Tag Archives: change

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Keep it simple

Sometimes I just despair as I read new guidelines. Don’t you? Maybe you are not a physician and don’t try to keep all of this impossible stuff in your head. Mine is full. Tilt.

Diabetes alone: if someone has type II diabetes, there are specific blood pressure guidelines, cholesterol guidelines, we are to do a hgbA1C lab test every six months minimum and more often if they are out of control, and a urine microalbumin/creatinine ratio yearly. If that starts being abnormal we are to start one of two classes of blood pressure medicines even if they have normal blood pressure.

Oh, and don’t forget: a yearly eye test and we are supposed to check their feet at EVERY visit to make sure they are not getting diabetic ulcers.

Got that? And that is just type II diabetes. And there are a whole raft of medicines, about forty right now. Some are weekly shots, some are daily tablets, some are twice a day or with every meal and they all have their own side effects, how fun. Check drug interactions, are their kidneys ok? Is their liver ok? Diabetes increases the risk of heart attack and stroke and don’t forget those feet.

Diabetes is one of the most complicated sets of guidelines, but there are a rather appalling number of guidelines. Maybe we should sic an AI on that job: Mr. Smith has type II diabetes poorly controlled, hypertension, erectile dysfunction, feels a little short of breath and has a bruise on his left shin after tripping yesterday. Please, AI, organize a twenty minute visit to cover as many things as possible efficiently and have the note finished and followup arranged by the end of it. Then it turns out that what Mr. Smith really wants to talk about is his niece who has just overdosed and nearly died from heroin, so everything else goes out the window. Maybe I should see him weekly for the next month.

Do you want to keep it simple and stay out of the doctor’s office and more importantly out of the hospital? If you are 25 and healthy, you don’t much care because old is unimaginable.

But there is a very nice study that looked at just five things regarding health, over 28 years for men and 34 for women: “The researchers looked at NHS and HPFS data on diet, physical activity, body weight, smoking, and alcohol consumption that had been collected from regularly administered, validated questionnaires.”

Here is an article about the study: https://www.health.harvard.edu/blog/healthy-lifestyle-5-keys-to-a-longer-life-2018070514186

Here is the study: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.032047

So let’s break the five things down. Here are the more formal definitions: “Using data from the Nurses’ Health Study (1980–2014; n=78 865) and the Health Professionals Follow-up Study (1986–2014, n=44 354), we defined 5 low-risk lifestyle factors as never smoking, body mass index of 18.5 to 24.9 kg/m2, ≥30 min/d of moderate to vigorous physical activity, moderate alcohol intake, and a high diet quality score (upper 40%), and estimated hazard ratios for the association of total lifestyle score (0–5 scale) with mortality.”

First: never smoking. I would add never vaping and not living in a cave and burning wood and hopefully not living right next to a 12 lane superhighway, all of which are bad for the lungs. Ok, while we are at it, don’t use methamphetamines or heroin or cocaine or krocodil, right? They didn’t even include those in the study.

Second: Body mass index 18.5-25. If you aren’t there, it is diet and exercise that need to change.

Third: Thirty minutes or more per day of moderate to vigorous physical activity. That can be ten minute intervals. Three can have an enormous effect on number two.

Fourth: moderate alcohol intake. Ok, alcohol is bad for the heart, period. So is tobacco. They defined moderate as less than or equal to “5 to 15 g/d for women and 5 to 30 g/d for men”. Let’s do the math: a 12 ounce beer that is 5% has 14gm of alcohol. Here: https://www.niaaa.nih.gov/alcohols-effects-health/overview-alcohol-consumption/what-standard-drink. The 8.9% 16 ounce beer at our local pub has quite a bit more. Here is a website where you can calculate how much alcohol is in a drink: https://www.rethinkingdrinking.niaaa.nih.gov/Tools/Calculators/Cocktail-Calculator.aspx.

Fifth: Diet. There is an overwhelming amount of confusing information on the internet and some of it is not only confusing but wrong. “Diet quality in the NHS, HPFS, and NHANES was assessed with the Alternate Healthy Eating Index score (Methods in the online-only Data Supplement), which is strongly associated with the onset of cardiometabolic disease in the general population.” I have not assessed my own Alternate Healthy Eating Index score. However, there are a couple very straightforward things that help with diet. First: No sweetened drinks. That means that sugary coffee with the syrup should go. I quit drinking mochas when I read that a 12 ounce one has 62 grams of carbohydrate. I would rather have a small dark chocolate. And sodas are just evil and juice not much better. Eat the fruit instead. Second: eat vegetables, every meal. A fruit is not a vegetable and no, potato chips don’t count. I mean a green or yellow or red vegetable. You can saute any vegetable, or any that I can think of. I am not counting grains as a vegetable, so pasta, pizza, potato chips and so forth do not count. Beans do count. Third: the DASH diet recommends only a tablespoon of sweetener per day. That is not very much. You can make that cheesecake slice last a week! A small piece of dark chocolate daily or tablespoon size chunk of that cheesecake.

I had a diabetic patient who would be fine, fine, fine, then out of control. “WHAT are you eating? And drinking?” The first time it was two 16 ounce Mochas a day. Then he was fine for a year and a half. Then labs went haywire again. “What are you drinking?” “Well,” he said, not wanting to admit it, “Ok, I decided to try Caramel Machiattos.” “No, no, no! You can’t do that! You’ll end up on insulin!” “Ok, ok, got it, got it.”

And what is the difference if I try to do those five things, you ask, skeptical. “We estimated that the life expectancy at age 50 years was 29.0 years (95% CI, 28.3–29.8) for women and 25.5 years (95% CI, 24.7–26.2) for men who adopted zero low-risk lifestyle factors. In contrast, for those who adopted all 5 low-risk factors, we projected a life expectancy at age 50 years of 43.1 years (95% CI, 41.3–44.9) for women and 37.6 years (95% CI, 35.8–39.4) for men.The projected life expectancy at age 50 years was on average 14.0 years (95% CI, 11.8–16.2) longer among female Americans with 5 low-risk factors compared with those with zero low-risk factors; for men, the difference was 12.2 years (95% CI, 10.1–14.2).”

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I took the photograph from Marrowstone Island. What does a healthy seal diet look like? I am so lucky to have miles of beach to hike, as long as I watch the tides and don’t mind rain.

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Make space for the difficult feelings

I am watching a four part video from the UK about illness and trauma.

The first part is about how trauma memories are stored differently from regular memories. Regular memories are stored in files, like stories in a book or a library.

Trauma memories are stored in the amygdala and often are disjointed and broken up and have all of the sensory input from the worst parts, including the emotions.

The therapist is talking about healing: that our tendency is to turn away from the trauma, smooth it over and try to ignore it.

However, the amygdala will not allow this. It will keep bringing the trauma up. And that is actually its’ job, to try to warn and protect us from danger!

The therapist counsels finding a safe time and place and safe person (if you have one) and then making space for the trauma to come back up. One approach is to write out the story, going through that most traumatic part, but not stopping there. What happened next? Writing the story and then putting it aside. Writing it again the next day and doing this for four days. As the story is rewritten and has an ending, even if it is not a happy ending, the story is eventually moved from the amygdala to the regular files. People can and do heal. They may need a lot of time and help, but they can heal.

I am not saying that four days of writing stories is enough. That is one approach, but nothing works for everyone and people need different sorts of help. There are all sorts of paths to healing.

In my Family Practice clinic I would see people in distress. With some gentle prompting and offering space, they would tell me about trauma and things happening in their personal life or work life. Things that were feeling so overwhelming that they could not tell their families or friends and they just could not seem to process the feelings about it. I would keep asking what was happening and give them the space to tell the story. Many times when they reached the present they would stop. There would be a silence. Then I would say, “It seems perfectly reasonable that you feel terrible, frightened, horrified, grieved, whatever they were feeling, with that going on.” And there was often a moment where the person looked inwards, at the arc of the story, and they too felt that their feelings were reasonable.

I would offer a referral to a counselor. “Or you can come back. Do you want to come back and talk about it if you need to?”

Sometimes they would take the referral. Sometimes they would schedule to come back. But nearly half the time they would say, “Let me wait and see. I think I am ok. I will call if I need to. Let me see what happens.”

When a person goes through trauma, many people cut them off. They don’t want to hear about it. They say let it go. They may avoid you. You will find out who your true friends are, who can stand by you when you are suffering. I have trouble when someone tries to show up in my life and wants to just pretend that nothing happened. “Let’s just start from now and go forward.” A family member said that to me recently. Um, no. You do not get to pretend nothing happened or say, “I wanted to stay out of it.” and now show back up. No. No. You are not my friend and will not be. And I am completely unwilling to trade silence about my trauma for your false friendship.

Yet rather than anger, I feel grief and pity. Because this family member can’t process his own trauma and therefore can’t be present for mine. Stunted growth.

People can heal but they need help and they need to choose to do the work of healing.

The four videos are here: https://www.panspandasuk.org/trauma.

This song is a darkly funny illustration: she may be trying to process past trauma, but the narrator doesn’t want anything to do with it. And he may not have the capacity to handle it. He may have his own issues that he has not dealt with. And maybe they both need professionals.

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This too two to

This two too to I want to remember.
Licking? Touch for certain, together.
Warmth and safety and rest and trust.
The trust eroded as you run away
over and over. You say always but
you say other things that I can’t believe.
And yet my heart is stubborn still.
This two too to I want to remember.

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Poem series: This. This too. This too two.

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This too two

This too two I want to remember.
Disagreeing. Respectful nearly always.
You say, “You argue with everything.”
“I think about both sides.” I say.
“And if I am alone I discuss both with myself.”
You roll your eyes and I grin and continue.
This too two I want to remember.

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This too

This too I want to remember.
Discussions of the world together.
The mysteries of science and sweatpants strings.
String theory and medicine, cabbages and kings.
Why the sea is boiling hot and whether pigs have wings.
This too I want to remember.

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Catch and release

The chances of you changing are quite small.
I know from very early in our time.
Why God makes angels that will one day fall.
We could be sent to teach each other rhymes
or something else. I wonder at it daily.
My heart opens like a flower even so.
The candle just at dusk burns quite palely.
I wonder what excuse you’ll use to go.
It’s a comic denouement I see at last.
You denigrate my knowledge and my skill.
After exposure you refuse to wear a mask
or test. I rise in anger at ill will.
It’s comic that I’ve liked your busy mind.
Respect for mine is nil: you elk’s behind.

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Yesterday

A triple play: a loss, a gain, a change.

Yesterday

Yesterday our friendship died for good
A small death that won’t be noticed
I want to place a small cross on the day
to mark this death and life
life because my small child is gone
she grew up, now part of the quiet woman
who came to me in a dream
when you left
you move on and tell me you won’t change
so you will find another to draw close
and push away, terror
that you will be trapped
you already are, in your own mind
you say you want freedom
in refusing change, that is death
slow and alone, is lonely different from alone?
call it freedom as you wish

I want to grow, I want to learn always
you want your past, your dead
you tell me I am keeping you from your life
you have it back I say as music restarts
I don’t, you say, my brother is dead, my wife
I did not cause those
they happened before we began to walk
and yet you blame me
like an angry child

I am in the gardens wandering
I am in the gardens wondering
the gardens of the world
everything is a garden
though some are planted with skulls
and young people fighting
It is strange to feel whole
I do not know what to do with it yet
but I will

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I have fallen for this band. I am really enjoying them.

For the Ragtag Daily Prompt: triple.

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trauma bunnies

We can work it out, the song says. But no, maybe not, not always.

Trauma bunnies together. Walking. Why would you walk with me, I am so down? Oh, you are a trauma bunny too. Walking on the beach, slowing down, looking at rocks. The walks get longer and longer. You bring FOOD and tell me I have food insecurity. I laugh. But it is true.

Comparing notes about childhood. You say yours was worse. Yours was terrifying. You ran away over and over and over, but came home. Small children need food and shelter. You get older. A neighbor says if you run away now, you will never stop running. You do not run away permanently. But you still run.

My childhood has no bruises to the skin. But the bruises to the heart are a nightmare. You finally say that I win, my childhood was worse. But I was not trying to win, I want to say. I was just telling you as you’ve told me.

We have both survived damage and coped. I have the resource of a grandmother with money who paid for medical school. I apply without telling my parents, after my mother says, “You don’t want to be a doctor. It’s too much work.” I am a poet, a writer, being a doctor so I can study people and have children and be certain there is food. Job security. And food security, true. With a husband or without.

You fight school all the way, but when you are told that you will be a failure or in jail, you decide that you will prove them wrong. You are still proving it. You won’t tell how you make your money, not to the locals, but the new car every two years tells them you have money. And it’s the wrong kind of car: a liberal car for a professed conservative. It stands out.

We start playing trauma bunnies after six months. You want me to come to dinner and I turn New Yorker and direct: is this a date? You are surprised. I set the boundaries and you think about it. And say yes.

But trauma bunnies is not as much fun as the beach. We get close and intimate and then you run. When you run, I run too: the other way. I don’t chase you. You haven’t experienced that before. You keep coming back. Why aren’t I chasing you? Because I too am a trauma bunny, remember?

Back and forth: close and far, together and apart. All holidays become times when you run, so that I will not be part of the family. I announce that I am now your mistress and you can’t be with my family either. Back and forth. Closer and then you refuse to come to my son’s wedding. Far again.

You say the summer will be very busy. You say your focus is music. You say we can go to one beach. One beach? For the whole summer? I run to europe and you are surprised. I ask, are you too busy to have me around? No, you say. But when I return, you have a friend staying with you. Intimacy disappears.

I am tired of it. My daughter is here.

At last I bring up sex: are we done with that?

No, you say. We have visitors.

Wouldn’t stop me, I say.

You say, sex is still on the table. Then you hem and haw. You say sex is not important, you can take or leave it. The friendship is more important. Well, the friendship is most important, but sex IS important to me and hello, it’s damn insulting of you to say you can take or leave it. Leave. This is all triggered by your yearly family get together. You need me at a distance so you won’t be tempted to invite me. You don’t want me there so I am distanced again.

And I am done, done, done. I dream of a small child, a wild woman, a woman doctor and someone new: a quiet woman. I think about the quiet woman and I ask the other three. Yes, they say.

The quiet woman is the adult. Not the mask of the professional, not the wild defense fighter, not the small child. The small child has healed. She is the connection to the Beloved, to the source of the poems. She blesses the others. The quiet woman takes over.

The quiet woman takes over. She says goodbye, farewell, Beloved keep you and bless you, you may contact me any time.

You are in your cave alone and do not answer.

You may end up there, alone, alone, alone. You want freedom most of all, you say. Another song: freedom is another word.

Yes it is. People can change and grow. But some want to and some don’t and sometimes we don’t grow at the same time.

Yes, says the quiet woman. Sometimes we don’t grow at the same time.

Fade to quiet.

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I took the photograph from a canoe at Lake Matinenda in Ontario, Canada.

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Ogre

I am now a full grown Ogre

We mature at a different rate
than you humans
I don’t really pass as human
but since I am 5’4″
no one guesses I’m an ogre

I have been an Ogre since
before birth
my mother ill
attacked by antibodies in the womb
luckily the illness does not cross
the barrier of the mixed mother daughter
the placenta
but the antibodies do cross

I am born with my immune system
red hot and ready to fight

my maternal grandmother is an Ogre too
she cares for me while my mother heals
you are right to refuse help she says
you may feed yourself
and she lets me
I am four months

Two grrl cousins are also stressed from birth
one arrives early and survives
smallest child to live in that city
all they have for premies is a warm box
her parents are warned
she might be slow

the other is born in Bangladesh
mother very ill
mother damaged by illness
she survives too

three Ogres?
No
different mitochondria
from three different mothers different immune systems different parents

Ogre, dark angel, and martyr

And the others wonder why we fight

A woman says “I like you when you’re well.”
to me when I am sick
and my partner disappears
he says, “I can’t have a disabled partner.”
I snarl, “I am not disabled.
I am just on oxygen.”
But it is not true
I am disabled
And very annoyed

I avoid the woman for a year
and think about it
I am never “well”
if it’s an antibody disorder
and if I got it in the womb
what would I be like if I did not have it?
no one knows
and I don’t either

So I have done well
in the end
to survive a chronic illness since before birth

Ogres take longer to mature
but once we do
we are hell on wheels

And at last I accept it

I am happy being an Ogre
and I will be the best Ogre I can

And it will be fun
At least, for me