Asking for a Friend: Providers Answer Your Questions

Michael Brode: “It’s a great question. Two groups of people are really developing long covid. The first is it seems people who are more predisposed to autoimmune disorders, usually younger people, women in a group that were not hospitalized for the illness who may have another kind of connective tissue disorder like Ehlers-Danlos syndrome or autoimmunity that predisposes. The other group is people who were sicker when they initially got COVID-19. The group of people who were in the hospital is more predisposed to having longer symptoms.”

Michael Brode: “So the neurologic effects, unfortunately, there are a lot of them. Commonly we’re seeing headaches. We’re seeing some people having nerve pain, but the one I think gets a lot of interest is that some people are describing what we call autonomic dysfunction. The autonomic nervous system is the automatic part of the nervous system that controls heart rate, blood pressure, temperature regulation, and the movement of the gut. And those small fiber nerves can be injured from long-COVID and affect all those systems. So, you know, regulating blood pressure, regulating the heart rate, or having a lot of stomach issues because it’s not moving properly. Uh, and we’re really finding, especially with long-COVID , it seems predominantly to be a neurologic disorder.”

Michael Brode: “The disclaimer we always give in the clinic is, while there’s no current recognized treatment, FDA-approved treatment, currently, we’re recommending we treat the symptoms because symptoms of fatigue, symptoms of anxiety, shortness of breath, we have medical treatments for these particular symptoms. We just try and keep in mind this, this paradigm of we understand post-COVID, long-COVID as a disease of inflammation, you know, immune dysregulation, these things that we try and address in our treatments. But by and large, you know, if you have shortness of breath with long-COVID, we’d recommend albuterol inhalers. For example, if you have anxiety, we recommend counseling, exercise, you know, antidepressant medications. So the treatments can really be varied and just kind of targeted to what you feel specifically.

And also too, our goal is to find targeted curative therapies, and that’s why we’re doing research with researchers at The University of Texas at Austin. But in the meantime, while we’re still trying to find those targeted therapies, we have excellent symptomatic care and medications and lifestyle modifications we can make, uh, to help with this disease.”

Jeff Saniuk: “Covid-19 has been a humbling process for everybody in the United States, especially clinicians and scientists. And so we are not the masters of Mother Nature and I think really first of all to the skeptics, we’ve seen over and over hundreds of patients telling us the same thing. They’re having fatigue, they feel worse when they push through. They’re having diffuse neurologic symptoms. Just because we can’t explain it doesn’t mean it’s not real and we’re seeing the same thing over and over with patients, so we absolutely believe them.”

Michael Brode: “I would say, you know, if there’s one thing I could tell patients in addition, you know, you’re not alone That’s something where, you know, we hear a lot, people coming in feeling
like they’ve been invalidated before and fortunately, it’s more and more a recognized condition, long-COVID, but you need to know you’re not alone in this. We’re here to help and just seek us out if you need us.”

Michael Brode: “For long-COVID, we’ve seen people having a lot of persistent lung issues after their infection. Usually, it can make their asthma worse or they just feel short of breath, and they never had that before.

What we’re seeing is it’s complex and we don’t quite understand it yet. For some people, you know, asthma is really wheezing or constriction of their lungs. But for some people when they walk, they just feel very short of breath. And that may not actually be a problem with their lungs It may be related to fatigue or circulation and not actually a lung problem. And so the answer’s a little bit of yes, it can make asthma worse, but the breathlessness is not always asthma, although sometimes it feels like that. And we’re just starting to understand it.”

Michael Brode: A good question. It’s variable for most people. The initial COVID-19 illness can last up until four weeks. That’s when a lot of the symptoms will go away, and then the healing process starts to slow. We usually think people have long covid when it’s been lasting about 12 weeks or three months.

People are slowly getting better over time. Usually, people notice that their health is not improved after the initial illness and they’ve never fully recovered. Although there is a group of people that have a honeymoon period in which they go about a month feeling better before they start developing the long-COVID symptoms. What I hear most talking with patients in our clinic is that fatigue, brain fog, and this term called “post-exertional malaise”, you do an activity that should not be tiring and it just wears you out for a lot of people, is long-COVID, and is the toughest part to deal with. And so while we don’t have a cure for this, we have good ways of managing it. A lot is focused on managing the energy, not pushing through, listening to your body, resting when you need it, and then of course talking to your doctor to see if there are other available treatments to help you with the recovery process.