Makindo Medical Notes"One small step for man, one large step for Makindo" |
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🧠 Long COVID (Post-COVID-19 condition) — persistent or new symptoms ≥12 weeks after acute infection, not explained by an alternative diagnosis. Multisystem; fluctuating course; pacing and symptom-guided rehab are central.
| Domain | Common features | Initial approach (primary care) |
|---|---|---|
| Energy / Fatigue | Profound fatigue; post-exertional symptom exacerbation (PESE/PEM); unrefreshing sleep | 🧭 Teach pacing & energy envelope; avoid fixed graded exercise. Sleep hygiene; screen for anaemia, thyroid, B12, ferritin, HbA1c; occupational/education adjustments. |
| Breathlessness / Chest | Dyspnoea, chest tightness, cough; palpitations | Vitals incl. SpO₂; CXR (≥12 wks if persistent), ECG; consider BNP if HF symptoms; inhaler trial if variable wheeze/cough. Safety-net for red flags. |
| Neurocognitive | “Brain fog”, poor concentration, headaches, dizziness | Rule out depression, anxiety, sleep apnoea, migraine. Cognitive pacing, task chunking, screen/limit multitasking; consider work/study accommodations. |
| Autonomic / Orthostatic | Orthostatic intolerance, tachycardia (possible PoTS), temperature dysregulation | Active stand test; fluids 2–3 L/day, ↑salt if appropriate, compression stockings, slow position changes. Consider propranolol/ivabradine under specialist advice if PoTS suspected. |
| MSK / Pain | Myalgia, arthralgia, deconditioning | Gentle flexibility and symptom-contingent strengthening within energy envelope; heat/ice; simple analgesia; avoid NSAIDs if gastritis risk. |
| Mental health | Anxiety, low mood, PTSD-like symptoms | Validate; brief CBT-informed strategies; peer support; consider SSRIs/SNRIs if indicated; manage insomnia. |
| GI | Nausea, diarrhoea, abdominal pain | Hydration; low-FODMAP trial if IBS-like (short term, dietitian if possible); rule out red flags; treat reflux/IBS per guidelines. |
| ENT / Olfactory | Hyposmia/anosmia, dysgeusia | Olfactory training (twice daily, 12+ weeks); treat rhinitis/reflux if present. |
| Tests | Why | Notes |
|---|---|---|
| FBC, U&E, LFTs, CRP, ferritin, TSH, HbA1c, B12/folate | Screen for anaemia, thyroid disease, inflammation, diabetes, deficiencies | Target correctables that mimic fatigue/brain fog |
| ECG; consider CXR (persistent resp symptoms ≥12 wks) | Exclude occult cardiopulmonary disease | Troponin/BNP guided by symptoms/exam |
| Urinalysis; pulse oximetry (rest/exertional) | Renal screen; exertional desaturation | 6-minute walk if safe; stop if symptomatic |
| Directed tests | Only if red flags (PE, myocarditis, new neuro deficits) | D-dimer/CTPA, echo, neuro imaging per presentation |
“Long COVID can wax and wane. Working within your energy limits, prioritising sleep, and tackling one problem at a time usually helps. We’ll rule out other causes, support your rehab, and review regularly. Seek urgent help if you develop chest pain, fainting, or new breathlessness.”