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A New study from Hudson Medical indicates the potential efficacy of Stellate Ganglion Blocks in treating Generalized Anxiety Disorder.

Generalized Anxiety Disorders (GAD) are a category of anxiety disorders in which excessive, persistent, and unrealistic fear, worry, and feeling of being overwhelmed are accompanied by nonspecific physiological symptoms. This group of disorders may be a result of dysfunction or disruption to certain biological processes. Interestingly, some of these biological abnormalities are shared with Post-Traumatic Stress Disorder (PTSD), a mental health disorder that is associated with functional and cognitive impairments resulting from exposure to either real or perceived physical or mental injury or threat. PTSD and GAD are often simultaneously present in patients, with up to 50% of civilian populations experiencing both conditions and up to 91% of the veteran population experiencing PTSD and Generalized Anxiety at the same time.

Additionally, PTSD and GAD are both associated with hyperactivity or dysregulation of the sympathetic nervous system. Hudson’s study, which highlights results from case studies and secondary outcomes from applicable randomized controlled trials, found that Stellate Ganglion Blocks (SGB)  may modulate signals from the sympathetic nervous system to initiate significant and long-lasting symptom relief for patients with PTSD and trauma-related anxiety.

Given the commonalities between the biological processes that lead to PTSD and Generalized Anxiety Disorder, SGB may prove to be an effective treatment for Generalized Anxiety Disorders following future research.

Read the full study here.

What really happens to you’re body when you take a GLP-1 medication like Ozempic?

2023 is the year of Ozempic. The FDA first approved Ozempic, a semaglutide medication from Novo Nordisk, back in 2017, but the drug went mainstream in 2022.¹ And by April of 2023 it had reached household recognition status. The court of public opinion regarding Semaglutide remains split, with one camp celebrating its potential to overall health and quality of life, and the other skeptical of expediting the weight loss process. 

It’s safe to assume public interest in semaglutide for weight loss will only increase in the coming months, which means it’s crucial to dispel the false beliefs that are swirling around the edges of cultural conversation on Semaglutide and the new era of weight loss we have entered. 

Before we separate the fact from the fiction, let’s define semaglutide. 

What is semaglutide and how does it work?

Semaglutide is the generic version of a FDA-approved drug that mimics the digestive hormone GLP-1. As a naturally occurring hormone, GLP-1 is released into the intestines and influences three major components of eating and digestion. 

Appetite  GLP-1 receptors in the hypothalamus suppress appetite. 

Satiety   GLP-1 receptors in the stomach regulate satiety by slowing down digestion.

Blood sugar  GLP-1 receptors in the pancreas promote the production of insulin to regulate blood sugar. 

When semaglutide is injected into the body it boosts the work GLP-1 is already enacting in the brain, stomach, and pancreas. 

Fiction:

Semaglutide can only help people with diabetes.

Fact:

Semaglutide helps people with diabetes manage their weight and blood sugar, and helps people without diabetes manage their weight. 

Yes, semaglutide was developed, first and foremost, as a tool to help diabetes patients regulate their blood sugar.  However, as more research emerged, the consistent weight management results across for people without diabetes were too consistent and powerful to ignore.² 

Fiction:

Semaglutide always causes gastrointestinal pain.

Fact:

Semaglutide may cause gastrointestinal discomfort, but this varies from person to person. 

Studies do show that semaglutide may increase the chances of nausea, diarrhea, vomiting, and constipation in comparison to placebo participants.³ But 99.5% of these cases were reported as non-serious and 98% as mild-to-moderate. It’s also necessary to note that uncomfortable GI side effects are typically most prevalent shortly after patients escalate their dosages.

Fiction

Stopping semaglutide leads to weight gain.

Fact:

Stopping semaglutide does not always lead to weight gain—especially when patients continue lifestyle modifications. 

Some patients experience rebound weight after stopping Semaglutide.⁴ Metabolic doctors and researchers note that many patients experience a surge in cravings after stopping medication, because they no longer have the added support of semaglutide in regulating their cravings and appetite. However, lifestyle modifications like exercise and practicing mindfulness while eating can not only help patients maintain their weight, but also improve their relationship with food in general. 

Fiction:

It is unsafe to stay on semaglutide forever. 

Fact:

More research is needed to determine how optimal long-term usage is. 

There are some debates around the long-term safety of semaglutide use as some studies conducted with rodents have found correlations with thyroid cancer.⁵ However, more research needs to be conducted to determine whether these risks may also be prevalent in humans. 

Interest in semaglutide and Ozempic for weight loss is not showing any signs of slowing down, and more people are searching for ways to find Ozempic online. As it becomes easier to access GLP-1 medications like Ozempic, Wegovy, and Mounjaro it’s important to remember that taking new medications that can significantly impact your hormones should always be done under the guidance of a doctor. 

Hudson’s Medical Weight Management Program not only includes ongoing medical consultations, but also gives you access to 1:1 sessions with our registered nutritionist to help you implement lifestyle changes that support the effects of Semaglutide. 

Contact concierge@hudson.health today to learn more about our Semaglutide Weight Management program.  

References

1.“Ozempic (SEMAGLUTIDE) FDA Approval History.” Drugs.com, https://www.drugs.com/history/ozempic.html. 

2. Rubino DM, Greenway FL, Khalid U, et al. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8 Randomized Clinical Trial. JAMA. 2022;327(2):138–150. doi:10.1001/jama.2021.23619

3.(Wharton, S, Calanna, S, Davies, M, et al. Gastrointestinal tolerability of once-weekly semaglutide 2.4 mg in adults with overweight or obesity, and the relationship between gastrointestinal adverse events and weight loss. Diabetes Obes Metab. 2022; 24( 1): 94- 105. doi:10.1111/dom.14551)

4.Blum, Dani. “Ozempic Can Cause Major Weight Loss. What Happens If You Stop Taking It?” The New York Times, The New York Times, 3 Feb. 2023, https://www.nytimes.com/2023/02/03/well/live/ozempic-wegovy-weight-loss.html. 

5.Smits MM, Van Raalte DH. Safety of Semaglutide. Front Endocrinol (Lausanne). 2021 Jul 7;12:645563. doi: 10.3389/fendo.2021.645563. Erratum in: Front Endocrinol (Lausanne). 2021 Nov 10;12:786732. PMID: 34305810; PMCID: PMC8294388. 

COVID-19 infection statistics are on the decline and the WHO president expects to officially declare the end of its pandemic classification in 2023. But, make no mistake, COVID-19 is still around and long COVID symptoms are still sidelining people. A July 2022 study published by the CDC showed that 1 in 5 Americans who had COVID still have Long COVID symptoms.  

Most lingering symptoms are signs of either inflammation in the brain, lack of blood flow, immune dysregulation, sympathetic nervous system dysfunction, or cellular dysfunction.

Common symptoms include:

Just as acute COVID-19 infections impact people differently, Long COVID symptoms don’t always manifest equally. As doctors continue to research the short and long-term implications of COVID infections, more treatment possibilities for lingering symptoms are emerging. 

Here at Hudson Health we offer a wide range of Long COVID treatments that correspond to specific symptoms and Long COVID-induced system dysfunctions. 

Based on our experience, we have had success with treatments that address some of the root systematic dysfunctions at the cellular level. Some of these treatments include peptide therapy, nerve blocks of the sympathetic system, IV therapies, and ozone dialysis 

We have concluded our first IRB-approved study: “The use of Dual-Sympathetic Blocks in treating dysautonomia in Long-Covid” which will be published soon. 

Read on to learn about the treatments that may help your Long COVID symptoms. 

Autonomic Nervous Dysfunction

Long COVID is known for wreaking havoc on the Autonomic Nervous System (ANS), which is responsible for maintaining involuntary body functions like heart rate, blood pressure, digestion, and breathing (1). The ANS consists of two parts: the sympathetic nervous system (SNS), which regulates the fight-or-flight response and the parasympathetic nervous system (PNS), which regulates the rest-and-digest response. 

Researchers are still defining the exact mechanisms by which Long COVID causes Autonomic Nervous Dysfunction. Some theories suggest that the immune response triggered by the initial infection may result in inflammation and damage to the nervous system, including the autonomic nervous system. This initial inflammatory response has been shown to cause microvascular injuries to the blood-brain barrier (BBB), a highly dense network of cells that are responsible for keeping harmful substances like viruses or other pathogens from reaching the brain. When the BBB becomes altered or weakened, it becomes increasingly difficult for the ANS to regulate the cerebral blood flow response, a process that regulates blood flow to and throughout the brain. Impaired cerebral blood flow response may lead to an overdrive of the sympathetic nervous system (2). This hyperactive state is a compensatory mechanism, and if it is not effectively and efficiently addressed, it can result in blunted baroreceptor responsiveness. Baroreceptors act as a feedback system to the cardiovascular system-controlling centers of that brain, and when appropriately activated, they reduce sympathetic signaling. In diseases that cause a hyperactive sympathetic state such as Long COVID, sympathetic overdrive over stimulates these baroreceptors, leading to decreased sensitivity and functioning (3,4). The body responds by either significantly increasing heart rate or increasing diastolic blood pressure to ensure that the brain is receiving sufficient blood flow (5). In addition, it is believed that the virus may directly invade and damage nerve cells, leading to dysfunction in various parts of the body, including the autonomic nervous system.

In healthy individuals, autonomic nervous system nerve fibers control our blood pressure through a mechanism called the vasomotor response, which determines our blood pressure by carefully regulating whether or not small blood vessels and capillaries are constricted or dilated at any given moment. In Long COVID, a phenomenon known as vasomotor denervation causes prolonged and inappropriate dilation of these blood vessels (6). Dilated blood vessels caused by vasomotor denervation can lead to reduced preload to the heart, which triggers an increase in sympathetic signaling. In essence, in Long COVID, autonomic nervous dysfunction can significantly impair our ability to shunting blood to the areas of the body where it is needed (7). In turn, patients with Long COVID may experience symptoms like dizziness, chronic fatigue, palpitations, shortness of breath (8). 

Long COVID patients also may experience symptoms related to temperature dysregulation. Research suggests that these symptoms may be attributed to hypothalamic dysfunction as a result of autonomic dysfunction (9). The hypothalamus is a brain structure that works like a thermostat, keeping the body temperature appropriate in the context of the environment and the immune system. The BBB in and around the hypothalamus is highly permeable to blood-borne substances, including viruses. Studies have found increased viral load in the hypothalamic region of the brain, indicating that the virus uses this area to access brain cells (10).  As the hypothalamus is involved in thermoregulation, COVID infection may cause a dysregulation of body temperature.

Treatment Option: Dual Sympathetic Block 

Dual Sympathetic Block

If any of the above symptoms resonate with you, a Dual Sympathetic Block (DSB) can restore balance to your overly-heightened nervous system. These blocks are injected in the neck, along the sympathetic chain and in the Stellate Ganglion nerve cluster, which influences your sympathetic response. By temporarily anesthetizing the nerve clusters, DSBs give the system a chance to reset to a more neutral biological level.

Having performed thousands of Dual Sympathetic Blocks, Hudson Medical is considered a global leader in DSB administration and an industry leader in Dual Sympathetic Block clinical research. 

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Neurological Dysfunction

One of the most common systems impacted by daily Long COVID symptoms is the neurological system. A 2022 JAMA network study demonstrated  brain fog as one of the most commonly-reported Long COVID symptoms (11).

Like other symptoms of COVID-induced dysregulation, the exact mechanisms that induce ongoing brain fog remain ill-defined. However, it is widely believed that inflammation from acute COVID infection may be linked to a decrease in cognitive functioning. When inflammation occurs in the brain in response to infection, it can lead to the release of inflammatory molecules like cytokines that can disrupt the normal functioning of brain cells and neural circuits. This disruption can interfere with the communication between neurons and affect the way that different brain regions work together, leading to neurological symptoms such as difficulty concentrating, headaches, and brain fog.

Migraines are also a common symptom of Long COVID. In the context of Long COVID, migraines may be due to an increase in intracranial pressure (IP), the pressure exerted by fluids inside the skull and on the brain tissue. Increased IP may be a result of faulty autonomic nervous system regulation of cerebral blood flow (the blood flow to and throughout the brain). This increased IP is sensed as pain anywhere on the cranium, but especially around the frontal lobes (12).

Tinnitus is a ringing or buzzing noise in one or both ears that may be constant. Tinnitus can occur on occasion or chronically with Long COVID dysautonomia. Tinnitus may occur as a result of decreased blood flow and hyperinflammation of the Cranial Nerve that controls functions of the ear (13).

Additionally, sleep problems have been identified in Long COVID and can occur occasionally or chronically. The autonomic nervous system controls the sleep cycle and the deep sleep cycle and REM sleep can be affected when the autonomic nervous system is dysregulated.

Potential Treatment(s) for you: NAD+ Infusion Therapy, Methylene Blue, Ketamine IV, Peptides, Prescription Medications

NAD+ Infusion Therapy

Nicotinamide adenine dinucleotide, NAD+, is a coenzyme that influences some of the most vital processes in the body, including how food is metabolized into energy, DNA repair, and overall immune system functioning. 

Studies have shown that viral infections like COVID-19 may deplete NAD+ stores. NAD+ infusions can boost mitochondrial function, improve prolonged fatigue and neurocognitive dysfunction, and may suppress post-COVID inflammation.

Ketamine IV Therapy

Low-dose ketamine infusions may significantly reduce symptoms of anxiety and depression. Research shows that lasting anxiety and depression can actually change the composition of the brain and damage some neural connectivity. Ketamine restores dormant neural circuits by triggering the production of Glutamate, which in turn, promotes BDNF, a protein that encourages neuroplasticity in the brain. Ketamine has also been shown to influence the activity of other neurotransmitter systems that are involved in the regulation of mood, including dopamine (14). 

Methylene Blue 

Methylene Blue is a compound that may aid the transportation of oxygen throughout the body by targeting mitochondrial dysfunction. Emerging research suggests that Methylene Blue may have neuroprotective effects, including: mitigating oxidative stress, increasing blood flow to the brain, and reducing inflammation and cellular death. Methylene blue can be given either via IV infusion or orally. 

Peptide Therapy

Peptides are short chains of amino acids that influence major biological processes. Peptide therapy reinforces our natural supply to help regulate and promote these biological processes.

BPC and TB4 are two peptides known for their anti-inflammatory and immunomodulating effects. 

Selank and Semax are two peptides known for their nootropic and neuroprotective effects. Selank improves anxiety and mood, while Semax improves attention and concentration. 

KPV  is a powerful anti-inflammatory peptide that is administered via intranasal spray.

Medications

Guanfacine and NAC

Guanfacine is a prescribed oral medication that works by stimulating certain receptors in the brain and reducing the activity of the sympathetic nervous system, which helps to lower blood pressure and improve ADHD symptoms. 

NAC is derived from amino acids and known for its antioxidant properties. It may be prescribed as an oral medication or administered intravenously. Guanfacine and NAC may be prescribed in tandem to combat COVID-related brain fog (15).

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Immune Dysregulation

Immune dysregulation following a COVID diagnosis is characterized by both hyperinflammatory and immunosuppressive conditions (16). Our immune systems are responsible for automatically responding to the threat of infection, and when this system is disrupted, the body does not appropriately respond to threats–resulting in either underreaction or overreaction. Research has demonstrated that the COVID virus has the ability to evade some of the immune system’s antiviral defenses, which can cause a delayed but magnified inflammatory response and is responsible for the characteristic mild initial stage of COVID infection (17). A postponed but enhanced inflammatory immune response leads to significant tissue damage and rapid progression of the infection through the excessive production of pro-inflammatory molecules like cytokines (18). Further, recent research has demonstrated that patients with Long COVID have highly activated immune cells that remain persistently activated for over 8 months after infection. In essence, the immune response becomes dysregulated during active COVID infection and, for those with Long COVID, remains dysfunctional for some time (19). Additionally, in response to COVID infection, the body may produce a variety of autoantibodies, including functionally active autoantibodies against G-protein-coupled receptors (GPCR-AAbs) (20). Some of these autoantibodies are associated with impaired circulation and neurological dysfunction.

Treatment options: Peptide therapy, IV Infusions,Ozone Dialysis EBOO, Medication (Oral and Infusions), Histamine Blockers

Peptide Therapy

Thymosin Beta 4 reduces inflammation and promotes regeneration while Thymosin Alpha 1 can improve your immunity and bolster your body’s defenses against infections. 

IV Infusions 

To combat immune dysregulation, IV infusions may include NAD, peptide immunomodulators, glutathione, NAC, and various additional vitamins to boost your body’s immune system and energy.

Ozone Dialysis EBOO

Extracorporeal Blood Oxygenation and Ozonation (EBOO) is a form of ozone therapy known for its efficacy in combating inflammatory conditions and autoimmune disorders. An EBOO procedure uses dialysis filters to essentially clean out germs and toxins from a patient’s bloodstream. Blood is drawn from a patient’s vein, and ozonated in a contained and sterile chamber before being reintroduced into the bloodstream via a separate vein.  

Oral Medication

Low-dose Naltrexone is known for its immune-modulating effects and is helpful in both treating and preventing immune issues (21). Low-dose Naltrexone for immune dysfunction is considered an off-label treatment. 

Lithium Orotate is known for its anti-inflammatory properties. Clinical studies have found significant improvement in patients taking lithium for Long COVID symptoms like fatigue and brain fog (22). 

Histamine Blockers

Researchers are studying the link between Long Covid and Mast Cell Activation, a process in which mast cells (a type of immune cell that defends against pathogens and allergens) are activated and release histamines and inflammatory mediators (23).

Histamine H1 and H2 blockers (like claritin and famotidine, respectively) are effective against common symptoms related to histamine release, like itching, swelling and respiratory distress. 

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Cardiopulmonary Dysregulation

Shortness of breath is one of the most notable symptoms of acute COVID infection, and long COVID sufferers also commonly experience persistent breathing complications. Breathing is an involuntary mechanism controlled by the autonomic nervous system, which regulates the opening and closing of air passages (24). When the autonomic nervous system is impacted from COVID-induced inflammation, air passages are hindered and patients often report feeling as though they are only able to inhale a fraction of their typical breath capacity. 

Treatment options:  Dual Sympathetic Block

Our airways are innervated by autonomic nerve fibers, so autonomic dysfunction may lead to problems regulating the activity of our airways. Dual Sympathetic Blocks temporarily anesthetizes a cluster of nerves in the neck that influence the nervous system. Following this brief timeout, the system is able to reset at a more normal level which can restore autonomic functioning. 

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Mitochondrial Dysfunction

Many Long-COVID patients report increased difficulty in performing their regular pre-COVID exercise routines. Although there are likely many disrupted physiological processes that contribute to this phenomenon, mitochondrial dysfunction may play a key role. Your mitochondria are small structures found in most cells that are responsible for producing energy. Mitochondria play a critical role in providing energy to the body’s cells, and any dysfunction in these structures can have a significant impact on overall cellular and bodily function.

Treatment options: NAD+ Infusion, Peptide Therapy, Hyperbaric Oxygen Therapy, Medication

NAD+ Infusion

Nicotinamide adenine dinucleotide, NAD+, is a coenzyme that influences some of the most vital processes in the body, including how food is metabolized into energy, DNA repair, and overall immune system functioning. Studies have shown that viral infections like COVID-19 may deplete NAD+ stores (25). NAD+ infusions can boost mitochondrial function, improve prolonged fatigue and neurocognitive dysfunction, and may suppress post-COVID inflammation.

Peptide Therapy

Humanin, SS-31 and MOTSc are all known for their ability to boost mitochondrial function. 

MOTSc is considered a mitochondrial-derived peptide made up of 16 amino acids. Research has found that MOTSc influences metabolic function, inflammation and insulin resistance (26).

Humanin is a mitochondrial-derived peptide consisting of 24 amino acids. Known for enhancing insulin sensitivity and protecting against age-related metabolic disorders, Humanin has emerged as an essential longevity-boosting peptide (27).

SS-31, also known as Elamipretide, is a synthetic peptide known for stabilizing mitochondrial function. SS-31 permeates cells and decreases reactive oxygen species production and enhances overall energy production (28).

Exogenous Ketone Therapy 

Ketones are molecules produced by the body when it breaks down fat for energy, instead of using carbohydrates. One type of ketone called R-βHB can influence energy production by balancing NAD+ and NADH ratios in cells (29). Supplementing this type of ketone can also help to maintain functioning mitochondria by reducing oxidative stress and inflammation. 

Hyperbaric Oxygen Therapy

Hyperbaric Oxygen Therapy is a treatment that involves breathing pure oxygen in a pressurized environment. This type of therapy may help mitochondrial dysfunction by increasing the availability of oxygen to cells and tissues throughout the body, including the mitochondria.

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Musculoskeletal Dysfunction

Muscle weakness and spasms are also common physical responses after an acute COVID diagnosis. These symptoms are believed to be caused by reduced blood flow and energy supply to the muscles due to a malfunctioning autonomic response. In Long COVID, chronic hyperinflammation is closely associated with muscle breakdown (30). Dysfunction of the immune system after COVID can cause the excessive production of pro-inflammatory molecules with well known roles in negatively impacting the metabolism of proteins in muscle (31). Muscle pain and spasms may also result from the accumulation of lactic acid due to lack of energy. 

Treatment options: Peptides, Regenerative Therapy, Hydrodissection, Interventional Pain Management, Physical Therapy

Peptides

BPC-157 enhances healing processes by reducing inflammation and increasing blood flow around damaged tissue.

TB4 is known for its anti-inflammatory properties and promotion of tissue repair and regeneration. 

GHK-Cu stimulates collagen, reduces oxidative damage, and generates healthy tissue.

Regenerative Therapy

Exosome Infusions harness the critical role exosomes play in intracellular communication. Derived by donor cells, exosomes promote healing and restoration of damaged tissues. 

Platelet-rich plasma therapy is a type of therapy that extracts and processes highly concentrated platelets from your own blood. Once processed, the platelet concentration is injected into the injured area to promote faster healing and tissue regeneration. 

Learn more about Hudson Medical’s regenerative treatments. 

Interventional Pain Management 

Hydrodissection involves the injections of fluid under ultrasound into injured muscles in order to separate inflamed tissue. Creating a separation between injured muscle and surrounding fascia and nerves may reduce pressure and promote blood flow to the injured area. 

Steroid Injections involve injecting afflicted joints or tendons with a steroid medication to reduce inflammation and alleviate pain. 

Nerve Blocks involve injecting a steroid medication near a nerve that is causing pain. The medication temporarily blocks the nerve’s ability to transmit pain signals, providing pain relief. 

Nerve Ablations utilize heat to effectively block the brain from processing pain signals transmitted by nerves in the spine.

Learn more about Hudson Medical’s interventional pain treatments.

Physical therapy uses a combination of stretching and strengthening exercises to improve mobility and prevent future strain. Here at Hudson we offer a specialized CAMP program that administers physical therapy with targeted acupuncture, medical massage, and chiropractic care. These successive treatments alleviate discomfort while restoring whole-body balance. 

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Psychological Dysfunction

It’s not just the stress of recovering from sickness, many people who are diagnosed with an acute COVID infection report lingering feelings of increased anxiety and depression. In fact, some studies report that Long COVID is associated with an estimated 13% increased presence of depression, 28% increase in anxiety, 10% increase in suicide ideation, and 20% increase in PTSD compared to healthy individuals (32). Further, these emotional and psychological disorders can lead to decreased life satisfaction and daily functioning. Studies have found that inflammation from the virus may actually spark changes in the brain’s composition. Research has also demonstrated that psychological distress is not only a symptom but also a risk factor of long COVID (33). 

Treatment options: Interventional Mental Health Treatments

Hudson Mind, Hudson Health’s interventional mental health division, offers a range of interventions proven to combat the physical and emotional symptoms of anxiety and depression. 

TMS

Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation therapy used to treat psychiatric disorders like depression, migraines, and obsessive compulsive disorder (34,35). In order to understand how TMS can provide significant and lasting depression symptom relief, it is essential to discuss how brain function is altered in patients with depression. TMS involves the application of targeted magnetic pulses to the superficial layers of the brain. This magnetic field is able to induce small electrical currents that stimulate nerve cells in mood-controlling areas of the brain (36, 37, 38, 39, 40). These small electrical currents are powerful enough and precise enough to elicit an activating signal in brain cells to release more neurotransmitters and therefore can increase the activity of connecting neurons. TMS is able to address the neurotransmitter imbalance associated with depression by stimulating targeted neurotransmitter release in mood-controlling areas of the brain (37). 

IV Ketamine

Low-dose ketamine infusions may significantly reduce symptoms of anxiety and depression. Research shows that lasting anxiety and depression can actually change the composition of the brain and damage some neural connectivity. Ketamine restores dormant neural circuits by triggering the production of Glutamate, which in turn, promotes BDNF, a protein that encourages neuroplasticity in the brain. Ketamine has also been shown to influence the activity of other neurotransmitter systems that are involved in the regulation of mood, including dopamine. 

Dual Sympathetic Blocks

A minimally-invasive anesthetic that alleviates symptoms of PTSD. By temporarily anesthetizing the nerve clusters, DSBs give the sympathetic nervous system a chance to reset to a more neutral biological level. Also known as Stellate Ganglion Block (SGB). 

Don’t know which treatment is best for your symptoms? Our team is here to help you navigate our Long COVID offerings. Schedule your Long COVID Consultation

References:

1. Colombo J, Weintraub MI, Munoz R, Verma A, Ahmad G, Kaczmarski K, Santos L, DePace NL. Long COVID and the Autonomic Nervous System: The Journey from Dysautonomia to Therapeutic Neuro-Modulation through the Retrospective Analysis of 152 Patients. NeuroSci. 2022; 3(2):300-310. https://doi.org/10.3390/neurosci3020021
2. Bonetto V, Pasetto L, Lisi I, et al. Markers of blood-brain barrier disruption increase early and persistently in COVID-19 patients with neurological manifestations. Front Immunol. 2022;13:1070379. Published 2022 Dec 15. doi:10.3389/fimmu.2022.1070379
3.  Mrowka R, Persson PB, Theres H, Patzak A. Blunted arterial baroreflex causes “pathological” heart rate turbulence. Am J Physiol Regul Integr Comp Physiol. 2000;279(4):R1171-R1175. doi:10.1152/ajpregu.2000.279.4.R1171
4.  Stute NL, Stickford JL, Province VM, Augenreich MA, Ratchford SM, Stickford ASL. COVID-19 is getting on our nerves: sympathetic neural activity and haemodynamics in young adults recovering from SARS-CoV-2. J Physiol. 2021;599(18):4269-4285. doi:10.1113/JP281888
5.  Faria D, Moll-Bernardes RJ, Testa L, et al. Sympathetic Neural Overdrive, Aortic Stiffening, Endothelial Dysfunction, and Impaired Exercise Capacity in Severe COVID-19 Survivors: A Mid-Term Study of Cardiovascular Sequelae. Hypertension. 2023;80(2):470-481. doi:10.1161/HYPERTENSIONAHA.122.19958
6.  Chadda KR, Blakey EE, Huang CL, Jeevaratnam K. Long COVID-19 and Postural Orthostatic Tachycardia Syndrome- Is Dysautonomia to Be Blamed?. Front Cardiovasc Med. 2022;9:860198. Published 2022 Mar 9. doi:10.3389/fcvm.2022.860198
7.  Chung TH, Azar A. Autonomic Nerve Involvement in Post-Acute Sequelae of SARS-CoV-2 Syndrome (PASC). J Clin Med. 2022;12(1):73. Published 2022 Dec 22. doi:10.3390/jcm12010073
8.  Mallick D, Goyal L, Chourasia P, Zapata MR, Yashi K, Surani S. COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review. Cureus. 2023;15(3):e36955. Published 2023 Mar 31. doi:10.7759/cureus.36955
9.  Turner S, Khan MA, Putrino D, Woodcock A, Kell DB, Pretorius E. Long COVID: pathophysiological factors and abnormalities of coagulation. Trends Endocrinol Metab. 2023;34(6):321-344. doi:10.1016/j.tem.2023.03.002
10.  Mussa BM, Srivastava A, Verberne AJM. COVID-19 and Neurological Impairment: Hypothalamic Circuits and Beyond. Viruses. 2021;13(3):498. Published 2021 Mar 17. doi:10.3390/v13030498
11.  Perlis RH, Santillana M, Ognyanova K, et al. Prevalence and Correlates of Long COVID Symptoms Among US Adults. JAMA Netw Open. 2022;5(10):e2238804. doi:10.1001/jamanetworkopen.2022.38804
12.  Silva MTT, Lima MA, Torezani G, et al. Isolated intracranial hypertension associated with COVID-19. Cephalalgia. 2020;40(13):1452-1458. doi:10.1177/0333102420965963
13.  Narozny W, Tretiakow D, Skorek A. Tinnitus in COVID-19 Pandemic. Ear Nose Throat J. 2021;100(3_suppl):197S-198S. doi:10.1177/0145561320988364
14.  Marcus DJ, Bruchas MR. Where ketamine and dopamine collide. Elife. 2021 Jun 17;10:e70148. doi: 10.7554/eLife.70148. PMID: 34137373; PMCID: PMC8211445.
15.  Backman, Isabella. “Potential New Treatment for ‘Brain Fog’ in Long Covid Patients.” Yale School of Medicine, 13 Dec. 2022, https://medicine.yale.edu/news-article/potential-new-treatment-for-brain-fog-in-long-covid-patients/. 
16.  Davitt E, Davitt C, Mazer MB, Areti SS, Hotchkiss RS, Remy KE. COVID-19 disease and immune dysregulation. Best Pract Res Clin Haematol. 2022 Sep;35(3):101401. doi: 10.1016/j.beha.2022.101401. Epub 2022 Oct 15. PMID: 36494149; PMCID: PMC9568269.
17. Kim YM, Shin EC. Type I and III interferon responses in SARS-CoV-2 infection. Exp Mol Med. 2021;53(5):750-760. doi:10.1038/s12276-021-00592-0
18. Dalskov L, Møhlenberg M, Thyrsted J, et al. SARS-CoV-2 evades immune detection in alveolar macrophages. EMBO Rep. 2020;21(12):e51252. doi:10.15252/embr.202051252
19. Phetsouphanh C, Darley DR, Wilson DB, et al. Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection. Nat Immunol. 2022;23(2):210-216. doi:10.1038/s41590-021-01113-x
20. Szewczykowski C, Mardin C, Lucio M, et al. Long COVID: Association of Functional Autoantibodies against G-Protein-Coupled Receptors with an Impaired Retinal Microcirculation. Int J Mol Sci. 2022;23(13):7209. Published 2022 Jun 29. doi:10.3390/ijms23137209
21.  Brown N, Panksepp J. Low-dose naltrexone for disease prevention and quality of life. Med Hypotheses. 2009 Mar;72(3):333-7. doi: 10.1016/j.mehy.2008.06.048. Epub 2008 Nov 28. PMID: 19041189.
22.  “Could Low-Dose Lithium Treat Long COVID? UB Launches Clinical Trial to Find Out.” University at Buffalo, 6 Jan. 2023, https://www.buffalo.edu/news/releases/2023/01/002.html#:~:text=Because%20long%20COVID%20is%20believed,for%20persistent%20long%20COVID%20symptoms.&text=%E2%80%9CI%20was%20shocked%20when%20the,of%20days%2C%E2%80%9D%20says%20Guttuso. 
23.  Arun S, Storan A, Myers B. Mast cell activation syndrome and the link with long COVID. Br J Hosp Med (Lond). 2022 Jul 2;83(7):1-10. doi: 10.12968/hmed.2022.0123. Epub 2022 Jul 26. PMID: 35938771.
24.  van der Velden VH, Hulsmann AR. Autonomic innervation of human airways: structure, function, and pathophysiology in asthma. Neuroimmunomodulation. 1999 May-Jun;6(3):145-59. doi: 10.1159/000026376. PMID: 10213912. 
25. Minyan Zheng, Michael B. Schultz, David A. Sinclair, NAD+ in COVID-19 and viral infections, Trends in Immunology, Volume 43, Issue 4, 2022, Pages 283-295, ISSN 1471-4906,https://doi.org/10.1016/j.it.2022.02.001. 
26. Wan, W., Zhang, L., Lin, Y. et al. Mitochondria-derived peptide MOTS-c: effects and mechanisms related to stress, metabolism and aging. J Transl Med 21, 36 (2023). https://doi.org/10.1186/s12967-023-03885-2 
27.  Abu Hazafa, Ammara Batool, Saeed Ahmad, Muhammad Amjad, Sundas Nasir Chaudhry, Jamal Asad, Hasham Feroz Ghuman, Hafiza Madeeha Khan, Muhammad Naeem, Usman Ghani, Humanin: A mitochondrial-derived peptide in the treatment of apoptosis-related diseases, Life Sciences, Volume 264, 2021, 118679, ISSN 0024-3205, https://doi.org/10.1016/j.lfs.2020.118679. 
28.  Zhu Y, Luo M, Bai X, Li J, Nie P, Li B, Luo P. SS-31, a Mitochondria-Targeting Peptide, Ameliorates Kidney Disease. Oxid Med Cell Longev. 2022 Jun 6;2022:1295509. doi: 10.1155/2022/1295509. PMID: 35707274; PMCID: PMC9192202. 
29.  Waldman HS, McAllister MJ. Exogenous Ketones as Therapeutic Signaling Molecules in High-Stress Occupations: Implications for Mitigating Oxidative Stress and Mitochondrial Dysfunction in Future Research. Nutr Metab Insights. 2020 Dec 10;13:1178638820979029. doi: 10.1177/1178638820979029. PMID: 33354110; PMCID: PMC7734540. 
30. Akbarialiabad H, Taghrir MH, Abdollahi A, et al. Long COVID, a comprehensive systematic scoping review. Infection. 2021;49(6):1163-1186. doi:10.1007/s15010-021-01666-x
31. Webster JM, Kempen LJAP, Hardy RS, Langen RCJ. Inflammation and Skeletal Muscle Wasting During Cachexia. Front Physiol. 2020;11:597675. Published 2020 Nov 19. doi:10.3389/fphys.2020.597675
32. Goodman ML, Molldrem S, Elliott A, Robertson D, Keiser P. Long COVID and mental health correlates: a new chronic condition fits existing patterns. Health Psychol Behav Med. 2023;11(1):2164498. Published 2023 Jan 8. doi:10.1080/21642850.2022.2164498
33. Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network – United States, March-June 2020. MMWR Morb Mortal Wkly Rep. 2020;69(30):993-998. Published 2020 Jul 31. doi:10.15585/mmwr.mm6930e1
34. Chail, Amit et al. “Transcranial magnetic stimulation: A review of its evolution and current applications.” Industrial psychiatry journal vol. 27,2 (2018): 172-180. doi:10.4103/ipj.ipj_88_18
35. Stultz, Debra J et al. “Transcranial Magnetic Stimulation (TMS) Safety with Respect to Seizures: A Literature Review.” Neuropsychiatric disease and treatment vol. 16 2989-3000. 7 Dec. 2020, doi:10.2147/NDT.S276635
36. Zhang, Fei-Fei et al. “Brain structure alterations in depression: Psychoradiological evidence.” CNS neuroscience & therapeutics vol. 24,11 (2018): 994-1003. doi:10.1111/cns.12835
37. Post, A, and M E Keck. “Transcranial magnetic stimulation as a therapeutic tool in psychiatry: what do we know about the neurobiological mechanisms?.” Journal of psychiatric research vol. 35,4 (2001): 193-215. doi:10.1016/s0022-3956(01)00023-1
38. Brigitta, Bondy. “Pathophysiology of depression and mechanisms of treatment.” Dialogues in clinical neuroscience vol. 4,1 (2002): 7-20. doi:10.31887/DCNS.2002.4.1/bbondy
39. Carpenter, Linda L et al. “Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice.” Depression and anxiety vol. 29,7 (2012): 587-96. doi:10.1002/da.21969
40. Janicak, Philip G et al. “Durability of clinical benefit with transcranial magnetic stimulation (TMS) in the treatment of pharmacoresistant major depression: assessment of relapse during a 6-month, multisite, open-label study.” Brain stimulation vol. 3,4 (2010): 187-99. doi:10.1016/j.brs.2010.07.003

NAD+ is everywhere. Everyone from podcasters to celebrities and, even, your coworkers are touting the benefits of NAD+ transfusions. As the popularity of NAD+ continues to climb across digital spheres—and IRL—the messaging around NAD+ could get murky, especially when it comes to conversations on how NAD+ and detoxification. To give you some clarity, we’re breaking down how NAD+ can be a powerful tool for people struggling with addiction.  

What is NAD+?

Nicotinamide adenine dinucleotide, NAD+ plays a crucial role in our existence. As a coenzyme found in all cells, it has the power to regulate processes like energy conversion, DNA repair, and immune system response.^1,2  Over time our natural NAD+ levels diminish, ushering in age-related conditions and health concerns. While more and more people are seeking out NAD+ for its longevity-boosting benefits, demand for NAD+ as a detoxification tool is also growing. 

Since the 1960s researchers have touted the potential benefits of utilizing NAD+ supplementation to support individuals fighting withdrawals and recovering from substance abuse.⁴ Here’s how it can help:

Restores depleted levels of NAD+

It’s not just age that can impact our NAD+ stores. Substance abuse, especially compounded over long periods of time, can deplete NAD+ levels by contributing to more oxidative stress and inflammation, which leads to cellular dysfunction and cellular death. Without adequate levels of NAD+ it’s increasingly difficult for body systems to operate at optimal levels. 

Protects against neurotoxicity

Neurotoxicity refers to natural or man-made toxic substances that cause damage to the brain or nervous system. Substances like alcohol are proven neurotoxins and especially damaging to brain health and function.⁵ NAD+ has been shown to protect against neurotoxicity by activating enzymes involved in DNA repair and reducing oxidative stress in the brain. 

Ameliorates painful withdrawal symptoms

Withdrawal periods result in physical and mental anguish, but NAD+ supplementation may abate this discomfort. Pioneering studies from 1961 showed the positive effects of NAD+ on withdrawal symptoms, and more recent studies are confirming reductions in craving, anxiety, and depression.^4,6 During withdrawal from drugs or alcohol, the body is often under significant physiological stress, and the demand for ATP production increases. ATP is the primary energy source for cells and is critical for maintaining cellular function and survival. If ATP levels are depleted, it can contribute to the symptoms of withdrawal, including fatigue, weakness, and cognitive impairment.⁷

Ready to experience the power of NAD+ for yourself. Schedule your NAD+ infusion here. 

References:

1.Cantó C, Menzies KJ, Auwerx J. NAD(+) Metabolism and the Control of Energy Homeostasis: A Balancing Act between Mitochondria and the Nucleus. Cell Metab. 2015 Jul 7;22(1):31-53. doi: 10.1016/j.cmet.2015.05.023. Epub 2015 Jun 25. PMID: 26118927; PMCID: PMC4487780.

2.Covarrubias AJ, Perrone R, Grozio A, Verdin E. NAD+ metabolism and its roles in cellular processes during ageing. Nat Rev Mol Cell Biol. 2021 Feb;22(2):119-141. doi: 10.1038/s41580-020-00313-x. Epub 2020 Dec 22. PMID: 33353981; PMCID: PMC7963035.

3. Braidy N, Villalva MD, van Eeden S. Sobriety and Satiety: Is NAD+ the Answer? Antioxidants (Basel). 2020 May 14;9(5):425. doi: 10.3390/antiox9050425. PMID: 32423100; PMCID: PMC7278809.

4. O’HOLLAREN P. Diphosphopyridine nucleotide in the prevention, diagnosis and treatment of drug addiction. A preliminary report. West J Surg Obstet Gynecol. 1961 May-Jun;69:213-5. PMID: 13730082.

5. 10th Special Report to the U.S. Congress on Alcohol and Health. National Institutes of Health, June 2000, https://pubs.niaaa.nih.gov/publications/10report/chap02e.pdf. 

6. Blum K, Han D, Baron D, Kazmi S, Elman I, Gomez LL, Gondre-Lewis MC, Thanos PK, Braverman ER, Badgaiyan RD. Nicotinamide Adenine Dinucleotide (NAD+) and Enkephalinase Inhibition (IV1114589NAD) Infusions Significantly Attenuate Psychiatric Burden Sequalae in Substance Use Disorder (SUD) in Fifty Cases. Curr Psychiatry Res Rev. 2022 Jul;18(2):125-143. doi: 10.2174/2666082218666220527114427. Epub 2022 Jun 21. PMID: 36118157; PMCID: PMC9474872.

7. Cuenoud B, Ipek Ö, Shevlyakova M, Beaumont M, Cunnane SC, Gruetter R, Xin L. Brain NAD Is Associated With ATP Energy Production and Membrane Phospholipid Turnover in Humans. Front Aging Neurosci. 2020 Dec 16;12:609517. doi: 10.3389/fnagi.2020.609517. PMID: 33390929; PMCID: PMC7772416.

Want to really improve your longevity? Start by checking in on your cells—specifically, the NAD+ levels in your cells.  

Biohacking searches are skyrocketing and more people are experimenting with fasting and immersion therapies to wind back their biological clocks. Though studies support the potentials of intermittent fasting and cold therapy to slow cellular aging and reduce the risk of disease, NAD+ testing as longevity targeting resource has gone largely overlooked—until recently.^1,2 

What is NAD+?

Nicotinamide adenine dinucleotide, NAD+, is a coenzyme that influences some of the most vital processes in the body, including metabolizing food into energy and regulating cellular processes like DNA repair and immune system functioning.^3,4  It acts as a helper molecule throughout the cellular respiration process, resulting in the production of our cell’s most viable energy currency, Adenosine Triphosphate (ATP).⁵ 

Though NAD+ plays an essential role in the body’s upkeep, NAD+ levels naturally decrease over time—a reduction that is associated with common aging markers and age-related diseases, including metabolic disorders and neurodegenerative conditions.⁶ 

And although we know that a decline in NAD+ levels does occur with age, until recently it’s been hard to determine the velocity of this decline and how it impacts individuals differently. 

Intracellular NAD+ testing—which is now available at Hudson Health—offers a clear and personalized view of the current state of your cellular health, and subsequently, insights into potential risk levels for future age-related diseases, including:

• Cardiovascular disease
• Alzheimer’s
• Parkinsons
• Type 2 diabetes  

Arming yourself with a baseline analysis is the crucial first step in your NAD optimization journey. From here, you can work with your longevity specialist to implement the best optimization strategies for your body and lifestyle. 

As more research around intracellular NAD+ optimization emerges, comprehensive baseline analyses are crucial for supporting their efficacy. 

If you’re ready to take your future health into your own hands, schedule your NAD+ test here. 

References:

1.Longo VD, Di Tano M, Mattson MP, Guidi N. Intermittent and periodic fasting, longevity and disease. Nat Aging. 2021 Jan;1(1):47-59. doi: 10.1038/s43587-020-00013-3. Epub 2021 Jan 14. PMID: 35310455; PMCID: PMC8932957.

2.Esperland D, de Weerd L, Mercer JB. Health effects of voluntary exposure to cold water – a continuing subject of debate. Int J Circumpolar Health. 2022 Dec;81(1):2111789. doi: 10.1080/22423982.2022.2111789. PMID: 36137565; PMCID: PMC9518606.

3.Cantó C, Menzies KJ, Auwerx J. NAD(+) Metabolism and the Control of Energy Homeostasis: A Balancing Act between Mitochondria and the Nucleus. Cell Metab. 2015 Jul 7;22(1):31-53. doi: 10.1016/j.cmet.2015.05.023. Epub 2015 Jun 25. PMID: 26118927; PMCID: PMC4487780.

4.Covarrubias AJ, Perrone R, Grozio A, Verdin E. NAD+ metabolism and its roles in cellular processes during ageing. Nat Rev Mol Cell Biol. 2021 Feb;22(2):119-141. doi: 10.1038/s41580-020-00313-x. Epub 2020 Dec 22. PMID: 33353981; PMCID: PMC7963035.

5.Xie, N., Zhang, L., Gao, W. et al. NAD+ metabolism: pathophysiologic mechanisms and therapeutic potential. Sig Transduct Target Ther 5, 227 (2020). https://doi.org/10.1038/s41392-020-00311-7

6.Yahyah Aman, Yumin Qiu, Jun Tao, Evandro F. Fang,

Therapeutic potential of boosting NAD+ in aging and age-related diseases,

Translational Medicine of Aging, Volume 2, 2018, Pages 30-37, ISSN 2468-5011,

7. Poljsak B, Kovač V, Milisav I. Healthy Lifestyle Recommendations: Do the Beneficial Effects Originate from NAD+ Amount at the Cellular Level? Oxid Med Cell Longev. 2020 Dec 12;2020:8819627. doi: 10.1155/2020/8819627. PMID: 33414897; PMCID: PMC7752291.

Flu season is ramping up and experts are concerned it may be especially severe this year. For one, the southern hemisphere experienced a sharp increase in cases which may translate to an uptick in the northern hemisphere. Additionally, all of our masking over the past couple of winters may have weakened our immunity against influenza. 

Influenza, or the flu, can come on very suddenly, with symptoms of fever, cough, sore throat, body aches, nasal congestion or runny nose, muscle aches, joint pain, headaches, and profound tiredness. Certain flu strains also carry a higher likelihood of causing symptoms like vomiting and diarrhea.

Usually, people experience just a few of these more predominant symptoms, and recovery time ranges from a few days to a couple of weeks. However, secondary infections (like bacterial pneumonia or sepsis) can also occur. Less commonly, the flu can cause multi-organ failure, brain inflammation, heart inflammation, or muscle tissue conditions. While anyone can experience a complication from the flu, they are far more likely in people with chronic illnesses, suppressed immune systems, or at the ends of the age spectrum (the very young or very old).

Precautions to take

The flu is highly preventable, and we are all essentially experts at flu prevention, having lived through the COVID-19 pandemic. To avoid contracting a respiratory virus like the flu, avoid close contact with people who are sick, cover your nose and mouth when you cough or sneeze, wash your hands often, avoid touching your face, clean and disinfect surfaces that may be contaminated, and wear masks when in crowded places.

The number one prevention tip is, of course, to get a flu shot.  Studies show that getting a flu vaccination reduces the risk of contracting the flu between 40% and 60% among the overall population. 

Flu shots contain different strains of the influenza virus and when you get a flu shot, your immune system essentially practices its defense response. This way, should you contract influenza your immune system will be familiar with the virus and have a higher chance of eliminating it. 

Which vaccine should you get?

Several types of flu vaccines are available this season. The CDC recommends flu shots for everyone aged 6 months and older, but this year they are relaying special considerations for the 65 and older crowd as this age demographic is at higher risk for developing complications associated with the flu. The CDC recommends the following vaccines for people 65 years and older:

• Fluzone High-Dose Quadrivalent vaccine
• Flublok Quadrivalent recombinant flu vaccine
• Fluad Quadrivalent adjuvanted flu vaccine

When you get a flu shot, your immune system will get a chance to try out its defense tactics on the inactivated (killed) forms of the flu viruses. Think of a boxer practicing for a match by hitting a punching bag. When your immune system encounters one of these influenza viruses in the wild, it will already know its opponent’s weaknesses, and it will have a much higher chance of knocking its lights out before you’re even aware of what’s going on.

How will Covid-19 affect this year’s flu season?

Experts have been vocal about their worries of a twindemic from rising Covid-19 cases and simultaneous spikes in influenza. But a third virus is on the horizon that could add even more complications this winter season. R.S.V, a respiratory virus, is already running rampant across pediatric hospitals. 

It’s still too early in the season to be able to predict with a degree of certainty, the extent of each virus. But now is the time to start taking precautions. Flu vaccines, COVID-19 vaccines (and boosters, if eligible) are vital defensive resources against the oncoming wave of illness. And, as always, masking up in public and practicing social distancing are also effective strategies for mitigating illness in your household this winter. 

And if you do contract the flu or virus, our vitamin IV therapies effectively replenish your body with essential nutrients. Additionally, studies have shown that Vitamin C IV therapies reduce fatigue and fatigue-related symptoms common to Long COVID. 

Schedule a consultation today to learn more about available recovery treatments.

References:

https://www.cedars-sinai.org/newsroom/arm-yourself-against-the-2022-23-flu-season/

https://www.cdc.gov/flu-vaccines-work/benefits/?CDC_AAref_Val=https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm

https://www.nytimes.com/2022/10/23/health/flu-covid-risk.html

https://www.cdc.gov/flu/about/index.html

What are Exosomes?

With restorative therapeutics gaining the attention of researchers and clinicians across the world, exosome therapy has been widely recognized as a potential treatment avenue for a range of degenerative conditions and diseases. Exosomes are small vesicles that are secreted by many different types of cells. These vesicles were initially viewed as cellular garbage, but in recent years researchers have discovered numerous clinical applications of exosome properties from drug delivery techniques to restorative therapeutics (41). Exosomes carry numerous biomolecules, such as lipids, proteins, microRNA, and nucleic acids, and deliver this cargo to target cells that subsequently carry out a distinct response based on the contents of the cargo. As such, both exosomes and their contents have the ability to alter cellular communication by influencing the activity of biological processes within tissue microenvironments (41). By expressing target cell-specific surface proteins, exosomal cargo can modulate cellular behavior within target cells with considerable precision.

Many exosome-based therapies contain exosomes that originated from mesenchymal stem cells (MSCs) of the umbilical cord, amniotic fluid, or bone. MSC-derived exosomes are used therapeutically because they mediate changes in biological function by altering gene expression. MSC-derived exosomes carry growth factors and microRNA (mRNA), which is a class of bioactive molecules that can very specifically fine-tune the production of certain proteins that regulate the activity of cellular pathways. By delivering growth factors and mRNA, MSC-derived exosomes can elicit therapeutic effects by enhancing target cell viability and proliferation (41-42). Importantly, MSC-derived exosomes have the ability to regulate the behavior and activity of immune cells (43-44). 

Here at Hudson Medical, we have published several studies on the usage of exosomes in clinical conditions, specifically for inflammatory conditions of the spine. Please read our safety study here. We are continuing with ongoing research with this promising new therapeutic. 

What is Exosome Infusion Therapy and how does it help reduce long COVID Symptoms?

Recently, exosomes secreted by MSCs have been studied as a novel therapeutic tool for the treatment of diseases and conditions ranging from osteoarthritis to chronic regional pain syndrome to long COVID (43-45). MSC-derived exosomal cargo contains several growth factors, cytokines and mRNAs that play significant roles in the regulation of wound healing, tissue regeneration, and immunomodulation (45-51). Each of these bioactive molecules target the activity of cellular pathways that promote tissue regeneration, which is a particularly advantageous property for treatments that target diseases associated with tissue damage or inflammation.

Exosome Infusion Therapy has been studied and used as an option for COVID-related conditions, like lung fibrosis, lung damage, and long COVID. Lung fibrosis can occur as a result of COVID infection and can lead to inflammation or scarring of lung tissue (52). Over 30% of moderate COVID patients experience persistent lung damage up to one year following recovery and an estimated 2-6% of these patients experience lung fibrosis (52). Research has demonstrated that the SARS-CoV-2 virus, the virus that causes COVID, can alter gene expression of lung cells to favor abnormal wound healing processes that can result in the development of lung damage and fibrosis (53). Although traditional treatment options for COVID-induced lung damage are limited to the prevention of further lung tissue damage and symptom relief, Exosome Infusion Therapy has been shown to significantly reduce symptoms of long COVID, including reducing lung inflammation, improving respiratory function, and improving oxygen saturation measurements (54-55). Further, multiple restorative medicine companies which produce exosomes are seeking approval by the Food and Drug Administration (FDA). There are currently several manufacturers of exosomes seeking FDA approval of their exosome products by conducting exosome infusions for long COVID patients who suffered from acute respiratory distress syndrome (ARDS) during an active COVID infection (56). The exact mechanisms by which the SARS-CoV-2 virus causes persistent symptoms in long COVID patients remains unclear, but the regenerative properties of MSC-derived exosomal cargo may in part explain the meaningful reduction in long COVID symptoms following Exosome Infusion Therapy. By modulating cellular communication and regulating cellular physiology, Exosome Infusion Therapy stimulates tissue regeneration and accelerates wound healing, processes that become aberrant in long COVID patients.

What happens during Exosome Infusion Therapy? 

Exosome Infusion Therapy can potentially provide symptom relief of long COVID through the anti-inflammatory and regenerative capabilities of exosomes. When administered intravenously, Exosome Infusion Therapy may address the physiological causes of long COVID symptoms by stimulating tissue regeneration and healing of damaged tissue. 

Exosomes are currently not FDA approved, and are considered experimental. Here at Hudson Medical, we have published several studies on the usage of exosomes in certain clinical conditions. We are currently conducting more clinical trials on this promising new therapy. 

What is NAD+?

NAD is the abbreviation for a compound called nicotinamide adenine dinucleotide, which is well-known for its critical role in energy production. This compound is also involved in the smooth execution of signaling pathways that govern proper functioning of the immune system and cell survival.

NAD+, a form of NAD, is responsible for many of these biological functions. As we age, DNA damage from toxin accumulation, ultraviolet light exposure and other stressors cause levels of NAD+ in the body to decline. In addition to the natural decline of NAD+ levels that occurs with aging, many disease states associated with increased oxidative stress cause a reduction of NAD+ levels (28).

Under normal conditions, reactive oxygen species (ROS) are produced by many cellular processes, such as oxygen metabolism and antimicrobial activities. These compounds are typically cleared or counteracted by enzymes, but ROS can accumulate if these antioxidant mechanisms are impaired, causing DNA damage and a subsequent reduction of NAD+ levels (29, 30). 

Reduced levels of NAD+ have been shown to cause altered metabolic states and increased disease susceptibility. The consequences of insufficient levels of NAD+ have been widely studied in the context of age-related disorders and neurodegenerative diseases (30-31). More recently, however, research suggests these consequences may contribute to the extensive biological abnormalities seen across the SARS-CoV-2 disease spectrum (32). Early data indicates that NAD+ repletion therapy may reduce symptoms of long COVID (33). 

How does NAD+ IV infusion therapy reduce long covid symptoms?

Enzymes are a type of protein that help speed up chemical reactions in the body. Normally, enzyme production is under tight control to ensure that products are not wasted through excessive synthesization and substrates are not used up too quickly. Many enzymes and proteins depend on NAD+ to carry out their respective functions. For example, some NAD+-dependent enzymes are required for the antiviral activity of the interferon system, an immune response to viral infection (34).

Enzymes involved in the interferon system rely on a supply of NAD+ to carry out antiviral responses (34-35). During many viral infections, the NAD+ supply required by the interferon system is undisrupted and the immune system can adequately respond (34). When a person’s cells become infected with SARS-CoV-2, the virus that causes COVID and long COVID, the composition of enzymes produced by the cell’s protein synthesizing machinery drastically changes.

Recent research has shown that the SARS-CoV-2 virus stimulates the infected cells to increase the synthesis of NAD+-consuming enzymes which preferentially provide NAD+ to viral activities (35-37). The NAD+-consuming enzymes which become upregulated in SARS-CoV-2 infection cause a severe depletion of available NAD+ (36-37). Without an adequate supply of NAD+, the NAD+-dependent enzymes of the interferon system cannot properly function, leading to impaired antiviral activity (34-37). Further, dysregulation of NAD+ metabolism has been shown to have a wide range of health implications from compromised cardiac function to hyperinflammation and DNA damage due to increased oxidative stress (38).

Although the consequences of SARS-CoV-2-mediated NAD+ depletion are not yet fully understood, preclinical and clinical data has suggested NAD+ supplementation may accelerate recovery from long COVID (39-40). NAD+ supplementation has been shown to increase the body’s resilience to many different diseases. Physician-guided intravenous administration of NAD+ may safely provide direct and effective symptom relief of long COVID symptoms involving NAD+-depletion.

Please see this linked article that we are publishing that summarizes our current understanding of this process. 

What happens during NAD+ infusion therapy?

NAD+ can be administered orally or intravenously, but intravenous administration results in higher concentrations of NAD+ in the bloodstream (21). Prior to your infusion, you will have a consultation with your physician, who will carefully consider your medical history and present symptoms to determine if you are a candidate for NAD+ IV Infusion Therapy. If you are an appropriate candidate, our staff will help you get comfortably set up in one of our infusion rooms.

During a NAD+ IV Infusion treatment, one of our highly experienced staff members will place an IV in your arm or hand, which will remain throughout the duration of the therapy. Over the course of 45 minutes to 1 hour, NAD+ will be administered through an IV drip with normal saline.

What is Vitamin C?

Vitamin C is a powerful antioxidant with many biological functions. The body requires vitamin C to synthesize a variety of essential compounds, such as collagen and certain neurotransmitters (18). Antioxidants are substances that are able to prevent the formation and inhibit the activity of cellular waste products called reactive oxygen species (ROS) that can damage DNA through a process called oxidative damage (19). Under normal conditions, many cellular processes produce ROS as waste products, but the body can minimize potential oxidative damage through the use of numerous antioxidants, including vitamin C. As such, antioxidants are an extremely important component of the body’s defense mechanisms against oxidative stress.

The antioxidant properties of vitamin C have been widely studied in the context of immunity, cancer prevention and anti-aging treatments. By acting as a potent antioxidant molecule, Vitamin C supports many cellular functions of the immune system. Of the many roles vitamin C has in boosting immune defense, the ability of vitamin C to reduce viral yield and inhibit excessive activation of inflammatory responses to viral infection are particularly important when examining vitamin C in the context of long COVID (20). 

Many clinical studies investigating the role of vitamin C in immunity utilize intravenous high-dose vitamin C supplementation because many of the immune-related benefits of vitamin C occur at serum concentrations only achievable with intravenous administration (21). As the vast majority of clinical trial patients who have received intravenous high-dose vitamin C infusions experience very few side effects, vitamin C IV therapy has a strong safety profile (22).

How does high-dose Vitamin C IV Therapy help reduce long COVID symptoms?

Research has suggested that the development of many diseases, such as cancer and cardiovascular disease, may be caused in part by the oxidative damage that occurs when the amount of oxidative stress exceeds the capacity of the body’s antioxidant mechanisms (23-24). Interestingly, many patients with long COVID experience chronic fatigue symptoms that are very similar to those described for cancer patients and cardiovascular disease patients (25). As such, recent research has focused on understanding how oxidative stress may contribute to the development of chronic fatigue symptoms associated with long COVID and developing long COVID treatment protocols that incorporate potent antioxidants, like vitamin C. 

High-dose vitamin C IV therapy can significantly reduce fatigue and fatigue-related symptoms like sleep disturbances and lack of concentration in long COVID patients (26). Viruses can cause cellular and tissue damage by altering the level of oxidative stress in infected cells. SARS-CoV-2, the virus that causes long COVID, causes tissue damage by increasing oxidative stress in infected cells. Though the exact mechanism by which this viral strategy causes long COVID symptoms remains unclear, research suggests that this oxidative imbalance may damage tissues implicated in fatigue-related long COVID symptoms (21, 27). 

What happens during a High-Dose Vitamin C IV Infusion?

Vitamin C can be administered orally or intravenously, intravenous administration results in higher concentrations of vitamin C in the bloodstream (21). Prior to your infusion, you will have a consultation with your physician, who will carefully consider your medical history and present symptoms to determine if you are a candidate for High-Dose Vitamin C IV Infusion Therapy. If you are an appropriate candidate, our staff will help you get comfortably set up in one of our infusion rooms. During a High-Dose Vitamin C IV Infusion, one of our highly experienced staff members will place an IV which will remain throughout the duration of the therapy. Over the course of 45 minutes-1 hour, our unique vitamin C cocktail will be administered through an IV drip.

Stellate Ganglion Blocks (SGBs) are minimally-invasive procedures used to treat many types of sympathetic nervous system-related disorders, including post-traumatic stress disorder (PTSD), complex regional pain syndrome, and ventricular arrhythmia. The stellate ganglion (SG) is a nerve cluster associated with the activation of the sympathetic nervous system, the branch of the nervous system that is responsible for initiating “fight-or-flight” responses to impending danger and fear. The SG is located in the upper neck and coordinates with the central nervous system to produce sympathetic physiological responses. Under normal conditions, sympathetic responses are initiated following appropriate stimuli, such as an increase in sweating and heart rate when running from a bear or while slamming on the brakes to avoid a car accident. The sympathetic nervous system is essential to normal functioning and survival because sympathetic responses liberate extra energy and equip the body to deal with emergency situations. Despite this vital role, overstimulation or dysregulation of the sympathetic nervous system can result in altered SG signaling and can lead to dysfunctional or inappropriate physiological responses (also referred to as dysautonomia) (5). Dysautonomia is abnormal activity of involuntary body functions that are regulated by the sympathetic nervous system, such as heart rate, breathing and digestion. The SG carries sympathetic signaling to many body regions and organs, including the head, neck, upper limbs, thymus, heart, lungs, lacrimal gland, salivary gland, thyroid gland and pineal gland (6). As such, dysautonomia can have detrimental effects on myriad organ systems and can severely impair quality of life. 

Why do Stellate Ganglion Blocks help treat long COVID?

Many neurological long COVID symptoms, such as fatigue, anosmia, headaches and hypoxia, that fail to respond to traditional treatment protocols are associated with dysautonomia (7). As long COVID may persist over weeks or months, persistent dysregulation of sympathetic signaling may potentially contribute to or exacerbate long COVID symptoms (8). Although the direction of causation remains unclear, research indicates that there is a relationship between long COVID and dysautonomia. This relationship underscores how Stellate Ganglion Blocks (SGBs) can be effectively implemented in the treatment of long COVID. 

 SGBs work by anesthetizing the physical source of sympathetic overdrive, the stellate ganglion nerve cluster (SG). As such, SGBs are able to effectively “reset” the sympathetic nervous system and restore normal biological function, providing rapid and significant symptom relief of even the most severe sympathetic symptoms. SGBs have been widely shown to provide significant and long-lasting relief for patients with PTSD and anxiety who experience sympathetic overdrive symptoms (9-13). SGBs have also been used to treat sympathetic nervous system-related conditions of the head, neck and upper body ranging from cardiac applications to complex regional pain syndrome (14-15). Recent research indicates SGBs can be used to safely and effectively treat symptoms of long COVID (16). By targeting the root cause of dysautonomia in long COVID patients, SGBs may reduce sympathetic hyperactivity and increase cerebral blood flow, providing patients with significant symptom relief. 

Sympathetic innervation plays a vital role in the communication between the immune system and the nervous system and dysregulation of this relationship can have serious health consequences (16). Research has shown that, in general, feedforward loops (physiological mechanisms that result in activation of a biological pathway) are essential to the body’s ability to elicit a rapid immune response to infection, and feedback loops (physiological mechanisms that result in inactivation of a biological pathway) may mitigate inflammation levels to prevent inflammation-related damage (16). As such, a balance between sympathetic feedforward and feedback loop signaling is required for normal communication between the immune and nervous systems. Many pathologies disrupt this relationship, promoting sympathetic responses (e.g., elevated cytokine and catecholamine levels) and subsequent inflammation-related problems (16). Importantly, the vagus nerve, a nerve that is responsible for counteracting sympathetic responses (i.e. a parasympathetic nerve), communicates information about pro-inflammatory biomarkers to the brainstem (16). During elevated sympathetic signaling, the brainstem responds by integrating this information into behavioral responses (i.e. sickness behaviors), which closely resemble long COVID symptoms (16). Persistent hyperactivation of the sympathetic nervous system can physically alter the connection between the vagus nerve and the brainstem, leading to prolonged dysautonomia (16). Research suggests that continued hyperactivation of the sympathetic nervous system may be at least partially responsible for persistent inflammation-related long COVID symptoms (16). 

Similarly, prolonged dysautonomia is associated with impaired cerebral blood flow (CBF) in myriad conditions (e.g., myalgic encephalitis/chronic fatigue syndrome (ME/CFS) and postural orthostatic tachycardia syndrome) with clinical presentations that parallel many symptoms of long COVID (16). In general, impaired CBF causes a range of clinical symptoms such as cognitive dysfunction, impaired memory and attention, and reduced visual, gustatory or olfactory function (16). 

Numerous case reports have demonstrated significant long COVID symptom relief following SGB treatments (16). Anesthetizing the physical source of sympathetic hyperactivation (the SG) through SGB procedures may recalibrate the communication between the immune and nervous systems toward a pre-COVID balance and may effectively reduce long COVID symptoms (16). Similarly, SGBs may alleviate some neurocognitive symptoms of long COVID by increasing CBF and improving perfusion to brain structures involved in sensory perception or processing (16). Indeed, SGBs have been utilized for the treatment of anosmia for years prior to the COVID-19 Pandemic (17). Studies suggest that SGBs may be an effective treatment for dysautonomia-related long COVID symptoms and may provide long-lasting relief of anosmia and dysgeusia (16-17). 

One recent case study demonstrating long COVID symptom relief following SGB treatments studied a 42-year old female who presented with long COVID symptoms eight months after the onset of her initial non-critical COVID course. This patient demonstrated significant and lasting symptom relief following two SGB procedures (16). The patient complained of many characteristic long COVID symptoms, including low oxygen saturation, debilitating fatigue, difficulty concentrating, mental fogginess, and diminished and altered sense of smell and taste (anosmia and dysgeusia, respectively). Following the initial SGB, the patient reported immediate ipsilateral improvement in anosmia and dysgeusia and significant improvement in concentration and mental clarity. Immediately after the second SGB, the patient experienced complete restoration of bilateral olfactory and gustatory function. At both the two week and 60-day follow up, the patient reported no change in these symptom improvements, suggesting SGBs provided significant and lasting relief of three long COVID symptoms: anosmia, dysgeusia and cognitive impairments (16).

Another recent case study reported on a 44-year old female who experienced long COVID symptoms for eight months prior to intervention with bilateral SGBs (16). The patient presented with significant cognitive impairment, dysgeusia, anosmia, stuttering speech, right sided paresis, memory deficits, impaired coordination, debilitating fatigue and inability to concentrate. Immediately following the first SGB procedure, the patient reported a significant improvement in anosmia and dysgeusia. At the two week follow-up, the patient reported a drastic resolution of stuttering speech and 75% improvement in all other long COVID symptoms. At the 60-day follow up, the patient reported durable restoration of olfactory and gustatory function, normal levels of fatigue, restoration of cognitive function, and absence of other long COVID symptoms (16). 

The significant improvement of long COVID symptoms following bilateral SGBs described in these case studies indicate an important role of dysautonomia and cerebral blood flow in the pathophysiology of long COVID (16). As such, the application of SGBs in treating long COVID is extremely promising. SGBs have a well-established safety profile and current research suggests that SGBs may effectively reduce dysautonomia and neurocognitive symptoms in at least a subset of long COVID patients. 

What happens during a Stellate Ganglion Block?

Stellate Ganglion Blocks are highly effective and safe minimally-invasive outpatient procedures performed under monitored care anesthesia (light sedation). Using X-ray fluoroscopy and ultrasound, your physician will guide a small needle into the neck region that contains the stellate ganglion nerve cluster. Once the needle position is confirmed, a local numbing anesthetic (e.g. bupivacaine or lidocaine) is injected into the stellate ganglion. The entire procedure is performed under ultrasound guidance and takes an average of 20 minutes to complete (13).

Successful SGBs will elicit a physiological response known as “Horner’s Syndrome” (16). Horner’s Syndrome may include facial flushing, ipsilateral ptosis (drooping of the eye on the same side the SGB was performed), meiosis (decreased pupil size), eye redness, reduced sweating and hoarseness (16). This response typically lasts between 4-8 hours and, in the vast majority of cases, will subside by the following day. Your physician will monitor you for evidence of Horner’s Syndrome for about 15 minutes after the completion of your procedure.