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Post COVID reflections from the plane. OP-ED by Ala Tocarciuc


https://www.ipn.md/public/index.php/en/post-covid-reflections-from-the-plane-op-ed-by-ala-7978_1078294.html

The biggest problem, however, remains the prevention of pulmonary fibrosis. Lung tissue found on the X-ray as matte glass begins to dry out and turns into fibrous tissue. This tissue can never breathe again. The main goal is not to admit after COVID-19 fibrosis of this tissue. Now, my most important recommendation would be, do your best not to contact the virus! Stay Healthy!!
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I promised I'd write another journal about my experience with COVID-19. I wanted to do it already out of COVID-19. Yesterday I understood that I still don't go out that easily. I'm writing to you now from the corridor yet, let's have some information about the current evolution.

I'm doing it from the plane, flying to Zurich. It's a unique experience to fly after 14 days of real solitary confinement and total isolation from the world. It's also interesting, of course.

Today at Airport, I was irritated by a lot of things that I didn't even pay attention to before. Give your passport, take your passport, take off your shoes, put on your shoes, remove the mask, put on the mask. All simple and routine. All annoying to the max.

Emotional instability is one of the consequences of this virus. You become unbearable, irritable, reactive, nervous. I've already said to all my surrounding people, "This isn't about you! This is about me and my COVID. Please forgive me! I hope to pass and return to my inner balance.".

I am not yet out of the acute phase of the disease. On day 14, the computer tomography fixed about 25% of lung damage. Analyses have said that my body is still slowly fighting this horrible virus. After multiple discussions with the team of doctors I decided to take the risk and fly. Continuing life, with all its components, even if 25% less air in the lungs, is crucial.

Yesterday some Swiss researchers published a study claiming that 1 in 3 COVID -19 patients show symptoms of the disease within six weeks of the first symptoms. I really wish I wasn't one of those three. Although I am today at day 16 and I still have them very clear.

I've been thinking a lot about whether to write about the medications I've been taking and the tests I've done. I decided to write in detail, with an insistent request to every reader of this OP-ED. DO NOT apply self-treatment. The ones medicines here were administered to me under the supervision of my doctor. It is good for you to talk to your doctor. Maybe it'll help him somehow. But don't decide for yourself about the treatment. You may lose precious time and complicate your condition.

So, my treatment started from the first day with the following drugs:
- Famotidine – 40 mg pills taken three times a day;
- Pentoxyphillinum – 400 mg pills taken three times a day;
- Multivitamins complex with minerals and amino acids taken daily;
- Xarelto – 20 mg taken daily at noon;
- At fever I took every 4 hours a medicine combined with paracetamol and pseudo ephedrine. It eased my general condition a little;
- A lot of liquid is recommended, for example a mineral water with a degree of mineralization 250-277 mg/liter to maintain electrolyte balance.

Those who make light form come out well with this protocol along the way for 14 days.

It requires constant consistency and adherence to treatment, and follow-up of symptoms permanently. Even if you have days when you think that it is finished, you're feeling fine, don't stop treatment. The feeling of well-being is a very deceitful one. The virus works there covertly in the cells.

Around day 6-7 it is good to do general blood analysis, general biochemical analysis, coagulogramma carried out, general urine analysis, d-dimers, ferritin, C-reactive protein, pro-calcitonin. These tests show well what's going on at the cellular level. In case of significant deviations from the norms, treatment adjustment will be required.

Adjustment starts on day 7-9. In some patients, corticosteroid drugs, such as prednisolone or dexamethasone, are added. I've been given dexamethasone intramuscular injections. Started with a dose of 8 mg plus 8 mg, then switched to 8 mg daily for 7 days, now continuing with the daily dose of 4 mg until day 21.

Some also add an antibiotic. I administered azithromycin 500 mg daily for 7 days.

The purpose of correcting therapy is to prevent complications caused by cytokine storms.

The cytokine storm fills the lungs with a kind of gel and turns them into flat glass on the radiological screen. It is a severe modification of lung tissues that prevents normal breathing and reduces the oxygen levels in the human body.

These storms are very hard to stop. It can be a level of lung damage of 5% and over 24 hours already 50%. With quick interventions, sometimes you manage to control them. Stopping them permanently in a short time is very complicated.

In cases where a patient takes form from medium to severe, the treatment according to protocol will need to be extended to 21 or 28 days. Analyses shall also be repeated at least after day 14. And an X-ray of the lungs or a computed tomography is required to assess the impact of the storm on lung tissue.

I continue treatment at 28 days, because the tests showed an active phase of the disease. To keep it under control, I still continue all medicines prescribed by doctors without modifications.

The doctor recommended to add spironolactone 25 mg daily to prevent fibrosis of lung tissue.

To facilitate coughing, I have added acetylcysteine 600 mg once a day.

All applied treatments have been permanently adjusted according to the course of the disease. If the disease evolves easily, not many adjustments are needed. In cases of complications, adjustments are inevitable, as sometimes the situation is irreversibly complicated quickly.

This virus triggers a kind of multiple explosions in various organs of the body. Explosions are invisible to the naked eye and you really don't often feel them. You have a false feeling of relative well, an escapade in thoughts that you make a light disease’s form, and you will come out easily. The reality is different in many cases.

Some patients arrive at day 14 with a negative test, with 3-5% lung damage, mild weakness, and it's considered out of the disease already.

Some patients arrive at day 14 with 25-40% lung damage, latent active phase disease, and they continue treatment until day 21-28. I'm in this group now. My disease is slowly smoldering in my body yet.

Some patients arrive at day 14 to be intubated, with 50-75% of lungs affected and an aggressive form of the disease. Some of these patients never recover.

Patients in the first two groups mentioned above need long-term recovery after basic treatment. Anticoagulant therapy remains on the agenda for a period of at least one month, sometimes even two and three months.

The biggest problem, however, remains the prevention of pulmonary fibrosis. Lung tissue found on the X-ray as matte glass begins to dry out and turns into fibrous tissue. This tissue can never breathe again. The main goal is not to admit after COVID-19 fibrosis of this tissue.

Doctors still do not have some widely confirmed and widely applied methods to prevent fibrosis. Research is being carried out in this direction. Kinetic therapy, special gymnastics, massage and other forms of balneotherapy are recommended now.

I started blowing balloons every day. Pink, green, slightly red flasks swell them and blow them. The remaining healthy alveoli are opened and tightened, bring oxygen to the body, and do not allow the affected alveoli to dry yet. I'll write if I can find something more efficient.  For now, a safe cure is not yet known.

Physical rehabilitation and emotional rehabilitation are extremely important after leaving the disease.

Now, my most important recommendation would be, do your best not to contact the virus! Stay Healthy!!

Chișinău-Istanbul-Zurich