Canada: Edmonton Long covid clinic - Park Integrative Health, Neeja Bakshi

[Mij]

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[Hutan]

An article about the clinic, Park Integrative Health
Specialized clinics to treat long COVID are in demand and physicians say they can't keep up
Jun 2022

Dr. Neeja Bakshi, an internal medicine physician based in Edmonton, runs a post-COVID clinic out of her private practice to help patients with long COVID.

Since it opened last fall, Bakshi says demand is so high that patients getting referrals now have to wait until November to get their first appointment. She's getting five referrals per day for post-COVID treatment, which is double what her clinic gets for general internal medicine.

She's also getting referrals from other provinces: B.C., Ontario and Manitoba.

"It feels great that I'm providing a service that can help so many people," said Bakshi. "But it's also an incredible pressure because I know that I can't see everybody and I know that I'm not going to be able to provide the care that I want if I'm burnt out."

At Bakshi's long-COVID clinic, patients are first tested for acute infections in their organs and then given a quality-of-life assessment.

"I use that as kind of my starting point to say, where do we want to get to between now and our next visit? And we look at both pharmacotherapy [medication], rehab, allied health, anything that we think that will help this patient," she said.
The clinic, part of Park Integrative Health, includes massage therapists and dietitians, but Bakshi is the only doctor there who sees long-COVID patients.

 

[Hutan]

From the twitter thread, Dr Bakshi has Long Covid herself.

She knows what PEM is

What I've learned... There are definite patterns. Dysautonomia/POTS. Cognitive dysfunction and brain fog. PEM (post exertional malaise). Unexplained rashes. Muscles feeling like cement. Migraines. Chest pain. So much chest pain. Shortness of breath.

She is obviously sympathetic and goes into bat with insurance companies for her patients:

How my clinical process has evolved.... Pre-appt screening tests, quality of life scores, functional assessment scores. During appointment visual aids to help understand possible pathophysiology.

Comprehensive educational documentation with personalized recommendations for each patient as info is often overwhelming, esp with brain fog. Treatment aimed at both "Band-Aid toolbox" to help quality of life and "Root cause" looking at immunomodulation, anti-inflammation.

Nursing and physician check ins. Regularly. Reflective listening, validation, and commiseration. Continuously reading, searching, hoping to find next breakthrough or tool that can be used.

Fighting tooth and nail to have claim adjusters understand that "pushing through" and excessive functional assessments for the patient is contraindicated in patients with long COVID and ME/CFS.

10 months in, some of my patients have been able to be discharged, feeling almost close to pre -COVID health. Some have gotten COVID again, which worsens their symptoms and we start everything from scratch.

But the vast majority of Long COVID patients are in this purgatory. Not knowing which way their life is going to go. Is this the best it's going to be? Am I one illness away from going back to where I started? Will I be able to work again? Will I feel normal again?

After 2.5 years, we have only begun to scratch the surface of Long COVID, and understand its impact on individuals. I fear we will continue to underestimate its impact on our province, our nation and truly the world.

But I find the list of treatments rather sad - rehabilitation, LDN? acupuncture? Where's the evidence? It feels as though medicine hasn't moved on very far from the days of blood-letting.

1. What treatments am I recommending? If dysautonomia/POTS- common known tx: fluids, electrolytes, beta blockers, ivabradine (the latter often comes with cost / coverage barrier). Fatigue/inflammatory symptoms: antihistamines (Blexten, rupall); LDN (low dose naltrexone)

Other treatments usually based on symptoms - vitamin deficiency replacement, mood support (ADHD, depression), inhalers, anti-inflammatories, and much much more. Non pharmacological - rehabilitation (with the right team that understands CFS), acupuncture, counseling / CBT.

 

[rvallee]

rehabilitation (with the right team that understands CFS)

And there's that trope again. A trope with zero evidence. There is zero evidence that "rehabilitation" makes any difference in outcome, and most will be BPS anyway, so they will not understand it at all, while being convinced they do, the worst-case scenario, especially given the complete lack of accountability for outcomes.