atmospheric river

The current flooding rivers in the Pacific Northwest (1) now are ascribed to an atmospheric river. Atmospheric rivers are long narrow weather regions that carry enormous amounts of moisture from the tropics in the sky. This sky river carries water vapor and moves with the weather, “carrying an amount of water vapor roughly equivalent to the average flow of water at the mouth of the Mississippi River.”(2) When they make landfall, they can release the water in the form of rain or snow.

They can stall over watersheds and release huge amounts of wind and rain and cause severe flooding. The atmospheric river from Hawaii to the Pacific Northwest is called the “Pineapple Express”. “On average, about 30-50% of annual precipitation on the West Coast occurs in just a few AR events and contributes to the water supply and flooding.”(2) An atmospheric river is approximately 250-375 miles wide.

“Not all atmospheric rivers cause damage; most are weak systems that often provide beneficial rain or snow that is crucial to the water supply.”(2) If it were colder we would have an amazing snow pack right now.

The bomb cyclone that came through a few weeks ago caused much less damage. An atmospheric river does not sound as dramatic, but the drone pictures of houses and cars deep in water (1) tell a different story. There is road and bridge damage and already talk of Thanksgiving travel disrupted.

(1) https://www.accuweather.com/en/winter-weather/pineapple-express-pummels-northwest-british-columbia/1047699

(2) https://www.noaa.gov/stories/what-are-atmospheric-rivers

(3) Meanwhile the Olympic Peninsula still has a section cut off: https://www.peninsuladailynews.com/news/flooded-roadways-cut-off-west-end/

The photographs are of the Sol Duc River, taken by a friend. The river rising and huge amounts of debris being carried down the river. The huge log in the earlier pictures that was on the other side of the river, is gone.

Sol Duc River Tuesday Oct 26, 2021
Sol Duc River Sunday November 7, 2021
Sol Duc River Sunday November 14, 2021

Next is the heading photograph, from Monday, November 15, 2021.

Sol Duc River Monday November 15, 2021. Carrying whole trees downriver.
Rialto Beach with all of the wood washed down the rivers, November 16, 2021.

whiskers

For today’s Ragtag Daily Prompt.

The kittens were both two pounds and a bit when I got them. Last Thursday they got their last set of vaccines for a year and they are now both six pounds. They are growing like weeds. My last cat was a small cat. If the stated age was right when I got them, these two are going to be BIG.

Why care for addicts?

I posted this in November, 2015. I am reposting it.

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Why care for addicts?

Children. If we do addiction medicine and help and treat addicts, we are helping children and their parents and our elderly patients’ children. We are helping families, and that is why I chose Family Practice as my specialty.

Stop thinking of addiction as the evil person who chooses to buy drugs instead of paying their bills. Instead, think of it as a disease where the drug takes over. Essentially, we have trouble with addicts because they lie about using drugs. But I think of it as the drug takes over: when the addict is out of control, the drug has control. The drug is not just lying to the doctor, the spouse, the parents, the family, the police: the drug is lying to the patient too.

The drug says: just a little. You feel so sick. You will feel so much better. Just a tiny bit and you can stop then. No one will know. You are smart. You can do it. You have control. You can just use a tiny bit, just today and then you can stop. They say they are helping you, but they aren’t. Look how horrible you feel! And you need to get the shopping done and you can’t because you are so sick…. just a little. I won’t hurt you. I am your best friend.

I think of drug and alcohol addiction as a loss of boundaries and a loss of control. I treat opiate overuse patients and I explain: you are here to be treated because you have lost your boundaries with this drug. Therefore it is my job to help you rebuild those boundaries. We both know that if the drug takes control, it will lie. So I have to do urine drug tests and hold you to your appointments and refuse to alter MY boundaries to help keep you safe. If the drug is taking over, I will have you come for more frequent visits. You have to keep your part of the contract: going to AA, to NA, to your treatment group, giving urine specimens. These things rebuild your internal boundaries. Meanwhile you and I and drug treatment are the external boundaries. If that fails, I will offer to help you go to inpatient treatment. Some people refuse and go back to the drug. I feel sad but I hope that they will have another chance. Some people die from the drug and are lost.

Addiction is a family illness. The loved one is controlled by the drug and lies. The family WANTS to believe their loved one and often the family “enables” by helping the loved one cover up the illness. Telling the boss that the loved one is sick, procuring them alcohol or giving them their pills, telling the children and the grandparents that everything is ok. Everything is NOT ok and the children are frightened. One parent behaves horribly when they are high or drunk and the other parent is anxious, distracted, stressed and denies the problem. Or BOTH are using and imagine if you are a child in that. Terror and confusion.

Children from addiction homes are more likely to be addicts themselves or marry addicts. They have grown up in confusing lonely dysfunction and exactly how are they supposed to learn to act “normally” or to heal themselves? The parents may have covered well enough that the community tells them how wonderful their father was or how charming their mother was at the funeral. What does the adult child say to that, if they have memories of terror and horror? The children learn to numb the feelings in order to survive the household and they learn to keep their mouths shut: it’s safer. It is very hard to unlearn as an adult.

I have people with opiate overuse syndrome who come to see me with their children. I have drawings by children that have a doctor and a nurse and the words “heroes” underneath and “thank you”. I  have had a young pregnant patient thank me for doing a urine drug screen as routine early in pregnancy. “My friend used meth the whole pregnancy and they never checked,” she said, “Now her baby is messed up.”

Addiction medicine is complicated because we think people should tell the truth. But it is a disease precisely because it’s the loss of control and loss of boundaries that cause the lying. We should be angry at the drug, not the person: love the person and help them change their behavior. We need to stop stigmatizing and demeaning addiction and help people. For them, for their families, for their children and for ourselves.

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?

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

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.

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.

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.

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?

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.