Tag Archives: choice

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Post Covid Sartorial Splendor

I dressed up in November for the Chamber of Commerce masquerade. This is a 1920s dress and I had to repair the lace around both arm openings. The underdress is rust colored silk and is beaded. The overdress is lace with the beaded and fringed flower with a tassel on the side. The lace is definitely see through and I wore a slip. The silk underdress has beaded squared off tags that hang outside the lace, which is a detail I haven’t seen before. I do not remember where I got this, second hand.

When the silk is nearly 100 years old, it wants to fall apart. I took a second dress just in case there was dancing. If I danced in this dress, it would probably disintegrate.

In other news, here is an article about the Post Covid exercise intolerance. It is a small sample size, but they biopsied skin and muscle in people who were still exercise intolerant one year out from Covid 19. These people all had Covid-19 in 2020, so unimmunized.

https://actaneurocomms.biomedcentral.com/articles/10.1186/s40478-023-01662-2

“Compared to two independent historical control cohorts, patients with post-COVID exertion intolerance had fewer capillaries, thicker capillary basement membranes and increased numbers of CD169+ macrophages. SARS-CoV-2 RNA could not be detected in the muscle tissues. In addition, complement system related proteins were more abundant in the serum of patients with PCS, matching observations on the transcriptomic level in the muscle tissue. We hypothesize that the initial viral infection may have caused immune-mediated structural changes of the microvasculature, potentially explaining the exercise-dependent fatigue and muscle pain.”

This is a big deal. More needs to be done to confirm this, but a talk earlier this year said that the muscles don’t get adequate blood flow and get hypoxic and that the fatigue is recovery afterwards, taking 1-3 days. That is the best hypothesis for why people have the activity “crashes” after exercise or doing a little bit more than usual. My chronic fatigue shuts my fast twitch muscles down when I have pneumonia. This time it was two years before I got them back and I still have to be careful. It’s weird when they won’t work. It’s like the muscles go on strike. They didn’t really hurt (ok, they burned like strep throat all over the two times I had systemic strep A) but it’s more like the muscles are screaming NO NO NO NO! at the brain. It is hard to describe. If I tried to push, it felt like dying. Perhaps the muscle cells really DO start dying if we push them too hard. Mine is annoying but it doesn’t confine me to bed. My slow twitch muscles were fine though this time I needed oxygen. I hope not to experience it again.

This is the mask I wore. Nice to be in a different sort of mask, but I masked at a concert last night and will mask for travel with an N95.

For the Ragtag Daily Prompt: sartorial choices.

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the elk remember

I am trying not to curse you
for hurting my small child AGAIN
she doesn’t deserve that, how can you?
hasn’t she been hurt enough?

I am trying not to curse you
I am a scientist not a witch
witches curse people, I won’t do that
at least, I try not, try not

I can see your choices though
the map laid before you: you must choose
the path to take. A serious decision
that will take some honest work.

I can see your choices: it’s not a curse
it’s not my fault. It’s up to you, your choice
Grief again makes me hurt and angry
but I don’t curse you, I try not

I don’t know when it is too late to choose
you have refused the path over and over
but I am not part of it any more, not angry,
sad. The choice is yours alone and always was

I believe it is never too late to choose the path
and at the same time some people never do
my sister, dying, saying to me alone: “I’m bad.”
Me saying “No.” My sister: “I’m sorry.”

I don’t want to do that again, do you hear me?
If you choose not to change, stay on this path
I suppose I would relent at the end
But I don’t want to. Do you hear me?

I am trying not to curse you
for hurting my small child AGAIN
she doesn’t deserve that, how can you?
hasn’t she been hurt enough?

but there are the elk
I spoke to them once and they answered
to my surprise and yours. I can’t help it if
the elk remember

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what would YOU choose?

Here is a story of a choice about an abortion, a theraputic abortion, where a mother has to make a difficult choice. I have seen Family Medicine patients since 1991, so this will not identify a particular person. No HIPAA problem.

I see a new patient in clinic, a woman, who already has children. She has back pain. All is routine until she says, “Sometimes my leg goes numb from the knee down.” I stop. This is NOT normal. “Completely numb?” I say. “Not patchy?” “Yes.” “How often?” I ask. She shrugs. “Not very.” “If it happens again, call me and I want to see you right away.”

Why? This is unusual because most numbness follows dermatomes if it is from back pain. The dermatomes on the skin wrap from the back down the leg all the way to the toes. When someone describes numbness or the pain of shingles in that distribution, we know which nerve is affected. Numbness from the knee down can come from diabetes and other causes, but it is not on one side and it doesn’t come and go. So the unusual stands out for me.

“Anything else weird?”

“I had vision problems in my last pregnancy. They sent me to specialists, even a neuro opthamologist. He couldn’t find anything.”

“Ok.” I shrug. We move on.

She calls two days later. “Both legs are numb from the knee down.”

“Come in today,” I say.

Both legs ARE numb from the knee down. She also can’t lift her feet. The muscles from the knees down are weak. I get neurology on the phone. “MRI her from the top of her head to the base of her spine.” I call the hospital and set it up. That day.

She has seven brain lesions suspicious for multiple sclerosis. She did have an MRI in the previous pregnancy, which was negative. I do not remember how old the child was, 2-4 years or more when I saw mother.

I call her back in for results, we talk about specialists, and I call a neurologist in the nearest big city, three hours by car from where she lives. We start medications and my patient is scheduled.

She has multiple sclerosis. The flare improves. The visual symptoms were MS in the previous pregnancy, but it was not yet visible on brain MRI.

Then she gets pregnant again. Her symptoms immediately flare. She comes to me and I call the neurologist.

The symptoms are not a little worse. Much worse. “I suggest she terminate the pregnancy.”

My patient is horrified. Until the neurologist’s next words. “She needs to terminate if she wants to be able to walk for the children she has.”

My patient chooses an abortion, to terminate the pregnancy. Because she has a bad version of MS*, she remembers the symptoms in the last pregnancy, she is young, she is clearly progressing and she wants to take care of the children she already has.

What would YOU choose? For yourself, for your sister, for your wife. If you are male, do you have any right to make that choice? Now picture yourself pregnant with that choice. And thank you for reading this.

*Addendum: present evidence says that multiple sclerosis does NOT worsen with pregnancy. However, another illness, NMO (neuromyelitis optica) instead tends to become more active in pregnancy. It previously was lumped in with MS until the antibodies (anti-NMO) were identified and it was realized it’s a different subtype of demyelination disease, with its own treatment options. Medicine changes over time and the woman, the neurologist and I were working with the information available at that time.

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the tide going out

I am thinking about the term “white trash” and choices.

Is “white trash” a discriminatory term? A derogatory term? Is it a type of person or is it a “lifestyle choice”? Or is it a sum of choices?

A friend tells me that it is not discriminatory. Not an insult. A lifestyle. Then the friend says, “Some people would assume that I am white trash because I live in a trailer (manufactured home) and don’t own my own land. I rent.”

Would this person be white trash to you? Does it make a difference if they are male or female? Over 60? Under 30? Single? Have children? Would you feel differently about a single male parent than a single female parent? Would you feel differently if they are widowed instead of divorced?

And at what age do we become responsible?

If I am a child growing up in a household with alcoholism, verbal abuse, parents with mental health issues or grave illness or abandonment, where is the line where I become responsible for myself?

I surveyed my smokers for years, what age did you start? The men mostly said age 9. There was more cultural pressure on women, but the youngest started at 11 or 12. And then the horrific stories, where the parent is offering whiskey to a child under 10. My sister and I wandered around peoples’ houses in the dark when we were under ten. She was three years younger. I was a kid who did not trust adults and was careful. Scared. So we did not get into drugs or alcohol and I hated my father’s unfiltered camels. My parents would not touch illegal drugs, thankfully. I took care of my sister, but we were entirely unsupervised in barns and houses and outside….

I think that our teens are making choices at far younger ages than parents want to admit. I see parents check out when the child is fourteen or even younger. Teens who are nearly living at friends. Teens who already seem lost. And sometimes the parent is wrapped up in a divorce or a parent is sick or dying or a parent is in jail or abandons the family.

What age did you make choices? Did you make good ones? And is white trash hate speech? If you made bad choices, were you able to change later on?

What is the line between free speech and hate speech? And what is the line between love and enabling?

I am still searching….


Over the Rhine: Fool and Let it fall

For the Daily Prompt: rhyme. No, it doesn’t rhyme. But I am thinking of the phrase: no rhyme or reason….

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Pick a plan right for you…..

We are in open enrollment for health insurance in the US. Meaning that they all are going up in cost and they are cancelling plans and offering new ones. And advertising: pick a plan right for you!

What the hell does that mean?

It means that all of the plans exclude things. Oh, well, aromatherapy…. that’s what you are thinking if you are not a US citizen. Of course the plan doesn’t cover aromatherapy or crystal healing or fringe treatments….

Well, no. I had to choose between two plans when my daughter was 17, that is, two years ago. I could choose the one that covered cancer OR the one that covered pregnancy. Uh, yes, that is correct. One EXCLUDED pregnancy healthcare and the other EXCLUDED cancer healthcare. For me and my children.

Which would you choose?

My mother died of cancer at 61 and my sister at 49. My daughter was not dating yet. Observing.

So we picked cancer.

I photographed the crows out on a walk the other day… how many does it take to make a murder?