Long-Covid Fatigue (A Tested Framework)

But the bottom line is, why do we do these unique lab tests when somebody comes in and their normal screening labs are all normal, but they still have symptoms? And what does that lead us to as far as clinical decision-making? Well, the reason that we do that, that we do these fill-in or add-on labs, is no pathology on the screening labs. Things like reverse T3 and morning cortisol and these other things that we check are there to confirm either There is no problem, or there's a functional problem. Hope for Long COVID-related fatigue. I want to relate a story of a patient whose primary problem in their Long COVID journey, at about 6 months after their primary infection, was fatigue. Now, this particular patient had already had any dangerous diagnoses ruled out, which was great, and they had been to their primary care, they were working with them, and they really weren't, you know, offered a whole lot of treatment because there was no pathology found that was at a high level, which is, that's great to not have pathology, but it also can leave you a little wanting when it comes to what do I do about my fatigue? Do I just wait around for it to get better, or what do we do? In this particular patient, everybody is different, but something that's real common when you've had the normal pathologies ruled out and you've had, you know, a blood count done and a metabolic metabolic panel and some other things done, is we might need to, in addition to maybe doing a little deeper dive into your history, look at what sorts of, you know, labs might be rewarding to take a look at in this case. And so we call those fill-in labs. It's basically, okay, we already have these labs here, they look pretty good, or maybe there's some little things with them, but let's get some other things to fill in, to, you know, elaborate a little bit. So we look specifically at the particular patient's dietary history, their prior health history, and also the of course the labs that they had had done, and you know all of the other normal things that you do. Now in particular, what we had looked at was patient had a screening blood count done, which was looking maybe a little towards anemia, but You know, not full-blown iron deficiency anemia. There was some confirmatory tests that we did that kind of helped inform the blood count and indeed did show that they were dipping into a little bit of iron deficiency type anemia, which can make you very tired and a number of other things. The other thing was that they had had a thyroid screening done, but as we've talked about, remember this is a 16-part series on Long COVID, in the hormonal section we talked about Sometimes the thyroid gets thrown off in a different way with long COVID, and so their thyroid screening looked good, but they actually had an elevation in their reverse T3, which is a T3 hormone that your body makes to block your normal T3. That's done under a stress response, usually. Certainly COVID and long COVID can be stressful. The other thing that we checked as a fill-in lab again, an add-on, was the morning cortisol output. And again, you know, real low disease-level low cortisol is called Addison's disease. They didn't have that, but they just had a very low output, which again is a stress response, and it's something that you can work on to kind of bring back. Now, in addition to their problems with low iron, their diet was also very low in an amino acid called carnitine. Now, carnitine is used to help get energy into your mitochondria, and it's doing that by shuttling fatty acids in the mitochondria so the mitochondria can do something called beta oxidation and burn those up to create energy. So if you have low carnitine levels, that little shuttle slows down. It's very common. And so you might say, well, wouldn't this person have noticed, you know, their anemia symptoms and maybe this low carnitine in their diet and stuff before? Well, they might have a little bit. This particular person didn't have a big, you know, fatigue history or other disease history. But sometimes, just like these hormonal things can shift out of balance and we can push them back to normal, uh, with appropriate treatment, uh, they'll shift out of balance because of the stress of COVID the stress of the infection, stress of long COVID. And so the same with some of these nutritional things. They may have been borderline anemic or had a bit of a low carnitine intake in their diet. And Indeed, they really didn't notice it before that, but with the stressors, it brings it all up to the surface. This is the thing that you want to keep in mind. This particular patient had what, upon doing these extra labs and looking at a bit broader picture with their history, they had this very targeted approach that worked for them. It's sort of like a key in a lock. If you find the right things that are just, you know, these are not disease states really, they're just things that are out of balance. Right. You put in the correct things to kind of fill up what was needed, then that patient will have the ability to, um, let their body do what it is supposed to do. And so you can get things back, you know, kind of right the ship and they will start to feel better. So this particular patient, that is indeed what happened. So after 6 months of long COVID, now it took a few months. It does. This doesn't happen overnight, but a combination of working on the thyroid imbalance, the low cortisol, and then these new nutrient things, the carnitine and the iron, et cetera, really helped to kind of fill the tank. They started to get better. And then what happens is after you start to kind of get on the level, you get to the other end of things and you can stop doing whatever it is you were doing to support. For instance, the low cortisol output and the reverse T3 thyroid issue, et cetera. So it doesn't need to be a forever type treatment. Now you gotta do the treatment as long as it takes, but it's not a forever treatment. Now I get questions a lot in this series because, you know, this is one of 16 parts. So we do get a lot of questions about this lab thing. And if you go back to the, the one about hormonal changes during COVID and long COVID, we talk more specifically specifically about that. But the bottom line is, why do we do these unique lab tests when somebody comes in and their normal screening labs are all normal but they still have symptoms? And what does that lead us to as far as clinical decision-making? Well, the reason that we do that, that we do these fill-in or add-on labs, is no pathology on the screening labs. Things like reverse T3 and morning cortisol and these other things that we check are there to Either there is no problem or there's a functional problem. And the functional problem is the inflammatory reaction because of the infection pushed the labs out of range, but just enough to make you feel bad. So that's why the fill-in labs are so important to do. Now, the bottom line of going through and trying to help somebody with this sort of an issue where fatigue is the primary thing, Is first off, you want to take a look and see if there is any target to go after. So in this case, we had a couple of nutritional things being low iron and a low carnitine intake in the diet. And you can take a look, you know, with the internet you can find everything. But if you look at carnitine sources in food, you can find lists of foods that are higher in carnitine and lower. And if you just take a look at those, And you look at the higher carnitine foods, you can figure out sort of what kind of a diet intake this person had had. And it's not that maybe that was a bad diet for them, it's just that for their healing, they needed to kind of bump that up. Then same with iron, you know, sometimes we can be just a little borderline low and then we get sick and it pushes us, you know, kind of over the edge into a low iron anemia type state. Now, What would happen if this didn't work? So this, this first approach didn't work. You always need to have a backup and a next step. Now, keeping in mind that you've been sick for 6 months, it's not going to get better in a week or 2. We go kind of check-ins at 3 to 4 weeks at a time. This person did improve, but if they didn't, the next thing would be some more specific nutrients and specific herbal medicines, botanical medicines. We'll do separate podcast sections on that. Then if that wasn't working, we would kind of kick up the intensity and we would consider doing things like intravenous nutrient therapy and/or hyperbaric oxygen. And we're going to do separate podcasts just on those 2 interventions as well. But the important thing with this particular case is that it was very frustrating for this person because, you know, they didn't have a great time having COVID in the beginning. Then they sort of had this kind of post-viral malaise where they just didn't feel really well as things went forward, and they thought, well, it'll just get better eventually, and they were trying to do everything they could, you know, they were trying to eat appropriately and get enough sleep, they're really trying everything, they really didn't have a lot of tolerance for exercising because they get so tired, but they would do a little bit, maybe walk around, And so they were really doing everything, but the frustration then is, is if I, you know, don't have the acute COVID anymore and now I just feel bad and I have fatigue, what can I do just to kind of crawl out of that hole? And if you get down certainly 4 to 6 or 8 weeks after COVID and you're still very fatigued and you're sleeping appropriately and your diet's not, you know, full of inflammatory and junky foods and sugar and stuff, and you're able to move a little bit to get your blood moving, you're still not getting better, it's really worth checking in with somebody to go over these different things. Now, again, we start with the basic diet lifestyle assessment, look at the labs, look at what can be filled in and what we can target, and then we do whatever is appropriate to target the lab deficiencies and/or the hormonal imbalance and all of that. If that's still If it's still not working, then we kind of increase the intensity of treatment and consider maybe more botanical medicines, maybe other hormonal interventions, other nutrient interventions, and then we might kick it up again and do something like hyperbaric oxygen or IV nutrient therapy, other things that we're going to do separate sections in this 16-part Long COVID series. Thank you for listening. I'm Dr. Paul Anderson. This is Medicine and Health. Thank you. Health with Dr. Paul Anderson, because that's me. I want you to like, share, and subscribe on whatever platform you're on. Please check out the YouTube channel if you haven't. That community is growing. You can find us at dranow.com, D-R-A-N-O-W dot com. And do remember, uh, we're, we're just giving stories, history information, and what's worked for our patients. This should not be construed as medical advice. You should always check everything out with your healthcare provider. And in the show notes, we'll also put in some links to referral sources, references and resources, and other helpful things for you to take a look at. I'll see you all on the next section.