Managing Long-COVID with a multidisciplinary Lifestyle Medicine approach

  • 25 Oct 2020
  • Posted by gsldavies
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The increasing recognition of Long-COVID as a significant health concern (around 10% of COVID patients) has reinforced the importance of a multidisciplinary approach to health. We have realised that the membership products we have created are a platform to support our patients who have been through COVID only to realise that they are left with ongoing symptoms impacting their Health.

LONG-COVID

Post Acute COVID or "Long-Covid" seems to be a multi system disease affecting about 10% of people infected with COVID-19. Broadly patients can be divided into those who have serious sequelae (e.g thrombosis in hospital, long ITU stay) and those with a non-specific clinical picture often dominated by fatigue and breathlessness. Many patients never have had a positive test for COVID-19 (ie they assumed it was another illness).

Why are some people affected?

It seems that being over 50 and female are risk factors, but it may be that patients are at risk because they have other factors such as a weak antibody response, inflammatory reactions, and mental factors such as post traumatic stress. These may all contribute.

What are the symptoms?

They vary widely: shortness of breath, chest pain, headaches, neurocognitive difficulties, muscle pains and weakness, poor control of diabetes, depression and other mental health issues seems to feature prominently. 

What tests are required?

Blood tests should be ordered selectively. Patients may not need any. Low white cells counts, raised inflammation markers, and other specialised markers (natriuretic peptides (heart failure), ferritin (inflammation and prothrombotic state), troponin (myocarditis and acute coronary syndromes), D-Dimer (pulmonary embolism) can help but can be falsely positive. British Thoracic Society Guidelines recommend patients who have has significant respiratory illness should have a 12 week follow up Chest X-ray and referee if symptoms persists. 

Supporting recovery

Breathing techniques

"Breathing Control" technique: sit-in supported position and breathe in and out slowly, in through the nose and out thorough the mouth while allowing the chest and shoulders to relax and the tummy to rise. Aim for an inspiration to expiration ration of 1:2. Perform frequently throughout the day in 5-10 minute bursts. Other breathing techniques such as deep breathing, pursed lip breathing and Yoga Techniques can be helpful. 

Pulse Oximeter

Having a pulse oximeter at home can be helpful if respiratory symptoms are the main concern: Seek medical advice if Saturations are <96%, breathlessness getting worse, unexplained chest pain, or feeling very weak or confused. 

How we can help:

  • Listening and Empathy
  • Attention to general health
  • Rest and relaxation
  • Self pacing and gradual increase in exercise (plan)
  • Setting achievable targets
  • Diet
  • Sleep
  • Quitting Smoking
  • Limiting Alcohol
  • Limiting caffeine
  • Nutritional Therapy
  • Social, Cultural and accessing financial support

At Shilpa Dave Health our Multidisciplinary Lifestyle Team are here to support you with our dedicated GP, Nutritional Therapist, Yoga Instructor and Personal Training available. We also have a dedicated cardiac rehabilitation physiotherapist we work with who can guide you to recovery aided by Polar heart rate monitoring. 

BOOK NOW 

 

More than ever we need to be ready now - despite the Governerments assurances, COVID-19 infection rates are climbing into the Winter period and now is the time to address the health concerns perhaps you have put off until now.

We have launched our membership which has three main strands - Lifestyle orientated Private General Practice (Functional Medicine as the philosophy), Nutritional Therapy, and Yoga and Mindfullness. Our Wellness team are taking our members forwards in their Health Goals. We are still first and foremost your Family GP and are here to cater for your everyday health needs.

We all need to check in with ourselves, are we up to date with health screening? Have I had my mammogram, FIT test, PSA, blood pressure checked?.What’s my BMI and can I do something about it now?

-Yes!

Get strong, lift weight, build muscle and maintain bone density and core strength and perhaps most importantly find balance, space and strategies to protect and nourish your self. We have launched a complete virtual (face to face consultations where needed) wellness programme where it is tailored to you. I feel nervous about the next few months as an at risk practitioner and I am trying my best to be the best physical and mental version of myself I can ready for winter.

Remember as a member you have priority appointment times such as 8am and Saturday afternoon and we hope to reopen at Kirby soon (infection rates permitting). We will be updating member content regularly but for this week

VITAMINS

Vitamin D and COVID-19

https://www.nice.org.uk/advice/es28/chapter/Key-messages

EXERCISE - ready for winter and COVID-19

Think about exercise as Medicine - find out more 

For patients in their 40's, lower levels of hormones such as Testosterone, Oestrogen and a slowing resting Metabolic Rate  means that the way we exercise has to change as we change.

The Solution: Strength train two to 4 times per week. When we do your health screen we use the Tanita Scales to give us valuable information around Body Fat Percentage and Body Fat and Muscle Mass using technology known as Bioelectrical impedance analysis (BIA). As you increase your muscle mass, the rate at which you burn energy (calories) increase which accelerates your Basal Metabolic Rate (BMR). The other really useful information is the level of visceral fat which surrounds your organs. High levels of visceral fat are linked to heart disease, blood pressure and reducing your visceral fat may delay the onset of Type 2 Diabetes. 

SLEEP and STRESS

How well do you sleep?. The duration and quality of our sleep is often a useful barometer of balance and if we are stress, consuming too much alcohol, suffering with perimenopausal symptoms etc, usually our sleep is the first thing to suffer. The lack of sleep of course compounds all of the above and so the cycle continues.

The Solution: Mindfullness and Yoga. Patients, particularly men often view Yoga as a sort of alternative therapy or not "proper" exercise, but ask any professional athlete about staying injury free and in the right mindset to win, and they will all say that Yoga is a vital part of their training regimen. More than ever we are entering the end of summer a little frustrated with the family life, many patients are furloughed, many have had their precious holiday plans cancelled and the practice patients who have already had COVID, many of them are still not quite right struggling with fatigue. This is where Sam Varriale (The Energy Nutritionist) and Nick Dye (Yoga and Mindfullness Coach) come in. These are specialist in their own field and using them in combination with your health screen results and body analysis can give you a meaningful, supported and tailored plan to reach your health goals, safely, without pressure of competition or crazy diets. It does not matter if you are 25 or 60, being supported and inspired is what we all need during this difficult year.

You can book your Yoga directly on the portal and Nicky will spend your first session exploring and getting to know you well before coming up with the perfect combination of Yoga and Mindfulness you need!. Strala Yoga combines the movement and healing wisdom of yoga, tai chi and qigong, and is infused with the principles of Chinese and Japanese Medicine. 

Nicky loves to help people soothe their souls, sleep well, and move easily through all kinds of challenge.  Particular areas of interest include stress and anxiety, recovering your sleep and guiding people back into balance.

OURA Ring

Have you heard of the OURA Ring?

Every night, your body performs the equivalent of modern health miracles - everything from improving memory to producing cancer killing T cells. And while you sleep, your body is sending a flurry of signals. When decoded, these signals - heart rate, body temperature and more - communicate your body’s progress as it prepares you for the next day. And night after night, you sleep through it. Oura interprets these signals so you can wake up to the insights you need to take on the day.

Want to go deeper on getting more out of your sleep?

There is a modern-day misconception about the importance of sleep. We’ve convinced ourselves that anything else is more productive and frequently hear the expression “you can sleep when you’re dead.”

Recently, though, sleep science has been gathering steam and proving what should have been intuitive all along–our bodies didn’t evolve to waste time. Sleep is central to your health and performance. Although we remember little from our time asleep, our brains are firing and our bodies are actively repairing.

This movement is starting to have a social impact, and people are waking up to the importance of investing in sleep. If you want to take better care of yourself, start by making your sleep a priority.

Investing in Sleep

How much are we undervaluing sleep? The widely accepted baseline for adults is 7 to 9 hours of sleep per night. Depending on which study you read, anywhere from half of the US population to two-thirds of all adults in developed nations are not getting enough sleep.1 If you think you can function on fewer than 6 hours, think again. Only 5% of the population has the genetic mutation to do so.

Our brains are wired to ignore signs of sleep deprivation, so many of us get used to insufficient sleep without feeling the damage we’re doing.

When you get enough quality sleep, here’s what you receive in return for the extra time invested:

Inside your body

  • enhanced immune function and disease resistance, helping you live longer
  • increased energy and strength, so you feel and act more vibrantly
  • improved weight loss and blood glucose regulation, helping you lose fat and improve your skin
  • upgraded coordination and flexibility, so you miss fewer steps and catch yourself when you do
  • boosted hormone levels, so you recover faster and improve your fertility

Inside your brain

increased focus and creativity, so you can perform at your highest level
enhanced memory and ability to learn complex skills, helping you retain what you learn
improved emotion regulation, so you can keep your cool under stress

Getting enough restorative sleep helps keep your autonomic nervous, hormone, and immune systems balanced. When you’re balanced, you sleep better. It’s a virtuous cycle that affects all aspects of your health and productivity.

You can start prioritizing your sleep today and optimize your physical and mental performance by trying these sleep tips.

Calculating the Cost of Sleep Deprivation

Still not convinced? Skipping out on sleep impacts your ability to think effectively, react quickly, create memories, and regulate your emotions.

Why is sleep Important?

Longevity

  • Your likelihood of developing diseases and chronic ailments increases–including obesity, depression, diabetes, and cardiovascular disease.
  • Your sympathetic, fight-or-flight nervous system becomes overactive, pumping excess cortisol into your system.
  • Your body’s primary healing resource, human growth hormone, dramatically reduces production.
  • Your reproductive system is disrupted. A man’s testosterone levels decrease to the equivalent of a man who is 10+ years older, and women have disrupted conception hormone cycles.

Energy and resilience

  • Your time to physical exhaustion drops.
  • Your injury rate increases.
  • Your tissue repair slows and lactic acid builds up faster.
  • Your peak muscular strength, vertical jump height, and running speed decrease.

Weight and metabolism

  • Your probability of gaining weight, being overweight, and/or developing Type 2 diabetes increases.
  • Your weight loss shifts to shedding valuable muscle rather than fat.
  • Your likelihood of overeating increases as hunger hormone levels rise while the levels of the hormones that signal that you feel full fall.
  • Your chance of having gastrointestinal problems and nutrition absorption issues rises, as increased cortisol levels cultivate bad bacteria in your gut.

Immune function

  • Your immune system is disrupted and handicapped at reducing inflammation.

Effective thinking

  • Your brain accumulates toxins that impair behavior and judgment.
  • Your short-term memory and attention are reduced.
  • Your ability to solve problems, be creative, and use divergent thinking declines.
  • Your crucial decision-making center, the prefrontal cortex, shows reduced activity.

Reaction time

  • Your cognitive impairment is equivalent to being inebriated after 20 hours of being awake.
  • Your risk of being in a motor vehicle accident increases.

Memory formation

  • Your brain’s ability to learn and create long-term memories is compromised.

Regulation of emotion

  • Your brain’s emotional centre, the amygdala, increases activity.
  • You are more likely to overreact to social situations, such as a fight with a spouse.

https://ouraring.com/product/heritage-silver

References

Jones, Jeffrey M. “In US, 40% get less than recommended amount of sleep.” Well Being 19 (2013). (link)

Harmon, Katherine. “Rare genetic mutation lets some people function with less sleep.” Sci Am (2009). (link)

Walker, Matthew. Why we sleep: Unlocking the power of sleep and dreams. Simon and Schuster, 2017.
Leproult, Rachel, and Eve Van Cauter. “Effect of 1 week of sleep restriction on testosterone levels in young healthy men.” Jama 305, no. 21 (2011): 2173-2174. (link) 
 Kloss, Jacqueline D., Michael L. Perlis, Jessica A. Zamzow, Elizabeth J. Culnan, and Clarisa R. Gracia. “Sleep, sleep disturbance, and fertility in women.” Sleep medicine reviews 22 (2015): 78-87. (link)
Martin, Bruce J. “Effect of sleep deprivation on tolerance of prolonged exercise.” European journal of applied physiology and occupational physiology 47, no. 4 (1981): 345-354. (link) 
Milewski, Matthew D., David L. Skaggs, Gregory A. Bishop, J. Lee Pace, David A. Ibrahim, Tishya AL Wren, and Audrius Barzdukas. “Chronic lack of sleep is associated with increased sports injuries in adolescent athletes.” Journal of Pediatric Orthopaedics 34, no. 2 (2014): 129-133. (link) 
Van Cauter, Eve, Karine Spiegel, Esra Tasali, and Rachel Leproult. “Metabolic consequences of sleep and sleep loss.” Sleep medicine 9 (2008): S23-S28. (link) 
AlDabal, Laila, and Ahmed S. BaHammam. “Metabolic, endocrine, and immune consequences of sleep deprivation.” The open respiratory medicine journal 5 (2011): 31. (link)
Eugene, Andy R., and Jolanta Masiak. “The neuroprotective aspects of sleep.” MEDtube science 3, no. 1 (2015): 35. (link) 
Alhola, Paula, and Päivi Polo-Kantola. “Sleep deprivation: Impact on cognitive performance.” Neuropsychiatric disease and treatment (2007). (link)
Goel, Namni, Hengyi Rao, Jeffrey S. Durmer, and David F. Dinges. “Neurocognitive consequences of sleep deprivation.” In Seminars in neurology, vol. 29, no. 04, pp. 320-339. © Thieme Medical Publishers, 2009. (link) 
Goel, Namni, Hengyi Rao, Jeffrey S. Durmer, and David F. Dinges. “Neurocognitive consequences of sleep deprivation.” In Seminars in neurology, vol. 29, no. 04, pp. 320-339. © Thieme Medical Publishers, 2009. (link)
Williamson, Ann M., and Anne-Marie Feyer. “Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication.” Occupational and environmental medicine 57, no. 10 (2000): 649-655.(link)
Tefft, Brian C. “Acute sleep deprivation and culpable motor vehicle crash involvement.” Sleep 41, no. 10 (2018): zsy144. (link) 
Goel, Namni, Hengyi Rao, Jeffrey S. Durmer, and David F. Dinges. “Neurocognitive consequences of sleep deprivation.” In Seminars in neurology, vol. 29, no. 04, pp. 320-339. © Thieme Medical Publishers, 2009. (link) 
Yoo, Seung-Schik, Ninad Gujar, Peter Hu, Ferenc A. Jolesz, and Matthew P. Walker. “The human emotional brain without sleep—a prefrontal amygdala disconnect.” Current Biology 17, no. 20 (2007): R877-R878. (link) 
Gordon, Amie M., and Serena Chen. “The role of sleep in interpersonal conflict: do sleepless nights mean worse fights?.” Social Psychological and Personality Science 5, no. 2 (2014): 168-175. (link)

 

Dr Shilpa