Blue Legs: A New Long-COVID Symptom;

How to Test for and Treat It

Long COVID comes with many symptoms, but this one can be scary if you don't expect it.
(JBArt/Shutterstock)

By George Citroner
9/4/2023
Updated:
9/4/2023
0:00

It started with an uncomfortable tingling and itchiness in his legs after standing for 10 minutes.
Then, the he watched as his lower limbs turned blue right before his eyes. He was experiencing
acrocyanosis, a pooling of blood in the extremities that had never afflicted him before.

Doctors attributed the 33-year-old man's symptoms, which started 18 months prior, to a bout of
COVID-19 he had suffered then, according to a recent case study in The Lancet. His case
provides new evidence that the virus may cause lasting dysautonomia—dysfunction of the
autonomic nervous system—that experts are only beginning to understand.
“This was a striking case of acrocyanosis in a patient who had not experienced it before his
COVID-19 infection,” Dr. Manoj Sivan, associate clinical professor and honorary consultant in
rehabilitation medicine at the University of Leeds’ School of Medicine, said in a press statement.

POTS and Long COVID

The anonymous patient had already been diagnosed with postural orthostatic tachycardia
syndrome (POTS)—a form of dysautonomia for which reddish-blue discoloration of the legs can
be a symptom—two months earlier by a cardiologist. POTS is a blood circulation disorder that
causes an abnormal increase in heart rate when transitioning from sitting or lying down to
standing up, which can also lead to lightheadedness, fainting, and fatigue.

POTS is a relatively uncommon condition, affecting an estimated 500,000 to 1 million people in

the United States. It is most commonly diagnosed in women between 15 and 50 but can occur in
people of any age and sex.
(Pepermpron/Shutterstock)
While the exact cause of POTS in long-COVID patients is unclear, it may be related to the virus'
impact on the autonomic nervous system. SARS-CoV-2, the virus that causes COVID-19, has
been found to directly affect the nervous system, causing inflammation and damage to the nerves
that regulate heart rate, blood pressure, and other autonomic functions.

There is no known cure for POTS, but doctors may prescribe medications to help manage
symptoms, such as beta blockers, fludrocortisone, and midodrine.

"Patients experiencing this may not be aware that it can be a symptom of long COVID and
dysautonomia and may feel concerned about what they are seeing," Dr. Sivan added, noting that
doctors themselves may be unaware of the link between long COVID and acrocyanosis.

Nearly 2 in 3 People With Long COVID Experience

Autonomic Dysfunction
About 28 percent of people infected with COVID-19 develop long-COVID symptoms, according
to a survey by the KFF, formerly known as the Kaiser Family Foundation, a health policy
research organization. For the majority, the symptoms clear up, but 11 percent are left with
persistent long COVID.

A separate online survey of over 2,300 adults with long COVID found that 67 percent had
moderate to severe autonomic nervous system dysfunction. This was unrelated to the severity of
their initial COVID-19 illness, suggesting autonomic dysfunction is highly prevalent in long-
COVID patients. This may be due to COVID-19's effect on a vital part of the nervous system.
“Extensive research has shown that long COVID causes malfunction of the key almond-size
circuit breaker in the brain called the hypothalamus,” Dr. Jacob Teitelbaum, a board-certified
internist and nationally known expert in the fields of chronic fatigue syndrome, fibromyalgia,
sleep, and pain, told The Epoch Times. The hypothalamus not only controls the autonomic
nervous system functions but also sleep and hormone regulation.

Without treatment, there is a risk autonomic dysfunction can become progressive, Dr.
Teitelbaum said. “Other key parts of the autonomic nervous system can begin to fail along with
the hypothalamus,” he added. “These include, especially, the vagus nerve and the nerve fibers
that control blood vessels. The latter is called small fiber neuropathy.”

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How to Screen for and Treat POTS at Home
Dr. Teitelbaum described a simple at-home test to check for symptoms of POTS.

First, lie down for 10 minutes and check your pulse rate. Then, stand up in one place for 10
minutes, without leaning on anything, while checking your pulse every two minutes.

If your pulse rate rises by 20 beats per minute or more during the 10 minutes of standing, it
indicates orthostatic intolerance, he said.

"However, if your pulse rate goes up by 30 bpm or more, [the test] confirms [POTS].”

If signs of POTS are detected, Dr. Teitelbaum recommends self-care approaches to relieve
symptoms. Treatment for POTS in long-COVID patients is similar to treatment for non-COVID
POTS cases, typically involving lifestyle changes and medications.

Helpful lifestyle changes can include moderate physical activity and avoiding triggers that
worsen symptoms. Wearing medium compression stockings when up and around, along with
increased salt and water intake, are simple at-home treatments, according to Dr. Teitelbaum.

“Knee-high compression stockings can help, but thigh-high ones are better," he added.
Comments
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Top Two Comments:
iain.harris1026
2023-09-05

Can ET please stop saying” Long Covid” without qualification please as it plays right into
pharma’s narrative. Its a meaningless term without understanding jab status etc to start with and
the presumption its always caused by the disease is very clearly baseless

Reply
Share
RJMR
2023-09-05

Everything talked about in this article is applicable to the COVID jab, which likely is the main
cause of these issues.

Reply
Share

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George Citroner
Author

George Citroner reports on health and medicine, covering topics that include cancer, infectious
diseases, and neurodegenerative conditions. He was awarded the Media Orthopaedic Reporting
Excellence (MORE) award in 2020 for a story on osteoporosis risk in men.
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Related Topics
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Comments
Write a comment...
Top Two Comments:
iain.harris1026
2023-09-05

Can ET please stop saying” Long Covid” without qualification please as it plays right into
pharma’s narrative. Its a meaningless term without understanding jab status etc to start with and
the presumption its always caused by the disease is very clearly baseless

Reply
Share
RJMR
2023-09-05

Everything talked about in this article is applicable to the COVID jab, which likely is the main
cause of these issues.

Reply
Share
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