ArcaMax

DEAR DR. ROACH: Is there anything a person can do to make it less likely that a COVID infection leads to long COVID symptoms? Does activity help or harm a person in this case? -- L.B.

ANSWER: Before getting COVID in the first place, being vaccinated helps prevent a COVID infection, and even if you get infected, it probably reduces the likelihood that a person will suffer long-term symptoms, often called "long COVID." Once a person is infected, early treatment with Paxlovid improves symptoms, but a randomized trial did not show a significant benefit in it reducing the risk of long COVID symptoms.

Activity has not been shown to help or worsen the likelihood of developing long COVID. In general, I recommend exercising as tolerated after a serious infection like influenza or COVID, neither pushing yourself to do more nor forcing yourself to stay in bed.

There are some suggestive data that metformin might help prevent long COVID even after vaccination and Paxlovid. A well-done trial estimated that 4% of people who would have otherwise gotten long COVID did not get it if they took metformin. But I'm not sure that this is enough for me to recommend this treatment for someone who isn't already on metformin.

DEAR DR. ROACH: I am an 84-year-old male who is very active and in good health. On a recent visit to my ophthalmologist, I described to him what I had been experiencing for the past year or so: a sensation like looking through a kaleidoscope primarily in my left eye, which lasts anywhere from a couple minutes to maybe 15 minutes.

There is no pain, and it doesn't hinder my ability to see somewhat clearly. It can come at any time of the day or night and doesn't seem to be related to any particular activity or event. I experience these about two to three times a month.

The ophthalmologist said, "Oh, you are having silent migraines," and he did not seem worried about it. When I went to my geriatric doctor, he suggested that I see a neurologist to make sure nothing else is going on. What can you tell me about silent migraines? -- D.P.

ANSWER: Migraine aura without headaches, also called an acephalic migraine, a migraine equivalent, and a silent migraine, is when a person gets the aura of a migraine without the headache. It's not that uncommon; I see this condition in my patients who are usually over 50.

The visual changes experienced vary from person to person. There may be flashing lights or zigzag lines. Some people see geometric shapes. These symptoms last for less than an hour and are usually in both eyes. When there are "positive" findings like zigzag lines or lights, the diagnosis isn't really in doubt.

Sometimes the initial finding can be visual loss -- the sudden inability to see in part of the field of vision. This is referred to as a "negative" finding. In people over 50, this could be a sign of a transient ischemic attack or a stroke and needs to be taken seriously. Most people who have migraine aura without headaches also get regular migraines with headaches as well.

New onset headaches at age 84 is still uncommon, so I tend to agree with your geriatrician that a visit to a neurologist would be worthwhile. I suspect your ophthalmologist is correct, but getting an expert opinion is not a waste of time.

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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.

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