Category Archives: rural doctor

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Mount Townsend

I took the photographs hiking Mount Townsend last July 2017.

When I got the tsunami warning, I wondered if there was anything I should pack.

The only thing I could think of is Boa Cat.

And then I thought about my emergency supplies, people at our nursing home (close to sea level) and my water filters. I drank tea and felt like I should be tearing up sheets for bandages, or doing something useful.

I decided that the most useful thing was to be quiet and wait.

Boa Cat relaxed when the warning was cancelled.

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the mystic E2 dragon

We are writing a quest where we ask different people to write more about a topic. The requests are anonymous and some are for existing titles that have no write ups. This topic was given to another person and then I was asked to write about it as well. My sister was an editor on the everything2 website. She was born in the year of the dragon. She died of cancer in 2012.

_____________________

the mystic E2 dragon

 

“Hey.”

“Hey.”

“They want me to write about the mystic E2 dragon.”

Laughs.

“So I think of you.”

Silence… a weight. “So it’s me?”

“No, but you are a dragon, born in the Year of the Dragon.”

“Like we’re Chinese.”

“Yeah, well.”

“And you are an ox.”

“Thanks.” I wait. “Come on, show up.”

The dragon is made of a coat hanger, a rough gold cloth and black felt hand sewn to the body, thin gold cloth on the wings, gold earrings with rubies for eyes. Probably fake rubies, I’m not sure. I made it in college, tail to curl around the neck so that it can sit upright on my shoulder when I walk around. A gold fire lizard. I gave it to my sister, who said I could take it back when she lay dying.

The dragon morphs and now fills the living room, pushing on the walls and squashing me. The scales are hard and hot!

“Stop it!” I say, “Don’t destroy the house!”

The dragon is now couch size. My couch groans under it. The dragon is very alive and smoke rises from her nostrils. It manages to look like my sister, like a dragon and like the borg all at once. Metal and wires on the left side of the dragon’s face, eye socket with a metal camera that whirrs.

“Mind the couch.” I say.

She shifts a little, not shrinking. I peel myself off the fireplace, with the ache of the metal insert and the mantel on my back.

“So.” I say, “what should I tell them?”

She narrows her eyes at me and shrugs.

“What do they want to hear?”

“You tell me.”

“Keep the site alive.”

“Yeah, ok.” I wait.

She looks around. “Your dust bunnies are dying of old age.”

“That’s ok.” I say. “They are better than a guard dog.”

She snorts smoke.

“Tea?” I say. I have it made already, on a tray. The tray was painted by one cousin, the tea cloth woven by another, the teapot made by our mother, with my poem on it.

She takes the cup and saucer delicately. Five claws on each forefoot.

“What’s it like?” I say.

Shrug again, as she sips the tea.

I wait.

“I’m not telling you. And this is your active imagination, so what a stupid question.”

“But I am talking to the unconscious.”

“Yeah, whatever. And anyhow, you’ve already decided, puny human.”

“Ox.”

“Ok.”

And here a curtains drops, while I thank her and we say goodbye.

 

Submitted to the Daily Prompt: candid.

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Women’s March 2018

My guesstimate is around 2000 people in Port Townsend yesterday, huge range of age, race and gender. Stand up, speak up, march and vote!

And my guess is LOW! The PDN estimates 4000: http://www.peninsuladailynews.com/news/thousands-turn-out-for-peninsula-womens-march-in-port-townsend/.

And more women to run for office. Bravo!

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Make America sick again: diabetes

The trend in diabetes treatment is clear: keep Americans sick.

The guidelines say that as soon as we diagnose type II diabetes, we should start a medicine. Usually metformin.

A recent study says that teaching patients to use a glucometer and to check home blood sugars is useless. The key word here is teach, because when I get a diabetic transferring into my clinic, the vast majority have not been taught much of anything.

What is the goal for your blood sugar? They don’t know.

What is normal fasting? What is normal after you eat? What is the difference between checking in the morning and when should you check it after a meal? What is a carbohydrate? What is basic carbohydrate counting?

I think that the real problem is that the US medical system assumes that patients are stupid and doesn’t even attempt to teach them. And patients just give up.

New patient recently, diabetes diagnosed four years ago, on metformin for two years, and has no idea what the normal ranges of fasting and postprandial (after eating) are. Has never had a glucometer.

When I have a new type II diabetic, I call them. I schedule a visit.

At the visit I draw a diagram. Normal fasting glucose is 70-100. Borderline 110 to 125. Two measurements fasting over 125 means diabetes.

After eating: normal is 70-140. Borderline 140-200. Over 200 means diabetes.

Some researchers are calling Alzheimer’s “Type IV diabetes”. The evidence is saying that a glucose over 155 causes damage: to eyes, brain, kidneys, small vessels and peripheral nerves.

Ok, so: what is the goal? To have blood sugars mostly under 155. That isn’t rocket science. People understand that.

Next I talk about carbohydrates. Carbohydrates are any food that isn’t fat or protein. Carbohydrates range from simple sugars: glucose and fructose, to long chain complicated sugars. Whole fruits and vegetables have longer chain carbohydrates, are absorbed slowly, the body breaks them down slowly and the blood sugar rises more slowly. Eat green, yellow, orange vegetables. A big apple is 30 grams of carbohydrate, a small one is 15, more or less. A tablespoon of sugar is 15 grams too. A coke has 30 grams and a Starbuck’s 12 ounce mocha has 62. DO NOT DRINK SWEETENED DRINKS THEY ARE EVIL AND TOOLS OF THE DEVIL. The evidence is saying that the fake sugars cause diabetes too.

Meals: half the small plate should be green, yellow or orange vegetables. A deck of card size “white” food: grains, potatoes, pasta, whole wheat bread, a roll, whatever. A deck of card size protein. Beans and rice, yes, but not too much rice.

For most diabetics, they get 3 meals and 3 snacks a day. A meal can have up to 30 grams of carbohydrate and the snacks, 15 grams.

Next I tell them to get a glucometer. Check with their pharmacy first. The expensive part is the testing strips, so find the cheapest brand. We have a pharmacy that will give the person a glucometer and the strips for it are around 4 for a dollar. Many machines have strips that cost over a dollar each.

I set the patient up with the diabetic educator. The insurance will usually cover classes with the educator and the nutritionist but only in the first year after diagnosis. So don’t put it off.

For type II diabetes, the insurance will usually only cover once a day glucose testing. So alternate. Test 3 days fasting. Test 1-2 hours after a meal on the other days. Test after a meal that you think is “good”. Also after a meal that you think is “bad”. I have had long term diabetics come in and say gleefully “I found a dessert that I can eat!” The numbers are not always what people expect. And there are sneaky sources of carbohydrate. Coffeemate and the coffee flavorings, oooo, those are REALLY BAD.

For most of my patients, the motivated ones, they have played with the glucometer for at least a week by the time they see the diabetic educator. I have had a person whose glucose was at 350 in the glucose testing. The diabetic educator called and scolded me for not starting metformin yet. The diabetic educator called me again a week later. “The patient brought their blood sugars down!” she said. “She’s under 200 after eating now! Maybe she doesn’t need the metformin, not yet!” Ah, that is my thought. If we don’t give people information and a tool to track themselves, then why would they bother? They eat the dessert and figure that the medicine will fix it or they can always get more medicine.

Type I diabetes has to have insulin. If a type II diabetic is out of control, high sugars, for long enough, they too will need insulin. The cells in the pancreas that make insulin are killed by prolonged high blood sugars.

I went to a lunch conference, paid for by a pharmaceutical company, at the AAFP conference in September. The drug company said start people on metformin at diagnosis and if they are not in control in 3 months, start a second medicine, the drug company’s new and improved and better and beastly expensive medicine!!!

Yeah, I don’t think so. All of my patients are smart and they all can figure it out. Some get discouraged and some are already on insulin, but they are still all smart.

Fight back against the moronization of US citizens. Keep America healthy, wealthy and wise.