you know you are hypoxic when

…singing. Singing on oxygen is a challenge. Why? Well, because I am TRAINED. I am trained to breathe through my mouth, slowly filling my lungs, for the next phrase. I don’t breathe through my nose because that is noisier, might make a sound during a rest.

No, really. Singers and conductors think that way. PERFECTION is not achieved but we sure have fun trying.

So if I breathe through my mouth as trained and ingrained, and the oxygen is coming by nasal cannula….

….I am goofy and hypoxic by the end of the song. WHY do I feel like I might fall over, I think? WHAT the hell is the matter with me? OH. I HAS NOT BIN BREATHING THE GOOD OXYGEN STUFF. Facepalm. Nosebreathe.

But it’s pretty ingrained. I keep forgetting.

The good news is I feel WAAAAY better. My lungs don’t feel like someone stuck a burning torch in them any more. It hurt for six weeks, every time I sat up or stood up, the muscles of heart and lung HURT. I knew it was my heart but I also was pretty damn sure it was not coronary artery disease and it wasn’t congestive heart failure. That day I went to the ER, normal labs and echocardiogram even though it hurt like shit. I do wish the ER doctor had thought to walk me. He would have put me on oxygen then and I would have gotten better faster. And then I think of 2014 and 2012 and 2005. I didn’t think of it and neither did ANY of my doctors. I did USE oxygen in 2014. I had my father’s tanks because Evil Lincare had kept delivering them even when my father had a concentrator and so there were 16 or 18 full size oxygen tanks in his small house which is a huge fungking fire hazard, those asshats.

Now Lincare is delivering to me and under much improved management. I think the man who delivered it WAS management. He said yes, they had some shady and inappropriate behaviors in the past but he has been KICKING BUTT AND TAKING NAMES and they aren’t going to do that shit any more, not with him in charge. I liked him. Thank goodness Lincare is being run ethically.

I have pulmonary function testing today. I think that will be abnormal. However, I am enough better that I may no longer qualify for oxygen. In which case my insurance may try to refuse to pay for it. Oh, goody, a totally legitimate fight and they will be darn sorry if they try to refuse the oxygen. Mr. or Ms. State Insurance Comissioner! CEO of Insurance! Board of the Insurance Company! Poor sorry little rural family practice doctor, now disabled from her clinic for her fourth pneumonia and ya’ll refusing her oxygen when she has no income because her disability doesn’t kick in until she’s been sick for three months.

Heh. Bring it on. Got my tai kwan do, kinda rusty, my katana, a yard long rusty pipe wrench… bet I get coverage for the oxygen.

Meanwhile I either gotta stick the nasal cannula in my mouth when I am singing or bloody well breathe through my nose…..

in the air

For the Ragtag Daily Prompt: ebullient.

I took this at the Great Port Townsend Bay Kinetic Sculpture Race. This is not part of the race, but our local school Robotics team, showing how many balls their robot can shoot into the air. I think the yellow balls look ebullient and the small observer is entranced. She is probably writing programs by now.

Mundane Monday #173: skies

For Mundane Monday #173, my theme is skies: not blue skies. Skies that worry me. This is a fire sky, the sun setting through smoke that we can smell. There are no big fires near us, so I don’t know if this is California, Oregon, Washington, or Idaho smoke…

Add a message with your post or a pingback and I will list them next week. There might be a delay, because I have some travel soon.

For the Mundane Monday #172 prompt: windy:

KL Allendoerfer joins in:

Mundane Monday #172: windy

Today’s Mundane Monday #172 theme is windy.

Last night a friend and I attended a reception at the Port Townsend Marine Science Center. A beautiful evening and windy. We were welcomed by this wind sock octopus.


Entries for Mundane Monday #171: faces.

KLAllendoerfer chooses clock faces.

Send a link or a comment and I will add your post next week.

And here are some of the denizens of the Marine Science Center:

orange and purple

I am posting this now, because even though it’s 6:28 am on Sunday for me, it’s already  1:28 am on the Kamchatka Peninsula, on Monday! I live more toward the tail end of Monday, so I am deciding to post on Sunday once it is Monday somewhere!

the mystic E2 dragon

We are writing a quest where we ask different people to write more about a topic. The requests are anonymous and some are for existing titles that have no write ups. This topic was given to another person and then I was asked to write about it as well. My sister was an editor on the everything2 website. She was born in the year of the dragon. She died of cancer in 2012.


the mystic E2 dragon




“They want me to write about the mystic E2 dragon.”


“So I think of you.”

Silence… a weight. “So it’s me?”

“No, but you are a dragon, born in the Year of the Dragon.”

“Like we’re Chinese.”

“Yeah, well.”

“And you are an ox.”

“Thanks.” I wait. “Come on, show up.”

The dragon is made of a coat hanger, a rough gold cloth and black felt hand sewn to the body, thin gold cloth on the wings, gold earrings with rubies for eyes. Probably fake rubies, I’m not sure. I made it in college, tail to curl around the neck so that it can sit upright on my shoulder when I walk around. A gold fire lizard. I gave it to my sister, who said I could take it back when she lay dying.

The dragon morphs and now fills the living room, pushing on the walls and squashing me. The scales are hard and hot!

“Stop it!” I say, “Don’t destroy the house!”

The dragon is now couch size. My couch groans under it. The dragon is very alive and smoke rises from her nostrils. It manages to look like my sister, like a dragon and like the borg all at once. Metal and wires on the left side of the dragon’s face, eye socket with a metal camera that whirrs.

“Mind the couch.” I say.

She shifts a little, not shrinking. I peel myself off the fireplace, with the ache of the metal insert and the mantel on my back.

“So.” I say, “what should I tell them?”

She narrows her eyes at me and shrugs.

“What do they want to hear?”

“You tell me.”

“Keep the site alive.”

“Yeah, ok.” I wait.

She looks around. “Your dust bunnies are dying of old age.”

“That’s ok.” I say. “They are better than a guard dog.”

She snorts smoke.

“Tea?” I say. I have it made already, on a tray. The tray was painted by one cousin, the tea cloth woven by another, the teapot made by our mother, with my poem on it.

She takes the cup and saucer delicately. Five claws on each forefoot.

“What’s it like?” I say.

Shrug again, as she sips the tea.

I wait.

“I’m not telling you. And this is your active imagination, so what a stupid question.”

“But I am talking to the unconscious.”

“Yeah, whatever. And anyhow, you’ve already decided, puny human.”



And here a curtains drops, while I thank her and we say goodbye.


Submitted to the Daily Prompt: candid.

Butterfly Girl Comes to Visit

For the Daily Prompt: carve. I think of skiing, bicycling. And I think of a piece of my heart. I wrote this in the early 2000s.

Butterfly Girl Comes to Visit

She is so beautiful with her wings
multicolored many splendored lights caught and multiplied
as she flutters

I freeze
I am an ogre
Huge and clumsy
I know from past past many times
Not to touch you
My rough fingers have brushed the tiny feathers from your wings
You cry in pain and your flight becomes erratic
My kiss is just as bad
Rough lips
If I move the wind of my passing blows you against a window
You fall stunned

I hold and crush
the box of feelings that can hurt you
Sorrow, anger, fear, dismay
Even fatigue turns my aura red
And scorches your wings

I hate to cause you pain

Fly butterfly girl
My baby needs me, my pager rings
My ogre husband stirs
The effort of holding still plain on his face
I can’t hold still much longer

Butterfly girl
Fly on home

on fire

This is an early morning photograph, downtown, not this year.

It was frightening to fly back from Wisconsin last week and have the plane descend into smoke in Seattle. The smoke from fires in British Columbia and Washington blanketed the city. I am used to descending into cloud, but smoke looks brown and was neither opaque nor transparent. Haze.

I missed the worst air, but the smoke still bothers me. One afternoon my receptionist and I both were having trouble with eye irritation from the bad air. My clinic is in a 1950s building and closing all the windows and doors is hot! No air conditioning.

I am hoping that we make changes to slow and mitigate climate change and global warming: I don’t want the world on fire!

How many summers will it take? My guess is three consecutive summers….

Influenza and lung swelling

Influenza is different from a cold virus and different from bacterial pneumonia, because it can cause lung tissue swelling.

Think of the lungs as having a certain amount of air space. Now, think of the walls between the air spaces getting swollen and inflamed: the air space can be cut in half. What is the result?

When the air space is cut down, in half or more, the heart has to work harder. The person may be ok when they are sitting at rest, but when they get up to walk, they cannot take a deeper breath. Their heart rate will rise to make up the difference, to try to get enough oxygen from the decreased lung space to give to the active muscles.

For example, I saw a person last week who had been sick for 5 days. No fever. Her heart rate at rest was 111. Normal is 60 to 100. Her oxygen level was fine at rest. She had also dropped 9 pounds since I had seen her last and she couldn’t afford that. I sent her to the emergency room and she was admitted, with influenza A.

I have seen more people since and taken two off work. Why? Their heart rate, the number of beats in one minute, was under 100 and their oxygen level was fine. But when I had them walk up and down a short hall three times, their heart rates jumped: to 110, 120. I put them off from work, to return in a week. If they rest, the lung swelling will have a chance to go down. If they return to work and activity, it’s like running a marathon all day, heart rate of 120. The lungs won’t heal and they are liable to get a bacterial infection or another viral infection and be hospitalized or die.

I had influenza in the early 2000s. My resting heart rate went from the 60s to 100. When I returned to clinic after a week, I felt like I was dying. I put the pulse ox on my finger. My heart rate standing was 130! I had seen my physician in the hospital that morning and he grabbed a prescription pad and wrote: GO TO BED! He said I was too sick to work and he was right. I went home. It took two months for the swelling to go down and I worried for a while that it never would. I dropped 10 pounds the first week I was sick and it stayed down for six months.

Since the problem in influenza is tissue swelling, albuterol doesn’t work. Albuterol relaxes bronchospasm, lung muscle spasms. Cough medicine doesn’t work either: there is not fluid to cough up. The lungs are like road rash, bruised, swollen, air spaces smaller. Steroids and prednisone don’t work. Antiviral flu medicine helps if you get it within the first 72 hours!

You can check your pulse at home. Count the number of beats in one minute. That is your heart rate. Then get up and walk until you are a little short of breath (or a lot) or your heart is going fast. Then count the rate again. If your heart rate is jumping 20-30 beats faster per minute or if it’s over 100, you need to rest until it is better. Hopefully it will only be a week, and not two months like me!

Adverse Childhood Experiences 4: Psychophysiological Illness

I went to the 46th Annual OHSU Primary Care Review, held at the Sentinel Hotel in Portland, Oregon last week.

It was excellent. It was surreal since the Sentinel Hotel started as a 1923 Elks’ Club and the satyr cupid friezes kept distracting me with the marble penises and war chariots during the lecture updating us on urinary incontinence.

Three lectures that I went to talked about Adverse Childhood Experiences.

This is the first conference that I’ve been to that anyone has talked about that study since I heard about it, in about 2005. I have not been to a lot of big conferences over the last few years because I opened my own clinic and money was tight.

Anyhow, the study is creeping into consciousness.

In the mornings, we had the big lectures in a large hall. There were three break out sessions in the afternoon, held in the main meeting, billiard room, club room and library. We all joked about Colonel Mustard and candlesticks.

A gastroenterologist, Dr. David Clarke, gave a two hour session titled “Hidden Stresses and Unexplained Symptoms II”.

1. How to uncover the cause of an illness when diagnostic tests are normal.
2. How to find hidden psychosocial stresses that are responsible for physical symptoms.
3. The process used to achieve successful outcomes in stress-related illness.

He talked about childhood stress. That if someone had a really difficult childhood:
“Surviving a dysfunction home is a heroic act and produces individuals who are:
a. reliable and get things done
b. detail-oriented
c. Perfectionist
d. Hard-working
e. Compassionate”

So what is the down side? “Surviving a dysfunctional home also produces emotional consequences that may lead to :
a. Long-term relationships with partners who treat you poorly.
b. Addictions to nicotine, Alcohol, Drugs, Food, Sex, Gambling, Work, Shopping, Exercise.
c. Quick Temper or being violence prone
d. Anorexia and/or bulimia
e. Mental health problems such as nervous breakdown or suicide attempts
f. Sacrificing your own needs to help others
g. Self-mutilation
h. Learning not to express or feel your emotions.”

Got that? Right. Not everyone, not all the time, but the adverse childhood experiences add up. These reliable individuals may eventually get enough positive feedback to decide that they deserve a relationship that is actually good. They may get angry about their childhood or past bad treatment. “They may have a really hard time expressing that anger because they spent years learning how to suppress emotion and the feelings may be directed at people for whom there is still some caring. When there is enough of this anger present it can cause physical symptoms that can be mild or severe or anywhere in between.”

Let me give two examples from my own practice. I can’t remember their names or the details, so I am making those up: no hipaa violation.

The first was an elderly woman who came in with her husband for stomach pain. We started with a careful history. We tested for helicobacter pylori. We tried ranitidine. We tried omeprazole. We studied her diet and did an ultrasound to rule out gallbladder disease.

At the third visit I was starting to talk about an upper endoscopy. This was more than 15 years ago, back when we did not start with a CT scan. Her husband said, “Doctor, is there anything else it could be?”

I was surprised. “Well, yes. Depression is on the diagnosis list. Sometimes depression can present as stomach pain. Could you be depressed?”

My elderly lady covered her face with her hands, started crying and said, “I try not to be!” while her husband nodded.

We cancelled the endoscopy. I said it really was not something to be ashamed of and we talked about therapy. She did not want talk therapy and we tried paxil. She came back in two weeks, and already she and her husband were brighter and relieved.

Second case: again, stomach pain, this time in a four year old. Mom brought her in.

I did a history and did a gentle exam. The exam was normal. Her stomach was not hurting now. She wouldn’t say anything.

We established that the stomach pain occurred on week days only, not on the weekend. In fact, usually at the after school daycare, not in school.

“Is there a time at the school daycare that she has stomach pain?” Mom was shaking her head when big sister piped up.

“It happens before recess.” Mom and I turned to stare at the six year old.

I said, “What happens at recess?”

“The big kids knock her down,” said big sister, pissed. “I try to stop them, but they are bigger than me. She’s scared. The teachers don’t see.”

“Oh. Thank you for telling us!” Little sister was crying and mom hugged her and big sister. Mom did not need instruction at that point. She called me a few days later. She talked to the daycare, they watched and the four year old was protected. Her stomach stopped hurting.

Dr. Clarke also described a case, where driving through a town would trigger four days of nausea and vomiting that required hospitalization. This had been going on for 15 years. He figured out why that particular town was a trigger: when the patient recognized the why, he was able to go for therapy.

People aren’t lying about these illness, they are not making them up. Doctors have called it somatization, but really it is the body holding the emotions until the person is safe enough to deal with them. Doctors need to learn how to recognize this and help with respect instead of stigmatization and dismissal.

I hope that more doctors learn soon…

Dr. Clarke’s list for further reading is below. I don’t have any of these yet, but they are on my wish list.

They can’t find anything wrong!, by David Clarke, MD. See also

Psychophysiologic Disorders Association:

Caring for Patients, Alan Barbour, MD

Unlearn Your Pain, Howard Schubiner, MD

Pathways to Pain Relief, Frances Anderson PhD and Eric Sherman PhD

Ted talk about ACE scores: