GET https://rct.dev.bbntimes.com/science/dealing-with-long-covid-today

Response
200 OK
IP
18.216.100.123
Profiled on
Token
f7bf2d

ArticleController :: show

Request

GET Parameters

None

POST Parameters

None

Uploaded Files

None

Request Attributes

Key Value
_controller 
"App\Controller\ArticleController::show"
_firewall_context 
"security.firewall.map.context.main"
_links 
Symfony\Component\WebLink\GenericLinkProvider {#3588
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    3707 => Symfony\Component\WebLink\Link {#3707
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    3706 => Symfony\Component\WebLink\Link {#3706
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      -attributes: [
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    }
    3705 => Symfony\Component\WebLink\Link {#3705
      -href: "/build/app.js"
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      ]
    }
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      ]
    }
    3701 => Symfony\Component\WebLink\Link {#3701
      -href: "/build/scroll-infinite-article.js"
      -rel: [
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      -attributes: [
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      ]
    }
    3700 => Symfony\Component\WebLink\Link {#3700
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      -attributes: [
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      ]
    }
    3699 => Symfony\Component\WebLink\Link {#3699
      -href: "/build/cookie-style.css"
      -rel: [
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      -attributes: [
        "as" => "style"
      ]
    }
    3698 => Symfony\Component\WebLink\Link {#3698
      -href: "/build/term-condition-css.css"
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      -attributes: [
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    3697 => Symfony\Component\WebLink\Link {#3697
      -href: "/build/contact-css.css"
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      -attributes: [
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    }
    3696 => Symfony\Component\WebLink\Link {#3696
      -href: "/build/comment-css.css"
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      -attributes: [
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_route 
"article_show"
_route_params 
[
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  "slug" => "dealing-with-long-covid-today"
]
_security_firewall_run 
"_security_main"
_stopwatch_token 
"0ce7b9"
category 
"science"
slug 
"dealing-with-long-covid-today"

Request Headers

Header Value
accept 
"*/*"
accept-encoding 
"gzip, br, zstd, deflate"
connection 
"close"
cookie 
"care_did=5f77789b-b4fa-4762-9555-964fdfb24299; PHPSESSID=liviqnturk78dprudqfid9vfua"
host 
"rct.dev.bbntimes.com"
user-agent 
"Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)"
x-php-ob-level 
"1"

Request Content

Request content not available (it was retrieved as a resource).

Response

Response Headers

Header Value
cache-control 
"no-cache, private"
content-type 
"text/html; charset=UTF-8"
date 
"Sat, 22 Feb 2025 13:29:01 GMT"
link 
"</build/runtime.js>; rel="preload"; as="script",</build/644.js>; rel="preload"; as="script",</build/502.js>; rel="preload"; as="script",</build/app.js>; rel="preload"; as="script",</build/view-more.js>; rel="preload"; as="script",</build/term-condition.js>; rel="preload"; as="script",</build/contact.js>; rel="preload"; as="script",</build/scroll-infinite-article.js>; rel="preload"; as="script",</build/app.css>; rel="preload"; as="style",</build/cookie-style.css>; rel="preload"; as="style",</build/term-condition-css.css>; rel="preload"; as="style",</build/contact-css.css>; rel="preload"; as="style",</build/comment-css.css>; rel="preload"; as="style""
x-debug-token 
"f7bf2d"

Cookies

Request Cookies

Key Value
PHPSESSID 
"liviqnturk78dprudqfid9vfua"
care_did 
"5f77789b-b4fa-4762-9555-964fdfb24299"

Response Cookies

No response cookies

Session 6

Session Metadata

Key Value
Created 
"Sat, 22 Feb 25 13:28:51 +0000"
Last used 
"Sat, 22 Feb 25 13:29:00 +0000"
Lifetime 
0

Session Attributes

Attribute Value
_csrf/https-comment 
"9_OfRmGqqTUcDAcwRLBqFlu2hnBHtjetkOqROJbTbVI"
_csrf/https-cookie_accept 
"YN5QZusfNnDfmpa4TVOgcUXIOjnA0983xgJyqBRmAc4"

Session Usage

6 Usages
Stateless check enabled
Usage
Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:76
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Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:79
Show trace 
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Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:52
Show trace 
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Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:56
Show trace 
[
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    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 181
    "function" => "show"
    "class" => "App\Controller\ArticleController"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 76
    "function" => "handleRaw"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/Kernel.php"
    "line" => 197
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/runtime/Runner/Symfony/HttpKernelRunner.php"
    "line" => 35
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\Kernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/autoload_runtime.php"
    "line" => 29
    "function" => "run"
    "class" => "Symfony\Component\Runtime\Runner\Symfony\HttpKernelRunner"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/public/index.php"
    "line" => 5
    "args" => [
      "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/autoload_runtime.php"
    ]
    "function" => "require_once"
  ]
]
Symfony\Component\Security\Core\Authentication\Token\Storage\UsageTrackingTokenStorage:41
Show trace 
[
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/security-core/Authentication/Token/Storage/UsageTrackingTokenStorage.php"
    "line" => 41
    "function" => "getMetadataBag"
    "class" => "Symfony\Component\HttpFoundation\Session\Session"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/twig-bridge/AppVariable.php"
    "line" => 103
    "function" => "getToken"
    "class" => "Symfony\Component\Security\Core\Authentication\Token\Storage\UsageTrackingTokenStorage"
    "type" => "->"
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    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/twig/twig/src/Extension/CoreExtension.php"
    "line" => 1635
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    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/var/cache/dev/twig/a4/a456f2f504a18cd81037fa69e543310c.php"
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    "function" => "twig_get_attribute"
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    "line" => 394
    "function" => "doDisplay"
    "class" => "__TwigTemplate_824a013e4f3f4a68e03a2d244e765025"
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    "line" => 367
    "function" => "displayWithErrorHandling"
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    "line" => 379
    "function" => "display"
    "class" => "Twig\Template"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/twig/twig/src/TemplateWrapper.php"
    "line" => 38
    "function" => "render"
    "class" => "Twig\Template"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/twig/twig/src/Environment.php"
    "line" => 280
    "function" => "render"
    "class" => "Twig\TemplateWrapper"
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    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/framework-bundle/Controller/AbstractController.php"
    "line" => 448
    "function" => "render"
    "class" => "Twig\Environment"
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    "line" => 453
    "function" => "doRenderView"
    "class" => "Symfony\Bundle\FrameworkBundle\Controller\AbstractController"
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    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/framework-bundle/Controller/AbstractController.php"
    "line" => 253
    "function" => "doRender"
    "class" => "Symfony\Bundle\FrameworkBundle\Controller\AbstractController"
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  [
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    "function" => "render"
    "class" => "Symfony\Bundle\FrameworkBundle\Controller\AbstractController"
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  ]
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    "line" => 181
    "function" => "renderHeader"
    "class" => "App\Controller\AppController"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 76
    "function" => "handleRaw"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpCache/SubRequestHandler.php"
    "line" => 86
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/Fragment/InlineFragmentRenderer.php"
    "line" => 78
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\HttpCache\SubRequestHandler"
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  [
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    "function" => "render"
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    "function" => "render"
    "class" => "Symfony\Component\HttpKernel\Fragment\FragmentHandler"
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  [
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    "line" => 44
    "function" => "render"
    "class" => "Symfony\Component\HttpKernel\DependencyInjection\LazyLoadingFragmentHandler"
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  [
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    "function" => "renderFragment"
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    "function" => "block_header"
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    "function" => "displayBlock"
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    "function" => "displayWithErrorHandling"
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  [
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    "function" => "display"
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    "line" => 394
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    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/twig/twig/src/Template.php"
    "line" => 367
    "function" => "displayWithErrorHandling"
    "class" => "Twig\Template"
    "type" => "->"
  ]
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    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/twig/twig/src/Template.php"
    "line" => 379
    "function" => "display"
    "class" => "Twig\Template"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/twig/twig/src/TemplateWrapper.php"
    "line" => 38
    "function" => "render"
    "class" => "Twig\Template"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/twig/twig/src/Environment.php"
    "line" => 280
    "function" => "render"
    "class" => "Twig\TemplateWrapper"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/framework-bundle/Controller/AbstractController.php"
    "line" => 448
    "function" => "render"
    "class" => "Twig\Environment"
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  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/framework-bundle/Controller/AbstractController.php"
    "line" => 453
    "function" => "doRenderView"
    "class" => "Symfony\Bundle\FrameworkBundle\Controller\AbstractController"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/framework-bundle/Controller/AbstractController.php"
    "line" => 253
    "function" => "doRender"
    "class" => "Symfony\Bundle\FrameworkBundle\Controller\AbstractController"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/src/Controller/ArticleController.php"
    "line" => 277
    "function" => "render"
    "class" => "Symfony\Bundle\FrameworkBundle\Controller\AbstractController"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 181
    "function" => "show"
    "class" => "App\Controller\ArticleController"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 76
    "function" => "handleRaw"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/Kernel.php"
    "line" => 197
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/runtime/Runner/Symfony/HttpKernelRunner.php"
    "line" => 35
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\Kernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/autoload_runtime.php"
    "line" => 29
    "function" => "run"
    "class" => "Symfony\Component\Runtime\Runner\Symfony\HttpKernelRunner"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/public/index.php"
    "line" => 5
    "args" => [
      "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/autoload_runtime.php"
    ]
    "function" => "require_once"
  ]
]
Symfony\Component\Security\Http\Firewall\ContextListener:171
Show trace 
[
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/security-http/Firewall/ContextListener.php"
    "line" => 171
    "function" => "remove"
    "class" => "Symfony\Component\HttpFoundation\Session\Session"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/event-dispatcher/Debug/WrappedListener.php"
    "line" => 116
    "function" => "onKernelResponse"
    "class" => "Symfony\Component\Security\Http\Firewall\ContextListener"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/event-dispatcher/EventDispatcher.php"
    "line" => 220
    "function" => "__invoke"
    "class" => "Symfony\Component\EventDispatcher\Debug\WrappedListener"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/event-dispatcher/EventDispatcher.php"
    "line" => 56
    "function" => "callListeners"
    "class" => "Symfony\Component\EventDispatcher\EventDispatcher"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/event-dispatcher/Debug/TraceableEventDispatcher.php"
    "line" => 139
    "function" => "dispatch"
    "class" => "Symfony\Component\EventDispatcher\EventDispatcher"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 214
    "function" => "dispatch"
    "class" => "Symfony\Component\EventDispatcher\Debug\TraceableEventDispatcher"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 202
    "function" => "filterResponse"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
  ]
  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/HttpKernel.php"
    "line" => 76
    "function" => "handleRaw"
    "class" => "Symfony\Component\HttpKernel\HttpKernel"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/symfony/http-kernel/Kernel.php"
    "line" => 197
    "function" => "handle"
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    "line" => 35
    "function" => "handle"
    "class" => "Symfony\Component\HttpKernel\Kernel"
    "type" => "->"
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  [
    "file" => "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/autoload_runtime.php"
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    "function" => "run"
    "class" => "Symfony\Component\Runtime\Runner\Symfony\HttpKernelRunner"
    "type" => "->"
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  [
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    "line" => 5
    "args" => [
      "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/vendor/autoload_runtime.php"
    ]
    "function" => "require_once"
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]

Flashes

Flashes

No flash messages were created.

Server Parameters

Server Parameters

Defined in .env

Key Value
APP_ENV 
"dev"
APP_SECRET 
"0a988e63f011514eaabfc650b599af4d"
CORS_ALLOW_ORIGIN 
"*"
DATABASE_URL 
"mysql://bbndb_rctuser:33F5W25z40or0f7@localhost:3306/rct_bbntimes"
GOOGLE_RECAPTCHA_SECRET_KEY 
"6LdV5fgpAAAAANxzTG8ZMfIjil1wu-1vrQvnUt-x"
GOOGLE_RECAPTCHA_SITE_KEY 
"6LdV5fgpAAAAAENKcn73MJAhQrbtQeqgyC4wDLMP"
MAILER_DSN 
"smtp://no-reply%40rct.dev.bbntimes.com:Bl6%26gLD48%26Of919@rct.dev.bbntimes.com:465"
MARIADB_PASSWORD 
"i!87pK&!85ezc8"

Defined as regular env variables

Key Value
APP_DEBUG 
"1"
BASE 
"/public"
CONTEXT_DOCUMENT_ROOT 
"/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com"
CONTEXT_PREFIX 
""
DOCUMENT_ROOT 
"/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com"
FCGI_ROLE 
"RESPONDER"
GATEWAY_INTERFACE 
"CGI/1.1"
HTTPS 
"on"
HTTP_ACCEPT 
"*/*"
HTTP_ACCEPT_ENCODING 
"gzip, br, zstd, deflate"
HTTP_CONNECTION 
"close"
HTTP_COOKIE 
"care_did=5f77789b-b4fa-4762-9555-964fdfb24299; PHPSESSID=liviqnturk78dprudqfid9vfua"
HTTP_HOST 
"rct.dev.bbntimes.com"
HTTP_USER_AGENT 
"Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)"
PASSENGER_COMPILE_NATIVE_SUPPORT_BINARY 
"0"
PASSENGER_DOWNLOAD_NATIVE_SUPPORT_BINARY 
"0"
PATH 
"/usr/local/sbin:/usr/local/bin:/usr/sbin:/usr/bin:/sbin:/bin:/snap/bin"
PHP_SELF 
"/public/index.php"
PP_CUSTOM_PHP_CGI_INDEX 
"plesk-php81-fastcgi"
PP_CUSTOM_PHP_INI 
"/var/www/vhosts/system/rct.dev.bbntimes.com/etc/php.ini"
QUERY_STRING 
""
REDIRECT_BASE 
"/public"
REDIRECT_HTTPS 
"on"
REDIRECT_PASSENGER_COMPILE_NATIVE_SUPPORT_BINARY 
"0"
REDIRECT_PASSENGER_DOWNLOAD_NATIVE_SUPPORT_BINARY 
"0"
REDIRECT_REDIRECT_HTTPS 
"on"
REDIRECT_REDIRECT_PASSENGER_COMPILE_NATIVE_SUPPORT_BINARY 
"0"
REDIRECT_REDIRECT_PASSENGER_DOWNLOAD_NATIVE_SUPPORT_BINARY 
"0"
REDIRECT_REDIRECT_SCRIPT_URI 
"https://rct.dev.bbntimes.com/science/dealing-with-long-covid-today"
REDIRECT_REDIRECT_SCRIPT_URL 
"/science/dealing-with-long-covid-today"
REDIRECT_REDIRECT_SSL_TLS_SNI 
"rct.dev.bbntimes.com"
REDIRECT_REDIRECT_STATUS 
"200"
REDIRECT_REDIRECT_UNIQUE_ID 
"Z7nRHJDyWLT8YV1VjBpUyAAAAIE"
REDIRECT_SCRIPT_URI 
"https://rct.dev.bbntimes.com/science/dealing-with-long-covid-today"
REDIRECT_SCRIPT_URL 
"/science/dealing-with-long-covid-today"
REDIRECT_SSL_TLS_SNI 
"rct.dev.bbntimes.com"
REDIRECT_STATUS 
"200"
REDIRECT_UNIQUE_ID 
"Z7nRHJDyWLT8YV1VjBpUyAAAAIE"
REDIRECT_URL 
"/public/science/dealing-with-long-covid-today"
REMOTE_ADDR 
"18.216.100.123"
REMOTE_PORT 
"35911"
REQUEST_METHOD 
"GET"
REQUEST_SCHEME 
"https"
REQUEST_TIME 
1740230940
REQUEST_TIME_FLOAT 
1740230940.9666
REQUEST_URI 
"/science/dealing-with-long-covid-today"
SCRIPT_FILENAME 
"/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/public/index.php"
SCRIPT_NAME 
"/public/index.php"
SCRIPT_URI 
"https://rct.dev.bbntimes.com/science/dealing-with-long-covid-today"
SCRIPT_URL 
"/science/dealing-with-long-covid-today"
SERVER_ADDR 
"5.196.1.209"
SERVER_ADMIN 
"[no address given]"
SERVER_NAME 
"rct.dev.bbntimes.com"
SERVER_PORT 
"443"
SERVER_PROTOCOL 
"HTTP/1.1"
SERVER_SIGNATURE 
"<address>Apache Server at rct.dev.bbntimes.com Port 443</address>\n"
SERVER_SOFTWARE 
"Apache"
SSL_TLS_SNI 
"rct.dev.bbntimes.com"
SYMFONY_DOTENV_VARS 
"APP_ENV,APP_SECRET,DATABASE_URL,MARIADB_PASSWORD,CORS_ALLOW_ORIGIN,MAILER_DSN,GOOGLE_RECAPTCHA_SECRET_KEY,GOOGLE_RECAPTCHA_SITE_KEY"
UNIQUE_ID 
"Z7nRHJDyWLT8YV1VjBpUyAAAAIE"

Sub Requests 6

CookieController :: renderAnalysis (token = e45a50)

Key Value
_controller 
"App\Controller\CookieController::renderAnalysis"
_format 
"html"
_locale 
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AppController :: renderHeader (token = 28338f)

Key Value
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"App\Controller\AppController::renderHeader"
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ArticleController :: trendingArticle (token = 028864)

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"App\Controller\ArticleController::trendingArticle"
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category 
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ArticleController :: relatedArticles (token = 63eeef)

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current_article 
App\Entity\Article {#1094
  -id: 8899
  -title: "Dealing with Long COVID...Today"
  -slug: "dealing-with-long-covid-today"
  -introtext: "<p>I devoted the latter half of my 30-year clinical career to&nbsp;<a href="https://imconsortium.org/" target="_blank" rel="nofollow noopener">Integrative Medicine</a>.</p>\r\n"
  -content: """
    \r\n
    <p>I took a fair amount of flack for that from the steadfastly conventional among my colleagues.&nbsp;Some of the flack was more or less friendly disagreement; some was rather more pernicious, devolving into&nbsp;<em>ad hominems</em>, aspersions, and at the extreme, attempts at character assassination.&nbsp;If that’s the kind of sport you enjoy, you can peruse most of these at the other end of a Google search.</p>\r\n
    <p>Why the vituperations?&nbsp;Well, integrative medicine refers to the blending of conventional and unconventional (<em>aka</em>, complementary and alternative) medical practices in patient care, and those with extreme fealty to the conventions of their turf tend to disdain the turf of others.&nbsp;It works both ways, however: the staunchly conventional see the practitioners of all else as hucksters and quacks, the staunchly alternative see the rigid conventionalists (<em>aka</em>, allopaths) as pill pushers.&nbsp;</p>\r\n
    <p>Both, of course, are wrong.&nbsp;There is, inevitably, dirty bathwater wherever humans are striving for the care of a pristine “baby” of good works; and there is, generally, a baby in the mix to account for dirty bathwater.&nbsp;There is no field of human endeavor I have ever encountered that is just the one and none of the other.&nbsp;</p>\r\n
    <p>As a board-certified Internist, I have abundant cause to&nbsp;<a href="https://www.linkedin.com/pulse/outrageous-fortune-david-l-katz-md-mph/" target="_blank" rel="noopener">celebrate the prowess of modern, conventional medicine</a>- but I also have an insider’s view of its misguided traditions, pedantry, dogma, and frequent if (generally) inadvertent harms.&nbsp;As for alternative medicine in the aggregate, it is a vast domain that runs the gamut from preposterous nonsense, to safer, gentler, and highly effective treatments.&nbsp;My colleagues and I have actually&nbsp;<a href="https://pubmed.ncbi.nlm.nih.gov/12868249/" target="_blank" rel="nofollow noopener">studied, and mapped that gamut</a>.</p>\r\n
    <p>I migrated to Integrative Medicine for one reason and one reason only: human need tends to go on long after textbook passages and the results of RCTs run out.&nbsp;I am a card-carrying member of the evidence-based-medicine club, having taught clinical epidemiology and biostatistics to Yale medical students for nearly a decade, and authored&nbsp;<a href="https://us.sagepub.com/en-us/nam/clinical-epidemiology-evidence-based-medicine/book8792" target="_blank" rel="nofollow noopener">a textbook</a>&nbsp;on the topic.&nbsp;But I believe there is a need to respect evidence and remain responsive to the needs of patients when the better varieties of evidence have run out.</p>\r\n
    <p>Striving to do this in practice - balance respect for science and responsiveness while dealing with especially hard-to-treat patients who had tried everything conventional medicine sanctioned without success - my colleagues and I developed, and&nbsp;<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4615581/" target="_blank" rel="nofollow noopener">published</a>&nbsp;(see Table 2) a construct called CARE:&nbsp;<em>clinical applications of research evidence.</em>&nbsp;In a nut shell, we argued that evidence is not a light switch, on or off, but rather encompasses a range of relevant considerations: is a treatment known to be safe, or not?&nbsp;Is there evidence of therapeutic benefit, or not?&nbsp;Is the science absent, scanty, abundant, or murky?&nbsp;Is there an alternative, better substantiated treatment for the job that hasn’t been tried yet, yes or no?&nbsp;And: does the patient want it?</p>\r\n
    <p>Consider the extremes: bad science, unsafe, probably ineffective, there are many likely better alternatives, and the patient has no clear preference.&nbsp;Saying “no” in this situation is a no-brainer.&nbsp;So is saying “yes” when a treatment has strong supporting science, is clearly very safe, is highly effective, there are no good alternatives to it, and the patient desperately wants you to “do something!”</p>\r\n
    <p>The trouble, of course, is in the middle: murky science, probably safe, might be effective.&nbsp;Here, the matter comes down to alternatives, and patient preference.&nbsp;If there is something “better” the patient will accept, that should come first.&nbsp;But if there is nothing better, then…this becomes the next best thing to try.&nbsp;Navigation through the fog of clinical uncertainty is the “art” part of medicine.&nbsp;It comes down to judgment, doing the best we can with what we’ve got- when what we’ve got is no longer the neatly scripted marching orders of a textbook.</p>\r\n
    <p>There is an important aphorism that nicely accompanies these reflections:&nbsp;<em>absence of evidence is not evidence of absence</em>.&nbsp;In other words, before we know that something does or doesn’t work, we will have cause to wonder about it.&nbsp;A study is never done BEFORE sense, experience, and observation suggest a potential benefit; studies are done afterward.&nbsp;Sense and intuition lead, science follows.</p>\r\n
    <p>But in the realm of alternative and natural treatments, high-quality studies may not be done at all, because funding for them is extremely elusive.&nbsp;Drugs and devices are routinely patented, and vast fortunes fuel pharmaceutical and device research, because vast fortunes ensue when these are applied.&nbsp;But there are no patents for&nbsp;massage, or Tai Chi, or&nbsp;<a href="https://pubmed.ncbi.nlm.nih.gov/16238507/" target="_blank" rel="nofollow noopener">meditation</a>, or most supplements- and thus, lack of cash leads to lack of research.&nbsp;Many looking at all of this from altitude have wryly noted we do not, really, have evidence-based medicine; we have profit-based medicine, since profits dictate what evidence we pursue, and generate.</p>\r\n
    <p>What this means is that much of what should be studied has not been yet, and in some cases, may never be.&nbsp;It also means that what will be studied, and proven effective or ineffective some time in the future, may be subject only to informed conjecture today.&nbsp;But if you are a patient in pain today, then today matters.&nbsp;Tomorrow, and tomorrow, and tomorrow…are just too far off.&nbsp;Medicine is obligated to do the best it can, today, for every patient- based on what it knows, and despite what it does not know, today.</p>\r\n
    <p>Exactly that is true of long-haul COVID, or PASC:&nbsp;<a href="https://www.nytimes.com/2021/06/15/health/covid-19-patients.html" target="_blank" rel="nofollow noopener"><em>post-acute effects of SARS-CoV-2</em></a>.&nbsp;The condition is real and prevalent right now, but we do not yet have mature science to instruct treatment.&nbsp;<a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-management.html" target="_blank" rel="nofollow noopener">CDC has provided</a>&nbsp;some rather general and vague guidance.&nbsp;Far more specific treatment protocols are available courtesy of the&nbsp;<a href="https://covid19criticalcare.com/covid-19-protocols/i-recover-protocol/" target="_blank" rel="nofollow noopener"><em>Front Line COVID-19 Critical Care Alliance</em></a>.&nbsp;These recommendations reflect an aggregation of judgment, informed opinion, clinical experience, and some rather inchoate research.&nbsp;If we had evidence ready for primetime, in the form of RCTs and meta-analysis, this would all just be standard of practice; it is not.</p>\r\n
    <p>I have long-haul COVID, and I am not following any elaborate treatment protocol.&nbsp;My wife massages my head and neck from time to time to relieve the headaches, and I have found there to be no better medicine for that. I am using a scent-retraining kit from my friends at Vanderbilt University to get my olfaction back to baseline (I am close, after nearly 5 months).</p>\r\n
    <div class="slate-resizable-image-embed slate-image-embed__resize-middle">&nbsp;</div>\r\n
    <div><img src="/images/Covid.jpeg" alt="Covid.jpeg" width="600" height="800" /><br /><br />&nbsp;</div>\r\n
    <div class="slate-resizable-image-embed slate-image-embed__resize-middle"><img src="/images/Covid_2.jpeg" alt="Covid_2.jpeg" width="598" height="797" /></div>\r\n
    <p><br />Otherwise, I am sticking with my usual commitments to eat optimally, exercise daily (on bad days, I have really had to force myself), get enough sleep, and manage stress.&nbsp;My short list of supplements- vitamin D, probiotic, omega-3, whole plant-food concentrates- remains as it was.&nbsp;</p>\r\n
    <p>I am counting on tincture of time- a powerful therapeutic that often fails to get the respect it deserves.&nbsp;The body has remarkable healing capacity- so just taking very good care of it with lifestyle, and giving it time to take care of itself, is among the greatest of all remedies.&nbsp;But I can afford this luxury because my case is mild, and I am improving.&nbsp;Were my symptoms more severe, I might not tolerate the wait.&nbsp;And, there is no guarantee about the prize for waiting.&nbsp;Time can work wonders, but sometimes- things stay the same, or get worse rather than better.</p>\r\n
    <p>My advice to you issues from this.&nbsp;If you have mild symptoms and a trend toward improvement, use&nbsp;<a href="https://www.lifestylemedicine.org/" target="_blank" rel="nofollow noopener">lifestyle as medicine</a>&nbsp;and time as your intervention.&nbsp;Your body, if you nurture it, is capable of remarkable recovery; I have been privileged to bear witness many times over my career.</p>\r\n
    <p>If your symptoms are severe, or your trend is unfavorable - static, or deteriorating- see your doctor with the FLCCC recommendations and the CARE construct in hand- and insist on some careful, compassionate creativity.&nbsp;Sense leads, while science follows to verify or refute.&nbsp;Sometimes, the best we can do is trust in sensible judgments predicated on very incomplete evidence.&nbsp;</p>\r\n
    <p>I have two related hopes.&nbsp;The first is that the field of medicine will recognize, and respect, that&nbsp;<a href="science/gaps-in-the-tale-of-covid-s-long-tail" target="_blank" rel="noopener">many other pathogens also induce long-haul syndromes</a>.&nbsp;The regrettable tendency has been to blame the victims, but with SARS-CoV-2 conferring obvious legitimacy, that may at last change.&nbsp;The second is that all health professionals reliably differentiate between evidence of absence- which is, indeed, a reason to demur- and absence of evidence, which only tells us: we don’t know for sure yet.</p>\r\n
    <p>All too often care, today, must prevail over gaps in evidence and knowledge to be filled only&nbsp;<a href="https://www.poetryfoundation.org/poems/56964/speech-tomorrow-and-tomorrow-and-tomorrow" target="_blank" rel="nofollow noopener">tomorrow, and tomorrow, and tomorrow</a>.&nbsp;You deserve the best today can offer; carpe diem.</p>
    """
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AppController :: renderFooter (token = effafd)

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"App\Controller\AppController::renderFooter"
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"html"
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"en"
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"e4fbe4"

CookieController :: renderCookie (token = bc2161)

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"App\Controller\CookieController::renderCookie"
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"html"
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"f94ea3"