Finding Your Anchor

by Dr. Iva Lloyd, ND

In times of chaos and change is it always helpful to have an anchor, something that keeps you steady during the storm. Anchors allow us to move forward through times of change by helping us stay grounded and limiting the chance that decisions that we make are based on fear.

The following are some tips on finding an anchor that works for you and supports your health during times of chaotic change.

Analogies

The mind likes analogies as they assist in making sense of chaotic times. They provide a perspective that helps us understand the complexity of new situations that threaten our sense of safety. They assist in providing a sense of order or process during difficult situations. At times, they can also provide a sense of meaning to things that we don't yet understand. For me, the analogies where there is extreme destruction and chaos which result in a "new normal" such as a hurricane, a forest fire, a home renovation or even war, may help explain this current pandemic.

We want to keep in mind that infections that threaten health are not a new thing. Learning from the past can help navigate the current situation. For example, an article in the European Journal of Cultural Studies has compared the current pandemic to the AIDS crisis 30 years ago in a paper titled, "Pandemic and its metaphors: Sontag revisited in the COVID-19 era.  This article highlights the overwhelming sense of fear that was originally associated with AIDS that has now significantly subsided even though AIDs has not gone away.

Change is Inevitable

Many people handle acute crises quite well. Acute crises, such as accidents, injuries, losing one's job, death of a loved one, the diagnosis of a serious condition and other life events, are seldom welcomed but there is the awareness that "things happen" and you get through them. There is generally a structured process that walks someone through the change. For example, there is a process that you follow once a loved one has passed or if there is a flood in your home - we know what needs to happen and in what order. The sense of structure and process helps us get through significant life events.

Yet, for everyone there is a cap or ceiling on the degree of change that they are comfortable with and that they are able to integrate into their lives and still maintain a sense of being okay. The pandemic is a new type of change for many of us as we are being asked to change because of an invisible external threat. Not to say that there isn't a virus, but the change that has happened as a result has affected people in many different ways.  

For some, this pandemic has resulted in the loss of loved ones. For others, it has resulted in concern for their children or their aging relatives or neighbors, the inability to spend time with family and friends and/or the realization of the tremendous mental strain the pandemic has had on people of all ages. For others, it has resulted in the loss of a job or business and/or other financial concerns. And for many, the major impact has been the loss of personal freedoms and civil rights and the impact that this will have on our future. 

The factors that have made change difficult for some people to navigate during this pandemic  include:

• External Forces: The change has been initiated by external forces in ways that we could never (and still don't) believe were possible.
• Lack of Debate: There has been a lack of consultation, debate and understanding of the broader perspective and breadth of the impact on so many.  As Canadians, we are used to filtering out the truth or at least what we believe to be true, through listening to experts debate. During this pandemic there has been pretty much no debate which has intensified the chaos and sense of fear - on all sides.

Acceptance 

When there is a significant change that has affected a person's life, it is always helpful to accept the reality of the situation - maybe not initially if there is a chance that things may change back, but eventually. Acceptance is not always about agreement. It is about recognizing that some changes alter the future forever. 

With over twenty years in healthcare, I have found that the greatest impact to health is when a person's energy is split - that is, they are living one life yet desiring something else. When your energy is split it drains you, frustrates you and/or it makes you angry. In can also show up in physical symptoms such as pain, inflammation and conditions like autoimmune and others.

This split in energy shows in many different ways. From little things such as eating "clean", but really desiring the junk food you are avoiding. It shows up as choosing a certain job or relationship because they make the most sense, but really desiring something or someone else. There can be a split in energy after an accident or injury when a person doesn't accept that something "bad" happened. At this point in the pandemic, there is a good chance that there will be a split in energy for those that still believe that there is a chance that we will go back to the "old normal".  

The aim of acceptance is to make decisions from a point of knowing, not from fear. It is about deciding to move forward within the reality of the new situation versus waiting or wanting things to go back to a previous reality. Knowingness comes from both knowledge and from instinct. For some, knowledge is the most important, while for others it is instinct. Having and trusting both is important.

Avoid Getting Overwhelmed

A little bit of stress and change can be motivating and can help facilitate change. Being overwhelmed, on the other hand, can become paralyzing.  It can actually be detrimental to acceptance and can be demotivating. When overwhelmed, the ability to make rationale decisions based on what it best for you is hampered. There is a greater likelihood for people to abdicate their own thinking processes and make decisions out of fear.

Steps to take to avoid being overwhelmed include:

• Decrease the time you spend listening to or engaged in whatever is overwhelming you.
• Engage in grounding exercises such as going for a walk (ideally in nature or in the forest), gardening, stretching exercises, breathing exercises, etc.
• Choose whole foods and limit sugar, caffeine and processed foods.
• Stay hydrated and active.
• Spend time doing things that you truly enjoy, like listening to music or reading a good book.
• Reach out to others. You may find that a phone call is more nurturing and grounding than text messages (or maybe I'm just showing my age!).
• Remember it is important to have your opinion and beliefs, but it is also important to recognize that others may have a different perspective that warrants consideration.

Truth Versus Relevance

Each person has their own truth, their belief and their position on any specific issue. Linking back to the section on change, we are reminded that the impact of a crisis may vary for different individuals. There is "truth" in many different perspectives - what matters to people is what is relevant to them. We have tended to lose sight of the difference between "truth" and "relevance".  For example, the following statements are all "true" (to someone):

• People are dying of infections.
• More people are suffering with mental health issues - young and old.
• The elderly have been more isolated which has had a significant impact on their quality of life and their health.
• The impact on children is immense and may affect them mentally, academically and socially for years to come.
• Our rights and freedoms have been significantly impacted in the last few years.
• Financially we are in trouble in Canada (and many other parts of the world).
• Businesses have closed and are closing all around us.
• Climate change is getting significantly worse and it is being ignored, for the most part.
• Environmental pollutants are likely going to be the next big crisis.

And on and on.  Each person has their own "truth" and their sense of "relevance".  When in fear, there is a tendency to jump to conclusions based on the truth that is in front of us. When grounded, there is a greater chance on making a decision based on relevance. Relevance takes the "truth" into consideration but it also weighs the short-term against the long-term and weighs a broad range of impacts for individuals and the greater community.

Find Your Lane

An analogy that I use with patients is that life is a paved highway with multiple lanes. When you are in sync with your life you are on the pavement. When you're not, it feels like you are riding on the shoulder and at times it can feel like you are going through life in the ditch. There is choice in life (the different paved lanes), but there is also the need to make choices that are best for you and that keep you on the pavement and not on the shoulder or in the ditch.

"Your lane" refers to what you should be doing. It is about your choices and your role in any situation. For example, as a naturopathic doctor, my "lane" during this pandemic is to provide primary health care by staying current on the research related to post-COVID infections and vaccine-related injuries so that I can support patients in their journey through this chaos. 

Each person has the ability to decide what lane they want to choose. An important point to remember is that there are various lanes and a lane is only the "right" lane, when it is aligned with your truth. For some, this pandemic has not changed very much in their life and they are comfortable with the lane they are in. For others, it has felt that they are moving through life in a fog and they aren't sure of their way. They may have lost their business or job and need to find a new way to support their family. Or they may be uncertain of the future for various reasons. Keep in mind, even in war there were those that were fighting the war, those that were building products to support the war, those that were fighting to end the war and those that were just trying to survive the war.

For some, their lane keeps them in the middle of the chaos - and that's okay - if that's their choice. For others, their lane simply involves taking care of a loved one or checking in on neighbors that are alone. Others may be focused on their own personal health, a family crisis or on keeping their job so that they can support themselves and their family. You will know when you are in the right lane as it is easier to move forward, despite the chaos.

Finding Your Anchor

Either at the beginning of the process, or at the end, it is helpful to find an anchor -- or a few anchors. Anchors are things that you can hang onto that pull you through a crisis. Your anchor can be anything that you know to be true - to you.  For some, that anchor is family and the desire to spend time with those they love. For others it is astrology and the belief that there is a higher purpose driving this change. For some, it will be the desire to graduate from University and make a difference in the world. Faith or spirituality has been the anchor for some during these uncertain times.  For others, it may include another person or practitioner that helps you navigate the change. 

An anchor is something outside of the chaos that you know to be true and to be beneficial for you. Your anchor should help provide a perspective that ensures that the decisions that you make are best for you, not only in the present moment, but in the future.  Anchors help ensure that we can keep an open mind and make decisions based on relevance to ourselves and others.

Master Your Mind

Is your mind supporting your health and your decision making or is it fighting you?  I truly believe that mastering the mind is the key to health in chaotic times and as you get older. The following are some tips on mastering the mind:

• Spend time eavesdropping on your mind. Get a sense for the mind chatter that occupies it.
• The mind generally settles more when it looks at a situation from a number of perspectives. Be open to seeing any chaotic situation from the perspective of you, others, community and global.
• If anxiety, fear, frustration or other emotions are driving your life, then look at ways of quelling these first. Check out books on the topic; talk to friends and family; seek help from your naturopathic doctor or healthcare provider.  Reach out.

For further information on the mind, check out the following:

• blog: Power of the Mind: Top 5 Things to Remember

If the chaos in your life is overwhelming you, I recommend that you talk to your naturopathic doctor or other healthcare provider for guidance. You can also call our clinic at 905-940-2727 to book an appointment with Dr. Iva Lloyd, ND.

What to Eat in Autumn

 by Parisa Wong, Nutritionist

The climate changes rapidly in autumn and changing your eating pattern to match the season is the key to health. In autumn, due to the rapid changes in temperature and climate, many people find that their physical ailments are aggravated. Changing your diet so that it is more suited to the changes in temperature can help to prevent many symptoms..

According to Chinese medicine, Yang foods should be eaten in spring and summer and Yin foods in autumn and winter. Autumn is actually a very good time to nurture the body when you are in sync with the season.

Nourishing your arteries and decreasing dryness

The air is dry in autumn, and people are more easily irritable. At this time of the year, choose foods that cleanse your arteries and moisturize dryness to balance the autumn dryness. Good choices include: pears, kiwi, pomegranates, sweet potatoes, carrots, walnuts, lotus root, chrysanthemum, duck, duck eggs, etc.

• Lotus root is a powerful plant that has been used in East and Southeast Asian traditional medicine and cuisine for centuries. Lotus root contains both fiber and complex carbohydrates. These two components work together to help manage your body’s cholesterol and blood sugar. Fiber and complex carbohydrates also help steady the digestive process and nourish dryness.

Nourishing your lungs

Autumn is the best time to nourish and replenish the lungs. Foods that nourish the lungs include: almonds, apples, broccoli, kale, pumpkin, squash, molasses, lily and water chestnut. The best of the season is almonds. There are two types of almonds: sweet almonds and bitter almonds. Sweet almonds have a stronger effect of nourishing the lungs.

Almonds contain lots of healthy fats, fiber, protein, magnesium and vitamin E. From a western perspective,  almonds lower blood sugar levels, reduce blood pressure and lower cholesterol levels. They can also reduce hunger and promote weight loss. From a Chinese perspective, almonds moisturize the lungs, relieve cough, smooth the intestines, have a relieving effect on a dry cough and address lung deficiency and chronic cough.

• In Chinese medicine a common food used in cooking to nourish the lungs is white fungus. White fungus (Tremella fuciformis) is a wild edible mushroom that grows on tree bark and branches, especially on broad-leaved trees. It has been used as one of Chinese herbs because of its medicinal benefits for centuries. It tastes sweet and goes to the lung channel. It is commonly used for healing dry coughs, dry skin, clearing heat in the lungs, nourishing the bodies.

Nourishing the blood

One of the most important principles of Chinese nutrition in the autumn diet is to eat less spicy and more foods that are sour, such as oranges and green apples.  Other foods that are beneficial include:

• Grapes nourish blood, promote body fluids and quench thirst. They invigorate the spleen and have diuretic properties. Eating grapes in early autumn can also help the body detoxify and relieve internal heat. Red grapes can soften blood vessels, invigorate blood and remove stasis.
• White grapes have the added  effect of moisturizing the lungs and are suitable for people with a cough and poor respiratory system. Green grapes focus on clearing away heat and detoxification. Purple grapes are rich in anthocyanins which can beautify and fight aging. Black grapes nourish yin and nourish the kidney more prominently.

Other Recommendations

The autumn diet regimen should avoid cold foods such as raw salad, cold drinks and food directly from the fridge.  It is also important to avoid a lot of dry food and fried foods. Warm foods, like soup or porridge, are the better choice in the fall.

In addition, people's vitamin A reserves in the body are likely to decrease in autumn. This can result in problems such as decreased night vision, dry eyes and respiratory tract infections. Choosing more orange and yellow vegetables, such as pumpkins, carrots and tomatoes, can help ensure that your vitamin A stays adequate.

Personalized Nutritional Support

A balanced diet is the foundation to health. What is optimum varies from person to person and is dependent on your underlying conditions, your age and health status. 

If you have questions about what type of foods or nutritional plan is best for you, I would welcome the opportunity to work with you. For more information on my approach to nutrition, check out my blog on Yin Yang theory and detoxification or check out my bio on the Naturopathic Foundations website.

To book an appointment, please contact Naturopathic Foundations Health Clinic at 905-940-2727.

 

 

Your Ayurvedic Constitution & Dual Doshas

By Dr. Leena Sripada (Athparia), ND, AAWC

When we work through the Ayurvedic lens, one of the aspects to consider for good health is the balance of the bio-energies of Vata, Pitta and Kapha in the body and mind. For some people, through an online quiz or through an assessment, one of the doshas appears most prominent. However, in some people, this is not the case. Two different doshas are dominant and I often get asked these questions: what happens if I'm a mix of 2 doshas? Should I treat vata or pitta first? Vata needs more warming and grounding foods while pitta needs more cooling foods. How do I know which route to take? This blog is to help clarify some of the features of dual dosha or mixed dosha types.

In an Ayurvedic assessment we look at the balance of the doshas in the overall body and in addition,  which organs or tissues. We also look at the balance of the doshas on a subtler level in the mind. For example, it's very common for people to fill up Ayurveda quizzes online and find out Vata is the dominant dosha. However, often this is a reflection of one's mental state (stress for example) and not necessarily what's happening in the body. You can be a Kapha type undergoing a lot of stress and anxiety (vata in the nervous system) but doesn't mean you should only follow a vata diet. 

When addressing dual doshas, we always look for the common elements between the doshas. We also take into consideration the stage of life of the individual and the season because these factors can bring imbalances up to the surface. For example, if you are a vata-pitta then I often suggest following a pitta-friendly diet in the summer and a vata-friendly diet in the fall & winter. Below are some general tips for supporting dual doshas:

Vata-Pitta Types

The common element between these two doshas is the need for grounding and earth element. Foods that are wholesome and activities that involve being outdoors are supportive for these types. We often consider a pitta type diet in the summer (more cooling foods) and a vata type diet in the fall and winter (more warming soups and stews). These body types are often more prone to inflammation and auto-immune disease so keeping these doshas at bay are very important.

Pitta-Kapha Types

The common element between these two doshas is the need for greens and cleansing food and activities. These types respond well to a diet high in leafy greens, herbs that are astringent, bitter and cleansing for the body. Water is the common element between these doshas, so often we look at food that is lighter and drier and helps the body get rid of excess water which might manifest as swelling or water retention. We often suggest a pitta diet in the summer and kapha diet in the winter.

Vata-Kapha Types

The common element between these two doshas is the need for warmth - spices like cinnamon and ginger and keeping warm with warm baths. Vatas need warm and hearty food and Kaphas need warm food but lighter and drier food. In these types, we need to look carefully and understand where the vata and kapha tendencies are and treat specifically. For example, if someone is gaining weight and feeling heavy, but feeling very anxious and stressed, we need to understand what approach to take. Blindly treating stress as vata imbalance (with remedies such as oils, nervine herbs) could lead to an excess in Kapha (heaviness, dullness). In this dual dosha it is very important to understand where the vata imbalance is and where the kapha imbalance is.

When we look at treating from an Ayurvedic perspective, it's important to distinguish the qualities and imbalances in the mind and also the body and treat accordingly. Health goes beyond looking at vata, pitta, kapha and includes so many other aspects such as agni (metabolic fire), ama (toxins), malas (elimination) and the trigunas (rajas, sattva, tamas). If you are looking for deeper wellness, it's always important to work with a practitioner to do a proper assessment and a customized treatment plan. Always keep in mind, Ayurveda is flexible and we don't necessarily come under the category of one or two doshas consistently - doshas change throughout the day, seasons and phases of life so it's important to continue to bring awareness to the changes in body and mind.

Dr. Leena Sripada is a naturopathic doctor with extensive training in Ayurveda. Whether you have specific health concerns or just want to promote general wellness Dr Leena provides customized care integrating Ayurveda & naturopathic medicine.  Please contact Naturopathic Foundations at 905-940-2727 or email lathparia@naturopathicfoundations.ca to book an appointment.

COVID Long-Haulers: There is Hope

 by Dr. Iva Lloyd, ND

For too many individuals the long-term effects of COVID have been more distressing than the acute phase. Like all diseases and discussions about health, it is imperative to remember that health and disease are complex. It is appreciating the complexity and the context that each individual finds themselves in that helps to understand what is relevant for them and how best to deal with the situation. Here is an overview of what we know about long-haulers also referred to as post-acute-sequelae of COVID (PASC).

PASC Symptoms

Most people with PASC will experience a range of symptoms. The symptoms depend on a person's underlying susceptibilities and where the virus "sits" in their body.  The symptoms can include:

• chronic fatigue 
• low grade fever that may be consistent or intermittent
• shortness of breath, especially on exertion with  or without a cough
• compromised lung and/or heart function
• joint and/or muscle pain or muscle atrophy
• mental health concerns especially as it relates to worsening anxiety and/or depression
• cognitive changes and brain fog
• skin rashes
• gastrointestinal upset
• headaches and sense of dizziness or instability
• decrease or change in smell and/or taste
• changes in sleep
• changes in menstrual cycle and flow

·       Risk of PASC

There does not seem to be a relationship between the severity of the initial infection and the risk of developing post-COVID symptoms. Research does tend to indicate that there may be an increased risk of developing PASC if a person had multiple symptoms (eg. >5) during the first week of illness. The symptoms associated with PASC tend to wax and wane, as well as shift, between physiological systems. The following outlines other risk factors.

• Comorbidities that may increase risk:  Underlying conditions that may increase a person's risk of post-COVID symptoms include significant cardiovascular disease, unstable diabetes, chronic lung disease, lowered renal function, obesity, progressive asthma, and significant mental health problems.
• Other characteristics that might increase an individual's risk: older age, female, blood type A, nutritional deficiencies, environmental factors (such as increased exposure to environmental pollutants, exposure to high levels EMF), chronic stress, lower socioeconomic status, and medications such as proton-pump inhibitors
• High risk blood indicators:  There are some blood tests that may be correlated with an increased risk of PASC.  High D-Dimer, high ferritin, high LDH, progressive decrease in lymphocytes, high neutrophil/lymphocyte ratio.  Your naturopathic or medical doctor can assess these for you and determine if they are relevant indicators for you.
• Nutrient deficiencies that may be worthwhile assessing: Vitamin A, Vitamin D, B12, Vitamin C, Vitamin K, Magnesium, Zinc, Omega 3 fatty acids, glutathione and melatonin.  Assessment of  gut health / microbiome.
• Home care: moderate exercise, clean diet (anti-inflammatory, avoid food intolerances, sugar and limiting dampness forming foods (wheat, yeast, dairy), decrease stress, ensure adequate sleep and hydration.

There are four main manifestations of PASC - neurological, heart and lung, kidney and liver, and skin.  Likely, a person's underlying suspectibilitites will influence the symptoms that they experience.

Post CV-19 Neurological Syndrome

Brain / Neurological	1st degree	2nd degree	3rd degree
Symptoms	Loss of smell, â cognition â short-term memory Brain fog, dysphagia, dysarthria, headache, Trouble sleeping, depression, anxiety	â â cognition / memory Confusion, delirium Dizzy spells, lightheadedness, Hair loss, HA	Cerebrovascular disease and/or changes in cognition and memory

Post CV-19 Heart / Lung Conditions

Heart / Blood vessels	1st degree	2nd degree	3rd degree
Symptoms Impaired endothelial function	Fatigue, exercise intolerance, easy bruising, dry cough, body aches, sore throat	Dyspnea, extreme SOB and fatigue, áá exercise intolerance, bulging veins, Erratic HT beat, arrythmia, worsening dry cough, tightness in chest, body aches, silent hypoxia, low affect, “lung burn”	Cerebrovascular disease

Post CV-19 Kidney / Liver Conditions

Kidney / Liver	1st degree	2nd degree	3rd degree
Symptoms	Fatigue, itchy skin, body aches	Ascites, itchy skin, áá fatigue	Liver and / or Kidney dysfunctions

 

Post COVID-19 Skin Conditions

Skin Conditions	1st degree	2nd degree	3rd degree
Symptoms	Fever, persistent cough, fatigue, chills and sweats, Urticaria	Pernio (persistent pain, discolouration of toes, cold) Chilbains, urticaria Morbilliform rash Macular erythema Vesicular eruptions Papulosquamous eruptions Retiform purpura	Organ dysfunction

 Naturopathic Approach to Post-COVID Symptoms

Naturopathic doctors treat the whole person. They assess an individual's underlying susceptibilities and healing potential, their current health status, lifestyle, as well the impact prior diseases have had from a mental-emotional and physical perspective. Naturopathic approach to PASC would likely involve:

• A detailed intake to fully understand an individual's susceptibilities, their current symptoms and how those symptoms have impacted their life.
• A physical exam, as needed.
• The requisitioning of blood work to verify the physical impact on the body. The specific laboratory tests would depend on each person's health history and PASC symptoms. 
• Some symptoms will warrant the need for chest X-ray, scans or other testing.

The treatment of PASC needs to be individualized based on each person's unique constitution, susceptibilities and manifestation of symptoms. PASC is a new condition. There is very little research specific to this condition and naturopathic treatments. Based on uses of specific modalities Naturopathic doctors are likely to consider approaches that include one or more of the following:

• Individualized dietary recommendations and other lifestyle recommendations to assist with healing.
• Naturopathic modalities and therapies that might be indicated include:
• Nutraceuticals such as N-Acetyl-Cysteine (NAC), Glutathione (nebulizer, oral), EGCG, Vitamin B12, Serropeptidase, Modified Citrus Pectin, Quercetin,     Lutein, Zexanthin, Astaxanthin, Vitamin A, C, D, E and Selenium and Zinc.

• Herbal medicines to address the specific symptoms such as St. John’s Wort (Hypericum perforatum), Ginkgo (Ginkgo biloba), Bromelain, Turmeic (Curcuma longa), Cordyceps, Hawthorn (Crataegus monogyna), Astragalus (Astragalus membranous), Andrographis (Andrographis paniculate), Milk Thistle (Silybum marianum), Buplerum falciparum, Taraxacum officinalis (Dandelion), Nettle (Urtica dioica), Burdock (Arctium lappa)

• Gemmotherapies such as Alnus glutinosa, Vaccinium vitis idea, Rosmarinus officinalis, Vinca minor, Lonicera nigra, Populus nigra, Prunus amygdalus, Corylus avelliana, Crataegus oxycacanta, Viscum album, Rosa canina, Gingko biloba, Juniperus communis, Ribes nigra, Fraxinus excelsior, Betula pubescens, Cedrus libani, Ulmus campestris

• Homeopathic remedies and tissue salts.

• Other naturopathic approaches as indicated such as acupuncture, hydrotherapy, Intravenous therapies, lifestyle counselling and others.

If you are someone you know is dealing with PASC, it might be worthwhile to work with a naturopathic doctor to discuss how they can support you on your journey back to health. To book an appointment with one of our naturopathic doctors, contact us at 905-940-2727 or email us at info@naturopathicfoundations.ca. 

References

Another article on COVID co-authored by Dr. Lloyd, ND:

 Lloyd I, Saunders P. Assessing for the co-morbidities and factors that may affect a patient's risk and response to COVID-19. CAND Vital Link. 2020;2:19-26.

The following is an overview of research on PASC.

 

Area of Study	References
Fatigue	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605. ·       Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. MMWR Morb Mortal Wkly Rep 2020;69:993-998. ·       Tolba M, Abo Omirah M, Hussein A, Saeed H. Assessment and Characterization of Post-COVID-19 manifestations. Int J Clin Pract. 2020 Sep 29:e13746 ·       https://evidence.nihr.ac.uk/themedreview/living-with-covid19/ (accessed Oct. 22, 2020) ·       https://www.thephysician.uk/editorial-after-the-pandemic (accessed Oct. 23, 2020) ·       Long COVID: let patients help define long-lasting COVID symptoms. Nature. 2020 Oct;586(7828):170 ·       Townsend L, Dyer AH et al. Persistent fatigue following SARS-CoV2-infection is common and independent of severity of initial infection. medRxiv https://www.medrxiv.org/content/10.1101/2020.07.29.20164293v1 (accessed Oct. 23, 2020)
Dyspnea/ breathlessness	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605. ·       https://evidence.nihr.ac.uk/themedreview/living-with-covid19/ (accessed Oct. 22, 2020) ·       Long COVID: let patients help define long-lasting COVID symptoms. Nature. 2020 Oct;586(7828):170
Cough	·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605.
Chest pain/ heaviness	·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026 ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605. ·       https://evidence.nihr.ac.uk/themedreview/living-with-covid19/ (accessed Oct. 22, 2020) ·       Long COVID: let patients help define long-lasting COVID symptoms. Nature. 2020 Oct;586(7828):170
Joint pain/ muscle pain	·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605. ·       Long COVID: let patients help define long-lasting COVID symptoms. Nature. 2020 Oct;586(7828):170
Chemosensory disturbances (persistent loss of sense of smell and taste)	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605
Cognitive blunting (“brain fog”)/ loss of concentration	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026.      ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605
Emotional health and well-being: ·	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       https://evidence.nihr.ac.uk/themedreview/living-with-covid19/ (accessed Oct. 22, 2020) ·       Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun. 2020 Oct;89:531-542. ·       Vittori A, Lerman J, Cascella M, Gomez-Morad AD, Marchetti G, Marinangeli F, Picardo SG. COVID-19 Pandemic Acute Respiratory Distress Syndrome Survivors: Pain After the Storm? Anesth Analg. 2020 Jul;131(1):117-119 ·       Leung TYM, Chan AYL, Chan EW, Chan VKY, Chui CSL, Cowling BJ, Gao L, Ge MQ, Hung IFN, Ip MSM, Ip P, Lau KK, Lau CS, Lau LKW, Leung WK, Li X, Luo H, Man KKC, Ng VWS, Siu CW, Wan EYF, Wing YK, Wong CSM, Wong KHT, Wong ICK. Short- and potential long-term adverse health outcomes of COVID-19: a rapid review. Emerg Microbes Infect. 2020 Dec;9(1):2190-2199
Skin rashes:	·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026 ·       Skin rash should be considered a 4th key sign of COVID-19 https://covid.joinzoe.com/us-post/skin-rash-covid (accessed Oct. 23, 2020)
Other:	·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605
Mitochrondia Support	·       Burtscher J, Cappellano G, Omori A, Koshiba T, Millet GP. Mitochondria: In the Cross Fire of SARS-CoV-2 and Immunity. iScience. 2020 Oct 23;23(10):101631 ·       Saleh J, Peyssonnaux C, Singh KK, Edeas M. Mitochondria and microbiota dysfunction in COVID-19 pathogenesis. Mitochondrion. 2020 Sep;54:1-7. ·       Singh KK, Chaubey G, Chen JY, Suravajhala P. Decoding SARS-CoV-2 hijacking of host mitochondria in COVID-19 pathogenesis. Am J Physiol Cell Physiol. 2020 Aug 1;319(2):C258-C267. ·       Kloc M, Ghobrial RM, Kubiak JZ. The Role of Genetic Sex and Mitochondria in Response to COVID-19 Infection. Int Arch Allergy Immunol. 2020;181(8):629-634 ·       Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, Walshaw C, Kemp S, Corrado J, Singh R, Collins T, O'Connor RJ, Sivan M. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol. 2020 Jul 30. doi: 10.1002/jmv.26368. ·       European Respiratory Journal 2020; 56: Suppl. 64, 4143. https://erj.ersjournals.com/content/56/suppl_64/4143.abstract (accessed Niv 6, 2020) ·       Ojo AS, Balogun SA, Williams OT, Ojo OS. Pulmonary Fibrosis in COVID-19 Survivors: Predictive Factors and Risk Reduction Strategies. Pulm Med. 2020 Aug 10;2020:6175964 ·       Li G, Hu R, Gu X. A close-up on COVID-19 and cardiovascular diseases. Nutr Metab Cardiovasc Dis. 2020 Jun 25;30(7):1057-1060 ·       Boukhris M, Hillani A, Moroni F, Annabi MS, Addad F, Ribeiro MH, Mansour S, Zhao X, Ybarra LF, Abbate A, Vilca LM, Azzalini L. Cardiovascular Implications of the COVID-19 Pandemic: A Global Perspective. Can J Cardiol. 2020 Jul;36(7):1068-1080
Specific organ dysfunction (heart): ·	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026 ·       Tolba M, Abo Omirah M, Hussein A, Saeed H. Assessment and Characterization of Post-COVID-19 manifestations. Int J Clin Pract. 2020 Sep 29:e13746 ·       Leung TYM, Chan AYL, Chan EW, Chan VKY, Chui CSL, Cowling BJ, Gao L, Ge MQ, Hung IFN, Ip MSM, Ip P, Lau KK, Lau CS, Lau LKW, Leung WK, Li X, Luo H, Man KKC, Ng VWS, Siu CW, Wan EYF, Wing YK, Wong CSM, Wong KHT, Wong ICK. Short- and potential long-term adverse health outcomes of COVID-19: a rapid review. Emerg Microbes Infect. 2020 Dec;9(1):2190-2199 ·       https://evidence.nihr.ac.uk/themedreview/living-with-covid19/ (accessed Oct. 22, 2020) ·       https://www.thephysician.uk/editorial-after-the-pandemic (accessed Oct. 23, 2020) ·       Long COVID and inflammation: a cardiologists point of view https://www.medscape.com/viewarticle/935488#vp_2 (accessed Oct 23, 2020) ·       Note: the reduction in heart pumping after recovering from COVID-19 may be more common in men according to preliminary results from the COVERSCAN study https://www.itv.com/news/2020-08-12/long-covid-what-is-it-what-are-the-symptoms-and-what-help-is-there-for-sufferers (accessed OCT 23, 2020)
Specific organ dysfunction (lung): ·	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026 ·       Tolba M, Abo Omirah M, Hussein A, Saeed H. Assessment and Characterization of Post-COVID-19 manifestations. Int J Clin Pract. 2020 Sep 29:e13746 ·       Leung TYM, Chan AYL, Chan EW, Chan VKY, Chui CSL, Cowling BJ, Gao L, Ge MQ, Hung IFN, Ip MSM, Ip P, Lau KK, Lau CS, Lau LKW, Leung WK, Li X, Luo H, Man KKC, Ng VWS, Siu CW, Wan EYF, Wing YK, Wong CSM, Wong KHT, Wong ICK. Short- and potential long-term adverse health outcomes of COVID-19: a rapid review. Emerg Microbes Infect. 2020 Dec;9(1):2190-2199 ·       https://evidence.nihr.ac.uk/themedreview/living-with-covid19/ (accessed Oct. 22, 2020) ·       https://www.thephysician.uk/editorial-after-the-pandemic (accessed Oct. 23, 2020)
Specific organ dysfunction (brain): ·	·       Del Rio C, Collins LF, Malani P. Long-term Health Consequences of COVID-19. JAMA. 2020 Oct 5. doi: 10.1001/jama.2020.19719 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026. ·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605 ·       Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020 Aug 11;370:m3026.
Specific organ dysfunction (kidney):	·       https://www.thephysician.uk/editorial-after-the-pandemic (accessed Oct. 23, 2020) ·       Tolba M, Abo Omirah M, Hussein A, Saeed H. Assessment and Characterization of Post-COVID-19 manifestations. Int J Clin Pract. 2020 Sep 29:e13746 ·       Prelimary results from the COVERSCAN study in Oxford https://www.itv.com/news/2020-09-29/long-covid-long-term-effects-of-coronavirus-include-damage-to-heart-liver-kidneys-oxford-study-reveals (accessed Oct. 23, 2020)
Other Research	·       Carfì A, Bernabei R, Landi F; Gemelli Against COVID-19 P ost-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020 Aug 11;324(6):603-605. ·         Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. MMWR Morb Mortal Wkly Rep 2020;69:993-998.  ·         Zhou H, Lu S, Chen J, Wei N, Wang D, Lyu H, Shi C, Hu S. The landscape of cognitive function in recovered COVID-19 patients. J Psychiatr Res. 2020 Oct;129:98-102 ·         Hascup ER, Hascup KN. Does SARS-CoV-2 infection cause chronic neurological complications? Geroscience. 2020 Aug;42(4):1083-1087. ·         Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain Behav Immun. 2020 Jul;87:34-39. ·         Steardo L Jr, Steardo L, Verkhratsky A. Psychiatric face of COVID-19. Transl Psychiatry. 2020 Jul 30;10(1):261. ·         Alam SB, Willows S, Kulka M, Sandhu JK. Severe acute respiratory syndrome coronavirus 2 may be an underappreciated pathogen of the central nervous system. Eur J Neurol. 2020 Jul 15:10.1111/ene.14442. ·         Heneka MT, Golenbock D, Latz E, Morgan D, Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimers Res Ther. 2020 Jun 4;12(1):69. ·         Salimi S, Hamlyn JM. COVID-19 and Crosstalk With the Hallmarks of Aging. J Gerontol A Biol Sci Med Sci. 2020 Sep 16;75(9):e34-. ·         Disser NP, De Micheli AJ, Schonk MM, Konnaris MA, Piacentini AN, Edon DL, Toresdahl BG, Rodeo SA, Casey EK, Mendias CL. Musculoskeletal Consequences of COVID-19. J Bone Joint Surg Am. 2020 Jul 15;102(14):1197-1204. ·         Azim D, Nasim S, Kumar S, Hussain A, Patel S. Neurological Consequences of 2019-nCoV Infection: A Comprehensive Literature Review. Cureus. 2020 Jun 24;12(6):e8790. ·         Kaniusas E, Szeles JC, Kampusch S, Alfageme-Lopez N, Yucuma-Conde D, Li X, Mayol J, Neumayer C, Papa M, Panetsos F. Non-invasive Auricular Vagus Nerve Stimulation as a Potential Treatment for Covid19-Originated Acute Respiratory Distress Syndrome. Front Physiol. 2020 Jul 28;11:890. ·         Kempuraj D, Selvakumar GP, Ahmed ME, Raikwar SP, Thangavel R, Khan A, Zaheer SA, Iyer SS, Burton C, James D, Zaheer A. COVID-19, Mast Cells, Cytokine Storm, Psychological Stress, and Neuroinflammation. Neuroscientist. 2020 Oct-Dec;26(5-6):402-414. ·         Conti P, Caraffa A, Tetè G, Gallenga CE, Ross R, Kritas SK, Frydas I, Younes A, Di Emidio P, Ronconi G. Mast cells activated by SARS-CoV-2 release histamine which increases IL-1 levels causing cytokine storm and inflammatory reaction in COVID-19. J Biol Regul Homeost Agents. 2020 Sep-Oct,;34(5):1629-1632. ·         Shaik Y, caraffa A, Ronconi G, Lessiani G, Conti P. Impact of polyphenols on mast cells with special emphasis on the effect of quercetin and luteolin. Cent Eur J. Immunol. 2018;43(4):476-481) ·         Akour A. Probiotics and COVID-19: is there any link? Lett Appl Microbiol. 2020 Sep;71(3):229-234. ·         Saleh J, Peyssonnaux C, Singh KK, Edeas M. Mitochondria and microbiota dysfunction in COVID-19 pathogenesis. Mitochondrion. 2020 Sep;54:1-7. ·         Dhar D, Mohanty A. Gut microbiota and Covid-19- possible link and implications. Virus Res. 2020 Aug;285:198018. ·         Baghbani T, Nikzad H, Azadbakht J, Izadpanah F, Haddad Kashani H. Dual and mutual interaction between microbiota and viral infections: a possible treat for COVID-19. Microb Cell Fact. 2020 Nov 26;19(1):217. ·         Baumann A, Gönnenwein S, Bischoff SC, Sherman H, Chapnik N, Froy O, Lorentz A. The circadian clock is functional in eosinophils and mast cells. Immunology. 2013 Dec;140(4):465-74