Hello, and welcome to the very first Long Covid, MD Discussion thread. I’m Dr Zeest Khan, a board-certified anesthesiologist specialized in heart and lung surgery. I’ve been disabled by Long Covid since 2021 and I want to share some of my energy helping you navigate the healthcare system. Let’s answer your questions about Long Covid and anesthesia!
I won’t be online at that time but I just wanted to say I think it’s awesome you’re doing this - thank you so much for providing support to those who need it.
Love that little birdie @illustr8d. It's very cute.
Let's talk about allergies and anesthesia.
New allergies, increased histamine levels, and Mast Cell Activation Syndrome (MCAS) are common features of Long COVID. Some drugs commonly used for anesthesia are known to release histamine, from pain meds to muscle relaxants to antibiotics.
Histamine release can present as hives on our skin, but it can also cause low blood pressure and increased heart rate. At its most severe, histamine release can cause the lungs to swell, stiffen, and block air exchange. In the operating room, medications are directly injected into your blood vessels or into your limbs/abdomen/skin, the risk of life-threatening allergic response is one that we do not take lightly. In fact, allergy-induced circulatory collapse is an event that all operating room staff prepare for diligently. We even do simulations to practice ways to respond. I'm involved as an anesthesiologist, but so is the surgeon, nurses, surgical technicians and attendants/orderlies. It's all-hands on deck.
That's the most catastrophic end of the spectrum. More commonly, histamine-mediated reactions are actively prevented, and if they do occur, are treated early. Anesthesia does not itself CAUSE new allergies, but if the allergy system has been primed, meaning it's seen the allergen before (even if it didn't respond the first time), a subsequent dose can trigger an allergic response. When the subsequent dose is a direct iV injection, then we can see why histamine can be released from anesthesia meds.
There is no way to avoid ALL histamine-releasing medication. There are simply too many and we need them to provide anesthesia. But as anesthesiologists we can avoid meds known to release histamine more, as long as we have a safe available alternative. So avoiding triggering meds is step one, but it's not going to be comprehensive.
Another way to prevent histamine release intraop is to pre-treat with anti-histamine like a long-acting fexofenadine orally before going to the hospital, and perhaps IV benadryl before the anesthesiologist takes you to the OR. IV benadryl will make you feel loopy and sleepy and it might increase your heart rate, too.
As anesthesiologists, we can offset the effects of histamine by administering IV fluid generously. There are limits to the amount we can adminster, though, depending on your health conditions, the type of surgery and the type of anesthesia.
How can we stay safe during routine colonoscopy, which normally involves sedation?
Can patient wear N95 throughout? And are some types of sedation better if masking (ie, don’t require putting anything in or on patient’s nose or mouth, which wld break mask seal?
How can patient get providers in room to also wear N95s during the procedure?
Great question that many people share, thanks, Ann.
I recently had a colonoscopy and upper endoscopy and received sedation. I actually took off my N95 mask before entering the operating room for my safety. I'll explain.
The OR is a dangerous place. Rather, it’s a place we do dangerous things. We rely on our specialized safety mechanisms - machines, people, and processes - to safely perform invasive procedures, including anesthesia. In the operating room, two parts of your body literally have the spotlight: Your site of surgery, and your airway (mouth, nose, neck, throat). We want the problem you’re having in your body - the site of surgery - repaired. Equally….and actually more than that…we want you to retain adequate oxygenation, so that your brain/heart/lungs/kidneys are not damaged. In other words, your survival is your anesthesiologist’s main priority.
Someone asked about breathing in surgery. Why would I be at risk for hypoxia under anesthesia? It’s because your lung dynamics change under anesthesia, as does your brain’s normal breathing signals. Under anesthesia, even sedation, your breathing is at risk, and your anesthesiologist requires access to your airway to ensure you are breathing adequately. Anesthesia is about vigilance, and even though we have monitors, those do not replace your anesthesiologist’s eyes. Monitors, especially oxygen saturation monitor, has a delay. Sometimes, by the time the machine registers a drop in oxygenation, you are well down a dangerous path. As an anesthesiologist, I look at my patient’s airway constantly, particularly in sedation cases where a breathing tube is not involved. With a breathing tube, since it’s connected to the ventilator, I have a pretty precise understanding of breathing rate and quality. With sedation, those monitors are not nearly as specific. In colonoscopy cases, I am looking at my patient's face continuously and intervening before a small obstruction becomes worse.
If you’ve ever taken a CPR class, you might have learned the ABCs. Airway, Breathing, Circulation. Those are an anesthesiologist’s priorities in a nutshell!
You do need a mask in the OR but it’s usually an oxygen mask. Limiting your anesthesiologist’s ability to evaluate and maintain your airway puts you at real risk. They may allow you to wear it through the surgery, but this is an accommodation based on a risk assessment (your health, the type of surgery, the type of anesthesia required) and it is not a binding promise that your mask will stay on through the case. The spotlight is on your airway for a very important reason.
I know this might make us feel really vulnerable in surgery. But I remember that risk calculations are very different in the OR and outside. The risk of airway obstruction and hypoxia are very real dangers in the operating room and must be prioritized.
So wearing any type of mask for Covid protection isn't possible during a procedure. This is a worry for my mother who needs to have routine colonoscopies for her colon cancer and we don't want her to get covid, not all doctors are wearing quality masks in the OR like N95s
That's a real concern, Jan, I agree with you. The anesthesiologist may be able to accommodate a mask, but the patient needs at least nasal oxygen to receive the level of sedation required for a colonsocopy. At best, Mom may be able to wear an N95 after she has a nasal cannula placed. But the seal will not be tight.
This all comes down to the anesthesiologist's safety assessment, which includes the patient's health status and physical airway anatomy.
Air flow and air quality are a big deal in the operating room. Air filtration is typically prioritized for the hospital OR wings.
Random and not related to surgeries - which viruses have been reactivated for you because of Long Covid? Do you have MCAS, and if so, how do you manage it?
Any suggestions on how to best prepare for general anaesthesia and major surgery? Is this even something that one can do with moderate to severe long covid?
This is the million dollar question! IMO the best way to prepare is some combination of the following:
-know your why: why am I having this invasive procedure? How will this benefit me? The answer is typically "I have tried other options. This problem is hindering my life, or has the potential to. Surgery is a valid next step."
-Know your body: What typically makes me feel in my best health? Hydration? Nutrition? Friendships? Sleep? Identify those things and then commit hard to them in the time leading up to your surgery. I know some prep for surgery can be hard on the body, too. Try to do the others
-Talk with your doctor(s) about your concerns, ask them for options to make this experience better. I know, I know...doctors can be a$$hats about this sometimes. Neither party - doc or patient - really has ultimate control over the situation, but we can collaborate on ways we can optimize the CHANCES for a good outcome
I had spinal stenosis surgery last November for symptoms that were probably related to long Covid rather than narrowing of my spinal canal. My long Covid got so much worse post op. I was bedridden for two months. I have seen one paper this spring in the surgical literature acknowledging that LC can get worse post op. Do you think there is increasing awareness that surgical stress can exacerbate LC ?
Sorry that happened to you, Gerry, and thank you for this question. Yes, surgical stress affects our bodies. It makes the healthiest bodies feel miserable post-op. I think we forget the impact that surgery has. It's literally a traumatic event. Anesthesia wears off, and we need to recover from having anesthetics. But surgery causes/involves a wound and requires us to HEAL. Healing is an energy-consuming process that activates the immune system. I don't know how we get around that part. While this topic is not yet studied well, it makes sense that our Long Covid symptoms can worsen after this type of event. The surgery and healing are more involved when the disease process has been going on for some time. That's why it's so important to take care of medical issues that may be separate from LC as quickly as we can. That's why screenings and preventive care are so necessary for people with chronic illness.
Small problems require small treatment. Big problems, big treatment.
Were you able to recover to baseline? I imagine it was a tremendous effort. Sending you good vibes.
Oh, hi, Gerry! I got your text message from the podcast and was so happy to hear from you. There are many of us in healthcare with Long Covid. I learned that I can't actually reply to the texts hosted by the podcast host I use, so I didn't know how to tell you I got your message. Thank you for your support and I hope you make continued progress. Keep me posted and maybe we'll find ways to collaborate more.
Thank you so much for doing this! Excited to follow along and look back at your other resources.
I had a similar experience to Gerald where I had Covid in April ‘23 and LC symptoms persisted right away but I feel like I declined even further (brain fog, fatigue, PEM) around the time I had anesthesia/1 dose of pain meds (for the first time) for an unrelated & very simple/quick procedure in August. Didn’t think anything of it at the time, but would love to hear your insight on if this is an experience you have seen and if so, is there anything to do about it or consider if any future surgery needs arise?
Soo tricky and sucks thst you joined our constsntly in bed club. 😭 def check out the mespine hashtag firstly unless that’s what inspired you to attempt healing this way to begin with❓That’s s community mostly of people who believe spinal impingements can exacerbate or even cause mecfs but ofc there’s a ton of complexity snd variability in reaction to these fusion snd untethering surgeries.
And secondly also from the me literature and anecdata yesss lots of people share your experience of worsening after or even having their mecfs triggered initially by surgeries. especially I reckon brain spine or abdominal surgeries. This includes some who were trying to access treatment for their underlying mecfs.
Ron Davis in his May twenty three investinme talk snd his more recent updates postulate innate immune system involvement since surgeries like infections vaccines injuries snd childbirth all involve the innate immune system. 🧐
I want to emphasize that I personally have s couple friends who’ve had success in the form of partial remission from these surgeries. This should be kuite s separate off chute topic I think from the gift of this overall convo with Dr khan ‼️
Just clarifying here that I’m not casting wholesale doubt on the mespine community just healthy skepticism for this emergent theory snd very intense invasive set of treatments in our very desperate community.
Thank you all for joining me on the first Long Covid, MD Discussion Post. I hope you learned something helpful about navigating surgery and anesthesia with Long COVID.
Subscribe to the Substack to participate in future Discussions. What should we talk about next??
Is there anything an anesthesiologist can do in preparing or monitoring a patient during surgery that would minimize further deterioration of someone with severe long covid? Certain type of general anesthetic that might be better than another, other considerations? Should I try to talk to anesthesiologist in advance of surgery about such things?
My most severe symptoms are fatigue and PEM, then moderate joint pain and cognitive dysfunction. That's the short list. I don't have MCAS, only mild histamine reactions at times, so I'm not overly concerned with that issue. I've never had major surgery before but do have one upcoming.
Do you think, given the relevance of cerebral blood flow and intracranial pressure in ME/CFS (which is a subtype of Long Covid), that experiences with anaesthesia in neurosurgery could be informative for this patient cohort?
Can you speak on the historic findings re surgery and anesthesia in mecfs ❓I’m most interested in whether patients tend to lose baseline post op which I feel might be more common in severe patients but that is sheer speculation on my part.
Then are there sny distinctions emerging in this realm of surgical care between historic mecfs findings and long COVID patients ❔ do the more overt and distinct issues with clotting snd microcirculation pose more risk here for COVID long haulers than for OG PwME❔
sre there possible subtypes emerging smong COVID long haulers whether or not they also have mecfs who are at more risk for complications❔
Any risk or harm reduction practices being promoted by sny surgeons or anesthesiologists that you know of or is the data just not clear enough yet. For thst matter sre there practicing surgeons or anesthesiologists involved in researching this❔
my tentative understanding is thst all PwME basically had micro circulatory impairment in brain snd periphery before COVID but now that most of us like myself hsve been repeatedly force infected with SARStwo with subsequent long COVID layered on top I guess we’ll never have robust comparator data ❕🤷🏼♀️ I’ve never had surgery beyond a dilation snd curretage snd s wisdom tooth extraction which other than going vasovsgsl in the former were uneventful so I have nothing personal thank goodness yet to add to this anecdata.
Every time I’ve had anaesthesia as I’m counted down I hyperventilate: it’s entirely beyond my control. Is there anything I can do pre-induction to mitigate this as I’m sure it’s pretty terrifying for the poor surgical personnel.
Thank you for sharing the paper. Tomorrow’s hour is dedicated to anesthesia. I will keep your feedback in mind for the future. I’m sorry you’re going through this ordeal
And if I haven’t provided you enough fodder yet I would love to hear particular attention to surgeries involving
The brain 🧠
if we have any data on those. I have s close friend who developed me sfter her brsin surgery for s rsre glioblstoms which thankfully appears to be in long term remission.
Spine
both in snd outside the context of the me spine community.
Heart
noting that people w mecfs hsve been shown to die decades earlier from heart failure ss well ss cancers thsn our healthy peers.
And gyno surgeries.
Laparotomies fibroid removals leeps hysterectomies etc.
This one is most immediately relevant for me ss I sm likely going to need some kind of gyn surgery soon. My hunch is thst PwME def hsve different outcomes in gynecology tjst need wsy more study snd perhaps differentiated sets of guidelines to optimize csre. this especially goes for endometriosis which is established to be far more common snd perhaps worse for us influenced by the micro circulatory impairments snd other factors. Snd for hpv rlested cervical lesions snd cancers more generally where I have a hunch our immune derangements affect outcomes. We die decades earlier from cancers for s reason.
My most basic kuestion would be evidence we have re whether long haulers snd PwME May hsve distinct responses or potentially more risk of adverse reactions esp longer term chronic ones to regular anesthetic pain management or antibiotic drugs.
Relatedly do you have general advice on writing advance directives for patient snd hcps when prepping for surgeries or planned inpatient stays or emergency planning ❔ particularly if or when there are particular snesthetics or pain meds or classes of drugs an individual patient or subgroup of patients might want to be more particular or more cautious about ❔
thoughts on using advance directives and or ada accommodations to try to avoid nosocomial COVID infections in hospital that permanently threaten our baseline even outside of the context of surgery ❔
Any thoughts on fluoroquinolone toxicity as it relates to antibiotic use adjacent to surgeries for COVID long haulers or others with infection associated illnesses❔personally I’m considering putting s note on my hospital advance directive paperwork to avoid their use and use alternatives whenever possible just because there are so many patients who clesrly link worsenings with their use.
This snd pretty much all other topics here for me bring up the historical specter of how seldom our experiences have been documented.
Hello, and welcome to the very first Long Covid, MD Discussion thread. I’m Dr Zeest Khan, a board-certified anesthesiologist specialized in heart and lung surgery. I’ve been disabled by Long Covid since 2021 and I want to share some of my energy helping you navigate the healthcare system. Let’s answer your questions about Long Covid and anesthesia!
I won’t be online at that time but I just wanted to say I think it’s awesome you’re doing this - thank you so much for providing support to those who need it.
I cross-posted about the Discussion Post tomorrow. Over in the twitter sphere, folks have asked about the following. What would you add?
-dental procedures
-local anesthetics
-histamine/mcas
-how to prepare for surgery
-how to talk to your anesthesiologist
-Lung dynamics
-Masking in the OR
does long covid exacerbate allergic reactions to various anesthesia
Love that little birdie @illustr8d. It's very cute.
Let's talk about allergies and anesthesia.
New allergies, increased histamine levels, and Mast Cell Activation Syndrome (MCAS) are common features of Long COVID. Some drugs commonly used for anesthesia are known to release histamine, from pain meds to muscle relaxants to antibiotics.
Histamine release can present as hives on our skin, but it can also cause low blood pressure and increased heart rate. At its most severe, histamine release can cause the lungs to swell, stiffen, and block air exchange. In the operating room, medications are directly injected into your blood vessels or into your limbs/abdomen/skin, the risk of life-threatening allergic response is one that we do not take lightly. In fact, allergy-induced circulatory collapse is an event that all operating room staff prepare for diligently. We even do simulations to practice ways to respond. I'm involved as an anesthesiologist, but so is the surgeon, nurses, surgical technicians and attendants/orderlies. It's all-hands on deck.
That's the most catastrophic end of the spectrum. More commonly, histamine-mediated reactions are actively prevented, and if they do occur, are treated early. Anesthesia does not itself CAUSE new allergies, but if the allergy system has been primed, meaning it's seen the allergen before (even if it didn't respond the first time), a subsequent dose can trigger an allergic response. When the subsequent dose is a direct iV injection, then we can see why histamine can be released from anesthesia meds.
There is no way to avoid ALL histamine-releasing medication. There are simply too many and we need them to provide anesthesia. But as anesthesiologists we can avoid meds known to release histamine more, as long as we have a safe available alternative. So avoiding triggering meds is step one, but it's not going to be comprehensive.
Another way to prevent histamine release intraop is to pre-treat with anti-histamine like a long-acting fexofenadine orally before going to the hospital, and perhaps IV benadryl before the anesthesiologist takes you to the OR. IV benadryl will make you feel loopy and sleepy and it might increase your heart rate, too.
As anesthesiologists, we can offset the effects of histamine by administering IV fluid generously. There are limits to the amount we can adminster, though, depending on your health conditions, the type of surgery and the type of anesthesia.
How can we stay safe during routine colonoscopy, which normally involves sedation?
Can patient wear N95 throughout? And are some types of sedation better if masking (ie, don’t require putting anything in or on patient’s nose or mouth, which wld break mask seal?
How can patient get providers in room to also wear N95s during the procedure?
Great question that many people share, thanks, Ann.
I recently had a colonoscopy and upper endoscopy and received sedation. I actually took off my N95 mask before entering the operating room for my safety. I'll explain.
The OR is a dangerous place. Rather, it’s a place we do dangerous things. We rely on our specialized safety mechanisms - machines, people, and processes - to safely perform invasive procedures, including anesthesia. In the operating room, two parts of your body literally have the spotlight: Your site of surgery, and your airway (mouth, nose, neck, throat). We want the problem you’re having in your body - the site of surgery - repaired. Equally….and actually more than that…we want you to retain adequate oxygenation, so that your brain/heart/lungs/kidneys are not damaged. In other words, your survival is your anesthesiologist’s main priority.
Someone asked about breathing in surgery. Why would I be at risk for hypoxia under anesthesia? It’s because your lung dynamics change under anesthesia, as does your brain’s normal breathing signals. Under anesthesia, even sedation, your breathing is at risk, and your anesthesiologist requires access to your airway to ensure you are breathing adequately. Anesthesia is about vigilance, and even though we have monitors, those do not replace your anesthesiologist’s eyes. Monitors, especially oxygen saturation monitor, has a delay. Sometimes, by the time the machine registers a drop in oxygenation, you are well down a dangerous path. As an anesthesiologist, I look at my patient’s airway constantly, particularly in sedation cases where a breathing tube is not involved. With a breathing tube, since it’s connected to the ventilator, I have a pretty precise understanding of breathing rate and quality. With sedation, those monitors are not nearly as specific. In colonoscopy cases, I am looking at my patient's face continuously and intervening before a small obstruction becomes worse.
If you’ve ever taken a CPR class, you might have learned the ABCs. Airway, Breathing, Circulation. Those are an anesthesiologist’s priorities in a nutshell!
You do need a mask in the OR but it’s usually an oxygen mask. Limiting your anesthesiologist’s ability to evaluate and maintain your airway puts you at real risk. They may allow you to wear it through the surgery, but this is an accommodation based on a risk assessment (your health, the type of surgery, the type of anesthesia required) and it is not a binding promise that your mask will stay on through the case. The spotlight is on your airway for a very important reason.
I know this might make us feel really vulnerable in surgery. But I remember that risk calculations are very different in the OR and outside. The risk of airway obstruction and hypoxia are very real dangers in the operating room and must be prioritized.
Thank you for this very helpful & important perspective! Much appreciated.
So wearing any type of mask for Covid protection isn't possible during a procedure. This is a worry for my mother who needs to have routine colonoscopies for her colon cancer and we don't want her to get covid, not all doctors are wearing quality masks in the OR like N95s
That's a real concern, Jan, I agree with you. The anesthesiologist may be able to accommodate a mask, but the patient needs at least nasal oxygen to receive the level of sedation required for a colonsocopy. At best, Mom may be able to wear an N95 after she has a nasal cannula placed. But the seal will not be tight.
This all comes down to the anesthesiologist's safety assessment, which includes the patient's health status and physical airway anatomy.
Air flow and air quality are a big deal in the operating room. Air filtration is typically prioritized for the hospital OR wings.
Random and not related to surgeries - which viruses have been reactivated for you because of Long Covid? Do you have MCAS, and if so, how do you manage it?
If we don’t cover this at tomorrow’s Q&A, I’ll find another opportunity to.
That would be awesome! Flu A has kicked my butt!
Any suggestions on how to best prepare for general anaesthesia and major surgery? Is this even something that one can do with moderate to severe long covid?
This is the million dollar question! IMO the best way to prepare is some combination of the following:
-know your why: why am I having this invasive procedure? How will this benefit me? The answer is typically "I have tried other options. This problem is hindering my life, or has the potential to. Surgery is a valid next step."
-Know your body: What typically makes me feel in my best health? Hydration? Nutrition? Friendships? Sleep? Identify those things and then commit hard to them in the time leading up to your surgery. I know some prep for surgery can be hard on the body, too. Try to do the others
-Talk with your doctor(s) about your concerns, ask them for options to make this experience better. I know, I know...doctors can be a$$hats about this sometimes. Neither party - doc or patient - really has ultimate control over the situation, but we can collaborate on ways we can optimize the CHANCES for a good outcome
-When in doubt, hydrate and rest!
I had spinal stenosis surgery last November for symptoms that were probably related to long Covid rather than narrowing of my spinal canal. My long Covid got so much worse post op. I was bedridden for two months. I have seen one paper this spring in the surgical literature acknowledging that LC can get worse post op. Do you think there is increasing awareness that surgical stress can exacerbate LC ?
Gerry
Sorry that happened to you, Gerry, and thank you for this question. Yes, surgical stress affects our bodies. It makes the healthiest bodies feel miserable post-op. I think we forget the impact that surgery has. It's literally a traumatic event. Anesthesia wears off, and we need to recover from having anesthetics. But surgery causes/involves a wound and requires us to HEAL. Healing is an energy-consuming process that activates the immune system. I don't know how we get around that part. While this topic is not yet studied well, it makes sense that our Long Covid symptoms can worsen after this type of event. The surgery and healing are more involved when the disease process has been going on for some time. That's why it's so important to take care of medical issues that may be separate from LC as quickly as we can. That's why screenings and preventive care are so necessary for people with chronic illness.
Small problems require small treatment. Big problems, big treatment.
Were you able to recover to baseline? I imagine it was a tremendous effort. Sending you good vibes.
Unfortunately, far from baseline. Multiple exposures to Covid and worsening each time. Love your podcasts they are very inspirational.
Was an endurance athlete and Cardiologist. Now trying to support others with Long Covid.
LDN and good diet. Limited exercise
Thanks
Gerry
Oh, hi, Gerry! I got your text message from the podcast and was so happy to hear from you. There are many of us in healthcare with Long Covid. I learned that I can't actually reply to the texts hosted by the podcast host I use, so I didn't know how to tell you I got your message. Thank you for your support and I hope you make continued progress. Keep me posted and maybe we'll find ways to collaborate more.
Dr Khan,
Sorry I am on another call right now but my email is ghwbourne55@gmail.com
I would love to talk about collaboration. I am setting up a long Covid website as we speak.
Gerry
Thank you so much for doing this! Excited to follow along and look back at your other resources.
I had a similar experience to Gerald where I had Covid in April ‘23 and LC symptoms persisted right away but I feel like I declined even further (brain fog, fatigue, PEM) around the time I had anesthesia/1 dose of pain meds (for the first time) for an unrelated & very simple/quick procedure in August. Didn’t think anything of it at the time, but would love to hear your insight on if this is an experience you have seen and if so, is there anything to do about it or consider if any future surgery needs arise?
Soo tricky and sucks thst you joined our constsntly in bed club. 😭 def check out the mespine hashtag firstly unless that’s what inspired you to attempt healing this way to begin with❓That’s s community mostly of people who believe spinal impingements can exacerbate or even cause mecfs but ofc there’s a ton of complexity snd variability in reaction to these fusion snd untethering surgeries.
And secondly also from the me literature and anecdata yesss lots of people share your experience of worsening after or even having their mecfs triggered initially by surgeries. especially I reckon brain spine or abdominal surgeries. This includes some who were trying to access treatment for their underlying mecfs.
Ron Davis in his May twenty three investinme talk snd his more recent updates postulate innate immune system involvement since surgeries like infections vaccines injuries snd childbirth all involve the innate immune system. 🧐
I want to emphasize that I personally have s couple friends who’ve had success in the form of partial remission from these surgeries. This should be kuite s separate off chute topic I think from the gift of this overall convo with Dr khan ‼️
Just clarifying here that I’m not casting wholesale doubt on the mespine community just healthy skepticism for this emergent theory snd very intense invasive set of treatments in our very desperate community.
Thank you all for joining me on the first Long Covid, MD Discussion Post. I hope you learned something helpful about navigating surgery and anesthesia with Long COVID.
Subscribe to the Substack to participate in future Discussions. What should we talk about next??
Is there anything an anesthesiologist can do in preparing or monitoring a patient during surgery that would minimize further deterioration of someone with severe long covid? Certain type of general anesthetic that might be better than another, other considerations? Should I try to talk to anesthesiologist in advance of surgery about such things?
My most severe symptoms are fatigue and PEM, then moderate joint pain and cognitive dysfunction. That's the short list. I don't have MCAS, only mild histamine reactions at times, so I'm not overly concerned with that issue. I've never had major surgery before but do have one upcoming.
Can you explain the impact of the different levels of anaesthesia on Long Covid patients please? Thanks
Do you think, given the relevance of cerebral blood flow and intracranial pressure in ME/CFS (which is a subtype of Long Covid), that experiences with anaesthesia in neurosurgery could be informative for this patient cohort?
Sammy lincroft may she rest in power shared here some crucial surgical accommodations she was able to access two years ago.
I recall she has more wonderful work on general inpatient or surgical considerations but cannot recommend her work highly enough.
She may have given her life for it.
https://www.meandmore.net/blog/84ju7m36zwoe210z3pg1ir04kzqxao
Firstly thank you for offering this ‼️
Can you speak on the historic findings re surgery and anesthesia in mecfs ❓I’m most interested in whether patients tend to lose baseline post op which I feel might be more common in severe patients but that is sheer speculation on my part.
Then are there sny distinctions emerging in this realm of surgical care between historic mecfs findings and long COVID patients ❔ do the more overt and distinct issues with clotting snd microcirculation pose more risk here for COVID long haulers than for OG PwME❔
sre there possible subtypes emerging smong COVID long haulers whether or not they also have mecfs who are at more risk for complications❔
Any risk or harm reduction practices being promoted by sny surgeons or anesthesiologists that you know of or is the data just not clear enough yet. For thst matter sre there practicing surgeons or anesthesiologists involved in researching this❔
my tentative understanding is thst all PwME basically had micro circulatory impairment in brain snd periphery before COVID but now that most of us like myself hsve been repeatedly force infected with SARStwo with subsequent long COVID layered on top I guess we’ll never have robust comparator data ❕🤷🏼♀️ I’ve never had surgery beyond a dilation snd curretage snd s wisdom tooth extraction which other than going vasovsgsl in the former were uneventful so I have nothing personal thank goodness yet to add to this anecdata.
What are the things I should be aware of regarding Long Covid and anesthesia?
Hi and thank you for doing this. I wonder if the talk was recorded?
Every time I’ve had anaesthesia as I’m counted down I hyperventilate: it’s entirely beyond my control. Is there anything I can do pre-induction to mitigate this as I’m sure it’s pretty terrifying for the poor surgical personnel.
Love this idea! Flu A has totally kicked my butt!
Thanks for all this info! New here, anybody know where to find the thread I presume will be today at 1 EST? Thanks!
I am clinical; 3 yrs this month; developed clotting disorder, migraines, PEM, dysgeusia (35 lb wt loss), orthostatic hypotension.
Thank you.
Would love if you would brainstorm about realistic options to address each area of Table 1: https://rdcu.be/dT86p
Thank you for sharing the paper. Tomorrow’s hour is dedicated to anesthesia. I will keep your feedback in mind for the future. I’m sorry you’re going through this ordeal
Theoretical
And if I haven’t provided you enough fodder yet I would love to hear particular attention to surgeries involving
The brain 🧠
if we have any data on those. I have s close friend who developed me sfter her brsin surgery for s rsre glioblstoms which thankfully appears to be in long term remission.
Spine
both in snd outside the context of the me spine community.
Heart
noting that people w mecfs hsve been shown to die decades earlier from heart failure ss well ss cancers thsn our healthy peers.
And gyno surgeries.
Laparotomies fibroid removals leeps hysterectomies etc.
This one is most immediately relevant for me ss I sm likely going to need some kind of gyn surgery soon. My hunch is thst PwME def hsve different outcomes in gynecology tjst need wsy more study snd perhaps differentiated sets of guidelines to optimize csre. this especially goes for endometriosis which is established to be far more common snd perhaps worse for us influenced by the micro circulatory impairments snd other factors. Snd for hpv rlested cervical lesions snd cancers more generally where I have a hunch our immune derangements affect outcomes. We die decades earlier from cancers for s reason.
My most basic kuestion would be evidence we have re whether long haulers snd PwME May hsve distinct responses or potentially more risk of adverse reactions esp longer term chronic ones to regular anesthetic pain management or antibiotic drugs.
Relatedly do you have general advice on writing advance directives for patient snd hcps when prepping for surgeries or planned inpatient stays or emergency planning ❔ particularly if or when there are particular snesthetics or pain meds or classes of drugs an individual patient or subgroup of patients might want to be more particular or more cautious about ❔
thoughts on using advance directives and or ada accommodations to try to avoid nosocomial COVID infections in hospital that permanently threaten our baseline even outside of the context of surgery ❔
Any thoughts on fluoroquinolone toxicity as it relates to antibiotic use adjacent to surgeries for COVID long haulers or others with infection associated illnesses❔personally I’m considering putting s note on my hospital advance directive paperwork to avoid their use and use alternatives whenever possible just because there are so many patients who clesrly link worsenings with their use.
This snd pretty much all other topics here for me bring up the historical specter of how seldom our experiences have been documented.
Fluoroquinolones can have significant side effects. Luckily, they are not typically the class of antibiotics used to prevent surgical site infection.