Transcription:
Covid Recovery – Lingering Symptoms and How to Get Back to Feeling Well

Bill Klaproth: (Host) The majority of people who contract COVID-19 recover. That's the good news, but many are experiencing lingering symptoms. So what are those lingering symptoms and how can people get back to feeling well.  Let's talk with Josh Leigh and Liz Chuasee both our staff physical therapists at Emerson's Clough family center for rehabilitative and sports therapies.  This is Health Works Here, the podcast from Emerson hospital. I'm Bill Klaproth, Josh and Liz, Thank you so much for your time. Josh, let me start with you. What is one of the most common lingering symptoms people with COVID have months after they've had the virus?  

Josh Leigh: (Guest) Thank you, Bill.  I just have to say fatigue, deconditioning and an overall limited functional capacity is one of the primary things patients that are recovering from COVID, have to deal with months after and this can be either from weakness, difficulty breathing, or difficulty with cognitive tasks. Picture that you have a gas tank and you can either fill the gas tank up to the very top, you can fill it halfway, you can fill it up to a quarter, and then you have a general path that everybody has to do such as walking up the stairs. If you have to walk up the stairs and let's say that uses a certain amount of gas. And then after being sick or recovering from COVID, the same task will require you to use more gas, but you also have a smaller capacity or a smaller tank. So the overall percentage of your effort that you have to use to complete the same task is greatly increased. And that is something that a lot of people have a lot of difficulty with.

Liz Chuasee: (Guest) I think also one big thing is that they have a hard time grasping that there's a lot of things that, the regular person just takes for granted, being able to just go about your daily life, cook for yourself to get dressed, all of those things that prior to COVID, even prior to quarantine, we're not a big deal. And now, especially because of this reduce gas tank is we're using that analogy everything's a little bit harder. You don't have as much energy and another big component to this as I think people don't necessarily grasp, why that is. And I think the gas tank analogy is a great way to think about it.

Host: Yeah, that is a great way to visualize that. So fatigue and deconditioning. So then the next question Josh, are there things people can do to reduce or eliminate this symptom and if so, what are some tips?

Josh: Absolutely folks can follow up with their providers to discuss treatment options and ways to safely increase their activity load by addressing their load tolerance. You can increase the intensity, the frequency, or the duration of exposure on a RPE or rated person exertion scale. What that basically means is going back to our gas tank, when you're coming off of a tough bout of COVID or you've been laid up for a while and everything feels harder and things don't feel as easy you can either, Let's say walking, you look and walk more. You can walk less. That is an example of frequency.  You can walk several times a week or several times a day. You can also adjust how long you walk. So the first one is frequency, the second one is duration and the third one is the intensity. Are you slowly walking? Are you quickly walking? So by heading patients Perceived exertion or how hard some of these tasks are getting back to our gas tank, trying to ask them what percentage of their gas tank are they using? Does it feel really hard? Does it feel pretty easy? Talking with their provider, the provider can form a plan of care to try and make sure that they're safely moving forward and increasing the size of their gas tank, as well as getting better gas mileage out of it too.

Host: Josh, that's really easy to remember frequency, duration, and intensity. So those are really good tips. And then Liz, what is another lingering symptom people with COVID have?

Liz: So after mentioning the fatigue, deconditioning, weakness, difficulty breathing, all of those other things, something else to consider is whether or not you've had a change in your balance or your stability, a lot of these folks have an increased fall risk after going through this because of that weakness. They may notice that they're a little bit more unstable. They may be losing their balance more often again, with just daily tasks. And another thing to consider is the emotional side of things, potentially PTSD just from the hospital experience or quarantining and going through this.  There's a fear of re-infection there's a fear of infecting loved ones. and these are also important things to consider.

Host: This is such an important podcast because we never hear of these things. Fatigue and deconditioning Liz, you were just talking about balance issues and the important emotional component of this, which I think really gets overlooked. So Josh, how can people deal with, or reduce or eliminate the symptoms of balance issues and then deal with the emotional component?

Josh: Excellent follow-up question I think that finding quality resources is critical to, dealing with some of this and, following the CDC and the world health organization guidelines for hand-washing mask use. Social distancing is really important to maintain healthy engagement in the community while following public health policies, it is important that patients understand that they're not alone and address the signs and symptoms of being down or depressed or isolated, early. There are many, and the increasing resources for some of these patients to help find, support, including Emerson's Behavioral Health, services, and psychology today dot com are two common resources. Being mindful can be a valuable resource and it is often paired with physical therapy to help create an environment that is inclusive and conducive to healing.

Liz: And following up to physical therapy, it's a great way to help work on your balance. A lot of us physical therapists are geared specifically towards, developing programs for people who have difficulty with their gait or their balance. And, coming to see us would be a great way to help work on that.

Host: So, Liz, you're talking about physical therapy. So what is the role of physical therapy and other rehab therapies to help patients return to their normal selves after a tough bout with COVID? Can you expand on that a little bit?

Liz: Absolutely, so our goal would definitely be to evaluate someone and right off the bat establish where are their specific deficits? What are they having difficulty with? We set our plans and our goals based on what that person needs, so for example, if someone's coming in and reporting that they're having trouble walking from one end of the house to the other, or they're noticing that's troublesome. They may be losing their balance more frequently, they're having difficulty getting dressed, difficulty going for their daily walk, they used to be able to walk a mile and now they can barely walk up their block. So we're going to perform specific assessments, specific tests. Devise a plan of care. That's going to help bring them back to ideally the level that they were at before. People with COVID may have comorbidities or other things that may also be affecting their current status and we're taking all of that into effect. In terms of other therapies between occupational therapy and speech therapy, they can work on ATLs we mentioned cognition before speech therapy is great for working on, any sort of cognitive deficits that someone may now be experiencing. But our biggest goal in general, across all therapies, is addressing what's specific deficits or problems people may be having now and trying to get them back to where they were before.

Host: And then Josh, let me ask you this. You and Liz are right up close. Most of us are trying to stay away from COVID, but people like you and Liz are right there in front of it. So tell us one thing that has surprised you about the symptoms people with COVID have?

Josh: Absolutely. It's, a, it's amazing to see how tough people are and how resilient folks can be.  Covid can affect anybody from an athlete to an elderly person, to a younger, kid in school. And we have been overwhelmingly amazed at how patients have responded and overcome this in a positive light. It's been very interesting to see the diversity of the range of presentations interacting with a wide range of preexisting conditions and how that impacts the treatment across the population.  Individuals have repetitively demonstrated that there is not only a little but ample hope, for overcoming this and actually growing and getting stronger after dealing with COVID.  I'm finding a lot of them, not only athletes are coming out of this as stronger people. And working towards goals that they didn't really think were possible and they're really trying to achieve and they're trying and actually achieving some pretty amazing things, and it really gives us hope, seeing how a lot of people are understanding that they're not alone and this is not an end, but it's a beginning to try and get stronger and better.

Host: That is such a great answer. And then Liz, if you could wrap this up for us, according to what Josh was saying, talking about hope and people actually growing stronger after a COVID-19 diagnosis and dealing with these lingering symptoms it sounds like there is hope that people can grow stronger after a COVID-19 diagnosis, is that right?  

Liz: They absolutely can, a lot of the people who are maybe going through a recovery from COVID, they're seeing things a little differently, but if they're seeking out the care and the support that they need, it may take time, but they're going to get back to where they were and, they might develop some new habits along the way. Maybe they weren't doing a walking program before or going to the gym regularly. But after going through this experience there, they may develop some new healthy habits that might be better for them in the long run. Even if they did have a difficult experience, there definitely is hope. They're going to have good days, they're going to have bad days, but it's going to ideally progress to more good days and hopefully like I said, some new healthy habits along the way.

Host:  More good days. I love how you said that Liz. That's great. And that's what everyone wants to hear and what a great message of hope you have left us with Josh and Liz, as you said, people before might've been fatigued before and deconditioned and have had balance issues even before COVID. And this is an opportunity to come out even stronger after. Thank you both for your time today. This has really been insightful and informative. Thank you again for your time.

Josh: Thank you Bill, and try and think about a sunny day with a full tank of gas.

Host: I'm thinking about it now. All right, Josh and Liz, thank you so much. And for more information about Emerson's COVID recovery program or to make an appointment, please call (978) 287-8200. Or visit Emerson hospital.org/covid recovery. Thanks for listening to Emerson's Health Works Here, podcast. Make sure to catch the next episode by subscribing to the Health Works Here podcast on Apple Podcasts, Google Podcasts, Spotify, or wherever podcasts can be heard. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is health Works Here from Emerson Hospital. Thanks for listening. �