On Psychosomatic Illness

I don't know anything about Fibromyalgia, yet I wince when someone says it's psychosomatic. I wonder about almost any conditioned considered psychosomatic now.

I realize I'm using the term in the vernacular to mean "it's all in your head". That's how it is largely understood even though, technically, psychosomatic illness can refer to anything without a medical explanation. People communicating with the public have to understand the common usage of the term as it's being heard.

Jane Brody wrote about the concern with this label almost a decade ago (in full at the very bottom):

"When I was given a diagnosis of breast cancer in February 1999, many friends and readers wondered: 'Why did you get breast cancer? You take such good care of yourself!' . . . It seems that many people believe that if you do everything 'right', bad things won't happen. But bad things can and do happen. And they happen to the 'best' and the 'worst' of us. . . . If you're blessed with good health, you can say, 'I did it.' But if you lose your health, you know that external forces beyond your control can get in your way. Healthy people tend to act as if beneath every sick person is a healthy person trying to come out. . . . 

Canada's Healthcare Crisis

A major backbone of Canada is falling apart, and much of it is from poor policy decisions that has led to a serious doctor shortage. 

Mary Fernando, MD, wrote about it. 

"A personal post in two parts: 1. Someone I love needs a specialist but wait times are dangerously long because of our specialist shortage. 2. As a doctor who resisted large money offers from the US to stay in Canada, I've lost something more important than money: my family's safety. 

I've worked on a solution; my team has put in hours of volunteer time because it...
* Fits within existing budgets
* Has over 90% doctor support
* Puts Canada at par with other countries.

I've taken it to the House of Commons and the Senate, but Health Minister Mark Holland refuses to meet. . . . No party has a platform to address the doctor shortage. They may have ones to address other issues, but, without enough doctors, no one is safe."

Mary's not prepared to release her plan publicly quite yet.

Many commenters there pointed out that it's a provincial issue because they're in charge of healthcare, but it's Canada wide. BC is facing the same issues as Ontario despite having an NDP government. 

One commenter, Adiane, responded about Mary's plan and in response to a headline from the Vancouver Sun: "Why are 15 times more Canadians than Californians choosing assisted death?" 

"I would love to hear it - the horrible healthcare in this country has at best taken decades off my life, and at worst it will soon end it. . . . It's NOT a mystery why so many more Canadians do MAiD when their health deteriorates. The healthcare system is ABYSMAL! You can't get quality, timely, compassionate care. The hospitals are inhumane. LTC worse. Living with severe illness in this country is HORRIFIC." 

More recently, a Canadian man who is quadriplegic chose MAiD after being stuck in the ER for four days - 95 hours straight on a stretcher - causing horrific bedsores. He was in the hospital for help with his "third respiratory virus in three months." These viruses are causing a greater influx in the hospitals AND, at the same time, we have fewer resources to help anybody. 

Then, from Dr. Nancy Olivieri:

"'This is the road we're going down. Doesn't matter that no one voted for it and no one wants it.' In 1955, my grandfather paid what would have been $16,000 in 2023 for one hospital admission. Tommy warned us the 'subtle strangulation' of Medicare. We are witnessing it."

 

Hostility Creating Isolation

A recent study found that older adults are spending less time in public due to hostility against people in masks. 

"The study comes amid what the U.S. Surgeon General recently called an 'epidemic of loneliness' in which older adults - especially those who are immune compromised or have disabilities - are particularly vulnerable. . . . 60% of respondents said they spend more time in their home while 75% said they dine out less. Some 62% said they visit cultural and arts venues less, adn more than half said they attend church or the gym less than before the pandemic. . . . 80% of respondents reported that there are some places they are reluctant to visit in person anymore. 'The thought of going inside a gym with lots of people breathing heavily and sweating is not something I can see myself ever doing again,' said one 72-year-old male. Those who said they still go to public places like grocery stores reported that they ducked in and out quickly and skipped casual chitchat. . . . 

Many respondents reported that they were afraid of getting infected with a virus or infecting young or immune-compromised loved ones, and said they felt 'irresponsible' for being around a lot of people. Some reported getting dirty looks or rude comments when wearing masks or asking others to keep their distance - interpersonal exchanges that reinforced their inclination to stay home. . . . The loss of spontaneous interactions in what sociologists call 'third places' could have serious health consequences. . . . 

Finlay hopes that her work can encourage policymakers to create spaces more amenable to people of all ages who are now more cautious about getting sick - things like outdoor dining spaces, ventilated concert halls or masked or hybrid events. She also hopes that people will give those still wearing masks or keeping distance some grace."

What's Good for the King is Good for the Kids

We KNOW that Covid makes kids sick, which affects attendance, and we KNOW cleaning the air will help (since so many have been convince not to wear masks to class), but we'll still only implement solutions for the wealthiest 1%. 

Back in June 2020, the New York Times reported how Covid short-circuits the immune system: 

"In many patients hospitalized with the coronavirus, the immune system is threatened by a depletion of certain essential cells, suggesting eerie parallels with H.I.V. . . . and hints that a cocktail of drugs may be needed to bring the coronavirus under control. . . . Ordinarily, IP10 levels are only briefly elevated while T cells are dispatched. But in Covid-19 patients--as was the case in patients with SARS and MERS, also caused by coronaviruses--IP10 levels go up and stay up. That may create chaotic signaling int he body: It's like Usain Bolt hearing the starting gun and starting to run. Then someone keeps firing the starting gun over and over. What would he do? He'd stop, confused and disoriented. The result is that the body may be signaling T cells almost at random, confusing the immune response."

But then, unfortunately, "aerosol physicists were essentially ignored in favour of medical dogma when attempting to advise the WHO at the start of the pandemic. Many lives would have been saved had public health institutions focused on mitigating airborne transmission." 

Avian Flu and You

Avian flu has jumped to cows and a person, which is a little bit bigger deal than just avoiding soft boiled eggs. 

H5N1 was contracted by someone in Texas who was in contact with dairy cattle. His only symptom is eye inflammation, and he's doing fine on Tamiflu. He was isolated, and it doesn't appear to have spread further. In cows, the virus doesn't kill them, but lowers milk production, and means we should really avoid non-pasteurized milk. BUT it's a concern that cows are getting it; they're not the type of animal typically expected to catch this virus. And now baby goats are getting it and dying from it!! This is the first time goats have contracted the virus, and they seem less equipped to fight it off. 

A big problem is that it's virtually impossible to keep wild birds out of barns or away from animals and feed. 

Four Long Years

A look back to four years ago:  

From Craig Spencer, MD MPH, 

Four years ago today, I walked into the apocalypse.
Crossing the line in the ER felt like entering a whole other world.
Frenetic alarms.
Patients strewn about, struggling to breathe.
Too few staff. Too many deaths.
Covid was everything.
It had completely taken over our ER.
Covid inundated NYC a week prior. 
And many of our staff fell ill.
Especially the nurses.
We had only a fraction of those we needed.
Too few to notice when the oxygen tanks under patients' beds ran out.
So we did something kinda insane.
Actually unbelievable.

One Step Forward...

More good news about antivirals.

From Nate Bear: People are experiencing, 

"almost complete Long Covid recovery with the use of an HIV antiretroviral [ART]. There is obviously viral persistence in a proportion of Long Covid cases and the denial of this fact in the medical establishment is killing people."

So, because some people rushed to insist Covid is nothing like AIDS, and it far more like a cold, this possibility took years to be tested. But Maraviroc/Atorvastatin, a drug used with HIV, is having a very positive effect on Covid cases in individual cases. Clinical trials are just beginning. Imagine if we looked down this road four years ago instead of pretending there's no connection between two viruses that both hibernate in the body and damage immunity in a long term and deadly fashion! 

In other frustrating news, Nukit Far-UV devises are no longer available in Canada because Nicholaus Jeffers, Compliance Officer with Health Canada in the Pesticide Compliance Program, has made a claim that the devises are pesticides being sold without registration despite the fact that they are harmless to insects. Manufacturer Cyber Night Market wrote this response to the charge (and no longer delivers to Canada). 

The maple syrup and "polite Mad Max" analogies are perfect, but the gun comment at the end falls flat. She might have ended it with something about all the microplastics we're allowed to ingest. 

On Suing Social Media Giants

A collection of school boards are suing a collection of social media sites for allegedly deliberately hurting  students. 

That's from the Toronto Star headline, but deliberate harm?? I'm not sure what the lawsuit actually says, and I'm not a lawyer, but I would think that a charge of deliberate harm means they'd have to prove that the companies want to negatively affect students, instead of their motive being to make as much money as possible with harm to kids just a possible side-effect. 

But let's keep reading. 

The lawsuit from Toronto, Peel, and Ottawa school boards is asking for $4.5 billion because Snapchat, TikTok, and Meta platforms are "designed for compulsive use and have rewired the way children think, behave, and learn." 

Cognitive Tests

 I lost an hour of my morning to cognitive tests - just for fun (and a baseline).

AARP has a battery of tests you can take. They're free, but you have to register. They save them and can be retaken monthly to monitor any changes. I've been part of a study on cognition since 2020 that randomly sends me a bunch of tests to do, but it never gives me a score. This one is nice because they tell you right away how well you did. One slip on your mousepad can cost you, though! 

Neither of my parents had signs of Alzheimers or dementia at all until after hitting 90, which bodes well for me, but it makes sense to me for everyone to check their cognitive health the way we keep tabs on our physical health. 

And we know Covid affects our brain health. Today many on social media are posting and re-posting this:

"If I were in a profession where my cognition was key to my continued employment, I'd wear a respirator everywhere. And I am, so I do."

More than a year ago Dr. Jim Jackson, author of Clearing the Fog, said, "It is hard to overestimate the impact of processing speed deficits. Unfortunately, these seem to be the primary difficulties we see in our Covid-19 long-haulers who can't think on their feet, can't respond to questions or request, and cannot 'keep up.'" Daniel Brittain Dugger took him to task today,

"When I get into a traffic accident, morons who do not read will be to blame. . . . This is not the first time we have observed a virus that depletes CD4 cells, it is persistent, there is an aversion to non-pharmaceutical interventions, vaccines are not protective, there is forward transmission, and a slowing in processing speed. It was known on September 28th, 2020 that SARS-CoV-2 depletes the CD4 compartment, as does HIV. The very next day, Kenneth Podell published a journal article you coudl have read instead of writing a book on brain fog. One can draw on the experience with an HIV/AIDS epidemic. . . . It did not take long to discover that the disease could attack the brain directly, which resulted in long-term cognitive impairment. Subsequently, HIV encephalopathy and AIDS dementia complex leading to long-term cognitive impairment were discovered. Based on the emerging literature, it is reasonable to hypothesize a somewhat similar scenario may unfold in relationship to Covid-19."

Also check out this website: You Have to Live Your Life. It's a collection of studies on Covid, but they're organized as a response to prompts like, "I got it and I'm fine," "Covid is mild now," and the ever popular, "What about the economy?"

ETA: more from Ziyad Al-Aly about the brain damaged caused from Covid was recently published in The Conversation and People, so that might be one way to get a larger audience paying attention to this problem. 

AND another study that found Covid affects the synaptic homeostasis - the balance of neurotransmitters that deliver messages through the synaptic gap between neurons. Jeez! Keep your brain alive with an N95!!

On Identity: Erikson, Freud, and Sartre

 I recently listened to a podcast of Dr. Louis Cozolino, a neuroscientist and psychoanalyst, discussing what he would teach if he were training psychotherapists. The first year would be phenomenology: the power of Carl Rogers' perspective to train how to develop an alliance through reflective listening while keeping countertransference out of the session. The second year would be physiology: developmental neuroscience and the evolutionary history of brains and bodies. The third year might be called intersectionality: the interpenetration of the spectrum of options that affect clients - brain, mind, family, culture - and a reaction against therapy as a mere opiate to calm the oppressed and exploited. The final year would be on narratives and stories that we live by and on that half second that it takes our brain to construct our experience of the present and feed it back to us. 

Cozolino insists that it's not enough to just sit and listen to people vent. After developing a non-judgmental alliance with the client, therapists need to be "amygdala whisperers," to be able to down modulate amygdala activation to stop any inhibitory effect on the parietal system that enables problem solving. In other words, they need to soothe anxieties while arousing enough interest for clients to be able to learn new information. Then it's time to challenge the client's old system of thinking, slowly and delicately, a little at a time, to help them expand previous conceptualizations of themselves and the world. There's a necessary plan and a strategy to the sessions. 

By contrast, in my MA psychotherapy program, we're currently learning Piaget and Erikson's stages of development that many of us first encountered in high school classes. There's little to no encouragement to look at these older theories with a critical eye, and we're required to identify stages without a clear idea of how that knowledge might practically help clients. I'm doing well in the class despite the reality that I don't understand how acknowledging that a client is in the "identity vs role confusion" stage can provoke a useful change in the client's perceptions. 

Some Meds that Might Help

A new PrEP for Covid!

Invivyd got FDA approval for Pemgarda, or pemivibart and formerly VYD222, to be used as Pre-exposure Prophylaxis (PrEP) for Covid, specifically for adults and adolescents with moderate-to-severe immune compromise. Of course it made their stock jump dramatically. They expect it to be available imminently (see more here and here).

People can't actively have an infection when taking it, but it should be a game-changer for anyone who has been stuck at home because getting a virus would be the end of them. 

In other good new, some medicine combinations have been found to be effective in treating Long Covid symptoms. Study synopsis from Kashif Pirzada, MD: 

When the Rain Comes

 A good rain metaphor from tern:

Some people just can't wrap their heads around the multiple dangers caused by covid infection. 

Speaking to a colleague yesterday, I tried to describe it like the effects of rain. If your roof is solid, and there's a light rain shower, your house can handle it easily. Absolutely no cause for alarm. But rain isn't always light, and your roof isn't always in good condition. 

Our bodies are set up to be self healing to some extent, but if they lose that ability due to exhaustion, damage, overload, age, etc, then they can lose the capacity to bounce back. And if it rains heavily, once, twice, three, six, ten times in succession... You may start to get problems with more than the roof. 

The Enshittification of Health Care

Last week David Moscrop wrote an excellent piece in The Walrus about Loblaw. 

He wrote, 

"If you live in Canada, you're probably part of the Loblaw ecosystem, whether you like it or not. . . . It accounts for nearly a third of Canada's grocery market. . . . Loblaw's sensational fourth-quarter results--$14.53 billion in revenue and $541 million in profit--suggest the mission is going well. . . . President Galen Weston Jr. was hauled before a parliamentary committee, which grilled him over soaring food prices. . . . Grocers in Canada have recently enjoyed not just higher profits but higher profit margins--a practice one might call profiteering. Retailers keep charging more, in other words, not just because of increased industry costs but because there isn't enough competition to stop them. . . . Another wave of outrage from customers and experts forced health insurer Manulife to walk back a deal to cover certain prescription drugs exclusively at Loblaw-owned pharmacies--an arrangement that would have deepened Loblaw's reach into Canadian lives, a presence already bordering on the imperial. . . . As Shoppers Drug Mart expanded into health services, critics warned it might be pressured into putting profits first and care second by cutting corners, rushing patients, and pushing unnecessary treatments. And right on target, Shoppers was recently accused of unethical billing practices in its MedsCheck consultation program.

Government Provoked Global Suicide

Governments around the world have discussed solutions to climate change, but not enough are seriously acting to reduce this threat.

From environmentalist Stephen Barlow:

I'd far rather not have to spell out uncomfortable truths, and I have no agenda, other than to stop humanity committing global suicide by ignoring the seriousness of the climate and ecological emergency. If our governments had done what they'd promised to do, after these UN Environment Summits I've highlighted, there would be no need for me to spell any of this out. But the thing is, they didn't take any meaningful action to change direction. In essence, our governments have not merely carried on with Business as Usual BaU, as if the climate and ecological emergency did not exist, but they are planning to reinforce this globally suicidal policy for the foreseeable future. Hence, why we have a crisis. It's not that the things I'm saying are extreme, it's our governments, which are pursuing radical extremist policy, putting our civilization on course for global suicide and an unliveable future. It's not even just me saying that, but António Guterres [Secretary-General to the UN].  

You Can't Care about Refugees and Not Care about Covid

 Disability activist Imani Barbarin made an important connection between Covid precautions and genocide. 

In this Tiktok video she explains why "It's wild that people think they can support Palestinians as they're being disabled without disability justice":

@crutches_and_spice De@th does not follow disabled people, nondisabled people carry it with them to us. #greenscreenvideo @mawd ✯ ♬ original sound - Crutches&Spice ♿️ :

Here's the first half if you don't want to click on the 3 minute video. She starts with another vid admonishing people who support Palestine but don't mask indoors:

Hiding in Plain Sight

Anecdotal information - what we see around us - is far, far less accurate when measuring risks than scientific studies; unfortunately, it's far more persuasive. We need to heed the science. 

I don't actually know anyone who died of lung cancer from smoking. In fact, my grandmother smoked like a chimney and lived a very long life. And, back in my extremely social days of yore, I was a smoker surrounded by tons of people who smoked and none got lung cancer - that I know of. Yet I believe the science when studies show a direct connection between the two, so I quit smoking.

So many studies show a direct connection between Covid and profound brain damage, cardiovascular damage, lung damage, immune system damage, and so much more. Long Covid is a brutal condition. Jeff Gilchrist wrote out a very long list of possible damage to a person with even just a mild or asymptomatic initial case. I get that many people don't know anyone who has it, which makes it feel like it can't possibly be that serious or common. That's why its important to look at stats from random samples of the population (and from wastewater measures and from air measures to see how Covid-y it is out there) and to recognize how serious this disease really is. 

Why Resist Clean Air?

Barry Hunt spent a lot of time in hospitals with a knee injury, but managed to never catch Covid because he knows how to avoid it. 

It's possible for all of us to avoid it!! He wrote this thread in December 2021, but it's still very applicable. This is all from his thread:

I keep saying, "Someday I'll write a book" about the struggle to bring an engineering perspective to infection prevention and control in healthcare. For now I'll just write a thread.

Is there anything worse than knowing there are oceans full of icebergs ahead, how easy it is to engineer systems to detect and steer around them, but not being able to get the owners of the lines or anyone in command to listen as you blindly head straight for them? I've been advocating for engineering and standards for air, water and surfaces in healthcare facilities to ⬇️ disease transmission for over 30 years. The irony of being accused by out-of-touch ID/PH/IPAC/Epi of epistemic trespassing before and during the pandemic is gobsmacking. 

A Long Post for Long Covid Awareness Day!

March 15th is LongCovid Awareness Day, recognized in the U.S. and the U.K., and in Canada, and Sweden, but not yet by the United Nations.

A bit about my biggest concern - the brain - from James Throt, MD:

Covid: A Brain Damaging Story
I believe that in the absence of large scale studies and conducting brain imaging on a mass scale, we have to rely upon ourselves to turn to real world examples we may already be witnessing. Some questions about what you may be seeing. Now before we delve deeper into this, I think it would be felicitous to provide a little background first. MRI brain imaging has previously revealed that Covid reduces the thickness of grey matter within the frontal and temporal lobes. This would mimic symptoms of FTD [Frontotemporal Dementia].

Shame-Free Guide to Masks

Chuck created a slideshow guide of coping with mask wearing:

Our Curious Relationship with Covid Studies

Some questionable ethics in recent studies are making the rounds.

The process and ethics of Didier Raoult's work, which led to the use of hydroxychloroquine (HCQ) as a Covid treatment, was scrutinized in the latest Science Magazine. 

Raoult was saying, ‘I understand everything, I have a solution,’ and people want that kind of information in troubled times, . . . If someone has such a presence in the media landscape, politicians have to listen to him—otherwise they will be really distrusted by the population. On 26 March—amid strong resistance from some other members of the scientific council—Véran issued a decree allowing HCQ to be prescribed to Covid-19 inpatients. . . . Elisabeth Bik decided to take a close look at the HCQ paper. A microbiologist by training, Bik already knew of Raoult and his reputation for prolific publication. On her blog she pointed to several problems she saw with the paper: Patients had not been randomly assigned to the treatment and control groups, which could have biased the results. . . . Besançon, too, was curious. He looked into the paper, which had been submitted to the journal on 16 March and accepted the next day, and noticed that one of the authors was also editor-in-chief at the journal. “So you have a very short reviewing time and editorial conflict of interest,” he says. “I just find this potentially a big red flag. But I thought, it’s just one paper.” . . .