Category Archives: hike

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Exercise mets

Mets could be metastases, a terrible word in cancer. But this is exercise mets. I am half way through my pulmonary rehabilitation for pneumonia and getting stronger. So what is a met? “One MET is approximately 3.5 milliliters of oxygen consumed per kilogram (kg) of body weight per minute.” (from https://www.healthline.com/health/what-are-mets#definition).

Ok, that doesn’t seem very useful. I find this way more useful, a chart of how many mets are used for certain activities:

https://www.healthline.com/health/what-are-mets#examples

The treadmill I am using at pulmonary rehab tells me how many mets I am using. However, last time I turned it on and didn’t enter my weight. It uses 155 pounds, which is more than I weigh. I think that then the mets are wrong. It isn’t exact anyhow. The important thing is that I am improving and off oxygen! I am now up to 5.3 mets, going at 3.3 mph, on a 4% grade, for 40 minutes. Pulmonary rehab is twelve weeks, twice a week, with a respiratory therapist and a physical therapist.

My respiratory therapist asks my goals. To bicycle distance, hike across the Olympics, and to ski again, off oxygen. That means altitude. Once we are above 5500 feet, the body really starts noticing the thinner air. I am not there yet but I am so pleased to be improving.

On the chart, I am in the moderate exercise range. To bicycle, I would have to be able to sustain 8 mets. Not yet, not yet.

Being off oxygen (except night, flute, sustained singing and heavy exercise) is GREAT! The intrinsic problem has not been fixed, thought. Fully twenty specialists since 2012 have not figured out why I get pneumonia easily and how to protect me, other than masking and not working in Family Medicine or anything people intensive. It’s annoying, my career has been blown up. I don’t have much hope of an overarching diagnosis at this point, but I’m willing to keep trying. We don’t know everything in medicine and really, I do not think we ever will. It’s endlessly complex and fascinating.

I think the mets chart should be shared with patients. I had one couple who insisted that the woman had PMS even though she was postmenopausal. I scratch my head and continue to watch her. After months something made me suspicious and I order an echocardiogram. She had congestive heart failure, seriously reduced heart output. I promptly called the cardiologist and said, “This is new, she is on NO MEDICINES.” He saw her within a week. Sometimes things do not present in a straight forward manner. She felt much better once we got her heart functioning better. If a person is losing their ability to perform moderate intensity mets, they should see their doctor. It could be spending too many hours in front of a screen (turn it off, get up, go outside, walk daily!) but it could also be something else. Heart is the number one killer still.

Stay healthy and keep those mets up!

Ha. I did use the word certain, didn’t I? And one of my favorite exercises is dancing. Listening to this right now:

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Healing

I realized I had pneumonia for the fourth time on March 20, 2021. It has been a year and five months now. I do not have an “overarching diagnosis” for why I am so vulnerable to pneumonia, though not for lack of trying. I have seen twenty specialists since 2012, including four pulmonologists.

Most specialists dismiss me as soon as their tests don’t fit me into one of their boxes.

I have one now who is not dismissing me. He referred me to the Mayo Clinic. They did not call back when I did a self referral three months ago nor when my primary care physician referred me. However, they called within a week of his referral.

Mayo Clinic called yesterday. I may need a prior authorization or something, I have a number to call today.

I am healing. I still am on oxygen for singing, flute, night and heavy exercise, but pulmonary rehabilitation is working. I have built up steadily on the treadmill for 6 weeks. I have 5-6 more. Many of the pulmonary rehabilitation people are on oxygen and will not get off oxygen, so I am an outlier here too.

I feel better than I have in seven years, since the 2014 pneumonia. I had strep A pneumonia in 2012 and 2014 and really did not fully heal after 2014. I was tired all the time. I think I went back to work too soon and just did what I could. Not returning to work is helping immensely. I can’t return anyhow, unless the Mayo Clinic or someone figures out my “overarching diagnosis” and how to make me less vulnerable to pneumonia. Seems unlikely after 19 years. My first round was influenza in 2003. Maybe choosing a different career than primary care would have made a difference, though maybe I would not have survived a pneumonia without being a primary care doctor. We aren’t supposed to treat ourselves, but if no one believes us, well, there is not much choice, is there?

The photograph is from a beach hike in November 2021.

For the Ragtag Daily Prompt: heal.

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pigeon guillemots

These are called sea pigeons locally.

We were trying to figure out who lives in the sand cliff holes on Marrowstone Island.

We see something fly out but weren’t quite sure who it is.

And then, aha! We see an owner.

https://www.allaboutbirds.org/guide/Pigeon_Guillemot/id

They look like ducks except the beak is not duck like. From the Cornell All About Birds Site: “Ornithologists recognize five subspecies that differ mostly in size: eureka in Oregon and California; adianta from Washington to the central Aleutians; kaiurka in the west-central Aleutians and the Commander Islands; columba from the Bering Strait to the Kamchatka Peninsula of Russia. The subspecies of Pigeon Guillemot that inhabits the Kuril Islands of Japan, snowi, has little to no white in the upperwing, unlike other subspecies.” They are in the family with auks and murres and puffins, rather than ducks. How aukward, heh, heh. I am informed that they “are not good eating”. Too fishy.

For the Ragtag Daily Prompt: float. They are very good at floating and diving, and make a whirring sound as they fly. They have a high piping song.

The range map is cool: https://www.allaboutbirds.org/guide/Pigeon_Guillemot/maps-range.

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lung pizazz

The tent in the center is mine. I took this two days ago as soon as I had it set up. The big deal is that pulmonary rehabilitation is WORKING.

My friend B from the east coast invited me to hike with him and two other friends. They were going up the Hoh River trail. The initial hike was five miles and then camp. They will go up to Glacier Meadows.

I looked the hike over. The first five miles starts at around 500 feet and stays near the river and fairly level. I bought a pass for the campsite and loaded my pack. I took the pack to pulmonary rehab on Monday and carried it on the treadmill. I went for 25 minutes at 3mph, loaded. My heart rate went to 110 (normal at rest is 60 to 100, though mostly cardiologists don’t care if it’s below 60 unless bad symptoms or heart block) and above, but I held my oxygen sats. I decided I could GO! We met in Port Angeles and then drove up. We didn’t start hiking until 3:30pm but got to the campsite, ate and set up tents.

The next day I hiked back alone. A couple coming in stopped me and said, “There is a bear. It went up a tree when we saw it.” The next trio said that the bear was on the ground and seemed undisturbed. I had my whistle out and kept hiking, a little cautious. I did not see a bear.

As I reached the parking lot, I reread the signs. “Cougar area, hiking alone not recommended.” Oh. Well, but I really was rarely alone. I counted the people hiking up and there were 147 in that 5 mile stretch. Some out for day hikes, some with packs headed to Glacier Meadows or beyond, some with almost no equipment.

Anyhow, I am so delighted that my lungs have recovered enough to hike! I don’t think they are ready for altitude and the climb to Glacier Meadows. Maybe by next summer. Hooray for lung pizazz!

https://www.nps.gov/olym/planyourvisit/hoh-river-trail.htm

For the Ragtag Daily Prompt: pizazz!