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Rehab for Long Covid
Mar 16, 2022 · News

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A patient getting help from a physiotherapist to sit up in bed, a simple task we take for granted that can be hard for long Covid sufferers. — Photos: FAIHAN GHANI/The Star

 

There are rehabilitation programmes available for those with post-Covid symptoms, so don’t suffer in silence, seek help.

Last week, the government acknowledged that an increasing number of people are being afflicted with post-Covid syndrome for long Covid.

It takes roughly two weeks to recover from mild or moderate Covid-19, but some people experience lingering health problems after recovering from the acute phase of the illness. 

Such patients, including those who originally had no symptoms, might indeed be severely debilitated, and medical science has yet to find a clear reason as to why this happens. 

People living with long Covid or “long haulers” as they are called - suffer from a broad spectrum of symptoms, such as fatigue (the most common symptom), breathlessness, chest pain or tightness, brain fog, insomnia, tachycardia (a fast heartbeat) upon movement, palpitation, dizziness, pins and needles, joint pain, depression and anxiety, tinnitus, ear aches, feeling sick, diarrhoea, stomach aches, loss of appetite, intermittent fever, headaches, sore throat, changes to sense of smell or taste, and so on. 

Our statistics show that 62.4% of Covid-19 category 4 and 5 patients continue to have symptoms even after more than three months.

Long haulers live with profound uncertainty as symptoms recede and return, sometimes inexplicably. 

Apparent recoveries can be followed months later by heartbreaking relapses. 

The Health Ministry has put in place measures to support long Covid sufferers. There are around 3o public hospitals nationwide offering rehabilitation services. 

However, the queue and wait time to get an appointment is long.

And more importantly, most of the public do not know such programmes exist.

Some private hospitals also offer such rehabilitation programmes, but the price may be steep and most insurance companies do not cover these inpatient and outpatient services. 

While the authorities are working with different groups to provide better care for those with long Covid symptoms, more needs to be done. 

Says consultant rehabilitation physician, Dr. Nor Azira Ismail: “I hear a lot of people complaining about having post-Covid-19 symptoms, but I wonder where they go and what they do?

“Not many people are coming in voluntarily for long Covid consultations unless they are referred by a respiratory physician. 

“So far, I’ve only had one patient who came (by herself) to improve her cardiac endurance as she had cardiomyopathy.

“People don’t seem to look at function and quality of life; when they recover from Covid-19, they are relieved, so whatever function they have left, they just manage and cope.” Around 60% of long Covid patients belong in rehabilitation is important so that they can go back to their pre-illness state and be independent again.

She says: “The virus causes your body systems to go haywire and there are problems from head to toe - they have multisystem issues.

“Some can cope with normal activities, but when they start working, they notice they lose concentration after and hour, so we have to address each person individually.

“We don’t want to miss anything that is disturbing their life.”

Working together

When a patient comes in for consultation, the rehabilitation physician will assess his problems and work on goals.

Those with severe symptoms need to be admitted for two to four weeks, or more, if required.

Usually, those in the working age group want to get back to work as soon as possible, but there are some who still need oxygen supplementation as their lungs are not working optimally.

“They may be afraid or anxious of getting off the oxygen, and we need to rebuild their confidence, so we assist them in terms of breathing.

“Other patients appear healthy, but when they sit up in bed, their oxygen levels drop to 60% and they get very scared,” shares Dr Nor Azira.

She explains: “We look at a few parameters, including the heart rate and blood pressure.

“These two go together: when you lack oxygen, your heart rate goes up, and that means your heart is compensating by pumping harder.

“When you have anxiety, your heart also pumps harder and these things contribute to breathing issues.”

The post-Covid rehab programme may consist of doing 30 minutes of intense physiotherapy, followed by a five-minute rest, then 30 minutes of occupational therapy, five minutes rest, and so on.

Muscle-strengthening activities do not need equipment, especially for patients who are very weak.

She says: “If you ask them to push your hand, which is giving resistance, it’s also a way of strengthening. 

“Imagine having to do that for 30 minutes – it can be very tiring. 

“If they cannot sustain it, then we reduce the time.

“Patients go throughout least five or six sessions daily, depending on their capability - it’s tough love!”

Any rehabilitation requires a bit of pushing for the patient to improve.

Dr. Nor Azira points out: “It’s not torture! We are doing things together and the patient’s input is important, so they must tell us if they are tired or if they cannot take the intensity of activity. If we push too hard, it might cause the heart rate to soar further and this induce arrhythmia. We don’t want patient to have a heart attack when they exercise!”

Once the patients’ goals are met and they can confidently and safely do the activity, they can be discharged.

However, she admits that with long Covid, patients seldom return to pre-fitness levels.

“They either have lingering fatigue issues or get palpitations easily, which could be psychological as well. We do counsel them: however, since there is a stigma  with mental health, some of them don’t want to be implicated with having a psychiatric condition as it can impact work, promotion, etc. It’s something of a worry, especially in the private sector,” she says.

Still, Dr. Nor Azira wishes more people are aware that rehabilitation help is available for long Covid and patients don’t have to suffer in silence.

“If long Covid is affecting your quality of life, consult a rehab physician to see if something can be done. We can sit down and talk-rehab is not only physical and medical as we see the patients as a whole. Many simple things can help, even going to the spa!” she says.

On her feet again

If she had not gone for post Covid-19 rehabilitation , K.Y. Lee would probably not have recovered as quickly, even though the process took her more than five months.

Last July, the 55-year old’s world came crashing when she tested positive for the infectious disease, along with her husband and sister-in-law.

While the latter two were discharged within a few days of being admitted to Hopsital Sungai Buloh, Selangor, Lee was warded for more than a month and needed oxygen supplementation as a category 4 patient.

The diabetic recalls: “I couldn’t eat; my lips and mouth were dry; I had to wear diapers because I couldn’t walk; and my back hurt from lying down all the time.

“I got my first dose of the vaccine and a day before my second dose was due, I caught the virus - it was a terrible period.”

Every day, she prayed she would recover as she needed to work to earn money.

Alas, she could barely sit up in bed.

“I work in a restaurant and if I don’t work, I have no salary. For more than five months, I had no income, so I had to withdraw from my EPF to pay for rent and groceries. My husband has a heart problem and stopped working more than a year ago - I’m the sole breadwinner. I told the doctor in Hospital Sungai Buloh that I needed to work, but I still couldn’t walk even after than a month. He kindly sent me to private rehabilitation hospital as part of the Health Ministry’s decanting programme,” says Lee, who was shuttled over to the private hospital in an ambulance. 

Although she was still bedridden, her rehabilitation included three exhausting sessions in the morning and another in the evening.

Every time Lee would attempt to sit, her pulse would quicken and she’d get breathless, so her first therapy task entailed sitting for five minutes - an activity most of us take for granted.

She says: “Even then, I wasn’t able to keep my back straight and would sway to the side. It took me about three weeks before I could stand - my legs had no strength and the would quiver.” 

Once she get better and didn’t need oxygen supplementation, Lee pushed herself harder, determined to recover. While the rest of the patients were resting or sleeping after their therapy sessions, she would hold on to the bed frame and walk around it. 

Much to her doctor’s amazement, she progressed rapidly, and within a week, was able to walk unaided. Slightly over a month later, Lee received the good news that she could be discharged.

“I was happy to hear this, but when I was about to go for my final physiotherapy session, my blood pressure and heartbeat suddenly rose very high, so the therapist sent me back to the ward. A few doctors and nurses surrounded me, machines and all - I was terrified, started to shiver and was given a jab. Then I fainted. I’m not sure what happened,” she says. A few days later however, Lee was allowed to go home. But in her quest to get stronger, she walked too fast, lost her balance and fell, injuring her leg. 

Once again, she was admitted to a hospital where she spent a week rehabilitating.

When the bubbly Lee reflects on her Covid-19 ordeal, it still scares her.

“That was my first ever hospital stay and I saw people who were so much healthier and fitter than me in wheelchairs - some didn't make it. Every time I go back for my follow-ups to check my lungs and fast heartbeat, I’m traumatised thinking of needles; I was pricked so many times, both my arms were bruised. On the bright side, I lost 13kg from 85kg, I’m now 72kg!” she says happily.  “But my hair has dropped from the medicinal side effects so I had to cut it really short.”

Prior to getting infected, Lee never controlled her diet despite having diabetes, but of late, she tries to eat healthier and exercise in the morning.

She says: “Something has changed because I cannot eat much anymore and food tastes different, although I didn’t lose my taste and smell when I had Covid-19” 

These days, she never ventures out except for work; hubby does all the grocery shopping. 

Her advice for those suffering from long Covid: “Go for rehabilitation, pray for strength and stay positive because life has so much to offer.

“I’m not back to 100%, but I’m thankful I can breathe and move again.”

By REVATHI MURUGAPPAN

WELLNESS Premium, Wednesday, 16 Mar 2022, 1:00 PM MYT

 

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