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Autoimmune disease

Autoimmune Diseases Statistics in US 2026 | Key Facts

After Lou Carreras commented on my write up on autoimmune disease, I thought I would do more research. The article above https://theworlddata.com/autoimmune-diseases-statistics-in-us/ shows an enormous increase in autoimmune disorders in the last twenty years. Also, I can’t tell if they include fibromyalgia, chronic fatigue, long covid and the encephalopathies. The first three can be ANA and ESR negative. To me that means that we have not found a good inflammatory marker for these disorders. It is certainly not that they do not exist.

The data is a bit overwhelming and horrifying. I know too many people with connective tissue disorders and those were very very rare when I was in medical school (1989-1993). Not nearly as rare now and all the people I know are young.

I stand by what I wrote and this reinforces it: as a culture and world we have to back off from the high sympathetic nervous system fight or flight.

And today, Formula One racers are driving around the mall and Washington, DC. So what do I think of that? Imbecilic, toxic, dangerous. Which egotist set that up?

For the Ragtag Daily Prompt: egotist:

https://ragtagcommunity.wordpress.com/

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Level up 

I just leveled up

Level pro

level pro in poetry
or in writing
or in emotional maturity
or maybe

or maybe connection to the Beloved
or my dead sister
or forgiveness

I don't know

all I know
is

I leveled up

______________

For the Ragtag Daily Prompt: egotist.

Written August 21, 2026.

Terry took the photograph. I had to dance very carefully so as not to trip Tom.

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Rong again 


Oogenesis: When do eggs form in humans?
https://www.britannica.com/science/oogenesis

Spermatogenesis: When do sperm form in humans
https://www.verywellhealth.com/how-long-does-sperm-live-8735193


Rong again


The sperm form all through a man's life
and die after what, ten weeks?
if they do not fertilize the egg

The egg

now that is a different story
the egg contains nutrition
to tide the new being over
until the placenta is implanted

and it has
the mitochondria
"the power house of the cell"

the sperm 
have no mitochondria

the mitochondria 
are maternal only

when do the eggs form?

the eggs form 
in the fetal girl
eight to twenty weeks after fertilization
by the time she is born
she has all the eggs 
that she will have

some will mature
some will not
most will die

the most common abortions
are "spontaneous" abortions
performed by God

we grieve anyway

except when we don't
and when we are relieved

So when did I form?

not when the sperm 
met the egg
sometime in June 
1960

my mother
is born in May
1938

she is forming me
as she develops 
in my grandmother's womb

I am started sometime
in 1937

do not tell me
that life starts 
in humans
when the sperm meets the egg

because that is wrong
rong again

that is the male view
isn't it? 
years ago 
they think that the man
contributs the entire homunculus
to the womb of the woman
and she is
merely
the vessel

also rong

and if 
each baby girl
holds eggs
and lives
that are already started

you would think

that we would treat women better

it isn't penis envy that kills
women

rong again

I think that it is envy
of the women
and the mitochondria

maybe if we understand
the eggs
the mitochondria
that women carry 
from before birth

maybe

we will treat women 
and girls 
better

___________________

I can't credit the photographer because I am the little girl in the canoe. The photographer is family, no doubt, and dead. Except for their genes, and some of them live on.

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Longing 

When I am little
I long to be old

I adore my grandmother
she is wise

when I come to her 
at four months

I am angry 
and turn my head from the spoon

my mother tells the story
I do not remember

my grandmother studies me
and says, "Yes,

you may feed yourself."
My mother laughs and tells

"You lived on cheerios
and chunks of banana

and would not let anyone
put anything in your mouth."

There might be a darkness there
that I don't want to think about.

And the finger thumb skill
does not appear

until nine months.
Before that it is a sweep of the hand

to pick things up.
Difficult with cheerios.

I held the bottle too. 
I am returned to my parents

at nine months
the grandmother gone

1000 miles away.
I do not like my mother

or my father
nor do I trust them

at first. But one must live
and I do

At two I play falldown
tackling my father

like the people on the television
and he falls down

and I laugh
It is only later that I realize

that only men play falldown.
I think to myself

nothing will stop me
if I want to do something

being a girl
will not stop me

if I want to play falldown
or anything anything else.

My grandmother gives me 
the gift of anger

the gift of independence
permission to refuse 

the spoon. Permission
to feed myself

and feel my feelings.
And I never ever stop.

I learn to hide some feelings
from my parents

because they cannot allow them.
Sorrow, fear and humiliation

three monsters that I must hide
or refuse to feel.

On a boat my father says
to my young daughter

"Don't be scared
or go below."

I say, "No.
What are you scared of?"

"I am scared that we are stuck
aground

we can't get to shore."
I say, "Look.

We are very close to shore. 
I can swim there.

We could wait for the tide
to come back in 

and float us free.
But we have two strong mothers

who are trying to winch
us off to float free."

My daughter is satisfied.
Soon another sailor sends a rowboat

taking the four children 
to play on shore

while my friend and I 
continue to use all our muscle

to winch the boat off 
the stubborn earth.

I think it is the tide
coming in 

that finally frees us
and we are too tired to sail

by then 
and return to the slip.

We have entertained 
every live aboard

and they tease us
mercilessly

and we do not care.
But my father's words

"Don't be scared
or go below."

resonate. I chose
to go below 

as a child
to hold my feelings sacred

and refuse to entirely 
stuff them.

As an adult
a friend says

"You feel things too strongly."
I clam up

immediately.
I feel things too strongly

for HER
but not for me.

My feelings are 
MINE and sacred.

My feelings are
prayers to the Beloved.

Your feelings are 
prayers to the Beloved.

My best work 
as a physician

is when I open the door
to someone's feelings

and they let them out
terrifying 

to them.
But not to me.

And when they are done
I say

"It seems to me
your feelings

are perfectly reasonable.
I would feel that way too."

Sometimes I ask
would they still want

the antidepressant?
A counselor?

A follow up visit?
They look surprised.

A weight lifted
for now.

"No.
I will see how I am doing.

I will call if I need 
to come in."

"That's fine."
I say.

Somehow I don't
think the AI

can really do this
as I do.

I may be wrong.

When I am very small
I want to be old

and wise 
as my grandmother

who saves my heart
and lets me feel.

Now I am middle aged.
I don't want to be old

and wise
for a while yet

but it isn't my choice now,
is it?

Bring it on
Beloved.

Bring it on.

For the Ragtag Daily Prompt: partner.

I think the Beloved is my partner in joy, in sorrow, in wicked humor. Thank you, Beloved.

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Predicting medicine again: autoimmune disease

Once again here I go out on a limb. Here is my prediction for the next Really Big Thing in medicine, which is already happening. It is slowly rising from the murky swampy depths of our unconscious.

Here are clues: https://my.clevelandclinic.org/health/diseases/autoimmune-encephalitis

https://www.mayoclinic.org/diseases-conditions/autoimmune-encephalitis/symptoms-causes/syc-20576380

Autoimmune encephalitis? Or encephalopathy? What a mouthful. And what the hell?

Well, we have always said that we do not know the causes of depression, mania, schizophrenia, psychosis and all the other psychiatric diagnoses.

And now I think we know, though we don’t have them all sorted yet.

The cause is the immune system. And what’s more, it’s adaptive.

“NO!” (you run screaming from the room). “Not MY immune system! NO!”

Yes, I say, your immune system, my immune system, everybody’s immune system.

WHY? Well, my version shuts me down. I get tachycardia (a fast heart rate), short of breath, accusations that I am manic, my fast twitch muscles don’t work and I get pneumonia. And it lasts longer each time. Two months. Two months. Six months. A year and a half on oxygen and then off but really it took four years before my muscles started working right again. It shuts down my fast twitch muscles but not my slow twitch muscles.

So how is shutting me down adaptive?

Think. If there is a pandemic, or huge danger, or someone is trying to harm me, it isolates me. People think I am very very weird when it is happening. So I isolate, to protect myself. Isolate and voila — protection from pandemic. If I have resources, and luckily I do have resources, I can hole up. Food, drink and a broadband connection.

The book Brain on Fire and movie are about an encephalopathy: antibodies to NMDR that made the author psychotic until it was recognized and treated. I went to a virtual continuing medical education on encephalopathy in 2022, I think. In the US alone, there were already 555 patients identified with NMDR antibodies.

Now there is a whole list of antibody encephalopathies, many associated with cancers. Not all.

Here: https://autoimmune-encephalitis.org/wp-content/uploads/2022/10/PNK-The-Known-types-and-categories-of-AE-as-of-2022.pdf

I like the addendum “as of 2022”.

and here: https://www.nature.com/articles/s41572-025-00650-1

A physician friend calls me a few years ago. “Have you heard of NMDR antibody disorder?”

“Yes,” I say

“I have a patient with it,” she says. We are a county of 32,000 people. Rural. She is looking it up. I tell her what I know.

In January I see a patient who turns out to have Anti-Caspr2. I have to look it up. Now I see the list of encephalopathies that is rapidly becoming longer and longer.

I think that chronic fatigue, fibromyalgia and long Covid fall into immune system disorders too. Just because we haven’t figured out the mechanism: well, we may. If we don’t destroy the planet first.

I also have reservations about treatment. We are using more and more immune suppressants. I read about one that stops B cells from working. Specifically, the B cells that produce antibodies. Well, that would work for my disorder, except, I already get pneumonia really easily. And destroying the B cells lowers immunity and increases the risk of infection.

I see a patient in clinic who has a skin infection and a fever and an autoimmune disease. They are on an immunosurpressant that I don’t know much about. “Have you called your rheumatologist?”

“No, why?”

“I think you are supposed to stop the immunosupressant. Please call them today. And let me know what they say. Please!” I start antibiotics.

The patient sends a MyChart message. Yes, stop the immunosupressant while on antibiotics. In the future they will call the rheumatology office as well as seeing the clinic for any infection.

I am not saying we shouldn’t use immunosupressants. Sometimes we have to. Rheumatoid arthritis. Hypothyroidism, the most common autoimmune disease, yes, we should and do give outside thyroid hormone. But there is something else we need to do.

The clues for this lie with chronic fatigue and fibromyalgia. What triggers them? One in ten severe infections, severe stress, or a combination.

So we need to learn as a culture, as a world, as humanity, to lower stress. We can’t be high sympathetic nervous system fight or flight high achieving high spending higher faster crazier all the time.

Here is to the parasympathetic state. That is where we need to go. Go down, slow down, be kind to each other and ourselves, be gentle, laugh, fail, lie in a hammock, watch silly cat videos and fat bear week. Then the immune system might calm down and not attack us to save us. I think the immune system is pretty smart, really. Even as it pisses me off and limits me.

Go down, slow down.

Blessings and peace you.

by

Unload 

I write Watching my sister die
a poem
14 years in the making

as usual
the poem goes off
in a direction I don't anticipate

I never know where my poems
will go

I just sit down
with something nagging at me

write me write me write me
NOW

and I've gotten up at 3 am
because the damn poem
won't let me sleep

that one was about
my future ex
a horse of course

Idaho Gigolo

my sister poem
takes me back
and deep 
until I cry

but the ending
is reconciliation
forgiveness
unexpected

that is why I cry

I don't expect reconciliation
from a damn poem
the poems do what they want
I never know 
what they will do

maybe they ARE alive

like a child
waiting for a fetus
waiting for the egg and sperm
to join

waiting to be born

wait

this poem is doing it too
damn it

but after the sister poem
I unload a huge burden
anger
and grief

and then to the facilities

and I unload there
too

so there

__________________

For the Ragtag Daily Prompt: waddle.

Do you think the seal rock is poopy? Do seals and sea lions waddle or is there another word?

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Watching my sister die 

I wrote this today thinking about my sister's write up "Watching my mother die" here: https://everything2.com/title/Watching+my+mother+die
Her write up is the fourth one down.

______________________________

Watching my sister die


I know before she does
but maybe not
maybe she knew
that last year

brave front
while soliciting money
on the internet
as the cancer progresses

she describes new treatments
I forget
how many rounds of chemo
she endured

eight years
from diagnosis 
to death

I stop visiting
for a year
after she bullies 30K more
from our father

and he calls me crying

I give myself permission
to change
to be a physician
more than a sister

because as a sister
my sister is 
cruel

she destroys my reputation
with my mother's family

or maybe they already
don't like me
because I think the family rules
are ludicrous and stupid

and I won't follow them

I suppose each generation
has someone who says
wait
these rules make no sense

why are we following these?

I think she will die
by February 2011
but there is another death
unexpected

the death of my hope
for a sister who loves me
for a sister who treats me well

for a sister who loves me

and I let that hope die
and I rise from the ashes
and I choose not to visit

and she uses this
tells people I won't visit
though I don't say I won't

people sent me checks

I sent them back
with thanks
saying

it is too soon 
to leave my nascent business

my sister
stays in touch 
this year

at last 
in February 2012
she calls me

my oncologist 
referred me to hospice
but I am not going

yes, I know
you are refusing to go

I don't saybut the cancer 
is progressing
and like it or not

you will go

my sister 
applies for a clinical trial
miles away

and at last
her enthralled circle 
refuses

they say
we are so tired
we cannot drive you there

daily

I fly down 
for a long weekend
and the hospice interview

I am excluded
but ask to step in
at the end

I ask the nurse
is this like where I live
that if there is a stroke

or a blood clot
or bleeding 
or whatever horror

hospice will keep 
her comfortable 

but will not treat it?

yes 

says the nurse

my sister stands
pushing away from the table
NO she says

I AM NOT READY

yes, I knew that

you are not going

I don't say
but you will go
willing or no

I fly down a second time
and as I leave
she cries

I am surprised

we have not talked
really

there are so many people
in and out
and I've been portrayed 
as a villian

there is still time

I fly down a third time

she is angry, angry
now in hospice
angry that she is dying

I start to sing a lullaby
and she says NO

I study her
I sing Samuel Hall

To the gallows I must go
I must go 
I must go

To the gallows I must go
with my friends all down below
saying Sam I told you so

damn their eyes
damn their eyes

saying Sam I told you so
damn their eyes

she smiles
a vicious secret smile

she is in renal failure
strange
says 

I have to take a trip

I say yes
you do

I don't know how

You will figure it out

How will I find you?

I am surprised again
the connection is still there
buried deep

You said I can take the dragon home
the one I made in college 
and gave you

You are born in the year of the dragon
you will have wings
find the dragon 

and you will find me

oh, good
she says 
relieved

she speaks of a bad pig

I say maybe it isn't bad
maybe it's done some bad things

she shakes her head

I say shall I take the 
bad pig away?

she still is not satisfied

I guess: do you want me
to keep the bad pig
from hurting anyone else

yes
she smiles
yes

again we are alone

I am Bad she says

You are not bad
I say
You have done some bad things

Very bad

She is crying

I say I love you anyway

and she blooms
like a rose
soft in a dark orange blanket
with matching lip gloss

forgiven
and reconciled

flying home
I name the dragon
Bad Pig

and gird myself
for death

three days later
she dies

and then the fallout
and the aftermath
begins

_____________________

I will attach this to the Ragtag Daily Prompt "escapade", though I think of escapades as fun.
The escapade is the photograph. She and I were dancing before my wedding, in 2007. 
I am the short one and clearly I was teasing her about something. 

Sorrow never dies, quite.

Neither does love.


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Old woman 

In middle age
I acquire a new skill
along with invisibility
middle age women
are ignored 
by almost everyone

and I am gifted with power
to be invisible 
and to curse

I could already curse
aloud
but this is something more

a hand gesture
and a rhyme

fingle fangle
what a tangle
dingle dangle
it won't work

for all the Epstein players
and other men
who use 
mistreat
rape
abuse
imprison 
women

Viagra
has nothing
on me

and all the other
invisible 

middle aged

women

_____________________

The photograph is my grandmother, Katherine White Burling. I took this in 1979.

For the Ragtag Daily Prompt: cone. Just add an r in the word.
by

Old man 

Old man
yes, we hear you
every niggling detail
it used to be about X
but now it's about Y
yells
about X 
and he doesn't like
the internet
where it has gone
at
the moment
in his car
it used to be
food, shelter
and a broadband connection
but now that doesn't 
seem to satisfy
as the tortured veins
repurposed as arteries
moved from the leg
to the heart
slowly close back down

the internet
is not the place
of glory and kindness and free exchange
of ideas
old man asks
hates to ask
for money
and in spite of evil internet
has a wishlist on Amazon
where he directs those
who do not care to donate
through apple pay
he is no longer allowed on
Go Fund Me

soon there will just be

cloud

________________________

For the Ragtag Daily Prompt: magnitude. 

The magnitude of trivia on the internet.

by

Liar, liar

Liar, liar, pants on fire, nose is as long as a telephone wire.

Trigger warning: sexism, child abuse, dating, US culture. Kinda not tame.

The last guy I date, only we don’t date, is a liar.

It is a bit into Covid. He knows I’ve had three pneumonias and he texts. “Are you worried about this?”

“Heck, yeah. Of course.” Then I ask if we can talk on the phone.

We start doing distanced beach walks and talking. Talk, talk, talk. At first he has to lure me out.

“Want to go for a beach walk?”

“I dunno.”

“I made lunch.”

“Oh, then yes!”

He points out that I have food insecurity. He is annoyingly correct. By the end of any meal, I am checking to see if there is food for the next meal. It is automatic and dates to when I was a toddler.

We compared abusive childhoods. Really. Back to toddlers. He finally says, “You win.”

“What?” I am not trying to win.

“Your childhood was more abusive than mine.”

I think various unprintable words.

I start noticing lies. They are stupid lies, as far as I am concerned. They shut me up over time because there really is no reply except, “Uh, why are you lying? I am not believing any of that.”

He says he is really really smart. Ok, fine. He says he can read my mind. I do some attempt at a girlie modest shy face which probably more resembles a grimace. But he is deep in his dream lies and honestly, notices me less and less. When he says he can read my mind, I know he can’t, because he’d be horrified by the swearing and laughter.

He is the smartest one in the room, though, he says modestly, often people don’t realize it. I nod and keep looking for calcedony nodules, aka agates. He’s better at finding them than me. I am automatically competitive, but that’s on an upper level of my mind. At the deeper level I could care less.

I also do not care if he’s trying to impress me with his smarts. My feminist level laughs hysterically and thinks nasty nasty nasty thoughts. But I have a deeper level that can love most people. I keep that stuff hidden and I know he can’t read it. Though I can read him: not his mind, but my inner psychiatrist gets involved and wants to know, why does he lie? And he’s lying to himself, not me. I don’t believe a word, but I am interested. What is the goal, here? Why lie?

He had a perfect marriage. I can’t control my expression on THAT one. Uh, doesn’t exist, hon. Why THAT lie? It starts to sort out. Well, in a way it was perfect. Perfect for him. Not perfect for his wife. She was super super depressed. Guess none of that was his fault. Our absolutely sexist culture. And now I know why he is hanging out with me. I am depressed. But it is situational and temporary. I need to close my clinic and I still have a year on the lease. And I will go work temp doctoring, but it is risky. I may get pneumonia a fourth time and it could kill or disable me. So I cannot take the risk of closing early and paying off the lease as a temp. I have to work the year out and I am really down. He is looking for a depressed woman and I seem to fit the bill. And I am a doctor. Who better for a really smart male to control than a woman who is smart enough to become a doctor (but not as smart as him).

Well, it all blows up after a year. I close my clinic, go work as a temp, and keep walking in to rooms where patients have their masks off. It only takes me five week to get bad Covid, even though I am masked and even though I ask the clinic manager, the nurses, the medical assistants to have people keep their masks on. I am down and this time I need oxygen.

Pneumonia for me comes with tachycardia and the opposite of brain fog. The tachycardia makes me drop ten pounds in the first week and wires my brain like a rocket. I wake up in the morning anxious like that cartoon of the cat attached to the ceiling with all four paws and fur all on end.

He says, “Pneumonia makes your brain go faster.”

I say, “Nope.”

“No? What do you mean?”

I say, “My brain is the same speed as it always is. But when I have this, I can’t hide it.”

“I don’t like that idea at all.” Yeah, that is the moment when our relationship is done. By him, not me. For one thing, I am no longer depressed. For another, he is the smartest person in the room. But. My brain might be faster. He says, “I can follow what you say, but you don’t even take a breath when you switch from one topic to another and I can barely keep up.” Yeah, well, sorry. That’s why I bloody well hide it most of the time. Because our culture dislikes smart women A LOT. It’s okay, barely, for a woman to be a physician, but men don’t want to date them. They wouldn’t mind screwing them. My maternal uncle told my mother that he was looking for a wife, “But I don’t want a woman who is smarter than I am.” My mother snarled about my uncle for weeks. Go, mom.

So this guy was a liar. But maybe I was a liar too. I shut up once he started lying and I shut the gates and doors of the vast garden and jungle that is my mind. No entry to people lying to themselves. There is a public garden in my mind that they can visit, but the rest is closed, hidden, contains the entire ocean and the deep trench, and maybe the universe.

And I haven’t dated since. Because I can’t stand that the virginal disney princess girl mythos in our culture feeds the sexist child abusive Epstein and all the men with him. And bloody well don’t say, “But there are some men that aren’t like Epstein.” Yeah? Well then why aren’t they fighting the Epstein crowd to the death with guns and knives. Until all the men are protecting all the children, all the girls and all the boys, and the gay folk and lesbians and trans and different races and yeah, I expect you to model Kwan Yin and protect EVERYONE from being abused. Meanwhile, men can stay the heck away from me. And yes, you can substitute a lot of swears for the word heck.

For the Ragtag Daily Prompt: tame. I think this is not a tame subject.