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So we've been dealing with COVID for a while now, and we are seeing kids who have what we call long-hauler symptoms. So what are these and is there anything that can be done?

In general, kids do pretty okay with COVID. Some have mild symptoms, some get pretty sick but recover after a week or two, and some kids have no symptoms at all. But more and more what I'm seeing are kids whose parents are saying, "I didn't know it would be this bad," or, "Why are they still having symptoms?"

Unfortunately, no one can predict who will develop long-haul COVID symptoms. There is a study out of England that shows that up to 15% of kids up to age 16 will still have symptoms five weeks after they initially test positive for COVID.

Long-haul symptoms can happen in kids who have minimal or no symptoms or in kids that have severe symptoms. That's the tricky thing with COVID. It doesn't follow any rules and it seems to do whatever it pleases on its own time frame.

So what are the symptoms of long-haul COVID? The most common are fatigue, brain fog or difficulty concentrating, breathing issues, chest, joint, or muscle pain, chronic cough, and headache. We also see changes in the sense of taste or smell, mood changes, or lightheadedness when standing up.

I know. It seems like anything can be a symptom of long-haul COVID. And not all of those symptoms can be attributed to having had COVID in the past.

How is long-haul COVID diagnosed? Well, that's tricky too. There are no specific tests that can be done. Your pediatrician can rule out other conditions and will usually refer your child to a specialist if their symptoms persist. But there are no good tests.

We have no idea how long it will last, we don't know what causes it, and we don't know what the treatment will be other than supportive care and treating your child's symptoms as best as possible. But there is no cure.

As we continue to move forward with COVID, hopefully we will have more answers as to how to help long-hauler symptoms. Until then, treating your child's symptoms and getting them set up with specialists to help with their specific medical needs is the best we can do.

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Scot: "Who Cares About Men's Health?" And we just wanted to kind of give you one final gift of 2020 because that's the kind of giving guys we are. I mean, I know Troy's a lot more giving than I am generally. And Troy, this was his idea really.

Troy: This was my gift to all of our listeners. You know, Scot, we wrapped it up last week, but we said we can't end 2020 like that. We've got to have one final thing we say here. So we're giving you this.

Scot: All right. So before we get to our final thing here, this is going to be just a short "Who Cares About Men's Health?" We wanted to let you know some of the episodes coming up next season that we're pretty excited about. We've got some familiar faces back on. Thunder Jalili is going to talk about obesity and why is that a big deal when it comes to your health, and you might be surprised . . .

Troy: Great way to ring in the new year.

Scot: Yes.

Troy: Because I'll feel guilty on January 3rd or whenever it's going to air.

Scot: We're also going to bring back John Smith, he's our urologist, with another episode of ask a urologist. One of Troy's acquaintances is going to come on, tell us about, [Roshago 00:00:58].

Troy: Yeah, Roshago is someone I've known for over a year now. And he is a bodybuilder, not a professional bodybuilder, but just below a professional level, fascinating guy in terms of what he goes through for these bodybuilding competitions. Like talking to him, I hear him talk about body fat and how low he goes and what that does to him, how he diets for this, his whole process. Really, it's going to be fun to hear from him and his experience and then how that translates to the average guy. You know, like Scot, you know, a completely different world, but how do we incorporate some of what he does to try and, you know, put on a little more muscle mass and take off some of that fat.

Scot: And then also our very first episode back will be on a topic called cognitive load, which is fascinating and how COVID-19 and the pandemic has maybe impacted your ability to concentrate and even solve difficult problems. And there's actually a psychological explanation for that, which we'll talk about and we'll have some tips on how to overcome that as you head into 2021. But here is your Christmas present, if you will, your gift, your final gift, whatever holiday you celebrate, this is our little thing that we are giving to you. Our final, just going to leave this here. I'm just going to leave this here. So I wanted to let you know, Troy, that I have started puzzling. I've started doing a puzzle.

I know I'm a little late to this party. I know that this is so beginning of the pandemic, you do puzzles.

Troy: Yeah.

Scot: But my wife got a puzzle for me of Bryce Canyon for my birthday, 500 piece puzzle. I finally dumped it out on our big table, and I've really enjoyed it. You know, we talk about finding those things that can kind of take our minds off of what's going on or distract us or use a different part of our brain, and puzzling really is kind of filling that for me. So what I've enjoyed about it is getting intimately kind of familiar with an image and just knowing every little, small detail. It forces you to look at these little, small details you may have overlooked before. And then you look at all the pieces on the table, so you're looking at the cover, right, and you get the overall image. And then you look into the pieces on the table and then starting to recognize those patterns, those little intimate details that you might not have noticed before. And just the kind of even searching for the different pieces that go there. I've really started to enjoy that, and I find myself in a Zen state. I was up till midnight last night because I lost track of time.

Troy: Wow.

Scot: Putting together this puzzle. And, you know, so anyway, I just was really excited to share that that is something that I found has really kind of helped distract me. It's kind of like that hobby that we talk about. So it's not all on exercises back to, you know, reduce that stress and that sort of thing. You're laughing, what do you got?

Troy: But I can't help it, Scot. You're talking about puzzling. My only association with puzzling is Christmas Eve at my in-law's house, and every year, my mother-in-law has this gigantic, super-involved Christmas puzzle. And she wants us all to get involved and do it. And I do as much as I can. And usually, the other family members who are there find some excuse to get away from there. And so one year it seemed like it was just me and her doing this puzzle all evening. And I was just like, "Please, please make it stop." Nothing against my mother-in-law, but it was just trying to find these pieces. What you were finding to be a Zen-like experience, I think with my difficulty with concentrating for a long period of time, I really struggled with, so maybe I need to do more puzzling, but I'm glad you found that satisfaction.

Scot: Well, and I think the context . . . Yeah. The context for you isn't that great either because that's not what you're looking to do over your holiday.

Troy: It is really not.

Scot: Like, for me, it's like I go down to have my lunch and instead of taking my electronic device and just scrolling, I'll eat my lunch and I'll just kind of look at the pieces and look at the picture and, you know, I might find two or three pieces that help me with it and that's fine. I'm not breaking any records solving this thing, but, you know, it's something different other than, you know, mindlessly scrolling.

Troy: No, it's good. It sounds more productive than sitting down and watching "The Office" for the 40th time on Netflix, which is usually how I spend my evenings. So, yeah, definitely, a better activity than that.

So, Scot, I'm just going to leave this here. I now have gotten the COVID vaccine and I got it last week. As you probably know, it came to the U.S., rolled out last week. The first person to get it was in New York City. I think it was a MICU nurse in New York on Monday. And then I think you were involved in the news conference at the university on Tuesday where our first person in Utah to get it was also an ICU nurse at the University of Utah, and then I was fortunate enough to get it later that day.

So they told me I was one of the first 50 people. It was just dumb luck. I was leaving my shift in the respiratory unit after taking care of COVID patients all day, very sick patients, and one of our nursing administrators said, "Hey, do you want to get your COVID vaccine right now?" And I said, "Absolutely." I went upstairs up to the medical intensive care unit. We had several other frontline healthcare workers there from the MICU, from the emergency department, some from the trauma service, and I got the vaccine.

And it was a really cool experience. It was like a very bonding experience with everyone there. Like people were all getting pictures of each other and pictures of themselves doing this, probably all sorts of HIPAA violations with that, but we didn't care. You know, it's like, "Hey, this is amazing." And I had a lot of emotions. I think, like, I didn't think a ton about it at the time, but afterwards I got home and went for a run and kind of thought about it and, you know, kind of had a few different emotions. I mean, one was a very deep sense of gratitude that I was able to get this. And, you know, just kind of this feeling like, "Hey, here's the light." This is the light at the end of this very dark tunnel that we've been traveling through, and this is how we get out of it.

And I felt so grateful that I could get that vaccine, and I also felt a little bit of guilt. I mean, I got to be honest. It's almost kind of that survivor guilt. I kind of thought about people I've cared for over the last nine months who haven't made it and how I wish they had that vaccine and they could have prevented this and they could have gotten through this and guilt too that I was getting this when I know so many other people both in my life and then patients I know, and other people who I would rather have this than I have it. You know, I'd rather that they get it before I get it. So a little bit of guilt too.

So kind of an interesting range of emotions there. But my biggest feeling was I am so grateful to have this. You know, I guess it's kind of like feeling like you're on a ship that's wrecked and you're the first one ashore and you want to get everyone else to shore. And my thought was I want everyone else to have this right now. I want it right now for everyone. I know that is not logistically possible, but it was kind of like that opening of the door to say this vaccine is here. We're rolling it out. People are getting it. And I'm so grateful to have this. And I want as many people to have this as soon as possible.

So what I can tell you, in terms of reaction, the shot, the vaccine did not hurt going in. It's sore. You know, it was sore afterward, just an ache for a day or two after in my left deltoid, on my left shoulder where I got the injection. Maybe a little bit more of an ache than a flu shot, kind of like a tetanus shot if you remember how you feel with the tetanus shot. But otherwise, I felt fine. You know, everything's good. I've been running consistently since then. Everything's been great. So I would absolutely encourage you whenever you have the opportunity to get the vaccine, when that opportunity comes to get it.

Scot: I'm excited for you. That makes me feel better. I know that you've got, you know, all the safety precautions in place in the ER, and you're very diligent about that, but this is just that added level of protection and security. Now, does this mean that you can go after your immunity builds in two weeks, you can go visit your parents again because you won't be carrying it or no?

Troy: It's tough. The guidance that we have received and that others have received and given as well is to continue to practice everything you had practiced prior to getting the vaccine, which means I'm going to be wearing the same PPE at work, you know, the same mask, the same PAPR helmet, all that kind of stuff I'm wearing. The reality is still I need a booster in 21 days. From what I understand, two weeks after I got the injection, I should have built up maybe to 50% to 80% in terms of that immune response, and then that booster at 21 days gets you up to the full response. So we're really . . .

Scot: Which is like 95%?

Troy: Yeah. I mean, 95% reduction in risk, 100% in terms of just the response you'll receive from it, but a 95% reduction in terms of risk of catching the virus. But you can still catch it. That's a little of the challenge. You can still catch it, but it reduces that risk significantly. I mean, the efficacy of this vaccine is mind-blowing for me. Like this is better than anything I think any of us ever hoped for. So, hopefully, that plays out in the long term. Again, I don't know what the implications are for family, but I've been visiting my parents, meaning that I'll go down and see them, we'll hang out outside, you know, social distance, that kind of stuff. So when I do them, that's how we do things, and I don't think that's going to change anytime soon.

Scot: Time to say the things that you say at the end of podcast, because we are at the end of our podcast. All right. So if you want to reach out . . . wow, this is the last podcast episode of the year, Troy.

Troy: Wow, this is it. Yeah.

Scot: We're heading into 2021 after this one. All right. So if you want to reach out, you can do that, we've got a lot of ways. You can email us at hello@thescoperadio.com, you can go to facebook.com/WhoCaresMensHealth, or you can go to the website whocaresmenshealth.com.

Troy: We also have our listener line, it is 601-55SCOPE. We'd love to hear from you. Subscribe anywhere you get your podcasts, Apple, Google Play, Spotify. Please rate us five stars if you like us. Thanks for listening. And thanks for caring about men's health.

Scot: Have a good holiday, my friend.

Troy: You too, Scot.

Interviewer: There's a brand new treatment for patients suffering from chronic or acute liver failure. We'll talk about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: There's a brand new treatment that are suffering from alcoholic liver related failure. We're talking with Dr. Juan Gallegos. He's a liver expert here at the University of Utah Hospital. You're really about this new possibility of this treatment which is in clinical trial right now. Tell me a little bit about what's going on.

Dr. Juan Gallegos: Thank you very much Scott. Yes we are very excited to participate in this clinical trial of this new therapy for patients with severe alcoholic liver disease. We're interested in it because alcoholic liver disease is very, very frequent in the United States. It's estimated that about two-thirds to three-quarters of adults in the United States drink some alcohol, most of them do so very mildly and moderately, but a subset of patients drink heavily and these patients are at increased risk of developing liver disease. And most patients have heard about alcoholic Cirrhosis and probably that's one of the top three causes of liver failure in the United States leading to liver transplantation.
But there is another entity called acute alcoholic hepatitis, or excessive alcohol drinking leads to significant inflammation and liver damage which could cause the liver to fail, and those are the patients that we're interested in studying and treating in this trial because up to until now the mortality for these patients, meaning the number of patients that die from this disease is about 70% six months after the initial episode. So there's a very dramatic impact of this condition.

Interviewer: And up until this point really no way to treat it, is that correct?

Dr. Juan Gallegos: Well there are some ways to treat it and mainly trying to get these patients abstinent from alcohol and that's the mainstay of treatment. Also adequate nutritional support is very important, and there's a couple of medical therapies that we can use that is medical medications that can be used to treat these patients, but even with that the mortality is still around 30 to 40% at 3 to 6 months after this episode of alcoholic hepatitis.

Interviewer: Okay so this is a dialysis machine, just briefly explain what this machine does then and why you're so excited about it?

Dr. Juan Gallegos: We're very excited about it because this is a machine that yes in a way is a dialysis machine; basically it is able to replace at least for a few days the major function of the liver. So basically what this company has made is a special machine where we have cartridges that are full of human liver cells that are alive and then can actually maintain the liver function for these several days, and these liver cells are grown here in the United States, and they're put in the special cartridges that go into this dialysis machine for the liver. The amount of cells there in these cartridges is equivalent to about 500 grams of liver tissue. Which is about a third of a normal liver.

Interviewer: Does it act as a filter, all those liver cells?

Dr. Juan Gallegos: They not only act as a filter they actually make proteins that are important for the normal physiologic function of the body so they make proteins that help with the clotting factors, they detoxify certain chemicals that are only detoxified by liver cells that in a patient that has acute liver failure are not working.

Interviewer: Is it like a respirator is doing the lungs job eventually this machine would be able to do the livers job?

Dr. Juan Gallegos: So what it can actually do the livers job for a few days but not more than that. Other machines that don't use liver cells really they only act like you mention as filters.

Interviewer: So traditional dialysis would be one of those machines?

Dr. Juan Gallegos: Traditional dialysis in a sense is such a machine is just that traditional dialysis can be used for long periods of time, and substitute the kidney function. The liver function is a bit more difficult to replace, and that's why this is so exciting. So what we are trying to see if it's this machine can help these patients over the hump of the severe or acute liver failure so that they can actually survive this episode and go on to either recover from the alcoholic liver disease, or if they don't necessarily recover but maintain their sobriety for a few months they can then go on to be considered for liver transplantation which we would be the definitive treatment for this alcoholic liver disease.

Interviewer: Yeah so the ultimate goal is the liver transplantation. This machine is by no means something you would stay on for the rest of your life.

Dr. Juan Gallegos: Correct that is not the case it's only basically to treat the acute episode and get you over this acute problem so that over time either you recover because sobriety is very important in some of these patients actually recover and if they maintain sobriety their liver can get back to almost normal.

Interviewer: Really it will heal almost to precondition?

Dr. Juan Gallegos: It might, it depends on how advanced the condition is to begin with. So in those patients that already have severe liver disease, and on top of this have an acute insult they're less likely to recover, but there are patients that don't have a severe liver disease to begin with and if they can get over this acute insult they're livers will recover to a point where they might not require a liver transplant in the future. As long as they maintain their sobriety.

Interviewer: And this is cutting edge technology obviously because it's in trial, the FDA hasn't approved it yet.

Dr. Juan Gallegos: Correct.

Interviewer: The whole process you're going through is hoping to prove...

Dr. Juan Gallegos: Yes we're hoping to prove that this will increase the chances of patients surviving to the point that it will be better than what our current medical therapies are, and the FDA is very interested in this so they have allowed us to participate in this trial. It's a multi-centric trial in the United States, and there are other centers in Europe and other places of the world.

Interviewer: So if somebody was interested in this trial what would they have to do?

Dr. Juan Gallegos: Well generally it will be a physician, or somebody taking care of these patients, they would just need to contact us at the University of Utah. I am the principal investigator so I'm readily available as well as our research coordinators.

Interviewer: Any final thoughts on this topic?

Dr. Juan Gallegos: Well I think that it's important to recognize that alcoholic liver disease is a significant problem in the United States, and that episodes of acute alcoholic hepatitis can be deadly, and we're trying to improve that with this machine, and hopefully people out there will be interested in and contact us.

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