In this third episode of a 16‑part series on Long COVID, Dr. Paul Anderson explains how patients with post‑COVID syndrome can stay safe and why primary‑care doctors often refer them to specialists. He outlines a comprehensive approach that includes a broad laboratory panel and imaging to screen for organ damage, and highlights the frequent presence of co‑infections—especially Mycoplasma pneumoniae—which can mimic or worsen Long COVID symptoms such as fatigue, cough, joint pain, and systemic inflammation. Dr. Anderson clarifies that referrals to cardiologists, pulmonologists, nephrologists, or neurologists are meant to rule out hidden organ injury and to ensure targeted treatment, not to dismiss the patient’s illness. He acknowledges the frustration many patients feel when specialist evaluations return “all clear,” noting that this often reflects a lack of expertise in post‑infectious medicine. He recommends seeking clinicians who specialize in post‑infectious or Long COVID care and provides links to referral resources. Throughout, he emphasizes that safety, thorough testing, and appropriate specialist involvement are essential for managing Long COVID effectively.
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Good day, welcome to Medicine and Health with Dr. Paul Anderson. That's me, I'm Dr. Paul, and today we are starting our big long 16-part series on Long COVID, post-COVID syndrome. This is part 3 out of 16, so we got a lot more of this to go through, but in this one I want to talk about something that is very important. It's very important for your safety, If you have long COVID, and it also can be very frustrating for patients because I hear back from a lot of people that they just don't understand why they're being asked to do certain things when they have long COVID. Okay, so this is really about staying safe when you have long COVID, and it's really the same idea as if you had any other disease process. It's just that with long COVID, We kind of lump it into this sort of amorphous, we're not sure what it is, you know, we've got these symptoms, etc. And you think, oh, maybe I'll just get over it, or maybe it'll just go away on its own. And sometimes indeed it does. But the idea behind your doctor, your healthcare provider seeing you for long COVID And maybe being more familiar or less familiar with post-infectious illness. If they've seen a lot of it, they'd be more familiar. If they haven't, they would not be as familiar. But why does my doctor send me, uh, to a specialist or send me to get particular testing done, or a little of both, when I came in and I just said I've got Long COVID? And I'm fatigued, and I've got palpitations, and I've got these other things going on. Why would the doctor do that? Well, here's a particular case, and there are many, many of them. This is one that I hope illustrates the point, and that is that the person comes in and they have had COVID. They qualify as long COVID because it was more than four weeks ago. And they have a lingering cough. They have temperature problems, fevers that come and go. They're very fatigued. They have joint pain. All of these things going on. And so we say, well, okay, that fits in the category. Certainly those are all on the CDC's list for long COVID. But in order to do good medicine, first do no harm, right? So one of the things in medicine that can frustrate patients is sometimes you have symptoms that look like one problem, and maybe they're that problem, but what if there's something else as well? And we don't do any investigation, we just blame it all on your initial issues, and then you have some sort of medical issue that comes downstream. from that. You have a problem with your heart or your kidneys or your lungs or some other thing. Well, in this particular case, the patient was very frustrated because it had been much longer than 4 weeks, and they really didn't like being fatigued all the time and in pain, having a cough, etc. And so in addition to A physical examination and a little bit of radiology, some imaging that was done to check on some things. We did a fairly broad laboratory panel, and on the laboratory panels you can pick up signs of clotting issues, kidney issues, some heart issues, many other things. So we're looking at the big you know, organ systems to make sure they're not falling apart. And then also in post-infectious illness, and we've seen this a lot with COVID there's another phenomenon which I've done a number of videos on. You can go to YouTube and look those up, which is called co-infection. And literally since the beginning of COVID the science are looking at Okay, if I have COVID, do we find any other infections with the COVID patient? Just about every paper that's been published, and now there are many, many papers that have been published on this, shows that when we look for infections with people who have COVID, we find other infections that are not COVID. Some are viral, some are fungal, some are bacterial, some are even parasites, and some other odd things. Yeah. So one of the problems in medicine is that when it's a broad spectrum of things like that, it does become hard to test for every single, you know, bug that you can be looking for. There's a particular group of them that are quite common, and so we tend to screen our long COVID patients for those. This particular patient, on the positive side, didn't appear to have any organ damage— their lungs, their heart, Kidneys all seemed to be functioning fine based on the labs and the imaging. But when we looked at some inflammatory markers, they were still elevated, very common in long COVID. And when we looked at some of the more common co-infections, or I call them you know it's like an infection sees you're sick and they pile on. So you know you see that in football. You know, someone's down and someone jumps on top, this guy's already down. Well, that's kind of what infections can do. In this case, with this patient who had this collage of fatigue and cough and joint pain and everything, they had a common co-infection called Mycoplasma pneumoniae. Now, this is an atypical pneumonia bacteria, so it doesn't cause your lungs to fill with pus, you know, like a streptococcal pneumonia or something, but it causes a global inflammation in the lungs. And you might think, well, wouldn't they just have a cough then or something like that? Well, the problem is that in the presence of other infections, Mycoplasma pneumoniae not only gives you lung inflammation, but it can also create other problems. It's associated with joint pain, fatigue, other Systemic type of effects. Now, we certainly found, as I said, other things that were inflammatory in the markers and other things to do, but if we wouldn't have gone and looked for that secondary cause of the symptoms, we wouldn't realize it was there and we wouldn't be able to target it and treat it. Now, imagine if your doctor said, well, okay, so you've You've got long COVID, but you're having a lot of cardiac symptoms, and I think that you have enough cardiac symptoms that that we should have you see a cardiologist. You know, I'll I'll do some labs, but I really you know think that you need to see a cardiologist. Some patients, you know, I've heard this, will say, "Do I have to go to a specialist?" Well, if your healthcare provider, your primary care provider. Has a high enough suspicion that you need to see a specialist, whether it's a kidney doctor, a heart doctor, neurologist, whoever. What they're saying is, we want to make sure somebody who really, really focuses on this organ system checks you out to make sure you haven't started to have a dysrhythmia, rhythm problem with your heart, or you're not not having some other secondary damage that your heart is having. Same could be for a pulmonologist for your lungs or whatever. So the reason, if you go in and you're complaining of post-COVID syndrome, you, you certainly ought to be getting a whole lot of labs done, but you might be sent to a specialist or two. It's just to make sure that, you know, there wasn't long-term organ damage that's also going to have to be dealt with. And so if your primary care provider feels it's at a lower level that they could do a few tests and check out, that's what they'll do. If they feel it's at a higher level that they're going to want a specialist to take a look at, that's why they're going to refer you. So when you're thinking it about Long COVID, the first thing is, why might I need a referral? Well, I just explained that. You may need a referral from primary care because there might be specialized testing, there may be other things that that specialist can look at, and the idea with a specialty referral is that's what they do all day, every day. And so they're going to see patterns and do testing that's a lot maybe more laser-focused and maybe a little quicker With their conclusions around the patterns of your illness or your organ disease than a general practitioner, etc. But the next thing is, if there is indeed damage to your lungs or to your heart or to your kidneys or your brain, you need to have that diagnosed appropriately so that then everybody who's treating you knows why you're getting a particular treatment. You know, if you have, for example, I've had patients where, uh, they had, uh, thankfully a small stroke and they were sent, you know, to the neurologist and they get cleared by the cardiologist and they wind up with a particular strategy for post-stroke care and we're back to managing, but at least we know we've quantified the organ damage. So that's why the referral exists. Now, how do most referrals with Long COVID work out? This is where people get frustrated, and I hear this weekly, if not daily. Well, I went in, I saw my primary care provider, I was a good patient, I went to their referrals, sometimes 1, 2, 3, if you count the lab testing and imaging, sometimes, you know, another couple on there, and they said everything's fine. Cardiologist checked you out, no problem with your heart. Neuro checked you out, your brain's doing fine, the imaging looks good. We don't have any conclusions. Now, pardon me, the frustrating part of that comes in not realizing the silver lining there, which is you don't want the cardiologist or neurologist to find something wrong with your organs. The downside is that if the originating doctor or healthcare provider isn't used to doing post-infectious illness care, they may not know where to go from there. And so that's where people like our clinic, people who do post-infectious medicine, people in the now new specialty of Long COVID, are usually where you try and wind up, which does wind up being quite frustrating at times. So where else can you go if those things have been cleared out and okay, we're happy, we're celebrating, our heart's in good shape, our brain's not got a problem, etc., but I'm still sick? Down in the show notes on the YouTube channel, I'm going to put some referral links for doctors that can look into those sorts of things and post-infectious illness. As always, I'm not giving medical advice, I'm just giving my experience and general information about these things. But it has repeatedly borne out to be the truth, and the big point of this is your doctor by referring you is just trying to keep you safe. If all of the referrals say there's no problem, that doesn't mean you're not sick. You just need to get with somebody who works on post-infectious illness. All right, please, whatever you're watching us on, like, share, and subscribe. Do the notification. Because sometimes we don't get pushed up on the algorithm. And check us out on dranow.com. I've got my newsletters and links to everything and all of our other media on there, dranow.com. But we are done for right now, and we'll get on to our next section.
