Robert Groysman, MD

02/19/2026

You never felt dizzy standing up before COVID.

You stood. You walked. You functioned. Standing was automatic. Never required planning or caution.

Now standing triggers dizziness. Lightheadedness. Vision tunneling. You grip counters. Brace against walls. Sit back down before you fall.

They checked your iron. Normal. Blood pressure sitting down. Normal. "Probably dehydration. Drink more water."

But you're not dehydrated. And this started after COVID.

Your autonomic nervous system is supposed to adjust blood pressure when you stand. Blood vessels constrict. Heart rate increases slightly. Blood keeps flowing to your brain. Standing happens without symptoms.

COVID disrupted this automatic adjustment. When you stand, blood pools in your legs. Your vessels don't constrict fast enough. Blood pressure drops. Heart rate spikes trying to compensate. Your brain loses adequate blood flow.

This is orthostatic intolerance from dysautonomia. Your blood pressure regulation system is damaged, not your hydration status.

Measurable with a simple stand test or tilt table. Explainable when testing goes beyond "drink more water."

02/19/2026

You never had temperature problems before COVID. Now you're always the wrong temperature.

You dressed for the weather. Adjusted automatically. Hot rooms made you warm. Cold rooms made you cool. Your body just handled it.

Now you're always the wrong temperature. Sweating in cold rooms. Freezing when everyone else is comfortable. Layering up, stripping down, layering up again. Never comfortable. Never stable.

They say it's hormones. Stress. Menopause at 34.

But you regulated temperature fine before COVID. This started after infection.

Your autonomic nervous system manages temperature through thousands of micro-adjustments. Blood vessel dilation and constriction. Sweat activation. Shivering response. All automatic.

COVID disrupted the control system. The sensors work. The heating and cooling systems work. But the connection between reading temperature and responding appropriately is unreliable.

Think of a smart thermostat with a damaged WiFi connection. The temperature sensor reads accurately. The heating and cooling systems function. But the signal between sensing and responding keeps dropping.

The sensor reads 95 outside. The system does nothing. You overheat. The sensor reads 40. The system does nothing. You freeze.

This isn't being dramatic about temperature. It's dysautonomia affecting thermoregulation. Measurable with autonomic function testing.

02/19/2026

Poor sleep improves with better sleep hygiene. Mitochondrial dysfunction doesn't.

You've tried everything. Blackout curtains. White noise. Magnesium. Melatonin. Sleep tracking. Consistent schedule. Eight hours in bed every night.

You still wake up exhausted.

Sleep hygiene fixes sleep disruption. It doesn't fix energy production failure.

Your cells aren't recharging overnight. Mitochondria produce ATP, the energy your body runs on. When mitochondrial function is impaired, sleep can't restore what the machinery can't produce.

Think of plugging in a phone with a broken charging port. Eight hours plugged in. Still at 5%. The outlet works. The cable works. The port is broken.

This is your mitochondria after COVID. The sleep happens. The cellular recharging doesn't. Because the infrastructure converting rest into energy is damaged.

Graded exercise makes this worse. Poor sleep improves with activity. Mitochondrial dysfunction drains faster than it recovers. You start each day with less charge than the last.

This exhaustion isn't behavioral. It's cellular energy production that COVID compromised. And it responds to targeted mitochondrial support, not better sleep hygiene.

02/18/2026

You filed for disability. Denied. Appealed with new evidence. Denied again.

"Insufficient objective findings."

You submitted tilt table results showing POTS. Heart rate jumping 40 beats from lying to standing. You submitted elevated mast cell markers. Tryptase above normal. You submitted neuropsychological testing showing cognitive impairment. Mitochondrial function testing showing ATP production failure.

All denied. Because the forms were designed for broken bones and blocked arteries, not post-viral chronic disease.

The system accepts MRIs. Yours are normal. It accepts EKGs. Yours are normal. It accepts standard blood panels. CBC, CMP, all unremarkable.

The testing that reveals your dysfunction isn't on the form. Autonomic function panels. Advanced immune markers. Mitochondrial stress testing. Small fiber neuropathy assessment. Tests that exist. Tests that demonstrate measurable impairment. Tests without checkboxes on disability forms.

You're caught between two realities. Too sick to work full days. Too "healthy" on standard testing to qualify for support. Functional enough to attend the appointment. Too depleted to do anything for three days after.

The system wasn't designed for what COVID did to you. Like applying for home insurance using a form that only covers fire and flood. Your damage is real. The form doesn't have a category for it.

This isn't your failing. It's a system gap. And millions are standing in it.

02/18/2026

You don't think you're the recovery type.

Other people recover from Long COVID. You see their posts. The gradual progress. The energy returning. The slow climb back to normal.

But you're different. You've always been the person things go wrong for. The one who gets complications. The outlier in recovery statistics.

This is deeper than pessimism. It's a script you've been running your whole life.

"I'm not lucky."
"Good things don't happen to me."
"My body doesn't heal like other people's."

You believe there's something fundamentally different about you. Something written into your biology. Your family history. Your past medical record. You've gathered evidence for years.

And Long COVID feels like confirmation.

But this script wasn't written by your biology. It was written by your experience. By doctors who missed things. By treatments that failed. By hope that didn't pay off.

Your belief that you won't recover isn't predictive. It's protective.

If you don't expect recovery, you can't be devastated when it doesn't happen. The script keeps you safe from hope. From disappointment. From trying things that might not work.

But it also keeps you from looking at treatment options. From trying protocols that work for others. From believing your biology is capable of change.

You are not exempt from recovery. You're protecting yourself from hoping for it.

02/18/2026

02/18/2026

You never had chest pain before COVID. Now it's constant.

Sharp. Terrifying. Wakes you up at night. Makes you check your pulse. Makes you wonder if this is the emergency everyone warned you about.

You've been to the ER three times. EKG normal. Cardiac enzymes normal. Stress test normal. "Your heart is fine."

But the pain isn't fine. And it's real.

Most likely, COVID triggered inflammation in the cartilage connecting your ribs to your sternum. Costochondritis. It feels cardiac. It's musculoskeletal.

Your autonomic nervous system is also involved. When dysautonomia affects your chest wall muscles and blood flow regulation, the pain intensifies. Breathing feels harder. Heart racing adds to the sensation that something is wrong.

Think of a car alarm stuck on. The alarm isn't detecting a real threat. The sensor is hypersensitive. Every minor vibration triggers the siren.

Your chest pain sensors are firing from inflammation and autonomic dysfunction, not cardiac disease. The panic is real. The heart threat isn't.

This is why cardiac workups miss it. They're testing the heart. The problem is the chest wall and autonomic signaling around it.

02/18/2026

You never needed recovery days from socializing before COVID.

Coffee with friends energized you. Dinners out were recharging. Conversations didn't drain you.

Now every social interaction costs energy you don't have. A 30-minute coffee means two days in bed. Dinner with family requires three days of recovery planning.

They think you're avoiding them. Pulling away. Not making an effort.

You're not avoiding people. You're running on empty.

Before COVID, your cells produced energy like a well that refills overnight. You could socialize, work, exercise, the well kept refilling. Now the well is shallow. Every activity draws from a reserve that barely covers survival.

Social engagement used to be free. Now it's a luxury you can't afford.

This isn't introversion appearing at 34. It's cellular energy bankruptcy. When your mitochondria can't produce enough ATP for basic function, everything beyond survival gets cut first.

Your personality didn't change. Your energy production capacity did.

02/18/2026

Deconditioning responds to graded exercise. Post-exertional malaise worsens.

Your doctor prescribed physical therapy. Progressive rehabilitation. Start slow, build gradually. The protocol works for deconditioning. It's making you worse.

Week one felt manageable. Week two, harder than expected. Week three, you crashed. Week four, you're back to baseline or worse.

This isn't lack of commitment. The protocol is correct for the wrong diagnosis.

Deconditioning means your cardiovascular fitness declined from inactivity. Exercise rebuilds capacity. Your heart and lungs get stronger. You progress.

Post-exertional malaise means your cells can't produce enough energy to meet exercise demands. Each session drains a reserve that doesn't refill. You're not building capacity. You're depleting it.

Think of a phone battery. Deconditioning is like never fully charging it, plug it in consistently and capacity returns. PEM is like a battery with a damaged charging port. Plug it in all day. Still at 5%. The charger works. The port is broken.

Your mitochondria are the damaged port. Exercise demands energy they can't produce. The deficit compounds with each session.

When mitochondrial function is tested directly, the energy production failure becomes measurable. And it responds to targeted support, not progressive exercise loading.

02/17/2026

What we see clinically is Long COVID patients with normal clotting panels but purple bruises on their legs.

Arms. Torso. Bruises from bumps they barely remember. Bruises appearing without any trauma at all.

They've had full workups. Platelets normal. Coagulation factors normal. No bleeding disorder detected. Case closed.

But the bruising persists. And it started after COVID.

The clotting system isn't the problem. The blood vessel walls are.

COVID damaged the endothelial cells lining your blood vessels. Think of a garden hose that's been sitting in the sun for years. The rubber becomes brittle. Cracks appear. Water leaks through before reaching the sprinkler.

Your vessels used to hold pressure without leaking. Now they leak under minimal stress. Red blood cells escape into surrounding tissue. You see it as a bruise.

Standard coagulation testing checks clotting factors. The clotting works fine. The vessel integrity is compromised. Different mechanism. Different test.

When endothelial function is assessed directly, not just clotting factors, the damage becomes measurable. Your bruising has a mechanism. And it's not clumsiness.

02/17/2026

Early IGA response in COVID clears the virus faster. But in long COVID, diminished IGA means the mucosal shield doesn't rebuild fully, leaving you vulnerable to new infections. It makes perfect sense why some say, "I get sick all the time now."

02/17/2026

You never searched for words before COVID.

Conversations flowed. Presentations came easily. The word you needed was just there when you needed it.

Now you pause mid-sentence. Searching. The word sits just out of reach. You describe around it. "The thing you use to... you know... the kitchen thing." Everyone waits while you hunt for "spatula."

They say it's stress. Aging. "Everyone forgets words sometimes."

But you're 32. And you didn't forget words. You accessed them instantly. This started after COVID.

Your brain's retrieval system is compromised. Think of a library where all the books are still there, but the catalog system is damaged. The information exists. The pathway to access it is disrupted.

Neuroinflammation from COVID affects the networks responsible for word retrieval. The words are stored. The connections that pull them forward are misfiring.

This isn't normal aging appearing at 32. It's measurable cognitive dysfunction with a clear timeline and mechanism.