Top ten causes of death: US 2020

Top ten causes of death US 2020, according to JAMA, here.

Total deaths: 3,358.814
Contrast total deaths in 2019, at 2,854,838. That number had been on a very slow rise since 2015 (2,712,630) to 2019 (2,854,838). That increase over four years is 142,208 people. Then the death rate suddenly jumps 503,976 people in one year. Ouch. I cannot say that I understand vaccine refusal.

1. Coronary artery disease: 690,882
Heart disease still wins. And it went up 4.8%. It is suspected that people were afraid to go to doctors and hospitals. I saw one man early on in the pandemic for “constipation”. He had acute appendicitis. I sent him to the ER and his appendix was removed that day. He thanked me for seeing him in person. Might have missed that one over zoom.

2. Cancer deaths: 598,932
This is cancer deaths, not all of the cancers.

3. Covid-19: 345,342
I have had various people complain that covid-19 is listed as the cause of death when the person has a lot of other problems: heart disease, cancer, heart failure. The death certificate allows for more than one cause but we are supposed to list the final straw first. I cannot list old age, for example. I have to list: renal failure (kidneys stopped working) due to anorexia (stopped eating) due to dementia. That patient was 104 and had had dementia for years. But dementia is not listed as the final cause. So if the person is 92, in a nursing home for dementia and congestive heart failure, gets covid-19 and dies, covid-19 is listed first, and then the others.

4. Unintentional injuries: 192,176
Accidents went up, not down, which is interesting since lots of people were not in their cars. However, remember that the top of the list for unintentional injuries is overdose death, more by legal than illicit drugs. If there is no note, it’s considered unintentional. Well, unless there is a really high blood level of opioids and benzos and alcohol. Then it becomes intentional. They do not always check, especially if the person is elderly. The number rose 11.1%, which seems like a lot of people.

5. Stroke: 159,050
This rose too.

6. Chronic lower respiratory diseases: 151,637
This went down a little. This is mostly COPD and emphysema. So why would it go down? Well, I think bad lung disease people were dying of covid-19, right?

7. Alzheimer’s: 133,182
This seems to belie me putting renal failure due to anorexia due to Alzheimer’s. I think they actually read the forms and would put that as Alzheimer’s rather than renal failure, because it is not chronic renal disease.

8. Diabetes: 101,106
This rose too. 15.4%, again, probably partly because people avoided going to clinic visits. Also perhaps some stress eating. Carbohydrate comfort.

9. Influenza and pneumonia: 53,495
So this went up too in spite of a lot less influenza. Other pneumonias, presumably.

10. Kidney disease: 52,260
This went up.

And what fell out of the top ten, to be replaced by covid-19?

11. Suicide: 44,834
This actually went down a little. What will it do in 2021?

So what will 2021 look like? I don’t know. It depends what the variants of covid-19 do, depends on what sort of influenza year we have, depends on whether we are open or closed, depends if we bloody well help the rest of the world get vaccinated so that there is not a huge continuing wave of variants.

Today the Johns Hopkins covid-19 map says that deaths in the US stand at 608,818 from covid-19. If we subtract the 2020 covid-19 deaths, we stand at 263,495 deaths from covid-19 so far this year. Will we have more deaths in the US from covid-19 than in 2020? It is looking like yes, unless more people get immunized fast.

Take care.

Oxygen testing

“If oxygen might help with chronic fatigue, as it has helped you,” a friend asks, “how do I get on oxygen?”

Complicated answer.

First of all, one of the things that is not clear, is what recovery looks like. I think I’ve had low grade chronic fatigue for the last 7 years compared to my “normal”. Now, will I get off oxygen? I don’t know. I am hoping for September but it may be that 7 years of low grade hypoxia means I have lung damage and no, I won’t get totally off oxygen.

They have apparently recently made the guidelines for oxygen more stringent. I sort of missed that update, even though I just recertified in Advanced Cardiac Life Support. You now have to have an oxygen saturation that goes to 87% or below. It used to be 88.

Now, you can test this at home with a pulse oximeter. In 2005 after the influenza, I held my saturations but my heart rate would go up to 135. Which means that I walked across the room very very slowly because a heart rate of 135 sustained does not feel good at all. Normal is 70-100 beats per minute. You can measure pulse with just a second hand, number of beats in a minute. For oxygen saturation, you need the pulse ox and it will measure both heart rate and oxygen saturation.

So: measure pulse and saturation at rest first. Write them down.
Then walk. I usually send patients up and down the hall three times then sit them down and watch the pulse ox. In some, the heart rate jumps up. If it’s over 100 and they are getting over pneumonia, I don’t want them back at work until it is staying under 100. Or if sitting they are at a pulse of 60 and then walking it’s 95, well, I think that person needs to convalesce for a while yet. They can test at home.

As the heart rate returns to the baseline, the oxygen level will often start to drop. Does it drop to 87? Describe the test to the doctor and make sure the respiratory technician does it that way and also they should do pulmonary function tests. Mine were not normal.

Now, what if the oxygen doesn’t drop to 87? We are not done yet. What does the person do for work or do they have a toddler? If they have a toddler do the same test carrying the toddler: they sit down, exhausted and grey and this time the oxygen level drops below 87. If they do not have a toddler, do the test with two bags of groceries. Or four bricks.

When I did the formal test, the respiratory therapist said, “Let’s have you put your things down so you don’t have to carry so much.”

“I’d rather not.” I said, “I want to be able to walk on the beach, so I need the two small oxygen tanks, my bird book, camera, binoculars and something to eat.”

“Oh, ok,” she said.

So I did the test with two full tanks of oxygen, small ones, and my bird book and etc. I dropped like a rock loaded. I think I would have dropped not loaded but perhaps not as definitively. Still hurts to carry anything, even one tank of oxygen.

We are making a mistake medically when we test people without having them carry the groceries, the toddler, the oxygen tank. My father’s concentrator is pre 2013. It weighs nearly 30 pounds. Now they make ones that weight 5 pounds. Huge massive difference.

Good luck.

I don’t think I realized what I had gotten myself into, but it seemed like the potential for fun and insanity were there in equal parts

sometimes you know things
without knowing

sometimes you no things
without noing

sometimes you know things
without noing

sometimes you no things
without knowing

sometimes you koanow things
without knowing

sometimes you no things
without koanowing

sometimes you koanow
without koanowing

sometimes you koanow

snow

also published on another site today.

still life

From the beach yesterday morning. I say still life, but there could be mites in the feather and the plants are still alive and no doubt there are lots of microscopic plants and animals in this picture. I am wondering how it is really possible to be vegan with bacteria around. Do they not count?

Do corals have venation? The feather does.

For the Ragtag Daily Prompt: venation.

He just left his body

This is about memory loss.

One of my patients eventually had to have her husband admitted to memory care. He was falling, he was angry, he outweighed her by 50 pounds and he was incontinent. When he fell, she could not get him up.

She went to our hospital Grief Group and came to see me, angry.

“They said he’s still alive!” she snarls. “I got mad and said, no, my husband is gone! He just left his body!”

“I’m so sorry.” I say. “I am sorry that they don’t understand.”

“I’m selling his stuff.” she says. “I don’t have any use for Ham Radio equipment. And HE doesn’t EITHER, now.”

She stomps out. I am sure she cried too.

That is how I think of Alzheimer’s. Neurons burning out from the present to the past. When the person can no longer talk, they are close. Then they are in the womb and stop eating.

Let them go, let them go, god bless them. Where ever they may be. You may search the wide world over but your memory person is free….

heatwave tricks

I went to high school in Alexandria, Virginia (Remember the Titans) and we had no air conditioning. I had the upstairs bedroom in front of the house. We were on the road that had the bridge over the train tracks, so we got every ambulance, fire truck and police car sirening from one part of town to the other. b

I live on a “busy” street. When the realtor warned me it was “busy”, I thought, well, not like Alexandria. No gun shots in the house a block over, at least not often. I used to hear the helicoptors landing at the hospital four blocks away, but now that I am not on call, my brain dismisses that as a “not worrisome” noise.

So here are my tricks to stay cool.

  1. Get a bandana or headband wet with cold water. Wrap it around your head. Keep wetting it as needed.
  2. If you are going outside, put a hat over the bandana or headband. If it is a straw hat, you can wet it too. Ditto wool.
  3. Stick your feet in cold water.
  4. Fountains make sounds that make you feel cooler. Find a website with a stream or water sounds. Let it play.
  5. Drink lots of water.
  6. Salt. Now, if you have high blood pressure or heart disease or congestive heart failure, be really careful. My symptom of being too low in salt is feeling nauseated and a bit off and woozy. Those are professional doctor terms, ok? I bought 5 kinds of chips yesterday, beer, seltzer (no sugar) and ice.
  7. Do NOT drink sodas to cool off. Most sodas have salt hidden under the sugar. Screw up your hypertension and the congestive heart disease. Oh, and kidney disease and some liver things. Hey, talk to your doctor. They will say “Do not drink sodas. They are the EVIL dwelling on earth.” Well, ok, your doctor might not say the second sentence. I said stuff like that.
  8. Get ice, put it in a cooler, and put in water, maybe beer if you are healthy enough, (go light on the beer. Max seven drinks weekly for women, fourteen for men, and no saving it up for the weekend. The recommendations are different in the UK and different again in Europe. Who is right? Science is a moving target. It is never DONE. Dang ol science. Just give us the stupid finished book so we can stop arguing about it all…. heh. The truth is, we’d argue about something else.) go light on juice (because sugar), cut the juice in half with seltzer or better yet just drink the seltzer. Now, seltzer has salt again, so all those people who has to watch salt intake… oh, shoot, that is everyone. I drank one beer yesterday and one seltzer and a lot of water and in the morning tea.
  9. Consider sleeping outside. It’s cooler here once it cools off! Alexandria, Virginia didn’t cool off. It would be 98% humidity and 98 degrees. So HOW did I sleep in that?
  10. Take a wet washcloth to bed. Wipe down your arms and face. Get your hair wet right before bed if you need to. Put a towel on your pillow. That, plus a fan blowing over me from the open window, and I could sleep, even in 99 degree weather with 98% humidity.
  11. Water animals, plants and don’t forget your trees. I’ve been watering the trees in the early morning and the lichen on the trunks turns BRIGHT GREEN when I do. Happy lichen. I am watering the leaves of everything in the garden in the early morning, to try to help the plants stay cool. Evaporation helps them too.
  12. Take heat stroke seriously. If someone with you stops making sense, then think about an ambulance and do not let them drive. If the core temperature gets too high, people can die, and they are too goofy to drink water. It also can be damn hard to put an iv into someone dehydrated so call early rather than late. Take care!
  13. Curtains. Shut the curtains to the east in the morning. Open them and shut the ones to the south at noon. Open them and shut the ones to the west in the afternoon.

Ok, so I put some rocks in the Beatnik bathtub fountain so that if a mouse falls in, it has somewhere to climb out. Then I went to QFC looking for a sprinkler. I would be hobbling through the sprinkler, but it’s still very cooling. They were out. However, I found fish. Squirt fish. They promptly went in the fountain.

look, ma, my feet match!

NO, I did not injure the other foot. But… I couldn’t find a shoe that matches in height and rocker bottom so I was walking funny. Which is bad for the hips and back and all the other joints….

I told my friend that arrived that I needed a boot for the right leg and she had one… in the trunk of her car… that she was going to throw away! WOW!

Feels peeeQueueliar, I do think, but at least the rocker bottoms match. The right leg is a large and I need a medium or hmm, dunno the size but smaller. If anyone has a smaller one lying around….

you know you are hypoxic when

Darn it. I went from two months of no hiking or beach walking to too fast too much… oops. Injured left tibialis anterior. Oxygen AND a boot. Dang blang curses… guess I have to behave slightly better.

Another outfit not appropriate for work: on the morning before the boot…. I am holding out my hand to be kissed. That area on my lower left shin is red… and later in the day I got in with ortho and got the boot.

flowered dress with long beads and above the elbow white gloves, hey, put that oxygen back on!

outfits inappropriate for work 3

Ok, maybe it is not inappropriate for work. But it would be a little weird for work… I was going in the woods with my oxygen tank. “Local doctor of 21 years found eaten by cougar, which then died because it couldn’t digest the oxygen tank.” Heh.

Listening to this, fabulous!!!

On covid-19

I am going to post a series of short essays I wrote on another site at the end of 2020. Because we have to work together and these are relevant. I will post one every day or two.

From Tuesday November 24, 2020:

I have just had a call asking for a Covid-19 test.

Not for symptoms.

Nope. Traveled from Washington to California with a buddy and “My sister thinks I should be tested.”

Me: “Oh, does your sister want you tested before you come to Thanksgiving?”

Patient: “Uh, I think so.”

Me: “First of all, the priority is for people who have symptoms or have been exposed. Secondly I am not ordering a test for someone who has no symptoms, chose to travel and then thinks it’s ok to go to a Thanksgiving dinner in another household if they get a negative. It’s not ok. You can test negative one day and be shedding virus the next. The quarantine after exposure is 14 days. The medical advice from the CDC, from the surgeon general and from me is STAY HOME.”

Others are asking for antibody tests. We don’t know if the antibodies mean you aren’t infectious. We don’t know how long they last. Typically with other covid viruses they don’t last long. In contrast, chicken pox virus gives lifelong immunity. We don’t know if a person can get Covid-19 again, though there have already been some cases. No, I won’t do an antibody test because the person “Just wants to know.”

STAY HOME STAY HOME STAY HOME.