Monthly Archives: May 2023

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Rhody, rhody, rhody

Oh, my gosh, the rhododendron’s are popping like popcorn.

The Rhody Run is coming up. https://runsignup.com/Race/WA/PortTownsend/JeffersonHeatlhcareRhodyRun

The Rhododendron Festival is also approaching like crazy.

https://www.jeffcountychamber.org/events/details/2023-annual-rhododendron-festival-1873

And our Sunrise Rotary Running of the Balls happens one hour before the Rhododendron Parade:

https://www.ptsunriserotary.org/page/our-fun-d-raiser-events

For Mother’s Day, my kids all called. My daughter sent tea and a card. A friend and I went to the Chimacum Woods Nursery and the rhododendrons there are mind blowing. They have been building the gardens there for over 40 years.

https://www.chimacumwoods.com/

For the next few weeks my flowers are going to be rhodys, rhodys and more beautiful rhodys!

For Cee’s Flower of the Day.

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Meditation

Fish fly in the ocean, water is their sky
their lives in three dimensions, they jump into the air
escaping larger fish, schools of large and small fry
but up above their ceiling fly birds who eat them there
I dwell on the flat, can jump on land or fly in planes
go right or left or back or front, but less up and down
did seals come onto land but regret the ocean main
return to ocean free again to swim around
my daughter’s team synchronized at the surface of the pool
legs held straight out then spiral down into the water’s embrace
breath held, they disappear, they seem to break the rules
of oxygen. I hold mine too until they surface for a space
fish fly in the ocean, water is their sky
sometimes we dream of heavens where we remember how to fly

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My daughter was a synchronized swimmer from age 7 to high school, then swim team. Her comfort in the element of water is way beyond most people.

My daughter entering her other element.

The close picture was taken with my zoom lens, but she was not close at all.

I was “life guarding” though she was out far enough that there was not much I could do.

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For the Ragtag Daily Prompt: sturdy. I am not sure why. I was thinking that the ocean is sturdy and that fish can swim in more dimensions than we humans on land. And swimmers are sturdy too.

I took the first photograph in 2017 at the Baltimore Aquarium.

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Working theory

I attended two Zoom one hour programs on Long Covid this week.

Thursday from the University of Arizona, 330 people logged on, hard science with thirty minutes of information about Mast Cell Activation Syndrome. They said 17% of the population, which is huge, if it’s correct. This is not mastocytosis, the cancer. This is the immune system going rather batshit. Though I would frame it differently, as the immune system fighting a really difficult battle.

Friday from the University of Washington. I don’t know how many were logged on. This was at a much more aimed right at the physicians level. People sent in questions and they collated and gave answers. They promised to answer some of the questions later on. My question was whether a high Adverse Childhood Experience Score predisposed to Mast Cell Activation and they did not address that.

So mast cells apparently can produce over 1000 different signals: cytokines, histamines, proteases and I don’t know what all. They are all over our bodies (are you creeped out? I am a little.) near the boundaries: skin, nose, gastrointestinal tract, genitals. They produce different signals depending on what is happening. The Thursday researcher basically said that they could affect nearly any system in the body.

I’ve heard of mastocytosis and even had a patient with it, but Mast Cell Activation Syndrome was barely on my radar. I am not sure if 17% of the population is at risk or has it. It is tricky to diagnose, because the best lab test is a rather tricky and rare one, and it is sort of an orphan illness: few doctors know about it and it does not fit neatly into any specialties. Patients have seen an average of ten specialists before they get diagnosed. Hmmm. Sounds familiar.

This researcher has a ton of papers out, that I have not started reading yet. MCAS is implicated in Ehlers-Danlos, a connective tissue disease and in ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) as well as POTS (postural orthostatic tachycardia syndrome) and can get triggered by Covid-19. Well.

The good thing is that treatment is quieting the sympathetic nervous system to let the parasympathetic take over. The sympathetic is the fight or flight hyper one. Parasympathetic is the rest, relax, mellow out, slow heart rate, blood pressure down, digestion and quiet one. I think United States culture is crazy fight or flight most of the time (We’re number one!– so what?) and the pandemic has put the whole world into fight or flight mode. Crazy.

Back in Family Medicine residency, 1993-96, I had a number of ME/CFS, chronic fatigue patients. They tended to be hyper sensitive to medicines and have all sorts of symptoms which were fluid and changable and difficult to pin down. What I noticed though is that many of them had been super high acheivers or working multiple jobs or crazy high stress, until they hit some sort of wall. Often an infection but not always. The ones I saw wanted to go back to working 18 hours a day. I said, “Um, that’s how you got this, I do not think that is a good goal.” This often pissed people off. Even back then, I thought that chronic fatigue was a body reset, where the body rebels, some sort of switch is thrown, and people rest whether they want to or not. Some do recover but it can take ages. The Thursday speaker seems to think it’s the mast cells doing this.

The UW speakers were careful. They said we do not know how long Long Covid lasts. One said they do not like to diagnose POTS, because POTS is usually permanent and the Long Covid tachycardia usually resolves. They are seeing people who got sick 2-3 years ago and are still sick, but they also have people who have recovered in 9-12 months. They do not know if patients are entirely recovered or whether there will be other problems later. They also aren’t sure that the chronic fatigue like symptoms are the same as the rest of the ME/CFS. Remember when dementia was Alzheimer’s? Now there are all sorts of different dementia diagnoses, Lewy body, frontotemporal, Huntington’s, stroke dementia, alcoholic dementia, Parkinson’s, Alzheimer’s, and others. When I was in residency, we had hepatitis A, hepatitis B and non A non B. Now we are up to G or beyond. Medicine changes and it’s moving as fast as possible for both acute Covid-19 and Long Covid.

The mast cell reasearcher talked about getting the sympathetic and parasympathetic nervous systems back in balance. I think maybe we ALL need that. Every person in the whole world. One way to quiet the sympathetic nervous system is to slow your breathing. Try it. For five minutes, or three minutes. Slow breath in for a count of four or five and slow breath out for a count of five. Let your brain roam around and fuss, but let go of each thought as it passes by and return to counting and breathing.

Slow in, slow out.

Practice and heal.

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The musicians are Johnathan Doyle and a friend. They were fabulous, last Tuesday at the Bishop Hotel.

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This might be bull

That might be a bullhead shark. It certainly looks like a grumpy shark. I like the face peeking from above. This is the Baltimore Aquarium in 2017, with my son, my two aunts, an uncle and two of their cousins.

That looks like a ray and a shark. I don’t know what kind of shark.

Maybe it’s a bullfrog.

It’s a snapping turtle. Are there bull snapping turtles?

The turtle is missing a left front flipper so lives at the aquarium and likes watermelon.

For the Ragtag Daily Prompt: bull.