Monthly Archives: November 2022

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sleep and defiance

Oh, gosh, CNN is making everyone panic about sleep again: https://www.cnn.com/2022/11/08/health/sleep-deprivation-wellness/index.html

Don’t buy it. It used to be 8 hours. Now they are saying 7 in this article. SLEEP AT LEAST 7 HOURS OR YOUR BRAIN WILL MELT.

Nope. The media likes us to panic because it sells papers and gets shares. Don’t buy the hoopla.

After all, I took call at night for 30 years and my brain has not melted. (Ok, if you disagree, post your own blog, heh, heh.) Starting third year of medical school. Sometimes it was every third night, sometimes every fourth. We were often up and awake and working for much of the night and then through the next day. If we had to be ready for rounds at 8 am, we had to be there earlier to see the patients, check the lab work, check any studies, drink a gallon of coffee and then be coherent on rounds, where the faculty physician might quiz us about the nineteen causes of high potassium. Uh. Taking too much potassium is one. Kidney failure, diabetic ketoacidosis, etc, etc.

I made up the number nineteen.

Anyhow, I was a sleep rather than eat person. If we got a break, I would go to sleep and skip food. The bad rotations were obvious because my weight would drop. We’d meet for “nutrition rounds” in the morning. I would skip lunch, hoping to have it at home post call, but the list might have things added even as I ran around checking things off. At last I would stop for lunch at 2 or 3 or 4 because my brain was no longer functioning.

Doesn’t sound very healthy, does it?

Here is a post on sleep from 2015: https://drkottaway.com/2015/01/08/sleep/. I sent a copy to our sleep specialist and he liked it.

When I got my flu vaccination and covid booster a month ago, it hit me pretty hard. I am sleeping as I normally do at night, for 6.5-7 hours. But I also started napping, once or twice a day. I was sleeping 11 or 12 hours total daily. I canceled pulmonary rehabilitation exercise, because it wiped me out. I was starting to feel better after three weeks, so I restarted pulmonary rehab. I promptly slept 12 hours a day again and my muscles gave me HELL.

So what in the heck IS this? Well, healing. My body is knocking me out to do repair work. It’s sending a pretty clear message that running on a treadmill is not ok right now. My immune system is busy making antibodies and is saying HEY WE DO NOT HAVE ENERGY TO SPARE FOR ANYTHING ELSE. This is sort of annoying except that having had four rounds of really bad pneumonia, the last one requiring oxygen for a year, still on oxygen to sing and for heavy exertion, I am willing to listen to my body. It is annoying, but: my mother, father and sister are dead, so even though I am struggling some, I’m not dead. It’s all relative, right?

When I had pneumonia #3 (2014) and pneumonia #4 (2021), both times part of the healing is sleeping twelve hours a day. I went back to work six months after the 2014 one and promptly slept twelve hours a night. I was seeing 4-5 patients a day and could barely do that. I went into denial about chronic fatigue, but I knew I had it. NO WAY, I AM TOUGH. Well, I am tough, but that means chronic fatigue and not dead.

I do not worry about sleeping 7 hours a night or 8 hours. I sleep when I get sleepy. Naps are fine and one gets to relearn napping after age 50 or 60 and it’s ok. If you need to stay awake after lunch, have a small lunch and no alcohol. Alcohol is not good for sleep in the long term and neither is marijuana. Benzodiazepines are worse than either. Ambien and those drugs are approved for “short term” use, meaning two weeks. Great. We don’t know what it does if you are on it for years, but some of us note that those drugs are closely related to the benzodiazepines. I think the most addictive drug is tobacco, followed by benzodiazepines and then methamphetamines. That is from asking patients and observation over 30 years. There are individual quirks though, and I have had people say, “Alcohol is no problem but the first time I was given oxycodone I wanted more.” Sometimes there is a bit of denial in those statements.

The photograph is me doing my second sleep study last week. I scored. Um, or rather, it was a positive test. Sleep apnea, darn. I am now waiting for my bipap machine. The funny bit is that I had to drive an hour to the lab. I was supposed to be there at 8. I got there an hour early because I get really tired at night. The tech let me in and wired me up. “But,” she said, “you can’t go to sleep until 9, because I have another patient and they are not here yet.” “Ok,” I said. I read for a while in the chair, put my head back and (don’t tell) fell asleep.

She came back in, did the final connections and then left. There is a ceiling camera and a disembodied voice. We tested the connections. “Flex and extend your right foot.” “Now breath through your nose.” I did and immediately fell asleep. She woke me, “Breath through your mouth now.” “Was I asleep?” “Yes.” The wires didn’t bother me much, though I had to surface part way during the night to change position.

I’ve slept sitting up in hospital meetings. I fell asleep standing against the wall in medical school. It is really a blessing to be able to fall asleep.

The year my father died, I had a terrible time falling asleep. His will was very out of date, written 40+ years before. It was a mess. His house had 13 years worth of unopened mail. I used Jon Kabat Zinn’s Mindfulness Meditation tape to fall asleep. But I used it in a rather weird way. He has a section where he says “Do NOT fall asleep.” It was a body scan. I would think, hey, you can’t tell ME what to do, and I would always fall asleep during it. So there, Dr. Kabat Zinn. Thank you.

The pandemic is enormously stressful, not to mention all of the other things. You can still relax though. What relaxes YOU? Stupid animal videos? A walk around a yard or park? Dancing in your kitchen? Knitting? Reading your absolutely most boring textbook? Put the phone and the television and the computer away at least one hour before you want to sleep and preferably two hours.

And here, to relax you, are pictures of sleep: https://drkottaway.com/2018/04/30/zzzzzz/

Blessings.

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Who snew?

Who snew the snow was falling deep
with votes to vote before we sleep
we’ll march for miles with votes to keep
breach of promise makes us weep

I go pogo Hellno no no
who snew the snow won’t make school no go
cold students trudge to bus oh so slow
school on a snow day sorrow blow woe

who snew the temperature would snow melt?
icy drips and drops from trees pelt
my cat on leash slips grumpy fur felt
my vote is cast against gilt hair hell bent

Who snew that science snews would soon die?
fentenyl kills like a drive by
kills more than heroin or meth, oh my my
science silenced while liars cry die

Who hopes for sanity not war?
who casts a vote to help the poor?
who snows the prophets words once more
are used to profit from human gore

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Chronic pain #I forget

The CDC has a new set of recommendations for chronic pain.

I will write about them. I have to read them first. Hurts too much, right now, the election, and all the pandemic fighting. Stress people and you see what they are really like.

My church has melted down into a huge fight. I was in a chorus singing instead of being in a meeting. Apparently there is a group that says brown people have “taken over” the national organization of the church. Um. Hello. That is discrimination. Does the color of the skin matter if it is a good leader? Why are people insane? I filled out a county survey on drug use today. I know we have methamphetamines and heroin in our high schools because patients have told me. But then I get to the race question. What race am I? I checked OTHER and wrote HUMAN. The race bullcrap is NOT SCIENCE. I haven’t done any genetics testing. I DO NOT KNOW WHAT RACE I AM THOUGH I LOOK WHITE.

It is important for medicine in that there is proven discrimination with less screen health services offered to “brown” people, whatever the heck “brown” people means. I wish the heavens would turn us all the same color over night. Or perhaps blind us. That is not nice of me and I do not care.

I am glad that this horror came out in my church. Because now the discrimination is out in the open. And the committee has sent out a message saying NO. We WILL stay part of the national organization. We WILL not give in to this discrimination. AND I SAY HOORAY AND BLESSINGS ON THEM.

Here is the new CDC set of recommendations for chronic pain: https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm . You can read them yourself.

I read to this sentence so far: “Approximately one in five U.S. adults had chronic pain in 2019 and approximately one in 14 adults experienced β€œhigh-impact” chronic pain, defined as having pain on most days or every day during the past 3 months that limited life or work activities (5).”

Part of me is horrified and part of me is calm. Because pain is a part of life. Pain, love, joy, fear, it’s all part of our emotional evolved systems to survive, right? If God is love, God is also pain and fear. It is not a split. It is both.

This song is a love song. But to me, it’s a love song from heroin to a woman. One lovely day, a place where there is no pain. There will be pain on the return, the withdrawal. I have patients say, “You need to get me pain free.” My reply was “I will not get you pain free. Pain free is dead. Or at least, they can no longer tell me if the next form hurts.” In this song, “she won’t let on, that the feelings have got so strong.” Addiction, opioid overuse.

I took the photograph of Elwha yesterday. He is my relaxation mentor.

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We want to believe

My cousin said to me once: “We want to believe what we want to believe.”

This was right before Mr. Trump was elected President.

After my cousin said that, I was unsurprised that Mr. Trump was elected. He was elected out of fear and anger and shame and grief. He was elected by people who are afraid that people rising out of discrimination will take things from them. Lower their standard of living. They are afraid that they will have to give things up.

A friend was working on my boat. He said that if I paid in cash, it would be less. Because, unspoken, he would not report the income. I thought about it. I said, “My medical practice is mostly medicare and state insurance. That is paid for out of our taxes: yours and mine. Therefore I am giving you a check and I don’t care if it costs more.”

There is a big culture here of not paying taxes. Cheat the government. Pay cash to each other, nod, nod, wink. It is tempting, takes a percentage off what I pay. But…. the people who I know are doing this are mostly conservative. They say drain the swamp. They say the government is cheating us. But THEY are cheating all of us.

I asked my cousin why he and my maternal family believed a story masterminded by my sister. That my father and my neice’s father and I were villains. One of the villainies was the our grandmother’s money had paid for MY graduate school but not my sister’s graduate school.

But that is not true. My grandmother paid four years of medical school tuition. 21K. I paid my own loans.

After my grandmother died, and then my mother died, my father used “my grandmother’s money” to pay off my sister’s graduate school loans. 36K. My parents also cosigned on a house, that my sister walked away from. They wrote 30K off thier taxes that year selling it. My father bailed her out of 7K on a work credit card. My father called me crying when she bullied him out of another 30K for another house. And that is when I said to her ENOUGH. I refused to visit for a year: until she went into hospice for her cancer. I visited three times while she was in hospice. We made peace. But she did not tell anyone else the truth.

I said to my cousin that I could send the bank statements showing that my father paid for my sister’s graduate school. That is when he said, “No. We want to believe what we want to believe.”

I thought really? So you want to believe my sister because she is dead. We will not speak ill of the dead, so you are ok with me and my father and my niece’s father being villainized and you will not even look at the lies.

VOTE and VOTE against FEAR, SHAME, DISCRIMINATION, ANGER AND GRIEF. We have to stand up. I loved my sister even when she was dishonest and bounced 1000$ worth of checks in my small town with people I knew. My father got threatening phone calls and he paid. That was the last straw for me.

So guess which politician stirs up fear and hate and discrimination and anger and grief? Well, honestly, both sides are guilty of that, but I stand against discrimination. We all shall rise up.

Love and Blessings and Peace you.

The photograph is on one of the last three visits to my sister. She died in March 2012.