Chronic Fatigue & Long COVID
- Matthew Altman
- Feb 13
- 6 min read
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Chronic Fatigue & Long COVID
URL slug: /chronic-fatigue Meta title: Chronic Fatigue & Long COVID Treatment | Functional Medicine | Salado, TX Meta description: Post-viral fatigue, Long COVID, chronic EBV, ME/CFS treatment in Central Texas. Root-cause functional medicine approach. Salado, TX. Target keywords: chronic fatigue Salado TX, Long COVID treatment Central Texas, post-viral fatigue Temple TX, functional medicine chronic fatigue, ME/CFS doctor near me
When Exhaustion Becomes Your Baseline
You used to have energy. You used to be able to work, exercise, keep up with your life. Then something changed.
Maybe it started after COVID. Maybe after mono. Maybe after a flu you thought you recovered from. Or maybe it just crept up on you over months or years and now you can barely make it through the day without crashing.
Your doctor ran basic labs. CBC, CMP, maybe a TSH. Everything came back "normal." They said you're fine. Maybe suggested antidepressants or told you to exercise more and sleep better — as if you haven't been trying that for months.
If you're looking for a chronic fatigue doctor near you who will actually investigate the root cause, this is what I do every day in my Central Texas practice. Here's what they're missing: Chronic fatigue is not a lack of motivation. It's a metabolic, immune, and inflammatory dysfunction that has real, measurable causes. And those causes are usually fixable — if you actually look for them.
Where I Start
Metabolic markers and an expanded thyroid panel. Every single time. Because if your cells can't make energy efficiently, you're going to feel it as fatigue before anything else.
Fasting insulin and glucose, HbA1c. Insulin resistance doesn't just make you gain weight — it tanks your energy. If your cells are insulin resistant, they can't efficiently take in glucose for fuel. You're functionally starving at a cellular level even though you're eating.
Thyroid: free T3, free T4, total T3, total T4, TSH. Not just TSH. A TSH of 3.5 might be "normal," but if your free T3 is on the floor or you're making too much reverse T3, your cells aren't getting the thyroid hormone they need to function. That shows up as crushing fatigue.
If the baseline doesn't explain it, we go deeper:
Reverse T3, thyroid antibodies (TPO, TG). Are you converting T4 to reverse T3 instead of active T3? Is Hashimoto's quietly destroying your thyroid?
Cortisol. Is your HPA axis dysregulated? Are you making too much cortisol (wired but exhausted) or too little (adrenal insufficiency)?
Inflammatory markers. High-sensitivity CRP, ESR, sometimes a full autoimmune panel. Chronic inflammation is exhausting — literally.
Viral reactivation markers. Epstein-Barr (EBV), HHV-6, CMV. These viruses don't just "go away" after acute infection. They go dormant. And in some people — especially after another viral illness, major stress, or immune suppression — they wake back up. Chronic EBV reactivation is one of the most common things I see in patients with persistent post-viral fatigue.
What's Usually Driving the Fatigue
Once the labs come back, we filter them through your history and symptoms. Patients come to us from Temple, Killeen, Georgetown, and throughout Central Texas because we treat chronic fatigue as the medical problem it is, not a psychological issue. The most common patterns:
Post-viral immune dysfunction. You had COVID, flu, EBV, or some other infection. Your immune system never fully turned off. It's stuck in a low-grade inflammatory state, which is metabolically expensive and physically exhausting.
Chronic viral reactivation. EBV is the big one. Most adults have been exposed. But in some people, the virus reactivates — not enough to make you acutely sick again, but enough to keep your immune system on high alert. I check four markers for EBV: VCA IgG, VCA IgM, Early Antigen IgG, and Nuclear Antibody. The pattern across all four tells the real story — not just one positive marker.
Mitochondrial dysfunction. Your mitochondria are the energy factories in your cells. Viral illness, chronic inflammation, oxidative stress, nutrient deficiencies — all of these can damage mitochondria. When they're not functioning well, you can't make ATP efficiently. That's fatigue at the cellular level.
Thyroid dysfunction. Already mentioned, but it's worth repeating. This is foundational. If your thyroid isn't working, nothing else will either.
Gut dysfunction driving systemic inflammation. Leaky gut, dysbiosis, SIBO — these create chronic low-grade inflammation that drains your energy and dysregulates your immune system.
Mold or environmental toxin exposure. Tier 3 territory, but worth investigating if nothing else is explaining it. Chronic inflammatory response syndrome (CIRS) from mold exposure looks a lot like chronic fatigue. And it's more common than people think.
What Treatment Actually Looks Like
This is not a one-size-fits-all protocol. It's individualized based on what we find. But here's the framework I use:
Step 1: Address active viral reactivation. If EBV or another herpesvirus is reactivated, we treat it. Ivermectin is my first-line medication for chronic EBV and Long COVID. It works by blocking viral protein transport into the nucleus via importin α/β inhibition. Clinically, I see significant improvement in fatigue, brain fog, and post-exertional malaise within weeks.
Low-dose naltrexone (LDN) is often added alongside. LDN modulates the immune system, reduces neuroinflammation, and improves energy in a lot of chronic fatigue patients. It's not a direct antiviral, but it helps the body regulate the immune response.
Step 2: Optimize metabolic and mitochondrial function. This means addressing insulin resistance, thyroid dysfunction, nutrient deficiencies (CoQ10, magnesium, B vitamins, vitamin D, iron if needed). We're giving your mitochondria the fuel and cofactors they need to produce energy.
Dietary intervention is huge here. For a lot of patients, a ketogenic or carnivore diet dramatically improves energy by switching the body to a more efficient fuel source and reducing inflammation.
Step 3: Reduce systemic inflammation. Fix the gut (leaky gut, SIBO, dysbiosis). Remove inflammatory triggers (food sensitivities, environmental exposures). Use targeted anti-inflammatory support when needed.
Step 4: Support HPA axis and stress resilience. If cortisol is dysregulated, we address it. Adaptogenic herbs, lifestyle modifications, stress management. Your body can't heal if it's stuck in fight-or-flight mode.
Step 5: Gradual reconditioning. Once energy starts to improve, we carefully reintroduce activity. Post-exertional malaise (PEM) is real — pushing too hard too fast will set you back. This is slow, patient, progressive reconditioning. Not "just exercise more."
Conditions I Treat in This Category
Long COVID / Post-Acute Sequelae of COVID-19 (PASC) Persistent fatigue, brain fog, shortness of breath, exercise intolerance months or years after COVID infection. This is a real, measurable dysfunction — not "just anxiety."
Chronic Epstein-Barr Virus (EBV) Reactivation You had mono years ago (or maybe never knew you had it). Now you're exhausted all the time, and standard labs don't explain it. EBV reactivation is incredibly common and incredibly under-diagnosed.
Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) Severe, disabling fatigue with post-exertional malaise, brain fog, unrefreshing sleep, often following a viral illness. This is not "just being tired." This is a real, physiologic dysfunction.
Post-Viral Fatigue Syndrome After flu, COVID, EBV, HHV-6, Lyme, or any other infection — you never fully bounced back. Energy, cognition, and exercise tolerance remain impaired.
Fibromyalgia with Chronic Fatigue Widespread pain plus crushing fatigue. Often overlaps with viral reactivation, gut dysfunction, and immune dysregulation.
Who This Is For
You're exhausted no matter how much you sleep
You crash after physical or mental exertion (post-exertional malaise)
You've been told your labs are "normal" but you feel anything but
You developed persistent fatigue after COVID, mono, or another infection
Brain fog is so bad you can barely focus or remember things
You've tried rest, caffeine, willpower — nothing works
You want someone who will actually investigate the root cause
What to Expect
First visit: 45-60 minutes. Full fatigue history, onset, triggers, what makes it better or worse, previous testing and treatments. We order comprehensive labs tailored to your presentation.
Lab review: We go through findings together. I explain what each marker means, what the pattern tells us, and what we're going to do about it.
Treatment: Phased, individualized approach. Address viral reactivation if present, optimize metabolic and mitochondrial function, reduce inflammation, support recovery. Regular follow-ups to adjust based on your response.
Pricing
| Service | Cost | |---------|------| | Adult Membership | $245/month | | Senior Membership (65+) | $225/month | | Specialized testing (EBV panels, viral titers, advanced inflammatory markers) | Ordered as needed, priced transparently | | Medications (ivermectin, LDN, etc.) | Priced at or near cost |
Your membership covers ongoing visits and direct access for questions and adjustments. Chronic fatigue recovery is not linear — it takes consistent support and monitoring.
If Any of This Sounds Familiar
You're not crazy. You're not lazy. Your fatigue is real, and it has real causes. Let's find them.
📞 Call: 254-780-0023 📍 Visit: 1401 N Stagecoach Rd, Salado, TX 76571 🌐 Book Online: rootedhealthclinic.com/book-online
Rooted Health Clinic serves patients in Salado, Temple, Belton, Killeen, Georgetown, Round Rock, and throughout Central Texas.
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