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

[jono]

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

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?

[Trackhead]

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?

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.

[Whiteroom_Guardian]

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."

[abraham]

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

[jono]

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.

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.

[skiJ]

[QUOTE=Trackhead;6610585]

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.

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

[Mofro261]

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.

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.

[Trackhead]

[QUOTE=skiJ;6610624]

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 )...

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.

[LongShortLong]

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.

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.

[skiJ]

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

[Mofro261]

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.

Yeah, maybe more effective than it was on earlier strains or cheap alternative to paxlovid? I don't think it's quite an either/or on usage of the pathways but maybe less reliance on, so alternatively hcq might just force the virus to use ace2/tmprss more instead of the endocytic pathway.

[jono]

Yeah, maybe more effective than it was on earlier strains or cheap alternative to paxlovid? I don't think it's quite an either/or on usage of the pathways but maybe less reliance on, so alternatively hcq might just force the virus to use ace2/tmprss more instead of the endocytic pathway.

Might that make a vaccine work better?

[SumJongGuy]

Wouldn't a phenomenon of a large number of people seeming to exhibit symptoms for an ailment they heard of and believe they were predisposition to have be a form of mass hysteria more than psychosomatic? Might we expand the definition of mass hysteria to include longer term symptoms if most of these people really aren't sick at all??

[leroy jenkins]

So how do you tell the difference between long covid and vaccine injuries?

[Mofro261]

Might that make a vaccine work better?

The 3 dose vaccine works great at reducing hospitalization and death metrics, drugs are now effective at further curbing those numbers. Because those drugs exist, hcq would be needed to looked at in addition to those therapies to see further improvement. Mostly its the prevention of infection metrics that are diminished vs current strains with vaccines.

But in order for HCQ make the vax more effective for prevention of infection, one would have to munch on HCQ prophylactically all the time to see the benefit. If I was so concerned as to prevent any infection from even occuring (say immunocomp) then seems healthier at that point to just keep an n95 on instead?

[jono]

The 3 dose vaccine works great at reducing hospitalization and death metrics, drugs are now effective at further curbing those numbers. Because those drugs exist, hcq would be needed to looked at in addition to those therapies to see further improvement. Mostly its the prevention of infection metrics that are diminished vs current strains with vaccines.

But in order for HCQ make the vax more effective for prevention of infection, one would have to munch on HCQ prophylactically all the time to see the benefit. If I was so concerned as to prevent any infection from even occuring (say immunocomp) then seems healthier at that point to just keep an n95 on instead?

Strongly agree. But I do wanna root for something ironic before it's all over, so LSL's scenario sounds awesome.

[old goat]

A good example of wrongly attributing symptoms to the mind would be PTSD, which in some cases is likely due to brain injury. That is not to say PTSD doesn't exist, only that in people exposed to head injury--ie veterans--head injury has to be considered. Also PTSD as a result of serious emotional trauma highlights the potential seriousness of psychosomatic conditions--just because someone's symptoms are determined to be likely due to emotional factors doesn't mean the condition shouldn't be taken seriously. Or look at the fact that chronic emotional stress elevated glucocorticoid steroid levels, which has significant physical consequences. Or that psychological interventions are effective in reducing chronic pain due to proven physical causes. It's complicated.

Rather than deciding that long covid is mass hysteria maybe we should keep studying the condition, keep looking for biochemical causes, keep an open mind, and hold off on making any decisions about it for now. One of my maxims is--make no decision before its time.

[Mofro261]

So how do you tell the difference between long covid and vaccine injuries?

You get the information on whether they had a confirmed infection, include vaccination status and run the numbers in the 4 possible categories.

Infected not vaxxed
Infected then vaxxed
Vaxxed never infected
Vaxxed then infected.

And look for which groups skew to expressing symptoms of long covid and for how long after either infection or vaccination they persist. Then when you find them in infected but absent in the vaxxed but never infected, dimminished in the vaxxed then infected, and see them resolve in a portion of those infected then vaxxed after the reveiving vaccination, you can establish pretty accurate baselines for vaccine related or infection related long covid symptoms.

[leroy jenkins]

You get the information on whether they had a confirmed infection, include vaccination status and run the numbers in the 4 possible categories.

Infected not vaxxed
Infected then vaxxed
Vaxxed never infected
Vaxxed then infected.

And look for which groups skew to expressing symptoms of long covid and for how long after either infection or vaccination they persist. Then when you find them in infected but absent in the vaxxed but never infected, dimminished in the vaxxed then infected, and see them resolve in a portion of those infected then vaxxed after the reveiving vaccination, you can establish pretty accurate baselines for vaccine related or infection related long covid symptoms.

I mean thats going to give you some meta level idea of the prevalence of some things, but in terms of an individual, case by case basis, is there any way to tell?

Theres also just a lot of ways that data is going to be muddied. Lack of symptoms supposedly means you're more likely to get long covid, although I'm not sure how they even gather data on asymptomatic infections that aren't reported.

[leroy jenkins]

A good example of wrongly attributing symptoms to the mind would be PTSD, which in some cases is likely due to brain injury. That is not to say PTSD doesn't exist, only that in people exposed to head injury--ie veterans--head injury has to be considered. Also PTSD as a result of serious emotional trauma highlights the potential seriousness of psychosomatic conditions--just because someone's symptoms are determined to be likely due to emotional factors doesn't mean the condition shouldn't be taken seriously. Or look at the fact that chronic emotional stress elevated glucocorticoid steroid levels, which has significant physical consequences. Or that psychological interventions are effective in reducing chronic pain due to proven physical causes. It's complicated.

Rather than deciding that long covid is mass hysteria maybe we should keep studying the condition, keep looking for biochemical causes, keep an open mind, and hold off on making any decisions about it for now. One of my maxims is--make no decision before its time.

PTSD isn't psychosomatic. Not even a tiny bit. That emotional trauma causes real physical changes that can be clearly seen in a catscan. Before the long term effects are visible in the brain, they are caused by huge amounts of chemicals released into the body. Like being in fight or flight mode constantly for a long period of time, creates chemical changes which have effects. Its not psychosomatic. I mean you're basically saying the same thing I am, but that doesn't make PTSD psychosomatic, and it doesn't make PTSD that isn't from brain trauma psychosomatic. People don't imagine themselves as traumatized then become that way. Thats Munchausen not PTSD>

This is one of those things if you go with the dictionary definition of a medical term it doesn't work so well. I just had to regoogle the definition of the word to make sure I'm not talking out of my ass. Websters definition is bodily problems caused by the mind which is way too simple. The clinical and medical definiitions for psychosomatic are like, social factors and your thoughts creating bodily problems, not long term truama changing your brain chemistry because you were afraid.

[summit]

I mean thats going to give you some meta level idea of the prevalence of some things, but in terms of an individual, case by case basis, is there any way to tell?

Theres also just a lot of ways that data is going to be muddied. Lack of symptoms supposedly means you're more likely to get long covid, although I'm not sure how they even gather data on asymptomatic infections that aren't reported.

There are studies demonstrating reduced long covid symptoms in those who were vaccinated then infected vs those who were unvaccinated then infected. The first study looks at exactly what Mofro mentions:

https://www.medrxiv.org/content/10.1....05.22268800v2
Vaccination with at least two doses of COVID-19 vaccine was associated with a substantial decrease in reporting the most common post-acute COVID-19 symptoms, bringing it back to baseline. Our results suggest that, in addition to reducing the risk of acute illness, COVID-19 vaccination may have a protective effect against long COVID.

https://www.thelancet.com/journals/l...460-6/fulltext
Vaccination (compared with no vaccination) was associated with reduced odds of ... long-duration (≥28 days) symptoms following the second dose. Almost all symptoms were reported less frequently in infected vaccinated individuals than in infected unvaccinated individuals

NIH reviewed 6 studies and came to the same conclusions that vaccination reduces Long COVID risk
https://ukhsa.koha-ptfs.co.uk/cgi-bi...5ad4f72ae0dfff

[skiJ]

A good example of wrongly attributing symptoms to the mind would be PTSD, which in some cases is likely due to brain injury. That is not to say PTSD doesn't exist, only that in people exposed to head injury--ie veterans--head injury has to be considered. Also PTSD as a result of serious emotional trauma highlights the potential seriousness of psychosomatic conditions--just because someone's symptoms are determined to be likely due to emotional factors doesn't mean the condition shouldn't be taken seriously. Or look at the fact that chronic emotional stress elevated glucocorticoid steroid levels, which has significant physical consequences. Or that psychological interventions are effective in reducing chronic pain due to proven physical causes. It's complicated.

Rather than deciding that long covid is mass hysteria maybe we should keep studying the condition, keep looking for biochemical causes, keep an open mind, and hold off on making any decisions about it for now. One of my maxims is--make no decision before its time.

I first hear of PTSD in the 1990s applied to veterans who experience the trauma of war -
so I have always been cautious about claims of PTSD that don't involve combat --

to me, 'emotional trauma' doesn't meet the criteria.
in drafting this message, I recognize there are circumstances that are highly traumatic - that may be as traumatic to the victim of long-term abuse, as combat is to a soldier.

But I will be cautious about accepting self-reporting of PTSD as a long-term effect of COVID ( unless the patient has been on a ventilator or more ).


the other recent comment ( Thank you, goat ) that I appreciate is we may not need to be in a rush to Explain long covid / post covid with psychosomatic or (mass) hysteria - just keep an open mind and see where these cases go
( similarly, the idea of long-term infectious processes is something I have some experience with ).
I think I am becoming aware of Thead's approach --

The Good news is WrG feels his symptoms are improving !
That will be Good, WrG !

This thread is on an interesting tanget -
I appreciate the discussion.

Thank you. skiJ

[skiJ]

There are studies demonstrating reduced long covid symptoms in those who were vaccinated then infected vs those who were unvaccinated then infected. The first study looks at exactly what Mofro mentions:

https://www.medrxiv.org/content/10.1....05.22268800v2
Vaccination with at least two doses of COVID-19 vaccine was associated with a substantial decrease in reporting the most common post-acute COVID-19 symptoms, bringing it back to baseline. Our results suggest that, in addition to reducing the risk of acute illness, COVID-19 vaccination may have a protective effect against long COVID.

https://www.thelancet.com/journals/l...460-6/fulltext
Vaccination (compared with no vaccination) was associated with reduced odds of ... long-duration (≥28 days) symptoms following the second dose. Almost all symptoms were reported less frequently in infected vaccinated individuals than in infected unvaccinated individuals

NIH reviewed 6 studies and came to the same conclusions that vaccination reduces Long COVID risk
https://ukhsa.koha-ptfs.co.uk/cgi-bi...5ad4f72ae0dfff

Excellent post. Thank you.

[leroy jenkins]

I first hear of PTSD in the 1990s applied to veterans who experience the trauma of war -
so I have always been cautious about claims of PTSD that don't involve combat --

to me, 'emotional trauma' doesn't meet the criteria.
in drafting this message, I recognize there are circumstances that are highly traumatic - that may be as traumatic to the victim of long-term abuse, as combat is to a soldier.

But I will be cautious about accepting self-reporting of PTSD as a long-term effect of COVID ( unless the patient has been on a ventilator or more ).


the other recent comment ( Thank you, goat ) that I appreciate is we may not need to be in a rush to Explain long covid / post covid with psychosomatic or (mass) hysteria - just keep an open mind and see where these cases go
( similarly, the idea of long-term infectious processes is something I have some experience with ).
I think I am becoming aware of Thead's approach --

The Good news is WrG feels his symptoms are improving !
That will be Good, WrG !

This thread is on an interesting tanget -
I appreciate the discussion.

Thank you. skiJ

The DSM disagrees with you.

No one said getting PTSD from getting COVID. It was used as an example of psychosomatic. You absolutly can get it from emotional truama, especially at a young age, and PTSD is never psychosomatic. They used the word psychosomatic wrong.

You can see PTSD in a catscan. You never heard of it before the 90s? How does emotional truma not meet the diagnostic criteria? Its part of the diagnostic criteria.

I could give you PTSD without combat for sure. I'm honestly flabbergasted you think it only applies to combat vets and doubt it even exists for anyone else. Again, every version of the DSM disagrees with you. You think you'd turn out fine if I slapped you around every day from birth to 4 years old? Agin, you can see it in a catscan, its not psychosomatic, and its existence in non combat vets is absolutely proven.

Mostly I just look for discussion and not argument but honestly you spreading shit like this does no favors to furthering mental health. Is your fundamentally invalidating opinion grounded in anything at all? I mean you never even heard of it before the fucking 90s so it seems like nothing but ignorance. By the 90s kindergarten teachers were already getting trained on how to spot symptoms in kids.

I don't really understand the desire to disbelieve in something so proven, especially when doing so is fundamentally invalidating to people who have been thrugh shit you can't imagine. I thought we 'trust the science' around here?

[ötzi]

I could give you PTSD without combat for sure.

I'm sure you've given it to many of those who've read your posts.