Lung swelling and long covid

I wrote this in 2017, about influenza. However, I think covid-19 can do the same thing. Part of long covid is letting the lungs really heal, which means infuriating amounts of rest and learning to watch your own pulse. Watching the pulse is easier then messing around with a pulse oximeter. The very basics of pulse is that normal beats per minute is 60 to 100. If your pulse is 70 in bed and 120 after you do the dishes, you need to go back to bed or the couch and REST.

From 2017: Influenza is different from a cold virus and different from bacterial pneumonia, because it can cause lung tissue swelling.

Think of the lungs as having a certain amount of air space. Now, think of the walls between the air spaces getting swollen and inflamed: the air space can be cut in half. What is the result?

When the air space is cut down, in half or more, the heart has to work harder. The person may be ok when they are sitting at rest, but when they get up to walk, they cannot take a deeper breath. Their heart rate will rise to make up the difference, to try to get enough oxygen from the decreased lung space to give to the active muscles.

For example, I saw a person last week who had been sick for 5 days. No fever. Her heart rate at rest was 111. Normal is 60 to 100. Her oxygen level was fine at rest. Her oxygen level would start dropping as soon as she stood up. She had also dropped 9 pounds since I had seen her last and she couldn’t afford that. I sent her to the emergency room and she was admitted, with influenza A.

I have seen more people since and taken two off work. Why? Their heart rate, the number of beats in one minute, was under 100 and their oxygen level was fine. But when I had them walk up and down a short hall three times, their heart rates jumped: to 110, 120. Tachycardia. I put them off from work, to return in a week. If they rest, the lung swelling will have a chance to go down. If they return to work and activity, it’s like running a marathon all day, heart rate of 120. The lungs won’t heal and they are liable to get a bacterial infection or another viral infection and be hospitalized or die.

I had influenza in the early 2000s. My resting heart rate went from the 60s to 100. When I returned to clinic after a week, I felt like I was dying. I put the pulse ox on my finger. My heart rate standing was 130! I had seen my physician in the hospital that morning and he’d gotten a prescription pad and wrote: GO TO BED! He said I was too sick to work and he was right. I went home. It took two months for the swelling to go down and I worried for a while that it never would. I dropped 10 pounds the first week I was sick and it stayed down for six months.

Since the problem in influenza is tissue swelling, albuterol doesn’t work. Albuterol relaxes bronchospasm, lung muscle tightness. Cough medicine doesn’t work very well either: there is not fluid to cough up. The lungs are like road rash, bruised, swollen, air spaces smaller. Steroids and prednisone don’t work. Antiviral flu medicine helps if you get it within the first 72 hours!

You can check your pulse at home. Count the number of beats in one minute. That is your heart rate. Then get up and walk until you are a little short of breath (or a lot) or your heart is going fast. Then count the rate again. If your heart rate is jumping 20-30 beats faster per minute or if it’s over 100, you need to rest until it is better. Hopefully it will only be a week, and not two months like me!


Feel free to take this to your doctor. I was not taught this: I learned it on the job.

I took the photograph, a stealthie, in June 2021, when I was still on oxygen continuously.

Vaccine refusal folly

Who should NOT get vaccinated for Covid-19?

This is supposed to be humor. You may not find it funny.

Clearly oppositional defiant people do NOT get vaccinated. Here are a list of the reasons that I have heard, most of them said to my face or on email:

Hyper Conservative:
1. God will take care of me.
2. It’s false news. All made up by the media. The media is liberal. Even Fox News. Even CNN. They don’t know the true meaning of conservatism. I honor the flag.
3. We do our own research. We have better and deeper sources even than QAnon. If you don’t know what I am talking about than you don’t know! Why are you so stupid?
4. Alien lizards made the vaccine and it has tiny nanobots and it is tracking us and will take over our brains. Some people have ALREADY HAD THEIR BRAINS TAKEN OVER BY LIBERAL MEDIA AND NOW QANON! It’s probably best to bunker down.
5. No I don’t vote. Where is my medicaid check? Those evil government people are trying to take away my mother’s social security. If I voted, I would be part of the problem.
6. Masks kill you. Because you breathe your own breath. It’s not the CO2. You didn’t realize that your breath was THAT foul, did you? EEEEEEE-YUK.
7. No one can tell me what to do. If they do, I won’t do it. I won’t die. So there.

Hyper Liberal:
1. Goddess will take care of me.
2. Antibiotics are evil. Vaccines are evil. If you live NATURALLY, you will live forever. But I ordered that book that tells you how to cook your own medicines on your stove!
3. There is this HERB. It fixes everything. What do you MEAN, my kidneys are failing? But I live NATURALLY.
4. Doctors are evil. Well, not naturopaths. The government is evil. Yeah, I’m on medicaid. My mother NEEDS her medicare check. WTF is WRONG with you people? Why would I VOTE on the evil government?
5. Scientists are evil. If they would use NATURAL remedies, we’d all be fine. No, I don’t get labs checked. I don’t need to. Yes, these are shoes. Whaddaya MEAN shoes aren’t natural? These are handmade with hemp processed in a massive factory and NO LEATHER because LEATHER IS EVIL. I have bamboo towels, too, bamboo is natural. What do you MEAN it takes a fungkload of chemicals to process bamboo into fabric? It’s NATURAL.
6. Humans are evil. We should live naturally. Yes, I live in a house. Houses are natural. If you use natural cleansers and only allow natural fabrics and toys and crystals and foods. I don’t approve of logging. Yes, my house is made of wood, what of it?
7. No one can tell me what to do. If they do, I won’t do it. I won’t die. So there.

Martians:
1. It makes their brains explode in their helmets.

Alien Lizards posing as humans:
1. Well, actually we need to get the vaccine. I got it.

Gorillas:
1. They get the vaccine too, even the oppositional defiant ones. Except for the wild ones that are really canny and who we can’t catch and dart gun with the vaccine.

This is supposed to be humor. You may not find it funny. Don’t use it as proof that you shouldn’t get the vaccine, though people with really crazy ideas shouldn’t get it. Did you hear that they are about to send all the remaining vaccine supply to Africa because people here are refusing it? Is that a rumor or is it true?
The CDC has other ideas. But we don’t trust them, right?

For the Ragtag Daily Prompt: folly.

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.

No pandas

Today is PANS/PANDAS awareness day. I wrote this a couple weeks ago.

PANDAS PHYSICIANS NETWORK: PANS/PANDAS AWARENESS DAY

___________________________________

No pandas

I don’t have PANDAS because in the United States we barely believe in it in children and we don’t at all in adults.

I don’t have PANDAS because even though one psychiatrist said I did, he retired, and the next one says I don’t. Then not sure then no. They don’t agree.

I don’t have PANDAS because my primary care doctor won’t read the guidelines even after I have been her patient for seven years.

I don’t have PANDAS because my pulmonologist has never heard of it.

I don’t have PANDAS because it would be a lot easier to put me on a mood stabilizer to shut me up than listen to me.

I don’t have PANDAS because I am labelled difficult because I am afraid to take a mood stabilizer because I do not get a fever or a white count so my main symptom of infection is that other doctors think that I am manic though I am hypoxic and short of breath. They want to fix my mood while I want to not die of pneumonia, so our goals are at odds.

I don’t have PANDAS because I am a doctor and if I had PANDAS my fellow local doctors would feel guilty that they have told each other that I am bipolar and manic for the last 18 years and have shunned me at the county medical meetings and won’t even send me the invitations, except for the one that forwards them. He says he has given them my email and he doesn’t understand why they don’t send me the invitations.

I don’t have PANDAS because Seattle Children’s doesn’t allow the Cunningham Panel to be drawn and they say there is not enough evidence yet.

I don’t have PANDAS because I can’t afford to pay $925 on my own for the Cunningham Panel and anyhow my antibody level is back to whatever is my new baseline, higher than before no doubt.

I don’t have PANDAS because the other doctors are frightened: if I have PANDAS then who else does and if I have chronic fatigue caused by hypoxia and fibromyalgia and it’s related to PANDAS then who else would they have to test and neuropsychiatric is a whole different thing from psychiatric and we swear that we don’t know what causes chronic fatigue and fibromyalgia.

I don’t have PANDAS because I am an adult who lives in the US though if I was in Canada or Europe I could in fact have PANDAS.

I don’t have PANDAS because in the United States we barely believe in it in children and we don’t at all in adults.

in fog

For the Ragtag Daily Prompt: myocarditis.

There is myocarditis and pericarditis in some 20 something year olds after the Pfizer vaccine. However, the amount of myocarditis and pericarditis is ten times as much in 20 something year olds unvaccinated with Covid-19. The myocarditis and pericarditis with the vaccine is short term. There is also a recent study just out of over 43, 000 people in Great Britan indicating that unvaccinated people with Delta variant Covid-19 are 2.26 times more likely to be hospitalized as unvaccinated with the Alpha variant.

The fog is burning off. It is becoming clearer and clearer that the vaccine is way safer than the Delta variant Covid-19 infection. It is still too late, too late, for some people.

https://www.newscientist.com/article/mg25133462-800-myocarditis-is-more-common-after-covid-19-infection-than-vaccination/

even if

even if

I never see you again
you never speak to me again
you never love your bearish parts
you never let yourself get angry
you never let yourself get sad
you never let yourself feel
you tell yourself you are happy
you tell yourself everything is the way it should be

even if

I never see you again

I still love you
I still forgive you

I still love you

I hope that you truly do

find happiness

Top ten causes of death: US 2020

Top ten causes of death US 2020, according to JAMA, here.

Total deaths: 3,358.814
Contrast total deaths in 2019, at 2,854,838. That number had been on a very slow rise since 2015 (2,712,630) to 2019 (2,854,838). That increase over four years is 142,208 people. Then the death rate suddenly jumps 503,976 people in one year. Ouch. I cannot say that I understand vaccine refusal.

1. Coronary artery disease: 690,882
Heart disease still wins. And it went up 4.8%. It is suspected that people were afraid to go to doctors and hospitals. I saw one man early on in the pandemic for “constipation”. He had acute appendicitis. I sent him to the ER and his appendix was removed that day. He thanked me for seeing him in person. Might have missed that one over zoom.

2. Cancer deaths: 598,932
This is cancer deaths, not all of the cancers.

3. Covid-19: 345,342
I have had various people complain that covid-19 is listed as the cause of death when the person has a lot of other problems: heart disease, cancer, heart failure. The death certificate allows for more than one cause but we are supposed to list the final straw first. I cannot list old age, for example. I have to list: renal failure (kidneys stopped working) due to anorexia (stopped eating) due to dementia. That patient was 104 and had had dementia for years. But dementia is not listed as the final cause. So if the person is 92, in a nursing home for dementia and congestive heart failure, gets covid-19 and dies, covid-19 is listed first, and then the others.

4. Unintentional injuries: 192,176
Accidents went up, not down, which is interesting since lots of people were not in their cars. However, remember that the top of the list for unintentional injuries is overdose death, more by legal than illicit drugs. If there is no note, it’s considered unintentional. Well, unless there is a really high blood level of opioids and benzos and alcohol. Then it becomes intentional. They do not always check, especially if the person is elderly. The number rose 11.1%, which seems like a lot of people.

5. Stroke: 159,050
This rose too.

6. Chronic lower respiratory diseases: 151,637
This went down a little. This is mostly COPD and emphysema. So why would it go down? Well, I think bad lung disease people were dying of covid-19, right?

7. Alzheimer’s: 133,182
This seems to belie me putting renal failure due to anorexia due to Alzheimer’s. I think they actually read the forms and would put that as Alzheimer’s rather than renal failure, because it is not chronic renal disease.

8. Diabetes: 101,106
This rose too. 15.4%, again, probably partly because people avoided going to clinic visits. Also perhaps some stress eating. Carbohydrate comfort.

9. Influenza and pneumonia: 53,495
So this went up too in spite of a lot less influenza. Other pneumonias, presumably.

10. Kidney disease: 52,260
This went up.

And what fell out of the top ten, to be replaced by covid-19?

11. Suicide: 44,834
This actually went down a little. What will it do in 2021?

So what will 2021 look like? I don’t know. It depends what the variants of covid-19 do, depends on what sort of influenza year we have, depends on whether we are open or closed, depends if we bloody well help the rest of the world get vaccinated so that there is not a huge continuing wave of variants.

Today the Johns Hopkins covid-19 map says that deaths in the US stand at 608,818 from covid-19. If we subtract the 2020 covid-19 deaths, we stand at 263,495 deaths from covid-19 so far this year. Will we have more deaths in the US from covid-19 than in 2020? It is looking like yes, unless more people get immunized fast.

Take care.

survived

Pneumonia is weird. I look good after I manage to not die from it. I start going outside a little more and I run in to people. “You look good,” they say.

“I nearly died of pneumonia.” I say.

“….but you LOOK good,” they say, looking confused.

It was weirdest in 2012 and 2014 when I had strep A and sepsis symptoms and couldn’t get any doctor in town to believe me. The out of town Pulmonolgist and Psychiatrist did. The ENT didn’t really care. The Neurologist said that it was not myasthenia gravis or one of those weird muscle diseases. How do you KNOW, I asked. “Your lungs are getting better and they wouldn’t be if it was one of those.” “Oh. So this is just really bad strep A in my muscles.” “Yes.” “And I will get better?” “I think so, eventually.” “But we don’t know and don’t know when.” “Correct.” How non-reassuring. The Infectious Disease doctor said we don’t know how to treat you but you can TRY taking one 250mg penicillin tablet daily. Didn’t work. I got nauseated pretty soon. In contrast to when I have pneumonia and can take 500mg four times a day. It’s ridiculous. The asthma/allergy testing was all negative and after the 2014 round my lungs healed.

I hope they do this time too.

I wonder if people will have the same, “Hey, you look really good,” as much with me being oxygen. Except I have the mask over the oxygen tubing (talk about tangled!!) so they can’t see my face anyhow.

“Hey, how are you?” someone says.

I hold up the oxygen tubing.

“OH.” they say.

“Okay,” I say.

Okay.

Free fall

I feel safest with the fallen

Everyone falls
No one is good

I am afraid
Of the people who
pretend to be good

the fallen
don’t pretend

We fell down down down
like an eternity
like it would never end

We were bad
depressed drunk addicted
liars cowards thieves

We held our arms out
There was nothing to stop us
Free fall

All we could do
was pray

We prayed
As best we could
With all our hearts
If we had no words

Falling angels
Caught us

Helped us
Claw our way back

Some people fall
Are still falling
Fall forever

Are they crazy
Or do they choose
To stay with the angels?

The people who say
They are good

We look at them

We know they haven’t fallen

They are lying to us
They are lying to themselves
They are lying to the Beloved
They want to be good
They want what they say to be true

But it isn’t

I meet the eyes of another fallen
Knowledge

I can see the memory
Of infinite free fall
In their eyes.