organize

I am ready to organize my house.

I thought for years that I am NOT capable of organizing a house.

It turns out that I never had time to organize my house. I was a single mother family physician doing rural medicine including obstetrics and frequently on call, and then I opened my own business.

So organizing the house was way down the list of priorities.

I’ve been home now since March 20, 2020. I am starting to really recover from the pneumonia and muscle dysfunction. So now I am organizing once again.

I need a work room, other than the computer room. I set one up upstairs, but in this 1930s house, the upstairs room is too cold. It is great for sleeping but not for a prolonged time working on a project. So I am eyeing my spaces. I could use the front room which is currently the invasion from my clinic. However, I love having the front windows right there when I am on the computer. The cats have a chair there too and keep me company.

I am eyeing rooms in the basement. There is baseboard electric in three rooms. It means moving things around, but that is not difficult. It may take me a little while, but I will get it done.

I am ready to organize it.

____________________

For the Ragtag Daily Prompt: READY!

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.

acoustic bicycle

Over KwanChunChrisSoliday, we discuss bicycles. We now have a plethora of electric bicycles, so we need a phrase that describes the “old” style bicycle. We came up with acoustic or analog. I like acoustic bicycle, because it sings.

My friend B-from-Arlington (BfA): “But they don’t make noise.” He didn’t approve of either idea.

“Well, we had spoke bells, and playing cards. My bikes make noise.” Sometimes it’s me making it.

We are riding on a rails to trails path in Northern Virginia. Seven of us and me on oxygen. It’s only my second bike ride since March 2021, when my lungs fell apart. We are all on acoustic bicycles.

I feel pretty strong for most of it, 14.5 miles. It seems flat, though it is a very gentle downgrade, until the last 0.5 mile, which is gently up hill. Oh, my lungs don’t like that bit at all and by now my muscles are saying Why are we doing this? I am relieved when we get to the coffee shop destination. Three of us will stay there, while the other four will ride back and get the cars. I hang out with K-f-A, BfA’s spouse, and their son. Their son examines my phone, asks why it has four camera eyes. I have no idea, so he proceeds to figure it out. We play with the slow motion camera for a while.

We know what a penny farthing is, and safety bicycles and tricycles. The early safety bicycles did not have brakes and had wooden rims and wooden spokes. My brother outlaw has one, from the 1880 or 90s. Another friend collects penny farthings and has one that is entirely of cast iron. It would be a little bumpy and the seat is pretty hard. It is also massively heavy. So now we add acoustic bicycles to the electric ones.

Go, google, spread the word.

________________________________

Dang, others have come up with it too. Traditional bicycle sounds too fogey.
https://www.reddit.com/r/ebikes/comments/hp2l30/can_we_please_stop_calling_traditional_bicycles/
https://www.bikebiz.com/what-shall-we-call-the-non-electrified-bicycle/

writhe

You are sick as shit.

You go to the ER.

You finally feel safe, on a bed, they will save me, you think.

The nurse is on autopilot. He does not seem concerned. You are shaking a little as he arranges you on the bed. He puts the heart monitor stickers on and hooks you up. Blood pressure cuff, pulse ox. Blood pressure is fine, pulse is a bit fast, at 110.

You notice he is not making eye contact.

“I’m cold.” you whisper.

He doesn’t reply. He keeps messing with the wires. He puts the call button next to your hand. He leaves and returns with a warm blanket. It feels wonderful. He doesn’t say a word.

You feel better under the warmth.

The respiratory therapist wheels in the ECG machine. You smile at her but again, no eye contact. She puts more stickers on you. “Hold a deep breath.” The ECG spits out. She takes it and leaves.

The radiology tech wheels the portable xray machine in. You watch his face but don’t bother to smile. He looks everywhere but at you. It’s a bit creepy. Are they all robots? It’s 3 pm, not 3 am. “Lean forward,” says the tech, putting the radiology cartridge behind you. “Take a deep breath and hold it.” He takes the cartridge and leaves.

The nurse is back. Puts in the iv and draws 5 tubes of blood. You are shivering a little. He doesn’t seem to notice. You think about another warm blanket. The iv fluid starts and you can feel it running cold into your arm.

There is a child crying in the ER, in some other room. You start noticing the noises. Machines beeping. People typing on computer keyboards. No one is talking. The kid gives a howl of protest, rising and then is abruptly quiet.

Your hands and feet are tingling and burning. You writhe a little under the blanket. Sensation is returning to your hands and feet. It hurts but it is also good. You were at the point where all your feeling had shrunk to a tiny spark in the center of your chest. As the iv fluid runs, feeling slowly spreads out from that.

The doctor comes in. Grumpy, clearly. “Lean forward.” Listens to your chest. “Sounds clear.”

“It’s been hurting for 5 days. It hurts to breathe. Burns.” You are anxious as hell. BELIEVE ME.

The ER doc gives a little shrug. “Oxygen sats are fine.” He does a half-assed exam. He leaves.

You look at your feet, taking your socks off. Because he didn’t. There are two black spots, a couple millimeters across, old blood. Those are new.

You press the call button.

Time goes by. The nurse floats back in.

“Look. Tell the doctor to look. These are petechiae.” You point to the black spots.

If the nurse had laser vision, your feet would be burned. The nurse glares at your feet. He goes out.

The doc comes in and looks at your feet.

“They are petichiae. I have an infection.”

He gives a tiny shrug. “Your chest xray looks clear. Your labs are normal. You are not running a fever.”

“I am on azithromycin for walking pneumonia. I suddenly felt like all the fluid was running out of my arms and legs. I am worried that I am septic.”

“Blood pressure is fine. You are really really anxious.”

You are furious. It probably shows on your face. You are terrified.

“Could it be an antibiotic reaction?”

Shrug. “No rash.”

“Except the petechiae.” A sign of sepsis.

“I will change the antibiotics. Clindamycin.” He leaves.

You lie back, terrified. He doesn’t believe you. He is sending you home, septic. You will probably die.

The nurse comes in. Removes the iv and unhooks the monitor and the blood pressure cuff. You get dressed, numb and frightened and cold. The nurse goes out and returns. He recites the patient instructions in a bored voice and gives you the first dose of clindamycin.

You walk shakily to the door of the emergency room. To go home. While you are septic and they don’t believe you. You know what happens with sepsis: your blood pressure will drop and then organ damage and then IF you survive you could have heart damage or lung damage or brain damage and you might not anyhow.

You go home.

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.

plane view

I took this last month when I flew to Michigan for an almost brother’s birthday. He turned 50. The rising sun was just amazing and I could see the mountains beautifully. Yesterday’s photograph was also from the plane. I flew from Seattle to Chicago. In Chicago I took a taxi to the train station. There I waited for a train for four hours and then rode up into Michigan. It was my first real journey with the oxygen concentrator. My carry on had the concentrator, three back up batteries, my camera, a laptop and phone and charging cords for all of them. A heavy bag and I had to pull out laptop, batteries and camera at security. Fun, eh? But I had enough oxygen for a 12 hour journey and could plug in on the train. I could have plugged in on the plane too, but the cord was in the overhead compartment. Anyhow, it worked. Oxygen tubing, N95 mask and second mask over the N95… whew.

I also learned that I need to let the airline know 48 hours in advance that I am traveling on oxygen. They tend to seat you by a window so no one trips over your tubing. Though I was in an aisle seat on the way back. Anyhow…. made it, hoorah!

Covid-19: simplified self care

  1. I am a Family Practice Physician for 30 years. I have had pneumonia four times. I last got pneumonia on March 20, 2021 and I am still off work and on oxygen. This is the first time I have been on oxygen. No tobacco, no marijuana, no lung disease found to date but my mother had tuberculosis when I was born and my father smoked unfiltered Camels. With the hospital beds filling up, this is to help keep people out of the emergency room if they don’t need to be there and to help people track how sick they are.
  2. Learn to take your pulse. You need a second hand. Your heart rate is the number of beats in 60 seconds. Take it at rest (which means sitting or lying down). Then try taking it after you walk. It should be regular unless you have known atrial fibrillation. Also, if you are fifty or older, you may skip some beats so that you have early or late ones. That is not worrisome.
  3. Normal is 60-100. If you are very out of shape, you might go up to 120 after you run up the stairs or walk fast.
  4. If your resting pulse is 120 or higher, call your physician. If you are very short of breath with that or your lips are turning blue, call an ambulance right away.
  5. If your resting pulse is normal, say, 70 beats per minute, and your pulse after walking goes up 30 points or over 100, you are sick. If you are very short of breath after walking you may need oxygen. Call your physician and walk… really… slowly. When your lungs are swollen, there is less air space to exchange oxygen and your heart makes up the difference. If your heart is beating at over 100 for long, it is like running a marathon. Don’t stop walking completely because you are at risk for blood clots. But walk really slowly.
  6. If your resting pulse is normal and your walking pulse is ok, try a loaded walk. Carry something that weighs 20 pounds if you can. Then sit down and check a pulse again. If it is over 100 or jumps 30 points, you too have lung swelling, it’s just a little more subtle. You need to rest too.
  7. With practice, you will have a good idea what your pulse is before you do a formal count.
  8. You can use a pulse oximeter but you have to use it accurately. The fingers should be not moving and lying on the person’s knee or table or something. Otherwise it will give inaccurate readings and scare you. With a regular heart rate, look for the light to be picking up regularly before you believe the oxygen level. O2 sats under 87% need oxygen, but also if someone is going below 95% or is a child, call doctor or ambulance.
  9. Take a multivitamin. It is a lot of work for your heart to race fast. Rest, rest, rest. I have had 4 rounds of pneumonia with lung swelling. It took two months, two months, a year and this time I am five months post pneumonia and still on oxygen.
  10. Don’t use quack supplements and don’t take veterinarian ivermectin. Hello, you are not a sheep.
  11. Remember that if someone is hypoxic, they may act goofy, happy and unconcerned or be scared or have memory loss or just be confused. I write really weird rhyming songs when hypoxic and have the poor judgement to sing them to my doctor.
  12. GETTING VACCINATED IS YOUR BEST BET TO NOT DIE OF COVID-19. AND WEARING A MASK ALL THE TIME AROUND OTHER PEOPLE.

Good luck and take care.

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

What do you see?

What do you see in this rock?