The Long-covid pattern I'd seen before..

Today we're starting a series on long COVID because it's become such an issue where we get so many questions and people are pretty frustrated with it if they have it. Doctors are kind of frustrated with it, so I thought we would go into this deeply but break it up into smaller segments so it makes a little bit more sense. So today, the first section I want to talk about is really, what is long COVID? And long COVID can also go by post-COVID. There's a few other names as well, but at this point, I think we all know at least the idea of what it is. So the first thing I think is just to kind of tell a story of long COVID early in COVID. So, you know, think about 2020, probably 6 months in. Of course, COVID had been around in the world prior to that because it was named COVID-19 from 2019, but we were really dealing with it more here in North America in 2020, and about 6 months in, I started to see a pattern developing with patients who had had COVID that I had seen before, and you might think, well, you'd probably never seen COVID patients before that you knew of, and You know, not many of us in many places had seen SARS-CoV-1, thankfully. So what was this pattern that I was seeing? Well, the pattern I was seeing was very, very similar to post-infectious illness that we dealt with in our chronically ill patients very, very commonly. And so I started to see, and I wondered, because, you know, COVID was a viral illness and we didn't know really anything about it, and we were just dealing with people who had it and doing the best that we all could. Mm-hmm. Would COVID have a portion or some sort of factor that pushed it into a post-viral illness category like we see with other infectious illnesses? So you may have heard of post-viral illness. I've done shows about it. You can have that after influenza. You can have that after Epstein-Barr virus. You have it after bacterial infections, all manner of things. The bottom line is a post-infectious illness is where something that the primary infection does sets off your system, whether it's your immune system specifically or other body systems that you have, and it sets your body on a different trajectory of health. So now you have lingering problems. And as we'll talk about in other areas, There are sometimes not lingering original virus or original viral problems that create this, so it can be triggered by the original infection, but sometimes the original infection may be long gone when you get the post-infectious illness. So that is where I started to see this pattern repeating. Now because we had been dealing for decades. Decades with people with other post-infectious illness, that's why I said this looks a lot like what we would see with other infections when we have these chronic problems that go on afterwards. So that's what led me into starting to think about post-COVID or long COVID as more of a typical post-infectious illness. Now you might think, well, You know, how come people weren't talking about that early on? Well, some people were, people like myself who already dealt with post-infectious illness, but in the general medical community, post-infectious illness was considered to be very rare or moderately rare, and we did not know whether or not COVID would qualify as a post-infectious illness trigger. Well, certainly it has, and it does. So that led down the pathway of, okay, If it's a post-infectious illness, which it clearly is, and just like every other post-infectious illness, not everybody who has COVID develops Long COVID or post-COVID, what could be things and what could be ways we could look at Long COVID that would be similar to the way that we deal with people with other post-infectious illnesses? So So a basic question, uh, as, as I'm going through these 16 different videos to talk about post-COVID illness, a basic question that I get right up front is, well, does anyone even know what, you know, long COVID is or what post-COVID is? Well, if you go to the CDC, so from cdc.gov, there are a couple of pages that they have for, for long COVID or post-COVID illness, and it goes through a listing of, okay, you have to have Symptoms that are following at least 4 or more weeks after your original COVID illness, and of course what we see now, this, you know, was sort of developed a little bit earlier, sometimes we see people with a little bit longer initial illness, some with a little shorter, but the bottom line is, if you're still having signs and symptoms after a month, you start to get into the qualification of long COVID. Now, when I look at the list of symptoms, if you look, there's particular categories that I think we've all seen and heard of. So there's systemic type of symptoms, we'll go over a couple of those. There's heart, there's lung, there are musculoskeletal, so joint and muscle issues, there are digestive issues, and certainly there are neurological issues. Now, the list from the CDC are just the most common, and then they have another list of less common. So one of the frustrating things, if you're looking at it as a very linear, well, I have to have these symptoms or I don't have post-COVID, it doesn't work that way with post-infectious illness. You have to have some late effect that is not letting go of your body, and so you have signs and symptoms that keep going on. Even after the infection has usually left your body. So in my working with other clinicians, helping, uh, with COVID management, working with my own COVID patients, and, uh, now working with people around long COVID, what would be the top, uh, let's say even, you know, 13, uh, symptoms that, or signs and symptoms that we often see? So it's not a lot, it's not a short list at all. There's many, many things, but the top ones, going in no particular order here really: fatigue, very common, post-exertional malaise, so you do something and you crash afterwards, maybe you felt fine before that, lingering cough, chest pain, Heart palpitations, other chest-type problems. Brain fog, very, very common. Headaches, sleep disturbances, dizziness of large varieties, changes in taste and smell, depression, anxiety, and other neuropsychiatric type of diagnoses that may either be aggravated from before or new. Joint pain, muscle pain, and then changes in hormonal parameters, often noticed in changes in the menstrual cycle. Some of our male patients notice low testosterone symptoms, any number of hormonal changes. So those are really the top 13 things that I've seen and had reported back. Now, this being the first of 16 parts, I just want to explain post COVID and explain how broad it is, because then what we're gonna talk about is how is it that it is diagnosed, how complex is the diagnosis of it, and then how might it be treated. Now, we already know if you read any, you know, popular media about Long COVID or post-COVID illness, that there are a number of layers to post-COVID illness that can create problems. Those layers then include both major organ damage and then other dysfunctional damage within the body, and so when we look at this, what we're going to think about is when we're thinking of long COVID, a reason that it can present with almost any body system involved as far as. Symptoms is that it is an immunologic challenge that is a little bit unique, but not totally unique in the post-infectious world, that can open the door to either a direct insult on an organ like your heart, kidneys, your lungs, etc., or may leave the organs alone and throw off A controlling system such as your hormonal system, your endocrine system, and we'll get into that more deeply in another section, but the endocrine system is often thrown off and then that gives you the other symptoms. Endocrine symptoms, like we described, could be, say, menstrual changes, low testosterone symptoms, but also low thyroid symptoms, neuropsychiatric problems, all sorts of things because the endocrine system Affects your whole body. So that's how long COVID can wind up being such a wild card when it comes to signs and symptoms. And so for most people, human nature is we want the simplest explanation possible. And the problem is is that the way that that long COVID develops in the body is very unique to your body and how your body dealt. with the initial infection. And then if you add on top of that, that you maybe had some other medical issues prior, and so the Long COVID stacked on top of your other medical issues, and/or maybe the COVID experience opened the door to some other infections you didn't even know you had, you could see that one person's Long COVID experience may be completely different from another person's. One person may have cardiac damage, lung issues, kidney issues. Another person may have none of that, but have all of these other seemingly bizarre signs and symptoms. So we're gonna wrap up this little section here in the last couple of minutes, but just to remember, the first thing is Long COVID is a new phenomenon, but it is not a new idea. It is a classic Post-infectious illness. Number two, technically speaking, according to the Centers for Disease Control, you need to have lingering symptoms somewhere from one month or longer after. Number three, now that we have had COVID in the human population for a few years, we see some people where their long COVID comes and goes rather quickly. We see some people where they have very long and lingering symptoms. that may go on for months to years. And in following sections, we're going to get into all of those and discuss why all of those things happen. But we need to end this particular section in order to get on to the next one. I'm Dr. Paul for Medicine and Health, and I want you to check us out on dranow.com, D-R-A-N-O-W dot com. We've got all of our links on there. Please check us out. Do the link over to the YouTube channel, which will have all the videos. It'll also have links to any of the pod burners that you want to see. And please, whatever way you consume this program, if you can, please like, share, subscribe, and do notifications, because sometimes when you're talking about COVID even if you're following all the rules, the algorithm slows your distribution down a little bit. But Dr. Paul, check us out on D-R-A-N-O-W, dranow.com, and I will see you in the next section. Thanks.