Tag Archives: Beloved

by

Volume of water

We check the tides before we go walk the beaches on the Olympic Peninsula. I am learning the patterns of the tide locally. On North Beach, the tide is about an hour later each day. However, low tide is at a different time further out the Olympic Peninsula. I had to think about that a bit.

Picture the tide a low with the Salish Sea volume down. Then the tide turns and starts flowing back in. The Salish Sea is like the roots of a tree, with a main trunk and then branches and branches and more branches. There is water coming in from the land, from streams and from rivers, but the tide rolls in from the trunk first and then spreads through all of the roots. I have a tide table for the peninsula for this year, and it has tables for multiple different sites! Most days we have two high and two low tides, but once in a while the low goes out so little that it matches both highs, and we only have two tides that day, a high and a low!

I took the photograph at Dungeness Spit this month. The tide was nearly low when we started walking and we only went 2-3 miles down the spit and turned back. It is beautiful! Check the weather, check the tides and always take something rain proof, even in July. Our water is not warm.

For the Ragtag Daily Prompt: volume.

by

Bird talk

A photo tale from a hike last week.

Her: “I think we should discuss our future.”

Him: “Well, um.”

Her: “Wait. Are you trying to tell me something?”

Her: “Is there someone else!!?!”

Him: “I was going to tell you!”

Her: “You lying scum.”

Him: “Wait! Oh, no, she’s GONE.”

__________________________________

For the Ragtag Daily Prompt: create.

These are Pigeon Guillemots, more here.

Photographs taken on Marrowstone Island last week.

by

homage

Homage to the Jubilee and a woman who has seen so many changes. I had two friends over for tea yesterday and had fun dressing up. The suit is made of wool, probably from the 1940s. The gloves were my mother’s. She loved gloves and I have a box. The hat should be pale yellow green too, but this is what I could find.

I am glad that I don’t have to dress this way every day, but it was very fun yesterday. I did not feel encumbered. How DID they keep the gloves clean?

For the Ragtag Daily Prompt: emcumbered.

The first song has tea! And a place in heaven for those who teach in Public School. Sigh.

by

peace me

peace me, loves
peace me, strangers
peace me, Beloved
free us from dangers

peace as a river
peace as a wave
peace as a verb
peace saves

peace my heart
peace all of ours
peace all the friends
peace the wars

peace a gift
peace a joy
peace fearless always
no war toys

peace apparent
peace dove
peace triumphant
peace love

peace me, loves
peace me, strangers
peace me, Beloved
free us from danger

I kept the paper cup in the picture, because the cup is animals and plants, but the cup also is a pair of lungs. Breathe peace. And breathe for all the people recovering from covid-19, short haul and long haul. And breathe love and shelter and support to all those grieving for our dead and let us grieve too.

For the Ragtag Daily Prompt: apparent. And for peace.

by

wild game

My maternal family played a wild game every summer when I was growing up. Wild in that we were in cabins, on a lake, no electricity, no television, living in tents and cabins. My grandparents had two cabins, my Uncles each had one and we were in tents. I loved our tents, though. I still have the tent that my sister and I used. It is over 50 years old now and doesn’t leak. We had very strict rules about tent care. And canoe care. And we could use all the tools but had to PUT THEM BACK. We had aladdin lamps and candles and drank the lake water. We filter it now, and the cabins are still there.

For the Ragtag Daily Prompt: game.

by

Covid-19 and walking pneumonia

I wrote this essay in July 2017. Before Covid-19. It is clear that Covid-19 is also causing a walking pneumonia. People are exhausted when they get out of bed. No fever, they may not cough much, but if they get up, they can feel exhausted. The key to this is the heart rate, the pulse. If the pulse jumps 30 points faster or more, this implies lung swelling and reduced lung capacity. Right now, the only treatment we have is rest and time to heal. I should know, I’ve had really bad walking pneumonia four times: the first two times I was out for two months. The third time 6 months with 6 more months half days and chronic fatigue. The fourth time put me on oxygen.

I want to offer hope to the people with Long Covid-19. Having been through four bad pneumonias, with increasingly long recovery times, and now disabled for doing Family Medicine, I have experience to share. I will write more about that in the next essay.

From 2017: Walking pneumonia is changing.

The classic bugs are four “atypical bacteria”:

mycoplasma pneumonia
chlamydia pneumonia (this is not the STD chlamydia. Different one.)
legionella
pertussis (whooping cough)

However, streptococcus pneumonia can also be a walking pneumonia OR a lobar pneumonia. In a lobar pneumonia the person usually is short of breath, running a fever of 102-104, and they point to where it is: hurts in the right upper chest. On chest x-ray there will be consolidation: whited out from fluid or swelling instead of nice ribs and dark air. They are often tachycardic and hypoxic.

In walking pneumonia the person often has no or minimal fever, they just feel tired or short of breath when they do things, and the chest xray can be “clear”. It isn’t really “normal”, it’s just that the bacteria or virus affects the entire lungs and causes some swelling throughout and doesn’t white it out.

“Double” pneumonia is when the chest film is whiting out on both sides. We also see the lungs whiting out with ARDS — acute respiratory distress syndrome. So after trauma in a car wreck and lots of broken ribs, the lungs can be bruised too and white out. Ow. Influenza virus can cause lung swelling and in the 1917-1918 flu infected military recruits lungs were swelling shut. They would turn blue and die.

“My” strep that I’ve had pneumonia with twice is streptococcus A, not strep pneumonia. It causes strep throat mostly though it can invade and cause sepsis or pneumonia or cellulitis. There are currently 4000+ known strains of strep A, and some are resistant to antibiotics or can cause kidney damage or do all sorts of nasty things. I think that “my” strep is resistant to azithromycin.

The current guidelines say to treat walking pneumonia with azithromycin. However, a paper came out this year saying that resistance to azithromycin is rising among streptococcus pneumonia and that nearly 50% of strains tested were resistant. Uh-oh. That means that azithomycin doesn’t work and the person can get sicker and may die. I talked to a pulmonologist in Seattle when I needed help with someone. He said that he would have said there weren’t any resistant strep pneumo strains here in Washington except that he had one intubated and in the ICU right then. “I’m convinced now, ” he said.

A lobar pneumonia is easier to diagnose. Abnormal chest x-ray, reasonably healthy people run a high white blood cell count (so my frail folks, immunosupressed folks and 90 year olds don’t raise their white blood cell count), and a fever (ditto) and look sick. The walking pneumonia people come in saying they have been coughing for 3 weeks or 4 weeks or two months. I am doing more lab testing because of the resistance.

This winter I have seen 6 different causes of walking pneumonia here: influenza A, respiratory syncytial virus (In more than one person over 60. That is NOT who the books say it should affect. It’s supposed to mostly cause bronchiolitis in babies and preemies), pertussis, strep pneumococcus, strep A and none of the above. All looking pretty much the same, but with different treatment.

https://wwwnc.cdc.gov/eid/article/15/8/08-1187_article
https://www.cdc.gov/pneumonia/atypical/mycoplasma/index.html
http://www.medscape.com/viewarticle/820736
https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=79
RSV: http://kidshealth.org/en/parents/rsv.html
Mycoplasma resistance to azithromycin has been reported too: http://erj.ersjournals.com/content/36/4/969