Thread by @drclairetaylor

Clinical pearls for #LongCovid
1. Find the clots. They are there. If not PE or DVT there are Microclots. 100% of all long Covid patients tested so far have them.

2. If you don’t find PE on CTPA, do a VQ or dual energy CT. You will find the missed clots.

3. Test for Autonomic dysfunction (Covid has a predilection for the ANS).
A 10 minute stand test will suffice. batemanhornecenter.org/wp-content/upl…

4. Then treat said autonomic dysfunction. Don’t tell people it’s ok to have a pulse of 160 doing the dishes. Great info at pots.org

5. Assess for mast cell activation syndrome. Some will says it’s not real. It’s real. Check for dermatographism. Ask about alcohol intolerance, new allergies, new rashes, urticaria. Etc etc

6. You don’t need fancy tests. Just treat it and see response. More info at @MastCellAction

7. Don’t tell people exercise will cure it. It won’t. It didn’t cure #MECFS and it won’t cure long Covid.
74% of patients felt worse with exercise in this study mdpi.com/1660-4601/19/9…

8. Don’t tell people it is psychological. They have been infected with a level 3 biohazard with unknown repercussions.

9. Don’t tell them to think themselves better, to try harder. They are already trying.

10. Advise them on pacing, which is a way of using what energy is available without crashing.
Familiarise yourself with post-exertional malaise- you are you are going to be seeing a LOT of it over the next few years. See @LongCOVIDPhysio

11. Don’t dismiss chest pain. This shouldn’t even have to be said but unfortunately does.
19% of long Covid patients in the coverscan study had myocarditisAlmost 1 in 5. Treat it. It’s not anxiety. bmjopen.bmj.com/content/11/3/e…

12. Try not to catch Covid yourself - you have between 1 in 10 and 1 in 20 chance each infection.
Damage is likely to be cumulative. It affects all the organs as every organ has a blood supply.

13. don’t think because you felt ok after one infection that this will be the case after 5 infections. (We can’t get long term immunity to this virus no matter what anyone on Twitter says).

14. Don’t listen to people who say it’s a cold- it’s not. It’s really really not. Colds don’t cause organ dysfunction and blood clots.

15. Anyone who uses this emoji 💉 over and over has an agenda. We knew the damage Covid caused in January 2020, well before the 💉

16. Protect the children from all of the above. They will be the generation with early heart disease. #CovidIsNotOver #MedTwitter #COVIDIsAirborne #CleanAirClassrooms #dontlookup

@Trinityaudiobot

Actual link to autonomic dysfunction treatment is here *forgot to put Uk after #potspotsuk.org