WesElyMD Profile picture
31 May, 13 tweets, 8 min read
1/🧵The Nightmare of #COVID19 & #LongCOVID
Im a doctor who is now spending more & more time daily caring for #LongHaulers (pts w LongCOVID). I just got a TINY dose of what it must feel like to be unheard and unseen…AND I want to apologize to you.
#MedTwitter #NurseTwitter
2/ I just keep hearing you say, “Doc, why doesn’t anyone believe me? My friends look at me and think I’m fine, even as I feel further and further adrift. I’m not myself and I can’t tell if I ever will be again. #COVID has ruined my life.”
3/ Yesterday as my plan landed, my phone vibrated. It was the wife of a former ICU #COVID pt, now trached & living on a vent in an LTAC, asking how she can get his new docs to understand & carefully manage her husband’s ongoing #LongCOVID & Post-Intensive Care Syndrome (#PICS).
4/ As an aside, I was returning from seeing my mom, who during COVID, without getting COVID, descended into Moderate Dementia from isolation & loneliness. This really ought to be a new category of #LongCOVID given the number of aging people w new dementia post-#pandemic.
5/ I’m not sure if I’m at all correct, but I counseled this wife to first call a meeting with the attending MD. Such a meeting will be tricky. Certain steps are regrettable but important: Don’t appear too emotional or “complainy.” Isn’t it terrible how Docs turn their brains off?
6/ I advised her (because she asked) 1st to thank the doc for listening AND then ask to share her top 3 ways things could get better: Don’t allow husband to miss an entire day of antibiotics, be found in feces, or stay in bed more than 12 hours. Ugh.
7/ My TINY dose: Last night I received a general email from leaders to adjust my website “areas of expertise.” They gave me a pre-populated list of specializations for lung doctors. Tradition would include diseases confined to the chest, which is antiquated.
8/ This paradigm just doesn’t work for YOU. YOU who get critical illnesses and #COVID generally, don’t get a disease that stays between your clavicles and diaphragm (chest only). Your disease spreads to your nerves, head, muscles and mind 🧠!
9/ I wrote to our Leadership and asked, “Where on this list is #LongCOVID? #PICS? #SEPSIS? #PTSD? #Delirium? #Dementia? My patients need me to see ALL OF THEM! Not just their lungs. Then I went to sleep…or tried to. It’s nighttime and I am up typing. Why?
10/ I just had the same nightmare - TWICE. I was trying to climb up a slick hill. I kept sliding down. There was nothing to grab hold of. Frantically, I’d slide back to the bottom and have to start over. I couldn’t get any footing and never made it to the top to be heard.
11/ Are the unheard reliving Munich’s Scream…sliding into oblivion? Like the wife of my former patient? Or another #COVID pt who called yesterday, never even hospitalized yet now suffering myriad problems? I’m so sorry for the many times I have made anyone feel like this.
12/ This #LongCOVID epidemic w/in the pandemic of feeling unheard amidst #suffering must find an escape hatch (a la Saul Bellow in Ravelstein). Medicine & society must respond. Please tell us more and hold us accountable. You need footing to tell your story, and we want to help!
P.S. Our Leadership already wrote me back. They are adding all those terms to our website list to reflect modern critical care – seeing the WHOLE person and your diseases not formerly on our radar. I detect some light, and I #hope my patients will soon, too!

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More from @WesElyMD

2 Jun
1/ 🧵Wisdom in Medicine
What’s going on here? And why it’s key in #COVID19
It’s quite simple: we finally had the #wisdom to ask Mr. D the right question! He and his wife encouraged us to use this picture to teach what we learned.
#PalliativeCare #MedTwitter #NurseTwitter Image
2/ What we learned was to switch the preposition!
Mr. D was a pre-#COVID patient. On this day, he was taken off the vent after a MONTH. The incessant mantra had been, “What’s the matter WITH Mr. D?” He was surprised when we asked, “What matters TO you, Mr. D?”
3/ He has a tracheostomy, as you can see. We insert this airway through the neck to improve #comfort when someone is on a vent well beyond 10 days. He’s more comfortable because he no longer has a tube in his mouth. We used a program called the #A2Fbundle to reduce his #delirium.
Read 13 tweets
1 Jun
1/🧵 AGEISM: Never be discouraged by age AND don’t judge others by age. Chronological age is a bogus constraint in life. I read today of some great examples of iconic people who did crazy cool things after 7 decades of life. See these & realize age is NOT a limitation...
#MedEd Image
2/ 👏 Major late-life #winners: 👏

#NelsonMandela, president of SA at 75 y/o
#Michelangelo started on St. Peter’s at 72
#GrandmaMoses folk artist sold her 1st painting at 90!
#ArthurMuir just scaled Mt Everest 🏔 at 75 (pic)
#JohnGlenn went into space at 77 y/o! Image
3/ Bonus 😀: German athlete Johanna Quaas at 86 y/o is the world’s oldest gymnast at age 86. She’s a retired P.E. teacher & started in this sport at age 56.

#NoLimits 🧠

bit.ly/3i5wclf Image
Read 7 tweets
26 May
1/🧵 Imagine 2 people, madly in love & married 28 years, in an impossible situation, both lives on the line & separated by different hospitals. Then imagine 2 sets of #nurses & #doctors separately determined to overcome ⛰ of obstacles…
(shared w perm)

#MedTwitter #NurseTwitter
2/ Last night this is what happened…

NOTE: the family wants to share their story to offer a glimpse of love ❤️ on all levels

For 3 years, Mark took care of Sharon, his #bride, as she battled breast #cancer. It relentlessly spread to her bones. He never stopped giving.
3/ She could tell he was spent and getting sick himself. “Mark, let’s get you to the doctor!” “Not until you are well, Sharon.” He remained laser focused on her every need. As she became weaker, he took her to get admitted yesterday.

#marriage #life #caregivers
Read 13 tweets
25 May
1/🧵 Lung Scarring in #COVID19 – what’s the deal?
I got a birds eye view of #LongCOVID yesterday from my patient who’s still on Oxygen at 8 months. WHY?

Let’s unpack what happens in the 🫁 and why it’s such a life-changing disease is for so many...
#MedTwitter #NurseTwitter
2/ 4-months after #COVID, this @JAMA_current study found 51% of N=478 pts had >=1 #LongCOVID symptom that wasn’t there before. 63% of those w CT scans had lung problems, with 1 in 5 showing scarring. What else?...
3/ This JAMA study also showed this important array of symptoms that essentially constitute #LongCOVID – 31% gross fatigue, 21% cognitive problems, and 23/18/7% anxiety, depression & PTSD. Their outsides look normal, but they aren’t!
Read 7 tweets
24 May
1/ 🎥 Asymptomatic #COVID = Silent Spreaders
This short video from @EricTopol & @Danieloran summarizes key issues about Asymptomatic Spread of #COVID19. Watch & then read the🧵for my unpacking…there is so much at stake!
#Pandemic #Vaccinate
2/ In 2020, @danieloran & @EricTopol predicted that up to 40-45% of people infected w #COVID19 were totally asymptomatic, meaning HUGE risk of silently spreading the disease to others. 👁 highlights

Next tweet for the UPDATE...


#MedTwitter #NurseTwitter
3/ Now we know ~1 in 3 people infected with #SARSCoV2 remain asymptomatic. This is based on 61 studies & ~1,800,000 pts! Also, of those who test + w/out any symptoms, 75% stay asymptomatic.  This poses a HUGE risk of silent spread to high risk patients.

Read 8 tweets
20 May
1/🧵#COVID19 Compassion

Our patient wants to live 3 days to see his grandson graduate. He has #COVID19 pneumonia & is extremely short of breath. He’s chosen NOT to go on a ventilator & is on 100% O2 HiFlow Canula. He’s afraid of tight-fitting a bipap mask.

2/ The intern said, “I never saw a patient whose respiratory rate was twice his oxygen saturation!” Yep, last night his O2 sats dropped to 30% and he was breathing 60 times a minute! By morning he was 85% sat and RR was 28. Better but tenuous.

#TipsForNewDocs #MedStudentTwitter
3/ All of this raises some complicated ethical + treatment questions that I’d like to cover. We addressed this on rounds several times this week & at times it got a bit heated. His #nurse said she noticed herself flushed, mad, and heart rate >130…why?
Read 13 tweets

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