{"id":62943,"date":"2022-03-14T12:54:43","date_gmt":"2022-03-14T18:54:43","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=62943"},"modified":"2024-07-18T14:37:17","modified_gmt":"2024-07-18T20:37:17","slug":"long-covid-physical-challenges-require-time-to-rehabilitate","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/long-covid-physical-challenges-require-time-to-rehabilitate\/","title":{"rendered":"Long COVID physical challenges require time and patience to rehabilitate"},"content":{"rendered":"
<\/div>
\"Chronic
Chronic fatigue and joint and muscle pain are frequent physical challenges of long COVID. Photo: UCHealth.<\/figcaption><\/figure>\n

Long-term effects of COVID-19 appear in people who recover from the disease only to be saddled with lingering, often mysterious physical symptoms. These \u201clong haulers\u201d are people struggling with long COVID, defined by the CDC<\/a> as symptoms people experience four weeks or longer after the original viral infection.<\/p>\n

Many long COVID patients face an array of physical challenges encompassing chronic fatigue; shortness of breath; brain fog; and nerve, joint and muscle pain, just to name a few. These are often tied to mental health challenges, including anxiety, depression, mood disorders, and post-traumatic stress disorder (PTSD).<\/p>\n

Patients battling the physical and emotional toll of long COVID benefit from multidisciplinary care, which is available at the UCHealth Post-COVID Clinic<\/a>. As part of an ongoing series on long COVID and its treatments, UCHealth Today spoke with Dr. William Niehaus<\/a>, assistant professor of Physical Medicine and Rehabilitation<\/a> at the University of Colorado School of Medicine. Niehaus treats long COVID patients at the UCHealth Rehabilitation Unit \u2013 University of Colorado Hospital<\/a>.<\/p>\n

\"Dr.
Dr. William Niehaus treats symptoms of long COVID like chronic fatigue and nerve pain and the UCHealth Rehabilitation Unit \u2013 University of Colorado Hospital. Photo by UCHealth.<\/figcaption><\/figure>\n

In addition to patients who had lengthy ICU stays, are you seeing patients with long COVID who had only moderate or mild symptoms but need physical rehabilitation?<\/strong><\/h2>\n

Yes. \u201cWe have had patients who did not need ICU care, but still need oxygen, have shortness of breath and are weaker because of deconditioning,\u201d Niehaus said.<\/p>\n

What are the most common long COVID physical challenges you treat?<\/strong><\/h2>\n

\u201cThe biggest issue is fatigue,\u201d Niehaus said. That includes loss of strength and stamina and cognitive decline. \u201cPeople feel like the tank is empty all the time,\u201d he said.<\/p>\n

How do you help long COVID patients handle their fatigue productively?<\/strong><\/h2>\n

Niehaus said he tries to \u201cempower\u201d patients to \u201ctake control\u201d of their situation. For example, he asks them to think of their daily energy level as they would a battery. \u201cThey have total control over how that battery gets spent,\u201d he said.<\/p>\n

For example, a patient may set a return to walking regularly as a top commitment, or \u201canchor goal,\u201d Niehaus said. But making that effort may be very taxing and leave the patient without the energy to do anything else. The key, he said, is to recognize the toll it takes and plan accordingly.<\/p>\n

\u201cEven an hour of walking might drain that battery for the whole day,\u201d Niehaus said. \u201cThe patient just has to be conscious that they are doing that. So if you plan to go to the doctor or talk to a friend you haven\u2019t seen in a while, it might not be the best idea to do that walking or an aggressive strength-building routine.\u201d<\/p>\n

Are physical medicine and rehabilitation specialists and other providers developing specific strategies for helping long COVID patients with chronic fatigue?<\/strong><\/h2>\n

Yes. Niehaus co-authored a \u201cconsensus guidance statement\u201d that offers guidelines for treatment of chronic fatigue. For example, the authors encourage providers to address its underlying sources, like inadequate sleep and nutrition; infectious and autoimmune diseases; and heart, lung and nerve disorders. They also recommend developing strategies to help patients return to activity gradually; conserve their energy; eat healthy foods; stay hydrated; and follow, if necessary, a regimen of medications and herbal and vitamin supplements.<\/p>\n

Niehaus noted that clinical specialists have also developed multidisciplinary guidelines for treating pulmonary symptoms and cognition problems<\/a> in long COVID patients. Another that addresses neurological issues is in the works, he added.<\/p>\n

Are there other common issues you see in patients with long COVID?<\/strong><\/h2>\n

\u201cYes. Sleep problems and neuropathic [nerve] pain are also challenges,\u201d Niehaus said. Nerve issues also include numbness, tingling and muscle weakness. \u201cNerve pain is hard to deal with in general,\u201d Niehaus said. \u201cWhen you combine that with sleep loss and fatigue, people feel like they aren\u2019t getting enough wind in their sails to make progress.\u201d<\/p>\n

How do you approach treating these overlapping problems?<\/strong><\/h2>\n

Niehaus noted the benefit of working with the UCHealth Post-COVID Clinic, directed by Dr. Sarah Jolley<\/a>, assistant professor of\u00a0Pulmonary Sciences & Critical Care Medicine at the University of Colorado School of Medicine<\/a>. Patients see Jolley and other specialists for lengthy initial visits and receive an individualized treatment plan, based on their health issues.<\/p>\n

\u201cIt\u2019s nice to have a collaborative approach,\u201d Niehaus said. \u201cIt helps the care we provide even more.\u201d For example, he said, a patient struggling with insomnia might get a referral for a sleep study, while another battling nerve pain could get neurodiagnostic tests in conjunction with their physical rehabilitation. This care supplements work by rehabilitation specialists to rebuild lost muscle mass and stamina.<\/p>\n

What important lessons have you learned about treating long COVID patients?<\/strong><\/h2>\n

For physical challenges, \u201cI try to walk a fine line of providing hope that things will get better while at the same trying to instill some resilience in patients I\u2019m treating because the recovery is not always fast,\u201d Niehaus said.<\/p>\n

\u201cThe thing I find really helpful is to recognize that patients have clear goals that they want to get back to,\u201d he said. \u201cAnd that can be anything. The athlete might want to get back into the mountains and start riding their bike again. Or it might be being able to play with their grandkids like they used to.\u201d<\/p>\n

A slow recovery can be difficult for patients to accept, Niehaus acknowledged. \u201cInherently we get locked into only looking forward and being frustrated that we can\u2019t do that thing that we want to be able to do as opposed to actually looking back at where things were when we first got sick. Where were things when I was in the hospital? Where were things when I left the hospital? How have the last few months been? How much ground have I actually made? Inevitably when you reframe it that way, people say, \u2018You know, I really have come a long way.\u2019\u201d<\/p>\n

Has your understanding of the condition we call long COVID changed since you began treating it?<\/strong><\/h2>\n

Yes, but much remains to be learned, Niehaus said. The \u201cgeneral consensus\u201d is that long COVID is a \u201cconstellation\u201d of three to five different problems, he said. These encompass pulmonology, cardiology, neurology and endocrinology, as well as physical medicine and rehabilitation. Physical symptoms can also become entangled with mental health issues. Chronic fatigue is a good example of that.<\/p>\n

\u201cWe don\u2019t know enough to parse all of it out,\u201d Niehaus said. \u201cIt\u2019s not clear if some of these problems go together or if they are their own entities. Or are they all one thing? We just don\u2019t know if there are different flavors [of long COVID] that will be helped with this intervention vs. that kind of intervention. We just aren\u2019t there yet.\u201d<\/p>\n

What have you learned about the mental toll of living with long COVID?<\/strong><\/h2>\n

\u201cAfter going through COVID-19, a lot of patients are fearful of getting it again,\u201d Niehaus said. \u201cLong haulers specifically don\u2019t want to go through the problems again or make them any worse than they already are. That\u2019s leading to a whole host of other problems, including strains on their personal relationships and family.\u201d<\/p>\n

How can you help patients deal with the fears surrounding long COVID?<\/strong><\/h2>\n

Niehaus said he doesn\u2019t prescribe anything specifically but rather tries to help patients develop their own plan and explore their options. For example, someone who wants to see their two-year-old grandchild but fears getting reinfected could wear a mask, meet outside or ensure the contact is in a space with good ventilation. If they haven\u2019t done so already, they could consider vaccination.<\/p>\n

\u201cI try to be a whiteboard that they draw their own conclusions on,\u201d Niehaus said. \u201cI\u2019m there as a resource to help them along that path toward their decision.\u201d<\/p>\n

Are there misconceptions about long COVID that need to be addressed?<\/strong><\/h2>\n

Niehaus echoes a theme that often comes up in discussions with providers who treat COVID long haulers. Its range of symptoms, unpredictability and possible connections with other conditions can make the causes of long COVID difficult to uncover. That can lead people \u2013 including providers \u2013 to question its validity.<\/p>\n

\u201cOne of the problems I see patients facing is getting buy-in and finding people who are comfortable treating symptoms that may be a bit more diffuse, vague and hard to pinpoint,\u201d Niehaus said. \u201cWe don\u2019t have a lot of x-y-z options that will make you get better. Providers may be a bit more guarded in their recommendations.\u201d<\/p>\n

The result may be a provider inadvertently suggesting to patients that the problems they feel so acutely are all in the head, Niehaus added. \u201cThat doesn\u2019t lead to a good therapeutic relationship or to good outcomes. And it can create distrust in the medical system. Patients need to see providers who take long COVID seriously.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Long-term effects of COVID-19 appear in people who recover from the disease only to be saddled with lingering, often mysterious physical symptoms. These \u201clong haulers\u201d are people struggling with long COVID, defined by the CDC as symptoms people experience four weeks or longer after the original viral infection. Many long COVID patients face an array […]<\/p>\n","protected":false},"author":2143,"featured_media":63063,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[4860,9087],"class_list":["post-62943","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-covid-19","tag-physical-therapy-and-rehabilitation"],"acf":[],"yoast_head":"\nLong COVID physical challenges require time, patience - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Long COVID patients suffer from physical challenges, such as fatigue. 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