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!

On pants and pronouns

My pronouns are now per and pers. And that’s what I am going to call you and you and you over there too. Because I don’t care what is in your pants unless I have personal interest (rare and unlikely) or unless I am working as a physician. Per and pers are short for person. Generic. Nongendered because I don’t care. I suppose we could use Pee and Pees for People, which would amuse small children and immature adults (which includes me).

As a physician I need to know if someone is XX, XY, XO, XYY, or any of the other variations because it affects health. I need to know if the XX is of childbearing age or before that or after that. I need to know if the testes are undescended or have been removed because of prostate cancer. But otherwise I don’t need to know and I don’t care what is in your pants.

Get over gender. Everyone can wear kilts or carhartts or makeup or glitter or boots or toe cleavage sandals (ok, the five inch heels are really bad for your feet) and I don’t care. The first time I met my future husband was in a contra dance line where the people coming up the line were upset or rattled. I wondered why and there he was, wearing his mother’s wrap around lavender flowered skirt and dancing the “male” part. Now the parts are often called “lead” and “follow” because the callers don’t care what is in the dancer’s pants either.

When I saw my future husband in a wrap around lavender skirt, it was not love at first sight. What I thought was, “Well, that is not your routine Beltway Bandit. Bet he’s not an attorney.” This was Washington, DC in 1985 or 6 and the place was crawling with attorneys. I was correct. He is not an attorney. I thought, well, at least he’d be interesting to talk to and I found the consternation in the contra dance line amusing.

I did not talk to him that night. The next time I ran into him was at a square dance at the Washington Cathedral Nunnery. (You now may be wondering if this is true. It is.) He was wearing pants. After the square ended, I said, “You look different from a week ago.” He laughed. “The woman I am here with hates it when I wear skirts,” and he promptly invited me out. Ok.

Marge Piercy published Woman on the Edge of Time back in 1976. The pronouns in one of the two futures were per and pers. I am fine with that and I am not fine with having every single person pick their own pronouns. If we are going to pick our own pronouns, I am going to be “Mother Superior”, because I think it is stupid. Make it generic and non-gendered and I have no issue with generic. I don’t care what is in people’s pants or shirts or whatever, nor do I care what gender they are born nor their present identification nor their future plans. Except, as I said, if I am romantically interested or if I am working as a physician.

And since I love words and wordplay, my reply to the next query about my pronouns will be in a very sexy voice. “My pronouns are puuuurrrr and puuurrrrrs.”

On meditation and breathing

In college at the University of Wisconsin, I dated a gentleman who was following the Zen Buddhist tradition.

He meditated daily, for forty minutes, facing a wall.

I was quite intrigued. I did not think I could do that. I am a fidgety person and can’t sit still. I promptly tried it.

Forty minutes is a long time facing a wall at age 19.

I would fall asleep. I would start tilting to one side or the other on my zafu and jerk back up. I knew I was not supposed to follow thoughts, but I couldn’t not think. It is more subtle than that: I slowly figured out that I can let the thoughts pop up from the toaster brain, but try not to follow them. Wave at the thought. Let it go.

One day there was a small hole in the wall when I faced it. A tiny spider came out and went back in. I was very happy about the spider.

The next day the spider came out and waved one leg at me. Then it went back in the hole. The end of the 40 minutes is signaled by a chime. I got suspicious afterwards and went back to the wall. Not only was there no spider, but there was no hole, either. I did not see any more holes or spiders.

I meditated regularly daily for two years. After that I would return to practice intermittently. Meditation trained my breathing: my breathing slows way down during meditation.

I use that breathing when I have pneumonia. In the worst episode, I was in the hospital and disbelieved. I slowed my breath way way down to calm myself and so that I could think. Eight counts in, eight counts out. Then ten, then twelve. I needed to focus and figure out what was causing sepsis symptoms. And I did figure it out. The provider sent me home that morning, septic and 6 liters behind on fluid, but I was able to survive.

Now the pain clinics are teaching slow breathing. Five seconds in and five seconds out. Start with a few minutes and work up to twenty minutes. “Almost everyone goes from high sympathetic nervous system fight or flight state to the parasympathetic relaxed nervous system state.” I think we need more of that, don’t you? This is being taught for anxiety, for chronic pain, for fear and depression. I asked a veteran to try it. His response: “I hate to admit it but it works.” Also, “I’m not used to being relaxed. It feels weird.” I laughed and said, “I think it might be good if you get used to it.” He reluctantly agreed and continued the practice.

Peace you, peace me.

Vape

First, the definition of vapor:

noun

  1. The gaseous state of a substance that is liquid or solid at room temperature.
  2. A faintly visible suspension of fine particles of matter in the air, as mist, fumes, or smoke.
  3. A mixture of fine droplets of a substance and air, as the fuel mixture of an internal-combustion engine.

So vaping is smoking. It can be called vaping, but that is to trick us into thinking that it is not smoking, that we are not sucking chemicals into our delicate lung tissue. We only have one set of lungs. Lungs are like a tree, either the roots or the leaf parts upside down. Air is drawn in by our muscles expanding the chest and diaphragm, down the trachea, the bronchi, the bronchioles and at last to the alveoli, where tiny veins wrap each alveoli, trading carbon dioxide for oxygen.

I think of smoking as every cigarrette distroying an alveolus.

Vaping too, vaping is smoking. The nicotine is suspended in a solution and the vaporizer heats up until it is in vapor form. I started reading about vaporizers at least a decade ago. There were over 500 different types, mostly made in China, and there are all sorts of solutions. I was horrified to read that ethylene glycol was one of the solutions that held nicotine. When a dog drinks antifreeze, ethylene glycol, it is poisonous to the brain. Does anyone think that we should inhale smoke with antifreeze and nicotine in it? Really?

There is no control of what is put in the solutions. We don’t know what they will do long term but we know that nicotine is addictive and damages the lungs. Some of the vaporizers get so hot that the metal is also vaporized. Heavy metals are clearly bad for the lungs and poisonous as well.

Here is an article from the U of Colorado Medical Center with further reasons NEVER to start vaping. Because vaping is smoking: don’t let the term fool YOU. 4 reasons why you should stop vaping.

For the RDP: vapor.

betrayed by my own brain

I took a very long nap after pulmonary rehab yesterday, pushed myself on the treadmill. I was tired. So then at midnight I can’t sleep, feel sad and sappy, get up, write Sorrow.

Then my own brain starts making fun of me.

It plays a soundtrack:

Yeah, ok, so my OWN BRAIN is making fun of me feeling heartbroken. Ok, ok, I am over it for this night. Let’s move on, I think I will manifest this instead. Yeah. I need a skintight dress and some heavy makeup, so there.

The header photograph is from Centrum’s Blues Fest on Saturday. Fabulous and fun!

sorrow

Most of the time I am fine (I miss you I miss you I miss you).
I am busy during the day (You said I needed my own life).
What shut you down, I wonder (the family event).
You said I always try to learn daily (you say you refuse to change).
I have friends that love me and my kids (you say you do not love me).
I don’t think I know what love is (your actions felt like love sometimes).
Mostly I don’t think about you (sometimes it is very dark).
I hope that you are well (I wish I wanted you to be happy without me).
I am patching my heart again (for you I use elk sinew).
The deer remind me (life goes on, even when one doesn’t want it to).

A previous poem, when my sister died: The deer remind me.

Surreal surroundings

It was so gorgeous up on Hurricane Ridge yesterday! I think the wildflowers are surreal: whole mountainsides of wildflowers and the more you look, the more different ones you see. I am just starting to learn their names.

https://www.nps.gov/olym/planyourvisit/visiting-hurricane-ridge.htm

For the Ragtag Daily Prompt: surreal.

I think the orange flower is a paintbrush, but it is not showing up here, on the wildflower identification site.

Another site: https://www.intangibility.com/inw/Wildflowers/Indian-Paintbrush.html

If anyone can identify it more closely, let me know!

Hurricane Ridge

Yesterday I woke to low clouds and slight sky spitting. A friend and I drove up to Hurricane Ridge and climbed Hurricane Hill. I am delighted that I can do it without oxygen! I get short of breath if I climb AND try to talk. He had to do most of the talking.

We drove out of the cloud as we got to Port Angeles and it was just gorgeous on top of Hurricane Ridge. There were lots of people up there. Tons of wildflowers, too and views of the Olympic Mountains. At the top we were looking at Vancouver Island and Canada to the north across the strait. A beautiful climb and a beautiful day.

For Cee’s Flower of the Day.

https://www.nps.gov/olym/planyourvisit/visiting-hurricane-ridge.htm

I think this is Oregon Sunshine, Eriophyllum lanatum, or else it’s an arnica. There are a lot of yellow wildflowers, here.

bleed

even when your heart is broken, monday still comes, every week
you pick yourself up, dust yourself off, make a list of your work
no one in the bank, the post office, the store sees your life bleed

_____________________________

For Ronovan Write’s Sijo Wednesday # 18: use regret.

Covid-19: Long Haul III

The CDC has guidelines for Long Covid and it can qualify for disability in the United States.

Here: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html

And here: “As of July 2021, “long COVID,” also known as post-COVID conditions, can be considered a disability under the Americans with Disabilities Act (ADA). Learn more: Guidance on “Long COVID” as a Disability Under the ADA, Section

Here is the list of “most common” symptoms from the CDC:

General symptoms

  • Tiredness or fatigue that interferes with daily life
  • Symptoms that get worse after physical or mental effort (also known as “post-exertional malaise”)
  • Fever

Respiratory and heart symptoms

  • Difficulty breathing or shortness of breath
  • Cough
  • Chest pain
  • Fast-beating or pounding heart (also known as heart palpitations)

Neurological symptoms

  • Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
  • Headache
  • Sleep problems
  • Dizziness when you stand up (lightheadedness)
  • Pins-and-needles feelings
  • Change in smell or taste
  • Depression or anxiety

Digestive symptoms

  • Diarrhea
  • Stomach pain

Other symptoms

  • Joint or muscle pain
  • Rash
  • Changes in menstrual cycles

There are recommendations for a work up by physicians. Depending on symptoms, this may include labs, ECG, echocardiogram (heart ultrasound), CT scan and other tests.

A friend has just gone through those four tests . They are “normal” except for her heart rate. At rest her heart rate is 70 with a normal oxygen level. Walking, her heart rate jumps to 135. Over 100 is abnormal in this athlete who is NOT exerting heavily.

So WHAT is going on with NORMAL testing? I think this is “Covid-19 Viral Pneumonia”, a complication of Covid-19, just as “Influenza Viral Pneumonia” is a complication of influenza. Ralph Netter MD has an illustration of lungs from a person who died of influenza viral pneumonia: the lungs are swollen and inflamed and bruised. WHY is the testing “normal” then? The swelling is throughout the lungs, so a chest x-ray sees it as all the same density and a CT scan also sees it as all the same density. The lungs may have mildly decreased breath sounds, but the sounds are even throughout the lungs. The useful TEST is a walk test. I have tested patients with “walking pneumonia” in clinic for years: get a resting heart rate and oxygen level. Then have my patient walk up and down the hall three times and sit back down. Watch the heart rate and oxygen level. If the heart rate jumps 30 beats up or is over 100, the person needs to continue rest until the heart rate stays under 100 or jumps less than 30 beats. It is important to observe the heart rate until they recover. Sometimes the oxygen saturation will drop as the heart rate comes down, and some people qualify for oxygen. Steroids do not seem to work for this. The length of time to healing is not totally surprising, because a lobar pneumonia that is visible on chest xray takes 6-8 weeks to fully clear. It is not too amazing that a bad walking pneumonia could also take 6 weeks or more to clear. If the person returns to work too soon, they prolong the lung inflammation and they are at risk for exhaustion and for a secondary pneumonia. The treatment is REST REST REST and support.

Do they need oxygen? Currently oxygen is covered only if the person’s oxygen saturation drops down to 88%. However, I think that oxygen would help recovery and make them less exhausted. With my first walking pneumonia, which was influenza, my walking heart rate was 135 and my resting heart rate was 100. Both were abnormal for me. Neither I nor my physician could figure it out. This was in 2003. I did look in my Netter book: I took one look at the painting of the influenza lungs and shut the book. “Oh.” I thought. “That’s why I can’t breathe.” The image is here, though I wish it were bigger.

It took two months for my heart rate to come down, the lung swelling to improve, and me to return to work. I read the text of Dr. Netter’s image a year later and then I read an entire book about the 1918-1919 influenza. Since then I have walked people who come in complaining of exhaustion after a “cold” or “bad cough”. Viruses can cause this and so can bacteria: mycoplasma pneumonia, chlamydia pneumonia, pneumococcal pneumonia, legionella and strep A. If the fever is gone, the infection has probably resolved, but it still can take days or weeks for the lung tissue to recover.

For Covid-19, I would add a third test: walking with weights. We test cardiac patients by asking if they can carry two bags of groceries up a flight of stairs. That is 3 Mets, a measure of the heart load. We need to measure the lung load as well. If the lung tissue is swollen, the amount of airspace is cut down and can be half normal. The heart attempts to take up the slack. The person may tolerate a heart rate of 135 for a while, but it is like running a marathon. If they are older or have heart disease, this can trigger a heart attack. I would walk the person carrying hand weights, and see the recovery.

Also, brain fog is unsurprising. If your oxygen level is borderline, it is darn hard to think. I write really strange songs when I am hypoxic. I get goofy and feel weird. The fast heart rate also feels like anxiety: I think that the body is trying to tell me to rest.

The definition of Long Covid is symptoms after 30 days. Please see your physician if you are still ill and continue to have symptoms.

Blessings.

Here is a recent article about T-cells and inflammation in the lungs of Covid-19 patients: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8460308/

and this: https://www.frontiersin.org/articles/10.3389/fimmu.2020.589380/full