LONG COVID UPDATES - MEDICAL GASLIGHTING & A BRAVE NEW WORLD | Medicine & Health Podcast

Welcome to Medicine and Health with Dr. Paul Anderson. This is a show about opening the often mysterious world of how doctors think and how science works. This program exists to educate and empower you, the listener. Now here's your host, Dr. Paul. Hey there, I'm Dr. A, and today Medical gaslighting and post-COVID or long COVID syndrome. None of it's going away. So what do we do about all this? Today, I really want to dive into this and both explain, you know, what I think goes on in these areas, but also kind of explain why long COVID or post-COVID is a diagnostic challenge and give you some tips as to ways to think about it. maybe things to ask for, or maybe other help to seek. So as we say in the intro, this is Medicine Health with Dr. Paul Anderson. I'm Dr. Paul, and we're going to get right into it now. Uh, we are coming to you through a whole bunch of different ways. It's live streamed on Facebook. We'll move this over to YouTube tomorrow. We're on pretty much every podcast pod burner I can think of, so Whatever way you use this, please like, share, subscribe, do notifications, comments, all that. It all helps. The YouTube channel is where I put all of the links I'm going to tell you about, so in the show notes. So I'll explain that coming up a little bit later. But this video will go on YouTube and you can get it there, and also the show notes. So we can't put the show notes at any of the other avenues. But But what I want to talk about today is I did a post, I reshared a post about medical gaslighting from the New York Times. They had a wonderful article about it, and I'm going to put a link to that, of course, in. And that is something that's, you know, it's unfortunate, but it's nothing new in medicine. So Medical gaslighting, gaslighting, and then why that's happening with some people with long COVID or post-COVID syndrome, whatever you like to call it. And then talk about some of the medical reasons why long COVID is such an enigma in a lot of parts of medicine. So to think about it now, gaslighting— there was a famous movie in 1944 with Ingrid Bergman and Charles Boyer called Gaslight. And it's a dark film noir picture you can watch if you want to. Doesn't have anything to do with long COVID, obviously, but to gaslight somebody technically is to use some kind of psychological manipulation to sow self-doubt and confusion in their mind. So in, in a non-medical sense, it might be And I think we've all had this happen where you talk to somebody and you say, well, remember yesterday, or remember last week when I told you this? And they look at you and they say, you never told me that, I've never heard that. Okay. And things of that nature, like just, just shutting you down, doubting what you're saying, you know, that sort of thing. Now, in medical gaslighting. If you want, you just go to the New York Times link that I'll share, and there's a whole article on— it's a very good article. But basically, medical gaslighting is where the provider, for various reasons that we'll talk about later, minimizes your experience. They may tell you that, well, there's nothing wrong with you. I can't find anything wrong with you. Maybe you're depressed. Maybe you're whatever, right? And it goes on and on. There's all these criteria that people make up, but that's sort of the bottom line of it. Now, when I started to see this and I started to see people writing about this, I was not surprised at all. Because if you work in the world of chronic illness, which has been the bulk of my career, whether with cancer patients or with non-cancer chronically ill people, You know, they experience this all the time. Now what I'm going to tell you is it's, it's very common. And I'll also tell you that in many cases, the healthcare provider that might be doing it might not realize that they're doing it. And there might be reasons why they're acting the way that they are that I want to talk about towards the end. But it does happen. Any chronically ill patient will tell you that this has probably happened to them. Anybody who has chronic fatigue syndrome or CFS/ME, any patient with chronic complex illness like Lyme, Lyme and co-infections, anybody with fibromyalgia, anybody with any number of these other sort of things will probably tell you this has happened. And in some cases more than once, in some cases kind of in some very unpleasant and unfortunate manners. So while this idea of medical gaslighting seems kind of obvious, it's, you know, the healthcare provider normally is not trying to sow seeds of doubt in your mind or make you confused or doubting yourself or whatever. It's just the interaction. And so it looks like gaslighting. And like I said, we'll circle back around. We'll talk about the whys that that happens. But The big picture there is that when you get to chronic illnesses, and now that COVID is worldwide, and now that long COVID or post-COVID syndrome or whatever you're going to call it— there are many names— now that that is a big deal and that's not going to go away, we'll be dealing with it for a long time. The forces that create a healthcare provider saying, well, we can't find anything wrong with you, I don't know why you feel so bad, or it's all in your head, or whatever it is that happens are coming to light, okay? And it's becoming, uh, well known all around, you know, the world that this is happening. So a lot of the reason that it happens is the paradigm through which you view medicine and illnesses and all of that. And while there's much that is the same regardless of what type of illness you have, if you have a complex chronic illness, which Long COVID now is, It is very difficult to apply the rules that we would apply for acute care medicine to a complex chronic illness, because some are the same and some are very different when you get there. So there's a big paradigm issue that creates this feeling of gaslighting, and I've heard, you know, just some real bad stories from patients. I've heard, you know, interesting and unpleasant stories from healthcare providers and all sorts of things. So As we go through there, what I want to talk about is specifically to long COVID. So as we go through, I'll probably just say post-COVID or long COVID, you know what I mean. Um, I think it's important for us to talk about why do we develop long COVID, so can we get some understanding around what causes it? And keeping in mind it's not one thing, of course it's associated with you having COVID probably, but that's about it that's in common. And more importantly, and more to the point of today's program, I want to spend the bulk of time talking about how do we think about it and what can we do about it if we have that going on. So we see things like— I saw a news report and they were interviewing Dr. Fauci. And if you don't know who Dr. Fauci is, you probably haven't watched anything in the last 2 and a half years. And they asked him about long COVID, and he said, well, the problem is that we don't know what causes it, and we have no treatment for it. So that's, you know, that's a real downer if you got all these, you know, hundreds of thousands of people with symptoms, and, and the purported, you know, chief infectious disease doctor is saying, well, good luck, we don't know what's causing it. And then I saw other interviews with doctors who said, you know, it's frustrating, as a doctor because we do these tests, we do objective tests on the patient and nothing is wrong. We can't find anything wrong. Again, going back to this idea of we're using an acute care medicine model to try and diagnose a chronic problem. So you got a problem there. And then I did a show just about a month ago and I'll put a link in there. And there were 2 papers that were published about long COVID. And one essentially said, look, we did all these tests on people And there was nothing that came out in the data that showed there was an objective cause for long COVID. And then the other paper, which was sort of a counterpoint— wasn't meant to be a counterpoint, just turned out that way— said, well, maybe we should be looking in other areas. So you've got some doctors saying, well, look, here's this research that says there's nothing wrong and we have no way to test it. So that's terribly frustrating on the side of the doctor. And so when we're thinking about that, and again, I'll make a link to that other, if you're interested in those papers about long COVID, I'll make a link. But as we think about it, you can kind of see where either through frustration or lack of knowledge or lack of expanding the paradigm in medicine or whatever it is, you could get a healthcare provider that's very frustrated and they'll say, oh, another long COVID patient. And here I tested the normal stuff and nothing came up that is helpful. So we think about post-COVID long COVID, the first thing that we need to think about is safety issues. Anything with medicine, when I was teaching medical students, About their taking their boards, and we would always say, well, look at the case that you're being tested on. And the first thing you want to look for is, how is this patient likely to die in the near future or be very sick? And that's, you know, you have to look at what's the worst possible outcome and then work our way out. So the first thing that we want to think about is safety issues. Now, as I always say, nothing about this program is medical advice. This is my opinion. This is for informational purposes, for you to be educated and informed and speak with your healthcare providers. So don't take healthcare advice from me or anybody else on TV or the radio. But you can get a lot of information that you can sift through and decide what you need to interact with healthcare provider about. But safety issues. So the first thing You do want to see somebody if you have long COVID. And the first thing that's going to happen, and we'll talk about, we'll break it down a little bit, but usually they're going to take a history. They may do physical exam and they may look at some labs. Now, in many cases, that might be the end of what the primary care provider does. They may refer you. So if you have lung symptoms or heart symptoms or brain symptoms or whatever, you might see a cardiologist, pulmonologist, neurologist. Might send you to some other specialist also, and that is because the referral is there to make sure that one of the very bad things that can happen in post-COVID, like organ damage, is being ruled out. And the primary care provider might not do those rule-outs. They may rely on the specialist to do that. So that, that's not a problem. That's just what happens. Okay. Um, And so the positive side of that is at least they're ruling out major things. So we're going to talk about what the rule-outs are, but they're making sure that, you know, you haven't gone into a severe anemia or you haven't got, you know, some supreme amount of liver or kidney damage, or there's, you know, your lungs or your heart or something isn't having big problems. So it's about safety, right? Now, when we think about this, the safety-first thing is always what you do in medicine, and you should. But that doesn't mean that tells us the whole picture or the whole story. And so there's a lot of people, um, who will come out of that and they'll be told, well, we can't find anything wrong with you. Um, maybe we should give you— and fill in the blank, you know, we'll give you an antidepressant or anxiety medicine or something like that. Now, it can be very frustrating when you feel horrible, and that's very legitimate. You, you should, you know, maybe get a little bit more advice than just that. But the provider, basically what they're saying is, well, we don't find any organ damage, we don't find anything else wrong, and your basic labs look okay. So we don't, we don't know— how do we treat something that we don't know what it is? So there's that. Now, the other thing that I heard a lot about as I was looking through interviews with patients is a lot of patients right now, because of the COVID environment and medicine, the way it's practiced and everything, a lot of patients are not getting seen in person. So they're doing, you know, online video conferences with their doctor. Doctor might send them to the lab to get some labs drawn. But, uh, they're not actually seeing them. And so then you get to this point where there, you know, there's no real physical examination, and that's a big piece of the diagnostic puzzle. So that's another problem there. Okay, then there's another thing that I saw as I was reading through CDC and NIH and, uh, and a lot of other articles. And, and we've talked about speculative language before here, and it's fine to use, you just got to watch out for it. Um, a lot of, uh, speculative language would say, well, there's, um, uh, if you had— if you're vaccinated, uh, you're less likely to have post-COVID syndrome and all this. And I always found that interesting because originally when that was being said, vaccines were kind of early and it was very speculative. And then data came out that maybe showed that, maybe didn't show that. And, um, then a paper which I'll put a link to. It's, uh, it's a preprint right now, but it is being published in, um, uh, well, I'll give you the link. You can see where it's being published. It's a published paper. It's in peer review. But basically, they looked at a pool of about 336,000 people who'd had COVID, and then they had exclusion criteria which weeded out a large number of them. They got down to uh, close to 30,000 people. Um, and then they weeded through them to try and get as pure a sample as possible, and they divided them up. And this is in the paper, it's a little tree there, and on one side is people who didn't get vaccinated, the other side is people who were vaccinated. And it was specifically about post-COVID syndrome. So, uh, this is pretty interesting data. Now, the wild variant, the original, the Wuhan strain, of course there was no vaccine, so there's no Um, there's no, you know, vaccinated versus unvaccinated. You get over to Alpha and then the Delta variant— they don't have any data on Omicron yet— but basically what you see is there's really no perceptible difference in post-COVID syndrome between the Alpha and the Delta variant vaccinated versus unvaccinated people. So the speculative language that a lot of people have shared around, well, we believe— remember, I'll say, when we say we believe, we think, we infer, um, whenever we say that, we're saying we don't have a lot of hard data on that. So when you get to that and they say, well, it's, you know, probably more protective to have the vaccines, um, it's not looking like that in the data. Now, maybe the Omicron data will come out and be totally different, but given the fact that Omicron has the highest amount of breakthrough infections with vaccination and people, you know, the people who are vaccinated are in some areas the primary people spreading COVID now because most people are vaccinated. It's still spreading, they're getting breakthrough infections. I don't think that those numbers are going to hold up for Omicron either, but it's interesting. So, um, and again, please, you know, I'm not making a pro or anti-vax comment. I'm just sharing the data with you. And there's a lot of stuff that's been said and a lot of things built up in people's minds, especially in you know, the, the media. Um, and a lot of it was just simply conjecture, and, and I think we need to, we need to be a little bit more critical than that. So, all right, so we've got all that going on. So we do get the safety stuff out of the way, and then we can look at, well, are there predictors of long COVID? And here's the most disturbing thing. There are some. But there is a large group of people where it's more of a mystery illness, where they were quote-unquote super healthy, they got a mild, moderate, or bad case of COVID and they have been debilitated ever since. Horrible stories to hear and very, very troublesome. Okay, so certainly there is some data, and I've shared this in many other programs, that shows the more severe your COVID experience, your likelihood of post-COVID does go up. And that kind of makes sense if you're hospitalized or had severe organ problems or something like that. But we see the converse, which is you could have had a low-level illness or you could have been quote-unquote healthy and been very sick too with post-COVID. So you cannot rely on your experience with the primary infection We now appear to know from this data that's coming out, you can't rely on being unvaccinated versus vaccinated for long COVID. You can't rely on a whole lot of stuff. And this also is terribly frustrating for the doctors, the patients, everybody, because, you know, and I watched interviews with a number of patients who were just so obviously dejected and down because They were a healthy, functional, you know, fill in the blank, and now they can barely do anything or they're in a wheelchair. Okay. So that's not so great. Now, one thing I will say, if you are planning ahead and looking forward, is if you do more of a whole body treatment when you do get COVID, Our experience in a— this is not published, this is a casual group of a number of physicians around North America and in some other countries, but mostly North America, where we have a treatment pool of somewhere around 4,000 patients with COVID In that group, the amount of long COVID when the people were treated aggressively early for their COVID Uh, the long COVID cases are very tiny. They're almost non-existent. So I believe that there's a case that you can make there for aggressive early treatment. And if you go back to previous shows, you'll see that aggressive early treatment means working up and treating, or empirically treating, co-infections, minding how your, you know, endocrine, your hormone system is. Uh, taking it, looking at kidney and liver function, other stuff like that. So early treatment does seem to be a help, not for everybody, but does seem to be a help. And so then you go, well, what's this deal with these healthy people and suddenly they go from healthy to super sick? Well, in modern times especially, but I, I have, uh, I am not old enough to have lived forever. So I can only speak to what I've seen. Um, in modern times, there are a lot of people who are walking around feeling, looking, and acting healthy who have a lot of subthreshold potential disease, meaning their body is one big insult away from a post-something syndrome. So it's super frustrating because you don't— if you're healthy, you don't go looking for trouble, and you probably shouldn't. But one of the reasons is that COVID, like some other diseases we might mention later, is a great unmasker of occult disease in the body or occult weaknesses. So COVID unlocks and lowers your sensitivity levels to disease and disease triggers and all of that. So you could be feeling pretty good, things are going well, and then you get COVID, but it just— it opens a couple of doors biochemically, medically speaking, and unleashes other disease processes that then leave you with post-COVID symptoms. other— any other symptom. There's so many symptoms, and I'll put some links to things you can look at. So the thing that we want to keep in mind is it's the insult that then changes your sensitivity to the disease process. And so if I was resistant when I was healthy, but then I get hit really hard with the disease and it pushes my resistance down, then things that either from the outside or from the inside of me weren't bothering me before now are a big problem. So we need to be careful to remember that, uh, looking normal and healthy and your body behaving normal and healthy does not equal disease resistance all the time. And that is evidenced by the thousands of people that who have had good health, then had COVID at one level or another, and now have very bad health. Okay, so you, you have to keep that in mind as you think about long COVID. It's very frustrating. Now, there are other analog conditions, and one of the ones Nature Medicine, you know, one of the premier periodicals in medicine and health, has a paper I will link for you, a review article, and it's called Unexplained Post-Acute Infection Syndromes. And largely because of COVID they did a whole review of post-infectious syndromes. And these are well known in medicine, but they tended to be, you know, kind of minor or not very common, etc. And so what they're saying is, well, we've known about this forever. We've always had post-viral and other syndromes. And what they're talking about is what do these things have in common? What can we learn from other post-infectious syndromes? And where does the trouble start? So what I would like to do now is talk about where does the post-COVID syndrome come from? And there will be a number of things, and it's not encyclopedic. These are just the big, big ones. I'm going to kind of set aside the idea of gaslighting till the end. We'll talk about paradigms and stuff like that. But we want to keep in mind that, and I will again, I'll link this paper from Nature if you want to know. It's got some great pictures, great diagrams, stuff like that. Any paper I talk about, I'll put in the link. Now, where are the links? Go to the YouTube. When we put this up on YouTube, go to the description, which is below. If you're on your phone or your device, it's on the right side, a little down V, down arrow. On the left side, it'll say more or show more, and you click on those words and it'll show more. If you click on a down V and it goes to an ad, then they stack the ad right above the description box. So go back and go to the description box. So if you go and there's, you know, they're trying to sell you something, that's not me, that's somebody else. So post-infectious, post-viral, post-other syndromes are nothing new. They've been around forever. They just have tended to be marginalized or put in certain specialties, and we didn't hear a lot about them. But like I said at the top, um, if you've ever had a chronic illness, you've experienced all of these things already, and that's where a lot of that trouble comes from. Now, one of the areas in the Nature paper talks about something that I've done a number of shows on, and I even put all my research links in one of them. About co-infections and comorbidity. So co-infection is an infection that may have been totally silent and giving you no symptoms, but then you get COVID and it opens that up and allows that infection to fulminate in you. Or co-infection can be, I get COVID, it weakens me, and then I collect other bugs, and then they create a longer problem. Because if you don't treat most infectious things, they don't just naturally go away on their own. They can, but when you're sick and you run down, they don't. So they call that the pathogen reservoir. Then the next thing would be tissue damage. So this would be like direct— and we did some things on neurological damage and other stuff in COVID— to be like direct transmission of the virus up through the nerves, or direct transmission of the viral activity. along muscles or your lungs or your heart or any other tissue damage. Obviously, those can create a lot of health issues. Then they have one which they call dysbiosis. And dysbiosis means that the normal flora— that is, the balance of the bacteria and other flora in our body that we use mostly for our good and their good, it's a commensal relationship gets thrown off because of the inflammatory nature of the disease. And then we wind up with inflammation in the gut-brain axis. They talk about this in the paper. We get a change in our immunity, our immune status. We get a bigger load on our immune system and all of this stuff. Then the next area that they look at is autoimmunity. And we know from a lot of research that all of these areas they talk about in this paper, whether it's the pathogens, the bugs if you will, tissue damage, the gut dysbiosis, autoimmunity, we have research that shows yes, COVID switches things around so these things happen. Now what goes on is that when, especially with the way that COVID works in the body, you get an this infection, but the infection then shifts your immune response around. And again, we've got a bunch of old videos on that. But the bottom line is, is that that feedback then of the inflammatory chemistry in your body can shift not only your biochemistry, which is kind of important, it can shift your hormones, it can shift your immune status, it can shift your brain chemicals and your heart and your blood chemicals, all of this. stuff. And so that becomes very important. The other thing is this change in your sensitivity or your threshold. So you could have started really healthy, but then the disease gives you all this change in your inflammatory markers and gives you all these other changes. Then it opens the door to other problems. Well, then you also can have other problems that make you more likely to have a long-term illness. Another point of this, and the easiest example is with co-infections or other infections, is you can easily have latent infections that are chronic that are not bothering you because your immune system has marginalized them in your body. But then you get sick and like I said, COVID opens the door and these infections start fulminate. Well, if they're not COVID, so we're not treating them, they kind of go crazy. Okay, and that could either be from inside of me that was latent, or I'm just run down and the people coughing and sneezing around me give me some other infection that I may not even know I have. Well, that can also happen both ways with things like toxins, toxins that shift immunity. Infections we mentioned, hormone changes we mentioned, also cell function changes. Being sick and having all these inflammatory chemicals is very stressful on your cells. Well, your energy and the way you feel is partially derived from how well the energy of your cells is being maintained. And so if your body has been wrung out and beat down, you are going to feel that. Okay? And if you've ever had any, you know, bad illness, you had a bad pneumonia or influenza A that lasted a couple weeks or whatever, you know the feeling of climbing out of the hole afterwards. You're better from the infection, but you still feel horrible. Well, there's a lot to that that is the damage to our cell function. Okay? So as we're going through and we're kind of looking at all this stuff, then it begs the question, well, okay. And, and I, I said, you know, earlier, and I'll put a link back to it, I compared and contrasted those 2 papers about post-COVID, you know, one of which said, well, nothing we looked at was, uh, was statistically significant to show us, oh, here's where the trouble is. Then the other one said maybe we should be looking in other places. But the bottom line is, you know, the scientists and the people doing studies are going to argue about this forever, probably. And in Western medicine, we really don't like, you know, like chronic illness is complex. It requires a lot of juggling of medicine. There's a lot of other things. So we kind of have this worldview, this paradigm shift that has to go on. And a lot of, you know, a lot of doctors don't practice that kind of medicine. So what I want to do here is talk about the difference between a standard workup for post-COVID and then a broader post-COVID workup, because I think that that's important. And again, I'm, I'm going to just say this is my opinion. I'm not telling you what you should do. You should do everything with your healthcare provider. You might need to find a healthcare provider who works with long COVID, however, and one of the problems that we're seeing is sort of two-pronged set of problems with post-COVID. One is the post-COVID specialty centers. Uh, there are some out there, university-based, etc. Um, they may have waiting lists that are months and months and months long. Okay, so that's one problem. The next thing is you might find a practitioner who does chronic illness, but they may not be part of your insurance, and so you may have to pay out of pocket. And there's nothing I can do about either one of those things. I'm just telling you that that's the way it is, uh, kind of in Western medicine right now. So again, it's very frustrating. It's also very limiting. If, for example, you know, the only way you can get medical care is through your health insurance plan and the only, you know, provider who can help you is not in that plan, that is a big conundrum in medicine. We can't solve that here. You all know that it occurs. Post-COVID illness is just bringing that out to be more and more of a problem. And here's the other problem for the healthcare providers. In the past, they could have probably just shoved to the side anybody with a complex chronic illness and said, go see a different specialist, and they would refer them out. And many times the specialist may or may not help them. Now there are so many people who have post-COVID syndrome, it's forcing everybody to maybe be a little more vocal about, you know, the fact that they don't treat that sort of illness, and that is a big deal. So the standard workup would include a physical examination. And like I said, a lot of people are still doing virtual visits, and so the physical exam can't be done that way. It will include some basic laboratory tests, and that's different depending on where you are in the facility and the doctor and all that stuff. But usually they're going to look at the big things like, do you have anemia or any other type of abnormality in your blood counts? Are your liver and kidney functions working? Are your electrolytes normal? They might look at some clotting and some inflammatory things. They may not, but they usually do. And they may check a couple other things depending on your symptoms, but that's going to be it. And if none of that stuff comes out and says— So if none of those factors come out and say, well, here's a clear problem, they're severely anemic, or they have a real big, you know, thyroid problem, or whatever, um, they're going to look and say, well, we don't see anything wrong. So, and here's the conundrum your healthcare provider has. If they work you up and in their paradigm they've worked up what they know to work up, and they find nothing wrong, they don't have anything to treat. Nothing is wrong, right? I mean, you're not going to give somebody most drugs, uh, if nothing is wrong. Now, the exception to that is you might get some anxiety medicine or depression or something like that, but that's really not gonna— I mean, it might help some things, but it's not gonna help the underlying problems with post-COVID. So what would a broader workup be? And when I train physicians to do these things, what do I recommend? Now, I'll say at the top of this that these recommendations, again, these are, these are my opinion based on a long history of treating people with these types of chronic complex illnesses. But your healthcare provider may totally disagree with all of this and say, we won't do that. So I'm just giving— again, I can't fix that, I can't change that. I'm just telling you the way that medicine is. But you may be able to find a different provider to help with that. So the first thing is you need to rule out organic disease safety first. Okay, so If we do see something and you've developed a heart dysrhythmia or you've got some other problem, you may need to go to a specialist and have that worked up, or maybe your, your primary care does that. But we do want to be mindful that we don't want to have an organic disease in your heart or your brains or your lungs or, you know, anywhere. So safety first, rule out organic disease or include that You know, if you've got some organic disease, it will still do the other stuff. And the rest of these don't go in any particular order, but another factor that is of great interest, uh, and what I have seen is you get hormone shifts in, uh, long COVID. And this is another thing where you're— that sensitivity change. So I was really healthy before, now I feel horrible. How could I go from healthy to disabled? Well, hormones can do that. Well, why would hormones shift? Well, when you have all these inflammatory chemicals in your body from something like COVID, that doesn't just affect, you know, hurting muscles and joints and stuff like that. It also has feedback into your hormone system, which is regulatory. So in addition to screen— this is a difference between a broader look and a standard look. In a standard look, they might do a screening test, say a thyroid, a TSH, or a TSH and a T4. And those are good screening tests, and those— they may look totally normal. What we're seeing in post-COVID is we also add on, uh, looking at free T3, which is the active thyroid hormone. We look at the antibodies for thyroid function because it's now known that people develop autoimmunity through, you know, COVID and other infections. And so we'll look at the antibodies. We'll also look at something called reverse T3, And the bottom line there is, uh, that is a test that's usually reserved for chronically ill people, and it is a way that the body tries to shut down thyroid function. So sometimes your rest of your panel can look good, but the reverse T3 is high. You've got a problem where your body's trying to shut off your thyroid, and that requires somebody to deal with that, of course. Also, we'll look at cortisol, which is your primary steroid from your adrenals. Your adrenals make lots of steroid hormones. hormones. But morning cortisol is a good marker. So you go get your blood drawn, we do all the thyroid tests, we'll add morning cortisol. And it's a big range. So there's adrenal diseases like Addison's and Cushing's disease, and there's some other adrenal diseases. What we tend to see with people is that morning cortisol is a broad range, but it really should be towards the upper half of that range. And a lot of people with fatiguing illnesses and stuff, will be at the very bottom end or the low end of the normal range of cortisol. Now, because it doesn't qualify as a disease, it's a functional problem. And what that means is there may be things that you— your provider would do to support your cortisol function or something of that nature, but should be looked at. Beyond the thyroid autoimmunity, so the thyroid antibodies, we also will run antinuclear antibody panels. Because some people with latent autoimmunity infections will make it not latent, and so the body is fighting with itself. And interestingly, in this Nature Reviews Medicine article, that is one of the big— it's the upper right corner here— is triggering of autoimmunity by COVID and the COVID process. And here's the thing with these tests, if you don't look you don't find it. Okay, then there's, uh, clotting and inflammatory testing. So that might be, uh, looking at, uh, fibrinogen, D-dimer, CRP, you know, any number of testing that may go on. We know that there's a lot of clotting issues around COVID complex. Then the, uh, seemingly controversial one, which really shouldn't be because of all the data on co-infections, is looking for co-infections. So first thing that you test for is anything the person had previously that's a chronic infection. So if they come in, they say, yeah, you know, I had Lyme disease and I haven't had any symptoms. I was treated and I got better, but I had Lyme before, or any other thing. We retest that. If they don't have a history of chronic infections, then remember, we can acquire them when we're run down. So I will usually look at certain viral illnesses like Epstein-Barr now has data showing it's commonly reactivated during COVID Epstein-Barr has some cousin viruses we will look at. There's some atypical pneumonia bugs, so the Mycoplasma pneumoniae, Chlamydia pneumoniae, and some of those we will look at those because they often come out of latency when you're sick. There's other things around chronic streptococcal inflammatory things. We mentioned Lyme and co-infections, Candida, other fungal infections. And in addition to Candida, there, there's also some other kind of nasty fungus that get kicked up with COVID Now the next one is the area of toxicants, and the one that we would there's a number of toxicants, but the one I think that should be tested no matter what would be mycotoxins, which are mold toxins. And so some will say, well, I haven't moved, I haven't changed my job, how could I have mycotoxin exposure and, uh, not change anything? Well, it's not that the exposure changes, it's that your sensitivity to it changes. Why would I pick mycotoxin screening first? Because mycotoxins tend to be immune suppressive. They're not good for you on a number of levels, but they're immune suppressive. If you're trying to recover from an infectious illness, you're going to have trouble if you have a lot of mycotoxins. Now, there's other toxins you can do, but you can do urine tests as a screening for mycotoxins. In some people, especially if they have a lot of pain and fatigue, we might do some cell function testing. There is, uh, there are some testing like 8-OH-DG and other testing for, uh, cell viability and DNA activity and things like that. Those are a little more specialized. And there's a whole bunch of other tests if they're indicated. So, you know, maybe it looks like you might have some, you know, kidney stress, we might do more kidney testing. You have some lung stress, you have whatever, you may do more, or you might be sent to a specialist for that. But you can see that there's a lot that goes on. There's a lot that goes into the workup of somebody. Now, interestingly, um, I think it was probably when I shared my experience, uh, when I had COVID the second time, uh, so yes, I'm that lucky, uh, I had, uh, what we believe now, uh, was the original Wuhan strain. I was in China The right place at the right time. That's that's sort of a joke. I didn't try to go there at that time. I just happened to be in China, and it happened to be when when the initial wild type was out there. And then later I got Omicron. You know, when when Omicron was new, and that's kind of a common pattern. People that had vaccines or early exposure to the earlier virus, Omicron, came around. It was like, we don't care about vaccines, we don't care about earlier exposure, we're going to give you Omicron. So when I, when I posted my story about that, people were— um, not everybody, I mean, a lot of people like the, the story in the video. It's, it's on the YouTube if you want to go listen. But, uh, some people were like, well, geez, you know, why did you treat yourself so aggressively, uh, for, for your second case of COVID And some people said, you know, all I did was rest more and I hydrated, or some people said, oh, I, you know, I did this or that, and you, why'd you do all this stuff? Well, part of that was my medical history. I'd already had a very bad bout with the wild type, the Wuhan strain of COVID didn't— almost didn't live through that. And then also I have a history because long career in medicine. that goes back to the '70s at this point. I've been exposed to all sorts of, you know, these sort of latent illnesses, and they get woken up. So I was very aggressive in treating the Omicron because I knew, I knew what I had at that point. And the reason I was that aggressive was this story I told you about, this big group where we share data, and the more aggressive we are with people more likely to get long COVID, the more they don't get long COVID. And that worked. I had no— I just had my acute COVID, and I had an exacerbation when the other infections came out, and then we got them all under control, got everything, you know, tidied up, and no long COVID. So great. But then you get people saying, well, that's excessive and no one would do that. No, no, what you need is not excessive. If you need it, it's not excessive. If you don't need it, it is excessive. So this is where you have to have some clinical acumen and some clinical advice that makes sense to you. So if you have a small problem, you probably need a small amount of treatment. Now, if you have a small problem and you're previously healthy and suddenly, boom, you've got this big post-COVID, you don't have a small problem anymore. The fact you were healthy before is meaningless As far as what you need to do now. If you're real sick with post-COVID, you got to do this broader sort of workup and start turning over rocks and find all the places where you're messed up so that you can get appropriate treatment. So if you have a small, medium, or large problem, start out with a small, medium, or large treatment and investigation. So if a post-COVID patient comes and they say to me, um, you know, I'm, I'm just so a little latent fatigue, but everything else is working good. I just would like to feel better. You know, our workup may be a little more focused. If we have somebody that says, you know, either I was super healthy before, I was sick before, and now I'm really sick with post-COVID, we're going to do a lot of things to uncover as many rocks as possible. Now, when I move this over, uh, from the radio and the Facebook Live and everything else and put it on YouTube. So it's, uh, Dr. A Online is the YouTube, D-R-A Online. Uh, I will, in the show notes, I'll put down, you know, lists of what we're— what I look for and all of that other stuff. So we— you don't need to try and scribble all that down. But the bottom line is you do need to kind of take a pretty broad look. Uh, and again, you match the investigation and the treatment to where you're at now. It's frustrating that you were healthy before you got COVID. Now you got hit really hard with long COVID, and we acknowledge that and we value that information. But if you got long COVID now that's debilitating you, prior health is out the door and we have to deal with you as a very ill person. Okay, so in the last minutes, what I want to talk about is I want to kind of wind back to why Why is medicine having such a hard time kind of ramping up? And, you know, and you feel like you're being gaslit. Maybe you're not, you know, or maybe it's just the frustration of your healthcare provider. Um, so why would your healthcare provider, you know, seemingly gaslight you? They're probably not trying to, but why would they? Um, well, the biggest thing is that COVID to a small degree and post-COVID to a large degree is a multi-factor illness. And acute care medicine is the main paradigm that we all are trained in and that we all do. And that means, you know, if you break your leg, we, we do what's appropriate to get your leg set and get it immobilized and do whatever else, and your leg's going to heal. If you get strep throat, we give you appropriate antibiotic and work through, and, and you're going to get better, uh, in most cases. If you you know, get stabbed in the arm, you know, we're going to take care of that and sew you up and all of that business. If your appendix gets hot or bursts, we're going to go in and surgically clean it out. These are, these are kind of acute things. They've got a linear pathway. When you get something like long COVID where you've got not one input, meaning a knife in your arm or an infection of one kind, or an burst appendix. Now you've got a whole bunch of inputs, and that's because the COVID is a piece of the problem, but what it does is opens the doors to all these other problems. So that's a multifactorial disease, chronic disease paradigm that is totally different from the acute care paradigm. What they share is safety first, but after that, you have to start looking at multiple factors. So Then that begs the question that, well, that's, you know, a lot of medicine is practiced in the acute care model, and your practitioner may not do multifactorial chronic illness. Okay. That practitioner then is going to be just as frustrated as you because they, they— that's not their thing. That's not what they do. Okay, the COVID specialist clinics, probably a step up if you can make it. And if you have time to wait for their lead times, which are quite long, then there's the financial issues around insurance. And what, you know, what if the providers that are on my insurance, none of them do chronic illness, and I have to go off insurance and pay out of pocket? Well, you know, that is a reality of medicine, especially in the United States and Canada, actually. And so It's a very frustrating thing for both sides of the equation. So one of the things that I want to do as I put these things up, and again, I won't belabor, you know, giving you links here, you know, on the audio or on the video if you're watching. I'll put them over on YouTube in the description with all the other links. I'm going to link a number of providers uh, not providers, but provider organizations that have providers that do more of the chronic illness care that's usually needed for this. I'll— it will not be inclusive to everybody, I apologize, but I'm gonna do the best I can to give you as many links as possible. And I will try and also have links to, you know, COVID specialty clinics and stuff like that. The thing that you need to do though Is obviously these are just links to, you know, find a doctor links for different organizations that do chronic illness care. You need to vet the healthcare provider and the clinic. So the first thing, and normally it may be on their website, so that might be easier, but usually you can communicate with a clinic either through phone or an email. and just ask, uh, do you treat chronic illness and specifically long COVID? And they will generally tell you yes or no because there are a lot of clinics that might do other chronic illness, but they just— they haven't got any long COVID patients. So the first thing you want to do is vet that the clinic actually does this. Then the next thing that you want to look at Just as a matter of practicality is some of them may be within your insurance reimbursement, some may not be. So just be clear on that. And that's not to make a judgment about, you know, as I said, I can't fix the way insurance is done in the United States. But you should know going into it, you know, is this going to cost me some money out of pocket or, or is my insurance, or it might be a mixed year, because there might be some things that your insurance won't pay for or will. Get as much information about that as you can on the front end. And then, if possible, and let's say it's a local, you know, clinic or something, see if they have any, you know, people who have already been there and, you know, can give feedback. And often that helps. So, you have to do some due diligence, but there are healthcare providers out there who have already been doing chronic illness care, and they're very set up to help you with long COVID. Now, it may not be a quick turnaround of treatment. You may take a long time to heal. It may be a lot going on. That's the, that's the way it is. I can't fix that either. But getting the right workup and getting to the right type of provider can very much help you in your quest. All right, so remember, uh, DRA Online is the YouTube channel. That's where we're going to put all this information, the links and all of that. If you get lost because I'm on so many media places, go to dranow.com. D-R-A-N-O-W dot com. That is my hub link, and it's got links to my YouTube and to every other piece of social media that I do, and you can find that, and we will. See you all next week on the radio, but I need to get off the radio right now. So check me out over on YouTube, like, share, subscribe, and thank you very much for all you guys who've been subscribing. I'll see you next week.