Abstract The diagnosis and treatment of long COVID patients is challenging. Our aim is to share lessons learned using a multidisciplinary approach within the Veterans Affairs system. Our long COVID clinic is based in primary care but has imbedded rehabilitations specialists, nutrition. whole health and different specialists within internal medicine. We conduct an extensive work-up to evaluate the presence of end-organ damage, ongoing inflammation and dysautonomia. Our treatments are based on the prior experience that the VA system has on chronic fatigue syndrome and gulf war illness. Paywall, https://www.amjmed.com/article/S0002-9343(24)00337-1/abstract
That’s a really short and undescriptive abstract for a paywalled article. But: Is not the best sign as far as I know
Mixed bag I think, with some good and some less supported points. A few snippets — I think we've also seen many people with disabling brain fog having normal MOCA scores. The instrument is inadequate for this condition. Here they're talking about pacing, while at the same time increasing physical activity. And a CPET is not without risk. On that last point I don't know that one could be at all confident that a crash will only ever take someone back down to their previous level of functioning.
It just goes on and on. Only 5% of patients are found to have cortisol levels lower than a reference range. Here's guidance on establishing standard ranges for tests: So, it is likely that the cortisol reference range has been set so that 2.5% of the healthy population have a cortisol level below the low end of the range and 2.5% of the healthy population have a cortisol level above the end of the range. Here, the authors are reporting that 5% of their LC sample have a cortisol level below the low end of the range. That difference is nothing - on this measure, their LC population is looking exceedingly normal. We have discussed ad nauseam reasons why the mean cortisol level of people with LC or ME/CFS might be lower than that of healthy people - e.g. most are not regularly engaging in high impact physical activity which mildly increases cortisol levels. There is nothing here to suggest that 'adrenal fatigue' is a characteristic of LC.