To Vaccinate or Not---The Rat Flu Odyssey Continues

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Originally Posted by bodywhomper

Is there a mechanism for an off ramp if the guidelines are not following the science? An easy low hanging fruit are the 5 day rule to return back to work (I’m not sure if hospitals are given that same guidance).

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We’re currently at 10 days off for positive covid test. Generally, guidelines can be interpreted but state and local mandates don’t have an “off ramp” unless the mandates are terminated by the ruling authority. IMO following the science is such a broad catch all, continuing a mask mandate in the hospital right now follows the science, they do work to varying degrees. Pulling the mask mandate for hcws also follows the science because right now every hcw is vaccinated and the risks to the patients and coworkers is very small.

It’s anxiety that keeps people from moving on, this thread is a prime example. People have lingering and long term symptoms from all kinds of viral infections but the ongoing hype about covid and long/post covid is being driven by the news cycle. Yes it’s real in some individuals but society’s generalized anxiety isn’t helping get back to normal. This is just my opinion.


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Originally Posted by old goat

For everyone with a psychosomatic symptoms given a diagnosis of a physical illness there is someone--or more likely 3 people--told it's all in the head when they have a real physical illness. (We could spend hours discussing the concept that the mind and the body are not separate, that disease is a combination of the pathology and how it interacts with the person's life, feelings, and thinking. But we'll save that for another day, or better yet, for never.)

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Appreciate both points. I didn't want to distract from the anxiety by going full thread drift, because evidence suggests my family's greatest risk factor is underdiagnosis, so I assume a personal bias. It really is a question about thinking, though. In your example of the unlikely patient, if that had been your patient, do you want to let that kind of example stand out as a strong warning or minimize it to avoid getting emotionally hung up on past mistakes?

There are some interesting concepts here -
I appreciate the point that some covid Policies are the result of bureaucratic input ;
the federal guidelines have been (varied) enough over the last two years, that is challenging ;

goat's claim and example are troubling enough to be worrisome -
Rhetorically, what is the effect of coronavirus on the brain (?)
The idea that three out of four people that are diagnosed with psychosomatic conditions have underlying undiagnosed pathology reminds me of something an old county doctor once told me -
' some things, it's better to learn to live with... '

Medicine ( - and Surgery - ) has come a long way in fifty years...
it's interesting to read 'psychsomatic' is considered a differential diagnosis.
in my experience, I would hope to refer such patients for further assessment and second opinions before diagnosing a psychosomatic/ psychologic ( psychiatric ) condition. especially with a voice with fifty years of experience saying 3/4 of these patients having underlying pathology...

I understand this may be difficult in a not-urban environment -

I don't pay much attention to the popular press / media anymore -
too many reporters want to be part of the story, and columnists bring their own (bias) ;
in the best case scenario, I would read a wide range, but I am old and probably (too) set in my ways...

I liked the claim up-thread that policy makers did they best they could with ever-and-still evolving information
( a couple of claims to the contrary fell flat with me ) --

I urge you to maintain resistance through vaccination ;
while the vaccines aren't perfect, to me the advantages over hoping omicron is going to provide a 'free asymptomatic booster' is definite.

as WrG has shown, we don't know what the long term effects of covid may be - it may be an ongoing matter, to reassess and adjust as necessary...
There is nothing wrong with that.

I'd rather hear that, than
' You may never get better '

( I'd at least seek a second opinion. )

my Thanks - especially to goat and -Unicorn. and Summit and Trackhead, too - for the knowledge of your Experience.

respectfully. skiJ

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Originally Posted by MagnificentUnicorn

... Pulling the mask mandate for hcws also follows the science because right now every hcw is vaccinated and the risks to the patients and coworkers is very small.

It’s anxiety that keeps people from moving on, this thread is a prime example. …]

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500+ deaths per day x 365 = 182.5k per year

Turns out Masking at the hospital saves a great many infections of all kinds and may be here to stay forever. Why do we need to “move on” from keeping people healthy at our health care institutions?

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Originally Posted by jfost

500+ deaths per day x 365 = 182.5k per year

Turns out Masking at the hospital saves a great many infections of all kinds and may be here to stay forever. Why do we need to “move on” from keeping people healthy at our health care institutions?

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I would bet that the numbers show community acquired infection is driving the pandemic not nosocomial infections. Yes masking helps, for the most part masks protect us from the sick patients.


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Originally Posted by bodywhomper

At the hospital that you work at, is there a trigger of when to step-up measures or is that reliant on government employee (eg public health officer) stipulated measures?

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CDC level setting is a combination of community levels (cases/100K) vs hospital levels (looks at how many admits and what percent of inpatient capacity are COVID patients). CDC levels inform local PH and hospital infection prevention guidance. I set our levels based on my judgement of COVID activity vs our hospital capacity in concert with system policy and PH guidance. That means masks when you are doing patient care or in areas where patients/public are present.

In another place I work, the guidance has been relaxed to "masks recommended, not required."

I'm sticking with masks because flu is still quite busy and COVID rates are increasing in the state.

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Originally Posted by bodywhomper

Is there a mechanism for an off ramp if the guidelines are not following the science? An easy low hanging fruit are the 5 day rule to return back to work (I’m not sure if hospitals are given that same guidance).

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CDC not follow the science? *gasp* Well some things you get a free hand with, other things you don't. Example, at the start of the pandemic CDC (and WHO) were flat wrong about the virus not being airborne, so plenty of us put in policies/action to treat it as such. Testing criteria was wild, in flux, and playing catchup, so we bent the rules when supply allowed. There were some wild rules on clearance testing, considerations for previous infection, and more. Judgements and practice were based on the evidence. The CDC was rarely moving as fast as we wanted them to or had unrealistic priorities.

Fast forward from 2020. CDC long ago gave up on setting policy based on highest theoretical safety and instead tried to mix what is practically safe vs other impacts and what people might actually be willing to do.

That is how you got the 5 day rule. That was actually some great foresight by CDC for Omicron. It works like a mask. Most people aren't shedding after day five, but some are, and the masks help with that. So if most people comply, you get better transmission control than if you keep it at 10 and a sizeable proportion of people say "fuck it, I'm not even gonna test."

Hospitals work at a higher standard. If not a a staffing crisis, 10 days off work or 7 days with a negative antigen.

We could potentially end up back in crisis return to work standards with some of these new variants that might cause summer surges.

Not sure where to leave this so I'm leaving it here.

https://www.youtube.com/watch?v=llx-SaGq4Fs

90 seconds, right on target. This guys is hilarious.

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Originally Posted by jono

Appreciate both points. I didn't want to distract from the anxiety by going full thread drift, because evidence suggests my family's greatest risk factor is underdiagnosis, so I assume a personal bias. It really is a question about thinking, though. In your example of the unlikely patient, if that had been your patient, do you want to let that kind of example stand out as a strong warning or minimize it to avoid getting emotionally hung up on past mistakes?

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We're talking about the Munchausen patient? He's not an example of anything. At least I sure hope he's not. So does his brother, Joe Montana. At least the guy claimed to be Joe's brother. Wonder why Joe never came to visit him.

It's not unusual for folks working in healthcare especially at the high integration level to call out psychosomatic or outright faked symptoms. It definitely happens a lot, people crying wolf all the time. However, the worst thing that can happen is for someone in the care setting to ignore or refuse care on the odd chance that the person really isn't faking or imagining things.

That's why we rarely see actual doctors scoffing or dismissing folks but techs and nurses definitely do..

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Originally Posted by old goat

My guess is that some long covid will turn out to have identifiable physical pathology and some will be anxiety or other mental disorders, and that it will take years to sort it all out.

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Yup. And I continue to read and try to appreciate it more. Interesting study recently about persistent SARS RNA in stool samples out to six months. So it's certainly plausible that could cause a persistent immune response causing fatigue, etc which invariably would lead any sane person to feel anxious, depressed, and have insomnia. I certainly don't doubt there is true pathology to some of it, but I have to accept that the numbers of "long covid" are as high as they are.

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Originally Posted by Summit

Not sure where to leave this so I'm leaving it here.

https://www.youtube.com/watch?v=llx-SaGq4Fs

90 seconds, right on target. This guys is hilarious.

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He's my hero.

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Originally Posted by old goat

We're talking about the Munchausen patient? He's not an example of anything. At least I sure hope he's not. So does his brother, Joe Montana. At least the guy claimed to be Joe's brother. Wonder why Joe never came to visit him.

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As not an example of anything he makes a good example of an extreme outlier, right? That was actually the context of my question. Not assuming you'd adjust all your thinking around his specific symptoms, but how does the walking (eventually?) proof that "extremely unlikely things eventually happen if your career is long enough" get incorporated into personal experience?

I have a friend who recites "when you hear hoof beats think horses, not zebras--but don't discount zebras." I don't think he's looked up to see a moose yet, but I hope he does--my brain actually tried to repaint the moose and add a rider for almost 2 seconds when I did it. Kinda cool!

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Originally Posted by Trackhead

Yup. And I continue to read and try to appreciate it more. Interesting study recently about persistent SARS RNA in stool samples out to six months. So it's certainly plausible that could cause a persistent immune response causing fatigue, etc which invariably would lead any sane person to feel anxious, depressed, and have insomnia. I certainly don't doubt there is true pathology to some of it, but I have to accept that the numbers of "long covid" are as high as they are.

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Certainly lots of virus that live in the gut. If it turned out that lots of people become GI carriers of SARS-CoV-2 that would be interesting and problematic.
Might have to start washing our hands again.

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Originally Posted by jono

As not an example of anything he makes a good example of an extreme outlier, right? That was actually the context of my question. Not assuming you'd adjust all your thinking around his specific symptoms, but how does the walking (eventually?) proof that "extremely unlikely things eventually happen if your career is long enough" get incorporated into personal experience?

I have a friend who recites "when you hear hoof beats think horses, not zebras--but don't discount zebras." I don't think he's looked up to see a moose yet, but I hope he does--my brain actually tried to repaint the moose and add a rider for almost 2 seconds when I did it. Kinda cool!

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Yeah--I get what you're getting at. I can't say Mr. Montana changed how I thought about anyone else. He was such an outlier--the only Munchausen I ever ran across and one of the two or three craziest patients I ever had--I can't say I learned anything from him, just a good story.

But the hardest thing in medicine is to keep an open mind.

https://www.youtube.com/watch?v=Dz4buD7LP9A

Make sure you observe airborne precautions!

Re: long covid, do you all have personal friends still dealing? I have a few. Some almost 18 months past infection.

I’ve read and seen such a large variety of qualitative range of ailments attributed to long covid and a huge range of % per total infected: recently from 5% (shared by Bob Wachter) to the 58% value from the article that I just posted. A friend was involved in that study published at the end of December that theorizes one pathology related to mitochondrial dysfunction.

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Originally Posted by old goat

Yeah--I get what you're getting at. I can't say Mr. Montana changed how I thought about anyone else. He was such an outlier--the only Munchausen I ever ran across and one of the two or three craziest patients I ever had--I can't say I learned anything from him, just a good story.

But the hardest thing in medicine is to keep an open mind.

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Thanks, that's helpful. Similarly, the challenge being a patient is often figuring out when to advocate harder for yourself and when to accept the expert opinion.

I'm not sure how it applies any more specifically to COVID, long or short, but using Trackhead's "Rule out what it likely isn’t" step as an example, there are at least a couple of ways to interpret that and knowing which a doc is using can be critical. My last PCP took the most literal/quickest version where "rule out" meant just imagine the unlikely as impossible, no further steps needed. I thought surely he'd eliminate at least the dangerous things first by actually ensuring they were impossible. Because that's how I thought as a patient.

If I'd known we weren't on the same page there I'd have GTFO ASAP and I might still have room in my stomach for a third pancake. That'd be cool. OTOH, I can still bitch and moan about it, which is definitely nice. But there's "critical" for ya. If there is a quick way to screen providers for this I'd love to know about it.

Are there any vaccine related long term side effects or is it all long covid?

Serious question, how would we know the difference? besides the obvious of someone with long covid symptoms who is unvaxxed.

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Originally Posted by bodywhomper

What response do you find more appropriate?

Here’s an interesting preprint on the prevalence of long covid: https://papers.ssrn.com/sol3/papers....act_id=4099429

Here’s what Topel has to say about it: “A systematic #LongCovid review of nearly 200 studies and over 120,000 participants, reinforces the high frequency of symptoms > 6 months, not linked to severity of acute illness, and potential for marked disability”

And he included this graphic:
Attachment 415559

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I'm not doubting long covid exists, but the 54% thing of at least one symptom seems bizarre when looking at some of those symptoms. Oh you have anxiety depression and trouble sleeping in an increasingly stressful world? Long covid for sure.

I have a couple friends who report feeling clearly different post covid, but they mostly seem to say trouble breathing and not feeling as strong cardio wise.

CDC has an entire website dedicated to it:

https://www.cdc.gov/coronavirus/2019...cts/index.html

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People with post-COVID conditions may develop or continue to have symptoms that are hard to explain and manage. Clinical evaluations and results of routine blood tests, chest x-rays, and electrocardiograms may be normal. The symptoms are similar to those reported by people with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) and other poorly understood chronic illnesses that may occur after other infections. People with these unexplained symptoms may be misunderstood by their healthcare providers, which can result in a long time for them to get a diagnosis and receive appropriate care or treatment.

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As someone who spent a year plus of my life trying to get my wife to a specialist that understood her disease and was able to quickly and effectively treat it after a cast of physicians were unable to treat and prescribed meditation, mental health, etc I’m a little disturbed by this “psychosomatic” discussion.

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Originally Posted by oldnew_guy

As someone who spent a year plus of my life trying to get my wife to a specialist that understood her disease and was able to quickly and effectively treat it after a cast of physicians were unable to treat and prescribed meditation, mental health, etc I’m a little disturbed by this “psychosomatic” discussion.

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It is disturbing, from the layperson perspective, but I can assure you the psychosomatic complaints certainly are very common and not something to be looked at as a weakness or in a negative light. That's where the defensive posture becomes unproductive, both by the provider and/or the patient. It's not always "in your head", but sometimes it is. Gotta consider both when appropriate.

Not having to wash my hands after using the bathroom was supposed to be part of the reward for making it through the pandemic.

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Originally Posted by oldnew_guy

CDC has an entire website dedicated to it:

https://www.cdc.gov/coronavirus/2019...cts/index.html



As someone who spent a year plus of my life trying to get my wife to a specialist that understood her disease and was able to quickly and effectively treat it after a cast of physicians were unable to treat and prescribed meditation, mental health, etc I’m a little disturbed by this “psychosomatic” discussion.

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I think better communication is key to mitigating these situations--whether that means getting the point across better or just recognizing when to break off the conversation. In that sense, much better to be aware of the challenges and biases of the person you're talking to. No matter how hard we screw on the expert halo, they're still humans. Some of them are even proud of it.

ETA: patients obviously have it as bad or worse--how many people are so invested in denying their own mortality that they'd rather hear "psychosomatic" than learn they have a degenerative disease?

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Originally Posted by Trackhead

It is disturbing, from the layperson perspective, but I can assure you the psychosomatic complaints certainly are very common and not something to be looked at as a weakness or in a negative light. That's where the defensive posture becomes unproductive, both by the provider and/or the patient. It's not always "in your head", but sometimes it is. Gotta consider both when appropriate.

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I’m admittedly a little touchy on this subject. Maybe I am summarizing in my head incorrectly but what is coming across to me is: “we don’t know, but I think most of this is psychosomatic and indicative of mental health issues not disease”.

“ I also think a large proportion of patients with long covid are suffering psychosomatic complaints and have significant underlying/pre-existing anxiety/depression.

Any person with a predisposition for anxiety/depression who gets covid is going to have a MUCH higher likelihood of assuming they will never return to normal health. It's a recipe for disaster, and we are seeing that now. Tell people they have a disease, and they will believe you. Tell them they may never recover, and they won't.

I've been at this healthcare shit for 25+ years, and while I think there is something to "long covid", I believe we are destroying our populations mental health with how the media and laypeople portray it.”

Ironically, my wife is not and was not a “layperson” in this context when this was occurring. IME it was used as a crutch by people who didn’t have any answers instead of saying “I don’t know how to treat this”. The disease she had has a long history of being labeled an in your head emotional problem by practitioners and the general public.

My understanding is that what, 5% of patients might fall in this category? Which probably seems common when you see it every day.

[QUOTE=oldnew_guy;6610514]I’m admittedly a little touchy on this subject. Maybe I am summarizing in my head incorrectly but what is coming across to me is: “we don’t know, but I think most of this is psychosomatic and indicative of mental health issues not disease”.
/QUOTE]

Defensive posture is natural. I agree much we don't know, and write off as psychosomatic. But to ignore that as a possibility is also a disservice to the patient. It remains in the differential diagnosis for many presentations (long covid, chest pain, shortness of breath, dizziness, etc). Also, given Covid was the number #1 story for two years, it's easy to understand how people would be anxious over it. I certainly was.

If something was truly without definitive pathology and the symptoms were psychosomatic, wouldn't you want to know? Would lead to a quicker resolution of symptoms. It's taboo to mention or consider anxiety in our culture. Our society lives with so much stress/anxiety. We work too much, spend too much, and overextend ourselves. We suck at mental health.

[QUOTE=Trackhead;6610524]

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Originally Posted by oldnew_guy

I’m admittedly a little touchy on this subject. Maybe I am summarizing in my head incorrectly but what is coming across to me is: “we don’t know, but I think most of this is psychosomatic and indicative of mental health issues not disease”.
/QUOTE]

Defensive posture is natural. I agree much we don't know, and write off as psychosomatic. But to ignore that as a possibility is also a disservice to the patient. It remains in the differential diagnosis for many presentations (long covid, chest pain, shortness of breath, dizziness, etc). Also, given Covid was the number #1 story for two years, it's easy to understand how people would be anxious over it. I certainly was.

If something was truly without definitive pathology and the symptoms were psychosomatic, wouldn't you want to know? Would lead to a quicker resolution of symptoms. It's taboo to mention or consider anxiety in our culture. Our society lives with so much stress/anxiety. We work too much, spend too much, and overextend ourselves. We suck at mental health.

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I just have experienced it being leaned on instead of figuring out or addressing the problem when there was at the end confirmed pathology, with life altering consequences if we didn’t find a doctor who knew what was going on.

The issue for me is that you seem to be saying “I don’t really know” yet seem to be putting it mentally in the “most of this is psychosomatic” category.

Yes, we should do more for mental health.

I also have experienced stress manifesting as physical symptoms, so I’m sympathetic to your angle on this as well.

Anyways, enough about that.

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Originally Posted by bodywhomper

What response do you find more appropriate?

Here’s an interesting preprint on the prevalence of long covid: https://papers.ssrn.com/sol3/papers....act_id=4099429

Here’s what Topel has to say about it: “A systematic #LongCovid review of nearly 200 studies and over 120,000 participants, reinforces the high frequency of symptoms > 6 months, not linked to severity of acute illness, and potential for marked disability”

And he included this graphic:
Attachment 415559

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Thank you for this post -
it has sparked an interesting discussion ;

I have not read the whole paper yet, and I may not ;
I have reviewed the abstract, and I have some concerns -
This study is a literature review, compiling the data from 200 other sources ; it reports patients were followed for six months, but was not itself involved in any of the patient interaction ;

one claim I am struggling with is that 14% of the patients reported experiencing PTSD post-covid -
I can understand how someone who ended-up on a ventilator could/would experience PTSD, but if this is a matter of self-diagnosis . . .
( the other thing I will look for is in reporting these symptoms, were the patients asked if they experienced the symptoms they were reporting/claiming before covid...

in the broadest terms, through life we accumulate "aches and pains" ;
a condition one was experiencing before covid does not become long covid/post covid if those symptoms continue after covid
( those surveys that are prepared by asking patients - yes or no - have they experience symptoms are particularly troubling to me. ))

regarding the idea that psychosomatic complaints are 'common', I can only offer my second-hand experience -
my old country doctor spent the last decade of his primary-care career caring for several patients he felt were seeking prescriptions ;
he always encouraged these patients to make other health changes ( quit smoking, quit drinking ), and to return to report the effects these changes had on their health.
Some patients responded to such ongoing care, some found their prescriptions elsewhere...

I have no doubt people are experiencing long covid / extended symptoms from covid -
two of my friends who are back hard at Work report symptoms including chest tightness (chest discomfort) more than six months after testing positive ;
These men are not looking for anything - except to continue their lives.

I will go back and review -whomper's citation.

Thanks... and
Good luck ! tj


please maintain you resistance with
vaccination and boosters --

The most common mistake in medicine is to make up an explanation--"psychosomatic", "evil humors", "witchcraft"--for that which we do not understand. Physicians have been doing that for thousands of years. No reason to expect that to change.

It's also possibly a factor that people want it to be over so badly that they're projecting good physical health and poor mental health on to people who claim to still be physically ill. Folks certainly were claiming that it was psychosomatic all along even when being put on a ventilator themselves..

Has anyone under 50 been able to get a second booster? Apparently in CO, we can’t?

[QUOTE=oldnew_guy;6610528]

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Originally Posted by Trackhead

I just have experienced it being leaned on instead of figuring out or addressing the problem when there was at the end confirmed pathology, with life altering consequences if we didn’t find a doctor who knew what was going on.

The issue for me is that you seem to be saying “I don’t really know” yet seem to be putting it mentally in the “most of this is psychosomatic” category.

Yes, we should do more for mental health.

I also have experienced stress manifesting as physical symptoms, so I’m sympathetic to your angle on this as well.

Anyways, enough about that.

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Syntax error: Not saying it's all psychosomatic, just that it IS in the differential. That's it. Nothing more. Glad you guys figured out whatever issue it was. No need to share.
I spent a night in the ICU with an abnormal EKG 15 years ago and an elevated troponin. Was all psychosomatic, sort of. Bumped the troponin from running up Snowbird three times, went to ER night shift, felt awful. Did EKG on myself, blah blah blah. LVH from exercise, troponin bumped from running like a madman at elevation. All normal, but set off a six month period of psychosomatic shit. Was horrible. Since then have had a much better understanding of how the mind plays tricks.

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Originally Posted by Trackhead

Since then have had a much better understanding of how the mind plays tricks.

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You see how from the outside this would be indistinguishable from you gaining a personal experience bias and then spending a few years building on that through confirmation bias, right?

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Originally Posted by jono

You see how from the outside this would be indistinguishable from you gaining a personal experience bias and then spending a few years building on that through confirmation bias, right?

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Yup. And I tell patients that in some settings. It's also VERY common across all demographics. Have several friends who have gone through similar shit. People you would never imagine going through it, some medical, some not. Wouldn't call it confirmation bias though, as it is at the bottom of the differential and still order all relevant studies.

What has been extremely helpful for me:

- Just say fuck it and get my ass outside on my bike. Sunshine, warm weather in UT, etc.
- Destroy your fucking arm on said bike.
- Stop reading anything on the internet about long covid. Helps I haven't had actual TV in like 15+ years so I don't watch shit network brainwash "news" on TV like apparently "normal" people do for 6+ hours/day.

Is there a huge psychosomatic component? Certainly. Does that explain 100% of the symptoms.....probably not, but it definitely helps people to spiral out on their relatively minor symptoms. I'm healthy and eat pretty good, hydrate etc. I've got other shit to worry about right now like my arm and how I'm gonna work enough over the next few months to not have to move to Miles City or something (only sort of kidding haha). Time seems to be the only cure right now for LC and my symptoms have improved.....slowly. So why fucking worry about it, right? I think I'm like 90 percent out of the woods and will probably be back to my old self within another month or so.

Go check out the long covid forums on reddit. Definitely some people there who have totally spun themselves out mentally by reading too damn much and feeding their anxiety. I saw that and was like, "Fuck this.....close the tabs and just live."

Not my favorite source but I remember reading this article when it came out about persistent effects after being infected by other viruses. It starts with ebola, and at least for me I remember reading it and thinking the long terms effects weren't necessarily something unique, new, and scary about COVID but rather something about viral infections that I wasn't aware of.

https://www.google.com/amp/s/www.vox...auler-symptoms

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Originally Posted by Trackhead

Yup. And I tell patients that in some settings. It's also VERY common across all demographics. Have several friends who have gone through similar shit. People you would never imagine going through it, some medical, some not. Wouldn't call it confirmation bias though, as it is at the bottom of the differential and still order all relevant studies.

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Fair point with the studies. Does the differential diagnosis process arrive at psychosomatic as an explanation if all of the things you test for are eliminated?

It seems like if that's the case the possibility of conditions for which we don't (yet?) have tests leaves everyone without a way to know their relative likelihoods.

[QUOTE=Trackhead;6610585]

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Originally Posted by oldnew_guy

Syntax error: Not saying it's all psychosomatic, just that it IS in the differential. That's it. Nothing more. Glad you guys figured out whatever issue it was. No need to share.
I spent a night in the ICU with an abnormal EKG 15 years ago and an elevated troponin. Was all psychosomatic, sort of. Bumped the troponin from running up Snowbird three times, went to ER night shift, felt awful. Did EKG on myself, blah blah blah. LVH from exercise, troponin bumped from running like a madman at elevation. All normal, but set off a six month period of psychosomatic shit. Was horrible. Since then have had a much better understanding of how the mind plays tricks.

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Trackhead, apparently I need you to define 'psychosomatic' , Because to me, if you have an abnormal EKG and an elevated troponin from exertion, that's Not 'psychosomatic'
( yes, you drove yourself to overexertion, but from my perspective, for it to be psychosomatic, you would have caused yourself to have an abnormal EKG and elevated troponin without exertion.
( you can run yourself to death ( you would not die by thinking about running. That's my ancient distinction. and I looked-up the definition of psychosomatic )...

I believe there is value in the conversation and consideration to mental health that has grown over the last two years ;
the pandemic has been uniquely stressful in my lifetime.
it is ,,, concerning to me the number of people who medicate for depression or (/and) anxiety...

I don't want to pursue this tangent much further, but I will offer one of the ideas I try to keep in-mind -

the pendulum swings...

some won't survive covid, and
for some others, it will change our lives...
others will survive ( just fine ) --

the pendulum swings... and
Time marches on...

please be boostered -- skiJ

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Originally Posted by Trackhead

Syntax error: Not saying it's all psychosomatic, just that it IS in the differential. That's it. Nothing more. Glad you guys figured out whatever issue it was. No need to share.
I spent a night in the ICU with an abnormal EKG 15 years ago and an elevated troponin. Was all psychosomatic, sort of. Bumped the troponin from running up Snowbird three times, went to ER night shift, felt awful. Did EKG on myself, blah blah blah. LVH from exercise, troponin bumped from running like a madman at elevation. All normal, but set off a six month period of psychosomatic shit. Was horrible. Since then have had a much better understanding of how the mind plays tricks.

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My experience was similar, had a full angio under general so they could get a better look at the heart from the inside when I was in my 30s and running sub3 marathons. Troponin was normal, ekg normal, but then the CT gave a false shadow on the heart that looked like a blockage. Posted a tr here about my day in the ER circa 2006, and yes heart was completely fine via the inside camera imaging.

What I did have that was giving me pain and a burning sensation down the left arm over a couple of months ended up being shoulder impingement, too much caffeine/coffee giving slight reflux, all which resolved later with PT. But those sensations were enough to give me a panic attack and I was working just across the street from the ER at rhe time. Luckily back then there was no out of pocket premium to meet and insurance took care all of the 25k bill.

But there are many viral infections set up life long host residence in immune protected tissue environments ie CMV, HPV, herpes, adnovirus, EBV, etc. Latent or chronic. Probably a good assumption that this may/will happen with a subset of viral infections with coronaviruses as well, media anxiety and psychosomatics aside.

I was Ag pos less than 18hrs from getting nasal congestion, remains my only symptom thru day4 now. Probably shouldn't have been day drinking the past few days but symptoms for me are benign and Im not concerned since no comorbidities and triple vaxxed.

I dont see much reason for a forth for most people who are not high risk until vax reformulation comes out to better address omicron strain drift, the bump in cross neutralizing Abs isn't enough to increase prevention of further infection much longer than 4 weeks.

Unfortunately, data im seeing now suggests infection with Omicron fails to induce meaningful levels neutralizing antibody to even the same infecting Omicron strains and virtually none to BA.2, the current dominant strain. Part of this is because Omicron may be less dependent of Ace2/tmprss2 for cell access and more reliant on clathrin mediated endocytosis, so even the antibodies that do block Ace2 binding become less effective. This also increases the cell types that can be infected via endocytosis but may also help limit infection to UTR and nasal passages until robust immune responses kick in.

Also clear that vaccination 3x works to reduce severity. A massive study out of Harvard/Boston area 130k people suggested Omicron is not less severe than previous waves in those with comorbity and no preexisting immunity. The lack of severity being contributed to vaccination or previous infection helping make Omicron self-limiting, along with previous waves removing many of the most vulnerable. I'll post links later when not on phone.

So probably no asymptomatic omicron immunity boosts that decrease infection risk via neutralizing antibody in circulation, hopefully they still contribute to reduced severity via cell mediated immunity bumps.

[QUOTE=skiJ;6610624]

Quote:

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Originally Posted by Trackhead

Trackhead, apparently I need you to define 'psychosomatic' , Because to me, if you have an abnormal EKG and an elevated troponin from exertion, that's Not 'psychosomatic'
( yes, you drove yourself to overexertion, but from my perspective, for it to be psychosomatic, you would have caused yourself to have an abnormal EKG and elevated troponin without exertion.
( you can run yourself to death ( you would not die by thinking about running. That's my ancient distinction. and I looked-up the definition of psychosomatic )...

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LVH - Left ventricular hypertrophy on EKG, abnormal, except not uncommon in athletes. Not specific, echocardiogram was normal.

Elevated troponin (slight bump), not uncommon with high sensitivity tests in the setting of extreme exertion (running 9,000 vertical feet in a morning, before work, at elevation, on a hot day).

Instead I got CT chest/head, Lovenox, metoprolol, echo, stress echo. All normal. Except it fucked my mind and I wouldn't let it go for six months (symptom recurrence-psychosomatic). Dad had fatal heart attack at 53, so was sorta paranoid.

My story is not unique. Now apply this to long covid. No different. It's possible, in some/many, long covid is anxiety leading to depression/anxiety/chronic fatigue and obsessive concentration on symptoms. We've seen this in this very forum recently. People fit into patterns, you realize that when you work healthcare for 25 years. Again, as disclaimers seem necessary, if not mandatory with long covid discussions, I still feel some of it is true pathology.

Quote:

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Originally Posted by Mofro261

Unfortunately, data im seeing now suggests infection with Omicron fails to induce meaningful levels neutralizing antibody to even the same infecting Omicron strains and virtually none to BA.2, the current dominant strain. Part of this is because Omicron may be less dependent of Ace2/tmprss2 for cell access and more reliant on clathrin mediated endocytosis, so even the antibodies that do block Ace2 binding become less effective. This also increases the cell types that can be infected via endocytosis but may also help limit infection to UTR and nasal passages until robust immune responses kick in.

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Is that the pathway HCQ blocked in vitro? IIRC it was some sort of endocytosis pathway, and the lab cell lines used didn't express Ace2, so HCQ worked in that case. Gonna warp some minds if HCQ starts working.

see yours, Thead -
I accept your explanation. with the disclaimer, running to gain 9,000feet in elevation is Not-normal.
( I would offer your six month recovery ,,, can be (excused) )


carry on. skiJ