Long-term COVID outlook gets better with vaccine

DEAR DR. ROACH: Can you get long COVID from symptomless post-vaccine infection?

ANSWER: “Long COVID” refers to long-term symptoms following an infection with the novel coronavirus. These symptoms, which may persist for months (at least), include fatigue, difficulty concentrating often called “brain fog,” persistent loss of smell or taste, headache, chest discomfort and palpitations.

Approximately 30% of people with persistent symptoms after COVID had them following an asymptomatic case.

There isn’t enough data to answer your question based on evidence. I suspect it is possible to get persistent postCOVID symptoms even after vaccination, since none of the COVID-19 vaccines is perfect (nothing is, in medicine).

However, there is certainly reason to be optimistic. The first is that new data show a 70% to 90% drop in asymptomatic infections, which should translate to far fewer people with persistent symptoms.

Second, although the initial side effects of the vaccine can be rough for people with long COVID symptoms, there are many case reports of the symptoms improving after vaccination. In one survey, about a third of people improved with vaccination, while 15% to 20% worsened. This has been a bit of a surprise to experts.

I am hopeful that the COVID vaccines will be analogous to what we see with the shingles vaccine — it reduces the likelihood of getting shingles, but also reduces the likelihood of longterm complications from shingles, even in those who get shingles despite the vaccine. However, this is a guess until there are good studies.

DEAR DR. ROACH: I had an X-ray for back pain, and was told I had a “10 mm sclerotic bone lesion” in the pelvis. They are sending me for an MRI. What could this be?

ANSWER: There are several possibilities when it comes to sclerotic (“stonelike”) bone lesions. Many of these are benign: a “bone island” is a small area of compact bone within the spongy bone; other benign tumours, such as osteomas and enchondromas; and Paget’s disease of bone.

The MRI will help to distinguish between these benign causes and bone cancer. Cancer of the bone can be primary (that is, starting in the bone, which is uncommon) or can have spread from some other place, such as the lung or breast. A single lesion is more likely to be benign.

Hopefully, the MRI will confirm that this is a benign lesion.

DEAR DR. ROACH: At 89 years old, I watch TV, read the papers and struggle to stay awake. I take my meds as instructed, including senior vitamins. Is this part of the aging process?

DEAR DR. ROACH: Although everybody ages differently, it is common that older people get tired at earlier hours than they used to when younger.

However, a good many medications may cause sleepiness and difficulty concentrating, and it is certainly worth a chat with your pharmacist to see whether any you are taking might be causing this, and with your doctor to see whether any you might be taking could be changed, if appropriate.

Senior vitamins probably have little benefit in keeping older adults awake, and have never been shown to have benefit in keeping people healthy, so long as the person is eating a reasonable diet.

There are many medical conditions that can cause easy fatigue.

Obstructive sleep apnea is one that frequently goes undiagnosed for years.

DEAR DR. ROACH: I am an active 66-year-old male who had three stents put into my right coronary artery about 10 years ago after I had two heart attacks. I have not had any problems since then.

I am restoring a 1966 GTO convertible, which includes many days of heavy work and have had no chest pains, shortness of breath or any problems.

I take Plavix, ramipril, aspirin, Crestor and metoprolol. My concern is with the metoprolol. Several months ago, I was taking a 25 mg dose, and I was lying in bed one morning and could barely breathe. I checked my heart rate, which was 38. I did not feel dizzy or lightheaded, but rather sluggish. I did some research to find that it was very low.

I reduced my metoprolol to 12.5 mg per day. My heart rate now is around 40 when I wake up and gets to around 50 when I am up and active, which, to me, is still very low. It also tells me that perhaps I would be better off without it. According to my recent research, athletes have a lower heart rate. I am very active six to seven hours per day, some days more stringently than others. I am in pretty good shape.

According to what I was told, there was no damage to my heart when I had my two heart attacks eight and 10 years ago.

Our family physician, who was a very close family friend, once told us that if there was no damage, then it is like you didn't have a heart attack at all. Do I need to take any metoprolol?

ANSWER: Beta blockers like metoprolol have multiple beneficial actions in people with blockages in their coronary arteries.

They decrease the amount of blood the heart needs by slowing the heart rate down, by keeping it from contracting so hard and by reducing blood pressure. This all helps reduce or prevent symptoms.

They also help prevent some types of severe rhythm disturbances. In people with a history of any type of heart attack, even one without much damage to the heart, beta blockers have been proven to improve survival and are therefore among the most important medicines we have for people with coronary artery disease. This is true for people with occasional chest discomfort (angina), even without any history of heart attack.

While a slow heart rate can limit the ability to use beta blockers, even the small dose of beta blockers you are taking now is helpful and does not seem to be limiting your activity despite your slow heart rate. I would recommend you keep taking it, and I am sure your cardiologist would agree.