Ask Me Anything (AMA) about ME/CFS, Long Covid, IACI. Drs. Ruhoy & Kaufman - Clinician's Roundtable.

In this clinician-focused AMA on infection-associated chronic illnesses (ME/CFS, Long COVID), Drs. Ruhoy and Kaufman discuss practical approaches to MCAS, POTS/dysautonomia, neuropathy, and structural contributors like craniocervical instability (CCI) and venous outflow issues. They outline how they “rule in/out” MCAS clinically, preferred treatment sequencing (H1/H2 blockers, mast cell stabilizers, leukotriene inhibitors, careful titration), test selection and timing around flares, and address common questions (e.g., lorazepam’s utility, metformin in Long COVID, “triple therapy” use). They review emerging/ongoing therapies and trials (e.g., rapamycin) and how to track updates, and share medications/supplements they use or monitor. For CCI, they stress it’s an anatomic problem requiring targeted evaluation and mechanical management; in profoundly disabled patients it’s a high-priority consideration. They touch on pregnancy considerations, hormone replacement in select cases, and when IVIG may help POTS (notably with autoimmune or small fiber neuropathy features). Additional topics include sensory hypersensitivity mechanisms, neuropathy in ME/CFS, collaboration with pain clinics, and procedural safety (e.g., endoscopy slides don’t cause MCAS). Overall, the session emphasizes individualized, mechanism-informed care and cross-specialty collaboration for complex post-infectious patients.