The Wall Street Journal - USA (2020-12-01)

PERSONAL JOURNAL.

HEALTH&WELLNESS

blood pressure, heart rate and blood volume. But the diagnosis also brings new challenges: Even gentle attempts to resume physical activity are proving especially arduous for many post-Covid patients, for reasons that aren’t yet clear. So progress is often quite slow. And it’s rare for POTS to completely go away even with treatment. It re- mains unclear whether patients with post-Covid POTS will follow similar recoveries to people with non-Covid POTS. It’s not known how many post- Covid patients may develop POTS. Outside of Covid, POTS is estimated to affect up to 1% of the world’s population, according to a 2018 study in the Journal of Internal Medicine. The disorder can affect men and women, but most POTS cases are diagnosed in women be- tween the ages of 15 and 50. Johns Hopkins has run a POTS clinic program for more than three years. After seeing an increasing number of post-Covid patients with POTS-like symptoms, it de- cided to open a new clinic dedi- cated to them, says Tae Chung, director of the Johns Hopkins POTS clinic. Doctors elsewhere are also identifying more post-Covid patients with POTS-like symptoms and case reports are being published in medical literature.

New Treatment,

Challenges

For Long Covid

More long-haul Covid patients are being

diagnosed with a disorder called POTS

BRITTANY GREESON FOR THE WALL STREET JOURNAL (2)

Tracy Tobiczyk was diagnosed with POTS. Her regimen includes three medications and more salt and fluid.

POTS is generally diagnosed with what’s called a tilt table test, which measures changes in heart rate when someone goes from ly- ing down to upright. If heart rate increases by 30 beats a minute or more when patients stand and they have symptoms such as light- headedness that is worse when standing and often disabling, they are believed to have POTS. Tracy Tobiczyk, a 46-year-old flight attendant in Brownstown, Mich., has been home on medical leave since contracting Covid in the spring. In July, she was admit- ted to the University of Michigan Medical Center after weeks of ex- periencing a skyrocketing heart rate even while resting. Doctors diagnosed her with POTS. Before Covid, Ms. Tobiczyk says she used to walk 4 to 5 miles every day. Now, she gets dizzy when she stands. She says she can’t sit up for more than an hour because of chest pain and shortness of breath, which she likens to feeling like she’s drowning. “It leaves me laying on the couch or laying in bed all the time because I can’t get

them very frequently in the hospi- tal and don’t see adverse effects,” says Annabelle de St. Maurice, assistant professor of pediatrics at UCLA’s David Geffen School of Medicine. Avoid expired products where the ingredients could have evaporated, she adds.

What are the main active ingredients in disinfectants that people need to be aware of when it comes to potential health hazards? On product labels, look for bleach or for quaternary ammonium compounds, known as quats. Both bleach and quats are considered safe if used as directed. But if in- haled, they may cause irritation in some people, at times resulting in sneezing, coughing or shortness of breath. In some cases, users may develop a sensitivity to the chemicals over time, says Karin Pacheco an allergist at National Jewish Health in Denver. People who are constantly spraying disinfectants are most at risk. “If you inhale irri- tants in a high enough concentration, you can cause asthma or up- per respiratory problems,” she says.

What should you do if you’re worried about exposure to quats or bleach? Use products in properly venti- lated rooms to lessen exposure, Dr. Pacheco says, and avoid contact with the skin. “‘Wear gloves and don’t inhale this stuff, and it

works really well, ” she says. The EPA recommends using non-aerosol sprays or wipes to reduce inhalation exposure at home. Keep in mind that while bleach has a dis- tinct odor, quats don’t, so isn’t al- ways evident if a disinfecting product was used recently on a surface you are touching.

Should you take extra precautions when using sanitizing sprays around children? Children are often at higher risk when disinfectants are used. For one, they are more likely to put their hands in their mouths after touching a surface, resulting in potential irritation. Their lower

weight means even small amounts of exposure through inhalation has potential for side effects. “It’s for the little kids that we are little bit concerned,” says Dingsheng Li, an environmental health professor at the University of Nevada, Reno. He recommends wiping off quat-based products after following disinfecting directions because they tend to linger on surfaces.

What about do-it-yourself disinfecting, instead of buying ready- made cleansers? The virus is relatively simple to kill with a host of materials, but users must follow directions to get the proper concentration of the active

ingredient, says Dr. Li, who con- ducted a risk assessment of ingredients in disinfectants used to kill Covid-19. In addition to soap and water, ethanol, also called ethyl alcohol, tends to be effective, he says. In addition, it evaporates quickly, so it won’t linger in the air or on surfaces. The EPA recommends products with citric acid and hydrogen peroxide as active ingredients, as long as the products are used cor- rectly.

What are foggers and what should you keep in mind if they are being used in your workplace or school? Fogging, or spraying a room with a disinfecting mist, currently isn’t recommended for most places including homes or schools. While it can cover an area quickly, aerosol “spraying is not recommended and can be irritating to mucus mem- branes,” says Albert Rizzo, chief medical officer of the American Lung Association.

Are there other drawbacks to pro- longed disinfectant use? There is evidence that antimicrobial resistance to quats could develop, making these chemicals less effective on many types of bacteria over time, says Bill Wuest, associate professor of chemistry at Emory Uni- versity, who specializes in develop- ing antimicrobial compounds. For individuals, it is important to find a balance as the pandemic continues.

F

requent use of disinfecting cleansers, wipes and aerosol sprays during the Covid pandemic has some people worried about possible health risks. While many doctors and medical re- searchers deem disinfectants generally safe, there are concerns when they are used incorrectly or around children and people with asthma or chronic respiratory conditions. The Environmental Protec- tion Agency maintains List-N, a searchable online tool where users can learn about more than 500 products registered with the agency that can be used to kill the coronavirus. Here’s what doctors and others advise about the proper use of disinfectants.

Is hand sanitizer safe? Yes, but check the label to be sure the sanitizer has at least a 60% concentration of alcohol, as recommended by the Centers for Disease GETTY IMAGESControl and Prevention. “We use

Safety First

When Using

Disinfectant

BYALINADIZIK

S

ome patients with long- term Covid symptoms are getting more potential treatment options as doctors diagnose them with a little-known syndrome called POTS. It’s a disorder of the autonomic nervous system that can have a va- riety of causes, and it existed before Covid. One common trigger is an in- fection, such as a virus. Now some doctors believe that the coronavirus is triggering the disorder in some people, providing an explanation for debilitating symptoms including dramatically elevated heart rates from small movements, dizziness and extreme fatigue after even mi- nor physical activity. The good news, experts say, is there are protocols and treatments for POTS, which stands for pos- tural orthostatic tachycardia syndrome. They include a guided, very gradual return to physical activity; compression stockings or abdominal compression to prevent blood pooling in the lower half of the body; increased salt and fluid in- take if blood pressure is low; and sometimes medications to regulate

YOUR HEALTH SUMATHI REDDY

up to do anything,” she says. After being diagnosed with POTS she started wearing compression stockings every day and an abdominal binder. A nurse comes to her house to give her so- dium chloride infusions to help increase blood volume. She takes three medications: one to increase her blood pressure, a beta-blocker to reduce her heart rate, and a mild steroid. “With the three of them together at least now I can walk to the refrigerator and go to the bathroom,” she says. She has had two rounds of physical and occupational therapy but didn’t make much progress. “I would do it and then that night I will have debilitating fatigue,” she says. “My husband had to carry me upstairs. It’s a tiredness where I feel like I’m almost dead.” Now, she is working on trying to exercise with a bicycle attached to her couch and with wall stands and leg lifts for about 10 minutes or less a day. “I try so hard because I’m an athletic per- son,” she says. “Every day is a struggle.” Amro Stino is an assistant professor and co-director of the autonomic lab at the University of Michigan Medical School and one of Ms. Tobiczyk’s doctors. Dr. Stino says he’s seen about half-a-dozen post-Covid patients who have POTS, generally young women who were previously active. Doctors caution that post-Covid patients need to get a complete work-up evaluating their heart and lungs before receiving a POTS diagnosis to rule out other conditions. If a patient has myocarditis, another common post-Covid condi-

tion, increasing salt and fluid in- take could cause further heart damage by stressing the heart. Elevated heart rates also have other causes, including blood clots in the lung, which Covid has been linked to. “One of the reasons I’m creating a special clinic is to make sure these symptoms are not com- ing from other causes, especially from blood clots,” says Dr. Chung at Johns Hopkins. POTS recovery rates vary. A re- cent study out of Italy of 42 patients published in the International Journal of Environmental Research found that most patients showed some improvement in symptoms after two years but still have the condition.“It’s a chronic condition,” says Lauren Stiles, president of Dysautonomia International, a nonprofit group, and a research assistant professor of neurology at Stony Brook University School of Medicine. Some experts believe POTS may be autoimmune in some cases. Several studies have indi- cated that patients with POTS have antibodies that are attacking the autonomic nerves in the heart and blood vessels. Benjamin Levine, a professor of internal medicine at UT South- western and director of Texas Health Presbyterian’s Institute for Exercise and Environmental Medi- cine, developed the “Levine proto- col,” an exercise intervention program for POTS patients. He thinks it might be prema- ture to be diagnosing Covid patients with conditions like POTS so soon. Some ath- letes, for exam- ple, might instead be suffering from muscle atrophy and decondition- ing caused by in- activity while convalescing. Other experts say decondition- ing may exacerbate symptoms but isn’t causing them. Brent Goodman is an autonomic neurologist who runs the autonomic laboratory at Mayo Clinic’s Scottsdale, Ariz., lo- cation. He is working on a report on six post-Covid patients who developed POTS. Dr. Goodman says the earlier treatment is started, the better the recovery. “If we identify autonomic dysfunction three weeks from symptoms onset we’re going to treat it,” he says.

Even gentle attempts to resume physical activity are arduous for many long Covid patients.

Symptoms of POTS

lAbnormal heart rate increases lBlood pressure fluctuations lDifficulty exercising lLightheadedness or dizziness when standing up lExtreme fatigue lBrain fog or difficulty with concentration lHeadache lShortness of breath lMuscle pains lDamage of the small nerve fibers in the hands or feet, which can cause burning pain, numb- ness, and tingling or sensations of coldness. lGastrointestinal issues

The Wall Street Journal - USA (2020-12-01)

PERSONAL JOURNAL.

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