ArcaMax

DEAR DR. ROACH: I am a 66-year-old woman in fairly good health, but I have visited enough doctors recently to make the following observation:

Almost without fail, a person will enter the examination room, make no introduction, and launch into a series of questions or perform whatever procedure is necessary. (In general, I do not see any identifying name tags.) Sometimes it is as simple as drawing blood or taking my blood pressure; in other instances, it may be a very in-depth assessment.

Regardless, I would still like to know the provider's name and position (nurse, P.A., N.P., etc.). I am assertive but still find this to be a poor approach to developing good patient rapport and trust. Perhaps in your position, you can impress upon the medical community how 30 seconds of an introduction can demonstrate respect for the patient and help people feel more at ease. -- B.H.

ASWER: It is disappointing to hear this. We try to impress upon all our health care providers how important it is to introduce oneself with your name and role. Medical students won't pass their standardized patient encounters if they fail to introduce themselves. I'm publishing your letter in the hope that a reminder may help.

DEAR DR. ROACH: I foolishly was in a crowded indoor location and got COVID (for the third time). I thought about getting Paxlovid. But I figured, heck, I'm healthy and vaccinated; I'll just tough it out. This turned out to be a big mistake.

I had three days of a super high fever. Then I spent two weeks flat on my back, and it took a month for me to get my strength back. But the worst symptom was that COVID attacked the myelin on the nerves controlling my bladder and bowel. Months later, I am still slowly getting control back.

My question is: Would Paxlovid have prevented the demyelination of the nerves? I asked my urologist, and he didn't know. -- P.M.

ANSWER: Nobody can answer this question for certain. We can certainly say that a COVID infection is known to cause damage to the peripheral nerves, which causes a wide variety of symptoms in different people. This includes demyelinating diseases, such as Guillain-Barre, and demyelination of the pudendal nerve, which causes bladder and bowel dysfunction. This complication was more common among people who had severe COVID that required hospitalization.

Paxlovid is most effective in people who are unvaccinated, especially those with risk factors. However, Paxlovid was effective at reducing severe COVID among vaccinated people over 70 or people who had a disease of their immune system. I interpret this to mean that the vaccine protects you so much that it is hard to show a benefit from Paxlovid unless you are at a high risk.

To answer your question about neurological complications like demyelination, one study from 2023 showed a reduction of post-COVID symptoms, including neurological symptoms, if they had at least one risk factor. (There are many risk factors, including being over 60, being overweight, smoking, diabetes, heart disease, or high blood pressure.) In contrast, a 2024 controlled trial was unable to show a benefit in reducing long COVID symptoms with Paxlovid.

In my mind, deciding whether to offer a patient Paxlovid comes down to the risks and benefits. The downsides of Paxlovid are small (with mild side effects like temporarily abnormal taste) against the potential for a decreased risk of hospitalization and death, which is limited to higher-risk patients.

I can't say for certain that there is a decreased risk for long COVID symptoms, but for nearly all people who fit into the broad group of being at a higher risk, I recommend Paxlovid as soon as possible after the diagnosis of COVID.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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