What started as light congestion and fatigue turned into a years-long battle for 25-year-old Terryn Mersch. While working in Memphis, Tennessee, in August 2021, Terryn came down with COVID-19. She had light congestion, fatigue and brain fog, but she wasn’t too concerned. She had had colds and the flu before, so she expected this to be no different. She thought her bout with the illness was done, seemingly recovering over the next six weeks. Then, a bad relapse in October 2021 landed her in the hospital, where she was diagnosed with long COVID.
“I was working a full-time job, but I began to struggle to work full-time due to symptoms,” Terryn said. “I was hospitalized a second time in April 2022 with the flu, and this seemed to make my post-COVID symptoms even worse.”
Soon, she struggled to walk on her own, and new symptoms kept popping up, including dizziness, heart palpitations, intense brain fog and body aches. Her mom moved to Memphis to help out, hoping Terryn could return to independence. Finally, Terryn made the difficult decision to return to Omaha and live with her family in June 2022. Her primary care physician, Dr. Craig Meier, referred her to Madonna’s post-COVID clinic.
Physical therapy and long COVID: Helping the body’s nervous system reset
When Terryn arrived for her first evaluation, she didn’t feel like herself. She was scoring objectively well on initial assessments, but scored herself very low on the quality of life scale, indicating she didn’t feel she was able to do things that were important to her at her highest capacity.
“She felt like everyone kept telling her she was doing well, but she knew she didn’t feel like herself,” Allison Carson, Madonna’s outpatient speech therapy supervisor, said.
Despite the uncertainty, Terryn was determined to make the most of her recovery. Her goals were to be independent again, work a job and return to her favorite hobbies, like baking and going to the zoo with her brother. She spent hours each week in intense physical, occupational and speech therapies, committed to slow and steady progress.
“Rehabilitating from a post-COVID condition is a long and arduous process with the rate of healing being dependent on your body/brain readiness,” Allison Field, a Madonna physical therapist, said. “She was motivated to get started on something to help her get back to that life she had built for herself, but despite Terryn wanting to be ready to return to Memphis, she knew her body would not be able to handle what was required to live there successfully and independently yet.”
Field taught Terryn several diaphragmatic breathing techniques to promote efficiency of breathing for energy conservation and to assist in the neuro re-education of her autonomic nervous system. Research shows that post-COVID infections can impact the body’s ability to regulate the sympathetic nervous system, jumping up to a “fight or flight” state uncontrollably or inexplicably. Madonna physical therapists start patients out at a gentle, “low and slow,” level of intensity, giving the nervous system a chance to reset, then gradually increasing the intensity as a person’s stamina increases.
“We utilize breathing on its own initially, then progress into using breathing techniques in conjunction with interval training,” Field said. “We emphasize use of internal feedback of body fatigue for Terryn to judge her level of participation in the programming, whether she needs to increase or decrease intensity or take a rest, through a 1-10 scale of Rate of Perceived Exertion.”
In speech therapy, her goals focused on complex attention, recall and problem-solving for situations related to her community and work environments. Carson helped her focus on skills that involved multi-step, multiple-part complex tasks that incorporated technology, desk work, hands-on and verbal responsibilities.
“I tried to mix up our tasks frequently to mimic how dynamic her environment was in her home/work roles,” Carson said. “Once she accomplished our goals, we then set her up with our Work Re-Entry Program, which I think truly empowered her. She felt she was finally able to not only succeed during novel tasks, but she also got to practice her self-advocacy with unfamiliar people, and felt like it really mirrored her specific job duties. Every time I checked in with her on her work trials, she was so positive, and I feel like this is really when she turned the corner.”
Long COVID mental health challenges require specialized care
Madonna’s post-COVID clinic emphasizes holistic care, making sure all aspects of a person’s health is addressed. In addition to treating her physical ailments, Terryn attended counseling to help cope with the difficulty of managing symptoms and daily life.
“The ability to say ‘yes,’ to these services and the willingness to accept help is a great driver in overall improvement,” Field said. “Terryn was a sponge with all the education we provided and did an amazing job implementing our strategies into her daily life. She had setbacks throughout our time together but she maintained the mental fortitude to reset and trust in our process.”
Kim Becker, a Madonna neuropsychologist and professional counselor, also helped Terryn assess her work re-entry readiness and access community resources available to her. Becker remembers her first impression of Terryn, like many post-COVID patients she sees, as being scared and overwhelmed.
“Terryn was understandably, definitely scared of the unknowns of this diagnosis and condition,” Becker said. “She was worried about whether or not she would be able to return to her previous life roles, social activities and social supports. Her biggest obstacle was the ups and downs in her symptoms. She would start to see progress and then be met with a re-emergence of symptoms.”
For Terryn, like many post-COVID patients, depression and anxiety only added to her symptoms. She struggled with feelings of isolation and failure. Neuropsychology helped her focus on what she can control.
“With the ups and downs she was experiencing, depression was important to address,” Becker said. “We worked on reframing the catastrophic thoughts that come with feeling hopeless. We also put together a sleep hygiene and self-care routine.”
From July until October, Terryn worked diligently to improve her cognition and endurance at Madonna’s post-COVID clinic. She asked questions during each session and wanted education on everything involving post-COVID. Leaning on her Christian faith, she also learned to give herself grace as she navigated her new normal. She decided not to return to Tennessee, and instead found a new part-time job in Omaha. She found comfort in reintegrating into the community and social activities despite her continued worry about COVID exposure.
“This is something you truly cannot ‘push through,’” Terryn said. “I tried that over several months and only got sicker. You really have to scale everything back and reach a baseline that you can maintain, and then slowly build on that. You have to slow down and really listen to your body and give it the rest it needs and be very mindful of how activities will tax your body so you don’t overdo it.”
Looking back on the last few months, Terryn and her family can see the incredible progress she has made, both physically and emotionally. Her symptoms have improved, and so has her ability to navigate and mitigate those symptoms. She’s returned to her love of baking, playing the piano and even some shopping trips. Her biggest accomplishment, she says, is her return to work in a part-time role. Progress can feel slow in the moment, but she says her progress is in the right direction, and for that, she’s incredibly thankful.
“There is no magical fix right now for those of us still dealing with long COVID, but the therapies at Madonna are extremely helpful for aiding your body in healing and recovering,” Terryn said.