E137: Update on Long COVID with Dr. Noah Greenspan

Episode 137 May 09, 2023 00:40:15
E137: Update on Long COVID with Dr. Noah Greenspan
The POTScast
E137: Update on Long COVID with Dr. Noah Greenspan

May 09 2023 | 00:40:15

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Hosted By

Cathy Pederson Jill Brook

Show Notes

Dr. Noah Greenspan returns to the show to update us on long COVID patients. He also discusses recovery strategies for COVID, prevention of long COVID, and oxygen therapies that seem helpful anecdotally.

You can read the transcript for this episode here: https://tinyurl.com/potscast137

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Episode Transcript

Update on COVID Longhaulers with Dr. Noah Greenspan [00:00:00] Jill Brook: Hello fellow POTS patients and super people who care about POTS patients. I'm Jill Brook, and today we are going to get an update on long COVID with the person who has been there since the beginning. I would not be surprised if the term long COVID was first uttered in his clinic in New York City. Our guest is the great Dr. Noah Greenspan with the Pulmonary Wellness Foundation. He is a board certified clinical specialist in cardiovascular and pulmonary physical therapy with over 28 years experience. He founded the Pulmonary Wellness and Rehabilitation Center in New York City, which has been named the best of the United States. And if follow him online, this will not surprise you because Dr. Noah is the man when it comes to knowledge, passion, and energy to help people with pulmonary issues of all kinds. He is an educator. A published researcher. He wrote the book, Ultimate Pulmonary Wellness. He founded the nonprofit Pulmonary Wellness Foundation, which you should check out online because it's amazing. It has lots of great resources. And when COVID struck, he was at the Epicenter in New York City and he was one of the first medical professionals to figure out that some people were developing POTS and other problems after COVID. Dr. Noah, thank you so much for joining us today. [00:01:22] Dr. Noah Greenspan: My pleasure and thank you for giving my haters so much to hate. [00:01:26] Jill Brook: You have no haters. You're a rockstar. [00:01:29] Dr. Noah Greenspan: many. it's Awesome. But anyway, thank you. I'm happy to be here. [00:01:32] Jill Brook: So we spoke to you over a year ago and we got the low down on the first COVID wave and heard about Long COVID when it was brand new and we were hoping for an update now. And I have a lot of specific questions for you, but can we just start with if you have any sort of definition of long COVID or like what really is long COVID to you as somebody who sees it every day. [00:01:56] Dr. Noah Greenspan: So I would say that long COVID is a term that was not coined in our clinic. In fact, I have an idea of where it was coined. So, I would say for many people we think of COVID as a let's go back to day one, where it was a respiratory virus that lasts seven to 12 days and then you go on your merry way. Initially here in New York City as an example, the idea was if you get sick, unless you're going to die, practically stay home, shelter in place, and in seven to 12 days, this should all clear up. That's all well and good, but for many people it didn't clear up right? Or for many people it cleared up. Even people who had mild cases of COVID. Except down the road, either their symptoms came back or new symptoms occurred or additional symptoms occurred. And for many people, as you and I were just saying, especially for the people who contracted, original case of COVID in February, March, April, 2020, many of those people are the people who are still suffering the most. And it really begs the question, well, what would have happened if we didn't take the approach of, well, you're young and healthy, therefore stay home. Even though, under normal circumstances or under any other condition, if you had 104 fever and couldn't breathe, or chest pain or what have you, you'd be taken immediately by ambulance to the hospital. These people were told, stay home and languish. Who knows what would've happened if things were different now or if things were started now. In addition to the fact that there were no vaccines, so it was brand new, really ripped through New York City. And again, many of the people that we deal with today are people from that first wave. [00:03:51] Jill Brook: So that's interesting. So are you saying that nowadays if someone gets COVID, say one month ago, do you expect their long COVID to look different, to be more mild, to be easier to get over? What's the difference between somebody who gets it now versus then? [00:04:10] Dr. Noah Greenspan: I will say this, you know, as sort of a caveat to everything we speak about going forward. There's There's no expectation with COVID, like there's no typical with COVID. But I definitely expect that somebody who is vaccinated and boosted will be less likely to have a severe case of COVID. Now I don't know if they're going to have a less likely chance of having long COVID. I don't think the data is in on that. Again, I have to believe that there's some benefit to being vaccinated. There's some benefit to being boosted. And again, I think there's treatments now things like paxlovid or things like Evusheld where at least there are some things that are kind of disrupting the pattern. I hate to also predict that this is going to be more mild. Some people wait for things to happen. Some people make things happen and some people say, what happened? There's people who are completely unfazed by COVID, right? Maybe they've had it, maybe they haven't had it, but they're not even remotely going to consider wearing a mask regardless of the circumstances. They could be on a bus, they could be on a subway, they could be on a elevator. They're not going to consider it. There's people who maybe at high risk, people who are immunocompromised, people who have had COVID or have long COVID and know what the possibilities are, and those people are going to wear masks under all circumstances. There's people who don't believe in vaccines. There's people who will get every vaccine under the sun. There's people who believe that the vaccines are not safe, and they're people who legitimately have had side effects and even long-term sequelae from the vaccine. So it's like really, really hard to know what's what. And I know you're asking me like, oh, well let's have this guy, he knows what's going on. I'm not sure what's going on. I mean, I have my ideas, I've always had my ideas. But the more this goes on, it's like the more I have to be like, well, what happened? what's happening. And coincidentally, you know, I was good. Like literally in the fire of COVID and did not get COVID. And then I slipped up recently and on December 9th, I contracted COVID for the first time. And so, it reinforced certain things for me that I've always believed. So it reinforced for me the fact that masks work, right? Because in the one situation that I caught it, I wasn't wearing a mask and I was exposed to somebody I thought had tested negative. Okay. And they did in fact tested negative. What they didn't tell me was that in between testing negative and seeing me, they attended SantaCon in New York City, which is this event where like thousands of people dress up like Santa, Mrs. Claus, Rudolph, and the elves and go bar hopping all over the city. If I would've known that, I would've just ordered an order of COVID to my hotel room. I, you know, reconfirmed that masks work, it reconfirmed for me the fact that home tests work because, for two years and nine months, I tested negative until I actually had COVID and I tested positive. So, I believe in that and I have to believe that having the vaccines and the boosters probably did help me have a relatively mild case. I also learned some things about the actual illness itself. And so I'm not saying I'm glad I had it, I wish I didn't have it. I definitely feel much less special now that I'm one of the millions that have had it. But if I am going to have it, at least I am happy that I got some learning experiences out of it, and I think some ways to better manage COVID. [00:07:38] Jill Brook: Do you think there's anything people can do if they get COVID to help prevent long COVID? [00:07:44] Dr. Noah Greenspan: Again, great question. I do think so. Okay and I would say that it's probably going to work in some people, and I'd say it's probably not going to work in other people. So, as an example, I've had this protocol that's been rolling around my mind that I've kind of been suggesting to people for the last X amount of months or years, and it's all over the counter. Like it's all over the counter stuff. It's Advil. So I took two Advil in the morning and two Advil in the evening no matter what. Why? Anti-inflammatory, fever control, body aches and pain control. Okay. I took Pepcid AC morning and night. Why? It's a H two blocker. Okay. There's been talk that the H two receptors could play a role in COVID slash long COVID. What else did I take? I took Excedrin. Caffeine, acetaminophen, and baby aspirin. Why? Because so much that we hear has to do with clots and micro clots, so I wanted some degree of blood thinning activity while I was doing that. And then, for example, I had some chest congestion, so I made use of albuterol and I made use of Qvar, an inhaled corticosteroid. And I used the acapella valve to help clear secretions. As I felt something throughout the day, I would put it out, like a fire. And I think that you know, a lot of it has to do with kind of tamping down the inflammatory response as it rises. Just not waiting. And I think, again, so much of what went wrong in the early days was like people were practically on fire in front of us and we were like, no, no, stay home. It's going to be okay, seven to 12 days. When had we may be gone in with steroids and Fever reducers and oxygen and things like that, maybe these people would not have gotten so sick and would not have gotten long COVID. But again, I don't know. And I think there's so much variability person to person that I believe there are probably people who, no matter what they do, they're going to get it. I would say there are some people who probably, no matter what they do, they're not going to get it. And I would say there's probably the majority of people, who probably can do some things to push themselves more likely to getting it and some things to do that may make it less likely that they get it. But again, I hate to keep saying, I don't know, like I'm supposed to be here as like a witness to the truth. But I think that, I don't know, is really the most honest answer for many, many, many of the questions related to COVID still. And I think when somebody says, I've got this all figured out. I understand what's going on here, run for your life cause that person is about to sell you something. [00:10:26] Jill Brook: That's some good advice right there. And it's humbling to know that even you, who has maybe seen more COVID than anyone is saying that it's not one predictable thing. It's kind of different in everybody. And that's fascinating. Are other disorders like that? [00:10:43] Dr. Noah Greenspan: I think there have been other postviral disorders in which we do see similar types of things. I mean, for me personally, the thing that this is most reminiscent of is really the HIV crisis so I started school in the late eighties and I started working in NYU in the early nineties. And at that time, probably 75% of my caseload was HIV patients. Except that at this time there were no treatments. There were no cocktails that were going to tamp it down and people were coming in and there were just hundreds and thousands of people all coming in, and some of them had neurologic problems and some of them had gastrointestinal problems and some of them had endocrine problems and some of them had musculoskeletal problems. and it was like, wow, mind blowing. COVID is one of my colleagues described it best really early on when he said that COVID is kind of a master of finding your weakness and exploiting it. So if you had a propensity or a predisposition to something before, or you had a preexisting condition before, COVID was going to take advantage of it. And I think that's part of what makes the treatment so difficult because people come in and even though we're talking about the same post-viral sort of trigger. The way that it presents itself is so variable, person to person. And I almost think of it as like, well, if you talk to a cow, he's going to moo, and a pig is going to oink and a duck is going to quack. And that's how I think COVID is. And I think when it comes to treatment, it's like the crypdex from the Da Vinci Code, where we're really trying to find that individual combination that's going to be the key that unlocks this individual's solution, except that there's so many variables and it seems like every time you turn one, it kind of unleashes another one. So it's still extremely, extremely challenging. As compared to, every other aspect of my career where I feel like I have these powers that I'm like, wow, I really can shapeshift and move these things around. COVID can really leave you hamstrung and at a loss. And, I have to say that many, many times, like even though you're doing your best tricks it seems like your words or your actions are falling on deaf ears. [00:13:02] Jill Brook: So can I ask, what are some of the treatments that you are hearing good things about? [00:13:07] Dr. Noah Greenspan: Yeah. It's tough. I've reopened the Pulmonary Wellness and Rehabilitation Center, so I am seeing less COVID patients than I was when it was just the COVID Rehab Clinic. But I will say this, I mean, there's certain basics that are not necessarily treatment for cure or treatment for advance, but for example, as the most simple baseline, a long COVID patient comes to us, we want to make sure that they are dealing with compression. Right. Because we know that POTS and autonomic dysfunction and postural orthostatic hypotension and all of these different changes related to fluid balance and movement of fluid around the body is really a big factor here. Right. A big contributor. So compression is key. Electrolyte supplementation is key throughout the day. Lot of people think that they should just be drinking water and they pound water. And what they don't realize is that water on its own is going to dilute and distort the body's natural chemistry. And so many of the things that we talk about with COVID related to, let's say, the neurologic system or the cardiovascular system, particularly the electrical system of the heart and the neurologic system of the brain and cognitive function are related to electrical activity. And so if your electrolytes are off and your electrical systems are all off, then you don't want to be just pounding water all day. You want to be replenishing the body's stores of sodium, potassium, chloride, things like that in the formulations that the body likes. So it's compression, it's electrolytes, it's rest, right? So rest is crucial. in my COVID days, I had moments where I was like, wow, I really want to be respectful of my body's desire to not do anything. And one of the things that we thought early on was, well people are starting to get better. We need to start pushing them a little bit, or we need to start challenging them a little bit physically. And to me it's really a lot like walking on thin ice, and we want to be careful that we don't overstep or we don't go out too far. And so I was really careful that, well, anything even remotely unusual that I felt was a signal to me that, nope. Another day. Another week, another however long it takes to be asymptomatic completely. And then I've been a big believer since the beginning in the power of oxygen therapy. And not just for COVID you know, I've been using oxygen therapy in very high doses with pulmonary hypertension patients, with COPD patients, with pulmonary fibrosis patients for decades, since like 1995. And I think that there's a lot to be said for that, and I think there's a lot of healing benefit to oxygen. [00:15:55] Jill Brook: can you just define oxygen therapy? I mean, is that just like wearing an oxygen mask or is there more to it? [00:16:01] Dr. Noah Greenspan: There's a lot of different ways to get supplemental oxygen, right? The most typical way that we'll see it, I guess, is a nasal cannula. So those are the two prongs that go in the nose. The nasal cannula is that what we consider a low concentration system, right? So the cannula is in your nose. There's nothing really holding oxygen in and mixing with the air. Every liter of continuous oxygen that you get will add about 4% oxygen to the concentration in the air. So, for example, most of us live in a place where the air is like 20.96%, let's say 21%, right? So , you give them one liter, 25%, two liters, 29%, three liters, 33%. So if we went up to six liters, which is the highest you would go with a cannula, that would be adding 24%. Which means we'd have about 45% oxygen. Okay. Now that's great. If you are just trying to bring up the saturation of somebody who maybe has COPD. Or in some cases has pulmonary fibrosis or pneumonia, or another reason why somebody might not be having enough oxygen to support their body's functions. Very often in COVID patients, we see the opposite, so we'll see normal oxygen saturations, which is one of the challenges because a lot of these patients have 98, 99, 100% oxygen, and from an insurance perspective or from a medical perspective, people would say, well, there's really no indication for you to have oxygen. But we've been kind of using it off-label in higher doses than usual because we know that by bathing the neurologic system in oxygen, by bathing the heart in oxygen, we help to offset some sympathetic activity. And we know that COVID has a very, very high fight or flight value to it. And so we want to enhance parasympathetic tone. So we use high concentration oxygen and we use a mask and we will use about 15 liters of oxygen with that mask. And so essentially we're giving people a hundred percent oxygen. And as part of our treatments, we usually give them about an hour of oxygen after or instead of exercise. And there's people who vilify exercise in long COVID and I encourage these people to just keep an open mind. It's not all or nothing. There's more than one way to kind of accomplish the same thing. And again, the oxygen really helps. Let me just put one thing out there, which I'll go back to during the talk, is that there are things that are restorative and replenishing. And there are things that are depleting, right? So in many energy depleting conditions like COVID, like ME/CFS , exercise can be depleting. Exercise can cause a lot of post exertional symptoms, post exertional symptom exacerbation, post exertional malaise, and it can even cause people to have setbacks. But we've found the oxygen to be extremely replenishing and can offset some of that. [00:18:54] Jill Brook: When they do the oxygen during the exercise or after the exercise. [00:18:58] Dr. Noah Greenspan: What we do is we have people do the oxygen during their exercise. And this is, don't get me wrong, there's no COVID patients that we're pushing vigorously. Okay? So We're not pushing them in the same way that we push the cardiopulmonary patients. But we do give them a hundred percent oxygen while they're exercising. And then we have a quiet room or a relaxation room where we have them go and lie back with their legs above their thorax. And again, this is to kind of help bring blood flow back to the core. And we give them a hundred percent oxygen for an hour after the exercise. [00:19:35] Jill Brook: Interesting. Now, are you hearing about hyperbaric oxygen therapy that a lot of long COVID people are doing? And one thing that's always interesting to me is breathing oxygen versus being in a tent full of oxygen. [00:19:51] Dr. Noah Greenspan: Yeah, I mean, either way you're still breathing oxygen, right? I mean, I definitely have heard about hyperbaric oxygen. And I've heard some people who get good results from hyperbaric oxygen. I'm not convinced. First of all, I think more people should be studying oxygen. Okay. That's first and foremost. I mean, There are groups that are very well known groups that we've reached out to, that we've spoken to extensively about that. There's a lot of politics, there's a lot of competition for money and things like that, and I don't like That hospital or this hospital or that guy said this and that guy said that. But somebody should study the difference between, let's say, a hundred percent oxygen and hyperbaric oxygen. Personally, I'm not convinced that the oxygen has to be hyperbaric. I just don't think you need those pressure gradients. I think if we give people a hundred percent oxygen, I think the chemical gradients are enough to give people the benefit. The oxygen therapy. My opinion, I can't say for sure because I haven't treated anyone with hyperbaric oxygen. I haven't seen any studies comparing the two. I hardly see anybody even studying oxygen. in fact a lot of the people that you hear getting hyperbaric are going to private clinics where they're being charged big prices for hyperbaric oxygen. And that's the case with a lot of the treatments that are out there, and that's unfortunately the case when people are really desperate and at the end of their rope. And you have people who are claiming things, and I'm not saying hyperbaric oxygen is, or isn't valid. I'm just saying that people have to be careful with who they're listening to, where they're getting their information and also what they're putting in their bodies. It's like they say if it were as easy as it seems, everyone would do it. If there were a pill for it, we'd all be fit or we'd all be healthy whatever. So it's tricky. And so again, my answer is I don't really know for sure. My gut feeling is it probably helps. An hour, a couple times a week I don't think is enough. Okay. So like the people that have done really well with the Oxygen, and I'm speaking now specifically of the people from my group it starts with Yes. Which is a support group, which we started I think in June or July of 2020 of long haulers, and we've met every Sunday night since. A lot of them have actually taken it upon themselves to purchase these oxygen concentrators, and they're spending a couple of hours a day on the oxygen, and they're having very good results with them. Although, this is anecdotal because I haven't studied it. It's like one thing with evidence-based medicine. People are like, where's the evidence? Where's the evidence? And fine, you need evidence. You can't always collect data. It's just that simple. Okay. But of the people that have purchased these concentrators and used them for let's say three hours a day, they're seeing positive results from it and would they have seen those results without the oxygen? Maybe yes, maybe no. But I tend to think that there's benefit to the oxygen. [00:22:46] Jill Brook: Okay. That's really interesting. In your mind, are there symptoms that seem more likely to resolve versus other symptoms where when you hear someone has those, you're like, oh shoot, that's the one that's really tricky and sticks. [00:23:01] Dr. Noah Greenspan: I wouldn't say that. I would say that there are different kind of classifications of people with long COVID, right? Where some people have symptoms that are mild and what some would call annoying and or kind of a nuisance like symptom versus people who look a little bit more like the ME/CFS community, like myalgic encephalopathy, chronic fatigue where there's really a dysfunction of the metabolic system and the energy system to where it's really hard for a lot of these people to dig out and to make progress. We have people in the group who've had COVID two times, three times four times. I have a person who's in the group who had COVID five times supposedly. Okay. And I say supposedly only because I'm not saying I doubt what this person's saying. I'm saying it's sometimes hard to know what's what with COVID. Right? So I have a patient now who's been my patient for probably a year and a half. He was doing very well. He was not back to his baseline. Right? Not back to where he was pre COVID, but he was relatively stable. Occasionally had some small improvements and recently got COVID again, was really, really, really set back. So again it's like the idea that people think COVID is gone or that COVID can't rear its head again or that you know, it's okay because you've had COVID to take precautions. I can't really say I've seen anything that really bodes poorly for long COVID or anything that makes me think like, oh no, this person's in deeper trouble than somebody else. Unless you go to like people who have had really severe acute cases and let's say somebody who had like real respiratory failure, somebody who was in the ICU for a long time, somebody who was on a ventilator for a long time. But I don't see those patients as really being long COVID patients. They definitely have had COVID. It's definitely been a long time. Those patients they recover slowly, but more surely in some ways than what I really think of as long COVID patients. And so I do see patients who, let's say, had very severe COVID pneumonia who wound up with pulmonary fibrosis, right? And it looks like this could be something that's permanent, if not progressive. But I can't say that there's any one thing that's kind of like the hallmark of this person's going to be in trouble. [00:25:21] Jill Brook: Okay. [00:25:22] Dr. Noah Greenspan: Long way again to say I don't know. [00:25:24] Jill Brook: Yeah, I mean, it almost sounds like every single patient is unique and in their own little battle to feel better. [00:25:31] Dr. Noah Greenspan: That's it. That's exactly it. That's really what it is. It's that every single patient is unique and as many similarities as there are between patients, you're going to see differences. And I've seen people do the same exact treatment. One gets this, one gets that, one gets better, one gets worse, one has nothing happened. and you know, We talk about the idea of individualized care. Or like you hear people use the phrase patient-centered care. And they say this like, we need to take a patient-centered approach. And you want to say, Okay, that is a good idea. But like what were you doing beforehand? I mean, like nothing else I've ever seen with COVID, you really have to address the individual and you have to address the individual symptoms and you have to try to address what you believe is causing these symptoms or has caused these symptoms. And again, in many cases it's super challenging. Because so many of these patients, even though they look terrible, feel terrible, look sick, everything about them says they're not well. A lot of their test results come back perfectly normal. [00:26:36] Jill Brook: Mm-hmm. Well, and that brings us to some of these people on Twitter. Even some doctors who kind of still act like long COVID is not a real thing. Do you and your patients encounter that? Do you get taken seriously, or is it a struggle? [00:26:51] Dr. Noah Greenspan: It's a struggle to get taken seriously, but it's always been that way. Yeah, I see patients all the time who have difficulty being taken seriously. They go to doctors who are not COVID savvy, who haven't seen a lot of COVID patients who are done seeing COVID patients or who really established their mindset early on or got set in their ways early on and never kind of moved on from that. And depending upon where you are in the world, that can be more or less prevalent than others. I mean, there's places where you go where there may not be a pulmonologist in the hospital, there may not be a neurologist in the hospital. it may be really raw care. And that's been a super challenge for people. If we're going to have success with COVID, to be an excellent, excellent COVID clinician, you have to see a lot of patients. You have to see a lot, a lot, a lot, a lot of patients. And just seeing a lot of patients doesn't make you an expert. Okay. But at least it means that you've tasted the soup. There's a lot of people who have very, very little experience with COVID. What they know, they know from Facebook or Twitter, as you said. And they really haven't seen a lot of patients. For me, after I had done about 150 consults remotely, That's when I decided, okay, we need to open a clinic. We need to open a little lab so we could start studying people in person. At this point, I think I've seen about 465 long COVID patients in personal consultation in addition to the groups that we've attended every week for years now. So I've seen a lot of patients, it doesn't make me an expert in long COVID. I don't think there is such a thing as a long COVID expert yet, but there are some long COVID, complete non-experts or long COVID imbeciles or idiots who just completely, as you said, deny the fact that it even exists. If you're a doctor and you can deny the fact that COVID even exists, then I think you really have to reexamine your Hippocratic Oath and really your value system. Long COVID is a mass disabling event. Right, but is it a mass hysteria event? I guess that's what people are saying, right? If there's no long COVID, but millions of people are suffering these symptoms and this kind of path and can't work and this and that and the other thing, and all their tests are normal, then it's gotta be a mass hysteria event. Right. Or a mass psychological event. I think one of the challenges also is that a lot of times people say it's in your head, right? Or they'll say it's, it's anxiety or it's depression, or it's this, that, the other thing. And it's not like it's one or the other. It's not like it's physical or it's psychological. When you have something serious, it's physical and it's psychological right? So if you have a heart attack, it's going to be physical and there's going to be psychological aspects of it. If you have COPD, it's going to be physical and there's going to be psychological aspects of it. If you have a stroke, it's going to be physical and psychological aspects of it. If you have POTS, if you have anything, if you have a broken legs, it's going to be physical and psychological aspects of it. there's going to be life changes to it. So like some people say, oh, it's just psychological as if that is the be all and end all. It's like you're saying that there's absolutely nothing to what these people are saying and it's completely dismissive. And there's that movie with William Hurt called The Doctor, where he was so cavalier and then he got cancer himself and it opened his eyes to what it's like. I know plenty of doctors with long COVID. I know plenty of doctors with long COVID and some of them were really believers before in helping patients with long COVID and then they developed long COVID and now they can't work because of long COVID. And I know some of them who just didn't believe it. And now they have long COVID. And it's like the Monkeys say, I saw her face and now I'm a believer. And I'm a believer now, when you see long COVID, you're a believer. [00:30:43] Jill Brook: Yeah. Well, I know that you have some amazing online resources for people. Where can people find those? [00:30:52] Dr. Noah Greenspan: People can go to the Pulmonary Wellness Foundation website at www.pulmonarywellness.org. And you know, I would say the most valuable thing that you will find is the COVID rehab and Recovery Lecture series in which we try to address every single aspect of Long COVID. I think we were one of the first people to really talk about POTS and Dysautonomia with your buddy, Dr. Blitshteyn. I think we were one of the first for sure to talk about it as long COVID. But , we also talk about the cardiology aspects of it. We talk about the respiratory aspects of it. We talk about things you can do for shortness of breath, things you can do to quiet the autonomic nervous system. Things you can do to help manage and stabilize the autonomic dysfunction and things like that. Again, it's not all things for all people, but at least says, Hey, we see you, we recognize that there's something here and here are some tools, some of which may help you. Okay. Or here are some in, here are some ingredients you can try adding to your soup. And they may make it better, they may make it worse. But at least we recognize that something is needed and I think a lot of it is beneficial. The other thing I would recommend is we do have this support group, it started out as being called, it starts with Yes. And it was initially led by myself and a social worker, Erica Mastro-Bono, and a psychologist, Lori Nadel. And we've recently transitioned it more to a peer-to-peer support group. I think there's huge benefit in peer-to-peer support and particularly as COVID drags on. I don't think anyone's really gone back to life the way it was because life is very different than it was before. Certainly here in New York, you get some glimpses of what it used to be like, but certainly there are tons of empty offices, empty stores. There's less people on the street. Thankfully there's less people partying in the street. But for many of these people , they can't move on because they're still suffering. And there are people who went to bed in March of 2020 and really never came out. And I think that that's something that we really have to keep our eye on the ball with. And remember that there's millions of people here that to a large majority of us are forgotten. [00:33:02] Jill Brook: Mm-hmm. Well, in addition to your amazing resources, do you have any other tips or suggestions for long COVID patients? [00:33:12] Dr. Noah Greenspan: I do. I think again, it's really important to seek out physicians, nurses, healthcare professionals who, number one, obviously believe in long COVID, right? Because if you don't believe in long COVID. Well, there's no use. Why go to see a doctor who doesn't believe long COVID is real, or who's going to make you feel as if what you're saying is not valid? Okay, so look for professionals that have experiencing a lot of COVID patients, even if that means having to travel further to see them, and even if that doing remote sessions with people. So that's number one. Seek out other people with long COVID. Right? Because one of the things that happens very often in a support group for people with long COVID is sometimes you don't know how to describe something and someone else says something and you're kind of like, wow. I had no idea how to describe this, but you just hit the nail on the head and there's so much value in that validation. I think we've all had experience and like someone's like, you are a liar, or you're lying and like, you have to try to prove yourself. And it's people with long COVID have enough going on that having to prove themselves should not be one of the things that they have to spend their energy on. Because we started talking about early on the fact that whether it's cognitive energy or physical energy or emotional energy. All these things draw from the same bank and can have a negative impact on people and sometimes even if it's something positive. So in other words, somebody could call you up and be like, Susie had the baby. Everything is great. And you can be like, oh my God. And you have this huge emotional reaction. But then there's a rebound to that, right? Or you say, well I worked on my taxes for three hours, or you know what? I tried to go back to work. And I say, well, what'd you do? And I said, well, I had friends in town and we walked three miles after not having walked more than a couple of blocks. And then there's payback for that. There's rebound to that, there's relapse to that. So I would say look for support groups. Advocacy is important. Okay. There's no question about it, but long COVID patients need help in that fight because you're talking about people with real energy concerns and real energy limitations, and a real need to preserve resources and conserve capital, right? Emotional, physical, and cognitive capital. That they can't do it on their own. And it's only a matter of time before people's batteries die out. People lose that ability to keep fighting. Again, I think when you have long COVID, all resources must go towards healing and all resources must go towards replenishment and restoration. And all depleting or diminishing activities have to be limited. [00:35:56] Jill Brook: That's great advice. That's great advice. So validating for people to hear that too, so they know that they're not being selfish... [00:36:04] Dr. Noah Greenspan: oh yeah, and I think it's great advice for everybody. One of the interesting things is like when COVID first started, you don't have to be a genius to like say, Hey, bats and pangolins probably shouldn't be in cages near each other, probably shouldn't be in cages at all. Right. And you say like, you have these animals and you have nature. And we take, and we take and we take and we take, and , animals naturally are replenishing trees and all these different things are naturally replenishing and restorative and there's balance in nature. And imbalance came and comes from human interaction. You know, It's like a metaphor for life, right? You can't just keep taking the ice cream out of the chocolate shell and expect that the shell is not going to cave in at some point. And you can't do the same with the earth. You can't do the same with the oceans. You can't do the same with the skies and the fields and this, that, the other thing, and , the evidence of that is that when COVID first came around and we were locked down, right, like the irony is that we were finally in cages and nature was allowed to run loose, and what happened? The oceans grew back better and animals came around places and my true hope for the world at that time was that people would say, Hey, you know what, there's a real lesson to be learned here, right? There's a real lesson that we need to slow down, that we're getting ahead of ourselves, that we're getting too big for our britches, that we're really taking liberties with the earth and with nature and with animals that we have no business doing and that might change people's attitudes towards how we treat the earth. And, unfortunately I don't see a lot of evidence of that. In fact I see a little bit more sort of you only live once attitude out there. I think we have to again, listen to our bodies. Our bodies give us the signals, right? It's like that 10,000 Maniac's song I'm going to say, see the signs and know their meanings. It's like, see the signs, see the red flags, and don't override the red flags. [00:38:00] Jill Brook: That's great advice and a great metaphor. Well, Dr. Noah, thank you so much for your time today for all you do and your nonprofit work and your educational work. [00:38:12] Dr. Noah Greenspan: Thank you so much. I've learned so much from you. And, incidentally, two of the best webinars that are on the website are the two that we did together because you're very modest, unlike me, but you talk so much about anti-inflammatory nutrition and I think that nutrition and anti-inflammatory is crucial in COVID. And again, I think people don't know what to do very often. And those two webinars happen to be at the top of the page. I encourage you to start with those because you, again, you're very modest and, and, and praising of others, but you're a wealth of information and there's a ton to be learned from you as well. So thank you so much for having me. [00:38:48] Jill Brook: Oh, thank you, and we're glad you're out there doing your amazing work. [00:38:53] Dr. Noah Greenspan: Thank you. All right. Bye everybody. [00:38:56] Jill Brook: Thank you. Okay, listeners, that's all for today, but we'll be back next week. Until then, thank you for listening. Remember, you're not alone, and please join us again soon.

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