Category Archives: rural doctor

by

adaptive theory of PANS/PANDAS

This is my working theory on PANS/PANDAS. Pediatric autoimmune neuropsychiatric syndrome/Pediatric autoimmune neuropsychiatric disorders associated with Strep A.

Four or more antibodies. The antibodies can take different patterns in different people.

  1. Antibodies to dopamine 1 and dopamine 2 receptors.

The antibodies are like keys fitting in a lock. The key may fit in the lock and BLOCK or fit in the lock and OPEN IT. So, there are a very large number of patterns that could arise from this, especially when we remember the rat neuron with 300 different receptors for serotonin in one neuron. Think of the possibilities here.

If this antibody BLOCKS, an ANTAGONIST, it will cause slowing/brain fog/depression/and I don’t know what all.

If this antibody is an AGONIST and the key turns, it apparently can cause mania, ADHD, OCD, oppositional defiance, clinginess, separation anxiety, anxiety, etc.

We do not know what causes psychiatric disorders. Now we have a category called neuropsychiatric, where it is caused by an antibody. Or antibodies. What percentage of psychiatric disorders are caused by this? I am betting high rather than low.

  1. Antibodies to tubulin.

If the antibody is an ANTAGONIST, blocking, then slow or fast twitch muscles won’t function correctly. It could block both. I think if it blocks both, that is the severe lie in bed chronic fatigue. I have trouble with my fast twitch muscles but my slow twitch ones work just fine.

If the antibody is an AGONIST, you get some super athletes. I know a number of people that I would suspect fall into this category. I can name five off the top of my head, friends.

  1. Antibodies to lysoganglioside.

This one worries me. Lysogangliosides lyse ganglions. These antibodies are used in soap making, among other things. They break down fatty cell walls.

When I have a high antibody level, I have trouble eating any carbohydrates. As I improve, I have trouble mostly with sucrose, fructose and gluten but not lactose. Also, when I eat gluten, I get acidic. When you get acidic, your body tries to compensate by slowing your breathing to hold on to CO2, because you need to balance the acid H+ with a base, OH-. So: triple whammy. Acidic I automatically breathe slower, which is not helpful when I am already hypoxic and tachycardic.

I have not figured out whether my antibody is an agonist or antagonist.

An agonist would lyse more ganglions. This could be bad for the brain and for peripheral nerves. Neuropathy and dementia.

An antagonist would stop ganglion lysing. Um, in theory, cancer. Lysogangliosides are supposed to clear out bad cells.My guess is that I have an antagonist because of the family history. At least, on my mother’s and sister’s side. My father smoked two packs of Camels for 55 years and did not get cancer: tough bugger, right? Or did he have an Agonist? This line of thinking makes me very highly motivated to eat in whatever way the antibodies want me to. I do not understand why gluten would trigger this and why the gluten effect in me lasts longer than the fructose and sucrose effect. Gluten intolerance and other gut problems are on the rise and this would certainly explain that. This is the cause of at least some fibromyalgia patterns. Not only does eating gluten screw up my breathing, but it makes any muscle that I have used recently hurt like hell. I ate some meatballs without reading the stupid package back in April. Two hours of chest wall muscle pain and honestly, heart pain. I dug the package out and duh: bread crumbs. Gol dang it, I hate it when I am stupid. However, it hurts like hell but at it’s worst I had normal cardiac enzymes and no heart attack. Weird.

Ok, but WAIT, you said ADAPTIVE. How can this nightmare be adaptive?

Sure, adaptive. Remember the back up system for when we are starving? We switch from metabolizing glucose to metabolizing protein and fats, our own if necessary. We go from glycogen metabolism to protein/fat metabolism which produces ketones.

This is the crisis shit hits the fan emotionally and in plagues system.

So, can be caused by stress or infection or a combination.

Why why why?

Because if the stress gets too high or the infection gets too bad, our body switches gears and runs a back up system. I’ve thought of chronic fatigue as some sort of switch the body throws for years, because it’s the hypercrazy work too hard workaholic Type A people who get it. Type B people do not get it or don’t notice or don’t care. Type B people just say, wow, I’m tired, I think I will rest. The Type A people flip out and say “Put me back like I was!!!!” and then they go to 47 doctors and refuse to do anything the doctors say and do internet research and see any kind of quack you can imagine and they are the most exhausting patients.

Why the psychiatric stuff? Ok, take mania. If there is plague or you are in a really dangerous abusive situation, mania suddenly makes sense. Overnight you are different and what’s more, it scares the hell out of everyone. You are shunned. You are alone. You may get thrown out of a job, family, friend group or all of the above. This would tend to protect you against both plague and the really dangerous abusive situation. Whether you like it or not.

And how clever of the brain/body. Here is a back up system. It changes at least four systems, so you are now a different person. You freak your employer, friends and family out. AND you are sick as shit and they won’t listen. You have to get out and go elsewhere for help or hide in your castle or house or whatever. You can’t move or you have super muscles. And every single person has a different pattern.

I look at the long haul covid. The most common symptoms are psychiatric, shortness of breath and fatigue. Sound familiar?

Now, will someone PLEASE fund my NIH west?

_________________________________________________________

Guidelines for treating PANS/PANDAS: https://www.pandasppn.org/jcap2017/

by

Beach encounter

Yesterday B and I walk about a mile and a half of beach on Marrowstone Island. We see five other people total. There are long stretches with no one in sight anywhere.

Way down the beach there is a sand cliff. A coyote runs half way across the exposed face and stops. It looks precarious. We watch it. “That’s weird,” says B. “They don’t hang out in plain sight.”

It scrabbles and runs the rest of the way across. It stops and turns and sits. Watching us.

I laugh.

B. frowns. “They don’t DO that.”

“I think it’s listening to us. We’ve been singing and laughing.” We are goofballs on the beach. Wordplay. We’ve both been coming up with advertising songs. Horrors, ear worms.

“They don’t do that.” he says, “Can you take your camera out slowly?”

I have my Panasonic FZ150, 24x zoom. I get some shots. B is acting nonchalant, hunting for agates again. He finds more than me from both practice and I am busy taking pictures and being distracted by other pretty rocks, not just clear agates. He is disciplined. I am a generalist.

I get lovely shots. We zigzag back and forth on the beach, trying to look at ALL the rocks. “If you are hunting like this, other animals think you are foraging. Birds and animals will ignore you. I can get really close to them.”

The coyote is watching us. “He’s listening to us, really!”

“Maybe he wants to know what we are foraging for.”

“Rocks.”

“He’s hungry. Or he’s young.” We don’t really know it’s a he.

I start singing. I zigzag closer and take more pictures. She is flicking her ears at the song.

“She doesn’t seem rabid.”

“There isn’t much rabies out here.”

“Bats.” I say. I’ve researched it twice in the last 8 years.

“Yes, but not mammals.”

I start a video and sing to the coyote. I sing The Fox, though I leave out the verses about Old Mother Flipperflopper and the hunters. Coyote flips her ears and turns her head. She is checking where B is since he is moving further down the beach. I finish the song and turn off the video. “Thank you!” I say.

We walk again.

When we turn around, there is Coyote. She has shadowed us down the beach, and she slips into the brush at the foot of the cliff. She is quickly not visible.

“Humph.” says B.

I laugh.

Later, we look up and a larger animal is coming toward me. We both startle, but it is in a submissive posture. A dog, not a coyote, with a red collar. We both thought it was a coyote for a moment. It comes up to me and is very friendly. Then to B. Then back to it’s owner, who limps into sight.

“Wow, I thought it was another bigger coyote for a minute.”

“Me too. I thought it was coming right after you.”

“It’s owner looks frail and old.”

“Our age.”

“No way!” laugh.

“Yes.”

I don’t think so, but maybe. I was more focused on the dog.

I find two clear agates, but come back with two windbreaker pockets with other rocks. B only finds one that meets his specifications. My two really aren’t up to the quality he wants. Well, one is borderline and one doesn’t qualify.

by

Email quack spam: try CBD oil for free!

Lovely email QUACK spam. TRY CBD OIL FOR FREE!

“The Miracle Molecule! Everything You Need To Know About the Health Benefits of CBD Oil“. The link implies that the article was in Reuters. I ain’t pressing no spam link. Internet search on Reuters Everything You Need to Know About the Health Benefits of CBD Oil does not bring up a Reuters article.

“All natural formula. All CBD products use proven, organic all natural ingredients that are toxin-free.”

Ok, now WAIT a minute. Proven? By what the hell method? We dropped some and got high so it’s good? And don’t get me started on toxin-free. Sure, and they’ll sell you a bridge too.

Let’s discuss all natural.

Is CBD oil “all natural”? Um. Well, it could be organically grown, I will give them that. There have been pesticide poisonings from illegal pot and the laws for growers vary state by state. Check your state laws re whether they have specified what the growers can use on the marijuana plants. Paraquat is very strongly implicated in Parkinson’s (https://pubmed.ncbi.nlm.nih.gov/20094060/) and you don’t want that, do you?

How do you define “all natural”? Innocent virgin farmer girls and boys, skipping through the pot plans and milking the oil out gently? Oh, ye innocent and foolish peoples. Here is a nice article about fires in CBD processing plants: https://www.sandiego.gov/sites/default/files/dsdfire-38-1.pdf. They burn real good, it turns out.

The National Fire Protection Agency (NFPA) has guidelines: https://www.firefighternation.com/prevention/nfpa-approves-420-standard-on-fire-protection-of-cannabis-growing-and-processing-facilities/. You do keep up with the NFPA, don’t you?

An older article illustrating the problem: https://www.politico.com/story/2019/02/18/marijuana-factories-explosions-safety-issues-1155850.

And the title of this seems pretty self explanatory: https://extraxx.com/the-top-five-safety-concerns-in-a-cannabis-extraction-facility/. “Let’s begin with the obvious. When dealing with flammable gasses or liquids in extract production, there is a risk of fire or explosion during the handling process. The easiest way to understand the risk of fire or explosion is to consider the fire triangle. Essentially, a fire needs three things to start: a fuel source, oxygen, and an ignition source. The basic philosophy here is that by removing legs from the fire triangle, we can make the process safer; by removing two legs, an operator can make their extraction process significantly less incident-prone.” Later in the article: “there are two tools that should be kept on site to make known the presence of unnoticed flammable vapors: a permanent LEL, or Lower Explosive Limit, monitor should be installed in the extraction room; and a handheld two or four gas portable monitor should be on site as well.”

I don’t have much experience with LFL monitors. Now I want to buy some of the gummies and try lighting them on fire. Does the smoke make one high? Well, I think it depends what it is suspended in. I thought vaping was insane when I read that some of the nicotine vapes suspended the product in antifreeze. Um, your dog may die if they drink it. Absorption in the lungs just does not seem wise. Also, some of the vapes get so hot that heavy metals get in the lungs. You know, lead and stuff. When I researched it last, China was turning out 500 different kinds of vape machines. Uh, ick, don’t do that. Sugar burns so the gummies might. I have some “Annie’s organic fruit gummies” so I can check whether they burn. Though they shouldn’t contain CBD oil. Now you know what I am doing while disabled. Home chemistry and on line research.

by

Cognitive behavioral therapy

Dr. Aaron Beck, father of cognitive behavioral therapy, died this week, November 2021, at age 100.

Oddly enough, the best explanations of cognitive behavioral therapy that I’ve read is on a writing website. It talks about writing down all of the horrible thoughts and then going back and writing counter thoughts. Psychologists have been talking at me at medical conferences for years about cognitive behavioral therapy, but they never explained it. They said we could do it in clinic. I thought cynically that maybe I could if I knew what the hell it was.

And the explanation by the author is oddly similar to what I think of as the angel and devil on my shoulders. It turns out that I do do it in clinic.

When I react to some event, I let the devil out first. It has a fit about whatever is happening, writes poems, is reactive, paranoid and full of anger and grief. It often imagines over the top terrible things happening to the person or people that did whatever it is. Then the angel wakes up and says, wait. What are you saying? What you are imagining and cursing that person with is WAY worse then what they did. The angel writes the poems of forgiveness.

So I have been doing a homemade form of cognitive behavioral therapy.

However, I would say that it can be overused. We need to listen to patients carefully. If they are in an abusive relationship, it should not be papered over with cognitive behavioral therapy. A friend and I have been comparing terrible childhoods. His involved being beaten without reason.

I said recently that what people hit with in my family is words. They make grief and fear into stories, funny stories, that make people laugh. Shame and humiliation and reliving the feelings. I said that I am reactive and pay close attention to words. But I have reason, back to age 2. I said that books are my refuge because the words are not about me, they don’t shame me, they do not humiliate me, and if I read a book twice, it has the same words. Home, love and safe.

In my maternal family, if I said that I was not comfortable with a comment, I was told that I took things too seriously, that I have no sense of humor, that I can’t take a joke. Gaslight and then dismiss any objection. That is how one side of my family loves. I do not like it. Unsurprisingly, they do not love me, or at least I do not feel loved.

And my friend said, your family, your childhood, was worse than mine.

One of my talents in clinic is that I can listen to insane family stories. I can listen because my family is insane. They are cruel. At least, it feels like cruelty and horror to me. I didn’t ever try to find out if a family story is true. I listen and then say, yes. I think it is appropriate for you to feel angry/sad/horrified/appalled/scared/hurt/whatever.

Somehow that listening and validation is huge. I have people come in and say, “I NEED AN ANTIDEPRESSANT.” They want to supress the feelings. So I had time in my clinic: why do you need an antidepressant? Tell me the story. Fill me in. What are you feeling and why?

And more than half the time after the story, after validation, I ask, “Do you need an antidepressant?”

The person thinks. “No. I don’t think so. Let me think about it. I feel better.”

“Ok. Do you want to schedule a follow up?”

Half do. Half say: “No, let me wait and see. I will if I need it.”

Mostly they don’t need it. They have emptied out the awful feelings in the exam room and they aren’t so awful after all. I say that it sounds like a pretty normal response and I would feel that way too. Because I would. Once the feelings, the monstrous feelings, are in the light of day, they relax and evaporate, dissipate like mist, fly home to the Beloved. Goodbye, dark feelings. You are appropriate and you are loved.

Blessings, Dr. Beck, and thank you.

by

Our town Covid-19 quarantine list

This is fiction. Though many of the people may exist in some form or other.

Subheading of police report:

Current covid-19 quarantine list

1. Katherine is quarantined for 10 days for chasing a deer out of her front yard with a broom without wearing a mask. Many thanks to the two neighbors who called in. Also, quit talking to deer and singing to the chickadees. You are just confusing everything.

2. Bob 1 is quarantined for 10 days for biking down his drive way without a mask on. Yes, we know you wore the mask for the other 48.25 miles. We don’t care.

3. Bill is quarantined for taking off his mask while hunting elk. No, being thirsty after butchering is not an acceptable excuse. You just be glad that you had that elk tag.

4. Two more Bobs are quarantined, one for playing the piano and the other for playing the fiddle, both with the windows open while not wearing a mask. It’s too cold for that right now and germs. Geeze.

5. Russ is quarantined because he can still talk fast, even through the mask. We aren’t allowed to say what else he’s done.

6. Joey is quarantined for miming fascism in public. We can tell who you are through the mask. Stick to magic, dude. Miming facisim is just creepy, ok? You are giving us nightmares.

7. Lou and Amelia are quarantined for abandoning the post office and for being too nice to bicyclers. What are you two, liberals?

8. Leah is quarantined for wearing that peek a boo mask and it didn’t match the rest of the outfit. Ok, you had matching gloves, shoes, hat, coat, dress and lipstick, but the mask was not right and we’re outlawing the peek a boo thing. People just get too hot.

9. Patrick is quarantined for nursing in public right out in the open. Really, now. Currently those fall under the mask rules too. You can use a big scarf or go indoors. It’s not socially acceptable yet for guys.

10. Geoff is quarantined for exposure to the 80 year old neurologist who is still working doing Independent Medical Exams. You guys took off your masks between patients in the back room. Fools.

11. Sue is quarantined for being around Geoff. Double fool.

12. Barbara and Carl and family are quarantined because they left everyone sad and hungry on Christmas Day 2020. Carl did not make the 500 gallons of hollandaise. We will happily set up a social distancing grid with 10 foot colored places for people to sit, with the neighborhood cordoned off for two blocks in all directions from your house. That is, we’d get eggs benedict first and any time one of us came on or off shift. The High School Robotics team has agreed to repurpose their robot to deliver to each person who is masked and sitting in a grid spot. We envision a pattern using both sides of each street so that the robot doesn’t go on the grass and fall over. We might even fund a second robot. Please? Could we have Christmas this year?

by

apparition

We are fishing and playing a little and then we hear something. I stick my head up. Dad does too, and my sisters. What is it? It is making noises! There, on the beach. Something roaring in two tones!

There are two. The smaller one is doing most of the roaring. It is weird. Two tones, a low growly one and a higher one that sings.

It is creepy, that smaller one. I think it sees us. It has a mechanical eye. Dad says, “Dive.” We talk under water. Maybe it is trying to steal our souls or lure us to death on the beach.

We do have to come up for air though. Now they both roar. Dad barks: “STOP” and what do the horrors do? They try to imitate him! Are they making fun of him?

Now the smaller one is just making high song noises. Sort of like a creepy bird. It keeps going back to the double growl, though.

Dad says, “Come on.” We dive and head the other way along the beach. The appartitions are picking up things from the beach. I am very glad they didn’t get us. This time.

For the Ragtag Daily Prompt: apparition.

by

werewolf

Time out word warning, in this poem. This poem is about discrimination. Substitute practically anything for werewolf…. disabled, bipolar, depressed, autistic, substance abuser. I am sick of discrimination. For human, substitute “normal”.

You know I’ve been a werewolf my whole life

Started in the womb
triggered by antibodies
to tuberculosis

And I am tired

of people telling me

I’m a werewolf.

Ok? I fucking know that.
I have known it since Kindergarten
where I arrived full of joy
ready to sing

and was shunned

we didn’t have a television

but I knew that wasn’t really it
I was different
I am different

and fuck you humans
different is ok.

I am a werewolf
and I am fucking proud
of all I have accomplished
in the teeth of humans hating me
and trying to shut me down
and shunning me
and reporting me
and doing everything short of shooting me
with real guns

I’ve been told to sit down
shut up
stop arguing
be nice
be good
go away
die
don’t read my writeups
don’t C! my work
don’t talk to me
stop making waves
been fired
been reported
been shunned
been alone

and fuck you humans

get ready
because I am middle aged now
for a werewolf
and I am ready

to be one all the timee

damn the torpedoes
full speed ahead
fuck you humans
for how you’ve treated me

I’ve turned the other cheek
for sixty years

and now
I
will
fight

by

If

This is one of the ten poems that my mother made etchings for, the year I was just done with college. 1983-4. I wanted to write, but had no idea what to do with the poems that I was writing. My mother Helen Burling Ottaway had done a series of etchings with a family friend’s poems, so I asked if she would do the same with me. She said, “Yes, on one condition.” “What is that?” “They have to rhyme.” She did not like the free verse. Almost all of the poems were about animals, except for one about my sister. Another friend printed the poems on a lead type press and then my mother worked on editions numbered 1-50 of each, inking the plate separately for each one. This one is number 5/50. You can see the imprint of the plate on the paper in the photograph.

If I could be anything
I’ll tell you what I’d like to be
One of those small green frogs
That sails from tree to tree

These frogs can jump, they have no laps
They are not birds with wings
the have parachutes between their toes
And I am sure that they can sing

They spread their toes and jump so high
To float like snowflakes in the air
Frogs fall like rain from clear blue skies
It must be nice up there

Why they jump I do not know
Maybe escaping hungry eyes
Perhaps to catch a tender bug
Or they just like to fly

If I could be anything
I’ll tell you what I’d like to be
One of those small green frogs
That sails from tree to tree.

by

we would have seen

Yesterday Rialto Beach was blocked off.

The forest service blocked it off because of the bomb cyclone. The winds are driving the waves way up the beach. The dead trees get thown around like tinker toys.

We would have seen how high the water had come if Rialto Beach was not blocked off.

We would have seen the corpse of a seal, washed up on the beach, if Rialto Beach was not blocked off.

We would have seen a soaking wet life jacket, just there on the beach, my size, if Rialto Beach was not blocked off.

We would have had to walk in over a mile and back, if Rialto Beach was not blocked off.

We would have wondered if the life jacket fell off a boat and we would have been glad not to find a body, if Rialto Beach was not blocked off.

We would have met a couple who said that they only got to the viewpoint and were chased back by a Forest Service worker on a bicycle, if Rialto Beach was not blocked off.

We would have seen the confluence of the four rivers, rushing high, a seal fishing in the river and cormorants, if Rialto Beach was not blocked off.

But Realto Beach was blocked off to keep us safe. We are home and safe.

For the Ragtag Daily Prompt, corpse.

The picture is not of Rialto Beach.

by

Bears all his sons away

Disclaimer: I am not Native American. I am not male. I did not live here when the ships arrived. I wrote this thinking about a dream a friend told me, about a bear. So it’s the fault of a dream bear, this story.

One
I am wailing. I am crying. The Bear came today, our bear, the tribe’s bear, our Spirit.

But he didn’t just walk through camp and take fish and his tribute.

He took my son.

He walked right up to where my wife stood still, as we must when he comes, and he lifted the boy in his paws. The boy was quiet and still, he did well, he was brave, but when the bear turned to leave, he called once.

Then our bear dropped to three legs, my son in the fourth, and turned and left.

My son, my son, my heart, my joy. Spirit Bear, return him to me!

Two
We fought, argued, for a very short time. The Shaman said that if Spirit Bear wants my son, he shall have him.

He does have him, I said, but I want him back. The Shaman knew that was true. Some shook their heads and say that my son is already dead, but most agreed with me. We were on the trail nearly immediately. The bear should not be able to move as quickly as usual when he is carrying my son. I dread evidence of my son’s loss, that he will be eaten. But that has never happened, in the history, in the songs. The Shaman said as much. But neither has a bear taken a chief’s son.

Three
Spirit Bear is moving amazingly fast on three legs. He is headed for the mountains. Not a surprise. My son may get cold. But bears are warm. My son has not been eaten.

Four
We have to make camp. I am so angry that we have not caught Spirit Bear. Out of our home camp he is fair game.

We do the Bear Dance, four times. We did not bring the masks and the young men dance the women’s part and one sings the woman’s part. We made quick rough masks and costumes. The Spirits will forgive us. This is past all understanding.

What does a Spirit Bear want with my son? Four years. No one knows.

Five
Day again. I am up before dawn praying for light, for my son, to find the Spirit Bear.

Six
We are hot on the trail. We find that Spirit Bear did sleep and rest. My son is dropping beads. Smart boy. Each bead means that he is still alive and relatively unhurt.

Seven
We have spotted them. Spirit Bear stood and looked down at us, my son tucked against his side. My son very slowly raised his arm, so he knows.

Eight
We are approaching the peak. Everyone is tired from the climb and hungry and thirsty. Yet we keep going. No one complains.

Nine
We reach the peak and Spirit Bear and my son. We arm our spears and arrows, but my son shouts “No! Look!” We turn. We see the water. There is something in the water. It has tannish wings that are filled with wind. It is huge compared with our boats.

We turn to my son. He stands and Spirit Bear leaves, ambling down the mountain, quickly, gone. I hurry to my son, sweep him up. He starts shaking and then cries, leaning his head into me.

We turn and watch the tan winged thing, which is coming against the wind. It comes at an angle and then turns, to the opposite angle, yet still it comes. We know this is new and that there can be terror or joy, we do not know which. There will be learning, we know that.

My son falls asleep. We carry him down to water and camp. We are all singing quietly, the song of new things, fear and joy. The Shaman will welcome us when we are home, and we will prepare for the winged thing. We do not know what it will bring.

We thank the Spirit Bear for warning us, for telling us to prepare.