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COVID19 Treatment!

COVID19 Treatment!

COVID19 Treatment!

TREATMENT FOR COVID19?
YES!

I have been tracking the scientific and clinical literature since the beginning of the COVID-19 pandemic. I have been particularly vigilant for safe and effective treatments for COVID-19 that are used in NON-HOSPITALIZED patients that have a heightened risk of serious problems.

There are two categories based on how these medications are administered: my mouth (oral) or intravenous (IV).  The medicines that are currently approved are not equal in their effectiveness and vary considerably in their cost.  In addition, the IV medications will require a trip (or several) to an infusion center.  The emergence of variants creates an additional problem:  some of these treatments are not effective against the most recent and dominant strain of the COVID-19 virus.  As of today, that is the Omicron BA.2 subvariant.  As of today, here are the NIH recommended medications for non-hospitalized, high-risk ADULT patients:

 

Paxlovid (Ritonavir-boosted nirmatrelvir) (1 dose by mouth twice a day for 5 days)

Sotrovimab (500 mg IV once) (and only in areas were Omicron BA.2 is not dominent)

Remdesivir (1 dose IV daily for 5 days)

Bebtelovimab (175 mg IV once)

Molnupiravir (1 dose my mouth every 12 hours for 5 days)

*Evushield (Tixagevimab plus cilgavimab) (1 dose of each intramuscular one time) – This IM injection is used as “Pre-exposure Prophylaxis” or “PrEP” – i.e. it is administered as a prevention measure before exposure.

As I assembled this list, I had to stop and recollect about how helpless my physician colleagues and I felt just one year ago, when we had so few options.

 

WHO IS ELIGIBLE?

Symptoms: mild to moderate illness (normal oxygen, not struggling to breathe)

Ages: 18 and older

Chronic Illness:  that places you at increased risk for severe COVID19 – this includes:

  •         Cancer
  •         Cerebrovascular disease (stroke)
  •         Chronic kidney disease* (polycystic, nephritis, nephrosis)
  •         COPD (chronic obstructive pulmonary disease, emphysema)
  •         Diabetes mellitus, type 1 and type 2*
  •         Heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies)
  •         Obesity (BMI ≥30 kg/m2)*
  •         Pregnancy and recent pregnancy
  •         Smoking, current and former

Where!

Infusions centers have been established in most states.  Go to this Website to locate one near you:

https://infusioncenter.org/infusion_resources/nica-monoclonal-antibody-therapies/

Oral medicines can be prescribed by your regular doctor or schedule an appointment on Wellivery to get an assessment to see if you are eligible

When?

You should get this treatment as soon as you can after receive a positive test for COVID19.

 

COVID-19 Treatment

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COVID19 Treatment!

TREATMENT FOR COVID19?YES! I have been tracking the scientific and clinical literature since the beginning of the COVID-19 pandemic. I have been particularly vigilant for safe and effective treatments for COVID-19 that are used in NON-HOSPITALIZED patients that have a...

Long COVID Lung

Long COVID Lung A large number of patients that experienced COVID-19 will have persisting lung symptoms such as shortness of breath, wheezing, cough,  and decreased exercise capacity.  These problems are usually worse in patients who became so ill that they required...

Leveraging Dietary Protein

* Why is protein needed? * What kind of protein? * How much? Why is Protein Needed? Obesity Prevention: The American diet tends to be high in carbohydrates and fats.  Excessive intake of these nutrients is driving an epidemic of obesity, diabetes, heart disease and...

Long COVID Brain

Long COVID Brain

Long COVID Brain You have either heard of or experienced first hand the “brain fog” associated with COVID-19 infection.  This disordered operation of thought and memory occurs during an active COVID-19 infection.  But what about later, down the road?  Do these issues...

Long COVID Heart

Long COVID Heart

Infection with COVID-19 has shown us many unique medical problems caused by the virus.  Once you as a patient get out of the danger zone with your initial infection, you may not be out of the woods.  Many patients COVID-19 are reporting new problems beginning many...

Take Control of Diabetes!

*  Diabetes means your body is struggling to keep your blood sugar normal. *  There are two types of diabetes: Typle 1 and Type 2. *  If you have been diagnosed with either, careful attention to your food intake and prescribed medicine is the most...

Everyday Health for

Everybody!

 Same Day Appointments are Available.

720-900-0943

Telemedicine for You!

Long COVID Lung

Long COVID Lung

Long COVID Lung

Long COVID Lung

A large number of patients that experienced COVID-19 will have persisting lung symptoms such as shortness of breath, wheezing, cough,  and decreased exercise capacity.  These problems are usually worse in patients who became so ill that they required hospitalization.

The evaluation and treatment for these pulmonary symptoms is the same as for symptoms caused by regular asthma and emphysema.  Vital signs and a chest examination are the first steps and along with symptoms, determine whether further testing is needed.

Additonal testing may include: imaging by x-ray, CT scan or MRI, pulmonary function testing, exercise testing, and cardiology consultation.  Typical treatments include bronchodilators, inhaled steroids, and frequent follow up for assessment of line function.

These symptoms seem to be related to damage in the lining of breathing tubes.  The cause of this damage is an active area of scientific study in an effort to understand how to reverse it and treat symptoms caused by it.

Treating Long COVID Lung

How should  patients with Long COVID Lung be managed?  Physicians and researchers are refining the best approach and since this is a new problem in medicine, new approaches are being developed daily.

Since patients with Long COVID lung are not hospitalized, a home-based way of tracking symptoms and lung function is needed.

The most standardized method available for self-measurement of lung performance is pulmonary expiratory flow or PEF.

This is measured using a peak expiratory flow meter that is portable, inexpensive and easy to operate by patients.

When the readings from these devices are logged, the numbers can be used as a reference for how lung function is progressing.

If these readings indicate improvement, medication supporting lung function can be reduced. If these readings indicate that lung function is not improving, more intervention is needed.   I recently reviewed all of the currently available PEF devices and you can read my recommendation here.

How Does

Long COVID Lung

Affect

You?

Long COVID Lung symptoms of cough, shortness of breath, and fatigue can dramatically limit your normal activities.  The cough can disrupt your sleep, create headaches, and disturb your work productivity.  Shortness of breath, both at rest and with exertion can be alarming!

What Causes

Long COVID Lung

At the moment, Long Covid Lung appears to involve damage to the lining of the small breathing tubes (bronchioles) throughout the lung.  This is based on CT scans of patients who have recovered from acute COVID-19 infection.  These finding are seen in patients who did not require hospitalization for their COVID-19 infection!

The cause of this damage is an area of active scientific investigation.  I’ll post updates as new discoveries occur.

Wellivery and Long COVID

I have created a dedicated page about Long COVID as a launching point for exploring what we know about Long COVID, its cause, treatment, and longterm affects.

Clinic Trials Long COVID

Are you interested in participating in a research study about Long COVID?  The National Institues of Health is recruiting volunteers who had and recovered from COVID-19.  The goal is to get at the causes and treatments for Long COVID!

I’ll post new scientific discoveries on this page, so BookMark it now!

Get Started with A Healthy Weight Plan!

Subscribe Now!

Get email notifications when I post new Health Topics.

COVID19 Treatment!

TREATMENT FOR COVID19?YES! I have been tracking the scientific and clinical literature since the beginning of the COVID-19 pandemic. I have been particularly vigilant for safe and effective treatments for COVID-19 that are used in NON-HOSPITALIZED patients that have a...

Long COVID Lung

Long COVID Lung A large number of patients that experienced COVID-19 will have persisting lung symptoms such as shortness of breath, wheezing, cough,  and decreased exercise capacity.  These problems are usually worse in patients who became so ill that they required...

Leveraging Dietary Protein

* Why is protein needed? * What kind of protein? * How much? Why is Protein Needed? Obesity Prevention: The American diet tends to be high in carbohydrates and fats.  Excessive intake of these nutrients is driving an epidemic of obesity, diabetes, heart disease and...

Long COVID Brain

Long COVID Brain

Long COVID Brain You have either heard of or experienced first hand the “brain fog” associated with COVID-19 infection.  This disordered operation of thought and memory occurs during an active COVID-19 infection.  But what about later, down the road?  Do these issues...

Long COVID Heart

Long COVID Heart

Infection with COVID-19 has shown us many unique medical problems caused by the virus.  Once you as a patient get out of the danger zone with your initial infection, you may not be out of the woods.  Many patients COVID-19 are reporting new problems beginning many...

Take Control of Diabetes!

*  Diabetes means your body is struggling to keep your blood sugar normal. *  There are two types of diabetes: Typle 1 and Type 2. *  If you have been diagnosed with either, careful attention to your food intake and prescribed medicine is the most...

Everyday Health for

Everybody!

 Same Day Appointments are Available.

720-900-0943

Telemedicine for You!

Leveraging Dietary Protein

Leveraging Dietary Protein

Leveraging Dietary Protein

* Why is protein needed?

* What kind of protein?

* How much?

Why is Protein Needed?

Obesity Prevention: The American diet tends to be high in carbohydrates and fats.  Excessive intake of these nutrients is driving an epidemic of obesity, diabetes, heart disease and cancer.  If protein intake is increased, it crowds out carbohydrates and fats and also makes you less hungry between meals.  The result, less obesity, heart disease, cancer and diabetes.

Skeletal Health: Many adults don’t have enough protein in their diet to support minimal health of the skeleton.  A diet low in protein cannot provide the amino acids necessary for all body systems.  The consequence?  Loss of muscle mass becomes a serious problem.  When you lose muscle, your risk of injury from falls increases.  For example, hip fractures are related to lower leg weakness (the result of reduced muscle mass).  Furthermore, normal spine shape depends on the muscles in the back to resist forward bending.  When muscles along the spine are lost, a forward bend in the  spine occurs, creating back pain and decreasing lung volume, which increases your risk of pneumonia or respiratory failure if you get sick.  

Glucose Metabolism:  Beyond its importance for your skeleton, muscle plays a huge role in energy metabolism. Muscle in your skeleton is an essential consumer of glucose .  When you have less muscle, blood glucose gets out of control and the risk of diabetes increases.  

CONCLUSION: We need protein for muscle health and all of its benefits.

What Kind of Protein?  There are both plant and animal sources of protein.  Is one better than the other?

A recent study from China points the the value of having dietary proteins from a wide range of plant and animal sources.  In this study,  people  who consumed protein from a wide variety of sources experienced fewer problems with high blood pressure. 

CONCLUSIONI: Get Protein from Variety of Sources:

 

Dietary Protein is Essential

How much protein do you need?  

The answer for people with regular intentional physical activity: 1 g of dietary protein for each kilogram of body weight.  So if you weigh 180 pounds (82 kg), you need 82 g of dietary protein each day.  Let’s consider an average eating scenario to see if it will deliver this much.

Breakfast: poultry egg x 2 (12 g)

slice of whole wheat toast (3.6 g)

sausage patties  x 2 (10 g)

greek yogurt x 1 cup (16 g)

blueberries 4 oz (0.5 g)

Lunch: Flour tortilla (for taco) x 2 (8 g)

chicken filling x 6 oz (52 g)

spinach leaf x 2 (1 g)

Dinner Salmon filet x 6 oz (34 g)

brussel sprouts x 6 oz (1 g)

dinner roll x 1 (2 g)

Total: 140 g!

If that a typical meal plan for you, then you can easily get 100 g of protein daily.

If you are doing resistance exercise to build strength, you need more protein.  Studies indicate that you will need approximately 2 grams of dietary protein per kilogram of body weight to make strength gains.  That could be tough to do without inserting some concentrated protein shakes into your daily meal plan.

 

Protein for Strength?

Summary:

  1. Dietary Protein Is Essential!
  2. A wide variety of protein is best for your health;
  3. You should aim to consume 1 gram of protein per kilogram of body weight – double that if you are working to get stronger.

Want to learn more?  Here are some references that will make interesting reading!

Protein – Which is Best?  Hoffman et al, 2004

Dietary protein intake and human health.  Wu, 2016

Dietary Reference Intakes, NIH

#backpocketdoc

#affordableaccessiblecare

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COVID19 Treatment!

TREATMENT FOR COVID19?YES! I have been tracking the scientific and clinical literature since the beginning of the COVID-19 pandemic. I have been particularly vigilant for safe and effective treatments for COVID-19 that are used in NON-HOSPITALIZED patients that have a...

Long COVID Lung

Long COVID Lung A large number of patients that experienced COVID-19 will have persisting lung symptoms such as shortness of breath, wheezing, cough,  and decreased exercise capacity.  These problems are usually worse in patients who became so ill that they required...

Leveraging Dietary Protein

* Why is protein needed? * What kind of protein? * How much? Why is Protein Needed? Obesity Prevention: The American diet tends to be high in carbohydrates and fats.  Excessive intake of these nutrients is driving an epidemic of obesity, diabetes, heart disease and...

Long COVID Brain

Long COVID Brain

Long COVID Brain You have either heard of or experienced first hand the “brain fog” associated with COVID-19 infection.  This disordered operation of thought and memory occurs during an active COVID-19 infection.  But what about later, down the road?  Do these issues...

Long COVID Heart

Long COVID Heart

Infection with COVID-19 has shown us many unique medical problems caused by the virus.  Once you as a patient get out of the danger zone with your initial infection, you may not be out of the woods.  Many patients COVID-19 are reporting new problems beginning many...

Take Control of Diabetes!

*  Diabetes means your body is struggling to keep your blood sugar normal. *  There are two types of diabetes: Typle 1 and Type 2. *  If you have been diagnosed with either, careful attention to your food intake and prescribed medicine is the most...

Everyday Health for

Everybody!

 Same Day Appointments are Available.

720-900-0943

Telemedicine for You!

Long COVID Brain

Long COVID Brain

Long COVID Brain

Long COVID Brain

You have either heard of or experienced first hand the “brain fog” associated with COVID-19 infection.  This disordered operation of thought and memory occurs during an active COVID-19 infection.  But what about later, down the road?  Do these issues persist? Is this Long COVID Brain?

The most comprehensive investigation of brain issues weeks after recovery from active COVID-19 was published in Nature (Douaud et al.)

These investigators performed brain scans on a 785 patients on two occasions.  Sometime after the first scan, 401 patients in this group tested positive for COVID-19.  The scientists compared the brain images before and after COVID-19 infection and compared these images with those obtained in 384 COVID-19-negative controls.  They reported structural changes in three main areas:

  1. A decrease in the outer layer of brain (grey matter) densely filled with nerves most noticeable in the front of the brain and in a layer called the parahippocampal gyrus;
  2. Signs of brain damage in the part of the brain connected to the olfactory nerve which is responsible for the sense of smell; and,
  3. An overall decrease in the size of the brain.

In addition, they found a decrease in cognitive skills like computation, judgement and memory in those patients who tested positive and showed the changes in brain structure.

These cognitive changes have been reported previously (Taquet et al, Taquet et. al.).

How Does

Long COVID Brain

Affect

Brain Function?

In the Douaud et al. study, the investigators used a neuropsychological measure called the Trail Making test, which reflects a number of complex brain functions that together comprise Executive Functioning.  Executive functioning is essential for planning, organizing and executing tasks.  We don’t know yet how long these brain disorders last.

Wellivery and Long COVID Brain.

I will track and update this section of Wellivery.com to give you the best information about this topic.

What Causes

Long COVID Brain?

At least 2 major theories that have been proposed to explain the brain effects of Long COVID.  So far, the mechanisms that have been proposed have not been proven.  Getting the answer to this question will be a key component of understanding how to treat, prevent, and possible reverse Long COVID brain.

Wellivery and Long COVID

I have created a dedicated page about Long COVID as a launching point for exploring what we know about Long COVID, its cause, treatment, and longterm affects.

I’ll post new scientific discoveries on this page, so BookMark it now!

Get Started with A Healthy Weight Plan!

Subscribe Now!

Get email notifications when I post new Health Topics.

COVID19 Treatment!

TREATMENT FOR COVID19?YES! I have been tracking the scientific and clinical literature since the beginning of the COVID-19 pandemic. I have been particularly vigilant for safe and effective treatments for COVID-19 that are used in NON-HOSPITALIZED patients that have a...

Long COVID Lung

Long COVID Lung A large number of patients that experienced COVID-19 will have persisting lung symptoms such as shortness of breath, wheezing, cough,  and decreased exercise capacity.  These problems are usually worse in patients who became so ill that they required...

Leveraging Dietary Protein

* Why is protein needed? * What kind of protein? * How much? Why is Protein Needed? Obesity Prevention: The American diet tends to be high in carbohydrates and fats.  Excessive intake of these nutrients is driving an epidemic of obesity, diabetes, heart disease and...

Long COVID Brain

Long COVID Brain

Long COVID Brain You have either heard of or experienced first hand the “brain fog” associated with COVID-19 infection.  This disordered operation of thought and memory occurs during an active COVID-19 infection.  But what about later, down the road?  Do these issues...

Long COVID Heart

Long COVID Heart

Infection with COVID-19 has shown us many unique medical problems caused by the virus.  Once you as a patient get out of the danger zone with your initial infection, you may not be out of the woods.  Many patients COVID-19 are reporting new problems beginning many...

Take Control of Diabetes!

*  Diabetes means your body is struggling to keep your blood sugar normal. *  There are two types of diabetes: Typle 1 and Type 2. *  If you have been diagnosed with either, careful attention to your food intake and prescribed medicine is the most...

Everyday Health for

Everybody!

 Same Day Appointments are Available.

720-900-0943

Telemedicine for You!

Long COVID Heart

Long COVID Heart

Long COVID Heart

Infection with COVID-19 has shown us many unique medical problems caused by the virus.  Once you as a patient get out of the danger zone with your initial infection, you may not be out of the woods.  Many patients COVID-19 are reporting new problems beginning many weeks later.  A number of body systems seem to be injured by this virus.  The heart and blood vessels is one we are learning more about.

Long COVID Heart

The most interesting source of this information comes from a recent study published in Nature Medicine by Xie et. al. showing that COVID-19 produces a number a serious disorders that become evident weeks after recovery from the initial infection.  They include:

  • Strokes (due to blood clots in the blood vessels of the brain);
  • Heart Rhythm problems;
  • Heart attacks (ischemic heart disease);
  • Inflammation around the heart (pericarditis);
  • Inflammation of the heart muscle (myocarditis);
  • Heart failure; and
  • Blood clots in vessels throughout the body.

Even minor symptoms from COVID-19 have been assciated with these disorders!

What To Do About It?

Be on the lookout for symptoms. Long COVID has a broad set of symptoms that appears at least four weeks after the initial COVID-19 infection.  Symptoms in this list related to the heart and blood vessels should alert your doctor to the possibility that more serious disorders exist.  More testing will be needed in each case to make sure you are ok.

Treating Long COVID Heart

So far, the disorders of the heart and blood vessels from COVID-19 are treated using standard, well established medicines or procedures.  Whether we can prevent the development of these disorders is not yet known.

My Job?

My job as a physician is to evaluate your symptoms, get a diagnosis of the underlying disorder, and launch treatment and/or intervention.  Perhaps in time, there will be specific treatments and interventions for heart and blood vessel problems caused by COVID-19.  For now, you keep an eye on your health and I’ll watch the scientific and medical literature for new information.

I’ll post new scientific discoveries on this page, so BookMark it now!

Get Started with A Healthy Weight Plan!

Subscribe Now!

Get email notifications when I post new Health Topics.

COVID19 Treatment!

TREATMENT FOR COVID19?YES! I have been tracking the scientific and clinical literature since the beginning of the COVID-19 pandemic. I have been particularly vigilant for safe and effective treatments for COVID-19 that are used in NON-HOSPITALIZED patients that have a...

Long COVID Lung

Long COVID Lung A large number of patients that experienced COVID-19 will have persisting lung symptoms such as shortness of breath, wheezing, cough,  and decreased exercise capacity.  These problems are usually worse in patients who became so ill that they required...

Leveraging Dietary Protein

* Why is protein needed? * What kind of protein? * How much? Why is Protein Needed? Obesity Prevention: The American diet tends to be high in carbohydrates and fats.  Excessive intake of these nutrients is driving an epidemic of obesity, diabetes, heart disease and...

Long COVID Brain

Long COVID Brain

Long COVID Brain You have either heard of or experienced first hand the “brain fog” associated with COVID-19 infection.  This disordered operation of thought and memory occurs during an active COVID-19 infection.  But what about later, down the road?  Do these issues...

Long COVID Heart

Long COVID Heart

Infection with COVID-19 has shown us many unique medical problems caused by the virus.  Once you as a patient get out of the danger zone with your initial infection, you may not be out of the woods.  Many patients COVID-19 are reporting new problems beginning many...

Take Control of Diabetes!

*  Diabetes means your body is struggling to keep your blood sugar normal. *  There are two types of diabetes: Typle 1 and Type 2. *  If you have been diagnosed with either, careful attention to your food intake and prescribed medicine is the most...

Everyday Health for

Everybody!

 Same Day Appointments are Available.

720-900-0943

Telemedicine for You!

Take Control of Diabetes!

Take Control of Diabetes!

Take Control of Diabetes!

*  Diabetes means your body is struggling to keep your blood sugar normal.

*  There are two types of diabetes: Typle 1 and Type 2.

*  If you have been diagnosed with either, careful attention to your food intake and prescribed medicine is the most important priority.

*  Your risk for Type 2 diabetes can be changed by focusing on food intake, weight control, and physical activity.

*  Wellivery can help you focus on these risk factors by providing affordable access to your doctor.

 

Diabetes. Sugar diabetes. Sugar.

Really scary.  Most non-medical people regard it the first step towards blindness, amputations, kidney failure, heart disease, and worse.

And for sure, blindness, amputations, kidney failure, and heart disease are all complications of diabetes.

But, what does diabetes mean? Where does it come from?  Can it be prevented?

Diabetes is a condition where your blood sugar (glucose) is elevated outside the normal measurements.  When this happens for a prolonged time, blood vessels in organs such as the eyes, kidneys, heart, and brain, are damaged.   These organs are slowly starved of the blood flow they need, and as a result, they fail.

The body controls glucose in a safe range using a hormone called insulin.  Insulin is released from the pancreas, an organ buried in your abdomen just above your belly button.  In the most common type of diabetes, type 2, the pancreas is working normally and releasing insulin to try to keep blood glucose normal.  It fails because of changes in how blood vessel cells react to the insulin.  This failure is caused by excess weight, which seems to release chemicals that block the action of insulin.

The less common type of diabetes, type 1, occurs when the pancreas loses its ability to make and release insulin.  This occurs when the pancreas is attacked by inflammation.

Medical science hasn’t solved how to prevent type 1 diabetes.  For now, treatment requires the injection of insulin to simulate the normal function of the pancrease.

Fortunately, doctors DO understand how to prevent type 2 diabetes.  The factors that push patients to this diagnosis are:

  • excess weight, particularly in the abdominal region;
  • excess carbohydrate intake in the food you eat;
  • physical inactivity.

Preventing type 2 diabetes means: control of body fat, healthy eating, and regular physical activity.

Really?  Is it that simple?

Yes, this is the formula for preventing type 2 diabetes.  But, its a hard formula to apply to yourself.  Its a formula that will require the development of new healthy habits.  And unhealthy behaviors will have to be abandoned

Wellivery focuses on three aspects of diabetes.

  • screening to allow earliest diagnosis and treatment of diabetes
  • screening to detect silent complications of diabetes
  • risk reduction – to prevent type 2 diabetes from getting a foothold.

In the U.S., hospitals and pharmaceutical companies have worked hard and at great expense to treat diabetes. Countless lives have been saved by this approach.

Unfortunately, many patients die when the diabetes is diagnosed too late or when the treatment fails.

Clearly, prevention of diabetes would have a vast impact.

The U.S. healthcare system has not been particularly effective at preventing diabetes.  Medical research has shown how doctors should work with patients to prevent diabetes and how to make screening happen.  However, this research is not universally used, and for many reasons, patients don’t have access to either screening or prevention planning.

Diabetes prevention and screening for earlist diagnosis is a primary focus of Wellivery.  Our formula?

  • Use established clinical guidelines
  • Get patients screened according to these guidelines
  • Develop a prevention plan for each patient
  • Control risk factors that are already present
  • Use the smartphone and phone visits as the primary platform for patient communication and education – not the doctor office.

Diabetes is like most chronic diseases that occur when a genetic susceptabilty that you inherited interacts with your environment (like: poor nutrition, stress, excess weight, physical inactivity, smoking, alcohol).  We can’t change your genetic profile.

You CAN change the enviromental factors that will push you into diabetes.  Wellivery is designed to be your expert physician counselor, guiding you to victory over your risk of diabetes and its complications.

Wellivery has a special focus on:

Diabetes Prevention in Children

If we can start our prevention efforts in kids that we can already recognize as high risk, we have a much better chance of making a lasting change for LIFE!

Until next topic, I wish the best of health to you!

#backpocketdoc

#affordableaccessiblecare

Subscribe Now!

Get email notifications when I post new Health Topics.

COVID19 Treatment!

TREATMENT FOR COVID19?YES! I have been tracking the scientific and clinical literature since the beginning of the COVID-19 pandemic. I have been particularly vigilant for safe and effective treatments for COVID-19 that are used in NON-HOSPITALIZED patients that have a...

Long COVID Lung

Long COVID Lung A large number of patients that experienced COVID-19 will have persisting lung symptoms such as shortness of breath, wheezing, cough,  and decreased exercise capacity.  These problems are usually worse in patients who became so ill that they required...

Leveraging Dietary Protein

* Why is protein needed? * What kind of protein? * How much? Why is Protein Needed? Obesity Prevention: The American diet tends to be high in carbohydrates and fats.  Excessive intake of these nutrients is driving an epidemic of obesity, diabetes, heart disease and...

Long COVID Brain

Long COVID Brain

Long COVID Brain You have either heard of or experienced first hand the “brain fog” associated with COVID-19 infection.  This disordered operation of thought and memory occurs during an active COVID-19 infection.  But what about later, down the road?  Do these issues...

Long COVID Heart

Long COVID Heart

Infection with COVID-19 has shown us many unique medical problems caused by the virus.  Once you as a patient get out of the danger zone with your initial infection, you may not be out of the woods.  Many patients COVID-19 are reporting new problems beginning many...

Take Control of Diabetes!

*  Diabetes means your body is struggling to keep your blood sugar normal. *  There are two types of diabetes: Typle 1 and Type 2. *  If you have been diagnosed with either, careful attention to your food intake and prescribed medicine is the most...

Everyday Health for

Everybody!

 Same Day Appointments are Available.

720-900-0943

Telemedicine for You!

Long COVID Treatment

Long COVID Treatment

Long COVID Treatment

Long COVID treatment is becoming a serious topic as doctors and scientists come to appreciate just how many COVID-19 survivors are likely to experience this disorder.  Both the CDC and the WHO are working establish more knowledge about it.  But first, what are we talking about?

Let’s Define It

The definition of Long COVID is evolving and this evolution is occurring faster than almost any other area of medicine.  Consequently, we will know dramatically more about Long COVID in 6 months. 

For now, Long COVID is a broad set of symptoms that appears at least four weeks after the initial COVID-19 infection.  None of these symptoms are unique to COVID-19 and are seen in other disorders.  

Treating It

In some of these other disorders, well defined treatments have been established. My job as a physician is to evaluate these symptoms, determine if they are part of a non-COVID disorder and launch treatment.  

For example, after recovery from COVID-19, many patients complain of shortness of breath. Shortness of breath is also a symptom seen in poorly controlled asthma. If the shortness of breath these patients report is from asthma, and we make the diagnosis of asthma, then asthma medicine can be prescribed with good relief of the symptoms.

What if asthma is not diagnosed in these patients? Would asthma medicine still provide them relief? These are valid and very important questions that doctors and patients will be discovering the answers to as we move forward.

 

Leave Long COVID behind!

Moving Ahead!

I believe there are a few main points to remember:

  1. At this time, it is believed that most post-Covid symptoms will resolve in a period of six months to one year.
  2. The medication or interventions that improve the long COVID symptoms are already well known.
  3. Most Long COVID patients can be managed by a primary care physician.
  4. As a physician, the most important task is to keep Long COVID patients hopeful while being vigilant for treatable serious underlying diseases. 
  5. Just as with all chronic health problems, building an expert, accessible, healing relationship between the patient and physician is be the best way to move through the Long COVID recovery process.

Long COVID will present some treatment challenges.

There is much that we don’t know about this disorder.  But, we know a lot about helping patients overcome the limitations of a chronic disease.  We can apply that knowlege and those approaches to help patients overcome Long COVID for life!

Subscribe Now!

Get email notifications when I post new Health Topics.

COVID19 Treatment!

TREATMENT FOR COVID19?YES! I have been tracking the scientific and clinical literature since the beginning of the COVID-19 pandemic. I have been particularly vigilant for safe and effective treatments for COVID-19 that are used in NON-HOSPITALIZED patients that have a...

Long COVID Lung

Long COVID Lung A large number of patients that experienced COVID-19 will have persisting lung symptoms such as shortness of breath, wheezing, cough,  and decreased exercise capacity.  These problems are usually worse in patients who became so ill that they required...

Leveraging Dietary Protein

* Why is protein needed? * What kind of protein? * How much? Why is Protein Needed? Obesity Prevention: The American diet tends to be high in carbohydrates and fats.  Excessive intake of these nutrients is driving an epidemic of obesity, diabetes, heart disease and...

Long COVID Brain

Long COVID Brain

Long COVID Brain You have either heard of or experienced first hand the “brain fog” associated with COVID-19 infection.  This disordered operation of thought and memory occurs during an active COVID-19 infection.  But what about later, down the road?  Do these issues...

Long COVID Heart

Long COVID Heart

Infection with COVID-19 has shown us many unique medical problems caused by the virus.  Once you as a patient get out of the danger zone with your initial infection, you may not be out of the woods.  Many patients COVID-19 are reporting new problems beginning many...

Take Control of Diabetes!

*  Diabetes means your body is struggling to keep your blood sugar normal. *  There are two types of diabetes: Typle 1 and Type 2. *  If you have been diagnosed with either, careful attention to your food intake and prescribed medicine is the most...

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Long COVID Treatment

What Causes Long COVID?

What Causes Long COVID?

What Causes Long COVID?

First, we need clarify what is meant by Long COVID.  The definition of long COVID is being perfected but for now, it refers to new mental or physical symptoms that are present four or more weeks after your acute COVID infection.  We know the SARS-CoV-2 virus causes COVID-19 and we are getting better understanding about why infection with SARS-CoV-2 creates so much lung damage.  How this virus causes the symptoms of Long COVID in other body systems is still being worked out but, we have some clues.

COVID-19 Hamster Clues

Clues From Hamsters?

Yep!  Hamsters get COVID-19 and they suffer the same complications as human, including LONG COVID!

This means they can be studied for clues to how COVID-19 induces Long COVID in humans.

The first symptom of long COVID explored in hamsters was loss of smell.  Hamsters loose their sense of smell with COVID-19 just like humans and this effect can be long lasting.  The study describing these observations performed by Zazhytska et al. was published in the journal Cell.

In hamsters that suffered lasting loss of smell, evaluation of the olfactory nerve showed damage to a particular structural cell in the olfactory (smell) bulb connected to the nose.  The damage to these cells results in a large amount of inflammation which impairs the normal functions of olfactory nerve cells in the same tissue.  The nerve cells are not damaged but cannot maintain their normal smell-functions resulting in loss of the sense of smell.

The normal immune response eventually gets control of this inflammation, allowing the olfactory nerve cells to resume their normal smell-related functions and the sense of smell returns.

The same inflammation-related malfunction was found in other areas of the hamster brain.   If true in humans, this may explain neurological and mental changes that have been reported in Long COVID.

Fixing it.

Studies are currently looking to see if shutting down the inflammation response with medication will allow more rapid recovery of these neurological functions including smell and other mental health functions.

Until we have a more detailed understanding of the cause of lasting changes in the brain and other body systems in Long COVID, we will focus on assisting patients with a wide variety of symptoms. Our overall goal is to improve functional capacity and quality of life in these patients.

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COVID19 Treatment!

TREATMENT FOR COVID19?YES! I have been tracking the scientific and clinical literature since the beginning of the COVID-19 pandemic. I have been particularly vigilant for safe and effective treatments for COVID-19 that are used in NON-HOSPITALIZED patients that have a...

Long COVID Lung

Long COVID Lung A large number of patients that experienced COVID-19 will have persisting lung symptoms such as shortness of breath, wheezing, cough,  and decreased exercise capacity.  These problems are usually worse in patients who became so ill that they required...

Leveraging Dietary Protein

* Why is protein needed? * What kind of protein? * How much? Why is Protein Needed? Obesity Prevention: The American diet tends to be high in carbohydrates and fats.  Excessive intake of these nutrients is driving an epidemic of obesity, diabetes, heart disease and...

Long COVID Brain

Long COVID Brain

Long COVID Brain You have either heard of or experienced first hand the “brain fog” associated with COVID-19 infection.  This disordered operation of thought and memory occurs during an active COVID-19 infection.  But what about later, down the road?  Do these issues...

Long COVID Heart

Long COVID Heart

Infection with COVID-19 has shown us many unique medical problems caused by the virus.  Once you as a patient get out of the danger zone with your initial infection, you may not be out of the woods.  Many patients COVID-19 are reporting new problems beginning many...

Take Control of Diabetes!

*  Diabetes means your body is struggling to keep your blood sugar normal. *  There are two types of diabetes: Typle 1 and Type 2. *  If you have been diagnosed with either, careful attention to your food intake and prescribed medicine is the most...

Everyday Health for

Everybody!

 Same Day Appointments are Available.

720-900-0943

Telemedicine for You!

Long COVID Treatment

Steroids and Long COVID

Steroids and Long COVID

Are Steroids Helpful in Long COVID?

Many patients ask me about steroids early in the treatment of long COVID-19. While it’s true that steroids are often used in hospitalized patients with active COVID-19, the evidence for their effectiveness in patients who are recovering is not strong.

In fact, in animal studies of how COVID affects the brain, it appears that the non-judicious use of steroids in COVID-19 infection can make things worse.  That’s because early in COVID-19 infection, the immune system needs to be fully functional and at full speed.  Steroids like prednisone and dexamethasone shut down immune defense systems, which gives the virus an unchecked advantage in spreading inside the body.

Steroids for COVID-19?

Steroids Are Helpful in Hospitalized COVID.

When COVID-19 patients land in the hospital, its usually because their lungs are failing.  The current evidence indicates that in some people, due to underlying disease or genetic factors, COVID-19 infection triggers a hyper-reaction in their immune system.  The lungs are at ground zero of this reaction and are damaged in the cross-fire.  In this setting, steroids are used to tone-down the immune response to lessen lung damage.

How Would Steroids Help in Long COVID?

We are at the very edge of understanding this question. The first studies that will answer this will be conducted in hamsters, a species that remarkably mimics COVID-19 infection in humans.

It will be sometime before we know how applicable these findings are to humans. Nonetheless, these studies are encouraging and provide additional insight into COVID-19 and long Covid symptoms.

Long COVID Information

Long COVID is a fascinating medical challenge!  Helping patients navigate to recovery from Long COVID is a top priority at Wellivery.  Keep track of Long COVID developments by bookmarking the Wellivery Long COVID page.

Subscribe Now!

Get email notifications when I post new Health Topics.

COVID19 Treatment!

TREATMENT FOR COVID19?YES! I have been tracking the scientific and clinical literature since the beginning of the COVID-19 pandemic. I have been particularly vigilant for safe and effective treatments for COVID-19 that are used in NON-HOSPITALIZED patients that have a...

Long COVID Lung

Long COVID Lung A large number of patients that experienced COVID-19 will have persisting lung symptoms such as shortness of breath, wheezing, cough,  and decreased exercise capacity.  These problems are usually worse in patients who became so ill that they required...

Leveraging Dietary Protein

* Why is protein needed? * What kind of protein? * How much? Why is Protein Needed? Obesity Prevention: The American diet tends to be high in carbohydrates and fats.  Excessive intake of these nutrients is driving an epidemic of obesity, diabetes, heart disease and...

Long COVID Brain

Long COVID Brain

Long COVID Brain You have either heard of or experienced first hand the “brain fog” associated with COVID-19 infection.  This disordered operation of thought and memory occurs during an active COVID-19 infection.  But what about later, down the road?  Do these issues...

Long COVID Heart

Long COVID Heart

Infection with COVID-19 has shown us many unique medical problems caused by the virus.  Once you as a patient get out of the danger zone with your initial infection, you may not be out of the woods.  Many patients COVID-19 are reporting new problems beginning many...

Take Control of Diabetes!

*  Diabetes means your body is struggling to keep your blood sugar normal. *  There are two types of diabetes: Typle 1 and Type 2. *  If you have been diagnosed with either, careful attention to your food intake and prescribed medicine is the most...

Everyday Health for

Everybody!

 Same Day Appointments are Available.

720-900-0943

Telemedicine for You!

How Widespread is Long COVID?

How Widespread is Long COVID?

How Widespread is Long COVID?

Long COVID is Real

Long COVID (also called Postacute Sequelae of SARS-CoV-2 Infection or PASC) is a new clinical diagnosis and as such, the diagnostic criteria for this disorder have not been settled.

What we can say is that survivors of COVID-19 infection are frequently reporting  new mental and physical problems that last weeks to months after their acute COVID-19 symptoms passed.

 

Does everybody with COVID-19 get long COVID?

This is very important question and is a moving target, like so many other aspects of COVID-19.  Only a few studies have been performed that can shed any light on this question.  In 2021, a systematic review of 57 published studies from around the world, covering 250,351 patients diagnosed with COVID-19 found that long covid symptoms occurred in 54% of survivors at 1 month, 55% at 2-5 months, and 54% at 6+ months (Groff et al, 2021).

Ok, so if 50% of COVID-19 survivors get long COVID, how many is that, in the U.S. and the world?  To get that number, we need to know how many people have gotten COVID19 and survived.

 

How Many People Have Survived COVID-19??

In the U.S. the current data from the CDC says 78M have survived COVID19 (as of 2/8/2022).  This number is currently increasing by 243K cases per day.
World-wide, WHO data indicate 397M cases, increasing at 1.8M cases per day;

How Accurate Are These Numbers?

On this point, we run into an ugly truth about how many people have had documented COVID19.  You see, I was there in early 2020, working in the ER when health systems said: “don’t come in unless you are really sick”, and, ‘we don’t have enough COVID tests to offer it to patients that aren’t being admitted”.  Then, throughout 2021, patients were instructed to assume they had COVID19 if they developed typical symptoms and had been exposed to a person known to be positive. We have all witnessed the widespread failure of COVID testing access.

 

The result: A lot of people that had, and currently have COVID19 didn’t get and aren’t getting counted.

 

So, you wouldn’t be shocked if I suggested the numbers offered above are a large under-representation of the true number of people infected with COVID19.  But, how far off is that number?  Why do I care?  Well, if ~50% of people surviving COVID19 are getting long COVID, it is important to know the size of that group so we can organize a clinical response that can reasonably deliver the needed care.

Estimating the ‘true’ Numbers

Though not often discussed in the media, epidemiologists appreciate that undercounting of COVID19 cases has occured.  In an effort to derive the real case counts, Reese et al considered the reasons for “underdetection” and derived a correction factor.  For every hospitalized patient,  2.5  patients weren’t counted. For every COVID19-positive patient that wasn’t hospitalized, 7.1 were not counted.  Let’s just consider the non-hospitilized scenario: To find the actual number of non-hospitalized COVID19 cases in the U.S., we need to multiply the CDC number by ‘7’.  That yields 546M, more than the population of the U.S., which suggests, as we know, that many people have gotten COVID19 more than once.

How Many Long COVID Patients Should We Prepare to Treat?

Given the currently reported undercounts, along with daily increases and the non-hospitalized correction factor (7. 1), it becomes clear that the current incidence of long COVID could easily be 273M.  As a frame of reference, the incidence of other chronic diseases is:

  • Diabetes: 34 M
  • Pre-diabetes: 88 M
  • Heart Disease: 30 M
  • Mental Health: 52 M
  • Obesity: 119 M

This means long COVID is already the #1 chronic disease in the U.S.

How is the U.S. health system going to respond to the needs of 273M patients with a new chronic disease?

We’ll get into that next.

If you believe you have long COVID, schedule an appointment on Wellivery to get an assessment.

 

Learning about Long COVID

Long COVID Information

Long COVID is a fascinating medical challenge!  Helping patients navigate to recovery from Long COVID is a top priority at Wellivery.  Keep track of Long COVID developments by bookmarking the Wellivery Long COVID page.

Subscribe Now!

Get email notifications when I post new Health Topics.

COVID19 Treatment!

TREATMENT FOR COVID19?YES! I have been tracking the scientific and clinical literature since the beginning of the COVID-19 pandemic. I have been particularly vigilant for safe and effective treatments for COVID-19 that are used in NON-HOSPITALIZED patients that have a...

Long COVID Lung

Long COVID Lung A large number of patients that experienced COVID-19 will have persisting lung symptoms such as shortness of breath, wheezing, cough,  and decreased exercise capacity.  These problems are usually worse in patients who became so ill that they required...

Leveraging Dietary Protein

* Why is protein needed? * What kind of protein? * How much? Why is Protein Needed? Obesity Prevention: The American diet tends to be high in carbohydrates and fats.  Excessive intake of these nutrients is driving an epidemic of obesity, diabetes, heart disease and...

Long COVID Brain

Long COVID Brain

Long COVID Brain You have either heard of or experienced first hand the “brain fog” associated with COVID-19 infection.  This disordered operation of thought and memory occurs during an active COVID-19 infection.  But what about later, down the road?  Do these issues...

Long COVID Heart

Long COVID Heart

Infection with COVID-19 has shown us many unique medical problems caused by the virus.  Once you as a patient get out of the danger zone with your initial infection, you may not be out of the woods.  Many patients COVID-19 are reporting new problems beginning many...

Take Control of Diabetes!

*  Diabetes means your body is struggling to keep your blood sugar normal. *  There are two types of diabetes: Typle 1 and Type 2. *  If you have been diagnosed with either, careful attention to your food intake and prescribed medicine is the most...

Everyday Health for

Everybody!

 Same Day Appointments are Available.

720-900-0943

Telemedicine for You!