Massage & Bodywork

JANUARY | FEBRUARY 2022

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the release of stress-related hormones, especially epinephrine and norepinephrine, which can cause rapid heart rate and breathlessness. This may be followed by parasympathetic overcompensation, which causes systemic vasodilation, hypotension, and possible fainting. Some researchers suggest the virus destroys neurons in the central and peripheral nervous systems, which has negative consequences on heart function. 78 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 2 All this is complicated by the fact that many COVID-19 patients sustain damage to myocardial cells, so symptoms of problems in heart function could be neurological, muscular, or both. TYPES AND CLASSIFICATIONS Dysautonomia can be classified in various ways. Primary disease occurs without any underlying condition; secondary dysautonomia is a symptom or complication of some other condition. It is also discussed as being either localized, where the autonomic dysfunction affects only certain organs and tissues, or systemic, involving the whole body. Forms of localized dysautonomia might include complex regional pain syndrome (in which an injury leads to a sustained and ultimately intractable localized sympathetic response and subsequent tissue damage), diabetic neuropathy of the vagus nerve (where diabetes causes nerve damage that impacts much of parasympathetic control to the thoracic and abdominal organs), and some others. However, this discussion will focus mainly on types of systemic dysautonomia, which affects whole- body function. See the sidebar on page 75 for a list of types of dysautonomia. SIGNS AND SYMPTOMS The signs and symptoms of dysautonomia obviously vary, but they look stunningly like the signs and symptoms of long COVID. Here is a short list: • Balance problems • Blurred vision • Brain fog • Chest pain • Constipation • Exercise intolerance • Fatigue that is not relieved by rest • Heart palpitations, tachycardia • Lack of sweating, too much sweating • Migraines, frequent headaches • Mood swings Some experts suggest the virus in the CNS induces dysregulation of heart rate variability, and that, along with suppressed respiratory drive, can lead to hypoxia, fatigue, and chest pain: all common features of long COVID. Another possibility is that the infection may create a new autoimmune response, which is responsible for the sympathetic activation of inflammatory reactions, like the cytokine storms that cause so much damage in acute infections. Sympathetic nervous system disruption may also cause Resources Alyesh, D. et al. "COVID-19 Dysautonomia: An Important Component of 'Long-Hauler Syndrome.'" EP Lab Digest (April 2021). www. hmpgloballearningnetwork.com/site/eplab/covid-19-dysautonomia- important-component-long-hauler-syndrome. Barizien, N. et al. "Clinical Characterization of Dysautonomia in Long COVID-19 Patients." Scientific Reports 11, no. 1 (2021): 14042. https://doi.org/10.1038/s41598-021-93546-5. Dani, M. et al. "Autonomic Dysfunction in 'Long COVID': Rationale, Physiology and Management Strategies." Clinical Medicine 21, no. 1 (January 2021): e63–e67. https://doi.org/10.7861/clinmed.2020-0896. Gurme, M. "Idiopathic Orthostatic Hypotension and other Autonomic Failure Syndromes." Medscape. Updated October 21, 2018. https://emedicine.medscape.com/article/1154266-overview. Long COVID Physio. "Dysautonomia & POTS." Accessed December 2021. https://longcovid.physio/dysautonomia-pots. National Dysautonomia Research Foundation. "What is Dysautonomia?" Accessed December 2021. www.ndrf.org. National Institute of Neurological Disorders and Stroke. "Dysautonomia Information Page." Accessed December 2021. www.ninds.nih.gov/ Disorders/All-Disorders/Dysautonomia-Information-Page. NORD (National Organization for Rare Disorders). "Dysautonomia, Familial." Accessed December 2021. www.rarediseases.org/rare-diseases/ dysautonomia-familial. Sánchez-Manso, J. C., R. Gujarathi, and M. Varacallo. "Autonomic Dysfunction." StatPearls [Internet]. Updated October 9, 2021. www.ncbi.nlm.nih.gov/books/NBK430888. Sliney, J. "Understanding the Care and Symptoms of Dysautonomia." Patients Rising. November 6, 2020. www.patientsrising.org/what-is- dysautonomia. The Dysautonomia Project. "Mast Cell Activation." Accessed December 2021. www.thedysautonomiaproject.org/mast-cell-activation.

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