hope for good coming out of isolation

This video is from 2011. I was invited to be a speaker and had ten minutes to present the Mad as Hell Doctor program, talking about single payer healthcare, medicare for all.

If there is a good thing to get from Covid-19, for me it is single payer healthcare. Because doctors and nurses and staff are worn out, sick, quitting, dying. We need people to take out sick appendixes. We need people to work in nursing homes. We need to support our medical people and I am NOT talking about insurance corporations. They are making more profit than ever. Twenty percent of every dollar paid to them or more.

People say, but it’s socialized medicine, to have medicare for all. Well, no. The only socialized medicine in the US currently is the Veterans Administration. No one that I talk to wants to take away Veterans benefits. Or any of the other government programs: medicare, medicaid, active duty military. The oldest, the poorest and disabled and the people defending our country.

But physicians can do a better job if they are not worrying about prior authorization from 500 + companies, each with multiple different insurance contracts, and who can change what they cover at any time. I get emails all the time: we have changed what we cover. Great. Like I have time to read and learn 500+ insurance contracts. I memorize medicare rules and they change too. Medicare for all, one set of rules and then if you ask if something is covered, we will know.

I am not the only physician who wants single payer: Physicians for a National Healthcare Program.

I find this on line: https://www.quora.com/Could-Medicare-or-Medicaid-be-expanded-to-the-general-population-to-create-single-payer-healthcare-Would-it-be-more-efficient-than-an-entirely-new-program?share=1

The answer is yes, yes, yes. And there would be a continuous ongoing battle about what is covered and what isn’t but that already happens. For two reasons: medicine changes continuously as the science changes and there is a vocal strong fringe, which is occasionally correct. I don’t trust the fringe, but then I don’t trust insurance companies, herbal medicine makers or politicians either.

_____________________________

I can’t credit the videographer because I did not know that the video was being taken or that it was posted. I found out when a new patient said she was seeing me because of my video. I had to look it up.

Four seasons

These are etchings by my mother, Helen Burling Ottaway, who died in 2000.

All four are done with the same etching plate.

Winter is done first. The zinc plate is covered with a protective layer and then she draws with tools, including dental tools. The plate is placed in an acid bath. The acid etches where the drawings are, different depths. The protective layer is removed. The plate is inked. Most of the ink is gently wiped off and the plate is placed on the press. Wet paper is laid on the plate and the heavy wool covers are folded down over that. The press is run. The wool is folded back on the other side and the paper is lifted and laid to dry.

The plate is re inked for each one.

She puts the protective cover back on the plate and adds the buds for spring. These are etched. Winter is now gone, the plate has changed. She prints all of the spring series.

Next is summer. Leaves are added. She prints those.

Last is autumn. Now there are leaves on the ground as well. She does some the plates with more than one ink color. This was one of her largest etchings. She did a small series first, where the etchings were about 4 by 6 inches. This was 18 by 24. She had a really big etching press. I don’t know who has it, my sister took it to California and it disappeared.

I have the etchings and I have all the plates. I can’t run this series, I could only run autumn. I grew up surrounded by my mother doing art, etchings, watercolors, oils, lithography, a constant sketchbook and crafts. I took a painting class a few years ago. The instructor says, “Acrylics are NOT watercolors.” I reply, “I know how to DO watercolors.” I was being quite creative with the acrylics only I automatically used the watercolor techniques that I grew up with.

The photograph doesn’t really do them justice. I will have to take some more. Plus I have her slides in some of the boxes left from when my father died. More cataloging.

Blessings and good memories of my mother.

Covid-19: Good and Bad News

I am writing this on Christmas morning.

The good news is this: National Guard Empties Bedpans and Clips Toenails at Nursing Homes. “In Minnesota, an ambitious initiative is training hundreds of Guard members to become certified nursing assistants and relieve burned-out nursing home workers.” (1) Well, hooray, the National Guard is called out to help, because the nursing homes are out of staff and we aren’t supposed to abuse our elderly. I think this is AMAZING. And the National Guard may learn some things about work and the elderly too. Hoorah and Hooray!

The bad news is a snippet from New York State: Omicron is milder, BUT the exception may be children. (2) Child cases of Covid-19 are going up really fast and hospital admissions of children. ICU work is hard hard hard, but child and infant ICU is even harder. Blessings on the nurses who do this and the physicians too. When I did my pediatrics rotation way back in Richmond, VA, in a tertiary care hospital, I had children who were dying: one with a brain tumor, one with liver cancer, one with Wilm’s disease. Hard work. I chose Family Practice. I have still had pediatric patients die, including an 18 month old where I had taken care of mother through the pregnancy, but not terribly many. Even less in the last ten years since my average patient was about age 70. All of my kids in the last ten years were complicated: one with Down’s, another a leukemia survivor, others. Children can be very medically complicated. I had two adults who had survived infant heart surgery as well. They were set up with UW’s Adults who had Childhood Heart Surgery Clinic, though that is not the correct name. I am pretty happy to have that sort of back up only two hours away. They both had pretty awesome heart murmurs and that midline chest zipper scar. Ouch.

So, why post this on Christmas? If the cases are rising in children, maybe that will inspire some folks to get vaccinated or at least not yell at family who refuse to bring small children to an unvaccinated Christmas gathering. Judging by the posts on the doctor mom facebook group, there is quite a bit of family yelling going on. Stand down, folks, and respect other peoples’ boundaries.

The problem is, if enough children are sick, we run out of beds. And staff. “As of Thursday, there were 1,987 confirmed or suspected pediatric covid-19 patients hospitalized nationally, a 31 percent jump in 10 days, according to a Washington Post analysis.” (3)

Blessings.

1. https://www.nytimes.com/2021/12/22/health/covid-national-guard-nursing-homes.html?action=click&campaign_id=154&emc=edit_cb_20211223&instance_id=48593&module=RelatedLinks&nl=coronavirus-briefing&pgtype=Article®i_id=165651500&segment_id=77808&te=1&user_id=c97a1a8547f511fe3bd45b0806ed713c

2. https://www.nytimes.com/2021/11/23/us/covid-cases-children.html

3. https://www.washingtonpost.com/health/2021/12/24/omicron-children-hospitalizations-us/

Covid-19: A tiny bit of good news

This: https://www.healio.com/news/primary-care/20211216/teen-drug-use-decreased-during-pandemic-survey-finds.

“Since 1975, the Monitoring the Future survey, funded by the National Institute on Drug Abuse (NIDA) and conducted by researchers at the University of Michigan Institute for Social Research, has been tracking substance use among adolescent students in the U.S.”

The numbers are interesting, aren’t they? “There was a sharp decrease in reported use (of alcohol) among 10th graders, from 40.7% in 2020 to 28.5% in 2021, and a mild decrease among 12th graders, from 55.3% in 2020 to 46.5%.”

What do YOU think the cause is? More parental supervision or less in person time with peers or something else or both? The news yammers about increased behavioral health issues and “crisis, crisis, crisis” but hello, it’s normal to be stressed during this. Learning to handle stress is important and useful. My elderly patients who lived alone came in to clinic after the first couple months of Covid-19, because they needed human contact. Since I had a one doctor clinic with me and a receptionist, my clinic was safer than the grocery store. We screened everyone for Covid-19 symptoms before they came in and diverted them to the testing site if they had symptoms. Only two of my people got Covid-19 by the time I closed, and both had traveled out of state. Neither one came in to clinic. They went and got tested because of symptoms.

Anyhow, I think it’s both parental supervision and less peer time in person. There is still a significant amount of alcohol consumed. A previous study of well off and very well off households showed increased risk of addiction by age 22 and 25 because 1. money 2. opportunity 3. parents more inclined to be in denial. Parents would turn a blind eye if grades were good. The biggest correlations for NOT being addicted were 1. family dinners and 2. parents who yapped about drugs/alcohol/addiction quite a lot. Caring, I think. Not giving up as the child enters their teens, but staying present and opinionated. Not to mention setting an example of moderation. The households where the parents use methamphetamines or heroin locally are higher risk for the teens.

More here: https://www.drugabuse.gov/drug-topics/trends-statistics/monitoring-future

This fits the Ragtag Daily Prompt: enigma.

Covid-19: Long Haul

https://www.bbc.com/news/av/world-us-canada-58918869 Some people with Long Haul Covid-19 are having to relearn how to walk and talk.

https://www.bbc.com/news/uk-england-leicestershire-59674203. Patients who were hospitalized are still affected at 5 months and one year after they are released from the hospital. Being female and obese are big risk factors. The article says “Long Covid has the potential to become highly prevalent as a new long-term condition.”

One more:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146298/ ” While the precise definition of long COVID may be lacking, the most common symptoms reported in many studies are fatigue and dyspnoea that last for months after acute COVID-19. Other persistent symptoms may include cognitive and mental impairments, chest and joint pains, palpitations, myalgia, smell and taste dysfunctions, cough, headache, and gastrointestinal and cardiac issues.”
“One puzzling feature of long COVID is that it affects survivors of COVID-19 at all disease severity. Studies have discovered that long COVID affects even mild-to-moderate cases and younger adults who did not require respiratory support or hospital or intensive care. Patients who were no longer positive for SARS-CoV-2 and discharged from the hospital, as well as outpatients, can also develop long COVID [24,30,31,41,50]. More concerningly, long COVID also targets children, including those who had asymptomatic COVID-19, resulting in symptoms such as dyspnoea, fatigue, myalgia, cognitive impairments, headache, palpitations, and chest pain that last for at least 6 months [51–53].”

And the symptoms? “The most common ongoing symptoms were fatigue, muscle pain, physically slowing down, poor sleep and breathlessness.”

Yes, the same as mine.

My initial evaluation of Long Haul Covid-19 patients will cover three areas:

1. Behavioral Health. Are they having brain fog, feeling slowed, feeling like they can’t think? Is that what happened during the Covid-19 or did the opposite happen? Were they manic/ADHD/OCD etc? What happened in the weeks leading up to getting sick? Any major worries or life trauma? Lose a job, a relationship, someone in the family die? I am looking for a dopamine antibody pattern.

2. Musculoskeletal Chronic Fatigue. What muscles work and which muscles don’t work? If they need to lie in bed for 20 hours a day, both slow and fast twitch muscles are affected. If they are short of breath, they should have pulmonary function tests, including a loaded and unloaded walk test. Are their oxygen saturations dropping? They also need a sleep study. Check for sleep apnea. Any signs of ongoing infection with anything? Teeth, sinuses, ears, throat, lungs, stomach, lower gut, urinary, skin.

3. Musculoskeletal Fibromyalgia. WHEN do their muscles hurt? Is it after eating? Do they fall asleep after they eat or does their blood pressure drop after eating? What diet changes have they made? Are there things they have identified that they can’t eat? Gluten, lactose, meat, sucrose, fructose, nightshades, whatever. I am looking for antibodies to lysogangliosides.

Treatment:

High antibody levels can be lowered somewhat just with “lifestyle changes” aka no drugs.

A. Treat infection if present. Look for strep A with an ASO, since we have an occult one that is in the lungs, not the throat. For fungal infection, even just on the skin, lower blood sugar as much as tolerated. This may mean a ketotic diet.

B. Treat behavioral health with drugs if emergent. If suicidal or really losing it (meaning job/relationships/whatever), then drugs may be needed. But not forever. Avoid benzodiazepines. Check for addictions.

C. Lower antibody levels:
a. Lower stress. Many people will resist this. Counseling highly recommended, ‘cept they are all swamped. Have the person draw the three circles: a day in the present life, their ideal life and then what their body wants. Listen to the body.

b. You can sweat antibodies out: hot baths, hot shower, steam room, sauna, exercise. Daily in the morning, because cortisol rises when we get up, and so levels should be lowered.

c. Is there a stimulant that works for this person to calm them down? Or an antidepressant if they are slowed instead of sped up. The relatives of dopamine that work for ME are coffee caffeine and terbutaline. Ones that do NOT work for me include albuterol and tea caffeine. Ones that I have not tried include theophylline, that new relative of albuterol and ADHD meds like adderall. This will be individual to the person because we all make different antibodies. We are looking for a drug that displaces the dopamine antibodies. For people who are slowed or have brain fog, the stimulants may not work. I would try the SSRI antidepressants first, like sertraline and citalopram, unless the patient tells me they don’t work or make them anxious. I would screen for PTSD. For high PTSD scores and high ACE scores, I would use the old tricyclics, mirtazapine (which is NOT a benzodiazepine), wellbutrin or trazodone. Again, avoid benzodiazepines. Also check how much alcohol and marijuana are on board, because those are definitely going to make brain fog worse. The functional medicine people are treating mystery patients with hyperbaric oxygen chambers and I suspect that this works for the people with blocker tubulin antibodies.

d. Muscle pain/fibromyalgia symptoms. Avoid opioids, they will only work temporarily and may addict. Avoid muscle relaxants, they will only work temporarily. Again, the tricyclics may help. The newer antiseizure drugs that are indicated for fibromyalgia are possibilities, though as an “old” doctor I am conservative about “new” drugs. Gabapentin, pregabalin, and if the person is sped up, antiseizure medicines that are used for mania. GENTLE exercise. The line between me having a good day today and overdoing is knife thin. On the overdoing days I go to bed at 5 pm. I went to sleep at 5 pm yesterday and 6:30 last night. I sang for church last night and even though I’d driven myself there, one of the quartet offered to drive me home. “Do I look that grey?” I asked. “Yes.” he said. I turn grey from fatigue and it can be sudden. Right now it’s after my second meal. If I am active, I will fall asleep after lunch if I can. If I go really light on lunch, I crash right after dinner. And remember, I am one of the lucky people who only have fast twitch muscles affected, not fast and slow twitch.

I am adding this to yesterday’s Ragtag Daily Prompt: hopeful.

hollow

The Ragtag Daily Prompt today is hollow. Hollow, halloween, hollow promises, and hallowed promises. Which is it?

My friend in Michigan was teaching his three children to use a fire extinguisher at Thanksgiving. What a wonderful use for the hollow rotting Halloween pumpkin! They each got a chance to use the fire extinguisher and put out the fire. Emergency preparedness on Thanksgiving Day! That is an example of wonderful parenting as far as I am concerned.

Covid-19: omicron

So far, it looks like the Omicron variant is more infectious and less virulent.

“This is good, right? you say, “We can all just get it, then we are immune, move on with our lives.”

There are three, no, four major problems that I can think of right off the bat.

1. Long Haul Covid. We do not know if Omicron will cause Long Haul Covid. This is a big deal. The numbers right now are suggesting that one third of the people who get Covid-19, even a mild case, still have problems at six months out and twelve months out. Are you willing to take a one in three chance? Not me! We do not know how to fix Long Haul Covid-19, we don’t know what it is (even though I have suspicions) and some people can’t even get out of bed. This is bad.

2. Omicron will be happily playing with Delta and trading genes and making NEW babies. As one math joker says, “hey, don’t screw up Pi for us.” We could get a version with the infectious capacity of Omicron and the virulence of Delta. This is also bad.

3. We don’t know what it will do to small children and babies and the very old and the immunosurpressed and Covid-19 turns out to infect fat cells which is theoretically why overweight and obese people in their thirties are dying with it. The doc group I am in on Facebutt is reporting a 5% survival with long term ECMO (heart lung bypass machine) and that people may need to be on the machine for months. Like, eight months. This requires two nurses at all times, not to mention a specialist. A few places report 30% survival, but they also say that they say NO a lot and refuse people they think will not survive. Might as well pick the ones that might survive, right?

4. We don’t know if the drugs we have right now work against it. Some may, some may not. Starting over.

So, I still say get immunized if you haven’t and get boosted if you have. Get your influenza shot too. The masks are helping with influenza this year too, but if flu really got a hold, flu in post-covid would be a very very effective killer. And if you are 65* you should get your prevnar vaccine, for pneumococcal pneumonia. It used to be called “the old man’s friend” because it’s such an effective killer of people 65 and up. The new shingles vaccine, yeah, get that too. Do you feel like a pincushion yet?

No word yet from my immunologist. If I am not making antibodies to Covid-19, do I cancel my Christmas trip? Dunno. Will wait to hear.

Happy whatever you celebrate.


1. https://www.cnn.com/2021/12/02/world/south-africa-omicron-origins-covid-cmd-intl/index.html?utm_source=fbCNN&utm_medium=social&utm_content=2021-12-02T13%3A31%3A02&utm_term=link&fbclid=IwAR0NySrFr-I_ieYmVMQawstw6-oEGlxf32MgcbKyLz8RvpdHHGfzZ678XTY

2. https://robinschoenthaler.medium.com/everything-you-ever-wanted-to-know-about-omicron-that-we-dont-know-yet-d85bdd64d76e

3. https://longbeach.gov/press-releases/omicron-variant-of-covid-19-virus-found-in-long-beach/. Yep, in my state.

4. https://www.cdc.gov/coronavirus/2019-ncov/variants/omicron-variant.html

* Or are younger and have heart disease, lung disease or anything really complicated, like cancer, lupus, autoimmune stuff, etc, etc.

mask up

Care for your family and friends and community. Mask up and do the best you can not to get nor give Covid-19 this season. The winter is dark but the sun will start returning to us soon. Like the seeds in the ground and the trees with no leaves, we can get through this dark season caring for each other.