Husband & Dad. ICU Doc. Vanderbilt. @CIBScenter studies Covid & Long Covid, ICU Survivorship, PICS, Dementia, Delirium. Tweets my own. Still learning.
Oct 17 • 4 tweets • 2 min read
1/🧵 Long COVID Disease State
COVID infects us & Interferon causes 3 dastardly plots:
📌 We absorb ⬇️ tryptophan & convert ⬇️ Serotonin
📌 Platelet pathology ⬇️ stores of Serotonin
📌 Vagal nerve signals peripherally ⬆️ impairs brain function & memory
bit.ly/3M5F9ZV 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.
Oct 10 • 25 tweets • 5 min read
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:
Sep 27 • 8 tweets • 3 min read
1/🧵 Post-Infectious Syndromes
…a Doctor’s admission
📌 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.
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.
Aug 24 • 6 tweets • 3 min read
1/🧵This weeks 2 important studies on Long COVID
📌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.
We show hypothesized points for interventions that we & others around the 🌍 are testing via robustly designed randomized controlled trials to get answers for those suffering this very real disease.
Jun 12 • 11 tweets • 6 min read
1/🧵Fusion of Neurons in COVID
🔹At 2 yrs many #LongCOVID pts still suffer 🧠
🔹We’re beginning to understand why
🔹“Fusogens” activated by viruses like COVID can create irreversible cell-to-cell damage & miscommunication
Pic = Spike infected neuron
Link in Tw 3 2/ Infections like SARS-Cov-2 drive expression of viral fusogens
These cause irreversible fusion of brain cells, causing bad neuronal communication
One of several possible explanations of brain pathology in #LongCOVID
Pic= Fused neurons w Spike & ACE2
May 31 • 4 tweets • 7 min read
Living w Disability
🔹I don’t know what you’re going through
🔹Is every day a struggle?
🔹Greg suffers #DownSyndrome, Alz Dz, Depression, Catatonia
🔹 Yet today he said, “Sunday’s donut day, but let’s have ‘chockle’ anyway & I’ll be ok.”
“What is causing their agitation? How can you respond to it? Do they have contraindications to mobility? How do you start?”
Jan 30 • 7 tweets • 4 min read
🔹Re-infection is a worry
🔹⬆️ plasma Nucleocapsid (N) Antigen levels predict outcomes
🔹If you get COVID, the best predictor of ⬇️ N-Ag levels (ie, viral replication) is having Spike Ab
🔹You get S-Ab by Vaxx
Read on bit.ly/3Ha8q2g2/ These data (N=2540) come from ACTIV-3 study of adults hospitalized for COVID in 114 centers in 10 countries Aug 2020-Nov 2021
I’m going back over this because there are so many people walking around without adequate protection due to waning immunity over time.
Jan 17 • 10 tweets • 6 min read
1/🧵 Real-World Long COVID
🔹She got COVID Oct 2020
🔹59 y/o walked 5mi 4x /wk
w no prior cognitive problems
🔹“I got better but 4 mo later my memory faded. I struggled.
🔹HR came after me, ‘You can’t do your job.’”
Husband: “I want my wife back!”
(Pics & story w perm) 2/ Could her new #dementia be unrelated to COVID?
Her excellent neurologist feels her negative work-up, young age, speed of demise, temporal onset in relation to COVID all fit LongCOVID-related brain dysfunction & not a pattern of Alzheimers.
📍N=1,846 pneumonia patients w versus w/out COVID
📍COVID didn’t “invent” a new lung disease
📍We freaked out saying vents needed to be so different
📍Docs erred as we deviated from our evidence-based
Why should YOU care?
bit.ly/3QIp2Tl2/ COVID is a very long pneumonia process, but we exacerbated it…
This graph shows that Death occurs similarly, but COVID #death takes longer (10 vs. 7 days).
Time to discharge alive is twice as long (10 vs. 5 days) in COVID vs non-COVID pneumonia.
We caused a lot of this 😞
Jan 11 • 19 tweets • 9 min read
1/🧵Gratitude is Pain’s big brother
▪️Prof Greg teaches me to accept life on life’s terms
▪️ICU pts teach me how to traverse pain
▪️Gratitude is their close companion
▪️Gratitude is not just a tenet of etiquette – it’s an essential quality of well-being
Pics w perm 2/ I can’t pay gratitude w a checkbook, only from the ❤️
📍My Gratitude Ledger is in deficit because I don’t nurture #Wisdom
📍I underutilize this superpower of recovery
📍Gratitude is Greg’s antidote to victimhood
📍It helps him rise above any situation
White Cells (monocytes) switch gene expression from an established innate immune profile to a pro-clotting signature in COVID.
Let’s unpack this…
go.nature.com/3GeDygW2/ These data explain how the COVID virus places our bodies at risk for macro (large) blood clots in acute dz (which we see often), brain disease due to down-stream micro-clotting, and possibly later cardiovascular dz.