I wanted to share a story of a patient I saw this week. Very fit man aged 52, previous marathon runner, suspected mild #COVID19 March 2020. Extensively investigated by cardiology in 2020 for symptoms of chest pain, dizziness and struggling to exercise 1/
Cardiac MR showed some fibrosis suggestive of previous myocarditis, but all other Ix were normal. By November 2021 he was back to running 15km, but very slow improvement. Dec 2021 had booster followed by COVID re-infection over a couple of weeks (again mild symptoms) 2/
After this he developed similar symptoms to 2020, dizziness on walking up stairs, chest pain (anginal sounding). We did his spirometry and gas transfer - completely normal. On the 1 minute sit-to-stand he desaturated to 92%, HR increased from 49 to 110 and he became quite SOB 3/
Put him through the CT scanner, CTPA was negative for PEs but showed some possible right heart strain. I discussed this with some colleagues and given the desaturation we decided to perform a VQ scan. This showed extensive clots 4/
He had been referred to Resp as non-urgent. It was a chance discussion that the appointment was expedited. He was walking around with PEs and RH strain! I am really concerned about the number of people with 'mild COVID' out there who may have undiagnosed thromboembolic disease 5/
causing non-specific chest pain and SOB. This chap's symptoms were not alarming, in fact he thought it was all a bit of a fuss about nothing 6/
This paper is a multi-national report of over 900,000 people indicating propensity of risk for arterial and venous thrombi is in men, with increasing age, and association with fatalities (4-fold in non-hospitalized) thelancet.com/journals/lanin… 7/
We also know that beyond the first 30d after infection, individuals with COVID-19 are at increased risk of cardiovascular disease spanning several categories, even in the non-hospitalised 8/
There is mounting evidence that COVID19 is a pro-thrombotic, vascular/endothelial disease. The question is, are the tests we are currently doing in #LongCOVID clinics good enough? If CTPA and lung function are normal, should we be looking harder? Do people have access to VQ? 9/
On a microvascular level there is evidence of abnormal clotting and platelet hyperactivation. Why is it that the 'knowns' are not translating into treatment options? We know that dual anti platelet therapy & anticoagulation are effective in preventing vascular events 10/
In the absence of any other treatment, why are we not prescribing these drugs to people with #LongCOVID? With monitoring / risk benefit discussion of course. RCTs are not the only type of evidence. Real-world studies could be set up quickly via LC clinics 11/
Surely we should be thinking about primary prevention of 'known' vascular and thrombotic complications? I worry for the people out there with #LongCOVID. The lucky ones will have access to the best care and treatment, but how many others don't? END/
(Everything shared in this thread is with express permission from the patient.)
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Firstly, close attention needs to be paid to the methodology. This is not something that can be set up in any old lab (certainly not yet anyway) and samples need to be carefully processed by people who know what they are doing 2/
After 3 years of painstaking work Prof Dalton @cazd45 and team have developed a method to automate the counting of microclots. This is a good thing as it reduces the manual work involved and will help to standardise results and in time scale up testing 3/
A 🧵for #SouthAsianHeritageMonth on why the campaign is needed.
I was told by a colleague and good friend (white middle aged man) that ‘I see racism everywhere’ and ‘by focussing on identity I am sewing division’. Also, that referring to him as a ‘white man’ is offensive (1/5)
I wish the campaign didn’t have to exist but by the end of the conversation, I’d had every trope that people of colour face when talking about racism.
It was deeply upsetting to hear it from a friend, who would be mortified at the thought that he might have racist ideology (2)
There is a big difference between conscious racism and the deeply ingrained, hard-wired thinking that develops from living in a society where structural racism exists.
Campaign like ours open up a space for these conversations (3)
Of all the things I thought I would do in my career, I didn’t think it would be getting involved with cases of children being denied life-saving treatment, or very sick children being removed by court order from their parents due to ‘factitious illness and FND’ 1/
I’m utterly horrified at what is happening to some children with #longcovid. History repeating itself - this has happened for decades to kids with #MECFS. These kids desperately need care and treatment.
When will the medical profession wake up? 2/
How many more children and young people need to die before action is taken? It’s one of the biggest scandals in medical history and no one talks about it within medicine. It’s devastating to walk with the families going through this 💔 3/
Thanks to @StaceyPooleITV there’s been a focus on #LongCovidKids in the media this week.
Whenever @NHSEngland are asked for a statement re:Long Covid, it states ‘we have invested £X million’.
I want that taxpayers money to create value for patients, the system and clinicians 1/
Who is currently winning?
The patients? No
The healthcare economy? No
Clinicians? No
U.K. workforce? No
So let’s measure proper outcomes for those three things to ensure that money is being invested in the right place 2/
.@Sunny_Rae1 and I have talked a lot about this. We believe we Post-viral illnesses need to be defined as a specialty with clinicians trained in the underlying pathophysiology.
Patients are then seen by experts who can deal with multisystem issues, treat, support & monitor
3/
Here’s a 10min talk I did for @TheWHN outlining her journey and how we got here.
Key points; there’s lots we can do with the right tests, expertise, courage & a leap of faith.
#TeamClots doing what we can to drive research. Making good progress 🤞🏽(3/3)
I endorse vaccines, I have personally had 5 mRNA vaccines, globally the impact has saved millions.
However, like with any good treatment an unlucky minority will suffer adverse effects. The support available to those is woeful. We need to understand adverse events (short 🧵)
..and understand why some people have a multi-system reactions.
For example, with the drug Azathioprine. Studying adverse events mean we now can check for a rare genetic mutation before starting it to prevent it from happening dtb.bmj.com/content/47/1/9 (2/3)
The politicisation of vaccines and anti-vax rhetoric means it’s very hard to have a sensible discussion about this. It’s harmful and prevents the work that needs to be done. Like everything that becomes polarised, it prevents progress.