Influenza: check your pulse!

This year influenza is bad. My key test in influenza is not a chest x-ray. It is taking a resting pulse and a walking pulse.

Why? Influenza can cause a walking pneumonia. Walking pneumonia is where the lungs are infected throughout and there is tissue swelling. It is different from a lobar pneumonia. In lobar pneumonia people run a higher fever, look sicker, and on the chest x-ray, that part of the lung is white: infection, not air.

In walking pneumonia, the chest x-ray may be read as normal. This is because all the lung tissue is equally swollen. The swelling means that there is less air space. The person may feel ok at rest. They feel exhausted when they walk because the heart must take up the slack for the missing air space, the swollen lungs. At rest this week one person’s heart rate is 84. After walking it is 124. Normal is 60-100, so 124 is like running a marathon: exhausting and hard on your heart and body.

I have patients saying “I was sick two weeks ago and I am still exhausted.” If their pulse is much over 100 after they walk, they cannot work until it comes down. If they work and wear themselves out, the lungs can’t heal. The treatment is rest. If they are at work with a pulse of 114 or 124, then they risk getting a secondary infection in already damaged lungs. They could die.

Check your pulse at home. Count the number of heartbeats in 60 seconds. That is your pulse. Walk around, sit down, and check again. That is the walking pulse. Over 100 is not normal.

This is a bad influenza. The tamiflu (oseltamivir) helps but works best in the first three days of flu. Check your pulse, be seen, rest and get well.

http://www.peninsuladailynews.com/news/three-die-of-flu-on-peninsula-public-helath-officals-say-a-fourth-death-said-to-have-been-in-seattle/

love poem to the monsters under my bed

I am trying to wrap my mind around an aspect of Adverse Childhood Experience Scores. Ace scores.

Raised in war or chaos or an addiction household or a crazy household, kids do their best to survive and thrive. I acknowledge that first. “You survived your terrible and terrifying childhood. You are amazing. You have crisis wiring in your brain. You had to wire that way in order to survive.”

And what does that mean? High alert, high adrenaline, high cortisol, reactive. One veteran says that the military loved him being able to go from zero to 60 instantly.

“Yes, and how is that serving you now?” I ask. “Do you want to change it?”

“No.” he says.

“Why not?” I say.

“Because I know I can protect myself.”

He can protect himself, as I can too. But being on the alert for a crisis, being good in a crisis, being able to fire up like a volcano, is that what I want and is that what he wants? If not, how do we change it?

I think of it as being able to see monsters. Other people’s monsters. My crisis childhood wiring is to pay attention to the non-verbal communication: what people do not what people say. The body language, the tone of voice, what the person is not saying in words, when someone is being polite but the body language is a shut down, a rejection, a dismissal, posturing, aggressive, they don’t like me no matter what the words are, belittling. But if I or my high ACE score patients respond to the body language and emotional feeling, we have named the monster. And the person is being “polite” and will not admit to the monstrous feelings. Those feelings are unconscious or at least the person does not want to admit if they are at all conscious.

In clinic I have learned to dance with the monstrous feelings. I don’t always succeed, but I keep leveling up. It’s a matter of delicacy, inviting the person to admit the monstrous. Some do, some don’t, some don’t the first time or second or third, but the fourth time the monsters are brought out. And they aren’t monstrous feelings after all. They are normal. All I do then is listen and say that the feeling sounds normal for what is happening. It’s like letting off a steam valve.

So how do I and my high ACE score folks learn to do this in social settings as well? When someone is talking to me with a monstrous feeling, meanly, I challenge it. Because I am not afraid of that monstrous feeling. But I have then broken a social contract and the person will like me even less then they already did. And maybe that monstrous feeling is not really about me at all. It’s about their own current life events and the feelings that they try not to feel, are ashamed of, are afraid of. It’s not polite of me to challenge that feeling in a social setting, I am not this person’s doctor or therapist and they didn’t ask me. It’s hard because I feel so sorry for the monstrous feeling and for the person feeling it. I am moving to compassion and love for that feeling rather than taking it as directed at me, taking it personally.

That is my intention. We will see how well it goes.

A natuopath told me to have the intention to release old grief. It’s not old grief though. It’s ongoing grief. Grief for all of the monstrous feelings that swirl around daily and the monsters that are not loved. Most people try to ignore them. I don’t. I love them, because someone has to and because they are so lonely and sad. They are crying. Don’t you hear them? That’s what love is, when you can love your own monstrous feelings and other people’s too.

And our own are the hardest.

ACE study: https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html

I took the photograph in the Ape Caves, the lava tube at Mount St. Helen’s.

sober garden

For the Ragtag Daily Prompt: garden.

We have beer gardens at many local events. Centrum music, the Wooden Boat Festival. People have to show identification to get into the beer garden and must keep the drink in there.

I want to start a Sober Garden as well as a Beer Garden. Let’s have a substance free area, roped off, for families and those who are choosing not to use substances, alcohol, opioids, tobacco, meth, whatever. At the events with families, the Beer Garden is roped off, but let’s rope both off. Let us have a Sober Garden and have food trucks and drinks and welcome families and welcome people who are not drinking alcohol or using other substances.

Let’s bring children out to the music and let families set a conscious example. There is no stigma if it is a Sober Garden for families and to support the whole community, including those recovering from addiction. Let us make it conscious and attractive.

When we rope off the Beer Garden and check identification to get in, aren’t we sending the message to the youth, especially teens, this is special, you are not allowed. Let us reverse that and have a bracelet for those going in to the Sober Garden. A sticker, a garden for families, a garden for people healing, a garden for making a different choice.

_____________________________________

music by Mike and Ruthy: simple and sober. https://www.youtube.com/watch?v=gsFlHuhDP0A

My garden waiting under snow for spring.
Spring buds in the ornamental plum, with a bird.

Sometimes it takes a while to warm up to an idea. But spring will come and warmth.

snow day

I am having a snow day. It snowed yesterday! Schools are closed and the roads are ice and it was 25 degrees when I walked into clinic. Clinic is cold and power and phones and computers are all out.

Now I have power back but internet is iffy. I have cancelled today’s patient. Some are 45 minutes or an hour away on good roads! We only have an inch of snow but the people north of me are reporting 6-8 inches. I have called people about tomorrow as well. Clinic will proceed if we have power and heat, but the people an hour away are cancelling. The weather forecast is that it will freeze at night all week, which is unusual here.

I am less than a mile from clinic and have ski clothes, so I should be able to get in unless we have an ice storm. We have paper files for back up so I could find phone numbers even with the power out. All except one new patient and now I’ve tracked that one down. We also have a battery lantern because the bathroom is really really dark with the power out. No windows.

I took the photograph last night. My ornamental plums were budding. I don’t know how happy they will be with a week of freezing weather!

Connections between Pain, Opioid use, Suicide and Opioid Use Disorder.

Excellent blog by Janaburson: https://janaburson.wordpress.com/2019/01/14/complex-connections-pain-opioid-use-suicide-and-opioid-use-disorder/

The picture is the tree with berries that the robins are eating, outside my clinic window. They clear it from the top down. Deer come too and stand on their back legs to reach up for berries.

Vital signs II

For the Ragtag Daily Prompt: vital. For me, vital brings up vital signs. I wrote this poem in 2006. Pain was made the fifth vital sign in 1996. I have written about it here. In June of 2016, the American Medical Association recommended dropping pain as a vital sign. The idea that we should be “free” of pain has not died yet and the latest CDC report says that the overdose death rate for women has risen a horrifying 240% from 1999 to 2017. That report is here: Drug Overdose Deaths Among Women Aged 30–64 Years — United States, 1999–2017. My poem is still relevant and we still have to change our ideas about pain.

Vital signs II

Pain
Is now a vital sign
On a scale of 1:10
What is your pain?
The nurses document
Every shift

Why isn’t joy
a vital sign?

In the hospital
we do see joy

and pain

I want feeling cared for
to be a vital sign

My initial thought
is that it isn’t
because we can’t treat it

But that isn’t true

I have been brainwashed

We can’t treat it
with drugs

We measure pain
and are told to treat it
helpful pamphlets
sponsored by the pharmaceutical companies
have articles
from experts

Pain is under treated
by primary care
in the hospital
and there are all
these helpful medicines

I find
in my practice
that much of the pain
I see
cannot be treated
with narcotics
and responds better
to my ear

To have someone
really listen
and be curious
and be present
when the person
speaks

If feeling cared for
were a vital sign
imagine

Some people
I think
have almost never felt cared for
in their lives

They might say
I feel cared for 2 on a scale of 10

And what could the nurses do?

No pills to fix the problem

But perhaps
if that question
were followed by another

Is there anything we can do
to make you feel more cared for?

I wonder
if asking the question
is all we need

I took the photograph yesterday with my cell phone. It was so gloriously sunny that the water really was turquoise and I did no photoshop changes.

blues too

For the Ragtag Daily Prompt: brilliance. The brilliance of the sky reflecting in the water.

blues

blues, Beloved

I am so blue, Beloved
about the things I can’t heal
about the people I can’t heal
about the relationships I can’t heal

I take my own advice
and walk after clinic
and the beauty of your sky, Beloved
heals me
lifts me
sensory

I am with the trees
the sky
the dirt
the clouds
the water

water water water
blue in the evening light

we only see the surface
of the water
not what is underneath
it reflects the sky
the light
the clouds

people are like water

we only see the surface
and see ourselves reflected back

my office manager came from hotels

this is so much harder, she says

and I say yes
because we see the depths

this person is behaving badly
yelling on the phone
calling crying yelling

but we both know
how much they are suffering
how much they want help
how they won’t listen or accept help

they want what they want

these people are breaking down
in the holidays stressed

I just long for rest Beloved

blues