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.

many flags

For the Ragtag Daily Prompt: language.

I spent three days with the Rotary President Elect Training this past weekend. I am part of District 5020, which stretches from the end of Vancouver Island, BC, Canada down the Olympic Peninsula, WA, United States. There were people from ten districts.

The Rotary’s Polio Plus program is working hard to eradicate polio. This year the match from the Gates Foundation will be 2 dollars for every dollar the Rotary brings to end polio.

The flags from all the different countries and people working together: that speaks the language of peace and hope to me.

the virtue of the disconnect

the virtue of the disconnect
learnt early
as a child

they say we are broken
wired wrong
enduring horror

he wakes at night
sleeps lightly

what was your childhood like?
how did you sleep?

it was not safe
we had to get up
leave in the night

you survived your childhood

yes, I did

sleeping lightly saved you

yes, it did

you could rewire that
it takes a lot of time
to change the childhood wiring

or you could just
be ok

with sleeping lightly

doctor’s orders

For the Ragtag Daily Prompt: recommend.

doctor’s orders

I recommend a daily walk

no earbuds
no headphones

listen to the wind
to the trees
to the birds
to the traffic
to the city
or the country

feel the ground
the pebbles
the sidewalk
the dirt
the grass
the wind
the sun
the rain
the cold
the crunch
of snow or ice

look at trees

smell cold

taste the wind
a snowflake
a leaf

touch the earth

and let the rest go


USPSTF is the United States Preventative Services Task Force.


This is a site I often use and frequently show to patients. For further reading….that is, if they want to know more about a topic. There is a nice two minute video about the Task Force right now, saying that it’s a volunteer organization that started 30 years ago, to review research about preventative care, agree on a recommendation and publish that recommendation.

Before they publish or update a recommendation, they ask for public comments and expert comments.

I have great respect for the USPSTF. Let’s take breast cancer screening. The current recommendation is here: There was a big furor when this came out, because the recommendation is for biennial mammograms. Every other year, not every year. The USPSTF went through reams of data and papers and said that they could discern no difference between yearly and every other year screens in normal risk patients. The screening recommendations are different for people with abnormal BRCA1 and BRCA2 genes.

So who yelled about that recommendation? Radiologists for one. Now, there is a financial incentive on their part to have women get the mammograms yearly. The American Cancer Society was annoyed and the Susan B. Komen Foundation too. But the USPSTF stand their ground. The guidelines get updated in a 5-10 year cycle.

Reasons that I like the guidelines:

1. They are online. My patients can look at them too.
2. They make recommendations for screening by age groups.
3. They rate their recommendation: A, B or C level evidence or I for Insufficient Evidence.
4. You can read the fine print. They put the article with all the detail and all the references on the website. The weight of evidence is apparent.
5. They say “We don’t know.” when there is insufficient evidence.
6. The site is pretty easy to use.

I have to weigh evidence in medicine. A functional medicine “study” that is not a randomized double blind clinical trial and that only has 20 patients is really more of a case report. Hey, we tried this supplement and they liked it. The recent study about alcohol from Europe with 599,912 patients has a lot more weight. The Women’s Health Initiative had 28,000 women in the estrogen/progesterone arm, and 21,000 in the estrogen only/had a hysterectomy arm. Length of study, design, all of these are important.

There is a recent headline about a study saying that coronary calcium scores have now had one study where they were useful. That is a study. The guideline from the USPSTF is here: The guideline says “insufficient evidence” and that’s what I tell patients who ask for it. I offer referral to a cardiologist to discuss it, but I am reluctant to do a test where I really don’t know what to do with the results. I pay very close attention to the guidelines and they are always changing. They have the strongest and least biased (by money and greed) evidence that I can find. And patients can read them too, which is wonderful.

Even though the USPSTF says that there is insufficient evidence for mammograms after age 75, we can still do them. That is, medicare will keep covering them. Some people keep doing them, some don’t. I discuss guidelines, but I will support the person continuing the care if that is what they want and they are informed. People are infinitely variable in their choices and logic.

I voted

…after I spent about three hours going through paper and throwing it out… ok, like a total numbskull I mislaid my ballot. Have you mislaid your ballot? FIND IT! VOTE!

” …that government of the people, by the people, for the people, shall not perish from the earth.

When I went across the country as a Mad as Hell Doctor in 2009, we talked to people everywhere. I joined the group in Seattle. I had never met any of them and had only heard about them two weeks before. But we were on the road, talking about health care, talking about single payer healthcare, talking about Medicare for All.

Some people said, “I don’t want the government in healthcare.”

We would ask, “Are you against medicare?” “No!” “Medicaid?” “No!” “Active duty military health care?” “No! We must take care of our active duty!” “Veterans?”  “No! They have earned it!”

…but those are all administered by the government. More than half of health care in the US. So let’s go forward: let’s all join together and have Medicare for ALL! And if you don’t agree… so you don’t think you should vote? Hmmm, I am wrestling my conscience here….

We need one system, without 20 cents of every insurance paid dollar going to health insurance profit and advertising and refusing care and building 500++ websites that really, I do not have time to learn and that change all the time anyhow. How about ONE website? How about ONE set of rules? We are losing doctors. It’s not just me worrying: it’s in the latest issue of the American Academy of Family Practice.

Vote. For your health and for your neighbor’s health.


Physicians for a National Healthcare Progam:

Healthcare Now:

I can’t credit the photograph, because I don’t remember who took it…. or if it was with my camera or phone or someone else’s! But thank you, whoever you are!