How to Assess Long-Covid (For Doctors)

Good day and welcome to Medicine Health with Dr. Paul Anderson. That's me, I'm Dr. Paul, and today we're beginning the series. This is part 4 of a 16-part series on Long COVID. Why so many parts? Because it's a very complex topic, and rather than make one giant long video that you wouldn't stay awake through, I'm breaking it up into bite-sized pieces. Also, sometimes breaking things up into bite-sized pieces makes it, uh, Easier to share the audio or the video because you may be only interested in one or two of those pieces as we go. So, in this part, which is actually part 4, this gets into what, as a healthcare provider and you as a patient, should we be considering When you have Long COVID. So we've talked about how Long COVID is triggered by the same thing, which is having COVID, but Long COVID is also many, many symptom patterns that are a collage because you can have a triggering event a post-infectious illness by the infection, how your body interprets it has many, many, many outlets. So you could have post-COVID symptoms that come from organ damage, and so that could be you had some lung damage or heart damage or something, and that's what's giving you your symptoms. Then the next person could have post-COVID symptoms For— with totally normal organs, but they had an immune response to the COVID that is now making their immune system either hyperactive, underactive, or just oddly active. Or they could have had COVID and their immune system had some response, but the bigger response actually came from their hormonal system. And so between their immune system, their hormonal system, you might wind up with other odd symptoms that come out the other side, or you could have many, many other things happen. So if you think of it that way, that yes, we have one inciting problem being COVID, but our body, which is an incredibly complex group of systems, Gets to decide however the COVID affected the body, and then whatever systems in the body were thrown off by that infection, they become the generators of your long COVID symptoms. And so if I have a generation of long COVID symptoms that is due to other infections that got triggered, that's going to be a whole different set of problems. Then if I have long COVID symptoms that are because of my immune system became hyperactive or underactive, and that's going to be different than if my endocrine, my hormonal system is what got thrown off, and that's going to be different than if my detoxification systems got jammed up. And then in many people, it's going to be different than you pick from that menu and you have 2 of one and one of the other. Okay, this is why it is so incredibly frustrating for patients to get this sorted out, but also especially in Western medicine where we tend to try and categorize things and we tend to try and have one cause giving us one problem and one set of symptoms and treatments. Okay, now that works really well If you have a, unfortunately, a broken bone, it's a fairly linear pathway there. You used to have a bone that was not broken, you had an injury, you broke the bone. Now we have to do something, and there are not that many options for what to do once you have a broken bone. It's going to be pretty similar treatment. Also, the diagnosis of your broken bone is going to be fairly straightforward. Okay. When you get these things that go into the human body that literally trigger the immune system, which then has multiple levels of outflow, you can see that the multiple levels of outflow from the triggering event of the infection could go in one person one direction, another person another direction, another person in 3 directions, And that's because the immune system is set up to react to multiple inputs and try and send the chemistry to tell your immune cells and your healing systems and all this what to do in the order that's best set up for whatever the injury was. Excuse me. So, when we think of it that way, we no longer have non-broken bone to broken bone and then broken bone treatment. Now, we have literally a roll of the dice that usually starts out with an immune inflammatory complex and then has an output that hits you usually wherever you're either the weakest or the most imbalanced. Okay. So, when we're looking at this problem, one of the biggest issues, and we see and hear about this all the time now, is I, I have literally seen, you know, for the last 20 to 30 years, let's say, working with post-infectious illness patients, I've seen patients who get gaslit Not only by friends and family who just don't understand why they're so sick, but also by maybe their healthcare providers because their healthcare providers may not see a lot of post-infectious or other complex illness, and they try and do this one disease, one intervention treatment, and it turns out that there's a lot of problems going on, and so it's it's a different way of looking at. How you get a disease or disease symptoms, so that that idea of gaslighting—and that's not to you know put the whole system down or anything—but it's very common. There's a lot of articles about medical gaslighting, which is not new; it's just COVID is making it kind of more famous. And it's not—I do not believe—for any ill intent. It's because our system in Western medicine is more set up. for non-complex illness. Now, there's some exceptions, but it's more set up for acute care or straight-line care. So how do we work around that? In the minutes that we have left here talking about where to assess, where to look, etc., how to do good medicine in the context of chronic illness, which Long COVID certainly qualifies for, You have to do, uh, what we often talk about in assessment and diagnosis as working from the ground up, because there's some people who have Long COVID that's a little easier to manage. There's some people that's a little more moderately complex, and there's some people it's horribly complex to manage. So you want to cover your bases in a particular order. So working from the ground up, there are 4 major areas that I think are important to assess as you as the patient or the healthcare provider are looking at Long COVID. The first one, it's all about do no harm, so the first one is to rule out organ disease or other major diseases that may be secondary to the event of the initial infection, or could have been silent diseases that are now not silent after you have the infection. Any of it can happen, But that would be looking critically at the major functions in the body, your liver functions, your kidney functions, your clotting functions, which everybody's paying a lot of attention to, your electrolytes, your blood sugar, your cardiac function, your neurological function, etc. This is often done by a combination of physical examination, laboratory examination, and in some cases, some imaging. Some radiography and imaging sorts of things. Now, why do we do that? We talked about that in part 3. That's to make sure that we don't miss something important in an organ. If an organ's damaged, you may have other reasons for your long COVID, but if you got a damaged organ, we have to take care of that, or at least watch it and monitor and don't let it get damaged any more than it already is. Next layer, so first layer, is check out the major organ systems. Second layer is to look at body system and history where they come together. So you're telling your provider these things are wrong, and that looks like it might be aimed at a body system, or historically maybe you've had a lot of a certain type of problem. And so beyond your global testing of the big organ systems, you might look more specifically For example, someone comes in and they say, or maybe you already know as a patient, you know, I had a heck of a time getting rid of this other chronic infection. I finally got it under control, but I've heard that COVID can reactivate that old infection. Well, certainly. Well, then we would want to check for that old problem you had, or you had a particular hormone imbalance, but it has been balanced. Long COVID has a way of throwing those things back off. Then after that, after the more obvious things of the main organ systems and then your specific medical history, we want to look at interfering comorbidities that we now know through the research are common in long COVID. So those would be areas such as a broader look at your hormonal system, a broader look at potential toxins in your system, which can be screened for often with urine tests, etc. Just to make sure that that's not an issue going on. Looking at another common area that's dysregulated, your digestive function, which is a couple of things. One is it has a huge control over, of course, your nutrients getting into you, but it can become inflamed with COVID You can have infectious inflammatory problems there, so GI system may not be working appropriately, and that can lead to a number of other things. And then a broader look at other infectious agents that we know now have associations with COVID and Long COVID. And then part 4, the final part, is to not only treat what you find, which is of course is obvious— if I find problems in 1 area or 6 areas, we want to be treating that— but we want to treat them in an integrated manner, knowing that your body is working together. So, for example, if there's a hormonal problem and then you have some clotting problems and you have some other problems, we want to do the right thing for each of those problems, but sometimes by improving one of the areas, let's say the hormonal area gets improved faster, some of the other areas may become less of an issue as well. So you have to think of them as a Unity as an integrated part of your body, creating your negative symptoms. And so when we're trying to heal you up and get you past Long COVID, we have to treat them and keep in mind that all of those moving parts may move together or separately, and we have to reassess them as we go. Well, we're out of time for this particular section. This is only part 4 out of 16, and we're gonna get much, much more deeply into assessments, treatments, and all of that rubber meets the road thing in the next of our 16 parts. But for right now, I'm Dr. Paul for Medicine Health. Check me out on dranow.com. It's got links to everything on there, our YouTube channel, whatever way you follow us, whether it's a PodBurner or YouTube, Facebook Live, however you find this. Please like, share, subscribe, and, and do the notifications because sometimes we're not first to come up on your feed and you might want to know what's going on. Also on the YouTube channel, uh, you can just take a look on Dr. A Now, go right to the YouTube channel from there. And on the YouTube channel, we also will put more stuff into the show notes, etc. But that's it for today. Thank you very much for listening, and we'll see you all again. Bye.