Mermaid Central Medical Clinic Research

Sharing research in Long COVID, POTS, fibromyalgia and other areas

Dysautonomia as a Neuroimmune–Metabolic Disorder: A Unified Model Linking TLR4 Activation, Brainstem Hypoxia, and Autonomic Plexus Dysfunction

Dr Graham Exelby May 2025 Contents: 1. Abstract 2. Introduction 3. Section 1- Linking Immune dysregulation to Metabolic,...

Graham Exelby

30 min read

Coeliac Plexus in POTS : Insights into MALS, SMA and Nutcracker Syndrome in POTS

Dr Graham Exelby, with Deborah Calleja and Michelle Hill Abstract Postural Orthostatic Tachycardia Syndrome (POTS) is increasingly...

Graham Exelby

19 min read

Cardiac Plexus in POTS- a Central Node in POTS Pathophysiology

Dr Graham Exelby May 2025 with physiotherapy input from Stuart Stevenson Abstract This hypothesis paper presents the cardiac plexus—a...

Graham Exelby

18 min read

Preload Dysfunction in POTS and ME/CFS: The Azygous System, Autonomic Plexii, and Inflammatory Pathways

Dr Graham Exelby May 2025 Abstract This paper investigates the pivotal but underrecognized role of the azygous venous system in preload...

Graham Exelby

22 min read

Autonomic Dysregulation: A Systems-Level Integration of Brainstem Hypoperfusion, Plexus Dysfunction, and Immune-Metabolic Crosstalk in Dysautonomia

Dr Graham Exelby May 2025 Abstract: Dysautonomia encompasses a diverse spectrum of syndromes marked by disordered autonomic nervous...

Graham Exelby

16 min read

Amino Acid Neurotransmitter Dysfunction as a Central Driver of Mitochondrial Failure and Autonomic Instability in POTS, CFS/ME, Long COVID and Gulf War Syndrome

Dr Graham Exelby May 2025 Abstract Amino acid neurotransmitter dysfunction—specifically involving glutamate, GABA, and aspartate—emerges...

Graham Exelby

5 min read

Dysautonomia in Clinical Practice

Dr Graham Exelby May 2025 Introduction Dysautonomia refers to a range of conditions caused by dysfunction in the autonomic nervous system...

Graham Exelby

21 min read

Heart Rate Variability (HRV) in Autonomic Assessment

Dr Graham Exelby May 2025 Overview: Heart Rate Variability (HRV) reflects the dynamic interplay between the sympathetic and...

Graham Exelby

2 min read

Long COVID Investigations

This is a personal methodology in Long COVID and similar in POTS A Clinical Guide for GPs Dr Graham Exelby May 2025 Checklist: 1. ...

Graham Exelby

4 min read

Thoracic Outlet Syndrome, Abdominal Vascular Compression Syndromes and the Functional Continuum in Dysautonomia

Dr Graham Exelby May 2025 Functional Continuum with Brainstem and Cardiac Plexus Involvement: Emerging evidence and clinical observation...

Graham Exelby

4 min read

RAGE–TLR4–NF-κB–CCL2 Looping Activation in Long COVID and Sensitization Syndromes

Dr Graham Exelby May 2025 Overview: In Long COVID, POTS, and ME/CFS, chronic inflammation is sustained not by acute infection, but by...

Graham Exelby

2 min read

QT Prolongation in COVID and Long COVID

Dr Graham Exelby May 2025 Overview: QT prolongation reflects delayed myocardial repolarization and increases the risk of ventricular...

Graham Exelby

2 min read

POTS Management in General Practice

Clinical Overview and Treatment Protocol for GPs Dr Graham Exelby May 2025 Overview: Postural Orthostatic Tachycardia Syndrome (POTS) is...

Graham Exelby

2 min read

Intracranial Fluid Dynamics and Structural Influences

Dr Graham Exelby May 2025 This section is to summary the hydraulic changes seen in POTS and Long COVID Venous (and Arterial)...

Graham Exelby

1 min read

Integrated Immune and Metabolic Dysfunction in POTS and Long COVID

Mechanistic Framework for Clinical Understanding Dr Graham Exelby May 2025 Overview: POTS and Long COVID share a complex clinical...

Graham Exelby

2 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

Beyond the Symptoms: Targeting Underlying Mechanisms in POTS

Dr Graham Exelby April 2025 Table of Contents 1. Introduction: A Shift Toward Root-Cause POTS Management 2. Hypoxia as the Common...

Graham Exelby

12 min read

Brainstem Hypoperfusion in POTS,CFS, Fibromyalgia, Long COVID and GWS -a Key Role

Dr Graham Exelby May 2025 Abstract Brainstem hypoperfusion represents a unifying and upstream pathophysiological mechanism in postural...

Graham Exelby

24 min read

POTS Part 2 Pathophysiology

The Unifying Hypotheses to understand the processes Driving POTS, how hypoxia, neuroimmune Dysregulation and Autonomic Dysfunction in...

Graham Exelby

5 min read

POTS Part 5 Comorbidities

Dr Graham Exelby March 2025 Introduction to POTS Comorbidities Postural Orthostatic Tachycardia Syndrome (POTS) exists not as an isolated...

Graham Exelby

2 min read

Articles Categories

Articles List

POTS 2026: Preload Failure, Pericyte Loss, and a New Path to Recovery

Long COVID in 2025: Why You Keep Crashing – and Why There’s Hope

Neuro-Immune–Hydraulic Integrative Phenotype Axis (NIHPA): The Conceptual Framework where One Core Engine drives Multiple Phenotypic Variants

Upright Head Pressure in Long COVID- from Acute Neurovascular Injury to Chronic Hypoxic Support Failure- a Mechanistic Hypothesis

Long COVID Beyond the Acute Phase: Inflammation, Hypoxia, and Redundant Pathways Driving Chronic Disease

Reframing Postural Orthostatic Tachycardia Syndrome (POTS) as a Disorder of Preload Failure: Integrating Neurovascular and Immune Pathways

Genomic Redundancy as a Driver of Chronicity in POTS and Long COVID: a Preliminary Study of Convergent Pathway Disruption

Supine–Standing Echocardiography Reveals Preload Failure as the Primary Driver of POTS and Long COVID Orthostatic Intolerance

Gastroparesis in POTS and Long COVID: A Simplified Version

Gastroparesis in POTS and Long COVID: A Unified Hydraulic–Neuroimmune Model

Decoding POTS: A Patient Guide to Preload Failure and Recovery

Reframing POTS as a Disorder of Preload Failure: Physician Version

Chronic Phase Pathways in Long COVID and POTS - for GPs and Patients

Epstein–Barr Virus Reactivation in Long COVID: A Clinical Overview for Physicians

What DNA Can Teach Us in Understanding POTS, ME/CFS, and Long COVID

Tilt Testing in POTS : Safe and Effective Options

Sensitization in POTS, Long COVID, and ME/CFS: A Guide for Patients

Upright Head Pressure in POTS and Long COVID: Understanding a Common but Overlooked Symptom

Malignancy Risk in Long COVID: a Guide for Patients and GPs

Ascending Aortic Dilatation in Athletes with Thoracic Outlet Syndrome and the Therapeutic Role of Telmisartan

Pericyte and Astrocyte Dysfunction in Long COVID: Key Insights for Family Physicians

Long COVID Beyond the Acute Phase: Key Insights for General Practitioners

Long COVID: Inflammation, Hypoxia, Pericytes, Astrocytes, and Chronic Disease – A Patient Guide

Azygous Vein Dysfunction in POTS

The Systemic Consequences of STAT3 Dysregulation in Long COVID:

Long COVID and Autism Spectrum Disorder- a Shared Pathophysiology-

Extracellular Matrix Toxicity and Post-Exertional Malaise

Fascial-Lymphatic Obstruction and Brainstem Hypoxia in Long COVID and POTS

Origin of Brainstem Hypoperfusion in POTS and Long COVID: A Dual-Gate Hypothesis Linking Mechanical and Molecular Initiation

POTS Comorbidities- by Functional Domain

RAGE: A Central Amplifier in POTS

POTS Symptoms Overview

Lymphatic Obstruction in POTS, CFS, and Long COVID: A Call for Integrated Therapeutic Approaches

Mast Cell Activation as a Driver of Central Sensitization in POTS, Long COVID, and Fibromyalgia

Neurovascular-Endocrine Dysfunction as a Core Axis in POTS, Long COVID, and Fibromyalgia

Neurometabolic Modelling of PEM and Central Sensitisation

Mould, Sustained Stress, and PTSD Converge on the RAGE–TLR4 Axis: A Unifying Model of Neuroimmune Dysregulation

Locus Coeruleus Hypoperfusion and Noradrenergic Vasospasm: A Central Mechanism in Dysautonomia and Cerebral Hypoperfusion

Intracranial Hypertension, Venous and Lymphatic Flow Dysfunction- the Core Hydraulic Dysfunctions

Hydraulic and Vascular Autonomic Dysregulation in POTS- The Modified Geddes Baroreceptor Hypothesis

Dysautonomia as a Neuroimmune–Metabolic Disorder: A Unified Model Linking TLR4 Activation, Brainstem Hypoxia, and Autonomic Plexus Dysfunction

Coeliac Plexus in POTS : Insights into MALS, SMA and Nutcracker Syndrome in POTS

Cardiac Plexus in POTS- a Central Node in POTS Pathophysiology

Preload Dysfunction in POTS and ME/CFS: The Azygous System, Autonomic Plexii, and Inflammatory Pathways

Autonomic Dysregulation: A Systems-Level Integration of Brainstem Hypoperfusion, Plexus Dysfunction, and Immune-Metabolic Crosstalk in Dysautonomia

Amino Acid Neurotransmitter Dysfunction as a Central Driver of Mitochondrial Failure and Autonomic Instability in POTS, CFS/ME, Long COVID and Gulf War Syndrome

Dysautonomia in Clinical Practice

Heart Rate Variability (HRV) in Autonomic Assessment

Long COVID Investigations

Thoracic Outlet Syndrome, Abdominal Vascular Compression Syndromes and the Functional Continuum in Dysautonomia

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Mermaid Central Medical Clinic Research Sharing research in Long COVID, POTS, fibromyalgia and other areas

Dysautonomia as a Neuroimmune–Metabolic Disorder: A Unified Model Linking TLR4 Activation, Brainstem Hypoxia, and Autonomic Plexus Dysfunction

Coeliac Plexus in POTS : Insights into MALS, SMA and Nutcracker Syndrome in POTS

Cardiac Plexus in POTS- a Central Node in POTS Pathophysiology

Preload Dysfunction in POTS and ME/CFS: The Azygous System, Autonomic Plexii, and Inflammatory Pathways

Autonomic Dysregulation: A Systems-Level Integration of Brainstem Hypoperfusion, Plexus Dysfunction, and Immune-Metabolic Crosstalk in Dysautonomia

Amino Acid Neurotransmitter Dysfunction as a Central Driver of Mitochondrial Failure and Autonomic Instability in POTS, CFS/ME, Long COVID and Gulf War Syndrome

Dysautonomia in Clinical Practice

Heart Rate Variability (HRV) in Autonomic Assessment

Long COVID Investigations

Thoracic Outlet Syndrome, Abdominal Vascular Compression Syndromes and the Functional Continuum in Dysautonomia

RAGE–TLR4–NF-κB–CCL2 Looping Activation in Long COVID and Sensitization Syndromes

QT Prolongation in COVID and Long COVID

POTS Management in General Practice

Intracranial Fluid Dynamics and Structural Influences

Integrated Immune and Metabolic Dysfunction in POTS and Long COVID

Hypoxia-Driven RAGE Activation: A Core Pathophysiology

Beyond the Symptoms: Targeting Underlying Mechanisms in POTS

Brainstem Hypoperfusion in POTS,CFS, Fibromyalgia, Long COVID and GWS -a Key Role

POTS Part 2 Pathophysiology

POTS Part 5 Comorbidities

Articles Categories

Articles List

POTS 2026: Preload Failure, Pericyte Loss, and a New Path to Recovery

Long COVID in 2025: Why You Keep Crashing – and Why There’s Hope

Neuro-Immune–Hydraulic Integrative Phenotype Axis (NIHPA): The Conceptual Framework where One Core Engine drives Multiple Phenotypic Variants

Upright Head Pressure in Long COVID- from Acute Neurovascular Injury to Chronic Hypoxic Support Failure- a Mechanistic Hypothesis

Long COVID Beyond the Acute Phase: Inflammation, Hypoxia, and Redundant Pathways Driving Chronic Disease

Reframing Postural Orthostatic Tachycardia Syndrome (POTS) as a Disorder of Preload Failure: Integrating Neurovascular and Immune Pathways

Genomic Redundancy as a Driver of Chronicity in POTS and Long COVID: a Preliminary Study of Convergent Pathway Disruption

Supine–Standing Echocardiography Reveals Preload Failure as the Primary Driver of POTS and Long COVID Orthostatic Intolerance

Gastroparesis in POTS and Long COVID: A Simplified Version

Gastroparesis in POTS and Long COVID: A Unified Hydraulic–Neuroimmune Model

Decoding POTS: A Patient Guide to Preload Failure and Recovery

Reframing POTS as a Disorder of Preload Failure: Physician Version

Chronic Phase Pathways in Long COVID and POTS - for GPs and Patients

Epstein–Barr Virus Reactivation in Long COVID: A Clinical Overview for Physicians

What DNA Can Teach Us in Understanding POTS, ME/CFS, and Long COVID

Tilt Testing in POTS : Safe and Effective Options

Sensitization in POTS, Long COVID, and ME/CFS: A Guide for Patients

Upright Head Pressure in POTS and Long COVID: Understanding a Common but Overlooked Symptom

Malignancy Risk in Long COVID: a Guide for Patients and GPs

Ascending Aortic Dilatation in Athletes with Thoracic Outlet Syndrome and the Therapeutic Role of Telmisartan

Pericyte and Astrocyte Dysfunction in Long COVID: Key Insights for Family Physicians

Long COVID Beyond the Acute Phase: Key Insights for General Practitioners

Long COVID: Inflammation, Hypoxia, Pericytes, Astrocytes, and Chronic Disease – A Patient Guide

Azygous Vein Dysfunction in POTS

The Systemic Consequences of STAT3 Dysregulation in Long COVID:

Long COVID and Autism Spectrum Disorder- a Shared Pathophysiology-

Extracellular Matrix Toxicity and Post-Exertional Malaise

Fascial-Lymphatic Obstruction and Brainstem Hypoxia in Long COVID and POTS

Origin of Brainstem Hypoperfusion in POTS and Long COVID: A Dual-Gate Hypothesis Linking Mechanical and Molecular Initiation

POTS Comorbidities- by Functional Domain

RAGE: A Central Amplifier in POTS

POTS Symptoms Overview

Lymphatic Obstruction in POTS, CFS, and Long COVID: A Call for Integrated Therapeutic Approaches

Mast Cell Activation as a Driver of Central Sensitization in POTS, Long COVID, and Fibromyalgia

Neurovascular-Endocrine Dysfunction as a Core Axis in POTS, Long COVID, and Fibromyalgia

Neurometabolic Modelling of PEM and Central Sensitisation

Mould, Sustained Stress, and PTSD Converge on the RAGE–TLR4 Axis: A Unifying Model of Neuroimmune Dysregulation

Locus Coeruleus Hypoperfusion and Noradrenergic Vasospasm: A Central Mechanism in Dysautonomia and Cerebral Hypoperfusion

Intracranial Hypertension, Venous and Lymphatic Flow Dysfunction- the Core Hydraulic Dysfunctions

Hydraulic and Vascular Autonomic Dysregulation in POTS- The Modified Geddes Baroreceptor Hypothesis

Dysautonomia as a Neuroimmune–Metabolic Disorder: A Unified Model Linking TLR4 Activation, Brainstem Hypoxia, and Autonomic Plexus Dysfunction

Coeliac Plexus in POTS : Insights into MALS, SMA and Nutcracker Syndrome in POTS

Cardiac Plexus in POTS- a Central Node in POTS Pathophysiology

Preload Dysfunction in POTS and ME/CFS: The Azygous System, Autonomic Plexii, and Inflammatory Pathways

Autonomic Dysregulation: A Systems-Level Integration of Brainstem Hypoperfusion, Plexus Dysfunction, and Immune-Metabolic Crosstalk in Dysautonomia

Amino Acid Neurotransmitter Dysfunction as a Central Driver of Mitochondrial Failure and Autonomic Instability in POTS, CFS/ME, Long COVID and Gulf War Syndrome

Dysautonomia in Clinical Practice

Heart Rate Variability (HRV) in Autonomic Assessment

Long COVID Investigations

Thoracic Outlet Syndrome, Abdominal Vascular Compression Syndromes and the Functional Continuum in Dysautonomia

Mermaid Central Medical Clinic Research

Sharing research in Long COVID, POTS, fibromyalgia and other areas