Tag Archives: photography

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do without

In a recession we learn how to do without.
We tighten our belts. We drive less.
I am glad that I’ve paid for the CSA for the season
Vegetables until late September. The money is gone.
I like the computer. I could do without.
I have songs and instruments and many books.
I wish my children lived closer. On the other hand
maybe they have a better chance of survival scattered
around these United States when it comes to war.
The war has already started. The war has been beating women down
for centuries. I am tired of it. Women are tough. I am tough.
I know how to do without. Right now I am glad each time
I turn the tap and there is clean water. There are many many people
without clean water. I have filter systems. They won’t last forever.
I am loved by my children and friends. I can do without.
I am sad but I can do without. I am preparing to do without
you.

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Local art

I took a photograph yesterday of a large chalkboard outside a coffee shop downtown. Isn’t it fabulous and creative? And she has a website, here: https://aine-sandford.format.com/#3

Now you can name another woman artist, who does chalk pastels and gorgeous water colors.

For the Ragtag Daily Prompt: creativity. My photograph of her chalk art and my blog!

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sciatica

Gnomes have dermatomes
call me on their cell phones
inflammed neurons fire moans
after lifting heavy stones

gnomes with grumpy dermatomes
stop riding on your spotted roans
ice your backs, lie down at home
gnomes complain and curse and moan

gnomes with calming dermatomes
glad they iced them there at home
families help, they’re not alone
healing gnomes pained dermatomes

For the Ragtag Daily Prompt: dermatome.

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Shift or not?

Shift or not? Oh. I read it as swift or not. I am not going to shift from swift. It is too early to swiftly shift from swift to shift. Swift or not? Well, both. Not a swift as in the bird, but a swift and strong flier. Great blue herons always look incongruous to me in trees. They do like really big trees, but they always surprise me out on a branch. They have very light hollow bones compared to us and can sit lightly on a branch like this.

For the RDP: shift. I am swiftly feeling incongruously shifty on this early Monday.

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Normalizing our behavioral health response

I keep seeing headlines: MENTAL HEALTH IS WORSE. TEENS ARE STRESSED. ADULTS ARE STRESSED. DRUGS AND ALCOHOL AND DOMESTIC VIOLENCE ARE UP.

Like they shouldn’t be? This isn’t news. It is expected, because we are in a pandemic, the death rate is up, people are frightened, the scientific news changes daily and now we add a war.

OF COURSE PEOPLE ARE ANXIOUS AND STRESSED. And when stress goes up, substance “overuse” goes up too. Add fenanyl to the mix and the overdose death rate is up. Should I call it the “overuse” death rate to be politically correct? I do think that it is stupid to stigmatize “overuse”. But I also do not like the term “overuse”. Addiction may be stigmatized, but to me addiction means the drug or alcohol or gambling has taken over the person’s brain and it is the addiction that is lying to the person and to me. It makes it much easier for me to watch for relapse if I think of it as the habit or substance in control. There is no stigma there: the person is deeply ill and needs help. Part of the help is recognizing relapse. I look for signs.

With behavioral health we learn to watch for signs. The latest guidelines say that we should screen for behavioral health problems at well people visits. One in ten people are depressed and the lifetime incidence is higher.

The online and news articles sound surprised that there is an increase in behavioral health problems. Why would anyone be surprised? We have evolved emotions along with logic and emotions help us to survive. If you are a child in a war zone or a family with abuse or domestic violence, your brain wires to survive the crisis as best you can. These are ACE scores, Adverse Childhood Experiences. Every child’s ACE score is going up during the pandemic. Adults can develop PTSD, depression, anxiety: of course. This is how our species survive. It isn’t FUN but it is not a disaster either. We can help each other. We can listen to each other. We may have to say “I can only listen to this for ten minutes,” and set a timer. There was a cartoon with a father with a stop watch. The daughter is complaining as fast as she can. He stops her: “There. You have had your one minute of whining today.” Limit the news if it is driving you bananas or you feel more depressed or frightened. Turn off the television: if you live in a safe place, go for a walk. I have goldfinches and pine siskins arguing with each other in my front yard. The cats are hugely entertained by this. The cats only go out with harness and leash. I may need to follow Sol Duc up trees. She leaped on top of the outdoor cat cage yesterday, four feet up. I was surprised. No wonder they can catch birds: from a stand to four feet up and she is about ten months old. And see? We are distracted by the cat and relax a little.

If you are not trying to escape a war zone or something else horrible, give yourself the gentle gifts: things that make you relax. Stupid cat videos, old music, reread a beloved book, a gentle walk outside. Yesterday I “walked” Elwha. He spent the whole walk sitting on the porch watching the birds. Two birds landed in the grass and he immediately morphed to hunter, but was still on a leash. I saw a pair of robins in the back yard. One was holding something in her beak. A gift for the other? Nest building? Nestlings already?

My other go to is the trees. I go lean on a tree when I feel overwhelmed. The trees do not seem to mind. Rocks don’t either and I am very grateful.

Blessings.

Our rhododendrons are blooming.

#ACE scores #behavioral health #emotion #fear #normal emotional response

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from blue to breathe

I attended a medical conference on line yesterday and today and it made me very blue. At first it just frustrated me, because it is about increasing behavioral health access. Isn’t that a good thing? Yes, but they completely missed the biggest barrier for primary care: TIME.

With the current US medical corporate money extracting insurance non-caring system, primary care is increasingly forced into 20 or 15 or 10 minute visits. I fought my hospital district when they said “See patients for one thing only.” I replied “That is unethical and dangerous: if it is a diabetic with an infected toe, I HAVE to check their kidney function, because antibiotic dose must be adjusted if their kidney function is reduced.” And there are at least two and maybe three problems there: infection, and if the diabetes is out of control that worsens the infection, and then kidney function. And actually I have to be sure anyone going on antibiotics has good kidney function or adjust my dose. I am very very good at this, but it takes time. I can work with complex patients, with veterans, with opiate overuse, with depression: but none of this is a simple template slam dunk. A study more than a decade ago says that the “average” primary care patient had 5 chronic illnesses. My patients don’t want to come in for each one separately and anyhow, if they have kidney problems I have to pay attention when I pick medicines for their high blood pressure. None of it can be separated out. That is why medicine is complicated.

Someone asked why can’t I just post the price of a “simple” visit for a sore throat. But a sore throat can be viral, can be strep A, can be a paralyzed vocal cord, can be a throat abscess, can be vocal cord cancer. I can’t tell ahead of time. I can’t. Early on during covid, a patient called and wanted a Zoom visit for abdominal pain that he said was constipation. I said “No, I can’t do abdominal pain over Zoom safely.” I can’t ASSUME it is constipation. It was appendicitis and he had his appendix out that evening. He called from his hospital bed the next day to thank me for making him come in.

The conference made me blue because they ignored my questions about why they were not advocating for primary care to have more time with patients. They claim to be all about change, but changing the US medical system? Nope. Do not want to talk about that. But I do want to talk about it. You can help by letting Congress know: single payer or medicare for all. That insurance company gets 20 cents of every dollar to profit and wastes tons of money forcing doctors’ offices to call for prior authorization. And if we have single payer, think of all the small businesses that will start because the terror about health insurance will disappear! I think it would reduce everyone’s stress, except the insurance CEOs. And they have earned more than enough, goodbye greed.

I am also tired of specialists telling me that primary care needs to do MORE. When I get told that I am not doing enough about hypertension, bladder leakage, depression and stopping smoking, and then 20 other specialists lecture me. Ok, so one minute per topic to fulfill what all of them think I should do? I want a primary care conference where primary care doctors are celebrated: cases are presented where the specialist says what a brilliant job the primary care doctor did.

I received a consult letter from a cancer doctor a few years ago. He wrote that I had diagnosed the earliest case of chronic leukemia that he had ever seen and that he was impressed and the patient would do fine. That’s the conference that I want to go to: where primary care and specialists talk about that and we inspire more doctors to do primary care.

You can learn more and how to talk to your congressperson here: HealthCare Now: https://www.healthcare-now.org/

or at Physicians for a National Healthcare Program: https://pnhp.org

And put your vote and your money towards healthcare, not health insurance.