Category Archives: rural doctor

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Frame

What is the tree and where is it?

I am still thinking about the Inflammatory Brain Disorder Conference.

The researchers and physicians are talking about the immune system as if it is broken in Long Covid and ME/CFS and the other illnesses, but I am not sure I agree. Maybe the immune system knows what it is doing. Maybe Covid-19 is a really really nasty infection and the immune system sends out antibodies to make us stay down, stay in bed, rest and keep from catching something else. Maybe an antibody that suddenly makes you weird will make you isolate and hide and not interact with the other potentially infectious humans.

Ok, the inflammatory brain disorders that destroy the brain, those are not adaptive. However, I’ve thought that MC/CFS was a “repair mode” since residency.

When I had my third pneumonia in 2014, I refused to admit to myself that I had chronic fatigue. It was sort of obvious. I went back to work six months after I got sick and seeing just four or five patients left me exhausted. I would come home and sleep on the couch. I also skipped breakfast, because I would go to sleep as soon as I ate. My blood sugar was fine and it was not a food allergy. It felt as if my body wanted to do repair work and wanted me to sleep while it was doing the repairs. I would sleep after lunch. For the next six months of work, I slept twelve hours a day and hoped that I would not have more than five patients. Also that I would not get sick.

We had everyone who had upper respiratory symptoms or a cough wear a mask and I wore one too, hoping to not get another pneumonia. That worked. I only got sick when I went to work in another hospital clinic system. I kept walking into rooms with patients with their masks off. I got Covid-19 in a mere five weeks there, after going a year at my clinic without getting it.

I spoke to a friend yesterday. She was talking about her damaged immune system. I said I didn’t think of it as damaged. With enough stress and infection, I think the immune system gets primed. And then it is as if it has PTSD: the immune system says, “Enough already! We are not going to LET you overdo and get sick again! We are putting you DOWN to sleep if you overdo!” It is an extreme version of “listen to your body”, as if the body is shouting. The immune system is hyperalert and goes all out if there is any threat or suspected threat.

Maybe we need to be more gentle with ourselves and each other. The US culture is so oriented to production and work and money as success. But is that really success, if we work 20 hours a day and drive our immune system to desperate measures?

Maybe we need to learn to relax. To take time off. To breathe.

And the talk about Mast Cell Activation Disorder said exactly that. We need to teach how to go from the sympathetic fight or flight crazy to the quiet, relaxed, parasympathetic state. That quiets the immune system down very nicely.

It won’t fix everything, I am not saying that. But it is something everyone can learn. Slow breathe, in five and out five. Practice.

Breathe.

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The tree is a Redwood and it’s in the Chimacum Woods Rhododendron Nursery. Not just rhodys and on the Olympic Peninsula.

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BRAINS

On Thursday and Friday I spent six hours daily glued to zoom, for the Inflammatory Brain Disorders Conference. Speakers, both physicians and scientists and physician-scientists, from all over the world, spoke. The research is intensive and ongoing. They spoke about Long Covid, both the immune response and “brain fog”. They spoke about anti-NMDA antibody disorder (the book Brain on Fire) and now there have been over 500 people identified with that disorder and a whole bunch more antibody-to-brain disorders! They talked about PANS and PANDAS and chronic fatigue and Mast Cell Activation Disorder and about the immune system over and over. The new information is amazing and I need to reread all my notes. Psychiatry and Neurology and Immunology are all overlapping in research, along with Rheumatology, since these disorders overlap all four.

It is a medical revolution in the making.

Best news was that 96% of Long Covid patients are better by 2 years from getting sick. That is tremendously reassuring, though the number may change. And the definition of Long Covid is still being sorted out and we do not know if people relapse.

I felt that MY brain was MELTED by the end, but I managed to enjoy the Rhododendron Parade on Saturday and just puttered around the house on Sunday.

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Fine fettle

Our giant salmon is in fine fettle
Stuffed with rhodys and not with nettles!

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Taken at the Rhododendron Parade in Port Townsend, Washington, on Saturday, May 20, 2023.

For the Ragtag Daily Prompt: nettle. Gosh, telepathy or prescience or something. I took the picture two days before the prompt and those are the only photographs I took of the fabulous parade!

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Naps

Naps are for the very young, then we forget
or scorn naps for years. We think of those who nap
as old when we are 8 or 10 or 20, still wet
behind the ears. Once we climb down from the laps
of those who try to teach us about the whirled
and we’ve mastered running free, we fight the time for bed.
My son would cry right before the pearled
evening would close his eyes, fighting sleep with dread.
He might miss a fun filled happening. We run
fast and learn until we reach an age or illness where we tire
and fall asleep in day on a couch in spite of sun.
Wake climbing out of sleep like from the ocean or swampy mire. Our children now make fun of us, they fill the gaps,
as we have reached the age where we once again need naps.

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I took the photograph from a train in 2017, going from Edmonds, Washington, to Chicago.

For the Ragtag Daily Prompt: nap.

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Untie

Untie my heart and go find
I am not looking anymore
I am playing for the summer
Back to work in the fall
but my heart is untied
and has escaped control.
It might be wild or quiet
or silly or angry. It might
like this today and that tomorrow.
It might wail with sorrow
and then laugh and laugh.

Heart untied and

Gone.

The white furry object is not a tie. It is a Barbie stole made of rabbit fur and lined with pink fabric. Both cats are enjoying carrying it around the house and shaking it and pretending that it is a live rabbit. That stole has to be nearly 50 years old, so I am letting the cats choose it as a toy. Good that I have great ancient cat toys.

For the Ragtag Daily Prompt: ties.

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Float

The flowers float like gold petillant bubbles in the woods, their crackling too soft for my human ears.

I think this is a berry, but I’m not sure. It is on an old farm in Quilcene, gone wild. There is a cherry tree and four rhododendrons, an old chicken coop and an apple tree. Salmonberries and this. What is it?

For the Ragtag Daily Prompt: petillant.

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Snow globe full of lies

I took the bandage off today. I would really like to heal.
The scab between my breasts is bright hot angry red.
I gently scrub with soap and the scab slowly peels
showing the crater in my chest. I am the walking dead.
The small child wants so badly to believe your word is true.
You say you’ll be her friend forever no matter what.
My devil laughs, a cynic. My angel turns away from you.
When you walk away you drag behind each inch of my child’s gut.
I see the wound is pulsing and now I give a start.
You break your word, you lie, to my much abused small child.
The pulsing mass I see is my aching bleeding heart.
Every injury triples on the child you hold inside.
I don’t stop loving even though I am gravely hurt.
You’ve never loved at all: you grind hearts into the dirt.

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For the Ragtag Daily Prompt: snow globe.

A world built of lies, like a snow globe. Detached from reality. Contained, with music, and you can shake it up. It looks so pretty, but it isn’t real.

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Medical conditions

I am reading the list of medical conditions that put people at high risk from Covid-19.

I can nearly say that being a live human “bean”, as Walk Kelly would say, puts one at high risk from Covid-19.

My intuition studies medical conditions
alcohol, overweight, diabetes, drugs
it doesn’t say much about auto emissions
or the healthy power of genuine hugs
hypertension, asthma, bad livers or hearts
Covid could get you if you don’t watch out
I wonder if risks include noxious farts
I’m in denial and not a bit stout
dementia, disability, HIV or depression
check off the ones you don’t have, think positive!
I eat an ice cream bar while secretly confessing
that eating and drinking might be causative
Happy or sad or pie in the sky
There is a daily risk that I could die

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https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

Really, that list contains nearly everyone.