This debilitating condition affects millions of people.  Dr. Barter has closely followed the work of Bruce Patterson, MD and the Critical Care Coalition, watching the emerging published data on exactly what causes long COVID and what can be done about it.  Cornerstones of treatment in our office include:

• Corticosteroid and adrenal support, as aggressive as tolerated
• Blood thinners and fibrinolytic agents such as lumbrokinase, nattokinase, aspirin, heparin and others
• Ivermectin
• Inhalation treatments such as steroids or dilute hydrogen peroxide
• Herbal or natural anti-inflammatories such as andrographis, elderberry, curcumin, resveratrol, melatonin, fish oil
• Herbal or natural immune boosters such as Vitamin D, Vitamin C, zinc, quercitin, black cumin seed oil, olive leaf, echinacea, low dose naltrexone
• Intravenous therapies such as IV Vitamin C, IV Ozone-UBI, IV Phosphatidylcholine & IV Glutathione often with other nutrients
• Beta blockers and short-term statins for cardiovascular inflammation and POTS symptoms
• Treatment for Mast Cell Activation Syndrome, which is often set off by COVID infection and sometimes vaccination

• Hashimoto thyroiditis
• Celiac disease
• Crohn's disease
• Ulcerative colitis
• Lymphocytic colitis
• Neurodegenerative conditions
• Rheumatoid arthritis
• PANS/PANDAS (Pediatric Auto-Immune Neuropsychiatric Syndrome)
• Adult Auto-Immune Encephalopathy

• Migraines
• Headaches
• Back & Neck pain
• Joint & Muscle pain
• Arthritis
• Muscle & Postural imbalances
• Fibromyalgia
• Ehlers Danlos Syndrome

• Food allergies & sensitivities
• Constipation
• Diarrhea
• Irritable bowel syndrome
• Heartburn
• Gas & bloating
• SIBO & SIFO
• Parasites

We offer all of the  specialized stool, breath and blood tests to evaluate the source of most digestive complaints

• Insomnia
• Fatigue
• Skin rashes
• Acne
• High blood pressure
• High cholesterol
• Heart disease
• Allergies
• Sinus infections
• MCAS (Mast Cell Activation Syndrome)

• Mold 
• Heavy metals - lead, mercury, cadmium, arsenic, uranium etc.
• Plastics, phthalates, dioxins
• PCBs, polyfluorinated compounds, PFAS and other "forever chemicals"
• Pesticides
• Herbicides
• Solvents
• Other petrochemicals
• Nitrates
• Wildfire smoke

Common Symptoms [1][2][3][i]

• • Cognitive dysfunction: Brain fog, confusion
  • Neurologic: Headaches, nerve pains, hypersensitive to pain
  • Hyper-reactivity: to everything – foods, meds, supplements, noise, odors
  • Skin: rash, hives, flushing, swelling
  • Abdominal: pain, cramping, bloating, nausea, heartburn, diarrhea, gastritis (H. pylori negative)
  • Respiratory: shortness of breath, cough, runny nose/eyes
  • Fainting or near-fainting
  • Cardiovascular: low/high/fluctuating blood pressure, POTS, Heart palpitations and racing, flushing
  • Psychiatric: Depression, anxiety, panic attacks, bipolar, psychosis

Symptom Assessment – Dr. Afrin’s Questionnaire

Testing

Testing can be challenging due to expense, timing and extreme difficulty of complex sample processing.  Discuss with the doctor.  Histamine, Chromagranin A, tryptase, Prostaglandins.

Treatment

Combo of trigger avoidance, nutrients, herbs, and medications most effective in most cases.

Avoid common triggers:

• Dust, mites, pollens, animals
• Viruses, bacteria, mold, fungi, yeast
• Toxins such as heavy metals, glyphosate, BPA, and from infections or vaccines
• Diet
• Stress
• Temperature changes
• Hormonal imbalances

Nutrients:

• Quercitin
• NAC
• Vitamin C
• Methylation support
• Diamine Oxidase Enzyme
• Alpha lipoic acid
• Resveratrol
• Rutin
• Luteolin
• Pomegranate
• Curcumin (turmeric)
• ECGC (green tea)
• Pantethine (Vitamin B5)
• Certain probiotic strains reduce histamine production: Lactobacillus rhamnosus

Pharmaceuticals:

• Claritin, Zyrtec, Allegra, Benadryl
• Hydroxyzine – very sedating
• Montelukast
• Cromolyn sodium
• Ketotifen
• Ranitidine, cimetidine
• Benzodiazepines
• Corticosteroids
• Low dose naltrexone
• Imatinib – immunosuppressant
• Peptides – BPC-157, Thymosin-Beta 4, KPV, Cerebrolysin

Diet

• Avoid known triggers.  No fermented foods.  No leftovers.  Food bacteria produce histamine that cannot be destroyed once formed.
• No “one-size-fits-all” low-histamine diet available
• Eat organic, local

GI Support

• Probiotics that rarely cause histamine issues: rhamnosus, bifido, spore-forming
• Treat imbalances in GI such as SIBO, yeast/fungus, parasites, dysbiosis,
• Treat leaky gut: L-glutamine, aloe, quercitin, DGL

1[1] Afrin In: Mast Cells Chapter 6 ISBN: 978-1-62618-166-3 2013

[2]2 Molderings et al. Journal of Hematology & Oncology 2011, 4:10


[3]3 Afrin Brain Behav Immun 2015 Nov50:314-321

PANDAS is an acronym for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep Infections. PANS stands for Pediatric Acute-onset Neuropsychiatric Syndrome. 

PANDAS/PANS is an autoimmune disorder that affects children with the average age of onset between 4 and 7 years.  The condition is often triggered by an infection such as Strep, various viruses including COVID, Lyme disease and related co-infections, mold exposure and other microbes.
Teenagers and adults can also acquire this auto-immune encephalopathy (brain inflammation).

PANDAS/PANS occurs when the antibodies the body has made to fight an infection mistakenly attack healthy tissue in the brain contributing to a host of movement disorders, neuropsychiatric symptoms, and abnormal neurologic behaviors.

The change is often "lightning like," developing within a 24 to 48 hour period.  Parents will describe having an angel child one day and a demon child the next. The OCD symptoms and/or eating restrictions begin so suddenly that most parents can recall the exact day and time that the OCD or restrictive eating began. 

Diagnosis & Treatment

• Often, PANDAS/PANS is misdiagnosed and only its symptoms are treated. To be effective, treatment must properly target the infection and support the underlying immune system. With proper medical care and appropriate medications, PANDAS/PANS can be successfully treated. Testing is the first step to proper diagnosis and treatment. 
  
  Common symptoms:
• Vocal tics
• Obsessions
  
• Motor tics
• Behavioral regression
• Compulsions
• Anxiety
• Irritability
• Sleep disturbances
• Depression
• Impulsivity
• Regression in handwriting
• Anorexia
• Aggression
• Sensory abnormalities 
• Mood swings 
• Bedwetting

 Diagnostic criteria guidelines from the National Institute of Mental Health for diagnosing PANDAS: 

• Presence of obsessive-compulsive disorder and/or a tic disorder
• Pediatric onset of symptoms (age 3 to puberty) 
• Episodic course of symptom severity
• A positive throat culture for strep or history of Scarlet Fever 
• Association with neurological abnormalities (motor hyperactivity or choreiform movements) 

Diagnostic criteria guidelines from The National Institute of Mental Health for diagnosing PANS: 

• Abrupt, dramatic onset of OCD or severely restricted food intake 
• Symptoms are not better explained by a known neurologic or medical disorder 
• Addition of at least 2 of the “accompanying” symptoms: anxiety, emotional swings and/or depression, irritability, aggression, behavioral regression, deterioration in school performance, sensory or motor abnormalities, sleep disturbances, bed wetting or urinary frequency changes 
• PANS may start with infectious agents other than strep, environmental triggers or immune dysfunction 

(NIMH - http://www.nimh.nih.gov) 

Testing:

• Moleculera Autoimmune Encephalopathy Profile
• Vibrant Wellnss Neural Zoomer