63 - Dr Michael Bagnell - Long Covid & the brain

Episode 63 of the Long Covid Podcast is a chat with Dr Michael Bagnell, Functional Neurologist & Chiropractic Physician based in Miami, Florida. We talk about all things Long Covid and the brain - what's causing things to go wrong and how to fix them!

Useful links below.

www.bagnellbraincenter.com
https://www.bagnellbraincenter.com/online-forms.html
"Persistent Brainstem Dysfunction in Long Covid - a Hypothesis" 

Transcript

Jackie Baxter  0:00  
Welcome to the long COVID podcast with me, Jackie Baxter. I'm really excited to bring you today's episode. Please check out the podcast website, longCOVID podcast.com, where there's a collection of resources, as well as a link to the Facebook support group. If you're able to please consider supporting the show is in the link in the show notes. If social media is your thing, you can follow me on Facebook @LongCOVIDpodcast, or on Twitter and Instagram, both @longCOVIDpod. I'm really keen to hear from you. If there's anyone you'd like to hear on the podcast, or if you've got any other feedback, please do get in touch through any of the social media channels, or email longCOVIDpodcast@gmail.com. I really hope you enjoyed this episode. So here we go. 

Hello, and welcome to this episode of long COVID Podcast. I am absolutely delighted to welcome my guest today, Dr. Michael Bagnell, functional neurologist, and many other things as well. So we're going to be talking about all sorts of things around Long COVID and the brain. So welcome to the podcast.

Michael Bagnell  1:30  
Thank you. It's wonderful to be here with you and get to know you a bit and then to share some hopefully hopeful and insightful things for your listeners.

Jackie Baxter  1:39  
That sounds absolutely wonderful. So to begin with, would you mind just giving a brief introduction of yourself and what it is that you do?

Michael Bagnell  1:47  
Yes, sure. I've been in medical or clinical practice for 33 years. And my beginning is in physical medicine here in the United States, which is considered chiropractic health care, chiropractic health care services. So we've been in that model for many years, but I was always interested in neuroscience and the brain. Of course, 33 years ago, it wasn't even neuroscience, it was just neurology. And so I began my postgraduate work, not only in clinical physical health care, but also working in the study of of neurology trying to pursuing that. And as that progressed, it became neuroscience and clinical neuroscience, and I moved my practical practice life into functional neurology. 

Now, the name is considered clinical neuroscience, where you're taking applications - or rehabilitation you might think of - models and using those in clinical practice to improve functional neurologic conditions. So it's not quite the same as what some people might think of functional neurologic disorders. Because many times those are considered more where someone is having a problem with the nervous system that's functional, meaning it's not a tumor, it's not something solid in a mass in the brain, but it's creating a change in the function of the brain that's affecting only the psychological state of the person. So that's a lot of explanation in that area, we can come back to that. 

But my work is in functional neurology, or clinical neuroscience. And it's designed to understand what's going on in someone's nervous system, their brain, and then how their body is then expressing that function, their body, or as you mentioned, before, their cognition, their mind, their emotional state. Really, I like to summarize it by saying our work is really brain based healthcare, brain based health care. And so we look at whatever condition presents to us whatever the client has, uniquely and say, is this, does this have targets or a an area in the brain that is related to what they're dealing with? Which is a very different model, because most healthcare I would say - and I'm going to generalize a lot of things - is related to things from the neck down. 

So if a a female comes in, and she has hormonal imbalances, difficulty with her menstrual cycle, it's only considered to be a hormonal issue, primarily, in most healthcare around the world. We would say, of course, there's a you know, it would be ignorant to not think about the hormones and to analyze the hormones, but also, how is their brain or is their brain playing a role in their hormonal expression in their body. And as we will go through the neuroscience of that, we'd say it's possible, then we have to have ways to measure it to see if there is an involvement that can be helped, not only chemically with maybe some type of hormones or supplements naturally, but a brain based activity that might help to rebalance or bring into balance her hormonal system. 

So that's, that's a pretty big string away from what we consider in typical medical practices, allopathic practices, so brain based health care is really the view that we have using functional neurology, or clinical neuroscience techniques, applications, therapies, you can use many, many terms for that. And that's how we look to help restore our clients restore people to a higher level of health. And what does that mean - function. So if you have somebody who's suffering, like yourself, and so many others with long COVID, and the constellation of symptoms, can we restore them to function? Whether it's working, whether it's just walking, whether it's exercising again, whether it's carrying on as a mother or a father, whether it's getting a child to be able to go back to school, in a normal way, we want to get their functionality back, by working through the brain system models, and we do address metabolic issues. We address many other things, which we'll talk about as we go - long answer to a short question.

Jackie Baxter  5:57  
That's amazing. So you really are looking at the whole person, but the whole person including the brain,

Michael Bagnell  6:03  
absolutely, yeah, have to let me just tag on this because I wrote this note down this morning. So we'll step back from that for a minute. And this is my consideration in medicine and healthcare, especially in the last two years with COVID and long COVID showing up, is that - I'll use the analogy of food. We have fast food in the world, primarily out of America that has been migrated or let's say infected other countries, the fast food model, which we know is not a real healthy model, we know it's convenient, but it's not a real health developing model. Okay, so I know that in Italy, they started the slow food movement some years ago, out of some areas, and there's some shows on this, perhaps I think it was with Stanley Tucci, or with Anthony Bourdain, or one of these wonderful people traveling there, the slow food movement says slow it down, farm to table, so to speak, let's take our time, let's prepare proper food that provides a nourishment and health to the person. 

Okay, what does that have to do with medicine? I think we need a slow medicine movement. I think medicine is just rolling way too fast that people walk in. And I see this all the time on Twitter. As a matter of fact, people I've been to my doctor, they said I'm fine. Five minutes in and out, take this, this medicine, take this drug, I can't help you. You don't really have COVID, Yatta, yatta, Yatta, yatta. It's too fast. We have to slow medicine down and then think as physicians think, okay, what is the algorithm here? What is this person showing up with? What is their history of their present illness, slow down doctors. Because this this fast pace of medicine is really - 

I slowed down dramatically in 33 years. And I don't mean because I'm getting older. I mean, because it's wise to slow down with with patients. One of the great killers of empathy with physicians is time. When you're running out of time, you're not going to be expressing a lot of empathy and taking care of people. And I'll use this word in a shepherding way, not just in a clinical, let me just kind of get it off my plate. Next one, next one, next one next one, a shepherding way - caring for them, walking with them a bit more, getting them to the other doctors, even if you can't really help them fully. Can you provide some level of hope to them, some level of encouragement to them, some level of going on? Slow medicine movement, is what we're about personally. And it's what I try to impart to colleagues and friends around the world, slow it down. You know, it's not how many that we see. It's like, let's just take care of the one before us properly. 

I love the word that most people in the UK use "properly." This is a wonderful word to incorporate into our language in medicine. are you caring for the patient? Especially with long COVID "properly?" Now. What good is that going to do for you as a patient? Not as much right? Because the doctors have to hear this and it has to really touch and sink into their heart and their head and then change their model based on their reimbursement and all those things. But it's really incumbent upon us as physicians, and there are doctors like that, there are - right I'm sure you may have met one out of a string of 20 and others, but be encouraged. There are doctors that will slow it down. Will think through the process. You know, we get very used to just relying on everything else we've seen and oh yes, that sounds like, smells like, tastes like - Okay, here you go. That's it. Slow down doctors and and patients and people listening who are not physicians or clinicians. Be encouraged. There are people like that you just kind of, it's going to take a while to find them.

Jackie Baxter  9:53  
Yeah, I love the idea of slow medicine. That's fantastic. I mean, like we were saying just before we came on, you know Every one with long COVID, and I'm sure this covers a lot of other chronic illnesses as well, you know, they have a lot in common, but everyone is individual as well, everybody's got their own personal circumstances and their own set of symptoms and their own, you know, everything. So, you know, it's like you say, you know, you kind of have to listen to each individual in a way that you can actually get their story before you can know what to do, can't you?

Michael Bagnell  10:23  
Yes, absolutely, it is. Every person that I've trained with, that has been, you know, 30, 40, 50 years in medicine, that have been some of the, I would say, top professionals in terms of health care, that they all go back to, and I'm just talking about a handful, maybe four or five different people, they all go back to The most important part of your examination is the history. When you talk with your patient, you learn more about it, you don't have to have a long examination necessarily, because it starts leading you in the direction of what may be going on with a person. So the history taking is really important. And so we have to be good listeners, we have to develop that, I'm still developing that - being a proper listener with clients. But what kills it again, is that lack of time, when you don't have time, you lose empathy, you lose listening skills, you lose many things. 

So we need to move out of this, hopefully, we can move at least a little bit out of the Well, this is what is found in the research to work. And so it's good for everyone. Not necessarily. It's good that we have research, we want to have research. Of course, I read research multiple times a week, I'm reading abstracts and studies that are going to help me have an expanded view. But we know that everything is not good for everyone and long COVID recovery - and I'm going to say that recovery - is one of those examples. For instance, vagal nerve stimulation. It's not good for everyone. It's great for many people, but you have to have a proper analysis to know if it's going to be the best therapy. So this is a challenging mix. We need to take care of everybody and slow down and try to figure out what's the best therapeutic models for them as they recover.

Jackie Baxter  12:07  
Yeah, definitely, definitely. So talking about, you know, long COVID and COVID. And this is probably a very wide open question. What is going on with COVID and long COVID in people? And I'm sure it's not the same for everyone, as we were just saying,

Michael Bagnell  12:26  
Yeah, so there's lots of different systems involved. It's a complex disorder. It's mysterious to some degree, we know that some people are going after it in response to their Apheresis or having their plasma their blood removed and trying to bring down the antibodies in the blood and the the neuro inflammation. So some people are going about it in that direction. Some people say it's a mitochondrial disorder, so that's why it looks more like chronic fatigue syndrome, CFS and ME. But there's a gentleman and I have it here I'm gonna just read it off my desk, Avindra Nath. Avindra Nath is a a leader of a study, intramural study on ME and CFS, which is condition that similar to what many people are expressing with Long COVID. He's a neuroscientist. He works with the National Institute of Health in the US. And he believes that it's a neuro inflammatory disease that is affecting primarily the brainstem. 

So we get sick, I got sick myself, I got COVID twice. I got it one time last year. And it was a pretty rough bout, but not nearly the level of many of your listeners and people that are continuing. So I was sicker for sure in that week than I've been my whole life. So I was like, wow, this is pretty rough. But fortunately, I was able to come through it with only some kidney malfunction, which then restored. I had a bit of breathing on my right lung that took me a little while, about a month, and then kidney malfunction which also restored to a more normal level. So my journey is shorter, but he's saying that he questioned about the brainstem being involved because the brainstem has a lot of these ACE two receptors and other areas in the brain. 

So we have these receptors, we get the infection, we create inflammation all over the body and a very strong inflammatory reaction, right, very strong. It's not like getting some more mild viral illness. This is a very potent viral illness and it binds to areas of your body that have these ACE two receptors, we know that for sure. There's a high propensity of them in the brainstem and other areas of the brain, the amygdala, the cortex, but the brainstem is loaded with them. So the brainstem gets very attacked, so to speak, by this, and in some people, it's much worse, and some people it's lessened. And that brainstem is what controls what we call the autonomic function. 

So I'm going to pause for a minute and go back so - people with long COVID - many people are searching out Apheresis and that you know, micro clots are the problem and other people are looking at mitochondrial dysfunction and that's the problem. And so other people are looking at Dysautonomia, so I think these are probably the three primary - and then there's other models of what might be going on. 

So I like to step back to to the biggest model, we'll say like a 30,000 foot view. Okay. Yes, we may have micro clotting, Yes, we may have mitochondrial dysfunction, yes, because we know immune issues knock down your mitochondrial function - that happens in all kinds of immune illness, but more so with COVID because of the potency of it. And then we have this thought Dysautonomia - well dysautonomia, an autonomic system that's not working. Why because it's really housed in the brainstem. The brainstem is very much attacked. So that could be if you listen to the symptoms of Dysautonomia, which are actually listed on my website. We recently put up a page talking about Dysautonomia because there was so many questions. You think about, Wow, a lot of these things are related and different people have different expressions. 

So an inability to stay upright, dizziness and vertigo, fainting. So when someone goes from sitting down or laying down to geting up, they feel super lightheaded, their heart might race, they might have tachycardia, chest pain, low blood pressure when they get up. Brain fog, super common. They feel blood pooling, other people's blood pooling in their legs or their back. Problems with their gut, GI system, nausea, disturbances in their visual field, weakness in their muscles or arms and legs, usually extremities, breathing difficulties, mood swings. So here's a paper in front of me on my browser - mid and long term neurologic and neuro psychiatric manifestations of post COVID. So we have psychological changes, like anxiety, depression, and we have fatigue, of course, intolerance to exercise as we were talking, headaches, migraines, tremors, disrupted sleep pattern, frequent urination, temperature regulation problems, memory and concentration, appetite changes, sensory sensitivity especially to noise and light. So that's a lot of different symptoms. 

So the autonomic system, which is housed in the brainstem, which is very much affected by the infectious process of COVID, can be maybe in some people, the primary area that we have to focus our neurologic recovery on. It does not mean that we should not address metabolic conditions involved with micro-clotting. We should if they have that, I like to go from low invasive therapies to more invasive therapies. So I like to be cautious with that - we don't want to get into too many things. We just want to go slow, slow and progressive. But of course, what's before slow and progressive? What is the diagnostic picture of this person? 

Say, oh, okay, because someone might listen to this and say, That sounds like me, I have Dysautonomia, that's what I'm going to treat. We need to make sure we need to make sure or you need to make sure. So that is measured in a way of testing, which we'll talk about in a minute. So, Nath of National Institute of Health says, Hey, this disorder, it looks a lot like me and CFS, which has a lot to do with the brain stem, which has a lot to do with how neuro inflammation attacks it. And that's maybe the target. And I'll use my word of rehabilitation, and getting people back - last night I answered someone on Twitter who asked me a question, can I get better with my brain? And my answer is, yes, there are ways for you to improve and get back to normal, in most people, there's a high probability, but you just have to have the right applications. And I told her, it's going to be longer, it's going to be slower. But yes, you can. 

That's where we're going to start with Yes, until our body proves us wrong. We're gonna start with Yes, we can get better, even if it's been a long haul, right? If someone has had a knee injury, and they play football, and I'm talking about football around the world, right, so what we would call soccer, a knee injury, and they never really have it rehabilitated. They could be 2, 3, 5, 7 years suffering with that knee every time they try to do something. But if they have the proper rehabilitation, many times they can recover almost to full - full activity again, so similar model, that's oversimplifying it, people are suffering in much more extreme ways. But yes, the Dysautonomia model is the 30,000 foot model, in my opinion, that's my opinion - based on data, based on research, based on other people working in brain stem and neuro inflammation research, they're saying, hey, let's pay attention to this. So it's not the only thing, it's just a very focal thing for us to consider as we look at the whole view, and how to help a person get back to function again.

Jackie Baxter  20:17  
Yeah, I mean, it's, it's fascinating, isn't it? I mean, when I first heard about the Autonomic nervous system, I think my first thought was, I have no idea what that is. And then once I kind of realized, you know, the massive wide range of symptoms that it can cause because it basically controls everything. 

Michael Bagnell  20:34  
It does

Jackie Baxter  20:34  
So you know, then you can attribute all of these different symptoms, or certainly most of them, we think, Ah, okay, so it's not that I've got problems with, you know, every single different part of my body, actually, it comes back to that one cause, you know, I mean, fixing that is, you know, not simple. But, you know, it's, it's kind of one problem rather than hundreds.

Michael Bagnell  20:56  
That's right. See, that's right. Very, very good statement there. So we would hope that people listening to this would then Google, or whatever your search engine is, would look up Autonomic Nervous System, and then you're going to see usually images, a picture of all these organs on the right side, and all these organs on the left side, and they show you like a spinal column with the nerves coming out. So it is the system, the autonomic nervous system, you could think of and use the word automatic, almost in replacement. It's the automatic system that controls the functions that you and I do not have to think about. Breathing, gut function, pupil change, sweating, swallowing, your libido, your urinating, you're defacating, eliminating, digestive function, right? 

All these things that are going on automatically, can become disrupted when the autonomic system is involved. So you can have symptoms from your head down to your toes, because not only does it affect all the organ systems, but what does it do for the organ systems, it allows for blood flow. So the autonomic system is primary, very simplified language, job is to get blood flow to the proper areas. And what's the most important area - the brain, it's got to get blood flow upstream to the brain. That's the primary function, keeping the blood pressure and heart rate in check. So the person can get blood flow to their extremities, to their gut, to their brain, to all the things that are needed when they are needed. 

So getting blood flow to my legs when I'm sleeping is not as important as when I'm running in the park. Getting blood flow to my head when I'm standing up is very important. It's not as much of an effort when I'm laying down. So autonomic system is the automatic nervous system, so to speak, controlling blood flow to all the systems on an "as needed" basis in a very rapid, beautifully integrated symphony of physiology. And long COVID affecting the brainstem can cause a disruption in various regions and blood flow supplies to those areas. 

But the brainstem can be a target of rehabilitation. Just like someone who has a stroke and they have rehabilitation for their, let's say their arm is affected or their leg, they start to rehabilitate the hemisphere, the cortex on the other side. So rehabilitation is the word I think - rehab rehab rehab. First, how do we understand which part of the brainstem? And then how do we target rehabilitation and develop clinical neuroscience applications for that, which we do. And many of my colleagues around the world, in UK, in Europe, in Australia, in New Zealand, all over the US, a few in South America. They're around - these people who do functional neurology and have this level of training, I would say an expertise, especially now in Dysautonomia related to long COVID. So rehabilitation is the key, gotta have the right exam, then you apply the right therapy so that we're not just throwing things against the wall, seeing what will stick. 

Jackie Baxter  24:06  
Yeah and I really want to get into what you would do. But you mentioned it earlier, and I think we should probably touch on it very briefly first - is how would you test for Dysautonomia? Because, you know, I was nodding my head as you read that list of symptoms, because I've experienced, I think pretty much every single one of them, and I'm sure a lot of people listening will be thinking exactly the same. That sounds like me. But as you say, you know, diagnostics are a key kind of part of the process. So how would you nail down that someone definitely does have Dysautonomia?

Michael Bagnell  24:43  
Well, one thing we can say is that on our website, there is a free downloaded survey. So you would download that and do it on your own. It's for you. It's called a compass, and it's used as an outcome assessment for Dysautonomia, so someone could go on there And they could download that on their own. There's no cost - we have people who are coming into the office do that. But also, as I consult with other people in the US, around the US, not in my local region, or around the world, I have them do that. So when I do a telemedicine with them, I get a good index of where they are. So that's one thing, it's a paper out self graded assessment, you're absolutely welcome to do that. And there are also brain localization surveys on there that people are welcome to download. It's under our forms. And then you know, the next step, they say, I want to get this interpreted more - that they just set up a consult with me. So that's a simple procedure, at least it gives some personal attention. So that's one. 

Number two, what could you do besides that, you want to understand what's going on with two things, your heart rate and your blood pressure, we can say those, alright, because you have the symptoms already say, Gosh, I think I might have this. So now we need to have something that gives us a proxy for how the autonomic nervous system is working. And so this is an indicator of how the autonomic nervous system is working. So you can get a wrist blood pressure cuff, they're very inexpensive, you can get a wrist blood pressure cuff - an automated one, or one for your upper arm area. And you can do a test on yourself, you can do it in one of two ways, you can lay down with that wrist blood pressure cuff, and lay there for three minutes. And then take your blood pressure and heart rate, you got to look at the two. 

So we think about those two as kind of what we would call a seesaw, or a teeter totter. The heart rate affects the blood pressure. So when the blood pressure drops, the body says Uh-Oh, through neurologic mechanisms of the autonomic system, heart blood pressure drops, heart rate is going to go up, and then that brings the blood pressure up, and it keeps the blood in your head. Perfect. But that doesn't always happen when the brainstem is affected, the blood pressure may drop, someone feels very dizzy, the heart rate goes up very high, and then it's racing. And they say like oh, I don't feel good. And it may take five, seven minutes to change. That's too long, right? Because you could pass out in that time. 

And then other times it's in the inverse, the blood pressure is really high, and the heart rate's low. And it should come down as the heart rate comes up. So it's got this push pull kind of system - that's not completely accurate doctors if you're listening, but it's helping people. And so it's working like that, like a seesaw. So we lay down three minutes, very calm, not talking, not on my phone scrolling. And we then we check our pressure. And many of those little devices are very inexpensive for blood pressure and heart rate. And you can even save it, okay, save. And then you start it again, and you sit up really quickly, while it's it's going and you hold your hand in front of you, perhaps it'll give you instructions. And you take it again, when you're sitting or if you're in relatively good shape, you stand up maybe near a wall. So in case you feel like you're going to tip over, and you take it in the process of getting up. And then you check to see the differences there. 

So in the lying down position, or a person could do it seated, they can sit for three minutes and do it. And they could stand up rapidly and do it in that moment. So you got to either  lying down to sitting up or standing, or a sitting up to standing - either or - so the difference in that reading between laying down and standing up rapidly gives you a proxy, a good marker and indication of how is my autonomic system responding based on the change of position. And that's very integrated between the heart, the brainstem and blood flow. So there's mechanisms involved with that, we don't need to get too deep into that. 

But let's say someone is laying down, their heart rate when they get up jumps up 20 or 30, or 40 beats. That is a good indicator that your autonomic system is not regulating. So when you change position, your heart rate - when I'm laying down, my heart rate may be 62 or 60. When I get up, it should maybe go up to like 68 or 70. So it shouldn't go from 62 when I'm laying down or 60 to 100. That's way too much of a jump. So it's not able to adapt in a small physiologic range. And that's an indicator of an autonomic system that's not regulated. Now the blood pressure may drop. So anything that's a big change, meaning especially the heart rate, that's kind of a really good one because easy to see, blood pressure may be 110 over 70 laying down and I get up and it's 118 over 74 But the heart rates still shot up really high, and then it came back down. 

So that's a good indicator - and you may not feel well, the person may say well I feel lousy. I feel my heart is racing. I feel a little panicky, I feel a little lightheaded. So the medical definition says you must change by 30 beats per minute. And then you're diagnosed with something called PoTS, which is a form of Dysautonomia, postural orthostatic - meaning your posture change to upright position, tachycardic, - your heart is racing, syndrome. Again, there's a diagram of all this on my website on that page. So you can kind of look at that and get an idea. But this is a good indicator - how does that sound? 

Jackie Baxter  30:24  
That's great. 

Michael Bagnell  30:25  
It's doable, right? It's doable. 

Jackie Baxter  30:26  
Yeah. 

Michael Bagnell  30:27  
And then people say, okay, great. I got it. What do I do?

Jackie Baxter  30:31  
Well, exactly. That's the next question, isn't it? You know, you think right. Well, I have just wanted to know me, I'm pretty sure about that. What do I do now?

Michael Bagnell  30:38  
Okay, so if I need brain surgery, I'm not going to be able to hack that at home. So I'm being facetious. Of course, I'm being silly. And I'm talking about being empathetic. But I like to help patients laugh too, right. So what can we do - people always want to know, even doctors, how do I fix this in my office, as we get, you're going to need some training, Dr. okay, you're not gonna be able to fix this because I tell you this ABC, it's we're looking at non cookbook approaches. I've heard it said this way that medicine and its approach is very linear, A, B, one symptom, one drug, one pill, one thing. When you look at neuroscience models for brain function, they are not linear at all. So you can have an area in the brain that has 14 inputs and 37 outputs. So it's not like let me just pop this pill and work on that one region, you have to be much more mindful. And consider all the different wiring strategies. 

So that maybe makes someone who hears this say, Oh, well, it doesn't sound hopeful. Okay, I'm just giving you a thought that the brains the body's most complex organ, so don't think it's going to be simple. And you're going to do one or two things. So now I step into my strong coaching hat to encourage and say, Okay, we're going to work on this. But first, we need to find out where in your brainstem, what systems are affected in the brainstem? And we'll talk about that in a moment. And then what is the rehabilitation strategy, which I'll explain to you a few of the ones I use, that may help the person within your metabolic capacity. 

This is also not seen very much, right. So we know, when we're dealing with long COVID, I can't do too much, I can't get up as early as I used to, I can't stay up as late as I used to, I don't have the capacity. So we cannot push people when we're rehabbing their brainstem, we have to watch and monitor things like their heart rate, or their blood pressure while we're taking care of them. Because we may have this whole rehab model set up that takes 45 minutes. And after seven minutes, I said, Okay, we have to stop for 15 minutes. So this is being very mindful, right? Slow medicine, slow it down. This person can't take much - 10 minutes, they're back and ready to go. Okay, let's jump back on. Medical models don't lend themselves to that - you're in with your therapist, maybe your physical therapist or occupational therapist, you have 45 minutes or an hour, we have to get it all done. Let's do it. So we need to slow it down - coming back to that. 

Okay, the brainstem, the brainstem is a area that houses control for things like eye movements. So we might be able to use eye movements, which are relatively gentle, right? It's not using the whole body - to rehabilitate the brainstem. Eye movements - eye movements that are maybe horizontal, eye movements that are vertical, eye movements that are fast, and eye movements that are slow. So a slow one would be like a pursuit, I'm watching something slowly. So we have to understand which eye movements are disrupted. And that tells us about certain areas in the brainstem. And then we work with those you see. So we have to understand eye movements. Number one. 

Some people might have problems with convergence, like looking at something, they feel like ooh, I'm dizzy, my depth perception is off, I can't read. So then we'd have to work on retraining that. So vision therapy might be a help to someone with long COVID. Not only because of their vision, because their acuity might be fine, but their eye tracking. So wouldn't necessarily be - Let me get my better glasses. It might be vision therapy. So that might be an idea. 

Then what else is in the brainstem? Things that control heart rate regulation and gut function and the vagal nerve complex. I mentioned that earlier. So some type of vagal activation or stimulation - especially if someone has a heart rate that goes up real high. If someone has very low blood pressure, see, we might not want to use vagal stimulation. So it has to be discerned by the proper person to help you use the proper therapy. 

So what kind of vagal stimulation could someone do at home? They could gargle. But strong gargling - so I did it this morning. I do it anyway, because it's good for your brainstem - in the shower. or, if you have not too much pressure, you let it hit you in the back of the throat, so your head is slightly up and the water's hitting you a little bit in the back of the throat, and you're gargling it out very strongly. That's a strong stimulus to the, of course to the throat, which is cranial nerve control from the brainstem. Also singing, phonating. So strong gargling, strong singing, I recommend praising - praising would be a best way of singing. 

Because you know, a lot of times in this suffering, people consider their faith again. And I hope they would, and the level of your growth in that faith. Very important, very important, because my body's going to fail eventually. Other things in my soul might really be broken and beat up, but you have a spirit. And so I encourage people to exercise their spirit. 

Back to brainstem, eye movements, gargling, singing, what else is in that brainstem? Areas that control the movement of your limbs, your arms and legs, there's a movement - now this is based on fact that somebody can do some movements, arm and leg movements that are called cross crawl activities where you're bringing the knee up to the opposite hand, almost like you were a child and you were crawling on the floor, it could be done on your bed on your back, especially if you have a Dysautonomia and you don't feel well standing up. So movements like that affect the lower brainstem, and that's the area that controls heart, gut, those functions. 

So upper brainstem, the very top of it is a little bit more difficult to get to but that's the area at the top that controls our fight or flight mechanism, our survival mode. So many times we don't want to activate that very much because we're already in that high sympathetic mode. So people know that - high sympathetic output. And we want to, we want to lower the threshold, we want to settle the body down. So gargling, singing, eye movements, body movements, 

I would recommend that people look at something called primitive reflexes, primitive reflexes, Google that, or primary reflexes or infant reflexes. These are reflexes that babies have. And newborns, up to about a year, year and a half, two years. These are reflexes that we do not have any longer as adults. But when the brain has injury, or when the brain is affected by long COVID, the brainstem and the brain, some of these reflexes may re-emerge, which means our neurologic integrity has become... disintegrous. That's not a word, but - has lost its stability. And what are some of those reflexes? Well, the simplest ones that most people are familiar with, if you ever seen a baby, have a toddler or a baby, and you put your finger in their hand, a newborn, they'll grab onto your finger. That's called a Palmar grasp reflex. 

So that one doesn't really come back with so many people with brain issues, but some of the other ones do and I would recommend looking them up. Like there's one that's probably the most critical called the MORO or also known as the startle reflex. So when I ask people in my consultation, do you startle easily, some people will say, Oh, my word, I've always been like that or and it's even worse now. They may have a Moro reflex. And that means that upper brainstem was already - think about this - the brainstem could already have been weakened, or not well integrated, way before you got COVID. 

Because a lot of people have brought to the - hate to use this word - but party, have brought to the party of COVID, this terrible party, pre existing issues in their nervous system, they've had a concussion, they bang their head really hard, but they never got diagnosed, they play different sports, head impacts, they have ADHD, they have anxiety already. They were dealing with a little bit of depression, they were dealing with a bit of OCD, prior to being infected, which tells me their brain may not have been as regulated in the way it's working as it could have been. And so you bring that and then you give a strong infection on top of that, and all things go haywire. 

So it may be what was going on prior to, which you adapted really well, you were doing fine, so to speak on top of that, but yet you still had a little OCD. And you still had a little anxiety, still had a little depression, and then the world blew up, so to speak, and you got sick. So these things were not good combinations for a lot of people, but we find this a lot - long COVID but I had a concussion when I was in primary school, long COVID Oh, yeah, I have diabetes. Long COVID Oh, yeah, I have OCD. I had that. So these things are not good combinations for the brain to be stable prior to that. And that complicated their recovery and more.

Jackie Baxter  39:57  
Yeah, so it could be, it could be a sort of a combination of a perfect storm almost, isn't it? 

Michael Bagnell  40:03  
Good word. Yeah. 

Jackie Baxter  40:04  
Yeah. I don't think I can take credit for it myself. I think it was someone else that said that!

Michael Bagnell  40:08  
Yeah. And that's, that's what we find a lot of times, we are pretty good at adapting to things, and compensating - the word is compensating. We've had different things go on, and we're compensated. And no one likes to admit any weakness. I certainly don't - I'd be the leader of that tribe. No, no, no, everything's fine. No, no, I'm good. I just have this one thing. But it's so frequent that I have people with dizziness and vertigo. And they will say, No, no, I only have anxiety because of the dizziness and vertigo. But when I dig down into their history, or consult with their spouse or with their parent, No, I've seen that kind of behavior before but not as strong. 

So things may be pre existing on some level, we're able to adapt. But we want to look at primitive reflexes, I definitely encourage people. One of the premier people in the world with understanding primitive reflexes and how they work and how - primitive reflexes are how your nervous system integrates, when you're a baby into maturity. She's in the UK. So she's fabulous person, so they can Google that. And read a little bit about that. And so I'm giving you ideas, right? I'm just opening windows, so to speak. Like, think about this, think about that. Think about - this is what I do with physicians, as I teach around the US, is think about it. I'm not giving you the solution, because one of my mentors says, I don't give solutions. I give thought processes. You need to think doctors, you need to think and not rely on everything else you saw - experience is very valuable. But it's not like becomes the cookbook. We want to make sure that we're thinking through what's in front of us, who's in front of us. What are they dealing with? What was their pre existing condition? Getting your empathy out front. And really, let's make let's work through this. 

So I sound now like I'm the most empathetic physician in the world. I am not I'm working on. Okay, I'm working on it!

Jackie Baxter  42:03  
Oh amazing! So what are your thoughts on vagus nerve stimulators? Because I think you mentioned them earlier, and you said that they can be good, but they might not be appropriate for everybody?

Michael Bagnell  42:14  
Yes, so vagal nerve stimulation is very effective. There are a number of different devices. Some people do it on the ear, there's a clip on portion for the year because the the nerve comes out of the brainstem and has a branch that goes up to the auricular area of the ear. So there's a clip on inexpensive device that's beneficial. Also the larger branches in the cervical area, and we use the left side primarily, based on research and there is a device that I use in the US and it's available around the world, it's rentable, so people can rent it, a doctor will consult with you by telemedicine. 

So, if a person has - I'll give you a general thought. So it's been FDA approved for migraines and cluster headaches. So it absolutely is beneficial to that, to rehabilitating the brainstem through vagal stimulus, to help the brainstem become stronger because many migraines have a neurologic basis in the brain stem, right? And someone might listen to this and say no, no, no, it has to do with these different foods I eat and hormones and barometric pressure, and I say yes, those are triggers. But what is the neurologic sight of weakness - brain stem. So vagal stimulation can be good for that. 

It's being used for many other things. We know that as you stimulate the vagus nerve through the neck, it has retrograde activity up into the cortex, which can help people with depression. So we also know that it's going to go downward and I'm going down from my neck, and it goes down - vagus nerve affects the gut dramatically. So people with microbiome problems and gut dysfunction. But, you know, the majority of people can use vagal nerve stimulation very well and tolerate it, and it's very proper for them. 

But there are a small subset of people that - if you have a pacemaker, you're not going to use vagal stimulation. If you have a metal stent in your neck, from some surgical wiring of something, unfortunately, you're not going to be able to use that. So what would they do in that place? Gargling. They can do gargling very strong. The other one I didn't mention I want to go back to as I said, gargling -  is there's been a lot of talk about cold water immersion. 

And breathing like with Wim Hof breathing can reregulate the autonomic nervous system, breathing practices that are practiced for more than a week. So it's going to take time, it's gonna take effort. Also, we start with cold immersion, we start with just the face. So you get like a baby bassinet, bathtub, and colder water in there and plopping your face in there holding your breath. 10, 20 seconds. So cold water immersion can begin with a face and then it can be like just bringing the warmth down in the shower so it's not fully cold just on your whole head eventually. So let's say you did facial immersion every day for a week, seven days and see - am I noticing any improvement in my autonomic regulation, am I feeling a little more resilient? Am I feeling a little lower threshold on my symptoms? 

Possibly, if not, you still might want to progress to now in the shower, just starting to bring down the warmer water to a little cooler over your head, you stand to the side, let your head get the cold water. Because the face, the inputs from the face, sensory inputs, the tongue, all these areas go into the brainstem. So cold water immersion, I had one client was still dealing with long COVID. And she's made great strides. She said, I didn't really believe you about that cold water in the shower thing. And then when I stopped seeing her on a regular basis, weekly, and I'm seeing her monthly now, she said, But I decided I would try it. And it made a huge difference. I wish I tried it earlier. 

So believe me when I say these things are worth your trial and your time, because they have shown benefits in many people. And there certainly isn't enough research to say, Oh, this is absolutely what everyone needs to do. It's not, it's one of those things that we have to determine what to do. But I'm giving some thought processes, they may want to do some trial things that are low invasive, not risky, vagal nerve stimulation, they won't get it, they can rent it, but they'll talk to a doctor. And those are factors they can consider. 

Jackie Baxter  46:17  
Sure yeah. And of course, there are lots of kind of natural things like the breathing, like the gargling that a lot of people can try. And there's any number of vagal nerve reset exercises on YouTube, I think, isn't there.

Michael Bagnell  46:31  
Yeah, be careful with those. But I mean, you should definitely learn, again because we want to understand things. Where people get into trouble, I think, is because they try things hit or miss, they try to biohack - now if I'm suffering, I'm going to do the same thing, because I get it. But also now here's a word to the wise. Okay, be cautious because we want to understand, you're in a more delicate situation. You're not biohacking someone that's in good health, and they're trying to make themselves better. Our health has taken a hit and we have a deficit. And it's very disrupted our nervous system. So we want to go slow, I'm going to send you an article called persistent brainstem dysfunction in long COVID: A hypothesis. This is from a wonderful neuroscience journal. So it's a scientific article, but it gives ideas and it gives pictures, images, so people can kind of look at that and go okay, that's, that's good.

Jackie Baxter  47:22  
Thank you. Yeah, I'll make sure I drop that into the show notes along with the page on your website that you were talking about earlier, as well.

Michael Bagnell  47:28  
But that's going back. It's brainstem mediated, as part of the whole picture, as we're addressing mitochondrial health, as we're addressing, of course, things in the metabolic nutritional and the gut, as we're addressing things maybe in the clotting issues. Maybe we can talk about some of those and some of the approaches that are being used nutritionally, that might be a good way to help people have a few more ideas.

Jackie Baxter  47:51  
Yeah, no, thank you so so much. It's been absolutely fascinating. So thank you so much for joining me today.

Michael Bagnell  47:59  
You're welcome. My pleasure.

Jackie Baxter  48:00  
Thank you so much to all of my guests, and to you for listening. I hope you've enjoyed it, or at least found it useful. The long COVID podcast is entirely self produced and self funded. I'm doing all of this myself. If you're able to please go to buymeacoffee.com/longCOVIDpod to help me cover the costs of hosting podcast. Please look out for the next episode of the long COVID podcast. It's available on all the usual podcast hosting things and doget in touch, I'd love to hear from you.

Transcribed by https://otter.ai