1/🧵#Covid19 is a disease of blood vessels that can affect your lungs, heart, brain, or any organ. Blood clotting sucks life from vital organs. This pt asked to have her story shared so that others may learn & seek #Vaccination. COVID caused blockage of blood to her arms & legs.
2/ During her acute illness, you can see that she had wounds that resembled BURN injury. It took #nurses many hours each day to change her wounds. I am being especially careful here only to show you images that are bandaged to avoid traumatizing anyone.
3/ (trigger warning on image)
As the illness progressed, it became clear that she was going to live, and we were all thrilled. Still, it was sad to think that this young woman would lose her hands and feet as they continued to dry up, lifeless and still.
4/ Over time, it became safe to undergo her amputations, and here she is w a loving @VUMChealth#nurse in the hospital courtyard the following week. Her desire for life became a huge inspiration to all of us. I gained way more from her than she ever gained from me.
4/ A very generous group of UK innovators from @KoalaaCommunity prosthetics made her a set of hands with her sisters and kids names on them to motivate her during recovery (first names shown with permission). This gave her great hope!
5/ Here you can see her during rehabilitation just after she finished doing some amazing planks. Even with healing wounds, she was doing 2 minutes of planking – such is her physical and mental strength!
6/ Her life is forever changed. Look at the bag of >12 medicines she takes every day. This is the reality of what can happen to a very young & totally healthy person. She said, “Please, Doctor Wes, share my story to help others get the #Vaccine. That’s 1 purpose of this 🧵.
7/Another purpose of this 🧵 is to help us all remember that life goes on no matter how hard the curve balls are that we are thrown. There is hope for tomorrow. Love of her kids and sisters is driving her onward. #Healing ❤️🩹
8/ We have become incredibly close friends. I call her my daughter, and she calls me a new dad (who won’t give her advice!). She is a treasure beyond measure for me. I don’t deserve her in my life, but I’m totally thankful she accepts me.
9/ During her long stay, I got the idea to #vaccinate people who consent before they leave the hospital. Here they revisit values & enter a major teachable moment. EVERY patient encounter is an opportunity to protect someone.
10/ Among other hospitalized patients who have gotten #vaccinated in the ICU (for free of course), some of the most interesting requests have come from inpatients who are #pregnant. Soon-to-be moms realize they want protection for their baby and themselves. 👍
11/ When a healing #Covid pt who still on ECMO said she didn’t want to get it again, we knew the best way to ensure she didn’t was to offer her the #vaccine - hands down the best protection. After 4.6 BILLION vaccines given, the safety profile is FABULOUS.
12/ VERY few drugs have such a great safety profile. #COVID patients want to get #Vaccinated and many have asked you to reconsider. 4 out of 5 people in the world still need protection. Do your part & share her story & its message of hope. Make her courage to share worth it!
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🔸Let’s Unpack @NEJM
🔸Hear from patients
🔸We call LC a disease state
🔸It’s a clinical definition
🔸Adding Inclusion/Exclusion Criteria to our @theNASEM definition fosters great research definitions
🔸 I admit my early mistake…
“Long Covid is an IACC occurring after SARS-CoV-2 infection & present >=3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems.”
Read caveats in text box…
3/ Patients describing Long COVID – read text box
“My long Covid life remains terrifying. Last weekend I washed my car, dried it, put it back in the garage. Then I got violently sick and could hardly get up to get food. I was unable to read or even call my mom. I’m a shell of myself. But my physical issues aren’t half as bad as my brain problems. It’s hard to describe. You can say brain fog, but that doesn’t come close to doing it justice.”
“At work my brain is just begging for rest. I struggle with finding words and completing tasks in a timely manner. … I’ll be in a meeting and know exactly what I want to say before I say it. …I’ll get to a word, and I just cannot think of the word. I’ll just be like, ‘Give me a moment,’ and I’ll go through my brain cycling through words. This week the word was “consistent.” I couldn’t think of the word consistent. I kept thinking it was coincident or concentric or constant. I used to build prototypes multiple days a week, and now if I do anything in the lab, I’m pretty much wiped out for a week. …I mean, I’ve had to dig real deep. How much longer will I feel like this? I’m scared.”
2/ Tryptophan is an essential amino acid - we don’t make it.
So if we’re “programmed” to absorb ⬇️ from our diet, we sleep poorly, think worse, and all sorts of other bodily functions go awry.
Will SSRI & SNRI meds help, or anti-virals, or immuno-modulators?
Trials will tell.
3/fin
This study by @maayanLevy_lab is a marvel of dozens of avenues of science that all point to a greater understanding of the realities of #LongCOVID as a chronic disease state.
Through work like this, we legitimize not only LC, but also #MECFS #LongLyme etc & take one step closer to finding medical solutions for past & future post-infectious states + syndromes like #PICS
1/🧵Catatonia - shocking & hopeful insights into a mysterious neurological disorder 💥
Did Oliver Sacks’s Catatonic “Awakening” Patients have a treatable Autoimmune Disease?
Here I unpack story & science from a stunningly well-done @WashingtonPost article
2/ Amazing Discoveries of Autoimmune Disease causing Decades of Catatonia, Schizophrenia
Autoantibodies and treatment with immunosuppressive medications are waking some patients up with crazy cool results. Here’s the article and my highlighted excerpts:
3/ “The first conclusive evidence was in her bloodwork: It showed that her immune system was producing copious amounts and types of antibodies that were attacking her body. Brain scans showed evidence that these antibodies were damaging her brain’s temporal lobes, brain areas that are implicated in schizophrenia and psychosis.”
📌 I didn’t think #MECFS was real till #LongCOVID opened my eyes
📌 It’s “mysterious” & we weren’t taught it in med school
📌 Yet 1,000s are suffering a disease traditional medicine doesn’t understand
📌 Let’s find answers
2/ Long COVID is estimated at 6% of US Population… @CDCgov
“Prevalence of #longCOVID among U.S. adults ≥18 ⬇️ from 7.5% during June 2022 to 6.0% during June 2023.”
More than 1 in 4 w LC have activity limitations, ie, it’s a LIFE altering disability.
📌A picture is emerging
📌It’s not pretty
📌Most pts w months-long symptoms aren’t recovered @ 2-yrs
📌The cluster including neurocognitive & cardiovasc symptoms is ominous
📌These data fuel trial design
2/ This Lancet investigation of just over 500 patients is not particularly large but is well done. The methodology used LC patients from Catalonia Spain from 3/2020 to 2/2022.
They included people who were unable to obtain Covid test but who had an acute onset of symptoms extremely consistent with the syndrome and who developed the same long-term definition of long Covid.
Some may argue about this point but the longCovid community has taught me how important these patients are to include in such research.
3/ Looking at this figure you can see the heat map emphasizing symptoms in clusters B & C that the authors are most confident indicate persistence.
📌Include ~340k COVID patients vs ~7M controls out to 2 yrs
📌Organ dysfunction persists in 33%
📌Levels of disability from #LongCOVID exceed those of cancer & heart disease‼️
Links at end of this thread
2/ Remember that these data complement the 8 or so other studies showing similar findings, and EXTEND the information using VERY large control groups w censoring if those controls got COVID.
✏️Thus, older and more white than the average #LongCOVID person
✏️They also do NOT help us with Delta and Omicron variant COVID
✏️These findings are robust and statistically sound and published by very astute and qualified investigators
✏️But they must be extended scientifically in cohorts that include a high number of younger women, people of color and lower SEC as well as newer COVID variants.