Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 1 of 13
`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page1of 13
`
`EXHIBIT D
`
`

`

`SNGIEOEA
`
`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 2 of 13
`Case 2:18-cr-00422059VRSOBOCLABhe tHEcA NeyESEerePHge 2 of 13
`
`Q =
`
`Menu
`
`
`Sees Harvard Health
`ae Publishing
`
`
`HARVARD MEDICAL SCHOOL
`
`
`
`HARVARD HEALTH BLOG
`
`What is COVID-19 brain fog — and
`how can youclear it?
`
` ena ye
`
`https://www.health.harvard.edu/blog/what-is-covid-1 9-brain-fog-and-how-can-you-clear-it-202 1030822076
`
`1/10
`
`

`

`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 3 of 13
`Case 2:18-cr-0042W3NA BOVBdebites tate catyePlee/?6farardbaee 3 of 13
`8/16/2021
`Gay 2 er
`
`ies cig
`
`March 08, 2021
`
`By: Andrew E. Budson, MD, Contributor
`
`As a cognitive behavioral neurologist, I’ve been hearing from manyindividuals who are
`
`complainingof “brain fog” after infection with COVID-19. So I thought it was worth
`
`discussing exactly what COVID-19 brain fog is, and some thingsto do that might help clear
`
`qi
`
`Whatis brain fog?
`
`Let's start by trying to understand brain fog. Brain fog is not a medicalor scientific term;it
`
`is used by individuals to describe how they feel whentheir thinking is sluggish, fuzzy, and
`
`not sharp.
`
`Weall experiencethis feeling from timeto time. Perhaps you couldn't think clearly when
`
`you were sick with the flu or anotherillness. Maybe you were jet-lagged and your thinking
`
`wassluggish becauseit felt like it was 2 AM. Or perhaps you took an antihistamine or
`
`another medication that made your thinking fuzzy for a few hours. In each case you
`
`probably just waited to get back to normal, whether that meant recovering from your
`illness, adjusting to the new time zone, or waiting for the side effects of the medication to
`
`wearoff.
`
`But whatif your thinking didn't return to normal?
`
`What is COVID-19 brain fog?
`
`https://www.health.harvard.edu/blog/what-is-covid-19-brain-fog-and-how-can-you-clear-it-202 1030822076
`
`2/10
`
`

`

`8/16/2021
`
`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 4 of 13
`Case 2:18-cr-O0422008MSCODOCUinae fy 246hdw Bale GS/1C/Bavaaeen4d of 13
`
`Stay Informed
`
`@ereaciee
`COVID-19
`
`Resource Center
`
`Recently I received an email from a man whodescribed howheisstill struggling with
`
`“cognitive challenges” since recovering from thevirus in the spring of 2020. His doctor ran
`
`him through a checkup anda battery of tests. Everything was normal, yet his cognitive
`
`challenges remain. Like this man, many people whohaverecovered from the acute,life-
`
`threatening effects of COVID-19, but still don’t feel that their thinking and memory are back
`
`to normal.
`
`How COVID-19 affects the brain
`https://www.health.harvard.edu/blog/what-is-covid-19-brain-fog-and-how-can-you-clear-it-2021030822076
`
`3/10
`
`

`

`eitniaee
`
`Case 2:18-cr-00422°8M°DOCLIABHE T2P8°A" PIREH WB/T6/FL"PAGE 5 of 13
`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 5 of 13
`
`There are many ways that COVID-19 can damage the brain. As I described in aprevious
`
`blogpost, some can bedevastating, such as encephalitis, strokes, and lack of oxygen to the
`
`brain. But other effects may be more subtle, such as the persistent impairment in sustained
`
`attention noted by Chinese researchers.
`
`In addition to direct effects on the brain, COVID-19 can also have long-term effects on other
`
`organ systems. So-called long haulers can have otherlingering symptomsincluding
`fatigue, body aches,inability to exercise, headache,anddifficulty sleeping. Some of these
`
`problems may be due to permanent damageto their lungs,heart, kidneys, or other organs.
`
`Damageto these organs — or even just the symptoms by themselves — can impair thinking
`
`and memory and causebrain fog. For example, how can you thinkclearly if you're feeling
`
`fatigued and your bodyis aching? How can you concentrate if you were up half the night
`
`and awoke with a headache?
`
`Whatshould you doif you may be experiencing
`COVID-19 brain fog?
`
`The first and most important thing to do is to see your doctor and share with themall of the
`
`lingering symptomsyou are experiencing. These should includeyour brain fog and other
`
`neurologic symptoms(such as weakness, numbness,tingling, loss of smell or taste), and
`
`also problems such as shortnessof breath, palpitations, and abnormal urineorstool.
`
`Whatmighthelp clear the brain fog?
`
`To help clear the brain fog, I recommendpursuingall of the activities that we know help
`
`everyone's thinking and memory.
`
`Perform aerobic exercise. You may needto start slow, perhapsjust two to three minutes
`a few times a day. While thereis no established “dose” of exercise to improvebrain
` health, it’s generally recommended you work toward 30 minutesa day,five days a
`week.
`
`
`Eat Mediterranean-style meals. A healthy diet including oliveoil, fruits and vegetables,
`
`nuts and beans. and whole arains has been proven to improve thinking. memorv. and
`https://www.health.harvard.edu/blog/what-is-covid-19-brain-fog-and-how-can-you-clear-it-202 1030822076
`
`4/10
`
`

`

`GiGieea!
`
`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 6 of 13
`Case 2:18-cr-00422V3VASO'Soeurriehe TA1Biw -PiedB/L6/2Le"Pee 6 of 13
`meee eee ew Sweeny eee wee gr rrrrr er rt rp reg coc rrr ry eee
`
`brain health.
`
`Avoid alcohol and drugs. Give your brain the best chanceto heal by avoiding
`
`substances which can adversely affectit.
`
`Sleep well. Sleep is a time when the brain and body can clear out toxins and work
`
`toward healing. Makesure you give your body the sleep it needs.
`
`Participate in social activities. We are social animals. Not only do social activities
`
`benefit our moods, but they help our thinking and memory aswell.
`
`Pursueother beneficial activities, including engaging in novel, cognitively stimulating
`
`activities; listening to music; practicing mindfulness; and keeping a positive mental
`
`attitude.
`
`SHARE THISPAGE BY ©
`
`PRINT THIS PAGE
`
`Disclaimer:
`
`As a service to our readers, Harvard Health Publishing providesaccessto ourlibrary of
`
`archived content. Please note the date of last review or update on all articles. No content on
`
`this site, regardless of date, should ever be used as a substitute for direct medical advice
`
`from your doctoror other qualified clinician.
`
`Comments
`
`Rick Ricketson
`
`March 15, 2021
`
`Mygirlfriend and I are both 66. I did have moderately severe infection with SARS-CoV-2 back in
`November 2020. Luckily, she ahas tested negative by PCR, rapid Ag, and CoV-2 Abs. She and I both went
`through the two-dose Pfizer schedule. As expected, I had increased residual cognitive dysfunction and
`the recurrent rash (surface glycoprotein hypersensitivity). She, however, had nevertested positive and
`now stated tonight she feels “exhausted and mentally fatigued” after her second dose. Is there evidence
`
`https://www.health.harvard.edu/blog/what-is-covid-19-brain-fog-and-how-can-you-clear-it-2021030822076
`
`5/10
`
`

`

`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 7 of 13
`8/16/2021
`Case 2:18-cr-00422051Odeafre T2nShaw cP) se B/G/BatvarPdegth 7 of 13
`of frontal lobe and/or hypothalamic/pituitary axis dysfunction occurring after COVID-19 or the surface
`glycoprotein? Pandemicisolation fatigue?
`
`Commenting has been closedfor this post.
`
`You mightalso be interestedin...
`
`6 steps to optimizing brain function and improving brain health
`
`HARVARD
`MEDICAL SCHOOL
`
`Special Health Report
`
`A Guide to
`Cognitive Fitness
`
`A Guide to Cognitive Fitness
`
`In this Special Health Report, Harvard Medical School doctors share a six-step program that
`can yield important andlasting results. Together these “super 6” can strengthen your
`intellectual prowess, promote your powersof recall, and protect the brain-basedskills that
`are essential for full, rewarding, and independentliving. From simple and specific changes
`in eating to waysto challenge your brain, this is guidance that will pay dividends for you
`and yourfuture.
`
`
`
`https://www.health.harvard.edu/blog/what-is-covid-1 9-brain-fog-and-how-can-you-clear-it-202 1030822076
`
`

`

`BG/2021
`
`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 8 of 13
`Case 2:18-cr-00422°55UEPOBOCRABIe L2184 Hy oe 19B/1GBarve"aege 8 Of 13
`
`©
`
`CBi
`receptor
`
`receptor
`
`©@—\Cannabinoid
`
`
`STAYING HEALTHY
`
`Fil
`
`The endocannabinoid system: Essential and
`mysterious
`
`https://www.health.harvard.edu/blog/what-is-covid-19-brain-fog-and-how-can-you-clear-it-202 1030822076
`
`7/10
`
`

`

`Case 2:18-cr-00420SMSBOCuHIeht TAB FewEsPE/FT"PEAe 9 of 13
`
`MIND & MOOD
`
`The book of neurogenesis
`
`
`
`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 9 of 13 B/igiaen
`
`
`MIND & MOOD
`
`A newAlzheimer’s drug has been approved. But
`should you takeit?
`
`
`
`De|
`
`https://www.health.harvard.edu/blog/what-is-covid-19-brain-fog-and-how-can-you-clear-it-202 1030822076
`
`8/10
`
`

`

`8/16/20
`
`ae
`Case 2:18-cr-00422°S15°DOEUTTEHE TALSAY PMUEB/6/PI"PAGE 10 of 13
`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 10 of 13
` BA) Harvard Healt
`ZG Publishing
`
`HARVARD MEDICAL SCHOOL
`
`f vin @
`
`MY ACCOUNT
`
`Customer Service
`
`Login
`
`ORDER NOW
`
`Online Learning Courses
`
`Digital Subscriptions
`
`Special Health Reports
`
`Print Subscriptions
`
`MORE
`
`About Us
`
`Permissions
`
`Licensing
`
`Topics
`
`https://www.health.harvard.edu/blog/what-is-covid-19-brain-fog-and-how-can-you-clear-it-202 1030822076
`
`9/10
`
`

`

`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 11 of 13
`
`2:1 0422-SMB Document 1218-4 Filed 08/16/21 Page 11 of 13
`
`MICHIGAN MEDicIneE4NumbnessandTingling After
`Seen COVID-19: Care Instructions
`
`What causes numbnessandtingling?
`Numbness andtingling, also knownas paresthesia, is a burning or prickling
`sensation that is usually felt in the hands, arms, legs, or feet, but can also occur
`in other parts of the body. The sensation, which happens without warning,is
`usually painless and described as tingling or numbness, skin crawling, or
`itching.
`
`Most people have experienced temporary paresthesia -- a feeling of "pins and
`needles" -- at some timein their lives when they have sat with legs crossed for
`too long, or fallen asleep with an arm crooked undertheir head.It happens
`when sustained pressure is placed on a nerve. The feeling quickly goes away
`once the pressureis relieved.
`
`Chronic numbness or tingling can be a symptom of any numberof disorders:
`stroke, tumor, multiple sclerosis - to name a few. Also, nerve entrapment
`disorders, where a nerve gets compressedorrestricted by nearby tissues can
`cause paresthesia accompanied by pain. (Carpel Tunnel Syndromeis an
`example of a nerve entrapment disorder). COVID-19 can also cause numbness
`and tingling in some people. It is difficult to predict who may get paresthesia
`following COVID.
`
`Howis paresthesia diagnosed?
`
`Diagnostic evaluation is based on determining the underlying condition causing
`the paresthetic sensations. Medical history, physical examination, and
`laboratory tests are essential for the diagnosis. Doctors may order additional
`tests depending on the suspected cause of the paresthesia. If there is concern
`your symptomsare related to your history of COVID-19, your doctor may ask
`you about your course withtheillness.
`
`Family Medicine
`ef. -
`
`

`

`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 12 of 13
`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 12 of 13
`
`Howis paresthesia treated?
`
`Proper treatment of paresthesia depends onthe exact diagnosis of the
`underlying cause.
`
`¢ Be sure you take any medication as directed. If you think you are having a
`reaction, please call your provider.
`« Do not miss any appointments and please call if you are having trouble.
`e
`It is important that you know your medications andtest results and can
`share them with your provider so they can better care for you.
`« Working closely with your medical provider is an important part of your
`
`treatment.
`
`When should | call for help?
`Call 911 anytime you think you need emergency care. For example,callif:
`« Have symptomsof a stroke like:
`o Sudden loss of movementin one side of your face or body.
`
`o New numbness, tingling, or weakness to one side of your body or
`
`face.
`
`o Trouble speaking or understanding what someoneis saying to you
`o Sudden trouble walking or balancing.
`o Sudden and worst headacheof yourlife.
`¢ Signs of other emergent conditionslike:
`o Sudden loss of bowelor bladder control.
`
`o Weakness, numbness, or tingling in both legs or in the pelvis.
`
`Call your doctor now or seek urgent medical careif:
`« Your symptomsare worse than normal
`
`Monitor your symptomsandhealth closely. Please call your health care
`provider if you are not improving like you normally do. Following up with your
`doctor is a very important part of your health and safety.
`
`Family Medicine
`Post-COVID Paresthesia
`sues
`
`

`

`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 13 of 13
`Case 2:18-cr-00422-SMB Document 1218-4 Filed 08/16/21 Page 13 of 13
`
`Disclaimer: This document contains information and/or instructional materials developed by
`Michigan Medicinefor the typical patient with your condition. It may includelinks to online
`content that was not created by Michigan Medicine and for which Michigan Medicine does not
`assumeresponsibility. It does not replace medical advice from your health care provider
`because your experience may differ from that of the typical patient. Talk to your health care
`provider if you have any questions about this document, your condition or your treatment plan.
`
`NonCommercial-ShareAlike 4.0 International Public License. Last Revised 05/2021
`
`
`Adapted from: NINDS. Paresthesia Information Page. Access at: https://www.ninds.nih.gov/
`
`Reviewer: Heather Vance MD
`Plain Language Editor: Ruti Volk, MSI, AHIP
`
`Patient Education by Michigan Medicineis licensed under a Creative Commons Attribution-
`
`Family Medicine
`Post-COVID Paresthesia
`a ne
`
`