamin C up and I’m like, you don’t think I’m thinking about those things? I’ve been sick for a whole year and a half.

Terry Brown (00:37:04) – But yeah. So the doctor ran a bunch of bloodwork to CBC, lipid blood plant panel.

Dr. Jessica Drummond (00:37:11) – Real lipids, looking good.

Terry Brown (00:37:12) – All those things. Everything looks fine. Yeah.

Dr. Jessica Drummond (00:37:15) – Was your vitamin D level tested?

Terry Brown (00:37:17) – I can pull it up right now. Okay, great. The only thing they pointed out was the white blood cells. And then that my chest X-ray was normal.

Dr. Jessica Drummond (00:37:24) – Well, that’s good.

Terry Brown (00:37:25) – But there was no follow up from that appointment. I looked at the results myself and just.

Dr. Jessica Drummond (00:37:31) – Oh, they didn’t even really, like, talk to you. That’s terrible.

Terry Brown (00:37:35) – Yeah, they call me that. My chest X-ray was good. And then that was, I think, all I talk through with them.

Dr. Jessica Drummond (00:37:39) – Oh my gosh. You know, while you’re looking up that data, this is a quick time to know that. Look, if you are struggling with long Covid or chronic, what feels like you’re getting sick all the time in this Covid experience of time? I guess in history, the medical gaslighting is intense, and I think it’s because the medical community just can’t wrap their heads around this.

Dr. Jessica Drummond (00:38:02) – It’s too overwhelming to think about that Covid is not going away and it’s not really going to weaken, or at least it hasn’t yet weakened and become similar to the flu. It’s a very difficult virus and it’s impacting people really in a large way. And I think just people who are having to deal with it day to day just can’t. There’s a lot of cognitive dissonance going on. So it’s not you, it’s them. Okay. Any vitamin D info. Did they test that?

Terry Brown (00:38:32) – So I’m looking through this now. I’m not seeing vitamin D, but it does show I forgot this that my neutrophil count was really high and my lymphocyte was low. Neither of those were insane, but both rang up as high neutrophil low for lymphocytes, and my white blood cells were pretty high coming in at 12.5 with normal being 9.8. Let me check this one other one. I’m not seeing vitamin D tested, but it seems like they would want to test it.

Dr. Jessica Drummond (00:38:59) – Yeah, you would think but we can do that. We can ask them.

Terry Brown (00:39:02) – I have a comprehensive metabolic panel and a complete blood count. Those are the two they gave.

Dr. Jessica Drummond (00:39:06) – Okay, so the CMP, how was your fasting glucose?

Terry Brown (00:39:10) – The glucose was at a 79 okay.

Dr. Jessica Drummond (00:39:12) – That’s good. And you said your cholesterol and all of that was normal.

Terry Brown (00:39:16) – Cholesterol.

Dr. Jessica Drummond (00:39:18) – Any homocysteine. Do they test any of those inflammatory markers.

Terry Brown (00:39:22) – Would it be listed as homocysteine on this breakdown.

Dr. Jessica Drummond (00:39:26) – that would be one or crp.

Terry Brown (00:39:29) – I do not believe so.

Dr. Jessica Drummond (00:39:30) – All right. That’s fine. We can circle back to that. So we have the story. We have the picture. We know kind of your underlying vulnerabilities. We talked about the exercise piece to being less stress to the immune system and your nervous system. We’re going to add in breathwork a few times a day tracking your stress. Now as we go through the systems. So we talked about nervous system. Really a key recommendation and strategy for you is to keep bringing that nervous system back into rest and digest using the tools that you already have. And we can always expand on that.

Dr. Jessica Drummond (00:40:05) – And then using exercise as a nourishing thing, strengthening of the musculoskeletal system, especially the joint stability and that mindful cardio. And then we start thinking about the immune system is about 70 to 80% intertwined with the digestive system. And so we have to think about the gut microbiome and the digestive function. So if you think about your digestion pre all the sickness how was it, you know, normal bowel movements, any abdominal pain, any bloating, any heartburn, any kind of digestive issues ever.

Terry Brown (00:40:42) – Yeah, especially in college. I don’t recall a lot from when I was younger. I always had just kind of a more like sensitive stomach. But in college, within my first about two months, I went from eating dairy all the time to not being able to tolerate it. It just kind of give me a stomach ache and kind of like give me a headache. And then by my sophomore year, I would like throw it for 12 straight hours if I had dairy. And that summer between sophomore year and junior year, I was at my parent’s home for that summer and every 72 hours to 3 to 4 days, I was throwing up like violently.

Terry Brown (00:41:19) – And they couldn’t figure out why they did all these tests to see allergies. Nothing was showing up as allergic. They diagnosed me with Gerd, which I didn’t really necessarily agree with just because I didn’t really fit the demographics of that diagnosis. But I think all they could reason was that I was throwing up a lot. I was having constant reflux. My weight was dropping just because of constantly, like couldn’t keep anything down. They gave me a bunch of food restrictions. I followed the Fodmap diet for a while and for about a year I worked on like healing my gut. So sophomore junior year was like completely just. I could eat no pepper. I didn’t eat garlic. I didn’t need tomatoes, I didn’t eat onions. I ate like bland, plain pasta, unseasoned chicken. Just the most boring diet you can imagine for that year to kind of heal my gut. And I was no longer getting sick. But I never had an answer. And they also put me on a pretzel for that whole year, which I was really not super happy about, has a lot of side effects and a pretty rough long term effect of that medication on my liver and my kidney.

Terry Brown (00:42:18) – So I was kind of focused on getting off that as quickly as I could. I was extremely sick for about a year. Constant bloating, really severe abdominal pain, IBS symptoms, it be between ibs-c and then IBS d back and forth. And then just like throwing up so frequently and like I said, it wasn’t just about throwing up one thing. It’d be like I’d have to empty out my whole system every few days. Never really got answer for that. Eventually it went away. I’m back to eating normal now. There’s some things. I hurt my stomach more than others, and they never have understood why. Dairy? Because it does. Because I’m not allergic to it and I’m not. So I guess I just kind of figured lactose intolerant like some of the other people, but I don’t know. So GI has been a huge part of my life. Most of college. That’s like what I would have been my most significant complaint.

Dr. Jessica Drummond (00:43:04) – Interesting. So are you on any medications now other than the hormonal birth control?

Terry Brown (00:43:09) – I am on fluoxetine, fluoxetine, 20mg for anxiety, and I had an eating disorder about that same time when I was throwing up constantly freshman year through that, which obviously that being told there’s more and more things I can’t eat was pretty hard because I was already kind of restricting.

Terry Brown (00:43:26) – And so they put me on that for anxiety control and I’ve been on it since.

Dr. Jessica Drummond (00:43:31) – Okay. So absolutely, optimizing your digestive resilience could really be key to helping your immune resilience. And how we do that is do you struggle with any kind of constipation.

Terry Brown (00:43:46) – Early on my period.

Dr. Jessica Drummond (00:43:47) – Okay. So I always start with what I call opening the windows and doors. So if anyone listening is dealing with constipation, that’s the first step of getting things moving. And then we think about how you eat as much as what you eat. So I wouldn’t with a history of eating disorder, really think about a lot of restriction and said I would be thinking about what to add. And at first we want to add things that are very easy to digest, that you feel comfortable cooking in your sort of grad school life, right? So I often start three meals a day. Even with soups or stews. It’s easy. You could bulk cook it. You can have it for breakfast, lunch and dinner. Broths, bone broth in particular would help.

Dr. Jessica Drummond (00:44:30) – We probably, in your case, need to start healing the lining of the small intestine so bone broth can be very nutrient dense. Then we can add cooked vegetables, cook cruciferous vegetables really good for the liver and to feed the gut microbiome. Leafy greens, you know everything like asparagus, mushrooms and all the non-starchy vegetables, but also things like squashes or sweet potatoes and sources of protein. In your case, I would do a nice, almost a mediterranean balance between animal proteins from as clean of sources as you can get, because we need to add nutrient density for you, especially if you’re trying to build strength. But also there’s a lot of healing to do. And the body needs some protein for that amino acids at least. And then layer that with beans and lentils. Again, I think they’re going to be easiest for you to digest with the least bloating if we do them in soups. But it’s okay to eat like the occasional eat in brand, for example, which is a canned bean brand makes them with kombu, which is a kind of seaweed which helps with their digestibility.

Dr. Jessica Drummond (00:45:42) – So say in the later, like summer to early fall, you may be better able to tolerate more salads and you could add some cooked lentils, some beans from Eden or some cooked beans. Chickpeas have actually been shown to reduce Covid risk because of the type of fibre in them. I actually read a recent book by a gastroenterologist. I forget where she was practicing. It might be Johns Hopkins, a anti-viral gut, if you will. And there is also some good research that the risk of Covid is decreased with a plant based diet. In your case, I probably wouldn’t go entirely no meat or no animal products because I do think you need the amino acids that are more bioavailable in animal proteins, but you can still be very plant heavy. And the reason why that’s so good for the gut is it actually helps build the beneficial microbiome, which is a key part of your immune system, but it’s also a key part of the gut microbiome heart brain axis. So a lot of your symptoms beyond the fevers and are things like tachycardia and dysautonomia.

Dr. Jessica Drummond (00:46:59) – And the healthier the gut microbiome is, the healthier your heart will also be your heart rhythm. Does that make sense? Because as the gut microbiome is essentially more diverse, more robust, more grounded, and that will help in a more optimized immune system. The gut microbiome also has direct conversation with the brain and the nervous system, which regulates the heart rhythm. So that heart arrhythmia stuff is not always a heart issue as much as it’s an autonomic nervous system issue. And so I would really suggest that we think about a very diet for you to your tolerance. You know, there’s really no I wouldn’t limit. In fact, I would add anti-inflammatory herbs and spices. But you could start with things that are less spicy, like rosemary and ginger and cinnamon. Fennel is really nice for adding digestive enzymes, and then how you eat is another opportunity to shift to that calmness, rest and digest. Eating, sitting down, undistracted, you know, chewing really thoroughly like 20 times per bite and then, you know, allowing the system to really move.

Dr. Jessica Drummond (00:48:15) – I would also support in your case, and we may not have time on this episode to get into all of the supplemental recommendations yet, but since your acid was suppressed for so long and now you have some energy suppression from this chronic infectious issue, adding just a little bit of diluted apple cider vinegar before each meal can help stimulate stomach acid, which we need to prevent some of these more bacterial infections to the gut. So which could be a part of why you were chronically nauseous? There’s a lot that could be going on. There could be some food sensitivities, could be an autonomic nervous system thing. But having enough stomach acid is actually really important to activating B12 and to activating the enzyme that helps with breaking down protein and then digestive enzymes can be really valuable. And there are lots of great quality brands of digestive enzymes. I like seeking health for people that have this more histamine picture. You were talking about the eczema flare. So Seeking health is a company that most of their enzyme products. There are two enzymes I could take with them with food are good with a histamine picture.

Dr. Jessica Drummond (00:49:27) – One is a Dao enzyme. I think they call it histamine digest, and the other is just their general digestive enzymes. But there are lots of great companies that make digestive enzymes, designs for health and transformation enzymes, enzymatic, and there are lots of good ones. So adding some support for your digestive juices, because those take a lot of ATP and likely your mitochondria are suppressed by all these chronic infections. Right? You’re more fatigued. So if we can boost that a little bit, that can be really valuable. And then just movement. Right. This is where the mobility comes in for gut motility. Walking is really helpful for consistent gut motility. Even a little bit of caffeine in the morning. I’m not opposed to that in the short term for you because, you know, we’ve got to kind of keep it going, but adding more nutrient density, eliminating or reducing things like sugar, alcohol and processed grains is going to be very helpful. But we make this shift over a couple of weeks to a couple of months to your tolerance, and so that will support digestion.

Dr. Jessica Drummond (00:50:36) – The other thing that we can do to support, like mobility and motility of digestive system is visceral physical therapy. We could also use things like castor oil packs and just simply making sure you have like a nice squatty potty. Your bowel function, as regular as you know, the brain and the bowel like routine. And so that routine is key. And even just like your morning routine, your evening routine. And then if we circle to the cardiovascular system, there is an impact in most cases of Covid to the vascular system, because that’s one of the places where it comes in. And we do know that there’s clotting risk that’s increased post Covid and there’s risk to the vascular epithelium, which is why people have risk of younger strokes or just other kind of micro clots that can make it harder to get blood to the muscles, which is another reason why people struggle with exercise tolerance. So from a nutrition standpoint, one of the ways we can support that is using things like beet powder, greens and reds powders.

Dr. Jessica Drummond (00:51:42) – And then specifically there are two products by a company called calorie is the supplement company and one is called Vacinacao. It’s a version of beet powder. So you can just get beet beat powder at Whole Foods. That’s one option, but there’s also a little bit more specificity to that, which helps with the vascular nitric oxide. So your ability to expand those vessels which also by the way can come with that slow breathwork. So there’s lots of ways we can improve nitric oxide. And then to heal the lining of the arteries and the vascular epithelium we can use things. The other product by Collaroy is called I think it’s called Arturo SIL or something. It’s something that looks like artery. What it’s really made of is a lot of polyphenols. So we can be thinking rainbow diet for the digestive function and also for the immune function, but also to heal the vascular epithelium and really pacing the exercise to your tolerance. And then the other thing that can really help with cardiovascular health is omega three fatty acids. So either eating sardines or taking fish oil or SPM mediators, which is like a very concentrated version of fish oil metagenomics has a good SPM mediator.

Dr. Jessica Drummond (00:53:05) – I don’t have any ownership of any of these supplement companies. They’re just some good quality brands. And you know, anyone can ask me questions about that. But I would suggest that we really think about building the quality of your diet as a way of really optimizing your recovery. And then the other thing that can help is there are two lab tests. I would suggest you ask your medical team for one, is your vitamin D level. Vitamin D is very protective for the immune function, and the other is any measures of inflammation they’re willing to do, whether that’s homocysteine, CRP, CRP, and it can be valuable after two Covid infections to look at your D-dimer just to be mindful of clotting risk, it doesn’t sound like you’re not really presenting with that sort of a picture, the kind of micro clots and clotting. In fact, it doesn’t really seem like a major part of this conversation. But I think anyone who’s had, you know, three mRNA vaccines and two infections within three years, you know, it’s just at risk for that.

Dr. Jessica Drummond (00:54:16) – So it’s worth checking your D-dimer at the minimum. We can also look at other clotting factors for people that have more challenges with clotting like fibrinogen and things like that. Or if you have a genetic risk factor for clotting. So I think given your key goal of energy, the last thing I want to talk about is mitochondrial function. So red light therapy is more and more accessible in like recovery type gyms. Do they have anything like that in Durham these days?

Terry Brown (00:54:49) – I can look it up. There are a few recovery centers so I can see if they offer. I’ve never looked at it before.

Dr. Jessica Drummond (00:54:55) – It’s worth looking at, you know, that could be valuable. And with the chronic viruses of things like Epstein-Barr, and if you have other chronic issues, like you said, you know, like in the dorms, perhaps mold was an issue or things like that. I.V. ozone can be helpful for sort of cleaning up some of those more chronic viruses and underlying toxins. So some of those recovery gyms will also offer low dose ozone therapy or a naturopathy clinic, which I do like.

Dr. Jessica Drummond (00:55:29) – I like to start with low dose because it can make your symptoms a little bit worse before they get better. So we’ve talked about oh, and then the other thing to support mitochondrial function is CoQ10. Usually within a or NMN in a nucleotide mononuclear it’s nicotinamide mono nucleotide. It’s a form of a B vitamin also helpful for longevity. So those are some nutrients. Now urethane A is actually developed from the gut bacteria. So the stronger we get your gut bacteria the better. Starting with food. And then there are some specific probiotics and things which I would recommend adding. But let’s add these in one thing at a time. You know, this is going to be more than enough for you for a while And for anyone listening who wants to do more of this. We teach this in detail in our Functional Nutrition course, so there are lots and lots more supplements we could dive into and strategies. But you know, we don’t want this episode to be two hours long. But for now, I think dialing back your exercise, really focusing on recovery, rebuilding the gut microbiome.

Dr. Jessica Drummond (00:56:44) – And you could gently do a little bit of probiotic food if it doesn’t flare your eczema. There’s a gentle balance between histamine and fermented foods. So the biggest driver of histamine is going to be things like alcohol and processed meats. But sometimes those fermented things like sauerkraut and, you know, even dairy free yogurts. Just be mindful of how it impacts your eczema. And then for the mitochondria, rest in between but also the nutrients of mitochondria and your life. And a in particular is made by the gut bacteria. It’s hard for us to know if you have the right species to make your life in a. So you could take that as a supplement. But if you do, and you could just test this and see how your energy goes after a few weeks simply eating more foods that feed the gut, bacteria that make your life an A. So that’s things like berries and pomegranate, cranberry, stuff like that. Colorful berries help to feed that. So you could add some of those gut friendly nutrients like make a chia pudding and then add berries and pomegranate seeds and things like that.

Dr. Jessica Drummond (00:57:56) – So how does that feel as a place to begin?

Terry Brown (00:58:00) – Good. Some of the supplements I’ve already been taking. I have a juice maker machine, and so I do a lot of those. And I actually have a friend that we made beet juice recently, so I think I might just find recipes where I can add that in more regularly, but it all feels very doable. I do have one question. So one time I tried the acid apple cider vinegar before and I just didn’t like it. Could I do a gummy? Is that okay? Like apple cider vinegar gummy? Yeah.

Dr. Jessica Drummond (00:58:24) – You could or you could also just really dilute it. So it’s like one tablespoon of apple cider vinegar to like eight tablespoons of water. But yeah they also have apple cider vinegar gummies and capsules and stuff.

Terry Brown (00:58:36) – That’s I guess I have to see how much sugar is in those. Yeah.

Dr. Jessica Drummond (00:58:38) – So that’s the only downside because we’re trying to, you know, remodel the gut. But yeah.

Terry Brown (00:58:43) – Right Okay. Perfect. Yeah.

Terry Brown (00:58:45) – And I do have some I use or gain protein products and I have their immunity juice powder, which has like so many fruits and veggies. Dehydrated.

Dr. Jessica Drummond (00:58:54) – Love that. Yeah. So greens and reds powders can be good. And I think for you, given your history of kind of dropping weight and, you know, adding some protein, the other thing that can be very valuable to add right around your workout is between 5 and 20g of creatine. So creatine is kind of another nutrient that helps build muscle and bone. And they’ve tested this. It’s a very safe nutrient that’s been tested in postmenopausal women who had osteoporosis. So I really like that during the 20s when you have your opportunity to still build up.

Terry Brown (00:59:30) – And is there a decision like is there better Or before the workout or after?

Dr. Jessica Drummond (00:59:34) – It’s any time within 30 minutes to about an hour and a half around the workout. So what I tend to do is just sort of put it in my workout water bottle and just drink it during the time of the workout.

Dr. Jessica Drummond (00:59:45) – Awesome. All right. So and that’s something you could integrate those days when you’re doing the strength training. So and then the final thing I want to mention before we wrap up today is we do have to think in terms of mitigation, because ultimately the fewer infections you get, the better. So now that it’s summer, you know one thing when you’re in classes or in clinicals or things like that, it would make sense for you to wear a mask, at least for the next six months. While we’re healing your system, we can reassess that, or in public, like in a movie theater or whatever, indoors with a lot of people. Absolutely. Your best protection is a mask. There are a few nasal sprays on the market. I’ll put those in the course to that you can use. One of them is called engVid, but there are others too, that have been shown in clinical research to clear a lot of Covid from the nasal passageways, you know, so that’s something good to have on hand.

Dr. Jessica Drummond (01:00:45) – But I do suggest a Kn95 and N95 or a Can 94 mask respirator any time you’re in an indoor situation with other people, because just all of our other mitigations have been minimized. Now, in your own home, or when you want to, like, deliberately meet up with people, you can use Hepa filters. And the safest thing, one of the best ways is just more outdoors. I do think it’s important that we keep within the conversation these mitigation factors of Hepa filters for UV light. Nasal sprays they’re CPC mouthwash, which I believe is in scope and crest a lot of the main brands. Again, if you’ve been exposed or you’ve been around people and weren’t masking for whatever reason, you can also just rinse your mouth with the CPC mouthwash. I don’t suggest doing that every single day, because we want to really strengthen the mouth microbiome so you can brush your teeth with dental side in, which is basically an herbal toothpaste, you know, use oral probiotics because we want to build that resilience from the mouth all the way through the digestive tract.

Dr. Jessica Drummond (01:02:01) – But, you know, if for whatever reason, you find yourself in a room with a lot of unmasked people and or you might have been exposed. It’s another little mitigation tool. So there’s not one perfect mitigation tool, but I think we need to keep those within the conversations around our closest friends. And the simplest way to do it is just to be like, you know, I’ve been really sick for 18 months. I’m working with my health team, and my first goal is to be virus free for the next six months. So I’m going to commit to doing what I need to do, including sometimes wearing a mask or only meeting with you outside. Luckily, we’re stepping into spring where you can meet for brunch outside. How does that feel? I know it’s really hard to do those things.

Terry Brown (01:02:51) – I think it can be hard, but I think also I’m entering a season of school where that’s going to be easier than it might have been earlier. It’s also, like you said, this is not a sustainable way of life where I’m getting seriously sick and relying on antibiotics or antiviral medications just to get past each one.

Terry Brown (01:03:08) – The pneumonia and the mono both really took a hit on me, so I think it’s important to not get sick again.

Dr. Jessica Drummond (01:03:13) – Yeah. And I really think in your case, optimizing your gut microbiome is going to make a huge difference. That’s going to take a little time to remodel that. And then we may later have a conversation about hormonal birth control. Because while there’s some evidence that it can be protective to kind of stabilize the estrogen levels, it It also can deregulate your gut microbiome. And so we may want to revisit is that the best birth control option for you now. But I don’t suggest we change it for at least the next 6 to 12 months. If otherwise, it’s working well for you. Any questions for me?

Terry Brown (01:03:51) – I don’t think so. This has been amazing. Thank you so much. My classmates who heard from you at CSM are all very excited to get my notes, and I guess I can tell them about this podcast episode so they can listen to themselves, but I just appreciated it so much.

Dr. Jessica Drummond (01:04:04) – Oh, absolutely. And yeah, we’ll check in in a few weeks or a month or so and see how you’re doing. But thank you so much for sharing your story. I’m sure you know, if you’re listening to this and you have a similar story, you’re wondering why you’ve been sick every month for the last year, year and a half, two years. You’re not alone. This is really, really common in this, you know, time that we’re in. And so, Terry, I really appreciate you sharing your story and being so vulnerable. And it will really help a lot of people.

Terry Brown (01:04:36) – Thank you so much.

Dr. Jessica Drummond (01:04:37) – Thanks so much, everyone. We’ll see you next time. That was such a great case study. Thank you so much to Terri for sharing her story. It’s so fascinating to me how we can see young, healthy people, you know, falling prey to long term Covid ramifications and the immune system collapse, then sets them up for all of these other infections and health issues.

Dr. Jessica Drummond (01:05:11) – You know, really, this has been going on for her for more than 18 months now, and I really appreciate her sharing some of the vulnerabilities. And we looked at the research and how those vulnerabilities could have potentially set her up and make her more vulnerable for another Covid infection, for more long haul symptoms. And what we can do to start to unwind that picture. I hope you enjoyed starting to get in my head as we take that seven step approach to really systematically unwinding and strengthening and building resilience in all of her systems so that if and when she gets ever another Covid infection, it doesn’t just completely knock her to the ground again and again every month. So that’s the goal. If you want to learn more about how to do that, I am constantly updating our professional education on long Covid. It’s a huge issue and it’s only going to get worse as Covid. These new strains are mutated and there are fewer and fewer public protections and mitigation strategies. I hope to see more cleaning of the air in the same way we’ve cleaned our water and started to wash our hands in healthcare.

Dr. Jessica Drummond (01:06:27) – I think some of these mitigation strategies are no brainers to just be put into all public spaces. You know, schools, Hepa filters for UV light, doing more things outdoors. I think there’s nothing but benefit to be gained public from a public health standpoint, if we integrate more mitigation strategies for the most vulnerable among us, and if you are among the vulnerable, which I’m right there with you, you know, whether it’s genetically or our past history or any number of reasons, there are ways to make ourselves more resilient. And that’s the goal. I hope that case studies showed you a few of the things that you and your clients can do to build resilience and to fully recover from long Covid, which is really, really difficult to do without intense intervention. The data shows that only 7% of people just recover within two years. It takes a lot of intense focus to recover from true long Covid, which this case is an obvious example of that. So thanks so much for joining me today. Join our functional Functional Nutrition Certificate program to learn more, to deep dive, to be even better resources for the client struggling with this in your community.

Dr. Jessica Drummond (01:07:44) – And I will see you next time. Have a great week. Thank you so much for joining me today for this episode of the Integrative Women’s Health Podcast. Please share this episode with a colleague and if you loved it, hit that subscribe or follow button on your favorite podcast streaming service so that we can do even more to make this podcast better for you and your clients. Let’s innovate and integrate in the world of women’s health.