203 - Carissa Conrad - Your New Best Friend: The Vagus Nerve

We explore how the vagus nerve shapes recovery from Long Covid and chronic fatigue, and why building parasympathetic tone changes sleep, digestion, pain, and mood. Carissa Conrad shares clear guidance on non-invasive vagus nerve stimulation, safe pacing, and common mistakes to avoid.

• what the vagus nerve does across heart, gut, immune and inflammation
• why sympathetic overdrive feels normal and how to spot it
• paced breathing, humming and gentle tools to build vagal tone
• what vagus nerve stimulation means and how it works
• TENS versus ultrasound, ear and neck targets, parameter basics
• passive stimulation to support busy days and low energy
• go slow: dosage, safety, and early warning signs
• using polyvagal maps to time stimulation and pacing
• avoiding boom‑and‑bust while expanding activity
• cost‑effective access, kits, and practical set‑up
• the mindset shift: nervous system literacy for life

Links:

Carissa's website: carissaconraddpt.com 

YouTube: @theVagusnervePT

For more information about Long Covid Breathing courses & workshops, please check out LongCovidBreathing.com

(music credit - Brock Hewitt, Rule of Life)

Chapters

• 0:00 Meet Carissa And The Big Idea
• 4:15 What The Vagus Nerve Actually Does
• 10:10 Living In Fight Or Flight
• 18:40 Tools To Build Parasympathetic Tone
• 27:17 What Vagus Nerve Stimulation Means
• 34:27 Devices, Methods, And Parameters
• 43:34 Passive Stimulation Versus Breathing And Humming
• 51:44 Go Slow: Safety, Dosage, And Pacing

Transcript

Jackie Baxter: 1:51

Hello and welcome to this episode of the Long COVID podcast. I am delighted to be joined today by Carissa Conrad, and we are going to be talking today about the vagus nerve, your new best friend. And we're going to get a bit into what it is, what it does, and what vagus nerve stem actually means. So, Carissa, thank you so much for being here today. I'm really excited to dive into all of this. And uh welcome to the podcast.

Carissa Conrad: 2:21

Thank you. Thank you so much for having me.

Jackie Baxter: 2:23

So before we get deeply into the vagus nerve, because this is going to be an awesome subject, um, can you just say a little bit about yourself and what you do?

Carissa Conrad: 2:36

So I am a doctor of physical therapy and a therapeutic pain specialist, which means that I spent quite a bit of time studying pain neuroscience and how the brain works. Um and uh and now I am an international coach for recovery from long COVID, chronic fatigue syndrome, among other conditions. Um, I also work with people with um gut issues, IBS, IBD, Crohn's, um, and um whole host of different things utilizing vagus nerve stimulation um as the primary tool for recovery and healing.

Jackie Baxter: 3:10

Amazing. And you yourself have had a journey with long COVID yourself, haven't you, that you've now come out the other side of.

Carissa Conrad: 3:18

Yeah, that's right. Yeah. So I developed long COVID after my initial COVID infection at the end of May of 2022 and just got much, much worse over the course of the next year, essentially, until I discovered vagus nerve stimulation and started uh starting fighting my my way out.

Jackie Baxter: 3:37

So this was something that was really central to your own recovery as well, um, which I suppose is one of the reasons why you have chosen to do what you do.

Carissa Conrad: 3:47

Yes, absolutely. Yeah. Um, it became a really um, it was absolutely vital for me with my recovery. My children were quite small when I became ill. And um, I was really struggling to uh to just find the right path out. Um and I think, you know, I had been watching lots of recovery stories and uh looking at all the different programs and something somebody had said at some point along there about vagus nerve stimulation just stuck in my brain. And I think when you're dealing with these conditions, if something sticks in your brain, you want to pay attention because it's usually um, you know, it's your like your subconscious or, you know, whatever you want to call it, saying, like, hey, remember this little thing. And so um, so I started doing more research on that um and uh figured out how to how to do it with a TENS unit. Um and you know, TENS units being very familiar to me as a physical therapist, um, I kind of did my research, figured out how to use it, and um, that was really the turning point for me in my in my recovery.

Jackie Baxter: 4:46

Yeah, and I think that's a really good point you just made as well, because you know, you can watch, I mean, there's hundreds, thousands of recovery stories out there, um, which is wonderful. And, you know, there's an awful lot of themes that weave through them, but they're all different. Every person's experience is different, and everyone's journey through is going to be different. You know, your recovery is going to be very different to mine and very different to person X over there. Um, and you know, I think, you know, it really is kind of finding your path through, finding your puzzle pieces. And if you hear a recovery story that really resonates with you, or even a little nugget of something that someone says that really resonates with you, as you say, it's that kind of seed that's been planted, isn't it? It's like, huh, okay, that that might be my thing, kind of thing. And you know, it is, it's kind of grab onto it and and and find find out what it can do for you, kind of thing. I I love that. Um so let's start off with what is the vagus nerve? Um, you know, we hear about it so often, don't we? The vagus nerve, this vagus nerve stim, vagus nerve. What is the vagus nerve and why is it so important?

Carissa Conrad: 6:03

I find it exciting that it is out there. You know, people are talking about it. Um, and more research is coming out all the time about what the vagus nerve is and what vagus nerve stimulation can do for you. Um the vagus nerve, um, vagus is Latin for wandering. It's the longest nerve in the body. We have two of them. They come from the brain stem down the lateral sides of the neck and then into the torso. Um, and the vagus nerve contains 75% of your parasympathetic nervous system's nerve fibers. So this is huge. The parasympathetic, we have our autonomic nervous system split into two uh uh two branches. The sympathetic is our fight or flight, parasympathetic is rest and digest. Um, fight or flight is, you know, we're being attacked by a lion, we're super stressed out, rest and digest parasympathetic, that's our healing state, that's our connection to other people's state, that's our groundedness, that is uh when all systems in the body are uh functioning optimally is when we're in a parasympathetic nervous system state. So the fact that the vagus nerve contains 75% of the parasympathetic nervous system's nerve fibers makes it extremely important and relevant. Um and the so the vagus nerve uh regulates essentially every automatic function in the body. So the things that you don't have control over. So your heart rate, your blood pressure, your digestion, your immune function, uh, your pancreatic functioning, hormone levels, um, the the vagus nerve has an interaction between with the HPA axis, the hypothalamus pituitary adrenal axis. Um, and through that interaction, it modulates um the release of inflammatory cytokines. So uh if you actually cut the vagus nerve, which they've done in like rat models, um, the inflammatory process completely stops. There is no release of inflammation. Um, so it's a pretty uh it's a very important uh nerve. Um and it, you know, stimulating the vagus nerve, keeping your vagus nerve active um is what keeps your your body functioning most optimally and and healthily.

Jackie Baxter: 8:06

Which is hugely important, isn't it? I mean, like the the vagus nerve has its fingers in all the pies. And you can tell that it's important because I mean you can sort of visualize my excitement, my absolute excitement when Andrew Huberman released a two-hour episode on the Vegas Nerve on the Huberman Lab podcast. I think it was earlier this year. I was just unimaginably excited. And you know, you know, it is starting to become more mainstream, isn't it? You know, you are hearing about it a bit more. There is more research starting to come out, it's starting to become a little bit more understood. But as you said, it is absolutely central to everything in our body, really, isn't it? Um, you know, there's this kind of no part of our body that isn't influenced by it in some way. Absolutely awesome. That's right.

Carissa Conrad: 8:56

Yep.

Jackie Baxter: 8:58

So you said that the vagus nerve obviously is hugely, hugely important to, yeah, all of all of our body systems, basically, and is very connected to our parasympathetic nervous system, which is absolutely crucial to our healing and our rest and our repair. And you know, certainly for me, I think before I'd become unwell, I don't think I knew what rest and relax and recover actually meant. I think actually I'd been living in this permanently sympathetic state. Um, so actually for me, when I started to find my way into that parasympathetic state, it actually felt really uncomfortable because I'd never been there before, really. And I think, you know, this is certainly something that I hear a lot of people say that they haven't really spent a lot of time there. It feels unfamiliar, it feels difficult to get to. And I don't know if this is something that you also have noticed with people, but what happens to the vagus nerve, I suppose, if we don't use it?

Carissa Conrad: 10:04

That's a great question. Yeah. So um, you know, from from what I've uh come to understand, you know, some of us are born with less activity in our vagus nerves. Like we are those of us who are more sensitive, um, like I definitely consider myself to be that way. I was a very sensitive kid. Um, there is just less what they call tone uh in the vagus nerve and less activity in the vagus nerve. Also, um, childhood experiences, childhood traumas can decrease activity in the vagus nerve. Um, and so, you know, we come into adulthood sometimes with just not a lot happening in our vagus nerves. And we are functioning, just like you said, in this sympathetic overdrive state. Um, and I think so many of us do. I mean, certainly, you know, being a healthcare provider for many years, you know, I've it's like all my patients come in and they're just always stressed out. You know, it's like they just you wake up in the morning and you're just you're already stressed because you're thinking about your day and getting your kids to school and going to work and the meeting you have and all the things you've got to do. And you just stay up there in a sympathetic overdrive state. And then you try to come home and go to sleep at night and you wonder why you can't sleep. And, you know, we just the the activity in the vagus nerve um is is just not not happening. It's not there. So um toning the vagus nerve by doing um by doing vagus nerve stimulation or you know, any kind of breathing exercises, cold exposure, humming, um, you know, all those things are are ways to to bring activity into the vagus nerve is really the way to um to counteract that. And so I used to tell my patients, even before I was sick or before I learned about you know all this stuff with the vagus nerve, like at least do some breathing exercises before before you try to do your physical therapy exercises because you're not gonna get very far. If you know you're all stressed out and you're like, no, I just got to do these exercises. So um, yeah, bringing that down into that parasympathetic state, like just stopping that kind of spike up into sympathetic and staying there all the time, um, it can really improve your health uh dramatically.

Jackie Baxter: 12:02

And it's it's fascinating, isn't it? Because I had no understanding whatsoever of all of this before I became unwell. I just thought I was normal and fine. And I think you know, so many people have that experience. They come in thinking everything's fine and very, very quickly everything becomes extremely not fine. But, you know, I I think, you know, in understanding it is so important, isn't it? Um, but I think what I'm starting to realize now, and when I'm two and a years on from recovery, and you know, I notice my own nervous system when it's very relaxed, when it's a little bit less relaxed, when it's really stressed out. And I'm able to respond to that. And I think learning my own nervous system much better in my own body has given me a much greater insight into other people's nervous systems as well. So whether that is clients that I'm working with, whether it's my partner, or whether it's people that I just see on the streets or in the shops or, you know, out and about. And like everyone, like everyone seems to have a lot of dysregulation in their nervous system, you know, some more than others, but it's kind of like it's it's one of those things that you can't unlearn, I think for me. And, you know, it sort of makes me realize that actually this work isn't just sort of work for recovery from long COVID from MECFS, you know, it is work that actually needs to be much more in the sort of public eye. You know, we need to be teaching this to kids in schools. This needs to be mainstream healthcare that's talked about in GP surgeries for people who are in for stress um or for indeed anything else. And I think again, it's it's that thing, you know, well, you you can't unlearn it. And I don't know if you see that again. You were you were mentioning that, you know, people come in stressed and you know, doing breathing exercises. Um, but I mean again, you know, it's very easy to see for me now. But if someone had said that to me six years ago before I'd got sick, would I listen to them? Probably not, because I would have thought, oh, I'm fine, I know better, I'm fine.

Carissa Conrad: 14:11

Right. Yeah, you made several excellent points. I mean, one just you know, the the awareness of your nervous system state. Yeah. Um, you know, I think many of us who develop long COVID or chronic fatigue syndrome, we were the type that, you know, that you described where we were always in that sympathetic overdrive all the time and so and weren't aware of it. We were just functioning there and, you know, and you're just you're in survival mode. You're just trying to get from one day to the next. And um, and so teaching people how to be aware of the state of their nervous system is a huge part of what we do as coaches for recovery, right? That becomes such a huge part of it's helping people understand um what it feels like to be in parasympathetic versus sympathetic versus freeze, um, and how to intervene and when to intervene to bring the nervous system back into that parasympathetic state. That's such a key part of recovery. And that really does become then like this lifelong uh process and this lifelong learning experience. Um, and I think those of us who have recovered um can see that, that, you know, it doesn't stop, that I'm still um regulating my nervous system and still learning, you know, well, how do I change my perspective on um, you know, my parenting or my relationship or, you know, whatever it is, so that um I'm not reacting from a fight or flight state. So that I'm I'm coming from a resourceful place, which is that parasympathetic nervous system state. Um and uh and it's it's it's all it's a constant learning of how to help other people understand those things too. Like how do I how do I relay this to another person in a way that they can understand um it uh how to identify their own nervous system state, how to how to catch it before it gets too far gone, you know, where then they're up in that that uh that crash place again. Um it's it's so challenging. But yeah, it is um, you know, watching the world. And I think, you know, I'm people talk about that over and over, especially now, you know, with all the the political climate. You know, I'm in the United States. It's definitely a challenging time politically for uh, and many people, you know, I love when people would tell me, um, I still do some in-person uh physical therapy services, and you know, my patients will tell me, well, I do my exercises while I'm watching the news at night. And I'm like, uh-uh, uh-uh. Let's turn the news off. Like and just like your nervous system needs to come down. We don't need to be watching the news all the time. Um, so yeah, it's helping people understand the importance of that and the value that you know that that brings to it's like that ever expanding circle, right? If you are regulated, the value that brings to your partner, to your children, to your extended family, to your society, um, you play a role in all of that. So um learning how to regulate your nervous system is, you know, it's kind of the key to to life in a lot of ways, I think.

Jackie Baxter: 17:04

Yeah, I completely agree. I think, you know, and I say this a lot about things that we learn in recovery, whether it's a breathing practice or meditation practice or a diet that you adapt, or, you know, you start doing yoga because you realize the importance of that, or you know, learning your nervous system, you know, there's so many things that we learn, boundaries, learning to say no, that was a big one for me, right? Oh yeah, you know, and we learn these things during recovery out of necessity, but they are tools that make us more resilient and more resourced for the rest of our lives, and they make us, as you say, a better member of society. But I think they also make us healthier and happier in our much smaller worlds. You know, I definitely find that I have conversations with my partner that I would never have had before, and I think that makes us much stronger together, for example. Um, but you know, I would never have been able to do that before because we would have just shouted at each other. Right. So I think it's absolutely amazing. Um going back to vagus nerve stimulation. Now you've mentioned pens machines, and we've talked about breathing exercises a little bit, and I'm not gonna get on my breathing bandwagon, don't worry, guys. But you know, breathing is an extremely effective way of um stimulating your vagus nerve. Um, but when you talk about vagus nerve stem, what do you mean by that? I suppose let's start there.

Carissa Conrad: 18:28

So um originally vagus nerve stimulation. Um certainly, if you ask uh the surgeons, um, you know, they would say the only true way to stimulate the vagus nerve is to surgically implant a device on directly onto the vagus nerve. Um so this is um something that has been done for I'm gonna say the last 30 years or so, uh maybe 25 years, um, and uh it is only FDA approved for treatment of epilepsy, severe depression, um, stroke rehabilitation, and most recently for um rheumatoid arthritis. Um and the the elect the device is similar to like a pacemaker, they put it right on the vagus nerve and it delivers electrical impulses into the nerve. Um, you can also stimulate the vagus nerve transcutaneously, so meaning through the skin. Um, that's what a TENS device does. TENS stands for transcutaneous electrical nerve stimulation. Um, and so there are a couple of locations where you can do that. One is at the auricular branch of the vagus nerve, which is in the ear, the other is at the cervical branch of the vagus nerve, which is running through the neck. Um, and so there are vagus nerve stimulation devices on the market that uh that stimulate in both of those locations. Most of them uh stimulate at the ear. There are some that stimulate at the neck. Um and actually, I really don't know if most are at the ear. Couldn't say, but they there are a number of them. Um these are essentially TENS units that are packaged a little differently that have electrodes built in that you know go right to those uh those locations and stimulate the nerve. You can also stimulate the nerve using ultrasound. Um, and ultrasound actually penetrates through the skin deeper than the electrical stimulation. So for some people that um actually works better and is more effective. And so, and there's a new uh um uh relatively new device um that I have made available for purchase um within my practice and on my website um that uses ultrasound, which is pretty cool. Um, so those are kind of the the two ways uh that that it can be done. Um I used a tens unit through my entire recovery. I still use a tens unit for a vagus nerve stimulation. Um it just kind of, I think now I just have it and it's I'm used to it and it's easy. Um, but and the tens unit is the most cost-effective way to do it. It's it's uh tens units are not very expensive. Um, and so it's just a matter of knowing, you know, how to set the parameters properly and how to use it. It's just like any other tool that you might use for recovery, how you use the tool is really what matters most, um, rather than just saying, okay, if I just breathe, I'll get better, right? It's it's having it's knowing how to use the tool of breathing to regulate your nervous system and progress your activity safely that makes the difference. So, same is true of vagus nerve stimulation.

Jackie Baxter: 21:11

Yeah, and then you know the same is true of any medication as well, isn't it? It's like the you've got to get the right dosage of it at the right time in order for it to work. Um, so it's the same as you say with the breathing exercise, you know, you've got to use the right breathing exercise and the right amount of it at the right time. And as you've just described, it's exactly the same with a vagus nerve stimulation device or a TENS machine or whatever you're you're using. Um so it's that kind of nuance, isn't it? It's not just as simple as just press that button. Um now, what what is the difference between using a uh a TENS machine or a a device of some description? And something like a breathing exercise, for example, humming is an amazing vagus nerve stimulator. So what what is the difference between one and the other, other than obviously humming you can do without any assistance?

Carissa Conrad: 22:03

Yeah. Well, so with the vagus nerve stimulation, um using like a TENS unit, you're putting uh electrical impulse into the nerve, right? So you're you're essentially firing the nerve using uh an external external device. Um something like um uh like humming or breathing, you're activating the nerve, but it's an internal, uh it's an internal process. So um what I've found with people is you know that the the vagus nerve stimulation, um it uh first of all, it allows you to do it passively, which is huge when um when you are working, when you have children, you know, all those things. That was really my struggle when I was recovering is I was trying some of these things like the breathing, and breathing was my other favorite because I could do that and still be chasing my two-year-old around, you know. Um, but I just, you know, uh the programs that were focusing on meditation or, you know, things where I had to take time out of my day to do it, I just could not accomplish enough of it in order to actually see changes in my nervous system. So um, so the Vegas nerve stimulation, I could clip the ear clip on and put the tens unit in my pocket and do what I had to do to get through my day with my kids. Um, and so that was really huge. And so it was this passive way, it was something that was helping me um while I was still doing what I had to do. Um and so what I what I find um with clients and and with myself is that uh, you know, more is accomplished with the the vagus nerve stimulation in a in a shorter period of time, I would say. Um and you can uh, you know, you still use your breathing, you still use your other techniques, but it was um you have to string together so many of those other approaches. Like, I mean, I I I felt like I would have had to hum all day long, you know, to to make a change, which is basically what I did with breathing in the beginning. I literally would just have a track playing. Um, like I loved the paced breathing. So paced breathing at five and a half seconds uh, you know, intervals is what's been shown with research to stimulate the vagus nerve. Um, and so I would turn that on and just have it playing and I would breathe as much as I could, and that did help. Um, but I needed something that was um that was passive uh so that I could still be functioning with my kids. Um and uh and so the vagus nerve stimulation is what did that for me. So um, but yeah, I think the challenge is just doing enough of the other things like cold exposure, like you know, um like humming, uh doing enough of it to actually see a change in the nervous system um is difficult for people to accomplish often.

Jackie Baxter: 25:18

Yeah, and and of course something like cold exposure isn't appropriate for everybody either at certain stages in their recovery.

Carissa Conrad: 25:24

Right.

Jackie Baxter: 25:24

You know, depending on well, whether you have access to cold water even. Um, but you know, I mean, what I hear from people time after time, I mean, cold water was a huge part of my recovery. Um, but it was something that I was able to do later on. Whereas if I'd tried it earlier, I would have been like all the other people that I heard from, you know, it made me worse. Um, you know, I crashed every time I tried it. So I think, you know, it can be really great. But um, you know, there's all sorts of strategies. Cold water is just one example, isn't it? Of things that uh can be really absolute dynamite, but they've got to be used at the right time and again in the right dosage, I guess, like we were saying a moment ago. Um so yeah, so that was really interesting what you were saying about um yeah, so so would you say that the vagus nerve is not a substitute, but it can be a really good thing to use alongside other strategies? Would that be your kind of take on it?

Carissa Conrad: 26:20

Yeah, I mean, I think I relied most heavily on the vagus nerve stimulation through my recovery. But I think the important thing is, like we spoke about earlier, knowing how to use it. And, you know, you can't get out of the learning part, you know, the the understanding the nervous system part, you know, understanding um what parasympathetic versus sympathetic is, uh, and and knowing when to intervene to bring yourself into that parasympathetic state. And so I I was able to develop a protocol using the vagus nerve stimulation um for recovery. And uh, and I think that's been I've gotten excellent feedback on that from the clients that I've worked with. They feel like it's you know, it helps guide their, you know, their using the vagus nerve stimulation as the recovery tool. Um because the the learning is still very crucial. Um and so you can, and absolutely you can use other, you know, other techniques. I still, like I said, I still did breathing, I still did meditation when I had the opportunity. Um I just didn't always have the opportunity. And your point of um about you know, something like cold exposure. Um I I'm I'm one that cold exposure doesn't feel good, you know, and and that's kind of an interesting thing that, you know, there if there was a one size fits all, you know, answer to everything, oh, wouldn't that be great? But um, and different stages of recovery, different things being helpful at different stages of recovery. When I was very, very ill at the beginning, um I remember just trying to do vagus nerve massage, just putting my fingers in my ears and drawing little circles. And it was like my whole nervous system wigged out. Like I just could not, like it was like, ugh, yuck, that does not feel good. Um, and so I think for me, the vagus, the discovery of the vagus nerve stimulation came at the right time in my recovery. I was getting a little bit of help from low-dose naltrexone and from a very low-dose SSRI. So I had a little boost to my nervous system already that had helped even me out just a little bit. What I always say is the medications got me off the couch, the vagus nerve stimulation got me out of the house. Um, so I had enough little boost from the medications that my nervous system was able to tolerate the vagus nerve stimulation. Um, for others, you know, uh exactly, you know, what you said about cold exposure, other people feel with the vagus nerve stimulation where they put it on initially and um and it doesn't feel good. And it's because the nervous system is not used to being in a parasympathetic state. So you're putting something on to uh activate your vagus nerve and move you into parasympathetic, and the brain is going, that's not safe. I need to be super aware of what's going on around me. I need to be careful, I need to watch for things that are going to kill me. That's essentially what your brain is doing when you're when you're in that sympathetic overdrive. So it doesn't feel safe to your brain to move into parasympathetic. So um, so going slowly um when you start something like vagus nerve stimulation and having guidance on how to do that is really important. Um and and that's you know true for, as you said, so many other approaches that we use for for recovery.

Jackie Baxter: 29:14

Yeah, exactly. And you know, that's such a good point. You know, even if we are trying to get into that place of safety, if we try to push ourselves anywhere too quickly, then the body is going to feel unsafe because it's unfamiliar. Um so it's it's that kind of unfamiliar pain is actually sometimes where we will kind of stay because it's it's familiar, right? You know, we'll stay in that familiar discomfort over I don't know, don't know what's over there. Um it's kind of the opposite of the grass is greener, isn't it? You know, you look over there and you're like, oh, I want to be there. It's kind of it's kind of the opposite of that. Um that's really interesting about that analogy.

Carissa Conrad: 29:53

Anyway. Yes, that is that is that's interesting. Yeah, you know, so much on my recovery, and I um this is I tell my clients this all the time, it was learning how the brain works, you know, why the brain does what it does, why the brain has developed to be more hyper-vigilant, you know, why we are constantly looking for the threat. Um, and that really helped me um set aside the thoughts. Because that's the hard part, right? When you're in when you're stuck in fight or flight all the time, your brain is cycling through thoughts, like, am I ever gonna get better? You know, am I um am I ever gonna be able to be with my kids again? Am I ever gonna get to go to their school plays? Am I, you know, all the thoughts that go through your head. Um, and that is uh that is so often the hardest part for people to break out of when they're recovering. Um, and so understanding that when you're in a fight or flight state, your brain is is basically putting you through a maze. It's it's trying to find a way out of a maze, but there's no way out. There's no way out of that maze. So uh what you have to do is recognize that those thoughts are there because your nervous system is in fight or flight and detached from them that way. Um but it's it's very challenging because the thoughts feel very real and very important and like survival. And that's exactly what they are to your brain. So understanding how the brain works is really ultimately, I think, how how you get out of these things.

Jackie Baxter: 31:13

I'm one of these people that has to know everything. You know, I'm I'm the why child, the why, why, why, why, why, you know, I'm a nightmare. But you know, for for me, I think I started to really start to see improvement when I really understood a bit about more what was going on, starting to recognize more and more body, but I had to understand a bit at least of the why. Because if you're going to make an effort to do breathing exercises, to do whatever, or to put money into buying a device and learning how to use it, or whatever strategies you're using. If you're going to do that, you you've got to kind of know that it's going to work or that there's some value in actually trying that. And I think we know that by understanding the why, don't we? You know, and it doesn't mean that we need to have read every single book on the vagus nerve, because like there's a lot of them, but you know, I think it's having that kind of a bit of an understanding is so important, isn't it? Which is why this conversation here is so important, um, which is which is awesome. So um I think, like you said, you know, getting the dosage right is so important. And what are the kind of most common mistakes that people make with this? You know, oh great, I heard that person on the long COVID podcast, she said, get a TENS machine and try it out. Okay, I'll do that. Plug it in, stick it on. Like what are the things that people are going to do wrong there? Um, I mean, probably exactly what I described there is the wrong way to go about it, isn't it?

Carissa Conrad: 32:44

Yeah, first of all, um, you must know the correct parameters. So how to set the TENS unit. Um, I have definitely worked with people before who did exactly what you talked about, you know, where they got it and they clipped some things together and they just turned it on without adjusting any of the parameters. Um the parameters that come set on the TENS unit when you buy it are not the right ones. I won't say that much. That's not you do have to read the instructions. You do have to, yes. You do want to um uh yes, have some sense of uh what well, no, you want to know the correct parameters for sure. There's some variation in the parameters, um, but generally speaking, um they're they're mostly the same. So you do want to know the parameters. Um and uh and starting slowly um is is another thing that's uh important. Um and so again, that comes uh along with that comes understanding your nervous system state. So knowing when it's starting to give you signs that it's not loving what you're doing, um what those signs can be. Um so for some people, they might get a little headache when they start out, some people might get a little nauseated when they start out, some people get fatigued. Um, and those are just signs that your nervous system is trying to figure out which end is up and what, you know, and that they go away with time, but you'll be a heck of a lot more comfortable if you go more slowly rather than jumping in and just saying, oh, my bottom get used to this. I'll just keep pushing through. We don't want to do that. Um The other thing that can happen sometimes is people will start using the stimulation, they'll start feeling better, and then they'll go out all day and go out with friends and have this fantastic time because they're feeling better. And then they come back and they do the stimulation again and they're like, well, now it's not working. And you know, now I'm not feeling better like I was before. And what's happened is that your nervous system has been pushed too far. Um, and the stimulation can only bring you down so much. So I love to use the polyvagal chart as a tool when I'm coaching people. Um, it's an excellent tool for understanding where your nervous system is at. So if you know, if you've pushed your nervous system all the way up into a free state, and then you try to use the vagus nerve stimulation, it can only bring you down so far on that chart. Um, and so you might feel anxiety when you have the stimulation on. You might feel um nausea again, you might, you know, any of those other uh symptoms. So um, so it's really important also to be again pairing that with good pacing strategies. Um and I know how hard it is when you start feeling better, you know, you just want to like run out and do life again. Um, but uh but yeah, knowing um that there's still a process, you know, that you're not gonna go from zero to a hundred. Um it took me eight months from being on the couch to being able to work five hours a week, you know. So it takes time, um, like anything. Your nervous system has to recalibrate itself, regulate itself. Your brain has to start perceiving um all the activities and stimulus that it has been, it's basically your brain has been perceiving all these things as a threat to your survival. You have to retrain your brain that these things are safe. Um, and that that takes time. Um, so those are those are usually the most common, um, common mistakes or you know, that people make. Um and so, you know, it's uh uh don't give up too soon, but but go slowly and uh give your nervous system time to to adjust.

Jackie Baxter: 35:58

And as you say, don't give up on all the other stuff either. Right. Um, because you know, your scenario where you know you did your vagus nerve stem, you know, you've been doing it for a wee while and you're starting to feel better. I think great, I've got some energy back. And you know, if anyone's an all or nothing person like me, um, you know, you go out and be like, brilliant, I'm gonna do all the things. Yep. I've finally got some energy, I'm gonna use it. Yeah. And, you know, as you say, you jack your nervous system up and then you come home and, you know, boom, um, end up crashing out. And, you know, again, it's not letting go of some of those pacing strategies, not letting go of some of the breathing exercises that maybe you could be doing while you were out that might have helped with that activation. Um, and also, as you say, not going too fast too soon either, you know, because you know, when I talk about reverse pacing, you know, as you do start to feel better, you know, it's like don't abandon everything straight away. You know, you you are still pacing, but you're kind of reverse pacing. So instead of reducing, you're actually very gently starting to increase, but only as you feel comfortable rather than kaboom. Um but like, you know, there's no blame there, right? It's so tempting to do if you do have a good day. Like, you know, things are stacking up that you want to get out, do, isn't it? Um and I think it's knowing that if that does happen, that's okay. You got your tools. That's right. Give yourself a break.

Carissa Conrad: 37:23

Yes, yes, absolutely. Give yourself a break. And um, you know, and know that this becomes, like we were speaking about earlier, this becomes a lifelong thing. You know, like I'm I'm always going to take care of my nervous system. Yeah, I'm always going to have to be aware. Um, and it's not, it's not really, it's not about the long COVID anymore. It's just that um, you know, like I want to function from a resourceful parasympathetic nervous system place. So um, so these are strategies that I still use, you know, to to recognize when my nervous system is starting to amp up and go, oh, okay, I need to take a little break. I need to, you know, I need to go meditate, I need to put on my vagus nerve stimulation, whatever it is I need to do to regulate myself. Um, this is how we're kind of meant to be living anyway. We just didn't know how to do it before. And so now we're learning.

Jackie Baxter: 38:09

Yeah, and you know, it's it is something that does make you much more aware of things, I think. And uh, and as you say, it's it's a it's a taking care of yourself kind of thing in the same way that you know you might go to a spa weekend for a pamper day or something like that, or you might just lie down with your your vagus nerve stem for 20 minutes or something. Um, or you might go and start your day with a breath practice, which is what I do every day. Um, so it's those things that you build into your day that maintain health. And, you know, it's it's much easier, obviously, once you're better, because you don't feel like you're sort of fighting against the illness as well, which can feel so difficult. Um, like, you know, you you there's there's an extra kind of there's an extra person in your body that you're trying to fight out. It almost feels like some of the time, doesn't it? Um so it it does all feel a very different thing when you're in the illness to when you're maintaining health, having regained it. Um but yeah, it absolutely is this this wonderful tool that that we are able to take forward. And I I love that, you know, it it just feels like all those things I learned, they were worth it and I can keep them kind of thing. I I like I like having that as a sort of um legacy from it, I suppose you could say.

Carissa Conrad: 39:55

Yeah, and I think that touches on the you know, the why and you know what you said earlier, like understanding the why, why we're doing this and why um, and you know, and that is so crucial. Um, and so I wanted to emphasize how important it is that point that you made about understanding the why. Um I struggled with that as well through my recovery. I I was trying things like symptom tracking and meditation and you know, and um I was like, well, this is what people are doing, you know, and pacing. And I'm like, why aren't I getting better? Like I'm doing it. Um, and I did not understand why I was doing it. Um and I didn't, and it was when I finally learned about um uh, well, it was it was piecing it all together. I finally started drawing those parallels, you know, between uh the recovery programs that were out there, um, the recovery stories I was hearing, like what is it people are doing? And when I when it finally clicked that it was about the nervous system and about um keeping your nervous system healthy and in that parasympathetic state as much as possible, then I actually started making progress with the tools that I was that I had available to me. Um, and then that that continues on to where I'm at now in my life, where you know, the why and the why has changed a little bit, right? Because it's not um like you were saying, it's not about it's not about survival anymore. It's not about just getting out of the illness. Um now it's about um, and this is a question, you know, people often ask me, well, do you still use the vagus nerve stimulation? It's kind of this like, well, do I have to use that for the rest of my life kind of thing? And I'm like, no, I mean, you don't have to use vagus nerve stimulation. I mean, I'm like, I get to use it. I'm so glad I have it, you know, like I it's part of my wellness routine. But it's also what I use for um, you know, when I like I was saying earlier, when I want to change my perspective on something, if I'm, you know, um, if I'm wanting to uh shift my perspective so I can have a different discussion, you know, with my partner or with my um uh, or if I want to uh approach some a challenge with my kids in a different way, I'll use the Vegas nerve stimulation to um to help me be in a more resourceful place so that I can uh I can change how I'm interacting with others. Um and but ultimately it's about it's about your nervous system and regulating your own nervous system. And that's really, you know, when we talk about recovery from uh childhood trauma and, you know, and all these things, like it's really about learning how to how to regulate yourself and manage your own nervous system. So that is that is the gift uh that we had to go through the awfulness of long COVID to uh to get to. Um yeah, learning how to regulate ourselves.

Jackie Baxter: 42:27

Yeah, absolutely. Um so you said that you used a TENS machine, which uh I mean, you know, prices are going to vary, I'm sure, but I think they're the more accessible end of sort of stimulation devices. Um, you mentioned things that go in the air, things I think people have them that sort of hang around their neck and and rest on the sort of upper chest. I've seen people have those sorts of things. I think they're generally much more expensive. Um so You know, for someone who's heard this episode and gone, okay, I'm interested, like what would your kind of next steps be? Um, I mean, presumably to get hold of a a device somehow. Um, but how how would you do that in the most cost-effective way without compromising what you're doing, obviously?

Carissa Conrad: 43:18

I wanted to make things as you know cost effective for people as possible because I know how I know that feeling. I've been through that. I mean, I spent hundreds, I'm sure thousands of dollars on you know, supplements and all these different things to try and didn't get better. So um uh so I've created a few different options for people within um on my website. You can purchase a whole kit from my website that has the uh the TENS unit that's already preset with the parameters that are optimal for vagus nerve stimulation. It comes with the ear clips and the electrodes and the gel and all the things that you need. Um, and what I also include in that is my video course that goes through my protocol for um uh for how to use the the vagus nerve stimulation um most effectively for recovering from long covert or chronic fatigue syndrome. Um you can also buy your own TENS unit and buy the course separately. So that way, especially um, so some of my international um uh clients have chosen that option because shipping is expensive. So if you can source your own TENS unit, sometimes that's um very um a very inexpensive way to do it. And then the course is digital, right? So I can just send you a link and then you can access the course. And in the course, it has also the parameters, so the right way to set your own TENS unit so that you've got it set the proper way. Um and then, of course, the videos on um on the protocol. Um the one thing I will say, if you buy your own TENS unit, you just want to make sure that it's the kind that you can manually set the mode, the pulse rate, and the pulse width. Um, some TENS units, particularly the um less expensive ones, uh, have preset programs. So they'll have things like push this button for your back or push this button for your shoulder, and it will have parameters that are already set, so different pulse rates and different pulse widths. Um, those uh usually you can't find the exact um program that would have the appropriate settings for vagus nerve stimulation. So I would encourage you to not get one of one of those type. Um I've really tried some of my um, you know, again, understanding that people want to uh make this as cost effective as possible. And people have bought those kind, and we've you know spent all this time on Zoom sessions trying to figure out how to make it work and it's very challenging. So spend the extra $20 or whatever and get the one that that allows you to um set the parameters uh yourself. Um and then like I said, I also have the ultrasound unit. Um the ultrasound unit, ultrasound is a little more expensive, but um, but that does work, uh it does work quite well. Um but yeah, so I've tried to make you know varied options available for people that um that can hopefully um meet uh meet the a budget that that works for you. Um, because I do understand that stress of, you know, uh a lot of times you're not working, right? You can't work because you're sick and then you're trying to figure out how to pay for this stuff. So um, so all that's on my website, carissaconrad dpt.com.

Jackie Baxter: 46:15

So perfect. And I'll make sure to drop the links in the show notes as well. So if anyone does want to follow up on that, then you know where to go. Um again, I don't know if it is the same everywhere, but like when I was a kid, I used to work in Boots. Um, for those of you who are not based in the UK, Boots is like a healthcare store. And um we used to be able to hire out tens machines to people who were pregnant. So it may even be worth, I've no idea if they still do it. This was some years ago. Um, I'm not gonna do the math on that because I'll feel old. Um, but it might even be worth investigating if there is some way of hiring something um, you know, close to where people are, because you know, I mean, obviously, as you say, it's got to have the right parameters and the right stuff in order for it to work. But uh, you know, if you can find a way of hiring or borrowing one to see if it works, then you know, it's like, is this worth me investing in? And if you try it out and think, my goodness, this is absolutely worth it, then you know that your money is gonna be well spent. Whereas if you try it and you think, no, this isn't for me, then you've not wasted a ton of money on something that maybe isn't right for you. Uh so I yeah, I don't know if that's possible in other places, but it might be worth exploring potentially.

Carissa Conrad: 47:36

Yeah, yeah, that's an excellent point. I I don't know how much of that uh they do in the US anymore. It's funny, you know, I've been so I've been a physical therapist for oh my gosh, now I have to do the math. Um 18 years, something like that. Um, and tens units used to be harder to come by. Uh, you know, uh tens units, we use them all the time in the physical therapy world. And when I first started practicing, you had to get like a referral and you had to get through your insurance and you know, all this stuff. And um, and now they're they're pretty widely available. So we used to do more of that where you would rent one, you know, or things like that. A 10,7,000 on Amazon is like $38, I think, in the US. So they're pretty uh pretty reasonably priced. That's what I include in my standard kit. Um, ear clips, you know, you got to buy those too. And gel, don't let anybody tell you you need fancy gel. I include the official gel in my in my kits, but you can literally use aloe vera gel. So um, you know, I always tell people don't worry about when you run out of gel, you know, you don't have to go buy some, you know, expensive gel. Just get a bottle of aloe vera. It works just as well. Any water-based gel works just fine. Um, so yeah, so all those things, you know, the components are not super, super expensive. It's um, you know, but but you do want to make sure that you have the right guidance in terms of how to set it and how to get started.

Jackie Baxter: 48:51

So yeah, I guess it's it's making sure that you do get the right device, but also then, you know, really, really importantly, making sure that you do it right, get that dosage right. Um because yeah, we we all know all too well what can happen when we uh dose ourselves incorrectly here.

Carissa Conrad: 49:10

So much of this is it's trial and error. We don't, you know, so many people don't necessarily have the guidance from an experienced practitioner, you know, who knows what to do with these things. And so it's I know um, you know, we are just trying our best. It's uh what do people call it? Yeah, like like self-diagnosing, Dr. Google, you know, all these things. It's kind of what we have had to resort to because uh yeah, people didn't know what to do. And and I know how scary that is. And that's why, you know, when I was recovering, um, I remember the feeling of being so scared of not knowing how to recover, not knowing how to get out of this. Nobody really had answers. The doctors were just basically telling you to wait it out, which is not the right solution. Waiting it out just made me worse. Um, and so, you know, it became really my um my life's purpose now is, you know, to help other people through this. Um and I'm sure you feel that way too, Jackie. You know, having been through it yourself, you know, it's like, you know how awful it is, you know how much it takes away from your life, um, and how scary it is to not know what to do next. So um I'm grateful to be where I am now and to be able to help other people find their way out. And um, it is the best feeling in the world when somebody emails you or messages you or calls you and says, Oh my gosh, Carissa, you know, like I went to the store and I'm doing so much better. And I'm just, you know, it's like, oh, you just feel like, oh my God, you know, like maybe that person wouldn't have gotten better if I hadn't decided I was gonna do this. And that's an amazing feeling to be part of somebody's somebody's healing and um somebody uh getting their life back.

Jackie Baxter: 50:47

Absolutely. Um, it definitely puts a smile on your face for sure. Um and I think you know, it it is wonderful that you know there is more information out there now. You know, this condition is still misunderstood and you know, there's still a lot of people that are really struggling, but you know, there is a lot more out there than there was five years ago, for example. And you know, that is down to the work of people like yourself, people like me putting out the podcast, and everyone else who is working so hard as well to really help people. So, you know, the things are getting easier, even if it doesn't always feel like it for sure. Um, so yeah, there's a little message of hope to end on. Um, Carissa, thank you so much. Um, this has been so fun chatting with you. I love a good geek out about the nervous system, and it's been really interesting hearing about the vagus nerve stimulation as well. So I'll make sure I drop all of your links into the show notes and thank you so much. It's been awesome.

Carissa Conrad: 51:48

Yes, thank you so much for having me on. This has been great.