Carolyn Forsyth thought she was going mad.

It was late 2021 and the GP from Inverness was bamboozled by a range of increasingly "bizarre" cognitive symptoms which had taken hold after a relatively mild bout of Covid in October 2021.

Despite working in a busy A&E department at Raigmore hospital throughout the pandemic, it was her first infection.

After self-isolation ended, she went to the supermarket.

"I remember just standing in the aisle for a full hour. I'd pick things up and put them down. I couldn't make a decision.

"I had no idea what was going on - my brain just wasn't working."

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Days later, on a resuscitation training course, she found herself re-reading the same page in a manual over and over again as the words "scrambled" and evaporated from her memory.

As well as crippling fatigue, she was plagued by strange sensations that left her feeling as though she were watching the world around her "like a TV, but with white noise".

Returning to work she was scared of making mistakes, but worried how extending her sick leave might be perceived.

She said: "I was terrified that people would think I was malingering and that not going back to work was me trying to skive off nightshifts.

"I tried desperately to hide what was wrong with me because I was mortified - I had no idea what was going on.

"I would actively avoid seeing unwell patients, which is difficult in an A&E department, so I would try to find ankle injuries or minor ailments. But I just didn’t feel safe.

"I was consumed by shame.

"I'm a coper, I just get on with it, but boom - suddenly I can't take the dog for a walk, I can't follow a recipe, I started doing bizarre things like I found the milk in the dishwasher.

"I thought I'd lost my mind."

In January 2023, Dr Forsyth handed in her notice - saying goodbye to the job she had had since 2015, and dreamed of ever since she was a teenager.

“It was horrendous," she said.

"It was the only job I’d ever wanted. When I was at school, I did work experience in that department and I remember seeing my first X-ray and thinking that it was the coolest thing I had seen in my life.

"I’m from Inverness, I wanted to come home. It was my ambition to work in that emergency department, and there I was - binning it.”

Dr Forsyth had worked at Raigmore since 2015 but quit due to long Covid in January 2022Dr Forsyth had worked at Raigmore since 2015 but quit due to long Covid in January 2022

A turning point came when she was seen at NHS Highland's newly-created long Covid service, although she admits she had to "beg" her GP for a referral - "they didn't know it existed" - and even then she was still "not entirely sure if I was mad".

In the end, she was diagnosed not only with long Covid but POTS - postural orthostatic tachycardia syndrome - where the heart rate increases rapidly on standing up.

It left her feeling "like I was going to die" if she attempted simple exertions like mowing the lawn.

First described as "breathing pattern disorder" among American Civil War soldiers in 1871, POTS is now thought to be a form of dysautonomia, where the body's autonomic nervous system (ANS) - which controls automatic processes such as heart rate, blood pressure, and digestion - malfunctions.

When the ANS fails, the functioning of the heart, bladder, intestines, sweat glands, pupils, and blood vessels can all be affected.

Viral and bacterial infections appear to be among the most common triggers for POTS, along with stress and trauma.

A diagnosis, after months of confusion, came as a relief.

"I burst into tears, " said Dr Forsyth. “If there was something wrong, there was something to fix.

"From then on, my mindset shifted.”

Today, she describes herself as "99.9%" recovered and wants other long Covid sufferers to know that it is possible.

Long Covid campaigners outside the UK Covid inquiry in LondonLong Covid campaigners outside the UK Covid inquiry in London (Image: PA)

Getting there began when she chanced upon a podcast interview with Suzy Bolt, a yoga teacher and Neuro-Linguistic Programming coach from Brighton, who had been left bed bound by long Covid in summer 2020.

Ms Bolt's mistake, she says, was "to keep on working" following a Covid infection shortly after lockdown - running online classes over the internet despite feeling run down by flu-like exhaustion.

Speaking to the Herald, Ms Bolt, 52, said: “I managed to drag my body to six, seven weeks, and then I just fell off a cliff. That began a really stark downward spiral.

"I started to get all sorts of symptoms in my organs – in my heart, my lungs, my stomach, my brain. Everything started to do very odd things.

"I had to lie in a dark room, I couldn’t have kids around me without having ear defenders on. It was pretty quick and pretty steep, the shutdown that my body did.”

In the absence of any treatment programme, Ms Bolt began to craft her own based on a suspicion that many of the problems she was experiencing - shortness of breath, heart palpitations, and a body "feeling out of control" - were rooted in dysautonomia.

Using a mixture of breathwork, gentle movement exercises, and relaxation techniques such as meditation and mindfulness she slowly began to "crawl out of the pit", although it took around a year before she was experiencing a sustained recovery.

A second Covid infection caused a "chronic fatigue crash" which lasted months.

Solidarity with an online community of fellow 'long haulers' was key.

Ms Bolt said: "I thought 'I need to set up a programme that makes me do the work every day', and I’m going to put two classes on my own timetable that are for me and some of the other people I’d been connecting with online.

"Connection was really important – I needed to be with people for whom this was their normal too.”

Suzy Bolt combined her previous work in counselling and yoga to tailor her own recovery from a devastating experience with long CovidSuzy Bolt combined her previous work in counselling and yoga to tailor her own recovery from a devastating experience with long Covid (Image: Supplied)

Today the programme has flourished into 'Rest. Repair. Recover' - the world's largest long Covid recovery programme - with thousands of members paying £9-a-week for access to 22 online classes designed to help calm and recalibrate the nervous system.

Ms Bolt said: “We get incredible results - but it’s slow. The thing that gets people most frustrated with this illness is that there isn’t a tablet you can take that will make you better.

"If you’re hanging onto an idea that ‘I’m going to wait until there’s a magic cure’, you’re just going to wait for quite a long time."

Back in Inverness, Dr Forsyth credits the programme not only for her recovery, but for transforming her outlook on medicine.

She says she recommends it to "every single one" of her long Covid patients.

She said: “It was a sort of instant relief because here were people describing exactly the same symptoms as me, to the letter, that made no sense, and bore no correlation to any anatomical teaching I had ever had.

"It was the first time I’d encountered the expression 'dysautonomia'. And reading about POTS, again, this was not something I had encountered in my career, ever."

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Dr Forsyth, 43, now spends eight hours a week working on NHS Highland's Covid Recovery Service, assessing long Covid patients and referring them onto specialist physiotherapy, psychology and occupational therapy support.

She also works part-time doing remote assessments for urgent care.

She said she is struck by how often she encounters long Covid patients slipping through the net.

"Every single time I do a shift [for urgent care] I speak to a patient who believes they have got long Covid or whose GP has diagnosed them, but they haven’t been referred to the service.

"I’m not sure why there’s a reluctance to refer people, but I’m forever saying to people ‘please get your GP to refer you – we have the means to help you, you can get better’."

Carolyn Forsyth said spending time in the garden to to relax had helped her to recoverCarolyn Forsyth said spending time in the garden to to relax had helped her to recover (Image: Peter Jolly)

She believes that part of the problem may be that long Covid and other post-viral syndromes, such as ME, still confound medical norms by causing debilitating symptoms without any detectable cause or pharmaceutical cure.

She said: "A doctor looks for disease by doing blood tests and examinations and if they can’t find anything will say to the patient ‘there’s nothing wrong’.

"But the patient still has symptoms.

“Long Covid would sit beneath what the profession currently likes to call ‘medically unexplained symptoms’.

"If I had the power to wave a magic wand, it would be to change that to 'medically misunderstood symptoms'.

"Just because we don’t have an explanation doesn’t mean they’re not there, but because they don’t follow the patterns of established disease process I think there's still a widespread belief within the profession that they don't exist.

“I remember mentioning POTS to a colleague whose response was: ‘another f***ing made up condition’."

For her part, Dr Forsyth thinks long Covid has made her a better doctor.

She said: “I wouldn’t change anything, I’m immensely grateful that this happened to me.

"I would never have understood any of this if I hadn’t gone through it myself.”