Episode 127: Being Your Own Best Advocate with Dr. Nancy Klimas
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Post-viral infections, chronic fatigue, and long COVID are complex conditions that many struggle to manage effectively.
In this episode, I’m joined by Dr. Nancy Klimas, a leading expert in clinical immunology and the Director of the Institute for Neuro-Immune Medicine.
We explain the importance of being a good historian of your health, recognizing the onset and triggers of symptoms, and the critical role of sleep in managing these conditions.
Dr. Klimas also discusses post-viral conditions in detail, sharing helpful advice for people dealing with these tough illnesses.
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Nancy Klimas, M.D., is the Director of the Institute for Neuro-Immune Medicine where she directs a group of remarkable interdisciplinary scientists and clinicians. They collaborate to discover innovative strategies for treating and preventing chronic illnesses, while also focusing on training the next generation of clinicians and scientists. With 40 years of professional experience, Dr. Nancy Klimas is internationally recognized for her work in multi-symptom disorders, including ME/CFS, GWI, fibromyalgia, and Long COVID.
LinkedIn: https://www.linkedin.com/in/nancy-klimas-49255178/
Instagram: https://instagram.com/nancyklimas
X: https://x.com/ngklimas
Transcript Below:
Haylie Pomroy: I'm Haylie Pomroy, #1 New York Times bestselling author and the Assistant Director of the Integrative Medicine Program at the Institute for Neuro-Immune Medicine. Today, I'm going to gather some pearls of wisdom about those of you that are suspecting or dealing with post-viral infection, post-viral chronic fatigue, M.E., maybe Long COVID. And of course, in order to do that, I am going to be joined by Dr. Nancy Klimas. She's the director of the Institute for Neuro-Immune Medicine at NSU, as well as the Director of Environmental Medicine at the Miami VAMC GRECC. Dr. Klimas, thank you so much. I am so excited to gather all of these pearls of wisdom from you today.
Dr. Nancy Klimas: I'm very excited to be here. It's fun being full of pearls.
Haylie Pomroy: I wish that everybody could spend three hours in the clinic with you as their patient visit. But I recognize and I realized that that's not a reality for 99.99999% of the US population and even though we do have people that fly in internationally, globally, as well. What I'm hoping to do today is take a distillation of your vast experience in this space, and see if we can just share some with all of our listeners today. I want to start with talking just a little bit about if you can give me the “Reader's Digest version” of how you became to be Dr. Nancy Klimas in this space and time.
Dr. Nancy Klimas: Anybody that is born after 1980 or so doesn't know what you mean by the “Reader’s Digest version.”
Haylie Pomroy: And my Yellow Pages phone book. Did I just date myself?
Dr. Nancy Klimas: You did, sorry.
Haylie Pomroy: I'm sitting on a phonebook right now. You can't sit on a Google when you're short like me. We had to sit on a phone book. The condensed version. Your front page version. It is a driving passion in all of your work, from research to clinical. How? Why?
Dr. Nancy Klimas: INIM is a lot of reasons behind why I do what I do, but I will say that perhaps the main reason is that I am a feminist in my heart and soul and I was so extraordinarily offended by the way the medical establishment was treating women with a very real disease and presenting to doctors that were not believing them. I'd have to say, perhaps my passion started just from my…
Haylie Pomroy: The hysteria diagnosis or the yappy diagnosis?
Dr. Nancy Klimas: Women were just disregarded and misrepresented and treated to a whole bunch of antidepressants and things rather than treating their illness as the very real entity that it is. Also of other things, my mom had fibromyalgia and I could see how much she suffered from that. That really blighted her life and many of my patients are my friends. I know not just from the doctor's office, but also from my own being able to share their lives in other ways, how much this illness has affected them.
Haylie Pomroy: I actually didn't know that that was a large motivation. It's been a very large motivation of my own, too, even being in the nutrition and weight loss space, I would say the guilt and shame club.
Dr. Nancy Klimas: The thing is, what is this business that we're teaching our girls not to...
Haylie Pomroy: Not to eat?
Dr. Nancy Klimas: Not to respect themselves and be respected. And the bottom line is now this is about respect. Your own perceptions of what's wrong. And if you think something's really wrong, don't let somebody else tell you that it's not. Just get after it and try to figure it out.
Haylie Pomroy: I want to dissect it a little bit today and talk about individuals that maybe haven't had a post-viral or post-episodic toxic injury diagnosis. Individuals just feel like they can't like they're losing traction, they can't gain traction, and they can't move forward in their health and wellness. They're having, fatigue, lack of sleep, pain, and headaches. I'm looking for three things that they can take action on. If a person is listening to this type of conversation, say, “Wait a minute, maybe that's going on with me.” What are some of the things that they can take action on?
Dr. Nancy Klimas: There are a lot of individuals, a lot of differences from person to person. But if someone comes in, if someone's feeling like their life is different, that they feel fatigued all the time, ill, just not right, having trouble concentrating and thinking, perhaps has a lot of body pain, episodes where their heart's racing and they're dizzy, and that type of thing. That is very serious stuff, and it's not to be ignored. It's not something that you can just say, well, if you get a good night's sleep, it'll get better. What do you need to do? There are a number of different things that can be impacting people, that have this illness. In your head, you have to say, “When did it start and what got this going?” And you may not be able to figure it out. It may have come on slowly but often it came on post-virally.
Haylie Pomroy: Becoming a good historian of their health?
Dr. Nancy Klimas: Yes, gain an understanding, “When did I start getting sick?” Sometimes you just tolerate an awful lot of misery, until you finally say this isn't right. Then you have to go back in your head and go, when did I feel right? When was the last time I felt right? And sometimes you have to figure that out. You might not, but if you can. I'll give my own example. I don't have ME/CFS, thank goodness. But I had something that was miserable and I was writing. What's going on here? What happened to me was during the pandemic, I was working from home and it turned out my home was sick, that I was being exposed to a tremendous amount of mold. And being a stubborn, seemingly knowledgeable, but not about-yourself person, I let it go on and on until my friends were saying, “All you do is cough, what's going on with you?” And I finally get the work up. Lo and behold, I had something really profound going on and my house was trying to kill me. That was my experience. I had to go back and say, when did this start? It's right when I started staying at home all the time. Why me? Environmental medicine doctor who knows stuff. Why would that happen? Oh my gosh, what's going on in my house? Because it wasn't that obvious until I hired somebody to come check my house out. My splendid doctor who did my work and sent this lady to my house that no matter what I said, she made sure she came and she said, look what's going on. She solved my problem.
Haylie Pomroy: I loved that you shared that because I think so many times, for me, when I was trying to navigate my autoimmune disorder, I felt dumb. I just felt like I can't figure it out because I don't have the knowledge base. But if someone like you sometimes has to go back and say, “Wait a minute, what's going on?” I appreciate the humility that you just shared with me because it made you suddenly feel less about how long it took me to get some answers.
Dr. Nancy Klimas: My sister, the architect, diagnosed my thyroid. Not the first time I've been willing to ignore problems.
Haylie Pomroy: I love them so have good people around you. I like also that you said that life is different in your body is a big deal, and I know that a lot of times women say, “Well, you're just a mom now.” or “You've had kids.” or “It was the pregnancy.” or “You're going through menopause.” or “You're going through divorce.” or you're going through, and all these things are symptomatic of you having the inability to manage your stress level.
Dr. Nancy Klimas: The blame game. If I was just less stressed I would be a healthy person. I just laugh at that one because first off, I challenge you to find someone who's stress-free. I have one person that might fit the bill. She's a mushroom farmer. She does a lot of yoga meditation. Just maybe she's there, but I don't know anybody else like that.
Haylie Pomroy: And when the hurricanes hit, I'm sure she's pretty stressed. If a person is out there, validate that it's a big deal and it needs resolution and attention.
Dr. Nancy Klimas: Also get a sense of what triggered it, because that'll give you some clues. One of the hardest things we've had since the pandemic is post-COVID because it turns out Long COVID can follow an asymptomatic infection. You don't even have to know you had COVID to get Long COVID. Initially, we were only looking for the people that got hospitalized and they were so sick and they were going to post COVID. But it turned out that wasn't necessary. You just had to have COVID. And then it turned out that wasn't even necessary you had COVID, there's Long COVID. Anyone that came up with ME/CFS-like illness in the last 4 years were assuming, had a COVID trigger, that's a huge assumption because some of them got it the ME/CFS way with some other virus. But since that was the predominant virus that we were dealing with in the last 4 years, it's mostly going to be Long COVID.
Haylie Pomroy: And that the majority of the population was exposed t. Although the majority of the population is exposed to Mono, EBV, too.
Dr. Nancy Klimas: Absolutely and that's a whole other path. But let's go back to the things that happened at the beginning. When did you first notice you were sick and was there something that you can line up with that beginning of your illness? You may not be able to and that's okay. The next thing is, what makes you worse? The most common thing that makes people worse is having a halfway decent day and then going out and seizing the world and trying to do everything they didn't get done last week because they felt lousy. That will always cause relapses. Getting an understanding of the cycle of exertion-induced relapse is a very common thing. And getting a sense of how to prevent that, if you don't recognize that, you can't fix it. But there are other things that trigger, look at my house, if somebody had been in my house with ME/CFS, really sick. Thank God that none of my house guests in that window of time were ME patients, that's an example. Foods. Some people are triggered off of foods or fasting, or you have some of the little signals that clue them that they can predict things that make them worse. And then the flip side of that is what makes you better.
Haylie Pomroy: What makes you better? I like creating that list. In business, we have this process that we go through and it's 100 lines and we say, everything that's irritating you, a potential bottleneck, little things. Jack Canfield gave the example when we were doing this together one time about he never had scissors on his desk, and he was so irritated and so frustrated because one of his family members would always come into his office and steal the scissors off his desk, and he would get an argument with his wife over it. And it was just this big, huge issue. Identifying the things that caused him stress and then going and relieving or supporting the ones that are the easiest to support, he bought himself a pack of 24 scissors. Didn't get irritated anymore, no more problems. But sometimes it's the big massive thing. I have to cure this or I have to have a curing in my body, but sometimes it's identifying some of those little things. I like that, make the list of what makes you worse, makes a list of what makes you feel better.
Dr. Nancy Klimas: And that’s true in life, but it's also true in medicine because you've been through a bunch of doctors and they've been trying all other stuff on you, and some of it didn't work and some of it helps. What was that list? One of the things that people will say makes them better is that they wake up knowing what kind of day they're going to have. That may not be because they got a good night's sleep. That's what you would assume and we all make way too many assumptions. Sometimes they wake up and their pulse is 120. Then they know this is going to be the world's worst day. This day is going to be dreadful. And on some days they wake up in their pulses 60. They're going, this might be a good day. Already their body has told them something that their sympathetic drive is off kilter. Don't push it versus you’re chill today. They got nerves kicked in. Good stuff's going to happen today and you're going to have a pretty steady day.
Haylie Pomroy: I'm going to call that get really intimate with yourself. Listen to your body right. Know yourself and don't let anybody else talk you out of it. That's my big thing. Once you know yourself, don't let anybody else tell you, that spends an hour with you, that they don't know what…
Dr. Nancy Klimas: We call that, the “Good Day - Bad Day list” What do you know will make a good day? What do you know is going to make a bad day? And be self-aware enough to figure that out and then I can see if I can improve at this.
Haylie Pomroy: What about someone that's recently been diagnosed?
Dr. Nancy Klimas: The recent diagnosis people are struggling with a great big diagnosis that's complicated and it's not easy to find out the information you need to know to understand it yourself. The NIH and the CDC have some nice web pages that are like primer level. We just had a guest, Port Johnson with healthrising.org where he's got a beautiful web page that goes into deep, into the weeds, of what is this illness and what's the latest science and things that help and things that hurt. The ME/CFS doctors have something called the mecfsclinicianscoalition.org web page that also gives you information to bring back to your doctor with guidelines and treatment clues and all of that.
Haylie Pomroy: Educate yourself about it.
Dr. Nancy Klimas: Education. You won't be your best advocate for yourself if you don't know what to ask. Immerse yourself a little. Don't obsess. Don't make it ruin your life. You should be able to put it back down and read the book. But do try to learn a lot, because you can't assume that your providers are well informed, and you may have to guide them towards information, or at least find out who are the local clinicians that know something about this.
Haylie Pomroy: And sometimes when we think about, I'm going to use that word: Educate then we advocate. Sometimes people can feel like the word advocacy has to have combativeness or confrontation. Sometimes medical advocacy can be the most loving thing that you can do because you invite your practitioner on the journey with you. They are on the journey, they aren't the journey. It's you that's got this going on.
Dr. Nancy Klimas: Physicians are advocates, they fight with your insurance company every day for the things you need. They've been advocating from the day they stepped into their first practice. Advocating with you, on your behalf to find your way is part of the job and it's part of the mission and part of what attracts people towards the field. It's not an unreasonable ask to ask your doctor to learn new things and to help you, and guide you. That's what they try to do anyway, guide you towards the best possible health you can have.
Haylie Pomroy: Dr. Klimas, when we talk about pearls of wisdom, can you give me some, I don't want to use the word generalizations, and just because things are common doesn't mean they're normal, but things that you see that there is some commonality in this with things to focus on. You've always shared with me that, you hit the sleep, if we can get people sleeping, it helps the trajectory. Sometimes it's, get their nutrition right. If you were to say there are three things that for the next 90 days because when you start reading about it and you start advocating, it's complex. What can we distill down in 3 areas that a person could say, I'm going to invest time, energy, and effort into working on this.
Dr. Nancy Klimas: Sleep, let's just start there. Because sleep does matter and I'm not minimizing it. And let's also say that a primary sleep disorder can look just like this. It has to be ruled out. If you have sleep apnea that's untreated or some other sleep disorder, you're going to have profound fatigue. Your body is going to hurt. You're not gonna be able to think. The symptoms are exactly the same. Straight up, everybody that comes in initially gets a sleep consult. Then nobody can leave my practice the first time without making sure if it's not really been done, that they've had a sleep assessment because people get all better. We always want to get people all better. Train something and it gets all better. Well, yay! Cindy Bateman told me a great story about some poor guy that lost everything, his business, his wife, his family. He was practically homeless, and only to discover that he had sleep apnea. The severity of his illness was being driven by a complete lack of restorative sleep. It happens. It does not necessarily mean you have ME/CFS or Long COVID, it can be a sleep disorder. Now you can have ME/CFS or Long COVID or Gulf War illness or toxic exposure related illnesses and also have sleep disturbances. That's where I'm going to spend my focus. Once you've ruled out the other thing and you're dealing with this, when you're profoundly fatigued, your muscles are profoundly fatigued, all night long you're trying to keep this airway open. It's subconscious, but you're keeping an airway open. There's upper airway resistance, a little different than classic sleep apnea. But upper airway resistance can happen. And how do you know? You snore, you may not have actual apnea episodes, and two centimeters on your finger could drop. There are ways to check on that. And there are simple things you can do, if you sleep on your side, you're not going to close your airway as much as if you sleep on your back. Simple things. Another thing that happens a lot with sleep with our patients is you're so tired during the day, they take long naps, then they're not tired at bedtime. Trying to get their cycle back to a day-night cycle. I'm a total believer in the power nap. I'm all about power naps, but I'm not good about
3 and 4-hour naps. Trying to get people back into a nighttime cycle. And then another important thing that happens in the morning when you wake up is you reset your circadian rhythm, but not without sunlight. How important it is to just walk outside for 5 or 10 minutes when you wake up in the morning and let the body know that the sun has risen.
Haylie Pomroy: I noticed that since I work from home a lot, I don't do that. I used to get up and get ready and go to the office. When I work from home, I get up and go to my office. And there is no sunshine. I mean, there's a window, but there's no sunshine in that 10-step, 13-step process. I really have to force myself. I sleep better when my morning hygiene routine makes more of an impact on my night sleeping, for me anyway.
Dr. Nancy Klimas: I'm with you on that. In fact, I'm the last person to still have a paper newspaper because I have to walk out to the end of my driveway. And then while I'm there, I've set a nice little bench out in the middle of my yard. I sit there, I read my paper in the morning because the other important thing is vitamin D needs at least 20 minutes of sunlight a day. In South Florida, the best time to get sunlight is in the morning because it's hot in the afternoon, you're not going to be out there at noontime. Get my morning paper, hang put, and read the 20 minutes worth of paper. I bring my tea with me. I'm all set, ready to go. If I get my morning routine and my vitamin D kicks in and my circadian rhythms are kicked off correctly. And that's a good way to start a day. that's another little sleep day-night cycle trick. There is a problem with sleep, and I don't want to say it's so simple because our patients have a terrible time with sleep. It's because there is their sympathetic nervous systems are so messed up that they're driving daytime signals in their brain at night while they're sleeping. Usually, let's relax, and restore. That's parasympathetic. Sympathetic-parasympathetic. The balancing act that our bodies are doing all the time. Sympathetic is adrenaline and the opposite of that is parasympathetic. And at nighttime, you're supposed to rest, relax, restore. You should have your parasympathetic going. Your heart rate should be low. You're breathing very steady, you're digesting, you're profusing your core and repairing a bunch of tissue that was needing repair and taking toxins away. All of that's happening while you're sleeping. But if you're on a sympathetic drive during the night, that's not happening. You're not in a deep stage of sleep. It's going to mess up your memory because you never got REM sleep. You're not restoring. You're not recovering your tissues over the night. This vagal thing is really important and there are tricks, you can see whole podcasts on the vagus nerve. But the idea of trying to get back into a parasympathetic rhythm at nighttime, it's terribly important. Some, it's just simple breathing stuff that you're falling asleep in and just trying to retrain your body to have a more parasympathetic time.
Haylie Pomroy: Looking at everything all the time. And I love to look at these chat rooms. Chat rooms with my Yellow Pages and my Reader's Digest. But in the community, Reddit. People talk about doing therapy like Lotus now track zone and melatonin. There are a lot of different things that you can work with your team to address. But addressing sleep is a big deal.
Dr. Nancy Klimas: But if you're going to take that on to a doctor, I often talk about using your doctor's time wisely. I’ll make an appointment for just that, and then make another appointment for something else because it takes some time to unravel the sleep thing.
Haylie Pomroy: I love that suggestion.
Dr. Nancy Klimas: Don’t just jump up an appointment with the 5 things you want to cover with your doctor. Make 5 appointments if you have to. But if you got something that needs some deep thinking and working through sleep is one of them.
Haylie Pomroy: What would be another one? Again, the person's been diagnosed either Long COVID, viral reactivation, post-viral infection, or post-viral illness, we're going to focus on and say, just because it is so complex, we're going to focus on sleep. What comes next? I'm a nutritionist.
Dr. Nancy Klimas: It depends on the individual what's bugging them the most. The big ones. Sleep is a big one. Dysautonomia, it's a huge deal. We can spend a whole visit just on trying to get the autonomic nervous system moving in the right direction. Easily, the autonomic nervous system is important, that sympathetic-parasympathetic thing I was talking about. But it affects so many things. That's where POTS is and slow gut motility and gastroparesis and all these other symptoms, people come in with a thousand different symptoms. But when you look at their underpinnings or diagnostic codes, and you're like, that's autonomic and that's autonomic. Underneath it all, it's the balance of sympathetic-parasympathetic. That's a whole visit, easy. A big one is bioenergetics. How are your mitochondria? What is your energy? What's your antioxidant status like? What do you eat? That's so important. What are your supplements? Are your supplements making you feel better or aren't they? Do we need to do a do-over and start over? There are very sophisticated ways to measure nutrient balances, we do that a lot in our clinic with different types of laboratory tests to measure levels of many dozens of things to try to understand the status of critical bioenergetics, vitamins, and other things, the antioxidants and the way the pathways are working, if anything's hung up and the genetics of that, that's all a big, messy appointment. But it's a terribly important employment to try to untangle.
Haylie Pomroy: I envision in my brain while I'm listening to this because I always try to go, how do I put it into practical aspect in a clinical setting? And I go, we talked about educating and advocating and learning and then the big hitter. I'm going, Monday, Wednesday, Friday like Monday I'm going to learn all about sleep and sleep hygiene and…
Dr. Nancy Klimas: Think about learning about things too.
Haylie Pomroy: Because sometimes if you can set them down when you talked about obsessing over it, you can set it down or you can say, today's my focus on sleep. Wednesdays’ my focus on dysautonomia. I want to learn about POTS. I want to check my blood pressure. Compression stockings, there's some really noninvasive, nurturing, profound things that can make a difference. And then maybe on Fridays, I'm going to focus on what is my nutrition protocol, what is my supplement protocol, get that organized, get that defined so that you're not every night or every day going, I'm not sleeping, it didn't work well. I don't know just sometimes those little bite-sized learnings because this is complicated.
Dr. Nancy Klimas: And it’s also a good way to manage your doctor because our visits are weird because you get 2 hours initial and it's not a 1 hour follow-up, and you can actually cover some ground, but the average doctor is spending 20 minutes with you for a high complexity visit. I will say one thing that I didn't mention, and we talked just recently about things that have changed. One thing that changed for us that's helped us is that Medicare changed billing to allow longer visits for high-complexity diseases, and that has changed how much time you spend with your doctor. If they can check the right boxes, they're allowed to spend more time with you.
Haylie Pomroy: But be organized. Be organized.
Dr. Nancy Klimas: And don’t waste it. I have done this because so many of my patients, they go check on my grandkids, I check on their grandkids, has things. I’m always, I just use 10 minutes of your time. Now I owe you an extra 10 minutes. The point is, use your time with your doctor wisely. When you're taking these early stages, when you're just getting your management together, spend enough time on the big, complicated things that you come away knowing what the plan is and why. Now, later on, when you're, this is my decision. I'm your regimen and this is what I'm doing for subs, and this is what my sleep is doing and my immune system and the virus and blah, blah. I know what I'm doing. Now, I come in for a follow-up appointment. I tick-tick-tick too, this and this is doing well. I'm having some symptoms over here. And then you can be the whole person that you are in a single visit and cover all the tabs. But initially, sometimes you take multiple visits to get the different bits organized enough that everyone's in agreement.
Haylie Pomroy: This is like just how to start tackling this one-on-one. And I'm just going to distill it down that if your life is different if you're feeling different, if it doesn't feel right, that's a big deal that you want to become a good historian for your health. When was the last time you felt better? When was the last time you felt good? When did things change? What did you notice first? I love making a list of what makes you worse so you don't have to think about it. It's just easily identified and what also makes you better and double down on that. I love to educate for yourself, to advocate for yourself, and then to start focusing on some of the things that, I don't want to use the word basic because they're really profound. If these 3 things were under control. If everybody said Dr. Klimas, we're not going to send you a patient. We're going to first take care and work on their sleep, their dysautonomia, their nutrition, and their supplementation, and then we'll send them to you.
Dr. Nancy Klimas: I could do 30-minute appointments. That'd be great.
Haylie Pomroy: You guys can do that. All of you out there. You can start to just take these concepts and get organized with the process. You're in it for the Long haul. This journey is one where the more versed, the more organized. And it's really hard because you feel not well or awful or having cognitive issues but also don't hesitate to ask for help. If you have this instruction manual, this one-on-one that Dr. Klimas just set out. You can hand that to a friend or a loved one and say, I need you to help me become a good historian. Can I just dictate this to you? What makes me worse? What makes me better and get help and support for that. Dr. Klimas, any other pearls of wisdom that you want to... I just wanted to give people a starting place.
Dr. Nancy Klimas: The immune system since I am an immunologist. As I sit here talking about everything else and everyone you have to own that, I'm a clinical immunologist. That's my original training and certification and how I got into this field. And yet here I am being a dysautonomia, sleep, the bioenergetics doctor.
Haylie Pomroy: I think, at least me, I used to think that immunology was like an event-driven episode. You cut yourself, you get a bacterial infection, you get a tooth infection. That's the immunology. It is so about adaptation.
Dr. Nancy Klimas: Just think about that sympathetic overdrive. Just having so much adrenaline circulating that just totally trashes the immune system. You can’t say it's separate these, they're not silos of thinking. They're very connected ways of thinking and so you have to fix them, that's really important. But back in the immune system space, there's another really important thing to notice, which is that the part of the system that's not working the best is the part that's antiviral. Specifically, the part that keeps old viruses from reactivating. The one that's supposed to be watching and snapping those little viruses up if they try to pop out again. And that is pretty busted. It's a pretty broken system. And so we spend a lot of our time trying to repair the immune system. And then the other thing that's wrong with the immune system that is driving a lot of inflammation, and particularly inflammation in the brain. We spend a fair amount of time in our practice trying to find things that are anti-inflammatory for the brain. It's totally messed up because if you have oxidative stress, you're going to have inflammation in your brain. When I say I'm dealing with bioenergetics and antioxidants and things, those are not simply treating energy in the brain. Those are treating inflammation in the brain. You have to see the big picture of this, that you can't just take it apart into its single little bits, because you ain't going to end up on a cocktail approach of intervention, where you're taking care of these very interactive elements to try to get a new balance, a homeostatic balance, and get back to health in that kind of way.
Haylie Pomroy: I keep saying this, I hope that there are some good things that came out of the pandemic. One thing that I've seen from the outside looking in, in medicine, is we're forced to look at complex treatment because of the complexity of Long COVID, which is so similar or mirrors the complexity of ME/CFS. The doctors that were addressing ME/CFS were acutely aware of that way ahead of time. But we're having all these other care centers pop up. I don't believe, I don't think that there's a magic pill because it's not a broken bone. It's not a high cholesterol. I think it's going to change the trajectory of medicine, I really do. I think that if we're going to treat these patients and there's a lot of them, we're going to have to think with more diverse or cocktail of options.
Dr. Nancy Klimas: My family accuses me of being a rose-colored glasses person. I've always been that way and I still am that way. Absolutely, I can't believe I've been doing this for so many years. I haven't gotten cynical yet. These are curable illnesses and that we're very close to that. One of the reasons why we did this Hope and Help thing was because I freak out when I hear about people that have reached their last thread, and I haven't been able to inject into them the optimism that they need to hear from me a frontline investigator, a frontline clinician. We are so close. This is not the time to give up on this field or yourself because we are so close. If I ever got one message across is that we are already helping people a lot. But we believe that these are curable illnesses, not just treatable illnesses. I just wanted to leave that great big pearl on the table. We're going to keep at it until we got it, and that's really, really important to hear.
Haylie Pomroy: I love that. Dr. Klimas, thank you so much! And I think that everybody out there if you know somebody that's struggling, make sure that you let them know that there is hope. I feel very fortunate to get to witness what we see in the clinic every day, our Friday clinicals, where everybody comes together and hundreds and hundreds of hours of education pour over cases. And there is a significant amount of hope and this is to provide help and I just can't thank you enough for being on. I think sometimes in the complexity of all of this, it helps to give us a guideline for where to start and to get in the right direction to getting well.
Dr. Nancy Klimas: Thanks, I appreciate that.
Haylie Pomroy: Absolutely. We'll talk again very soon.
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Post-viral infections, chronic fatigue, and long COVID are complex conditions that many struggle to manage effectively.
In this episode, I’m joined by Dr. Nancy Klimas, a leading expert in clinical immunology and the Director of the Institute for Neuro-Immune Medicine.
We explain the importance of being a good historian of your health, recognizing the onset and triggers of symptoms, and the critical role of sleep in managing these conditions.
Dr. Klimas also discusses post-viral conditions in detail, sharing helpful advice for people dealing with these tough illnesses.
Tune in to the Fast Metabolism Matters Podcast – Being Your Own Best Advocate with Dr. Nancy Klimas
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Nancy Klimas, M.D., is the Director of the Institute for Neuro-Immune Medicine where she directs a group of remarkable interdisciplinary scientists and clinicians. They collaborate to discover innovative strategies for treating and preventing chronic illnesses, while also focusing on training the next generation of clinicians and scientists. With 40 years of professional experience, Dr. Nancy Klimas is internationally recognized for her work in multi-symptom disorders, including ME/CFS, GWI, fibromyalgia, and Long COVID.
LinkedIn: https://www.linkedin.com/in/nancy-klimas-49255178/
Instagram: https://instagram.com/nancyklimas
X: https://x.com/ngklimas
Transcript Below:
Haylie Pomroy: I'm Haylie Pomroy, #1 New York Times bestselling author and the Assistant Director of the Integrative Medicine Program at the Institute for Neuro-Immune Medicine. Today, I'm going to gather some pearls of wisdom about those of you that are suspecting or dealing with post-viral infection, post-viral chronic fatigue, M.E., maybe Long COVID. And of course, in order to do that, I am going to be joined by Dr. Nancy Klimas. She's the director of the Institute for Neuro-Immune Medicine at NSU, as well as the Director of Environmental Medicine at the Miami VAMC GRECC. Dr. Klimas, thank you so much. I am so excited to gather all of these pearls of wisdom from you today.
Dr. Nancy Klimas: I'm very excited to be here. It's fun being full of pearls.
Haylie Pomroy: I wish that everybody could spend three hours in the clinic with you as their patient visit. But I recognize and I realized that that's not a reality for 99.99999% of the US population and even though we do have people that fly in internationally, globally, as well. What I'm hoping to do today is take a distillation of your vast experience in this space, and see if we can just share some with all of our listeners today. I want to start with talking just a little bit about if you can give me the “Reader's Digest version” of how you became to be Dr. Nancy Klimas in this space and time.
Dr. Nancy Klimas: Anybody that is born after 1980 or so doesn't know what you mean by the “Reader’s Digest version.”
Haylie Pomroy: And my Yellow Pages phone book. Did I just date myself?
Dr. Nancy Klimas: You did, sorry.
Haylie Pomroy: I'm sitting on a phonebook right now. You can't sit on a Google when you're short like me. We had to sit on a phone book. The condensed version. Your front page version. It is a driving passion in all of your work, from research to clinical. How? Why?
Dr. Nancy Klimas: INIM is a lot of reasons behind why I do what I do, but I will say that perhaps the main reason is that I am a feminist in my heart and soul and I was so extraordinarily offended by the way the medical establishment was treating women with a very real disease and presenting to doctors that were not believing them. I'd have to say, perhaps my passion started just from my…
Haylie Pomroy: The hysteria diagnosis or the yappy diagnosis?
Dr. Nancy Klimas: Women were just disregarded and misrepresented and treated to a whole bunch of antidepressants and things rather than treating their illness as the very real entity that it is. Also of other things, my mom had fibromyalgia and I could see how much she suffered from that. That really blighted her life and many of my patients are my friends. I know not just from the doctor's office, but also from my own being able to share their lives in other ways, how much this illness has affected them.
Haylie Pomroy: I actually didn't know that that was a large motivation. It's been a very large motivation of my own, too, even being in the nutrition and weight loss space, I would say the guilt and shame club.
Dr. Nancy Klimas: The thing is, what is this business that we're teaching our girls not to...
Haylie Pomroy: Not to eat?
Dr. Nancy Klimas: Not to respect themselves and be respected. And the bottom line is now this is about respect. Your own perceptions of what's wrong. And if you think something's really wrong, don't let somebody else tell you that it's not. Just get after it and try to figure it out.
Haylie Pomroy: I want to dissect it a little bit today and talk about individuals that maybe haven't had a post-viral or post-episodic toxic injury diagnosis. Individuals just feel like they can't like they're losing traction, they can't gain traction, and they can't move forward in their health and wellness. They're having, fatigue, lack of sleep, pain, and headaches. I'm looking for three things that they can take action on. If a person is listening to this type of conversation, say, “Wait a minute, maybe that's going on with me.” What are some of the things that they can take action on?
Dr. Nancy Klimas: There are a lot of individuals, a lot of differences from person to person. But if someone comes in, if someone's feeling like their life is different, that they feel fatigued all the time, ill, just not right, having trouble concentrating and thinking, perhaps has a lot of body pain, episodes where their heart's racing and they're dizzy, and that type of thing. That is very serious stuff, and it's not to be ignored. It's not something that you can just say, well, if you get a good night's sleep, it'll get better. What do you need to do? There are a number of different things that can be impacting people, that have this illness. In your head, you have to say, “When did it start and what got this going?” And you may not be able to figure it out. It may have come on slowly but often it came on post-virally.
Haylie Pomroy: Becoming a good historian of their health?
Dr. Nancy Klimas: Yes, gain an understanding, “When did I start getting sick?” Sometimes you just tolerate an awful lot of misery, until you finally say this isn't right. Then you have to go back in your head and go, when did I feel right? When was the last time I felt right? And sometimes you have to figure that out. You might not, but if you can. I'll give my own example. I don't have ME/CFS, thank goodness. But I had something that was miserable and I was writing. What's going on here? What happened to me was during the pandemic, I was working from home and it turned out my home was sick, that I was being exposed to a tremendous amount of mold. And being a stubborn, seemingly knowledgeable, but not about-yourself person, I let it go on and on until my friends were saying, “All you do is cough, what's going on with you?” And I finally get the work up. Lo and behold, I had something really profound going on and my house was trying to kill me. That was my experience. I had to go back and say, when did this start? It's right when I started staying at home all the time. Why me? Environmental medicine doctor who knows stuff. Why would that happen? Oh my gosh, what's going on in my house? Because it wasn't that obvious until I hired somebody to come check my house out. My splendid doctor who did my work and sent this lady to my house that no matter what I said, she made sure she came and she said, look what's going on. She solved my problem.
Haylie Pomroy: I loved that you shared that because I think so many times, for me, when I was trying to navigate my autoimmune disorder, I felt dumb. I just felt like I can't figure it out because I don't have the knowledge base. But if someone like you sometimes has to go back and say, “Wait a minute, what's going on?” I appreciate the humility that you just shared with me because it made you suddenly feel less about how long it took me to get some answers.
Dr. Nancy Klimas: My sister, the architect, diagnosed my thyroid. Not the first time I've been willing to ignore problems.
Haylie Pomroy: I love them so have good people around you. I like also that you said that life is different in your body is a big deal, and I know that a lot of times women say, “Well, you're just a mom now.” or “You've had kids.” or “It was the pregnancy.” or “You're going through menopause.” or “You're going through divorce.” or you're going through, and all these things are symptomatic of you having the inability to manage your stress level.
Dr. Nancy Klimas: The blame game. If I was just less stressed I would be a healthy person. I just laugh at that one because first off, I challenge you to find someone who's stress-free. I have one person that might fit the bill. She's a mushroom farmer. She does a lot of yoga meditation. Just maybe she's there, but I don't know anybody else like that.
Haylie Pomroy: And when the hurricanes hit, I'm sure she's pretty stressed. If a person is out there, validate that it's a big deal and it needs resolution and attention.
Dr. Nancy Klimas: Also get a sense of what triggered it, because that'll give you some clues. One of the hardest things we've had since the pandemic is post-COVID because it turns out Long COVID can follow an asymptomatic infection. You don't even have to know you had COVID to get Long COVID. Initially, we were only looking for the people that got hospitalized and they were so sick and they were going to post COVID. But it turned out that wasn't necessary. You just had to have COVID. And then it turned out that wasn't even necessary you had COVID, there's Long COVID. Anyone that came up with ME/CFS-like illness in the last 4 years were assuming, had a COVID trigger, that's a huge assumption because some of them got it the ME/CFS way with some other virus. But since that was the predominant virus that we were dealing with in the last 4 years, it's mostly going to be Long COVID.
Haylie Pomroy: And that the majority of the population was exposed t. Although the majority of the population is exposed to Mono, EBV, too.
Dr. Nancy Klimas: Absolutely and that's a whole other path. But let's go back to the things that happened at the beginning. When did you first notice you were sick and was there something that you can line up with that beginning of your illness? You may not be able to and that's okay. The next thing is, what makes you worse? The most common thing that makes people worse is having a halfway decent day and then going out and seizing the world and trying to do everything they didn't get done last week because they felt lousy. That will always cause relapses. Getting an understanding of the cycle of exertion-induced relapse is a very common thing. And getting a sense of how to prevent that, if you don't recognize that, you can't fix it. But there are other things that trigger, look at my house, if somebody had been in my house with ME/CFS, really sick. Thank God that none of my house guests in that window of time were ME patients, that's an example. Foods. Some people are triggered off of foods or fasting, or you have some of the little signals that clue them that they can predict things that make them worse. And then the flip side of that is what makes you better.
Haylie Pomroy: What makes you better? I like creating that list. In business, we have this process that we go through and it's 100 lines and we say, everything that's irritating you, a potential bottleneck, little things. Jack Canfield gave the example when we were doing this together one time about he never had scissors on his desk, and he was so irritated and so frustrated because one of his family members would always come into his office and steal the scissors off his desk, and he would get an argument with his wife over it. And it was just this big, huge issue. Identifying the things that caused him stress and then going and relieving or supporting the ones that are the easiest to support, he bought himself a pack of 24 scissors. Didn't get irritated anymore, no more problems. But sometimes it's the big massive thing. I have to cure this or I have to have a curing in my body, but sometimes it's identifying some of those little things. I like that, make the list of what makes you worse, makes a list of what makes you feel better.
Dr. Nancy Klimas: And that’s true in life, but it's also true in medicine because you've been through a bunch of doctors and they've been trying all other stuff on you, and some of it didn't work and some of it helps. What was that list? One of the things that people will say makes them better is that they wake up knowing what kind of day they're going to have. That may not be because they got a good night's sleep. That's what you would assume and we all make way too many assumptions. Sometimes they wake up and their pulse is 120. Then they know this is going to be the world's worst day. This day is going to be dreadful. And on some days they wake up in their pulses 60. They're going, this might be a good day. Already their body has told them something that their sympathetic drive is off kilter. Don't push it versus you’re chill today. They got nerves kicked in. Good stuff's going to happen today and you're going to have a pretty steady day.
Haylie Pomroy: I'm going to call that get really intimate with yourself. Listen to your body right. Know yourself and don't let anybody else talk you out of it. That's my big thing. Once you know yourself, don't let anybody else tell you, that spends an hour with you, that they don't know what…
Dr. Nancy Klimas: We call that, the “Good Day - Bad Day list” What do you know will make a good day? What do you know is going to make a bad day? And be self-aware enough to figure that out and then I can see if I can improve at this.
Haylie Pomroy: What about someone that's recently been diagnosed?
Dr. Nancy Klimas: The recent diagnosis people are struggling with a great big diagnosis that's complicated and it's not easy to find out the information you need to know to understand it yourself. The NIH and the CDC have some nice web pages that are like primer level. We just had a guest, Port Johnson with healthrising.org where he's got a beautiful web page that goes into deep, into the weeds, of what is this illness and what's the latest science and things that help and things that hurt. The ME/CFS doctors have something called the mecfsclinicianscoalition.org web page that also gives you information to bring back to your doctor with guidelines and treatment clues and all of that.
Haylie Pomroy: Educate yourself about it.
Dr. Nancy Klimas: Education. You won't be your best advocate for yourself if you don't know what to ask. Immerse yourself a little. Don't obsess. Don't make it ruin your life. You should be able to put it back down and read the book. But do try to learn a lot, because you can't assume that your providers are well informed, and you may have to guide them towards information, or at least find out who are the local clinicians that know something about this.
Haylie Pomroy: And sometimes when we think about, I'm going to use that word: Educate then we advocate. Sometimes people can feel like the word advocacy has to have combativeness or confrontation. Sometimes medical advocacy can be the most loving thing that you can do because you invite your practitioner on the journey with you. They are on the journey, they aren't the journey. It's you that's got this going on.
Dr. Nancy Klimas: Physicians are advocates, they fight with your insurance company every day for the things you need. They've been advocating from the day they stepped into their first practice. Advocating with you, on your behalf to find your way is part of the job and it's part of the mission and part of what attracts people towards the field. It's not an unreasonable ask to ask your doctor to learn new things and to help you, and guide you. That's what they try to do anyway, guide you towards the best possible health you can have.
Haylie Pomroy: Dr. Klimas, when we talk about pearls of wisdom, can you give me some, I don't want to use the word generalizations, and just because things are common doesn't mean they're normal, but things that you see that there is some commonality in this with things to focus on. You've always shared with me that, you hit the sleep, if we can get people sleeping, it helps the trajectory. Sometimes it's, get their nutrition right. If you were to say there are three things that for the next 90 days because when you start reading about it and you start advocating, it's complex. What can we distill down in 3 areas that a person could say, I'm going to invest time, energy, and effort into working on this.
Dr. Nancy Klimas: Sleep, let's just start there. Because sleep does matter and I'm not minimizing it. And let's also say that a primary sleep disorder can look just like this. It has to be ruled out. If you have sleep apnea that's untreated or some other sleep disorder, you're going to have profound fatigue. Your body is going to hurt. You're not gonna be able to think. The symptoms are exactly the same. Straight up, everybody that comes in initially gets a sleep consult. Then nobody can leave my practice the first time without making sure if it's not really been done, that they've had a sleep assessment because people get all better. We always want to get people all better. Train something and it gets all better. Well, yay! Cindy Bateman told me a great story about some poor guy that lost everything, his business, his wife, his family. He was practically homeless, and only to discover that he had sleep apnea. The severity of his illness was being driven by a complete lack of restorative sleep. It happens. It does not necessarily mean you have ME/CFS or Long COVID, it can be a sleep disorder. Now you can have ME/CFS or Long COVID or Gulf War illness or toxic exposure related illnesses and also have sleep disturbances. That's where I'm going to spend my focus. Once you've ruled out the other thing and you're dealing with this, when you're profoundly fatigued, your muscles are profoundly fatigued, all night long you're trying to keep this airway open. It's subconscious, but you're keeping an airway open. There's upper airway resistance, a little different than classic sleep apnea. But upper airway resistance can happen. And how do you know? You snore, you may not have actual apnea episodes, and two centimeters on your finger could drop. There are ways to check on that. And there are simple things you can do, if you sleep on your side, you're not going to close your airway as much as if you sleep on your back. Simple things. Another thing that happens a lot with sleep with our patients is you're so tired during the day, they take long naps, then they're not tired at bedtime. Trying to get their cycle back to a day-night cycle. I'm a total believer in the power nap. I'm all about power naps, but I'm not good about
3 and 4-hour naps. Trying to get people back into a nighttime cycle. And then another important thing that happens in the morning when you wake up is you reset your circadian rhythm, but not without sunlight. How important it is to just walk outside for 5 or 10 minutes when you wake up in the morning and let the body know that the sun has risen.
Haylie Pomroy: I noticed that since I work from home a lot, I don't do that. I used to get up and get ready and go to the office. When I work from home, I get up and go to my office. And there is no sunshine. I mean, there's a window, but there's no sunshine in that 10-step, 13-step process. I really have to force myself. I sleep better when my morning hygiene routine makes more of an impact on my night sleeping, for me anyway.
Dr. Nancy Klimas: I'm with you on that. In fact, I'm the last person to still have a paper newspaper because I have to walk out to the end of my driveway. And then while I'm there, I've set a nice little bench out in the middle of my yard. I sit there, I read my paper in the morning because the other important thing is vitamin D needs at least 20 minutes of sunlight a day. In South Florida, the best time to get sunlight is in the morning because it's hot in the afternoon, you're not going to be out there at noontime. Get my morning paper, hang put, and read the 20 minutes worth of paper. I bring my tea with me. I'm all set, ready to go. If I get my morning routine and my vitamin D kicks in and my circadian rhythms are kicked off correctly. And that's a good way to start a day. that's another little sleep day-night cycle trick. There is a problem with sleep, and I don't want to say it's so simple because our patients have a terrible time with sleep. It's because there is their sympathetic nervous systems are so messed up that they're driving daytime signals in their brain at night while they're sleeping. Usually, let's relax, and restore. That's parasympathetic. Sympathetic-parasympathetic. The balancing act that our bodies are doing all the time. Sympathetic is adrenaline and the opposite of that is parasympathetic. And at nighttime, you're supposed to rest, relax, restore. You should have your parasympathetic going. Your heart rate should be low. You're breathing very steady, you're digesting, you're profusing your core and repairing a bunch of tissue that was needing repair and taking toxins away. All of that's happening while you're sleeping. But if you're on a sympathetic drive during the night, that's not happening. You're not in a deep stage of sleep. It's going to mess up your memory because you never got REM sleep. You're not restoring. You're not recovering your tissues over the night. This vagal thing is really important and there are tricks, you can see whole podcasts on the vagus nerve. But the idea of trying to get back into a parasympathetic rhythm at nighttime, it's terribly important. Some, it's just simple breathing stuff that you're falling asleep in and just trying to retrain your body to have a more parasympathetic time.
Haylie Pomroy: Looking at everything all the time. And I love to look at these chat rooms. Chat rooms with my Yellow Pages and my Reader's Digest. But in the community, Reddit. People talk about doing therapy like Lotus now track zone and melatonin. There are a lot of different things that you can work with your team to address. But addressing sleep is a big deal.
Dr. Nancy Klimas: But if you're going to take that on to a doctor, I often talk about using your doctor's time wisely. I’ll make an appointment for just that, and then make another appointment for something else because it takes some time to unravel the sleep thing.
Haylie Pomroy: I love that suggestion.
Dr. Nancy Klimas: Don’t just jump up an appointment with the 5 things you want to cover with your doctor. Make 5 appointments if you have to. But if you got something that needs some deep thinking and working through sleep is one of them.
Haylie Pomroy: What would be another one? Again, the person's been diagnosed either Long COVID, viral reactivation, post-viral infection, or post-viral illness, we're going to focus on and say, just because it is so complex, we're going to focus on sleep. What comes next? I'm a nutritionist.
Dr. Nancy Klimas: It depends on the individual what's bugging them the most. The big ones. Sleep is a big one. Dysautonomia, it's a huge deal. We can spend a whole visit just on trying to get the autonomic nervous system moving in the right direction. Easily, the autonomic nervous system is important, that sympathetic-parasympathetic thing I was talking about. But it affects so many things. That's where POTS is and slow gut motility and gastroparesis and all these other symptoms, people come in with a thousand different symptoms. But when you look at their underpinnings or diagnostic codes, and you're like, that's autonomic and that's autonomic. Underneath it all, it's the balance of sympathetic-parasympathetic. That's a whole visit, easy. A big one is bioenergetics. How are your mitochondria? What is your energy? What's your antioxidant status like? What do you eat? That's so important. What are your supplements? Are your supplements making you feel better or aren't they? Do we need to do a do-over and start over? There are very sophisticated ways to measure nutrient balances, we do that a lot in our clinic with different types of laboratory tests to measure levels of many dozens of things to try to understand the status of critical bioenergetics, vitamins, and other things, the antioxidants and the way the pathways are working, if anything's hung up and the genetics of that, that's all a big, messy appointment. But it's a terribly important employment to try to untangle.
Haylie Pomroy: I envision in my brain while I'm listening to this because I always try to go, how do I put it into practical aspect in a clinical setting? And I go, we talked about educating and advocating and learning and then the big hitter. I'm going, Monday, Wednesday, Friday like Monday I'm going to learn all about sleep and sleep hygiene and…
Dr. Nancy Klimas: Think about learning about things too.
Haylie Pomroy: Because sometimes if you can set them down when you talked about obsessing over it, you can set it down or you can say, today's my focus on sleep. Wednesdays’ my focus on dysautonomia. I want to learn about POTS. I want to check my blood pressure. Compression stockings, there's some really noninvasive, nurturing, profound things that can make a difference. And then maybe on Fridays, I'm going to focus on what is my nutrition protocol, what is my supplement protocol, get that organized, get that defined so that you're not every night or every day going, I'm not sleeping, it didn't work well. I don't know just sometimes those little bite-sized learnings because this is complicated.
Dr. Nancy Klimas: And it’s also a good way to manage your doctor because our visits are weird because you get 2 hours initial and it's not a 1 hour follow-up, and you can actually cover some ground, but the average doctor is spending 20 minutes with you for a high complexity visit. I will say one thing that I didn't mention, and we talked just recently about things that have changed. One thing that changed for us that's helped us is that Medicare changed billing to allow longer visits for high-complexity diseases, and that has changed how much time you spend with your doctor. If they can check the right boxes, they're allowed to spend more time with you.
Haylie Pomroy: But be organized. Be organized.
Dr. Nancy Klimas: And don’t waste it. I have done this because so many of my patients, they go check on my grandkids, I check on their grandkids, has things. I’m always, I just use 10 minutes of your time. Now I owe you an extra 10 minutes. The point is, use your time with your doctor wisely. When you're taking these early stages, when you're just getting your management together, spend enough time on the big, complicated things that you come away knowing what the plan is and why. Now, later on, when you're, this is my decision. I'm your regimen and this is what I'm doing for subs, and this is what my sleep is doing and my immune system and the virus and blah, blah. I know what I'm doing. Now, I come in for a follow-up appointment. I tick-tick-tick too, this and this is doing well. I'm having some symptoms over here. And then you can be the whole person that you are in a single visit and cover all the tabs. But initially, sometimes you take multiple visits to get the different bits organized enough that everyone's in agreement.
Haylie Pomroy: This is like just how to start tackling this one-on-one. And I'm just going to distill it down that if your life is different if you're feeling different, if it doesn't feel right, that's a big deal that you want to become a good historian for your health. When was the last time you felt better? When was the last time you felt good? When did things change? What did you notice first? I love making a list of what makes you worse so you don't have to think about it. It's just easily identified and what also makes you better and double down on that. I love to educate for yourself, to advocate for yourself, and then to start focusing on some of the things that, I don't want to use the word basic because they're really profound. If these 3 things were under control. If everybody said Dr. Klimas, we're not going to send you a patient. We're going to first take care and work on their sleep, their dysautonomia, their nutrition, and their supplementation, and then we'll send them to you.
Dr. Nancy Klimas: I could do 30-minute appointments. That'd be great.
Haylie Pomroy: You guys can do that. All of you out there. You can start to just take these concepts and get organized with the process. You're in it for the Long haul. This journey is one where the more versed, the more organized. And it's really hard because you feel not well or awful or having cognitive issues but also don't hesitate to ask for help. If you have this instruction manual, this one-on-one that Dr. Klimas just set out. You can hand that to a friend or a loved one and say, I need you to help me become a good historian. Can I just dictate this to you? What makes me worse? What makes me better and get help and support for that. Dr. Klimas, any other pearls of wisdom that you want to... I just wanted to give people a starting place.
Dr. Nancy Klimas: The immune system since I am an immunologist. As I sit here talking about everything else and everyone you have to own that, I'm a clinical immunologist. That's my original training and certification and how I got into this field. And yet here I am being a dysautonomia, sleep, the bioenergetics doctor.
Haylie Pomroy: I think, at least me, I used to think that immunology was like an event-driven episode. You cut yourself, you get a bacterial infection, you get a tooth infection. That's the immunology. It is so about adaptation.
Dr. Nancy Klimas: Just think about that sympathetic overdrive. Just having so much adrenaline circulating that just totally trashes the immune system. You can’t say it's separate these, they're not silos of thinking. They're very connected ways of thinking and so you have to fix them, that's really important. But back in the immune system space, there's another really important thing to notice, which is that the part of the system that's not working the best is the part that's antiviral. Specifically, the part that keeps old viruses from reactivating. The one that's supposed to be watching and snapping those little viruses up if they try to pop out again. And that is pretty busted. It's a pretty broken system. And so we spend a lot of our time trying to repair the immune system. And then the other thing that's wrong with the immune system that is driving a lot of inflammation, and particularly inflammation in the brain. We spend a fair amount of time in our practice trying to find things that are anti-inflammatory for the brain. It's totally messed up because if you have oxidative stress, you're going to have inflammation in your brain. When I say I'm dealing with bioenergetics and antioxidants and things, those are not simply treating energy in the brain. Those are treating inflammation in the brain. You have to see the big picture of this, that you can't just take it apart into its single little bits, because you ain't going to end up on a cocktail approach of intervention, where you're taking care of these very interactive elements to try to get a new balance, a homeostatic balance, and get back to health in that kind of way.
Haylie Pomroy: I keep saying this, I hope that there are some good things that came out of the pandemic. One thing that I've seen from the outside looking in, in medicine, is we're forced to look at complex treatment because of the complexity of Long COVID, which is so similar or mirrors the complexity of ME/CFS. The doctors that were addressing ME/CFS were acutely aware of that way ahead of time. But we're having all these other care centers pop up. I don't believe, I don't think that there's a magic pill because it's not a broken bone. It's not a high cholesterol. I think it's going to change the trajectory of medicine, I really do. I think that if we're going to treat these patients and there's a lot of them, we're going to have to think with more diverse or cocktail of options.
Dr. Nancy Klimas: My family accuses me of being a rose-colored glasses person. I've always been that way and I still am that way. Absolutely, I can't believe I've been doing this for so many years. I haven't gotten cynical yet. These are curable illnesses and that we're very close to that. One of the reasons why we did this Hope and Help thing was because I freak out when I hear about people that have reached their last thread, and I haven't been able to inject into them the optimism that they need to hear from me a frontline investigator, a frontline clinician. We are so close. This is not the time to give up on this field or yourself because we are so close. If I ever got one message across is that we are already helping people a lot. But we believe that these are curable illnesses, not just treatable illnesses. I just wanted to leave that great big pearl on the table. We're going to keep at it until we got it, and that's really, really important to hear.
Haylie Pomroy: I love that. Dr. Klimas, thank you so much! And I think that everybody out there if you know somebody that's struggling, make sure that you let them know that there is hope. I feel very fortunate to get to witness what we see in the clinic every day, our Friday clinicals, where everybody comes together and hundreds and hundreds of hours of education pour over cases. And there is a significant amount of hope and this is to provide help and I just can't thank you enough for being on. I think sometimes in the complexity of all of this, it helps to give us a guideline for where to start and to get in the right direction to getting well.
Dr. Nancy Klimas: Thanks, I appreciate that.
Haylie Pomroy: Absolutely. We'll talk again very soon.
