Category Archives: The Mother Daughter Show

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Covid-19: Long Haul

https://www.bbc.com/news/av/world-us-canada-58918869 Some people with Long Haul Covid-19 are having to relearn how to walk and talk.

https://www.bbc.com/news/uk-england-leicestershire-59674203. Patients who were hospitalized are still affected at 5 months and one year after they are released from the hospital. Being female and obese are big risk factors. The article says “Long Covid has the potential to become highly prevalent as a new long-term condition.”

One more:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146298/ ” While the precise definition of long COVID may be lacking, the most common symptoms reported in many studies are fatigue and dyspnoea that last for months after acute COVID-19. Other persistent symptoms may include cognitive and mental impairments, chest and joint pains, palpitations, myalgia, smell and taste dysfunctions, cough, headache, and gastrointestinal and cardiac issues.”
“One puzzling feature of long COVID is that it affects survivors of COVID-19 at all disease severity. Studies have discovered that long COVID affects even mild-to-moderate cases and younger adults who did not require respiratory support or hospital or intensive care. Patients who were no longer positive for SARS-CoV-2 and discharged from the hospital, as well as outpatients, can also develop long COVID [24,30,31,41,50]. More concerningly, long COVID also targets children, including those who had asymptomatic COVID-19, resulting in symptoms such as dyspnoea, fatigue, myalgia, cognitive impairments, headache, palpitations, and chest pain that last for at least 6 months [51–53].”

And the symptoms? “The most common ongoing symptoms were fatigue, muscle pain, physically slowing down, poor sleep and breathlessness.”

Yes, the same as mine.

My initial evaluation of Long Haul Covid-19 patients will cover three areas:

1. Behavioral Health. Are they having brain fog, feeling slowed, feeling like they can’t think? Is that what happened during the Covid-19 or did the opposite happen? Were they manic/ADHD/OCD etc? What happened in the weeks leading up to getting sick? Any major worries or life trauma? Lose a job, a relationship, someone in the family die? I am looking for a dopamine antibody pattern.

2. Musculoskeletal Chronic Fatigue. What muscles work and which muscles don’t work? If they need to lie in bed for 20 hours a day, both slow and fast twitch muscles are affected. If they are short of breath, they should have pulmonary function tests, including a loaded and unloaded walk test. Are their oxygen saturations dropping? They also need a sleep study. Check for sleep apnea. Any signs of ongoing infection with anything? Teeth, sinuses, ears, throat, lungs, stomach, lower gut, urinary, skin.

3. Musculoskeletal Fibromyalgia. WHEN do their muscles hurt? Is it after eating? Do they fall asleep after they eat or does their blood pressure drop after eating? What diet changes have they made? Are there things they have identified that they can’t eat? Gluten, lactose, meat, sucrose, fructose, nightshades, whatever. I am looking for antibodies to lysogangliosides.

Treatment:

High antibody levels can be lowered somewhat just with “lifestyle changes” aka no drugs.

A. Treat infection if present. Look for strep A with an ASO, since we have an occult one that is in the lungs, not the throat. For fungal infection, even just on the skin, lower blood sugar as much as tolerated. This may mean a ketotic diet.

B. Treat behavioral health with drugs if emergent. If suicidal or really losing it (meaning job/relationships/whatever), then drugs may be needed. But not forever. Avoid benzodiazepines. Check for addictions.

C. Lower antibody levels:
a. Lower stress. Many people will resist this. Counseling highly recommended, ‘cept they are all swamped. Have the person draw the three circles: a day in the present life, their ideal life and then what their body wants. Listen to the body.

b. You can sweat antibodies out: hot baths, hot shower, steam room, sauna, exercise. Daily in the morning, because cortisol rises when we get up, and so levels should be lowered.

c. Is there a stimulant that works for this person to calm them down? Or an antidepressant if they are slowed instead of sped up. The relatives of dopamine that work for ME are coffee caffeine and terbutaline. Ones that do NOT work for me include albuterol and tea caffeine. Ones that I have not tried include theophylline, that new relative of albuterol and ADHD meds like adderall. This will be individual to the person because we all make different antibodies. We are looking for a drug that displaces the dopamine antibodies. For people who are slowed or have brain fog, the stimulants may not work. I would try the SSRI antidepressants first, like sertraline and citalopram, unless the patient tells me they don’t work or make them anxious. I would screen for PTSD. For high PTSD scores and high ACE scores, I would use the old tricyclics, mirtazapine (which is NOT a benzodiazepine), wellbutrin or trazodone. Again, avoid benzodiazepines. Also check how much alcohol and marijuana are on board, because those are definitely going to make brain fog worse. The functional medicine people are treating mystery patients with hyperbaric oxygen chambers and I suspect that this works for the people with blocker tubulin antibodies.

d. Muscle pain/fibromyalgia symptoms. Avoid opioids, they will only work temporarily and may addict. Avoid muscle relaxants, they will only work temporarily. Again, the tricyclics may help. The newer antiseizure drugs that are indicated for fibromyalgia are possibilities, though as an “old” doctor I am conservative about “new” drugs. Gabapentin, pregabalin, and if the person is sped up, antiseizure medicines that are used for mania. GENTLE exercise. The line between me having a good day today and overdoing is knife thin. On the overdoing days I go to bed at 5 pm. I went to sleep at 5 pm yesterday and 6:30 last night. I sang for church last night and even though I’d driven myself there, one of the quartet offered to drive me home. “Do I look that grey?” I asked. “Yes.” he said. I turn grey from fatigue and it can be sudden. Right now it’s after my second meal. If I am active, I will fall asleep after lunch if I can. If I go really light on lunch, I crash right after dinner. And remember, I am one of the lucky people who only have fast twitch muscles affected, not fast and slow twitch.

I am adding this to yesterday’s Ragtag Daily Prompt: hopeful.

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Baby doctor

I pick up a Steffi-baby doctor while I am in Michigan.

For whom, you say?

For ME. I collect mother/baby images and statues. I have photographs, statues and toys, of mothers and babies and of pregnant women. Some family ones too. I am a Family Practice doctor, after all.

The Steffi is in with a bunch of Barbies. I am glad to see Barbie Princesses that are ethnically diverse. Next I hope the Disney will decide that adult women who are not virgins are human too, but judging by the way the second Frozen was received, I am not holding my breath. The only good Disney Queen is a dead one. The ones who survive, well, sex apparently turns them evil. It is pretty consistent in the Disney animated movies.

So, Steffi. I was thinking of Skipper, Barbie’s friend, but I realize that Steffi is not Skipper. Note that the baby has a facial rash. This apparently resolves if a cool washcloth is used on the baby’s face. I wish all babies were that easy to treat.

I look up Steffi on the internet and she is German. The packaging confirms this, with an instruction sheet in German and multiple other languages. I like Steffi a lot better than the Disney Princesses. She has tools: a stethoscope and a bottle and an otoscope and a thermometer and a rather mysterious looking caliper set. She has a green version of the white coat and a dress with hearts to reassure the babies. And LOOK! Steffi is wearing a MASK!

I love it. Up with Steffi, who can do things. I am not totally against princesses, I am just against the whole princesses are waiting for some prince to arrive and then their life will… well, they will die in childbirth if they remain nice and they will turn evil if they live. It seems like a poor choice of careers, honestly. My favorite princess is the Dealing with Dragons series, because that princess decides not to follow the usual princess path. The first thing she does is follow a frog’s advice and runs away. And the dragons are wonderful too.

For the Ragtag Daily Prompt: worry. I worry about the message of the Disney Princesses.

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The Introverted Thinker in New York

The Introverted Thinker is eight. Her mother takes her out of school for a week to go to New York City.

They leave her sister and her father behind.

Her mother complains about the school paperwork. “Never let school get in the way of your children’s education,” she says. “That’s what my father says.”

The IT is not sure what all this means. But she is excited.

They go on an airplane. She gets to sit by the window. She can see the ground and it is squares like a quilt with hills. It is so beautiful! She is amazed, magic!

In New York City they go to the house of an old friend of her mother’s. The old friend is old and wears dresses to the ground and a lot of jewelry. The house is dark and there are many things in it. The IT is told that the things are antiques and she must not touch anything. She walks around carefully in the dark places, looking at all of the strange things while her mother talks to the old friend. They talk about the past and people that she does not know.

Her mother takes her to museums on some days. Some are art museums. The IT is already used to art museums because her mother is an artist. The museum is like an art gallery only much bigger and the ceilings are very high. A lot of the art is very big too.

One museum is different. Natural History, says her mother. There are dinosaur bones. The IT can’t touch them either but they are wonderful. Huge animals from the past that are not here any more! She loves it.

They fly home. First she has to thank the old friend with the house like a museum, only darker. Then they go to the plane. This time there are some clouds so the IT can’t see as much, but she still gets to see the quilt of the land.

She decides that she likes museums and she likes natural history. Especially dinosaurs.

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If

This is one of the ten poems that my mother made etchings for, the year I was just done with college. 1983-4. I wanted to write, but had no idea what to do with the poems that I was writing. My mother Helen Burling Ottaway had done a series of etchings with a family friend’s poems, so I asked if she would do the same with me. She said, “Yes, on one condition.” “What is that?” “They have to rhyme.” She did not like the free verse. Almost all of the poems were about animals, except for one about my sister. Another friend printed the poems on a lead type press and then my mother worked on editions numbered 1-50 of each, inking the plate separately for each one. This one is number 5/50. You can see the imprint of the plate on the paper in the photograph.

If I could be anything
I’ll tell you what I’d like to be
One of those small green frogs
That sails from tree to tree

These frogs can jump, they have no laps
They are not birds with wings
the have parachutes between their toes
And I am sure that they can sing

They spread their toes and jump so high
To float like snowflakes in the air
Frogs fall like rain from clear blue skies
It must be nice up there

Why they jump I do not know
Maybe escaping hungry eyes
Perhaps to catch a tender bug
Or they just like to fly

If I could be anything
I’ll tell you what I’d like to be
One of those small green frogs
That sails from tree to tree.