My transformation through COVID-19 - ESRA

ESRA Updates

November 2020 | Issue 03

My transformation through COVID-19

Athmaja Thottungal, MBBS, FRCA, FFPMRCA, EDRA, FIPP (Kent and Canterbury Hospital, UK) @athmathottungal
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As any other new year, in 2020 January, my personal and professional life was filled with new year resolutions, plans for various meetings, lectures, teaching, holidays and new research ideas in the field of Regional anaesthesia and Pain medicine. I kicked off my exciting journey by attending the 16th ESRA Winter Scientific meeting on 12-17th of January in Langenfeld, Austria as a faculty lecturing and demonstrating ultrasound guided regional anaesthesia blocks. It was a great week of teaching and learning. A week after I travelled to Tignes le lac, France on 22nd January to lecture and demonstrate ultrasound guided chronic pain interventions at the London Pain Forum 8th “Advances in Pain Medicine” International Winter Symposium. After these two air travel I started having a cough by the end of January. The news of Covid 19 spreading to Europe was coming out during this time. But I did not feel anything unusual than a normal cold and cough that is common in the winter season. The cough persisted for two weeks which was unusual. I was already committed as a faculty and examiner for FIPP (Fellow of Interventional Pain Practice) and CIPS (Certified Interventional Pain Sonologist) examinations conducted by the WIP (World Institute of Pain) which was scheduled for February 13-18th at Miami, Florida. As I felt my cough was better, I set off to Miami on 13th February.

Listen to the patient

On my return to UK, after 3 days I started having shortness of breath and dry cough. I felt very unwell and had to come off work. After two days started having fever, sore throat and severe myalgia. It was the time the news about the Covid was spreading like a wildfire. I was treating myself at home like a winter viral infection. I started thinking the possibility of Covid 19 infection considering the travel history, reported case locations and after 7 days of misery. My shortness of breath became severe and I could not get out of the bed other than just for going to toilet. Now retrospectively that week is just a hazy memory. The severe cough caused significant chest pain; both pleuritic type and mechanical costochondritis pain. I attended the hospital as I was starting to struggle for breath. An x ray was taken, and it was reported as “normal” As Oxygen saturation was 96% and other vitals stable, they sent me back home. The advice was to treat with antibiotics as it was nearly 3 weeks of chest infection altogether. The misery continued as the chest pain became very severe and shortness of breath increased. I attended the emergency department again after the advice from the 111 service here in UK.

By this time, the Covid- 19 situation was getting out of control in many places, the protocols for testing was changing every day and the advice was to wait and see. The guidance at that time was not to test unless the travel was into hot spots like Wuhan or Spain. A routine blood test was done which was only showing some signs of infection. They changed the antibiotics to another one and I was sent home. Two weeks continued like this and my husband and 8-year son started showing symptoms. Husband had severe dry cough, sore throat, myalgia and fever and son had only dry cough and fever. They both got better after two weeks even though my husband’s cough continued for nearly 4 weeks. My cough and shortness of breath continued for further 3 weeks. As the guidelines changed by that time, we were offered a Covid testing which was almost 4 weeks since the infection started. As expected, it came back as negative. Clinically I had my left middle and lower lobe pneumonic changes. I had 4th course of antibiotic prescribed by GP which caused severe alteration of LFT. Clinically I had all the classical symptoms of Covid-19. But as the infection was during the early period of the Covid curve, the possible diagnosis was missed clinically. The chest pain and shortness of breath took nearly 6 weeks to get better. I was referred to a chest clinic and was reviewed by a chest physician after nearly 8 weeks following the first infection. By this time everyone was familiar with the classical radiological signs and haematological changes of Covid. I was given a retrospective diagnosis of possible Covid-19 infection at that time.

During my medical school training; I was taught by a great teacher that the clinical diagnosis is always with your patient itself. As a clinician we need to learn to listen to them properly. That will give you the clues for the correct diagnosis. My journey was the best example of this. It was a very emotionally and physically draining experience.

Aftermath

As I was recovering, I started noticing severe fatigue, mental “fogging” and breathlessness continuing. The multiple joint pain was severe enough to cause me struggle to get down the stairs. From a very physically and mentally active personality, I became a person who just wanted to take rest all the time. Even 20 minutes’ walk was a struggle. As I learned more about Covid, it became more clearer that being an Asian female and diabetic (gestational diabetes continuing) I fall into the higher risk category for severe infection. There were several articles published about “post Covid” syndromes.

«As the saying goes, don’t be a problem but be a solution; I decided to take over my own recovery.»

Trying to be “normal” again

I returned to full time work after 6 weeks of illness and recovery. But very soon I realised that my physical body and stamina has not recovered fully. As the “new normal” that we call now, all the consultations were remote over the phone or via video. As a Pain management clinician, I never felt comfortable making a diagnosis without the full physical examination of my pain patients. But that was the possible option due to the lockdown and social distancing guidelines. As a patient when I was on the receiving end, I was getting the same. The physiotherapy online told few exercises for improving my lung function which did not make much sense as it was just a protocol driven verbal exercise. I wondered if it was that difficult for me, what will the situation of a frail elderly person who find very difficult to comprehend our complex instructions over the phone? I did not feel it was “normal” and was not prepared accept the situation that I was in. As the saying goes- don’t be a problem but be a solution; I decided to take over my own recovery.

A new era begins in my life

The thought of self-control and changing the situation brought me back to the world of Yoga. For me the connection with Yoga was purely in the form Asanas (postures/exercises) for the physical fitness aspect before and the other components of Yoga like Pranayama (breathing techniques), Dhyana (meditation), Yukthahara (right type of food and inputs) were neglected.

Yoga and me

The word “Yoga” means union in Sanskrit language. Yoga is essentially a spiritual discipline based on subtle science which focusses on bringing harmony between mind, body, human and nature. It teaches the art and science of healthy living.
It dates back to the Indus Saraswathi Valley civilization – dating back to 2700 B.C., has proved itself catering to both material and spiritual upliftment of humanity. As per the Yogic scriptures, the practice of all components of Yoga leads to the union of individual consciousness with the universal consciousness. It resonates with the modern science that the universe is just the manifestation of quantum firmament.

Inner engineering and daily Yoga practice

I came across Inner Engineering programme offered by Sadhguru Jaggi Vasudev from South India during this recovery time. He is a Yogi, mystic and visionary who started a non-profit voluntary organisation called Isha Foundation. The inner engineering programme is an online training programme that guides you to learn how to look into yourself and start engineering your life the way you want it to be. (www.Innerengineering.com) This has changed my perception about self management and started doing the regular Yoga practise as well. My typical daily 1-1.5 hours of Yoga practice now consists of Upa Yoga ( warm up), 12-24 cycles of Surya namaskar (sun salutation), Different types of Pranayama (breathing techniques) including Simha Kriya (specifically to improve respiratory immunity), various Asanas (Yoga poses) and Dhyana (meditation) along with Yukthahara (right food selection). There are several scientific studies showing how these practises reduce the stress levels, improve the body function, immunity and also enhances your total wellbeing. Currently I am on the road to almost full recovery. My lung capacity has improved dramatically, the joint pain and myalgia settled, feels more energetic as the fatigue is disappearing and more positive about life as a whole with clarity in my thought process again. I realised what I was missing even while doing some “Yoga” before. As it says- you will only see what your mind knows. This has been my greatest self-realisation so far.

The lessons learned to move forward

The year 2020 will not be forgotten very soon by the world. The Covid -19 virus has given us all an opportunity to understand our limitations and propels us to reflect upon these lessons learned. As a human race we have to change our ways for a better future life. This has taught us to slow down, reconnect with nature, relations and cherish what is important in life. I have definitely learned to be more joyful in life and appreciative of what is actually important as an individual. Yoga has given me that transcendental wisdom to root myself firmly showing the purpose and peace to move forward in a very positive way.

Topics: COVID-19 , Doctor , Recovery , Yoga

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