Editor’s word: Find extra details about lengthy COVID in Medscape’s Long COVID Resource Center.

Sept. 22, 2022 – Entrepreneur Maya McNulty, 49, was one of many first victims of the COVID-19 pandemic. The Schenectady, NY, businesswoman spent 2 months within the hospital after catching the illness in March 2020. That September, she was recognized with lengthy COVID.

“Even a simple task such as unloading the dishwasher became a major challenge,” she says.

Over the following a number of months, McNulty noticed a variety of specialists, together with neurologists, pulmonologists, and cardiologists. She had months of bodily remedy and respiratory remedy to assist regain energy and lung operate. While lots of the docs she noticed had been sympathetic to what she was going via, not all had been.

“I saw one neurologist who told me to my face that she didn’t believe in long COVID,” she remembers. “It was particularly astonishing since the hospital they were affiliated with had a long COVID clinic.”

McNulty started to attach with different sufferers with lengthy COVID via a assist group she created on the finish of 2020 on the social media app Clubhouse. They exchanged concepts and tales about what had helped each other, which led her to attempt, over the following 12 months, a plant-based weight loss plan, Chinese drugs, and vitamin C dietary supplements, amongst different therapies.

She additionally acted on unscientific reviews she discovered on-line and did her personal analysis, which led her to find claims that some bronchial asthma sufferers with power coughing responded effectively to halotherapy, or dry salt remedy, throughout which sufferers inhale micro-particles of salt into their lungs to scale back irritation, widen airways, and skinny mucus. She’s been doing this process at a clinic close to her house for over a 12 months and credit it with serving to along with her power cough, particularly as she recovers from her second bout of COVID-19.

It’s not low-cost – a single half-hour session can value as much as $50 and isn’t lined by insurance coverage. There’s additionally no good analysis to recommend that it could actually assist with lengthy COVID, based on the Cleveland Clinic.

McNulty understands that however says many individuals who reside with lengthy COVID flip to those therapies out of a way of desperation.

“When it comes to this condition, we kind of have to be our own advocates. People are so desperate and feel so gaslit by doctors who don’t believe in their symptoms that they play Russian roulette with their body,” she says. “Most just want some hope and a way to relieve pain.”

Across the nation, 16 million Americans have lengthy COVID, based on the Brookings Institution’s evaluation of a 2022 Census Bureau report. The report additionally estimated that as much as 1 / 4 of them have such debilitating signs that they’re not in a position to work. While lengthy COVID facilities could supply therapies to assist relieve signs, “there are no evidence-based established treatments for long COVID at this point,” says Andrew Schamess, MD, a professor of inner drugs at Ohio State Wexner Medical Center, who runs its Post-COVID Recovery Program. “You can’t blame patients for looking for alternative remedies to help them. Unfortunately, there are also a lot of people out to make a buck who are selling unproven and disproven therapies.”

Sniffing Out the Snake Oil

With few evidence-based therapies for lengthy COVID, sufferers with debilitating signs will be tempted by unproven choices. One that has gotten a variety of consideration is hyperbaric oxygen. This remedy has historically been used to deal with divers who’ve decompression illness, or the bends. It’s additionally being touted by some clinics as an efficient therapy for lengthy COVID.

A really small trial of 73 sufferers with lengthy COVID, revealed this July within the journal Scientific Reports, discovered that these handled in a high-pressure oxygen system 5 days per week for two months confirmed enhancements in mind fog, ache, power, sleep, nervousness, and despair, in contrast with comparable sufferers who bought sham therapies. But bigger research are wanted to point out how effectively it really works, notes Schamess.

“It’s very expensive – roughly $120 per session – and there just isn’t the evidence there to support its use,” he says.

In addition, the remedy itself carries dangers, reminiscent of ear and sinus ache, center ear damage, non permanent imaginative and prescient adjustments, and, very not often, lung collapse, based on the FDA.

One “particularly troubling” therapy being supplied, says Kathleen Bell, MD, chair of the Department of Physical Medicine and Rehabilitation on the University of Texas Southwestern Medical Center, is stem cell remedy. This remedy continues to be in its infancy, nevertheless it’s being marketed by some clinics as a technique to stop COVID-19 and likewise deal with long-haul signs.

The FDA has issued advisories that there are not any merchandise accredited to deal with lengthy COVID and recommends in opposition to their use, besides in a medical trial.

“There’s absolutely no regulation – you don’t know what you’re getting, and there’s no research to suggest this therapy even works,” says Bell. It’s additionally prohibitively costly – one Cayman Islands-based firm advertises its therapy for as a lot as $25,000.

Patients with lengthy COVID are even touring so far as Cyprus, Germany, and Switzerland for a process generally known as blood washing, wherein giant needles are inserted into veins to filter blood and take away lipids and inflammatory proteins, the British Medical Journal reported in July. Some sufferers are additionally prescribed blood thinners to take away microscopic blood clots that will contribute to lengthy COVID. But this therapy can also be costly, with many individuals paying $10,000-$15,000 out of pocket, and there’s no revealed proof to recommend it really works, based on theBMJ.

It will be notably exhausting to discern what may go and what’s unproven, since many main care suppliers are themselves unfamiliar with even conventional lengthy COVID therapies, Bell says. She recommends that sufferers ask the next questions:

• What revealed analysis is there to assist these claims?
• How lengthy ought to I anticipate to do that therapy earlier than I see an enchancment?
• What are the potential uncomfortable side effects?
• Will the medical supplier recommending the therapy work along with your present medical group to observe progress?

“If you can’t get answers to these questions, take a step back,” says Bell.

Sorting Through Supplements

Yufang Lin, MD, an integrative specialist on the Cleveland Clinic, says many sufferers with lengthy COVID enter her workplace with baggage of dietary supplements.

“There’s no data on them, and in large quantities, they may even be harmful,” she says.

Instead, she works carefully with the Cleveland Clinic’s lengthy COVID middle to do an intensive workup of every affected person, which frequently consists of screening for sure dietary deficiencies.

“Anecdotally, we do see many patients with long COVID who are deficient in these vitamins and minerals,” says Lin. “If someone is low, we will suggest the appropriate supplement. Otherwise, we work with them to institute some dietary changes.”

­This normally entails a plant-based, anti-inflammatory consuming sample such because the Mediterranean weight loss plan, which is wealthy in fruits, greens, complete grains, nuts, fatty fish, and wholesome fat reminiscent of olive oil and avocados.

Other dietary supplements some docs suggest for sufferers with lengthy COVID are supposed to deal with irritation, Bell says, though there’s not good proof they work. One is the antioxidant coenzyme Q10.

But a small preprint examine revealed in The Lancet this previous August of 121 sufferers with lengthy COVID who took 500 milligrams a day of coenzyme Q10 for six weeks noticed no variations in restoration than those that took a placebo. Because the examine continues to be a preprint, it has not been peer-reviewed.

Another is probiotics. A small 2021 examine revealed within the journal Infectious Diseases Diagnosis & Treatment discovered {that a} mix of 5 lactobacillus probiotics, together with a prebiotic referred to as inulin, taken for 30 days, helped with long-term COVID signs reminiscent of coughing and fatigue. But bigger research must be performed to assist their use.

One that will have extra promise is omega-3 fatty acids. Like many different dietary supplements, these could assist with lengthy COVID by easing irritation, says Steven Flanagan, MD, a rehabilitation drugs specialist at NYU Langone in New York who works with lengthy COVID sufferers. Researchers on the Mount Sinai School of Medicine in New York are finding out whether or not a complement can assist sufferers who’ve misplaced their sense of style or scent after an an infection, however outcomes aren’t but out there.

Among the few options which have been proven to assist sufferers are mindfulness-based therapies – specifically, mindfulness-based types of train reminiscent of tai chi and qi gong could also be useful, as they mix a delicate exercise with stress discount.

“Both incorporate meditation, which helps not only to relieve some of the anxiety associated with long COVID but allows patients to redirect their thought process so that they can cope with symptoms better,” says Flanagan.

A 2022 examine revealed in BMJ Open discovered that these two actions decreased inflammatory markers and improved respiratory muscle energy and performance in sufferers recovering from COVID-19.

“I recommend these activities to all my long COVID patients, as it’s inexpensive and easy to find classes to do either at home or in their community,” he says. “Even if it doesn’t improve their long COVID symptoms, it has other benefits such as increased strength and flexibility that can boost their overall health.”

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FRIDAY, March 11, 2022 (HealthDay News) — Women tormented by frequent urinary tract infections typically take every day antibiotics to ward them off. But an outdated antibiotic various may work simply as properly, a brand new medical trial finds.

Researchers discovered that the medicine, referred to as methenamine, was comparable to straightforward, low-dose antibiotics in stopping girls’s recurrent urinary tract infections (UTIs). Either remedy curbed the infections to round one per yr, on common.

Methenamine is a long-established medicine that works by making the urine extra acidic and stopping bacterial development. Studies have proven that it could possibly forestall recurrent UTIs, but it surely’s not extensively used.

It’s such an “outdated” drug, many medical doctors in the present day have no idea about it, mentioned Dr. Karyn Eilber, a urologist at Cedars-Sinai Medical Center in Los Angeles.

Eilber, who was not concerned within the new research, mentioned she reserves every day antibiotics as a final resort for stopping recurrent UTIs, favoring methenamine as an alternative.

A priority with every day antibiotic use is feeding antibiotic resistance, the place micro organism study to thwart the drugs used to kill them. Plus, Eilber mentioned, it disrupts the physique’s regular bacterial stability.

Dr. Chris Harding, a guide urological surgeon at Freeman Hospital within the United Kingdom, led the trial.

He mentioned it “provides supportive proof for the usage of methenamine and might be notably welcome to these girls with recurrent UTI who wish to keep away from long-term antibiotic remedy.”

UTIs are exceedingly widespread and might have an effect on anybody, however are notably prevalent amongst girls. Studies recommend as much as 80% of girls develop a UTI sooner or later, and about one-quarter of these girls go on to have frequent recurrences.

Some signs embody burning throughout urination, and feeling a robust, persistent urge to urinate.

The new research — revealed on-line March 9 in theBMJ— concerned 240 girls with recurring UTIs. At the beginning, they have been averaging round six UTIs per yr.

Half of the ladies have been randomly assigned to every day low-dose antibiotic remedy, whereas the opposite half took methenamine twice a day.

Over one yr of remedy, each teams noticed a major decline in UTI episodes. Women within the antibiotic group averaged just below one bout per individual for the yr, whereas these taking methenamine had simply over one episode per individual.

That is a small distinction, Harding mentioned, and one which, primarily based on affected person focus teams, wouldn’t be thought-about “clinically significant.”

As for unintended effects, a small variety of girls in every group reported issues like nausea, belly ache and diarrhea. Six girls developed a UTI with fever, and 4 wanted to be hospitalized — all of whom have been within the methenamine group.

Whether treating extra UTIs with methenamine will assist battle the issue of antibiotic resistance is an open query. During the one yr of remedy on this trial, girls on antibiotics have been extra prone to harbor micro organism proof against at the very least one antibiotic. But that modified when their micro organism have been sampled six months later: Those who had taken methenamine had extra antibiotic-resistant bugs.

Harding mentioned that discovering “ought to be interpreted with warning,” because the trial was not primarily aimed toward gauging antibiotic resistance.

“Further analysis is unquestionably indicated on this space,” he mentioned.

For now, girls ought to know there are alternatives for stopping frequent UTIs, the consultants mentioned.

“Low-dose antibiotics ought to undoubtedly not be the primary line,” Eilber mentioned.

Besides methenamine, one other various is to take an antibiotic solely after intercourse. (Sexual exercise can encourage UTI-causing micro organism to maneuver into the urethra, the tube that releases urine from the physique.)

For postmenopausal girls, Eilber mentioned, vaginal estrogen could assist forestall recurrent UTIs. After menopause, the vaginal tissue modifications in ways in which could foster the expansion of “dangerous” micro organism.

Experts additionally typically advise some self-care steps that may assist, like consuming loads of water, urinating earlier than and after intercourse, and wiping entrance to again after utilizing the lavatory.

Many of the ladies within the present trial have been going by or previous menopause. But, Harding mentioned, his crew didn’t have a look at the results of remedy in response to age. Nor did the research embody males. So it isn’t clear whether or not the findings would apply to older adults, one other group at elevated danger of recurrent UTI.

The research was funded by the U.Ok. National Institute for Health Research.

More info

The U.S. Office on Women’s Health has extra on urinary tract infections.

SOURCES: Chris Harding, MD, guide urological surgeon, Freeman Hospital, Newcastle upon Tyne, U.Ok.; Karyn Eilber, MD, urologist, Cedars-Sinai Medical Center, Los Angeles; BMJ, March 9, 2022, on-line

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WEDNESDAY, March 9, 2022 (HealthDay News) — Folks with sleep apnea are sometimes prescribed a CPAP machine to assist them get a superb night time’s sleep, however there’s a substitute for the clunky, noisy units that’s rising in recognition.

Oral home equipment much like mouthguards — known as mandibular development units (MADs) — have been proven to work in addition to CPAP in treating sleep apnea for a lot of sufferers, consultants say.

MADs have “change into a rising a part of our observe. We routinely advocate and supply the oral equipment as one of many choices for therapy of sleep apnea,” stated Dr. Jing Wang, an assistant professor of sleep drugs on the Icahn School of Medicine at Mount Sinai in New York City.

“The oral home equipment have been round for much less time than CPAP, however they’ve grown loads in recognition over the past couple of years and they are often as efficient as CPAP for the precise affected person,” Wang stated.

Obstructive sleep apnea happens when your throat muscular tissues chill out to the purpose of collapse and block your airway throughout sleep. When this occurs, your physique turns into starved for oxygen and also you periodically get up for a number of seconds to gasp for air.

People with extreme sleep apnea can wake greater than 30 occasions an hour whereas making an attempt to get their relaxation, in accordance with the National Sleep Foundation. Daytime sleepiness is probably the most distinguished aspect impact, however sleep apnea additionally has been linked to severe well being issues akin to hypertension, coronary heart illness and diabetes.

Sleep apnea sufferers given a CPAP (steady strain airway strain) machine put on a masks by way of the night time that retains the airway propped open.

But CPAP units might be annoying to make use of, stated Dr. Mitchell Levine, president-elect of the American Academy of Dental Sleep Medicine.

The masks could make folks really feel claustrophobic, the noise of the machine can disturb mattress companions, and other people utilizing CPAP can undergo from dry eyes, bloody noses and sores on their face, Levine stated.

As a outcome, some sufferers are turning to oral units to assist with their sleep apnea.

Mouthguards maintain airways open

These units include two items that cowl your higher and decrease enamel, related by a mechanism that makes use of your higher jaw as leverage to push the decrease jaw ahead, defined Dr. Colleen Lance, a doctor within the Cleveland Clinic’s Sleep Disorders Center.

“By bringing the decrease jaw ahead and by getting the tongue base out of the way in which of the airway, you are manually splinting the airway open,” Lance stated.

MADs are much like over-the-counter units offered to assist deal with loud night breathing, however they’re custom-made by dentists working with sleep medical doctors, Lance and Levine stated.

The higher and decrease items are molded to your enamel, and the dentist performs a bodily examination of your airway, together with X-rays, to find out the precise adjustment you will want.

“They calculate what number of millimeters ahead — we’re speaking about millimeters right here, itty-bitty actions of the decrease jaw — they would want to maneuver the decrease jaw to maintain that airway open,” Lance stated.

These changes are often made very slowly over a matter of weeks to stop your jaw from aching or your chew from altering dramatically, Lance stated.

“Once you are used to sleeping with the gadget, they very slowly begin inching that decrease jaw ahead, millimeter by millimeter,” Lance stated. “Your jaw actually would not like modifications, and it actually hates fast modifications.”

These {custom} units aren’t low cost, starting from $1,500 to $2,000 , however Medicare and most insurance coverage will cowl them, consultants stated.

Off-the-shelf aids price a lot much less, between $75 and $150, in accordance with the American Sleep Association. But “one of many largest challenges is getting the gadget to remain nicely within the mouth. If it isn’t {custom} match, it is like placing a measurement 10 shoe on a measurement 8 foot,” Levine stated.

CPAP stays the gold customary for treating sleep apnea, as a result of “we all know we will get your apnea out of the equation straight away. It’s a positive factor. I do know I can have it for you shortly. It would not matter if it is delicate, reasonable or extreme apnea,” Lance stated.

Oral units not for everybody

Patients as of late will sometimes be began on a CPAP to get their sleep apnea underneath management, and an oral gadget will later be supplied as a possible long-term resolution, Lance stated.

“Some folks can have each,” Lance stated. “When they’re at house doing their regular factor, they will have a CPAP machine, but when they journey loads for work they will journey with a dental equipment.”

Currently, sleep medical doctors advocate these oral units primarily for folks with delicate to reasonable sleep apnea, Lance and Levine stated. Weight additionally performs a think about who will profit from the gadget.

“The increased your physique mass index is, the much less doubtless the dental equipment goes to work,” Lance stated. “Any further weight goes to shut that airway much more.”

But latest research have proven that MADs is perhaps simply as efficient as CPAP for some with extreme apnea.

MADs offered simply as a lot profit as CPAP in sufferers with extreme sleep apnea when it got here to sleepiness and high quality of life, in accordance with a latest proof evaluation.

However, CPAP was higher at decreasing the variety of waking occasions that sufferers skilled and bettering their blood oxygen ranges, the evaluation concluded.

But a French examine of practically 350 sufferers discovered that oral home equipment lowered waking occasions by greater than 50% in two-thirds of instances of reasonable to extreme sleep apnea.

“Eventually I feel the literature will broaden to incorporate sufferers with increased BMIs and sufferers with extra extreme sleep apnea,” Wang stated.

More info

The American Sleep Association has extra about mandibular development units.

SOURCES: Jing Wang, MD, assistant professor, sleep drugs, Icahn School of Medicine at Mount Sinai, New York City; Mitchell Levine, DMD, president-elect, American Academy of Dental Sleep Medicine; Colleen Lance, MD, Cleveland Clinic’s Sleep Disorders Center; Sleep Medicine Reviews, December 2021; The Laryngoscope, June 2021

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Feb. 18, 2022 — Can I eat my placenta? Is a water delivery secure for my child? These are a few the questions that extra individuals have been asking Sarah Pachtman, MD, over the previous couple of years amid a increase in different birthing practices.

Pachtman, an obstetrics and gynecology physician and a specialist in maternal-fetal drugs at Northwell Health in New York City, and the voice behind the @healthymamadoc Instagram account, says curiosity in these practices has been fueled — not less than partly — by the pandemic.

“There’s a lot of distrust in the medical system and a lot of distrust in the way physicians practice now. And I think COVID and the pandemic amplified that a lot,” she says.

Recent curiosity in different practices has included water births, encapsulating and consuming the placenta, and even vaginal seeding, or smearing a child born by C-section with vaginal fluid with the objective of creating a traditional microbiome within the child. Some have additionally expressed curiosity in lotus births, by which dad and mom depart the umbilical twine intact after delivery till it falls of by itself, with the purpose of giving the child further blood and vitamins from the still-attached twine.

A current search of the web market Etsy, for instance, turned up tons of of hits for merchandise concerned in lotus births, together with kits with “lotus birth herbal blend, the lotus birth bag, seven disposable bag liners and a roll of gauze for wrapping the umbilical cord to keep baby warm while still attached.” New dad and mom may even purchase a onesie for his or her new child that boasts, “My Mom Ate My Placenta.”

But few of those practices have been studied. Scientists and docs lack a transparent concept of their advantages — if there are any — or the attainable dangers to dad or mum and child. Since they don’t have proof of profit, Pachtman and plenty of of her colleagues don’t advocate these practices.

Here’s what we all know — and don’t know — concerning the security and advantages of two much-discussed different delivery practices: water births and consuming the placenta.

Water Labor and Births

When speaking about water births, it’s vital to differentiate between laboring in water and giving delivery whereas submerged in water.

Laboring in water through the first part of being pregnant has been linked to ache reduction amongst individuals with wholesome, uncomplicated pregnancies carried utterly to time period.

“Certainly, in selected patients, that is a reasonable option,” says Alison Cahill, MD, a maternal-fetal drugs specialist at UT Health Austin’s Women’s Health Institute. Cahill can also be chair of the scientific consensus committee in obstetrics for the American College of Obstetricians and Gynecologists (ACOG).

Cahill says she is extra involved about ladies giving delivery whereas submerged. Major medical associations, just like the ACOG, don’t help this observe due to an absence of proof that it does extra good than hurt. Cahill worries about infants drowning, whereas Pachtman stresses that any residence delivery may be dangerous ought to an emergency come up.

Infection, whereas uncommon, remains to be a sensible concern, as there may be devastating outcomes. In 2016, for instance, two infants born through water delivery contracted Legionnaires’ illness, a life-threatening bacterial an infection. While each of these infants survived, one toddler in 2014 was additionally recognized with Legionnaires’ after a water delivery and died. And in 2017, a child in Canada died of an an infection with a herpes virus after a water delivery.

Ashton Gelzinis, a doula with Birth Naturally Brevard in Indian Harbour Beach, FL, delivered each of her youngsters in water at residence.

“It doesn’t necessarily take everything away, but it just turns the dial down on the intensity of labor,” she says. Gelzinis says she has not had points with infections in her time working as a doula, although she notes the significance of creating certain the delivery workforce is certified and may act rapidly in emergencies. Midwives and their assistants needs to be educated in neonatal resuscitation and carry medicines to cease bleeding, as an illustration.

Eating the Placenta

Pachtman says consuming the placenta after giving delivery is among the many extra common practices that individuals ask her about. Most dry out the placenta, grind it right into a powder, and put it into tablets — a course of referred to as encapsulation.

People who’ve executed this report having extra power, much less concern about their milk provide, and therapeutic a bit of quicker.

“But again, just like water birth, there’s not a whole lot of research and evidence to support [these reports]” says Gelzinis, who consumed her placenta after giving delivery and presents encapsulation for her purchasers.

should you get pregnant and take into account pure/different birthing, i extremely advocate going via with it. i additionally advocate different birthing heart at ochsner baptist

— Princess Bubblegum (@debamichelle) January 13, 2021

“I haven’t had anybody have negative outcomes with taking the placenta,” she says.

Still, the tales about this observe don’t imply there’s scientific proof that consuming the placenta is useful.

“We have no way to say there’s any sort of benefit,” Cahill says.

“It’s all anecdotal … and while I respect those stories, I also tell my patients there is a risk your placenta has a virus,” like hepatitis, HIV, Zika, or COVID, Pachtman says.

The placenta acts as a filter and gathers poisonous substances for 9 months, so there could also be a threat of an infection should you eat it, Pachtman explains. One report from Oregon in June 2017 discovered {that a} new child developed group B strep linked to the placenta capsules the kid’s mom had consumed after giving delivery.

Making Decisions

For pregnant individuals and their companions with questions on different birthing practices, Pachtman and Cahill advocate talking with their obstetrician about what they’re studying, listening to, and pondering.

“We want to respect patients’ autonomy, but of course want to keep pregnant people and unborn babies safe,” Cahill says.

Gelzinis recommends that every one soon-to-be dad and mom take a childbirth training class to study their choices reasonably than taking place web “rabbit holes” to choose.

“I am frequently shocked by the number of people who ask for medical advice from random people on the internet. If you want to make the best decision for you and your family, find a doctor or a birth provider who you trust. And if you want more information and they don’t have it, ask them to look it up” and assist put the brand new info in context, Pachtman says. “Get the information from people who have read and studied and have learned about this for many, many years.”

WebMD Health News

Sources

Sarah Pachtman, MD, maternal-fetal drugs specialist, Northwell Health, New York City.

Alison Cahill, MD, maternal-fetal drugs specialist, Women’s Health Institute, UT Health Austin.

Ashton Gelzinis, doula, Birth Naturally Brevard, Indian Harbour Beach, FL.

CDC: “Notes from the Field: Late-Onset Infant Group B Streptococcus Infection Associated with Maternal Consumption of Capsules Containing Dehydrated Placenta — Oregon, 2016.”

American College of Obstetricians and Gynecologists: “Committee Opinion: Immersion in Water During Labor and Delivery.”

Etsy.

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