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Ask the hospitalist if their IM colleagues in the clinic would tell the likely GBS patient to see neuro at some point or send them to the ED to be admitted.
Post acute-covid 19 syndrome
- Thread starter scoopdaboop
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Heart disease with long covid should always be viewed seriously seeing how underrated it is. People keep thinking covid is a respiratory disease and forgetting about cardiac/vascular problems
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It's very thrombotic. Had a young guy (40's) who came in complaining of chest pain, shortness of breath, abdominal pain, and right leg pain. Had COVID 3 weeks prior. Exam showed a pulseless foot. He ended up having an ischemic right leg from multiple emboli, a splenic infarction, and an LV thrombus.
Ugh that's horrible.
Have heard similar stories.
That's why it's mind boggling to me that people are just like whatever, I'll get covid and it'll be no big deal.
I feel like there's so much we don't know (understandably), so why take the risk?
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I saw a pediatric patient with dural sinus thrombosis about 2 weeks after COVID ran through his household.
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How old was the peds pt?
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It was a month ago so I don't recall exactly, but he was between 5-10 years old.
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I fortunately haven't had any patients present to the ED with "longhaulers," though I have a previously healthy and active family member who experienced a lot of strange things this year. I don't know what to make of it, but it seems unfair to label it all as psychosomatic when we're dealing with a new virus that effects multiple organ systems...
Internal medicine no longer has procedural requirements. They're supposed to seek out relevant procedural experience in line with their career goals. Seriously.
I admitted a 300+ pound lady with over a month of supposedly intermittent altered mental status recently. Multiple inpatient stays in multiple systems, including at a psychiatric facility and not taking the antipsychotic they prescribed, but medicine clinic felt probably not psychiatric in nature so sent her to the ED. No fevers, no meningismus, mild tachycardia that resolved after lying in bed for a few minutes. The clinic note included a laundry list of recommended labs including CSF studies. I had to give her sedation to draw labs myself with U.S. guidance because the nurses and vascular access team couldn't. Called medicine PGY-2 for admission, told him I sent their labs but they could call IR in the morning if they wanted an LP. He said okay, he wasn't "signed off" to do them anyway.
Admission H&P: "ER provider not comfortable with LP, will consult IR in AM."
Internal medicine no longer has procedural requirements. They're supposed to seek out relevant procedural experience in line with their career goals. Seriously.
I admitted a 300+ pound lady with over a month of supposedly intermittent altered mental status recently. Multiple inpatient stays in multiple systems, including at a psychiatric facility and not taking the antipsychotic they prescribed, but medicine clinic felt probably not psychiatric in nature so sent her to the ED. No fevers, no meningismus, mild tachycardia that resolved after lying in bed for a few minutes. The clinic note included a laundry list of recommended labs including CSF studies. I had to give her sedation to draw labs myself with U.S. guidance because the nurses and vascular access team couldn't. Called medicine PGY-2 for admission, told him I sent their labs but they could call IR in the morning if they wanted an LP. He said okay, he wasn't "signed off" to do them anyway.
Admission H&P: "ER provider not comfortable with LP, will consult IR in AM."
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Are you an attending? I feel like this kind of verbiage from a resident would warrant a friendly email to their program leadership or hospital risk management.
As an aside our IM residents/attendings cover all LPs on the floor. I thought this was normal and am kinda surprised...makes me appreciate them more.
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This is a real issue that I think is underappreciated. At some more academic IM programs you're only required to have "assisted" in a procedure to meet graduation requirements, which might mean standing in the room while someone else does a line. The attendings do no procedures at all. It can be a big hindrance for moving to community practice in non-large urban centers if you decide to go that route post residency. It's something that should really be a bigger deal when med students are choosing programs.
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Very much an anomaly nowadays as noted above. Surprising since I think you're at a pretty large academic center which usually means procedures are even much more scattered out than normal so kudos to those residents. I think us and IR are the only people in my entire hospital that do LPs.
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Anesthesia will do them in unit players too sick to go to IR at my place. Makes sense as they access that space more than anyone.
Are you suggesting that connective tissue disorders are somehow psychosomatic?
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I think they meant IBS not EDS. Or maybe it’s an acronym for something else.
But yes I agree Ehlers-Danlos is not a condition I associate with psychosomatic issues. Now fibromyalgia...that’s a different story.
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I wonder how many of the "Long COVID Syndromes" will be dilaudid-responsive?
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"You just don't know or understand or care! Now, the Dilaudid only works if you push it really fast."
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Post-Acute (yawn) Post check count = 3.
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Others can correct me if I'm wrong or out of line as I'm not an ED physician, but I imagine it's not that they're "unable or too bored to look out for [their] patients"; rather, whatever answers the patient was hoping to get are not going to come from their visit to the emergency department, and that emergency physicians shouldn't be expected to do that kind of work-up in that setting anyway.
Also, for some reason it has become somewhat popular to have a tendency to "diagnose" people through brief interactions or observations on television or through the internet as having something wrong with them. I don't think it's fair to extrapolate personality disorders or suboptimal "physicianship" from a few comments online venting about one's day.
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Sorry for the delay in dealing with the trolling. Unfortunately, above my head in disaster planning for our COVID crisis situation.
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I'm sitting around doing nothing, but SDN admin doesn't like me or want me enough to give you help.
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Why are you sitting around doing nothing?
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Hypermobile EDS (formerly type 3) is absolutely associated with psychosomatic issues and has become an extremely popular internet diagnosis. There is no genetic test for this EDS subtype and ~10% of the population have hypermobile joints, making the most prominent feature of the subtype very non-specific.
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Huh interesting. I’ve yet to see it at least in my neck of the woods.
Although I did recently have a very well educated otherwise normal person show up to the ED stating he was having a “Biotoxic flare of his MARCONs Syndome”
Which, after some googling, I found there’s a lab where you can pay cash and they’ll diagnose you with MRSA nasal colonization, which allegedly causes a remarkable spectrum of non-specific, untestable for, symptoms.
Arch Guillotti
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It makes sense to some degree. Nothing beats fluoro though. Unfortunately am asked to sedate/anesthetize LP patients sometimes but I would never do the procedure myself.
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Arch - you got love for Dre? His aneurysm came up on rounds today and a student said, "is he a rapper or something?" I sighed, then dropped a verse from Forgot About Dre on her.
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That's not Dr. Dre, that's Eazy-E. Eazy was by far my fave from NWA. Eazy was a way better rapper than Dre (better producer) but unfortunately died too young, from that other pandemic. Check out the album Eazy-Duz-It. Classic.
Real Gangster by ripsta on DeviantArt
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Arch Guillotti
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My name is Eazy-E or Eric Wright it’s all the same.That's not Dr. Dre, that's Eazy-E. Eazy was by far my fave from NWA. Eazy was a way better rapper than Dre (better producer) but unfortunately died too young, from that other pandemic. Check out the album Eazy-Duz-It. Classic.
Real Gangster by ripsta on DeviantArt
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You think I didn't know who Eazy-E and NWA are? Pu-leez, I asked because of the Eazy-E avitar. Dr. Dre was in NWA, man.That's not Dr. Dre, that's Eazy-E. Eazy was by far my fave from NWA. Eazy was a way better rapper than Dre (better producer) but unfortunately died too young, from that other pandemic. Check out the album Eazy-Duz-It. Classic.
Real Gangster by ripsta on DeviantArt
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What kinda attitude is that, man?
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Of course, man! Have you listened to that Eazy-Duz-It album, though? Ultimate sophomore high school gangster-rap jam (at least it sounded that way to 15-year-old lizard-brains, at the time
).
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Eazy, bro, eazy
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Doggystyle was my sophomore jam... and I think I just pretty precisely dated myselfOf course, man! Have you listened to that Eazy-Duz-It album, though? Ultimate sophomore high school gangster-rap jam (at least it sounded that way to 15-year-old lizard-brains, at the time
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I know many on here don't think symptoms from covid can linger and that people are faking their symptoms, but thankfully some are looking in to it and offering clinics for these patients as we learn more. I actually think more people need this type of care, especially after ICU stays.
Overall, maybe some of these symptoms "are in their head," but at the same time we're going through a pandemic where a lot of people have lost money, jobs, healthcare, etc, so providing support, both physical and mental, for their symptoms doesn't seem like a bad idea.
“We know this is real,” said Dr. Alan Roth, who oversees the Jamaica Hospital clinic. He has been grappling with body pain, fatigue and “brain fog” characterized by occasional forgetfulness since his own relatively mild bout with COVID-19 in March.
Current indications are that up to 30% of patients continue to have significant problems that intrude on daily life two to three weeks after testing positive. Perhaps as many as 10% are still afflicted three to six months later, according to Dr. Wesley Self, a Vanderbilt University emergency physician and researcher who co-wrote a July report from the Centers for Disease Control and Prevention.
apnews.com
Overall, maybe some of these symptoms "are in their head," but at the same time we're going through a pandemic where a lot of people have lost money, jobs, healthcare, etc, so providing support, both physical and mental, for their symptoms doesn't seem like a bad idea.
“We know this is real,” said Dr. Alan Roth, who oversees the Jamaica Hospital clinic. He has been grappling with body pain, fatigue and “brain fog” characterized by occasional forgetfulness since his own relatively mild bout with COVID-19 in March.
Current indications are that up to 30% of patients continue to have significant problems that intrude on daily life two to three weeks after testing positive. Perhaps as many as 10% are still afflicted three to six months later, according to Dr. Wesley Self, a Vanderbilt University emergency physician and researcher who co-wrote a July report from the Centers for Disease Control and Prevention.
'We know this is real': New clinics aid virus 'long-haulers'
NEW YORK (AP) — COVID-19 came early for Catherine Busa, and it never really left. The 54-year-old New York City school secretary didn’t have any underlying health problems when she caught the coronavirus in March, and she recovered at her Queens home.
apnews.com
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It's not that we (or at least I) think this is "all in their head" or whatever. But there are multiple confounders:I know many on here don't think symptoms from covid can linger and that people are faking their symptoms, but thankfully some are looking in to it and offering clinics for these patients as we learn more. I actually think more people need this type of care, especially after ICU stays.
Overall, maybe some of these symptoms "are in their head," but at the same time we're going through a pandemic where a lot of people have lost money, jobs, healthcare, etc, so providing support, both physical and mental, for their symptoms doesn't seem like a bad idea.
“We know this is real,” said Dr. Alan Roth, who oversees the Jamaica Hospital clinic. He has been grappling with body pain, fatigue and “brain fog” characterized by occasional forgetfulness since his own relatively mild bout with COVID-19 in March.
Current indications are that up to 30% of patients continue to have significant problems that intrude on daily life two to three weeks after testing positive. Perhaps as many as 10% are still afflicted three to six months later, according to Dr. Wesley Self, a Vanderbilt University emergency physician and researcher who co-wrote a July report from the Centers for Disease Control and Prevention.
'We know this is real': New clinics aid virus 'long-haulers'
NEW YORK (AP) — COVID-19 came early for Catherine Busa, and it never really left. The 54-year-old New York City school secretary didn’t have any underlying health problems when she caught the coronavirus in March, and she recovered at her Queens home.
--most studies published seem to be on patients recovering from a severe illness or critical illness, whereas most news articles focus on patients who had a mild initial illness but persistent (often vague, unverifiable) symptoms
--many patients who've been in the ICU for whatever reason will have symptomatology or functional deficits at 6 months. These patients have suffered a tremendous physiologic insult combined with profound deconditioning
--Many (all?) of the commonly reported symptoms, eg fatigue, MSK pain, paresthesias, 'brain fog', are, in addition to being entirely subjective, quite plausible related to months of social isolation and chronic psycho-social stress. Many covid patients have had to deal w/ increased isolation, related to rather ridiculous notions about prolonged viral shedding
--Unfortunately, this disease as taken on a moralistic dimension, where those afflicted are seen as having 'misbehaved' in some fashion or another and responsible for catching a respiratory virus. This attitude takes a real psychic toll on some people, and it's really pretty ridiculous (I mean, I felt some guilty satisfaction myself when I heard Trump got it, but in reality it's a virus and not anymore of a moral judgement from god than HIV).
While labeling these symptoms as 'Long Covid' may be easy, pleasing to patients and good clickbait, it, in my estimation, is a little premature. I'm sure you've seen patients whose entire essence have been taken over by their self-identification as chronic disease sufferers, be it low back pain, 'myalgic encephalitis' or chronic lyme. Do you really want to have a third of the population labeled as "Long Coviders" based on some preprints and news articles?
Can we please get rid of the name "Long Covid"? It's meaningless and implies ongoing viral-induced disease, without any evidence of chronic viral replication.
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I certainly think post-COVID syndrome is more legit than chronic Lyme requiring antibiotics, chronic EBV requiring chronic steroids, or cardiac fibromyalgia (autonomic dysfunction) requiring benzos. Yes, I agree that ANY infection can cause a chronic immune response if it triggers antibodies in the right way and there is truly autonomic dysfunction, but it doesn't require benzodiazepines to manage.
Ok, then change the name? Would that make you feel better?
I'm guessing we all see different populations and have anecdotes about patients and maybe your patient population is more likely to exaggerate their chronic disease symptoms?
In my outpatient experience (I work in a large city and most of my patients are people of color in wide ranging age groups), no, I don't have TONS of patients whose entire essence has been taken over by their self-identification of chronic disease sufferers. So when my patients who had covid started telling me about symptoms they were continuing to experience weeks after being told they recovered from covid and are back at work, I certainly believe them. Most of my patients that complained of these symptoms started complaining of them in late April and early May, which I don't think there was much comprehensive knowledge about more people having these ongoing symptoms.
So I'm not sure where you're getting the data that 1/3 of the population is labeled as long-covid based on news articles.
Many of the info that I've read about people having at least 1 symptom for a month after covid is also from other countries as well, so that also makes it seem more valid that it's covid that's doing it, regardless of culture/society.
But yes I'm all for another name if that makes it easier to understand that it's not actually the virus causing the symptoms.
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That's the key.
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Or dilaudid, or fentanyl, or 180 percs a month. I'm always skeptical of any dilaudid-responsive chronic condition.
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Like bony mets?
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Always gotta pick on me. You know that's not what I meant.
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You've gotta be kidding. Anyone who follows @Apollyon would recognize that he's not singling you out. Nobody escapes his scrutiny.
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I'll leave aside that you didn't address any of my points....
Look, I just don't think you're doing a kindness to patients by labeling them as having a disease-state we don't even know exists yet. Certainly we aren't doing anything productive by lumping together patients who have expected after-effects of critical illness with patients who may or may not have ongoing systemic inflammation triggered by a virus.
(I took my one-third figure from your post, you wrote that up to 30% of patients have ongoing symptoms, sorry I rounded up a bit)
Usually not chronic for long.
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That reminds me of what somebody posted in the practicing physicians forum. One person said, "two pts with pancreatic CA". Someone else responded, "That’s ok. Pretty soon you won’t have any."
It seems like more and more data is coming out about on going symptoms 4 weeks after covid (not just in the U.S.). And even in non-hospitalized people. The cdc has a little info about it now, but apparently they’re coming out with more guidance soon.
Are you all seeing cases? Are you all still not believing this info?
Are you all seeing cases? Are you all still not believing this info?
