

Recovery Failure in POTS, Long COVID, ME/CFS and Related Disorders: A Unified Biological Framework
Dr Graham Exelby 2026 Abstract Successful recovery following infection, injury and physiological stress requires coordinated resolution of inflammatory signalling, restoration of microvascular function, tissue repair and rebuilding of physiological reserve. Although persistent inflammation, endothelial dysfunction, mitochondrial abnormalities and chronic hypoxic signalling have each been implicated in Long COVID, postural orthostatic tachycardia syndrome (POTS), myalgic...
Graham Exelby
52 min read
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome:An Endothelial–Neurovascular Hypothesis of Brainstem Oxygen Homeostasis Failure
Dr Graham Exelby 2026 Abstract Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic multisystem disorder characterised by post-exertional malaise (PEM), autonomic dysfunction, cognitive impairment, sleep disturbance and profound loss of functional capacity. Although abnormalities involving cerebral perfusion, endothelial function, neurovascular coupling, mitochondrial metabolism, immune activation and autonomic regulation have each been describ
Graham Exelby
4 min read
Understanding Long COVID: How a Viral Illness Can Become a Disorder of Neurovascular Dysfunction, Impaired Recovery and Loss of Physiological Reserve
Dr Graham Exelby 2026 About This Paper This document is a simplified companion to a series of more detailed scientific papers exploring Long COVID, POTS, ME/CFS and related disorders. The formal papers examine the underlying biology in depth, including neurovascular dysfunction, pericyte biology, autonomic regulation, inflammatory signalling, metabolism, recovery physiology and the renin–angiotensin–aldosterone system (RAAS). While these concepts are important, the scientific
Graham Exelby
5 min read


Understanding Recovery Failure in Long COVID, POTS, ME/CFS and Related Disorders: A Guide to Energy Production, Hypoxia and Recovery
Dr Graham Exelby June 2026 About This Paper This paper is part of the Understanding Series, a collection of companion guides designed to explain complex medical concepts in a practical and accessible way for patients, families and healthcare professionals. The aim of this paper is to explain how recovery may become impaired in Long COVID, POTS, ME/CFS and related disorders using straightforward language. Many important scientific concepts have therefore been simplified to imp
Graham Exelby
15 min read


Hashimoto's Thyroiditis, Thyroid Nodules and Cervical Drainage DysfunctionA Neurovascular–Lymphatic Model of Thyroid Inflammatory Persistence
Dr Graham Exelby 2026 Abstract Hashimoto's thyroiditis and thyroid nodules are traditionally viewed as manifestations of autoimmune and endocrine disease arising from genetic susceptibility, environmental triggers, loss of immune tolerance, thyroid autoantibody production, and progressive glandular dysfunction. While these mechanisms remain central to disease pathogenesis, they incompletely incorporate the regional venous and lymphatic anatomy upon which normal thyroid physio
Graham Exelby
16 min read
Endometriosis as a Chronic HIF-2α-Dominant Hypoxia–Fibrosis Syndrome: A Unified Mechanistic Framework and Rationale for Metabolic Repurposing
Authors: Dr Graham Exelby1,2 & Dr Cris Beer1,3. 2025. 1MCMC-Research Collaborative, Gold Coast, Australia 2 University of Queensland School of Medicine (Adjunct), Brisbane 3Integrative Gynaecology & Women’s Health, Gold Coast Reviewed by Dr Valerio Vittone (PhD), Gold Coast Abstract Endometriosis is traditionally defined as ectopic endometrial-like tissue that evades immune clearance. Emerging molecular, vascular, and immunometabolic data suggest this view is incomplete. Evi
Graham Exelby
1 min read
From Genomic Redundancy to Physiological Network Fragility:A Systems-Level Model of Chronicity in POTS, Long COVID, and Related Neuroimmune Disorders
Dr Graham Exelby (2026) Systems-Level Insights Derived from Genomic Studies in POTS and Long COVID (2022–2026) with Dr Valerio Vittone Abstract Background POTS, Long COVID, ME/CFS, vaccine-associated syndromes, and connective tissue-associated neuroimmune disorders are traditionally approached as distinct clinical entities. However, increasing overlap in autonomic dysfunction, neurovascular abnormalities, inflammatory activation, connective tissue signatures, oxidative stress
Graham Exelby
2 min read
ADHD, Autism, and Neurodivergence After COVID-19:A Hypoxic–Neurovascular Model of Acquired Executive and Sensory Dysfunction
Dr Graham Exelby 2026. Abstract The post-2020 rise in ADHD diagnoses, particularly among adolescents and young adults, coincides temporally with the COVID-19 pandemic and raises important questions regarding causality versus increased diagnostic awareness. This paper proposes an integrated physiological model in which SARS-CoV-2 infection acts as a systems-level stressor, unmasking or amplifying ADHD- and ASD-like phenotypes through disruption of preload-dependent cerebral pe
Graham Exelby
2 min read
A New Understanding of POTS, Long COVID and Related Disorders
A personal update from Dr Graham Exelby June 2026 Over the past several years, what started as an attempt to better understand POTS has evolved into a much broader investigation of Long COVID, ME/CFS, Fibromyalgia, migraine, Ehlers-Danlos syndrome, chronic head pressure syndromes and related disorders. The more patients we studied, the clearer it became that many of these conditions may not be separate diseases at all. Instead, they appear to share common physiological pathwa
Graham Exelby
5 min read


Neuro-Immune–Hydraulic Integrative Phenotype Axis (NIHPA): The Conceptual Framework where One Core Engine drives Multiple Phenotypic Variants
Dr Graham Exelby December 2025- in peer review Preview: This diagram shows the root network of all chronic immunometabolic diseases: hypoxia HIF-1α → HIF-2α reprogramming ROS / RAGE / NF-κB activation STAT3–CCL2 macrophage/microglial loops NLRP3 inflammasome pericyte dropout BBB leak mast-cell activation mitochondrial failure / PDH shutdown glycolytic trap autonomic failure central sensitisation This is the “motherboard,” where from this “motherboard,” you can derive variants
Graham Exelby
1 min read
Epstein–Barr Virus Reactivation in Long COVID: A Clinical Overview for Physicians
Dr Graham Exelby, September 2025 Extracted from “EBV Reactivation in Long COVID: A Mechanistic Synthesis,” September 2025...
Graham Exelby
3 min read
Tilt Testing in POTS : Safe and Effective Options
Dr Graham Exelby September 2025. This is a personal opinion and may differ from that of your medical advisers. Introduction Many centres...
Graham Exelby
2 min read
Ascending Aortic Dilatation in Athletes with Thoracic Outlet Syndrome and the Therapeutic Role of Telmisartan
Dr Graham Exelby September 2025 Background : I have been involved in a long term longitudinal study of this problem, initially comparing...
Graham Exelby
6 min read
The Systemic Consequences of STAT3 Dysregulation in Long COVID:
A Unifying Molecular Pathway Across Malignancy, Autoimmunity, and Immune Dysregulation Dr Graham Exelby June 2025- revised September 2025...
Graham Exelby
6 min read


RAGE: A Central Amplifier in POTS
Dr Graham Exelby May 2025 Introduction Chronic hypoxia is a powerful initiator of immune dysregulation, neurovascular injury, and...
Graham Exelby
13 min read


Hypoxia-Driven RAGE Activation: A Core Pathophysiology
Dr Graham Exelby May 2025 Abstract Hypoxia-induced RAGE (Receptor for Advanced Glycation End Products) activation emerges as a unifying...
Graham Exelby
19 min read
The Genetic Basis to Improving Toxin Detoxification
Your genetics determine if the body can clear toxins efficiently. Dr Valerio Vittone (PH.D) January 2023 Clearance of toxic compounds...
Graham Exelby
7 min read


DNA Mutations in POTS and Long Covid-Practitioner version MCAS Conference- April 2 2023-
By Dr Valerio Vittone Screendumps from Dr Vittone's presentation at the MCAS Conference April 2023
Graham Exelby
1 min read
A 50 Year Journey in Medicine
Dr Graham Exelby Updated June 2026 As I pass more than fifty years in medicine, including over forty-five years in general practice, one lesson has remained constant: We never stop learning. Medicine continually reminds us that certainty is often temporary. What is accepted today may be revised tomorrow. The most important question I have learned to ask is not "What is the diagnosis?" but rather "Why is this happening?" That question has guided much of my professional life.
Graham Exelby
4 min read












