Dr. Jenny Tufenkian, ND
A phased naturopathic approach addressing foundational digestive stabilization, EBV reactivation, neuroinflammation, and autonomic dysfunction in a severely disabled patient.
Abstract
Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Long COVID, mast cell activation syndrome (MCAS), and postural orthostatic tachycardia syndrome (POTS) frequently co-occur in patients with complex post-infectious multisystem illness. Conventional medicine can offer some symptomatic management for these conditions but rarely provides functional restoration, as it does not systematically address underlying root causes. This case examines a structured naturopathic approach that adapted care delivery to the patient’s neurological reality, prioritized foundational digestive and blood sugar restoration, and introduced an integrative antiviral protocol once laboratory workup could be completed.
Case Presentation: A 32-year-old woman with five years of Social Security Disability Income (SSDI) presented with ME/CFS, POTS, MCAS, multiple traumatic brain injuries (TBI), complex PTSD, ADHD, and suspected autism spectrum condition. She was wheelchair-dependent outside the home, spending most of her day supine, with self-rated energy of 0–3 out of 10 and debilitating migraines multiple times weekly. She was already receiving guideline-consistent conventional care — including MCAS pharmacotherapy, autonomic support, antiviral therapy, and psychiatric medications — and remained profoundly disabled.
Intervention: Labs were ordered at intake but could not be completed for six months due to the patient’s executive dysfunction. Care was restructured around her actual capacity: weekly nutritionist coaching focused on blood sugar stabilization and digestive health. Once labs were completed, EBV reactivation was confirmed and a three-part antiviral protocol was introduced: valacyclovir 1g daily with L-lysine 2g twice daily; botanical antivirals (monolaurin combination product and an olive leaf extract-based botanical blend); and sequential homeopathic EBV nosodes across a two-month ascending and descending potency protocol. Subconscious trauma processing and low-dose naltrexone (LDN) were introduced in later phases.
Outcomes: Clear functional improvement was documented at 13–14 months, with a 20-month follow-up confirming continued progress. The patient progressed from wheelchair dependence and a 0–3/10 energy baseline to a sustained 6–7/10, with rare post-exertional malaise. She independently completed her garden for the first time since her injuries, rides an e-bike regularly, maintains an active social life, and recovered from a second COVID-19 infection without relapse.
Conclusion: Substantial functional improvement is possible in profoundly disabled patients with complex post-infectious illness when care meets the patient where they are, addresses root causes systematically and holds therapeutic hope across a multi-year horizon.
Introduction
Whenever I begin working with a complex patient, I notice three feelings arise at once: curiosity, excitement, and a quiet edge of fear. Curiosity, because everybody carries a story. Excitement, because I have seen people recover after being told they would not. And fear, because the question is always the same — will I be able to help this person recover?
Patients with complex post-infectious multisystem illness can be challenging in clinical practice. ME/CFS/Long COVID involves dysregulation across interconnected systems — neuroimmune, hormonal, cardio-vascular, autonomic, mitochondrial, and gut-brain — that amplify one another and rarely respond to a single-axis treatment approach.¹
They are challenging — not because they are untreatable, but because the complexity can feel overwhelming, and the conventional model simply does not provide the time or framework to unwind it systematically. These patients often get dismissed or undertreated as a result.
Over decades of working with this population, I have developed a framework that helps me organize complexity and direct care. I am always evaluating two things in parallel: the health foundations and the root causes.
The health foundations — digestion/detoxification, movement and breath, rhythm and sleep, mindset and spirit, and connection. A body locked in sympathetic overdrive cannot heal. Addressing these foundations is how we begin to shift the nervous system toward the parasympathetic state where healing becomes possible.
The root causes I systematically rule in and out are: hormonal triangle dysregulation (HPA axis, thyroid, and gonadal hormones); chronic or reactivated infections (viral, bacterial, fungal) and immune dysregulation — whether overactive, underactive, or both; mitochondrial dysfunction; toxic overload including mycotoxins; and limbic-autonomic hyperreactivity involving the amygdala, insula, and vagus nerve. Most of these patients have two, three, or all five operating simultaneously.
This framework does not simplify these cases — they are genuinely complex. But it gives me a map. And it gives patients a way to understand what is happening in their own bodies.¹˒²
The gut-brain-immune axis is central to all of this — microglial activation, mast cell degranulation, and chronic infections sustain the neuroinflammatory cascade that underlies the fatigue, cognitive impairment and autonomic dysfunction these patients live with every day.³–⁹ This case illustrates what becomes possible when we go beyond symptom management and address what is actually driving the illness.
Case Presentation
Patient Information and Presenting Concern
A 32-year-old woman presented via telemedicine in April 2024, having received SSDI for five years. She had a background in corporate marketing and had previously been highly physically active, including equestrian sport, skiing, mountain biking, and polo. She was deeply interested in botanical medicine and was motivated to heal. She had a formal ADHD diagnosis and suspected — but not yet formally confirmed — autism spectrum condition.
Her primary concerns were profound fatigue, post-exertional malaise (PEM), debilitating migraines multiple times weekly lasting full days, orthostatic intolerance, and inability to reliably perform activities of daily living. She described herself as ‘vertically challenged’ — spending most waking hours supine, requiring a wheelchair for any out-of-home activity. On her self-constructed energy scale (0 = dead in bed; 1 = migraine on the couch; 10 = full function), she typically operated at 1–2, with better days reaching 2–3.
Clinical History and Context
TBI, Neuroinflammation, and the Setup for Collapse
To understand how this patient arrived at this level of disability, we need to understand what was happening in her brain long before COVID-19 found her. She sustained her first TBI at age 4 and continued to experience head injuries throughout her life: at age 8 (struck a curb, transient vision blackout and tinnitus); age 12 (fell from a horse); repeated equestrian injuries through adolescence during polo training; a 2015 skiing TBI with documented brachial plexus involvement coinciding with a suicidal crisis; a vasovagal fall from a stone walkway in college; and in 2019 when her health really tanked— falling backward onto her occiput while rollerblading, followed ten months later by a second concussion.
Each TBI activates microglia — the brain’s resident immune cells — initiating a neuroinflammatory cascade that grows more reactive with each subsequent injury.¹¹ By adulthood, her brain had been in a state of chronic neuroinflammation for most of her life. Growing up in a home with significant family stress compounded this: psychological trauma activates the same neuroinflammatory pathways as physical TBI, maintaining microglial activation and priming the limbic-amygdala-insula system for threat hyperreactivity. Her ADHD and suspected autism spectrum condition added further neurological vulnerability. When COVID-19 arrived, it did not land in a healthy brain. It landed in a brain already set up for a ‘forward feeding’ cycle of inflammation.
Prior Care at Intake
She had significant high-quality care prior to our visit. Following the 2019 injuries she received comprehensive concussion rehabilitation including PT, OT, speech therapy, vision therapy with a neuro-optometrist, and hyperbaric oxygen therapy. She had a naturopathic physician, mental health therapist, and occupational therapist. Her conventional providers were aware of her EBV history — she had infectious mononucleosis at age 19 — and were treating it with valacyclovir 1 gram once daily. She had good care. Yet she was struggling to get through her day.
Medications and Supplements at Intake
On intake she was taking fexofenadine 180 mg twice daily and ketotifen 2 mg twice daily (dual H1 blockade); famotidine 40 mg twice daily (H2 blockade); montelukast 10 mg daily; propranolol up to 30 mg daily; fludrocortisone 0.1 mg nightly; valacyclovir 1 gram once daily; sertraline 150 mg twice daily; bupropion XL 300 mg daily; buspirone up to 45 mg daily; progesterone 100 mg nightly. She also maintained an extensive botanical self-care regimen demonstrating real herbal literacy: nervines, adaptogens, gut support, mitochondrial support, and daily medicinal teas. This system kept her surviving, but was not restoring her.
Clinical Findings
All encounters were conducted via telemedicine. Within the first 10–15 minutes of early sessions, cognitive fatigue was evident — she became easily distracted, lost her train of thought, and showed signs of sensory overload. Gastrointestinal findings were prominent: four to six loose bowel movements daily with undigested food, alternating constipation and diarrhea, severe morning nausea, and significant food aversion. She required 6 liters of fluid and 15 grams of sodium daily to maintain minimal autonomic stability. Sleep was shifted to a nocturnal pattern. She was underweight at intake.
Diagnostic Assessment
Conventional Labs
A standard panel from prior providers showed results largely within conventional normal limits — the ‘your labs are normal’ workup that ends the investigation in conventional settings. Of note: hemoglobin A1c 5.3%; serum cortisol 4.5 mcg/dL (low-normal); TSH 1.14 mIU/L; vitamin D, magnesium, sex hormones, and thyroid antibodies were unremarkable.
Adrenal Stress Index
Salivary cortisol revealed a flattened diurnal pattern: low morning cortisol, noon at the lower boundary of normal, afternoon and midnight within normal range. DHEA-S elevated at 11. This was consistent with HPA dysregulation and circadian disruption — correlating with her documented morning difficulty and nocturnal energy peak, patterns well-documented in ME/CFS and Long COVID.⁹
Mycotoxin Panel
Mild elevation of multiple mycotoxin markers, consistent with her history of mold exposure in prior and current residences.
GI-MAP Stool Analysis
Completed on the third(!) collection attempt. Results showed mildly elevated H. pylori, elevated Streptococcus species, yeast, and low fecal elastase. Overall findings were modest — the gut symptoms were likely driven more by food sensitivities, nervous system and mast cell dysregulation than by primary microbial pathology.
EBV Viral Panel
Results took six months to obtain due to executive dysfunction. Labs confirmed EBV reactivation: VCA IgG 144 (elevated); EBNA IgG 377 (elevated); EA-D IgG 15 (reference <9) — the key reactivation marker. These matched her clinical picture. It is important to note that serology often normalizes long after patient feels better. We are taught, treat the patient, not the lab value – this is never more important than in viral reactivity.¹⁰
Cyrex Arrays
Lymphocyte Array: The Lymphocyte MAP demonstrated a pattern of simultaneous immune hyperactivation and hypoactivation — including elevated Th2 and Treg populations alongside critically depleted CD57+ NK and T cell populations — consistent with chronic herpesvirus reactivation and immune exhaustion. Arrays 11 and 12 showed negative immune reactivity to toxins tested.
A Note on Testing I Would Add Now
In retrospect, I would now routinely include SARS-CoV-2 antibody testing in a case like this. While not diagnostic for Long COVID, patients with significantly and persistently elevated antibody levels raise my clinical suspicion for ongoing viral persistence — a pattern worth tracking alongside other reactivated viruses. I would have also tested D-Dimer to assess for clotting common with SARS-CoV 2, and an Iron panel, as many have heme variations due to inflammation or underlying genetic issues.
Clinical Assessment
Working diagnoses: ME/CFS with Long COVID overlap; reactivated EBV with undertreated viral burden; MCAS with autonomic comorbidity (POTS); CPTSD; multiple TBI with chronic microglial neuroinflammation and cervical instability; hypermobility (probable EDS, undiagnosed); ADHD and suspected autism spectrum condition; HPA dysregulation; gut dysfunction; environmental mycotoxin burden; blood sugar dysregulation contributing to neurological and fatigue symptoms.
Therapeutic Intervention
Phase 1: Restructuring Care and Restoring the Foundation (Months 1–6)
In naturopathic medicine we are taught: heal the gut, as a first clinical principle. Two to three months into our work together, watching this patient struggle to complete a lab collection, I had a moment of reckoning. The fear I had felt at the beginning was growing. Was I going to be able to get anywhere with her? Lab kits were being lost, forgotten, returned to wrong addresses — not through carelessness but because her executive function, fractured by years of neuroinflammation and TBI, made multi-step tasks genuinely impossible.
I stopped and asked myself: what is the one thing I can do right now, given exactly who she is? The answer pointed to blood sugar regulation and digestive restoration. Her HPA axis was being destabilized by erratic glucose. Her nervous system was further dysregulated by gut dysfunction and mast cell reactivity. Her brain — already chronically inflamed — was not getting the metabolic stability it needed. And she was barely eating.
Instead of always meeting with me to discuss more than her brain could handle, we restructured her care. The holistic nutritionist in my practice began meeting with her weekly in brief, 15–30 minute sessions focused on one health foundation. The nutritionist functioned as a coach: they created a capsule grocery list, simple default meal plans for lowest-energy days, meal delivery guidance, and consistent encouragement. Motivational interviewing was used throughout. For a neurodivergent patient with sensory processing differences, food aversion, and unreliable hunger signaling, learning to eat regularly was neurological rehabilitation and frankly, empowering— the foundation on which everything else depended.
Concurrent supplementation: HPA botanical support, 2 capsules twice daily; adrenal cortex 1 capsule twice daily; liver support herbs, 2 capsules twice daily, introduced gradually; L-tyrosine 500–1,500 mg twice daily for dopaminergic and ADHD support; UNDA HAD 5 drops before meals for HPA support and appetite normalization. Environmental interventions were reviewed: HEPA filtration, dust mite reduction (her highest allergenic trigger), and art material toxin exposure assessment.
Phase 2: The Three-Legged Stool Antiviral Protocol (Months 6–13)
When the viral panel returned confirming EBV reactivation, it validated what the clinical picture had long suggested — and revealed that her existing antiviral regimen was insufficient. I use what I call a three-legged stool approach to chronic viral infections. In my experience, each leg is necessary.
Leg One — Pharmaceutical and Amino Acid Antiviral: Her conventional provider was already prescribing valacyclovir 1 gram once daily. I gave her the option of increasing to 1 gram three times daily, or staying on the existing dose and adding L-lysine. She chose the latter: valacyclovir 1 gram once daily (continued from her PCP) plus L-lysine 2 grams twice daily. L-lysine competitively inhibits arginine, which herpesviruses require for replication, working through a complementary mechanism to the antiviral.
Leg Two — Botanical Antivirals: A monolaurin combination product providing per two-capsule dose: 500 mg monolaurin, 350 mg olive leaf, 250 mg humic acid, and 25 mcg Lactobacillus rhamnosus — taken twice daily. A standardized olive leaf extract with complementary botanical herbs, 2 capsules twice daily. These work through distinct mechanisms — monolaurin disrupts lipid-enveloped viral membranes; olive leaf extract provides antiviral and immune-modulating activity — reducing the likelihood of viral adaptation.
Leg Three — Homeopathic EBV Nosodes: DesBio EBV nosode series, one vial every three days across two months — ascending potencies the first month (15X, 20X, 30X, 60X, 90X, 120X, 150X, 200X), descending the second. My clinical model: by presenting the immune system with successively different potencies of the viral material, the nosodes function as progressively different views of a pathogen the immune system has learned to overlook. Patients often notice a transient immune reaction partway through – usually between vials 3-5 — followed by meaningful improvement.
Additional support at this phase: CoQ10 100 mg twice daily for mitochondrial support; more agency in food preparation; LDN 0.5 mg nightly, introduced and incrementally increased — she reported this made a meaningful difference in her energy and resilience over time.
Phase 3: Nervous System, Hormones, and Deeper Healing (Months 13–20)
As her physiological foundation stabilized, we turned to deeper layers. She began to explore brain retraining, dipping her toe into a limbic retraining program but she did not stick with it. This layer requires cognitive stability to engage meaningfully, and we had to wait until she was more stable to begin working here. Her concentration and attention during visits was remarkably improved. We did subconscious parts work. She described a significant somatic release of fear that had been long held in her body. Connecting to her own inner wisdom and healing capacity addressed something no supplement or pharmaceutical could reach — the chronic threat signal running beneath her physiology since childhood.
I had independent conversations with her parents throughout her care, separate from the patient. This allowed me to educate them about the neurological realities of her illness, validate her experience as a clinician who could explain what was happening in her body, and help them move from urgency and fear into genuine understanding and support. The shift in her family dynamics over the treatment period was part of her healing environment, not incidental to it.
Hormonal refinement: Vitex tincture was added alongside her existing progesterone for additional PMDD support; evening primrose oil (GLA 1,300 mg) for mast-cell-mediated menstrual amplification; cycle tracking to anticipate luteal phase escalation. Zolair (omalizumab) monthly injection — managed by her allergist — was identified by the patient as the pharmaceutical missing piece for her mast cell burden, providing a qualitative shift the H1/H2/leukotriene stacking had not achieved. Exercise rehabilitation was introduced using heart rate variability as the gating parameter, with PT guidance to gradually expand her PEM threshold.
Follow-up and Outcomes
Clear functional improvement was documented at 13–14 months, with a 20-month follow-up in January 2026 confirming continued progress. The arc of change is best understood through the contrast: before working together, walking around the block was not possible. A medical appointment would cause a crash lasting for days. She felt like her body was filled with cement.
At 20 months: energy sustained at 6–7 out of 10 on most days. When she has a lower energy day, she does housework at home — that is now her ‘down day.’ That contrast- feels like a clinical win.
In spring 2025 she independently prepared her garden for the first time since 2018 — every prior year she had hired it out. She rides an e-bike regularly. She cooked a full Thanksgiving dinner for guests. She lives with her partner. She has applied to art markets and a mentorship program. She is discussing having a child. When she contracted COVID-19 for the second time in January 2025, she did not relapse — she recovered and continued forward. That resilience is the clearest evidence of genuine physiological restoration rather than symptom management.
Her family relationships transformed substantially. Parents who had entered this process wondering when their daughter would return to her corporate career came to genuine understanding of her condition and pride in her progress. The 20-month follow-up call confirmed she was still doing well and continuing to improve.
Her own words from that call capture what mattered most: ‘What helped the most is that you took the time to slow down and meet me where I was. Not just a list of things and now you are on your way. I really needed to have my hand held, and you guys did not shame me. For neuro-diverse and complex patients, I think it is why I got better.’
Safety and Tolerability
No significant adverse events occurred. The antiviral protocol was well tolerated. A transient immune activation response occurred partway through the nosode series, consistent with an expected therapeutic response, followed by improvement. LDN was introduced at 0.5 mg nightly; initial overenthusiasm as energy improved led to overexertion — a common pattern when these patients feel better — managed with pacing guidance. The olive leaf content in her olive leaf supplement was reviewed in the context of her SSRI; the dose was assessed as clinically acceptable, and she was counseled to monitor for any serotonergic symptoms.
Timeline
| Timeframe | Key Events | Interventions | Functional Status |
| Childhood–Adolescence | Multiple TBIs from age 4; hypermobility; early orthostatic symptoms; chronic family stress | Conventional care as needed | Functioning, independent; brain in chronic low-grade inflammatory state |
| 2015 | Significant ski-related TBI with brachial plexus involvement; suicidal crisis | Rehabilitation therapies | Increased neurologic vulnerability |
| 2019 | Major concussion (rollerblading fall); progressive neurologic decline | PT, OT, speech therapy, vision therapy, HBOT at major medical center; SSDI awarded | Declining stamina; increasing migraines; orthostatic intolerance |
| 2021–2022 | COVID-19 vaccination; worsening dysautonomia; SARS-CoV-2 infection during acute family crisis | Acute care; IV fluids | Bed-bound to wheelchair; patient reports being ‘vertically challenged’; energy 0–3/10 |
| April 2024 | Initiated naturopathic care; labs ordered at intake (viral panel, ASI, mycotoxin, GI-MAP) | Foundational assessment; nutritionist consultation; blood sugar stabilization; lab kits mailed | Severe fatigue; frequent PEM; poor oral intake; unable to complete labs due to executive dysfunction |
| May–Aug 2024 | Repeated lab attempts unsuccessful; summer heat flare; clinical restructuring of care model | Weekly nutritionist coaching initiated; pacing guidance; botanical HPA and liver support | Gradual appetite improvement; migraines worsening with heat; labs still incomplete |
| Sept–Oct 2024 | GI-MAP completed (third attempt); mycotoxin and ASI results returned | Targeted gut support; mycotoxin protocol; HPA botanical support continued | Appetite returning; meals more consistent; energy beginning to shift |
| Nov 2024 | EBV reactivation confirmed — six months after labs first ordered; antiviral protocol initiated | Three-legged antiviral protocol: valacyclovir 1g daily + L-lysine 2g BID; monolaurin combination product 2 caps BID; Oliverex (Biocidin Botanicals) 2 caps BID; DesBio EBV nosodes one vial every 3 days, ascending then descending potencies (15X–200X) over two months | Energy improving; heaviness lifting; migraines less frequent |
| Dec 2024–Jan 2025 | Second COVID-19 infection; recovered without relapse | Discussed paxlovid; patient obtained from PCP; continued integrated botanical and pharmaceutical support | Recovered without prior disability level returning; energy 5–6/10; notable resilience |
| Spring 2025 | Hormonal stabilization; began exploring brain retraining | Vitex tincture added; evening primrose oil for MCAS/PMDD; dipped toe into brain retraining; subconscious parts work in visits | PMS window narrowing; migraines rare; bowel movements normalized (3x/day, formed) |
| Summer 2025 | Summer heat triggered MCAS/PEM flare; LDN initiated | LDN 0.5 mg nightly; continued MCAS layering; Zolair injections ongoing | Energy 6–7/10; riding e-bike; heat tolerance improved with medications |
| 13–14 Months | Clear functional improvement documented | Maintenance and continued optimization of all protocols | Energy sustained 6–7/10; independent gardening; cycling; active social life; living with partner |
| 20-Month Follow-up (Jan 2026) | Check-in: continuing to do well and improve; disability review affirmed; family relationships transformed | Ongoing herbalism, subconscious work, and PT as needed | Functional gains holding and building; discussing future family; creative work flourishing |
Discussion
Meeting the Patient Where She Is
It’s easy these days to think the magic is in the more heroic or expensive treatments. In this case it was in slowing down, meeting the patient where she was, and working on the basics — food, blood sugar, digestion — delivered with consistency and without shame. That was the intervention.
She went from someone who found food nauseating and forgot to eat, to someone who enjoyed food. She cooked a full Thanksgiving dinner for guests. That shift did not come from a sophisticated protocol. It came from someone showing up every week, meeting her exactly where she was, and offering heart-based care in small, doable steps. The naturopathic principle of heal the gut — wins again
The Gut Really Is Everything
The gut-brain-immune axis is now well-established: gut dysbiosis drives microglial activation, mast cell reactivity, and neuroinflammation through mechanisms that directly sustain the fatigue, cognitive impairment, and autonomic dysfunction central to these conditions.³–⁵ In this patient, restoring digestive function created the physiological platform on which everything else became possible. We changed the ‘terrain’ so that viral reactivation is less likely.
Undertreated Viral Reactivation: A Pattern Worth Naming
I see this consistently: a patient with confirmed EBV reactivation, being treated with a single antiviral agent at a dose insufficient for chronic reactivation. The three-legged stool — pharmaceutical or amino acid antiviral, botanical antivirals, and homeopathic nosodes — addresses the viral burden through complementary mechanisms and, in my clinical experience, produces results that single-agent therapy does not. The energy shift this patient experienced after beginning the protocol — the lifting of what she described as legs of cement — was the clearest objective signal in this entire case. We treat the patient, not the lab value.
I want to flag something for colleagues that I would do differently now: I would routinely add SARS-CoV-2 antibody testing in complex post-infectious cases. It is not diagnostic for Long COVID, but when antibody levels are significantly and persistently elevated, I suspect ongoing viral persistence driving the immune exhaustion. I also screen systematically for co-infections — HHV-6, CMV, Parvo-B12, mycoplasma — as these frequently co-occur and each may need its own targeted approach. This patient came in already diagnosed with POTS, so orthostatic assessment was not a workup priority here — but for practitioners working with patients who do not yet have that diagnosis confirmed, the NASA lean test is a practical and informative tool: the patient stands passively against a wall for up to 20 minutes with heart rate and symptom monitoring, and can be done in clinic or at home.
What is next for her to work on?
As always, in complex cases there are many layers to healing. She has continued work in nervous system regulation with her POTS/Dysautonomia. Brain retraining may be helpful to lower her reactivity to certain stimuli like light. Her immune system could be supported by working on lowering mycotoxin load. At this point do not think she has on-going mold exposure.
The Honor of This Work
There was a moment in this case — two or three months in, lab kits lost for the third time — where I genuinely wondered whether I was going to be able to help this person. I had to be willing to sit with that question and find a different answer. That willingness to stay present, to think differently rather than give up, is what ‘broke the case’.
I am grateful that naturopathic medicine gave me the tools — root cause framework, integrative pharmacology, botanical and homeopathic medicine, and the understanding that we are physical, mental, emotional, and energetic beings — to do this work. It’s validating to the principles of our medicine to see the complex patients return to living life more fully. Even after years of disability. The body is resilient and waiting for the right support, in the right sequence, delivered with patience and care.
Limitations
This is a single case report; causal attribution of specific outcomes to specific interventions is not possible. Multiple interventions were introduced across overlapping timeframes. The patient’s motivated engagement, partner support, family relationship stabilization, and improved living situation all represent confounders limiting generalizability. These limitations are inherent to complex chronic illness care and argue for longitudinal case series rather than dismissal of individual cases as insufficiently rigorous.
Conclusion
When I began working with this patient, I felt curiosity, excitement, and a quiet edge of fear. Twenty months later I feel something else: gratitude, and a deep sense of honor.
This case demonstrates that meaningful functional improvement is possible in profoundly disabled patients with complex post-infectious illness — even when they arrive on maximal conventional care, even when executive dysfunction makes basic clinical tasks nearly impossible, and even when the path forward requires abandoning the standard model to meet the patient where she actually is.
The clinical lessons are not complicated, though they require patience and humility to execute: start with the gut; stabilize the blood sugar; treat the viral root cause adequately; hold hope across the long arc of healing; and never decide for the patient what the limit of their improvement will be.
It is an honor to be trusted with the health of people who have often been failed by a system that has run out of answers. And it is an honor to have naturopathic medicine as a framework — one that goes deeper, stays longer, and believes that more is always possible.
Jenny Tufenkian, ND is a licensed naturopathic physician and founder of Enjoy Full Health LLC in Portland, Oregon. Dr. Tufenkian earned her Doctor of Naturopathic Medicine degree from the National University of Natural Medicine (NUNM) and is committed to compassionate, longitudinal care that meets patients where they are while building sustainable functional recovery.
She specializes in complex chronic illnesses, including ME/CFS, Long COVID, POTS, mast cell activation syndrome (MCAS), chronic viral reactivation, and neuroinflammatory conditions. Dr. Tufenkian is known for her structured, root-cause approach that integrates conventional pharmacology, botanical medicine, homeopathy, nutritional therapeutics, and trauma-informed nervous system regulation.
Jenny Tufenkian, ND
Enjoy Full Health LLC, Portland, Oregon
Corresponding Author: Jenny Tufenkian, ND | jt@enjoyfullhealth.com | 503-894-9677
Conflicts of Interest: None declared | Funding: None
Patient consent for publication obtained; all identifying details removed.
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