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/

Not quite acculturated

And she was unsympathetic
That doctor
That immigrant doctor
I heard she told a patient
“You’re too fat.”
This was whispered
In accents of pleased shocked horror

She came to dinner
That unsympathetic doctor
Southeast asian
Told a little of her story
To my wide eyed children

When she was 10
They were boat people
Escapees
Refugees
Pirates caught them
Real pirates
“They weren’t so bad,” she said
“We were about to die from lack
of food and water
Though we heard other stories
that were very bad.”

My daughter could imagine the boat.
She moved to my lap.
The pirates were too real.

Perhaps plenty is not always taken
for granted
And sympathy is a matter of degree.

 

previously posted on everything2.com in 2009 and here too, though I have not figured out how to find it….

for the Daily Prompt: enlighten.

Luminous night of the soul: https://www.youtube.com/watch?v=0OaRZrdoTQ0

 

Advice to a college daughter

I am submitting this to the Daily Prompt: Careful.

I talked to a young woman recently who left the college that my daughter is going to.

And then I gave my daughter advice.

“If you are attacked or assaulted, sexually or otherwise, do not go to the campus police. Go to the city police. Or better yet, a State Trooper.”

Because, you see, the Campus Police work for the school. It is a conflict of interest.

If you are attacked, get a friend. Have them help you get to the City or State Police. Have them record your initial story on their cell phone. Have them photograph any injuries, torn clothes, you crying while you tell them. If you are raped, have your friend get you to the City or State Police and then to an emergency room for a rape kit. This is documentation of your story. Write out what happened the next day. Keep all of it. It is admissible in court. Name names. Tell every word that you can remember that the other person said. Try to figure out if there are any witnesses.

Because too many men lie. Men lie in our culture and the system dismisses what women and girls say, dismisses domestic violence, dismisses assault, dismisses rape. You do not want to be Cosbyed or Trumped. You will not stand for it. None of us should stand for it.

Fight back. Stand up. We will not tolerate this culture and we will make it stop.

sing for the girls

Sing for the girls who grow up in war zones.
Sing for the girls who grow up scared.
Sing for the girls who grow up abused.
Sing for the girls unprepared.

Sing for the girls who grow up with alcohol.
Sing for the girls who grow in broken homes.
Sing for the girls who don’t tell anyone.
Sing for the girls alone.

Sing for the girls who grow up beaten.
Sing for the girls who grow up raped.
Sing for the girls who care for siblings.
Sing for the girls who learn to hate.

Sing for the women who now look frozen.
Sing for the women who now look old.
Sing for the women who survived it anyway.
Sing for the women who told.

Sing for the girls who grow up broken.
Sing for the girls who break everything.
Sing for the girls who break the silence.
We are broken and breaking: sing.

I took the photograph at the US Synchronized Swimming Nationals in 2012.

Fraud in medicine: medicare application

Medicare quit paying my clinic at the end of July, on the 31st.

I was still half time in clinic, we were interviewing a new receptionist as my receptionist of five years wanted to retire by August first. We got some sort of notification from medicare, but their letters are very cryptic.

My new receptionist was needing orientation and help and I was really tired after July. I redid the medicare application and sent it in. We continued to see medicare patients and turn in the bills.

Our medicare contractor is noridian. They sent us a cryptic letter saying that something was wrong with the application. This was, mind you, a renewal. I had been seeing medicare patients for five years in my clinic.

I call them. I am given a name and a number to identify the call. I have two Ptan numbers, one for me as a physician and a second for the clinic. The first call said that my personal Ptan application was correct but the clinic one wasn’t.

I did it again and mailed it. Second day air. He said that our payments should be released in 10-14 days.

Ten days. Nothing. Fourteen. Nothing. I am pulling from savings to run the clinic. I call a second time. Again I am given a name and a number. She said I had to CALL to get paid once the application was received. I said the first guy didn’t say that. She said another 10-14 days.

We wait. After ten days I call. A third number and person. Once again I have a cryptic email. I ask about the PTan number on the email, which is not my clinic’s Ptan number. Oh, says the man, that is what is wrong with your application. He says to do form (numbernumbernumber B) not form (numbernumbernumber A). And it will be 10-14 days after they receive it.

I do it AGAIN. I do notice that all of the old copies of the form in our file have the PTan numbers wrong. Weird. They have been paying me for five years.

Ten days. I call a fourth time. She says that it will be 30 days not 10 to 14 until medicare lets me know if my application is correct. Or they might pay me after 10-14 days. They aren’t, so I argue that something must still be wrong. What is it? She can’t tell me. I want a supervisor. She says that I can talk to a supervisor in 10-14 days. We figure out that the Ptan number on the application is correct. I say, “I am writing my congresswoman.” and hang up.

So I do. I find my Senator’s email and I write to her. I have been a rural family practice doctor for 25 years and I saw a 98 year old yesterday and a 91 year old today and I LIKE my elderly patients, but I have HAD it with medicare, at least with the contractor noridian that is running medicare for my state. I list the phone call dates and names and identifying numbers and I say FIX IT because otherwise I am for the first time in 25 years seriously considering quitting medicare.

Two days later noridian sends an email saying they are releasing my payments.

The next day we get a direct deposit for $9000.00. That is a START.

One week later we get a call from noridian explaining what is wrong with our application. Not just one thing. Noridian doesn’t seem to have a copy of our business license from five years ago. We have to put the personal Ptan on page xgyb-14. They want details about the nursing home. Do I do home visits?

The noridian person explains that our application has actually been wrong for five years, but now they are getting audited so they have to get everything cleaned up.

So THEY have KNOWN it was wrong for five years, but held my payments since July, while they try to get their act together and tell me what the hell is wrong with it?

I want to be paid INTEREST for all the time I have spent on the phone and redoing the cryptic application.

And many thanks to my congresswoman, for keeping my clinic open.

I took the picture at the Kinetic Sculpture Festival here in September. The outfits make more sense than dealing with noridian, that’s for sure….

first posted on everything2.com on 11/30/15

what I miss

what I miss after 8 years of divorce and 14 years of marriage is sleeping with a warm body not you but anyone after you fill the U-Haul and are surprised because you think that I am the packrat and all the stuff is mine but you have a piano and bicyles and a motorcycle and clothes and music and books and really you are one too, it’s just that I am worse and you drive away and I can’t sleep though really it did start before then we did over a year of couselling and I slept alone some and then kick you out and sleep alone more our daughter moves into the room across the hall up from the basement when you leave and in the middle of the night she comes up with me because you are gone to Colorado and now 6 years later she asks about it and I say you came in with me and she says she didn’t know that and would wonder why I would steal her in the middle of the night and I say I didn’t but as she is older and moves back two flights down to have that distance that one needs from a parent when one is in puberty and growing up and away and I wake at four am and now that same sex marriages are legal I wonder about buying an asian bride and then I would have a body a warm body to sleep with but it wouldn’t work and yes I miss sex too but not in the same way it’s the warm breath and heartbeat and movements and I am the monkey longing for a mother to cling to and I too make do with a pillow I could make a scarecrow for my bed a body not an inflatable too cold but something warm and I could put a watch in its chest an old one that ticked it doesn’t actually help to be in love because I am not sleeping with my love and that makes it all the worse I long for a warm body really no I long for my warm love this particular body and breath and heartbeat and I wake often longing for my warm love

the picture is my sister, who died in 2012 of breast cancer. I made her stuffed animals and puppets for years starting when we were little. I made the red eared puppet and bought her the puppet with legs that year….