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<v Speaker 1>Drivers know what trouble sounds like.

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<v Speaker 2>Oh hey, it's your aunt who always carries kleenex Ali

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<v Speaker 2>ward in This episode is a long time coming, just

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<v Speaker 2>about five years so. March eleventh, twenty twenty. It's been

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<v Speaker 2>called the day that everything changed. I'm sure you remember

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<v Speaker 2>a little something called the SARS Kobe two virus started

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<v Speaker 2>to make its debut globally and COVID nineteen pandemic became

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<v Speaker 2>a part of our lives and history, some people more

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<v Speaker 2>than others. It's woven into your history, as worldwide studies

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<v Speaker 2>estimate that the virus has caused directly or indirectly the

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<v Speaker 2>deaths of up to thirty six million people. So, if

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<v Speaker 2>you have had COVID and you bounced back quickly, you're lucky.

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<v Speaker 2>If you haven't had it, you're lucky. If you've had it,

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<v Speaker 2>you still feel weird. Sit down, let's discuss, and please

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<v Speaker 2>do send this episode around to anyone who could use it.

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<v Speaker 2>I know long COVID is on a lot of our

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<v Speaker 2>minds and it's hard to find the information that you need.

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<v Speaker 2>This is exactly what I've hoped that it would be. Okay,

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<v Speaker 2>So in this part one, we're going to learn how

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<v Speaker 2>to know if you have long COVID, the symptoms, why

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<v Speaker 2>it happens, where in the body it happens, how it feels.

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<v Speaker 2>And then next week we're going to talk more about

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<v Speaker 2>treatments and advice if you think you have it, and

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<v Speaker 2>some really wonderful firsthand experience from some friends and scientists

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<v Speaker 2>I know who have struggled with long COVID, including some

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<v Speaker 2>great advice for caregivers. So this expert ugh so good.

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<v Speaker 2>So he got his MD from Tulane University in New Orleans, Louisiana.

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<v Speaker 2>He is now a professor of medicine at Vanderbilt University

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<v Speaker 2>Medical Center. He has published over four hundred and fifty

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<v Speaker 2>peer reviewed papers. He's been cited over one hundred thousand times. Somehow,

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<v Speaker 2>he also found time to author a critically acclaimed book.

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<v Speaker 2>It's called Every Deep Drawn Breath, and it's about developing

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<v Speaker 2>treatment for patients in the ICU that will improve their

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<v Speaker 2>lives after illness. We'll talk about it. His lovely spouse

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<v Speaker 2>also a pathologist. This guy lives in Breese It He's

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<v Speaker 2>also a pulmonologist. Now when it comes to long COVID,

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<v Speaker 2>he is one of the most highly respected and sought

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<v Speaker 2>after specialists, and I was thrilled when he agreed to

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<v Speaker 2>let me barrage him with all of our questions. We're

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<v Speaker 2>going to get there in a second, but first, thank

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<v Speaker 2>you to all the patrons at patreon dot com slash

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<v Speaker 2>ologies who send their questions for this episode in and

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<v Speaker 2>who support the show for as little as a dollar

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<v Speaker 2>a month. Thank you to everyone out there listening to Somologies,

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<v Speaker 2>which is our classroom safe, kid friendly, shorter spinoff show.

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<v Speaker 2>You can find Smologies wherever you get podcasts. Thanks also

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<v Speaker 2>to everyone out there wearing ologies merch fromologiesmerch dot com.

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<v Speaker 2>Also for zero dollars and help just by leaving a review.

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<v Speaker 2>I read every single one of them. Here's one just

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<v Speaker 2>left by Yodelbat, who wrote, if you love hearing someone

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<v Speaker 2>gush about a passion, then you will have a good time.

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<v Speaker 2>And although, okay, this episode seems like, oh lord, covid still,

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<v Speaker 2>but this expert is so passionate about it and so

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<v Speaker 2>great at his job and so personable, and it lays

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<v Speaker 2>out how yeah, COVID still, especially for some people. And

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<v Speaker 2>also I could have never imagined how brightly, enthusiastic and

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<v Speaker 2>compassionate he could. Be absolutely honored to have met him.

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<v Speaker 2>So tuck in, breathe deep if he can, and let's

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<v Speaker 2>load you up with true facts about what long COVID is,

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<v Speaker 2>how it differs from other post viral illnesses, variance, and

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<v Speaker 2>long COVID risks, why people say it's not real, Advice

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<v Speaker 2>for caregivers, symptoms to look for, changing opinions in medicine,

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<v Speaker 2>similarities to HIV treatment options, autoimmune issues, pots, post exertional malaise,

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<v Speaker 2>The best way to prevent long COVID. How many spoons

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<v Speaker 2>does it take to change a light bulb and why

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<v Speaker 2>I need to start swimming and more with physician, professor, author, researcher, pulmonologist, intensivist,

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<v Speaker 2>and post viral epidemiologist doctor Wes Ely.

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<v Speaker 5>My name is Wes Ealy, and I'm a hymn and

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<v Speaker 5>I am so thankful to be here today.

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<v Speaker 2>I'm so excited. We've wanted to do this for a

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<v Speaker 2>long long time. And long COVID is a tough one

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<v Speaker 2>because you're not quite sure what experts are super up

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<v Speaker 2>on the latest research. The biggest question I feel like

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<v Speaker 2>I get or I hear is long COVID real, which

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<v Speaker 2>is an interesting thing to say about, like a condition.

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<v Speaker 2>But how often does the veracity of long COVID come

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<v Speaker 2>up in your work?

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<v Speaker 5>Ali? That's a great question and so important because we

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<v Speaker 5>started to basics do we believe our patients? And I'll

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<v Speaker 5>admit right off the bat, I'm a good person to

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<v Speaker 5>ask because I didn't and I was wrong and I

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<v Speaker 5>had to learn and wake up and say, wait a minute, Wes,

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<v Speaker 5>look in the mirror. You're a fraud. You don't think

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<v Speaker 5>this is real, but it is real, and you know

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<v Speaker 5>I came to it naturally. If you really want to know,

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<v Speaker 5>because I'm a product of traditional academic medicine, and we

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<v Speaker 5>were not taught in medical school that chronic fatigue syndrome

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<v Speaker 5>was real. We were taught that it was perhaps made

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<v Speaker 5>up in people's mind. And then for twenty five years

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<v Speaker 5>I studied the post intensive care syndrome, which is when

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<v Speaker 5>people come into the ICU and get super sick and

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<v Speaker 5>leave with head problems and body problems. And I just

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<v Speaker 5>thought that COVID patients complaining months after COVID was that.

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<v Speaker 5>And I just thought, Oh, these people don't even realize.

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<v Speaker 5>It's just post intense care syndrome.

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<v Speaker 2>And PICS or post most intensive care syndrome. It's a

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<v Speaker 2>term that was coined in twenty ten and it's defined

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<v Speaker 2>as this new onset or worsening of impairment in physical, cognitive,

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<v Speaker 2>and or mental health that arises after the ICU and

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<v Speaker 2>persists beyond hospital discharge. So PICKS symptoms can include fatigue

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<v Speaker 2>and muscle weakness, anxiety and depression, and cognitive impairment at

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<v Speaker 2>a year after an ICU stay and longer than that.

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<v Speaker 2>And among surgery patients, it's more common for those who

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<v Speaker 2>have had an unplanned urgent surgery than elective expected ones.

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<v Speaker 2>So doctors have been hipped two picks post intensive care

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<v Speaker 2>syndrome in ICU patients for at least fifteen years, and

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<v Speaker 2>after recovering from an inpatient's day with COVID, it seemed

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<v Speaker 2>to align with PICKS.

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<v Speaker 5>But then they started calling said, wait a minute, I

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<v Speaker 5>was never in the hospital, And I said what they said, No,

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<v Speaker 5>I've never been in the hospital, and I can't walk right,

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<v Speaker 5>and I can't my heart rates too high, and I

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<v Speaker 5>can't think clearly. And so I had to say, wait

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<v Speaker 5>a minute, West, this is not what you thought it was.

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<v Speaker 5>There's something else going on.

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<v Speaker 2>How far into the pandemic did that switch happen for you?

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<v Speaker 5>It happened around not too late, obviously it's pretty early.

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<v Speaker 5>But my doubting days were all the spring and early

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<v Speaker 5>summer of twenty twenty, and already by June or July,

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<v Speaker 5>especially July and August of twenty twenty, we had people

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<v Speaker 5>contacting our research office saying, can you help us? And

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<v Speaker 5>that was when I had real live conversations with people

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<v Speaker 5>who said they were long hollers who had never been hospitalized,

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<v Speaker 5>had only been outpatient, and were having these tremendous life

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<v Speaker 5>changing difficulties. So I'd say four to six months into

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<v Speaker 5>the pandemic, I was absolutely convinced it was real. But

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<v Speaker 5>those first two or three months, even on Twitter, I

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<v Speaker 5>was really confused to what was going on.

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<v Speaker 2>What makes long COVID different from just post viral malaise.

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<v Speaker 2>How is long COVID different from your system just trying

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<v Speaker 2>to reboot and say, oh, man, that sucked, but I'm

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<v Speaker 2>getting better.

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<v Speaker 5>Yeah, I'd say two big things. Let's talk individual patients differences,

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<v Speaker 5>and then epidemiologically at the population level. Individually, post viral illness,

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<v Speaker 5>you know, after a bad flu, you feel bad for

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<v Speaker 5>a couple of weeks. But what happens with patients who

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<v Speaker 5>experience long COVID is that they oftentimes have a honeymoon.

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<v Speaker 5>They don't always, but a lot of times they'll have

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<v Speaker 5>a two or three month, ninety day honeymoon and then

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<v Speaker 5>they just wham. They just get hit with these cognitive

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<v Speaker 5>body disabilities that get worse and worse, and they really

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<v Speaker 5>get incapacitated and disabled. So that's on the individual level.

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<v Speaker 5>It's that this is way more pronounced than just a

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<v Speaker 5>post viral malaise just a few weeks of recovery. This

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<v Speaker 5>is something that's going on weeks and months and there's

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<v Speaker 5>no recovery in sight on their own. And then on

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<v Speaker 5>the epidemiological level, we've never had a post viral like

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<v Speaker 5>a post flu epidemic of this proportion. So now we

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<v Speaker 5>just have you know, millions of people with this problem

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<v Speaker 5>societally and as a whole globally. So we've never had

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<v Speaker 5>this many people to study an IACC infection associated chronic condition,

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<v Speaker 5>which is what we call this. Now it's a disease state.

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<v Speaker 2>Again, the term for this is now IACC. That's infection

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<v Speaker 2>associated chronic condition. And no matter what the initial cause,

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<v Speaker 2>and IACC tends to cause severe impacts to quality of life.

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<v Speaker 2>It impacts more female patients than male, It involves neurological

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<v Speaker 2>or immunological pathology, and it can affect a bunch of organs.

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<v Speaker 2>So IACC doesn't have to be long covid Specifically, IACC

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<v Speaker 2>is infection associated chronic condition, but long covid is an IACC,

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<v Speaker 2>just like how not all succulents are cacti, but all

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<v Speaker 2>cacti are succulents. Long covid is an IACC, not all

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<v Speaker 2>iaccs are long covid. Cool.

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<v Speaker 5>Yes, this is a disease state and it is real.

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<v Speaker 2>What is it about covid itself that has a tendency to,

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<v Speaker 2>or rather has the possibility to create long covid? You know?

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<v Speaker 2>Is there something about the virus itself? Is it that

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<v Speaker 2>it's a coronavirus? Is it the spike proteins? Why are

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<v Speaker 2>we seeing so much long covid but not long influenza

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<v Speaker 2>A or long step throat or something.

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<v Speaker 5>Yeah, well there is long influence. So there's the pandemic

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<v Speaker 5>of nineteen eighteen. The Spanish flu had post viral illnesses

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<v Speaker 5>and so for over one hundred years we've known these exists.

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<v Speaker 2>And just a quick recap on the nineteen eighteen flu pandemic.

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<v Speaker 2>This caused fifty million deaths globally, and at the time

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<v Speaker 2>there was obviously no vaccine, and according to a recent

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<v Speaker 2>paper titled an Unwanted but long Known Company, post viral

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<v Speaker 2>symptoms in the context of past pandemics in Switzerland and beyond,

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<v Speaker 2>doctors in nineteen nineteen reported that the duration of recovery

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<v Speaker 2>from this flu the nineteen eighteen flu varied considerably among patients,

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<v Speaker 2>and it was often a desperately slow recovery, even in

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<v Speaker 2>mild cases, and it continues that patients suffered from general weakness, exhaustion,

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<v Speaker 2>sometimes acute psychosis or severe nervous depression which delayed their

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<v Speaker 2>recovery further. And in addition, the paper says persistent heart

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<v Speaker 2>problems were the main cause of long recovery times in

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<v Speaker 2>a large number of cases. And that was about again

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<v Speaker 2>the nineteen eighteen flu pandemic. We also have a three

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<v Speaker 2>part ADHD episode with expert doctor Russell Barkley, and he

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<v Speaker 2>mentioned that a big spike of kids who survived the

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<v Speaker 2>nineteen eighteen flu were being diagnosed with what is now

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<v Speaker 2>known as ADHD. So big illness waves leave a lot

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<v Speaker 2>of ripple effects in terms of symptoms. But post flu

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<v Speaker 2>conditions are a little different than long covid because.

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<v Speaker 5>What COVID does. COVID is a very vascular problem. This

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<v Speaker 5>is a viral illness that is extremely vascular. So the

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<v Speaker 5>endothelium of our blood vessels gets infected with this virus,

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<v Speaker 5>and it also does something to our immune system, whereby

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<v Speaker 5>it basically turns on a light switch with our immune

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<v Speaker 5>system which creates an immune mediated disorder in our bodies.

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<v Speaker 5>And so these two things, the vascular nature of it

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<v Speaker 5>and the way it turns on an immune mediated problem,

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<v Speaker 5>which affects then the brain, that the autonomic nervous system,

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<v Speaker 5>the cardiovastrosystem, the gias system, so many different organ systems,

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<v Speaker 5>is something that becomes basically very dastardly for the human body.

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<v Speaker 2>So if you heard the surgical angiology episode with a

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<v Speaker 2>brilliant doctor Sheila Blumberg about veins and arteries, and our

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<v Speaker 2>recent cardiology episode with doctor Hermann Taylor, you may remember

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<v Speaker 2>how the endothelium lines the blood vessels and inflammation of

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<v Speaker 2>that tissue can lead to injury of it and plaque

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<v Speaker 2>build up. And remember that doctor Taylor said that there

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<v Speaker 2>are several thousand miles of these vessels in your body.

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<v Speaker 2>They go to every remote part of you. And in

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<v Speaker 2>that episode, doctor Taylor explained why we don't want to

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<v Speaker 2>treat the endothelium tissue like garbage, and one reason is

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<v Speaker 2>to protect the veins, arteries and root to our hearts.

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<v Speaker 2>We're going to get right back to doctor Eely in

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<v Speaker 2>a minute or two, but I want to really quick

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<v Speaker 2>refresh your memory with a clip from doctor Herman Taylor's

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<v Speaker 2>cardiology episode we just did where he explains how those

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<v Speaker 2>endothelial tissues inside your veins work or don't work. So

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<v Speaker 2>let's have a quick listen to that.

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<v Speaker 6>There's a certain head of pressure that's needed in the heart,

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<v Speaker 6>but it can't be too much. If it's too much,

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<v Speaker 6>then what can happen is those arteries that are so

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<v Speaker 6>vital to the heart survival become damaged the lining inside

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<v Speaker 6>of them called the endothelium. That then lining that allows

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<v Speaker 6>for the exchange of oxygen and nutrients and so forth,

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<v Speaker 6>is so very important. If it becomes damaged and starts

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<v Speaker 6>to dysfunction, that allows all sorts of badness, like cholesterol accumulation,

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<v Speaker 6>the formation of what we call fatty streaks, which are

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<v Speaker 6>just it's like a giant oil slick on a road

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<v Speaker 6>where you have cholesterol gathering breaking through the barrier that

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<v Speaker 6>should be intact. That cholesterol event is being consumed by

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<v Speaker 6>cells from the body that are designed to protect the

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<v Speaker 6>body against invaders. But they come in they and gorge

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<v Speaker 6>themselves on the cholesterol. They break down and form debris.

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<v Speaker 6>It causes inflammation, and there's this cascade of events that

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<v Speaker 6>then leads to the body trying to contain it by

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<v Speaker 6>forming a plaque over the top. A very fragile covering

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<v Speaker 6>over this whole mess, right, and that contains the damage

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<v Speaker 6>for a while, and it could be years. This whole

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<v Speaker 6>process can take years in development. In fact, we see

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<v Speaker 6>some of these changes I'm describing, and the autopsies of

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<v Speaker 6>soldiers who are eighteen nineteen years old, you can see

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<v Speaker 6>the very beginnings of this process. Anyway, that type of

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<v Speaker 6>damage can be initiated by pressures that are too high.

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<v Speaker 6>That then sets up a situation where that plaque could

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<v Speaker 6>erode or rupture.

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<v Speaker 2>And remember that plaque is like spackle over a moldy.

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<v Speaker 6>Wall, exposing all of that garbage to the blood passing by,

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<v Speaker 6>which sort of sees it as this disruption in the

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<v Speaker 6>artery and then sends all sorts of things to fix

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<v Speaker 6>this break in the artery. Platelets, which you remember from

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<v Speaker 6>high school biology, are mainly intended to stop you from bleeding, right,

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<v Speaker 6>They form a clot to close a cut you may

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<v Speaker 6>have or a bruise. But in this case, the platelets,

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<v Speaker 6>which are like think of these tiny pieces of velcrow.

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<v Speaker 6>They come to the site where all of this has happened,

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<v Speaker 6>and they stick to each other as well as sticking

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<v Speaker 6>to the site.

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<v Speaker 2>And also, as we covered in the surgical in geology episode.

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<v Speaker 2>It's been estimated that the human circulatory system would stretch

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<v Speaker 2>out to be over ninety five thousand kilometers in order

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<v Speaker 2>to pump more than seventy five liters of your blood

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<v Speaker 2>every day. By the way, that's sixty thousand miles and

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<v Speaker 2>two thousand gallons if you are American now. As for

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<v Speaker 2>COVID and clotting, a twenty twenty three study risk of

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<v Speaker 2>thrombosis during and after SARS COVID two infection Pathogenesis, Diagnostic

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<v Speaker 2>Approach and Management in the journal Hematology Reports says that

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<v Speaker 2>COVID nineteen increases the risk of thrombo embolic events, especially

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<v Speaker 2>in patients with severe infections requiring intensive care and cardio

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<v Speaker 2>respiratory support ventilation and COVID nineteen patients with these clotting

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<v Speaker 2>complications have a higher risk of death and if they survive,

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<v Speaker 2>these complications are expected to negatively impact their quality of life.

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<v Speaker 2>So COVID increases the risk of blood clots, and the

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<v Speaker 2>worser case of it, the more at risk you are

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<v Speaker 2>for those blood clots. And it also says that recent

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<v Speaker 2>data show that the risk of thrombo embolism remains high

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<v Speaker 2>months after infection, So COVID ups your chance of clots,

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<v Speaker 2>and data show that it can infect coronary vessels. So

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<v Speaker 2>how do you not get blood clots and thrombosis? Never

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<v Speaker 2>a bad idea to avoid getting COVID. Remember, get your boosters.

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<v Speaker 2>Don't be afraid to mask up because a blood clot

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<v Speaker 2>is way scarier than a weird look from a stranger.

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<v Speaker 2>In my opinion and my experience. Did I fly three

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<v Speaker 2>days ago and was I the only person I saw

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<v Speaker 2>on the plane wearing a mask? Sure?

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<v Speaker 5>Was?

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<v Speaker 2>Do I give a shit? No? I don't want that.

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<v Speaker 2>But back to doctor Eli, why is long COVID such

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<v Speaker 2>a bitch?

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<v Speaker 5>Let's talk a little bit about how it might be

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<v Speaker 5>different though than other viral ilysis. Would that be okay?

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<v Speaker 2>Yes? Yes, get into it, okay, Like if.

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<v Speaker 5>You think about diseases like HIV. You know HIV is

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<v Speaker 5>a global viral problem that creates a chronic illness. And

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<v Speaker 5>what the HIV virus does, which is so genius of

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<v Speaker 5>the virus, is that it figures out a way to

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<v Speaker 5>go undetected in the body, So it hides itself in

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<v Speaker 5>the body in a dormant state and inculcates itself into

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<v Speaker 5>the genome, so that where the virus is hanging out,

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<v Speaker 5>instead of those cells dying, it actually promotes the life

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<v Speaker 5>of those cells and can even increase their cell turnover.

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<v Speaker 5>So thereby doubling and tripling and quadrupling, the virus copies itself.

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<v Speaker 2>So HIV hides in specific cells and then encourages just

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<v Speaker 2>those cells to make more of them. It's kind of

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<v Speaker 2>like a Ponzi scheme.

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<v Speaker 5>So thank goodness COVID hasn't learned that COVID doesn't know

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<v Speaker 5>how to do that. And the main two theories of

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<v Speaker 5>long COVID it's probably a little at both end, but

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<v Speaker 5>in fact, we just published a paper two days ago

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<v Speaker 5>on viral persistence, which is one leading theory. But the

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<v Speaker 5>other one is not just that the virus is still

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<v Speaker 5>hanging around causing problems, but that while it was here

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<v Speaker 5>it did something to activate the immune system, which may

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<v Speaker 5>need immune modulation down the line for therapies to dampen

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<v Speaker 5>down and either turn off or turn down the disease

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<v Speaker 5>state of long COVID.

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<v Speaker 2>And so what the common theory or the common thought

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<v Speaker 2>of is is you get COVID, your immune system goes

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<v Speaker 2>what is this? What's going on? And then instead of

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<v Speaker 2>getting better from the virus, your immune system just goes WHOA,

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<v Speaker 2>I'm still out of whack and just keeps firing things off.

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<v Speaker 2>Is it tend to just be thought of under the

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<v Speaker 2>umbrella of autoimmune diseases.

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<v Speaker 5>Yeah, generally you can put this in a camp of

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<v Speaker 5>is this an ongoing infectious problem, infectious disease problem, or

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<v Speaker 5>is it an ongoing immunological disease. You might think like

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<v Speaker 5>rheumator earthritis or loopus. And in fact, we now know

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<v Speaker 5>through millions of patients studied in Germany, the UK, the

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<v Speaker 5>United States in the very large coorch studies, that there

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<v Speaker 5>is a doubling or a tripling of these autoimmune diseases

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<v Speaker 5>like lupus, rheumature arthritis, chogrin syndrome, And so we know

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<v Speaker 5>that that happens. Diabetes as well, oftentimes is thought to

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<v Speaker 5>be an immunological disease, and there's a very clear cut

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<v Speaker 5>risk of getting acquired diabetes in long COVID. Wow.

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<v Speaker 2>And we have a great two part diabetology episode with

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<v Speaker 2>self described diabetic diabetologists doctor Mike Natter, which explains the

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<v Speaker 2>different ways that pancreas can crap out on you. Causing

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<v Speaker 2>type one or type two diabetes. But yeah, if your

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<v Speaker 2>body sees its own tissue as the enemy, like with MS,

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<v Speaker 2>or psoriasis or lupus or rheumatoid arthritis, etc. Then it's

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<v Speaker 2>a really delicate operation to calm your own shit down.

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<v Speaker 2>And the two main thoughts are that long COVID is

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<v Speaker 2>this continued attack by the virus plus continued to attack

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<v Speaker 2>on yourself by your own immune system because of the virus.

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<v Speaker 2>It's a real why are you hitting yourself situation? It's infuriating.

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<v Speaker 2>Now if the virus, say, was an arsonist, then your

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<v Speaker 2>immune system is like a firefighter who is trying to

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<v Speaker 2>put out the fire, but who is blasting you so

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<v Speaker 2>hard with a fire host that you're drowning. At least

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<v Speaker 2>that's a hypothesis.

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<v Speaker 5>We've learned a lot, but there's a lot more to learn.

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<v Speaker 2>What about other diseases kind of under or rather, what

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<v Speaker 2>about other autoimmune diseases that might be sparked by a

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<v Speaker 2>virus like MS or chronic fatigue syndrome or I always

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<v Speaker 2>say this wrong. I think it's wheelan bar but I'm

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<v Speaker 2>or Wheelin Yan Beret gyanbre Gillanbret Gyan beret. Always say

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<v Speaker 2>that wrong, and then I always triple guess myself. It's French.

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<v Speaker 2>It looks like Gillian bar, but it's pronounced beret like

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<v Speaker 2>as Gillan beret, and it sucks. Gian beret can arise

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<v Speaker 2>after an illness or a surgery, and symptoms can include

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<v Speaker 2>muscle weakness, starting in the hands and feet and progressing

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<v Speaker 2>even up to the facial and eye muscles and the

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<v Speaker 2>respiratory system, and can even be fatal. But back to COVID,

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<v Speaker 2>but is long COVID similar to those at all that

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<v Speaker 2>could be kind of ignited by a virus or an illness.

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<v Speaker 5>That's a really good analogy and in medicine, that is

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<v Speaker 5>essentially what we think happens. You know, these diseases like

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<v Speaker 5>after a viral illness. I have a friend who just

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<v Speaker 5>this past December got a viral illness upper and lower

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<v Speaker 5>restore tract infection, and then within a week started feeling

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<v Speaker 5>very weak in her hands and feet and then ascended

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<v Speaker 5>and she ended up on a ventilator. And that was

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<v Speaker 5>a post viral onset of gion beret. And she got

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<v Speaker 5>better and we gave aminoglobulin for that disease process, and

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<v Speaker 5>we know Some of these are well treated by therapies

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<v Speaker 5>like aminoglobulin, but others aren't. And unfortunately, long COVID hasn't

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<v Speaker 5>been proven to respond to different types of disease treatments

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<v Speaker 5>that we've used in other diseases, like systemic steroids or

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<v Speaker 5>immunotherapy or plasmaphoresis. Those things haven't helped patients in concrete manners.

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<v Speaker 2>And just a few options when it comes to therapies.

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<v Speaker 2>There are systemic cortico steroids that can tamp down inflammation

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<v Speaker 2>in your body, and those are delivered either orally or

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<v Speaker 2>through injections. There's also something called plasma faresis, which involves

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<v Speaker 2>a blood draw and then the blood is separated into

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<v Speaker 2>its red blood cells, white blood cells, and its plasma,

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00:22:58.319 --> 00:23:01.799
<v Speaker 2>and then the plasma is delivered to the patient intraveniously.

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<v Speaker 2>And according to a very recent study which came out

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<v Speaker 2>less than two weeks ago it was titled Plasma exchange

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<v Speaker 2>Therapy for the post COVID nineteen condition, a phase two,

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<v Speaker 2>double blind, placebo controlled randomized trial within the journal Nature

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<v Speaker 2>found that while plasma exchange was safely tolerated, it did

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<v Speaker 2>not lead to any discernible improvement of the long COVID

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<v Speaker 2>in this clinical trial.

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<v Speaker 5>Unfortunately, there are individual people who say they've been helped,

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00:23:28.839 --> 00:23:32.359
<v Speaker 5>but we don't have well done, random, mask controlled trials

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<v Speaker 5>showing that that's a reproducible benefit for our long COVID patients.

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<v Speaker 2>Why do you think COVID is like nah?

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<v Speaker 5>Well, sometimes I globin is hitting a specific antibody that's

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<v Speaker 5>been produced that's causing the problem, and we don't have

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<v Speaker 5>immune markers like that for long COVID. In fact, there

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<v Speaker 5>are no really beautifully proven blood tests and or biomarkers

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<v Speaker 5>for long COVID yet now there are some coming out.

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<v Speaker 5>I don't want people to say, wait minute, he didn't

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<v Speaker 5>know about I know about research that's coming down the pipe,

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00:23:59.000 --> 00:24:02.119
<v Speaker 5>but there's nothing commercially available and on a large scale

419
00:24:02.200 --> 00:24:03.559
<v Speaker 5>that is yet mainstream.

420
00:24:03.960 --> 00:24:07.640
<v Speaker 2>So there's promising research, but no easy long COVID tests

421
00:24:07.799 --> 00:24:08.400
<v Speaker 2>you can take.

422
00:24:08.799 --> 00:24:11.359
<v Speaker 5>But there's a lot of people in labs around the

423
00:24:11.359 --> 00:24:14.079
<v Speaker 5>world that we're learning that hopefully we will have a

424
00:24:14.079 --> 00:24:16.799
<v Speaker 5>bio marker. I was on the committee of the National

425
00:24:16.839 --> 00:24:20.880
<v Speaker 5>Academy of Sciences, Engineering and Medicine NASUM where we helped

426
00:24:21.160 --> 00:24:24.160
<v Speaker 5>redefine long COVID. Maybe we'll get to that later. We will,

427
00:24:24.480 --> 00:24:27.319
<v Speaker 5>And that was one of the caveats in our report

428
00:24:27.599 --> 00:24:30.160
<v Speaker 5>after working for over a year on this project, was

429
00:24:30.200 --> 00:24:34.319
<v Speaker 5>that we need to update our long COVID definition every

430
00:24:34.480 --> 00:24:38.400
<v Speaker 5>couple of years because the science is fast and furious

431
00:24:38.599 --> 00:24:41.799
<v Speaker 5>and we don't want to be out of date and irrelevant.

432
00:24:42.759 --> 00:24:46.359
<v Speaker 2>Well, that's a perfect time to ask, what does long

433
00:24:46.400 --> 00:24:48.920
<v Speaker 2>COVID look like? What kind of symptoms do people have?

434
00:24:49.039 --> 00:24:51.880
<v Speaker 2>If right now as we're speaking, there's not a commercially

435
00:24:51.920 --> 00:24:54.319
<v Speaker 2>available test for long COVID. You can't roll into your

436
00:24:54.319 --> 00:24:56.480
<v Speaker 2>doctors and be like, hey, yes or no, do I

437
00:24:56.480 --> 00:24:59.519
<v Speaker 2>have long COVID? What kind of symptoms are we seeing

438
00:24:59.559 --> 00:25:02.000
<v Speaker 2>that we're grouping together under long COVID?

439
00:25:02.759 --> 00:25:05.000
<v Speaker 5>Sure? Let me Can we just use real life examples

440
00:25:05.039 --> 00:25:06.920
<v Speaker 5>that I have permission to share. I won't say their names,

441
00:25:06.920 --> 00:25:09.279
<v Speaker 5>but these people have given me written sign permission to

442
00:25:09.319 --> 00:25:11.720
<v Speaker 5>share their stories generally even their names. But I'm not

443
00:25:11.759 --> 00:25:14.119
<v Speaker 5>gonna do that today. But how about a young man

444
00:25:14.279 --> 00:25:18.359
<v Speaker 5>in his mid twenties who is an engineer working with

445
00:25:18.519 --> 00:25:22.960
<v Speaker 5>experiments to make, for example, electric cars better and faster,

446
00:25:23.359 --> 00:25:27.480
<v Speaker 5>and or surgical equipment better and more safe, and ticking

447
00:25:27.559 --> 00:25:31.440
<v Speaker 5>along a very good athlete riding two thousand feet in

448
00:25:31.480 --> 00:25:35.000
<v Speaker 5>elevation for six hours at a time and gets COVID,

449
00:25:35.519 --> 00:25:39.160
<v Speaker 5>has a honeymoon, gets a little better, but within sixty

450
00:25:39.240 --> 00:25:43.839
<v Speaker 5>to eighty days starts getting hit with extreme fatigue, has

451
00:25:43.839 --> 00:25:46.680
<v Speaker 5>a tremendous difficulty riding his bike, then notices at work

452
00:25:46.720 --> 00:25:51.640
<v Speaker 5>he can't finish his experiments cognitively and just says, you know, now,

453
00:25:52.279 --> 00:25:55.319
<v Speaker 5>even a year or two into this, washing his car

454
00:25:56.200 --> 00:25:59.599
<v Speaker 5>will wipe him out for a week. Yesterday, I went

455
00:25:59.640 --> 00:26:02.440
<v Speaker 5>to the home of a young woman who is suffering

456
00:26:02.480 --> 00:26:05.640
<v Speaker 5>from long COVID, a teenager, and she knows that I

457
00:26:05.680 --> 00:26:08.279
<v Speaker 5>have permission to share her story as well. I met

458
00:26:08.279 --> 00:26:11.200
<v Speaker 5>with her in her bedroom with her mother, and she

459
00:26:11.240 --> 00:26:13.440
<v Speaker 5>said that she will go out of her bedroom one

460
00:26:13.519 --> 00:26:16.960
<v Speaker 5>day in a week. Perhaps has been in that bedroom,

461
00:26:17.000 --> 00:26:20.880
<v Speaker 5>bed bound, as she said, for over a year, and

462
00:26:21.039 --> 00:26:25.960
<v Speaker 5>has had to drop out of school and has no hope.

463
00:26:26.000 --> 00:26:27.839
<v Speaker 5>I was trying to build hope for and I want

464
00:26:27.920 --> 00:26:29.640
<v Speaker 5>these people to never lose hope, because we're not going

465
00:26:29.720 --> 00:26:32.240
<v Speaker 5>to stop until we get answers for them. But she

466
00:26:32.319 --> 00:26:34.519
<v Speaker 5>told me this great story, which I think is relevant

467
00:26:34.519 --> 00:26:37.839
<v Speaker 5>for your listeners, that she operates by the spoon theory,

468
00:26:38.119 --> 00:26:40.599
<v Speaker 5>and I have this many spoons in my cup and

469
00:26:41.079 --> 00:26:42.839
<v Speaker 5>this activity is going to take two of my four

470
00:26:42.880 --> 00:26:45.400
<v Speaker 5>spoons or two of my six spoons, and I'm gonna

471
00:26:45.400 --> 00:26:48.000
<v Speaker 5>have to stop. And she said, after we finished this interview,

472
00:26:48.079 --> 00:26:50.880
<v Speaker 5>doctor Eli, doctor West, I will be in the bed

473
00:26:51.160 --> 00:26:53.920
<v Speaker 5>for four days. She sat up, She was exuberant. She

474
00:26:53.960 --> 00:26:55.480
<v Speaker 5>talked to me the whole time. She said, this is

475
00:26:55.519 --> 00:26:57.759
<v Speaker 5>taking everything I've got. I will use all six of

476
00:26:57.759 --> 00:27:00.160
<v Speaker 5>my spoons for this interview, which would lasted now and

477
00:27:00.160 --> 00:27:02.559
<v Speaker 5>an hour and a half. And I felt terrible after

478
00:27:02.640 --> 00:27:05.000
<v Speaker 5>hearing her say that, And she said, it'll take me

479
00:27:05.640 --> 00:27:08.559
<v Speaker 5>four days to get myself back after this. And I'm

480
00:27:08.640 --> 00:27:10.319
<v Speaker 5>checking in with her later today to make sure she's

481
00:27:10.359 --> 00:27:12.599
<v Speaker 5>doing okay. But that's what they're suffering from, is this

482
00:27:12.680 --> 00:27:16.119
<v Speaker 5>massive amount of PEM or post exertional malaise or like

483
00:27:16.160 --> 00:27:20.440
<v Speaker 5>the first pasion I told you, tremendous cognitive difficulties even

484
00:27:20.440 --> 00:27:25.559
<v Speaker 5>at a young, very otherwise brilliant mind, life changing.

485
00:27:26.720 --> 00:27:29.559
<v Speaker 2>So this spoon theory was coined in a two thousand

486
00:27:29.599 --> 00:27:33.279
<v Speaker 2>and three essay by American writer Christine Miserandino and folks

487
00:27:33.279 --> 00:27:36.559
<v Speaker 2>who are dealing with chronic illness sometimes refer affectionately to

488
00:27:36.599 --> 00:27:40.519
<v Speaker 2>themselves as spoonies. And for more on chronic illness and disability,

489
00:27:40.559 --> 00:27:43.920
<v Speaker 2>we put out a great disability sociology episode for Disability

490
00:27:43.920 --> 00:27:47.920
<v Speaker 2>Pride Month last July, featuring the legendary doctor Gwenn Chambers.

491
00:27:48.200 --> 00:27:52.119
<v Speaker 2>And now a quick background on EMYCFS. So, the CDC

492
00:27:52.359 --> 00:27:56.039
<v Speaker 2>defines it as a serious and often long lasting illness

493
00:27:56.039 --> 00:27:58.640
<v Speaker 2>and it keeps people from doing their usual activities. It

494
00:27:58.759 --> 00:28:03.559
<v Speaker 2>makes physical and mental exertion really difficult. Symptoms include trouble thinking,

495
00:28:03.960 --> 00:28:08.480
<v Speaker 2>severe tiredness, and there's no known cure. Care usually means

496
00:28:08.559 --> 00:28:12.279
<v Speaker 2>treating the symptoms that most affect a person's life. Would

497
00:28:12.359 --> 00:28:16.920
<v Speaker 2>this be classified under MECFS or is that a different

498
00:28:17.039 --> 00:28:19.759
<v Speaker 2>kind of label on a different disease? But I feel

499
00:28:19.759 --> 00:28:22.400
<v Speaker 2>like my friends who have had long COVID talk a

500
00:28:22.400 --> 00:28:24.960
<v Speaker 2>lot about that, and you know, I hear a lot

501
00:28:24.960 --> 00:28:29.359
<v Speaker 2>about that post exertional malaise being completely wiped out. Have

502
00:28:29.440 --> 00:28:32.319
<v Speaker 2>you heard of the physics girl Diana Khan? Yeah, so

503
00:28:32.359 --> 00:28:34.559
<v Speaker 2>she's a friend of ours too, and she's getting a

504
00:28:34.559 --> 00:28:38.279
<v Speaker 2>little bit better, which is great. But MEYCFS is something

505
00:28:38.319 --> 00:28:41.400
<v Speaker 2>that I hadn't heard about until friends had long COVID.

506
00:28:41.680 --> 00:28:44.880
<v Speaker 2>Where does that? Where's the Venn diagram of that? Yeah?

507
00:28:44.960 --> 00:28:47.480
<v Speaker 5>Thank you for bringing up Dinah's story. She's a beautiful

508
00:28:47.519 --> 00:28:50.400
<v Speaker 5>person and her husband as well an amazing caregiver and

509
00:28:50.480 --> 00:28:52.720
<v Speaker 5>a good example of how the caregivers are a big

510
00:28:52.720 --> 00:28:56.559
<v Speaker 5>part of this story because the caregiver burden is a myss.

511
00:28:56.839 --> 00:28:59.200
<v Speaker 2>We're going to hear more firsthand advice for patients and

512
00:28:59.279 --> 00:29:03.039
<v Speaker 2>caregivers from Diana and her husband Kyle in part two,

513
00:29:03.240 --> 00:29:04.799
<v Speaker 2>but first we're going to donate to a cause of

514
00:29:04.839 --> 00:29:08.359
<v Speaker 2>doctor Eli's choice, and he pointed us toward Critical Illness,

515
00:29:08.519 --> 00:29:12.559
<v Speaker 2>Brain Dysfunction and Survivorship Center, which is composed of an

516
00:29:12.599 --> 00:29:16.640
<v Speaker 2>interprofessional group of physicians and nurses and psychologists and biostaticians,

517
00:29:16.759 --> 00:29:20.440
<v Speaker 2>epidemiologists and more who work with patients who are or

518
00:29:20.480 --> 00:29:23.319
<v Speaker 2>have been critically ill and are at risk for long

519
00:29:23.400 --> 00:29:27.839
<v Speaker 2>term cognitive, functional, and neuropsychological impairments. Now Wes is the

520
00:29:27.839 --> 00:29:30.119
<v Speaker 2>center's co director and you'll learn a little bit more

521
00:29:30.200 --> 00:29:33.920
<v Speaker 2>about how ologies can support their patients in next week's episode.

522
00:29:34.119 --> 00:29:36.400
<v Speaker 2>Thanks to you, and thanks to sponsors of the show.

523
00:29:37.240 --> 00:29:39.240
<v Speaker 1>Drivers know what trouble sounds like.

524
00:29:39.359 --> 00:29:43.920
<v Speaker 6>No no, okay forward?

525
00:29:45.119 --> 00:29:49.759
<v Speaker 3>Oh no oh please no no, That's why they get

526
00:29:49.759 --> 00:29:53.759
<v Speaker 3>covered from Ireland's Soundest Car Insurance provider Supervalue Insurance.

527
00:29:54.039 --> 00:29:56.359
<v Speaker 4>Thanks for calling us beIN and don't beat yourself up

528
00:29:56.400 --> 00:29:59.240
<v Speaker 4>about it. Sure, I'm driving ten years and parallel parking

529
00:29:59.240 --> 00:29:59.839
<v Speaker 4>still baptis.

530
00:30:01.039 --> 00:30:03.640
<v Speaker 3>Get a quote from Supervalue Car Insurance to get ten

531
00:30:03.640 --> 00:30:05.640
<v Speaker 3>percent off online and we'll even.

532
00:30:05.480 --> 00:30:08.839
<v Speaker 1>Throw in forty euroin vouchers. TEASNC supply vouchers include two

533
00:30:08.880 --> 00:30:11.680
<v Speaker 1>twenty euro or forty eurospend. This car insurance is underwritten

534
00:30:11.680 --> 00:30:14.359
<v Speaker 1>by ACS Insurance Deck Supervalue Financial Services STACK, trading as

535
00:30:14.359 --> 00:30:16.759
<v Speaker 1>Supervalue Insurance is regulated by the Central Bank of Ireland.

536
00:30:17.640 --> 00:30:20.319
<v Speaker 2>Okay, back to long COVID and Wes and I were

537
00:30:20.359 --> 00:30:23.359
<v Speaker 2>talking about caregivers and how next week we're going to

538
00:30:23.400 --> 00:30:25.519
<v Speaker 2>hear more advice from them. In talking to Kyle, the

539
00:30:25.640 --> 00:30:29.599
<v Speaker 2>husband of physics girl science communicator Diana Coweren, who's been

540
00:30:29.640 --> 00:30:33.680
<v Speaker 2>suffering with long COVID and EMMYCFS since twenty twenty two,

541
00:30:34.160 --> 00:30:37.240
<v Speaker 2>and last June, Kyle posted in honor of the couple's

542
00:30:37.440 --> 00:30:41.400
<v Speaker 2>second wedding anniversary detailing that quote. Diana has been one

543
00:30:41.440 --> 00:30:44.440
<v Speaker 2>hundred percent bedbound with long COVID. She lays in a

544
00:30:44.559 --> 00:30:47.799
<v Speaker 2>dark room ear plugs in with only her mind and

545
00:30:47.839 --> 00:30:50.880
<v Speaker 2>simple thoughts to keep her company. No she can't talk,

546
00:30:51.240 --> 00:30:55.319
<v Speaker 2>watch TV, read books, listen to podcasts, or even music.

547
00:30:55.680 --> 00:30:59.079
<v Speaker 2>She can't tolerate visitors. Even the faint smell of laundry

548
00:30:59.079 --> 00:31:02.160
<v Speaker 2>detergent makes her sick. It's a kind of locked in hell,

549
00:31:02.440 --> 00:31:06.279
<v Speaker 2>he writes, and there's currently no cure for this disease. Thankfully,

550
00:31:06.519 --> 00:31:09.920
<v Speaker 2>Diana's condition has improved modestly in the last few months,

551
00:31:09.960 --> 00:31:13.400
<v Speaker 2>but it's still extreme ups and downs.

552
00:31:12.920 --> 00:31:15.160
<v Speaker 5>And my heart goes out to her and to all

553
00:31:15.200 --> 00:31:21.559
<v Speaker 5>of those suffering MECFS. Hermologic andcephalomiaelitis. Chronic fatigue syndrome is

554
00:31:21.559 --> 00:31:23.920
<v Speaker 5>the formal name of what we used to call chronic fatigue,

555
00:31:24.440 --> 00:31:29.680
<v Speaker 5>and these Venn diagrams are very overlapping. This young woman

556
00:31:29.720 --> 00:31:31.400
<v Speaker 5>I met with yesterday thought for a year and a

557
00:31:31.440 --> 00:31:36.519
<v Speaker 5>half that she just HADCFS, and everybody was dissing her

558
00:31:36.799 --> 00:31:40.920
<v Speaker 5>informal medical evaluations about the possibility of long COVID, And

559
00:31:40.960 --> 00:31:44.519
<v Speaker 5>when I reviewed her history and her actual documented times

560
00:31:44.559 --> 00:31:48.440
<v Speaker 5>when she had positive COVID tests, her story fits perfectly

561
00:31:48.960 --> 00:31:54.000
<v Speaker 5>for long COVID, and her symptom complex is broad enough

562
00:31:54.319 --> 00:31:58.279
<v Speaker 5>that I think in her example, the MAACFS fits underneath

563
00:31:58.279 --> 00:32:01.440
<v Speaker 5>the umbrella of a larger diagnosis of long COVID, and

564
00:32:02.000 --> 00:32:05.200
<v Speaker 5>many patients would tell you that MACFS is part of

565
00:32:05.279 --> 00:32:10.160
<v Speaker 5>their long COVID disease state. Others might argue with that characterization,

566
00:32:10.519 --> 00:32:14.480
<v Speaker 5>but for example, as a scientist, as a physician scientist,

567
00:32:14.799 --> 00:32:16.640
<v Speaker 5>I'm working with a lot of people on a large

568
00:32:16.640 --> 00:32:19.519
<v Speaker 5>trial that we are now enrolling into call Reverse long

569
00:32:19.559 --> 00:32:25.759
<v Speaker 5>Covid our VLC, and I sponsored, and we use MACFS

570
00:32:26.519 --> 00:32:31.279
<v Speaker 5>tests and symptom batteries as part of our measurements to

571
00:32:31.359 --> 00:32:34.680
<v Speaker 5>see what our intervention is doing or not doing. And

572
00:32:34.880 --> 00:32:36.920
<v Speaker 5>it's a double bland placiba control trial, so I can't

573
00:32:36.920 --> 00:32:39.079
<v Speaker 5>tell you anything about the results as of yet, and

574
00:32:39.119 --> 00:32:41.079
<v Speaker 5>we'll be doing this trial for several years.

575
00:32:41.279 --> 00:32:45.519
<v Speaker 2>Okay, So long covid can cause MACFS in that inflammation

576
00:32:45.640 --> 00:32:49.720
<v Speaker 2>in the brain coupled with fatigue may be diagnosed as MACFS,

577
00:32:50.079 --> 00:32:53.359
<v Speaker 2>and that MECFS could be long covid or it could

578
00:32:53.400 --> 00:32:57.079
<v Speaker 2>be another AICC infection associated chronic condition.

579
00:32:57.720 --> 00:33:01.079
<v Speaker 5>But my point to you is that I absolutely believe

580
00:33:01.440 --> 00:33:05.000
<v Speaker 5>that patients who suffer long covid meet the criteria of

581
00:33:05.039 --> 00:33:10.200
<v Speaker 5>a MECFS. And if MACFS is new and onset after

582
00:33:10.599 --> 00:33:14.039
<v Speaker 5>the COVID pandemic, many of those patients actually have long

583
00:33:14.039 --> 00:33:14.559
<v Speaker 5>COVID or.

584
00:33:14.559 --> 00:33:18.640
<v Speaker 2>Both, and you said there's no test as of now.

585
00:33:18.920 --> 00:33:22.880
<v Speaker 2>But as a doctor, you're very patient centered, and you

586
00:33:22.960 --> 00:33:25.519
<v Speaker 2>wrote a whole book about how the way that we

587
00:33:25.559 --> 00:33:29.000
<v Speaker 2>look at how we treat patients needs to shift a

588
00:33:29.039 --> 00:33:31.440
<v Speaker 2>little bit. And you know, you don't hear a lot

589
00:33:31.480 --> 00:33:33.839
<v Speaker 2>of doctors being like I went to a patient's bedside

590
00:33:33.839 --> 00:33:35.680
<v Speaker 2>and talk to her for a while, Like it doesn't

591
00:33:36.079 --> 00:33:38.960
<v Speaker 2>I feel like that doesn't happen very often. How do

592
00:33:39.039 --> 00:33:42.839
<v Speaker 2>you approach this kind of care, especially for a disease

593
00:33:42.880 --> 00:33:47.039
<v Speaker 2>that is still our knowledge is still developing, and you

594
00:33:47.160 --> 00:33:51.079
<v Speaker 2>might be the fifth doctor that someone's seen because no

595
00:33:51.160 --> 00:33:53.799
<v Speaker 2>one believes them. What's your philosophy and how to care

596
00:33:53.880 --> 00:33:54.839
<v Speaker 2>for patients with this?

597
00:33:56.440 --> 00:33:59.119
<v Speaker 5>All I can say, Ali, is that a lot happens

598
00:33:59.119 --> 00:34:01.160
<v Speaker 5>in my mind when you ask me that question, But

599
00:34:01.240 --> 00:34:04.960
<v Speaker 5>I just approach it on my knees. And what I

600
00:34:05.000 --> 00:34:07.319
<v Speaker 5>mean by that is actually on my knees, you know,

601
00:34:07.400 --> 00:34:10.360
<v Speaker 5>kneel down before this person because I am there to

602
00:34:10.480 --> 00:34:12.119
<v Speaker 5>serve them and to try and make them big and

603
00:34:12.199 --> 00:34:15.400
<v Speaker 5>me small. And by that I mean that there's nothing

604
00:34:15.440 --> 00:34:19.480
<v Speaker 5>I can ever do to earn the privilege of being

605
00:34:19.519 --> 00:34:22.519
<v Speaker 5>with people who are suffering in this regard, and our

606
00:34:22.519 --> 00:34:25.039
<v Speaker 5>patients who are suffering with long COVID have been through

607
00:34:25.119 --> 00:34:28.079
<v Speaker 5>so much and not listened to that. The way I

608
00:34:28.119 --> 00:34:31.840
<v Speaker 5>want to start this relationship is to listen. I want

609
00:34:31.880 --> 00:34:35.199
<v Speaker 5>to hear who are you, how are you suffering? What

610
00:34:35.400 --> 00:34:38.360
<v Speaker 5>makes you you? I start, oftentimes by simple questions like

611
00:34:38.480 --> 00:34:40.559
<v Speaker 5>can you just tell me? I call them e les

612
00:34:40.599 --> 00:34:44.119
<v Speaker 5>four questions. What are your favorite hobbies, your favorite music,

613
00:34:44.519 --> 00:34:47.960
<v Speaker 5>your favorite food, and your pet's names? Because once I

614
00:34:48.039 --> 00:34:50.920
<v Speaker 5>know these things about people, you know that they love

615
00:34:51.119 --> 00:34:54.159
<v Speaker 5>Bob Dylan, and you know they love Chinese fusion, and

616
00:34:54.239 --> 00:34:56.559
<v Speaker 5>their dog's name is Bacchus, the god of wine. And

617
00:34:57.360 --> 00:35:00.320
<v Speaker 5>their favorite hobbies is that they work on cars, spare

618
00:35:00.320 --> 00:35:02.880
<v Speaker 5>tivers something. Then I have a I go, oh my gosh,

619
00:35:02.920 --> 00:35:06.360
<v Speaker 5>this is an entire person, mind, body, and spirit. Wes

620
00:35:06.599 --> 00:35:09.239
<v Speaker 5>never allow yourself to think of this person as a

621
00:35:09.239 --> 00:35:14.000
<v Speaker 5>diseased heart or kidneys, or stomach or brain. This is

622
00:35:14.039 --> 00:35:16.880
<v Speaker 5>a whole person West How willing am I to dive

623
00:35:16.920 --> 00:35:20.119
<v Speaker 5>into the chaos of this person's life and provide lifting

624
00:35:20.159 --> 00:35:22.519
<v Speaker 5>and healing? And so that's where it all starts for me,

625
00:35:22.639 --> 00:35:26.760
<v Speaker 5>Ali is can we see how you're suffering? Try and

626
00:35:26.840 --> 00:35:29.639
<v Speaker 5>understand that and I don't have all the answers for you,

627
00:35:29.840 --> 00:35:31.960
<v Speaker 5>but I'm going to stay with you and we'll start

628
00:35:32.000 --> 00:35:32.960
<v Speaker 5>this process together.

629
00:35:33.440 --> 00:35:35.559
<v Speaker 2>Do you have just like a years long waiting list

630
00:35:35.880 --> 00:35:38.920
<v Speaker 2>of people that want to see you? How do you

631
00:35:38.920 --> 00:35:41.039
<v Speaker 2>decide who you see?

632
00:35:40.800 --> 00:35:43.000
<v Speaker 5>I see who I can and we know we love it.

633
00:35:43.119 --> 00:35:44.760
<v Speaker 5>I'm an ic you doctor, you know. I started at

634
00:35:44.760 --> 00:35:48.079
<v Speaker 5>the bedside and I love taking care of critically ill people.

635
00:35:48.280 --> 00:35:49.760
<v Speaker 5>And that was why I got it wrong at the

636
00:35:49.840 --> 00:35:51.800
<v Speaker 5>very meeting with long COVID, because we had all these

637
00:35:52.000 --> 00:35:54.920
<v Speaker 5>COVID patients in the ICU on the ventilators, and no

638
00:35:55.039 --> 00:35:59.719
<v Speaker 5>doubt they left with tremendously bad post intensive care syndrome picks.

639
00:36:00.440 --> 00:36:04.400
<v Speaker 5>But it's a really beautiful thing to be able to

640
00:36:04.400 --> 00:36:07.159
<v Speaker 5>be let in. People let you into their life. There's

641
00:36:07.159 --> 00:36:09.039
<v Speaker 5>no way I can earn that. I mean, they're allowing

642
00:36:09.039 --> 00:36:11.840
<v Speaker 5>me into their life and it's a gift to me.

643
00:36:12.599 --> 00:36:14.599
<v Speaker 5>So we have to do everything we can for these

644
00:36:14.639 --> 00:36:17.760
<v Speaker 5>patients and make them feel heard. And they bring into

645
00:36:17.840 --> 00:36:21.119
<v Speaker 5>this situation not only the trauma of their bodies disease,

646
00:36:21.519 --> 00:36:23.519
<v Speaker 5>but the trauma of having not been listened to and

647
00:36:23.519 --> 00:36:26.960
<v Speaker 5>having been shunned and turned away. And that's adding insult

648
00:36:27.000 --> 00:36:28.800
<v Speaker 5>to injury. So that needs to stop.

649
00:36:29.679 --> 00:36:32.199
<v Speaker 2>If you suspect you have long COVID and you go

650
00:36:32.280 --> 00:36:35.159
<v Speaker 2>to a doctor, how do you feel like doctors should

651
00:36:35.639 --> 00:36:38.960
<v Speaker 2>approach this? If there are any doctors listening, or if

652
00:36:38.960 --> 00:36:41.880
<v Speaker 2>there's any patients who could have some kind of game plan,

653
00:36:42.360 --> 00:36:45.599
<v Speaker 2>what is the arc of treatment or seeing a patient

654
00:36:46.280 --> 00:36:47.920
<v Speaker 2>like in an idealized way.

655
00:36:49.159 --> 00:36:51.199
<v Speaker 5>The first thing that the doctor, the nurse partition, or

656
00:36:51.199 --> 00:36:53.679
<v Speaker 5>the PA, the nurse, anybody needs to do is say,

657
00:36:54.039 --> 00:36:57.840
<v Speaker 5>let me get rid of my biases, get rid of

658
00:36:57.880 --> 00:37:01.639
<v Speaker 5>my presuppositions, and any any judgments of you at all.

659
00:37:01.719 --> 00:37:03.559
<v Speaker 5>I'm talking to the patient. I mean, you don't have

660
00:37:03.599 --> 00:37:05.320
<v Speaker 5>to say this out loud. This is just a mental approach,

661
00:37:05.559 --> 00:37:07.320
<v Speaker 5>and let me just see who you are and tell

662
00:37:07.360 --> 00:37:09.079
<v Speaker 5>me your stories. So I need to be a sleuth here.

663
00:37:09.480 --> 00:37:13.320
<v Speaker 5>Let's understand when did you get COVID exactly and what

664
00:37:13.360 --> 00:37:15.920
<v Speaker 5>documentation do you have of that COVID? So let's see

665
00:37:15.920 --> 00:37:18.440
<v Speaker 5>you know, okay, in January of twenty twenty two, you

666
00:37:18.480 --> 00:37:21.360
<v Speaker 5>got COVID. That was your second bout. Before that, you

667
00:37:21.400 --> 00:37:24.280
<v Speaker 5>had no symptoms. But on the second round of COVID,

668
00:37:24.519 --> 00:37:28.480
<v Speaker 5>you're telling me that in late February eight weeks later,

669
00:37:29.159 --> 00:37:31.239
<v Speaker 5>you got wham hit. You couldn't go back to work,

670
00:37:31.280 --> 00:37:34.159
<v Speaker 5>you were bedbound, and you couldn't think clearly. Okay, that's

671
00:37:34.159 --> 00:37:36.920
<v Speaker 5>a seven to eight week timeframe that fits perfectly for

672
00:37:37.199 --> 00:37:39.239
<v Speaker 5>disease state onng COVID. Now tell me how did your

673
00:37:39.239 --> 00:37:42.199
<v Speaker 5>symptoms evolve, what did you try to do to fix it,

674
00:37:42.599 --> 00:37:45.119
<v Speaker 5>how did it get worse or better? And what have

675
00:37:45.199 --> 00:37:48.119
<v Speaker 5>you tried since? So it's just being a good history

676
00:37:48.159 --> 00:37:52.320
<v Speaker 5>taker and a good listener and not thinking that. We know.

677
00:37:53.519 --> 00:37:56.119
<v Speaker 5>I'm not Buddhist, but this great Tao ta Ching number

678
00:37:56.119 --> 00:38:00.320
<v Speaker 5>sixty five in Buddhism says the ancient masters taught the

679
00:38:00.360 --> 00:38:03.719
<v Speaker 5>student to not know, because if the student thinks they know,

680
00:38:04.360 --> 00:38:06.880
<v Speaker 5>they cannot be taught. But if you know, you don't know.

681
00:38:07.159 --> 00:38:09.440
<v Speaker 5>So when you come to me with your complaints, I

682
00:38:09.519 --> 00:38:12.880
<v Speaker 5>don't know how you're suffering. Yet I have to suspend

683
00:38:12.960 --> 00:38:15.320
<v Speaker 5>judgment and listen to you. And that's where we start,

684
00:38:15.360 --> 00:38:17.519
<v Speaker 5>and all good clinicians should start with that.

685
00:38:19.159 --> 00:38:24.800
<v Speaker 2>What have you seen as the most effective intervention for

686
00:38:25.039 --> 00:38:27.119
<v Speaker 2>long COVID. I know we used to hear if you've

687
00:38:27.159 --> 00:38:30.239
<v Speaker 2>got COVID, you should exercise, that'll help, And now we

688
00:38:30.320 --> 00:38:33.880
<v Speaker 2>hear maybe don't do that. But any tips for preventing

689
00:38:33.960 --> 00:38:35.119
<v Speaker 2>getting long COVID.

690
00:38:36.719 --> 00:38:40.159
<v Speaker 5>The best evidence about prevention of long COVID is to

691
00:38:40.760 --> 00:38:42.960
<v Speaker 5>not get COVID obviously, And so that kind of sounds

692
00:38:42.960 --> 00:38:45.880
<v Speaker 5>stupid like it does statement, But you know, do what

693
00:38:45.960 --> 00:38:48.079
<v Speaker 5>you think is right or what your doctor or health

694
00:38:48.079 --> 00:38:53.320
<v Speaker 5>professional advises you to avoid exposure. And if you have

695
00:38:53.480 --> 00:38:56.360
<v Speaker 5>had multiple infections, you are clearly at higher risks for

696
00:38:56.360 --> 00:39:00.239
<v Speaker 5>getting long COVID, And there are good data to say

697
00:39:00.239 --> 00:39:05.280
<v Speaker 5>that either multiple vaccinations, completing a series and or not

698
00:39:05.280 --> 00:39:11.079
<v Speaker 5>getting infected as many times are some of the protective factors. Now,

699
00:39:11.320 --> 00:39:14.519
<v Speaker 5>let me say on that that I absolutely believe in

700
00:39:14.599 --> 00:39:18.360
<v Speaker 5>vaccine injury. There's no question in my mind that people

701
00:39:18.480 --> 00:39:22.559
<v Speaker 5>have gotten this disease state of a long COVID like

702
00:39:22.599 --> 00:39:25.280
<v Speaker 5>illness from the vaccine. And we have patients in our

703
00:39:25.320 --> 00:39:29.599
<v Speaker 5>clinic who have vaccine injury and the symptom complex is

704
00:39:29.599 --> 00:39:33.679
<v Speaker 5>basically identical to what our long COVID patients have experienced.

705
00:39:33.719 --> 00:39:36.519
<v Speaker 5>So I know that's true, and many people have said

706
00:39:36.559 --> 00:39:39.239
<v Speaker 5>it's not true, and I think that's incorrect. So I

707
00:39:39.280 --> 00:39:41.320
<v Speaker 5>want to acknowledge and know that the people who have

708
00:39:41.400 --> 00:39:44.800
<v Speaker 5>vaccine injury have a voice here and that I'm hearing

709
00:39:44.800 --> 00:39:47.000
<v Speaker 5>them and many others are hearing them as well. And

710
00:39:47.039 --> 00:39:49.159
<v Speaker 5>what we hope, by the way, is that our treatments

711
00:39:49.559 --> 00:39:52.719
<v Speaker 5>for long COVID will also help those with vaccine injury

712
00:39:52.760 --> 00:39:54.480
<v Speaker 5>as well. So there's going to be a hopefully an

713
00:39:54.480 --> 00:39:56.159
<v Speaker 5>overlap and therapeutic approach here.

714
00:39:56.559 --> 00:39:59.920
<v Speaker 2>So while some people's bodies react with immune issues out

715
00:40:00.079 --> 00:40:03.159
<v Speaker 2>dur an actual viral illness, others might be triggered by

716
00:40:03.199 --> 00:40:06.800
<v Speaker 2>an antibody in a vaccine, which is very unfortunate. And

717
00:40:06.880 --> 00:40:09.679
<v Speaker 2>I myself have gotten five COVID shots, I've never had

718
00:40:09.719 --> 00:40:14.360
<v Speaker 2>COVID thankfully, knocking on would or a bad reaction, and

719
00:40:14.480 --> 00:40:18.360
<v Speaker 2>vaccine's still best way to prevent getting COVID in the

720
00:40:18.360 --> 00:40:18.880
<v Speaker 2>first place.

721
00:40:19.039 --> 00:40:21.760
<v Speaker 5>Yes, I believe in vaccines. As I said earlier, I'm

722
00:40:21.800 --> 00:40:23.519
<v Speaker 5>sorry for those who have vaccine injuries. Some of your

723
00:40:23.559 --> 00:40:28.119
<v Speaker 5>listeners will have that. I'm not trying to disregard what

724
00:40:28.159 --> 00:40:31.840
<v Speaker 5>you've suffered from that. But at a population level, no doubt,

725
00:40:31.880 --> 00:40:34.840
<v Speaker 5>the data are clear that being vaccinated lowers your risk

726
00:40:34.880 --> 00:40:36.079
<v Speaker 5>of getting long COVID.

727
00:40:36.400 --> 00:40:38.760
<v Speaker 2>Are there stats in terms of like the percentage of

728
00:40:38.760 --> 00:40:40.719
<v Speaker 2>people that get a vaccine injury? Does it tend to

729
00:40:40.760 --> 00:40:42.599
<v Speaker 2>be very slim right.

730
00:40:42.719 --> 00:40:46.360
<v Speaker 5>So that's why I say that vaccines are still the recommended.

731
00:40:46.400 --> 00:40:48.760
<v Speaker 5>So if your doctor recommends you to get a vaccine,

732
00:40:49.079 --> 00:40:51.079
<v Speaker 5>you go get that vaccine. You're not doing it with

733
00:40:51.119 --> 00:40:55.320
<v Speaker 5>no risk, but you're actually mathematically lowering your risk of

734
00:40:55.320 --> 00:40:58.360
<v Speaker 5>long COVID, not increasing it. And that's the thing. So

735
00:40:58.559 --> 00:41:00.599
<v Speaker 5>you could get a vaccine injury, but chance of getting

736
00:41:00.639 --> 00:41:04.480
<v Speaker 5>vaccine injury is so much less than getting COVID and

737
00:41:04.480 --> 00:41:06.679
<v Speaker 5>then have a substitute long COVID that the odds are

738
00:41:06.679 --> 00:41:09.760
<v Speaker 5>in your favor if you go with the vaccine route.

739
00:41:09.920 --> 00:41:12.559
<v Speaker 5>I hate it that some people who do that will

740
00:41:12.639 --> 00:41:15.800
<v Speaker 5>end up suffering vaccine injury. The numbers, though, are way different.

741
00:41:15.840 --> 00:41:17.039
<v Speaker 5>It's not a comparable number.

742
00:41:18.119 --> 00:41:18.800
<v Speaker 2>That's great to know.

743
00:41:19.000 --> 00:41:20.920
<v Speaker 5>So I dove into prevention a little bit. But let's

744
00:41:20.920 --> 00:41:24.239
<v Speaker 5>go back to treatment. So if somebody develops long COVID

745
00:41:24.320 --> 00:41:30.719
<v Speaker 5>or any IICC infection associated chronic condition, we believe that

746
00:41:30.840 --> 00:41:34.280
<v Speaker 5>the right approach is these people have to be listened

747
00:41:34.280 --> 00:41:38.239
<v Speaker 5>to carefully and individually approach. So one person's symptom complex

748
00:41:38.559 --> 00:41:42.639
<v Speaker 5>will be more GI and cognitively related, another person's symptom

749
00:41:42.719 --> 00:41:46.920
<v Speaker 5>complex will be more fatigue PEM, and another person simptom

750
00:41:46.920 --> 00:41:49.760
<v Speaker 5>complex will more pots, postural orthoceptic tack of gardia.

751
00:41:49.559 --> 00:41:51.639
<v Speaker 2>Syndrome more on pots in a bit.

752
00:41:52.079 --> 00:41:56.800
<v Speaker 5>So that's the reason that your listeners are probably frustrated

753
00:41:56.880 --> 00:42:00.440
<v Speaker 5>right now. There's not anyone blanket treatment which is best treatment,

754
00:42:00.480 --> 00:42:03.360
<v Speaker 5>because this treatment has got to be individualized. If you

755
00:42:03.400 --> 00:42:08.320
<v Speaker 5>talk to the world's best clinicians in mecfs, who are

756
00:42:08.320 --> 00:42:11.840
<v Speaker 5>excellent in carrying, doctors who take good care, they say

757
00:42:11.880 --> 00:42:15.079
<v Speaker 5>it's always I start with the individual. Bob and Sally

758
00:42:15.440 --> 00:42:17.840
<v Speaker 5>may have very different approaches because I'm going to listen

759
00:42:17.840 --> 00:42:20.280
<v Speaker 5>to what they've got. One person may need salt loading

760
00:42:20.280 --> 00:42:23.599
<v Speaker 5>and volume loading to prevent them from getting hypotensive and

761
00:42:23.800 --> 00:42:27.159
<v Speaker 5>extreme tachycardia, and another person doesn't need that at all,

762
00:42:27.280 --> 00:42:30.360
<v Speaker 5>but needs an actual medication to control their heart rate.

763
00:42:30.679 --> 00:42:34.239
<v Speaker 5>While a third person is really having tremendous GIS symptoms

764
00:42:34.360 --> 00:42:36.760
<v Speaker 5>and we're gonna have to work with those symptoms rather

765
00:42:36.800 --> 00:42:41.119
<v Speaker 5>than the cardiovascosymptoms. You also asked about exercise. Do you

766
00:42:41.159 --> 00:42:43.280
<v Speaker 5>want to talk about that and how we've gotten mixed messages?

767
00:42:43.400 --> 00:42:44.480
<v Speaker 2>Yeah, yeah, I would love that.

768
00:42:45.440 --> 00:42:50.239
<v Speaker 5>Okay. So a great example of this individualization of treatment is,

769
00:42:50.239 --> 00:42:56.119
<v Speaker 5>for example, that in post intensive care syndrome. We rehabilitate

770
00:42:56.159 --> 00:42:59.159
<v Speaker 5>people with physical and cognitive rehabilitation and they get a

771
00:42:59.159 --> 00:43:03.119
<v Speaker 5>lot of benefit. And so at the beginning of long COVID,

772
00:43:03.440 --> 00:43:06.719
<v Speaker 5>when we were just starting out taking care of patients

773
00:43:06.719 --> 00:43:09.440
<v Speaker 5>who have this new disease date, we tried those similar

774
00:43:09.440 --> 00:43:12.039
<v Speaker 5>approaches and many of them got worse. And the reason

775
00:43:12.159 --> 00:43:15.159
<v Speaker 5>is that their post exertional malays, which we think probably

776
00:43:15.199 --> 00:43:20.039
<v Speaker 5>is related to mitochondrial injury, really couldn't tolerate those same

777
00:43:20.079 --> 00:43:24.000
<v Speaker 5>sorts of ramping up of physical therapy approaches which we

778
00:43:24.039 --> 00:43:26.679
<v Speaker 5>had taken in the past. Ramped up, I mean, Monday

779
00:43:27.000 --> 00:43:28.840
<v Speaker 5>this week is going to be less than next week,

780
00:43:28.880 --> 00:43:30.239
<v Speaker 5>and next week can be more than the previous, and

781
00:43:30.280 --> 00:43:32.440
<v Speaker 5>we keep ramping up in time, and those people got

782
00:43:32.480 --> 00:43:35.599
<v Speaker 5>tremendously ill because we didn't approach it from an ECFS

783
00:43:35.719 --> 00:43:39.079
<v Speaker 5>approach of post exertional malays. The fame is true with

784
00:43:39.440 --> 00:43:45.079
<v Speaker 5>cognitive rehabilitation, whereas patients years after an ICU stay who

785
00:43:45.119 --> 00:43:48.719
<v Speaker 5>have essentially an acquired dementia can really get their brain

786
00:43:49.000 --> 00:43:52.639
<v Speaker 5>back with brain exercises. In fact, we have several ongoing

787
00:43:52.679 --> 00:43:57.119
<v Speaker 5>randomizes controlled trials of brain exercises in people who have

788
00:43:57.280 --> 00:44:00.760
<v Speaker 5>acquired dementia after critical illness, But our long COVID patients

789
00:44:00.800 --> 00:44:03.559
<v Speaker 5>tell us that the brain exercises wear them out and

790
00:44:03.599 --> 00:44:06.599
<v Speaker 5>make them have physical fatigue just from the brain exercises.

791
00:44:06.719 --> 00:44:10.960
<v Speaker 5>So really we have to take a fresh look at

792
00:44:10.960 --> 00:44:12.960
<v Speaker 5>these approaches and don't think it's a one shoe fits

793
00:44:13.000 --> 00:44:15.559
<v Speaker 5>all because it isn't. And that's one thing that really

794
00:44:15.599 --> 00:44:18.159
<v Speaker 5>angers the long COVID community when we try and push

795
00:44:18.280 --> 00:44:21.000
<v Speaker 5>onto them some treatment that worked in a different population.

796
00:44:21.760 --> 00:44:25.559
<v Speaker 2>Right. You mentioned that it's a very vascular disease. Is

797
00:44:25.599 --> 00:44:30.559
<v Speaker 2>that the vascular system sort of going haywire in different ways?

798
00:44:30.679 --> 00:44:33.760
<v Speaker 2>Or is it the vascular system, it's the mitochondrial system.

799
00:44:33.920 --> 00:44:36.039
<v Speaker 2>It's so many things affected.

800
00:44:36.840 --> 00:44:39.000
<v Speaker 5>Okay, so let's talk about the vascular system for a minute.

801
00:44:39.079 --> 00:44:40.840
<v Speaker 5>When I was in medical school with the two Lane

802
00:44:40.840 --> 00:44:43.280
<v Speaker 5>Medical School back in the eighties, I'm old now, I'm

803
00:44:43.280 --> 00:44:45.079
<v Speaker 5>sixty one years old. You can see that right.

804
00:44:44.960 --> 00:44:48.760
<v Speaker 2>Here, this dude appears to be maybe fifty tops even

805
00:44:48.880 --> 00:44:51.559
<v Speaker 2>over like a zoom call. He's the kind of guy

806
00:44:51.840 --> 00:44:54.320
<v Speaker 2>who you can tell wakes up like early to go

807
00:44:54.400 --> 00:44:57.679
<v Speaker 2>swimming and always wears nice socks. The dude has his

808
00:44:57.679 --> 00:44:58.760
<v Speaker 2>shit together, you could tell.

809
00:44:59.159 --> 00:45:00.679
<v Speaker 5>But when I was in a school. We were just

810
00:45:00.719 --> 00:45:02.760
<v Speaker 5>taught the endothelium was just the lining of the blood

811
00:45:02.800 --> 00:45:05.119
<v Speaker 5>vessel Snow, big deal. We now know that the endothelium

812
00:45:05.159 --> 00:45:09.800
<v Speaker 5>possesses these engines of bleeding and clotting. In fact, twenty

813
00:45:09.880 --> 00:45:12.039
<v Speaker 5>years ago, Gordon Bernard and I and a lot of

814
00:45:12.079 --> 00:45:15.960
<v Speaker 5>other investigators came up with a drug for sepsis. Sepsis

815
00:45:16.000 --> 00:45:18.199
<v Speaker 5>is a systemic infection, you know, like you can get

816
00:45:18.199 --> 00:45:21.559
<v Speaker 5>strip sepsis or staff sepsis. Different bacteria or virus can

817
00:45:21.599 --> 00:45:23.199
<v Speaker 5>cause this, and we take care of this all the

818
00:45:23.199 --> 00:45:26.239
<v Speaker 5>time in ICU, and the treatment the first ever FDA

819
00:45:26.280 --> 00:45:29.360
<v Speaker 5>approved drug for sepsis was a way of calming down

820
00:45:29.480 --> 00:45:34.440
<v Speaker 5>the endothelium because people were developing thousands and thousands in

821
00:45:34.480 --> 00:45:38.079
<v Speaker 5>their body of these microclots small blood clots. Well, in COVID,

822
00:45:38.480 --> 00:45:43.480
<v Speaker 5>the endothelium is activated and so the patients developed both microclots,

823
00:45:43.519 --> 00:45:47.519
<v Speaker 5>small clots and capillaries and also large clots. There's an

824
00:45:47.519 --> 00:45:51.039
<v Speaker 5>excess of what we call DVTs or deep venus thrombosis

825
00:45:51.440 --> 00:45:53.960
<v Speaker 5>and pumlary imbali blood clots in the legs and in

826
00:45:54.000 --> 00:45:54.400
<v Speaker 5>the chest.

827
00:45:54.760 --> 00:45:58.159
<v Speaker 2>So again, as we covered in surgical angiology, COVID can

828
00:45:58.159 --> 00:46:01.119
<v Speaker 2>wreak some havoc and cause blood to clot in both

829
00:46:01.119 --> 00:46:04.280
<v Speaker 2>the big plumbing and the narrowest plumbing of the body,

830
00:46:04.360 --> 00:46:06.880
<v Speaker 2>like a hair ball and a cat or a fat

831
00:46:06.920 --> 00:46:10.280
<v Speaker 2>berg made of baby wipes stopping up the sewer that

832
00:46:10.360 --> 00:46:12.280
<v Speaker 2>you definitely do not want there.

833
00:46:12.840 --> 00:46:18.039
<v Speaker 5>So the vascular nature of COVID is both macro and micro. Now,

834
00:46:18.119 --> 00:46:20.199
<v Speaker 5>the macropart you have to get a blood thinner, like

835
00:46:20.719 --> 00:46:22.719
<v Speaker 5>you know, something that things your blood out for three

836
00:46:22.719 --> 00:46:24.800
<v Speaker 5>to six months to keep you from dying of a

837
00:46:24.840 --> 00:46:28.079
<v Speaker 5>stroke or a pulman or emblast. But the micro clots,

838
00:46:28.639 --> 00:46:31.800
<v Speaker 5>the micro clots are not that large. They're tiny in

839
00:46:31.840 --> 00:46:34.159
<v Speaker 5>the capillary beds. And imagine if you got those in

840
00:46:34.199 --> 00:46:38.519
<v Speaker 5>your head or your kidney or your pancreas, you might

841
00:46:38.639 --> 00:46:43.400
<v Speaker 5>develop diabetes or kidney dysfunction or heaven forbid, in your

842
00:46:43.400 --> 00:46:47.360
<v Speaker 5>head you develop cogniti difficulties, so that your neuropsychological tests

843
00:46:47.480 --> 00:46:52.559
<v Speaker 5>would show memory deficits, processing speed problems, executive dysfunction, and

844
00:46:52.599 --> 00:46:55.199
<v Speaker 5>so part of the disease of lung covid is this

845
00:46:55.280 --> 00:46:58.719
<v Speaker 5>vascular business. And then the other part, though, is that

846
00:46:59.119 --> 00:47:01.880
<v Speaker 5>the immune system turned on. So in the head it's

847
00:47:01.960 --> 00:47:05.280
<v Speaker 5>not just about microclots in the capitoy beds. It's that

848
00:47:05.559 --> 00:47:08.400
<v Speaker 5>if you take your neurons in your head, the neurons

849
00:47:08.440 --> 00:47:13.719
<v Speaker 5>are supported by these cells astrocytes called glial cells, astracyites, microglia,

850
00:47:13.760 --> 00:47:16.800
<v Speaker 5>other types of cells, and those cells do get diseased

851
00:47:17.519 --> 00:47:20.599
<v Speaker 5>in long COVID, and when they're disease, they essentially don't

852
00:47:20.639 --> 00:47:24.239
<v Speaker 5>provide the sort of nurturing environment for the neurons. Think

853
00:47:24.280 --> 00:47:28.239
<v Speaker 5>of a plant that needs good soil and water, and

854
00:47:28.280 --> 00:47:30.119
<v Speaker 5>all of a sudden you remove the soil in the

855
00:47:30.119 --> 00:47:32.840
<v Speaker 5>water and get it too dry, and the plant is

856
00:47:32.880 --> 00:47:35.480
<v Speaker 5>going to wither. In this case, the plant the leaves

857
00:47:35.519 --> 00:47:37.719
<v Speaker 5>the plant of the neurons, and the soil and the

858
00:47:37.760 --> 00:47:40.960
<v Speaker 5>water are the glial cells providing the nurturing environment for

859
00:47:41.039 --> 00:47:41.440
<v Speaker 5>the plant.

860
00:47:41.639 --> 00:47:45.760
<v Speaker 2>That makes sense, Yeah, yeah, totally. That's a great analogy.

861
00:47:46.039 --> 00:47:49.320
<v Speaker 2>You know, you mentioned your med school in Chilane and

862
00:47:50.400 --> 00:47:52.400
<v Speaker 2>how long you've been doing this, which, by the way,

863
00:47:52.480 --> 00:47:55.320
<v Speaker 2>you look amazing. What exercise routine do you do? What

864
00:47:55.360 --> 00:47:55.679
<v Speaker 2>do you do?

865
00:47:56.480 --> 00:47:59.440
<v Speaker 5>I'm a swimmer. I do trithlons. I'm swimming, biking and

866
00:47:59.519 --> 00:48:01.880
<v Speaker 5>running and then doing whatever my wife says to make

867
00:48:01.920 --> 00:48:02.800
<v Speaker 5>sure I'm not crazy at.

868
00:48:02.719 --> 00:48:05.880
<v Speaker 2>The end of the day, whatever you're doing, I'm like, Okay,

869
00:48:05.920 --> 00:48:09.360
<v Speaker 2>I guess I got to start doing triathlones. But I

870
00:48:09.400 --> 00:48:11.280
<v Speaker 2>wanted to ask a little bit about if you ever

871
00:48:12.159 --> 00:48:17.840
<v Speaker 2>anticipated sort of being a physician during a pandemic of

872
00:48:17.880 --> 00:48:21.480
<v Speaker 2>this scale. Was that something that they ever talked about

873
00:48:21.519 --> 00:48:24.440
<v Speaker 2>in med school? Is that something that you knew was

874
00:48:24.480 --> 00:48:27.119
<v Speaker 2>possibly on the horizon? Are you looking at bird flu

875
00:48:27.239 --> 00:48:28.679
<v Speaker 2>likere we go again?

876
00:48:29.320 --> 00:48:31.320
<v Speaker 5>Yeah, this is the public health question, you know. When

877
00:48:31.320 --> 00:48:33.719
<v Speaker 5>I was at Tulane in medical school, I also got

878
00:48:33.880 --> 00:48:36.360
<v Speaker 5>a master's in public health from the School of Public

879
00:48:36.360 --> 00:48:38.599
<v Speaker 5>Health and Tropical Medicine there at Tulane, and so my

880
00:48:38.760 --> 00:48:42.239
<v Speaker 5>mind was already being trained to think on large scale.

881
00:48:42.880 --> 00:48:45.800
<v Speaker 5>And when the Haiti earthquake happened, we started going down

882
00:48:45.840 --> 00:48:48.760
<v Speaker 5>to Haiti for ten years trying to provide better public

883
00:48:48.800 --> 00:48:52.440
<v Speaker 5>health there or vaccination programs, dental care programs. My three

884
00:48:52.480 --> 00:48:55.320
<v Speaker 5>daughters came with us to do this work. So my

885
00:48:55.400 --> 00:48:58.599
<v Speaker 5>mind was already on global health. And right now we

886
00:48:58.679 --> 00:49:03.000
<v Speaker 5>have studies going on and subsiharent Africa, Malawi, Rwanda, Kenya

887
00:49:03.039 --> 00:49:06.440
<v Speaker 5>to try and treat respiratory failure better in l miic's

888
00:49:06.480 --> 00:49:09.039
<v Speaker 5>lower middle income countries. So yes, I think I was

889
00:49:09.119 --> 00:49:12.440
<v Speaker 5>already trained to think on a global scale regarding illness,

890
00:49:12.519 --> 00:49:15.440
<v Speaker 5>and I didn't know that obviously I'd ever be able

891
00:49:15.480 --> 00:49:18.920
<v Speaker 5>to serve others in an absolute pandemic. But we've been

892
00:49:18.920 --> 00:49:21.960
<v Speaker 5>dealing with epidemics for many years. And what was one

893
00:49:22.039 --> 00:49:25.119
<v Speaker 5>interesting thing, by the way, Ali, is that we for

894
00:49:25.159 --> 00:49:27.920
<v Speaker 5>twenty five years were studying the brain during critical illness.

895
00:49:27.920 --> 00:49:29.880
<v Speaker 5>That one of our expertise was that we came up

896
00:49:29.920 --> 00:49:34.280
<v Speaker 5>with tools to measure delirium in the ICU, and delirium

897
00:49:34.360 --> 00:49:38.679
<v Speaker 5>became the epidemic within the pandemic of SARS Kobe two.

898
00:49:39.119 --> 00:49:44.599
<v Speaker 5>So many patients had ripped roaring delirium that my inbox

899
00:49:44.679 --> 00:49:47.599
<v Speaker 5>was just filled up. And at one point in twenty twenty,

900
00:49:47.840 --> 00:49:50.280
<v Speaker 5>we launched a study by Twitter, believe it or not,

901
00:49:50.599 --> 00:49:53.920
<v Speaker 5>and we got two thousand, one hundred patients in ic

902
00:49:54.000 --> 00:49:57.440
<v Speaker 5>US around the world enrolled in this delirium study. And

903
00:49:57.519 --> 00:49:59.599
<v Speaker 5>what we found was that the main drivers of the

904
00:49:59.679 --> 00:50:03.039
<v Speaker 5>deliri and these COVID critically ill patients was under use

905
00:50:03.039 --> 00:50:07.800
<v Speaker 5>of family and overuse of benzodesepines and heavy sedatives. And

906
00:50:07.840 --> 00:50:11.880
<v Speaker 5>we created, unknowingly an environment with a virus that was

907
00:50:11.920 --> 00:50:15.760
<v Speaker 5>already hitting the brain was made so much worse by

908
00:50:15.840 --> 00:50:18.440
<v Speaker 5>us not allowing the families to be there and by

909
00:50:18.480 --> 00:50:21.559
<v Speaker 5>giving too much sedation. And it's just a very hurtful

910
00:50:21.559 --> 00:50:24.159
<v Speaker 5>thing for me to think that I was a part

911
00:50:24.199 --> 00:50:27.000
<v Speaker 5>of that, and I was complicit. So we used the

912
00:50:27.079 --> 00:50:30.000
<v Speaker 5>data though to undo that and to make absolutely certain

913
00:50:30.039 --> 00:50:32.239
<v Speaker 5>that we opened the ic US back, got the families there,

914
00:50:32.440 --> 00:50:34.599
<v Speaker 5>and didn't use such heavy sedation going forward.

915
00:50:34.960 --> 00:50:36.679
<v Speaker 2>But what were you supposed to do it's a very

916
00:50:36.679 --> 00:50:37.719
<v Speaker 2>contagious disease.

917
00:50:38.639 --> 00:50:40.599
<v Speaker 5>Well, I've said that in many talks that you know,

918
00:50:40.639 --> 00:50:42.719
<v Speaker 5>we were doing the best we could with the light

919
00:50:42.760 --> 00:50:44.880
<v Speaker 5>we had at the time. We didn't have vaccines, we

920
00:50:44.920 --> 00:50:48.559
<v Speaker 5>didn't have enough ppe, so we took some steps to

921
00:50:48.639 --> 00:50:53.280
<v Speaker 5>protect ourselves and others. They were, though, injurious to the patients,

922
00:50:53.320 --> 00:50:55.400
<v Speaker 5>and it's hard for me to consider it, but it

923
00:50:55.440 --> 00:50:57.719
<v Speaker 5>did make it worse for people, and I don't ever

924
00:50:57.800 --> 00:50:59.119
<v Speaker 5>want to live that way as a doctor.

925
00:50:59.159 --> 00:50:59.440
<v Speaker 6>Again.

926
00:50:59.639 --> 00:51:02.280
<v Speaker 5>That's why I wrote Every Deep Drawn Breath. I mean

927
00:51:02.280 --> 00:51:04.679
<v Speaker 5>this book I call eddb Every Deep drum Breath, and

928
00:51:04.719 --> 00:51:08.199
<v Speaker 5>the stories and there are all human stories. It's narrative nonfiction.

929
00:51:08.559 --> 00:51:10.880
<v Speaker 5>And what I did was I said, Wes, just let's

930
00:51:10.880 --> 00:51:15.159
<v Speaker 5>take these people's stories show how these people changed the

931
00:51:15.199 --> 00:51:17.800
<v Speaker 5>way that we do medicine for the better and give

932
00:51:17.840 --> 00:51:20.679
<v Speaker 5>them the kudos and the thanks and the glory that

933
00:51:20.719 --> 00:51:24.320
<v Speaker 5>they were contributing to humankind in such a beautiful and

934
00:51:24.400 --> 00:51:25.159
<v Speaker 5>selfless way.

935
00:51:25.760 --> 00:51:28.559
<v Speaker 2>And again his book is called Every Deep Drawn Breath.

936
00:51:28.679 --> 00:51:32.960
<v Speaker 2>A Critical Care Doctor on Healing, Recovery, and Transforming Medicine

937
00:51:32.960 --> 00:51:35.239
<v Speaker 2>in the ICU. At what point did you say I

938
00:51:35.280 --> 00:51:36.920
<v Speaker 2>need to share some of these stories in a book,

939
00:51:37.559 --> 00:51:40.679
<v Speaker 2>And also how did you end up writing and also

940
00:51:40.960 --> 00:51:42.199
<v Speaker 2>being an I see you physician?

941
00:51:42.800 --> 00:51:45.480
<v Speaker 5>Yeah? You know, for twenty five years as a doctor,

942
00:51:45.679 --> 00:51:47.719
<v Speaker 5>I kept up with my patients and I have my

943
00:51:47.800 --> 00:51:49.440
<v Speaker 5>cell phone on my card and they call me. They

944
00:51:49.440 --> 00:51:52.000
<v Speaker 5>don't abuse it, and we've got I've got great friendships

945
00:51:52.000 --> 00:51:54.480
<v Speaker 5>with these people. What I realized early on as an

946
00:51:54.679 --> 00:51:58.559
<v Speaker 5>ICU doctor was that my job is not just to

947
00:51:58.559 --> 00:52:00.679
<v Speaker 5>get you out of the ICU. If I get you

948
00:52:00.679 --> 00:52:02.320
<v Speaker 5>out of the ICU and you can't go back to work,

949
00:52:02.320 --> 00:52:04.679
<v Speaker 5>I had a young woman once point her finger at

950
00:52:04.679 --> 00:52:07.199
<v Speaker 5>me and say, doctor, really, you didn't do your job.

951
00:52:07.280 --> 00:52:08.960
<v Speaker 5>She was back in the clinic. She goes, I can't

952
00:52:09.000 --> 00:52:10.840
<v Speaker 5>pick my kids up, I can't go back to work.

953
00:52:10.880 --> 00:52:13.599
<v Speaker 5>My brain doesn't work and I was so convicted that

954
00:52:13.719 --> 00:52:15.599
<v Speaker 5>day and I said, you know what, I'm going to

955
00:52:15.760 --> 00:52:18.960
<v Speaker 5>use your telling me that to make a difference going forward.

956
00:52:19.039 --> 00:52:23.639
<v Speaker 5>So survivorship is a critical piece of all of these illnesses,

957
00:52:24.039 --> 00:52:27.119
<v Speaker 5>and so eddb every deep drawn breath is all about

958
00:52:27.280 --> 00:52:29.800
<v Speaker 5>me saying and us saying to the world we have

959
00:52:29.880 --> 00:52:33.639
<v Speaker 5>an entire person here and their whole life matters is

960
00:52:33.679 --> 00:52:36.039
<v Speaker 5>going forward. It can't be that when I finished giving

961
00:52:36.039 --> 00:52:39.159
<v Speaker 5>you a packed slovid course or a course of some

962
00:52:39.679 --> 00:52:42.039
<v Speaker 5>therapy you're getting in the ICU, that I'm like washing

963
00:52:42.039 --> 00:52:44.079
<v Speaker 5>my hands of you and saying, Okay, I'm done, have

964
00:52:44.159 --> 00:52:46.159
<v Speaker 5>a nice life, and you go out there and suffer. No.

965
00:52:46.639 --> 00:52:48.679
<v Speaker 5>So we've actually used the funds from the book to

966
00:52:48.760 --> 00:52:51.320
<v Speaker 5>hire social workers. That woman that I told you I

967
00:52:51.320 --> 00:52:54.199
<v Speaker 5>met with yesterday, her mother and the young woman reached

968
00:52:54.199 --> 00:52:56.559
<v Speaker 5>out this morning and we plugged her into our social

969
00:52:56.599 --> 00:52:59.800
<v Speaker 5>worker that we pay for to help her. Because people

970
00:53:00.119 --> 00:53:02.320
<v Speaker 5>need assistance like that and they don't have it. When

971
00:53:02.360 --> 00:53:06.199
<v Speaker 5>they leave the hospitalization or other care, they have nobody

972
00:53:06.199 --> 00:53:08.280
<v Speaker 5>to help them get by. So that's what we're trying

973
00:53:08.280 --> 00:53:10.079
<v Speaker 5>to do, is provide that public health assistance.

974
00:53:10.360 --> 00:53:13.000
<v Speaker 2>Oh that's amazing. We also donate to a charity of

975
00:53:13.039 --> 00:53:15.320
<v Speaker 2>your choosing a related charity. Do you have one top

976
00:53:15.320 --> 00:53:16.599
<v Speaker 2>of mine or do you want to look into it.

977
00:53:17.280 --> 00:53:20.840
<v Speaker 5>Our center has people every day on support groups. We

978
00:53:20.880 --> 00:53:24.800
<v Speaker 5>have local long COVID and post ic support groups every

979
00:53:24.880 --> 00:53:27.000
<v Speaker 5>day and if people want to donate to our center,

980
00:53:27.039 --> 00:53:30.199
<v Speaker 5>we will put all the money towards these patients support groups.

981
00:53:30.199 --> 00:53:34.280
<v Speaker 5>It's the Critical Illness, Brain Dysfunction and Survivorship Center and

982
00:53:34.320 --> 00:53:37.239
<v Speaker 5>then you can just find us at icedelirium dot org. Okay,

983
00:53:37.320 --> 00:53:40.519
<v Speaker 5>I seeudelirium dot organ. We commit to you that every penny,

984
00:53:40.599 --> 00:53:41.960
<v Speaker 5>if you tell us that's how you want it to

985
00:53:41.960 --> 00:53:46.320
<v Speaker 5>be used, will go towards creating a community, a survivorship

986
00:53:46.320 --> 00:53:49.199
<v Speaker 5>community where people can yell, scream, cry and get the

987
00:53:49.239 --> 00:53:50.519
<v Speaker 5>social worker help that they need.

988
00:53:50.800 --> 00:53:54.199
<v Speaker 2>That's so great. Okay, I'm going to lightning round as

989
00:53:54.239 --> 00:53:59.960
<v Speaker 2>many as we can. Okay. Marcella mathis from Long Beach, California,

990
00:54:00.000 --> 00:54:02.199
<v Speaker 2>currently residing in South Carolina. HI.

991
00:54:02.280 --> 00:54:06.360
<v Speaker 7>This is Marcella And the question that I had I

992
00:54:06.559 --> 00:54:10.480
<v Speaker 7>had just got over about of COVID for the second time,

993
00:54:11.119 --> 00:54:15.159
<v Speaker 7>and how does the experience of COVID different individuals who've

994
00:54:15.159 --> 00:54:19.679
<v Speaker 7>had multiple infections compared to those who've had it only once.

995
00:54:21.159 --> 00:54:23.920
<v Speaker 2>So ask wonderful people what you were wondering, and yes,

996
00:54:24.000 --> 00:54:26.320
<v Speaker 2>next week we're going to drop the part two to this.

997
00:54:26.360 --> 00:54:27.840
<v Speaker 2>We're going to kick it off with an answer to

998
00:54:27.960 --> 00:54:30.599
<v Speaker 2>Marcella's question and then dive in to all of the

999
00:54:30.679 --> 00:54:34.760
<v Speaker 2>questions you submit. It about brain fog, if diet can help,

1000
00:54:35.119 --> 00:54:39.480
<v Speaker 2>advice for caregivers, variants and long COVID, how not to

1001
00:54:39.519 --> 00:54:44.960
<v Speaker 2>get duped by snake oil, what's to deal with pots, histamines, hormones,

1002
00:54:45.239 --> 00:54:48.239
<v Speaker 2>heart health, and how to treat your blood well, and

1003
00:54:48.280 --> 00:54:50.559
<v Speaker 2>some hope coming down the pike in the form of

1004
00:54:50.639 --> 00:54:54.320
<v Speaker 2>new research. You can find more info and studies linked

1005
00:54:54.360 --> 00:54:56.719
<v Speaker 2>at the Lincolner show Notes. There are also links to

1006
00:54:57.119 --> 00:54:59.880
<v Speaker 2>doctor Eli's book, Every Deep Drawn Breath, as well as

1007
00:54:59.760 --> 00:55:03.440
<v Speaker 2>his research. We are at Ologies on Blue Sky and Instagram.

1008
00:55:03.480 --> 00:55:05.760
<v Speaker 2>I'm at Ali Ward on both and again we have

1009
00:55:05.800 --> 00:55:08.800
<v Speaker 2>kid friendly episodes called Smologies. Wherever we get podcasts. You

1010
00:55:08.840 --> 00:55:12.360
<v Speaker 2>can submit questions for Ologists before we record at patreon

1011
00:55:12.360 --> 00:55:16.039
<v Speaker 2>dot com. Slash ologies Ologies Merch is available at ologiesmerch

1012
00:55:16.119 --> 00:55:18.760
<v Speaker 2>dot com. Thank you so much Aaron Talbert for admitting

1013
00:55:18.800 --> 00:55:22.360
<v Speaker 2>Theologies podcast Facebook group. Aveline Malick makes our professional transcripts.

1014
00:55:22.440 --> 00:55:24.960
<v Speaker 2>Kelly ar Dwyer makes the website. Nowell Dilworth is our

1015
00:55:25.000 --> 00:55:28.679
<v Speaker 2>scheduling producer. Our managing director is the Susan Hale. Jake

1016
00:55:28.760 --> 00:55:31.679
<v Speaker 2>Chafy edits and lead editor is of course Mercedes Maitland

1017
00:55:31.679 --> 00:55:34.480
<v Speaker 2>of Maitland Audio. Nick Thorburn made our theme music. And

1018
00:55:34.519 --> 00:55:37.000
<v Speaker 2>if you stick around to the very end of the episode,

1019
00:55:37.039 --> 00:55:40.039
<v Speaker 2>I'd burden you with a secret for my life this week.

1020
00:55:40.119 --> 00:55:43.000
<v Speaker 2>It's that I'm recording this. I'm in my pajamas in

1021
00:55:43.119 --> 00:55:46.480
<v Speaker 2>the guest room closet of my friend Katherine Burne's parents.

1022
00:55:46.679 --> 00:55:49.920
<v Speaker 2>I'm visiting them all in Austin for south By Southwest right,

1023
00:55:50.039 --> 00:55:52.920
<v Speaker 2>never been to south By. Very excited. Tonight are the

1024
00:55:52.960 --> 00:55:56.920
<v Speaker 2>iHeart Podcast Awards and Ologies is up for Best Science Podcast,

1025
00:55:57.239 --> 00:56:00.280
<v Speaker 2>and we're against like Stuff to Blow your Mind, Neil

1026
00:56:00.320 --> 00:56:04.400
<v Speaker 2>de grasse Tyson's Star Talk, Hidden Brain and Science Versus.

1027
00:56:04.679 --> 00:56:07.559
<v Speaker 2>We won in twenty twenty two for the Best Science Podcast,

1028
00:56:07.679 --> 00:56:09.400
<v Speaker 2>which was a thrill, but that was remote, so I

1029
00:56:09.400 --> 00:56:10.679
<v Speaker 2>didn't get to go in person. So I get to

1030
00:56:10.679 --> 00:56:13.360
<v Speaker 2>go tonight. We'll see if Ologies wins. I'm about to

1031
00:56:13.519 --> 00:56:16.039
<v Speaker 2>shower and put my hair in a ponytail, try to

1032
00:56:16.039 --> 00:56:19.119
<v Speaker 2>look normal on a red carpet, and I will update

1033
00:56:19.159 --> 00:56:21.800
<v Speaker 2>you If Ologies takes home a trophy, I'll let you

1034
00:56:21.840 --> 00:56:23.840
<v Speaker 2>know at the end of part two. And thank you

1035
00:56:24.280 --> 00:56:27.239
<v Speaker 2>Dallas and Dudah Burns for the hospitality. I'm off to

1036
00:56:27.239 --> 00:56:31.159
<v Speaker 2>go put on a velvet suit. Okay, byebye pacadermatology, homeiology,

1037
00:56:31.440 --> 00:56:42.519
<v Speaker 2>r doo Zoology, lithology, technology, meteorology, old paratology, anthology, seriology, selenology.

1038
00:56:48.519 --> 00:56:51.239
<v Speaker 7>It's been eighty four years.