Blog, Chirosecure Live Event September 10, 2021

The Signs and Symptoms of Long COVID In Your Patients?

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Hello everybody. Dr. Julie McLaughlin here from Vital Health Protocols. It’s been a long time since I’ve been here on the show and about that today. So, um, let’s get started. We’re going to be talking a little bit about COVID and, uh, I know that we’re so over it we’re, we’re just done hearing about COVID it’s just messed up the world and, and, you know, we think, well, you get over it. You know, you have a box of tissue and you’re in you’re good in a day, but I gotta tell you there’s a lot more to it. There’s a lot, lot more to it that most people don’t even know until it happens to you. So let’s do this first. Let’s think ChiroSecure because without ChiroSecure, none of us would be here. So I want to do, you know, thumbs up little hearts because they are so great. They sponsor so many educational, um, programs for us and they not only are our malpractice carrier, but they are much, much more so let’s make sure we give them all the love that we can.

So I want you to know that COVID can happen to anyone. And I know by being in these women’s chiropractic groups in these chiropractic groups has happened to a lot of docs. And I’m also in groups with tens of thousands of other people who have something called long COVID. And last spring I got COVID and it actually, I think it was my second time getting it. The first time was way back in the beginning of 20, 21. We didn’t have tasks and we didn’t know. Um, and we’re not going to talk about vaccines cause we don’t want to have any issues. This can happen to anyone. It doesn’t matter your vaccine status and it can happen multiple, multiple times. Um, it really, really is a huge, huge deal, but it’s different for every single person. So back in, I’ll tell you a little bit about what happened back in the spring.

I felt a little sick and I thought, uh, you know, I I’m, I’m just having a little cold or maybe it’s the spring. I have some allergies and I went about a week and then all of a sudden I lost my sense of taste and smell and I got tested and I was positive. The other people in my family also got tested and they were negative. Um, so I thought, okay, I’m just gonna get better at home. And uh, everything’s gonna be fine. Well, long story short, it didn’t get better at home. And I started getting worse. Um, I started losing my ability to breathe. My pulse ox went down and I went into the hospital and they did some fluids and they did a little bit of testing and said, you’re okay, go home. And you’ll be fine. Well, two days later I collapsed on the floor and couldn’t breathe.

I couldn’t talk, I couldn’t stand up. I had to have an ambulance come and this is the first time in my entire life that I’ve been. I, I don’t even want to tell you how old I am, but I’ve never taken medications, nothing. So it’s a Berry Berry first time I’ve ever had any kind of illness because I’ve been practicing functional medicine and chiropractic since I was in my twenties and I never had a need for this, but this time it was totally different. And so when I went into the hospital, I was there for five days and they did every treatment you can even imagine on me. And I came out and I was a little bit better. And then another week went by and I was back in the hospital again. So the thing is with COVID and I’m going to talk about the symptoms and I’ll talk about the symptoms in what I experienced and what the study show and what other people are experiencing because you are seeing this in your practice and you’re seeing it. [inaudible] post backs, pre COVID post COVID. You’re seeing with people with multiple COVID, um, test positive. I know at least multiple people that have had COVID three times. Um, so we want to look and make sure that we’re not missing anything. And I want you to make sure ChiroSecure has an excellent informed consent form. They want you make sure you download from them about COVID information and have all your patients do it. It’s super, super important to document this in your notes. And as we go on, you’re going to see why.

So when we look at just the clinical course of COVID, and this is what the CDC says, that it’s about a six week course. So initially you get your exposure and it’s like five to six days, and then you get symptoms and then most people recover in two weeks. Or if you get it really severe, you recover in six weeks. But I can tell you with long COVID, the recovery is a year to a year and a half. And that’s really, as long as we know COVID has been along around, because some people aren’t recovering like that. So 30% of people who get COVID experience long, COVID an 85% of people with long COVID had the mild form in the beginning. It never even needed to be hospitalized. So we have it in our minds that the people are getting long COVID are people were on ventilators and, and happened to be hospitalized, but that’s not the case.

The bast majority were never hospitalized. And so it’s a scary, scary thing. When you don’t know that you’re not getting better. So we’re used to getting a cold and flu that we get better from. We used to have back pain that you get better from this morphs. It’s very, very deceiving because it morphs and you just don’t get better. So what long COVID does is it just stays in your system and the symptoms change. So these are the different phases. There’s acute COVID. And it’s really important to look at these timelines because the sooner you can get somebody’s treatment, the better off they’re going to have to alleviate the long. So the cute COVID is the first two weeks of symptoms. Post acute COVID is up to 12 weeks of symptoms. And chronic COVID is greater than 12 weeks of symptoms. Once you hit greater than 12 weeks of symptoms, that’s when you know this isn’t going away anytime soon and long, COVID really describes those symptoms that are happening after those 12 weeks.

So when we look at how do we determine somebody has a mild case versus someone who has a critical case, because we always think that, you know, you either have it where you need a box of tissue for two days, or you’re in the hospital on event and not recovering, but there’s a lot of places in between. So I want you to look at these categories and the mild case, you’re going to have the typical cold and flu symptoms, right? Some GI symptoms, as well as loss of taste and smell. There’s going to be no pneumonia on the chest x-rays or, or chest CTS. There’s no evidence on any of the testing and you’re gonna have no shortness of breath at all. In the moderate cases, you’re going to have radiographic findings of, uh, of a pneumonia. You’re going to have fever and you’re gonna have a lot of respiratory symptoms.

And then the saturation of oxygen is actually going to be below 94 on these people in room air in the severe cases. And this is where I fall into this. The saturation of the oxygen is going to be below 94. And then some of the partial oxygen is going to be below 300. There’s going to be infiltrates in the lungs at least 50% within 24 to 48 hours. So in COVID is a little different. I’m going to show you an x-ray, how those infiltrates get into the lungs. The heart rates can be very rapid above 125. And like my resting heart rate is an 110. So as long as I’m 110 that’s my resting heart rate is COVID does crazy, crazy things to us. And then the respiratory rate’s going to be greater than 30 breaths per minute. Now in the critical ones, they’re going to have respiratory failure. These are the patients needing to be on ventilators and it happens very, very quickly. It’s not a long drawn out thing with this. They’re getting subsisted going into shock and they’re having multiorgan dysfunction. So when we look at these categories, we want to say, well, really the people in the severe and the, the critical are going to get long. COVID false. It’s not true. You can get mild COVID and still get long COVID. You can, you can get the backs and get long COVID.

So we’re going to talk about, oh, my slides are a little goofy here. Sorry about that. But we’re going to talk about eight organ systems that are affected by Kobe. Cause we just think of it as a respiratory thing, but it affects all the tissues that have ACE two receptors on them. So these are little receptors that COVID can kind of plug into and it, those symptoms. So we’re going to look at the heart, but we’re gonna look at the circulatory system separate from the heart. We’re gonna look at the lungs. We’re looking at the brain and the central nervous system, the thyroid, the kidneys, the liver, and the GI system.

So the most common symptom with COVID with long COVID is that your symptom will change whatever your symptom is, you better be ready because it’s going to change. And you’re going to think your patients are making it up. Or if you have it yourself, I was thinking, am I imagining this? How could my symptoms change so much? So you get one symptom and it morphs into another symptom. And maybe that first symptom stays. And maybe that first symptom goes away. So most patients with long COVID have an average of 20 symptoms. There’s over 50 symptoms altogether, but the average person has more than 20. So think about our patients when they come into our office and they have lower back pain, that’s one condition think about 20. So when it effects the heart, it gets mild carditis and tachycardia. And the tech cardia happens. If you walk down the hall to the bathroom, you can go from laying to sitting in your heart races. And this is what’s been happening to me. And it’s also considered in dysautonomia, which affects these same symptoms.

So the next one is the circulatory system and really COVID is endothelial disease. It affects the lining of our blood vessels. And we usually don’t talk about the lining of our blood vessels, unless we’re talking about plaque and heart disease, but it causes the clotting and it causes microvascular damage, which causes hypoxia. And it actually causes your tissues to be starved for oxygen. And that’s one of the reasons people get COVID toes. And I can tell you, I have oxygen that I’m actually on 24 7 right now, as a result of COVID, I’m not wearing it because it would be really noisy for me to talk with you, but that hypoxia affects every organ and every system in your body, not just your lungs.

So the lungs, obviously the big problem is the SARS Colby to pneumonia. And that can lead to fibrosis, which is permanent scarring in the lungs. Now I had a cat scan originally when we first started COVID and now I’ve had it three months later and it hasn’t changed at all. It hasn’t improved. Now. Normally pneumonia always improves. I want to show you this little picture here. So on the left is a chest x-ray of someone with COVID and see those white cottony, fluffy patches. Those are the COVID pneumonia in the differences. It affects both lungs it’s bilateral. And it really shows up in the periphery, which is not really common where the other pneumonias show up and it will show up as ground glass. Like for me, myself, I have ground glass in all the lobes of my lung on both sides. So my perfusion is really poor on the right, just to give you an idea, if you’re not used to looking at your accessories, that’s a clear chest x-ray so those cottony puffy things on a CT scan look like paint splatters. You see that all the little AB Oler Sachs have paint splatters in them. And I think of it like super glue where it glued those AVL or sacks closed, and you can’t get any oxygen exchange through them. And if you can get it back, it takes a very, very long time. But in the meantime, it affects your other organs.

So let’s talk about the brain. The brain is a huge one that COVID effects and the central nervous system. It causes strokes because of the blood clot. It causes mass cell activation, which is a histamine response. And we can talk about more of that later. I have so much information to tell you, I just want to get you an idea of thinking about these things when they walk through your door, or if you or a loved one are experiencing it can cause seizures. It can cause Berets brain fog where you’re inserting wrong words. I was looking at a menu and I thought it said, cemetery, chicken. Now nobody would ever serve cemetery chicken, unless it was some kind of, you know, crazy Halloween stunt, but it makes you have the wrong words in the wrong place and makes you have memory problems, dizziness central nervous system, dysregulation like pots. We all know what pots is and it causes neuroinflammation. It causes PTSD, anxiety and depression and people who have never had it before. So it affects the brain and our central nervous system in so many ways as chiropractors. What do we deal with? We deal with our central nervous system. So chiropractic care, super, super important for patients suffering from long COVID.

It affects the thyroid. It can make the thyroid either hyper or hypo. And the other thing it can do is it can cause new or exacerbated autoimmune conditions. So this is one of the big things that we see is a triggering of auto-immune in the kidneys. It can cause low urine output. It can cause frequent urination. It causes all kinds of kidney dysfunction and even kidney failures, wherever that COVID virus hits, that’s where you’re going to get your symptoms. Or if you didn’t get the symptoms starting out there, it may morph into a different system.

The liver due to the rush of the cytokines in the liver, the liver can become damaged in some cases is not repairable. And most of the CA COVID patients you’ll see very high liver enzymes. And that’s a result of those cytokines inflammation in the liver. When we talk about the GI symptoms, some people get this really, really bad, where they’re getting nausea and vomiting and diarrhea, nausea, pancreatitis, and it’s a barrier issue. And they finding that if your gut biome isn’t healthy, that’s going to contribute to it. And we know unhealthy gut biome also affects the brain.

So one of the things that COVID does is it can expand the Bible burden of other viruses that you may have in your body already that were dormant. And it reactivates them in like 78% of people who have had Epstein-Barr before it will reactivate it. And same thing with chronic fatigue syndrome, H as B parvo, mycoplasma, and even hepatitis. These are viruses this state in our body that COVID will come along and reactivate. It is a very, very sneaky virus. So some of the other words that are called long COVID that you might hear is the past P a S C that’s post-acute sequella of SARS COVID two or persistent COVID or long COVID or long haulers or post-acute COVID or chronic COVID or post COVID syndromes. I want you guys to know this because you will have patients walking into your office, having these things. And I don’t want you not to know it. I can’t tell you how many places that I’ve been. And they had no idea what this even was. And they thought, oh, you must be contagious. No long COVID you’re not contagious. That contagion stages very, very short. And so this is people who are having 12 weeks or longer of symptoms after COVID with no other explanation or diagnosis.

So what are the triggers? Why do 30% of the people who get COVID get Mon COVID? And these are the things that I’ve come up with with the research. So far, the number one is genetics and genders. So women tend to get it more than men and genetics, and now they don’t know what gene, but that’s what’s caused mine. There’s some kind of genetics that has triggered me into this long COVID cause I had no pre-existing conditions prior to this. I was perfectly, perfectly healthy. In fact, when I went into the ER, they gave me a Z-Pak, which is very common antibiotic and I had a terrible allergic reaction to it. And they, they said, how could you have had an allergic reaction to this is such a common antibiotic. I said, I’ve never needed antibiotics my whole life. So when you see that people can have preexisting things that could lead you into this, or you could just have genetics.

So people with diabetes are going to be more likely to get long COVID obesity is a trigger cardiovascular disease, menopause or menopause. So low testosterone or low estradiol that can trigger you into low Mon COVID auto-immune conditions. Anybody who’s immunocompromised already can trigger them into this long COVID. And this is a really interesting triad that a large percentage of the long COVID patients have. If they have asthma eczema and allergic rhinitis, all those three together, they have a higher chance of getting lung COVID. So there’s no guarantee on who will get it and who won’t. I always think of it. You know, when my kids were little, we’d go to the grocery store and they had those gumball machines and they get a little bouncy ball and it’s got all the angles on is not round. And every time you drop it and it goes in a different direction, that’s what COVID is because it’s going to go in a different direction every day, every time.

And every person is unique. So you need to be a really good diagnostician when you’re looking at these patients. So, because it’s so new, we don’t know everything about it. And if anybody out there is telling you, they know everything about it, or they have all the answers, they’re lying to you because every single patient is different. And you have to treat that patient individually, but it could be a collection of four different syndromes, oppose viral fatigue syndrome, a fluctuating multi-symptom seven drum lasting organ damage that you have to deal with and post intensive care syndrome. So people who have been in intensive care and on ventilators, they have a whole nother hurdle to get over with this long COVID. But these symptoms fluctuate and there’s significant psychological and social impact on the long COVID as well. If you don’t manage it, we’ve all had that psychological social thing because of being locked up with a pandemic.

But when you add these symptoms on top of it, it can really be overwhelming. So really there’s more than 50 symptoms of on COVID. But the most common symptom I want you to know is that your symptoms will always change. In the beginning. I lost my taste of smell and taste taste. Then it transformed to, they would just weren’t right? Like if I smelled the cinnamon, I knew it was cinnamon smell like lemon to me. Then I decided, okay, my body doesn’t want to do that anymore. Or my body decided for me is more like it. And I was smelling cigarette smoke 24, 7. I’ve never smoked in my life and I don’t go anywhere where there’s smoke. So COVID does these crazy, crazy things. And you think what is going on? So let’s take a look at some of the symptoms. These are the symptoms.

And if you want to really look at these, you can pause, um, on the replay and you’ll be able to see all the symptoms. And so patients coming in with these symptoms might not even realize that it’s one COVID that they have at first. I didn’t realize that I had long COVID. And when you see all of these symptoms, they could be anything, any kind of organ system, anything, but don’t get fooled by this. When we look at with the list is 26% are pain symptoms. Now we’re going to get patients walking into our office with pain and they can’t describe it. And a lot of times it can be bilateral pain, a patient with bilateral ankle pain, knee pain, and hip pain that they’ve never had before. I’ve got shoulder pain and elbow pain, like, like never before. So these things are going to show up constant burning in the bottom of the feet, pain in the middle of the back of the thoracic spine. So I want you guys to be aware that the long haulers we always think of respiratory, but it’s so much more, and they’re going to show up in your office.

So nearly 30% of infected people, like you said, get long COVID. And 75% of them have never, um, or 85% of them have never been admitted to the hospital. But if you take the people who were hospitalized, 75% of the patients have been admitted to the hospital, have abnormal patient outcomes three months after the onset. That’s huge, right? Think about if you’ve ever been sick for three months and 50% of the patients admitted to the hospital will have symptoms 12 months after the onset. And a crazy thing is at the six month mark, the studies show that the symptoms can be worse than they were at three months. But then at 12 months, the symptoms can be worse than they were at six months. So you can think you’re getting better, right? And you hit six months, you think, oh, I’m getting better. And then you hit 12 months and your symptoms can be worse than they were six months ago. So it does, you don’t get better in a linear pattern, like most other conditions.

So how do we assess if someone’s getting better, how someone’s getting improved. And it’s a really hard thing. So I read one study said that improvement could be up to 5% a month. Now, can I just tell you I’ve been sick for months and months and months that is painfully slow and it makes you think that you’re never going to get better and you’re not getting better. So I want to give you some tools to be able to use with your patients in your practice. And these are some really helpful symptom inventories that are subjective, that the patient fills out. And I would have them fill them out every month to make sure that they are getting improvement and that they can see it in. You can see it because I present in a month, day by day, you’re saying I’m not getting better of one symptom goes away and another one comes on and that symptom may be way worse. You’re thinking that you’re getting worse instead of better. So these symptom questionnaires really, really are helpful and they’re available everywhere. Online. Those PDFs are very, very common, but we don’t typically use them in our practice, but it’s a great way to, to assess the patient in the beginning, but also look at the progress.

So I can tell you the pain and suffering is real. Um, I never realized what COVID was possible to do. Um, it’s, it’s really destroyed my lungs. Um, I destroyed my heart. It had so much pressure on my heart that they had to put me on oxygen 24 7. Um, and if I walk, you know, 10 feet, my heart rate skyrockets up to 160, my resting heart rates really, really high. It changed my sense of taste and smell. And that’s the least of it. It affects your GI symptoms. It affects the brain fog where you’re putting different words in and effects your memory. It makes you shake. It makes you have dry mouth. It has so many symptoms that you can’t even realize it. So I want you never to experienced is number one. And I want you to recognize it when your patients come in, that these symptoms are real and they need someone to listen to them and to support them.

And I can tell you that there’s no better place for them to get support and get adjusted in the, your chiropractic office and, and help get them through these really, really tough times. And, uh, at, at the end, most people will recover, but the pain and suffering during that time is real. So please support your patients and be aware that these symptoms are coming in. And that they’re real. They’re just not to be sent out to every specialist in the world because they’re looking at their little niche, put it all together and look at the possibilities along COVID.

So I would like to thank I was a care. If you guys have any questions, please let me know. We only scratched the surface today, um, because it’s a huge, huge topic, but at least it will start getting you thinking in the right direction. So lots of love to ChiroSecure and not, I will be talking to you soon. And remember, it doesn’t matter if you’re vaccinated or not vaccinated long COVID happens. And if you had COVID one time and it was mild, any combination that you could possibly think of can happen with COVID and long COVID. And it’s not just in these little boxes that people like to put them in. So you have to be aware it can affect anyone at any time. So I’m Dr. Julie McLaughlin from vital health protocols and be sure to tune in to empowering women and a couple of weeks. And now they’re going to have a great show for you. So we’ll talk to you soon.

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