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Now, where did I put my glasses?

A common medical term is sequela. You pronounce it like this: seh-QWEL-uh. And it means the after-effects of a disease. In other words, a medical condition that is the consequence of a previous disease or injury.

In the 1950s when polio was ravaging our communities, many individuals who survived had permanent musculoskeletal issues requiring canes, crutches, and other devices. However, long-term follow-up of these survivors indicated a post-polio syndrome that occurred decades after the initial viral infection. Some of these patients developed fatigue, exhaustion, loss of muscle mass, and a decreased tolerance of cold temperatures. Sequela.

And more recently, sports medicine experts and neurologists now recognize the long-term consequences of concussions in terms of behavioral changes and impairment of memory and judgment. Sequela.

But there is a new demon on the horizon, a demon who may be a game changer when it comes to COVID.

This is the XBB 0.1.5 mutation that the World Health Organization says is the most transmissible mutation of the omicron variant. Just two months ago it accounted for only 2% of US cases and now (January 2023) is 27%. More than 70% of cases in the Northeast are believed to be this variant. And New York City health officials are now strongly advising the use of masks in indoor environments.

Now let us turn back the clock to reflect on one of the disabling sequela of a COVID infection: brain fog. We all know people who had COVID and are now suffering consequences, months and years after.

Here are some real-life examples of real people, not theoretical discussion.

  • Mrs. JP is a 55-year-old insurance company adjuster. Thirty-five years of experience filing claims. Acknowledged by the company as an award-winning and valued employee with a superb professional track record. Three years ago she went to a professional football game, and five days later came down with symptoms of COVID. The acute issues resolved, but she now has lingering frustration filling out the same forms that she had filled out thousands of times. She has lost that swagger at work and her career may be in jeopardy. She said, “I am just not that confident anymore.”

  • Ms. MN retired from an active cardiology practice where she administered stress tests to patients with heart conditions. Following institutional policy, she religiously wore a mask, washed her hands, and vaccinations were up-to-date. Following retirement about seven months ago, she became sloppy about the mask, went to Sam’s Club, and about five days later came down with symptoms of COVID. The acute muscular aches and low-grade fever disappeared, but brain fog is a major issue. At a recent community function, she explained, “I can't find anything, I’m losing everything.” Here was a meticulously organized, valued professional who now cannot find car keys, and she wonders if she will ever get back to baseline.

  • Dr. MW had been a prominent endocrinologist, a valued educator, a superb clinician, and an innovative researcher. Evaluations following some Zoom conferences indicated that “he was not on top of his game,” he “seemed befuddled and tangential in addressing routine questions.” He had had a mild case of COVID just months earlier. So mild, in fact, he only tested because his wife insisted on it.

Each one of us has a litany of experiences along the same lines. Interestingly, some of these infected patients had trivial almost insignificant symptoms of COVID but did test positive and here they are months or a year or more following the infection and not quite back on track. Sequela.

How do you know you have brain fog? This syndrome is characterized by confusion, forgetfulness, and a lack of focus and mental clarity. There is no specific test, but a general medical evaluation in concert with a neurologic assessment including cognitive testing would be an important evaluation. You should expect some routine blood studies to see if there is something else going on such as anemia or metabolic or endocrine abnormalities.

Lifestyle modifications have a proven track record of modifying brain fog in most individuals. Here are some helpful solutions:

  • Spend less time on the computer and cell phones. Take a break.

  • Without doubt, stress can worsen brain fog. Find ways to decompress (yoga, meditation, reading). Prioritize your limited energy or someone will prioritize it for you.

  • Follow a plant-based Mediterranean-type diet minimizing meats of animal origin. And be mindful of processed food.

  • Get 8 hours of restorative sleep with consistent and predictable cycles for sleep and wakefulness. Losing a night of sleep affects mental performance as much as being legally intoxicated.

  • Practice regular aerobic activity consisting of exercise for approximately 30 minutes 5 days of the week.

  • Talk with your doctor about your concerns to rule out other causes.

Bottom line, take away—

With the emergence of this new virulent mutation, we need to understand our risks and the need to be vigilant about wearing masks, avoiding crowds, and having our immunizations current. Yes. Still. This is not over.

Understand modifiable lifestyle factors that can shift the odds in your favor. Be engaged, be proactive and know what you can do if you become concerned about losing your cognitive bandwidth.

Join me on Instagram for a daily message about lifestyle and stress: @AskDoctorEd.

Image from Unsplash.


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