Shaun Barcavage, FNP-BC

28/ What evidence would convince you microclots aren’t the main issue for a given patient? 29/ If large trials fail to show benefit, would you stop offering this approach? 30/ Question that matters: If microclots weren’t present, how would your evaluation and treatment change?

25/ Are costs, number of sessions, and expectations disclosed clearly in advance? 26/ Do you formally track and report non-responders or people who worsen? 27/ Science posture: Is this part of a registered study or registry?

Questions anyone should ask before paying for microclot testing or apheresis 1/ Microclots existed before COVID. So before we accept testing + apheresis as answers, here are fair, basic questions every researcher/clinic should be able to answer.

Matrix metalloproteinase-9 (MMP-9) is significantly elevated in the serum of long COVID patients: pmc.ncbi.nlm.nih.gov/articles/PMC11… - Microglia release MMP-9 when stimulated by SARS-CoV-2 Spike protein - "MMP-9 can disrupt the polysaccharide scaffolding of the brain matrix & digest tight junction proteins, thus disrupting neuronal connectivity. MMP-9 can cause vascular inflammation and increase blood brain barrier (BBB) permeability" (The COVID-19 vacciantion status of the study participants was not taken into account) (An increase in MMP-9 has been documented in patients with systemic inflammation following COVID-19 vaccination: journals.lww.com/jcma/fulltext/…)

Normocomplementemic urticarial vasculitis (UV) following influenza vaccination: dovepress.com/normocomplemen… "The exact mechanism underlying the development of UV following vaccination remains unclear." "Accumulation of further cases and research is required to investigate the clinical course and underlying mechanisms of vaccine-induced UV."

Secondary T-cell deficiency (particularly affecting CD4 T cells) & chronic spontaneous urticaria after COVID-19 vaccination: jaci-global.org/article/S2772-… - "The precise mechanism underlying this occurrence remains unknown, although there have been numerous reports highlighting the association between COVID-19 vaccination and autoimmune disorders." - During his treatment period, he received another COVID-19 vaccine, got COVID-19, and the doctors administered additional vaccines (pneumococcal conjugate vaccine 13-valent, herpes zoster vaccine, pneumococcal polysaccharide vaccine 23-valent, and diphtheria, tetanus, and pertussis vaccine) "to prevent further complications."

Otitis media with ANCA-associated vasculitis following COVID-19 mRNA vaccination -> pubmed.ncbi.nlm.nih.gov/39344100/ "The pathogenesis of adverse events following COVID-19 vaccination are still unclear. This report has indicated that ANCA-associated vasculitis can be related to COVID-19 mRNA vaccines. As our knowledge of autoimmune disease developing after COVID-19 vaccination is still in the accumulation phase, it is relevant to amass such case reports and use them for assistance in diagnosis in the future."

Type 1 diabetes mellitus caused by COVID-19 mRNA vaccination: A case report and literature review of 17 published cases -> pmc.ncbi.nlm.nih.gov/articles/PMC11… "New-onset type 1 DM has been reported after COVID-19 mRNA vaccination. Clinicians should maintain a high index of suspicion and pursue early testing for the same to reduce adverse outcomes and improve long-term prognosis."

Guillain Barré Syndrome (GBS) 4 weeks after receiving the COVID-19 vaccine -> pmc.ncbi.nlm.nih.gov/articles/PMC11… Case of a 66-year-old woman. She died. "Despite the treatment, a deterioration of respiratory function led the patient to premature mortality."

New onset of neuro-Sjögren's syndrome 9 months after the 3rd COVID-19 vaccine dose -> pmc.ncbi.nlm.nih.gov/articles/PMC11… Case of a 34-year-old woman. "This case highlights the need for increased vigilance and research into vaccine-induced autoimmunity."

Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis following the 4th dose of the COVID-19 vaccine -> journals.lww.com/neur/fulltext/… "... the question should be kept in mind whether subsequent booster doses of COVID-19 vaccines are associated with an increased risk of neuroinflammatory complications."

Normocomplementemic urticarial vasculitis (UV) following influenza vaccination: dovepress.com/normocomplemen… "The exact mechanism underlying the development of UV following vaccination remains unclear." "Accumulation of further cases and research is required to investigate the clinical course and underlying mechanisms of vaccine-induced UV."