Thanks for joining us here on 9 news.
Plus. I'm Chris Bianchi.
And you've probably heard
about socalled long COVID,
which often involves longterm complications,
such as serious health issues
that can take place for months,
sometimes even years after
you initially got COVID.
But there's maybe a bit of a glimmer
of hope for those of you who may
have long COVID or those of you who
might know who have had long COVID.
In relation to taste and smell
and for a bit more honest we're
now joined by 9 news medical
expert Doctor Pyle Coley.
Dr.
Coley,
it seems that there's been
maybe some breakthroughs
in that department right
there really have Chris and and
so long COVID a lot of people say
oh as soon as I got over COVID.
Do I have long COVID?
It usually takes about four to six
weeks after the infection is cleared
if you still have persistent symptoms.
And as you said, Chris,
it can look different for different people,
but a lot of people are having that
persistent loss of taste or smell.
I know there's a firefighter
who lost his sense of smell,
and so it doesn't just impact
your quality of life,
it can impact what you do
for a living as well.
So having hope for a treatment,
and that's what we're learning
is we're sort of digging out
from the fallout of the pandemic,
so to speak.
We're going to have to come up
with new treatments.
And this new treatment is very fascinating,
particularly for the loss of taste or smell.
But it actually also works on other
aspects of long COVID as well,
by the way. So you may have seen there's
a viral video of a woman in America.
This was in early April,
a woman who had her first cup of
coffee after taking this treatment.
Is it strong? Yeah. So Dr.
Kelly mentioned there is a
breakthrough in terms of that.
Can you describe that for us?
Yeah. So this is called a
stellate ganglion block,
which is a fancy way of saying that we
have these nerve bundles at the base of
our neck that are part of our nervous system.
It's called the sympathetic nervous system,
and it regulates a whole bunch of functions.
Our heart rate, our blood pressure can
also regulate hormones or chemicals that
our body releases in response to stimuli.
And we know for a fact.
For reasons we don't quite understand,
that COVID can actually affect the function
of our nervous system in many different ways.
And that's really how it causes for some
people that fast heart rates or tachycardia,
the shortness of breath, the fatigue,
many of those other types of
clinical features of COVID as well.
What we learned with this treatment is
that that sympathetic nervous system
may also be involved in the loss of
sense of taste or sense of smell.
And then of course, the recovery from it.
So by by blocking it using an anesthetic.
An anesthetic is basically a medicine that
sort of turns off your nerve function.
So if you think about when you're
having a surgery or procedure,
if you don't want to feel pain,
you inject an anesthetic and it turns
off the pain nerves, so to speak.
So in this case,
when you inject the anesthetic
close to these ganglia,
it can change the way the sympathetic nerves,
which again regulate a whole host
of body functions and hormones,
behave.
And by changing the way that those
sympathetic nerves are behaving,
you can actually also change the blood
flow to the brain and you can change the
way that the nerves cause us to perceive
things in an inappropriate fashion.
Is that, okay,
I guess that is kind of exciting.
Can I just say that initially
when I hear that these sorts of
things that really regulate a lot
of your key functions is there?
A bit of a I'm sure it's been
tested out that there's no
side effects from this, right.
You know, we've been using it for
patients with chronic pain for a long
time and and and obviously you don't
want to block out all your nerves because
that'll impair your body functions.
But if you're very targeted go in
using ultrasound and other tools to
target it just to specific ganglia,
it is a reasonably safe and
well tolerated procedure.
And for a lot of patients such as
those with refractory chronic pain,
it actually works really well.
So, you know,
it's not something I'm overly concerned
about in terms of the risk to the patient.
But I am still trying to wrap my head
around the mechanism by which it helps
our sense of taste and our sense of smell.
Because one thing we know about COVID,
one of the ways in which it
attacks our sense of smell,
is that it directly poisons the nerves.
So it gets into the nerve cells and
causes damage to those nerve cells.
So now is it the chronic inflammation
left behind by long COVID?
Is it permanent damage to those nerves?
Is it changing the way the nerves
are responding to their inputs?
What is the way in which COVID has sort
of left those nerves permanently damaged?
That would help us to
understand how to reverse it,
and I think this is a step
closer in that direction.
Just understanding the
pathophysiology of that phenomena,
as I say, is that one of those
big takeaways from this is that.
Maybe they're not permanently
damaged and maybe there is a
way to alter course, right,
exactly. So it's sort of almost like
hitting reset on your computer like a
hard on your on the nerves of of your,
you know, sympathetic nervous system,
which may have been sort of left or right
or running a little clunky, so to speak,
because of the COVID infection.
Now we know that inflammation
is a part of this as well.
That's what we're still trying to tease out
is how much chronic inflammation plays a
role in some of those long COVID symptoms.
But the fact that patients have
not only improvement in,
you know, taste and smell,
but this is also case study.
Have been published and using this
therapy for actually changing some of
those other sympathetic nervous system
functions like the fast heart rates,
the shortness of breath,
the fatigue,
even those respond to these delic
ganglion blocks that really does sort of,
you know,
make us lead to the hypothesis that perhaps
they're somehow rewiring the nerves
and kind of hitting a reset on the body,
as you say. Sounds like a lot of the
initial takeaways have been helping
those with less severe, I mean not,
not to your point, not to mitigate.
Or not talk down about
the taste and smell loss.
But the more serious functions are also
perhaps coming back a bit more from this.
Yes, very much so.
And that's great news.
And it's yeah, it's not just
therefore the the, you know,
the quantity of our life,
but even the quality of our life
that we're learning how to sort of
recover and improve after kovat 19.
Now, what's interesting is that
the the different variants behave
differently in terms of how they sort
of poisoned or made our nerves clunky.
So there are variants that are
higher risk for potentially long.
Kovat. Some of the earlier variants,
particularly the Delta variant and
some of the later variants because
they have a milder initial illness,
may not leave as much kind of
long term chronic inflammation as
some of those earlier variants.
The vaccination status of the
person can affect whether or not
they have a risk for long COVID
and then the use of paxlovid,
which is that antiviral that really
suppresses viral inflammation.
New data is emerging that tells us
that that may also modulate the risk
of long COVID after an infection.
So I'm really encouraging most
of my patients now.
To talk to their doctors about Paxillovid,
not just if they're in that high risk group,
but also some of the young ones,
because I see plenty of young
people in my office that have
long COVID and are struggling.
And so if they're worried about long
COVID based on their initial illness,
they may want to be on paxillovid.
I guess when it comes to long COVID as well,
you mentioned a lot of your younger
patients that you're seeing.
My understanding and again this is
purely anecdotal on my side that
a lot of people have exhausting
and just a bit more of a. Right.
A bit more foggy headed as well.
I think those are some of
the symptoms of hurt.
Is there any indication that this
can help that specifically as well?
Yes. And that's the other thing because
we're really it's not just the exhaustion,
it's it's the exhaustion that leads
to then the depression that then
leads to the slowing down which
can then lead to the weight gain.
It's the foggy head which leads to
performance at work which can then lead
to lack of sleep which can then you know.
So it's the dominoes all falling one
after the other and it's really,
really hard because we as physicians
are struggling with their.
And sometimes I'm really left sort of
shrugging my shoulders to my patients.
Now, thankfully,
some patients have done really well with
what we call cardiopulmonary rehabilitation,
meaning graded exercise programs,
those types of things, to really help
kind of get their body back in shape,
retrain their nerves and their body as to
how to exercise and how to feel better.
Certain antidepressants have worked in
some patients, but for some, as you said,
the headaches, the brain fog, the fatigue,
the sleep disturbances, you know,
the shortness of breath, the tachycardia.
I have young.
A woman who's a physician,
when she stands up,
her heart rates kind of shoot
way up into the one 50s.
And she used to be an athlete.
So it makes it really difficult for
her to exercise just so many different
ways in which this has left its impact.
And,
and we don't yet know,
but we have some theories that perhaps
young people may even be struggling
more with long COVID because their
immune system is even more in shape.
So when it reacts to a virus like COVID,
it can sort of overreact even
more than kind of an older,
you know,
less in shape immune system which
might have a blunted response to the virus.
Because we think part of this is a
virus itself and part of this is just
the inflammatory response from our
immune system that it leaves behind.
I guess also final thought about this is
that we're still really learning a lot.
About COVID and we're more than three
years now into this being a global
pandemic and yet feels like every day,
every week there's new things
coming up, isn't there?
Very much so. And I also think
it's not just one virus,
it is a whole family of viruses
because the variants kept changing.
I mean, you know, from the very
first variant to the Delta variant,
which you know was very lethal to this
latest Omicron and it's subvariants,
it's almost like dealing with different
diseases and and it's one of those viruses
that has left us so humbled because it
has receptors on so many different cells.
It's not just the lungs,
it's not just the blood vessels,
the brain, the heart, you know,
all sorts of organs that it can potentially
infect and live within and cause changes in.
And and we're going to continue,
I think not just today or this year,
but for the next several decades,
I think to really try to understand
the pathophysiology of kovat,
how it's affected our thinking,
how it's affected our.
Or brain size.
We've seen brain atrophy or shrinkage
for people that have had COVID.
So I call anyone who's had
COVID or COVID survivor.
And I think that the medical textbooks
from now on are really going to
be looking at a lot of these COVID
survivors and really helping us
inform future decisions and and
learning about new treatments.
As you said,
I was going to end it there, but.
Brains are shrinking as a result of COVID.
Yeah, so we've seen data that you have brain,
you can have brain atrophy
after a COVID infection.
So the size of the brain can
potentially actually also be smaller.
So terrifying, so much that we're learning.
But at the same time,
I feel like it's really helping us
to empower ourselves and each other
to find therapies to reverse some
of this because it doesn't mean we
have to accept it for what it is.
It just means we need to look harder
to try to make things better and
kind of recover from everything
that's happened to us.
This is fascinating insight. So Dr.
Pile Coley, we really appreciate
a few minutes of your time and
letting us your expertise and
a bit more about some of those
treatments for long COVID.
So thanks again.