May 27, 2023 by drkottaway

Tea with a friend

I have a friend over for tea on Thursday.

I make Katy B’s fruit torte, recipe here. Katherine Burling was my maternal grandmother.

The friend worked with me for five years and is surviving lung cancer. She has one of the new treatments. She gets an infusion every three weeks. “For the rest of my life.” she says, but they may come up with something new eventually. She feels pretty terrible after the infusion for a few days.

I use this tea set. I love this set. It says Rose China, Japan, on the bottom. What I like best is that the lid of the teapot has the roof of the pagoda, to line up before I pour. There are six plates, but only three cups and saucers. The sugar bowl and creamer are intact.

For the Ragtag Daily Prompt: tea.

May 23, 2023 by drkottaway

Pink rhodys

From Chimacum Woods.

For Cee’s Flower of the Day.

May 13, 2023 by drkottaway

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.

_____________________

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

May 3, 2023 by drkottaway

What the body wants

My lungs are much much better than a year ago, shown by no problem at altitude at rest. Of course, I did not exercise heavily above 5000 feet, but walked a lot.

The last three days I have been waking up very very stiff, knees hurting when I walk downstairs, and throat closed again.

I think it’s about work. I am contemplating going back to work. I am getting a clear “not yet” message from my body. I was sick for two years and it’s only been a month that my muscles have been working normally. Same with lungs. So I think the stiffness is the body resisting.

In clinic sometimes I would have people draw two charts. A pie chart of a day. The first chart is how they are spending their days now. The second chart is what they want. In order to do more of what you want, you have to do less of something you are presently doing. What are you going to cut out? Not food or sleep or baths or maintaining the home. How about television?

Anyhow, I added a third chart, to do a few days after the first two. Draw a pie chart of what your body wants. I had one person say, “But my body just wants to sit and do nothing!” I said, “So when are you going to do that?” At first she said, I can’t, I can’t, I can’t. After a while she said maybe. Then she rearranged work and took a two week vacation. She said, “After a week, one day I had a book, a cup of tea, the cat on my lap, the dog on my feet, and suddenly my body just entirely relaxed. And then it stayed relaxed.”

She went back to work. “Are you still relaxed?” I asked. “Not all the time, but when I start tightening up, it’s often because I am taking on someone else’s problem. I am learning to let it be their problem, not mine.”

I am listening to my body too. What does it want? Not yet, for work. I have some work at home, or some jobs to do there first.

Wise body, I am listening.

April 30, 2023 by drkottaway

Finish line

I did manage to cross the finish line for the Blogging from A to Z.

It was a bit tricky because I had a last minute trip. I got the tickets last Sunday and flew on Tuesday. I flew back on Friday and got home on Saturday. I traveled super light: no laptop, no big camera, only phone and a small day pack and one change of clothes, so I washed some by hand daily. I am proud that I still got the A to Z done!

I feel more like a finisher than a winner. It does feel good to share so much of my mother’s artwork. Helen Burling Ottaway died at age 61 in 2000, so her artwork did not have much of an internet presence. She is present in the Lake Matinenda Cottage Owners Association here. She and my uncle and other family and friends worked on a Matinenda flora of the wildflowers and plants. There have been two more since.

Hooray for everyone who contributed to or supported or read the Blogging from A to Z this month and hmmm, what should I do next year?

April 24, 2023 by drkottaway

Local lions

Our local lions are sea lions! I don’t think of sea lions as being good tempered, with the movies of them chasing prey. But out of the water in the sun off of Marrowstone Island, they seem pretty calm and I did not see displays of bad temper.

Sea lions can dive more deeply than seems reasonable because they slow their heart rates, to use less oxygen, and slow digestion. When they arrive back on the surface, they can get oxygen quickly but getting rid of the CO2 is slower. They have to sit around on the surface and the head back posture helps. I’ll bet they can beat any high school or college student in a burping contest. And as you can see, some of these are just huge. We wondered how they got on the rock. Do they have to at low tide or do they just jump?

I do like to hear them roar. Hooray for our local lions.

For the Ragtag Daily Prompt: temper.

April 23, 2023 by drkottaway

Daily Evil: U is for Unlikely

Unlikely isn’t evil. Well, I am tired of evil, so U is for Unlikely because I am tossing in a monkey wrench. U for unexpected, too.

Back to etchings: U is for Unicorn. This is titled “The Virgin and the Unicorn II”, number 10/75, 1986, H. Ottaway. The etching is 7 inches by 8 inches and the paper is 11 inches by 15 inches. She would often frame them mounted but not matted, in frames that have a slot to hold the glass away from the picture. She did her own framing and especially disliked cutting glass. I knew when a show was close because she would be framing and grumpy.