Dr Graham Exelby revised December 2024
As I finish 51 years in medicine (45 years in general practice), experience has taught me that we never stop learning. The need to keep asking “why” and not just accepting “what is the accepted” has taken me in a direction where I see health as a combination of what we inherit (our genes), what we do with our lifestyles, and what life’s circumstances inflict on us.
Learning to treat problems like atopic eczema and irritable bowel syndrome (IBS) with diet was a significant factor in this direction change, courtesy of Dr Merv Garrett, an allergist and pioneer in Australia. Then as I journeyed down the rabbithole that is POTS and Fibromyalgia things started to come together.
COVID-19 then answered many of the questions that kept popping up- how a virus (and here add trauma, mould, parasites, sustained stress) can activate threat receptors (Toll-like receptors, or TLRs) which then activate Mast Cells that are responsible for the cytokine storm that is what happens in COVID.
The addition of DNA assessments from Dr Valerio Vittone revealed common threads of DNA mutations in these syndromes, and a way to tackle these disabling conditions. DNA mutations in mast cells, the COMT, methylation, oxidative stress and other mutations have opened the door to successful treatments, ignoring the normal advice given in Long Covid to “accept your lot.”
A revision of the DNA findings from Dr Vittone has provided a link to what may be the most important of the DNA mutations- CCL2, with its effect on RAGE receptors as discussed in the Sensitization article, with their ability to food "feed-forward" inflammatory loops.
Major influences on my work:
Firstly the pioneering work of Dr Merv Garrett in diet,
Simply seeing so many "damaged" patients with POTS, fibromyalgia, chronic fatigue, Long COVID and how they all are closely interlinked, then exploring possible causes and solutions. This is an ongoing part of continuing to work in this field.
Lawrence Afrin and his cohorts in the USA on mast cell activation syndrome
Griffith University research on brainstem connectivity, glymphatic function and TRP mutations that affect natural killer cell function and glymphatic function itself. The use of brain SPECT scanning to identify damage versus inflammation especially in Long COVID
Kjetil Larsen and others in Thoracic Outlet, Jugular Outlet Syndrome and the impact of neck pathology and posture on craniovascular perfusion
The regular assistance from Profs Pete Smith and Jon Jenkins when the "going gets tough" and I cannot see a clear direction, and more recently from Dr Kevin Lee (endocrinology and nuclear medicine) in brain SPECT scans.
A new team of physiotherapy, osteopathic and lymphatic researcher clinicians to discuss possible management protocols to deal with the mechanical and hydraulic problems we have been finding.
Radiologists Drs Vini Nascimenco, Zane Sherif and a number of sonographers to work out how to best image some of the clinical findings. In particular assessment of the newly-discovered extremely high correlation of POTS with stylohyoid compression of the Internal Jugular Vein/s at C1, found in 90% of the newer scanned patients.
Through 2024, with the assistance of Rylee White and her team at Australian Ultrasound Specialists at Miami, we have developed dynamic ultrasounds of the vertebral arteries and veins that have provided the answers to the causes of the head pressure in different positions, and how it is increasing pressure when erect that causes CSF leaks in EDS and similar patients to relieve the increasing pressure.
Rylee and her team have also been able to identify valve dysfunction and stenosis in the Internal Jugular Veins, vital in intracranial venous obstruction.
Discussions with an ENT surgeon successfully treating stylojugular syndrome (venous Eagle) and a lymphatic therapist treating POTS has led to ways of tackling altered head and neck fascial changes that can cause recurring upper cervical dysfunction.
Discussions with Dr Raymond Perrin has added to the breadth of knowledge of the importance of lymphatic obstruction, usually at the venous angles of the neck from Thoracic Outlet Syndrome, has led to non-surgical approaches to MALS, SMA and Nutcracker Syndromes.
Accurate retinal photography primarily through optometrist Alan Ming assessing retinal arterial, venous change and looking for pressure in the optic discs.
Most importantly with help from Dr Valerio Vittone, to understand the underlying DNA mutations that lie behind both POTS and Long Covid and most diseases.
As the current research progresses in Covid, there is glimpse into the near-future with better management of many diseases, including Alzheimers, Parkinson's, Multiple Sclerosis, cancer, auto-immune diseases, and even arthritis as the pathways are being unlocked. Time will tell as medicine moves into very exciting new areas.
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