wee update:
had a couple of pretty good weeks which has surprised me. everything in life is tolerable. still worse than before my last relapse, but if life stays like this, i can work around it. tho i usually feel "good" pre-relapse, so hoping it's not the calm before the storm
had TWO dr apps this week:
1. at the nutrition clinic: anaemia has resolved so i can stop iron supps, just got some follow up apps to check my haemoglobin, B12 etc stay stable

2. GP: spoke to advanced nurse practitioner. i was sorta ready to put up a bit of a fight as it was...
to discuss tests & meds recommended by a private dr. she was absolutely lovely tho, & shocked how much ive been suffering

- agreed to D-dimer: if elevated 1 month after anticoagulation ends I may be indicated for longer term anticoagulation as i have a high risk of further clots
- agreed to fludrocortisone (YAY!)

- agreed to increasing famotidine (from 20 to 40 mg/d)

- didn't agree to steroids, but said i can call back if i relapse

- didn't agree to melatonin but not at all shocked by that, esp as we asked for 9 mg!
- agreed to tests for antiphospholipid tests but after discussing with a GP, they werent keen on doing things piecemeal so referred to haematology, should be in 2-3 weeks
bit concerned as ive heard haematology arent up to speed on the type of clotting seen post-vaccine
#TeamClots
but hopefully (if i need them) the solution will be something standard (like APS or DASH score)

So overall, very happy with that outcome and glad they were happy to help like this
i'll add also that the nurse COMPLIMENTED me on being a well read & "clearly very intelligent" patient & she REALLY listened to my concerns & explained things well
i cant stress enough how much of a difference medical professionals appreciating patient expertise makes
#MedTwitter
simply by listening and explaining her POV compassionately i came away content despite not getting everything i was hoping for. if the practitioner was dismissive, we could have had the VERY SAME OUTCOME but i would feel belittled, angry, and gaslit

#MedTwitter
lastly, some weird blood results
in A&E in Dec, my WBC were slightly high. Sort of expected in that situation & werent alarmingly high


Bloods yesterday: they havent changed much, & now my neutrophils are slightly elevated too with slightly low eosinophils
(urea also a bit low in both measures, assuming low protein diet)

No signs of current infection, and as above, my general post-vax symptoms are "good"

maybe immunostimulation is helping me:
but no idea why it's happening (PCR yesterday was negative too)
will see if they calm down, and will discuss with haematology but ideas welcome about wtf my immune system is doing (beyond the possibility that there is some low level infection). in terms of potential immune modulators, im on loratidine, famotidine, ketotifen, statins, aspirin

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More from @angryhacademic

Nov 27
Had an appointment with my best dr today. The only dr i fully 100 % trust. Some points for #medtwitter:

1. I trust him because he believes me, first and foremost

2. He knows i struggle being upright and with light so he turns the lights down & preps a couch for me to lie on
3. He knows i am clinically vulnerable so wears a respirator, and if med students/whoever are observing, he gets them to mask up too. Also has the window cracked for ventilation
4. Even though i see him for very specific things, he provides space for me to talk through how EVERYTHING has been since we last spoke. He writes up any symptom changes in my notes so its an accurate record. This is important as it clearly shows i am still highly symptomatic
Read 12 tweets
Nov 22
Update to the @NHSScotland #POTS pathway disaster:
In EDIT 7, I went through a bunch of emails & one showed Dr Claire Taylor was invited to help on the pathway. I wanted to know Dr Taylor's involvement so I FOI'd any emails between her & NSS/POTS groups👇🏻
dontbelievehype.co.uk/covid-%26-vacc… x.com/angryhacademic…
As you will see in the blog, Dr Taylor had no substantive involvement. Having seen the pathway, this is no surprise. She was clearly unable to attend meetings due to her clinic. But what is maybe a surprise is that Dr Taylor absolutely hammered NHS Lothian's approach to POTS
Her critique was sent at a similar time to my complaint, so maybe our collective efforts were the trigger towards the pathway being retracted.
Read 7 tweets
Nov 13
Latest paper!
Venesection for chronic illness: N-of-1 blinded randomised controlled trial


As some of you may recall, I did a n-of-1 study on therapeutic phlebotomy (venesection). The results were surprising...🧵

#postvac #longcovid #chronicillnessdoi.org/10.31219/osf.i…
Brief recap on methods:
This was a blinded randomised placebo controlled n-of-1 trial. What does that mean?

Blinded: this means I did not know if I was truly getting blood taken, or if it was sham (placebo) phlebotomy
To do this, a suitably qualified friend would take my blood as normal using either proper tubes (real), or dudded tubes (sham). I was blindfolded & wore noise cancelling headphones so didnt know what I was having done, & tubes were disposed of before I took the blindfold off
Read 20 tweets
Nov 1
A NEW SIGN FOR THE DETECTION OF MALINGERING AND FUNCTIONAL PARESIS OF THE LOWER EXTREMITIES (Hoover, 1908)


This is the paper that defined the Hoover's sign. Let's delve in...sci-hub.se/10.1001/jama.1…
It starts that this is a sign Hoover as seen in 4 (yes, FOUR) patients, but he feels justified in saying it's VERY IMPORTANT The sign I wish to describe is one which I have employed for the past two years. Although the cases observed number only four, I feel justified in attaching great importance to the sign because it is dependent on a normal function, which I find always exhibited in healthy persons and invariably present in the sound leg of patients suffering from hemiplegia or paresis of one leg due to some pathologic lesion.
He describes the response in hemiparetic patients, then notes that two cases claiming for personal injury did not respond the same

It get's worse... In two cases in which paresis of one leg was claimed by the plaintiffs in suits for personal injuries, there were wanting the characteristic physical signs to sustain the claim of paresis of the lower extremity as the result of injuries. Furthermore, in both of these cases, when the patient was asked to lift the normal leg off the couch, the leg which was alleged to be very paretic was opposed strongly against the surface when resistance was offered to lifting the normal leg. When the patient was requested to lift the paretic leg, there was an apparent attempt to respond to my demand, but t...
Read 11 tweets
Oct 7
I previously explained how antihistamines work: x.com/angryhacademic…

This post will talk through different mast cell stabilisers, which are also common medications for mast cell activation syndrome (MCAS)

Blog: lc-sc.co.uk/bodily-systems…

#longcovid #postvac #MCAS
💊 Examples: Sodium cromolyn, ketotifen, vit C, quercetin, luteolin

🧪 Main mechanism: Unlike antihistamines, which block the histamine receptor as their primary mechanism of action, mast cell stabilisers help prevent mast cells from spewing out their contents ("degranulation")
In MCAS, this degranulation is inappropriate, with mast cells reacting to benign triggers such as foods, air pressure, or scents (among many other things). Therefore, stabilising mast cells can help with some histamine issues...
Read 26 tweets
Oct 6
Mast cell activation syndrome (#MCAS) & histamine intolerance are common features for many #longcovid & #PostVac patients. 🧵on antihistamines which are commonly used in MCAS & histamine intolerance. (I will do another post on mast cell stabilisers)
lc-sc.co.uk/bodily-systems…
There are different types of antihistamines with different actions, but they all block a histamine receptor so histamine can no longer attach to the receptor & cause chaos. I.e. antihistamines do not stop histamine production, they just stop histamine from working properly
First-generation H1 antihistamines:
💊 Examples: Diphenhydramine, chlorpheniramine, brompheniramine

🧪 Main mechanism: These work by blocking the H1 receptor, which has roles in hypersensitive reactions (e.g. wheezing, itching, coughing, blood pressure dropping)...
Read 19 tweets

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