Do you know the round?
Spring would be a dreary season
If twere nothing else but spring
would be a deary season….
For the Ragtag Daily Prompt: awakening.
trees awake
Category Archives: people
The introverted thinker on the playground
My daughter is an introverted thinker. Sometimes this is extremely entertaining.
When she was in first grade she came home part way through the year and said, “I want to get my hair cut like a boy.” “Short?” I said. “Yes,” she said. I didn’t think about it too much but made an appointment. I thought it was because she has that fine tangly hair that is really difficult to comb.
On the way to the salon, my intuition kicked in and I realized that something was up. She was in that deep abstraction mode, thinking.
I said, “Why do you want to get your hair cut like a boy?”
Her reply, “The boys chase the girls on the playground.”
Hmmmm.
“Do they chase you?”
“No.”
“Why not?”
“They are not sure if I am a boy or a girl.”
“You don’t want them to be sure?”
“No.”
“Why not?”
“There is another class that gets to recess before us. They get the tire swing. They have a club that is all boys. They won’t let us use the tire swing.”
“You are going to fool them. Okay.” I sat back to see how she would proceed with whatever plan she had regarding the tire swing.
She had her hair cut very short. The next morning she chose hand-me-downs from her brother. A rugby shirt, a navy blue sweatshirt, flannel lined thick jeans and his old hiking boots. She had never worn any of them before and her usual preference was pink. I took her to school. She went into her class and just went to stand by some other children, not saying anything at all. They commented on her haircut.
I went to the principal and described my daughter’s plan, mostly because I thought it was quite brilliant. He said, “Oh, we have to do something about this.” I said, “I wasn’t trying to get anyone to interfere.” He said, “No, but we have a playground policy. They are allowed to have clubs, but they are not allowed to exclude anyone. In other words, no ‘boys only’ clubs. We will hold an assembly to remind them.”
So for a seven year old introverted thinker on the playground, a problem required careful thought and a plan, which she then carried out. I liked the approach of challenging gender. As far as I could tell it did not occur to her to ask for help. I do wonder at times what other plans she is implementing.
She did get to use the tire swing. Then she went back to wearing pink.
cereal mean stupidity
Some people act mean. Not only do they act mean but they are cereally mean. They are mean about cheerios, about count chocula, about granola, about oatmeal.
Not only do they act mean, and cereally mean, but stupidly mean.
They are stupidly mean because they heard that you like cheerios. It doesn’t matter if you actually do or don’t like cheerios. Someone told them that you like cheerios, they think cereal is sinful and you are LABELLED. They have you labelled as liking cheerios and you are a sinner.
And it doesn’t matter what you say or do. You can say “I don’t like cheerios.” Yeah, they don’t believe you. They think that maybe YOU EAT CHEERIOS when no one is looking, behind curtains, in the basement. They did a search on the internet and you bought Cheerios in 1997. You are a sinner.
You can show photos of your breakfast. “Look! Yohgurt and raspberries!” Doesn’t matter. They whisper, she eats cheerios in secret. You are still a sinner and you are a sinner and a liar.
You can be an upright citizen for years, join the Rotary, volunteer, donate money. Doesn’t matter. The whispers circle back to you: cereal.
So finally you figure it out: fungk them. You do not have time in your life for cereal mean stupidity. You put those people on ignore and leave them there. You cheerfully help if they have a flat tire or appendicitis. You commiserate when they complain that they are miserable. Well, actually, fungk that. Your goal if they call is: get off the phone. “I got a pan burning on the stove, I gotta go to the bathroom, I gotta trim my nosehairs…” Anything but talk to one of them. Because your life is a lot of fun, once you stop trying to change their minds.
And it doesn’t have to be cereal. It can be bipolar disorder or race or politics or the country you are from. Cereal mean stupidity is rather rampant. We have the choice to ignore it and live with more joy than ever.
Peace out.
Covid 19 long term and PANDAS
It is not looking like I will be able to return to medicine. Based on the current research, the PANDAS reaction will get worse with each infection. I will be moving in to a hamster ball next week, (*&^*&(*&*&^.
You, gentle reader, can work your way through the research, which I am going to present to you. You have no reason to do this unless you have chronic fatigue, fibromyalgia or myalgic encephalopathy or post covid syndrome. Or you know someone with one of those. I think there are a few people out there.
First, read the guidelines for treating PANS/PANDAS.
https://www.pandasppn.org/guidelines/
https://www.pandasppn.org/jcap2017/
The article about the three antibodies involved is in this section:
https://www.liebertpub.com/doi/full/10.1089/cap.2016.0148
“Evidence for group A Streptococcus (GAS)-specific cross-reactive antibodies having affinity for neuronal components (including receptors) in the basal ganglia has been demonstrated in human and animal studies (Husby et al. 1976; Kirvan et al. 2003, 2006a, 2006b, 2007; Hoffman et al. 2004; Yaddanapudi et al. 2010; Brimberg et al. 2012; Lotan et al. 2014). Sera and immunoglobulin G (IgG) from SC and PANDAS patients known to bind to components of the GAS cell wall have also been shown to cross-react with components of neurons in the basal ganglia caudate, putamen, and internal segment of the globus pallidus (Kirvan et al. 2006b). Antineuronal IgG antibodies binding to multiple targets, including lysoganglioside, tubulin, and dopamine receptors, have been reported to be elevated in patients with SC and PANDAS compared to controls (Kirvan et al. 2003, 2006a, 2006b, 2007; Cox et al. 2013, 2015). Targeting of such antibodies to dopaminergic neurons in the substantia nigra and ventral tegmental area in the basal ganglia (as well as other cortical neurons) was confirmed in transgenic mice expressing a chimeric antineuronal autoantibody containing VHΒ±VL regions cloned from a patient with SC (Cox et al. 2013).”
All right, three antibodies. So WHAT, doctor?
The antibodies are to dopamine, tubulin and lysoganglioside.
Here is an article looking at chronic lyme disease.
https://www.sciencedirect.com/science/article/pii/S2666354619300158
Basically that article looks at four groups. No lyme disease, one episode, more than one and chronic. No dopamine antibodies. But the tubulin and lysoganglioside antibodies are not present in the healthy folks and are present in the lyme folks, highest in the chronic lyme. Those two antibodies are associated with chronic fatigue (the tubulin) and fibromyalgia/gluten and sugar intolerance (the lysoganglioside).
Now wrap your head around that one in ten severe infections can trigger chronic fatigue. ANY INFECTION. I am normal, I just bloody well got antibodies early because my mother had tuberculosis through the whole pregnancy. So I was born with PANS. Then, smartied that I am, I chose to be a physician, meaning I get exposed to infections. Guess I am not going to be doing Doctors Without Borders, right?
Treatment, well, that is complicated. I think it depends on the person’s profile: which antibody is giving them the most trouble. I am a special case, because I have all of the antibodies firing full bore at once. Which has forced me to be extremely creative about how to survive this now and in the past.
First off for the treatment: DO NOT PUSH THE CHRONIC FATIGUE. Because the tubulin is damaging not just skeletal muscles but the heart muscle as well. So even with squeaky clean coronary arteries, pushing through the chronic fatigue could trigger a heart attack or broken heart syndrome. And we aren’t (yet) measuring these antibodies routinely. Hell, I hadn’t heard of tubulin since the distant mists of college until 2 weeks ago.
Secondly: if there are neurological symptoms, that is, any two or more of manic/word finding difficulty/ADHD/OCD/emotional lability/oppositional defiance/clingy/brain fog/yeah I forget the rest, then the anti-dopamine antibodies are present. In addition to speeding the thoughts, I think that they speed cell metabolism. I always drop ten pounds the first week. So, vitamins are vital. If your vitamin K drops, you may clot. Also vitamin D for teeth and vitamin B12 — if it’s low you can get Guillain Barre. The myelin sheaths unwind. Ok, that could also be thiamine or folate or all three. Bleeding strokes from low vitamin K.
Third: I don’t know if it’s just me, but the things I have to change in my diet are NO SUGAR and NO GLUTEN. I tried rice yesterday and it was ok, so I think it’s gluten and not just all bread/rice/potatoes/pasta. I have mostly been eating meat or cheese with kale/collards/mustard greens/parsley or turnip greens. All of which are vitamin rich. I have not had bread in three weeks and have been not even eating much fruit. Blueberries and grapefruit are safest. In two of my bouts of this, with strep A pneumonia, I would have fluid shifts when I ate sugar or gluten. Normal urine output is up to 2 liters. I had 10. That was documented in a 24 hour inpatient observation, though the doc did not actually notice. I did. I also figured out how to get it to stop, by stopping carbohydrates as much as possible. Greens only, because they are food sources of vitamin K. At any rate, it’s worth a try for other people. I use electrolyte tabs with fluids too, NUNN tabs or Airborne.
There’s other stuff. But I am tired and my chest hurts. Take care of yourself and each other.
Juxtaposition
The photograph in my Quimper Family Medicine home clinic and guest room is of my grandmother and my daughter, in 1988. I took the picture. My grandmother is Evelyn Ottaway. The other picture is one of my mother/baby or parent/child pictures. I like the juxtaposition.
It’s not just parent/child that is important. It is parent/child, grandparent/child, great grandparent/child.
I am reading a book that appeared in my little free library box, about grandmothering skills. It’s got some very interesting ideas and I am enjoying it! Radical, man.
My grandmother had amazing organizational skills. I think that my daughter got them from her.
Quota
Quota
honestly
I feelΒ despair
when I try
to think about the newΒ schedule
Twenty four slots
Of 20 minutes
See three people
For 40 minutes
Twenty on the schedule
UnansweredΒ questions
Wake me on Sunday morning
If I am called to a labor patient
Must I make up that clinicΒ face time?
What ofΒ holidays?
The clinic is closed.
Night callΒ is nowhere addressed
Will they hire more and more
Who don’t take call
Until I am the last woman standing
Red rimmed eyes staring
Numb with fatigue
What of my nearly deaf patient
WhoΒ reads lips
May we take forty minutes?
All the fairly deaf elderly?
New parents, anxious
Questions pour out like
Coins from a jackpot win
What of the tearfulΒ brokenhearted
And anxious?
I shrink at the thought
Of crushing their hearts
Into twenty minutes
And what if I’mΒ sick?
(sick leave & vacation all one)
It’s not aΒ holidayΒ if I’m on call
No make-up day off
If I cancelΒ clinic
For illness
Do I make up those days
A quota of patient face days
I am in theΒ factory
TheΒ mines
People are the shirts I must sew
TheΒ tons of coalΒ I must load
I mustΒ meet a quota
Doctors die younger
Our life is measured out
InΒ patients
I won’t let theΒ quota
KillΒ my love
sober garden
For the Ragtag Daily Prompt: garden.
We have beer gardens at many local events. Centrum music, the Wooden Boat Festival. People have to show identification to get into the beer garden and must keep the drink in there.
I want to start a Sober Garden as well as a Beer Garden. Let’s have a substance free area, roped off, for families and those who are choosing not to use substances, alcohol, opioids, tobacco, meth, whatever. At the events with families, the Beer Garden is roped off, but let’s rope both off. Let us have a Sober Garden and have food trucks and drinks and welcome families and welcome people who are not drinking alcohol or using other substances.
Let’s bring children out to the music and let families set a conscious example. There is no stigma if it is a Sober Garden for families and to support the whole community, including those recovering from addiction. Let us make it conscious and attractive.
When we rope off the Beer Garden and check identification to get in, aren’t we sending the message to the youth, especially teens, this is special, you are not allowed. Let us reverse that and have a bracelet for those going in to the Sober Garden. A sticker, a garden for families, a garden for people healing, a garden for making a different choice.
_____________________________________
music by Mike and Ruthy: simple and sober. https://www.youtube.com/watch?v=gsFlHuhDP0A
Sometimes it takes a while to warm up to an idea. But spring will come and warmth.
strategy
KO Rural Mad As Hell Blog 
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