In college at the University of Wisconsin, I dated a gentleman who was following the Zen Buddhist tradition.
He meditated daily, for forty minutes, facing a wall.
I was quite intrigued. I did not think I could do that. I am a fidgety person and can’t sit still. I promptly tried it.
Forty minutes is a long time facing a wall at age 19.
I would fall asleep. I would start tilting to one side or the other on my zafu and jerk back up. I knew I was not supposed to follow thoughts, but I couldn’t not think. It is more subtle than that: I slowly figured out that I can let the thoughts pop up from the toaster brain, but try not to follow them. Wave at the thought. Let it go.
One day there was a small hole in the wall when I faced it. A tiny spider came out and went back in. I was very happy about the spider.
The next day the spider came out and waved one leg at me. Then it went back in the hole. The end of the 40 minutes is signaled by a chime. I got suspicious afterwards and went back to the wall. Not only was there no spider, but there was no hole, either. I did not see any more holes or spiders.
I meditated regularly daily for two years. After that I would return to practice intermittently. Meditation trained my breathing: my breathing slows way down during meditation.
I use that breathing when I have pneumonia. In the worst episode, I was in the hospital and disbelieved. I slowed my breath way way down to calm myself and so that I could think. Eight counts in, eight counts out. Then ten, then twelve. I needed to focus and figure out what was causing sepsis symptoms. And I did figure it out. The provider sent me home that morning, septic and 6 liters behind on fluid, but I was able to survive.
Now the pain clinics are teaching slow breathing. Five seconds in and five seconds out. Start with a few minutes and work up to twenty minutes. “Almost everyone goes from high sympathetic nervous system fight or flight state to the parasympathetic relaxed nervous system state.” I think we need more of that, don’t you? This is being taught for anxiety, for chronic pain, for fear and depression. I asked a veteran to try it. His response: “I hate to admit it but it works.” Also, “I’m not used to being relaxed. It feels weird.” I laughed and said, “I think it might be good if you get used to it.” He reluctantly agreed and continued the practice.
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.
I took this May 31, 2022. I was still pretty sick with pneumonia and needed oxygen to do practically anything. I had dropped ten pounds the first week of being sick, March 20th. In 2014 it was six months before I could return to work and then only part time and exhausted. So I knew I was likely to be in for a six month haul. I hadn’t figured on needing oxygen, but it made me feel so much better and be able to think again!
Anyhow, I was entertaining myself by going through my closet and putting on things that I did not wear to work. I like the sun lighting up my legs in this photograph. The dress is shorter than it looks and the jacket has tags in Japanese and is a soft woven silk. I thrift shop by feel, because silk and mohair and cashmere and wool and cotton feel so wonderful.
Later the same day, I took this photograph:
I would wear out very quickly during the day. Today it is pouring here and last summer by now it was much much warmer! The sun made my lungs hurt less.
I wrote this in 2017, about influenza. However, I think covid-19 can do the same thing. Part of long covid is letting the lungs really heal, which means infuriating amounts of rest and learning to watch your own pulse. Watching the pulse is easier then messing around with a pulse oximeter. The very basics of pulse is that normal beats per minute is 60 to 100. If your pulse is 70 in bed and 120 after you do the dishes, you need to go back to bed or the couch and REST.
From 2017: 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. Her oxygen level would start dropping as soon as she stood up. 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. Tachycardia. 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’d gotten 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 tightness. Cough medicine doesn’t work very well 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!
Feel free to take this to your doctor. I was not taught this: I learned it on the job.
I took the photograph, a stealthie, in June 2021, when I was still on oxygen continuously.
A friend says he does whatever he wants. He refuses to answer questions about how he makes his money. He doesn’t care if this annoys people. I suspect he may enjoy it.
I have one of those public jobs. Well, had. I have now been disabled from Family Medicine for a year. My lungs are much better than a year ago but they are not normal. And I have now seen 17 specialists and 3 primary care doctors since 2012. The consensus is “We don’t know.” Though many specialists are not willing to say that. What they say instead is, MY testing is NORMAL, go to someone else. My lungs are not normal, but I am on my fourth pulmonologist. I saw a cardiologist this year and the first thing he says is, “It’s your lungs, not your heart.” Well, yeah, I know that.
I miss my patients, but there is something freeing about not working. Ok, more money would be nice, but I am doing ok. Meanwhile, I am thinking about what to do now. I can write full time. Write, make music, travel (on a budget) and sing. And speak up.
Doctors have interesting portrayals on television. We went from Dr. Kildare to Dr. House, working our way through the shows with an emergency room and medical residents. ER drove me nuts. No one EVER dictated a chart so at the end of each show I hyperventilated at the hours of paperwork/computer/dictating they had left. House interests me because it’s always the thing that the patient is hiding or lying about that is the key. “Go search his apartment.” says House. I have figured out cases by getting permission to call family or a group home. More than once.
But a physician is a public figure. I had been here for less than a year when a woman comes up to me in the grocery store and says “What are my lab results?” I look at her blankly. I can’t remember if I really did the snappy comeback that comes to mind: “Take off your clothes and I will see if I remember.” I respond politely and she says, “Oh. I should call the office, right?” “Yes, I try to leave the work there,” I say. If a particularly difficult person was bearing down on me, I would whisper “cry” to my kids. That worked. They would act out on cue and I would be the harassed mother. The person would back off.
I am in a small town. We have three grocery stores. I see patients everywhere, now that it has been 22 years. If I remember every detail, that means they are or were really sick. And we have the layers of relationships: someone might have kids the same age or work with boats or be in chorus with me. Once I take my daughter to a party. The mom introduces me to two other mothers. “She’s my doctor,” says the introducing mom. “Well, me too.” says the second. “And me,” says the third. We all laugh.
Once I am visiting my brother outlaw’s bicycle shop. He has a customer. The customer starts talking to me too. Brother outlaw says, “Do you two know each other?” The customer eyes me. I have my neutral doc face on. “She’s seen me NAKED!” says the customer and I howl with laughter. What a great reply. And my brother outlaw gets it.
Docs have to pay attention to HIPAA. When three women say that I am their doctor, I reply, “Yeah and I left my brain at work, so I can’t remember a thing.” Those three were healthy, so I really do not remember labs or the results of a pap smear. Once I was in cut off shorts and waved at an older woman who was at the ophthalmologist’s. She sniffs and looks away. I get the giggles: I think she did not recognize me. My town is only 10,000 people, so after 22 years I have taken care of many of them. Though sometimes people thank me for taking care of their mother, and after it sounds unfamiliar I ask if they mean Dr. Parkman? Oh. Yes. People get me mixed up with two other small Caucasian woman doctors.
I started the “outfits inappropriate for work” category last year when I was still very sick and short of breath and on oxygen. I did not go out much, partly to avoid covid. My pneumonia was something other than covid and it was my fourth pneumonia and I should not need oxygen. Now I’ve had mild covid and the oxygen is only part time. I sang at my son’s wedding, off oxygen, so I can sing off oxygen for a short time. I danced off oxygen too and did get QUITE short of breath. Since I am no longer a public figure, I can speak out and speak up more. I am thinking about that, particularly with the recent Supreme Court news. I do not agree with what they seem to be planning.
I had covid recently AND I have been very lucky with it.
WHAT?
Ok, so when the war started I had been talking to a friend in Europe about visiting. He said nice seasons were May and September, but he and his wife have a kitchen make over planned for September.
“My son is getting married at the end of April, after two year long postponements, and so May doesn’t seem feasible. Maybe next May.”
Then the war starts. And it is affecting gasoline and causing inflation. I call my friend. “Can I come in two weeks?” March to early April.
“Yes. We have other guests a week after that.”
“Ok.” I try to get a British Airways ticket to stop in London to see an old friend from high school. British Airways has a computer attack and three days go by. To heck with it. I buy a ticket to Paris and on to my friend’s country.
I spend an hour on the phone trying to change to a layover in Paris for three days. I manage that. I fly to Paris and then take the train to London. Three wonderful days with my friend in London. I mask on planes, metros and trains. I double mask on the airplane, with my oxygen, and use a ceramic straw to drink liquids.
After three days I take the train back to Paris, the local train to the airport, and fly to my old friend’s. I arrive at midnight and we take the metro.
We do lots of sightseeing and take a memory trip to his parents’ graves and the town we lived in when I was 17 and he was 18.5. I was an exchange student. The language comes back. I can read but listening is more difficult. My brain won’t process it fast enough.
Four days before I am due to fly back, I get an email from AirFrance. I need a negative PCR covid test within 24 hours of flying to return to the US.
Well. I have a mild headache and muscle aches. Probably not covid, BUT. I go online, register in the country for a test and go to the testing site. Positive. I read about covid. The muscle aches of this strain usually happen at day 4-5. I did notice that going from London to Paris to my destination four days earlier, I feel a little off balance. Not bad, not spinning, just slightly weird. So my guess is that I am at day 4 or 5 of covid.
My hosts have both had covid within the last month, so I am not confined to my room. I read the rules for being allowed on the airplane once you HAVE covid. I have to wait 11 days, have a certificate of the test and then the eleven day certificate saying cleared. I isolate for 5 days, spend about 8 hours rescheduling the flight with Air France and Delta, and contact my doctor. My doc wants me to take medicine, but the local medical people where I am say I am not sick enough. I agree with the local people. The headache is gone the next day, I have mild sniffles, and my lungs are fine. Well, at least, they are no worse.
When I am out of isolation, I take a train to another town masked and stay at a hotel for four days. In that country, 80% of the people are vaccinated and 80% have had covid. They are no longer masking, except a few. I am feeling good. I mask when I am around other people and in all public spaces in the hotel.
The trip home is rather more exciting than I would like. At the airport I am informed that I need a doctor clearance ALSO. They say retest. I say “I AM a doctor.” and pull out a copy of my license. I brought it just in case the war spread and I needed to help out. They let me on the plane. In Paris I nearly miss my connection, but am one of the last 8 people on the plane. I am very relieved once we take off.
The silver lining is that at my son’s wedding I am now very unlikely to get covid or give anyone covid and mine was very mild. The Omicron BA2.12.1 that is circulating in Europe is milder than the previous strains AND ten times more contagious or more. So the covid is morphing towards a cold, which is what coronaviruses used to do to us. There are some strains that I read about that are going in a more virulent direction, so I would prefer to have the mild one and be protected from the nasty ones.
I am hoping that it’s more and more Omicron BA2.12.1, since it seems to be milder. I am reassured that covid did not make my lungs worse. Within a week I am better from covid and then get what seems like a normal cold. Covid testing negative. I am feeling well for the wedding and reassured that a normal cold does not force me on to continuous oxygen. I am feeling lucky about the version of covid that I have but I am NOT recommending that people get it on purpose, because even with mild covid, some people go on to develop long covid. Here is an article that I got yesterday through the American Academy of Family Practice:
Long covid is very worrisome and we don’t know what it will look like after a year or more. Many of the present studies are on unimmunized people, from the first year of covid, so the studies of immunized are still evolving. There is hope that there is less risk of long covid with immunization but there is still a risk.
Covid will continue to morph into different strains. We continue to get “colds” or “upper respiratory infections” because the viruses are very very good and fast at changing and avoiding our immune systems. Consider checking the CDC data tracker above regularly to see if your county or your destination has a high covid level and if so, mask back up.
One caveat: my local health department says we have a high level of transmission right now, here:
Remember that all of these sites have to exchange data and update everything. My best guess is that the local has the best numbers, but that is a guess.
Over KwanChunChrisSoliday, we discuss bicycles. We now have a plethora of electric bicycles, so we need a phrase that describes the “old” style bicycle. We came up with acoustic or analog. I like acoustic bicycle, because it sings.
My friend B-from-Arlington (BfA): “But they don’t make noise.” He didn’t approve of either idea.
“Well, we had spoke bells, and playing cards. My bikes make noise.” Sometimes it’s me making it.
We are riding on a rails to trails path in Northern Virginia. Seven of us and me on oxygen. It’s only my second bike ride since March 2021, when my lungs fell apart. We are all on acoustic bicycles.
I feel pretty strong for most of it, 14.5 miles. It seems flat, though it is a very gentle downgrade, until the last 0.5 mile, which is gently up hill. Oh, my lungs don’t like that bit at all and by now my muscles are saying Why are we doing this? I am relieved when we get to the coffee shop destination. Three of us will stay there, while the other four will ride back and get the cars. I hang out with K-f-A, BfA’s spouse, and their son. Their son examines my phone, asks why it has four camera eyes. I have no idea, so he proceeds to figure it out. We play with the slow motion camera for a while.
We know what a penny farthing is, and safety bicycles and tricycles. The early safety bicycles did not have brakes and had wooden rims and wooden spokes. My brother outlaw has one, from the 1880 or 90s. Another friend collects penny farthings and has one that is entirely of cast iron. It would be a little bumpy and the seat is pretty hard. It is also massively heavy. So now we add acoustic bicycles to the electric ones.
So, should healthcare workers be required to have Covid-19 vaccines?
Yes.
What is the precedent?
Take tuberculosis, for example. Airborne, very contagious. I was born in a Knoxville, Tennessee tuberculosis sanatorium, because my mother coughed blood a month before she was due and got quarantined for active tuberculosis. Yes, the state could quarantine my mother. I was removed immediately at birth because tuberculosis doesn’t cross the placenta. The antibodies do, but the infection doesn’t. However, newborns usually catch it and die very quickly. I was lucky. My father and grandparents took care of me for 5 months. Then my mother was allowed out (after 6 months total) but was not strong enough to take care of me. So I was taken to my maternal grandparents for the next four months, and did not touch my mother until I was 9 months old.
My mother was taking 36 pills a day at home, because you have to use multiple drugs to kill tuberculosis. It develops drug resistance very very quickly.
Well, so what, you say?
Healthcare workers in the United States are routinely checked with a ppd for tuberculosis. If it is positive, you cannot work until further testing. If you have latent tuberculosis, you are treated. If you have active tuberculosis, the treatment is longer and more complicated, here: https://www.cdc.gov/tb/topic/infectioncontrol/default.htm
My cousin then said, “Well, you don’t have to show the tuberculosis test to go in a restaurant!”
Well, not right NOW, because currently tuberculosis is under more or less reasonable control in the US. Remember that guy who came in to the US with active multi drug resistant tuberculosis and knowingly exposed everyone on that airplane? Great. I remember reading about that and thinking what a selfish jerk he was. And then the group of unimmunized people who went to India and all got measles. The US at that time did not bar anyone from returning, but asked them to finish a 3 week quarentine before returning to the US. One person did not do that. There was a measles outbreak in the midwest which cost the CDC (and therefore you and me because those is tax dollars) millions to trace, quarantine and clean up. So there was discussion at that time about whether the policy should be changed and we should not allow US citizens with known infectious diseases to come in on airplanes. We DON’T allow immigrants in with infectious diseases: they are tested for tuberculosis if coming from countries where it is endemic.
So, if we had a huge outbreak of tuberculosis, we WOULD have quarantines and shut downs.
I have tested a patient for tuberculosis, about two years ago. Her son had been diagnosed with active tuberculosis. We tested her with a blood test and then repeated it in three months. Negative, hooray. In residency I also saw a case of miliary tuberculosis. That is where the tuberculosis is growing so well in the lungs that it looks like little grains of rice in the lungs on imaging. Not a good thing.
My cousin: “You shouldn’t have to put something in your body to work.”
If you have tuberculosis, you do not get to work in healthcare, because you can kill your patients. I think that this is a good thing, to not kill our patients.
I am submitting this to the Ragtag Daily Prompt: starspangled. Keep America Healthy, how about that?
Discover and re-discover Mexicoβs cuisine, culture and history through the recipes, backyard stories and other interesting findings of an expatriate in Canada
Engaging in some lyrical athletics whilst painting pictures with words and pounding the pavement. I run; blog; write poetry; chase after my kids & drink coffee.
Refugees welcome - FlΓΌchtlinge willkommen I am teaching German to refugees. Ich unterrichte geflΓΌchtete Menschen in der deutschen Sprache. I am writing this blog in English and German because my friends speak English and German. Ich schreibe auf Deutsch und Englisch, weil meine Freunde Deutsch und Englisch sprechen.
KO Rural Mad As Hell Blog 
You must be logged in to post a comment.