pulmonary rehabilitation

I am fractious and grumpy when I first go to pulmonary rehabilitation at my local hospital.

This is because I have local hospital PTSD because of past treatment. However, there is only one hospital in my county.

I am anxious and tachycardic when I first arrive. I have sent patients to cardiac rehabilitation and to pulmonary rehabilitation, but it’s the first time I’ve gone. My doctor did not refer me until I ask her. I thought it up while I was talking to my insurance company’s chronic care person. You know you are desperate when you call your insurance company for ideas. The insurance company is motivated to pay for pulmonary rehabilitation because I am expensive. I have had loads of tests this year and cost a bunch of money. They would like me well. Me too. So yes, I qualify for pulmonary rehab by virtue of four pneumonias in nineteen years and this time a year on oxygen continuously and still part time now.

I have two people to help me. One is a respiratory therapist and the other a physical therapist. I am an unusual referral. Many of their patients have chronic obstructive pulmonary disease and/or emphysema, usually from cigaretes, but also from things like asbestos or alpha-1-antitrypsin disorder or progressive muscular disorders.

They explain. There are 24 visits, over 12 weeks. I come in twice a week. I am weighed, they ask about symptoms, and we go to the small gym. It has three treadmills, three stationary bikes and three of those semi-horizontal not really a bike things. I pick the treadmill. After I describe my lung weirdness, that a fast heart rate preceeds hypoxia, they put a wrist pulse oximeter on me. Unlike the little finger ones, it can pick up heart rate and oxygen rate even when I am walking on the treadmill. My blood pressure and pulse is checked and I start the treadmill. I go slowly the first time. My heartrate is over 100 to start with, but that’s partly the PTSD reaction. I can slow my heart rate just by slowing my breathing and not talking, into the 80s.

Here is how I looked the first time:

https://www.reddit.com/r/FunnyAnimals/comments/zadptv/this_is_whats_happened_in_gym/

Ok, not really. I start walking on the treadmill and go for 30 minutes. Blood pressure and heart rate are checked mid way through. The only time I drop my oxygen level is when I walk AND talk and then I drop it to 87. I stop talking.

After the treadmill, there is another 15-20 minutes of “patient education” about the lungs. This is usually a video, discussion and handouts. They can have up to 3 people simultaneously. At first there is another woman, but she finishes her 12 weeks. She is still on oxygen. I am doing the treadmill without oxygen. “What is your goal?” asks the respiratory therapist. “I want to ski this winter.” I say. She blinks.

The patient education alternates with lifting hand weights. The physical therapist does that with me. There is a stretching session each time too. The weights are slow twitch muscles so that is easier for me to push.

On the third day on the treadmill, I start pushing myself. My heart rate before starting was 81. I get to 120. “Um, don’t push it further than that.” says the therapist.

“Why not?” I say.

“Well, the guidelines are that we’re supposed to not have the person exercising at a heart rate of more than 30 over their baseline.”

“Oh,” I say. I am at 40 over. I slow down a little, aiming for a heart rate of 115. My blood pressure is between 90 and 115 systolic to start with, even anxious, and goes up to the 140s or 150s in the middle of exercising. If I talk too much while I am on the treadmill, my oxygen level starts to drop. It drops the third time down below 88 and the therapist says, “Shall I get oxygen?” “No,” I say. “I just need to shut up.” I do and my oxygen level recovers.

I steadily improve on the treadmill. I can enter my weight and it will measure “METS”. I start out at only a few mets. My goal is as high as I can go. By week 8 I am pleased to be alternating walking and running and I am averaging over 8 mets. Bicycling takes 7-9 mets, and more if you race. I want to return to bicycling.

Then I get my flu vaccine. I feel terrible the next day and cancel my rehab. I see my doctor for a routine visit the next Tuesday and she gives me the covid booster. That hammers me. I go back to being tachycardic much more easily and my fast twitch muscles are not working again. I contact my cardiologist and primary, do I put pulmonary rehabilitation on hold?

I decide to go and I do not drop my oxygen. However, I get tachycardic much more quickly, I can’t get up to over 8 mets, and it feels truly terrible. And my muscles give me hell and hurt horribly for the next two days. I put pulmonary rehab on hold and wait and do slow twitch exercises. The working theory is that there are antibodies to my fast twitch muscles, so the vaccines have activated my immune system. Not just antibodies to influenza and covid, but also the ones that make my muscles not work and hurt. A fibromyalgia/chronic fatigue flare. I start sleeping 12 hours a day again, as I did when I got sick over a year ago. I am really anxious at first but there are no signs of pneumonia, I am not hypoxic, and it’s mostly muscles and fatigue.

After three weeks I return and do my last four pulmonary rehab visits. It hurts way more than the first 8 weeks and it is way more exhausting. I don’t like sleeping 12 hours a night. It could be worse, though. Some people have chronic fatigue where they have to lie in bed most of the time. I don’t have that, so I consider myself lucky. Mine is fast twitch muscles only. Presumably theirs is fast and slow twitch muscles. I have an annoying but relatively mild version of chronic fatigue.

I graduate from pulmonary rehabilitation. Many thanks for the help with my muscles! I want a wrist pulse oximeter, but they cost $700 and I dont’ really need it. By now I can tell when I have a fast heart rate and I can tell when I am getting hypoxic. It makes me goofy and silly, though I normally have that anyhow.

Many thanks to Jefferson Healthcare’s Pulmonary Rehabilitation Department. And if you have had pneumonia more than once or long Covid, consider asking your doctor to refer you. It makes me much more confident about exercising and pushing myself and what is safe. And eventually these stupid antibodies will fall off the receptors again. I hope.

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For the Ragtag Daily Prompt: fractious.

PS: The Rehabilitation Department was closed then open then closed then open during the last two years. They did not have many people when I was there. Get in soon, because there are limited spaces!

Nanowrimo

I have finished my first try at Nanowrimo.

I do NOT have a coherent novel at the end. I have pieces and sections and chapters and questions. I have to look up a bunch of microbiology and also how the goblets cells in the stomach work, because I don’t remember and anyhow, I am sure it has changed since I was in medical school.

BUT I DO have 50,000 words.

I got stuck twice at the beginning and had two days where I didn’t write anything except this blog. And then another two. I kept dreaming about an ogre who wanted to be in the novel. Well, ok. I finally decided that the goal was to write the 50, 000 words, not stick to an outline. I added the ogre and have not missed a day since. To finish 50,000 words in 30 days, it breaks down to 1667 per day. If you miss four days it is more. I had two days where I wrote over 5100 words. That helped a lot.

Now I think I will rest for a day or two and then start looking it over. Write a list of questions, work on some needed research, think about it. That ogre is interesting. Unexpected.

I think it was fun! At least, some of it was. I got stuck writing about something based on when I was ill, so that was difficult. It brought up the fear and the deep loneliness of that time. I learned to skip to something else when I get overwhelmed.

Anyhow, HOORAY!

Sterling too

I grow up with sterling.

My mother has a set of sterling. It is important to her. It is an emblem, a badge. She does not have as extensive a set as her mother.

My sister and I know the silver is special because of our mother. We like the tiny spoons best. They are silver with gold on the bowl.

“Can we use the special spoons?” we ask. For ice cream.

“Yes,” says my mother, smiling.

We run to get them, the small spoons, heavy for their size. Silver is heavier than stainless steel. The spoon also gets colder than stainless steel and tastes different. We eat our ice cream with our special spoons very happily.

We know that the silver is sterling. I don’t know what that means for a while. It means it is not plate. Plate? But these are spoons.

My mother shows us the stamp on the back of each spoon. “See? It says sterling. That means it is silver all the way through. Plate has silver over another metal.” She shows us the back of another spoon. The bowl has a worn spot. “The silver has worn away. And it does not say sterling.” We both study the two spoons and weigh them in our hands. The plate one is lighter. My mother is scornful of silver plate.

My mother is an artist and goes to museums. She comes back from one laughing. “They have an exhibit about homes and decoration. There is a room with tv trays and very few books and wall to wall carpet and a large color television. I thought it was so dull and ugly. Then I went to the next room. Oriental carpet and books and a guitar and no television and art!” She laughs. “They have me nailed. I am such a snob and it looked just like our house!”

We do have a tv but it is the smallest black and white that you can get. And my father knocked it over one night. Now the picture is cup shaped. The top of heads are wide and swollen. Neither of my parents care enough to get it fixed or replace it. They spend their money on art supplies and books and music. Friends visit. “What is wrong with your tv?” I look at it in surprise. I am so used to the deformed picture, I stopped noticing long ago.

Once we are at my mother’s mother’s house. My mother tells another story. “I found mother sweeping to get ready for guests. She swept the dirt under the edge of the rug! I said, “MOTHER! What are you DOING!” Mother just looked at me and said, “It’s a poor mistress who doesn’t know the maid’s tricks.” My mother’s mother did grow up with servants. But not here. She was born in Turkey because her father was a minister, running an orphanage and school. My grandmother lived there until she was sixteen and the family was exiled from Turkey at the start of World War I.

I give my mother’s sterling to my niece, after my sister dies. My children are not very interested in sterling. That is ok with me. Things change and values change.

I still have some special spoons, and think of my mother and father and sister when I eat ice cream.

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For the Ragtag Daily Prompt: sterling.

Underground fungus networks

Mushrooms are the excrescences of underground fungus networks.

Excrescences! In my yard! At my home! Do the underground fungus networks make you reassured about the health of my yard or is it worrisome? Will the fungus grab me and pull me under?

We’ll have to wait and see.

For the Ragtag Daily Prompt: excrescence.

The tweeter is twerked

Ok, I never signed up to twitter. Bunch of twits.

But I did write another verse for the song SAVED. It might not be the one that comes up on the You tube search. I learn it as a teen from side B of Moondog Matinee by The Band.

I sang it to my father. He said, “Where did you learn THAT?” I didn’t know and did an internet search. I forgot what album I leaned it from. It was his album, that I recorded on tape before I went to college.

Here is my new verse:

I used to Tweet, I used to Twerk, I used to Tweet, Twerk, I was such a Jerk

I used to tweet and twerk, tweet and twerk and I was such a jerk

But now I’m standing on the corner, it was too much work

That’s cause I’m saved, that’s cause I’m saved

People let me tell you about Kingdom Come

I’m saved, I’m saved, I’m going to preach until you’re deaf and dumb

I’m in the Salvation Army, beating on the big bass drum!

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Who else sang it? Laverne Baker! She is the earliest I’ve found. Recorded in 1960, though the videos are later.

And here too, along with her hit “Jim Dandy”.

The authors: https://en.wikipedia.org/wiki/Saved_(Leiber_and_Stoller_song) .

Anyone else? Oh, yes, and I haven’t even listened to them all. But one is Elvis Presley. A gospel album:

And here is the dance video:

So, chief twit, tweeting gets a verse. I do not mind if it dies other than the verse. Shake your money maker, twitter!

Dead letter

I get a letter for my mother on Saturday, asking for money.

I am answering the request. I write: Helen Ottaway died May 15, 2000. Take her off your mailing list.

I did not sign my name and I do not fill out a return address. Here is a picture of it, before the stamp. Habitat for Humanity, the next county south. They have not endeared themselves to me.

I get mail for the dead. My mother, my father, my sister. It is the colleges and universities that hang on. Princeton and Cornell have not found me, but my father’s preparatory school Williston, knows where I live. They send me reports. My father hated Williston. My sister went to the University of Washington and graduate school at the University of Oregon. I went to the University of Wisconsin and the Medical College of Virginia and residency at OHSU in Portland, Oregon, so I get mail from all of those. I like the science reports from the University of Wisconsin best. My son went to Washington State University, but has escaped their alumni association, who send me mail. My daughter went to Western Washington and has also escaped their clutches.

I get medical mail too. The American Academy of Family Practice Journal. I do not pay for JAMA but it comes anyhow. Various Family Practice journals and then drug company propaganda. Every so often I get a box of samples. Last time it was glucerna. I guess they have noticed I am older. One odd piece of medical mail is Guns and Ammo. The back story is that we ordered Woman’s Day when the clinic opened in 2010. Then we watched who they sold our information to. The scam is that a magazine will arrive for a year and then they will bill for the next year. We got Smithsonian for a while and that creepy right wing paper all about how we’ll all die soon. Smithsonian gave up on us and then it was RV World and Guns and Ammo. We quit putting magazines in the waiting room when Covid-19 hit. People had to bring their own and anyhow, we only had one person out there at a time.

I subscribe to my local weekly paper. I subscribe to one magazine. With all of the college and university stuff, I have a large pile to donate to the library monthly. Right now the AARP is sending two magazines to my house: one for me and one for my closed office.

And I still get weird junk mail from insurance companies saying “We have changed our rules again just like we did last month! Go on line and read the 47 new pages of rules for us and the other 499 health insurance money stealers!” Makes me gloomy about the wisdom of the US populace. When will we be smart enough to vote for medicare for all? How far will the medical system have to break down? People are dying and will die, including lots of medical personnel.

Vote for medicare for all, single payer, single set of rules. It’s not socialized medicine, the only socialized medicine in the US is the Veterans Benefits, and you aren’t going to vote to take them away, are you? Vote, vote, vote.

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For the Ragtag Daily Prompt: envelope.

Elephant

My daughter got the elephant in the mail yesterday.

She called me, very happy with it. “It has a TAIL! It matches the pillowcase. I love the fishy fabric.”

The back story is that when she was a baby, her father’s mother made her a pillow. It had two pockets. In the pockets were four small stuffed toys. Her older brother has one too. The toys were not exactly the same. Hers had an elephant.

When she got sick earlier this year, I start sending her care packages. I send the pillow with three of the stuffed toys. However, I don’t find the elephant.

She loves it but asks, “Where’s the elephant?”

“I’m still looking.” The elephant is pink, with fabric ears that are different from the body. I find it! She is coming here for a month, so I don’t mail it. She is very pleased with the elephant.

It goes AWOL before she flies back to work. “Check the tent, mom.” She stayed in the tent in the back yard with two of her friends. I take the tent apart. No elephant. I check the sleeping bags. I sweep under her bed and search the house. As my daughter says, my house has a lot of hiding places and the cats like the elephant too. No elephant.

So for her birthday I make one. I remember how it looks and I make it while watching some continuing medical education. It’s easier to hand stitch than to get out the machine. I have to buy a large bag of stuffing, because the store downtown only has one size. Never mind, maybe I will make more elephants.

I made her a pillowcase last year, with the whale/mermaid fabric and the fish. So the elephant matches.

And she likes it! Hooray!

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My daughter says I can’t make clothes for her, but pillowcases and elephants are great! A breakthrough!

For the Ragtag Daily Prompt: breakthrough.