Assistant Professor
@RehabHopkins
and
@HopkinsKids
, Long COVID/Chronic Fatigue Clinic. Human, mother, physician, dancer, and scientist! My opinions are my own.
Tip of the day from one of my
#LongCovid
patients with orthostatic intolerance: Meet the TaDa Seat Stick, so you can stop worrying about finding a place to seat when you are out and about.
This is a
#LongCovid
patient during 10 min stand test in clinic today.
#MedTwitter
tell me again how anxiety explains this physical exam finding ?
#POTS
since SARS CoV 2 in August 2020, dozens of doctors visits and no treatment offered until today. WE MUST DO BETTER!
I asked my Long COVID patient if he ever noticed a change in color of his legs when standing, his answer was no…
#MedTwitter
When examining a LC patient, take their shoes and socks off, you can see acrocyanosis with standing or prolonged sitting secondary to dysautonomia.
For those doing LC research… around you having trouble finding controls? We are experiencing that most of our “HC” volunteers, when further assessed, end up having post COVID symptoms😩
I wish I could have spent the appt time more productively but I was so overcome with emotion that I was focused on holding back tears and not begging him to fix me. I don't know what else to say. I guess I wanted to reach out to someone who understands what I'm going through.
“I had a doctors appt yesterday and I couldn't stop crying:( I am so embarrassed. All I could think about is that an entire year has passed since he told me that my life was going to change and I absolutely DID NOT believe him and here I am living mostly in bed, mostly homebound.
My poor kids lost their active mother-now a nanny takes them to all their activities. It's my daughters 4th bday tomorrow and I'm grieving for her- all she knows is ever having a sick mommy. She's never had me at a school event or cheering her on at a soccer game or swim lessons.
My son has never had me walk him to the bus stop because I can't stand and wait. I panic and crash and get too sick. I can't believe this is my life now. I was an active, successful working mom and now I'm a hermit hobbling around the house attached to an IV pole.
Some days I can't even read to them because my voice is too weak. This is a torture chamber and I would never wish it on anyone. I do feel like I've made progress since last year but its soooo sloowwww and my worst fear is that this is the best I'm going to get.
I've never taken her to camp or even a playground. Its so devastating sending them on summer vacation and looking at pictures. She doesn't even remember a time when mommy went on vacations. It's just normal for her for me to always stay home and its so heart breaking.
“Postexertional malaise is not just feeling tired … It’s an out-of-proportion onset of symptoms that range from neurological to musculoskeletal, which arise from activity that was previously tolerated”
#Fangirl
moment! Such a treat to be able to meet
@WesElyMD
in person. Thank you for highlighting the importance of bringing humanism, empathy, and compassion to the field of medicine. Also for the ongoing advocacy in
#LongCovid
We don’t need to start from scratch when it comes to treating
#longcovid
. Let’s build upon the decades of existing research in
#MECFS
. This is a must watch!!! Dr. Peter Rowe presents Observations on long COVID through an ME/CFS lens via
@YouTube
Exited to present on COVID fatigue at
#AAPMR23
. I shared our clinics approach integrating insights of MECFS in the evaluation of LC patients that meet diagnostic criteria for MECFS. Identifying and optimizing management of these common co morbid conditions is key!
As a physician working with long Covid patients I find this article unethical. The author, an internist, is intentionally mocking and discrediting the
#LongCovid
movement. Widening the gap between patients and medical community. We must work together!
@DhruvKhullar
As a physician treating long Covid patients, your article seems unethical, intentionally discrediting and mocking the
#LongCovid
movement. The medical community has a duty to protect patients. Your words effectively disrupt the essential partnership between medicine and patients.
"This is not in their heads," Azola said of her patients. "This is not something that is just to get out work or a disability scam. These patients just want to be themselves again."
Exciting news! Our Johns Hopkins ME/CFS team is expanding and we're hiring! We're looking for a Nurse Practitioner or Physician Assistant to join us in providing exceptional care to those with ME/CFS, Long COVID, and related conditions.
#JohnsHopkins
#MECFS
#LongCOVID
#healthcare
🩺 We’re thrilled to announce the launch of our clinics page. We are dedicated to the care patients with
#MECFS
,
#LongCOVID
& related disorders. Follow us & stay updated on our research and advancements in treatment.
I was privileged to be a panelist at the
#RECOVERTLC
NIH meeting. I advocated for research informed by the expertise of
#MECFS
and
#IACC
researchers. I emphasized the critical need to understand post-exertional malaise (
#PEM
) and its neurobiological mechanisms. 🧠🔬 1/
Our JHCFS clinic's website is live! The vision is to build upon our landmark work in ME/CFS, continue expanding our research footprint with interdisciplinary collaborations, and providing excellent clinical care for our patients.
I disagree with withholding a diagnosis of ME from a LC patient. There is clear diagnostic criteria established and we should be building on the decades of work and not reinventing the wheel. Not all Long COVID patients meet MECFS criteria, but those who do need to be identified.
care will be taken to NOT diagnosis them with other conditions just because they meet diagnostic criteria and for no other reason. For instance, people with
#LongCOVID
at our center will not receive an
#MECFS
diagnosis just because they meet international consensus criteria 3/
"We are not enough," Azola told MedPage Today. "In terms of the post-COVID clinics, there's just not enough for the millions and millions of Americans that are affected."
Today is Long COVID awareness day. I stand in solidarity with the millions of people living with LC in a call to action. Funding to support 1.Access to care and basic needs of disabled patients suffering now 2. Research 3. Clinical trials and 4. Public Education
Multiple studies show that historically and persistently oppressed communities are at higher risk of developing
#LongCOVID
. Unfortunately they face barriers in access to care and implicit biases in healthcare that hinder their ability to get treatment.
@PutrinoLab
I disagree with withholding a diagnosis of ME from a LC patient. There is clear diagnostic criteria established and we should be building on the decades of work and not reinventing the wheel. Not all Long COVID patients meet MECFS criteria, but those who do need to be identified.
@Opinions_Survey
Im sorry you have been dealing with long COVID. Thankfully you can sleep with your arms down, acrocyanosis in long COVID is likely related to a faulty signal in you autonomic nervous system and not blood clots.
“Postexertional malaise is not just feeling tired or like you can’t walk up the steps. It’s an out-of-proportion onset of symptoms that range from neurological to musculoskeletal, which arise from activity that was previously tolerated.”-PEM is not fatigue
#LongCOVID
's impact on the brain goes beyond lingering concerns, it is a pressing health challenge.
Expert insights, recent studies, and research from
@neurology_live
reveal symptoms can persist long after the initial infection.
Neurology consult on my pwLC ... "Various conditions have been raised recently including Long COVID, ME/CFS as potentially explanatory. While I am not an expert in these conditions, I am highly doubtful these are useful / valid constructs to approach her symptoms"
Had the privilege to attend Demystifying Long Covid conference and represent the work of our JH Long COVID ME/CFS clinic and our collaborations with Dr. Antar on the COVID Cortisol study 🤩
@HopkinsMedicine
@Hopkins_PMR
Women are disproportionately affected by Long COVID and other infection associated chronic illnesses such as MECFS. We do not know why, however, it has certainly shaped the historical view of these “contested illnesses”
One of my favorite lines from the report on Long COVID: "These symptoms should be assessed and treated appropriately, and the ICD-10 code U09.9 (post COVID-19 condition,unspecified) may be used even before establishing a Long COVID diagnosis.
.
@awgaffney
I am more troubled by the lack of humility in the field of medicine, than by suffering patients looking for answers. “To know what you know and what you do not know, that is true knowledge.” Physicians must remain inquisitive and open minded, we do not have all the answers.
@HeyJanae1
@Dakota_150
I often ask my patients about this … some memorable examples included laying down in the middle of Macy’s, sidewalks, or in the DC Metro…Really telling about the severity of orthostatic intolerance.
@LauraineWe52738
😂 yep he can see, and after seeing it he said… “ok, so maybe I should take the salt tabs and drink 100 oz.” This patient is a physician himself.
@G_Commish
We check common post Covid conditions sx that include autonomic dysfunction sx, new allergies or MCAS sx, smell and taste disorders, cognitive and neuro sx. If they report not having LC and have some of the symptoms positive, I called them and go over a review of symptoms myself.
#MedTwitter
treating Long COVID patients, this one is a must read "Post-COVID dysautonomias: what we know and (mainly) what we don’t know" Another gem form my favorite "catecholaminaholic", Dr David Goldstein.
@microbeminded2
@AAPMR
I find extraordinarily helpful to implement the insights of clinicians that have treated ME for decades such as my mentor Dr Rowe. I’m hopeful that scientist like you and others that I collaborate with at
@HopkinsMedicine
will help find treatments that target the root cause.
@microbeminded2
@AAPMR
I’m following very closely the exciting scientific work into understanding the pathophysiology of LC. My role is to take care of patients that are suffering right now. I have found applying the insight of clinical management of ME has helped my LC patients gain function. 1/
@ahandvanish
As a physician working with long Covid patients I find this article unethical. The author, who is an internist, is intentionally mocking and discrediting the
#LongCovid
movement. Widening the gap between patients and medical community. We need to work together!
@MzAllieOsin1
Yep! Walking is better than standing still. When standing still the leg muscles are not as active and blood 🩸 pools in the legs, and less blood gets to your brain 🧠. Walking activates leg muscles and helps pump the 🩸 up to your heart and brain.
HOT OFF THE PRESS:
Our article is on Long COVID and Its Impact on Adolescents and Young Adults. We discuss special considerations for this population and a detailed clinical approach for those pwLC meeting criteria for ME/CFS.
What’s filling your cup today? .. For me is my
#LongCovid
patient who sent me this selfie celebrating 🥳 her first day back to work! Shared with permission, with the goal to inspire the ones struggling today!
@Elana_Brooklyn
We check common post Covid conditions sx that include autonomic dysfunction sx, new allergies or MCAS sx, smell and taste disorders, cognitive and neuro sx. If they report not having LC and have some of the symptoms positive, I called them and go over a review of symptoms myself.
We absolutely need to focus on finding a cure for
#pwLC
; however, we do know repurposed drugs can help patients gain function and QoL. At 4 yr into this mess we have unsurmountable resistance from the medical community to adopt these practices given the lack of evidence ... 2/
@OnTapPhysio
Our neuropsychology team has preliminary data demonstrating that the degree of objective cognitive impairments in long COVID patients is independent to the degree of coexisting depression and anxiety.
.. and the historical skepticism on dx like
#MECFS
#POTS
, etc. I spoke of my pre-pandemic stigma toward these dx and how caring for
#pwLC
caused a paradigm shift in me. I reached out to clinicians treating these conditions & they enthusiastically shared their experiences.
@MartyMakary
You have an open invitation to our Hopkins post COVID. Would love to discuss the “exaggeration” of long COVID you are reporting on. 💯 agree that there are some taking advantage of this vulnerable population…
I am not sure what I was saying at the moment this pic was taken, but it looks like I was imploring the NIH gods for a miracle ... preferably in the form of billions in funding for the next ten years ...lol
@ErinMariLee
I’m sorry you had to go through that! There is so much work to be done to educate physicians on
#MECFS
& Associated Chronic Conditions. I have the opportunity to present on
#LongCOVID
at Internal JH Medicine Grand Rounds next month🤩 One step at a time we will get there!
A few other pearls: The 2024 NASEM Long COVID Definition does note ME/CFS and POTS, among others, as examples of
diagnosable conditions that can be part of the picture of Long COVID.
.
🚨 New POTS Self-Advocacy Program Alert!
Awareness for POTSies has launched a pilot program designed to help those with POTS advocate for themselves effectively.
#POTS
#SelfAdvocacy
#POTSies
@edyong209
Thank you for this story! As co director of the post Covid clinic in my academic hospital I struggle with the fact that my best is not good enough for my long Covid patients. We are failing our patients, and there is a lack of urgency of medical community to take action.
1/2
Tomorrow is my last day at Bayview inpatient rehab unit and as co director of the Johns Hopkins Post Acute COVID team.
Excited for the future as I step into my new role at the Hopkins Chronic Fatigue Clinic.
I wanted to share my goodbye message to my work family 1/
@PutrinoLab
So MECFS is a blanket dx but LC is not a blanket dx ? 🤔 Lumping all pw LC in studies without clinically phenotyping them will continue to muddy the science. My clinical lens may be skewing my view. I leave the science to you. I guess we can agree to disagree(;
Thank you
@ABCNewsLive
for raising awareness of the human toll of
#LongCovid
. Grateful for the opportunity to be able to advocate for the millions of patients suffering in silence.
@PutrinoLab
I give both, U09.9 and G93.32, and also add additional codes for other things we are treating the patient for ie migraines, neuropathy, MCAS, POTS or Autonomic Dysfunction ect…
I am beyond excited to be part of the
@LongCOVIDPhysio
team😍 I have admired the work of this collective for the past 2 years and the positive impact they have on the
#LongCovid
space🤩looking forward to contributing my grain of sand and keep the momentum as a healthcare ally!
@loscharlos
@MVGutierrezMD
I have had good response in terms of cognitive fatigue, like it widens the window before the brain fog sets in. Here are my slides on Amantadine, 3 different mechanisms of action that are potentially at play.
Hispanic communities are experiencing higher rates of
#LongCovid
, but many aren’t receiving the care they need. It’s time we address the disparities in healthcare access.” From Dr Linda Martinez at the LC Summit in Chicago
#HealthEquity
#LongCovidCare
#SystemicInequality
Great paper on CPET findings in
#LongCovid
patients. It is NOT deconditioning!!!!
“The findings of this review do not support deconditioning as the primary mechanism of low VO2peak post-COVID-19.”
@ahandvanish
Yes, I’m a big fan! We just started using the FUNCAP 27, the shorter version of this questionnaire to assess PEM, and also to assess the PEM experienced after participating in a study.
Special thanks to Meghan Swope, Camille Broussard, Renee Swope,
@AgosCasamentoM
and Peter Rowe for his inspirational leadership! Grateful for our talented extended JH family collaborators and the patients for entrusting us with your care and supporting our work.
@microbeminded2
@AAPMR
@HopkinsMedicine
We are on the same team! I’m one of many clinicians that work in the trenches helping LC patients one on one. I’m lucky to practice in a setting where I can collaborate with brilliant scientists, and work towards the ultimate goal of finding a cure.
If you are a person with Long COVID or a caregiver to one, let your voice be heard! Please complete the following questionnaire to inform the government of your experience with SSI.
Hello
#LongCOVID
Team!
In 2022, 44% of respondents in a
#C19LAP
survey said they had applied for
#SocialSecurity
#Disability
.
We are re-evaluating the experience of the U.S.
#LongCOVID
community when it comes to applying for Social Security Disability.
We are asking everyone
@ItsAngInLA
@MVGutierrezMD
@AAPMR
If you think about the pathophysiology of hyperadrenergic POTS it totally makes sense, we just don’t get taught about POTS in med school. The IV fluids volume expand and prevent the cathecolamine surge that causes the hypertension. Midodrine also works in these patients
This paper was sent to me by a colleague…. feel bullied. This comes on the heels of stating that multiple members of a family having MECFS is a result of learned behavior. There is much work to be done!
@ahandvanish
I think you have earned an honorary medical degree! You are helping clinicians caring for Covid patients deliver better care. Thank you for all the work that you do!
@DanChapmanDPT
@sunsopeningband
@LongCOVIDPhysio
A key piece on rehab of Long Covid patients with predominant fatigue is to identify those experiencing PEM. If PEM is present is important to give them the tools to understand how to manage their energy envelope and identify triggers and how to avoid them.
@dysclinic
I don’t, do you order it? Would love to hear arguments for the clinical utility of the test. I do understand the research value, but do the results lead to actionable readily available treatments?