Category Archives: rural doctor

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Meditation

Fish fly in the ocean, water is their sky
their lives in three dimensions, they jump into the air
escaping larger fish, schools of large and small fry
but up above their ceiling fly birds who eat them there
I dwell on the flat, can jump on land or fly in planes
go right or left or back or front, but less up and down
did seals come onto land but regret the ocean main
return to ocean free again to swim around
my daughter’s team synchronized at the surface of the pool
legs held straight out then spiral down into the water’s embrace
breath held, they disappear, they seem to break the rules
of oxygen. I hold mine too until they surface for a space
fish fly in the ocean, water is their sky
sometimes we dream of heavens where we remember how to fly

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My daughter was a synchronized swimmer from age 7 to high school, then swim team. Her comfort in the element of water is way beyond most people.

My daughter entering her other element.

The close picture was taken with my zoom lens, but she was not close at all.

I was “life guarding” though she was out far enough that there was not much I could do.

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For the Ragtag Daily Prompt: sturdy. I am not sure why. I was thinking that the ocean is sturdy and that fish can swim in more dimensions than we humans on land. And swimmers are sturdy too.

I took the first photograph in 2017 at the Baltimore Aquarium.

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Working theory

I attended two Zoom one hour programs on Long Covid this week.

Thursday from the University of Arizona, 330 people logged on, hard science with thirty minutes of information about Mast Cell Activation Syndrome. They said 17% of the population, which is huge, if it’s correct. This is not mastocytosis, the cancer. This is the immune system going rather batshit. Though I would frame it differently, as the immune system fighting a really difficult battle.

Friday from the University of Washington. I don’t know how many were logged on. This was at a much more aimed right at the physicians level. People sent in questions and they collated and gave answers. They promised to answer some of the questions later on. My question was whether a high Adverse Childhood Experience Score predisposed to Mast Cell Activation and they did not address that.

So mast cells apparently can produce over 1000 different signals: cytokines, histamines, proteases and I don’t know what all. They are all over our bodies (are you creeped out? I am a little.) near the boundaries: skin, nose, gastrointestinal tract, genitals. They produce different signals depending on what is happening. The Thursday researcher basically said that they could affect nearly any system in the body.

I’ve heard of mastocytosis and even had a patient with it, but Mast Cell Activation Syndrome was barely on my radar. I am not sure if 17% of the population is at risk or has it. It is tricky to diagnose, because the best lab test is a rather tricky and rare one, and it is sort of an orphan illness: few doctors know about it and it does not fit neatly into any specialties. Patients have seen an average of ten specialists before they get diagnosed. Hmmm. Sounds familiar.

This researcher has a ton of papers out, that I have not started reading yet. MCAS is implicated in Ehlers-Danlos, a connective tissue disease and in ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) as well as POTS (postural orthostatic tachycardia syndrome) and can get triggered by Covid-19. Well.

The good thing is that treatment is quieting the sympathetic nervous system to let the parasympathetic take over. The sympathetic is the fight or flight hyper one. Parasympathetic is the rest, relax, mellow out, slow heart rate, blood pressure down, digestion and quiet one. I think United States culture is crazy fight or flight most of the time (We’re number one!– so what?) and the pandemic has put the whole world into fight or flight mode. Crazy.

Back in Family Medicine residency, 1993-96, I had a number of ME/CFS, chronic fatigue patients. They tended to be hyper sensitive to medicines and have all sorts of symptoms which were fluid and changable and difficult to pin down. What I noticed though is that many of them had been super high acheivers or working multiple jobs or crazy high stress, until they hit some sort of wall. Often an infection but not always. The ones I saw wanted to go back to working 18 hours a day. I said, “Um, that’s how you got this, I do not think that is a good goal.” This often pissed people off. Even back then, I thought that chronic fatigue was a body reset, where the body rebels, some sort of switch is thrown, and people rest whether they want to or not. Some do recover but it can take ages. The Thursday speaker seems to think it’s the mast cells doing this.

The UW speakers were careful. They said we do not know how long Long Covid lasts. One said they do not like to diagnose POTS, because POTS is usually permanent and the Long Covid tachycardia usually resolves. They are seeing people who got sick 2-3 years ago and are still sick, but they also have people who have recovered in 9-12 months. They do not know if patients are entirely recovered or whether there will be other problems later. They also aren’t sure that the chronic fatigue like symptoms are the same as the rest of the ME/CFS. Remember when dementia was Alzheimer’s? Now there are all sorts of different dementia diagnoses, Lewy body, frontotemporal, Huntington’s, stroke dementia, alcoholic dementia, Parkinson’s, Alzheimer’s, and others. When I was in residency, we had hepatitis A, hepatitis B and non A non B. Now we are up to G or beyond. Medicine changes and it’s moving as fast as possible for both acute Covid-19 and Long Covid.

The mast cell reasearcher talked about getting the sympathetic and parasympathetic nervous systems back in balance. I think maybe we ALL need that. Every person in the whole world. One way to quiet the sympathetic nervous system is to slow your breathing. Try it. For five minutes, or three minutes. Slow breath in for a count of four or five and slow breath out for a count of five. Let your brain roam around and fuss, but let go of each thought as it passes by and return to counting and breathing.

Slow in, slow out.

Practice and heal.

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The musicians are Johnathan Doyle and a friend. They were fabulous, last Tuesday at the Bishop Hotel.

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Lions

The sea lions that I wrote about look static in my still pictures from Marrowstone, here. I am zoomed all the way in with my Canon PowerShot SX40HS, and in bright sunlight hand held, I can’t really see much through the camera. I try to get it in focus and hold it still.

But yesterday I found a rock and tried to take a film, a movie! The sea lions are not static at all. The tide was going out, so the little island off the southern part of Marrowstone was rising from the waters. The sea lions are getting on the island as it appears. And perhaps not agreeing about position. It is amazing to watch how quickly the island changes.

Here is a sea lion film! I propped my camera on a rock, but got early wiggles turning the camera on and off, too. But there is a lot going on between the motion of the water, the sea lions, the sail boat and birds. Not to mention the small plane. I do not think the sea lions liked it.

I think I need to take a tripod and really set up. Next project!

For the Ragtag Daily Prompt: film.

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Words

Always, perfect, us, and forever
A part of me stands back wondering why
I want to believe but cannot almost ever
He tells these formidable obvious lies
Like my sister you build a story
You are the star and say you never lie
I blink in wonder at your false silly glory
You build a castle of lies while I wonder why
I’d like to believe we’ll always be friends
A part of me wants security, foolish hope
I give it 50/50, unsurprised when it ends
I think you should wash your mouth out with soap
The best liars adore and believe their own words
And it takes years for the real truth to be heard

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For the Ragtag Daily Prompt: words.

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Lose the chest strap

After my fourth pneumonia, I couldn’t stand the chest strap any more. Chest strap? say the guys. “What chest strap?” Dudes, bra, brassiere, whatever you want to call it.

It made my lungs hurt. My lungs already hurt. I thought, ok. I am 60 years old. I am “small” and don’t need any “support” unless I go running or something that really makes breasts jiggle. Don’t need a bra for dancing. And anyone who stares at my tits, well, gosh, thought you guys didn’t like “old” ladies. I don’t care.

Let’s think about that chest strap though. Guys, have you ever tried a bra on? What exactly is a bra for? Well, running or soccer or pole vault or football or all sorts of other heavy athletics, yeah, it can be really uncomfortable. Strap those babies down. But the day to day bra is to enhance support, stop jiggle and hide nipple action.

Uh, and meanwhile guys can take off their shirts in public. I think this is unfair. They have nipples too and breast tissue, just less.

Also, what is wrong with jiggle? The breast tissue drains in multiple directions, through lymphatics. I think some breast jiggle may be important to that drainage. Jiggle means slut to guys? Well, go suck a lemon, guys. And if you really stare at my breasts when I am talking to you, I might not sock your eye, but I sure as hell will lose all respect for you. All. And why are nipples evil in women but not in men? Because they are functional in women and men are jealous? Tit envy.

Now support. Yes, there are women who are so well endowed that they have back pain and may choose a breast reduction. This is covered by insurance if the clinician documents that pain over time. And breasts do change with time and age. But when is our culture going to accept and even celebrate aging! We do congratulate people turning 80 or 90 or 100, but otherwise older women are often ignored. I am delighted by the older actresses and musicians who are now finding parts and are still out there and dancing. Go Tina Turner, the legs go last!

I also think the chest strap is not nice for the lungs. Certainly not after four rounds of pneumonia, but bras have to be tight enough that they do have an effect on a deep breath. I’ve retired my bras. Ok, if I am in a Madonna mood and want to wear a lace see through white shirt, then I might pull out the scarlet one for the evening, but otherwise, no way. How good are bras for people with asthma, with emphysema, with post covid?

Lose that chest strap, ladies, and take a deep breath. Breathe free.

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Gone wild

There must have been a garden here long ago
No house but a chicken coop still stands
Three rhodys gone wild: lush and gorgeous show
Taller than I can reach overhead with hands
Scattered daffodils, the deer don’t like them much.
No tulips, the deer eat them down to the ground.
Petunia purple faces spread through brush.
The deer are shy not like the herds in town
Who teach the fawns to cross at crosswalks during day.
They don’t like rhodys either so the trio grows
Untrimmed, untrammeled, untamed, without a stay
I wonder if there’s envy from wild roses
Wild roses thorn each inch to hide in brush,
while the rhodys climb like trees, flowering lush.

For the Ragtag Daily Prompt: lush and for Cee’s Flower of the Day.

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Beach finds

I picked this agate up. See how it looks like a Gummi Bear, a different texture than the other rocks? The clear ones light up when the sun is polarized. It is harder to find them when it is not sunny.

This is not an agate, but some agates are this color. I try not to bring occupied houses home.

This is an agate too, not clear, but lovely color and striping.

Here is another clear one:

I am not the only creature searching the beach.

These were taken on Marrowstone Island and on the beach below Chetzemoka Park in Port Townsend.

For the Ragtag Daily Prompt: find.

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catch

Catch

What bucket can catch this light and color?
None, I think, and then I think I am wrong.
A bucket lowered and set in the water,
Turquoise and blue and black, a song.
Lift the bucket and the turquoise is gone.
Reflected light, a dance on on the riffles.
It’s like the happiness for which we long.
Caught for a moment, containment stifles
the reflection of joy in our face and hearts.
The face that lights from music or dance
or a moment touched by another’s art.
Let joy come and go, take the chance.
The light on the water will be gone at night.
Joy wants to be free and not held too tight.

I heard the band The Winetree last September in Ohio.

Sonnet 17.

For the Ragtag Daily Prompt: bucket.