I have been functionally recovered for about 20 months
Got sick in December 2023, with initial recovery around September 2024.
Just an average bout of COVID during med school exam period. I didn’t rest, kept pushing through, and failed my exams (European system, so I could retake them later).
Initial symptoms were severe cognitive dysfunction: prosopagnosia (couldn’t recognize/name faces), difficulty forming sentences, getting lost in my own neighborhood, profound exhaustion, inability to concentrate, sleeping deeply but waking exhausted with no dreams.
From January onward I developed progressively worsening PEM, eventually to the point I couldn’t even use my phone, alongside general fatigue, horrific brain fog, and aphantasia. I knew fairly early it was long COVID, but I kept trying to push through it, crashing repeatedly. The hardest part psychologically was accepting that this was not something I could brute-force my way through and that I actually needed to rest.
Things that helped, roughly in order: antihistamines, oral Ketotifen, beetroot juice, magnesium, gluten-free diet. Around this point I started suspecting a vascular component. I also did hot saunas around May, which helped somewhat.
With another exam session approaching, I started a strict epilepsy-style ketogenic diet. I was absolutely exhausted, but I managed to pass a major exam. I then convinced myself I was recovered and stopped everything, which was a mistake.
July/August was probably the worst period. I restarted Ketotifen (honestly a lifesaver) and added a low-dose SSRI, which at least helped psychologically. Despite maintaining a positive attitude and never really admitting (to myself or others) how sick I was, after 9 months I was genuinely scared for my future. At that point the PEM was so severe I spent most days lying in the dark except to eat or shower.
Then in September 2024 I started pycnogenol, which honestly changed everything. Within a week I was back at my desk; within two weeks I passed another exam. Since then I have not had true PEM again, only occasional next-day tiredness after very intense physical exertion.
Between September 2024 and March 2026 I remained stable on pycnogenol, Endocalyx Pro, escitalopram, and Ketotifen. I graduated, started working, had no crashes, and functioned normally.
The remaining issues were that I couldn’t discontinue Ketotifen without brain fog returning, and I had gained about 30 kg.
In March 2026 I started semaglutide, tapered off Ketotifen and escitalopram, and continued pycnogenol. My cognition is clear, energy is good, the weight is coming off, and I feel completely fine again.
I’m writing this while recovering from a concussion, which temporarily brought back some fatigue and brain fog, but nowhere near the level of long COVID, and I already feel almost recovered from that too.
Oh, and I can eat gluten again. Anyway, that’s my story.